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<1>
Accession Number
615031922
Author
Shirai S.; Taniguchi T.; Morimoto T.; Ando K.; Korai K.; Minakata K.;
Hanyu M.; Yamazaki F.; Koyama T.; Komiya T.; Kanamori N.; Murata K.; Kitai
T.; Kawase Y.; Izumi C.; Inada T.; Minamino-Muta E.; Kato T.; Inoko M.;
Ishii K.; Saito N.; Yamanaka K.; Nishiwaki N.; Nakajima H.; Saga T.;
Nakayama S.; Sakaguchi G.; Iwakura A.; Shiraga K.; Ueyama K.; Fujiwara K.;
Miwa S.; Nishizawa J.; Kitano M.; Kitayama H.; Sakata R.; Kimura T.
Institution
(Shirai, Ando, Korai) Department of Cardiology, Kokura Memorial Hospital,
Kitakyushu, Japan
(Hanyu) Department of Cardiovascular Surgery, Kokura Memorial Hospital,
Kitakyushu, Japan
(Taniguchi, Minamino-Muta, Kato, Saito, Kimura) Department of
Cardiovascular Medicine, Kyoto, Japan
(Minakata, Sakata) Department of Cardiovascular Surgery, Kyoto University
Graduate School of Medicine, Kyoto, Japan
(Morimoto) Department of Clinical Epidemiology, Hyogo College of Medicine,
Nishinomiya, Japan
(Yamazaki) Department of Cardiovascular Surgery, Shizuoka City Shizuoka
Hospital, Shizuoka, Japan
(Murata) Department of Cardiology, Shizuoka City Shizuoka Hospital,
Shizuoka, Japan
(Koyama) Department of Cardiovascular Surgery, Medical Center General
Hospital, Kobe, Japan
(Kitai) Department of Cardiovascular Medicine, Medical Center General
Hospital, Kobe, Japan
(Komiya) Department of Cardiovascular Surgery, Kurashiki Central Hospital,
Kurashiki, Japan
(Kawase) Department of Cardiovascular Medicine, Kurashiki Central
Hospital, Kurashiki, Japan
(Kanamori) Division of Cardiology, Shimada Municipal Hospital, Shimada,
Japan
(Izumi) Department of Cardiology, Shimada Municipal Hospital, Shimada,
Japan
(Yamanaka) Department of Cardiovascular Surgery, Tenri Hospital, Tenri,
Japan
(Inada) Department of Cardiovascular Center, Osaka Red Cross Hospital,
Osaka, Japan
(Nakayama) Department of Cardiovascular Surgery, Osaka Red Cross Hospital,
Osaka, Japan
(Inoko) Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
(Ueyama) Department of Cardiovascular Surgery, Cardiovascular Center, The
Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
(Ishii) Department of Cardiology, Kansai Electric Power Hospital, Osaka,
Japan
(Nishiwaki) Department of Cardiovascular Surgery, Kindai University Nara
Hospital, Nara, Japan
(Nakajima) Department of Cardiovascular Surgery, Mitsubishi Kyoto
Hospital, Kyoto, Japan
(Saga) Department of Cardiovascular Surgery, Kindai University Hospital,
Osakasayama, Japan
(Sakaguchi) Department of Cardiovascular Surgery, Shizuoka General
Hospital, Shizuoka, Japan
(Iwakura) Department of Cardiovascular Surgery, Japanese Red Cross
Wakayama Medical Center, Wakayama, Japan
(Shiraga) Department of Cardiovascular Surgery, National Hospital
Organization Kyoto Medical Center, Kyoto, Japan
(Fujiwara) Department of Cardiovascular Surgery, Hyogo Prefectural
Amagasaki General Medical Center, Amagasaki, Japan
(Miwa) Department of Cardiovascular Surgery, Shiga Medical Center for
Adults, Moriyama, Japan
(Nishizawa) Department of Cardiovascular Surgery, Hamamatsu Rosai
Hospital, Hamamatsu, Japan
(Kitano) Department of Cardiovascular Surgery, Japanese Red Cross Otsu
Hospital, Otsu, Japan
(Kitayama) Department of Cardiovascular Surgery, Kishiwada City Hospital,
Kishiwada, Japan
Title
Five-year clinical outcome of asymptomatic vs. Symptomatic severe aortic
stenosis after aortic valve replacement.
Source
Circulation Journal. 81 (4) (pp 485-494), 2017. Date of Publication: 2017.
Publisher
Japanese Circulation Society
Abstract
Background: There is discordance regarding the effect of symptom status
before aortic valve replacement (AVR) on long-term outcome after AVR in
severe aortic stenosis (AS). Methods and Results: The CURRENT AS registry
is a multicenter retrospective registry enrolling 3,815 consecutive
patients with severe AS. Among 1,196 patients managed with the initial AVR
strategy, long-term clinical outcomes were compared between the
symptomatic patients (n=905), and asymptomatic patients (n=291). Median
follow-up interval was 1337 days with a 91% follow-up rate at 2 years. AVR
was performed in 886 patients (98%) in the symptomatic group and in 287
patients (99%) in the asymptomatic group. Symptomatic patients were older
and more often had comorbidities than asymptomatic patients with similar
echocardiographic AS severity. The cumulative 5-year incidences of
all-cause death and heart failure (HF) hospitalization were significantly
higher in symptomatic patients than in asymptomatic patients (25.6% vs.
15.4%, P=0.001, and 14.2% vs. 3.8%, P<0.001, respectively). On landmark
analysis at 30 days after AVR, the differences in mortality and HF
hospitalization between the 2 groups were mainly observed beyond 30 days.
Conclusions: When managed with the initial AVR strategy, the long-term
outcomes of symptomatic severe AS were worse than those of asymptomatic
severe AS. Early AVR strategy might be recommended in some selected
asymptomatic severe AS patients with reasonable operative risk. Copyright
&#xa9; 2017, Japanese Circulation Society. All rights reserved.

<2>
Accession Number
615031511
Author
Cheung C.W.; Wong S.S.C.; Qiu Q.; Wang X.
Institution
(Cheung, Wong, Qiu) Laboratory and Clinical Research Institute for Pain,
Department of Anaesthesiology, The University of Hong Kong, Hong Kong
(Wang) Department of Anesthesiology, Taihe Hospital, Hubei University of
Medicine, Shiyan, Hubei Province, China
Title
Oral oxycodone for acute postoperative pain: A review of clinical trials.
Source
Pain Physician. 20 (2) (pp SE33-SE52), 2017. Date of Publication: February
2017.
Publisher
American Society of Interventional Pain Physicians (E-mail:
editor@painphysicianjournal.com)
Abstract
Background: Opioids are the mainstay of pain management for acute
postsurgical pain. Oral oxycodone is an opioid that can provide effective
acute postoperative pain relief. Objectives: To evaluate the use of oral
oxycodone for acute postoperative pain management. Study Design: This is a
narrative review based on published articles searched in PubMed and
Medline from 2003 to 2015 on oral oxycodone for acute postoperative pain
management. Methods: Clinical trials related to the use of oral oxycodone
for acute postoperative pain management were searched via PubMed and
Medline from 2003 to 2015. The search terms used were "oral strong
opioids," "postsurgical," "postoperative," "post-surgical," and
"postoperative." Treatment interventions were compared for analgesic
efficacy, rescue medication use, side effects, recovery, length of
hospital stay, and patient satisfaction. Results: There were 26 clinical
trials included in the review. Oral oxycodone showed superior
postoperative analgesic efficacy compared with placebo in patients
undergoing laparoscopic cholecystectomy, abdominal or pelvic surgery,
bunionectomy, breast surgery, and spine surgery. When compared with
intravenous opioids, oral oxycodone provided better or comparable pain
relief following knee arthroplasty, spine surgery, caesarean section,
laparoscopic colorectal surgery, and cardiac surgery. One study of dental
postsurgery pain reported inferior pain control with oral oxycodone versus
rofecoxib. (withdrawn from the US market due to cardiac safety concerns).
In many studies, the demand for rescue analgesia and total opioid
consumption were reduced in the oxycodone treatment arm. Patients
receiving oral oxycodone experienced fewer opioid-related side effects
than those on other opioids, and had a similar occurrence of postoperative
nausea and vomiting as patients on placebo. Furthermore, oral oxycodone
did not prolong hospital stay and was associated with lower drug costs
compared with epidural and intravenous analgesics. Oxycodone administered
as part of a multimodal analgesic regimen produced superior pain relief
with fewer side effects and a reduced hospital stay. Limitation: There is
a limited number of randomized double blinded studies in individual
surgical operations, thus making it more difficult to come up with
definitive conclusions. Conclusion: Oral oxycodone appears to offer safe
and effective postoperative analgesia, and is a well-accepted and
reasonable alternative to standard intravenous opioid analgesics.
Copyright &#xa9; 2017, American Society of Interventional Pain Physicians.
All rights reserved.

<3>
Accession Number
615008148
Author
Avanzas P.; Pascual I.; Munoz-Garcia A.J.; Segura J.; Alonso-Briales J.H.;
Suarez de Lezo J.; Pan M.; Jimenez-Navarro M.F.; Lopez-Aguilera J.;
Hernandez-Garcia J.M.; Moris C.
Institution
(Avanzas, Pascual, Moris) Area del Corazon, Hospital Universitario Central
de Asturias, Oviedo, Asturias, Spain
(Munoz-Garcia, Alonso-Briales, Jimenez-Navarro, Hernandez-Garcia) Servicio
de Cardiologia, Hospital Clinico Universitario Virgen de la Victoria,
Malaga, Spain
(Segura, Suarez de Lezo, Pan, Lopez-Aguilera) Servicio de Cardiologia,
Hospital Universitario Reina Sofia, Cordoba, Spain
Title
Long-term Follow-up of Patients With Severe Aortic Stenosis Treated With a
Self-expanding Prosthesis.
Source
Revista Espanola de Cardiologia. 70 (4) (pp 247-253), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Ediciones Doyma, S.L. (E-mail: suscripciones@doyma.es)
Abstract
Introduction and objectives Transcatheter aortic valve implantation (TAVI)
is a safe and effective alternative to surgical treatment in patients with
severe aortic stenosis (AS) and those who are inoperable or at high
surgical risk. The primary objective of this study was to evaluate the
long-term survival of consecutive patients with severe AS treated with
TAVI. Methods Observational, multicenter, prospective, follow-up study of
consecutive patients with severe symptomatic AS treated by TAVI in 3
high-volume hospitals in Spain. Results We recruited 108 patients, treated
with a self-expanding CoreValve prosthesis. The mean age at implantation
was 78.6 +/- 6.7 years, 49 (45.4%) were male and the mean logistic
EuroSCORE was 16% +/- 13.9%. The median follow-up was 6.1 years (2232
days). Survival rates at the end of years 1, 2, 3, 4, 5, and 6 were 84.3%
(92.6% after hospitalization), 77.8%, 72.2%, 66.7%, 58.3%, and 52.8%.
During follow-up, 71 patients (65.7%) died, 18 (25.3%) due to cardiac
causes. Most (82.5%) survivors were in New York Heart Association class I
or II. Six patients (5.5%) developed prosthetic valve dysfunction.
Conclusions Long-term survival in AS patients after TAVI is acceptable.
The main causes of death are cardiovascular in the first year and
noncardiac causes in subsequent years. Valve function is maintained over
time. Full English text available from: www.revespcardiol.org/en Copyright
&#xa9; 2016 Sociedad Espanola de Cardiologia

<4>
Accession Number
614001760
Author
Debray T.P.A.; Damen J.A.A.G.; Snell K.I.E.; Ensor J.; Hooft L.; Reitsma
J.B.; Riley R.D.; Moons K.G.M.
Institution
(Debray, Damen, Hooft, Reitsma, Moons) Cochrane Netherlands, University
Medical Center Utrecht, PO Box 85500 Str 6.131, Utrecht 3508 GA,
Netherlands
(Debray, Damen, Hooft, Reitsma, Moons) Julius Center for Health Sciences
and Primary Care, University Medical Center Utrecht, PO Box 85500 Str
6.131, Utrecht 3508 GA, Netherlands
(Snell, Ensor, Riley) Research Institute for Primary Care and Health
Sciences, Keele University, Staffordshire, United Kingdom
Title
A guide to systematic review and meta-analysis of prediction model
performance.
Source
BMJ (Online). 356 (no pagination), 2017. Article Number: i6460. Date of
Publication: 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Validation of prediction models is highly recommended and increasingly
common in the literature. A systematic review of validation studies is
therefore helpful, with meta-analysis needed to summarise the predictive
performance of the model being validated across different settings and
populations. This article provides guidance for researchers systematically
reviewing and meta-analysing the existing evidence on a specific
prediction model, discusses good practice when quantitatively summarising
the predictive performance of the model across studies, and provides
recommendations for interpreting meta-analysis estimates of model
performance. We present key steps of the meta-analysis and illustrate each
step in an example review, by summarising the discrimination and
calibration performance of the EuroSCORE for predicting operative
mortality in patients undergoing coronary artery bypass grafting.

<5>
Accession Number
613219109
Author
Davari Dolatabadi A.; Khadem S.E.Z.; Asl B.M.
Institution
(Davari Dolatabadi, Khadem, Asl) Mechanical Engineering Department,
Tarbiat Modares University, Tehran, Iran, Islamic Republic of
Title
Automated diagnosis of coronary artery disease (CAD) patients using
optimized SVM.
Source
Computer Methods and Programs in Biomedicine. 138 (pp 117-126), 2017. Date
of Publication: 01 Jan 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background and objective Currently Coronary Artery Disease (CAD) is one of
the most prevalent diseases, and also can lead to death, disability and
economic loss in patients who suffer from cardiovascular disease.
Diagnostic procedures of this disease by medical teams are typically
invasive, although they do not satisfy the required accuracy. Methods In
this study, we have proposed a methodology for the automatic diagnosis of
normal and Coronary Artery Disease conditions using Heart Rate Variability
(HRV) signal extracted from electrocardiogram (ECG). The features are
extracted from HRV signal in time, frequency and nonlinear domains. The
Principal Component Analysis (PCA) is applied to reduce the dimension of
the extracted features in order to reduce computational complexity and to
reveal the hidden information underlaid in the data. Finally, Support
Vector Machine (SVM) classifier has been utilized to classify two classes
of data using the extracted distinguishing features. In this paper,
parameters of the SVM have been optimized in order to improve the
accuracy. Results Provided reports in this paper indicate that the
detection of CAD class from normal class using the proposed algorithm was
performed with accuracy of 99.2%, sensitivity of 98.43%, and specificity
of 100%. Conclusions This study has shown that methods which are based on
the feature extraction of the biomedical signals are an appropriate
approach to predict the health situation of the patients. Copyright &#xa9;
2016 Elsevier Ireland Ltd

<6>
Accession Number
614671283
Author
Badings E.A.; Remkes W.S.; The S.H.K.; Dambrink J.-H.E.; Tjeerdsma G.;
Rasoul S.; Timmer J.R.; Van Der Wielen M.L.J.; Lok D.J.A.; Hermanides
R.S.; Van Wijngaarden J.; Suryapranata H.; Van't Hof A.W.J.
Institution
(Badings, Lok, Van Wijngaarden) Department of Cardiology, Deventer
Ziekenhuis, Deventer, Netherlands
(Remkes, Dambrink, Timmer, Hermanides, Suryapranata, Van't Hof) Isala
Klinieken, Department of Cardiology, Dokter van Heesweg 2, Zwolle, AB
8025, Netherlands
(The, Van Der Wielen) Department of Cardiology, Treant Zorggroep Locatie
Ziekenhuis Bethesda, Hoogeveen, Netherlands
(Tjeerdsma) Department of Cardiology, Ziekenhuis de Tjongerschans,
Heerenveen, Netherlands
(Rasoul) Department of Cardiology, Maastricht UMC, Maastricht, Netherlands
(Rasoul) Department of Cardiology, Atrium Medisch Centrum, Heerlen,
Netherlands
(Suryapranata) Department of Cardiology, Radboudumc, Nijmegen, Netherlands
Title
Two-year outcome after early or late Intervention in non-ST elevation
acute coronary syndrome.
Source
Open Heart. 4 (1) (no pagination), 2017. Article Number: e000538. Date of
Publication: 01 Mar 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To compare long-Term outcome of an early to a delayed invasive
strategy in high-risk patients with non-ST elevation acute coronary
syndrome (NSTE-ACS). Methods This prospective, multicentre trial included
patients with NSTE-ACS and at least two out of three of the following
high-risk criteria: (1) evidence of extensive myocardial ischaemia on ECG,
(2) elevated biomarkers for myocardial necrosis and (3) age above 65
years. Patients were randomised to either an early (angiography and
revascularisation if appropriate <12 hours) or a delayed invasive strategy
(>48 hours after randomisation). Endpoint for this prespecified long-Term
follow-up was the composite incidence of death or reinfarction after 2
years. Data collection was performed by telephone contact with the
patients, their relatives or general practitioner and by review of
hospital records. Results Endpoint status after 2-year follow-up was
collected in 521 of 542 initially enrolled patients. Incidence of death or
reinfarction was 11.8% in the early and 13.1% in the delayed treatment
group (relative risk (RR)=0.90, 95% CI 0.57 to 1.42). No significant
differences were found in occurrence of the individual components of the
primary endpoint: death 6.1% vs 8.9%, RR 0.69 (95% CI 0.37 to 1.27),
reinfarction 6.5% vs 5.4%, RR 1.20 (95% CI 0.60 to 2.38). Post-hoc
subgroup analysis showed statistical significant interaction between age
and treatment strategy on outcome (p=0.02). Conclusions After 2 years
follow-up, no difference in incidence of death or reinfarction was seen
between early to late invasive strategy. These findings are in line with
results of other studies with longer follow-up. Older patients seem to
benefit more from early invasive treatment. Copyright &#xa9; Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article) 2017. All rights reserved.

<7>
Accession Number
614141495
Author
Bangalore S.; Fakheri R.; Wandel S.; Toklu B.; Wandel J.; Messerli F.H.
Institution
(Bangalore, Fakheri) New York University School of Medicine, New York, NY,
United States
(Toklu) Mount Sinai Beth Israel Medical Center, New York, NY, United
States
(Wandel) Novartis Pharma AG, Basel, Switzerland
(Wandel) Institute for Risks and Extremes, Bern University of Applied
Sciences, Switzerland
(Messerli) University Hospital, Bern, Switzerland
(Messerli) Mount Sinai, Icahn School of Medicine, New York, NY, United
States
(Messerli) Jagiellonian University, Krakow, Poland
Title
Renin angiotensin system inhibitors for patients with stable coronary
artery disease without heart failure: Systematic review and meta-analysis
of randomized trials.
Source
BMJ (Online). 356 (no pagination), 2017. Article Number: j4. Date of
Publication: 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: To critically evaluate the efficacy of renin angiotensin system
inhibitors (RASi) in patients with coronary artery disease without heart
failure, compared with active controls or placebo. Design: Meta-analysis
of randomized trials. Data sources: PubMed, EMBASE, and CENTRAL databases
until 1 May 2016. Eligibility criteria for selecting studies: Randomized
trials of RASi versus placebo or active controls in patients with stable
coronary artery disease without heart failure (defined as left ventricular
ejection fraction >40% or without clinical heart failure). Each trial had
to enroll at least 100 patients with coronary artery disease without heart
failure, with at least one year's follow-up. Studies were excluded if they
were redacted or compared use of angiotensin converting enzyme inhibitors
with angiotensin receptor blockers. Outcomes were death, cardiovascular
death, myocardial infarction, angina, stroke, heart failure,
revascularization, incident diabetes, and drug withdrawal due to adverse
effects. Results: 24 trials with 198 275 patient years of follow-up were
included. RASi reduced the risk of all cause mortality (rate ratio 0.84,
95% confidence interval 0.72 to 0.98), cardiovascular mortality (0.74,
0.59 to 0.94), myocardial infarction (0.82, 0.76 to 0.88), stroke (0.79,
0.70 to 0.89), angina, heart failure, and revascularization when compared
with placebo but not when compared with active controls (all cause
mortality, 1.05, 0.94 to 1.17; P<inf>interaction</inf> =0.006;
cardiovascular mortality, 1.08, 0.93 to 1.25, P<inf>interaction</inf>
<0.001; myocardial infarction, 0.99, 0.87 to 1.12, P<inf>interaction</inf>
=0.01; stroke, 1.10, 0.93 to 1.31; P<inf>interaction</inf> =0.002).
Bayesian meta-regression analysis showed that the effect of RASi when
compared with placebo on all cause mortality and cardiovascular mortality
was dependent on the control event rate, such that RASi was only
beneficial in trials with high control event rates (>14.10 deaths and
>7.65 cardiovascular deaths per 1000 patient years) but not in those with
low control event rates. Conclusions: In patients with stable coronary
artery disease without heart failure, RASi reduced cardiovascular events
and death only when compared with placebo but not when compared with
active controls. Even among placebo controlled trials in this study, the
benefit of RASi was mainly seen in trials with higher control event rates
but not in those with lower control event rates. Evidence does not support
a preferred status of RASi over other active controls. Copyright &#xa9;
2016 Published by the BMJ Publishing Group Limited.

<8>
Accession Number
614855326
Author
Srisung W.; Teerakanok J.; Tantrachoti P.; Karukote A.; Nugent K.
Institution
(Srisung) Division of Nephrology and Hypertension, Weill Cornell Medical
College, New York, NY, United States
(Teerakanok, Tantrachoti, Nugent) Department of Internal Medicine, Texas
Tech University Health Sciences Center, Lubbock, TX, United States
(Karukote) Mahidol University, Bangkok, Thailand
Title
Surgical prophylaxis with gentamicin and acute kidney injury: A systematic
review and meta-analysis.
Source
Annals of Translational Medicine. 5 (5) (no pagination), 2017. Article
Number: 100. Date of Publication: March 2017.
Publisher
AME Publishing Company (E-mail: info@amepc.org)
Abstract
Gentamicin has been increasingly used instead of cephalosporins for
surgical prophylaxis in an attempt to reduce the rate of "Clostridium
difficile" infection. There are limited data regarding nephrotoxicity
related to gentamicin in these patients. Methods: We have conducted a
systematic review and meta-analysis to evaluate the risk of acute kidney
injury (AKI) in gentamicin-containing surgical prophylactic regimens,
compared to regimens without gentamicin, in several types of surgery.
Electronic searches were performed using PubMed and Embase, including
terms for "AKI, gentamicin, and surgical prophylaxis" with and without
MeSH/EMTREE functions. Statistical analysis was then performed using a
random-effect model; risk ratios (RR), risk differences (RD) and
heterogeneity (I2) were calculated. Funnel plot was used for assessment of
publication bias. Results: Eleven studies with fifteen cohorts with 18,354
patients were included in the analysis. Subgroup analysis was performed
according to surgery type. We have found that antibiotic prophylaxis with
gentamicin containing regimen has significant risk for developing
postoperative AKI in orthopedic surgery (RR 2.99; 95% CI: 1.84, 4.88). The
results were inconclusive in other types of surgery. Funnel plot indicates
potential publication bias. Conclusions: Gentamicin-induced AKI is
significant in patients undergoing orthopedic surgery. Physicians should
consider risks and benefits of using this regimen in individual patients.
Copyright &#xa9; Annals of Translational Medicine.

<9>
Accession Number
610888718
Author
Hickey P.A.; Pasquali S.K.; Gaynor J.W.; He X.; Hill K.D.; Connor J.A.;
Gauvreau K.; Jacobs M.L.; Jacobs J.P.; Hirsch-Romano J.C.
Institution
(Hickey, Connor) Department of Nursing Patient Care Services, Boston
Children's Hospital, Boston, Massachusetts, United States
(Pasquali) Department of Pediatrics, University of Michigan Medical
School, Ann Arbor, Michigan, United States
(Gaynor) Department of Surgery, The Children's Hospital of Philadelphia,
Philadelphia, Pennsylvania, United States
(He, Hill) Duke Clinical Research Institute, Durham, North Carolina,
United States
(Gauvreau) Department of Cardiology, Boston Children's Hospital, Boston,
Massachusetts, United States
(Jacobs) Department of Surgery, Johns Hopkins University School of
Medicine, Baltimore, Maryland, United States
(Jacobs) Johns Hopkins Children's Heart Surgery, All Children's Hospital,
St. Petersburg, Florida, United States
(Hirsch-Romano) Department of Cardiac Surgery, University of Michigan
Medical School, Ann Arbor, Michigan, United States
Title
Critical Care Nursing's Impact on Pediatric Patient Outcomes.
Source
Annals of Thoracic Surgery. 102 (4) (pp 1375-1380), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier USA
Abstract
Background Previous studies have demonstrated the effect of adult nursing
skill mix, staffing ratios, and level of education on patient deaths,
complication rates, and failure to rescue (FTR). To date, only one known
study had examined the effect of nursing experience and education on
postoperative pediatric cardiac operations. Methods Nursing survey data
were linked to The Society of Thoracic Surgeons (STS) Congenital Heart
Surgery Database for patients undergoing cardiac operations (2010 to
2011). Logistic regression models were used to estimate associations of
nursing education and years of clinical experience with in-hospital
mortality rates, complication rates, and FTR. Generalized estimating
equations and robust standard error estimates were used to account for
within-center correlation of outcomes. Results Among 15,463 patients (29
hospitals), the in-hospital mortality rate was 2.8%, postoperative
complications occurred in 42.4%, and the FTR rate was 6.4%. After
covariate adjustment, pediatric critical care units with a higher
proportion of nurses with a Bachelor of Science degree or higher had lower
odds of complication (odds ratio for 10% increase, 0.85; 95% confidence
interval, 0.76 to 0.96; p = 0.009). Units with a higher proportion of
nurses with more than 2 years of experience had lower mortality rates
(odds ratio for 10% increase, 0.92; 95% confidence interval, 0.85 to 0.99;
p = 0.025). Conclusions This is the first study to demonstrate that higher
levels of nursing education and experience are significantly associated
with fewer complications after pediatric cardiac operations and aligns
with our previous findings on their association with reduced deaths. These
results provide data for pediatric hospital leaders and reinforce the
importance of organization-wide mentoring strategies for new nurses and
retention strategies for experienced nurses. Copyright &#xa9; 2016 The
Society of Thoracic Surgeons

<10>
Accession Number
610222281
Author
Jamshidi P.; Nyffenegger T.; Sabti Z.; Buset E.; Toggweiler S.; Kobza R.;
Cuculi F.
Institution
(Jamshidi, Nyffenegger, Sabti, Buset, Toggweiler, Kobza, Cuculi)
Department of Cardiology, Heart Centre Lucerne, Luzerner Kantonsspital,
Spitalstrasse, Lucerne 16 6000, Switzerland
Title
A novel approach to treat in-stent restenosis: 6-and 12-month results
using the everolimus-eluting bioresorbable vascular scaffold.
Source
EuroIntervention. 11 (13) (pp 1479-1486), 2016. Date of Publication: April
2016.
Publisher
EuroPCR
Abstract
Aims: The treatment of in-stent restenosis (ISR) remains challenging.
Small case series have described successful utilisation of bioresorbable
vascular scaffolds (BVS) (Absorb; Abbott Vascular, Santa Clara, CA, USA)
to treat ISR. We report our experience with this novel approach. Methods
and results: Patients with ISR in native coronary arteries undergoing
percutaneous coronary intervention (PCI) for ISR were treated using BVS. A
total of 84 ISR lesions were treated in 65 patients. The mean age was
66+/-11 years, 28% had acute coronary syndrome (ACS) and 28% were
diabetic. PCI was successful in all patients and all scaffolds were
delivered and deployed successfully in the target lesion. All 65 patients
had six-month follow-up and 49 patients had 12-month clinical follow-up.
The target lesion revascularisation (TLR) rate was 3.1% at six months and
12.2% at 12 months. The mean duration from PCI to TLR was 301+/-148 days.
No scaffold thrombosis occurred during the study period. Conclusions: This
proof of concept study demonstrates that ISR treatment utilising BVS is
feasible and appears to have acceptable target lesion failure rates.
Prospective randomised trials are necessary to assess whether BVS are more
effective than drug-eluting stents or drug-eluting balloons to treat ISR.
Copyright &#xa9; Europa Digital & Publishing 2016. All rights reserved.

<11>
Accession Number
611693098
Author
Penny-Dimri J.C.; Cochrane A.D.; Perry L.A.; Smith J.A.
Institution
(Penny-Dimri, Cochrane, Perry, Smith) Department of Surgery (School of
Clinical Sciences at Monash Health), Monash University and Department of
Cardiothoracic Surgery, Monash Health, Melbourne, Vic., Australia
Title
Characterising the Role of Perioperative Erythropoietin for Preventing
Acute Kidney Injury after Cardiac Surgery: Systematic Review and
Meta-Analysis.
Source
Heart Lung and Circulation. 25 (11) (pp 1067-1076), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Ltd
Abstract
Background The role of perioperative erythropoietin (EPO) for preventing
cardiac surgery associated acute kidney injury (CSA-AKI) remains uncertain
with published trials producing conflicting results. Perspective into the
factors at work is needed, due to ongoing uncertainty. Methods We
undertook the systematic review and meta-analysis of randomised-controlled
trials (RCTs) using random-effects modelling. The primary outcome was
safety and efficacy of perioperative EPO to prevent CSA-AKI and the
secondary outcomes were change in serum creatinine, urinary neutrophil
gelatinase-associated lipocalin, time in ICU, rates of postoperative
transfusions, haemodialysis, and mortality. Subgroup analysis explored the
effect of the timing of the EPO dose in relation to surgery, the dose
response, and the impact of the preoperative risk for CSA-AKI for the
patient group. Results Six RCTs were included, which totalled 473
participants. Erythropoietin administration did not reduce the incidence
of CSA-AKI compared with controls (OR: 0.69, 95% CI: 0.35 to 1.36, P=0.28;
I²=64%, P=0.001), however, subgroup analysis suggested
administrating EPO before anaesthesia was correlated with a reduction in
CSA-AKI (OR: 0.27, 95% CI: 0.13 to 0.54, P=0.0002; I²=0%,
P=0.98). Additionally, in low risk populations, perioperative EPO
administration correlated with significant reduction in CSA-AKI when
compared to controls (OR: 0.25, 95% CI: 0.11 to 0.56, P=0.0008;
I²=0%, P=0.86). Conclusion Our findings suggest that
administering EPO before anaesthesia is emerging as an important factor
for efficacy. Erythropoietin may have a role in preventing CSA-AKI,
however, additional high-quality prospective studies are warranted,
particularly aimed at describing the methodological components, such as
the timing and size of the dose, which potentiate the cytoprotective
effect of EPO in the clinical setting. Copyright &#xa9; 2016 Australian
and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the
Cardiac Society of Australia and New Zealand (CSANZ)

<12>
Accession Number
610218331
Author
Ando T.; Holmes A.A.; Taub C.C.; Slovut D.P.; DeRose J.J.
Institution
(Ando) Department of Internal Medicine Mount Sinai Beth Israel, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Holmes, Taub, Slovut) Division of Cardiology, Montefiore Medical Center,
Albert Einstein College of Medicine, Bronx, NY, United States
(Slovut, DeRose) Department of Cardiothoracic and Vascular Surgery,
Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY,
United States
Title
Iatrogenic Ventricular Septal Defect Following Transcatheter Aortic Valve
Replacement: A Systematic Review.
Source
Heart Lung and Circulation. 25 (10) (pp 968-974), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier Ltd
Abstract
Background Ventricular septal defects (VSD) are rarely reported as a
complication following transcatheter aortic valve replacement (TAVR). We
sought to characterise the patients, clinical management, and outcomes
regarding this rare phenomenon. Methods Relevant articles were identified
by a systematic search of MEDLINE and EMBASE databases from January, 2002
to September, 2015. Results A total of 18 case reports, including 20
patients, were identified. The median age was 83 years and six were male.
Twelve were performed by trans-femoral approach. Pre-dilation was
performed in 12 patients and post-dilation in four. Balloon expandable
valves were used in the majority (85%) of cases. The clinical presentation
varied from asymptomatic to progressive heart failure. The timing of the
diagnosis also varied significantly from immediately post valve
implantation to one year afterwards. There were two cases of Gerbode-type
defect while the rest were inter-ventricular defects. The location was
mostly membranous or perimembranous (79%) and adjacent to the valve
landing zone. A total of seven interventions (one open surgery and six
percutaneous closure) were performed. Four patients died during the same
hospital admission. Sixteen survived past discharge (range 12 days to two
years). Conclusions Ventricular septal defects post-TAVR were seen more
with balloon expandable valves and with pre-dilation or post-dilation.
Percutaneous treatment of the VSD was preferred over open cardiac surgery
given the high surgical risk in this patient population. Some, but not
all, patients survived TAVR and VSD and had a good prognosis for both
patient groups with or without VSD closure. Copyright &#xa9; 2016
Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

<13>
Accession Number
610217864
Author
Yamasaki M.; Deb S.; Tsubota H.; Moussa F.; Kiss A.; Cohen E.A.;
Radhakrishnan S.; Dubbin J.; Ko D.; Schwartz L.; Fremes S.E.
Institution
(Yamasaki, Deb, Tsubota, Moussa, Cohen, Radhakrishnan, Dubbin, Ko, Fremes)
The Schulich Heart Centre, Sunnybrook Health Sciences Centre, University
of Toronto, Toronto, Ontario, Canada
(Deb, Kiss, Fremes) Institute of Health Policy Management and Evaluation,
University of Toronto, Toronto, Ontario, Canada
(Kiss) Sunnybrook Research Institute, Toronto, Ontario, Canada
(Schwartz) Department of Medicine, University Health Network, Toronto,
Ontario, Canada
Title
Comparison of Radial Artery and Saphenous Vein Graft Stenosis More Than 5
Years After Coronary Artery Bypass Grafting.
Source
Annals of Thoracic Surgery. 102 (3) (pp 712-719), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier USA
Abstract
Background Graft stenosis may be associated with future graft failure. The
purpose of this investigation was to compare graft stenosis between radial
artery (RA) grafts and saphenous vein grafts (SVGs) at least 5 years
postoperatively using the multicenter Radial Artery Patency Study (RAPS)
data. Methods Two hundred thirty-four patients underwent late invasive
angiography after coronary artery bypass operations. The study population
consists of 163 patients with thrombolysis in myocardial infarction (TIMI)
3 flow of both the RA graft and study SVGs. Angiograms were reviewed
centrally and in a blinded fashion. Graft stenosis was recorded for the
proximal anastomosis, graft body, and distal anastomosis; significant
stenosis was defined as greater than or equal to 50%. Major adverse
cardiac events (MACE) were reported in patients with and those without
significant graft stenosis. Results There was no difference in significant
graft stenosis of the patent RA grafts and SVGs (14 of 163 [8.6%] versus
19 of 163 [11.7%]) or in the proximal anastomosis (5 of 163 [3.1%] versus
5 of 163 [3.1%]), graft body (6 of 163 [3.7%] versus 13 of 163 [8.0%]), or
distal anastomosis (4 of 163 [2.5%] versus 5 of 163 [3.1%]) considered
separately. However, the overall burden of graft body disease was higher
in SVGs (p = 0.03). MACE was higher in patients with significant graft
stenosis than in patients without stenosis (10 of 28 [35.7%] versus 7 of
135 [5.2%]; p < 0.0001). Conclusions There was no significant difference
in the rates of significant stenosis of patent RA grafts and SVGs more
than 5 years postoperatively. However, the burden of graft body stenosis
was less in RA grafts compared with SVGs, suggesting that the RA grafts
will continue to outperform the SVGs late after operation. Copyright
&#xa9; 2016 The Society of Thoracic Surgeons

<14>
Accession Number
610217837
Author
Keski-Nisula J.; Pesonen E.; Olkkola K.T.; Ahlroth T.; Puntila J.;
Andersson S.; Neuvonen P.J.; Suominen P.K.
Institution
(Keski-Nisula, Ahlroth, Suominen) Department of Anesthesia and Intensive
Care, Children's Hospital, University of Helsinki and Helsinki University
Hospital, Helsinki, Finland
(Pesonen) Department of Anesthesiology, Intensive Care, and Pain Medicine,
Meilahti Hospital, University of Helsinki and Helsinki University
Hospital, Helsinki, Finland
(Olkkola) Department of Anesthesiology, Intensive Care, Emergency Care and
Pain Medicine, University of Helsinki and Helsinki University Hospital,
Helsinki, Finland
(Puntila) Department of Pediatric Surgery, Children's Hospital, University
of Helsinki and Helsinki University Hospital, Helsinki, Finland
(Andersson) Department of Neonatal Intensive Care, Children's Hospital,
University of Helsinki and Helsinki University Hospital, Helsinki, Finland
(Neuvonen) Department of Clinical Pharmacology, University of Helsinki and
HUSLAB, Helsinki University Hospital, Helsinki, Finland
Title
High-Dose Methylprednisolone Has No Benefit Over Moderate Dose for the
Correction of Tetralogy of Fallot.
Source
Annals of Thoracic Surgery. 102 (3) (pp 870-876), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier USA
Abstract
Background The optimal dose of methylprednisolone during pediatric open
heart surgical procedures is unknown. This study compared the
antiinflammatory and cardioprotective effects of high and lower doses of
methylprednisolone in children undergoing cardiac operations. Methods
Thirty children, between 1 and 18 months old and undergoing total
correction of tetralogy of Fallot, were randomized in double-blind fashion
to receive either 5 or 30 mg/kg of intravenous methylprednisolone after
anesthesia induction. Plasma concentrations of methylprednisolone,
interleukin-6 (IL-6), IL-8, and IL-10, troponin T, and glucose were
measured at anesthesia induction before administration of the study drug,
at 30 minutes on cardiopulmonary bypass (CPB), just after weaning from
CPB, and at 6 hours after CPB. Troponin T and blood glucose were also
measured on the first postoperative morning. Results Significantly higher
methylprednisolone concentrations were measured in patients receiving 30
mg/kg of methylprednisolone at 30 minutes on CBP, after weaning from CPB
and at 6 hours after CPB (p < 0.001). No differences were detected in
IL-6, IL-8, IL-10, or troponin concentrations at any time point. Blood
glucose levels were significantly higher in patients receiving 30 mg/kg of
methylprednisolone at 6 hours after CPB (p = 0.04) and on the first
postoperative morning (p = 0.02). Conclusions Based on the measured
concentrations of interleukins or troponin T, a 30 mg/kg dose of
methylprednisolone during pediatric open heart operations does not offer
any additional antiinflammatory or cardioprotective benefit over a 5 mg/kg
dose. Higher dose of methylprednisolone exposes patients more frequently
to hyperglycemia. Copyright &#xa9; 2016 The Society of Thoracic Surgeons

<15>
Accession Number
610260988
Author
Bussieres J.S.; Somma J.; del Castillo J.L.C.; Lemieux J.; Conti M.;
Ugalde P.A.; Gagne N.; Lacasse Y.
Institution
(Bussieres, Somma, del Castillo, Lemieux) Department of Anesthesiology,
IUCPQ-UL, Quebec City, QC, Canada
(Conti, Ugalde) Department of Thoracic Surgery, IUCPQ-UL, Quebec City, QC,
Canada
(Bussieres, Gagne) Research Centre, IUCPQ-UL, Quebec City, QC, Canada
(Lacasse) Pneumology Center, IUCPQ-UL, Quebec City, QC, Canada
(Bussieres) Institut universitaire de cardiologie et de pneumologie de
Quebec - Universite Laval, 2725, Chemin Sainte-Foy, Quebec City, QC G1V
4G5, Canada
Title
Bronchial blocker versus left double-lumen endotracheal tube in
video-assisted thoracoscopic surgery: a randomized-controlled trial
examining time and quality of lung deflation.
Source
Canadian Journal of Anesthesia. 63 (7) (pp 818-827), 2016. Date of
Publication: 01 Jul 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Introduction: Double-lumen endotracheal tubes (DL-ETT) and bronchial
blockers (BB) have both been used for lung isolation in video-assisted
thoracic surgery (VATS). Though not well studied, it is widely thought
that a DL-ETT provides faster and better quality lung collapse. The aim of
this study was to compare a BB technique vs a left-sided DL-ETT strategy
with regard to the time and quality of lung collapse during one-lung
ventilation (OLV) for elective VATS. Methods: Forty patients requiring OLV
for VATS were randomized to receive a BB (n = 20) or a left-sided DL-ETT
(n = 20). The primary endpoint was the time from pleural opening
(performed by the surgeon) until complete lung collapse. The time was
evaluated offline by reviewing video recorded during the VATS. The quality
of lung deflation was also graded offline using a visual scale (1 = no
lung collapse; 2 = partial lung collapse; and 3 = total lung collapse) and
was recorded at several time points after pleural incision. The surgeon
also graded the time to complete lung collapse and quality of lung
deflation during the procedure. The surgeon's guess as to which device was
used for lung isolation was also recorded. Results: Of the 40 patients
enrolled in the study, 20 patients in the DL-ETT group and 18 in the BB
group were analyzed. There mean (standard deviation) time to complete lung
collapse of the operative lung was significantly faster using the BB
compared with using the DL-ETT [7.5 (3.8) min vs 36.6 (29.1) min,
respectively; mean difference, 29.1 min; 95% confidence interval, 1.8 to
7.2; P < 0.001]. Overall, a higher proportion of patients in the BB group
than in the DL-ETT group achieved a quality of lung collapse score of 3 at
five minutes (57% vs 6%, respectively; P < 0.004), ten minutes (73% vs
14%, respectively; P = 0.005), and 20 min (100% vs 25%, respectively; P =
0.002) after opening the pleura. The surgeon incorrectly guessed the type
of device used in 78% of the BB group and 50% of the DL-ETT group (P =
0.10). Conclusion: The time and quality of lung collapse during OLV for
VATS was significantly better when using a BB than when using a left-sided
DL-ETT. Surgeons could not reliably determine which device was being used
based on the time and quality of lung collapse. This trial was registered
at ClinicalTrials.gov number, NCT01615263. Copyright &#xa9; 2016, Canadian
Anesthesiologists' Society.

<16>
Accession Number
610790052
Author
Tanaka Y.; Miyamoto T.; Naito Y.; Yoshitake S.; Sasahara A.; Miyaji K.
Institution
(Tanaka, Miyamoto, Naito, Yoshitake, Sasahara) Department of
Cardiovascular Surgery, Gunma Children's Medical Center, Shibukawa, Japan
(Miyaji) Department of Cardiovascular Surgery, Kitasato University
Hospital, Sagamihara, Japan
Title
Randomized Study of a New Noninvasive Skin Closure Device for Use After
Congenital Heart Operations.
Source
Annals of Thoracic Surgery. 102 (4) (pp 1368-1374), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier USA
Abstract
Background We report a new, noninvasive Zip surgical skin closure device
(ZipLine Medical, Campbell, CA). This device is considered to have good
cosmetic outcomes after operations and reduces surgical time. In this
study, skin closure using the Zip device was compared with subcuticular
sutures and the usefulness and safety of this new device was evaluated.
Methods This was a prospective, randomized study of 214 patients who
underwent cardiac operations through a median sternotomy from June 2014 to
December 2015. In 136 patients, this was a first operation group of which
71 patients underwent Zip surgical skin closure (Zip group), and 65
patients underwent subcuticular sutures (suture group). In 78 patients,
this was a reoperation group, of which 42 patients were in the Zip group
and 36 patients were in the suture group. Cosmetic results using the
Vancouver Scar Scale were evaluated separately in the first operation
group and reoperation group. Results There were significant differences in
the total Vancouver Scar Scale score between the first operation group (p
< 0.001) and reoperation group (p = 0.007). The skin closure time was
significantly shorter in the Zip group than in the suture group (113.0 +/-
9.1 seconds vs 375.9 +/- 60.2 seconds, p < 0.001). No significant
differences were found regarding the rate of surgical site infection
between the groups. Complications peculiar to this device included skin
discoloration (0.9%), epidermolysis (0.9%), and exfoliation of the device
(1.8%); however, no serious complications developed. Conclusions In
congenital heart operations through a median sternotomy, the Zip surgical
skin closure device was an excellent choice for improving the cosmetic
appearance and reducing the wound closure time. In addition, it proved to
be a device that could be used safely. Copyright &#xa9; 2016 The Society
of Thoracic Surgeons

<17>
Accession Number
610767145
Author
Allen M.S.; Blackmon S.H.; Nichols F.C.; Cassivi S.D.; Harmsen W.S.;
Lechtenberg B.; Pierson K.; Wigle D.A.; Shen K.R.
Institution
(Allen, Blackmon, Nichols, Cassivi, Lechtenberg, Pierson, Wigle, Shen)
Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic,
Rochester, Minnesota, United States
(Harmsen) Division of Biomedical Statistics and Informatics, Department of
Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States
Title
Optimal Timing of Urinary Catheter Removal After Thoracic Operations: A
Randomized Controlled Study.
Source
Annals of Thoracic Surgery. 102 (3) (pp 925-930), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier USA
Abstract
Background There are very few randomized trials confirming the belief that
prolonged urinary catheterization increases urinary tract infections, and
none of these have included a comparative analysis of patients with an
epidural catheter in place. The aim of this prospective randomized trial
was to determine if removal of the urinary catheter within 48 hours after
a thoracic operation, as required by the Surgical Care Improvement Project
(SCIP) Measure 9, leads to increases in urinary tract reintervention and
lower rates of urinary tract infections. Methods From February 2012 to
August 2014, patients undergoing a general thoracic surgical procedure in
whom an epidural catheter was placed for analgesia were eligible for
inclusion in the trial. Patients were randomized to urinary catheter
removal within 48 hours of the operation completion or 6 hours after
epidural catheter removal. Results The study enrolled 374 patients, 217
men (58%) and 157 women (42%). The 247 eligible and evaluated patients,
141 (57.1%) men and 106 (42.9%) women, were a median age of 61.5 years
(range, 21 to 87 years). There were no statistically significant
differences in any of the preoperative or operative categories between the
two groups. Median length of stay was 5 days (range, 2 to 42 days) for all
patients, and there was no difference between the two groups.
Postoperatively, 19 patients (7.7%) required urinary catheter reinsertion
after it was removed. A significantly greater number of patients in the
early removal group required reinsertion of the urinary catheter (15
[12.4%] vs 4 [3.2%]); p = 0.0065). Patients whose urinary catheter was
removed within 48 hours of the operation had a much higher rate of bladder
scans postoperatively (59.5% [n = 72]) and required more in-and-out
catheterization than those whose urinary catheter was removed 6 hours
after the epidural analgesia was discontinued (31.0% [n = 39]; p <
0.0001). The only documented urinary tract infection in the entire cohort
occurred in a patient whose urinary catheter was removed within 48 hours
after the operation. No urinary tract infections developed in the 126
patients whose urinary catheter remained in place until the epidural
catheter was removed. Conclusions In a randomized control trial, patients
with an epidural catheter in place after a general thoracic surgical
operation have a higher rate of urinary problems when the urinary catheter
is removed early, while the epidural catheter is still in place, compared
with patients whose urinary catheter is removed after the epidural
analgesia is discontinued. Copyright &#xa9; 2016 The Society of Thoracic
Surgeons

<18>
Accession Number
612989116
Author
Amara W.; Naccache S.; Akret C.; Cheggour S.; M'Zoughi S.; Galuscan G.;
Dompnier A.
Institution
(Amara, Naccache) Unite de rythmologie, GHI Le Raincy-Montfermeil, 10, rue
du General-Leclerc, Montfermeil 93370, France
(Akret, Dompnier) Centre hospitalier Annecy-Genevois, 1, avenue de
l'Hopital, Epagny Metz-Tessy 74370, France
(Cheggour, M'Zoughi) Centre hospitalier d'Avignon, 305, rue
Raoul-Follereau, Avignon 84000, France
(Galuscan) Centre hospitalier Andre-Mignot, 177, rue de Versailles, Le
Chesnay 78150, France
Title
Safety of device implantation under antipatelet therapy with ticagrelor:
About 20 cases.
Source
Annales de Cardiologie et d'Angeiologie. 65 (5) (pp 318-321), 2016. Date
of Publication: 01 Nov 2016.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Introduction Management of antiplatelet therapy at the time of device
implantation remains controversial. This study aimed to assess the risk of
bleeding complications in patients receiving ticagrelor at the time of
cardiac device surgery. Methods We performed a multicentre (n = 4),
retrospective study from January 2015 to January 2016. The survey included
all patients (pts) treated with ticagrelor before undergoing pacemaker,
implantable cardioverter-defibrillator (ICD) implantation or generator
replacement. We report hemorrhagic post-procedural complications at 1
month. A significant bleeding complication was defined as pocket hematoma
requiring a surgical evacuation or prolonged hospitalization, hemothorax,
pericardial effusion, or tamponade. Results A total of 20 patients
underwent a permanent pacemaker or ICD implantation while taking a
combination of antipatelet therapy with ticagrelor and aspirin. The mean
age of the patients was 65 +/- 9 years, 95% were male, 25% of patients
were diabetics, 55% had hypertension and 50% presented a history of heart
failure. All the patients had a history of acute coronary syndrome [6
(4-26) months before the procedure]. The majority of implanted devices
were ICDs (17, 85%) with 5 single chamber, 4 dual chambers and 9 triple
chambers ICDs. Subclavian venous approach was utilized in 9 patients. The
mean duration of procedure was 60 minutes. One per-procedure bleeding was
described due to high venous pressure, without post-procedure hematoma. A
post-procedure pocket hematoma has been experienced by one patient. The
subclavian approach was used for the 2 patients. No blood transfusion was
needed for these 2 cases. Conclusion Ticagrelor treatment at the time of
heart rhythm device procedures does not seem to be associated with an
increased risk of significant bleeding complications. In our study, 2
patients experienced nonsignificant bleeding complications. Copyright
&#xa9; 2016 Elsevier Masson SAS

<19>
Accession Number
612989094
Author
Moini C.; Sidia B.; Poindron D.; Fiorina L.; Farge A.; Amara W.; El Issa
M.
Institution
(Moini, Sidia, Poindron, Fiorina, El Issa) Unite de rythmologie et de
stimulation cardiaque, hopital d'Antony, 1, rue Velpeau, Antony 92160,
France
(Moini, Poindron, Fiorina) Unite de rythmologie et de stimulation
cardiaque, clinique Les Fontaines, 54, boulevard Aristide-Briand, Melun
77000, France
(Moini) Service de cardiologie, centre hospitalier de Melun, 2, rue
Freteau-de-Peny, Melun cedex 77011, France
(Farge) Unite de chirurgie cardiaque, hopital Jacques-Cartier, 6, avenue
du Noyer-Lambert, Massy 91300, France
(Amara) Unite de rythmologie, GHI Le Raincy-Montfermeil, 10, rue du
General-Leclerc, Montfermeil 93370, France
Title
Cardiac permanent pacemaker after transcatheter aortic valve implantation:
A predictive and scientific review.
Source
Annales de Cardiologie et d'Angeiologie. 65 (5) (pp 346-351), 2016. Date
of Publication: 01 Nov 2016.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Transcatheter aortic valve implantation (TAVI) is nowadays a worldwide
technique in the field of treating aortic stenosis. One of the main side
effects linked to the technique are mostly attached to rhythm
disturbances, such as atrioventricular (AV) and intraventricular blocks.
Consequently, a pacemaker implantation is often required. That
implantation rate is estimated between 8 and 30%, depending on the valve
chosen. Thanks to main meta analysis on the subject, it has been managed
to isolate the following risks factors for AV block development:
preoperative right bundle branch block (RBBB: the most powerful element),
complete AV block during the procedure, male gender, a so-called porcelain
aorta, the absence of previous valvular surgery, the aortic annulus size
(i.e when that size is inferior to the valve's one) and the QRS duration
after the procedure (the superior threshold has been set at 128 ms for the
Corevalve). The currently recommendations advice to implant a pacemaker
are as followed: high grade AV block (in the main studies, the
implantation occurs within the 5 days after the TAVI), complete and
transient AV block during the TAVI, second degree AV block and RBBB
associated with first degree AV block. Our article aims to review the
arrhythmic issues of TAVI. Copyright &#xa9; 2016 Elsevier Masson SAS

<20>
Accession Number
612633060
Author
Crocker E.; Beggs T.; Hassan A.; Denault A.; Lamarche Y.; Bagshaw S.;
Elmi-Sarabi M.; Hiebert B.; Macdonald K.; Giles-Smith L.; Tangri N.; Arora
R.C.
Institution
(Crocker) Faculty of Medicine, University of Manitoba, Winnipeg, Canada
(Beggs) School of Medicine, Royal College of Surgeons in Ireland, Dublin,
Ireland
(Hassan) Saint John Regional Hospital, Saint John, Canada
(Denault, Lamarche, Elmi-Sarabi) Montreal Heart Institute, Montreal,
Canada
(Bagshaw) Faculty of Medicine and Dentistry and School of Public Health,
University of Alberta, Edmonton, Canada
(Hiebert) St. Boniface Hospital, Winnipeg, Canada
(Macdonald, Giles-Smith) University of Manitoba Libraries, Winnipeg,
Canada
(Tangri) Seven Oaks General Hospital Renal Program, Winnipeg, Canada
(Tangri) Section of Nephrology, Department of Medicine, University of
Manitoba, Winnipeg, Canada
(Arora) Department of Surgery (Cardiac Surgery), University of Manitoba,
Winnipeg, Canada
Title
Long-Term Effects of Postoperative Delirium in Patients Undergoing Cardiac
Operation: A Systematic Review.
Source
Annals of Thoracic Surgery. 102 (4) (pp 1391-1399), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier USA
Abstract
Delirium is an acute syndrome that involves fluctuating changes in
attention and cognition. Although delirium is the most common neurologic
complication after cardiac operation, data about its impact on long-term
outcomes are lacking. The purpose of this systematic review was to examine
the effect of postoperative delirium (PoD) on long-term outcomes,
including morbidity, probability of death, cognitive decline,
institutionalization, and health-related quality of life (HRQoL) in
patients undergoing cardiac operation. After performing this systematic
review we determined that PoD after cardiac operation is associated with
an increased risk of probability of death and readmission to the hospital
and a decrease in cognitive function, overall function, and HRQoL.
Copyright &#xa9; 2016 The Society of Thoracic Surgeons

<21>
Accession Number
612632993
Author
Mihos C.G.; Pineda A.M.; Capoulade R.; Santana O.
Institution
(Mihos, Capoulade) Cardiac Ultrasound Laboratory, Massachusetts General
Hospital, Harvard Medical School, Boston, Massachusetts, United States
(Pineda, Santana) Columbia University Division of Cardiology, Mount Sinai
Heart Institute, Miami Beach, Florida, United States
Title
A Systematic Review of Mitral Valve Repair With Autologous Pericardial
Leaflet Augmentation for Rheumatic Mitral Regurgitation.
Source
Annals of Thoracic Surgery. 102 (4) (pp 1400-1405), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier USA
Abstract
A systematic review was conducted to assess the efficacy of mitral valve
repair using glutaraldehyde-treated autologous pericardial leaflet
augmentation for rheumatic mitral regurgitation (MR). Five retrospective
studies were identified, which included 196 patients with moderate or
greater MR. There was 1 operative death (0.5%). At a mean follow-up of 3.2
+/- 2.2 years, moderate or greater MR reoccurred in 22 patients (11.2%),
reoperation was required in 9 (4.6%), and the cumulative survival was
98.9%. Finally, outcomes were similar between the patients who underwent
augmentation of the anterior vs the posterior mitral leaflet. Pericardial
leaflet augmentation is a viable technique for the treatment of rheumatic
MR. Copyright &#xa9; 2016 The Society of Thoracic Surgeons

<22>
Accession Number
610457646
Author
Castelvecchio S.; Menicanti L.; Garatti A.; Tramarin R.; Volpe M.;
Parolari A.
Institution
(Castelvecchio, Menicanti, Garatti) Department of Cardiac Surgery, IRCCS
Policlinico San Donato, Milan, Italy
(Tramarin, Volpe) Department of Cardiac Rehabilitation, IRCCS Policlinico
San Donato, Milan, Italy
(Parolari) Unit of Cardiac Surgery and Translational Research, IRCCS
Policlinico San Donato, Milan, Italy
(Parolari) Department of Biomedical Sciences for Health, Universita Degli
Studi di Milano, Milan, Italy
Title
Myocardial Revascularization for Patients With Diabetes: Coronary Artery
Bypass Grafting or Percutaneous Coronary Intervention?.
Source
Annals of Thoracic Surgery. 102 (3) (pp 1012-1022), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier USA
Abstract
Patients affected by diabetes usually have extensive coronary artery
disease. Coronary revascularization has a prominent role in the treatment
of coronary artery disease in the expanding diabetic population. However,
diabetic patients undergoing coronary artery bypass grafting or
percutaneous coronary intervention experience worse outcomes than
nondiabetic patients. Several studies comparing coronary artery bypass
grafting vs percutaneous coronary intervention in subgroups of diabetic
patients demonstrated a survival advantage and fewer repeat
revascularization procedures with an initial surgical strategy. This
review summarizes the current state of evidence comparing the
effectiveness and safety of coronary artery bypass grafting and
percutaneous coronary intervention in diabetic patients. Copyright &#xa9;
2016

<23>
Accession Number
607246451
Author
Stachon P.; Ahrens I.; Bode C.; Zirlik A.
Institution
(Stachon, Ahrens, Bode, Zirlik) Department of Cardiology and Angiology I,
University Heart Center Freiburg, Hugstetterstrasse 55, Freiburg 79106,
Germany
Title
Dual pathway therapy in acute coronary syndrome.
Source
Journal of Thrombosis and Thrombolysis. 42 (2) (pp 254-260), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
In 10 % of patients, who suffer an acute coronary syndrome (ACS), a major
cardiovascular event occurs despite optimal therapy. The occlusion of the
vessel is driven by atherothrombosis, which arises from platelet
activation and activation of the coagulation cascade. In the last decade
the secondary prevention continuously improved by development of dual
anti-platelet therapy with new P2Y12-inhibitors such as clopidogrel,
prasugrel, and ticagrelor. Until recently, the coagulation cascade was not
targeted in secondary prevention. The coagulation factor Xa plays a
crucial role in thrombosis and is elevated in patients after acute
coronary syndrome, therefore representing an attractive target for novel
therapies in ACS. Former studies with vitamin K antagonists showed
reduction of cardiovascular events but increased major bleedings. Two
phase-3 trials investigated the role of novel oral anticoagulant agents on
top of aspirin and clopidogrel in patients with ACS. The APPRAISE-2 study,
which tested the oral factor Xa inhibitor apixaban was prematurely
terminated because of an increase of major bleedings in the absence of an
effect on cardiovascular events. In contrast, the ATLAS ACS2 TIMI-51 trial
interrogating the oral factor Xa inhibitor rivaroxaban in a low dose
regimen showed significant reduction of cardiovascular events as well as
total mortality. Thus, add-on treatment with low dose rivaroxaban emerged
as a new option for patients with ACS. This review illustrates recent
advances in the development of antithrombotic therapy in acute coronary
syndromes, provides guidance on which patients should receive which
therapy for secondary prevention of events, and points out potentially
fruitful new strategies for the future of antithrombotic treatment in ACS.
Copyright &#xa9; 2015, Springer Science+Business Media New York.

<24>
Accession Number
612967201
Author
Brat K.; Tothova Z.; Merta Z.; Taskova A.; Homolka P.; Vasakova M.;
Skrickova J.; Sramek V.; Olson L.J.; Cundrle I.
Institution
(Brat, Merta, Skrickova) Department of Respiratory Diseases, University
Hospital Brno, Brno, Czech Republic
(Brat, Merta, Homolka, Skrickova) Faculty of Medicine, Masaryk University,
Brno, Czech Republic
(Tothova, Vasakova) Department of Respiratory Medicine, Thomayer Hospital,
Prague, Czech Republic
(Taskova) Department of Thoracic Surgery, Thomayer Hospital, Prague, Czech
Republic
(Homolka) Department of Sports Medicine and Rehabilitation, St. Anne's
University Hospital, Brno, Czech Republic
(Homolka, Cundrle) International Clinical Research Center, St. Anne's
University Hospital, Brno, Czech Republic
(Sramek, Cundrle) Department of Anesthesiology and Intensive Care, St.
Anne's University Hospital, Brno, Czech Republic
(Olson) Division of Cardiovascular Diseases, Mayo Clinic, Rochester,
Minnesota, United States
Title
Resting End-Tidal Carbon Dioxide Predicts Respiratory Complications in
Patients Undergoing Thoracic Surgical Procedures.
Source
Annals of Thoracic Surgery. 102 (5) (pp 1725-1730), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier USA
Abstract
Background Ventilatory efficiency (VE/VCO<inf>2</inf> slope [minute
ventilation to carbon dioxide output slope]) has been shown to predict
morbidity and mortality in lung resection candidates. Patients with
increased VE/VCO<inf>2</inf> during exercise also exhibit an increased
VE/VCO<inf>2</inf> ratio and a decreased end-tidal CO<inf>2</inf> at rest.
This study hypothesized that ventilatory values at rest predict
respiratory complications and death in patients undergoing thoracic
surgical procedures. Methods Inclusion criteria for this retrospective,
multicenter study were thoracotomy and cardiopulmonary exercise testing as
part of routine preoperative assessment. Respiratory complications were
assessed from the medical records (from the hospital stay or from the
first 30 postoperative days). For comparisons, Student's t test or the
Mann-Whitney U test was used. Logistic regression and receiver operating
characteristic analyses were performed for evaluation of measurements
associated with respiratory complications. Data are summarized as mean +/-
SD; p <0.05 is considered significant. Results Seventy-six subjects were
studied. Postoperatively, respiratory complications developed in 56 (74%)
patients. Patients with postoperative respiratory complications had
significantly lower resting tidal volume (0.8 +/- 0.3 vs 0.9 +/- 0.3L; p =
0.03), lower rest end-tidal CO<inf>2</inf> (28.1 +/- 4.3vs 31.5 +/- 4.2 mm
Hg; p < 0.01), higher resting VE/VCO<inf>2</inf> ratio (45.1 +/- 7.1 vs
41.0 +/- 6.4; p = 0.02), and higher VE/VCO<inf>2</inf> slope (34.9 +/- 6.4
vs 31.2 +/- 4.3; p = 0.01). Logistic regression (age and sex adjusted)
showed resting end-tidal CO<inf>2</inf> to be the best predictor of
respiratory complications (odds ratio: 1.21; 95% confidence interval: 1.06
to 1.39; area under the curve: 0.77; p = 0.01). Conclusions Resting
end-tidal CO<inf>2</inf> may identify patients at increased risk for
postoperative respiratory complications of thoracic surgical procedures.
Copyright &#xa9; 2016 The Society of Thoracic Surgeons

<25>
Accession Number
604520840
Author
Duggal A.; Ganapathy A.; Ratnapalan M.; Adhikari N.K.J.
Institution
(Duggal) Medical Intensive Care Unit, Respiratory Institute, Cleveland
Clinic Foundation, Cleveland, OH, United States
(Ganapathy) Critical Care Unit, Guelph General Hospital and Division of
Internal Medicine, William Osler Brampton Civic Hospital, Brampton, Canada
(Ratnapalan) Faculty of Medicine, Imperial College London, London, United
Kingdom
(Adhikari) Department of Critical Care Medicine, Sunnybrook Health
Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
(Adhikari) Interdepartmental Division of Critical Care, University of
Toronto, Toronto, Canada
Title
Pharmacological treatments for acute respiratory distress syndrome:
Systematic review.
Source
Minerva Anestesiologica. 81 (5) (pp 567-588), 2015. Date of Publication:
01 May 2015.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Background. Our objective was to systematically review the effect of
pharmacological therapies on mortality in patients with acute respiratory
distress syndrome (ARDS), focusing on randomized controlled trials (RCTs)
published since a previous review in 2004. Methods. We updated previous
searches and searched OVID versions of MEDLINE, EMBASE and CENTRAL (to
January 2013) and proceedings from conferences and bibliographies of
included studies. We included RCTs of pharmacologic therapies compared
with placebo or no therapy for adult patients with ARDS, using authors'
definitions, which reported on mortality (<3 months after randomization).
We excluded subgroups of patients with ARDS reported in RCTs enrolling
other populations and RCTs of therapies to prevent ARDS, nutritional or
fluid interventions, inhaled nitric oxide, therapies coupled to a
mechanical ventilation strategy, or oxygen. Two reviewers independently
screened citations, selected articles for inclusion, and abstracted
clinical and methodological data from included studies with disagreements
resolved by a third reviewer. Mortality data were pooled using
random-effects models. Results. From 13461 citations, 58 trials (6635
patients) of 21 classes of medications met selection criteria; 26 trials
(3880 patients) were published after 2003. Meta-analyses showed reduced
28-day mortality with a 48-hour infusion of cis-atracurium in early ARDS
(relative risk 0.66, 95% confidence interval 0.50 to 0.87; 431 patients,
138 deaths). There was no effect on mortality with granulocyte-macrophage
colony stimulating factor, late low-dose methylprednisolone, neutrophil
elastase inhibitors, intravenous salbutamol, surfactant, or
N-acetylcysteine; each meta-analysis included >1 trial published after
2003. Seven single trials of other treatments published after 2003 showed
no effect. Meta-analysis of older trials of prostaglandin E1 also showed
no effect. Conclusion. Effective pharmacotherapy for ARDS remains
extremely limited. Cis-atracurium is a promising treatment for early
moderate-severe ARDS (using Berlin definition nomenclature) and merits
further investigation in a large RCT. Copyright COPYRIGHT &#xa9; 2015
EDIZIONI MINERVA MEDICA.

<26>
Accession Number
603336365
Author
Guzzetti S.; Bassani T.; Latini R.; Masson S.; Barlera S.; Citerio G.;
Porta A.
Institution
(Guzzetti) Department of Emergency Medicine Luigi Sacco Hospital, Milan,
Italy
(Bassani) Internal Medicine - Clinical and Research Center, IRCCS
Humanitas Clinical Institute, Rozzano, Milan, Italy
(Latini, Masson, Barlera) Department of Cardiovascular Research, IRCCS -
Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
(Citerio) Neuroanaesthesia and Neurointensive Care Unit, Anestesia E
Rianimazione, San Gerardo Hospital, Monza, Italy
(Porta) Department of Biomedical Sciences for Health, Galeazzi Orthopedic
Institute, University of Milan, Milano, Italy
Title
Autonomic cardiovascular modulation with three different anesthetic
strategies during neurosurgical procedures.
Source
Minerva Anestesiologica. 81 (1) (pp 3-11), 2015. Date of Publication: 01
Jan 2015.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Background. Autonomic cardiovascular modulation during surgery might be
affected by different anesthetic strategies. Aim of the present study was
to assess autonomic control during three different anesthetic strategies
in the course of neurosurgical procedures by the linear and non-linear
analysis of two cardiovascular signals. Methods. Heart rate (EKG-RR
intervals) and systolic arterial pressure (SAP) signals were analyzed in
93 patients during elective neurosurgical procedures at fixed points:
anesthetic induction, dura mater opening, first and second hour of
surgery, dura mater and skin closure. Patients were randomly assigned to
three anesthetic strategies: sevoflurane+fentanyl (S-F),
sevoflurane+remifentanil (S-R) and propofol+remifentanil (P-R). Results.
All the three anesthetic strategies were characterized by a reduction of
RR and SAP variability. A more active autonomic sympathetic modulation, as
ratio of low to high frequency spectral components of RR variability
(LF/HF), was present in the P-R group vs. S-R group. This is confirmed by
non-linear symbolic analysis of RR series and SAP variability analysis. In
addition, an increased parasympathetic modulation was suggested by
symbolic analysis of RR series during the second hour of surgery in S-F
group. Conclusion. Despite an important reduction of cardiovascular signal
variability, the analysis of RR and SAP signals were capable to detect
information about autonomic control during anesthesia. Symbolic analysis
(non-linear) seems to be able to highlight the differences of both the
sympathetic (slow) and vagal (fast) modulation among anesthetics, while
spectral analysis (linear) underlines the same differences but only in
terms of balance between the two neural control systems. Copyright &#xa9;
2015, Edizioni Minerva Medica. All rights reserved.

<27>
Accession Number
372485215
Author
Garg A.X.; Kurz A.; Sessler D.I.; Cuerden M.; Robinson A.; Mrkobrada M.;
Parikh C.; Mizera R.; Jones P.M.; Tiboni M.; Rodriguez R.G.; Popova E.;
Gomez M.F.R.; Meyhoff C.S.; Vanhelder T.; Chan M.T.V.; Torres D.; Parlow
J.; De Nadal Clanchet M.; Amir M.; Bidgoli S.J.; Pasin L.; Martinsen K.;
Malaga G.; Myles P.; Acedillo R.; Roshanov P.; Walsh M.; Dresser G.; Kumar
P.; Fleischmann E.; Villar J.C.; Painter T.; Biccard B.; Bergese S.;
Srinathan S.; Cata J.P.; Chan V.; Mehra B.; Leslie K.; Whitlock R.;
Devereaux P.J.
Institution
(Garg, Mrkobrada, Jones, Acedillo, Roshanov, Dresser) Western University,
London Health Sciences Centre, London, ON, Canada
(Kurz, Sessler) Cleveland Clinic, Cleveland, OH, United States
(Cuerden) University of Waterloo, Waterloo, Canada
(Robinson, Mizera, Tiboni, Vanhelder, Walsh, Whitlock, Devereaux)
Population Health Research Institute, McMaster University, Hamilton Health
Sciences/St Joseph's Healthcare, Hamilton, ON, Canada
(Parikh) Yale University, CT, United States
(Rodriguez, Popova) Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
(Gomez) Fundacion Oftalmologica de Santander (FOSCAL), Bucaramanga,
Colombia
(Meyhoff) Copenhagen University Hospital Herlev, Herlev, Denmark
(Chan) Chinese University of Hong Kong, Hong Kong Special Administrative
Region, China
(Torres) Clinica Santa Maria, Santiago, Chile
(Parlow) Kingston General Hospital, Kingston, Canada
(De Nadal Clanchet) Hospital Vall d'Hebron, Barcelona, Spain
(Amir) Shifa International Hospitals Limited, Islamabad, Pakistan
(Bidgoli) CHU Brugmann, Brussels, Belgium
(Pasin) San Raffaele Scientific Institute, Milan, Italy
(Martinsen) Vejle Hospital, Vejle, Denmark
(Malaga) Hospital Nacional Cayetano Heredia, Lima, Peru
(Myles) Monash University, Melbourne, VIC, Australia
(Kumar) University of North Carolina Medical School, Chapel Hill, NC,
United States
(Fleischmann) Vienna General Hospital, Medical University of Vienna,
Vienna, Austria
(Villar) Fundacion Cardioinfantil (FCI), Bogota, Colombia
(Painter) Royal Adelaide Hospital, Adelaide, SA, Australia
(Biccard) Nelson R Mandela School of Medicine, Durban, South Africa
(Bergese) Ohio State University Medical Center, Columbus, OH, United
States
(Srinathan) University of Manitoba, Winnipeg, MB, Canada
(Cata) University of Texas, MD Anderson Cancer Center, Houston, TX, United
States
(Chan) University of Toronto, Toronto, ON, Canada
(Mehra) Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra,
India
(Leslie) Royal Melbourne Hospital, Melbourne, VIC, Australia
Title
Aspirin and clonidine in non-cardiac surgery: Acute kidney injury substudy
protocol of the Perioperative Ischaemic Evaluation (POISE) 2 randomised
controlled trial.
Source
BMJ Open. 4 (2) (no pagination), 2014. Article Number: 004886. Date of
Publication: 2014.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Introduction: Perioperative Ischaemic Evaluation-2 (POISE-2) is an
international 2x2 factorial randomised controlled trial of low-dose
aspirin versus placebo and low-dose clonidine versus placebo in patients
who undergo non-cardiac surgery. Perioperative aspirin (and possibly
clonidine) may reduce the risk of postoperative acute kidney injury (AKI).
Methods and analysis: After receipt of grant funding, serial postoperative
serum creatinine measurements began to be recorded in consecutive patients
enrolled at substudy participating centres. With respect to the study
schedule, the last of over 6500 substudy patients from 82 centres in 21
countries were randomised in December 2013. The authors will use logistic
regression to estimate the adjusted OR of AKI following surgery (compared
with the preoperative serum creatinine value, a postoperative increase
>26.5 mumol/L in the 2 days following surgery or an increase of >50% in
the 7 days following surgery) comparing each intervention to placebo, and
will report the adjusted relative risk reduction. Alternate definitions of
AKI will also be considered, as will the outcome of AKI in subgroups
defined by the presence of preoperative chronic kidney disease and
preoperative chronic aspirin use. At the time of randomisation, a
subpopulation agreed to a single measurement of serum creatinine between 3
and 12 months after surgery, and the authors will examine intervention
effects on this outcome. Ethics and dissemination: The authors were
competitively awarded a grant from the Canadian Institutes of Health
Research for this POISE-2 AKI substudy. Ethics approval was obtained for
additional kidney data collection in consecutive patients enrolled at
participating centres, which first began for patients enrolled after
January 2011. In patients who provided consent, the remaining longer term
serum creatinine data will be collected throughout 2014. The results of
this study will be reported no later than 2015. Clinical Trial
Registration Number: NCT01082874.

<28>
Accession Number
615080363
Author
Agren S.; Berg S.; Svedjeholm R.; Stromberg A.
Institution
(Agren) Department of Medicine and Health Sciences, Linkoping University,
Department of Cardiothoracic Surgery, County Council of Ostergotland,
Linkoping, Sweden; Department of Medicine and Health Sciences, Linkoping
University, Division of Nursing Sciences, Linkoping University, Linkoping,
Sweden
(Berg, Svedjeholm) Department of Medicine and Health Sciences, Linkoping
University, Department of Cardiothoracic Surgery, County Council of
Ostergotland, Linkoping, Sweden
(Stromberg) Department of Medicine and Health Sciences, Linkoping
University, Division of Nursing Sciences, Linkoping University, Linkoping,
Sweden; Department of Medicine and Health Sciences, Linkoping University,
Department of Cardiology, County Council of Ostergotland, Linkoping,
Sweden
Title
Psychoeducational support to post cardiac surgery heart failure patients
and their partners--a randomised pilot study.
Source
Intensive & critical care nursing. 31 (1) (pp 10-18), 2015. Date of
Publication: 01 Feb 2015.
Abstract
OBJECTIVES: Postoperative heart failure is a serious complication that
changes the lives of both the person who is critically ill and family in
many ways. The purpose of this study was to evaluate the effects of an
intervention in postoperative heart failure patient-partner dyads
regarding health, symptoms of depression and perceived control.
RESEARCH METHODOLOGY/DESIGN: Pilot study with a randomised controlled
design evaluating psychosocial support and education from an
interdisciplinary team.
SETTING: Patients with postoperative heart failure and their partners.
MAIN OUTCOME MEASURES: SF-36, Beck Depression Inventory, Perceived Control
at baseline, 3 and 12 months.
RESULTS: A total of 42 patient-partner completed baseline assessment.
Partners in the intervention group increased health in the role emotional
and mental health dimensions and patients increased health in vitality,
social function and mental health dimensions compared with the control
group. Patients' perceived control improved significantly in the
intervention group over time.
CONCLUSION: Psychoeducational support to post cardiac surgery heart
failure dyads improved health in both patients and partners at short term
follow-up and improved patients' perceived control at both short and
long-term follow-up. Psychoeducational support appears to be a promising
intervention but the results need to be confirmed in larger studies.
Copyright &#xa9; 2014 Elsevier Ltd. All rights reserved.

<29>
[Use Link to view the full text]
Accession Number
615079142
Author
Hwang B.; Eastwood J.-A.; McGuire A.; Chen B.; Cross-Bodan R.; Doering
L.V.
Institution
(Hwang) Boyoung Hwang, PhD Assistant Professor, School of Nursing,
University of California, Los Angeles. Jo-Ann Eastwood, PhD Assistant
Professor, School of Nursing, University of California, Los Angeles.
Anthony McGuire, PhD Assistant Professor, School of Nursing, California
State University, Long Beach. Belinda Chen, MPH Project Director, School
of Nursing, University of California, Los Angeles. Rebecca Cross-Bodan,
PhD Assistant Professor, School of Nursing, California State University,
Fullerton. Lynn V. Doering, DNSc Professor and Chair, Translational
Sciences, School of Nursing, University of California, Los Angeles
Title
Cognitive behavioral therapy in depressed cardiac surgery patients: role
of ejection fraction.
Source
The Journal of cardiovascular nursing. 30 (4) (pp 319-324), 2015. Date of
Publication: 01 Jul 2015.
Abstract
AIMS: The aim of this study was to evaluate the relationship of ejection
fraction (EF) and depressive symptoms in cardiac surgery patients assigned
to nurse-guided cognitive behavioral therapy (CBT) or usual care (UC).
METHODS: Depressive symptoms were assessed using the Beck Depression
Inventory (BDI). Seventy-seven patients (31% women; mean [SD] age, 63.6
[9.8] years) received 8 weeks of either CBT or UC. Using repeated-measures
analysis of variance, changes in depressive symptoms over time were
evaluated.
RESULTS: There was a significant interaction among time, treatment group,
and EF status (p = 0.019). In the patients with preserved EF (>40%), mean
BDI scores in the UC group worsened by 1.9%, whereas those in the CBT
group improved by 31.0%. In the patients with low EF (<40%), mean BDI
scores worsened by 26.8% and improved by 75.3% in the UC and CBT groups,
respectively.
CONCLUSIONS: Nurse-guided CBT is effective in reducing depressive symptoms
after cardiac surgery, particularly in patients with low EF.

<30>
Accession Number
615095875
Author
Singh V.; Yadav P.K.; Eng M.H.; Macedo F.Y.; Silva G.V.; Mendirichaga R.;
Badiye A.P.; Sakhuja R.; Elmariah S.; Inglessis I.; Alfonso C.E.;
Schreiber T.L.; Cohen M.; Palacios I.; O'Neill W.W.
Institution
(Singh, Sakhuja, Elmariah, Inglessis, Palacios) Massachusetts General
Hospital, Harvard Medical School, Boston, MA, United States
(Yadav) Penn State Milton S. Hershey Medical Center, Hershey, PA, United
States
(Eng, O'Neill) Henry Ford Hospital, Detroit, MI, United States
(Macedo, Silva) Baylor College of Medicine, Houston, TX, United States
(Silva) Texas Heart Institute, Houston, TX, United States
(Mendirichaga, Badiye, Alfonso, Cohen) University of Miami Miller School
of Medicine, Miami, FL, United States
(Schreiber) Detroit Medical Center and Wayne State University, Detroit,
MI, United States
Title
Outcomes of hemodynamic support with Impella in very high-risk patients
undergoing balloon aortic valvuloplasty: Results from the Global cVAD
Registry.
Source
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: March 03, 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Reports on the role of hemodynamic support devices in patients
with severe aortic stenosis (AS) and left ventricular (LV) dysfunction
undergoing balloon aortic valvuloplasty (BAV) are limited. Methods:
Patients were identified from the cVAD registry, an ongoing multicenter
voluntary registry at selected sites in North America that have used
Impella in >. 10 patients. Results: A total of 116 patients with AS who
underwent BAV with Impella support were identified. Mean age was 80.41.
+/-. 9.03. years and most patients were male. Mean STS score was 18.77%.
+/-. 18.32, LVEF was 27.14%. +/-. 16.07, and 42% underwent concomitant
PCI. In most cases Impella was placed electively prior to BAV, whereas
26.7% were placed as an emergency. The two groups had similar baseline
characteristics except for higher prevalence of CAD and lower LVEF in the
elective group, and higher STS score in the emergency group. Elective
strategy was associated higher 1-year survival compared to emergency
placement (56% vs. 29.2%, p = 0.003). One-year survival was higher when
BAV was used as a bridge to definitive therapy as opposed to palliative
treatment (90% vs. 28%, p. <. 0.001). On multivariate analysis, STS score
and aim of BAV (bridge to definitive therapy vs. palliative indication)
were independent predictors of mortality. Conclusion: In this large cohort
of patients with AS and severe LV dysfunction undergoing BAV, our results
demonstrates feasibility and promising long-term outcomes using elective
Impella support with the intention to bridge to a definitive therapy.
Copyright &#xa9; 2017 Elsevier B.V.

<31>
Accession Number
615095277
Author
Bytyci I.; Bajraktari G.; Bhatt D.L.; Morgan C.J.; Ahmed A.; Aronow W.S.;
Banach M.
Institution
(Bytyci, Bajraktari) Clinic of Cardiology, University Clinical Centre of
Kosovo, Prishtina, Kosovo
(Bajraktari) Medical Faculty, University of Prishtina, Prishtina, Kosovo
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, MA, USA
(Morgan) VA Medical Center and George Washington University, Washington,
DC, USA
(Ahmed) University of Alabama at Birmingham, Birmingham, AL, USA
(Aronow) Division of Cardiology, Department of Medicine, New York Medical
College, Valhalla, NY, USA
(Banach) Department of Hypertension, Medical University of Lodz, Lodz,
Poland
(Banach) Polish Mother's Memorial Hospital Research Institute (PMMHRI),
Lodz, Poland
(Banach) Cardiovascular Research Centre, University of Zielona Gora,
Zielona Gora, Poland
Title
Hydrophilic vs lipophilic statins in coronary artery disease: A
meta-analysis of randomized controlled trials.
Source
Journal of Clinical Lipidology. (no pagination), 2017. Date of
Publication: December 06, 2016.
Publisher
Elsevier Ltd
Abstract
Introduction: Some available experimental studies have reported that
hydrophilic statins might have advantages compared with lipophilic statins
in patients with coronary artery disease (CAD). Therefore, we performed a
meta-analysis of randomized controlled trials (RCTs) investigating the
potential differences of lipophilic and hydrophilic statins in patients
with CAD. Methods: We systematically searched selected electronic
databases up to September 2016 to select RCTs, which compared clinical
outcomes of hydrophilic vs lipophilic statins. Primary endpoints were
cardiovascular (CV) events: major adverse cardiac events, myocardial
infarction, cardiac revascularization, stroke, CV death, CV
hospitalization, and all-cause mortality. Secondary endpoints were safety
parameters: drug discontinuation, statin-associated muscle symptoms and
alanine aminotransferase level increase. Results: A total of 11,697
patients from 11 RCTs, randomly allocated to lipophilic (n = 5736) or
hydrophilic statins (n = 5961), with a mean follow-up 14 months, were
included in the meta-analysis. In comparison with hydrophilic, the
lipophilic statins showed similar risk reduction for major adverse cardiac
events (relative risk = 0.969, 95% confidence interval [CI], 0.835-1.125,
P = .682), myocardial infarction (0.880, 95% CI: 0.731-1.058, P = .174),
CV death (0.757, 95% CI: 0.486-1.180, P = .219), and all-cause mortality
(0.797, 95% CI: 0.590-1.075, P = .137), as well as cardiac
revascularization, stroke, drug discontinuation, and statin-associated
muscle symptoms. CV hospitalization was lower (0.789, 95% CI: 0.643-0.969,
P = .024) and alanine aminotransferase elevation was higher (2.689, 95%
CI: 1.841-3.954, P < .001) in lipophilic than in hydrophilic-treated
patients. Conclusions: In conclusion, similarity between hydrophilic and
lipophilic statins holds between various clinical CAD settings. Copyright
&#xa9; 2017 National Lipid Association.

<32>
[Use Link to view the full text]
Accession Number
611864515
Author
Rizik D.G.; Hermiller J.B.; Simonton C.A.; Klassen K.J.; Kereiakes D.J.
Institution
(Rizik) HonorHealth, Scottsdale-Lincoln Health Network, 10101 N. 92nd
Street #101, Scottsdale, AZ 85258, United States
(Klassen) HonorHealth, Scottsdale Shea Medical Center, Scottsdale, AZ,
United States
(Hermiller) St Vincent Heart Center, Indianapolis, IN, United States
(Simonton) Abbott Vascular, Santa Clara, CA, United States
(Kereiakes) Christ Hospital, Heart and Vascular Center, Lindner Research
Center, Cincinnati, OH, United States
Title
Bioresorbable vascular scaffolds for the treatment of coronary artery
disease: What have we learned from randomized-controlled clinical trials?.
Source
Coronary Artery Disease. 28 (1) (pp 77-89), 2017. Date of Publication:
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Although current everolimus-eluting coronary stents have shown improved
event-free survival within the first year following implantation compared
with bare-metal stents or earlier generation drug-eluting stents, they
remain associated with an ongoing risk for adverse outcomes (thrombosis,
myocardial infarction, and restenosis) beyond 1 year at rates similar to
those observed following bare-metal stent deployment. This ongoing very
late hazard has been attributed to the permanent presence of the metal
frame and/or polymer in these stents. The Absorb everolimus-eluting
bioresorbable vascular scaffold (Absorb BVS) has been developed to provide
mechanical support and drug-delivery functions similar to metallic
drug-eluting stents, followed by complete resorption with recovery of more
normal vascular structure and function, thus avoiding the limitations
associated with permanent metallic endovascular prostheses. Absorb BVS has
shown safety and efficacy in the dedicated clinical trial development
program of Abbott Vascular and in an array of investigator-sponsored
studies involving a broad spectrum of clinical (patient) as well as
coronary anatomic complexity. Longer-term evidence, largely limited to
single-arm studies, appears to reflect durable safety and efficacy and
suggests Absorb BVS to be an attractive therapeutic option. Interim
evidence from a series of randomized-clinical trials (RCTs) comparing
Absorb BVS with the Xience cobalt-chromium metallic everolimus-eluting
stent has shown noninferiority of Absorb BVS with respect to target lesion
failure (composite occurrence of cardiac death, target vessel-related
myocardial infarction, and ischemia-driven target lesion
revascularization) beyond the first year, with no statistically
significant differences in other safety/efficacy measures. However,
concerns do exist in terms of increased rates of scaffold thrombosis, the
risk for which may be mitigated by improved patient and lesion selection,
procedural technique, and device iteration. We provide an overview of the
evolution of percutaneous coronary intervention, in-vivo characterization
of Absorb BVS resorption, and a summary with a critical evaluation of
available evidence from RCTs, pooled analyses, and meta-analyses of RCTs
for the safety and efficacy of Absorb BVS obtained primarily following the
treatment of noncomplex coronary lesions in patients with stable ischemic
heart disease and/or stabilized acute coronary syndromes. Copyright &#xa9;
2016 Wolters Kluwer Health, Inc.

<33>
Accession Number
614075930
Author
Xiu J.; Cui K.; Wang Y.; Zheng H.; Chen G.; Feng Q.; Bin J.; Wu J.; Porter
T.R.
Institution
(Xiu, Cui, Wang, Zheng, Chen, Feng, Bin, Wu) Department of Cardiology,
Nanfang Hospital Southern Medical University, Guangzhou, China
(Porter) Division of Cardiology Internal Medicine, University of Nebraska
Medical Center, Omaha, Nebraska, United States
Title
Prognostic Value of Myocardial Perfusion Analysis in Patients with
Coronary Artery Disease: A Meta-Analysis.
Source
Journal of the American Society of Echocardiography. 30 (3) (pp 270-281),
2017. Date of Publication: 01 Mar 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Myocardial perfusion (MP) imaging during stress myocardial
contrast echocardiography (MCE) improves the detection of coronary artery
disease (CAD). However, its prognostic value to predict cardiac events in
patients with known or suspected CAD is still undefined. Methods A search
was conducted for single- or multicenter prospective studies that
evaluated the prognostic value of stress MCE in patients with known or
suspected CAD. A database search was performed through June 2015. Effect
sizes of relative risk ratios (RRs) with their corresponding 95% CIs were
used to evaluate the association between the occurrence of total cardiac
events (cardiac death, nonfatal myocardial infarction, coronary
revascularization) and hard cardiac events (cardiac death and nonfatal
myocardial infarction) in subjects with normal and abnormal MP measured by
MCE. The Cochran Q statistic and the I² statistic were used to
assess heterogeneity. Results A comprehensive literature search of the
MEDLINE, Google Scholar, Cochrane, and Embase databases identified 11
studies enrolling a total of 4,045 patients. The overall analysis of RRs
revealed that patients with abnormal MP were at higher risk for total
cardiac events compared with patients with normal MP (RR, 5.58; 95% CI,
3.64-8.57; P < .001), with low heterogeneity among trials (I² =
48.15%, Q = 7.71, P = .103). Similarly, patients with abnormal MP were at
higher risk for hard cardiac events compared with patients with normal MP
(RR, 4.99; 95% CI, 1.75-14.32; P = .003), with significant heterogeneity
among trials (I² = 81.48%, Q = 21.59, P < .001). Conclusions
The results of this meta-analysis suggest that MP assessment using stress
MCE is an effective prognostic tool for predicting the occurrence of
cardiac events in patients with known or suspected CAD. Copyright &#xa9;
2016 American Society of Echocardiography

<34>
Accession Number
614212872
Author
Girish G.; D'souza R.E.; D'souza P.; Lewis M.G.; Baker D.M.
Institution
(Girish) Department of General & Vascular Surgery, Watford General
Hospital, Watford, United Kingdom
(D'souza, Baker) Department of Vascular Surgery, Royal Free Hospital,
Royal Free London NHS Foundation Trust, London, United Kingdom
(D'souza) Social Science Research Unit and EPPI-Centre, UCL Institute of
Education, London, United Kingdom
(Lewis) Department of statistics, Public Health Evidence, South Asia
(PHESA), Manipal University, Manipal, India
Title
Role of surgical thoracic sympathetic interruption in treatment of facial
blushing: a systematic review.
Source
Postgraduate Medicine. 129 (2) (pp 267-275), 2017. Date of Publication: 17
Feb 2017.
Publisher
Taylor and Francis Inc. (325 Chestnut St, Suite 800, Philadelphia PA
19106, United States)
Abstract
Objectives: This paper aims to review the evidence to support the
effectiveness of sympathectomy as a treatment for facial blushing in terms
of relief of facial blushing, patient satisfaction, recurrence of
blushing, patients regretting treatment and its associated complications.
Methods: A systematic search strategy was performed in Ovid-Medline,
Embase, Cochrane library and NICE. Studies reporting outcomes of
sympathetic interruption in the treatment of facial blushing were
retrieved. Results: Nine studies met the inclusion criteria with 1369
patients included in the final analysis. The age range of patients was 8
to 74 years (from 7 studies) with 56% females. Mean follow up was 21
months in 8 studies (range 6 to 30 months). The pooled proportion of
patients who had good relief of facial blushing was 78.30% (95% C.I.
58.20%-98.39%). Complete satisfaction was reported in 84.02% (95% C.I.
71.71%-96.33%). Compensatory sweating and gustatory sweating were the
commonest complications occurring in 74.18% (95% C.I. 58.10%-90.26%) and
24.42% (95% C.I. 12.22%-36.61%) respectively. The estimated proportion of
patients regretting surgery was 6.79% (C.I 2.08% 11.50%). Conclusion:
Sympathetic interruption at T2 or T2-3 ganglia appears to be an effective
treatment for facial blushing. However, lack of randomized trials
comparing sympathetic interruption with non-surgical methods of treatment
and heterogeneity of included studies with respect to assessment of
outcome measures preclude strong evidence and definitive recommendations.
Copyright &#xa9; 2017 Informa UK Limited, trading as Taylor & Francis
Group.

<35>
Accession Number
614686872
Author
Qi W.; Zhang N.; Korantzopoulos P.; Letsas K.P.; Cheng M.; Di F.; Tse G.;
Liu T.; Li G.
Institution
(Qi, Zhang, Liu, Li) Tianjin Key Laboratory of Ionic-Molecular Function of
Cardiovascular Disease, Department of Cardiology, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
(Qi) School of Public Health, Chinese Academy of Medical Sciences, Peking
Union Medical College, Beijing, China
(Korantzopoulos) First Department of Cardiology, University of Ioannina
Medical School, Ioannina, Greece
(Letsas) Second Department of Cardiology, Laboratory of Cardiac
Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
(Cheng) State Key Laboratory of Cardiovascular Disease, Fuwai Hospital,
National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences, Peking Union Medical College, Beijing, China
(Di) Department of Endocrinology and Metabolism, Third Central Hospital of
Tianjin, Tianjin, China
(Tse) Department of Medicine and Therapeutics, Chinese University of Hong
Kong, Hong Kong, Hong Kong
(Tse) Li Ka Shing Institute of Health Sciences, Chinese University of Hong
Kong, Hong Kong, Hong Kong
Title
Serum glycated hemoglobin level as a predictor of atrial fibrillation: A
systematic review with meta-analysis and metaregression.
Source
PLoS ONE. 12 (3) (no pagination), 2017. Article Number: e0170955. Date of
Publication: March 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background and Aim Glycated hemoglobin (HbA1c) is a long-term measure of
glucose control. Although recent studies demonstrated a potential
association between HbA1c levels and the risk of atrial fibrillation (AF),
the results have been inconsistent. The aim of this meta-analysis is to
evaluate the utility of HbA1c level in predicting AF. Methods PubMed and
the Cochrane Library databases were searched for relevant studies up to
March 2016. Prospective cohort studies and retrospective case-control
studies were included. Relative risk (RR) or odds ratio (OR) with 95%
confidence intervals (CIs) of AF development were determined for different
HbA1c levels. The random effect model was conducted according to the test
of heterogeneity among studies. Subgroup analyses and meta-regression
models were carried out to identify potential sources of heterogeneity.
Results Eight prospective cohort studies with 102, 006 participants and 6
retrospective case-control studies with 57, 669 patients were finally
included in the meta-analysis. In the primary metaanalysis, HbA1c levels
were not associated with an increased risk of AF whether as a continuous
(RR, 1.06; 95% CI, 0.96-1.18) or categorical variable (RR, 0.99; 95% CI,
0.83- 1.18). Nevertheless, prospective studies showed about 10% increased
risk of AF with elevated HbA1c levels both as a continuous (RR, 1.11; 95%
CI, 1.06-1.16) and as a categorical variable (RR, 1.09; 95% CI,
1.00-1.18). In subgroup analyses, pooled results from studies with longer
follow-up durations, published after 2012, aged < 63 years, with exclusion
of cardiac surgery patients demonstrated an increased risk of AF for every
1% increase in HbA1c levels, while studies conducted in the United States
with longer follow-up (more than 96 months), larger sample size and higher
quality score (<6) showed an increased risk of AF for higher HbA1c level
as a categorical variable. Conclusions Elevated serum HbA1c levels may be
associated with an increased risk of AF, but further data are needed.
Serum HbA1c levels might be considered as a potential biomarker for
prediction of AF. Copyright &#xa9; 2017 Qi et al. This is an open access
article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original author and source are credited.

<36>
Accession Number
614639110
Author
Geraci S.; Kawamoto H.; Caramanno G.; Ruparelia N.; Capodanno D.;
Brugaletta S.; Gori T.; Nef H.; Sabate M.; Mehilli J.; Lesiak M.; Naber
C.; Di Mario C.; Capranzano P.; Wiebe J.; Araszkiewicz A.; Pyxaras S.;
Mattesini A.; Munzel T.; Tamburino C.; Colombo A.; Latib A.
Institution
(Geraci, Caramanno) San Giovanni di Dio Hospital, Agrigento, Italy
(Kawamoto, Ruparelia, Colombo, Latib) EMO-GVM Centro Cuore and San
Raffaele Hospitals, Milan, Italy
(Capodanno, Capranzano, Tamburino) Ferrarotto Hospital, University of
Catania, Catania, Italy
(Brugaletta, Sabate) Department of Cardiology, Thorax Institute, Hospital
Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain, United States
(Gori, Munzel) Medizinische Klinik und Poliklinik, Universitatsmedizin
Mainz, University Medical Center, Mainz, Germany
(Nef, Wiebe) Department of Cardiology, University of Giessen, Giessen,
Germany
(Mehilli) Department of Cardiology, Klinikum Groshadern, Ludwig-Maximilian
Universitat, Munich, Germany
(Lesiak, Araszkiewicz) Department of Cardiology, University of Medical
Sciences, Poznan, Poland
(Naber, Pyxaras) Klinik fur Kardiologie und Angiologie,
Elisabeth-Krankenhaus, Essen, Germany
(Di Mario, Mattesini) National Institute of Health Research Cardiovascular
BRU, Royal Brompton Hospital & Imperial College, London, United Kingdom
Title
Bioresorbable Everolimus-Eluting Vascular Scaffold for Long Coronary
Lesions: A Subanalysis of the International, Multicenter GHOST-EU
Registry.
Source
JACC: Cardiovascular Interventions. 10 (6) (pp 560-568), 2017. Date of
Publication: 27 Mar 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The authors sought to investigate 1-year outcomes in patients
treated with bioresorbable everolimus-eluting vascular scaffolds (BVS) for
"long coronary lesions." Background The present substudy derived from the
GHOST-EU registry included 1,722 lesions in 1,468 consecutive patients,
enrolled between November 2011 and September 2014 at 11 European centers.
Methods The lesions were divided into 3 groups according to continuous BVS
length: 1) shorter than 30 mm; 2) between 30 and 60 mm; and 3) longer than
60 mm. Primary device-oriented endpoint (target lesion failure [TLF]) was
defined as a combination of cardiovascular death, target vessel myocardial
infarction, or clinically driven target lesion revascularization. Results
Patients with lesions >60 mm had more comorbidities and more complex
lesion characteristics, including chronic total occlusions (37%),
bifurcation lesions (40.3%), higher Syntax score (16.4 +/- 7.8), and
higher number of scaffolds implanted per lesion (3.3 +/- 0.9 mm). The main
target vessel was the left anterior coronary artery in all groups. Median
follow-up was 384 (interquartile range: 359 to 459) days. One-year
follow-up was completed in 70.3% of patients. TLF at 1 year was
significantly higher in group C (group A 4.8%, group B 4.5%, group C
14.3%; overall p = 0.001), whereas there were no significant differences
between groups A and B. Finally, a numerically higher (but not
statistically significant) number of scaffold thromboses were observed in
group C when compared with shorter lesions (group A 2.1%, group B 1.1%,
group C 3.8%; overall p = 0.29). Conclusions In a real-world setting,
treatment of long coronary lesions with BVS >60 mm was associated with a
higher TLF rate, driven by myocardial infarction and clinically driven
target lesion revascularization. Copyright &#xa9; 2017

<37>
Accession Number
614638994
Author
Kim H.Y.; Doh J.-H.; Lim H.-S.; Nam C.-W.; Shin E.-S.; Koo B.-K.; Lee
J.M.; Park T.K.; Yang J.H.; Song Y.B.; Hahn J.-Y.; Choi S.H.; Gwon H.-C.;
Lee S.-H.; Kim S.M.; Choe Y.; Choi J.-H.
Institution
(Kim) Department of Medicine, Jeju University Hospital, Jeju National
University School of Medicine, Jeju, South Korea
(Doh) Department of Medicine, Inje University Ilsan-Paik Hospital, College
of Medicine, Goyang, South Korea
(Lim) Department of Cardiology, Ajou University School of Medicine, Suwon,
South Korea
(Nam) Department of Medicine, Keimyung University Dongsan Medical Center,
Daegu, South Korea
(Shin) Department of Cardiology, Ulsan University Hospital, University of
Ulsan College of Medicine, Ulsan, South Korea
(Koo) Department of Medicine, Seoul National University Hospital, Seoul,
South Korea
(Lee, Park, Yang, Song, Hahn, Choi, Gwon, Lee, Choi) Department of
Medicine, Heart Vascular Stroke Institute, Samsung Medical Center,
Sungkyunkwan University School of Medicine, Seoul, South Korea
(Kim, Choe) Department of Radiology, Heart Vascular Stroke Institute,
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
South Korea
(Choi) Department of Emergency Medicine, Heart Vascular Stroke Institute,
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
South Korea
Title
Identification of Coronary Artery Side Branch Supplying Myocardial Mass
That May Benefit From Revascularization.
Source
JACC: Cardiovascular Interventions. 10 (6) (pp 571-581), 2017. Date of
Publication: 27 Mar 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The authors sought to identify whether a coronary side branch
(SB) is supplying a myocardial mass that may benefit from
revascularization. Background The amount of subtending myocardium and
physiological stenosis is frequently different between the main vessel
(MV) and SB. Methods In this multicenter registry, 482 patients who
underwent coronary computed tomography angiography and fractional flow
reserve (FFR) measurement were enrolled. The % fractional myocardial mass
(FMM), the ratio of vessel-specific myocardial mass to whole myocardium,
was assessed in 5,860 MV or SB consisting of 2,930 bifurcations.
Physiological stenosis was defined by fractional flow reserve (FFR) <0.80.
Myocardial mass that may benefit from revascularization was defined by
%FMM >10%. Results In per-bifurcation analysis, MV supplied a 1.5- to
9-fold larger myocardial mass compared with SB. Unlike left main
bifurcation (n = 482), only 1 of every 5 non-left main SB (n = 2,448)
supplied %FMM >10% (97% vs. 21%; p < 0.001). SB length >73 mm could
estimate %FMM >10% (c-statistic = 0.85; p < 0.001). In 604 vessels
interrogated by FFR, diameter stenosis was similar (p = NS), but %FMM
>10%, FMM/minimal luminal diameter, and frequency of FFR <0.80 was higher
in MV compared with SB (p < 0.001, all). Generalized estimating equations
modeling demonstrate that vessel diameter, left myocardial mass, and FFR
were not (p = NS), but SB length >73 mm and left main bifurcation were
significant predictors for %FMM >10% (p < 0.001). Conclusions Compared
with MV, SB supplies a smaller myocardial mass and showed less
physiological severity despite similar stenosis severity. SB supplying a
myocardial mass of %FMM>10%, which may benefit revascularization could be
identified by vessel length >73 mm. Pre-procedural recognition of these
findings may guide optimal revascularization strategy for bifurcation.
Copyright &#xa9; 2017 American College of Cardiology Foundation

<38>
Accession Number
614921778
Author
Rusch D.; Koch T.; Seel F.; Eberhart L.
Institution
(Rusch, Koch, Seel, Eberhart) Department of Anesthesia and Intensive Care,
University Hospital Giessen - Marburg, Marburg Campus, Marburg, Germany
Title
Vapocoolant Spray Versus Lidocaine Infiltration for Radial Artery
Cannulation: A Prospective, Randomized, Controlled Clinical Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (1) (pp 77-83),
2017. Date of Publication: 01 Feb 2017.
Publisher
W.B. Saunders
Abstract
Objectives Local infiltration with lidocaine is a frequently used measure
to prevent pain during arterial cannulation. Its administration is
associated with pain. Vapocoolants like ethyl chloride or alkanes also
affect rapid-onset anesthesia. However, their administration causes less
discomfort compared with administration of lidocaine. The effectiveness of
vapocoolants in mitigating discomfort associated with arterial cannulation
never has been studied. The authors therefore compared vapocoolant with
lidocaine for reducing discomfort caused by arterial cannulation. Design
Prospective, randomized, controlled study. Setting University hospital,
single center. Participants One hundred sixty adult patients requiring
arterial cannulation before induction of general anesthesia for cardiac
surgery or carotid endarterectomy. Interventions Patients received either
lidocaine infiltration or vapocoolant spray prior to arterial cannulation.
Overall discomfort resulting from the whole procedure (applying
local/topical anesthesia followed by arterial puncture) was rated on a 0
to 10 numerical rating scale. Puncture failure rate and time required for
the intervention also were recorded. Measurements and Main Results One
hundred forty-three patients were included in the per-protocol analysis.
Mean pain scores in the vapocoolant group were 3.4 (+/-1.58) compared with
4.5 (+/-2.29) in the lidocaine group (difference 1.1+/-0.33; p = 0.032;
Mann-Whitney U-test). The higher puncture failure rate in the lidocaine
group (n = 11 v 4) was not significant (p = 0.06; Fisher's exact test).
The time required for the intervention was longer in the lidocaine group
(138+/-44 s v 128+/-44 s; p = 0.019; Mann-Whitney U-test). Conclusions
Vapocoolant spray is an alternative to lidocaine infiltration to mitigate
discomfort associated with arterial cannulation. Copyright &#xa9; 2017
Elsevier Inc.

<39>
Accession Number
614921777
Author
Bulte C.S.E.; Boer C.; Hartemink K.J.; Kamp O.; Heymans M.W.; Loer S.A.;
de Marchi S.F.; Vogel R.; Bouwman R.A.
Institution
(Bulte, Boer, Loer, Bouwman) Department of Anesthesiology, VU University
Medical Center, 1007 MB, Amsterdam, Netherlands
(Hartemink) Department of Surgery, VU University Medical Center, 1007 MB,
Amsterdam, Netherlands
(Kamp) Department of Cardiology, VU University Medical Center, 1007 MB,
Amsterdam, Netherlands
(Heymans) Epidemiology and Biostatistics, VU University Medical Center,
1007 MB, Amsterdam, Netherlands
(de Marchi) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
(Vogel) Department of Cardiology, Burgerspital Solothurn, Solothurn,
Switzerland
Title
Myocardial Microvascular Responsiveness During Acute Cardiac Sympathectomy
Induced by Thoracic Epidural Anesthesia.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (1) (pp 134-141),
2017. Date of Publication: 01 Feb 2017.
Publisher
W.B. Saunders
Abstract
Objective To evaluate the effect of acute cardiac sympathectomy by
thoracic epidural anesthesia on myocardial blood flow and microvascular
function. Design A prospective observational study. Setting The study was
conducted in a tertiary teaching hospital. Participants Ten patients with
a mean age of 48 years (range 22-63 years) scheduled for thoracic surgery.
Interventions Myocardial contrast echocardiography was used to study
myocardial blood flow and microvascular responsiveness at rest, during
adenosine-induced hyperemia, and after sympathetic stimulation by the cold
pressor test. Repeated measurements were performed without and with
thoracic epidural anesthesia. Measurements and Main Results An increased
myocardial blood volume was observed with thoracic epidural anesthesia
compared to baseline (from 0.08+/-0.02 to 0.10+/-0.03 mL/mL; p = 0.02). No
difference existed in resting myocardial blood flow between baseline
conditions and epidural anesthesia (0.85+/-0.24 v 1.03+/-0.27 mL/min/g,
respectively). Hyperemia during thoracic epidural anesthesia increased
myocardial blood flow to 4.31+/-1.07 mL/min/g (p = 0.0008 v baseline) and
blood volume to 0.17+/-0.04 mL/mL (p = 0.005 baseline). After sympathetic
stimulation, no difference in myocardial blood flow parameters was
observed Conclusions Acute cardiac sympathectomy by thoracic epidural
anesthesia increased the blood volume in the myocardial capillary system.
Also, thoracic epidural anesthesia increased hyperemic myocardial blood
flow, indicating augmented endothelial-independent vasodilator capacity of
the myocardium. Copyright &#xa9; 2017

<40>
Accession Number
613951008
Author
Arunamata A.; Balasubramanian S.; Mainwaring R.; Maeda K.; Selamet Tierney
E.S.
Institution
(Arunamata, Balasubramanian, Selamet Tierney) Division of Pediatric
Cardiology, Department of Pediatrics, Stanford University Medical Center,
Palo Alto, California, United States
(Mainwaring, Maeda) Department of Cardiovascular Surgery, Stanford
University Medical Center, Palo Alto, California, United States
Title
Right-Dominant Unbalanced Atrioventricular Septal Defect: Echocardiography
in Surgical Decision Making.
Source
Journal of the American Society of Echocardiography. 30 (3) (pp 216-226),
2017. Date of Publication: 01 Mar 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Management of right-dominant atrioventricular septal defect
(AVSD) remains a challenge given the spectrum of ventricular hypoplasia.
The purpose of this study was to assess whether reported echocardiographic
indices and additional measurements were associated with operative
strategy in right-dominant AVSD. Methods A blinded observer
retrospectively reviewed preoperative echocardiograms of patients who
underwent surgery for right-dominant AVSD (January 2000 to July 2013).
Ventricular dimensions, atrioventricular valve index (AVVI; left valve
area/right valve area), and right ventricular (RV)/left ventricular
(RV/LV) inflow angle were measured. A second observer measured a subset of
studies to assess agreement. Pearson correlation analysis was performed to
examine the relationship between ventricular septal defect size (indexed
to body surface area) and RV/LV inflow angle in systole. A separate
validation cohort was identified using the same methodology (August 2013
to July 2016). Results Of 46 patients with right-dominant AVSD (median
age, 1 day; range, 0-11 months), overall survival was 76% at 7 years.
Twenty-eight patients (61%) underwent single-ventricle palliation and had
smaller LV dimensions and volumes, AVVIs (P = .005), and RV/LV inflow
angles in systole (P = .007) compared with those who underwent
biventricular operations. Three patients undergoing biventricular
operations underwent transplantation or died and had lower indexed LV
end-diastolic volumes compared with the remaining patients (P = .005).
Interobserver agreement for the measured echocardiographic indices was
good (intraclass correlation coefficient = 0.70-0.95). Ventricular septal
defect size and RV/LV inflow angle in systole had a strong negative
correlation (r = -0.7, P < .001). In the validation cohort (n = 12), RV/LV
inflow angle in systole < 114degree yielded sensitivity of 100% and AVVI <
0.70 yielded sensitivity of 88% for single-ventricle palliation.
Conclusions Mortality remains high among patients with right-dominant
AVSD. RV/LV inflow angle in systole and AVVI are reproducible measurements
that may be used in conjunction with several echocardiographic parameters
to support suitability for a biventricular operation in right-dominant
AVSD. Copyright &#xa9; 2016 American Society of Echocardiography

<41>
Accession Number
614830258
Author
Redden M.D.; Chin T.Y.; van Driel M.L.
Institution
(Redden) Ipswich Hospital, Ipswich, QLD, Australia
(Chin) The Prince Charles Hospital, Rode Road, Chermside, QLD 4032,
Australia
(Chin) The University of Queensland, School of Medicine, 288 Herston Road,
Brisbane, QLD 4006, Australia
(van Driel) The University of Queensland, Primary Care Clinical Unit,
Faculty of Medicine, Brisbane, QLD 4029, Australia
Title
Surgical versus non-surgical management for pleural empyema.
Source
Cochrane Database of Systematic Reviews. 2017 (3) (no pagination), 2017.
Article Number: CD010651. Date of Publication: 17 Mar 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Empyema refers to pus in the pleural space, commonly due to
adjacent pneumonia, chest wall injury, or a complication of thoracic
surgery. A range of therapeutic options are available for its management,
ranging from percutaneous aspiration and intercostal drainage to
video-assisted thoracoscopic surgery (VATS) or thoracotomy drainage.
Intrapleural fibrinolytics may also be administered following intercostal
drain insertion to facilitate pleural drainage. There is currently a lack
of consensus regarding optimal treatment. Objectives: To assess the
effectiveness and safety of surgical versus non-surgical treatments for
complicated parapneumonic effusion or pleural empyema. Search methods: We
searched the Cochrane Central Register of Controlled Trials (CENTRAL)
(2016, Issue 9), MEDLINE (Ebscohost) (1946 to July week 3 2013, July 2015
to October 2016) and MEDLINE (Ovid) (1 May 2013 to July week 1 2015),
Embase (2010 to October 2016), CINAHL (1981 to October 2016) and LILACS
(1982 to October 2016) on 20 October 2016. We searched ClinicalTrials.gov
and WHO International Clinical Trials Registry Platform for ongoing
studies (December 2016). Selection criteria: Randomised controlled trials
that compared a surgical with a non-surgical method of management for all
age groups with pleural empyema. Data collection and analysis: Two review
authors independently assessed trials for inclusion and risk of bias,
extracted data, and checked the data for accuracy. We contacted trial
authors for additional information. We assessed the quality of the
evidence using the GRADE approach. Main results: We included eight
randomised controlled trials with a total of 391 participants. Six trials
focused on children and two on adults. Trials compared tube thoracostomy
drainage (non-surgical), with or without intrapleural fibrinolytics, to
either VATS or thoracotomy (surgical) for the management of pleural
empyema. Assessment of risk of bias for the included studies was generally
unclear for selection and blinding but low for attrition and reporting
bias. Data analyses compared thoracotomy versus tube thoracostomy and VATS
versus tube thoracostomy. We pooled data for meta-analysis where
appropriate. We performed a subgroup analysis for children along with a
sensitivity analysis for studies that used fibrinolysis in non-surgical
treatment arms. The comparison of open thoracotomy versus thoracostomy
drainage included only one study in children, which reported no deaths in
either treatment arm. However, the trial showed a statistically
significant reduction in mean hospital stay of 5.90 days for those treated
with primary thoracotomy. It also showed a statistically significant
reduction in procedural complications for those treated with thoracotomy
compared to thoracostomy drainage. We downgraded the quality of the
evidence for length of hospital stay and procedural complications outcomes
to moderate due to the small sample size. The comparison of VATS versus
thoracostomy drainage included seven studies, which we pooled in a
meta-analysis. There was no statistically significant difference in
mortality or procedural complications between groups. This was true for
both adults and children with or without fibrinolysis. However, mortality
data were limited: one study reported one death in each treatment arm, and
seven studies reported no deaths. There was a statistically significant
reduction in mean length of hospital stay for those treated with VATS. The
subgroup analysis showed the same result in adults, but there was
insufficient evidence to estimate an effect for children. We could not
perform a separate analysis for fibrinolysis for this outcome because all
included studies used fibrinolysis in the non-surgical arms. We downgraded
the quality of the evidence to low for mortality (due to wide confidence
intervals and indirectness), and moderate for other outcomes in this
comparison due to either high heterogeneity or wide confidence intervals.
Authors' conclusions: Our findings suggest there is no statistically
significant difference in mortality between primary surgical and
non-surgical management of pleural empyema for all age groups.
Video-assisted thoracoscopic surgery may reduce length of hospital stay
compared to thoracostomy drainage alone. There was insufficient evidence
to assess the impact of fibrinolytic therapy. A number of common outcomes
were reported in the included studies that were not directly examined in
our primary and secondary outcomes. These included duration of chest tube
drainage, duration of fever, analgesia requirement, and total cost of
treatment. Future studies focusing on patient-centred outcomes, such as
patient functional scores, and other clinically relevant outcomes, such as
radiographic improvement, treatment failure rates, and amount of fluid
drainage, are needed to inform clinical decisions. Copyright &#xa9; 2017
The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

<42>
Accession Number
614805231
Author
Al-Khudairy L.; Flowers N.; Wheelhouse R.; Ghannam O.; Hartley L.;
Stranges S.; Rees K.
Institution
(Al-Khudairy, Flowers, Wheelhouse, Ghannam, Hartley, Stranges, Rees)
Warwick Medical School, University of Warwick, Division of Health
Sciences, Coventry CV4 7AL, United Kingdom
Title
Vitamin C supplementation for the primary prevention of cardiovascular
disease.
Source
Cochrane Database of Systematic Reviews. 2017 (3) (no pagination), 2017.
Article Number: CD011114. Date of Publication: 16 Mar 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Vitamin C is an essential micronutrient and powerful
antioxidant. Observational studies have shown an inverse relationship
between vitamin C intake and major cardiovascular events and
cardiovascular disease (CVD) risk factors. Results from clinical trials
are less consistent. Objectives: To determine the effectiveness of vitamin
C supplementation as a single supplement for the primary prevention of
CVD. Search methods: We searched the following electronic databases on 11
May 2016: the Cochrane Central Register of Controlled Trials (CENTRAL) in
the Cochrane Library; MEDLINE (Ovid); Embase Classic and Embase (Ovid);
Web of Science Core Collection (Thomson Reuters); Database of Abstracts of
Reviews of Effects (DARE); Health Technology Assessment Database and
Health Economics Evaluations Database in the Cochrane Library. We searched
trial registers on 13 April 2016 and reference lists of reviews for
further studies. We applied no language restrictions. Selection criteria:
Randomised controlled trials of vitamin C supplementation as a single
nutrient supplement lasting at least three months and involving healthy
adults or adults at moderate and high risk of CVD were included. The
comparison group was no intervention or placebo. The outcomes of interest
were CVD clinical events and CVD risk factors. Data collection and
analysis: Two review authors independently selected trials for inclusion,
abstracted the data and assessed the risk of bias. Main results: We
included eight trials with 15,445 participants randomised. The largest
trial with 14,641 participants provided data on our primary outcomes.
Seven trials reported on CVD risk factors. Three of the eight trials were
regarded at high risk of bias for either reporting or attrition bias, most
of the 'Risk of bias' domains for the remaining trials were judged as
unclear, with the exception of the largest trial where most domains were
judged to be at low risk of bias. The composite endpoint, major CVD events
was not different between the vitamin C and placebo group (hazard ratio
(HR) 0.99, 95% confidence interval (CI) 0.89 to 1.10; 1 study; 14,641
participants; low-quality evidence) in the Physicians Health Study II over
eight years of follow-up. Similar results were obtained for all-cause
mortality HR 1.07, 95% CI 0.97 to 1.18; 1 study; 14,641 participants; very
low-quality evidence, total myocardial infarction (MI) (fatal and
non-fatal) HR 1.04 (95% CI 0.87 to 1.24); 1 study; 14,641 participants;
low-quality evidence, total stroke (fatal and non-fatal) HR 0.89 (95% CI
0.74 to 1.07); 1 study; 14,641 participants; low-quality evidence, CVD
mortality HR 1.02 (95% 0.85 to 1.22); 1 study; 14,641 participants; very
low-quality evidence, self-reported coronary artery bypass grafting
(CABG)/percutaneous transluminal coronary angioplasty (PTCA) HR 0.96 (95%
CI 0.86 to 1.07); 1 study; 14,641 participants; low-quality evidence,
self-reported angina HR 0.93 (95% CI 0.84 to 1.03); 1 study; 14,641
participants; low-quality evidence. The evidence for the majority of
primary outcomes was downgraded (low quality) because of indirectness and
imprecision. For all-cause mortality and CVD mortality, the evidence was
very low because more factors affected the directness of the evidence and
because of inconsistency. Four studies did not state sources of funding,
two studies declared non-commercial funding and two studies declared both
commercial and non-commercial funding. Authors' conclusions: Currently,
there is no evidence to suggest that vitamin C supplementation reduces the
risk of CVD in healthy participants and those at increased risk of CVD,
but current evidence is limited to one trial of middle-aged and older male
physicians from the USA. There is limited low- and very low-quality
evidence currently on the effect of vitamin C supplementation and risk of
CVD risk factors. Copyright &#xa9; 2017 The Cochrane Collaboration.
Published by John Wiley & Sons, Ltd.

<43>
Accession Number
612826331
Author
Brener S.J.; Mehran R.; Lansky A.J.; Ayele G.M.; Stone G.W.
Institution
(Brener) Department of Medicine, Cardiac Catheterization Laboratory, New
York Methodist Hospital, United States
(Brener, Mehran, Ayele, Stone) Department of Medicine, Cardiovascular
Research Foundation, United States
(Mehran) Mount Sinai Medical Center, United States
(Lansky) Yale University Medical Center, United States
(Stone) Columbia University Medical Center, United States
Title
Pretreatment with aspirin in acute coronary syndromes: Lessons from the
ACUITY and HORIZONS-AMI trials.
Source
European Heart Journal: Acute Cardiovascular Care. 5 (5) (pp 449-454),
2016. Date of Publication: 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Aspirin is promptly administered to patients presenting with
acute coronary syndromes. It is not known whether aspirin pretreatment in
acute coronary syndrome patients is beneficial, particularly because some,
but not all, prior studies identified aspirin pretreatment as an
independent risk factor for adverse ischemic events. Objective: To study
the effect of aspirin pretreatment in patients with acute coronary
syndromes enrolled in two large randomized clinical trials. Methods:
Patients enrolled in the ACUITY and HORIZONS-AMI trials were analyzed
according to aspirin pretreatment within 5-7 days before acute coronary
syndromes. We evaluated the incidence of death, myocardial infarction,
target vessel revascularization, stent thrombosis and bleeding at 30 days
and 1 year. Multivariable regression analysis was performed for all-cause
and cardiac death. Results: Among 17,387 patients, 10,587 (60.9%) were
pretreated with aspirin. Pretreated patients were significantly older and
more likely to have diabetes mellitus, hypertension and prior
revascularization, and receive only medical therapy without
revascularization. Aspirin pretreatment was associated with reduced
48-hour cardiac death (adjusted hazard ratio 0.50, 95% confidence interval
0.26-0.97; P=0.04) and 30-day death (adjusted hazard ratio 0.68, 95%
confidence interval 0.49-0.94; P=0.04). Myocardial infarction was more
frequent in the aspirin pretreatment group at 30 days (P<0.0001), while
stent thrombosis was less frequent (P=0.01). A strong interaction was
present such that aspirin pretreatment was associated with reduced 30-day
death in patients with non-ST-segment elevation acute coronary syndrome
(NSTEACS), but not in those with ST-segment elevation myocardial
infarction (P=0.001). Conclusions: Among patients with acute coronary
syndromes in these two large prospective studies, aspirin pretreatment
identified a higher risk cohort and was an independent predictor of
reduced mortality at 30 days, especially in patients with NSTEACS.
Copyright &#xa9; The European Society of Cardiology 2016.

<44>
[Use Link to view the full text]
Accession Number
610067867
Author
Li Y.; Wang C.; Zuo G.; Wang K.; Cao Z.; Du X.
Institution
(Li, Wang, Zuo, Wang, Cao, Du) Department of Cardiology, Tianjin Fifth
Central Hospital, No. 41 Zhejiang Road, Tianjin 300450, China
Title
Drug-eluting balloons in the treatment of de-novo coronary lesions: A
meta-analysis of randomized-controlled trials.
Source
Coronary Artery Disease. 27 (6) (pp 467-477), 2016. Date of Publication:
01 Sep 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Aim The aim of this meta-analysis was to evaluate the efficacy of
drug-eluting balloons (DEBs) plus bare-metal stents (BMS) for the
treatment of de-novo coronary lesions. Methods and results Eleven trials
involving 1279 patients were included in this study. The main endpoints
were as follows: late lumen loss (LLL), binary restenosis, stent
thrombosis (ST), and major adverse cardiovascular events (MACEs). The
definition of MACEs was a composite of death, myocardial infarction (MI),
and target lesion revascularization (TLR). Compared with BMS alone, DEB
plus BMS showed a lower risk for LLL (P=0.007) and MACEs (P=0.010). There
were no significant differences in binary restenosis (P=0.212), ST
(P=0.199), death (P=0.141), MI (P=0.439), and TLR (P=0.340). Compared with
drug-eluting stents (DES), DEB plus BMS could increase the risk of LLL
(P=0.002) and MACEs (P=0.026). The risks of binary restenosis (P=0.113),
ST (P=0.832), death (P=0.115), MI (P=0.831), and TLR (P=0.111) were
similar between DEB plus BMS and DES. Conclusion DEB plus BMS was better
than BMS alone in reducing LLL and MACEs, especially when dilatation was
performed after stenting for de-novo coronary lesions, but it was inferior
to DES. Therefore, the treatment strategy with DEB plus BMS should not be
recommended for de-novo coronary lesions, except for patients who have
contraindications for DES. Copyright &#xa9; 2016 Wolters Kluwer Health,
Inc. All rights reserved.

<45>
[Use Link to view the full text]
Accession Number
611216219
Author
Ungar L.; Rodriguez F.; Mahaffey K.W.
Institution
(Ungar, Mahaffey) Department of Medicine, Stanford Center for Clinical
Research, Stanford University, 300 Pasteur Drive, Stanford, CA 94305,
United States
(Rodriguez, Mahaffey) Division of Cardiovascular Medicine, Stanford Center
for Clinical Research, Stanford University, Stanford, CA, United States
Title
Vorapaxar: Emerging evidence and clinical questions in a new era of PAR-1
inhibition.
Source
Coronary Artery Disease. 27 (7) (pp 604-615), 2016. Date of Publication:
01 Nov 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Despite the use of therapies recommended in practice guidelines for
secondary prevention in patients with atherosclerotic coronary artery
disease, the residual risk for cardiovascular events remains high. Some of
the residual risk is believed to result from incomplete platelet
inhibition with current therapy. Vorapaxar is a first-in-class, novel
antiplatelet agent that acts by antagonizing the PAR-1 receptor,
inhibiting thrombin-mediated platelet activation. Vorapaxar was recently
approved by the Food and Drug Administration for secondary prevention of
cardiovascular events in patients with a history of myocardial infarction
or peripheral artery disease who do not have a history of transient
ischemic attack or stroke. We review the data from two key phase III
cardiovascular outcome trials with vorapaxar: TRACER and TRA 2P-TIMI 50.
We will focus on identifying the key patient populations that should be
identified for treatment, highlight practical clinical issues when
prescribing vorapaxar, and review unanswered questions. Vorapaxar should
be considered in patients at high risk for recurrent ischemic events and
low risk of bleeding. Copyright &#xa9; 2016 Wolters Kluwer Health, Inc.

<46>
Accession Number
609991760
Author
Baumbach H.; Rustenbach C.J.; Ahad S.; Nagib R.; Albert M.; Ratge D.;
Franke U.F.W.
Institution
(Baumbach, Rustenbach, Ahad, Nagib, Albert, Ratge, Franke) Department of
Cardiovascular Surgery and Clinical Chemistry and Laboratory Medicine,
Robert Bosch Hospital, Auerbachstr 110, Stuttgart D-70376, Germany
Title
Minimally Invasive Extracorporeal Bypass in Minimally Invasive Heart Valve
Operations: A Prospective Randomized Trial.
Source
Annals of Thoracic Surgery. 102 (1) (pp 93-100), 2016. Date of
Publication: 01 Jul 2016.
Publisher
Elsevier USA
Abstract
Background. Minimally invasive extracorporeal circulation (MECC) is
predominantly used in coronary operations. Data supporting the benefits of
MECC in minimally invasive valve operations are still absent. Methods.
Patients undergoing either isolated minimally invasive mitral or aortic
valve procedures were prospectively randomized to a minimally invasive
group (MECC; n = 101) or a conventional extracorporeal circulation group
(CECC; n = 99). The procedural and postoperative outcomes were compared,
including the levels of inflammation factors (procalcitonin, interleukin
[IL]-6, IL-8, and IL-10), tumor necrosis factor-alpha [TNF-alpha], and
interferon-gamma [IFN-gamma]). Results. The demographics were comparable
between the groups regarding age (MECC versus CECC, 70.5 +/- 10.2 years
versus 73.1 +/- 8.9 years; P = 0.086), left ventricular function (59.2%
+/- 13.4% versus 62.1% +/- 14.0%; p = 0.302), EuroSCORE (7.4% +/- 7.9%
versus 6.8% +/- 4.0%; p = 0.256), and other comorbidities. Hospital
mortality (n = 1 versus n = 3; p = 0.339) and other complications were
similar. However, hemoglobin level (111.9 +/- 19.0 g/L versus 103.8 +/-
14.6 g/L; p = 0.001), the number of packed red blood cells (PRBCs) (1.1
+/- 1.9 versus 1.7 +/- 1.8; p = 0.003), the levels of ILs (IL-6, 194.0 +/-
131.8 pg/mL versus 289.2 +/- 62.5 pg/mL; p = 0.020; IL-8, 38.1 +/- 27.3
pg/mL versus 45.8 +/- 43.4 pg/mL; p = 0.012; IL-10, 29.0 +/- 123.9 pg/mL
versus 49.9 +/- 85.6 pg/mL; p = 0.012), TNF-alpha (3.8 +/- 6.7 ng/mL
versus 10.8 +/- 47.7 ng/mL; p = 0.049), and IFN-gamma (1.9 +/- 1.9 pg/mL
versus 4.5 +/- 2.7 pg/mL; p = 0.027) were in favor of patients in the MECC
group. Additionally, those patients had shorter postoperative ventilation
time (7.7 +/- 8.4 hours versus 9.3 +/- 12.9 hours; p = 0.010) and
intensive care unit (ICU) stay (1.2 +/- 1.2 days versus 2.2 +/- 3.8 days;
p = 0.047). Conclusions. The intraprocedural data were excellent and
comparable in the groups, but postoperative outcomes were better in the
MECC group. Thus MECC is preferable to CECC even for minimally invasive
valve procedures. These findings strongly support a combined strategy of
minimally invasive valve operations and minimally invasive extracorporeal
circulation. Copyright &#xa9; 2016 The Society of Thoracic Surgeons.

<47>
Accession Number
614975153
Author
da Costa Torres D.; dos Santos P.M.R.; Reis H.J.L.; Paisani D.M.;
Chiavegato L.D.
Institution
(da Costa Torres, dos Santos, Chiavegato) Universidade Cidade de Sao
Paulo, Sao Paulo, Brazil
(Reis) Hospital de Clinicas Gaspar Vianna, Belem, Brazil
(Paisani) Hospital do Coracao, Sao Paulo, Brazil
Title
Effectiveness of an early mobilization program on functional capacity
after coronary artery bypass surgery: A randomized controlled trial
protocol.
Source
SAGE Open Medicine. 4 (no pagination), 2016. Date of Publication: 2016.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Muscle atrophy and prolonged inactivity are associated with an
increased sensation of fatigue and reduced functional capacity in the
postoperative period in patients undergoing coronary artery bypass
grafting. Cardiac rehabilitation after hospital discharge is highly
recommended and contributes to improvement in functional capacity and
quality of life. However, few studies have evaluated the effectiveness of
early mobilization protocols during hospitalization on the patterns of
physical activity and functional capacity after coronary artery bypass
grafting. Objective: To investigate the effectiveness of an early
mobilization program on the functional capacity of patients undergoing
coronary artery bypass grafting in the short and long term. Methods: This
is a prospective, randomized, controlled, single-blind trial protocol that
will evaluate 66 consecutive patients undergoing coronary artery bypass
grafting. Patients will be randomized into two training groups: the
control group (N = 33), which will perform breathing exercises and the
intervention group (N = 33), which will perform breathing exercises and
aerobic exercises. The groups will receive treatment from first to the
seventh postoperative day, twice daily. In the preoperative period, the
following outcomes will be assessed: physical activity level (Baecke
Questionnaire), Functional Independence Measure, and functional capacity
(6-min walking test). Functional capacity will be reassessed after the 7th
and 60th postoperative day. Pulmonary complications and length of hospital
stay will also be evaluated. Statistical analysis will be calculated using
linear mixed models and will be based on intention-to-treat. The level of
significance will be set at alpha = 5%. Copyright &#xa9; The Author(s)
2016.

<48>
Accession Number
610887252
Author
Blyme A.; Asferg C.; Nielsen O.W.; Boman K.; Gohlke-Barwolf C.; Wachtell
K.; Olsen M.H.
Institution
(Blyme, Asferg) Department of Cardiology, Glostrup Hospital, University of
Copenhagen, Glostrup, Denmark
(Nielsen) Department of Cardiology, Bispebjerg Hospital, University of
Copenhagen, Copenhagen, Denmark
(Boman) Research Unit, Skelelftea, Institution of Public Health and
Clinical Medicine, Umea University, Umea, Sweden
(Gohlke-Barwolf) Heart Center Bad Krozingen, Bad Krozingen, Germany
(Wachtell) Oslo University Hospital, Division of Cardiovascular and
Pulmonary Diseases, Department of Cardiology, Section Cardiology
Intervention, Unit Ulleval, Oslo, Norway
(Olsen) Centre for Individualized Medicine in Arterial Diseases (CIMA),
Odense University Hospital, University of Southern Denmark, Denmark
(Olsen) Medical Research Council Unit on Hypertension and Cardiovascular
Disease, Hypertension in Africa Research Team (HART), North-West
University, Potchefstroom, South Africa
Title
Increased hsCRP is associated with higher risk of aortic valve replacement
in patients with aortic stenosis.
Source
Scandinavian Cardiovascular Journal. 50 (3) (pp 138-145), 2016. Date of
Publication: 03 May 2016.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Objective To investigate relations between inflammation and aortic valve
stenosis (AS) by measuring high-sensitivity C-reactive protein, at
baseline (hsCRP<inf>0</inf>) and after 1 year (hsCRP<inf>1</inf>) and
exploring associations with aortic valve replacement (AVR). Design We
examined 1423 patients from the Simvastatin and Ezetimibe in Aortic
Stenosis study. Results During first year of treatment, hsCRP was reduced
both in patients later receiving AVR (2.3 [0.9-4.9] to 1.8 [0.8-5.4] mg/l,
p < 0.001) and not receiving AVR (1.90 [0.90-4.10] to 1.3 [0.6-2.9] mg/l,
p <0.001). In Cox-regression analyses, hsCRP<inf>1</inf> predicted later
AVR (HR = 1.17, p < 0.001) independently of hsCRP<inf>0</inf> (HR = 0.96,
p = 0.33), aortic valve area (AVA) and other risk factors. A higher rate
of AVR was observed in the group with high hsCRP<inf>0</inf> and an
increase during the first year (AVR<inf>highCRP0CRP1inc</inf>=47.3% versus
AVR<inf>highCRP0CRP1dec</inf>=27.5%, p < 0.01). The prognostic benefit of
a 1-year reduction in hsCRP was larger in patients with high versus low
hsCRP<inf>0</inf> eliminating the difference in incidence of AVR between
high versus low hsCRP<inf>0</inf> (AVR<inf>highCRP0CRP1dec</inf>=27.5%
versus AVR<inf>lowCRP0CRP1dec</inf>=25.8%, p = 0.66) in patients with
reduced hsCRP during the first year. Conclusions High hsCRP<inf>1</inf> or
an increase in hsCRP during the first year of follow-up predicted later
AVR independently of AVA, age, gender and other risk factors, although no
significant improvement in C-statistics was observed. Copyright &#xa9;
2016 Taylor & Francis.

<49>
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.

<50>
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.

<51>
Accession Number
614732653
Author
Bilecen S.; De Groot J.A.H.; Kalkman C.J.; Spanjersberg A.J.; Brandon
Bravo Bruinsma G.J.; Moons K.G.M.; Nierich A.P.
Institution
(Bilecen, Kalkman, Moons) Division of Anesthesiology, Intensive Care and
Emergency Medicine, University Medical Center Utrecht, PO Box 85500,
Utrecht 3508 GA, Netherlands
(Bilecen, Spanjersberg, Nierich) Department of Cardiothoracic Anesthesia
and Intensive Care, Isala Zwolle, Netherlands
(De Groot, Moons) Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht, Netherlands
(Brandon Bravo Bruinsma) Department of Cardiothoracic Surgery, Isala
Zwolle, Netherlands
Title
Effect of fibrinogen concentrate on intraoperative blood loss among
patients with intraoperative bleeding during high-risk cardiac surgery: A
randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 317 (7) (pp 738-747),
2017. Date of Publication: 21 Feb 2017.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Fibrinogen concentrate might partly restore coagulation
defects and reduce intraoperative bleeding. Objective: To determine
whether fibrinogen concentrate infusion dosed to achieve a plasma
fibrinogen level of 2.5 g/L in high-risk cardiac surgery patients with
intraoperative bleeding reduces intraoperative blood loss. Design,
Setting, and Participants: A randomized, placebo-controlled, double-blind
clinical trial conducted in Isala Zwolle, the Netherlands (February
2011-January 2015), involving patients undergoing elective, high-risk
cardiac surgery (ie, combined coronary artery bypass graft [CABG] surgery
and valve repair or replacement surgery, the replacement of multiple
valves, aortic root reconstruction, or reconstruction of the ascending
aorta or aortic arch) with intraoperative bleeding (blood volume between
60 and 250 mL suctioned from the thoracic cavity in a period of 5 minutes)
were randomized to receive either fibrinogen concentrate or placebo.
Interventions: Intravenous, single-dose administration of fibrinogen
concentrate (n = 60) or placebo (n = 60), targeted to achieve a
postinfusion plasma fibrinogen level of 2.5 g/L. Main Outcomes and
Measures: The primary outcomewas blood loss in milliliters between
intervention (ie, after removal of cardiopulmonary bypass) and closure of
chest. Safety variables (within 30 days) included: in-hospital mortality,
myocardial infarction, cerebrovascular accident or transient ischemic
attack, renal insufficiency or failure, venous thromboembolism, pulmonary
embolism, and operative complications. Results: Among 120 patients (mean
age; 71 [SD, 10] years, 37women [31%]) included in the study, combined
CABG and valve repair or replacement surgery comprised 72%of procedures
and had a mean (SD) cardiopulmonary bypass time of 200 minutes (83)
minutes. For the primary outcome, median blood loss in the fibrinogen
groupwas 50mL (interquartile range [IQR], 29-100 mL) compared with 70 mL
(IQR, 33-145 mL) in the control group (P = .19), the absolute difference
20 mL (95%CI, -13 to 35 mL). Therewere 6 cases of stroke or transient
ischemic attack (4 in the fibrinogen group); 4myocardial infarctions (3 in
the fibrinogen group); 2 deaths (both in the fibrinogen group); 5 cases
with renal insufficiency or failure (3 in the fibrinogen group); and 9
cases with reoperative thoracotomy (4 in the fibrinogen group).
Conclusions and Relevance: Among patients with intraoperative bleeding
during high-risk cardiac surgery, administration of fibrinogen
concentrate, compared with placebo, resulted in no significant difference
in the amount of intraoperative blood loss. Copyright &#xa9; 2017 American
Medical Association. All rights reserved.

<52>
Accession Number
614031385
Author
Olper L.; Bignami E.; Di Prima A.L.; Albini S.; Nascimbene S.; Cabrini L.;
Landoni G.; Alfieri O.
Institution
(Olper, Bignami, Di Prima, Albini, Nascimbene, Cabrini, Landoni, Alfieri)
Cardiothoracic and Vascular Department, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Landoni, Alfieri) Vita-Salute San Raffaele University, Milan, Italy
Title
Continuous Positive Airway Pressure Versus Oxygen Therapy in the Cardiac
Surgical Ward: A Randomized Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (1) (pp 115-121),
2017. Date of Publication: 01 Feb 2017.
Publisher
W.B. Saunders
Abstract
Background Noninvasive ventilation (NIV) is a common technique to manage
patients with acute respiratory failure in the intensive care unit.
However, use of NIV in general wards is less well described. The authors'
aim was to demonstrate efficacy of NIV, applied in a cardiac surgery ward,
in improving oxygenation in patients who developed hypoxemic acute
respiratory failure after being discharged from the intensive care unit.
Design Randomized, open-label trial. Setting University hospital.
Participants Sixty-four patients with hypoxemia
(PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> ratio between 100 and 250)
admitted to the main ward after cardiac surgery. Interventions Patients
were randomized to receive standard treatment (oxygen, early mobilization,
a program of breathing exercises and diuretics) or continuous positive
airway pressure in addition to standard treatment. Continuous positive
airway pressure was administered 3 times a day for 2 consecutive days.
Every cycle lasted 1 to 3 hours. All patients completed their 1-year
follow-up. Data were analyzed according to the intention-to-treat
principle. Measurements and Main Results The primary endpoint was the
number of patients with PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf><200 48
hours after randomization. Continuous positive airway pressure use was
associated with a statistically significant reduction in the number of
patients with PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf><200 (4/33 [12%] v
14/31 [45%], p = 0.003). One patient in the control group died at the
30-day follow-up. Conclusions Among patients with acute respiratory
failure following cardiac surgery, administration of continuous positive
airway pressure in the main ward was associated with improved respiratory
outcome. This was the first study that was performed in the main ward of
post-surgical patients with acute respiratory failure. Copyright &#xa9;
2017 Elsevier Inc.

<53>
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.

<54>
Accession Number
613367741
Author
Gu J.; Andreasen J.J.; Melgaard J.; Lundbye-Christensen S.; Hansen J.;
Schmidt E.B.; Thorsteinsson K.; Graff C.
Institution
(Gu, Andreasen, Thorsteinsson) Department of Cardiothoracic Surgery,
Aalborg, Denmark
(Gu, Andreasen, Schmidt, Thorsteinsson) Clinical Medicine, Aalborg
University Hospital, Aalborg, Denmark
(Gu) Department of Cardiovascular Surgery, Heart Centre of General
Hospital, Ningxia Medical University, Yinchuan, Ningxia, China
(Gu, Andreasen, Lundbye-Christensen, Schmidt) Atrial Fibrillation Study
Group, Aalborg University Hospital, Aalborg, Denmark
(Melgaard, Hansen, Graff) Department of Health Science and Technology,
Aalborg University, Aalborg, Denmark
(Lundbye-Christensen) Unit of Clinical Biostatistics and Bioinformatics,
Aalborg University Hospital, Aalborg, Denmark
(Schmidt) Department of Cardiology, Aalborg University Hospital, Aalborg,
Denmark
Title
Preoperative Electrocardiogram Score for Predicting New-Onset
Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (1) (pp 69-76),
2017. Date of Publication: 01 Feb 2017.
Publisher
W.B. Saunders
Abstract
Objective To investigate if electrocardiogram (ECG) markers from routine
preoperative ECGs can be used in combination with clinical data to predict
new-onset postoperative atrial fibrillation (POAF) following cardiac
surgery. Design Retrospective observational case-control study. Setting
Single-center university hospital. Participants One hundred consecutive
adult patients (50 POAF, 50 without POAF) who underwent coronary artery
bypass grafting, valve surgery, or combinations. Interventions
Retrospective review of medical records and registration of POAF.
Measurements and Main Results Clinical data and demographics were
retrieved from the Western Denmark Heart Registry and patient records.
Paper tracings of preoperative ECGs were collected from patient records,
and ECG measurements were read by two independent readers blinded to
outcome. A subset of four clinical variables (age, gender, body mass
index, and type of surgery) were selected to form a multivariate clinical
prediction model for POAF and five ECG variables (QRS duration, PR
interval, P-wave duration, left atrial enlargement, and left ventricular
hypertrophy) were used in a multivariate ECG model. Adding ECG variables
to the clinical prediction model significantly improved the area under the
receiver operating characteristic curve from 0.54 to 0.67 (with
cross-validation). The best predictive model for POAF was a combined
clinical and ECG model with the following four variables: age,
PR-interval, QRS duration, and left atrial enlargement. Conclusion ECG
markers obtained from a routine preoperative ECG may be helpful in
predicting new-onset POAF in patients undergoing cardiac surgery.
Copyright &#xa9; 2017 Elsevier Inc.

<55>
Accession Number
614616356
Author
Dong C.-S.; Zhang J.; Lu Q.; Sun P.; Yu J.-M.; Wu C.; Sun H.
Institution
(Dong, Zhang, Lu, Sun, Yu, Wu, Sun) Third affiliation hospital of Anhui
Medical University, Department of Anesthesiology, Hefei huaihe road No.
390, Hefei 230061, China
Title
Effect of Dexmedetomidine combined with sufentanil for post- thoracotomy
intravenous analgesia: A randomized, controlled clinical study.
Source
BMC Anesthesiology. 17 (1) (no pagination), 2017. Article Number: 33. Date
of Publication: 01 Mar 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Few studies have investigated the use of dexmedetomidine in
patient-controlled intravenous analgesia (PCIA) after thoracic surgery.
This study to evaluate the effect of dexmedetomidine combined with
sufentanil for PCIA after thoracotomy under general anaesthesia. Methods:
Ninety-seven adults patients scheduled for thoracotomy surgery. All two
groups received PCIA with either sufentanil alone (control group) or
combining dexmedetomidine with sufentanil (dexmedetomidine group).
Hemodynamic measurements, visual analog scale (VAS) scores at rest and at
coughing, Ramsay sedation score (RSS), analgesic consumption, and
postoperative nausea and vomiting (PONV) as well as drug-related adverse
effects were compared at 2, 6, 12, 24, 36 and 48 h postoperatively.
Results: In the patients of the dexmedetomidine group, compared to the
control group, the pain scores at rest or at coughing during 48 h
postoperatively were lower (P < 0.001), the sedation scores were lower,
the consumption of sufentanil and rescue meperidine were lower, and the
number of episode of moderate PONV was three times lower. No signs of
toxicity or local complications were observed. There was a non-significant
trend for a lower HR and BP in the dexmedetomidine group vs. Control.
Conclusion: The combining dexmedetomidine with sufentanil for
post-thoracotomy PCIA can improve pain control together with the decrease
in sufentanil requirements, and improve postoperative patient's
satisfaction compared with sufentanil alone in PCIA. Trial Registration:
This trial was retrospectively registered on 27 April 2016 at the Chinese
Clinical Trial Register (number: ChiCTR-ONC-16008376 ). Copyright &#xa9;
2017 The Author(s).

<56>
Accession Number
613613932
Author
Momeni M.; Poncelet A.; Rubay J.; Matta A.; Veevaete L.; Detaille T.;
Houtekie L.; Clement de Clety S.; Derycke E.; Moniotte S.; Sluysmans T.;
Veyckemans F.
Institution
(Momeni, Matta, Veevaete, Veyckemans) Department of Anesthesiology,
Universite Catholique de Louvain, Cliniques Universitaires Saint Luc,
Brussels, Belgium
(Poncelet, Rubay) Department of Cardiac Surgery, Universite Catholique de
Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
(Detaille, Houtekie, Clement de Clety, Derycke) Department of Pediatrics
Intensive Care Unit, Universite Catholique de Louvain, Cliniques
Universitaires Saint Luc, Brussels, Belgium
(Moniotte, Sluysmans) Department of Pediatrics, Universite Catholique de
Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
Title
Does Postoperative Cardiac Troponin-I Have Any Prognostic Value in
Predicting Midterm Mortality After Congenital Cardiac Surgery?.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (1) (pp 122-127),
2017. Date of Publication: 01 Feb 2017.
Publisher
W.B. Saunders
Abstract
Objectives This study evaluated the prognostic value of postoperative
cardiac troponin-I (cTnI) in predicting all-cause mortality up to 3 months
after normothermic congenital cardiac surgery. Design Prospective
observational study. Setting University hospital. Participants All
children ages 0 to 10 years. Interventions None. Measurements and Main
Results cTnI was measured after the induction of anesthesia but before the
surgery, at the pediatric intensive care unit arrival, and at 4, 12, and
24 hours postoperatively. Follow-up was extended up to 6 months. Overall,
169 children were analyzed, of whom 165 were survivors and 4 were
nonsurvivors. cTnI levels were significantly higher in nonsurvivors only
at 24 hours (p = 0.047). Children undergoing surgery with cardiopulmonary
bypass (CPB) had significantly higher cTnI concentrations compared with
those without CPB (p<0.001). Logistic regression analysis was performed on
the 146 children in the CPB group with the following predictive variables:
CPB time, postoperative cTnI concentrations, the presence of a cyanotic
malformation, and intramyocardial incision. None of the variables
predicted mortality. Postoperative cTnI concentrations did not predict 6
months mortality. Only cTnI at 24 hours predicted the length of stay in
the pediatric intensive care unit. Conclusions This study did not find
that postoperative cTnI concentration predicted midterm mortality after
normothermic congenital heart surgery. (ClinicalTrials.gov identifier:
NCT01616394). Copyright &#xa9; 2017 Elsevier Inc.

<57>
Accession Number
614925142
Author
Van Mieghem N.M.; Latib A.; van der Heyden J.; van Gils L.; Daemen J.;
Sorzano T.; Ligthart J.; Witberg K.; de Kroon T.; Maor N.; Mangieri A.;
Montorfano M.; de Jaegere P.P.; Colombo A.; Roubin G.
Institution
(Van Mieghem, van Gils, Daemen, Ligthart, Witberg, de Jaegere) Department
of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam,
Netherlands
(Latib, Mangieri, Montorfano, Colombo) Department of Interventional
Cardiology, San Raffaele Scientific Institute, Milan, Italy
(Latib, Colombo) Department of Interventional Cardiology, EMO-GVM Centro
Cuore, Milan, Italy
(van der Heyden, de Kroon) Department of Cardiology and Cardiac Surgery,
St. Antonius Ziekenhuis, Nieuwegein, Netherlands
(Sorzano, Maor, Roubin) Essential Medical, Inc., Malvem, Pennsylvania,
United States
(Roubin) Cardiovascular Associates, Birmingham, Alabama, United States
Title
Percutaneous Plug-Based Arteriotomy Closure Device for Large-Bore Access:
A Multicenter Prospective Study.
Source
JACC: Cardiovascular Interventions. 10 (6) (pp 613-619), 2017. Date of
Publication: 27 Mar 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The authors sought to study the safety and efficacy of the
MANTA Vascular Closure Device (VCD), a novel collagen-based technology
dedicated to closure of large-bore arteriotomies. Background Novel
transfemoral therapeutic interventions requiring large-bore catheters have
become valid minimally invasive options but have inherent access
management challenges. To date, no dedicated vascular closure devices
exist for large arteriotomies. Methods A prospective, single-arm clinical
investigation enrolling patients who underwent elective percutaneous
interventions with large-bore catheters and planned percutaneous
arteriotomy closure in 3 European institutions. Results A total of 50
patients with a mean age of 79.5 +/- 8.3 years underwent high-risk
percutaneous coronary intervention, balloon aortic valvuloplasty, or
transcatheter aortic valve replacement with large-bore catheters sized
12-F to 19-F. MANTA closure was performed by 9 different operators. The
14-F MANTA VCD was deployed in one-third of the overall cohort (16 of 50,
32%), and the 18-F MANTA VCD in the remainder. The MANTA VCD was deployed
successfully in all patients. The mean time to hemostasis was 2 min, 23 s.
One patient had a major vascular and major bleeding complication with
prolonged femoral bleeding that was successfully treated with a covered
stent and eventual surgical repair. There were no other access
site-related complications. Conclusions This first multicenter experience
demonstrates rapid and reliable hemostasis and low complication rates with
the use of the plug-based MANTA VCD for large-bore arteriotomy closure.
Copyright &#xa9; 2017 American College of Cardiology Foundation

<58>
Accession Number
614921131
Author
Anonymous
Title
Erratum: Percutaneous coronary angioplasty versus coronary artery bypass
grafting in treatment of unprotected left main stenosis (NOBLE): a
prospective, randomised, open-label, non-inferiority trial (The Lancet
(2016) 388(10061)
(2743-2752)(S0140673616320529)(10.1016/S0140-6736(16)32052-9)).
Source
The Lancet. 389 (10074) (pp 1102), 2017. Date of Publication: 18 Mar 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Makikallio T, Holm NR, Lindsay M, et al. Percutaneous coronary angioplasty
versus coronary artery bypass grafting in treatment of unprotected left
main stenosis (NOBLE): a prospective, randomised, open-label,
non-inferiority trial. Lancet 2016; 388: 2743-52-Due to administrative and
coding errors, the Kaplan-Meier estimates, graph figures, and table 2 data
are incorrect in this Article and have been updated. The affiliation for M
Corbascio and the appendix has also been updated. These corrections have
been made to the online version as of March 16, 2017. Copyright &#xa9;
2017 Elsevier Ltd

<59>
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.

<60>
Accession Number
613353885
Author
Jha A.K.; Malik V.; Gharde P.; Chauhan S.; Kiran U.; Hote M.P.
Institution
(Jha, Malik, Gharde, Chauhan, Kiran, Hote) All India Institute of Medical
Sciences, New Delhi, India
Title
Echocardiographic Predictors of Immediate Postoperative Outcomes in
Patients With Severe Left Ventricular Systolic Dysfunction Undergoing
On-Pump Coronary Artery Bypass Grafting.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (1) (pp 184-190),
2017. Date of Publication: 01 Feb 2017.
Publisher
W.B. Saunders
Abstract
Objectives The postoperative course following on-pump coronary artery
bypass grafting (CABG) in patients with severe left ventricular (LV)
systolic dysfunction is often unpredictable. Therefore, the aim of this
study was to identify predictors of poor postoperative outcome in this
subset of patients. Design Prospective observational study Setting Single
university hospital Participants Forty patients with severe LV systolic
dysfunction undergoing isolated on-pump CABG Interventions None
Measurements and Main Results Comprehensive transesophageal
echocardiographic examination was performed to obtain the indices of
systolic and diastolic LV function after induction of anesthesia. A poor
postoperative outcome was defined as patient death or vasoactive inotropic
score>20 for at least 6 hours and/or requiring intra-aortic balloon
counterpulsation and/or mechanical ventilation for>24 hours. Poor
postoperative outcome was observed in 40% (16/40) of patients. Patients
with poor postoperative outcomes had a significantly higher systolic
dyssynchrony index, septal-lateral delay with a significantly lower global
longitudinal strain and isovolumic acceleration, end-diastolic volume,
end-systolic volume, and lateral and medial mitral annulus systolic
velocity. In a binary logistic regression model, global longitudinal
strain (odds ratio, 1.5, confidence interval [CI] 95%, 1.19-1.88, p =
0.001), septal-lateral delay (odds ratio, 1.02, 95% CI, 1.01-1.03; p =
0.001) and systolic dyssychrony index (odds ratio, 1.3, 95% CI, 1.13-1.48;
p = 0.000) were found to be predictors of poor postoperative outcome.
Conclusion Global longitudinal strain, systolic dyssynchrony index, and
septal-lateral delay were reliable and accurate predictors of adverse
outcomes in patients with severe LV systolic dysfunction undergoing
on-pump CABG. Copyright &#xa9; 2017 Elsevier Inc.

<61>
Accession Number
613194453
Author
Katz M.; Carlos Bacelar Nunes Filho A.; Caixeta A.; Antonio Carvalho L.;
Sarmento-Leite R.; Alves Lemos Neto P.; Eduardo Koenig Sao Thiago L.; Dias
Dourado Oliveira A.; Antonio Marino M.; Tadeu Tumelero R.; Antonio Perin
M.; Abizaid A.; Tarasoutchi F.; Sandoli de Brito F.
Institution
(Katz, Carlos Bacelar Nunes Filho, Caixeta, Antonio Perin, Abizaid,
Tarasoutchi, Sandoli de Brito) Hospital Israelita Albert Einstein, Sao
Paulo, SP, Brazil
(Antonio Carvalho) Hospital Pro-Cardiaco, Rio de Janeiro, RJ, Brazil
(Sarmento-Leite) Instituto de Cardiologia do Rio Grande do
Sul/Universidade Federal de Ciencias da Saude de Porto Alegre, Porto
Alegre, RS, Brazil
(Alves Lemos Neto, Tarasoutchi) Heart Institute (InCor), University of Sao
Paulo Medical School, Sao Paulo, SP, Brazil
(Eduardo Koenig Sao Thiago) Hospital S.O.S Cardio, Florianopolis, SC,
Brazil
(Eduardo Koenig Sao Thiago) Instituto de Cardiologia de Santa Catarina,
Sao Jose, SC, Brazil
(Dias Dourado Oliveira) Hospital Santa Izabel da Santa Casa de
Misericordia da Bahia, Salvador, BA, Brazil
(Antonio Marino) Hospital Madre Teresa, Belo Horizonte, MG, Brazil
(Tadeu Tumelero) Associacao Hospitalar Beneficente Sao Vicente de Paulo,
Passo Fundo, RS, Brazil
(Abizaid) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, SP, Brazil
Title
Gender-related differences on short- and long-term outcomes of patients
undergoing transcatheter aortic valve implantation.
Source
Catheterization and Cardiovascular Interventions. 89 (3) (pp 429-436),
2017. Date of Publication: 15 Feb 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: This study aimed to compare gender-related differences in
outcomes of patients undergoing TAVI over a long-term follow-up period.
Background: Transcatheter aortic valve implantation (TAVI) has been
considered the standard therapy for patients with inoperable or high-risk
symptomatic aortic stenosis. The influence of gender-related differences
in outcomes of patients undergoing TAVI is currently on debate. Methods:
From January 2008 to January 2015, 819 patients (49% men) underwent TAVI
and were included in a multicenter Brazilian registry. Patients were
followed-up and clinical outcomes were evaluated according to the updated
Valve Academic Research Consortium-2 criteria. Results: Mean follow-up was
497 +/- 478 days. Compared with women, men had a lower rate of major or
life-threatening bleeding (12.0% vs. 20.6%; HR = 0.57 [95CI% 0.40-0.81]; P
= 0.001), and major vascular complications (6% vs. 11.7%; HR = 0.50 [95CI%
0.31-0.82]; P = 0.004). At 30 days, all-cause mortality was lower in men
than in women (6.5% vs. 11.5%; P = 0.013), however, cumulative all-cause
mortality was similar between groups (25.9% vs. 29.7%, men and women,
respectively, HR = 0.92 [95CI% 0.71-1.19]; P = 0.52) over the entire
follow-up period. By adjusted Cox regression model, renal function,
diabetes, peripheral artery disease, and chronic obstructive pulmonary
disease (COPD) remained independently predictors of all-cause mortality.
Conclusions: In this large-scale study evaluating patients undergoing
TAVI, 30-day mortality was higher among women than men driven by
significant higher rates of major or life-threatening bleeding and major
vascular complications. However, all-cause mortality on long-term
follow-up was similar between groups. &#xa9; 2016 Wiley Periodicals, Inc.
Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<62>
Accession Number
613239491
Author
Secco G.G.; Rittger H.; Hoffmann S.; Richardt G.; Abdel-Wahab M.; Reinecke
H.; Lotan C.; Werner G.; Sievert H.; Foin N.; Di Mario C.
Institution
(Secco) Department of Clinical and Experimental Medicine, University of
Eastern Piedmont, Novara, Italy
(Rittger) Medizinische Klinik 2, Universitatsklinikum Erlangen, Erlangen,
Germany
(Hoffmann) Vivantes Klinikum Am Urban, Berlin, Germany
(Richardt, Abdel-Wahab) Department of Cardiology, Heart Center, Segeberger
Kliniken GmbH, Bad Segeberg, Germany
(Reinecke) Department of Cardiology and Angiology, University Hospital
Munster, Munster, Germany
(Lotan) Hadassah-Hebrew University Medical Center, Jerusalem, Israel
(Werner) Klinikum Darmstadt, Darmstadt, Germany
(Sievert) Cardiovascular Center Frankfurt, Frankfurt, Germany
(Foin) Department of Bioengineering, Imperial College London, London,
United Kingdom
(Di Mario) Biomedical Research Unit, Royal Brompton & Harefield NHS
Foundation Trust, London, United Kingdom
Title
The Glider registry.
Source
Catheterization and Cardiovascular Interventions. 89 (1) (pp E1-E6), 2017.
Date of Publication: 01 Jan 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Provisional stenting of the side-branch (SB) is the
universally accepted gold standard while there is still controversy on the
usefulness of routine dilatation of the SB ostium. Recrossing the struts
of a previously deployed stent with a wire and a balloon can prove
challenging and is occasionally unsuccessful, mainly because the balloon
tip hits a stent strut. This prospective multicenter international
registry tested the crossing ability procedural results of a new-dedicated
ultrashort balloon specifically designed for side branch dilatation
(Glider, TriReme Medical, Pleasanton, CA, USA). Methods: One hundred and
twenty five patients (for a total of 131 bifurcation lesions) were
enrolled in the registry between January 2009 and May 2012. The Glider was
used as first choice in alternative to conventional balloon (group I, 72%)
or as bail-out after unsuccessful previous attempt at crossing with small
conventional low-profile balloons (group II, 28%). Postprocedural coronary
artery dissections and in-hospital MACE (death, myocardial infarction and
repeat revascularization) were assessed. Technical success was defined as
the ability of the Glider to recross the struts of a previously deployed
stent while procedural success was defined as less of residual 50%
diameter stenosis at the origin of the SB with a final TIMI 3 and/or
freedom from in-hospital MACE. Results: Technical success was achieved,
respectively, in 92% (group I), and 83% (group II). Clinical and
angiographic procedural success was achieved in 98% of the lesions. In
Group II, no other balloon of the same size could cross in cases where
Glider could not. A total of 13 complications were observed, including
nine ostial SB dissection four of which needed a second stent on the SB,
one stent loss, two severe coronary spasms, and two by thrombus formation.
Conclusion: The unique possibility offered by this short dedicated balloon
to orientate its beveled tip provides an effective strategy for recrossing
stent struts when conventional low profile balloons fail achieving greater
SB ostial expansion thus reducing the incidence of strut malapposition
during provisional treatment of bifurcational lesions. &#xa9; 2016 Wiley
Periodicals, Inc. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<63>
Accession Number
613487706
Author
Kavrut Ozturk N.; Kavakli A.S.
Institution
(Kavrut Ozturk, Kavakli) Department of Anesthesiology and Reanimation,
Antalya Education and Research Hospital, Antalya, Turkey
Title
Use of McGrath MAC Videolaryngoscope to Assist Transesophageal
Echocardiography Probe Insertion in Intubated Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (1) (pp 191-196),
2017. Date of Publication: 01 Feb 2017.
Publisher
W.B. Saunders
Abstract
Objectives Transesophageal echocardiography (TEE) probe insertion with the
conventional blind insertion technique may be difficult in anesthetized
and intubated patients. The use of a videolaryngoscope may facilitate the
insertion of the TEE probe. The aim of this study was to compare the
conventional technique with the use of the McGrath MAC videolaryngoscope
for TEE probe insertion in terms of success rate, duration of insertion,
and complications in patients undergoing cardiovascular surgery. Design A
prospective, randomized study. Setting Training and research hospital.
Participants Eighty-six adult patients undergoing cardiovascular surgery
were included. Interventions Eighty-six adult patients were randomized
into 2 groups: conventional group (n = 43) and McGrath videolaryngoscope
group (n = 43). Success rates, duration of insertion, complications, and
hemodynamic changes during insertion were recorded. Measurements and Main
Results The success rate of TEE probe insertion at the first attempt was
higher in the McGrath videolaryngoscope group (90.5%) than in the
conventional group (43.9%) (p = 0.012). The mean duration for successful
insertion of the TEE probe at the first attempt was longer in the McGrath
videolaryngoscope group (24 s v 11 s) (p = 0.016). The total time for
successful insertion of the TEE probe was similar in both groups.
Pharyngeal injuries were observed more frequently in the conventional
group (17.1% v 2.4%) (p = 0.037). The rate of blood presence on the probe
tip in the conventional group was higher than in the McGrath group (21.9%
v 4.8%). There were no statistical differences between the 2 groups in
systolic blood pressure, mean arterial pressure, diastolic blood pressure,
and heart rate before and after TEE insertion. Conclusions The use of the
McGrath MAC videolaryngoscope for TEE insertion in cardiovascular surgery
patients increases the success rate and reduces pharyngeal injuries
compared to the conventional technique. The use of the McGrath MAC
videolaryngoscope for TEE insertion causes similar hemodynamic changes as
in the conventional blind insertion technique. Copyright &#xa9; 2017
Elsevier Inc.

<64>
Accession Number
612901782
Author
Narula J.; Kiran U.; Malhotra Kapoor P.; Choudhury M.; Rajashekar P.;
Kumar Chowdhary U.
Institution
(Narula, Kiran, Malhotra Kapoor, Choudhury) Departments of Cardiac
Anesthesiology and, Cardio and Neurosciences Centre, All India Institute
of Medical Sciences, New Delhi, India
(Rajashekar, Kumar Chowdhary) Cardio-Thoracic and Vascular Surgery, Cardio
and Neurosciences Centre, All India Institute of Medical Sciences, New
Delhi, India
Title
Assessment of Changes in Hemodynamics and Intrathoracic Fluid Using
Electrical Cardiometry During Autologous Blood Harvest.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (1) (pp 84-89),
2017. Date of Publication: 01 Feb 2017.
Publisher
W.B. Saunders
Abstract
Objective To evaluate the effect of autologous blood harvest (ABH)-induced
volume shifts using electrical cardiometry (EC) in patients with pulmonary
artery hypertension secondary to left heart disease. Design Prospective,
randomized, controlled trial. Setting A tertiary care hospital.
Participants The study comprised 50 patients scheduled to undergo heart
valve replacement. Interventions Patients were divided randomly into 2
experimental groups that were distinguished by whether ABH was performed.
Blood volume extracted in the test group was replaced simultaneously with
1:1 colloid (Tetraspan; B Braun Melsungen, Melsungen, Germany).
Hemodynamic, respiratory, and EC-derived parameters were recorded at
predefined set points (T1 [post-induction/pre-ABH] and T2 [20 minutes
post-ABH]). Measurements and Main Results Withdrawal of 15% of blood
volume in the ABH group caused significant reductions in thoracic fluid
content (TFC) (-10.1% [-15.0% to -6.1%]); right atrial pressure (-23%
[-26.6% to -17.6%]); mean arterial pressure (-12.6% [-22.2% to -3.8%]);
airway pressures: (peak -6.2% [-11.7% to -2.8%] and mean -15.4% [-25.0% to
-8.3%]); and oxygenation index (-10.34% [-16.4% to -4.8%]). Linear
regression analysis showed good correlation between the percentage change
in TFC after ABH and the percentage of change in right atrial pressure,
stroke volume variation, autologous blood extracted, peak and mean airway
pressures, and oxygen index. Conclusions In addition to its proven role in
blood conservation, therapeutic benefits derived from ABH include
decongestion of volume-loaded patients, decrease in TFC, and improved gas
exchange. EC tracks beat-to-beat fluid and hemodynamic fluctuations during
ABH and helps in the execution of an early patient-specific, goal-directed
therapy, allowing for its safe implementation in patients with pulmonary
hypertension secondary to left heart disease. Copyright &#xa9; 2017
Elsevier Inc.

<65>
Accession Number
614701189
Author
Davar J.; Connolly H.M.; Caplin M.E.; Pavel M.; Zacks J.; Bhattacharyya
S.; Cuthbertson D.J.; Dobson R.; Grozinsky-Glasberg S.; Steeds R.P.;
Dreyfus G.; Pellikka P.A.; Toumpanakis C.
Institution
(Davar) Carcinoid Heart Disease Clinic, Department of Cardiology, Royal
Free Hospital, London, United Kingdom
(Connolly, Pellikka) Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minnesota, United States
(Caplin, Toumpanakis) Neuroendocrine Tumor Unit, ENETS Centre of
Excellence, Royal Free Hospital, London, United Kingdom
(Pavel) Internal Medicine with Gastroenterology and Nephrology,
Charite-Universitatsmedizin Berlin, Berlin, Germany
(Zacks) Center for Carcinoid and Neuroendocrine Tumors of the Icahn School
of Medicine at Mount Sinai, New York, New York, United States
(Bhattacharyya) Barts Heart Centre, St. Bartholomew's Hospital, London,
UCL Institute of Cardiovascular Science, University College London,
London, United Kingdom
(Cuthbertson) Obesity and Endocrinology Research Group, Institute of
Ageing and Chronic Diseases, University of Liverpool, Liverpool, United
Kingdom
(Dobson) Department of Cardiology, Liverpool Heart and Chest Hospital,
Liverpool, United Kingdom
(Grozinsky-Glasberg) Neuroendocrine Tumor Unit, Endocrinology and
Metabolism Service, Department of Medicine, Hadassah-Hebrew University
Medical Center, Jerusalem, Israel
(Steeds) University Hospital Birmingham, NHS Foundation Trust and
Institute of Cardiovascular Sciences, University of Birmingham,
Birmingham, United Kingdom
(Dreyfus) Cardiothoracic Center of Monaco, Monaco, France
Title
Diagnosing and Managing Carcinoid Heart Disease in Patients With
Neuroendocrine Tumors: An Expert Statement.
Source
Journal of the American College of Cardiology. 69 (10) (pp 1288-1304),
2017. Date of Publication: 14 Mar 2017.
Publisher
Elsevier USA
Abstract
Carcinoid heart disease is a frequent occurrence in patients with
carcinoid syndrome and is responsible for substantial morbidity and
mortality. The pathophysiology of carcinoid heart disease is poorly
understood; however, chronic exposure to excessive circulating serotonin
is considered one of the most important contributing factors. Despite
recognition, international consensus guidelines specifically addressing
the diagnosis and management of carcinoid heart disease are lacking.
Furthermore, there is considerable variation in multiple aspects of
screening and management of the disease. The aim of these guidelines was
to provide succinct, practical advice on the diagnosis and management of
carcinoid heart disease as well as its surveillance. Recommendations and
proposed algorithms for the investigation, screening, and management have
been developed based on an evidence-based review of the published data and
on the expert opinion of a multidisciplinary consensus panel consisting of
neuroendocrine tumor experts, including oncologists, gastroenterologists,
and endocrinologists, in conjunction with cardiologists and cardiothoracic
surgeons. Copyright &#xa9; 2017 American College of Cardiology Foundation

<66>
Accession Number
614701176
Author
Miller J.M.; Kalra V.; Das M.K.; Jain R.; Garlie J.B.; Brewster J.A.;
Dandamudi G.
Institution
(Miller, Kalra, Das, Jain, Garlie, Brewster, Dandamudi) Krannert Institute
of Cardiology, Department of Medicine, Indiana University School of
Medicine, Indianapolis, Indiana, United States
Title
Clinical Benefit of Ablating Localized Sources for Human Atrial
Fibrillation: The Indiana University FIRM Registry.
Source
Journal of the American College of Cardiology. 69 (10) (pp 1247-1256),
2017. Date of Publication: 14 Mar 2017.
Publisher
Elsevier USA
Abstract
Background Mounting evidence shows that localized sources maintain atrial
fibrillation (AF). However, it is unclear in unselected "real-world"
patients if sources drive persistent atrial fibrillation (PeAF),
long-standing persistent atrial fibrillation (LPeAF), or paroxysmal atrial
fibrillation (PAF); if right atrial sites are important; and what the
long-term success of source ablation is. Objectives The aim of this study
was to analyze the role of rotors and focal sources in a large academic
registry of consecutive patients undergoing source mapping for AF. Methods
One hundred seventy consecutive patients (mean age 59 +/- 12 years, 79%
men) with PAF (37%), PeAF (31%), or LPeAF (32%). Of these, 73 (43%) had
undergone at least 1 prior ablation attempt (mean 1.9 +/- 0.8; range: 1 to
4). Focal impulse and rotor modulation (FIRM) with an endocardial basket
catheter was used in all cases. Results FIRM analysis revealed sources in
the right atrium in 85% of patients (1.8 +/- 1.3) and in the left atrium
in 90% of patients (2.0 +/- 1.3). FIRM ablation terminated AF to sinus
rhythm or atrial flutter or tachycardia in 59% (PAF), 37% (PeAF), and 19%
(LPeAF) of patients, with 15 of 67 terminations due to right atrial
ablation. On follow-up, freedom from AF after a single FIRM procedure for
the entire series was 95% (PAF), 83% (PeAF), and 82% (LPeAF) at 1 year and
freedom from all atrial arrhythmias was 77% (PAF), 75% (PeAF), and 57%
(LPeAF). Conclusions In the Indiana University FIRM registry, FIRM-guided
ablation produced high single-procedure success, mostly in patients with
nonparoxysmal AF. Data from mapping, acute terminations, and outcomes
strongly support the mechanistic role of biatrial rotors and focal sources
in maintaining AF in diverse populations. Randomized trials of FIRM-guided
ablation and mechanistic studies to determine how rotors form, progress,
and regress are needed. Copyright &#xa9; 2017 American College of
Cardiology Foundation

<67>
Accession Number
612895793
Author
Geerdink L.M.; du Marchie Sarvaas G.J.; Kuipers I.M.; Helbing W.A.;
Delhaas T.; ter Heide H.; Rozendaal L.; de Korte C.L.; Singh S.K.; Ebels
T.; Hazekamp M.G.; Haas F.; Bogers A.J.J.C.; Kapusta L.
Institution
(Geerdink, Kapusta) Department of Pediatric Cardiology, Radboud University
Medical Center, Nijmegen, Netherlands
(Geerdink) Department of Pediatric Cardiology and Intensive Care Medicine,
Hannover Medical School, Hannover, Germany
(du Marchie Sarvaas) Center for Congenital Heart Diseases, University
Medical Center Groningen, Groningen, Netherlands
(Kuipers) Department of Pediatric Cardiology, Academic Medical Center,
Amsterdam, Netherlands
(Helbing) Department of Pediatric Cardiology, Erasmus Medical Center,
Rotterdam, Netherlands
(Delhaas) Department of Pediatric Cardiology, Maastricht University
Medical Center, Maastricht, Netherlands
(ter Heide) Department of Pediatric Cardiology, University Medical Center
Utrecht, Utrecht, Netherlands
(Rozendaal) Department of Pediatric Cardiology, Leiden University Medical
Center, Leiden, Netherlands
(de Korte) Department of Radiology, Medical Ultrasound Imaging Center,
Radboud University Medical Center, Nijmegen, Netherlands
(Singh) Department of Cardiothoracic Surgery, Isala Clinics, Zwolle,
Netherlands
(Ebels) Department of Cardiothoracic Surgery, University Medical Center
Groningen, Groningen, Netherlands
(Hazekamp) Department of Cardiothoracic Surgery, Leiden University Medical
Center, Leiden, Netherlands
(Haas) Department of Cardiothoracic Surgery, University Medical Center
Utrecht, Utrecht, Netherlands
(Bogers) Department of Cardiothoracic Surgery, Erasmus Medical Center,
Rotterdam, Netherlands
(Kapusta) Department of Pediatric Cardiology, Tel Aviv Sourasky Medical
Center, Tel Aviv, Israel
Title
Surgical outcome in pediatric patients with Ebstein's anomaly: A
multicenter, long-term study.
Source
Congenital Heart Disease. 12 (1) (pp 32-39), 2017. Date of Publication: 01
Jan 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Objective: Surgical outcomes of pediatric patients with Ebstein's anomaly
are often described as part of all-age-inclusive series. Our objective is
to focus on patients treated surgically in childhood (0-18 y). We study
the intended treatment (biventricular or 1.5 ventricle repair or
univentricular palliation), freedom from unplanned reoperation and
survival of this specific age group, in a nationwide study. Design:
Records of all Ebstein's anomaly patients born between 1980 and 2013 were
reviewed. Demographic variables, intraoperative procedures and
postoperative outcomes were analyzed. Results: Sixty-three patients
underwent 109 operations. Median follow-up after diagnosis was 121 months
(range 0-216 months). Twenty-nine (46%) patients required surgery in the
first year of life, including 21 who required neonatal surgery. The
intended treatment was biventricular (n = 37, 59%) and 1.5 ventricle (n =
5, 8%) repair or univentricular (n = 21, 33%) palliation. The one-, five-,
and 10-year freedom from unplanned reoperation was 89%, 79%, and 75%
respectively. There were nine (14%) in hospital deaths (within 30 d after
surgery). Causes of death were low cardiac output syndrome, cardiac
failure, hypoxemia, pulmonary hypertension or an unknown cause. There were
no late deaths. Conclusions: Surgery in childhood represents the worse
spectrum of disease, biventricular repair is often not applied. Patients
often face revision surgery. Mortality is limited to the immediate
postsurgical period. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<68>
Accession Number
614200909
Author
O'Byrne M.L.; Gillespie M.J.; Kennedy K.F.; Dori Y.; Rome J.J.; Glatz A.C.
Institution
(O'Byrne) Division of Cardiology, Children's National Medical Center,
George Washington University School of Medicine and Health Sciences,
United States
(O'Byrne) Department of Pediatrics, George Washington University School of
Medicine and Health Sciences, United States
(Gillespie, Dori, Rome, Glatz) Division of Cardiology, The Children's
Hospital of Philadelphia, United States
(Gillespie, Dori, Rome, Glatz) Department of Pediatrics, Perelman School
of Medicine, The University of Pennsylvania, Philadelphia, United States
(Kennedy) Mid America Heart Institute St. Luke's Health System, United
States
(Glatz) Center for Clinical Epidemiology and Biostatistics, Perelman
School of Medicine at the University of Pennsylvania, United States
Title
The influence of deficient retro-aortic rim on technical success and early
adverse events following device closure of secundum atrial septal defects:
An Analysis of the IMPACT Registry.
Source
Catheterization and Cardiovascular Interventions. 89 (1) (pp 102-111),
2017. Date of Publication: 01 Jan 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Concern regarding aortic erosion has focused attention on the
retro-aortic rim in patients undergoing device closure of atrial septal
defects (ASD), but its effect on early outcomes is not well studied.
Methods: A multicenter retrospective cohort study of patients undergoing
device occlusion of ASD between 1/2011-10/2014 was performed, using data
from the IMproving Pediatric and Adult Congenital Treatment Registry.
Subjects were divided between those with retro-aortic rim <5 and >5 mm.
Primary outcomes were technical failure and major early adverse events.
Case times were measured as surrogates of technical complexity. The effect
of deficient retro-aortic rim on primary outcomes was assessed using
hierarchical logistic regression, adjusting for other suspected covariates
and assessing whether they represent independent risk factors. Results:
1,564 subjects (from 77 centers) were included, with deficient
retro-aortic rim present in 40%. Technical failure occurred in 91 subjects
(5.8%) and a major early adverse event in 64 subjects (4.1%). Adjusting
for known covariates, the presence of a deficient retro-aortic rim was not
significantly associated with technical failure (OR: 1.3, 95% CI: 0.9-2.1)
or major early adverse event (OR: 0.7, 95% CI: 0.4-1. 2). Total case (P =
0.01) and fluoroscopy time (P = 0.02) were greater in subjects with
deficient rim, but sheath time was not significantly different (P = 0.07).
Additional covariates independently associated with these outcomes were
identified. Conclusion: Deficient retro-aortic rim was highly prevalent
but not associated with increased risk of technical failure or early
adverse events. Studies with longer follow-up are necessary to assess
other outcomes, including device erosion. &#xa9; 2016 Wiley Periodicals,
Inc. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<69>
Accession Number
613108601
Author
Colleran R.; Kufner S.; Harada Y.; Giacoppo D.; Cassese S.; Repp J.; Wiebe
J.; Lohaus R.; Lahmann A.; Schneider S.; Ibrahim T.; Laugwitz K.-L.;
Kastrati A.; Byrne R.A.
Institution
(Colleran, Kufner, Harada, Giacoppo, Cassese, Repp, Wiebe, Lohaus,
Lahmann, Kastrati, Byrne) Deutsches Herzzentrum Munchen, Technische
Universitat Munchen, Munich, Germany
(Schneider, Ibrahim, Laugwitz) I. Medizinische Klinik, Klinikum Rechts der
Isar, Technische Universitat Munchen, Munich, Germany
(Laugwitz, Kastrati) DZHK (German Centre for Cardiovascular Research),
Partner Site Munich Heart Alliance, Munich, Germany
Title
Five-year follow-up of polymer-free sirolimus- and probucol-eluting stents
versus new generation zotarolimus-eluting stents in patients presenting
with st-elevation myocardial infarction.
Source
Catheterization and Cardiovascular Interventions. 89 (3) (pp 367-374),
2017. Date of Publication: 15 Feb 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Patients with ST-segment elevation myocardial infarction
(STEMI) undergoing drug-eluting stent (DES) implantation are at increased
risk of late adverse events, partly explained by an exaggerated
inflammatory reaction to durable-polymer stent coatings. Objectives: We
sought to investigate whether implantation of polymer-free DES would
reduce this risk. Methods: In the ISAR-TEST 5 (the Intracoronary Stenting
and Angiographic Results: Test Efficacy of Sirolimus- and Probucol- and
Zotarolimus-Eluting Stents) trial, patients were randomly allocated to
receive a polymer-free sirolimus- and probucol-eluting stent or a new
generation durable-polymer zotarolimus-eluting stent. We analyzed late
clinical outcomes in the subgroup of patients presenting with STEMI. The
primary endpoint was the combined incidence of cardiac death, target
vessel-related myocardial infarction or target lesion revascularization at
5 years. Results: 311 patients with STEMI were randomized to receive
sirolimus- and probucol-eluting stents (n = 215) or zotarolimus-eluting
stents (n = 96). At 5 years, there was no difference in the incidence of
the primary endpoint in patients treated with sirolimus- and
probucol-eluting stents versus zotarolimus-eluting stents (18.3% versus
20.1% respectively, hazard ratio = 0.87, 95% CI, 0.50-1.51; P = 0.62).
Rates of the individual components of the primary endpoint were also
comparable in both groups. The incidence of definite/probable stent
thrombosis was 1.4% versus 1.0% respectively (hazard ratio = 1.35, 95% CI,
0.14-12.94, P = 0.80). Conclusions: Long-term outcomes of patients with
STEMI treated with polymer-free sirolimus- and probucol-eluting stents
versus durable-polymer zotarolimus-eluting stents were similar. Stent
thrombosis rates were low and comparable in both treatment groups, with no
events beyond 12 months. Clinical Trial Registration: Registered at
ClinicalTrials.gov (Identifier NCT 00598533) &#xa9; 2016 Wiley
Periodicals, Inc. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<70>
Accession Number
613437623
Author
Martinez-Parachini J.R.; Karatasakis A.; Karmpaliotis D.; Alaswad K.;
Jaffer F.A.; Yeh R.W.; Patel M.; Bahadorani J.; Doing A.; Nguyen-Trong
P.-K.; Danek B.A.; Karacsonyi J.; Alame A.; Rangan B.V.; Thompson C.A.;
Banerjee S.; Brilakis E.S.
Institution
(Martinez-Parachini, Karatasakis, Nguyen-Trong, Danek, Karacsonyi, Alame,
Rangan, Banerjee, Brilakis) VA North Texas Healthcare System and UT
Southwestern Medical Center, Dallas, TX, United States
(Karmpaliotis) Columbia University, New York, NY, United States
(Alaswad) Henry Ford Hospital, Detroit, MI, United States
(Jaffer) Massachusetts General Hospital and Harvard Medical School,
Boston, MA, United States
(Yeh) Beth Israel Deaconess Medical Center and Harvard Medical School,
Boston, MA, United States
(Patel, Bahadorani) VA San Diego Healthcare System and University of
California San Diego, San Diego, CA, United States
(Doing) Medical Center of the Rockies, Loveland, CO, United States
(Thompson) Boston Scientific, Natick, MA, United States
(Brilakis) Minneapolis Heart Institute, Minneapolis, MN, United States
Title
Impact of diabetes mellitus on acute outcomes of percutaneous coronary
intervention in chronic total occlusions: insights from a US multicentre
registry.
Source
Diabetic Medicine. 34 (4) (pp 558-562), 2017. Date of Publication: 01 Apr
2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Aim: To examine the impact of diabetes mellitus on procedural outcomes of
patients who underwent percutaneous coronary intervention for chronic
total occlusion. Methods: We assessed the impact of diabetes mellitus on
the outcomes of percutaneous coronary intervention for chronic total
occlusion among 1308 people who underwent such procedures at 11 US centres
between 2012 and 2015. Results: The participants' mean +/- sd age was 66
+/- 10 years, 84% of the participants were men and 44.6% had diabetes. As
compared with participants without diabetes, participants with diabetes
were more likely to have undergone coronary artery bypass graft surgery
(38 vs 31%; P = 0.006), and to have had previous heart failure (35 vs 22%;
P = 0.0001) and peripheral arterial disease (19 vs 13%; P = 0.002). They
also had a higher BMI (31 +/- 6 kg/m² vs 29 +/- 6
kg/m²; P = 0.001), similar Japanese chronic total occlusion
scores (2.6 +/- 1.2 vs 2.5 +/- 1.2; P = 0.82) and similar final successful
crossing technique: antegrade wire escalation (46 vs 47%; P = 0.66),
retrograde (30 vs 28%; P = 0.66) and antegrade dissection re-entry (24 vs
25%; P = 0.66). Technical (91 vs 90%; P = 0.80) and procedural (89 vs 89%;
P = 0.93) success was similar in the two groups, as was the incidence of
major adverse cardiac events (2.2 vs 2.5%; P = 0.61). Conclusions: In a
contemporary cohort of people undergoing percutaneous coronary
intervention for chronic total occlusion, nearly one in two (45%) had
diabetes mellitus. Procedural success and complication rates were similar
in people with and without diabetes. Copyright &#xa9; 2016 Diabetes UK

<71>
Accession Number
612771058
Author
MacKay E.J.; Patel P.A.; Gutsche J.T.; Weiss S.J.; Augoustides J.G.
Institution
(MacKay, Patel, Gutsche, Weiss, Augoustides) Cardiovascular and Thoracic
Section, Anesthesiology and Critical Care, Perelman School of Medicine,
University of Pennsylvania, Philadelphia, PA, United States
Title
Contemporary Clinical Niche for Intra-Aortic Balloon Counterpulsation in
Perioperative Cardiovascular Practice: An Evidence-Based Review for the
Cardiovascular Anesthesiologist.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (1) (pp 309-320),
2017. Date of Publication: 01 Feb 2017.
Publisher
W.B. Saunders

<72>
Accession Number
613145958
Author
Asgar A.; Chandrasekhar J.; Mikhail G.; Webb J.; Lefevre T.; Tamburino C.;
Hildick-Smith D.; Hambrecht R.; Van Belle E.; Widder J.; Dumonteil N.;
Hink U.; Jeger R.; Linke A.; Deliargyris E.; Gao P.; Mehran R.;
Hengstenberg C.; Anthopoulos P.; Dangas G.
Institution
(Asgar) Division of Cardiology, Montreal Heart Institute, Montreal, Canada
(Chandrasekhar, Mehran, Dangas) Icahn School of Medicine at Mount Sinai,
The Zena and Michael a. Wiener Cardiovascular Institute, New York, NY,
United States
(Mikhail) Imperial College Healthcare NHS Trust, Hammersmith Hospital,
London, United Kingdom
(Webb) Division of Cardiology, St. Paul's Hospital, Vancouver, BC, Canada
(Lefevre) Ramsay Generale De Sante, Institut Hospitalier Jacques Cartier,
Massy, France
(Tamburino) Department of Cardiology, University of Catania, Catania,
Italy
(Hildick-Smith) Sussex Cardiac Centre-Brighton & Sussex University
Hospitals NHS Trust, Brighton, East Sussex, United Kingdom
(Hambrecht) Department of Cardiology and Angiology, Klinikum Links Der
Weser, Bremen, Germany
(Van Belle) Centre Hospitalier Universitaire De Lille, Lille, France
(Widder) Department of Cardiology and Angiology, Hannover Medical School,
Hannover, Germany
(Dumonteil) Department of Cardiology, Rangueil University Hospital,
Toulouse, France
(Hink) Cardiology Department, Johannes Gutenberg University Hospital,
Mainz, Germany
(Jeger) Department of Cardiology, University Hospital Basel, Basel,
Switzerland
(Linke) Department of Internal Medicine/Cardiology, University of Leipzig,
Heart Centre, Germany
(Deliargyris, Gao) The Medicines Company, Parsippany, NJ, United States
(Hengstenberg) DZHK (German Centre for Cardiovascular Research), Partner
Site Munich Heart Alliance, Munich, Germany, and Deutsches Herzzentrum
Munchen, Technische Universitat Munchen, Munich, Germany
(Anthopoulos) The Medicines Company, Zurich, Switzerland
Title
Sex-based differences in outcomes with bivalirudin or unfractionated
heparin for transcatheter aortic valve replacement: Results from the
BRAVO-3 randomized trial.
Source
Catheterization and Cardiovascular Interventions. 89 (1) (pp 144-153),
2017. Date of Publication: 01 Jan 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Women comprise almost 50% of patients undergoing transcatheter
aortic valve replacement (TAVR) and previous studies have indicated higher
rates of procedural complications and bleeding in women compared to men.
It is unknown whether men and women demonstrate a differential response to
bivalirudin versus unfractionated heparin (UFH) in TAVR. We sought to
evaluate outcomes by sex and type of anticoagulant from the Bivalirudin
Versus Heparin Anticoagulation in Transcatheter Aortic Valve Replacement
(BRAVO-3) trial of transfemoral TAVR. Methods: BRAVO-3 was a randomized
multicenter trial comparing transfemoral TAVR with bivalirudin versus UFH
(31 centers, n = 802). The primary endpoint was 48 h major bleeding
defined as Bleeding Academic Research Consortium (BARC) type >3b. Major
adverse cardiovascular events (MACE) were a composite of 30-day death,
myocardial infarction, or stroke. Net adverse cardiovascular events (NACE)
were a composite of BARC >3b bleeding or 30-day MACE. We examined the
outcomes in men and women. Results: The total cohort included 49% women (n
= 391, 195 received bivalirudin and 196 UFH) and 51% men (n = 411, 209
received bivalirudin and 202 UFH). Women were older than men with fewer
comorbidities including coronary artery disease, atrial fibrillation,
diabetes but similar EuroSCORE I. Women received smaller sheath and device
sizes compared with men without differences in the use of vascular closure
devices. At 48-hr post-TAVR there was no difference in bleeding or
vascular complications in women compared to men. The use of bivalirudin
did not result in significantly lower bleeding at 48 hr or 30-days
compared to UFH. Conclusions: There was no difference in early outcomes
with bivalirudin versus UFH in men or women undergoing contemporary TAVR.
&#xa9; 2016 Wiley Periodicals, Inc. Copyright &#xa9; 2016 Wiley
Periodicals, Inc.

<73>
Accession Number
613145841
Author
Meneguz-Moreno R.A.; Ramos A.I.O.; Siqueira D.; de Castro-Filho A.; Jatene
T.; Dias Jeronimo A.; Le Bihan D.; Moreira A.; Arrais M.; Abizaid A.;
Sousa A.; Eduardo Sousa J.
Institution
(Meneguz-Moreno, Ramos, Siqueira, de Castro-Filho, Jatene, Dias Jeronimo,
Le Bihan, Arrais, Abizaid, Sousa, Eduardo Sousa) Instituto Dante Pazzanese
de Cardiologia, Sao Paulo, Brazil
(Siqueira, Moreira, Arrais, Abizaid, Sousa, Eduardo Sousa) Hospital do
Coracao, Sao Paulo, Brazil
Title
Prognostic value of renal function in patients with aortic stenosis
treated with transcatheter aortic valve replacement.
Source
Catheterization and Cardiovascular Interventions. 89 (3) (pp 452-459),
2017. Date of Publication: 15 Feb 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: The objectives of the present study were to analyze the
variation of renal function after transcatheter aortic valve replacement
(TAVR) focused on acute kidney injury (AKI) and its impact on short- and
mid-term mortality. Background: Changes on renal function after TAVR and
their impact on clinical outcomes are incompletely understood until now.
Methods: At two tertiary centers 221 consecutive patients were submitted
to TAVR. Kidney injury was defined according to VARC-2 criteria. Patients
were classified according to the presence (group 1) or absence (group 2)
of AKI. Creatinine values were collected daily until seventh day after
procedure, 1 month, 6 months, and then 1 year after TAVR. Results: At
baseline, groups were similar, except for EuroSCORE II (8.66% vs. 7.34%, P
= 0.02) and glomerular filtration rate (GFR) (39.59 vs. 48.49 mL/min.1.73
m², P = 0.002). Overall 30 day-mortality and 1-year mortality
were 6.3% and 14.0%, respectively. Both 30-day mortality (23.1% vs. 1.2%,
P < 0.001) and 1-year mortality (44.2% vs. 4.7%, P < 0.001) were higher in
group 1. After multivariable-adjusted models, the only independent
predictor for AKI after TAVR was baseline GFR (HR: 1.37, 95% CI:
1.08-1.77, P = 0.01). The independent risk factors for 1-year mortality
were AKI (HR: 15.66, 95% CI: 6.07-44.63, P < 0.001), COPD (HR: 3.14, 95%
CI: 1.05-9.40, P = 0.04) and aortic regurgitation grade postprocedure > 2
(P = 0.05) also after multivariate analysis. Conclusions: In this TAVR
cohort, baseline GFR was the only independent predictor of AKI, which
negatively impacted on 30-day and 1-year mortality. &#xa9; 2016 Wiley
Periodicals, Inc. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<74>
Accession Number
613137113
Author
Shah A.H.; Horlick E.M.; Eicken A.; Asnes J.D.; Bocks M.L.; Boudjemline
Y.; Cabalka A.K.; Fagan T.E.; Schubert S.; Mahadevan V.S.; Dvir D.; Osten
M.; McElhinney D.B.
Institution
(Shah, Horlick, Osten) Toronto General Hospital, Toronto, Canada
(Eicken) German Heart Centre, Munich, Germany
(Asnes) Yale University, New Haven, CT, United States
(Bocks) University of Michigan, Ann Arbor, MI, United States
(Boudjemline) Necker Enfants Malades Hospital, Paris, France
(Cabalka) Mayo Clinic, Rochester, MN, United States
(Fagan) University of Tennessee Health Science Center and Le Bonheur
Children's Hospital, Memphis, TN, United States
(Schubert) Deutsches Herzzentrum, Berlin, Germany
(Mahadevan) University of California, San Francisco, CA, United States
(Dvir) St. Paul's Hospital, Vancouver, Canada
(McElhinney) Stanford University, Palo Alto, CA, United States
Title
Transcatheter valve implantation for right atrium-to-right ventricle
conduit obstruction or regurgitation after modified Bjork-fontan
procedure.
Source
Catheterization and Cardiovascular Interventions. 89 (2) (pp 298-305),
2017. Date of Publication: 01 Feb 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: The most common reason for reintervention after a Bjork
modification of the Fontan procedure, in which the right ventricle (RV) is
incorporated into the pulmonary circulation by connecting the right atrial
(RA) appendage to the RV directly or with an extra-anatomic graft, is
obstruction or regurgitation of the RA-RV connection. Transcatheter
implantation of a valved stent is an appealing option for the treatment of
RA-RV conduit dysfunction in these patients. In the present study, we
assessed early and intermediate results after transcatheter valve
implantation within an obstructed or regurgitant RA-RV modified Fontan
pathway. Methods: Through a retrospective multicenter registry, we
collected data from 16 patients with a modified Fontan circulation who
were treated with percutaneous Melody or Sapien valve implantation for
dysfunction of an extra-anatomic RA-RV conduit or valve. Results: All
patients had successful and uncomplicated implantation of a Melody (n =
15) or Sapien 3 (n = 1) valve with hemodynamic and, in most cases,
clinical improvement. During a median follow-up of 3.3 years, 3 patients
died of cardiovascular causes unrelated to the procedure or the valve, and
no major valve dysfunction was observed. Conclusion: Percutaneous
transcatheter valve deployment to treat a dysfunctional RA-RV connection
after a Bjork modification of the Fontan procedure is a viable alternative
to surgery, with low procedural risk, and appears to offer good early and
intermediate results.&#xa9; 2016 Wiley Periodicals, Inc. Copyright &#xa9;
2016 Wiley Periodicals, Inc.

<75>
Accession Number
613084377
Author
Rossini R.; Angiolillo D.J.; Musumeci G.; Capodanno D.; Lettino M.;
Trabattoni D.; Pilleri A.; Calabria P.; Colombo P.; Bernabo P.; Ferlini
M.; Ferri M.; Tarantini G.; De Servi S.; Savonitto S.
Institution
(Rossini, Musumeci) Dipartimento Cardiovascolare, ASST Papa Giovanni
XXIII, Bergamo, Italy
(Angiolillo) College of Medicine-Jacksonville, University of Florida,
Jacksonville, FL, United States
(Capodanno) Dipartimento Di Cardiologia, Ospedale Ferrarotto, Universita
Di Catania, Italy
(Lettino) U.O.C. Cardiologia Clinica I, Istituto Clinico Humanitas,
Rozzano, (MI), Italy
(Trabattoni) Dipartimento Di Scienze Cardiovascolari, Centro Cardiologico
Monzino, IRCCS, Universita Degli Studi Di Milano, Milano, Italy
(Pilleri) SSD Centro di valutazione e consulenza cardiologica, Azienda
Ospedaliera Brotzu, Presidio San Michele, Cagliari, Italy
(Calabria) UO Emodinamica, Ospedale Misericordia, Grosseto, USL Toscana
Sudest, Italy
(Colombo) Dipartimento Cardiovascolare, ASST Niguarda Grande Ospedale
Metropolitano, Milano, Italy
(Bernabo) Divisione di Cardiologia, Ente Ospedaliero Ospedali Galliera,
Genova, Italy
(Ferlini, De Servi) SC Cardiologia, Fondazione IRCCS Policlinico San
Matteo, Pavia, Italy
(Ferri) S.C. Di Cardiologia, Arcispedale S. Maria Nuova, IRCCS, Reggio
Emilia, Italy
(Tarantini) Dipartimento Di Scienze Cardiache, Toraciche E Vascolari,
Universita Di Padova, Italy
(Savonitto) Dipartimento Cardiovascolare, Ospedale A. Manzoni, Lecco,
Italy
(Angiolillo) Division of Cardiology, University of Florida College of
Medicine-Jacksonville, Jacksonville, FL, United States
(Lettino) Dipartimento Cardiovascolare, Humanitas Research Hospital,
Rozzano, Milano, Italy
Title
Antiplatelet therapy and outcome in patients undergoing surgery following
coronary stenting: Results of the surgery after stenting registry.
Source
Catheterization and Cardiovascular Interventions. 89 (1) (pp E13-E25),
2017. Date of Publication: 01 Jan 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: The aim of the present study was to define the feasibility and
clinical impact of complying with national consensus recommendations on
perioperative management of antiplatelet therapy in patients with coronary
stents undergoing cardiac and noncardiac surgery. Background: There are
limited evidence-based recommendations on the perioperative management of
antiplatelet therapy in stented patients undergoing surgery. Methods: The
recommendations provided by the national consensus document were applied
in a multicenter, prospective registry of consecutive patients with prior
coronary stenting undergoing any type of surgery at 19 hospitals in Italy.
The primary end-point was in-hospital net adverse clinical events (NACE)
represented by the composite of all-cause death, myocardial infarction,
probable/definite stent thrombosis and Bleeding Academic Research
Consortium (BARC) grade >3 bleeding. Patients were followed for 30 days.
Results: A total of 1,082 patients were enrolled. Adherence to consensus
recommendations occurred in 85% of the cases. Perioperative aspirin and
dual antiplatelet therapy were maintained in 69.7 and 10.5% of the cases,
respectively. In-hospital NACE rate was 12.7%, being significantly higher
in patients undergoing cardiac surgery (36.3% vs. 7.3%, P < 0.01), mainly
due to BARC 3 bleeding events (32.3%). At 30 days, MACE rates were similar
(3.5% vs. 3.5%, P = NS) in patients undergoing cardiac and noncardiac
surgery, whereas BARC >3 bleeding events were significantly higher with
cardiac surgery (36.3% vs. 5.6%, P < 0.01). Conclusions: The results of
this registry demonstrate the safety and feasibility of applying a
national consensus document on the perioperative management of
antiplatelet therapy in stented patients undergoing surgery. &#xa9; 2016
Wiley Periodicals, Inc. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<76>
Accession Number
608880453
Author
Haiek C.; Fernandez-Pereira C.; Santaera O.; Mieres J.; Rifourcat I.;
Lloberas J.; Larribau M.; Pocovi A.; Rodriguez-Granillo A.M.; Sarmiento
R.A.; Antoniucci D.; Rodriguez A.E.
Institution
(Haiek) Interventional Cardiology Department, Sanatorio De La Trinidad,
Quilmes, Buenos Aires Province, Argentina
(Fernandez-Pereira) Interventional Cardiology Department, Clinica IMA,
Adrogue, Buenos Aires Province, Argentina
(Fernandez-Pereira, Mieres, Rodriguez-Granillo, Rodriguez) Clinical
Research Department, Centro De Estudios En Cardiologia Intervencionista,
Buenos Aires City, Argentina
(Santaera) Interventional Cardiology Department, Clinica Privada
Provincial, Merlo, Buenos Aires Province, Argentina
(Mieres) Interventional Department, Sanatorio Las Lomas, San Isidro,
Buenos Aires Province, Argentina
(Rifourcat) Interventional Cardiology Department, Instituto De Diagnostico
Y Tratamiento De Afecciones Cardiovasculares, La Plata, Buenos Aires
Province, Argentina
(Lloberas) Interventional Cardiology Department, Sanatorio San Miguel, San
Miguel, Buenos Aires Province, Argentina
(Larribau) Interventional Cardiology Department, Hospital Espanol, Godoy
Cruz City, Mendoza Province, Argentina
(Pocovi) Interventional Cardiology Department, Centro Medico Talar, San
Isidro, Buenos Aires Province, Argentina
(Sarmiento) Interventional Cardiology Department, Hospital El Cruce,
Florencio Varela, Buenos Aires Province, Argentina
(Antoniucci) Cardiology Department, Careggi Hospital, Firenze, Italy
(Rodriguez) Cardiology Department, Sanatorio Otamendi Y Miroli, Buenos
Aires City, Argentina
Title
Second vs. First generation drug eluting stents in multiple vessel disease
and left main stenosis: Two-year follow-up of the observational,
prospective, controlled, and multicenter ERACI IV registry.
Source
Catheterization and Cardiovascular Interventions. 89 (1) (pp 37-46), 2017.
Date of Publication: 01 Jan 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: To compare second generation drug eluting stents (2DES) with
first generation (1DES) for the treatment of patients (pts) with multiple
coronary vessel disease (MVD). Background: Although 2DES improved safety
and efficacy compared to 1DES, MVD remains a challenge for percutaneous
coronary interventions. Methods: ERACI IV was a prospective,
observational, and controlled study in pts with MVD including left main
and treated with 2DES (Firebird 2, Microport). We included 225 pts in 15
sites from Argentina. Primary endpoint was the incidence of major adverse
cardiovascular events (MACCE) defined as death, myocardial infarction
(MI), cerebrovascular accident (CVA) and unplanned revascularization; and
to compare with 225 pts from ERACI III study (1DES). PCI strategy was
planned to treat lesions >70% in vessels > 2.00 mm, introducing a modified
Syntax score (SS) where severe lesions in vessels < 2.0 mm and
intermediate lesions were not scored. Results: Baseline characteristics
showed that compared to ERACI III, ERACI IV pts had higher number of
diabetics (P = 0.02), previous revascularization (P = 0.007), unstable
angina IIb/IIIc (P < 0.001) and three vessels/left main disease (P =
0.003). Modified SS was 22.2 +/- 11. At 2 years of follow-up ERACI IV
group had significantly lower incidence of death+ MI + CVA, (P = 0.01) and
MACCE (P = 0.001). MACCE rate was similar in diabetics, (5.8%) and
nondiabetics (7.0%). After performing a matched propensity score, MACCE
remain significantly lower in ERACI IV (P = 0.005). Conclusion: This
registry showed that 2DES in MVD has a remarkable low incidence of MACCE
in unadjusted and adjusted analysis. &#xa9; 2016 Wiley Periodicals, Inc.
Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<77>
Accession Number
614976491
Author
Panikker S.; Lord J.; Jarman J.W.E.; Armstrong S.; Jones D.G.; Haldar S.;
Butcher C.; Khan H.; Mantziari L.; Nicol E.; Hussain W.; Clague J.R.;
Foran J.P.; Markides V.; Wong T.
Institution
(Panikker, Jarman, Jones, Haldar, Butcher, Khan, Mantziari, Nicol,
Hussain, Clague, Foran, Markides, Wong) Heart Rhythm Centre, NIHR
Cardiovascular Research Unit, Royal Brompton and Harefield Hospitals,
National Heart and Lung Institute, Imperial College, Sydney Street, London
SW3 6NP, United Kingdom
(Lord) Southampton Health Technology Assessments Centre, University of
Southampton, Southampton, United Kingdom
(Armstrong) GfK Bridgehead, Wayland, MA, United States
Title
Outcomes and costs of left atrial appendage closure fromrandomized
controlled trial and realworld experience relative to oral
anticoagulation.
Source
European Heart Journal. 37 (46) (pp 3470-3482), 2016. Date of Publication:
01 Dec 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims The aim of this study was to analyse randomized controlled study and
real-world outcomes of patients with non-valvular atrial fibrillation
(NVAF) undergoing left atrial appendage closure (LAAC) with theWatchman
device and to compare costs with available antithrombotic therapies.
Methods and results Registry data of LAAC from two centres were
prospectively collected from 110 patients with NVAF at risk of stroke,
suitable and unsuitable for long-term anticoagulation (age 71.3+9.2 years,
CHADS2 2.8+1.2, CHA2DS2-VASc 4.5+1.6, and HAS-BLED 3.8+1.1). Outcomes from
PROTECT AF and registry study LAAC were compared with warfarin,
dabigatran, rivaroxaban, apixaban, aspirin, and no treatment using a
network meta-analysis. Costs were estimated over a 10-year horizon.
Uncertainty was assessed using sensitivity analyses. The procedural
success ratewas 92% (103/112). Follow-up was 24.1+4.6 months, during which
annual rates of stroke, major bleeding, and all-cause mortality were 0.9%
(2/223 patient-years), 0.9% (2/223 patient-years), and 1.8% (4/223
patient-years), respectively. Anticoagulant therapy was successfully
stopped in 91.2% (93/102) of implanted patients by 12 months. Registry
study LAAC stroke and major bleeding rates were significantly lower than
PROTECT AF results: mean absolute difference of stroke, 0.89% (P = 0.02)
and major bleeding, 5.48% (P , 0.001). Left atrial appendage closure
achieved cost parity between 4.9 years vs. dabigatran 110 mg and 8.4 years
vs. warfarin. At 10 years, LAAC was cost-saving against all therapies
(range 1162-7194). Conclusion Left atrial appendage closure in NVAF in a
real-world setting may result in lower stroke and major bleeding rates
than reported in LAAC clinical trials. Left atrial appendage closure in
both settings achieves cost parity in a relatively short period of time
and may offer substantial savings compared with current therapies. Savings
are most pronounced among higher risk patients and those unsuitable for
anticoagulation.

<78>
Accession Number
614976482
Author
Galat A.; Guellich A.; Bodez D.; Slama M.; Dijos M.; Zeitoun D.M.;
Milleron O.; Attias D.; Dubois-Rande J.-L.; Mohty D.; Audureau E.; Teiger
E.; Rosso J.; Monin J.-L.; Damy T.
Institution
(Galat, Guellich, Bodez, Dubois-Rande, Audureau, Teiger, Rosso, Monin,
Damy) UPEC, Creteil F-94000, France
(Galat, Guellich, Bodez, Dubois-Rande, Audureau, Teiger, Rosso, Monin,
Damy) MondorAmyloidosis Network, Creteil F-94000, France
(Galat, Guellich, Bodez, Dubois-Rande, Teiger, Rosso, Monin, Damy)
Department of Cardiology, AP-HP, Henri-Mondor Teaching Hospital, Creteil
F-94000, France
(Galat, Guellich, Bodez, Dubois-Rande, Audureau, Teiger, Monin, Damy)
INSERM U955, Creteil F-94000, France
(Galat, Guellich, Bodez, Dubois-Rande, Audureau, Teiger, Monin, Damy) DHU
A-TVB, Creteil F-94000, France
(Slama) Department of Cardiology, AP-HP, Antoine Beclere Teaching
Hospital, Clamart F-92140, France
(Dijos) Department of Cardiology, Bordeaux Teaching Hospital, Pessac
F-33604, France
(Zeitoun, Milleron) Department of Cardiology, AP-HP, Bichat Teaching
Hospital, Paris F-75018, France
(Attias) Department of Cardiology, Centre Cardiologique du Nord,
Saint-Denis F-93200, France
(Mohty) Department of Cardiology, Dupuytren Teaching Hospital, Limoges
F-87042, France
(Audureau) Department of Public Health, Henri-Mondor Teaching Hospital,
Creteil F-94000, France
(Audureau) CEpiA (Clinical Epidemiology and Ageing), EA4393, Universite
Paris Est (UPE), UPEC, Creteil F-94000, France
Title
Aortic stenosis and transthyretin cardiac amyloidosis: The chicken or the
egg?.
Source
European Heart Journal. 37 (47) (pp 3525-3531), 2016. Date of Publication:
01 Dec 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Background Aortic stenosis (AS) and transthyretin cardiac amyloidosis
(TTR-CA) are both frequent in elderly. The combination of these two
diseases has never been investigated. Aims To describe patients with
concomitant AS and TTR-CA. Methods Six cardiologic French centres
identified retrospectively cases of patients with severe or moderate AS
associated with TTR-CA hospitalized during the last 6 years. Results
Sixteen patients were included. Mean+SD age was 79+6 years, 81% were men.
Sixty per cent were NYHA III-IV, 31% had carpal tunnel syndrome, and 56%
had atrial fibrillation. Median (Q1;Q4) NT-proBNP was 4382 (2425;4730)
pg/mL and 91% had elevated cardiac troponin level. Eighty-eight per cent
had severe AS (n = 14/16), of whom 86% (n = 12) had low-gradient AS.
Mean+SD interventricular septum thickness was 18+4 mm. Mean left
ventricular ejection fraction and global LS were 50+13% and 27+4%,
respectively. Diagnosis of TTR-CAwas histologically proven in 38%, and was
based on strong cardiac uptake of the tracer at biphosphonate scintigraphy
in the rest. Eighty-one per cent had wild-type TTR-CA (n = 13), one had
mutated Val122I and 19% did not had genetic test (n = 3). Valve
replacement was surgical in 63% and via transcatheter in 13%. Median
follow-up in survivors was 33 (16;65) months. Mortality was of 44% (n = 7)
during the whole follow-up period. Conclusions Combination of AS and
TTR-CA may occur in elderly patients particularly those with a low-flow
low-gradient AS pattern and carries bad prognosis. Diagnosis of TTR-CA in
AS is relevant to discuss specific treatment and management. Copyright
&#xa9; The Author 2016.

<79>
Accession Number
614976448
Author
Moat N.; Brecker S.
Institution
(Moat) Cardiovascular BRU, Royal Brompton and Harefield NHS Trust, London,
United Kingdom
(Brecker) Department of Cardiology, Cardiology Clinical Academic Group,
St. George's Hospital, St. George's University of London, Blackshaw Road,
London SW17 0QT, United Kingdom
Title
Transfemoral TAVI is superior to SAVR in elderly high-risk patients with
symptomatic severe aortic stenosis!.
Source
European Heart Journal. 37 (47) (pp 3513-3514), 2016. Date of Publication:
01 Dec 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)

<80>
Accession Number
614976424
Author
Siontis G.C.M.; Praz F.; Pilgrim T.; Mavridis D.; Verma S.; Salanti G.;
Sondergaard L.; Juni P.; Windecker S.
Institution
(Siontis, Praz, Pilgrim, Windecker) Department of Cardiology, INSELSPITAL,
Bern University Hospital, University of Bern, Bern 3010, Switzerland
(Mavridis, Salanti) Department of Hygiene and Epidemiology, University of
Ioannina, School of Medicine, Ioannina, Greece
(Verma) Division of Cardiac Surgery, St Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Salanti) Institute of Social and Preventive Medicine, Clinical Trials
Unit, University of Bern, Bern, Switzerland
(Salanti) Institute of Primary Health Care (BIHAM), University of Bern,
Bern, Switzerland
(Sondergaard) Department of Cardiology, Heart Centre, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Denmark
(Juni) Applied Health Research Centre (AHRC), Li Ka Shing Knowledge
Institute, St. Michael's Hospital, Toronto, Canada
Title
Transcatheter aortic valve implantation vs. surgical aortic valve
replacement for treatment of severe aortic stenosis: A meta-analysis of
randomized trials.
Source
European Heart Journal. 37 (47) (pp 3503-3512a), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims In view of the currently available evidence from randomized trials,
we aimed to compare the collective safety and efficacy of transcatheter
aortic valve implantation (TAVI) vs. surgical aortic valve replacement
(SAVR) across the spectrum of risk and in important subgroups. Methods and
results Trials comparing TAVI vs. SAVR were identified through Medline,
Embase, and Cochrane databases. The primary outcome was death from any
cause at 2 years.We performed random-effects meta-analyses to combine the
available evidence and to evaluate the effect in different subgroups. This
systematic review and meta-analysis is registered with PROSPERO
(CRD42016037273). We identified four eligible trials including 3806
participants, who were randomly assigned to undergo TAVI (n = 1898) or
SAVR (n = 1908). For the primary outcome of death from any cause, TAVI
when compared with SAVR was associated with a significant 13% relative
risk reduction [hazard ratio (95% CI): 0.87 (0.76-0.99); P = 0.038] with
homogeneity across all trials irrespective of TAVI device (Pinteraction =
0.306) and baseline risk (Pinteraction = 0.610). In subgroup analyses,
TAVI showed a robust survival benefit over SAVR for patients undergoing
transfemoral access [0.80 (0.69-0.93); P = 0.004], but not transthoracic
access [1.17 (0.88-1.56); P = 0.293] (Pinteraction = 0.024) and in female
[0.68 (0.50-0.91); P = 0.010], but not male patients [0.99 (0.77-1.28); P
= 0.952] (Pinteraction = 0.050). Secondary outcomes of kidney injury,
new-onset atrial fibrillation, and major bleeding favoured TAVI, while
major vascular complications, incidence of permanent pacemaker
implantation, and paravalvular regurgitation favoured SAVR. Conclusion
Compared with SAVR, TAVI is associated with a significant survival benefit
throughout 2 years of follow-up. Importantly, this superiority is observed
irrespective of the TAVI device across the spectrum of intermediate and
high-risk patients, and is particularly pronounced among patients
undergoing transfemoral TAVI and in females. Copyright &#xa9; The Author
2016.

<81>
[Use Link to view the full text]
Accession Number
608873070
Author
Bai S.; Fu X.; Gu X.; Wang Y.; Li W.; Fan Y.; Wei L.; Bi X.
Institution
(Bai, Fu, Gu, Wang, Li, Fan, Wei, Bi) Department of Cardiology, Second
Hospital of Hebei Medical University, No 215 Heping West Road,
Shijiazhuang, Hebei 050000, China
Title
Intracoronary administration of different doses of anisodamine in primary
percutaneous coronary intervention: Protective effect in patients with
ST-segment elevation myocardial infarction.
Source
Coronary Artery Disease. 27 (4) (pp 302-310), 2016. Date of Publication:
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective: The aim of this study was to evaluate the effects of
intracoronary administration of anisodamine on myocardial reperfusion in
patients with ST-segment elevation myocardial infarction (STEMI)
undergoing a primary percutaneous coronary intervention (pPCI). Methods:
Patients with acute STEMI undergoing pPCI were enrolled in this
randomized-controlled study (January 2014-June 2015) and divided randomly
into four groups: group A (normal saline), group B (1000 mug anisodamine),
group C (2000 mug anisodamine), and group D (4000 mug anisodamine).
Results: The study group included 140 patients. Percentages of
thrombolysis in myocardial infarction (TIMI) myocardial perfusion grade 3,
increased values of TIMI myocardial perfusion grade after stenting, and
decreased values of corrected TIMI frame count in groups B, C, and D were
all significantly higher than those in group A (P=0.031, 0.027, 0.003, and
P<0.001, respectively). TIMI frame count after stenting in groups B, C,
and D was significantly lower than that in group A (P=0.001). Left
ventricular ejection fraction at 1 week after pPCI and at the 3-month
follow-up, as well as the major adverse cardiac event-free survival rate
in groups B, C, and D were higher than those in group A (P=0.027, 0.016,
and 0.019, respectively). Conclusion: Intracoronary administration of
anisodamine at different doses improved myocardial reperfusion in patients
with STEMI undergoing pPCI and reduced major adverse cardiac events. The
protective effect of anisodamine at a dose of 4000 mug might be better
than the doses at 1000 and 2000 mug. Copyright &#xa9; 2016 Wolters Kluwer
Health, Inc. All rights reserved.

<82>
Accession Number
608854631
Author
Du X.; Pi Y.; Dreyer R.P.; Li J.; Li X.; Downing N.S.; Li L.; Feng F.;
Zhan L.; Zhang H.; Guan W.; Xu X.; Li S.-X.; Lin Z.; Masoudi F.A.; Spertus
J.A.; Krumholz H.M.; Jiang L.
Institution
(Du, Pi, Li, Li, Li, Feng, Zhan, Zhang, Guan, Jiang) National Clinical
Research Center of Cardiovascular Diseases, State Key Laboratory of
Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing, China
(Dreyer, Downing, Xu, Li, Lin, Krumholz) Center for Outcomes Research and
Evaluation, Yale-New Haven Hospital, New Haven, CT, United States
(Xu) Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale
School of Medicine, New Haven, CT, United States
(Masoudi) Division of Cardiology, University of Colorado Anschutz Medical
Campus, Aurora, CO, United States
(Spertus) Saint Luke's Mid America Heart Institute/University of
Missouri-Kansas City, Kansas City, MO, United States
(Krumholz) Section of Cardiovascular Medicine, Robert Wood Johnson
Clinical Scholars Program, Department of Internal Medicine, Yale
University School of Medicine, New Haven, CT, United States
(Krumholz) Department of Health Policy and Management, Yale School of
Public Health, New Haven, CT, United States
Title
The china patient-centered evaluative assessment of cardiac events (PEACE)
prospective study of percutaneous coronary intervention: Study design.
Source
Catheterization and Cardiovascular Interventions. 88 (7) (pp E212-E221),
2016. Date of Publication: 01 Dec 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: The number of percutaneous coronary interventions (PCI) in
China has increased more than 20-fold over the last decade. Consequently,
there is a need for national-level information to characterize PCI
indications and long-term patient outcomes, including health status, to
understand and improve evolving practice patterns. Objectives: This
nationwide prospective study of patients receiving PCI is to: (1) measure
long-term clinical outcomes (including death, acute myocardial infarction
[AMI], and/or revascularization), patient-reported outcomes (PROs),
cardiovascular risk factor control and adherence to medications for
secondary prevention; (2) determine patient- and hospital-level factors
associated with care process and outcomes; and (3) assess the
appropriateness of PCI procedures. Methods: The China Patient-centered
Evaluative Assessment of Cardiac Events (PEACE) Prospective Study of PCI
has enrolled 5,000 consecutive patients during 2012-2014 from 34 diverse
hospitals across China undergoing PCI for any indication. We abstracted
details of patient's medical history, treatments, and in-hospital outcomes
from medical charts, and conducted baseline, 1-, 6-, and 12-month
interviews to characterize patient demographics, risk factors, clinical
presentation, healthcare utilization, and health status using validated
PRO measures. The primary outcome, a composite measure of death, AMI
and/or revascularization, as well as PROs, medication adherence and
cardiovascular risk factor control, was assessed throughout the 12-month
follow-up. Blood and urine samples were collected at baseline and 12
months and stored for future analyses. To validate reports of coronary
anatomy, 2,000 angiograms are randomly selected and read by two
independent core laboratories. Hospital characteristics regarding their
facilities, processes and organizational characteristics are assessed by
site surveys. Conclusion: China PEACE Prospective Study of PCI will be the
first study to generate novel, high-quality, comprehensive national data
on patients' socio-demographic, clinical, treatment, and metabolic/genetic
factors, and importantly, their long-term outcomes following PCI,
including health status. This will build the foundation for PCI
performance improvement efforts in China. &#xa9; 2016 The Authors.
Catheterization and Cardiovascular Interventions. Published by Wiley
Periodicals, Inc. Copyright &#xa9; 2016 The Authors. Catheterization and
Cardiovascular Interventions. Published by Wiley Periodicals, Inc.

<83>
Accession Number
607491013
Author
Christopoulos G.; Papayannis A.C.; Alomar M.; Christakopoulos G.E.; Kotsia
A.; Michael T.T.; Rangan B.V.; Roesle M.; Shorrock D.; Makke L.;
Maragkoudakis S.; Mohammad A.; Sarode K.; Chambers C.E.; Banerjee S.;
Brilakis E.S.
Institution
(Christopoulos, Papayannis, Alomar, Christakopoulos, Kotsia, Michael,
Rangan, Roesle, Shorrock, Makke, Mohammad, Sarode, Banerjee, Brilakis) VA
North Texas Health Care System and University of Texas Southwestern
Medical Center, Dallas, TX, United States
(Maragkoudakis) Department of Cardiovascular Diseases, University of
Heraklion, Heraklion, Greece
(Chambers) Penn State Hershey Medical Center, Hershey, PA, United States
Title
Determinants of operator and patient radiation exposure during cardiac
catheterization: Insights from the RadiCure (RADIation reduction during
cardiac catheterization using real-timE monitoring) trial.
Source
Catheterization and Cardiovascular Interventions. 88 (7) (pp 1046-1055),
2016. Date of Publication: 01 Dec 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: In the RadiCure study 505 catheterization procedures were 1:1
randomized to use or no use of real-time radiation monitoring. Use of the
Bleeper Sv monitor resulted in a significant reduction in operator
radiation exposure. Methods: We examined the association between several
baseline and procedural parameters with operator and patient radiation
exposure using univariable and multivariable analysis in the 505 patients
that were enrolled in RadiCure. All baseline demographic and procedure
characteristics recorded were included in the univariable analysis.
Results: Median fluoroscopy time was 6.2 (2.5-12.5) minutes, median
patient air kerma dose was 0.908 (0.602-1.636) Gray and median first
operator exposure was 10 (5-22) muSv. For analysis purposes, the 505
procedures were dichotomized based on the median operator exposure (10
muSv) and median patient radiation dose (0.908 Gray). On multivariable
analysis, factors associated with high (above median or >10 muSv) first
operator radiation exposure included radial access (odds ratio [OR] 5.44,
95% Confidence Interval [CI] 2.88-10.76), chronic total occlusion (CTO)
intervention (OR 12.78, 95% CI 4.42-43.60), real-time radiation monitoring
(OR 0.42, 95% CI 0.26-0.66), and use of a radioabsorbent drape (OR 0.53,
95% CI 0.28-0.96). High patient radiation dose (above median or >0.908
Gray) was associated with body mass index>30 kg/m² (OR 3.22,
95% CI 1.99-5.29), prior MI (OR 2.26, 95% CI 1.29-4.04), prior
cerebrovascular disease (OR 0.34, 95% CI 0.15-0.75), hypertension (OR
2.40, 95% CI 1.05-5.82), prior coronary artery bypass graft surgery (OR
2.46, 95% CI 1.40-4.39) and CTO intervention (OR 12.93, 95% CI
3.28-87.31), but was not associated with real-time radiation monitoring
and use of a radioabsorbent drape. Conclusions: Several clinical and
procedural factors are associated with higher patient and operator
radiation exposure. Real-time radiation monitoring and use of disposable
radiation shields were associated with lower operator, but not patient,
radiation dose. &#xa9; 2015 Wiley Periodicals, Inc. Copyright &#xa9; 2015
Wiley Periodicals, Inc.

<84>
Accession Number
612978344
Author
Ando T.; Takagi H.
Institution
(Ando) Department of Internal Medicine, Mount Sinai Beth Israel Medical
Center, Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
Title
The Prognostic Impact of New-Onset Persistent Left Bundle Branch Block
Following Transcatheter Aortic Valve Implantation: A Meta-analysis.
Source
Clinical Cardiology. 39 (9) (pp 544-550), 2016. Date of Publication: 01
Sep 2016.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
New-onset persistent left bundle branch block (NOP-LBBB) is one of the
most common conduction disturbances after transcatheter aortic valve
implantation (TAVI). We hypothesized that NOP-LBBB may have a clinically
negative impact after TAVI. To find out, we conducted a systematic
literature search of the MEDLINE/PubMed and Embase databases.
Observational studies that reported clinical outcomes of NOP-LBBB patients
after TAVI were included. The random-effects model was used to combine
odds ratios, risk ratios, or hazard ratios (HRs) with 95% confidence
intervals. Adjusted HRs were utilized over unadjusted HRs or risk ratios
when available. A total of 4049 patients (807 and 3242 patients with and
without NOP-LBBB, respectively) were included. Perioperative (in-hospital
or 30-day) and midterm all-cause mortality and midterm cardiovascular
mortality were comparable between the groups. The NOP-LBBB patients
experienced a higher rate of permanent pacemaker implantation (HR: 2.09,
95% confidence interval: 1.12-3.90, P = 0.021, I² = 83%) during
midterm follow-up. We found that NOP-LBBB after TAVI resulted in higher
permanent pacemaker implantation but did not negatively affect the midterm
prognosis. Therefore, careful observation during the follow-up is
required. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<85>
Accession Number
613094640
Author
Said S.A.M.
Institution
(Said) Department of Cardiology, Hospital Group Twente, Hengelo,
Netherlands
Title
Characteristics of Congenital Coronary Artery Fistulas Complicated with
Infective Endocarditis: Analysis of 25 Reported Cases.
Source
Congenital Heart Disease. 11 (6) (pp 756-765), 2016. Date of Publication:
01 Nov 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Congenital coronary artery fistulas (CAFs) are infrequent congenital
coronary artery anomalies. Complications such as left-to-right shunt,
congestive heart failure, myocardial infarction, pericardial effusion,
aneurysm formation, rupture, hemopericardium, pulmonary hypertension,
infective endocarditis (IE), syncope, stroke, and sudden death may occur
with a variable low frequency. To describe the clinical characteristics of
patients with CAFs complicated by IE. A search was conducted through
PubMed using the terms "CAFs" and "IE." Papers with a full description of
the fistula characteristics and detailed data regarding bacterial
endocarditis were included for evaluation. In the overall group of
reviewed subjects (n = 25, 9 females), the mean patient age was 42.5 years
(range: 16 and 87). The right coronary artery (RCA) and left coronary
artery (LCA) contributed equally to fistula formation. Terminations into
the right heart side occurred in 19 (76%) fistulas. The majority of the
fistulas (92%) were unilateral. The cultured microorganism was
Streptococcus in 14 (56%) and Staphylococcus in 4 (16%) of the reviewed
subjects. Echocardiographic single or multiple valvular regurgitation was
found in 8 (32%) of the reviewed subjects. Small and large intracardiac
vegetations were detected in 18 patients (72%). Antibiotic therapy was
initiated in 20 (80%) subjects and 16 fistulas were treated surgically.
During surgery, spontaneous closure of the fistula was observed in one
patient. Percutaneous therapeutic embolization (PTE) was successfully
performed in two subjects. CAFs complicated by IE may affect all age
groups with a slight male preponderance. Unilateral fistulas, either
arising from the right or left coronary artery, are predominant, draining
mainly into the right heart side. It is emphasized that antibiotic
prophylaxis is strongly advised for pediatric and adult patients with
congenital CAFs. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<86>
Accession Number
613103598
Author
Gargiulo G.; Windecker S.; R Da Costa B.; Feres F.; Hong M.-K.; Gilard M.;
ImHyo-Soo K.; Colombo A.; Bhatt D.L.; Kim B.-K.; Morice M.-C.; Park K.W.;
Chieffo A.; Palmerini T.; Stone G.W.; Valgimigli M.
Institution
(Gargiulo, Windecker, R Da Costa, Valgimigli) Department of Cardiology,
Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
(Gargiulo) Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy
(R Da Costa) Institute of Primary Health Care (BIHAM), University of Bern,
Switzerland
(Feres) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
(Hong, Kim) Division of Cardiology, Severance Cardiovascular Hospital,
Yonsei University College of Medicine, Seoul, South Korea
(Gilard, Morice) Department of Cardiology, CHU de la Cavale Blanche,
Brest, France
(ImHyo-Soo, Park) Department of Internal Medicine, Cardiovascular Center,
Seoul National University Hospital, Seoul, South Korea
(Colombo, Chieffo) Interventional Cardiology Unit, San Raffaele Scientific
Institute, Milan, Italy
(Bhatt) Brigham and Women's Hospital, Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
(Palmerini) Dipartimento Cardio-Toraco-Vascolare, University of Bologna,
Bologna, Italy
(Stone) Columbia University Medical Center, New York-Presbyterian
Hospital, Cardiovascular Research Foundation, New York, NY, United States
Title
Short term versus long term dual antiplatelet therapy after implantation
of drug eluting stent in patients with or without diabetes: Systematic
review and meta-analysis of individual participant data from randomised
trials.
Source
BMJ (Online). 355 (no pagination), 2016. Article Number: i5483. Date of
Publication: 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: To compare clinical outcomes between short term (up to 6
months) and long term (12 months) dual antiplatelet therapy (DAPT) after
placement of a drug eluting stent in patients with and without diabetes.
Design: Individual participant data meta-analysis. Cox proportional
regression models stratified by trial were used to assess the impact of
diabetes on outcomes. Data source: Medline, Embase, and Cochrane databases
and proceedings of international meetings searched for randomised
controlled trials comparing durations of DAPT after placement of a drug
eluting stent. Individual patient data pooled from six DAPT trials.
Primary outco me: Primary study outcome was one year risk of major adverse
cardiac events (MACE), defined as cardiac death, myocardial infarction, or
definite/probable stent thrombosis. All analyses were conducted by
intention to treat. Results: Six trials including 11 473 randomised
patients were pooled. Of these patients, 3681 (32.1%) had diabetes and
7708 (67.2%) did not (mean age 63.7 (SD 9.9) and 62.8 (SD 10.1),
respectively), and in 84 (0.7%) the information was missing. Diabetes was
an independent predictor of MACE (hazard ratio 2.30, 95% confidence
interval 1.01 to 5.27; P=0.048 At one year follow-up, long term DAPT was
not associated with a decreased risk of MACE compared with short term DAPT
in patients with (1.05, 0.62 to 1.76; P=0.86) or without (0.97, 0.67 to
1.39; P=0.85) diabetes (P=0.33 for interaction). The risk of myocardial
infarction did not differ between the two DAPT regimens (0.95, 0.58 to
1.54; P=0.82; for those with diabetes and 1.15, 0.68 to 1.94; P=0.60; for
those without diabetes (P=0.84 for interaction). There was a lower risk of
definite/ probable stent thrombosis with long term DAPT among patients
with (0.26, 0.09 to 0.80; P=0.02) than without (1.42, 0.68 to 2.98;
P=0.35) diabetes, with positive interaction testing (P=0.04 for
interaction), although the landmark analysis showed a trend towards
benefit in both groups. Long term DAPT was associated with higher rates of
major or minor bleeding, irrespective of diabetes (P=0.37 for
interaction). Conclusions: Although the presence of diabetes emerged as an
independent predictor of MACE after implantation of a drug eluting stent,
compared with short term DAPT, long term DAPT did not reduce the risk of
MACE but increased the risk of bleeding among patients with stents with
and without diabetes.

<87>
Accession Number
611851515
Author
Cannon C.P.; Gropper S.; Bhatt D.L.; Ellis S.G.; Kimura T.; Lip G.Y.H.;
Steg P.G.; ten Berg J.M.; Manassie J.; Kreuzer J.; Blatchford J.; Massaro
J.M.; Brueckmann M.; Ferreiros Ripoll E.; Oldgren J.; Hohnloser S.H.
Institution
(Cannon) Harvard Clinical Research Institute, Boston, MA, United States
(Cannon, Bhatt) Cardiovascular Division, Brigham and Women's Hospital,
Boston, MA, United States
(Cannon, Bhatt) Harvard Medical School, Boston, MA, United States
(Gropper, Kreuzer, Brueckmann, Ferreiros Ripoll) Boehringer Ingelheim
Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany
(Ellis) Cleveland Clinic, Cleveland, OH, United States
(Kimura) Department of Cardiovascular Medicine, Graduate School of
Medicine, Kyoto University, Kyoto, Japan
(Lip) University of Birmingham Institute of Cardiovascular Sciences, City
Hospital, Birmingham, United Kingdom
(Steg) FACT (French Alliance for Cardiovascular Trials), an F-CRIN
network, Departement Hospitalo-Universitaire FIRE, AP-HP, Hopital Bichat,
Universite Paris-Diderot, Sorbonne Paris-Cite, INSERM U-1148, Paris,
France
(Steg) NHLI Imperial College, ICMS Royal Brompton Hospital, London, United
Kingdom
(ten Berg) St. Antonius Hospital, Nieuwegein, Netherlands
(Manassie, Blatchford) Medical Division Boehringer Ingelheim Ltd,
Bracknell, Berkshire, United Kingdom
(Kreuzer) Faculty of Medicine, University of Heidelberg, Heidelberg,
Germany
(Massaro) Boston University School of Public Health, Boston, MA, United
States
(Brueckmann) Faculty of Medicine Mannheim of the University of Heidelberg,
Mannheim, Germany
(Oldgren) Department of Medical Sciences and Uppsala Clinical Research
Centre, Uppsala University Hospital, Uppsala, Sweden
(Hohnloser) Department of Cardiology, J.W. Goethe University, Frankfurt,
Germany
Title
Design and Rationale of the RE-DUAL PCI Trial: A Prospective, Randomized,
Phase 3b Study Comparing the Safety and Efficacy of Dual Antithrombotic
Therapy With Dabigatran Etexilate Versus Warfarin Triple Therapy in
Patients With Nonvalvular Atrial Fibrillation Who Have Undergone
Percutaneous Coronary Intervention With Stenting.
Source
Clinical Cardiology. 39 (10) (pp 555-564), 2016. Date of Publication: 01
Oct 2016.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Antithrombotic management of patients with atrial fibrillation (AF)
undergoing coronary stenting is complicated by the need for anticoagulant
therapy for stroke prevention and dual antiplatelet therapy for prevention
of stent thrombosis and coronary events. Triple antithrombotic therapy,
typically comprising warfarin, aspirin, and clopidogrel, is associated
with a high risk of bleeding. A modest-sized trial of oral anticoagulation
with warfarin and clopidogrel without aspirin showed improvements in both
bleeding and thrombotic events compared with triple therapy, but large
trials are lacking. The RE-DUAL PCI trial (NCT 02164864) is a phase 3b, a
strategy of prospective, randomized, open-label, blinded-endpoint trial.
The main objective is to evaluate dual antithrombotic therapy with
dabigatran etexilate (110 or 150 mg twice daily) and a P2Y12 inhibtor
(either clopidogrel or ticagrelor) compared with triple antithrombotic
therapy with warfarin, a P2Y12 inhibtor (either clopidogrel or ticagrelor,
and low-dose aspirin (for 1 or 3 months, depending on stent type) in
nonvalvular AF patients who have undergone percutaneous coronary
intervention with stenting. The primary endpoint is time to first
International Society of Thrombosis and Hemostasis major bleeding event or
clinically relevant nonmajor bleeding event. Secondary endpoints are the
composite of all cause death or thrombotic events (myocardial infarction,
or stroke/systemic embolism) and unplanned revascularization; death or
thrombotic events; individual outcome events; death, myocardial
infarction, or stroke; and unplanned revascularization. A hierarchical
procedure for multiple testing will be used. The plan is to randomize ~
2500 patients at approximately 550 centers worldwide to try to identify
new treatment strategies for this patient population. Copyright &#xa9;
2016 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.

<88>
Accession Number
611257060
Author
Ando T.; Takagi H.
Institution
(Ando) Department of Internal Medicine, Mount Sinai Beth Israel Medical
Center, Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
Title
Percutaneous Closure of Paravalvular Regurgitation After Transcatheter
Aortic Valve Implantation: A Systematic Review.
Source
Clinical Cardiology. 39 (10) (pp 608-614), 2016. Date of Publication: 01
Oct 2016.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Paravalvular regurgitation (PVR) remains one of the drawbacks of
transcatheter aortic valve implantation (TAVI). Details of percutaneous
closure (PCC) of PVR after TAVI remain obscure. We aimed to explore the
patient characteristics, procedural details, closure devices used, and
outcomes of PCC after TAVI. A systematic search of the MEDLINE/PubMed and
Embase databases from January 2002 to September 2015 was conducted.
Reports considered to include same patient were excluded and only the
studies with largest cohorts were included. A total of 14 studies
including 58 patients (61 cases) were included in the study. A
balloon-expandable (BE) valve was used more frequently compared with a
self-expandable (SE) valve (72.6% vs 27.4%, respectively). The mean
success rate was 86.9% (100% and 77.8%, respectively; P = 0.097). The
median number of closure devices used was 1 (range, 1-4) and did not
differ between SE and BE valves (P = 0.71). Mean time from index procedure
to PCC did not differ between SE and BE valves (295 +/- 380 days vs 379
+/- 353 days; P = 0.71). Seven patients had history of valve-in-valve and
6 patients had procedural success. Among the patients with available
follow-up data (94.8%), there were 15 deaths (27.3%). Percutaneous closure
of PVR after TAVI had a high success rate in selected patients in both BE
and SE valves. The success rate, timing, and number of closure devices
were similar between BE and SE valves. However, prognosis remains fairly
poor. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<89>
Accession Number
608330619
Author
Farrington D.K.; Kilgo P.D.; Thourani V.H.; Jacob J.T.; Steinberg J.P.
Institution
(Farrington) Emory University, School of Medicine, Atlanta, GA, United
States
(Kilgo) Department of Biostatistics and Bioinformatics, Emory University,
Rollins School of Public Health, Atlanta, GA, United States
(Thourani) Division of Cardiothoracic Surgery, Department of Surgery,
Emory University, School of Medicine, Atlanta, GA, United States
(Jacob, Steinberg) Division of Infectious Diseases, Department of
Medicine, Emory University, School of Medicine, Atlanta, GA, United States
(Farrington) Department of Medicine, University of Chicago, Chicago, IL,
United States
Title
High Risk of Prosthetic Valve Endocarditis and Death after Valve
Replacement Operations in Dialysis Patients.
Source
Annals of Thoracic Surgery. 101 (6) (pp 2217-2223), 2016. Date of
Publication: 01 Jun 2016.
Publisher
Elsevier USA
Abstract
Background Despite a high burden of dialysis access-related bloodstream
infections and an increasing incidence of endocarditis, few data are
available addressing the risk of prosthetic valve endocarditis (PVE) in
the dialysis population. We sought to assess the risk of PVE and death
after valve replacement operations in patients receiving long-term
dialysis. Methods A matched retrospective cohort study was conducted
comprising patients admitted for valve replacement operations at two
university hospitals. Patients without dialysis were matched 1:1 with
dialysis patients by valve(s) replaced, year of operation, and presence of
active endocarditis as the indication for valve replacement. Patient
characteristics were compared using chi² and t tests. The
development of PVE was defined by use of the modified Duke criteria and
analyzed with Cox proportional hazards regression. Results Two hundred
seventy-eight patients were included, with 139 in either cohort. The PVE
risk per year of follow-up was 0.14 in the dialysis cohort and 0.03 in the
nondialysis cohort. Dialysis remained a risk factor (adjusted hazard ratio
5.61 [95% confidence interval, 2.17 to 14.5], p = 0.0004) after age and
race were controlled for. The 5-year survival rate was lower after valve
replacement operation in the dialysis group (25.4%) than in the
nondialysis group (75.9%, p < 0.001). Conclusions The risk of PVE and
death after valve replacement operations in dialysis patients is
substantial and significantly higher than in patients without dialysis.
These findings highlight the importance of a careful preoperative
risk-benefit assessment and underscore the need to prevent
hemodialysis-related bloodstream infections. Copyright &#xa9; 2016 The
Society of Thoracic Surgeons.

<90>
Accession Number
610177868
Author
Brewer Z.E.; Ogden W.D.; Fann J.I.; Burdon T.A.; Sheikh A.Y.
Institution
(Brewer, Ogden, Fann, Burdon, Sheikh) Department of Cardiothoracic
Surgery, Stanford University School of Medicine, Stanford, California,
United States
Title
Creation and Global Deployment of a Mobile, Application-Based Cognitive
Simulator for Cardiac Surgical Procedures.
Source
Seminars in Thoracic and Cardiovascular Surgery. 28 (1) (pp 1-9), 2016.
Date of Publication: 01 Feb 2016.
Publisher
W.B. Saunders
Abstract
Several modern learning frameworks (eg, cognitive apprenticeship, anchored
instruction, and situated cognition) posit the utility of nontraditional
methods for effective experiential learning. Thus, development of novel
educational tools emphasizing the cognitive framework of operative
sequences may be of benefit to surgical trainees. We propose the
development and global deployment of an effective, mobile cognitive
cardiac surgical simulator. In methods, 16 preclinical medical students
were assessed. Overall, 4 separate surgical modules (sternotomy,
cannulation, decannulation, and sternal closure) were created utilizing
the Touch Surgery (London, UK) platform. Modules were made available to
download free of charge for use on mobile devices. Usage data were
collected over a 6-month period. Educational efficacy of the modules was
evaluated by randomizing a cohort of medical students to either module
usage or traditional, reading-based self-study, followed by a
multiple-choice learning assessment tool. In results, downloads of the
simulator achieved global penetrance, with highest usage in the USA,
Brazil, Italy, UK, and India. Overall, 5368 unique users conducted a total
of 1971 hours of simulation. Evaluation of the medical student cohort
revealed significantly higher assessment scores in those randomized to
module use versus traditional reading (75% +/- 9% vs 61% +/- 7%,
respectively; P < 0.05). In conclusion, this study represents the first
effort to create a mobile, interactive cognitive simulator for cardiac
surgery. Simulators of this type may be effective for the training and
assessment of surgical students. We investigated whether an interactive,
mobile-computing-based cognitive task simulator for cardiac surgery could
be developed, deployed, and validated. Our findings suggest that such
simulators may be a useful learning tool. Copyright &#xa9; 2016

<91>
[Use Link to view the full text]
Accession Number
614926737
Author
Nguyen J.; Nacpil N.
Institution
(Nguyen, Nacpil) The Center for Translational Research, Joanna Briggs
Institute Center of Excellence, Forth Worth, United States
Title
A comparison between dexmedetomidine and propofol on extubation times in
postoperative adult cardiac surgery patients: A systematic review
protocol.
Source
JBI Database of Systematic Reviews and Implementation Reports. 14 (11) (pp
63-71), 2016. Date of Publication: 2016.
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
Review question/objective: The objective of this systematic review is to
synthesize the best available evidence regarding the effects of
dexmedetomidine compared to propofol on time to extubation, intensive care
unit (ICU) length of stay (LOS), hospital LOS and mortality in
postoperative adult cardiac surgery patients. The specific review question
is as follows: What is the effectiveness of dexmedetomidine compared to
propofol on times to extubation, ICU LOS, hospital LOS and mortality in
postoperative adults undergoing cardiac surgery?. Copyright &#xa9; 2016
Joanna Briggs Institute.

<92>
Accession Number
613194594
Author
Jackson L.R.; Piccini J.P.; Cyr D.D.; Roe M.T.; Neely M.L.; Martinez F.;
Luscher T.F.; Lopes R.D.; Winters K.J.; White H.D.; Armstrong P.W.; Fox
K.A.A.; Prabhakaran D.; Bhatt D.L.; Magnus Ohman E.; Corbalan R.
Institution
(Jackson, Piccini, Roe, Lopes, Magnus Ohman) Division of Cardiology,
Department of Medicine, Duke University School of Medicine, Durham, NC,
United States
(Jackson, Piccini, Cyr, Roe, Neely, Lopes, Magnus Ohman) Duke Clinical
Research Institute, Durham, NC, United States
(Martinez) Department of Cardiology, Cordoba National University, Cordoba,
Argentina
(Luscher) University Heart Center, Cardiology, University Hospital Zurich,
Zurich, Switzerland
(Winters) Department of Research and Development, Research Cardiologist,
Indianapolis, IN, United States
(Winters) Eli Lilly and Company, Indianapolis, IN, United States
(White) Green Lane Cardiovascular Service, Department of Medicine,
Division of Cardiology, Auckland, New Zealand
(White, Armstrong) Auckland City Hospital, Auckland, New Zealand
(Armstrong) Canadian VIGOUR Centre, University of Alberta, Edmonton, AB,
Canada
(Fox) Centre for Cardiovascular Science, University of Edinburgh,
Edinburgh, United Kingdom
(Prabhakaran) Centre for Chronic Disease Control and Public Health
Foundation of India, New Delhi, India
(Bhatt) Division of Cardiology, Department of Medicine, Boston, MA, United
States
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center and Harvard
Medical School, Boston, MA, United States
(Corbalan) Department of Medicine, Division of Cardiology, Santiago, Chile
(Corbalan) Pontificia Universidad Catolica de Chile, Santiago, Chile
Title
Dual Antiplatelet Therapy and Outcomes in Patients With Atrial
Fibrillation and Acute Coronary Syndromes Managed Medically Without
Revascularization: Insights From the TRILOGY ACS Trial.
Source
Clinical Cardiology. 39 (9) (pp 497-506), 2016. Date of Publication: 01
Sep 2016.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Associations between atrial fibrillation (AF), outcomes, and response to
antiplatelet therapies in patients with acute coronary syndrome (ACS)
managed medically without revascularization remain uncertain. We examined
these associations for medically managed ACS patients randomized to dual
antiplatelet therapy (DAPT) using patient data from the TRILOGY ACS trial.
DAPT included aspirin plus clopidogrel 75 mg/d or prasugrel 10 mg/d (5
mg/d for those <60 kg or age >75 years). Patients receiving oral
anticoagulants were excluded. Cox proportional hazards regression modeling
was used to characterize associations between patients with AF (AF+) vs
those without (AF-) and risk of ischemic and bleeding events, and to
explore effects of randomized treatment on outcomes. Among 9101 patients
with baseline AF status, 710 (7.8%) had AF. AF+ patients were older and
had more comorbidities. Unadjusted associations of the composite of
cardiovascular death/myocardial infarction/stroke were significantly
higher among AF patients at 30 months (31.1% vs 18.4%; HR: 1.61, 95% CI:
1.35-1.92, P < 0.001), but differences did not persist after adjustment
(HR: 1.16, 95% CI: 0.97-1.39, P = 0.11). When individual components of the
composite endpoint were evaluated, 30-month risk of events in AF+ patients
was significantly higher. Thirty-month risk of all-cause death was
significantly higher in AF+ patients: 18.1% vs 11.1% (HR: 1.62, 95% CI:
1.30-2.02, P < 0.001). There was no significant interaction with
randomized treatment and AF for the primary endpoint. Among medically
managed high-risk ACS patients receiving DAPT, AF was associated with
higher unadjusted risks of ischemic and bleeding outcomes that were
similar by treatment group. Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<93>
Accession Number
614678370
Author
Bottet B.; Bouchard F.; Peillon C.; Baste J.-M.
Institution
(Bottet, Peillon, Baste) Department of General and Thoracic Surgery, Rouen
University Hospital, 1 rue de Germont, Rouen Cedex 1 76031, France
(Bouchard) Department of Thoracic and Cardiac Surgery, Rouen University
Hospital, Rouen, France
Title
When and how should we manage thoracic aortic injuries in the modern era?.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (6) (pp 970-975),
2016. Date of Publication: 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in cardiovascular surgery was written according to a
structured protocol. The question addressed was what are the optimum
treatment modality and timing of intervention for blunt thoracic aortic
injury (BTAI) in the modern era? Of the 697 papers found using the
reported search, 14 (5 meta-Analyses, 2 prospective and 7 retrospective
studies) represented the best evidence to answer the clinical question.
The author, journal, country, date of publication, patient group studied,
study type, relevant outcomes, results and weakness of these papers are
tabulated. All five meta-Analyses reported a reduction in mortality with
thoracic endovascular aortic repair (TEVAR) compared with open repair
(OR), but only four found the same benefit on paraplegia rate. Similarly,
the two prospective and four retrospective studies showed significantly
lower mortality with TEVAR than with OR. Only one study (a meta-Analysis)
reported a significantly lower stroke rate with TEVAR than with OR,
whereas the 13 others reported a similar or even higher stroke rate. Other
complication rates were identical. Four studies demonstrated that
non-operative management (NOM) as a treatment option for BTAI was
associated with increased mortality, even if it has declined in recent
years. One study emphasized that some cases with minimal aortic injuries
(Grade I and II on CT scan) could benefit from NOM. Regarding the timing
of repair, only three studies analysed outcomes of delayed repair and
reported significantly lower mortality than for early repair. We conclude
that with lower mortality and similar overall complications including
paraplegia but higher stroke rate, TEVAR is the most suitable treatment
for BTAI in the modern era, where expertise exists, especially for cases
of multiple associated injuries and in the older age group. Delayed aortic
repair can be proposed based on CT scan analysis, but emergent repair
should still be advocated for imminent free aortic rupture. NOM remains a
therapeutic option but only with selected patients. Copyright &#xa9; The
Author 2016. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<94>
Accession Number
614678367
Author
Tsitsias T.; Toufektzian L.; Routledge T.; Pilling J.
Institution
(Tsitsias, Toufektzian, Routledge, Pilling) Department of Thoracic
Surgery, Guy's Hospital, Great Maze Pond, London SE1 9RT, United Kingdom
Title
Are there recognized prognostic factors for patients undergoing pulmonary
metastasectomy for colorectal carcinoma?.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (6) (pp 962-969),
2016. Date of Publication: 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether there is a
specific subgroup of patients that would benefit from pulmonary
metastasectomy for colorectal carcinoma (CRC). A total of 524 papers were
identified using the reported search, of which 1 meta-Analysis, 1
systematic review and 17 retrospective studies represented the best
evidence to answer the clinical question. The authors, date, journal,
country, study type, population, outcomes and key results are tabulated.
Single pulmonary metastasis (PM) was identified as an independent
prognostic favourable factor of survival in 5 of the studies (P =
0.059-0.001), whereas in 2 of the retrospective studies there was linear
inverse correlation between the number of PMs and survival (P =
0.005-0.001). The presence of involved hilar and/or mediastinal lymph
nodes was reported as a significant negative prognostic factor on
multivariate analysis in 7 of the studies (P = 0.042 to <0.001), whereas
the level and number of lymph node stations affected were not
statistically significant. Seven studies showed an elevated
pre-Thoracotomy carcinoembrionic antigen (CEA) level (>5 ng/ml) to be a
significant predictor of poor survival (P = 0.047-0.0008). In one of the
studies, sublobar resection (wedge or segmentectomy) was associated with
better survival compared with anatomic resection (P = 0.04). The size of
the tumour (maximum diameter >3.75 cm) was associated with worse survival
in 1 of the studies (P = 0.04), while another one reported size as a
continuous variable to be a prognostic factor of poor survival.
Synchronous chemotherapy (P = 0.027) on one study and neo-Adjuvant
chemotherapy prior to pulmonary metastasectomy (P = 0.0001) on another
were found to be favourable prognostic factors, while disease progression
during chemotherapy was associated with poor outcome in another paper (P <
0.0001). Patients older than 70 years were shown to have a worse prognosis
in one of the studies. Rectal position of the tumour was associated with
worse survival in one of the studies and worse disease-free interval in
another one. Finally, one report showed no significant difference in terms
of overall survival between thoracotomy and video-Assisted thoracoscopic
surgery groups. In conclusion, the prognostic factors for patients
undergoing pulmonary metastasectomy for CRC include the size and number of
metastases, intra-Thoracic lymph node involvement, pre-Thoracotomy CEA
levels and the response to induction chemotherapy. Copyright &#xa9; The
Author 2016. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<95>
Accession Number
614678286
Author
Shi J.; Bai Z.-X.; Zhang B.-G.; Ren W.-J.; Guo Y.-Q.
Institution
(Shi, Bai, Zhang, Ren, Guo) Department of Cardiovascular Surgery, West
China Hospital, Sichuan University, Chengdu, Sichuan, China
Title
A modified Cox maze IV procedure: A simpler technique for the surgical
treatment of atrial fibrillation.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (6) (pp 856-860),
2016. Date of Publication: 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES: To determine the effectiveness of a simplified surgical
treatment method for atrial fibrillation (AF). METHODS: Between September
2012 and October 2013, 120 patients (mean age, 52.3 +/- 8.8 years)
underwent valve surgery and concomitant bipolar radiofrequency ablation
for the treatment of AF. Patients were randomized to a Cox maze IV
procedure (CMP-IV) group (n = 60) or a modified CMP-IV (MCMP-IV) group (n
= 60). Freedom from AF was defined as freedom from any left atrial
arrhythmia lasting <30 s and no requirement of antiarrhythmic drugs after
6 months. Data were recorded at postoperative follow-up examinations,
which were scheduled at 1, 3, 6 and 12 months, and annually thereafter.
RESULTS: No ablation-related complications occurred in either group. The
mean ablation time was longer in the CMP-IV group than in the MCMP-IV
group (18.5 +/- 1.7 vs 16.6 +/- 1.6 min, P < 0.001). The mean follow-up
time was 32.4 +/- 3.6 months (range, 26-39 months). Freedom from AF tended
to be higher, but not significantly so, among the MCMP-IV group than among
the CMP-IV group over the entire follow-up period. CONCLUSIONS: The
MCMP-IV is an effective surgical procedure for the treatment of AF. In
certain patients, such as those with anatomic variations of the pulmonary
veins, the MCMP-IV is simpler than the CMP-IV. CLINICAL TRIALS
REGISTRATION ID: ChiCTR-TRC-12002742. Copyright &#xa9; The Author 2016.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<96>
Accession Number
615055053
Author
Chung M.J.; Novak E.; Brown D.L.
Institution
(Chung) Department of Medicine, Cardiovascular Division, Washington
University School of Medicine, St Louis, Missouri, USA
Title
Effect of early revascularization on outcomes in diabetic patients with
stable ischemic heart disease and previous myocardial infarction in the
bypass angioplasty investigation 2 diabetes trial.
Source
Coronary Artery Disease. (no pagination), 2017. Date of Publication: 24
Mar 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND: Survivors of a myocardial infarction (MI) are at a
considerable risk of developing further cardiovascular events, including
recurrent MI, heart failure, stroke, and death. Patients with type 2
diabetes mellitus and stable ischemic heart disease (SIHD) have worse
outcomes than their nondiabetic counterparts, and those with previous MI
may be at particularly high risk. Yet, little is known about the effect of
adding early revascularization to intensive medical therapy in this
high-risk group. PATIENTS AND METHODS: We carried out a post-hoc analysis
of the Bypass Angioplasty Revascularization 2 Diabetes trial, which
randomized patients with type 2 diabetes mellitus and SIHD to early
revascularization with percutaneous coronary intervention or coronary
artery bypass grafting in addition to intensive medical therapy or
intensive medical therapy alone. Previous MI status was defined by a
history of MI or pathologic Q-waves. The primary endpoints were death,
nonfatal or fatal MI, nonfatal or fatal stroke, congestive heart failure,
and a composite of death/MI/stroke. RESULTS: Of the 2280 patients with
evaluable data, 936 had previous MI. In these patients, there were no
differences in the 5-year event-free rates of all-cause death, MI, stroke,
congestive heart failure, or death/MI/stroke between those who were
randomized to early revascularization in addition to intensive medical
therapy and those who were randomized to intensive medical therapy alone.
CONCLUSION: In diabetic patients with SIHD and previous MI, adding early
revascularization to intensive medical therapy yielded no benefit compared
with intensive medical therapy alone. These findings underscore the
importance of intensive medical therapy in mitigating further ischemic
events. Copyright &#xa9; 2017 Wolters Kluwer Health, Inc. All rights
reserved.

<97>
Accession Number
610173586
Author
Li J.; Wang W.; Jiang L.; Yin W.; Liu J.; Shao W.; Chen H.; Ang K.-L.;
Jiao W.; Kang M.; He J.
Institution
(He) Department of Thoracic Surgery, First Affiliated Hospital of
Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, China
(Li, Wang, Jiang, Yin, Liu, Shao, Chen, Ang, Jiao, Kang) State Key
Laboratory of Respiratory Diseases, Guangzhou, China; National Clinical
Research Center for Respiratory Disease, Guangzhou, China; Department of
Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao,
China; Department of Thoracic Surgery, Fujian Medical University Union
Hospital, Fuzhou, China
Title
Video-Assisted Thoracic Surgery Resection and Reconstruction of Carina and
Trachea for Malignant or Benign Disease in 12 Patients: Three Centers'
Experience in China.
Source
Annals of Thoracic Surgery. 102 (1) (pp 295-303), 2016. Date of
Publication: 01 Jul 2016.
Publisher
Elsevier USA
Abstract
Background. Although video-assisted thoracoscopic surgery (VATS) has been
widely applied to both peripheral and central lung cancer treatment in
many centers, there is great hesitation to adopt it for carinal or
tracheal surgical procedures. The aims of this study were to explore the
feasibility of VATS in the treatment of benign and malignant diseases
involving the carina and trachea and to highlight relevant techniques.
Methods. Patients undergoing VATS carinal or tracheal procedures between
May 2012 and July 2015 from three centers in China were included in this
study. Their clinical characteristics, operative details, and
postoperative course were analyzed. Results. Twelve patients underwent
five different types of VATS airway reconstructions with or without
lobectomy: including right bronchial resection with partial carinal
reconstruction (3 patients), tracheal resection and reconstruction (4
patients), tracheal or right bronchial resection with carinal
reconstruction (3 patients), left bronchial resection with carinal
reconstruction (1 patient), and right pneumonectomy with carinal
reconstruction (1 patient). Complete resection was achieved in all
patients. The mean operative time was 224 +/- 78 minutes, and the median
time of the first anastomosis was 41 minutes (range, 15 to 60 minutes),
regardless of whether the reconstruction was a tracheal or carinal. The
median estimated blood loss was 100 mL (range 10 to 1000 mL). The mean
postoperative hospital stay was 12.5 +/- 2.5 days. There was no
perioperative mortality or major morbidity. Median duration of follow-up
was 12 months (range 5 to 43 months). Conclusions. VATS resection and
reconstruction of the carina or trachea are feasible, and these procedures
can be safely performed using the techniques described. We believe, with
the accumulation of VATS experience, these procedures could be adopted as
routine approaches in tracheal surgery. Copyright &#xa9; 2016 The Society
of Thoracic Surgeons.

<98>
Accession Number
614093266
Author
Picano E.; Ciampi Q.; Citro R.; D'Andrea A.; Scali M.C.; Cortigiani L.;
Olivotto I.; Mori F.; Galderisi M.; Costantino M.F.; Pratali L.; Di Salvo
G.; Bossone E.; Ferrara F.; Gargani L.; Rigo F.; Gaibazzi N.; Limongelli
G.; Pacileo G.; Andreassi M.G.; Pinamonti B.; Massa L.; Torres M.A.R.;
Miglioranza M.H.; Daros C.B.; De Castro E Silva Pretto J.L.; Beleslin B.;
Djordjevic-Dikic A.; Varga A.; Palinkas A.; Agoston G.; Gregori D.;
Trambaiolo P.; Severino S.; Arystan A.; Paterni M.; Carpeggiani C.;
Colonna P.
Institution
(Picano, Pratali, Gargani, Andreassi, Paterni, Carpeggiani) Institute of
Clinical Physiology, National Research Council, Pisa, Italy
(Ciampi) Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
(Citro, Bossone, Ferrara) Heart Department, University Hospital San
Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
(D'Andrea, Pacileo) Division of Cardiology, Monaldi Hospital, Second
University of Naples, Naples, Italy
(Scali) Cardiology Department, Pisa University, Nottola (Siena) Hospital,
Pisa, Italy
(Cortigiani) Cardiology Department, San Luca Hospital, Lucca, Italy
(Olivotto, Mori) Cardiology Department, Careggi Hospital, Florence, Italy
(Galderisi) Department of Advanced Biomedical Sciences, Federico II
University Hospital, Naples, Italy
(Costantino) Cardiology Department, San Carlo Hospital, Potenza, Italy
(Di Salvo) Pediatric Cardiology Department, Brompton Hospital, London,
United Kingdom
(Rigo) Division of Cardiology, Ospedale dell'Angelo Mestre-Venice, Mestre,
Italy
(Gaibazzi) Cardiology Department, Parma University Hospital, Parma, Italy
(Limongelli) Pediatric Cardiology Department, Monaldi Hospital Clinics,
Naples, Italy
(Pinamonti, Massa) Cardiology Department, University Hospital Ospedale
Riuniti, Trieste, Italy
(Torres) Hospital de Clinicas de Porto Alegre, Universidade Federal Do Rio
Grande Do sul, Porto Alegre, Brazil
(Miglioranza) Cardiology Institute of Rio Grande Do sul, Porto Alegre,
Brazil
(Daros) Cardiology Division, Hospital San Jose, Criciuma, Brazil
(De Castro E Silva Pretto) Hospital Sao Vicente de Paulo, Hospital de
Cidade, Passo Fundo, Brazil
(Beleslin, Djordjevic-Dikic) Cardiology Clinic, Clinical Center of Serbia,
Medical School, University of Belgrade, Belgrade, Serbia
(Varga, Agoston) Institute of Family Medicine, University of Szeged,
Szeged, Hungary
(Palinkas) Department of Internal Medicine, Elisabeth Hospital,
Hodmezovasarhely, Hungary
(Gregori) Department of Biostatistics, University of Padua, Padua, Italy
(Trambaiolo) Department of Cardiology, Sandro Pertini Hospital, Rome,
Italy
(Severino) Cardiology Department, Monaldi Hospital, Naples, Italy
(Arystan) RSE, Medical Centre Hospital of the President's Affairs
Administration of the Republic of Kazakhstan, Astana, Kazakhstan
(Colonna) Cardiology Hospital, Policlinico of Bari, Bari, Italy
Title
Stress echo 2020: The international stress echo study in ischemic and
non-ischemic heart disease.
Source
Cardiovascular Ultrasound. 15 (1) (no pagination), 2017. Article Number:
3. Date of Publication: 18 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Stress echocardiography (SE) has an established role in
evidence-based guidelines, but recently its breadth and variety of
applications have extended well beyond coronary artery disease (CAD). We
lack a prospective research study of SE applications, in and beyond CAD,
also considering a variety of signs in addition to regional wall motion
abnormalities. Methods: In a prospective, multicenter, international,
observational study design, > 100 certified high-volume SE labs (initially
from Italy, Brazil, Hungary, and Serbia) will be networked with an
organized system of clinical, laboratory and imaging data collection at
the time of physical or pharmacological SE, with structured follow-up
information. The study is endorsed by the Italian Society of
Cardiovascular Echography and organized in 10 subprojects focusing on:
contractile reserve for prediction of cardiac resynchronization or medical
therapy response; stress B-lines in heart failure; hypertrophic
cardiomyopathy; heart failure with preserved ejection fraction; mitral
regurgitation after either transcatheter or surgical aortic valve
replacement; outdoor SE in extreme physiology; right ventricular
contractile reserve in repaired Tetralogy of Fallot; suspected or initial
pulmonary arterial hypertension; coronary flow velocity, left ventricular
elastance reserve and B-lines in known or suspected CAD; identification of
subclinical familial disease in genotype-positive, phenotype- negative
healthy relatives of inherited disease (such as hypertrophic
cardiomyopathy). Results: We expect to recruit about 10,000 patients over
a 5-year period (2016-2020), with sample sizes ranging from 5,000 for
coronary flow velocity/ left ventricular elastance/ B-lines in CAD to
around 250 for hypertrophic cardiomyopathy or repaired Tetralogy of
Fallot. This data-base will allow to investigate technical questions such
as feasibility and reproducibility of various SE parameters and to assess
their prognostic value in different clinical scenarios. Conclusions: The
study will create the cultural, informatic and scientific infrastructure
connecting high-volume, accredited SE labs, sharing common criteria of
indication, execution, reporting and image storage of SE to obtain
original safety, feasibility, and outcome data in evidence-poor diagnostic
fields, also outside the established core application of SE in CAD based
on regional wall motion abnormalities. The study will standardize
procedures, validate emerging signs, and integrate the new information
with established knowledge, helping to build a next-generation SE lab
without inner walls. Copyright &#xa9; 2017 The Author(s).

<99>
Accession Number
614850254
Author
Hothem Z.; Baker D.; Jenkins C.S.; Douglas J.; Callahan R.E.; Shuell C.C.;
Long G.W.; Welsh R.J.
Institution
(Hothem, Baker, Jenkins, Douglas, Callahan, Long, Welsh) Department of
Surgery, Beaumont Health, Royal Oak, Michigan, United States
(Shuell) Department of Quality, Safety, Standards and Outcomes, Beaumont
Health, Royal Oak, Michigan, United States
Title
Predictors of readmission in nonagenarians: analysis of the American
College of Surgeons National Surgical Quality Improvement Project dataset.
Source
Journal of Surgical Research. 213 (pp 32-38), 2017. Date of Publication:
01 Jun 2017.
Publisher
Academic Press Inc. (E-mail: apjcs@harcourt.com)
Abstract
Background Increased longevity has led to more nonagenarians undergoing
elective surgery. Development of predictive models for hospital
readmission may identify patients who benefit from preoperative
optimization and postoperative transition of care intervention. Our goal
was to identify significant predictors of 30-d readmission in
nonagenarians undergoing elective surgery. Methods Nonagenarians
undergoing elective surgery from January 2011 to December 2012 were
identified using the American College of Surgeons National Surgical
Quality Improvement Project participant use data files. This population
was randomly divided into a 70% derivation cohort for model development
and 30% validation cohort. Using multivariate step-down regression,
predictive models were developed for 30-d readmission. Results Of 7092
nonagenarians undergoing elective surgery, 798 (11.3%) were readmitted
within 30 d. Factors significant in univariate analysis were used to
develop predictive models for 30-d readmissions. Diabetes (odds ratio
[OR]: 1.51, 95% confidence interval [CI]: 1.24-1.84), dialysis dependence
(OR: 2.97, CI: 1.77-4.99), functional status (OR: 1.52, CI: 1.29-1.79),
American Society of Anesthesiologists class II or higher (American Society
of Anesthesiologist physical status classification system; OR: 1.80, CI:
1.42-2.28), operative time (OR: 1.05, CI: 1.02-1.08), myocardial
infarction (OR: 5.17, CI: 3.38-7.90), organ space surgical site infection
(OR: 8.63, CI: 4.04-18.4), wound disruption (OR: 14.3, CI: 4.80-42.9),
pneumonia (OR: 8.59, CI: 6.17-12.0), urinary tract infection (OR: 3.88,
CI: 3.02-4.99), stroke (OR: 6.37, CI: 3.47-11.7), deep venous thrombosis
(OR: 5.96, CI: 3.70-9.60), pulmonary embolism (OR: 20.3, CI: 9.7-42.5),
and sepsis (OR: 13.1, CI: 8.57-20.1), septic shock (OR: 43.8, CI:
18.2-105.0), were included in the final model. This model had a
c-statistic of 0.73, indicating a fair association of predicted
probabilities with observed outcomes. However, when applied to the
validation cohort, the c-statistic dropped to 0.69, and six variables lost
significance. Conclusions A reliable predictive model for readmission in
nonagenarians undergoing elective surgery remains elusive. Investigation
into other determinants of surgical outcomes, including social factors and
access to skilled home care, might improve model predictability, identify
areas for intervention to prevent readmission, and improve quality of
care. Copyright &#xa9; 2017 Elsevier Inc.

<100>
[Use Link to view the full text]
Accession Number
614538458
Author
Chen S.-L.; Santoso T.; Zhang J.-J.; Ye F.; Xu Y.-W.; Fu Q.; Kan J.; Zhang
F.-F.; Zhou Y.; Xie D.-J.; Kwan T.W.
Institution
(Chen, Zhang, Ye, Kan, Zhang) Division of Cardiology, Nanjing First
Hospital, Nanjing Medical University, 68 Changle Rd, Nanjing 210006, China
(Santoso) Division of Cardiology, Medistra Hospital, University of
Indonesia Medical School, Jakarta, Indonesia
(Xu) Division of Cardiology, Shanghai 10th People's Hospital, China
(Fu) Division of Cardiology, Xuzhou Central Hospital, China
(Zhou) Division of Cardiology, Zhangjiagang People's Hospital, China
(Xie) Division of Cardiology, Huainan Xinhua Hospital, China
(Kwan) Division of Cardiology, Beth Israel Hospital, New York, NY, United
States
Title
Clinical Outcome of Double Kissing Crush Versus Provisional Stenting of
Coronary Artery Bifurcation Lesions.
Source
Circulation: Cardiovascular Interventions. 10 (2) (no pagination), 2017.
Article Number: e004497. Date of Publication: 01 Feb 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Provisional stenting is effective for anatomic simple
bifurcation lesions. Double kissing crush stenting reduces the 1-year rate
of target lesion revascularization. This study aimed to investigate the
5-year clinical results of the DKCRUSH-II study (Randomized Study on
Double Kissing Crush Technique Versus Provisional Stenting Technique for
Coronary Artery Bifurcation Lesions). Methods and Results - A total of 370
patients with coronary bifurcation lesions who were randomly assigned to
either the double kissing crush or provisional stenting group in the
DKCRUSH-II study were followed for 5 years. The primary end point was the
occurrence of a major adverse cardiac event at 5 years. Patients were
classified by simple and complex bifurcation lesions according to the
DEFINITION criteria (Definitions and Impact of Complex Bifurcation Lesions
on Clinical Outcomes After Percutaneous Coronary Intervention Using
Drug-Eluting Stents). At 5 years, the major adverse cardiac event rate
(23.8%) in the provisional stenting group was insignificantly different to
that of the double kissing group (15.7%; P=0.051). However, the difference
in the target lesion revascularization rate between 2 groups was sustained
through the 5-year follow-up (16.2% versus 8.6%; P=0.027). The definite
and probable stent thrombosis rate was 2.7% in each group (P=1.0). Complex
bifurcation was associated with a higher rate of target lesion
revascularization (21.6%) at 5 years compared with 11.1% in patients with
a simple bifurcation (P=0.037), with an extremely high rate in the
provisional stenting group (36.8% versus 12.5%, P=0.005) mainly because of
final kissing balloon inflation (19.4% versus 5.2%; P=0.036). Conclusions
- The double kissing crush stenting technique for coronary bifurcation
lesions is associated with a lower rate of target lesion
revascularization. The optimal stenting approach based on the lesions'
complexity may improve the revascularization for patients with complex
bifurcations. Clinical Trial Registration - URL: http://www.chictr.org.
Unique identifier: ChiCTR-TRC-0000015. Copyright &#xa9; 2017 The Authors.

<101>
Accession Number
614538407
Author
Rossini R.; Iorio A.; Pozzi R.; Bianco M.; Musumeci G.; Leonardi S.;
Lettieri C.; Bossi I.; Colombo P.; Rigattieri S.; Dossena C.; Anzuini A.;
Capodanno D.; Senni M.; Angiolillo D.J.
Institution
(Rossini, Iorio, Musumeci, Senni) Dipartimento Cardiovascolare, ASST Papa
Giovanni XXIII, Piazza OMS, 1, Bergamo 24127, Italy
(Pozzi, Bianco) Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano
Torino, Italy
(Leonardi) IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
(Lettieri) Divisione di Cardiologia, Ospedale Carlo Poma, Mantova, Italy
(Bossi, Colombo) Cardiologia 1 Emodinamica, Dipartimento Cardiovascolare,
ASST Niguarda Grande Ospedale Metropolitano, Milano, Italy
(Rigattieri) U.O. Emodinamica, Ospedale Sandro Pertini, Roma, Italy
(Dossena) Universita Degli Studi di Pavia, Italy
(Anzuini) Unita Operativa di Cardiologia, Humanitas Mater Domini,
Castellanza (Varese), Italy
(Capodanno) Cardio-Thoracic-Vascular Department, Ferrarotto Hospital,
University of Catania, Italy
(Angiolillo) Division of Cardiology, University of Florida College of
Medicine, Jacksonville, United States
Title
Aspirin Desensitization in Patients with Coronary Artery Disease.
Source
Circulation: Cardiovascular Interventions. 10 (2) (no pagination), 2017.
Article Number: e004368. Date of Publication: 01 Feb 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - There are limited data on aspirin (ASA) desensitization for
patients with coronary artery disease. The aim of the present study was to
assess the safety and efficacy of a standard rapid desensitization
protocol in patients with ASA sensitivity undergoing coronary angiography.
Methods and Results - This is a prospective, multicenter, observational
study including 7 Italian centers including patients with a history of ASA
sensitivity undergoing coronary angiography with intent to undergo
percutaneous coronary intervention. A total of 330 patients with history
of ASA sensitivity with known/suspected stable coronary artery disease or
presenting with an acute coronary syndrome, including ST-segment-elevation
myocardial infarction were enrolled. Adverse effects to aspirin included
urticaria (n=177, 53.6%), angioedema (n=69, 20.9%), asthma (n=65, 19.7%),
and anaphylactic reaction (n=19, 5.8%). Among patients with
urticaria/angioedema, 13 patients (3.9%) had a history of idiopathic
chronic urticaria. All patients underwent a rapid ASA (5.5 hours)
desensitization procedure. The desensitization procedure was performed
before cardiac catheterization in all patients, except for those (n=78,
23.6%) presenting with ST-segment-elevation myocardial infarction who
underwent the desensitization after primary percutaneous coronary
intervention. Percutaneous coronary intervention was performed in 235
patients (71%) of the overall study population. The desensitization
procedure was successful in 315 patients (95.4%) and in all patients with
a history of anaphylactic reaction. Among the 15 patients (4.6%) who did
not successfully respond to the desensitization protocol, adverse
reactions were minor and responded to treatment with corticosteroids and
antihistamines. Among patients with successful in-hospital ASA
desensitization, 253 patients (80.3%) continued ASA for at least 12
months. Discontinuation of ASA in the 62 patients (19.7%) who had
responded to the desensitization protocol was because of medical decision
and not because of hypersensitivity reactions. Conclusions - A standard
rapid desensitization protocol is safe and effective across a broad
spectrum of patients, irrespective of the type of aspirin sensitivity
manifestation, with indications to undergo coronary angiography with
intent to perform percutaneous coronary intervention. Clinical Trial
Registration - URL: http://www.clinicaltrials.gov. Unique identifier:
NCT02848339. Copyright &#xa9; 2017 American Heart Association, Inc.

<102>
Accession Number
612362080
Author
Pearson K.L.; Hall N.J.
Institution
(Pearson) Department of General Surgery, Queen Alexandra Hospital,
Portsmouth, United Kingdom
(Pearson, Hall) University Surgery Unit, Faculty of Medicine, University
of Southampton, Southampton, United Kingdom
(Hall) Department of Paediatric Surgery and Urology, Southampton
Children's Hospital, Southampton, United Kingdom
Title
What is the role of enhanced recovery after surgery in children? A scoping
review.
Source
Pediatric Surgery International. 33 (1) (pp 43-51), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Enhanced recovery after surgery (ERAS) pathways are standard
practice in adult specialties resulting in improved outcomes. It is
unclear whether ERAS principles are applicable to Paediatric Surgery. We
performed a scoping review to identify the extent to which ERAS has been
used in Paediatric Surgery, the nature of interventions, and outcomes.
Methods: Pubmed, Cochrane library, Google Scholar, and Embase were
searched using the terms enhanced recovery, post-operative
protocol/pathway, fast track surgery, and paediatric surgery. Studies were
excluded if they did not include abdominal/thoracic/urological procedures
in children. Results: Nine studies were identified (2003-2014; total 1269
patients): three case control studies, one retrospective review and five
prospective implementations, no RCTs. Interventional elements identified
were post-operative feeding, mobilisation protocols, morphine-sparing
analgesia, reduced use of nasogastric tubes and urinary catheters.
Outcomes reported included post-operative length of stay (LOS), time to
oral feeding and stooling, complications, and parent satisfaction.
Fast-track programmes significantly reduced LOS in 6/7 studies, time to
oral feeding in 3/3 studies, and time to stooling in 2/3 studies.
Conclusion: The use of ERAS pathways in Paediatric surgery appears very
limited but such pathways may have benefits in children. Prospective
studies should evaluate interventions used in adult ERAS on appropriate
outcomes in the paediatric setting. Copyright &#xa9; 2016, Springer-Verlag
Berlin Heidelberg.

<103>
Accession Number
614926838
Author
Sanders J.; Cooper J.; Mythen M.G.; Montgomery H.E.
Institution
(Sanders) St Bartholomew's Hospital, Barts Health NHS Trust, London,
United Kingdom
(Sanders, Mythen, Montgomery) Institute for Sport, Exercise and Health,
University College London, 1st Floor 170 Tottenham Court Rd, London W1T
7HA, United Kingdom
(Cooper) Centre for Cardiovascular Genetics, University College London,
London, United Kingdom
(Mythen) Department of Anaesthesia, University College London Hospitals
NHS Trust, London, United Kingdom
Title
Predictors of total morbidity burden on days 3, 5 and 8 after cardiac
surgery.
Source
Perioperative Medicine. 6 (1) (no pagination), 2017. Article Number: 2.
Date of Publication: 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Post-operative morbidity affects up to 36% of cardiac surgical
patients. However, few countries reliably record morbidity outcome data,
despite patients wanting to be informed of all the risks associated with
surgery. The Cardiac Post-Operative Morbidity Score (C-POMS) is a new tool
for describing and scoring (0-13) total morbidity burden after cardiac
surgery, derived by noting the presence/absence of 13 morbidity domains on
days 3, 5, 8 and 15. Identifying modifiable C-POMS risk factors may
suggest targets for intervention to reduce morbidity and healthcare costs.
Thus, we explored the association of C-POMS with previously identified
predictors of post-operative morbidity. Methods: A systematic literature
review of pre-operative risk assessment models for post-operative
morbidity was conducted to identify variables associated with
post-operative morbidity. The association of those variables with C-POMS
was explored in patients drawn from the original C-POMS study (n = 444).
Results: Seventy risk factors were identified, of which 56 were available
in the study and 49 were suitable for analysis. Numbers were too few to
analyse associations on D15. Thirty-three (67.3%) and 20 (40.8%) variables
were associated with C-POMS on at least 1 or 2 days, respectively.
Pre-operative albumin concentration, left ventricular ejection fraction
and New York Heart Association functional class were associated with
C-POMS on all days. Of the 16 independent risk factors, pre-operative
albumin and haemoglobin concentrations and weight are potentially
modifiable. Conclusions: Different risk factors are associated with total
morbidity burden on different post-operative days. Preoperative albumin
and haemoglobin concentrations and weight were independently predictive of
post-operative total morbidity burden suggesting therapeutic interventions
aimed at these might reduce both post-operative morbidity risk and
health-care costs in patients undergoing cardiac surgery. Copyright &#xa9;
The Author(s). 2017.

<104>
Accession Number
611990335
Author
Mukete B.N.; Riehl R.A.; Alonso A.; Samson R.; Jaiswal A.; Le Jemtel T.H.
Institution
(Mukete, Alonso, Samson, Jaiswal, Le Jemtel) Division of Cardiology,
Department of Medicine, Tulane University School of Medicine, Heart and
Vascular Institute, 1430 Tulane Avenue, SL-48, New Orleans, LA 70112,
United States
(Riehl) Tulane University School of Medicine, New Orleans, LA, United
States
Title
Multivessel Revascularization Does Not Increase Contrast-Induced Acute
Kidney Injury Incidence in Acute Myocardial Infarction: A Meta-Analysis.
Source
American Journal of Cardiovascular Drugs. 16 (6) (pp 419-426), 2016. Date
of Publication: 01 Dec 2016.
Publisher
Springer International Publishing
Abstract
Background: Recent studies and meta-analysis have shown that complete
revascularization (CR) compared with infarct-related artery
revascularization (IRA) during percutaneous coronary intervention for
ST-segment elevation myocardial infarction (STEMI) is associated with
decreased mortality. However, it is unclear if CR versus IRA in STEMI
during indexed hospitalization is associated with risk of contrast-induced
acute kidney injury (CI-AKI). Methods: A database search was conducted for
all randomized controlled trials that enrolled STEMI patients and compared
CR versus IRA and reported CI-AKI. Comprehensive Meta-Analysis Version 2.0
(Wiley, Chichester) was used to determine summary effect size with a
fixed-effect model and expressed as a risk ratio with 95 % confidence
intervals. Results: A total of four trials were identified and had a mean
follow-up of 24.5 +/- 9.9 months, a total sample size of 1537, a mean age
of 63.8 +/- 1.2 versus 64.2 +/- 2.1 years, 31.2 +/- 5.3 versus 30.1 +/-
4.7 % three-vessel disease, and 33.7 +/- 4.1 versus 37.2 +/- 4.5 %
anterior STEMI in the CR versus IRA groups, respectively. A total of 276.7
+/- 25.2 versus 186.7 +/- 15.3 mL contrast was used in the CR versus IRA
respectively (p = 0.006). There were no statistical significant
differences between the two groups in the reported incidence of CI-AKI
(1.3 % CR vs. 1.9 % IRA; p = 0.4), major bleeding (1.7 % CR vs. 2.5 % IRA;
p = 0.4) and stroke (1.1 % CR vs. 0.4 % IRA; p = 0.24). However, there was
a significantly increased incidence of cardiovascular death (2.0 % CR vs.
4.7 % IRA; p = 0.01) and ischemia-driven revascularization (6.2 % CR vs.
18.3 % IRA; p < 0.01). Conclusion: In the index hospitalization, CR in
STEMI patients is associated with significant risk reduction in cardiac
death and revascularization and a non-significant reduced trend of CI-AKI,
despite increased use of contrast when compared with IRA. Copyright &#xa9;
2016, Springer International Publishing Switzerland.

<105>
Accession Number
609036692
Author
Wijeysundera D.N.; Pearse R.M.; Shulman M.A.; Abbott T.E.F.; Torres E.;
Croal B.L.; Granton J.T.; Thorpe K.E.; Grocott M.P.W.; Farrington C.;
Myles P.S.; Cuthbertson B.H.; Wallace S.; Thompson B.; Ellis M.; Borg B.;
Kerridge R.; Douglas J.; Brannan J.; Pretto J.; Godsall M.G.; Beauchamp
N.; Allen S.; Kennedy A.; Wright E.; Malherbe J.; Ismail H.; Riedel B.;
Melville A.; Sivakumar H.; Murmane A.; Kenchington K.; Gurunathan U.;
Stonell C.; Brunello K.; Steele K.; Tronstand O.; Masel P.; Dent A.; Smith
E.; Bodger A.; Abolfathi M.; Sivalingam P.; Hall A.; Painter T.; Elliott
A.; Carrera A.M.; Terblanche N.C.S.; Pitt S.; Samuels J.; Wilde C.;
MacCormick M.; Leslie K.; Bramley D.; Southcott A.M.; Grant J.; Taylor H.;
Bates S.; Towns M.; Tippett A.; Marshall F.; Mazer C.D.; Kunasingam J.;
Yagnik A.; Crescini C.; McCartney C.J.L.; Choi S.; Somascanthan P.; Flores
K.; Beattie W.S.; Karkouti K.; Clarke H.A.; Jerath A.; McCluskey S.A.;
Wasowicz M.; Day L.; Pazmino-Canizares J.; Oh P.; Belliard R.; Lee L.;
Dobson K.; Chan V.; Brull R.; Ami N.; Stanbrook M.; Kagen K.; Campbell D.;
Short T.; Van Der Westhuizen J.; Higgie K.; Lindsay H.; Jang R.; Wong C.;
McAllister D.; Ali M.; Kumar J.; Waymouth E.; Dimech J.; Lorimer M.; Sara
R.; Collingwood A.; Olliff S.; Gabriel S.; Houston H.; Dalley P.; Hurford
S.; Hunt A.; Andrews L.; Navarra L.; Jason-Smith A.; Lum M.; Martin D.;
James S.; Phull M.; Beilstein C.; Bodger P.; Everingham K.; Hu Y.;
Niebrzegowska E.; Corriea C.; Creary T.; Januszekska M.; Ahmad T.; Whalley
J.; Haslop R.; McNeil J.; Brown A.; MacDonald N.; Jhani S.; Raobaikady R.;
Black E.; Rooms M.; Lawrence H.; Jack S.; Celinski M.; Levett D.; Edwards
M.; Salmon K.; Bolger C.; Loughney L.; Seaward L.; Collins H.; Tyrell B.;
Tantony N.; Golder K.; Ackland G.; Stephens R.C.M.; Gagello-Paredes L.;
Raj A.; Lifford R.; Melo M.; Mamdani M.; Hillis G.; Wijeysundera H.C.
Institution
(Wijeysundera) St. Michael's Hospital, Toronto General Hospital,
University of Toronto, Toronto, ON, Canada
(Pearse, Abbott) Queen Mary University of London, London, United Kingdom
(Shulman, Farrington, Myles) Alfred Hospital, Monash University,
Melbourne, VIC, Australia
(Torres) St. Michael's Hospital, Toronto, ON, Canada
(Croal) NHS Grampian, Aberdeen, United Kingdom
(Granton) University Health Network, Mount Sinai Hospital, University of
Toronto, Toronto, ON, Canada
(Thorpe) University of Toronto, St. Michael's Hospital, Toronto, ON,
Canada
(Grocott) University Hospital Southampton, University of Southampton,
Southampton, United Kingdom
(Cuthbertson) Sunnybrook Health Sciences Centre, University of Toronto,
Toronto, ON, Canada
Title
Measurement of Exercise Tolerance before Surgery (METS) study: A protocol
for an international multicentre prospective cohort study of
cardiopulmonary exercise testing prior to major non-cardiac surgery.
Source
BMJ Open. 6 (3) (no pagination), 2016. Article Number: e010359. Date of
Publication: 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: Preoperative functional capacity is considered an important
risk factor for cardiovascular and other complications of major
non-cardiac surgery. Nonetheless, the usual approach for estimating
preoperative functional capacity, namely doctors' subjective assessment,
may not accurately predict postoperative morbidity or mortality. 3
possible alternatives are cardiopulmonary exercise testing; the Duke
Activity Status Index, a standardised questionnaire for estimating
functional capacity; and the serum concentration of N-terminal pro-B-type
natriuretic peptide (NT pro-BNP), a biomarker for heart failure and
cardiac ischaemia. Methods and analysis: The Measurement of Exercise
Tolerance before Surgery (METS) Study is a multicentre prospective cohort
study of patients undergoing major elective non-cardiac surgery at 25
participating study sites in Australia, Canada, New Zealand and the UK. We
aim to recruit 1723 participants. Prior to surgery, participants undergo
symptom-limited cardiopulmonary exercise testing on a cycle ergometer,
complete the Duke Activity Status Index questionnaire, undergo blood
sampling to measure serum NT pro-BNP concentration and have their
functional capacity subjectively assessed by their responsible doctors.
Participants are followed for 1 year after surgery to assess vital status,
postoperative complications and general health utilities. The primary
outcome is all-cause death or non-fatal myocardial infarction within 30
days after surgery, and the secondary outcome is all-cause death within 1
year after surgery. Both receiver-operating-characteristic curve methods
and risk reclassification table methods will be used to compare the
prognostic accuracy of preoperative subjective assessment, peak oxygen
consumption during cardiopulmonary exercise testing, Duke Activity Status
Index scores and serum NT pro- BNP concentration. Ethics and
dissemination: The METS Study has received research ethics board approval
at all sites. Participant recruitment began in March 2013, and 1- year
follow-up is expected to finish in 2016. Publication of the results of the
METS Study is anticipated to occur in 2017.

<106>
Accession Number
611521903
Author
Jones P.M.; Bainbridge D.; Chu M.W.A.; Fernandes P.S.; Fox S.A.; Iglesias
I.; Kiaii B.; Lavi R.; Murkin J.M.
Institution
(Jones, Bainbridge, Iglesias, Lavi, Murkin) Department of Anesthesia &
Perioperative Medicine, University of Western Ontario, London, ON, Canada
(Jones, Bainbridge, Iglesias, Lavi, Murkin) Schulich School of Medicine &
Dentistry, The University of Western Ontario, London, ON, Canada
(Jones, Bainbridge) Program in Critical Care, Department of Medicine, The
University of Western Ontario, London, ON, Canada
(Jones) Department of Epidemiology & Biostatistics, University of Western
Ontario, London, ON, Canada
(Chu, Fox, Kiaii) Division of Cardiac Surgery, Department of Surgery, The
University of Western Ontario, London, ON, Canada
(Fernandes) Clinical Perfusion Services, Cardiac Care, London Health
Sciences Centre, London, ON, Canada
(Jones) University Hospital - London Health Sciences Centre, Room C3-110,
339 Windermere Rd, London, ON N6A 5A5, Canada
Title
Comparison of isoflurane and sevoflurane in cardiac surgery: a randomized
non-inferiority comparative effectiveness trial.
Source
Canadian Journal of Anesthesia. 63 (10) (pp 1128-1139), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Volatile anesthetics possess cardioprotective properties, but it
is unknown if the cardioprotective effects extend equally to all members
of the class. Although sevoflurane is a relatively newer anesthetic than
isoflurane, its introduction into practice was not preceded by a
head-to-head comparison with isoflurane in a trial focusing on clinically
important outcomes. Our objective was to determine whether sevoflurane was
non-inferior to isoflurane on a clinically important primary outcome in a
heterogeneous group of adults undergoing cardiac surgery. Methods: This
was a pragmatic randomized non-inferiority comparative effectiveness
clinical trial in 464 adults having coronary artery bypass graft and/or
single valve surgery during November 2011 to March 2014. The intervention
was maintenance of anesthesia with sevoflurane (n = 231) or isoflurane (n
= 233) administered at a dose of 0.5-2.0 MAC throughout the entire
operation. All caregivers were blinded except for the anesthesiologist and
perfusionist. The primary outcome was a composite of intensive care unit
(ICU) length of stay > 48 hr and all-cause 30-day mortality. We
hypothesized that sevoflurane would be non-inferior to isoflurane
(non-inferiority margin < 10% based on an expected event rate of 25%).
Secondary outcomes included prolonged ICU stay, 30- and 365-day all-cause
mortality, inotrope or vasopressor usage, new-onset hemodialysis or atrial
fibrillation, stroke, and readmission to the ICU. Results: No losses to
follow-up occurred. The primary outcome occurred in 25% of sevoflurane
patients and 30% of isoflurane patients (absolute difference, -5.4%;
one-sided 95% confidence interval, 1.4), thus non-inferiority was
declared. Sevoflurane was not superior to isoflurane for the primary
outcome (P = 0.21) or for any secondary outcomes. Conclusion: Sevoflurane
is non-inferior to isoflurane on a composite outcome of prolonged ICU stay
and all-cause 30-day mortality. Sevoflurane is not superior to isoflurane
on any other of the clinically important outcomes. This trial was
registered at clinicaltrials.gov; NCT01477151. Copyright &#xa9; 2016, The
Author(s).

<107>
Accession Number
612633097
Author
Schwann T.A.; Habib J.R.; Khalifeh J.M.; Nauffal V.; Bonnell M.; Clancy
C.; Engoren M.C.; Habib R.H.
Institution
(Schwann, Bonnell, Clancy) Department of Surgery, University of Toledo
College of Medicine, Toledo, Ohio, United States
(Schwann, Engoren) Mercy Saint Vincent Medical Center, Toledo, Ohio,
United States
(Habib, Khalifeh, Nauffal, Habib) Department of Internal Medicine,
Outcomes Research Unit and Vascular Medicine Program, American University
of Beirut, Beirut, Lebanon
(Nauffal) Department of Medicine, Johns Hopkins Medical Institutes,
Baltimore, Maryland, United States
(Engoren) Department of Anesthesiology, University of Michigan, Ann Arbor,
Michigan, United States
Title
Effects of Blood Transfusion on Cause-Specific Late Mortality After
Coronary Artery Bypass Grafting-Less Is More.
Source
Annals of Thoracic Surgery. 102 (2) (pp 465-473), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Elsevier USA
Abstract
Background Red blood cell transfusion after coronary artery bypass graft
surgery has been associated with increased late all-cause death. Yet,
whether this association is, first, independent of the packed red blood
cells and perioperative morbidity association, and second, of a cardiac
versus noncardiac etiology remains unknown. Methods We analyzed patients
undergoing coronary artery bypass graft surgery at two Ohio hospitals (n =
6,947) from 1994 to 2007. Salvage operations and patients with
preoperative renal failure were excluded. Long-term outcomes and leading
cause of death (cardiac, noncardiac, all cause) were derived from the US
Social Security Death Index and later from Ohio Department of Health Death
Index. Fifteen-year mortality cumulative incidence functions were compared
for transfusion groups (yes, n = 2,540; no, n = 4,806) overall, and then
stratified based on perioperative complications status (yes, n = 2,638;
no, n = 4,708). Comprehensive, 32 covariates, risk-adjusted transfusion
effects were estimated by competing risk regression. Results were
confirmed by propensity score adjusted analysis. Results Perioperative
transfusions and complications occurred in 33.9% and 35.2% of patients,
respectively. In all, 3,108 deaths (48.1%) have been documented (median
time to death, 7.43 years). Both transfusion rates (25.6% versus 49.1%, p
< 0.001) and deaths (58.2% versus 38.5%, p < 0.001) were more frequent
among complications patients. Red blood cells transfusion increased
intermediate to late mortality risk overall (15-year adjusted hazard ratio
[AHR] 1.21, 95% confidence interval [CI]: 1.11 to 1.31), and for
complications (AHR 1.24, 95% CI: 1.11 to 1.39) and no complications (AHR
1.16, 95% CI: 1.03 to 1.31). The increased mortality was true for cardiac
and noncardiac etiologies (AHR 1.19, 95% CI: 1.03 to 1.36, and AHR 1.14,
95% CI: 1.01 to 1.29, respectively). Red blood cell transfusion increased
mostly cardiac deaths (AHR 1.38, 95% CI: 1.14 to 1.66) among the
complications group, and noncardiac mortality (AHR 1.24, 95% CI: 1.05 to
1.47) for the no complications group. A parallel propensity matched
sensitivity analysis confirmed these findings. Conclusions Perioperative
red blood cells transfusion is associated with significant adverse late
death effects among both complicated patients and noncomplicated patients,
principally seen between 0 and 5 years postoperatively, and is driven by
both increased cardiovascular and noncardiovascular mortality. Further
studies are needed to elucidate the mechanisms behind these findings,
including their potential dose dependence. Copyright &#xa9; 2016 The
Society of Thoracic Surgeons

<108>
Accession Number
612633059
Author
He G.-W.; Taggart D.P.
Institution
(He) Department of Cardiovascular Surgery and Center for Basic Medical
Research, TEDA International Cardiovascular Hospital, Chinese Academy of
Medical Sciences & Peking Union Medical College, Tianjin and Zhejiang
University and The Affiliated Hospital of Hangzhou Normal University,
Hangzhou, China, Department of Surgery, Oregon Health and Science
University, Portland, Oregon, United States
(Taggart) Department of Cardiothoracic Surgery, Oxford University, United
Kingdom
Title
Antispastic Management in Arterial Grafts in Coronary Artery Bypass
Grafting Surgery.
Source
Annals of Thoracic Surgery. 102 (2) (pp 659-668), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Elsevier USA
Abstract
Arterial grafts have long-term patency superior to vein grafts but have a
tendency to develop spasm that can lead to potentially life-threatening
complications. A perfect antispastic protocol should include advanced
surgical technique and adequate pharmacologic methods. All pharmacologic
vasodilator drugs relax the vessel through specific mechanisms, and
therefore, there is no perfect, single best vasodilator to prevent or
treat spasm of the arterial graft against all mechanisms of contraction.
One of the choices is to use a combination of pharmacologic vasodilators
targeting different mechanisms of spasm to obtain the reliable and best
effect. Copyright &#xa9; 2016 The Society of Thoracic Surgeons

<109>
Accession Number
609434923
Author
de Caterina R.; Husted S.; Wallentin L.; Andreotti F.; Arnesen H.;
Bachmann F.; Baigent C.; Collet J.-P.; Halvorsen S.; Huber K.; Jespersen
J.; Kristensen S.D.; Lip G.Y.H.; Morais J.; Rasmussen L.H.; Ricci F.;
Sibbing D.; Siegbahn A.; Storey R.F.; ten Berg J.; Verheugt F.W.A.; Weitz
J.I.
Institution
(de Caterina, Ricci) "G. d'Annunzio" University, Chieti and Fondazione
Toscana "G. Monasterio", Pisa, Italy
(Husted) University of Aarhus, Aarhus, Denmark
(Wallentin, Siegbahn) Uppsala Clinical Research Center, University of
Uppsala, Sweden
(Andreotti) Catholic University, Rome, Italy
(Arnesen, Halvorsen) Oslo University Hospital Ulleval and University of
Oslo, Oslo, Norway
(Bachmann) University of Lausanne, Lausanne, Switzerland
(Baigent) University of Oxford, Oxford, United Kingdom
(Collet) INSERM UMRS-ICAN 1166, Groupe Hospitalier Pitie-Salpetriere,
Paris, France
(Huber) Wilhelminenhospital, Vienna, Austria
(Jespersen) University of Southern Denmark, Esbjerg, Denmark
(Kristensen) Aarhus University Hospital, Aarhus, Denmark
(Lip) University of Birmingham Institute of Cardiovascular Sciences, City
Hospital, Birmingham, United Kingdom
(Morais) Hospital Santo Andre, Leiria, Portugal
(Rasmussen) Aalborg University, Aalborg, Denmark
(Sibbing) Medizinische Klinik und Poliklinik I, Klinikum der Universitat
Munchen, Ludwig- Maximilians-Universitat Munchen, Munich, Germany
(Storey) University of Sheffield, Sheffield, United Kingdom
(ten Berg) St Antonius Hospital, Nieuwegein, Netherlands
(Verheugt) Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
(Weitz) McMaster University and Thrombosis and Atherosclerosis Research
Institute, Hamilton, ON, Canada
Title
Oral anticoagulants in coronary heart disease (Section IV): Position paper
of the ESC working group on thrombosis - Task force on anticoagulants in
heart disease.
Source
Thrombosis and Haemostasis. 115 (4) (pp 685-711), 2016. Date of
Publication: April 2016.
Publisher
Schattauer GmbH (E-mail: info@schattauer.de)
Abstract
Until recently, vitamin K antagonists (VKAs) were the only available oral
anticoagulants evaluated for long-term treatment of patients with coronary
heart disease (CHD), particularly after an acute coronary syndrome (ACS).
Despite efficacy in this setting, VKAs are rarely used because they are
cumbersome to administer. Instead, the more readily manageable
antiplatelet agents are the mainstay of prevention in ACS patients. This
situation has the potential to change with the introduction of non-VKA
oral anticoagulants (NOACs), which are easier to administer than VKAs
because they can be given in fixed doses without routine coagulation
monitoring. The NOACs include dabigatran, which inhibits thrombin, and
apixaban, rivaroxaban and edoxaban, which inhibit factor Xa. Apixaban and
rivaroxaban were evaluated in phase III trials for prevention of recurrent
ischaemia in ACS patients, most of whom were also receiving dual
antiplatelet therapy with aspirin and clopidogrel. Although at the doses
tested rivaroxaban was effective and apixaban was not, both agents
increased major bleeding. The role for the NOACs in ACS management,
although promising, is therefore complicated, because it is uncertain how
they compare with newer antiplatelet agents, such as prasugrel, ticagrelor
or vorapaxar, and because their safety in combination with these other
drugs is unknown. Ongoing studies are also now evaluating the use of NOACs
in non-valvular atrial fibrillation patients, where their role is
established, with coexistent ACS or coronary stenting. Focusing on CHD, we
review the results of clinical trials with the NOACs and provide a
perspective on their future incorporation into clinical practice.
Copyright &#xa9; Schattauer 2016.

<110>
Accession Number
608912414
Author
Chin C.W.L.; Messika-Zeitoun D.; Shah A.S.V.; Lefevre G.; Bailleul S.;
Yeung E.N.W.; Koo M.; Mirsadraee S.; Mathieu T.; Semple S.I.; Mills N.L.;
Vahanian A.; Newby D.E.; Dweck M.R.
Institution
(Chin, Shah, Yeung, Koo, Mirsadraee, Semple, Mills, Newby, Dweck) British
Heart Foundation, University Centre for Cardiovascular Science, University
of Edinburgh, 49 Little France Crescent, Edinburgh EH164SB, United Kingdom
(Chin) National Heart Center Singapore, Singapore, Singapore
(Messika-Zeitoun, Mathieu, Vahanian) Cardiology Department, Bichat
Hospital, Paris, France
(Lefevre, Bailleul) Biochemistry Department, Tenon Hospital, Paris, France
Title
A clinical risk score of myocardial fibrosis predicts adverse outcomes in
aortic stenosis.
Source
European Heart Journal. 37 (8) (pp 713-723), 2016. Date of Publication: 21
Feb 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims Midwall myocardial fibrosis on cardiovascular magnetic resonance
(CMR) is a marker of early ventricular decompensation and adverse outcomes
in aortic stenosis (AS). We aimed to develop and validate a novel clinical
score using variables associated with midwall fibrosis. Methods and
results One hundred forty-seven patients (peak aortic velocity
(V<inf>max</inf>) 3.9 [3.2,4.4] m/s) underwent CMR to determine midwall
fibrosis (CMR cohort). Routine clinical variables that demonstrated
significant association with midwall fibrosis were included in a
multivariate logistic score. We validated the prognostic value of the
score in two separate outcome cohorts of asymptomatic patients (internal:
n = 127, follow-up 10.3 [5.7,11.2] years; external: n = 289, follow-up 2.6
[1.6,4.5] years). Primary outcome was a composite of AS-related events
(cardiovascular death, heart failure, and new angina, dyspnoea, or
syncope). The final score consisted of age, sex, V<inf>max</inf>,
high-sensitivity troponin I concentration, and electrocardiographic strain
pattern [c-statistic 0.85 (95% confidence interval 0.78-0.91), P < 0.001;
Hosmer-Lemeshow chi² = 7.33, P = 0.50]. Patients in the outcome
cohorts were classified according to the sensitivity and specificity of
this score (both at 98%): low risk (probability score <7%), intermediate
risk (7-57%), and high risk (>57%). In the internal outcome cohort,
AS-related event rates were >10-fold higher in high-risk patients compared
with those at low risk (23.9 vs. 2.1 events/100 patient-years,
respectively; log rank P < 0.001). Similar findings were observed in the
external outcome cohort (31.6 vs. 4.6 events/100 patient-years,
respectively; log rank P < 0.001). Conclusion We propose a clinical score
that predicts adverse outcomes in asymptomatic AS patients and potentially
identifies high-risk patients who may benefit from early valve
replacement. Copyright &#xa9; 2015 The Author.

<111>
Accession Number
607757971
Author
Zhao D.F.; Seco M.; Wu J.J.; Edelman J.B.; Wilson M.K.; Vallely M.P.;
Byrom M.J.; Bannon P.G.
Institution
(Zhao, Seco, Wu, Edelman, Wilson, Vallely, Byrom, Bannon) Sydney Medical
School, University of Sydney, Sydney; Baird Institute of Applied Heart and
Lung Surgical Research, Sydney; Cardiothoracic Surgery Unit and Institute
of Academic Surgery, Royal Prince Alfred Hospital, Sydney; and Australian
School of Advanced Medicine, Macquarie University, Sydney, Australia
Title
Mechanical Versus Bioprosthetic Aortic Valve Replacement in Middle-Aged
Adults: A Systematic Review and Meta-Analysis.
Source
Annals of Thoracic Surgery. 102 (1) (pp 315-327), 2016. Date of
Publication: 01 Jul 2016.
Publisher
Elsevier USA
Abstract
The choice of a bioprosthetic valve (BV) or mechanical valve (MV) in
middle-aged adults undergoing aortic valve replacement is a complex
decision that must account for numerous prosthesis and patient factors. A
systematic review and meta-analysis was performed to compare long-term
survival, major adverse prosthesis-related events, anticoagulant-related
events, major bleeding, reoperation, and structural valve degeneration in
middle-aged patients receiving a BV or MV. A comprehensive search from six
electronic databases was performed from their inception to February 2016.
Results. from patients aged less than 70 years undergoing aortic valve
replacement with a BV or MV were included. There were 12 studies involving
8,661 patients. Baseline characteristics were similar. There was no
significant difference in long-term survival among patients aged 50 to 70
or 60 to 70 years. Compared with MVs, BVs had significantly fewer
long-term anticoagulant-related events (hazard ratio [HR] 0.54, p = 0.006)
and bleeding (HR 0.48, p < 0.00001) but significantly greater major
adverse prosthesis-related events (HR 1.82, p = 0.02), including
reoperation (HR 2.19, p < 0.00001). The present meta-analysis found no
significant difference in survival between BVs and MVs in patients aged 50
to 70 or 60 to 70 years. Compared with MVs, BVs have reduced risk of major
bleeding and anticoagulant-related events but increased risk of structural
valve degeneration and reoperation. However, the mortality consequences of
reoperation appear lower than that of major bleeding, and recent advances
may further lower the reoperation rate for BV. Therefore, this review
supports the current trend of using BVs in patients more than 60 years of
age. Copyright &#xa9; 2016 The Society of Thoracic Surgeons.

<112>
Accession Number
609001835
Author
Morley S.L.; Hudson C.L.; Llewelyn C.A.; Wells A.W.; Johnson A.L.;
Williamson L.M.
Institution
(Morley, Hudson, Llewelyn, Williamson) Cambridge Blood Centre, NHS Blood
and Transplant, Cambridge, United Kingdom
(Wells) Scottish National Blood Transfusion Service, Edinburgh, United
Kingdom
(Johnson) MRC Clinical Trials Unit at UCL, NHS Blood and Transplant,
London, United Kingdom
Title
Transfusion in children: Epidemiology and 10-year survival of transfusion
recipients.
Source
Transfusion Medicine. 26 (2) (pp 111-117), 2016. Date of Publication: 01
Apr 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Objective: To describe the epidemiology of blood transfusion in children:
including the incidence of transfusion, the diagnoses leading to
transfusion, donor exposure (DE) and post-transfusion survival. Study
design and methods: The Epidemiology and Survival of Transfusion
Recipients (EASTR) Study was a multi-centre epidemiological study with
prospective survival monitoring. Cross-sectional sampling of adult and
paediatric transfusion recipients in 29 hospitals was used to select three
separate cohorts of red cell (RBC), platelet (PLT) and fresh frozen plasma
(FFP) recipients between October 2001 and September 2002. This paper
presents the analysis of results for children <16 years. Results: Children
<16 years comprised 449 (5%) of the RBC, 362 (9%) of the FFP and 452 (13%)
of the PLT recipients. In children 54% of RBC, 63% FFP and 45% PLT
recipients were under 1 year of age and 57% RBC, 60% FFP and 52% PLT were
male. Median (IQR) DEduring the study year was 3(2-8); 5(2-13) and
11(6-21) in the RBC, FFP and PLT cohorts, respectively. A total of 20% of
RBC, 31% of FFP and 54% of PLT recipients had been exposed to >10 donors.
Perinatal conditions were the commonest indication for transfusion in the
RBC (36%) and FFP (44%) cohorts and comprised 31% of the PLT cohort.
Medical conditions (48%), predominantly malignancy (33%), were the most
frequent indication in the PLT cohort. The 10 year (95% CI) survival rates
were 81% (77-85%), 72% (67-76%) and 71% (66-75%)for RBC, FFP and PLT
cohorts, respectively. Conclusions: Around half of paediatric transfusion
recipients are under 1 year of age. Exposure to components from multiple
donors is common. At least 70% of paediatric recipients are long survivors
and are at risk for late complications of transfusion. Copyright &#xa9;
2016 British Blood Transfusion Society.

<113>
Accession Number
611256000
Author
Giblett J.P.; Axell R.G.; White P.A.; Clarke S.J.; McCormick L.; Read
P.A.; Reinhold J.; Brown A.J.; O'Sullivan M.; West N.E.J.; Dutka D.P.;
Hoole S.P.
Institution
(Giblett, McCormick, Read, Brown, O'Sullivan, West, Hoole) Papworth
Hospital, Department of Interventional Cardiology, Papworth Everard,
Cambridge CB23 3RE, United Kingdom
(Giblett, Clarke, Reinhold, Brown, Dutka) University of Cambridge,
Department of Cardiovascular Medicine, Cambridge, United Kingdom
(Axell, White) Addenbrooke's Hospital, Department of Clinical Engineering,
Cambridge, United Kingdom
Title
Glucagon-like peptide-1 derived cardioprotection does not utilize a
KATP-channel dependent pathway: Mechanistic insights from human supply and
demand ischemia studies.
Source
Cardiovascular Diabetology. 15 (1) (no pagination), 2016. Article Number:
99. Date of Publication: 19 Jul 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Glucagon-like peptide-1 (7-36) amide (GLP-1) protects against
stunning and cumulative left ventricular dysfunction in humans. The
mechanism remains uncertain but GLP-1 may act by opening mitochondrial
K-ATP channels in a similar fashion to ischemic conditioning. We
investigated whether blockade of K-ATP channels with glibenclamide
abrogated the protective effect of GLP-1 in humans. Methods: Thirty-two
non-diabetic patients awaiting stenting of the left anterior descending
artery (LAD) were allocated into 4 groups (control, glibenclamide, GLP-1,
and GLP-1 + glibenclamide). Glibenclamide was given orally prior to the
procedure. A left ventricular conductance catheter recorded
pressure-volume loops during a 1-min low-pressure balloon occlusion (BO1)
of the LAD. GLP-1 or saline was then infused for 30-min followed by a
further 1-min balloon occlusion (BO2). In a non-invasive study, 10
non-diabetic patients were randomized to receive two dobutamine stress
echocardiograms (DSE) during GLP-1 infusion with or without oral
glibenclamide pretreatment. Results: GLP-1 prevented stunning even with
glibenclamide pretreatment; the DELTA % dP/dt<inf>max</inf> 30-min
post-BO1 normalized to baseline after GLP-1: 0.3 +/- 6.8 % (p = 0.02) and
GLP-1 + glibenclamide: -0.8 +/- 9.0 % (p = 0.04) compared to control:
-11.5 +/- 10.0 %. GLP-1 also reduced cumulative stunning after BO2: -12.8
+/- 10.5 % (p = 0.02) as did GLP-1 + glibenclamide: -14.9 +/- 9.2 % (p =
0.02) compared to control: -25.7 +/- 9.6 %. Glibenclamide alone was no
different to control. Glibenclamide pretreatment did not affect global or
regional systolic function after GLP-1 at peak DSE stress (EF 74.6 +/- 6.4
vs. 74.0 +/- 8.0, p = 0.76) or recovery (EF 61.9 +/- 5.7 vs. 61.4 +/- 5.6,
p = 0.74). Conclusions: Glibenclamide pretreatment does not abrogate the
protective effect of GLP-1 in human models of non-lethal myocardial
ischemia. Trial registration Clinicaltrials.gov Unique Identifier:
NCT02128022 Copyright &#xa9; 2016 The Author(s).

<114>
Accession Number
612992878
Author
Rizik D.G.; Hermiller J.B.; Kereiakes D.J.
Institution
(Rizik) Director of Structural and Coronary Intervention, HonorHealth and
the Scottsdale-Lincoln Health Network, Scottsdale, AZ, United States
(Hermiller) Director of Interventional Cardiology and Director of
Interventional Cardiology Fellowship, St. Vincent Heart Center of Indiana,
Indianapolis, IN, United States
(Kereiakes) The Christ Hospital Heart and Vascular Center, The Lindner
Research Center, Cincinnati, OH, United States
Title
Bioresorbable vascular scaffolds for the treatment of coronary artery
disease: Clinical outcomes from randomized controlled trials.
Source
Catheterization and Cardiovascular Interventions. 88 (pp 21-30), 2016.
Date of Publication: 01 Nov 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
The permanent metal prosthesis common to bare metal stents (BMS) as well
as both first- and second-generation drug-eluting stents (DES) following
treatment of coronary artery disease represents a long-lasting substrate
for late adverse coronary events including restenosis, thrombosis, and
neoatherosclerosis. Following resorbtion, bioresorbable scaffolds (BRS)
may eliminate this nidus and improve late outcomes through restoration of
the vessel to more normal vascular structure and function. BRS represents
a single platform which incorporates the mechanical features of metallic
stents to provide safe and effective revascularization, suppression of
restenosis and prevention of constrictive remodeling with long-term
restoration of the treated vessel to a more natural state. The landscape
of BRS is rapidly evolving with new materials which target various
performance goals for the duration of vascular support and polymer
resorption time. The Absorb bioresorbable vascular scaffold (Absorb BVS),
recently approved by United States Food and Drug Administration, has
extensive clinical evidence to date in support of its clinical efficacy
and safety. Recently published data from well-executed randomized clinical
trials (RCTs) as part of the ABSORB Clinical development program along
with other investigator-initiated trials provide insights into the safety
and performance of this device in patients with de novo coronary lesions
as well in the setting of ST-segment elevation myocardial infarction
(STEMI). This review provides a comprehensive, outcomes based
understanding of the available evidence from RCTs that offer head-to-head
comparisons of Absorb BVS with metallic everolimus-eluting stents (EES).
&#xa9; 2016 Wiley Periodicals, Inc. Copyright &#xa9; 2016 Wiley
Periodicals, Inc.

<115>
Accession Number
612992875
Author
Tamburino C.; Capranzano P.; Francaviglia B.; Ina Tamburino C.; Longo G.;
Capodanno D.
Institution
(Tamburino, Capranzano, Francaviglia, Ina Tamburino, Longo, Capodanno)
Cardiovascular Department, Ferrarotto Hospital, University of Catania,
Catania, Italy
Title
Update on clinical evidence (Part II): A summary of the main post market
studies.
Source
Catheterization and Cardiovascular Interventions. 88 (pp 31-37), 2016.
Date of Publication: 01 Nov 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Bioresorbable vascular scaffolds (BVS, Absorb, Abbott Vascular, Santa
Clara, CA) received the CE mark in October 2011, and were approved by the
Food and Drug Administration in July 2016. After their introduction in
clinical practice a broad amount of post-marketing clinical experience
with BVS has been generated so far in Europe and outside the United
States. The available BVS registries differ in many aspects, including
their being single-center or multicenter, single-arm or controlled,
sponsored or investigator-initiated, published or presented at a
large-scale international meeting. This article provides an overview of
clinical results of the main post-marketing studies of BVS available.
&#xa9; 2016 Wiley Periodicals, Inc. Copyright &#xa9; 2016 Wiley
Periodicals, Inc.

<116>
Accession Number
611532987
Author
Denault A.Y.; Bussieres J.S.; Arellano R.; Finegan B.; Gavra P.; Haddad
F.; Nguyen A.Q.N.; Varin F.; Fortier A.; Levesque S.; Shi Y.; Elmi-Sarabi
M.; Tardif J.-C.; Perrault L.P.; Lambert J.
Institution
(Denault, Elmi-Sarabi) Department of Anesthesia, Montreal Heart Institute,
Universite de Montreal, 5000 Belanger Street, Montreal, QC H1T 1C8, Canada
(Bussieres) Department of Anesthesiology, Institut Universitaire de
Cardiologie et de Pneumologie de Quebec, Quebec, QC, Canada
(Arellano) Department of Anesthesiology, Kingston General Hospital,
Queen's University, Kingston, ON, Canada
(Finegan) Department of Anesthesiology, Edmonton Heart Institute,
University of Alberta, Edmonton, AB, Canada
(Haddad) Department of Cardiology, Stanford Cardiovascular Institute,
Stanford, CA, United States
(Gavra, Nguyen, Varin) Faculty of Pharmacy, Universite de Montreal,
Montreal, QC, Canada
(Fortier, Levesque) Montreal Health Innovations Coordinating Center
(MHICC), Montreal, QC, Canada
(Shi, Tardif) Department of Medicine, Montreal Heart Institute, Universite
de Montreal, Montreal, QC, Canada
(Perrault) Department of Cardiac Surgery, Montreal Heart Institute,
Universite de Montreal, Montreal, QC, Canada
(Lambert) Department of Social and Preventive Medicine, School of Public
Health, Universite de Montreal, Montreal, QC, Canada
Title
A multicentre randomized-controlled trial of inhaled milrinone in
high-risk cardiac surgical patients.
Source
Canadian Journal of Anesthesia. 63 (10) (pp 1140-1153), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Inhaled milrinone (iMil) has been used for the treatment of
pulmonary hypertension (PH) but its efficacy, safety, and prophylactic
effects in facilitating separation from cardiopulmonary bypass (CPB) and
preventing right ventricular (RV) dysfunction have not yet been evaluated
in a clinical trial. The purpose of this study was to investigate if iMil
administered before CPB would be superior to placebo in facilitating
separation from CPB. Methods: High-risk cardiac surgical patients with PH
were randomized to receive iMil or placebo after the induction of
anesthesia and before CPB. Hemodynamic parameters and RV function were
evaluated by means of pulmonary artery catheterization and transesophageal
echocardiography. The groups were compared for the primary outcome of the
level of difficulty in weaning from CPB. Among the secondary outcomes
examined were the reduction in the severity of PH, the incidence of RV
failure, and mortality. Results: Of the 124 patients randomized, the mean
(standard deviation [SD]) EuroSCORE II was 8.0 (2.6), and the baseline
mean (SD) systolic pulmonary artery pressure (SPAP) was 53 (9) mmHg. The
use of iMil was associated with increases in cardiac output (P = 0.03) and
a reduction in SPAP (P = 0.04) with no systemic hypotension. Nevertheless,
there was no difference in the combined incidence of difficult or complex
separation from CPB between the iMil and control groups (30% vs 28%,
respectively; absolute difference, 2%; 95% confidence interval [CI], -14
to 18; P = 0.78). There was also no difference in RV failure between the
iMil and control groups (15% vs 14%, respectively; difference, 1%; 95% CI,
-13 to 12; P = 0.94). Mortality was increased in patients with RV failure
vs those without (22% vs 2%, respectively; P < 0.001). Conclusion: In
high-risk cardiac surgery patients with PH, the prophylactic use of iMil
was associated with favourable hemodynamic effects that did not translate
into improvement of clinically relevant endpoints. This trial was
registered at ClinicalTrials.gov; identifier: NCT00819377. Copyright
&#xa9; 2016, Canadian Anesthesiologists' Society.

<117>
Accession Number
611532893
Author
Klinger R.Y.; Cooter M.; Berger M.; Podgoreanu M.V.; Stafford-Smith M.;
Ortel T.L.; Welsby I.J.; Levy J.H.; Rinder H.M.; Newman M.F.; Mathew J.P.;
For the Neurologic Outcomes Research Group (NORG) of The Duke Heart Center
Institution
(Klinger, Cooter, Berger, Podgoreanu, Stafford-Smith, Welsby, Levy,
Newman, Mathew) Department of Anesthesiology, Duke University Medical
Center, Box 3094, Durham, NC 27710, United States
(Ortel) Departments of Pathology, Hematology, and Medicine, Duke
University Medical Center, Durham, NC, United States
(Rinder) Departments of Medicine and Laboratory Medicine, Yale University,
New Haven, CT, United States
Title
Effect of intravenous lidocaine on the transcerebral inflammatory response
during cardiac surgery: a randomized-controlled trial.
Source
Canadian Journal of Anesthesia. 63 (11) (pp 1223-1232), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Postoperative cognitive dysfunction (POCD) occurs frequently
after cardiac surgery. The pathophysiology of POCD remains elusive, but
previous work showed that intravenous lidocaine may be protective against
POCD, possibly by modulating cerebral inflammation. We hypothesized that
intravenous lidocaine would attenuate the cerebral inflammatory response
to cardiopulmonary bypass (CPB) by reducing the transcerebral activation
gradients of platelets, leukocytes, and/or platelet-leukocyte conjugates.
Methods: We studied 202 patients undergoing cardiac surgery with CPB in
this prospective randomized double-blinded placebo-controlled trial.
Subjects were randomized to receive either intravenous lidocaine (bolus +
48-hr infusion) or placebo (identical infusion volume and duration).
Paired jugular venous and radial arterial blood samples were drawn at
several time points and analyzed by fluorescence-activated cell sorting to
identify activated platelets and platelet-leukocyte conjugates.
Transcerebral activation gradients were calculated by subtracting arterial
values from venous values and were compared between groups using repeated
measures regression models with covariate adjustment for age, sex, surgery
type, and CPB duration. Results: Beginning after aortic cross-clamp
release and peaking ten minutes after the termination of CPB, the mean
(SD) transcerebral activation gradient of platelet-monocyte conjugates
decreased in lidocaine-treated vs placebo-treated patients [-1.84 (11.47)
mean linear fluorescence intensity (MLFI) vs 1.46 (13.88) MLFI,
respectively; mean difference, -4.08 MLFI; 95% confidence interval, -7.86
to -0.29; P = 0.03). No difference was seen at any time point for
activated platelets or for platelet-neutrophil conjugates. Conclusion:
While lidocaine did not affect the systemic or transcerebral activation of
platelets or leukocytes, we did observe a reduction in the transcerebral
activation of platelet-monocyte conjugates after aortic cross-clamp
release. This may be a manifestation of reduced cerebral inflammation
during cardiopulmonary bypass in response to treatment with lidocaine.
This trial was registered at ClinicalTrials.gov (NCT00938964). Copyright
&#xa9; 2016, Canadian Anesthesiologists' Society.

<118>
Accession Number
610219153
Author
Gaies M.; Pasquali S.K.; Donohue J.E.; Dimick J.B.; Limbach S.; Burnham
N.; Ravishankar C.; Ohye R.G.; Gaynor J.W.; Mascio C.E.
Institution
(Gaies, Pasquali) Department of Pediatrics and Communicable Diseases,
University of Michigan Medical School, Ann Arbor, Michigan, United States
(Donohue) Michigan Congenital Heart Outcomes Research and Discovery Unit,
Ann Arbor, Michigan, United States
(Dimick) Department of Surgery, University of Michigan Medical School, Ann
Arbor, Michigan, United States
(Limbach, Burnham, Gaynor, Mascio) Division of Cardiac Surgery, The
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United
States
(Ravishankar) Department of Pediatrics, Perelman School of Medicine at the
University of Pennsylvania, Philadelphia, Pennsylvania, United States
(Ohye) Department of Cardiac Surgery, University of Michigan Medical
School, Ann Arbor, Michigan, United States
Title
Seminal Postoperative Complications and Mode of Death After Pediatric
Cardiac Surgical Procedures.
Source
Annals of Thoracic Surgery. 102 (2) (pp 628-635), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Elsevier USA
Abstract
Background Understanding the seminal complications leading to death after
pediatric cardiac surgical procedures may provide opportunities to reduce
mortality. This study analyzed all deaths at two pediatric cardiac
surgical programs and developed a method to identify the seminal
complications and modes of death. Methods Trained nurses abstracted all
cases of in-hospital mortality meeting inclusion criteria from each site
over 5 years (2008 to 2012). Complication definitions were consistent with
those of a multicenter clinical registry. An adjudication committee
assigned a seminal complication in each case (the complication initiating
the cascade of events leading to death). Seminal complications were
grouped into categories to designate "mode of death." The epidemiology of
seminal complications and of mode of death was described. Results In 191
subjects, low cardiac output syndrome (71% of all subjects), cardiac
arrest (52%), and arrhythmia (48%) were the most common complications. The
committee assigned low cardiac output syndrome (30%), failure to separate
from bypass (16%), and cardiac arrest (12%) most frequently as seminal
complications. Seminal complications occurred a median 2 hours
(interquartile range [IQR], 0 to 35 hours) postoperatively. Patients
experienced a median of seven (IQR, 3 to 12) additional complications
before death at a median of 15 days (IQR, 4 to 46). Systemic circulatory
failure was the most common mode of death (51%), followed by inadequate
pulmonary blood flow (13%) and cardiac arrest (12%). Conclusions Seminal
complications occurred early postoperatively, and systemic circulatory
failure was the most common mode of death. Our classification system is
likely scalable for subsequent multicenter analysis to understand
cause-specific mortality variation across hospitals and to drive quality
improvement. Copyright &#xa9; 2016 The Society of Thoracic Surgeons

<119>
Accession Number
607666124
Author
Moschetti K.; Petersen S.E.; Pilz G.; Kwong R.Y.; Wasserfallen J.-B.;
Lombardi M.; Korosoglou G.; Van Rossum A.C.; Bruder O.; Mahrholdt H.;
Schwitter J.
Institution
(Moschetti) Healthcare Evaluation Unit, Inst. of Social and Preventive
Medicine (IUMSP), Lausanne, Switzerland
(Moschetti, Wasserfallen) Technology Assessment Unit, University Hospital
of Lausanne, Lausanne, Switzerland
(Petersen) William Harvey Research Institute, NIHR Cardiovascular
Biomedical Research Unit at Barts, Queen Mary University of London,
London, United Kingdom
(Pilz) Clinic Agatharied, Academic Teaching Hospital, University of
Munich, Munich, Germany
(Kwong) Brigham and Women's Hospital, Harvard Medical School, Boston,
United States
(Lombardi) Policlinics of San Donato, Italian Research Hospital, Milano,
Italy
(Korosoglou) University Hospital of Heidelberg, Heidelberg, Germany
(Van Rossum) VU University Medical Center, Amsterdam, Netherlands
(Bruder) Elisabeth Hospital, Department of Cardiology and Angiology,
Elisabeth Hospital Essen, Essen, Germany
(Mahrholdt) Department of Cardiology, Robert Bosch Hospital, Stuttgart,
Germany
(Schwitter) Division of Cardiology, Direc. Cardiac MR Center, University
Hospital Lausanne, CHUV, Rue du Bugnon 46, Lausanne 1011, Switzerland
Title
Cost-minimization analysis of three decision strategies for cardiac
revascularization: Results of the "suspected CAD" cohort of the european
cardiovascular magnetic resonance registry.
Source
Journal of Cardiovascular Magnetic Resonance. 18 (1) (no pagination),
2016. Article Number: 22. Date of Publication: 11 Jan 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Coronary artery disease (CAD) continues to be one of the top
public health burden. Perfusion cardiovascular magnetic resonance (CMR) is
generally accepted to detect CAD, while data on its cost effectiveness are
scarce. Therefore, the goal of the study was to compare the costs of a
CMR-guided strategy vs two invasive strategies in a large CMR registry.
Methods: In 3'647 patients with suspected CAD of the EuroCMR-registry (59
centers/18 countries) costs were calculated for diagnostic examinations
(CMR, X-ray coronary angiography (CXA) with/without FFR),
revascularizations, and complications during a 1-year follow-up. Patients
with ischemia-positive CMR underwent an invasive CXA and revascularization
at the discretion of the treating physician (=CMR + CXA-strategy). In the
hypothetical invasive arm, costs were calculated for an initial CXA and a
FFR in vessels with >50 % stenoses (=CXA + FFR-strategy) and the same
proportion of revascularizations and complications were applied as in the
CMR + CXA-strategy. In the CXA-only strategy, costs included those for CXA
and for revascularizations of all >50 % stenoses. To calculate the
proportion of patients with >50 % stenoses, the stenosis-FFR relationship
from the literature was used. Costs of the three strategies were
determined based on a third payer perspective in 4 healthcare systems.
Results: Revascularizations were performed in 6.2 %, 4.5 %, and 12.9 % of
all patients, patients with atypical chest pain (n = 1'786), and typical
angina (n = 582), respectively; whereas complications (=all-cause death
and non-fatal infarction) occurred in 1.3 %, 1.1 %, and 1.5 %,
respectively. The CMR + CXA-strategy reduced costs by 14 %, 34 %, 27 %,
and 24 % in the German, UK, Swiss, and US context, respectively, when
compared to the CXA + FFR-strategy; and by 59 %, 52 %, 61 % and 71 %,
respectively, versus the CXA-only strategy. In patients with typical
angina, cost savings by CMR + CXA vs CXA + FFR were minimal in the German
(2.3 %), intermediate in the US and Swiss (11.6 % and 12.8 %,
respectively), and remained substantial in the UK (18.9 %) systems.
Sensitivity analyses proved the robustness of results. Conclusions: A CMR
+ CXA-strategy for patients with suspected CAD provides substantial cost
reduction compared to a hypothetical CXA + FFR-strategy in patients with
low to intermediate disease prevalence. However, in the subgroup of
patients with typical angina, cost savings were only minimal to moderate.
Copyright &#xa9; 2016 Moschetti et al.

<120>
Accession Number
611313674
Author
Zeymer U.; Montalescot G.; Ardissino D.; Bolognese L.; Clemmensen P.;
Collet J.-P.; Lopez-Sendon J.; Widimsky P.
Institution
(Zeymer) Klinikum Ludwigshafen and Institut fur Herzinfarktforschung,
Germany
(Montalescot, Collet) Centre Hospitalier Universitaire Pitie-Salpetriere,
France
(Ardissino) Azienda Ospedaliero-Universitaria, Italy
(Bolognese) Azienda Ospedaliero, Italy
(Clemmensen) Department of Medicine, Division of Cardiology, Nykoebing F
Hospital, Denmark
(Lopez-Sendon) University Hospital La Paz, Spain
(Widimsky) Cardiology Department at the Third Faculty of Medicine, Charles
University and University Hospital, Kralovske Vinohrady, Czech Republic
Title
Optimal timing of initiation of oral P2Y12-receptor antagonist therapy in
patients with non-ST elevation acute coronary syndromes. Lessons learnt
from the ACCOAST-trial.
Source
European Heart Journal: Acute Cardiovascular Care. 5 (3) (pp 282-288),
2016. Date of Publication: 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
The optimal time-point of the initiation of P2Y12 antagonist therapy in
patients with non-ST elevation acute coronary syndromes (NTSE-ACS) is
still a matter of debate. European guidelines recommend P2Y12 as soon as
possible after first medical contact. However, the only trial which
compared the two strategies did not demonstrate any benefit of
pretreatment with prasugrel before angiography compared to starting
therapy after angiography and just prior to percutaneous coronary
intervention (PCI). This paper summarizes the results of pharmacodynamic
and previous studies, and gives recommendations for the initiation of
P2Y12 antagonist therapy in NSTE-ACS in different clinical situations.
Copyright &#xa9; The European Society of Cardiology 2015.

<121>
Accession Number
611313671
Author
White H.D.; Westerhout C.M.; Alexander K.P.; Roe M.T.; Winters K.J.; Cyr
D.D.; Fox K.A.A.; Prabhakaran D.; Hochman J.S.; Armstrong P.W.; Ohman E.M.
Institution
(White) Green Lane Cardiovascular Service, Auckland City Hospital and
University of Auckland, Auckland, New Zealand
(Westerhout, Armstrong) Canadian VIGOUR Centre, University of Alberta,
Canada
(Alexander, Roe, Cyr, Ohman) Duke Clinical Research Institute, United
States
(Alexander, Roe, Ohman) Division of Cardiology, Department of Medicine,
Duke University School of Medicine, United States
(Winters) Eli Lilly and Company, United States
(Fox) Centre for Cardiovascular Science, University of Edinburgh, United
Kingdom
(Prabhakaran) Centre for Chronic Disease Control, Public Health Foundation
of India, India
(Hochman) Division of Cardiology, Department of Medicine, Langone Medical
Center, New York University, United States
(Armstrong) Division of Cardiology, Department of Medicine, University of
Alberta, Canada
Title
Frailty is associated with worse outcomes in non-ST-segment elevation
acute coronary syndromes: Insights from the TaRgeted platelet Inhibition
to cLarify the Optimal strateGy to medicallY manage Acute Coronary
Syndromes (TRILOGY ACS) trial.
Source
European Heart Journal: Acute Cardiovascular Care. 5 (3) (pp 231-242),
2016. Date of Publication: 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Aims: Little is known regarding consequences of frailty in patients with
acute coronary syndrome (ACS). We assessed the associations of frailty and
outcomes in ACS patients who were participating in a clinical trial.
Methods and results: The TaRgeted platelet Inhibition to cLarify the
Optimal strateGy to medicallY manage Acute Coronary Syndromes (TRILOGY
ACS) trial randomized 9326 patients planned for medical management to
prasugrel or clopidogrel. The primary endpoint was a composite of
cardiovascular death, myocardial infarction (MI), or stroke over a period
of 30 months. A frailty score based upon the Fried score was self-reported
at baseline in patients aged >65 years. Five frailty questions were
recorded for 4996/5102 (97.9%) patients: 72.3% were classified as
not-frail (0 items), 23.0% as pre-frail (1-2 items), and 4.7% as frail (>3
items). Increasing frailty score was associated with older age, diabetes,
and higher Global Registry of Acute Coronary Events (GRACE) scores.
Frailty was associated with a higher unadjusted incidence of the primary
endpoint (pre-frail vs not-frail: 29.2% vs 23.1%; hazard ratio [HR]: 1.39;
95% confidence interval [CI]: 1.19-1.61; p<0.001; frail vs not-frail:
39.7% vs 23.1%; HR: 1.76; 95% CI: 1.36-2.28; p<0.001), and all-cause
mortality (pre-frail vs not-frail: 21.7% vs 15.0%; HR: 1.45; 95% CI:
1.22-1.73; p<0.001; frail vs not-frail: 30.2% vs 15.0%; HR: 1.98; 95% CI:
1.47-2.68; p<0.001). After adjustment for baseline characteristics and
GRACE covariates, frailty remained independently associated with the
primary endpoint: pre-frail vs not-frail, HR: 1.33; 95% CI: 1.15-1.54;
p<0.001; frail vs not-frail, HR: 1.52; 95% CI: 1.18-1.98; p=0.002. There
was no association of frailty with bleeding. Conclusion: Frailty is
associated with the composite of cardiovascular death, MI, or stroke.
Frailty assessment contributes to risk prediction and adds to the GRACE
score. Copyright &#xa9; The European Society of Cardiology 2015.

<122>
Accession Number
612155677
Author
Bergman R.; Hiemstra B.; Nieuwland W.; Lipsic E.; Absalom A.; van der
Naalt J.; Zijlstra F.; Van Der Horst I.C.C.; Nijsten M.W.N.
Institution
(Bergman, Hiemstra, Van Der Horst, Nijsten) Department of Critical Care,
University Medical Center Groningen, Netherlands
(Bergman, Absalom) Department of Anaesthesiology, University Medical
Center Groningen, Netherlands
(Nieuwland, Lipsic) Department of Cardiology, University Medical Center
Groningen, Netherlands
(van der Naalt) Department of Neurology, University Medical Center
Groningen, Netherlands
(Zijlstra) Department of Cardiology, Erasmus University Rotterdam,
Netherlands
Title
Long-term outcome of patients after out-of-hospital cardiac arrest in
relation to treatment: A singlecentre study.
Source
European Heart Journal: Acute Cardiovascular Care. 5 (4) (pp 328-338),
2016. Date of Publication: 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Introduction: Outcome after out-of-hospital cardiac arrest (OHCA) remains
poor. With the introduction of automated external defibrillators,
percutaneous coronary intervention (PCI) and mild therapeutic hypothermia
(MTH) the prognosis of patients after OHCA appears to be improving. The
aim of this study was to evaluate short and long-term outcome among a
non-selected population of patients who experienced OHCA and were admitted
to a hospital working within a ST elevation myocardial infarction network.
Methods: All patients who achieved return of spontaneous circulation
(ROSC) (n=456) admitted to one hospital after OHCA were included. Initial
rhythm, reperfusion therapy with PCI, implementation of MTH and additional
medical management were recorded. The primary outcome measure was survival
(hospital and long term). Neurological status was measured as cerebral
performance category. The inclusion period was January 2003 to August
2010. Follow-up was complete until April 2014. Results: The mean patient
age was 63+/-14 years and 327 (72%) were men. The initial rhythm was
ventricular fibrillation, pulseless electrical activity, asystole and
pulseless ventricular tachycardia in 322 (71%), 58 (13%), 55 (12%) and 21
(5%) of the 456 patients, respectively. Treatment included PCI in 191
(42%) and MTH in 188 (41%). Overall in-hospital and long-term (5-year)
survival was 53% (n=240) and 44% (n=202), respectively. In the 170
patients treated with primary PCI, in-hospital survival was 112/170 (66%).
After hospital discharge these patients had a 5-year survival rate of 99%
and cerebral performance category was good in 92%. Conclusions: In this
integrated ST elevation myocardial infarction network survival and
neurological outcome of selected patients with ROSC after OHCA and treated
with PCI was good. There is insufficient evidence about the outcome of
this approach, which has a significant impact on utilisation of resources.
Good quality randomised controlled trials are needed. In selected patients
successfully resuscitated after OHCA of presumed cardiac aetiology, we
believe that a more liberal application of primary PCI may be considered
in experienced acute cardiac referral centres. Copyright &#xa9; The
European Society of Cardiology 2015.

<123>
Accession Number
612155636
Author
Andersen J.G.; Grepperud S.; Klow N.-E.; Johansen O.
Institution
(Andersen) Oslo University Hospital Ulleval, X-Ray Department, Norway
(Grepperud) Oslo University, Institute of Health and Society, Faculty of
Medicine, Norway
(Klow) Oslo University Hospital Ulleval, X-Ray Department, The University
of Oslo, Norway
(Johansen) The Section for Interventional Cardiology, Division of
Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Norway
Title
Effects on length of stay and costs with same-day retransfer to the
referring hospitals for patients with acute coronary syndrome after
angiography and/or percutaneous coronary intervention.
Source
European Heart Journal: Acute Cardiovascular Care. 5 (4) (pp 375-380),
2016. Date of Publication: 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Fast track interventions may generate benefits for patients
and hospitals by representing a potential for shorter hospital stay. The
aim of this study was to investigate how same-day retransfers to the
referring hospital after angiographic examination and/or percutaneous
coronary intervention (PCI) at the PCI centre affected length of stay and
hospital treatment costs for patients with acute coronary syndrome.
Methods and results: Three hundred and ninety-nine consecutive admitted
patients were prospectively randomized to ordinary care with overnight
stay or fast track with same-day retransfer. Length of stay at both the
PCI centre and the referring hospital after the stay at the PCI centre
were recorded. Costs at the PCI centre related to examinations and
treatments were also collected. The ordinary care group included 206
patients and the fast track group 193 patients. Forty-six per cent
underwent PCI and 10% coronary artery bypass graft (CABG) in the ordinary
care group. In the fast track group 40% had PCI and 6% CABG. Length of
stay was reduced at the PCI centre from a median 1.25 days for the
ordinary care group to median 0.24 days for the FT group (p<0.001). Length
of stay at the PCI centre was significantly reduced after selective
coronary angiography and PCI but not for patients undergoing CABG. No
significant difference was identified in length of stay for the referring
hospitals. Total median treatment costs were reduced from NOK23,657
(US$3838) for the ordinary care group to NOK15,730 (US$2552) for the fast
track group (p<0.001). The main contributor to this reduction was shorter
length of stay and the corresponding reduction in ward costs at the PCI
centre. Conclusions: We conclude that fast-track intervention with
same-day retransfer for patients with acute coronary syndrome to the
referring hospital reduced length of stay and the hospital treatment costs
for patients undergoing selective coronary angiography and PCI. Copyright
&#xa9; The European Society of Cardiology 2015.

<124>
Accession Number
613401874
Author
Izquierdo-Palomares J.M.; Fernandez-Tabera J.M.; Plana M.N.; Anino Alba
A.; Gomez Alvarez P.; Fernandez-Esteban I.; Saiz L.C.; Martin-Carrillo P.;
Pinar Lopez O.
Institution
(Izquierdo-Palomares) Servicio Madrileno de Salud, Subdireccion General de
Farmacia y Productos Sanitarios, Pza. Carlos Trias Beltran 7, Madrid,
Spain
(Fernandez-Tabera) Madrid Health Service (Servicio Madrileno de Salud),
Hospital Management, ColladoVillaba, Madrid, Road from Alpedrete to
Moralzarzal M 608 Km 41, Collado Villalba, Madrid, Comunidad de Madrid
28400, Spain
(Plana) Clinical Biostatistics Unit, Ramon y Cajal Hospital (IRYCIS),
CIBER Epidemiology and Public Health (CIBERESP), Carretera de Colmenar Km
9.100, Madrid 28034, Spain
(Anino Alba) Servicio Madrileno de Salud, Pharmacy Department, Alberto
Palacios 22 Madrid, Madrid 28021, Spain
(Gomez Alvarez) Gerencia de Atencion Primaria, Servicio Madrileno de
Salud, Centro de Salud Villaamil, Calle de Villaamil, 19, Madrid 28028,
Spain
(Fernandez-Esteban) Servicio Madrileno de Salud, Servicio de Farmacia.
Direccion Asistencial Centro, Gerencia de Atencion Primaria, Calle Alberto
Palacios 22, Madrid 28021, Spain
(Saiz) Navarre Health Service, Drug Prescribing Service, Plaza de la Paz,
s/n, 7th floor, Pamplona, Navarre 31002, Spain
(Martin-Carrillo) Madrid Health Service, Colmenarejo Health Centre, C/
Canada de las Merinas no. 64, Colmenarejo, Madrid 28270, Spain
(Pinar Lopez) Doce de Octubre University Hospital, Hospital Pharmacy
Service, Avenida de Cordoba, s/n, Madrid 28041, Spain
Title
Chronotherapy versus conventional statins therapy for the treatment of
hyperlipidaemia.
Source
Cochrane Database of Systematic Reviews. 2016 (11) (no pagination), 2016.
Article Number: CD009462. Date of Publication: 26 Nov 2016.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Elevated levels of total cholesterol and low-density
lipoprotein play an important role in the development of atheromas and,
therefore, in cardiovascular diseases. Cholesterol biosynthesis follows a
circadian rhythm and is principally produced at night (between 12:00 am
and 6:00 am). The adjustment of hypolipaemic therapy to biologic rhythms
is known as chronotherapy. Chronotherapy is based on the idea that
medication can have different effects depending on the hour at which it is
taken. Statins are one of the most widely used drugs for the prevention of
cardiovascular events. In usual clinical practice, statins are
administered once per day without specifying the time when they should be
taken. It is unknown whether the timing of statin administration is
important for clinical outcomes. Objectives: To critically evaluate and
analyse the evidence available from randomised controlled trials regarding
the effects of chronotherapy on the effectiveness and safety of treating
hyperlipidaemia with statins. Search methods: We searched the CENTRAL,
MEDLINE, Embase, LILACS, ProQuest Health & Medical Complete, OpenSIGLE,
Web of Science Conference Proceedings, and various other resources
including clinical trials registers up to November 2015. We also searched
the reference lists of relevant reviews for eligible studies. Selection
criteria: We included randomised controlled trials (RCTs), enrolling
people with primary or secondary hyperlipidaemia. To be included, trials
must have compared any chronotherapeutic lipid-lowering regimen with
statins and any other statin lipid-lowering regimen not based on
chronotherapy. We considered any type and dosage of statin as eligible, as
long as the control and experimental arms differed only in the timing of
the administration of the same statin. Quasi-randomised studies were
excluded. Data collection and analysis: We used the standard
methodological procedures expected by Cochrane. We extracted the key data
from studies in relation to participants, interventions, and outcomes for
safety and efficacy. We calculated odds ratios (OR) for dichotomous data
and mean differences (MD) for continuous data with 95% confidence
intervals (CI). Using the GRADE approach, we assessed the quality of the
evidence and we used the GRADEpro Guideline Development Tool to import
data from Review Manager to create 'Summary of findings' tables. Main
results: This review includes eight RCTs (767 participants analysed in
morning and evening arms). The trials used different lipid-lowering
regimens with statins (lovastatin: two trials; simvastatin: three trials;
fluvastatin: two trials; pravastatin: one trial). All trials compared the
effects between morning and evening statin administration. Trial length
ranged from four to 14 weeks. We found a high risk of bias in the domain
of selective reporting in three trials and in the domain of incomplete
outcome data in one trial of the eight trials included. None of the
studies included were judged to be at low risk of bias. None of the
included RCTs reported data on cardiovascular mortality, cardiovascular
morbidity, incidence of cardiovascular events, or deaths from any cause.
Pooled results showed no evidence of a difference in total cholesterol (MD
4.33, 95% CI -1.36 to 10.01), 514 participants, five trials, mean
follow-up 9 weeks, low-quality evidence), low-density lipoprotein
cholesterol (LDL-C) levels (MD 4.85 mg/dL, 95% CI -0.87 to 10.57, 473
participants, five trials, mean follow-up 9 weeks, low-quality evidence),
high-density lipoprotein cholesterol (HDL-C) (MD 0.54, 95% CI -1.08 to
2.17, 514 participants, five trials, mean follow-up 9 weeks, low-quality
evidence) or triglycerides (MD -8.91, 95% CI -22 to 4.17, 510
participants, five trials, mean follow-up 9 weeks, low-quality evidence)
between morning and evening statin administration. With regard to safety
outcomes, five trials (556 participants) reported adverse events. Pooled
analysis found no differences in statins adverse events between morning
and evening intake (OR 0.71, 95% CI 0.44 to 1.15, 556 participants, five
trials, mean follow-up 9 weeks, low-quality evidence). Authors'
conclusions: Limited and low-quality evidence suggested that there were no
differences between chronomodulated treatment with statins in people with
hyperlipidaemia as compared to conventional treatment with statins, in
terms of clinically relevant outcomes. Studies were short term and
therefore did not report on our primary outcomes, cardiovascular clinical
events or death. The review did not find differences in adverse events
associated with statins between both regimens. Taking statins in the
evening does not have an effect on the improvement of lipid levels with
respect to morning administration. Further high-quality trials with
longer-term follow-up are needed to confirm the results of this review.
Copyright &#xa9; 2016 The Cochrane Collaboration. Published by John Wiley
& Sons, Ltd.

<125>
Accession Number
615023680
Author
Lima A.C.; Fernandes G.A.; Gonzaga I.C.; de Barros Araujo R.; de Oliveira
R.A.; Nicolau R.A.
Institution
(Lima, Fernandes, Gonzaga, Nicolau) 1 Lasertherapy and Photobiology
Center, Research and Development Institute , IP&D Universidade do Vale do
Paraiba, UNIVAP, Sao Paulo, Brazil
(Lima, de Oliveira) 2 University of Piaui State (UESPI) , Center of Health
Sciences, Teresina, Piaui, Brazil
(Fernandes, Gonzaga, de Oliveira) 3 Uninovafapi College , Department of
Physical Therapy, Teresina, Piaui, Brazil
(de Barros Araujo) 4 Department of Cardiac Surgery, Santa Maria Hospital,
University of Piaui State (UESPI) , Teresina, Piaui, Brazil
Title
Low-Level Laser and Light-Emitting Diode Therapy for Pain Control in
Hyperglycemic and Normoglycemic Patients Who Underwent Coronary Bypass
Surgery with Internal Mammary Artery Grafts: A Randomized, Double-Blind
Study with Follow-Up.
Source
Photomedicine and laser surgery. 34 (6) (pp 244-251), 2016. Date of
Publication: 01 Jun 2016.
Abstract
OBJECTIVE: This study aimed to evaluate the efficacy of low-level laser
therapy (LLLT) and light-emitting diodes (LEDs) for reducing pain in
hyperglycemic and normoglycemic patients who underwent coronary artery
bypass surgery with internal mammary artery grafts.
METHODS: This study was conducted on 120 volunteers who underwent elective
coronary artery bypass graft (CABG) surgery. The volunteers were randomly
allocated to four different groups of equal size (n=30): control, placebo,
LLLT [lambda=640nm and spatial average energy fluence (SAEF)=1.06J/cm(2)],
and LED (lambda=660+/-20nm and SAEF=0.24J/cm(2)). Participants were also
divided into hyperglycemic and normoglycemic subgroups, according to their
fasting blood glucose test result before surgery. The outcome assessed was
pain during coughing by a visual analog scale (VAS) and the McGill Pain
Questionnaire.
RESULTS: The patients were followed for 1 month after the surgery. The
LLLT and LED groups showed a greater decrease in pain, with similar
results, as indicated by both the VAS and the McGill questionnaire
(p<0.05), on the 6th and 8th postoperative day compared with the placebo
and control groups. The outcomes were also similar between hyperglycemic
and normoglycemic patients. One month after the surgery, almost no
individual reported pain during coughing.
CONCLUSIONS: LLLT and LED had similar analgesic effects in hyperglycemic
and normoglycemic patients, better than placebo and control groups.

<126>
Accession Number
615026825
Author
Aboul-Hassan S.S.; Stankowski T.; Marczak J.; Cichon R.
Institution
(Aboul-Hassan, Stankowski, Marczak) Department of Cardiac Surgery, MEDINET
Heart Centre Ltd, Wroclaw, Poland
(Marczak) Department of Cardiac Surgery, Wroclaw Medical University,
Wroclaw, Poland
(Cichon) Department of Cardiac Surgery, Warsaw Medical University, Warsaw,
Poland
Title
What is the impact of preoperative aspirin administration on patients
undergoing coronary artery bypass grafting?.
Source
Interactive Cardiovascular and Thoracic Surgery. 24 (2) (pp 280-285),
2017. Date of Publication: 01 Feb 2017.
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 whether continuation of
administration of preoperative aspirin until the day of coronary artery
bypass grafting (CABG) could minimize postoperative mortality, prevalence
of postoperative myocardial infarction (MI) with or without influence on
postoperative bleeding, packed red blood cell (PRBC) transfusion and
reoperation for bleeding. Altogether, 662 papers were found using the
reported search, 7 of which represented the best evidence to answer the
clinical question. The authors, journal, date and country of publication,
patient group studied, study type, relevant outcomes and results of these
papers are tabulated. Seven studies, included in this review, consisted of
five meta-analyses and two randomized controlled trials. One
meta-analysis, involving 27 533 patients submitted to CABG, showed that
the administration of preoperative aspirin decreased postoperative 30-day
mortality by 27%. Another meta-analysis, including 1437 patients, showed
that preoperative aspirin decreased the incidence of perioperative MI by
44%, the effect being even more pronounced with low-dose aspirin, which
reduced the prevalence of perioperative MI by 63%. One RCT showed that
preoperative aspirin is associated with reduced long-term hazard of MI or
repeated revascularization. Four meta-analyses and two RCTs showed that
preoperative aspirin is associated with increased postoperative bleeding,
PRBC transfusion and reoperation for bleeding. However, this was not the
case with preoperative administration of low-dose aspirin. The results
presented in these studies suggest that preoperative aspirin
administration in patients undergoing CABG has a significant benefit in
reducing the incidence of perioperative MI and 30-day mortality rate, as
well as reduced long-term hazard of MI or repeated revascularization. At a
higher dose (>100 mg/day), postoperative bleeding, PRBC transfusion and
reoperation for bleeding increased. However, with low-dose aspirin (<100
mg/day), these benefits were not at the expense of increased postoperative
bleeding or transfusion. Copyright &#xa9; The Author 2016. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<127>
Accession Number
615026823
Author
Ariyaratnam P.; Tcherveniakov P.; Milton R.; Chaudhuri N.
Institution
(Ariyaratnam, Tcherveniakov, Milton, Chaudhuri) Department of Thoracic
Surgery, Leeds Teaching Hospitals, Leeds LS9 7TF, United Kingdom
Title
Is preoperative hypercapnia a justified exclusion criterion for lung
volume reduction surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 24 (2) (pp 273-279),
2017. Date of Publication: 01 Feb 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether potential surgical
candidates for lung volume reduction surgery (LVRS), who have preoperative
hypercapnia, should be excluded on this basis. Using the reported search,
45 papers were found, of which 14 represented the best evidence to answer
the clinical question. The author, journal, date and country of
publication, patient group studied, study type, relevant outcomes, results
and study weaknesses were tabulated. Of these, seven papers showed a
significant (P < 0.05) improvement in postoperative forced expiratory
volume in 1 second (FEV1) at up to 6 months in hypercapnic patients. There
were six papers which found significant decreases in postoperative
arterial carbon dioxide partial pressures (PaCO<inf>2</inf>) levels
following LVRS up to 6 months. There were three papers which showed
significant (P < 0.05) improvements in the 6-min walk test in hypercapnic
patients following LVRS. Only two papers showed an increased operative
mortality in the hypercapnic group compared to the normocapnic group,
while nine papers did not find a difference in perioperative mortality.
The only randomized controlled study, the landmark NETT study, excluded
patients with severe hypercapnia (PaCO<inf>2</inf> >55 mmHg and >60 mmHg)
and the mean PaCO2 in the surgical and medical group were 43.3 +/- 5.9 and
43.0 +/- 5.8, respectively. We conclude that the evidence is not strong
enough to consider hypercapnia in isolation as high risk or unsuitable for
LVRS. Copyright &#xa9; The Author 2016. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.

<128>
Accession Number
615026821
Author
Tan M.K.H.; Jarral O.A.; Thong E.H.E.; Kidher E.; Uppal R.; Punjabi P.P.;
Athanasiou T.
Institution
(Tan, Jarral, Thong, Kidher, Athanasiou) Department of Surgery and Cancer,
Imperial College London, London W2 1NY, United Kingdom
(Uppal) Department of Cardiothoracic Surgery, St. Bartholomew's Hospital,
London, United Kingdom
(Punjabi) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
Title
Quality of life after mitral valve intervention.
Source
Interactive Cardiovascular and Thoracic Surgery. 24 (2) (pp 265-272),
2017. Date of Publication: 01 Feb 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Advancements in surgical technique and understanding of the
pathophysiology of mitral valve (MV) dysfunction have led to improved
outcomes. Seen as a development beyond measures of morbidity and
mortality, health-related quality-of-life (HRQOL) outcome measures are
becoming increasingly popular. These measures are important because
complications following routine (i.e. low-risk) operations on the MV are
uncommon and further markers of outcome are needed. Surgeons are
increasingly operating earlier on asymptomatic patients and will need to
prove that HRQOL is not impacted. Novel minimally invasive and
transcatheter technologies will also need to demonstrate satisfactory
HRQOL outcomes prior to widespread use. This systematic review provides an
overview of all available literature detailing HRQOL in patients receiving
MV interventions. In the 43 studies included, 6865 patients underwent
procedures ranging from open replacement to percutaneous repair using
devices such as the Mitraclip Clip Delivery System (MitraClip) (Abbott
Vascular, Santa Clara, CA, USA). Most studies performed baseline HRQOL
assessment, allowing postinterventional comparison. While the underlying
literature had deficiencies, most studies report acceptable
postintervention HRQOL that was comparable to that of matched general
populations. Patient-specific (e.g. female gender, renal dysfunction) and
surgical-specific factors (e.g. replacement instead of repair, elevated
transmitral gradient) were identified that predispose patients to poorer
long-term HRQOL outcomes. These factors are important for clinicians
developing strategies to maximize their HRQOL outcomes. Future randomized
studies would benefit from HRQOL measurements at specific time points to
allow large-scale comparisons. Establishing a common HRQOL instrument for
use in MV intervention studies may support detailed comparisons between
specific techniques. Physical activity monitors, physiological biomarkers
and radiological markers could also be used as innovative indicators of
functional outcome. Copyright &#xa9; The Author 2016. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<129>
Accession Number
615038621
Author
Pasquali S.K.; Ravishankar C.; Romano J.C.; Kane K.; Viers S.; Kennedy A.;
Burnham N.; Lowery R.; Uzark K.; Retzloff L.; Rome J.J.; Rossano J.W.;
Charpie J.R.; Spray T.L.; Gaies M.G.; Ohye R.G.; Gaynor J.W.
Institution
(Pasquali, Romano, Viers, Lowery, Uzark, Retzloff, Charpie, Gaies, Ohye)
Congenital Heart Center, University of Michigan C.S. Mott Children's
Hospital, 1540 E. Hospital Drive, Ann Arbor, MI 48105, United States
(Ravishankar, Kane, Kennedy, Burnham, Rome, Rossano, Spray, Gaynor)
Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, PA,
United States
Title
Design and initial results of a programme for routine standardised
longitudinal follow-up after congenital heart surgery.
Source
Cardiology in the Young. 26 (8) (pp 1590-1596), 2016. Date of Publication:
01 Dec 2016.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Background: With improvements in early survival following congenital heart
surgery, it has become increasingly important to understand longer-term
outcomes; however, routine collection of these data is challenging and
remains very limited. We describe the development and initial results of a
collaborative programme incorporating standardised longitudinal follow-up
into usual care at the Children's Hospital of Philadelphia (CHOP) and
University of Michigan (UM). Methods: We included children undergoing
benchmark operations of the Society of Thoracic Surgeons. Considerations
regarding personnel, patient/parent engagement, funding, regulatory
issues, and annual data collection are described, and initial follow-up
rates are reported. Results: The present analysis included 1737 eligible
patients undergoing surgery at CHOP from January 2007 to December 2014 and
887 UM patients from January 2010 to December 2014. Overall, follow-up
data, of any type, were obtained from 90.8% of patients at CHOP (median
follow-up 4.3 years, 92.2% survival) and 98.3% at UM (median follow-up 2.8
years, 92.7% survival), with similar rates across operations and
institutions. Most patients lost to follow-up at CHOP had undergone
surgery before 2010. Standardised questionnaires assessing burden of
disease/quality of life were completed by 80.2% (CHOP) and 78.4% (UM) via
phone follow-up. In subsequent pilot testing of an automated e-mail
system, 53.4% of eligible patients completed the follow-up questionnaire
through this system. Conclusions: Standardised follow-up data can be
obtained on the majority of children undergoing benchmark operations.
Ongoing efforts to support automated electronic systems and integration
with registry data may reduce resource needs, facilitate expansion across
centres, and support multi-centre efforts to understand and improve
long-term outcomes in this population. Copyright &#xa9; 2017 Cambridge
University Press.

<130>
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.

<131>
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.

<132>
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.

<133>
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.

<134>
Accession Number
615032232
Author
Paparella D.; Parolari A.; Rotunno C.; Vincent J.; Myasoedova V.; Guida
P.; De Palo M.; Margari V.; Devereaux P.J.; Lamy A.; Alamanni F.; Yusuf
S.; Whitlock R.
Institution
(Paparella, Rotunno, Guida, De Palo, Margari) Department of Emergency and
Organ Transplant, Division of Cardiac Surgery, University of Bari Aldo
Moro, Bari, Italy
(Parolari) Department of Cardiac Surgery, Operative Unit of Cardiac
Surgery and Translational Research, Policlinico San Donato IRCCS, Milan,
Italy
(Vincent, Devereaux, Lamy, Yusuf, Whitlock) Population Health Research
Institute, McMaster University, Hamilton, Ontario, Canada
(Myasoedova, Alamanni) Unit for Clinical Research in Atherothrombosis,
Centro Cardiologico Monzino (IRCCS), Milan, Italy
(Devereaux, Lamy, Yusuf, Whitlock) Division of Cardiac Surgery, McMaster
University, Hamilton, Ontario, Canada
Title
The Effects of Steroids on Coagulation Dysfunction Induced by
Cardiopulmonary Bypass: A Steroids in Cardiac Surgery (SIRS) Trial
Substudy.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Cardiopulmonary bypass (CPB) surgery, despite heparin administration,
elicits activation of coagulation system resulting in coagulopathy.
Anti-inflammatory effects of steroid treatment have been demonstrated, but
its effects on coagulation system are unknown. The primary objective of
this study is to assess the effects of methylprednisolone on coagulation
function by evaluating thrombin generation, fibrinolysis, and platelet
activation in high-risk patients undergoing cardiac surgery with CPB. The
Steroids In caRdiac Surgery study is a double-blind, randomized,
controlled trial performed on 7507 patients worldwide who were randomized
to receive either intravenous methylprednisolone, 250 mg at anesthetic
induction and 250 mg at initiation of CPB (n = 3755), or placebo (n =
3752). A substudy was conducted in 2 sites to collect blood samples
perioperatively to measure prothrombin fragment 1.2 (PF1+2, thrombin
generation), plasmin-antiplasmin complex (PAP, fibrinolysis), platelet
factor 4 (PF4 platelet activation), and fibrinogen. Eighty-one patients
were enrolled in the substudy (37 placebo vs 44 in treatment group). No
difference in clinical outcome was detected, including postoperative
bleeding and need for blood products transfusion. All patients showed
changes of all plasma biomarkers with greater values than baseline in both
groups. This reaction was attenuated significantly in the treatment group
for PF1.2 (P = 0.040) and PAP (P = 0.042) values at the first
intraoperative measurement. No difference between groups was detected for
PF4. Methylprednisolone treatment attenuates activation of coagulation
system in high-risk patients undergoing CPB surgery. Reduction of thrombin
generation and fibrinolysis activation may lead to reduced blood loss
after surgery. Copyright &#xa9; 2017 Elsevier Inc.

<135>
Accession Number
615007679
Author
Penna M.; Markar S.R.; Mackenzie H.; Hompes R.; Cunningham C.
Institution
(Penna) *Department of Surgery and Cancer, Imperial College London,
London, United Kingdom +Department of Colorectal Surgery, Churchill
Hospital, University Hospitals of Oxford, Oxford, United Kingdom.
Title
Laparoscopic Lavage Versus Primary Resection for Acute Perforated
Diverticulitis: Review and Meta-analysis.
Source
Annals of Surgery. (no pagination), 2017. Date of Publication: 23 Mar
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
OBJECTIVE:: To compare clinical outcomes after laparoscopic lavage (LL) or
colonic resection (CR) for purulent diverticulitis. BACKGROUND::
Laparoscopic lavage has been suggested as an alternative treatment for
traditional CR. Comparative studies to date have shown conflicting
results. METHODS:: Electronic searches of Embase, Medline, Web of Science,
and Cochrane databases were performed. Weighted mean differences (WMD)
were calculated for effect size of continuous variables and pooled odds
ratios (POR) calculated for discrete variables. RESULTS:: A total of 589
patients recruited from 3 randomized controlled trials (RCTs) and 4
comparative studies were included; 85% as Hinchey III. LL group had
younger patients with higher body mass index and lower ASA grades, but
comparable Hinchey classification and previous diverticulitis rates. No
significant differences were noted for mortality, 30-day reoperations and
unplanned readmissions. LL had higher rates of intraabdominal abscesses
(POR = 2.85; 95% confidence interval, CI, 1.52-5.34; P = 0.001),
peritonitis (POR = 7.80; 95% CI 2.12-28.69; P = 0.002), and increased
long-term emergency reoperations (POR = 3.32; 95% CI 1.73-6.38; P <
0.001). Benefits of LL included shorter operative time, fewer cardiac
complications, fewer wound infections, and shorter hospital stay. Overall,
90% had stomas after CR, of whom 74% underwent stoma reversal within
12-months. Approximately, 14% of LL patients required a stoma; 48%
obtaining gut continuity within 12-months, whereas 36% underwent elective
sigmoidectomy. CONCLUSIONS:: The preservation of diseased bowel by LL is
associated with approximately 3 times greater risk of persistent
peritonitis, intraabdominal abscesses and the need for emergency surgery
compared with CR. Future studies should focus on developing composite
predictive scores encompassing the wide variation in presentations of
diverticulitis and treatment tailored on case-by-case basis. Copyright
&#xa9; 2017 Wolters Kluwer Health, Inc. All rights reserved.

<136>
Accession Number
615007607
Author
Lambert L.M.; Trachtenberg F.L.; Pemberton V.L.; Wood J.; Andreas S.;
Schlosser R.; Barnard T.; Daniels K.; Harrington A.T.; Dagincourt N.;
Miller T.A.
Institution
(Lambert, Wood) Primary Children's Hospital, Salt Lake City, Utah, United
States of America
(Trachtenberg, Dagincourt) New England Research Institutes, Watertown,
Massachusetts, United States of America
(Pemberton) National Heart, Lung, and Blood Institute, Bethesda, Maryland,
United States of America
(Andreas, Schlosser) Texas Children's Hospital, Houston, Texas, United
States of America
(Barnard) Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio,
United States of America
(Daniels, Harrington) The Children's Hospital of Philadelphia,
Philadelphia, Pennsylvania, United States of America
(Miller) University of Utah, Salt Lake City, Utah, United States of
America
Title
Passive range of motion exercise to enhance growth in infants following
the Norwood procedure: a safety and feasibility trial.
Source
Cardiology in the Young. (pp 1-8), 2017. Date of Publication: 23 Mar 2017.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Objective: The aim of this study was to evaluate the safety and
feasibility of a passive range of motion exercise programme for infants
with CHD. Study design: This non-randomised pilot study enrolled 20
neonates following Stage I palliation for single-ventricle physiology.
Trained physical therapists administered standardised 15-20-minute passive
range of motion protocol, for up to 21 days or until hospital discharge.
Safety assessments included vital signs measured before, during, and after
the exercise as well as adverse events recorded through the pre-Stage II
follow-up. Feasibility was determined by the percent of days that >75% of
the passive range of motion protocol was completed. Results: A total of 20
infants were enrolled (70% males) for the present study. The median age at
enrolment was 8 days (with a range from 5 to 23), with a median start of
intervention at postoperative day 4 (with a range from 2 to 12). The
median hospital length of stay following surgery was 15 days (with a range
from 9 to 131), with an average of 13.4 (with a range from 3 to 21)
in-hospital days per patient. Completion of >75% of the protocol was
achieved on 88% of eligible days. Of 11 adverse events reported in six
patients, 10 were expected with one determined to be possibly related to
the study intervention. There were no clinically significant changes in
vital signs. At pre-Stage II follow-up, weight-for-age z-score
(-0.84+/-1.20) and length-for-age z-score (-0.83+/-1.31) were higher
compared with historical controls from two earlier trials. Conclusion: A
passive range of motion exercise programme is safe and feasible in infants
with single-ventricle physiology. Larger studies are needed to determine
the optimal duration of passive range of motion and its effect on somatic
growth. Copyright &#xa9; Cambridge University Press 2017

<137>
[Use Link to view the full text]
Accession Number
614962304
Author
Fernandez R.S.; Lee A.
Institution
(Fernandez) Centre for Evidence Based Initiatives in Health Care, Joanna
Briggs Institute Centre of Excellence, Australia
(Fernandez) School of Nursing, University of Wollongong, Wollongong,
Australia
(Fernandez) Centre for Research in Nursing and Health, St George Hospital,
Sydney, Australia
(Lee) Wollongong Hospital, Wollongong, Australia
(Lee) School of Medicine, University of Wollongong, Wollongong, Australia
Title
Effects of methods used to achieve hemostasis on radial artery occlusion
following percutaneous coronary procedures: A systematic review.
Source
JBI Database of Systematic Reviews and Implementation Reports. 15 (3) (pp
738-764), 2017. Date of Publication: 01 Mar 2017.
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
Background Transradial access to percutaneous coronary procedures is
becoming the preferred access route, and it is being increasingly used for
emergent and elective procedures. However, radial artery occlusion (RAO)
continues to remain an adverse occurrence following sheath removal or in
the first 24 hours following sheath removal due to the smaller diameter of
the artery. Objectives The overall objective of this study was to
synthesize the best available research evidence related to the effects of
methods used to achieve hemostasis on RAO rates after percutaneous
coronary procedures. Inclusion criteria Types of participants The current
review considered trials that included adult patients (18 years and over)
who have had a coronary angiography or coronary re-vascularization
intervention via the radial artery. Types of intervention(s) The
interventions of interest were the use of various hemostatic methods
compared to traditional interventions to prevent RAO. Types of studies All
randomized and quasi-randomized controlled trials evaluating the effect of
various hemostatic methods on RAO rates after percutaneous coronary
procedures were included in the review. Outcomes The primary outcome of
interest was the incidence of RAO at the time of discharge and persistent
occlusion at the time of follow-up. Search strategy The search aimed to
find published and unpublished trials through electronic databases,
reference lists and key reports. An extensive search was undertaken for
the following databases - CINAHL, Embase, PubMed and the Cochrane Central
Register of Controlled Trials (CENTRAL). Databases were searched up to May
2016. The search for unpublished trials included Dissertation Abstracts
International, World Cat, Clinicaltrials.gov, ProQuest Dissertation and
Theses and MedNar. Methodological quality Methodological quality was
assessed independently by two reviewers using the Joanna Briggs Institute
Meta- Analysis of Statistics Assessment and Review Instrument
(JBI-MAStARI) checklist. Disagreements that arose between the reviewers
were resolved through discussion. Data extraction Quantitative data were
extracted from papers included in the review by one reviewer using the
standardized data extraction tool from JBI-MAStARI. The data extracted
were checked by a second reviewer. Disagreements that arose between the
reviewerswere resolved through discussion. All resultswere subject to
double data entry in ReviewManager. Data synthesis Statistical pooling of
the data was not possible due to the heterogeneity of the trials;
therefore, the findings are presented in narrative form. However, figures
have been used to illustrate the results. Results A total of seven trials
were included in the review. One trial demonstrated a significant
reduction in RAO rates in patients who had a mean arterial pressure
(MAP)-guided TR band to a standard TR band (odds ratio [OR] 0.08; 95%
confidence interval [CI] 0.02, 0.37). A statistically significant
reduction in the incidence of RAO was observed among patients who received
a biopolymer dressing (Chitosen) compared to those who received the TR
band (OR 2.20; 95% CI 1.20, 4.02). No statistically significant difference
in the incidence of RAO was reported between those who received the TR
band and those who received either the elastic bandage (P1/40.08) or T
band (P1/40.76). Similarly, no statistically significant difference in
rates of RAO among patients was reported among those who had pro-coagulant
dressings compared to those who had short or long manual compression. One
trial that compared the TR band to a MAP-guided TR band demonstrated no
statistically significant difference in the time taken to obtain
hemostasis between the two groups (P1/40.61). A statistically significant
reduction in the time taken to obtain hemostasis was observed among
patients who received the hemostatic biopolymer dressing compared to the
TR band. No statistically significant difference in the incidence of
hematoma was identified among patients who received pneumatic compression
or traditional compression to achieve hemostasis. Conclusion There is
limited evidence to support the use of any single hemostatic method to
prevent RAO rates after percutaneous coronary procedures. Although used
extensively, there is evidence of no effect of the pneumatic compression
method using the TR band on the incidence of RAO at discharge or
follow-up, the time taken to obtain hemostasis and the incidence of
hematoma. The MAP-guided compression method and the Biopolymer dressing
(Chitosen) were superior to the TR band compression method, and patent
hemostasis was superior to hemoband in the prevention of RAO. However,
these results are based on single trials and should be interpreted with
caution. The evidence obtained from the review does not provide a concrete
base for the development of practice guidelines. Until more robust
evidence is available, practices will continue to be dictated by local
preferences and available resources. Copyright &#xa9; 2017 The Joanna
Briggs Institute.

<138>
Accession Number
614684165
Author
Cotogni P.; Barbero C.; Passera R.; Fossati L.; Olivero G.; Rinaldi M.
Institution
(Cotogni) University of Turin, Department of Anesthesia and Intensive
Care, S. Giovanni Battista Hospital, Via Giovanni Giolitti 9, Turin 10123,
Italy
(Barbero, Rinaldi) University of Turin, Department of Cardiovascular
Surgery, S. Giovanni Battista Hospital, Turin, Italy
(Passera) University of Turin, Nuclear Medicine Unit, S. Giovanni Battista
Hospital, Turin, Italy
(Fossati) University of Turin, Microbiology and Virology Laboratory, S.
Giovanni Battista Hospital, Turin, Italy
(Olivero) University of Turin, Department of Surgical Sciences, S.
Giovanni Battista Hospital, Turin, Italy
Title
Violation of prophylactic vancomycin administration timing is a potential
risk factor for rate of surgical site infections in cardiac surgery
patients: A prospective cohort study.
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 73. Date of Publication: 08 Mar 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Intensivists and cardiothoracic surgeons are commonly worried
about surgical site infections (SSIs) due to increasing length of stay
(LOS), costs and mortality. The antimicrobial prophylaxis is one of the
most important tools in the prevention of SSIs. The objective of this
study was to investigate the relationship between the timing of
antimicrobial prophylaxis administration and the rate of SSIs. Methods: A
prospective cohort study was carried out over 1-year period in all
consecutive adult patients undergoing elective cardiac surgery. The
population was stratified in patients whose antimicrobial prophylaxis
administration violated or not the vancomycin timing protocol (i.e., when
the first skin incision was performed before the end of vancomycin
infusion). To compare SSI rates, the cohort was further stratified in
patients at low and high risk of developing SSIs. Results: Over the study
period, 1020 consecutive adult patients underwent cardiac surgery and
according to study inclusion criteria, 741 patients were prospectively
enrolled. A total of 60 SSIs were identified for an overall infection rate
of 8.1%. Vancomycin prophylaxis timing protocol was violated in 305 (41%)
out of 741 enrolled patients. SSIs were observed in 3% of patients without
violation of the antimicrobial prophylaxis protocol (13/436) compared with
15.4% of patients with a violation of the timing protocol (47/305) (P <
0.0001). Patients at low risk with protocol violation had a higher
occurrence of SSIs (P = 0.004) and mortality (P = 0.03) versus patients at
low risk without protocol violation. Similarly, patients at high risk with
protocol violation had a higher occurrence of SSIs (P < 0.001) and
mortality (P < 0.001) versus patients at high risk without protocol
violation. The logistic regression analysis showed that internal mammary
artery use (P = 0.025), surgical time (P < 0.001), intensive care unit
(ICU) LOS (P = 0.002), high risk of developing SSIs (P < 0.001) and
protocol violation (P < 0.001) were risk factors for SSI occurrence as
well as age (P = 0.003), logistic EuroSCORE (P < 0.001), ICU LOS (P <
0.001), mechanical ventilation time (P < 0.001) and protocol violation (P
< 0.001) were risk factors for mortality. Conclusions: This study showed
that violation of the timing of prophylactic vancomycin administration
significantly increased the probability of SSIs and mortality from
infectious cause in cardiac surgery patients. Copyright &#xa9; 2017 The
Author(s).

<139>
Accession Number
614652703
Author
Bin Abdulhak A.A.; Tleyjeh I.M.
Institution
(Bin Abdulhak) Department of Medicine, Division of Cardiovascular
Diseases, University of Iowa Hospitals and Clinics, 200 Hawkins Dr., Int.
Med. E315 GH, Iowa City, IA 52242, United States
(Bin Abdulhak) College of Public Health, University of Iowa, Iowa City,
IA, United States
(Tleyjeh) Division of Infectious Diseases, Mayo Clinic, Rochester, MN,
United States
(Tleyjeh) Division of Epidemiology, Mayo Clinic, Rochester, MN, United
States
(Tleyjeh) Department of Medicine, Infectious Diseases Section, King Fahad
Medical City, PO Box 59046, Riyadh 11525, Saudi Arabia
(Tleyjeh) College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
Title
Indications of Surgery in Infective Endocarditis.
Source
Current Infectious Disease Reports. 19 (3) (no pagination), 2017. Article
Number: 10. Date of Publication: 01 Mar 2017.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of the Review: Infective endocarditis (IE) is a serious disease
with significant morbidity and mortality. Valve surgery is fundamental in
the standard of care of selected IE patients. Indeed, valve surgery can be
a lifesaving procedure in critically ill endocarditis patients. Our goal
from this review is to discuss the indications of surgery in IE population
and international cardiac societies' guideline recommendations. Recent
Findings: Though IE is an uncommon disease, its incidence is noted to be
on rise in some parts of the world, and the disease is expected to
continue to be a major health problem. Antimicrobials remain the mainstay
of IE therapy, but as many as 50% of endocarditis patients will undergo
surgical intervention. Heart failure most commonly from acute valvular
insufficiency, uncontrolled and persistent infection, and recurrent
embolic events are the major indications for valve surgery in IE
population. Heart failure is by far the most common indication for surgery
in IE patients. Despite the fact that many IE patients will require
surgical interventions, most of the international societies'
recommendations to perform valve surgery are based on observational
studies or experts' opinion. Summary: Surgery plays a major role in the
management of IE patients, and it is most commonly performed in patients
with heart failure, persistent or uncontrolled infection, and recurrent
emboli. Most of the current evidence supporting surgical intervention in
IE patients is based on observational studies and experts' opinion.
Randomized clinical trials are urgently needed to guide surgical therapy
in IE. Copyright &#xa9; 2017, Springer Science+Business Media New York.

<140>
Accession Number
614530211
Author
Helmerhorst H.J.F.; de Wilde R.B.P.; Lee D.H.; Palmen M.; Jansen J.R.C.;
van Westerloo D.J.; de Jonge E.
Institution
(Helmerhorst, de Wilde, Jansen, van Westerloo, de Jonge) Department of
Intensive Care Medicine, Leiden University Medical Center, Post Box 9600,
Leiden 2300 RC, Netherlands
(Helmerhorst) Department of Anesthesiology, Leiden University Medical
Center, Leiden, Netherlands
(Helmerhorst) Laboratory of Experimental Intensive Care and
Anesthesiology, Academic Medical Center, Amsterdam, Netherlands
(Lee) Department of Nephrology, Einthoven Laboratory for Vascular
Medicine, Leiden University Medical Center, Leiden, Netherlands
(Palmen) Department of Cardiothoracic Surgery, Leiden University Medical
Center, Leiden, Netherlands
Title
Hemodynamic effects of short-term hyperoxia after coronary artery bypass
grafting.
Source
Annals of Intensive Care. 7 (1) (no pagination), 2017. Article Number: 20.
Date of Publication: 01 Dec 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Background: Although oxygen is generally administered in a liberal manner
in the perioperative setting, the effects of oxygen administration on
dynamic cardiovascular parameters, filling status and cerebral perfusion
have not been fully unraveled. Our aim was to study the acute hemodynamic
and microcirculatory changes before, during and after arterial hyperoxia
in mechanically ventilated patients after coronary artery bypass grafting
(CABG) surgery. Methods: This was a single-center physiological study in a
tertiary care ICU in the Netherlands. Twenty-two patients scheduled for
ICU admission after elective CABG were enrolled in the study between
September 2014 and September 2015. In the ICU, patients were exposed to a
fraction of inspired oxygen (FiO<inf>2</inf>) of 90% allowing a 15-min
wash-in period. Various hemodynamic parameters were measured using direct
pressure signals and continuous arterial waveform analysis at three
sequential time points: before, during and after hyperoxia. Results:
During a 15-min exposure to a fraction of inspired oxygen
(FiO<inf>2</inf>) of 90%, the partial pressure of arterial oxygen
(PaO<inf>2</inf>) and arterial oxygen saturation (SaO<inf>2</inf>) were
significantly higher. The systemic resistance increased (P < 0.0001),
without altering the heart rate. Stroke volume variation and pulse
pressure variation decreased slightly. The cardiac output did not
significantly decrease (P = 0.08). Mean systemic filling pressure and
arterial critical closing pressure increased (P < 0.01whereas the
percentage of perfused microcirculatory vessels decreased (P < 0.01).
Other microcirculatory parameters and cerebral blood flow velocity showed
only slight changes. Conclusions: We found that short-term hyperoxia
affects hemodynamics in ICU patients after CABG. This was translated in
several changes in central circulatory variables, but had only slight
effects on cardiac output, cerebral blood flow and the microcirculation.
Clinical trial registration Netherlands Trial Register: NTR5064 Copyright
&#xa9; 2017, The Author(s).

<141>
Accession Number
614894494
Author
Unlu A.; Kaymak S.; Urkan M.; Ozmen P.; Hancerliogullari O.; Zeybek N.
Institution
(Unlu, Kaymak, Urkan, Hancerliogullari, Zeybek) Department of General
Surgery, Gulhane Military Medical Academy, Ankara, Turkey
(Ozmen) Department of Military Health Services, Gulhane Military Medical
Academy, Ankara, Turkey
Title
The time has come to rethink our mass casualty preparedness level in
response to terrorist attacks: Initial contribution from the department of
war surgery in Gulhane military medical academy.
Source
Erciyes Tip Dergisi. 38 (3) (pp 106-110), 2016. Date of Publication:
September 2016.
Publisher
AVES Ibrahim Kara (105/9 Buyukdere Cad, Mecidiyekoy,Sisli, Istanbul 34394,
Turkey)
Abstract
Objective: Urban terrorist attacks are increasing worldwide. After suicide
bombings in Ankara and Urfa in 2015, the Department of War Surgery in
Gulhane Military Medical Academy (GATA) started the "Current Approaches to
Firearms Injuries Course" for training civilian doctors potentially
unfamiliar with these injury mechanisms. Here we present the attending
doctors' pretest and posttest results. Materials and Methods: The course
comprised 30 lectures from 16 departments. Medical deontology was
excluded; the remaining 29 lecturers prepared one multiple-choice question
each for the study. These questions were randomized in order to select 15
questions for the pretest. The order of the 15 questions was changed in
the posttest. Results: All 46 attendees were male, and their mean age was
36.8+/-6.3 years. General surgeons and thoracic surgeons accounted for 23
(50%) and 7 (15.2%) of the 46 attendees. Compared with their pretest
scores, doctors' posttest scores were significantly higher. Most
profoundly, 95.2% of attending doctors' answers on Chemical Biological
Radiological and Nuclear (CBRN) were improved by the lecture. Overall, the
accuracy of the posttest answers on 11 of the 15 (73.3%) trauma lectures
was improved, and the difference was significant. Conclusion: The severity
of combat and terrorist attack injuries is higher than that of the usual
civilian mechanisms of injury. The only question is when the next
terrorist attack will occur instead of "if it will occur," and as such,
all relevant clinical specialties and interested health care providers
should participate in such trauma-training programs. Copyright &#xa9; 2016
by Erciyes University School of Medicine.