EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
615321751
Author
Al Otaibi A.; Gupta S.; Belley-Cote E.P.; Alsagheir A.; Spence J.; Parry
D.; Whitlock R.P.
Institution
(Al Otaibi, Gupta, Alsagheir, Parry, Whitlock) Department of Surgery,
Division of Cardiac Surgery, McMaster University, Hamilton General
Hospital, 237 Barton St. E., Hamilton, ON L8L 2X2, Canada
(Belley-Cote, Spence, Whitlock) Department of Clinical Epidemiology and
Biostatistics, McMaster University, Hamilton, ON, Canada
(Belley-Cote) Department of Medicine, McMaster University, Hamilton, ON,
Canada
(Belley-Cote, Spence, Whitlock) Population Health Research Institute,
Hamilton, ON, Canada
(Belley-Cote) Department of Medicine, Universite de Sherbrooke,
Sherbrooke, ON, Canada
(Spence) Department of Anesthesia, McMaster University, Hamilton, ON,
Canada
Title
Mini-thoracotomy vs. conventional sternotomy mitral valve surgery: A
systematic review and meta-analysis.
Source
Journal of Cardiovascular Surgery. 58 (3) (pp 489-496), 2017. Date of
Publication: June 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: Minimal access mitral valve surgery (mini-MVS) approaches
are becoming increasingly common. They are thought to be associated with
less perioperative bleeding and postoperative pain, resulting in shorter
hospital length-of-stay (LOS) and faster return to daily activities.
However, there are concerns that this approach may have inferior surgical
results - with resultant increases in morbidity and mortality - when
compared to conventional mitral valve surgery. To address this gap in the
literature, we undertook a systematic review and meta-analysis, comparing
right thoracotomy mini-MVS (MT-MVS) to conventional mitral valve surgery
using a median sternotomy (sternotomy-MVS) approach. EVIDENCE ACQUISITION:
We searched the Cochrane Library, MEDLINE, PubMed, EMBASE and
Clinicaltrials.gov for randomized trials comparing MT-MVS to
sternotomy-MVS in adults. Outcomes of interest were mortality, stroke,
hospital length of stay, bleeding, cardiopulmonary bypass (CPB) and
cross-clamp times. Studies reporting reoperation data were excluded.
References were screened independently and in duplicate, and studies
deemed to be potentially relevant were evaluated for inclusion by
full-text review. Risk of bias was assessed using the Cochrane tool.
Extracted outcome data were pooled for meta-analysis using RevMAN 5.3. The
overall quality of evidence for each outcome was evaluated using the GRADE
framework. EVIDENCE SYNTHESIS: Three trials including 280 patients met
eligibility criteria. Studies were considered to be at high risk of bias
due to lack of blinding and small number of patients. Pooled results
showed no significant difference in mortality (RR 0.50, 95% CI [0.05 to
5.39], low quality) or stroke (RR 0.50, 95% CI [0.05 to 5.39], low
quality). Technique-related outcomes were also similar: Cardiopulmonary
bypass (CPB) time (MD 17.72 minutes, 95% CI [-7.22 to 42.67), very low
quality), cross-clamp time (MD 5.31 minutes, 95% CI [-14.35 to 24.96),
very low quality), and bleeding (MD -148.95 mL, 95% CI [-491.02 to
193.12), low quality). Length of stay was significantly shorter in the
mini-MVS group (MD -1.89 days, 95% CI [-3.57 to -0.22], P=0.03, low
quality). CONCLUSIONS: MT-MVS does not result in increased morbidity and
mortality or procedural duration, and may decrease hospital LOS. Our
preliminary results suggest that MT-MVS is a safe and potentially
beneficial approach to the surgical management of mitral valve disease.
However, current evidence is of low quality and larger, more
methodologically rigorous randomized trials are required. Copyright &#xa9;
2013 Edizioni Minerva Medica.

<2>
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Accession Number
615319883
Author
Chi D.; Chen C.; Shi Y.; Wang W.; Ma Y.; Zhou R.; Yu H.; Liu B.
Institution
(Chi, Chen, Shi, Wang, Ma, Zhou, Yu, Liu) Department of Anesthesiology,
West China Hospital, Sichuan University, Chengdu, Sichuan, China
Title
Ventilation during cardiopulmonary bypass for prevention of respiratory
insufficiency: A meta-analysis of randomized controlled trials.
Source
Medicine (United States). 96 (12) (no pagination), 2017. Article Number:
e6454. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Cardiopulmonary bypass (CPB) is necessary for most cardiac
surgery, which may lead to postoperative lung injury. The objective of
this paper is to systematically evaluate whether ventilation during CPB
would benefit patients undergoing cardiac surgery. Methods: We searched
randomized controlled trials (RCTs) through PubMed, Embase, and Cochrane
Library from inception to October 2016. Eligible studies compared clinical
outcomes of ventilation versus nonventilation during CPB in patients
undergoing cardiac surgery. The primary outcome includes oxygenation index
(PaO2/FiO2 ratio) or alveolar to arterial oxygen tension difference
(AaDO2) immediately after weaning from bypass. The secondary outcomes
include postoperative pulmonary complications (PPCs), shunt fraction
(Qs/Qt), hospital stay, and AaDO2 4hours after CPB. Results: Seventeen
trials with 1162 patients were included in this meta-analysis. Ventilation
during CPB significantly increased post-CPB PaO2/FiO2 ratio (mean
difference [MD]=21.84; 95% confidence interval [CI]=1.30 to 42.37; P=0.04;
I2=75%) and reduced post-CPB AaDO2 (MD=-50.17; 95% CI=-71.36 to -28.99;
P<0.00001; I2=74%). Qs/Qt immediately after weaning from CPB showed a
significant difference between groups (MD=-3.24; 95% CI=-4.48 to -2.01;
P<0.00001; I2=0%). Incidence of PPCs (odds ratio [OR]=0.79; 95% CI=0.42 to
1.48; P=0.46; I2=37%) and hospital stay (MD=0.09; 95% CI=-23 to 0.41;
P=0.58; I2=37%) did not differ significantly between groups. Conclusion:
Ventilation during CPB might improve post-CPB oxygenation and gas exchange
in patients who underwent cardiac surgery. However, there is no sufficient
evidence to show that ventilation during CPB could influence long-term
prognosis of these patients. The beneficial effects of ventilation during
CPB are requisite to be evaluated in powerful and well-designed RCTs.
&#xa9; Copyright 2017 the Author(s). Published by Wolters Kluwer Health,
Inc.

<3>
Accession Number
613747563
Author
Takagi H.; Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
Title
Similar Survival After Repair vs Replacement for Ischemic Mitral
Regurgitation.
Source
Seminars in Thoracic and Cardiovascular Surgery. 28 (4) (pp 748-756),
2016. Date of Publication: 04 Feb 2016.
Publisher
W.B. Saunders
Abstract
To determine whether mitral valve (MV) repair improves early and late
survival compared with MV replacement for patients with ischemic mitral
regurgitation (IMR), we performed a meta-analysis of randomized controlled
trials (RCTs) and adjusted observational studies. Databases including
MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials
were searched through January 2016 using PubMed and Ovid. Studies
considered for inclusion met the following criteria: the design was a RCT
or adjusted observational study, the study population was patients with
IMR; patients were assigned to MV repair vs replacement, and outcomes
included early (30 days or in hospital) or late (>1 year) overall survival
or all-cause mortality. An adjusted odds or hazard ratio (OR/HR) with its
95% CI of early or late (including early) all-cause mortality for MV
repair vs replacement was abstracted from each individual study. Our
search identified 12 articles from one RCT and 10 adjusted observational
studies including 2784 patients. Pooled analyses demonstrated no
significant difference in both early (OR = 0.90; 95% CI: 0.69-1.16; P =
0.41) and late mortality (HR = 0.90; 95% CI: 0.72-1.13; P = 0.38) between
MV repair and replacement. Exclusion of any single study from the
meta-analysis did not substantively alter the overall result of no
significant difference. There was no evidence of significant publication
bias. For patients with IMR, MV repair appears to be unassociated with a
significant decrease in both early and late all-cause mortality compared
with MV replacement. Copyright &#xa9; 2016 Elsevier Inc.

<4>
Accession Number
613858239
Author
McQuilten Z.K.; Zatta A.J.; Andrianopoulos N.; Aoki N.; Stevenson L.;
Badami K.G.; Bird R.; Cole-Sinclair M.F.; Hurn C.; Cameron P.A.; Isbister
J.P.; Phillips L.E.; Wood E.M.
Institution
(McQuilten, Zatta, Aoki, Phillips, Wood) Transfusion Research Unit, Monash
University, Melbourne, Australia
(McQuilten, Zatta) Australian and New Zealand Intensive Care Research
Centre (ANZIC-RC), Monash University, Melbourne, Australia
(Andrianopoulos, Cameron) Department of Epidemiology and Preventive
Medicine, Monash University, Melbourne, Australia
(Stevenson) Barwon Health, University Hospital Geelong, Geelong, Australia
(Badami) New Zealand Blood Service, Christchurch, New Zealand
(Bird) Princess Alexandra Hospital, Brisbane, QLD, Australia
(Bird) School of Medicine, Griffith University, Brisbane, Australia
(Cole-Sinclair) Department of Haematology, St Vincent's Hospital,
Melbourne, Australia
(Isbister) Royal North Shore Hospital, The University of Sydney, Sydney,
Australia
(Hurn) School of Medicine, University of Queensland, Brisbane, Australia
Title
Evaluation of clinical coding data to determine causes of critical
bleeding in patients receiving massive transfusion: a bi-national,
multicentre, cross-sectional study.
Source
Transfusion Medicine. 27 (2) (pp 114-121), 2017. Date of Publication: 01
Apr 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Objectives: To evaluate the use of routinely collected data to determine
the cause(s) of critical bleeding in patients who receive massive
transfusion (MT). Background: Routinely collected data are increasingly
being used to describe and evaluate transfusion practice.
Materials/methods: Chart reviews were undertaken on 10 randomly selected
MT patients at 48 hospitals across Australia and New Zealand to determine
the cause(s) of critical bleeding. Diagnosis-related group (DRG) and
International Classification of Diseases (ICD) codes were extracted
separately and used to assign each patient a cause of critical bleeding.
These were compared against chart review using percentage agreement and
kappa statistics. Results: A total of 427 MT patients were included with
complete ICD and DRG data for 427 (100%) and 396 (93%), respectively. Good
overall agreement was found between chart review and ICD codes (78.3%;
kappa = 0.74, 95% CI 0.70-0.79) and only fair overall agreement with DRG
(51%; kappa = 0.45, 95% CI 0.40-0.50). Both ICD and DRG were sensitive and
accurate for classifying obstetric haemorrhage patients (98% sensitivity
and kappa > 0.94). However, compared with the ICD algorithm, DRGs were
less sensitive and accurate in classifying bleeding as a result of
gastrointestinal haemorrhage (74% vs 8%; kappa = 0.75 vs 0.1), trauma (92%
vs 62%; kappa = 0.78 vs 0.67), cardiac (80% vs 57%; kappa = 0.79 vs 0.60)
and vascular surgery (64% vs 56%; kappa = 0.69 vs 0.65). Conclusion:
Algorithms using ICD codes can determine the cause of critical bleeding in
patients requiring MT with good to excellent agreement with clinical
history. DRG are less suitable to determine critical bleeding causes.
Copyright &#xa9; 2016 British Blood Transfusion Society

<5>
Accession Number
615145718
Author
Deppe A.-C.; Weber C.; Liakopoulos O.J.; Zeriouh M.; Slottosch I.;
Scherner M.; Kuhn E.W.; Choi Y.-H.; Wahlers T.
Institution
(Deppe, Weber, Liakopoulos, Zeriouh, Slottosch, Scherner, Kuhn, Choi,
Wahlers) Department of Cardiothoracic Surgery, Heart Center of the
University of Cologne, Cologne, Germany
(Choi) Center of Molecular Medicine Cologne, University of Cologne,
Cologne, Germany
Title
Preoperative intra-aortic balloon pump use in high-risk patients prior to
coronary artery bypass graft surgery decreases the risk for morbidity and
mortality-A meta-analysis of 9,212 patients.
Source
Journal of Cardiac Surgery. 32 (3) (pp 177-185), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
AIMS: Prophylactic intra-aortic balloon pump (IABP) support for high-risk
patients before coronary artery bypass grafting (CABG) is controversial.
This meta-analysis sought to determine the current role of preoperative
IABP support. METHODS: We performed a meta-analysis of randomized (RCT)
and observational trials (OT) that fulfilled the following criteria: (1)
Group comparison of patients with prophylactic IABP implantation before
CABG with a control group; (2) reporting at least one desired clinical
endpoint, including all-cause mortality, myocardial infarction,
cerebrovascular accident (CVA), and renal failure. Pooled treatment
effects (odds ratio [OR] or weighted mean difference, and 95% confidence
intervals [95%CI]) were assessed using a fixed or random effects model.
RESULTS: A total of 9,212 patients from 23 studies (7 RCT, 16 OT) were
identified after a literature search of major databases using a predefined
keyword list. Absolute risk reduction for mortality in RCTs was 4.4% (OR
0.43; 95%CI 0.25-0.73; p = 0.0025). Prophylactic IABP use before CABG
surgery also decreased the risk for myocardial infarction (OR 0.58; 95%CI
0.43-0.78; p = 0.004), CVA (OR 0.67; 95%CI 0.47-0.97; p = 0.042), and
renal failure (OR 0.62; 95%CI 0.47-0.83; p = 0.0014). Length of intensive
care unit stay (p < 0.0001) and length of hospital stay (p < 0.0001) were
significantly reduced in patients with preoperative IABP use. CONCLUSION:
Current evidence from RCT and OT suggests beneficial effects for the IABP
in high-risk patients before CABG surgery. Copyright &#xa9; 2017 Wiley
Periodicals, Inc.

<6>
Accession Number
615229923
Author
Morris N.; Howard L.
Institution
(Morris, Howard) Institution Central Manchester University Hospitals NHS
Foundation Trust, Manchester, United Kingdom
(Morris) University of Manchester, Manchester, United Kingdom
(Howard) Manchester Metropolitan University, Manchester, United Kingdom
Title
Bet 1: In patients with suspected acute coronary syndrome, does Wellens'
sign on the electrocardiograph identify critical left anterior descending
artery stenosis?.
Source
Emergency Medicine Journal. 34 (4) (pp 264-266), 2017. Date of
Publication: April 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Wellens' syndrome consists of a history suggestive of an acute coronary
syndrome and biphasic or deeply inverted T waves in ECG leads V2-V3. A
shortcut review was carried out to establish whether this ECG pattern
identifies patients with a critical left anterior descending artery
stenosis. Six relevant papers were found. The clinical bottom line is that
biphasic T-wave inversion in lead V2-V3 should alert the clinician to a
probable critical stenosis of the left anterior descending artery.
Copyright &#xa9; 2017, BMJ Publishing Group. All rights reserved.

<7>
Accession Number
615108626
Author
Razzouk L.; Feit F.; Farkouh M.E.
Institution
(Razzouk, Feit) Department of Medicine, Division of Cardiology, New York
University Langone Medical Center, New York, NY 10016, United States
(Farkouh) Peter Munk Cardiac Centre, Toronto, ON, Canada
(Farkouh) Heart and Stroke Richard Lewar Centre of Excellence in CV
Research, University of Toronto, Toronto, ON, Canada
Title
Revascularization for Advanced Coronary Artery Disease in Type 2 Diabetic
Patients: Choosing Wisely Between PCI and Surgery.
Source
Current Cardiology Reports. 19 (5) (no pagination), 2017. Article Number:
37. Date of Publication: 01 May 2017.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of Review: Patients with type 2 diabetes mellitus (T2DM) are at an
increased risk of systemic atherosclerosis and advanced coronary artery
disease (CAD). Herein, we review clinical trials comparing surgical to
percutaneous revascularization in the context of the unique
pathophysiology in this patient population, and seek to answer the
question of optimal strategy of revascularization. Recent Findings: Early
studies showed a signal towards benefit of surgical revascularization over
percutaneous revascularization in this group, but there was a paucity of
randomized clinical trials (RCT) to directly support this finding. The
Future Revascularization Evaluation in Patients with Diabetes Mellitus:
Optimal Management of Multivessel Disease (FREEDOM), a large-scale
international RCT, was then undertaken and established the benefit of
coronary artery bypass grafting (CABG) over percutaneous coronary
intervention (PCI) in terms of mortality, myocardial infarction and repeat
revascularization; CABG was inferior to PCI with regards to stroke. The
quality of life and cost effectiveness also demonstrated a long-term
benefit for surgery. Summary: The decision as to choice of mode of
revascularization in patients with T2DM and advanced CAD depends upon a
multitude of factors, including the coronary anatomy, co-morbidities and
the patient's surgical risk. These factors influence the recommendation of
the cardiovascular team, which should result in a balanced presentation of
the short and long-term risks and benefits of either mode of
revascularization to the patient and his/her family. Copyright &#xa9;
2017, Springer Science+Business Media New York.

<8>
Accession Number
615228168
Author
Rastan A.J.
Institution
(Rastan) Department of Cardiac and Vascular Surgery,
Herz-Kreislauf-Zentrum Rotenburg, Rotenburg, Germany
Title
Treatment of Coronary Artery Disease: Randomized Trials on Myocardial
Revascularization and Complete Arterial Bypass Grafting.
Source
Thoracic and Cardiovascular Surgeon, Supplement. 65 (pp S167-S173), 2017.
Date of Publication: 01 Apr 2017.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Friedrich Wilhelm Mohr from the very beginning of his career as a cardiac
surgeon was involved in the refinements of coronary artery bypass grafting
(CABG). At the Leipzig Heart Center, his spirit of early adapting to new
technologies inspired the entire team and led to a matchless scientific
atmosphere to find solutions to improve almost all fields of cardiac
surgery, including CABG. In combination with a tremendous number of
patients with indications for isolated coronary artery bypass Prof. Mohr
as the surgical principle investigator and the Leipzig Heart Center were
able to include patients in the Synergy between PCI [percutaneous coronary
intervention] with Taxus and Cardiac Surgery (SYNTAX) trial, the first
randomized trials comparing CABG and PCIs using the drug-eluting stents.
Final SYNTAX results after 5 years gave direction and scientific evidence
for contemporary European revascularization guidelines. These guidelines
recommend PCI as an alternative first-line treatment option in patients
with coronary three-vessel disease and left main stenosis having low
coronary complexity based on the angiographic SYNTAX score. However, the
study demonstrated the significant superiority of CABG over PCI in all
other patients, especially in these with complex three-vessel disease. The
specific characteristic of the SYNTAX study is that the distinguished
results were confirmed by several post-SYNTAX comparative randomized
trials on coronary revascularization including left main disease and
clinical registries even when contemporary drug-eluting stent designs were
used. When performing CABG the question of the best second graft remains
unclear. While several mono-institutional reports and large meta-analyses
demonstrated clear superiority in terms of long-term survival when using
bilateral mammary versus single mammary revascularization, this benefit
could not be confirmed in randomized trials after 5 years.

<9>
Accession Number
615201325
Author
Elliott J.; Kelly S.E.; Bai Z.; Liu W.; Skidmore B.; Boucher M.; So
D.Y.F.; Wells G.A.
Institution
(Elliott, Kelly, Bai, Liu, Wells) Cardiovascular Research Methods Centre,
University of Ottawa, Heart Institute, Ottawa, ON, Canada
(Skidmore) Independent Contractor, Ottawa, ON, Canada
(Boucher) Canadian Agency for Drugs and Technologies in Health (CADTH),
Ottawa, ON, Canada
(So) Division of Cardiology, University of Ottawa, Heart Institute,
Ottawa, ON, Canada
Title
Optimal duration of dual antiplatelet therapy following percutaneous
coronary intervention: Protocol for an umbrella review.
Source
BMJ Open. 7 (4) (no pagination), 2017. Article Number: 015421. Date of
Publication: 01 Apr 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: Although dual antiplatelet therapy (DAPT) is routinely given
to patients after percutaneous coronary intervention (PCI) with stenting,
the optimal duration is unknown. Recent evidence indicates there may be
benefits in extending the duration beyond 12 months but such decisions may
increase the risk of bleeding. Our objective is to provide a comprehensive
overview of the literature for clinicians and policymakers via an umbrella
review assessing the optimal duration of DAPT. Methods and analysis: We
will perform a comprehensive search of the published and grey literature
for systematic reviews involving randomised controlled trials (RCTs)
assessing the optimal duration of DAPT following PCI with stenting. The
intervention of interest is extended DAPT (beyond 12 months) compared with
short-term DAPT (6-12 months). Studies will be selected for inclusion by
two reviewers, and the quality will be assessed. The primary outcomes of
interest are all-cause mortality and cardiovascular mortality. Secondary
outcomes will be bleeding (major, minor and gastrointestinal), urgent
target vessel revascularisation, major adverse cardiovascular events,
myocardial infarction, stroke and stent thrombosis. Outcomes will be
assessed while on DAPT and after withdrawal of DAPT. Data will be
summarised with respect to the number of included RCTs, number of
participants, effect estimates and heterogeneity. Data will be reported
separately based on patient demographics, procedural parameters (eg, stent
types, lesion complexity and concurrent disease) and clinical presentation
(eg, acute coronary syndromes, infarct type). Ethics and dissemination:
Our umbrella review aims to provide a comprehensive overview of the
benefits and harms associated with extending DAPT beyond 12 months
following PCI with stenting. The results of this review will inform
clinical and policy decisions regarding the optimal treatment duration and
reimbursement of DAPT following PCI with stenting. Results will be
disseminated through a peer-reviewed publication and conference
presentations. Ethics approval is not required for this study. Trial
registration number: CRD42016047735.

<10>
Accession Number
613802186
Author
Vijarnsorn C.; Noga M.; Schantz D.; Pepelassis D.; Tham E.B.
Institution
(Vijarnsorn, Noga, Tham) Stollery Children's Hospital and Mazankowski
Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
(Vijarnsorn) Department of Pediatrics, Faculty of Medicine, Siriraj
Hospital, Mahidol University, Bangkok, Thailand
(Schantz, Pepelassis) Variety Children's Hospital, Winnipeg, MB, Canada
Title
Stress perfusion magnetic resonance imaging to detect coronary artery
lesions in children.
Source
International Journal of Cardiovascular Imaging. 33 (5) (pp 699-709),
2017. Date of Publication: 01 May 2017.
Publisher
Springer Netherlands
Abstract
Background: Stress perfusion cardiovascular magnetic resonance (CMR) is
used widely in adult ischemic heart disease, but data in children is
limited. We sought to evaluate feasibility, accuracy and prognostic value
of stress CMR in children with suspected coronary artery disease (CAD).
Methods: Stress CMR was reviewed from two pediatric centers over 5 years
using a standard pharmacologic protocol. Wall motion abnormalities,
perfusion deficits and late enhancement were correlated with coronary
angiogram (CAG) when available, and clinical status at 1 year follow-up
for major adverse cardiovascular events (MACE; coronary revascularization,
non-fatal myocardial infarction and death due to CAD) was recorded.
Results: Sixty-four stress perfusion CMR studies in 48 children (10.9 +/-
4.8 years) using adenosine; 59 (92%) and dipyridamole; 5 (8%), were
reviewed. Indications were Kawasaki disease (39%), post arterial switch
operation (12.5%), post heart transplantation (12.5%), post anomalous
coronary artery repair (11%), chest pain (11%), suspected myocarditis or
CAD (3%), post coronary revascularization (3%), and others (8%).
Twenty-six studies were performed under sedation. Of all studies
performed, 66% showed no evidence of ischemia or infarction, 28% had
perfusion deficits and 6% had late gadolinium enhancement (LGE) without
perfusion deficit. Compared to CAG, the positive predictive value (PPV) of
stress CMR was 80% with negative predictive value (NPV) of 88%. At 1 year
clinical follow-up, the PPV and NPV of stress CMR to predict MACE were 78
and 98%. Conclusion: Stress-perfusion CMR, in combination with LGE and
wall motion-analysis is a feasible and an accurate method of diagnosing
CAD in children. In difficult cases, it also helps guide clinical
intervention by complementing conventional CAG with functional
information. Copyright &#xa9; 2016, Springer Science+Business Media
Dordrecht.

<11>
Accession Number
613247537
Author
Basaran O.; Dogan V.; Beton O.; Tekinalp M.; Aykan A.C.; Kalaycioglu E.;
Bolat I.; Tasar O.; Safak O.; Kalcik M.; Yaman M.; Inci S.; Altintas B.;
Kalkan S.; Kirma C.; Biteker M.; and Collaborators; Karadeniz F.O.;
Tekkesin A.I.; Cakilli Y.; Turkkan C.; Hamidi M.; Demir V.; Gursoy M.O.;
Ozturk M.T.; Aksan G.; Seyis S.; Balli M.; Alici M.H.; Bozyel S.; Altun
I.; Calik F.; Karaca O.; Helvaci F.; Akay K.; Canga Y.; Celebi S.;
Altuntas E.; Ayturk M.; Gunes H.M.; Bezgin T.; Aksakal A.; Cakal B.; Colak
A.; Kaplan O.; Tatlisu A.; Gozubuyuk G.; Demirelli S.; Kaya A.;
Rencuzogullari I.; Bayram Z.; Simsek Z.; Civan M.; Batgharel U.; Ata A.E.;
Gol G.; Mert G.O.; Mert K.U.; Degirmencioglu A.; Candan O.; Celebi O.O.;
Dogan C.; Yavuz F.; Ulucan S.; Arisoy A.; Sahin B.D.; Ermis E.; Gokaslan
S.; Pektas I.; Tanindi A.; Tekin K.; Sancar K.M.; Cekic E.G.; Basaran N.F.
Institution
(Basaran, Dogan, Biteker) Department of Cardiology, Faculty of Medicine,
Mugla Sitki Kocman Universitesi Tip Fakultesi, Orhaniye Mah. Haluk Ozsoy
Cad., Mugla 48000, Turkey
(Beton) Department of Cardiology, Faculty of Medicine, Sivas Cumhuriyet
University, Sivas, Turkey
(Tekinalp) Department of Cardiology, Kahramanmaras Necip Fazil State
Hospital, Kahramanmaras, Turkey
(Aykan, Kalaycioglu) Department of Cardiology, Trabzon Ahi Evren Chest
Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey
(Bolat) Department of Cardiology, Fethiye State Hospital, Mugla, Turkey
(Tasar) Department of Cardiology, Elazig Education and Research Hospital,
Elazig, Turkey
(Safak) Department of Cardiology, Burdur State Hospital, Burdur, Turkey
(Kalcik) Department of Cardiology, Iskilip Atif Hoca State Hospital,
Iskilip, Turkey
(Yaman) Department of Cardiology, Samsun Education and Research Hospital,
Samsun, Turkey
(Inci) Department of Cardiology, Aksaray State Hospital, Aksaray, Turkey
(Altintas) Department of Cardiology, Diyarbakir Gazi Yasargil Education
and Research Hospital, Diyarbakir, Turkey
(Kalkan) Department of Cardiology, Gonen State Hospital, Gonen, Turkey
(Kirma) Kartal Kosuyolu Heart Education and Research Hospital, Istanbul,
Turkey
Title
Impact of valvular heart disease on oral anticoagulant therapy in
non-valvular atrial fibrillation: results from the RAMSES study.
Source
Journal of Thrombosis and Thrombolysis. 43 (2) (pp 157-165), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The definition of non-valvular atrial fibrillation (NVAF) is
controversial. We aimed to assess the impact of valvular heart disease on
stroke prevention strategies in NVAF patients. The RAMSES study was a
multicenter and cross-sectional study conducted on NVAF patients
(ClinicalTrials.gov identifier NCT02344901). The study population was
divided into patients with significant valvular disease (SVD) and
non-significant valvular disease (NSVD), whether they had at least one
moderate valvular disease or not. Patients with a mechanical prosthetic
valve and mitral stenosis were excluded. Baseline characteristics and oral
anticoagulant (OAC) therapies were compared. In 5987 patients with NVAF,
there were 3929 (66%) NSVD and 2058 (34%) SVD patients. The predominant
valvular disease was mitral regurgitation (58.1%), followed by aortic
regurgitation (24.1%) and aortic stenosis (17.8%). Patients with SVD had
higher CHA<inf>2</inf>DS<inf>2</inf>VASc [3.0 (2.0; 4.0) vs. 4.0 (2.0;
5.0), p < 0.001] and HAS-BLED [2.0 (1.0; 2.0) vs. 2.0 (1.0; 2.0), p =
0.004] scores compared to patients with NSVD. Overall, 2763 (71.2%) of
NSVD and 1515 (73.8%) of SVD patients were on OAC therapy (p = 0.035).
When the patients with SVD were analyzed separately, the mean
CHA<inf>2</inf>DS<inf>2</inf>VASc and HAS-BLED scores were higher in
patients with mitral regurgitation compared to patients with aortic
regurgitation and aortic stenosis [4.0 (3.0; 5.0), 3.0 (2.0; 4.0), 3.0
(2.0; 4.0) p < 0.001 and 2.0 (1.0; 3.0), 1.0 (1.0; 2.0), 1.0 (0.0; 2.0) p
< 0.001, respectively]. In patients with SVD, 65.7% of mitral
regurgitation, 82.6% of aortic regurgitation and 88.0% of aortic stenosis
patients were on OAC therapy. One out of three NVAF patients had at least
one moderate valvular heart disease with the predominance of mitral
regurgitation. Patients with SVD were at greater risk of stroke and
bleeding compared to patients with NSVD. Although patients with mitral
regurgitation should be given more aggressive anticoagulant therapy due to
their higher risk of stroke, they are undertreated compared to patients
with aortic valve diseases. Copyright &#xa9; 2016, Springer
Science+Business Media New York.

<12>
Accession Number
615088649
Author
Sekaran N.K.; Crowley A.L.; de Souza F.R.; Resende E.S.; Rao S.V.
Institution
(Sekaran, Crowley, Rao) Durham Veterans Affairs Health System, Duke
University Medical Center, Durham, NC 27710, United States
(de Souza, Resende) Department of Cardiology and Clinical Hospital,
Federal University of Uberlandia, Uberlandia, Brazil
Title
The Role for Cardiovascular Remodeling in Cardiovascular Outcomes.
Source
Current Atherosclerosis Reports. 19 (5) (no pagination), 2017. Article
Number: 23. Date of Publication: 01 May 2017.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of Review: Ischemic and non-ischemic injury to the heart causes
deleterious changes in ventricular size, shape, and function. This adverse
remodeling is mediated by neurohormonal and hemodynamic alterations and is
reflected in non-invasive measures of left ventricular ejection fraction
(LVEF), left ventricular end-systolic volume (LVESV), and left ventricular
end-diastolic volume (LVEDV). These measures are closely linked to
cardiovascular outcomes and have become key surrogate endpoints for
evaluating the therapeutic efficacy of contemporary treatments for heart
failure with reduced ejection fraction (HFrEF). In this review, we
critically evaluate recent published data (2015-2016) from randomized
clinical trials (RCTs) and observational studies of HFrEF therapies to
assess the role of ventricular remodeling on outcomes. Recent Findings:
These data highlight the benefits of certain guideline-directed medical
therapies (GDMT) such as cardiac resynchronization therapy, surgical
revascularization, and mechanical circulatory support on remodeling, while
revealing the limitations of other therapies-routine mitral valve repair
for patients with moderate ischemic mitral regurgitation and adjuncts to
percutaneous coronary intervention in patients with ST elevation
myocardial infarction (cyclosporine A and bioabsorbable cardiac matrix).
The new angiotensin receptor blocker/neprilysn inhibitor,
sacubitril/valsartan, demonstrates convincing improvements in clinical
outcomes with a study of remodeling parameters to follow; the new cardiac
myosin activator, omecamtiv mecarbil, demonstrates improvement in
remodeling parameters without a clear early clinical benefit. Summary: The
concepts and contemporary trials reviewed in this paper reinforce the
value of non-invasive measures of ventricular remodeling (LVEF, LVESV, and
LVEDV) as important metrics across a range of cardiovascular therapies.
Global non-invasive measures of cardiovascular remodeling have roughly
paralleled or preceded hard clinical outcomes. Additionally, the capacity
for reverse remodeling in HFrEF with GDMT motivates continued research in
the fields of implementation science, diagnostic imaging, and gene-based
therapeutics. Copyright &#xa9; 2017, Springer Science+Business Media New
York.

<13>
Accession Number
613591573
Author
Goncalves A.; Nyman C.; Okada D.R.; Singh A.; Swanson J.; Cheezum M.;
Steigner M.; Di Carli M.; Solomon S.; Shah P.B.; Bhatt D.L.; Shook D.;
Blankstein R.
Institution
(Goncalves, Singh, Di Carli, Solomon, Shah, Bhatt, Blankstein)
Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street,
Boston, MA 02115, United States
(Nyman, Okada, Swanson, Shook) Anesthesiology Division, Brigham and
Women's Hospital, Boston, MA, United States
(Cheezum, Steigner, Di Carli, Blankstein) Department of Radiology, Brigham
and Women's Hospital, Boston, MA, United States
(Goncalves) University of Porto Medical School, Porto, Portugal
Title
Transthoracic Echocardiography to Assess Aortic Regurgitation after TAVR:
A Comparison with Periprocedural Transesophageal Echocardiography.
Source
Cardiology (Switzerland). 137 (1) (pp 1-8), 2017. Date of Publication: 01
Apr 2017.
Publisher
S. Karger AG
Abstract
Background: We aimed to compare periprocedural transesophageal
echocardiography (TEE) with postprocedural transthoracic echocardiography
(TTE) for the diagnosis of aortic regurgitation (AR). Methods and Results:
TEE and TTE images of 163 transcatheter aortic valve replacement (TAVR)
patients (mean age 81 +/- 8 years; 56% men) were reviewed separately and
blinded to each other as well as to all clinical data. The median time
between TEE during TAVR (TEE/TAVR) and TTE was 4 days (IQR 2-10 days).
After TAVR, 48% of the patients had at least trace AR by TEE, 56% by
angiography and 67% by TTE. The majority of AR was paravalvular (78%).
More patients were classified with mild-to-moderate AR by TTE than by TEE
(44 vs. 22%, p < 0.01). When examining the 46 patients with AR by TTE
which was not at TEE/TAVR, both systolic and diastolic blood pressure (SBP
and DBP) were significantly higher during TTE than during TEE (mean
DELTASBP = 9 +/- 4 mm Hg and mean DELTADBP = 6 +/- 2 mm Hg, p < 0.01 for
both). No differences in BP between TEE and TTE were found among patients
with no AR or among those who had AR in both studies. At a median
follow-up of 185 days (IQR 39-424 days), the overall mortality was 17%,
but this was not associated with the presence of AR on TTE or TEE.
Conclusions: Patients' hemodynamic conditions may result in underdiagnosis
of paravalvular regurgitation in periprocedural TEE. Our findings suggest
that a postprocedural evaluation for AR by TTE could serve as a reasonable
alternative to TEE for the evaluation of AR. Copyright &#xa9; 2016 S.
Karger AG, Basel.

<14>
Accession Number
614229287
Author
Guinot P.-G.; Abou-Arab O.; Guilbart M.; Bar S.; Zogheib E.; Daher M.;
Besserve P.; Nader J.; Caus T.; Kamel S.; Dupont H.; Lorne E.
Institution
(Guinot, Abou-Arab, Guilbart, Bar, Zogheib, Daher, Besserve, Dupont,
Lorne) Department of Anaesthesiology and Critical Care Medicine, Amiens
University Hospital, Place Victor Pauchet, Amiens 80054, France
(Guinot, Nader, Caus, Kamel, Dupont, Lorne) INSERM U1088, Jules Verne
University of Picardy, Amiens 80054, France
(Nader, Caus) Department of Cardiac Surgery, Amiens University Hospital,
Amiens 80054, France
Title
Monitoring dynamic arterial elastance as a means of decreasing the
duration of norepinephrine treatment in vasoplegic syndrome following
cardiac surgery: a prospective, randomized trial.
Source
Intensive Care Medicine. 43 (5) (pp 643-651), 2017. Date of Publication:
01 May 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: To evaluate the ability of an algorithm based on dynamic arterial
elastance to decrease the duration of norepinephrine treatment. Methods:
We performed a prospective, open-label, randomized study in patients
requiring norepinephrine for vasoplegic syndrome after cardiac surgery
with cardiopulmonary bypass. Patients were randomized to an
algorithm-based intervention group or a control group. The primary outcome
was the duration of norepinephrine treatment. The secondary outcomes
included the total dose of norepinephrine, the length of stay (LOS) in the
ICU, central venous oxygen saturation, arterial lactate levels, arrhythmia
and diuresis. Results: Of 130 included patients, 118 were analysed on an
intention-to-treat basis (intervention group: n = 59; control group: n =
59). On inclusion, the intervention and control groups did not differ
significantly in terms of demographic characteristics, surgical data or
the prior duration of norepinephrine treatment [5 h (4-10) vs. 5 h (5-7),
respectively; P = 0.543]. The cumulative duration of norepinephrine
treatment after inclusion was shorter in the intervention group than in
the control group [17 h (13-26)] vs. 39 h (19-58), respectively; (P <
0.001). The cumulative dose of norepinephrine and the LOS in the ICU were
also lower in the intervention group (P < 0.05). There were no intergroup
differences for other outcomes (the sepsis-related organ failure score,
central venous oxygen saturation, arrhythmia, and arterial lactate
levels). Conclusion: A haemodynamic algorithm based on dynamic arterial
elastance was associated with a shorter duration of norepinephrine
treatment and a shorter LOS in the ICU. Use of the algorithm did not alter
perfusion parameters or increase the volume of fluid infused.
ClinicalTrials.gov Identifier: NCT02479529. Copyright &#xa9; 2017,
Springer-Verlag Berlin Heidelberg and ESICM.

<15>
Accession Number
610090572
Author
Boudoulas K.D.; Triposciadis F.; Geleris P.; Boudoulas H.
Institution
(Boudoulas) Division of Cardiovascular Medicine, Section of Interventional
Cardiology, The Ohio State University, Columbus, OH, United States
(Triposciadis) Department of Cardiology, Larissa University Hospital,
Larissa, Greece
(Geleris, Boudoulas) Aristotle University of Thessaloniki, Thessaloniki,
Greece
(Boudoulas) The Ohio State University, Columbus, OH, United States
Title
Coronary Atherosclerosis: Pathophysiologic Basis for Diagnosis and
Management.
Source
Progress in Cardiovascular Diseases. 58 (6) (pp 676-692), 2016. Date of
Publication: 01 May 2016.
Publisher
W.B. Saunders
Abstract
Coronary atherosclerosis is a long lasting and continuously evolving
disease with multiple clinical manifestations ranging from asymptomatic to
stable angina, acute coronary syndrome (ACS), heart failure (HF) and
sudden cardiac death (SCD). Genetic and environmental factors contribute
to the development and progression of coronary atherosclerosis. In this
review, current knowledge related to the diagnosis and management of
coronary atherosclerosis based on pathophysiologic mechanisms will be
discussed. In addition to providing state-of-the-art concepts related to
coronary atherosclerosis, special consideration will be given on how to
apply data from epidemiologic studies and randomized clinical trials to
the individual patient. The greatest challenge for the clinician in the
twenty-first century is not in absorbing the fast accumulating new
knowledge, but rather in applying this knowledge to the individual
patient. Copyright &#xa9; 2016 Elsevier Inc.

<16>
Accession Number
611157091
Author
Gupta P.; Rettiganti M.; Jeffries H.E.; Brundage N.; Markovitz B.P.;
Scanlon M.C.; Simsic J.M.
Institution
(Gupta) Division of Pediatric Cardiology, Department of Pediatrics,
University of Arkansas for Medical Sciences, Little Rock, Arkansas, United
States
(Rettiganti) Section of Biostatistics, Department of Pediatrics,
University of Arkansas for Medical Sciences, Little Rock, Arkansas, United
States
(Jeffries) Department of Pediatrics, Seattle Children's Hospital,
University of Washington School of Medicine, Seattle, Washington, United
States
(Brundage, Markovitz, Scanlon) Virtual PICU Systems, LLC, Los Angeles,
California, United States
(Markovitz) Division of Critical Care Medicine, Department of Pediatrics
and Anesthesiology, Children's Hospital Los Angeles, University of
Southern California Keck School of Medicine, Los Angeles, California,
United States
(Scanlon) Division of Critical Care, Department of Pediatrics, Medical
College of Wisconsin, Milwaukee, Wisconsin, United States
(Simsic) Division of Cardiology, Department of Pediatrics, Nationwide
Children's Hospital, Columbus, Ohio, United States
Title
Association of 24/7 In-House Intensive Care Unit Attending Physician
Coverage With Outcomes in Children Undergoing Heart Operations.
Source
Annals of Thoracic Surgery. 102 (6) (pp 2052-2061), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Elsevier USA
Abstract
Background Multicenter data regarding the around-the-clock (24/7) presence
of an in-house critical care attending physician with outcomes in children
undergoing cardiac operations are limited. Methods Patients younger than
18 years of age who underwent operations (with or without cardiopulmonary
bypass [CPB]) for congenital heart disease at 1 of the participating
intensive care units (ICUs) in the Virtual PICU Systems (VPS, LLC)
database were included (2009-2014). The study population was divided into
2 groups: the 24/7 group (14,737 patients; 32 hospitals), and the No 24/7
group (10,422 patients; 22 hospitals). Propensity-score matching was
performed to match patients 1:1 in the 24/7 group and in the No 24/7
group. Results Overall, 25,159 patients from 54 hospitals qualified for
inclusion. By propensity matching, 9,072 patients (4,536 patient pairs)
from 51 hospitals were matched 1:1 in the 2 groups. After matching,
mortality at ICU discharge was lower among the patients treated in
hospitals with 24/7 coverage (24/7 versus No 24/7, 2.8% versus 4.0%; p =
0.002). The use of extracorporeal membrane oxygenation (ECMO), the
incidence of cardiac arrest, extubation within 48 hours after operation,
the rate of reintubation, and the duration of arterial line and central
venous line use after operation were significantly improved in the 24/7
group. When stratified by surgical complexity, survival benefits of 24/7
coverage persisted among patients undergoing both high-complexity and
low-complexity operations. Conclusions The presence of 24-hour in-ICU
attending physician coverage in children undergoing cardiac operations is
associated with improved outcomes, including ICU mortality. It is possible
that 24-hour in-ICU attending physician coverage may be a surrogate for
other factors that may bias the results. Further study is warranted.
Copyright &#xa9; 2016 The Society of Thoracic Surgeons

<17>
Accession Number
612842838
Author
Davidson L.J.; Davidson C.J.
Institution
(Davidson, Davidson) Division of Cardiology, Feinberg School of Medicine,
Northwestern University, Chicago, IL, United States
Title
Stroke Prevention: Let's Prepare for Generation X TAVR.
Source
Catheterization and Cardiovascular Interventions. 88 (4) (pp 653-655),
2016. Date of Publication: 01 Oct 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Stroke leads to significant morbidity, disability, and mortality after
TAVR. CKD and prior stroke are risk factors for stroke. Stratification of
stroke risk would improve outcomes associated with TAVR. Ongoing
prospective randomized trials on embolic protection and post implant
anticoagulation are promising strategies to reduce stroke risk and new
brain MRI lesions. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<18>
Accession Number
602793318
Author
Ammirati E.; Oliva F.G.; Colombo T.; Russo C.F.; Cipriani M.G.; Garascia
A.; Guida V.; Colombo G.; Verde A.; Perna E.; Cannata A.; Paino R.;
Martinelli L.; Frigerio M.
Institution
(Ammirati, Oliva, Colombo, Russo, Cipriani, Garascia, Guida, Colombo,
Verde, Perna, Cannata, Paino, Martinelli, Frigerio) Cardiothoracic and
Vascular Department, Azienda Ospedaliera Ospedale Niguarda Ca' Granda,
Piazza Ospedale Maggiore 3, Milan 20162, Italy
Title
Mid-term survival after continuous-flow left ventricular assist device
versus heart transplantation.
Source
Heart and Vessels. 31 (5) (pp 722-733), 2016. Date of Publication: 01 May
2016.
Publisher
Springer-Verlag Tokyo (E-mail: orders@springer.jp)
Abstract
There is a paucity of data about mid-term outcome of patients with
advanced heart failure (HF) treated with left ventricular assist device
(LVAD) in Europe, where donor shortage and their aging limit the
availability and the probability of success of heart transplantation
(HTx). The aim of this study is to compare Italian single-centre mid-term
outcome in prospective patients treated with LVAD vs. HTx. We evaluated
213 consecutive patients with advanced HF who underwent continuous-flow
LVAD implant or HTx from 1/2006 to 2/2012, with complete follow-up at 1
year (3/2013). We compared outcome in patients who received a LVAD (n =
49) with those who underwent HTx (n = 164) and in matched groups of 39
LVAD and 39 HTx patients. Patients that were treated with LVAD had a worse
risk profile in comparison with HTx patients. Kaplan-Meier survival curves
estimated a one-year survival of 75.5 % in LVAD vs. 82.3 % in HTx
patients, a difference that was non-statistically significant [hazard
ratio (HR) 1.46; 95 % confidence interval (CI) 0.74-2.86; p = 0.27 for
LVAD vs. HTx]. After group matching 1-year survival was similar between
LVAD (76.9 %) and HTx (79.5 %; HR 1.15; 95 % CI 0.44-2.98; p = 0.78).
Concordant data was observed at 2-year follow-up. Patients treated with
LVAD as bridge-to-transplant indication (n = 22) showed a non significant
better outcome compared with HTx with a 95.5 and 90.9 % survival, at 1-
and 2-year follow-up, respectively. Despite worse preoperative conditions,
survival is not significantly lower after LVAD than after HTx at 2-year
follow-up. Given the scarce number of donors for HTx, LVAD therapy
represents a valid option, potentially affecting the current allocation
strategy of heart donors also in Europe. Copyright &#xa9; 2015, Springer
Japan.

<19>
Accession Number
613343204
Author
Balachandran S.; Lee A.; Denehy L.; Lin K.-Y.; Royse A.; Royse C.;
El-Ansary D.
Institution
(Balachandran, Lee, Denehy, Lin, El-Ansary) Physiotherapy Department, The
University of Melbourne, Carlton, Victoria, Australia
(Royse, Royse) Department of Surgery, The University of Melbourne,
Carlton, Victoria, Australia
(Royse) Department of Cardiothoracic Surgery, The Royal Melbourne
Hospital, Parkville, Victoria, Australia
(Royse) Department of Anaesthesia and Pain Management, The Royal Melbourne
Hospital, Parkville, Victoria, Australia
Title
Risk Factors for Sternal Complications After Cardiac Operations: A
Systematic Review.
Source
Annals of Thoracic Surgery. 102 (6) (pp 2109-2117), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Elsevier USA
Abstract
Early detection of patients at risk of sternal complications is essential
to facilitate prevention and optimize timely intervention. A systematic
review and meta-analysis was conducted to identify risk factors associated
with sternal complications. The review included 17 full-text studies, of
which 10 were entered into meta-analyses. Female gender, diabetes
mellitus, obesity, bilateral internal mammary artery grafts, reoperation
for postoperative complications, and blood product requirement were
reported as significant predictors of sternal infection. The compilation
of these risk factors may help to screen and stratify patients at risk of
impaired sternal healing and warrants further investigation. Copyright
&#xa9; 2016 The Society of Thoracic Surgeons

<20>
Accession Number
613342764
Author
Wang C.; Hua K.; Yin L.; Wang Y.; Li W.
Institution
(Wang, Yin, Wang, Li) State Key Laboratory of Cardiovascular Disease,
Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union
Medical College and Chinese Academy of Medical Sciences, Beijing, China
(Hua) Beijing Anzhen Hospital, Capital Medical University, Beijing, China
Title
A Meta-Analysis of Miniaturized Versus Conventional Extracorporeal
Circulation in Valve Surgery.
Source
Annals of Thoracic Surgery. 102 (6) (pp 2099-2108), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Elsevier USA
Abstract
The effects of miniaturized extracorporeal circulation in patients
operated on for heart valve surgery are still inconsistent. We performed a
meta-analysis of eight studies involving 1,011 patients to evaluate the
comprehensive effects of miniaturized extracorporeal circulation. The
results suggested its application significantly reduced the length of stay
in the intensive care unit and total hospital stay after heart valve
surgery, but no significant effects on reducing postoperative morbidity
and mortality were observed. Further studies with long-term follow-up are
needed to confirm our results. Copyright &#xa9; 2016 The Society of
Thoracic Surgeons

<21>
Accession Number
615135913
Author
Martin E.T.; Kaye K.S.; Knott C.; Nguyen H.; Santarossa M.; Evans R.;
Bertran E.; Jaber L.
Institution
(Martin, Evans) Department of Epidemiology, University of Michigan, School
of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029,
United States
(Kaye) Division of Infectious Diseases, Wayne State University, Detroit
Medical Center, Detroit, MI, United States
(Knott, Nguyen, Santarossa, Bertran, Jaber) Department of Pharmacy
Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne
State University, Detroit, MI, United States
Title
Diabetes and risk of surgical site infection: A systematic review and
meta-analysis.
Source
Infection Control and Hospital Epidemiology. 37 (1) (pp 88-99), 2016. Date
of Publication: 2016.
Publisher
Cambridge University Press (E-mail: subscriptions@press.uchicago.edu)
Abstract
OBJECTIVE To determine the independent association between diabetes and
surgical site infection (SSI) across multiple surgical procedures. DESIGN
Systematic review and meta-analysis. METHODS Studies indexed in PubMed
published between December 1985 and through July 2015 were identified
through the search terms risk factors or glucose and surgical site
infection. A total of 3,631 abstracts were identified through the initial
search terms. Full texts were reviewed for 522 articles. Of these, 94
articles met the criteria for inclusion. Standardized data collection
forms were used to extract study-specific estimates for diabetes, blood
glucose levels, and body mass index (BMI). A random-effects meta-analysis
was used to generate pooled estimates, and meta-regression was used to
evaluate specific hypothesized sources of heterogeneity. RESULTS The
primary outcome was SSI, as defined by the Centers for Disease Control and
Prevention surveillance criteria. The overall effect size for the
association between diabetes and SSI was odds ratio (OR)=1.53 (95%
predictive interval [PI], 1.11-2.12; I², 57.2%). SSI class,
study design, or patient BMI did not significantly impact study results in
a meta-regression model. The association was higher for cardiac surgery
2.03 (95% PI, 1.13-4.05) compared with surgeries of other types (P=.001).
CONCLUSIONS These results support the consideration of diabetes as an
independent risk factor for SSIs for multiple surgical procedure types.
Continued efforts are needed to improve surgical outcomes for diabetic
patients. Copyright &#xa9; 2015 by The Society for Healthcare Epidemiology
of America. All rights reserved.

<22>
Accession Number
608909592
Author
Bowdish M.E.; Hui D.S.; Cleveland J.D.; Mack W.J.; Sinha R.; Ranjan R.;
Cohen R.G.; Baker C.J.; Cunningham M.J.; Barr M.L.; Starnes V.A.
Institution
(Bowdish, Hui, Cleveland, Sinha, Ranjan, Cohen, Baker, Cunningham, Barr,
Starnes) Department of Surgery, Keck School of Medicine of USC, University
of Southern California, Los Angeles, CA, United States
(Mack) Department of Preventive Medicine, Keck School of Medicine of USC,
University of Southern California, Los Angeles, CA, United States
Title
A comparison of aortic valve replacement via an anterior right
minithoracotomy with standard sternotomy: A propensity score analysis of
492 patients.
Source
European Journal of Cardio-thoracic Surgery. 49 (2) (pp 456-463), 2016.
Article Number: ezv038. Date of Publication: 01 Feb 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Right anterior minithoracotomy with central arterial
cannulation is our preferred technique of minimally invasive aortic valve
replacement (AVR). We compared perioperative outcomes with this technique
to those via sternotomy. METHODS: Between March 1999 and December 2013,
492 patients underwent isolated AVR via either sternotomy (SAVR, n = 198)
or minimally invasive right anterior thoracotomy (MIAVR, n = 294) in our
institution. Univariate comparisons between groups were made to evaluate
overall outcomes and adverse events. To control treatment selection bias,
propensity scores were constructed from core patient characteristics. A
propensity score-stratified analysis of outcome and adverse events was
then performed. RESULTS: Overall mortality was 2.5 and 1.0% in the SAVR
and MIAVR groups, respectively. Hospital and ICU stays were shorter, there
was less intraoperative blood product usage, and fewer wound infections in
the MIAVR group. There were no differences in other adverse events,
including strokes. The composite end-point of alive and adverse event-free
was significantly more common in the MIAVR group (83 vs 74%, P = 0.002).
After adjusting for the propensity score, hospital and ICU stays remained
shorter and intraoperative blood product usage remained less in the MIAVR
group. There was no difference in mortality, stroke or other adverse
events between groups. CONCLUSION: Minimally invasive AVR via an anterior
right thoracotomy with predominately central cannulation can be performed
with morbidity and mortality similar to that of a sternotomy approach.
There appear to be advantages to this minimally invasive approach when
compared with sternotomy in terms of less intraoperative blood product
usage, lower wound infection rates and decreased hospital stays. If
mortality and the occurrence of adverse events are taken together, MIAVR
may be associated with better outcomes. As minimally invasive AVR becomes
more common, further long-term follow-up is needed and a prospective
multicentre randomized trial would be warranted. Copyright &#xa9; The
Author 2015. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<23>
Accession Number
608909554
Author
Garcia-Valentin A.; Mestres C.A.; Bernabeu E.; Bahamonde J.A.; Martin I.;
Rueda C.; Domenech A.; Valencia J.; Fletcher D.; Machado F.; Amores J.
Institution
(Garcia-Valentin, Bahamonde, Martin, Rueda, Domenech, Valencia, Fletcher,
Machado, Amores) Department of Cardiovascular Surgery, Hospital Clinic,
Valencia, Spain
(Mestres) Department of Cardiovascular Surgery, Hospital Clinic,
University of Barcelona, Barcelona, Spain
(Bernabeu) Department of Cardiac Surgery, Alicante General Hospital,
Alicante, Spain
Title
Validation and quality measurements for EuroSCORE and EuroSCORE II in the
Spanish cardiac surgical population: A prospective, multicentre study.
Source
European Journal of Cardio-thoracic Surgery. 49 (2) (pp 399-405), 2016.
Article Number: ezv090. Date of Publication: 01 Feb 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Since its development in the late 1990s, the European System
for Cardiac Operative Risk Evaluation (EuroSCORE) has been the predictive
model of choice for estimating mortality after cardiac surgery. As
outcomes from cardiac surgery improved, the EuroSCORE showed a loss of
calibration, and a revised version of the model was developed, EuroSCORE
II. The objectives of this study were to examine the validity of both
scores in the Spanish population, and to depict the performance of both
models on a funnel plot. METHODS: A prospective multicentre study was
performed, with requests to participate sent to all centres in Spain.
Participating centres reported the EuroSCORE, EuroSCORE II and the actual
mortality of each patient. Incomplete data were requested to get a zero
incidence of lost data. Calibration of models was evaluated with the
Hosmer-Lemeshow goodness-of-fit test, and discrimination with the areas
under the receiver operating characteristic (ROC) curve. A funnel plot was
constructed using mortality data from the 2010 European Registry, to
represent risk-adjusted mortality. RESULTS: Twenty Spanish centres
participated in the study; 4034 patients undergoing cardiac surgery
between 1 October 2012 and 31 March 2013 were collected. Prevalence of
risk factors was analysed. The observed mortality rate was 6.5%. The mean
additive EuroSCORE was 6.5. The mean expected mortality rate was 9.8% for
the logistic EuroSCORE, and 5.7% for EuroSCORE II. Areas under the ROC
curves were EuroSCORE: 0.77 [95% confidence interval (CI): 0.75-0.80],
EuroSCORE II: 0.79 (95% CI: 0.76-0.82). Results for the goodness-of-fit
test were EuroSCORE: 33.02 (P < 0.001), EuroSCORE II: 38.98 (P < 0.001).
Risk-adjusted mortality is far beyond the lower bound of the CI if
EuroSCORE is used as the reference model, and is between the confidence
limits, but near to the upper bound when EuroSCORE II is used.
CONCLUSIONS: Spanish cardiac surgical patients have a high-risk profile.
Areas under the ROC curve show good discrimination for both models.
Predicted mortality using EuroSCORE II more closely matches actual
mortality than that predicted by the original EuroSCORE. Both models show
statistically significant differences from the actual mortality rate, with
EuroSCORE overpredicting and EuroSCORE II underpredicting mortality. The
funnel plot illustrates risk-adjusted mortality clearly out of boundaries
when EuroSCORE is used, and near underprediction when the reference is
EuroSCORE II. Copyright &#xa9; The Author 2015. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<24>
Accession Number
613254036
Author
Collins R.; Reith C.; Emberson J.; Armitage J.; Baigent C.; Blackwell L.;
Blumenthal R.; Danesh J.; Smith G.D.; DeMets D.; Evans S.; Law M.;
MacMahon S.; Martin S.; Neal B.; Poulter N.; Preiss D.; Ridker P.; Roberts
I.; Rodgers A.; Sandercock P.; Schulz K.; Sever P.; Simes J.; Smeeth L.;
Wald N.; Yusuf S.; Peto R.
Institution
(Collins, Reith, Emberson, Armitage, Baigent, Blackwell, Preiss, Peto)
Clinical Trial Service Unit & Epidemiological Studies Unit and MRC
Population Health Research Unit, Nuffield Department of Population Health,
University of Oxford, Oxford, United Kingdom
(Blumenthal, Martin) Ciccarone Center for the Prevention of Heart Disease,
Division of Cardiology, Johns Hopkins University School of Medicine,
Baltimore, MD, United States
(Danesh) MRC/BHF Cardiovascular Epidemiology Unit, Department of Public
Health and Primary Care, University of Cambridge, Cambridge, United
Kingdom
(Smith) MRC Integrative Epidemiology Unit, University of Bristol, Bristol,
United Kingdom
(DeMets) Department of Biostatistics and Medical Informatics, University
of Wisconsin, Madison, WI, United States
(Evans) Department of Medical Statistics, London School of Hygiene &
Tropical Medicine, University of London, London, United Kingdom
(Roberts) Clinical Trials Unit, London School of Hygiene & Tropical
Medicine, University of London, London, United Kingdom
(Smeeth) Department of Non-Communicable Disease Epidemiology, London
School of Hygiene & Tropical Medicine, University of London, London,
United Kingdom
(Law, Wald) Wolfson Institute of Preventive Medicine, Barts and The London
School of Medicine and Dentistry, Queen Mary University of London, London,
United Kingdom
(MacMahon, Neal, Rodgers) The George Institute for Global Health,
University of Sydney, Sydney, Australia
(Simes) National Health and Medical Research Council Clinical Trial
Centre, University of Sydney, Sydney, Australia
(Poulter) International Centre for Circulatory Health & Imperial Clinical
Trials Unit, Imperial College London, London, United Kingdom
(Sever) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
(Ridker) Center for Cardiovascular Disease Prevention, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States
(Sandercock) Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, United Kingdom
(Schulz) FHI 360, University of North Carolina School of Medicine,
University of North Carolina, Chapel Hill, NC, United States
(Yusuf) Population Health Research Institute, Hamilton Health Sciences and
McMaster University, Hamilton, ON, Canada
Title
Interpretation of the evidence for the efficacy and safety of statin
therapy.
Source
The Lancet. 388 (10059) (pp 2532-2561), 2016. Date of Publication: 19 Nov
2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
This Review is intended to help clinicians, patients, and the public make
informed decisions about statin therapy for the prevention of heart
attacks and strokes. It explains how the evidence that is available from
randomised controlled trials yields reliable information about both the
efficacy and safety of statin therapy. In addition, it discusses how
claims that statins commonly cause adverse effects reflect a failure to
recognise the limitations of other sources of evidence about the effects
of treatment. Large-scale evidence from randomised trials shows that
statin therapy reduces the risk of major vascular events (ie, coronary
deaths or myocardial infarctions, strokes, and coronary revascularisation
procedures) by about one-quarter for each mmol/L reduction in LDL
cholesterol during each year (after the first) that it continues to be
taken. The absolute benefits of statin therapy depend on an individual's
absolute risk of occlusive vascular events and the absolute reduction in
LDL cholesterol that is achieved. For example, lowering LDL cholesterol by
2 mmol/L (77 mg/dL) with an effective low-cost statin regimen (eg,
atorvastatin 40 mg daily, costing about 2 per month) for 5 years in 10 000
patients would typically prevent major vascular events from occurring in
about 1000 patients (ie, 10% absolute benefit) with pre-existing occlusive
vascular disease (secondary prevention) and in 500 patients (ie, 5%
absolute benefit) who are at increased risk but have not yet had a
vascular event (primary prevention). Statin therapy has been shown to
reduce vascular disease risk during each year it continues to be taken, so
larger absolute benefits would accrue with more prolonged therapy, and
these benefits persist long term. The only serious adverse events that
have been shown to be caused by long-term statin therapy-ie, adverse
effects of the statin-are myopathy (defined as muscle pain or weakness
combined with large increases in blood concentrations of creatine kinase),
new-onset diabetes mellitus, and, probably, haemorrhagic stroke.
Typically, treatment of 10 000 patients for 5 years with an effective
regimen (eg, atorvastatin 40 mg daily) would cause about 5 cases of
myopathy (one of which might progress, if the statin therapy is not
stopped, to the more severe condition of rhabdomyolysis), 50-100 new cases
of diabetes, and 5-10 haemorrhagic strokes. However, any adverse impact of
these side-effects on major vascular events has already been taken into
account in the estimates of the absolute benefits. Statin therapy may
cause symptomatic adverse events (eg, muscle pain or weakness) in up to
about 50-100 patients (ie, 0.5-1.0% absolute harm) per 10 000 treated for
5 years. However, placebo-controlled randomised trials have shown
definitively that almost all of the symptomatic adverse events that are
attributed to statin therapy in routine practice are not actually caused
by it (ie, they represent misattribution). The large-scale evidence
available from randomised trials also indicates that it is unlikely that
large absolute excesses in other serious adverse events still await
discovery. Consequently, any further findings that emerge about the
effects of statin therapy would not be expected to alter materially the
balance of benefits and harms. It is, therefore, of concern that
exaggerated claims about side-effect rates with statin therapy may be
responsible for its under-use among individuals at increased risk of
cardiovascular events. For, whereas the rare cases of myopathy and any
muscle-related symptoms that are attributed to statin therapy generally
resolve rapidly when treatment is stopped, the heart attacks or strokes
that may occur if statin therapy is stopped unnecessarily can be
devastating. Copyright &#xa9; 2016 Elsevier Ltd

<25>
Accession Number
607332438
Author
Yano H.; Horinaka S.; Ishikawa M.; Ishimitsu T.
Institution
(Yano, Horinaka, Ishikawa, Ishimitsu) Department of Cardiology, Nasu Red
Cross Hospital, Ohtawara, Tochigi 324-8686, Japan
(Yano, Horinaka, Ishikawa, Ishimitsu) Department of Cardiology and
Nephrology, Dokkyo Medical University, Mibu, Tochigi 321-0293, Japan
Title
The efficacy of everolimus-eluting stent implantation in patients with
ST-segment elevation myocardial infarction: outcomes of 2-year clinical
follow-up.
Source
Heart and Vessels. 31 (10) (pp 1609-1615), 2016. Date of Publication: 01
Oct 2016.
Publisher
Springer-Verlag Tokyo (E-mail: orders@springer.jp)
Abstract
First-generation drug-eluting stents (DES) demonstrated delay in vascular
healing and increase in incidence of late and very late stent thrombosis
compared with bare-metal stents (BMS). Second-generation DES, however,
have shown a reduction of late and very late stent thrombosis compared
with first-generation DES. Thus, we decided to evaluate whether the
second-generation everolimus-eluting stent (EES) has an advantage over BMS
in Japanese patients with ST-segment elevation myocardial infarction
(STEMI). This study was conducted in two centers, retrospective,
non-randomized and observational design in patients with STEMI.
Three-hundred eighty patients were randomly selected to receive EES (198
patients) or cobalt-chromium BMS (182 patients). The primary endpoints
were cardiac death, recurrent myocardial infarction (MI), target lesion
revascularization (TLR), target vessel revascularization (TVR), and stent
thrombosis (ST). At 2 years, the rates of TLR, TVR, and recurrent MI were
significantly lower in the EES group than in the BMS group (TLR 1.5 vs.
8.3 %, p < 0.05; TVR 2.5 vs. 9.4 %, p < 0.05; recurrent MI 1.0 vs. 4.1 %,
p < 0.05), and the rate of ST was also significantly lower in the EES
group than in the BMS group (0.5 vs. 4.3 %, p < 0.05). Thus, major adverse
cardiac events defined at the composite cardiac death, MI, TLR, TVR, or ST
were significantly lower in EES group than in BMS group (3.0 vs. 9.9 %, p
= 0.008). The rate of cardiac death, however, did not differ between both
groups. In STEMI patients, EES may be associated with improved
outcomes-specifically, a significant reduction in TVR, ST, and recurrent
MI compared to BMS throughout 2 years. Copyright &#xa9; 2015, Springer
Japan.

<26>
Accession Number
605502924
Author
Abdelsattar Z.M.; Hendren S.; Wong S.L.; Campbell D.A.; Ramachandran S.K.
Institution
(Abdelsattar, Hendren, Wong, Campbell) Center for Healthcare Outcomes and
Policy, University of Michigan, Ann Arbor, MI, United States
(Ramachandran) Department of Anesthesiology, University of Michigan,
Medical School, 1500 East Medical Center Drive, 1H247 UH, SPC 5048, Ann
Arbor, MI 48109-5048, United States
Title
The impact of untreated obstructive sleep apnea on cardiopulmonary
complications in general and vascular surgery: A cohort study.
Source
Sleep. 38 (8) (pp 1205-1210), 2015. Date of Publication: 01 Aug 2015.
Publisher
Associated Professional Sleep Societies,LLC (2510 N. Frontage Road, Darien
IL 60561, United States)
Abstract
Study Objective: To determine whether preoperatively untreated obstructive
sleep apnea (OSA) affects postoperative outcomes. Design: Cohort study of
patients undergoing surgery between July 2012 and September 2013,
utilizing prospectively collected data from the Michigan Surgical Quality
Collaborative. Multivariable regression models were used to compare
complication rates between treated and untreated OSA, while adjusting for
important patient covariates and clustering within hospitals. Setting:
Fifty-two community and academic hospitals in Michigan. Patients: Adult
patients undergoing various general or vascular operations were
categorized as: (1) no diagnosis or low risk of OSA; (2) documented OSA
without therapy or suspicion of OSA; and (3) diagnosis of OSA with
treatment (e.g., positive airway pressure). Exposures: OSA, preoperatively
treated or untreated, was the exposure variable. Postoperative 30-day
cardiopulmonary complications including arrhythmias, cardiac arrest,
myocardial infarction, unplanned reintubation, pulmonary embolism, and
pneumonia were the outcomes of interest. Measurements and Results: Of
26,842 patients, 2,646 (9.9%) had a diagnosis or suspicion of OSA. Of
those, 1,465 (55.4%) were untreated. Patient and procedural risk factors
were evenly balanced between treated and untreated groups. Compared with
treated OSA, untreated OSA was independently associated with more
cardiopulmonary complications (risk-adjusted rates 6.7% versus 4.0%;
adjusted odds ratio [aOR] = 1.8, P = 0.001), particularly unplanned
reintubations (aOR = 2.5, P = 0.003) and myocardial infarction (aOR = 2.6,
P = 0.031). Conclusions: Patients with obstructive sleep apnea (OSA) who
are not treated with positive airway pressure preoperatively are at
increased risks for cardiopulmonary complications after general and
vascular surgery. Improving the recognition of OSA and ensuring adequate
treatment may be a strategy to reduce risk for surgical patients with OSA.
&#xa9; Copyright 2015 Associated Professional Sleep Societies, LLC.

<27>
Accession Number
602889287
Author
Gershlick A.H.; Khan J.N.; Kelly D.J.; Greenwood J.P.; Sasikaran T.;
Curzen N.; Blackman D.J.; Dalby M.; Fairbrother K.L.; Banya W.; Wang D.;
Flather M.; Hetherington S.L.; Kelion A.D.; Talwar S.; Gunning M.; Hall
R.; Swanton H.; McCann G.P.
Institution
(Gershlick, Khan, McCann) Department of Cardiovascular Sciences,
University of Leicester, Glenfield Hospital, Groby Road Site, Leicester
LE3 9QP, United Kingdom
(Kelly) Department of Cardiology, Royal Derby Hospital, Derby, United
Kingdom
(Greenwood) Division of Cardiovascular and Diabetes Research, Leeds
Institute of Cardiovascular and Metabolic Medicine, University of Leeds,
Leeds, United Kingdom
(Greenwood, Blackman) Department of Cardiology, Leeds Teaching Hospitals
NHS Trust, Leeds, United Kingdom
(Sasikaran) Clinical Trials and Evaluation Unit, Royal Brompton and
Harefield NHS Foundation Trust, Imperial College London, London, United
Kingdom
(Curzen) University Hospital Southampton and Faculty of Medicine,
University of Southampton, Southampton, United Kingdom
(Dalby) Royal Brompton and Harefield NHS Trust, London, United Kingdom
(Fairbrother) University Hospitals of Leicester NHS Trust, Leicester,
United Kingdom
(Banya) National Institute for Health Research Cardiovascular Biomedical
Research Unit, Royal Brompton and Harefield NHS Trust, London, United
Kingdom
(Wang) Department of Clinical Sciences, Liverpool School of Tropical
Medicine, Liverpool, United Kingdom
(Flather, Hall) Norfolk and Norwich University Hospitals NHS Foundation
Trust, Norwich Medical School, University of East Anglia, Norwich, United
Kingdom
(Hetherington) Kettering General Hospital, Kettering, United Kingdom
(Kelion) Oxford Heart Centre, John Radcliffe Hospital, Oxford University
Hospitals NHS Trust, Oxford, United Kingdom
(Talwar) Royal Bournemouth Hospital, Bournemouth, United Kingdom
(Gunning) Royal Stoke University Hospital, University Hospitals of North
Midlands NHS Trust, Stoke-on-Trent, Staffordshire, United Kingdom
(Swanton) Heart Hospital, University College London Hospitals, London,
United Kingdom
Title
Randomized trial of complete versus lesion-only revascularization in
patients undergoing primary percutaneous coronary intervention for stemi
and multivessel disease: The CvLPRIT trial.
Source
Journal of the American College of Cardiology. 65 (10) (pp 963-972), 2015.
Date of Publication: 17 Mar 2015.
Publisher
Elsevier USA
Abstract
Background The optimal management of patients found to have multivessel
disease while undergoing primary percutaneous coronary intervention
(P-PCI) for ST-segment elevation myocardial infarction is uncertain.
Objectives CvLPRIT (Complete versus Lesion-only Primary PCI trial) is a
U.K. open-label randomized study comparing complete revascularization at
index admission with treatment of the infarct-related artery (IRA) only.
Methods After they provided verbal assent and underwent coronary
angiography, 296 patients in 7 U.K. centers were randomized through an
interactive voice-response program to either in-hospital complete
revascularization (n = 150) or IRA-only revascularization (n = 146).
Complete revascularization was performed either at the time of P-PCI or
before hospital discharge. Randomization was stratified by infarct
location (anterior/nonanterior) and symptom onset (< 3 h or >3 h). The
primary endpoint was a composite of all-cause death, recurrent myocardial
infarction (MI), heart failure, and ischemia-driven revascularization
within 12 months. Results Patient groups were well matched for baseline
clinical characteristics. The primary endpoint occurred in 10.0% of the
complete revascularization group versus 21.2% in the IRA-only
revascularization group (hazard ratio: 0.45; 95% confidence interval: 0.24
to 0.84; p = 0.009). A trend toward benefit was seen early after complete
revascularization (p = 0.055 at 30 days). Although there was no
significant reduction in death or MI, a nonsignificant reduction in all
primary endpoint components was seen. There was no reduction in ischemic
burden on myocardial perfusion scintigraphy or in the safety endpoints of
major bleeding, contrast-induced nephropathy, or stroke between the
groups. Conclusions In patients presenting for P-PCI with multivessel
disease, index admission complete revascularization significantly lowered
the rate of the composite primary endpoint at 12 months compared with
treating only the IRA. In such patients, inpatient total revascularization
may be considered, but larger clinical trials are required to confirm this
result and specifically address whether this strategy is associated with
improved survival. Copyright &#xa9; 2015 American College of Cardiology
Foundation.

<28>
Accession Number
602889137
Author
Murphy T.P.; Cutlip D.E.; Regensteiner J.G.; Mohler E.R.; Cohen D.J.;
Reynolds M.R.; Massaro J.M.; Lewis B.A.; Cerezo J.; Oldenburg N.C.; Thum
C.C.; Jaff M.R.; Comerota A.J.; Steffes M.W.; Abrahamsen I.H.; Goldberg
S.; Hirsch A.T.
Institution
(Murphy, Cerezo) Department of Diagnostic Imaging, Vascular Disease
Research Center, Rhode Island Hospital, Gerry 337, 593 Eddy Street,
Providence, RI 02903, United States
(Cutlip) Division of Cardiology, Beth Israel Deaconess Medical Center,
Boston, MA, United States
(Cutlip, Reynolds, Massaro, Thum, Abrahamsen) Harvard Clinical Research
Institute, Boston, MA, United States
(Regensteiner) University of Colorado School of Medicine-Aurora, Center
for Women's Health Research, Aurora, CO, United States
(Mohler) Section of Vascular Medicine, Cardiovascular Division at Perelman
School of Medicine, University of Pennsylvania, Philadelphia, PA, United
States
(Cohen) Division of Cardiology, University of Missouri-Kansas City, Kansas
City, MO, United States
(Massaro) Department of Biostatistics, Boston University, Boston, MA,
United States
(Lewis) School of Kinesiology, University of Minnesota, Minneapolis, MN,
United States
(Oldenburg, Steffes, Hirsch) Lillehei Heart Institute, Cardiovascular
Division, University of Minnesota Medical School, Minneapolis, MN, United
States
(Jaff) Division of Cardiology, Massachusetts General Hospital, Boston, MA,
United States
(Comerota) Jobst Vascular Institute, Toledo Hospital, Toledo, OH, United
States
(Goldberg) National Heart Lung and Blood Institute, Bethesda, MD, United
States
Title
Supervised exercise, stent revascularization, or medical therapy for
claudication due to aortoiliac peripheral artery disease: The CLEVER
study.
Source
Journal of the American College of Cardiology. 65 (10) (pp 999-1009),
2015. Date of Publication: 17 Mar 2015.
Publisher
Elsevier USA
Abstract
Background Treatment for claudication that is due to aortoiliac peripheral
artery disease (PAD) often relies on stent revascularization (ST).
However, supervised exercise (SE) is known to provide comparable
short-term (6-month) improvements in functional status and quality of
life. Longer-term outcomes are not known. Objectives The goal of this
study was to report the longer-term (18-month) efficacy of SE compared
with ST and optimal medical care (OMC). Methods Of 111 patients with
aortoiliac PAD randomly assigned to receive OMC, OMC plus SE, or OMC plus
ST, 79 completed the 18-month clinical and treadmill follow-up assessment.
SE consisted of 6 months of SE and an additional year of telephone-based
exercise counseling. Primary clinical outcomes included objective
treadmill-based walking performance and subjective quality of life.
Results Peak walking time improved from baseline to 18 months for both SE
(5.0 +/- 5.4 min) and ST (3.2 +/- 4.7 min) significantly more than for OMC
(0.2 +/- 2.1 min; p < 0.001 and p = 0.04, respectively). The difference
between SE and ST was not significant (p = 0.16). Improvement in
claudication onset time was greater for SE compared with OMC, but not for
ST compared with OMC. Many disease-specific quality-of-life scales
demonstrated durable improvements that were greater for ST compared with
SE or OMC. Conclusions Both SE and ST had better 18-month outcomes than
OMC. SE and ST provided comparable durable improvement in functional
status and in quality of life up to 18 months. The durability of
claudication exercise interventions merits its consideration as a primary
PAD claudication treatment. Copyright &#xa9; 2015 American College of
Cardiology Foundation.

<29>
Accession Number
615360558
Author
Hlavicka J.; Straka Z.; Jelinek S.; Budera P.; Vanek T.; Maly M.; Widimsky
P.
Institution
(Hlavicka, Straka, Jelinek, Budera, Vanek, Widimsky) Cardiocentre,
University Hospital Kralovske Vinohrady and Third Faculty of Medicine,
Charles University in Prague, Czech Republic
(Maly) National Institute of Public Health, Prague, Czech Republic
Title
Off-pump versus on-pump coronary artery bypass grafting surgery in
high-risk patients: PRAGUE-6 trial at 30 days and 1 year.
Source
Biomedical papers of the Medical Faculty of the University Palacky,
Olomouc, Czechoslovakia. 160 (2) (pp 263-270), 2016. Date of Publication:
01 Jun 2016.
Abstract
AIMS: Off-pump coronary artery bypass graft surgery (OPCAB) is an
established alternative to on-pump surgical revascularization. Previous
studies in patients with low or intermediate risk showed no significant
differences between off-pump and on-pump surgical revascularization. The
aim of this study was to compare the two techniques in patients with high
operative risk.
METHODS: PRAGUE-6 is a prospective randomized single-center study of 206
patients, with an additive EuroSCORE > 6, scheduled for isolated coronary
surgery: Group A - on-pump (n = 108) versus Group B - off-pump (n = 98).
The primary outcome was a combined endpoint of all-cause deaths, stroke,
myocardial infarction, or renal failure requiring new hemodialysis, within
30 days and 1 year after randomization. All data were analyzed using the
"intention-to-treat" principle.
RESULTS: Early postoperative myocardial infarction was detected in 12.1%
(A) vs. 4.1% (B) of patients (P = 0.048, hazard ratio 0.32, 95% CI
0.11-0.99). There was a significantly higher incidence of primary combined
end-point in group A (20.6% vs. 9.2%, P = 0.028, HR 0.41, 95% CI
0.19-0.91) in the first 30 days, but not after 1 year (30.8% vs. 21.4%, P
= 0.117, HR 0.65, CI 0.37-1.12).
CONCLUSION: Off-pump surgical revascularization in patients with high
operative risks can significantly reduce the incidence of major
postoperative complications during the first 30 days. There was no
statistically significant difference in the incidence of these
complications after 1 year.

<30>
Accession Number
615380051
Author
Cortez D.; Barham W.; Ruckdeschel E.; Sharma N.; Mccanta A.C.; von
Alvensleben J.; Sauer W.H.; Collins K.K.; Kay J.; Patel S.; Nguyen D.T.
Institution
(Cortez, von Alvensleben, Collins, Kay, Patel) Department of Pediatric
Cardiology Children's Hospital of Colorado Aurora
(Cortez, von Alvensleben, Sauer, Collins, Kay, Patel, Nguyen) Department
of Cardiology University of Colorado Aurora
(Cortez, Barham) Division of Cardiovascular Sciences Lund University
Sweden
(Cortez, Sharma) Department of Cardiology Penn State Milton S. Hershey
Medical Center Hershey, Pennsylvania
(Ruckdeschel) Department of Cardiology Children's Hospital of Philadelphia
Pennsylvania
(Mccanta) Department of Cardiology CHOC Children's Orange, California
(Collins, Kay, Patel) Department of Cardiology University of Colorado
Denver School of Medicine
Title
Noninvasive predictors of perioperative atrial arrhythmias in patients
with tetralogy of Fallot undergoing pulmonary valve replacement.
Source
Clinical Cardiology. (no pagination), 2017. Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: Patients with tetralogy of Fallot (TOF) have increased risk of
atrial arrhythmias. Hypothesis: A measure of atrial dispersion, the P-wave
vector magnitude (Pvm), can identify patients at risk for perioperative
atrial flutter (AFL) or intra-atrial re-entrant tachycardia (IART) in a
large TOF cohort. Methods: We performed a blinded, retrospective analysis
of 158 TOF patients undergoing pulmonary valve replacement between 1997
and 2015. History of AFL/IART was documented using electrocardiogram,
Holter monitor, exercise stress test, implanted cardiac device, and
electrophysiology study. P-R intervals, Pvm, QRS duration, and QRS vector
magnitude were assessed from resting sinus-rhythm 12-lead
electrocardiograms and identification of those with AFL/IART was
determined. Results: Fourteen patients (8.9%) were found to have AFL/IART.
Pvm, QRS duration, and QRS vector magnitude significantly differentiated
those with AFL/IART from those without on univariate analysis: 0.09+/-0.04
vs 0.18+/-0.07 mV, 161.3+/-21.9 vs 137.7+/-31.4ms, and 1.2 (interquartile
range, 1.0-1.2) vs 1.6 mV (1.0-2.3), respectively (P < 0.05 for each). The
Pvm had the highest area under the ROC curve (0.88) and was the only
significant predictor on multivariate analysis, with odds ratio of 0.02
(95% confidence interval: 0.01-0.53). P-R duration, MRI volumes, and
right-heart hemodynamics did not significantly differentiate those with vs
those without AFL/IART. Conclusions: In TOF patients undergoing pulmonary
valve replacement, Pvm has significant value in predicting those with
perioperative AFL/IART. These clinical features may help further evaluate
TOF patients at risk for perioperative atrial arrhythmias. Prospective
studies are warranted. Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<31>
Accession Number
615378310
Author
Alawami M.; Chatfield A.; Ghashi R.; Walker L.
Institution
(Alawami, Chatfield) Cardiology Department, Auckland City Hospital,
Auckland, New Zealand
(Ghashi) Science Department, Auckland University, Auckland, New Zealand
(Walker) Cardiothoracic and Vascular Intensive Care Unit, Auckland City
Hospital, Auckland, New Zealand
Title
Atrial fibrillation after cardiac surgery: Prevention and management: The
Australasian experience.
Source
Journal of the Saudi Heart Association. (no pagination), 2017. Date of
Publication: February 01, 2017.
Publisher
Elsevier B.V.
Abstract
Background: Atrial fibrillation (AF) after cardiac surgery is a major
health problem that is associated with a significant financial burden.
This paper aims to highlight this problem and review the current
guidelines in the prevention and management of AF after cardiac surgery,
providing our experience in the Australasian centers. Methods: We
conducted a literature review using mainly PubMed to compare the current
practice with the available evidence. EMBASE and Cochrane library were
also searched. We concurrently developed an online questionnaire to
collect data from other Australasian centers regarding their approach to
this problem. Results: We identified 194 studies that were considered
relevant to our research. We did not find any formal protocols published
in the literature. From our Australasian experience; seven centers (58%)
had a protocol for AF prophylaxis. The protocols included electrolytes
replacement, use of amiodarone and/or beta-blockers. Other strategies were
occasionally used but were not part of a structured protocol. Conclusion:
The development of an integrated medical and surgical protocol for the
prophylaxis of AF after cardiac surgery is an important aspect for the
care of postoperative cardiac patients. Considerations of prophylactic
strategies other than those routinely used should be included in the
protocol. This area should receive considerable attention in order to
reduce the postoperative complications and health costs. Copyright &#xa9;
2017 The Authors.

<32>
Accession Number
615371991
Author
Sandri A.; Petersen R.H.; Decaluwe H.; Moons J.; Ferguson M.K.; Hansen
H.J.; Brunelli A.
Institution
(Sandri, Brunelli) Department of Thoracic Surgery, St James's University
Hospital, Leeds, United Kingdom
(Petersen, Hansen) Department of Cardio-thoracic Surgery, Copenhagen
University Hospital, Copenhagen, Denmark
(Decaluwe, Moons) Department of Thoracic Surgery UZ Leuven, Leuven,
Belgium
(Ferguson) Department of Surgery and The Comprehensive Cancer Center, The
University of Chicago, Chicago, Ill
Title
Coronary artery disease is associated with an increased mortality rate
following video-assisted thoracoscopic lobectomy.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: November 09, 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: To compare the incidence of major adverse cardiac events (MACE)
and mortality following video-assisted thoracoscopic surgery (VATS)
lobectomy in patients with and without coronary artery disease (CAD).
Methods: Multicentre retrospective analysis of 1699 patients undergoing
VATS lobectomy (January 2012-March 2015). CAD definition: previous acute
myocardial infarct (AMI), angina, percutaneous coronary intervention (PCI)
or coronary artery bypass graft (CABG). MACE definition: postoperative
acute myocardial ischemia, cardiac arrest or any cardiac death. Propensity
score analysis was performed to match patients with and without CAD.
Outcomes of the 2 matched groups were compared. Results: The incidence of
MACE and mortality for the entire population was 0.4% (7 patients) and
1.7% (29 patients); 218 patients (13%) had a history of CAD: 106 previous
AMI, 55 angina, 32 CABG, and 81 PCI. The propensity score yielded 2
well-balanced groups of 218 pairs with and without CAD. MACE (CAD 2 [0.9%]
vs no-CAD 1 [0.5%]; P = 1), cardiovascular and pulmonary complications
(CAD 61 [28%] vs no-CAD 51 [23%]; P = .3) and postoperative stay (CAD 7.3
days vs no-CAD 6.2 days; P = .3) were not different between the groups.
The incidence of atrial fibrillation (CAD 31 [14%] vs no-CAD 18 [8.2%]; P
= .07), 30-day mortality (CAD: 11 [5%] vs no-CAD 2 [0.9%]; P = .02) and
death among complicated patients (CAD 18% vs no-CAD 3.9%; P = .009) were
higher in the CAD group. Conclusions: The incidence of MACE following VATS
lobectomy in patients with CAD is low and similar to patients without CAD.
However, their risk of postoperative mortality is fivefold higher compared
with non-CAD patients, warranting refined preoperative functional
evaluation and more intense postoperative monitoring. Copyright &#xa9;
2017 The American Association for Thoracic Surgery.

<33>
Accession Number
615370263
Author
Maeno Y.; Abramowitz Y.; Kawamori H.; Kazuno Y.; Kubo S.; Takahashi N.;
Mangat G.; Okuyama K.; Kashif M.; Chakravarty T.; Nakamura M.; Cheng W.;
Friedman J.; Berman D.; Makkar R.R.; Jilaihawi H.
Institution
(Maeno, Abramowitz, Kawamori, Kazuno, Kubo, Takahashi, Mangat, Okuyama,
Kashif, Chakravarty, Nakamura, Cheng, Friedman, Berman, Makkar, Jilaihawi)
Cedars-Sinai Heart Institute, Los Angeles, California
Title
A Highly Predictive Risk Model for Pacemaker Implantation After TAVR.
Source
JACC: Cardiovascular Imaging. (no pagination), 2017. Date of Publication:
May 24, 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study sought to develop a robust and definitive risk
model for new permanent pacemaker implantation (PPMI) after SAPIEN 3
(third generation balloon expandable valve) (Edwards Lifesciences, Irvine,
California) transcatheter aortic valve replacement (third generation
balloon expandable valve TAVR), including calcification in the
aortic-valvular complex (AVC). Background: The association between calcium
in the AVC and need for PPMI is poorly delineated after third generation
balloon expandable valve TAVR. Methods: At Cedars-Sinai Heart Institute in
Los Angeles, California, a total of 240 patients with severe aortic
stenosis underwent third generation balloon expandable valve TAVR and had
contrast computed tomography. AVC was characterized precisely by leaflet
sector and region. Results: The total new PPMI rate was 14.6%. On
multivariate analysis for predictors of PPMI, pre-procedure third
generation balloon expandable valve TAVR, right bundle branch block
(RBBB), shorter membranous septum (MS) length, and noncoronary cusp
device-landing zone calcium volume (NCC-DLZ CA) were included. Predictive
probabilities were generated using this logistic regression model. If 3
pre-procedural risk factors were present, the c-statistic of the model for
PPMI was area under the curve of 0.88, sensitivity of 77.1%, and
specificity of 87.1%; this risk model had high negative predictive value
(95.7%). The addition of the procedural factor of device depth to the
model, with the parameter of difference between implantation depth and MS
length, combined with RBBB and NCC-DLZ CA increased the c-statistic to
0.92, sensitivity to 94.3%, specificity to 83.8%, and negative predictive
value to 98.8%. Conclusions: By using a precise characterization of
distribution of calcification in the AVC in a single-center, retrospective
study, NCC-DLZ CA was found to be an independent predictor of new PPMI
post-third generation balloon expandable valve TAVR. The findings also
reinforce the importance of short MS length, pre-existing RBBB, and
ventricular implantation depth as important synergistic PPMI risk factors.
This risk model will need validation by future prospective multicenter
studies. Copyright &#xa9; 2017.

<34>
Accession Number
615369098
Author
Jung D.M.; Ahn H.J.; Jung S.-H.; Yang M.; Kim J.A.; Shin S.M.; Jeon S.
Institution
(Jung, Ahn, Yang, Kim, Jeon) Department of Anesthesiology and Pain
Medicine, Samsung Medical Centre, Sungkyunkwan University School of
Medicine, Seoul, Korea
(Shin) Department of Thoracic and Cardiovascular Surgery, Samsung Medical
Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
(Jung) Biostatistics and Clinical Epidemiology Centre, Research Institute
for Future Medicine, Samsung Medical Centre, Seoul, Korea
Title
Apneic oxygen insufflation decreases the incidence of hypoxemia during
one-lung ventilation in open and thoracoscopic pulmonary lobectomy: A
randomized controlled trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: August 26, 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Hypoxemia is common during one-lung ventilation (OLV) for
thoracic surgery. When hypoxemia occurs, surgery is interrupted for rescue
ventilation. Apneic oxygen insufflation (AOI), which provides
O<inf>2</inf> without applying pressure, may prevent hypoxemia and does
not interrupt surgery. The aim of this study was to determine the
effectiveness of the AOI technique for preventing hypoxemia during OLV in
thoracic surgery. Methods: Patients undergoing open or thoracoscopic
pulmonary lobectomy from September to December 2015 were included.
Patients were assigned randomly to a non-AOI group or an AOI group (n = 45
each). OLV was initiated and at the 15-minute mark (OLV15), patients in
the AOI group received oxygen insufflation at 3 L/min to the nonventilated
lung for 30 minutes (OLV45). The primary endpoint was the occurrence of
hypoxemia (SaO<inf>2</inf> <90%) during OLV. Results: The demographic and
operative data were similar between the 2 groups. The incidence of
hypoxemia was greater in the non-AOI than the AOI group (18% vs 0%; P =
.009). deltaPaO<inf>2</inf> (the difference in partial pressure of oxygen
in arterial blood between OLV 45 and 15 minutes) was smaller in the AOI
than the non-AOI group (-29 mm Hg vs -69 mm Hg; P = .005). Duration of
surgery and incidence of complications did not vary between groups.
Conclusions: AOI decreases the incidence of hypoxemia and improves
arterial oxygenation during OLV for open and thoracoscopic surgery. AOI
may be a valuable option to prevent hypoxemia. It can be used before
relying on continuous positive airway pressure or intermittent two-lung
ventilation and result in fewer interruptions in surgery. Copyright &#xa9;
2017 The American Association for Thoracic Surgery.

<35>
Accession Number
615369067
Author
Munoz M.; Laso-Morales M.J.; Gomez-Ramirez S.; Cadellas M.; Nunez-Matas
M.J.; Garcia-Erce J.A.
Institution
(Munoz) Peri-operative Transfusion Medicine School of Medicine Malaga
Spain
(Laso-Morales) Anesthesiology Corporacio Sanitaria Parc Tauli Sabadell
Spain
(Gomez-Ramirez) Internal Medicine University Hospital Virgen de la
Victoria Malaga Spain
(Cadellas) Cardiology University Hospital Mar-Esperanca Barcelona Spain
(Nunez-Matas) Obstetrics and Gynaecology Regional University Hospital
Malaga Spain
(Garcia-Erce) Blood and Tissue Bank of Navarra Osansubidea, Pamplona Spain
Title
Pre-operative haemoglobin levels and iron status in a large multicentre
cohort of patients undergoing major elective surgery.
Source
Anaesthesia. (no pagination), 2017. Date of Publication: 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Pre-operative anaemia in patients undergoing major surgical procedures has
been linked to poor outcomes. Therefore, early detection and treatment of
pre-operative anaemia is recommended. However, to effectively implement a
pre-operative anaemia management protocol, an estimation of its prevalence
and main causes is needed. We analysed data from 3342 patients (44.5%
female) scheduled for either: elective orthopaedic surgery (n = 1286);
cardiac surgery (n = 691); colorectal cancer resection (n = 735); radical
prostatectomy (n = 362); gynaecological surgery (n = 203) or resection of
liver metastases (n = 122). For both sexes, anaemia was defined by a
haemoglobin level < 130 g.l^-1; absolute iron deficiency by
ferritin < 30 ng.ml^-1 (< 100 ng.ml^-1, if transferrin
saturation < 20% or C-reactive protein > 5 mg.l^-1); iron
sequestration by transferrin saturation < 20% and ferritin > 100
ng.ml^-1; and low iron stores by transferrin saturation > 20%
and ferritin 30-100 ng.ml^-1. The overall prevalence of anaemia
was 36%, with differences according to the type of surgery. Laboratory
parameters allowing classification of iron status were available for 2884
patients. Among those with anaemia (n = 986), 677 (69%) were women, 608
(62%) presented with absolute iron deficiency, 101 (10%) with iron
sequestration; and 150 (5%) with low iron stores. Iron status alterations
were similar in women with haemoglobin < 130 g.l^-1 or < 120
g.l^-1. For those who were not anaemic (n = 1898), corresponding
figures were 656 (35%), 621 (33%), 165 (9%) and 518 (27%), respectively.
Anaemia was present in one-third of patients undergoing major elective
procedures. Over two-thirds of anaemic patients presented with absolute
iron deficiency or iron sequestration. Over half of non-anaemic patients
presented with absolute iron deficiency or low iron stores. We consider
these data useful for planning pre-operative management of patients
scheduled for major elective surgery. Copyright 2017 Copyright &#xa9; The
Association of Anaesthetists of Great Britain and Ireland

<36>
[Use Link to view the full text]
Accession Number
611064365
Author
Di Giammarco G.; Marinelli D.; Foschi M.; Di Mauro M.
Institution
(Di Giammarco, Marinelli, Foschi, Di Mauro) Department of Cardiac Surgery,
University G. d'Annunzio, Chieti, Italy
Title
Intraoperative graft verification in coronary surgery.
Source
Journal of Cardiovascular Medicine. 18 (5) (pp 295-304), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Transit-time flow measurement (TTFM) is a reliable method to check the
graft function intraoperatively in coronary surgery. The given parameters
are: Mean Graft Flow (MGF); Pulsatility Index (PI) and Insufficiency Ratio
(%BF). Some cutoffs of these parameters have been identified as predictors
for unfair 1-y clinical outcome: mean graft flow (MGF) less than 20 ml/min
and high pulsatility index greater than 5. Other cutoffs have been found
as related to postoperative angiography: MGF 15 ml/min or less and
pulsatility index at least 3 (sensitivity 94%; specificity 61%); MGF less
than 15 ml/min and pulsatility index greater than 3 for left coronary
artery or pulsatility index greater than 5 for right coronary artery
(sensitivity 96%; specificity 77%); MGF 15 ml/min or less and pulsatility
index at least 5.1 left coronary artery (sensitivity 98%; specificity
26%). Hence, with the need to improve the diagnostic accuracy of TTFM, a
high-resolution epicardic coronary ultrasound module has been added to
graft flow evaluation providing 2D ultrasound imaging (either in
short-axis or long-axis) and color-flow mapping, allowing an accurate
morphological evaluation of body graft and anastomosis. An intraoperative
method aimed to verify coronary grafts should be easy to handle, not time
consuming, minimally invasive, easily meaningful and relatively cheap; in
addition, it should offer objective parameters more than qualitative
criteria. We herein report the results of our experience with
intraoperative graft verification with TTFM and high-resolution imaging
along with a systematic review of the literature in this field with the
aim to provide a road map to be followed. Copyright &#xa9; 2017 Italian
Federation of Cardiology. All rights reserved.

<37>
Accession Number
613265024
Author
Sakrana A.A.; Nasr M.M.; Ashamallah G.A.; Abuelatta R.A.; Naeim H.A.; El
Tahlawi M.A.
Institution
(Sakrana, Abuelatta, Naeim) Madina Cardiac Center, 23411, AL Madinah Al
Munawwrah, Khaled Bin Al Waleed Road, Saudi Arabia
(Sakrana, Nasr, Ashamallah) Department of Diagnostic and Interventional
Radiology, Mansoura University Hospital, 35112, 12 El-Gomhoreya Street,
Mansoura, Egypt
(El Tahlawi) Zagazig University Hospital, Cardiology Department, Zagazig,
Egypt
Title
Paravalvular leak after transcatheter aortic valve implantation: is it
anatomically predictable or procedurally determined? MDCT study.
Source
Clinical Radiology. 71 (11) (pp 1095-1103), 2016. Date of Publication: 01
Nov 2016.
Publisher
W.B. Saunders Ltd
Abstract
Aim To investigate the determinants of paravalvular leak (PVL) occurring
after transcatheter aortic valve implantation (TAVI). Materials and
methods One hundred and eight patients with severe symptomatic aortic
stenosis (mean age 75.5+/-11.8 years, 72.2% male) underwent
contrast-enhanced electrocardiogram (ECG)-gated multidetector computed
tomography (MDCT) then successful TAVI. The following parameters were
determined in the late systolic phase: annular and left ventricular
outflow tract (LVOT) diameters, annular perimeter, ellipticity index,
annular area, indexed annular area, LVOT perimeter, annulus/LVOT perimeter
difference ratio, the LVOT to ascending aorta angle (< LVOT-AO). In the
diastolic phase, the extent of calcification of the aortic valve (AVC) was
assessed visually and graded semi-quantitatively as grade I, II, and III
at the annulus, LVOT, and aortic cusps levels. Pre-discharge transthoracic
echocardiography (TTE) was performed, and the PVL was graded as grade I,
II, and III. The area-dependent device-annulus sizing ratio was
calculated. Results Absence of PVL was observed in 44.44% of the patients,
30.56% had grade I PVL, 25% of the patients had grade II or above, and any
PVL was observed in 55.56%. There was no statistically significant
association between the degree of PVL and the extent or the distribution
of AVC, aortic annulus diameters, ellipticity index, annulus/LVOT
perimeter difference ratio or < LVOT-AO. The frequency of PVL was not
significantly different with the use of balloon-expandable or
self-expandable valves. A larger transcatheter heart valve (THV)/annulus
sizing ratio was associated with a lower incidence and degree of PVL
(p<0.001); there was no detectable PVL with a mean sizing ratio of
14.89+/-7.29, and grade I PVL occurred with a mean sizing ratio
12.43+/-0.84, while PVL of grade II or above occurred using the mean
sizing ratio -0.42+/-5.57. Conclusion The procedure-related THV/annulus
sizing ratio was an important determinant of the degree of PVL after TAVI,
whereas the MDCT-derived anatomical measurements of the aortic root and
AVC were not predictors of PVL. Copyright &#xa9; 2016 The Royal College of
Radiologists

<38>
Accession Number
614130201
Author
Wang T.K.M.; Wang M.T.M.; Gamble G.D.; Webster M.; Ruygrok P.N.
Institution
(Wang, Webster, Ruygrok) Green Lane Cardiovascular Service, Auckland City
Hospital, Auckland, New Zealand
(Wang, Wang, Gamble, Ruygrok) Department of Medicine, University of
Auckland, Auckland, New Zealand
Title
Performance of contemporary surgical risk scores for transcatheter aortic
valve implantation: A meta-analysis.
Source
International Journal of Cardiology. 236 (pp 350-355), 2017. Date of
Publication: 01 Jun 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Transcatheter aortic valve implantation (TAVI) is considered
for severe aortic valve disease at high and now intermediate risk for
surgical aortic valve replacement. Risk stratification plays a critical
role decision-making for intervention and modality. We compared the
prognostic utility of surgical risk scores for TAVI in this meta-analysis.
Methods MEDLINE, Embase, Cochrane and Web of Science databases from 1
January 1980 to 31 December 2015 were searched. Studies were
systematically reviewed for inclusion, and data extracted for pooled
analyses. Results Amongst 1688 articles searched, 47 full-text articles
were screened and 24 studies (12,346 TAVI cases) included for analyses.
Pooled c-statistics (95% confidence interval) for operative mortality were
EuroSCORE 0.62 (0.57-0.67), EuroSCORE II 0.62 (0.59-0.66), STS Score 0.62
(0.59-0.65). Pooled calibration odds ratios (95%CI) were EuroSCORE 0.31
(0.25-0.38), EuroSCORE II 1.26 (1.06-1.51), STS 0.95 (0.72-1.27).
C-statistics (95%CI) for 1-year mortality were EuroSCORE 0.62 (0.57-0.67),
EuroSCORE II 0.66 (0.61-0.71) and STS Score 0.58 (0.53-0.64). Conclusion
Surgical risk scores at most modestly discriminated operative and 1-year
mortality. The EuroSCORE grossly over-estimated operative mortality while
the EuroSCORE II and STS Scores fitted better to TAVI outcomes with their
own limitations. There is a need for the development and validation of
TAVI-specific risk models. Copyright &#xa9; 2017 Elsevier B.V.

<39>
[Use Link to view the full text]
Accession Number
614298055
Author
Wendler O.; Schymik G.; Treede H.; Baumgartner H.; Dumonteil N.; Ihlberg
L.; Neumann F.-J.; Tarantini G.; Zamarano J.L.; Vahanian A.
Institution
(Wendler) Department of Cardiac Surgery, King's Health Partners, London,
Denmark Hill, London SE5 9RS, United Kingdom
(Schymik) Municipal Hospital, Karlsruhe, Germany
(Treede) University Heart Centre, Hamburg, Germany
(Baumgartner) Department of Cardiovascular Medicine, University Hospital
Muenster, Germany
(Dumonteil) Clinique Pasteur, Toulouse, France
(Ihlberg) University Central Hospital, Helsinki, Finland
(Neumann) University Heart Centre, Bad Krozingen, Germany
(Tarantini) University Padua, Department of Cardiac, Thoracic and Vascular
Sciences, Italy
(Zamarano) University Hospital Ramon y Cajal, Madrid, Spain
(Vahanian) Hopital Bichat, Paris, France
Title
SOURCE 3 Registry: Design and 30-day results of the european postapproval
registry of the latest generation of the sapien 3 transcatheter heart
valve.
Source
Circulation. 135 (12) (pp 1123-1132), 2017. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: The SOURCE 3 Registry (SAPIEN Aortic Bioprosthesis European
Outcome) is a European multicenter, observational registry of the latest
generation of transcatheter heart valve, the SAPIEN 3 (Edwards
Lifesciences, Irvine, CA). Its purpose is to document outcomes of clinical
safety and performance after European approval was given. METHODS: Here,
we present the 30-day outcome of the SOURCE 3 Registry. All data are
self-reported, and all participating centers have committed to support
their consecutive experience with the SAPIEN 3 transcatheter heart valve,
dependent on patient consent, before the start of the study. Adverse
events are defined with Valve Academic Research Consortium 2 criteria and
adjudicated by an independent clinical events committee. RESULTS: A total
of 1950 patients from 80 centers in 10 countries were enrolled between
July 2014 and October 2015. Of those, 1947 patients underwent
transcatheter aortic valve implantation (TAVI) with the SAPIEN 3 (mean
age, 81.6-6.6 years; 48.1% female). Main comorbidities included coronary
artery disease (51.5%), renal insufficiency (27.4%), diabetes mellitus
(29.5%), chronic obstructive pulmonary disease (16.0%), and a mean
logistic EuroSCORE of 18.3-13.2. Transfemoral access was used in 87.1%
(n=1695); nontransfemoral, in 252 patients. Conscious sedation was used in
59.9% of transfemoral procedures, and in 50% of patients, TAVI was
performed without aortic balloon valvuloplasty. Implantation success (1
valve in the intended location) was 98.3%. Conversion to conventional
surgery (0.6%) and use of cardiopulmonary bypass (0.7%) were rare. Adverse
events were low, with site-reported 30-day all-cause mortality of 2.2%,
cardiovascular mortality of 1.1%, stroke of 1.4%, major vascular
complications of 4.1%, life-threatening bleeding of 5%, and post- TAVI
pacemaker implantation of 12%. Moderate or greater paravalvular
regurgitation was observed in 3.1% of reporting patients. CONCLUSIONS:
Results from the SOURCE 3 Registry demonstrate contemporary European
trends and good outcomes of TAVI in daily practice when this
third-generation TAVI device is used. Copyright &#xa9; 2017 American Heart
Association, Inc.

<40>
[Use Link to view the full text]
Accession Number
614341167
Author
Rao M.P.; Al-Khatib S.M.; Pokorney S.D.; She L.; Romanov A.; Nicolau J.C.;
Lee K.L.; Carson P.; Selzman C.H.; Stepinska J.; Cleland J.G.F.;
Tungsubutra W.; Desvigne-Nickens P.M.; Sueta C.A.; Siepe M.; Lang I.;
Feldman A.M.; Yii M.; Rouleau J.L.; Velazquez E.J.
Institution
(Rao, Al-Khatib, Pokorney, She, Lee, Velazquez) Duke Clinical Research
Institute, Duke University, School of Medicine, PO Box 17969, Durham, NC
27715, United States
(Lee) Departments of Biostatistics and Bioinformatics, Duke University
School of Medicine, Durham, United States
(Al-Khatib, Velazquez) Departments of Medicine, Duke University School of
Medicine, Durham, United States
(Romanov) State Research Institute of Circulation Pathology, Novosibirsk,
Russian Federation
(Nicolau) Heart Institute, University of Sao Paulo Medical School, Brazil
(Carson) Washington DC Veterans Affairs Medical Center, United States
(Selzman) Division of Cardiothoracic Surgery, University of Utah, Salt
Lake City, United States
(Stepinska) Institute of Cardiology, Warsaw, Poland
(Cleland) National Heart and Lung Institute, Royal Brompton and Harefield
Hospitals, Imperial College, London, United Kingdom
(Tungsubutra) Siriraj Hospital, Mahidol University, Bangkok, Thailand
(Desvigne-Nickens) Division of Cardiovascular Sciences, National Heart,
Lung, and Blood Institute, Bethesda, United States
(Sueta) University of North Carolina, Chapel Hill, United States
(Siepe) University Heart Center Freiburg-Bad Krozingen, Germany
(Lang) Medical University of Vienna, Austria
(Feldman) Department of Medicine, Temple University School of Medicine,
Philadelphia, United States
(Yii) St. Vincent's Hospital, University of Melbourne, Fitzroy, Australia
(Rouleau) Department of Medicine, Montreal Heart Institute, University of
Montreal, QC, Canada
Title
Sudden cardiac death in patients with ischemic heart failure undergoing
coronary artery bypass grafting: Results from the STICH randomized
clinical trial (Surgical Treatment for Ischemic Heart Failure).
Source
Circulation. 135 (12) (pp 1136-1144), 2017. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: The risk of sudden cardiac death (SCD) in patients with heart
failure after coronary artery bypass graft surgery (CABG) has not been
examined in a contemporary clinical trial of surgical revascularization.
This analysis describes the incidence, timing, and clinical predictors of
SCD after CABG. METHODS: Patients enrolled in the STICH trial (Surgical
Treatment of Ischemic Heart Failure) who underwent CABG with or without
surgical ventricular reconstruction were included. We excluded patients
with prior implantable cardioverter-defibrillator and those randomized
only to medical therapy. The primary outcome was SCD as adjudicated by a
blinded committee. A Cox model was used to examine and identify predictors
of SCD. The Fine and Gray method was used to estimate the incidence of SCD
accounting for the competing risk of other deaths. RESULTS: Over a median
follow-up of 46 months, 113 of 1411 patients who received CABG without (n
= 934) or with (n = 477) surgical ventricular reconstruction had SCD; 311
died of other causes. The mean left ventricular ejection fraction at
enrollment was 28-9%. The 5-year cumulative incidence of SCD was 8.5%.
Patients who had SCD and those who did not die were younger and had fewer
comorbid conditions than did those who died of causes other than SCD. In
the first 30 days after CABG, SCD (n=5) accounted for 7% of all deaths.
The numerically greatest monthly rate of SCD was in the 31- to 90-day time
period. In a multivariable analysis including baseline demographics, risk
factors, coronary anatomy, and left ventricular function, end-systolic
volume index and B-type natriuretic peptide were most strongly associated
with SCD. CONCLUSIONS: The monthly risk of SCD shortly after CABG among
patients with a low left ventricular ejection fraction is highest between
the first and third months, suggesting that risk stratification for SCD
should occur early in the postoperative period, particularly in patients
with increased preoperative end-systolic volume index or B-type
natriuretic peptide. CLINICAL TRIAL REGISTRATION: URL:
http://www.clinicaltrials.gov. Unique identifier: NCT0002359. Copyright
&#xa9; 2017 American Heart Association, Inc.

<41>
Accession Number
614991134
Author
Charuluxananan S.; Sriraj W.; Punjasawadwong Y.; Pitimana-Aree S.;
Lekprasert V.; Werawatganon T.; Wasinwong W.; Ratanachai P.; Sriramatr D.;
Atichat S.; Angkasuvan W.; Somchat C.; Tanutanud D.; Ariyanuchitkul T.;
Choorat J.; Sintavanuruk K.; Janngam J.
Institution
(Charuluxananan, Werawatganon) Department of Anesthesiology, Faculty of
Medicine, Chulalongkorn University, Bangkok 10330, Thailand
(Sriraj) Department of Anesthesiology, Faculty of Medicine, Khon Kaen
University, Khon Kaen 40000, Thailand
(Punjasawadwong) Department of Anesthesiology, Faculty of Medicine, Chiang
Mai University, Chiang Mai 50200, Thailand
(Pitimana-Aree) Department of Anesthesiology, Faculty of Medicine, Siriraj
Hospital, Mahidol University, Bangkok 10700, Thailand
(Lekprasert) Department of Anesthesiology, Faculty of Medicine,
Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
(Wasinwong) Department of Anesthesiology, Faculty of Medicine, Prince of
Songkla University, Songkhla 90110, Thailand
(Ratanachai, Angkasuvan) Department of Anesthesiology, Hatyai Hospital,
Songkhla 90110, Thailand
(Sriramatr) Department of Anesthesiology, Faculty of Medicine,
Srinakharinwirot University, Nakhon Nayok 26120, Thailand
(Atichat) Department of Anesthesiology, Chonburi Regional Hospital,
Chonburi 20000, Thailand
(Somchat) Department of Anesthesiology, Lamphun Hospital, Lamphun 51000,
Thailand
(Tanutanud) Department of Anesthesiology, Lampang Hospital, Lampang 52100,
Thailand
(Ariyanuchitkul) Department of Anesthesiology, Maharat Nakhon Ratchasima
Hospital, Nakhon Ratchasima 30000, Thailand
(Choorat) Department of Anesthesiology, Sunpasitthiprasong Hospital,
Ubonratchathani 34000, Thailand
(Sintavanuruk) Department of Anesthesiology, Charoenkrung Pracharak
Hospital, Bangkok 10120, Thailand
(Janngam) Department of Anesthesiology, Bangkok Metropolitan
Administration General Hospital, Bangkok 10100, Thailand
Title
Perioperative and Anesthetic Adverse events in Thailand (PAAd Thai)
incident reporting study: Anesthetic profiles and outcomes.
Source
Asian Biomedicine. 11 (1) (pp 21-32), 2017. Date of Publication: February
2017.
Publisher
Asian Biomedicine (E-mail: chulamed@md.chula.ac.th)
Abstract
Background: The Royal College of Anesthesiologists of Thailand initiated
registry and reporting of anesthesia service incidents and outcomes in
2005. Objectives: The Perianesthetic Anesthetic Adverse Events in Thailand
(PAAd Thai) study aimed to investigate patient, surgical, and anesthetic
profiles, and suggest strategies for prevention of adverse events.
Methods: A prospective descriptive study was conducted in 22 hospitals
across Thailand. Each hospital was invited to report, on an anonymous
basis, any perianesthetic adverse incident during 12 months (between
January 1 and December 31, 2015). A standardized incident report form was
completed to determine the type of incident, and where, when, how, and why
it occurred using closed and open-ended questionnaires. Data regarding
main anesthetic techniques were also reported monthly. Descriptive
statistics were used. Results: For 333,219 cases, 2,206 incident reports
with 3,028 critical incidents were reported. The incidents commonly
occurred in male patients (52.0%), aged <10 y (13.0%) and >70 y (18.2%).
The incidence of adverse events included cardiac arrest within 24 h
(15.5:10,000), death (13.0:10,000), reintubation (11.1:10,000), esophageal
intubation (8.5:10,000), difficult intubation (8.0:10,000), and malignant
hyperthermia (1:200,000). General, cardiothoracic, neurological, and
otorhinolaryngological surgical specialties posed a high risk of
incidents. Operating and recovery rooms were common locations for
incidents. Conclusion: In the past decade, there were dramatic reductions
of perioperative cardiac arrests and difficult intubations. Common factors
related to critical incidents were inexperience, emergency, inadequate
preanesthetic evaluation, inappropriate decisions, lack of vigilance, and
inexperienced assistants. Suggested corrective strategies are compliance
with guidelines, additional training, and improvement of supervision and
quality assurance.

<42>
Accession Number
614921821
Author
Wang W.; Liu J.; Fang J.; Liu Y.; An T.; Zou M.; Cheng G.
Institution
(Wang, Fang, Liu, An, Zou, Cheng) Shenyang Pharmaceutical University, 103
Wenhua Road, Shenhe District, Shenyang, Liaoning, China
(Liu) Department of Cardiology, General Hospital of Shenyang Military
Area, Shenhe District, Shenyang, Liaoning, China
Title
The optimal discontinuation of dual antiplatelet therapy in patients
undergoing percutaneous coronary intervention with drug-eluting stents: A
meta-analysis of randomized trials.
Source
International Journal of Cardiology. 235 (pp 73-86), 2017. Date of
Publication: 15 May 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Current guidelines recommend prolonged dual antiplatelet
therapy (DAPT) for patients with drug-eluting stents (DES) implantation.
Nevertheless, optimal discontinuation of DAPT remains a controversy. We
performed a meta-analysis of all randomized controlled trials (RCTs) that
evaluate optimal discontinuation of DAPT in patients undergoing
percutaneous coronary intervention (PCI) with DES. Methods We searched
electronic databases including PubMed, Cochrane Library, EMBASE and
ClinicalTrials.gov from database RCTs that reported different modes of
discontinuation of DAPT in patients with DES. The primary endpoints were
all-cause death, cardiovascular death, myocardial infarction (MI) and
probably or definite stent thrombosis (ST). Secondary endpoints were
repeat revascularization, stroke, major bleeding and net adverse clinical
events (NACE). Results We included 13 RCTs meeting the criteria with a
total of 36,749 patients. No significant difference was observed in
all-cause death (RR [95% CI] = 0.87 [0.75, 1.01], P = 0.07, I²
= 0%), cardiovascular death (RR [95% CI] = 0.97 [0.79, 1.19], P = 0.76,
I² = 0%), repeat revascularization (RR [95% CI] = 1.07 [0.92,
1.25], P = 0.36, I² = 0%), and stroke (RR [95% CI] = 1.01
[0.80, 1.28], P = 0.94, I² = 0%). Compared with shorter DAPT,
longer DAPT was associated with a significant reduction in MI (RR [95% CI]
= 1.46 [1.26, 1.69], P < 0.00001, I² = 28%) and ST (RR [95% CI]
= 1.93 [1.45, 2.58], P < 0.00001, I² = 32%), and a significant
increase in major bleeding (RR [95% CI] = 0.60 [0.49, 0.74], P < 0.00001,
I² = 0%). However, there was no difference in NACE (RR [95% CI]
= 1.03 [0.91, 1.17], P = 0.63, I² = 0%). In subgroup analyses
based on stent type, we demonstrated that longer DAPT was associated with
a significant reduction in thrombotic events (MI and ST) after
first-generation DES implantation (RR [95% CI] = 2.58 [1.85, 3.58],
I² = 0%) and everolimus-eluting stents (EES, RR [95% CI] = 1.54
[1.12, 2.11], I² = 0%). Conversely, there was no difference in
thrombotic events in patients with zotarolimus-eluting stents (ZES, RR
[95% CI] = 1.17 [0.83, 1.63], I² = 75%) and biodegradable
polymer DES (BP-DES, RR [95% CI] = 1.15 [0.74, 1.79]). Conclusions 1)
Compared with shorter DAPT, longer DAPT was associated with a significant
reduction in thrombotic events (MI and ST) and a higher rate of major
bleeding. 2) By the assessment of the trade-off between thrombotic and
hemorrhagic events, shorter DAPT was non-inferior to longer DAPT. 3) The
benefit of longer DAPT was significant in patients with first-generation
DES and EES and weakened with other second-generation DES (ZES and
BP-DES). Copyright &#xa9; 2017 Elsevier Ireland Ltd

<43>
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.

<44>
Accession Number
611990109
Author
Reser D.; Walser R.; Van Hemelrijk M.; Holubec T.; Weber A.; Plass A.;
Maisano F.
Institution
(Reser, Walser, Van Hemelrijk, Holubec, Weber, Plass, Maisano) Department
of Cardiovascular Surgery, University Hospital Zurich, Ramistrasse 100,
Zurich 8092, Switzerland
Title
Long-Term Outcomes after Minimally Invasive Aortic Valve Surgery through
Right Anterior Minithoracotomy.
Source
Thoracic and Cardiovascular Surgeon. 65 (3) (pp 191-197), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Background Minimally invasive aortic valve surgery (MIAV) through a right
anterior minithoracotomy evolved to an accepted procedure with favorable
short- and mid-term outcomes, whereas long-term results lack. The aim of
this study was to evaluate the long-term outcomes. Materials and Methods
All our MIAV patients were included (n = 225). Mean age was 68 +/- 12
years, 29% were older than 75 years, and median EuroSCORE was 5 (0-11).
Baseline characteristics, inhospital outcomes, and follow-up information
about survival, major adverse cardiac and cerebrovascular events (MACCE),
and need for reoperation were collected and analyzed. Results In this
study, 30-day mortality was 1.3%, and there was no permanent stroke. Mean
follow-up time was 69.65 +/- 24 months, being the longest so far reported
in the literature. At 1 and 7 years, survival was 95.8 and 79%, freedom
from MACCE 98.1 and 95.7%, and from reoperation 99.5 and 98.7%,
respectively. Conclusion MIAV is safe and feasible with favorable
long-term outcomes. In the future, it could serve as benchmark for
interventional methods as soon as indications are expanded to young and
low-risk patients. Randomized studies are needed to compare the long-term
outcomes of these approaches.

<45>
Accession Number
615121632
Author
Kober L.
Institution
(Kober) Department of Cardiology, Rigshospitalet, University of
Copenhagen, Copenhagen, Denmark
Title
Complete revascularization in ST-elevation myocardial infarction?.
Source
New England Journal of Medicine. 376 (13) (pp 1282-1284), 2017. Date of
Publication: 30 Mar 2017.
Publisher
Massachussetts Medical Society

<46>
Accession Number
615121613
Author
Smits P.C.; Abdel-Wahab M.; Neumann F.-J.; Boxma-De Klerk B.M.; Lunde K.;
Schotborgh C.E.; Piroth Z.; Horak D.; Wlodarczak A.; Ong P.J.; Hambrecht
R.; Angeras O.; Richardt G.; Omerovic E.
Institution
(Smits, Boxma-De Klerk) Department of Cardiology, Maasstad Hospital,
Maasstadweg 21, Rotterdam 3079 DZ, Netherlands
(Schotborgh) Department of Cardiology, Haga Ziekenhuis, The Hague,
Netherlands
(Abdel-Wahab, Richardt) Department of Cardiology, Heart Center, Segeberger
Kliniken, Bad Segeberg, Germany
(Neumann) Department of Cardiology, University Heart Center Freiburg-Bad
Krozingen, Bad Krozingen, Germany
(Hambrecht) Department of Cardiology, Klinikum Links der Weser, Bremen,
Germany
(Lunde) Department of Cardiology, Rigshospitalet, University of Oslo,
Oslo, Norway
(Piroth) Department of Cardiology, Gyorgy Hungarian Institute of
Cardiology, Budapest, Hungary
(Horak) Department of Cardiology, Liberec Regional Hospital, Liberec,
Czech Republic
(Wlodarczak) Department of Cardiology, Miedziowe Centrum Zdrowia, Lubin,
Poland
(Ong) Department of Cardiology, Tan Tock Seng Hospital, Singapore
(Angeras, Omerovic) Department of Cardiology, Gothenburg University
Hospital, Gothenburg, Sweden
Title
Fractional flow reserve-guided multivessel angioplasty in myocardial
infarction.
Source
New England Journal of Medicine. 376 (13) (pp 1234-1244), 2017. Date of
Publication: 30 Mar 2017.
Publisher
Massachussetts Medical Society
Abstract
Background: In patients with ST-segment elevation myocardial infarction
(STEMI), the use of percutaneous coronary intervention (PCI) to restore
blood flow in an infarct-related coronary artery improves outcomes. The
use of PCI in non-infarct-related coronary arteries remains controversial.
Methods: We randomly assigned 885 patients with STEMI and multivessel
disease who had undergone primary PCI of an infarct-related coronary
artery in a 1:2 ratio to undergo complete revascularization of
non-infarct-related coronary arteries guided by fractional flow reserve
(FFR) (295 patients) or to undergo no revascularization of
non-infarct-related coronary arteries (590 patients). The FFR procedure
was performed in both groups, but in the latter group, both the patients
and their cardiologist were unaware of the findings on FFR. The primary
end point was a composite of death from any cause, nonfatal myocardial
infarction, revascularization, and cerebrovascular events at 12 months.
Clinically indicated elective revascularizations performed within 45 days
after primary PCI were not counted as events in the group receiving PCI
for an infarct-related coronary artery only. Results: The primary outcome
occurred in 23 patients in the complete-revascularization group and in 121
patients in the infarct-artery-only group that did not receive complete
revascularization, a finding that translates to 8 and 21 events per 100
patients, respectively (hazard ratio, 0.35; 95% confidence interval [CI],
0.22 to 0.55; P<0.001). Death occurred in 4 patients in the
complete-revascularization group and in 10 patients in the
infarct-artery-only group (1.4% vs. 1.7%) (hazard ratio, 0.80; 95% CI,
0.25 to 2.56), myocardial infarction in 7 and 28 patients, respectively
(2.4% vs. 4.7%) (hazard ratio, 0.50; 95% CI, 0.22 to 1.13),
revascularization in 18 and 103 patients (6.1% vs. 17.5%) (hazard ratio,
0.32; 95% CI, 0.20 to 0.54), and cerebrovascular events in 0 and 4
patients (0 vs. 0.7%). An FFR-related serious adverse event occurred in 2
patients (both in the group receiving infarct-related treatment only).
Conclusions: In patients with STEMI and multivessel disease who underwent
primary PCI of an infarct-related artery, the addition of FFR-guided
complete revascularization of non-infarct-related arteries in the acute
setting resulted in a risk of a composite cardiovascular outcome that was
lower than the risk among those who were treated for the infarct-related
artery only. This finding was mainly supported by a reduction in
subsequent revascularizations. &#xa9; Copyright 2017 Massachusetts Medical
Society.

<47>
Accession Number
614506802
Author
Constant A.-L.; Mongardon N.; Morelot Q.; Pichon N.; Grimaldi D.;
Bordenave L.; Soummer A.; Sauneuf B.; Merceron S.; Ricome S.; Misset B.;
Bruel C.; Schnell D.; Boisrame-Helms J.; Dubuisson E.; Brunet J.; Lasocki
S.; Cronier P.; Bouhemad B.; Carreira S.; Begot E.; Vandenbunder B.;
Dhonneur G.; Jullien P.; Resche-Rigon M.; Bedos J.-P.; Montlahuc C.;
Legriel S.
Institution
(Constant, Grimaldi, Merceron, Bedos, Legriel) Medical-Surgical Intensive
Care Unit, Intensive Care Department, Centre Hospitalier de
Versailles-Site Andre Mignot, 177 rue de Versailles, Le Chesnay Cedex
78150, France
(Constant) Department of Anesthesiology and Critical Care Medicine,
Hopital Europeen Georges Pompidou, Paris 75015, France
(Mongardon, Dhonneur) Department of Anesthesiology and Surgical Intensive
Care Units, Hopital Henri Mondor, Assistance Publique des Hopitaux de
Paris, 51 avenue du Marechal de Lattre de Tassigny, Creteil 94000, France
(Mongardon, Dhonneur) Faculte de medecine, Universite Paris Est, 8 avenue
du general Sarrail, Creteil 94000, France
(Mongardon) Inserm, U955, Equipe 3 "Strategies pharmacologiques et
therapeutiques experimentales des insuffisances cardiaques et coronaires",
8 avenue du general Sarrail, Creteil, France
(Morelot, Resche-Rigon, Montlahuc) SBIM Biostatistics and Medical
information, Hopital Saint-Louis, APHP, 1, avenue Claude Vellefaux, Paris,
France
(Morelot, Resche-Rigon, Montlahuc) Universite Paris Diderot, Paris, France
(Morelot, Resche-Rigon, Montlahuc) ECSTRA Team (Epidemiologie Clinique et
Statistiques pour la Recherche en Sante), UMR 1153 INSERM, Universite
Paris Diderot, Sorbonne Paris Cite, Paris, France
(Pichon, Begot) Medical-Surgical Intensive Care Unit, Centre Hospitalier
Universitaire de Limoges, 2, avenue Martin-Luther-King, Limoges 87042,
France
(Bordenave) Department of Anesthesiology, Institut Gustave Roussy, 39, rue
Camille-Desmoulins, Villejuif Cedex 94805, France
(Soummer) Department of Intensive Care Medicine, Foch Hospital, 40 rue
Worth, Suresnes 92150, France
(Sauneuf, Brunet) Pole Anesthesie-Reanimation-SAMU, CHU de Caen, Avenue de
la cote de Nacre, CS30001, Caen Cedex 9 14033, France
(Ricome) Department of Anesthesiology and Critical Care, Assistance
Publique des Hopitaux de Paris, 100 boulevard du General-Leclerc, Clichy
la Garenne 92110, France
(Misset, Bruel) Medical-Surgical Intensive Care Unit, Groupe Hospitalier
Saint Joseph, 185 rue Raymond Losserand, Paris Cedex 75614, France
(Misset, Legriel) Sorbonne Paris Cite-Medical School, Paris Descartes
University, Paris, France
(Schnell, Boisrame-Helms) Medical Intensive Care Unit, Nouvel Hopital
Civil, Hopitaux Universitaires de Strasbourg, Strasbourg, France
(Boisrame-Helms) EA 7293, Federation de Medecine Translationnelle de
Strasbourg (FMTS), Faculte de medecine, Universite de Strasbourg,
Strasbourg, France
(Dubuisson, Jullien) Department of Anesthesiology, Centre Hospitalier de
Versailles-Site Andre Mignot, 177 rue de Versailles, Le Chesnay Cedex
78150, France
(Lasocki) Pole d'Anesthesie Reanimation, CHU d'Angers, 4 rue Larrey,
Angers Cedex 9, Angers 49933, France
(Lasocki) LUNAM Universite, CHU d'Angers, Angers Cedex 49933, France
(Cronier) Intensive Care Unit, Centre Hospitalier Sud-Francilien, 116
boulevard Jean Jaures, Corbeil-Essonnes Cedex 91106, France
(Bouhemad) Department of Anesthesiology and Critical Care, Groupe
Hospitalier Saint Joseph, 185 rue Raymond Losserand, Paris Cedex 75614,
France
(Carreira) Department of Intensive Care Medicine, Hopital Saint-Camill, 2
rue des Peres-Camiliens, Bry-sur-Marne 94360, France
(Vandenbunder) Department of Anesthesiology, Foch Hospital, 40 rue Worth,
Suresnes 92150, France
(Legriel) INSERM U970, Paris Cardiovascular Research Center, Paris, France
Title
Targeted temperature management after intraoperative cardiac arrest: a
multicenter retrospective study.
Source
Intensive Care Medicine. 43 (4) (pp 485-495), 2017. Date of Publication:
01 Apr 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Few outcome data are available about temperature management after
intraoperative cardiac arrest (IOCA). We describe targeted temperature
management (TTM) (32-34 degreeC) modalities, adverse events, and
association with 1-year functional outcome in patients with IOCA. Methods:
Patients admitted to 11 ICUs after IOCA in 2008-2013 were studied
retrospectively. The main outcome measure was 1-year functional outcome.
Results: Of the 101 patients [35 women and 66 men; median age, 62 years
(interquartile range, 42-72)], 68 (67.3%) were ASA PS I to III and 57
(56.4%) had emergent surgery. First recorded rhythms were asystole in 44
(43.6%) patients, pulseless electrical activity in 36 (35.6%), and
ventricular fibrillation/tachycardia in 20 (19.8%). Median times from
collapse to cardiopulmonary resuscitation and return of spontaneous
circulation (ROSC) were 0 min (0-0) and 10 min (4-20), respectively. The
30 (29.7%) patients who received TTM had an increased risk of infection (P
= 0.005) but not of arrhythmia, bleeding, or metabolic/electrolyte
disorders. By multivariate analysis, one or more defibrillation before
ROSC was positively associated with a favorable functional outcome at
1-year (OR 3.06, 95% CI 1.05-8.95, P = 0.04) and emergency surgery was
negatively associated with 1-year favorable functional outcome (OR 0.36;
95% CI 0.14-0.95, P = 0.038). TTM use was not independently associated
with 1-year favorable outcome (OR 0.82; 95% CI 0.27-2.46, P = 0.72).
Conclusions: TTM was used in less than one-third of patients after IOCA.
TTM was associated with infection but not with bleeding or coronary events
in this setting. TTM did not independently predict 1-year favorable
functional outcome after IOCA in this study. Copyright &#xa9; 2017,
Springer-Verlag Berlin Heidelberg and ESICM.

<48>
[Use Link to view the full text]
Accession Number
612362801
Author
Urbinati A.; Pellicori P.; Guerra F.; Capucci A.; Clark A.L.
Institution
(Urbinati, Pellicori, Guerra, Capucci, Clark) Castle Hill Hospital,
Cottingham, United Kingdom
(Urbinati, Pellicori, Guerra, Capucci, Clark) Ospedali Riuniti di Ancona,
Ancona, Italy
Title
Takotsubo syndrome in the paediatric population: A case report and a
systematic review.
Source
Journal of Cardiovascular Medicine. 18 (4) (pp 262-267), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
We describe the case of a takotsubo syndrome in a 12-year-old male patient
following an acute intracranial haemorrhage, which had a favourable
outcome. We also performed a systematic review of published case reports
in patients younger than 18 years. Although takotsubo syndrome is common
in postmenopausal women, in the paediatric population it equally affects
both sexes. Compared with adults, paediatric patients more commonly
present with heart failure symptoms or loss of consciousness. A higher
proportion of paediatric patients have ST segment depression on ECG.
Moreover, in younger patients, a high proportion has nonapical anatomical
variants and more severe left ventricular impairment. The increase in
troponin and the decrease in left ventricular ejection fraction, the
prevalence of neurological or psychological disorders, and in-hospital
outcome are similar between adults and children. Copyright &#xa9; 2017
Italian Federation of Cardiology. All rights reserved.

<49>
Accession Number
615305012
Author
Stuijver D.J.; Romualdi E.; van Zaane B.; Bax L.; Buller H.R.; Gerdes
V.E.; Squizzato A.
Institution
(Stuijver) Department of Internal Medicine, Slotervaart Hospital,
Amsterdam, The Netherlands
Title
Under-reporting of venous and arterial thrombotic events in randomized
clinical trials: a meta-analysis.
Source
Internal and emergency medicine. 10 (2) (pp 219-246), 2015. Date of
Publication: 01 Mar 2015.
Abstract
For the detection of unwanted outcomes of new interventions, physicians
rely on adverse event reporting. We attempt to quantify the reported
incidence of venous thromboembolism (VTE) and arterial thrombosis (AT) in
randomized clinical trials (RCTs), and evaluate the extent of
under-reporting. We selected all therapeutic RCTs published in the four
highest-impact general medicine journals between January 2011 and July
2011. Patients were categorized according to VTE risk. The occurrences of
VTE and AT, either as predefined outcome or adverse event, were assessed.
We identified 131 RCTs. VTE and AT were not reported in 89 and 70 % of
these studies, respectively. The raw-unweighted reported incidence in the
3 studies with predefined outcomes for VTE was 8.4 (7.8-9.1) per 1,000
person-years. In the 128 studies without predefined outcomes for VTE,
(consisting of 322,029 individuals, including patients with cancer,
inflammatory disease, cardiovascular disease, surgery, adding up to a
follow-up >500,000 person-years), an incidence of 0.4 (0.4-0.5) per 1,000
person-years was found. The reported incidence of AT in 18 studies in
which AT was part of predefined outcomes was 25.6 (24.9-26.3) per 1,000
person-years. In 92 studies without predefined outcomes for AT (231,638
individuals, follow-up >200,000 person-years,), the incidence was 2.5
(2.3-2.7) per 1,000 person-years. The incidence of VTE and AT in RCTs is
highly under-reported. Uniform registration of adverse events, even when
unlikely to be related to the intervention, is necessary to be able to
inform physicians about the potential toxicities of new therapeutic
strategies.

<50>
Accession Number
615305942
Author
Zhang X.; Wang Q.; Zhang S.; Tan W.; Wang Z.; Li J.
Institution
(Zhang, Wang, Zhang) Department of Critical Care Medicine, Shanghai Tenth
People's Hospital, Tongji University School of Medicine
(Tan) Shanghai Jiangong Hospital
(Wang) Department of Thoracic Surgery, Shanghai Putuo District Center
Hospital
(Li) Tongji University School of Medicine, Shanghai, China
Title
The use of a modified, oscillating positive expiratory pressure device
reduced fever and length of hospital stay in patients after thoracic and
upper abdominal surgery: a randomised trial.
Source
Journal of physiotherapy. 61 (1) (pp 16-20), 2015. Date of Publication: 01
Jan 2015.
Abstract
QUESTION: Does the use of an oscillating positive expiratory pressure
(PEP) device reduce postoperative pulmonary complications in thoracic and
upper abdominal surgical patients?
DESIGN: A multi-centre, parallel-group, randomised controlled trial with
intention-to-treat analysis, blinding of some outcomes, and concealed
allocation.
PARTICIPANTS: A total of 203 adults after thoracic or upper abdominal
surgery with general anaesthesia.
INTERVENTION: Participants in the experimental group used an oscillating
PEP device, thrice daily for 5 postoperative days. Both the experimental
and control groups received standard medical postoperative management and
early mobilisation.
OUTCOME MEASURES: Fever, days of antibiotic therapy, length of hospital
stay, white blood cell count, and possible adverse events were recorded
for 28 days or until hospital discharge.
RESULTS: The 99 participants in the experimental group and 104 in the
control group were well matched at baseline and there was no loss to
follow-up. Fever affected a significantly lower percentage of the
experimental group (22%) than the control group (42%), with a RR of 0.56
(95% CI 0.36 to 0.87, NNT 6). Similarly, length of hospital stay was
significantly shorter in the experimental group, at 10.7 days (SD 8.1),
than in the control group, at 13.3 days (SD 11.1); the mean difference was
2.6 days (95% CI 0.4 to 4.8). The groups did not differ significantly in
the need for antibiotic therapy, white blood cell count or total expense
of treatment.
CONCLUSION: In adults undergoing thoracic and upper abdominal surgery,
postoperative use of an oscillating PEP device resulted in fewer cases of
fever and shorter hospital stay. However, antibiotic therapy and total
hospital expenses were not significantly reduced by this intervention.
TRIAL REGISTRATION: NCT00816881. Copyright &#xa9; 2014. Published by
Elsevier B.V.

<51>
Accession Number
615348189
Author
Yang R.-F.; Jiang Z.-M.; Zhang R.-Q.; Yu B.; Wang X.-H.; Wang P.
Institution
(Yang, Jiang) Department of Thoracic Surgery, Qianfoshan Hospital of
Shandong Province, Shandong University, Ji'nan, Shandong 250012, China
(Yang, Zhang, Wang) Department of Thoracic Surgery, Tai'an City Central
Hospital, Tai'an, Shandong 271000, China
(Yu) Department of Colorectal Surgery, Tai'an City Central Hospital,
Tai'an, Shandong 271000, China
(Wang) Department of Digestive System, Tai'an City Central Hospital,
Tai'an, Shandong 271000, China
Title
Effect of ligation of the thoracic duct during oesophagectomy on the
absorption of D-xylose.
Source
Journal of the College of Physicians and Surgeons Pakistan. 27 (3) (pp
153-156), 2017. Date of Publication: 01 Mar 2017.
Publisher
College of Physicians and Surgeons Pakistan (7th Central Street, Karachi
755000, Pakistan)
Abstract
Objective: To assess if prophylactic thoracic duct ligation during
oesophagectomy influences the absorptive function of oesophageal cancer
patients. Study Design: Randomized controlled trial. Place and Duration of
Study: Department of Thoracic Surgery, Tai'an City Central Hospital,
Tai'an, from August 2014 to December 2015. Methodology: Based on the
management of the thoracic duct during oesophagectomy, 60 patients were
randomized into two groups. D-xylose absorption test was used to evaluate
the absorptive function. The two-independent-samples t-test was employed
for statistical analysis with statistical significance at p < 0.05.
Results: The serum D-xylose concentration of ligation-group was
significantly lower than that of no-ligation group on the first day after
operation, (t=2.82, p=0.0066). However, there was no significant
differences between them even before operation (t=1.34, p=0.1849).
Conclusion: Ligation of the thoracic duct during oesophagectomy
immediately affected the absorption of D-xylose, which may lead to
malabsorption in the long run.

<52>
Accession Number
615341349
Institution
Cardiac Surgery Unit, Community Hospital, Brescia, Italy
Cardiac Surgery Unit, Ospedale della Carita', Novara, Italy
Cardiac Surgery Unit, Ospedale Mauriziano, Turin, Italy
Cardiac Surgery Unit, European Hospital, Rome, Italy
Cardiac Surgery Unit, Ospedale Ferrarotto, Catania, Italy
Cardiac Surgery Unit, Legnano, Italy
Cardiac Surgery Unit, Ospedale Poliambulanza, Brescia, Italy
Cardiac Surgery Unit, Ospedale, Terni, Italy
Cardiac Surgery Unit, Alessandria, Italy
Cardiac Surgery Unit, Ospedale di Circolo, Varese, Italy
Cardiac Surgery Unit, Istituto Clinico Humanitas, Milan, Italy
Cardiac Surgery Unit, S. Gerardo Hospital, Monza, Italy
Heart and Vessel Department, Careggi Hospital, Florence, Italy
Title
Corrigendum: The Italian study on the Mitroflow postoperative results
(ISTHMUS): A 20-year, multicentre evaluation of Mitroflow pericardial
bioprosthesis [Eur J Cardiothorac Surg, 39, (2011) (18-26)] Doi:
10.1016/j.ejcts.2010.03.069.
Source
European Journal of Cardio-thoracic Surgery. 51 (4) (pp 1), 2017. Article
Number: ezw415. Date of Publication: 01 Apr 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
The authors of the above paper wish to inform readers that there was a
misspelling of the author name Luca Weltert as given in Appendix B
section. Copyright &#xa9; The Author 2017. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.

<53>
Accession Number
615341253
Author
Carnero-Alcazar M.; Maroto L.C.; Cobiella-Carnicer J.; Vilacosta I.;
Nombela-Franco L.; Alswies A.; Villagran-Medinilla E.; Macaya C.
Institution
(Carnero-Alcazar, Maroto, Cobiella-Carnicer, Alswies, Villagran-Medinilla)
Department of Cardiac Surgery, Hospital Clinico San Carlos, Madrid, Spain
(Vilacosta, Nombela-Franco, Macaya) Department of Cardiology, Hospital
Clinico San Carlos, Madrid, Spain
Title
Transcatheter versus surgical aortic valve replacement in moderate and
high-risk patients: A meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 51 (4) (pp 644-652), 2017.
Article Number: ezw373. Date of Publication: 01 Apr 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The evidence of the benefits of transcatheter aortic valve
replacement (TAVR) or surgical aortic valve replacement (SAVR) for
patients of high or intermediate surgical risk is not consistent. We
performed a meta-analysis to compare major adverse outcomes after TAVR or
SAVR. METHODS: We searched propensity score matched studies or randomized
clinical trials comparing the risks of mortality, stroke, major bleeding,
acute renal injury, pacemaker implantation, vascular complications and
prostheses haemodynamic performance between TAVR and SAVR in patients with
moderate or high risk. Combined odds ratios (ORs), relative risk or mean
differences with corresponding 95% confidence intervals (CIs) were
calculated using a random effects model. Analyses of sensitivity and
publication bias were also conducted. RESULTS: We included 5 clinical
trials and 37 observational studies, enrolling 20 224 patients (TAVR, n =
9099 and SAVR, n = 11 125). The pooled analysis suggested no differences
in early (OR = 1.11, 95% CI 0.9-1.39, P = 0.355) or late mortality
(relative risk = 0.91, 95% CI 0.78- 1.05, P = 0.194). TAVR was associated
with a lower risk of major bleeding (OR = 0.42, 95% CI 0.25-0.69, P <
0.001) and acute kidney injury (OR = 0.51, 95% CI 0.34-0.71) but with an
increase in the incidence of pacemaker implantation (OR = 2.31, 95% CI
1.73-3.08) and vascular complications (OR = 4.88, 95% CI 2.84-8.39).
Residual aortic regurgitation was more frequent after TAVR (OR= 6.83, 95%
CI 4.87-9.6). SAVR prostheses were associated with poor trans-prosthetic
gradients (mean difference: -2.4 mmHg, 95% CI - 3.27 to - 1.53).
CONCLUSIONS: TAVR and SAVR have similar short and long-term all-cause
mortality and risk of stroke among patients of moderate or high surgical
risk. TAVR decreases the risk of major bleeding, acute kidney injury and
improves haemodynamic performance compared with SAVR but increases the
risk of vascular complications, the need for a pacemaker and residual
aortic regurgitation. Copyright &#xa9; The Author 2016.

<54>
Accession Number
615341249
Author
Yi B.; Chen X.; Shi H.; Lin T.; Lin H.; Xu Y.; Rong J.
Institution
(Yi) Department of Cardiothoracic Surgery, Heart Center, The First
Affiliated Hospital, Ministry of Health, Sun Yat-Sen University, and Key
Laboratory on Assisted Circulation, Guangzhou, China
(Yi, Shi, Rong) Department of Extracorporeal Circulation, Heart Center,
The First Affiliated Hospital, Sun Yat-Sen Department of General Surgery,
The Second Xiangya Hospital, Central South University, Changsha, China
(Chen) Musculoskeletal Oncology Center, The First Affiliated Hospital, Sun
Yat-Sen University, Guangzhou, China
(Lin) Scientific Research Section, The First Affiliated Hospital, Sun
Yat-Sen University, Guangzhou, China
(Lin) Department of Oncology, The First Affiliated Hospital, Sun Yat-Sen
University, Guangzhou, China
Title
Remote ischaemic preconditioning reduces acute kidney injury in adult
patients undergoing cardiac surgery with cardiopulmonary bypass: A
meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 51 (4) (pp 616-623), 2017.
Article Number: ezw372. Date of Publication: 01 Apr 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
This article represents the first attempt to perform a pooled analysis
about remote ischaemic preconditioning (RIPC) in reduction of acute kidney
injury (AKI) of adult patients undergoing cardiac surgery with
cardiopulmonary bypass (CPB). A systematic search was performed using
PubMed (1966-5 January 2016), the Cochrane Library (1996-5 January 2016),
the Web of Science (1986-5 January 2016) and Chinese database (SinoMed)
(1978-5 January 2016) to identify studies that have described the effect
of RIPC on AKI in adult patients undergoing cardiac surgery with CPB. The
outcomes used for this analysis included the incidence of AKI and the need
for renal replacement therapy (RRT). Thirteen randomized controlled trials
(4370 participants) were included in this analysis. RIPC significantly
reduced the risk of AKI (risk ratio, 0.81; 95% confidence interval, [0.66,
0.99]; P = 0.04; I²=46%) for adult patients compared with
control group. However, there was no significant difference with respect
to the incidence of RRT between the two groups. The present meta-analysis
found that RIPC may reduce the incidence of AKI among adult patients
following cardiac surgery with CPB. Adequately powered trials are
warranted to provide further corroboration of our findings in the future.
Copyright &#xa9; The Author 2016.

<55>
[Use Link to view the full text]
Accession Number
615334855
Author
Tjong F.V.Y.; Reddy V.Y.
Institution
(Tjong) AMC Heart Center, Department of Clinical and Experimental
Cardiology, Academic Medical Center, Amsterdam, Netherlands
(Reddy) Helmsley Electrophysiology Center, Icahn School of Medicine at
Mount Sinai, B. 1030, One Gustave L. Levy Place, New York, NY 10029,
United States
Title
Permanent Leadless Cardiac Pacemaker Therapy: A Comprehensive Review.
Source
Circulation. 135 (15) (pp 1458-1470), 2017. Date of Publication: 11 Apr
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
A new technology, leadless pacemaker therapy, was recently introduced
clinically to address lead- and pocket-related complications in
conventional transvenous pacemaker therapy. These leadless devices are
self-contained right ventricular single-chamber pacemakers implanted by
using a femoral percutaneous approach. In this review of available
clinical data on leadless pacemakers, early results with leadless devices
are compared with historical results with conventional single-chamber
pacing. Both presently manufactured leadless pacemakers show similar
complications, which are mostly related to the implant procedure: cardiac
perforation, device dislocation, and femoral vascular access site
complications. In comparison with conventional transvenous single-chamber
pacemakers, slightly higher short-term complication rates have been
observed: 4.8% for leadless pacemakers versus 4.1% for conventional
pacemakers. The complication rate of the leadless pacemakers is influenced
by the implanter learning curve for this new procedure. No long-term
outcome data are yet available for the leadless pacemakers. Larger
leadless pacing trials, with long-term follow-up and direct randomized
comparison with conventional pacing systems, will be required to define
the proper clinical role of these leadless systems. Although current
leadless pacemakers are limited to right ventricular pacing, future
advanced, communicating, multicomponent systems are expected to expand the
potential benefits of leadless therapy to a larger patient population.
Copyright &#xa9; 2017 American Heart Association, Inc.

<56>
Accession Number
615349383
Author
Karathanassis J.; Potaris K.; Karathanassis A.; Konstantinou M.; Syrigos
K.
Institution
(Karathanassis, Potaris, Konstantinou) Department of Thoracic Surgery,
Sotiria General Hospital, Athens, GR, United Kingdom
(Karathanassis) Oncology Department, Medway Maritime Hospital, Gillingham,
Kent, United Kingdom
(Syrigos) Oncology Unit of the 3rd Internal Medicine, Department of Athens
University, Sotiria General Hospital, Athens, GR, United Kingdom
Title
Indications and methods of surgical treatment of solitary pulmonary
nodule.
Source
Pneumon. 29 (4) (pp 348-356), 2016. Date of Publication: October-December
2016.
Publisher
Technogramma (E-mail: tech@hol.gr)
Abstract
Purpose: The diagnosis and treatment of solitary pulmonary nodule (SPN) is
a common but complex clinical problem, for which the investigation of the
role of thoracic surgery comprised the purpose of the present study.
Methods: By computerized literature search we tried to answer three
questions: a) when is surgical resection (diagnostic or therapeutic) of
SPN is indicated? b) what type of surgical resection is required
{lobectomy or limited (sublobar) lung resection such as wedge resection or
anatomic segmentectomy} for malignant SPN? and c) by what method (VATS or
open thoracotomy) should be performed biopsy-resection of SPN? Results: We
noted that the increased probability for malignancy of a SPN as reflected
by the existing imaging methods and the failure to set histological
diagnosis with modern invasive but non-surgical methods are the main
indications for thoracic surgical intervention (diagnostic or
therapeutic). About whether lobectomy or sublobar resection is the best
surgical treatment approach, we found that although they have comparable
survival rates, wedge resection is associated with fewer complications,
shorter hospitalization but higher percentages of local recurrences in
contrast to anatomic segmentectomy which has similar results to those of
lobectomy. As to whether video-assisted thoracic surgery or open
thoracotomy is the best diagnostic or therapeutic surgical approach for a
SPN, they exhibit comparable results, both diagnostically and
therapeutically. Conclusions: More randomized controlled trials are needed
for comparing videoassisted thoracic surgery with open thoracotomy and the
various types of surgical resection of SPN. Copyright &#xa9; 2016,
Technogramma. All rights reserved.

<57>
Accession Number
615332232
Author
Delgado V.; Ewe S.H.; Messika-Zeitoun D.; Bax J.J.; Vahanian A.
Institution
(Delgado, Ewe, Bax) Department of Cardiology, Leiden University Medical
Center, Leiden, Netherlands
(Ewe) Department of Cardiology, National Heart Centre, Singapore
(Messika-Zeitoun, Vahanian) Service de Cardiologie, Hopital Bichat, Paris,
France
Title
Measuring aortic valve annulus size for transcatheter aortic valve
implantation - 2D or 3D imaging techniques?.
Source
Interventional Cardiology Review. 6 (2) (pp 161-164), 2011. Date of
Publication: 01 Aug 2011.
Publisher
Radcliffe Publishing Ltd (E-mail: contact.us@radcliffemed.com)
Abstract
To date, more than 20,000 patients with severe symptomatic aortic valve
stenosis and high-risk or contraindication to conventional surgery have
been successfully treated with transcatheter aortic valve implantation
(TAVI). The results of the multicentre randomised Placement of aortic
transcatheter valve trial (PARTNER)7 have shown the superior long-term
survival of patients who received a transcatheter aortic valve compared to
patients who were medically treated. In order to optimise the procedural
success rate and minimise the number of complications, patient selection
and procedural strategy planning are crucial. Selection of prosthesis size
is one of the key steps in this pre-procedural evaluation. Accurate
measurement of the aortic valve annulus is pivotal to select the most
appropriate prosthesis size and avoid complications such as prosthesis
migration, paravalvular aortic regurgitation or aortic annulus rupture.
Currently, the reference method to measure the aortic valve annulus
dimension is still debated. While 2D echocardiography remains as the
imaging modality of first choice to measure the aortic valve annulus, 3D
imaging techniques have provided important information on the shape,
geometry and spatial relationships of this structure. The present review
provides an overview of the different imaging techniques to measure the
aortic valve annulus and the inherent clinical implications of each
technique. Copyright &#xa9; TOUCH BRIEFINGS 2011.

<58>
Accession Number
615342823
Author
Takagi H.; Ando T.; Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI, USA
Title
A meta-analysis of effects of transcatheter versus surgical aortic valve
replacement on left ventricular ejection fraction and mass.
Source
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: July 07, 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives: To determine which procedure, transcatheter aortic valve
implantation (TAVI) or surgical aortic valve replacement (SAVR), for
severe aortic stenosis (AS) improves follow-up left ventricular (LV)
function or hypertrophy more effectively, we performed the first
meta-analysis of comparative studies reporting LV ejection fraction (LVEF)
or mass (LVM) after TAVI versus SAVR. Methods: Studies considered for
inclusion met the following criteria: the article was written in English;
the design was a comparative study; the study population was patients with
severe AS; patients were assigned to TAVI versus SAVR; and outcomes
included follow-up (6-12-month) LVEF or LVM. For each study, data
regarding fractional changes in LVEF or LVM in both the TAVI and SAVR
groups were used to generate mean differences (MDs) and 95% confidence
intervals (CIs). Results: Our search identified 8 eligible studies. Two
studies with baseline LVEF. <. 40% demonstrated significantly greater
fractional changes in LVEF after TAVI than after SAVR. A pooled analysis
of 6 studies demonstrated no statistically significant difference in
fractional changes in LVEF between TAVI and SAVR (MD, 3.25%; 95% CI,
-1.30% to 7.80%; p = 0.16). Another pooled analysis of 5 studies
demonstrated significantly greater fractional changes (i.e. less
fractional "reductions") in LVM after TAVI than after SAVR (MD, 4.75%; 95%
CI, 2.18% to 7.32%; p = 0.0003). Conclusions: For patients with severe AS,
SAVR may be associated with greater improvement in LVM, probably not in
LVEF, at 6-12 months. For limited patients with reduced LVEF, TAVI might
be associated with greater improvement in LVEF. Copyright &#xa9; 2017
Elsevier Ireland Ltd.

<59>
Accession Number
603438918
Author
Przyklenk K.
Institution
(Przyklenk) Cardiovascular Research Institute, Departments of Physiology
and Emergency Medicine, Wayne State University School of Medicine,
Detroit, MI, United States
Title
Ischaemic conditioning: Pitfalls on the path to clinical translation.
Source
British Journal of Pharmacology. 172 (8) (pp 1961-1973), 2015. Date of
Publication: 01 Apr 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
The development of novel adjuvant strategies capable of attenuating
myocardial ischaemia-reperfusion injury and reducing infarct size remains
a major, unmet clinical need. A wealth of preclinical evidence has
established that ischaemic 'conditioning' is profoundly cardioprotective,
and has positioned the phenomenon (in particular, the paradigms of
postconditioning and remote conditioning) as the most promising and potent
candidate for clinical translation identified to date. However, despite
this preclinical consensus, current phase II trials have been plagued by
heterogeneity, and the outcomes of recent meta-analyses have largely
failed to confirm significant benefit. As a result, the path to clinical
application has been perceived as 'disappointing' and 'frustrating'. The
goal of the current review is to discuss the pitfalls that may be stalling
the successful clinical translation of ischaemic conditioning, with an
emphasis on concerns regarding: (i) appropriate clinical study design and
(ii) the choice of the 'right' preclinical models to facilitate clinical
translation. Copyright &#xa9; 2015 The British Pharmacological Society.

<60>
Accession Number
612265871
Author
Wang Y.; Tao Y.
Institution
(Wang, Tao) Department of Pediatrics, West China Second University
Hospital, Sichuan University, No.20, Section 3, Renmin Nan Lu, Chengdu,
Sichuan Province 610041, China
(Wang) Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases
and Birth Defects, Ministry Education, West China Second University
Hospital, Sichuan University, Sichuan, China
Title
Diagnosis and treatment of congenital abdominal aortic aneurysm: A
systematic review of reported cases.
Source
Orphanet Journal of Rare Diseases. 10 (1) (no pagination), 2015. Article
Number: 4. Date of Publication: 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Congenital abdominal aortic aneurysm (AAA) is distinctly rare
in infants and children and carries a high mortality rate. Our objective
was to summarize the experience of the diagnosis and treatment in patients
with congenital AAA. Methods: Reported cases of congenital AAA published
prior to November 8, 2014, were identified through PubMed, EMBASE, Web of
Science, and reference lists. All selected cases were evaluated for main
clinical characteristics. Results: Twenty-six cases of congenital AAA were
identified in the English language literature. Congenital AAA occurred
primarily in children under three years old, but it was also found in
young adults and fetuses. With regards to the localization, the great
majority of congenital AAA was infrarenal AAA. The majority of the AAA
patients lacked specific symptoms, and a painless pulsatile abdominal mass
was the most common clinical presentation. The diagnosis of AAA was based
on ultrasound scanning in twenty-five cases, multi-slice spiral computed
tomography angiography (MSCTA) in sixteen cases, and magnetic resonance
angiography (MRA) in nine cases. Histopathological analyses were available
in seven cases. Seven patients received conservative management. Surgical
treatment was performed in seventeen cases, and open repair with an
artificial graft was the main surgical intervention. The mortality
associated with congenital AAA was high (30.76%). Ruptured aneurysm and
renal failure were the main causes of death. Conclusions: Good outcomes
can be achieved in children with early identification of congenital AAA
and individualized surgical repair with grafts. Copyright &#xa9; 2015 Wang
and Tao.; licensee BioMed Central.

<61>
Accession Number
604125493
Author
Ruf B.; Bonelli V.; Balling G.; Horer J.; Nagdyman N.; Braun S.L.; Ewert
P.; Reiter K.
Institution
(Ruf, Balling, Nagdyman, Ewert) Department of Pediatric Cardiology and
Congenital Heart Disease, German Heart Centre Munich, Technical
University, Lazarettstr. 36, Munich 80636, Germany
(Bonelli) Department of Anaesthesiology, German Heart Centre Munich,
Technical University, Lazarettstr. 36, Munich 80636, Germany
(Horer) Department of Thoracic and Cardiovascular Surgery, German Heart
Centre Munich, Technical University, Lazarettstr. 36, Munich 80636,
Germany
(Braun) Institute of Laboratory Medicine, German Heart Centre Munich,
Technical University, Lazarettstr. 36, Munich 80636, Germany
(Reiter) Department of Pediatric Intensive Care, University Children's
Hospital, von Haunersche Children hospital, Ludwigs-Maximilian University,
Lindwurmstr. 4, Munich 80337, Germany
Title
Intraoperative renal near-infrared spectroscopy indicates developing acute
kidney injury in infants undergoing cardiac surgery with cardiopulmonary
bypass: A case-control study.
Source
Critical Care. 19 (1) (no pagination), 2015. Article Number: 27. Date of
Publication: January 29, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Introduction: Acute kidney injury (AKI) is a frequent complication after
cardiac surgery with cardiopulmonary bypass in infants. Renal
near-infrared spectroscopy (NIRS) is used to evaluate regional oximetry in
a non-invasive continuous real-time fashion, and reflects tissue
perfusion. The aim of this study was to evaluate the relationship between
renal oximetry and development of AKI in the operative and post-operative
setting in infants undergoing cardiopulmonary bypass surgery. Methods: In
this prospective study, we enrolled 59 infants undergoing cardiopulmonary
bypass surgery for congenital heart disease for univentricular (n = 26) or
biventricular (n = 33) repair. Renal NIRS was continuously measured
intraoperatively and for at least 24 hours postoperatively and analysed
for the intraoperative and first 12 hours, first 24 hours and first 48
hours postoperatively. The renal oximetry values were correlated with the
paediatric risk, injury, failure, loss, end (pRIFLE) classification for
AKI, renal biomarkers and the postoperative course. Results: Twenty-eight
(48%) infants developed AKI based on pRIFLE classification. Already during
intraoperative renal oximetry and further in the first 12 hours, 24 hours
and 48 hours postoperatively, significantly lower renal oximetry values in
AKI patients compared with patients with normal renal function were
recorded (P < 0.05). Of the 28 patients who developed AKI, 3 (11%) needed
renal replacement therapy and 2 (7%) died. In the non-AKI group, no deaths
occurred. Infants with decreased renal oximetry values developed
significantly higher lactate levels 24 hours after surgery. Cystatin C was
a late parameter of AKI, and neutrophil gelatinase-associated lipocalin
values were not correlated with AKI occurrence. Conclusion: Our results
suggest that prolonged low renal oximetry values during cardiac surgery
correlate with the development of AKI and may be superior to conventional
biochemical markers. Renal NIRS might be a promising non-invasive tool of
multimodal monitoring of kidney function and developing AKI in infants
undergoing cardiac surgery with cardiopulmonary bypass. Copyright &#xa9;
2015 Ruf et al.; licensee BioMed Central.

<62>
Accession Number
606888519
Author
Dasgupta R.; Parsons A.; McClelland S.; Morgan E.; Robertson M.J.; Noel
T.R.; Schmitz M.L.; Rettiganti M.; Gupta P.
Institution
(Dasgupta, Schmitz) Division of Pediatric Anesthesia, Department of
Anesthesiology, University of Arkansas for Medical Sciences, Little Rock,
United States
(Parsons, McClelland, Morgan, Robertson) Department of Medical Education,
College of Medicine, University of Arkansas for Medical Sciences, Little
Rock, United States
(Noel, Gupta) Division of Pediatric Cardiology, University of Arkansas for
Medical Sciences, Little Rock, United States
(Rettiganti) Biostatistics Section, Department of Pediatrics, University
of Arkansas for Medical Sciences, Little Rock, United States
Title
Association of haematocrit and red blood cell transfusion with outcomes in
infants with shunt-dependent pulmonary blood flow and univentricular
physiology.
Source
Blood Transfusion. 13 (3) (pp 417-422), 2015. Date of Publication: July
2015.
Publisher
SIMTI Servizi Sri (Via Desiderio 21, Milan 20131, Italy)
Abstract
Background. The aim of this study was to investigate the association
between red blood cell (RBC) transfusion and haematocrit values with
outcomes in infants with univentricular physiology undergoing surgery for
a modified Blalock-Taussig shunt. Material and methods. This study
included infants <2 months of age who underwent modified Blalock-Taussig
shunt surgery at the Arkansas Children's Hospital (2006-2012). Infants
undergoing a Norwood operation or Damus-Kaye-Stansel operation with
modified Blalock-Taussig shunt were excluded. Demographics, pre-operative,
operative, daily laboratory data, and post-operative variables were
collected. We studied the association between haematocrit and blood
transfusion with a composite clinical outcome. Multivariable logistic
regression models were fitted to study the probability of study outcomes
as a function of haematocrit values and RBC transfusions after operation.
Results. Seventy-three patients qualified for inclusion. All study
patients received blood transfusion within the first 48 hours after heart
surgery. The median haematocrit was 44.3 (interquartile range [IQR]
42.5-46.2), and the median volume of RBC transfused was 28 mL/kg (IQR,
10-125) in the first 14 days after surgery. The overall in-hospital
mortality rate was 13.6% (10 patients). A multivariable analysis adjusted
for risk factors, including weight, prematurity, cardiopulmonary bypass
and postoperative need for nitric oxide and dialysis, revealed no
association between haematocrit values and RBC transfusion with the
composite clinical outcome. Discussion. We did not find an association
between higher haematocrit values and increasing RBC transfusions with
improved outcomes in infants with shunt-dependent pulmonary blood flow and
univentricular physiology. The power of our study was small, which
prevents any strong statement on this lack of association. Future
multi-centre, randomised controlled trials are needed to investigate this
topic in further detail. Copyright &#xa9; SIMTI Servizi Srl.

<63>
Accession Number
608982107
Author
Sechterberger M.K.; Van Der Voort P.H.J.; Strasma P.J.; Hans De Vries J.
Institution
(Sechterberger, Hans De Vries) Department of Internal Medicine, Academic
Medical Center, Meibergdreef 9, Amsterdam 1105 AZ, Netherlands
(Van Der Voort) Department of Intensive Care, Onze Lieve Vrouwe Gasthuis,
Amsterdam, Netherlands
(Van Der Voort) TIAS School for Business and Society, Tilburg University,
Netherlands
(Strasma) GluMetrics Inc, Irvine, CA, United States
Title
Accuracy of intra-arterial and subcutaneous continuous glucose monitoring
in postoperative cardiac surgery patients in the ICU.
Source
Journal of Diabetes Science and Technology. 9 (3) (pp 663-667), 2015. Date
of Publication: May 2015.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: The GluCath intra-arterial continuous glucose monitoring
(IA-CGM) system uses a novel quenched chemical fluorescence sensing
mechanism to optically measure blood glucose when deployed in the radial
artery. The aim of this study was to compare the accuracy of the IA-CGM
and the FreeStyle Navigator subcutaneous continuous glucose monitoring
(SC-CGM) system with standard care. Methods: After admission to the
intensive care unit (ICU), the IA-CGM was inserted via a 20 gauge radial
arterial study catheter and the SC-CGM was placed at the abdominal wall of
postoperative cardiac surgery patients with an expected ICU length of stay
> 24 hours. Each device was calibrated according to manufacturer
instructions. Glucose values of both CGM systems were blinded for the
clinical staff. Reference blood glucose samples were collected from the
study catheter every 1-2 hours for at least 24 hours and analyzed on a
Radiometer ABL blood gas analyzer. Results: The IA-CGM and SC-CGM sensors
were successfully inserted in 8 subjects. Accuracy assessment was
performed with 183 paired points: 85.8% of the IA-CGM measurements and
84.2% of the SC-CGM measurements met ISO 15197:2003 glucometer criteria
(within 20%) across a 79-248 mg/dl (4.4-13.8 mmol/L) glucose range.
Overall +/- SD mean absolute relative difference was 12.3 +/- 11.3% for
IA-CGM and 11.1 +/- 8.3% for SC-CGM (difference -1.2%, 95% CI -3.3 to 0.8;
P =.24). Conclusions: The IA-CGM system directly measured arterial blood
glucose and did not interfere with clinical care. However, accuracy was
similar to that of the less invasive SC-CGM device. Copyright &#xa9; 2015
Diabetes Technology Society Reprints and permissions.

<64>
Accession Number
600651314
Author
Sayed S.A.; Katewa A.; Srivastava V.; Jana S.; Patwardhan A.M.
Institution
(Sayed, Katewa, Srivastava, Jana, Patwardhan) King Edward Memorial
Hospital, Seth Gordhandas Sunderdas Medical College, Mumbai, India
(Sayed, Katewa, Srivastava) Sr. Registrar, Dept. of CVTS, J. N. Med.
College, Sawangi, Wardha (M), India
(Jana, Patwardhan) Dept. of CVTS, J. N. Med. College, Sawangi, Wardha (M),
India
(Patwardhan) CVTS, J. N. Med. College, Sawangi, Wardha (M), India
Title
Modified radial v/s biatrial maze for atrial fibrillation in rheumatic
valvular heart surgery.
Source
Indian Heart Journal. 66 (5) (pp 510-516), 2014. Date of Publication: 01
Sep 2014.
Publisher
Elsevier
Abstract
Background Atrial fibrillation (AF) is commonest sustained atrial
arrhythmia producing high morbidity. Although Cox's Maze III procedure
cures AF in majority, reduced atrial transport function (ATF) is a
concern. Radial approach with ablation lines radial from sinus node
towards atrioventricular annulii and parallel to atrial coronary arteries,
has shown better ATF.
Methods Single blind open randomized prospective study of 80 patients was
undertaken in two groups (40 each) of modified Cox's maze III and modified
radial approach, to evaluate conversion to normal sinus rhythm (NSR) and
ATF. Patients undergoing surgery for rheumatic valvular heart disease with
continuous AF were prospectively randomized. Ablation lines were created
with radiofrequency (RF) bipolar coagulation with cryoablation for the
isthmal lesions and coronary sinus.
Results were compared at 6 months and ATF was evaluated by atrial filling
fraction (AFF) and A/E ratio on echocardiography. Results The rate of
conversion to NSR in both groups was statistically insignificant by
Fisher's exact test (p > 0.05). ATF was better in modified radial approach
compared to modified Cox's Maze III (A/E compared by unpaired t test:0.52
+/- 0.08 v/s 0.36 +/- 0.10; p < 0.05. AFF compared using Mann Whitney U
test: median AFF for radial group was 23 v/s 20 for biatrial group; p <
0.05).
Discussion In patients with AF undergoing rheumatic valvular surgery,
radiofrequency radial approach is as effective as modified Cox's maze III
for conversion to NSR with better atrial transport function. Copyright
&#xa9; 2014, Cardiological Society of India. All rights reserved.

<65>
Accession Number
600651004
Author
Raghuram N.; Parachuri V.R.; Swarnagowri M.V.; Babu S.; Chaku R.; Kulkarni
R.; Bhuyan B.; Bhargav H.; Nagendra H.R.
Institution
(Raghuram, Swarnagowri, Babu, Chaku, Bhargav, Nagendra) Division of Yoga
and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana
University, 19 Eknath Bhavan, Gavipuram Circle, Kempegowda Nagar,
Bangalore, Karnataka, India
(Parachuri, Babu, Bhuyan) Department of Cardiology, Narayana Hrudayalaya
Institute of Cardiac Sciences, No. 258/A, Bommasandra Industrial Area,
Hosur Road, Anekal Taluk, Karnataka, India
(Kulkarni) Symbiosis International University, Pune, India
Title
Yoga based cardiac rehabilitation after coronary artery bypass surgery:
One-year results on LVEF, lipid profile and psychological states - A
randomized controlled study.
Source
Indian Heart Journal. 66 (5) (pp 490-502), 2014. Date of Publication: 01
Sep 2014.
Publisher
Elsevier
Abstract
Objective To compare the long term effects of yoga based cardiac
rehabilitation program with only physiotherapy based program as an add-on
to conventional rehabilitation after coronary artery bypass grafting
(CABG) on risk factors.
Methods In this single blind prospective randomized parallel two armed
active control study, 1026 patients posted for CABG at Narayana
Hrudayalaya Institute of Cardiac Sciences, Bengaluru (India) were
screened. Of these, 250 male participants (35-65 years) who satisfied the
selection criteria and consented were randomized into two groups. Within
and between group comparisons were done at three points of follow up (i.e.
6th week, 6th month, and 12th month) by using Wilcoxon's signed ranks test
and Mann Whitney U test respectively.
Results Yoga group had significantly (p = 0.001, Mann Whitney) better
improvement in LVEF than control group in those with abnormal baseline EF
(<53%) after 1 year. There was a better reduction in BMI in the yoga group
(p = 0.038, between groups) in those with high baseline BMI (>23) after 12
months. Yoga group showed significant (p = 0.008, Wilcoxon's) reduction in
blood glucose at one year in those with high baseline FBS >110 mg/dl.
There was significantly better improvement in yoga than the control group
in HDL (p = 0.003), LDL (p = 0.01) and VLDL (p = 0.03) in those with
abnormal baseline values. There was significantly better improvement (p =
0.02, between groups) in positive affect in yoga group. Within Yoga group,
there was significant decrease in perceived stress (p = 0.001), anxiety (p
= 0.001), depression (p = 0.001), and negative affect (p = 0.03) while in
the control group there was reduction (p = 0.003) only in scores on
anxiety.
Conclusion Addition of yoga based relaxation to conventional post-CABG
cardiac rehabilitation helps in better management of risk factors in those
with abnormal baseline values and may help in preventing recurrence.
Copyright &#xa9; 2014, Cardiological Society of India. All rights
reserved.

<66>
Accession Number
615265376
Author
Kestler M.; Munoz P.; Marin M.; Goenaga M.A.; Idigoras Viedma P.; de
Alarcon A.; Lepe J.A.; Sousa Regueiro D.; Bravo-Ferrer J.M.; Pajaron M.;
Costas C.; Garcia-Lopez M.V.; Hidalgo-Tenorio C.; Moreno M.; Bouza E.
Institution
(Kestler, Munoz, Marin, Bouza) Servicio de Microbiologia y Enfermedades
Infecciosas, Hospital General Universitario Gregorio Maranon, Departamento
de Medicina, Facultad de Medicina, Universidad Complutense de Madrid,
Instituto de Investigacion Sanitaria Gregorio Maranon, CIBERES, Spain
(Goenaga, Idigoras Viedma) Hospital Universitario de Donosti, Spain
(de Alarcon, Lepe) Hospital Universitario Virgen del Rocio, Spain
(Sousa Regueiro, Bravo-Ferrer) Hospital Universitario A Coruna, Spain
(Pajaron) Hospital Universitario Marques de Valdecilla, Spain
(Costas) Hospital Universitario Central de Asturias, Spain
(Garcia-Lopez) Hospital Universitario Virgen de la Victoria, Spain
(Hidalgo-Tenorio) Hospital Universitario Virgen de las Nieves, Spain
(Moreno) Hospital Universitario La Paz, Spain
(Munoz, Bouza) CIBER de Enfermedades Respiratorias -CIBERES(CB06/06/0058),
Madrid, Spain
Title
Endocarditis caused by anaerobic bacteria.
Source
Anaerobe. 47 (pp 33-38), 2017. Date of Publication: 01 Oct 2017.
Publisher
Academic Press
Abstract
Background Infective endocarditis (IE) caused by anaerobic bacteria is a
rare and poorly characterized disease. Most data reported in the
literature are from case reports [1-3]. Therefore, we assessed the
situation of anaerobic IE (AIE) in Spain using the database of the Spanish
Collaboration on Endocarditis (GAMES). Methods We performed a prospective
study from 2008 to 2016 in 26 Spanish centers. We included 2491
consecutive cases of definite IE (Duke criteria). Results Anaerobic
bacteria caused 22 cases (0.9%) of definite IE. Median age was 66 years
(IQR, 56-73), and 19 (86.4%) patients were men. Most patients (14 [63.6%])
had prosthetic valve IE and all episodes were left-sided: aortic valves,
12 (54.5%); and mitral valves, 8 (36.4%). The most common pathogens were
Propionibacterium acnes (14 [63.6%]), Lactobacillus spp (3 [13.63%]), and
Clostridium spp. (2 [9.0%]), and the infection was mainly odontogenic.
Fifteen of the 22 patients (68.2%) underwent cardiac surgery. Mortality
was 18.2% during admission and 5.5% after 1 year of follow-up. When
patients with AIE were compared with the rest of the cohort, we found that
although those with AIE had a similar age and Charlson comorbidity index,
they were more likely to have community-acquired IE (86.4% vs. 60.9%, p =
0.01), have undergone cardiac surgery (68.2% vs 48.7% p = 0.06), and have
had lower mortality rates during admission (18.2% vs. 27.3%). Conclusion
IE due to anaerobic bacteria is an uncommon disease that affects mainly
prosthetic valves and frequently requires surgery. Otherwise, there are no
major differences between AIE and IE caused by other microorganisms.
Copyright &#xa9; 2017 Elsevier Ltd

<67>
Accession Number
615250695
Author
Whiting P.; Morden A.; Tomlinson L.A.; Caskey F.; Blakeman T.; Tomson C.;
Stone T.; Richards A.; Savovic J.; Horwood J.
Institution
(Whiting, Morden, Stone, Richards, Savovic, Horwood) Natl. Inst. for Hlth.
Research Collaboration for Leadership in Applied Health Research and Care
West, University Hospitals Bristol NHS Foundation Trust, Bristol, United
Kingdom
(Whiting, Morden, Caskey, Stone, Richards, Savovic, Horwood) School of
Social and Community Medicine, University of Bristol, Bristol, United
Kingdom
(Tomlinson, Caskey) UK Renal Registry, Bristol, United Kingdom
(Tomlinson) Department of Non-communicable Disease Epidemiology, London
School of Hygiene and Tropical Medicine, London, United Kingdom
(Blakeman) Centre for Primary Care, Institute of Population Health,
University of Manchester, Manchester, United Kingdom
(Blakeman) Natl. Inst. for Hlth. Res. Collaboration for Leadership in
Appl. Hlth. Res. and Care Gtr. Manchester, Centre for Primary Care,
University of Manchester, Manchester, United Kingdom
(Tomson) Department of Renal Medicine, Freeman Hospital, Newcastle Upon
Tyne Hospitals Foundation Trust, Tyne and Wear, United Kingdom
Title
What are the risks and benefits of temporarily discontinuing medications
to prevent acute kidney injury? A systematic review and meta-Analysis.
Source
BMJ Open. 7 (4) (no pagination), 2017. Article Number: e012674. Date of
Publication: 01 Apr 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives To summarise evidence on temporary discontinuation of
medications to prevent acute kidney injury (AKI). Design Systematic review
and meta-Analysis of randomised and non-randomised studies. Participants
Adults taking diuretics, ACE inhibitors (ACEI), angiotensin receptor
blockers (ARB), direct renin inhibitors, non-steroidal
anti-inflammatories, metformin or sulfonylureas, experiencing intercurrent
illnesses, radiological or surgical procedures. Interventions Temporary
discontinuation of any of the medications of interest. Primary and
secondary outcome measures Risk of AKI. Secondary outcome measures were
estimated glomerular filtration rate and creatinine post-AKI, urea,
systolic and diastolic blood pressure, death, clinical outcomes and
biomarkers. Results 6 studies were included (1663 participants), 3
randomised controlled trials (RCTs) and 3 prospective cohort studies. The
mean age ranged from 65 to 73a ..years, and the proportion of women ranged
from 31% to 52%. All studies were in hospital settings; 5 evaluated
discontinuation of medication prior to coronary angiography and 1 prior to
cardiac surgery. 5 studies evaluated discontinuation of ACEI and ARBs and
1 small cohort study looked at discontinuation of non-steroidal
anti-inflammatory drugs. No studies evaluated discontinuation of
medication in the community following an acute intercurrent illness. There
was an increased risk of AKI of around 15% in those in whom medication was
continued compared with those in whom it was discontinued (relative risk
(RR) 1.17, 95% CI 0.99 to 1.38; 5 studies). When only results from RCTs
were pooled, the increase in risk was almost 50% (RR 1.48, 95% CI 0.84 to
2.60; 3 RCTs), but the CI was wider. There was no difference between
groups for any secondary outcomes. Conclusions There is low-quality
evidence that withdrawal of ACEI/ARBs prior to coronary angiography and
cardiac surgery may reduce the incidence of AKI. There is no evidence of
the impact of drug cessation interventions on AKI incidence during
intercurrent illness in primary or secondary care. Trial registration
number PROSPERO CRD42015023210. Copyright &#xa9; Published by the BMJ
Publishing Group Limited. For permission to use (where not already granted
under a licence) please go to
http://www.bmj.com/company/products-services/rights-And-licensing/.

<68>
Accession Number
615250033
Author
Reardon M.J.; Van Mieghem N.M.; Popma J.J.; Kleiman N.S.; Sondergaard L.;
Mumtaz M.; Adams D.H.; Deeb G.M.; Maini B.; Gada H.; Chetcuti S.; Gleason
T.; Heiser J.; Lange R.; Merhi W.; Oh J.K.; Olsen P.S.; Piazza N.;
Williams M.; Windecker S.; Yakubov S.J.; Grube E.; Makkar R.; Lee J.S.;
Conte J.; Vang E.; Nguyen H.; Chang Y.; Mugglin A.S.; Serruys P.W.J.C.;
Kappetein A.P.
Institution
(Reardon, Kleiman) Methodist DeBakey Heart and Vascular Center, 6550
Fannin St., Houston, TX 77030, United States
(Van Mieghem, Serruys, Kappetein) Erasmus University Medical Center,
Rotterdam, Netherlands
(Popma) Beth Israel Deaconess Medical Center, Boston, PA, United States
(Sondergaard, Olsen) Rigshospitalet Heart Center, Copenhagen, PA, Denmark
(Mumtaz, Gada) PinnacleHealth Hospitals, Harrisburg, PA, United States
(Gleason, Lee) University of Pittsburgh Medical Center, Pittsburgh, PA,
United States
(Adams, Williams) Mount Sinai Health System, United States
(Deeb) New York University Langone Medical Center, New York, MI, United
States
(Chetcuti) University of Michigan, Ann Arbor, MI, United States
(Heiser, Merhi) Spectrum Health Hospitals, Grand Rapids, MI, United States
(Maini) Tenet Healthcare, Delray Beach, FL, United States
(Lange) German Heart Center Munich, Munich, Germany
(Grube) Siegburg Heart Center, Siegburg, Germany
(Oh) Mayo Clinic, Rochester, United States
(Vang, Nguyen, Chang) Medtronic, Minneapolis, United States
(Mugglin) Paradigm Biostatistics, Anoka, MN, United States
(Piazza) McGill University Medical Centre, Montreal, Canada
(Windecker) University Hospital Bern, Bern, Switzerland
(Yakubov) Riverside Methodist Hospital, Columbus, OH, United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, United States
(Conte) Johns Hopkins University, Baltimore, United States
Title
Surgical or transcatheter aortic-valve replacement in intermediate-risk
patients.
Source
New England Journal of Medicine. 376 (14) (pp 1321-1331), 2017. Date of
Publication: 06 Apr 2017.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Although transcatheter aortic-valve replacement (TAVR) is an
accepted alternative to surgery in patients with severe aortic stenosis
who are at high surgical risk, less is known about comparative outcomes
among patients with aortic stenosis who are at intermediate surgical risk.
METHODS We evaluated the clinical outcomes in intermediate-risk patients
with severe, symptomatic aortic stenosis in a randomized trial comparing
TAVR (performed with the use of a self-expanding prosthesis) with surgical
aortic-valve replacement. The primary end point was a composite of death
from any cause or disabling stroke at 24 months in patients undergoing
attempted aortic-valve replacement. We used Bayesian analytical methods
(with a margin of 0.07) to evaluate the noninferiority of TAVR as compared
with surgical valve replacement. RESULTS A total of 1746 patients
underwent randomization at 87 centers. Of these patients, 1660 underwent
an attempted TAVR or surgical procedure. The mean (?}SD) age of the
patients was 79.8?}6.2 years, and all were at intermediate risk for
surgery (Society of Thoracic Surgeons Predicted Risk of Mortality,
4.5?}1.6%). At 24 months, the estimated incidence of the primary end point
was 12.6% in the TAVR group and 14.0% in the surgery group (95% credible
interval [Bayesian analysis] for difference, -5.2 to 2.3%; posterior
probability of noninferiority, >0.999). Surgery was associated with higher
rates of acute kidney injury, atrial fibrillation, and transfusion
requirements, whereas TAVR had higher rates of residual aortic
regurgitation and need for pacemaker implantation. TAVR resulted in lower
mean gradients and larger aortic-valve areas than surgery. Structural
valve deterioration at 24 months did not occur in either group.
CONCLUSIONS TAVR was a noninferior alternative to surgery in patients with
severe aortic stenosis at intermediate surgical risk, with a different
pattern of adverse events associated with each procedure. (Funded by
Medtronic; SURTAVI ClinicalTrials.gov number, NCT01586910.).

<69>
Accession Number
614664038
Author
Qian C.; Feng H.; Cao J.; Wei B.; Wang Y.
Institution
(Qian, Feng, Cao, Wei, Wang) Department of Cardiology, Zhongnan Hospital
of Wuhan University, Wuhan University, Wuhan, China
(Wang) Medical Research Institute of Wuhan University, Wuhan University,
Wuhan, China
Title
Meta-Analysis of Randomized Control Trials Comparing Drug-Eluting Stents
Versus Coronary Artery Bypass Grafting for Significant Left Main Coronary
Narrowing.
Source
American Journal of Cardiology. 119 (9) (pp 1338-1343), 2017. Date of
Publication: 01 May 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Previous meta-analyses showed that drug-eluting stent (DES) implantation
may serve as an alternative to coronary artery bypass grafting (CABG) for
unprotected left main coronary artery (ULMCA) stenosis, largely driven by
data from registries. Hence, we performed a meta-analysis of randomized
controlled trials (RCTs) to overcome this limitation. PubMed, the Cochrane
Library, and Scopus were systematically searched through October 2016 to
identify eligible RCTs. The primary outcomes were major adverse cardiac
and cerebrovascular events (MACCE) at 1-year and long-term (>3 years)
follow-ups. This meta-analysis included 5 RCTs, totaling 4,595 patients
with ULMCA disease. Compared with CABG, DES showed similar 1-year rates of
MACCE (risk ratio [RR] 1.14, 95% confidence interval [CI] 0.91-1.42),
all-cause death, and myocardial infarction, with a higher incidence of
revascularization (RR 1.68, 95% CI 1.24-2.27) and lower incidence of stoke
(RR 0.43, 95% CI 0.23-0.78). At long-term follow-up, DES placement was
inferior to CABG in terms of MACCE (RR 1.27, 95% CI 1.13-1.43) and
revascularization (RR 1.70, 95% CI 1.43-2.01). There was no difference in
long-term risk of other outcomes between these 2 strategies. In
conclusion, DES stenting and CABG for ULMCA disease yield comparable rates
of MACCE at 1-year follow-up; however, CABG is associated with a decreased
risk of long-term MACCE compared with DES, exclusively driven by the
considerable reduction in revascularization events. Copyright &#xa9; 2017
Elsevier Inc.

<70>
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, United States
(Roberts, Rao, Shaw, Gallup, Patel) Duke University School of Medicine,
Durham, North Carolina, United States
(Rao, Patel) Duke Clinical Research Institute, Durham, North Carolina,
United States
(Marroquin) Department of Medicine, University of Pittsburgh Medical
Center, Pittsburgh, Pennsylvania, United States
Title
Comparative Efficacy of Coronary Revascularization Procedures for
Multivessel Coronary Artery Disease in Patients With Chronic Kidney
Disease.
Source
American Journal of Cardiology. 119 (9) (pp 1344-1351), 2017. Date of
Publication: 01 May 2017.
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.

<71>
Accession Number
614488909
Author
Jennings D.L.; Baker W.L.
Institution
(Jennings) Department of Pharmacy, NewYork Presbyterian Columbia
University Irving Medical Center, New York, NY, United States
(Baker) School of Pharmacy, University of Connecticut, Storrs, CT, United
States
Title
Pre-cardiac transplant amiodarone use is not associated with postoperative
mortality: An updated meta-analysis.
Source
International Journal of Cardiology. 236 (pp 345-347), 2017. Date of
Publication: 01 Jun 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Amiodarone remains the preferred agent for the treatment and
prevention of life-threatening ventricular arrhythmias in patients with
end-stage heart failure. While several reports suggest that pre-operative
amiodarone exposure worsens outcomes in heart transplant recipients, other
studies have failed to validate this relationship. We sought to clarify
this issue by performing a meta-analysis of the available literature
surrounding this topic. Methods We searched Medline, SCOPUS and the
Cochrane Central Register of Controlled Trials through December 15th 2016,
as well as proceedings from related conferences over the prior 3 years.
Included studies evaluated patients undergoing cardiac transplantation who
had received pre-transplant amiodarone and reported postoperative
mortality. Outcomes were pooled using a Hartung-Knapp random-effects model
producing odds ratios (OR) and 95% confidence intervals (CI). Statistical
heterogeneity was evaluated using the Cochrane Q statistic p-value and
I² value. Publication bias was assessed by visual inspection of
funnel plots and using Egger's weighted regression statistic. Results Nine
studies including 16,509 participants were included in the overall
analysis. Use of pre-transplant amiodarone was not associated with an
increase in postoperative mortality versus control (OR 1.38, 95% 0.8 to
2.36). Moderate statistical heterogeneity was present (I² =
45.8%, p = 0.06); visual inspection of funnel plot analysis did not
suggest publication bias. No association was noted between a longer
duration of follow-up and higher odds of mortality with amiodarone use (p
= 0.91). Conclusion Meta-analysis of the available evidence suggests that
pre-operative amiodarone exposure does not increase mortality in cardiac
transplant recipients. Copyright &#xa9; 2017 Elsevier Ireland Ltd

<72>
Accession Number
615243894
Author
Mosa O.; Skitek M.; Jerin A.
Institution
(Mosa, Skitek, Jerin) Health Science College at Al-Leith, Umm Al-Qura
University, Saudi Arabia
(Mosa) Department of Public Health, Health Science College at Al-Leith,
Umm Al-Qura University, Saudi Arabia
(Skitek) Institute of Clinical Chemistry and Biochemistry, Ljubljana
University Medical Center, Ljubljana, Slovenia
(Jerin) Department of Hormones and Tumor Markers, Institute of Clinical
Chemistry and Biochemistry, Ljubljana University Medical Center,
Ljubljana, Slovenia
Title
Validity of klotho, CYR61 and YKL-40 as ideal predictive biomarkers for
acute kidney injury: Review study.
Source
Sao Paulo Medical Journal. 135 (1) (pp 57-65), 2017. Date of Publication:
January-February 2017.
Publisher
Associacao Paulista de Medicina (E-mail: revistas@apm.org.br)
Abstract
CONTEXT AND OBJECTIVE: Acute kidney injury (AKI) is still a headache for
clinicians and scientists as a possible reason for increased death among
intensive care unit (ICU) patients after invasive cardiac surgery.
Furthermore, the diagnostic process for AKI using conventional biomarkers
is not sufficient to ensure early warning of this condition because of the
morbid influence of non-renal factors that definitively delay the time for
the prognosis. These imposed limitations have led to significant amounts
of research targeted towards identifying novel biomarkers for AKI with a
sustained degree of sensitivity and specificity. Here, we reviewed
previous studies conducted on the Klotho, CYR61 and YKL-40 biomarkers in
relation to AKI. DESIGN AND SETTING: Review of the literature conducted in
the Institute of Clinical Chemistry & Biochemistry, Ljubljana University
Medical Center, Slovenia. METHODS: The literature was searched in PubMed
and the Cochrane Library. From the database of this specialty, we selected
17 references that matched our context for detailed analysis and further
investigation. RESULTS: The studies reviewed showed notable differences in
their results relating to the diagnostic impact of Klotho, CYR61 and
YKL-40 on early prediction of AKI. CONCLUSIONS: The results regarding the
Klotho, CYR61 and YKL-40 biomarkers showed markedly equivocal performance
in the previous studies and did not fulfill the expectations that these
factors would form valid possible biomarkers for AKI. Copyright &#xa9;
2017, Associacao Paulista de Medicina. All rights reserved.

<73>
Accession Number
615243502
Author
Hu X.; Zhuang X.-D.; Li Y.; Li F.-F.; Guo Y.; Du Z.-M.; Liao X.-X.
Institution
(Hu, Zhuang, Li, Li, Guo, Du, Liao) Department of Cardiology, The First
Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
Title
A nomogram to predict contrast induced nephropathy in patients undergoing
percutaneous coronary intervention: Is the "anti-aging" agent klotho a
candidate predictor?.
Source
International Heart Journal. 58 (2) (pp 191-196), 2017. Date of
Publication: 2017.
Publisher
International Heart Journal Association (E-mail: : jhj-office@umin.ac.jp)
Abstract
Contrast-induced nephropathy (CIN) is the third leading cause of
hospital-acquired acute kidney injury (AKI). Emerging evidence has
revealed that soluble klotho (sklotho) could be a novel biomarker for
early AKI diagnosis. The aims of this study were to assess the predictive
role of sklotho for CIN and to develop a prediction nomogram in patients
undergoing percutaneous coronary intervention (PCI). This study is
registered on Clinicaltrials.gov (NCT 02650336). Patients aged 18 years or
older undergoing planned PCI were prospectively recruited between May 2014
and July 2015. CIN was defined as an increase in serum creatinine of 0.5
mg/dL within 48-72 hours after the procedure. Plasma sklotho was measured
by enzyme linked immunosorbent assay (ELISA). Stratified analysis,
interaction test, covariate screening, and curve fitting were performed to
explore the association between sklotho and CIN. A nomogram was then
developed and validated using the bootstrapped technique. A total of 192
patients aged 54.75 +/- 12.19 years were selected, 32 (16.7%) of whom were
diagnosed with CIN. A logistic regression model indicated significant
associations between CIN and sklotho, age > 75 years, diabetes, and the
Mehran risk score. Saturation effects analysis detected a two-stage change
between sklotho and CIN, with the inflection point was 477.4 pg/mL. The
area under the ROC curve was 0.758 and the sensitivity and specificity of
this point were 90.6% and 53.9%, respectively. A nomogram was developed
for the prediction of CIN and showed a bootstrapped-cor-rected area under
the curve value of 0.913. In addition, sklotho significantly increased the
predictive value of the nomogram. A strong association between sklotho and
CIN was identified in patients undergoing elective PCI. A lower level of
sklotho would be well correlated with CIN. The nomogram with sklotho is a
useful tool to predict CIN in patients who will undergo PCI. (Int Heart J
2017; 58: 191-196) Copyright &#xa9; 2017, International Heart Journal
Association. All rights reserved.

<74>
Accession Number
615243491
Author
Wu X.; Liu G.; Lu J.; Zheng X.-X.; Cui J.-G.; Zhao X.-Y.; Huang X.-H.
Institution
(Wu, Lu, Zheng, Cui, Zhao, Huang) Department of Cardiology, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Science and Peking Union Medical College, Beijing, China
(Liu) Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen
University, Guangzhou, China
Title
Administration of ticagrelor and double-dose clopidogrel based on platelet
reactivity determined by verifynow-P2Y12 for chinese subjects after
elective PCI.
Source
International Heart Journal. 58 (2) (pp 167-173), 2017. Date of
Publication: 2017.
Publisher
International Heart Journal Association (E-mail: : jhj-office@umin.ac.jp)
Abstract
Previous studies have identified high on treatment platelet reactivity
(HTPR) as a potent factor predicting ischemic events for patients with
coronary heart disease. We assessed the efficacy and safety of ticagrelor
(90 mg twice-daily) and double-dose of clopidogrel (150 mg once-daily)
among Chinese patients for elective percutaneous coronary intervention. We
enrolled 40 patients with HTPR from among 317 patients with non-ST-segment
elevation acute coronary syndromes after a successful elective
percutaneous coronary intervention (PCI). Platelet reactivity was measured
by VerifyNow P2Y12 assay. Platelet reactivity was significantly lower for
both groups when compared with baseline platelet reactivity after
medication adjustment (all P < 0.001). The mean platelet reactivity units
(PRU) was significantly lower for the ticagrelor group compared with that
of the clopidogrel group over time (all P < 0.001). The differences in the
rate of sustained HTPR at different time points between the two groups
were significant (2 hours: 0% versus 60%; 8 hours: 5.6% versus 50%; 24
hours: 5.9% versus 43.8%, all P < 0.05). Genetic variation of CYP2C19*2
had no impact on PRU means or rate of HTPR in the ticagrelor group (P >
0.05). During the 30-day follow-up, no MACE occurred in any patient, and
the overall risk of bleeding showed no difference between the two groups
(35% versus 21%, P = 0.48). Our results suggest that ticagrelor may
achieve a more rapid and greater platelet inhibition than double-dose
clopidogrel. Further studies are still needed to assess the differences in
efficacy and safety between ticagrelor and double-dose clopidogrel
administration for Chinese patients post elective PCI. (Int Heart J
Copyright &#xa9; 2017, International Heart Journal Association. All rights
reserved.

<75>
Accession Number
607267582
Author
Wolk R.; Bertolet M.; Brooks M.M.; Pratley R.E.; Sobel B.E.; Frye R.L.;
Singh P.; Calvin A.D.; Rutter M.K.; Mooradian A.D.; Somers V.K.
Institution
(Wolk, Frye, Singh, Calvin, Somers) Division of Cardiovascular Diseases,
Department of Medicine, Mayo Clinic, Rochester, United States
(Wolk) Pfizer Global Research and Development, Pfizer Inc., 445 Eastern
Point Rd, Grotona, CT 06340, United States
(Bertolet, Brooks) University of Pittsburgh, United States
(Pratley) Florida Hospital Diabetes and Translational Research Institutes,
Orlando, United States
(Sobel) University of Vermont, Burlington, United States
(Rutter) Endocrinology and Diabetes Research Group, Institute of Human
Development, Faculty of Medical and Human Sciences, University of
Manchester, United Kingdom
(Rutter) Manchester Diabetes Centre, Central Manchester University
Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre,
United Kingdom
(Mooradian) Division of Endocrinology, Diabetes and Metabolism, College of
Medicine-Jacksonville, University of Florida, United States
Title
Differential effects of insulin sensitization and insulin provision
treatment strategies on concentrations of circulating adipokines in
patients with diabetes and coronary artery disease in the BARI 2D trial.
Source
European Journal of Preventive Cardiology. 23 (1) (pp 50-58), 2016. Date
of Publication: 01 Jan 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Aims To determine the effects of insulin sensitization (IS) and insulin
provision (IP) treatment strategies on adipokines associated with
cardiovascular disease in patients with type 2 diabetes mellitus and
coronary artery disease in the Bypass Angioplasty Revascularization
Investigation 2 Diabetes trial (BARI 2D). Methods and results Changes in
adipokine levels were compared in patients with type 2 diabetes mellitus
and coronary artery disease randomized to IS (n = 1037) versus IP (n =
1019) treatment strategies in BARI 2D. Circulating concentrations of
leptin, adiponectin, monocyte chemoattractant protein-1, tumor necrosis
factor-alpha, interleukin 6 and C-reactive protein were evaluated at
baseline and one year. IS and IP treatment strategies exerted significant
(p < 0.0001) differential effects on: leptin (IS: 0.02% decrease, p =
0.01; IP: 13% increase, p < 0.0001); adiponectin (IS: 73% increase, p <
0.0001; IP: no change, p = 0.52); interleukin 6 (IS: 14% decrease, p <
0.0001; IP: no change, p = 0.68). Changes in monocyte chemoattractant
protein-1 and tumor necrosis factor-alpha were not statistically different
between groups. C-reactive protein decreased, but the effect was
significantly greater in the IS group (-32%, p < 0.0001) than in the IP
group (-5%, p = 0.0005). Conclusion The IS and IP treatment strategies
exerted divergent effects on adipokine and inflammatory profile in
patients with type 2 diabetes mellitus and coronary artery disease. The IS
treatment strategy-induced changes may be more favorable than the IP
treatment strategy regarding cardiovascular pathophysiology. Copyright
&#xa9; 2014 European Society of Cardiology.

<76>
[Use Link to view the full text]
Accession Number
53229408
Author
Kannan A.; Poongkunran C.; Medina R.; Ramanujam V.; Poongkunran M.;
Balamuthusamy S.
Institution
(Kannan, Poongkunran) Department of Inpatient Medicine, University of
Arizona, 1501 N Campbell Avenue, Tucson, AZ 85724, United States
(Medina, Ramanujam, Poongkunran, Balamuthusamy) Angiocare, Tucson, AZ,
United States
Title
Coronary revascularization in chronic and end-stage renal disease: A
systematic review and meta-analysis.
Source
American Journal of Therapeutics. 23 (1) (pp e16-e28), 2016. Date of
Publication: 01 Jan 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Patients with chronic kidney disease (CKD) and end-stage renal disease
(ESRD) on dialysis have an increased risk for cardiovascular mortality and
morbidity secondary to occlusive coronary artery disease. Optimal
revascularization strategy is unclear in this high-risk population. We
have performed a meta-analysis to compare coronary artery bypass grafting
(CABG) versus percutaneous coronary intervention (PCI) in patients with
ESRD and CKD. We searched PubMed, Ovid, MEDLINE, CINAHL, and EMBASE
(19802013) and found 17 trials (N 5 33,584) in the ESRD arm and 6 studies
(n 5 15,493) in the CKD arm. Two investigators independently collected the
data. All the studies were retrospective trials. In the ESRD and CKD
groups, we found significantly reduced early mortality with the PCI group
with the odds ratio of 2.08 (1.902.26; P , 0.00001) and 2.55 (1.454.51; P
5 0.001), respectively. Contrary to the early mortality results, we found
decreased late mortality with the CABG group when compared with the PCI
group [odds ratio: 0.86 (0.830.89; P , 0.000001) and 0.82 (0.760.88; P ,
0.00001)] in the ESRD and CKD arm, respectively. When compared with PCI,
there was decreased cardiovascular mortality with an odds ratio of 0.61
(0.400.92; P 5 0.02) in patients who underwent CABG in ESRD population.
Similar trends were observed in the incidence of myocardial infarction and
repeat revascularization. There is a strong trend for decreased risk of
stroke with PCI when compared with CABG in ESRD and CKD populations.
Copyright &#xa9; 2014 Wolters Kluwer Health, Inc. All rights reserved.

<77>
Accession Number
603438910
Author
Kikuchi C.; Dosenovic S.; Bienengraeber M.
Institution
(Kikuchi, Dosenovic, Bienengraeber) Department of Anesthesiology, Medical
College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226,
United States
(Kikuchi) Department of Anesthesiology, Asahikawa Medical University,
Asahikawa, Japan
(Bienengraeber) Department of Pharmacology and Toxicology, Medical College
of Wisconsin, Milwaukee, WI, United States
Title
Anaesthetics as cardioprotectants: Translatability and mechanism.
Source
British Journal of Pharmacology. 172 (8) (pp 2051-2061), 2015. Date of
Publication: 01 Apr 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
The pharmacological conditioning of the heart with anaesthetics, such as
volatile anaesthetics or opioids, is a phenomenon whereby a transient
exposure to an anaesthetic agent protects the heart from the harmful
consequences of myocardial ischaemia and reperfusion injury. The cellular
and molecular mechanisms of anaesthetic conditioning appear largely to
mimic those of ischaemic pre- and post-conditioning. Progress has been
made on the understanding of the underlying mechanisms although the order
of events and the specific targets of anaesthetics that trigger protection
are not always clear. In the laboratory, the protection afforded by
certain anaesthetics against cardiac ischaemia and reperfusion injury is
powerful and reproducible but this has not necessarily translated into
similarly robust clinical benefits. Indeed, clinical studies and
meta-analyses delivered variable results when comparing in the laboratory
setting protective and non-protective anaesthetics. Reasons for this
include underlying conditions such as age, obesity and diabetes. Animal
models for disease or ageing, human cardiomyocytes derived from stem cells
of patients and further clinical studies are employed to better understand
the underlying causes that prevent a more robust protection in patients.
Copyright &#xa9; 2014 The British Pharmacological Society.

<78>
Accession Number
603980240
Author
Mockel M.; Searle J.; Hamm C.; Slagman A.; Blankenberg S.; Huber K.; Katus
H.; Liebetrau C.; Muller C.; Muller R.; Peitsmeyer P.; Von Recum J.;
Tajsic M.; Vollert J.O.; Giannitsis E.
Institution
(Mockel, Searle, Slagman, Von Recum) Division of Emergency Medicine and
CPU, Department of Cardiology, Charite-University Medicine Berlin,
Augustenburger Platz 1, Berlin 13353, Germany
(Hamm, Liebetrau) Kerckhoff Heart and Thoraxcenter, Bad Nauheim, Germany
(Hamm, Liebetrau) Medical Clinic i, University Hospital Giesen, Giesen,
Germany
(Blankenberg, Peitsmeyer) Department of General and Interventional
Cardiology, University Heart Centre Hamburg, Hamburg, Germany
(Huber, Tajsic) Department of Cardiology and Internal Emergency Medicine,
Wilhelminenspital, Vienna, Austria
(Katus, Giannitsis) Department of Angiology, Cardiology and Pneumology,
University Hospital Heidelberg, Germany
(Muller) Department of Cardiology, Universitatsspital Basel, Switzerland
(Muller) School of Public Health and Tropical Medicine, James Cook
University, Townsville, Australia
(Vollert) Thermo Fisher Scientific, Clinical Diagnostics, B.R.A.H.M.S
GmbH, Hennigsdorf, Germany
Title
Early discharge using single cardiac troponin and copeptin testing in
patients with suspected acute coronary syndrome (ACS): A randomized,
controlled clinical process study.
Source
European Heart Journal. 36 (6) (pp 369-376), 2015. Date of Publication: 07
Feb 2015.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims: This randomized controlled trial (RCT) evaluated whether a process
with single combined testing of copeptin and troponin at admission in
patients with low-to-intermediate risk and suspected acute coronary
syndrome (ACS) does not lead to a higher proportion of major adverse
cardiac events (MACE) than the current standard process (non-inferiority
design). Methods and results: A total of 902 patients were randomly
assigned to either standard care or the copeptin group where patients with
negative troponin and copeptin values at admission were eligible for
discharge after final clinical assessment. The proportion of MACE (death,
survived sudden cardiac death, acute myocardial infarction (AMI),
re-hospitalization for ACS, acute unplanned percutaneous coronary
intervention, coronary artery bypass grafting, or documented life
threatening arrhythmias) was assessed after 30 days. Intention to treat
analysis showed a MACE proportion of 5.17% [95% confidence intervals (CI)
3.30-7.65%; 23/445] in the standard group and 5.19% (95% CI 3.32-7.69%;
23/443) in the copeptin group. In the per protocol analysis, the MACE
proportion was 5.34% (95% CI 3.38-7.97%) in the standard group, and 3.01%
(95% CI 1.51-5.33%) in the copeptin group. These results were also
corroborated by sensitivity analyses. In the copeptin group, discharged
copeptin negative patients had an event rate of 0.6% (2/362). Conclusion:
After clinical work-up and single combined testing of troponin and
copeptin to rule-out AMI, early discharge of low- to intermediate risk
patients with suspected ACS seems to be safe and has the potential to
shorten length of stay in the ED. However, our results need to be
confirmed in larger clinical trials or registries, before a clinical
directive can be propagated. Copyright &#xa9; 2014 &#xa9; The Author 2014.
Published by Oxford University Press on behalf of the European Society of
Cardiology.

<79>
Accession Number
600261706
Author
Hu Y.; Craig S.J.; Rowlingson J.C.; Morton S.P.; Thomas C.J.; Persinger
M.B.; Isbell J.; Lau C.L.; Kozower B.D.
Institution
(Hu, Isbell) Department of Surgery, University of Virginia, School of
Medicine, Charlottesville, VA, United States
(Craig, Thomas, Persinger, Isbell, Lau, Kozower) Department of Thoracic
and Cardiovascular Surgery, University of Virginia, School of Medicine, PO
Box 800709, Charlottesville, VA 22908-0679, United States
(Rowlingson, Morton) Department of Anesthesiology, University of Virginia,
School of Medicine, Charlottesville, VA, United States
Title
Early removal of urinary catheter after surgery requiring thoracic
epidural: A prospective trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (5) (pp 1302-1306),
2014. Date of Publication: 01 Oct 2014.
Publisher
W.B. Saunders
Abstract
Objectives To prevent urinary retention, urinary catheters commonly are
removed only after thoracic epidural discontinuation after thoracotomy.
However, prolonged catheterization increases the risk of infection. The
purpose of this study was to determine the rates of urinary retention and
catheter-associated infection after early catheter removal.
Design This study described a prospective trial instituting an early
urinary catheter removal protocol compared with a historic control group
of patients.
Setting The protocol was instituted at a single, academic thoracic surgery
unit.
Participants The study group was comprised of patients undergoing surgery
requiring thoracotomy who received an intraoperative epidural for
postoperative pain control.
Interventions An early urinary catheter removal protocol was instituted
prospectively, with all catheters removed on or before postoperative day
2. Urinary retention was determined by bladder ultrasound and treated with
recatheterization.
Measurements and Main Results The primary outcomes were urinary retention
rate, defined as bladder volume>400 mL, and urinary tract infection rate.
Results were compared with a retrospective cohort of 210 consecutive
patients who underwent surgery before protocol initiation. Among the 101
prospectively enrolled patients, urinary retention rate was higher (26.7%
v 12.4%, p = 0.003), while urinary tract infection rate improved
moderately (1% v 3.8%, p = 0.280).
Conclusions Early removal of urinary catheters with thoracic epidurals in
place is associated with a high incidence of urinary retention. However,
an early catheter removal protocol may play a role in a multifaceted
approach to reducing the incidence of catheter-associated urinary tract
infections. Copyright &#xa9; 2014 Elsevier Inc.

<80>
Accession Number
615299064
Author
Doenst T.; Essa Y.; Jacoub K.; Moschovas A.; Gonzalez-Lopez D.; Kirov H.;
Diab M.; Bargenda S.; Faerber G.
Institution
(Doenst, Essa, Jacoub, Moschovas, Gonzalez-Lopez, Kirov, Diab, Bargenda,
Faerber) Department of Cardiothoracic Surgery,
Friedrich-Schiller-University of Jena, Am Klinikum 1, Jena 07747, Germany
Title
Cardiac surgery 2016 reviewed.
Source
Clinical Research in Cardiology. (pp 1-17), 2017. Date of Publication: 10
Apr 2017.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
For the year 2016, more than 20,000 published references can be found in
Pubmed when entering the search term "cardiac surgery". Publications last
year have helped to more clearly delineate the fields where classic
surgery and modern interventional techniques overlap. The field of
coronary bypass surgery (partially compared to percutaneous coronary
intervention) was enriched by five large prospective randomized trials.
The value of CABG for complex coronary disease was reconfirmed and for
less complex main stem lesions, PCI was found potentially equal. For
aortic valve treatment, more evidence was presented for the superiority of
transcatheter aortic valve implantation for patients with intermediate
risk. However, the 2016 evidence argued against the liberal expansion to
the low-risk field, where conventional aortic valve replacement still
appears superior. For the mitral valve, many publications emphasized the
significant impact of mitral valve reconstruction on survival in
structural mitral regurgitation. In addition, there were many relevant and
other interesting contributions from the purely operative arena in the
fields of coronary revascularization, surgical treatment of valve disease,
terminal heart failure (i.e., transplantation and ventricular assist
devices), and aortic surgery. While this article attempts to summarize the
most pertinent publications it does not have the expectation of being
complete and cannot be free of individual interpretation. As in recent
years, it provides a condensed summary that is intended to give the reader
"solid ground" for up-to-date decision-making in cardiac surgery.
Copyright &#xa9; 2017 Springer-Verlag Berlin Heidelberg

<81>
Accession Number
615287648
Author
Chopard R.; Genet B.; Ecarnot F.; Chatot M.; Napporn G.; Hyvert A.;
Didier-Petit K.; Schiele F.; Meneveau N.
Institution
(Chopard, Genet, Ecarnot, Chatot, Schiele, Meneveau) Department of
Cardiology, EA3920, University Hospital Besancon, Besancon, France
(Napporn) Department of Cardiology, General Hospital of Dole, Dole, France
(Hyvert) Department of Cardiology, General Hospital of Pontarlier,
Pontarlier, France
(Didier-Petit) Department of Cardiology, General Hospital of Vesoul,
Vesoul, France
Title
Detection of Residual Pulmonary Vascular Obstruction by
Ventilation-Perfusion Lung Scan Late After a First Pulmonary Embolism.
Source
American Journal of Cardiology. (no pagination), 2017. Date of
Publication: November 19, 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The long-term impact of persistent pulmonary vascular obstruction after
pulmonary embolism (PE) remains unknown. Based on ventilation-perfusion
lung scan performed at discharge and 3 months after a first PE, we aimed
to investigate the prognostic value on 5-year adverse events of (1)
residual pulmonary vascular obstruction (RPVO) at discharge (DIS-RPVO),
(2) RPVO at 3 months (3M-RPVO), and (3) relative change in RPVO between
the 2 scans (RC-RPVO). We performed a prospective, multicenter cohort
study from January 2007 to December 2009 including patients who survived
at least 3 months after a PE. RC-RPVO was defined as (DIS-RPVO -
3M-RPVO)/DIS-RPVO. The primary end point was a combined end point at 5
years, composed of all-cause death, recurrent venous thromboembolism,
chronic thromboembolic pulmonary hypertension, heart failure, and
rehospitalization for cardiac causes. Receiver-operating characteristic
curves were computed to define thresholds of DIS-RPVO, 3M-RPVO, and
RC-RPVO predictive of the primary combined end point at 5 years. Overall,
241 patients were included (high-risk PE: 11.2%, intermediate-risk PE:
51.8%, low-risk PE: 37%). Mean DIS-RPVO was 27.9 +/- 15.1%, mean 3M-RPVO
was 10.3 +/- 10.8%, and mean RC-RPVO was 61.7 +/- 33.4%. At 5 years, 112
patients (46.5%) experienced the combined end point. Both 3M-RPVO >15% and
RC-RPVO <37.5% were independently related to the occurrence of the
combined end point at 5 years (p = 0.01 and p = 0.02, respectively).
DIS-RPVO did not predict long-term adverse events. In conclusion, RC-RPVO
<37.5% and 3M-RPVO >15% were independently related to the occurrence of
adverse events 5 years after a first PE. Copyright &#xa9; 2017 Elsevier
Inc.

<82>
Accession Number
615293874
Author
Wang Y.; Zhu S.; Gao P.; Zhang Q.
Institution
(Wang, Zhang) Department of Cardiology, West China Hospital, Sichuan
University, 37 Guoxue Street, Chengdu 610041, Sichuan, China
(Zhu) Department of Epidemiology and Biostatistics, School of Public
Health, Sichuan University, Chengdu, Sichuan, China
(Gao) Department of Nephrology, West China Hospital, Sichuan University,
Chengdu, Sichuan, China
Title
Comparison of coronary artery bypass grafting and drug-eluting stents in
patients with chronic kidney disease and multivessel disease: A
meta-analysis.
Source
European Journal of Internal Medicine. (no pagination), 2016. Date of
Publication: October 29, 2016.
Publisher
Elsevier B.V.
Abstract
Background: The optimal revascularization strategy of coronary artery
bypass grafting (CABG) versus percutaneous coronary intervention with
drug-eluting stent (PCI-DES) in patients with chronic kidney disease (CKD)
and multivessel disease (MVD) remains unclear. Methods: Pubmed, EMBASE and
Cochrane Library electronic databases were searched from inception until
June 2016. Studies that evaluate the comparative benefits of DES versus
CABG in CKD patients with multi-vessel disease were considered for
inclusion. We pooled the odds ratios from individual studies and conducted
heterogeneity, quality assessment and publication bias analyses. Results:
A total of 11 studies with 29,246 patients were included (17,928 DES
patients; 11,318 CABG). Compared with CABG, pooled analysis of studies
showed DES had higher long-term all-cause mortality (OR, 1.22; p. <.
0.00001), cardiac mortality (OR, 1.29; p. <. 0.00001), myocardial
infarction (OR, 1.89; p = 0.02), repeat revascularization (OR, 3.47; p. <.
0.00001) and major adverse cardiac and cerebrovascular events (MACCE) (OR,
2.00; p = 0.002), but lower short-term all-cause mortality (OR, 0.33; p.
<. 0.00001) and cerebrovascular accident (OR, 0.64; p = 0.0001). Subgroup
analysis restricted to patients with end-stage renal disease (ESRD)
yielded similar results, but no significant differences were found
regarding CVA and MACCE. Conclusions: CABG for patients with CKD and MVD
had advantages over PCI-DES in long-term all-cause mortality, MI, repeat
revascularization and MACCE, but the substantial disadvantage in
short-term mortality and CVA. Future large randomized controlled trials
are certainly needed to confirm these findings. Copyright &#xa9; 2016.

<83>
Accession Number
613513126
Author
Kotsoeva O.T.
Institution
(Kotsoeva) Department of Medical Rehabilitation, North-Caucasian
Multidisciplinary Medical Center, 139a, Frieva str., Beslan 363025,
Russian Federation
Title
Comparison of impact of medical therapy and surgical treatment on overall
mortality in patients with severe chronic heart failure: A meta-analysis.
Source
Russian Open Medical Journal. 5 (3) (no pagination), 2016. Article Number:
e0304. Date of Publication: 2016.
Publisher
Russian Open Medical Journal (E-mail: rusomj@mail.ru)
Abstract
Aim - Meta-analysis of clinical trials comparing the efficacy of medical
therapy (MT) and surgical treatment, including cardiac resynchronization
therapy with and without cardioversion-defibrillation (CRT and CRT-D),
circulatory support system (CSS) and heart transplantation (HT), in terms
of decreasing overall mortality in patients with severe chronic heart
failure (CHF). Material and Methods - Meta-analysis included 39 clinical
trials with a total number of 30,257 patients. Search was performed in
MEDLINE, Medscape, Pubmed databases and on web resources, dedicated to
clinical trials (National Institutes of Health, Clinical Center,
ClinicalStudyResults.org, ClinicalTrials.gov). Results - There was no
significant overall mortality reduction in patients receiving MT when
compared to control group: OR=0.97 (95% CI: 0.85-1.10), p=0.211. Treatment
with CRT and CRT-D, as well as CSS implantation and HT reduced overall
mortality: OR=0.67 (95% CI: 0.57-0.79), p < 0.001 for CRT/CRT-D and
OR=0.46 (95% CI: 0.24-0.86), p = 0.018 for CSS/HT. Conclusion -
Superiority of surgical treatment over traditional MT in terms of overall
mortality was observed in patients with severe CHF. Copyright &#xa9; 2016,
Kotsoeva O.T.

<84>
Accession Number
614857833
Author
Kearney K.; Hira R.S.; Riley R.F.; Kalyanasundaram A.; Lombardi W.L.
Institution
(Kearney, Hira, Riley, Lombardi) Division of Cardiology, University of
Washington, Seattle, WA, United States
(Kalyanasundaram) Division of Cardiology, Swedish Medical Center, Seattle,
WA, United States
Title
Update on the Management of Chronic Total Occlusions in Coronary Artery
Disease.
Source
Current Atherosclerosis Reports. 19 (4) (no pagination), 2017. Article
Number: 19. Date of Publication: 01 Apr 2017.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of the Review: Chronic total occlusions (CTOs) are found in about
a third of patients with coronary artery disease (CAD) and can pose a
significant challenge during percutaneous revascularization. However,
advances in CTO percutaneous coronary intervention (PCI) strategies,
devices, and algorithms have led to significant improvements in successful
treatment of CTOs. This review summarizes current management of CTOs in
the context of modern PCI techniques and current evidence. Recent
Findings: The hybrid algorithm now provides a standardized, teachable
approach to CTO PCI, and success rates are approximately 90% in
experienced hands. The first randomized controlled trial in patients with
CTOs recently reported that patients with ST elevation myocardial
infarction (STEMI) and a CTO in the non-culprit vessel showed an
improvement in ejection fraction in patients undergoing CTO PCI of the
LAD, but not other vessels. Updated data from the SYNTAX trial showed a
benefit with complete revascularization in patients with coronary artery
disease (CAD). Incomplete revascularization of CTOs in the PCI group may
explain some of the benefit seen with CABG over PCI in patients with
complex coronary disease. Contemporary CTO registries have reported
success rates of approximately 90%, and the OPEN-CTO registry updates our
understanding of CTO PCI complication rates and outcomes. Summary: The
available evidence highlights the potential benefits of CTO PCI in
patients with an indication for revascularization. Technological
advancements have paved the way for success rates approaching 90% at
high-volume centers, but further studies evaluating outcomes following CTO
PCI are needed, with several currently underway. Copyright &#xa9; 2017,
Springer Science+Business Media New York.

<85>
Accession Number
614738416
Author
Seco M.; Zhao D.F.; Byrom M.J.; Wilson M.K.; Vallely M.P.; Fraser J.F.;
Bannon P.G.
Institution
(Seco, Zhao, Byrom, Vallely, Bannon) Sydney Medical School, The University
of Sydney, Sydney, Australia
(Seco, Zhao, Byrom, Wilson, Vallely, Bannon) The Baird Institute of
Applied Heart and Lung Surgical Research, Sydney, Australia
(Seco, Byrom, Wilson, Vallely, Bannon) Cardiothoracic Surgical Unit, Royal
Prince Alfred Hospital, Sydney, Australia
(Byrom, Vallely, Bannon) Institute of Academic Surgery, Royal Prince
Alfred Hospital, Sydney, Australia
(Byrom, Wilson, Vallely, Bannon) Sydney Heart and Lung Surgeons, Sydney,
Australia
(Wilson, Vallely) Australian School of Advanced Medicine, Macquarie
University, Sydney, Australia
(Fraser) Critical Care Research Group, The Prince Charles Hospital, The
University of Queensland, Australia
Title
Long-term prognosis and cost-effectiveness of left ventricular assist
device as bridge to transplantation: A systematic review.
Source
International Journal of Cardiology. 235 (pp 22-32), 2017. Date of
Publication: 15 May 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background This systematic review aimed to evaluate the clinical outcomes
and cost-effectiveness of left ventricular assist devices (LVADs) used as
bridge to transplantation (BTT), compared to orthotopic heart
transplantation (OHT) without a bridge. Method Systematic searches were
performed in electronic databases with available data extracted from text
and digitized figures. Meta-analysis of short and long-term term
post-transplantation outcomes was performed with summation of
cost-effectiveness analyses. Results Twenty studies reported clinical
outcomes of 4575 patients (1083 LVAD BTT and 3492 OHT). Five studies
reported cost-effectiveness data on 837 patients (339 VAD BTT and 498
OHT). There was no difference in long-term post-transplantation survival
(HR 1.24, 95% CI 1.00-1.54), acute rejection (HR 1.10, 95% CI 0.93-1.30),
or chronic rejection and cardiac allograft vasculopathy (HR 0.99, 95% CI
0.73-1.36). No differences were found in 30-day post-operative mortality
(OR 0.91, 95% CI 0.42-2.00), stroke (OR 1.64, 95% CI 0.43-6.27), renal
failure (OR 1.43, 95% CI 0.58-3.54), bleeding (OR 1.56, 95% CI 0.78-3.13),
or infection (OR 2.44, 95% CI 0.81-7.38). Three of the five studies
demonstrated incremental cost-effectiveness ratios below the acceptable
maximum threshold. The total cost of VAD BTT ranged from $316,078 to
$1,025,500, and OHT ranged from $179,051 to $802,200. Conclusion LVADs
used as BTT did not significantly alter post-transplantation long-term
survival, rejection, and post-operative morbidity. LVAD BTT may be
cost-effective, particularly in medium and high-risk patients with
expected prolonged waiting times, renal dysfunction, and young patients.
Copyright &#xa9; 2017 Elsevier Ireland Ltd

<86>
Accession Number
613593348
Author
Winkler B.; Heinisch P.P.; Gahl B.; Aghlmandi S.; Jenni H.J.; Carrel T.P.
Institution
(Winkler, Heinisch, Gahl, Jenni, Carrel) Department of Cardiovascular
Surgery, Inselspital, University of Bern, Bern, Switzerland
(Aghlmandi) Institute of Social and Preventive Medicine, University of
Bern, Bern, Switzerland
Title
Minimally Invasive Extracorporeal Circulation Circuit Is Not Inferior to
Off-Pump Coronary Artery Bypass Grafting: Meta-Analysis Using the Bayesian
Method.
Source
Annals of Thoracic Surgery. 103 (1) (pp 342-350), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Elsevier USA
Abstract
The pathophysiologic side effects of cardiopulmonary bypass have already
been identified. Minimally invasive extracorporeal circulation
technologies (MiECT) and off-pump coronary artery bypass graft surgery
(OPCABG) aim to reduce these problems. This meta-analysis provides a
comparison of MiECT and OPCABG in randomized and observational studies. A
fully probabilistic, Bayesian approach of primary and secondary endpoints
was conducted. MiECT does not give inferior results when compared with
OPCABG. However, there is a trend to borderline significantly higher blood
loss in this group in randomized controlled trials. The question whether
MiECT is equivalent to OPCABG can be answered with the affirmative, but
long-term follow-up data are needed to detect any advantage over time.
Copyright &#xa9; 2017 The Society of Thoracic Surgeons

<87>
Accession Number
613732051
Author
Kowalewski M.; Malvindi P.G.; Suwalski P.; Raffa G.M.; Pawliszak W.;
Perlinski D.; Kowalkowska M.E.; Kowalewski J.; Carrel T.; Anisimowicz L.
Institution
(Kowalewski, Pawliszak, Perlinski, Anisimowicz) Department of Cardiac
Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland
(Kowalewski) Department of Hygiene, Epidemiology and Ergonomics, Division
of Ergonomics and Physical Effort, Collegium Medicum UMK in Bydgoszcz,
Bydgoszcz, Poland
(Malvindi) University Hospital Southampton NHS Foundation Trust, Wessex
Cardiothoracic Centre, Southampton, United Kingdom
(Suwalski) Clinical Department of Cardiac Surgery, Central Clinical
Hospital of the Ministry of the Interior and Administration in Warsaw,
Warsaw, Poland
(Suwalski) Faculty of Health Science and Physical Education, Pulaski
University of Technology and Humanities, Radom, Poland
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo
per I Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
(Kowalkowska) Department and Clinic of Obstetrics, Gynecology, and
Oncological Gynecology, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
(Kowalewski) Lung Cancer and Thoracic Surgery Department, Collegium
Medicum, Nicolaus Copernicus University, Torun, Poland
(Carrel) Clinic for Cardiovascular Surgery, University Hospital and
University of Bern, Bern, Switzerland
Title
Clinical Safety and Effectiveness of Endoaortic as Compared to
Transthoracic Clamp for Small Thoracotomy Mitral Valve Surgery:
Meta-Analysis of Observational Studies.
Source
Annals of Thoracic Surgery. 103 (2) (pp 676-686), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Elsevier USA
Abstract
Controversies remain on the increased rate of neurological events after
small thoracotomy mitral valve surgery attributed to endoaortic balloon
occlusion (EABO). Systematic literature search of databases identified 17
studies enrolling 6,643 patients comparing safety and effectiveness of
EABO versus transthoracic clamp. In a meta-analysis, there was no
difference in occurrence of cerebrovascular events, all-cause mortality,
and kidney injury. EABO was associated with a significantly higher risk of
iatrogenic aortic dissection (0.93% versus 0.13%; risk ratio, 4.67; 95%
confidence interval, 1.62 to 13.49; p = 0.004) and a trend toward longer
operative times. The data is limited to observational studies. Copyright
&#xa9; 2017 The Society of Thoracic Surgeons

<88>
Accession Number
611340982
Author
Hanedan M.O.; Cicekcioglu F.; Aksoyek A.; Diken A.I.; Unal E.U.; Parlar
A.I.; Katircioglu S.F.
Institution
(Hanedan, Cicekcioglu, Aksoyek, Diken, Unal, Parlar, Katircioglu) Turkiye
Yuksek Ihtisas Education and Research Hospital, Cardiovascular Surgery,
Ankara, Turkey
Title
Tricuspid Valve Replacement Through Right Thoracotomy has Better Outcomes
in Redo Cases.
Source
Heart Lung and Circulation. 26 (1) (pp 88-93), 2017. Date of Publication:
01 Jan 2017.
Publisher
Elsevier Ltd
Abstract
Background The tricuspid valve is usually ignored and tricuspid
interventions are mostly done in the context of other planned cardiac
surgery. Isolated tricuspid reoperative procedure, especially tricuspid
valve replacement (TVR) is very rare and carries a very high mortality
rate. In this prospective study, clinical results of isolated TVR either
through a median re-sternotomy or an antero-lateral thoracotomy with
conventional cardiopulmonary bypass (CPB) have been evaluated. Methods
Thirty patients with previous open heart surgery through median sternotomy
had isolated TVR between 2004 and 2011. Operative approaches were through
a median re-sternotomy in 13 patients and a right antero-lateral
thoracotomy in 17 patients. Results Follow-up period is complete with a
mean duration of 19.77+/-17.08 months. The hospital mortality rates were
46.2% (six patients) in the Median Re-sternotomy Group and 5.9% (one
patient) in the Thoracotomy Group (p= 0.025). The surgical procedures
lasted shorter and the postoperative drainage amounts were lower in the
Thoracotomy Group (298.08+/-76.64 min vs 246.76+/-47.40 min, p= 0.032 and
1787.50+/-1399.53 mL vs 903.33+/-692.43 mL, p= 0.03 respectively).
Presence of ascites in the preoperative period (p= 0.007), operative
technique (median re-sternotomy) (p= 0.025), use of cross-clamp (p=
0.048), and need for inotropic support during the operation (p= 0.002)
were statistically significant factors affecting the hospital mortality.
The mean estimated life period was better for the Thoracotomy Group
(16.7+/-5.03 versus 35.9+/-5.01 months, p= 0.044). Presence of ascites in
the preoperative period was a significant risk factor for overall
mortality according to Cox regression analysis. Conclusion Thoracotomy for
TVR in patients with previous median sternotomy is a practical and safe
technique with lower mortality rates. Copyright &#xa9; 2016 Australian and
New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the
Cardiac Society of Australia and New Zealand (CSANZ)

<89>
Accession Number
612885313
Author
Hill Q.A.; Harrison L.C.; Padmakumar A.D.; Owen R.G.; Prasad K.R.; Lucas
G.F.; Tachtatzis P.
Institution
(Hill) Department of Haematology, St James's University Hospital, Leeds,
United Kingdom
(Harrison, Tachtatzis) Department of Hepatology, St James's University
Hospital, Leeds, United Kingdom
(Padmakumar) Department of Anaesthesia & Intensive Care Medicine, St
James's University Hospital, Leeds, United Kingdom
(Owen) HMDS Laboratory and Department of Haematology, St James's
University Hospital, Leeds, United Kingdom
(Prasad) Department of Transplant and Hepatobiliary Surgery, St James's
University Hospital, Leeds, United Kingdom
(Lucas) Histocompatibility & Immunogenetics Laboratory, NHS Blood and
Transplant, North Bristol Park, Bristol, United Kingdom
Title
A fatal case of transplantation-mediated alloimmune thrombocytopenia
following liver transplantation.
Source
Hematology. 22 (3) (pp 162-167), 2017. Date of Publication: 16 Mar 2017.
Publisher
Taylor and Francis Ltd. (E-mail: maney@maney.co.uk)
Abstract
Objective and importance: Transplantation-mediated alloimmune
thrombocytopenia (TMAT) occurs when leukocytes transferred in a donor
organ from a patient with immune thrombocytopenia (ITP), mount a response
against recipient platelets. We present the first fatal case of TMAT
following liver transplantation and review its aetiology and treatment.
Clinical presentation: The liver donor had ITP and died from an
intracranial haemorrhage. The recipient platelet count fell to 2 x
10⁹/l on post-operative day 2. Treatment refractory
thrombocytopenia resulted in pulmonary haemorrhage and death. TMAT did not
occur in a kidney recipient from the same ITP donor. Intervention:
Extramedullary haematopoiesis was identified in the donor liver biopsy.
Antibodies against platelet GPIb/IX were demonstrated in both donor and
recipient. The thrombocytopenia was refractory to platelet transfusions,
intravenous immunoglobulin, methylprednisolone, rituximab, romiplostim,
plasmapheresis, vincristine and splenic artery embolization. On review of
the literature, severe thrombocytopenia (<10 x 10⁹/l) has
started within 3 days of transplantation in all reported TMAT cases.
Serious non-fatal bleeding was observed in 3/5 previously reported cases.
The optimal treatment is unclear. TMAT should resolve as donor lymphocytes
are eliminated but re-transplantation may be required in severe refractory
cases. TMAT has been reported in recipients of a liver but not kidney or
heart transplant from ITP donors, probably because of the greater burden
of co-transplanted lymphoid tissue. Conclusion: Before using the liver of
an ITP donor, the recipient's fully informed consent is required. However,
the risk of TMAT from an ITP donor is currently unknown and systematic
review of donor registries is needed. Copyright &#xa9; 2016 Informa UK
Limited, trading as Taylor & Francis Group.

<90>
Accession Number
613800718
Author
Mokhles S.; Takkenberg J.J.; Treasure T.
Institution
(Mokhles, Takkenberg) Department of Cardio-Thoracic Surgery, Erasmus
University Medical Center, Rotterdam, Netherlands
(Treasure) Clinical Operational Research Unit, University College London,
London, United Kingdom
Title
Evidence-Based and Personalized Medicine. It's [AND] not [OR].
Source
Annals of Thoracic Surgery. 103 (1) (pp 351-360), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Elsevier USA
Abstract
Good clinical practice is an amalgamation of personalized medicine with
evidence-based medicine in the best interests of patient. Hence, our title
uses Boolean operators to indicate that it is [AND] not [OR]. This is the
syntax of formal searching for systematic reviews, ensuring that all the
evidence is found. Comprehensive evidence-based guidance can thus be
formulated. Many residents and fellows around the world, and their chiefs,
are now exposed to consensus documents, white papers, levels of
appropriateness, and guidelines and are in many jurisdictions expected to
comply with them. However, they are the summation of many forms of
evidence, each of which has its place, and we consider them in turn in
this article. Copyright &#xa9; 2017 The Society of Thoracic Surgeons

<91>
Accession Number
613800486
Author
Badhwar V.; Rankin J.S.; Damiano R.J.; Gillinov A.M.; Bakaeen F.G.;
Edgerton J.R.; Philpott J.M.; McCarthy P.M.; Bolling S.F.; Roberts H.G.;
Thourani V.H.; Suri R.M.; Shemin R.J.; Firestone S.; Ad N.
Institution
(Badhwar, Rankin, Ad) Division of Cardiothoracic Surgery, West Virginia
University, Morgantown, West Virginia, United States
(Damiano) Division of Cardiothoracic Surgery, Washington University, St.
Louis, Missouri, United States
(Gillinov, Bakaeen, Suri) Division of Thoracic and Cardiovascular Surgery,
Cleveland Clinic, Cleveland, Ohio, United States
(Edgerton) Department of Cardiothoracic Surgery, Baylor Plano Heart
Hospital, Plano, Texas, United States
(Philpott) Department of Cardiothoracic Surgery, Sentara Heart Hospital,
Norfolk, Virginia, United States
(McCarthy) Division of Cardiac Surgery, Northwestern University Feinberg
School of Medicine, Chicago, Illinois, United States
(Bolling) Department of Cardiac Surgery, University of Michigan, Ann
Arbor, Michigan, United States
(Roberts) Department of Cardiovascular Services, Florida Heart and
Vascular Care at Aventura, Aventura, Florida, United States
(Thourani) Division of Cardiothoracic Surgery, Emory University, Atlanta,
Georgia
(Shemin) Division of Cardiothoracic Surgery, University of California Los
Angeles David Geffen School of Medicine, Los Angeles, California, United
States
(Firestone) The Society of Thoracic Surgeons, Chicago, Illinois, United
States
Title
The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the
Surgical Treatment of Atrial Fibrillation.
Source
Annals of Thoracic Surgery. 103 (1) (pp 329-341), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Elsevier USA
Abstract
Executive Summary Surgical ablation for atrial fibrillation (AF) can be
performed without additional risk of operative mortality or major
morbidity, and is recommended at the time of concomitant mitral operations
to restore sinus rhythm. (Class I, Level A) Surgical ablation for AF can
be performed without additional operative risk of mortality or major
morbidity, and is recommended at the time of concomitant isolated aortic
valve replacement, isolated coronary artery bypass graft surgery, and
aortic valve replacement plus coronary artery bypass graft operations to
restore sinus rhythm. (Class I, Level B nonrandomized) Surgical ablation
for symptomatic AF in the absence of structural heart disease that is
refractory to class I/III antiarrhythmic drugs or catheter-based therapy
or both is reasonable as a primary stand-alone procedure, to restore sinus
rhythm. (Class IIA, Level B randomized) Surgical ablation for symptomatic
persistent or longstanding persistent AF in the absence of structural
heart disease is reasonable, as a stand-alone procedure using the Cox-Maze
III/IV lesion set compared with pulmonary vein isolation alone. (Class
IIA, Level B nonrandomized) Surgical ablation for symptomatic AF in the
setting of left atrial enlargement (>4.5 cm) or more than moderate mitral
regurgitation by pulmonary vein isolation alone is not recommended. (Class
III no benefit, Level C expert opinion) It is reasonable to perform left
atrial appendage excision or exclusion in conjunction with surgical
ablation for AF for longitudinal thromboembolic morbidity prevention.
(Class IIA, Level C limited data) At the time of concomitant cardiac
operations in patients with AF, it is reasonable to surgically manage the
left atrial appendage for longitudinal thromboembolic morbidity
prevention. (Class IIA, Level C expert opinion) In the treatment of AF,
multidisciplinary heart team assessment, treatment planning, and long-term
follow-up can be useful and beneficial to optimize patient outcomes.
(Class I, Level C expert opinion) Copyright &#xa9; 2017 The Society of
Thoracic Surgeons

<92>
Accession Number
614782928
Author
Koh J.-S.; Park Y.; Tantry U.S.; Ahn J.-H.; Kang M.G.; Kim K.; Jang J.Y.;
Park H.W.; Park J.R.; Hwang S.-J.; Kwak C.H.; Hwang J.-Y.; Gurbel P.A.;
Jeong Y.-H.
Institution
(Koh, Kang, Kim, Park, Park, Hwang, Hwang) Department of Internal
Medicine, Gyeongsang National University School of Medicine and Gyeongsang
National University Hospital, Jinju, South Korea
(Park, Ahn, Jang, Kwak, Jeong) Department of Internal Medicine, Gyeongsang
National University School of Medicine and Cardiovascular Center,
Gyeongsang National University Changwon Hospital, Changwon, South Korea
(Tantry, Gurbel) Inova Center for Thrombosis Research and Drug
Development, Inova Heart and Vascular Institute, Fairfax, VA, United
States
(Jeong) Institute of the Health Sciences, Gyeongsang National University,
Jinju, South Korea
Title
Pharmacodynamic effects of a new fixed-dose clopidogrel-aspirin
combination compared with separate administration of clopidogrel and
aspirin in patients treated with coronary stents: The ACCEL-COMBO trial.
Source
Platelets. 28 (2) (pp 187-193), 2017. Date of Publication: 17 Feb 2017.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin is a widely
prescribed regimen to prevent ischemic events in patients undergoing
percutaneous coronary intervention (PCI). A fixed-dose combination (FDC)
capsule (HCP0911) has been developed to provide dosing convenience and
improve adherence. We compared the antiplatelet effects of single daily
dose HCP0911 with separate treatment with daily 75 mg clopidogrel plus 100
mg aspirin. This was a randomized, open-label, two-period, crossover,
non-inferiority study conducted in stented patients who had been treated
for at least 6 months with clopidogrel and aspirin. Thirty patients were
randomly assigned to receive either daily 75 mg clopidogrel plus 100 mg
aspirin treatment or HCP0911 for 2 weeks and then were crossed over to the
other treatment for 2 weeks. Pharmacodynamic effects were measured with
VerifyNow, light transmittance aggregometry (LTA), and thromboelastography
(TEG). The primary endpoint was P2Y12 Reaction Units (PRU)
measured by VerifyNow. PRUs during treatment with HCP0911 were not
inferior to those during separate treatment (202 +/- 52 vs. 207 +/- 60
PRU; mean difference, -5 PRU; 90% confidence interval of difference, -23
to 13 PRU; P for non-inferiority = 0.015 for predetermined limit). "BASE"
and Aspirin Reaction Units by VerifyNow did not differ between the two
treatments. During each treatment, there were no differences in maximal
and final platelet aggregations by LTA (all P values >0.822) and
TEG measurements. In conclusion, in stented patients, the
antiplatelet effect of a fixed-dose clopidogrel-aspirin combination,
HCP0911, was not inferior to separate administration of clopidogrel and
aspirin. Copyright &#xa9; 2016 Taylor & Francis.

<93>
[Use Link to view the full text]
Accession Number
614176459
Author
Bosch P.; Kenkre T.S.; Londino J.A.; Cassara A.; Yang C.; Waters J.H.
Institution
(Bosch, Londino) Department of Orthopaedic Surgery, Children's Hospital of
Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA,
United States
(Cassara) Department of Anesthesia, Children's Hospital of Pittsburgh,
University of Pittsburgh Medical Center, Pittsburgh, PA, United States
(Kenkre, Yang) Epidemiology Data Center, University of Pittsburgh,
Graduate School of Public Health, Pittsburgh, PA, United States
(Waters) Department of Anesthesia, Magee-Womens Hospital, University of
Pittsburgh Medical Center, Pittsburgh, PA, United States
Title
Coagulation profile of patients with adolescent idiopathic scoliosis
undergoing posterior spinal fusion.
Source
Journal of Bone and Joint Surgery - American Volume. 98 (20) (pp e88),
2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background: Blood loss and transfusion requirements during posterior
spinal fusion for adolescent idiopathic scoliosis remain a concern. The
mechanism of bleeding in these patients is poorly characterized.
Thromboelastography is a comprehensive test of a patient's coagulation
system commonly used in cardiac surgical procedures. It has not been well
studied for use in patients with adolescent idiopathic scoliosis. Methods:
A prospective, observational study of the coagulation profile of patients
with adolescent idiopathic scoliosis undergoing posterior spinal fusion is
presented. Healthy patients with adolescent idiopathic scoliosis without a
bleeding abnormality were analyzed during posterior spinal fusion.
Standard coagulation laboratory and thromboelastogram measures were
obtained at the time of the incision and at 1-hour intervals during the
surgical procedure. Laboratory values were analyzed in relation to
outcomes such as bleeding, transfusion, and a fibrinolysis score. Results:
Fifty-eight patients were observed. Eighty-one percent of patients were
female, the mean age was 13.5 years, a mean of 11.1 levels were fused, the
median estimated blood loss was 645 mL, and 47% of patients received blood
products. Overall, laboratory values remained stable throughout the
surgical procedure. Mild increases in prothrombin time and partial
thromboplastin time were observed, and platelets remained stable. From
thromboelastogram analysis, an acceleration of clot formation (decreased
reaction time) and a slight increase in clot lysis (increased lysis
percentage at 30 minutes) were observed. Afibrinolysis score compiled from
the presence of fibrin degradation products, the presence of D-dimers, and
increased prothrombin time rose steadily over surgical time. The
fibrinolysis score was predictive of both transfusion and greater
estimated blood loss per level. Conclusions: The stress of posterior
spinal fusion induces a hypercoagulable state in patients with adolescent
idiopathic scoliosis. Over the first 2 hours of a surgical procedure,
varying degrees of fibrinolysis develop. Platelets and coagulation factors
are not depleted. Our data support the use of antifibrinolytic therapy for
patients with adolescent idiopathic scoliosis. &#xa9; Copyright 2016 BY
THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED.

<94>
Accession Number
611083543
Author
Gui Y.-Y.; Huang F.-Y.; Huang B.-T.; Peng Y.; Liu W.; Zhang C.; Chen
S.-J.; Pu X.-B.; Wang P.-J.; Chen M.
Institution
(Gui, Huang, Huang, Peng, Liu, Zhang, Chen, Pu, Wang, Chen) Department of
Cardiology, West China Hospital, Sichuan University, China
Title
The effect of activated clotting time values for patients undergoing
percutaneous coronary intervention: A systematic review and meta-analysis.
Source
Thrombosis Research. 144 (pp 202-209), 2016. Date of Publication: 01 Aug
2016.
Publisher
Elsevier Ltd
Abstract
Our aim was to illustrate the effect of higher activated clotting time
(ACT) values versus lower ACT values on thrombotic or hemorrhagic events
in coronary atherosclerotic heart disease (CHD) patients undergoing
percutaneous coronary intervention (PCI). PubMed, Embase, Web of Science,
and Cochrane Library were searched. Observational studies assessing ACT
related major adverse cardiac event (MACE) and major bleeding were
included. Studies were allocated into three groups. Group 1 included
studies with low percentage of participants prescribed with glycoprotein
IIb/IIIa inhibitors ([GPI] < 30%), Group 2 with high percentage of
participants prescribed with GPI (> 30%), and Group 3 with routine direct
thrombin inhibitors (DTI) prescription. The cutoff is designed as 300 s
(290-310 s) for Group 1, and 250 s (240-260 s) for Group 2. With regard to
MACE and major bleeding in Group 1, there was no significant difference
between higher ACT values and lower ACT values (risk ratio [RR] for MACE,
1.16, 95% confidence interval [CI], 0.65-2.05, p = 0.62, I² =
94%, RR for major bleeding, 0.96, 95% CI, 0.66-1.40, p = 0.83,
I² = 0%). Likewise, no significant difference was found in
Group 2 between higher ACT values and lower ACT values (RR for MACE, 1.15,
95% CI, 0.97-1.35, p = 0.10, I² = 0%, RR for major bleeding,
0.85, 95% CI, 0.45-1.60, p = 0.61, I² = 83%). In conclusion,
ACT may not have a substantial effect on thrombotic or hemorrhagic
complications. Under current clinical practice, target ACT may be higher
than what is necessary to prevent thrombotic events. We may achieve a
relative low ACT level to preserve efficacy and enhance safety. Copyright
&#xa9; 2016 Elsevier Ltd

<95>
Accession Number
610916187
Author
Alkherayf F.; Xu Y.; Gandara E.; Westwick H.; Moldovan I.D.; Wells P.S.
Institution
(Alkherayf) Division of Neurosurgery, Department of Surgery, University of
Ottawa, Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON, Canada
(Alkherayf, Moldovan, Wells) Clinical Epidemiology Program, Ottawa
Hospital Research Institute, Ottawa, Canada
(Xu) School of Medicine, Queen's University, Kingston, Canada
(Gandara, Wells) Division of Hematology, Department of Medicine,
University of Ottawa, Ottawa, Canada
(Westwick) Division of Neurosurgery, Department of Surgery, Hopital du
Sacre-Coeur de Montreal, Montreal, Canada
Title
Timing of Vitamin K antagonist re-initiation following intracranial
hemorrhage in mechanical heart valves: Systematic review and
meta-analysis.
Source
Thrombosis Research. 144 (pp 152-157), 2016. Date of Publication: 01 Aug
2016.
Publisher
Elsevier Ltd
Abstract
Background While evidence supports resumption of vitamin K antagonists
(VKAs) among mechanical heart valve (MHV) patients presenting with
anticoagulant-associated intracranial hemorrhage (ICH), ideal timing of
resumption is uncertain. Objective To determine the optimal timing of VKA
re-initiation and its associated clinical outcomes. Methods We performed a
systematic review and a meta-analysis of studies published from January
1950 to August 2015. We extracted data on the location of initial ICH, use
of cranial surgery, presence of atrial fibrillation, MHV type and
position, number of MHVs, and timing of VKA resumption. Outcomes including
valve thrombosis, thromboembolic events or ICH recurrence were recorded.
Meta-regression analysis was conducting with controlling for covariates.
We calculated absolute risks, and assessed the effect of anticoagulant
resumption timing on ICH recurrence. Results 23 case-series and
case-reports were identified. Overall ICH recurrence was 13% (95%
confidence interval [CI], 7%-25%), while valve thrombosis and ischemic
strokes occurred at 7% (95% CI, 3%-17%) and 12% (95% CI, 5%-23%)
respectively. A trend towards lower ICH recurrence was observed with
delayed VKA resumption (slope estimate - 0.2154, p = 0.10). Recurrence
rate ranged from 50% with VKA resumption at 3 days to 0% with resumption
at 16 days. Conclusion Among patients with MHV, there is inadequate data
to suggest an optimal timing of VKA re-initiation following an ICH, though
delayed restart appears to be protective against recurrence but is
associated with higher risk of thrombosis. Our analysis suggests 4-7 days
might be an ideal time with least risk of thrombosis or ICH recurrence.
Copyright &#xa9; 2016 Elsevier Ltd.

<96>
Accession Number
613260169
Author
Joo H.J.; Cho S.-A.; Hong S.J.; Hur S.-H.; Bae J.-H.; Choi D.-J.; Ahn
Y.-K.; Park J.-S.; Choi R.-K.; Choi D.; Kim J.-H.; Han K.-R.; Park H.-S.;
Choi S.-Y.; Yoon J.-H.; Kwon H.-C.; Rha S.-W.; Hwang K.-K.; Jung K.-T.; Oh
S.-K.; Lee J.-H.; Shin E.-S.; Kim K.-S.; Kim H.-S.; Lim D.-S.
Institution
(Joo, Cho, Hong, Lim) Division of Cardiology, Korea University Anam
Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul 136-705, South Korea
(Hur) Division of Cardiology, Keimyung University Dongsan Medical Center,
Daegu, South Korea
(Bae) Division of Cardiology, Konyang University Hospital, Daejeon, South
Korea
(Choi) Division of Cardiology, Seoul National University Bundang Hospital,
Seongnam, South Korea
(Ahn) Division of Cardiology, Chonnam National University Hospital,
Gwangju, South Korea
(Park) Division of Cardiology, Yeungnam University Hospital, Daegu, South
Korea
(Choi) Division of Cardiology, Sejong General Hospital, Bucheon, South
Korea
(Choi) Division of Cardiology, Yonsei University Severance Hospital,
Seoul, South Korea
(Kim) Division of Cardiology, Pusan National University Yangsan Hospital,
Yangsan, South Korea
(Han) Division of Cardiology, Hallym University Kangdong Sacred Heart
Hospital, Seoul, South Korea
(Park) Division of Cardiology, Kyungpook National University Hospital,
Daegu, South Korea
(Choi) Division of Cardiology, Ajou University Hospital, Suwon, South
Korea
(Yoon) Division of Cardiology, Wonju Severance Christian Hospital, Wonju,
South Korea
(Kwon) Division of Cardiology, Samsung Medical Center, Seoul, South Korea
(Rha) Division of Cardiology, Korea University Guro Hospital, Seoul, South
Korea
(Hwang) Division of Cardiology, Chungbuk National University Hospital,
Cheongju, South Korea
(Jung) Division of Cardiology, Eulji University Hospital, Daejeon, South
Korea
(Oh) Division of Cardiology, Wonkwang University Hospital, Iksan, South
Korea
(Lee) Division of Cardiology, Chungnam National University Hospital,
Daejeon, South Korea
(Shin) Division of Cardiology, Ulsan University Hospital, Ulsan, South
Korea
(Kim) Division of Cardiology, Daegu Catholic University Medical Center,
Daegu, South Korea
(Kim) Division of Cardiology, Seoul National University Hospital, 101,
DaeHak-ro, JongRo-gu, Seoul 110-744, South Korea
Title
Impact of low high-density lipoprotein-cholesterol level on 2-year
clinical outcomes after acute myocardial infarction in patients with
diabetes mellitus.
Source
Lipids in Health and Disease. 15 (1) (pp 1-8), 2016. Date of Publication:
18 Nov 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: It is still unclear whether low high-density lipoprotein
cholesterol (HDL-C) affects cardiovascular outcomes after acute myocardial
infarction (AMI), especially in patients with diabetes mellitus. Methods:
A total of 984 AMI patients with diabetes mellitus from the DIabetic Acute
Myocardial InfarctiON Disease (DIAMOND) Korean multicenter registry were
divided into two groups based on HDL-C level on admission: normal HDL-C
group (HDL-C > 40 mg/dL, n = 519) and low HDL-C group (HDL-C < 40 mg/dL, n
= 465). The primary endpoint was 2-year major adverse cardiovascular
events (MACE), defined as a composite of cardiac death, non-fatal
myocardial infarction (MI), and target vessel revascularization (TVR).
Results: The median follow-up duration was 730 days. The 2-year MACE rates
were significantly higher in the low HDL-C group than in the normal HDL-C
group (MACE, 7.44% vs. 3.49%, p = 0.006; cardiac death, 3.72% vs. 0.97%, p
= 0.004; non-fatal MI, 1.75% vs. 1.55%, p = 0.806; TVR, 3.50% vs. 0.97%, p
= 0.007). Kaplan-Meier analysis revealed that the low HDL-C group had a
significantly higher incidence of MACE compared to the normal HDL-C group
(log-rank p = 0.013). After adjusting for conventional risk factors, Cox
proportional hazards analysis suggested that low HDL-C was an independent
risk predictor for MACE (hazard ratio [HR] 3.075, 95% confidence interval
[CI] 1.034-9.144, p = 0.043). Conclusions: In patients with diabetes
mellitus, low HDL-C remained an independent risk predictor for MACE after
adjusting for multiple risk factors during 2-year follow-up of AMI. Trial
registration: This study was the sub-analysis of the prospective
multi-center registry of DIAMOND (Diabetic acute myocardial infarction
Disease) in Korea. This is the observational study supported by Bayer
HealthCare, Korea. Study number is 15614. First patient first visit was 02
April 2010 and last patient last visit was 09 December 2013. Copyright
&#xa9; 2016 The Author(s).

<97>
Accession Number
609079292
Author
Valdis M.; Chu M.W.A.; Schlachta C.; Kiaii B.
Institution
(Valdis, Chu, Kiaii) Division of Cardiac Surgery, Department of Surgery,
Western University, London Health Sciences Centre, 339 Windermere Rd,
London, ON N6A 5A5, Canada
(Schlachta) Division of General Surgery, Department of Surgery, Western
University, London Health Sciences Centre, London, ON, Canada
Title
Evaluation of robotic cardiac surgery simulation training: A randomized
controlled trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 151 (6) (pp 1498-1505),
2016. Date of Publication: 01 Jun 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective To compare the currently available simulation training
modalities used to teach robotic surgery. Methods Forty surgical trainees
completed a standardized robotic 10-cm dissection of the internal thoracic
artery and placed 3 sutures of a mitral valve annuloplasty in porcine
models and were then randomized to a wet lab, a dry lab, a virtual reality
lab, or a control group that received no additional training. All groups
trained to a level of proficiency determined by 2 expert robotic cardiac
surgeons. All assessments were evaluated using the Global Evaluative
Assessment of Robotic Skills in a blinded fashion. Results Wet lab
trainees showed the greatest improvement in time-based scoring and the
objective scoring tool compared with the experts (mean, 24.9 +/- 1.7 vs
24.9 +/- 2.6; P =.704). The virtual reality lab improved their scores and
met the level of proficiency set by our experts for all primary outcomes
(mean, 24.9 +/- 1.7 vs 22.8 +/- 3.7; P =.103). Only the control group
trainees were not able to meet the expert level of proficiency for both
time-based scores and the objective scoring tool (mean, 24.9 +/- 1.7 vs
11.0 +/- 4.5; P <.001). The average duration of training was shortest for
the dry lab and longest for the virtual reality simulation (1.6 hours vs
9.3 hours; P <.001). Conclusions We have completed the first randomized
controlled trial to objectively compare the different training modalities
of robotic surgery. Our data demonstrate the significant benefits of wet
lab and virtual reality robotic simulation training and highlight key
differences in current training methods. This study can help guide
training programs in investing resources in cost-effective, high-yield
simulation exercises. Copyright &#xa9; 2016 by The American Association
for Thoracic Surgery.

<98>
Accession Number
614959242
Author
Hong S.J.; Ahn C.M.; Kim B.-K.; Ko Y.-G.; Hur S.-H.; Yu C.W.; Lee S.-J.;
Choi C.U.; Kim J.S.; Yoon J.S.; Hong Y.J.; Choi J.-W.; Choi S.-H.; Jang
Y.; Lim D.-S.
Institution
(Hong, Ahn, Yu, Lim) Department of Cardiology, Cardiovascular Center,
Korea University Anam Hospital, 126-1, 5ka, Anam-dong, Sungbuk-ku, Seoul
136-705, South Korea
(Ahn, Kim, Ko, Jang) Severance Cardiovascular Hospital, Yonsei University,
50-1, Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
(Hur) Keimyung University Dongsan Medical Center, 56 Dalseong-Ro, Jung-Gu,
Daegu 700-712, South Korea
(Lee) Soonchunhyang University Medical Center, 23-20, Byeongmyeong-dong,
Dongnam-gu, Cheonan, Chungcheongnam-do 31151, South Korea
(Choi) Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul
08308, South Korea
(Kim) Sejong General Hospital, Sosabon-dong, Sosa-gu, Bucheon-si,
Gyeonggi-do 14754, South Korea
(Yoon) Yonsei University Wonju College of Medicine, Wonju Christian
Hospital, 20 Ilsan-ro, Wonju, Gangwon-do, Wonju 220-701, South Korea
(Hong) Chonnam National University Hospital, 77 Yongbong-ro, Buk-gu,
Gwangju 500-757, South Korea
(Choi) Eulji General Hospital, 68 Hangeulbiseok-Ro, Nowon-Gu, Seoul 01830,
South Korea
(Choi) Samsung Medical Center, Sungkyunkwan University School of Medicine,
81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea
Title
Prospective randomized comparison of clinical and angiographic outcomes
between everolimus-eluting vs. zotarolimus-eluting stents for treatment of
coronary restenosis in drug-eluting stents:Intravascular ultrasound
volumetric analysis (RESTENT-ISR trial).
Source
European Heart Journal. 37 (45) (pp 3409-3418), 2016. Date of Publication:
2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims At present no proven standard treatment for drug-eluting stent (DES)
restenosis is available, and the efficacy and safety of everolimus-eluting
stent (EES) and zotarolimus-eluting stent (ZES) for DES restenosis are
limited. The purpose of this prospective, randomized 9-month intracoronary
ultrasound (IVUS) and 3-year clinical follow-up study was to compare the
effects of EESs and ZESs on neointima volume and major adverse
cardiovascular events (MACEs) such as death, myocardial infarction (MI),
target lesion revascularization (TLR) and stent thrombosis in DES
restenosis patients. Methods and results Patients were eligible for this
study if they were between 40 and 75 years old with in-stent
restenosis>50% by quantitative coronary angiographic analysis in DES or
within 5mm of the stent edges with signs of ischaemia. Eligible patients
(n=304, 146 women and 158 men) were randomly assigned to receive either
EES (158 patients) or ZES (146 patients). The primary endpoint of the
study was to compare neointima volume between the EES and ZES groups at
the 9-month follow-up IVUS. MACEs, including death, non-fatal MI, stent
thrombosis and the need for repeated TLR within 3 years, were noted. The
9-month angiographic and IVUS follow-up showed no significant differences
in late lumen loss (0.4060.56 vs. 0.4560.61 mm, P=0.57, respectively) and
neointima volume (0.5160.48 vs. 0.5660.54mm3/1 mm, P=0.47, respectively)
in the EES and the ZES groups. Composite MACEs such as death, MI, stent
thrombosis and TLR during 3-year follow-up were comparable between the two
groups [15.8% (n=25) in the EES group and 22.6% (n=33) in the ZES group,
P=0.276], independent of de novo DES type, sex, age, body mass index,
presence of diabetes, hypertension and dyslipidaemia. Conclusions Patients
with first- and second-generation DES restenosis, both EES and ZES
implantation were effective and safe in reducing neointima volume and late
loss with a comparable rate of MACEs independent of cardiovascular risk
factors. Copyright &#xa9; 2016 The Author All rights reserved.

<99>
Accession Number
614959240
Author
Ferenc M.; Gick M.; Comberg T.; Rothe J.; Valina C.; Toma A.; Loffelhardt
N.; Hochholzer W.; Riede F.; Kienzle R.-P.; Achtari A.; Neumann F.-J.
Institution
(Ferenc, Gick, Comberg, Rothe, Valina, Toma, Loffelhardt, Hochholzer,
Riede, Kienzle, Achtari, Neumann) Division of Cardiology and Angiology II,
University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
Title
Culotte stenting vs. TAP stenting for treatment of de-novo coronary
bifurcation lesions with the need for side-branch stenting: The
Bifurcations Bad Krozingen (BBK) II angiographic trial.
Source
European Heart Journal. 37 (45) (pp 3399-3405), 2016. Date of Publication:
2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims In percutaneous coronary intervention for de-novo coronary
bifurcation lesions, the optimal technique for provisional side-branch
stenting is still a matter of debate. We tested whether in this setting
culotte stenting reduces the incidence of restenosis as compared with
T-and-protrusion (TAP) stenting. Methods and Results This trial included
300 patients with a coronary bifurcation lesion requiring a side-branch
stent. Patients were randomly assigned to culotte stenting or TAP stenting
using drug-eluting stents in a 1:1 fashion. Primary endpoint was maximal
per cent diameter stenosis of the bifurcation lesion at 9-month
angiographic follow-up. As clinical endpoints we assessed target lesion
re-intervention (TLR) and target lesion failure (composite of cardiac
death, target vessel myocardial infarction, and TLR). Angiographic
follow-up was available in 91% of the patients. After culotte stenting,
the maximum per cent diameter stenosis in the treated bifurcation lesion
was 21620% as compared with 27625% after TAP stenting (P=0.038). The
respective corresponding binary restenosis rates were 6.5 and 17%
(P=0.006). The 1-year incidence of TLR was 6.0% after culotte stenting vs.
12.0% after T-stenting (P=0.069). Target lesion failure occurred in 6.7%
of the culotte group and in 12.0% of the TAP group (P=0.11). Only one
patient of the culotte group incurred a definite stent thrombosis during
1-year follow-up. Conclusions Compared with the TAP stenting, culotte
stenting was associated with a significantly lower incidence of
angiographic restenosis. Copyright &#xa9; 2016 The Author All rights
reserved.

<100>
Accession Number
614959238
Author
Yamaji K.; Raber L.; Zanchin T.; Spitzer E.; Zanchin C.; Pilgrim T.;
Stortecky S.; Moschovitis A.; Billinger M.; Schonenberger C.; Eberli F.;
Juni P.; Luscher T.F.; Heg D.; Windecker S.
Institution
(Yamaji, Raber, Zanchin, Spitzer, Zanchin, Pilgrim, Stortecky,
Moschovitis, Billinger, Schonenberger, Windecker) Department of
Cardiology, Bern University Hospital, Bern 3010, Switzerland
(Eberli) Department of Cardiology, Triemlispital, Zurich, Switzerland
(Juni) Applied Health Research Centre (AHRC), Department of Medicine and
Institute of Health Policy, Management and Evaluation, University of
Toronto, Toronto, ON, Canada
(Luscher) Department of Cardiology, University Hospital Zurich, Zurich,
Switzerland
(Heg) Institute of Social and Preventive Medicine and Clinical Trials
Unit, University of Bern, Bern, Switzerland
Title
Ten-year clinical outcomes of first-generation drug-eluting stents: The
Sirolimus-Eluting vs. Paclitaxel-Eluting Stents for Coronary
Revascularization (SIRTAX) VERY LATE trial.
Source
European Heart Journal. 37 (45) (pp 3386-3395), 2016. Date of Publication:
2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims Compared with bare metal stents, first-generation drug-eluting stents
(DES) are associated with an increased risk of late restenosis and stent
thrombosis (ST). Whether this risk continues or attenuates during
long-term follow-up remains unknown. Methods and results We extended the
follow-up of 1012 patients [sirolimus-eluting stent (SES): N=503 and
paclitaxel-eluting stent (PES): N=509] included in the all-comers,
randomized Sirolimus-Eluting vs. Paclitaxel-Eluting Stents for Coronary
Revascularization (SIRTAX) trial to 10 years. Follow-up was complete in
895 patients (88.4%) at 10 years. At 1, 5, and 10 years of follow-up,
rates of ischaemia-driven target lesion revascularization (ID-TLR) were
8.1%, 14.6% and 17.7%, respectively, and rates of ST were 1.9%, 4.5% and
5.6%, respectively. The annual risks of ID-TLR and definite ST were
significantly higher between 1 and 5 years as compared with the 5- to
10-year period [ID-TLR: 1.8% vs. 0.7%/year, hazard ratio (HR) 0.36, 95%
confidence intervals (95% CI) 0.21-0.62, P<0.001; definite ST: 0.67% vs.
0.23%/year, HR 0.31, 95% CI 0.13-0.75, P=0.01]. The attenuation of the
risk of ID-TLR and ST beyond 5 years was independent of age. Major adverse
events (cardiac death, myocardial infarction, and ID-TLR) occurred in
33.7% of SES- and 33.8% of PES-treated patients (P=0.72). Conclusions
During long-term follow-up through 10 years, the annual risks of ID-TLR
and definite ST significantly decreased beyond 5 years after
first-generation DES implantation. These findings may have important
implications for secondary prevention after percutaneous coronary
intervention with first-generation DES including long-term antiplatelet
therapy. Copyright &#xa9; 2016 The Author All rights reserved.

<101>
Accession Number
613342600
Author
Rabiu T.B.; Oshola H.A.; Adebayo B.O.
Institution
(Rabiu, Oshola) Division of Neurological Surgery Department of Surgery,
Ladoke Akintola University of Technology Teaching Hospital, Osogbo,
Nigeria
(Rabiu, Adebayo) Division of Neurological Surgery, Department of Surgery,
Federal Medical Centre, Ido Ekiti, Nigeria
Title
Survey of the Knowledge of Brainstem Death and Attitude Toward Organ
Donation Among Relations of Neurosurgical Patients in Nigeria.
Source
Transplantation Proceedings. 48 (6) (pp 1898-1903), 2016. Date of
Publication: 01 Jul 2016.
Publisher
Elsevier USA
Abstract
Background Organ transplantation is a developing field in Nigeria, and
availability of organs for donation would be a determining factor of the
success of the transplant programs. Patients with brainstem death (BSD)
are a major source of organs for transplantation. The level of knowledge
of BSD as well as attitudes toward organ donation are very important
determinants of people's willingness or otherwise to donate organs. We
conducted a survey of relations of our in-service neurosurgical patients
to assess their knowledge of brainstem death and attitude toward organ
donation. To our knowledge, this is the first study of its kind among the
growing Nigerian neurosurgery patient and patient-relations population.
Methods Convenience sampling of randomly selected relations of
neurosurgical patients on admission using interviewer-administered
questionnaires was performed. Demographic information and information
about brainstem death, attitude toward brainstem death, knowledge of organ
donation, and attitude toward organ donation were obtained. Results The
study comprised 127 respondents with a mean age of 36 years (range,
19-72). The majority of the respondents (87, 62.4%) were Christians, 122
(96.1%) were Yorubas, and 66 (52.0%) were women. Eighty-five (66.9%) of
the respondents had at least a secondary level of education, and 77
(60.6%) were of low socioeconomic status. Twenty-eight (22.2%) of the
respondents had heard of brainstem death. Twenty-six (92.9%) of those who
had heard of brainstem death believed that the brain could die long before
life finally ceases. One hundred twenty-five (98.4%) of the respondents
believed that death only occurs when both breathing and heartbeat stop,
and 107 (83.6%) would agree with the physician on a diagnosis of brainstem
death in the relation. Sixty-five (51.2%) would want such patients put on
a ventilator, and, of these, 43 (66.2%) would want such patients on the
ventilator in hope that he or she may recover. One hundred twelve (88.2%)
of the relations were aware of organ donation, 109 (85.8%) knew that the
kidney can be transplanted, and 27 (21.6%) and 17 (13.4%), respectively,
were aware of heart and cornea transplant. One hundred five (82.7%)
supported organ transplantation, 85 (66.9%) would donate an organ, and 97
(76.4%) would accept a transplanted organ. The majority of the respondents
(76, 59.8%) would generally not allow an organ to be taken from their
relation, although 70 (55.1%) would allow organ(s) to be harvested from
their relation if the person had consented to it before death. More men
are likely to donate organs and allow organs to be harvested from their
relations than were women. Likewise, respondents with at least a secondary
level of education had better awareness of brainstem death and were more
likely to donate organs and allow organs to be harvested from their
relations than were their less-educated counterparts. Conclusions The
knowledge of brainstem death was low among respondents, although most of
them would agree with the physician if such diagnosis was made for their
relation. Most of the respondents were aware of organ donation and
supported it, but the majority would not allow an organ to be harvested
from their relations. Hence, education of the Nigerian people about
brainstem death and organ donation is essential to increase the pool of
available organs for transplantation in our community. Copyright &#xa9;
2016 Elsevier Inc.

<102>
Accession Number
604479280
Author
Colli A.; Manzan E.; Rucinskas K.; Janusauskas V.; Zucchetta F.;
Zakarkaite D.; Aidietis A.; Gerosa G.
Institution
(Colli, Manzan, Zucchetta, Gerosa) Department of Cardiac, Thoracic and
Vascular Sciences, University of Padua, Via Giustiniani, 2, Padova 35128,
Italy
(Rucinskas, Janusauskas, Zakarkaite, Aidietis) Department of Cardiac
Surgery, University of Vilnius, Vilnius, Lithuania
Title
Acute safety and efficacy of the NeoChord procedure.
Source
Interactive Cardiovascular and Thoracic Surgery. 20 (5) (pp 575-581),
2015. Date of Publication: 01 May 2015.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES Transapical off-pump mitral valve repair using the NeoChord
device has been proposed to treat degenerative mitral valve regurgitation.
This prospective study sought to evaluate acute safety and efficacy of
this innovative, minimally invasive, transcatheter mitral valve repair
approach. METHODS Symptomatic patients with severe mitral regurgitation
(MR) were selected if they presented a favourable valve anatomy (the
presence of leaflet flail/prolapse with consistent overlap of tissue).
Early device success was defined as placement of at least two neochordae
with residual mitral regurgitation <2+ after the procedure. The primary
acute safety and efficacy end points were evaluated at 30 days. RESULTS
Between February 2013 and June 2014, in Padua and Vilnius University
Hospitals, a total of 62 patients were treated, with a median age of 66
years (IQR 52-76) and a median EuroSCORE I of 1.9% (IQR 0.9-6). Fifty-six
patients (88.9%) presented with a posterior leaflet prolapse, 4 (6%) with
an anterior leaflet prolapse and 3 (5%) with a combined disease. Early
procedural success was achieved in all patients. Two neochordae were
implanted in 2 patients (3%), 3 in 20 (32%), 4 in 28 (44%), 5 in 10 (16%),
6 in 2 (3%) and 7 in 1 (2%). At 30 days, major adverse events included
only 1 acute myocardial infarction (2%) successfully treated
percutaneously and 2 cases of sepsis (3%). Mitral regurgitation at 30 days
was absent in 29 patients (46%), Grade 1+ in 16 (25%), Grade 2+ in 10
(16%), Grade 3+ in 7 (11%) and Grade 4+ in 1 (2%). All 8 patients with MR
>2+ were successfully reoperated with conventional surgery or NeoChord
reintervention. CONCLUSIONS Initial results with the NeoChord procedure in
a small number of patients indicate that transapical off-pump mitral valve
repair is feasible and safe. Efficacy is maintained up to the 30-day
follow-up with significant clinical benefit for patients. Copyright &#xa9;
2015 &#xa9; The Author 2015. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<103>
Accession Number
604479269
Author
Toufektzian L.; Zisis C.; Balaka C.; Roussakis A.
Institution
(Toufektzian) Department of Thoracic Surgery, Guy's Hospital, Great Maze
Pond, London SE1 9RT, United Kingdom
(Zisis, Balaka, Roussakis) Department of Cardiothoracic Surgery,
Evangelismos General Hospital, Athens, Greece
Title
Effectiveness of brain natriuretic peptide in predicting postoperative
atrial fibrillation in patients undergoing non-cardiac thoracic surgery.
Source
Interactive Cardiovascular and Thoracic Surgery. 20 (5) (pp 654-657),
2015. Date of Publication: 01 May 2015.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic was written according to a structured protocol. The
question addressed was whether plasma brain natriuretic peptide (BNP)
levels could effectively predict the occurrence of postoperative atrial
fibrillation (AF) in patients undergoing non-cardiac thoracic surgery. A
total of 14 papers were identified using the reported search, of which 5
represented the best evidence to answer the clinical question. The
authors, date, journal, country, study type, population, outcomes and key
results are tabulated. All studies were prospective observational, and all
reported a significant association between BNP and N-terminal (NT)-proBNP
plasma levels measured in the immediate preoperative period and the
incidence of postoperative AF in patients undergoing either anatomical
lung resections or oesophagectomy. One study reported a cut-off value of
30 pg/ml above which significantly more patients suffered from
postoperative AF (P < 0.0001), while another one reported that this value
could predict postoperative AF with a sensitivity of 77% and a specificity
of 93%. Another study reported that patients with NT-proBNP levels of 113
pg/ml or above had an 8-fold increased risk of developing postoperative
AF. These findings support that BNP or NT-proBNP levels, especially when
determined during the preoperative period, if increased, are able to
identify patients at risk for the development of postoperative AF after
anatomical major lung resection or oesophagectomy. The same does not seem
to be true for lesser lung resections. These high-risk patients might have
a particular benefit from the administration of prophylactic
antiarrhythmic therapy. Copyright &#xa9; 2015 &#xa9; The Author 2015.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<104>
Accession Number
604479096
Author
Fouquet O.; Tariel F.; Desulauze P.; Mevel G.
Institution
(Fouquet) Department of Thoracic and Cardiovascular Surgery, University
Hospital, Centre Hospitalier Universitaire, 4 rue Larrey, Angers Cedex 9
49933, France
(Fouquet) CNRS UMR 6214, INSERM 1083, University of Angers, Angers, France
(Tariel, Desulauze, Mevel) School of Medicine, University of Angers,
Angers, France
Title
Does a skeletonized internal thoracic artery give fewer postoperative
complications than a pedicled artery for patients undergoing coronary
artery bypass grafting?.
Source
Interactive Cardiovascular and Thoracic Surgery. 20 (5) (pp 663-668),
2015. Date of Publication: 01 May 2015.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was 'Does a skeletonized
internal thoracic artery (ITA) give fewer postoperative complications than
a pedicled artery for patients undergoing coronary artery bypass
grafting?' Altogether, 98 papers were found using the reported search, of
which 11 represented the best evidence to answer the clinical question.
Papers about patency of skeletonized versus pedicled internal thoracic
artery were excluded. The analysed complications were essentially
mediastinitis, superficial sternal infection, wound infection, chest pain
and pulmonary function. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. Grafts used were either single ITA
(LITA or RITA, left or right, respectively) or bilateral ITAs (BITAs). One
prospective randomized controlled trial was identified, which found that
benefits of skeletonized harvesting included increased graft length,
increased graft flow and decreased incidence of mediastinitis. All of the
six studies concerning wound infection demonstrate fewer complications
when ITA is skeletonized. One of the three papers describing postoperative
mortality demonstrated lower 30-day mortality, but there was no long-term
analysis. Three studies describing postoperative chest pain reported a
lower score on the visual analogue scale (VAS) within 30 days. One of them
indicates that the pedicled group has a significantly greater VAS, pain
disability index and short-form McGill Pain questionnaire score at 1 and 3
months. The hospital stay was shorter for three studies conducted on this
subject. One study about pulmonary function reported a better ratio of
pre- versus postoperative values of forced vital capacity. Despite longer
operating times, skeletonization leads to fewer wound infections, reduced
chest pain, allows a shorter hospital stay and better preserves pulmonary
function. Copyright &#xa9; 2015 &#xa9; The Author 2015. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<105>
Accession Number
604479090
Author
Arrigoni S.C.; Mecozzi G.; Grandjean J.G.; Hillege J.L.; Kappetein A.P.;
Mariani M.A.
Institution
(Arrigoni, Mariani) Thoraxcenter, University Medical Center, Hanzeplein 1,
Groningen 9700 RB, Netherlands
(Mecozzi, Grandjean) Thoraxcenter Twente, Enschede, Netherlands
(Hillege) Department of Epidemiology, University Medical Center,
Groningen, Netherlands
(Kappetein) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
Title
Off-pump no-touch technique: 3-year results compared with the SYNTAX
trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 20 (5) (pp 601-604),
2015. Date of Publication: 01 May 2015.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES A 3-year follow-up of a retrospective, single-centre clinical
study of OPCAB (off-pump coronary artery bypass) no-touch technique with
arterial composite grafts and an indirect comparison with clinical
outcomes of the 3-year follow-up of the SYNTAX trial. METHODS A total of
400 consecutive patients ('all-comers') who underwent OPCAB no-touch
coronary surgery. Primary endpoint was 3-year MACCE (major adverse
cardiovascular and cerebrovascular events). These results were compared
with the randomized arms of the SYNTAX trial. RESULTS The observed 3-year
survival was 82.2%. The cumulative 3-year freedom from MACCE was 89.7%.
The percentage of MACCE was significantly lower (P < 0.001) in the OPCAB
no-touch group (10.3%) compared with both arms of the SYNTAX trial (20.2
and 28.0%, respectively). Repeat revascularization in the OPCAB no-touch
group (4.3%) was significantly lower (P < 0.001) compared with both arms
of the SYNTAX trial (10.7 and 19.7%, respectively). The percentage of
stroke was significantly lower (P = 0.032) in the OPCAB no-touch group
compared with the CABG arm in the SYNTAX trial (1.3 vs 3.4%). There was no
significant difference of stroke rate between the OPCAB no-touch group and
the PCI arm of the SYNTAX trial (1.3 vs 2%, P = 0.347). CONCLUSIONS The
results at the 3-year follow-up showed the safety and efficacy of OPCAB
no-touch technique. The OPCAB no-touch technique may improve patients'
outcome by minimizing the morbidity and the neurological complications.
Prospective controlled trials are needed to confirm these results.
Copyright &#xa9; 2015 &#xa9; The Author 2015. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<106>
[Use Link to view the full text]
Accession Number
615193814
Author
Gjovaag T.F.; Mirtaheri P.; Simon K.; Berdal G.; Tuchel I.; Westlie T.;
Bruusgaard K.A.; Nilsson B.B.; Hisdal J.
Institution
(Gjovaag) 1Faculty of Health Sciences, Department of Occupational Therapy,
Prosthetics and Orthotics, Oslo and Akershus University College, Oslo,
NORWAY; 2Faculty of Technology, Art and Design, Department of Industrial
Development, Oslo and Akershus University College, Oslo, NORWAY; 3Faculty
of Health Sciences, Department of Physiotherapy, Oslo and Akershus
University College, Oslo, NORWAY; 4Faculty of Medicine, Institute of
Health and Society, University of Oslo, Oslo, NORWAY; and 5Oslo Vascular
Centre, Oslo University Hospital, Aker, Oslo, NORWAY
Title
Hemodynamic Responses to Resistance Exercise in Patients with Coronary
Artery Disease.
Source
Medicine and science in sports and exercise. 48 (4) (pp 581-588), 2016.
Date of Publication: 01 Apr 2016.
Abstract
METHODS: Medically stable male (n = 11) and female patients (n = 4)
treated with PCI or percutaneous coronary intervention, or coronary artery
bypass surgery a minimum of 6 months before this study, performed three
sets of 15RM and 4RM RE in a randomized order on separate days.
Beat-to-beat systolic (SBP), diastolic (DBP) blood pressure, heart rate
(HR), stroke volume (SV), cardiac output (CO), and systemic vascular
resistance (SVR) were monitored at preexercise, and continuously during
RE.
RESULTS: Compared with preexercise, SBP and DBP (mean of three sets)
increased by 12% to 13% (both; P < 0.001) and 35% to 40% after 15RM RE
(both; P < 0.001). 15RM SBP and DBP were higher than 4RM SBP and DBP
(both; P < 0.001). The SBP of the fourth repetition of 15 RM RE was
similar to the SBP of the fourth repetition of 4RM RE. Compared with
preexercise, SV increased moderately after 4RM and 15 RM RE, respectively
(both, P < 0.001). HR increased more after 15RM compared with 4RM RE (P <
0.05); thus, higher CO after 15RM (compared with 4RM RE; P < 0.05) was
mainly caused by higher HR. SVR decreased by 15% (P < 0.001) and 50% (P <
0.01) after 4RM and 15RM RE.
CONCLUSIONS: SBP and DBP increased significantly more during moderate load
RE; thus, the magnitude of the external load is not the prime determinant
of the pressure response during RE. If management of blood pressure is of
concern, high load/low rep RE is preferable to medium load/high rep RE.
PURPOSE: Investigate hemodynamic responses of resistance exercise (RE)
with moderate load (i.e., international guidelines for RE of patients)
versus RE with high load in patients with coronary artery disease (CAD).

<107>
Accession Number
615207343
Author
Anderson L.; Nguyen T.T.; Dall C.H.; Burgess L.; Bridges C.; Taylor R.S.
Institution
(Anderson, Nguyen, Taylor) University of Exeter Medical School, Institute
of Health Research, Veysey Building, Salmon Pool Lane, Exeter EX2 4SG,
United Kingdom
(Dall) Bispebjerg Hospital, University of Copenhagen, Dept. of Cardiology,
Dept. of Physical Therapy and IOC Sports Institute Copenhagen, Bispebjerg
Bakke 23, Copenhagen, Denmark
(Burgess) Wythenshawe Hospital, University Hospital of South Manchester
NHS Foundation Trust, Cardiac Rehabilitation, Manchester, United Kingdom
(Bridges) University College London, Farr Institute of Health Informatics
Research, 222 Euston Road, London NW1 2DA, United Kingdom
Title
Exercise-based cardiac rehabilitation in heart transplant recipients.
Source
Cochrane Database of Systematic Reviews. 2017 (4) (no pagination), 2017.
Article Number: CD012264. Date of Publication: 04 Apr 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Heart transplantation is considered to be the gold standard
treatment for selected patients with end-stage heart disease when medical
therapy has been unable to halt progression of the underlying pathology.
Evidence suggests that aerobic exercise training may be effective in
reversing the pathophysiological consequences associated with cardiac
denervation and prevent immunosuppression-induced adverse effects in heart
transplant recipients. Objectives: To determine the effectiveness and
safety of exercise-based rehabilitation on the mortality, hospital
admissions, adverse events, exercise capacity, health-related quality of
life, return to work and costs for people after heart transplantation.
Search methods: We searched the Cochrane Central Register of Controlled
Trials (CENTRAL) in the Cochrane Library, MEDLINE (Ovid), Embase (Ovid),
CINAHL (EBSCO) and Web of Science Core Collection (Thomson Reuters) to
June 2016. We also searched two clinical trials registers and handsearched
the reference lists of included studies. Selection criteria: We included
randomised controlled trials (RCTs) of parallel group, cross-over or
cluster design, which compared exercise-based interventions with (i) no
exercise control (ii) a different dose of exercise training (e.g. low-
versus high-intensity exercise training); or (iii) an active intervention
(i.e. education, psychological intervention). The study population
comprised adults aged 18 years or over who had received a heart
transplant. Data collection and analysis: Two review authors independently
screened all identified references for inclusion based on pre-specified
inclusion criteria. Disagreements were resolved by consensus or by
involving a third person. Two review authors extracted outcome data from
the included trials and assessed their risk of bias. One review author
extracted study characteristics from included studies and a second author
checked them against the trial report for accuracy. Main results: We
included 10 RCTs that involved a total of 300 participants whose mean age
was 54.4 years. Women accounted for fewer than 25% of all study
participants. Nine trials which randomised 284 participants to receive
exercise-based rehabilitation (151 participants) or no exercise (133
participants) were included in the main analysis. One cross-over RCT
compared high-intensity interval training with continued
moderate-intensity training in 16 participants. We reported findings for
all trials at their longest follow-up (median 12 weeks). Exercise-based
cardiac rehabilitation increased exercise capacity (VO<inf>2peak</inf>)
compared with no exercise control (MD 2.49 mL/kg/min, 95% CI 1.63 to 3.36;
N = 284; studies = 9; moderate quality evidence). There was evidence from
one trial that high-intensity interval exercise training was more
effective in improving exercise capacity than continuous
moderate-intensity exercise (MD 2.30 mL/kg/min, 95% CI 0.59 to 4.01; N =
16; 1 study). Four studies reported health-related quality of life (HRQoL)
measured using SF-36, Profile of Quality of Life in the Chronically Ill
(PLC) and the World Health Organization Quality Of Life (WHOQoL) - BREF.
Due to the variation in HRQoL outcomes and methods of reporting we were
unable to meta-analyse results across studies, but there was no evidence
of a difference between exercise-based cardiac rehabilitation and control
in 18 of 21 HRQoL domains reported, or between high and moderate intensity
exercise in any of the 10 HRQoL domains reported. One adverse event was
reported by one study. Exercise-based cardiac rehabilitation improves
exercise capacity, but exercise was found to have no impact on
health-related quality of life in the short-term (median 12 weeks
follow-up), in heart transplant recipients whose health is stable. There
was no evidence of statistical heterogeneity across trials for exercise
capacity and no evidence of small study bias. The overall risk of bias in
included studies was judged as low or unclear; more than 50% of included
studies were assessed at unclear risk of bias with respect to allocation
concealment, blinding of outcome assessors and declaration of conflicts of
interest. Evidence quality was assessed as moderate according to GRADE
criteria. Authors' conclusions: We found moderate quality evidence
suggesting that exercise-based cardiac rehabilitation improves exercise
capacity, and that exercise has no impact on health-related quality of
life in the short-term (median 12 weeks follow-up), in heart transplant
recipients. Cardiac rehabilitation appears to be safe in this population,
but long-term follow-up data are incomplete and further good quality and
adequately-powered trials are needed to demonstrate the longer-term
benefits of exercise on safety and impact on both clinical and
patient-related outcomes, such as health-related quality of life, and
healthcare costs. Copyright &#xa9; 2017 The Cochrane Collaboration.
Published by John Wiley & Sons, Ltd.

<108>
Accession Number
615270224
Author
Ranucci M.
Institution
(Ranucci) Department of Cardiothoracic and Vascular Anesthesia and ICU,
IRCCS Policlinico San Donato, Milan, Italy
Title
The Hidden Traps of Meta-Analyses on Cardiac Surgery Mortality Risk
Scores.
Source
American Journal of Cardiology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)

<109>
Accession Number
615266779
Author
Sardar P.; Giri J.; Elmariah S.; Chatterjee S.; Kolte D.; Kundu A.;
Nairooz R.; Aronow W.S.; Owan T.; Mukherjee D.; Feldman D.N.; Abbott J.D.
Institution
(Sardar, Owan) Division of Cardiovascular Medicine, University of Utah,
Salt Lake City, Utah
(Giri) Cardiovascular Division, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania
(Elmariah) Cardiology Division, Department of Medicine, Massachusetts
General Hospital, Harvard Medical School, Boston, Massachusetts
(Chatterjee) Cardiology Division, Temple University School of Medicine,
Philadelphia, Pennsylvania
(Kolte, Abbott) Division of Cardiology, Brown Medical School, Rhode Island
Hospital, Providence, Rhode Island
(Kundu) Department of Medicine, University of Massachusetts Medical
School, Worcester, Massachusetts
(Nairooz) Division of Cardiovascular Medicine, University of Arkansas for
Medical Sciences, Little Rock, Arizona
(Aronow) Division of Cardiovascular Medicine, Westchester Medical
Center-New York Medical College, New York, New York
(Mukherjee) Division of Cardiovascular Medicine, Texas Tech University
Health Sciences Center, El Paso, Texas
(Feldman) Division of Cardiology, New York Presbyterian Hospital, Weill
Cornell Medical College, New York, New York
Title
Meta-Analysis of Drug-Eluting Stents Versus Coronary Artery Bypass
Grafting in Unprotected Left Main Coronary Narrowing.
Source
American Journal of Cardiology. (no pagination), 2017. Date of
Publication: January 14, 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Patients with unprotected left main coronary artery (ULMCA) disease are
increasingly treated with percutaneous coronary intervention (PCI) using
new-generation drug-eluting stents (DES); however, the benefits of DES
compared with coronary artery bypass grafting (CABG) in ULMCA remain
controversial. This meta-analysis evaluated the effects of PCI with DES
compared with CABG for the treatment of ULMCA stenosis. Databases were
searched through November 30, 2016. Randomized controlled trials (RCTs)
comparing DES with PCI versus CABG for ULMCA stenosis were identified. We
calculated summary odds ratios (ORs) and 95% CIs with the random-effects
model. The primary outcome was major adverse cardiovascular events,
defined as a composite of death from any cause, stroke, or myocardial
infarction (MI). The analysis included 4,612 patients from 5 RCTs.
Compared with CABG, patients assigned to PCI had a similar rate of major
adverse cardiovascular events (OR 1.06, 95% CI 0.79 to 1.43), all-cause
mortality (OR 1.03, 95% CI 0.79 to 1.35), cardiovascular death (OR 1.03,
95% CI 0.73 to 1.45), stroke (OR 0.81, 95% CI 0.38 to 1.76), and MI (OR
1.47, 95% CI 0.87 to 2.47). The risk of any repeat revascularization was
significantly greater in the PCI group than that in the CABG group (OR
1.85, 95% CI 1.53 to 2.24). In conclusion, our meta-analysis of RCTs
suggest that PCI with DES results in comparable mortality, stroke, and MI
compared with CABG for revascularization of ULMCA stenosis, with PCI
associated with higher rates of repeat revascularization. Copyright &#xa9;
2017 Elsevier Inc.

<110>
Accession Number
615259904
Author
Hayek S.S.; Corrigan F.E.; Condado J.F.; Lin S.; Howell S.; MacNamara
J.P.; Zheng S.; Keegan P.; Thourani V.; Babaliaros V.C.; Lerakis S.
Institution
(Hayek, Corrigan, Condado, Lin, Howell, Keegan, Babaliaros, Lerakis)
Division of Cardiology, Emory University School of Medicine, Atlanta,
Georgia
(MacNamara) Division of Internal Medicine, Emory University School of
Medicine, Atlanta, Georgia
(Zheng) Department of Bioinformatics, Emory University, Atlanta, Georgia
(Thourani) Division of Cardiothoracic Surgery, Emory University School of
Medicine, Atlanta, Georgia
Title
Paravalvular Regurgitation after Transcatheter Aortic Valve Replacement:
Comparing Transthoracic versus Transesophageal Echocardiographic Guidance.
Source
Journal of the American Society of Echocardiography. (no pagination),
2017. Date of Publication: 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is increasingly
being performed in cardiac catheterization laboratories using
transthoracic echocardiography (TTE) to guide valve deployment. The risk
of paravalvular regurgitation (PVR) remains a concern. Methods: We
retrospectively reviewed 454 consecutive patients (mean age, 82 +/- 8; 58%
male) who underwent transfemoral TAVR at Emory Healthcare from 2007 to
2014. Two hundred thirty-four patients underwent TAVR in the cardiac
catheterization laboratory with TTE guidance (TTE-TAVR; mean Society of
Thoracic Surgeons score, 10%), while 220 patients underwent the procedure
in the hybrid operating room with transesophageal echocardiography (TEE)
guidance (TEE-TAVR; mean Society of Thoracic Surgeons score, 11%). All
patients received an Edwards valve (SAPIEN 55%, SAPIEN-XT 45%). Clinical
and procedural characteristics, echocardiographic parameters, and
incidence of PVR were compared. Results: The incidence of at least mild
PVR at discharge was comparable between TTE-TAVR and TEE-TAVR (33% vs 38%,
respectively; P = .326) and did not differ when stratified by valve type.
However, in the TTE-TAVR group, there was a higher incidence of second
valve implantation (7% vs 2%; P = .026) and postdilation (38% vs 17%; P <
.001) during the procedure. Although not independently associated with PVR
at discharge (odds ratio = 1.12; 95% CI, 0.69-1.79), TTE-TAVR was
associated with PVR-related events: the combined outcome of mild PVR at
discharge, intraprocedural postdilation, and second valve insertion (odds
ratio = 1.58; 95% CI, 1.01-2.46). There were no significant differences in
PVR at 30 days, 6 months, and 1 year between the two groups. Conclusions:
TTE-TAVR in a high-risk group of patients was associated with increased
incidence of intraprocedure PVR-related events, although it was not
associated with higher rates of PVR at follow-up. Multicenter randomized
trials are required to confirm the cost-effectiveness and safety of
TTE-TAVR. Copyright &#xa9; 2017 American Society of Echocardiography.

<111>
Accession Number
613819706
Author
Prodhan P.; Agarwal A.; ElHassan N.O.; Bolin E.H.; Beam B.; Garcia X.;
Gaies M.; Tang X.
Institution
(Prodhan, Bolin, Beam, Garcia) Pediatric Cardiology, University of
Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock,
Arkansas, United States
(Prodhan, Garcia) Pediatric Critical Care, University of Arkansas for
Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas,
United States
(Agarwal) Pulmonary Medicine, University of Arkansas for Medical Sciences,
Arkansas Children's Hospital, Little Rock, Arkansas, United States
(ElHassan) Neonatology, University of Arkansas for Medical Sciences,
Arkansas Children's Hospital, Little Rock, Arkansas, United States
(Gaies) Pediatric Cardiology, University of Michigan, C.S. Mott Children's
Hospital, Ann Arbor, Michigan, United States
(Tang) Biostatistics, University of Arkansas for Medical Sciences,
Arkansas Children's Hospital, Little Rock, Arkansas, United States
Title
Tracheostomy Among Infants With Hypoplastic Left Heart Syndrome Undergoing
Cardiac Operations: A Multicenter Analysis.
Source
Annals of Thoracic Surgery. 103 (4) (pp 1308-1314), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Elsevier USA
Abstract
Background Less than 2.7% of infants undergoing congenital heart disease
operations have difficulty weaning from invasive mechanical ventilation.
In such instances, clinicians may choose to perform tracheostomy. Limited
literature has examined tracheostomy placement specifically in infants
with hypoplastic left heart syndrome (HLHS). This study evaluated the risk
factors for tracheostomy placement in infants with HLHS and examined the
outcomes of these infants before their first hospital discharge. Methods
This retrospective analysis of the Pediatric Heath Information System data
set included infants with HLHS who underwent stage 1 Norwood operation, a
hybrid procedure, or heart transplant from 2004 through 2013. Results We
identified 5721 infants with HLHS, and 126 underwent tracheostomy
placement. Infants in the tracheostomy group had more morbidities and a
higher mortality rate across the study period. Diagnosis of chromosomal
abnormalities, anomalies of the trachea and esophagus, larynx, diaphragm
and nervous system, bilateral vocal cord paralysis, and necrotizing
enterocolitis, and procedures including extracorporeal membrane
oxygenation support, cardiac catheterization, and gastrostomy tube were
independently associated with tracheostomy placement in the study
population. Despite an overall increase in rates of tracheostomy performed
in infants with HLHS during the study period, the mortality rate did not
improve among tracheostomy patients. Conclusions Several risk factors were
identified in infants with HLHS in whom a tracheostomy was placed during
their first hospitalization. Despite an overall increase in rates of
tracheostomies during the study period, the mortality rate did not improve
among these patients. Appropriate family counseling and thorough
preoperative case selection is suggested when discussing possible
tracheostomy placement in infants with HLHS. Copyright &#xa9; 2017 The
Society of Thoracic Surgeons

<112>
Accession Number
614181939
Author
Guan C.; Xu B.; Qiao S.; Qin L.; Li Y.; Li Z.; Guo Y.; Sun Z.; Song L.;
Gao R.
Institution
(Guan, Xu, Qiao, Sun, Song, Gao) Department of Cardiology, Fu Wai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences, Beijing, China
(Qin) Department of Cardiology, Kaifeng Central Hospital, Kaifeng, China
(Li) Department of Cardiology, Yunnan St. John's Hospital, Kunming, China
(Li) Department of Cardiology, Liaoning Provincial People's Hospital,
Shenyang, China
(Guo) Department of Cardiology, Dazhou Central Hospital, Dazhou, China
Title
Comparison of two biodegradable-polymer-based sirolimus-eluting stents
with varying elution and absorption kinetics in patients with acute
myocardial infarction: A subgroup analysis of the PANDA III trial.
Source
Catheterization and Cardiovascular Interventions. 89 (pp 520-527), 2017.
Date of Publication: 01 Mar 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Implantation of early-generation metallic drug-eluting stents
(DES) in patients with acute myocardial infarction (AMI) is associated
with poor vessel wall healing. Use of biodegradable polymer (BP) DES might
improve safety outcomes; however, the impact of varying drug elution and
polymer absorption kinetics of BP-DES on clinical outcomes in the AMI
population is unknown. Methods: This subgroup analysis of the randomized
PANDA III trial included 732 patients (366 in each group) presenting with
recent (<1 month) AMI. Primary endpoint was 1-year target lesion failure
(TLF), a composite of cardiac death, target vessel myocardial infarction
(MI), or ischemia-driven target lesion revascularization. Secondary
endpoints included a patient-oriented composite endpoint (PoCE) of
all-cause death, all MI, or any revascularization; individual TLF and PoCE
components; and definite/probable stent thrombosis (ST). Results: There
were no significant differences between-groups in baseline clinical,
angiographic, or procedural characteristics other than the proportion of
post-dilatation, which was performed more frequently with the BuMA stent
(53.9% vs. 44.5%; P = 0.004). After 1 year, compared to Excel SES
implantation in patients with AMI, BuMA was associated with similar
incidences of TLF and PoCE (5.5% vs. 8.3%, P = 0.14; 8.8% vs. 9.9%, P =
0.61, respectively) but lower incidences of MI (2.5% vs. 6.1%, P = 0.02),
target vessel MI (2.2% vs. 5.8%, P = 0.01), and definite/probable ST (0.3%
vs. 2.2%, P = 0.04). Conclusions: BuMA SES, with faster drug elution rate
and polymer absorption kinetics, might improve safety outcomes compared to
Excel SES in the high-risk AMI population. &#xa9; 2017 Wiley Periodicals,
Inc. Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<113>
Accession Number
615039650
Author
Nederlof R.; Weber N.C.; Juffermans N.P.; de Mol B.A.M.J.; Hollmann M.W.;
Preckel B.; Zuurbier C.J.
Institution
(Nederlof, Weber, Hollmann, Preckel, Zuurbier) Academic Medical Center,
Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.),
Department of Anesthesiology, Amsterdam, Netherlands
(Juffermans) Academic Medical Center, Laboratory of Experimental Intensive
Care and Anesthesiology (L.E.I.C.A.), Department of Intensive Care
Medicine, Amsterdam, Netherlands
(de Mol) Academic Medical Center, Department of Cardiothoracic Surgery,
Amsterdam, Netherlands
(Zuurbier) University of Amsterdam, Academic Medical Center, Meibergdreef
9, Amsterdam 1105 AZ, Netherlands
Title
A randomized trial of remote ischemic preconditioning and control
treatment for cardioprotection in sevoflurane-anesthetized CABG patients.
Source
BMC Anesthesiology. 17 (1) (no pagination), 2017. Article Number: 51. Date
of Publication: 29 Mar 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Remote ischemic preconditioning (RIPC) efficacy is debated.
Possibly, because propofol, which has a RIPC-inhibiting action, is used in
most RIPC trials. It has been suggested that clinical efficacy is,
however, present with volatile anesthesia in the absence of propofol,
although this is based on one phase 1 trial only. Therefore, in the
present study we further explore the relation between RIPC and
cardioprotection with perioperative anesthesia restricted to sevoflurane
and fentanyl, in CABG patients without concomitant procedures. Methods: In
a single-center study, we aimed to randomize 46 patients to either RIPC
(3x5 min inflation of a blood pressure cuff around the arm) or control
treatment (deflated cuff around the arm). Blood samples were obtained
before and after RIPC to evaluate potential RIPC-induced mediators
(Interleukin (IL)-6, IL-10, Tumor Necrosis Factor-alpha, Macrophage
Inhibitory Factor). An atrial tissue sample was obtained at cannulation of
the appendix of the right atrium for determination of mitochondrial bound
hexokinase II (mtHKII) and other survival proteins (Akt and AMP-activated
protein kinase alpha). In blood samples taken before and 6, 12 and 24 h
after surgery cardiac troponin T (cTnT) and C-reactive protein (CRP) were
determined. Surgery was strictly performed under sevoflurane anesthesia
(no propofol). Results: We actually randomized 16 patients to control
treatment and 13 patients to RIPC. The mean 24 h area under the curve
(AUC) cTnT was 11.44 (standard deviation 4.66) in the control group and
10.90 (standard deviation 4.73) in the RIPC group (mean difference 0.54,
95% CI -3.06 to 4.13; p = 0.76). The mean 24 h AUC CRP was 1319 (standard
deviation 92) in the control group and 1273 (standard deviation 141) in
the RIPC group (mean difference 46.2, 95% CI -288 to 380; p = 0.78). RIPC
was without effect on survival proteins in atrial tissue samples obtained
before surgery (mitochondrial hexokinase, Akt and AMPK) and inflammatory
mediators obtained before and immediately after RIPC (IL-6, IL-10,
TNF-alpha, macrophage migration inhibitory factor). Conclusion: Many
factors can interfere with the outcome of RIPC. Trying to correct for this
led to strict inclusion criteria, which, in combination with a decreased
institutional frequency of CABG without concomitant procedures and a
change in institutional anesthetic regimen away from volatile anesthetics
towards total intravenous anesthesia, caused slow inclusion and halting of
this trial after 3 years, before target inclusion could be reached.
Therefore this study is underpowered to prove its primary goal that RIPC
reduced AUC cTnT by < 25%. Nevertheless, we have shown that the effect of
RIPC on 24 h AUC cTnT, in cardiac surgery with anesthesia during surgery
restricted to sevoflurane/fentanyl (no propofol), was between a decrease
of 27% and an increase of 36%. These findings are not in line with
previous studies in this field. Trial registration: The Netherlands Trial
Register: NTR2915 ; Registered 25 Mei 2011. Copyright &#xa9; 2017 The
Author(s).

<114>
Accession Number
614075979
Author
Gozdek M.; Pawliszak W.; Hagner W.; Zalewski P.; Kowalewski J.; Paparella
D.; Carrel T.; Anisimowicz L.; Kowalewski M.
Institution
(Gozdek, Pawliszak, Anisimowicz, Kowalewski) Department of Cardiac
Surgery, Dr Antoni Jurasz Memorial University Hospital in Bydgoszcz,
Bydgoszcz, Poland
(Gozdek, Zalewski, Kowalewski) Department of Hygiene, Epidemiology and
Ergonomics, Division of Ergonomics and Physical Effort, Collegium Medicum
UMK in Bydgoszcz, Bydgoszcz, Poland
(Hagner) Chair and Clinic of Rehabilitation, Faculty of Health Sciences,
Nicolaus Copernicus University in Torun, Torun, Poland
(Kowalewski) Lung Cancer and Thoracic Surgery Department, Collegium
Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
(Paparella) Division of Cardiac Surgery, Department of Emergency and Organ
Transplant, University of Bari Aldo Moro, Bari, Italy
(Carrel) Clinic for Cardiovascular Surgery, University Hospital and
University of Bern, Bern, Switzerland
Title
Systematic review and meta-analysis of randomized controlled trials
assessing safety and efficacy of posterior pericardial drainage in
patients undergoing heart surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (4) (pp 865-875),
2017. Date of Publication: 01 Apr 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives To investigate the potential beneficial effects of posterior
pericardial drainage in patients undergoing heart surgery. Methods
Multiple online databases and relevant congress proceedings were screened
for randomized controlled trials assessing the efficacy and safety of
posterior pericardial drainage, defined as posterior pericardiotomy
incision, chest tube to posterior pericardium, or both. Primary endpoint
was in-hospital/30 days' cardiac tamponade. Secondary endpoints comprised
death or cardiac arrest, early and late pericardial effusion,
postoperative atrial fibrillation (POAF), acute kidney injury, pulmonary
complications, and length of hospital stay. Results Nineteen randomized
controlled trials that enrolled 3425 patients were included. Posterior
pericardial drainage was associated with a significant 90% reduction of
the odds of cardiac tamponade compared with the control group: odds ratio
(95% confidence interval) 0.13 (0.07-0.25); P < .001. The corresponding
event rates were 0.42% versus 4.95%. The odds of early and late
pericardial effusion were reduced significantly in the intervention arm:
0.20 (0.11-0.36); P < .001 and 0.05 (0.02-0.10); P < .001, respectively.
Posterior pericardial drainage significantly reduced the odds of POAF by
58% (P < .001) and was associated with significantly shortened (by nearly
1 day) overall length of hospital stay (P < .001). Reductions in
postoperative complications translated into significantly reduced odds of
death or cardiac arrest (P = .03) and numerically lower odds of acute
kidney injury (P = .08). Conclusions Posterior pericardial drainage is
safe and simple technique that significantly reduces not only the
prevalence of early pericardial effusion and POAF but also late
pericardial effusion and cardiac tamponade. These benefits, in turn,
translate into improved survival after heart surgery. Copyright &#xa9;
2016 The American Association for Thoracic Surgery

<115>
Accession Number
613951017
Author
Anderson B.R.; Blancha V.L.; Duchon J.M.; Chai P.J.; Kalfa D.; Bacha E.A.;
Krishnamurthy G.; Ratner V.
Institution
(Anderson) Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan
Stanley Children's Hospital, Columbia University Medical Center, New York,
NY, United States
(Krishnamurthy, Ratner) Division of Neonatology,
NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia
University Medical Center, New York, NY, United States
(Blancha) Columbia University College of Physicians and Surgeons, New
York, NY, United States
(Duchon) Division of Pediatric Infectious Disease,
NewYork-Presbyterian/Morgan Stanley Children's Hospital, New York, NY,
United States
(Chai, Kalfa, Bacha) Division of Cardiothoracic Surgery, Columbia
University College of Physicians and Surgeons, New York, NY, United States
Title
The effects of postoperative hematocrit on shunt occlusion for neonates
undergoing single ventricle palliation.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (4) (pp 947-955),
2017. Date of Publication: 01 Apr 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives Our primary objective was to test the effects of first
postoperative hematocrit on early shunt occlusion for children undergoing
systemic to pulmonary artery shunt placement. Because any intervention to
reduce shunt occlusion is only beneficial if it reduces mortality or is,
at least, mortality neutral, we also tested the effects of first
postoperative hematocrit on in-hospital mortality. Methods We conducted a
retrospective study on all neonates who underwent primary systemic to
pulmonary artery shunt placement, with or without a
Norwood/Damus-Kaye-Stansel procedure, at Columbia University Medical
Center between January 2010 and July 2015. Univariable regression was used
to test the effects of first postoperative hematocrit on early shunt
occlusion and 30-day mortality, clustering standard errors by surgeon. In
secondary analyses, we also tested associations between red blood cell
transfusion volumes in the first 24 postoperative hours and first
postoperative hematocrit, shunt occlusion, and mortality. Results Eighty
infants met inclusion criteria. Median initial postoperative hematocrit
was 41.7% (interquartile range, 37.9-46.0). Six infants (7.5%) died. Four
infants (5.0%) died within the first 30 days. Five infants (6.3%)
experienced early shunt occlusion. No children with early shunt occlusion
died. In univariable models, for every 5 additional percentage points of
hematocrit, an infant's odds of early shunt occlusion more than doubled
(odds ratio, 2.70; P = .009). The odds of all-cause 30-day mortality
remained unchanged. Conclusions Higher postoperative hematocrit levels are
associated with early shunt occlusions in infants undergoing primary
systemic to pulmonary artery shunt placement. Multicenter investigations
are warranted to validate these findings and to determine ideal
postoperative hematocrit targets for this population. Copyright &#xa9;
2016 The American Association for Thoracic Surgery

<116>
Accession Number
615204195
Author
Jose J.; Sulimov D.S.; El-Mawardy M.; Sato T.; Allali A.; Holy E.W.;
Becker B.; Landt M.; Kebernik J.; Schwarz B.; Richardt G.; Abdel-Wahab M.
Institution
(Jose, Sulimov, El-Mawardy, Sato, Allali, Holy, Becker, Landt, Kebernik,
Schwarz, Richardt, Abdel-Wahab) Heart Center, Segeberger Kliniken
(Academic Teaching Hospital of the Universities of Kiel, Lubeck, and
Hamburg), Bad Segeberg, Germany
(Jose) Christian Medical College Hospital, Vellore, Tamil Nadu, India
(Sato) Tachikawa General Hospital, Nagaoka, Japan
Title
Clinical Bioprosthetic Heart Valve Thrombosis After Transcatheter Aortic
Valve Replacement: Incidence, Characteristics, and Treatment Outcomes.
Source
JACC: Cardiovascular Interventions. 10 (7) (pp 686-697), 2017. Date of
Publication: 10 Apr 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to determine the incidence,
characteristics, and treatment outcomes of patients diagnosed with
clinical transcatheter heart valve thrombosis. Background Limited data
exists on clinical or manifest transcatheter heart valve thrombosis. Prior
studies have focused on subclinical thrombosis. Methods A retrospective
analysis was conducted of prospectively collected data from a
single-center registry that included 642 consecutive patients who
underwent transcatheter aortic valve replacement between 2007 and 2015
(305 patients had self-expanding valves; balloon-expandable, n = 281;
mechanically expanding, n = 56). Long-term oral anticoagulation (OAC) was
indicated in 261 patients, while 377 patients received dual-antiplatelet
therapy post-procedure. All patients underwent scheduled clinical and
echocardiographic follow-up. Results The overall incidence of clinical
valve thrombosis was 2.8% (n = 18). No patient on OAC developed
thrombosis. Of the detected thrombosis cases, 13 patients had
balloon-expandable, 3 had self-expanding, and 2 had mechanically expanding
valves. Thrombosis occurred significantly more often with
balloon-expandable valves (odds ratio: 3.45; 95% confidence interval: 1.22
to 9.81; p = 0.01) and following valve-in-valve procedures (odds ratio:
5.93; 95% confidence interval: 2.01 to 17.51; p = 0.005). Median time to
diagnosis of valve thrombosis was 181 days. The median N-terminal
pro-brain natriuretic peptide level was 1,318 pg/ml (interquartile range:
606 to 1,676 pg/ml). The mean transvalvular gradient and valve area were
34 +/- 14 mm Hg and 1.0 +/- 0.46 cm², respectively. Computed
tomography showed hypoattenuating areas with reduced leaflet motion.
Initiation of OAC resulted in significant reduction of transvalvular
gradient and clinical improvement. No deaths were related to valve
thrombosis. Conclusions Clinical transcatheter heart valve thrombosis is
more common than previously considered, characterized by imaging
abnormalities and increased gradients and N-terminal pro-brain natriuretic
peptide levels. It occurred more commonly after balloon-expandable
transcatheter aortic valve replacement and valve-in-valve procedures. OAC
appeared to be effective in the prevention and treatment of valve
thrombosis. Randomized control trials are needed to define optimal
antithrombotic therapy after transcatheter aortic valve replacement.
Copyright &#xa9; 2017 American College of Cardiology Foundation

<117>
Accession Number
614202058
Author
Wang G.; Xu B.; Yang Y.; Yang Z.; Li H.; Zhang Z.; Wang H.; Yang L.; Han
Y.
Institution
(Wang, Wang, Han) Department of Cardiology, General Hospital of Shenyang
Military Region, Shenyang, China
(Xu, Yang) Department of Cardiology, Cardiovascular Institute and Fu Wai
Hospital, Beijing, China
(Yang) Department of Cardiology, The 2nd Affiliated Hospital of Shanxi
Medical University, Taiyuan, China
(Li) Department of Cardiology, Daqing Oilfield General Hospital, Daqing,
China
(Zhang) Department of Cardiology, The First Hospital of Lanzhou
University, Lanzhou, China
(Wang) Department of Cardiology, Affiliated 1st Hospital of The Fourth
Military Medical University, Xi'an, China
(Yang) Department of Cardiology, General Hospital of Chengdu Military
Region, Kunming, China
Title
Efficacy and safety of a biodegradable polymer Cobalt-Chromium
sirolimus-eluting stent (EXCEL2) in treating de novo coronary artery
disease: A pooled analysis of the CREDIT II and CREDIT III trials.
Source
Catheterization and Cardiovascular Interventions. 89 (pp 512-519), 2017.
Date of Publication: 01 Mar 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: The safety and efficacy of the second-generation biodegradable
polymer Cobalt-Chromium sirolimus-eluting stent (EXCEL2) in daily clinical
practice remains unknown. Additionally, to meet the China Food and Drug
Administration requirements, we conducted an objective performance
criterion study from the CREDIT II and CREDIT III trials. Methods: CREDIT
II was a randomized trial comparing the EXCEL2 versus EXCEL stent in
patients with up to 2 de novo coronary lesions. CREDIT III was a
prospective, single-arm study evaluating the efficacy and safety of EXCEL2
in broad types of de novo coronary artery lesions. This pooled analysis
included patients in the CREDIT III and EXCEL2 arm of the CREDIT II trial.
The primary outcome was 12-month target lesion failure (TLF), a composite
of cardiac death, target vessel myocardial infarction (TV-MI), and
clinical indicated target lesion revascularization (CI-TLR). The
patient-oriented composite endpoint (PoCE) of all-cause death, all MI, or
any revascularization was also analyzed. Results: A total of 833 patients
were included, consisting of 625 in the CREDIT III trial and 208 in the
EXCEL2 arm of the CREDIT II trial. Twelve-month TLF occurred in 6.1%
patients, cardiac death in 0.4%, TV-MI in 5%, and CI-TLR in 1.1%.
Additionally, 64 (7.7%) PoCE and 3 probable late stent thromboses (0.4%)
were recorded. Conclusion: EXCEL2 stent met the objective performance
criterion on efficacy and safety with a low level of 12-month TLF as well
as stent thrombosis when treating patients with de novo coronary lesions.
&#xa9; 2017 Wiley Periodicals, Inc. Copyright &#xa9; 2017 Wiley
Periodicals, Inc.

<118>
Accession Number
614831848
Author
Bhatt D.L.; Steg P.G.; Brinton E.A.; Jacobson T.A.; Miller M.; Tardif
J.-C.; Ketchum S.B.; Doyle R.T.; Murphy S.A.; Soni P.N.; Braeckman R.A.;
Juliano R.A.; Ballantyne C.M.
Institution
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center and Harvard
Medical School, Boston, MA, United States
(Steg) FACT (French Alliance for Cardiovascular Trials), an F-CRIN
network, Departement Hospitalo-Universitaire FIRE, AP-HP, Hopital Bichat,
Universite Paris-Diderot, INSERM U-1148, Paris, France
(Steg) NHLI, Imperial College, Royal Brompton Hospital, London, United
Kingdom
(Brinton) Utah Foundation for Biomedical Research, and Utah Lipid Center,
Salt Lake City, United States
(Jacobson) Office of Health Promotion and Disease Prevention, Department
of Medicine, Emory University School of Medicine, Atlanta, GA, United
States
(Miller) Department of Medicine, University of Maryland School of
Medicine, Baltimore, United States
(Tardif) Montreal Heart Institute, Universite de Montreal, QC, Canada
(Ketchum, Doyle, Soni, Braeckman, Juliano) Amarin Pharma Inc., Bedminster,
NJ, United States
(Soni) Albireo Pharma, Boston, MA, United States
(Braeckman) KemPharm, Inc., Celebration, FL, United States
(Murphy) TIMI Study Group, Cardiovascular Division, Department of
Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston,
MA, United States
(Ballantyne) Department of Medicine, Baylor College of Medicine, and
Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and
Vascular Center, Houston, TX, United States
Title
Rationale and design of REDUCE-IT: Reduction of Cardiovascular Events with
Icosapent Ethyl-Intervention Trial.
Source
Clinical Cardiology. 40 (3) (pp 138-148), 2017. Date of Publication: 01
Mar 2017.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Residual cardiovascular risk persists despite statins, yet outcome studies
of lipid-targeted therapies beyond low-density lipoprotein cholesterol
(LDL-C) have not demonstrated added benefit. Triglyceride elevation is an
independent risk factor for cardiovascular events. High-dose
eicosapentaenoic acid (EPA) reduces triglyceride-rich lipoproteins without
raising LDL-C. Omega-3s have postulated pleiotropic cardioprotective
benefits beyond triglyceride-lowering. To date, no large, multinational,
randomized clinical trial has proved that lowering triglycerides on top of
statin therapy improves cardiovascular outcomes. The Reduction of
Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT;
NCT01492361) is a phase 3b randomized, double-blinded, placebo-controlled
trial of icosapent ethyl, a highly purified ethyl ester of EPA, vs
placebo. The main objective is to evaluate whether treatment with
icosapent ethyl reduces ischemic events in statin-treated patients with
high triglycerides at elevated cardiovascular risk. REDUCE-IT enrolled men
or women age >45 years with established cardiovascular disease or age >50
years with diabetes mellitus and 1 additional risk factor. Randomization
required fasting triglycerides >150 mg/dL and <500 mg/dL and LDL-C >40
mg/dL and <100 mg/dL with stable statin (+/- ezetimibe) >4 weeks prior to
qualifying measurements. The primary endpoint is a composite of
cardiovascular death, nonfatal myocardial infarction, nonfatal stroke,
coronary revascularization, or unstable angina. The key secondary endpoint
is the composite of cardiovascular death, nonfatal myocardial infarction,
or nonfatal stroke. Several secondary, tertiary, and exploratory endpoints
will be assessed. Approximately 8000 patients have been randomized at
approximately 470 centers worldwide. Follow-up will continue in this
event-driven trial until approximately 1612 adjudicated primary-efficacy
endpoint events have occurred. Copyright &#xa9; 2017 The Authors. Clinical
Cardiology published by Wiley Periodicals, Inc.

<119>
Accession Number
614680135
Author
Tadphale S.D.; Tang X.; ElHassan N.O.; Beam B.; Prodhan P.
Institution
(Tadphale) Pediatric Cardiology, Department of Pediatrics, University of
Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis,
Tennessee, United States
(Tadphale) Pediatric Critical Care, Department of Pediatrics, University
of Tennessee Health Science Center, Le Bonheur Children's Hospital,
Memphis, Tennessee, United States
(Tang) Department of Biostatistics, University of Arkansas for Medical
Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, United
States
(ElHassan) Department of Neonatology, University of Arkansas for Medical
Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, United
States
(Beam, Prodhan) Department of Pediatric Cardiology, University of Arkansas
for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas,
United States
(Prodhan) Department of Pediatric Critical Care, University of Arkansas
for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas,
United States
Title
Cavopulmonary Anastomosis During Same Hospitalization as Stage 1
Norwood/Hybrid Palliative Surgery.
Source
Annals of Thoracic Surgery. 103 (4) (pp 1285-1291), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Elsevier USA
Abstract
Background Limited literature has examined characteristics of infants with
hypoplastic left heart syndrome (HLHS) who remain hospitalized during the
interstage period. We described their epidemiologic characteristics,
in-hospital outcomes, and identified risk factors that predict the need
for superior cavopulmonary anastomosis (SCPA) during the same
hospitalization. Methods This retrospective multicenter database analysis
included infants with HLHS who underwent stage 1 palliation from 2004
through 2013. Results Among 5374 infants with HLHS, 314 (5.8%) underwent
SCPA during the same hospitalization as stage 1 palliation. They had a
higher incidence of baseline comorbidities, complications, and
interventions than infants who were discharged. Despite an overall
increase in need for SCPA in the same hospitalization across different
eras, there was no significant statistical difference in mortality in the
two groups in the same era. Septicemia, necrotizing enterocolitis,
modified Blalock-Taussig shunt, cardiac catheterization, cardiopulmonary
resuscitation, extracorporeal membrane oxygenation, gastrostomy tube, and
antiarrhythmic agents were independently associated with increased odds of
undergoing SCPA during the same hospitalization. Patients undergoing right
ventricle to pulmonary artery shunt were less likely to remain
hospitalized until stage 2 palliation. Nonsurvivors in the SCPA group had
greater need for interventions and worse intensive care unit outcomes.
Conclusions Infants with HLHS who remain hospitalized after stage 1 until
their stage 2 palliation differ significantly from infants who were
discharged. Several clinical characteristics, comorbidities, and need for
interventions are associated with the likelihood for undergoing stage 2
palliation during the same hospitalization. Timely identification and
intervention of adjustable causes of heart failure may improve outcomes.
Copyright &#xa9; 2017 The Society of Thoracic Surgeons

<120>
Accession Number
614881081
Author
Kedhi E.; Fabris E.; van der Ent M.; Kennedy M.W.; Buszman P.; von
Birgelen C.; Cook S.; Wedel H.; Zijlstra F.
Institution
(Kedhi, Fabris, Kennedy) Isala Hartcentrum, Zwolle, Netherlands
(Fabris) Cardiovascular Department, University of Trieste, Trieste, Italy
(van der Ent) Maasstad Ziekenhuis, Rotterdam, Netherlands
(Buszman) American Heart of Poland, Ustron, Poland
(von Birgelen) University of Twente, Enschede, Netherlands
(Cook) Department of Cardiology, University & Hospital, Fribourg,
Switzerland
(Wedel) Sahlgrenska Academy, University of Gothenburg, Nordic School of
Public Health, Gothenburg, Sweden
(Zijlstra) Erasmus Medisch Centrum, Rotterdam, Netherlands
Title
A prospective, randomized, open-label trial of 6-month versus 12-month
dual antiplatelet therapy after drug-eluting stent implantation in
ST-elevation myocardial infarction: Rationale and design of the
"DAPT-STEMI trial".
Source
American Heart Journal. 188 (pp 11-17), 2017. Date of Publication: 01 Jun
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background The optimal duration of dual antiplatelet therapy (DAPT) after
percutaneous coronary intervention with second-generation drug eluting
stents (DESs) is unclear. Because prolonged DAPT is associated with higher
bleeding risk and health care costs, establishing optimal DAPT duration is
of paramount importance. No other randomized controlled trials have
evaluated the safety of shorter DAPT duration in ST-elevation myocardial
infarction (STEMI) patients treated with second-generation DESs and latest
P2Y12 platelet receptor inhibitors. Hypothesis Six months of DAPT after
Resolute Integrity stent implantation in STEMI patients is not inferior to
12 months of DAPT in clinical outcomes. Study design The Dual Antiplatelet
Therapy After Drug-Eluting Stent Implantation In ST-elevation Myocardial
Infarction (DAPT-STEMI) trial is a randomized, multicenter, international,
open-label trial designed to examine the safety (noninferiority) of
6-month DAPT after Resolute Integrity stent implantation in STEMI patients
compared with 12-month DAPT. Event-free patients on DAPT at 6month will be
randomized (1:1 fashion) between single (aspirin only) versus DAPT for an
additional 6 months and followed until 2 years after primary percutaneous
coronary intervention. The primary end point is a patient-oriented
composite endpoint of all-cause mortality, any myocardial infarction, any
revascularization, stroke, and major bleeding (net adverse clinical events
[NACE]) at 18 months after randomization. To achieve a power of 85% for a
noninferiority limit of 1.66, a total of 1100 enrolled patients are
required. Summary The DAPT-STEMI trial aims to assess in STEMI patients
treated with second-generation DESs whether discontinuation of DAPT after
6 months of event-free survival is noninferior to routine 12-month DAPT.
Copyright &#xa9; 2017 Elsevier Inc.

<121>
Accession Number
614666953
Author
Ferguson M.K.; Bennett C.
Institution
(Ferguson) Department of Surgery, University of Chicago, Chicago,
Illinois, United States
(Ferguson) Comprehensive Cancer Center, University of Chicago, Chicago,
Illinois, United States
(Bennett) Centre for Technology Enabled Health Research, Coventry
University, Coventry, United Kingdom
Title
Identification of Essential Components of Thoracoscopic Lobectomy and
Targets for Simulation.
Source
Annals of Thoracic Surgery. 103 (4) (pp 1322-1329), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Elsevier USA
Abstract
Background Fewer than 50% of lobectomies for lung cancer are performed
using thoracoscopic (video-assisted thoracic surgery [VATS]) techniques.
This situation could be mitigated through the use of simulation training.
Using a Delphi process, this study identified essential components of VATS
right upper lobectomy most amenable to focused simulation. Methods
Experienced VATS surgeons were randomly selected for participation. A
custom Internet interface permitted anonymous voting, commenting, and the
ability to modify and propose new components. A component was declared
essential when 80% or more of the study participants agreed or strongly
agreed on this designation. Participants rated each component for
difficulty and then voted for components that were most appropriate for
simulation. Results Thirty-five surgeons initially agreed to participate,
and 30 completed the study. Twenty-four components were identified after
three votes, and 21 of these components were considered essential.
Procedural components that scored the highest for overall difficulty and
that were deemed most appropriate for focused simulation included division
of the truncus anterior, division of the posterior segmental artery,
division of the upper lobe vein, and division of the upper lobe bronchus.
Conclusions A Delphi approach enabled surgeons of disparate training
backgrounds and experience to agree on essential components of a VATS
lobectomy. There was agreement on the components that are most appropriate
for simulation. These findings can be used to design simulation exercises
for VATS lobectomy by using targeted anatomy. Copyright &#xa9; 2017 The
Society of Thoracic Surgeons

<122>
Accession Number
613945281
Author
Allen K.B.; Thourani V.H.; Naka Y.; Grubb K.J.; Grehan J.; Patel N.; Guy
T.S.; Landolfo K.; Gerdisch M.; Bonnell M.; Cohen D.J.
Institution
(Allen) Department of Cardiothoracic Surgery, Saint Luke's Mid America
Heart Institute and University of Missouri-Kansas City School of Medicine,
Kansas City, Mo, United States
(Cohen) Department of Cardiology, Saint Luke's Mid America Heart Institute
and University of Missouri-Kansas City School of Medicine, Kansas City,
Mo, United States
(Thourani) Department of Cardiothoracic Surgery, Emory University,
Atlanta, Ga, United States
(Naka) Department of Cardiothoracic Surgery, Columbia University Medical
Center, New York, NY, United States
(Grubb) Department of Cardiothoracic Surgery, University of Louisville,
Louisville, Ky, United States
(Grehan) Department of Cardiothoracic Surgery, Allina Health, Saint Paul,
Minn, United States
(Patel) Department of Cardiothoracic Surgery, Lenox Hill Hospital, New
York, NY, United States
(Guy) Department of Cardiothoracic Surgery, Temple University,
Philadelphia, Pa, United States
(Landolfo) Department of Cardiothoracic Surgery, Mayo Clinic,
Jacksonville, Fla, United States
(Gerdisch) Department of Cardiothoracic Surgery, Franciscan St. Francis
Health, Indianapolis, Ind, United States
(Bonnell) Department of Cardiothoracic Surgery, University of Toledo,
Toledo, Ohio, United States
Title
Randomized, multicenter trial comparing sternotomy closure with rigid
plate fixation to wire cerclage.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (4) (pp 888-896),
2017. Date of Publication: 01 Apr 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective To evaluate sternal healing, complications, and costs after
sternotomy closure with rigid plate fixation or wire cerclage. Methods
This prospective, single-blinded, multicenter trial randomized 236
patients at 12 US centers at the time of sternal closure to either rigid
plate fixation (n = 116) or wire cerclage (n = 120). The primary endpoint,
sternal healing at 6 months, was evaluated by a core laboratory using
computed tomography and a 6-point scale (greater scores represent greater
healing). Secondary endpoints included sternal complications and costs
from the time of sternal closure through 6 months. Results Rigid plate
fixation resulted in better sternal healing scores at 3 (2.6 +/- 1.1 vs
1.8 +/- 1.0; P < .0001) and 6 months (3.8 +/- 1.0 vs 3.3 +/- 1.1; P =
.0007) and greater sternal union rates at 3 (41% [42/103] vs 16% [16/102];
P < .0001) and 6 months (80% [81/101] vs 67% [67/100]; P = .03) compared
with wire cerclage. There were fewer sternal complications through 6
months with rigid plate fixation (0% [0/116] vs 5% [6/120]; P = .03) and a
trend towards fewer sternal wound infections (0% [0/116] vs 4.2% [5/120];
P = .06) compared with wire cerclage. Although rigid plate fixation was
associated with a trend toward greater index hospitalization costs
($23,437 vs $20,574; P = .11), 6-month follow-up costs tended to be lower
($9002 vs $13,511; P = .14). As a result, total costs from randomization
through 6 months were similar between groups ($32,439 vs $34,085; P =
.61). Conclusions Sternotomy closure with rigid plate fixation resulted in
significantly better sternal healing, fewer sternal complications, and no
additional cost compared with wire cerclage at 6 months after surgery.
Copyright &#xa9; 2016 The American Association for Thoracic Surgery

<123>
Accession Number
614949867
Author
Cavaca R.; Teixeira R.; Vieira M.J.; Goncalves L.
Institution
(Cavaca, Teixeira, Goncalves) Faculdade de Medicina, Universidade de
Coimbra, Coimbra, Portugal
(Teixeira, Goncalves) Servico de Cardiologia, Centro Hospitalar e
Universitario de Coimbra - Hospital Geral, Coimbra, Portugal
(Vieira) Servico de Cardiologia, Hospital de Santarem, Santarem, Portugal
Title
Paradoxical aortic stenosis: A systematic review.
Source
Revista Portuguesa de Cardiologia. 36 (4) (pp 287-305), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Sociedade Portuguesa de Cardiologia (E-mail: secretariado@mail.spc.pt)
Abstract
Aortic stenosis (AS) is a complex systemic valvular and vascular disease
with a high prevalence in developed countries. The new entity "paradoxical
low-flow, low-gradient aortic stenosis" refers to cases in which patients
have severe AS based on assessment of aortic valve area (AVA) (<1
cm²) or indexed AVA (<0.6 cm²/m²), but
paradoxically have a low mean transvalvular gradient (<40 mmHg) and a low
stroke volume index (<35 ml/m²), despite preserved left
ventricular ejection fraction (>50%). A search was carried out in the
PubMed database on paradoxical AS for the period 2007-2014. A total of 57
articles were included for this review. The prevalence of paradoxical AS
ranged from 3% to 35% of the population with severe degenerative AS. It
was more frequent in females and in older patients. Paradoxical AS was
associated with characteristic left ventricular remodeling as well as an
increase in systemic arterial stiffness. It was noted that there may be
errors and inaccuracies in the calculation of AVA by the continuity
equation, which could erroneously suggest the paradoxical phenotype. There
are new diagnostic methods to facilitate the study of AS, such as aortic
valve calcium score, valvuloarterial impedance and the longitudinal
mechanics of the left ventricle. With regard to its natural history, it is
not clear whether paradoxical AS corresponds to an advance stage of the
disease or if paradoxical AS patients have a distinct phenotype with
specific characteristics. Valve replacement, either surgical or
percutaneous, may be indicated in patients with severe and symptomatic
paradoxical AS. Copyright &#xa9; 2016 Sociedade Portuguesa de Cardiologia

<124>
Accession Number
613930457
Author
Bunge J.J.; Doevendans P.A.; Suyker W.J.; Bredee J.J.; Buhre W.F.;
Dieleman J.M.; van Dijk D.; van Herwerden L.A.; Kalkman C.J.; van
Klarenbosch J.; Moons K.G.; Nathoe H.M.; Numan S.C.; Ottens T.H.; Roes
K.C.; Sauer A.-M.C.; Slooter A.J.; van Osch D.; Jacob K.A.; Nierich A.P.;
Ennema J.J.; Rosseel P.M.; van der Meer N.J.; van der Maaten J.M.; Cernak
V.; Hofland J.; van Thiel R.J.; Diephuis J.C.; Schepp R.M.; Haenen J.; de
Lange F.; Boer C.; de Jong J.R.; Tijssen J.G.
Institution
(van Osch, Doevendans, Nathoe) Department of Cardiology, University
Medical Center Utrecht, Utrecht, Netherlands
(Dieleman, van Dijk) Department of Anesthesiology and Intensive Care,
University Medical Center Utrecht, Utrecht, Netherlands
(Suyker) Department of Cardiothoracic Surgery, University Medical Center
Utrecht, Utrecht, Netherlands
(Bunge) Department of Intensive Care, Erasmus Medical Center, Rotterdam,
Netherlands
Title
Risk factors and prognosis of postpericardiotomy syndrome in patients
undergoing valve surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (4) (pp 878-885.e1),
2017. Date of Publication: 01 Apr 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective The study aim was to investigate the long-term prognosis and
risk factors of postpericardiotomy syndrome (PPS). Methods We performed a
single-center cohort study in 822 patients undergoing nonemergent valve
surgery. Risk factors of PPS were evaluated using multivariable logistic
regression analysis. We also compared the incidence of reoperation for
tamponade at 1 year between patients with and without PPS. Main secondary
outcomes were hospital stay and mortality. Results Of the 822 patients,
119 (14.5%) developed PPS. A higher body mass index (odds ratio (OR) per
point increase, 0.94; 95% confidence interval (CI), 0.89-0.99) was
associated with a lower risk of PPS, whereas preoperative treatment for
pulmonary disease without corticosteroids (OR, 2.55; 95% CI, 1.25-5.20)
was associated with a higher risk of PPS. The incidence of reoperation for
tamponade at 1 year in PPS versus no PPS was 20.9% versus 2.5% (OR, 15.49;
95% CI, 7.14-33.58). One-year mortality in PPS versus no PPS was 4.2%
versus 5.5% (OR, 0.68; 95% CI, 0.22-2.08). Median hospital stay was 13
days (interquartile range, 9-18 days) versus 11 days (interquartile range,
8-15 days) (P = .001), respectively. Conclusions Despite longer hospital
stays and more short-term reoperations for tamponade, patients with PPS
had an excellent 1-year prognosis. Copyright &#xa9; 2016 The American
Association for Thoracic Surgery

<125>
Accession Number
615134233
Author
Healy D.; Clarke-Moloney M.; Gaughan B.; O'Daly S.; Hausenloy D.; Sharif
F.; Newell J.; O'Donnell M.; Grace P.; Forbes J.F.; Cullen W.; Kavanagh
E.; Burke P.; Cross S.; Dowdall J.; McMonagle M.; Fulton G.; Manning B.J.;
Kheirelseid E.A.; Leahy A.; Moneley D.; Naughton P.; Boyle E.; McHugh S.;
Madhaven P.; O'Neill S.; Martin Z.; Courtney D.; Tubassam M.; Sultan S.;
McCartan D.; Medani M.; Walsh S.
Institution
(Healy, Kavanagh, Burke) Department of Vascular Surgery, University
Hospital Limerick, Saint Nessan's Road, Dooradoyle, Limerick, Ireland
(Clarke-Moloney, Grace, Forbes, Cullen) University of Limerick,
Castletroy, Limerick, Ireland
(Gaughan) National Cardiovascular and Stroke Research Network, Irish Heart
Foundation, 50 Ringsend Road, Dublin, Ireland
(O'Daly) National Cardiovascular and Stroke Research Network, Irish Heart
Foundation, 50 Ringsend Road, Dublin, Ireland. sodaly@irishheart.ie
(Hausenloy) The Hatter Cardiovascular Institute, University College
London, 67 Chenies Mews, London, WC1E 6HX, UK
(Sharif) NUI Galway, University Road, Galway, Ireland
(Newell, O'Donnell, Walsh) Health Research Board Clinical Research
Facility Galway, National University of Ireland, Galway, Geata an Eolais,
University Road, Galway, Ireland
(Cross, Dowdall, McMonagle) Waterford Regional Hospital, Dunmore Road,
Waterford, Ireland
(Fulton, Manning) Cork University Hospital, Corcaigh, Wilton, Co. Cork,
Ireland
(Kheirelseid) Department of Vascular Surgery, University Hospital
Limerick, Saint Nessan's Road, Dooradoyle, Limerick, Ireland.
rashmed1111@gmail.com
(Leahy, Moneley, Naughton) Beaumont Hospital, Beaumont Road, Dublin 9,
Ireland
(Boyle, McHugh) Department of Vascular Surgery, Beaumont Hospital,
Beaumont Road, Dublin 9, Ireland
(Madhaven, O'Neill, Martin) St. James's Hospital, James Street, Dublin 8,
Ireland
(Courtney, Tubassam, Sultan) Galway University Hospital, Newcastle Road,
Galway, Ireland
(McCartan, Medani) Department of Vascular Surgery, Waterford Regional
Hospital, Dunmore Road, Waterford, Ireland
Title
Preconditioning Shields Against Vascular Events in Surgery (SAVES), a
multicentre feasibility trial of preconditioning against adverse events in
major vascular surgery: study protocol for a randomised control trial.
Source
Trials. 16 (pp 185), 2015. Date of Publication: 23 Apr 2015.
Abstract
BACKGROUND: Patients undergoing vascular surgery procedures constitute a
'high-risk' group. Fatal and disabling perioperative complications are
common. Complications arise via multiple aetiological pathways. This
mechanistic redundancy limits techniques to reduce complications that
target individual mechanisms, for example, anti-platelet agents. Remote
ischaemic preconditioning (RIPC) induces a protective phenotype in at-risk
tissue, conferring protection against ischaemia-reperfusion injury
regardless of the trigger. RIPC is induced by repeated periods of upper
limb ischaemia-reperfusion produced using a blood pressure cuff. RIPC
confers some protection against cardiac and renal injury during major
vascular surgery in proof-of-concept trials. Similar trials suggest
benefit during cardiac surgery. Several uncertainties remain in advance of
a full-scale trial to evaluate clinical efficacy. We propose a feasibility
trial to fully evaluate arm-induced RIPC's ability to confer protection in
major vascular surgery, assess the incidence of a proposed composite
primary efficacy endpoint and evaluate the intervention's acceptability to
patients and staff.
METHODS/DESIGN: Four hundred major vascular surgery patients in five Irish
vascular centres will be randomised (stratified for centre and procedure)
to undergo RIPC or not immediately before surgery. RIPC will be induced
using a blood pressure cuff with four cycles of 5 minutes of ischaemia
followed by 5 minutes of reperfusion immediately before the start of
operations. There is no sham intervention. Participants will undergo serum
troponin measurements pre-operatively and 1, 2, and 3 days
post-operatively. Participants will undergo 12-lead electrocardiograms
pre-operatively and on the second post-operative day. Predefined
complications within one year of surgery will be recorded. Patient and
staff experiences will be explored using qualitative techniques. The
primary outcome measure is the proportion of patients who develop elevated
serum troponin levels in the first 3 days post-operatively. Secondary
outcome measures include length of hospital and critical care stay,
unplanned critical care admissions, death, myocardial infarction, stroke,
mesenteric ischaemia and need for renal replacement therapy (within 30
days of surgery).
DISCUSSION: RIPC is novel intervention with the potential to significantly
improve perioperative outcomes. This trial will provide the first
evaluation of RIPC's ability to reduce adverse clinical events following
major vascular surgery.
TRIAL REGISTRATION: www.clinicaltrials.gov NCT02097186 Date Registered: 24
March 2014.

<126>
Accession Number
615211068
Author
Dogan M.; Yasar M.; Gokahmetoglu G.; Guneri E.; Ozcan I.
Institution
(Dogan, Yasar, Guneri, Ozcan) Department of ENT, Kayseri Training and
Research Hospital, Kayseri, Turkey
(Gokahmetoglu) Department of Anesthesiology, Kayseri Training and Research
Hospital, Kayseri, Turkey
Title
Assessment of hearing via otoacoustic emission in patients that underwent
spinal anesthesia.
Source
European Review for Medical and Pharmacological Sciences. 20 (7) (pp
1224-1228), 2016. Date of Publication: 2016.
Publisher
Verduci Editore (E-mail: g.lombardi@verduci.it)
Abstract
OBJECTIVE: In this study, our aim is to show the differences between the
preoperative and postoperative otoacoustic emissions (OAE) value in
patients, who underwent spinal anesthesia. PATIENTS AND METHODS: The
presented study was carried out as a randomized, doubleblinded,
prospective study upon the approval of Ethics Committee of Medicine
School, Erciyes University. The study was conducted in accordance with the
Helsinki Declaration. The study involved 39 ASA I-II patients (aged 18-65
years), who underwent varicectomy operation in the Cardiovascular Surgery
Department. For each of the patients, 3 OAE measurements were performed;
the day before surgery, during surgery and the 1st day after surgery.
RESULTS: Significant differences were detected between the 2000 F2
measurements performed before, during and after the surgery (p<0.05). The
differences originated from measurements performed before and during
surgery. Significant differences were detected among 3000 F1 measurements
performed before, during and after surgery (p<0.05). Hearing loss is one
of the late complications of spinal anesthesia. In this study, we observed
the differences between the preoperative and postoperative OAE values. The
incidence of hearing loss detectable with auditory measurements has been
reported to vary between 10 and 50%. Of these, 25% is clinically relevant
or recognizable. However, it is considered to be a subjective test,
because it is influenced from mental, motor and psychological status of
the patient. But the management in hearing loss following spinal
anesthesia is still controversial. Hearing loss is generally spontaneously
resolved within a few days. However, there are case reports of hearing
loss lasting for months. CONCLUSIONS: In this study, we observed
differences between some preoperative and postoperative OAE values.

<127>
Accession Number
615179737
Author
Xiao L.-B.; Zhang Y.-H.; Zhou J.-W.; Yang M.; Ling Y.-P.; Gao Z.-S.; Wang
Y.-S.
Institution
(Xiao, Zhang, Zhou, Yang) Cardio-Thoracic Surgery Department, Cangzhou
Center Hospital, Cangzhou, China
(Ling) Cardiac Surgery Department Peking University People's Hospital,
Beijing, China
(Gao, Wang) Department of Cardiology, Cangzhou Center Hospital, Cangzhou,
China
Title
The clinical research of off-pump coronary artery bypass grafting by small
incision at the left chest.
Source
European Review for Medical and Pharmacological Sciences. 20 (2) (pp
305-310), 2016. Date of Publication: 2016.
Publisher
Verduci Editore (E-mail: g.lombardi@verduci.it)
Abstract
OBJECTIVE: To explore the clinical value of off-pump coronary artery
bypass grafting by small incision at the left chest, and develop a better
surgical regimen for coronary heart disease patients. PATIENTS AND
METHODS: 201 coronary heart disease patients who need coronary artery
bypass grafting were required and randomly divided into 2 groups including
a control group and an observation group. There were 107 cases in the
control group who received coronary bypass grafting by extracorporeal
circulation; there were 103 cases in the observation group who received
off-pump coronary bypass grafting by small incision at the left chest. The
duration of the mechanism ventilation, length of stay in ICU,
hospitalization time, postoperative drainage volume, and the occurrence
rate of complications were recorded and compared. RESULTS: The duration of
mechanism ventilation, length of stay in ICU, hospitalization time and
postoperative drainage volume in the control group were (19.21 +/- 1.33)
hours, (5.08 +/- 0.57) days, (21.20 +/- 2.34) days and (997.68 +/- 96.35)
mL, which were (7.73 +/- 0.74) hours, (2.83 +/- 0.16) days, (15.67 +/-
1.18) days and (901.53 +/- 89.32) mL in the observation group
respectively, with statistical difference between the two groups (p<0.05).
The occurrence rates of renal insufficiency and arrhythmia were both 6.54%
and 0.97% in the control group and the observation group, respectively.
The occurrence rates of postoperative renal insufficiency and arrhythmia
in the observation group were both significantly lower than those in the
control group, with statistical significance analysis (p < 0.05).
Postoperative low cardiac output, second thoracotomy, cerebrovascular
disease, pulmonary infection, perioperative cardiac infarction and
mortality did not display a significant difference between the two groups
(p > 0.05). CONCLUSIONS: Off-pump coronary artery bypass grafting by small
incision at the left chest is a surgical method with less injury and fast
recovery, which can be used as the preferred therapeutical method for the
coronary heart disease patients who need coronary artery bypass grafting.

<128>
Accession Number
615245066
Author
Biancari F.; Dalen M.; Perrotti A.; Fiore A.; Reichart D.; Khodabandeh S.;
Gulbins H.; Zipfel S.; Al Shakaki M.; Welp H.; Vezzani A.; Gherli T.;
Lommi J.; Juvonen T.; Svenarud P.; Chocron S.; Verhoye J.P.; Bounader K.;
Gatti G.; Gabrielli M.; Saccocci M.; Kinnunen E.-M.; Onorati F.;
Santarpino G.; Alkhamees K.; Ruggieri V.G.; Dell'Aquila A.M.
Institution
(Biancari, Kinnunen) Department of Surgery, Oulu University Hospital,
Oulu, Finland
(Dalen, Khodabandeh, Svenarud) Department of Molecular Medicine and
Surgery, Department of Cardiothoracic Surgery and Anesthesiology,
Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
(Perrotti, Chocron) Department of Thoracic and Cardio-Vascular Surgery,
University Hospital Jean Minjoz, Besancon, France
(Fiore) Department of Cardiothoracic Surgery, Henri Mondor University
Hospital, AP-HP, Paris-Est University, Creteil, France
(Reichart, Gulbins, Zipfel) Hamburg University Heart Center, Hamburg,
Germany
(Al Shakaki, Welp, Dell'Aquila) Department of Cardiothoracic Surgery,
University Hospital Muenster, Muenster, Germany
(Vezzani, Gherli) Division of Cardiac Surgery, University of Parma, Parma,
Italy
(Lommi, Juvonen) Cardiac Surgery, Heart and Lung Center, Helsinki
University Central Hospital, Helsinki, Finland
(Verhoye, Bounader, Ruggieri) Division of Cardiothoracic and Vascular
Surgery, Pontchaillou University Hospital, Rennes, France
(Gatti, Gabrielli) Division of Cardiac Surgery, Ospedali Riuniti, Trieste,
Italy
(Saccocci) Department of Cardiac Surgery, Centro Cardiologico-Fondazione
Monzino IRCCS, University of Milan, Milan, Italy
(Onorati) Division of Cardiovascular Surgery, Verona University Hospital,
Verona, Italy
(Santarpino) Cardiovascular Center, Paracelsus Medical University,
Nuremberg, Germany
(Alkhamees) Saud Al-Babtain Cardiac Center, Ministry of Health, Dammam,
Saudi Arabia
Title
Venoarterial extracorporeal membrane oxygenation after coronary artery
bypass grafting: Results of a multicenter study.
Source
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: December 07, 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background: The evidence of the benefits of using venoarterial
extracorporeal membrane oxygenation (VA-ECMO) after coronary artery bypass
grafting (CABG) is scarce. Methods: We analyzed the outcomes of patients
who received VA-ECMO therapy due to cardiac or respiratory failure after
isolated CABG in 12 centers between 2005 and 2016. Patients treated
preoperatively with ECMO were excluded from this study. Results: VA-ECMO
was employed in 148 patients after CABG for median of 5.0days (mean, 6.4,
SD 5.6days). In-hospital mortality was 64.2%. Pooled in-hospital mortality
was 65.9% without significant heterogeneity between the centers
(I² 8.6%). The proportion of VA-ECMO in each center did not
affect in-hospital mortality (p =0.861). No patients underwent heart
transplantation and six patients received a left ventricular assist
device. Logistic regression showed that creatinine clearance (p =0.004, OR
0.98, 95% CI 0.97-0.99), pulmonary disease (p =0.018, OR 4.42, 95% CI
1.29-15.15) and pre-VA-ECMO blood lactate (p =0.015, OR 1.10, 95% CI
1.02-1.18) were independent baseline predictors of in-hospital mortality.
One-, 2-, and 3-year survival was 31.0%, 27.9%, and 26.1%, respectively.
Conclusions: One third of patients with need for VA-ECMO after CABG
survive to discharge. In view of the burden of resources associated with
VA-ECMO treatment and the limited number of patients surviving to
discharge, further studies are needed to identify patients who may benefit
the most from this treatment. Copyright &#xa9; 2017 Elsevier B.V.

<129>
Accession Number
615245057
Author
Mauthner O.; Claes V.; Deschodt M.; Jha S.R.; Engberg S.; Macdonald P.S.;
Newton P.J.; De Geest S.
Institution
(Mauthner, Claes, Deschodt, De Geest) Institute of Nursing Science,
Faculty of Medicine, University of Basel, Switzerland
(Claes, Deschodt, De Geest) Academic Centre for Nursing and Midwifery,
Department of Public Health and Primary Care, KU Leuven, Belgium
(Jha, Macdonald) Heart Transplant Program, St Vincent's Hospital, Sydney,
Australia
(Jha, Newton) Centre for Cardiovascular and Chronic Care, Faculty Health,
University of Technology Sydney
(Engberg) School of Nursing, University of Pittsburgh, USA
(Macdonald) Victor Chang Cardiac Research Institute, Sydney, NSW
Title
Handle with care: A systematic review on frailty in cardiac care and its
usefulness in heart transplantation.
Source
Transplantation Reviews. (no pagination), 2017. Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Background: There is growing consensus that frailty, a state of
vulnerability and a decline in functioning across multiple physiological
body systems, is a valuable criterion to guide clinicians' risk prediction
for poor outcomes in adult transplant candidates. In its 2016 listing
criteria for heart transplantation the International Society for Heart
Lung Transplantation recommends frailty assessment. We aimed to summarize
the usefulness of frailty assessment in heart transplant candidates or
recipients reported throughout the literature. Methods: We performed a
systematic literature search in PubMed to identify papers reporting on
frailty in transplantation, chronic heart failure, and ventricualr assist
device implantation published over the last 10 years in English.
Additionally, a hand search was conducted, including manually searching
the reference lists and a citation search of relevant papers. Results:
Eleven primary research articles were included in this systematic review.
Frailty is a risk factor for morbidity, hospitalization, and mortality in
patients with advanced heart failure and individuals being considered for
ventricualr assist device implantation. Of the patients being considered
for transplantation, 33% are frail. The Frailty Phenotype by Fried is a
particularly useful tool to quickly identify higher risk patients for
adverse outcomes. Conclusion: A lack of standardization and limited
evidence on frailty in transplantation limit its use as a definitive
listing criterion. Future research efforts should focus on systematic
integration of frailty measures in transplant practice. Copyright &#xa9;
2017 Elsevier Inc.

<130>
Accession Number
615238224
Author
Gist K.M.; Goldstein S.L.; Wrona J.; Alten J.A.; Basu R.K.; Cooper D.S.;
Soranno D.E.; Duplantis J.; Altmann C.; Gao Z.; Faubel S.
Institution
(Gist, Soranno, Duplantis) Children's Hospital Colorado-The University of
Colorado, 13123 E 16th Ave, Aurora, CO 80045, United States
(Gist, Wrona) The Heart Institute, Children's Hospital Colorado, 13123 E
16th Ave, B100, Aurora, CO 80045, United States
(Goldstein) Center for Acute Care Nephrology, Cincinnati Children's
Hospital Medical Center, 3333 Burnet Ave, MLC 7022, Cincinnati, OH 45229,
United States
(Alten) Pediatric Critical Care Medicine, Children's of Alabama-University
of Alabama, WIC 1799 6th Ave S, Suite 9100 176 F, Birmingham, AL 35233,
United States
(Basu) Pediatric Critical Care Medicine, Center for Acute Care Nephrology,
Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2005,
Cincinnati, OH 45229, United States
(Cooper) The Heart Institute, Cincinnati Children's Hospital Medical
Center, 3333 Burnet Ave, MLC 2003, Cincinnati, OH 45229, United States
(Soranno, Duplantis) The Kidney Center, Children's Hospital Colorado-The
University of Colorado, 13123 E 16th Ave, Aurora, CO 80045, United States
(Altmann, Faubel) Department of Internal Medicine, Division of Renal
Disease and Hypertension, University of Colorado Anschutz Medical Campus,
12700 E 19th Ave, Box C281, Aurora, CO 80045, United States
(Gao) Heart Institute Research Core, Cincinnati Children's Hospital
Medical Center, 3333 Burnet Ave, MLC, Cincinnati, OH 45229, United States
Title
Kinetics of the cell cycle arrest biomarkers (TIMP-2*IGFBP-7) for
prediction of acute kidney injury in infants after cardiac surgery.
Source
Pediatric Nephrology. (pp 1-9), 2017. Date of Publication: 05 Apr 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Background: Tissue inhibitor metalloproteinase-2 (TIMP-2) and insulin-like
growth factor binding protein-7 (IGFBP-7) are cell-cycle arrest biomarkers
that have been shown to be predictive of acute kidney injury (AKI) in
critically ill adults. AKI affects a large proportion (40%) of children
following cardiac surgery. The aim of this study was to describe the
kinetics of TIMP-2*IGFBP-7 and test its ability to predict AKI in infants
following cardiac surgery. Methods: A multicenter prospective study was
performed in infants undergoing cardiac surgery with cardiopulmonary
bypass (CPB) from October 2013 to January 2015. Urine samples were
obtained at baseline and at 2, 6, 12, 24, 48 and 72 h after CPB
initiation. TIMP-2*IGFBP-7 concentration was measured in urine samples
using the Astute 140 meter to determine a risk score for AKI. This risk
score is the product of TIMP-2 (ng/mL) and IGFBP-7 (ng/mL) divided by
1000. Results: A total of 94 infants with a mean age of 154.2 +/- 85.7
days were enrolled in the study, of whom 31 (33%) subsequently developed
AKI. The mean time to AKI diagnosis was 25 +/- 7 h after CPB initiation.
The concentration of TIMP-2*IGFBP-7 was significantly higher in patients
with AKI at 12 h after CPB initiation relative to baseline (p = 0.006). At
12 h after CPB initiation patients with a TIMP-2*IGFBP-7 concentration of
>0.78 had a threefold higher odds of developing AKI than those with a
TIMP-2*IGFBP-7 concentration of < 0.78 (95% confidence interval 1.47-6.11,
p = 0.001). Conclusion: These results demonstration that TIMP-2*IGFBP-7
concentration can be used in infants to predict subsequent serum
creatinine-defined AKI following CPB. Copyright &#xa9; 2017 IPNA

<131>
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. 51 (3) (pp 172-181), 2017. Date of
Publication: 04 May 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] > 25 mmHg), 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 >7 mmHg than in those with DPG <7 mmHg, 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.

<132>
Accession Number
614230602
Author
Tamura T.; Mori S.; Mori A.; Ando M.; Yokota S.; Shibata Y.; Nishiwaki K.
Institution
(Tamura, Yokota) Division of Anesthesia, Japanese Red Cross Nagoya Daiichi
Hospital, Nagoya, Japan
(Tamura, Shibata, Nishiwaki) Department of Anesthesiology, Nagoya
University Graduate School of Medicine, 65 Tsurumai-cho, Showa-Ku, Nagoya
466-8550, Japan
(Mori) Division of Thoracic Surgery, Japanese Red Cross Nagoya Daiichi
Hospital, Nagoya, Japan
(Mori) Department of Perioperative Management System, Nagoya University
Graduate School of Medicine, Nagoya, Japan
(Ando) Center for Advanced Medicine and Clinical Research, Nagoya
University Hospital, Nagoya, Japan
Title
A randomized controlled trial comparing paravertebral block via the
surgical field with thoracic epidural block using ropivacaine for
post-thoracotomy pain relief.
Source
Journal of Anesthesia. 31 (2) (pp 263-270), 2017. Date of Publication: 01
Apr 2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Purpose: We conducted a comparative study to evaluate analgesic efficacy
between paravertebral block via the surgical field (PVB-sf), in which the
catheter was inserted into the ventral side of the sympathetic trunk in
the paravertebral space by a thoracic surgeon under thoracoscopic
visualization, and epidural block (Epi) using ropivacaine for
post-thoracotomy pain relief. Methods: Lung cancer patients scheduled for
lobectomy via thoracotomy were randomly allocated to receive either PVB-sf
or Epi (n = 36 per group). Before thoracotomy closure, 0.375% ropivacaine
was administered as a bolus (PVB-sf, 20 mL; Epi, 5 mL), followed by a
300-mL continuous infusion of 0.2% ropivacaine at 5 mL/h. Postoperative
pain was assessed using a visual analog scale (VAS) score at various time
points, including the primary endpoint of 2 h after ropivacaine bolus
injection. Sensory block area, vital signs, serum ropivacaine
concentrations, and side effects were also evaluated. Results: The Epi
group showed significantly lower VAS scores and blood pressure and a wider
sensory block area than the PVB-sf group at all evaluation time points.
While the mean serum ropivacaine concentration in the PVB-sf group was
significantly higher than that in the Epi group until 1 h after injection
of the ropivacaine bolus, there was no significant difference at any
subsequent assessment point. The incidence of side effects was similar
between the groups. Conclusion: The Epi was superior to PVB-sf for the
management of post-thoracotomy pain in this patient cohort. The number of
dermatomes anaesthetized by Epi was greater than that anaesthetized by
PVB-sf. No difference in complication rates was observed between the two
groups. Copyright &#xa9; 2017, Japanese Society of Anesthesiologists.

<133>
Accession Number
613877561
Author
Boeder N.F.; Dorr O.; Rixe J.; Weipert K.; Bauer T.; Bayer M.; Hamm C.W.;
Nef H.M.
Institution
(Boeder, Dorr, Rixe, Weipert, Bauer, Bayer, Hamm, Nef) Department of
Cardiology, University Hospital of Giessen, Giessen, Germany
Title
Endocarditis after interventional repair of the mitral valve: Review of a
dilemma.
Source
Cardiovascular Revascularization Medicine. 18 (2) (pp 141-144), 2017. Date
of Publication: 01 Mar 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background The MitraClip procedure can be an alternative treatment option
for patients with high surgical risk for whom surgical treatment is
contraindicated. Patients with prosthetic material have an increased risk
for infective endocarditis. Hypothesis Incidence, treatment and outcome of
patients with endocarditis after interventional mitral valve repair are
not known. Methods We searched for articles using PubMed using the terms
"interventional mitral valve repair", "mitraclip" and "endocarditis". We
have also searched for case reports in major congresses. Furthermore, we
report two cases. Results Four cases of IE after MitraClip were found in
addition to our cases. The leading cause is a bacterial infection,
typically with staphylococcal bacteria. Approximately two thirds of these
patients underwent surgery. Short-term outcome seems to be reasonable for
these patients. During the early postoperative period and if
Staphylococcus aureus can be cultivated mortality seems to be
significantly elevated. Conclusion IE after MitraClip procedure is a
dilemma. While surgical bail-out seems to be the favorable treatment
option, patients were rejected conventional surgery in first place due to
their high operative risk. Best treatment recommendation must be made on
an individual basis. Predisposing factors should be conscientiously
addressed prior to the procedure. Copyright &#xa9; 2016 Elsevier Inc.

<134>
Accession Number
615088146
Author
Tastet L.; Simard L.; Clavel M.-A.
Institution
(Tastet, Simard, Clavel) Institut Universitaire de Cardiologie et de
Pneumologie de Quebec (Quebec Heart and Lung Institute), Universite Laval,
2725, Chemin Sainte-Foy, #A-2047, Quebec G1V 4G5, Canada
Title
Severe and Asymptomatic Aortic Stenosis Management Challenge: Knowing That
We Do Not Really Know.
Source
Current Treatment Options in Cardiovascular Medicine. 19 (5) (no
pagination), 2017. Article Number: 33. Date of Publication: 01 May 2017.
Publisher
Springer Healthcare
Abstract
The clinical management of asymptomatic patients with severe aortic valve
stenosis (AS) may be challenging. Indeed, there is substantial controversy
over the optimal timing of intervention for these patients, as some
advocate early intervention while others urge for a conservative
management until symptom onset. In the meantime of randomized clinical
trials aiming to compare both strategies of management, an integrative
approach including several imaging modalities as well as biomarkers of the
myocardial damage may help to improve the risk stratification of patients
with asymptomatic severe AS and individualize strategy of treatment. The
extent of aortic valve calcification, semi-quantitatively assessed by
echocardiography but better fully quantitatively measured by computed
tomography (CT), provides incremental value to predict rapid disease
progression and adverse event and thus could be a potential trigger for
early referral to intervention or guide the timing of clinical follow-up.
In addition, the assessment of disease activity using positron emission
tomography, combined with CT calcium scoring, may also help to better
predict the disease progression. The comprehensive assessment of left
ventricular (LV) function using speckle-tracking echocardiography and/or
cardiac magnetic resonance may provide useful information regarding the
actual repercussion of AS on the myocardium. Besides imaging modalities,
the measurement of several circulating biomarkers associated with the
extent of the myocardial damage may also improve the risk stratification
of asymptomatic patients with severe AS and help guiding management.
Finally, it should be emphasized that a personalized medicine, including
this comprehensive integrative approach in heart valve clinics, should be
advocated for the management of these challenging patients. Copyright
&#xa9; 2017, Springer Science+Business Media New York.

<135>
Accession Number
614318092
Author
Li P.; Qu L.-P.; Qi D.; Shen B.; Wang Y.-M.; Xu J.-R.; Jiang W.-H.; Zhang
H.; Ding X.-Q.; Teng J.
Institution
(Li, Qi) Department of Nephrology, Yantai Yuhuangding Hospital, Yantai,
Shandong, China
(Qu) Department of Obstetrics, Yantai Yuhuangding Hospital, Yantai,
Shandong, China
(Shen, Wang, Xu, Jiang, Zhang, Ding, Teng) Department of Nephrology,
Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai,
China
(Shen, Wang, Xu, Jiang, Zhang, Ding, Teng) Kidney and Dialysis Institute
of Shanghai, Shanghai, China
(Ding, Teng) Shanghai Key Laboratory of Kidney and Blood Purification,
Shanghai, China
Title
Significance of perioperative goal-directed hemodynamic approach in
preventing postoperative complications in patients after cardiac surgery:
a meta-analysis and systematic review.
Source
Annals of Medicine. 49 (4) (pp 343-351), 2017. Date of Publication: 19 May
2017.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Purpose: Goal-directed hemodynamic therapy (GDT) is used to prevent
hypoperfusion resulting from surgery. The objective of this study was to
analyze the efficacy and importance of perioperative GDT. Methods: PUBMED,
MEDLINE, CENTRAL, and Google Scholar databases were searched until 17 June
2016 using the search terms: cardiac output, cardiac surgical procedures,
hemodynamics, goal-directed therapy, and intraoperative.
Randomized-controlled trials with pre-emptive hemodynamic intervention for
cardiac surgical population versus standard hemodynamic therapy were
included. Results: Nine studies were included with a total of 1148
patients. The overall analysis revealed no significant difference in the
all-cause mortality (pooled peto OR =0.58, 95%CI =0.27-1.525, p = 0.164),
duration of mechanical ventilation (pooled difference in mean= -1.48,
95%CI= -3.24 to 0.28, p = 0.099), or length of intensive care unit (ICU)
stay (pooled difference in mean= -9.10, 95%CI= -20.14 to 1.93, p = 0.106)
between patients in the GDT and control groups. Patients in the GDP group
were associated with shorter hospital stay than those in the control group
(pooled difference in mean= -1.52, 95%CI= -2.31 to -0.73, p < 0.001).
Conclusion: GDT reduces the length of hospital stay compared with the
standard of care. Further studies are necessary to continually assess the
benefit of GDT following major surgery.Key Messages The results of this
analysis revealed no significant difference between cardiac surgery
patients receiving goal-directed hemodynamic therapy (GDT) or conventional
fluid therapy in terms of the all-cause mortality, duration of mechanical
intervention, and length of ICU-stay. The length of hospital stay was
significantly reduced in patients treated with GDT compare to conventional
fluid therapy. GDT may have limited benefit in reducing mortality;
however, the association to shorter length of hospital stay may suggest
that better hemodynamic balance can facilitate postoperative recovery.
Copyright &#xa9; 2017 Informa UK Limited, trading as Taylor & Francis
Group.

<136>
Accession Number
614814597
Author
Bundhun P.K.; Yanamala C.M.; Huang W.-Q.
Institution
(Bundhun, Huang) The First Affiliated Hospital of Guangxi Medical
University, Institute of Cardiovascular Diseases, Nanning, Guangxi 530021,
China
(Yanamala) EALING Hospital, University of Buckingham, Department of
Internal Medicine, Uxbridge road, Southall, London UB1 3HW, United Kingdom
Title
Comparing Stent Thrombosis associated with Zotarolimus Eluting Stents
versus Everolimus Eluting Stents at 1 year follow up: A systematic review
and meta-analysis of 6 randomized controlled trials.
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 84. Date of Publication: 16 Mar 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Two thousand fifteen has been a winning year for Drug Eluting
Stents (DES). Increase in the number of patients with cardiovascular
diseases treated by Percutaneous Coronary Intervention (PCI) has resulted
to a high demand for second generation DES. This current analysis aimed to
compare the different types of Stent Thrombosis (ST) associated with
Zotarolimus Eluting Stents (ZES) versus Everolimus Eluting Stents (EES) at
1 year follow up. Methods: Electronic databases were searched for studies
comparing ZES with EES. Different types of ST reported at 1 year follow up
were considered as the primary endpoints in this analysis. Odds Ratios
(OR) with 95% Confidence Intervals (CIs) were used as the statistical
parameters and the pooled analyses were carried out by the RevMan 5 . 3
software. Results: A total number of 10,512 patients were included in this
analysis. No significant difference in any definite ST, acute definite ST,
subacute definite ST, and late definite ST were observed between ZES and
EES, at 1 year follow up with OR: 1.70, 95% CI: 0.92 - 3.16; P = 0.09, OR:
3.44, 95% CI: 0.82 - 14.43; P = 0.09, OR: 1.13, 95% CI: 0.43 - 2.95; P =
0.80 and OR: 2.39, 95% CI: 0.83 - 6.85; P = 0.11 respectively. Moreover,
any definite or probable ST and definite/probable/possible ST were also
not significantly different with OR: 1.39, 95% CI: 0.89 - 2.17; P = 0.15
and OR: 1.19, 95% CI: 0.84 - 1.70; P = 0.33 respectively. In addition, any
probable ST, acute probable ST, late probable ST and possible ST were also
not significantly different at 1 year follow up with OR: 1.11, 95% CI:
0.60 - 2.05; P = 0.75, OR: 0.53, 95% CI: 0.12 - 2.40; P = 0.41, OR: 1.67,
95% CI: 0.35 - 7.86; P = 0.52 and OR: 1.08, 95% CI: 0.64 - 1.82; P = 0.78
respectively. Conclusion: At 1 year follow up, ZES were not associated
with significantly lower or higher definite and probable ST compared to
EES. In addition, no significant difference was observed in acute,
subacute and late definite or probable ST. However, further trials are
recommended to assess the effects of these second-generation DES during
the long-term. Copyright &#xa9; 2017 The Author(s).

<137>
Accession Number
614943041
Author
Qi J.; Li Y.; Li J.; Jing Q.; Xu K.; Gao C.; Ma L.; Zhang Z.; Xu B.; Han
Y.
Institution
(Qi, Li, Li, Jing, Xu, Han) The Department of Cardiology, General Hospital
of Shenyang Military Region, Shenyang, China
(Qi) The Department of Cardiology, The First Clinical College, Liaoning
University of Traditional Chinese Medicine, Shenyang, China
(Gao) The Department of Cardiology, Henan Provincial People's Hospital,
Zhengzhou, China
(Ma) The Department of Cardiology, Anhui Provincial Hospital, Hefei, China
(Zhang) The Department of Cardiology, Third Affiliated Hospital of
Liaoning Medical College, Jinzhou, China
(Xu) Catheterization Laboratory, Fuwai Hospital, Chinese Academy of
Medical Sciences, Beijing, China
Title
Safety and efficacy of 6-month versus 12-month dual antiplatelet therapy
in patients after implantation of multiple biodegradable polymer-coated
sirolimus-eluting coronary stents: Insight from the I-LOVE-IT 2 trial.
Source
Catheterization and Cardiovascular Interventions. 89 (pp 555-564), 2017.
Date of Publication: 01 Mar 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: This study sought to compare the clinical outcomes of 6-month
versus 12-month dual antiplatelet therapy (DAPT) in patients receiving
multiple biodegradable polymer-coated sirolimus-eluting stents (BP-SES)
implants. Background: The clinical outcomes for patients who undergo
multiple BP-SES implantation with different DAPT durations are uncertain.
Methods: In the I-LOVE-IT 2 trial, 907 patients treated with multiple
BP-SES (total stent number >2) were assigned to receive 6-month (n = 440)
or 12-month (n = 467) DAPT. The primary endpoint was 12-month target
lesion failure (TLF), which is a composite of cardiac death, target vessel
myocardial infarction (MI) or clinically indicated target lesion
revascularization. The major secondary endpoints were 12-month net adverse
clinical events, a composite of all causes of death, MI, stroke, any
revascularization and bleeding. Results: The number of stents per patient
between the 6-month and 12-month DAPT group was similar (2.4 +/- 0.7 vs.
2.4 +/- 0.7, P = 0.47). The incidence of 12-month TLF was comparable in
the 6-month and 12-month DAPT groups (9.3% vs.7.5%, Log-rank P = 0.33).
However, landmark analysis showed that 12-month DAPT, compared to 6-month
DAPT, was associated with a significantly lower risk of TLF (4.8% vs.
2.4%, Log-rank P = 0.049) at a cost of a slightly increased risk of all
bleeding events (0.5% vs. 1.7%, Log-rank P = 0.07) between 6 and 12
months. Conclusions: In patients treated with multiple BP-SES, 6- and
12-month DAPT had similar impacts on 12-month clinical outcomes.
Additionally, 12-month DAPT might reduce TLF between 6 and 12 months at
the cost of a slightly increased risk of all bleeding events. &#xa9; 2017
Wiley Periodicals, Inc. Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<138>
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.

<139>
Accession Number
614692569
Author
Kristensen A.W.; Mortensen J.; Berg R.M.G.
Institution
(Kristensen, Mortensen) Department of Clinical Physiology, Nuclear
Medicine & PET, University Hospital Rigshospitalet, Copenhagen, Denmark
(Berg) Department of Clinical Physiology and Nuclear Medicine, Bispebjerg
and Frederiksberg Hospitals, Copenhagen, Denmark
Title
Pulmonary thromboembolism as a complication of lung transplantation.
Source
Clinical Transplantation. 31 (4) (no pagination), 2017. Article Number:
e12922. Date of Publication: 01 Apr 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Post-transplantation mortality after lung transplantation (LTX) is higher
than for other solid organ transplantations. Thoracic surgery is
associated with increased risk of thromboembolic complications, and as LTX
recipients lack the collateral bronchial circulation, pulmonary
thromboembolism (PTE) may represent a pertinent yet largely underdiagnosed
cause of post-transplantation respiratory failure. In this systematic
review, we sought to elucidate the occurrence and predilection site of PTE
after LTX, and its potential impact on LTX-associated mortality. Based on
twelve original articles identified by a systematic search strategy in
PubMed, we found that PTE was reported in 4% of LTX recipients, and 38% of
these events occurred within the first 30 days after the LTX procedure. In
single-lung transplantation (SLTX) recipients, 12% were diagnosed with
PTE, with 92% of these affecting the allograft. Of LTX patients diagnosed
with PTE, 11% died within 1 year after LTX and 75% of these deaths
occurred within the first 30 days. Our findings suggest that PTE is a
potentially underdiagnosed cause of early post-LTX respiratory failure.
This should be confirmed in larger studies with systematic follow-up
diagnostic imaging. Copyright &#xa9; 2017 John Wiley & Sons A/S. Published
by John Wiley & Sons Ltd

<140>
Accession Number
614990959
Author
Nerlekar N.; Cheshire C.J.; Verma K.P.; Ihdayhid A.-R.; McCormick L.M.;
Cameron J.D.; Bennett M.R.; Malaiapan Y.; Meredith I.T.; Brown A.J.
Institution
(Nerlekar, Cheshire, Verma, Ihdayhid, McCormick, Cameron, Malaiapan,
Meredith, Brown) Monash Cardiovascular Research Centre and MonashHeart,
Monash Health, Clayton, VIC 3168, Australia
(Bennett, Brown) Division of Cardiovascular Medicine, University of
Cambridge, Cambridge, United Kingdom
Title
Intravascular ultrasound guidance improves clinical outcomes during
implantation of both first-and secondgeneration drug-eluting stents: A
meta-analysis.
Source
EuroIntervention. 12 (13) (pp 1632-1642), 2017. Date of Publication: 2017.
Publisher
EuroPCR
Abstract
Aims: Our aim was to assess whether intravascular ultrasound (IVUS)
improves clinical outcomes during implantation of first-and
second-generation drug-eluting stents (DES). IVUS guidance is associated
with improved clinical outcomes during DES implantation, but it is unknown
whether this benefit is limited to either first-or second-generation
devices. Methods and results: MEDLINE, EMBASE and PubMed were searched for
studies comparing outcomes between IVUS-and angiography-guided PCI. Among
909 potentially relevant studies, 15 trials met the inclusion criteria.
The primary endpoint was MACE, defined as death, myocardial infarction,
target vessel/ lesion revascularisation (TVR/TLR) or stent thrombosis
(ST). Summary estimates were obtained using Peto modelling. In total,
9,313 patients from six randomised trials and nine observational studies
were included. First-generation DES were implanted in 6,156 patients
(3,064 IVUS-guided and 3,092 angiography-guided) and second-generation in
3,157 patients (1,528 IVUS-guided and 1,629 angiography-guided). IVUS
guidance was associated with a significant reduction in MACE (odds ratio
[OR] 0.73, 95% CI: 0.64-0.85, p<0.001), across both first-(OR 0.79, 95%
CI: 0.67-0.92, p=0.01) and second-generation DES (0.57, 95% CI: 0.43-0.77,
p<0.001). For second-generation DES, IVUS guidance was associated with
significantly lower rates of cardiac death (OR 0.33, 95% CI: 0.14-0.78,
p=0.02), TVR (OR 0.47, 95% CI: 0.28-0.79, p=0.006), TLR (OR 0.61, 95% CI:
0.42-0.90, p=0.01) and ST (OR 0.31, 95% CI: 0.12-0.78, p=0.02). Cumulative
meta-analysis highlighted progressive temporal benefit towards IVUS-guided
PCI to reduce MACE (OR 0.60, 95% CI: 0.48-0.75, p<0.001). Conclusions:
IVUS guidance is associated with a significant reduction in MACE during
implantation of both first-and second-generation DES platforms. These data
support the use of IVUS guidance in contemporary revascularisation
procedures using second-generation DES. Copyright &#xa9; Europa Digital &
Publishing 2017. All rights reserved.

<141>
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.

<142>
Accession Number
614990946
Author
Hager A.; Schubert S.; Ewert P.; Sondergaard L.; Witsenburg M.; Guccione
P.; Benson L.N.; De Lezo J.S.; Lung T.-H.; Hess J.; Eicken A.; Berger F.
Institution
(Hager, Ewert, Hess, Eicken) Department of Pediatric Cardiology and
Congenital Heart Disease, Deutsches Herzzentrum Munchen, Technische
Universitat Munchen, Lazarettstr. 36, Munich D-80636, Germany
(Schubert, Ewert, Berger) Department of Pediatric Cardiology-Congenital
Heart Defects, Deutsches Herzzentrum Berlin, Germany
(Sondergaard) Department of Cardiology, Heart Centre, Rigshospitalet,
Copenhagen, Denmark
(Witsenburg) Department of Cardiology/Congenital Heart Disease, Erasmus
Medical Center, Rotterdam, Netherlands
(Guccione) Department of Pediatric Cardiology and Cardiac Surgery,
Ospedale Bambino Gesu, Rome, Italy
(Benson) Department of Paediatrics, Cardiac Diagnostic and Interventional
Unit, Hospital for Sick Children, University of Toronto, Toronto, ON,
Canada
(De Lezo) Department of Cardiology, Hospital Reina Sofia, University of
Cordoba, Cordoba, Spain
(Lung) Department of Coronary and Structural Heart Clinical Affairs,
Medtronic, Minneapolis, MN, United States
Title
Five-year results from a prospective multicentre study of percutaneous
pulmonary valve implantation demonstrate sustained removal of significant
pulmonary regurgitation, improved right ventricular outflow tract
obstruction and improved quality of life.
Source
EuroIntervention. 12 (14) (pp 1715-1723), 2017. Date of Publication:
February 2017.
Publisher
EuroPCR
Abstract
Aims: Percutaneous pulmonary valve implantation (PPVI) is used to treat
patients with dysfunctional pulmonary valve conduits. Short-and
longer-term results from multiple trials have outlined haemodynamic
improvements. Our aim was to report the long-term results, including
quality of life, from a multicentre trial in Europe and Canada. Methods
and results: From October 2007 to April 2009, 71 patients (24 female;
median age 19.0 [IQR: 14.0 to 25.0] years) were enrolled in a prospective
cohort study. PPVI was performed successfully in 63 patients. At five-year
follow-up four patients had died. Moderate and severe pulmonary
regurgitation were completely resolved in all except one patient, who
needed re-PPVI. Outflow tract obstruction improved significantly from a
mean pressure gradient of 37.7+/-12.1 mmHg before PPVI to 17.3+/-9.7 mmHg
at five-year follow-up; however, 11 patients needed treatment for
restenosis. The EQ-5D quality of life utility index and visual analogue
scale scores were both significantly improved six months post PPVI and
remained so at five years. Conclusions: Five-year results following PPVI
demonstrate resolved moderate or severe pulmonary regurgitation, improved
right ventricular outflow tract obstruction, and improved quality of life.
Copyright &#xa9; Europa Digital & Publishing 2017. All rights reserved.

<143>
Accession Number
613864823
Author
Maniotis C.; Andreou C.; Karalis I.; Koutouzi G.; Agelaki M.; Koutouzis M.
Institution
(Maniotis, Agelaki, Koutouzis) 2nd Cardiology Department, Hellenic Red
Cross Hospital of Athens, Athens, Greece
(Andreou, Karalis) Interventional Cardiology Department, University
Hospital of Leiden, Leiden, Netherlands
(Koutouzi) Interventional Radiology Department, Sahlgrenska University
Hospital, Gothenburg, Sweden
Title
A systematic review on the safety of Prostar XL versus ProGlide after TAVR
and EVAR.
Source
Cardiovascular Revascularization Medicine. 18 (2) (pp 145-150), 2017. Date
of Publication: 01 Mar 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background Endovascular aortic aneurysm repair (EVAR) and transfemoral
transcatheter aortic valve replacement (TAVR) are widely spreading
minimally invasive procedures performed mainly through the femoral artery.
Prostar XL and ProGlide vascular closure devices are used in clinical
practice for the hemostasis in these procedures and they have been shown
to be safe and effective. Purpose The aim of our systematic review is to
compare the safety of these two devices for percutaneous closure of large
arteriotomies in patients undergoing TAVR and EVAR. Methods We searched
PubMed, EMBASE, Google Scholar and the Cochrane Central Register of
Controlled Trials for all randomized and observational published studies
that compared Prostar XL vs. ProGlide. Relative risk was calculated by
random-effects model. Review Manager 5.1 was used for statistical
analysis. Results A total number of 2909 patients were included in our
analysis. The rate of overall vascular complications did not differ
between Prostar XL and ProGlide {RR 1.35 (0.80-2.29), p = 0.27}. In
contrary, the risk ratio of all bleeding complications with Prostar XL
compared to ProGlide was 1.82 (1.47-2.24, p < 0.001) and for major and
life-threatening bleeding complications was 2.48 (1.65-3.73, p < 0001,
suggesting a lower bleeding risk with ProGlide). No statistical difference
was found between groups for end-stage acute kidney injury (AKI), with a
risk ratio of 2.14 (0.81-5.66), p = 0.05. Finally, there were no
differences in in-hospital and 30-days mortality rate between the two
groups (1.41, 0.56-3.54, p = 0.46 and 1.43, 0.55-3.73, p = 0.47,
respectively). Conclusions Prostar XL is associated with greater risk of
any bleeding as well as life threatening bleeding compared to the ProGlide
device. However, no significant differences were observed in the rate of
overall vascular complications, end stage AKI and in-hospital and 30-days
mortality. Copyright &#xa9; 2016 Elsevier Inc.

<144>
Accession Number
614490588
Author
Sangnawakij P.; Bohning D.; Adams S.; Stanton M.; Holling H.
Institution
(Sangnawakij) Department of Applied Statistics, King Mongkut's University
of Technology North Bangkok, Bangkok 10800, Thailand
(Bohning) School of Mathematics & Southampton Statistical Sciences
Research Institute, University of Southampton, Southampton SO17 1BJ,
United Kingdom
(Adams, Stanton) Department of Paediatric Surgery, Southampton General
Hospital, Southampton SO16 6YD, United Kingdom
(Holling) Statistics and Quantitative Methods, Faculty of Psychology and
Sports Science, University of Munster, Muenster, Germany
Title
Statistical methodology for estimating the mean difference in a
meta-analysis without study-specific variance information.
Source
Statistics in Medicine. 36 (9) (pp 1395-1413), 2017. Date of Publication:
30 Apr 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Statistical inference for analyzing the results from several independent
studies on the same quantity of interest has been investigated frequently
in recent decades. Typically, any meta-analytic inference requires that
the quantity of interest is available from each study together with an
estimate of its variability. The current work is motivated by a
meta-analysis on comparing two treatments (thoracoscopic and open) of
congenital lung malformations in young children. Quantities of interest
include continuous end-points such as length of operation or number of
chest tube days. As studies only report mean values (and no standard
errors or confidence intervals), the question arises how meta-analytic
inference can be developed. We suggest two methods to estimate
study-specific variances in such a meta-analysis, where only sample means
and sample sizes are available in the treatment arms. A general likelihood
ratio test is derived for testing equality of variances in two groups. By
means of simulation studies, the bias and estimated standard error of the
overall mean difference from both methodologies are evaluated and compared
with two existing approaches: complete study analysis only and partial
variance information. The performance of the test is evaluated in terms of
type I error. Additionally, we illustrate these methods in the
meta-analysis on comparing thoracoscopic and open surgery for congenital
lung malformations and in a meta-analysis on the change in renal function
after kidney donation. Copyright &#xa9; 2017 John Wiley & Sons, Ltd.
Copyright &#xa9; 2017 John Wiley & Sons, Ltd.

<145>
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

<146>
Accession Number
614854788
Author
Allan G.M.; Finley C.R.; McCormack J.; Kumar V.; Kwong S.; Braschi E.;
Korownyk C.; Kolber M.R.; Lindblad A.J.; Babenko O.; Garrison S.
Institution
(Allan, Finley, Kumar, Kwong, Korownyk, Kolber, Lindblad, Garrison)
University of Alberta, Evidence-Based Medicine, Department of Family
Medicine - Research Program, 6-10 University Terrace, Edmonton, AB T6G
2T4, Canada
(McCormack) University of British Columbia, Faculty of Pharmaceutical
Sciences, Vancouver, BC, Canada
(Braschi) McGill University, Family Medicine, Montreal, QC, Canada
(Babenko) University of Alberta, Medical Education, Department of Family
Medicine, Edmonton, AB, Canada
Title
Are potentially clinically meaningful benefits misinterpreted in
cardiovascular randomized trials? A systematic examination of statistical
significance, clinical significance, and authors' conclusions.
Source
BMC Medicine. 15 (1) (no pagination), 2017. Article Number: 58. Date of
Publication: 20 Mar 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: While journals and reporting guidelines recommend the
presentation of confidence intervals, many authors adhere strictly to
statistically significant testing. Our objective was to determine what
proportions of not statistically significant (NSS) cardiovascular trials
include potentially clinically meaningful effects in primary outcomes and
if these are associated with authors' conclusions. Methods: Cardiovascular
studies published in six high-impact journals between 1 January 2010 and
31 December 2014 were identified via PubMed. Two independent reviewers
selected trials with major adverse cardiovascular events (stroke,
myocardial infarction, or cardiovascular death) as primary outcomes and
extracted data on trial characteristics, quality, and primary outcome.
Potentially clinically meaningful effects were defined broadly as a
relative risk point estimate <0.94 (based on the effects of ezetimibe)
and/or a lower confidence interval <0.75 (based on the effects of
statins). Results: We identified 127 randomized trial comparisons from
3200 articles. The primary outcomes were statistically significant (SS)
favoring treatment in 21% (27/127), NSS in 72% (92/127), and SS favoring
control in 6% (8/127). In 61% of NSS trials (56/92), the point estimate
and/or lower confidence interval included potentially meaningful effects.
Both point estimate and confidence interval included potentially
meaningful effects in 67% of trials (12/18) in which authors' concluded
that treatment was superior, in 28% (16/58) with a neutral conclusion, and
in 6% (1/16) in which authors' concluded that control was superior. In a
sensitivity analysis, 26% of NSS trials would include potential meaningful
effects with relative risk thresholds of point estimate <0.85 and/or a
lower confidence interval <0.65. Conclusions: Point estimates and/or
confidence intervals included potentially clinically meaningful effects in
up to 61% of NSS cardiovascular trials. Authors' conclusions often reflect
potentially meaningful results of NSS cardiovascular trials. Given the
frequency of potentially clinical meaningful effects in NSS trials,
authors should be encouraged to continue to look beyond significance
testing to a broader interpretation of trial results. Copyright &#xa9;
2017 The Author(s).

<147>
Accession Number
614842125
Author
Puri R.; Rodes-Cabau J.
Institution
(Puri, Rodes-Cabau) Quebec Heart and Lung Institute, Laval University,
Quebec City, QC, Canada
Title
Transcatheter interventions for tricuspid regurgitation: The FORMA Repair
System.
Source
EuroIntervention. 12 (pp Y113-Y115), 2016. Date of Publication: 2016.
Publisher
EuroPCR
Abstract
A percutaneous technique for reducing severe TR using the FORMA Repair
System appears safe, and technically feasible. First-in-man data have
demonstrated an acute intraprocedural reduction in TR severity in the vast
majority of cases, coupled with evidence of functional improvement in the
short to medium term. The ongoing registries will enrol larger patient
numbers with longer follow-up periods to understand device performance
better. Ultimately, randomised trials will be needed to provide definite
data on the efficacy of the FORMA device for the treatment of this
high-risk group of patients with severe symptomatic TR. Copyright &#xa9;
Europa Digital & Publishing 2016. All rights reserved.

<148>
Accession Number
607332886
Author
Pighi M.; Tomai F.; Petrolini A.; de Luca L.; Tarantini G.; Barioli A.;
Colombo P.; Klugmann S.; Ferlini M.; Ormezzano M.F.; Loi B.; Calabro P.;
Bianchi R.M.; Faggian G.; Forni A.; Vassanelli C.; Valgimigli M.;
Ribichini F.
Institution
(Pighi, Vassanelli, Ribichini) Department of Medicine, University of
Verona, Piazzale Aristide Stefani n 1, Verona 37126, Italy
(Tomai, Petrolini, de Luca) Department of Cardiovascular Sciences,
European Hospital, Via Portuense, 700, Rome 00149, Italy
(Tarantini, Barioli) Department of Cardiac, Thoracic and Vascular
Sciences, University of Padua Medical School, Padua, Italy
(Colombo, Klugmann) Department of Cardiology and Cardiac Surgery, A. De
Gasperis Niguarda Ca' Granda Hospital, Milan, Italy
(Ferlini, Ormezzano) Department of Cardiovascular Sciences, IRCCS
Foundation, Policlinico San Matteo, Pavia, Italy
(Loi) Department of Cardiovascular Sciences, Brotzu Hospital, Cagliari,
Italy
(Calabro, Bianchi) Cardio-thoracic and Respiratory Sciences Department,
Second University of Naples, Monaldi Hospital, A.O.R.N. dei Colli, Naples,
Italy
(Faggian, Forni) Department of Cardiac Surgery, University of Verona,
Piazzale Aristide Stefani n 1, Verona 37126, Italy
(Valgimigli) Cardialysis, Rotterdam, Netherlands
Title
Everolimus-Eluting Bioresorbable Vascular Scaffold System in the Treatment
of Cardiac Allograft Vasculopathy: the CART (Cardiac Allograft Reparative
Therapy) Prospective Multicenter Pilot Study.
Source
Journal of Cardiovascular Translational Research. 9 (1) (pp 40-48), 2016.
Date of Publication: 01 Feb 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Cardiac allograft vasculopathy (CAV) is a form of accelerated
atherosclerosis, which represents the leading cause of late morbidity and
mortality after heart transplantation. The recent bioresorbable vascular
scaffold (BVS) technology represents a potential novel therapeutic tool,
in the context of CAV, by allowing transient scaffolding and concomitant
vessel healing. Eligible subjects will be treated by using the Absorb
Everolimus-Eluting BVS (Abbott Vascular, Santa Clara, CA, USA), and
evaluated at pre-determined time points, up to 3 years since the index
procedure. Both clinical and imaging data will be collected in dedicated
case report forms (CRF). All imaging data will be analyzed in an
independent core laboratory. The primary aim of the study is to evaluate
the angiographic performance at 1 year of second-generation Absorb BVS, in
heart transplant recipients affected by CAV. Copyright &#xa9; 2015,
Springer Science+Business Media New York.

<149>
Accession Number
614025709
Author
Constantin J.-M.; Momon A.; Mantz J.; Payen J.-F.; De Jonghe B.; Perbet
S.; Cayot S.; Chanques G.; Perreira B.
Institution
(Constantin, Momon, Perbet, Cayot) Perioperative Department, University
Hospital of Clermont-Ferrand, Clermont-Ferrand 63000, France
(Perreira) Biostatistics Unit, Department of Clinical Research and
Innovation, University Hospital of Clermont-Ferrand, Clermont-Ferrand
63000, France
(Mantz) Department of Anaesthesiology and Critical Care Medicine, Hopital
Europeen Georges-Pompidou, Universite Paris-Descartes Sorbonne Paris Cite,
Paris 75908, France
(Payen) Department of Anaesthesia and Critical Care, Michallon Hospital,
boulevard de la Chantourne, Grenoble 38000, France
(Payen) Joseph-Fourier University, Grenoble Institute of Neurosciences,
chemin Fortune-Ferrini, Grenoble 38042, France
(De Jonghe) Reanimation Medico-Chirurgicale, Centre Hospitalier de
Poissy-St-Germain, Poissy 78300, France
(Chanques) Intensive Care and Anaesthesiology Department, University of
Montpellier Saint-Eloi Hospital, Montpellier 34000, France
Title
Efficacy and safety of sedation with dexmedetomidine in critical care
patients: A meta-analysis of randomized controlled trials.
Source
Anaesthesia Critical Care and Pain Medicine. 35 (1) (pp 7-15), 2016. Date
of Publication: 01 Feb 2016.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Introduction Dexmedetomidine may help physicians target a low level of
sedation. Unfortunately, the impact of dexmedetomidine on major endpoints
remains unclear in intensive care unit (ICU). Material and methods To
evaluate the association between dexmedetomidine use with efficacy and
safety outcomes, two reviewers independently identified randomized
controlled trials comparing dexmedetomidine with other sedative agents in
non-post-cardiac surgery critically ill patients in the PubMed and
Cochrane databases. Random effects models were considered if heterogeneity
was detected using the DerSimonian and Laird estimation method.
Statistical heterogeneity between results was assessed by examining forest
plots, confidence intervals (CI) and by using the I² statistic.
The risk of bias was assessed using the risk of bias tool. Results This
meta-analysis included 1994 patients from 16 randomized controlled trials.
Comparators were lorazepam, midazolam and propofol. Dexmedetomidine was
associated with a reduction in ICU length of stays (WMD = -0.304; 95% CI
[-0.477, -0.132]; P = 0.001), mechanical ventilation duration (WMD =
-0.313, 95% CI [-0.523, -0.104]; P = 0.003) and delirium incidence (RR =
0.812, 95% CI [0.680, 0.968]; P = 0.020). Dexmedetomidine is also
associated with an increase in the incidence of bradycardia (RR = 1.947,
95% CI [1.387, 2.733]; P = 0.001) and hypotension (RR = 1.264; 95% CI
[1.013, 1.576]; P = 0.038). Conclusions and relevance In this first
meta-analysis including only randomized controlled trials related to ICU
patients, dexmedetomidine was associated with a 48 h reduction in ICU
length of stay, mechanical ventilation duration and delirium occurrence
despite a significant heterogeneity among studies. Dexmedetomidine was
also associated with an increase in bradycardia and hypotension. Copyright
&#xa9; 2015 Societe francaise d'anesthesie et de reanimation (Sfar)

<150>
Accession Number
607165841
Author
Alderman M.H.; Davis B.R.; Piller L.B.; Ford C.E.; Baraniuk M.S.; Pressel
S.L.; Assadi M.A.; Einhorn P.T.; Haywood L.J.; Ilamathi E.; Oparil S.;
Retta T.M.
Institution
(Alderman) Department of Epidemiology and Population Health, Albert
Einstein College of Medicine, Bronx, NY, United States
(Davis, Piller, Ford, Baraniuk, Pressel) University of Texas School of
Public Health, Coordinating Center for Clinical Trials, Houston, TX,
United States
(Assadi) State University of New York, Health Sciences Center at Brooklyn,
Brooklyn, NY, United States
(Einhorn) Division of Prevention and Population Sciences, National Heart,
Lung, and Blood Institute, Bethesda, MD, United States
(Haywood) LAC + USC Medical Center, Keck School of Medicine, Los Angeles,
CA, United States
(Ilamathi) Suffolk Nephrology Consultants, Stony Brook, NY, United States
(Oparil) Department of Medicine and Physiology and Biophysics, University
of Alabama at Birmingham, Birmingham, AL, United States
(Retta) Department of Medicine, Howard University College of Medicine,
Washington, DC, United States
Title
Should Antihypertensive Treatment Recommendations Differ in Patients with
and Without Coronary Heart Disease? (from the Antihypertensive and
Lipid-Lowering Treatment to Prevent Heart Attack Trial [ALLHAT]).
Source
American Journal of Cardiology. 117 (1) (pp 105-115), 2016. Date of
Publication: 01 Jan 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Thiazide-type diuretics have been recommended for initial treatment of
hypertension in most patients, but should this recommendation differ for
patients with and without coronary heart disease (CHD)? The
Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack
Trial (ALLHAT) was a randomized, double-blind hypertension treatment trial
in 42,418 participants with high risk of combined cardiovascular disease
(CVD) (25% with preexisting CHD). This post hoc analysis compares
long-term major clinical outcomes in those assigned amlodipine (n = 9048)
or lisinopril (n = 9,054) with those assigned chlorthalidone (n = 15,255),
stratified by CHD status. After 4 to 8 years, randomized treatment was
discontinued. Total follow-up (active treatment + passive surveillance
using national databases for deaths and hospitalizations) was 8 to 13
years. For most CVD outcomes, end-stage renal disease, and total
mortality, there were no differences across randomized treatment arms
regardless of baseline CHD status. In-trial rates of CVD were
significantly higher for lisinopril compared with chlorthalidone, and
rates of heart failure were significantly higher for amlodipine compared
with chlorthalidone in those with and without CHD (overall hazard ratios
[HRs] 1.10, p <0.001, and 1.38, p <0.001, respectively). During extended
follow-up, significant outcomes according to CHD status interactions (p =
0.012) were noted in amlodipine versus chlorthalidone comparison for CVD
and CHD mortality (HR 0.88, p = 0.04, and 0.84, p = 0.04, respectively) in
those with CHD at baseline (HR 1.06, p = 0.15, and 1.08, p = 0.17) and in
those without. The results of the overall increased stroke mortality in
lisinopril compared with chlorthalidone (HR 1.2; p = 0.03) and
hospitalized heart failure in amlodipine compared with chlorthalidone (HR
1.12; p = 0.01) during extended follow-up did not differ by baseline CHD
status. In conclusion, these results provide no reason to alter our
previous recommendation to include a properly dosed diuretic (such as
chlorthalidone 12.5 to 25 mg/day) in the initial antihypertensive regimen
for most hypertensive patients. Copyright &#xa9; 2016 Elsevier Inc.

<151>
Accession Number
607223037
Author
Briasoulis A.; Papageorgiou N.; Zacharia E.; Palla M.; El Abdallah M.D.;
Androulakis E.; Tousoulis D.
Institution
(Briasoulis, Palla, El Abdallah) Division of Cardiology, Wayne State
University, Detroit Medical Center, Detroit, MI, United States
(Papageorgiou) Barts Heart Centre, St Bartholomew's Hospital, London,
United Kingdom
(Papageorgiou, Zacharia, Androulakis, Tousoulis) 1st Department of
Cardiology, Hippokration Hospital, University of Athens, Athens, Greece
(Androulakis) John Radcliffe Hospital, University of Oxford, Oxford,
United Kingdom
Title
Meta-analysis of oral anticoagulants with dual versus single antiplatelet
therapy in patients after percutaneous coronary intervention.
Source
American Journal of Cardiovascular Drugs. 16 (2) (pp 103-110), 2016. Date
of Publication: 09 Dec 2016.
Publisher
Springer International Publishing
Abstract
Background: The combined use of dual antiplatelet therapy with oral
anticoagulation (OAC) is required after coronary artery stenting or acute
coronary syndromes (ACS). Methods and Results: We performed a
meta-analysis (Embase and MEDLINE search) of the comparative effects of
triple antithrombotic therapy (TT) versus OAC with single antiplatelet
therapy (dual therapy [DT]) on allcause mortality, stroke, cardiovascular
death, myocardial infarction (MI), target vessel revascularization, and
major bleeding. Three prospective controlled studies and five cohort
studies compared TT versus DT. We identified three prospective controlled
and five cohort studies with 4564 patients on TT and 1848 on DT with an
average follow-up duration of 10.1 months. TT is associated with similar
rates of all-cause mortality, stroke, and major bleeding but significantly
lower rates of MI compared with DT. Conclusions: Triple antithrombotic
therapy is associated with similar mortality and bleeding rates but fewer
MIs compared with OAC and single antiplatelet therapy. Copyright &#xa9;
Springer International Publishing Switzerland 2015.

<152>
Accession Number
608248828
Author
Pan W.; Wang Y.; Lin L.; Zhou G.; Hua X.; Mo L.
Institution
(Pan, Wang, Lin, Zhou, Hua, Mo) Department of Anaesthesiology, First
Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road,
Guangzhou 510080, China
Title
Outcomes of dexmedetomidine treatment in pediatric patients undergoing
congenital heart disease surgery: A meta-Analysis.
Source
Paediatric Anaesthesia. 26 (3) (pp 239-248), 2016. Date of Publication: 01
Mar 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background Dexmedetomidine decreases cardiac complications in adults
undergoing cardiovascular surgery. This systematic review assessed whether
perioperative dexmedetomidine improves congenital heart disease (CHD)
surgery outcomes in children. Methods The PubMed, Embase, and Cochrane
Library databases were searched for randomized controlled trials (RCTs) or
observational studies that were published until 16 April 2015 and compared
dexmedetomidine with placebo or an alternative anesthetic agent during
pediatric CHD surgery. The assessed outcomes included hemodynamics,
ventilation length, intensive care unit (ICU) and hospital stays, blood
glucose and serum cortisol levels, postoperative analgesia requirements,
and postoperative delirium. Results Five RCTs and nine observational
studies involving 2229 patients were included. In pooled analyses,
dexmedetomidine was associated with shorter length of mechanical
ventilation (mean difference: -93.36, 95% CI: -137.45, -49.27), lower
postoperative fentanyl (mean difference: -24.11, 95% CI: -36.98, -11.24)
and morphine (mean difference: -0.07, 95% CI: -0.14, 0.00) requirements,
reduced stress response (i.e., lower blood glucose and serum cortisol
levels), and lower risk of delirium (OR: 0.39, 95% CI: 0.21, 0.74). The
hemodynamics of dexmedetomidine-treated patients appeared more stable, but
there were no significant differences in the ICU or hospital stay
durations. Dexmedetomidine may increase the bradycardia and hypotension
risk (OR: 3.14, 95% CI: 1.47, 6.69). Conclusions Current evidence
indicates that dexmedetomidine improves outcomes in children undergoing
CHD surgery. However, this finding largely relies on data from
observational studies; high-quality RCTs are warranted because of the
potential for subject selection bias. Copyright &#xa9; 2015 The Authors.
Pediatric Anesthesia Published by John Wiley & Sons Ltd.

<153>
Accession Number
614942113
Author
Twerenbold R.; Jaeger C.; Gimenez M.R.; Wildi K.; Reichlin T.;
Nestelberger T.; Boeddinghaus J.; Grimm K.; Puelacher C.; Moehring B.;
Pretre G.; Schaerli N.; Campodarve I.; Rentsch K.; Steuer S.; Osswald S.;
Mueller C.
Institution
(Twerenbold, Jaeger, Gimenez, Wildi, Reichlin, Nestelberger, Boeddinghaus,
Grimm, Puelacher, Moehring, Pretre, Schaerli, Osswald, Mueller) Department
of Cardiology, University Hospital Basel, Petersgraben 4, Basel CH-4031,
Switzerland
(Twerenbold, Jaeger, Gimenez, Wildi, Reichlin, Nestelberger, Boeddinghaus,
Grimm, Puelacher, Moehring, Pretre, Schaerli, Osswald, Mueller)
Cardiovascular Research Institute Basel (CRIB), University Hospital Basel,
Basel, Switzerland
(Campodarve) Servicio de Urgencias y Medicina Interna, Hospital Del Mar,
Barcelona, Spain
(Rentsch) Laboratory Medicine, University Hospital Basel, Basel,
Switzerland
(Steuer) Emergency Department, Kantonsspital Luzern, Luzern, Switzerland
Title
Impact of high-sensitivity cardiac troponin on use of coronary
angiography, cardiac stress testing, and time to discharge in suspected
acute myocardial infarction.
Source
European Heart Journal. 37 (44) (pp 3324-3332a), 2016. Date of
Publication: 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims: High-sensitivity cardiac troponin (hs-cTn) assays provide higher
diagnostic accuracy for acute myocardial infarction (AMI) when compared
with conventional assays, but may result in increased use of unnecessary
coronary angiographies due to their increased detection of cardiomyocyte
injury in conditions other than AMI. Methods and results: We evaluated the
impact of the clinical introduction of high-sensitivity cardiac troponin T
(hs-cTnT) on the use of coronary angiography, stress testing, and time to
discharge in 2544 patients presenting with symptoms suggestive of AMI to
the emergency department (ED) within a multicentre study either before
(1455 patients) or after (1089 patients) hscTnT introduction. Acute
myocardial infarction was more often the clinical discharge diagnosis
after hs-cTnT introduction (10 vs. 14%, P < 0.001), while unstable angina
less often the clinical discharge diagnosis (14 vs. 9%, P = 0.007). The
rate of coronary angiography was similar before and after the introduction
of hs-cTnT (23 vs. 23%, P = 0.092), as was the percentage of coronary
angiographies showing no stenosis (11 vs. 7%, P = 0.361). In contrast, the
use of stress testing was substantially reduced from 29 to 19% (P <
0.001). In outpatients, median time to discharge from the ED decreased by
79 min (P < 0.001). Mean total costs decreased by 20% in outpatients after
the introduction of hs-cTnT (P = 0.002). Conclusion: The clinical
introduction of hs-cTn does not lead to an increased or inappropriate use
of coronary angiography. Introduction of hs-cTn is associated with an
improved rule-out process and thereby reduces the need for stress testing
and time to discharge. Copyright &#xa9; The Author 2016.

<154>
Accession Number
609068456
Author
Walsh M.; Whitlock R.; Garg A.X.; Legare J.-F.; Duncan A.E.; Zimmerman R.;
Miller S.; Fremes S.; Kieser T.; Karthikeyan G.; Chan M.; Ho A.; Nasr V.;
Vincent J.; Ali I.; Lavi R.; Sessler D.I.; Kramer R.; Gardner J.; Syed S.;
Van T.; Guyatt G.; Rao-Melacini P.; Thabane L.; Devereaux P.J.
Institution
(Walsh, Whitlock, Vincent, Rao-Melacini, Thabane, Devereaux) Population
Health Research Institute, Hamilton, ON, Canada
(Walsh, Whitlock, Syed, Van, Guyatt, Devereaux) McMaster University,
Hamilton, ON, Canada
(Garg, Lavi) London Health Sciences Centre, Western University, London,
ON, Canada
(Legare) Dalhousie University, Halifax, NS, Canada
(Duncan, Nasr, Sessler) Cleveland Clinic, Cleveland, OH, United States
(Zimmerman, Miller, Fremes, Gardner) Maine Medical Center, Portland, ME,
United States
(Miller, Gardner) Wake Forest University, Winston-Salem, NC, United States
(Fremes, Kramer) Sunnybrook Health Sciences Centre, University of Toronto,
Toronto, ON, Canada
(Kieser, Ali) University of Calgary, Calgary, AB, Canada
(Karthikeyan) All India Institute of Medical Sciences, New Delhi, India
(Chan, Ho) Chinese University of Hong Kong, Hong Kong, Hong Kong
Title
Effects of remote ischemic preconditioning in high-risk patients
undergoing cardiac surgery (Remote IMPACT): A randomized controlled trial.
Source
CMAJ. 188 (5) (pp 329-336), 2016. Date of Publication: 15 Mar 2016.
Publisher
Canadian Medical Association (1867 Alta Vista Drive, Ottawa KIG5W8,
Canada)
Abstract
Background: Remote ischemic preconditioning is a simple therapy that may
reduce cardiac and kidney injury. We undertook a randomized controlled
trial to evaluate the effect of this therapy on markers of heart and
kidney injury after cardiac surgery. Methods: Patients at high risk of
death within 30 days after cardiac surgery were randomly assigned to
undergo remote ischemic preconditioning or a sham procedure after
induction of anesthesia. The preconditioning therapy was three 5-minute
cycles of thigh ischemia, with 5 minutes of reperfusion between cycles.
The sham procedure was identical except that ischemia was not induced. The
primary outcome was peak creatine kinase myocardial band (CK-MB) within 24
hours after surgery (expressed as multiples of the upper limit of normal,
with log transformation). The secondary outcome was change in creatinine
level within 4 days after surgery (expressed as log-transformed micromoles
per litre). Patient-important outcomes were assessed up to 6 months after
randomization. Results: We randomly assigned 128 patients to remote
ischemic preconditioning and 130 to the sham therapy. There were no
significant differences in postoperative CK-MB (absolute mean difference
0.15, 95% confidence interval [CI] 0.07 to 0.36) or creatinine (absolute
mean difference 0.06, 95% CI-0.10 to 0.23). Other outcomes did not differ
significantly for remote ischemic preconditioning relative to the sham
therapy: for myocardial infarction, relative risk (RR) 1.35 (95% CI 0.85
to 2.17); for acute kidney injury, RR 1.10 (95% CI 0.68 to 1.78); for
stroke, RR 1.02 (95% CI 0.34 to 3.07); and for death, RR 1.47 (95% CI 0.65
to 3.31). Interpretation: Remote ischemic preconditioning did not reduce
myocardial or kidney injury during cardiac surgery. This type of therapy
is unlikely to substantially improve patient-important outcomes in cardiac
surgery. Copyright &#xa9; 2016 8872147 Canada Inc.

<155>
Accession Number
609034307
Author
Ranchord A.M.; Spertus J.A.; Buchanan D.M.; Gosch K.L.; Chan P.S.
Institution
(Ranchord, Spertus, Buchanan, Gosch, Chan) Saint Luke's Mid America Heart
Institute, 4401 Wornall Rd, Kansas City, MO 64111, United States
(Spertus, Buchanan, Chan) University of Missouri-Kansas City, Kansas City,
MO, United States
Title
Initiation of beta-blocker therapy and depression after acute myocardial
infarction.
Source
American Heart Journal. 174 (pp 37-42), 2016. Date of Publication: April
2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Introduction Although beta-blockers reduce mortality after acute
myocardial infarction (AMI), early reports linking beta-blocker use with
subsequent depression have potentially limited their use in vulnerable
patients. We sought to provide empirical evidence to support or refute
this concern by examining the association between beta-blocker initiation
and change in depressive symptoms in AMI patients. Methods Using data from
2 US multicenter, prospective registries of AMI patients, we examined 1-,
6-, and 12-month changes in depressive symptoms after the index
hospitalization among patients who were beta-blocker-naive on admission.
Depressive symptoms were assessed using the validated 8-item Patient
Health Questionnaire (PHQ-8), which rates depressive symptoms from 0 to
24, with higher scores indicating more depressive symptoms. A
propensity-matched repeated-measures linear regression model was used to
compare change in depressive symptoms among patients who were and were not
initiated on a beta-blocker after AMI. Results Of 3,470 AMI patients who
were beta-blocker-naive on admission, 3,190 (91.9%) were initiated on a
beta-blocker and 280 (8.1%) were not. Baseline PHQ-8 scores were higher in
patients not initiated on a beta-blocker (mean 5.78 +/- 5.45 vs 4.88 +/-
5.11, P =.005). PHQ-8 scores were progressively lower at 1, 6, and 12
months in both the beta-blocker (mean decrease at 12 months 1.16, P
<.0001) and no-beta-blocker groups (mean decrease 1.71, P <.0001). After
propensity matching 201 untreated patients with 567 treated patients,
initiation of beta-blocker therapy was not associated with a difference in
mean change in PHQ-8 scores at 1, 6, or 12 months after AMI (absolute mean
difference with beta-blocker initiation at 12 months of 0.08, 95% CI -0.81
to 0.96, P =.86). Conclusions Initiation of beta-blocker therapy after AMI
was not associated with an increase in depressive symptoms. Restricting
beta-blocker use because of concerns about depression appears unwarranted
and may lead to undertreatment of AMI patients. Copyright &#xa9; 2015
Elsevier Inc. All rights reserved.

<156>
Accession Number
613877784
Author
Taggart D.P.; Altman D.G.; Gray A.M.; Lees B.; Gerry S.; Benedetto U.;
Flather M.
Institution
(Taggart, Lees) Nuffield Department of Surgical Sciences, United Kingdom
(Altman, Gerry) Centre for Statistics in Medicine, Nuffield Department of
Orthopaedics, Rheumatology, Musculoskeletal Sciences, Botnar Research
Centre, United Kingdom
(Gray) Health Economics Research Centre, Nuffield Department of Population
Health, United Kingdom
(Benedetto) University of Oxford, Oxford, United Kingdom
(Benedetto) School of Clinical Sciences, University of Bristol and Bristol
Royal Infirmary, Bristol, United Kingdom
(Flather) Norwich Medical School, University of East Anglia and Norfolk
and Norwich University Hospital, Norwich NR4 7TJ, United Kingdom
Title
Randomized trial of bilateral versus single internal-thoracic-artery
grafts.
Source
New England Journal of Medicine. 375 (26) (pp 2540-2549), 2016. Date of
Publication: 29 Dec 2016.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND The use of bilateral internal thoracic (mammary) arteries for
coronary-artery bypass grafting (CABG) may improve long-term outcomes as
compared with the use of a single internal-thoracic-artery plus vein
grafts. METHODS We randomly assigned patients scheduled for CABG to
undergo single or bilateral internal-thoracic-artery grafting in 28
cardiac surgical centers in seven countries. The primary outcome was death
from any cause at 10 years. The composite of death from any cause,
myocardial infarction, or stroke was a secondary outcome. Interim analyses
were prespecified at 5 years of follow-up. RESULTS A total of 3102
patients were enrolled; 1554 were randomly assigned to undergo single
internal-thoracic-artery grafting (the single-graft group) and 1548 to
undergo bilateral internal-thoracic-artery grafting (the bilateral-graft
group). At 5 years of follow-up, the rate of death was 8.7% in the
bilateral-graft group and 8.4% in the single-graft group (hazard ratio,
1.04; 95% confidence interval [CI], 0.81 to 1.32; P = 0.77), and the rate
of the composite of death from any cause, myocardial infarction, or stroke
was 12.2% and 12.7%, respectively (hazard ratio, 0.96; 95% CI, 0.79 to
1.17; P = 0.69). The rate of sternal wound complication was 3.5% in the
bilateralgraft group versus 1.9% in the single-graft group (P = 0.005),
and the rate of sternal reconstruction was 1.9% versus 0.6% (P = 0.002).
CONCLUSIONS Among patients undergoing CABG, there was no significant
difference between those receiving single internal-thoracic-artery grafts
and those receiving bilateral internal-thoracic-artery grafts with regard
to mortality or the rates of cardiovascular events at 5 years of
follow-up. There were more sternal wound complications with bilateral
internal-thoracic-artery grafting than with single internal-thoracicartery
grafting. Ten-year follow-up is ongoing. Copyright &#xa9; 2016
Massachusetts Medical Society. All rights reserved.

<157>
Accession Number
607238954
Author
Braun D.; Orban M.; Gross L.; Nabauer M.; Hagl C.M.; Massberg S.;
Hausleiter J.
Institution
(Orban, Braun, Orban, Gross, Nabauer, Massberg, Hausleiter) Medizinische
Klinik und Poliklinik I, Klinikum der Universitat Munchen, Marchioninistr.
15, Munich 81377, Germany
(Hagl) Herzchirurgische Klinik und Poliklinik, Klinikum der Universitat
Munchen, Munich, Germany
Title
Established interventions for mitral valve regurgitation: Current
evidence.
Source
Herz. 41 (1) (pp 19-25), 2016. Date of Publication: 01 Feb 2016.
Publisher
Urban und Vogel GmbH (E-mail: verlag@urban-vogel.de)
Abstract
Severe mitral regurgitation (MR) is a growing medical challenge in today's
aging population, leading to increased health expenditure due to the
resultant morbidity and mortality. Surgery, either replacement or repair,
has been the mainstay of therapy for primary MR. In high-risk or
inoperable patients, treatment was limited to medical therapy until 2008.
Since then, alternative percutaneous therapies have been introduced and
have proven to be safe and effective in patients with secondary MR.
Edge-to-edge repair with the MitraClip system is applied worldwide for
primary and secondary MR. Randomized data do not support its application
in low-risk patients with primary MR. Results from ongoing and future
randomized trials will clarify its impact on important clinical endpoints
in high-risk and inoperable patients. The Carillon device is a
percutaneous indirect annuloplasty technique introduced in 2009 for
secondary MR. Clinical data for the novel Cardioband system, using a
different intra-atrial annuloplasty technique, have been gathered from
more than 40 patients and the system recently received CE mark approval.
Other percutaneous repair devices and implantable valves are under
development and may be introduced into clinical practice soon. The
percutaneous interventional therapy of MR is a highly dynamic field of
cardiovascular medicine and has the potential to improve quality of life
as well as morbidity and mortality in selected patients. Copyright &#xa9;
2015, Springer Medizin Verlag.

<158>
Accession Number
607490591
Author
Ansley D.M.; Raedschelders K.; Choi P.T.; Wang B.; Cook R.C.; Chen D.D.Y.
Institution
(Ansley, Choi, Wang) Department of Anesthesiology, Pharmacology and
Therapeutics, The University of British Columbia, Vancouver, BC, Canada
(Ansley, Choi) Department of Anesthesiology and Perioperative Care,
Vancouver General Hospital, Vancouver, BC, Canada
(Raedschelders) Heart Institute - Cedars Sinai Medical Center, Los
Angeles, CA, United States
(Choi) Center for Clinical Epidemiology and Evaluation, Vancouver Coastal
Health Research Institute, Vancouver, BC, Canada
(Cook) Department of Surgery (Division of Cardiac Surgery), The University
of British Columbia, Vancouver, BC, Canada
(Chen) Department of Chemistry, The University of British Columbia,
Vancouver, BC, Canada
(Ansley) Department of Anesthesiology, Pharmacology and Therapeutics,
University of British Columbia, Room 3300, 3rd Floor JPP, 910 West 10th
Ave, Vancouver, BC V5Z 1M9, Canada
Title
Propofol cardioprotection for on-pump aortocoronary bypass surgery in
patients with type 2 diabetes mellitus (PRO-TECT II): a phase 2
randomized-controlled trial.
Source
Canadian Journal of Anesthesia. 63 (4) (pp 442-453), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: The efficacy of myocardial conditioning strategies is compromised
in patients with advanced age, diabetes, or low ejection fraction. We
conducted a single-centre parallel-arm blinded randomized-controlled trial
to determine whether propofol provides perioperative myocardial
protection. Methods: Patients enrolled in this study were scheduled for
primary aortocoronary bypass surgery utilizing normothermic
cardiopulmonary bypass (CPB) with blood cardioplegia. The participants
were stratified by diabetic status and left ventricular ejection fraction
and randomly assigned to receive either an elevated dose of propofol
-previously associated with experimental cardioprotection- or an
isoflurane preconditioning regime. The primary endpoint was the coronary
sinus (CS) concentration of 15-F<inf>2t</inf>-isoprostane (isoP).
Secondary endpoints included in-hospital low cardiac output syndrome
(LCOS) and major adverse cardiac events, 12- and 24-hr CS cardiac troponin
I (cTnI) release, and myocardial B-cell lymphoma 2 (Bcl-2) protein
expression. Results: Data were analyzed from 125 of 137 randomized
participants. Participants receiving propofol experienced a greater mean
(SD) increase from baseline in CS 15-F<inf>2t</inf>-isoP levels compared
with those receiving isoflurane [26.9 (10.9) pg.mL^-1vs 12.1
(10.4) pg.mL^-1, respectively; mean difference, 14.8; 95%
confidence interval (CI), 11.0 to 18.6; P < 0.001] but a decreased
incidence of LCOS (20.9% vs 57.1%, respectively; relative risk [RR],0.37;
95% CI, 0.22 to 0.62; P < 0.001). The incidence of LCOS was similar
between groups in participants without type 2 diabetes mellitus (DM2) (P =
0.382) but significantly decreased in the propofol DM2 subgroup compared
with the isoflurane DM2 subgroup (17.9% vs 70.3%, respectively; RR, 0.26;
95% CI, 0.13 to 0.52; P < 0.001). Propofol was associated with an increase
in myocardial Bcl-2 protein expression (P = 0.005), a lower incidence of a
CS cTnI threshold for myocardial infarction (P = 0.014), and fewer heart
failure events (P < 0.001). Conclusion: Propofol may be a preemptive
intraoperative cardioprotectant for patients with DM2 under conditions of
normothermic CPB and blood cardioplegic arrest. The study is registered at
www.clinicaltrials.gov (NCT00734383) and www.controlled-trials.com
(ISRCTN70879185). Copyright &#xa9; 2015, Canadian Anesthesiologists'
Society.

<159>
Accession Number
607446949
Author
Frontera J.A.; Lewin III J.J.; Rabinstein A.A.; Aisiku I.P.; Alexandrov
A.W.; Cook A.M.; del Zoppo G.J.; Kumar M.A.; Peerschke E.I.B.; Stiefel
M.F.; Teitelbaum J.S.; Wartenberg K.E.; Zerfoss C.L.
Institution
(Frontera) The Cerebrovascular Center, Neurological Institute, Cleveland
Clinic and Case Western Reserve University, 9500 Euclid Ave. S80,
Cleveland, OH 44195, United States
(Lewin III) The Departments of Pharmacy and Anesthesiology & Critical Care
Medicine, The Johns Hopkins Hospital and Johns Hopkins University School
of Medicine, Baltimore, MD, United States
(Rabinstein) The Department of Neurology, Mayo Clinic, Rochester, MN,
United States
(Aisiku) Harvard Medical School, Brigham and Women's Hospital, Boston, MA,
United States
(Alexandrov) The University of Tennessee Health Science Center, Memphis,
TN, United States
(Alexandrov) Australian Catholic University, Sydney, Australia
(Cook) Department of Pharmacy (UK Healthcare) & Department of Pharmacy
Practice & Science (UK College of Pharmacy), University of Kentucky,
Lexington, KY, United States
(del Zoppo) The Departments of Medicine (Hematology) and Neurology,
University of Washington School of Medicine, Seattle, WA, United States
(Kumar) The Departments of Neurology, Neurosurgery, Anesthesiology &
Critical Care, Perelman School of Medicine, Hospital of the University of
Pennsylvania, Philadelphia, PA, United States
(Peerschke) The Department of Laboratory Medicine and Pathology, Memorial
Sloan Kettering Cancer Center and Weill Cornell Medical School, New York,
NY, United States
(Stiefel) The Department of Neurosurgery, Westchester Medical Center, New
York Medical College, Valhalla, NY, United States
(Teitelbaum) Hopital du Sacre-Coeur and University of Montreal and
Montreal Neurological Institute and McGill University, Montreal, QC,
Canada
(Wartenberg) Klinik fur Neurologie, Martin-Luther-Universitat
Halle-Wittenberg, Halle, Germany
(Zerfoss) The Neuroscience and Neurosurgery Departments, Centra Lynchburg
General Hospital, Lynchburg, VA, United States
Title
Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage: A
Statement for Healthcare Professionals from the Neurocritical Care Society
and Society of Critical Care Medicine.
Source
Neurocritical Care. 24 (1) (pp 6-46), 2016. Date of Publication: 01 Feb
2016.
Publisher
Humana Press Inc. (E-mail: humana@humanapr.com)
Abstract
Background: The use of antithrombotic agents, including anticoagulants,
antiplatelet agents, and thrombolytics has increased over the last decade
and is expected to continue to rise. Although antithrombotic-associated
intracranial hemorrhage can be devastating, rapid reversal of coagulopathy
may help limit hematoma expansion and improve outcomes. Methods: The
Neurocritical Care Society, in conjunction with the Society of Critical
Care Medicine, organized an international, multi-institutional committee
with expertise in neurocritical care, neurology, neurosurgery, stroke,
hematology, hemato-pathology, emergency medicine, pharmacy, nursing, and
guideline development to evaluate the literature and develop an
evidence-based practice guideline. Formalized literature searches were
conducted, and studies meeting the criteria established by the committee
were evaluated. Results: Utilizing the GRADE methodology, the committee
developed recommendations for reversal of vitamin K antagonists, direct
factor Xa antagonists, direct thrombin inhibitors, unfractionated heparin,
low-molecular weight heparin, heparinoids, pentasaccharides,
thrombolytics, and antiplatelet agents in the setting of intracranial
hemorrhage. Conclusions: This guideline provides timely, evidence-based
reversal strategies to assist practitioners in the care of patients with
antithrombotic-associated intracranial hemorrhage. Copyright &#xa9; 2015,
Springer Science+Business Media New York.

<160>
Accession Number
612636079
Author
Hummel J.D.; Coppess M.A.; Osborn J.S.; Yee R.; Fung J.W.H.; Augostini R.;
Li S.; Hine D.; Singh J.P.
Institution
(Hummel, Augostini) Ohio State University, Columbus, OH, United States
(Coppess) Stern Cardiovascular Center, Germantown, TN, United States
(Osborn) Intermountain Medical Center, Murray, UT, United States
(Yee) London Health Sciences Centre, London, ON, Canada
(Fung) Chinese University of Hong Kong, Shatin, Hong Kong
(Li, Hine) Medtronic, Mounds View, MN, United States
(Singh) Massachusetts General Hospital, Boston, MA, United States
Title
Real-World Assessment of Acute Left Ventricular Lead Implant Success and
Complication Rates: Results from the Attain Success Clinical Trial.
Source
PACE - Pacing and Clinical Electrophysiology. 39 (11) (pp 1246-1253),
2016. Date of Publication: 01 Nov 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Left ventricular lead (LVL) implant success rates have
historically ranged between 70.5% and 95.5%. To date, there are few large
studies that evaluate LVL implant success utilizing a single family of
delivery catheters and leads. The Attain Success study was a prospective
nonrandomized multicenter global study with the main objectives of
assessing single-system LVL implant success and complication rates.
Methods: Patients undergoing cardiac resynchronization therapy
implantation were eligible for enrollment. There was no prespecified level
of experience for investigator participation. LVL implant success and
complication rates were assessed though 3 months of follow-up. Results: A
total of 2,014 patients (69.1 +/- 12.0 years, 71% male and 38% atrial
fibrillation) were enrolled from 114 centers with a follow-up of 3.5 +/-
2.1 months. Coronary sinus cannulation success rate was 96.4% with Attain
Family delivery catheters. Implant success rate for Attain Family leads
using Attain Family catheters was 94.0%; overall LVL implant success rate
was 97.1%. Median procedure time was 4 minutes for cannulation and 9
minutes for LVL placement. Median fluoroscopy time was 17 minutes and
median contrast used was 25 cc. There were 55 catheter or LVL-related
complications in 53 subjects; the majority were LVL dislodgements (34,
1.7%) and extracardiac stimulation (11, 0.5%). The Kaplan-Meier estimate
of the 3-month complication probability was 2.6%. Conclusion: This study
represents the largest prospective evaluation of LVL implantation to date,
revealing a high LVL implant success rate and low complication rate using
a single family of leads and delivery catheters. Copyright &#xa9; 2016
Wiley Periodicals, Inc.

<161>
Accession Number
608552068
Author
Roe Y.L.; Esterman A.; Mcdermott R.; Zeitz C.
Institution
(Roe) Sansom Institute for Health Research, University of South Australia,
Adelaide, SA, United States
(Esterman) School of Nursing and Midwifery, University of South Australia,
Adelaide, SA, United States
(Mcdermott) Faculty of Medicine, Health and Molecular Sciences, James Cook
University, Cairns, QLD, Australia
(Zeitz) Division of Medicine, The Queen Elizabeth Hospital, Woodville, SA,
Australia
Title
Management of Indigenous patients presenting with non ST-segment elevation
acute coronary syndrome in South Australia: A retrospective cohort study.
Source
Internal Medicine Journal. 46 (2) (pp 202-213), 2016. Date of Publication:
01 Feb 2016.
Publisher
Blackwell Publishing (E-mail: info@asia.blackpublishing.com.au)
Abstract
Aim: Using Australian guidelines for management of acute coronary
syndromes, we assessed the probability of an Indigenous patient receiving
interventional and therapeutic care after presenting in two metropolitan
hospitals. Methods: A retrospective case note review of patients admitted
through two Adelaide public tertiary hospital emergency departments from
December 2007 to December 2009. The study cohort was 488 patients with
high-risk clinical features without ST-segment elevation. Results:
Indigenous patients were significantly younger, present later in the
disease process and have a higher burden of cardiovascular risk factors
when compared with non-Indigenous patients. Indigenous patients were 54%
more likely to receive angiography (Risk ratios (RR)=1.54; 95% CI 1.31;
1.81) than non-Indigenous patients, however, this difference disappeared
after adjustment for age, sex and propensity score. Indigenous patients
were 20% more likely to receive the recommended medications (RR=1.19, 95%
CI 1.01; 1.40) compared with non-Indigenous patients. Patients over
65years were 53% less likely to receive an angiogram (RR=0.47, 95% CI
0.38; 0.56) and were 35% less likely to receive the recommended
medications (RR=0.65, 95% CI 0.54; 0.78) than a patient at the ages of
18-49. Women were almost 20% less likely to receive an angiogram (RR=0.81,
95% CI 0.66; 0.99) and 20% less likely to receive the recommended
medications (RR=0.80, 95% CI 0.71; 0.91) when compared with men. The
likelihood of receiving medications on discharge was significantly
influenced by age, gender, ethnicity, comorbid burden and
revascularisation. Conclusions: The younger age and significantly
higher-risk profile of Indigenous adults presenting to SA hospitals with
acute coronary syndromes appears to lead to different management
decisions, which may well be led by patient factors. Many of these risk
conditions can be better managed in the primary care setting. &#xa9; 2016
The Authors Internal Medicine Journal Copyright &#xa9; 2016 Royal
Australasian College of Physicians.

<162>
Accession Number
609430538
Author
Puri R.; Abdul-Jawad Altisent O.; Del Trigo M.; Campelo-Parada F.;
Regueiro A.; Barbosa Ribeiro H.; Delarochelliere R.; Paradis J.-M.; Dumont
E.; Rodes-Cabau J.
Institution
(Puri, Abdul-Jawad Altisent, Del Trigo, Campelo-Parada, Regueiro, Barbosa
Ribeiro, Delarochelliere, Paradis, Dumont, Rodes-Cabau) Quebec Heart and
Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, QC G1V
4G5, Canada
Title
Transcatheter mitral valve implantation for inoperable severely calcified
native mitral valve disease: A systematic review.
Source
Catheterization and Cardiovascular Interventions. 87 (3) (pp 540-548),
2016. Date of Publication: 15 Feb 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background Transcatheter mitral valve implantation (TMVI) for severely
calcified native mitral valve disease recently emerged as a treatment
option in patients deemed inoperable by conventional techniques. Yet no
systematic appraisal currently exists characterizing this novel treatment
paradigm. Methods A systematic literature review summarizing the clinical,
anatomical, peri- and post-procedural characteristics underscoring the
technical feasibility of this procedure was performed. Results Nine
publications describing 11 patients [mean age 68 +/- 10 years, 82% female,
82% severe mitral stenosis (MS), 18% severe mitral regurgitation (MR)]
were identified. Mean STS score, trans-mitral gradient and effective
orifice area were 10.5 +/- 4.6%, 12 +/- 2.4 mm Hg and 0.93 +/- 0.06
cm² respectively. All patients had severe, circumferential
mitral annular calcification on imaging. Dedicated balloon-expanding
transcatheter aortic valves were used in 10/11 cases, with 8/11 cases
involving a true percutaneous approach with peri-procedural 3D
trans-esophageal echocardiographic guidance; 3/11 cases involved an open
left atrial approach. Following initial balloon inflation and valve
deployment, procedural success rate was 73%, without residual paravalvular
leaks (PVL). Successful immediate re-deployment of a 2nd valve was needed
in 2 instances following significant PVL detection. Residual
trans-valvular gradients ranged from 3 to 7 mm Hg, with no patient
demonstrating >grade 2 MR. All patients survived the procedure, with 2
reported deaths on days 10- and 41 post-TMVI being non-cardiac-related.
Mid-term clinical follow-up, reported in 8 patients, revealed 6 patients
to be alive at 3-months with much improved functional status. Conclusions
TMVI for native severely calcified mitral valve disease appears
technically feasible with acceptable initial acute and mid-term
hemodynamic and clinical outcomes. The outcomes of an ongoing, dedicated
global Sapien TMVI registry will shed further light on this evolving
treatment paradigm. Copyright &#xa9; 2015 Wiley Periodicals, Inc.

<163>
Accession Number
609406286
Author
Min J.J.; Bae J.-Y.; Kim T.K.; Kim J.H.; Hwang H.Y.; Kim K.-H.; Ahn H.; Oh
A.Y.; Bahk J.-H.; Hong D.M.; Jeon Y.
Institution
(Min, Bae, Kim, Bahk, Hong, Jeon) Department of Anesthesiology and Pain
Medicine, Seoul National University Hospital, Seoul, South Korea
(Kim) Department of Anesthesiology and Pain Medicine, Inje University
Ilsan Paik Hospital, Gyeonggi, South Korea
(Hwang, Kim, Ahn) Department of Thoracic and Cardiovascular Surgery, Seoul
National University Hospital, Seoul, South Korea
(Oh) Department of Anesthesiology and Pain Medicine, Seoul National
University Bundang Hospital, Seongnam, Gyeonggi, South Korea
Title
Pulmonary Protective Effects of Remote Ischaemic Preconditioning with
Postconditioning in Patients Undergoing Cardiac Surgery Involving
Cardiopulmonary Bypass: A Substudy of the Remote Ischaemic Preconditioning
with Postconditioning Outcome trial.
Source
Heart Lung and Circulation. 25 (5) (pp 484-492), 2016. Date of
Publication: 01 May 2016.
Publisher
Elsevier Ltd
Abstract
Background: The RISPO (Remote Ischemic Preconditioning with
Postconditioning Outcome) trial evaluated whether remote ischaemic
preconditioning (RIPC) combined with remote ischaemic postconditioning
(RIPostC) improves the clinical outcomes of patients undergoing cardiac
surgery. This substudy of the RISPO trial aimed to evaluate the effect of
RIPC with RIPostC on pulmonary function in patients undergoing cardiac
surgery with cardiopulmonary bypass (CPB). Methods: Sixty-five patients
were enrolled (32: control and 33: RIPC-RIPostC). In the RIPC-RIPostC
group, four cycles of 5 min ischaemia and 5 min reperfusion were
administered before and after CPB to the upper limb. Peri-operative
PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> ratio, intra-operative
pulmonary shunt, and dynamic and static lung compliance were determined.
Results: The mean PaO<inf>2</inf>/ F<inf>I</inf>O<inf>2</inf> was
significantly higher in the RIPC-RIPostC group at 24h after surgery [290
(96) vs. 387 (137), p = 0.001]. The incidence of mechanical ventilation
for longer than 48h was significantly higher in the control group (23% vs.
3%, p < 0.05). However, there were no significant differences in other
pulmonary profiles, post-operative mechanical ventilation time, and
duration of intensive care unit stay. Conclusions: In our study,
RIPC-RIPostC improved the post-operative 24h
PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> ratio. Remote ischaemic
preconditioning-Remote ischaemic postconditioning has limited and delayed
pulmonary protective effects in cardiac surgery patients with CPB.
Copyright &#xa9; 2015 Australian and New Zealand Society of Cardiac and
Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New
Zealand (CSANZ).

<164>
Accession Number
607305373
Author
Setala P.; Kalliomaki M.-L.; Jarvela K.; Huhtala H.; Sisto T.; Puolakka P.
Institution
(Setala, Kalliomaki, Puolakka) Department of Anaesthesia, Tampere
University Hospital, PO Box 2000, Tampere FIN-33521, Finland
(Jarvela, Sisto) Heart Center, Tampere University Hospital, Tampere,
Finland
(Huhtala) School of Health Sciences, University of Tampere, Tampere,
Finland
Title
Postoperative hyperalgesia does not predict persistent post-sternotomy
pain; Observational study based on clinical examination.
Source
Acta Anaesthesiologica Scandinavica. 60 (4) (pp 520-528), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background Persistent post-sternotomy pain is a common problem, but the
risk of developing it varies among patients. We sought to find out whether
the risk of persistent post-sternotomy pain could be predicted by
measuring the area of acute sensory dysfunction around the sternotomy
wound. The secondary aim was to determine risk factors for persistent
post-sternotomy pain. Patients and methods Hundred patients who were
scheduled to undergo elective coronary artery bypass surgery were
recruited to the study. Patients were excluded if they had undergone
previous cardiac surgery or if they lacked co-operation. Preoperative pain
scores were determined and the patients filled in questionnaires about
depression, anxiety, and pain. The area of sensory dysfunction around the
sternotomy wound was assessed by pin prick on postoperative day 4. The
presence of persistent post-sternotomy pain was determined at a follow-up
evaluation at 4-6 months after surgery. Results The sizes of the area of
hyperalgesia or overall sensory dysfunction were not associated with
persistent post-sternotomy pain. Independent risk factors for persistent
post-sternotomy pain were found to be smoking and high pain score on
postoperative day 1. The prevalence of persistent post-sternotomy pain in
our study population was 38% analyzed by only the questionnaire and 15%
according to the clinical examination. Conclusion Measuring the area of
hyperalgesia in the acute phase does not give any additional information
on the risk of developing a persistent post-sternotomy pain. We do thus
not recommend measuring the area in this particular group of patients.
Evaluation of pain by only a questionnaire risks to overestimate the
presence of persistent post-sternotomy pain as compared to clinical
examination. Copyright &#xa9; 2015 The Acta Anaesthesiologica Scandinavica
Foundation. Published by John Wiley & Sons Ltd.

<165>
Accession Number
610906648
Author
van Diepen S.; Alemayehu W.G.; Zheng Y.; Theroux P.; Newby L.K.; Mahaffey
K.W.; Granger C.B.; Armstrong P.W.
Institution
(van Diepen) Divisions of Critical Care and Cardiology, University of
Alberta, Edmonton, AB, Canada
(van Diepen, Alemayehu, Zheng, Armstrong) Canadian VIGOUR Centre,
University of Alberta, Edmonton, AB, Canada
(Theroux, Granger) Institut de Cardiologie de Montreal, Universite de
Montreal, Quebec, Canada
(Newby) Duke Clinical Research Institute, Duke University Medical Center,
Durham, NC, United States
(Armstrong) Division of Cardiology, University of Alberta, Edmonton, AB,
Canada
(Mahaffey) Stanford University Medical Center, Stanford University School
of Medicine, Stanford, CA, United States
(van Diepen) 2C2 Cardiology Walter MacKenzie Center, University of Alberta
Hospital, 8440-11 St., Edmonton, AB T6G 2B7, Canada
Title
Temporal changes in biomarkers and their relationships to reperfusion and
to clinical outcomes among patients with ST segment elevation myocardial
infarction.
Source
Journal of Thrombosis and Thrombolysis. 42 (3) (pp 376-385), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Coronary plaque rupture mediating acute ST segment elevation myocardial
infarction (STEMI) is associated with a systemic inflammatory response.
Whether early temporal changes in inflammatory biomarkers are associated
with angiographic and electrocardiographic markers of reperfusion and
subsequent clinical outcomes is unclear. In the APEX-AMI biomarker
substudy, 376 patients with STEMI had inflammatory biomarkers measured at
the time of hospital presentation and 24 h later. The primary outcome was
the 90-day composite of death, shock, or heart failure. Secondary
reperfusion outcomes were (1) worst least residual ST segment elevation
(ST-E: <1 mm, 1 to <2 mm, >2 mm) and (2) post-percutaneous coronary
intervention (PCI) TIMI flow grade (0/1/2 vs 3) and TIMI myocardial
perfusion grade (TMPG 0/1 vs 2/3). The 90-day incidence of death, shock or
heart failure was 21.3 % in this cohort. Electrocardiographic reperfusion
(worst residual ST-E <1 mm, 1 to <2 mm, >2 mm) was associated with
differences in 24 h change in N-terminal proB-type natriuretic peptide
(NT-proBNP) (1192.8, 1332.5, 1859.0 ng/mL; p = 0.043) and the
pro-inflammatory cytokines Interleukin (IL)-6 (14.0, 13.6, 22.1 pg/mL; p =
0.016), IL-12 (-0.5, -0.9, -0.1 pg/mL; p = 0.013), and tumor necrosis
factor alpha (TNFalpha) (1.0, 0.6, 3.6 pg/mL; p = 0.023). Angiographic
reperfusion (TMPG 0/1 vs 2/3) was associated with changes in median
NT-proBNP (2649.3, 1382.7 ng/mL; p = 0.002) and IL-6 (28.7, 15.1; p =
0.040). After adjustment for baseline covariates, the 24 h change in the
pro-inflammatory cytokine TNFalpha [hazard ratio (HR) 0.49; 95 % CI
0.26-0.95; p = 0.035] and the anti-inflammatory cytokine IL 10 (HR 1.41;
95 % CI 1.06-1.87; p = 0.018) were independently associated with the
primary composite outcome. Successful coronary reperfusion was associated
with less systemic inflammatory response and greater temporal inflammatory
changes were independently associated with higher 90-day composite of
death, shock, or heart failure. These findings provide support for an
association between success of reperfusion, an acute STEMI inflammatory
response and subsequent clinical outcomes. Copyright &#xa9; 2016, Springer
Science+Business Media New York.

<166>
Accession Number
612502022
Author
Lee M.S.; Shlofmitz E.; Nguyen H.; Shlofmitz R.A.
Institution
(Lee, Nguyen) UCLA Medical Center, Los Angeles, CA, United States
(Shlofmitz) Northwell Health, Manhasset, NY, United States
(Shlofmitz) St. Francis Hospital-The Heart Center, Roslyn, NY, United
States
Title
Outcomes in Diabetic Patients Undergoing Orbital Atherectomy System.
Source
Journal of Interventional Cardiology. 29 (5) (pp 491-495), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: We evaluated the angiographic and clinical outcomes of orbital
atherectomy to treat severely calcified coronary lesions in diabetic and
non-diabetic patients. Background: Diabetics have increased risk for
death, myocardial infarction, and target vessel revascularization after
percutaneous coronary intervention. Severely calcified coronary lesions
are associated with increased cardiac events. Orbital atherectomy
facilitates stent delivery and optimizes stent expansion by modifying
severely calcified plaque. Outcomes in diabetic patients who undergo
orbital atherectomy have not been reported. Methods: Our retrospective
multicenter registry included 458 consecutive real-world patients with
severely calcified coronary arteries who underwent orbital atherectomy.
The primary safety endpoint was the rate of major adverse cardiac and
cerebrovascular events at 30 days. Results: Diabetics represented 42.1%
(193/458) of the entire cohort. The primary endpoint was similar in
diabetics and non-diabetics (1.0% vs. 3.0%%, P = 0.20), as were 30-day
rates of death (0.5% vs. 1.9%, P = 0.41), myocardial infarction (0.5% vs.
1.5%, P = 0.40), target vessel revascularization (0% vs. 0%, P = 1), and
stroke (0% vs. 0.4%, P > 0.9). Angiographic complications and stent
thrombosis rate were low and did not differ between the 2 groups.
Conclusion: Diabetics represented a sizeable portion of patients who
underwent orbital atherectomy. Diabetics who had severely calcified
coronary arteries and underwent orbital atherectomy had low event rates
that were similar to non-diabetics. Orbital atherectomy appears to be a
viable treatment strategy for diabetic patients. Randomized trials with
longer-term follow-up are needed to determine the ideal treatment strategy
for diabetics. Copyright &#xa9; 2016, Wiley Periodicals, Inc.

<167>
Accession Number
610109035
Author
Vallabhaneni S.; Purfield A.E.; Benedict K.; Luvsansharav U.; Lockhart
S.R.; Pham C.D.; Pascoe N.; Heseltine G.; Chung W.; Hall E.; Brust K.B.;
Wheeler C.F.; Halpin A.L.; Park B.J.
Institution
(Vallabhaneni, Purfield, Luvsansharav) Epidemic Intelligence Service,
Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta,
GA 30329, United States
(Vallabhaneni, Purfield, Benedict, Luvsansharav, Lockhart, Pham, Park)
Division of Foodborne, Waterborne and Environmental Diseases, Centers for
Disease Control and Prevention, Atlanta, GA, United States
(Pascoe, Heseltine) Texas Department of State Health Services, Austin, TX,
United States
(Chung, Hall) Dallas County Health and Human Services, Dallas, TX, United
States
(Brust, Wheeler) Scott and White Hospital, Temple, TX, United States
(Halpin) Division of Healthcare Quality Promotion, Centers for Disease
Control and Prevention, Atlanta, GA, United States
Title
Cardiothoracic surgical site phaeohyphomycosis caused by Bipolaris mould,
multiple US states, 2008-2013: A clinical description.
Source
Medical Mycology. 54 (3) (pp 318-321), 2016. Date of Publication: 14 Jan
2016.
Publisher
Taylor and Francis Ltd (E-mail: jnl.info@oup.co.uk)
Abstract
Bipolaris mould surgical site infections (SSIs) are exceedingly rare. We
describe 21 cases of Bipolaris SSIs in pediatric and adult cardiothoracic
surgery patients at ten hospitals in Texas, Arkansas, and Florida during
2008-2013. Median case-patient age was 55 years (range: 3 daysa'82 years),
and 19 (90%) were male. Ten (48%) had coronary artery bypass or valve
surgery, and seven (33%) had heart transplantation. Fifteen (71%) had more
than one cardiothoracic procedure (median: 3, range: 1-11). Thirteen (62%)
case-patients (all 5 pediatric patients, and 8 (50%) of 16 adult patients)
had delayed sternal closure (chest closed >1 day [median = 8 days; range:
2-22] following the initial cardiothoracic procedure). Thirteen (62%) had
mediastinitis. Median time from initial surgery to positive Bipolaris
culture was 20 days (range: 6-497). Sixteen (76%) case-patients died.
Copyright &#xa9; 2016 Published by Oxford University Press.

<168>
Accession Number
607342699
Author
Panchal H.B.; Barry N.; Bhatheja S.; Albalbissi K.; Mukherjee D.; Paul T.
Institution
(Panchal, Bhatheja, Albalbissi, 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
Title
Mortality and major adverse cardiovascular events after transcatheter
aortic valve replacement using Edwards valve versus CoreValve: A
meta-analysis.
Source
Cardiovascular Revascularization Medicine. 17 (1) (pp 24-33), 2016. Date
of Publication: 01 Jan 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: In patients with severe aortic stenosis who are at high risk
for surgery, transcatheter aortic valve replacement (TAVR) has emerged as
an alternative procedure using EV or CV. The objective of this
meta-analysis is to compare 1-year mortality and major adverse
cardiovascular and cerebrovascular events (MACCE) between Edwards valve
(EV) and Medtronic CoreValve (CV). Methods: PubMed and the Cochrane Center
Register of Controlled Trials were searched through December 2014. Twenty
seven studies (n = 12,249) comparing TAVR procedure that used EV (n =
5745) and CV (n = 6504) were included. End points were procedural success
rates, post-procedural mortality, myocardial infarction (MI), stroke,
major bleeding, major vascular complications, incidence of new permanent
pacemaker (PPM) placement and new left bundle branch block (LBBB). The
odds ratio (OR) with 95% confidence interval (CI) was computed and p <
0.05 was considered for significance. Results: There were no significant
differences between EV and CV for post-procedural in-hospital, 30-day and
1-year all-cause mortality rates (p = 0.53, 0.33 and 0.94 respectively),
cardiovascular mortality (p = 0.61), stroke (p = 0.54), major bleeding (p
= 0.25) and major vascular complications (p = 0.27). MI was significantly
lower with EV compared to CV (OR: 0.56, CI: 0.35-0.89, p = 0.01).
Placement of new PPM and new onset LBBB were significantly higher in CV
compared to EV (OR: 3.35, CI: 2.96-3.79, p < 0.00001 and OR: 6.55, CI:
4.76-9.03, p < 0.00001 respectively). Conclusions: The results of our
meta-analysis suggest that TAVR procedure using CV may be associated with
a higher incidence of MI, new PPM placement, and new onset LBBB compared
to EV. However, the type of valve placed does not affect mortality.
Copyright &#xa9; 2015 Elsevier Inc..

<169>
Accession Number
607522229
Author
Mahler S.A.; Riley R.F.; Russell G.B.; Hiestand B.C.; Hoekstra J.W.;
Lefebvre C.W.; Nicks B.A.; Cline D.M.; Askew K.L.; Bringolf J.; Elliott
S.B.; Herrington D.M.; Burke G.L.; Miller C.D.
Institution
(Mahler, Hiestand, Hoekstra, Lefebvre, Nicks, Cline, Askew, Bringolf,
Elliott, Miller) Department of Emergency Medicine, Wake Forest School of
Medicine, Winston-Salem, NC, United States
(Riley, Herrington) Department of Internal Medicine, Division of
Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, United
States
(Russell, Burke) Division of Public Health Sciences, Wake Forest School of
Medicine, Winston-Salem, NC, United States
Title
Adherence to an accelerated diagnostic protocol for chest pain: Secondary
analysis of the HEART pathway randomized trial.
Source
Academic Emergency Medicine. 23 (1) (pp 70-77), 2016. Date of Publication:
01 Jan 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives Accelerated diagnostic protocols (ADPs), such as the HEART
Pathway, are gaining popularity in emergency departments (EDs) as tools
used to risk stratify patients with acute chest pain. However, provider
nonadherence may threaten the safety and effectiveness of ADPs. The
objective of this study was to determine the frequency and impact of ADP
nonadherence. Methods A secondary analysis of participants enrolled in the
HEART Pathway RCT was conducted. This trial enrolled 282 adult ED patients
with symptoms concerning for acute coronary syndrome without ST-elevation
on electrocardiogram. Patients randomized to the HEART Pathway (N = 141)
were included in this analysis. Outcomes included index visit disposition,
nonadherence, and major adverse cardiac events (MACEs) at 30 days. MACE
was defined as death, myocardial infarction, or revascularization.
Nonadherence was defined as: 1) undertesting - discharging a high-risk
patient from the ED without objective testing (stress testing or coronary
angiography) or 2) overtesting - admitting or obtaining objective testing
on a low-risk patient. Results Nonadherence to the HEART Pathway occurred
in 28 of 141 patients (20%, 95% confidence interval [CI] = 14% to 27%).
Overtesting occurred in 19 of 141 patients (13.5%, 95% CI = 8% to 19%) and
undertesting in nine of 141 patients (6%, 95% CI = 3% to 12%). None of
these 28 patients suffered MACE. The net effect of nonadherence was 10
additional admissions among patients identified as low-risk and
appropriate for early discharge (absolute decrease in discharge rate of
7%, 95% CI = 3% to 13%). Conclusions Real-time use of the HEART Pathway
resulted in a nonadherence rate of 20%, mostly due to overtesting. None of
these patients had MACE within 30 days. Nonadherence decreased the
discharge rate, attenuating the HEART Pathway's impact on health care use.
Copyright &#xa9; 2015 by the Society for Academic Emergency Medicine.

<170>
[Use Link to view the full text]
Accession Number
607321379
Author
Axelrod D.M.; Sutherland S.M.; Anglemyer A.; Grimm P.C.; Roth S.J.
Institution
(Axelrod, Roth) Department of Pediatrics (Cardiology), Stanford University
Medical Center, Stanford, CA, United States
(Sutherland, Grimm) Department of Pediatrics (Nephrology), Stanford
University Medical Center, Stanford, CA, United States
(Anglemyer) Department of Clinical Pharmacy, School of Pharmacy,
University of California-San Francisco, San Francisco, CA, United States
Title
A Double-Blinded, Randomized, Placebo-Controlled Clinical Trial of
Aminophylline to Prevent Acute Kidney Injury in Children Following
Congenital Heart Surgery with Cardiopulmonary Bypass.
Source
Pediatric Critical Care Medicine. 17 (2) (pp 135-143), 2016. Date of
Publication: 01 Feb 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: Acute kidney injury occurs commonly in children following
congenital cardiac surgery with cardiopulmonary bypass and has been
associated with increased morbidity and mortality. Aminophylline, a
methylxanthine nonselective adenosine receptor antagonist, has been
effective in the management of acute kidney injury in certain populations.
This study sought to determine whether postoperative administration of
aminophylline attenuates acute kidney injury in children undergoing
congenital cardiac surgery with cardiopulmonary bypass. Design:
Single-center, double-blinded, placebo-controlled, randomized clinical
trial. Setting: Tertiary center, pediatric cardiovascular ICU. Patients: A
total of 144 children after congenital heart surgery with cardiopulmonary
bypass. Interventions: Seventy-two patients were randomized to receive
aminophylline and 72 patients received placebo. Study drug was
administered every 6 hours for 72 hours. Measurements and Main Results:
The primary outcome variable was the development of any acute kidney
injury, defined by the serum creatinine criteria of the Kidney Diseases:
Improving Global Outcomes. Secondary outcomes included the development of
severe acute kidney injury, time between cardiovascular ICU admission and
first successful extubation, percent fluid overload, total fluid balance,
urine output, bioelectrical impedance, and serum neutrophil
gelatinase-associated lipocalin. The unadjusted rate and severity of acute
kidney injury were not different between groups; 43 of 72 (60%) of the
treatment group and 36 of 72 (50%) of the placebo group developed acute
kidney injury (p = 0.32). Stage 2/3 acute kidney injury occurred in 23 of
72 (32%) of the treatment group and 15 of 72 (21%) of the placebo group (p
= 0.18). Secondary outcome measures also demonstrated no significant
difference between treatment and placebo groups. Aminophylline
administration was safe; no deaths occurred in either group, and rates of
adverse events were similar (14% in the treatment group vs 18% in the
placebo group; p = 0.30). Conclusions: In this placebo-controlled
randomized clinical trial, we found no effect of aminophylline to prevent
acute kidney injury in children recovering from cardiac surgery performed
with cardiopulmonary bypass. Future study of preoperative aminophylline
administration to prevent acute kidney injury may be warranted. Copyright
&#xa9; 2016 by the Society of Critical Care Medicine and the World
Federation of Pediatric Intensive and Critical Care Societies.

<171>
[Use Link to view the full text]
Accession Number
607622761
Author
Weiss M.J.; Hornby L.; Witteman W.; Shemie S.D.
Institution
(Weiss) Division of Pediatric Critical Care, Departement of Pediatrics,
Centre Mere-Enfant Soleil du Centre Hospitalier Universitaire de Quebec,
Quebec, QC, Canada
(Weiss, Witteman) Research Center of the CHU de Quebec, Reproduction,
Mother and Youth Health Axis, Quebec, QC, Canada
(Weiss) Department of Pediatrics, Faculty of Medicine, Universite Laval,
Quebec, QC, Canada
(Weiss) Canadian PDCDD Guideline Development Committee, Canadian Blood
Services, Ottawa, ON, Canada
(Hornby) DePPaRT Study, Pediatric Critical Care, Children s Hospital of
Eastern Ontario Research Institute, Ottawa, ON, Canada
(Hornby) Deceased Donation, Organs and Tissue, Canadian Blood Services,
Ottawa, ON, Canada
(Shemie) Division of Critical Care, Department of Pediatrics, Montreal
Children s Hospital, McGill University Health Centre and Research
Institute, Montreal, QC, Canada
(Shemie) Department of Pediatrics, McGill University, Montreal, QC, Canada
(Shemie) Deceased Donation, Organs and Tissues, Canadian Blood Services,
Ottawa, ON, Canada
Title
Pediatric donation after circulatory determination of death: A scoping
review.
Source
Pediatric Critical Care Medicine. 17 (3) (pp e87-e108), 2016. Date of
Publication: 23 Mar 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: Although pediatric donation after circulatory determination of
death is increasing in frequency, there are no national or international
donation after circulatory determination of death guidelines specific to
pediatrics. This scoping review was performed to map the pediatric
donation after circulatory determination of death literature, identify
pediatric donation after circulatory determination of death knowledge
gaps, and inform the development of national or regional pediatric
donation after circulatory determination of death guidelines. Data
Sources: Terms related to pediatric donation after circulatory
determination of death were searched in Embase and MEDLINE, as well as the
non-MEDLINE sources in PubMed from 1980 to May 2014. Study Selection:
Seven thousand five hundred ninety-seven references were discovered and 85
retained for analysis. All references addressing pediatric donation after
circulatory determination of death were considered. Exclusion criteria
were articles that did not address pediatric patients, animal or
laboratory studies, surgical techniques, and local pediatric donation
after circulatory determination of death protocols. Narrative reviews and
opinion articles were the most frequently discovered reference (25/85) and
the few discovered studies were observational or qualitative and almost
exclusively retrospective. Data Extraction: Retained references were
divided into themes and analyzed using qualitative methodology. Data
Synthesis: The main discovered themes were 1) studies estimating the
number of potential pediatric donation after circulatory determination of
death donors and their impact on donation; 2) ethical issues in pediatric
donation after circulatory determination of death; 3) physiology of the
dying process after withdrawal of life-sustaining therapy; 4) cardiac
pediatric donation after circulatory determination of death; and 5)
neonatal pediatric donation after circulatory determination of death.
Donor estimates suggest that pediatric donation after circulatory
determination of death will remain an event less common than brain death,
albeit with the potential to substantially expand the existing organ
donation pool. Limited data suggest outcomes comparable with organs
donated after neurologic determination of death. Although there is
continued debate around ethical aspects of pediatric donation after
circulatory determination of death, all pediatric donation after
circulatory determination of death publications from professional
societies contend that pediatric donation after circulatory determination
of death can be practiced ethically. Conclusions: This review provides a
comprehensive overview of the published literature related to pediatric
donation after circulatory determination of death. In addition to
informing the development of pediatric-specific guidelines, this review
serves to highlight several important knowledge gaps in this topic.
Copyright &#xa9; 2016 by the Society of Critical Care Medicine and the
World Federation of Pediatric Intensive and Critical Care Societies.

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[Use Link to view the full text]
Accession Number
610119400
Author
Santos A.B.S.; Roca G.Q.; Claggett B.; Sweitzer N.K.; Shah S.J.; Anand
I.S.; Fang J.C.; Zile M.R.; Pitt B.; Solomon S.D.; Shah A.M.
Institution
(Santos, Roca, Claggett, Solomon, Shah) Cardiovascular Division, Brigham
and Women's Hospital, Boston, MA, United States
(Santos) Cardiology Division, Hospital de Clinicas de Porto Alegre,
Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil
(Sweitzer) Division of Cardiovascular Medicine, Sarver Heart Center,
University of Arizona, Tucson, AZ, United States
(Shah) Cardiology Division, Northwestern University Feinberg, School of
Medicine, Chicago, IL, United States
(Anand) Cardiovascular Division, VA Medical Center, Minneapolis, MN,
United States
(Fang) Cardiology Division, University of Utah, School of Medicine, Salt
Lake City, UT, United States
(Zile) RHJ Department, Veterans Affairs Medical Center, Medical University
of South Carolina, Charleston, SC, United States
(Pitt) Cardiology Division, University of Michigan, School of Medicine,
Ann Arbor, MI, United States
Title
Prognostic relevance of left atrial dysfunction in heart failure with
preserved ejection fraction.
Source
Circulation: Heart Failure. 9 (4) (no pagination), 2016. Article Number:
e002763. Date of Publication: 01 Apr 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Left atrial (LA) size is an established marker of risk for
adverse outcomes in heart failure with preserved ejection fraction
(HFpEF). However, the independent prognostic importance of LA function in
HFpEF is not known. Methods and Results - We assessed LA function measured
by speckle-tracking echocardiography in 357 patients with HFpEF enrolled
in the Treatment Of Preserved Cardiac Function Heart Failure With an
Aldosterone Antagonist (TOPCAT) trial who were in sinus rhythm at the time
of echocardiography. Lower peak LA strain, indicating LA dysfunction, was
associated with older age, higher prevalence of atrial fibrillation and
left ventricular (LV) hypertrophy, worse LV and right ventricular systolic
function, and worse LV diastolic function. At a mean follow-up of 31
months (interquartile range, 18-43months), 91 patients (25.5%) experienced
the primary composite end point of cardiovascular death, HF
hospitalization, and aborted sudden death. Lower peak LA strain was
associated with a higher risk of the composite end point (hazard ratio,
0.96 per unit of reduction in strain; 95% confidence interval, 0.94-0.99;
P=0.009) and of HF hospitalization alone (hazard ratio, 0.95 per unit of
reduction in strain; 95% confidence interval, 0.92-0.98; P=0.003). The
association of LA strain with incident HF hospitalization remained
significant after adjustment for clinical confounders, but not after
further adjustment for LV global longitudinal strain and the E/E' ratio,
parameters of LV systolic and diastolic function, respectively.
Conclusions - LA dysfunction in HFpEF is associated with a higher risk of
HF hospitalization independent of potential clinical confounders, but not
independent of LV strain and filling pressure. Impairment in LV systolic
and diastolic function largely explains the association between impaired
LA function and higher risk of HF hospitalization in HFpEF. Copyright
&#xa9; 2016 American Heart Association, Inc.

<173>
Accession Number
607178586
Author
Mottin B.; Baruteau A.; Boudjemline Y.; Piechaud F.J.; Godart F.; Lusson
J.-R.; Hascoet S.; Le Gloan L.; Fresse K.W.; Guyomarch B.; Bouzguenda I.;
Malekzadeh-Milani S.; Petit J.; Guerin P.
Institution
(Mottin, Le Gloan, Fresse, Guyomarch, Guerin) Institut du Thorax, Centre
Hospitalier Universitaire de Nantes, France
(Baruteau, Hascoet, Petit) Centre Medico-Chirurgical de Marie Lannelongue,
Le-Plessis-Robinson, France
(Boudjemline, Malekzadeh-Milani) Hopital Necker Enfants Malades,
Assistance Publique des Hopitaux de Paris, France
(Piechaud, Bouzguenda) Institut Cardiologique Paris Sud, Massy, France
(Godart) Centre Hospitalier Regional Universitaire de Lille, France
(Lusson) Centre Hospitalier Universitaire Gabriel Montpied,
Clermont-Ferrand, France
(Hascoet) Centre Hospitalier Universitaire de Toulouse, France
Title
Transcatheter closure of coronary artery fistulas in infants and children:
A French multicenter study.
Source
Catheterization and Cardiovascular Interventions. 87 (3) (pp 411-418),
2016. Date of Publication: 15 Feb 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives The short-term efficacy and safety of transcatheter closure
(TCC) for the management of coronary artery fistulas (CAFs) was
investigated in pediatric patients. Background CAFS are rare with
potentially severe complications and their management is still a matter of
debate. Percutaneous closure appears to be the treatment of choice in
anatomically suitable vessels but limited data are available in the
pediatric population. Methods This retrospective, observational,
multicenter, national study included patients under 16 years of age who
underwent TCC of a congenital CAF. Patients with additional congenital
heart defect were excluded. Results 61 patients (36 girls, 25 boys) with a
median age of 0.6 year [0-15.4] at diagnosis and 3.9 years [0-16] at
procedure were included. The CAF was large in 48 patients (79%); it was
distal in 23 (38%) and proximal in 22 (36%). Most patients (77%) were
asymptomatic at diagnosis. Clinical signs of congestive heart failure were
present in seven patients (11%). Perioperative complications included
three cases of ST elevation myocardial infarction (exclusively during
attempted closure of a distal CAF), three devices migrations, and one case
of leg ischemia. One patient died after surgical closure of a large distal
CAF that could not be closed by TCC. Follow-up data were collected for 43
patients (70%) for a median of 91 days [0-4,824]. The Kaplan-Meyer
estimate for complete occlusion at 2 years was 73 +/- 7.6%. Conclusion TCC
in the pediatric population appears to be effective and associated with
few complications. Copyright &#xa9; 2015 Wiley Periodicals, Inc.

<174>
[Use Link to view the full text]
Accession Number
607208973
Author
Higashigaito K.; Husarik D.B.; Barthelmes J.; Plass A.R.; Manka R.;
Maisano F.; Alkadhi H.
Institution
(Higashigaito, Husarik, Manka, Alkadhi) Institute of Diagnostic and
Interventional Radiology, University Hospital Zurich, University of
Zurich, Raemistrasse 100, Zurich 8091, Switzerland
(Barthelmes, Plass, Maisano) Division of Cardiovascular Surgery,
Switzerland
(Manka) Department of Cardiology, University Hospital Zurich, University
of Zurich, Switzerland
(Manka) Institute for Biomedical Engineering, University and ETH Zurich,
Zurich, Switzerland
Title
Computed Tomography Angiography of Coronary Artery Bypass Grafts: Low
Contrast Media Volume Protocols Adapted to Tube Voltage.
Source
Investigative Radiology. 51 (4) (pp 241-248), 2016. Date of Publication:
01 Apr 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective The aim of this study was to evaluate the potential of contrast
media (CM) reduction in computed tomography angiography (CTA) of coronary
artery bypass grafts (CABGs) when adapting CM volume to automatically
selected tube voltages. Material and Methods Sixty consecutive patients
(mean age, 71 +/- 14.5 years) with a total of 176 CABGs (692 bypass
segments) underwent contrast-enhanced prospectively
electrocardiography-gated high-pitch CTA with automated, attenuation-based
tube voltage selection (100 ref. peak kilovoltage [kVp], 200 ref. mAs,
tube voltages from 70-150 kVp in 10-kVp steps) using a third-generation
192-slice dual-source computed tomography scanner. Volume and flow of CM
(370 mg/mL iodine) was adapted according to the tube voltages using iodine
attenuation-curves derived from a foregoing phantom study. In patients, CM
volumes ranged from 80 mL (flow rate, 7 mL/s) at 120 kVp to 48 mL (flow
rate, 4.2 mL/s) at 80 kVp. Two independent, blinded readers evaluated
subjective image quality of the proximal anastomosis, bypass graft, distal
anastomosis, and postanastomotic native coronary artery using a 3-point
Likert scale. Objective image quality (attenuation of graft and noise) was
determined and contrast-to-noise ratio (CNR) was calculated. Volume
computed tomography dose index and dose-length product of each CTA
examination were noted. Cohen kappa was used to define interreader
agreement of subjective image quality. Regression analysis was used to
determine relationships between tube voltage and vascular attenuation,
image noise, and CNR. Results Using attenuation-based tube voltage
selection, 5 patients (8%) were scanned at 80 kVp, 22 (37%) at 90 kVp, 11
(18%) at 100 kVp, 10 (17%) at 110 kVp, and 12 (20%) at 120 kVp. Agreement
in subjective image quality between readers was good (kappa = 0.678).
Diagnostic image quality was achieved in 679 of 692 (98%) bypass segments
in 169 of 176 bypass grafts (96%). Thirteen of 692 bypass segments (2%) in
7 of 176 bypass grafts (4%) were rated as nondiagnostic because of severe
artifacts caused by motion or beam hardening (2 proximal anastomoses of
sequential bypasses, 3 graft bodies, 5 distal anastomoses, and 3
postanastomotic coronary artery segments). Regression analysis revealed no
significant relationship between the automatically selected tube voltages
and objective image quality parameters (bypass graft attenuation: P =
0.315; noise: P = 0.433; and CNR: P = 0.168), indicating homogenous
attenuation, noise, and CNR across tube voltage levels. Mean volume
computed tomography dose index was 4.0 +/- 0.9 mGy, and mean dose length
product was 135.0 +/- 29.6 mGy*cm. Conclusion Adapting CM protocols to
automatically selected tube voltage levels allows for low-volume CM CTA
examinations of CABG grafts with diagnostic image quality. Copyright
&#xa9; 2016 Wolters Kluwer Health, Inc. All rights reserved.

<175>
[Use Link to view the full text]
Accession Number
607208921
Author
Berg R.A.; Nadkarni V.M.; Clark A.E.; Moler F.; Meert K.; Harrison R.E.;
Newth C.J.L.; Sutton R.M.; Wessel D.L.; Berger J.T.; Carcillo J.; Dalton
H.; Heidemann S.; Shanley T.P.; Zuppa A.F.; Doctor A.; Tamburro R.F.;
Jenkins T.L.; Dean J.M.; Holubkov R.; Pollack M.M.
Institution
(Berg, Nadkarni, Sutton, Zuppa) Department of Anesthesiology and Critical
Care, Children's Hospital of Philadelphia, University of Pennsylvania
Perelman School of Medicine, Philadelphia, PA, United States
(Clark, Dean, Holubkov) Department of Pediatrics, University of Utah
School of Medicine, Salt Lake City, UT, United States
(Moler, Shanley) Department of Pediatrics, University of Michigan, Ann
Arbor, MI, United States
(Meert, Heidemann) Department of Pediatrics, Children's Hospital of
Michigan, Detroit, MI, United States
(Harrison) Department of Pediatrics, University of California at Los
Angeles, Los Angeles, CA, United States
(Newth) Department of Anesthesiology and Critical Care Medicine,
Children's Hospital Los Angeles, Los Angeles, CA, United States
(Wessel, Berger) Department of Pediatrics, Children's National Medical
Center, Washington, DC, United States
(Carcillo) Department of Critical Care Medicine, Children's Hospital of
Pittsburgh, Pittsburgh, PA, United States
(Dalton) Department of Child Health, Phoenix Children's Hospital,
University of Arizona, College of Medicine-Phoenix, Phoenix, AZ, United
States
(Doctor) Departments of Pediatrics and Biochemistry, Washington University
School of Medicine, St. Louis, MO, United States
(Tamburro, Jenkins) Branch of Trauma and Critical Illness, Eunice Kennedy
Shriver National Institutes of Child Health and Human Development,
National Institutes of Health, Bethesda, MD, United States
(Pollack) Department of Pediatrics, Children's National Medical Center,
George Washington University School of Medicine, Washington, DC, United
States
Title
Incidence and Outcomes of Cardiopulmonary Resuscitation in PICUs.
Source
Critical Care Medicine. 44 (4) (pp 798-808), 2016. Date of Publication: 01
Apr 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: To determine the incidence of cardiopulmonary resuscitation in
PICUs and subsequent outcomes. Design, Setting, and Patients: Multicenter
prospective observational study of children younger than 18 years old
randomly selected and intensively followed from PICU admission to hospital
discharge in the Collaborative Pediatric Critical Care Research Network
December 2011 to April 2013. Results: Among 10,078 children enrolled, 139
(1.4%) received cardiopulmonary resuscitation for more than or equal to 1
minute and/or defibrillation. Of these children, 78% attained return of
circulation, 45% survived to hospital discharge, and 89% of survivors had
favorable neurologic outcomes. The relative incidence of cardiopulmonary
resuscitation events was higher for cardiac patients compared with
non-cardiac patients (3.4% vs 0.8%, p <0.001), but survival rate to
hospital discharge with favorable neurologic outcome was not statistically
different (41% vs 39%, respectively). Shorter duration of cardiopulmonary
resuscitation was associated with higher survival rates: 66% (29/44)
survived to hospital discharge after 1-3 minutes of cardiopulmonary
resuscitation versus 28% (9/32) after more than 30 minutes (p < 0.001).
Among survivors, 90% (26/29) had a favorable neurologic outcome after 1-3
minutes versus 89% (8/9) after more than 30 minutes of cardiopulmonary
resuscitation. Conclusions: These data establish that contemporary PICU
cardiopulmonary resuscitation, including long durations of cardiopulmonary
resuscitation, results in high rates of survival-to-hospital discharge
(45%) and favorable neurologic outcomes among survivors (89%). Rates of
survival with favorable neurologic outcomes were similar among cardiac and
noncardiac patients. The rigorous prospective, observational study design
avoided the limitations of missing data and potential selection biases
inherent in registry and administrative data. Copyright &#xa9; 2016 by the
Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All
Rights Reserved.

<176>
Accession Number
608756107
Author
Andrioli E.R.; Furtado G.H.C.; Medeiros E.A.
Institution
(Andrioli, Furtado, Medeiros) Division of Infectious Diseases, Department
of Internal Medicine, Hospital Sao Paulo, Escola Paulista de Medicina,
Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 690, 2- andar,
Sao Paulo, SP CEP 04024-002, Brazil
Title
Catheter-associated urinary tract infection after cardiovascular surgery:
Impact of a multifaceted intervention.
Source
American Journal of Infection Control. 44 (3) (pp 289-293), 2016. Date of
Publication: 01 Mar 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background The aims of this study were to assess the impact of a
multifaceted intervention on the incidence of catheter-associated urinary
tract infection (CAUTI) and on the urinary catheter utilization (UCU)
ratio, evaluating adherence to recommendations for the use of indwelling
urinary catheters (IUCs). Methods This prospective, before-and-after
interventional study was conducted in three 6-month phases:
preintervention (phase 1), intervention (phase 2), and postintervention
(phase 3). We observed IUC insertion technique, maintenance care, and
removal/nonremoval practices; provided training on CAUTI prevention
measures; evaluated professional knowledge; provided adherence feedback;
determined the incidence of CAUTI, and calculating the UCU ratio. Results
Between phases 1 and 3, CAUTI incidence fell from 11.42 to 4.40 cases/1000
catheter-days (P =.216), whereas the UCU ratio remained constant. The risk
of CAUTI was 2.6-fold higher in phase 1 than in phase 3. Adherence to hand
hygiene (before and after IUC insertion) improved significantly, as did
adherence to attaching the IUC to the patient and maintenance care
guidelines. The reasons for IUC use (including inappropriate reasons) did
not differ significantly. Professional knowledge improved significantly
after training. Conclusion A multifaceted intervention effectively reduced
CAUTI incidence and improved the quality of care. Copyright &#xa9; 2016
Association for Professionals in Infection Control and Epidemiology, Inc.

<177>
Accession Number
613222338
Author
Pedersen S.S.; Nielsen J.C.; Riahi S.; Haarbo J.; VidebAEk R.; Larsen
M.L.; Skov O.; Knudsen C.; Johansen J.B.
Institution
(Pedersen, Skov, Knudsen) Department of Psychology, University of Southern
Denmark, Odense, Denmark
(Pedersen, Johansen) Department of Cardiology, Odense University Hospital,
Odense, Denmark
(Pedersen) Department of Cardiology, Erasmus Medical Center, Rotterdam,
Netherlands
(Nielsen) Department of Cardiology, Skejby, Aarhus University Hospital,
Aarhus, Denmark
(Riahi, Larsen) Department of Cardiology, Aalborg University Hospital,
Aalborg, Denmark
(Haarbo) Department of Cardiology, Gentofte Hospital, Copenhagen
University Hospital, Copenhagen, Denmark
(VidebAEk) Department of Cardiology, Rigshospitalet, Copenhagen University
Hospital, Copenhagen, Denmark
Title
Study Design and Cohort Description of DEFIB-WOMEN: A National Danish
Study in Patients with an ICD.
Source
PACE - Pacing and Clinical Electrophysiology. 39 (11) (pp 1261-1268),
2016. Date of Publication: 01 Nov 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Little systematic evidence is available on potential gender
differences in patients with an implantable cardioverter defibrillator
(ICD) from a real-world cohort. We designed the DEFIB-WOMEN (The
Utilization of Implantable Cardioverter DEFIBrillator Therapy in the
Treatment of Heart Disease: Clinical and Psychological outcomes in WOMEN)
study to examine gender differences on (1) patient-reported outcomes
(PROs), (2) procedure- and device-related complications, and (3)
ventricular tachyarrhythmia and mortality. This presents the study design
and baseline characteristics of the cohort. Methods: DEFIB-WOMEN is a
national, multicenter, prospective, observational study. First-time
implanted patients are asked to complete PROs at several time points.
Information on baseline and follow-up characteristics are captured from
patients' medical records, purpose-designed questions, and the Danish
national registers. The DEFIB-WOMEN cohort is composed of 1,790 (19%
women; 343/1,790) patients implanted between June 2010 and April 2013.
Results: Women and men differed on several demographic and clinical
baseline characteristics, including on the prescription of beta-blockers,
statins, angiotensin-converting enzyme inhibitors, and psychotropic
agents. Although women generally had a healthier clinical profile, they
reported significantly more symptoms of anxiety and depression and ICD
concerns (fear of shock) as compared to men. These differences were not
only statistically significant but also clinically relevant, with the
magnitude of the differences in anxiety and ICD concerns being 0.44 and
0.42, respectively, as indicated by Cohen's effect size index.
Conclusions: These preliminary results indicate that women with an ICD
experience particularly more anxiety and ICD concerns as compared to men
at the time of implant. Future results of DEFIB-WOMEN will show whether
these gender differences persist and whether there are also gender
differences in complications and survival. Copyright &#xa9; 2016 Wiley
Periodicals, Inc.

<178>
Accession Number
607949700
Author
Goldstein D.; Moskowitz A.J.; Gelijns A.C.; Ailawadi G.; Parides M.K.;
Perrault L.P.; Hung J.W.; Voisine P.; Dagenais F.; Gillinov A.M.; Thourani
V.; Argenziano M.; Gammie J.S.; Mack M.; Demers P.; Atluri P.; Rose E.A.;
O'Sullivan K.; Williams D.L.; Bagiella E.; Michler R.E.; Weisel R.D.;
Miller M.A.; Geller N.L.; Taddei-Peters W.C.; Smith P.K.; Moquete E.;
Overbey J.R.; Kron I.L.; O'Gara P.T.; Acker M.A.
Institution
(Goldstein, Michler) Department of Cardiothoracic Surgery, Montefiore
Medical Center-Albert Einstein College of Medicine, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
(Moskowitz, Gelijns, Parides, O'Sullivan, Williams, Bagiella, Moquete,
Overbey) International Center for Health Outcomes and Innovation Research,
Department of Population Health Science and Policy, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
(Rose) Cardiovascular Institute, Icahn School of Medicine at Mount Sinai,
New York, NY, United States
(Argenziano) Division of Cardiothoracic Surgery, Department of Surgery,
College of Physicians and Surgeons, Columbia University, New York, NY,
United States
(Ailawadi, Kron) Division of Thoracic and Cardiovascular Surgery,
University of Virginia School of Medicine, Charlottesville, VA, United
States
(Perrault, Demers) Montreal Heart Institute, University of Montreal,
Montreal, QC, Canada
(Voisine, Dagenais) Institut Universitaire de Cardiologie de Quebec,
Hopital Laval, Quebec, QC, Canada
(Weisel) Peter Munk Cardiac Centre, Division of Cardiovascular Surgery,
Toronto General Hospital, University Health Network, Division of Cardiac
Surgery, University of Toronto, Toronto, ON, Canada
(Hung) Echocardiography Core Lab, Massachusetts General Hospital, Boston,
MA, United States
(O'Gara) Cardiovascular Division, Brigham and Women's Hospital, Boston,
MA, United States
(Gillinov) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic Foundation, Cleveland, OH, United States
(Thourani) Clinical Research Unit, Division of Cardiothoracic Surgery,
Emory University School of Medicine, Atlanta, GA, United States
(Gammie) University of Maryland, Baltimore, MD, United States
(Miller, Taddei-Peters) Division of Cardiovascular Sciences, National
Heart, Lung, and Blood Institute, Bethesda, MD, United States
(Geller) Office of Biostatistics Research, National Heart, Lung, and Blood
Institute, Bethesda, MD, United States
(Mack) Baylor Research Institute, Dallas, TX, United States
(Atluri, Acker) Department of Surgery, Division of Cardiovascular Surgery,
University of Pennsylvania School of Medicine, Philadelphia, PA, United
States
(Smith) Division of Cardiovascular and Thoracic Surgery, Department of
Surgery, Duke University Medical Center, Durham, NC, United States
Title
Two-year outcomes of surgical treatment of severe ischemic mitral
regurgitation.
Source
New England Journal of Medicine. 374 (4) (pp 344-353), 2016. Date of
Publication: 28 Jan 2016.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: In a randomized trial comparing mitral-valve repair with
mitral-valve replacement in patients with severe ischemic mitral
regurgitation, we found no significant difference in the left ventricular
end-systolic volume index (LVESVI), survival, or adverse events at 1 year
after surgery. However, patients in the repair group had significantly
more recurrences of moderate or severe mitral regurgitation. We now report
the 2-year outcomes of this trial. METHODS: We randomly assigned 251
patients to mitral-valve repair or replacement. Patients were followed for
2 years, and clinical and echocardiographic outcomes were assessed.
RESULTS: Among surviving patients, the mean (+/-SD) 2-year LVESVI was
52.6+/-27.7 ml per square meter of body-surface area with mitral-valve
repair and 60.6+/-39.0 ml per square meter with mitral-valve replacement
(mean changes from baseline, -9.0 ml per square meter and -6.5 ml per
square meter, respectively). Two-year mortality was 19.0% in the repair
group and 23.2% in the replacement group (hazard ratio in the repair
group, 0.79; 95% confidence interval, 0.46 to 1.35; P=0.39). The
rank-based assessment of LVESVI at 2 years (incorporating deaths) showed
no significant between-group difference (z score=-1.32, P=0.19). The rate
of recurrence of moderate or severe mitral regurgitation over 2 years was
higher in the repair group than in the replacement group (58.8% vs. 3.8%,
P<0.001). There were no significant between-group differences in rates of
serious adverse events and overall readmissions, but patients in the
repair group had more serious adverse events related to heart failure
(P=0.05) and cardiovascular readmissions (P=0.01). On the Minnesota Living
with Heart Failure questionnaire, there was a trend toward greater
improvement in the replacement group (P=0.07). CONCLUSIONS: In patients
undergoing mitral-valve repair or replacement for severe ischemic mitral
regurgitation, we observed no significant between-group difference in left
ventricular reverse remodeling or survival at 2 years. Mitral
regurgitation recurred more frequently in the repair group, resulting in
more heart-failure-related adverse events and cardiovascular admissions.
Copyright &#xa9; 2015 Massachusetts Medical Society.

<179>
[Use Link to view the full text]
Accession Number
607026755
Author
Stopyra J.P.; Miller C.D.; Hiestand B.C.; Lefebvre C.W.; Nicks B.A.; Cline
D.M.; Askew K.L.; Riley R.F.; Russell G.B.; Hoekstra J.W.; Mahler S.A.
Institution
(Stopyra, Miller, Hiestand, Lefebvre, Nicks, Cline, Askew, Hoekstra,
Mahler) Department of Emergency Medicine, Wake Forest School of Medicine,
Medical Center Boulevard, Winston-Salem, NC 27157, United States
(Riley) Division of Cardiology, Department of Internal Medicine,
Winston-Salem, NC, United States
(Russell) Department of Biostatistical Sciences, Wake Forest School of
Medicine, Winston-Salem, NC, United States
Title
Performance of the EDACS-accelerated diagnostic pathway in a cohort of US
patients with acute chest pain.
Source
Critical Pathways in Cardiology. 14 (4) (pp 134-138), 2015. Date of
Publication: 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The Emergency Department Assessment of Chest pain Score-
Accelerated Diagnostic Protocol (EDAC S-ADP) is a decision aid designed to
safely identify emergency department (ED) patients with chest pain for
early discharge. Derivation and validation studies in Australasia have
demonstrated high sensitivity (99%-100%) for major adverse cardiac events
(MACE ). Objectives: To validate the EDAC S-ADP in a cohort of US ED
patients with symptoms suspicious for acute coronary syndrome (AC S).
Methods: A secondary analysis of participants enrolled in the HEART
Pathway Randomized Controlled Trial was conducted. This single-site trial
enrolled 282 ED patients >21 years old with symptoms concerning for AC S
inclusive of all cardiac risk levels. Each patient was classified as low
risk or at risk by the EDAC S-ADP based on EDAC S, electrocardiogram, and
serial troponins. Potential early discharge rate and sensitivity for MACE
at 30 days, defined as cardiac death, myocardial infarction (MI), or
coronary revascularization were calculated. Results: MACE occurred in
17/282 (6.0%) participants, including no deaths 16/282 (5.6%) with MI, and
1/282 (0.4%) with coronary revascularization without MI. The EDAC S-ADP
identified 188/282 patients [66.7%, 95% confidence interval (CI):
60.8%-72.1%] as low risk. Of these, 2/188 (1.1% 95% CI: 0.1%-3.9%) had
MACE at 30 days. EDAC S-ADP was 88.2% (95% CI: 63.6%-98.5%) sensitive for
MACE, identifying 15/17 patients. Of the 2 patients identified as low risk
with MACE, 1 had MI and 1 had coronary revascularization without MI.
Conclusions: Within a US cohort of ED patients with symptoms concerning
for AC S, sensitivity for MACE was 88.2%. We are unable to validate the
EDAC S-ADP as sufficiently sensitive for clinical use. Copyright &#xa9;
2015 Wolters Kluwer Health, Inc. All rights reserved.

<180>
Accession Number
607918546
Author
Filho M.F.S.; Barral M.; Barrucand L.; Cavalcanti I.L.; Vercosa N.
Institution
(Filho, Barrucand, Vercosa) Federal University of Rio de Janeiro, Rio de
Janeiro, Brazil
(Barral) Faculty of Medical Sciences of Juiz de Fora, Juiz de Fora, Brazil
(Cavalcanti) Fluminense Federal University, Niteroi, Brazil
Title
A randomized blinded study of the left ventricular myocardial performance
index comparing epinephrine to levosimendan following cardiopulmonary
bypass.
Source
PLoS ONE. 10 (12) (no pagination), 2015. Article Number: e0143315. Date of
Publication: 01 Dec 2015.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
The objective was to evaluate the effect of epinephrine and levosimendan
on the left ventricle myocardial performance index in patients undergoing
on-pump coronary artery by-pass grafting (CABG). Methods In a
double-blind, randomized clinical trial, 81 patients (age: 45a"65 years)
of both genders were randomly divided to receive either epinephrine at a
dosage of 0.06 mcg.kg1.min-1 (epinephrine group, 39 patients) or
levosimendan at 0.2 mcg.kg1.min-1 (levosimendan group, 42 patients) during
the rewarming of cardiopulmonary by-pass (CPB). Hemodynamic data were
collected 30 minutes after tracheal intubation, before chest open
(pre-CPB) and 10 minutes after termination of protamine (post-CPB). As the
primary outcome, we evaluated the left ventricle myocardial performance
index by the Doppler echocardiography. The myocardial performance index is
the sum of the isovolumetric contraction time and the isovolumetric
relaxation time, divided by the ejection time. Secondary outcomes were
systolic and diastolic evaluations of the left ventricle and postoperative
troponin I and MB-CK levels. Results Of the 81 patients allocated to the
research, we excluded 2 patients in the epinephrine group and 6 patients
in the levosimendan group because they didnaTMt wean from CPB in the first
attempt. There was no statistical difference between the groups in terms
of patient characteristics, risk factors, or CPB time. The epinephrine
group had a lower left ventricle myocardial performance index (p =
0.0013), higher cardiac index (p = 0.03), lower systemic vascular
resistance index (p = 0.01), and higher heart rate (p = 0.04) than the
levosimendan group at the post-CPB period. There were no differences
between the groups in diastolic dysfunction. The epinephrine group showed
higher incidence of weaning from CPB in the first attempt (95% vs 85%, p =
0.0001) when compared to the levosimendan group and the norepinephrine
requirement was higher in the levosimenandan group than epinephrine group
(16% vs. 47%; p = 0.005) in post-CPB period. Twenty-four hours after
surgery, the plasma levels of troponin I (epinephrine group: 4.5 A+/- 5.7
vs. levosimendan group: 2.5 A+/- 3.2 g/dl; p = 0.09) and MB-CK
(epinephrine group: 50.7 A+/- 31 vs. levosimendan group: 37 A+/- 17.6
g/dl; p = 0.08) were not significantly different between the two groups.
Conclusion When compared to levosimendan, patients treated with
epinephrine had a lower left ventricle myocardial performance index in the
immediate post-CPB period, encouraging an efficient weaning from CPB in
patients undergoing on-pump CABG. Copyright &#xa9; 2015 Salgado Filho et
al. This is an open access article distributed under the terms of the
Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original author
and source are credited.

<181>
[Use Link to view the full text]
Accession Number
607109074
Author
Xu R.; Li C.; Qian J.; Ge J.
Institution
(Xu, Li, Qian, Ge) Department of Cardiology, Zhongshan Hospital, Fudan
University, 180 Fenglin Road, Shanghai 200032, China
Title
Computed tomography-derived fractional flow reserve in the detection of
lesion-specific ischemia an integrated analysis of 3 pivotal trials.
Source
Medicine (United States). 94 (46) (pp e1963), 2015. Date of Publication:
2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Invasive fractional flow reserve (FFR) is the gold standard for the
determination of physiologic stenosis severity and the need for
revascularization. FFR computed from standard acquired coronary computed
tomographic angiography datasets (FFRCT) is an emerging technology which
allows calculation of FFR using resting image data from coronary computed
tomographic angiography (CCTA). However, the diagnostic accuracy of FFRCT
in the evaluation of lesion-specific myocardial ischemia remains to be
confirmed, especially in patients with intermediate coronary stenosis. We
performed an integrated analysis of data from 3 prospective,
international, and multicenter trials, which assessed the diagnostic
performance of FFRCT using invasive FFR as a reference standard. Three
studies evaluating 609 patients and 1050 vessels were included. The total
calculated sensitivity, specificity, positive predictive value, negative
predictive value, and accuracy of FFRCT were 82.8%, 77.7%, 60.8%, 91.6%,
and 79.2%, respectively, for the per-vessel analysis, and 89.4%, 70.5%,
69.7%, 89.7%, and 78.7%, respectively, for the per-patient analysis.
Compared with CCTA alone, FFRCT demonstrated significantly improved
accuracy (P<0.001) in detecting lesion-specific ischemia. In patients with
intermediate coronary stenosis, FFRCT remained both highly sensitive and
specific with respect to the diagnosis of ischemia. In conclusion, FFRCT
appears to be a reliable noninvasive alternative to invasive FFR, as it
demonstrates high accuracy in the determination of anatomy and
lesion-specific ischemia, which justifies the performance of additional
randomized controlled trials to evaluate both the clinical benefits and
the costeffectiveness of FFRCT-guided coronary revascularization.
Copyright &#xa9; 2015 Wolters Kluwer Health, Inc. All rights reserved.

<182>
Accession Number
611124447
Author
Bajaj N.S.; Kalra R.; Aggarwal H.; Ather S.; Gaba S.; Arora G.; McGiffin
D.C.; Ahmed M.; Aslibekyan S.; Arora P.
Institution
(Bajaj, Aggarwal, Ather, Gaba, Arora, Ahmed, Arora) Division of
Cardiology, Department of Medicine, University of Alabama, Birmingham, AL,
United States
(Bajaj, Aslibekyan) Ryals School of Public Health, Department of
Epidemiology, University of Alabama, Birmingham, AL, United States
(Kalra) Department of Medicine, University of Alabama, Birmingham, AL,
United States
(McGiffin) Alfred Hospital and Monash University, Melbourne, VIC,
Australia
(Ahmed) Division of Cardiology, Baptist Princeton, Birmingham, AL, United
States
Title
Comparison of approaches to revascularization in patients with multivessel
coronary artery disease presenting with st-segment elevation myocardial
infarction: Meta-analyses of randomized control trials.
Source
Journal of the American Heart Association. 4 (12) (no pagination), 2015.
Article Number: e002540. Date of Publication: 01 Dec 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Significant controversy exists regarding the best approach for
nonculprit vessel revascularization in patients with multivessel coronary
artery disease presenting with ST-segment elevation myocardial infarction.
We conducted a systematic investigation to pool data from current
randomized controlled trials (RCTs) to assess optimal treatment strategies
in this patient population. Methods and Results-A comprehensive search of
SCOPUS from inception through May 2015 was performed using predefined
criteria. We compared efficacy and safety outcomes of different approaches
by categorizing the studies into 3 groups: (1) complete revascularization
(CR) versus culprit lesion revascularization (CL) at index
hospitalization, (2) CR at index hospitalization versus staged
revascularization (SR) of nonculprit vessels at a separate
hospitalization, and (3) comparison of SR versus CL. Eight eligible RCTs
met the inclusion criteria: (1) CR versus CL (6 RCTs, n=1727) (2) CR
versus SR (3 RCTs, n=311), and (3) SR versus CL (1 RCT, n=149). We
observed significantly lower rates of major adverse cardiovascular events,
revascularization, and repeat percutaneous coronary interventions among
patients treated with CR and SR compared with a CL approach (P < 0.05).
The rates of all-cause mortality, cause-specific mortality, major
bleeding, reinfarction, stroke, and contrast-induced nephropathy did not
differ in the CR arm compared with the CL arm. The rates of these outcomes
were similar in the CR and SR arms. Conclusion-Results suggest that CR and
SR compared with CL reduce major adverse cardiovascular event and
revascularization rates primarily by lowering repeated percutaneous
coronary intervention rates. We did not observe any increase in the rate
of adverse events while using a CR or SR strategy compared with a CL
approach. Current guidelines discouraging CR need to be reevaluated, and
clinical judgment should prevail in treating multivessel coronary artery
disease patients with ST-segment elevation myocardial infarction as data
from larger RCTs accumulate. Copyright &#xa9; 2015 The Authors.

<183>
Accession Number
609055220
Author
Jolicoeur E.M.; Dunning A.; Castelvecchio S.; Dabrowski R.; Waclawiw M.A.;
Petrie M.C.; Stewart R.; Jhund P.S.; Desvigne-Nickens P.; Panza J.A.;
Bonow R.O.; Sun B.; San T.R.; Al-Khalidi H.R.; Rouleau J.L.; Velazquez
E.J.; Cleland J.G.F.
Institution
(Jolicoeur, Rouleau) Department of Medicine, Montreal Heart Institute,
Universite de Montreal, Montreal, Canada
(Dunning, Al-Khalidi, Velazquez) Duke Clinical Research Institute, Duke
University School of Medicine, Durham, NC, United States
(Castelvecchio) IRCCS Policlinico San Donato, Milan, Italy
(Dabrowski) National Institute of Cardiology, Warsaw, Poland
(Waclawiw, Desvigne-Nickens) National Institutes of Health, National
Heart, Lung, and Blood Institute, Bethesda, MD, United States
(Petrie) Golden Jubilee National Hospital, Glasgow, United Kingdom
(Stewart) Auckland City Hospital, Auckland, New Zealand
(Jhund) British Heart Foundation Cardiovascular Research Centre,
University of Glasgow, Glasgow, United Kingdom
(Panza) Westchester Medical Center and New York Medical College, Valhalla,
NY, United States
(Bonow) Northwestern University Feinberg, School of Medicine, Chicago, IL,
United States
(Sun) Allina Health, Minneapolis, MN, United States
(San) National Heart Centre, Singapore, Singapore
(Cleland) National Heart and Lung Institute, Royal Brompton and Harefield
Hospitals, Imperial College, London, United Kingdom
(Cleland) National Heart and Lung Institute, Heart Sciences Building,
Imperial College, Harefield Hospital, Hill End Road, London UB9 6JH,
United Kingdom
Title
Importance of Angina in Patients with Coronary Disease, Heart Failure, and
Left Ventricular Systolic Dysfunction Insights from STICH.
Source
Journal of the American College of Cardiology. 66 (19) (pp 2092-2100),
2015. Date of Publication: 2015.
Publisher
Elsevier USA
Abstract
Background Patients with left ventricular (LV) systolic dysfunction,
coronary artery disease (CAD), and angina are often thought to have a
worse prognosis and a greater prognostic benefit from coronary artery
bypass graft (CABG) surgery than those without angina. Objectives This
study investigated: 1) whether angina was associated with a worse
prognosis; 2) whether angina identified patients who had a greater
survival benefit from CABG; and 3) whether CABG improved angina in
patients with LV systolic dysfunction and CAD. Methods We performed an
analysis of the STICH (Surgical Treatment for Ischemic Heart Failure)
trial, in which 1,212 patients with an ejection fraction <35% and CAD were
randomized to CABG or medical therapy. Multivariable Cox and logistic
models were used to assess long-term clinical outcomes. Results At
baseline, 770 patients (64%) reported angina. Among patients assigned to
medical therapy, all-cause mortality was similar in patients with and
without angina (hazard ratio [HR]: 1.05; 95% confidence interval [CI]:
0.79 to 1.38). The effect of CABG was similar whether the patient had
angina (HR: 0.89; 95% CI: 0.71 to 1.13) or not (HR: 0.68; 95% CI: 0.50 to
0.94; p interaction = 0.14). Patients assigned to CABG were more likely to
report improvement in angina than those assigned to medical therapy alone
(odds ratio: 0.70; 95% CI: 0.55 to 0.90; p < 0.01). Conclusions Angina
does not predict all-cause mortality in medically treated patients with LV
systolic dysfunction and CAD, nor does it identify patients who have a
greater survival benefit from CABG. However, CABG does improve angina to a
greater extent than medical therapy alone. (Comparison of Surgical and
Medical Treatment for Congestive Heart Failure and Coronary Artery Disease
[STICH]; NCT00023595) Copyright &#xa9; 2015 American College of Cardiology
Foundation.

<184>
Accession Number
607206275
Author
Labaf A.; Sjalander A.; Stagmo M.; Svensson P.J.
Institution
(Labaf, Stagmo, Svensson) Department of Clinical Sciences, Malmo, Lund
University, Sweden
(Labaf, Stagmo) Department of Cardiology, Skane University Hospital, Malmo
20502, Sweden
(Sjalander) Department of Public Health and Clinical Medicine, Umea
University, Sweden
(Svensson) Department of Coagulation Disorders, Skane University Hospital,
Malmo, Sweden
Title
INR variability and outcomes in patients with mechanical heart valve
prosthesis.
Source
Thrombosis Research. 136 (6) (pp 1211-1215), 2015. Date of Publication: 01
Dec 2015.
Publisher
Elsevier Ltd
Abstract
Background The quality of treatment with warfarin is mainly assessed by
the time in therapeutic range (TTR) in patients with mechanical heart
valve prosthesis (MHV). Our aim was to evaluate if International
Normalized Ratio (INR) variability predicted a combined endpoint of
thromboembolism, major bleeding and death better than TTR. Methods and
results We included 394 patients at one center with MHV during 2008-2011
with adverse events and death followed prospectively. TTR 2.0-4.0 and
log-transformed INR variability was calculated for all patients. In order
to make comparisons between the measures, the gradient of the risk per one
standard deviation (SD) was assessed. INR variability performed equal as
TTR 2.0-4.0 per one SD unit adjusted for covariates, hazard ratio (HR)
1.30 (95% CI 1.1-1.5) and 0.71 (95% CI 0.6-0.8) respectively for the
combined endpoint, and performed better for mortality HR 1.47 (95% CI
1.1-1.9) and 0.70 (95% CI 0.6-0.8). INR variability was categorized into
high and low group and TTR into tertiles. High variability within the low
and high TTR, had a HR 2.0 (95% CI 1.7-3.6) and 2.2 (95% CI 1.1-4.1)
respectively, of the combined endpoint compared to the low
variability/high TTR group. INR values < 2.0 greatly increased the rate of
thromboembolism whereas the rate of major bleeding increased moderately
between INR 3.0 and 4.0 and increased substantially after INR > 4.0.
Conclusion The INR variability is an equal predictor as TTR of the
combined endpoint of thromboembolism, major bleeding and death, and adds
important information on top of TTR in patients with MHV. Copyright &#xa9;
2015 Elsevier Ltd. All rights reserved.

<185>
Accession Number
607030783
Author
Steenen S.A.; van Wijk A.J.; van Westrhenen R.; de Lange J.; de Jongh A.
Institution
(Steenen, de Lange) Academic Medical Center of the University of
Amsterdam, Department of Oral and Maxillofacial Surgery, Meibergdreef 9,
Amsterdam, AZ 1105, Netherlands
(van Wijk, de Jongh) Academic Centre for Dentistry Amsterdam, Department
of Social Dentistry and Behavioral Sciences, Gustav Mahlerlaan 3004,
Amsterdam, LA 1081, Netherlands
(van Westrhenen) Erasmus University Medical Center, Department of
Psychiatry, 's-Gravendijkwal 230, Rotterdam, CE 3015, Netherlands
(de Jongh) School of Health Sciences, Salford University, Salford, United
Kingdom
Title
Effects of propranolol on fear of dental extraction: Study protocol for a
randomized controlled trial.
Source
Trials. 16 (1) (no pagination), 2015. Article Number: 536. Date of
Publication: November 25, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Undergoing an extraction has been shown to pose a
significantly increased risk for the development of chronic apprehension
for dental surgical procedures, disproportionate forms of dental anxiety
(that is, dental phobia), and symptoms of post-traumatic stress. Evidence
suggests that intrusive emotional memories of these events both induce and
maintain these forms of anxiety. Addressing these problems effectively
requires an intervention that durably reduces both the intrusiveness of
key fear-related memories and state anxiety during surgery. Moreover,
evidence suggests that propranolol is capable of inhibiting "memory
reconsolidation" (that is, it blocks the process of storing a recently
retrieved fear memory). Hence, the purpose of this trial is to determine
the anxiolytic and fear memory reconsolidation inhibiting effects of the
s-adrenoreceptor antagonist propranolol on patients with high levels of
fear in anticipation of a dental extraction. Methods/Design: This trial is
designed as a multicenter, randomized, placebo-controlled, two-group,
parallel, double-blind trial of 34 participants. Consecutive patients who
have been referred by their dentist to the departments of oral and
maxillofacial surgery of a University hospital or a secondary referral
hospital in the Netherlands for at least two tooth and/or molar removals
and with self-reported high to extreme fear in anticipation of a dental
extraction will be recruited. The intervention is the administration of
two 40 mg propranolol capsules 1 hour prior to a dental extraction,
followed by one 40 mg capsule directly postoperatively. Placebo capsules
will be used as a comparator. The primary outcome will be dental trait
anxiety score reduction from baseline to 4-weeks follow-up. The secondary
outcomes will be self-reported anxiety during surgery, physiological
parameters (heart rate and blood pressure) during recall of the crucial
fear-related memory, self-reported vividness, and emotional charge of the
crucial fear-related memory. Discussion: This randomized trial is the
first to test the efficacy of 120 mg of perioperative propranolol versus
placebo in reducing short-term ("state") anxiety during dental extraction,
fear memory reconsolidation, and lasting dental ("trait") anxiety in a
clinical population. If the results show a reduction in anxiety, this
would offer support for routinely prescribing propranolol in patients who
are fearful of undergoing dental extractions. Trial registration:
ClinicalTrials.gov identifier: NCT02268357 , registered on 7 October 2014.
The Netherlands National Trial Register identifier: NTR5364 , registered
on 16 August 2015. Copyright &#xa9; 2015 Steenen et al.

<186>
Accession Number
607136132
Author
Guerra A.; Rangan B.V.; Coleman A.; Xu H.; Kotsia A.; Christopoulos G.;
Sosa A.; Chao H.; Han H.; Abdurrahim G.; Roesle M.; De Lemos J.A.; McGuire
D.K.; Packer M.; Banerjee S.; Brilakis E.S.
Institution
(Guerra, Rangan, Coleman, Xu, Kotsia, Christopoulos, Sosa, Chao, Han,
Abdurrahim, Roesle, De Lemos, McGuire, Packer, Banerjee, Brilakis) Dallas
VA Medical Center (111A), 4500 South Lancaster Road, Dallas, TX 75216,
United States
Title
Effect of Extended-Release Niacin on Carotid Intima Media Thickness,
Reactive Hyperemia, and Endothelial Progenitor Cell Mobilization: Insights
from the Atherosclerosis Lesion Progression Intervention Using Niacin
Extended Release in Saphenous Vein Grafts (ALPINE-SVG) Pilot Trial.
Source
Journal of Invasive Cardiology. 27 (12) (pp 555-560), 2015. Date of
Publication: December 2015.
Publisher
HMP Communications
Abstract
BACKGROUND: Thirty-eight patients with intermediate (30%-60% diameter
stenosis) saphenous vein graft lesions were randomized to extended-release
niacin (ER-niacin) or placebo for 12 months. We sought to evaluate the
impact of ER-niacin on carotid intima media thickness (CIMT), endothelial
function, and endothelial progenitor cell (EPC) mobilization. METHODS:
Carotid B-mode ultrasound was used to image the common and internal
carotid arteries, at baseline and at 12 months after enrollment. Reactive
hyperemia peripheral arterial tonometry, as assessed with EndoPAT 2000
(Itamar Medical, Inc) and EPC mobilization assessed with flow cytometry,
were measured at enrollment, and at 1 and 12 months. RESULTS: The baseline
clinical characteristics were similar in the two study groups.
High-density lipoprotein cholesterol levels tended to increase more in the
ER-niacin group (5.9 +/- 8.7 mg/dL vs 1.4 +/- 7.1 mg/dL; P<.14). Between
baseline and 12 months, right common carotid artery (0.96 +/- 0.44 mm vs
0.70 +/- 0.24 mm; P<.04), and left common carotid artery (0.80 +/- 0.30 mm
vs 0.70 +/- 0.20 mm; P<.08) CIMT tended to decrease in the ER-niacin
group, compared with no change in the placebo group. The change in
logarithmic reactive hyperemia index between 1 month and 12 months was
similar in patients receiving ER-niacin vs placebo (0.003 +/- 0.12 vs
-0.058 +/- 0.12; P<.39), whereas EPC mobilization increased in the
ER-niacin group and decreased in the placebo group (8.65 +/- 28.41 vs
-5.87 +/- 30.23 EPC colony forming units/mL of peripheral blood; P<.02).
CONCLUSIONS: ER-niacin did not have a significant impact on CIMT or
endothelial function, but increased EPC mobilization.

<187>
Accession Number
607136121
Author
Moretti C.; Chandran S.; Vervueren P.-L.; D'Ascenzo F.; Barbanti M.;
Weerackody R.; Boccuzzi G.; Lee D.-H.; De La Torre Hernandez J.; Omede P.;
Nijenhuis V.; Igbineweka N.; Lim P.; Berg T.; Carrie D.; Hildick-Smith D.;
Gulino S.; Cannata S.; Gargiulo G.; Tamburino C.; Conrotto F.; Meynet I.;
Quadri G.; Marangoni L.; Taha S.; Biondi-Zoccai G.; Salizzoni S.; Marra
S.; Gaita F.
Institution
(Moretti, D'Ascenzo, Omede, Meynet, Quadri, Marangoni, Taha, Salizzoni,
Marra) Division of Cardiology, University of Turin, Citta della Salute e
della Scienza, Turin, Italy
(Chandran, Weerackody) Chest Hospital, London, United Kingdom
(Vervueren, Carrie) Toulouse University Hospital, Toulouse, France
(Barbanti, Cannata, Gargiulo, Tamburino, Conrotto, Gaita) Ferrarotto
Hospital, University of Catania, Catania, Italy
(Boccuzzi) Division of Cardiology, San Giovanni Bosco Hospital, Turin,
Italy
(Lee, De La Torre Hernandez) Hospital Universitario MarquH, Marques de
Valdecilla, Unidad de Hemodinamica y Cardiologia Intervencionista, Avda,
Valdecilla, Santander, Spain
(Nijenhuis, Berg) St. Antonius Hospital, CM Nieuwegein, Netherlands
(Igbineweka, Hildick-Smith) Sussex Cardiac Centre, Sussex University
Hospitals, Interventional Structural and Congenital Heart Disease,
Brighton, United Kingdom
(Lim) Translational Research, Heart Research Institute, Sydney, Australia
(Gulino) Azienda Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
(Taha) Cardiology Department, Assuit University, Assuit, Egypt
(Biondi-Zoccai) Division of Cardiology, La Sapienza, Rome, Italy
Title
Outcomes of Patients Undergoing Balloon Aortic Valvuloplasty in the TAVI
Era: A Multicenter Registry.
Source
Journal of Invasive Cardiology. 27 (12) (pp 547-553), 2015. Date of
Publication: December 2015.
Publisher
HMP Communications
Abstract
BACKGROUND: Few clinical data about indications and prognoses of patients
undergoing balloon aortic valvuloplasty (BAV) in the transcatheter aortic
valve implantation (TAVI) era have been reported. METHODS: Data from all
consecutive patients undergoing BAV in seven European centers from 2006 to
2013 were collected. Acute results and long-term outcomes were assessed.
RESULTS: A total of 811 patients aged 82 +/- 9 years were included; 416
patients (51%) underwent BAV as palliative destination therapy, 320
patients (40%) as bridge to TAVI, and 75 patients (9%) as bridge to
surgical aortic valve replacement (SAVR). Patients undergoing BAV as
destination therapy had a higher risk profile (logistic EuroSCORE, 20 +/-
17 vs 22 +/- 14 vs 11 +/- 8, respectively; P<.001). Post procedure, peak
gradient decreased from 87 +/- 22 mm Hg to 66 +/- 22 mm Hg (P<.001) and
aortic valve area increased from 0.61 +/- 0.2 cm² to 0.8 +/-
0.2 cm² (P<.001). At 30 days, the all-cause death rate (6.5% vs
6.2% vs 7.4%, respectively; P<.56) and the rate of life-threatening and
major bleedings (8.0% vs 5.7% vs 6.0%, respectively) did not differ
between groups. After a mean follow-up of 318 days (range, 116-500 days),
rates of all-cause death were similar (30% vs 34% vs 31%, respectively;
P>.99), although patients undergoing BAV as bridge to SAVR showed a lower
cardiovascular death rate (11% vs 11% vs 3%, respectively; P<.04).
CONCLUSION: In the TAVI era, BAV may represent a reasonable option for
patients with severe aortic stenosis and temporary contraindications to
definite therapy. Given the mortality rates at 30 days, patients should be
carefully selected, while events at follow-up are deeply influenced by the
decision of whether or not subsequent interventions are performed.

<188>
Accession Number
611503959
Author
Moeinipour A.; Zarifian A.; Andalibi M.S.S.; Shamloo A.S.; Ahmadabadi A.;
Amouzeshi A.; Hoseinikhah H.
Institution
(Moeinipour, Hoseinikhah) Atherosclerosis Prevention Research Center,
Mashhad University of Medical Sciences, Imam Reza Hospital, Mashhad, Iran,
Islamic Republic of
(Zarifian, Andalibi, Shamloo, Ahmadabadi) Mashhad University of Medical
Sciences, Imam Reza Hospital, Mashhad, Iran, Islamic Republic of
(Amouzeshi) Birjand University of Medical Sciences, Birjand, Iran, Islamic
Republic of
Title
The best anticoagulation therapy in multiple-trauma patients with
mechanical heart valves: Evaluation of latest guidelines and studies.
Source
Heart Surgery Forum. 18 (6) (pp E271-E274), 2015. Date of Publication:
December 2015.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Background: It is common practice for patients with prosthetic cardiac
devices, especially heart valve prosthesis, arterial stents,
defibrillators, and pacemaker devices, to use anticoagulation treatment.
When these patients suffer from multiple trauma after motor vehicle
accidents, the best medical management for this challenging position is
mandatory. This strategy should include a rapid diagnosis of all possible
multiple organ injuries, with special attention to anticoagulation therapy
so as to minimize the risk of thromboembolism complication in prosthetic
devices. In this review, we describe the best medical management for
patients with multiple trauma who use anticoagulants after heart valve
replacement. Methods: We searched electronic databases PubMed/Medline,
Scopus, Embase, and Google Scholar using the following terms:
anticoagulant, warfarin, heparin, and multiple trauma. Also, similar
studies suggested by the databases were included. Non-English articles
were excluded from the review. Results: For patients who use
anticoagulation therapy, teamwork between cardiac surgeons, general
surgeons, anesthesiologists, and cardiologists is essential. For optimal
medical management, multiple consults between members of this team is
mandatory for rapid diagnosis of all possible damaged organs, with special
attention to the central nervous system, chest, and abdominal traumas.
With this strategy, it is important to take note of anticoagulation drugs
to minimize the risk of thromboembolism complications in cardiac devices.
Conclusion: The best anticoagulant agents for emergency operations in
patients with multiple trauma who are using an anticoagulant after heart
valve replacement are fresh frozen plasma (FFP) and prothrombin complex
concentrates (PCC). Copyright &#xa9; 2015 Forum Multimedia Publishing,
LLC.

<189>
Accession Number
615180316
Author
Dong K.; Song Y.; Li X.; Ding J.; Gao Z.; Lu D.; Zhu Y.
Institution
(Dong) Department of Respiration, The 2nd Jiangsu Province Hospital of
TCM, Nanjing University of Chinese Medicine, No.155, Hanzhong Road,
Nanjing, China
Title
Pentasaccharides for the prevention of venous thromboembolism.
Source
The Cochrane database of systematic reviews. 10 (pp CD005134), 2016. Date
of Publication: 31 Oct 2016.
Abstract
BACKGROUND: Venous thromboembolism (VTE) is a common condition with
potentially serious and life-threatening consequences. The standard method
of thromboprophylaxis uses an anticoagulant such as low molecular weight
heparin (LMWH) or warfarin. In recent years, another type of
anticoagulant, pentasaccharide, an indirect factor Xa inhibitor, has shown
good anticoagulative effect in clinical trials. Three types of
pentasaccharides are available: short-acting fondaparinux, long-acting
idraparinux and idrabiotaparinux. Pentasaccharides cause little
heparin-induced thrombocytopenia and are better tolerated than
unfractionated heparin, LMWH and warfarin. However, no consensus has been
reached on whether pentasaccharides are superior or inferior to other
anticoagulative methods.
OBJECTIVES: To assess effects of pentasaccharides versus other methods of
thromboembolic prevention (thromboprophylaxis) in people who require
anticoagulant treatment to prevent venous thromboembolism.
SEARCH METHODS: The Cochrane Vascular Information Specialist (CIS)
searched the Specialised Register (last searched March 2016) and the
Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 2).
The CIS searched trial databases for details of ongoing and unpublished
studies. Review authors searched LILACS (Latin American and Caribbean
Health Sciences) and the reference lists of relevant studies and reviews
identified by electronic searches.
SELECTION CRITERIA: We included randomised controlled trials on any type
of pentasaccharide versus other anticoagulation methods (pharmaceutical or
mechanical) for VTE prevention.
DATA COLLECTION AND ANALYSIS: Two review authors independently selected
trials, assessed methodological quality and extracted data in predesigned
tables.
MAIN RESULTS: We included in this review 25 studies with a total of 21,004
participants. All investigated fondaparinux for VTE prevention; none
investigated idraparinux or idrabiotaparinux. Studies included
participants undergoing abdominal surgery, thoracic surgery, bariatric
surgery or coronary bypass surgery; acutely ill hospitalised medical
patients; people requiring rigid or semirigid immobilisation; and those
with superficial venous thrombosis. Most studies focused on orthopaedic
patients. We lowered the quality of the evidence because of heterogeneity
between studies and a small number of events causing imprecision.When
comparing fondaparinux with placebo, we found less total VTE (risk ratio
(RR) 0.24, 95% confidence interval (CI) 0.15 to 0.38; 5717 participants; 8
studies; I2 = 64%; P < 0.00001), less symptomatic VTE (RR 0.15, 95% CI
0.06 to 0.36; 6503 participants; 8 studies; I2 = 0%; P < 0.0001), less
total DVT (RR 0.25, 95% CI 0.15 to 0.40; 5715 participants; 8 studies; I2
= 67%; P < 0.00001), less proximal DVT (RR 0.12, 95% CI 0.04 to 0.39; 2746
participants; 7 studies; I2 = 64%; P = 0.0004) and less total pulmonary
embolism (PE) (RR 0.16, 95% CI 0.04 to 0.62; 6412 participants; 8 studies;
I2 = 0%; P = 0.008) in the fondaparinux group. The quality of the evidence
was moderate for total VTE, total DVT and proximal DVT, and high for
symptomatic VTE and total PE.When fondaparinux was compared with LMWH,
analyses indicated that fondaparinux reduced total VTE and DVT (RR 0.55,
95% CI 0.42 to 0.73; 9339 participants; 11 studies; I2 = 64%; P < 0.0001;
and RR 0.54, 95% CI 0.40 to 0.71; 9356 participants; 10 studies; I2 = 67%;
P < 0.0001, respectively), and showed a trend toward reduced proximal DVT
(RR 0.58, 95% CI 0.33 to 1.02; 8361 participants; 9 studies; I2 = 53%; P =
0.06). Symptomatic VTE (RR 1.03, 95% CI 0.65 to 1.63; 12240 participants;
9 studies; I2 = 35%; P = 0.90) and total PE (RR 1.24, 95% CI 0.65 to 2.34;
12350 participants; 10 studies; I2 = 0%; P = 0.51) indicated no difference
between fondaparinux and LMWH. The quality of the evidence was moderate
for total VTE, symptomatic VTE, total DVT and total PE, and low for
proximal DVT.We showed that fondaparinux increased major bleeding compared
with both placebo and LWMH (RR 2.56, 95% CI 1.48 to 4.44; 6659
participants; 8 studies; I2 = 0%; P = 0.0008; moderate-quality evidence;
and RR 1.38, 95% CI 1.09 to 1.75; 12,501 participants; 11 studies; I2 =
24%; P = 0.008; high-quality evidence, respectively). All-cause mortality
was not different between fondaparinux and placebo or LMWH (RR 0.76, 95%
CI 0.48 to 1.22; 6674 participants; 8 studies; I2 = 14%; P = 0.26;
moderate-quality evidence; and RR 0.88, 95% CI 0.63 to 1.22; 12,400
participants; 11 studies; I2 = 0%; P = 0.44; moderate-quality evidence,
respectively).One study compared fondaparinux with variable and fixed (1
mg per day) doses of warfarin after elective hip or knee replacement
surgery and showed no difference in primary and secondary outcomes between
fondaparinux and both variable and fixed doses of warfarin. The quality of
the evidence was very low. One small study compared fondaparinux with
edoxaban in patients with severe renal impairment undergoing lower-limb
orthopaedic surgery and reported no thromboembolic events, major bleeding
events or deaths in either group. The quality of the evidence was very
low. One small study compared fondaparinux with mechanical
thromboprophylaxis. Results showed no difference in total VTE and total
DVT between fondaparinux and mechanical thromboprophylaxis. This study
reported no cases pertaining to the other outcomes of this review. The
quality of the evidence was low.There were insufficient studies to permit
meaningful conclusions for subgroups of clinical conditions other than
orthopaedic surgery.
AUTHORS' CONCLUSIONS: Moderate to high quality evidence shows that
fondaparinux is effective for short-term prevention of VTE when compared
with placebo. It can reduce total VTE, DVT, total PE and symptomatic VTE,
and does not demonstrate a reduction in deaths compared with placebo. Low
to moderate quality evidence shows that fondaparinux is more effective for
short-term VTE prevention when compared with LMWH. It can reduce total VTE
and total DVT and does not demonstrate a reduction in deaths when compared
with LMWH. However, at the same time, moderate to high quality evidence
shows that fondaparinux increases major bleeding when compared with
placebo and LMWH. Therefore, when fondaparinux is chosen for the
prevention of VTE, attention should be paid to the person's bleeding and
thrombosis risks. Most data were derived from patients undergoing
orthopaedic surgery. Therefore, the conclusion predominantly pertains to
these patients. Data on fondaparinux for other clinical conditions are
sparse.

<190>
Accession Number
615204294
Author
Hahn R.T.; Meduri C.U.; Davidson C.J.; Lim S.; Nazif T.M.; Ricciardi M.J.;
Rajagopal V.; Ailawadi G.; Vannan M.A.; Thomas J.D.; Fowler D.; Rich S.;
Martin R.; Ong G.; Groothuis A.; Kodali S.
Institution
(Hahn, Nazif, Kodali) Department of Medicine, Division of Cardiology/New
York Presbyterian Hospital, New York-Presbyterian/Columbia University
Medical Center, New York, New York, United States
(Hahn, Ong) Cardiovascular Research Foundation, New York, New York, United
States
(Meduri, Vannan, Martin) Marcus Heart Valve Center, Piedmont Heart
Institute, Atlanta, Georgia
(Davidson, Ricciardi, Rajagopal, Thomas, Rich) Bluhm Cardiovascular
Institute, Feinberg School of Medicine, Northwestern University, Chicago,
Illinois, United States
(Lim, Ailawadi, Fowler) University of Virginia, Charlottesville, Virginia,
United States
(Groothuis) Mitralign, Inc., Tewksbury, Massachusetts, United States
Title
Early Feasibility Study of a Transcatheter Tricuspid Valve Annuloplasty:
SCOUT Trial 30-Day Results.
Source
Journal of the American College of Cardiology. 69 (14) (pp 1795-1806),
2017. Date of Publication: 11 Apr 2017.
Publisher
Elsevier USA
Abstract
Background The SCOUT (Percutaneous Tricuspid Valve Annuloplasty System for
Symptomatic Chronic Functional Tricuspid Regurgitation) trial is a
prospective, single-arm, multicenter, early feasibility study of a novel
transcatheter device to plicate the tricuspid annulus (TA) and reduce
tricuspid regurgitation (TR). Objectives This study tested the feasibility
and safety of a novel transcatheter device and assessed its early
performance and functional outcomes. Methods Between November 2015 and
June 2016, 15 patients with New York Heart Association (NYHA) functional
class >II and moderate or greater functional TR were enrolled. Primary
performance and safety endpoint outcomes were technically successful at 30
days with no reintervention. Echocardiographic measurements (TA diameter,
effective regurgitant orifice area [EROA], left ventricular stroke volume
[LVSV]) and quality-of-life (QoL) measurements (NYHA functional class,
Minnesota Living with Heart Failure Questionnaire [MLHFQ], and 6-min walk
test [6MWT]) were performed at baseline and 30 days. Results All patients
(mean 73.2 +/- 6.9 years of age, 87% female) underwent successful device
implantation with no deaths, strokes, bleeding, tamponade, or valve
reintervention. Technical success rate at 30 days was 80%, with 3
single-pledget annular detachments without reintervention. In the
remaining 12 patients, there were significant reductions in TA (12.3 +/-
3.1 cm² to 11.3 +/- 2.7 cm², respectively; p =
0.019) and EROA (0.51 +/- 0.18 cm² vs. 0.32 +/- 0.18
cm², respectively; p = 0.020), with significant increase in
LVSV (63.6 +/- 17.9 ml vs. 71.5 +/- 25.7 ml, respectively; p = 0.021). In
the intention-to-treat cohort, there were significant improvements in NYHA
functional class (>1 class, p = 0.001), MLHFQ (47.4 +/- 17.6 to 20.9 +/-
14.8; p < 0.001), and 6MWT (245.2 +/- 110.1 to 298.0 m +/- 107.6 m; p =
0.008). Conclusions The 30-day results of the SCOUT trial confirmed the
safety of the novel transcatheter device, which reduced TA and EROA,
increased LVSV, and improved QoL. (Early Feasibility of the Mitralign
Percutaneous Tricuspid Valve Annuloplasty System (PTVAS) Also Known as
TriAlign [SCOUT]; NCT02574650.) Copyright &#xa9; 2017 American College of
Cardiology Foundation

<191>
Accession Number
615204239
Author
Banerjee S.; Angiolillo D.J.; Boden W.E.; Murphy J.G.; Khalili H.; Hasan
A.A.; Harrington R.A.; Rao S.V.
Institution
(Banerjee, Khalili) University of Texas Southwestern Medical Center,
Dallas, Texas, United States
(Banerjee, Khalili) Veterans Affairs North Texas Health Care System,
Dallas, Texas, United States
(Angiolillo) University of Florida College of Medicine-Jacksonville,
Jacksonville, Florida, United States
(Boden) Veterans Affairs New England Healthcare System, Boston,
Massachusetts, United States
(Murphy) Mayo Clinic, Rochester, Minnesota, United States
(Hasan) National Heart, Lung, and Blood Institute, Bethesda, Maryland,
United States
(Harrington) Stanford University School of Medicine, Stanford, California,
United States
(Rao) Duke University School of Medicine, Durham, North Carolina, United
States
(Rao) Durham VA Medical Center, Durham, North Carolina, United States
Title
Use of Antiplatelet Therapy/DAPT for Post-PCI Patients Undergoing
Noncardiac Surgery.
Source
Journal of the American College of Cardiology. 69 (14) (pp 1861-1870),
2017. Date of Publication: 11 Apr 2017.
Publisher
Elsevier USA
Abstract
Dual antiplatelet therapy (DAPT) is prescribed to millions of patients
worldwide following coronary stenting. DAPT is indicated to lower the risk
of ischemic events, such as myocardial infarction, including stent
thrombosis, ischemic stroke, or death from cardiovascular causes. A
significant number of these patients undergo noncardiac surgery and may
require DAPT interruption. This poses a significant clinical dilemma
because DAPT interruption exposes patients to the potential risk of stent
thrombosis, perioperative myocardial infarction, or both. Conversely,
continuing DAPT may be associated with excess bleeding complications.
Observational data in this area are conflicting, and there are no
randomized clinical trials to guide practitioner decision making. On the
basis of predominantly consensus recommendations, various strategies for
managing DAPT during the perioperative period have been proposed. This
review presents 3 commonly encountered clinical scenarios that lead into
an evidence-based discussion of practical strategies for managing
perioperative antiplatelet therapy in patients following percutaneous
coronary intervention. Copyright &#xa9; 2017

<192>
Accession Number
615120211
Author
Estrela A.L.; Bauer M.E.
Institution
(Estrela, Bauer) Laboratorio de Imunologia do Envelhecimento, Instituto de
Pesquisas Biomedicas, Pontificia Universidade Catolica do Rio Grande do
Sul, Porto Alegre, RS, Brazil
Title
Healthy aging and physical activity: A systematic review on the effects of
exercise on cardiovascular diseases.
Source
Scientia Medica. 27 (1) (pp 147-154), 2017. Date of Publication: 2017.
Publisher
Editora Universitaria da PUCRS (E-mail: scientiamedica@pucrs.br)
Abstract
Aims: To perform a systematic review of randomized controlled trials that
assess the benefits of physical exercise (regular or competitive) for the
health of the elderly and prevention of cardiovascular diseases. Methods:
Publications in PubMed, Web of Science, Library of Congress, Cochrane, and
in databases with records of clinical trials between 2005 and 2016, and
also in the proceedings of major congresses on cardiovascular diseases in
the elderly were investigated using the terms defined in accordance with
the &quot;patient, intervention, comparison, and outcome&quot;
methodology. The following key words were used: physical effort, exercise,
exercise therapy, physical activity, physical fitness, resistance
training, cardiovascular disease, C-reactive protein, dyslipidemia, heart
failure, cardiac insufficiency, revascularization, cardiac stent and heart
transplant. Only randomized clinical trials with individuals aged over 60
years were included. The articles were assessed independently by two
reviewers. Results: A total of 3,672 studies were assessed and 24 that met
the inclusion criteria were selected. Most of these studies had small
sample sizes and showed physical exercise as health-promoting. Only 16
studies reported the relationship of adherence to physical exercise as a
preventive factor against cardiovascular diseases. The outcome measures
included quality of life, physical ability or fitness status, muscle
strength, heart rate, psychological aspects, inflammatory and nutritional
markers, and progression of cardiovascular diseases. There is strong
evidence that aerobic exercise improves physical fitness, muscle strength,
and the quality of life of elderly patients with cardiovascular disease.
Conclusions: The benefits of exercise training for elderly patients with
cardiovascular disease are well established, supporting the prescription
of exercise training for their regular treatments. Interventions that use
exercise need to be progressively included in cardiovascular treatment
regimens, although the best exercise protocol for patients with
cardiovascular disease is not yet fully established.

<193>
Accession Number
614608021
Author
Bail D.H.L.
Institution
(Bail) Karl-Olga-Hospital, Stuttgart, Germany
Title
Treatment of functional mitral regurgitation by percutaneous annuloplasty
using the Carillon Mitral Contour System-Currently available data state.
Source
Journal of Interventional Cardiology. 30 (2) (pp 156-162), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: The purpose of this study is to provide a systematic review of
currently available data about the percutaneous trans-coronary-venous
mitral annuloplasty with the Carillon Mitral Contour System. Method: A
systematic literature search was conducted using the common medical and
scientific databases. The documented parameters included among others
grade of mitral regurgitation (MR), vena contracta (VC), effective
regurgitant orifice area (EROA), 6 minute-walk-test (6MWT),
NYHA-classification, and Quality of Life (QoL) at baseline, 30 days and in
the long-term follow-up. Results: The exact total number of successfully
implantations with available data remains unclear because so many
publications are either of the same institution or study group, or they
present overlapping results. Reduction of functional mitral regurgitation
(FMR) was associated with significant inverse left-ventricular (LV))
remodeling, improvement in 6MWT, QoL and NYHA-class during the 12-month
follow-up. In almost half of the enrolled patients, the Carillon System
could not be implanted or had to be removed due to coronary compromission.
Adverse advent rate (AE) ranged between 2.8-39%. Conclusions: Results with
regard to reduction of MR and inverse LV remodeling have been remarkable.
Indication and selection criteria for suitable patients, the expected
complications, and the long-term results with regard to survival and
quality of life still remain unclear. The available results do not
establish superiority of the Carillon Mitral Contour System and support
the lack of a clear benefit. The approach with the Carillon Mitral Contour
System should be limited to participants of prospective and randomized
trials. Copyright &#xa9; 2017, Wiley Periodicals, Inc.

<194>
Accession Number
615223178
Author
Tahmasebi F.; Hurrell A.; Gupta M.
Institution
(Tahmasebi, Hurrell, Gupta) Whipps Cross University Hospital, London,
United Kingdom
Title
Coronary artery dissection in the puerperium: Case report and literature
review.
Source
BJOG: An International Journal of Obstetrics and Gynaecology. Conference:
19th Annual Conference of the British Maternal and Fetal Medicine Society,
BMFMS 2017. Netherlands. Conference Start: 20170330. Conference End:
20170331. 124 (pp 87-88), 2017. Date of Publication: March 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Background Spontaneous coronary artery dissection (SCAD) is a rare but
vitally important cause of acute coronary syndrome. Its preponderance for
women and particularly women during the peripartum period signifies that
all healthcare professionals caring for this cohort of the population
should have a sound understanding of the condition. Aetiology remains
poorly understood, but may represent eosinophilic inflammatory
infiltration of vessel walls or defects in collagen. The exceedingly high
mortality rate necessitates prompt diagnosis, usually by angiography -
diagnosis has been made all to often at autopsy in the past. There is no
one-size-fits-all treatment; management must be individualised according
to haemodynamic status and affected vessel(s) and may include conservative
management, percutaneous coronary intervention or bypass grafting.
Recovery may be complicated by extension of the haematoma / false lumen,
valvular pathology secondary to ischaemia and sudden cardiac death, and
close postoperative surveillance is mandatory. Here, we present a case
report of a 41-year-old lady who had SCAD two weeks postpartum,
complicated by ischaemic papillary rupture and mitral regurgitation
requiring mechanical valve replacement. Additionally, we present a review
of the current literature on SCAD, including management and critical
analysis potential complications.

<195>
Accession Number
614796560
Author
van Gils L.; Tchetche D.; Lhermusier T.; Abawi M.; Dumonteil N.; Olivares
R.R.; de Nicolas J.M.; Stella P.R.; Carrie D.; De Jaegere P.P.; Van
Mieghem N.M.
Institution
(van Gils, De Jaegere, Van Mieghem) Erasmus Medical Center, Rotterdam,
Netherlands
(Tchetche, Dumonteil, de Nicolas) Clinique Pasteur, Toulouse, France
(Lhermusier, Carrie) Hopital Rangueil, Toulouse, France
(Abawi, Olivares, Stella) University Medical Center Utrecht, Utrecht,
Netherlands
Title
Transcatheter heart valve selection and permanent pacemaker implantation
in patients with pre-existent right bundle branch block.
Source
Journal of the American Heart Association. 6 (3) (no pagination), 2017.
Article Number: e005028. Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Right bundle branch block is an established predictor for new
conduction disturbances and need for a permanent pacemaker (PPM) after
transcatheter aortic valve replacement. The aim of the study was to
evaluate the absolute rates of transcatheter aortic valve replacement
related PPM implantations in patients with pre-existent right bundle
branch block and categorize for different transcatheter heart valves.
Methods and Results-We pooled data on 306 transcatheter aortic valve
replacement patients from 4 high-volume centers in Europe and selected
those with right bundle branch block at baseline without a previously
implanted PPM. Logistic regression was used to evaluate whether PPM rate
differed among transcatheter heart valves after adjustment for
confounders. Mean age was 83+/-7 years and 63% were male. Median Society
of Thoracic Surgeons score was 6.3 (interquartile range, 4.1-10.2). The
following transcatheter valve designs were used: Medtronic CoreValve
(n=130; Medtronic, Minneapolis, MN); Edwards Sapien XT (ES-XT; n=124) and
Edwards Sapien 3 (ES-3; n=32; Edwards Lifesciences, Irvine, CA); and
Boston Scientific Lotus (n=20; Boston Scientific Corporation, Marlborough,
MA). Overall permanent pacemaker implantation rate post-transcatheter
aortic valve replacement was 41%, and per valve design: 75% with Lotus,
46% with CoreValve, 32% with ES-XT, and 34% with ES-3. The indication for
PPM implantation was total atrioventricular block in 98% of the cases.
Lotus was associated with a higher PPM rate than all other valves. PPM
rate did not differ between ES-XT and ES-3. Ventricular paced rhythm at
30-day and 1-year follow-up was present in 81% at 89%, respectively.
Conclusions-Right bundle branch block at baseline is associated with a
high incidence of PPM implantation for all transcatheter heart valves. PPM
rate was highest for Lotus and lowest for ES-XT and ES-3. Pacemaker
dependency remained high during followup. Copyright &#xa9; 2017 The
Authors.

<196>
Accession Number
614796546
Author
Qiao J.; Zhang B.; Wang J.; Zhao Y.; Yang R.; Du H.; Jiang J.; Jin C.;
Xiong E.
Institution
(Qiao, Zhang, Wang, Zhao, Yang, Du, Jiang, Jin, Xiong) Department of
Cardiology, Tongling People's Hospital, Tongling, Anhui, China
Title
Deferred versus immediate stenting in patients with ST-segment elevation
myocardial infarction: A systematic review and meta-analysis.
Source
Journal of the American Heart Association. 6 (3) (no pagination), 2017.
Article Number: e004838. Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-A number of studies have evaluated the efficacy of deferred
stenting vs immediate stenting in patients with STsegment elevation
myocardial infarction, but the findings were not consistent across these
studies. This meta-analysis aims to assess optimal treatment strategies in
patient with ST-segment elevation myocardial infarction. Methods and
Results-We searched the PubMed, EMBASE, and the Cochrane Library for
studies that assessed deferred vs immediate stenting in patients with
ST-segment elevation myocardial infarction. Nine studies including 1456
patients in randomized controlled trials and 719 patients in observational
studies were included in the meta-analysis. No significant differences
were observed in the incidence of no- or slow-reflow between deferred
stenting and immediate stenting in randomized controlled trials (odds
ratio [OR] 0.51, 95%CI 0.17-1.53, P=0.23, I²=70%) but not in
observational studies (OR 0.13, 95%CI 0.06- 0.31, P<0.0001,
I²=0%). Deferred stenting was associated with an increase in
long-term left ventricular ejection fraction (weighted mean difference
1.90%, 95%CI 0.77-3.03, P=0.001, I²=0%). No significant
differences were observed in the rates of major adverse cardiovascular
events (OR 0.53, 95%CI 0.27-1.01, P=0.06 [randomized OR 0.98, 95%CI
0.73-1.30, P=0.87, I²=0%; nonrandomized OR 0.30, 95%CI
0.15-0.58, P=0.0004, I²=0%]), major bleeding (OR=0.1.61, 95%CI
0.70-3.69, P=0.26, I²=0%), death (OR=0.78, 95% CI 0.53-1.15,
P=0.22, I²=0%), MI (OR=0.97, 95%CI 0.34-2.78, P=0.96,
I²=35%) and target vessel revascularization (OR 0.97, 95%CI
0.40-2.37, P=0.95, I²=24%), between deferred and immediate
stenting. Conclusions-Compared with immediate stenting, a
deferred-stenting strategy did not reduce the occurrence of no- or
slowreflow, death, myocardial infarction, or repeat revascularization
compared with immediate stenting in patients with ST-segment elevation
myocardial infarction, but showed an improved left ventricular function in
the long term. Copyright &#xa9; 2017 The Authors.

<197>
Accession Number
614796531
Author
El Amrousy D.M.; Elshmaa N.S.; El-Kashlan M.; Hassan S.; Elsanosy M.;
Hablas N.; Elrifaey S.; El-Feky W.
Institution
(El Amrousy, Hassan, Elsanosy, Hablas, Elrifaey) Pediatric Department,
Tanta University Hospital, Tanta, Egypt
(El-Feky) Cardiothoracic Surgery Department, Tanta University Hospital,
Tanta, Egypt
(Elshmaa, El-Kashlan) Department of Anesthesia and Surgical ICU, Faculty
of Medicine, Tanta University, Tanta, Egypt
Title
Efficacy of prophylactic dexmedetomidine in preventing postoperative
junctional ectopic tachycardia after pediatric cardiac surgery.
Source
Journal of the American Heart Association. 6 (3) (no pagination), 2017.
Article Number: e004780. Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Postoperative junctional ectopic tachycardia is one of the most
serious arrhythmias that occur after pediatric cardiac surgery, difficult
to treat and better to be prevented. Our aim was to assess the efficacy of
prophylactic dexmedetomidine in preventing junctional ectopic tachycardia
after pediatric cardiac surgery. Methods and Results-A prospective
controlled study was carried out on 90 children who underwent elective
cardiac surgery for congenital heart diseases. Patients were randomized
into 2 groups. Group I (dexmedetomidine group): 60 patients received
dexmedetomidine; Group II (Placebo group): 30 patients received the same
amount of normal saline intravenously. The primary outcome was the
incidence of postoperative junctional ectopic tachycardia. Secondary
outcomes included bradycardia, hypotension, vasoactive inotropic score,
ventilation time, pediatric cardiac care unit stay, length of hospital
stay, and perioperative mortality. The incidence of junctional ectopic
tachycardia was significantly reduced in the dexmedetomidine group (3.3%)
compared with the placebo group (16.7%) with P < 0.005. Heart rate while
coming off cardiopulmonary bypass was significantly lower in the
dexmedetomidine group (130.6+/-9) than the placebo group (144+/-7.1) with
P < 0.001. Mean ventilation time, and mean duration of intensive care unit
and hospital stay (days) were significantly shorter in the dexmedetomidine
group than the placebo group (P < 0.001). However, there was no
significant difference between the 2 groups as regards mortality,
bradycardia, or hypotension (P > 0.005). Conclusion-Prophylactic use of
dexmedetomidine is associated with significantly decreased incidence of
postoperative junctional ectopic tachycardia in children after congenital
heart surgery without significant side effects. Copyright &#xa9; 2017 The
Authors.

<198>
Accession Number
614796490
Author
Hu S.; Zhu Y.; Zhang Y.; Dai J.; Li L.; Dauerman H.; Soeda T.; Wang Z.;
Lee H.; Wang C.; Zhe C.; Wang Y.; Zheng G.; Zhang S.; Jia H.; Yu B.; Jang
I.-K.
Institution
(Hu, Zhu, Zhang, Li, Wang, Zhe, Wang, Zheng, Zhang, Jia, Yu) Department of
Cardiology, The 2nd Affiliated Hospital of Harbin Medical University,
Harbin, China
(Hu, Zhu, Zhang, Li, Wang, Zhe, Wang, Zheng, Zhang, Jia, Yu) The Key
Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin,
China
(Dai) Cardiology Division, Massachusetts General Hospital, Harvard Medical
School, Boston, MA, United States
(Lee) Biostatistics, Massachusetts General Hospital, Harvard Medical
School, Boston, MA, United States
(Dauerman) Division of Cardiology, University of Vermont College of
Medicine/Fletcher Allen Healthcare, Burlington, VT, United States
(Wang) Department of Electrical Engineering and Computer Science,
Massachusetts Institute of Technology, Cambridge, MA, United States
(Soeda) Nara Medical University, Nara, Japan
(Jang) Kyung Hee University, Seoul, South Korea
Title
Management and outcome of patients with acute coronary syndrome caused by
plaque rupture versus plaque erosion: An intravascular optical coherence
tomography study.
Source
Journal of the American Heart Association. 6 (3) (no pagination), 2017.
Article Number: e004730. Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Plaque rupture and erosion are the 2 most common mechanisms for
acute coronary syndromes. However, the outcome of these 2 distinct
pathologies in patients with acute coronary syndromes has never been
studied. Methods and Results-We retrospectively studied 141 patients with
acute coronary syndromes who underwent optical coherence tomography (OCT)
imaging of the culprit lesion prior to stenting from the Massachusetts
General Hospital OCT Registry. Management (stent versus no stent),
poststent OCT findings, and outcomes were compared. Among the 141 culprit
lesions, rupture was found in 79 (56%) patients and erosion in 62 (44%).
Stent implantation was performed in 77 (97.5%) patients with rupture
versus 49 (79.0%) in those with erosion (P < 0.001). Immediately after
percutaneous coronary intervention, OCT showed a higher incidence of
malapposition (37.5% versus 7.3%, P < 0.001), thrombus (59.4% versus
14.6%, P < 0.001), and protrusion (93.8% versus 73.2%, P = 0.008) in the
rupture group compared with the erosion group. Plaque rupture was
associated with a higher incidence of no reflow or slow flow and distal
embolization. Although cardiac event rates were comparable between the two
groups at the 1-year follow-up, none of the erosion patients who were
treated conservatively without stenting had adverse cardiac events.
Conclusions-Unfavorable poststent OCT findings were more frequent in
rupture patients compared with erosion patients. A subset of erosion
patients who were treated conservatively without stenting remained free of
adverse cardiac events for up to 1 year. Copyright &#xa9; 2017 The
Authors.

<199>
Accession Number
615059249
Author
Liao Y.; Flaherty J.H.; Yue J.; Wang Y.; Deng C.; Chen L.
Institution
(Liao, Wang, Deng, Chen) Department of Geriatrics, West China Hospital,
Sichuan University, Chengdu, Sichuan, China
(Flaherty) Division of Geriatrics, Department of Internal Medicine, Saint
Louis University, St Louis, MO, United States
(Yue) Department of Geriatrics, West China Hospital, National Center for
Geriatric Clinical Research in West China Hospital, Sichuan University,
Chengdu, Sichuan, China
Title
The incidence of delirium after cardiac surgery in the elderly: Protocol
for a systematic review and meta-analysis.
Source
BMJ Open. 7 (3) (no pagination), 2017. Article Number: 014726. Date of
Publication: 01 Mar 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Delirium is one of the most common complications after
cardiac surgery in the elderly. Future studies aimed at preventing
postoperative delirium will need an accurate estimate of incidence.
However, there are no available systematic reviews on the incidence, and
reports of incidence of postoperative delirium after a cardiac operation
vary widely with significant heterogeneity. Therefore, we aim to perform a
systematic review and meta-analysis to determine the most accurate
incidence possible of postoperative delirium in individuals aged >65 years
after cardiac surgery. Methods and analyses We will undertake a
comprehensive literature search among PubMed, EMBASE, the Cochrane
Library, PsycINFO and CINAHL, from their inception to January 2017.
Prospective cohort and cross sectional studies that described the
incidence of delirium will be eligible for inclusion. The primary outcome
will be the incidence of delirium. Risk of bias and methodological quality
for the included studies will be assessed using a risk of bias tool for
prevalence studies and the Cochrane guidelines. Heterogeneity of the
estimates across studies will be assessed. Incidence data will be pooled
by selective or emergency surgery. This systematic review will be reported
according to the Preferred Reporting Items for Systematic reviews and
Meta-Analyses (PRISMA). Ethics and dissemination This proposed systematic
review and meta-analysis is based on published data, and thus there is no
requirement for ethics approval. The study will provide an up to date and
accurate incidence of postoperative delirium among the older population
after cardiac surgery, which is necessary for future research in this
area. The findings of this study will be presented at conferences and
disseminated through publication in a peer reviewed journal. Trial
registration number CRD42016047773. Copyright &#xa9; Published by the BMJ
Publishing Group Limited.

<200>
Accession Number
615036545
Author
Li X.; Ji X.; Qian T.; Cai P.; Sun C.
Institution
(Li, Ji, Qian, Cai, Sun) Department of Anesthesia, The People's Hospital
of Taizhou, Taizhou, Jiangsu 225300, China
Title
Clinical research of dexmedetomidine combined with target-controlled
infusion of propofol for surgery under general anesthesia in elderly
patients.
Source
International Journal of Clinical and Experimental Medicine. 10 (3) (pp
5435-5439), 2017. Article Number: IJCEM0047038. Date of Publication: 30
Mar 2017.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Objective: To evaluate the anesthetic efficacy and adverse reactions of
dexmedetomidine combined with target-controlled infusion (TCI) of propofol
in elderly patients scheduled for surgery under general anesthesia.
Methods: A total of 60 elderly patients scheduled for surgery under
general anesthesia were recruited and randomly divided into the
observation group (30 cases) and the control group (30 cases). For general
anesthesia, patients in the control group and the observation group were
given sufentanil combined with TCI of propofol, and dexmedetomidine
combined with TCI of propofol, respectively. The anesthetic efficacy and
the incidence of adverse reactions were evaluated and compared between the
two groups. Results: Our study showed that there were no significant
differences between the two groups at different time points and time
duration with respect to pulse oxygen saturation (SPO<inf>2</inf>) (T0:
P=0.091, T1: P=0.201, T2: P=0.106, and T3: P=0.266, respectively). And
heart rate (HR), respiratory rate (RR) and mean arterial pressure (MAP) in
the observation group at T1, T2 and T3, were all higher than those in the
control group (P=0.013, 0.040, and 0.031, respectively). What's more,
anesthetic onset time, breathing recovery time, extubation time and time
of Observer's Assessment of Alertness/Sedation Scale (OAAS) which reached
grade 5 in the observation group were all shorter than those of the
control group (P=0.007, 0.031, 0.003 and 0.019, respectively). The
incidence of adverse reactions in the observation group was 26.6%, which
was significantly lower than that of the control group (56.6%) (P=0.039).
Conclusion: Dexmedetomidine combined with propofol target-controlled
infusion presented good anesthetic efficacy for surgery under general
anesthesia in elderly patients, which can stabilize blood flow dynamics,
shorten anesthetic onset and recovery time, and reduce the incidence of
adverse reactions. Copyright &#xa9; 2017, E-Century Publishing
Corporation. All rights reserved.

<201>
Accession Number
615036504
Author
Ge J.; Zhou G.; Peng L.
Institution
(Ge, Zhou, Peng) Department of Anesthesia, Shanghai Fifth People's
Hospital, Fudan University, Shanghai 200240, China
(Ge) Department of Anesthesia, Chuzhou First People's Hospital, Chuzhou
239000, China
Title
Use of the modified left-sided double-lumen tube in thoracic surgeries.
Source
International Journal of Clinical and Experimental Medicine. 10 (3) (pp
5222-5227), 2017. Article Number: IJCEM0039061. Date of Publication: 30
Mar 2017.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
This study is aimed to investigate the effectiveness of two endotracheal
tubes used in lung isolation: the modified left-sided double-lumen
endotracheal tube (DLT) (group M) and the left-sided Robertshaw DLT (group
C). A randomized controlled clinical trial was used to assess the
effectiveness of two endotracheal tubes in lung isolation. Fifty-six
patients with American Society of Anesthesiologists physical status
classification (ASA grade) I-II who were undergoing thoracic surgery that
required OLV, including esophageal surgery and lobectomy surgery except
for surgeries involved in the region of the left mainstem bronchus.
Patients were randomly allocated by computer-coded envelopes into two
groups (Group C, n = 27 patients; Group M, n = 29 patients) to receive
either a left-sided Robertshaw DLT (Teleflex medical, Tecate, Mexico,
Group C), or a modified left-sided DLT (Tuoren Medical Device Co., Ltd,
Xinxiang, China, Group M). The following variables were recorded: the
first intubation success rate; frequency of tube displacement;
intraoperative airway pressure; lung collapse; and tracheal and bronchial
mucosal injury. The first intubation success rate was significantly better
in group M (27 of 29) compared with group C (16 of 27) (P = 0.003). The
frequency of tube displacement was significantly superior in group M
compared with group C after repositioning (4 vs. 10, P = 0.045) and during
OLV (2 vs. 8, P = 0.013). Intraoperative airway pressure changes during
the two-lung and one-lung ventilation were comparable. There were better
lung collapse (P = 0.03) and less tracheal and bronchial mucosal injuries
in group M (P = 0.032). In conclusion, the modified left-sided DLT can be
used efficaciously in thoracic anesthesia and causes less injury to the
tracheal and bronchial mucosa. Copyright &#xa9; 2017, E-Century Publishing
Corporation. All rights reserved.

<202>
Accession Number
615112835
Author
Wen S.Y.B.; Peng A.Z.Y.; Boyle S.; Cai S.; Pope L.; Tran M.T.; Short T.G.;
Aneman A.; Jaeger M.; Chuan A.
Institution
(Wen, Peng) South West Sydney Clinical School, University of NSW, Sydney,
NSW, Australia
(Boyle, Cai, Pope, Tran, Aneman, Chuan) Department of Anaesthesia,
Liverpool Hospital, Sydney, NSW, Australia
(Short) Department of Anaesthesia, Auckland City Hospital, New Zealand
(Jaeger) South Western Sydney Clinical School, University of NSW, Sydney,
NSW, Australia
Title
A pilot study using preoperative cerebral tissue oxygen saturation to
stratify cardiovascular risk in major non-cardiac surgery.
Source
Anaesthesia and Intensive Care. 45 (2) (pp 202-209), 2017. Date of
Publication: March 2017.
Publisher
Australian Society of Anaesthetists (E-mail: aicsubscriptions@asa.org.au)
Abstract
This prospective pilot study evaluated whether low preoperative cerebral
tissue oxygen saturation is associated with unfavourable outcomes after
major elective non-cardiac surgery. Eighty-one patients over 60 years of
age, American Society of Anesthesiologists physical status 3 or 4, were
recruited. Resting cerebral tissue oxygen saturation was recorded on room
air, and after oxygen supplementation, using cerebral oximetry. The
primary outcome was 30-day major adverse event of combined mortality or
severe morbidity, and the secondary outcome was 30-day new disability.
Eleven patients (13.6%) suffered a major adverse event, and 28 patients
(34.6%) experienced new disability. Room air cerebral tissue oxygen
saturation was significantly different between patients who had a major
adverse event, 67% (95% confidence interval [CI] 65-70) versus unaffected,
71% (95% CI 70-72; P=0.04). No statistical difference was found between
patients for new disability (range 70%-74%; P=0.73). Room air cerebral
tissue oxygen saturation was significantly associated with major adverse
events (odds ratio 1.36 (95% CI 1.03-1.79), P=0.03). Saturation levels
=68% carried a positive likelihood ratio of 2.2 for death or severe
morbidity, P=0.04. A definitive trial is required to confirm if cerebral
oximetry can be used to stratify the cardiovascular risk of patients
presenting for non-cardiac surgery.

<203>
Accession Number
614739338
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) Division of Cardiology,
Department of Internal Medicine, College of Medicine, Seoul National
University, Cardiovascular Center, 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.

<204>
Accession Number
608694137
Author
Rezaei Y.; Gholami-Fesharaki M.; Dehghani M.R.; Arya A.; Haghjoo M.;
Arjmand N.
Institution
(Rezaei, Arjmand) Seyyed-al-Shohada Heart Center, Urmia University of
Medical Science, 17 Shahrivar Blvd, Urmia 5718749441, Iran, Islamic
Republic of
(Gholami-Fesharaki) Department of Biostatistics, Faculty of Medical
Sciences, Tarbiat Modares University, Tehran, Iran, Islamic Republic of
(Dehghani) Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia
University of Medical Sciences, Urmia, Iran, Islamic Republic of
(Arya) Department of Electrophysiology, Heart Center, University of
Leipzig, Leipzig, Germany
(Haghjoo) Cardiac Electrophysiology Research Center, Rajaie Cardiovascular
Medical and Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
Title
Statin Antiarrhythmic Effect on Atrial Fibrillation in Statin-Naive
Patients Undergoing Cardiac Surgery.
Source
Journal of Cardiovascular Pharmacology and Therapeutics. 21 (2) (pp
167-176), 2016. Date of Publication: 01 Mar 2016.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Statin therapy has been thought to improve outcomes in cardiac
surgeries. We aimed to determine the statin effects on the development of
postoperative atrial fibrillation (AF), hospital length of stay (LOS), and
inflammatory status in patients undergoing cardiac surgeries. Methods: A
systematic literature search in databases was performed, until January
2015. Randomized clinical trial (RCT) studies evaluating statin effect on
statin-naive patients with sinus rhythm undergoing cardiac surgeries were
eligible to be analyzed. Results: Twelve RCTs involving 1116 patients, 559
receiving statin and 557 receiving control regimen, were analyzed.
Postoperative AF occurred in 17.9% and 36.1% of patients in the statin and
control groups, respectively. The statin therapy was associated with
decreases in the postoperative AF (risk ratio [RR] 0.50, 95% confidence
interval [CI] 0.41-0.61, P <.000010), hospital LOS (mean difference in
days, RR -'0.44, 95% CI -'0.67 to -'0.20, P =.0002), and postoperative
C-reactive protein (CRP) compared with control (mean difference in mg/L,
RR -'12.37, 95% CI -'23.87 to -'0.87, P =.04). The beneficial effects on
AF and CRP were more marked in patients receiving atorvastatin compared to
other statins. Decrease in postoperative AF was greater in coronary artery
bypass graft surgery compared to that in isolated valvular surgery.
Conclusion: Perioperative statin therapy in statin-naive patients with
sinus rhythm undergoing cardiac surgeries was associated with decreases in
the development of postoperative AF, the hospital LOS, and the CRP level.
However, there were insufficient data to provide evidences regarding
statin impacts in patients undergoing isolated valvular surgery. Copyright
&#xa9; The Author(s) 2015.

<205>
Accession Number
609978623
Author
Uchida N.; Katayama A.; Higashiue S.; Shiono M.; Hata M.; Minami K.;
Yamanaka K.; Miyamoto S.; Sawa Y.; Kuratani T.; Kato M.
Institution
(Uchida) Department of Cardiovascular Surgery, Akane-foundation, Tsuchiya
General Hospital, Hiroshima, Japan
(Katayama) Department of Cardiovascular Surgery, Hiroshima City Asa
General Hospital, Hiroshima, Japan
(Higashiue) Division of Cardiovascular Surgery, Kishiwada Tokushukai
Hospital, Kishiwada, Japan
(Shiono, Hata) Department of Cardiovascular Surgery, Nihon University
Itabashi Hospital, Tokyo, Japan
(Minami) Department of Cardiovascular Surgery, Kitakanto Junkanki
Hospital, Gunma, Japan
(Yamanaka) Department of Cardiovascular Surgery, Tenri Hospital, Tenri,
Japan
(Miyamoto) Department of Cardiovascular Surgery, Faculty of Medicine, Oita
University, Oita, Japan
(Sawa, Kuratani) Department of Cardiovascular Surgery, Osaka University
Graduate School of Medicine, Osaka, Japan
(Kato) Department of Cardiovascular Surgery, Morinomiya Hospital, Osaka,
Japan
Title
A new device as an open stent graft for extended aortic repair: A
multicentre early experience in Japan.
Source
European Journal of Cardio-thoracic Surgery. 49 (4) (pp 1270-1278), 2016.
Article Number: ezv310. Date of Publication: 01 Apr 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Open stent grafting for extended aortic repair has been widely
carried out around their world. We reported the effectiveness of a new
device as an open stent graft for extended aortic repair. METHODS: A new
device was used as an open stent graft in this study. The graft part of
the device has a woven structure made of Nitinol wire, a
superelastic/shape-memory alloy. The subjects of this study were patients
aged 20-84 with aneurysms (n = 38) or aortic dissection (n = 22) in the
thoracic aorta, including the distal aortic arch and the proximal
descending aorta. This study was a multicentre, non-blinded study. The
follow-up period was 36 months. RESULTS: Three subjects (5.0%) died during
hospitalization due to multiorgan failure. Spinal cord injury (SCI) was
observed in 4 subjects (6.7%): paraplegia in 1 and paraparesis in 3
subjects. The 3-year survival rate was 76.7% overall: 68.4% for the
subjects diagnosed as having aortic aneurysms (the aortic aneurysm group)
and 90.9% for those having aortic dissection (the aortic dissection
group). For the aortic aneurysm group, thrombus formation in the aortic
aneurysm was observed in 97% of the patients 6 months after operation, and
in 100% 12 months after operation. Meanwhile, for the aortic dissection
group, with regard to the false lumen of aortic dissection, thrombus
formation was observed in 94% of the patients 6 months after operation, in
94% 12 months after operation and in 100% 24 months after operation.
Expansion of the aortic aneurysm sac was observed in 2 subjects (6.1%).
Among these 2 subjects, endoleak was observed in 1 subject, which was
improved by additional thoracic endovascular aortic repair. CONCLUSIONS:
The safety and effectiveness of this investigational device was verified
over a period up to 36 months after operation. A long-term follow-up would
be necessary to further verify the effectiveness of the device in the
future. Copyright &#xa9; The Author 2015.

<206>
Accession Number
609978581
Author
Nappi F.; Spadaccio C.; Chello M.; Lusini M.; Acar C.
Institution
(Nappi, Spadaccio, Chello, Lusini) Department of Cardiovascular Surgery,
University Campus Bio-Medico, Rome, Italy
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord, Saint
Denis, France
(Acar) Department of Cardiothoracic Surgery, Hopital Pitie-Salpetriere,
Paris, France
Title
Double row of overlapping sutures for downsizing annuloplasty decreases
the risk of residual regurgitation in ischaemicmitral valve repair.
Source
European Journal of Cardio-thoracic Surgery. 49 (4) (pp 1182-1187), 2016.
Article Number: ezv291. Date of Publication: 01 Apr 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The aim of this study was to evaluate a novel insertion
technique of the prosthetic ring that would further magnify the degree of
annulus narrowing, thereby reducing the potential for a residual leak in
ischaemic mitral valve repair. METHODS: Thirty-six patients with ischaemic
mitral regurgitation (MR) were randomly assigned into two groups. In 18
patients, the prosthetic ring was inserted in the conventional manner with
a single row of sutures (control group). In the remaining 18 patients, the
ring was attached using a double row of sutures tied both on the inner and
on the outer part of the sewing cuff. Both groups had similar preoperative
clinical and echocardiographic characteristics with severe leaflet
tethering: mean tenting area >2.5 cm², mean anterior leaflet
angle >25degree and posterior leaflet angle >45degree. The mean prosthetic
ring sizes inserted in both groups were identical (mean: 27.3 mm).
RESULTS: At 12 months, there was no clinical event except for 1
rehospitalization in the control group. The mean mitral regurgitation
grade was higher in the control group than in the group with the double
row of sutures at 1.6 +/- 0.9 vs 0.7 +/- 0.3 (P = 0.0003). Annulus
diameter reduction was less pronounced in the control group when compared
with the group with the double row of sutures, both in the parasternal
long-axis: 29.3 +/- 3 vs 26.3 +/- 3 mm (P = 0.0003) and in apical
four-chamber views: 31 +/- 3 vs 28 +/- 2 mm (P = 0.003). Leaflet tethering
indices were greater in the control group than in the group with the
double row of sutures: tenting area: 1.42 +/- 0.3 vs 1.1 +/- 0.5 cm2 (P =
0.002), anterior leaflet angle: 33 +/- 3degree vs 28 +/- 5degree (P =
0.0009) and posterior leaflet angle: 110 +/- 13degree vs 80 +/- 11degree
(P = 0.0001). Left ventricular function parameters were not statistically
different among the two groups. CONCLUSION: A double row of overlapping
sutures for attaching the prosthetic ring in downsizing annuloplasty is
more efficient in narrowing the mitral annulus than the conventional
technique in ischaemic mitral repair. Even in high-risk patients whose
leaflets were severely tethered on echocardiography, it almost eliminated
the risk of MR recurrence in this study. Copyright &#xa9; The Author 2015.

<207>
Accession Number
609978481
Author
Deppe A.-C.; Arbash W.; Kuhn E.W.; Slottosch I.; Scherner M.; Liakopoulos
O.J.; Choi Y.-H.; Wahlers T.
Institution
(Deppe, Arbash, Kuhn, Slottosch, Scherner, Liakopoulos, Choi, Wahlers)
Department of Cardiothoracic Surgery, Heart Center of the University of
Cologne, Cologne, Germany
(Choi) Center of Molecular Medicine Cologne, University of Cologne,
Cologne, Germany
Title
Current evidence of coronary artery bypass grafting off-pump versus
on-pump: A systematic review with meta-analysis of over 16 900 patients
investigated in randomized controlled trials.
Source
European Journal of Cardio-thoracic Surgery. 49 (4) (pp 1031-1041), 2016.
Article Number: ezv268. Date of Publication: 01 Apr 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
In the present systematic review with meta-analysis, we sought to
determine the current strength of evidence for or against off-pump and
on-pump coronary artery bypass grafting (CABG) with regard to hard
clinical end-points, graft patency and cost-effectiveness. We performed a
meta-analysis of only randomized controlled trials (RCT) which reported at
least one of the desired end-points including: (i) major adverse cardiac
and cerebrovascular events (MACCE), (ii) all-cause mortality, (iii)
myocardial infarction, (iv) cerebrovascular accident, (v) repeat
revascularization, (vi) graft patency and (vii) cost-effectiveness. The
pooled treatment effects [odds ratio (OR) or weighted mean difference, 95%
confidence intervals (95% CIs)] were assessed using a fixed or random
effects model. A total of 16 904 patients from 51 studies were identified
after literature search of the major databases using a predefined keyword
list. The incidence of MACCE did not differ between the groups, neither
during the first 30 days (OR: 0.93; 95% CI: 0.82-1.04) nor for the longest
available follow-up (OR: 1.01; 95% CI: 0.92-1.12). While the incidence of
mid-term graft failure (OR: 1.37; 95% CI: 1.09-1.72) and the need for
repeat revascularization (OR: 1.55; 95% CI: 1.33-1.80) was increased after
off-pump surgery, on-pump surgery was associated with an increased
occurrence of stroke (OR: 0.74; 95% CI: 0.58-0.95), renal impairment (OR:
0.79; 95% CI: 0.71-0.89) and mediastinitis (OR: 0.44; 95% CI: 0.31-0.62).
There was no difference with regard to hard clinical end-points between
on- or off-pump surgery, including myocardial infarction or mortality. The
present systematic review emphasizes that both off- and on-pump surgery
provide excellent and comparable results in patients requiring surgical
revascularization. The choice for either strategy should take into account
the individual patient profile (comorbidities, life expectancy, etc.) and
importantly, the surgeon's experience in performing on- or off-pump CABG
in their routine practice. Copyright &#xa9; 2015 The Author.

<208>
Accession Number
607185647
Author
Heyman S.N.; Leibowitz D.; Mor-Yosef Levi I.; Liberman A.; Eisenkraft A.;
Alcalai R.; Khamaisi M.; Rosenberger C.
Institution
(Heyman, Leibowitz, Alcalai) Department of Medicine, Hadassah Hebrew
University Hospitals, Jerusalem, Israel
(Leibowitz, Alcalai) Department of Cardiology, Hadassah Hebrew University
Hospitals, Jerusalem, Israel
(Mor-Yosef Levi) Department of Nephrology, Hadassah Hebrew University
Hospitals, Jerusalem, Israel
(Liberman) Department of Neurology, Hadassah Hebrew University Hospitals,
Jerusalem, Israel
(Eisenkraft) The Research Institute for Military Medicine, The Hebrew
University Medical School and the Israeli Defense Force Medical Corps,
Jerusalem, Israel
(Khamaisi) Joslin Diabetes Center, Boston, MA, United States
(Rosenberger) Department of Nephrology, Charite, Berlin, Germany
Title
Adaptive response to hypoxia and remote ischaemia pre-conditioning: A new
hypoxia-inducible factors era in clinical medicine.
Source
Acta Physiologica. 216 (4) (pp 395-406), 2016. Date of Publication: 01 Apr
2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Transient ischaemia leads to tolerance to subsequent protracted ischaemia.
This 'ischaemia pre-conditioning' results from the induction of numerous
protective genes, involved in cell metabolism, proliferation and survival,
in antioxidant capacity, angiogenesis, vascular tone and erythropoiesis.
Hypoxia-inducible factors (HIF) play a pivotal role in this
transcriptional adaptive response. HIF prolyl hydroxylases (PHDs), serving
as oxygen sensors, control HIFalpha degradation. HIF-mediated ischaemic
pre-conditioning can be achieved with the administration of PHD
inhibitors, with the attenuation of organ injury under various hypoxic and
toxic insults. Clinical trials are currently under way, evaluating PHD
inhibitors as inducers of erythropoietin. Once their safety is
established, their potential use might be further tested in clinical
trials in various forms of acute ischaemic and toxic organ damage.
Repeated transient limb ischaemia was also found to attenuate ischaemic
injury in remote organs. This 'remote ischaemic pre-conditioning'
phenomenon (RIP) has been extensively studied recently in small clinical
trials, preceding, or in parallel with an abrupt insult, such as
myocardial infarction, cardiac surgery or radiocontrast administration.
Initial results are promising, suggesting organ protection. Large-scale
multi-centre studies are currently under way, evaluating the protective
potential of RIP in cardiac surgery, in the management of myocardial
infarction and in organ transplantation. The mechanisms of organ
protection provided by RIP are poorly understood, but HIF seemingly play a
role as well. Thus, Inhibition of HIF degradation with PHD inhibitors, as
well as RIP (in part through HIF), might develop into novel clinical
interventions in organ protection in the near future. Copyright &#xa9;
2016 Scandinavian Physiological Society.

<209>
Accession Number
609080677
Author
Lei Q.; Zeng Q.-S.; Zhang X.-S.; Xie B.; Huang H.-L.; Wang S.; Guo H.-M.;
Chen J.-M.; Zhuang J.
Institution
(Lei, Zeng, Zhang, Xie, Huang, Wang, Guo, Chen, Zhuang) Department of
Cardiac Surgery and Anesthesiology, Guangdong Cardiovascular Institute,
Guangdong General Hospital and Guangdong Academy of Medical Sciences, 106
ZhongShanEr Road, Guangzhou 510080, China
Title
Bilateral subclavian vein sheaths for superior vena cava drainage during
thoracoscopic repair of atrial septal defects: Cosmetic outcomes, safety
and effectiveness.
Source
Perfusion (United Kingdom). 31 (3) (pp 240-246), 2016. Date of
Publication: 01 Apr 2016.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Objective: To investigate the cosmetic outcomes, safety and effectiveness
of using bilateral subclavian vein sheaths for superior vena cava drainage
during thoracoscopic repair of atrial septal defects. Methods: Sixty-one
consecutive adults scheduled for thoracoscopic repair of atrial septal
defects between July 2012 and June 2013 were randomized into two groups:
one group underwent placement of a 16 Fr percutaneous superior vena cava
cannula (n = 30) and the other group underwent placement of bilateral 8 Fr
subclavian vein sheaths (n = 31) for superior vena cava drainage during
peripheral cardiopulmonary bypass. The perioperative data, central venous
pressure during cardiopulmonary bypass, complications and the patient
satisfaction scale scores for the incisions were compared between the two
groups. Results: The theoretical cardiopulmonary bypass flow rate was
reached without complications in all patients. The average central venous
pressure during cardiopulmonary bypass was not significantly different
between the two groups [(6.9 +/- 3.1) mmHg vs. (7.0 +/- 3.5) mmHg,
p=0.92]. The patient satisfaction scale scores for the incisions were
significantly higher in the patients who underwent placement of bilateral
subclavian vein sheaths than in the patients who underwent placement of a
percutaneous superior vena cava cannula [(2.81 +/- 0.75) vs. (2.07 +/-
0.74), p<0.001]. Conclusions: Placement of bilateral subclavian vein
sheaths is a safe and effective alternative to placement of a percutaneous
superior vena cava cannula for superior vena cava drainage during
thoracoscopic repair of atrial septal defects and results in greater
patient satisfaction with the cosmetic outcome. Copyright &#xa9; The
Author(s) 2015.

<210>
Accession Number
609080651
Author
Itoh H.; Ichiba S.; Ujike Y.; Douguchi T.; Kasahara S.; Arai S.; Sano S.
Institution
(Itoh) Department of Medical Engineering, Faculty of Health Sciences,
Junshin Gakuen University, 1-1-1, Chikushigaoka, Minami-ku, Fukuoka
815-8510, Japan
(Itoh, Ujike) Department of Emergency and Critical Care Medicine, Okayama
University Graduate School of Medicine, Dentistry and Pharmaceutical
Sciences, Okayama, Japan
(Ichiba) Department of Community and Emergency Medicine, Okayama
University Graduate School of Medicine, Dentistry and Pharmaceutical
Sciences, Okayama, Japan
(Douguchi, Kasahara, Arai, Sano) Department of Cardiovascular Surgery,
Okayama University Hospital, Okayama, Japan
Title
A prospective randomized trial comparing the clinical effectiveness and
biocompatibility of heparin-coated circuits and PMEA-coated circuits in
pediatric cardiopulmonary bypass.
Source
Perfusion (United Kingdom). 31 (3) (pp 247-254), 2016. Date of
Publication: 01 Apr 2016.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Object: We compared the clinical effectiveness and biocompatibility of
poly-2-methoxyethyl acrylate (PMEA)-coated and heparin-coated
cardiopulmonary bypass (CPB) circuits in a prospective pediatric trial.
Methods: Infants randomly received heparin-coated (n=7) or PMEA-coated
(n=7) circuits in elective pediatric cardiac surgery with CPB for
ventricular septum defects. Clinical and hematologic variables,
respiratory indices and hemodynamic changes were analyzed perioperatively.
Results: Demographic and clinical variables were similar in both groups.
Leukocyte counts were significantly lower 5 minutes after CPB in the PMEA
group than the heparin group. Hemodynamic data showed that PMEA caused
hypotension within 5 minutes of CPB. The respiratory index was
significantly higher immediately after CPB and 1 hour after transfer to
the intensive care unit (ICU) in the PMEA group, as were levels of
C-reactive protein 24 hours after transfer to the ICU. Conclusion: Our
study shows that PMEA-coated circuits, unlike heparin-coated circuits,
cause transient leukopenia during pediatric CPB and, perhaps, systemic
inflammatory respiratory syndrome after pediatric CPB. Copyright &#xa9;
The Author(s) 2015.

<211>
Accession Number
606299112
Author
Cho J.S.; Shim J.-K.; Soh S.; Kim M.K.; Kwak Y.-L.
Institution
(Cho, Shim, Soh, Kim, Kwak) Department of Anesthesiology and Pain
Medicine, Anesthesia and Pain Research Institute, Yonsei Cardiovascular
Hospital, Yonsei University College of Medicine, 50 Yonsei-ro,
Seodaemun-gu, Seoul 120-752, South Korea
(Shim, Kwak) Anesthesia and Pain Research Institute, Yonsei University
College of Medicine, Seoul, South Korea
Title
Perioperative dexmedetomidine reduces the incidence and severity of acute
kidney injury following valvular heart surgery.
Source
Kidney International. 89 (3) (pp 693-700), 2016. Date of Publication: 01
Mar 2016.
Publisher
Elsevier
Abstract
Acute kidney injury (AKI) following cardiac surgery is closely
interrelated with hemodynamic instability and sympathetic activity, and
adversely influences prognosis. Here, we investigated in a randomized
placebo-controlled trial whether dexmedetomidine, an alpha2 adrenoreceptor
agonist, could prevent AKI after valvular heart surgery. Two hundred
patients undergoing valvular heart surgery were randomly assigned to equal
placebo or treatment groups. Dexmedetomidine was infused at a rate of 0.4
mug/kg/h starting immediately after anesthetic induction and continuing
for 24 h after surgery. We then assessed the incidence of AKI during the
first 48 postoperative hours, hemodynamic variables, and a composite of
major morbidity end points. The incidence of AKI, based on Acute Kidney
Injury Network criteria, was significantly lower in the treatment group
compared with the control group (14 vs. 33%). The dexmedetomidine group
exhibited a significantly lower incidence of a composite of major
morbidity end points (21 vs. 38%) and a significantly shorter length of
intensive care unit stay (3 [2, 3] days vs. 3 [2, 4] days) compared with
the control group. Thus, perioperative infusion of dexmedetomidine
effectively reduced both the incidence and severity of AKI, and improved
outcome in patients undergoing valvular heart surgery without untoward
hemodynamic side effects. Copyright &#xa9; 2015 International Society of
Nephrology.

<212>
Accession Number
606090813
Author
Dutta S.; Cohn S.L.; Pfeifer K.J.; Slawski B.A.; Smetana G.W.; Jaffer A.K.
Institution
(Dutta, Jaffer) Department of Medicine, Rush Medical College, Chicago, IL,
United States
(Cohn) University of Miami Miller School of Medicine, Miami, FL, United
States
(Pfeifer, Slawski) Froedtert Memorial Lutheran Hospital Clinical Cancer
Center, Medical College of Wisconsin, Milwaukee, WI, United States
(Smetana) Division of General Medicine and Primary Care, Harvard Medical
School, Boston, MA, United States
Title
Updates in perioperative medicine.
Source
Journal of Hospital Medicine. 11 (3) (pp 231-236), 2016. Date of
Publication: 01 Mar 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
BACKGROUND: As our surgical population becomes older and more medically
complex, knowledge of the most recent perioperative literature is
necessary to optimize perioperative care. We aim to summarize and critique
literature published over the past year with the highest potential to
impact the clinical practice of perioperative medicine. METHODS: We
reviewed articles published between January 2014 and April 2015,
identified via MEDLINE search. The final 10 articles selected were
determined by consensus among all authors, with criteria for inclusion
including scientific rigor and relevance to perioperative medicine
practice. RESULTS: Key findings include: long term beta-blockade should be
continued prior to surgery, routine screening with postoperative troponin
is not recommended, initiation/continuation of aspirin or clonidine in the
perioperative period is not beneficial and may increase adverse outcomes,
preoperative diagnosis and treatment of obstructive sleep apnea may reduce
risk of postoperative cardiovascular complications, new pulmonary risk
indices are available that accurately estimate postoperative pulmonary
complications, postoperative atrial fibrillation is associated with
increased long-term stroke risk, risk scores such as the CHADS<inf>2</inf>
(Congestive heart failure, Hypertension, Age >75 years, Diabetes Mellitus,
previous stroke or transient ischemic attack) are superior to the Revised
Cardiac Risk Index in predicting adverse postoperative outcomes for
patients with nonvalvular atrial fibrillation, and utilization of bridging
anticoagulation comes with a much higher risk of bleeding compared to
patients who are not bridged. CONCLUSIONS: The body of literature reviewed
provides important information for clinicians caring for surgical patients
across multiple fronts, including preoperative risk assessment, medication
management, and postoperative medical care. Copyright &#xa9; 2016 Society
of Hospital Medicine.

<213>
Accession Number
605643359
Author
Ahmad I.G.; Abdulla R.K.; Klem I.; Margulis R.; Ivanov A.; Mohamed A.;
Judd R.M.; Borges-Neto S.; Kim R.J.; Heitner J.F.
Institution
(Klem, Judd, Kim, Heitner) Duke Cardiovascular Magnetic Resonance Center,
Duke University Medical Center, Durham, NC, United States
(Klem, Judd, Kim, Heitner) Department of Medicine, Duke University Medical
Center, Durham, NC, United States
(Borges-Neto) Department of Radiology, Duke University Medical Center,
Durham, NC, United States
(Ahmad, Abdulla, Margulis, Ivanov, Mohamed, Heitner) Department of
Cardiology, New York Methodist Hospital, 506 6th Street, Brooklyn, NY,
United States
Title
Comparison of stress cardiovascular magnetic resonance imaging (CMR) with
stress nuclear perfusion for the diagnosis of coronary artery disease.
Source
Journal of Nuclear Cardiology. 23 (2) (pp 287-297), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Objectives: To assess the diagnostic performance of stress cardiac
magnetic resonance (stress CMR) vs stress single-photon emission computed
tomography (SPECT) in patients presenting to the emergency department (ED)
with chest pain. Background: SPECT imaging is the most utilized outpatient
procedure in the United States. The diagnostic accuracy of SPECT can be
limited by soft tissue attenuation and low spatial resolution. Stress CMR
has much higher spatial resolution and without the susceptibility to soft
tissue attenuation. Methods: Eighty-seven patients without a history of
CAD presenting to the ED with chest pain were prospectively enrolled.
Patients underwent both stress CMR and stress SPECT imaging within 12
hours of presentation. Both the stress imaging tests were interpreted
immediately for clinical purposes and coronary angiography was performed
if either was abnormal. Patients were considered to have significant CAD
if identified by angiography (>50%) or if a cardiac event (cardiac death,
myocardial infarction or revascularization) occurred during follow-up
(mean 2.6 +/- 1.1 years). Results: Thirty-seven patients were referred for
coronary angiography; 29 due to a positive stress test and eight patients
for persistent chest pain despite two negative stress tests. There were 22
patients who had significant CAD (>50%). The remaining patients were
followed for 2.6 +/- 1.1 years. At the conclusion of the follow-up period,
there were four clinical events. The sensitivity, specificity, and
diagnostic accuracy of CMR are 85%, 93%, and 89%, respectively. The
sensitivity, specificity, and diagnostic accuracy of stress SPECT are 84%,
91%, and 88%, respectively. Conclusion: Stress CMR has similar diagnostic
accuracy as stress SPECT in diagnosis of CAD. Copyright &#xa9; 2015,
American Society of Nuclear Cardiology.

<214>
Accession Number
607419566
Author
Cardoso R.; Ansari M.; Garcia D.; Sandhu S.; Brinster D.; Piazza N.
Institution
(Cardoso, Sandhu) Division of Cardiology Department of Medicine,
University of Miami, Jackson, Memorial Hospital, Miami, FL, United States
(Ansari) Division of Structural Heart Diseases, Department of
Cardiothoracic Surgery, Lenox Hill Heart and Vascular Institute, New York,
NY, United States
(Garcia) Department of Cardiology, Ochsner Medical Center, New Orleans,
LA, United States
(Brinster) Department of Cardiothoracic Surgery, Lenox Hill Heart and
Vascular Institute, New York, NY, United States
(Piazza) Division of Cardiology, Department of Medicine, McGill University
Health Centre, Montreal, QC, Canada
Title
Prestenting for prevention of melody valve stent fractures: A systematic
review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 87 (3) (pp 534-539),
2016. Date of Publication: 15 Feb 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Introduction The role of right ventricular outflow tract (RVOT)
prestenting in the prevention of Melody valve stent fractures (SFs) is not
well defined. We aimed to perform a systematic review and meta-analysis
comparing the incidence of SF in Melody valve transcatheter pulmonary
implants with and without prestenting. Methods PubMed, EMBASE, and
Cochrane Central were searched for studies that reported the incidence of
SF in Melody valve transcatheter pulmonary implants stratified by the
presence or absence of RVOT prestenting. Subgroup analyses were performed
for (1) SF associated with a loss of stent integrity and (2) SF requiring
reintervention. Results Five studies and 360 patients were included, of
whom 207 (57.5%) received prestenting. Follow-up ranged from 15 to 30
months. SF were significantly reduced in the prestenting group (16.7%)
when compared to no prestenting (33.5%) (odds-ratio [OR] 0.39; 95%CI
0.22-0.69). Patients who received prestenting also had a lower incidence
of (1) SF associated with loss of stent integrity (OR 0.16; 95%CI
0.05-0.48) and (2) SF requiring reintervention (OR 0.15; 95%CI 0.02-0.91).
Conclusion Our findings suggest that stenting of the RVOT prior to Melody
valve implantation is associated with a reduction in the incidence of SF
and fracture-related reinterventions. Copyright &#xa9; 2015 Wiley
Periodicals, Inc.

<215>
Accession Number
609627424
Author
Costa F.; Adamo M.; Ariotti S.; Ferrante G.; Navarese E.P.; Leonardi S.;
Garcia-Garcia H.; Vranckx P.; Valgimigli M.
Institution
(Costa, Adamo, Ariotti, Valgimigli) Thoraxcenter, Ba 587, Erasmus MC,
s-Gravendijkwal 230, Rotterdam 3015 CE, Netherlands
(Ferrante) Interventional Cardiology, Humanitas Clinical and Research
Institute IRCCS, Milan, Italy
(Navarese) Department of Internal Medicine, Division of Cardiology,
Pulmonology and Vascular Medicine, Heinrich-Heine-University, Dusseldorf,
Germany
(Leonardi) Fondazione I.R.CCS, Policlinico San Matteo, Pavia, Italy
(Garcia-Garcia) Cardialysis, Rotterdam, Netherlands
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
Title
Left main or proximal left anterior descending coronary artery disease
location identifies high-risk patients deriving potentially greater
benefit from prolonged dual antiplatelet therapy duration.
Source
EuroIntervention. 11 (11) (pp e1222-e1230), 2016. Date of Publication:
February 2016.
Publisher
EuroPCR
Abstract
Aims: It is currently unclear if the location of coronary artery disease
affects decision making with regard to dual antiplatelet therapy (DAPT).
We investigated if the presence of at least 30% luminal narrowing in the
left main (LM) and/or proximal left anterior descending (pLAD) coronary
arteries on angiography is an outcome modifier with respect to DAPT
duration. Methods and results: In the Prolonging Dual Antiplatelet
Treatment After Grading Stent-Induced Intimal Hyperplasia (PRODIGY) study,
953 (54.3%) patients with and 801 (45.7%) without LM/pLAD lumen narrowing
at the qualifying coronary intervention were randomised to six or 24
months of DAPT. Twentyfour month as compared to six-month DAPT reduced the
occurrence of definite, probable or possible stent thrombosis by 50% in
patients with (2.8% vs. 5.6%; HR 0.45, 95% CI: 0.23-0.89; p=0.02) but not
in those without LM/pLAD lumen narrowing, with a highly significant
interaction testing (P<inf>INT</inf> = 0.002). This result remained
consistent irrespective of whether stenting was (P: 0.01) or was not
(P<inf>INT</inf>: 0.02) performed in the LM/pLAD. Conclusions: Left main
and/or proximal LAD lumen narrowing may be a treatment modifier with
respect to the duration of DAPT. Patients fulfilling these angiographic
characteristics seem to benefit from a prolonged dual antiplatelet
treatment. Trial registration: ClinicalTrials.gov Identifier: NCT00611286
Copyright &#xa9; Europa Digital & Publishing 2016. All rights reserved.

<216>
Accession Number
607271197
Author
Moller J.H.
Institution
(Moller) Department of Medicine, University of Minnesota, Minneapolis, MN,
United States
Title
Using Data to Improve Quality: The Pediatric Cardiac Care Consortium.
Source
Congenital Heart Disease. 11 (1) (pp 19-25), 2016. Date of Publication: 01
Jan 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
A program to collect and analyze cardiac catheterization,
electrophysiologic studies and cardiac operations in children was
initiated in 1982. The purpose was to help centers compare their
experience and outcomes with a group of centers to determine areas where
their performance might improve. Cardiac centers became members of the
Pediatric Cardiac Care Consortium and submitted demographic data and
copies of procedure reports regularly to a central office. Data were
extracted from the reports, coded by trained coders and entered into a
computer database. Annually, the data were analyzed to compare the
experience of an individual center with that of the entire group of
centers. The annual data were adjusted for severity on the basis of eight
factors selected after discussion with participants in the Consortium.
Adjustment was by multivariate analysis. Reports were prepared for each
center and distributed at an annual meeting. The data were used by centers
to review operations where the mortality rate exceeded +2 standard
deviations of the group. With discussion, the center staff often initiated
changes to improve outcome. The outcome could then be monitored by the
annual reports. Our data were also utilized in the creation of the Risk
Adjustment for Surgery for Congenital Heart Disease (RACHS)-1 categories
of disease severity. The mortality rates of our centers were comparable
with the combined hospital discharge data from New York, Massachusetts,
and California. From 1982 through 2007, the mortality rates of our centers
dropped for each RACHS-1 category, falling to less than 1% for categories
1 and 2 for the last 5-year period. During the 25 years, we received data
from 52 centers about 137654 patients who underwent 117756 cardiac
operations. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<217>
Accession Number
607320309
Author
Yildirim F.; Iskesen I.; Kurdal A.T.; Ozturk T.; Taneli F.; Gozukara C.;
Ozbakkaloglu A.
Institution
(Yildirim, Iskesen, Kurdal, Ozbakkaloglu) Department of Cardiovascular
Surgery, Celal Bayar University, School of Medicine, Manisa, Turkey
(Ozturk) Department of Anesthesiology, Celal Bayar University, School of
Medicine, Manisa, Turkey
(Taneli, Gozukara) Department of Biochemistry, Celal Bayar University,
School of Medicine, Manisa, Turkey
Title
Is "attenuation of Oxidative Stress" Helpful to Understand the Mechanism
of Remote Ischemic Preconditioning in Cardiac Surgery?.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (1) (pp 134-140),
2016. Date of Publication: 01 Jan 2016.
Publisher
W.B. Saunders
Abstract
Objectives The aim of this study was to determine the effect of remote
ischemic preconditioning (RIPC) on markers of cardiac ischemia and
response to oxidative stress in patients undergoing coronary artery bypass
grafting (CABG) surgery. Design A prospective, randomized, and blinded
study. Setting A single-center university hospital. Participants This
study included patients who underwent isolated CABG surgery with
cardiopulmonary bypass who were selected carefully to prevent confounding
with factors known to affect markers of ischemia-reperfusion and response
to oxidative stress. Interventions The authors randomly assigned patients
to RIPC to the left lower extremity using a blood pressure cuff (study
group) or a cuff that was applied but not inflated or deflated (control
group). Measurements and Main Results At 6 hours after CABG surgery,
high-sensitivity cardiac troponin T levels were significantly lower in the
study group than in the control group. Levels of superoxide dismutase, an
antioxidant enzyme, were significantly greater 15 minutes after release of
the cross-clamp in the study group, whereas malondialdehyde levels were
lower (not significantly) at 1 and 15 minutes after release of the
cross-clamp. Hemodynamic parameters were not significantly different at
any time point during the study. Conclusions The authors' method of RIPC
before CABG surgery resulted in less myocardial ischemia, as indicated by
lower troponin levels. Changes in levels of endogenous antioxidant enzymes
supported the hypothesis that this protection from ischemia-reperfusion
injury was related to scavenging of free oxygen radicals. Future studies
might include a more heterogeneous population and medications that lower
the body's response to oxidative stress. Copyright &#xa9; 2016 Elsevier
Inc.

<218>
Accession Number
607312896
Author
Weber U.; Glassford N.J.; Eastwood G.M.; Bellomo R.; Hilton A.K.
Institution
(Weber, Glassford, Eastwood, Hilton) Department of Intensive Care, Austin
Hospital, 145 Studley Road, Melbourne 3084, Australia
(Bellomo) Australian and New Zealand Intensive Care Research Centre,
Department of Epidemiology and Preventive Medicine, Monash University,
Melbourne, Australia
Title
A Pilot Assessment of Carotid and Brachial Artery Blood Flow Estimation
Using Ultrasound Doppler in Cardiac Surgery Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (1) (pp 141-148),
2016. Date of Publication: 01 Jan 2016.
Publisher
W.B. Saunders
Abstract
Objectives To estimate carotid and brachial artery blood flow with Doppler
ultrasound in cardiac surgery patients and relate such estimates to
cardiac index, lactate levels, and markers of renal function. Design A
prospective observational study. Setting A teaching hospital. Participants
Twenty-five elective cardiac surgery patients. Interventions The authors
measured bilateral carotid and brachial artery blood flows using Doppler
ultrasound and, simultaneously, cardiac index using a pulmonary artery
catheter; lactate and serum creatinine levels; and urine output. The
relationship between these indices and biomarkers was assessed
statistically. Measurements and Main Results Median carotid arterial blood
flow was estimated at 0.323 L/min (interquartile ratio [IQR], 0.256-0.429
L/min) on the right and 0.308 L/min (IQR, 0.247-0.376 L/min) on the left
at baseline. Median brachial arterial blood flow was estimated at 0.063
L/min (IQR, 0.039-0.115 L/min) on the right and 0.063 L/min (IQR,
0.039-0.081 L/min) on the left at baseline. There was a weak correlation
between right- and left-sided flows (brachial: rho = 0.285; carotid: rho =
0.384) and between brachial and carotid flow (right: rho = 0.135, left:
rho = 0.225). There also was a weak correlation between cardiac index and
brachial flow (right: rho = 0.215; left: rho = 0.320) and carotid flow
(left: rho = 0.159) immediately after surgery, and no correlation 1 day
after surgery (right brachial: rho = -0.010; left brachial: rho = -0.064;
left carotid: rho = -0.060). There were no significant correlations
between carotid or brachial flows and lactate and serum creatinine levels
or urine output. Conclusions In cardiac surgery patients,
Doppler-estimated carotid and brachial arterial blood flows have only a
weak correlation with cardiac index and no correlation with lactate or
creatinine levels or urine output. Thus, Doppler estimation of these blood
flows cannot be used to provide noninvasive estimates of cardiac index in
patients after cardiac surgery. Copyright &#xa9; 2016 Elsevier Inc.

<219>
[Use Link to view the full text]
Accession Number
606627138
Author
Ziegler T.R.; May A.K.; Hebbar G.; Easley K.A.; Griffith D.P.; Dave N.;
Collier B.R.; Cotsonis G.A.; Hao L.; Leong T.; Manatunga A.K.; Rosenberg
E.S.; Jones D.P.; Martin G.S.; Jensen G.L.; Sax H.C.; Kudsk K.A.; Galloway
J.R.; Blumberg H.M.; Evans M.E.; Wischmeyer P.E.
Institution
(Ziegler, Hebbar, Hao) Division of Endocrinology, Metabolism and Lipids,
Department of Medicine, Emory University, School of Medicine, Atlanta, GA,
United States
(Ziegler, Galloway) Center for Clinical and Molecular Nutrition, Emory
University, School of Medicine, Atlanta, GA, United States
(Ziegler, Hebbar, Griffith, Dave, Galloway) Emory University Hospital,
Nutrition and Metabolic Support Service, Atlanta Clinical and
Translational Science Institute, 1364 Clifton Rd, Atlanta, GA 30322,
United States
(May, Collier) Department of Surgery, Vanderbilt University Medical
Center, Nashville, TN, United States
(Easley, Cotsonis, Leong, Manatunga) Department of Biostatistics and
Bioinformatics, Rollins School of Public Health, Emory University,
Atlanta, GA, United States
(Collier) Department of Surgery, Virginia Technical Institute Carilion,
School of Medicine, Roanoke, VA, United States
(Rosenberg) Department of Epidemiology, Rollins School of Public Health,
Emory University, Atlanta, GA, United States
(Jones) Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, Emory University, School of Medicine, Atlanta, GA,
United States
(Martin) Department of Nutritional Sciences, Pennsylvania State
University, University Park, PA, United States
(Jensen, Blumberg) Department of Surgery, Miriam Hospital, Providence, RI,
United States
(Sax) Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA,
United States
(Sax) Department of Surgery, University of Wisconsin, Schools of Medicine
and Public Health, Madison, WI, United States
(Kudsk) Department of Surgery, Emory University, School of Medicine,
Atlanta, GA, United States
(Galloway) Division of Infectious Diseases, Department of Medicine, Emory
University, School of Medicine, Atlanta, GA, United States
(Evans) Hubert Department of Global Health Rollins, School of Public
Health, Emory University, Atlanta, GA, United States
(Wischmeyer) National Institutes of Health, National Institute of Diabetes
and Digestive and Kidney Diseases, Bethesda, MD, United States
(Wischmeyer) Department of Anesthesiology, University of Colorado, School
of Medicine, Aurora, CO, United States
Title
Efficacy and safety of glutamine-supplemented parenteral nutrition in
surgical ICU patients: An American mul ticenter rand omized controlled
trial.
Source
Annals of Surgery. 263 (4) (pp 646-655), 2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: To determine whether glutamine (GLN)-supplemented parenteral
nutrition (PN) improves clinical outcomes in surgical intensive care unit
(SICU) patients. Summary Background Data: GLN requirements may increase
with critical illness. GLN-supplemented PN may improve clinical outcomes
in SICU patients. Methods: A parallel-group, multicenter, double-blind,
randomized, controlled clinical trial in 150 adults after
gastrointestinal, vascular, or cardiac surgery requiring PN and SICU care.
Patients were without significant renal or hepatic failure or shock at
entry. All received isonitrogenous, isocaloric PN [1.5 g/kg/d amino acids
(AAs) and energy at 1.3x estimated basal energy expenditure]. Controls (n
= 75) received standard GLN-free PN (STD-PN); the GLN group (n = 75)
received PN containing alanyl-GLN dipeptide (0.5 g/kg/d), proportionally
replacing AA in PN (GLN-PN). Enteral nutrition (EN) was advanced and PN
weaned as indicated. Hospital mortality and infections were primary
endpoints. Results: Baseline characteristics, days on study PN and daily
macronutrient intakes via PN and EN, were similar between groups. There
were 11 hospital deaths (14.7%) in the GLN-PN group and 13 deaths in the
STD-PN group (17.3%; difference,-2.6%; 95% confidence interval,-14.6% to
9.3%; P = 0.66). The 6-month cumulative mortality was 31.4% in the GLN-PN
group and 29.7% in the STD-PN group (P = 0.88). Incident bloodstream
infection rate was 9.6 and 8.4 per 1000 hospital days in the GLN-PN and
STD-PN groups, respectively (P = 0.73). Other clinical outcomes and
adverse events were similar. Conclusions: PN supplemented with GLN
dipeptide was safe, but did not alter clinical outcomes among SICU
patients. Copyright &#xa9; 2015 Wolters Kluwer Health, Inc. All rights
reserved.

<220>
Accession Number
607389165
Author
Montenij L.J.; Sonneveld J.P.; Nierich A.P.; Buhre W.F.; De Waal E.E.
Institution
(Montenij, De Waal) Department of Anaesthesiology, University Medical
Centre Utrecht, Heidelberglaan 100,3584 CX, Utrecht, Netherlands
(Sonneveld, Nierich) Department of Anaesthesia and Intensive Care, Isala
Clinics, Zwolle, Netherlands
(Buhre) Department of Anaesthesia and Pain Therapy, Maastricht University
Medical Centre, Maastricht, Netherlands
Title
Accuracy, Precision, and Trending Ability of Uncalibrated Arterial
Pressure Waveform Analysis of Cardiac Output in Patients with Impaired
Left Ventricular Function: A Prospective, Observational Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (1) (pp 115-121),
2016. Date of Publication: 01 Jan 2016.
Publisher
W.B. Saunders
Abstract
Objectives Uncalibrated arterial waveform analysis provides minimally
invasive and continuous measurement of cardiac output (CO). This technique
could be of great value in patients with impaired left ventricular
function, but the validity in these patients is not well established. The
aim of this study was to investigate the accuracy, precision, and trending
ability of uncalibrated arterial waveform analysis of cardiac output in
patients with impaired left ventricular function. Design Prospective,
observational, method-comparison study. Setting Nonuniversity teaching
hospital, single center. Participants The study included 22 patients with
a left ventricular ejection fraction of 40% or less undergoing elective
coronary artery bypass grafting. Interventions In the period between
induction of anesthesia and sternotomy, CO was measured using the
FloTrac/Vigileo system (third-generation software) and intermittent
pulmonary artery thermodilution before and after volume loading.
Measurements and Main Results Accuracy and precision as determined using
Bland-Altman analysis revealed a bias of -0.7 L/min, limits of agreement
of -2.9 to 1.5 L/min, and a mean error of 55% for pooled data.
Proportional bias and spread were present, indicating that bias and limits
of agreement were underestimated for high CO values. Trending ability was
assessed using 4-quadrant analysis, which revealed a concordance of 86%.
Concordance from a clinical perspective was 36%. Polar plot analysis
showed an angular bias of 13degree degrees, with radial limits of
agreement of -55degree to 51degree. Polar concordance at+/-30degree was
50%. Conclusions Arterial waveform analysis of cardiac output and
pulmonary artery thermodilution cardiac output were not interchangeable in
patients with impaired left ventricular function. Copyright &#xa9; 2016
Elsevier Inc.

<221>
Accession Number
605856060
Author
Aggarwal R.; Harling L.; Efthimiou E.; Darzi A.; Athanasiou T.; Ashrafian
H.
Institution
(Aggarwal, Harling, Efthimiou, Darzi, Athanasiou, Ashrafian) The
Department of Surgery and Cancer, Imperial College London, 10th Floor,
Queen Elizabeth the Queen Mother (QEQM) Building, Imperial College
Healthcare NHS Trust at St Mary's Hospital, Praed Street, London W2 1NY,
United Kingdom
(Harling, Athanasiou) Department of Cardiothoracic Surgery, Imperial
College Healthcare NHS Trust, London, United Kingdom
(Efthimiou, Ashrafian) Department of Bariatric Surgery, Chelsea and
Westminster Hospital, London, United Kingdom
Title
The Effects of Bariatric Surgery on Cardiac Structure and Function: a
Systematic Review of Cardiac Imaging Outcomes.
Source
Obesity Surgery. 26 (5) (pp 1030-1040), 2016. Date of Publication: 01 May
2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Obesity is associated with cardiac dysfunction,
atherosclerosis, and increased cardiovascular risk. It can be lead to
obesity cardiomyopathy and severe heart failure, which in turn raise
morbidity and mortality while carrying a negative impact on quality of
life. There is increasing clinical and mechanistic evidence on the
metabolic and weight loss effects of bariatric surgery on improving
cardiac structure and function in obese patients. Objectives: The
objective of this study was to quantify the effects of bariatric surgery
on cardiac structure and function by appraising cardiac imaging changes
before and after metabolic operations. Methods: This is a comprehensive
systematic review of studies reporting pre-operative and post-operative
echocardiographic or magnetic resonance cardiac indices in obese patients
undergoing bariatric surgery. Studies were quality scored, and data were
meta-analyzed using random effects modeling. Results: Bariatric surgery is
associated with significant improvements in the weighted incidence of a
number of cardiac indices including a decrease in left ventricular mass
index (11.2 %, 95 % confidence intervals (CI) 8.2-14.1 %), left
ventricular end-diastolic volume (13.28 ml, 95 % CI 5.22-21.34 ml), and
left atrium diameter (1.967 mm, 95 % CI 0.980-2.954). There were
beneficial increases in left ventricular ejection fraction (1.198 %, 95
%CI -0.050-2.347) and E/A ratio (0.189 %, 95 %CI -0.113-0.265).
Conclusions: Bariatric surgery offers beneficial cardiac effects on
diastolic function, systolic function, and myocardial structure in obese
patients. These may derive from surgical modulation of an enterocardiac
axis. Future studies must focus on higher evidence levels to better
identify the most successful bariatric approaches in preventing and
treating the broad spectrum of obesity-associated heart disease while also
enhancing treatment strategies in the management of obesity
cardiomyopathy. Copyright &#xa9; 2015, Springer Science+Business Media New
York.

<222>
Accession Number
610170493
Author
Berwanger O.; Manach Y.L.; Suzumura E.A.; Biccard B.; Srinathan S.K.;
Szczeklik W.; Santo J.A.E.; Santucci E.; Cavalcanti A.B.; Archbold R.A.;
Devereaux P.J.
Institution
(Berwanger, Suzumura, Santo, Santucci, Cavalcanti) Research Institute,
Heart Hospital (Hospital do Coracao - HCor), Rua Abilio Soares 250, 12
Andar, Sao Paulo, SP 04005-000, Brazil
(Manach, Devereaux) Population Health Research Institute, McMaster
University, Hamilton, ON, Canada
(Biccard) Perioperative Research Group, Discipline of Anaesthesiology and
Critical Care, School of Clinical Medicine, University of KwaZulu-Natal,
Durban, South Africa
(Srinathan) Department of Surgery, University of Manitoba, Winnipeg, MB,
Canada
(Szczeklik) Jagiellonian University, Medical College, Krakow, Poland
(Archbold) Barts Heart Centre, Barts Health NHS Trust, London, United
Kingdom
Title
Association between pre-operative statin use and major cardiovascular
complications among patients undergoing non-cardiac surgery: The VISION
study.
Source
European Heart Journal. 37 (2) (pp 177-185), 2016. Date of Publication:
2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims: The aim of this study was to assess the effects of pre-operative
statin therapy on cardiovascular events in the first 30-days after
non-cardiac surgery. Methods and results: We conducted an international,
prospective, cohort study of patients who were =45 years having in-patient
non-cardiac surgery. We estimated the probability of receiving statins
pre-operatively using a multivariable logistic model and conducted a
propensity score analysis to correct for confounding. A total of 15 478
patients were recruited at 12 centres in eight countries from August 2007
to January 2011. The matched population consisted of 2845 patients (18.4%)
treated with a statin and 4492 (29.0%) controls. The pre-operative use of
statins was associated with lower risk of the primary outcome, a composite
of all-cause mortality, myocardial injury after non-cardiac surgery
(MINS), or stroke at 30 days [relative risk (RR), 0.83; 95% confidence
interval (CI), 0.73-0.95; P = 0.007]. Statins were also associated with a
significant lower risk of all-cause mortality (RR, 0.58; 95% CI,
0.40-0.83; P = 0.003), cardiovascular mortality (RR, 0.42; 95% CI,
0.23-0.76; P = 0.004), and MINS (RR, 0.86; 95% CI, 0.73-0.98; P = 0.02).
There were no statistically significant differences in the risk of
myocardial infarction or stroke. Conclusion: Among patients undergoing
non-cardiac surgery, pre-operative statin therapy was independently
associated with a lower risk of cardiovascular outcomes at 30 days. These
results require confirmation in a large randomized trial. Copyright &#xa9;
The Author 2015.

<223>
Accession Number
607132209
Author
Chi X.; Liao M.; Chen X.; Zhao Y.; Yang L.; Luo A.; Yang H.
Institution
(Chi, Liao, Chen, Zhao, Yang, Luo, Yang) Huazhong University of Science
and Technology, Department of Anesthesiology, Tongji Hospital, Tongji
Medical College, 1095 JieFang Road, Wuhan, Hubei 430030, China
Title
Dexmedetomidine Attenuates Myocardial Injury in Off-Pump Coronary Artery
Bypass Graft Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (1) (pp 44-50),
2016. Date of Publication: 01 Jan 2016.
Publisher
W.B. Saunders
Abstract
Objective To investigate the cardioprotective effect of the continuous
administration of dexmedetomidine using serum cardiac troponin I (cTnI)
and creatine kinase MB (CK-MB) concentrations as biomarkers during
off-pump coronary artery bypass grafting (OPCAB) surgery. Design A
prospective, randomized, parallel-group controlled study. Setting A
university hospital. Participants One hundred sixteen patients undergoing
OPCAB surgery. Interventions Patients were divided randomly into 3
experimental groups that were separated by the dexmedetomidine
administration protocol: a high-dose group (loading dose, 1 mug/kg;
maintenance dose, 0.6 mug/kg/h); low-dose group (loading dose, 0.6 mug/kg;
maintenance dose, 0.3 mug/kg/h); and control group (the same amount of
0.9% saline as placebo). Serum cTnI and CK-MB levels were measured before
surgery and 24 hours and 48 hours after surgery. Measurements and Main
Results Serum cTnI and CK-MB levels in patients of the high-dose group
were less than those of the other 2 groups 48 hours after surgery. The
administration of dexmedetomidine significantly decreased the heart rate.
Compared with the control group, there was a significantly reduced
requirement of sevoflurane in the other 2 groups (p<0.05). The
intraoperative and postoperative cumulative volumes of urine output in the
high-dose group were greater than those of the other 2 groups (p<0.05).
The authors also found that the extubation time and length of stay in the
intensive care unit were prolonged in the high-dose group. Conclusions
Myocardial damage was reduced by the administration of a 1 mug/kg loading
dose and a 0.6 mug/kg/h infusion dose of dexmedetomidine. However, further
studies are needed to understand the underlying mechanism and to confirm
that high doses of dexmedetomidine could be administered safely in
patients undergoing OPCAB surgery. Copyright &#xa9; 2016 Elsevier Inc.

<224>
Accession Number
606695264
Author
Jasudavisius A.; Arellano R.; Martin J.; McConnell B.; Bainbridge D.
Institution
(Jasudavisius, Arellano, Martin, Bainbridge) Schulich School of Medicine
and Dentistry, London Health Sciences Centre, Western University, London,
ON, Canada
(McConnell, Bainbridge) Department of Anesthesiology and Perioperative
Medicine, Western University, London, ON, Canada
Title
A systematic review of transthoracic and transesophageal echocardiography
in non-cardiac surgery: implications for point-of-care ultrasound
education in the operating room.
Source
Canadian Journal of Anesthesia. 63 (4) (pp 480-487), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Point-of-care ultrasound (POCU) is an evolving field in
anesthesia. Therefore a systematic review of common diagnoses made by POCU
during non-cardiac surgery was conducted. The information obtained from
the review may be used to develop POCU curricula for the perioperative
setting during non-cardiac surgery. Source: A systematic review was
conducted for perioperative use of transthoracic /transesophageal
echocardiography (TTE/TEE) in high-risk patients or in other patients
experiencing periods of hemodynamic instability. The diagnoses included
segmental wall motion abnormalities (SWMAs), low left ventricular ejection
fraction (LVEF), hypovolemia, air embolism, cardiac/aortic thrombus,
pulmonary embolus (PE), aortic valve disease, mitral valve disease,
tricuspid valve disease, right ventricular (RV) failure, pericardial
disease, and patent foramen ovale. Principal findings: Three hundred
twenty-one studies were found using our search terms, and thirteen studies
were retained that met our inclusion criteria for review. The studies
included 968 patients analyzed as either preoperative exams in high-risk
patients (n = 568) or intraoperative exams during times of hemodynamic
compromise/cardiac arrest (n = 400). The most common diagnoses in the
preoperative exam group were low ejection fraction (25.4%), aortic valve
disease (24.4%), mitral valve disease (20.0%), RV failure (6.6%), and
hypovolemia (6.3%). In the intraoperative exam group, the most common
diagnoses were hypovolemia (33.2%), low ejection fraction (20.5%), RV
failure (13.1%), SWMAs (10.1%), and PE (5.8%). Conclusion: In this
systematic review examining the use of TTE or TEE in non-cardiac surgery,
the most frequent diagnoses were valvulopathy, low LVEF, hypovolemia, PE,
SWMAs, and RV failure. This information should be used to inform
evidence-based curricula for POCU in anesthesiology. Copyright &#xa9;
2015, Canadian Anesthesiologists' Society.

<225>
Accession Number
606535091
Author
Gomes-Neto M.; Saquetto M.B.; da Silva e Silva C.M.; Conceicao C.S.;
Carvalho V.O.
Institution
(Gomes-Neto, Saquetto, da Silva e Silva, Conceicao) Departamento de
Biofuncao, Curso de Fisioterapia, Instituto de Ciencias da Saude,
Universidade Federal da Bahia, UFBA, Av. Reitor Miguel Calmon s/n - Vale
do Canela, Salvador, BA CEP 40.110-100, Brazil
(Gomes-Neto) Programa de Pos Graduacao em Medicina e Saude, Universidade
Federal da Bahia, UFBA, Salvador, BA, Brazil
(Gomes-Neto, Carvalho) The GREAT Group (GRupo de Estudos em ATividade
fisica), Aracaju, Brazil
(Carvalho) Departamento de Fisioterapia, Universidade Federal de Sergipe,
UFS, Aracaju, SE, Brazil
Title
Impact of Exercise Training in Aerobic Capacity and Pulmonary Function in
Children and Adolescents After Congenital Heart Disease Surgery: A
Systematic Review with Meta-analysis.
Source
Pediatric Cardiology. 37 (2) (pp 217-224), 2016. Date of Publication: 01
Feb 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The aim of the study was to examine the effects of exercise training on
aerobic capacity and pulmonary function in children and adolescents after
congenital heart disease surgery. We searched MEDLINE, Cochrane Controlled
Trials Register, EMBASE, (from the earliest date available to January
2015) for controlled trials that evaluated the effects of exercise
training on aerobic capacity and pulmonary function (forced expiratory
volume in 1 s and forced vital capacity) in children and adolescents after
congenital heart disease surgery. Weighted mean differences and 95 %
confidence intervals (CIs) were calculated,, and heterogeneity was
assessed using the I² test. Eight trials (n = 292) met the
study criteria. The results suggested that exercise training compared with
control had a positive impact on peak VO<inf>2</inf>. Exercise training
resulted in improvement in peak VO<inf>2</inf> weighted mean difference
(3.68 mL kg^-1 min^-1, 95 % CI 1.58-5.78). The
improvement in forced expiratory volume in 1 s and forced vital capacity
after exercise training was not significant. Exercise training may improve
peak VO<inf>2</inf> in children and adolescents after congenital heart
disease surgery and should be considered for inclusion in cardiac
rehabilitation. Further larger randomized controlled trials are urgently
needed to investigate different types of exercise and its effects on the
quality of life. Copyright &#xa9; 2015, Springer Science+Business Media
New York.

<226>
Accession Number
607405899
Author
Hu J.; Chen R.; Liu S.; Yu X.; Zou J.; Ding X.
Institution
(Hu, Chen, Liu, Yu, Zou, Ding) Department of Nephrology, Zhongshan
Hospital, Shanghai Medical College, Fudan University, No 180 Fenglin Road,
Shanghai 200032, China
(Hu, Chen, Liu, Yu, Zou, Ding) Shanghai Institute of Kidney and Dialysis,
Shanghai, China
Title
Global Incidence and Outcomes of Adult Patients with Acute Kidney Injury
after Cardiac Surgery: A Systematic Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (1) (pp 82-89),
2016. Date of Publication: 01 Jan 2016.
Publisher
W.B. Saunders
Abstract
Objectives To estimate the global incidence and outcomes of acute kidney
injury (AKI) after cardiac surgery in adult patients. Design A systematic
review and meta-analysis. Setting Cardiac surgery wards. Participants
Adult patients after cardiac surgery Interventions None. Measurements and
Main Results The authors searched PubMed, Web of Science, Cochrane
Library, OVID, and EMBASE databases for all articles on cardiac surgery
patients published during 2004 to 2014. Meta-analyses were conducted to
generate pooled incidence, mortality, ICU length of stay, and length of
hospital stay. The authors also described the variations according to
study design, criteria of AKI, surgical methods, countries, continents,
and their economies. After a primary and secondary screen, 91
observational studies with 320,086 patients were identified. The pooled
incidence rates of AKI were 22.3% (95% confidence interval [CI], 19.8 to
25.1) in total and 13.6%, 3.8%, and 2.7% at stages 1, 2, and 3,
respectively, whereas 2.3% of patients received renal replacement therapy.
The pooled short-term and long-term mortality were 10.7% and 30%,
respectively, and increased along with the severity of stages. The pooled
unadjusted odds ratio for short-term and long-term mortality in patients
with AKI relative to patients without AKI was 0.144 (95% CI, 0.108 to
0.192, p<0.001) and 0.342 (95% CI 0.287-0.407, p<0.001), respectively. The
pooled average ICU length of stay and length of hospital stay in the AKI
group were 5.4 and 15 days, respectively, while they were 2.2 and 10.5
days in the no-AKI group. Conclusions AKI is a great burden for patients
undergoing cardiac surgery and can affect short-term and long-term
prognoses of these patients. Copyright &#xa9; 2016 Elsevier Inc.

<227>
Accession Number
607404825
Author
Corredor C.; Thomson R.; Al-Subaie N.
Institution
(Corredor, Thomson, Al-Subaie) Cardiothoracic Intensive Care Unit, St.
Georges Hospital NHS Foundation Trust, Blackshaw Road, London SW170QT,
United Kingdom
Title
Long-Term Consequences of Acute Kidney Injury after Cardiac Surgery: A
Systematic Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (1) (pp 69-75),
2016. Date of Publication: 01 Jan 2016.
Publisher
W.B. Saunders
Abstract
Objectives To determine the effect of acute kidney injury (AKI) associated
with cardiac surgery on long-term mortality. Design Systematic review and
meta-analysis of 9 observational studies extracted from the MEDLINE and
EMBASE electronic databases. Setting Hospitals undertaking cardiac
surgery. Participants The study included 35,021 cardiac surgery patients
from 9 observational studies. Interventions None. Measurements and Main
Results Nine studies including 35,021 patients reported incidence of AKI
data. The median incidence of AKI was 27.75% (IQR, 16.3%-38.86%). There
was significant variation in the reported incidence (range, 11.97%-54%),
which can be explained by the different AKI definitions used in the
included studies. Eight studies provided adjusted effect size data with
95% confidence intervals on the impact of the occurrence of postoperative
AKI and long-term mortality outcomes. Occurrence of postoperative AKI is
associated with a significantly increased risk of long-term mortality (HR,
1.68; 95% CI, 1.45-1.95; p<0.00001). Recovery of renal function before
hospital discharge is associated with a lower long-term mortality risk
(HR, 1.31; 95% CI, 1.16-1.47; p<0.00001) compared with patients who
experienced persistent abnormal renal function on hospital discharge (HR,
2.71; 95% CI, 1.26-5.82; p = 0.01). Conclusions There is wide variation in
the reported incidence of AKI after cardiac surgery, reflecting the
different AKI classification systems used. AKI after cardiac surgery is
associated with an increased risk of long-term mortality. Patients with
persistent renal dysfunction after hospital discharge carry a higher risk
of AKI. Copyright &#xa9; 2016 Elsevier Inc.

<228>
Accession Number
607459910
Author
Gunda S.; Reddy M.; Nath J.; Nagaraj H.; Atoui M.; Rasekh A.; Ellis C.R.;
Badhwar N.; Lee R.J.; Di Biase L.; Mansour M.; Ruskin J.N.; Natale A.;
Earnest M.; Lakkireddy D.R.
Institution
(Gunda, Reddy, Nath, Atoui, Earnest, Lakkireddy) Mid America Cardiology,
University of Kansas Hospital, Kansas City, KS 66160, United States
(Nagaraj) Nebraska Heart Institute, Lincoln, NE, United States
(Rasekh) Texas Heart Institute, Houston, TX, United States
(Ellis) Vanderbilt University Medical Center, Nashville, TN, United States
(Badhwar, Lee) University of California, San Francisco, CA, United States
(Di Biase) Texas Cardiac Arrhythmia Institute, St. David's Medical Center,
Albert Einstein College of Medicine, Montefiore Hospital, Austin, TX,
United States
(Mansour, Ruskin) Massachusetts General Hospital, Boston, MA, United
States
(Natale) Texas Cardiac Arrhythmia Institute, Austin, TX, United States
Title
Impact of periprocedural colchicine on postprocedural management in
patients undergoing a left atrial appendage ligation using LARIAT.
Source
Journal of Cardiovascular Electrophysiology. 27 (1) (pp 60-64), 2016. Date
of Publication: 01 Jan 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Periprocedural Colchicine for Epicardial Access Procedures Introduction
Left atrial appendage (LAA) can be effectively and safely excluded using a
novel percutaneous LARIAT ligation system. However, due to pericardial
catheter manipulation and LAA ligation and subsequent necrosis,
postprocedural course is complicated by pericarditis. We intended to
evaluate the preprocedural use of colchicine on the incidence of
postprocedural pericardial complications. Methods and Results In this
multicenter observational study, we included all consecutive patients who
underwent LARIAT procedure at the participating centers. Many patients
received periprocedural colchicine at the discretion of the physician. We
compared the postprocedural outcomes of patients who received prophylactic
periprocedural colchicine (colchicine group) with those who did not
receive colchicine (standard group). A total of 344 consecutive patients,
243 in the "colchicine group" and 101 in the "standard group," were
included. The mean age, median CHADS2VASc score, and HASBLED scores were
70 +/- 11 years, 3 +/- 1.7, and 3 +/- 1.1, respectively. There were no
significant differences in major baseline characteristics between the two
groups. Severe pericarditis was significantly lower in the "colchicine
group" compared to the "standard group" (10 [4%] vs. 16 [16%] P<0.0001).
The colchicine group, compared to the standard group, had lesser
pericardial drain output (186 +/- 84 mL vs. 351 +/- 83, P<0.001), shorter
pericardial drain duration (16 +/- 4 vs. 23 +/- 19 hours, P<0.04), and
similar incidence of delayed pericardial effusion (4 [1.6%] to 3 [3%], P =
0.42) when compared to the standard group. Conclusion Use of colchicine
periprocedurally was associated with significant reduction in
postprocedural pericarditis and associated complications. Copyright &#xa9;
2015 Wiley Periodicals, Inc.

<229>
Accession Number
606397653
Author
Breuer T.; Emontzpohl C.; Coburn M.; Benstoem C.; Rossaint R.; Marx G.;
Schalte G.; Bernhagen J.; Bruells C.S.; Goetzenich A.; Stoppe C.
Institution
(Breuer, Coburn, Rossaint, Schalte, Stoppe) University Hospital of the
RWTH Aachen, Department of Anaesthesiology, Pauwelsstr. 30, Aachen 52074,
Germany
(Emontzpohl, Benstoem, Goetzenich, Stoppe) University Hospital of the RWTH
Aachen, Department of Thoracic and Cardiovascular Surgery, Aachen, Germany
(Breuer, Marx, Bruells) University Hospital of the RWTH Aachen, Department
of Intensive and Intermediate Care, Pauwelsstr. 30, Aachen 52074, Germany
(Emontzpohl, Bernhagen, Stoppe) University Hospital, RWTH Aachen
University, Institute of Biochemistry and Molecular Cell Biology,
Pauwelsstr. 30, Aachen 52074, Germany
Title
Xenon triggers pro-inflammatory effects and suppresses the
anti-inflammatory response compared to sevoflurane in patients undergoing
cardiac surgery.
Source
Critical Care. 19 (1) (no pagination), 2015. Date of Publication: October
15, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Introduction: Cardiac surgery encompasses various stimuli that trigger
pro-inflammatory mediators, reactive oxygen species and mobilization of
leucocytes. The aim of this study was to evaluate the effect of xenon on
the inflammatory response during cardiac surgery. Methods: This randomized
trial enrolled 30 patients who underwent elective on-pump coronary-artery
bypass grafting in balanced anaesthesia of either xenon or sevoflurane.
For this secondary analysis, blood samples were drawn prior to the
operation, intra-operatively and on the first post-operative day to
measure the pro- and anti-inflammatory cytokines interleukin-6 (IL-6),
interleukin-8/C-X-C motif ligand 8 (IL-8/CXCL8), and interleukin-10
(IL-10). Chemokines such as C-X-C motif ligand 12/ stromal cell-derived
factor-1aalpha (CXCL12/SDF-1aalpha) and macrophage migration inhibitory
factor (MIF) were measured to characterize xenon's perioperative
inflammatory profile and its impact on migration of peripheral blood
mononuclear cells (PBMC). Results: Xenon enhanced the postoperative
increase of IL-6 compared to sevoflurane (Xenon: 90.7 versus sevoflurane:
33.7 pg/ml; p = 0.035) and attenuated the increase of IL-10 (Xenon: 127.9
versus sevoflurane: 548.3 pg/ml; p = 0.028). Both groups demonstrated a
comparable intraoperative increase of oxidative stress (intra-OP: p =
0.29; post-OP: p = 0.65). While both groups showed an intraoperative
increase of the cardioprotective mediators MIF and CXCL12/SDF-1aalpha,
only MIF levels decreased in the xenon group on the first postoperative
day (50.0 ng/ml compared to 23.3 ng/ml; p = 0.012), whereas it remained
elevated after sevoflurane anaesthesia (58.3 ng/ml to 53.6 ng/ml). Effects
of patients' serum on chemotactic migration of peripheral mononuclear
blood cells taken from healthy volunteers indicated a tendency towards
enhanced migration after sevoflurane anaesthesia (p = 0.07). Conclusions:
Compared to sevoflurane, balanced xenon anaesthesia triggers
pro-inflammatory effects and suppresses the anti-inflammatory response in
cardiac surgery patients even though the clinical significance remains
unknown. Trial registration: This clinical trial was approved by the
European Medicines Agency (EudraCT-number: 2010-023942-63) and at
ClinicalTrials.gov (NCT01285271 ; first received: January 24, 2011).
Copyright &#xa9; 2015 Breuer et al.

<230>
[Use Link to view the full text]
Accession Number
606468973
Author
Pack Q.R.; Squires R.W.; Valdez-Lowe C.; Mansour M.; Thomas R.J.; Keteyian
S.J.
Institution
(Pack, Valdez-Lowe, Mansour, Keteyian) Division of Cardiovascular
Medicine, Department of Internal Medicine, Henry Ford Hospital, Detroit,
MI, United States
(Pack, Squires, Thomas) Division of Cardiovascular Diseases, Department of
Internal Medicine, Mayo Clinic, Rochester, MN, United States
(Pack) Department of Cardiovascular Medicine, Baystate Medical Group, 759
Chestnut St, Springfield, MA 01089, United States
(Pack) Tufts University School of Medicine, Boston, MA, United States
Title
Employment status and participation in cardiac rehabilitation: Does
encouraging earlier enrollment improve attendance?.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. 35 (6) (pp
390-398), 2015. Date of Publication: 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
PURPOSE: For patients hospitalized for a cardiac event, an earlier
appointment to outpatient cardiac rehabilitation (CR) increases
participation. However, it is unknown what effect hastening CR enrollment
might have among employed patients planning to return to work (RTW).
METHODS: Using 2 complementary data sets from Henry Ford Hospital (HFH)
and Mayo Clinic, we assessed when employed patients eligible for CR
anticipated a RTW, the impact of an earlier appointment on CR enrollment,
and the effect of employment status on the number of CR sessions attended.
Patients at HFH attended CR at either 8 or 42 days (through
randomization), whereas Mayo Clinic patients attended 10 days after
hospital discharge per standard routines. RESULTS: Among 148 patients at
HFH, 65 (44%) were employed and planned to RTW. Of these, 67% desired to
RTW within 1 to 2 weeks, whereas 28% anticipated an RTW within 1 to 3
days. Home financial strain predicted nonparticipation in CR ( P .001) and
was associated with an earlier planned RTW. Among 1030 patients at Mayo
Clinic, 393 (38%) were employed. Employed (vs nonemployed) patients
enrolled in CR 3.3 days sooner ( P .001), but attended 1.6 fewer CR
sessions ( P = .04). In employed patients from both health systems, an
earlier (vs later) appointment to CR did not result in additional exercise
sessions of CR. CONCLUSIONS: Employed patients plan to RTW quickly, in
part because of home finances. They also enroll earlier into CR than
nonemployed patients. Despite these findings, earlier appointments do not
seem to favorably impact overall CR participation. Copyright &#xa9; 2015
Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is
prohibited.

<231>
[Use Link to view the full text]
Accession Number
606468937
Author
Lutsep H.L.; Lynn M.J.; Cotsonis G.A.; Derdeyn C.P.; Turan T.N.; Fiorella
D.; Janis L.S.; Lane B.F.; Montgomery J.; Chimowitz M.I.
Institution
(Lutsep) Department of Neurology, Oregon Health and Science University,
Oregon Stroke Center, 3181 SW Sam Jackson Park Rd, Portland, OR 97239,
United States
(Lynn, Cotsonis, Lane, Montgomery) Department of Biostatistics and
Bioinformatics, Rollins School of Public Health, Emory University,
Atlanta, GA, United States
(Derdeyn) Department of Radiology, Washington University School of
Medicine, St. Louis, MO, United States
(Turan, Chimowitz) Department of Neurology, Medical University of South
Carolina, Charleston, United States
(Fiorella) Department of Neurological Surgery, State University of New
York, Old Westbury, United States
(Janis) National Institutes of Health, Bethesda, MD, United States
Title
Does the Stenting Versus Aggressive Medical Therapy Trial Support Stenting
for Subgroups with Intracranial Stenosis?.
Source
Stroke. 46 (11) (pp 3282-3284), 2015. Date of Publication: 01 Nov 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background and Purpose-Although the Stenting Versus Aggressive Medical
Therapy for Intracranial Arterial Stenosis (SAMMPRIS) trial showed that
medical therapy alone was superior to stenting plus medical therapy for
preventing recurrent strokes in patients with symptomatic intracranial
stenosis, we determined whether SAMMPRIS supported the use of stenting in
any subpopulations of patients with symptomatic intracranial arterial
stenosis. Methods-The primary outcome, 30-day stroke and death and later
strokes in the territory of the qualifying artery, was compared in those
with and without baseline factors in the 2 treatment arms, percutaneous
transluminal angioplasty and stenting (PTAS) plus aggressive medical
therapy versus aggressive medical therapy alone. Baseline factors included
sex, age, race, diabetes mellitus, hypertension, lipid disorder, smoking
status, type of qualifying event, qualifying event hypoperfusion symptoms,
use of antithrombotic or proton pump inhibitor at baseline, days to
enrollment, old infarcts in the same territory, percent stenosis, other
artery stenosis, and location of the symptomatic artery. Results-A total
of 451 patients were enrolled, 227 randomized to aggressive medical
therapy and 224 to PTAS. Of all variables evaluated, the observed 2-year
event rates were higher with PTAS than with aggressive medical therapy in
the vast majority and the interaction with treatment was not statistically
significant for any of the factors. Conclusions-The SAMMPRIS results do
not provide evidence to support the use of PTAS using the Wingspan stent
system compared with medical treatment in any examined subpopulation of
patients with symptomatic intracranial stenosis, including those with
qualifying event hypoperfusion symptoms. Copyright &#xa9; 2015 American
Heart Association, Inc.

<232>
Accession Number
611563091
Author
Choi Y.S.; Bae M.K.; Kim S.H.; Park J.-E.; Kim S.Y.; Oh Y.J.
Institution
(Choi, Kim, Park, Kim, Oh) Department of Anesthesiology and Pain Medicine,
Anesthesia and Pain Research Institute, Severance Hospital, Yonsei
University College of Medicine, Seoul, South Korea
(Bae) Department of Thoracic and Cardiovascular Surgery, National Health
Insurance Service Ilsan Hospital, Goyang, South Korea
Title
Effects of alveolar recruitment and positive end-expiratory pressure on
oxygenation during one-lung ventilation in the supine position.
Source
Yonsei Medical Journal. 56 (5) (pp 1421-1427), 2015. Date of Publication:
01 Sep 2015.
Publisher
Yonsei University College of Medicine
Abstract
Purpose: Hypoxemia during one-lung ventilation (OLV) remains a serious
problem, particularly in the supine position. We investigated the effects
of alveolar recruitment (AR) and positive end-expiratory pressure (PEEP)
on oxygenation during OLV in the supine position. Materials and Methods:
Ninety-nine patients were randomly allocated to one of the following three
groups: a control group (ventilation with a tidal volume of 8 mL/kg), a
PEEP group (the same ventilatory pattern with a PEEP of 8 cm
H<inf>2</inf>O), or an AR group (an AR maneuver immediately before OLV
followed by a PEEP of 8 cm H<inf>2</inf>O). The tidal volume was reduced
to 6 mL/kg during OLV in all groups. Blood gas analyses, respiratory
variables, and hemodynamic variables were recorded 15 min into TLV
(TLV<inf>baseline</inf>), 15 and 30 min after OLV (OLV<inf>15</inf> and
OLV<inf>30</inf>), and 10 min after re-establishing TLV
(TLV<inf>end</inf>). Results: Ultimately, 92 patients were analyzed. In
the AR group, the arterial oxygen tension was higher at TLV<inf>end</inf>,
and the physiologic dead space was lower at OLV<inf>15</inf> and
TLV<inf>end</inf> than in the control group. The mean airway pressure and
dynamic lung compliance were higher in the PEEP and AR groups than in the
control group at OLV<inf>15</inf>, OLV<inf>30</inf>, and
TLV<inf>end</inf>. No significant differences in hemodynamic variables
were found among the three groups throughout the study period. Conclusion:
Recruitment of both lungs with subsequent PEEP before OLV improved
arterial oxygenation and ventilatory efficiency during video-assisted
thoracic surgery requiring OLV in the supine position. Copyright &#xa9;
Yonsei University College of Medicine 2015.

<233>
Accession Number
606039204
Author
Jolly S.S.; Cairns J.A.; Yusuf S.; Meeks B.; Gao P.; Hart R.G.; Kedev S.;
Stankovic G.; Moreno R.; Horak D.; Kassam S.; Rokoss M.J.; Leung R.C.M.;
El-Omar M.; Romppanen H.O.; Alazzoni A.; Alak A.; Fung A.; Alexopoulos D.;
Schwalm J.D.; Valettas N.; Dzavik V.
Institution
(Jolly, Yusuf, Meeks, Gao, Hart, Rokoss, Alazzoni, Alak, Schwalm,
Valettas) Population Health Research Institute, McMaster University,
Hamilton General Hospital, 237 Barton St. East, Hamilton, ON L8L2X2,
Canada
(Cairns) Department of Medicine, University of British Columbia,
Vancouver, BC, Canada
(Kedev) University Clinic of Cardiology, Sts. Cyril and Methodius
University, Skopje, Macedonia
(Stankovic) Clinical Center of Serbia, Department of Cardiology,
University of Belgrade, Belgrade, Serbia
(Moreno) University Hospital la Paz, Madrid, Spain
(Horak) Krajska Nemocnice Liberec, Liberec, Czech Republic
(Kassam) Rouge Valley Health System, Toronto, ON, Canada
(Leung) CK Hui Heart Centre, Edmonton, AB, Canada
(El-Omar) Central Manchester Foundation Trust, Manchester Academic Health
Science Centre, Manchester, United Kingdom
(Romppanen) Heart Centre, Kuopio University Hospital, Kuopio, Finland
(Fung) Division of Cardiology, Vancouver General Hospital, University of
British Columbia, Vancouver, BC, Canada
(Alexopoulos) Patras University Hospital, Patras, Greece
(Dzavik) Peter Munk Cardiac Centre, University Health Network, Toronto,
ON, Canada
Title
Stroke in the TOTAL trial: A randomized trial of routine thrombectomy vs.
percutaneous coronary intervention alone in ST elevation myocardial
infarction.
Source
European Heart Journal. 36 (35) (pp 2364-2372), 2015. Date of Publication:
14 Sep 2015.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims TOTAL (N = 10 732), a randomized trial of routine manual thrombectomy
vs. percutaneous coronary intervention alone in ST elevation myocardial
infarction, showed no difference in the primary efficacy outcome but a
significant increase in stroke. We sought to understand these findings.
Methods and results A detailed analysis of stroke timing, stroke severity,
and stroke subtype was performed. Strokes were adjudicated by neurologists
blinded to treatment assignment. Stroke within 30 days, the primary safety
outcome, was increased [33 (0.7%) vs. 16 (0.3%), hazard ratio (HR) 2.06;
95% confidence interval (CI) 1.13-3.75]. The difference in stroke was
apparent within 48 h [15 (0.3%) vs. 5 (0.1%), HR 3.00; 95% CI 1.09-8.25].
There was an increase in strokes within 180 days with minor or no
disability (Rankin 0-2) [18 (0.4%) vs. 13 (0.3%) HR 1.38; 95% CI
0.68-2.82] and in strokes with major disability or fatal (Rankin 3-6) [35
(0.7%) vs. 13 (0.3%), HR 2.69; 95% CI 1.42-5.08]. Most of the absolute
difference was due to an increase in ischaemic strokes within 180 days [37
(0.7%) vs. 21 (0.4%), HR 1.71; 95% CI 1.03-3.00], but there was also an
increase in haemorrhagic strokes [10 (0.2%) vs. 2 (0.04%), HR 4.98; 95% CI
1.09-22.7]. Patients that had a stroke had a mortality of 30.8% within 180
days vs. 3.4% without a stroke (P < 0.001). A meta-analysis of randomized
trials (N = 21 173) showed an increase in risk of stroke (odds ratio 1.59;
95% CI 1.11-2.27) but a trend towards reduction in mortality odds ratio
(odds ratio 0.87; 95% CI 0.76-1.00). Conclusion Thrombectomy was
associated with a significant increase in stroke. Based on these findings,
future trials must carefully collect stroke to determine safety in
addition to efficacy. Copyright &#xa9; 2015 The Author.

<234>
Accession Number
605996617
Author
Lee J.M.; Jung J.-H.; Park K.W.; Shin E.-S.; Oh S.K.; Bae J.-W.; Rhew
J.Y.; Lee N.; Kim D.-B.; Kim U.; Han J.-K.; Lee S.E.; Yang H.-M.; Kang
H.-J.; Koo B.-K.; Kim S.; Cho Y.K.; Shin W.-Y.; Lim Y.-H.; Rha S.-W.; Kim
S.-Y.; Lee S.Y.; Kim Y.-D.; Chae I.-H.; Cha K.S.; Kim H.-S.
Institution
(Lee, Jung, Park, Han, Lee, Yang, Kang, Koo, Kim) Seoul National
University Hospital, Division of Cardiology, Department of Internal
Medicine, 101 Daehak-ro, Jongro-gu, Seoul 110-744, South Korea
(Shin) University of Ulsan College of Medicine, Division of Cardiology,
Ulsan University Hospital, Ulsan, South Korea
(Oh) Wonkwang University Hospital, Department of Cardiovascular Medicine,
Regional Cardiocerebrovascular Center, Iksan, South Korea
(Bae) Chungbuk National University, Cheongju, South Korea
(Rhew) Presbyterian Medical Center, Department of Internal Medicine and
Cardiovascular Center, Jeonju, South Korea
(Lee) Hallym University Medical Center, Cardiology Division, Kangnam
Sacred Heart Hospital, Seoul, South Korea
(Kim) The Catholic University of Korea, Cardiovascular Center, St. Paul's
Hospital, Seoul, South Korea
(Kim) Yeungnam University Medical Center, Division of Cardiology, Daegu,
South Korea
(Kim) Seoul National University, Cardiovascular Center, Boramae Medical
Center, Seoul, South Korea
(Cho) Keimyung University College of Medicine, Division of Cardiology,
Department of Internal Medicine, Dongsan Medical Center, Daegu, South
Korea
(Shin) Soon Chun Hyang University Hospital Cheonan, Department of
Cardiology, Cheonan, South Korea
(Lim) Hanyang University Medical Center, Division of Cardiology,
Department of Internal Medicine, College of Medicine, Seoul, South Korea
(Rha) Korea University Guro Hospital, Seoul, South Korea
(Kim) Seoul Medical Center, Department of Cardiology, Seoul, South Korea
(Lee) Inje University Ilsan Paik Hospital, Goyang, South Korea
(Kim) Dong-A University Hospital, Department of Cardiology, Busan, South
Korea
(Chae) Seoul National University Bundang Hospital, Seongnam, South Korea
(Cha) Pusan National University Hospital, Department of Cardiology, Busan,
South Korea
Title
Harmonizing Optimal Strategy for Treatment of coronary artery diseases -
comparison of REDUCtion of prasugrEl dose or POLYmer TECHnology in ACS
patients (HOST-REDUCE-POLYTECH-ACS RCT): Study protocol for a randomized
controlled trial.
Source
Trials. 16 (1) (no pagination), 2015. Article Number: 409. Date of
Publication: September 15, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Antiplatelet treatment is an important component in optimizing
the clinical outcomes after percutaneous coronary intervention (PCI)
especially in patients with acute coronary syndrome (ACS). Prasugrel,
which is a new P2Y12 inhibitor, has been confirmed as efficacious in a
large trial in Western countries, and a similar trial is also to be
launched in Asian countries. Although a 60-mg loading dose of prasugrel
followed by 10 mg per day should be acceptable, there have been no data
regarding the optimal dose in Asian patients. Furthermore, serum levels of
prasugrel and the rates of platelet inhibition are known to be higher in
Asians than Caucasians with the same dose of the drug. Polymer, a key
component of drug-eluting stents (DES), has been suggested as the cause of
inflammation leading to late complications, and has driven many companies
to develop biodegradable-polymer DES. Currently, there are limited data
regarding the head-to-head comparison between BP-BES and the biostable
polymer CoCr-EES or the newest platinum-chromium everolimus-eluting stent
(PtCr-EES). Furthermore, the polymer issue may be more important in ACS
where there is ruptured thrombotic plaque where polymer-induced
inflammation may affect the local milieu of the stented artery. Therefore,
the present study dedicated only to ACS patients, will offer important
information on the optimal prasugrel dose in the Asian population by
comparing a 10-mg versus a 5-mg maintenance dose beyond 1 month after PCI,
as well as giving important insight into the polymer issue by comparing
BP-BES versus biostable-polymer PtCr-EES. Method/Design: Harmonizing
Optimal Strategy for Treatment of coronary artery diseases - comparison of
REDUCtion of prasugrEl dose or POLYmer TECHnology in ACS patients
(HOST-REDUCE-POLYTECH-ACS) trial is a multicenter, randomized and
open-label clinical study with a 2 x 2 factorial design, according to the
type of stent (PtCr-EES versus BP-BES) and prasugrel maintenance dose (5
mg versus 10 mg), to demonstrate non-inferiority of PtCr-EES relative to
BP-BES or the reduced prasugrel dose relative to conventional dose in an
Asian all-comers PCI population presenting with ACS. Approximately 3400
patients will undergo prospective, random assignment separately to either
stent or prasugrel arm (1:1 ratio, respectively). When the patients have
contraindications to prasugrel, they are categorized into an antiplatelet
observation group after stent-randomization. The primary endpoint is the
patient-oriented composite outcome, which is a composite of all-cause
mortality, any myocardial infarction (MI), any repeat revascularization in
the stent arm at 12 months after index PCI. In the prasugrel arm, primary
endpoint is any major adverse cardiovascular event, which is a composite
of all-cause mortality, any MI, any stent thrombosis (Academic Research
Consortium (ARC)-defined), any repeat revascularization, stroke, or
bleeding (BARC class > 2). Discussion: The HOST-REDUCE-POLYTECH-ACS RCT is
the first study exploring the optimal maintenance dose of prasugrel beyond
1 month after PCI for ACS in Asian all-comers. In addition, this is the
largest study dedicated only to ACS patients to evaluate the polymer issue
in the situation of ACS by directly comparing biostable-polymer PtCr-EES
versus BP-BES. Copyright &#xa9; 2015 Lee et al.

<235>
Accession Number
606316274
Author
Crespo-Leiro M.G.; Stypmann J.; Schulz U.; Zuckermann A.; Mohacsi P.; Bara
C.; Ross H.; Parameshwar J.; Zakliczynski M.; Fiocchi R.; Hoefer D.; Deng
M.; Leprince P.; Hiller D.; Eubank L.; Deljkich E.; Yee J.P.; Vanhaecke J.
Institution
(Crespo-Leiro) Instituto de Investigacion Biomedica de A Coruna (INIBIC),
Complexo Hospitalario Universitario de A Coruna (CHUAC), SERGAS,
Universidade da Coruna (UDC), Coruna, Spain
(Stypmann) University Hospital Muenster, Muenster, Germany
(Schulz) Ruhr University of Bochum, Bad Oeynhausen, Germany
(Zuckermann) Medical University of Vienna, Vienna, Austria
(Mohacsi) University Hospital Bern, Bern, Switzerland
(Bara) Hannover Medical School, Hannover, Germany
(Ross) Toronto General Hospital, Toronto, Canada
(Parameshwar) Papworth Hospital, Papworth Everard, Cambridge, United
Kingdom
(Zakliczynski) Silesian Center for Heart Disease, Zabrze, Poland
(Fiocchi) Ospedali Riuniti di Bergamo, Bergamo, Italy
(Hoefer) Innsbruck Medical University, Innsbruck, Austria
(Deng) David Geffen School of Medicine, University of California, Los
Angeles, United States
(Leprince) Groupe Hospitalier Pitie-Salpetriere, Paris, France
(Hiller, Eubank, Deljkich, Yee) CareDx, Brisbane, United States
(Vanhaecke) University Hospital of Leuven, Leuven, Belgium
(Vanhaecke) Department of Cardiology, Herestraat 49, Leuven 3000, Belgium
Title
Performance of gene-expression profiling test score variability to predict
future clinical events in heart transplant recipients.
Source
BMC Cardiovascular Disorders. 15 (1) (no pagination), 2015. Article
Number: 120. Date of Publication: October 09, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: A single non-invasive gene expression profiling (GEP) test
(AlloMap) is often used to discriminate if a heart transplant recipient is
at a low risk of acute cellular rejection at time of testing. In a
randomized trial, use of the test (a GEP score from 0-40) has been shown
to be non-inferior to a routine endomyocardial biopsy for surveillance
after heart transplantation in selected low-risk patients with respect to
clinical outcomes. Recently, it was suggested that the within-patient
variability of consecutive GEP scores may be used to independently predict
future clinical events; however, future studies were recommended. Here we
performed an analysis of an independent patient population to determine
the prognostic utility of within-patient variability of GEP scores in
predicting future clinical events. Methods: We defined the GEP score
variability as the standard deviation of four GEP scores collected >315
days post-transplantation. Of the 737 patients from the Cardiac Allograft
Rejection Gene Expression Observational (CARGO) II trial, 36 were assigned
to the composite event group (death, re-transplantation or graft failure
>315 days post-transplantation and within 3 years of the final GEP test)
and 55 were assigned to the control group (non-event patients). In this
case-controlled study, the performance of GEP score variability to predict
future events was evaluated by the area under the receiver operator
characteristics curve (AUC ROC). The negative predictive values (NPV) and
positive predictive values (PPV) including 95 % confidence intervals (CI)
of GEP score variability were calculated. Results: The estimated
prevalence of events was 17 %. Events occurred at a median of 391
(inter-quartile range 376) days after the final GEP test. The GEP
variability AUC ROC for the prediction of a composite event was 0.72 (95 %
CI 0.6-0.8). The NPV for GEP score variability of 0.6 was 97 % (95 % CI
91.4-100.0); the PPV for GEP score variability of 1.5 was 35.4 % (95 % CI
13.5-75.8). Conclusion: In heart transplant recipients, a GEP score
variability may be used to predict the probability that a composite event
will occur within 3 years after the last GEP score. Trial registration:
Clinicaltrials.gov identifier NCT00761787 Copyright &#xa9; 2015
Crespo-Leiro et al.

<236>
Accession Number
605787559
Author
Verma S.; Eikelboom J.W.; Nidorf S.M.; Al-Omran M.; Gupta N.; Teoh H.;
Friedrich J.O.
Institution
(Verma, Teoh) Division of Cardiac Surgery, Keenan Research Centre for
Biomedical Science, Li Ka Shing Knowledge Institute of St. Michael's
Hospital, Toronto, ON, Canada
(Al-Omran) Division of Vascular Surgery, Keenan Research Centre for
Biomedical Science, Li Ka Shing Knowledge Institute of St. Michael's
Hospital, Toronto, ON, Canada
(Teoh) Division of Endocrinology and Metabolism, Keenan Research Centre
for Biomedical Science, Li Ka Shing Knowledge Institute of St. Michael's
Hospital, Toronto, ON, Canada
(Verma, Al-Omran, Teoh) Department of Surgery, Keenan Research Centre for
Biomedical Science, Li Ka Shing Knowledge Institute of St. Michael's
Hospital, Toronto, ON, Canada
(Teoh, Friedrich) Department of Medicine, Keenan Research Centre for
Biomedical Science, Li Ka Shing Knowledge Institute of St. Michael's
Hospital, Toronto, ON, Canada
(Friedrich) Department of Critical Care, Keenan Research Centre for
Biomedical Science, Li Ka Shing Knowledge Institute of St. Michael's
Hospital, Toronto, ON, Canada
(Verma, Al-Omran) Department of Surgery, University of Toronto, Toronto,
ON, Canada
(Friedrich) Department of Medicine and Interdepartmental Division of
Critical Care, University of Toronto, Toronto, ON, Canada
(Eikelboom, Gupta) Department of Medicine, McMaster University, Hamilton,
ON, Canada
(Nidorf) Heart Research Institute, Perth, WA, Australia
Title
Colchicine in cardiac disease: A systematic review and meta-analysis of
randomized controlled trials.
Source
BMC Cardiovascular Disorders. 15 (1) (no pagination), 2015. Article
Number: 96. Date of Publication: August 29, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Colchicine has unique anti-inflammatory properties that may be
beneficial in various cardiovascular conditions. This systematic review
and meta-analysis of randomized controlled trials (RCTs) examines this
issue. Methods: We searched MEDLINE, EMBASE, and the Cochrane Database
from inception to June 2014 for RCTs using colchicine in adult patients
with cardiac diseases. Results were pooled using random effects. Results:
15 RCTs (n = 3431 patients, median treatment 3 and follow-up 15 months)
were included. All but 2 used colchicine 1 mg/day. In 5 trials, n = 1301)
at risk for cardiovascular disease (coronary artery disease, acute
coronary syndrome or stroke, post-angioplasty [2 RCTs], or congestive
heart failure), colchicine reduced composite cardiovascular outcomes by
~60 % (risk ratio [RR] 0.44, 95 % confidence interval [CI] 0.28-0.69,
p=0.0004; I²=0 %) and showed a trend towards lower all-cause
mortality (RR 0.50, 95 % CI 0.23-1.08, p=0.08; I²=0 %). In
pericarditis or post-cardiotomy, colchicine decreased recurrent
pericarditis or post-pericardiotomy syndrome (RR 0.50, 95 % CI 0.41-0.60,
p<0.0001; I²=0 %; 8 RCTs, n=1635), and post-pericardiotomy or
ablation induced atrial fibrillation (RR 0.65, 95 % CI 0.51-0.82,
p=0.0003; I²=31 %; 4 RCTs, n=1118). The most common adverse
event was diarrhea. Treatment discontinuation overall and due to adverse
events (RR 4.34, 95 % CI 1.70-11.07, p=0.002; I²=29 %; 7 RCTs,
83/790 [10.5 %] vs. 11/697 [1.6 %]) was higher in colchicine-assigned
patients. Conclusions: Current RCT data suggests that colchicine may
reduce the composite rate of cardiovascular adverse outcomes in a range of
patients with established cardiovascular disease. Furthermore, colchicine
reduces rates of recurrent pericarditis, post-pericardiotomy syndrome, and
peri-procedural atrial fibrillation following cardiac surgery. Further
RCTs evaluating the potential of colchicine for secondary prevention of
cardiovascular events would be of interest. Copyright &#xa9; 2015 Verma et
al.

<237>
Accession Number
605404260
Author
Takesue T.; Takeuchi H.; Ogura M.; Fukuda K.; Nakamura R.; Takahashi T.;
Wada N.; Kawakubo H.; Kitagawa Y.
Institution
(Takesue, Takeuchi, Ogura, Fukuda, Nakamura, Takahashi, Wada, Kawakubo,
Kitagawa) Department of Surgery, Keio University School of Medicine,
Tokyo, Japan
Title
A Prospective Randomized Trial of Enteral Nutrition After Thoracoscopic
Esophagectomy for Esophageal Cancer.
Source
Annals of Surgical Oncology. 22 (pp 802-809), 2015. Date of Publication:
01 Dec 2015.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Several studies have reported that postoperative enteral
nutrition (EN) reduced complications and decreased weight loss and
hospital stay periods; however, the majority of patients analyzed in these
studies underwent open thoracic surgery. No studies have been conducted
regarding EN in patients after thoracoscopic esophagectomy as a less
invasive surgery. The aim of this study was to investigate the efficacy of
EN after thoracoscopic esophagectomy. Methods: Fifty patients who
underwent thoracoscopic esophagectomy for esophageal cancer were divided
into two groups: parenteral nutrition (PN; n = 25) and EN (n = 25). The
rate of weight loss at postoperative day (POD) 14, levels of prealbumin at
POD 10, postoperative complications until POD 14, and other perioperative
data were collected for each group. Results: This study analyzed data for
47 patients. The rate of weight loss at POD 14 was significantly lower in
the EN group (3.0 +/- 3.2 %) than in the PN group (4.0 +/- 3.6 %; p =
0.020). Prealbumin levels were 21.0 +/- 7.5 mg/dL in the PN group and 18.4
+/- 5.8 mg/dL in the EN group at POD 10, with no significant differences
between the groups. However, the incidence of postoperative pneumonia was
higher in the PN group (30.4 %) than in the EN group (12.5 %).
Conclusions: EN could suppress weight loss and reduce the incidence of
pneumonia after thoracoscopic esophagectomy. Copyright &#xa9; 2015,
Society of Surgical Oncology.

<238>
Accession Number
605939123
Author
Bonvini J.M.; Beck-Schimmer B.; Kuhn S.J.; Graber S.M.; Neff T.A.;
Schlapfer M.
Institution
(Bonvini, Beck-Schimmer, Kuhn, Schlapfer) Institute of Anesthesiology,
University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland
(Beck-Schimmer, Schlapfer) Zurich Center for Integrative Human Physiology,
Institute of Physiology, University of Zurich, Winterthurerstrasse 190,
Zurich 8057, Switzerland
(Beck-Schimmer) Department of Anesthesiology, University of Illinois
College of Medicine at Chicago, 1740 West Taylor Street, Chicago, IL
60612, United States
(Graber) Antropological Institute and Museum, University of Zurich,
Winterthurerstrasse 190, Zurich 8057, Switzerland
(Neff) Department of Anesthesia and Intensive Care Medicine, Cantonal
Hospital of Muensterlingen, Campus 1, Muensterlingen 8596, Switzerland
Title
Late post-conditioning with sevoflurane after cardiac surgery - Are
surrogate markers associated with clinical outcome?.
Source
PLoS ONE. 10 (7) (no pagination), 2015. Article Number: e0132165. Date of
Publication: 21 Jul 2015.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Introduction In a recent randomized controlled trial our group has
demonstrated in 102 patients that late post-conditioning with sevoflurane
performed in the intensive care unit after surgery involving
extracorporeal circulation reduced damage to cardiomyocytes exposed to
ischemia reperfusion injury. On the first post-operative day the
sevoflurane patients presented with lower troponin T values when compared
with those undergoing propofol sedation. In order to assess possible
clinical relevant long-term implications in patients enrolled in this
study, we performed the current retrospective analysis focusing on cardiac
and non-cardiac events during the first 6 months after surgery. Methods
All patients who had successfully completed the late post-conditioning
trial were included into this follow-up. Our primary and secondary
endpoints were the proportion of patients experiencing cardiac and
non-cardiac events, respectively. Additionally, we were interested in
assessing therapeutic interventions such as initiation or change of drug
therapy, interventional treatment or surgery. Results Of 102 patients
analyzed in the primary study 94 could be included in this follow-up. In
the sevoflurane group (with 41 patients) 16 (39%) experienced one or
several cardiac events within 6 months after cardiac surgery, in the
propofol group (with 53 patients) 19 (36%, p=0.75). Four patients (9%)
with sevoflurane vs. 7 (13%) with propofol sedation had non-cardiac events
(p=0.61). While a similar percentage of patients suffered from cardiac
and/or non-cardiac events, only 12 patients in the sevoflurane group
compared to 20 propofol patients needed a therapeutic intervention (OR:
0.24, 95% CI: 0.04-1.43, p=0.12). A similar result was found for hospital
admissions: 2 patients in the sevoflurane group had to be re-admitted to
the hospital compared to 8 in the propofol group (OR 0.23, 95% CI: 0.04-
1.29, p=0.10). Conclusions Sevoflurane does not seem to provide protection
with regard to the occurrence of cardiac and non-cardiac events in the
6-month period following cardiac surgery with the use of extracorporeal
circulation. However, there was a clear trend towards fewer interventions
(less need for treatment, fewer hospital admissions) associated with
sevoflurane post-conditioning in patients experiencing any event. Such
results might encourage launching large multicenter post-conditioning
trials with clinical outcome defined as primary endpoint. Copyright &#xa9;
2015 Bonvini et al.

<239>
Accession Number
612923171
Author
Calcagno S.; Lucisano L.; Mancone M.; Cavallo E.; Pennacchi M.; Stio R.E.;
Sardella G.
Institution
(Calcagno, Lucisano, Mancone, Cavallo, Pennacchi, Stio, Sardella)
Department of Cardiovascular Respiratory, Nephrologic, Anesthesiologic and
Geriatric Sciences, Umberto i Hospital, Sapienza University of Rome,
Policlinico Umberto i, Viale del Policlinico 155, Rome 00186, Italy
Title
Bleeding versus thrombosis: Role of short DAPT in complex lesions.
Source
Minerva Cardioangiologica. 63 (6) (pp 533-546), 2015. Date of Publication:
December 2015.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Therapy with dual antiplatelet agents, defined as the combination of a
platelet P2Y12 inhibitor and aspirin, is required to prevent thrombotic
complications, after percutaneous coronary intervention (PCI) with stent
implantation. Usually current guidelines recommend administration of dual
antiplatelet therapy (DAPT) following percutaneous revascularization with
drug-eluting stent (DES) for a period of at least 12 months or for 6 to 12
months in patients not at high risk. Nevertheless, the treatment of
stable/unstable coronary artery disease with DES implantation increasing
largely, the optimal duration of DAPT is still unclear. The duration of
DAPT after coronary stenting has been evaluated in recent randomized
studies with conflicting results. The administration of long period of
DAPT is a strategy to reduce thrombosis events but largely increase the
hemorrhagic ones. Otherwise, shorter DAPT period is protective about
bleeds with consequently increased ischemic events. In addition, as new
DES carry a lower risk of stent thrombosis (ST) compared with the
first-generation DES and possibly even bare-metal stents, a shift toward
better protection from ST may have an effect on the duration and the
intensity of DAPT. Whether the duration of DAPT should be shorter or
longer than the currently recommended 6 to 12 months is analyzed in this
review, drawing on results from the most recent studies and meta-analysis.

<240>
Accession Number
606267513
Author
Lantos J.D.; Wendler D.; Septimus E.; Wahba S.; Madigan R.; Bliss G.
Institution
(Lantos) Childrens Mercy Bioethics Center, Department of Pediatrics,
Childrens Mercy Hospital, University of Missouri - Kansas City, 2401
Gilham Road, Kansas City, MO 64108, United States
(Wendler) National Institutes of Health Clinical Center, Bethesda, MD,
United States
(Septimus) Department of Internal Medicine, Texas A and M Health Science
Center, Houston, TX, United States
(Septimus) Clinical Services Group, Hospital Corporation of America,
Nashville, TN, United States
(Wahba) Patient-Centered Outcomes Research Institute, Washington, DC,
United States
(Madigan) Perelman School of Medicine, University of Pennsylvania Health
System, Philadelphia, PA, United States
(Bliss) Research Support Committee, Phelan-McDermid Syndrome Foundation,
Venice, FL, United States
Title
Considerations in the evaluation and determination of minimal risk in
pragmatic clinical trials.
Source
Clinical Trials. 12 (5) (pp 485-493), 2015. Date of Publication: 01 Oct
2015.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Institutional review boards, which are charged with overseeing research,
must classify the riskiness of proposed research according to a federal
regulation known as the Common Rule (45 CFR 46, Subpart A) and by
regulations governing the US Food and Drug Administration codified in 21
CFR 50. If an institutional review board determines that a clinical trial
constitutes "minimal risk," there are important practical implications:
the institutional review board may then allow a waiver or alteration of
the informed consent process; the study may be carried out in certain
vulnerable populations; or the study may be reviewed by institutional
review boards using an expedited process. However, it is unclear how
institutional review boards should assess the risk levels of pragmatic
clinical trials. Such trials typically compare existing, widely used
medical therapies or interventions in the setting of routine clinical
practice. Some of the therapies may be considered risky of themselves but
the study comparing them may or may not add to that pre-existing level of
risk. In this article, we examine the common interpretations of research
regulations regarding minimal-risk classifications and suggest that they
are marked by a high degree of variability and confusion, which in turn
may ultimately harm patients by delaying or hindering potentially
beneficial research. We advocate for a clear differentiation between the
risks associated with a given therapy and the incremental risk incurred
during research evaluating those therapies as a basic principle for
evaluating the risk of a pragmatic clinical trial. We then examine two
pragmatic clinical trials and consider how various factors including
clinical equipoise, practice variation, research methods such as cluster
randomization, and patients perspectives may contribute to current and
evolving concepts of minimal-risk determinations, and how this
understanding in turn affects the design and conduct of pragmatic clinical
trials. Copyright &#xa9; 2015 The Society for Clinical Trials.

<241>
Accession Number
606266001
Author
Mennuni M.G.; Dangas G.D.; Mehran R.; Ben-Gal Y.; Xu K.; Genereux P.;
Brener S.J.; Feit F.; Lincoff A.M.; Ohman E.M.; Hamon M.; Stone G.W.
Institution
(Mennuni, Dangas, Mehran) Icahn School of Medicine at Mount Sinai, One
Gustave L. Levy Place, New York, NY 10029, United States
(Dangas, Mehran, Xu, Genereux, Brener, Stone) Cardiovascular Research
Foundation, New York, NY, United States
(Ben-Gal) Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv,
Israel
(Genereux, Stone) Columbia University Medical Center, New York, NY, United
States
(Genereux) Hopital du Sacre-Coeur de Montreal, Montreal, QC, Canada
(Brener) New York Methodist Hospital, Brooklyn, NY, United States
(Feit) NYU Langone Medical Center, New York, NY, United States
(Lincoff) Cleveland Clinic, Lerner College of Medicine, Case Western
Reserve University, Cleveland, OH, United States
(Ohman) Duke Heart Center, Durham, NC, United States
(Hamon) University Hospital of Caen Normandy, France
Title
Coronary Artery Bypass Surgery Compared with Percutaneous Coronary
Intervention for Proximal Left Anterior Descending Artery Treatment in
Patients with Acute Coronary Syndrome: Analysis from the ACUITY Trial.
Source
Journal of Invasive Cardiology. 27 (10) (pp 468-473), 2015. Date of
Publication: 01 Oct 2015.
Publisher
HMP Communications
Abstract
BACKGROUND: The optimal revascularization strategy in patients with acute
coronary syndrome (ACS) and proximal left anterior descending (pLAD)
coronary artery lesions is not well defined. The aim of this study was to
compare the outcomes of ACS patients with pLAD culprit lesions receiving
percutaneous coronary intervention (PCI) vs coronary artery bypass graft
(CABG). METHODS: The ACUITY trial was a multicenter, prospective trial of
patients with ACS treated with an early invasive strategy. Major adverse
cardiac event (MACE; defined as death, myocardial infarction [MI], and
repeat revascularization) and stroke were compared at 30 days and 1 year
between PCI and CABG in patients with significant stenosis of the pLAD
undergoing revascularization. Postprocedural major bleeding was evaluated
at 30 days. RESULTS: Among patients with a significant pLAD stenosis (n <
842), a total of 562 (66.7%) underwent PCI and 280 (33.3%) underwent CABG.
Baseline characteristics, including age, sex, diabetes, and TIMI risk
score, were well matched between groups; however, patients undergoing PCI
were more likely to have had previous CABG (21.9% vs 6.4%; P<.001). Death,
MI, MACE, and stroke rates did not differ between groups at 1 year. PCI
patients had lower bleeding rates (8.1% vs 52.4%; P<.001) and blood
product transfusion at 30 days (4.5% vs 41.3%; P<.001), but higher rates
of unplanned revascularization at 1 year (12.7% vs 5.2%; P<.01). These
results were consistent in patients with single vs multivessel disease and
in diabetics vs non-diabetics. CONCLUSIONS: Among ACS patients with pLAD
culprit lesions, an initial revascularization strategy of PCI compared
with CABG yields similar 1-year death, MI, and MACE rates, although
unplanned revascularization is more common after PCI.

<242>
Accession Number
605463166
Author
Banning A.S.; Gershlick A.H.
Institution
(Banning, Gershlick) Department of Cardiovascular Sciences, University of
Leicester Glenfield Hospital, Groby Road, Leicester LE3 9QP, United
Kingdom
(Gershlick) Department of Cardiology, University Hospitals of Leicester
NHS Trust Glenfield Hospital, Groby Road, Leicester LE3 9QP, United
Kingdom
Title
Management of Multivessel Coronary Disease in ST-segment Elevation
Myocardial Infarction.
Source
Current Cardiology Reports. 17 (9) (no pagination), 2015. Article Number:
75. Date of Publication: 06 Sep 2015.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Primary PCI of infarct-related arteries is the preferred reperfusion
strategy in patients presenting with ST-segment elevation myocardial
infarction (STEMI). Up to 40 % of such patients demonstrate evidence of
multivessel, non-infarct-related artery coronary disease. Previous
non-randomised observational studies and their associated meta-analyses
have suggested that in such cases only the culprit infarct-related artery
(IRA) lesion should be treated. However, recent randomised controlled
trials have demonstrated improved clinical outcomes with lower major
adverse cardiovascular events (MACE) rates when complete revascularisation
is undertaken either at index primary percutaneous coronary intervention
(PPCI) or during index admission. These trials suggest that current
guidelines pertaining to treatment of non-infarct-related artery (N-IRA)
lesions in STEMI patients with multivessel disease may need to be
reconsidered depending on future trials. However, issues remain around
timing of N-IRA intervention, the use of fractional flow reserve (FFR) or
intravascular imaging to guide intervention in N-IRA lesions and the need
to demonstrate reductions in hard clinical endpoints (death and MI) after
complete revascularisation; these issues will need to be addressed through
future trials. Clinicians must judge on the currently available data,
whether it is still safer to leave important stenosis in N-IRA untreated.
Copyright &#xa9; 2015, The Author(s).

<243>
Accession Number
605325873
Author
Murphy E.; Vellinga A.; Byrne M.; Cupples M.E.; Murphy A.W.; Buckley B.;
Smith S.M.
Institution
(Murphy, Vellinga, Byrne, Murphy) Discipline of General Practice, National
University of Ireland Galway 1, School of Psychology, Distillery Road,
Galway, Ireland
(Cupples) Department of General Practice and UKCRC Centre for Excellence
for Public Health Research (NI), Queen's University, Belfast, United
Kingdom
(Buckley) Department of Surgery, University of the Philippines Manila,
Manila Philippines, Philippines
(Buckley) Discipline of General Practice, National University of Ireland,
Galway, Ireland
(Smith) Department of General Practice, Royal College of Surgeons in
Ireland, I-Dublin, Ireland
Title
Primary care organisational interventions for secondary prevention of
ischaemic heart disease: A systematic review and meta-Analysis.
Source
British Journal of General Practice. 65 (636) (pp e460-e468), 2015. Date
of Publication: 01 Jul 2015.
Publisher
Royal College of General Practitioners (E-mail: info@rcgp.co.uk)
Abstract
Background Ischaemic heart disease (IHD) is the most common cause of death
worldwide. Aim To determine the long-term impact of organisational
interventions for secondary prevention of IHD. Design and setting
Systematic review and meta-Analysis of studies from CENTRAL, MEDLINE,
Embase, and CINAHL published January 2007 to January 2013. Method Searches
were conducted for randomised controlled trials of patients with
established IHD, with long-term follow-up, of cardiac secondary prevention
programmes targeting organisational change in primary care or community
settings. A random-effects model was used and risk ratios were calculated.
Results Five studies were included with 4005 participants. Meta-Analysis
of four studies with mortality data at 4.7-6 years showed that
organisational interventions were associated with approximately 20%
reduced mortality, with a risk ratio (RR) for all-cause mortality of 0.79
(95% confidence interval [CI] = 0.66 to 0.93), and a RR for
cardiac-related mortality of 0.74 (95% CI = 0.58 to 0.94). Two studies
reported mortality data at 10 years. Analysis of these data showed no
significant differences between groups. There were insufficient data to
conduct a meta-Analysis on the effect of interventions on hospital
admissions. Additional analyses showed no significant association between
organisational interventions and risk factor management or appropriate
prescribing at 4.7-6 years. Conclusion Cardiac secondary prevention
programmes targeting organisational change are associated with a reduced
risk of death for at least 4-6 years. There is insufficient evidence to
conclude whether this beneficial effect is maintained indefinitely.

<244>
Accession Number
606714565
Author
Hendriks A.A.; Khan M.; Geller L.; Kardos A.; de Vries L.J.; Yap S.-C.;
Wijchers S.A.; Theuns D.A.M.J.; Szili-Torok T.
Institution
(Hendriks, de Vries, Yap, Wijchers, Theuns, Szili-Torok) Erasmus Medical
Center, Department of Clinical Electrophysiology, Postbus 2040, Rotterdam
3015 CE, Netherlands
(Hendriks, Khan) Onze Lieve Vrouwe Gasthuis, Department of Clinical
Electrophysiology, Amsterdam, Netherlands
(Geller) Cardiovascular Center Semmelweis University, Department of
Clinical Electrophysiology, Budapest, Hungary
(Kardos) Hungarian National Institute of Cardiology, Department of
Clinical Electrophysiology, Budapest, Hungary
Title
Ventricular tachycardia in ischemic cardiomyopathy; a combined
endo-epicardial ablation as the first procedure versus a stepwise approach
(EPILOGUE) - study protocol for a randomized controlled trial.
Source
Trials. 16 (1) (no pagination), 2015. Article Number: 487. Date of
Publication: October 29, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The role of epicardial substrate ablation of ventricular
tachycardia (VT) as a first-line approach in patients with ischemic heart
disease is not clearly defined. Epicardial ablation as a first-line option
is standard for patients with nonischemic dilated cardiomyopathy and
arrhythmogenic right ventricular cardiomyopathy. Several nonrandomized
studies, including studies on patients with ischemic heart disease, have
shown that epicardial VT ablation improves outcome but this approach was
often used after a failed endocardial approach. The aim of this study is
to determine whether a combined endo-epicardial scar homogenization as a
first-line approach will improve the outcome of VT ablation.
Methods/Design: The EPILOGUE study is a multicenter, two-armed,
nonblinded, randomized controlled trial. Patients with ischemic heart
disease who are referred for VT ablation will be randomly assigned to
combined endo-epicardial scar homogenization or endocardial scar
homogenization only (control group). The primary outcome is recurrence of
sustained VT during a 2-year follow-up. Secondary outcomes include
procedural success and safety. Discussion: This study is the first
randomized trial that evaluates the role of a combined endo-epicardial
scar homogenization versus endocardial scar homogenization for the
treatment of ischemic scar-related VT. Trial registration:NL4816807814v02
Copyright &#xa9; 2015 Hendriks et al.

<245>
Accession Number
605953909
Author
Demir T.; Ergenoglu M.U.; Demir H.B.; Tanrikulu N.; Sahin M.; Gok E.;
Korkut K.; Demirsoy E.
Institution
(Demir, Ergenoglu, Korkut, Demirsoy) Department of Cardiovascular Surgery,
Kolan International Hospital, Turkey
(Demir) Department of Cardiovascular Surgery, Medicana International
Hospital, Turkey
(Tanrikulu) Department of Anesthesiology, Kolan International Hospital,
Turkey
(Sahin, Gok) Department of Cardiovascular Surgery, Istanbul Medical
Faculty, Istanbul University, Istanbul, Turkey
Title
Pretreatment with methylprednisolone improves myocardial protection during
on-pump coronary artery bypass surgery.
Source
Heart Surgery Forum. 18 (4) (pp E171-E177), 2015. Date of Publication: 01
Aug 2015.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States. E-mail: ijh@cjp.com)
Abstract
Background: This study was undertaken to determine whether
methylprednisolone could improve myocardial protection by altering the
cytokine profile toward an anti-inflammatory course in patients undergoing
elective coronary artery bypass grafting (CABG) surgery with
cardiopulmonary bypass (CPB). Methods: Forty patients who were scheduled
for elective CABG surgery were randomized into two groups: the study group
(n = 20), who received 1 g of methylprednisolone intravenously before CPB,
and the control group (n = 20), who underwent a standard CABG surgery
without any additional medication. Blood samples were withdrawn prior to
surgery (T1) and then 4 hours (T2), 24 hours (T3), and 36 hours (T4) after
CPB. Plasma levels of interleukin (IL)-6, IL-10, creatine kinase isoenzyme
MB (CK-MB), cardiac troponin-t (cTnT), and blood glucose as well as
neutrophil counts were measured at each sampling time. Results: A
comparison of patients between both groups revealed significantly high
levels of IL-6 in the control group at T2, T3, and T4 with respect to T1
(T2: P < .001; T3: P < .001; T4: P < .001). IL-10 levels were
significantly higher in the study group at T2 compared with the control
group (P = .007). CK-MB levels were significantly lower in the study group
than in the control group at T4 (P = .001). The increase of cTnT was
higher in the control group at T3 and T4 compared with the study group
(T3: P = .002; T4: P = .001). Conclusions: This study demonstrates that
methylprednisolone is effective for ensuring better myocardial protection
during cardiac surgery by suppressing the inflammatory response via
decreasing the levels of IL-6 and by increasing anti-inflammatory activity
through IL-10. Copyright &#xa9; 2015 Forum Multimedia Publishing, LLC.

<246>
Accession Number
605953907
Author
Zhao A.; Minhui H.; Li X.; Zhiyun X.
Institution
(Zhao, Li, Zhiyun) Department of Cardiothoracic Surgery, Changhai
Hospital, Second Military Medical University, Changhai Road No. 168,
Shanghai 200433, China
(Minhui) Department of Colorectal Surgery, The, Sixth Affiliated Hospital,
Sun Yat-sen University, Guangzhou, China
Title
A meta-analysis of transfemoral versus transapical transcatheter aortic
valve implantation on 30-day and 1-year outcomes.
Source
Heart Surgery Forum. 18 (4) (pp E161-E166), 2015. Date of Publication: 01
Aug 2015.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States. E-mail: ijh@cjp.com)
Abstract
Background: Transfemoral (TF) and transapical (TA) are two commonly used
accesses in transcatheter aortic valve implantation (TAVI). Currently, the
influence of TAVI access choice on 30-day and 1-year outcomes is unclear.
The purpose of this study was to compare the 30-day and 1-year outcomes
between TF-TAVI and TA-TAVI. Methods: Studies published from 2002 to
September 2014 were collected by searching PubMed and Web of Knowledge.
Studies were selected by two independent investigators. 30-day and 1-year
outcomes were endpoints. Odds ratios (ORs) and hazard ratio (HR) with 95%
confidence interval (CI) were computed. Fixed effect model was used if
I² < 50%; if I² > 50%, random effect model was used.
Results: 14 studies met inclusion criteria and were included in our
analysis (3837 patients in TF group, 1881 patients in TA group). Two were
retrospective trials and the others were prospective trials. Our
meta-analysis showed that compared with TA group, TF group had a lower
30-day mortality (7.5% versus 11.6%) and higher 1-year survival [HR 0.75,
95% CI (0.66, 0.86)], but the Logistic EuroSCORE was higher in TA group (P
= 0.00). TF group had a significantly higher stroke rate of 4.0% compared
with 2.2% in TA group at <30 days. The incidence of major vascular
complications was significantly higher in TF group compared with TA group
(8.2% versus 5.3%). MI was more common in TA group (2.4%) compared with TF
group (1.2%), but there were no significant difference [0.46, 95% CI
(0.20, 1.06)]. Conclusions: TF-TAVI had a higher 30-day and 1-year
survival rate compared with TA-TAVI, but these differences might be
because of the higher Logistic EuroSCORE in TA group. Stroke and major
vascular complications rates were higher in TF-TAVI patients at <30 days.
Copyright &#xa9; 2015 Forum Multimedia Publishing, LLC.

<247>
Accession Number
605953906
Author
Ariturk C.; Ozgen Z.S.; Kilercik M.; Ulugol H.; Okten E.M.; Aksu U.;
Karabulut H.; Toraman F.
Institution
(Ariturk, Okten, Karabulut) Departmentof Cardiovascular Surgery, Istanbul,
Turkey
(Ozgen, Kilercik, Ulugol, Toraman) Department of Anesthesiology and
Reanimation, Acibadem University, School of Medicine, Istanbul, Turkey
(Aksu) Istanbul University, School of Biology, Istanbul, Turkey
(Ariturk) Haci Mehmet Efendi Sok, Ali Bey Apt. No:17 D:14 Kadikoy,
Istanbul, Turkey
Title
Comparative effects of hemodilutional anemia and transfusion during
cardiopulmonary bypass on acute kidney injury: A prospective randomized
study.
Source
Heart Surgery Forum. 18 (4) (pp E154-E160), 2015. Date of Publication: 01
Aug 2015.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States. E-mail: ijh@cjp.com)
Abstract
Aim: Acute kidney injury after cardiopulmonary bypass has been associated
with dilutional anemia during surgery. We aimed both to explore if this
relation is modulated by blood transfusion and to understand the
postoperative contribution of protein oxidation. Methods: In this
randomized prospective study, after ethics committee approval and informed
consent, 30 patients undergoing first-time elective coronary artery bypass
grafting (CABG) with hematocrit between 21% and 25% at any time during
extracorporeal circulation (ECC) were randomly and equally allocated into
two groups. Group I consisted of patients who received red blood cells
(RBC) during ECC, while in Group II, patients did not receive any RBCs.
Besides routine hemodynamic and biochemical parameters, markers of renal
injury such as neutrophil gelatinase-associated lipocalin (NGAL),
creatinine clearance, and protein oxidation parameters (advanced oxidative
protein products [AOPP], total thiol [T-SH]) were determined in both
groups. Results: (1) Both cardiovascular parameters (MAP, HR) and the
hospitalization period of the transfused group were not significantly
different compared to the non-transfused group (P > .05); (2) While urine
NGAL level (P < .05) increased and GFR (P < .01) decreased in the
transfused group compared to the preoperative period, there were no
significant changes in respective parameters of the non-transfused group
compared to preoperative period; (3) AOPP concentrations did not change
compared to postoperative periods in both groups (P > .05). However, T-SH
concentration showed a transient increased at postoperative hour 6 (P <
.001 vs preoperative period) but normalized at postoperative hour 24 (P >
.05 versus preoperative period). Conclusion: These findings suggest that a
hematocrit value over 21% during ECC is safe for renal functions. RBC
transfusion just to increase hematocrit may be deleterious. Copyright
&#xa9; 2015 Forum Multimedia Publishing, LLC.

<248>
Accession Number
609632341
Author
Umpierrez G.; Cardona S.; Pasquel F.; Jacobs S.; Peng L.; Unigwe M.;
Newton C.A.; Smiley-Byrd D.; Vellanki P.; Halkos M.; Puskas J.D.; Guyton
R.A.; Thourani V.H.
Institution
(Umpierrez, Cardona, Pasquel, Jacobs, Unigwe, Newton, Smiley-Byrd,
Vellanki) Department of Medicine, Emory University, Atlanta, GA, United
States
(Peng) Rollins School of Public Health, Emory University, Atlanta, GA,
United States
(Halkos, Puskas, Guyton, Thourani) Joseph B. Whitehead Department of
Surgery, Emory University, Atlanta, GA, United States
Title
Randomized controlled trial of intensive versus conservative glucose
control in patients undergoing coronary artery bypass graft surgery:
GLUCOCABG trial.
Source
Diabetes Care. 38 (9) (pp 1665-1672), 2015. Date of Publication: September
2015.
Publisher
American Diabetes Association Inc. (E-mail: membership@diabetes.org)
Abstract
OBJECTIVE The optimal level of glycemic control needed to improve outcomes
in cardiac surgery patients remains controversial. RESEARCH DESIGN AND
METHODS We randomized patients with diabetes (n = 152) and without
diabetes (n = 150) with hyperglycemia to an intensive glucose target of
100-140 mg/dL (n = 151) or to a conservative target of 141-180 mg/dL (n =
151) after coronary artery bypass surgery (CABG) surgery. After the
intensive care unit (ICU), patients received a single treatment regimen in
the hospital and 90 days postdischarge. Primary outcome was differences in
a composite of complications, including mortality, wound infection,
pneumonia, bacteremia, respiratory failure, acute kidney injury, and major
cardiovascular events. RESULTS Mean glucose in the ICU was 132 +/- 14
mg/dL (interquartile range [IQR] 124-139) in the intensive and 154 +/- 17
mg/dL (IQR 142-164) in the conservative group (P < 0.001). There were no
significant differences in the composite of complications between
intensive and conservative groups (42 vs. 52%, P = 0.08). We observed
heterogeneity in treatment effect according to diabetes status, with no
differences in complications among patients with diabetes treated with
intensive or conservative regimens (49 vs. 48%, P = 0.87), but a
significant lower rate of complications in patients without diabetes
treated with intensive compared with conservative treatment regimen (34
vs. 55%, P = 0.008). CONCLUSIONS Intensive insulin therapy to target
glucose of 100 and 140mg/dL in the ICU did not significantly reduce
perioperative complications compared with target glucose of 141 and
180mg/dL after CABG surgery. Subgroup analysis showed a lower number of
complications in patients without diabetes, but not in patients with
diabetes treated with the intensive regimen. Large prospective randomized
studies are needed to confirm these findings. Copyright &#xa9;2015 by the
American Diabetes Association.

<249>
Accession Number
608546204
Author
Yi J.; Xiang Z.; Deng X.; Fan T.; Fu R.; Geng W.; Guo R.; He N.; Li C.; Li
L.; Li M.; Li T.; Tian M.; Wang G.; Wang L.; Wang T.; Wu A.; Wu D.; Xue
X.; Xu M.; Yang X.; Yang Z.; Yuan J.; Zhao Q.; Zhou G.; Zuo M.; Pan S.;
Zhan L.; Yao M.; Huang Y.
Institution
(Yi, Huang) Peking Union Medical College Hospital, Beijing, China
(Xiang, Pan, Zhan, Yao) 3M China R And D Center, Shanghai, China
(Deng) Plastic Surgery Hospital and Institute, CAMS, PUMC, Beijing, China
(Fan) Tsinghua University Yuquan Hospital, Beijing, China
(Fu) Beijing Chuiyangliu Hospital, Beijing, China
(Geng) Beijing Chest Hospital, Capital Medical University, Beijing, China
(Guo) Miyunxian Hospital, Beijing, China
(He) Peking University Shougang Hospital, Beijing, China
(Li) China-Japan Friendship Hospital, Beijing, China
(Li) China Meitan General Hospital, Beijing, China
(Li) Peking University Third Hospital, Beijing, China
(Li) Beijing Tongren Hospital Capital Medical University, Beijing, China
(Tian) Beijing Friendship Hospital, Capital Medical University, Beijing,
China
(Wang) Beijing Jishuitan Hospital, Beijing, China
(Wang) Haidian Maternal and Child Health Hospital, Beijing, China
(Wang) Xuanwu Hospital Capital Medical University, Beijing, China
(Wu) Beijing Chao-Yang Hospital, Beijing, China
(Wu) Luhe Teaching Hospital of the Capital Medical University, Beijing,
China
(Xue, Yang) Air Force General Hospital, PLA, Beijing, China
(Xu) Beijing Obstetrics and Gynecology Hospital, Capital Medical
University, Beijing, China
(Yang) Central Hospital of China Aerospace Corporation, Beijing, China
(Yuan) Beijing Rectum Hospital, Beijing, China
(Zhao) Beijing Shi Jing Shan Hospital, Beijing, China
(Zhou) Beijing Pinggu Hospital, Beijing, China
(Zuo) Beijing Hospital of the Ministry of Health, Beijing, China
Title
Incidence of inadvertent intraoperative hypothermia and its risk factors
in patients undergoing general anesthesia in Beijing: A prospective
regional survey.
Source
PLoS ONE. 10 (9) (no pagination), 2015. Article Number: e0136136. Date of
Publication: 11 Sep 2015.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background/Objective Inadvertent intraoperative hypothermia (core
temperature <360 C) is a recognized risk in surgery and has adverse
consequences. However, no data about this complication in China are
available. Our study aimed to determine the incidence of inadvertent
intraoperative hypothermia and its associated risk factors in a sample of
Chinese patients. Methods We conducted a regional cross-sectional survey
in Beijing from August through December, 2013. Eight hundred thirty
patients who underwent various operations under general anesthesia were
randomly selected from 24 hospitals through a multistage probability
sampling. Multivariate logistic regression analyses were applied to
explore the risk factors of developing hypothermia. Results The overall
incidence of intraoperative hypothermia was high, 39.9%. All patients were
warmed passively with surgical sheets or cotton blankets, whereas only
10.7%of patients received active warming with space heaters or electric
blankets. Pre-warmed intravenous fluid were administered to 16.9%of
patients, and 34.6%of patients had irrigation of wounds with pre-warmed
fluid. Active warming (OR = 0.46, 95%CI 0.26a"0.81), overweight or obesity
(OR = 0.39, 95%CI 0.28a"0.56), high baseline core temperature before
anesthesia (OR = 0.08, 95%CI 0.04a"0.13), and high ambient temperature (OR
= 0.89, 95%CI 0.79a"0.98) were significant protective factors for
hypothermia. In contrast, major-plus operations (OR = 2.00, 95%CI
1.32a"3.04), duration of anesthesia (1a"2 h) (OR = 3.23, 95%CI 2.19a"4.78)
and >2 h (OR = 3.44, 95%CI 1.90a"6.22,), and intravenous un-warmed fluid
(OR = 2.45, 95%CI 1.45a" 4.12) significantly increased the risk of
hypothermia. Conclusions The incidence of inadvertent intraoperative
hypothermia in Beijing is high, and the rate of active warming of patients
during operation is low. Concern for the development of intraoperative
hypothermia should be especially high in patients undergoing major
operations, requiring long periods of anesthesia, and receiving un-warmed
intravenous fluids. Copyright &#xa9; 2015 Yi et al. This is an open access
article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original author and source are credited.

<250>
Accession Number
605930417
Author
McNally J.D.; O'Hearn K.; Lawson M.L.; Maharajh G.; Geier P.; Weiler H.;
Redpath S.; McIntyre L.; Fergusson D.; Menon K.
Institution
(McNally, Lawson, Geier, Redpath, Menon) Faculty of Medicine, University
of Ottawa, Children's Hospital of Eastern Ontario, Department of
Pediatrics, Ottawa, Canada
(McNally, O'Hearn, Lawson, Geier, Menon) Children's Hospital of Eastern
Ontario, Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
(Maharajh) Division of Cardiovascular Surgery, University of Ottawa,
Ottawa, Canada
(Weiler) School of Dietetics and Human Nutrition, McGill University,
Montreal, QC, Canada
(McIntyre) University of Ottawa, Department of Medicine (Division of
Critical Care), Ottawa Hospital Research Institute (OHRI), Ottawa, ON,
Canada
(Fergusson) Ottawa Hospital Research Institute (OHRI), University of
Ottawa, Department of Epidemiology and Community Medicine, Ottawa, ON,
Canada
Title
Prevention of vitamin D deficiency in children following cardiac surgery:
study protocol for a randomized controlled trial.
Source
Trials. 16 (1) (no pagination), 2015. Article Number: 402. Date of
Publication: September 09, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Vitamin D is a pleiotropic hormone important for the recovery
of organ systems after critical illness. Recent observational studies have
suggested that three out of every four children are vitamin D deficient
following cardiac surgery, with inadequate preoperative intake and
surgical losses playing important contributory roles. Observed
associations between postoperative levels, cardiovascular dysfunction and
clinical course suggest that perioperative optimization of vitamin D
status could improve outcome. With this two-arm, parallel, double blind,
randomized controlled trial (RCT), we aim to compare immediate
postoperative vitamin D status in children requiring cardiopulmonary
bypass for congenital heart disease who receive preoperative daily high
dose vitamin D supplementation (high-dose arm) with those who receive
usual intake (low-dose arm). Methods/Design: Eligibility requirements
include age (>36 weeks, <18 years) and a congenital heart defect requiring
cardiopulmonary bypass surgical correction. Enrollment of 62 participants
will take place at a single Canadian tertiary care center over a period of
2 years. Children randomized to the high-dose group will receive age-based
dosing that was informed by the Institute of Medicine (IOM) daily
tolerable upper intake level (<1 year old = 1,600 IU/day, >1 year old =
2,400 IU/day). Children in the low-dose arm will receive usual care based
on IOM recommendations (<1 year old = 400 IU, >1 year old = 600 IU). The
primary outcome measure is immediate postoperative vitamin D status, using
blood 25(OH)D. Discussion: Maintaining adequate postoperative vitamin D
levels following surgery could represent an effective therapy to speed
recovery following CHD surgery. The proposed research project will
determine whether preoperative supplementation with a dosing regimen based
on the IOM recommended daily upper tolerable intake will prevent
postoperative vitamin-D deficiency in the majority of children. The
results will then be used to inform the design of a large international
RCT exploring whether preoperative optimization of vitamin D status might
improve short and long-term outcomes in this vulnerable population. Trial
Registration: Clinicaltrials.gov Identifier - NCT01838447Date of
registration: 11 April 2013 Copyright &#xa9; 2015 McNally et al.

<251>
Accession Number
605719104
Author
Miell J.; Dhanjal P.; Jamookeeah C.
Institution
(Miell) Department of Endocrinology, University Hospital Lewisham, London,
United Kingdom
(Dhanjal) Otsuka Pharmaceutical UK Limited, Gallions, Wexham Springs,
Framewood Road, Wexham SL3 6PJ, United Kingdom
(Jamookeeah) Otsuka Pharmaceutical Europe Limited, Wexham, United Kingdom
Title
Evidence for the use of demeclocycline in the treatment of hyponatraemia
secondary to SIADH: A systematic review.
Source
International Journal of Clinical Practice. 69 (12) (pp 1396-1417), 2015.
Date of Publication: 01 Dec 2015.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Aims Hyponatraemia (HN) is the most common electrolyte balance disorder in
clinical practice. Since the 1970s, demeclocycline has been used in some
countries to treat chronic HN secondary to syndrome of inappropriate
antidiuretic hormone secretion (SIADH). The precise mechanism of action of
demeclocycline is unclear, but has been linked to the induction of
nephrogenic diabetes insipidus. Furthermore, the safety profile of
demeclocycline is variable with an inconsistent time to onset, and a
potential for complications. There has been no systematic evaluation of
the use of demeclocycline for the treatment of HN secondary to SIADH to
date. A systematic literature review was performed to obtain an insight
into the clinical safety and efficacy of demeclocycline for this
condition. Methods Embase^TM, MEDLINE,
MEDLINE In-Process, and The Cochrane Library were searched on
two occasions using MeSH terms combined with free-text terms. References
were screened by two independent reviewers. Relevant publications were
then extracted by two independent reviewers, with a third reviewer
collating and finalising extractions. Results The searches returned a
total of 705 hits. 632 abstracts were screened after the removal of
duplicates. Following screening, 35 full-length publications were
reviewed. Of these, 17 were excluded, resulting in 18 studies deemed
relevant for data extraction. Two were randomised controlled trials
(RCTs), 16 were non-RCTs, and 10 were case reports. Discussion Although
most reports suggest that demeclocycline can address serum sodium levels
in specific patients with HN, efficacy is variable, and may depend upon
the underlying aetiology. Demeclocycline dose adjustments can be complex,
and as its use in clinical practice is not well defined, it can differ
between healthcare professionals. Conclusion There is a lack of clinical
and economic evidence supporting the use of demeclocycline for HN
secondary to SIADH. Patients receiving demeclocycline for HN secondary to
SIADH must be closely monitored. Copyright &#xa9; 2015 The Authors.
International Journal of Clinical Practice Published by John Wiley & Sons
Ltd.

<252>
Accession Number
605917810
Author
Alak A.; Lugomirski P.; Aleksova N.; Jolly S.S.
Institution
(Alak, Aleksova, Jolly) Department of Medicine, McMaster University,
Hamilton General, Hospital, Rm. C3-118 DBCSVRI Building, Hamilton, ON L8L
2X2, Canada
(Lugomirski) Division of Cardiology, University of Ottawa Heart Institute,
Ottawa, ON, Canada
Title
A meta-analysis of randomized controlled trials of conventional stenting
versus direct stenting in patients with acute myocardial infarction.
Source
Journal of Invasive Cardiology. 27 (9) (pp 405-409), 2015. Date of
Publication: 01 Sep 2015.
Publisher
HMP Communications
Abstract
BACKGROUND: Direct stenting (DS) is commonly used during percutaneous
coronary intervention for acute myocardial infarction (AMI) to prevent
distal embolization; however, no guideline recommendations exist regarding
DS. We sought to compare DS with conventional stenting (CS) in patients
presenting with AMI in a meta-analysis of randomized controlled trials.
METHODS: Studies were identified from EMBASE, MEDLINE, and Cochrane
databases. To be included, randomized controlled trials must have compared
DS with CS in patients with AMI. Data were extracted and articles were
critically appraised by two authors. A fixed effects model was used, with
Peto odds ratios (ORs). The primary endpoint was death from cardiovascular
causes. RESULTS: Five trials (n < 754) met the eligibility criteria.
ST-segment resolution occurred in 68.9% (146/212) in the DS group vs 60.2%
(127/211) in the CS group (OR, 1.51; 95% CI, 1.00-2.27; P<.05;
I²<52%). No-reflow occurred in 6.6% in the DS group compared
with 6.9% in the CS group (OR, 0.78; 95% CI, 0.39-1.55; P<.48;
I²<0%). DS was associated with a significant reduction in the
risk of in-hospital cardiovascular death (OR, 0.21; 95% CI, 0.06-0.77;
P<.02; I²<0%). No significant differences were observed in
myocardial infarction (OR, 0.38; 95% CI, 0.09-1.51; P<.17;
I²<7%) or target lesion revascularization (OR, 1.20; 95% CI,
0.36-3.97; P<.76; I²<0%). CONCLUSION: Small trials suggest a
potential benefit to DS in AMI. Further large-scale randomized trials are
warranted to confirm the benefit of this approach.

<253>
Accession Number
608824876
Author
Hamshere S.; Arnous S.; Choudhury T.; Choudry F.; Mozid A.; Yeo C.;
Barrett C.; Saunders N.; Gulati A.; Knight C.; Locca D.; Davies C.; Cowie
M.R.; Prasad S.; Parmar M.; Agrawal S.; Jones D.; Martin J.; McKenna W.;
Mathur A.
Institution
(Hamshere, Arnous, Choudhury, Choudry, Mozid, Yeo, Barrett, Knight, Locca,
Davies, Jones, Mathur) Department of Cardiology, St Bartholomew's
Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, United
Kingdom
(Saunders, Agrawal) Stem Cell Laboratory, Barts Health NHS Trust and
Blizard Institute, Queen Mary University of London, London, United Kingdom
(Gulati, Prasad) Cardiovascular Magnetic Resonance Unit, Royal Brompton
Hospital, Imperial College London, Sydney Street, London SW3 6NP, United
Kingdom
(Davies, Mathur) Barts Health NIHR Cardiovascular Biomedical Research
Unit, London Chest Hospital, Barts Health NHS Trust, London E2 9JX, United
Kingdom
(Cowie) Imperial College London, Royal Brompton Hospital, London SW3 6NP,
United Kingdom
(Parmar) Cancer Division, Medical Research Council, Clinical Trials Unit,
London, United Kingdom
(Martin) British Heart Foundation Laboratories, Department of Medicine,
University College London, London WC1E 6JJ, United Kingdom
(McKenna) Institute of Cardiovascular Science, University College London,
Heart Hospital, UCLH, 16-18 Westmoreland Street, London W1G 8PH, United
Kingdom
Title
Randomized trial of combination cytokine and adult autologous bone marrow
progenitor cell administration in patients with non-ischaemic dilated
cardiomyopathy: The REGENERATEDCM clinical trial.
Source
European Heart Journal. 36 (44) (pp 3061-3069), 2015. Date of Publication:
2015.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims The REGENERATE-DCM trial is the first phase II randomized,
placebo-controlled trial aiming to assess if granulocyte
colony-stimulating factor (G-CSF) administration with or without
adjunctive intracoronary (IC) delivery of autologous bone marrow-derived
cells (BMCs) improves global left ventricular (LV) function in patients
with dilated cardiomyopathy (DCM) and significant cardiac dysfunction.
Methods and results Sixty patients with DCM and left ventricular ejection
fraction (LVEF) at referral of =45%, New York Heart Association (NYHA)
classification =2 and no secondary cause for the cardiomyopathy were
randomized equally into four groups: peripheral placebo (saline),
peripheral G-CSF, peripheral G-CSF and IC serum, and peripheral G-CSF and
IC BMC. All patients, except the peripheral placebo group, received 5 days
of G-CSF. In the IC groups, this was followed by bone marrow harvest and
IC infusion of cells or serum on Day 6. The primary endpoint was LVEF
change from baseline to 3 months, determined by advanced cardiac imaging.
At 3 months, peripheral G-CSF combined with IC BMC therapy was associated
with a 5.37% point increase in LVEF (38.30% +/- 12.97 from 32.93% +/-
16.46 P = 0.0138), which was maintained to 1 year. This was associated
with a decrease in NYHA classification, reduced NT-pro BNP, and improved
exercise capacity and quality of life. No significant change in LVEF was
seen in the remaining treatment groups. Conclusion This is the first
randomized, placebo-controlled trial with a novel combination of G-CSF and
IC cell therapy that demonstrates an improvement in cardiac function,
symptoms, and biochemical parameters in patients with DCM. Copyright
&#xa9; 2015 The Author.

<254>
Accession Number
604475007
Author
Ansari M.T.; Ahmadzai N.; Coyle K.; Coyle D.; Moher D.
Institution
(Ansari, Ahmadzai, Moher) Ottawa Hospital Research Institute, Ottawa, ON,
Canada
(Coyle) Brunel University London, Uxbridge, Middlesex, United Kingdom
(Coyle) Department of Epidemiology and Community Medicine, University of
Ottawa, Ottawa, ON, Canada
Title
Mitral valve clip for treatment of mitral regurgitation: An evidence-based
analysis.
Source
Ontario Health Technology Assessment Series. 15 (12) (pp 1-104), 2015.
Date of Publication: 2015.
Publisher
Medical Advisory Secretariat (E-mail: keelee.kaulback@ontario.co)
Abstract
Background: Many of the 500,000 North American patients with chronic
mitral regurgitation may be poor candidates for mitral valve surgery.
Objective: The objective of this study was to investigate the comparative
effectiveness, harms, and cost-effectiveness of percutaneous mitral valve
repair using mitral valve clips in candidates at prohibitive risk for
surgery. Data Sources: We searched articles in MEDLINE, Embase, and the
Cochrane Library published from 1994 to February 2014 for evidence of
effectiveness and harms; for economic literature we also searched NHS EED
and Tufts CEA registry. Grey literature was also searched. Review Methods:
Primary studies were sought from existing systematic reviews that had
employed reliable search and screening methods. Newer studies were sought
by searching the period subsequent to the last search date of the review.
Two reviewers screened records and assessed study validity. We used the
Cochrane risk of bias tool for randomized, generic assessment for
non-randomized studies, and the Phillips checklist for economic studies.
Results: Ten studies including 1 randomized trial were included. The
majority of the direct comparative evidence compared the mitral valve clip
repair with surgery in patients not particularly at prohibitive surgical
risk. Irrespective of degenerative or functional chronic mitral
regurgitation etiology, evidence of effectiveness and harms is
inconclusive and of very low quality. Very-low-quality evidence indicates
that percutaneous mitral valve clip repair may provide a survival
advantage, at least during the first 1 to 2 years, particularly in
medically managed chronic functional mitral regurgitation. Because of
limitations in the design of studies, the cost-effectiveness of mitral
valve clips in patients at prohibitive risk for surgery also could not be
established. Limitations: Because of serious concerns of risk of bias,
indirectness, and imprecision, evidence is of very low quality.
Conclusions: No meaningful conclusions can be drawn about the comparative
effectiveness, harms, and cost-effectiveness of mitral valve clips in the
population with chronic mitral regurgitation who are at prohibitive risk
for surgery. Copyright &#xa9; 2015 Medical Advisory Secretariat. All
rights reserved.

<255>
[Use Link to view the full text]
Accession Number
606569744
Author
Theis C.; Konrad T.; Mollnau H.; Sonnenschein S.; Kampfner D.; Potstawa
M.; Ocete B.Q.; Bock K.; Himmrich E.; Munzel T.; Rostock T.
Institution
(Theis, Konrad, Mollnau, Sonnenschein, Kampfner, Potstawa, Ocete, Bock,
Himmrich, Munzel, Rostock) II. Medical Clinic, Department of
Electrophysiology, University Medical Center, Johannes
Gutenberg-University Mainz, Langenbeckstr. 1, Mainz D-55131, Germany
Title
Arrhythmia Termination Versus Elimination of Dormant Pulmonary Vein
Conduction as a Procedural End Point of Catheter Ablation for Paroxysmal
Atrial Fibrillation.
Source
Circulation: Arrhythmia and Electrophysiology. 8 (5) (pp 1080-1087), 2015.
Date of Publication: 01 Oct 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Pulmonary vein isolation (PVI) is still associated with a
substantial number of arrhythmia recurrences in paroxysmal atrial
fibrillation (AF). This prospective, randomized study aimed to compare 2
different procedural strategies. Methods and Results - A total of 152
patients undergoing de novo ablation for paroxysmal AF were randomized to
2 different treatment arms. The procedure in group A consisted of PVI
exclusively. In this group, all isolated PVs were challenged with
adenosine to reveal and ablate dormant conduction. In group B, PVI was
performed with the patient either in spontaneous or in induced AF. If AF
did not terminate with PVI, ablation was continued by targeting extra-PV
AF sources with the desired procedural end point of termination to sinus
rhythm. Primary study end point was freedom from arrhythmia during 1-year
follow-up. In group A, adenosine provoked dormant conduction in 31 (41%)
patients with a mean of 1.6+/-0.8 transiently recovered PVs per patient.
Termination of AF during PVI was observed in 31 (65%) patients, whereas AF
persisted afterward in 17 (35%) patients. AF termination occurred in 13
(76%) patients by AF source ablation. After 1-year follow-up,
significantly more group B patients were free of arrhythmia recurrences
(87 versus 68%; P=0.006). During redo ablation, the rate of PV
reconduction did not differ between both groups (group A: 55% versus group
B: 61%; P=0.25). Conclusions - Elimination of extra-PV AF sources after
PVI is superior to sole PV isolation with the adjunct of abolishing
potential dormant conduction. Copyright &#xa9; 2015 The Authors.

<256>
Accession Number
607062019
Author
Rosenkranz S.; Ghofrani H.-A.; Beghetti M.; Ivy D.; Frey R.; Fritsch A.;
Weimann G.; Saleh S.; Apitz C.
Institution
(Rosenkranz) Department III of Internal Medicine, Cologne Cardiovascular
Research Center (CCRC), Cologne University Heart Center, Kerpener Str. 62,
Cologne 50937, Germany
(Ghofrani) University of Giessen and Marburg Lung Center (UGMLC), Giessen,
Germany
(Ghofrani) Department of Medicine, Imperial College London, London, United
Kingdom
(Beghetti) Pediatric Cardiology Unit, Children's Hospital, University of
Geneva, Geneva, Switzerland
(Ivy) Department of Pediatrics, University of Colorado, School of
Medicine, Children's Hospital Colorado, Aurora, CO, United States
(Frey, Fritsch, Weimann, Saleh) Bayer Pharma AG, Wuppertal, Germany
(Apitz) Pediatric Heart Centre, University Children's Hospital, Giessen,
Germany
Title
Riociguat for pulmonary arterial hypertension associated with congenital
heart disease.
Source
Heart. 101 (22) (pp 1792-1799), 2015. Date of Publication: 01 Nov 2015.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective The Pulmonary Arterial hyperTENsion sGCstimulator Trial-1
(PATENT-1) was a randomised, doubleblind, placebo-controlled phase III
trial evaluating riociguat in patients with pulmonary arterial
hypertension (PAH). PATENT-2 was an open-label long-term extension to
PATENT-1. Here, we explore the efficacy and safety of riociguat in the
subgroup of patients with persistent/recurrent PAH after correction of
congenital heart disease (PAH-CHD) from the PATENT studies. Methods In
PATENT-1, patients received riociguat (maximum 2.5 or 1.5 mg three times
daily) or placebo for 12 weeks; efficacy assessments included change from
baseline to study end in 6-min walking distance (6MWD; primary), pulmonary
vascular resistance (PVR), N-terminal of the prohormone of brain
natriuretic peptide (NT-proBNP), WHO functional class (WHO FC) and time to
clinical worsening. In PATENT-2, eligible patients from PATENT-1 received
long-term riociguat (maximum 2.5 mg three times daily); the primary
assessment was safety and tolerability. All PAH-CHD patients had a
corrected cardiac defect. Results In PATENT-1, riociguat increased
mean+/-SD 6MWD from baseline to week 12 by 39+/-60 m in patients with
PAH-CHD versus 0+/-42 m for placebo. Riociguat also improved several
secondary variables versus placebo, including PVR (-250+/-410 vs-66+/-632
dyn.s/cm⁵), NT-proBNP (-164+/-317 vs-46+/-697 pg/mL) and WHO FC
(21%/79%/0% vs 8%/83%/8% improved/stabilised/worsened). One patient
experienced clinical worsening (riociguat 1.5 mg group). Riociguat was
well tolerated. In PATENT-2, riociguat showed sustained efficacy and
tolerability in patients with PAH-CHD at 2 years. Conclusions Riociguat
was well tolerated in patients with PAH-CHD and improved clinical outcomes
including 6MWD, PVR, WHO FC and NT-proBNP.

<257>
Accession Number
605133643
Author
Valooran G.J.; Nair S.K.; Chandrasekharan K.
Institution
(Valooran, Chandrasekharan) Department of Cardiovascular and Thoracic
Surgery, Rajagiri Hospital, India
(Nair) Department of Cardiovascular and Thoracic Surgery, Rajagiri
Hospital, Chunangamvely, Aluva, Kochi, Kerala 683112, India
Title
Strategies for the coronary surgeon to remain "competitive and
co-operative" in the PCI era.
Source
Indian Heart Journal. 67 (4) (pp 351-358), 2015. Date of Publication: 01
Jul 2015.
Publisher
Elsevier
Abstract
Background The advent of percutaneous intervention has made surgical
treatment of coronary artery disease less favored by patients though the
evidence that supports CABG in certain patient subsets is strong. Methods
Literature review was done using Pubmed, Scopus, Google and Google Scholar
with MeSH terms-coronary artery bypass grafting, internal mammary artery,
drug eluting stent, stroke, myocardial revascularization. Results The
adoption of evolving techniques like anaortic off pump grafting, bilateral
internal mammary artery use, hybrid and minimally invasive coronary
revascularization techniques, intra-operative graft assessment, and heart
team approach can lead to better outcomes following surgery as is
evidenced by recent literature. Conclusions Though the adoptability of the
newer strategies may vary between centers a close coalition between
coronary surgeons and cardiologists would ensure that the management of
coronary artery disease is based on evidence for the benefit of the
patient. Copyright &#xa9; 2015 Cardiological Society of India.

<258>
[Use Link to view the full text]
Accession Number
607152735
Author
Brinkman W.T.; Squiers J.J.; Filardo G.; Arsalan M.; Smith R.L.; Moore D.;
Mack M.J.; Dimaio J.M.
Institution
(Brinkman, Arsalan, Smith, Moore, Mack, Dimaio) Heart Hospital Baylor
Plano, Plano, TX, United States
(Squiers, Filardo, Dimaio) Department of Epidemiology, Baylor Scott and
White Health, Dallas, TX, United States
Title
Perioperative outcomes, transfusion requirements, and inflammatory
response after coronary artery bypass grafting with off-pump,
mini-extracorporeal, and on-pump circulation techniques.
Source
Journal of Investigative Medicine. 63 (8) (pp 916-920), 2015. Date of
Publication: 01 Dec 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives Mini-extracorporeal circulation (MECC) units were developed to
reduce postoperative morbidity, transfusion requirements, and inflammation
associated with conventional on-pump coronary artery bypass (ONCAB)
surgery without the technical demands of the off-pump (OPCAB) technique.
We compared perioperative outcomes and inflammatory mediation among OPCAB,
MECC, and ONCAB techniques. Methods We prospectively enrolled 102 patients
undergoing elective isolated coronary bypass grafting. Perfusion methods
were OPCAB (n = 34), MECC (n = 34), and ONCAB (n = 34). Serial blood
samples were collected to measure serum inflammatory markers. Results
There were no operative deaths or strokes. Total red blood cell (RBC)
products used in OPCAB, MECC, and ONCAB patients were 0.676, 1.000, and
1.235 units, respectively. Adjusted (by splined Society of Thoracic
Surgeons operative risk score) analysis showed no statistically
significant differences in mean RBC product use among the different
operative systems (OPCAB vs MECC, P = 0.580; OPCAB vs ONCAB, P = 0.311;
MECC vs ONCAB, P = 0.633). Adjusted (by Society of Thoracic Surgeons risk
score and baseline level) mean plasma level differences (24 hours
postoperative - baseline) of C-reactive protein for OPCAB (117.89; 95%
confidence interval [95% CI], 106.23-129.54) and for MECC (124.88; 95% CI,
113.45-136.32) were significantly higher than for ONCAB (98.82; 95% CI,
86.40-111.24). No significant adjusted differences (P = 0.304) in
interleukin-6 level changes were observed. Conclusions Off-pump coronary
artery bypass and MECC did not significantly reduce mean total RBC
transfusion requirements. Off-pump coronary artery bypass and MECC were
associated with greater C-reactive protein elevation than ONCAB,
suggestive of an increased inflammatory response to each of these
techniques. Copyright &#xa9; 2015 Lippincott Williams & Wilkins.

<259>
Accession Number
607111618
Author
Jungen C.; Zeus T.; Balzer J.; Eickholt C.; Petersen M.; Kehmeier E.;
Veulemans V.; Kelm M.; Willems S.; Meyer C.
Institution
(Jungen, Eickholt, Willems, Meyer) Department of Cardiology -
Electrophysiology, CNEP, Cardiac Neuro- and Electrophysiology Research
Group, University Heart Center, University Hospital Hamburg-Eppendorf,
Hamburg, Germany
(Jungen, Eickholt, Willems, Meyer) DZHK (German Center for Cardiovascular
Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
(Jungen, Zeus, Balzer, Eickholt, Petersen, Kehmeier, Veulemans, Kelm,
Meyer) Department of Cardiology, Pulmonology and Vascular Medicine,
Medical Faculty, University Hospital Duesseldorf, Duesseldorf, Germany
Title
Left atrial appendage closure guided by integrated echocardiography and
fluoroscopy imaging reduces radiation exposure.
Source
PLoS ONE. 10 (10) (no pagination), 2015. Article Number: e0140386. Date of
Publication: 14 Oct 2015.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Aims: To investigate whether percutaneous left atrial appendage (LAA)
closure guided by automated real-time integration of
2D-/3D-transesophageal echocardiography (TEE) and fluoroscopy imaging
results in decreased radiation exposure. Methods and Results: In this
open-label single-center study LAA closure (Amplatzer^TM Cardiac
Plug) was performed in 34 consecutive patients (8 women; 73.1+/-8.5 years)
with (n = 17, EN+) or without (n = 17, EN-) integrated
echocardiography/fluoroscopy imaging guidance (EchoNavigator [EN]; Philips
Healthcare). There were no significant differences in baseline
characteristics between both groups. Successful LAA closure was documented
in all patients. Radiation dose was reduced in the EN+ group about 52%
(EN+: 48.5+/-30.7 vs. EN-: 93.9+/-64.4 Gy/ cm^{2; p = 0.01).
Corresponding to the radiation dose fluoroscopy time was reduced (EN+:
16.7+/-7 vs. EN-}: 24.0+/-11.4 min; p = 0.035). These advantages were
not at the cost of increased procedure time (89.6+/-28.8 vs. 90.1+/-30.2
min; p = 0.96) or periprocedural complications. Contrast media amount was
comparable between both groups (172.3+/-92.7 vs. 197.5+/-127.8 ml; p =
0.53). During short-term follow-up of at least 3 months (mean: 8.1+/-5.9
months) no device-related events occurred. Conclusions: Automated
real-time integration of echocardiography and fluoroscopy can be
incorporated into procedural work-flow of percutaneous left atrial
appendage closure without prolonging procedure time. This approach results
in a relevant reduction of radiation exposure. Copyright &#xa9; 2015
Jungen et al. This is an open access article distributed under the terms
of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original
author and source are credited.

<260>
Accession Number
607844074
Author
Goldfarb M.; Drudi L.; Almohammadi M.; Langlois Y.; Noiseux N.; Perrault
L.; Piazza N.; Afilalo J.
Institution
(Goldfarb, Afilalo) Division of Cardiology, Jewish General Hospital,
McGill University, Montreal, QC, Canada
(Langlois) Division of Cardiac Surgery, Jewish General Hospital, McGill
University, Montreal, QC, Canada
(Drudi) Division of Vascular Surgery, Centre for Clinical Epidemiology,
McGill University, Montreal, QC, Canada
(Afilalo) Lady Davis Institute, McGill University, Montreal, QC, Canada
(Almohammadi) Division of Medicine, McGill University Health Center,
McGill University, Montreal, QC, Canada
(Piazza) Division of Cardiology, McGill University Health Center, McGill
University, Montreal, QC, Canada
(Noiseux) Division of Cardiac Surgery, Centre Hospitalier de L'Universite
de Montreal, Montreal, QC, Canada
(Perrault) Division of Cardiac Surgery, Montreal Heart Institute,
Universite de Montreal, Montreal, QC, Canada
Title
Outcome reporting in cardiac surgery trials: Systematic review and
critical appraisal.
Source
Journal of the American Heart Association. 4 (8) (no pagination), 2015.
Article Number: e002204. Date of Publication: 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-There is currently no accepted standard for reporting outcomes
following cardiac surgery. The objective of this paper was to
systematically review the literature to evaluate the current use and
definition of perioperative outcomes reported in cardiac surgery trials.
Methods and Results-We reviewed 5 prominent medical and surgical journals
on Medline from January 1, 2010, to June 30, 2014, for randomized
controlled trials involving coronary artery bypass grafting and/or valve
surgery. We identified 34 trials meeting inclusion criteria. Sample sizes
ranged from 57 to 4752 participants (median 351). Composite end points
were used as a primary outcome in 56% (n=19) of the randomized controlled
trials and as a secondary outcome in 12% (n=4). There were 14 different
composite end points. Mortality at any time (all-cause and/or
cardiovascular) was reported as an individual end point or as part of a
combined end point in 82% (n=28), myocardial infarction was reported in
68% (n=23), and bleeding was reported in 24% (n=8). Patient-centered
outcomes, such as quality of life and functional classification, were
reported in 29% (n=10). Definition of clinical events such as myocardial
infarction, stroke, renal failure, and bleeding varied considerably among
trials, particularly for postoperative myocardial infarction and bleeding,
for which 8 different definitions were used for each. Conclusions-Outcome
reporting in the cardiac surgery literature is heterogeneous, and efforts
should be made to standardize the outcomes reported and the definitions
used to ascertain them. The development of standardizing outcome reporting
is an essential step toward strengthening the process of evidence-based
care in cardiac surgery. Copyright &#xa9; 2015 The Authors. Published on
behalf of the American Heart Association, Inc., by Wiley Blackwell.

<261>
Accession Number
606421919
Author
Ferguson L.D.; Logue J.
Institution
(Ferguson) Chemical Pathology & Metabolic Medicine, Department of Clinical
Biochemistry, Glasgow Royal Infirmary, Glasgow, United Kingdom
(Logue) Institute of Cardiovascular and Medical Sciences, University of
Glasgow, Glasgow, United Kingdom
Title
Has IMPROVE-IT improved cardiovascular outcome?.
Source
Journal of the Royal College of Physicians of Edinburgh. 45 (3) (pp
215-217), 2015. Date of Publication: 2015.
Publisher
Royal College of Physicians of Edinburgh (E-mail: k.oneill@rcpe.ac.uk)
Abstract
The Improved Reduction of Outcomes: Vytorin Efficacy International Trial
(IMPROVE-IT) was a large double-blind, randomised controlled trial to
investigate whether ezetimibe, an inhibitor of cholesterol absorption in
the intestine, could further reduce cardiovascular events in addition to
statins after acute coronary syndrome (ACS).¹ A total of 18,144
hospitalised patients within 10 days of ACS were randomised to receive
simvastatin 40mg plus ezetimibe 10mg or simvastatin 40mg plus placebo.
Inclusion criteria included an LDL-cholesterol concentration of 1.3-2.6
mmol/L in those already receiving lipid-lowering therapy or 1.3-3.2 mmol/L
in those without lipid-lowering therapy at baseline. Patient
characteristics were matched at baseline. Thirty-four percent of patients
were on statins at the time of the index event. Mean LDL-cholesterol
concentrations pretrial were 2.4 mmol/L in both groups. The primary
endpoint was a composite of cardiovascular death, non-fatal myocardial
infarction, unstable angina requiring rehospitalisation, coronary
revascularisation, or nonfatal stroke. Median follow-up was 6 years. Over
the course of the entire trial, the median timeweighted average
LDL-cholesterol concentration was 1.4 mmol/L in the simvastatin-ezetimibe
group, compared to 1.8 mmol/L in the simvastatin monotherapy group (p
<0.001). The absolute risk reduction (ARR) with simvastatin-ezetimibe for
the primary end-point was 2% (Kaplan-Meier event rate 32.7% in the
simvastatinezetimibe group vs 34.7% in the simvastatin monotherapy group,
hazard ratio 0.936; 95% CI 0.89-0.99; p = 0.016). This translated into a
number needed to treat of 50 over a 7-year period to prevent one primary
end-point. Subgroup analysis suggested greater benefit in individuals with
diabetes mellitus and those > 75 years old. The absolute risk of any
myocardial infarction was 1.7% lower in the simvastatin-ezetimibe group
than with simvastatin alone (HR 0.87, p = 0.002) and the absolute risk of
ischaemic stroke was 0.7% lower with combination therapy (HR 0.79, p =
0.008). No significant between-group differences were found in muscle,
gallbladder, and hepatic adverse effects or cancer. The authors concluded
that ezetimibe in addition to simvastatin improved cardiovascular outcomes
after ACS through lowering LDL-cholesterol. Prior to IMPROVE-IT, national
guidelines have emphasised statin therapy as the preferred treatment for
established cardiovascular disease.^2,3 This is based on the
'statin hypothesis' that statins have additional cardioprotective
properties that cannot be fully explained by lowering LDL-cholesterol
alone, e.g. antioxidant properties and improved endothelial
function.⁴ However, in IMPROVEIT there was a 7.2% lower rate of
major vascular events with a between-group difference in LDL-cholesterol
of 0.33 mmol/L. This reduction in event-rate with addition of ezetimibe
was the same as that predicted for a similar LDL-cholesterol reduction
with statin therapy by the Cholesterol Treatment Trialists
(CTT).⁵ This suggests that LDL-cholesterol lowering per se is
central to protecting against coronary heart disease, and provides for the
first time clinical trial evidence that lowering LDL-cholesterol with a
non-statin lipid-lowering agent can reduce cardiovascular disease risk.
Copyright &#xa9; 2015 Royal College of Physicians of Edinburgh.

<262>
Accession Number
606362468
Author
Li Y.-W.; Li H.-J.; Feng Y.; Yu Y.; Guo X.-Y.; Li Y.; Zhao B.-J.; Hu
X.-Y.; Zuo M.-Z.; Zhang H.-Y.; Wang M.-R.; Ji P.; Yan X.-Y.; Wu Y.-F.;
Wang D.-X.
Institution
(Li, Li, Wang) Peking University First Hospital, Department of
Anesthesiology and Critical Care Medicine, No.8 Xishiku Street, Xicheng
District, Beijing 100034, China
(Li, Wang, Ji, Yan, Wu) Peking University Clinical Research Institute,
No.38 Xueyuan Road, Haidian District, Beijing 100191, China
(Feng, Yu) Peking University People's Hospital, Department of
Anesthesiology, No.11 Xizhimen South Street, Xicheng District, Beijing
100044, China
(Guo, Li) Peking University Third Hospital, Department of Anesthesiology,
No.49 Huayuan North Road, Haidian District, Beijing 100191, China
(Zhao, Hu) Beijing Shijitan Hospital, Department of Anesthesiology, No.10
Tieyi Road, Haidian District, Beijing 100038, China
(Zuo, Zhang) Beijing Hospital, Department of Anesthesiology, No.1 Dahua
Road, Dongcheng District, Beijing 100730, China
Title
Effects of two different anesthesia-analgesia methods on incidence of
postoperative delirium in elderly patients undergoing major thoracic and
abdominal surgery: Study rationale and protocol for a multicenter
randomized controlled trial.
Source
BMC Anesthesiology. 15 (1) (no pagination), 2015. Article Number: 144.
Date of Publication: October 13, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Delirium is a common complication in elderly patients after
surgery and associated with increased morbidity and mortality. Studies
suggest that deep anesthesia and intense pain are important precipitating
factors of postoperative delirium. Neuraxial block is frequently used in
combination with general anesthesia for patients undergoing major thoracic
and abdominal surgery. Compared with general anesthesia alone and
postoperative intravenous analgesia, combined epidural-general anesthesia
and postoperative epidural analgesia decreases the requirement of general
anesthetics during surgery and provided better pain relief after surgery.
However, whether combined epidural-general anesthesia plus epidural
analgesia is superior to general anesthesia plus intravenous analgesia in
decreasing the incidence of postoperative delirium remains unknown.
Methods/design: This is a multicenter, open-label, randomized,
parallel-controlled clinical trial. One thousand eight hundred elderly
patients (age range 60-90 years) who are scheduled to undergo major
thoracic or abdominal surgery are randomized to receive either general
anesthesia plus postoperative intravenous analgesia or combined
epidural-general anesthesia plus postoperative epidural analgesia. The
primary outcome is the 7-day incidence of postoperative delirium.
Secondary outcomes include the duration of postoperative delirium, the
intensity of pain during the first three days after surgery, the 30-day
incidences of postoperative non-delirium complications, the length of stay
in hospital after surgery and 30-day all-cause mortality. Discussion:
Results of the present study will provide information to guide clinical
practice in choosing appropriate anesthesia-analgesia method for elderly
patients undergoing major thoracic and abdominal surgery. Trial
registration: The study is registered on ClinicalTrials.gov NCT01661907and
Chinese Clinical Trial Registry ChiCTR-TRC-12002371. Copyright &#xa9; 2015
Li et al.

<263>
Accession Number
615152457
Author
Biancari F.; Ruggieri V.G.; Perrotti A.; Svenarud P.; Dalen M.; Onorati
F.; Faggian G.; Santarpino G.; Maselli D.; Dominici C.; Nardella S.;
Musumeci F.; Gherli R.; Mariscalco G.; Masala N.; Rubino A.S.; Mignosa C.;
De Feo M.; Della Corte A.; Bancone C.; Chocron S.; Gatti G.; Gherli T.;
Kinnunen E.-M.; Juvonen T.
Institution
(Biancari, Kinnunen, Juvonen) Department of Surgery, Oulu University
Hospital, Oulu, Finland
(Ruggieri) Division of Cardiothoracic and Vascular Surgery, Pontchaillou
University Hospital, Rennes, France
(Perrotti, Chocron) Department of Thoracic and Cardio-Vascular Surgery,
University Hospital Jean Minjoz, Besancon, France
(Svenarud, Dalen) Department of Molecular Medicine and Surgery, Department
of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet,
Karolinska University Hospital, Stockholm, Sweden
(Onorati, Faggian) Division of Cardiovascular Surgery, Verona University
Hospital, Verona, Italy
(Santarpino) Department of Cardiac Surgery, Klinikum Nurnberg, Paracelsus
Medical University, Nuremberg, Germany
(Maselli, Dominici, Nardella) Department of Cardiac Surgery, St. Anna
Hospital, Catanzaro, Italy
(Musumeci, Gherli) Unit of Cardiac Surgery, Department of Cardiosciences,
Hospital S. Camillo-Forlanini, Rome, Italy
(Mariscalco, Masala) Department of Cardiac Surgery, Leicester University
Hospital, Leicester, UK
(Rubino, Mignosa) Cardiac Surgery Unit, Ferrarotto Hospital, University of
Catania, Catania, Italy
(De Feo, Della Corte, Bancone) Division of Cardiac Surgery, Department of
Cardiothoracic Sciences, Second University of Naples, Naples, Italy
(Gatti) Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
(Gherli) Division of Cardiac Surgery, University of Parma, Parma, Italy
Title
European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG
registry): Study Protocol for a Prospective Clinical Registry and Proposal
of Classification of Postoperative Complications.
Source
Journal of cardiothoracic surgery. 10 (pp 90), 2015. Date of Publication:
30 Jun 2015.
Abstract
BACKGROUND: Clinical evidence in coronary surgery is usually derived from
retrospective, single institutional series. This may introduce significant
biases in the analysis of critical issues in the treatment of these
patients. In order to avoid such methodological limitations, we planned a
European multicenter, prospective study on coronary artery bypass
grafting, the E-CABG registry.
DESIGN: The E-CABG registry is a multicenter study and its data are
prospectively collected from 13 centers of cardiac surgery in university
and community hospitals located in six European countries (England, Italy,
Finland, France, Germany, Sweden). Data on major and minor immediate
postoperative adverse events will be collected. Data on late all-cause
mortality, stroke, myocardial infarction and repeat revascularization will
be collected during a 10-year follow-up period. These investigators
provided a score from 0 to 10 for any major postoperative adverse events
and their rounded medians were used to stratify the severity of these
complications in four grades. The sum of these scores for each
complication/intervention occurring after coronary artery bypass grafting
will be used as an additive score for further stratification of the
prognostic importance of these events.
DISCUSSION: The E-CABG registry is expected to provide valuable data for
identification of risk factors and treatment strategies associated with
suboptimal outcome. These information may improve the safety and
durability of coronary artery bypass grafting. The proposed classification
of postoperative complications may become a valuable research tool to
stratify the impact of such complications on the outcome of these patients
and evaluate the burden of resources needed for their treatment.
CLINICAL TRIALS NUMBER: NCT02319083.

<264>
Accession Number
615153464
Author
Ripolles J.; Espinosa A.; Casans R.; Tirado A.; Abad A.; Fernandez C.;
Calvo J.
Institution
(Ripolles) Anestesia y Reanimacion, Hospital Universitario Infanta Leonor,
Madrid, Spain. Electronic address: ripo542@gmail.com
(Espinosa) Thorax Anesthesiology and Intensive Care Consultant, Thorax
Centrum, Karlskrona, Sweden
(Casans) Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain
(Tirado) Anestesia y Reanimacion, Hospital Universitario Infanta Leonor,
Madrid, Spain
(Abad) Anestesia y Reanimacion, Hospital Universitario La Paz, Madrid,
Spain
(Fernandez) Universidad Complutense de Madrid, Unidad de Metodologia de la
Investigacion y Epidemiologia clinica, Servicio de Medicina Preventiva,
Hospital Clinico San Carlos, Madrid, Spain
(Calvo) Universidad Complutense de Madrid, Hospital Universitario Infanta
Leonor, Madrid, Spain
Title
Colloids versus crystalloids in objective-guided fluid therapy, systematic
review and meta-analysis. Too early or too late to draw conclusions.
Source
Brazilian journal of anesthesiology (Elsevier). 65 (4) (pp 281-291), 2015.
Date of Publication: 01 Jul 2015.
Abstract
INTRODUCTION: Several clinical trials on Goal directed fluid therapy
(GDFT) were carried out, many of those using colloids in order to optimize
the preload. After the decision of European Medicines Agency, there is
such controversy regarding its use, benefits, and possible contribution to
renal failure. The objective of this systematic review and meta-analysis
is to compare the use of last-generation colloids, derived from corn, with
crystalloids in GDFT to determine associated complications and mortality.
METHODS: A bibliographic research was carried out in MEDLINE PubMed,
EMBASE and Cochrane Library, corroborating randomized clinical trials
where crystalloids are compared to colloids in GDFT for major non-cardiac
surgery in adults.
RESULTS: One hundred thirty references were found and among those 38 were
selected and 29 analyzed; of these, six were included for systematic
review and meta-analysis, including 390 patients. It was observed that the
use of colloids is not associated with the increase of complications, but
rather with a tendency to a higher mortality (RR [95% CI] 3.87
[1.121-13.38]; I(2)=0.0%; p=0.635).
CONCLUSIONS: Because of the limitations of this meta-analysis due to the
small number of randomized clinical trials and patients included, the
results should be taken cautiously, and the performance of new randomized
clinical trials is proposed, with enough statistical power, comparing
balanced and unbalanced colloids to balanced and unbalanced crystalloids,
following the protocols of GDFT, considering current guidelines and
suggestions made by groups of experts. Copyright &#xa9; 2014 Sociedade
Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All
rights reserved.

<265>
Accession Number
615161703
Author
Verma S.; Goodman S.G.; Mehta S.R.; Latter D.A.; Ruel M.; Gupta M.;
Yanagawa B.; Al-Omran M.; Gupta N.; Teoh H.; Friedrich J.O.
Institution
(Verma, Latter, Yanagawa, Teoh) Division of Cardiac Surgery, Keenan
Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute
of St. Michael's Hospital, Toronto, ON, M5B 1W8, Canada
(Verma, Latter, Yanagawa, Teoh) Department of Surgery, St. Michael's
Hospital, Toronto, ON, M5B 1W8, Canada
(Verma, Latter, Yanagawa) Department of Surgery, University of Toronto,
Toronto, ON, M5S 2J7, Canada
(Verma) King Saud University, Riyadh, 12372, Saudi Arabia
(Goodman) Division of Cardiology, Li Ka Shing Knowledge Institute of St.
Michael's Hospital, Toronto, ON, M5B 1W8, Canada
(Goodman, Teoh, Friedrich) Department of Medicine, St. Michael's Hospital,
Toronto, ON, M5B 1W8, Canada
(Goodman, Gupta, Friedrich) Department of Medicine, University of Toronto,
Toronto, ON, M5S 2J7, Canada
(Mehta, Gupta) Department of Medicine, McMaster University, Hamilton, ON
L8L 2X2, Canada
(Mehta) Population Health Research Institute, Hamilton Health Sciences,
Hamilton, ON, L8L 2X2, Canada
(Ruel) University of Ottawa Heart Institute, Ottawa, ON, K1Y 4W7, Canada
(Gupta) Canadian Cardiovascular Research Network, Brampton, ON, L6Z 4N5,
Canada
(Al-Omran) Division of Vascular Surgery, Keenan Research Centre for
Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's
Hospital, Toronto, ON, M5B 1W8, Canada. AlOmranM@smh.ca
(Al-Omran) Department of Surgery, St. Michael's Hospital, Toronto, ON, M5B
1W8, Canada. AlOmranM@smh.ca
(Al-Omran) Department of Surgery, University of Toronto, Toronto, ON, M5S
2J7, Canada. AlOmranM@smh.ca
(Al-Omran) King Saud University, Riyadh, 12372, Saudi Arabia.
AlOmranM@smh.ca
(Gupta) The Ottawa Hospital, Ottawa, ON, K1H 8L6, Canada
(Teoh) Division of Endocrinology & Metabolism, Keenan Research Centre for
Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's
Hospital, Toronto, ON, M5B 1W8, Canada
(Friedrich) Department of Critical Care, St. Michael's Hospital, Toronto,
ON, M5B 1W8, Canada
(Friedrich) Interdepartmental Division of Critical Care, University of
Toronto, Toronto, ON, M5S 2J7, Canada
Title
Should dual antiplatelet therapy be used in patients following coronary
artery bypass surgery? A meta-analysis of randomized controlled trials.
Source
BMC surgery. 15 (pp 112), 2015. Date of Publication: 14 Oct 2015.
Abstract
BACKGROUND: We assessed the effectiveness of dual antiplatelet therapy
(DAPT) post elective or urgent (i.e., post acute coronary syndrome [ACS])
coronary artery bypass graft surgery (CABG).
METHODS: We systematically searched MEDLINE, EMBASE, and the Cochrane
Registry from inception to August 2015. Randomized controlled trials
(RCTs) in adults undergoing CABG comparing either dual vs. single
antiplatelet therapy or higher- vs. lower-intensity DAPT were identified.
RESULTS: Nine RCTs (n=4,887) with up to 1y follow-up were included. Five
RCTs enrolled patients post-elective CABG (n=986). Two multi-centre RCTs
enrolled ACS patients who subsequently underwent CABG (n=2,155). These 7
RCTs compared clopidogrel plus aspirin to aspirin alone. Two other
multi-centre RCTs reported on ACS patients who subsequently underwent CABG
comparing higher intensity DAPT with either ticagrelor (n=1,261) or
prasugrel (n=485) plus aspirin to clopidogrel plus aspirin. Post-operative
anti-platelet therapy was started when chest tube bleeding was no longer
significant, typically within 24-48 h. There were no differences in
all-cause mortality in clopidogrel plus aspirin vs. aspirin RCTs;
conversely, all-cause mortality was significantly lower in ticagrelor and
prasugrel vs. clopidogrel RCTs (risk ratio[RR] 0.49, 95% confidence
interval[CI] 0.33-0.71, p=0.0002; 2 RCTs, n=1695; I(2) =0%; interaction
p<0.01 compared to clopidogrel plus aspirin vs aspirin RCTs). There were
no differences in myocardial infarctions, strokes, or composite outcomes.
Overall, major bleeding was not significantly increased (RR 1.31, 95% CI
0.81-2.10, p=0.27; 7 RCTs, n=4500). There was heterogeneity (I(2) =42%)
due almost entirely to higher bleeding reported for the prasugrel RCT
which included mainly CABG-related major bleeding (RR 3.15, 95% CI
1.45-6.87, p=0.004; 1 RCT, n=437).
CONCLUSIONS: Most RCT data for DAPT post CABG is derived from subgroups of
ACS patients in DAPT RCTs requiring CABG who resume DAPT post-operatively.
Limited RCT data with heterogeneous trial designs suggest that higher
intensity (prasugrel or ticagrelor) but not lower intensity (clopidogrel)
DAPT is associated with an approximate 50% lower mortality in ACS patients
who underwent CABG based on post-randomization subsets from single RCTs.
Large prospective RCTs evaluating the use of DAPT post-CABG are warranted
to provide more definitive guidance for clinicians.

<266>
Accession Number
615171860
Author
Murarka S.; Lazkani M.; Moualla S.; Verma D.R.; Pershad A.
Institution
(Murarka, Lazkani, Moualla, Verma, Pershad) Division of Interventional
Cardiology, University of Arizona at Banner University Medical Center,
Phoenix, AZ, United States
Title
Left atrial anatomy and patient-related factors associated with adverse
outcomes with the watchman device-a real world experience.
Source
Journal of Interventional Cardiology. 30 (2) (pp 163-169), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: This study sought to identify patient and left atrial
morphology specific factors associated with early complications for left
atrial appendage occlusion with the WatchmanTM (Boston Scientific, Natick,
MA) device. Background: Oral anticoagulation (OAC) is recommended for
patients with atrial fibrillation, however, long-term OAC compliance is
poor. In randomized control trials, the WatchmanTM device has demonstrated
superiority over OAC with warfarin for all cause and cardiovascular
mortality and hemorrhagic stroke. However, predictors of procedural
complications have not yet been well established. Methods: There were 137
patients included in this study from a total of 141 consecutive patients
prospectively enrolled in the registry between 8/1/2015 and 08/31/2016.
Unadjusted, multivariate cox proportional hazards model was used for
analysis. Primary end-point was a composite major adverse cardiac and
cerebrovascular event (MACCE) defined to include death, stroke, major and
life threatening bleeding, major vascular complications, device
embolization, need for cardiovascular surgery, need for cardiopulmonary
resuscitation, and significant pericardial effusion. Results: The primary
endpoint was reached in 5.8% of patients. There were no device
embolization and no strokes. Anterior chicken morphology (ACW) of the left
atrial appendage (LAA) conferred a hazard ratio of 3.7 for MACCE and a
body mass index >30 kg/m² significantly lowered the likelihood
of a MACCE. Conclusion: Certain LAA morphologies and patient
characteristics increase the risk for a MACCE following left atrial
appendage occlusion (LAAO) with the WatchmanTM device. Anterior chicken
wing morphology of the LAA and low BMI <30 kg/m² were
independent predictors of MACCE in the multivariate regression model.
Copyright &#xa9; 2017, Wiley Periodicals, Inc.

<267>
Accession Number
615168777
Author
Banovic M.D.
Institution
(Banovic) Cardiology Department, University Clinical Center of Serbia,
Belgrade, Serbia
(Banovic) Belgrade Medical School, University of Belgrade, Belgrade,
Serbia
Title
Changing concept in treatment of asymptomatic severe aortic stenosis and
normal ejection fraction: Time for biomarkers reappraisal.
Source
Biomarkers in Medicine. 11 (4) (pp 369-376), 2017. Date of Publication:
April 2017.
Publisher
Future Medicine Ltd. (E-mail: info@futuremedicine.com)
Abstract
The uncertainty of whether/how to treat asymptomatic patients with
isolated severe aortic stenosis and normal left ventricular ejection
fraction is one of the most topical in cardiovascular medicine. Recently,
the AVATAR trial: First ever randomized trial in the setting of aortic
stenosis has been started in an attempt to adequately address this
'burning issue'. In light of this fact it is important to identify
biomarkers which might help in risk stratification of these patients, not
only in the referring physician's office during a routine exam, but also
for preoperative patients scheduled for surgical replacement/transcatheter
aortic valve implantation. This report is focusing on novel laboratory
parameters which might be helpful in this risk stratification. Copyright
&#xa9; 2017 Future Medicine Ltd.

<268>
Accession Number
615172811
Author
Rubboli A.; Saia F.; Sciahbasi A.; Leone A.M.; Palmieri C.;
Bacchi-Reggiani M.L.; Calabro P.; Bordoni B.; Piccalo G.; Franco N.;
Nicolino A.; Magnavacchi P.; Vignali L.; Mameli S.; Dallago M.; Maggiolini
S.; Steffanon L.; Piovaccari G.; Di Pasquale G.
Institution
(Rubboli, Di Pasquale) Division of Cardiology - Laboratory of
Interventional Cardiology, Ospedale Maggiore, Bologna, Italy
(Saia, Bacchi-Reggiani, Bordoni) Cardio-Thoraco-Vascular Department,
University Hospital S. Orsola-Malpighi, Bologna, Italy
(Sciahbasi) Unit of Interventional Cardiology, Ospedale Sandro Pertini,
Roma, Italy
(Leone) Department of Cardiovascular Sciences, Universita Cattolica del
Sacro Cuore, Roma, Italy
(Palmieri) Division of Interventional Cardiology, Ospedale del Cuore G.
Pasquinucci, Massa, Italy
(Calabro) Division of Cardiology, Seconda Universita, Ospedale Monaldi,
Napoli, Italy
(Piccalo) Division of Cardiology 1, Ospedale Niguarda, Milano, Italy
(Franco, Piovaccari) Division of Cardiology, Ospedale degli Infermi,
Rimini, Italy
(Nicolino) Division of Cardiology, Ospedale S. Corona, Pietra Ligure,
Italy
(Magnavacchi) Division of Cardiology, Ospedale Civile S. Agostino Estense,
Modena, Italy
(Vignali) Division of Cardiology, Azienda Ospedaliera-Universitaria,
Parma, Italy
(Mameli) Division of Cardiology, Ospedale S. Francesco, Nuoro, Italy
(Dallago) Division of Cardiology, Ospedale S. Chiara, Trento, Italy
(Maggiolini) Division of Cardiology, Ospedale S. Leopoldo Mandic, Merate,
Italy
(Steffanon) Unit of Cardiac and Vascular interventions, Hesperia Hospital,
Modena, Italy
Title
Twelve-Month Outcome of Patients with an Established Indication for Oral
Anticoagulation Undergoing Coronary Artery Stenting and Stratified by the
Baseline Risk of Bleeding. Insights from the Warfarin and Coronary
Stenting (War-Stent) Registry.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2017. Date of
Publication: February 08, 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Purpose: To evaluate the outcome of patients with an established
indication for oral anticoagulation (OAC) undergoing coronary stent
implantation (PCI-S) and stratified by the baseline risk of bleeding.
Material and methods: The database of the prospective, multicentre,
observational WAR-STENT registry (ClinicalTrials.gov identifier
NCT00722319) was analyzed and patients with atrial fibrillation and
CHA<inf>2</inf>DS<inf>2</inf>-VASc score >2, mechanical heart valve, prior
cardiac embolism, intra-cardiac thrombus and recent venous thromboembolism
who were treated with either triple (warfarin, aspirin and clopidogrel) or
dual (warfarin and clopidogrel) or dual antiplatelet (aspirin and
clopidogrel) therapy, identified. Patients were then sorted into two
groups at non-low and low risk of bleeding, as defined by an ATRIA score
>3 and <3 respectively, and compared regarding major adverse cardiac and
vascular events (MACVE) and bleeding. Results: At 12-month follow up,
MACVE were comparable in the two groups, whereas total, major and minor
bleeding, as well as combined MACVE and total bleeding, were significantly
more frequent in the non-low bleeding risk group. Upon Cox univariate and
multivariable analysis, non-low bleeding risk category confirmed as an
independent predictor of major bleeding. The choice of antithrombotic
therapy however, appeared not to be influenced by the bleeding risk
category at baseline. Conclusions: In patients with an established
indication for OAC undergoing PCI-S, non-low bleeding risk category is the
most potent independent predictor of major bleeding. Stratification of the
bleeding risk at baseline should therefore be regarded as an indispensable
process to be carried out before selection of the antithrombotic therapy.
Copyright &#xa9; 2017 Elsevier Inc.

<269>
Accession Number
613011746
Author
Aytekin B.; Unal E.U.; Demir A.; Aksu U.; Caliskan A.; Vardar K.; Toraman
F.; Saritas A.
Institution
(Aytekin, Unal, Caliskan, Saritas) Department of Cardiovascular Surgery,
Turkey Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
(Demir) Department of Anesthesiology and Reanimation, Turkey Yuksek
Ihtisas Training and Research Hospital, Ankara, Turkey
(Aksu, Vardar) Department of Biology, Science Faculty, Istanbul
University, Istanbul, Turkey
(Toraman) Department of Anesthesiology and Reanimation, University of
Acibadem, Istanbul, Turkey
Title
Unilateral Antegrade Cerebral Perfusion and Moderate Hypothermia:
Assessing Safety With Novel Biomarkers.
Source
Heart Lung and Circulation. 26 (5) (pp 495-503), 2017. Date of
Publication: 01 May 2017.
Publisher
Elsevier Ltd
Abstract
Background Antegrade cerebral perfusion in aortic surgery is a
well-established brain protection method. Open distal anastomosis during
aortic surgery has some well-known advantages. Antegrade cerebral
perfusion allows repair to some extent of the aortic arch, even in
isolated ascending aortic aneurysm. The present study aims to investigate
the adequacy of contralateral perfusion with novel oxidative stress
parameters during unilateral antegrade cerebral perfusion. Method The
study included 30 consecutive patients undergoing thoracic aortic surgery
with unilateral antegrade cerebral perfusion (uACP) under moderate
hypothermia (28degree C). Blood samples from right and left jugular vein
were obtained at four time intervals during surgery (after the anaesthetic
induction - Phase 1, at the beginning of cardiopulmonary bypass - Phase 2,
15^th minute of uACP - Phase 3 and after weaning from
cardiopulmonary bypass - Phase 4). Novel oxidative stress parameters
(advanced oxidation protein products, sialic acid, thiol reagents and
ischaemia-modified serum albumin), blood gas analysis, and serum glucose
and lactate levels were measured. In addition, intraoperative and early
postoperative follow-up parameters were recorded. Results Mean unilateral
antegrade cerebral perfusion time was observed to be 16.4 +/- 5.9 min (9 -
46 min). No significant differences between right and left hemispheres
were observed in novel oxidative parameters or biochemical values. There
was only one temporary neurological deficit (3.3%) in the patient group.
Conclusions The present study demonstrated that open distal anastomosis
for hemiarch repair can be performed safely with unilateral antegrade
cerebral perfusion under moderate hypothermia with both clinical outcome
and novel biomarkers. Copyright &#xa9; 2016 Australian and New Zealand
Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society
of Australia and New Zealand (CSANZ)

<270>
Accession Number
615114640
Author
Nguyen A.; Dean S.; Frank R.; Molina M.; Kamoun M.; Lal P.
Institution
(Nguyen, Dean, Frank, Molina, Kamoun, Lal) Hospital of the University of
Pennsylvania, Philadelphia, PA, United States
Title
Assessment of the ISHLT antibody-mediated rejection grading system for
cardiac transplantation and association with donor specific antibodies and
endothelial activation.
Source
Laboratory Investigation. Conference: 106th Annual Meeting of the United
States and Canadian Academy of Pathology, USCAP 2017. United States.
Conference Start: 20170304. Conference End: 20170310. 97 (pp 83A), 2017.
Date of Publication: February 2017.
Publisher
Nature Publishing Group
Abstract
Background: Antibody-mediated rejection (AMR) is a diagnostic and
therapeutic challenge in heart transplantation. The International Society
for Heart and Lung Transplant (ISHLT) proposed a new grading scheme for
AMR in 2011 that combines both histopathologic and immunologic features.
Design: This retrospective, single institutional analysis (2005-2011)
evaluated cardiac transplant endomyocardial biopsies (EMBs) of patients
who had concurrent C4d immunofluorescence (IF) and donor specific antibody
(DSA) levels. After blinded screening and categorization of EMBs for the
histopathologic AMR features, EMBs were then immunostained with
E-selectin, a purported marker for endothelial activation. EMBs with >2 or
>4 histopathologic features were considered at least AMR1 or AMR3,
respectively. C4d IF was deemed positive if >50% capillary staining was
observed. E-selectin was positive if membranous endothelial staining was
present. Results: AMR was assessed in 106 EMBs and further classified as
follows: Circulating DSA was observed in 48% of patients spanning all
grades (AMR0 to AMR3). Endothelial activation was the most frequently
observed histologic finding across all AMR grades (68%) with a 78%
sensitivity in predicting a positive DSA status. Moreover, endothelial
activation and intravascular macrophages independently correlated with DSA
status (p<0.01). Among the pAMR+ specimens, E-selectin
immunohistochemistry was overall positive in only 10%, and predominantly
in AMR1-h and AMR-2. All E-selectin positive cases histologically
correlated with endothelial activation and interstitial edema. Lastly, of
the E-selectin positive cases, 40% were concomitantly C4d positive at the
time of biopsy. Interestingly, all cases with E-selectin positivity went
on to develop C4d positivity. Conclusions: The ISHLT 2011 pAMR grading
system statistically correlates with DSA. Moreover, the presence of
endothelial activation should raise the suspicion for AMR. This study's
proposed immunomarker for endothelial activation, E-selectin, was
biologically promising, though the proportion of cases staining positive
may be too small for clinical significance and will be further
characterized. (Table Presented) .

<271>
Accession Number
614538074
Author
Tong A.; Sautenet B.; Chapman J.R.; Harper C.; MacDonald P.; Shackel N.;
Crowe S.; Hanson C.; Hill S.; Synnot A.; Craig J.C.
Institution
(Tong, Sautenet, Harper, Hanson, Craig) Sydney School of Public Health,
The University of Sydney, Sydney, NSW, Australia
(Tong, Sautenet, Harper, Hanson, Craig) Centre for Kidney Research, The
Children's Hospital at Westmead, Sydney, NSW, Australia
(Chapman) Centre for Transplant and Renal Research, Westmead Hospital,
Sydney, NSW, Australia
(MacDonald) Heart Transplant Unit, St Vincent's Hospital, Sydney, NSW,
Australia
(MacDonald) Transplantation Research Laboratory, Victor Chang, Cardiac
Research Institute, Sydney, NSW, Australia
(Shackel) Department of Medicine, University of New South Wales, Sydney,
NSW, Australia
(Crowe) Crowe Associates Ltd, Oxon, United Kingdom
(Hill, Synnot) Centre for Health Communication and Participation, La Trobe
University, Melbourne, VIC, Australia
(Synnot) School of Preventive Medicine and Public Health, Monash
University, Melbourne, VIC, Australia
Title
Research priority setting in organ transplantation: a systematic review.
Source
Transplant International. 30 (4) (pp 327-343), 2017. Date of Publication:
01 Apr 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Barriers to access and long-term complications remain a challenge in
transplantation. Further advancements may be achieved through research
priority setting with patient engagement to strengthen its relevance. We
evaluated research priority setting in solid organ transplantation and
described stakeholder priorities. Databases were searched to October 2016.
We synthesized the findings descriptively. The 28 studies (n = 2071
participants) addressed kidney [9 (32%)], heart [7 (25%)], liver [3
(11%)], lung [1 (4%)], pancreas [1 (4%)], and nonspecified organ
transplantation [7 (25%)] using consensus conferences, expert panel
meetings, workshops, surveys, focus groups, interviews, and the Delphi
technique. Nine (32%) reported patient involvement. The 336 research
priorities addressed the following: organ donation [43 priorities (14
studies)]; waitlisting and allocation [43 (10 studies)];
histocompatibility and immunology [31 (8 studies)]; immunosuppression [21
(10 studies)]; graft-related complications [38 (13 studies)]; recipient
(non-graft-related) complications [86 (14 studies)]; reproduction [14 (1
study)], psychosocial and lifestyle [49 (7 studies)]; and disparities in
access and outcomes [10 (4 studies)]. The priorities identified were broad
but only one-third of initiatives engaged patients/caregivers, and details
of the process were lacking. Setting research priorities in an explicit
manner with patient involvement can guide investment toward the shared
priorities of patients and health professionals. Copyright &#xa9; 2017
Steunstichting ESOT

<272>
Accession Number
615008549
Author
Katsargyris A.; Klonaris C.; Verhoeven E.L.G.
Institution
(Katsargyris, Verhoeven) Department of Vascular and Endovascular Surgery,
Paracelsus Medical University, Nuremberg General Hospital, Breslauer
Strasse 201, Nuremberg, Germany
(Klonaris) Vascular Division, First Department of Surgery, Athens
University Medical School, Athens, Greece
Title
Is volume important in aneurysm treatment outcome?.
Source
Journal of Cardiovascular Surgery. 58 (2) (pp 187-193), 2017. Date of
Publication: April 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Several studies have suggested that surgical procedures performed at
high-volume centers may result in superior outcome. Technically more
demanding procedures such as aortic aneurysm repair appear to demonstrate
a stronger relationship with volume. The present chapter reviewed the
literature using the MEDLINE database to identify studies investigating
the effect of volume in aortic aneurysm repair outcomes. The great
majority of studies identified shows an advantage for high-volume
hospitals with regard to perioperative mortality of abdominal (AAA),
thoracic (TAA) and thoracoabdominal (TAAA) aortic aneurysm repair. A
similar advantage is shown for high-volume surgeons. The volume advantage
appears to be less evident for simple endovascular procedures (EVAR &
TEVAR), compared to more complex endovascular (F/BEVAR) and open surgical
procedures. Superior outcomes observed in high-volume hospitals are not
only explained by increased surgeons' experience, but importantly also by
a more effective management of intra- and postoperative complications.
Confounding factors to be taken into account are the timing of the studies
in relation to positive evolution of outcomes in several high-risk
procedures, and patient cohorts selected in regions with very low- and
very high-volume hospitals only. Copyright &#xa9; 2016 EDIZIONI MINERVA
MEDICA.

<273>
Accession Number
614951242
Author
Landray M.J.; REVEAL Collaborative Group
Institution
(Landray, REVEAL Collaborative Group) REVEAL Central Coordinating Office,
Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield
Department of Population Health, University of Oxford, United Kingdom
Title
Randomized Evaluation of the Effects of Anacetrapib through
Lipid-modification (REVEAL)-A large-scale, randomized, placebo-controlled
trial of the clinical effects of anacetrapib among people with established
vascular disease: Trial design, recruitment, and baseline characteristics.
Source
American Heart Journal. 187 (pp 182-190), 2017. Date of Publication: 01
May 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Patients with prior vascular disease remain at high risk for
cardiovascular events despite intensive statin-based treatment. Inhibition
of cholesteryl ester transfer protein by anacetrapib reduces low-density
lipoprotein (LDL) cholesterol by around 25% to 40% and more than doubles
high-density lipoprotein (HDL) cholesterol. However, it is not known if
these apparently favorable lipid changes translate into reductions in
cardiovascular events. Methods The REVEAL study is a randomized,
double-blind, placebo-controlled clinical trial that is assessing the
efficacy and safety of adding anacetrapib to effective LDL-lowering
treatment with atorvastatin for an average of at least 4 years among
patients with preexisting atherosclerotic vascular disease. The primary
assessment is an intention-to-treat comparison among all randomized
participants of the effects of allocation to anacetrapib on major coronary
events (defined as the occurrence of coronary death, myocardial
infarction, or coronary revascularization). Results Between August 2011
and October 2013, 30,449 individuals in Europe, North America, and China
were randomized to receive anacetrapib 100 mg daily or matching placebo.
Mean (SD) age was 67 (8) years, 84% were male, 88% had a history of
coronary heart disease, 22% had cerebrovascular disease, and 37% had
diabetes mellitus. At the randomization visit (after at least 8 weeks on a
protocol-defined atorvastatin regimen), mean plasma LDL cholesterol was 61
(15) mg/dL and HDL cholesterol was 40 (10) mg/dL. Interpretation The
REVEAL trial will provide a robust evaluation of the clinical efficacy and
safety of adding anacetrapib to an effective statin regimen. Results are
anticipated in 2017. Copyright &#xa9; 2017 The Authors

<274>
Accession Number
614508721
Author
Migliore F.; Allocca G.; Calzolari V.; Crosato M.; Facchin D.; Daleffe E.;
Zecchin M.; Fantinel M.; Cannas S.; Arancio R.; Marchese P.; Zanon F.;
Zorzi A.; Iliceto S.; Bertaglia E.
Institution
(Migliore, Zorzi, Iliceto, Bertaglia) Department of Cardiac, Thoracic and
Vascular Sciences, University of Padova, Padova, Italy
(Allocca) Department of Cardiology, General Hospital of Conegliano,
Treviso, Italy
(Calzolari, Crosato) Department of Cardiology, Ca Foncello, Civil
Hospital, Treviso, Italy
(Facchin, Daleffe) Ospedale S. Maria della Misericordia, University of
Udine, Udine, Italy
(Zecchin) Cardiovascular Department, University of Trieste, Trieste, Italy
(Fantinel) Department of Cardiology, Civil Hospital, Feltre, Belluno,
Italy
(Cannas, Arancio) Department of Cardiology, Santorso Civil Hospital,
Thiene, Vicenza, Italy
(Marchese) Department of Cardiology, Mazzoni Civil Hospital, Ascoli
Piceno, Italy
(Zanon) Cardiology Department, Arrhythmia and Electrophysiology Unit,
Santa Maria Della Misericordia Hospital, Rovigo, Italy
Title
Intermuscular Two-Incision Technique for Subcutaneous Implantable
Cardioverter Defibrillator Implantation: Results from a Multicenter
Registry.
Source
PACE - Pacing and Clinical Electrophysiology. 40 (3) (pp 278-285), 2017.
Date of Publication: 01 Mar 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: The traditional technique for subcutaneous implantable
cardioverter defibrillator (S-ICD) implantation, which involves three
incisions and a subcutaneous pocket, is associated with possible
complications, including inappropriate interventions. The aim of this
prospective multicenter study was to evaluate the efficacy and safety of
an alternative intermuscular two-incision technique for S-ICD
implantation. Methods: The study population included 36 consecutive
patients (75% male, mean age 44 +/- 12 years [range 20-69]) who underwent
S-ICD implantation using the intermuscular two-incision technique. This
technique avoids the superior parasternal incision for the lead placement
and consists of creating an intermuscular pocket between the anterior
surface of the serratus anterior and the posterior surface of the
latissimus dorsi muscles instead of a subcutaneous pocket. Results: All
patients were successfully implanted in the absence of any
procedure-related complications with a successful 65-J standard polarity
defibrillation threshold testing, except in one, who received a second
successful shock after pocket revision. During a mean follow-up of 10
months (range 3-30), no complications requiring surgical revision were
observed. At device interrogation, stable sensing without interferences
was observed in all patients. Two patients (5.5%) experienced appropriate
and successful shock on ventricular fibrillation and in four patients
(11%), a total of seven nonsustained self-terminated ventricular
tachycardias were correctly detected. No inappropriate interventions were
observed. Conclusions: Our experience suggests that the two-incision
intermuscular technique is a safe and efficacious alternative to the
current technique for S-ICD implantation that may help reducing
complications including inappropriate interventions and offer a better
cosmetic outcome, especially in thin individuals. Copyright &#xa9; 2016
The Authors. Pacing and Clinical Electrophysiology published by Wiley
Periodicals, Inc.

<275>
Accession Number
614848415
Author
Renda G.; Ricci F.; Giugliano R.P.; De Caterina R.
Institution
(Renda, Ricci, De Caterina) Institute of Cardiology and Center of
Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy
(Giugliano) Division of Cardiovascular Medicine, Brigham and Women's
Hospital, TIMI Study Group, Boston, Massachusetts, United States
Title
Non-Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial
Fibrillation and Valvular Heart Disease.
Source
Journal of the American College of Cardiology. 69 (11) (pp 1363-1371),
2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background Valvular heart disease (VHD) and atrial fibrillation (AF) often
coexist. Phase III trials comparing non-vitamin K antagonist oral
anticoagulants (NOACs) with warfarin excluded patients with
moderate/severe mitral stenosis or mechanical heart valves, but variably
included patients with other VHD and valve surgeries. Objectives This
study aimed to determine relative safety and efficacy of NOACs in patients
with VHD. Methods We performed a meta-analysis of the 4 phase III AF
trials of the currently available NOACs versus warfarin in patients with
coexisting VHD to assess pooled estimates of relative risk (RR) and 95%
confidence intervals (CIs) for stroke/systemic embolic events (SSEE),
major bleeding, intracranial hemorrhage (ICH), and all-cause death.
Results Compared with warfarin, the rate of SSEE in patients treated with
higher-dose NOACs was lower and consistent among 13,585 patients with (RR:
0.70; 95% CI: 0.58 to 0.86) or 58,098 without VHD (RR: 0.84; 95% CI: 0.75
to 0.95; interaction p = 0.13). Major bleeding in patients on higher-dose
NOACs versus warfarin was similar and consistent among patients with (RR:
0.93; 95% CI: 0.68 to 1.27) or without VHD (RR: 0.85; 95% CI: 0.70 to
1.02; interaction p = 0.63 for VHD/no-VHD difference). Intracranial
hemorrhage was lower with higher-dose NOACs than with warfarin
irrespective of VHD (RR: 0.47; 95% CI: 0.24 to 0.93, and 0.49; 95% CI:
0.41 to 059, respectively; interaction p = 0.91). No protective effect of
higher-dose NOACs in preventing all-cause death seemed to be present in
patients with VHD versus without VHD (RR:1.01; 95% CI: 0.90 to 1.14 vs.
RR: 0.88; 95% CI: 0.82 to 0.94, respectively; interaction p = 0.03).
Conclusions High-dose NOACs provide overall efficacy and safety similar in
AF patients with or without VHD. Copyright &#xa9; 2017 The Authors

<276>
Accession Number
614848100
Author
De Caterina R.; Renda G.; Carnicelli A.P.; Nordio F.; Trevisan M.; Mercuri
M.F.; Ruff C.T.; Antman E.M.; Braunwald E.; Giugliano R.P.
Institution
(De Caterina, Renda) Institute of Cardiology and Center of Excellence on
Aging, G. d'Annunzio University, Chieti, Italy
(Carnicelli, Nordio, Trevisan, Ruff, Antman, Braunwald, Giugliano)
Cardiovascular Medicine Division, Brigham and Women's Hospital, Boston,
Massachusetts, United States
(Mercuri) Pharma Development, Daiichi-Sankyo, Parsippany, New Jersey,
United States
Title
Valvular Heart Disease Patients on Edoxaban or Warfarin in the ENGAGE
AF-TIMI 48 Trial.
Source
Journal of the American College of Cardiology. 69 (11) (pp 1372-1382),
2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background The use of non-vitamin K antagonist oral anticoagulants (NOACs)
instead of vitamin K antagonists (VKAs) in patients with atrial
fibrillation (AF) and coexisting valvular heart disease (VHD) is of
substantial interest. Objectives This study explored outcomes in patients
with AF with and without VHD in the ENGAGE AF-TIMI 48 (Effective
Anticoagulation with factor Xa Next Generation in Atrial
Fibrillation-Thrombolysis In Myocardial Infarction 48) trial, comparing
edoxaban with warfarin. Methods Valvular heart disease was defined as
history or baseline echocardiography evidence of at least moderate
aortic/mitral regurgitation, aortic stenosis, or prior valve surgery
(bioprosthesis replacement, valve repair, valvuloplasty). Patients with
moderate to severe mitral stenosis or mechanical heart valves were
excluded from the trial. Comparisons were made of rates of stroke/systemic
embolic event (SSEE), major bleeding, additional efficacy and safety
outcomes, as well as net clinical outcomes, in patients with or without
VHD treated with edoxaban or warfarin, using adjusted Cox proportional
hazards. Results After adjustment for multiple baseline characteristics,
compared with no-VHD patients (n = 18,222), VHD patients (n = 2,824) had a
similar rate of SSEE but higher rates of death (hazard ratio [HR]: 1.40;
95% confidence interval [CI]:1.26 to 1.56; p <0.001), major adverse
cardiovascular events (HR: 1.29; 95% CI: 1.16 to 1.43; p <0.001), and
major bleeding (HR: 1.21; 95% CI: 1.03 to 1.42; p = 0.02). Higher-dose
edoxaban regimen had efficacy similar to warfarin in the presence of VHD
(for SSEE, HR: 0.69; 95% CI: 0.44 to 1.07, in patients with VHD, and HR:
0.91; 95% CI: 0.77 to 1.07, in patients without VHD; p interaction
[p<inf>int</inf>] = 0.26; and for less major bleeding, HR: 0.74; 95% CI:
0.53 to 1.02 in patients with VHD, and HR: 0.82; 95% CI: 0.71 to 0.94, in
patients with no VHD; p<inf>int</inf> = 0.57). Conclusions The presence of
VHD increased the risk of death, major adverse cardiovascular events, and
major bleeding but did not affect the relative efficacy or safety of
higher-dose edoxaban versus warfarin in AF. (Global Study to Assess the
Safety and Effectiveness of Edoxaban (DU-176b) vs. Standard Practice of
Dosing With Warfarin in Patients With Atrial Fibrillation [ENGAGE AF-TIMI
48]; NCT00781391) Copyright &#xa9; 2017 The Authors

<277>
Accession Number
612609477
Author
Bonaa K.H.; Mannsverk J.; Wiseth R.; Aaberge L.; Myreng Y.; Nygard O.;
Nilsen D.W.; Klow N.-E.; Uchto M.; Trovik T.; Bendz B.; Stavnes S.;
Bjornerheim R.; Larsen A.-I.; Slette M.; Steigen T.; Jakobsen O.J.; Bleie
O.; Fossum E.; Hanssen T.A.; Dahl-Eriksen O.; Njolstad I.; Rasmussen K.;
Wilsgaard T.; Nordrehaug J.E.
Institution
(Bonaa, Njolstad, Wilsgaard) Department of Community Medicine, Norway
(Steigen, Hanssen, Rasmussen) Department of Clinical Medicine, University
of Tromso, Arctic University of Norway, Norway
(Mannsverk, Trovik, Steigen, Hanssen, Dahl-Eriksen, Rasmussen) Department
of Cardiology, University Hospital of North Norway, Tromso, Norway
(Bonaa) Departments of Public Health and General Medicine, Norway
(Wiseth) Department of Circulation and Medical Imaging, Norwegian
University of Science and Technology, Norway
(Bonaa, Wiseth, Slette) Clinic for Heart Disease, St. Olav's University
Hospital, Trondheim N 7006, Norway
(Aaberge, Bendz, Fossum) Department of Cardiology, Norway
(Klow) Department of Radiology, Norway
(Bjornerheim) Department of Heart Disease, Oslo University Hospital,
Norway
(Klow, Bendz) Faculty of Medicine, University of Oslo, Oslo, Norway
(Myreng, Stavnes) Department of Cardiology, Feiring Heart Clinic, Feiring,
Norway
(Nygard, Bleie) Department of Heart Disease, Haukeland University
Hospital, Norway
(Nygard, Nilsen, Larsen, Nordrehaug) Department of Clinical Science,
University of Bergen, Bergen, Norway
(Nilsen, Larsen, Nordrehaug) Department of Cardiology, Stavanger
University Hospital, Stavanger, Norway
(Uchto, Jakobsen) Department of Medicine, Sorlandet Hospital, Arendal,
Norway
Title
Drug-eluting or bare-metal stents for coronary artery disease.
Source
New England Journal of Medicine. 375 (13) (pp 1242-1252), 2016. Date of
Publication: 29 Sep 2016.
Publisher
Massachussetts Medical Society
Abstract
Background Limited data are available on the long-term effects of
contemporary drug-eluting stents versus contemporary bare-metal stents on
rates of death, myocardial infarction, repeat revascularization, and stent
thrombosis and on quality of life. METHODS We randomly assigned 9013
patients who had stable or unstable coronary artery disease to undergo
percutaneous coronary intervention (PCI) with the implantation of either
contemporary drug-eluting stents or bare-metal stents. In the group
receiving drug-eluting stents, 96% of the patients received either
everolimus-or zotarolimus-eluting stents. The primary outcome was a
composite of death from any cause and nonfatal spontaneous myocardial
infarction after a median of 5 years of follow-up. Secondary outcomes
included repeat revascularization, stent thrombosis, and quality of life.
RESULTS At 6 years, the rates of the primary outcome were 16.6% in the
group receiving drug-eluting stents and 17.1% in the group receiving
bare-metal stents (hazard ratio, 0.98; 95% confidence interval [CI], 0.88
to 1.09; P=0.66). There were no significant between-group differences in
the components of the primary outcome. The 6-year rates of any repeat
revascularization were 16.5% in the group receiving drug-eluting stents
and 19.8% in the group receiving bare-metal stents (hazard ratio, 0.76;
95% CI, 0.69 to 0.85; P<0.001); the rates of definite stent thrombosis
were 0.8% and 1.2%, respectively (P=0.0498). Quality-of-life measures did
not differ significantly between the two groups. CONCLUSIONS In patients
undergoing PCI, there were no significant differences between those
receiving drug-eluting stents and those receiving bare-metal stents in the
composite outcome of death from any cause and nonfatal spontaneous
myocardial infarction. Rates of repeat revascularization were lower in the
group receiving drugeluting stents. Copyright &#xa9; 2016 Massachusetts
Medical Society.

<278>
Accession Number
604498872
Author
Magliano C.A.S.; Saraiva R.M.; Azevedo V.M.P.; Innocenzi A.M.; Tura B.R.;
Santos M.
Institution
(Magliano, Azevedo, Innocenzi, Tura, Santos) Instituto Nacional de
Cardiologia, Mexico
(Saraiva) Instituto Nacional de Infectologia Evandro Chagas, Fundacao
Oswaldo Cruz, Brazil
Title
EFFICACY of CARPENTIER-EDWARDS PERICARDIAL PROSTHESES: A SYSTEMATIC REVIEW
and META-ANALYSIS.
Source
International Journal of Technology Assessment in Health Care. 31 (1-2)
(pp 19-26), 2015. Date of Publication: 14 Jul 2015.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Objectives: The Carpentier-Edwards pericardial (CEP) prostheses are the
type of bioprostheses most used worldwide. Although they were designed to
minimize the rate of valve deterioration and reoperation, their clinical
superiority over other prostheses models still lacks confirmation. The
objective of this study was to evaluate its effectiveness. Methods: We
performed a systematic review and meta-analysis in the PubMed, Embase,
Cochrane, and Lilacs databases. Operative mortality, overall mortality and
reoperation rates after heart valve surgery were compared between the use
of CEP and other cardiac prostheses. Two independent reviewers screened
studies for inclusion and extracted the data. Disagreements were resolved
by consensus. The GRADE criterion was used to assess the evidence quality.
Results: A total of twenty-eight studies were selected, including 19,615
individuals. The studies presented a high heterogeneity and low quality of
evidence what limited the reliability of the results. The pooled data from
the selected studies did not demonstrate significant differences between
CEP and porcine, pericardial or stentless prostheses regarding operative
mortality, overall mortality and reoperation rates. However, the pooled
data from 3 observational trials pointed out a higher risk for reoperation
after valve replacement using CEP prostheses against mechanical prostheses
(OR 4.92 [95 percent confidence interval 2.43-9.96]). Conclusions: The
current data present in the literature still does not support a clinical
advantage for the use of CEP prostheses over other bioprostheses. The
quality of the studies in the literature is limited and further studies
are needed to address if CEP prostheses will have a clinical advantage
over other prostheses. Copyright &#xa9; Cambridge University Press 2015.

<279>
Accession Number
604806059
Author
Johansson P.I.; Rasmussen A.S.; Thomsen L.L.
Institution
(Johansson, Rasmussen) Department of Clinical Immunology, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Denmark
(Thomsen) Pharmacosmos A/S, Holbaek, Denmark
Title
Intravenous iron isomaltoside 1000 (Monofer) reduces
postoperative anaemia in preoperatively non-anaemic patients undergoing
elective or subacute coronary artery bypass graft, valve replacement or a
combination thereof: A randomized double-blind placebo-controlled clinical
trial (the PROTECT trial).
Source
Vox Sanguinis. 109 (3) (pp 257-266), 2015. Date of Publication: 01 Oct
2015.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background and Objectives: This trial explores whether intravenous iron
isomaltoside 1000 (Monofer) results in a better regeneration of
haemoglobin levels and prevents anaemia compared to placebo in
preoperative non-anaemic patients undergoing cardiac surgery. Study Design
and Methods: The trial is a prospective, double-blind, comparative,
placebo-controlled trial of 60 non-anaemic patients undergoing cardiac
surgery. The patients were randomized 1:1 to either 1000 mg intravenous
iron isomaltoside 1000 administered perioperatively by infusion or
placebo. Results: Mean preoperative haemoglobin in the active treatment
group was 14.3 g/dl vs. 14.0 g/dl in the placebo group. At discharge 5
days after surgery, haemoglobin levels were reduced to 10.7 and 10.5 g/dl,
respectively. One month after surgery, haemoglobin concentration had
increased to an average of 12.6 g/dl vs. 11.8 g/dl (p = 0.012) and
significantly more patients were non-anaemic in the intravenous iron
isomaltoside 1000-treated group compared to the placebo group (38.5% vs.
8.0%; p = 0.019). There were no differences in side-effects between the
groups. Conclusion: A single perioperative 1000 mg dose of intravenous
iron isomaltoside 1000 significantly increased the haemoglobin level and
prevented anaemia 4 weeks after surgery, with a short-term safety profile
similar to placebo. Future trials on potential clinical benefits of
preoperative treatment with intravenous iron in non-anaemic patients are
needed. Copyright &#xa9; 2015 International Society of Blood Transfusion.

<280>
Accession Number
605325796
Author
Ward A.; Tompson A.; Fitzmaurice D.; Sutton S.; Perera R.; Heneghan C.
Institution
(Ward, Tompson, Perera, Heneghan) University of Oxford, Nuffield
Department of Primary Care Health Sciences, Radcliffe Observatory Quarter,
Woodstock Road, Oxford OX2 6GG, United Kingdom
(Fitzmaurice) University of Birmingham, Edgbaston, United Kingdom
(Sutton) Institute of Public Health, University of Cambridge, Cambridge,
United Kingdom
Title
Cohort study of anticoagulation self-monitoring (CASM): A prospective
study of its effectiveness in the community.
Source
British Journal of General Practice. 65 (636) (pp e428-e437), 2015. Date
of Publication: 01 Jul 2015.
Publisher
Royal College of General Practitioners (E-mail: info@rcgp.co.uk)
Abstract
Background Trials show that oral anticoagulation therapy (OAT)
substantially reduces thromboembolic events without an increase in major
haemorrhagic events, but it is not known whether these results translate
into routine practice. Aim To estimate the current levels of control and
adverse events in patients self-monitoring OAT, explore the factors that
predict success, and determine whether the level of side effects reported
from randomised controlled trials are translated to a non-selected
population. Design and setting Prospective cohort study in the UK. Method
Participants were aged <18 years and registered with a GP. Main outcomes
were the proportion of participants, over 12 months, who were still
self-monitoring, had not experienced adverse events, and had achieved 80%
of time in therapeutic range (TTR). Results In total, 296 participants
were recruited their median age was 61 years and 55.1% were male.
Participants were predominately professional or held a university
qualification (82.7%). At 12 months, 267 (90.2%) were still
self-monitoring. Mean TTR was 75.3% (standard deviation 16.9).Six serious
and two minor adverse events were reported by GPS. Only 45.9% of
participants received any in-person training at the outset. Increased age
(P = 0.027), general wellbeing (EQ-5D visual score, P = 0.020), and lower
target international normalised range (INR, P = 0.032) were all associated
with high (<80% TTR) levels of control. Conclusion The findings show that,
even with little training, people on OAT can successfully self-monitor,
and even self-manage, their INR. TTR was shown to improve with age.
However, widespread use of self-monitoring of INR may be limited by the
initial costs, as well as a lack of training and support at the outset.

<281>
Accession Number
602649462
Author
Sibilitz K.L.; Berg S.K.; Hansen T.B.; Risom S.S.; Rasmussen T.B.;
Hassager C.; Kober L.; Gluud C.; Thygesen L.C.; Lindschou J.; Schmid J.P.;
Taylor R.S.; Zwisler A.-D.
Institution
(Sibilitz, Berg, Risom, Rasmussen, Hassager, Kober, Zwisler) The Heart
Centre, Department of Cardiology, Rigshospitalet, Copenhagen, University
Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark
(Berg, Rasmussen) Department of Cardiology, Gentofte Hospital, Gentofte,
Denmark
(Sibilitz, Berg, Thygesen, Taylor, Zwisler) National Institute of Public
Health, University of Southern Denmark, Copenhagen, Denmark
(Hansen) Department of Cardiology, Roskilde Hospital, Roskilde, Denmark
(Gluud, Lindschou) Copenhagen Trial Unit, Centre for Clinical Intervention
Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
(Schmid) Cardiology Clinic, Tiefenau Hospital and University of Bern,
Bern, Switzerland
(Taylor) University of Exeter Medical School, Health Services Research,
University of Exeter, Exeter, Devon, United Kingdom
(Zwisler) Department of Cardiology, Holbaek Sygehus, Holbaek, Denmark
Title
Update to the study protocol, including statistical analysis plan for a
randomized clinical trial comparing comprehensive cardiac rehabilitation
after heart valve surgery with control: The CopenHeart<inf>VR</inf> trial.
Source
Trials. 16 (1) (no pagination), 2015. Article Number: 38. Date of
Publication: February 05, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Heart valve diseases are common with an estimated prevalence
of 2.5% in the Western world. The number is rising because of an ageing
population. Once symptomatic, heart valve diseases are potentially lethal,
and heavily influence daily living and quality of life. Surgical
treatment, either valve replacement or repair, remains the treatment of
choice. However, post-surgery, the transition to daily living may become a
physical, mental and social challenge. We hypothesize that a comprehensive
cardiac rehabilitation program can improve physical capacity and
self-assessed mental health and reduce hospitalization and healthcare
costs after heart valve surgery. Methods: This randomized clinical trial,
CopenHeart<inf>VR</inf>, aims to investigate whether cardiac
rehabilitation in addition to usual care is superior to treatment as usual
after heart valve surgery. The trial will randomly allocate 210 patients
1:1 to an intervention or a control group, using central randomization,
and blinded outcome assessment and statistical analyses. The intervention
consists of 12 weeks of physical exercise and a psycho-educational
intervention comprising five consultations. The primary outcome is peak
oxygen uptake (VO<inf>2</inf> peak) measured by cardiopulmonary exercise
testing with ventilatory gas analysis. The secondary outcome is
self-assessed mental health measured by the standardized questionnaire
Short Form-36. Long-term healthcare utilization and mortality as well as
biochemistry, echocardiography and cost-benefit will be assessed. A
mixed-method design will be used to evaluate qualitative and quantitative
findings, encompassing a survey-based study before the trial and a
qualitative pre-and post-intervention study. Conclusion: This randomized
clinical trial will contribute with evidence of whether cardiac
rehabilitation should be provided after heart valve surgery. The study is
approved by the local regional Research Ethics Committee (H-1-2011-157),
and the Danish Data Protection Agency (j.nr. 2007-58-0015). Copyright
&#xa9; 2015 Sibilitz et al.

<282>
Accession Number
603600428
Author
Denardo S.J.; Gong Y.; Cooper-Dehoff R.M.; Farsang C.; Keltai M.; Szirmai
L.; Messerli F.H.; Bavry A.A.; Handberg E.M.; Mancia G.; Pepine C.J.
Institution
(Denardo, Cooper-Dehoff, Bavry, Handberg, Pepine) Division of
Cardiovascular Medicine, College of Medicine, University of Florida,
Gainesville, FL, United States
(Gong) Center for Pharmacogenomics, College of Pharmacy, University of
Florida, Gainesville, FL, United States
(Cooper-Dehoff) Department of Pharmacotherapy and Translational Research,
College of Pharmacy, University of Florida, Gainesville, FL, United States
(Farsang) St Imre Teaching Hospital Cardiometabolic Centre, Budapest,
Hungary
(Keltai) Semmelweis University, Hungarian Institute of Cardiology,
Budapest, Hungary
(Szirmai) NandSz Study Master Medical Research Center Ltd., Szentendre,
Hungary
(Messerli) Division of Cardiology, St Luke's-Roosevelt Hospital Center,
Columbia University, New York, NY, United States
(Bavry) North Florida/South Georgia Veterans Affairs Health System,
Gainesville, FL, United States
(Mancia) Clinica Medica, Ospedale San Gerardodei Tintori Monza, University
of Milano-Bicocca, Milan, Italy
(Denardo) Division of Cardiovascular Medicine, Duke University Medical
Center, Durham, NC, United States
Title
Effects of verapamil SR and atenolol on 24-hour blood pressure and heart
rate in hypertension patients with coronary artery disease: An
international verapamil SR-trandolapril ambulatory monitoring substudy.
Source
PLoS ONE. 10 (4) (no pagination), 2015. Article Number: e0122726. Date of
Publication: 02 Apr 2015.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Elevated nighttime blood pressure (BP) and heart rate (HR), increased BP
and HR variability, and altered diurnal variations of BP and HR (nighttime
dipping and morning surge) in patients with systemic hypertension are each
associated with increased adverse cardiovascular events. However, there
are no reports on the effect of hypertension treatment on these important
hemodynamic parameters in the growing population of hypertensive patients
with atherosclerotic coronary artery disease (CAD). This was a
pre-specified subgroup analysis of the INternational VErapamil
SR-Trandolapril STudy (INVEST), which involved 22,576 clinically stable
patients aged >50 years with hypertension and CAD randomized to either
verapamil SR-oratenolol-based hypertension treatment strategies. The
subgroup consisted of 117 patients undergoing 24-hour ambulatory
monitoring at baseline and after 1 year of treatment. Hourly systolic and
diastolic BP (SBP and DBP) decreased after 1 year for both verapamil SR-
and atenolol-based treatment strategies compared with baseline (P<0.0001).
Atenolol also decreased hourly HR (P<0.0001). Both treatment strategies
decreased SBP variability (weighted standard deviation: P = 0.012 and
0.021, respectively). Compared with verapamil SR, atenolol also increased
the prevalence of BP and HR nighttime dipping among prior non-dippers (BP:
OR = 3.37; 95% CI: 1.26-8.97; P = 0.015; HR: OR = 4.06; 95% CI:
1.35-12.17; P = 0.012) and blunted HR morning surge (+2.8 vs. +4.5
beats/min/hr; P = 0.019). Both verapamil SR- and especially atenolol-based
strategies resulted in favorable changes in ambulatory monitoring
parameters that have been previously associated with increased adverse
cardiovascular events. Copyright: &#xa9; 2015 Denardo et al.

<283>
Accession Number
604642348
Author
Haghikia A.; Podewski E.; Berliner D.; Sonnenschein K.; Fischer D.;
Angermann C.E.; Bohm M.; Rontgen P.; Bauersachs J.; Hilfiker-Kleiner D.
Institution
(Haghikia, Podewski, Berliner, Sonnenschein, Rontgen, Bauersachs,
Hilfiker-Kleiner) Department of Cardiology and Angiology, Hannover Medical
School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
(Fischer) Department of Cardiology and Angiology, University Hospital
Muenster, Muenster, Germany
(Angermann) Department of Internal Medicine I, Comprehensive Heart Failure
Center, University Hospital of Wuerzburg, Wurzburg, Germany
(Bohm) Department of Internal Medicine III, University Hospital of
Saarland, Homburg/Saar, Germany
Title
Rationale and design of a randomized, controlled multicentre clinical
trial to evaluate the effect of bromocriptine on left ventricular function
in women with peripartum cardiomyopathy.
Source
Clinical Research in Cardiology. 104 (11) (pp 911-917), 2015. Date of
Publication: 31 May 2015.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: Peripartum cardiomyopathy (PPCM) is an idiopathic heart
disease that develops in the last month of pregnancy and/or the first
months following delivery in previously healthy women and may lead to
acute heart failure. A cleaved fragment of the nursing hormone prolactin
is considered essential in the pathophysiology of PPCM. To date, no
specific therapy has been tested for PPCM in a randomized controlled trial
of adequate size. Aims: The purpose of this trial is to investigate the
safety of the dopamin-D2-receptor agonist bromocriptine and its effects on
left ventricular (LV) function in women with PPCM. Methods: This is an 11
center German trial with a prospective randomized controlled open-label
design. The trial enrolls females with newly diagnosed PPCM according to
European Society of Cardiology criteria with a LV ejection fraction (LVEF)
<35 %. Patients are randomized 1:1 to either best supportive care (BSC)
including standard heart failure therapy plus 8 weeks of bromocriptine
therapy (2.5 mg b.i.d. for 14 days and 2.5 mg q.d. from day 15 to 56) or
to BSC plus 1 week of low-dose bromocriptine (2.5 mg q.d.) with
anticoagulant therapy at a prophylactic dose administered during the
period of bromocriptine treatment in both groups. The primary endpoint is
change in LVEF from baseline to 6 months follow-up as assessed by cardiac
magnetic resonance imaging (or echocardiography if CMR is not tolerated).
The secondary endpoints are hospitalization for worsening heart failure,
heart transplantation, and all-cause mortality during follow-up or a
combination of these endpoints. A total of 60 patients will be recruited
(including 6 potential dropouts) giving a power of 0.9 for an expected
LVEF change of 10.8 % between treatment groups at 6 months. Perspective:
This trial will provide important knowledge on potential benefits and
safety of prolonged inhibition of prolactin release with bromocriptine in
addition to standard heart failure therapy in newly diagnosed PPCM. Trial
registration: ClinicalTrials.gov Identifier: NCT00998556. Copyright &#xa9;
2015, The Author(s).

<284>
Accession Number
603644749
Author
Sasse M.; Dziuba F.; Jack T.; Koditz H.; Kaussen T.; Bertram H.; Beerbaum
P.; Boehne M.
Institution
(Sasse, Dziuba, Jack, Koditz, Kaussen, Bertram, Beerbaum, Boehne)
Department of Pediatric Cardiology and Intensive Care Medicine, Hannover
Medical School, Carl-Neuberg-Strasse 1, Hannover 30625, Germany
Title
In-line Filtration Decreases Systemic Inflammatory Response Syndrome,
Renal and Hematologic Dysfunction in Pediatric Cardiac Intensive Care
Patients.
Source
Pediatric Cardiology. 36 (6) (pp 1270-1278), 2015. Date of Publication: 07
Apr 2015.
Publisher
Springer New York LLC (E-mail: journals@springer-sbm.com)
Abstract
Cardiac surgery with cardiopulmonary bypass (CPB) frequently leads to
systemic inflammatory response syndrome (SIRS) with concomitant organ
malfunction. Infused particles may exacerbate inflammatory syndromes since
they activate the coagulation cascade and alter inflammatory response or
microvascular perfusion. In a randomized, controlled, prospective trial,
we have previously shown that particle-retentive in-line filtration
prevented major complications in critically ill children. Now, we
investigated the effect of in-line filtration on major complications in
the subgroup of cardiac patients. Children admitted to tertiary pediatric
intensive care unit were randomized to either control or filter group
obtaining in-line filtration throughout complete infusion therapy. Risk
differences and 95 % confidence intervals (CI) of several complications
such as SIRS, sepsis, mortality, various organ failure and dysfunction
were compared between both groups using the Wald method. 305 children (n =
150 control, n = 155 filter group) with cardiac diseases were finally
analyzed. The majority was admitted after cardiac surgery with CPB. Risk
of SIRS (-11.3 %; 95 % CI -21.8 to -0.5 %), renal (-10.0 %; 95 % CI -17.0
to -3.0 %) and hematologic (-8.1 %; 95 % CI -14.2 to -0.2 %) dysfunction
were significantly decreased within the filter group. No risk differences
were demonstrated for occurrence of sepsis, any other organ failure or
dysfunctions between both groups. Infused particles might aggravate a
systemic hypercoagulability and inflammation with subsequent organ
malfunction in pediatric cardiac intensive care patients.
Particle-retentive in-line filtration might be effective in preventing
SIRS and maintaining renal and hematologic function. In-line filtration
offers a novel therapeutic option to decrease morbidity in cardiac
intensive care. Copyright &#xa9; 2015, The Author(s).

<285>
[Use Link to view the full text]
Accession Number
605326452
Author
Fisher J.G.; Sparks E.A.; Khan F.A.; Alexander J.L.; Asaro L.A.; Wypij D.;
Gaies M.; Modi B.P.; Duggan C.; Agus M.S.D.; Yu Y.-M.; Jaksic T.
Institution
(Fisher, Sparks, Khan, Modi, Jaksic) Center for Advanced Intestinal
Rehabilitation, Department of Surgery, Boston Children's Hospital, Boston,
MA, United States
(Fisher, Sparks, Khan, Wypij, Modi, Duggan, Agus, Yu, Jaksic) Harvard
Medical School, Boston, MA, United States
(Alexander, Agus) Division of Medicine Critical Care, Boston Children's
Hospital, Boston, MA, United States
(Asaro, Wypij) Department of Cardiology, Boston Children's Hospital,
Boston, MA, United States
(Wypij) Department of Biostatistics, Harvard School of Public Health,
Boston, MA, United States
(Gaies) Division of Pediatric Cardiology, C.S. Mott Children's Hospital,
University of Michigan Medical School, Ann Arbor, MI, United States
(Duggan) Center for Advanced Intestinal Rehabilitation, Division of
Gastroenterology and Nutrition, Boston Children's Hospital, Boston, MA,
United States
(Yu) Shriners Hospital for Children, Massachusetts General Hospital,
Boston, MA, United States
Title
Tight glycemic control with insulin does not affect skeletal muscle
degradation during the early postoperative period following pediatric
cardiac surgery.
Source
Pediatric Critical Care Medicine. 16 (6) (pp 515-521), 2015. Date of
Publication: 22 Jul 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: LRorders@phl.lrpub.com)
Abstract
Objective: Critical illness is associated with significant catabolism, and
persistent protein loss correlates with increased morbidity and mortality.
Insulin is a potent anticatabolic hormone; high-dose insulin decreases
skeletal muscle protein breakdown in critically ill pediatric surgical
patients. However, insulin's effect on protein catabolism when given at
clinically utilized doses has not been studied. The objective was to
evaluate the effect of postoperative tight glycemic control and clinically
dosed insulin on skeletal muscle degradation in children after cardiac
surgery with cardiopulmonary bypass. Design: Secondary analysis of a
two-center, prospective randomized trial comparing tight glycemic control
with standard care. Randomization was stratified by study center.
Patients: Children 0-36 months who were admitted to the ICU after cardiac
surgery requiring cardiopulmonary bypass. Interventions: In the tight
glycemic control arm, insulin was titrated to maintain blood glucose
between 80 and 110 mg/dL. Patients in the control arm received standard
care. Skeletal muscle breakdown was quantified by a ratio of urinary
3-methylhistidine to urinary creatinine. Measurements and Main Results: A
total of 561 patients were included: 281 in the tight glycemic control arm
and 280 receiving standard care. There was no difference in
3-methylhistidine to creatinine between groups (tight glycemic control,
249 +/- 127 vs standard care, 253 +/- 112, mean +/- sd in mumol/g; p =
0.72). In analyses restricted to the patients in tight glycemic control
arm, higher 3-methylhistidine to creatinine correlated with younger age,
as well as lower weight, weight-for-age z score, length, and body surface
area (p < 0.005 for each) and lower postoperative day 3 serum creatinine
(r = -0.17; p = 0.02). Sex, prealbumin, and albumin were not associated
with 3-methylhistidine to creatinine. During urine collection, 245
patients (87%) received insulin. However, any insulin exposure did not
impact 3-methylhistidine to creatinine (t test, p = 0.45), and there was
no dose-dependent effect of insulin on 3-methylhistidine to creatinine (r
= -0.03; p = 0.60). Conclusion: Although high-dose insulin has an anabolic
effect in experimental conditions, at doses necessary to achieve
normoglycemia, insulin appears to have no discernible impact on skeletal
muscle degradation in critically ill pediatric cardiac surgical patients.
Copyright &#xa9; 2015 by the Society of Critical Care Medicine and the
World Federation of Pediatric Intensive and Critical Care Societies.

<286>
[Use Link to view the full text]
Accession Number
605325662
Author
Gada H.; Kirtane A.J.; Wang K.; Lei Y.; Magnuson E.; Reynolds M.R.;
Williams M.R.; Kodali S.; Vahl T.P.; Arnold S.V.; Leon M.B.; Thourani V.;
Szeto W.Y.; Cohen D.J.
Institution
(Gada) Robert Wood Johnson Medical School, New Brunswick, NJ, United
States
(Kirtane, Kodali, Vahl, Leon) Columbia University Medical Center, New York
Presbyterian Hospital and the Cardiovascular Research Foundation, New
York, NY, United States
(Wang, Lei, Magnuson, Arnold, Cohen) Saint Luke's Mid America Heart
Institute, University of Missouri-Kansas City School of Medicine, 4401
Wornall Rd, Kansas City, MO 64111, United States
(Reynolds) Lahey Hospital and Medical Center, Burlington, MA, United
States
(Reynolds) Harvard Clinical Research Institute, Boston, MA, United States
(Williams) NYU Langone Medical Center, New York, NY, United States
(Thourani) Emory University School of Medicine, Atlanta, GA, United States
(Szeto) University of Pennsylvania School of Medicine, Philadelphia,
United States
Title
Temporal Trends in Quality of Life Outcomes after Transapical
Transcatheter Aortic Valve Replacement: A Placement of AoRTic
TraNscathetER Valve (PARTNER) Trial Substudy.
Source
Circulation: Cardiovascular Quality and Outcomes. 8 (4) (pp 338-346),
2015. Date of Publication: 23 Jul 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: LRorders@phl.lrpub.com)
Abstract
Background - In the Placement of AoRTic TraNscathetER Valve (PARTNER)
randomized controlled trial (RCT), which represented the first exposure to
transapical transcatheter aortic valve replacement (TA-TAVR) for many
clinical sites, high-risk patients undergoing TA-TAVR derived similar
health-related quality of life (HRQoL) outcomes when compared with
surgical aortic valve replacement (SAVR). With increasing experience, it
is possible that HRQoL outcomes of TA-TAVR may have improved. Methods and
Results - We evaluated HRQoL outcomes at 1-, 6-, and 12-month follow-ups
among 875 patients undergoing TA-TAVR in the PARTNER nonrandomized
continued access (NRCA) registry and compared these outcomes with those of
the TA-TAVR and SAVR patients in the PARTNER RCT. HRQoL was assessed with
the Kansas City Cardiomyopathy Questionnaire (KCCQ), the Medical Outcomes
Study Short-Form 12, and the EuroQoL-5D, with the KCCQ overall summary
score serving as the primary end point. The NRCA TA-TAVR and RCT TA-TAVR
and SAVR groups were generally similar. The primary outcome, the KCCQ
summary score, did not differ between the NRCA TA-TAVR and the RCT TA-TAVR
group at any follow-up timepoints, although there were small differences
in favor of the NRCA cohort on several KCCQ subscales at 1 month. There
were no significant differences in follow-up HRQOL between the NRCA-TAVR
and the RCT SAVR cohorts on the KCCQ overall summary scale or any of the
disease-specific or generic subscales. Conclusions - Despite greater
experience with TA-TAVR in the NRCA registry, HRQoL outcomes remained
similar to those of TA-TAVR in the original RCT cohort and no better than
those with SAVR. These findings have important implications for patient
selection for TAVR when transfemoral access is not an option. Copyright
&#xa9; 2015 American Heart Association, Inc.

<287>
Accession Number
613110328
Author
Mansourian S.; Bina P.; Fehri A.; Karimi A.A.; Boroumand M.A.; Abbasi K.
Institution
(Mansourian, Bina, Fehri, Karimi, Boroumand, Abbasi) Department of Cardiac
Surgery, Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
Title
Preoperative oral pentoxifylline in case of coronary artery bypass
grafting with left ventricular dysfunction (Ejection fraction equal
to/less than 30%).
Source
Anatolian Journal of Cardiology. 15 (12) (pp 1014-1019), 2015. Date of
Publication: 2015.
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: Most coronary artery bypass grafts are done by applying
cardiopulmonary bypass, which usually induces unwanted inflammatory
reactions and impairs the outcomes. In order to minimize the perilous
response of cardiopulmonary bypass, pentoxifylline was getting used
orally. Methods: In a prospective, placebo-controlled, randomized clinical
trial, 178 coronary artery bypass graft candidates with ejection fraction
lower/equal to 30%, divided into two equal groups (pentoxifylline and
control), participated in the study. Pentoxifylline patients received 400
mg pentoxifylline 3 times a day for 3 days before operation. The outcomes
were compared between groups using student's t-test, Mann-Whitney U-test,
Pearson chi-square, or Fisher's exact test. Results: Pentoxifylline
administration did not significantly affect troponin-T (p=0.68), but it
reduced tumor necrosis factor-alpha (p=0.01) and inter-leukin-6 (p=0.01).
It improved left ventricular ejection fraction significantly (p=0.01).
White blood cell and platelet counts, hemoglobin, and hematocrit were not
influenced by pentoxifylline. The drug did not affect blood urea nitrogen
and creatinine, occurrence of renal failure, cere-brovascular accidents,
and in-hospital mortality rate. The need for an intra-aortic balloon pump,
cardiopulmonary bypass, and aortic cross-clamp times were not affected,
either. Pentoxifylline decreased the intensive care unit stay (p<0.001),
ventilation time, 10.4 hours in the pentoxifylline group against 14.7
hours in the control group (p=0.01), and the requirement of inotropic
agents (p=0.02) and blood transfusion (p=0.01). Conclusion: Pentoxifylline
has more beneficial potencies in reducing adverse events after coronary
artery bypass graft using cardiopulmonary bypass, than what are known.
Copyright &#xa9; 2015 by Turkish Society of Cardiology.

<288>
Accession Number
612650365
Author
Ranucci M.; Baryshnikova E.; Crapelli G.B.; Rahe-Meyer N.; Menicanti L.;
Frigiola A.; Castelvecchio S.; Pistuddi V.; Trimarchi S.; Carlucci C.;
Varrica A.; Satriano A.; Rovere M.T.L.
Institution
(Ranucci, Baryshnikova, Crapelli) Department of Cardiothoracic, Vascular
Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
(Menicanti, Frigiola) Department of Cardiac Surgery, IRCCS Policlinico San
Donato, Milan, Italy
(Rahe-Meyer) Clinic for Anesthesiology and Intensive Care Medicine,
Hannover Medical School, Hannover, Germany
(Ranucci, Baryshnikova, Menicanti, Frigiola, Castelvecchio, Pistuddi,
Trimarchi, Carlucci, Varrica, Satriano) San Donato Milanese, Milan, Italy
(Rovere) Montescano, Pavia, Italy
Title
Randomized, double-blinded, placebo-controlled trial Of fibrinogen
concentrate supplementation after complex cardiac surgery.
Source
Journal of the American Heart Association. 4 (6) (no pagination), 2015.
Article Number: e002066. Date of Publication: 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Postoperative bleeding after heart operations is still a common
finding, leading to allogeneic blood products transfusion. Fibrinogen and
coagulation factors deficiency are possible determinants of bleeding. The
experimental hypothesis of this study is that a first-line fibrinogen
supplementation avoids the need for fresh frozen plasma (FFP) and reduces
the need for any kind of transfusions. Methods and Results--This was a
single-center, prospective, randomized, placebo-controlled, double-blinded
study. One-hundred sixteen patients undergoing heart surgery with an
expected cardiopulmonary bypass duration >90 minutes were admitted to the
study. Patients in the treatment arm received fibrinogen concentrate after
protamine administration; patients in the control arm received saline
solution. In case of ongoing bleeding, patients in the treatment arm could
receive prothrombin complex concentrates (PCCs) and those in the control
arm saline solution. The primary endpoint was avoidance of any allogeneic
blood product. Patients in the treatment arm had a significantly lower
rate of any allogeneic blood products transfusion (odds ratio, 0.40; 95%
confidence interval, 0.19 to 0.84, P=0.015). The total amount of packed
red cells and FFP units transfused was significantly lower in the
treatment arm. Postoperative bleeding was significantly (P=0.042) less in
the treatment arm (median, 300 mL; interquartile range, 200 to 400 mL)
than in the control arm (median, 355 mL; interquartile range, 250 to 600
mL). Conclusions--Fibrinogen concentrate limits postoperative bleeding
after complex heart surgery, leading to a significant reduction in
allogeneic blood products transfusions. No safety issues were raised.
Copyright &#xa9; 2015 The Authors.

<289>
Accession Number
604363153
Author
Chamarthi B.; Gaziano J.M.; Blonde L.; Vinik A.; Scranton R.E.; Ezrokhi
M.; Rutty D.; Cincotta A.H.
Institution
(Chamarthi) Division of Endocrinology, Diabetes and Hypertension, Brigham
and Women's Hospital, 221 Longwood Avenue, Boston, MA, United States
(Chamarthi, Gaziano) Harvard Medical School, Boston, MA, United States
(Chamarthi, Scranton, Ezrokhi, Cincotta) VeroScience LLC, 1334 Main Road,
Tiverton, RI 02878, United States
(Gaziano) Veterans Afairs Healthcare System, 1400 VFW Parkway, W Roxbury,
Boston, MA 02132, United States
(Gaziano) Divisions of Aging, Cardiology and Preventive Medicine, Brigham
and Women's Hospital, 75 Francis Street, Boston, MA, United States
(Blonde) Ochsner Medical Center, 1514 Jeferson Hwy, New Orleans, LA 70121,
United States
(Vinik) Eastern Virginia Medical School, Strelitz Diabetes Center,
Neuroendocrine Unit, 855 W. Brambleton Avenue, Norfolk, VA 23510, United
States
(Rutty) Everest Clinical Research Services Inc., 675 Cochrane Dr.,
Markham, ON L3R 0B8, Canada
Title
Timed bromocriptine-QR therapy reduces progression of cardiovascular
disease and dysglycemia in subjects with well-controlled type 2 diabetes
mellitus.
Source
Journal of Diabetes Research. 2015 (no pagination), 2015. Article Number:
157698. Date of Publication: 2015.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Background: Type 2 diabetes (T2DM) patients, including those in good
glycemic control, have an increased risk of cardiovascular disease (CVD).
Maintaining good glycemic control may reduce long-term CVD risk. However,
other risk factors such as elevated vascular sympathetic tone and/or
endothelial dysfunction may be stronger potentiators of CVD. This study
evaluated the impact of bromocriptine-QR, a sympatholytic dopamine D2
receptor agonist, on progression of metabolic disease and CVD in T2DM
subjects in good glycemic control (HbA1c <7.0%). Methods: 1834 subjects
(1219 bromocriptine-QR; 615 placebo) with baseline HbA1c <70% derived from
the Cycloset Safety Trial (this trial is registered with
ClinicalTrials.gov Identifer: NCT00377676), a 12-month, randomized,
multicenter, placebo-controlled, double-blind study in T2DM, were
evaluated. Treatment impact upon a prespecified composite CVD endpoint
(first myocardial infarction, stroke, coronary revascularization, or
hospitalization for angina/congestive heart failure) and the odds of
losing glycemic control (HbA1c >70% after 52 weeks of therapy) were
determined. Results: Bromocriptine-QR reduced the CVD endpoint by 48%
(intention-to-treat; HR: 0.52 [0.28-0.98]) and 52% (on-treatment analysis;
HR: 0.48 [0.24-0.95]). Bromocriptine-QR also reduced the odds of both
losing glycemic control (OR: 0.63 (0.47-0.85), p = 0.002) and requiring
treatment intensification to maintain HbA1c <70% (OR: 0.46 (0.31-0.69), p
= 0.0002). Conclusions: Bromocriptine-QR therapy slowed the progression of
CVD and metabolic disease in T2DM subjects in good glycemic control.
Copyright &#xa9; 2015 Bindu Chamarthi et al.

<290>
Accession Number
604602414
Author
MacDonald M.R.; She L.; Doenst T.; Binkley P.F.; Rouleau J.L.; Tan R.-S.;
Lee K.L.; Miller A.B.; Sopko G.; Szalewska D.; Waclawiw M.A.; Dabrowski
R.; Castelvecchio S.; Adlbrecht C.; Michler R.E.; Oh J.K.; Velazquez E.J.;
Petrie M.C.
Institution
(MacDonald) Department of Cardiology, Changi General Hospital, 2 Simei
Street 3, Singapore 529889, Singapore
(She) Duke Clinical Research Institute, Duke University School of
Medicine, Durham, NC, United States
(Doenst) Department of Cardiothoracic Surgery, Jena University Hospital,
Friedrich Schiller University, Jena, Germany
(Binkley) Ohio State University Wexner Medical Center, Columbus, OH,
United States
(Rouleau) Montreal Heart Institute, Universite de Montreal, Canada
(Tan) National Heart Centre, Singapore, Singapore
(Lee) Department of Biostatistics and Bioinformatics, Duke University
School of Medicine, Durham, NC, United States
(Miller) Department of Cardiology, University of Florida, Jacksonville,
FL, United States
(Sopko, Waclawiw) National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, MD, United States
(Szalewska) Department of Rehabilitation, Medical University of Gdansk,
Gdansk, Poland
(Dabrowski) Institute of Cardiology, Warsaw, Poland
(Castelvecchio) IRCCS Policlinico San Donato, Milan, Italy
(Adlbrecht) Department of Medicine II, Division of Cardiology, Medical
University of Vienna, Austria
(Michler) Department of Surgery, Montefiore Medical Center, Albert
Einstein College of Medicine, New York City, NY, United States
(Oh) Department of Medicine, Mayo Clinic, Rochester, MN, United States
(Velazquez) Department of Medicine-Cardiology, Duke University School of
Medicine, Durham, NC, United States
(Petrie) Scottish National Advanced Heart Failure Service, Golden Jubilee
National Hospital, University of Glasgow, Glasgow, United Kingdom
Title
Clinical characteristics and outcomes of patients with and without
diabetes in the Surgical Treatment for Ischemic Heart Failure (STICH)
trial.
Source
European Journal of Heart Failure. 17 (7) (pp 725-734), 2015. Date of
Publication: 01 Jul 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Aims Hypothesis 1 of the Surgical Treatment for Ischemic Heart Failure
(STICH) trial enrolled 1212 patients with an LVEF of <35% and CAD amenable
to coronary artery bypass grafting (CABG). Patients were randomized to
CABG and optimal medical therapy (MED) or MED alone. The objective was to
assess whether or not patients with diabetes mellitus (DM) enrolled in the
STICH trial would have greater benefit from CABG than patients without DM.
Methods and results The characteristics and clinical outcomes of patients
with and without DM randomized to CABG and MED or MED alone were compared.
DM was present in 40%. At baseline, patients with DM had more triple
vessel CAD, higher LVEF, and smaller left ventricular volumes. In patients
with DM, the primary outcome of all-cause mortality occurred in 39% of
patients in the MED group and 39% in the CABG group [hazard ratio (HR)
with CABG 0.96, 95% confidence interval (CI) 0.73-1.26]. In patients
without DM, the primary outcome occurred in 41% of patients in the MED
group and 32% in the CABG group (HR with CABG 0.80, 95% CI 0.63-1.02).
While numerically it would appear that the treatment effect of CABG is
blunted in patients with DM, there was no significant interaction between
DM and treatment group on formal statistical testing. Conclusions Patients
with DM enrolled in the STICH trial had more triple vessel disease,
smaller hearts, and higher LVEF than those without DM. CABG did not exert
greater benefit in patients with DM. Copyright &#xa9; 2015 The Authors.
European Journal of Heart Failure European Society of Cardiology.

<291>
Accession Number
604195674
Author
Ottens T.H.; Nijsten M.W.N.; Hofland J.; Dieleman J.M.; Hoekstra M.; van
Dijk D.; van der Maaten J.M.A.A.
Institution
(Ottens, Dieleman, van Dijk) Department of Anesthesiology and Intensive
Care, University Medical Center Utrecht, Mail stop Q.04.2.313, PO Box
85500, Utrecht, GA 3508, Netherlands
(Nijsten, van der Maaten) Department of Critical Care, University Medical
Center, University of Groningen, Hanzeplein 1, Groningen, RB 9700,
Netherlands
(Hofland) Department of Anesthesiology, Erasmus University Medical Center,
s Gravendijkwal 230, Rotterdam, CE 3015, Netherlands
(Hoekstra, van der Maaten) Department of Anesthesiology, University
Medical Center Groningen, University of Groningen, Hanzeplein 1,
Groningen, RB 9700, Netherlands
Title
Effect of high-dose dexamethasone on perioperative lactate levels and
glucose control: A randomized controlled trial.
Source
Critical Care. 19 (1) (no pagination), 2015. Article Number: 41. Date of
Publication: February 13, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Introduction: Blood lactate levels are increasingly used to monitor
patients. Steroids are frequently administered to critically ill patients.
However, the effect of steroids on lactate levels has not been adequately
investigated. We studied the effect of a single intraoperative high dose
of dexamethasone on lactate and glucose levels in patients undergoing
cardiac surgery. Methods: The Dexamethasone for Cardiac Surgery (DECS)
trial was a multicenter randomized trial on the effect of dexamethasone 1
mg/kg versus placebo on clinical outcomes after cardiac surgery in adults.
Here we report a pre-planned secondary analysis of data from DECS trial
participants included at the University Medical Center Groningen. The use
of a computer-assisted glucose regulation protocol-Glucose Regulation for
Intensive care Patients (GRIP)-was part of routine postoperative care.
GRIP aimed at glucose levels of 4 to 8 mmol/L. Primary outcome parameters
were area under the lactate and glucose curves over the first 15 hours of
ICU stay (AUC<inf>15</inf>). ICU length of stay and mortality were
observed as well. Results: The primary outcome could be determined in 497
patients of the 500 included patients. During the first 15 hours of ICU
stay, lactate and glucose levels were significantly higher in the
dexamethasone group than in the placebo group: lactate AUC<inf>15</inf>
25.8 (13.1) versus 19.9 (11.2) mmol/L x hour, P <0.001 and glucose
AUC<inf>15</inf> 126.5 (13.0) versus 114.4 (13.9) mmol/L x hour, P <0.001.
In this period, patients in the dexamethasone group required twice as much
insulin compared with patients who had received placebo. Multivariate and
cross-correlation analyses suggest that the effect of dexamethasone on
lactate levels is related to preceding increased glucose levels. Patients
in the placebo group were more likely to stay in the ICU for more than 24
hours (39.2%) compared with patients in the dexamethasone group (25.0%, P
= 0.001), and 30-day mortality rates were 1.6% and 2.4%, respectively (P =
0.759). Conclusions: Intraoperative high-dose dexamethasone increased
postoperative lactate and glucose levels in the first 15 hours of ICU
stay. Still, patients in the dexamethasone group had a shorter ICU length
of stay and similar mortality compared with controls. Trial registration:
ClinicalTrials.gov NCT00293592. Registered 16 February 2006. Copyright
&#xa9; 2015 Ottens et al.; licensee BioMed Central.

<292>
Accession Number
604997653
Author
Ilic M.K.; Madzarac G.; Kogler J.; Stancic-Rokotov D.; Hodoba N.
Institution
(Ilic, Kogler, Hodoba) Department of Anesthesiology, University Hospital
Centre Zagreb, Zagreb, Croatia
(Madzarac, Stancic-Rokotov) Department of Thoracic Surgery 'Jordanovac,',
University Hospital Centre Zagreb, Zagreb, Croatia
Title
Intraoperative volume restriction in esophageal cancer surgery: An
exploratory randomized clinical trial.
Source
Croatian Medical Journal. 56 (3) (pp 290-296), 2015. Date of Publication:
2015.
Publisher
Medicinska Naklada Zagreb
Abstract
Aim To investigate whether the fluid volume administered during esophageal
cancer surgery affects pulmonary gas exchange and tissue perfusion.
Methods An exploratory single-center randomized clinical trial was
performed. Patients with esophageal cancer who underwent Lewis-Tanner
procedure between June 2011 and August 2012 at the Department of Thoracic
surgery "Jordanovac", Zagreb were analyzed. Patients were randomized (1:1)
to receive a restrictive volume of intraoperative fluid (<8 mL/kg/h) or a
liberal volume ( > 8 mL/kg/h). Changes in oxygen partial pressure
(Pao<inf>2</inf>), inspired oxygen fraction (FiO<inf>2</inf>), creatinine,
and lactate were measured during and after surgery. Results Overall 16
patients were randomized and they all were analyzed (restrictive group n =
8, liberal group n = 8). The baseline value
Pao<inf>2</inf>/FiO<inf>2</inf> ratio (restrictive) was 345.01 +/- 35.31
and the value six hours after extubation was 315.51 +/- 32.91; the
baseline Pao<inf>2</inf>/FiO<inf>2</inf> ratio (liberal) was 330.11 +/-
34.71 and the value six hours after extubation was 307.11 +/- 30.31. The
baseline creatinine value (restrictive) was 91.91 +/- 12.67 and the value
six hours after extubation was 100.88 +/- 18.33; the baseline creatinine
value (liberal) was 90.88 +/- 14.99 and the value six hours after
extubation was 93.51 +/- 16.37. The baseline lactate value (restrictive)
was 3.93 +/- 1.33 and the value six hours after extubation was 2.69 +/-
0.91. The baseline lactate value (liberal) was 3.26 +/- 1.25 and the value
six hours after extubation was 2.40 +/- 1.08. The two groups showed no
significant differences in Pao<inf>2</inf>/FiO<inf>2</inf> ratio (P =
0.410), creatinine (P = 0.410), or lactate (P = 0.574). Conclusions
Restriction of intraoperative applied volume does not significantly affect
pulmonary exchange function or tissue perfusion in patients undergoing
surgical treatment for esophageal cancer.

<293>
Accession Number
600887317
Author
Lopes-Conceicao L.; Pereira M.; Araujo C.; Laszczynska O.; Lunet N.;
Azevedo A.
Institution
(Lopes-Conceicao, Pereira, Araujo, Laszczynska, Lunet, Azevedo) Department
of Clinical Epidemiology, Predictive Medicine and Public Health,
University of Porto, Medical School, Porto, Portugal
(Lopes-Conceicao, Pereira, Araujo, Laszczynska, Lunet, Azevedo) EPIUnit,
Institute of Public Health, University of Porto, Porto, Portugal
(Araujo) Centro Hospitalar de Tras-Os-Montes e Alto Douro EPe, Vila Real,
Portugal
Title
The use of reperfusion and revascularization procedures in acute coronary
syndrome in Portugal: A systematic review.
Source
Revista Portuguesa de Cardiologia. 33 (11) (pp 707-715), 2014. Date of
Publication: 01 Nov 2014.
Publisher
Sociedade Portuguesa de Cardiologia (E-mail: secretariado@mail.spc.pt)
Abstract
Introduction and Objectives Reperfusion and revascularization therapies
play an important role in the management of coronary heart disease and
have contributed to decreases in case fatality rates. We aimed to describe
the use of these therapies for the treatment of acute coronary syndrome
(ACS) patients over time in Portugal.
Methods PubMed was searched in July 2012. The proportion of patients
treated with fibrinolysis, primary percutaneous coronary intervention
(PCI), any PCI and coronary artery bypass grafting (CABG) was described
according to type of ACS: STEMI (>90% patients with ST-segment elevation
or Q-wave myocardial infarction), NSTE-ACS (>90% patients with
non-ST-segment elevation ACS) and mixed ACS (all others).
Results We identified 41 eligible studies, published between 1989 and
2011. Twenty-eight reported on samples considered representative of ACS
patients treated in Portugal. The small number of estimates of the use of
each treatment in STEMI and NSTE-ACS patients precluded identification of
any time trend. In the last 20 years, the proportion of mixed ACS patients
treated with fibrinolysis decreased and the use of PCI increased, while
the use of CABG did not change.
Conclusions The general pattern of the use of reperfusion and
revascularization is in accordance with that reported in other developed
countries, reflecting a favorable trend in the quality of care of ACS
patients. The relatively small number of estimates on the same procedure
in comparable patients limits the generalizability of the conclusions, and
highlights the need for systematic approaches to monitor the use of
treatments over time. Copyright &#xa9; 2014 Sociedade Portuguesa de
Cardiologia.

<294>
Accession Number
615130840
Author
Boitor M.; Martorella G.; Arbour C.; Michaud C.; Gelinas C.
Institution
(Boitor) Ingram School of Nursing, McGill University, Montreal, Quebec,
Canada
(Martorella) Ingram School of Nursing, McGill University, Montreal,
Quebec, Canada; Quebec Nursing Intervention Research Network (RRISIQ),
Montreal, Quebec, Canada; Faculty of Nursing, Universite de Montreal,
Montreal, Quebec, Canada
(Arbour) Ingram School of Nursing, McGill University, Montreal, Quebec,
Canada; Quebec Nursing Intervention Research Network (RRISIQ), Montreal,
Quebec, Canada; Alan Edwards Centre for Research on Pain, McGill
University, Montreal, Quebec, Canada
(Michaud) Quebec Nursing Intervention Research Network (RRISIQ), Montreal,
Quebec, Canada; School of Nursing, Univeriste de Sherbrooke, Sherbrooke,
Quebec, Canada
(Gelinas) Ingram School of Nursing, McGill University, Montreal, Quebec,
Canada; Centre for Nursing Research and Lady Davis Institute, Jewish
General Hospital, Montreal, Quebec, Canada; Quebec Nursing Intervention
Research Network (RRISIQ), Montreal, Quebec, Canada; Alan Edwards Centre
for Research on Pain, McGill University, Montreal, Quebec, Canada.
Electronic address: celine.gelinas@mcgill.ca
Title
Evaluation of the preliminary effectiveness of hand massage therapy on
postoperative pain of adults in the intensive care unit after cardiac
surgery: a pilot randomized controlled trial.
Source
Pain management nursing : official journal of the American Society of Pain
Management Nurses. 16 (3) (pp 354-366), 2015. Date of Publication: 01 Jun
2015.
Abstract
Although many intensive care unit patients experience significant pain,
very few studies explored massage to maximize their pain relief. This
study aimed to evaluate the preliminary effects of hand massage on pain
after cardiac surgery in the adult intensive care unit. A pilot randomized
controlled trial was used for this study. The study was conducted in a
Canadian medical-surgical intensive care unit. Forty adults who were
admitted to the intensive care unit after undergoing elective cardiac
surgery in the previous 24 hours participated in the study. They were
randomly assigned to the experimental (n = 21) or control (n = 19) group.
The experimental group received a 15-minute hand massage, and the control
group received a 15-minute hand-holding without massage. In both groups
the intervention was followed by a 30-minute rest period. The
interventions were offered on 2-3 occasions within 24 hours after surgery.
Pain, muscle tension, and vital signs were assessed. Pain intensity and
behavioral scores were decreased for the experimental group. Although hand
massage decreased muscle tension, fluctuations in vital signs were not
significant. This study supports potential benefits of hand massage for
intensive care unit postoperative pain management. Although larger
randomized controlled trials are necessary, this low-cost nonpharmacologic
intervention can be safely administered. Copyright &#xa9; 2015 American
Society for Pain Management Nursing. Published by Elsevier Inc. All rights
reserved.

<295>
Accession Number
615143632
Author
Gedik E.; Atar F.; Ozdemirkan A.; Firat A.C.; Zeyneloglu P.; Sezgin A.;
Pirat A.
Institution
(Gedik, Atar, Ozdemirkan, Firat, Zeyneloglu, Pirat) Department of
Anesthesiology and Critical Care Medicine, Faculty of Medicine, Baskent
University, Ankara, Turkey
(Sezgin) Department of Cardiovascular Surgery, Faculty of Medicine,
Baskent University, Ankara, Turkey
Title
Perioperative venoarterial extracorporeal membrane oxygenation support
during heart transplant.
Source
Experimental and Clinical Transplantation. 15 (pp 224-230), 2017. Date of
Publication: February 2017.
Publisher
Baskent University (26 Austin Avenue,Baglica Kampusu, P.O. Box 337,Ankara
06530, Turkey)
Abstract
Objectives: Heart transplant is the only definitive treatment of end-stage
heart failure. Venoarterial extracorporeal membrane oxygenation may be
used as a bridge to heart transplant. This technique may be used after
heart transplant for conditions refractory to medical treatment like
primary graft failure. Previously, we reported our experience with
patients who received extracorporeal support as a bridge to emergency
heart transplant. In this study, we present our perioperative experience
with heart transplants in which extracorporeal support was used. Materials
and Methods: We retrospectively screened the data of 31 patients who were
seen at our center between January 2014 and June 2016. We screened for
patients who were admitted to the intensive care unit before transplant
and who required venoarterial extracorporeal membrane oxygenation for
circulatory support and postoperative patients who required extracorporeal
support. Patient demographics and characteristics, clinical data, and
extracorporeal support data were collected from our electronic database
and patient medical records. Results: There were 14 patients who required
peri-operative extracorporeal support. Preoperative support was performed
in 3 patients before transplant, and postoperative support was performed
in 11 patients after transplant. The mean age was 37.7 years in patients
within the preoperative group and 29.7 years in patients within the
postoperative group. One patient with preoperative support and 5 with
postoperative support were pediatric patients. The main indication for
transplant was dilated cardiomyopathy in both groups (100% and 63.7%).
Overall mortality rates were 33% in the preoperative group and 63.7% in
the postoperative group. Conclusions: For patients on heart transplant
wait lists who are worsening despite optimal medical therapy, venoarterial
extracorporeal membrane oxygenation support is a safe and viable last
resort. In addition, extracorporeal support can be used during the
posttransplant period as salvage therapy in heart recipients with
hemodynamic deterioration. In our experience, preoperative extracorporeal
support had lower mortality rates compared with postoperative support.
Copyright &#xa9; Baskent University 2017 Printed in Turkey. All Rights
Reserved.

<296>
Accession Number
615150250
Author
Wang N.; Lal S.
Institution
(Wang, Lal) University of SydneySydney, New South WalesAustralia
(Wang, Lal) Royal Prince Alfred HospitalCamperdown, New South
WalesAustralia
Title
Post-dilation in transcatheter aortic valve replacement: A systematic
review and meta-analysis.
Source
Journal of Interventional Cardiology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: The aim of this study was to perform a meta-analysis to
compare the outcomes of patients undergoing TAVR with and without balloon
post-dilation (PD). Background: PD is a commonly used technique in TAVR to
minimize paravalvular regurgitation (PVR), albeit supported by little
evidence. Methods: Systematic review and meta-analysis of 6 studies
comparing 889 patients who had PD compared to 4118 patients without PD.
Results: Patients undergoing PD were more likely male (OR 1.92; 95% CI,
1.41-2.61; P<0.001) and to have coronary artery disease (OR 1.31; 95% CI,
1.03-1.68; P=0.03) than those patients not requiring PD. There were no
significant differences in 30-day mortality (OR 1.24; 95% CI, 0.88-1.74;
P=0.22) and myocardial infarction (OR 0.93; 95% CI, 0.46-1.90; P=0.85).
Patients undergoing TAVR did not have higher 1-year mortality rates (OR
0.98; 95% CI, 0.61-1.56; P=0.92). The incidence of stroke was
significantly greater in patients with PD (OR, 1.71; 95% CI, 1.10-2.66).
PD was able to reduce the incidence of moderate-severe PVR by 15 fold (OR
15.0; 95% CI, 4.2-54.5; P<0.001), although rates of moderate-severe PVR
were still higher after PD than patients who did not require PD (OR 3.64;
95% CI, 1.96-6.75; P<0.001). Conclusions: PD significantly improves rates
of PVR, however careful patient selection is needed to minimize increased
risk of strokes. Copyright &#xa9; 2017, Wiley Periodicals, Inc.

<297>
Accession Number
615145662
Author
Wang J.; Yu W.; Zhou Y.; Yang Y.; Li C.; Liu N.; Hou X.; Wang L.
Institution
(Wang, Yu, Wang) Department of Cardiac Surgery, Beijing An Zhen Hospital
Capital Medical University, Beijing, China
(Wang, Zhou, Yang, Li, Liu, Hou) Center for Cardiac Intensive Care,
Beijing An Zhen Hospital Capital Medical University, Beijing, China
Title
Independent Risk Factors Contributing to Acute Kidney Injury According to
Updated Valve Academic Research Consortium-2 Criteria After Transcatheter
Aortic Valve Implantation: A Meta-analysis and Meta-regression of 13
Studies.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objectives: This study aimed to examine the risk factors for transcatheter
aortic valve implantation (TAVI)-associated acute kidney injury (AKI)
according to the AKI definition from the Valve Academic Research
Consortium-2 (VARC-2). Setting: A meta-analysis. Participants: A total of
661 patients with post-TAVI AKI according to the VARC-2 definition and
2,012 controls were included in the meta-analysis. Interventions: Patients
undergoing TAVI were included in this meta-analysis. Measurements and Main
Results: Multiple electronic databases were searched using predefined
criteria. The diagnosis of AKI was based on the VARC-2 classification. The
authors found that preoperative New York Heart Association class IV (odds
ratio [OR], 7.77; 95% confidence interval [CI], 3.81-15.85), previous
chronic renal disease (CKD) (OR, 2.81; 95% CI, 1.96-4.03), and requirement
for transfusion (OR, 2.03; 95% CI, 1.59-2.59) were associated
significantly with an increased risk for post-TAVI AKI. Furthermore,
previous peripheral vascular disease (PVD), hypertension, atrial
fibrillation, congestive heart failure, diabetes mellitus, and stroke were
also risk factors for TAVI-associated AKI. Additionally, transfemoral
access significantly correlated with a reduced risk for post-TAVI AKI (OR,
0.43; 95% CI, 0.33-0.57). The potential confounders, including Society of
Thoracic Surgeons Score, the logistic European System for Cardiac
Operative Risk Evaluation, aortic valve area, mean pressure gradient, left
ventricular ejection fraction, age, body mass index, contrast volume, and
valve type, had no impact on the association between the risk factors and
post-TAVI AKI. Subgroup analysis of the eligible studies presenting
multivariate logistic regression analysis on the independent risk factors
for post-TAVI AKI revealed that previous CKD, previous PVD, and
transapical access were independent risk factors for TAVI-associated AKI.
Conclusions: The current meta-analysis suggested that previous CKD,
previous PVD, and transapical access may be independent risk factors for
TAVI-associated AKI. Copyright &#xa9; 2017.

<298>
Accession Number
615137717
Author
da Silva Guimaraes S.; de Souza Cruz W.; da Silva L.; Maciel G.; Huguenin
A.B.; de Carvalho M.; Costa B.; da Silva G.; da Costa C.; D'Ippolito J.A.;
Colafranceschi A.; Scalco F.; Boaventura G.
Institution
(da Silva Guimaraes, de Souza Cruz, da Silva, Maciel, Huguenin, de
Carvalho, Costa, da Silva, da Costa, D'Ippolito, Colafranceschi, Scalco,
Boaventura) aExperimental Nutrition Laboratory, College of Nutrition
Fluminense Federal University, bNational Institute of Cardiology,
Department of Surgical Procedures, cLaboratory of Inborn Errors of
Metabolism (LABEIM), and dCollege of Medicine, Rio de Janeiro Federal
University, eIstitute of Mathematics, and fClinical Pathology Service,
Fluminense Federal University, Rio de Janeiro, Brazil
Title
Effect of L-Carnitine Supplementation on Reverse Remodeling in Patients
with Ischemic Heart Disease Undergoing Coronary Artery Bypass Grafting: A
Randomized, Placebo-Controlled Trial.
Source
Annals of Nutrition and Metabolism. (pp 106-110), 2017. Date of
Publication: 25 Mar 2017.
Publisher
S. Karger AG
Abstract
During cardiac failure, cardiomyocytes have difficulty in using the
substrates to produce energy. L-carnitine is a necessary nutrient for the
transport of fatty acids that are required for generating energy. Coronary
artery graft surgery reduces the plasma levels of L-carnitine and
increases the oxidative stress. This study demonstrates the effect of
L-carnitine supplementation on the reverse remodeling of patients
undergoing coronary artery bypass graft. Patients with ischemic heart
failure who underwent coronary graft surgery were randomized to group A -
supplemented with L-carnitine or group B controls. Left ventricular
ejection fraction, left ventricular systolic and diastolic diameters were
assessed preoperatively, 60 and 180 days after surgery. Our study included
28 patients (26 [93.0%] males) with a mean age +/- SD of 58.1 +/- 10.5
years. The parameters for the evaluation of reverse remodeling did not
improve after 60 and 180 days of coronary artery bypass grafting in
comparison between groups (p > 0.05). Evaluation within the L-carnitine
group showed a 37.1% increase in left ventricle ejection fraction (p =
0.002) and 14.3% (p = 0.006) and 3.3% (p > 0.05) reduction in systolic and
diastolic diameters, respectively. L-carnitine supplementation at a dose
of 50 mg/kg combined with artery bypass surgery did not demonstrate any
additional benefit in reverse remodeling. However, evaluation within the
L-carnitine group may indicate a clinical benefit of L-carnitine
supplementation. Copyright &#xa9; 2017 S. Karger AG, Basel

<299>
Accession Number
613415492
Author
Sabra M.J.; Smotherman C.; Kraemer D.F.; Nussbaum M.S.; Tepas J.J.; Awad
Z.T.
Institution
(Sabra, Nussbaum, Tepas, Awad) Department of Surgery, University of
Florida College of Medicine, Jacksonville, FL, United States
(Smotherman, Kraemer) Center for Health Equity and Quality Research
(CHEQR), University of Florida, Jacksonville, FL, United States
Title
The effects of neoadjuvant therapy on morbidity and mortality of
esophagectomy for esophageal cancer: American college of surgeons national
surgical quality improvement program (ACS-NSQIP) 2005-2012.
Source
Journal of Surgical Oncology. 115 (3) (pp 296-300), 2017. Date of
Publication: 01 Mar 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: This study used a multi-center database to evaluate the impact
of neoadjuvant therapy on the 30-day morbidity and mortality following
esophagectomy for esophageal cancer. Methods: The NSQIP database was
queried for 2005-2012 for patients, who had esophagectomy for esophageal
cancer. Patients were divided into two groups: neoadjuvant therapy and
esophagectomy only. Results: The neoadjuvant group had a lower rates of
sepsis (8% vs. 13%, unadjusted P = 0.004) and acute renal failure (0.4%
vs. 2%, unadjusted P = 0.01), and a higher rate of pulmonary embolism (PE)
(3% vs. 1%, unadjusted P = 0.04). The adjusted odds of PE for patients,
who received neoadjuvant therapy were 2.8 times the odds of PE for
patients in the esophagectomy group, controlling for BMI. The association
with renal failure was not significant, when one adjusted for race. There
was no difference in the rates of reoperation, readmission, stroke,
cardiac arrest, MI, surgical site and deep organ infections, anastomosis
failure, blood transfusions, DVT, septic shock, pneumonia, UTI,
respiratory failure, and 30-day mortality between the two groups.
Conclusions: We conclude that neoadjuvant therapy followed by
esophagectomy for esophageal cancer does not have a negative impact on
30-day mortality. Neoadjuvant therapy is associated with increased odds of
PE. J. Surg. Oncol. 2017;115:296-300. &#xa9; 2016 Wiley Periodicals, Inc.
Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<300>
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

<301>
Accession Number
615034041
Author
Nielsen L.H.; Botker H.E.; Sorensen H.T.; Schmidt M.; Pedersen L.; Sand
N.P.; Jensen J.M.; Steffensen F.H.; Tilsted H.H.; Bottcher M.;
Diederichsen A.; Lambrechtsen J.; Kristensen L.D.; Ovrehus K.A.; Mickley
H.; Munkholm H.; Gotzsche O.; Husain M.; Knudsen L.L.; Norgaard B.L.
Institution
(Nielsen, Steffensen, Munkholm) Department of Cardiology, Lillebaelt
Hospital-Vejle, Kabbeltoft 25, Vejle DK-7100, Denmark
(Botker, Jensen, Ovrehus, Gotzsche, Norgaard) Department of Cardiology,
Aarhus University Hospital, Aarhus, Denmark
(Sorensen, Schmidt, Pedersen) Department of Clinical Epidemiology, Aarhus
University Hospital, Aarhus, Denmark
(Sand, Husain) Department of Cardiology, Hospital of South West Jutland,
Esbjerg, Denmark
(Tilsted) Department of Cardiology, Aalborg University Hospital, Aalborg,
Denmark
(Bottcher, Knudsen) Department of Cardiology, Regional Hospital Herning,
Herning, Denmark
(Diederichsen, Mickley) Department of Cardiology, Odense University
Hospital, Denmark
(Lambrechtsen) Department of Cardiology, Svendborg Hospital, Denmark
(Kristensen) Department of Cardiology, Regional Hospital Silkeborg,
Silkeborg, Denmark
Title
Prognostic assessment of stable coronary artery disease as determined by
coronary computed tomography angiography: A Danish multicentre cohort
study.
Source
European Heart Journal. 38 (6) (pp 413-421), 2017. Date of Publication: 01
Feb 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims To examine the 3.5 year prognosis of stable coronary artery disease
(CAD) as assessed by coronary computed tomography angiography (CCTA) in
real-world clinical practice, overall and within subgroups of patients
according to age, sex, and comorbidity. Methods and results This cohort
study included 16,949 patients (median age 57 years; 57% women) with
new-onset symptoms suggestive of CAD, who underwent CCTA between January
2008 and December 2012. The endpoint was a composite of late coronary
revascularization procedure >90 days after CCTA, myocardial infarction,
and all-cause death. The Kaplan-Meier estimator was used to compute 91 day
to 3.5 year risk according to the CAD severity. Comparisons between
patients with and without CAD were based on Cox-regression adjusted for
age, sex, comorbidity, cardiovascular risk factors, concomitant cardiac
medications, and post-CCTA treatment within 90 days. The composite
endpoint occurred in 486 patients. Risk of the composite endpoint was 1.5%
for patients without CAD, 6.8% for obstructive CAD, and 15% for
three-vessel/left main disease. Compared with patients without CAD, higher
relative risk of the composite endpoint was observed for non-obstructive
CAD [hazard ratio (HR): 1.28; 95% confidence interval (CI): 1.01-1.63],
obstructive one-vessel CAD (HR: 1.83; 95% CI: 1.37-2.44), two-vessel CAD
(HR: 2.97; 95% CI: 2.09-4.22), and three-vessel/left main CAD (HR: 4.41;
95% CI :2.90-6.69). The results were consistent in strata of age, sex, and
comorbidity. Conclusion Coronary artery disease determined by CCTA in
real-world practice predicts the 3.5 year composite risk of late
revascularization, myocardial infarction, and all-cause death across
different groups of age, sex, or comorbidity burden. Copyright &#xa9; The
Author 2017..

<302>
Accession Number
614767446
Author
Secrest M.H.; Udell J.A.; Filion K.B.
Institution
(Secrest, Filion) Center for Clinical Epidemiology, Lady Davis Institute,
Jewish General Hospital, Montreal, Quebec, Canada
(Udell) Women's College Research Institute, Department of Medicine,
Women's College Hospital, Toronto, Ontario, Canada
(Udell) Peter Munk Cardiac Centre, University Health Network, Network
University of Toronto, Toronto, Ontario, Canada
(Filion) Department of Epidemiology, Biostatistics, and Occupational
Health, McGill University, Montreal, Quebec, Canada
(Filion) Division of Clinical Epidemiology, Department of Medicine, McGill
University, Montreal, Quebec, Canada
Title
The cardiovascular safety trials of DPP-4 inhibitors, GLP-1 agonists, and
SGLT2 inhibitors.
Source
Trends in Cardiovascular Medicine. 27 (3) (pp 194-202), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
In this paper, we review the results of large, double-blind,
placebo-controlled randomized trials mandated by the US Food and Drug
Administration to examine the cardiovascular safety of newly-approved
antihyperglycemic agents in patients with type 2 diabetes. The
cardiovascular effects of dipeptidyl peptidase-4 (DPP-4) inhibitors remain
controversial: while these drugs did not reduce or increase the risk of
primary, pre-specified composite cardiovascular outcomes, one DPP-4
inhibitor (saxagliptin) increased the risk of hospitalization for heart
failure in the overall population; another (alogliptin) demonstrated
inconsistent effects on heart failure hospitalization across subgroups of
patients, and a third (sitagliptin) demonstrated no effect on heart
failure. Evidence for cardiovascular benefits of glucagon-like peptide-1
(GLP-1) agonists has been similarly heterogeneous, with liraglutide and
semaglutide reducing the risk of composite cardiovascular outcomes, but
lixisenatide having no reduction or increase in cardiovascular risk. The
effect of GLP-1 agonists on retinopathy remains a potential concern. In
the only completed trial to date to assess a sodium-glucose
cotransporter-2 (SGLT2) inhibitor, empagliflozin reduced the risk of
composite cardiovascular endpoints, predominantly through its impact on
cardiovascular mortality and heart failure hospitalization. Copyright
&#xa9; 2017 Elsevier Inc.

<303>
[Use Link to view the full text]
Accession Number
615047856
Author
Naoum C.; Berman D.S.; Ahmadi A.; Blanke P.; Gransar H.; Narula J.; Shaw
L.J.; Kritharides L.; Achenbach S.; Al-Mallah M.H.; Andreini D.; Budoff
M.J.; Cademartiri F.; Callister T.Q.; Chang H.-J.; Chinnaiyan K.; Chow B.;
Cury R.C.; DeLago A.; Dunning A.; Feuchtner G.; Hadamitzky M.; Hausleiter
J.; Kaufmann P.A.; Kim Y.-J.; Maffei E.; Marquez H.; Pontone G.; Raff G.;
Rubinshtein R.; Villines T.C.; Min J.; Leipsic J.
Institution
(Naoum, Blanke, Leipsic) Department of Medicine and Radiology, University
of British Columbia, St Paul's Hospital, 1081 Burrard St, Vancouver, BC
V6Z1Y6, Canada
(Berman, Gransar) Department of Imaging, Cedars Sinai Medical Center, Los
Angeles, CA, United States
(Ahmadi, Narula) Department of Cardiology, Mount Sinai Hospital Medical
Centre, New York, NY, United States
(Shaw) Division of Cardiology, Emory University, School of Medicine,
Atlanta, GA, United States
(Kritharides) Department of Cardiology, Concord Hospital, University of
Sydney, Sydney, NSW, Australia
(Achenbach) Department of Medicine, University of Erlangen, Germany
(Al-Mallah) Department of Medicine, Wayne State University, Henry Ford
Hospital, Detroit, MI, United States
(Andreini, Pontone) Department of Clinical Sciences and Community Health,
University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy
(Budoff) Department of Medicine, Harbor University of California, Los
Angeles Medical Center, United States
(Cademartiri, Maffei) Cardiovascular Imaging Unit, Giovanni XXIII
Hospital, Monastier, Treviso, Italy
(Cademartiri, Maffei) Department of Radiology, Erasmus Medical Center,
Rotterdam, Netherlands
(Callister) Tennessee Heart and Vascular Institute, Hendersonville, United
States
(Chang) Division of Cardiology, Severance Cardiovascular Hospital,
Severance Biomedical Science Institute, Yonsei University, College of
Medicine, Yonsei University Health System, Seoul, South Korea
(Chinnaiyan, Raff) William Beaumont Hospital, Royal Oaks, MI, United
States
(Chow) Department of Medicine and Radiology, University of Ottawa, ON,
Canada
(Cury) Baptist Cardiac and Vascular Institute, Miami, FL, United States
(DeLago) Capitol Cardiology Ass., Albany, NY, United States
(Dunning) Duke Clinical Research Institute, Durham, NC, United States
(Feuchtner) Department of Radiology, Medical University of Innsbruck,
Innsbruck, Austria
(Hadamitzky, Hausleiter) Division of Cardiology, Deutsches Herzzentrum
Munchen, Munich, Germany
(Kaufmann) Department of Nuclear Medicine, University Hospital, Zurich,
Switzerland
(Kim) Seoul National University Hospital, South Korea
(Marquez) Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
(Rubinshtein) Department of Cardiology, Lady Davis Carmel Medical Center,
Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel
(Villines) Department of Medicine, Walter Reed Medical Center, Washington,
DC, United States
(Min) Department of Radiology, New York-Presbyterian Hospital, Weill
Cornell Medical College, New York, United States
Title
Predictive Value of Age-and Sex-Specific Nomograms of Global Plaque Burden
on Coronary Computed Tomography Angiography for Major Cardiac Events.
Source
Circulation: Cardiovascular Imaging. 10 (3) (no pagination), 2017. Article
Number: e004896. Date of Publication: 01 Mar 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background-Age-adjusted coronary artery disease (CAD) burden identified on
coronary computed tomography angiography predicts major adverse
cardiovascular event (MACE) risk; however, it seldom contributes to
clinical decision making because of a lack of nomographic data. We aimed
to develop clinically pragmatic age-and sex-specific nomograms of CAD
burden using coronary computed tomography angiography and to validate
their prognostic use. Methods and Results-Patients prospectively enrolled
in phase I of the CONFIRM registry (Coronary CT Angiography Evaluation for
Clinical Outcomes) were included (derivation cohort: n=21,132; 46% female)
to develop CAD nomograms based on age-sex percentiles of segment
involvement score (SIS) at each year of life (40-79 years). The
relationship between SIS age-sex percentiles (SIS%) and MACE (all-cause
death, myocardial infarction, unstable angina, and late revascularization)
was tested in a nonoverlapping validation cohort (phase II, CONFIRM
registry; n=3030, 44% female) by stratifying patients into 3 SIS% groups
(<50th, 51-75th, and >75th) and comparing annualized MACE rates and time
to MACE using multivariable Cox proportional hazards models adjusting for
Framingham risk and chest pain typicality. Age-sex percentiles were well
fitted to second-order polynomial curves (men: R²=0.86+/-0.12;
women: R²=0.86+/-0.14). Using the nomograms, there were 1576,
965, and 489 patients, respectively, in the <50th, 51-75th, and >75th SIS%
groups. Annualized event rates were higher among patients with greater CAD
burden (2.1% [95% confidence interval: 1.7%-2.7%], 3.9% [95% confidence
interval: 3.0%-5.1%], and 7.2% [95% confidence interval: 5.4%-9.6%] in
<50th, 51-75th, and >75th SIS% groups, respectively; P<0.001). Adjusted
MACE risk was significantly increased among patients in SIS% groups above
the median compared with patients below the median (hazard ratio [95%
confidence interval]: 1.9 [1.3-2.8] for 51-75th SIS% group and 3.4
[2.3-5.0] for >75th SIS% group; P<0.01 for both). Conclusions-We have
developed clinically pragmatic age-and sex-specific nomograms of CAD
prevalence using coronary computed tomography angiography findings. Global
plaque burden measured using SIS% is predictive of cardiac events
independent of traditional risk assessment. Copyright &#xa9; 2017 American
Heart Association, Inc.

<304>
Accession Number
615028111
Author
Bartunek J.; Terzic A.; Davison B.A.; Filippatos G.S.; Radovanovic S.;
Beleslin B.; Merkely B.; Musialek P.; Wojakowski W.; Andreka P.; Horvath
I.G.; Katz A.; Dolatabadi D.; El Nakadi B.; Arandjelovic A.; Edes I.;
Seferovic P.M.; Obradovic S.; Vanderheyden M.; Jagic N.; Petrov I.; Atar
S.; Halabi M.; Gelev V.L.; Shochat M.K.; Kasprzak J.D.; Sanz-Ruiz R.;
Heyndrickx G.R.; Nyolczas N.; Legrand V.; Guedes A.; Heyse A.; Moccetti
T.; Fernandez-Aviles F.; Jimenez-Quevedo P.; Bayes-Genis A.;
Hernandez-Garcia J.M.; Ribichini F.; Gruchala M.; Waldman S.A.; Teerlink
J.R.; Gersh B.J.; Povsic T.J.; Henry T.D.; Metra M.; Hajjar R.J.; Tendera
M.; Behfar A.; Alexandre B.; Seron A.; Stough W.G.; Sherman W.; Cotter G.;
Wijns W.
Institution
(Bartunek, Vanderheyden, Heyndrickx, Wijns) Cardiovascular Center,
Onze-Lieve-Vrouwziekenhuis OLV Hospital, Moorselbaan 164, Aalst, Aalst
B-9300, Belgium
(Terzic, Gersh, Behfar) Mayo Clinic, Center for Regenerative Medicine,
Department of Cardiovascular Diseases, 200 First Street SW, Rochester, MN
550905, United States
(Davison, Cotter) Momentum Research, Inc, Durham, NC, United States
(Filippatos) National and Kapodistrian University of Athens, School of
Medicine, Attikon University Hospital, Athens, Greece
(Radovanovic) University Hospital Center Bezanijska Kosa, Belgrade, Serbia
(Beleslin) Cardiology Clinic, Clinical Centre of Serbia, Medical School,
University of Belgrade, Belgrade, Serbia
(Merkely) Semmelweis University Heart and Vascular Center, Budapest,
Hungary
(Musialek) Jagiellonian University Department of Cardiac and Vascular
Diseases, John Paul II Hospital, Krakow, Poland
(Wojakowski, Tendera) Third Division of Cardiology, Medical University of
Silesia, Katowice, Poland
(Andreka) Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest,
Hungary
(Horvath) Heart Institute, University of Pecs, Pecs, Hungary
(Katz) Department of Cardiology, Barzilai Medical Center, Israel Faculty
of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
(Dolatabadi, El Nakadi) Division of Cardiology, Centre Hospitalier
Universitaire de Charleroi, Charleroi, Belgium
(Arandjelovic) Cardiology Department, Clinical Hospital Zvezdara,
Belgrade, Serbia
(Edes) Department of Cardiology, University of Debrecen, Debrecen, Hungary
(Seferovic) University of Belgrade School of Medicine, Belgrade University
Medical Center, Belgrade, Serbia
(Obradovic) Clinic of Emergency Medicine, Military Medical Academy, School
of Medicine, University of Defense, Belgrade, Serbia
(Jagic) Clinical Center Kragujevac, Kragujevac, Serbia
(Petrov, Gelev) Department of Cardiology, Angiology and Electrophysiology,
City Clinic Heart and Vascular Institute, Sofia University, Sofia,
Bulgaria
(Atar) Department of Cardiology, Galilee Medical Center, Nahariya, Israel
(Atar, Halabi) Faculty of Medicine in the Galilee, Bar-Ilan University,
Safed, Israel
(Shochat) Heart Institute, Hillel Yaffe Medical Center, Rappaport School
of Medicine, Haifa, Israel
(Kasprzak) Department of Cardiology Medical University of Lodz, Lodz,
Poland
(Sanz-Ruiz, Fernandez-Aviles) Hospital General Universitario Gregorio
Maranon, Madrid, Spain
(Nyolczas) Medical Centre, Hungarian Defense Forces, Budapest, Hungary
(Legrand) Department of Cardiology, Centre Hospitalier Universitaire de
Liege, Liege, Belgium
(Guedes) Department of Cardiology, Universite Catholique de Louvain, CHU
UcL Namur, Yvoir, Belgium
(Heyse) Department of Cardiology, AZ Glorieux, Ronse, Belgium
(Moccetti) Cardiocentro Ticino, Lugano, Switzerland
(Jimenez-Quevedo) Department of Cardiology, Hospital Clinico San Carlos,
Madrid, Spain
(Bayes-Genis) Hospital Universitari Germans Trias i Pujol, Universitat
Autonoma, Barcelona, Spain
(Hernandez-Garcia) Hospital Clinico Universitario Virgen de la Victoria,
Malaga, Spain
(Ribichini) Department of Cardiology, University of Verona, Italy
(Gruchala) Department of Cardiology, Medical University of Gdansk, Gdansk,
Poland
(Waldman) Sidney Kimmel Medical College, Thomas Jefferson University,
Philadelphia, PA, United States
(Teerlink) School of Medicine, University of California San Francisco and
Section of Cardiology, San Francisco Veterans Affairs Medical Center, San
Francisco, CA, United States
(Povsic) Duke Clinical Research Institute and Duke Medicine, Durham, NC,
United States
(Henry) Cedars Sinai Heart Institute, Los Angeles, CA, United States
(Metra) Cardiology, Department of Medical and Surgical Specialties,
Radiological Sciences and Public Health, University and Spedali Civili,
Brescia, Italy
(Hajjar) Mount Sinai School of Medicine, New York, NY, United States
(Alexandre, Seron, Sherman) Celyad, Mont Saint Guibert, Belgium
(Stough) Departments of Clinical Research and Pharmacy Practice, Campbell
University College of Pharmacy and Health Sciences, Cary, NC, United
States
(Wijns) Lambe Institute for Translational Medicine and Curam, National
University of Ireland Galway and Saolta University Healthcare Group,
Galway, Ireland
Title
Cardiopoietic cell therapy for advanced ischaemic heart failure: Results
at 39 weeks of the prospective, randomized, double blind, sham-controlled
CHART-1 clinical trial.
Source
European Heart Journal. 38 (9) (pp 648-660), 2017. Date of Publication: 01
Mar 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims Cardiopoietic cells, produced through cardiogenic conditioning of
patients' mesenchymal stem cells, have shown preliminary efficacy. The
Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART-1)
trial aimed to validate cardiopoiesis-based biotherapy in a larger heart
failure cohort. Methods and results This multinational, randomized,
double-blind, sham-controlled study was conducted in 39 hospitals.
Patients with symptomatic ischaemic heart failure on guideline-directed
therapy (n= 484) were screened; n = 348 underwent bone marrow harvest and
mesenchymal stem cell expansion. Those achieving> 24 million mesenchymal
stem cells (n=315) were randomized to cardiopoietic cells delivered
endomyocardially with a retention-enhanced catheter (n=157) or sham
procedure (n= 158). Procedures were performed as randomized in 271
patients (n = 120 cardiopoietic cells, n= 151 sham). The primary efficacy
endpoint was a Finkelstein Schoenfeld hierarchical composite (all-cause
mortality, worsening heart failure, Minnesota Living with Heart Failure
Questionnaire score, 6-min walk distance, left ventricular end-systolic
volume, and ejection fraction) at 39 weeks. The primary outcome was
neutral (Mann Whitney estimator 0.54, 95% confidence interval [CI] 0.47
0.61 [value> 0.5 favours cell treatment], P = 0.27). Exploratory analyses
suggested a benefit of cell treatment on the primary composite in patients
with baseline left ventricular end-diastolic volume 200-370mL (60% of
patients) (Mann Whitney estimator 0.61, 95% CI 0.52-0.70, P = 0.015). No
difference was observed in serious adverse events. One (0.9%)
cardiopoietic cell patient and 9 (5.4%) sham patients experienced aborted
or sudden cardiac death. Conclusion The primary endpoint was neutral, with
safety demonstrated across the cohort. Further evaluation of cardiopoietic
cell therapy in patients with elevated end-diastolic volume is warranted.
Copyright &#xa9; The Author 2016.

<305>
Accession Number
608789640
Author
Martinez-Selles M.; Bouza E.; Diez-Villanueva P.; Valerio M.; Farinas
M.C.; Munoz-Garcia A.J.; Ruiz-Morales J.; Galvez-Acebal J.; Antorrena I.;
De La Hera Galarza J.M.; Navas E.; Munoz P.
Institution
(Martinez-Selles, Bouza, Diez-Villanueva, Valerio, Munoz) Hospital General
Universitario Gregorio Maranon, Universidad Europea Madrid, Calle Doctor
Esquerdo 46, Madrid 28007, Spain
(Martinez-Selles) Universidad Europea, Madrid, Spain
(Farinas) Hospital Universitario Marques de Valdecilla, Santander, Spain
(Munoz-Garcia, Ruiz-Morales) Hospital Clinico Universitario Virgen de la
Victoria, Malaga, Spain
(Galvez-Acebal) Hospital Universitario Virgen Macarena, Seville, Spain
(Antorrena) Hospital Universitario la Paz, Madrid, Spain
(De La Hera Galarza) Hospital Central de Asturias, Oviedo, Spain
(Navas) Hospital Universitario Ramon y Cajal, Madrid, Spain
Title
Incidence and clinical impact of infective endocarditis after
transcatheter aortic valve implantation.
Source
EuroIntervention. 11 (10) (pp 1180-1187), 2016. Date of Publication:
February 2016.
Publisher
EuroPCR
Abstract
Aims: To describe the characteristics of infective endocarditis (IE) after
transcatheter aortic valve implantation (TAVI). Methods and results: This
study was performed using the GAMES database, a national prospective
registry of consecutive patients with IE in 26 Spanish hospitals. Of the
739 cases of IE diagnosed during the study, 1.3% were post-TAVI IE, and
these 10 cases, contributed by five centres, represented 1.1% of the 952
TAVIs performed. Mean age was 80 years. All valves were implanted
transfemorally. IE appeared a median of 139 days after implantation. The
mean age-adjusted Charlson comorbidity index was 5.45. Chronic kidney
disease was frequent (five patients), as were atrial fibrillation (five
patients), chronic obstructive pulmonary disease (four patients), and
ischaemic heart disease (four patients). Six patients presented aortic
valve involvement, and four only mitral valve involvement; the latter
group had a higher percentage of prosthetic mitral valves (0% vs. 50%).
Vegetations were found in seven cases, and four presented embolism. One
patient underwent surgery. Five patients died during follow-up: two of
these patients died during the admission in which the valve was implanted.
Conclusions: IE is a rare but severe complication after TAVI which affects
about 1% of patients and entails a relatively high mortality rate. IE
occurred during the first year in nine of the 10 patients. Copyright
&#xa9; Europa Digital & Publishing 2016. All rights reserved.

<306>
Accession Number
608789629
Author
Waltenberger J.; Brachmann J.; Van Der Heyden J.; Richardt G.; Frobert O.;
Seige M.; Erglis A.; Dewilde W.; Winkens M.; Hegeler-Molkewehrum C.; Klein
N.; Hoffmann S.
Institution
(Waltenberger) Department of Cardiovascular Medicine, Universitatsklinikum
Munster, Albert-Schweitzer-Campus 1, Gebaude A1, Munster 48149, Germany
(Brachmann) II. Medizinische Klinik, Klinikum Coburg, Coburg, Germany
(Van Der Heyden) Department of Cardiology, St. Antonius Ziekenhuis,
Nieuwegein, Netherlands
(Richardt) Department of Cardiology and Angiology, Herzzentrum Segeberger
Kliniken GmbH, Bad Segeberg, Germany
(Frobert) Department of Cardiology, Universitetssjukhuset Orebro, Orebro,
Sweden
(Seige) I. Medizinische Klinik, Krankenhaus Martha-Maria GGmbH,
Halle-Dolau, Germany
(Erglis) Latvian Centre of Cardiology, Paul Stradins Clinical University
Hospital, University of Latvia, Riga, Latvia
(Dewilde, Winkens) Department of Cardiology, Twee Steden Hospital Tilburg,
Tilburg, Netherlands
(Hegeler-Molkewehrum) Kardiologisch-Angiologische Praxis Hegeler, Bremen,
Germany
(Klein) Department of Cardiology, University of Leipzig, Leipzig, Germany
(Hoffmann) Department of Internal Medicine and Cardiology, Vivantes
Klinikum im Friedrichshain, Berlin, Germany
Title
Real-world experience with a novel biodegradable polymer sirolimus-eluting
stent: Twelve-month results of the BIOFLOW-III registry.
Source
EuroIntervention. 11 (10) (pp 1106-1110), 2016. Date of Publication:
February 2016.
Publisher
EuroPCR
Abstract
Aims: We aimed to assess the safety and performance of a novel
sirolimus-eluting stent with biodegradable polymer under real-world
conditions. Methods and results: This prospective, multicentre,
observational, all-comers registry enrolled 1,356 patients. The primary
endpoint was target lesion failure at 12 months: it occurred in 5.1% (95%
CI: 4.0-6.4) of patients in the overall population and in 7.7% (95% CI:
5.5-10.9), 5.8% (95% CI: 4.2-8.1), 1.8% (95% CI: 0.2-11.8) and 7.2% (95%
CI: 5.1-10.0) of patients with diabetes mellitus, small vessels, chronic
total occlusion and acute myocardial infarction, respectively.
Conclusions: This novel stent platform demonstrated good clinical outcomes
in an all-comers population, even in predefined high-risk groups.
Copyright &#xa9; Europa Digital & Publishing 2016. All rights reserved.

<307>
Accession Number
600404847
Author
Bae J.S.; Jang J.-S.
Institution
(Bae) Department of Medicine, Kangdong Sacred Heart Hospital, Hallym
University College of Medicine, Seoul, South Korea
(Jang) Cardiovascular Outcomes Research, Saint Luke's Mid America Heart
Institute, University of Missouri-Kansas City, Kansas City, MO, United
States
(Jang) Department of Cardiology, Busan Paik Hospital, Inje University
College of Medicine, 633-165 Gaegum-dong, Jin-gu, Busan 614-735, South
Korea
Title
Comparison of new adenosine diphosphate receptor antagonists with
clopidogrel in patients with coronary artery disease: a meta-analysis.
Source
Heart and Vessels. 31 (3) (pp 275-287), 2016. Date of Publication: 01 Mar
2016.
Publisher
Springer-Verlag Tokyo (E-mail: orders@springer.jp)
Abstract
Recent data suggest the superiority of new adenosine diphosphate (ADP)
receptor antagonists compared with clopidogrel in acute coronary syndrome
patients. We aimed to assess the risks and benefits of new ADP receptor
antagonists in patients with coronary artery disease (CAD). Relevant
studies published through February 28, 2014 were searched and identified
in the MEDLINE, EMBASE, and Cochrane databases. Summary estimates were
obtained using a random-effects model. All nine published randomized
controlled studies comparing new ADP receptor antagonists with clopidogrel
in CAD were included. The database consisted of 66,900 patients; 33,782 on
novel agents, and 33,118 on clopidogrel. New ADP receptor antagonists
reduced the composite incidence of all-cause mortality, myocardial
infarction or stroke (odds ratio [OR] 0.89, 95 % confidence interval [CI]
0.81-0.97, p = 0.01) but increased the incidence of non-coronary artery
bypass grafting-related major bleeding (OR 1.24, 95 % CI 1.08-1.42, p =
0.003). The composite end point of the net rate of adverse clinical
events, which was the combination of the primary efficacy end point and
the primary safety end point, was significantly lower in the new agent
group compared to the clopidogrel group (9.7 versus 10.6 %, OR 0.92, 95 %
CI 0.85-1.00). Use of recently introduced new ADP receptor antagonists
results in a reduction in adverse clinical outcomes but a substantial
increase in bleeding. New agents revealed an improved combined efficacy
and safety outcome compared to that of clopidogrel in patients with CAD.
Copyright &#xa9; 2014, Springer Japan.

<308>
Accession Number
608564123
Author
Puri R.; Nissen S.E.; Shao M.; Kataoka Y.; Uno K.; Kapadia S.R.; Tuzcu
E.M.; Nicholls S.J.
Institution
(Puri, Nissen, Shao, Uno) Cleveland Clinic Coordinating Center for
Clinical Research (C5R), Cleveland, OH, United States
(Puri, Nissen, Kapadia, Tuzcu) Department of Cardiovascular Medicine,
Cleveland Clinic, OH, United States
(Kataoka, Nicholls) South Australian Health and Medical Research
Institute, University of Adelaide, PO Box 11060, Adelaide, SA 5001,
Australia
Title
The beneficial effects of raising high-density lipoprotein cholesterol
depends upon achieved levels of low-density lipoprotein cholesterol during
statin therapy: Implications for coronary atheroma progression and
cardiovascular events.
Source
European Journal of Preventive Cardiology. 23 (5) (pp 474-485), 2016. Date
of Publication: 01 Mar 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Aims Controversy exists regarding benefits of raising HDL-C in
statin-treated coronary artery disease (CAD) patients. We assessed the
anti-atherosclerotic efficacy of raising HDL-C in statin-treated
individuals with CAD across a range of achieved LDL-C, including lower
(<70 mg/dL) versus higher (>70 mg/dL) levels. Methods and results In seven
prospective randomized trials utilizing serial coronary intravascular
ultrasound, 3469 statin-treated CAD patients were stratified according to
achieved LDL-C (< vs >70 mg/dL) and changes in HDL-C (> vs < median), as
well as across a broader spectrum of changes in HDL-C and achieved LDL-C
levels. Changes in coronary percent atheroma volume and MACE
(cardiovascular death, non-fatal MI, stroke, coronary revascularization,
hospitalization for unstable angina) were evaluated across these groups.
Results Overall, median change in HDL-C was +6.03%, and mean achieved
LDL-C in the lower and higher LDL-C groups were 55.1 +/- 11 and 97.4 +/-
22 mg/dL, respectively. Following multivariable adjustment, in patients
with achieved LDL-C < 70 mg/dL, greater HDL-C-raising did not associate
with disease progression/regression. In those with achieved LDL-C > 70
mg/dL, greater HDL-C-raising associated with less disease progression (OR
0.80 (95% CI 0.67, 0.97)) and MACE (HR 0.78 (95% CI 0.64, 0.96)). Greater
increases in HDL-C (up to 25% from baseline) across the continuous range
of on-treatment LDL-C levels associated with less disease progression)OR
0.90 (95% CI 0.83, 0.98)) and lower MACE (HR 0.87 (95% CI 0.77, 0.998)).
Conclusions Increasing HDL-C via a broad spectrum of mechanisms appears
beneficial in statin-treated CAD patients, but is likely of greater
benefit in patients with achieved LDL-C levels >70 mg/dL. Copyright &#xa9;
The European Society of Cardiology 2015.

<309>
Accession Number
615011851
Author
Silaschi M.; Treede H.; Rastan A.J.; Baumbach H.; Beyersdorfe F.; Kappert
U.; Eichinger W.; Ruter F.; de Kroon T.L.; Lange R.; Ensminger S.; Wendler
O.
Institution
(Silaschi, Wendler) Department of Cardiothoracic Surgery, King's College
Hospital London, London, United Kingdom
(Treede) Department of Cardiovascular Surgery, University Heart Center
Hamburg, Hamburg, Germany
(Rastan) Department of Cardiac Surgery, Center of Cardiovascular Diseases
Rotenburg a. d. Fulda, Rotenburg, Germany
(Baumbach) Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus
Stuttgart, Stuttgart, Germany
(Beyersdorfe) Department of Cardiovascular Surgery Freiburg, University
Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
(Kappert) Department of Cardiac Surgery, University Heart Center Dresden,
Dresden, Germany
(Eichinger) Department of Cardiovascular Surgery, Klinikum Bogenhausen,
Munich, Germany
(Ruter) Department of Cardiac Surgery, University Hospital Basel, Basel,
Switzerland
(de Kroon) Department of Cardiothoracic Surgery, St. Antonius Hospital,
Nieuwegein, Netherlands
(Lange) Department of Cardiovascular Surgery, German Heart Center Munich
at Technische Universitat Munchen, Munich, Germany
(Ensminger) Department of Cardiothoracic Surgery, Heart and Diabetes
Center North Rhine-Westphalia, Bad Oeynhausen, Germany
Title
The JUPITER registry: 1-year results of transapical aortic valve
implantation using a second-generation transcatheter heart valve in
patients with aortic stenosis.
Source
European Journal of Cardio-thoracic Surgery. 50 (5) (pp 874-881), 2016.
Date of Publication: 01 Nov 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Transcatheter aortic valve replacement (TAVR) is an
established therapy for patients with aortic stenosis (AS) at high
surgical risk. The JenaValveTM is a second-generation, self-expanding
transcatheter heart valve (THV), implanted through transapical access
(TA). During stent deployment, a specific 'clipping-mechanism' engages
native aortic valve cusps for fixation. We present 1-year outcomes of the
JUPITER registry, a post-market registry of the JenaValve for TA-TAVR.
METHODS: The JUPITER registry is a prospective, multicentre, uncontrolled
and observational European study to evaluate the long-term safety and
effectiveness of the Conformite Europeenne-marked JenaValve THV. A total
of 180 patients with AS were enrolled between 2012 and 2014. End-points
were adjudicated in accordance with the valve academic research consortium
document no. 1 definitions. RESULTS: The mean age was 80.4 +/- 5.9 years
and the mean logistic European system for cardiac operative risk
evaluation I 21.2 +/- 14.7%. The procedure was successful in 95.0%
(171/180), implantation of a second THV (valve-in-valve) was performed in
2.2% (4/180) and conversion to surgical aortic valve replacement (SAVR)
was necessary in 2.8% (5/180). No annular rupture or coronary ostia
obstruction occurred. Two patients required SAVR after the day of index
procedure (1.1%). All-cause mortality at 30 days was 11.1% (20/180), being
cardiovascular in 7.2% (13/180). A major stroke occurred in 1.1% (2/180)
at 30 days, no additional major strokes were observed during 1 year.
All-cause mortality after 30 days was 13.1% (21/160) and combined efficacy
at 1 year was 80.8% (122/151). At 1-year follow-up, no patient presented
with more than moderate paravalvular leakage, while 2 patients (3.2%)
showed moderate, 12 (19.0%) mild and 49 (82.4%) trace/none paravalvular
regurgitation. CONCLUSIONS: In a high-risk cohort of patients undergoing
TA-TAVR for AS, the use of the JenaValve THV is safe and effective. In
patients at higher risk for coronary ostia obstruction, annular rupture or
with limited aortic valve calcification, the JenaValve might be preferable
for implantation due to its clipping-mechanism engaging native aortic
valve cusps for fixation with reduced radial forces of the self-expanding
stent. Copyright &#xa9; The Author 2016. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.

<310>
Accession Number
615011844
Author
Conrotto F.; D'Ascenzo F.; D'Onofrio A.; Agrifoglio M.; Chieffo A.; Cioni
M.; Regesta T.; Tarantini G.; Gabbieri D.; Saia F.; Tamburino C.;
Ribichini F.; Cugola D.; Aiello M.; Sanna F.; Iadanza A.; Pompei E.;
Stolcova M.; Cappai A.; Minati A.; Cassese M.; Martinelli G.L.;
Agostinelli A.; Gerosa G.; Gaita F.; Rinaldit M.; Salizzoni S.
Institution
(Conrotto, D'Ascenzo, Gaita) Division of Cardiology, Citta della Salute e
della Scienza Hospital, Torino, Italy
(D'Onofrio, Tarantini, Gerosa) Department of Cardiac, Thoracic and
Vascular Sciences, University of Padova, Padova, Italy
(Agrifoglio) Centro Cardiologico Monzino, Department of Clinical Sciences
and Community, University of Milano, Milano, Italy
(Chieffo, Cioni) Ospedale San Raffaele, Milano, Italy
(Regesta) Divisione di Cardiochirurgia, IRCCS San Martino-IST, Genova,
Italy
(Gabbieri) Hesperia Hospital, Modena, Italy
(Saia) AOU Policlinico S. Orsola-Malpighi, Bologna, Italy
(Tamburino) Ospedale Ferrarotto, Universita di Catania, Catania, Italy
(Ribichini) AOU Integrata Verona, Verona, Italy
(Cugola) AO Papa Giovanni XXIII, Bergamo, Italy
(Aiello) IRCCS Policinico S. Matteo, Pavia, Italy
(Sanna) AO Brotzu, Cagliari, Italy
(Iadanza) AOU Policlinico Le Scotte, Siena, Italy
(Pompei) AOUD Santa Maria della Misericordia, Udine, Italy
(Stolcova) AOU Careggi, Firenze, Italy
(Cappai) Humanitas Research Hospital, Rozzano, Italy
(Minati) Ospedale Cattinara, Trieste, Italy
(Cassese, Martinelli) Clinica S. Maria, Bari, Italy
(Agostinelli) Ospedale Maggiore, Parma, Italy
(Rinaldit, Salizzoni) Department of Surgical Sciences, Citta della Salute
e della Scienza Hospital, Torino, Italy
Title
Predictive ability of the CHADS<inf>2</inf> and
CHA<inf>2</inf>DS<inf>2</inf>-VASc scores for stroke after transcatheter
aortic balloon-expandable valve implantation: An Italian Transcatheter
Balloon-Expandable Valve Implantation Registry (ITER) sub-analysis.
Source
European Journal of Cardio-thoracic Surgery. 50 (5) (pp 867-873), 2016.
Date of Publication: 01 Nov 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Stroke incidence after transcatheter aortic valve implantation
(TAVI) still represents a concern. This multicentre study aimed at
investigating the hypothesis that CHADS2 and CHA2DS2-VASc scores may be
used to predict perioperative stroke after TAVI. METHODS: The Italian
Transcatheter Balloon-Expandable Valve Implantation Registry (ITER) is a
multicentre, prospective registry of patients undergoing
balloon-expandable TAVI using Edwards Sapien and Sapien XT prosthesis
between 2007 and 2012. The primary endpoint of this study was the 30-day
stroke rate. Secondary safety end-points were all the major adverse events
based on Valve Academic Research Consortium (VARC-2) criteria. RESULTS:
One thousand nine hundred and four patients were enrolled in the registry.
Mean age was 81.6 +/- 6.2 years and 1147 (60.2%) patients were female;
mean CHADS<inf>2</inf> and CHA<inf>2</inf>DS<inf>2</inf>-VASc scores were
2.2 +/- 0.8 and 4.4 +/- 1.1, respectively. Fifty-four (2.8%) patients had
a stroke within 30 days. At multivariable logistic regression analysis,
CHA2DS<inf>2</inf>-VASc (OR: 1.35, 95% CI: 1.03-1.78; P = 0.031) and
previous cardiac surgery (OR: 1.96, 95% CI: 1.06-3.6; P = 0.033) but not
CHADS<inf>2</inf> (OR: 1.05, 95% CI: 0.76-1.44; P = 0.77) were found to be
independent predictors of in-hospital stroke. A
CHA<inf>2</inf>DS<inf>2</inf>-VASc score >5 was strongly related to the
occurrence of in-hospital stroke (OR: 2.51, 95% CI: 1.38-4.57; P= 0.001).
However, CHA<inf>2</inf>DS<inf>2</inf>-VASc score showed only poor
accuracy for in-hospital stroke with a trend for better accuracy when
compared with CHADS<inf>2</inf> score (area under the curve: 0.61, 95% CI:
0.59-0.63 vs 0.51; 95% CI: 0.49-0.54, respectively, P = 0.092).
CONCLUSIONS: In TAVI patients, CHA<inf>2</inf>DS<inf>2</inf>-VASc provided
a strong correlation for in-hospital stroke but with low accuracy.
Dedicated scores to properly tailor procedures and preventive strategies
are needed. Copyright &#xa9; The Author 2016. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<311>
Accession Number
615011826
Author
Schmitto J.D.; Zimpfer D.; Fiane A.E.; Larbalestier R.; Tsui S.; Jansz P.;
Simon A.; Schueler S.; Strueber M.
Institution
(Schmitto) Hannover Medical School, Hannover, Germany
(Zimpfer) Medical University of Vienna, Vienna, Austria
(Fiane) Oslo University Hospital, Oslo, Norway
(Larbalestier) Royal Perth Hospital, Perth, Australia
(Tsui) Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
(Jansz) St Vincent's Clinic, Sydney, Australia
(Simon) Royal Brompton and Harefield Hospital, London, United Kingdom
(Schueler) Freeman Hospital, Newcastle upon Tyne, United Kingdom
(Strueber) Spectrum Health, Grand Rapids, MI, United States
Title
Long-term support of patients receiving a left ventricular assist device
for advanced heart failure: A follow-up analysis of the Registry to
Evaluate the Heart Ware Left Ventricular Assist System.
Source
European Journal of Cardio-thoracic Surgery. 50 (5) (pp 834-838), 2016.
Date of Publication: 01 Nov 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The Registry to Evaluate the HeartWare Left Ventricular Assist
System (ReVOLVE) is an investigator-initiated multicentre, prospective,
single-arm database established to collect post-Conformite Europeenne Mark
clinical information on patients receiving the HeartWare Ventricular
Assist System (HVAD). The number of patients requiring longer periods of
mechanical circulatory support is ever increasing and so further
investigation into long-term outcomes in bridge-to-transplant populations
is necessary. METHODS: Data were collected on 254 commercial implants
performed between February 2009 and March 2012 from nine centres in Europe
(7 centres) and Australia (2 centres). Patients were followed to device
explant, heart transplant or death, and the outcomes of patients who
remained on support longer than 2 years were analysed. Summary statistics
were used to describe patient demographics, adverse events, length of
support and outcomes for this long-term cohort. RESULTS: A total of 124
patients (49% of the original ReVOLVE population) were on support for more
than 2 years (range: 731-2108 days), 76 of whom are still alive on
support. Overall survival through 5 years was 59%. CONCLUSIONS: Owing to
the low rate of heart transplants, a significant number of patients
receiving a left ventricular assist device as a bridge to transplant
remain on support for prolonged periods, often exceeding 2, 3 and even 4
years. Real-world use of the HVAD system continues to show excellent
outcomes for patients on the device, including those on support beyond 2
years. Copyright &#xa9; The Author 2016. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.

<312>
Accession Number
615011816
Author
Ueki C.; Sakaguchi G.; Akimoto T.; Ohashi Y.; Sato H.
Institution
(Ueki, Sakaguchi, Akimoto, Ohashi, Sato) Department of Cardiovascular
Surgery, Shizuoka General Hospital, Shizuoka, Japan
Title
On-pump beating-heart technique is associated with lower morbidity and
mortality following coronary artery bypass grafting: A meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 50 (5) (pp 813-821), 2016.
Date of Publication: 01 Nov 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
A hybrid procedure of beating-heart coronary artery bypass grafting (CABG)
with the concomitant use of cardiopulmonary bypass termed on-pump
beating-heart CABG (ON-BH CABG) has emerged as an alternative for
high-risk patient populations. Although several studies have reported the
advantage of ON-BH CABG in high-risk patients, the clinical benefit of
ON-BH CABG is still under discussion. Here, we performed a meta-analysis
of the data derived from published studies comparing the clinical outcomes
of ON-BH CABG with that of conventional arrested heart CABG. Medline,
Embase and Scopus databases were searched for relevant publications up to
March 2015. A systematic review of the published literature identified 14
published studies incorporating 2040 patients (884 ON-BH CABG and 1156
conventional CABG). Odds ratios (ORs) for binary variables or weighted
mean difference for continuous variables were combined using the inverse
variance method in a fixed-effects model. Study heterogeneity was tested
using Cochran's Q test and the publication bias was assessed using Begg's
and Egger's tests. The fixed-effects meta-analysis for early mortality
showed that ON-BH CABG provided a 45% lower risk of early mortality
compared with conventional CABG (OR 0.553; 95% confidence interval [CI]
0.376-0.815; P = 0.003). There was minimal heterogeneity in the included
studies (P = 0.29) and no evidence of significant publication bias. A
sensitivity analysis, including a random-effects meta-analysis (OR 0.552;
95% CI 0.356-0.856; P = 0.008) and a one-study-removed meta-analysis,
supported the validity of the primary analysis for early mortality. There
was significantly lower perioperative morbidity associated with ON-BH
CABG, including myocardial infarction (OR 0.294; 95% CI 0.141-0.613; P =
0.001), renal failure (OR 0.362; 95% CI 0.209-0.626; P < 0. 001) and low
output syndrome (OR 0.330; 95% CI 0.197-0.551; P < 0.001) with no
significant heterogeneity. In conclusion, current evidence from
comparative studies indicates that ON-BH CABG is associated with
significantly lower early morbidity and mortality. The ON-BH CABG could be
an attractive planned alternative for high-risk patient populations.
Copyright &#xa9; The Author 2016. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<313>
Accession Number
608383534
Author
Pocock S.; Bueno H.; Licour M.; Medina J.; Zhang L.; Annemans L.; Danchin
N.; Huo Y.; De Werf F.V.
Institution
(Pocock) London School of Hygiene and Tropical Medicine, United Kingdom
(Bueno) Hospital General Universitario Gregorio Maranon, Spain
(Licour) Medical Department, AstraZeneca France, France
(Medina) AstraZeneca Observational Research Center, Spain
(Zhang) AstraZeneca Medical Evidence Center, United States
(Annemans) Interuniversity Centre for Health Economics Research UGent,
Vrije Universiteit Brussel, Belgium
(Danchin) Hopital Europeen Georges Pompidou, Rene Descartes University,
France
(Huo) Peking University First Hospital, China
(De Werf) University Hospitals Leuven, Belgium
Title
Predictors of one-year mortality at hospital discharge after acute
coronary syndromes: A new risk score from the EPICOR (longtErm follow uP
of antithrombotic management patterns In acute CORonary syndrome patients)
study.
Source
European Heart Journal: Acute Cardiovascular Care. 4 (6) (pp 509-517),
2015. Date of Publication: 2015.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Aims: A reliable prediction tool is needed to identify acute coronary
syndrome (ACS) patients with high mortality risk after their initial
hospitalization. Methods: EPICOR (long-tErm follow uP of antithrombotic
management patterns In acute CORonary syndrome patients: NCT01171404) is a
prospective cohort study of 10,568 consecutive hospital survivors after an
ACS event (4943 STsegment elevation myocardial infarction (STEMI) and 5625
non-ST-elevation ACS (NSTE-ACS)). Of these cases, 65.1% underwent
percutaneous coronary intervention (PCI) and 2.5% coronary artery bypass
graft (CABG). Post-discharge mortality was recorded for up to two years.
From over 50 potential predictor variables a new risk score for oneyear
mortality was developed using forward stepwise Cox regression, and
examined for goodness-of-fit, discriminatory power, and external
validation. Results: A total of 407 patients (3.9%) died within one year
of discharge. We identified 12 highly significant independent predictors
of mortality (in order of predictive strength): age, lower ejection
fraction, poorer EQ-5D quality of life, elevated serum creatinine,
in-hospital cardiac complications, chronic obstructive pulmonary disease,
elevated blood glucose, male gender, no PCI/CABG after NSTE-ACS, low
hemoglobin, peripheral artery disease, on diuretics at discharge. When
combined into a new risk score excellent discrimination was achieved
(c-statistic=0.81) and this was also validated on a large similar cohort
(9907 patients) in Asia (c=0.78). For both STEMI and NSTE-ACS there was a
steep gradient in oneyear mortality ranging from 0.5% in the lowest
quintile to 18.2% in the highest decile. NSTE-ACS contributes over twice
as many high-risk patients as STEMI. Conclusions: Post-discharge mortality
for ACS patients remains of concern. Our new user-friendly risk score
available on www.acsrisk.org can readily identify who is at high risk.
Copyright &#xa9; The European Society of Cardiology 2014.

<314>
Accession Number
604381414
Author
Parfrey P.S.; Drueke T.B.; Block G.A.; Herzog C.A.; London G.M.; Mahaffey
K.W.; Moe S.M.; Wheeler D.C.; Kubo Y.; Dehmel B.; Goodman W.G.; Chertow
G.M.; Santos J.; Najun Zarazaga C.; Marin I.; Garrote N.; Cusumano A.;
Penalba N.; Del Valle E.; Juncos L.; Martinez Saye J.; Lef L.; Altobelli
V.; Petraglia G.; Rosa Diez G.; Douthat W.; Lobo J.; Gallart C.; Lafalla
A.; Diez G.; Linares B.; Lopez N.; Ramirez N.; Gonzalez R.; Valtuille R.;
Beresan H.; Hermida O.; Rudolf G.; Marchetta N.; Rano M.; Ramirez M.;
Garcia N.; Gillies A.; Jones B.; Pedagogos E.; Walker R.; Talaulikar G.;
Bannister K.; Suranyi M.; Kark A.; Roger S.; Kerr P.; Disney A.; Mount P.;
Fraenkel M.; Mathew M.; Fassett R.; Jose M.; Hawley C.; Lonergan M.;
Mackie J.; Ferrari P.; Menahem S.; Sabto J.; Hutchison B.; Langham R.;
Pollock C.; Holzer H.; Oberbauer R.; Arias I.; Graf H.; Mayer G.; Lhotta
K.; Neyer U.; Klauser R.; Hoerl W.; Horn S.; Kovarik J.; Kramar R.; Eigner
M.; Dhaene M.; Billiouw J.; De Meester J.; Warling X.;
Cambier-Dwelschauwers P.; Evenepoel P.; Daelemans R.; Dratwa M.; Maes B.;
Stolear J.; Dejagere T.; Vanwalleghem J.; Bouman K.; Jadoul M.; Peeters
J.; Vanholder R.; Tielemans C.; Donck J.; Almeida F.; Picollo de Oliveira
J.; Burdmann E.; Garcia V.; Saldanha Thome F.; Deboni L.; Bregman R.;
Lugon J.; Araujo S.; Ferreira Filho S.; de Francesco Daher E.; Sperto
Baptista M.; Carvalho A.; d'Avila D.; Moyses Neto M.; Yu L.; Bastos M.;
Sampaio Lacativa P.; Jorgetti V.; de Almeida Romao E.; Cardeal da Costa
J.; Pecoits Filho R.; Gordan P.; Salgado N.; Teixeira Araujo M.; Neiva
Coelho S.; Oliveira I.; Moyses R.; Vasconcellos L.; Batista P.; Luiz Gross
J.; Pedrosa A.; Cournoyer S.; LeBlanc M.; Chow S.; Karunakaran S.; Wong
G.; Tobe S.; Desmeules S.; Zimmerman D.; Murphy S.; Montambault P.;
Donnelly S.; MacRae J.; Culleton B.; Soroka S.; Rabbat C.; Jindal K.;
Vasilevsky M.; Michaud M.; Wijeyesinghe E.; Zacharias J.; Lok C.; Muirhead
N.; Verrelli M.; Da Roza G.; Sapir D.; Olgaard K.; Daugaard H.; Brandi L.;
Jensen P.; Boulechfar H.; Ang K.; Simon P.; Rieu P.; Brunet P.; Touchard
G.; London G.; Urena Torres P.; Combe C.; Durrbach A.; Ortiz J.;
Hannedouche T.; Vela C.; Lionet A.; Ryckelynck P.; Zaoui P.; Choukroun G.;
Fessi H.; Lang P.; Stroumza P.; Joly D.; Mousson C.; Laville M.; Dellanna
F.; Erley C.; Braun J.; Rambausek M.; Riegel W.; Klingberg M.;
Schwertfeger E.; Wizemann V.; Eckardt K.; Reichel H.; Floege J.; Passauer
J.; Hubel E.; Frischmuth N.; Liebl R.; Fiedler R.; Schwenger V.;
Vosskuhler A.; Kunzendorf U.; Renders L.; Rattensberger D.; Rump L.;
Ketteler M.; Neumayer H.; Zantvoort F.; Stahl R.; Ladanyi E.; Kulcsar I.;
Mezei I.; Csiky B.; Rikker C.; Arkossy O.; Berta K.; Szegedi J.; Major L.;
Ferenczi S.; Fekete A.; Szabo T.; Zakar G.; Wagner G.; Kazup Erdelyine S.;
Borbas B.; Eustace J.; Reddan D.; Capasso G.; Locatelli F.; Villa G.;
Cozzolino M.; Brancaccio D.; Messa P.; Bolasco P.; Ricciardi B.; Malberti
F.; Moriero E.; Cannella G.; Ortalda V.; Stefoni S.; Frasca G.; Cappelli
G.; Albertazzi A.; Zoccali C.; Farina M.; Elli A.; Avella F.; Ondei P.;
Mingardi G.; Errico R.; Losito A.; Di Giulio S.; Pertosa G.; Schena F.;
Grandaliano G.; Gesualdo L.; Auricchio M.; Bochicchio-Ricardelli T.;
Correa-Rotter R.; Aranda Verastegui F.; Pena J.; Chew Wong A.; Cruz-Valdez
J.; Torres Zamora M.; Solis M.; Sebastian Diaz M.; Vital Flores M.;
Alvarez Sandoval E.; van den Dorpel M.; Brink H.; Van Kuijk W.; Vermeij
C.; Smak Gregoor P.; Hagen E.; van der Sande F.; Klinger M.; Nowicki M.;
Muszytowski M.; Bidas K.; Bentkowski W.; Wiecek A.; Ksiazek A.; Marczewski
K.; Ostrowski M.; Switalski M.; Sulowicz W.; Matuszkiewicz-Rowinska J.;
Mysliwiec M.; Durlik M.; Rutkowski B.; Macario F.; Carvalho B.; Frazao J.;
Machado D.; Weigert A.; Andrusev A.; Khrustalev O.; Zemtchenkov A.;
Gurevich K.; Staroselsky K.; Khadikova N.; Rozhinskaya L.; Timokhovskaya
G.; Strokov A.; Balkarova O.; Ermolenko V.; Kolmakova E.; Komandenko M.;
Timofeev M.; Shilo V.; Shostka G.; Smirnov A.; Anashkin V.; Volgina G.;
Domashenko O.; Gurevich A.; Perlin D.; Martinez Garcia J.; Andres Ribes
E.; Coll Piera E.; Fernandez Lucas M.; Galicia M.; Prados M.; Gonzalez M.;
Romero R.; Martin de Francisco A.; Montenegro J.; Santiago C.; Garcia F.;
Alcazar de La Ossa J.; Arrieta J.; Pons J.; Martin-Malo A.; Soler Amigo
J.; Cases A.; Sterner G.; Jensen G.; Wikstrom B.; Jacobson S.; Lund U.;
Weiss L.; Stahl A.; von Albertini B.; Burnier M.; Meier P.; Martin P.;
Uehlinger D.; Dickenmann M.; Yaqoob M.; Zehnder D.; Kalra P.; Wheeler D.;
Padmanabhan N.; Roe S.; Eadington D.; Pritchard N.; Hutchison A.; Davies
S.; Wilkie M.; Davies M.; Pai P.; Swift P.; Kwan J.; Goldsmith D.; Tomson
C.; Stratton J.; Dasgupta I.; Sarkar S.; Moustafa M.; Gandhi K.; Jamal A.;
Galindo-Ramos E.; Tuazon J.; Batlle D.; Tucker K.; Schiller-Moran B.;
Assefi A.; Martinez C.; Samuels L.; Goldman J.; Cangiano-Rivera J.;
Darwish R.; Lee M.; Topf J.; Kapatkin K.; Baer H.; Kopelman R.; Acharya
M.; Tharpe D.; Bernardo M.; Nader P.; Guzman-Rivera J.; Pergola P.;
Sekkarie M.; Alas E.; Zager P.; Liss K.; Navarro J.; Roppolo M.;
Denu-Ciocca C.; Kshirsagar A.; El Khatib M.; Kant K.; Scott D.; Murthyr
B.; Finkelstein F.; Keightley G.; McCrary R.; Pitone J.; Cavalieri T.;
Tsang A.; Pellegrino B.; Schmidt R.; Ahmad S.; Brown C.; Friedman E.;
Mittman N.; Fadem S.; Shapiro W.; Reddy M.; Goldberger S.; Woredekal Y.;
Agarwal A.; Anger M.; Haque M.; Chidester P.; Kohli R.; Rubinstein S.;
Newman G.; Gladish R.; Ayodeji O.; Soman S.; Sprague S.; Hunt N.; Gehr T.;
Rizk D.; Warnock D.; Polack D.; Pahl M.; Fischer D.; Dreyer P.; James G.;
Husserl F.; Rogers T.; Raff A.; Sedor J.; Silver M.; Smith M.; Steinberg
S.; DelGiorno T.; Jones E.; Cunha P.D.; Cheng J.; Pogue V.; Block G.;
Blumenthal S.; Brown E.; Charytan C.; Buerkert J.; Cook M.; Felsenfeld A.;
Tareen N.; Herman T.; Diamond S.; Hura C.; Laski M.; MacLaurin J.; Plumb
T.; Brosnahan G.; Kumar J.; Henriquez M.; Poole C.; Osanloo E.; Matalon
A.; Sholer C.; Arfeen S.; Azer M.; Belledonne M.; Gross M.; Dunnigan E.;
McConnell K.; Becker B.; Skinner F.; Rigolosi R.; Spiegel D.; Stegman M.;
Patak R.; Streja D.; Ranjit U.; Youell T.; Wooldridge T.; Stafford C.;
Cottiero R.; Weinberg M.; Schonefeld M.; Shahmir E.; Hazzan A.; Ashfaq A.;
Bhandari K.; Cleveland W.; Culpepper M.; Golden J.; Lai L.; Lien Y.;
Lorica V.; Robertson J.; Malireddi K.; Morse S.; Thakur V.; Israelit A.;
Raguram P.; Alfred H.; Weise W.; Al-Saghir F.; El Shahawy M.; Rastogi A.;
Nissenson A.; Kopyt N.; Lynn R.; Lea J.; McClellan W.; Teredesai P.; Ong
S.; Tolkan S.; Sugihara J.; Minga T.; Mehrotra R.; Minasian R.; Bhatia D.;
Specter R.; Capelli J.; Sidhu P.; Dalal S.; Dykes P.; Khan M.; Rahim F.;
Saklayen M.; Thomas A.; Michael B.; Torres M.; Al-Bander H.; Murray B.;
Abukurah A.; Gupta B.; Nosrati S.; Raja R.; Zeig S.; Braun M.; Amatya A.;
Endsley J.; Sharon Z.; Gupta A.; Dolson G.; Dumler F.; Ntoso K.; Rosansky
S.; Kumar N.; Gura V.; Thompson N.; Goldfarb D.; Halligan R.; Middleton
J.; Widerhorn A.; Arbeit L.; Arruda J.; Crouch T.; Friedman L.; Khokhar
S.; Mittleman J.; Light P.; Taparia B.; West C.; Cotton J.; Dhingra R.;
Kleinman L.; Arif F.; Lew S.; Nammour T.; Sterrett J.; Williams M.;
Ramirez J.; Rubin J.; McCarthy J.; Noble S.; Chaffin M.; Rekhi A.;
Evaluation of Cinacalcet HCL Therapy to Lower Cardiovascular Events
(EVOLVE) Trial Investigators
Institution
(Parfrey) Department of Medicine, Health Sciences Center, St. John's, NL,
Canada
(Drueke) French Institute of Health and Medical Research Unit 1088,
University of Picardie, Amiens, France
(Block) Denver Nephrology, Denver, CO, United States
(Correa-Rotter) Department of Nephrology and Mineral Metabolism, Salvador
Zubiran National Institute of Health Sciences and Nutrition, Mexico City,
Mexico
(Floege) Department of Nephrology, RWTH Aachen University Hospital,
Aachen, Germany
(Herzog) Department of Internal Medicine, University of Minnesota,
Minneapolis, MN, United States
(London) Service of Nephrology, Manhes Hospital, Paris, France
(Mahaffey, Chertow) Department of Medicine, Stanford University School of
Medicine, Palo Alto, CA, United States
(Moe) Department of Medicine, Indiana University School of Medicine,
Roudebush Veterans Administration Medical Center, Indianapolis, IN, United
States
(Wheeler) Centre for Nephrology, University College London, United Kingdom
(Kubo, Dehmel, Goodman) Amgen Inc, Thousand Oaks, CA, United States
(Santos, Najun Zarazaga, Marin, Garrote, Cusumano, Penalba, Del Valle,
Juncos, Martinez Saye, Lef, Altobelli, Petraglia, Rosa Diez, Douthat,
Lobo, Gallart, Lafalla, Diez, Linares, Lopez, Ramirez, Gonzalez,
Valtuille, Beresan, Hermida, Rudolf, Marchetta, Rano, Ramirez, Garcia)
Argentina
(Gillies, Jones, Pedagogos, Walker, Talaulikar, Bannister, Suranyi, Kark,
Roger, Kerr, Disney, Mount, Fraenkel, Mathew, Fassett, Jose, Hawley,
Lonergan, Mackie, Ferrari, Menahem, Sabto, Hutchison, Langham, Pollock)
Australia
(Holzer, Oberbauer, Arias, Graf, Mayer, Lhotta, Neyer, Klauser, Hoerl,
Horn, Kovarik, Kramar, Eigner) Austria
(Dhaene, Billiouw, De Meester, Warling, Cambier-Dwelschauwers, Evenepoel,
Daelemans, Dratwa, Maes, Stolear, Dejagere, Vanwalleghem, Bouman, Jadoul,
Peeters, Vanholder, Tielemans, Donck) Belgium
(Almeida, Picollo de Oliveira, Burdmann, Garcia, Saldanha Thome, Deboni,
Bregman, Lugon, Araujo, Ferreira Filho, de Francesco Daher, Sperto
Baptista, Carvalho, d'Avila, Moyses Neto, Yu, Bastos, Sampaio Lacativa,
Jorgetti, de Almeida Romao, Cardeal da Costa, Pecoits Filho, Gordan,
Salgado, Teixeira Araujo, Neiva Coelho, Oliveira, Moyses, Vasconcellos,
Batista, Luiz Gross, Pedrosa) Brazil
(Cournoyer, LeBlanc, Chow, Karunakaran, Wong, Tobe, Desmeules, Zimmerman,
Murphy, Montambault, Donnelly, MacRae, Culleton, Soroka, Rabbat, Jindal,
Vasilevsky, Michaud, Wijeyesinghe, Zacharias, Lok, Muirhead, Verrelli, Da
Roza, Sapir) Canada
(Olgaard, Daugaard, Brandi, Jensen) Denmark
(Boulechfar, Ang, Simon, Rieu, Brunet, Touchard, London, Urena Torres,
Combe, Durrbach, Ortiz, Hannedouche, Vela, Lionet, Ryckelynck, Zaoui,
Choukroun, Fessi, Lang, Stroumza, Joly, Mousson, Laville) France
(Dellanna, Erley, Braun, Rambausek, Riegel, Klingberg, Schwertfeger,
Wizemann, Eckardt, Reichel, Floege, Passauer, Hubel, Frischmuth, Liebl,
Fiedler, Schwenger, Voskuhler, Kunzendorf, Renders, Rattensberger, Rump,
Ketteler, Neumayer, Zantvoort, Stahl) Germany
(Ladanyi, Kulcsar, Mezei, Csiky, Rikker, Arkossy, Berta, Szegedi, Major,
Ferenczi, Fekete, Szabo, Zakar, Wagner, Kazup Erdelyine, Borbas) Hungary
(Eustace, Reddan) Ireland
(Capasso, Locatelli, Villa, Cozzolino, Brancaccio, Messa, Bolasco,
Ricciardi, Malberti, Moriero, Cannella, Ortalda, Stefoni, Frasca,
Cappelli, Albertazzi, Zoccali, Farina, Elli, Avella, Ondei, Mingardi,
Errico, Losito, Di Giulio, Pertosa, Schena, Grandaliano, Gesualdo,
Auricchio) Italy
(Bochicchio-Ricardelli, Correa-Rotter, Aranda Verastegui, Pena, Chew Wong,
Cruz-Valdez, Torres Zamora, Solis, Sebastian Diaz, Vital Flores, Alvarez
Sandoval) Mexico
(van den Dorpel, Brink, Van Kuijk, Vermeij, Smak Gregoor, Hagen, van der
Sande) Netherlands
(Klinger, Nowicki, Muszytowski, Bidas, Bentkowski, Wiecek, Ksiazek,
Marczewski, Ostrowski, Switalski, Sulowicz, Matuszkiewicz-Rowinska,
Mysliwiec, Durlik, Rutkowski) Poland
(Macario, Carvalho, Frazao, Machado, Weigert) Portugal
(Andrusev, Khrustalev, Zemtchenkov, Gurevich, Staroselsky, Khadikova,
Rozhinskaya, Timokhovskaya, Strokov, Balkarova, Ermolenko, Kolmakova,
Komandenko, Timofeev, Shilo, Shostka, Smirnov, Anashkin, Volgina,
Domashenko, Gurevich, Perlin) Russian Federation
(Martinez Garcia, Andres Ribes, Coll Piera, Fernandez Lucas, Galicia,
Prados, Gonzalez, Romero, Martin de Francisco, Montenegro, Santiago,
Garcia, Alcazar de La Ossa, Arrieta, Pons, Martin-Malo, Soler Amigo,
Cases) Spain
(Sterner, Jensen, Wikstrom, Jacobson, Lund, Weiss, Stahl) Sweden
(von Albertini, Burnier, Meier, Martin, Uehlinger, Dickenmann) Switzerland
(Yaqoob, Zehnder, Kalra, Wheeler, Padmanabhan, Roe, Eadington, Pritchard,
Hutchison, Davies, Wilkie, Davies, Pai, Swift, Kwan, Goldsmith, Tomson,
Stratton, Dasgupta) United Kingdom
(Sarkar, Moustafa, Gandhi, Jamal, Galindo-Ramos, Tuazon, Batlle, Tucker,
Schiller-Moran, Assefi, Martinez, Samuels, Goldman, Cangiano-Rivera,
Darwish, Lee, Topf, Kapatkin, Baer, Kopelman, Acharya, Tharpe, Bernardo,
Nader, Guzman-Rivera, Pergola, Sekkarie, Alas, Zager, Liss, Navarro,
Roppolo, Denu-Ciocca, Kshirsagar, El Khatib, Kant, Scott, Murthyr,
Finkelstein, Keightley, McCrary, Pitone, Cavalieri, Tsang, Pellegrino,
Schmidt, Ahmad, Brown, Friedman, Mittman, Fadem, Shapiro, Reddy,
Goldberger, Woredekal, Agarwal, Anger, Haque, Chidester, Kohli,
Rubinstein, Newman, Gladish, Ayodeji, Soman, Sprague, Hunt, Gehr, Rizk,
Warnock, Polack, Pahl, Fischer, Dreyer, James, Husserl, Rogers, Raff,
Sedor, Silver, Smith, Steinberg, DelGiorno, Jones, Cunha, Cheng, Pogue,
Block, Blumenthal, Brown, Charytan, Buerkert, Cook, Felsenfeld, Tareen,
Gupta, Herman, Diamond, Hura, Laski, MacLaurin, Plumb, Brosnahan, Kumar,
Henriquez, Poole, Osanloo, Matalon, Sholer, Arfeen, Azer, Belledonne,
Gross, Dunnigan, McConnell, Becker, Skinner, Rigolosi, Spiegel, Stegman,
Patak, Streja, Ranjit, Youell, Wooldridge, Stafford, Cottiero, Weinberg,
Schonefeld, Shahmir, Hazzan, Ashfaq, Bhandari, Cleveland, Culpepper,
Golden, Lai, Lien, Lorica, Robertson, Malireddi, Morse, Thakur, Israelit,
Raguram, Alfred, Weise, Al-Saghir, El Shahawy, Rastogi, Nissenson, Kopyt,
Lynn, Lea, McClellan, Teredesai, Ong, Tolkan, Sugihara, Minga, Mehrotra,
Minasian, Bhatia, Specter, Capelli, Sidhu, Dalal, Dykes, Khan, Rahim,
Saklayen, Thomas, Michael, Torres, Al-Bander, Murray, Abukurah, Gupta,
Nosrati, Raja, Zeig, Braun, Amatya, Endsley, Sharon, Gupta, Dolson,
Dumler, Ntoso, Rosansky, Kumar, Gura, Thompson, Goldfarb, Halligan,
Middleton, Widerhorn, Arbeit, Arruda, Crouch, Friedman, Khokhar,
Mittleman, Light, Taparia, West, Cotton, Dhingra, Kleinman, Arif, Lew,
Nammour, Sterrett, Williams, Ramirez, Rubin, McCarthy, Noble, Chaffin,
Rekhi) United States
Title
The effects of cinacalcet in older and younger patients on hemodialysis:
The evaluation of cinacalcet HCL therapy to lower cardiovascular events
(EVOLVE) trial.
Source
Clinical Journal of the American Society of Nephrology. 10 (5) (pp
791-799), 2015. Date of Publication: 01 Jan 2015.
Publisher
American Society of Nephrology (E-mail: email@asn-online.org)
Abstract
Background and objectives The calcimimetic cinacalcet reduced the risk of
death or cardiovascular (CV) events in older, but not younger, patients
with moderate to severe secondary hyperparathyroidism (HPT) who were
receiving hemodialysis. To determine whether the lower risk in younger
patients might be due to lower baseline CV risk and more frequent use of
cointerventions that reduce parathyroid hormone (kidney transplantation,
parathyroidectomy, and commercial cinacalcet use), this study examined the
effects of cinacalcet in older (> 65 years, n=1005) and younger (<65
years, n=2878) patients. Design, setting, participants, & measurements
Evaluation of Cinacalcet HCl Therapy to Lower Cardiovascular Events
(EVOLVE) was a global, multicenter, randomized placebo-controlled trial in
3883 prevalent patients on hemodialysis, whose outcomes included death,
major CV events, and development of severe unremitting HPT. The age
subgroup analysis was prespecified. ResultsOlder patients had higher
baseline prevalence of diabetesmellitus and CV comorbidity. Annualized
rates of kidney transplantation and parathyroidectomy were > 3-fold higher
in younger relative to older patients and were more frequent in patients
randomized to placebo. In older patients, the adjusted relative hazard
(95% confidence interval) for the primary composite (CV) end point
(cinacalcet versus placebo) was 0.70 (0.60 to 0.81); in younger patients,
the relative hazard was 0.97 (0.86 to 1.09). Corresponding adjusted
relative hazards for mortality were 0.68 (0.51 to 0.81) and 0.99 (0.86 to
1.13). Reduction in the risk of severe unremitting HPT was similar in both
groups. Conclusions In the EVOLVE trial, cinacalcet decreased the risk of
death and of major CV events in older, but not younger, patients with
moderate to severe HPT who were receiving hemodialysis. Effect
modification by age may be partly explained by differences in underlying
CV risk and differential application of cointerventions that reduce
parathyroid hormone. Copyright &#xa9; 2015 by the American Society of
Nephrology.

<315>
Accession Number
603238378
Author
Layland J.; Oldroyd K.G.; Curzen N.; Sood A.; Balachandran K.; Das R.;
Junejo S.; Ahmed N.; Lee M.M.Y.; Shaukat A.; O'Donnell A.; Nam J.; Briggs
A.; Henderson R.; McConnachie A.; Berry C.
Institution
(Layland, Oldroyd, Ahmed, Lee, Shaukat, O'Donnell, Berry) West of Scotland
Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United
Kingdom
(Layland, Berry) BHF Glasgow Cardiovascular Research Centre, Institute of
Cardiovascular and Medical Sciences, University of Glasgow, 126 University
Place, Glasgow G12 8TA, United Kingdom
(Curzen) University Hospital Southampton Foundation Trust, Southampton,
United Kingdom
(Sood) Hairmyres Hospital, East Kilbride, United Kingdom
(Balachandran) Royal Blackburn Hospital, Blackburn, United Kingdom
(Das) Freeman Hospital, Newcastle, United Kingdom
(Junejo) City Hospitals Sunderland Foundation Trust, Sunderland, United
Kingdom
(Nam, Briggs) Health Economics and Health Technology Assessment Unit,
University of Glasgow, Glasgow, United Kingdom
(Henderson) Trent Cardiac Centre, Nottingham University Hospitals,
Nottingham, United Kingdom
(McConnachie) Robertson Centre for Biostatistics, University of Glasgow,
United Kingdom
Title
Fractional flow reserve vs. Angiography in guiding management to optimize
outcomes in non-ST-segment elevation myocardial infarction: The British
Heart Foundation FAMOUS-NSTEMI randomized trial.
Source
European Heart Journal. 36 (2) (pp 100-111), 2015. Date of Publication: 07
Jan 2015.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aim We assessed the management and outcomes of non-ST segment elevation
myocardial infarction (NSTEMI) patients randomly assigned to fractional
flow reserve (FFR)-guided management or angiography-guided standard care.
Methods and results We conducted a prospective, multicentre, parallel
group, 1: 1 randomized, controlled trial in 350 NSTEMI patients with >1
coronary stenosis >30% of the lumen diameter assessed visually (threshold
for FFR measurement) (NCT01764334). Enrolment took place in six UK
hospitals from October 2011 to May 2013. Fractional flow reserve was
disclosed to the operator in the FFR-guided group (n = 176). Fractional
flow reserve was measured but not disclosed in the angiography-guided
group (n = 174). Fractional flow reserve <0.80 was an indication for
revascularization by percutaneous coronary intervention (PCI) or coronary
artery bypass surgery (CABG). The median (IQR) time from the index episode
of myocardial ischaemia to angiography was 3 (2, 5) days. For the primary
outcome, the proportion of patients treated initially by medical therapy
was higher in the FFR-guided group than in the angiography-guided group
[40 (22.7%) vs. 23 (13.2%), difference 95% (95% CI: 1.4%, 17.7%), P =
0.022]. Fractional flow reserve disclosure resulted in a change in
treatment between medical therapy, PCI or CABG in 38 (21.6%) patients. At
12 months, revascularization remained lower in the FFR-guided group [79.0
vs. 86.8%, difference 7.8% (-0.2%, 15.8%), P = 0.054]. There were no
statistically significant differences in health outcomes and quality of
life between the groups. Conclusion In NSTEMI patients, angiography-guided
management was associated with higher rates of coronary revascularization
compared with FFR-guided management. A larger trial is necessary to assess
health outcomes and cost-effectiveness. Copyright &#xa9; The Author 2014.
Published by Oxford University Press on behalf of the European Society of
Cardiology.

<316>
Accession Number
601056318
Author
Wang K.; Kong X.; Zhu Y.; Wang J.
Institution
(Wang, Kong, Zhu, Wang) Department of Cardiovascular Surgery, Tianjin
First Center Hospital, Tianjin 300192, China
Title
Use of an intra-aortic balloon pump with chronic renal cardiac surgery.
Source
Clinica Terapeutica. 165 (5) (pp e353-e356), 2014. Date of Publication:
2014.
Publisher
Societa Editrice Universo
Abstract
Objective. To investigate the protective effect of an intra-aortic balloon
pump (IABP) on renal function during open-heart surgery in patients with
chronic renal insufficiency. Materials and Methods. Seventeen patients
with moderate renal insufficiency who underwent cardiac pulmonary bypass
surgery were randomly assigned to receive either IABP or usual care
(control group). In the IABP group, the IABP was inserted immediately
after anesthesia, and built-in counterpulsation was continued during
aortic blockade. The IABP was gradually removed when postoperative
hemodynamics and renal function was recovered. Clinical parameters related
to renal function, including urine output and serum creatinine levels,
were recorded perioperatively. Results. Urine volume during surgery,
postoperative usage of diuretics, and mechanical ventilation time were
better in the IABP group than in the control group. Serum creatinine
increased after surgery in both groups, but the increase was significantly
smaller in the IABP group. Conclusion. Preoperative use of IABP in
patients with moderate renal insufficiency undergoing cardiac surgery can
help protect renal function and may improve prognosis. Copyright &#xa9;
2014. Societa Editrice Universo (SEU).

<317>
Accession Number
600126553
Author
Leclercq F.; Delseny D.; Nogue E.; Macioce V.; Nagot N.; Roubille F.;
Gervasoni R.; Macia J.C.
Institution
(Leclercq, Delseny, Roubille, Gervasoni, Macia) Department of Cardiology,
University of Montpellier, Arnaud de Villeneuve University Hospital, 295
avenue du doyen Giraud, Montpellier cedex 5 34295, France
(Nogue, Macioce, Nagot) Department of Medical Information, University of
Montpellier, Arnaud de Villeneuve Hospital, Montpellier, France
Title
Decrease of vascular and bleeding complications after balloon aortic
valvuloplasty performed without heparin.
Source
Journal of Invasive Cardiology. 26 (10) (pp 528-533), 2014. Date of
Publication: 01 Oct 2014.
Publisher
HMP Communications
Abstract
OBJECTIVES: To determine whether vascular and bleeding complications may
be reduced with balloon aortic valvuloplasty (BAV) performed without
heparin. BACKGROUND: Vascular and bleeding complications are currently the
main adverse events occurring after BAV. METHODS: This registry included
162 consecutive patients with severe aortic stenosis who underwent BAV by
femoral approach in our center between 2008 and 2012. Eighty-five patients
had unfractionated heparin (UH) 50 IU/kg bolus IV during the procedure,
whereas 77 patients did not have heparin. Our primary combined endpoint
included severe vascular or bleeding complications (BARC score >3), severe
ischemic events (acute limb ischemia or systemic embolism) or death at
1-month follow-up. RESULTS: The primary composite endpoint was achieved in
25 patients overall (15.4%) and was significantly lower in the
heparin-free group (10.3% vs 20.0%; P=.03). Vascular, bleeding, or
ischemic events were dramatically lower in the heparin-free group (6.5%)
compared with the heparin group (18.8%; P=.01). UH use was associated with
an increased risk of vascular and bleeding complications (relative risk,
2.92; 95% confidence interval, 1.35-7.94), but not with a decreased risk
of ischemic events (relative risk, 1.81, 95% confidence interval,
0.34-9.61). After adjustment for patient and procedure characteristics,
including the sheath size, heparin use was the only significant predictor
of the primary endpoint (adjusted odds ratio, 2.94; 95% confidence
interval, 1.75-14.74). CONCLUSION: BAV performed without heparin is
associated with a reduction of severe vascular events or death without
increased ischemic risk. This marked difference is difficult to explain by
confounding factors, but should be confirmed in a randomized controlled
trial.

<318>
Accession Number
615123560
Author
Sian K.; Li S.; Selvakumar D.; Mejia R.
Institution
(Sian, Li, Mejia) Department of Cardiothoracic Surgery, John Hunter
Hospital, New Lambton Heights, NSW, Australia
(Selvakumar) Faculty of Health and Medicine, University of Newcastle,
Newcastle, NSW, Australia
Title
Early results of the Sorin Perceval S sutureless valve: Systematic review
and meta-analysis.
Source
Journal of Thoracic Disease. 9 (3) (pp 711-724), 2017. Date of
Publication: 01 Mar 2017.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Minimally invasive aortic valve replacement (MAVR) has
demonstrated a benefit with respect to increased patient satisfaction due
to minimised pain and earlier recovery. Sutureless valves may benefit MAVR
and conventional aortic valve replacement (AVR) by reducing operative
times and blood transfusion requirements. The Perceval valve (Sorin,
Salluggia, Italy) is a self-expanding prosthesis made from bovine
pericardium mounted in a nitinol stent, designed to simplify the
implantation of an aortic valve. This metaanalysis evaluates the clinical,
haemodynamic, and survival outcomes of the Perceval sutureless valve.
Methods: An electronic search of 4 databases was performed from January
2000 to December 2016. Primary outcomes included mortality and stroke.
Secondary outcomes included minimally invasive access, paravalvular leak,
overall long-term survival, postoperative echocardiographic findings, and
functional class improvement. Results: After the application of inclusion
and exclusion criteria, 14 of 66 relevant articles were selected for
assessment. Of these 14 studies, a total number of 2,505 patients were
included. The current evidence on the Perceval valve for aortic valve
disease is limited to observational studies only. Minimally invasive
surgery was performed in 976 patients, of which 336 were via the right
anterior thoracotomy approach. The Perceval M and L sutureless valves were
the most frequently used, 782 and 770 respectively. The incidence of major
adverse events included 30-day mortality (0 to 4.9%), cerebrovascular
accident (0 to 3%), permanent pacemaker insertion (0 to 17%), moderate to
severe paravalvular leak (0 to 8.6%), and re-operation (0 to 4.8%).
Post-operative mean aortic valve gradient ranged from 9 to 15.9 mmHg and
post-operative New York Heart Association (NYHA) Class I or II ranged from
82% to 96%. The 1-year survival ranged from 86% to 100%; and 5-year
survival was 71.3% to 85.5% in two studies. Conclusions: The Perceval
valve is associated with excellent post-operative results in MAVR and in
conventional AVR. Larger randomised controlled studies are required to
evaluate the long-term efficacy of the prosthesis.

<319>
Accession Number
615123475
Author
Tsilimigras D.I.; Antonopoulou A.; Ntanasis-Stathopoulos I.; Patrini D.;
Papagiannopoulos K.; Lawrence D.; Panagiotopoulos N.
Institution
(Tsilimigras, Antonopoulou, Patrini, Lawrence, Panagiotopoulos) Department
of Thoracic Surgery, University College London Hospitals (UCLH), London,
United Kingdom
(Tsilimigras, Ntanasis-Stathopoulos) School of Medicine, National and
Kapodistrian University of Athens, Athens, Greece
(Antonopoulou) School of Medicine, University of Patras, Patras, Greece
(Papagiannopoulos) Department of Thoracic Surgery, St. James's University
Hospital, Leeds, United Kingdom
Title
The role of BioGlue in thoracic surgery: A systematic review.
Source
Journal of Thoracic Disease. 9 (3) (pp 568-576), 2017. Date of
Publication: 01 Mar 2017.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: BioGlue is a commonly used sealant in thoracic surgery.
Prolonged air leak and presence of bronchopleural fistulae (BPF) are often
encountered in clinical practice. We therefore, investigated the role and
the efficacy of BioGlue in these scenarios. Methods: A systematic review
was conducted by searching Medline [1966-2016] and Cochrane Central
Register of Controlled Trials (CENTRAL) [1999-2016] along with reference
lists of the included studies. Included studies reported on thoracic
surgery operations and use of BioGlue in thoracic surgical procedures,
whereas excluded studies met at least one of the following criteria:
non-English language studies, nonhuman population, studies on surgical
specialties other than Thoracic surgery, reviews and meta-analyses and
sealants other than BioGlue. Results: Twelve studies with a total number
of 194 patients were included. Amongst them, 178 were treated for alveolar
air leaks (AAL), 14 for BPF and 2 for lymphatic leaks. BioGlue was
utilized at the time of initial operation in 172 (96.7%) patients for AAL,
while at secondary intervention in 13 (92.9%) for BPF and 1 (50%) for
lymphatic leak. In terms of AAL, only 2 out of 4 studies showed
statistically significant reduction in duration of air leak, duration of
intercostal drainage and length of stay (LOS) when BioGlue was applied. No
complications were encountered after using BioGlue in sealing BPF, apart
from the re-application of BioGlue in 3 cases. Conclusions: Although
BioGlue has been shown to be efficient in treating AAL, it should be used
with caution against BPF, despite encouraging preliminary results.
Potential adverse effects must always be taken into consideration. Future
randomized controlled trials are warranted in an attempt to establish its
benefit in current clinical practice.

<320>
Accession Number
615124595
Author
Garijo J.M.; Wijeysundera D.N.; Munro J.C.; Meineri M.
Institution
(Garijo, Wijeysundera, Munro, Meineri) Department of Anesthesia and Pain
Management, Toronto General Hospital, Toronto, ON, Canada
Title
Correlation Between Transhepatic and Subcostal Inferior Vena Cava Views to
Assess Inferior Vena Cava Variation: A Pilot Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objectives: To assess the feasibility and reliability of transthoracic
echocardiography to measure inferior vena cava (IVC) diameter variation
using a transhepatic view. Design: Prospective cohort study. Setting:
Single-center hospital. Patients: Forty consecutive patients undergoing
elective cardiac surgery. Interventions: Bedside transthoracic
echocardiography. Measurements and Main Results: Correlation between the
two views was measured using Pearson R, while agreement was measured using
the intraclass correlation coefficient (ICC). In a nested sub-study of 16
randomly selected participants, all images were re-rated by the same
rater, who was blinded to the original measurement results, and by a
second blinded operator. Correlation between the subcostal and
transhepatic views was moderate when assessing maximum (R 0.46; 95%
confidence interval [CI], 0.18-0.68), and minimum (R 0.55; CI, 0.29-0.74)
IVC diameter. Correlation when measuring IVC diameter variation was higher
(R 0.70; CI, 0.49-0.83). Agreement between the two views for IVC diameter
variation measurement was substantial (ICC 0.73; CI, 0.49-0.85).
Intra-rater reliability was excellent (ICC 0.95-0.99). Conclusions:
Agreement between subcostal and transhepatic views was substantial for the
assessment of IVC diameter variation; however, the magnitude of agreement
was less than anticipated. Further research is needed to determine if the
transhepatic view can be used reliably in the assessment of fluid
responsiveness. Copyright &#xa9; 2017 Elsevier Inc.

<321>
Accession Number
615119481
Author
Zafar F.; Jaquiss R.D.; Almond C.S.; Lorts A.; Chin C.; Rizwan R.; Bryant
R.; Tweddell J.S.; Morales D.L.S.
Institution
(Zafar, Lorts, Chin, Rizwan, Bryant, Tweddell, Morales) Cincinnati
Children's Hospital Medical Center, Cincinnati, Ohio, USA
(Jaquiss) Duke University School of Medicine, Durham, North Carolina, USA
(Almond) Stanford University School of Medicine, San Francisco,
California, USA
Title
Pediatric Heart Donor Assessment Tool (PH-DAT): A novel donor risk scoring
system to predict 1-year mortality in pediatric heart transplantation.
Source
Journal of Heart and Lung Transplantation. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier USA
Abstract
Background: In this study we sought to quantify hazards associated with
various donor factors into a cumulative risk scoring system (the Pediatric
Heart Donor Assessment Tool, or PH-DAT) to predict 1-year mortality after
pediatric heart transplantation (PHT). Methods: PHT data with complete
donor information (5,732) were randomly divided into a derivation cohort
and a validation cohort (3:1). From the derivation cohort, donor-specific
variables associated with 1-year mortality (exploratory p-value < 0.2)
were incorporated into a multivariate logistic regression model. Scores
were assigned to independent predictors (p < 0.05) based on relative odds
ratios (ORs). Results: The final model had an acceptable predictive value
(c-statistic = 0.62). The significant 5 variables (ischemic time, stroke
as the cause of death, donor-to-recipient height ratio, donor left
ventricular ejection fraction, glomerular filtration rate) were used for
the scoring system. The validation cohort demonstrated a strong
correlation between the observed and expected rates of 1-year mortality (r
= 0.87). The risk of 1-year mortality increases by 11% (OR 1.11 [1.08 to
1.14]; p < 0.001) in the derivation cohort and 9% (OR 1.09 [1.04 to 1.14];
p = 0.001) in the validation cohort with an increase of 1-point in score.
Mortality risk increased 5 times from the lowest to the highest donor
score in this cohort. Based on this model, a donor score range of 10 to 28
predicted 1-year recipient mortality of 11% to 31%. Conclusion: This novel
pediatric-specific, donor risk scoring system appears capable of
predicting post-transplant mortality. Although the PH-DAT may benefit
organ allocation and assessment of recipient risk while controlling for
donor risk, prospective validation of this model is warranted. Copyright
&#xa9; 2017 International Society for the Heart and Lung Transplantation.