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<1>
Accession Number
614999893
Author
Nguyen T.-L.; Collins G.S.; Lamy A.; Devereaux P.J.; Daures J.-P.; Landais
P.; Le Manach Y.
Institution
(Nguyen, Daures, Landais) Laboratory of Biostatistics, Epidemiology,
Clinical Research and Health Economics, UPRES EA2415, University of
Montpellier, Montpellier, France
(Nguyen, Devereaux, Le Manach) Department of Clinical Epidemiology and
Biostatistics, Michael DeGroote School of Medicine, Faculty of Health
Sciences, McMaster University, Hamilton, Canada
(Nguyen, Le Manach) Department of Anesthesia, Michael DeGroote School of
Medicine, Faculty of Health Sciences, McMaster University, Hamilton,
Canada
(Nguyen, Lamy, Devereaux, Le Manach) Population Health Research Institute,
David Braley Cardiac, Vascular and Stroke Research Institute,
Perioperative Medicine and Surgical Research Unit, Perioperative Research
Group, Population Health Research Institute, McMaster University,
Hamilton, Canada
(Collins) Centre for Statistics in Medicine, Nuffield Department of
Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research
Centre, University of Oxford, Windmill Road, Oxford, United Kingdom,
United Kingdom
(Devereaux) Department of Medicine, Michael DeGroote School of Medicine,
Faculty of Health Sciences, McMaster University, Hamilton, Canada
(Landais) Department of Biostatistics, Clinical Research and Medical
Informatics, Nimes University Hospital, Nimes, France, France
Title
Simple randomization did not protect against bias in smaller trials.
Source
Journal of Clinical Epidemiology. 84 (pp 105-113), 2017. Date of
Publication: April 2017.
Publisher
Elsevier USA
Abstract
Objectives By removing systematic differences across treatment groups,
simple randomization is assumed to protect against bias. However, random
differences may remain if the sample size is insufficiently large. We
sought to determine the minimal sample size required to eliminate random
differences, thereby allowing an unbiased estimation of the treatment
effect. Study Design and Setting We reanalyzed two published multicenter,
large, and simple trials: the International Stroke Trial (IST) and the
Coronary Artery Bypass Grafting (CABG) Off- or On-Pump Revascularization
Study (CORONARY). We reiterated 1,000 times the analysis originally
reported by the investigators in random samples of varying size. We
measured the covariates balance across the treatment arms. We estimated
the effect of aspirin and heparin on death or dependency at 30 days after
stroke (IST), and the effect of off-pump CABG on a composite primary
outcome of death, nonfatal stroke, nonfatal myocardial infarction, or new
renal failure requiring dialysis at 30 days (CORONARY). In addition, we
conducted a series of Monte Carlo simulations of randomized trials to
supplement these analyses. Results Randomization removes random
differences between treatment groups when including at least 1,000
participants, thereby resulting in minimal bias in effects estimation.
Later, substantial bias is observed. In a short review, we show such an
enrollment is achieved in 41.5% of phase 3 trials published in the highest
impact medical journals. Conclusions Conclusions drawn from completely
randomized trials enrolling a few participants may not be reliable. In
these circumstances, alternatives such as minimization or blocking should
be considered for allocating the treatment. Copyright © 2017
Elsevier Inc.

<2>
Accession Number
614254252
Author
Alfonso F.; Perez-Vizcayno M.J.; Garcia del Blanco B.; Garcia-Touchard A.;
Lopez-Minguez J.-R.; Sabate M.; Zueco J.; Melgares R.; Hernandez R.;
Moreno R.; Dominguez A.; Sanchis J.; Moris C.; Moreu J.; Cequier A.;
Romaguera R.; Rivero F.; Cuesta J.; Gonzalo N.; Jimenez-Quevedo P.;
Cardenas A.; Fernandez C.
Institution
(Alfonso, Rivero, Cuesta) Hospital Universitario de La Princesa, Madrid,
Spain
(Perez-Vizcayno, Gonzalo, Jimenez-Quevedo, Cardenas, Fernandez) Hospital
Universitario Clinico San Carlos, Madrid, Spain
(Perez-Vizcayno) Funacion Interhospitalaria Investigacion Cardiovascular,
Madrid, Spain
(Garcia del Blanco) Hospital Universitario Vall d'Hebron, Barcelona, Spain
(Garcia-Touchard) Hospital Universitario Puerta de Hierro-Majadahonda,
Madrid, Spain
(Lopez-Minguez) Hospital Universitario Infanta Cristina, Badajoz, Spain
(Sabate) Hospital Universitario Clinic de Barcelona, Barcelona, Spain
(Zueco) Hospital Universitario Marques de Valdecilla, Santander, Spain
(Melgares) Hospital Universitario Virgen de las Nieves, Granada, Spain
(Hernandez) Hospital Universitario Ramon y Cajal, Madrid, Spain
(Moreno) Hospital Universitario La Paz, Madrid, Spain
(Dominguez) Hospital Universitario Virgen de la Victoria, Malaga, Spain
(Sanchis) Hospital Universitario Clinico de Valencia, Valencia, Spain
(Moris) Hospital Universitario Central de Asturias, Oviedo, Spain
(Moreu) Hospital Universitario Virgen de la Salud Toledo, Toledo, Spain
(Cequier, Romaguera) Hospital Universitario de Bellvitge, Barcelona, Spain
Title
Usefulness of Drug-Eluting Balloons for Bare-Metal and Drug-Eluting
In-Stent Restenosis (from the RIBS IV and V Randomized Trials).
Source
American Journal of Cardiology. 119 (7) (pp 983-990), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Treatment of patients with drug-eluting stent (DES) in-stent restenosis
(ISR) is particularly challenging. We sought to compare results of
drug-eluting balloons in patients with DES-ISR with those in patients with
bare-metal stent (BMS) ISR. A pooled analysis of the Restenosis
Intra-Stent: Drug-Eluting Balloon versus Everolimus-Eluting Stent IV and V
randomized trials was performed. Both trials had identical inclusion and
exclusion criteria. Results of drug-eluting balloons in 95 patients with
BMS-ISR and 154 patients with DES-ISR were compared. Patients with DES-ISR
were more frequently diabetics, presented more often as an acute coronary
syndrome and had more severe lesions and more frequently a focal pattern,
including edge-ISR. Late angiographic findings (92% of eligible patients),
including minimal lumen diameter (1.80 +/- 0.6 vs 2.01 +/- 0.6 mm, p =
0.001; absolute mean difference 0.21 mm; 95% confidence interval 0.04 to
0.38; p = 0.014) and restenosis rate (19% vs 9.5%, p <0.05) were poorer in
DES-ISR. Results were consistent across 10 prespecified subgroups.
Moreover, on multiple linear regression analysis, minimal lumen diameter
at follow-up remained significantly smaller in patients with DES-ISR after
adjusting for potential confounders (adjusted absolute mean difference
0.17 mm; 95% confidence interval 0.04 to 0.41; p = 0.019). Finally, at
1-year clinical follow-up (100% of patients), rates of target vessel
revascularization (16% vs 6%, p = 0.02) and of the main combined clinical
end point (18% vs 8%, p = 0.03) were significantly higher in patients
treated for DES-ISR. In conclusion, this study confirms the efficacy of
DEB for patients with ISR. However, the long-term clinical and
angiographic results of DEB are poorer in patients with DES-ISR than in
those with BMS-ISR. (ClinicalTrials.gov Identifier: NCT01239953 &
NCT01239940). Copyright © 2017 Elsevier Inc.

<3>
Accession Number
610123953
Author
Rashidi M.; Esmaily S.; Fiane A.E.; Gude E.; Atonseth K.; Ueland T.;
Gustafsson F.; Eiskjaer H.; Radegran G.; Dellgren G.
Institution
(Rashidi, Fiane) Department of Cardiothoracic Surgery, Oslo University
Hospital, Oslo, Norway
(Rashidi, Atonseth) Department of Plastic and Reconstructive Surgery, Oslo
University Hospital, Oslo, Norway
(Esmaily, Dellgren) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Fiane, Atonseth, Ueland) Faculty of Medicine, University of Oslo, Norway
(Gude) Department of Cardiology, Oslo University Hospital, Oslo, Norway
(Ueland) Research Institute of Internal Medicine, Oslo University
Hospital, Rikshospitalet, Oslo, Norway
(Ueland) K.G. Jebsen Inflammatory Research Center, University of Oslo,
Oslo, Norway
(Ueland) K.G. Jebsen Thrombosis Research and Expertise Center, University
of Tromso, Norway
(Gustafsson) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Eiskjaer) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(Radegran) Clinic for Heart Failure and Valvular Disease, Skane University
Hospital and Department of Clinical Sciences Lund, Cardiology, Lund
University, Lund, Sweden
Title
Wound complications and surgical events in de novo heart transplant
patients treated with everolimus: Post-hoc analysis of the SCHEDULE trial.
Source
International Journal of Cardiology. 210 (pp 80-84), 2016. Date of
Publication: 01 May 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives The use of mammalian target of rapamycin (mTOR) inhibitors have
been limited by adverse events (AE), including delayed wound healing. We
retrospectively reviewed all AE and serious AE (SAE) in The Scandinavian
heart transplant (HTx) everolimus (EVE) de novo trial with early
calcineurin (CNI) avoidance (SCHEDULE). The aim of the study was to
compare wound complications between EVE and CNI based regimen. Materials
and methods A total of 115 patients (mean age 51 +/- 13 years, 73% men)
were randomized within five days post-HTx to low dose EVE and reduced dose
Cyclosporine (CyA) followed by early CyA withdrawal (EVE group; n = 56) or
standard CyA regimen (CyA group; n = 59). All AE/SAEs were prospectively
recorded according to the SCHEDULE study protocol, and re-assessed
retrospectively by two independent reviewers. Wound complication as
primary endpoint was defined as any complication associated with failure
of tissue healing. Secondary endpoint was total number of events involving
surgical intervention. Results There were no significant differences
between the groups with regards to wound complications (EVE = 20, CyA =
12)(p = 0.08) or total surgical events (EVE = 38, CyA = 34) (p = 0.44).
Age > 54.5 years (median) was an overall risk factor for surgical wound
complications regardless of treatment group (p = 0.025). There was no
difference in the EVE versus CyA group with regards to other surgical
events. Majority of events were in 1/3 of the patients. Conclusion De novo
initiation of EVE and early CyA withdrawal in HTx patients did not show
any significant differences in wound complications or in total surgical
events. Majority of complications were seen in a small number of
patients. Copyright © 2016 Elsevier Ireland Ltd. All rights
reserved.

<4>
Accession Number
610123936
Author
Benedetto U.; Gaudino M.; Ng C.; Biondi-Zoccai G.; D'Ascenzo F.; Frati G.;
Girardi L.N.; Angelini G.D.; Taggart D.P.
Institution
(Benedetto, Ng, Angelini) Bristol Heart Institute, University of Bristol,
School of Clinical Sciences, Upper Maudlin St, Bristol BS2 8HW, United
Kingdom
(Gaudino, Girardi) Division of Cardio-thoracic Surgery, Cornell
University, New York, NY, United States
(Biondi-Zoccai, Frati) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Biondi-Zoccai) Eleonora Lorillard Spencer Cenci Foundation, Rome, Italy
(D'Ascenzo) Dipartimento Di Scienze Mediche, Divisione di Cardiologia,
Citta della Salute e della Scienza, Turin, Italy
(Frati) Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli,
Italy
(Taggart) Nuffield Department of Surgical Sciences, Oxford University
Hospital, Oxford, United Kingdom
Title
Coronary surgery is superior to drug eluting stents in multivessel
disease. Systematic review and meta-analysis of contemporary randomized
controlled trials.
Source
International Journal of Cardiology. 210 (pp 19-24), 2016. Date of
Publication: 01 May 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objective Current randomized controlled trials (RCTs) comparing
percutaneous coronary intervention with drug eluting stent (DES-PCI) with
coronary artery bypass grafting (CABG) in multivessel disease are
underpowered to detect a difference in hard clinical end-points such as
mortality, myocardial infarction and stroke. We aimed to overcome this
limitation by conducting a meta-analysis of contemporary RCTs. Methods A
systematic literature search was conducted for all RCTs comparing DES-PCI
versus CABG in multivessel disease published through May 2015. Inverse
variance weighting was used to pool data from individual studies (< 1
favouring DES-PCI and > 1 CABG favouring surgery). Results A total of five
randomized trials including 4563 subjects were analysed. After an average
follow-up of 3.4 years, DES-PCI was associated with a significantly
increased risk of overall mortality (HR 1.51; 95%CI 1.23-1.84; P < 0.001),
MI (HR 2.02; 95%CI 1.57-2.58; P < 0.001) and repeat revascularization (HR
2.54; 95%CI 2.07-3.11; P = < 0.001). CABG marginally increased the risk of
stroke (HR 0.70; 95%CI 0.50-0.98; P = 0.04). The absolute risk reduction
for all-cause mortality (3.3%) and myocardial infarction (4.3%) with CABG
was larger than the absolute risk reduction for stroke (0.9%) with
DES-PCI. Conclusion In patients with multivessel coronary disease, CABG
was found to be superior to DES-PCI by reducing the risk of mortality and
subsequent myocardial infarction at the expense of a marginally increased
risk of stroke. Copyright © 2016 Elsevier Ireland Ltd. All rights
reserved.

<5>
Accession Number
609705156
Author
Sharma P.; Patel K.; Baria K.; Lakhia K.; Malhotra A.; Shah K.; Patel S.
Institution
(Sharma, Patel, Baria, Lakhia, Malhotra) Department of Cardiovascular and
Thoracic Surgery, U N Mehta Institute of Cardiology and Research Center,
Asarwa, Ahmedabad, Gujarat, India
(Shah, Patel) Department of Research, U N Mehta Institute of Cardiology
and Research Center, Asarwa, Ahmedabad, Gujarat, India
Title
Procalcitonin level for prediction of postoperative infection in cardiac
surgery.
Source
Asian Cardiovascular and Thoracic Annals. 24 (4) (pp 344-349), 2016. Date
of Publication: 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background Diagnosing infection after cardiac surgery remains difficult
due to the systemic inflammatory response induced by cardiopulmonary
bypass. We compared procalcitonin levels with white blood cell counts as
predictors of infection after cardiac surgery. Methods We prospectively
enrolled 100 consecutive adult cardiac patients. Postoperative white blood
cell counts, serum procalcitonin levels, and blood cultures were examined.
Result The sensitivity and specificity of white blood cell count and
procalcitonin > 2 ng mL-1 were 60% and 100%, 58.8% and 42.5%,
respectively. Procalcitonin > 7 ng mL-1 had 95% sensitivity and
80% specificity. Receiver-operating characteristic analysis showed a
greater area under the curve for procalcitonin level (p < 0.0001) compared
to white blood cell count (p = 0.31). Patients with positive blood
cultures had significantly higher procalcitonin levels (51.97 +/- 39.62
vs. 6.67 +/- 10.73 ng mL-1), Acute Physiology and Chronic
Health Evaluation-II scores (16.95 +/- 3.24 vs. 13.60 +/- 2.98), and
intensive care unit stay (6.35 +/- 3.42 vs. 4.6 +/- 2.2 days).
Non-survivors had significantly higher Acute Physiology and Chronic Health
Evaluation-II scores (19.09 +/- 1.30 vs. 13.67 +/- 2.97) and procalcitonin
levels (43.83 +/- 52.15 vs. 12.26 +/- 19.89 ng mL-1) but on
logistic regression analysis, only Acute Physiology and Chronic Health
Evaluation-II score was an independent risk factor for mortality.
Conclusion The diagnostic accuracy of procalcitonin for bacterial
infection is fairly high. Acute Physiology and Chronic Health
Evaluation-II score is a better predictor of mortality and morbidity than
absolute procalcitonin level. Procalcitonin > 7 ng mL-1 can
prognosticate and identify the high-risk group. Copyright © SAGE
Publications.

<6>
Accession Number
608563751
Author
Bertolet M.; Brooks M.M.; Bittner V.
Institution
(Bertolet) Department of Epidemiology, Clinical and Translational
Sciences, University of Pittsburgh, Pittsburgh, PA, United States
(Brooks) Department of Epidemiology and Biostatistics, Clinical and
Translational Sciences, University of Pittsburgh, Pittsburgh, PA, United
States
(Bittner) Preventive Cardiology, University of Alabama at Birmingham,
Birmingham, AL, United States
Title
Tree-based identification of subgroups for time-varying covariate survival
data.
Source
Statistical Methods in Medical Research. 25 (1) (pp 488-501), 2016. Date
of Publication: 01 Feb 2016.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Classification and regression tree analyses identify subsets of a sample
that differ on an outcome. Discrimination of subsets is performed using
recursive binary splitting on a set of covariates, allowing for
interactions of variable subgroups not easily captured in standard model
building techniques. Using classification and regression tree with
epidemiological data can be problematic as there is often a need to adjust
for potential confounders and to account for time-varying covariates in
the context of right-censored survival data. While classification and
regression tree variations exist individually for survival analysis,
time-varying covariates and incorporating possible confounders, examples
of classification and regression tree using all three together are
lacking. We propose a method to identify subsets of time-varying covariate
risk factors that affect survival while adjusting for possible
confounders. The technique is demonstrated on data from the Bypass
Angioplasty Revascularization Investigation 2 Diabetes clinical trial to
find combinations of modifiable time-varying cardiac risk factors (e.g.
smoking status, blood pressure, lipid levels and HbA1c level) that are
associated with time-to-event clinical outcomes. Copyright © SAGE
Publications 2012.

<7>
Accession Number
610284261
Author
Kirmani B.H.; Brazier A.; Sriskandarajah S.; Azzam R.; Keenan D.J.
Institution
(Kirmani, Brazier, Sriskandarajah, Azzam, Keenan) Department of
Cardiothoracic Surgery, Manchester Royal Infirmary, Oxford Road,
Manchester M13 9WL, United Kingdom
Title
A meta-analysis of computerized tomography scan for reducing complications
following repeat sternotomy for cardiac surgery.
Source
Interactive Cardiovascular and Thoracic Surgery. 22 (4) (pp 472-479),
2016. Date of Publication: 01 Apr 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Cardiac reoperation carries additional risks compared with surgery in
patients who are sternotomy-naive. To identify if preoperative
computerized tomography (CT) can reduce this risk, we performed a
systematic review of the literature and meta-analysis. Literature search
identified 178 studies of which 4 retrospective cohort studies
incorporating 900 patients met inclusion criteria. There were no
statistically significant differences in the risk of death, re-entry
injury, renal failure or perfusion/ischaemic times. CT scan reduced the
risk of stroke by 0.42 [95% confidence interval (CI): 0.19-0.93, P = 0.03]
and a composite of major complications by 0.65 (95% CI: 0.47-0.88, P =
0.006). The use of preoperative cross-sectional imaging to reduce the risk
of complications following cardiac reoperation is advocated. Copyright
© 2016 The Author 2016. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<8>
Accession Number
607178982
Author
De Waha S.; Allali A.; Buttner H.-J.; Toelg R.; Geist V.; Neumann F.-J.;
Khattab A.A.; Richardt G.; Abdel-Wahab M.
Institution
(De Waha, Allali, Toelg, Geist, Richardt, Abdel-Wahab) Department of
Cardiology and Angiology, Segeberger Kliniken - Heart Centre, Am Kurpark
1, Bad Segeberg 23795, Germany
(Buttner, Neumann) Department of Cardiology, University Heart Centre
Freiburg-Bad Krozingen, Bad Krozingen, Germany
(Khattab) Department of Cardiology, University of Bern, Bern, Switzerland
Title
Rotational atherectomy before paclitaxel-eluting stent implantation in
complex calcified coronary lesions: Two-year clinical outcome of the
randomized ROTAXUS trial.
Source
Catheterization and Cardiovascular Interventions. 87 (4) (pp 691-700),
2016. Date of Publication: 01 Mar 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background In the randomized ROTAXUS trial, routine lesion preparation of
complex calcified coronary lesions using rotational atherectomy (RA) prior
to paclitaxel-eluting stent implantation did not reduce the primary
endpoint of angiographic late lumen loss at 9 months compared to stenting
without RA. So far, no long-term data of prospective head-to-head
comparisons between both treatment strategies have been reported. Methods
and Results ROTAXUS randomly assigned patients with complex calcified
coronary lesions to RA followed by stenting (n = 120) or stenting without
RA (n = 120). The primary endpoint of the current analysis was the
occurrence of major adverse cardiac events (MACE) at 2-year follow-up
defined as the composite of death, myocardial infarction, and target
vessel revascularization (TVR). At 2 years, MACE occurred in 32 patients
in the RA group and 37 patients in the standard therapy group (29.4% vs.
34.3%, P = 0.47). The rates of death (8.3% vs. 7.4%, P = 1.00), myocardial
infarction (8.3% vs. 6.5%, P = 0.80), target lesion revascularization
(TLR, 13.8% vs. 16.7%, P = 0.58), and TVR (19.3% vs. 22.2%, P = 0.62) were
similar in both groups. Conclusion Despite high rates of initial
angiographic success, nearly one third of patients enrolled in ROTAXUS
experienced MACE within 2-year follow-up, with no differences between
patients treated with or without RA. Copyright © 2015 Wiley
Periodicals, Inc.

<9>
Accession Number
608853575
Author
Lin Z.; Xiaoyi Z.
Institution
(Lin, Xiaoyi) Department of Neurology, West China Hospital, Sichuan
University, No.37 Guoxuexiang, Chengdu 610041, China
Title
Tranexamic acid-associated seizures: A meta-analysis.
Source
Seizure. 36 (pp 70-73), 2016. Date of Publication: 01 Mar 2016.
Publisher
W.B. Saunders Ltd
Abstract
Purpose To investigate the incidence rate of tranexamic acid
(TXA)-associated seizures. Methods Two electronic databases (Medline and
Embase) were searched. We looked for additional studies in the references
of all identified publications. The cutoff day was 2015 Dec 06. Two
authors independently reviewed the titles and abstracts of the
publications identified firstly. Odds ratio (OR) and 95% confidence
interval (CI) were used to compare discontinuous variables. Results Ten
studies enrolling 26,079 patients with TXA exposure and 7395 patients with
non-TXA exposure were included. The cumulative incidence rate of
TXA-associated seizures is 2.7%. The odds ratio of seizure is 5.39 (95%CI:
3.29-8.85; I2 = 0%; P < 0.001) in patients with TXA exposure vs
patients with non-TXA exposure. The incidence rate of TXA-associated
seizures increased when the dose levels increased. Conclusion The risk of
seizure increased in patients with TXA exposure and the incidence rate of
TXA-associated seizures increased when the dose levels
increased. Copyright © 2016 British Epilepsy Association.
Published by Elsevier Ltd. All rights reserved.

<10>
Accession Number
616321886
Author
Jovev S.; Mitrovska S.; Dameska S.; Lazovski N.; Andov M.; Kolev A.;
Zdraveski V.; Dzemali O.
Institution
(Jovev, Dameska, Lazovski, Andov, Kolev, Zdraveski) Cardiac Surgery,
University Clinic for Cardiac Surgery, Skopje, Macedonia
(Mitrovska) Polyclinic Cair, Skopje, Macedonia
(Dzemali) University Clinic for Cardiac Surgery, Triemli Zurich,
Switzerland
Title
Optimal coronary artery bypass graft timing in high-risk acute myocardial
infarction with ST elevation.
Source
Russian Open Medical Journal. 6 (2) (pp 1-4), 2017. Date of Publication:
2017.
Publisher
Russian Open Medical Journal (E-mail: rusomj@mail.ru)
Abstract
Background - Despite advances in surgical techniques, still tendency for
waiting up to 6 weeks after myocardial infarction with ST segment
elevation (STEMI). We aimed to evaluate optimal timing for coronary artery
bypass graft (CABG) in stable patients with STEMI. Material and Methods -
Prospective, randomised study consisted of 30 patients with STEMI (age
57-78 years, 22 male) underwent on-pump CABG. According to the timing of
CABG they were stratified as urgent (0-2 day) and late group (3 day and
after). Transthoracic echocardiography and selective coronarography were
done before surgery. Patients with ejection ftaction (EF) > 50%, left main
stenosis and/or multivessel coronary disease were included in the study.
We excluded patients with mechanical complications, reduced EF,
cerebrrovacular insult (CVI), renal failure or respiratory insufficiency.
Results - The primary endpoint for 30 days were adverse cardiac events
(death, recurrent angina, prolonged mechanical ventilation/IABP insertion
CVI, acute kidney injury, major bleeding). Eight (26.6%) patients
underwent urgent CABG in first 48 h. due to haemodynamic
instability/ongoing ischemia Three (37.5%) of them died and 6 (75%) had
prolonged mechanical ventilation support and/or IABP. Twenty two (73.3%)
patients in late group were operated after period of stabilization (10-14
day). They were discharged on 6-7 postoperative day. Conclusion - Early
surgery may be risky, but its delay also carries the risk of devastating
complications. Stable patients operated on 10-14 day had similar outcomes
as elective cases. Copyright © 2017, LLC Science and Innovations,
Saratov, Russia.

<11>
Accession Number
616266600
Author
Thongprayoon C.; Cheungpasitporn W.; Thamcharoen N.; Ungprasert P.;
Kittanamongkolchai W.; Mao M.A.; Sakhuja A.; Greason K.L.; Kashani K.
Institution
(Thongprayoon, Cheungpasitporn, Kittanamongkolchai, Mao, Kashani) Division
of Nephrology and Hypertension, Department of Internal Medicine, Mayo
Clinic, Rochester, MN, United States
(Thongprayoon, Thamcharoen) Department of Medicine, Bassett Medical
Center, Cooperstown, NY, United States
(Ungprasert) Division of Rheumatology, Department of Internal Medicine,
Mayo Clinic, Rochester, MN, United States
(Sakhuja, Kashani) Division of Pulmonary and Critical Care Medicine,
Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
(Greason) Division of Cardiovascular Surgery, Department of Surgery, Mayo
Clinic, Rochester, MN, United States
Title
Association of frailty status with acute kidney injury and mortality after
transcatheter aortic valve replacement: A systematic review and
meta-analysis.
Source
PLoS ONE. 12 (5) (no pagination), 2017. Article Number: e0177157. Date of
Publication: May 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Objective: Frailty is a common condition in patients with severe aortic
stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).
The aim of this systematic review was to assess the impact of frailty
status on acute kidney injury (AKI) and mortality after TAVR. Methods: A
systematic literature search was conducted using MEDLINE, EMBASE, and
Cochrane databases from the inception through November 2016. The protocol
for this study is registered with PROSPERO (International Prospective
Register of Systematic Reviews; no. CRD42016052350). Studies that reported
odds ratios, relative risks or hazard ratios comparing the risk of AKI
after TAVR in frail vs. non-frail patients were included. Mortality risk
was evaluated among the studies that reported AKI-related outcomes. Pooled
risk ratios (RR) and 95% confidence interval (CI) were calculated using a
random-effect, generic inverse variance method. Results: Eight cohort
studies with a total of 10,498 patients were identified and included in
the metaanalysis. The pooled RR of AKI after TAVR among the frail patients
was 1.19 (95% CI 0.97- 1.46, I2 = 0), compared with non-frail
patients. When the meta-analysis was restricted only to studies with
standardized AKI diagnosis according to Valve Academic Research Consortium
(VARC)-2 criteria, the pooled RRs of AKI in frail patients was 1.16 (95%
CI 0.91-1.47, I2 = 0). Within the selected studies, frailty
status was significantly associated with increased mortality (RR 2.01; 95%
CI 1.44-2.80, I2 = 58). Conclusion: The findings from our study
suggest no significant association between frailty status and AKI after
TAVR. However, frailty status is associated with mortality after TAVR and
may aid appropriate patient selection for TAVR. Copyright © 2017
Thongprayoon 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.

<12>
Accession Number
614681390
Author
Kohman L.J.; Gu L.; Altorki N.; Scalzetti E.; Veit L.J.; Wallen J.M.; Wang
X.
Institution
(Kohman, Veit, Wallen) Department of Surgery, State University of New York
Upstate Medical University, Syracuse, NY, United States
(Gu, Wang) Alliance Statistics and Data Center, Duke University Medical
Center, Durham, NC, United States
(Altorki) Department of Surgery, Weill Cornell Medicine, New York
Presbyterian Hospital, New York, NY, United States
(Scalzetti) Department of Radiology, State University of New York Upstate
Medical University, Syracuse, NY, United States
Title
Biopsy first: Lessons learned from Cancer and Leukemia Group B (CALGB)
140503.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (6) (pp 1592-1597),
2017. Date of Publication: June 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective Cancer and Leukemia Group B 140503 is an ongoing, multicenter
randomized trial assessing whether sublobar resection is equivalent to
lobectomy for the treatment of stage I A non-small cell lung cancer
(NSCLC) <=2 cm in diameter. The objective of this report is to determine
the reasons precluding intraoperative randomization. Methods From June 15,
2007, to March 22, 2013, 637 patients were preregistered to the trial.
Three hundred eighty-nine were randomized successfully (61%), and 248
patients were not randomized (39%). We analyzed the reasons for
nonrandomization among a subset of the nonrandomized patients (208) for
whom additional data were available. Results Of these 208 patients,
undiagnosed benign nodules (n =104, 16% of all registered patients) and
understaging of NSCLC (n =45, 7% of all registered patients) were the
dominant reasons precluding randomization. Granulomas represent
one-quarter of the benign nodules. The understaged patients had
unsuspected nodal metastases (n =28) or other more advanced NSCLC. The
rate of randomization was significantly greater in those patients who had
a preoperative biopsy (P <.001). Conclusions In a carefully monitored
cohort of patients with suspected small NSCLC <=2 cm, a substantial number
are misdiagnosed (benign nodules) or understaged. These patients may not
have benefited from a thoracic surgical procedure. Preoperative biopsy
significantly increased the rate of correct diagnosis. Preoperative biopsy
of small suspected NSCLC will reduce the number of nontherapeutic or
unnecessary thoracic procedures. Accuracy in preoperative diagnosis is
increasingly important as more such small nodules are discovered through
lung cancer screening. Copyright © 2017 The American Association
for Thoracic Surgery

<13>
Accession Number
613977497
Author
Toeg H.; French D.; Gilbert S.; Rubens F.
Institution
(Toeg, Rubens) Division of Cardiac Surgery, University of Ottawa Heart
Institute, Ottawa, Ontario, Canada
(French, Gilbert) Division of Thoracic Surgery, University of Ottawa,
Ottawa, Ontario, Canada
Title
Incidence of sternal wound infection after tracheostomy in patients
undergoing cardiac surgery: A systematic review and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (6) (pp 1394-1400.e7),
2017. Date of Publication: June 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Purpose This systematic review and meta-analysis was performed to
determine whether timing or type of tracheostomy was associated with
superficial or deep sternal wound infections after cardiac surgery.
Methods All studies reporting the incidence of sternal wound infection
after tracheostomy in patients undergoing cardiac surgery were collected
and analyzed. Subgroup analyses determined a priori included timing of
tracheostomy and type of procedure (open vs percutaneous). All analyses
used the random effects model. A meta-regression analysis was performed on
the proportion of sternal wound infection and number of days between
tracheostomy and initial cardiac surgery. Results A total of 13 studies
met inclusion criteria. The incidence of sternal wound infection across
all studies reported was 7% (95% confidence interval [CI], 4-10). The
percutaneous tracheostomy group had a sternal wound infection proportion
of 3% (95% CI, 1-8), and the open tracheostomy group had a sternal wound
infection proportion of 9% (95% CI, 5-14). The incidence of sternal wound
infection with early (<14 days) (7%; 95% CI, 3-11) versus late (>=14 days)
(7%; 95% CI, 4-10) tracheostomy was similar. Meta-regression demonstrated
no significant relationship between incidence of sternal wound infection
and number of days between tracheostomy and initial cardiac surgery
(R2 = 6.13%, P = .72). Reported secondary outcomes included
30-day and 1-year mortality, which were high at 23% (95% CI, 19-28) and
63% (95% CI, 43-80), respectively. Conclusions The incidence of sternal
wound infection after tracheostomy in patients undergoing cardiac surgery
remains high at 7% (95% CI, 4-10). Open or percutaneous tracheostomy after
cardiac surgery is a feasible option because the incidence of sternal
wound infection and short-term mortality are comparable. Moreover, the
timing of tracheostomy (early or late) had comparable rates of sternal
wound infection and short-term mortality. Copyright © 2016 The
American Association for Thoracic Surgery

<14>
Accession Number
614950722
Author
Ailawadi G.; Chang H.L.; O'Gara P.T.; O'Sullivan K.; Woo Y.J.; DeRose
J.J.; Parides M.K.; Thourani V.H.; Robichaud S.; Gillinov A.M.;
Taddei-Peters W.C.; Miller M.A.; Perrault L.P.; Smith R.L.; Goldsmith L.;
Horvath K.A.; Doud K.; Baio K.; Gelijns A.C.; Moskowitz A.J.; Bagiella E.;
Alexander J.H.; Iribarne A.
Institution
(Ailawadi) Cardiothoracic Surgery, University of Virginia,
Charlottesville, Va, United States
(Chang, O'Sullivan, Parides, Gelijns, Moskowitz, Bagiella) Population
Health Science and Policy, Icahn School of Medicine at Mount Sinai, New
York, NY, United States
(O'Gara) Cardiovascular Medicine, Brigham and Women's Hospital, Boston,
Mass, United States
(Woo) Department of Cardiothoracic Surgery, Stanford University, Stanford,
Calif, United States
(DeRose) Cardiovascular and Thoracic Surgery, Montefiore-Einstein Heart
Center, Bronx, NY, United States
(Thourani, Baio) Cardiothoracic Surgery, Emory University Hospital
Midtown, Atlanta, Ga, United States
(Robichaud, Perrault) Montreal Heart Institute, Montreal, Canada
(Gillinov) Thoracic and Cardiovascular Surgery, Cleveland Clinic,
Cleveland, Ohio, United States
(Taddei-Peters, Miller) Division of Cardiovascular Sciences, National
Heart, Lung, and Blood Institute, Bethesda, Md, United States
(Smith) Cardiac Surgery, The Heart Hospital Baylor Plano, Plano, Tex,
United States
(Goldsmith) Division of Cardiothoracic Surgery, Columbia University
Medical Center, New York, NY, United States
(Horvath) NIH Heart Center at Suburban Hospital, Bethesda, Md, United
States
(Doud) Cardiothoracic Research, Cleveland Clinic, Cleveland, Ohio, United
States
(Alexander) Division of Cardiology and Duke Clinical Research Institute,
Duke Medicine, Durham, NC, United States
(Iribarne) Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon,
NH, United States
Title
Pneumonia after cardiac surgery: Experience of the National Institutes of
Health/Canadian Institutes of Health Research Cardiothoracic Surgical
Trials Network.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (6) (pp 1384-1391.e3),
2017. Date of Publication: June 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Rationale Pneumonia remains the most common major infection after cardiac
surgery despite numerous preventive measures. Objectives To prospectively
examine the timing, pathogens, and risk factors, including modifiable
management practices, for postoperative pneumonia and estimate its impact
on clinical outcomes. Methods A total of 5158 adult cardiac surgery
patients were enrolled prospectively in a cohort study across 10 centers.
All infections were adjudicated by an independent committee. Competing
risk models were used to assess the association of patient characteristics
and management practices with pneumonia within 65 days of surgery.
Mortality was assessed by Cox proportional hazards model and length of
stay by a multistate model. Measurements and Main Results The cumulative
incidence of pneumonia was 2.4%, 33% of which occurred after discharge.
Older age, lower hemoglobin level, chronic obstructive pulmonary disease,
steroid use, operative time, and left ventricular assist device/heart
transplant were risk factors. Ventilation time (24-48 vs <=24 hours;
hazard ratio [HR], 2.83; 95% confidence interval [95% CI], 1.72-4.66; >48
hours HR, 4.67; 95% CI, 2.70-8.08), nasogastric tubes (HR, 1.80; 95% CI,
1.10-2.94), and each unit of blood cells transfused (HR, 1.16; 95% CI,
1.08-1.26) increased the risk of pneumonia. Prophylactic use of
second-generation cephalosporins (HR, 0.66; 95% CI, 0.45-0.97) and
platelet transfusions (HR, 0.49, 95% CI, 0.30-0.79) were protective.
Pneumonia was associated with a marked increase in mortality (HR, 8.89;
95% CI, 5.02-15.75) and longer length of stay of 13.55 +/- 1.95 days
(bootstrap 95% CI, 10.31-16.58). Conclusions Pneumonia continues to impose
a major impact on the health of patients after cardiac surgery. After we
adjusted for baseline risk, several specific management practices were
associated with pneumonia, which offer targets for quality improvement and
further research. Copyright © 2017 The American Association for
Thoracic Surgery

<15>
Accession Number
614582599
Author
Gaudiani V.; Deeb G.M.; Popma J.J.; Adams D.H.; Gleason T.G.; Conte J.V.;
Zorn G.L.; Hermiller J.B.; Chetcuti S.; Mumtaz M.; Yakubov S.J.; Kleiman
N.S.; Huang J.; Reardon M.J.
Institution
(Gaudiani) Department of Thoracic and Cardiac Surgery, El Camino Hospital,
Mountain View, Calif, United States
(Deeb) Department of Cardiovascular Surgery, University of Michigan
Hospitals, Ann Arbor, Mich, United States
(Popma) Department of Interventional Cardiology, Beth Israel Deaconess
Medical Center, Boston, Mass, United States
(Adams, Chetcuti) Department of Cardiovascular Surgery, Mount Sinai Health
System, New York, NY, United States
(Gleason) Department of Cardiothoracic Surgery, University of Pittsburgh,
Pittsburgh, Pa, United States
(Conte) Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore,
Md, United States
(Zorn) Cardiovascular Research Institute, University of Kansas, Kansas
City, Kan, United States
(Hermiller) Interventional Cardiology, St Vincent Medical Center,
Indianapolis, Ind, United States
(Mumtaz) Department of Cardiovascular Surgery, Pinnacle Health,
Harrisburg, Pa, United States
(Yakubov) Interventional Cardiology, Riverside Methodist Hospital,
Columbus, Ohio, United States
(Kleiman, Reardon) Department of Cardiothoracic Surgery, Houston Methodist
DeBakey Heart & Vascular Center, Houston, Tex, United States
(Huang) Biostatistical Services, Medtronic, Minneapolis, Minn, United
States
Title
Causes of death from the randomized CoreValve US Pivotal High-Risk Trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (6) (pp 1293-1301.e1),
2017. Date of Publication: June 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective Explore causes and timing of death from the CoreValve US Pivotal
High-Risk Trial. Methods An independent clinical events committee
adjudicated causes of death, followed by post hoc hierarchical
classification. Baseline characteristics, early outcomes, and causes of
death were evaluated for 3 time periods (selected based on threshold of
surgical 30-day mortality and on the differences in the continuous hazard
between the 2 groups): early (0-30 days), recovery (31-120 days), and late
(121-365 days). Results Differences in the rate of death were evident only
during the recovery period (31-120 days), whereas 15 patients undergoing
transcatheter aortic valve replacement (TAVR) (4.0%) and 27 surgical
aortic valve replacement (SAVR) patients (7.9%) died (P = .025). This
mortality difference was largely driven by higher rates of technical
failure, surgical complications, and lack of recovery following surgery.
From 0 to 30 days, the causes of death were more technical failures in the
TAVR group and lack of recovery in the SAVR group. Mortality in the late
period (121-365 days) in both arms was most commonly ascribed to other
circumstances, comprising death from medical complications from comorbid
disease. Conclusions Mortality at 1 year in the CoreValve US Pivotal
High-Risk Trial favored TAVR over SAVR. The major contributor was that
more SAVR patients died during the recovery period (31-121 days), likely
affected by the overall influence of physical stress associated with
surgery. Similar rates of technical failure and complications were
observed between the 2 groups. This suggests that early TAVR results can
improve with technical refinements and that high-risk surgical patients
will benefit from reducing complications. Copyright © 2017 The
American Association for Thoracic Surgery

<16>
Accession Number
614641345
Author
Benneyworth B.D.; Mastropietro C.W.; Graham E.M.; Klugman D.; Costello
J.M.; Zhang W.; Gaies M.
Institution
(Benneyworth, Mastropietro) Section of Critical Care Medicine, Department
of Pediatrics, Indiana University School of Medicine, Indianapolis, Ind,
United States
(Benneyworth) Children's Health Services Research, Department of
Pediatrics, Indiana University School of Medicine, Indianapolis, Ind,
United States
(Graham) Division of Cardiology, Department of Pediatrics, Medical
University of South Carolina, Charleston, SC, United States
(Klugman) Division of Cardiac Critical Care Medicine and Cardiology,
Children's National Health System, Washington, DC, United States
(Costello) Division of Cardiology, Department of Pediatrics, Northwestern
University Feinberg School of Medicine, Ann & Robert H. Lurie Children's
Hospital of Chicago, Chicago, Ill, United States
(Zhang, Gaies) Division of Cardiology, Department of Pediatrics and
Communicable Diseases, C.S. Mott Children's Hospital and University of
Michigan Medical School, Ann Arbor, Mich, United States
Title
Variation in extubation failure rates after neonatal congenital heart
surgery across Pediatric Cardiac Critical Care Consortium hospitals.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (6) (pp 1519-1526),
2017. Date of Publication: June 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective In a multicenter cohort of neonates recovering from cardiac
surgery, we sought to describe the epidemiology of extubation failure and
its variability across centers, identify risk factors, and determine its
impact on outcomes. Methods We analyzed prospectively collected clinical
registry data on all neonates undergoing cardiac surgery in the Pediatric
Cardiac Critical Care Consortium database from October 2013 to July 2015.
Extubation failure was defined as reintubation less than 72 hours after
the first planned extubation. Risk factors were identified using
multivariable logistic regression with generalized estimating equations to
account for within-center correlation. Results The cohort included 899
neonates from 14 Pediatric Cardiac Critical Care Consortium centers; 14%
were premature, 20% had genetic abnormalities, 18% had major extracardiac
anomalies, and 74% underwent surgery with cardiopulmonary bypass.
Extubation failure occurred in 103 neonates (11%), within 24 hours in 61%.
Unadjusted rates of extubation failure ranged from 5% to 22% across
centers; this variability was unchanged after adjusting for procedural
complexity and airway anomaly. After multivariable analysis, only airway
anomaly was identified as an independent risk factor for extubation
failure (odds ratio, 3.1; 95% confidence interval, 1.4-6.7; P = .01).
Neonates who failed extubation had a greater median postoperative length
of stay (33 vs 23 days, P < .001) and in-hospital mortality (8% vs 2%, P =
.002). Conclusions This multicenter study showed that 11% of neonates
recovering from cardiac surgery fail initial postoperative extubation.
Only congenital airway anomaly was independently associated with
extubation failure. We observed a 4-fold variation in extubation failure
rates across hospitals, suggesting a role for collaborative quality
improvement to optimize outcomes. Copyright © 2017 The American
Association for Thoracic Surgery

<17>
[Use Link to view the full text]
Accession Number
614916923
Author
Manfredini V.; Leone O.; Agostini V.; Potena L.
Institution
(Manfredini, Potena) Heart and Lung Transplant Program, Bologna University
Hospital S.Orsola-Malpighi, Bologna, Italy
(Leone, Agostini) Pathology Department, Bologna University Hospital
S.Orsola-Malpighi, Bologna, Italy
(Potena) Azienda Ospedaliero-Universitaria di Bologna, Dipartimento
Cardio-Toraco-Vascolare, Padiglione 21, Via Massarenti, 9, Bologna 40138,
Italy
Title
Antibody-mediated rejection in heart transplantation: New developments and
old uncertainties.
Source
Current Opinion in Organ Transplantation. 22 (3) (pp 207-214), 2017. Date
of Publication: 01 Jun 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose of review Antibody-mediated rejection (AMR) currently represents
one of the main problems for clinical management of heart transplant
because of its diagnostic complexity and poor evidences supporting
treatments. Recent findings Disorder-based diagnosis is a cornerstone in
defining AMR. The limitations of the current classification have been
partially overcome by novel studies improving the description of the
immune-pathological graft abnormalities, and by new molecular approaches
allowing a better understanding of the mechanisms behind AMR and of its
relationship with cellular rejection and chronic vasculopathy. In-depth
characterization of donor-specific antibodies showed to provide additional
prognostic information and guide for treatment. Clinical relevance of AMR
is bound to appropriate detection of graft dysfunction. In addition to
traditional longitudinal evaluation by echocardiogram, cardiac magnetic
resonance and detection of cell-free DNA may represent novel sensitive
markers for graft injury that could prompt treatment before dysfunction
becomes clinically manifest. Summary Despite improvements in the
diagnostic process, therapeutic strategies made little progress in
addition to the consolidation of practices supported by limited evidences.
Novel complement inhibitors appear promising in changing this scenario.
Nevertheless, collaborative multicenter studies are needed to develop
standardized approaches tailored to the highly variable clinical and
laboratory features of AMR. Copyright © 2017 Wolters Kluwer
Health, Inc. All rights reserved.

<18>
Accession Number
610253343
Author
Seres D.S.; Ippolito P.R.
Institution
(Seres, Ippolito) Division of Preventive Medicine and Nutrition,
Department of Medicine, Columbia University Medical Center, New York, NY,
United States
(Seres) Institute of Human Nutrition, Columbia University Medical Center,
New York, NY, United States
Title
Pilot study evaluating the efficacy, tolerance and safety of a
peptide-based enteral formula versus a high protein enteral formula in
multiple ICU settings (medical, surgical, cardiothoracic).
Source
Clinical Nutrition. 36 (3) (pp 706-709), 2017. Date of Publication: June
2017.
Publisher
Churchill Livingstone
Abstract
Introduction Predigested, peptide-based enteral formulas are commonly used
to promote GI tolerance in critically ill patients, but studies comparing
these against polymeric enteral formulas are lacking. We performed a
prospective, randomized clinical comparison pilot study to assess safety,
tolerance and effectiveness of a peptide-based enteral product. Methods
Critically ill patients from ICUs, including medical, surgical, and
cardiothoracic, were randomized to either of two enteral feeding products:
Group A: Peptide-based, high Protein, high omega-3 fat (Vital
AF, Abbott Nutrition); Group B: high protein standard enteral
formula (Osmolite, Abbott Nutrition). Tolerance and
comorbidities as well as enteral feeding volume were collected at baseline
and then daily for up to 21 days, or until the patient was discharged from
the ICU. Results A total of 49 patients were included, 25 (51%) on group
A, 24 (49%) on group B. Adverse events and undesired gastrointestinal
events at baseline and mean intake (ml/d and percent of goal) post
baseline were not different between the groups. There were significantly
fewer days with adverse events (p = 0.0336, odds ratio = 3.02, standard
error = 1.60, n = 24 per group) and undesired gastrointestinal events (p =
0.0489, odds ratio = 2.79, standard error = 1.48, n = 24 per group) in
group A. There was no difference in other clinical outcomes. Conclusion
This pilot study suggests that feeding a peptide-based formula to ICU
patients may be associated with a statistically significant reduction in
the number of days during which adverse events occurred as compared to a
standard formula. Copyright © 2016 Elsevier Ltd and European
Society for Clinical Nutrition and Metabolism

<19>
Accession Number
613819482
Author
Langlois P.L.; Hardy G.; Manzanares W.
Institution
(Langlois) Department of Anesthesiology and Reanimation, Faculty of
Medicine and Health Sciences, Sherbrooke University Hospital, Sherbrooke,
Quebec, Canada
(Hardy) Ipanema Research Trust, Auckland, New Zealand
(Manzanares) Department of Critical Care, Intensive Care Unit, University
Hospital, Faculty of Medicine, UDELAR, Montevideo, Uruguay
Title
Omega-3 polyunsaturated fatty acids in cardiac surgery patients: An
updated systematic review and meta-analysis.
Source
Clinical Nutrition. 36 (3) (pp 737-746), 2017. Date of Publication: June
2017.
Publisher
Churchill Livingstone
Abstract
Background Omega-3 polyunsaturated fatty acids (omega-3 PUFA)
supplementation is an attractive therapeutic option for patients
undergoing open-heart surgery due to their anti-inflammatory and
anti-arrhythmic properties. Several randomized controlled trials (RCT)
have found contradictory results for perioperative omega-3 PUFA
administration. Therefore, we conducted an updated systematic review and
meta-analysis evaluating the effects of perioperative omega-3 PUFA on some
clinically important outcomes for cardiac surgery. Methods A systematic
literature search was conducted to find RCT evaluating clinical outcomes
after omega-3 PUFA therapy in adult patients undergoing cardiac surgery.
Intensive care unit (ICU) length of stay (LOS) was the primary outcome;
secondary outcomes were hospital LOS, postoperative atrial fibrillation
(POAF), mortality and duration of mechanical ventilation (MV). Predefined
subgroup analysis and sensibility analysis were performed. Results A total
of 19 RCT including 4335 patients met inclusion criteria. No effect of
omega-3 PUFA on ICU LOS was found (weighted mean difference WMD -2.95, 95%
confidence interval, CI -10.28 to 4.39, P = 0.43). However, omega-3 PUFA
reduced hospital LOS (WMD -1.37, 95% CI -2.41 to -0.33; P = 0.010) and
POAF incidence (Odds Ratio OR = 0.78, 95% CI 0.68 to 0.90; P = 0.004). No
effects were found on mortality or MV duration. Heterogeneity remained in
subgroup analysis and we found a significant POAF reduction when omega-3
PUFA doses were administered to patients exposed to extra-corporeal
circulation. Oral/enteral administration seemed to further reduce POAF.
Conclusions In patients undergoing cardiac surgery, omega-3 PUFA
supplementation by oral/enteral and parenteral route reduces hospital LOS
and POAF. Nonetheless considerable clinical and statistical heterogeneity
weaken our findings. Copyright © 2016 Elsevier Ltd and European
Society for Clinical Nutrition and Metabolism

<20>
Accession Number
616161456
Author
Sharma S.P.; Dahal K.; Khatra J.; Rosenfeld A.; Lee J.
Institution
(Sharma, Khatra) University of New England, LRGHealthcare, Laconia, NH,
United States
(Dahal) Division of Cardiology, Louisiana State University Health Science
Center, Shreveport, LA, United States
(Rosenfeld) Concord Cardiac Associates, Concord, NH, United States
(Lee) Division of Interventional Cardiology, Section of Cardiology,
University of Connecticut, Farmington, CT, United States
Title
Percutaneous coronary intervention vs coronary artery bypass grafting for
left main coronary artery disease? A systematic review and meta-analysis
of randomized controlled trials.
Source
Cardiovascular Therapeutics. 35 (3) (no pagination), 2017. Article Number:
e12260. Date of Publication: June 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background: It is not clear whether percutaneous coronary intervention
(PCI) is as effective and safe as coronary artery bypass grafting (CABG)
for left main coronary artery disease. We aimed to perform a systematic
review and meta-analysis of all randomized controlled trials (RCTs) that
compared PCI and CABG in left main coronary disease. Methods: We searched
PubMed, EMBASE, Cochrane, Scopus and relevant references for RCTs
(inception through, November 20, 2016 without language restrictions) and
performed meta-analysis using random-effects model. All-cause mortality,
myocardial infarction, revascularization rate, stroke, and major adverse
cardiac and cerebrovascular events (MACCE) were the measured outcomes.
Results: Six RCTs with a total population of 4700 were analyzed. There was
no difference in all-cause mortality at 30-day, one-year, and five-year
(1.8% vs 1.1%; OR 0.60; 95% CI: 0.26-1.39; P=.23; I2=9%)
follow-up between PCI and CABG. CABG group had less myocardial infarction
(MI) at five-year follow-up than PCI (5% vs 2.5%; OR 2.04; CI: 1.30-3.19;
P=.002; I2=1%). Revascularization rate favored CABG in one-year
(8.6% vs 4.5%; OR 2; CI: 1.46-2.73; P<.0001; I2=45%) and
five-year (15.9% vs 9.9%; OR 1.73; CI: 1.36-2.20; P<.0001;
I2=0%) follow-up. Although stroke rate was lower in PCI group
at 1 year, there was no difference in longer follow-up. MACCE at 5 years
favored CABG (24% vs 18%; OR 1.45; CI: 1.19-1.76; P=.0001;
I2=0%). On subgroup analysis, MACCE were not different between
two groups in low-to-intermediate SYNTAX group while it was higher for PCI
group with high SYNTAX group. Conclusion: Percutaneous coronary
intervention could be as safe and effective as CABG in a select group of
left main coronary artery disease patients. Copyright © 2017 John
Wiley & Sons Ltd

<21>
Accession Number
616161404
Author
Wang H.; Liang Z.; Li Y.; Li B.; Liu J.; Hong X.; Lu X.; Wu J.; Zhao W.;
Liu Q.; An J.; Li L.; Pu F.; Ming Q.; Han Y.
Institution
(Wang, Liang, Li, Han) General Hospital of Shenyang Military Region,
Shenyang, China
(Li) Hainan General Hospital, Haikou, China
(Liu) Xinjiang Corps General Hospital, Urumchi, China
(Hong) Beijing Shijingshan Hospital, Beijing, China
(Lu) Fujian Medical University Affiliated First Quanzhou Hospital,
Quanzhou, China
(Wu) Shenzhen Forth Hospital, Shenzhen, China
(Zhao) Tianjin Chest Hospital, Tianjin, China
(Liu) Shenzhen Sun Yat-sen Cardiovascular Hospital, Shenzhen, China
(An) Shanxi Cardiovascular Hospital, Taiyuan, China
(Li) Jiangxi Province People's Hospital, Nanchang, China
(Pu) Dongying People's Hospital, Dongying, China
(Ming) Shanghai Tenth People's Hospital, Shanghai, China
Title
Effect of postprocedural full-dose infusion of bivalirudin on acute stent
thrombosis in patients with ST-elevation myocardial infarction undergoing
primary percutaneous coronary intervention: Outcomes in a large real-world
population.
Source
Cardiovascular Therapeutics. 35 (3) (no pagination), 2017. Article Number:
e12251. Date of Publication: June 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Aim: This study aimed to evaluate the effect of prolonged full-dose
bivalirudin infusion in real-world population with ST-elevation myocardial
infarction (STEMI). Background: Subgroup data as well as meta-analysis
from randomized clinical trials have shown the potency of postprocedural
full-dose infusion (1.75 mg/kg/h) of bivalirudin on attenuating acute
stent thrombosis (ST) after primary percutaneous coronary intervention
(PCI). Methods: In this multicenter retrospective observational study,
2047 consecutive STEMI patients treated with bivalirudin during primary
PCI were enrolled in 65 Chinese centers between July 2013 and May 2016.
The primary outcome was acute ST defined as ARC definite/probable within
24 hours after the index procedure, and the secondary endpoints included
total ST, major adverse cardiac or cerebral events (MACCE, defined as
death, reinfarction, stroke, and target vessel revascularization), and any
bleeding at 30 days. Results: Among 2047 STEMI patients, 1123 (54.9%) were
treated with postprocedural bivalirudin full-dose infusion (median 120
minutes) while the other 924 (45.1%) received low-dose (0.25 mg/kg/h) or
null postprocedural infusion. A total of three acute ST (0.3%) occurred in
STEMI patients with none or low-dose prolonged infusion of bivalirudin,
but none was observed in those treated with post-PCI full-dose infusion
(0.3% vs 0.0%, P=.092). Outcomes on MACCE (2.1% vs 2.7%, P=.402) and total
bleeding (2.1% vs 1.4%, P=.217) at 30 days showed no significant
difference between the two groups, and no subacute ST was observed.
Conclusion: Post-PCI full-dose bivalirudin infusion is safe and has a
trend to protect against acute ST in STEMI patients undergoing primary PCI
in real-world settings. Copyright © 2017 John Wiley & Sons Ltd

<22>
Accession Number
615334306
Author
Fakhoury H.; Ghabach M.; Hajj E.E.L.; Helou M.
Institution
(Fakhoury, Ghabach, Hajj, Helou) Departement D'anesthesie et Reanimation,
Faculte de Sciences Medicales, Universite Libanaise, Beyrouth, Lebanon
Title
Fentanyl-etomidate versus fentanyl alone for induction in patients with
poor left ventricular function.
Source
Journal Medical Libanais. 65 (1) (pp 15-19), 2017. Date of Publication:
2017.
Publisher
Lebanese Order of Physicians (E-mail: lop@cyberia.net.lb)
Abstract
Introduction: Hemodynamic stability during induction of anesthesia is a
major concern in patients undergoing cardiac surgery. Several studies
proved that etomidate is an induction drug with minimal hemodynamic
effect, and similar results were found with opioids at high doses. The aim
of our study is to compare the hemodynamic effects of the combination
etomidate-fentanyl versus fentanyl alone at induction of anesthesia for
patients undergoing cardiac surgery with ejection fraction less than
45[%]. Methods: After approval of the ethics committee, a randomized
prospective study was done on 24 patients in two groups: F (fentanyl
group), E (etomidate + fentanyl group); the hemodynamic parameters were
measured using a Swan Ganz catheter before induction, before and just
after intubation, and 10 minutes after intubation. Results: A significant
difference was noted in some hemodynamic parameters: systolic arterial
pressure (p < 0.01) mean arterial pressure (p < 0.01) cardiac
output (p < 0.01) cardiac index (p < 0.01) systolic ejection index
(p < 0.01) systemic vascular resistance (p < 0.05) pulmonary
vascular resistance (p < 0.05) left ventricular work index (p <
0.001). The delay of loss of consciousness was significantly shorter in
the etomidate-fentanyl group. Conclusion: Anesthetic induction with
fentanyl causes a temporary decrease in blood pressure without changes in
cardiac output. The combination etomidate-fentanyl has a more pronounced
effect on blood pressure; the cardiac output shows no significant changes.

<23>
Accession Number
615604231
Author
Kamran S.; Conti F.; Pomey M.-P.; Baron G.; Calmus Y.; Vidal-Trecan G.
Institution
(Kamran, Vidal-Trecan) Public Health Ward: Quality and Risk Management,
Paris left University Hospitals, Assistance Publique - Hopitaux de Paris,
Paris, France
(Kamran) Doctoral School of Public Health (EDSP), Paris, France
(Conti, Calmus) Centre de Transplantation Hepatique, Pitie Salpetriere
Hospital, Assistance Publique - Hopitaux de Paris, Paris, France
(Pomey) Department of Health Administration, Institut de Recherche en
Sante Publique, Universite de Montreal, Montreal, QC, Canada
(Baron, Vidal-Trecan) UMR 1153 Epidemiology and Statistics Sorbonne Paris
Cite left (CRESS), METHODS Team, INSERM, Paris, France
(Baron) Centre d'Epidemiologie Clinique, Hopital Hotel Dieu, Assistance
Publique des Hopitaux de Paris, Paris, France
(Vidal-Trecan) Department of Public Health, Medical School, Paris
Descartes University, Paris, France
Title
Patients' preferences in transplantation from marginal donors: results of
a discrete choice experiment.
Source
Transplant International. 30 (6) (pp 589-602), 2017. Date of Publication:
June 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
To increase the donor pool, the strategy of transplantation from
"marginal" donors was developed though patients' preferences about these
donors were insufficiently known. The preferences of patients registered
on the waiting list or already transplanted in eight transplant teams
covering four main organs (i.e., kidney, liver, heart, and lung) were
evaluated using the discrete choice experiment method. In each left during
2 days, patients were interviewed on four scenarios. Of 178 eligible
patients, 167 were interviewed; 40% accepted marginal graft in their own
situation and 89% at least in one of the scenarios. Imagining urgent
situations or rare profiles with difficult access to transplantation,
respectively, 86% and 71% accepted these grafts. Most (76%) preferred to
be informed about these grafts and 43% preferred to be involved in
decision. The emergency [OR = 1.24; 95% CI: (1.06-1.45)] and the
hazardousness [OR = 0.88; 95% CI: (0.78-0.99)] of the transplantation were
factors independently associated with marginal graft acceptance. Most
patients preferred to be informed and to be involved in the decision.
Marginal grafts could be more accepted by patients in critical medical
situations or perceiving their situation as critical. Physicians'
practices in transplantation should be reconsidered taking into account
individual preferences. This study was performed in a single country and
thus reflects the cultural bias and practice thereof. Copyright ©
2017 Steunstichting ESOT

<24>
Accession Number
614114891
Author
Bajaj A.; Pancholy S.; Sethi A.; Rathor P.
Institution
(Bajaj, Pancholy) The Wright Center for Graduate Medical Education,
Scranton, PA, United States
(Bajaj, Pancholy) The Common Wealth Medical College, Scranton, PA, United
States
(Sethi) St. Luke's Cardiology Associates, Bethlehem, PA, United States
(Rathor) Zhengzhou University, China
Title
Safety and feasibility of PCI in patients undergoing TAVR: A systematic
review and meta-analysis.
Source
Heart and Lung: Journal of Acute and Critical Care. 46 (2) (pp 92-99),
2017. Date of Publication: 01 Mar 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
We aimed to evaluate the safety and feasibility of PCI (percutaneous
coronary intervention) for coronary artery disease (CAD) in patients
undergoing transcatheter aortic valve replacement (TAVR) by performing a
meta-analysis. A systemic search of the database was performed. Studies
were included comparing TAVR versus TAVR with PCI for significant CAD in
patients undergoing TAVR for severe aortic stenosis. The primary outcome
was 30 day mortality and secondary outcomes were myocardial infarction,
stroke, life threatening bleeding, major access site vascular
complications and renal failure. There were no significant differences in
30 day and six months-one year mortality between TAVR and TAVR with PCI
group. There were also no significant differences in myocardial
infarction, stroke, and life threatening bleeding and major access site
vascular complications between the two groups. PCI in addition to TAVR in
patients with concomitant severe aortic stenosis and CAD is safe and
feasible and does not increase procedural risk. Copyright © 2016
Elsevier Inc.

<25>
Accession Number
614424080
Author
Naito S.; Gross T.; Disha K.; von Kodolitsch Y.; Reichenspurner H.;
Girdauskas E.
Institution
(Naito, Gross, Reichenspurner, Girdauskas) Department of Cardiovascular
Surgery, University Heart Center Hamburg, Martinistrase 52, Hamburg 20246,
Germany
(Disha) Department of Cardiac Surgery, Central Hospital Bad Berka, Bad
Berka, Germany
(von Kodolitsch) Department of Cardiology, University Heart Center
Hamburg, Hamburg, Germany
Title
Late post-AVR progression of bicuspid aortopathy: link to hemodynamics.
Source
General Thoracic and Cardiovascular Surgery. 65 (5) (pp 252-258), 2017.
Date of Publication: 01 May 2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Background and aim of the study: The ascending aortic dilatation may
progress after aortic valve replacement (AVR) in bicuspid aortic valve
(BAV) patients. Our aim was to evaluate rheological flow patterns and
histological characteristics of the aneurysmal aorta in BAV patients at
the time of reoperative aortic surgery. Materials and Methods: 13 patients
(mean age: 42 +/- 9 years, 10 (77%) male) with significant progression of
proximal aortopathy after isolated AVR surgery for BAV disease (i.e., 16.7
+/- 8.1 years post-AVR) were identified by cardiac phase-contrast cine
magnetic resonance imaging (MRI) in our hospital. A total of nine patients
(69%) underwent redo aortic surgery. Based on the MRI data, the aortic
area of the maximal flow-induced stress (jet sample) and the opposite site
(control sample) were identified and corresponding samples were collected
intraoperatively. Histological sum-score values [i.e. aortic wall changes
were graded based on a summation of seven histological criteria (each
scored from 0 to 3)] were compared between these samples. Results: Mean
proximal aortic diameter at MRI follow-up was 55 +/- 6 mm (range 47-66mm).
Preoperative cardiac MRI demonstrated eccentric systolic flow pattern
directed towards right-lateral/right posterior wall of the proximal aorta
in 9/13 (69%) patients. Histological sum-score values were significantly
higher in the jet sample vs control sample (i.e., 8.3 +/- 3.8 vs 5.6 +/-
2.4, respectively, p = 0.04). Conclusions: Hemodynamic factors may still
be involved in the late progression of bicuspid aortopathy even after
isolated AVR surgery for BAV disease. Copyright © 2017, The
Japanese Association for Thoracic Surgery.

<26>
Accession Number
614345987
Author
Upadhaya S.; Baniya R.; Madala S.; Subedi S.K.; Khan J.; Velagapudi R.K.;
Bachuwa G.
Institution
(Upadhaya, Baniya, Madala, Subedi, Khan, Velagapudi, Bachuwa) Department
of Internal Medicine, Hurley Medical Center, Michigan State University,
Flint, MI, United States
Title
Drug-eluting stent placement versus coronary artery bypass surgery for
unprotected left main coronary artery disease: A meta-analysis of
randomized controlled trials.
Source
Journal of Cardiac Surgery. 32 (2) (pp 70-79), 2017. Date of Publication:
01 Feb 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: Coronary artery bypass grafting (CABG) is the standard of care
for treating left main coronary lesions. However, recently published
randomized controlled trials (RCT) have shown conflicting results. We
sought to compare clinical outcomes of percutaneous coronary intervention
(PCI) with drug-eluting stent placement to CABG using a meta-analysis of
randomized controlled trials. METHODS: A systemic search of Pubmed,
Scopus, Cochrane library, and Clinicaltrials.gov was performed for
randomized controlled trials comparing PCI with CABG in patients with left
main stenosis. Data were analyzed using random effect models and
Mantel-Haenszel methods. The primary outcome was major adverse
cardiovascular and cerebral events (MACCE). The secondary outcomes were
myocardial infarction, stroke, cardiac, and all-cause mortality. A
subgroup analysis based on SYNTAX score was also performed. RESULTS: A
total of 4595 patients (2297 in the PCI group and 2298 in the CABG group)
from five RCTs were included in the analysis. There were significant
differences in MACCE (odds ratio [OR] 1.36, confidence interval [CI] 95%,
1.18-1.58, p-value: < 0.0001) and repeat revascularization (OR 1.85, CI
95%, 1.53-2.23, p-value: < 0.00001) favoring CABG. There were no
significant differences in the incidence of myocardial infarction, stroke,
or cardiac and all-cause mortality. Based on SYNTAX score, CABG was
superior in terms of MACCE only in the subgroup with SYNTAX score of 33 or
more. CONCLUSIONS: CABG results in fewer MACCE and need for repeat
revascularization than PCI in patients with unprotected left main
disease. Copyright © 2017 Wiley Periodicals, Inc.

<27>
Accession Number
614187261
Author
Candy N.; Ng E.; Velu R.
Institution
(Candy, Ng, Velu) Department of Vascular and Endovascular Surgery, The
Townsville Hospital, Townsville, Queensland, Australia
Title
Paclitaxel-coated balloon reduces target lesion revascularization compared
with standard balloon angioplasty.
Source
Journal of Vascular Surgery. 65 (2) (pp 558-570), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective Peripheral arterial disease (PAD) is a highly prevalent
condition that contributes significantly to the morbidity and mortality of
affected patients. PAD creates a significant economic burden on health
care systems around the world. We reviewed all available literature to
provide a meta-analysis assessing the outcome of patients treated with
drug-eluting balloons (DEBs) compared with percutaneous transluminal
balloon angioplasty (PTA) through measuring the rate of target lesion
revascularization (TLR). Methods An electronic search of the MEDLINE,
Scopus, Embase, Web of Science, and Cochrane Library databases was
performed. Articles reporting randomized controlled trials that compared
treatment with DEBs vs PTA were selected for inclusion. A meta-analysis
was performed by pooling data on rates of TLR, binary restenosis (BR), and
late lumen loss (LLL). Results The 10 included articles comprised a sample
size of 1292 patients. Meta-analysis demonstrated the rate of TLR in
DEB-treated patients was significantly lower compared with patients
treated with PTA at 6 months (odds ratio [OR], 0.24; 95% confidence
interval [CI], 0.11-0.53; P = .0004), 12 months (OR, 0.28; 95% CI,
0.13-0.62; P = .002), and 24 months (OR, 0.25; 95% CI, 0.10-0.61; P =
.002). Decreased LLL and BR was demonstrated at 6 months in patients
treated with DEBs compared with patients treated with PTA (mean
difference, -0.74; 95% CI, -0.97 to -0.51; P = .00001; OR, 0.34; 95% CI,
0.23-0.49; P = .00001). Conclusions This meta-analysis demonstrates that
treatment with DEBs compared with PTA results in reduced rates of
reintervention in patients with PAD. Comparison of DEBs to other emerging
treatments to determine which method results in the lowest reintervention
rates and in the greatest improvement in quality of life should be the
focus of future trials. Copyright © 2016

<28>
Accession Number
613834989
Author
Boehne M.; Sasse M.; Karch A.; Dziuba F.; Horke A.; Kaussen T.;
Mikolajczyk R.; Beerbaum P.; Jack T.
Institution
(Boehne, Sasse, Dziuba, Kaussen, Beerbaum, Jack) Department of Pediatric
Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover,
Germany
(Karch, Mikolajczyk) Department of Epidemiology, Helmholtz Centre for
Infection Research, Braunschweig, Germany
(Horke) Department of Cardiothoracic, Transplantation and Vascular
Surgery, Hannover Medical School, Hannover, Germany
Title
Systemic inflammatory response syndrome after pediatric congenital heart
surgery: Incidence, risk factors, and clinical outcome.
Source
Journal of Cardiac Surgery. 32 (2) (pp 116-125), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
BACKGROUND: Systemic inflammatory response syndrome (SIRS) is frequent
after cardiac surgery, but data on its incidence and perioperative risk
factors are scarce for children with congenital heart disease. METHODS:
SIRS incidence within 72 hours following cardiac surgery was evaluated in
a secondary analysis of children enrolled to a treatment-free control
group of a randomized controlled trial. Intraoperative parameters were
investigated for their association with SIRS using multivariable
fractional polynomial logistic regression models. Effects of SIRS on
various organ functions and length of stay were evaluated using
time-varying Cox regression models. RESULTS: In 116 children after cardiac
surgery (median age [range]: 7.4 month [1 day-16.2 years]) SIRS occurred
in n = 39/102 with and n = 1/14 without cardiopulmonary bypass (CPB).
Duration of CPB (hazard ratio [HR]: 2.28 per hour; 95% confidence interval
[CI] 1.17; 4.42) and amount of fresh frozen plasma (HR: 1.23 per 10 mL/kg;
95%CI 1.06; 1.42) were identified as predictors for SIRS; neonates seemed
to be less susceptible for SIRS development (HR: 0.86; 95%CI 0.79; 0.95).
SIRS was associated with organ dysfunction (HR: 2.69; 95%CI 1.41; 5.12)
and extended stay in the pediatric intensive care unit (PICU) (median: 168
vs. 96 hours; p = 0.007). CONCLUSIONS: SIRS is a frequent complication
after pediatric congenital heart surgery; it affects nearly one third of
children and prolongs PICU stay significantly. Duration of CPB and amount
of fresh frozen plasma were identified as important risk factors. Neonates
seem to be less susceptible to SIRS development. Copyright © 2016
Wiley Periodicals, Inc.

<29>
Accession Number
608969554
Author
Huisman J.; Van Der Heijden L.C.; Kok M.M.; Danse P.W.; Jessurun G.A.J.;
Stoel M.G.; Van Houwelingen K.G.; Lowik M.M.; Hautvast R.W.M.; Ijzerman
M.J.; Doggen C.J.; Von Birgelen C.
Institution
(Huisman, Van Der Heijden, Kok, Stoel, Van Houwelingen, Lowik, Von
Birgelen) Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum
Twente, Enschede, Netherlands
(Danse) Department of Cardiology, Rijnstate Hospital, Arnhem, Netherlands
(Jessurun) Department of Cardiology, Treant Zorggroep, Emmen, Netherlands
(Hautvast) Department of Cardiology, Medical Center Alkmaar, Alkmaar,
Netherlands
(Ijzerman, Doggen, Von Birgelen) Health Technology and Services Research,
MIRA, Institute for Biomedical Technology and Technical Medicine,
University of Twente, Enschede, Netherlands
(Von Birgelen) Thoraxcentrum Twente, University of Twente, Medisch
Spectrum Twente (MST), Department of Cardiology, Postbus 50.000, Enschede
7500 KA, Netherlands
Title
Impact of severe lesion calcification on clinical outcome of patients with
stable angina, treated with newer generation permanent polymer-coated
drug-eluting stents A patient-level pooled analysis from TWENTE and DUTCH
PEERS (TWENTE II).
Source
American Heart Journal. 175 (pp 121-129), 2016. Date of Publication: 01
May 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background The outcome of percutaneous coronary intervention with newer
generation permanent polymer-coated drug-eluting stents (DES) in patients
with severely calcified lesions is greatly unknown. We assessed the impact
of severe lesion calcification on clinical outcome in patients with stable
angina who underwent percutaneous coronary intervention with newer
generation DES. Methods TWENTE and DUTCH PEERS randomized trials enrolled
1423 patients with stable angina, who were categorized into patients with
versus without severe target lesion calcification. A patient-level pooled
analysis assessed clinical outcome, including target vessel failure (TVF),
a composite of cardiac death, target vessel-related myocardial infarction,
or target vessel revascularization (TVR). Results Patients with severe
calcification (n = 342) were older (66.6 +/- 9.1 vs 64.2 +/- 9.8 years, P
<.001) and had more diabetes (25.7% vs 20.4%, P =.04) than other patients
(n = 1081). Patients with calcified lesions had higher rates of TVF (16.4%
vs 9.8%, pLogrank =.001), cardiac death (4.4% vs 1.5%, P =.03), target
vessel myocardial infarction (7.6% vs 3.4%, P =.001), and definite stent
thrombosis (1.8% vs 0.4%, P =.02). Multivariate analysis demonstrated that
severe calcification was an independent risk factor of 2-year TVF (HR
1.42, 95% CI: 1.02-1.99, pLogrank =.04); landmark analysis showed that
this was based on a difference during the first year (periprocedural: 5.8%
vs. 3.1%, pLogrank =.02; first year: 7.5% vs. 3.8%, pLogrank =.007; second
year: 4.1% vs. 3.3%, pLogrank =.54). Conclusion In patients with stable
angina, severe target lesion calcification is associated with an increased
risk of adverse cardiovascular events following treatment with newer
generation permanent polymer-coated DES. This increase in risk is
restricted to the first year of follow-up, which is an encouraging
finding. Copyright © 2016 Elsevier, Inc. All rights reserved.

<30>
Accession Number
608546747
Author
Liao Y.-B.; He Z.-X.; Zhao Z.-G.; Wei X.; Zuo Z.-L.; Li Y.-J.; Xiong
T.-Y.; Xu Y.-N.; Feng Y.; Chen M.
Institution
(Liao, He, Zhao, Wei, Zuo, Li, Xiong, Xu, Feng, Chen) Department of
Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street,
Chengdu 610041, China
Title
The relationship between chronic obstructive pulmonary disease and
transcatheter aortic valve implantation - A systematic review and
meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 87 (pp 570-578), 2016.
Date of Publication: 01 Mar 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective The present study was performed to investigate the relationship
between chronic obstructive pulmonary disease (COPD) and transcatheter
aortic valve implantation (TAVI). Background: Controversies regarding the
relationship between COPD and TAVI have intensified. Methods: A literature
review of the PubMed online database was performed, and articles published
between January 1, 2002 and March 20, 2015 were analyzed. Random-effect
and fixed-effect models were used, depending on the between-study
heterogeneity. Results: A total of 28 studies, involving 51,530 patients,
were identified in our review. The burden of COPD ranged from 12.5% to
43.4%, and COPD negatively impacted both short-term and long-term
all-cause survival (30 days: odds ratio [OR], 1.43, 95% CI, 1.14-1.79; >2
years: hazard ratio [HR], 1.34, 95% CI, 1.12-1.61). COPD was also
associated with increased short-term and mid-term cardiac-cause mortality
(30 days: OR, 1.29, 95% CI, 1.02-1.64; 1 year: HR: 1.09, 1.02-1.17).
Moreover, COPD (OR, 1.97, 95% CI, 1.29-3.0) predicted post-TAVI acute
kidney disease. Importantly, chronic kidney disease (CKD) (HR, 1.2, 95%
CI, 1.1-1.32) and the distance of the 6 minute walk test (6MWT) (HR, 1.16,
1.06-1.27) predicted TAVI futility in patients with COPD. Conclusion: COPD
is common among patients undergoing TAVI, and COPD impacts both short- and
long-term survival. COPD patients, who had a lower BMI, shorter distance
of 6MWT and CKD, were at higher risk for TAVI futility. Copyright
© 2016 Wiley Periodicals, Inc.

<31>
Accession Number
608492661
Author
Hillebrand J.; Rouhollahpour A.; Zierer A.; Moritz A.; Martens S.
Institution
(Hillebrand, Martens) Department of Cardiothoracic Surgery, Division of
Cardiac Surgery, University Hospital, Westfaelische Wilhelms-University
Muenster, Albert-Schweitzer-Campus 1, Muenster D-48159, Germany
(Rouhollahpour, Zierer, Moritz) Department of Thoracic and Cardiovascular
Surgery, Johann Wolfgang Goethe-University Hospital, Frankfurt am Main,
Germany
Title
Digital carotid compression: A simple method to reduce solid cerebral
emboli during cardiac surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (2) (pp 304-308),
2016. Date of Publication: 01 Apr 2016.
Publisher
W.B. Saunders
Abstract
Objectives Serious neurologic injury can be attributed to embolization of
solid particles into cerebral vessels during cardiac surgery. Previous
studies using transcranial Doppler (TCD) identified arterial cannulation
and aortic declamping to be associated with cerebral embolization. The
purpose of this study was to investigate the impact of transient
compression of the carotid arteries during these maneuvers on the embolic
load during cardiac surgery with cardiopulmonary bypass. Design
Prospective, randomized, clinical trial/pilot study. Setting Single-center
study at a university hospital. Participants Patients with multiple types
of procedures were included and they were prospectively, randomly assigned
to group I (n = 20, carotid compression during arterial cannulation and
aortic declamping) and group II (n = 20, no carotid compression).
Interventions Bilateral continuous monitoring of the middle cerebral
arteries was performed with a multirange, multifreqency transcranial
Doppler (DopplerBoxX, DWL, Singen, Germany), allowing for discrimination
between solid and gaseous emboli. For aortic cannulation the carotid
arteries were compressed for 5 seconds and for declamping for 3 seconds,
and microemboli signals were detected within the following 45 seconds.
Measurements and Main Results A reduction of intraoperative solid emboli
was detected in group I compared with group II (26+/-16 v 38+/-18; p =
0.04). Looking specifically at the maneuver of arterial cannulation, the
observed difference was 0.5+/-0.8 in group I versus 5.7+/-5.8 in group II
(p<0.0001). During aortic declamping, 6.6+/-6.2 emboli were encountered in
group I and 10.8+/-5.2 in group II (p = 0.02). The incidence of neurologic
events was not significantly different between groups (2 patients in group
II had pathologic changes on magnetic resonance imaging). Conclusions The
data of this preliminary trial demonstrated that transient compression of
the carotid arteries during arterial cannulation and aortic declamping led
to a decreased number of solid cerebral emboli. Further prospective,
randomized clinical studies should be undertaken to investigate the
influence of transient carotid artery compression during specific surgical
procedures. Copyright © 2016 Elsevier Inc. Allrights reserved.

<32>
Accession Number
608799841
Author
Shimada Y.J.; Cannon C.P.; Liu Y.; Wilson C.; Kupfer S.; Menon V.; Cushman
W.C.; Mehta C.R.; Bakris G.L.; Zannad F.; White W.B.
Institution
(Shimada, Cannon, Liu) Harvard Clinical Research Institute, 930
Commonwealth Avenue West, Boston, MA 02215, United States
(Shimada) Cardiology Division, Massachusetts General Hospital, Harvard
Medical School, Boston, MA, United States
(Shimada, Cannon) Cardiovascular Division, Department of Medicine, Brigham
and Women's Hospital, Harvard Medical School, Boston, MA, United States
(Liu) Department of Biostatistics, Boston University, Boston, MA, United
States
(Wilson, Kupfer) Takeda Development Center Americas, Deerfield, IL, United
States
(Menon) Department of Cardiovascular Medicine, Cleveland Clinic
Foundation, Cleveland, OH, United States
(Cushman) University of Tennessee College of Medicine, Memphis Veterans
Affairs Medical Center, Memphis, TN, United States
(Mehta) Harvard School of Public Health, Boston, MA, United States
(Bakris) University of Chicago Medicine, Chicago, IL, United States
(Zannad) Institut Lorrain du Coeur et des Vaisseaux, Centre
d'Investigation Clinique Inserm, Universite de Lorraine, CHU,
Vandoeuvre-Les-Nancy, France
(White) Calhoun Cardiology Center, University of Connecticut School of
Medicine, Farmington, CT, United States
Title
Ischemic cardiac outcomes and hospitalizations according to prior
macrovascular disease status in patients with type 2 diabetes and recent
acute coronary syndrome from the Examination of Cardiovascular Outcomes
with Alogliptin versus Standard of Care trial.
Source
American Heart Journal. 175 (pp 18-27), 2016. Date of Publication: 01 May
2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Concerns raised regarding adverse cardiovascular (CV) outcomes
with new therapies for type 2 diabetes mellitus (T2DM) have led to several
large-scale CV outcome trials. The EXAMINE trial confirmed noninferiority
of the dipeptidyl dipeptidase 4 inhibitor alogliptin to placebo on major
adverse cardiac event rates in a post-acute coronary syndrome (ACS) T2DM
population. We present data on additional ischemic cardiac events and CV
hospitalizations in EXAMINE. Methods: Patients with T2DM and an ACS event
in the previous 15 to 90 days were randomly assigned to alogliptin or
placebo on a background of standard treatment for diabetes. The incident
rates of a 5-component composite end point of CV death, stroke, myocardial
infarction, unstable angina, and coronary revascularization as well as CV
hospitalization were calculated in all participants and according to
macrovascular disease at baseline. Results: There were no significant
differences between alogliptin (n = 2,701) and placebo (n = 2,679) in the
event rate of the 5-component composite endpoint with median follow-up 533
days (21.0% vs 21.5%, hazard ratio [HR] 0.98 [0.87-1.10], P =.72). No
differences were observed in terms of CV hospitalization (25.0% vs 25.4%,
HR 0.98 [0.88-1.09], P =.70) or coronary revascularization (10.6% vs
10.2%, HR 1.05 [0.88-1.09], P =.60). No interactions were observed for
treatment and prior macrovascular disease. Conclusions: EXAMINE
demonstrates that there was no increase in the risk of cardiac ischemic
events and CV hospitalizations with alogliptin in a high-risk post-ACS
patient population. Because these are major driver of overall health care
costs, these data suggest that there would be no adverse impact on health
care resource utilization. Copyright © 2016 Mosby, Inc.

<33>
Accession Number
613014793
Author
Pourier V.E.C.; de Borst G.J.
Institution
(Pourier, de Borst) Department of Vascular Surgery, University Medical
Center Utrecht, Utrecht, Netherlands
Title
Technical options for treatment of in-stent restenosis after carotid
artery stenting.
Source
Journal of Vascular Surgery. 64 (5) (pp 1486-1496), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective This review summarizes the available evidence and analyzes the
current trends on treatments for carotid in-stent restenosis (ISR) after
carotid artery stenting (CAS). Methods An update of a 2010 review of the
literature (which included 20 articles) was conducted using PubMed and
Embase. All studies published from inception until January 2016 reporting
original data on ISR treatments were included. Treatment trends before and
after 2005 were compared. Results We found 22 new articles reporting ISR
treatments in 138 patients, of which two (case series) were published
before 2005. With the inclusion of the 20 articles of the 2010 report (n =
96 patients), a total of 42 articles were included (23 case reports and 19
case series) reporting 239 interventions for ISR in 234 patients. Of these
42 studies, 14 (including 10 case series) were published before 2005. The
interventions were percutaneous transluminal angioplasty (PTA) in 136,
repeat CAS in 51, carotid endarterectomy in 39, carotid artery bypass in
10, or brachytherapy in 3. Compared with the articles published before
2005, PTA with regular balloon remains the most practiced treatment (26%
before 2005, 40% after 2005). PTA with drug-coated balloons started after
2005. Carotid endarterectomy with stent removal was the second most
reported treatment before 2005 but moved to the third place of reported
interventions after 2005 owing to an increase in repeat CAS treatment. Of
the treated patients, 140 were asymptomatic, 72 were symptomatic, and for
22 the symptomology was unclear. ISR treatment averaged 18 months after
CAS, and the follow-up thereafter was 16 months. Treatment for recurrent
ISR was performed in 48 of 239 treated arteries, mostly after PTA (n = 35)
and repeat CAS (n = 8). Conclusions The available evidence for ISR
treatment is still limited owing to methodologic heterogeneity; therefore,
no recommendation on the optimal intervention can be provided. Although
PTA is the common treatment for ISR, recurrent ISR seems to limit the
durability, leading to recurrent interventions and cost implications. A
uniform definition for ISR is needed with a standardized workup to compare
the treatment options based on individual patient data analysis.
Drug-eluting techniques are emerging and may become the preferred
treatment option, but long-term follow-up is needed to evaluate their
efficacy. Further study and understanding of the effect of drug-eluting
technologies on the brain and neurologic function is
warranted. Copyright © 2016 Society for Vascular Surgery

<34>
Accession Number
604795763
Author
Nunes A.J.; MacArthur R.G.G.; Kim D.; Singh G.; Buchholz H.; Chatterley
P.; Klarenbach S.W.
Institution
(Nunes, MacArthur, Singh, Buchholz) Division of Cardiac Surgery,
Department of Surgery, Faculty of Medicine and Dentistry, Edmonton, AB,
Canada
(Kim) Division of Cardiology, Department of Medicine, Faculty of Medicine
and Dentistry, Edmonton, AB, Canada
(Chatterley) University of Alberta Libraries, Edmonton, AB, Canada
(Klarenbach) Division of Nephrology, Department of Medicine, Faculty of
Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
Title
A Systematic Review of the Cost-Effectiveness of Long-Term Mechanical
Circulatory Support.
Source
Value in Health. 19 (4) (pp 494-504), 2016. Date of Publication: 01 Jun
2016.
Publisher
Elsevier Ltd
Abstract
Background Mechanical circulatory support (MCS) is an option for the
treatment of medically intractable end-stage heart failure. MCS therapy,
however, is resource intensive. Objective The purpose of this report was
to systematically review the MCS cost-effectiveness literature as it
pertains to the treatment of adult patients in end-stage heart failure.
Methods We conducted a systematic search and narrative review of available
cost- effectiveness and cost-utility analyses of MCS in adult patients
with end-stage heart failure. Results Eleven studies analyzing the
cost-effectiveness or cost-utility of MCS were identified. Seven studies
focused on bridge to transplantation, three studies focused on destination
therapy, and one study presented analyses of both strategies. Two articles
evaluated the cost-effectiveness of the HeartMate II (Thoratec Corp.,
Pleasanton, CA). Incremental cost-effectiveness ratios between MCS and
medical management ranged between 85,025 and 200,166 for bridge to
transplantation and between 87,622 and 1,257,946 for destination therapy
(2012 Canadian dollars per quality-adjusted life-year). Sensitivity
analyses indicated that improvements in survival and quality of life and
reductions in device and initial hospital-stay costs may improve the
cost-effectiveness of MCS. Conclusions Current studies suggest that MCS is
likely not cost-effective with reference to generally accepted or
explicitly stated thresholds. Refined patient selection, complication
rates, achieved quality of life, and device/surgical costs, however, could
modify the cost-effectiveness of MCS. Copyright © 2016
International Society for Pharmacoeconomics and Outcomes Research (ISPOR)

<35>
Accession Number
613139992
Author
Aldemir M.; Keles I.; Karalar M.; Tecer E.; Adali F.; Pektas M.B.; Parlar
A.I.; Darcin O.T.
Institution
(Aldemir, Tecer, Adali, Darcin) Department of Cardiovascular Surgery,
Afyon Kocatepe University, Afyonkarahisar, Turkey
(Keles, Karalar) Department of Urology, Afyon Kocatepe University,
Afyonkarahisar, Turkey
(Pektas) Department of Pharmacology, Faculty of Medicine, Afyon Kocatepe
University, Afyonkarahisar, Turkey
(Parlar) Department of Cardiovascular Surgery, Akut Kalp Damar Hospital,
Izmir, Turkey
Title
Nebivolol compared with metoprolol for erectile function in males
undergoing coronary artery bypass graft.
Source
Anatolian Journal of Cardiology. 16 (2) (pp 131-136), 2016. Date of
Publication: 2016.
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: The aim of this study was to evaluate erectile function in
males undergoing coronary artery bypass graft (CABG) while on two
different adrenoceptor beta-blocker regimens, namely nebivolol and
metoprolol. We hypothesize that the negative effects of cardiopulmonary
bypass on erectile function may be possibly attenuated by preferring a
vasodilating selective beta 1-blocker, nebivolol, to metoprolol as an
antiischemic and antiarrhythmic agent in males undergoing CABG. Methods:
This randomized, double-blind, prospective clinical study was conducted in
patients scheduled for CABG surgery between February 2012 and June 2014. A
total of 60 consecutive patients who met inclusion criteria were
randomized and divided into the following two groups: N group, which
received 5 mg of nebivolol orally for 2 weeks before surgery plus 12 weeks
after surgery or M group, which received 50 mg of metoprolol orally for
the same period. All patients were evaluated by the erectile function
domain of the International Index of Erectile Function-5 (IIEF-5) at the
time of admission (before starting the beta-blocker) and 3 months after
surgery. Results: In the metoprolol group, the mean IIEF-5 score decreased
significantly from a baseline of 15.2+/- 5.8 to 12.9+/- 5.8 (p< 0.001),
but in the nebivolol group, this difference was not significant (from a
baseline 12.9+/- 5.5 to 12.4+/- 5.5, p=0.053). In all patients, the mean
IIEF-5 score decreased significantly from a baseline of 14.0+/- 5.7 to
12.6+/- 5.6 (p< 0.001). Conclusion: Although erectile function in males
undergoing CABG surgery decreases when metoprolol is used, nebivolol
exerts protective effects on erectile function against the disruptive
effects of cardiopulmonary bypass in patients undergoing
CABG. Copyright © 2016 by Turkish Society of Cardiology.

<36>
Accession Number
613362981
Author
Harris S.K.; Roos M.G.; Landry G.J.
Institution
(Harris, Roos, Landry) Oregon Health and Science University, Portland,
Ore, United States
Title
Statin use in patients with peripheral arterial disease.
Source
Journal of Vascular Surgery. 64 (6) (pp 1881-1888), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Statins are recommended for use in patients with peripheral
arterial disease (PAD) to reduce cardiovascular events and mortality.
However, much of the data regarding benefits of statins stem from the
cardiovascular literature. Here, we review the literature regarding statin
use specifically in patients with PAD regarding its effects on
cardiovascular events and mortality, limb-related outcomes, statin use
after endovascular interventions, statin dosing, and concerns about
statins. Methods We performed a literature review using PubMed for
literature after the year 2000. Search terms included "statins,"
"peripheral arterial disease," "peripheral vascular disease,"
"lipid-lowering medication," and "cardiovascular disease." Results There
is good evidence of statins lowering cardiovascular events and
cardiovascular-related mortality in patients with PAD. Though
revascularization rates were reduced with statins, amputation rates and
amputation-free survival did not improve. Small randomized controlled
trials show that patients taking statins can slightly improve pain-free
walking distance or pain-free walking time, although the extent of the
effect on quality of life is unclear. Statin use for patients undergoing
endovascular interventions is recommended because of the reduction of
postoperative cardiovascular events. Not enough data exist to support
local effects of systemic statin therapy, such as prevention of
restenosis. For statin dosing, there is little increased benefit to
intense therapy compared with the adverse effects, whereas moderate-dose
therapy has significant benefits with very few adverse effects. Adverse
effects of moderate-dose statin therapy are rare and mild and are greatly
outweighed by the cardiovascular benefits. Conclusions There is strong
evidence to support use of statins in patients with PAD to reduce
cardiovascular events and mortality. Use in patients undergoing open and
endovascular interventions is also recommended. Statin use may reduce the
need for revascularization, but reductions in amputation have not been
shown. Moderate-dose statin therapy is safe, and the minor risks are
greatly outweighed by benefits. Copyright © 2016 Society for
Vascular Surgery

<37>
Accession Number
613127821
Author
De Vecchis R.; Baldi C.; Palmisani L.
Institution
(De Vecchis) Cardiology Unit, Napoli, Italy
(Palmisani) Presidio Sanitario Intermedio "Elena d'Aosta", Napoli, Italy
(Baldi) Heart Department, Interventional Cardiology, A.O.U. "San Giovanni
di Dio e Ruggi D'Aragona", Salerno, Italy
Title
Protective effects of methotrexate against ischemic cardiovascular
disorders in patients treated for rheumatoid arthritis or psoriasis: Novel
therapeutic insights coming from a meta-analysis of the literature data.
Source
Anatolian Journal of Cardiology. 16 (1) (pp 2-9), 2016. Date of
Publication: 2016.
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: The association between chronic use of methotrexate and
decreased risk of ischemic cardiovascular events (CVE) among patients with
psoriatic or rheumatoid arthritis (RA) was investigated using a systematic
review and meta-analysis. Methods: The studies should have recruited
adults receiving methotrexate, followed up for at least one year.
Moreover, studies should have reported "hard" cardiovascular endpoints, by
evaluating the cardiovascular outcomes of the habitual users of the drug
or of new users compared with patients with the same disease who had never
used methotrexate. The outcome of interest was the overall pooled odds
ratio (OR) of major adverse cardiovascular events, i.e., a composite of
new- onset angina, acute coronary syndrome, need for percutaneous or
surgical coronary revascularization, stroke, and cardiovascular death. The
study was performed according to the PRISMA statement. Results: Seven
observational studies, mostly engaging patients with RA, were included in
the meta-analysis. The pooled odds ratio (OR) was 0.73 (95% CI=0.70- 0.77
p<0.001). When stratified meta-analysis models were assessed, the pooled
OR was 0.80 (95% CI=0.66-0.97; p=0.022) for studies adjusting for clinical
severity of RA. Furthermore, the OR was even more significant after
adjustment for concomitant use of other drugs specific for RA (OR=0.71,
95% CI=0.67-0.75, p<0.001). Conclusion: Methotrexate at low doses, such
those used for maintenance therapy of RA, predicted a decreased risk of
CVE. Since methotrexate doesn't interfere with blood lipids, platelet
aggregation or insulin resistance, the protective association may
originate from mechanisms other than those exerted by antiplatelet drugs
or statins. Copyright © 2016 by Turkish Society of Cardiology.

<38>
Accession Number
609229684
Author
Ali-Faisal S.F.; Scott L.B.; Johnston L.; Grace S.L.
Institution
(Ali-Faisal) York University, Toronto, ON, Canada
(Ali-Faisal, Scott) Stony Brook University, Program in Public Health,
Stony Brook Medicine, School of Health, Technology and Management, Stony
Brook, NY, United States
(Johnston, Grace) School of Kinesiology and Health Science, York
University, Toronto, ON, Canada
Title
Cardiac rehabilitation referral and enrolment across an academic health
sciences centre with eReferral and peer navigation: A randomised
controlled pilot trial.
Source
BMJ Open. 6 (3) (no pagination), 2016. Article Number: e010214. Date of
Publication: 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives: To describe (1) cardiac rehabilitation (CR) referral across
cardiac units in a tertiary centre with eReferral; (2) characteristics
associated with CR referral and enrolment and (3) the effects of peer
navigation (PN) on referral and enrolment. This pilot was a 2
parallel-arm, randomised, single-blind trial with allocation concealment.
Setting: 3 cardiac units (ie, interventional, general cardiology, and
cardiac surgery) in 1 of 2 hospitals of a tertiary centre. Participants:
CR-eligible adult cardiac inpatients were randomised to PN or usual care.
94 (54.7%) patients consented, of which 46 (48.9%) were randomised to PN.
Outcomes were ascertained in 76 (80.9%) participants. Intervention: The PN
(1) visited participant at the bedside, (2) mailed a card to participant's
home reminding about CR and (3) called participant 2 weeks postdischarge
to discuss CR barriers. Outcome measures: The primary outcome of enrolment
was defined as participant attendance at a scheduled CR intake appointment
(yes/no). The secondary outcome was referral. Blinded outcome assessment
was conducted 12 weeks postdischarge, via CR chart extraction. Results:
Those who received care on the cardiac surgery unit (77.9%) were more
likely to be referred than those treated on the general cardiology (61.1%)
or interventional unit (33.3%; p=0.04). Patients who had cardiac surgery,
hypertension and hyperlipidaemia were significantly more likely, and those
with congenital heart disease, cancer and a previous cardiac diagnosis
were less likely to be referred. Participants referred to a site closer to
home (76.2% of those referred) were more likely to enrol than those not
(23.7%, p<0.05). PN had no effect on referral (77.6%, p=0.45) or enrolment
(46.0%, p=0.24). Conclusions: There is wide variability in CR referral,
even within academic centres, and despite eReferral. Referral was quite
high, and thus, PN did not improve CR utilisation. Results support
triaging patients to the CR programme closest to their home.

<39>
Accession Number
611081988
Author
Chen I.-C.; Lee C.-H.; Chao T.-H.; Tseng W.-K.; Lin T.-H.; Chung W.-J.; Li
J.-K.; Huang H.-L.; Liu P.-Y.; Chao T.-K.; Chu C.-Y.; Lin C.-C.; Hsu
P.-C.; Lee W.-H.; Lee P.-T.; Li Y.-H.; Tseng S.-Y.; Tsai L.-M.; Hwang
J.-J.
Institution
(Chen) Tainan Municipal Hospital, Department of Internal Medicine, Tainan,
Taiwan (Republic of China)
(Lee, Chao, Liu, Lin, Lee, Lee, Li, Tseng, Tsai) National Cheng Kung
University College of Medicine and Hospital, Department of Internal
Medicine, Tainan, Taiwan (Republic of China)
(Chao) National Cheng Kung University College of Medicine and Hospital,
Division of Cardiology, Department of Internal Medicine, No. 138, Sheng-Li
Road, North District, Tainan 704, Taiwan (Republic of China)
(Tseng) E-Da University College of Medicine and Hospital, Division of
Cardiology, Department of Internal Medicine, Kaohsiung, Taiwan (Republic
of China)
(Lin, Chu, Hsu) Kaohsiung Medical University and Hospital, Division of
Cardiology, Department of Internal Medicine, Kaohsiung, Taiwan (Republic
of China)
(Chung) Chang-Gung Memorial Hospital Kaohsiung, Division of Cardiology,
Department of Internal Medicine, Kaohsiung, Taiwan (Republic of China)
(Li, Hwang) National Taiwan University Hospital, Division of Cardiology,
Department of Internal Medicine, Taipei, Taiwan (Republic of China)
(Huang) Buddhist Tzu Chi General Hospital, Taipei Branch, Division of
Cardiology, Department of Internal Medicine, Taipei, Taiwan (Republic of
China)
(Chao) Far Eastern Memorial Hospital, Department of Otolaryngology, New
Taipei City, Taiwan (Republic of China)
(Chao) Faculty of Medicine and Dentistry, University of Alberta, Division
of Public Health and Preventive Medicine, Department of Medicine,
Edmonton, AB, Canada
Title
Impact of routine coronary catheterization in low extremity artery disease
undergoing percutaneous transluminal angioplasty: Study protocol for a
multi-center randomized controlled trial.
Source
Trials. 17 (1) (no pagination), 2016. Article Number: 112. Date of
Publication: 29 Feb 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The prevalence of significant obstructive coronary artery
disease with complex lesions is high in patients who have low extremity
artery disease (LEAD). However, intermediate- or long-term cardiovascular
prognosis of LEAD patients undergoing percutaneous transluminal
angioplasty (PTA) remains poor. Accordingly, prophylactic coronary
revascularization may modify short- and long-term cardiovascular outcomes
of LEAD patients receiving PTA. Because myocardial ischemic symptoms are
often masked in LEAD and the accuracy of non-invasive stress tests is
usually limited, a high-quality randomized controlled trial aimed at the
investigation of the prognostic role of coronary evaluation strategies
before PTA is warranted. Methods/Design: The proposed study is designed as
a prospective, multi-center, open-label, superiority, randomized
controlled trial. The study is conducted in high-volume centers for PTA
and coronary revascularization in Taiwan. To meet the inclusion criteria,
the patients must be at least 20years old, have known LEAD, and have been
admitted for elective PTA. We plan to enroll 450 participants who are
randomly allocated to a routine group (routine coronary angiography
without a previous non-invasive stress test before PTA) and a selective
group (selective coronary angiography based on the results of non-invasive
stress tests before PTA) with 1:1 ratio. Besides, we expect to enroll
about 250 additional participants, who are not willing to be randomly
assigned, in the registration group. The choice of revascularization
procedure depends on the operator's or cardiovascular team's suggestion
and the patient's decision. Clinical follow-up will be performed 30days
after PTA and every 6months until the end of the 1-year follow-up for the
last randomly assigned participant. The primary endpoint is the composite
major adverse cardiac event on long-term follow-up. Pre-specified
secondary and other endpoints are also evaluated. Those assessing
biomarkers and clinical endpoints are all blinded after assignment to
interventions. Discussion: The results of the trial will, for the first
time, support better decision-making for coronary evaluation before PTA in
LEAD. If favorable, routine coronary angiography followed by
revascularization will improve cardiovascular outcomes in LEAD patients
undergoing PTA. Trial registration: ClinicalTrials.gov identifier:
NCT02169258(registered on 21 June 2014); registry name: Routine Coronary
Catheterization in Low Extremity Artery Disease Undergoing Percutaneous
Transluminal Angioplasty (PIROUETTE-PTA). Copyright © 2016 Chen
et al.

<40>
Accession Number
610541427
Author
Bauters C.; Lemesle G.
Institution
(Bauters, Lemesle) Centre Hospitalier Regional et Universitaire de Lille,
Lille, France
(Bauters) Inserm U1167, Institut Pasteur de Lille, Universite Lille Nord
de France, Lille, France
(Bauters, Lemesle) Faculte de Medecine de Lille, Lille, France
(Bauters, Lemesle) Hopital Cardiologique, CHRU de Lille, Boul. Prof.
Leclercq, Lille Cedex 59037, France
Title
Screening for asymptomatic coronary artery disease in patients with
diabetes mellitus: A systematic review and meta-analysis of randomized
trials.
Source
BMC Cardiovascular Disorders. 16 (1) (no pagination), 2016. Article
Number: 90. Date of Publication: 10 May 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Screening diabetic patients for the presence of asymptomatic
coronary artery disease (CAD) may potentially impact therapeutic
management and outcome. We performed a systematic review and meta-analysis
of randomized trials addressing this question. Methods: We searched the
PubMed database for studies reporting a randomized comparison of
systematic screening for CAD in diabetic patients versus no systematic
screening. The screening protocols were variable with the use of exercise
electrocardiogram test, or stress echocardiography, or nuclear test, or
coronary computed tomography angiography. Results: The final analysis
included 5 randomized studies and 3,314 patients altogether. The screening
strategy had no detectable impact on outcome with odds ratios (OR) [95 %
confidence interval (CI)] of 1.00 [0.67-1.50], 0.72 [0.33-1.57], 0.71
[0.40-1.27], and 0.60 [0.23-1.52] for all-cause death, cardiovascular
death, non-fatal myocardial infarction, and the composite cardiovascular
death or non-fatal myocardial infarction, respectively. Protocol-related
coronary procedures were relatively infrequent in screened patients:
coronary angiography was performed in 8 % of the cases, percutaneous
coronary intervention in 2.5 %, and coronary artery bypass surgery in 1.5
%. There was no evidence for an effect of screening on the use of statins
(OR = 1.19 [0.94-1.51]), aspirin (OR = 1.02 [0.83-1.25]), or
angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (OR
= 0.97 [0.79-1.19]). Conclusion: The present analysis shows no evidence
for a benefit of screening diabetic patients for the presence of
asymptomatic CAD. The proportion of patients who undergo myocardial
revascularization as a consequence of screening was low. Copyright
© 2016 Bauters and Lemesle.

<41>
Accession Number
615211068
Author
Dogan M.; Yasar M.; Gokahmetoglu G.; Guneri E.; Ozcan I.
Institution
(Dogan, Yasar, Guneri, Ozcan) Department of ENT, Kayseri Training and
Research Hospital, Kayseri, Turkey
(Gokahmetoglu) Department of Anesthesiology, Kayseri Training and Research
Hospital, Kayseri, Turkey
Title
Assessment of hearing via otoacoustic emission in patients that underwent
spinal anesthesia.
Source
European Review for Medical and Pharmacological Sciences. 20 (7) (pp
1224-1228), 2016. Date of Publication: 2016.
Publisher
Verduci Editore (E-mail: g.lombardi@verduci.it)
Abstract
OBJECTIVE: In this study, our aim is to show the differences between the
preoperative and postoperative otoacoustic emissions (OAE) value in
patients, who underwent spinal anesthesia. PATIENTS AND METHODS: The
presented study was carried out as a randomized, doubleblinded,
prospective study upon the approval of Ethics Committee of Medicine
School, Erciyes University. The study was conducted in accordance with the
Helsinki Declaration. The study involved 39 ASA I-II patients (aged 18-65
years), who underwent varicectomy operation in the Cardiovascular Surgery
Department. For each of the patients, 3 OAE measurements were performed;
the day before surgery, during surgery and the 1st day after surgery.
RESULTS: Significant differences were detected between the 2000 F2
measurements performed before, during and after the surgery (p<0.05). The
differences originated from measurements performed before and during
surgery. Significant differences were detected among 3000 F1 measurements
performed before, during and after surgery (p<0.05). Hearing loss is one
of the late complications of spinal anesthesia. In this study, we observed
the differences between the preoperative and postoperative OAE values. The
incidence of hearing loss detectable with auditory measurements has been
reported to vary between 10 and 50%. Of these, 25% is clinically relevant
or recognizable. However, it is considered to be a subjective test,
because it is influenced from mental, motor and psychological status of
the patient. But the management in hearing loss following spinal
anesthesia is still controversial. Hearing loss is generally spontaneously
resolved within a few days. However, there are case reports of hearing
loss lasting for months. CONCLUSIONS: In this study, we observed
differences between some preoperative and postoperative OAE values.

<42>
[Use Link to view the full text]
Accession Number
610136399
Author
Elgendy I.Y.; Mahmoud A.N.; Elgendy A.Y.; Bavry A.A.
Institution
(Elgendy, Mahmoud, Elgendy, Bavry) Department of Medicine, University of
Florida, Gainesville, FL, United States
(Bavry) North Florida/South Georgia Veterans Health System, Gainesville,
FL, United States
Title
Outcomes with intravascular ultrasound-guided stent implantation.
Source
Circulation: Cardiovascular Interventions. 9 (4) (no pagination), 2016.
Article Number: e003700. Date of Publication: 01 Apr 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - In the era of drug-eluting stents, it is unknown if
intravascular ultrasound (IVUS) guidance for percutaneous coronary
intervention should be routinely endorsed. This study aimed to determine
if IVUS-guided stent implantation is associated with improved outcomes.
Methods and Results - Randomized trials that reported clinical outcomes
and compared routine IVUS-guided stent implantation with an
angiography-guided approach in the era of drug-eluting stents were
included. Summary estimates were constructed primarily using the Peto
model. Seven trials with 3192 patients were analyzed. The mean length of
the coronary lesions was 32 mm. At a mean of 15 months, routine
IVUS-guided percutaneous coronary intervention was associated with a
reduction in the risk of major adverse cardiac events (6.5% versus 10.3%;
odds ratio, 0.60; 95% confidence interval, 0.46-0.77; P<0.0001), mainly
because of reduction in the risk of ischemia-driven target lesion
revascularization (4.1% versus 6.6%; odds ratio, 0.60; 95% confidence
interval, 0.43-0.84; P=0.003). The risk of cardiovascular mortality (0.5%
versus 1.2%; odds ratio, 0.46; 95% confidence interval, 0.21-1.00;
P=0.05), and stent thrombosis (0.6% versus 1.3%; odds ratio, 0.49; 95%
confidence interval, 0.24-0.99; P=0.04) also appeared to be lower in the
IVUS-guided group. Conclusions - In the era of drug-eluting stents for
diffuse coronary lesions, IVUS-guided percutaneous coronary intervention
is superior to angiography-guided percutaneous coronary intervention in
reducing the risk of major adverse cardiac events. This is primarily
because of reduction in the risk of ischemia-driven target lesion
revascularization. This analysis also suggests that risk of cardiovascular
mortality and stent thrombosis might be lower with an IVUS-guided
approach. Copyright © 2016 American Heart Association, Inc.

<43>
Accession Number
608637620
Author
Leone A.M.; D'Amario D.; Teofili L.; Basile E.; Cannata F.; Graziani F.;
Marzilli M.; Russo A.M.; Tarantini G.; Ceconi C.; Leone G.; Trani C.;
Rebuzzi A.G.; Crea F.
Institution
(Leone, D'Amario, Basile, Cannata, Graziani, Trani, Rebuzzi, Crea)
Dipartimento di Scienze Cardiovascolari, Universita Cattolica del Sacro
Cuore, Largo Agostino Gemelli, 8, Rome 00168, Italy
(Teofili, Leone) Istituto di Ematologia, Universita Cattolica del Sacro
Cuore, Largo Agostino Gemelli, 8, Rome 00168, Italy
(Marzilli) Dipartimento Cardio-Toraco-Vascolare, Universita di Pisa, Via
Paradisa, 2, Pisa 56124, Italy
(Russo) MEBIC, Universita San Raffaele, Via di Val Cannuta, 247 - 00166,
Rome, Italy
(Tarantini) Dipartimento di Scienze Cardiologiche Toraciche e Vascolari,
Universita di Padova, Via Giustiniani, 2, Padova 35128, Italy
(Ceconi) Dipartimento di Medicina Clinica e Sperimentale, Universita di
Ferrara, Corso Giovecca, 203, Ferrara 44100, Italy
Title
The combined effect of subcutaneous granulocyte- colony stimulating factor
and myocardial contrast echocardiography with intravenous infusion of
sulfur hexafluoride on post-infarction left ventricular function, the
RIGENERA 2.0 trial: Study protocol for a randomized controlled trial.
Source
Trials. 17 (1) (no pagination), 2016. Article Number: 97. Date of
Publication: February 19, 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Several clinical trials and recent meta-analyses have
demonstrated that administration of recombinant human granulocyte-colony
stimulating factor (G-CSF) is safe and, only in patients with large acute
myocardial infarction (AMI), is associated with an improvement in left
ventricular ejection fraction. Moreover, the mobilization and engraftment
of the bone marrow-derived cells may differ significantly among patients,
interfering with the restoration of left ventricular function after
treatment. Therefore, the clinical potential application of the G-CSF has
not yet been fully elucidated. Methods/Design: The RIGENERA 2.0 trial is a
multicenter, phase II, placebo-controlled, randomized, open-label, with
blinded evaluation of endpoints (PROBE) trial in which 120 patients with
an acute ST-elevation myocardial infarction (STEMI) undergoing successful
revascularization but with residual myocardial dysfunction will be
enrolled. In cases where there is a left ventricular ejection fraction
(LVEF) <=45% the patient will be electronically randomized (1:1 ratio) to
receive either subcutaneous recombinant human G-CSF (group 1) or placebo
(group 2) both added on top of optimal standard of care. Both groups will
undergo myocardial contrast echocardiography with intravenous infusion of
sulfur hexafluoride (MCE) whilst undergoing the echocardiogram. The
primary efficacy endpoint is the evaluation of the LVEF at 6months after
AMI assessed by cardiac magnetic resonance. Secondary efficacy endpoints
are the evaluation of LVEF at 6months after AMI assessed by
echocardiography, left ventricular end-diastolic volume (LVEDV) and left
ventricular end-systolic volume (LVESV) assessed by cardiac magnetic
resonance and echocardiography at 6months, together with the incidence of
major adverse clinical events (MACE) defined as death, myocardial
infarction, sustained cardiac arrhythmias, cardiogenic shock, stroke and
re-hospitalization due to heart failure at 1year. Discussion: The RIGENERA
2.0 trial will test whether G-CSF administration and MCE, through the
enhancement of the bone marrow-derived cells homing in the myocardium,
determines an improvement in regional and global contractile function,
myocardial perfusion and infarct extension in patients with large AMI. The
results of the present study are expected to envision routine clinical use
of this safe, affordable and reproducible approach in patients with
successful revascularization after AMI. Trial registration:
ClinicalTrials.gov: NCT02502747(29 June 2015); EudraCT: 2015-002189-21 (10
July 2015). Copyright © 2016 Leone et al.

<44>
Accession Number
610976838
Author
Goto A.; Goto M.; Terauchi Y.; Yamaguchi N.; Noda M.
Institution
(Goto, Yamaguchi) Department of Public Health, Tokyo Women's Medical
University, Tokyo, Japan
(Goto, Goto, Noda) Department of Diabetes Research, Diabetes Research
Center, National Center for Global Health and Medicine, Tokyo, Japan
(Terauchi) Department of Endocrinology and Metabolism, Graduate School of
Medicine, Yokohama City University, Yokohama, Japan
(Noda) Department of Endocrinology and Diabetes, Saitama Medical
University, Saitama, Japan
Title
Association between severe hypoglycemia and cardiovascular disease risk in
japanese patients with type 2 diabetes.
Source
Journal of the American Heart Association. 5 (3) (no pagination), 2015.
Article Number: e002875. Date of Publication: 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: It remains unclear whether severe hypoglycemia is associated
with cardiovascular disease (CVD) in Asian populations with type 2
diabetes (T2D). Furthermore, no study in Japan, where the prescription
patterns differ from those in other countries, has examined this
association. Methods and Results: We retrospectively included 58 223
patients (18-74 years old) with T2D. First, we examined the potential
predictors of severe hypoglycemia. Then, we investigated the association
between severe hypoglycemia and CVD risk. Finally, we performed an updated
systematic review and meta-analysis to incorporate our findings and
recently published studies into the previous systematic review and
meta-analysis. During 134 597 person-years from cumulative observation
periods, 128 persons experienced severe hypoglycemia and 550 developed CVD
events. In a multivariate Cox proportional hazard model, severe
hypoglycemia was strongly and positively associated with the risk of CVD
(multivariate-adjusted adjusted hazard ratio, 3.39; 95% CI, 1.25-9.18). In
a propensity score-matched cohort that had similar baseline
characteristics for patients with severe hypoglycemia and those without,
severe hypoglycemia was more strongly associated with the risk of CVD. An
updated systematic review and meta-analysis that included 10 studies found
that severe hypoglycemia was associated with an =2-fold increased risk of
CVD (pooled relative risk, 1.91; 95% CI, 1.69-2.15). Conclusions: Our
results suggest that severe hypoglycemia is strongly associated with an
increased risk of CVD in Japanese patients with T2D, further supporting
the notion that avoiding severe hypoglycemia may be important in
preventing CVD in this patient population. Copyright © 2016 The
Authors.

<45>
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Accession Number
616277624
Author
Santos E.; Cardoso D.; Neves H.; Cunha M.; Rodrigues M.; Apostolo J.
Institution
(Santos, Cardoso, Neves, Rodrigues, Apostolo) Health Sciences Research
Unit: Nursing, Nursing School of Coimbra, Portugal Centre for Evidence
Based Practice, Joanna Briggs Institute Centre of Excellence, Australia
(Santos) Emergency Department, Centro Hospitalar e Universitario de
Coimbra (CHUC), Coimbra, Portugal
(Cunha) Research and Development Unit, Centre of Studies in Education,
Health and Technology, Viseu, Portugal
Title
Effectiveness of haloperidol prophylaxis in critically ill patients with a
high risk of delirium: A systematic review.
Source
JBI Database of Systematic Reviews and Implementation Reports. 15 (5) (pp
1440-1472), 2017. Date of Publication: 01 May 2017.
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
EXECUTIVE SUMMARYBackground Delirium is associated with increased
intensive care unit and hospital length of stay, prolonged duration of
mechanical ventilation, unplanned removal of tubes and catheters, and
increased morbidity and mortality. Prophylactic treatment with low-dose
haloperidol may have beneficial effects for critically ill patients with a
high risk of delirium. Objectives To identify the effectiveness of
haloperidol prophylaxis in critically ill patients with a high risk for
delirium. Inclusion criteria Types of participants Patients with a
predicted high risk of delirium, aged 18 years or over, and in intensive
care units. Patients with a history of concurrent antipsychotic medication
use were excluded. Types of intervention(s)/phenomena of interest
Haloperidol prophylaxis for preventing delirium. Types of studies
Experimental and epidemiological study designs. Outcomes Primary outcome
is the incidence of delirium. Secondary outcomes are duration of
mechanical ventilation, incidence of re-intubation, incidence of
unplanned/accidental removal of tubes/lines and catheters, intensive care
unit and hospital length of stay, and re-admissions to both settings.
Search strategy An initial search of MEDLINE and CINAHL was undertaken,
followed by a second search for published and unpublished studies from
January 1967 to September 2015 in major healthcare-related electronic
databases. Studies in English, Spanish and Portuguese were included.
Methodological quality Two independent reviewers assessed the
methodological quality of five studies using the standardized critical
appraisal instrument from the Joanna Briggs Institute Meta-Analysis of
Statistics Assessment and Review Instrument. There was general agreement
among the reviewers to exclude one relevant study due to methodological
quality. Data extraction Data were extracted using the JBI data extraction
form for experimental studies and included details about the
interventions, populations, study methods and outcomes of significance to
the review questions. Data synthesis Significant differences were found
between participants, interventions, outcome measures (clinical
heterogeneity) and designs (methodological heterogeneity). For these
reasons, we were unable to perform a meta-analysis. Therefore, the results
have been described in a narrative format. Results Five studies met the
inclusion criteria. One of these studies was excluded due to poor
methodological quality. The remaining four original studies (total of 1142
patients) were included in this review. Three studies were randomized
controlled trials and one was a cohort study. Two studies confirmed the
effectiveness of haloperidol prophylaxis in critically ill patients with a
high risk of delirium. These studies showed that short-term prophylactic
administration of low-dose intravenous haloperidol significantly decreased
the incidence of delirium in elderly patients admitted to intensive care
units after non-cardiac surgery and in general intensive care unit
patients with a high risk of delirium. However, the two remaining studies
showed contradictory results in mechanically ventilated critically ill
adults, revealing that the administration of haloperidol reduced delirium
prevalence, delayed its occurrence, and/or shorten its duration.
Conclusions The evidence related to the effectiveness of haloperidol
prophylaxis in critically ill patients with a high risk of delirium is
contradictory. However, balancing the benefits and low side effects
associated with haloperidol prophylaxis, this preventive intervention may
be useful to reduce the incidence of delirium in critically ill adults in
intensive care units. Copyright © 2017 THE JOANNA BRIGGS
INSTITUTE.

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Accession Number
616268191
Author
Wang S.; Yao H.; Chen C.; Zhou R.; Wang R.; Yu H.; Liu B.
Institution
(Wang, Yao, Yu, Chen, Zhou, Wang, Yu, Liu) Department of Anesthesiology,
West China Hospital of Sichuan University, No. 37 Guoxuexiang, Chengdu,
China
Title
Effect of perioperative statin therapy on renal outcome in patients
undergoing cardiac surgery.
Source
Medicine (United States). 96 (19) (no pagination), 2017. Article Number:
e6883. Date of Publication: 01 May 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Acute renal injury (AKI) is a common renal complication after
cardiac surgery. The aim of this study was to determine the effect of
perioperative statin therapy (PST) on postoperative renal outcome in
patients undergoing cardiac procedures. Methods: We searched for the
reports that evaluating the effect of PST on renal outcomes after cardiac
surgery between March 1983 and June 2016 in the electronic database
Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE/PubMed,
and EMBASE/OVID. Results: Nine randomized controlled trials (RCTs)
enrolling 2832 patients, with 1419 in the PST group and 1413 in the
control group, were included in this meta-analysis. Our results suggested
that PST increased the incidence of postoperative renal complication
(relative risk [RR] 1.18, 95% confidence interval [CI] 1.01-1.36, P=.03)
with low heterogeneity (I 2 =30%, P=.18). Six studies with 3116 patients
detected no significant difference in severe renal complication between
PST and control groups (RR 1.23, 95%CI 0.84-1.79, P=.28). Postoperative
serum creatinine (sCr) at 48hours was shown to be higher in the PST group
(mean difference [MD] 0.03, 95% CI 0.03-0.03; P<.01). The length of
hospital stay was decreased slightly by 0.59 day in the PST group (95%
CI-0.85 to-0.33; P<.01). Conclusions: Perioperative statin therapy seems
to jeopardize short-term renal outcome in patients undergoing cardiac
surgery, but the occurrence of severe renal complication was not
affected. Copyright © 2017 the Author(s).

<47>
[Use Link to view the full text]
Accession Number
610533632
Author
Bagai A.; Bhatt D.L.; Eikelboom J.W.; Mancini G.B.J.; Cohen E.A.;
Vijayaraghavan R.; Cheema A.N.; Udell J.A.; Niznick J.; Tanguay J.-F.;
Verma S.; Mehta S.R.
Institution
(Bagai, Cheema) Terrence Donnelly Heart Center, St. Michael's Hospital,
University of Toronto, Toronto, ON, Canada
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
(Eikelboom, Mehta) Population Health Research Institute, McMaster
University, Hamilton Health Sciences, ON, Canada
(Mancini) Vancouver Hospital, University of British Columbia, Vancouver,
BC, Canada
(Cohen) Department of Medicine, Sunnybrook Health Sciences Centre,
University of Toronto, Toronto, ON, Canada
(Vijayaraghavan) Division of Cardiology, Rouge Valley Health System,
Scarborough, ON, Canada
(Udell) Peter Munk Cardiac Centre, Toronto General Hospital, University of
Toronto, Toronto, ON, Canada
(Niznick) University of Ottawa, Ottawa, ON, Canada
(Tanguay) Montreal Heart Institute, Universite de Montreal, Montreal, QC,
Canada
(Verma) Division of Cardiac Surgery, Keenen Research Centre for Biomedical
Science, St. Michael's Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada
(Mehta) Hamilton Health Sciences, General Division, 237 Barton St E,
Hamilton, ON L8L 2X2, Canada
Title
Individualizing duration of dual antiplatelet therapy after acute coronary
syndrome or percutaneous coronary intervention.
Source
Circulation. 133 (21) (pp 2094-2098), 2016. Date of Publication: 24 May
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)

<48>
Accession Number
612630186
Author
Zhang H.; Liu Y.; Bin J.; Qiu S.; Chen F.
Institution
(Zhang, Liu) Department of Medical Ultrasound, Second Affiliated Hospital
of Guangzhou Medical University, Guangzhou, Guangdong, China
(Bin) Southern Medical University, Guangzhou, Guangdong, China
(Qiu, Chen) Department of Cardiology, Nanfang Hospital of Southern Medical
University, Guangzhou, Guangdong, China
Title
Meta-analysis of two different surgical treatments of ischaemic mitral
regurgitation with the same outcome: Mitral valve repair vs mitral valve
replacement.
Source
Acta Cardiologica. 71 (5) (pp 573-580), 2016. Date of Publication: 2016.
Publisher
Acta Cardiologica (Weldadigheidsstraat 49, Leuven B-3000, Belgium)
Abstract
Background Mitral valve replacement (MVR) and mitral valve repair (MVP)
are the most common clinical treatment for ischaemic mitral insufficiency
(IMR). But controversy exists on the optimal surgical strategy for IMR.
Methods A literature search was performed in OvidSP, PubMed and Cochrane
Library to find articles comparing MVP versus MVR for the treatment of
IMR. A meta-analysis was performed for the differences in short- and
long-term survival. Secondary outcomes analysed the postoperative left
ventricular diastolic diameter (LVDD), left ventricular ejection fraction
(LVEF) and the New York Heart Association (NYHA) class. Results Out of the
584 studies, we only included 12 articles. A total of 2953 patients were
enrolled, including 1731 patients in the MVP group and 1222 patients in
the MVR group. The total number of bioprosthesis valves was 1.2 times
(631/535) the number of mechanical valves. After surgery, LVDD and LVEF
had improved and the proportion of NYHA III-IV class declined, but the
differences between the two groups were not significant (P > 0.05).
Shortterm survival in the MVP group was higher than that in the MVR group
(odds ratio [OR], 0.44; 95% confidence interval [CI] 0.32-0.60; P <
0.00001). Long-term survival was similar in both two groups (hazard ratio
[HR], 0.86; 95% CI 0.68-1.10, P = 0.24). Conclusion Both MVP and MVR can
play a role in reducing IMR and improving left ventricular function. The
short-term survival of MVP is better than MVR but long-term survival is
similar. Further exploration is needed to install optimal treatment of IMR
and individualized therapy. Copyright © 2016, Acta Cardiologica.
All rights reserved.

<49>
Accession Number
609851225
Author
Egypto Rosa V.E.; De Santis Andrade Lopes A.S.; Duenhas Accorsi T.A.;
Cordeiro Fernandes J.R.; Spina G.S.; Sampaio R.O.; Paixao M.R.;
Pomerantzeff P.M.; Lemos Neto P.A.; Tarasoutchi F.
Institution
(Egypto Rosa, De Santis Andrade Lopes, Duenhas Accorsi, Cordeiro
Fernandes, Spina, Sampaio, Paixao) Clinical Unit of Heart Valve Disease,
Brazil
(Pomerantzeff, Tarasoutchi) Surgical Unit of Heart Valve Disease, Brazil
(Lemos Neto) Hemodynamics Unit, Brazil
(Egypto Rosa, De Santis Andrade Lopes, Duenhas Accorsi, Cordeiro
Fernandes, Spina, Sampaio, Paixao, Pomerantzeff, Lemos Neto, Tarasoutchi)
Instituto Do Coracao (InCor) Do Hospital das Clinicas, Faculdade de
Medicina, Universidade de Sao Paulo (FMUSP), Sao Paulo, SP, Brazil
Title
EuroSCORE II and STS as mortality predictors in patients undergoing TAVI.
Source
Revista da Associacao Medica Brasileira. 62 (1) (pp 32-37), 2016. Date of
Publication: January-February 2016.
Publisher
Associacao Medica Brasileira
Abstract
Introduction: the EuroSCORE II and STS are the most used scores for
surgical risk stratification and indication of transcatheter aortic valve
implantation (TAVI). However, its role as a tool for mortality prediction
in patients undergoing TAVI is still unclear. Objective: to evaluate the
performance of the EuroSCORE II and STS as predictors of in-hospital and
30-day mortality in patients undergoing TAVI. Methods: we included 59
symptomatic patients with severe aortic stenosis that underwent TAVI
between 2010 and 2014. The variables were analyzed using Student's t-test
and Fisher's exact test and the discriminative power was evaluated using
receiver operating characteristic curve (ROC) and area under the curve
(AUC) with a 95% confidence interval. Results: mean age was 81+/-7.3
years, 42.3% men. The mean EuroSCORE II was 7.6+/-7.3 % and STS was
20.7+/-10.3%. Transfemoral procedure was performed in 88.13%, transapical
in 3.38% and transaortic in 8.47%. In-hospital mortality was 10.1% and
30-day mortality was 13.5%. Patients who died had EuroSCORE II and STS
higher than the survivors (33.7+/-16.7 vs. 18.6+/-7.3% p=0,0001 for STS
and 13.9+/-16.1 vs. 4.8+/-3.8% p=0.0007 for EuroSCORE II). The STS showed
an AUC of 0.81 and the EuroSCORE II of 0.77 and there were no differences
in the discrimination ability using ROC curves (p=0.72). Conclusion: in
this cohort, the STS and EuroSCORE II were predictors of in-hospital and
30-days mortality in patients with severe aortic stenosis undergoing TAVI.

<50>
Accession Number
607978021
Author
Zhao Y.; Nicoll R.; He Y.H.; Henein M.Y.
Institution
(Zhao, He) Ultrasound Department, Beijing Anzhen Hospital, Capital Medical
University, Beijing 100029, China
(Nicoll, Henein) Department of Public Health and Clinical Medicine, Umea
University, Umea, Sweden
Title
The effect of statins on valve function and calcification in aortic
stenosis: A meta-analysis.
Source
Atherosclerosis. 246 (pp 318-324), 2016. Date of Publication: March 01,
2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Aortic calcification has been shown to share the same risk
factors as atherosclerosis which suggested a potential benefit from
statins therapy. In view of the existing conflicting results, we aimed to
provide objective evidence on the effect of statins in aortic stenosis
(AS). Methods and results: A meta-analysis of eligible studies that used
statins in AS was performed. Fourteen studies were identified, 5
randomized controlled trials (RCTs) and 9 observational studies. In the 14
studies as a whole, no significant differences were found in all cause
mortality (OR = 0.98, p = 0.91), cardiovascular mortality (OR = 0.80, P =
0.23) or the need for valve replacement (OR = 0.93, p = 0.45) between the
statins and the control groups. LDL-cholesterol dropped in the statins
groups in both < 24 months and >=24 months follow-up (p < 0.001 for both)
but not in controls (p = 0.35 and p = 0.33, respectively). In the <24
months statins group, the annual increase in peak aortic velocity and peak
gradient was less (p < 0.0001 and p = 0.004, respectively), but the mean
gradient, valve area and calcification score were not different from
controls. In the >= 24 months statins group, none of the above parameters
was different from controls. Conclusions: Despite the consistent
beneficial effect of statins on LDL-cholesterol levels, the available
evidence showed no effect on aortic valve structure, function or
calcification and no benefit for clinical outcomes. Copyright ©
2016 Elsevier Ireland Ltd.

<51>
Accession Number
609627523
Author
Fiedler K.A.; Ndrepepa G.; Schulz S.; Floh S.; Hoppmann P.; Kufner S.;
Bernlochner I.; Byrne R.A.; Schunkert H.; Laugwitz K.-L.; Kastrati A.
Institution
(Fiedler, Ndrepepa, Schulz, Floh, Kufner, Byrne, Schunkert, Kastrati)
Deutsches Herzzentrum, Technische Universitat, Lazarettstrasse 36, Munchen
80636, Germany
(Hoppmann, Bernlochner, Laugwitz) Medizinische Klinik, Klinikum Rechts der
Isar, Technische Universitat, Munich, Germany
(Schunkert, Laugwitz, Kastrati) DZHK (German Centre for Cardiovascular
Research), Partner Site Munich Heart Alliance, Munich, Germany
Title
Impact of bivalirudin on post-procedural epicardial blood flow, risk of
stent thrombosis and mortality after percutaneous coronary intervention.
Source
EuroIntervention. 11 (11) (pp e1275-e1282), 2016. Date of Publication:
February 2016.
Publisher
EuroPCR
Abstract
Aims: We aimed to assess the association of bivalirudin with
post-procedural Thrombolysis In Myocardial Infarction (TIMI) flow, acute
(<=24 hours) and 30-day stent thrombosis (ST), and one-year mortality.
Methods and results: The study included 11,623 patients undergoing
percutaneous coronary intervention (PCI). The primary outcomes were
post-procedural TIMI flow grade <=2 and definite acute ST. In groups
treated with bivalirudin (n=3,135), abciximab plus unfractionated heparin
(UFH; n=3,539) and UFH alone (n=4,949), post-procedural TIMI was <=2 in
5.2%, 3.2% and 3.2% of patients, respectively (adjusted odds ratio
[OR]=1.96 [95% confidence interval] 1.47-2.56 for bivalirudin versus
abciximab plus UFH and OR=1.56 [1.20-2.04] for bivalirudin versus UFH).
Definite acute ST occurred in two patients (0.06%) treated with
bivalirudin, two patients (0.06%) treated with abciximab plus UFH, and
seven patients (0.14%) treated with UFH (p=0.47). Bivalirudin was not
associated with increased risk of 30-day ST (hazard ratio [HR]=1.20
[0.59-2.43] versus abciximab plus UHF, and HR=0.93 [0.48-1.82] versus UFH)
or one-year mortality (HR=0.95 [0.70-1.28] versus abciximab plus UHF, and
HR=1.05 [0.78-1.41] versus UFH). Conclusions: Bivalirudin was associated
with higher risk of suboptimal post-PCI TIMI flow but not with increased
risk of acute or 30-day definite ST or one-year mortality compared with
abciximab plus UFH or UFH alone. Copyright © Europa Digital &
Publishing 2016. All rights reserved.

<52>
Accession Number
608327557
Author
Zhou D.; Fan Y.; Wan Z.; Wen W.; Wang X.; Zhou J.; Chen T.; Yuan Z.
Institution
(Zhou, Fan, Wan, Wen, Wang, Zhou, Chen, Yuan) Department of Cardiovascular
Medicine, First Affiliated Hospital of xi'An Jiaotong University, 277
Yanta West Road, Xi'an, Shaanxi 710061, China
(Yuan) Key Laboratory of Environment and Genes Related to Diseases,
Ministry of Education, Xi'an, China
(Yuan) Key Laboratory of Molecular Cardiology, Xi'an, China
(Zhou) Department of Cardiovascular Medicine, Hanzhong Central Hospital,
Hanzhong, China
Title
Platelet-to-Lymphocyte Ratio Improves the Predictive Power of GRACE Risk
Score for Long-Term Cardiovascular Events in Patients with Acute Coronary
Syndrome.
Source
Cardiology (Switzerland). 134 (1) (pp 39-46), 2016. Date of Publication:
01 Apr 2016.
Publisher
S. Karger AG
Abstract
Objectives: This study aims to evaluate the relationship between
platelet-to-lymphocyte ratio (PLR) and GRACE risk score and to examine
whether PLR on admission can improve the predictive value of GRACE risk
score for cardiovascular disease (CVD) events in patients with acute
coronary syndrome (ACS). Methods: PLR was calculated from the platelet and
lymphocyte counts from the complete blood count of 2,230 ACS patients upon
admission. The GRACE risk score was also calculated. Results: Spearman's
rank correlation demonstrated that GRACE risk score was positively
correlated with PLR (r = 0.190, p < 0.001). After a median follow-up
period of 58 months, multivariate Cox analysis showed that both GRACE risk
score [hazard ratio (HR) 1.092, 95% confidence interval (CI) 1.067-1.117,
p < 0.001] and PLR (HR 1.100, 95% CI 1.088-1.112, p < 0.001) could
independently predict CVD events. Receiver-operating characteristic curve
(ROC) analysis proved that using PLR together with GRACE risk score
improved the score from 0.70 (95% CI 0.67-0.73, p < 0.001) when used alone
to 0.81 (95% CI 0.79-0.83, p < 0.001) for CVD events and from 0.73 (95% CI
0.70-0.77, p < 0.001) when used alone to 0.80 (95% CI 0.77-0.83, p <
0.001) for all-cause mortality. Conclusions: This study proves, for the
first time, a positive association between GRACE risk score and PLR, and
that a combination of PLR and GRACE risk score is more effective in
predicting CVD events in ACS patients. Copyright © 2016 S. Karger
AG, Basel.

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Accession Number
609208670
Author
Meredith I.T.; Tanguay J.-F.; Kereiakes D.J.; Cutlip D.E.; Yeh R.W.;
Garratt K.N.; Lee D.P.; Steg P.G.; Weaver W.D.; Holmes D.R.; Brindis R.G.;
Trebacz J.; Massaro J.M.; Hsieh W.-H.; Mauri L.
Institution
(Meredith, Hsieh) Monash Heart and Monash University, Melbourne, Australia
(Tanguay) Montreal Heart Institute, Universite de Montreal, QC, Canada
(Kereiakes) Christ Hospital Heart, Vascular Center, Lindner Center for
Research and Education, Cincinnati, OH, United States
(Cutlip) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Cutlip, Yeh, Massaro, Mauri) Harvard Clinical Research Institute, Boston,
MA, United States
(Cutlip, Yeh, Mauri) Harvard Medical School, Boston, MA, United States
(Yeh) Smith Center for Outcomes Research in Cardiology, Beth Israel
Deaconess Medical Center, Boston, MA, United States
(Garratt) Lenox Hill Hospital, New York, NY, United States
(Lee) Stanford University, Stanford, CA, United States
(Steg) Universite Paris-Diderot, INSERM U-1148, Hopital Bichat,
Departement Hospitalo-Universitaire Fibrosis, Inflammation, and
Remodeling, Assistance Publique-Hopitaux de Paris, Paris, France
(Steg) National Heart and Lung Institute, Imperial College, Royal Brompton
Hospital, London, United Kingdom
(Weaver) Henry Ford Medical Group, Detroit, MI, United States
(Holmes) Mayo Clinic, Rochester, MN, United States
(Brindis) Institute for Health Policy Studies, University of California,
San Francisco, United States
(Trebacz) Jan Pawel II Hospital Krakow, Poland
(Massaro) Boston University, School of Public Health, Boston, MA, United
States
(Mauri) Division of Cardiovascular Medicine, Department of Medicine,
Brigham and Women's Hospital, 75 Francis -St, Boston, MA 02115, United
States
Title
Diabetes mellitus and prevention of late myocardial infarction after
coronary Stenting in the randomized dual Antiplatelet therapy study.
Source
Circulation. 133 (18) (pp 1772-1782), 2016. Date of Publication: 03 May
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Patients with diabetes mellitus (DM) are at high risk for
recurrent ischemic events after coronary stenting. We assessed the effects
of continued thienopyridine among patients with DM participating in the
Dual Antiplatelet Therapy (DAPT) Study as a prespecified analysis. Methods
and Results - After coronary stent placement and 12 months treatment with
open-label thienopyridine plus aspirin, 11 648 patients free of ischemic
or bleeding events and who were medication compliant were randomly
assigned to continued thienopyridine or placebo, in addition to aspirin,
for 18 more months. After randomization, patients with DM (n=3391), in
comparison with patients without DM (n=8257), had increased composite
outcome of death, myocardial infarction (MI), or stroke (6.8% versus 4.3%,
P<0.001), increased death (2.5% versus 1.4%, P<0.001), and MI (4.2% versus
2.6%, P<0.001). Among patients with DM, in a comparison of continued
thienopyridine versus placebo, rates of stent thrombosis were 0.5% versus
1.1%, P=0.06, and rates of MI were 3.5% versus 4.8%, P=0.058; and among
patients without DM the rates were 0.4% versus 1.4%, P<0.001 (stent
thrombosis, P interaction=0.21) and 1.6% versus 3.6%, P<0.001 (MI, P
interaction=0.02). Bleeding risk with continued thienopyridine was similar
among patients with or without DM (interaction P=0.61). Conclusions - In
patients with DM, continued thienopyridine beyond 1 year after coronary
stenting is associated with reduced risk of MI, although this benefit is
attenuated in comparison with patients without DM. Clinical Trial
Registration - URL: http://www.clinicaltrials.gov. Unique identifier:
NCT00977938. Copyright © 2016 American Heart Association, Inc.

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[Use Link to view the full text]
Accession Number
611522428
Author
Bohula E.A.; Bonaca M.P.; Braunwald E.; Aylward P.E.; Corbalan R.; De
Ferrari G.M.; He P.; Lewis B.S.; Merlini P.A.; Murphy S.A.; Sabatine M.S.;
Scirica B.M.; Morrow D.A.
Institution
(Bohula, Bonaca, Braunwald, He, Murphy, Sabatine, Scirica, Morrow)
Department of Medicine, Harvard Medical School, Brigham and Women's
Hospital, Boston, MA, United States
(Aylward) South Australian Health and Research Institute, Flinders
University and Medical Centre, Adelaide, Australia
(Corbalan) Division of Cardiovascular Diseases, School of Medicine,
Pontificia Universidad Catolica de Chile, Santiago, Chile
(De Ferrari) Department of Cardiology, Fondazione IRCCS Policlinico San
Matteo, Pavia, Italy
(Lewis) Lady Davis Carmel Medical Center, Ruth and Bruce Rappaport School
of Medicine, Technion, Haifa, Israel
(Merlini) IV Divisione Cardiologia, Azienda Ospedaliera Niguarda Ca'
Granda, Milan, Italy
Title
Atherothrombotic Risk Stratification and the Efficacy and Safety of
Vorapaxar in Patients with Stable Ischemic Heart Disease and Previous
Myocardial Infarction.
Source
Circulation. 134 (4) (pp 304-313), 2016. Date of Publication: 26 Jul 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Patients with stable ischemic heart disease and previous
myocardial infarction (MI) vary in their risk for recurrent cardiovascular
events. Atherothrombotic risk assessment may be useful to identify
high-risk patients who have the greatest potential to benefit from more
intensive secondary preventive therapy such as treatment with vorapaxar.
Methods: We identified independent clinical indicators of atherothrombotic
risk among 8598 stable, placebo-treated patients with a previous MI
followed up for 2.5 years (median) in TRA 2degreeP-TIMI 50 [Thrombin
Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic
Events-TIMI 50]. The efficacy and safety of vorapaxar (SCH 530348;
MK-5348) were assessed by baseline risk among patients with previous MI
without prior stroke or transient ischemic attack for whom there is a
clinical indication for vorapaxar. End points were cardiovascular death,
MI, or ischemic stroke and GUSTO (Global Use of Strategies to Open
Occluded Coronary Arteries) severe bleeding. Results: The 9 independent
risk predictors were age, diabetes mellitus, hypertension, smoking,
peripheral arterial disease, previous stroke, previous coronary bypass
grafting, heart failure, and renal dysfunction. A simple integer-based
scheme using these predictors showed a strong graded relationship with the
rate of cardiovascular death/MI/ischemic stroke and the individual
components (P for trend <0.001 for all). High-risk patients (>=3 risk
indicators; 20% of population) had a 3.2% absolute risk reduction in
cardiovascular disease/MI/ischemic stroke with vorapaxar, and
intermediate-risk patients (1-2 risk indicators; 61%) had a 2.1% absolute
risk reduction (P<0.001 each), translating to a number needed to treat of
31 and 48. Bleeding increased across risk groups (P for trend<0.01);
however, net clinical outcome was increasingly favorable with vorapaxar
across risk groups. Fatal bleeding or intracranial hemorrhage was 0.9%
with both treatments in high-risk patients. Conclusions: Stratification of
baseline atherothrombotic risk can assist with therapeutic decision making
for vorapaxar use for secondary prevention after MI. Clinical Trial
Registration: URL: https://www.clinicaltrials.gov. Unique identifier:
NCT00526474. Copyright © 2016 American Heart Association, Inc.

<55>
Accession Number
610072686
Author
Gleason T.G.; Schindler J.T.; Adams D.H.; Reardon M.J.; Kleiman N.S.;
Caplan L.R.; Conte J.V.; Deeb G.M.; Hughes G.C.; Chenoweth S.; Popma J.J.
Institution
(Gleason, Schindler) University of Pittsburgh School of Medicine, Division
of Cardiac Surgery, Department of Cardiothoracic Surgery, 5200 Centre Ave,
Suite 715, Pittsburgh, PA 15232, United States
(Adams) Department of Surgery Mount Sinai Medical Center, New York, NY,
United States
(Reardon, Kleiman) Houston-Methodist-Debakey Heart and Vascular Center,
Houston, TX, United States
(Caplan, Popma) Beth Israel Deaconess Medical Center, Boston, MA, United
States
(Conte) Johns Hopkins University School of Medicine, Baltimore, MD, United
States
(Deeb) University of Michigan, Ann Arbor, MI, United States
(Hughes) Duke University Medical Center, Durham, NC, United States
(Chenoweth) Medtronic, Inc, Minneapolis, MN, United States
Title
The risk and extent of neurologic events are equivalent for high-risk
patients treated with transcatheter or surgical aortic valve replacement.
Source
Journal of Thoracic and Cardiovascular Surgery. 152 (1) (pp 85-96), 2016.
Date of Publication: 01 Jul 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives This study was designed to characterize the incidence of new
clinically detectable neurologic events, or any comparative change in
indices of higher cognitive function following transcatheter aortic valve
replacement (TAVR) or surgical aortic valve replacement (SAVR) within the
framework of a prospective, randomized clinical trial for high-risk
patients. Methods High-risk patients (predicted SAVR mortality 15%) with
severe aortic stenosis (n = 750) were randomized 1:1 to TAVR or SAVR and
underwent evaluation using the National Institutes of Health Stroke Scale
(NIHSS) and modified Rankin Scale assessment at each follow-up and any
suspected event. Neurologic outcomes were ascertained by a neurologist and
further evaluated by Mini-Mental State Examination (MMSE), visual fields
testing, gait assessment, hand function, writing evaluation, and drawing
assessment. Results The 30-day, 1-year, and 2-year stroke rates were 4.9%,
8.7%, and 10.9%, respectively, for TAVR and 6.2%, 12.5%, and 16.6%,
respectively, for SAVR (P =.46,.11, and.05, respectively). All-cause
mortality in patients with a major stroke was 83.3% for TAVR and 54.5% for
SAVR at 2 years (P =.29). Late major stroke was disproportionately higher
(23.8% at 2 years) among patients with poor iliofemoral access randomized
to SAVR. Peripheral vascular disease and falls within 6 months predicted
early stroke, and severe aortic calcification and high Charlson score
(>=5) predicted 1-year stroke post-TAVR. NIHSS and MMSE scores trended
higher after SAVR than after TAVR. Lack of dual antiplatelet therapy use
during and after TAVR was associated with early stroke. Conclusions This
study defines an equivalent postprocedural stroke risk, stroke extent, and
degree of cognitive change after TAVR or SAVR in a high-risk population,
and also defines several predictors of stroke after TAVR. Copyright
© 2016 The American Association for Thoracic Surgery.

<56>
Accession Number
612973121
Author
Cayla G.; Cuisset T.; Silvain J.; Leclercq F.; Manzo-Silberman S.;
Saint-Etienne C.; Delarche N.; Bellemain-Appaix A.; Range G.; El Mahmoud
R.; Carrie D.; Belle L.; Souteyrand G.; Aubry P.; Sabouret P.; du Fretay
X.H.; Beygui F.; Bonnet J.-L.; Lattuca B.; Pouillot C.; Varenne O.; Boueri
Z.; Van Belle E.; Henry P.; Motreff P.; Elhadad S.; Salem J.-E.; Abtan J.;
Rousseau H.; Collet J.-P.; Vicaut E.; Montalescot G.
Institution
(Cayla, Lattuca) ACTION Study Group, Service de Cardiologie, Centre
Hospitalier Universitaire de Nimes, Universite de Montpellier, Nimes,
France
(Cuisset, Bonnet) Department of Cardiology, Centre Hospitalier
Universitaire Timone, Marseille, France
(Cuisset, Bonnet) INSERM UMR1062, INRA UMR1260, Nutrition, Obesity and
Risk of Thrombosis, Faculty of Medicine, Aix-Marseille University,
Marseille, France
(Silvain, Sabouret, Collet, Montalescot) Sorbonne Universite-Paris 06,
ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hopital
Pitie-Salpetriere (AP-HP), Paris, France
(Leclercq) Departement de Cardiologie, Centre Hospitalier Universitaire
Montpellier, Montpellier, France
(Manzo-Silberman, Henry) Service de Cardiologie, Hopital Lariboisiere,
Paris, France
(Saint-Etienne) Service de Cardiologie, Centre Hospitalier Universitaire
Tours, Tours, France
(Delarche) Hopital Francois Mitterrand, Centre Hospitalier de Pau, Pau,
France
(Bellemain-Appaix) ACTION Study Group, Service de Cardiologie, Centre
Hospitalier d'Antibes-Juans-Les-Pins, Antibes, France
(Range) Service de Cardiologie, Les Hopitaux de Chartres, Le Coudray,
Chartres, France
(El Mahmoud) Hopital Ambroise Pare, Boulogne-Billancourt, France
(Carrie) Service de Cardiologie, Centre Hospitalier Universitaire
Toulouse, Toulouse, France
(Belle) Service de Cardiologie, Centre Hospitalier d'Annecy, Annecy,
France
(Souteyrand, Motreff) Service de Cardiologie, Centre Hospitalier
Universitaire Clermont-Ferrand, Clermont-Ferrand, France
(Aubry, du Fretay, Abtan) Service de Cardiologie, Hopital Bichat Claude
Bernard, Paris, France
(Beygui) ACTION Study Group, Service de Cardiologie, Centre Hospitalier
Universitaire de Caen, Caen, France
(Pouillot) Clinique Sainte Clotilde, Saint Denis de La Reunion, La
Reunion, France
(Varenne) Service de Cardiologie, Hopital Cochin, Paris, France
(Boueri) Service de Cardiologie de Bastia, Centre Hospitalier de Bastia,
Bastia, France
(Van Belle) Service de Cardiologie, Centre Hospitalier Universitaire de
Lille, Lille, France
(Elhadad) Centre Hospitalier de Lagny Marne la Vallee, Jossigny, France
(Salem) Department of Pharmacology, CIC-1421, INSERM U1166-ICAN, Hopital
Pitie-Salpetriere (AP-HP), Paris, France
(Rousseau, Vicaut) ACTION Study Group, Unite de Recherche Clinique,
Lariboisiere, Paris, France
Title
Platelet function monitoring to adjust antiplatelet therapy in elderly
patients stented for an acute coronary syndrome (ANTARCTIC): an
open-label, blinded-endpoint, randomised controlled superiority trial.
Source
The Lancet. 388 (10055) (pp 2015-2022), 2016. Date of Publication: 22 Oct
2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Elderly patients are at high risk of ischaemic and bleeding
events. Platelet function monitoring offers the possibility to
individualise antiplatelet therapy to improve the therapeutic risk-benefit
ratio. We aimed to assess the effect of platelet function monitoring with
treatment adjustment in elderly patients stented for an acute coronary
syndrome. Methods We did this multicentre, open-label, blinded-endpoint,
randomised controlled superiority study at 35 centres in France. Patients
aged 75 years or older who had undergone coronary stenting for acute
coronary syndrome were randomly assigned (1:1), via a central interactive
voice-response system based on a computer-generated permuted-block
randomisation schedule with randomly selected block sizes, to receive oral
prasugrel 5 mg daily with dose or drug adjustment in case of inadequate
response (monitoring group) or oral prasugrel 5 mg daily with no
monitoring or treatment adjustment (conventional group). Randomisation was
stratified by centre. Platelet function testing was done 14 days after
randomisation and repeated 14 days after treatment adjustment in patients
in the monitoring group. Study investigators and patients were not masked
to treatment allocation, but allocation was concealed from an independent
clinical events committee responsible for endpoint adjudication. The
primary endpoint was a composite of cardiovascular death, myocardial
infarction, stroke, stent thrombosis, urgent revascularisation, and
Bleeding Academic Research Consortium-defined bleeding complications
(types 2, 3, or 5) at 12 months' follow-up. We did analysis by intention
to treat. This trial is registered with ClinicalTrials.gov, number
NCT01538446. Findings Between March 27, 2012, and May 19, 2015, we
randomly assigned 877 patients to the monitoring group (n=442) or the
conventional group (n=435). The primary endpoint occurred in 120 (28%)
patients in the monitoring group compared with 123 (28%) patients in the
conventional group (hazard ratio [HR], 1.003, 95% CI 0.78-1.29; p=0.98).
Rates of bleeding events did not differ significantly between groups.
Interpretation Platelet function monitoring with treatment adjustment did
not improve the clinical outcome of elderly patients treated with coronary
stenting for an acute coronary syndrome. Platelet function testing is
still being used in many centres and international guidelines still
recommend platelet function testing in high-risk situations. Our study
does not support this practice or these recommendations. Funding Eli Lilly
and Company, Daiichi Sankyo, Stentys, Accriva Diagnostics, Medtronic, and
Fondation Coeur et Recherche. Copyright © 2016 Elsevier Ltd

<57>
Accession Number
613333292
Author
Silverman M.G.; Ference B.A.; Im K.; Wiviott S.D.; Giugliano R.P.; Grundy
S.M.; Braunwald E.; Sabatine M.S.
Institution
(Silverman, Im, Wiviott, Giugliano, Braunwald, Sabatine) TIMI Study Group,
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard
Medical School, 75 Francis St, Boston, MA 02115, United States
(Ference) Division of Cardiovascular Medicine, Wayne State University
School of Medicine, Detroit, MI, United States
(Grundy) Center for Human Nutrition, Department of Internal Medicine,
University of Texas Southwestern Medical Center, Dallas, United States
Title
Association between lowering LDL-C and cardiovascular risk reduction among
different therapeutic interventions: A systematic review and
meta-analysis.
Source
JAMA - Journal of the American Medical Association. 316 (12) (pp
1289-1297), 2016. Date of Publication: 27 Sep 2016.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE The comparative clinical benefit of nonstatin therapies that
reduce low-density lipoprotein cholesterol (LDL-C) remains uncertain.
OBJECTIVE To evaluate the association between lowering LDL-C and relative
cardiovascular risk reduction across different statin and nonstatin
therapies. DATA SOURCES AND STUDY SELECTION The MEDLINE and EMBASE
databaseswere searched (1966-July 2016). The key inclusion criteria were
that the study was a randomized clinical trial and the reported clinical
outcomes includedmyocardial infarction (MI). Studies were excluded if the
duration was less than 6 months or had fewer than 50 clinical events.
Studies of 9 different types of LDL-C reduction approaches were included.
DATA EXTRACTION AND SYNTHESIS Two authors independently extracted and
entered data into standardized data sheets and data were analyzed
usingmeta-regression. MAIN OUTCOMES AND MEASURES The relative risk (RR) of
major vascular events (a composite of cardiovascular death, acute MI or
other acute coronary syndrome, coronary revascularization, or stroke)
associated with the absolute reduction in LDL-C level; 5-year rate of
major coronary events (coronary death or MI) associated with achieved
LDL-C level. RESULTS A total of 312 175 participants (mean age, 62 years;
24%women; mean baseline LDL-C level of 3.16 mmol/L [122.3mg/dL]) from 49
trials with 39 645 major vascular eventswere included. The RR for major
vascular events per 1-mmol/L (38.7-mg/dL) reduction in LDL-C level was
0.77 (95%CI, 0.71-0.84; P < .001) for statins and 0.75 (95%CI, 0.66-0.86;
P = .002) for established nonstatin interventions thatwork primarily via
upregulation of LDL receptor expression (ie, diet, bile acid sequestrants,
ileal bypass, and ezetimibe) (between-group difference, P = .72). For
these 5 therapies combined, the RRwas 0.77 (95%CI, 0.75-0.79, P < .001)
for major vascular events per 1-mmol/L reduction in LDL-C level. For other
interventions, the observed RRs vs the expected RRs based on the degree of
LDL-C reduction in the trialswere 0.94 (95%CI, 0.89-0.99) vs 0.91 (95%CI,
0.90-0.92) for niacin (P = .24); 0.88 (95%CI, 0.83-0.92) vs 0.94 (95%CI,
0.93-0.94) for fibrates (P = .02), whichwas lower than expected (ie,
greater risk reduction); 1.01 (95%CI, 0.94-1.09) vs 0.90 (95%CI,
0.89-0.91) for cholesteryl ester transfer protein inhibitors (P = .002),
whichwas higher than expected (ie, less risk reduction); and 0.49 (95%CI,
0.34-0.71) vs 0.61 (95%CI, 0.58-0.65) for proprotein convertase
subtilisin/kexin type 9 inhibitors (P = .25). The achieved absolute LDL-C
levelwas significantly associated with the absolute rate of major coronary
events (11 301 events, including coronary death or MI) for primary
prevention trials (1.5%lower event rate [95%CI, 0.5%-2.6%] per each
1-mmol/L lower LDL-C level; P = .008) and secondary prevention trials
(4.6%lower event rate [95%CI, 2.9%-6.4%] per each 1-mmol/L lower LDL-C
level; P < .001). CONCLUSIONS AND RELEVANCE In this meta-regression
analysis, the use of statin and nonstatin therapies that act via
upregulation of LDL receptor expression to reduce LDL-C were associated
with similar RRs of major vascular events per change in LDL-C. Lower
achieved LDL-C levels were associated with lower rates of major coronary
events. © Copyright 2016 American Medical Association. All rights
reserved.

<58>
Accession Number
612327511
Author
Fernandes G.A.; Lima A.C.G.; Gonzaga I.C.A.; de Barros Araujo R.; de
Oliveira R.A.; Nicolau R.A.
Institution
(Fernandes, Lima, Gonzaga, Nicolau) Lasertherapy and Photobiology Center,
Research and Development Institute, IP&D, Universidade do Vale do Paraiba,
UNIVAP, Sao Paulo, Brazil
(Fernandes, Gonzaga) Uninovafapi College, Teresina, Piaui, Brazil
(Lima) University of Piaui State (UESPI), Teresina, Piaui, Brazil
(de Barros Araujo) Cardiac Surgery Department, Santa Maria Hospital,
Teresina, Piaui, Brazil
(de Oliveira) Uninovafapi College and University of Piaui State (UESPI),
Teresina, Piaui, Brazil
(Fernandes) Vitorino Orthigues Fernandes Street, 6123, Teresina, Piaui
64073-505, Brazil
Title
Low-intensity laser (660 nm) on sternotomy healing in patients who
underwent coronary artery bypass graft: a randomized, double-blind study.
Source
Lasers in Medical Science. 31 (9) (pp 1907-1913), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Springer London
Abstract
The aim of this study was to analyze the healing effects of low-level
laser therapy (LLLT) on the longitudinal sternotomy incisions of patients
who underwent coronary artery bypass graft (CABG). The volunteers were
randomized into three groups of equal size (n = 30): control, placebo, and
laser (lambda = 660 nm and spatial average energy fluency [SAEF] = 1.06
J/cm2). The patients in the laser group underwent irradiation
on postoperative days 2, 4, 6, and 8, and their sternotomy incisions were
photographed immediately after the surgery and 8 days later for analysis.
Three researchers who were blinded to the patient treatment groups
analyzed the incision photographs to assess hyperemia and wound closure on
the day of hospital discharge (eighth postoperative day). The sternotomy
incisions in the LLLT group demonstrated less hyperemia, incisional
bleeding, and dehiscence (p <= 0.005). Copyright © 2016,
Springer-Verlag London.

<59>
Accession Number
608249561
Author
Ng V.G.; Mori K.; Costa R.A.; Kish M.; Mehran R.; Urata H.; Saku K.; Stone
G.W.; Lansky A.J.
Institution
(Ng, Kish, Lansky) Yale University Medical Center, New Haven, CT, United
States
(Mori, Urata) Fukuoka University Chikushi Hospital, Fukuoka, Japan
(Costa) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
(Mehran, Stone) Columbia University Medical Center, Cardiovascular
Research Foundation, New York, NY, United States
(Saku) Department of Cardiology, Fukuoka University School of Medicine,
Fukuoka, Japan
(Lansky) Yale University School of Medicine, PO Box 208017, New Haven, CT
06520-8017, United States
Title
Impact of gender on infarct size, ST-segment resolution, myocardial blush
and clinical outcomes after primary stenting for acute myocardial
infarction: Substudy from the EMERALD trial.
Source
International Journal of Cardiology. 207 (pp 269-276), 2016. Date of
Publication: 15 Mar 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Women with AMI may have worse outcomes than men. However, it is
unclear if this is related to differences in treatment, treatment effect
or gender specific factors. We sought to determine whether primary
percutaneous intervention (PCI) has a differential impact on infarct size,
myocardial perfusion and ST segment resolution in men and women with acute
myocardial infarction (AMI). Methods A total of 501 AMI patients were
prospectively enrolled in the EMERALD study and underwent PCI with or
without distal protection. Post hoc gender subset analysis was performed.
Results 501 patients (108 women, 393 men) with ST-segment elevation AMI
presenting within 6 h underwent primary (or rescue) PCI with stenting and
a distal protection device. Women were older, had more hypertension, less
prior AMI, smaller BSA, and smaller vessel size, but had similar rates of
diabetes (30% versus 20.2%, p = 0.87), LAD infarct, and
time-to-reperfusion compared to men. Women more frequently had complete
ST-resolution (> 70%) at 30 days (72.8% versus 59.8%, p = 0.02), and
smaller infarct size compared to males (12.2 +/- 19.6% versus 18.4 +/-
18.5%, p = 0.006). At 6 months, TLR (6.9% versus 5.2%) and MACE (11.4%
versus 10.3%) were similar for women and men. Conclusions Despite worse
comorbidities, women with AMI treated with primary PCI with stenting
showed similar early and midterm outcomes compared to men. Copyright
© 2016 Elsevier Ireland Ltd. All rights reserved.

<60>
Accession Number
609614423
Author
Squiers J.J.; Lima B.; DiMaio J.M.
Institution
(Squiers, DiMaio) Baylor Research Institute, Baylor Scott and White
Health, 3310 Live Oak, Ste 501, Dallas, TX 75204, United States
(Lima, DiMaio) Department of Cardiac and Thoracic Surgery, Baylor
University Medical Center, Baylor Healthcare System, Dallas, TX, United
States
Title
Contemporary extracorporeal membrane oxygenation therapy in adults:
Fundamental principles and systematic review of the evidence.
Source
Journal of Thoracic and Cardiovascular Surgery. 152 (1) (pp 20-32), 2016.
Date of Publication: 01 Jul 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Extracorporeal membrane oxygenation (ECMO) provides days to weeks of
support for patients with respiratory, cardiac, or combined
cardiopulmonary failure. Since ECMO was first reported in 1974, nearly
70,000 runs of ECMO have been implemented, and the use of ECMO in adults
increased by more than 400% from 2006 to 2011 in the United States. A
variety of factors, including the 2009 influenza A epidemic, results from
recent clinical trials, and improvements in ECMO technology, have
motivated this increased use in adults. Because ECMO is increasingly
becoming available to a diverse population of critically ill patients, we
provide an overview of its fundamental principles and a systematic review
of the evidence basis of this treatment modality for a variety of
indications in adults. Copyright © 2016 The American Association
for Thoracic Surgery.

<61>
Accession Number
608905896
Author
Den Harder A.M.; De Heer L.M.; Meijer R.C.A.; Das M.; Krestin G.P.;
Maessen J.G.; Bogers A.J.J.C.; De Jong P.A.; Leiner T.; Budde R.P.J.
Institution
(Den Harder, De Jong, Leiner) Department of Radiology, University Medical
Center, P.O. Box 85000, Utrecht 3508 GA, Netherlands
(De Heer, Meijer) Department of Cardiothoracic Surgery, University Medical
Center, P.O. Box 85000, Utrecht 3508 GA, Netherlands
(Das) Department of Radiology, Maastricht University Medical Center,
Maastricht, P.O. Box 5800 6202 AZ, Netherlands
(Das) CARIM School for Cardiovascular Diseases, Maastricht University
Medical Center, Maastricht, P.O. Box 5800 6202 AZ, Netherlands
(Krestin, Budde) Department of Radiology, Erasmus Medical Center, P.O. Box
2040, Rotterdam 3000 CA, Netherlands
(Maessen) Department of Cardiothoracic Surgery, Maastricht University
Medical Center, Maastricht, P.O. Box 5800 6202 AZ, Netherlands
(Bogers) Department of Cardiothoracic Surgery, Erasmus Medical Center,
P.O. Box 2040, Rotterdam 3000 CA, Netherlands
Title
Effect of computed tomography before cardiac surgery on surgical strategy,
mortality and stroke.
Source
European Journal of Radiology. 85 (4) (pp 744-750), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Aim To investigate whether preoperative chest computed tomography (CT)
decreases postoperative mortality and stroke rate in cardiac surgery by
detection of calcifications and visualization of postoperative anatomy in
redo cardiac surgery which can be used to optimize the surgical approach.
Methods The PubMed, EMBASE and Cochrane databases were searched and
articles concerning preoperative CT in cardiac surgery were included.
Articles not reporting mortality, stroke rate or change in surgical
approach were excluded. Studies concerning primary cardiac surgery as well
as articles concerning redo cardiac surgery were both included. Results
Eighteen studies were included (n = 4057 patients) in which 2584 patients
received a preoperative CT. Seven articles (n = 1754 patients) concerned
primary surgery and eleven articles (n = 2303 patients) concerned redo
cardiac surgery. None of the studies was randomized but 8 studies provided
a comparison to a control group. Stroke rate decreased with 77-96%
(primary surgery) and 18-100% (redo surgery) in patients receiving a
preoperative CT. Mortality decreased up to 66% in studies investigating
primary surgery while the effect on mortality in redo surgery varied
widely. Change in surgical approach based on CT-findings consisted of
choosing a different cannulation site, opting for off-pump surgery and
cancellation of surgery. Conclusions Current evidence suggests that
preoperative CT imaging may lead to decreased stroke and mortality rate in
patients undergoing primary cardiac surgery by optimizing surgical
approach. In patients undergoing redo cardiac surgery stroke rate is also
decreased but the effect on mortality is unclear. However, evidence is
weak and included studies were of moderate quality. Copyright ©
2016 Elsevier Ireland Ltd. All rights reserved.

<62>
Accession Number
611544617
Author
Kokoska L.A.; Wilhelm S.M.; Garwood C.L.; Berlie H.D.
Institution
(Kokoska) United Physicians Inc., Bingham Farms, MI, United States
(Wilhelm, Garwood) Department of Pharmacy, Harper University Hospital,
Detroit Medical Center, Detroit, MI, United States
(Wilhelm, Garwood, Berlie) Department of Pharmacy Practice, Eugene
Applebaum College of Pharmacy and Health Sciences, Wayne State University,
Detroit, MI, United States
(Berlie) Health Centers of Detroit Medical Group, Detroit, MI, United
States
Title
Aspirin for primary prevention of cardiovascular disease in patients with
diabetes: A meta-analysis.
Source
Diabetes Research and Clinical Practice. 120 (pp 31-39), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Aims Aspirin use for primary prevention of cardiovascular disease (CVD) is
controversial, especially in patients with diabetes. The objective of this
meta-analysis was to evaluate aspirin's safety and efficacy for primary
prevention of CVD [fatal or nonfatal myocardial infarction (MI), fatal or
nonfatal stroke, angina, transient ischemic attack (TIA), peripheral
artery disease (PAD) and revascularization] in patients with diabetes.
Methods A literature search was conducted using the terms cardiovascular
disease, aspirin, diabetes mellitus to identify trials of patients with
diabetes who received aspirin for primary prevention of CVD. Study sample
size, and ischemic and bleeding events were extracted and analyzed using
RevMan 5.2.7. Results In total, 6 studies (n = 10,117) met criteria.
Aspirin doses ranged from 100 mg every other day to 650 mg daily.
Follow-up ranged from 3.6 to 10.1 years. In patients with diabetes, there
was no difference between aspirin and placebo with respect to the risk of
all cause mortality (OR 0.93, 95% CI 0.81-1.06), or individual
atherosclerotic events compared to placebo. There were no differences in
bleeding (OR 2.53, 95% CI 0.77-8.34), GI bleeding (OR 2.14, 95% CI
0.63-7.33) or hemorrhagic stroke rates (OR 0.90, 0.34-2.33) between
groups. Conclusions It remains unclear whether aspirin may reduce the
occurrence of a first atherosclerotic event or mortality in patients with
diabetes. More research on this use of aspirin in patients with diabetes
is required to supplement currently available research. Copyright
© 2016 Elsevier Ireland Ltd

<63>
Accession Number
610933806
Author
Mah D.Y.; Cheng H.; Alexander M.E.; Sleeper L.; Newburger J.W.; Del Nido
P.J.; Thiagarajan R.R.; Rajagopal S.K.
Institution
(Mah, Cheng, Alexander, Sleeper, Newburger, Thiagarajan, Rajagopal)
Department of Cardiology, Boston Children's Hospital, Harvard Medical
School, 300 Longwood Ave, Boston, MA 02115, United States
(Del Nido) Department of Cardiovascular Surgery, Boston Children's
Hospital, Harvard Medical School, Boston, MA, United States
Title
Heart block following stage 1 palliation of hypoplastic left heart
syndrome.
Source
Journal of Thoracic and Cardiovascular Surgery. 152 (1) (pp 189-194),
2016. Date of Publication: 01 Jul 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives Publicly available data from the Pediatric Heart Network's
Single Ventricle Reconstruction Trial was analyzed to determine the
prevalence, timing, risk factors for, and impact of second- and
third-degree heart block (HB) on outcomes in patients who underwent stage
1 palliation (S1P) for hypoplastic left heart syndrome (HLHS). Methods The
presence and date of onset of post-S1P HB occurring within the first year
of life, potential risk factors for HB, and factors known to predict poor
outcomes after S1P were extracted. Multivariable logistic and Cox
regression analyses were performed to identify risk factors for HB and to
determine the effect of HB on 3-year transplantation-free survival.
Results Among the 549 patients in the cohort, 33 (6%) developed HB after
S1P. The median interval between S1P and HB was 8 days (interquartile
range, 0-133 days). Regression analysis showed that tricuspid valve repair
during S1P and obstruction of pulmonary venous drainage requiring pre-S1P
intervention were independently associated with HB (adjusted odds ratio
[aOR], 11.6, 95% confidence interval [CI] 3.3-40; P <.001 and aOR, 5.1;
95% CI, 1.3-20.6; P =.02, respectively). Transplantation-free survival at
3 years was lower for those with HB (39% vs 65%; P =.004). HB remained
associated with transplantation-free survival after controlling for known
risk factors (adjusted hazard ratio, 3.1; 95% CI, 1.9-5.0; P <.001). Nine
children (27%) had a pacemaker implanted, and 7 of these children (78%)
died or underwent heart transplantation. Conclusions HB after S1P is rare
but heralds a poor outcome. Careful monitoring of these patients is
recommended given their significantly increased risks of death and heart
transplantation. Copyright © 2016 The American Association for
Thoracic Surgery.

<64>
Accession Number
363072980
Author
Sepehripour A.H.; Jarral O.A.; Shipolini A.R.; McCormack D.J.
Institution
(Sepehripour) Department of Cardiothoracic Surgery, Wythenshawe Hospital,
Southmoor Road, Manchester M23 9LT, United Kingdom
(Jarral, Shipolini, McCormack) Department of Cardiothoracic Surgery, The
London Chest Hospital, Bonner Road, London E2 9JX, United Kingdom
Title
Does a 'no-touch' technique result in better vein patency?.
Source
Interactive Cardiovascular and Thoracic Surgery. 13 (6) (pp 626-630),
2011. Date of Publication: December 2011.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic was written according to a structured protocol. The
question addressed was whether harvesting the saphenous vein (SV) as a
conduit for coronary artery bypass grafting (CABG) using a no-touch
technique would result in better patency rates. This technique involves
the harvest of the SV with a pedicle of peri-vascular tissue left intact
and the avoidance of distension of the vein prior to anastomosis. A total
of 405 papers were found using the reported searches of which eight
represented the best evidence to answer the clinical question. The
authors, date, journal, study type, population, main outcome measures and
results are tabulated. The studies found analysed the ultrastructural and
mechanical properties of the endothelium and vessel walls of the two
harvesting techniques; the protein and enzymatic expression and activity
observed; the early atherosclerotic changes detected; and the overall
patency of the grafts during short-and long-term angiographical follow-up.
Three small prospectively randomised studies compared the patency of
grafts harvested using the two techniques and found significant
improvements in graft patency using the no-touch harvesting technique in
comparison to both the conventional technique and more importantly
comparable to the left internal thoracic artery (LITA) patency. The most
favourable difference was that of graft patency after 8.5 years of
follow-up [90% vs. 76% (P=0.01), LITA patency 90%], and incidence of graft
stenosis [11% vs. 25% (P=0.006)]. These findings were supported by the
demonstrated improvements in the cellular integrity of the vessels and the
reduction in the mechanisms leading to graft failure seen in the no-touch
harvested SV grafts. These morphological and cellular analyses were
carried by five small comparative studies, demonstrating improved
endothelial integrity and reduced injury, decelerated atherosclerotic
processes, intact adventitial collagen layers, increase in the total area
of vasa vasorum, elevated endothelial nitric oxide synthase expression and
activity, and increased peri-vascular leptin levels and activity. We
conclude that there are clear enhancements in vessel wall properties at a
cellular level and angiographical evidence of superior graft patency when
the no-touch SV harvesting technique is employed. © 2011 Published by
European Association for Cardio-Thoracic Surgery. All rights reserved.

<65>
Accession Number
613143233
Author
Ladia V.; Panchal H.B.; O'Neil T.J.; Sitwala P.; Bhatheja S.; Patel R.;
Ramu V.; Mukherjee D.; Mahmud E.; Paul T.K.
Institution
(Ladia, Panchal, Sitwala, Bhatheja, Patel, Ramu, Paul) Department of
Internal Medicine, East Tennessee State University, Johnson City,
Tennessee
(O'Neil) Department of Internal Medicine, Mountain Home VA Medical Center,
Johnson City, Tennessee
(Mukherjee) Division of Cardiology, Department of Internal Medicine, Texas
Tech University, El Paso, Texas
(Mahmud) Division of Cardiovascular Medicine, Department of Internal
Medicine, University of California, San Diego, California
Title
Incidence of Renal Failure Requiring Hemodialysis Following TAVR: A
Meta-Analysis of Transfemoral Versus Transapical Approach.
Source
American Journal of the Medical Sciences. (no pagination), 2016. Date of
Publication: October 23, 2015.
Publisher
Elsevier B.V. (E-mail: kathiest.clai@apta.org)
Abstract
Objective: Studies have shown that iodinated radiocontrast use is
associated with acute renal failure especially in the presence of chronic
kidney disease, and multiple factors modulate this risk. The purpose of
this meta-analysis is to compare incidence of renal failure requiring
hemodialysis between transfemoral (TF) and transcatheter aortic valve
replacement (TA-TAVR) using the Edwards valve. Methods: The PubMed
database was searched from January 2000 through December 2014. A total of
10 studies (n = 2,459) comparing TF (n = 1,268) and TA (n = 1,191) TAVR
procedures using the Edwards valve were included. Variables of interest
were baseline logistic EuroSCORE, prevalence of diabetes mellitus,
hypertension, peripheral arterial disease, chronic kidney disease and
amount of contrast used. The primary endpoint was incidence of renal
failure requiring hemodialysis. The odds ratio and 95% CI were computed
and . P < 0.05 was considered as the level of significance. Results: The
LES was significantly higher in TA compared to TF (P = 0.001) TAVR. The
amount of contrast (mL) used was significantly higher in TF group compared
to the TA group (mean difference: 36.9, CI: 25.7-48.1, . P < 0.001). The
incidence of hemodialysis following the procedure was significantly higher
in the TA group compared to TF group (odds ratio = 4.3, CI: 2.4-7.8, . P <
0.00001). Conclusions: This meta-analysis suggests that despite the lower
amount of contrast used in TA-TAVR, the incidence of renal failure
requiring hemodialysis was higher with the Edwards valve. This suggests
that the incidence of renal failure requiring hemodialysis after TAVR is
associated with baseline comorbidities in the TA-TAVR group rather than
the volume of contrast used. Copyright © 2016 Southern Society
for Clinical Investigation.

<66>
Accession Number
616269887
Author
Radi B.; Rossimarina V.; Hanafy D.A.
Institution
(Radi, Rossimarina, Hanafy) Department of Cardiology and Vascular
Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Title
Effect of short term respiratory training to pulmonary function and
functional capacity improvement in post coronary artery bypass graft
surgery patients who underwent cardiac rehabilitation program.
Source
European Journal of Preventive Cardiology. Conference: EuroPRevent 2017.
Spain. 24 (1 Supplement 1) (pp S151), 2017. Date of Publication: April
2017.
Publisher
SAGE Publications Inc.
Abstract
Background: Patients undergoing coronary artery bypass graft (CABG)
surgery develop pulmonary dysfunction due respiratory muscle weakness. No
data of adjuctive effects of short term respiratory training related to
improvent of pulmonary function and functional capacity. Objectives: To
study the effects of short term respiratory training in phase 2 cardiac
rehabilitation program after CABG in improving pulmonary function which
was measured by maximum inspiratory volume (MIV) and functional capacity
was measured by 6 minutes walk test (6MWT) distance. Methods: It is a
randomized controled trial which recruited patients after CABG surgery
into intervention group (IG) or control group (CG). The IG received 10-12
sessions early respiratory training (30 minutes per session) with up to
60% MIV as an adjuvant to the standard exercise program. MIV and 6MWT
distance were evaluated before and after the program. Result: Forty five
patients were recruited which were 22 in IG and 23 in CG. Both groups had
similar characteristic and showed improvement in MIV (IG: from
1590.9+440.1 to 2761.4 + 924,1 mL, p<0,01; CG: from 1334.8+647.1 to
1945.7+612.2 mL, p<0.01) and in 6MWT distance (IG: from 346.5+51.3 to
417.4+42,6 meters, p<0.01; CG: from 326.5+64.7 to 385.9+58.1 meters,
p<0.01). The improvement of MIV in IG was higher than in CG (1170.5+850 mL
vs 610.4 + 492.9 mL, p=0.011), but not in 6MWT ( 71+52.1 meters in IG and
59.4+54 meters in CG, p=0.47) Conclusion: Short term respiratory training
gave adjuctive effects to pulmonary function in phase 2 cardiac
rehabilitation program, but not to 6MWT distance.

<67>
Accession Number
616269870
Author
Eichler S.; Salzwedel A.; Harnath A.; Nothroff J.; Butter C.; Schikora M.;
Chiorean M.; Voller H.
Institution
(Eichler, Salzwedel, Voller) Center of Rehabilitation Research, University
of Potsdam, Potsdam, Germany
(Harnath) Sana Heart Center Cottbus, Cottbus, Germany
(Nothroff) MediClin Reha-Zentrum Spreewald, Burg, Germany
(Butter) Brandenburg Heart Center, Bernau bei Berlin, Germany
(Schikora) Brandenburg Klinik, Bernau bei Berlin, Germany
(Chiorean) Clinic Am See, Klinik Am See, Rudersdorf, Germany
Title
Frailty as a predictor for all-cause mortality in patients 12 months after
transcatheter aortic valve implantation (TAVI).
Source
European Journal of Preventive Cardiology. Conference: EuroPRevent 2017.
Spain. 24 (1 Supplement 1) (pp S150), 2017. Date of Publication: April
2017.
Publisher
SAGE Publications Inc.
Abstract
Purpose: For more than a decade, transcatheter aortic valve implantation
(TAVI) has become a promising treatment modality for patients with severe
aortic stenosis. As the procedure enlarges from high-risk to lower-risk
patients, the amount of patients in cardiac rehabilitation (CR) is rapidly
growing. Up to now, there are no sufficient data about frailty and its
possible predictive value of mortality. Therefore, we aimed to evaluate
pre-interventional predictors for all-cause mortality in patients after
TAVI with a 12-month follow up. Methods: From 10/2013 to 07/2015, 344
patients with an elective TAVI were consecutively enrolled in the
prospective multicentre cohort study, whereby 333 patients (80.1 +/- 5.1
years, 44.1%male) survived the procedure. Pre-interventionally, we
documented sociodemographic, laboratory and echocardiographic parameters
as well as comorbidities. Additionally, function by 6-minute walk test,
quality of life by SF-12 and a Frailty Index (a score consisting of
Activities of Daily Living, Instrumental Activities of Daily Living, Mini
Mental State Exam [MMSE], Mini Nutritional Assessment [MNA], Timed Up and
Go, and a subjective preclinical mobility disability) were performed.
Predictors for all-cause mortality were identified using a multivariate
regression model. Results: During a follow up of 381.0 +/- 41.9 days, 46
patients (13.8%) died. The non-survivors were older (82.3 +/- 5.0 vs. 80.6
+/- 5.1 years; p = 0.035), had a higher number of comorbidities (2.6 +/-
1.4 vs. 2.1 +/- 1.3; p = 0.026) as well as a lower left ventricular
ejection fraction (51.0 +/- 13.6 vs. 54.6 +/- 10.6; p = 0.048) and
additionally, more of the non-survivors suffered from diabetes mellitus
(60.9 % vs. 44.6 %; p = 0.040). The Frailty-Index does not seem to be a
predictor for all-cause mortality itself, but its single components such
as MNA (OR 0.69, CI 0.70 - 0.95; p = 0.009) and MMSE (OR 0.77, CI 0.76 -
0.99; p = 0.030) show a predictive value. Furthermore, the physical
component scale of SF-12 (OR = 0.90, CI 0.90 - 1.00; p = 0.031) as well as
clinical parameters such as diabetes mellitus (OR 1.11, CI 1.11 - 5.29; p
= 0.026) and EuroScore (OR 1.01, CI 1.01 - 1.08; p = 0.006) could be
identified as predictors. Conclusions: The results of the underlying
analysis provide information about pre-interventional parameters being
predictive for one-year all-cause mortality in patients after TAVI.
Frailty as a whole still seems to be difficult to capture. Thus, beside
clinical parameters and quality of life, single dimensions of frailty,
such as cognitive function and nutrition status, should be considered in
the decision of possible therapies and aftercare programs in high-risk
patients with severe aortic stenosis.

<68>
Accession Number
616269845
Author
Giuseppe Caminiti G.; Battaglia D.; Selli S.; Fortuna D.; Sansonetti S.;
D'Antoni V.
Institution
(Giuseppe Caminiti, Battaglia, Selli, Fortuna, Sansonetti, D'Antoni) IRCCS
San Raffaele Pisana Hospital, Rome, Italy
Title
Ventilatory response and right ventricular dysfunction during submaxymal
exercise in elderly patients undergoing cardiac rehabilitation early after
cardiac surgery: Effects of ventilatory muscle train.
Source
European Journal of Preventive Cardiology. Conference: EuroPRevent 2017.
Spain. 24 (1 Supplement 1) (pp S149-S150), 2017. Date of Publication:
April 2017.
Publisher
SAGE Publications Inc.
Abstract
Background Patients with recent cardiac surgery often experience impaired
ventilatory response to exercise and right ventricular dysfunction (RVD)
Study Aim: to evaluate if the addition of respiratory muscle training
(RMT) to aerobic training (AT) improves ventilatory response and RVD to a
greater extent than AT alone in patients undergoing intensive phase of
cardiac rehabilitation Methods: we enrolled 27 patients, age 74 y,
male/female 20/7, with recent cardiac surgery admitted to our
Rehabilitative department. All subjects performed a six minute walking
test with assessment of cardiopulmonary parameters at baseline and after 3
weeks. They were randomly divided into to groups: 1) combined training
group CT (11 pts), performing one hour of AT and one hour of RMT daily; 2)
AT group ( 16 pts) performing two hours of AT daily Results: At 3 weeks,
distance walked at 6MWT increased significantly in both groups compared to
baseline (CT=225+/-48m p=0.0001; AT= 212+/-61 m; p=0.0001) without
intergroups differences. VO2, at steady state phase of 6MWT, increased
significantly in both groups compared to baseline (CT=2.9+/-0.3m p=0.0001;
AT= 3.1+/-0.6 ml/kg/min; p=0.0001) without intergroups differences.
VE/VCO2 decreased significantly in the combined group(-4.3+/-1.9; p=0.007)
compared to baseline, while there was a mild no significant decrease in
the AT group (p=0.13). There was a significant greater decrease of VE/VCO2
in favour of the CT group (intergroups difference 24.7%+/-6.3; p=0.002).
TAPSE increased in both groups compared to baseline; with a significant
greater increase of TAPSE in the CT compared to AT (19.1%; p=0.009) Right
ventricle A wave increased significantly in both group compared to
baseline with a greater significant increase in the CT compared to AT
(31.0%+/-12; p=0.0005). The increase of TAPSE was significantly related to
thwe decrease of VE/VCO2 (r= 0.39; p=0.002). Conclusion: The addiction of
RMT to AT during an intensive phase of cardiac rehabilitation improved
ventilatory response and right ventricular function leading to a more
cost/effective exercise in post-cardiac surgery patients.

<69>
Accession Number
616269833
Author
Beatrix Bodone Rafael B.; Simon A.; Kovacs P.; Balog P.
Institution
(Beatrix Bodone Rafael) Deszk Hospital of Chest Disease, Deszk, Hungary
(Simon) State Hospital for Cardiology, Balatonfured, Hungary
(Kovacs) Faculty of Economic Sciences, University of Szeged, Szeged,
Hungary
(Balog) Institute of Behavioral Sciences, Semmelweis University Faculty of
Medicine, Budapest, Hungary
Title
Vital exhaustion predicts the progression of myocardial infarction, a
2-year followup study.
Source
European Journal of Preventive Cardiology. Conference: EuroPRevent 2017.
Spain. 24 (1 Supplement 1) (pp S149), 2017. Date of Publication: April
2017.
Publisher
SAGE Publications Inc.
Abstract
Background:There is growing evidence that besides important behavioural
and somatic factors psychological factors influence the development and
prognosis of myocardial infarction (MI). Some researchers suggest that
mortality and other long-term consequences of MI might be predicted by
psychological conditions during hospitalization. Purpose: We proposed to
examine psychological risk factors (depression, anxiety, vital exhaustion,
sleep disturbances) and somatic factors (left ventricular ejection
fraction, Metabolic Equivalents /METs/ achieved during exercise test,
number of diseased vessels, diabetes) in patients who were admitted to
phase II residential cardiac rehabilitation programme following an acute
myocardial infarction. Our aims were to determine the impact of above
mentioned psychological risk factors and somatic factors on the occurrence
of new cardiac events and mortality after two years following MI. Methods:
In patients (N=142, 99 men, mean age: 56.34+ 10.15 years) the level of
depression (Beck Depression Inventory), anxiety (Spielberger State-Trate
Anxiety Inventory), vital exhaustion (Maastricht Vital Exhaustion
Questionnaire) and sleep disturbances (Athens Insomnia Scale) were
assessed during the hospitalization after MI. Left ventricular ejection
fraction, Metabolic Equivalents (METs), number of diseased vessels and
diabetes were retrieved from medical records. The main outcomes were
hospitalization because of cardiac event (angina pectoris, arrhythmia,
myocardial infarction, percutaneous coronary angioplasty, bypass surgery,
survived cardiac arrest) and all-cause mortality during two years.
Results: During two-year follow-up 19 patients died (14 because of
cardiovascular causes) and 30 patients had (once or twice) new cardiac
events. The level of depression (t=-3.22, p=0.002), vital exhaustion
(t=-3.56, p=0,001) and sleep disturbances (t=-3.72, p<0,001) at baseline
were higher in patients who had a new cardiac event or died during the
two-year follow-up. Cox proportional hazards modelling showed that from
the psychological and somatic factors only vital exhaustion (hazard ratio
/HR/=2.76, 95% confidence interval / CI/=1.49-4.93) and Metabolic
Equivalents (HR=0,72, 95% CI=0,60-0,86) were predictive of mortality and
the occurrence of new cardiac event adjustment for demographic factors
(sex, age, marital status). Kaplan-Meier analysis and log-rank test showed
a significant effect of baseline vital exhaustion on mortality (log rank
test=17.63, p<0.001). Conclusion: Psychological factors particularly vital
exhaustion, play an important part in determining disease outcomes in
patients with myocardial infarction. High level of vital exhaustion and
low level of exercise capacity (METs) at baseline predicted progression of
MI (relapses/mortality) during the two-year follow-up. Therefore, it is
essential to evaluate the mental and physical status of patients admitted
for cardiac rehabilitation and initiate adequate therapy.

<70>
Accession Number
616269816
Author
Yulia Argunova Y.; Trubnikova O.A.; Kagan E.S.; Barbarash O.L.
Institution
(Yulia Argunova, Trubnikova, Barbarash) Research Institute for Complex
Issues of Cardiovascular Diseases, Kemerovo, Russian Federation
(Kagan) Federal State Budgetary Educational Institution of Higher
Education, Kemerovo State University, Kemerovo, Russian Federation
Title
Cerebroprotective effects of physical training in patients undergoing
coronary artery bypass grafting.
Source
European Journal of Preventive Cardiology. Conference: EuroPRevent 2017.
Spain. 24 (1 Supplement 1) (pp S149), 2017. Date of Publication: April
2017.
Publisher
SAGE Publications Inc.
Abstract
Purpose: To evaluate the impact of different rehabilitation programs on
neuropsychological status and the likelihood of developing early
postoperative cognitive dysfunction (POCD), in coronary artery disease
(CAD) patients undergoing on-pump coronary artery bypass grafting (CABG).
Methods: 113 male patients with stable CAD who have undergone on-pump CABG
were included in the study. Patients were randomly assigned to receive
different in-hospital rehabilitation programs. Group 1 patients (n=38, the
mean age 56.6 +/- 5.5 years) underwent a two-phase cardiac rehabilitation
program consisting of exercise training (phase 1, inpatient) and
supervised cycling training (phase 2, inpatient). Group 2 patients (n=22,
the mean age 55.2 +/- 4.6 years) received exercise training in both
phases, but without supervised cycling. Group 3 patients (n=53, the mean
age 57.2 +/- 6.2 years) underwent traditional phase 1 cardiac
rehabilitation. Phase 2 included additional inpatient supervised cycling
training beginning 14 days postoperatively and lasting for 3 weeks (5-6
trainings per week). Neuropsychological assessment was performed using the
automated software complex <<Status PF>> at days 5-7 before CABG, at days
7-10 and 1 month after it. The following parameters were assessed: complex
visual-motor reaction time (CVMR), functional mobility of nervous
processes (FMNP), brain performance (BP); attention (Burdon's attention
test); and short-term memory. The presence of POCD was estimated on the
basis of criteria defined as a 20% decline on 20% of the tests. Results:
All patients were comparable in clinical, neuropsychological indicators
and demographic data as well as in intraoperative parameters and in the
incidence of postoperative complications. One month after CABG, Group 1
patients showed faster reaction time while completing CVMR tests (p=0.04)
and FMNP tests (p=0.04) compared to those in Group 3 patients. Patients in
Group 1 spent less time completing FMNP tests, compared to patients in
Group 3 (p=0.001) and Group 2 (p=0.04). Moreover, patients in Group 1
demonstrated lower rate of missed target signals while completing FMNP
tests (p=0.04) and BP tests (p=0.002), compared to Group 3 patients. Group
1 patients processed more signs during the Bourdon's test (p=0.04) and had
less mistakes (p=0.01) compared to Group 3 patients. One month after CABG,
patients in Group 1 had significantly lower incidence of early POCD (21.1%
of cases), compared to Group 2 (45.5% of cases, p =0.028) and Group 3
(52.8% of cases, p=0.0017). Regression analysis suggested phase 2 physical
training, being a part of the in-hospital rehabilitation program, to be a
protective factor against the development of POCD 1 month after CABG (B =
-2,848, Sig = 0,007). Conclusion: The 3-week supervised cycling training
included in the in-hospital rehabilitation program effectively prevents
the development of early POCD 1 month after CABG by improving neurodynamic
performance and attention.

<71>
Accession Number
616269749
Author
Abdul Halim Raynaldo A.H.; Basuni Radi B.R.; Ambari A.M.; Anwar Santoso
A.S.; Budhi Setianto B.S.
Institution
(Abdul Halim Raynaldo) University of Sumatera Utara, Cardiology, Medan,
Indonesia
(Basuni Radi, Ambari, Anwar Santoso, Budhi Setianto) Harapan Kita
Hospital, Cardiology, Jakarta, Indonesia
Title
Comparation between functional capacity and exercise results in patients
who underwent phase ii cardiac rehabilitation program after coronary
artery bypass graft surgery and valve surgery at national.
Source
European Journal of Preventive Cardiology. Conference: EuroPRevent 2017.
Spain. 24 (1 Supplement 1) (pp S103), 2017. Date of Publication: April
2017.
Publisher
SAGE Publications Inc.
Abstract
Introduction: Coronary artery bypass grafting (CABG) is one of effective
and established treatments for clinically significant coronary artery
disease (CAD). Meanwhile, surgery is still the most established treatment
in valvular heart disease. The functional capacity of the patients who
underwent CABG and valve surgery is still one of most important thing to
predict outcome after surgery. We have evaluated the functional capacity
those patients with 6 minute walk test (6MWT) pre discharge. Background:
The objective of this study was evaluated and compare between functional
capacity and exercise results in post CABG surgery and valvular surgery
patients. Methods: 243 patients post CABG surgery and 75 patients post
valvular surgery sent to our rehabilitation unit in National
Cardiovascular Centre, to attend functional capacity pre test discharge,
from December 2014 until May 2015. This study was retrospective
descriptive. We analyzed the distance of 6MWT, and left ventricle ejection
fraction. Then, we categorized our sample in two group each type of
surgery procedure. The patient with LVEF <= 40% ( n=45 ) and patients with
LVEF >= 40% (n = 198) in post CABG surgery. In patients with valvular
surgery LVEF <= 40%( n= 20) and LVEF >= 40% (n = 55). Results: All of the
243 patients post CABG surgery, the mean age was 58.27 +/- 7.844 years old
(35 - 80), the mean of LVEF was 52.33 +/- 14.566%, the 6MWT distance
average 249.44 +/-69.589 meters (60-485). In post valvular surgery, the
mean age was 34.28 +/- 5.847 years old ( 24 - 43), the mean of LVEF was
54.35 +/- 6.738 %, the distance average 290.59 +/- 53.765 meters. Patients
with good ejection fraction in post valvular surgery could have increased
of functional capacity and distance. Conclusion: Aerobic functional
capacity patients was higher in patients post valvular surgery with high
ejection fraction.

<72>
Accession Number
616269652
Author
Stein R.S.; Zanini M.Z.; Raquel Petry Buhler R.P.B.; Lima J.B.L.; Silveira
A.D.S.; Nery R.M.N.
Institution
(Stein, Zanini, Raquel Petry Buhler, Lima, Silveira, Nery) Hospital de
Clinicas de Porto Alegre, Porto Alegre, Brazil
Title
Effects of different physical therapy protocols in phase-1 cardiac
rehabilitation after coronary artery bypass graft surgery: A randomized
clinical trial.
Source
European Journal of Preventive Cardiology. Conference: EuroPRevent 2017.
Spain. 24 (1 Supplement 1) (pp S40), 2017. Date of Publication: April
2017.
Publisher
SAGE Publications Inc.
Abstract
Background: Patients undergoing coronary artery bypass graft (CABG)
surgery typically experience loss of cardiopulmonary capacity in the
postoperative period. Purpose: To evaluate the effects of different
physical therapy protocols used in phase-1 cardiac rehabilitation (P1CR)
on functional capacity and pulmonary function in patients status post
CABG. Methods: This was a single-blind randomized controlled trial.
Functional capacity, lung capacity, and respiratory muscle function were
assessed in patients scheduled to undergo CABG. After surgery, patients
were randomly assigned across four P1CR groups: G1, inspiratory muscle
training (IMT), active upper-limb and lower-limb exercise training, and
early ambulation; G2, same protocol as G1 without IMT; G3, IMT alone; and
G4, control. All groups received chest physical therapy (CPT) and
expiratory positive airway pressure (EPAP). Patients were reassessed on
postoperative day 6 and post-discharge day 30 (including cardiopulmonary
exercise testing). Results: Forty patients were included (n=10/group). The
6-minute walk distance on postoperative day 6 was as follows: G1,
365+/-23; G2, 401+/-20; G3, 275+/-23; G4, 291+/-22 meters. On
postdischarge day 30: G1, 531+/-23; G2, 531+/-16; G3, 471+/-14; G4,
433+/-14 meters (p<0.001). Peak oxygen uptake on day 30: G1, 21.4+/-3.1;
G2, 21.4+/-2.8; G3, 17.6+/-3.2; G4, 17.3+/-3.2 mL.Kg- 1.min-1 (P=0.005).
All achieved similar recovery of lung function at these time points.
Conclusion: Protocols G1 and G2 were more effective at improving
functional capacity before hospital discharge and at 30 days
post-discharge. However, CPT and EPAP appear to be sufficient to restore
pulmonary function in this phase.

<73>
Accession Number
616269499
Author
Anonymous
Title
Abstract Book EuroPRevent 2017.
Source
European Journal of Preventive Cardiology. Conference: EuroPRevent 2017.
Spain. 24 (1 Supplement 1) (no pagination), 2017. Date of Publication:
April 2017.
Publisher
SAGE Publications Inc.
Abstract
The proceedings contain 558 papers. The topics discussed include:
Comparison of 3 electrocardiographic criteria for the detection of cardiac
abnormalities in South-East Asian athletes; Internet-based combined
exercise training in the management of type 2 diabetes; evaluation of a
novel method to assess blood volume changes in skeletal muscle during
exercise: power Doppler ultrasound; the dynamic of physical capacity in
heart transplanted patients; prevalence and influence of obesity and
hypertension on arterial stiffness in Swiss primary school children: the
ExAMIN youth study; resistance training decreases PCSK9 levels in patients
who undergo phase II cardiac rehabilitation after coronary artery bypass
grafting: a randomized study; and heart rate kinetics during standard
cardiopulmonary exercise testing in heart transplant recipients: a
cross-sectional and longitudinal observational single centre study.

<74>
Accession Number
616269491
Author
Hoejskov I.; Moons P.; Hansen N.V.; La Cour S.; Gluud C.; Winkel P.;
Lindschou J.; Thygesen L.C.; Egerod I.; Berg S.K.
Institution
(Hoejskov, Berg) Department of Cardiothoracic Surgery, Heart Centre,
Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
(Moons) Catholic University of Leuven, Center for Health Services and
Nursing Research, Leuven, Belgium
(Hansen) Interacting Minds Center, Aarhus University, Aarhus, Denmark
(La Cour) Centre for Research in Existence and Society, University of
Copenhagen, Copenhagen, Denmark
(Gluud, Winkel, Lindschou) Copenhagen Trial Unit, Rigshospitalet
Copenhagen University, Rigshospitalet Copenhagen Universityw, Copenhagen,
Denmark
(Thygesen) National Institute of Public Health, University of Southern
Denmark, Odense, Denmark
(Egerod) Rigshospitalet, Trauma Centre, HOC, Copenhagen, Denmark
Title
Early rehabilitation after coronary artery bypass grafting - Results from
the SheppHeartCABG trial.
Source
European Journal of Preventive Cardiology. Conference: EuroPRevent 2017.
Spain. 24 (1 Supplement 1) (pp S98), 2017. Date of Publication: April
2017.
Publisher
SAGE Publications Inc.
Abstract
Background: In phase one rehabilitation after coronary artery bypass
grafting patients often experience pain, fatigue, and low physical
activity. In addition, anxiety and depressive symptoms are common.
Purpose: The purpose was to evaluate the effect of a comprehensive 4-week
rehabilitation programme during hospitalisation and after discharge versus
usual care. Methods: Patients were randomised 1:1. The primary outcome was
physical function measured by the 6-minute walk test. The secondary
outcomes were; mental health physical activity, anxiety, depression,
quality of life, sleep, pain, and the sit-to-stand test. Patients
allocated to the experimental intervention followed a 4-week
rehabilitation programme. Results: We randomised 326 participants, of whom
11 dropped out. There was a mean age of 65 years and 87% were male. There
were no significant differences between the two groups after 4 weeks
measured by the 6-minute walk test. The secondary outcomes showed no
difference between the groups, except for a potential difference in favour
of the experimental intervention was detected on HADS-D (Table 1).
Conclusions: There was no significant difference between the two groups on
physical function, pain, sleep, quality of life, and anxiety, which could
be due to the short intervention period. The experimental intervention
might have had a beneficial effect on depressive symptoms. However, this
is a secondary outcome and should be interpreted with caution. [TABLE
PRESENTED].

<75>
Accession Number
616269456
Author
Dwiputra B.; Santoso A.; Purwowiyoto B.S.; Radi B.; Ambari A.M.
Institution
(Dwiputra, Santoso, Purwowiyoto, Radi, Ambari) Department of Cardiology
and Vascular Medicine, Faculty of Medicine, Universitas Indonesia,
Jakarta, Indonesia
Title
Resistance training decreases PCSK9 levels in patients who undergo phase
II cardiac rehabilitation after coronary artery bypass grafting: A
randomized study.
Source
European Journal of Preventive Cardiology. Conference: EuroPRevent 2017.
Spain. 24 (1 Supplement 1) (pp S3), 2017. Date of Publication: April 2017.
Publisher
SAGE Publications Inc.
Abstract
Backgorund: As a part of secondary prevention during cardiac
rehabilitation, resistance training is recommended to post-coronary artery
bypass grafting (CABG) patients in addition to aerobic training component.
Its safety and benefit to endurance and muscle strength have been
established. However, there is a lack of studies that investigate the
impact of resistance training on cardiovascular biomarker, particularly
proprotein convertase subtilisin kexin 9 (PCSK9). PCSK9 itself has been
promising since inhibition of this molecule is proved to reduce low
density lipoprotein cholesterol (LDL-C) levels which thus lower
cardiovascular risk as well. Purpose: This study was designed to assess
the impact of intensive resistance training on PCSK9 level among post-CABG
patients who undergo phase II cardiac rehabilitation. Methods: In this
randomized, prospective, open-label trial, 87 post-CABG patients were
randomly assigned to phase II cardiac rehabilitation programs that consist
of moderate to high intensity resistance training and aerobic training
(intervention group, 44 patients) and aerobic training only (control
group, 43 patients) for 3-4 weeks. The resistance training consists of
three incrimental stages of free weight training that involve upper and
lower extremities. The primary endpoint was the change of PCSK9 levels
after cardiac rehabilitation program. Secondary endpoints included the
change of 6-minute walk test result, aerobic capacity, WHO-5 well-being
index, fasting blood glucose and lipid profile. Intention to treat
analysis was performed in both groups. Results: After completion of phase
II cardiac rehabilitation, mean PCSK9 levels in intervention group
decrease significantly compared to control group (intervention vs control;
407.0 to 322.5 vs 382.4 to 377.5 ng/ml, beta=-55 ng/ml, 95%CI -6.7 to
-103.3, p=0.026). This reduction was followed by significant improvement
of 6-minute walk test result (288.3 to 388.9 vs 285.5 to 360.7 meters,
beta=28.2 m, 95%CI 2.4 to 53.9, p=0.033), aerobic capacity (b=0.9 Mets,
95%CI 0.1 to 1.7, p=0.021), and WHO-5 well-being index (beta=8.1, 95%CI
2.0 to 14.4, p=0.011) in patients who received resistance training.
Nonetheless, there are still no significant changes in terms of fasting
blood glucose, total cholesterol, LDL-C, high density lipoprotein
cholesterol (HDL-C) and triglyseride levels pre- and post-intervention
between two groups. Conclusion: The addition of resistance training to
aerobic training component in phase II cardiac rehabilitation
significantly reduces PCSK-9 levels at the end of phase II cardiac
rehabilitation. This biological finding is associated with the improvement
of patients' functional capacity and quality of life. Altough it is not
statistically significant yet, we predict that this reduced PCSK9 levels
may lead to more advance LDL-C reduction in the longer period of
intervention.

<76>
Accession Number
616269450
Author
Argunova Y.; Trubnikova O.A.; Pomeshkina S.A.; Barbarash O.L.
Institution
(Argunova, Trubnikova, Pomeshkina, Barbarash) Research Institute for
Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation
Title
Adherence to non-pharmacological therapy in patients after coronary artery
bypass grafting following different cardiac rehabilitation programs.
Source
European Journal of Preventive Cardiology. Conference: EuroPRevent 2017.
Spain. 24 (1 Supplement 1) (pp S36), 2017. Date of Publication: April
2017.
Publisher
SAGE Publications Inc.
Abstract
Purpose: To evaluate the effects of a three-week cycling training
integrated in an in-hospital cardiac rehabilitation on adherence to
non-pharmacological therapy in patients with coronary artery disease (CAD)
who have undergone on-pump coronary artery bypass grafting (CABG).
Methods: 113male patients with stableCADwho have undergone on-pump
CABGwere included in the study. Patients were enrolled into 3 groups
according to the cardiac rehabilitation program. Group 1 patients (n=38,
the mean age 56.6 +/- 5.5 years) underwent a two-phase cardiac
rehabilitation consisting of exercise training (phase 1, inpatient) and
supervised cycling training (phase 2, inpatient). Group 2 patients (n=22,
the mean age 55.2 +/- 4.6 years) received exercise training in both
phases, but without supervised cycling. Group 3 patients (n=53, the mean
age 57.2 +/- 6.2 years) underwent traditional phase 1 cardiac
rehabilitation. Phase 2 included additional inpatient supervised cycling
beginning 14 days postoperatively and lasting for 3weeks (5 trainings per
week). Changes in target levels of lipid metabolism (total cholesterol
(TC), low density lipoprotein cholesterol (LDL-C), high density
lipoprotein cholesterol (HDL-C)), blood pressure (BP), and heart rate (HR)
were used to measure patients' adherence to treatment. In addition,
smoking cessation and weight loss were also taken into account. All
above-mentioned parameters were evaluated prior toCABGand 1 year after
surgery. The statistical analysis was conducted using Statistica 8.0.
Results:All patients were comparable in clinical and demographic data as
well as in intraoperative parameters and the incidence of postoperative
complications. Body mass index (BMI) and smoking status did not differ
significantly in patients prior to CABG, and 1 year after surgery. The
number of patients who had achieved target BP values significantly
increased compared to the preoperative period. Thus, it increased by 46%in
Group 1 (p=0.001), by 45.7%- in Group 2 (p =0.02), by 40.6%- inGroup 3
(p=0.002). Over 1 year after CABG, total cholesterol decreased compared to
preoperative values (Group 1 - p=0.001; Group 2 - p=0.01; Group 3 -
p=0.03). Thus, a significant reduction in LDL-C was found only in Group 1
patients compared to preoperative values (p=0.001). The number of patients
who had achieved target LDL-C levels one year afterCABGincreased in all
groups (Group 1 - p<0.0001;Group 2 - p=0.03;Group 3 - p= 0.01). However,
the number of patients who had achieved target LDL-C levels one year after
CABG was significantly higher in Group 1 compared to Group 3 (p = 0.02).
Conclusion: The two-phase in-hospital cardiac rehabilitation consisting of
exercise training and supervised cycling training had a positive effect on
patients' adherence to non-pharmacological therapy for one year after
direct myocardial revascularization compared to the standard cardiac
rehabilitation program without supervised cycling training.

<77>
Accession Number
616269397
Author
Stoickov V.; Deljanin Ilic M.; Stoickov M.; Tasic I.; Saric S.; Andonov
S.; Petrovic D.; Stojanovic S.; Mitic S.
Institution
(Stoickov, Deljanin Ilic, Tasic, Petrovic) Institute of Cardiology Niska
Banja, Medical Faculty, University of Nis, Nis, Serbia
(Stoickov, Saric, Andonov, Stojanovic, Mitic) Institute of Cardiology,
Niska Banja, Serbia
Title
Effects of exercise training and beta blockers on QT dispersion and double
product in patients after coronary artery bypass graft surgery with
hyperkinetic state.
Source
European Journal of Preventive Cardiology. Conference: EuroPRevent 2017.
Spain. 24 (1 Supplement 1) (pp S154), 2017. Date of Publication: April
2017.
Publisher
SAGE Publications Inc.
Abstract
Introduction: Patients after coronary artery bypass graft surgery (CABG)
are at high risk of cardiovascular and arrhythmic events. QT dispersion
(QTd) is a measure of inhomogeneous repolarization of myocardium and is
used as an indicator of arrhythmogenicity. Abnormally high QTd has been
correlated with risk of cardiac death in coronary patients. Purpose: The
aim of this study was to establish the influence of short-term exercise
training and beta blockers on QT dispersion and DP in patients after CABG
with hyperkinetic state. Methods: The study involved 135 patients after
CABG with hyperkinetic state, in the sinus rhythm without AV blocks or
branch blocks. Average age of patients was 56.7 years. Patients were
randomly divided into the physical training group (TG: 109 patients) and
control group (non-training group: 26 patients). In all subjects exercise
test on treadmill according to Bruce protocol were performed. TG patients
increased doses of beta blockers and are involved in rehabilitation
treatment for three weeks. TG patients were instructed to follow a
training program using the bicycle ergometer (10 min, 2 times a day) and
walking. From standard ECG corrected QT dispersion (QTdc) was calculated.
Results: After three days, we have found significant reduction of heart
rate from 87.1 +/- 5.8 to 75.9 +/- 5.5 beats/min (p<0.001), of systolic
blood pressure from 148.5 +/- 12.7 to 142.2 +/- 9.3 mmHg (p<0.001), of
diastolic blood pressure from 90.3 +/- 6.9 to 85.9 +/- 4.9 mmHg (p<0.001)
and of DP from 13102.3 +/- 797.8 to 12287.6 +/- 633.6 beat/min x mmHg
(p<0.001) in the TG. After three weeks, we have found significant
reduction of QTdc from 54.5 +/- 16.5 to 47.8 +/- 14.7 ms (p<0.005) in the
TG. Also, in the TG, we have found significant reduction of heart rate
from 87.1 +/- 5.8 to 69.9 +/- 4.9 beats/min (p<0.001), of systolic blood
pressure from 148.5 +/- 12.7 to 136.3 +/- 6.7 mmHg (p<0.001), of diastolic
blood pressure from 90.3 +/- 6.9 to 82.7 +/- 3.8 mmHg (p<0.001) and of DP
from 13102.3 +/- 797.8 to 10912.2 +/- 602.4 beat/min x mmHg (p<0.001).
After three weeks, TG patients in the exercise test reached a
significantly longer time (8.6 +/- 2.8 v.s. 5.3 +/- 2.2 min (p<0.001). In
contrast, the non-training group showed no significant changes.
Conclusions: The study showed that short-term exercise training and beta
blockers have favourable effects on QT dispersion and DP and lead to a
significant increase in physical working capacity in patients after CABG
with hyperkinetic state. Beta blockers are enabled to properly implement
and improve the program of physical training in study patients.

<78>
Accession Number
616208064
Author
Debray D.; Dhawan A.; Grenda R.; Kazeem G.; Lachaux A.; Marks S.D.; Parisi
F.; Undre N.; Vondrak K.; Webb N.J.A.
Institution
(Debray) Pediatric Hepatology Unit, APHPHopital Universitaire Necker,
Enfants Malades, Paris, France
(Dhawan) Paediatric Liver GI and Nutrition Center, King's College
Hospital, London, United Kingdom
(Grenda) Department of Nephrology and Kidney Transplantation, Children's
Memorial Health Institute, Warsaw, Poland
(Kazeem, Undre) Astellas Pharma Europe Ltd, Chertsey, United Kingdom
(Lachaux) Universite Lyon 1 et Hospices Civils De Lyon, Service
D'Hepatologie Pediatrique, HFME, Bron cedex, France
(Marks) Department of Paediatric Nephrology, Great Ormond Street Hospital
for Children, NHS Foundation Trust, London, United Kingdom
(Parisi) Department of Pediatric Cardiology and Cardiac Surgery, Thoracic
Transplant Unit, Osp Pediatrico Bambino Gesu, Rome, Italy
(Vondrak) Department of Pediatrics, University Hospital Motol, Charles
University, Prague, Czech Republic
(Webb) Department of Paediatric Nephrology, Royal Manchester Children's
Hospital, Manchester, United Kingdom
Title
Comparative pharmacokinetics of tacrolimus in de novo pediatric transplant
recipients randomized to receive immediate-or prolongedrelease tacrolimus.
Source
Pediatric Transplantation. Conference: 9th Congress on Pediatric
Transplantation, IPTA 2017. Spain. 21 (pp 28), 2017. Date of Publication:
May 2017.
Publisher
Blackwell Publishing Inc.
Abstract
INTRODUCTION: Limited pharmacokinetic (PK) data exist in pediatric
transplant patients treated with prolonged-release tacrolimus (PR-T). This
study compared the PK of tacrolimus in de novo pediatric allograft
recipients, aged <16 years, receiving PR-T or immediate-release tacrolimus
(IR-T). METHODS: Phase II, parallel-group, multicenter, open-label study
in de novo renal, liver or heart allograft recipients randomized (1:1) to
PR-T or IR-T-based immunosuppression. PR-T and IR-T (oral or nasogastric
route) were initiated within 4 and 2 days after skin closure in heart and
liver recipients, respectively (24 h post-reperfusion in renal
recipients), and continued for 4 weeks. PK profiles were taken on days 1
(first dose), 7, and 28. PK analysis set (PKAS): patients receiving
randomized study drug and providing three complete PK profiles. Primary PK
objective: comparison of tacrolimus area under the blood
concentration-time curve over 24 h (AUC<inf>24</inf>) at days 1, 7 and 28
for PR-T vs. IR-T. Secondary objectives: comparison of maximum
concentration (C<inf>max</inf>), concentration at 24 h (C24). The
predefined similarity interval for confidence intervals (CIs) of least
squares mean (LSM) ratios was 80-125%. RESULTS: PKAS consisted of 33
transplant recipients (renal, n=20; liver, n=8; heart, n=5). Day 1
AUC<inf>24</inf> LSM ratio (PR-T:IR-T) was 66% on an equivalent total
daily dose; after dose adjustment, exposure ratios were 92% and 100% on
days 7 and 28, respectively. AUC<inf>24</inf> LSM ratio 90% CIs were
within the similarity interval at day 28, but not days 1 and 7. The
PR-T:IR-T LSM ratios for tacrolimus C<inf>24</inf> and C<inf>max</inf> at
day 28 were 91% and 92%, respectively (Figure 1); 90% CI lower limits were
outside the predefined similarity interval. For PR-T and IR-T, linear
relationships between tacrolimus AUC<inf>24</inf> and C24 were comparable,
with strong positive correlation overall and for each organ group. Pearson
correlation coefficient between AUC<inf>24</inf> and C<inf>24</inf> was
0.83 and 0.84 for PR-T and IR-T, respectively. Regression slopes were
similar. CONCLUSION: Exposure (AUC<inf>24</inf>) to tacrolimus was lower
for PR-T vs. IR-T on day 1, but, following dose adjustments, was similar
by day 28. The linear relationship between AUC<inf>24</inf> and
C<inf>24</inf> was similar with PR-T and IR-T, indicating that the same
target trough levels will result in similar systemic exposure to
tacrolimus in de novo pediatric transplant recipients. Therefore, the same
therapeutic drug monitoring method can be used.

<79>
Accession Number
616208056
Author
Webb N.; Baumann U.; Camino M.; Frauca E.; Undre N.
Institution
(Webb) Department of Paediatric Nephrology, Royal Manchester Children's
Hospital, Manchester, United Kingdom
(Baumann) Division of Pediatric Gastroenterology and Hepatology,
Children's Hospital, Hannover Medical School, Hannover, Germany
(Camino) Department of Pediatric Cardiology, Hospital Gregorio Maranon,
Madrid, Spain
(Frauca) Hospital Universitario La Paz, Madrid, Spain
(Undre) Astellas Pharma Europe Ltd, Surrey, United Kingdom
Title
Pharmacokinetics of tacrolimus granules in pediatric de novo liver,
kidney, and heart transplantation: The option study.
Source
Pediatric Transplantation. Conference: 9th Congress on Pediatric
Transplantation, IPTA 2017. Spain. 21 (pp 27-28), 2017. Date of
Publication: May 2017.
Publisher
Blackwell Publishing Inc.
Abstract
INTRODUCTION: In children, tacrolimus granules are an important treatment
option for the prevention of transplantation rejection. The aim of this
study was to determine the PK of tacrolimus granules after the first oral
dose and at steady state in pediatric patients undergoing de novo
allograft transplantation. METHODS: This multicenter, single-arm, phase IV
study (Clinicaltrials.gov NCT01371331) included pediatric patients (<=12
years of age) undergoing liver, kidney, or heart transplantation. The
initial daily dose for tacrolimus was 0.3 mg/kg per day orally given in
two doses (0.15 mg/kg twice daily) postoperatively, with the first dose
administered within 24 h after reperfusion (or up to five days for heart
transplant recipients). Blood samples were collected following the first
dose (Day 1) and at steady state (Day 7) after a minimum of four days
without a dose change. Whole blood concentration data were used to obtain
the following PK parameters: AUC<inf>tau</inf>, tmax, C<inf>max</inf>, and
C<inf>trough</inf>. The correlation between C<inf>trough</inf> and
AUC<inf>tau</inf> was assessed by Pearson's coefficient at each sample
time by visit. RESULTS: Of 52 patients enrolled, 38 had two evaluable PK
profiles (liver transplant [n=14], kidney transplant [n=12], and heart
transplant [n=12]). In patients with liver, kidney, and heart transplants,
the mean AUC<inf>tau</inf> following the first oral dose of tacrolimus
(Day 1) was 211, 97, and 224 h*ng/mL, respectively and the mean
AUC<inf>tau</inf> for the second PK profile (Day 7) was 195, 208, and 165
h*ng/ml, respectively (Table). Overall, the mean (SD) daily dose in the
liver, kidney and heart transplant groups were 0.25 (0.14), 0.29 (0.07),
and 0.26 (0.10) mg/kg, respectively. C<inf>trough</inf> and
AUC<inf>tau</inf> were positively correlated both at Days 1 and 7
(Pearson's coefficients were 0.81 and 0.87, respectively). CONCLUSION: A
two-fold higher AUC<inf>tau</inf> at Day 1 suggests a higher clearance or
lower oral bioavailability of tacrolimus in pediatric patients with a
kidney transplant, compared with those with a liver or heart transplant.
These data are in line with the PK profile of the immediate release
tacrolimus formulation in pediatric patients, and demonstrate a positive
correlation between C<inf>trough</inf> and AUC<inf>tau</inf> at Days 1 and
7, irrespective of age. TABLE. SUMMARY OF PK PARAMETERS: Tacrolimus at Day
1 and at Day 7 in patients with liver, kidney, or heart transplants.
AUC<inf>tau</inf>, area under the concentration-time curve for a dosing
interval; C<inf>max</inf>, maximum blood concentration;
C<inf>trough</inf>, minimum blood concentration; SD, standard deviation;
tmax, time to C<inf>max</inf>.

<80>
Accession Number
616208017
Author
Czubkowski P.; Debray D.; Kazeem G.; Kelly D.; Leclerc A.-L.; Rubik J.;
Undre N.; Vondrak K.
Institution
(Czubkowski) Department of Gastroenterology, Hepatology, Eating Disorders
and Pediatrics, Children's Memorial Health Institute, Warsaw, Poland
(Debray) Pediatric Hepatology Unit, APHP-Hopital Universitaire Necker,
Enfants Malades, Paris, France
(Kazeem, Undre) Astellas Pharma Europe Ltd, Chertsey, United Kingdom
(Kelly) Liver Unit, Birmingham Childrens Hospital, Birmingham, United
Kingdom
(Leclerc) Service De Nephrologie Rhumatologie Dermatologie Pediatrique,
Centre De Reference Maladies Renales Rares Nephrogones, Hospices Civils De
Lyon, HFME, Bron cedex, France
(Rubik) Department of Nephrology, Kidney Transplantation and Hypertension,
Children's Memorial Health Institute, Warsaw, Poland
(Vondrak) Department of Pediatrics, University Hospital Motol, Charles
University, Prague, Czech Republic
Title
Comparative pharmacokinetics of tacrolimus in stable pediatric allograft
recipients converted from immediate-to prolonged-release tacrolimus.
Source
Pediatric Transplantation. Conference: 9th Congress on Pediatric
Transplantation, IPTA 2017. Spain. 21 (pp 26-27), 2017. Date of
Publication: May 2017.
Publisher
Blackwell Publishing Inc.
Abstract
INTRODUCTION: Once-daily (QD) dosing is more convenient in pediatrics vs.
twice-daily (BD) dosing. Limited pharmacokinetic (PK) data exist in
pediatric transplant patients treated with QD prolonged-release tacrolimus
(PR-T). This study compared PK of tacrolimus in stable pediatric allograft
recipients aged 5- 16 years, converted from BD immediate-release
tacrolimus (IR-T) to PR-T. METHODS: Phase II, open-label, multicenter,
single arm cross-over study in stable pediatric renal, liver or heart
allograft recipients taking IR-T-based immunosuppression. Days -30 to -1
(screening), patients received their IR-Tbased regimen; Days 1-7, patients
received study IR-T capsules orally BD (same dose as screening). On Day 7,
the first 24-h PK profile was taken (ending Day 8); patients were then
converted to QD PR-T capsules (1:1 mg total daily dose) and received PR-T
until Day 14, when a second 24-h PK profile was taken. PK analysis set
(PKAS): patients receiving PR-T until Day 14 who had two complete PK
profiles. Primary PK endpoint: tacrolimus area under the blood
concentration-time curve over 24 h (AUC<inf>24</inf>). Secondary
endpoints: maximum concentration (C<inf>max</inf>), concentration at 24 h
(C24). The predefined similarity interval for confidence intervals (CIs)
of least squares mean (LSM) ratios was 80-125%. RESULTS: The PKAS
comprised 74 pediatric patients (kidney transplant, n=45; liver, n=28;
heart, n=1). AUC<inf>24</inf>, C<inf>max</inf> and C<inf>24</inf> were
comparable for PR-T vs. IR-T; LSM ratio 90% CIs were within the similarity
interval (Figure 1). For IR-T and PR-T, linear relationships between
tacrolimus AUC<inf>24</inf> and C<inf>24</inf> were comparable, with a
strong positive correlation; the Pearson correlation coefficient between
AUC<inf>24</inf> and C<inf>24</inf> was 0.84 and 0.89, respectively.
Regression line slopes were similar. The PR-T:IR-T LSM ratio (90% CI) was
similar overall for AUC<inf>24</inf>, C<inf>max</inf>, and C24(Figure 1),
and for kidney and liver recipients for AUC<inf>24</inf> (kidney 91.75%
(86.64%, 97.16%); liver 104.07% (96.78%, 111.91%)) and C<inf>max</inf>
(kidney 83.89% (77.02%, 91.36%); liver 108.09% (97.01%, 120.44%)).
CONCLUSION: AUC<inf>24</inf>, C<inf>max</inf> and C<inf>24</inf> were
comparable for PR-T and IR-T, with a similar linear relationship between
AUC<inf>24</inf> and C24. As such, stable pediatric transplant patients
can be converted from IR-T to PR-T at the same total daily dose, using the
same therapeutic drug monitoring method. Postconversion tacrolimus trough
levels should be monitored and doses adjusted to maintain tacrolimus
exposure.

<81>
Accession Number
616280389
Author
Uber A.J.; Liu X.; Holmberg M.J.; Sophia M.; Donnino M.W.; Andersen L.W.
Institution
(Uber, Liu, Holmberg, Sophia, Donnino, Andersen) Beth Israel Deaconess
Medical Center, United States
Title
In vitro ubiquinol increases cellular oxygen consumption in peripheral
blood mononuclear cells from patients undergoing coronary artery bypass
grafting.
Source
Academic Emergency Medicine. Conference: 2017 Annual Meeting of the
Society for Academic Emergency Medicine, SAEM 2017. United States. 24 (pp
S226), 2017. Date of Publication: May 2017.
Publisher
Blackwell Publishing Inc.
Abstract
Background: Ubiquinol (Coenzyme Q10) is a mitochondrial molecule that is
essential for adequate aerobic metabolism. The objective of the current
study was to investigate the effects of in vitro ubiquinol administration
on cellular oxygen consumption in peripheral blood mononuclear cells
(PBMCs) from patients undergoing coronary artery bypass grafting. This
population was evaluated to capture pre- and post blood sampling for
patients in a state of severe metabolic stress, akin to those who present
to the emergency department in a shock state. Methods: Patients scheduled
for coronary artery bypass grafting with cardiopulmonary bypass were
enrolled at Beth Israel Deaconess Medical Center, a tertiary care center
in Boston, USA, between January 2015 and July 2015. Blood was drawn and
PMBCs were isolated from patients before and after surgery. Cells were
then randomized to either treatment with placebo or 1 lg/mL ubiquinol. The
complete mitochondrial respiration profiles were measured using XF Cell
Stress Mito Kit (Seahorse Bioscience) to reveal the key parameters of
cellular oxygen consumption. Wilcoxon Signed Rank test was used to analyze
differences in oxygen consumption rate between groups. Results: Basal
cellular oxygen consumption was available on 23 patients pre-operatively
and 17 patients post-operatively. The mean age was 71 (SD: 7), and 22/ 26
(85%) were male. We found a significant difference in post-operative
relative basal (1.1 mL/min/mg difference [0.9, 1.6] p < 0.001) oxygen
consumption and maximal (4.2 mL/min/mg difference [0.3, 7.0] p = 0.01)
oxygen consumption between the ubiquinol and placebo group. There were no
significant differences in pre-operative basal (1.0 mL/min/mg [-0.9, 2.2]
p = 0.08) or maximal (0.5 mL/min/mg [-4.3, 7.3] p = 0.56) cellular oxygen
consumption between ubiquinol vs. placebo groups. Conclusions: In a sample
of cardiac surgery patients, in vitro administration of ubiquinol enhanced
post-operative cellular oxygen consumption. These findings suggest
ubiquinol may have potential as a mitochondrial resuscitator in states of
metabolic stress, akin to typical physiology for critically ill patients
in the emergency department.

<82>
Accession Number
616280180
Author
Wylde V.; Dennis J.; Beswick A.; Bruce J.; Eccleston C.; Howells N.;
Peters T.; Gooberman-Hill R.
Institution
(Wylde, Dennis, Beswick, Gooberman-Hill) Musculoskeletal Research Unit
University of Bristol, United Kingdom
(Bruce) Warwick Clinical Trials Unit University of Warwick, United Kingdom
(Eccleston) Centre for Pain Research University of Bath, United Kingdom
(Howells) Avon Orthopaedic Centre North Bristol NHS Trust, United Kingdom
(Peters) School of Clinical Sciences University of Bristol, United Kingdom
Title
Management of chronic pain after surgery: A systematic review.
Source
British Journal of Pain. Conference: 50th Annual Scientific Meeting of the
British Pain Society. United Kingdom. 11 (2 Supplement 1) (pp 9), 2017.
Date of Publication: May 2017.
Publisher
SAGE Publications Ltd
Abstract
Pain present for at least three months after a surgical procedure is
described as chronic postsurgical pain (CPSP). CPSP affects between 10%
and 50% of patients following common surgeries such as mastectomy, cardiac
surgery, hysterectomy, hernia repair, joint replacement, back surgery and
also more minor procedures. Possible forms of management for CPSP may
focus on the condition that indicated a need for surgery, on the aetiology
of the pain, or be multifactorial in recognition of the diverse causes of
post-operative pain. While some forms of management may have limited
applicability outside of the specific condition for which they were
intended, others may be transferrable and of importance more widely,
regardless of the surgical procedure. There are systematic reviews of
pharmacological and non-pharmacological interventions for the management
of chronic pain, but no review has considered management of CPSP. Aims The
aim of this systematic review was to identify randomised controlled trials
of interventions for the management of CPSP and to synthesize data across
treatment type to provide an estimate of the effectiveness and safety of
treatments. Methods The protocol for this systematic review was registered
on the international prospective register of systematic reviews (PROSPERO;
registration number 15957). MEDLINE, Embase, PsycINFO, CINAHL and The
Cochrane Library were searched up to 23rd March 2016. Reference lists were
checked, registers inspected and grey literature was searched for in
OpenGrey. No language restrictions were applied. Randomised controlled
trials of interventions for pain received by patients at a minimum of
three months after surgery were eligible for inclusion in the review.
Abstracts or full text articles were screened to determine if they met the
eligibility criteria. Data from eligible studies were extracted onto a
standardised proforma. The primary clinical effectiveness outcome was pain
intensity and the primary harm outcome was the occurrence of serious
adverse events. Risk of bias was assessed using the Cochrane Risk of Bias
tool. Results A total of 66 studies with data from 3,149 participants met
the inclusion criteria. The majority of trials were conducted with
patients who had chronic pain after spinal surgery (23 trials) or phantom
limb pain (21 trials). Interventions were predominantly pharmacological,
including anti-epileptics, capsaicin, epidural steroid injections, local
anaesthetic, neurotoxins, N-methyl-D-aspartate receptor antagonists,
opioids, calcitonin, and naloxone as an adjuvant to morphine. Other
interventions evaluated included acupuncture/dry needling, exercise, limb
cover/liner after amputation, spinal cord stimulation, further surgery,
laser therapy, magnetic stimulation, mindfulness-based stress reduction,
mirror therapy and sensory discrimination training. Opportunities for
meta-analysis were limited by heterogeneity between studies. For all
interventions there was insufficient evidence to draw conclusions on
clinical effectiveness. Conclusion In conclusion, this review has
highlighted the need for more evidence regarding interventions for CPSP.
It is clear that trials to date have predominantly focused on
pharmacological interventions, and no trials have been conducted to
evaluate multimodal interventions matched to pain characteristics for the
management of CPSP. Given the complexity of pain that extends or emerges
after surgery, individualised interventions should be developed and
evaluated. High quality trials of these interventions are needed to
provide a robust evidence base to guide the management of CPSP and improve
care for patients.

<83>
Accession Number
616279919
Author
Lieurance R.S.; O'Neill J.; Scheatzle M.D.
Institution
(Lieurance, O'Neill, Scheatzle) Allegheny Health Network/Allegheny General
Hosptial, United States
Title
Point of care ultrasound thoracic "quick look" for chest tube insertion
site location.
Source
Academic Emergency Medicine. Conference: 2017 Annual Meeting of the
Society for Academic Emergency Medicine, SAEM 2017. United States. 24 (pp
S65), 2017. Date of Publication: May 2017.
Publisher
Blackwell Publishing Inc.
Abstract
Background: For the emergent decompression of a pneumothorax, physicians
rely on anatomic landmarks to determine the proper intercostal space (ICS)
for chest tube insertion. Using this technique, physicians select an
insertion site too low in nearly 30% of cases, resulting in
intraperitoneal placement in approximately 1% of insertions. We developed
point of care ultrasound (POCUS) thoracic "quick look" procedure that
allows the operator to visualize the structure (lung or
diaphragm+liver/spleen) underlying the selected ICS. Our objective was to
determine whether advocating for a "quick look" prior to chest tube
placement is justified. Methods: We performed an observational study on a
convenience sample of adult emergency department patients and treating
emergency medicine resident and attending physicians. Stable patients over
17 years old were included. The physician was asked to rapidly assess for
the location on the chest wall that they would insert a chest tube and to
place a mark on the patient's chest at this hypothetical insertion site. A
separate physician then performed a POCUS thoracic "quick look" exam at
the site of the mark on the chest wall. The identification of the standard
lung pattern underlying the mark was considered a negative scan whereas
identifying the diaphragm+liver/spleen during any portion of the
respiratory cycle was considered a positive scan. To determine inter-rater
reliability, video clips of each scan were saved and reviewed by a second
blinded reviewer. Results: Forty patients were enrolled along with 21
emergency medicine resident and attending physicians. All but 4 subjects
had both sides of their chest marked and scanned, and thus a total of 76
POCUS thoracic "quick look" scans were performed. 17% (13/76, 95%CI 8-26%)
of scans were positive. The average time for performing this study was 43
(95%CI 30-57) seconds. Inter-rater reliability of the POCUS thoracic
"quick look" was excellent (j=0.95). Conclusion: Thoracic POCUS "quick
look" performed at mock chest tube insertion sites demonstrated
potentially dangerous insertions in 17% of the cases. Point of care
thoracic ultrasound "quick look" is a reliable and fast technique that may
improve safety when placing an emergent chest tube.

<84>
Accession Number
616279152
Author
Qureshi W.; Nasir U.; Zawadzka S.; Shabbir O.; Zhao D.
Institution
(Qureshi, Zhao) Wake Forest University, Cardiology, United States
(Nasir, Zawadzka) University of Conneccticut, School of Medicine, United
States
(Shabbir) Rawalpindi Medical College, Pakistan
Title
Syntax score can risk stratify patients undergoing left main
revascularization.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S60-S62), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Left main obstructive coronary disease has high mortality
risk. It is unclear whether percutaneous coronary intervention (PCI) is
better than coronary artery bypass graft (CABG) in these patients. Syntax
score may help in identifying patients with better outcomes undergoing
revascularization procedure. Methods: We identified 5 randomized clinical
trials and 1 registry that compared left main coronary artery
revascularization by PCI and CABG and with information on outcomes and
syntax score. Primary outcome (major adverse cardiovascular events; MACE)
was a composite outcome of all - cause death, non-fatal myocardial
infarction, cardiac death and stroke. Random effects model was used to
compute odds ratio with 95% confidence intervals for association of PCI
with primary outcome compared with CABG among 3 subgroups of Syntax score
namely 1-22, 23 - 32 and >=33. Results: Overall, 2499 patients underwent
PCI and 2706 patients underwent CABG. The mean follow up was available for
up to 5 years. There were 510 (20.4%) MACE in PCI and 436 (16.1%) in CABG
group. Compared with CABG, PCI was associated with higher risk of MACE in
group with Syntax score >=33 (Odds ratio for MACE; 1.67; 95% CI 1.27 -
2.19, p=0.0002). PCI was non inferior to CABG among groups with Syntax
score 23 - 32 (OR 1.22; 95% CI 0.97 - 1.55, p=0.09) and Syntax score 1 -
22 (OR 1.21; 95% CI 0.95, 1.55, p=0.13). The net reclassification index
for Syntax >=33 was 0.29 and 38.8% of the patients were reclassified using
Syntax score. Figure 1 shows the forrest plot showing random effects
model. Conclusion: This meta-analysis shows that CABG is preferable in
patients with left main disease revascularization in patients with Syntax
score >=33. However, PCI is comparable to CABG in patients with Syntax
score 1 - 32. Future studies should focus on risk stratification methods
to personalize revascularization strategy in left main disease. (Table
presented).

<85>
Accession Number
616279142
Author
Khan A.A.; Zaidi S.I.; Panchal H.B.; Papireddy M.R.; Paul T.K.
Institution
(Khan, Zaidi, Panchal, Papireddy, Paul) East Tennessee State University,
United States
Title
Efficacy of cerebral embolic protection devices in transcatheter aortic
valve replacement: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S187-S188), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Recent FDA approval of transcatheter aortic valve replacement
(TAVR) in intermediate surgical risk patients would increase the number of
nationwide TAVR procedures. Stroke represents an adverse outcome of this
procedure. Recent randomized controlled trials (RCTs) have questioned the
efficacy of cerebral embolic protection devices (CEPD) for stroke
prevention in patients undergoing TAVR. Methods: We searched PubMed,
Google Scholar and clinicaltrials.- gov for RCTs and other studies that
compared outcomes in TAVR with or without use of CEPD. End points were
total lesion volume, single lesion volume and number of new lesions on
imaging. The odds ratio (OR) or mean difference (MD) with 95% confidence
interval (CI) was computed and p<0.05 was considered as a level of
significance. Results: We identified 5 RCTs and 3 retrospective studies
(n=575) of patients undergoing TAVR with CEPD (n=282) versus without CEPD
(n=293). There was no difference in number of lesions per patient (figure
1) (MD: 21.74, CI 24.1-0.62, p=0.15), total lesion volume (MD: 256.15 mm3,
CI 2166.47- 54.18, p=0.32) or single lesion volume (MD: 27.23 mm3, CI
219.23-4.77, p=0.24). There is no significant difference noted in the
number of patients with new lesions (figure 2) (OR: 0.95, CI 0.89-1.03, p=
0.2). Conclusion: Our meta-analysis of 575 patients demonstrates no
difference in lesion volumes on brain imaging during TAVR with or without
CEPD. Although much emphasis is laid on lesion volumes, the clinical
significance of embolic protection devices is yet to be determined in
future studies.

<86>
Accession Number
616279132
Author
Khan A.A.; Zaidi S.I.; Panchal H.B.; Papireddy M.R.; Paul T.K.
Institution
(Khan, Zaidi, Panchal, Papireddy, Paul) East Tennessee State University,
United States
Title
Clinical outcomes in transcatheter aortic valve replacement with and
without cerebral embolic protection devices: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S187), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Previous Randomized Controlled Trials (RCTs) have shown
decreased brain lesion volumes on imaging with cerebral embolic protection
devices (CEPD) during Transcatheter Aortic Valve Replacement (TAVR)
procedures. We aimed to assess whether these newly developed devices
affect clinical outcomes. However, the presence of debris in brain matter
may not correlate with the extent of cognitive function or brain injury.
Methods: We searched PubMed through Dec 2016 for studies comparing
outcomes in TAVR with or without use of CEPD. End points were mortality,
stroke, life threatening bleeding and change in Montreal Cognitive
Assessment (MoCA) and National Institute of Health Stroke Scale (NIHSS)
scores on discharge. The odds ratio (OR) or mean difference (MD) with 95%
confidence interval (CI) was computed and p<0.05 was considered as a level
of significance. Results: We identified 5 RCTs and 3 retrospective studies
(n=575) of patients undergoing TAVR with CEPD (n=282) versus without CEPD
(n=293). There were no differences in mortality (RR: 0.58, CI 0.21-1.58,
p=0.29), stroke (RR: 0.64, CI 0.37-1.10, p=0.11) or life threatening
bleeding (RR 0.38, CI 0.12-1.2, p=0.10) seen. NIHSS scores were not
statistically significant between the two groups (RR: 0.86, CI 0.52-1.41,
p=0.54), however fewer patients had worse MoCA scores (figure) (OR: 0.67,
CI 0.48-0.94, p=0.02) with use of CEPD. Conclusion: Our meta-analysis of
575 patients failed to demonstrate improved clinical outcomes in terms of
mortality, stroke and NIHSS scores, however fewer patients in CEPD group
had worse MoCA scores. Larger RCTs currently underway will continue to
help assessing clinical outcomes.

<87>
Accession Number
616279124
Author
Sciahbasi A.; Miklin D.J.; Ferrante G.; Fischetti D.; Alessandro S.;
Schirripa V.; Guarracini F.; Arya A.; Loreni G.; Bruni A.; Rigattieri S.;
Marini M.; Vagnarelli S.; Scevola G.; Reimers B.; Hindricks G.; Cohen M.
Institution
(Sciahbasi, Loreni, Rigattieri, Scevola) Sandro Pertini Hospital, Italy
(Miklin, Cohen) University of Miami Miller, School of Medicine, United
States
(Ferrante, Reimers) Humanitas Clinical and Research Center, Italy
(Fischetti) Vito Fazzi Hospital, Italy
(Alessandro) HSE Management, Italy
(Schirripa) Ospedale Grassi, Italy
(Guarracini, Marini) S. Chiara Hospital, Italy
(Arya, Hindricks) Heart Center, University of Leipzig, Germany
(Bruni, Vagnarelli) San Giovanni Hospital, Italy
Title
Radiation dose among different cardiac and vascular invasive procedures:
The rodeo study.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S126-S127), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Interventional radiology and cardiology procedures contribute
significantly to the collective dose of radiation exposure from medical
interventions. Recent and dedicated studies directly comparing these
procedures in terms of patient radiation exposure are lacking. We sought
to compare radiation exposure, assessed as the dose area product (DAP)
among different interventional procedures performed under fluoroscopic
guidance. Methods: The RODEO study (NCT: 02972736) was an international
observational retrospective multicenter study enrolling consecutive
patients undergoing diagnostic or interventional procedures performed by
different interventional operators (i.e. radiologists, interventional
cardiologists or electrophysiologists) at 6 centers, without exclusion
criteria. The primary objective of the study was the comparison of DAP
among interventional cardiology, electrophysiology and interventional
radiology procedures. Results: A total of 17,711 procedures were included
in the study: 13,522 interventional cardiology, 2,352 electrophysiology
and 1,864 interventional radiology procedures. The highest DAP values were
observed for interventional radiology procedures (74 Gy*cm2
[Interquartile range 27-178 Gy*cm2]), followed by
interventional cardiology (40 Gy*cm2 [22-78 Gy*cm2])
and electrophysiology procedures (13 Gy*cm2 [4-44
Gy*cm2], p<0.0001). In terms of specific procedures, the
highest DAP values were observed for structural or valvular cardiac
procedures (134 Gy*cm2 [51-260 Gy*cm2]) whereas the
lowest DAP values were observed for pacemaker insertions (11
Gy*cm2 [4-28 Gy*cm2]). Conclusion: In this large
study, the highest radiation exposure was observed in procedures performed
by interventional radiologists. However, among specific procedures,
structural or valvular cardiac procedures were associated with the highest
radiation exposure. Opportunities to reduce radiation exposure, eventually
with the use of alternative imaging guidance in this field should be
further investigated. (Table Presented).

<88>
Accession Number
616279110
Author
Kanmanthareddy A.; Anugula D.; Gujjula N.; Parekh J.; Tandra A.; Urja P.;
Mooss A.; Alla V.; Del Core M.; White M.; Lilly S.
Institution
(Kanmanthareddy, Anugula, Gujjula, Parekh, Tandra, Urja, Mooss, Alla, Del
Core, White) Creighton University, School of Medicine, United States
(Lilly) Ohio State University, Department of Cardiovascular Medicine,
United States
Title
Moderate sedation versus general anesthesia for transcatheter aortic valve
replacement.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S186-S187), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is mostly
performed under general anesthesia. However, as TAVR procedure has
matured, these procedure are being performed using moderate sedation. We
performed a meta-analysis of outcomes comparing moderate sedation versus
general anesthesia in patients undergoing TAVR. Methods: Electronic search
of databaseswere performed to search for relevant articles. Outcomes of
all-cause mortality, vascular complications, myocardial infarction,
stroke, major bleeding, pacemaker implantation and length of stay (LOS)
were extracted from individual studies and metaanalysis was performed
using STATA 13 software. A Fixed or random effects meta-analysis was
performed depending on the heterogeneity (I2 test). Risk ratio (RR) and
weighted mean difference (WMD) with their respective 95% confidence
interval (CI) were computed. Metaregression was performed using the
predictor variables of STS Score and Euroscore. Results: A total of 22
studies met our inclusion criteria and included 10,777 patients of which
4,888 patients underwent TAVR under general anesthesia. LOS was shorter in
the moderate sedation group (WMD 21.44, 95% CI - 2.46 to 20.43 days).
All-cause mortality (RR 1.02, 95% CI 0.84 - 1.24), acute kidney injury (RR
0.93, 95% CI 0.69 - 1.25), major bleeding (RR 0.96, 95% CI 0.76 - 1.21),
myocardial infarction (RR 1.33, 95% CI 0.76 - 2.34), stroke (RR 1, 95% CI
0.75 - 1.34) and vascular complications (RR 0.79, 95% CI 0.55 - 1.13) were
similar in the two groups. Risk of pacemaker implantation was higher in
the moderate sedation group (RR 1.16, 95% CI 1.03 - 1.31). STS score and
Euroscore were not found to be significant predictors of the outcomes on
metaregression. Conclusion: In our meta-analysis the clinical outcomes of
TAVR were similar in patients undergoing this procedure under moderate
sedation or general anesthesia. The LOS was shorter in the group
undergoing TAVR under moderate sedation. The role of operator experience
and selection bias should be considered in interpreting the above data and
these should be further evaluated in a randomized comparative trial.

<89>
Accession Number
616279100
Author
Kanmanthareddy A.; Anugula D.; Gujjula N.; Sharma R.; Balmuri A.; Urja P.;
Parekh J.; Tandra A.; White M.; Del Core M.; Hunter C.; Alla V.; Agarwal
H.; Esterbrooks D.; Lilly S.; Gafoor S.; Mooss A.
Institution
(Kanmanthareddy, Anugula, Gujjula, Balmuri, Urja, Parekh, Tandra, White,
Del Core, Hunter, Alla, Esterbrooks, Mooss) Creighton University, School
of Medicine, United States
(Sharma, Gafoor) Seattle Cardiology and Swedish Medical Center, United
States
(Agarwal) CHI health Creighton University Medical Canter, United States
(Lilly) Ohio State University, Department of Cardiovascular Medicine,
United States
Title
Impact of moderate to severe mitral regurgitation on the outcomes after
transcatheter aortic valve replacement: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S185-S186), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is a minimally
invasive alternative to surgical aortic valve replacement in moderate to
high risk severe aortic stenosis. Moderate to severe mitral regurgitation
(MR) is present in about 20 230% of patients undergoing TAVR and the
clinical impact of this was evaluated in this meta-analysis. Methods:
Electronic search of PubMed, Google Scholar and Web of Science databases
was performed to identify relevant studies. Data extracted from the
included studies was analyzed using STATA 13.0 software using appropriate
models based on heterogeneity. Risk ratio (RR) with 95% confidence
intervals (CI) was calculated for the respective outcomes. Results: A
total of 10 studies with 9,461 patients were included in this study and of
these 7,385 patients had-mild MR and 2,076 patients had moderate to severe
MR. The group with moderate to severe MR had a higher risk of all cause
mortality at 30 days (RR 1.39, 95% CI 1.19 - 1.63) compared to the group
with-mild MR. However cardiovascular mortality at 30 days was not
significantly different (RR 1.66, 95% CI 0.50 - 5.54). Moderate to Severe
MR group also had a significantly higher all cause mortality at 1 year (RR
1.36, 95% CI 1.15 - 1.60) but again the cardiovascular mortality at 1 year
was not statistically different (RR 1.69, 95% CI 0.74 - 3.83). Conclusion:
Our analysis suggests that the presence of moderate to severe MR increases
all cause mortality in patients undergoing TAVR. Therefore, patients
presenting with mixed aortic stenosis and moderate to severe MR need
further risk stratification prior to TAVR and aggressive treatment of MR
after TAVR.

<90>
Accession Number
616279087
Author
Kanmanthareddy A.; Urja P.; Tandra A.; Anugula D.; Gujjula N.; Parekh J.;
Alla V.; Mooss A.; Lilly S.; White M.
Institution
(Kanmanthareddy, Urja, Tandra, Anugula, Gujjula, Parekh, Alla, Mooss,
White) Creighton University, School of Medicine, United States
(Lilly) Ohio State University, Department of Cardiovascular Medicine,
United States
Title
Embolic protection devices for transcatheter aortic valve replacement:
Evidence from meta-analysis of randomized controlled trials.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S184-S185), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Embolic events to the brain during transcatheter aortic vavle
replacement (TAVR) are common and embolic protection (EP) devices are
being evaluated to decrease these events. We performed a meta-analysis of
trials evaluating these devices. Methods: Electronic search of PubMed,
EBSCO and Google Scholar databases was performed for relevant articles.
Outcomes of all-cause mortality, stroke, presence of new ischemic lesions
on the MRI, number of new ischemic lesions, worsening national institute
of health stroke scale (NIHSS) and total lesion volume on the MRI were
extracted. Meta-analysis was performed using STATA 13 software. Risk ratio
(RR) and weighted mean difference (WMD) with their respective 95%
confidence intervals (CI) were computed using fixed or random effects
model based on the heterogeneity (I2 test). Results: A total of 5
randomized trials were included with a total of 643 patients and of these
385 patients were randomized to the EP device arm. All-cause mortality (RR
0.57, 95% CI 0.19 - 1.74), new ischemic lesions (RR 0.86, 95% CI 0.72 -
1.04), overt stroke (RR 1.47, 95% CI 0.71 - 3.06) and worsening NIHSS (RR
0.54, 95% CI 0.27 - 1.08) were similar in the groups with and without EP
device. Number of new ischemic lesions (WMD 23.71, 95% CI 28.69 to 1.28,
p=0.145) was not different, however, the total lesion volume was
significantly lower in the group with EP device (WMD 2122.63, 95% CI
2242.27 to 22.99 mm3, p 50.045). Conclusion: Use of EP device was
associated with significantly lower stroke lesion volume but not
associated with better clinical outcomes. Further evaluation of EP devices
is therefore needed prior to widespread adaptation of these devices.
(Table Presented).

<91>
Accession Number
616279075
Author
Kanmanthareddy A.; Anugula D.; Gujjula N.; Sharma R.; Urja P.; Parekh J.;
Tandra A.; Balmuri A.; Koduri H.; Saurav A.; White M.; Hunter C.; Del Core
M.; Agarwal H.; Mooss A.; Esterbrooks D.; Lilly S.; Gafoor S.; Alla V.
Institution
(Kanmanthareddy, Anugula, Gujjula, Urja, Parekh, Tandra, Balmuri, Koduri,
Saurav, White, Hunter, Del Core, Mooss, Esterbrooks, Alla) Creighton
University, School of Medicine, United States
(Sharma, Gafoor) Seattle Cardiology and Swedish Medical Center, United
States
(Agarwal) CHI health Creighton University Medical Canter, United States
(Lilly) Ohio State University, Department of Cardiovascular Medicine,
United States
Title
Clinical impact of pulmonary hypertension on patients undergoing
transcatheter aortic valve replacement: Meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S184), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Patients undergoing transcatheter aortic valve replacement
(TAVR) with coexisting pulmonary hypertension (PH) have been reported to
have worse clinical outcomes. The impact of PH on the clinical outcomes of
TAVR was analyzed in this meta-analysis. Methods: Electronic search of
PubMed, Google Scholar and Web of Science databases was carried out to
identify the studies evaluating the impact of PH on TAVR outcomes. Data
extracted was then analyzed using STATA 13.0 software using appropriate
weighting models. Risk ratio (RR) with 95% confidence intervals (CI) was
calculated for the respective outcomes. Results: A total of 7 studies were
6,601 patients were included and of these 2,289 patients did not have any
pulmonary hypertension and 4,312 patients had PH. Mortality risk at 30
days and during long term follow up was increased in the group with PH; RR
of 1.38 (95% CI 1.12 - 1.72) and 1.45 (95% CI 1.30 - 1.62), respectively.
The group with PH also had increased risk of renal failure at 30 days (RR
1.71, 95% CI 1.19 - 2.46). The risk of bleeding at 30 days (RR 0.97, 95%
CI 0.80 - 1.17) and stroke at 30 days (RR 1.26, 95% CI 0.85 - 1.62) were
not significantly different in the groups with and without PH. Conclusion:
The results of our meta-analysis suggests that the presence of PH is
associated with increased risk of 30 day, long term mortality and renal
failure in patients undergoing TAVR. Aggressive recognition and management
of PH should be done in patients undergoing TAVR. (Figure Presented).

<92>
Accession Number
616279057
Author
Anonymous
Title
40th Annual SCAI Scientific Sessions.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (no pagination), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
The proceedings contain 337 papers. The topics discussed include:
ventricular septal rupture complicating acute myocardial infarction:
incidence, treatment, and outcomes among medicare beneficiaries 1999-2014;
application and outcomes of the hybrid approach to chronic total occlusion
percutaneous coronary intervention: an update from progress CTO
(prospective global registry for the study of chronic total occlusion
intervention); management and outcomes of perioperative acute myocardial
infarction after non-cardiac surgery; silent cerebral infarct after
coronary procedures as detected with neuron specific enolase: comparison
of transradial and transfemoral access site; implementation of a
minimalist approach to TAVR is associated with improved outcomes and
decreased length of stay category: quality improvement; association
between hospital transcatheter aortic valve replacement volume and 30-day
readmissions; transcatheter versus surgical aortic valve replacement in
patients with prior non-cardiac transplantation: an analysis of the
national inpatient sample database 2011-2013; alcohol septal ablation vs
myectomy in the treatment of hypertrophic obstructive cardiomyopathy: a
meta-analysis of long-term outcomes; and transcatheter versus surgical
aortic valve replacement in patients with prior non-cardiac
transplantation: an analysis of the national inpatient sample database
2011-2013.

<93>
Accession Number
616278922
Author
Zaid S.; Tang G.; Ahmad H.; Kaple R.; Undemir C.; Bennett J.; Feng C.;
Poniros A.; Kearns A.; Dutta T.; Gilet A.; Rozenshtein A.; Cohen M.;
Lansman S.
Institution
(Zaid, Tang, Ahmad, Kaple, Undemir, Bennett, Feng, Poniros, Kearns, Dutta,
Gilet, Rozenshtein, Cohen, Lansman) Westchester Medical Center, New York
Medical College, Valhalla, NY, United States
Title
Transcatheter aortic valve replacement with latest generation
balloon-expandable valve with extremely large annuli beyond 683 mm2.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S212), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: The largest recommended annular area for Transcatheter aortic
valve replacement (TAVR) with 29mm Sapien3 (S3) valve is 683 mm2 but no
case series have been reported for 29mm S3 implanted in even larger
annuli. Methods: From 10/2015 to 12/2016, 100/157 (64%) patients with
symptomatic severe aortic stenosis underwent S3 TAVR, of which 6 had
annular area >683mm2 (Mean 718 +/- 29mm2, range 692- 772mm2) by
multidetector computed tomography (MDCT) (Figure). 2 patients with area
>683mm2 underwent 31mm CoreValve TAVR during the same period. Balloon
filling for S3 inflation was finalized after balloon aortic valvuloplasty
with aortography. Bottom of S3 marker was positioned at annular plane in
all patients. VARC-2 outcomes were reported. Results: All cases were
successful with no death, stroke, vascular complication or pacemaker at 30
days. Post dilatation occurred in 67% with final balloon overfilling
(1-3cc) in 3/6 patients. Implant depth by angiography averaged 29+/-12%
(range 11-40%) by non-coronary cusp and 28+/-12% (range 12-48%) by left
coronary cusp. New left bundle branch block occurred in 2/6 patients and
only 1/6 had mild paravalvular leak. Conclusion: TAVR with 29 mm S3 valve
beyond recommended range is safe. Overexpansion of the S3 frame can be
achieved by adding balloon volume before valve deployment or post
dilatation with additional volume. Placing bottom marker band just above
annular plane to aim for a higher S3 implant, even in undersized annuli,
may minimize paravalvular leak and pacemaker rate. Post-TAVR MDCT may
further determine the theoretical annular limit of safe implantation of
29mm S3 valve. A multicenter study is ongoing.

<94>
Accession Number
616278917
Author
Quinn B.; Bergersen L.
Institution
(Quinn, Bergersen) Children's Hospital Boston, United States
Title
Radiation risk categories for adjusting case mix complexity in cardiac
catheterization for congenital heart disease.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S19), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: We sought to define groups of diverse procedure types with
similar radiation exposure to allow robust and equitable risk adjustment
methods in cardiac catheterization for congenital heart disease. Methods:
Data between January, 2014 and December, 2015 were collected on all cases
performed at sites participating in C3PO-QI (Congenital Cardiac
Catheterization Outcomes Project - Quality Improvement Initiative) and 12
sites with verified complete data capture were included. Forty unique
procedure types were defined and dose area product (DAP) per kilogram of
body weight (muGy*M2/kg) was summarized by median and IQR for
each of the procedure type then ranked according to exposure. Using both
empiric and consensus methods radiation risk categories were created.
Results: Among 13,937 cases, 94% were assigned to 1 of 40 unique procedure
types defined by diagnostic characteristics and or the interventions
performed during the catheterization. The majority of procedure types (37
of 40) each occurred infrequently in 1 to 3% of cases, but with a wide
range of radiation exposure outcomes, median of 33 to 376 DAP/kg, with the
remaining 35% categorized as diagnostic and 19% post heart transplant
assessments. Ten radiation risk categories were created with a median
DAP/kg from lowest to highest category: 4, 39, 46, 52, 65, 116, 155, 224,
278, 361, figure 1. Conclusion: The radiation exposure risk categories
created in this multi-center data set is a critical step towards
developing robust risk adjustment methodology to allow equitable
comparison of radiation exposure outcomes among institutions. (Figure
presented).

<95>
Accession Number
616278902
Author
Danek B.; Karatasakis A.; Hatem R.; Karmpaliotis D.; Alaswad K.; Jaffer
F.; Yeh R.; Kandzari D.; Lembo N.; Patel M.; Mahmud E.; Choi J.; Doing A.;
Lombardi W.; Wyman R.M.; Toma C.; Uretsky B.; Garcia S.; Moses J.; Kirtane
A.; Ali Z.; Karacsonyi J.; Sandoval Y.; Rangan B.; Khalili H.; Banerjee
S.; Brilakis E.
Institution
(Danek, Karatasakis, Karacsonyi) VA North Texas Healthcare System, UT
Southwestern Medical Center, United States
(Hatem, Karmpaliotis, Moses, Kirtane, Ali) Columbia University, United
States
(Alaswad) Henry Ford Hospital, United States
(Jaffer) Massachusetts General Hospital, United States
(Yeh) Beth Israel Deaconess Medical Center, Harvard Medical School, United
States
(Kandzari, Lembo) Piedmont Heart Institute, United States
(Patel, Mahmud) UCSD Medical Center, Cardiology, United States
(Choi) Baylor Heart and Vascular Hospital, Dallas, TX, United States
(Doing) Medical Center of the Rockies, United States
(Lombardi) University of Washington, United States
(Wyman) Torrance Memorial Medical Center, United States
(Toma) UPMC, United States
(Uretsky) Central Arkansas Veterans Healthcare System, United States
(Garcia) University of Minnesota, United States
(Sandoval, Brilakis) Minneapolis Heart Institute, United States
(Rangan, Khalili, Banerjee) VA North Texas Healthcare System, UT
Southwestern Medical Center at Dallas, United States
Title
Incidence, treatment, and outcomes of coronary perforation during chronic
total occlusion percutaneous coronary interventions: Insights from a
multicenter registry.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S49-S50), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Coronary perforation is a potential procedural complication of
chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Methods: We analyzed data from 1952 patients who underwent CTO PCI in a
multicenter registry. Results: Mean patient age was 65+/-10 years, 85%
were men, 36% had prior coronary artery bypass grafting (CABG). Overall
technical and procedural success were 88% and 87%. A major adverse
cardiovascular event (death, myocardial infarction, stroke, repeat
revascularization, pericardiocentesis) occurred in 2.6%. Coronary
perforation occurred in 80 patients (4.1%). Perforation was more frequent
in older patients (71+/-9 vs. 65+/-10 years, p<0.001) and with prior CABG
(61% vs. 35%, p<0.001). Perforation occurred at the CTO target vessel in
75%, an epicardial collateral in 16%, and a septal collateral in 9% of
cases. Cases with perforation were angiographically more complex
(moderate/severe calcification 81% vs. 56%, p<0.001; blunt/no stump 75%
vs. 53%, p=0.002; poor distal landing zone 52% vs. 36%, p=0.023; J-CTO
score 3.0+/-1.2 vs. 2.5+/-1.2, p=0.001, PROGRESS-CTO Complications score
4.4+/-1.8 vs. 3.2+/-1.9, p<0.001). Ten perforations resulted in tamponade
requiring pericardiocentesis (12.5% of perforations, 0.5% of overall
cohort). Figure 1 shows treatment and concurrent complications (related or
unrelated to perforation) stratified by perforation Ellis type.
Conclusion: Coronary perforation occurs relatively infrequently in
contemporary CTO PCI, and is associated with patient age, prior CABG, and
angiographic complexity. A small proportion of perforations required
pericardiocentesis.

<96>
Accession Number
616278890
Author
Martin M.H.; Shahanavaz S.; Peng L.; Riley M.; Gray R.; McElhinney D.
Institution
(Martin, Riley, Gray) University of Utah Medical Center, United States
(Shahanavaz) Washington University in Saint Louis, United States
(Peng, McElhinney) Stanford University, Lucile Packard Children's
Hospital, United States
Title
Percutaneous transcatheter pulmonary valve replacement in children
weighing less than 20kg.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S18), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Since FDA approval of the Melody valve in 2010, transcatheter
pulmonary valve replacement (TPVR) has been offered to an expanding
patient population. Limited data exist regarding the safety and
feasibility of TPVR in smaller patients. Methods: All patients weighing
<20 kg who underwent catheterization for potential percutaneous TPVR at 3
centers were reviewed. Results: Of the 43 patients reviewed, 35 (81%) had
successful percutaneous valve implantation and 8 (19%) were found not to
be candidates for percutaneous TPVR due to inadequate peripheral vein size
(n=3), coronary artery/aortic root compression (n=3), and right
ventricular outflow tract (RVOT) too large (n=2). Median age and weight in
the nonimplanted group was 6 yrs (5-8.2) and 18.7 kg (11.7-19.1). Two of
the 3 patients with inadequate vascular access underwent successful TPVR
via a hybrid perventricular approach at a later date. The 35 patients who
underwent successful percutaneous TPVR had a median age and weight of 5.8
yrs (3.3-10) and 17.7 kg (13.3-19.8), and most had tetralogy of Fallot
(TOF). The most common type of RVOT was a homograft conduit; 12 patients
had a non-conduit RVOT. The indication for TPVR was PR or mixed PR/PS in
all but 1 patient. TPVR was performed via femoral vein (FV) access in 16
patients and internal jugular vein (IJV) access in 19 patients. Nine
patients who converted from FV to IJV delivery were 1.5 kg smaller (17.8
vs. 16.3 kg, p=0.043). There were 4 adverse events, 1 iliac vein injury
requiring stent placement, 1 contained main pulmonary artery tear treated
with an occlusion device, and 2 patients with recurrent femoral vein
bleeding >24 hours post-procedure. All patients were alive at recent
follow-up, a median of 2.0 years (0.1-6.0) after TPVR. There was excellent
valve function; mean Doppler gradients ranged from 3-20 mmHg (median 7
mmHg), and all patients had trivial or mild PR except 1 who had moderate
PR 4.3 years after implant. There were no RVOT reinterventions and no
cases of endocarditis. Conclusion: Percutaneous TPVR can be safely
performed in patients <20kg with excellent mid-term results. The procedure
frequently requires IJV approach, and access site/bleeding complications
may be more common in this cohort.

<97>
Accession Number
616278881
Author
Irure J.; Riesco L.; Llano-Cardenal M.; Rubio-Ruiz S.; Romon I.;
Lopez-Hoyos M.; Cobo M.; Arribas D.S.S.
Institution
(Irure, Lopez-Hoyos) Marques De Valdecilla Universitary Hospital-IDIVAL,
Santander, Spain
(Riesco, Llano-Cardenal, Rubio-Ruiz, Romon, Cobo, Arribas) Marques De
Valdecilla Universitary Hospital, Santander, Spain
Title
Early post-transplant monitoring of anti-HLA antibodies in heart
transplant recipients fails to detect patients at risk of humoral
rejection.
Source
HLA. Conference: 31st European Immunogenetics and Histocompatibility
Conference, EFI 25th Annual Meeting of the German Society for
Immunogenetics, DGI. Germany. 89 (6) (pp 388), 2017. Date of Publication:
June 2017.
Publisher
Blackwell Publishing Ltd
Abstract
There is growing interest in the monitoring of anti-HLA antibodies after
heart transplantation as their presence has been linked with coronary
allograft vasculopathy (CAV) and implicated in allograft injury, but there
is no consensus in their follow-up timing. 93 consecutive patients that
underwent heart transplantation between 2011 and 2015 at the Marques de
Valdecilla Universitary Hospital were included in the study. The presence
of anti-HLA antibodies was assessed in pre-transplant sera and during the
first year every three months after transplantation by using LABScreen
Mixed and Single Antigen assays (One Lambda, Canoga Park, CA, USA),
according to the manufacturer's protocol. Positive specificities were
considered when two out of three criteria were fulfilled: raw mean
fluorescence intensity (MFI) above 1500, baseline MFI above 1000 and above
25% of maximum MFI. Anti-HLA antibodies were found prior to transplant in
6.5% of all recipients (two against HLA class I; two against class II and
two against both class I and class II antigens). 8.1% of the patients
analyzed prior transplantation had anti-HLA antibodies at three months and
8.6% at 12 months. Two out of six de novo reactions were donorspecific
(all against class II antigens) and both with rejection episode confirmed.
37.6% of patients had transplant rejection, being humoral rejection in 20%
of the cases. C4d staining was positive in 71.4% of the biopsies. 74.3% of
the patients who lost the graft did not present anti-HLA antibodies at any
time. Therefore, anti-HLA antibody monitoring in heart transplant patients
did not allow predicting graft rejection. Multi-center and prospective
studies on heart transplant candidates should be addressed in order to
assess the best plan of anti-HLA antibodies monitoring in heart transplant
recipients.

<98>
Accession Number
616278878
Author
Singh S.; Husseini O.; Kovacs D.; Parmar S.; Arora R.R.; Khosla S.
Institution
(Singh, Husseini, Arora) Chicago Medical School, Rosalind Franklin
University, United States
(Kovacs, Parmar, Khosla) Mt. Sinai Medical Center, United States
Title
PCI is as safe and efficasious as CABG for treatment of unprotected left
main coronary artery disease: A meta-analysis of randomized controlled
trials.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S117), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: The efficacy and safety percutaneous coronary intervention
(PCI) vs coronary-artery bypass grafting (CABG) in unprotected left main
coronary artery (UPLM) disease remains a matter of debate. Methods: We
sought to compare PCI against CABG among patients with UPLM disease using
only randomized data. The PubMed, EMBASE, and Cochrane Central Register of
Controlled Trials were searched for randomized controlled trials of PCI vs
CABG among patients with UPLM disease. Effect Sizes (ES) in form of Odds
Ratios were pooled using Der- Simonian and Laird random effect
meta-analysis models. Meta-regression analysis was conducted to explore
heterogeneity. Results: Five randomized trials comprising 4, 595 patients
were included in analysis. The contributing trials excluded proximal
triple vessel disease. At complete follow up (range 1 to 5 years), there
was no difference in all-cause mortality, myocardial infarction and major
adverse cardiovascular events among PCI vs CABG [Fig. 1]. PCI was
associated with significantly higher Target Vessel Revascularizations
[Odds Ratio (OR), 1.80; 95% Confidence Interval (CI), 1.44 to 216)] and
CABG was associated with significantly higher incidence of stroke (OR,
0.51; CI, 0.22, 0.79). Follow up duration or sample size did not alter the
outcomes upon metaregression analysis. Overall clinical and statistical
heterogeneity was low. Conclusion: There is no difference in all-cause
mortality, myocardial infarction and major adverse cardiovascular events
among PCI vs CABG for treatment of UPLM coronary artery disease. PCI leads
to higher Target Vessel Revascularizations and CABG is associated with
higher incidence of stroke.

<99>
Accession Number
616278871
Author
Yerasi C.; Moole H.; Mishra S.; Dawit S.; Nafisi S.; Kalya A.; Naik H.
Institution
(Yerasi, Mishra, Dawit, Nafisi, Kalya, Naik) St. Josephs Hospital, United
States
(Moole) University of Illinois College of Medicine At peoria, United
States
Title
Efficacy and safety of embolic protection devices during transcatheter
aortic valve replacement (TAVR): A systematic review and an updated
meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S209-S210), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Prior studies have shown that cerebrovascular accidents are
higher in TAVR group when compared to medical therapy or surgery.
Randomized controlled trials on Embolic protection devices (EPD) have been
relatively underpowered. The aim to study was to evaluate the efficacy and
safety of EPD during TAVR. Methods: Randomized trials evaluating the use
of EPD during TAVR were searched in Medline, Ovid, Clinical trials,
Meetings, Cochrane central register of controlled trials. Pooled
proportions were calculated using both Mantel-Haenszel method (fixed
effects model) and DerSimonian Laird method (random effects model). The
heterogeneity among studies was tested using I2 statistic. Results: Our
meta-analysis included 5 randomized clinical trials involving 643
patients. Median age of the population was 82 years. 46% were males, 33%
had DM, 7.2% had prior stroke, 31% had Atrial fibrillation and 15% had
PVD. Median STS risk score was 5.6. Implantation of EPD was successful in
90.4% patients. There was significant decrease in total cerebral lesion
volume (Standardized mean difference -0.71; 95% confidence interval [CI]
-0.95 to -0.48; p<0.00001; I2596%) and mean number of new
cerebral ischemic lesions (Standardized mean difference -0.30; 95% CI
-0.53 to -0.07; p<0.00001; I2596%), as assessed by follow up
MRI in EPD group when compared to control group. Number of patients with
worsening Montreal Cognitive assessment score (Odds ratio [OR] 0.79; 95%
CI 0.42 to 1.47, p=0.45), new ischemic lesions (OR 0.50 95% CI 0.21 to
1.17; p=0.11), new stroke during follow up (OR 0.62 95% CI 0.32 to 1.20;
p=0.15), all cause mortality (OR 0.70; 95% CI 0.52 to 2.24; p=0.55) and
any major vascular complication (OR 0.86; 95% CI 0.52 to 1.42; p5 0.56)
trended to be lower in embolic protection device group when compared to
control group. Conclusion: Our meta-analysis concludes that embolic
protection devices during TAVR significantly reduced the total cerebral
lesion volume and number of new cerebral ischemic lesions on MRI and
showed a trend towards lower major adverse clinical events. Further
randomized trials with larger sample sizes are needed to assess the effect
of use of embolic protection device on neurological and cognitive function
after TAVR. (Table Presented).

<100>
Accession Number
616278847
Author
Chava S.; Gentchos G.; Abernethy A.; Schmoker J.; Terrien E.; Dauerman H.
Institution
(Chava, Abernethy, Terrien, Dauerman) University of Vermont, Cardiology,
United States
(Gentchos, Schmoker) University of Vermont, United States
Title
Coronary CT angiography to detect severe coronary artery disease prior to
transcatheter aortic valve replacement.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S172), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Patients undergoing TAVR routinely undergo CT angiography
(CTA) and invasive coronary angiography (ICA) to assess aorto-iliac
pathology, annular dimension and coronary artery disease(- CAD). While CTA
may exclude severe CAD in younger patients, its efficacy prior to TAVR has
not been well studied. Methods: We retrospectively studied 50 consecutive
patients (Oct 2015 - Feb 2016) undergoing both ICA and CTA prior to TAVR
to determine the incidence of severe CAD (>=50% stenosis by QCA, visual
estimation by CTA) confined to 4 segments: left main and 3 prox to mid
major coronaries. Coronary assessment was performed using standard
reconstructed ECG phases (30%,40%, 60%, 70%) from pre-TAVR chest CTAs on a
Philips 256 iCT scanner; QCA and CTA measurements were done in a blinded
fashion. Results: Patients were predominantly elderly: 65% >=75 years old,
57% were female, half were diabetic and 45% had prior PCI. By ICA, 49% had
significant coronary calcification. Incidence of severe prox to mid vessel
CAD by ICA was 39%. A third of patients required PCI prior to TAVR. CTA
was unable to exclude severe prox to mid vessel CAD in 88% of patients in
all 4 segments: non-diagnostic CTA readings were mainly due to
calcification (60%) or motion artifact (28%). Nondiagnostic coronary CTA
readings ranged from 25-72% according to segment analyzed: only the left
main segment had diagnostic quality CTA in the majority of patients.
(p<0.01) Conclusion: PCI is performed frequently prior to TAVR based upon
ICA assessment. Routine chest CTA algorithms do not provide adequate
diagnostic information to exclude severe CAD, primarily due to severe
coronary calcification in the TAVR population. (Table Presented).

<101>
Accession Number
616278831
Author
Bounds R.; Naimi I.; Wang H.; Atallah-Yunes N.; Smith F.; Byrum C.;
Kveselis D.; Leonard G.; Egan M.; Devanagondi R.
Institution
(Bounds, Wang, Leonard, Devanagondi) University of Rochester Medical
Center, United States
(Naimi, Atallah-Yunes, Smith, Byrum, Kveselis, Egan) SUNY Upstate Medical
University, United States
Title
Increased incidence of severe pulmonary valve insufficiency up to 25 years
after balloon pulmonary valvuloplasty: A multicenter study.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S16-S17), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Balloon pulmonary valvuloplasty (BPV) is the treatment of
choice for moderate and severe pulmonary valve stenosis (PVS), though long
term outcome data to date is limited to small cohort, single center
studies. We evaluated the incidence and risk factors of>=moderate
pulmonary insufficiency (PI) after up to 25 years following initial BPV.
Methods: Patients with BPV from 12/4/1985 to 7/1/2015 for isolated PVS
from 3 separate centers (n=254) were included. PI severity by most recent
echo was the main outcome of interest. Risk factors for- >=moderate PI
were assessed by univariate and multivariate analysis. Results: Of the 254
patients enrolled in the study, mean age at initial BPV was 4.6 years
(range 1 day - 67 years), weight was 17.5 kg (range 2 -135 kg), initial
peak echocardiographic PVS gradient was 68 mmHg (IQR 55-81 mmHg), initial
cath right ventricular (RV) to pulmonary artery (PA) peak systolic
ejection gradient (PSEG) was 53 mmHg (IQR 40-70 mmHg), initial RV/systemic
ratio was 0.98 (range 0.33-2.29, IQR 0.7-1.39), and 19% had critical PVS.
32% had BPV prior to 1/1/2000. Follow up echocardiogram data was available
for 242 patients (mean 7.5 years after BPV, IQR 2-11.8 years, maximum 25
years). Of these patients, 69 (29%), had moderate to severe PI on most
recent echo (27% moderate PI, 2% severe PI). Four patients had PV
replacement due to severe PI 8-18 years after BPV. Younger age, lower
weight, greater initial RV to PA PSEG, greater RV/systemic pressure ratio
at initial BPV, critical PVS and longer follow up duration were associated
with>=moderate PI (all p<0.05). In multivariate analysis, lower weight (OR
0.8, 95% CI 0.67-0.96) and greater initial RV to PA PSEG (OR 1.021, 95% CI
1.001-1.041) remained independent risk factors for>=moderate PI. There was
no statistically significant association between balloon/annulus ratio or
presence of a genetic syndrome and>=moderate PI. Conclusion: In the
largest, multicenter study to date with up to 25 years follow up after
BPV, 29% of patients developed moderate to severe PI. Smaller patients
with more severe PVS were more likely to develop significant PI in late
follow up. Evidence for progressive PI over time necessitates lifelong
clinical follow up and further long-term study of this population.

<102>
Accession Number
616278814
Author
Morsy M.; Askari R.; Oluwaseun A.; Salem S.; Shahreyar M.; Shah R.
Institution
(Morsy, Askari, Oluwaseun, Salem, Shahreyar) University of Tennessee,
Health and Science Center, United States
(Shah) Memphis VA Medical Center, United States
Title
Relative efficacy of various generation drug-eluting stents and coronary
artery bypass grafting for left main disease: A network meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S113-S114), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Recently, several randomized controlled trials (RCTs) have
shown favorable results for PCI with drug eluting stents (DESs) for left
main coronary artery (LMCA) disease, but it is unclear whether new
generation DESs are more efficacious than older ones. Methods: Using data
from 6 RCTs involving 4700 patients, a Bayesian network meta-analysis was
performed utilizing a randomeffects model. Results: Coronary artery bypass
grafts (CABGs) were associated with a decreased risk of revascularization
but similar risks of death and MI compared to either generation of DESs
(Figure). Also, no differences in the risk of revascularization,
mortality, or MI were found between the two generations of DESs (Figure).
However, 1st generation DESs were associated with a numerically decreased
risk of stroke compared to CABG as well as a statistically significant
decreased risk compared to 2nd generation DESs (Figure). CABG was also
associated with decreased MACCE risk compared to 2nd generation DESs,
driven by a decreased rate of revascularization. However, the decreased
risk of revascularization with CABG, compared to 1st generation DESs, was
counterbalanced by an increased stroke risk, leading to similar MACCE
rates. Conclusion: In patients with LMCA disease, PCI with either
generation DESs yields similar all-cause mortality and MI when compared to
CABG. However, CABG results in decreased risk of revascularization
compared to either generation DESs but increased risk of stroke compared
to 1st generation DESs. This unexpected finding of increased stroke risk
with 2nd generation DESs seems to be driven by data from the NOBLE trial.
(Figure Presented).

<103>
Accession Number
616278811
Author
Velagapudi P.; Turagam M.; Katta N.; Kolte D.; Khera S.; Heo S.; Aronow
H.; Gordon P.; Abbott J.D.
Institution
(Velagapudi, Kolte, Heo, Aronow, Gordon, Abbott) Brown University Program,
Rhode Island Hospital, United States
(Turagam, Katta) University of Missouri Columbia, United States
(Khera) New York Medical College, United States
Title
Cerebral embolic protection device in transcatheter aortic valve
replacement: An updated meta-analysis of randomized controlled trials.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S206-S207), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Stroke is a known complication after transcatheter aortic
valve replacement (TAVR) and is associated with increased mortality and
morbidity. There are limited data on the role of cerebral embolic
protection devices (EPDs) in improving TAVR outcomes. We performed a
meta-analysis of randomized controlled trials (RCTs) comparing EPD vs no
EPD- during TAVR. Methods: A comprehensive literature search using PubMed,
Ebsco and Google Scholar for RCTs comparing EPD vs. no-EPD in TAVR was
performed. Five eligible RCTs consisting of 625 patients (EPD: 376, no
EPD: 249) undergoing TAVR were identified. Follow-up ranged from 1 to 6
months. Results: There was no significant difference in baseline
characteristics or follow up between both groups. Total lesion volume in
all territories (Fig 1) and total number of new lesions (Fig 2) as noted
on diffusion weighted magnetic resonance imaging (DW-MRI) were
significantly lower in the EPD group. There was no significant difference
in all-cause mortality (Fig 3), clinical stroke (Fig 4), acute kidney
injury (AKI) and major vascular complications between the two groups.
Conclusion: Our meta-analysis demonstrates significantly lower total
lesion volume and number of new lesions in all territories on DW-MRI in
the EPD group with no significant differences in clinical outcomes when
compared with no EPD in TAVR.

<104>
Accession Number
616278792
Author
Bajaj A.; Pancholy S.; Kaushik N.; Sethi A.; Thaker P.; Patel T.; Coppola
J.; Tiwari H.
Institution
(Bajaj, Pancholy, Kaushik) Wright Center for Graduate Medical Education,
United States
(Sethi) St.Lukes Cardiology Associates, United States
(Thaker) Abington Jefferson Health, United States
(Patel) Apex Heart Institute, India
(Coppola) New York University, School of Medicine, United States
(Tiwari) SMT.NHL Municipal Medical College, India
Title
Transcatheter versus Surgical aortic valve replacement for severe aortic
stenosis in patients with low to intermediate risk: A Meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S170), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has been
recognized as the treatment of choice for patients with severe aortic
stenosis who are considered high or prohibitive risk for surgery. The
scope of TAVR has been evaluated in low to intermediate risk population,
however, these studies are mostly observational and few in number. We
aimed to evaluate the outcomes in low to intermediate risk patients with
severe aortic stenosis who underwent TAVR compared to surgical aortic
valve replacement (SAVR). Methods: A systemic search of database,
including, Pubmed, Web of Science, Google scholar and Cochrane Database
were performed by two independent reviewers to identify relevant studies.
Studies were included comparing TAVR versus SAVR in patients with low to
intermediate risk. The primary outcome was 30 day mortality and secondary
outcomes were one year mortality, myocardial infarction, stroke, major or
life threatening bleeding, permanent pacemaker implantation, paravalvular
regurgitation and acute kidney injury. Results: Nine studies were included
in the analysis. There were no significant differences in 30 day (OR, 0.83
[CI 0.63,1.10], I2= 0%) and one year (OR, 0.92 [CI 0.78,1.09],
I2=0%) mortality between TAVR and SAVR group. There were also
no significant differences in myocardial infarction (OR, 0.65 [CI
0.40,1.05], I2=0%), and a stroke rate (OR, 0.83 [CI 0.64,1.07],
I2=0%) between the two groups. However, the rate of permanent
pacemaker implantation (OR, 3.97 [CI 2.12,7.45], I2=83%) and
moderate to severe paravalvular regurgitation (OR, 6.04 [CI 3.80,9.61],
I2=0%) were more in TAVR group and acute kidney injury (OR,
0.50 [CI 0.31,0.78], I2=65%) and major and life threatening
bleeding (OR, 0.29 [CI 0.15,0.55], I2=86%) were more in SAVR
group. Conclusion: TAVR and SAVR has a similar rate of mortality, stroke
and myocardial infarction rate. TAVR has more number of permanent
pacemaker implantation and paravalvular regurgitation rates and SAVR have
more number of life threatening bleeding and acute kidney injury.

<105>
Accession Number
616278781
Author
Ando T.; Takagi H.; Telila T.; Afonso L.
Institution
(Ando) Detroit Medical Center, United States
(Takagi) Shizuoka Medical Center, Japan
(Telila) Wayne State University, Detroit Medical Center Program, Harper
University, United States
(Afonso) Wayne State University, United States
Title
Does mild paravalvular regurgitation post transcatheter aortic valve
implantation affect survival?: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S204-S205), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: More than moderate post aortic regurgitation (PAR) after
transcatheter aortic valve implantation (TAVI) has decreased with the
advent of new-generation prosthetic valves. However, mild PAR remains
common and its clinical impact has been inconsistent. We aimed to assess
the impact of mild PAR through meta-analysis. Methods: A systematic
literature search was conducted through PUBMED and EMBSE. Manuscripts that
reported hazard ratio (HR) with 95% confidence interval (CI) for clinical
outcome of interest (allcause and cardiac mortality) has been included.
Random-effects model was used for calculation of HR. Results: A total of
25 articles including total of 21,018 patients were finally included for
quantitative synthesis (meta-analysis). Our pooled analysis demonstrated
higher all-cause mortality in patients with mild PAR compared to
none/trivial PAR (HR 1.26, 95%CI 1.11-1.43, I2=45%, p<0.001)
(follow up duration range 6 months to 5 years) (Figure 1). Significant
heterogenetiy among studies was observed (p for heterogeneity50.005).
Egger's test showed no evidence of asymmetry of the funnel plot.
Cardiovascular mortality was associated with increased in patients with
mild PAR compared with none/trivial PAR (HR 1.28, 95%CI 1.05-1.57,
I2=8%, p=0.02) (follow up duration range 1 to 3 years).
Conclusion: Mild PVR was associated with increased all-cause and
cardiovascular mortality after TAVI.

<106>
Accession Number
616278772
Author
Bajaj A.; Pancholy S.; Kaushik N.; Sethi A.; Thaker P.; Coppola J.; Patel
T.; Tiwari H.
Institution
(Bajaj, Pancholy, Kaushik) Wright Center for Graduate Medical Education,
United States
(Sethi) St.Lukes Cardiology Associates, United States
(Thaker) Abington Jefferson Health, United States
(Coppola) New York University, School of Medicine, United States
(Patel) Apex Heart Institute, India
(Tiwari) SMT.NHL Municipal Medical College, India
Title
Complete versus incomplete revascularization for concomitant CAD in
patients undergoing TAVR: A Meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S169-S170), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Patients undergoing Transcatheter aortic valve replacement
(TAVR) for symptomatic aortic stenosis (AS) have a high prevalence of
coronary artery disease (CAD) and it adversely impacts long term outcomes
of patients undergoing TAVR. However, the strategies for treatment of CAD
prior to TAVR are more heterogenous and no consensus exists whether a
"complete revascularization" (CR) strategy is superior to "incomplete
revascularization" (ICR) strategy. We aimed to assess the prognostic
effect of concomitant CAD, stratified by completeness versus the
incompleteness of revascularization, on the oneyear clinical outcomes.
Methods: A systemic search of database, including, Pubmed, Web of Science,
Google scholar and Cochrane Database were performed by two independent
reviewers to identify relevant studies. Studies were included comparing
complete versus incomplete revascularization with PCI for CAD in patients
undergoing TAVR. The primary outcome was one year all cause mortality. We
also evaluated the outcome stratified by residual syntax score (less than
8 versus more than 8). Results: Seven studies were included in the
analysis. The prevalence of CAD was 45.9% in our pooled sample. The one
year all-cause mortality was comparable between the 2 groups (19.7% in CAD
group and 17.3% in no CAD group, OR=1.08, [CI 0.79,1.49], I25 0%). Five
studies reported data on complete versus incomplete revascularization.
There was no difference in one year all-cause mortality among two groups
(18.8% in CR group versus 27.7% in ICR group, OR=0. 58, [CI 0.20,1.70],
I2= 86%). The one year all cause mortality was also not different between
patients with a residual syntax score less than 8 and more than 8 (18.3%
vs 36%, respectively, OR=0.29, [CI 0.08,1.11], I25 77%). Conclusion: The
presence of CAD, incomplete revascularization strategy, and residual
unrevascularized CAD burden are not associated with decreased survival in
patients with AS and CAD undergoing TAVR. (Figure Presented).

<107>
Accession Number
616278757
Author
Khan S.; Heckle M.; Morsy M.; Nayyar M.; Rashid A.; Shah R.
Institution
(Khan) Aga Khan University, Pakistan
(Heckle, Morsy, Nayyar, Rashid, Shah) University of Tennessee, United
States
Title
Drug eluting stents are associated with improved survival in patients with
unprotected left main coronary artery disease: An updated comprehensive
network meta-analysis of randomized trials.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S107-S108), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Coronary artery bypass graft (CABG) surgery has been shown to
improve survival compared to medical therapy (MT) for unprotected left
main coronary artery (LMCA) disease. Randomized controlled trials (RCTs)
have also suggested an equivalence between drug eluting stents (DESs) and
CABG, but no RCT directly compares DES with MT. Therefore, AHA/ACC
guidelines have assigned a Class IIa recommendation to PCI for improving
survival in high-surgical-risk patients with LMCA disease based on an
indirect comparison using network metaanalysis. However, since those
analyses, several new RCTs, including the two largest ones using
new-generation DESs, have been reported; therefore, those network
meta-analyses can be argued to be outdated. Thus, we conducted an updated
comprehensive network metaanalysis of RCTs to compare CABG, MT, and PCI
for LMCA disease. Methods: Using data from 8 RCTs involving the largest
sample size (4850 patients) ever reported, a Bayesian network
meta-analysis was performed utilizing a random-effects model on the
longest follow-up data available in each trial. Results: Both CABG (OR,
0.22; 95% CI, 0.09-0.63) and PCI (OR, 0.21; 95% CI, 0.08-0.64) were
associated with decreased risk for all-cause mortality compared to MT
alone (Figure). No difference in all-cause mortality was found between PCI
and CABG (OR, 0.97; 95% CI, 0.74-1.27). Conclusion: Both DES and CABG were
associated with improved survival from LMCA disease compared to medical
therapy alone, but no difference was found between the two
revascularizations strategies. (Table Presented).

<108>
Accession Number
616278753
Author
Tandar A.; Luton K.; Saidi A.F.; Lindman B.; Bull D.; Patel A.; Dranow E.;
Stoddard G.; Welt F.G.P.
Institution
(Tandar, Saidi, Bull, Patel, Dranow, Stoddard, Welt) University Of Utah
Hospitals And Clinics, United States
(Tandar) Intermountain Utah Heart Clinic, United States
(Luton) Banner - University Medical Center Tucson, United States
(Lindman) George Washington University Hospital, United States
Title
Stroke prevention with carotid compression in patients undergoing
transcatheter aortic valve replacement: A multi-center study.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S201-S202), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has
revolutionized the management of severe aortic stenosis. TAVR, however, is
associated with several complications including stroke. Carotid
compression has been suggested as a maneuver to reduce embolic events.
Therefore, we sought to study the association between carotid compression
and the incidence of transient ischemic attack (TIA) and stroke in
patients undergoing TAVR Methods: This is a retrospective multicenter
study of patients who underwent TAVR with and without carotid compression.
Primary outcomes were stroke or TIA at 72 hours post-procedure and between
72 hours and 30-day follow-up Results: A total of 536 TAVR patients were
included in the study. Patients were divided into two groups. Group I
includes patients who did not undergo carotid compression (n=361), group
II included patients who underwent carotid compression (n=175) during
TAVR. The mean age was 81.9+/-8.1 years in group I and 78.8+/-7.3 in group
II. A complete baseline and procedure characteristics are shown in the
table. There was no significant difference in combined stroke/TIA rates at
72 hours post-procedure (1.5% vs. 2.1%, p=0.65) or between 72 hours and
30- day follow-up (1.6% vs 2.5%, p=0.54). Similarly, was no significant
difference between groups with regard to major stroke rate postprocedure-
72 hours (1.4% vs 1.2%, p=0.83) or between 72 hours and 30-day follow-up
(0.8% vs 2.5%, p=0.21) (Figure 1). Analysis to evaluate the association
between specific clinical characteristics and carotid compression with
regard to major stroke and TIA risk post-procedure (procedure to 72 hours)
was completed. Due to the small number of events in the sample population,
subgroup analysis could be completed on only the following baseline
characteristics: diabetes, atrial fibrillation, previous stroke or TIA,
prior carotid stenosis, and gender. There was no change in risk for major
stroke at discharge among subgroups analyzed (Figure 2). Conclusion:
Stroke prevention by means of using carotid compression during TAVR may
not have an impact on the incidence rate of TIA or major stroke after
TAVR. However, larger prospective randomized clinical trials may be
warranted.

<109>
Accession Number
616278738
Author
Reddy G.; Wang Z.; Holmes D.R.
Institution
(Reddy, Wang, Holmes) Mayo Clinic, United States
Title
Transcatheter aortic valve replacement for stenotic bicuspid aortic
valves: Meta analysis of observational studies.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S200), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: The use of transcatheter aortic valve replacement (TAVR) for
bicuspid aortic valve stenosis (BAV) has been reported in case series.
Adverse signals related to valve malposition, paravalvular regurgitation
(PVL), pacemaker implantation (PPM) rates and excessive mortality were
noted in some studies. Findings are limited by small sample sizes. We
therefore performed systematic review and meta analyses of observational
studies of TAVR for BAV. Methods: We searched Medline, Embase, Central,
PubMed, Scopus from database inception to September 30, 2016. Valve
Academic Research Consortium (VARC) 2 definitions were used. The primary
end points were device success and early safety. Secondary end points were
individual components of the primary end points. DerSimonian and Laird
random effect models were used to pool event rates. Results: We found 13
unique studies with 758 BAV patients. Where bicuspid type was reported,
16.1% had Type 0, 45.3% had Type I, 3.8% had Type II, with the rest
(34.8%) being indeterminate. 50% had Edwards Sapien and 32% had Medtronic
Corevalve. Other devices included Lotus valve (1.8%) and Venus device
(0.7%). The pooled device success rate was 94.0% (95% CI 90% to 97%).
Early safety events occurred in 17% (95% CI 12% to 22%). All-cause
mortality was 4% (95% CI 2% to 6%). PVL 2+ or greater was present in 12%
(95% CI 3% to 25%), The PPM rate was 18% (95% CI 14% to 22%) (Figure 2).
There was no correlation between outcomes and MDCT use, BAV type and TAVR
device. We compared outcomes with those from the ACC STS TVT registry and
high risk/extreme risk cohorts of the PARTNER II (Sapien S3) and the
CoreValve (Evolut R) studies (Figure 3). The STS PROM as marker of
procedural risk is similar. All cause death is also comparable. A signal
towards higher PVL and PPM rates is seen in the pooled BAV analysis,
consistent with observations from prior studies. Conclusion: This analysis
indicates that TAVR for BAV is technically feasible. All-cause mortality
at 30 days is low and comparable to that achieved with current generation
TAVR valves. However, there may be a trend toward higher rates of PVL and
PPM implantation. Operators should therefore weigh the potentially
increased risk of PVL and PPM against the definite clinical benefit
provided by TAVR. (Table Presented).

<110>
Accession Number
616278725
Author
Alam M.; Khan M.; Ahmad W.; Hamzeh I.; Virani S.; Jneid H.; Denktas A.;
Lakkis N.
Institution
(Alam, Hamzeh, Lakkis) Baylor College of Medicine, United States
(Khan) McLaren Flint - Michigan State University, United States
(Ahmad) Nishtar Medical College, United States
(Virani, Jneid, Denktas) Baylor College of Medicine, Michael E. DeBakey
Veterans Affair Medical Center, United States
Title
Long term outcomes of percutaneous coronary intervention vs. coronary
artery bypass grafting in 6,637 patients with unprotected left main
coronary artery disease in the era of drug eluting stents: A
meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S104-S105), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Patients with unprotected left main coronary artery (ULMCA)
disease are increasingly being treated with percutaneous coronary
intervention (PCI) using drug-eluting stents (DES), but long term outcomes
comparing PCI with coronary artery bypass grafting (CABG) remain limited.
Methods: We performed aggregate data meta-analyses of clinical outcomes
[all cause death; non-fatal myocardial infarction (MI); stroke; repeat
revascularization; cardiac death and major adverse cardiac and
cerebrovascular events (MACCE)] in studies comparing 5 year outcomes of
PCI with DES vs. CABG in patients with ULMCA disease. A comprehensive
literature search (01/01/2003 to 12/10/2016) identified 9 studies (6,637
patients). Effect size for individual clinical outcomes were estimated
using odds ratio (OR) with 95% Confidence Intervals (CI) using a
random-effects model. Results: At 5 years, PCI with DES was associated
with equivalent cardiac (OR 0.95, 95% CI 0.62 - 1.46) and all cause
mortality (OR 0.98, 95% CI 0.72-1.33), lower rates of stroke (OR 0.50, 95%
CI 0.30-0.84) and higher rates of repeat revascularization (OR 2.52, 95%
CI 1.63-3.91), MACCE showed a trend favoring CABG but did not reach
statistical significance (OR 1.19, 95% CI 0.93- 1.54). Conclusion: For
ULMCA disease, PCI can be considered as an effective and yet less invasive
alternative to CABG given the comparable long term mortality and lower
incidences of stroke in a selected group of patients. (Figure Presented).

<111>
Accession Number
616278666
Author
Bansal M.; Kobayashi D.; Forbes T.; Nykanen D.
Institution
(Bansal) University of Iowa, Stead Family Children's Hospital, United
States
(Kobayashi, Forbes) Children's Hospital of Michigan, United States
(Nykanen) Heart Center at Arnold Palmer Hospital for Children, United
States
Title
Does trainee affect outcomes in pediatric cardiac catherization
laboratory? A Congenital Cardiovascular Interventional Study Consortium
(CCISC) study.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S135), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: No previous study has analyzed the effects of presence of a
trainee and outcome of pediatric cardiac catheterization procedures. Our
objective to identify association of a trainee and outcomes in pediatric
cardiac catheterization laboratory. Methods: This is a multicenter
observation study of the effects of presence of a trainee in pediatric
cardiac catheterization laboratory. The 2 groups were divided based on
presence of the trainee during the procedure. Subject's demographic and
procedural data were analyzed. Results: A total of 5067 cardiac
catheterization procedures were included from 16 sites in 2015 and 2016. A
trainee was present in 52% of the cases (n=2635). There was no difference
in the weight, age, total CRISP (Catheterization risk score for
Pediatrics) score (table 1). The procedure and sheath duration was higher
in the trainee group. The fluoroscopy time and adverse events were not
statistically different between the 2 groups (table 2) Conclusion:
Presence of a trainee is not associated with increased frequency of
adverse events in the pediatric cardiac catheterization laboratory. The
procedure time and sheath duration is higher in trainee group but is not
clinically significant.

<112>
Accession Number
616278625
Author
Mina G.; Watti H.; Soliman D.; Atkins J.; Dominic P.
Institution
(Mina, Watti, Soliman, Atkins, Dominic) LSU, Shreveport, United States
Title
New generation drug eluting stents versus coronary artery bypass grafting
for multivessel and/or left main coronary artery disease. A comprehensive
network meta-analysis of randomized controlled trials.
Source
Catheterization and Cardiovascular Interventions. Conference: 40th Annual
Scientific Sessions of the Society for Cardiovascular Angiography and
Intervention, SCAI 2017. United States. 89 (pp S67-S68), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Coronary artery bypass grafting (CABG) is associated with
better outcomes in patients with multivessel coronary artery disease (MVD)
when compared to percutaneous coronary intervention (PCI) with old
generation stents. However, data on the new generation drug eluting stents
(DES) is unclear. Methods: We searched PUBMED and Cochrane database for
randomized controlled trials evaluating revascularization of MVD and/or
left main disease (LMD) with CABG and/or new generation DES (everolimus
eluting stents, zotarolimus eluting stents and biolimus eluting stents).
Primary outcome was major adverse cardiac events (MACE) at one year and
3-5 years. Secondary outcomes were mortality, myocardial infarction (MI)
and repeat revascularization at 3-5 years A network meta-analysis was
performed by mixed treatment comparison analyses using random effect
models. Results: We included 17 trials with a total of 11,580 patients.
There was no significant difference in MACE between patients treated with
new generation DES and those treated with CABG at one year (OR: 0.77, CI:
0.52-1.12) or at 3-5 years (OR: 0.76, CI: 0.52-1.17). likewise, there was
no significant difference between CABG and new generation DES in mortality
(OR: 0.85, CI: 0.311.99) and MI (OR: 0.62, CI: 0.2- 1.69). On the other
hand, PCI with new generation DES was associated with an increased rate of
repeat revascularization (OR: 0.56, CI: 0.36- 0.82). In a subgroup of
patients with LMD, there were no significant differences between CABG and
new generation DES in any of the studied outcomes. Conclusion: When
compared to CABG, PCI using new generation DES has similar rate of MACE
and increased long term repeat revascularization in patients with MVD. On
the other hand, outcomes of the new generation DES are similar to CABG in
patients with LMD.

<113>
Accession Number
614272324
Author
de Souza Brito F.; Mehta R.H.; Lopes R.D.; Harskamp R.E.; Lucas B.D.;
Schulte P.J.; Tardif J.-C.; Alexander J.H.
Institution
(de Souza Brito, Mehta, Lopes, Harskamp, Alexander) Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC, United States
(Lucas) Clinical Research, Charleston Area Medical Center Health Education
and Research Institute, Charleston, WVa, United States
(Schulte) Department of Health Sciences Research, Mayo Clinic, Rochester,
Minn, United States
(Tardif) Montreal Heart Institute, Quebec, Canada
Title
Nonsteroidal Anti-Inflammatory Drugs and Clinical Outcomes in Patients
Undergoing Coronary Artery Bypass Surgery.
Source
American Journal of Medicine. 130 (4) (pp 462-468), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used
in perioperative pain management of patients undergoing coronary artery
bypass graft surgery. However, the association of periprocedural use of
NSAIDs and clinical outcomes after coronary artery bypass graft is
understudied. Methods We conducted a retrospective analysis using pooled
data from 2 multicenter randomized controlled trials (PREVENT IV [n =
3014] and MEND-CABG II [n = 3023]). Rates of death, death or myocardial
infarction, and death, myocardial infarction, or stroke in the 30 days
following coronary artery bypass graft surgery were compared in patients
using or not using perioperative NSAIDs. Inverse probability of treatment
weighting and Cox proportional hazards regression models were used to
adjust for confounding. Results A total of 5887 patients were studied.
Median age was 65 years, 78% were male, and 91% were White. NSAIDs were
used in 2368 (40.2%) patients. The majority of patients (1822 [30.9%])
received NSAIDs after coronary artery bypass graft surgery; 289 (4.9%)
used them prior to and after the surgery; and 257 (4.4) received NSAIDs
prior to the surgery only. Adjusted 30-day outcomes were similar in
patients receiving and not receiving NSAIDs (death: hazard ratio [HR]
1.18; 95% confidence interval [CI], 0.48-2.92; death or myocardial
infarction: HR 0.87; 95% CI, 0.42-1.79; death, myocardial infarction, or
stroke: HR 0.87; 95% CI, 0.46-1.65). Conclusion In this pooled data
analysis, perioperative NSAID use was common among patients undergoing
coronary artery bypass graft surgery and was not associated with an
increased short-term risk for major adverse clinical
outcomes. Copyright © 2016 Elsevier Inc.

<114>
Accession Number
616105938
Author
Voitov A.; Omelchenko A.; Gorbatykh Y.; Zaitsev G.; Arkhipov A.; Soynov
I.; Bogachev-Prokophiev A.; Karaskov A.
Institution
(Voitov, Omelchenko, Gorbatykh, Zaitsev, Arkhipov, Soynov,
Bogachev-Prokophiev, Karaskov) Department of Congenital Heart Surgery,
State Research Institute of Blood Circulation Pathology, Novosibirsk,
Russian Federation
Title
Outcomes of perventricular off-pump versus conventional closure of
ventricular septal defects: A prospective randomized study.
Source
European Journal of Cardio-thoracic Surgery. 51 (5) (pp 980-986), 2017.
Article Number: ezx002. Date of Publication: 01 May 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Perventricular device closure (PVDC) of ventricular septal
defects (VSDs) has demonstrated excellent clinical results. However, no
prospective studies have compared PVDC with the conventional approach
(CA). METHODS: Between June 2012 and August 2014, 640 consecutive patients
with isolated VSD were enrolled in the study, and randomized into the PVDC
group (n = 320) and the CA group (n = 320). The mean ages were 36.2 (10;
36) months and 36.2 (10; 36) months, respectively. The average weights
were 13.9 (8.1; 15.0) kg and 14.5 (6.9; 13.8) kg, respectively. The mean
follow-up was 24.9 (standard deviation 1.8) months. RESULTS: No early or
late deaths occurred in either group. The procedural success rate reached
96.6% in the PVDC group, with a 3.4% conversion rate to CA. Mean procedure
time was 56.9 (30; 70) min in the PVDC group and 162 (120; 180) min in the
CA group (P = 0.000). Thirteen (3.9%) patients in the CA group and only 4
(1.3%) in the PVDC group required postoperative blood transfusion in the
intensive care unit (P = 0.040). At the final follow-up, significantly
more residual shunts were found in the CA group. No rhythm or conduction
disorders occurred in any patient of either group. CONCLUSIONS: According
to the mid-term follow-up results, PVDC has similar efficacy to CA for VSD
closure. The off-pump PVDC technique reduces blood product transfusion and
the procedural time and minimizes surgical trauma while providing
excellent cosmetic results. Copyright © The Author 2017.
Published by Oxford University Press. All rights reserved.

<115>
Accession Number
613834196
Author
Alexander G.C.; Iyer G.; Lucas E.; Lin D.; Singh S.
Institution
(Alexander, Iyer, Lucas, Lin) Department of Epidemiology, Johns Hopkins
Bloomberg School of Public Health, Baltimore, Md, United States
(Alexander, Iyer, Lucas, Lin, Singh) Center for Drug Safety and
Effectiveness, Johns Hopkins University, Baltimore, Md, United States
(Alexander, Singh) Division of General Internal Medicine, Department of
Medicine, Johns Hopkins Medicine, Baltimore, Md, United States
Title
Cardiovascular Risks of Exogenous Testosterone Use Among Men: A Systematic
Review and Meta-Analysis.
Source
American Journal of Medicine. 130 (3) (pp 293-305), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Purpose We sought to evaluate whether exogenous testosterone therapy is
associated with increased risk of serious cardiovascular events as
compared with other treatments or placebo. Methods Study selection
included randomized controlled trials (RCTs) and observational studies
that enrolled men aged 18 years or older receiving exogenous testosterone
for 3 or more days. The primary outcomes were death due to all causes,
myocardial infarction, and stroke. Secondary outcomes were other hard
clinical outcomes such as heart failure, arrhythmia, and cardiac
procedures. Peto odds ratio was used to pool data from RCTs. Risk of bias
was assessed using Cochrane Collaboration tool and Newcastle and Ottawa
scale, respectively. The strength of evidence was evaluated using the
Grades of Recommendation, Assessment, Development, and Evaluation Working
Group approach. Results A total of 39 RCTs and 10 observational studies
were included. Meta-analysis was done using data from 30 RCTs. Compared
with placebo, exogenous testosterone treatment did not show any
significant increase in risk of myocardial infarction (odds ratio [OR]
0.87; 95% CI, 0.39-1.93; 16 RCTs), stroke (OR 2.17; 95% CI, 0.63-7.54; 9
RCTs), or mortality (OR 0.88; 95% CI, 0.55-1.41; 20 RCTs). Observational
studies showed marked clinical and methodological heterogeneity. The
evidence was rated as very low quality due to the high risk of bias,
imprecision, and inconsistency. Conclusions We did not find any
significant association between exogenous testosterone treatment and
myocardial infarction, stroke, or mortality in randomized controlled
trials. The very low quality of the evidence precludes definitive
conclusion on the cardiovascular effects of testosterone. Copyright
© 2016 Elsevier Inc.

<116>
Accession Number
614112417
Author
Zhao B.-C.; Huang T.-Y.; Deng Q.-W.; Liu W.-F.; Liu J.; Deng W.-T.; Liu
K.-X.; Li C.
Institution
(Zhao, Liu, Deng, Liu, Li) Department of Anesthesiology, Nanfang Hospital,
Southern Medical University, Guangzhou, China
(Zhao, Deng, Liu) Department of Anesthesiology, the First Affiliated
Hospital, Sun Yat-Sen University, Guangzhou, China
(Huang) Department of Ultrasonography, the First Affiliated Hospital, Sun
Yat-Sen University, Guangzhou, China
Title
Prophylaxis Against Atrial Fibrillation After General Thoracic Surgery:
Trial Sequential Analysis and Network Meta-Analysis.
Source
Chest. 151 (1) (pp 149-159), 2017. Date of Publication: 01 Jan 2017.
Publisher
Elsevier Inc
Abstract
Background Postoperative atrial fibrillation/flutter (POAF) is associated
with significant morbidity and mortality after general thoracic surgery,
but the need for and the best agent for prophylaxis remains obscure.
Methods A systematic literature search was performed to identify
randomized controlled trials that compared regimens for POAF prophylaxis
after general thoracic surgery. Random-effects meta-analyses with trial
sequential analyses were performed to compare the effects of medical
prophylaxis vs placebo/usual care. The risk of POAF among patients
receiving various prophylactic regimens was subjected to Bayesian network
meta-analysis. Results Twenty-two trials (2,891 patients and 11 regimens)
were included. Overall, medical prophylaxis reduced the incidence of POAF
(OR, 0.33; 95% CI, 0.22-0.49) but not short-term mortality (OR, 0.85; 95%
CI, 0.41-1.73). There was no significant difference in patient withdrawal
due to adverse events (OR, 1.67; 95% CI, 0.67-4.16). Trial sequential
analysis showed that as of 2012, sufficient evidence had accrued in
support of the effectiveness of medical prophylaxis in reducing POAF after
general thoracic surgery. In network meta-analysis, beta-blockers,
angiotensin-converting enzyme inhibitors, amiodarone, magnesium, and
calcium channel blockers significantly reduced the risk of POAF compared
with placebo/usual care. beta-Blockers had the highest probability of
being the most effective agents (OR, 0.12; 95% credible interval [CrI],
0.05-0.27; probability of being best, 77.7%; number needed to treat, 5.2).
Conclusions The current literature supports the effectiveness and
tolerability of medical prophylaxis and the superiority of beta-blockers
in preventing POAF after general thoracic surgery. beta-Blockers are
recommended, taking into consideration the status of the bronchopulmonary
system. Copyright © 2016 American College of Chest Physicians

<117>
Accession Number
615956392
Author
Sabatine M.S.; Giugliano R.P.; Keech A.C.; Honarpour N.; Wiviott S.D.;
Murphy S.A.; Kuder J.F.; Wang H.; Liu T.; Wasserman S.M.; Sever P.S.;
Pedersen T.R.
Institution
(Sabatine, Giugliano, Wiviott, Murphy, Kuder) Division of Cardiovascular
Medicine, Brigham and Women's Hospital, 60 Fenwood Rd, Boston, MA 02115,
United States
(Keech) Sydney Medical School, National Health and Medical Research
Council Clinical Trials Centre, University of Sydney, Sydney, Australia
(Honarpour, Wang, Liu, Wasserman) Amgen, Thousand OaksCAUnited States
(Sever) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
University of Oslo, Oslo, Norway
Title
Evolocumab and clinical outcomes in patients with cardiovascular disease.
Source
New England Journal of Medicine. 376 (18) (pp 1713-1722), 2017. Date of
Publication: 04 May 2017.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Evolocumab is a monoclonal antibody that inhibits proprotein
convertase subtilisin-kexin type 9 (PCSK9) and lowers low-density
lipoprotein (LDL) cholesterol levels by approximately 60%. Whether it
prevents cardiovascular events is uncertain. METHODS We conducted a
randomized, double-blind, placebo-controlled trial involving 27,564
patients with atherosclerotic cardiovascular disease and LDL cholesterol
levels of 70 mg per deciliter (1.8 mmol per liter) or higher who were
receiving statin therapy. Patients were randomly assigned to receive
evolocumab (either 140 mg every 2 weeks or 420 mg monthly) or matching
placebo as subcutaneous injections. The primary efficacy end point was the
composite of cardiovascular death, myocardial infarction, stroke,
hospitalization for unstable angina, or coronary revascularization. The
key secondary efficacy end point was the composite of cardiovascular
death, myocardial infarction, or stroke. The median duration of follow-up
was 2.2 years. RESULTS At 48 weeks, the least-squares mean percentage
reduction in LDL cholesterol levels with evolocumab, as compared with
placebo, was 59%, from a median baseline value of 92 mg per deciliter (2.4
mmol per liter) to 30 mg per deciliter (0.78 mmol per liter) (P<0.001).
Relative to placebo, evolocumab treatment significantly reduced the risk
of the primary end point (1344 patients [9.8%] vs. 1563 patients [11.3%];
hazard ratio, 0.85; 95% confidence interval [CI], 0.79 to 0.92; P<0.001)
and the key secondary end point (816 [5.9%] vs. 1013 [7.4%]; hazard ratio,
0.80; 95% CI, 0.73 to 0.88; P<0.001). The results were consistent across
key subgroups, including the subgroup of patients in the lowest quartile
for baseline LDL cholesterol levels (median, 74 mg per deciliter [1.9 mmol
per liter]). There was no significant difference between the study groups
with regard to adverse events (including new-onset diabetes and
neurocognitive events), with the exception of injection-site reactions,
which were more common with evolocumab (2.1% vs. 1.6%). CONCLUSIONS In our
trial, inhibition of PCSK9 with evolocumab on a background of statin
therapy lowered LDL cholesterol levels to a median of 30 mg per deciliter
(0.78 mmol per liter) and reduced the risk of cardiovascular events. These
findings show that patients with atherosclerotic cardiovascular disease
benefit from lowering of LDL cholesterol levels below current
targets. Copyright © 2017 Massachusetts Medical Society.

<118>
Accession Number
613692212
Author
Conrotto F.; D'Ascenzo F.; D'Amico M.; Moretti C.; Pavani M.; Scacciatella
P.; Omede P.; Montefusco A.; Biondi-Zoccai G.; Gaita F.; Maisano F.;
Nietlispach F.
Institution
(Conrotto, D'Ascenzo, D'Amico, Moretti, Pavani, Scacciatella, Omede,
Montefusco, Gaita) Division of Cardiology, Citta della Salute e della
Scienza Hospital, Turin, Italy
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Rome, Italy
(Maisano, Nietlispach) Heart Surgery and Cardiology, University Heart
Center, Zurich, Switzerland
Title
Outcomes of patients with low-pressure aortic gradient undergoing
transcatheter aortic valve implantation: A Meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 89 (6) (pp 1100-1106),
2017. Date of Publication: May 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: The risk/benefit balance of transcatheter aortic valve
implantation (TAVI) in patients with low-gradient aortic stenosis (LGAS)
remains to be well defined. Aim of the study was to investigate the impact
of LGAS in patients undergoing TAVI. Methods: Medline, Cochrane Library,
and Scopus were searched for articles reporting outcome of patients with
LGAS undergoing TAVI. The primary endpoint was 12-months all-cause
mortality and the secondary endpoint was 30-day all-cause mortality. Using
event-rates as dependent variable, a meta-regression was performed to test
for interaction between baseline clinical features (age, gender, diabetes
mellitus, coronary artery disease, left ventricular ejection fraction
(LVEF) and type of implanted valve) and transaortic gradient for the
primary endpoint. Results: Eight studies with a total of 12,589 patients
were included. Almost one-third of the patients presented with LGAS
(27.3%: 24.4-29.2). Median LVEF was 48% in patients with LGAS and 56% in
patients with high-gradient AS. Patients with LGAS were more likely to
have diabetes mellitus, previous coronary artery disease, higher mean
Logistic EuroSCORE, and lower EF. At 12 (12-16.6) months, low transaortic
gradient emerged as independently associated with all-cause death, both if
evaluated as a dichotomous and continuous value (respectively OR 1.17;
1.11-1.23 and OR 1.02; 1-1.04, all CI 95%). Clinical variables, including
EF did not affect this result. Conclusions: In a population of TAVI
patients, LGAS appears to be independently related to dismal prognosis.
© 2016 Wiley Periodicals, Inc. Copyright © 2016 Wiley
Periodicals, Inc.

<119>
Accession Number
616115547
Author
Robertson J.M.; Dias R.D.; Yule S.; Smink D.S.
Institution
(Robertson, Dias, Yule, Smink) STRATUS Center for Medical Simulation,
Brigham and Women's Hospital, 75 Francis Street, Neville House, Boston, MA
02115, United States
(Robertson) Department of Emergency Medicine, Harvard Medical School,
Boston, MA, United States
(Yule, Smink) Department of Surgery, Harvard Medical School, Boston, MA,
United States
(Yule, Smink) Center for Surgery and Public Health, Brigham and Women's
Hospital, Boston, MA, United States
Title
Operating room team training with simulation: A systematic review.
Source
Journal of Laparoendoscopic and Advanced Surgical Techniques. 27 (5) (pp
475-480), 2017. Date of Publication: May 2017.
Publisher
Mary Ann Liebert Inc. (E-mail: info@liebertpub.com)
Abstract
Introduction: Nontechnical skills (NTS) such as teamwork and communication
play an important role in preventing adverse outcomes in the operating
room (OR). Simulation-based OR team training focused on these skills
provides an environment where team members can learn with and from one
another. We sought to conduct a systematic review to identify
simulation-based approaches to NTS training for surgical teams. Materials
and Methods: We conducted a systematic search of PubMed, ERIC, and the
Cochrane Database using keywords and MeSH terms for studies describing
simulation-based training for OR teams, including members from surgery,
anesthesia, and nursing in September 2016. Information on the simulations,
participants, and NTS assessments were abstracted from the articles
meeting our search criteria. Results: We identified 10 published articles
describing simulation-based OR team-training programs focused on NTS. The
primary focus of these programs was on communication, teamwork,
leadership, and situation awareness. Only four of the programs used a
validated instrument to assess the NTS of the individuals or teams
participating in the simulations. Discussion: Simulation-based OR
team-training programs provide opportunities for NTS development and
reflection by participants. Future programs could benefit from involving
the full range of disciplines and professions that compose an OR team, as
well as increased use of validated assessment instruments. ©
Copyright 2017, Mary Ann Liebert, Inc. 2017.

<120>
Accession Number
610427069
Author
Regueiro A.; Altisent O.A.-J.; Del Trigo M.; Campelo-Parada F.; Puri R.;
Urena M.; Philippon F.; Rodes-Cabau J.
Institution
(Regueiro, Altisent, Del Trigo, Campelo-Parada, Puri, Philippon,
Rodes-Cabau) Quebec Heart and Lung Institute, Laval University, 2725
Chemin Ste-Foy, Quebec City, QC G1V 4GS, Canada
(Urena) Cardiology Department, Bichat-Claude Bernard Hospital, Paris,
France
Title
Impact of new-onset left bundle branch block and periprocedural permanent
pacemaker implantation on clinical outcomes in patients undergoing
transcatheter aortic valve replacement.
Source
Circulation: Cardiovascular Interventions. 9 (5) (no pagination), 2016.
Article Number: e003635. Date of Publication: 01 May 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Available data on the clinical impact of new-onset left
bundle branch block (LBBB) and permanent pacemaker implantation (PPI)
after transcatheter aortic valve replacement (TAVR) remains controversial.
We aimed to evaluate the impact of (1) periprocedural new-onset LBBB or
PPI post-TAVR on cardiac mortality and all-cause 1-year mortality and (2)
new-onset LBBB on the need for PPI at 1-year follow-up. Methods and
Results - We performed a systematic search from PubMed and EMBASE
databases for studies reporting raw data on new-onset LBBB post-TAVR and
the need for PPI or mortality at 1-year follow-up, or on 1-year mortality
according to the need for periprocedural PPI post-TAVR. Data from 17
studies, including 4756 patients (8 studies) and 7032 patients (11
studies) for the evaluation of the impact of new-onset LBBB and
periprocedural PPI post-TAVR were sourced, respectively (with 2 studies
used for both outcomes). New-onset LBBB post-TAVR was associated with a
higher risk of PPI (risk ratio [RR], 2.18; 95% confidence interval [CI],
1.28-3.70) and cardiac death (RR, 1.39; 95% CI, 1.04-1.86) during
follow-up, as well with a tendency toward an increase in all-cause
mortality (RR, 1.21; 95% CI, 0.98-1.50). Periprocedural PPI post-TAVR was
not associated with any increased risk of all-cause mortality at 1 year
(RR, 1.03; 95% CI, 0.9-1.18), yet a tendency toward a protective effect on
cardiac death was observed (RR, 0.78; 95% CI, 0.60-1.03). Conclusions -
New-onset LBBB post-TAVR is a marker of an increased risk of cardiac death
and need for PPI at 1-year follow-up. The need for PPI early post-TAVR did
not increase the risk of death. Copyright © 2016 American Heart
Association, Inc.

<121>
[Use Link to view the full text]
Accession Number
610427049
Author
Popma C.J.; Sheng S.; Korjian S.; Daaboul Y.; Chi G.; Tricoci P.; Huang
Z.; Moliterno D.J.; White H.D.; Van De Werf F.; Harrington R.A.; Wallentin
L.; Held C.; Armstrong P.W.; Aylward P.E.; Strony J.; Mahaffey K.W.;
Gibson C.M.
Institution
(Popma, Korjian, Daaboul, Chi, Gibson) Division of Cardiology, Department
of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United
States
(Sheng) Department of Vascular Surgery, Tongji Medical College, Huazhong
University of Science and Technology, Wuhan, China
(Tricoci, Huang) Duke Clinical Research Institute, Durham, NC, United
States
(Moliterno) Department of Medicine, Gill Heart Institute, University of
Kentucky, Lexington, KY, United States
(White) Department of Cardiology, Green Lane Cardiovascular Service,
Auckland City Hospital, Auckland, New Zealand
(Van De Werf) Department of Cardiology, University of Leuven, Leuven,
Belgium
(Harrington, Mahaffey) Department of Medicine, Stanford University,
Stanford, CA, United States
(Wallentin, Held) Department of Medical Sciences, Cardiology, Uppsala
Clinical Research Center, Uppsala University, Uppsala, Sweden
(Armstrong) Division of Cardiology, Department of Medicine, University of
Alberta, Edmonton, Canada
(Aylward) Department of Medicine, South Australian Health and Medical
Research Institute, Flinders University and Medical Centre, Adelaide,
Australia
(Strony) Merck Clinical Research, Merck and Co, Whitehouse Station, NJ,
United States
Title
Lack of concordance between local investigators, angiographic core
laboratory, and clinical event committee in the assessment of stent
thrombosis.
Source
Circulation: Cardiovascular Interventions. 9 (5) (no pagination), 2016.
Article Number: e003114. Date of Publication: 01 May 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Stent thrombosis (ST) is an important end point in
cardiovascular clinical trials. Adjudication is traditionally based on
clinical event committee (CEC) review of case report forms and source
documentation rather than angiograms. However, the degree to which this
method of adjudication is concordant with the review of independent
angiographic core laboratories (ACLs) has not been studied. This report
represents the first assessment of variability between local investigators
(LIs), a CEC, and an ACL. Methods and Results - Serial angiograms of 329
patients with acute coronary syndrome without ST-segment-elevation who
underwent percutaneous coronary intervention at entry in the Trial to
Assess the Effects of Vorapaxar in Preventing Heart Attack and Stroke in
Particpants With Acute Coronary Syndrome (TRACER) and who met criteria for
possible ST subsequent to the index event were reviewed by an ACL. The ACL
was blinded to the assessment by both LIs and the CEC regarding the
presence or absence of ST. CEC adjudication was based on Academic Research
Consortium definitions of ST, using case report form data and source
documents, including catheterization laboratory reports. The ACL, CEC, and
LIs agreed on the presence or absence of ST in 52.9% events (kappa=0.32;
95% confidence interval, 0.26-0.39). The ACL and CEC agreed on 82.7% of
events (kappa=0.57; 95% confidence interval, 0.47-0.67); the ACL and LIs
agreed on 61.1% of events (kappa=0.25; 95% confidence interval,
0.16-0.34); and the CEC and LIs agreed on 62% of events (kappa=0.28; 95%
confidence interval, 0.21-0.36). Conclusions - ST reporting by an ACL, a
CEC, and LIs is discordant. The assessment of ST is more often detected by
direct review of angiograms by an ACL. Copyright © 2016 American
Heart Association, Inc.

<122>
Accession Number
616264343
Author
Hu Q.; Luo W.; Huang L.; Huang R.; Chen R.
Institution
(Hu, Luo, Huang, Huang, Chen) Department of cardiovascular surgery,
Xiangya Hospital, Central-South University, Changsha, Hunan, China, 410078
Title
Apoptosis-related microRNA changes in the right atrium induced by remote
ischemic perconditioning during valve replacement surgery.
Source
Scientific reports. 6 (pp 18959), 2016. Date of Publication: 07 Jan 2016.
Abstract
We previously found that remote ischemic perconditioning (RIPerc) was
effective in attenuating myocardial injury during cardiac surgery. Given
that microRNAs (miRs) act as an important player in ischemic/reperfusion
(I/R) injury and apoptosis, this study aimed to investigate whether RIPerc
reduces apoptosis in atrial myocardium and which apoptosis-related miRs
are involved during valve replacement surgery. Here, we demonstrated that
RIPerc inhibited apoptosis in atrial myocardium during cardiac ischemia
and that 17 miRs showed at least a 1.5-fold change in expression after
ischemia. Of the 17 miRs, 9 miRs, including miR-1, miR-21, miR-24, and
miR-195, which are related to apoptosis, exhibited different expression
patterns in the RIPerc group compared with the control. Using qRT-PCR and
Western blotting, we demonstrated that miR-1 and miR-195 were
downregulated and that their common putative target gene Bcl-2 was
upregulated in the RIPerc group. However, the differences in miR-21 and
miR-24 expression, together with programmed cell death 4 (PDCD4), which is
the target gene of miR-21, were not significant. These findings provide
some insight into the role of miRs in the cardioprotective effects induced
by RIPerc.

<123>
Accession Number
616224500
Author
Pan X.-J.; Ou D.-B.; Lin X.; Ye M.-F.
Institution
(Pan, Ou, Lin, Ye) General Thoracic Surgery Department, Fujian Provincial
Hospital, Fujian Medical University, Fuzhou City 350003, China
Title
Management of Pleural Space after Lung Resection by Cryoneuroablation of
Phrenic Nerve: A Randomized Study.
Source
Surgical Innovation. 24 (3) (pp 240-244), 2017. Date of Publication: 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objectives. Residual air space problems after pulmonary lobectomy are an
important concern in thoracic surgical practice, and various procedures
have been applied to manage them. This study describes a novel technique
using controllable paralysis of the diaphragm by localized freezing of the
phrenic nerve, and assesses the effectiveness of this procedure to reduce
air space after pulmonary lobectomy. Methods. In this prospective
randomized study, 207 patients who underwent lobectomy or bilobectomy and
systematic mediastinal node dissection in our department between January
2009 and November 2013 were randomly allocated to a cryoneuroablation
group or a conventional group. Patients in the cryoneuroablation group (n
= 104) received phrenic nerve cryoneuroablation after lung procedures, and
patients in the conventional group (n = 103) did not receive
cryoneuroablation after the procedure. Data regarding preoperative
clinical and surgical characteristics in both groups were collected. Both
groups were compared with regard to postoperative parameters such as total
amount of pleural drainage, duration of chest tube placement, length of
hospital stay, requirement for repeat chest drain insertion, prolonged air
leak, and residual space. Perioperative lung function was also compared in
both groups. Recovery of diaphragmatic movement in the cryoneuroablation
group was checked by fluoroscopy on the 15th, 30th, and 60th day after
surgery. Results. There was no statistically significant difference in
patient characteristics between the 2 groups; nor was there a difference
in terms of hospital stay, new drain requirement, and incidence of
empyema. In comparison with the conventional group, the cryoneuroablation
group had less total drainage (1024 +/- 562 vs 1520 +/- 631 mL, P <.05),
fewer cases of residual space (9 vs 2, P <.05), fewer cases of prolonged
air leak (9 vs 1, P <.01), and shorter duration of drainage (3.2 +/- 0.2
vs 4.3 + 0.3 days, P <.01). Diaphragmatic paralyses caused by
cryoneuroablation reversed within 30 to 60 days. Conclusions.
Cryoneuroablation of the phrenic nerve offers a reasonable option for
prevention of residual air space following major pulmonary
resection. Copyright © The Author(s) 2017.

<124>
Accession Number
616230675
Author
Allen K.B.
Institution
(Allen) Department of Cardiothoracic Surgery, Heart Center of Indiana,
United States
Title
Transmyocardial revascularization as an adjunct to coronary artery bypass
surgery.
Source
US Cardiology Review. 9 (1) (pp 12-15), 2012. Date of Publication: 2012.
Publisher
Radcliffe Publishing Ltd (E-mail: contact.us@radcliffemed.com)
Abstract
Many patients with angina secondary to coronary artery disease (CAD)
respond to medical management or can be completely revascularized using
available percutaneous coronary interventions or coronary artery bypass
grafting (CABG). There is evidence, however, to indicate that up to 25% of
patients are incompletely revascularized following CABG, and that
incomplete revascularization is a significant independent predictor of
early and late mortality and adverse events. Transmyocardial
revascularization (TMR) is a surgical option for patients with
debilitating angina due to CAD in areas of the heart not amenable to
complete revascularization using conventional treatments. In randomized,
one-year controlled trials with long-term follow-up and in additional
clinical experience, TMR performed adjunctively to CABG in patients who
would be incompletely revascularized by CABG alone has yielded
significantly improved clinical outcomes. Based on these published
results, the Society of Thoracic Surgeons (STS) and the International
Society for Minimally Invasive Cardiaothoracic Surgery (ISMICS) have
issued practice guidelines recommending adjunctive TMR in this difficult
patient group.

<125>
Accession Number
616237485
Author
Mina G.S.; Gill P.; Soliman D.; Reddy P.; Dominic P.
Institution
(Mina, Gill, Soliman, Reddy, Dominic) Department of Cardiology Louisiana
State University Health Sciences Center-Shreveport Shreveport, Louisiana
Title
Diabetes mellitus is associated with increased acute kidney injury and
1-year mortality after transcatheter aortic valve replacement: A
meta-analysis.
Source
Clinical Cardiology. (no pagination), 2017. Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: Diabetes mellitus (DM) is associated with adverse outcomes
after surgical aortic valve replacement. However, there are conflicting
data on the impact of DM on outcomes of transcatheter aortic valve
replacement (TAVR). Hypothesis: DM is associated with poor outcomes after
different cardiac procedures. Therefore, DM can also be associated with
poor outcomes after TAVR. Methods: We searched PubMed and Cochrane Central
Register of Controlled Trials for studies that evaluated outcomes after
TAVR and stratified at least 1 of the studied endpoints by DM status. The
primary endpoint was all-cause mortality at 1 year. Secondary endpoints
were early (up to 30 days) mortality, acute kidney injury (AKI),
cerebrovascular accident (CVA), major bleeding, and major vascular
complications. Pooled odds ratio (OR) and 95% confidence interval (CI)
were calculated using random effects models. Results: We included 64
studies with a total of 38686 patients. DM was associated with
significantly higher 1-year mortality (OR: 1.14, 95% CI: 1.04-1.26, P =
0.008) and periprocedural AKI (OR: 1.28, 95% CI: 1.08-1.52, P = 0.004). On
the other hand, there were no significant differences between diabetics
and nondiabetics in early mortality, CVAs, major bleeding, or major
vascular complications. Conclusions: DM is associated with increased
1-year mortality and periprocedural AKI in patients undergoing TAVR. The
results of this study suggest that DM is a predictor of adverse outcomes
in patients undergoing TAVR. Copyright © 2017 Wiley Periodicals,
Inc.

<126>
Accession Number
616235956
Author
Preda G.; Bige N.; Bonsey M.; Joffre J.; Ait-Oufella H.; Maury E.; Vezzani
A.; Manca T.; Brusasco C.; Santori G.; Cantadori L.; Ramelli A.; Gonzi G.;
Nicolini F.; Gherli T.; Corradi F.
Institution
(Preda) Intensive Care Unit, Hopital Delafontaine, Centre Hospitalier de
Saint Denis, 2 rue docteur Delafontaine, Saint Denis 93200, France
(Bige, Bonsey, Joffre, Ait-Oufella, Maury) Medical Intensive Care Unit,
Hopital Saint-Antoine, Assistance Publique-Hopitaux de Paris, 184 rue du
Faubourg Saint-Antoine, Paris Cedex 12 75571, France
(Joffre, Ait-Oufella, Maury) Paris-Sorbonne and Pierre-and-Marie Curie
Universities (UPMC), Paris, France
(Vezzani, Manca, Ramelli, Nicolini, Gherli) Department of Surgery,
University Hospital of Parma, Parma, Italy
(Brusasco, Corradi) Anaesthesia and Intensive Care Unit, E.O. Ospedali
Galliera, Genoa, Italy
(Santori) Department of Surgical Sciences and Integrated Diagnostics,
University of Genoa, Genoa, Italy
(Cantadori) Department of Emergency Medicine, Fidenza Hospital, Health
Organization of Parma (AUSL), Parma, Italy
(Gonzi) Department of Cardiology, University Hospital of Parma, Parma,
Italy
Title
Discussion on "A randomized clinical trial of ultrasound-guided
infra-clavicular cannulation of the subclavian vein in cardiac surgical
patients: short-axis versus long-axis approach".
Source
Intensive Care Medicine. (pp 1-2), 2017. Date of Publication: 16 May 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)

<127>
Accession Number
616223035
Author
Ahmed N.O.; Osman B.; Abdelhai Y.M.; El-Hadiyah T.M.H.
Institution
(Ahmed) Department of Pharmacy Practice, Faculty of Pharmacy, Qassim
University, Al-Malida, Saudi Arabia
(Osman) Department of Pharmacology, Faculty of Pharmacy, University of
Khartoum, P.O. Box 1996, Khartoum, Sudan
(Abdelhai) Ahmed Gasim Cardiac Surgery and Renal Transplant Center,
Khartoum, Sudan
(El-Hadiyah) Department of Pharmacology, Faculty of Pharmacy,
International University of Africa, Khartoum, Sudan
Title
Impact of clinical pharmacist intervention in anticoagulation clinic in
Sudan.
Source
International Journal of Clinical Pharmacy. (pp 1-5), 2017. Date of
Publication: 15 May 2017.
Publisher
Springer Netherlands
Abstract
Background Many trials have compared anticoagulation management provided
by a pharmacist led anticoagulation clinic versus usual physician care
showing the role for clinical pharmacist in the management of
anticoagulant therapy, and demonstrating excellent outcomes. In Sudan,
there is no published research evaluating the role of pharmacist in
providing pharmaceutical care for patients taking warfarin. Objective The
objective of the study is to assess the role of clinical pharmacist
intervention in warfarin patients compared to usual medical care. Setting
This study was conducted in Ahmed Gasim cardiac surgery and renal
transplant center warfarin clinic. Methods One hundred thirty-five
patients were randomly selected from adult patients on warfarin therapy
The history of INR records, and adverse effects for the past year, were
recorded. Then patients' warfarin dose adjustments according to INR, was
done by the clinical pharmacist for one year. Patients received continuous
verbal education and written information about warfarin. Main outcome
measure The primary outcome for this study was the INR control, while the
secondary outcomes were the bleeding events and hospitalization due to
warfarin. Results After the clinical pharmacist intervention there was
significant (P < 0.01) improvement in INR control and a significant (P <
0.05) reduction in incidence of bleeding after clinical pharmacist
intervention. Hospitalization due to warfarin related complications
(bleeding, high INR, low INR) was also significantly (P < 0.001) reduced.
Conclusion Clinical pharmacists intervention in warfarin therapy improve
INR control, reduce bleeding and hospitalization due to warfarin
complications. Copyright © 2017 Springer International Publishing

<128>
Accession Number
615452596
Author
Ridker P.M.; Revkin J.; Amarenco P.; Brunell R.; Curto M.; Civeira F.;
Flather M.; Glynn R.J.; Gregoire J.; Jukema J.W.; Karpov Y.; Kastelein
J.J.P.; Koenig W.; Lorenzatti A.; Manga P.; Masiukiewicz U.; Miller M.;
Mosterd A.; Murin J.; Nicolau J.C.; Nissen S.; Ponikowski P.; Santos R.D.;
Schwartz P.F.; Soran H.; White H.; Wright R.S.; Vrablik M.; Yunis C.;
Shear C.L.; Tardif J.-C.
Institution
(Ridker, Glynn) Center for Cardiovascular Disease Prevention, Brigham and
Women's Hospital, Harvard Medical School, 900 Commonwealth Ave., Boston,
MA 02215, United States
(Revkin, Brunell, Curto, Masiukiewicz, Schwartz, Yunis, Shear) Pfizer, New
York, United States
(Amarenco) Paris-Diderot Sorbonne Paris Cite University, Paris, France
(Civeira) Universidad de Zaragoza, IIS Aragon, Zaragoza, Spain
(Flather) University of East Anglia, Norwich, United Kingdom
(Soran) Central Manchester University Hospital, Manchester, United Kingdom
(Gregoire, Tardif) Montreal Heart Institute, Universite de Montreal,
Montreal, Canada
(Jukema) Leiden University Medical Center, Leiden, Netherlands
(Kastelein) Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
(Mosterd) Meander Medical Center, Amersfoort, Netherlands
(Karpov) Russian Cardiology Research and Production Center, Moscow,
Russian Federation
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
Munich Heart Alliance, Munich, Germany
(Lorenzatti) Cordoba Hospital, Cordoba, Argentina
(Manga) University of the Witwatersrand, Johannesburg, South Africa
(Miller) University of Maryland, Baltimore, United States
(Murin) University of Comenius, Bratislava, Slovakia
(Nicolau) Heart Institute, University of Sao Paulo Medical School, Sao
Paulo, Brazil
(Santos) Lipid Clinic Heart Institute, University of Sao Paulo Medical
School Hospital, Sao Paulo, Brazil
(Nissen) Cleveland Clinic Foundation, Cleveland, United States
(Ponikowski) Wroclaw Medical University, Wroclaw, Poland
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Wright) Mayo Clinic, Rochester, MN, United States
(Vrablik) First Faculty of Medicine, Charles University, Prague, Czech
Republic
Title
Cardiovascular efficacy and safety of bococizumab in high-risk patients.
Source
New England Journal of Medicine. 376 (16) (pp 1527-1539), 2017. Date of
Publication: 20 Apr 2017.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Bococizumab is a humanized monoclonal antibody that inhibits
proprotein convertase subtilisin- kexin type 9 (PCSK9) and reduces levels
of low-density lipoprotein (LDL) cholesterol. We sought to evaluate the
efficacy of bococizumab in patients at high cardiovascular risk. METHODS
In two parallel, multinational trials with different entry criteria for
LDL cholesterol levels, we randomly assigned the 27,438 patients in the
combined trials to receive bococizumab (at a dose of 150 mg)
subcutaneously every 2 weeks or placebo. The primary end point was
nonfatal myocardial infarction, nonfatal stroke, hospitalization for
unstable angina requiring urgent revascularization, or cardiovascular
death; 93% of the patients were receiving statin therapy at baseline. The
trials were stopped early after the sponsor elected to discontinue the
development of bococizumab owing in part to the development of high rates
of antidrug antibodies, as seen in data from other studies in the program.
The median follow-up was 10 months. RESULTS At 14 weeks, patients in the
combined trials had a mean change from baseline in LDL cholesterol levels
of -56.0% in the bococizumab group and +2.9% in the placebo group, for a
between-group difference of -59.0 percentage points (P<0.001) and a median
reduction from baseline of 64.2% (P<0.001). In the lower-risk,
shorter-duration trial (in which the patients had a baseline LDL
cholesterol level of >=70 mg per deciliter [1.8 mmol per liter] and the
median follow-up was 7 months), major cardiovascular events occurred in
173 patients each in the bococizumab group and the placebo group (hazard
ratio, 0.99; 95% confidence interval [CI], 0.80 to 1.22; P = 0.94). In the
higher-risk, longer-duration trial (in which the patients had a baseline
LDL cholesterol level of >=100 mg per deciliter [2.6 mmol per liter] and
the median follow-up was 12 months), major cardiovascular events occurred
in 179 and 224 patients, respectively (hazard ratio, 0.79; 95% CI, 0.65 to
0.97; P = 0.02). The hazard ratio for the primary end point in the
combined trials was 0.88 (95% CI, 0.76 to 1.02; P = 0.08). Injection-site
reactions were more common in the bococizumab group than in the placebo
group (10.4% vs. 1.3%, P<0.001). CONCLUSIONS In two randomized trials
comparing the PCSK9 inhibitor bococizumab with placebo, bococizumab had no
benefit with respect to major adverse cardiovascular events in the trial
involving lower-risk patients but did have a significant benefit in the
trial involving higher-risk patients. Copyright © 2017
Massachusetts Medical Society. All rights reserved.

<129>
Accession Number
613674138
Author
Tang M.; Liu X.; Lin C.; He Y.; Cai X.; Xu Q.; Hu P.; Gao F.; Jiang J.;
Lin X.; Zhu Q.; Wang L.; Kong H.; Yu Y.; Wang J.
Institution
(Tang, Liu, Lin, He, Xu, Hu, Gao, Jiang, Lin, Zhu, Wang, Kong, Wang)
Department of Cardiology, Second Affiliated Hospital Zhejiang University
School of Medicine, Hangzhou, China
(Cai) Department of General Surgery, Ningbo Medical Treatment Center
Lihuili Hospital, Ningbo, China
(Yu) Department of Epidemiology and Health Statistics, School of Public
Health, School of Medicine, Zhejiang University, Hangzhou, China
Title
Meta-Analysis of Outcomes and Evolution of Pulmonary Hypertension Before
and After Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 119 (1) (pp 91-99), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Pulmonary hypertension (PH) is a common entity in patients with severe
aortic stenosis (AS) who underwent transcatheter aortic valve implantation
(TAVI), but its role on clinical outcomes remains undetermined. We
evaluated the impact of baseline and postprocedural PH on clinical
outcomes and changes in pulmonary artery systolic pressure after TAVI by
performing a meta-analysis of 16 studies enrolling 9,204 patients with AS
who underwent TAVI. In patients with baseline PH, all-cause mortality was
significantly increased, as shown by pooled odds ratio (ORs) for overall
30-day (OR 1.52, 95% confidence interval [CI] 1.28 to 1.80), 1-year (OR
1.39, 95% CI 1.27 to 1.51), and 2-year all-cause mortality (OR 2.00, 95%
CI 1.49 to 2.69), compared with those without PH, independent of different
methods of PH assessment. The presence of post-TAVI PH was associated with
a significant increase in 2-year all-cause mortality (OR 2.32, 95% CI 1.43
to 3.74). Nevertheless, pulmonary artery systolic pressure decreased at
3-month to 1-year follow-up (standardized mean difference -1.12, 95% CI
-1.46 to -0.78). Baseline PH was associated with higher 30-day and 1-year
cardiovascular mortality. Patients with baseline PH had higher risk of
stroke at 1 year and acute kidney injury at 30 days. But the risk of major
vascular complications was significantly lower in patients with baseline
PH. In conclusion, the presence of PH is associated with increased short-
and long-term mortality, also higher risk of stroke and acute kidney
injury after TAVI. A significant decrease in PSAP is detected in patients
with AS in midterm follow-up after TAVI. Copyright © 2016
Elsevier Inc.

<130>
Accession Number
613674129
Author
Jatene T.; Biering-Sorensen T.; Nochioka K.; Mangione F.M.; Hansen K.W.;
Sorensen R.; Jensen J.S.; Jorgensen P.G.; Jeger R.; Kaiser C.; Pfisterer
M.; Galatius S.
Institution
(Jatene, Mangione) Department of Interventional Cardiology, Brigham and
Women's Hospital Heart and Vascular Center and Harvard Medical School,
Boston, Massachusetts, United States
(Biering-Sorensen, Sorensen, Jensen, Jorgensen) Department of Cardiology,
Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen,
Denmark
(Nochioka) Department of Cardiovascular Medicine, Tohoku University
Graduate School of Medicine, Clinical Research, Innovation and Education
Center, Tohoku University Hospital, Sendai, Japan
(Hansen, Galatius) Department of Cardiology, Bispebjerg University
Hospital, Copenhagen, Denmark
(Jeger, Kaiser, Pfisterer) Department of Cardiology, University Hospital,
Basel, Switzerland
Title
Frequency of Cardiac Death and Stent Thrombosis in Patients With Chronic
Obstructive Pulmonary Disease Undergoing Percutaneous Coronary
Intervention (from the BASKET-PROVE I and II Trials).
Source
American Journal of Cardiology. 119 (1) (pp 14-19), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Chronic obstructive pulmonary disease (COPD) is associated with long-term
all-cause death after percutaneous coronary intervention with bare-metal
stents. Regarding other outcomes, previous studies have shown conflicting
results and the impact of drug-eluting stent (DES) in this population is
not well known. We analyzed 4,605 patients who underwent percutaneous
coronary intervention with bare-metal stents (33.1%) or DES (66.9%) from
the Basel Stent Kosten-Effektivitats Trial-Prospective Validation
Examination trials I and II. COPD patients (n = 283, 6.1%), were older and
had more frequently a smoking or cardiovascular event history. At 2-year
follow-up, cumulative event rates for patients with versus without COPD
were the following: major adverse cardiac events (MACE: composite of
cardiac death, nonfatal myocardial infarction, and target vessel
revascularization): 15.2% versus 8.1% (p <0.001); all-cause death: 11.7%
versus 2.4% (p <0.001); cardiac death: 5.7% versus 1.2% (p <0.001);
myocardial infarction: 3.5% versus 1.9% (p = 0.045);
definite/probable/possible stent thrombosis: 2.5% versus 0.9% (p = 0.01);
and major bleeding: 4.2% versus 2.1% (p = 0.014). After adjusting for
confounders including smoking status, COPD remained an independent
predictor for MACE (hazard ratio [HR] 1.80, 95% confidence interval [CI]
1.31 to 2.49), all-cause death (HR 3.62, 95% CI 2.41 to 5.45), cardiac
death (HR 3.12, 95% CI 1.74 to 5.60), and stent thrombosis (HR 2.39, 95%
CI 1.03 to 5.54). We did not find evidence of an interaction between COPD
and DES implantation (p for interaction = 0.29) for MACE. In conclusion,
COPD is associated with increased 2-year rates of all-cause death, cardiac
death, and stent thrombosis after stent implantation. DES use appears to
be beneficial also in patients with COPD. Copyright © 2016
Elsevier Inc.

<131>
Accession Number
608249609
Author
Poirier Y.; Voisine P.; Plourde G.; Rimac G.; Barria Perez A.; Costerousse
O.; Bertrand O.F.
Institution
(Poirier, Voisine, Plourde, Rimac, Barria Perez, Costerousse, Bertrand)
Quebec Heart-Lung Institute, Laval University, Interventional Cardiology
Labs, 2725, Chemin Ste-Foy, Quebec, QC G1V4G5, Canada
Title
Efficacy and safety of preoperative intra-aortic balloon pump use in
patients undergoing cardiac surgery: A systematic review and
meta-analysis.
Source
International Journal of Cardiology. 207 (pp 67-79), 2016. Date of
Publication: 15 Mar 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Intra-aortic balloon pump (IABP) can be used prior to coronary
artery bypass graft surgery (CABG) in high-risk patients. Whether this
technique remains safe and effective in contemporary practice is
controversial. Objective We have completed a systematic review and
meta-analysis of randomized trials and observational studies to evaluate
the safety and benefits of IABP prior to CABG surgery. Methods We searched
PubMed, EMBASE, Cochrane Library databases, with cross-referencing of
relevant articles for studies assessing the impact of IABP prior to and
after isolated CABG. Two investigators independently sorted the
potentially relevant studies, and three extracted data. The assessed
outcomes included in-hospital and 30-day mortality, IABP-related
complications and length of intensive care unit and hospital stay. Results
From 1977 to 2015 we included 11 randomized controlled trials (n = 1293)
(RCTs) and 22 observational studies, including a total of 46,067 patients.
Analyses from RCTs suggested that IABP prior to CABG was associated with a
significant reduction in hospital mortality (odds ratio (OR) 0.20; 95%
confidence interval (CI): 0.09-0.44; P < 0.0001) and 30-day mortality
compared to no preoperative IABP (OR 0.43, 95% CI: 0.25-0.76; P = 0.003).
IABP prior to CABG was also associated with shorter intensive care unit
(weighted mean difference (WMD) - 1.47 day; 95% CI: - 1.82 to - 1.12 day;
P < 0.00001) and hospital length of stay (WMD - 3.25 days; 95% CI: - 5.18
to - 1.33 days; P = 0.0009). However, there were significant bias and
limitations among included studies. Furthermore, results for similar
outcomes from observational studies remained inconclusive. Conclusions In
contemporary practice, evidence showing clinical benefit for preoperative
IABP in high-risk patients remains limited and requires further validation
in an appropriately sized multicenter randomized trial. Copyright
© 2016 Elsevier Ireland Ltd. All rights reserved.

<132>
Accession Number
604100898
Author
Amanullah M.M.; Hamid M.; Hanif H.M.; Muzaffar M.; Siddiqui M.T.; Adhi F.;
Ahmad K.; Khan S.; Hasan Z.
Institution
(Amanullah, Hanif, Muzaffar, Siddiqui, Adhi, Ahmad) Department of Surgery,
Aga Khan University Hospital, Stadium Road, Karachi 74800, Pakistan
(Hamid) Department of Cardiac Anaesthesia, AKUH, Karachi, Pakistan
(Khan) Medical College, Agha Khan University, AKUH, Karachi, Pakistan
(Hasan) Department of Pathology and Microbiology, AKUH, Karachi, Pakistan
Title
Effect of steroids on inflammatory markers and clinical parameters in
congenital open heart surgery: A randomised controlled trial.
Source
Cardiology in the Young. 26 (3) (pp 506-515), 2016. Date of Publication:
01 Mar 2016.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Background Cardiopulmonary bypass is associated with systemic inflammatory
response. Steroids suppress this response, although the therapeutic
evidence remains controversial. We hypothesised that intravenous steroids
in children undergoing open-heart surgery would decrease inflammation
leading to better early post-operative outcomes. We conducted a randomised
controlled trial to evaluate the trends in the levels of immunomodulators
and their effects on clinical parameters. Objective To assess the effects
of intravenous steroids on early post-operative inflammatory markers and
clinical parameters in children undergoing open-heart surgery. Materials
and methods A randomised controlled trial involving 152 patients, from one
month up to 18 years of age, who underwent open-heart surgery for
congenital heart disease from April 2010-2012 was carried out. Patients
were randomised and administered either three scheduled intravenous pulse
doses of dexamethasone (1 mg/kg) or placebo. Blood samples were drawn at
four time intervals and serum levels of inflammatory cytokines -
Interleukin-6, 8, 10, 18, and tumour necrosis factor-alpha - were
measured. Clinical parameters were also assessed. Results Blood cytokine
levels were compared between the dexamethasone (n=65) and placebo (n=64)
groups. Interleukin-6 levels were lower at 6 and 24 hours post-operatively
(p<0.001), and Interleukin-10 levels were higher 6 hours post-operatively
(p<0.001) in the steroid group. Interleukin-8, 18, and tumour necrosis
factor-alpha levels did not differ between the groups at any time
intervals. The clinical parameters were similar in both the groups.
Conclusion Dexamethasone caused quantitative suppression of Interleukin-6
and increased Interleukin-10 activation, contributing to reduced
immunopathology, but it did not translate into clinical benefit in the
short term. Copyright ©Cambridge University Press 2015.

<133>
Accession Number
610089030
Author
Cao C.; Liou K.P.; Pathan F.K.; Virk S.; McMonnies R.; Wolfenden H.;
Indraratna P.
Institution
(Cao, Virk, McMonnies, Indraratna) The Systematic Reviews Unit, The
Collaborative Research (CORE) Group, Macquarie University, Sydney,
Australia
(Cao, Wolfenden) Department of Cardiothoracic Surgery, Prince of Wales
Hospital, Sydney, Australia
(Liou, Pathan) Department of Cardiology, Prince of Wales Hospital, Sydney,
Australia
Title
Transcatheter aortic valve implantation versus surgical aortic valve
replacement: Meta-analysis of clinical outcomes and cost-effectiveness.
Source
Current Pharmaceutical Design. 22 (13) (pp 1965-1977), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Objective: Transcatheter aortic valve implantation (TAVI) has emerged as a
feasible alternative treatment to conventional surgical aortic valve
replacement (AVR) for high-risk patients with aortic stenosis. The present
systematic review aimed to assess the comparative clinical and
cost-effectiveness outcomes of TAVI versus AVR, and meta-analyse
standardized clinical endpoints. Methods: An electronic search was
conducted on 9 online databases to identify all relevant studies. Eligible
studies had to report on either periprocedural mortality or incremental
cost-effectiveness ratio (ICER) to be included for analysis. Results: The
systematic review identified 24 studies that reported on comparative
clinical outcomes, including three randomized controlled trials and ten
matched observational studies involving 7906 patients. Meta-analysis
demonstrated no significant differences in regards to mortality, stroke,
myocardial infarction or acute renal failure. Patients who underwent TAVI
were more likely to experience major vascular complications or arrhythmias
requiring permanent pacemaker insertion. Patients who underwent AVR were
more likely to experience major bleeding. Eleven analyses from 7 economic
studies reported on ICER. Six analyses defined TAVI to be low value, 2
analyses defined TAVI to be intermediate value, and three analyses defined
TAVI to be high value. Conclusion: The present study demonstrated no
significant differences in regards to mortality or stroke between the two
therapeutic procedures. However, the cost-effectiveness and long-term
efficacy of TAVI may require further investigation. Technological
improvement and increased experience may broaden the clinical indication
for TAVI for low-intermediate risk patients in the future. Copyright
© 2016 Bentham Science Publishers.

<134>
Accession Number
610088989
Author
Vavuranakis M.; Kolokathis A.-M.; Vrachatis D.A.; Kalogeras K.; Magkoutis
N.A.; Fradi S.; Ghostine S.; Karamanou M.; Tousoulis D.
Institution
(Vavuranakis, Kolokathis, Vrachatis, Kalogeras, Tousoulis) 1st Department
of Cardiology, Hippokration Hospital, National & Kapodistrian University
of Athens, Greece
(Vavuranakis) Department of Cardiovascular Medicine, Ohio State
University, Columbus, OH, United States
(Magkoutis, Fradi, Ghostine) Department of Cardiology, Chirurgical Center
Marie Lannelongue, Le Plessis-Robinson, France
(Karamanou) University Institute of History of Medicine and Public Health,
Lausanne, Switzerland
Title
Atrial fibrillation during or after TAVI: Incidence, implications and
therapeutical considerations.
Source
Current Pharmaceutical Design. 22 (13) (pp 1896-1903), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Aortic stenosis is one of the most frequent valvulopathy of modern time
necessitating interventional therapy when symptoms arise and stenosis
becomes severe. First line treatment has traditionally been surgical
aortic valve replacement (SAVR). However in the last decade transcatheter
aortic valve implantation (TAVI) with bioprosthetic valves has proved to
be a sound solution for high-risk for SAVR or inoperable patients. As
expected implantation of the bioprosthetic device requires administration
of antiplatelet regimen to the patients for a certain period. Atrial
fibrillation (AF) may occur frequently during the peri-procedural period.
In this background, the occurrence of AF after device implantation may be
a challenging issue. Methods: We performed a literature search of PubMed
and Embase database. Published articles reporting the incidence, clinical
implications and description of antithrombotic regimen of New-onset atrial
fibrillation (NOAF) in individuals undergoing TAVI were considered
eligible. Incidence, Implications and Antithrombotic Regimen: The overall
occurrence of NOAF is reported to be 1%-32% after TAVI. Left atrial
enlargement and transapical approach constitute independent predictors for
NOAF. Additionally it has been shown that patients with AF face an
increased risk of death irrespective of the type of AF. Patients, with a
history of AF, present greater rate of death than individuals with NOAF.
NOAF is responsible for cerebrovascular events (CVE) occurring in the
subacute phase (days 1-30) after the procedure. The risk of
stroke/transient ischemic attack after TAVI is increased at least two fold
by the presence of atrial fibrillation. Empirically, a dual antiplatelet
strategy has been used for patients undergoing TAVR, including aspirin and
a thienopyridine. In cases where patients are in need of oral
anticoagulation after TAVI a combination of aspirin or thienopyridine with
acenocoumarol has been the preferred regimen. Discussion: Despite the
continuously crescent use of TAVI for patients with symptomatic severe
aortic stenosis, there are still many aspects of this procedure to be
clarified. A lack of data exists from the available clinical trials
regarding the appropriate anticoagulation therapy for patients with
greater risk for thromboembolic events. As a result, patient's treatment
remains at the discretion of the physician. Conclusion: Limited data are
available regarding the optimal therapeutic regimen in patients undergoing
TAVI who need therapy for AF. Carefully designed clinical studies might
further clarify the incidence and interrelation between atrial
fibrillation and TAVI. The balance between the efficacy and risk of
anticoagulation needs to be further clarified in patients undergoing
TAVI. Copyright © 2016 Bentham Science Publishers.

<135>
Accession Number
610088978
Author
Maas E.H.A.; Pieters B.M.A.; Van de Velde M.; Rex S.
Institution
(Maas, Pieters) Department of Anesthesiology, University Hospitals Leuven,
Belgium
(Van de Velde) Department of Anesthesiology, University Hospitals Leuven,
Belgium
(Van de Velde) Department of Cardiovascular Sciences, KU Leuven, Belgium
(Rex) Department of Anesthesiology University, Hospitals Leuven, Belgium
(Rex) Department of Cardiovascular Sciences, KU Leuven-University of
Leuven, Belgium
Title
General or local anesthesia for TAVI? A systematic review of the
literature and meta-analysis.
Source
Current Pharmaceutical Design. 22 (13) (pp 1868-1878), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is becoming a
valuable alternative to surgical aortic valve replacement in patients with
severe aortic stenosis that are at high surgical risk or deemed
inoperable. The optimal anesthesia technique for TAVI is still undecided.
We performed a systematic review and metaanalysis to compare the safety of
locoregional anesthesia (LRA) with or without conscious sedation and
general anesthesia (GA) for the TAVI-procedure. Methods: We searched
PUBMED, MEDLINE, EMBASE and the Cochrane central register of controlled
trials from January 1st 2002 to February 15th 2015.
The primary outcome parameters searched were 30-days mortality, hospital
length of stay, procedure time, use of adrenergic support, stroke rate,
incidence of myocardial infarction, incidence of acute kidney injury, rate
of procedural succes. Results: Ten studies, including 5919 patients,
fulfilled the inclusion criteria. None of these studies was randomized
resulting in a considerable risk of bias. The choice for a specific
anesthesia technique did neither affect the average 30-day mortality rate
[RR 0.91 (95% CI: 0.53 to 1.56), p=0.72] nor a wide variety of safety
endpoints. LRA for TAVI was associated with a significantly shorter
procedure time when compared to GA, and a reduction in hospital length of
stay. However, LRA significantly increased the risk for implantation of a
permanent pacemaker (RR 1.23, p=0.02) and for paravalvular leakage (RR
1.31, p=0.006.). Conclusion: Neither mortality nor the incidence of major
adverse cardiac and cerebrovascular events after TAVI is affected by the
choice for either LRA or GA. Copyright © 2016 Bentham Science
Publishers.

<136>
[Use Link to view the full text]
Accession Number
612424322
Author
Mc Ardle B.; Shukla T.; Nichol G.; Dekemp R.A.; Bernick J.; Guo A.; Lim
S.P.; Davies R.A.; Haddad H.; Duchesne L.; Hendry P.; Masters R.; Ross H.;
Freeman M.; Gulenchyn K.; Racine N.; Humen D.; Benard F.; Ruddy T.D.; Chow
B.J.; Mielniczuk L.; Dasilva J.N.; Garrard L.; Wells G.A.; Beanlands
R.S.B.
Institution
(Mc Ardle, Shukla, Dekemp, Bernick, Guo, Lim, Davies, Haddad, Duchesne,
Hendry, Masters, Ruddy, Chow, Mielniczuk, Dasilva, Garrard, Wells,
Beanlands) Molecular Function and Imaging Program, National Cardiac PET
Centre, Division of Cardiology, Department of Medicine, Canada
(Mc Ardle, Shukla, Dekemp, Bernick, Guo, Lim, Davies, Haddad, Duchesne,
Hendry, Masters, Ruddy, Chow, Mielniczuk, Dasilva, Garrard, Wells,
Beanlands) Division of Cardiac Surgery, Department of Surgery, Cardiac
Research Methods Centre, University of Ottawa, Heart Institute, University
of Ottawa, Canada
(Nichol) Department of Medicine, Division of General Internal Medicine,
University of Washington, Harborview Center for Prehospital Emergency
Care, Seattle, United States
(Ross, Freeman) Department of Medicine, Divisions of Cardiology,
University Health Network, St Michael's Hospital, University of Toronto,
Canada
(Gulenchyn) ES Garnett Memorial PET Center, Department of Nuclear
Medicine, Hamilton Health Sciences, Canada
(Racine) Department of Medicine, Division of Cardiology, Montreal Heart
Institute, Canada
(Humen) Department of Medicine, Division of Cardiology, London Health
Sciences Centre, Canada
(Benard) Department of Molecular Oncology, University of British Columbia,
Vancouver, Canada
(Benard) Department of Nuclear Medicine and Radiobiology, Division of
Nuclear Medicine, Centre Hospitalier Universitaire de Sherbrooke, Canada
Title
Long-Term Follow-Up of Outcomes with F-18-Fluorodeoxyglucose Positron
Emission Tomography Imaging-Assisted Management of Patients with Severe
Left Ventricular Dysfunction Secondary to Coronary Disease.
Source
Circulation: Cardiovascular Imaging. 9 (9) (no pagination), 2016. Article
Number: e004331. Date of Publication: 01 Sep 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Whether viability imaging can impact long-term patient
outcomes is uncertain. The PARR-2 study (Positron Emission Tomography and
Recovery Following Revascularization) showed a nonsignificant trend toward
improved outcomes at 1 year using an F-18-fluorodeoxyglucose positron
emission tomography (PET)-assisted strategy in patients with suspected
ischemic cardiomyopathy. When patients adhered to F-18-fluorodeoxyglucose
PET recommendations, outcome benefit was observed. Long-term outcomes of
viability imaging-assisted management have not previously been evaluated
in a randomized controlled trial. Methods and Results - PARR-2 randomized
patients with severe left ventricular dysfunction and suspected CAD being
considered for revascularization or transplantation to standard care (n=
195) versus PET-assisted management (n=197) at sites participating in
long-term follow-up. The predefined primary outcome was time to composite
event (cardiac death, myocardial infarction, or cardiac hospitalization).
After 5 years, 105 (53%) patients in the PET arm and 111 (57%) in the
standard care arm experienced the composite event (hazard ratio for time
to composite event =0.82 [95% confidence interval 0.62-1.07]; P=0.15).
When only patients who adhered to PET recommendations were included, the
hazard ratio for the time to primary outcome was 0.73 (95% confidence
interval 0.54-0.99; P=0.042). Conclusions - After a 5-year follow-up in
patients with left ventricular dysfunction and suspected CAD, overall,
PET-assisted management did not significantly reduce cardiac events
compared with standard care. However, significant benefits were observed
when there was adherence to PET recommendations. PET viability imaging may
be best applied when there is likely to be adherence to imaging-based
recommendations. Clinical Trial Registration - URL:
http://www.clinicaltrials.gov. Unique identifier:
NCT00385242. Copyright © 2016 American Heart Association, Inc.

<137>
Accession Number
612967122
Author
Trzeciak P.; Wozakowska-Kaplon B.; Niedziela J.; Gierlotka M.; Hawranek
M.; Lekston A.; Wasilewski J.; Polonski L.; Gasior M.
Institution
(Trzeciak, Niedziela, Gierlotka, Hawranek, Lekston, Wasilewski, Polonski,
Gasior) Third Department of Cardiology, SMDZ in Zabrze, Medical University
of Silesia, Katowice, Poland
(Wozakowska-Kaplon) First Clinical Department of Cardiology,
Swietokrzyskie Centre of Cardiology, Kielce, Poland
(Wozakowska-Kaplon) University of Health Sciences, Jan Kochanowski
University, Kielce, Poland
Title
Comparison of Inhospital and 12- and 36-Month Outcomes After Acute
Coronary Syndrome in Men Versus Women <40 Years (from the PL-ACS
Registry).
Source
American Journal of Cardiology. 118 (9) (pp 1300-1305), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The study was aimed to compare the characteristics and inhospital and 12-
and 36-month outcomes of men and women <40 years with acute coronary
syndrome (ACS). The analysis involved 932 patients <40 years with ACS in
the Silesia region enrolled into the ongoing, prospective Polish Registry
of Acute Coronary Syndromes from January 2006 to December 2014. The
composite end point involved death, recurrence of ACS, a need for
percutaneous coronary intervention, and coronary artery bypass graft
surgery within 12 and 36 months after ACS. Compared with men, women <40
years were less frequently smokers (66.1% vs 55.4%, p = 0008), had older
average age (35.6 +/- 4.2 vs 34.7 +/- 4.4, p = 0.002), more often had
unstable angina at admission (29.1% vs 19.3%, p <0.001), and less
frequently had ST-elevation myocardial infarction: 41.3% versus 51.3%, p =
0.02, at admission. There was no significant difference in the mortality
(4.8% vs 3.1%, p = 0.29) and the composite end point (21.6% vs 16.0%, p =
0.14) within 12 months after ACS. Compared with men, women had a higher
incidence of the composite end point (28.4% vs 20.1%, p = 0.04) and
indicated a tendency of a higher mortality within the 36-month follow-up
period (9.2% vs 5.0%, p = 0.055). Female gender turned out to be an
independent risk factor of death in the multivariate analysis (hazard
ratio 2.76, 95% confidence interval 1.21 to 6.31, p <0.016). In
conclusion, women had a higher incidence of the composite end point and
showed a tendency toward a higher mortality than the men within the
36-month follow-up period. Copyright © 2016 Elsevier Inc.

<138>
Accession Number
607726048
Author
Hansen L.S.; Hjortdal V.E.; Jakobsen C.-J.
Institution
(Hansen, Jakobsen) Department of Anaesthesiology and Intensive Care,
Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N
8200, Denmark
(Hansen, Hjortdal) Department of Cardiothoracic Surgery, Aarhus University
Hospital, Aarhus N, Denmark
Title
Relocation of patients after cardiac surgery: Is it worth the effort?.
Source
Acta Anaesthesiologica Scandinavica. 60 (4) (pp 441-449), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background Fast-track protocols may facilitate early patient discharge
from the site of surgery through the implementation of more expedient
pathways. However, costs may merely be shifted towards other parts of the
health care system. We aimed to investigate the consequence of patient
transfers on overall hospitalisation, follow-up and readmission rate after
cardiac surgery. Methods A single-centre descriptive cohort study using
prospectively entered registry data. The study included 4,515 patients who
underwent cardiac surgery at Aarhus University Hospital during the period
1 April 2006 to 31 December 2012. Patients were grouped and analysed based
on type of discharge: Directly from site of surgery or after transfer to a
regional hospital. The cohort was obtained from the Western Denmark Heart
Registry and matched to the Danish National Hospital Register. Results
Median overall length of stay was 9 days (7.0;14.4). Transferred patients
had longer length of stay, median difference of 2.0 days, p < 0.001. Time
to first outpatient consultation was 41(30;58) days in transferred
patients vs. 45(29;74) days, p < 0.001. 18.6% was readmitted within 30
days. Mean time to readmission was 18.4 +/- 6.4 days. Median length of
readmission was 3(1,6) days. There was no difference in readmissions
between groups. Leading cause of readmission was cardiovascular disease
with 48%. Conclusion Transfer of patients does not overtly reduce health
care costs, but overall LOS and time to first outpatient consultation are
substantially longer in patients transferred to secondary hospitals than
in patients discharged directly. Readmission rate is high during the month
after surgery, but with no difference between groups. Copyright ©
2016 The Acta Anaesthesiologica Scandinavica Foundation. Published by John
Wiley & Sons Ltd.

<139>
Accession Number
607019609
Author
Chernyavskiy A.; Kareva Y.; Pak I.; Rakhmonov S.; Pokushalov E.; Romanov
A.
Institution
(Chernyavskiy, Kareva, Pak, Rakhmonov) Department of Surgery, Aorta,
Coronary and Peripheral Arteries, Novosibirsk Research Institute of
Circulation Pathology, Novosibirsk, Russian Federation
(Pokushalov, Romanov) Department of Rhythm Disorders of the Heart,
Novosibirsk Research Institute of Circulation Pathology, Novosibirsk,
Russian Federation
Title
Quality of Life after Surgical Ablation of Persistent Atrial Fibrillation:
A Prospective Evaluation.
Source
Heart Lung and Circulation. 25 (4) (pp 378-383), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Elsevier Ltd
Abstract
Aim: To compare the quality of life (QoL) of patients with persistent
atrial fibrillation (AF) and ischaemic heart disease after modified
mini-maze (MM) procedure or pulmonary vein isolation (PVI) using
radiofrequency ablation (RFA) with patients in the control group (coronary
artery bypass graft [CABG]) alone. Methods: In this prospective randomised
study, we included 95 patients with persistent AF and coronary heart
disease who underwent open-heart surgery combined with intraoperative
irrigated RFA (irrRFA). Patients were randomly assigned to three groups:
CABG and PVI using irrRA (CABG+PVI, n=31), CABG and MM procedure using
irrRA (CABG+MM, n=30), and isolated CABG (CABG alone, n=34). All patients
received implantable loop recorders (ILRs). Patient QoL was assessed using
the Short Form 36 (SF-36) preoperatively, and one and two years
post-operatively. The study primary end point was freedom from AF one year
after operation, measured by implantable loop recorders (ILRs); secondary
endpoint included long-term clinical outcomes. Results: No reoperations or
hospital mortalities were recorded. Mean follow-up was 14.4+/-9.7 months.
The percentages of patients free from AF determined by ILR were 80%,
86.2%, and 44.1% in the CABG+PVI, CABG+MM, and in the CABG alone groups,
respectively. The QoL significantly improved in CABG+PVI and CABG+MM
groups compared with CABG alone group in most domains. Conclusion:
Effective elimination of AF during CABG surgery improves QoL in all
physical health domains of the SF-36 and the role-emotional functioning
domain. Thus, patients with concomitant AF and coronary heart disease may
benefit from intraoperative radiofrequency ablation to prevent relapse of
the arrhythmia. Copyright © 2015 Australian and New Zealand
Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society
of Australia and New Zealand (CSANZ).

<140>
Accession Number
613197549
Author
Kim D.H.; Kim C.A.; Placide S.; Lipsitz L.A.; Marcantonio E.R.
Institution
(Kim, Kim, Lipsitz) Beth Israel Deaconess Medical Center, 110 Francis
Street, Boston, MA 02215, United States
(Placide) Albert Einstein College of Medicine, 1300 Morris Park Avenue,
Bronx, NY 10461, United States
(Marcantonio) Division of General Medicine and Primary Care, Beth Israel
Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United
States
Title
Preoperative frailty assessment and outcomes at 6 months or later in older
adults undergoing cardiac surgical procedures: A systematic review.
Source
Annals of Internal Medicine. 165 (9) (pp 650-660), 2016. Date of
Publication: 01 Nov 2016.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Background: Frailty assessment may inform surgical risk and prognosis not
captured by conventional surgical risk scores. Purpose: To evaluate the
evidence for various frailty instruments used to predict mortality,
functional status, or major adverse cardiovascular and cerebrovascular
events (MACCEs) in older adults undergoing cardiac surgical procedures.
Data Sources: MEDLINE and EMBASE (without language restrictions), from
their inception to 2 May 2016. Study Selection: Cohort studies evaluating
the association between frailty and mortality or functional status at 6
months or later in patients aged 60 years or older undergoing major or
minimally invasive cardiac surgical procedures. Data Extraction: 2
reviewers independently extracted study data and assessed study quality.
Data Synthesis: Mobility, disability, and nutrition were frequently
assessed domains of frailty in both types of procedures. In patients
undergoing major procedures (n = 18 388; 8 studies), 9 frailty instruments
were evaluated. There was moderate-quality evidence to assess mobility or
disability and very-low-to lowquality evidence for using a multicomponent
instrument to predict mortality or MACCEs. No studies examined functional
status. In patients undergoing minimally invasive procedures (n = 5177; 17
studies), 13 frailty instruments were evaluated. There was moderate-to
high-quality evidence for assessing mobility to predict mortality or
functional status. Several multicomponent instruments predicted mortality,
functional status, or MACCEs, but the quality of evidence was low to
moderate. Multicomponent instruments that measure different frailty
domains seemed to outperform single-component ones. Limitation:
Heterogeneity of frailty assessment, limited generalizability of
multicomponent frailty instruments, few validated frailty instruments, and
potential publication bias. Conclusion: Frailty status, assessed by
mobility, disability, and nutritional status, may predict mortality at 6
months or later after major cardiac surgical procedures and functional
decline after minimally invasive cardiac surgery. Copyright ©
2016 American College of Physicians.

<141>
Accession Number
607706868
Author
Protogerou C.; Fleeman N.; Dwan K.; Richardson M.; Dundar Y.; Hagger M.S.
Institution
(Protogerou) Institute of Psychology Health and Society, Department of
Health Services Research, University of Liverpool, Eleanor Rathbone
Building, 74 Bedford Street South, Liverpool L69 7ZQ, United Kingdom
(Fleeman, Dwan) Liverpool Reviews and Implementation Group, University of
Liverpool, United Kingdom
(Richardson) Liverpool Reviews and Implementation Group, Department of
Biostatistics, University of Liverpool, United Kingdom
(Dundar) Mersey Care NHS Trust, Department of Health Services Research,
University of Liverpool, United Kingdom
(Hagger) Health Psychology and Behavioural Medicine Research Group, School
of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin
University, Perth, Australia
(Protogerou) Department of Psychology, University of Cape Town, Rondebosch
7701, South Africa
Title
Moderators of the effect of psychological interventions on depression and
anxiety in cardiac surgery patients: A systematic review and
meta-analysis.
Source
Behaviour Research and Therapy. 73 (pp 151-164), 2015. Date of
Publication: 2015.
Publisher
Elsevier Ltd
Abstract
Cardiac surgery patients may be provided with psychological interventions
to counteract depression and anxiety associated with surgical procedures.
This systematic review and meta-analysis investigated whether intervention
efficacy was impacted by type of cardiac procedure/cardiac event; control
condition content; intervention duration; intervention timing; facilitator
type; and risk of bias. MEDLINE, EMBASE, and PsycINFO were searched for
randomized controlled trials comparing anxiety and depression outcomes,
pre and post psychological and cardiac interventions. Twenty-four studies
met the inclusion criteria for the systematic review (. N = 2718) and 16
of those were meta-analysed (. N = 1928). Depression and anxiety outcomes
were reduced more in interventions that lasted longer, were delivered
post-surgery, and by trained health professionals. Depression (but not
anxiety) was reduced more when the experimental intervention was compared
to an 'alternative' intervention, and when the intervention was delivered
to coronary artery bypass graft patients. Anxiety (but not depression) was
decreased more when interventions were delivered to implantable
cardioverter defibrillator patients, and were of 'high' or 'unclear' risk
of bias. In addition to estimating efficacy, future work in this domain
needs to take into account the moderating effects of intervention, sample,
and study characteristics. Copyright © 2015 Elsevier Ltd.

<142>
Accession Number
614924738
Author
Dieleman J.M.; de Wit G.A.; Nierich A.P.; Rosseel P.M.; van der Maaten
J.M.; Hofland J.; Diephuis J.C.; de Lange F.; Boer C.; Neslo R.E.; Moons
K.G.; van Herwerden L.A.; Tijssen J.G.; Kalkman C.J.; van Dijk D.
Institution
(Dieleman, Kalkman, van Dijk) Department of Anesthesiology and Intensive
Care, University Medical Center, Utrecht, Netherlands
(de Wit, Neslo, Moons) Julius Center for Health Sciences and Primary Care,
University Medical Center, Utrecht, Netherlands
(Nierich) Department of Cardiothoracic Anesthesia, Isala Klinieken,
Zwolle, Netherlands
(Rosseel) Department of Cardiothoracic Anesthesia, Amphia Ziekenhuis,
Breda, Netherlands
(van der Maaten) Department of Anesthesiology, University Medical Center,
Groningen, Netherlands
(Hofland) Department of Cardiothoracic Anesthesia, Erasmus Medical Center,
Rotterdam, Netherlands
(Diephuis) Department of Cardiothoracic Anesthesia, Medisch Spectrum
Twente, Enschede, Netherlands
(de Lange) Department of Cardiothoracic Anesthesia, Medical Center,
Leeuwarden, Netherlands
(Boer) Department of Anesthesiology, Vrije Universiteit University Medical
Center, Amsterdam, Netherlands
(van Herwerden) Department of Cardiothoracic Surgery, University Medical
Center, Utrecht, Netherlands
(Tijssen) Department of Cardiology, Academic Medical Center, Amsterdam,
Netherlands
Title
Long-term outcomes and cost effectiveness of high-dose dexamethasone for
cardiac surgery: a randomised trial.
Source
Anaesthesia. 72 (6) (pp 704-713), 2017. Date of Publication: June 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Prophylactic intra-operative administration of dexamethasone may improve
short-term clinical outcomes in cardiac surgical patients. The purpose of
this study was to evaluate long-term clinical outcomes and cost
effectiveness of dexamethasone versus placebo. Patients included in the
multicentre, randomised, double-blind, placebo-controlled DExamethasone
for Cardiac Surgery (DECS) trial were followed up for 12 months after
their cardiac surgical procedure. In the DECS trial, patients received a
single intra-operative dose of dexamethasone 1 mg.kg-1 (n =
2239) or placebo (n = 2255). The effects on the incidence of major
postoperative events were evaluated. Also, overall costs for the 12-month
postoperative period, and cost effectiveness, were compared between
groups. Of 4494 randomised patients, 4457 patients (99%) were followed up
until 12 months after surgery. There was no difference in the incidence of
major postoperative events, the relative risk (95%CI) being 0.86
(0.72-1.03); p = 0.1. Treatment with dexamethasone reduced costs per
patient by 921 [1084] (95%CI -1672 to -137; p = 0.02), mainly through
reduction of postoperative respiratory failure and duration of
postoperative hospital stay. The probability of dexamethasone being cost
effective compared with placebo was 97% at a threshold value of 17,000
[20,000] per quality-adjusted life year. We conclude that intra-operative
high-dose dexamethasone did not have an effect on major adverse events at
12 months after cardiac surgery, but was associated with a reduction in
costs. Routine dexamethasone administration is expected to be cost
effective at commonly accepted threshold levels for cost
effectiveness. Copyright © 2017 The Association of Anaesthetists
of Great Britain and Ireland

<143>
Accession Number
616123710
Author
Abawi M.; Agostoni P.; Kooistra N.H.M.; Samim M.; Nijhoff F.; Voskuil M.;
Nathoe H.; Doevendans P.A.; Chamuleau S.A.; Urgel K.; Hendrikse J.; Leiner
T.; Abrahams A.C.; van der Worp B.; Stella P.R.
Institution
(Abawi, Agostoni, Kooistra, Nijhoff, Voskuil, Nathoe, Doevendans,
Chamuleau, Urgel, Stella) Department of Cardiology, University Medical
Centre Utrecht, Utrecht, Netherlands
(Agostoni, Samim) Department of Cardiology, St. Antonius Hospital,
Nieuwegein, Netherlands
(Hendrikse, Leiner) Department of Radiology, University Medical Centre
Utrecht, Utrecht, Netherlands
(Abrahams) Department of Nephrology and Hypertension, University Medical
Centre Utrecht, Utrecht, Netherlands
(van der Worp) Department of Neurology, University Medical Centre Utrecht,
Utrecht, Netherlands
Title
Rationale and design of the edwards SAPIEN-3 periprosthetic leakage
evaluation versus medtronic corevalve in transfemoral aortic valve
implantation (ELECT) trial: A randomised comparison of balloon-expandable
versus self-expanding transcatheter aortic valve prostheses.
Source
Netherlands Heart Journal. 25 (5) (pp 318-329), 2017. Date of Publication:
May 2017.
Publisher
Bohn Stafleu van Loghum (E-mail: e.smid@ntvg.nl)
Abstract
Background and objectives Periprosthetic aortic regurgitation (PPR) after
transcatheter aortic valve implantation (TAVI) remains an important issue
associated with impaired long-term outcomes. The current randomised study
aims to evaluate potential differences between the balloon-expandable
Edwards SAPIEN-3 and the self-expanding Medtronic CoreValve system with
the main focus on post-TAVI PPR by means of novel imaging endpoints, and
an additional focus on other clinical endpoints. Endpoints The primary
endpoint of this study is quantitative assessment of the severity of
post-procedural PPR using cardiac magnetic resonance imaging. Several
other novel imaging modalities (X-ray contrast angiography,
echocar-diography) are used as secondary imaging modalities for the
assessment of PPR following TAVI. Secondary objectives of the study
include clinical outcomes such as cerebral and kidney injury related to
TAVI, and quality of life. Methods and design The ELECT study is a
single-centre, prospective, two-armed randomised controlled trial. For the
purpose of this study, 108 consecutive adult patients suitable for
transfemoral TAVI will be randomly allocated to receive the SAPIEN-3 (n =
54) or the CoreValve system (n = 54). Discussion The ELECT trial is the
first randomised controlled trial to quantitatively compare the extent of
post-TAVI PPR between the SAPIEN-3 and CoreValve. Furthermore, it will
evaluate potential differences between the two prostheses with regard to
mid-term clinical outcome and quality of life. Copyright © The
Author(s) 2017.

<144>
Accession Number
616113042
Author
Siddiqu N.U.R.; Merchant Q.; Hasan B.S.; Rizvi A.; Amanullah M.; Rehmat
A.; Haq A.U.
Institution
(Siddiqu, Merchant, Hasan, Rizvi, Haq) Department of Pediatrics and Child
Health, Aga Khan University Hospital, Karachi, Pakistan
(Amanullah) Department of Surgery, Aga Khan University, Karachi, Pakistan
(Rehmat) Aga Khan University, Karachi, Pakistan
Title
Comparison of enteral versus intravenous potassium supplementation in
hypokalaemia in paediatric patients in intensive care post cardiac
surgery: Open-label randomised equivalence trial (EIPS).
Source
BMJ Open. 7 (5) (no pagination), 2017. Article Number: e011179. Date of
Publication: 01 May 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives The primary objective was to compare the efficacy of enteral
potassium replacement (EPR) and intravenous potassium replacement (IVPR)
as first-line therapy. Secondary objectives included comparison of adverse
effects and number of doses required to resolve the episode of
hypokalaemia. Trial design The EIPS trial is designed as a randomised,
equivalence trial between two treatment arms. Study setting The study was
conducted at the paediatric cardiac intensive care unit (PCICU) at Aga
Khan University Hospital, Karachi. Participants 41 patients (aged 1 month
to 15 years) who were admitted to PCICU post cardiac surgery were
recruited (23 IVPR arm and 18 EPR arm). Intervention Intervention arms
were block randomised on alternate weeks for IVPR and EPR. Outcome measure
Change in serum potassium levels in (mmol/L) and percentage change after
each event of potassium replacement by the intravenous or enteral route.
Results Both groups (41 patients) had similar baseline characteristics.
Mean age was 4.7 (SD+/-4) years while the most common surgical procedure
was ventricular septal defect repair (12 patients, 29.3%). No mortality
was observed in either arm. Four episodes of vomiting and one arrhythmia
were seen in the EPR group. After adjusting for age, potassium level at
the beginning of the episode, average urine output, inotropic score and
diuretic dose, it was found that there was no statistically significant
difference in change in potassium levels after EPR and IVPR: 0.86 mmol/L
(+/-0.8) and 0.82 mmol/L (+/-0.7) respectively (p=0.86, 95% CI-0.08 to
1.10), or percentage change in potassium level after enteral and
intravenous replacement: 26% (+/-30) and 24% (+/-20) (95% CI-3.42 to 4.03,
p=0.87). Conclusion EPR may be an equally efficacious alternative
first-line therapy in treating hypokalaemia after surgery in selective
patients with congenital heart disease. Ethics and dissemination This
study has been approved by Ethics Review Committee at AKU. Copyright
© 2017 Article author(s) (or their employer(s) unless otherwise
stated in the text of the article) 2017. All rights reserved. No
commercial use is permitted unless otherwise expressly granted.

<145>
Accession Number
616189476
Author
Zhang J.; Wang S.
Institution
(Zhang) Department of Anesthesia, East Area of the Central Hospital of
Xinxiang, No. 56 Jinsui Road, Xinxiang City 453000, China
(Wang) Quality and Technical Supervision and Inspection Center of
Xinxiang, Xinxiang, China
Title
Effects of sevoflurane on cardiopulmonary function in patients undergoing
coronary artery bypass.
Source
Journal of Biological Regulators and Homeostatic Agents. 30 (4) (pp
1079-1083), 2016. Date of Publication: 2016.
Publisher
Biolife s.a.s. (E-mail: biolife_sas@yahoo.it)
Abstract
The objective of the current study was to investigate effects of
sevoflurane on cardiopulmonary function in patients undergoing coronary
artery bypass grafting (CABG). In this study, 60 cases of patients with
coronary heart disease (CHD) were selected and randomly divided into the
sevoflurane group (group S) and the control group C (group C) with 30
cases in each group. The two groups received intravenous anesthesia. The
patients of group C were only given oxygen mask and physiological saline
to keep vein open; while the patients of group S were administered with 1%
sevoflurane immediately after the beginning of cardiopulmonary bypass
(CPB) until the end of the treatment. The cardiopulmonary functions at 30
min before operation (T<inf>0</inf>), postoperative 2 h (T<inf>1</inf>),
6h (T<inf>2</inf>), 24h (T<inf>3</inf>) and 48 (T<inf>4</inf>) were
observed. The mean arterial pressure (MAP) of the group S at
T<inf>1</inf>, T<inf>2</inf>, T<inf>3</inf> was lower than that of the
group C, as were the heart rate (HR) and left ventricular ejection
fraction (LVEF). The creatine kinase isoenzyme (CK-MB) during
T<inf>1</inf> to T<inf>4</inf> in the group S was less than that of the
group C, and there were significant differences between the two groups (P
< 0.05). The tidal volume (Vt), vital capacity (Vc) and oxygenation index
(PaO<inf>2</inf>/FiO<inf>2</inf>) of the two groups during T<inf>1</inf>
and T<inf>2</inf> were decreased, while respiratory frequency (RR) and
alveolar-arterial blood oxygen partial pressure (PA-aO<inf>2</inf>) were
increased and they began to decrease during T<inf>3</inf> and
T<inf>4</inf>. Vt and Vc of the group S were higher during T<inf>1</inf>
and T<inf>2</inf> periods than those of the group C, while RR was lower
than that of the group C; PaO<inf>2</inf>/FiO<inf>2</inf> during
T<inf>1</inf> to T<inf>4</inf> period of group S was higher than that of
group C, while PA-aO<inf>2</inf> was significantly lower than that of the
control group (P < 0.05). In conclusion, although LVEF was not improved in
the sevoflurane group, sevoflurane may contribute to stabilizing the
cardiopulmonary function and preventing from myocardial
injury. Copyright © by BIOLIFE, s.a.s.

<146>
Accession Number
616130964
Author
Elbarbary M.; Madani W.H.; Robertson-Malt S.
Institution
(Elbarbary) King Abdulaziz Cardiac Center, PO Box 22490, Riyadh 11426,
Saudi Arabia
(Madani) King Saud bin Abdul Aziz University for Health Science, National
and Gulf Centre of Evidence Based Health Practice, Khashm Al-Aan, Riyadh,
Saudi Arabia
(Robertson-Malt) The Joanna Briggs Institute, Implementation Science,
Adelaide 5000, Australia
Title
Prophylactic steroids for pediatric open heart surgery.
Source
Cochrane Database of Systematic Reviews. 2017 (5) (no pagination), 2015.
Article Number: CD005550. Date of Publication: 21 Oct 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: The immune response to cardiopulmonary bypass in infants and
children can lead to a series of postoperative morbidities and mortality
i.e. hemodynamic instability, increased infection and arrhythmias. The
systemic Inflammatory response syndrome (SIRS) that may develop post
bypass can affect the outcome. Administration of prophylactic doses of
corticosteroids is sometimes used to try and ameliorate the
pro-inflammatory response of SIRS. However, the clinical benefits and
harms of this type of intervention in the pediatric patient remains
uncertain. Objectives: Is to update the previously published review
"Prophylactic steroids for pediatric open heart surgery" which
systematically review the beneficial and harmful effects of the
prophylactic administration of corticosteroids, compared with placebo, in
pediatric open heart surgery. Search methods: The Cochrane Central
Register of Controlled Trials (CENTRAL) in The Cochrane Library (2014,
issue 1); MEDLINE (1966 to October 2014); EMBASE (1980 to October 2014);
CINAHL (1964 to October 2014) were searched. An additional hand search of
the EMRO database for Arabic literature was performed. Grey literature was
searched and experts in the field were contacted for any unpublished
material. No language restrictions were applied. Selection criteria: All
randomized and quasi-randomized controlled trials of open heart surgery in
the pediatric population that received corticosteroids pre-, peri- or
post-operatively, with reported clinical outcomes in terms of morbidity
and mortality. Data collection and analysis: Eligible studies were
abstracted and evaluated by two independent reviewers. All meta-analyses
were completed using RevMan 5.2 We calculated the risk ratio (RR) with 95%
confident intervals (CI) for comparing the outcomes between groups.
Weighted mean difference (WMD) was the primary summary statistic with data
pooled using a random-effects model. Main results: Two trials were added
in the updated review namely Lerzo 2011 with 29 participants and
Keski-Nisula 2013 with 40 participants, that makes total studies of seven
with total number of participants is 226. All studies are in general with
poor quality due mainly to small sample size according to the Cochrane
Handbook section(Chapter 12). Despite it did not reach statistical
significance and more research is needed. There was trend in favor of
prophylactic corticosteroid administration for reducing intensive care
length of stay WMD (-0.38 )days (95% CI -1.23 to 0.46), peak core
temperature -0.17degreeC (-0.93 to 0.59)there is no evidence to suggest
effect of steroids in peak core temperature; duration of ventilation -0.63
hours (-4.01 to 2.75) there is no evidence to suggest effect of steroids
in total hours ventilated; and reduction in mortality OR of 0.57 (0.02 to
13.19). There was no reported increase in the side effects particularly
regarding infection, wound healing and GIT bleeding. Authors' conclusions:
The use of prophylactic steroids in pediatric patients to reduce
postoperative complications commonly experienced following cardiopulmonary
bypass surgery is not supported by the existing evidence despite the trend
in favour. Further well designed and adequately powered randomized
controlled trials are needed to more accurately estimate the benefit and
harm of this intervention. Copyright © 2017 The Cochrane
Collaboration. Published by John Wiley & Sons, Ltd.

<147>
Accession Number
616204732
Author
Sanfilippo F.; Johnson C.; Bellavia D.; Morsolini M.; Romano G.;
Santonocito C.; Centineo L.; Pastore F.; Pilato M.; Arcadipane A.
Institution
(Sanfilippo, Santonocito, Centineo, Pastore, Arcadipane) Department of
Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i
Trapianti e Terapie ad alta specializzazione), Palermo, Italy
(Johnson) Department of Anesthesiology, University of Pittsburgh Medical
Center, Pittsburgh, PA
(Bellavia, Romano) Cardiology Unit, Department for the Treatment and Study
of Cardiothoracic Diseases and Cardiothoracic Transplantation,
IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta
Specializzazione), Palermo, Italy
(Morsolini, Pilato) Cardiac Surgery and Heart Transplantation Unit,
Department for the Treatment and Study of Cardiothoracic Diseases and
Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i
Trapianti e Terapie ad alta Specializzazione), Palermo, Italy
Title
Mitral Regurgitation Grading in the Operating Room: A Systematic Review
and Meta-analysis Comparing Preoperative and Intraoperative Assessments
During Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objective: To assess differences in mitral regurgitation (MR) grade
between the preoperative and the intraoperative evaluations. Design:
Systematic review and meta-analysis of 6 observational studies found from
MEDLINE and EMBASE. Setting: Cardiac surgery. Participants: One hundred
thirty-seven patients. Intervention: Comparison between the preoperative
MR assessment and the intraoperative evaluation conducted under general
anesthesia (GA), with or without "hemodynamic matching" (HM) (artificial
increase of afterload). Measurements and Main Results: The primary outcome
was the difference between the preoperative and intraoperative MR grade
under "GA-only" or "after-HM." Secondary analyses addressed differences
according to effective regurgitant orifice area (EROA), regurgitant volume
(RVol), color-jet area, and vena contracta width. Risk of MR
underestimation was found under "GA-only" (SMD: 0.55; 95% confidence
interval [CI], 0.31-0.79, p < 0.00001), but not "after-HM" (SMD: -0.16;
95% CI, -0.46 to 0.13, p = 0.27). Under "GA-only", EROA had a trend toward
underestimation (p = 0.07), RVol was reliable (p = 0.17), while reliance
on color-jet area and vena contracta width incur risk of underestimation
(both p = 0.003). After HM, EROA accurately reflected preoperative MR (p =
0.68) while RVol had a trend toward overestimation (p = 0.05). The overall
reported incidence of misdiagnoses was slightly more common under
"GA-only" (mean 48%, 39% underestimation, 9% overestimation; range:
32%-57%) than "after-HM" (mean 41%, 12% underestimation, 29%
overestimation; range: 33%-50%). Only the minority of misdiagnoses were
clinically relevant: underestimation was around 10% (both approaches), but
18% had clinically significant overestimation "after-HM" as compared with
3% under GA-only. Conclusions: Intraoperative assessment under "GA-only"
significantly underestimated MR. A more accurate intraoperative evaluation
can be obtained with afterload manipulation, although HM strategy carries
high risk of clinically significant overestimation. Copyright ©
2017 Elsevier Inc.

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[Use Link to view the full text]
Accession Number
610964372
Author
Khan J.N.; Nazir S.A.; Singh A.; Shetye A.; Lai F.Y.; Peebles C.; Wong J.;
Greenwood J.P.; McCann G.P.
Institution
(Khan, Nazir, Singh, Lai, Greenwood) Department of Cardiovascular
Sciences, University of Leicester and the NIHR Leicester Cardiovascular
BRU, Glenfield Hospital, Groby Rd, Leicester LE3 9QP, United Kingdom
(Peebles) Department of Cardiology, University Hospital Southampton NHS
Trust, United Kingdom
(Wong) Department of Cardiology, Royal Brompton and Harefield NHS Trust,
London, United Kingdom
(McCann) Leeds Institute of Cardiovascular and Metabolic Medicine
(LICAMM), University of Leeds, United Kingdom
Title
Relationship of Myocardial Strain and Markers of Myocardial Injury to
Predict Segmental Recovery after Acute ST-Segment-Elevation Myocardial
Infarction.
Source
Circulation: Cardiovascular Imaging. 9 (6) (no pagination), 2016. Article
Number: e003457. Date of Publication: 01 Jun 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Late gadolinium-enhanced cardiovascular magnetic resonance
imaging overestimates infarct size and underestimates recovery of
dysfunctional segments acutely post ST-segment-elevation myocardial
infarction. We assessed whether cardiovascular magnetic resonance
imaging-derived segmental myocardial strain and markers of myocardial
injury could improve the accuracy of late gadolinium-enhancement in
predicting functional recovery after ST-segment-elevation myocardial
infarction. Methods and Results - A total of 164 ST-segment-elevation
myocardial infarction patients underwent acute (median 3 days) and
follow-up (median 9.4 months) cardiovascular magnetic resonance imaging.
Wall-motion scoring, feature tracking-derived circumferential strain
(Ecc), segmental area of late gadolinium-enhancement (SEE), microvascular
obstruction, intramyocardial hemorrhage, and salvage index (MSI) were
assessed in 2624 segments. We used logistic regression analysis to
identify markers that predict segmental recovery. At acute CMR 32% of
segments were dysfunctional, and at follow-up CMR 19% were dysfunctional.
Segmental function at acute imaging and odds ratio (OR) for functional
recovery decreased with increasing SEE, although 33% of dysfunctional
segments with SEE 76% to 100% improved. SEE was a strong predictor of
functional improvement and normalization (area under the curve [AUC],
0.840 [95% confidence interval {CI}, 0.814-0.867]; OR, 0.97 [95% CI,
0.97-0.98] per +1% SEE for improvement and AUC, 0.887 [95% CI,
0.865-0.909]; OR, 0.95 [95% CI, 0.94-0.96] per +1% SEE for normalization).
Its predictive accuracy for improvement, as assessed by areas under the
receiver operator curves, was similar to that of MSI (AUC, 0.840 [95% CI,
0.809-0.872]; OR, 1.03 [95% CI, 1.02-1.03] per +1% MSI for improvement and
AUC, 0.862 [0.832-0.891]; OR, 1.04 [95% CI, 1.03-1.04] per +1% SEE for
normalization) and Ecc (AUC, 0.834 [95% CI, 0.807-0.862]; OR, 1.05 [95%
CI, 1.03-1.07] per +1% MSI for improvement and AUC, 0.844 [95% CI,
0.818-0.871]; OR, 1.07 [95% CI, 1.05-1.10] per +1% SEE for normalization),
and for normalization was greater than the other predictors. MSI and Ecc
remained as significant after adjustment for SEE but provided no
significant increase in predictive accuracy for improvement and
normalization compared with SEE alone. MSI had similar predictive accuracy
to SEE for functional recovery but was not assessable in 25% of patients.
Microvascular obstruction provided no incremental predictive accuracy
above SEE. Conclusions - This multicenter study confirms that SEE is a
strong predictor of functional improvement post ST-segment-elevation
myocardial infarction, but recovery occurs in a substantial proportion of
dysfunctional segments with SEE >75%. Feature tracking-derived Ecc and MSI
provide minimal incremental benefit to SEE in predicting segmental
recovery. Clinical Trial Registration - URL: http://www.isrctn.com. Unique
identifier: ISRCTN70913605. Copyright © 2016 American Heart
Association, Inc.

<149>
[Use Link to view the full text]
Accession Number
607152735
Author
Brinkman W.T.; Squiers J.J.; Filardo G.; Arsalan M.; Smith R.L.; Moore D.;
Mack M.J.; Dimaio J.M.
Institution
(Brinkman, Arsalan, Smith, Moore, Mack, Dimaio) Heart Hospital Baylor
Plano, Plano, TX, United States
(Squiers, Filardo, Dimaio) Department of Epidemiology, Baylor Scott and
White Health, Dallas, TX, United States
Title
Perioperative outcomes, transfusion requirements, and inflammatory
response after coronary artery bypass grafting with off-pump,
mini-extracorporeal, and on-pump circulation techniques.
Source
Journal of Investigative Medicine. 63 (8) (pp 916-920), 2015. Date of
Publication: 01 Dec 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives Mini-extracorporeal circulation (MECC) units were developed to
reduce postoperative morbidity, transfusion requirements, and inflammation
associated with conventional on-pump coronary artery bypass (ONCAB)
surgery without the technical demands of the off-pump (OPCAB) technique.
We compared perioperative outcomes and inflammatory mediation among OPCAB,
MECC, and ONCAB techniques. Methods We prospectively enrolled 102 patients
undergoing elective isolated coronary bypass grafting. Perfusion methods
were OPCAB (n = 34), MECC (n = 34), and ONCAB (n = 34). Serial blood
samples were collected to measure serum inflammatory markers. Results
There were no operative deaths or strokes. Total red blood cell (RBC)
products used in OPCAB, MECC, and ONCAB patients were 0.676, 1.000, and
1.235 units, respectively. Adjusted (by splined Society of Thoracic
Surgeons operative risk score) analysis showed no statistically
significant differences in mean RBC product use among the different
operative systems (OPCAB vs MECC, P = 0.580; OPCAB vs ONCAB, P = 0.311;
MECC vs ONCAB, P = 0.633). Adjusted (by Society of Thoracic Surgeons risk
score and baseline level) mean plasma level differences (24 hours
postoperative - baseline) of C-reactive protein for OPCAB (117.89; 95%
confidence interval [95% CI], 106.23-129.54) and for MECC (124.88; 95% CI,
113.45-136.32) were significantly higher than for ONCAB (98.82; 95% CI,
86.40-111.24). No significant adjusted differences (P = 0.304) in
interleukin-6 level changes were observed. Conclusions Off-pump coronary
artery bypass and MECC did not significantly reduce mean total RBC
transfusion requirements. Off-pump coronary artery bypass and MECC were
associated with greater C-reactive protein elevation than ONCAB,
suggestive of an increased inflammatory response to each of these
techniques. Copyright © 2015 Lippincott Williams & Wilkins.

<150>
[Use Link to view the full text]
Accession Number
613828654
Author
Michael T.T.; Badhey N.; Banerjee S.; Brilakis M.S.
Institution
(Michael, Badhey, Banerjee, Brilakis) VA North Texas Health Care System,
University of Texas Southwestern Medical Center at Dallas, Division of
Cardiology (111A), 4500 S Lancaster d, Dallas, TX 75216, United States
Title
Comparison of Characteristics and Outcomes of Patients Undergoing
Saphenous Vein Graft Stenting Who Were or Were Not nrolled in the Stenting
of Saphenous Vein Grafts andomized Controlled Trial.
Source
Journal of Investigative Medicine. 59 (2) (pp 259-266), 2011. Date of
Publication: 2011.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective We sought to compare the characteristics and outcomes of
patients who were enrolled versus those who were not enrolled in the
Stenting of Saphenous Vein Grafts (SOS) randomized controlled trial.
Methods and esults We identified all patients who underwent saphenous vein
graft stenting during the SOS Trial enrollment period (May 2005 and
October 2007) at our institution. Baseline characteristics and clinical
outcomes were compared between patients who were versus those who were not
enrolled in SOS. Of the 97 patients who underwent saphenous vein graft
stenting during the study period, 62 patients (64%) were enrolled in SOS.
In the enrolled group, 62 patients with 91 lesions were randomized to a
bare metal stent (BMS) (n = 39) or paclitaxel-eluting stent (n = 41). In
the nonenrolled group, 35 patients with 44 lesions received a drug-eluting
stent (DS) (n = 27) or BMS (n = 8). During a median follow-up period of
2.66 years, nonenrolled patients had higher mortality (31.4% vs 14.5%, P =
0.039), but lower rates of myocardial infarction (5.7% vs 32.3%, P =
0.005) and target vessel failure (37% vs 61.3%, P = 0.023). Overall,
patients who received DS had lower incidence of myocardial infarction,
target lesion revascularization, target vessel failure and major adverse
cardiac events, and similar mortality compared with the BMS group.
Conclusions Compared with nonenrolled patients, those who were enrolled in
SOS had lower mortality. Patients receiving DS had better outcomes than
those receiving BMS in both groups. Copyright © 2011 American
Federation for Medical Research.

<151>
Accession Number
616041459
Author
Abdallah M.S.; Wang K.; Magnuson E.A.; Osnabrugge R.L.; Kappetein A.P.;
Morice M.-C.; Mohr F.A.; Serruys P.W.; Cohen D.J.
Institution
(Abdallah) Robert and Suzanne Tomsich Department of Cardiovascular
Medicine, Cleveland Clinic, Cleveland, Ohio, United States
(Wang, Magnuson, Cohen) Saint Luke's Mid America Heart Institute, Kansas
City, Missouri, United States
(Magnuson, Cohen) University of Missouri-Kansas City School of Medicine,
Kansas City, Missouri, United States
(Osnabrugge, Kappetein, Serruys) Erasmus University Medical Center,
Rotterdam, Netherlands
(Morice) Hopital Prive Jacques Cartier, Massy, France
(Mohr) Herzzentrum Universitat Leipzig, Leipzig, Germany
Title
Quality of Life After Surgery or DES in Patients With 3-Vessel or Left
Main Disease.
Source
Journal of the American College of Cardiology. 69 (16 Supplement) (pp
2039-2050), 2017. Date of Publication: 25 Apr 2017.
Publisher
Elsevier USA
Abstract
Background In the SYNTAX (Synergy Between Percutaneous Coronary
Intervention With Taxus and Cardiac Surgery) trial, patients with 3-vessel
or left main coronary artery disease (CAD) had improved long-term outcomes
with coronary artery bypass graft (CABG) surgery compared with
percutaneous coronary intervention (PCI) with drug-eluting stents (DES),
improvements driven mainly by differences in myocardial infarction and
repeat revascularization. Objectives This study compared the long-term
quality-of-life benefits of DES-PCI versus CABG for patients with 3-vessel
or left main CAD. Methods Between 2005 and 2007, the SYNTAX trial
randomized 1,800 patients with 3-vessel or left main CAD to either CABG or
DES-PCI. Health status was assessed at baseline and at 1, 6, 12, 36, and
60 months by using the Seattle Angina Questionnaire (SAQ) and the 36-Item
Short Form Health Survey. Results At 5-year follow-up, CABG was superior
to DES-PCI on several SAQ domains including angina frequency and physical
function, as well as the role physical and role emotional scales of the
36-Item Short Form Health Survey. Subgroup analysis demonstrated a
significant interaction between angiographic complexity (as assessed by
the SYNTAX score) and angina relief (mean difference in the SAQ angina
frequency score for CABG vs. PCI of -0.9, 3.3, and 3.9 points for low,
intermediate, and high SYNTAX score patients, respectively; p = 0.048 for
interaction). Conclusions Among patients with 3-vessel or left main CAD,
both CABG and DES-PCI were associated with substantial and sustained
quality-of-life benefits over 5 years of follow-up. In general, CABG
resulted in greater angina relief, although the absolute treatment benefit
was small. Angina relief at 5 years was enhanced with CABG among patients
with high SYNTAX scores, a finding reinforcing the recommendation that
CABG should be strongly preferred for such patients. (Synergy Between
Percutaneous Coronary Intervention With Taxus and Cardiac Surgery
[SYNTAX]; NCT00114972) Copyright © 2017 American College of
Cardiology Foundation

<152>
Accession Number
616041411
Author
Palmerini T.; Bacchi Reggiani L.; Della Riva D.; Romanello M.; Feres F.;
Abizaid A.; Gilard M.; Morice M.-C.; Valgimigli M.; Hong M.-K.; Kim B.-K.;
Jang Y.; Kim H.-S.; Park K.W.; Colombo A.; Chieffo A.; Ahn J.-M.; Park
S.-J.; Schupke S.; Kastrati A.; Montalescot G.; Steg P.G.; Diallo A.;
Vicaut E.; Helft G.; Biondi-Zoccai G.; Xu B.; Han Y.; Genereux P.; Bhatt
D.L.; Stone G.W.
Institution
(Palmerini, Bacchi Reggiani, Della Riva, Romanello) Dipartimento
Cardio-Toraco-Vascolare, University of Bologna, Bologna, Italy
(Feres, Abizaid) Istituto Dante Pazzanese de Cardiologia, Sao Paulo,
Brazil
(Gilard) Department of Cardiology, Brest University, Brest, France
(Morice) Generale de Sante, Institut Cardiovasculaire Paris Sud, Massy,
France
(Valgimigli) Swiss Cardiovascular Center, Bern, Switzerland
(Hong, Kim, Jang) Severance Cardiovascular Hospital, Yonsei University
College of Medicine, Seoul, South Korea
(Kim, Park) Department of Internal Medicine, Seoul National University
Hospital, Seoul, South Korea
(Colombo, Chieffo) San Raffaele Scientific Institute, Milan, Italy
(Ahn, Park) The Heart Institute, University of Ulsan College of Medicine,
Asan Medical Center, Seoul, South Korea
(Schupke, Kastrati) ISAResearch Center, Deutsches Herzzentrum and
Deutsches Zentrum fur Herz-Kreislauf-Forschung, partner site Munich Heart
Alliance, Munich, Germany
(Montalescot) Sorbonne Universite-Paris 6, ACTION Study Group, Institut de
Cardiologie, Centre Hospitalier Universitaire Pitie-Salpetriere, Paris,
France
(Steg) Hopital Bichat, Assistance Publique-Hopitaux de Paris, Paris,
France
(Diallo, Vicaut) Unite de Recherche Clinique Lariboisiere Saint-Louis
Hopital Fernand Widal, Assistance Publique-Hopitaux de Paris, Paris,
France
(Helft) Institut de Cardiologie, Hopital Pitie-Salpetriere, Assistance
Publique-Hopitaux de Paris, Paris, France
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, and Department of
AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
(Xu) Catheterization Laboratory, Fu Wai Hospital, National Center for
Cardiovascular Diseases, Beijing, China
(Han) Department of Cardiology, General Hospital of Shenyang Military
Region, Shenyang, China
(Genereux, Stone) Columbia University Medical Center/New York-Presbyterian
Hospital and the Cardiovascular Research Foundation, New York, New York,
United States
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center and Harvard
Medical School, Boston, Massachusetts, United States
Title
Bleeding-Related Deaths in Relation to the Duration of Dual-Antiplatelet
Therapy After Coronary Stenting.
Source
Journal of the American College of Cardiology. 69 (16 Supplement) (pp
2011-2022), 2017. Date of Publication: 25 Apr 2017.
Publisher
Elsevier USA
Abstract
Background Although some randomized controlled trials (RCTs) and
meta-analyses have suggested that prolonged dual-antiplatelet therapy
(DAPT) may be associated with increased mortality, the mechanistic
underpinnings of this association remain unclear. Objectives The aim of
this study was to analyze the associations among bleeding, mortality, and
DAPT duration after drug-eluting stent implantation in a meta-analysis of
RCTs. Methods RCTs comparing different DAPT durations after drug-eluting
stent placement were sought through the MEDLINE, Embase, and Cochrane
databases and the proceedings of international meetings. Deaths were
considered possibly bleeding related if occurring within 1 year of the
episodes of bleeding. Primary analysis was by intention-to-treat.
Secondary analysis was performed in a modified intention-to-treat
population in which events occurring when all patients were on DAPT were
excluded. Results Individual patient data were obtained for 6 RCTs, and
aggregate data were available for 12 RCTs. Patients with bleeding had
significantly higher rates of mortality compared with those without, and
in a time-adjusted multivariate analysis, bleeding was an independent
predictor of mortality occurring within 1 year of the bleeding episode
(hazard ratio: 6.93; 95% confidence interval: 4.53 to 10.60; p < 0.0001).
Shorter DAPT was associated with lower rates of all-cause death compared
with longer DAPT (hazard ratio: 0.85; 95% confidence interval: 0.73 to
1.00; p = 0.05), which was driven by lower rates of bleeding-related
deaths with shorter DAPT compared with prolonged DAPT (hazard ratio: 0.65;
95% confidence interval: 0.43 to 0.99; p = 0.04). Mortality unrelated to
bleeding was comparable between the 2 groups. Similar results were
apparent in the modified intention-to-treat population. Conclusions
Bleeding was strongly associated with the occurrence of mortality within 1
year after the bleeding event. Shorter compared with longer DAPT was
associated with lower risk for bleeding-related death, a finding that may
underlie the lower all-cause mortality with shorter DAPT in the RCTs of
different DAPT durations after DES. Copyright © 2017 American
College of Cardiology Foundation

<153>
Accession Number
615953030
Author
Vaquero Roncero L.M.; Sanchez Poveda D.; Valdunciel Garcia J.J.; Sanchez
Barrado M.E.; Calvo Vecino J.M.
Institution
(Vaquero Roncero, Sanchez Poveda, Valdunciel Garcia, Sanchez Barrado,
Calvo Vecino) Service of Anesthesiology, Reanimation and Pain Medicine,
Complejo Asistencial Universitario de Salamanca, CAUSA, Spain
Title
Perioperative use of angiotensin-converting-enzyme inhibitors and
angiotensin receptor antagonists.
Source
Journal of Clinical Anesthesia. 40 (pp 91-98), 2017. Date of Publication:
01 Aug 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective Clinical repercussions of perioperative treatment with
ACEIs/ARBs. Design Systematic review according to PRISMA statement.
Setting Perioperative period. Patients 29 studies 11 cases/cases series,
12 observational studies and 6 randomized studies. Measurements Arterial
blood pressure differences, refractory hypotension, other comorbidities.
Main results The studies show different results regarding the topics
measured. They are divided in the results regarding blood pressure, long
term morbidities and effects in neuraxial anesthesia. Conclusions
Withholding AECI/ARBs on the morning prior to surgery could be recommended
as a potentially effective measure, with a low level of evidence, in order
to reduce the appearance of hypotension in the perioperative period of
non-cardiac surgery. Copyright © 2017 Elsevier Inc.

<154>
Accession Number
615953753
Author
Wei S.; Chen M.; Chen N.; Liu L.
Institution
(Wei, Chen, Liu) Sichuan University, Department of Thoracic surgery, West
China Hospital, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China
(Chen) Guangdong Women and Children Hospital, Center for Reproductive
Medicine, Guangzhou 510010, China
(Wei, Chen, Liu) Sichuan University, Western China Collaborative
Innovation Center for Early Diagnosis, Multidisciplinary Therapy of Lung
Cancer, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China
Title
Feasibility and safety of robot-assisted thoracic surgery for lung
lobectomy in patients with non-small cell lung cancer: A systematic review
and meta-analysis.
Source
World Journal of Surgical Oncology. 15 (1) (no pagination), 2017. Article
Number: 98. Date of Publication: 08 May 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The aim of this study is to evaluate the feasibility and
safety of robot-assisted thoracic surgery (RATS) lobectomy versus
video-assisted thoracic surgery (VATS) for lobectomy in patients with
non-small cell lung cancer (NSCLC). Methods: An electronic search of six
electronic databases was performed to identify relevant comparative
studies. Meta-analysis was performed by pooling the results of reported
incidence of overall morbidity, mortality, prolonged air leak, arrhythmia,
and pneumonia between RATS and VATS lobectomy. Subgroup analysis was also
conducted based on matched and unmatched cohort studies, if possible.
Relative risks (RR) with their 95% confidence intervals (CI) were
calculated by means of Revman version 5.3. Results: Twelve retrospective
cohort studies were included, with a total of 60,959 patients. RATS
lobectomy significantly reduced the mortality rate when compared with VATS
lobectomy (RR = 0.54, 95% CI 0.38-0.77; P=0.0006), but this was not
consistent with the pooled result of six matched studies (RR = 0.12, 95%
CI 0.01-1.07; P=0.06). There was no significant difference in morbidity
between the two approaches (RR = 0.97, 95% CI 0.85-1.12; P=0.70).
Conclusions: RATS lobectomy is a feasible and safe technique and can
achieve an equivalent short-term surgical efficacy when compared with
VATS, but its cost effectiveness also should be taken into
consideration. Copyright © 2017 The Author(s).

<155>
Accession Number
609203018
Author
Karthikesalingam A.; Holt P.J.; Thompson M.M.; Bak A.A.A.; Pattynama P.M.;
Van Voorthuisen A.E.; Grobbee D.E.; Hunink M.G.; Van Engelshoven J.M.;
Jacobs M.J.H.M.; De Mol B.A.J.M.; Van Bockel J.H.; Reekers J.; Tielbeek
X.; Boekema N.; Heuveling L.M.; Sikking I.; Cuypers P.W.M.; De Bruin J.L.;
Baas A.F.; Prinssen M.; Buth J.; Tielbeek A.V.; Blankensteijn J.D.; Balm
R.; Reekers J.A.; Van Sambeek M.R.H.M.; Pattynama P.; Verhoeven E.L.G.;
Prins T.; Van Der Ham A.C.; Van Der Velden J.J.I.M.; Van Sterkenburg
S.M.M.; Ten Haken G.B.; Bruijninckx C.M.A.; Van Overhagen H.; Tutein
Nolthenius R.P.; Hendriksz T.R.; Teijink J.A.W.; Odink H.F.; De Smet
A.A.E.A.; Vroegindeweij D.; Van Loenhout R.M.M.; Rutten M.J.; Hamming
J.F.; Lampmann L.E.H.; Bender M.H.M.; Pasmans H.; Vahl A.C.; De Vries C.;
MacKaay A.J.C.; Van Dortmont L.M.C.; Van Der Vliet A.J.; Schultze Kool
L.J.; Boomsma J.H.B.; Van H.R.; De Mol Van Otterloo J.C.A.; De Rooij
T.P.W.; Smits T.M.; Yilmaz E.N.; Wisselink W.; Van Den Berg F.G.; Visser
M.J.T.; Van Der Linden E.; Schurink G.W.H.; De Haan M.; Smeets H.J.;
Stabel P.; Van Elst F.; Poniewierski J.; Vermassen F.E.G.
Institution
(De Bruin, Blankensteijn) Division of Vascular Surgery, Department of
Surgery, VU University Medical Center, Amsterdam, Netherlands
(De Bruin, Karthikesalingam, Holt, Thompson) Division of Vascular Surgery,
St George's Vascular Institute, St George's Healthcare NHS Trust, St James
Wing, Blackshaw Rd, London SW17 0QT, United Kingdom
(Prinssen) Julius Center for Health Sciences and Primary Care, University
Medical Center Utrecht, Utrecht, Netherlands
Title
Predicting reinterventions after open and endovascular aneurysm repair
using the St George's Vascular Institute score.
Source
Journal of Vascular Surgery. 63 (6) (pp 1428-1433e1), 2016. Date of
Publication: 01 Jun 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Identifying patients at risk for aneurysm rupture and sac
expansion after open and endovascular abdominal aortic aneurysm (AAA)
repair (EVAR) may help to attenuate this risk by intensifying follow-up
and early detection of problems. The goal of this study was to validate
the St George's Vascular Institute (SGVI) score to identify patients at
risk for a secondary intervention after elective aneurysm repair. Methods
A post hoc on-treatment analysis of a randomized trial comparing open AAA
repair and EVAR was performed. In this multicenter trial, 351 patients
were randomly assigned to undergo open AAA repair or EVAR. Information on
survival and reinterventions was available for all patients at 5 years
postoperatively, for 79% at 6 years, and for 53% at 7 years. Open repair
was completed in 173 patients and EVAR in 171, based on an on-treatment
analysis. Because 17 patients had incomplete anatomic data, 327 patients
(157 open repair and 170 EVAR) were available for analysis. During 6 years
of follow-up, 78 patients underwent at least one reintervention. The SGVI
score, which is calculated from preoperative AAA morphology using aneurysm
and iliac diameter, predictively dichotomized patients into groups at
high-risk or low-risk for a secondary intervention. The observed freedom
from reintervention was compared between groups at predicted high-risk and
predicted low-risk. Results The 20 patients in the high-risk group were
indeed at higher risk for a secondary intervention compared with the 307
patients predicted to be at low risk (hazard ratio [HR], 3.82; 95%
confidence interval [CI], 2.05-7.11; P <.001). Discrimination between
high-risk and low-risk groups was valid for EVAR (HR, 4.06; 95% CI,
1.93-8.51; P <.001) and for open repair (HR, 3.41; 95% CI, 1.02-11.4; P
=.033). Conclusions The SGVI score appears to be a useful tool to predict
reintervention risk in patients after open repair and EVAR. Copyright
© 2016 Society for Vascular Surgery.

<156>
Accession Number
616112943
Author
Rados D.V.; Pinto L.C.; Leitao C.B.; Gross J.L.
Institution
(Rados, Pinto, Leitao, Gross) Division of Endocrinology, Hospital de
Clinicas de Porto Alegre, Porto Alegre, Brazil
Title
Screening for coronary artery disease in patients with type 2 diabetes: A
meta-Analysis and trial sequential analysis.
Source
BMJ Open. 7 (5) (no pagination), 2017. Article Number: e015089. Date of
Publication: 01 May 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To evaluate the efficacy of coronary artery disease screening in
asymptomatic patients with type 2 diabetes and assess the statistical
reliability of the findings. Methods Electronic databases (MEDLINE,
EMBASE, Cochrane Library and clinicaltrials.org) were reviewed up to July
2016. Randomised controlled trials evaluating coronary artery disease
screening in asymptomatic patients with type 2 diabetes and reporting
cardiovascular events and/or mortality were included. Data were summarised
with Mantel-Haenszel relative risk. Trial sequential analysis (TSA) was
used to evaluate the optimal sample size to detect a 40% reduction in
outcomes. Main outcomes were all-cause mortality and cardiac events
(non-fatal myocardial infarction and cardiovascular death); secondary
outcomes were non-fatal myocardial infarction, myocardial
revascularisations and heart failure. Results One hundred thirty-five
references were identified and 5 studies fulfilled the inclusion criteria
and totalised 3315 patients, 117 all-cause deaths and 100 cardiac events.
Screening for coronary artery disease was not associated with decrease in
risk for all-cause deaths (RR 0.95(95% CI 0.66 to 1.35)) or cardiac events
(RR 0.72(95% CI 0.49 to 1.06)). TSA shows that futility boundaries were
reached for all-cause mortality and a relative risk reduction of 40%
between treatments could be discarded. However, there is not enough
information for firm conclusions for cardiac events. For secondary
outcomes no benefit or harm was identified; optimal sample sizes were not
reached. Conclusion Current available data do not support screening for
coronary artery disease in patients with type 2 diabetes for preventing
fatal events. Further studies are needed to assess the effects on cardiac
events. PROSPERO CRD42015026627. Copyright © Article author(s)
(or their employer(s) unless otherwise stated in the text of the article)
2017. All rights reserved. No commercial use is permitted unless otherwise
expressly granted.

<157>
Accession Number
616112927
Author
Brindle M.E.; Roberts D.J.; Daodu O.; Haynes A.B.; Cauley C.; Dixon E.; La
Flamme C.; Bain P.; Berry W.
Institution
(Brindle, Daodu) Department of Surgery, University of Calgary, Calgary,
Canada
(Roberts) Departments of Surgery and Community Health Sciences, University
of Calgary and the Foothills Medical Centre, Calgary, Canada
(Haynes, Cauley) Department of Surgery, Massachusetts General Hospital,
Boston, MA, United States
(Haynes, Berry) Ariadne Labs, Boston, MA, United States
(Dixon) Department of Surgery, University of Calgary and the Foothills
Medical Centre, Calgary, Canada
(La Flamme) Sunnybrook Health Sciences Centre, Toronto, Canada
(Bain) Department of Countway Library, Harvard Medical School, Boston, MA,
United States
Title
Deriving literature-based benchmarks for surgical complications in
high-income countries: A protocol for a systematic review and
meta-Analysis.
Source
BMJ Open. 7 (5) (no pagination), 2017. Article Number: e013780. Date of
Publication: 01 May 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction To improve surgical safety, health systems must identify
preventable adverse outcomes and measure changes in these outcomes in
response to quality improvement initiatives. This requires understanding
of the scope and limitations of available population-level data. To derive
literature-based summary estimates of benchmarks of care, we will
systematically review and meta-Analyse rates of postoperative
complications associated with several common and/or high-risk operations
performed in five high-income countries (HICs). Methods and analysis An
electronic search of PubMed, Embase, Web of Science, Cochrane Central, the
NHS Economic Evaluations Database and Health Technology Assessment
database will be performed to identify studies reviewing national surgical
complication rates between 2000 and 2016. Two reviewers will screen titles
and abstracts and full texts of potentially relevant studies to determine
eligibility for inclusion in the systematic review. We will include
English-language publications using data from health databases in the USA,
Canada, the UK, Australia and New Zealand. We will include studies of
patients who underwent hip or knee arthoplasty, appendectomy,
cholecystectomy, oesophagectomy, abdominal aortic aneurysm repair, aortic
valve replacement or coronary artery bypass graft. Outcomes will include
mortality, length of hospital stay, pulmonary embolism, pneumonia, sepsis
or septic shock, reoperation, surgical site infection, wound
dehiscence/disruption, blood transfusion, bile duct injury, stroke and
myocardial infarction. We will calculate summary estimates of cumulative
incidence, incidence rate, prevalence and occurrence rate of complications
using DerSimonian and Laird random effects models. Heterogeneity in these
estimates will be examined using subgroup analyses and meta-regression. We
will correlate findings within contemporary clinical databases. Ethics and
dissemination This study of secondary data does not require ethics
approval. It will be presented internationally and published in the
peer-reviewed literature. Results will inform a future quality improvement
tool and provide benchmarks of surgical complication rates within HICs.
Trial registration International Prospective Register of Systematic
Reviews (PROSPERO). Registration number CRD42016037519. Copyright
© Article author(s) (or their employer(s) unless otherwise stated in
the text of the article) 2017. All rights reserved. No commercial use is
permitted unless otherwise expressly granted.

<158>
Accession Number
616180586
Author
Elmaraezy A.; Ebraheem Morra M.; Tarek Mohammed A.; Al-Habaa A.; Elgebaly
A.; Abdelmotaleb Ghazy A.; Khalil A.M.; Tien Huy N.; Hirayama K.
Institution
(Elmaraezy, Ebraheem Morra, Tarek Mohammed, Elgebaly) Faculty of
MedicineAl-Azhar UniversityCairo11884 Egypt
(Elmaraezy) Online Research Club, Nagasaki UniversityNagasaki Japan
(Al-Habaa) Department of CardiologyFaculty of Medicine, Al-Azhar
UniversityCairo Egypt
(Abdelmotaleb Ghazy) Department of CadiologyShebin El-Kom Teaching
Hospital31515 Egypt Menofia
(Khalil) Faculty of MedicineZagazig UniversityZagazig44519 Egypt
(Tien Huy) Evidence Based Medicine Research Group and Faculty of Applied
SciencesTon Duc Thang UniversityHo Chi Minh City, Vietnam
(Tien Huy) Department of Clinical Product DevelopmentInstitute of Tropical
Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of
Biomedical Sciences, Nagasaki University1-12-4 SakamotoNagasaki852-8523
Japan
(Hirayama) Department of ImmunogeneticsInstitute of Tropical Medicine
(NEKKEN), Leading Graduate School Program, and Graduate School of
Biomedical Sciences, Nagasaki University1-12-4 SakamotoNagasaki852-8523
Japan
Title
Risk of cataract among interventional cardiologists and catheterization
lab staff: A systematic review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2017.
Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: We performed a systematic review and meta-analysis to assess
the risk of developing a radiation-induced cataract in interventional
cardiologists (ICs). Background: ICs are forced to radiation exposure
during cardiac catheterization procedures. Since the eye lens is one of
the most radiosensitive organs in the body, ICs are highly susceptible to
develop a radiation-induced cataract. Method: We performed a systematic
literature search of nine electronic databases to retrieve studies that
report cataract among interventional cardiologists. Records were screened
for eligibility and data were extracted and analyzed using review manager
(RevMan) for windows. Results: Eight studies involving 2559 subjects
(exposed ICs=1224) were included. Posterior lens opacity was significantly
higher in ICs relative to the control group (RR= 3.21, 95% CI [2.14,
4.83], P<0.00001). In contrast, there was no significant difference
between both groups in cortical lens opacity (RR= 0.69, 95% CI [0.46,
1.06], P=0.09) and nuclear opacity (RR= 0.85, 95% CI [0.71, 1.02],
P=0.08). Conclusion: Interventional cardiologists are at high risk of
developing radiation-induced cataract; therefore, protective measures with
high safety rates should be implied. Copyright © 2017 Wiley
Periodicals, Inc.

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