EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
605877884
Author
Fujihara M.; Higashimori A.; Kato Y.; Taniguchi H.; Iwasaki Y.; Amano T.;
Sumiyoshi A.; Nishiya D.; Yokoi Y.
Institution
(Fujihara, Higashimori, Yokoi) Department of Cardiology, Kishiwada
Tokushukai Hospital, 4-27-1 Kamori-cho, Kishiwada, Osaka 596-8522, Japan
(Kato, Taniguchi) Department of Cardiology, Saiseikai Noe Hospital, Osaka,
Japan
(Iwasaki) Department of Cardiology, Osaka General Medical Center, Osaka,
Japan
(Amano) Department of Cardiology, Uji Tokushukai Hospital, Kyoto, Japan
(Sumiyoshi) Department of Cardiology, Sakurabashi Watanabe Hospital,
Osaka, Japan
(Nishiya) Department of Cardiology, Higashi Sumiyoshi Morimoto Hospital,
Osaka, Japan
Title
Nitinol stent implantation for femoropopliteal disease in patients on
hemodialysis: results of the 3-year retrospective multicenter APOLLON
study.
Source
Heart and Vessels. 31 (9) (pp 1476-1483), 2016. Date of Publication: 01
Sep 2016.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
The clinical outcomes of nitinol stents for femoropopliteal arterial (FP)
disease in patients on hemodialysis were assessed. Endovascular therapy
(EVT) is accepted for symptomatic FP disease. However, the clinical
outcomes of patients on dialysis are not well known. A multicenter
retrospective study was conducted with data between November 2010 and
August 2013. A total of 484 consecutive patients who successfully
underwent EVT for FP disease with nitinol stents were recruited and
analyzed. Patients were categorized into the hemodialysis group (N = 161)
and non-hemodialysis group (N = 323). The primary measure was primary
patency verified by duplex ultrasound at a rest peak systolic velocity
(PSVR) of >2.5, and secondary measures were freedom from target lesion
revascularization (TLR) and major amputation-free survival (AFS). Average
follow-up duration was 19.5 +/- 13.5 months. The primary patency rate at 3
years was significantly lower in the hemodialysis group than the
non-hemodialysis group (33.8 vs. 43.7 %; p = 0.036). Freedom from TLR at 3
years was 55.0 % in the hemodialysis group and 66.1 % in the
non-hemodialysis group (p = 0.032). The hemodialysis group showed a
significantly lower AFS rate at 3 years than the non-hemodialysis group
(86.4 vs. 58.2 %; p < 0.001). In hemodialysis patients, nitinol stent use
resulted in a lower patency rate, higher TLR rate, and lower AFS rate
compared to non-hemodialysis patients. These data suggest that nitinol
stent implantation for FP arteries in hemodialysis patient needs to be
reconsidered.
Copyright &#xa9; 2015, Springer Japan.

<2>
Accession Number
613090450
Author
Shah R.; Berzingi C.; Mumtaz M.; Jasper J.B.; Goswami R.; Morsy M.S.;
Ramanathan K.B.; Rao S.V.
Institution
(Shah, Jasper, Goswami, Morsy, Ramanathan) Section of Cardiology, School
of Medicine, University of Tennessee, Memphis, Tennessee, United States
(Shah, Ramanathan) Veterans Affairs Medical Center, Memphis, Tennessee,
United States
(Berzingi) West Virginia University Heart Institute, Morgantown, West
Virginia, United States
(Mumtaz) Pinnacle Health, Wormleysburg, Pennsylvania, United States
(Rao) The Duke Clinical Research Institute, Durham, North Carolina, United
States
Title
Meta-Analysis Comparing Complete Revascularization Versus Infarct-Related
Only Strategies for Patients With ST-Segment Elevation Myocardial
Infarction and Multivessel Coronary Artery Disease.
Source
American Journal of Cardiology. 118 (10) (pp 1466-1472), 2016. Date of
Publication: 15 Nov 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Several recent randomized controlled trials (RCTs) demonstrated better
outcomes with multivessel complete revascularization (CR) than with
infarct-related artery-only revascularization (IRA-OR) in patients with
ST-segment elevation myocardial infarction. It is unclear whether CR
should be performed during the index procedure (IP) at the time of primary
percutaneous coronary intervention (PCI) or as a staged procedure (SP).
Therefore, we performed a pairwise meta-analysis using a random-effects
model and network meta-analysis using mixed-treatment comparison models to
compare the efficacies of 3 revascularization strategies (IRA-OR, CR-IP,
and CR-SP). Scientific databases and websites were searched to find RCTs.
Data from 9 RCTs involving 2,176 patients were included. In
mixed-comparison models, CR-IP decreased the risk of major adverse cardiac
events (MACEs; odds ratio [OR] 0.36, 95% CI 0.25 to 0.54), recurrent
myocardial infarction (MI; OR 0.50, 95% CI 0.24 to 0.91),
revascularization (OR 0.24, 95% CI 0.15 to 0.38), and cardiovascular (CV)
mortality (OR 0.44, 95% CI 0.20 to 0.87). However, only the rates of
MACEs, MI, and CV mortality were lower with CR-SP than with IRA-OR.
Similarly, in direct-comparison meta-analysis, the risk of MI was 66%
lower with CR-IP than with IRA-OR, but this advantage was not seen with
CR-SP. There were no differences in all-cause mortality between the 3
revascularization strategies. In conclusion, this meta-analysis shows that
in patients with ST-segment elevation myocardial infarction and
multivessel coronary artery disease, CR either during primary PCI or as an
SP results in lower occurrences of MACE, revascularization, and CV
mortality than IRA-OR. CR performed during primary PCI also results in
lower rates of recurrent MI and seems the most efficacious
revascularization strategy of the 3.
Copyright &#xa9; 2016

<3>
Accession Number
605908824
Author
Williams A.M.; Watson J.; Mansour M.A.; Sugiyama G.T.
Institution
(Williams, Watson, Mansour) Department of Surgery, Michigan State
University, College of Human Medicine, 15 Michigan Street NE, Grand
Rapids, MI 49503, United States
(Watson, Mansour, Sugiyama) Department of Surgery, Spectrum Health Medical
Group, Grand Rapids, MI, United States
Title
Combined Coronary Artery Bypass Grafting and Abdominal Aortic Aneurysm
Repair: Presentation of 3 Cases and a Review of the Literature.
Source
Annals of Vascular Surgery. 30 (pp 321-330), 2016. Date of Publication: 01
Jan 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background Coronary artery disease and abdominal aortic aneurysmal disease
can occur in a single patient, and a therapeutic conundrum presents when
open surgical repair is indicated for both conditions. The traditional
standard of care is to conduct coronary artery bypass grafting (CABG)
followed by abdominal aortic aneurysm (AAA) repair 2-6 months later, but
there is significant risk with staging these 2 major surgeries. An
alternative method is to surgically repair both diseases in 1 combined
operation. The aim of our study is to review our own experience with the
combined procedure and to review the published literature to assess
morbidity and mortality of combined CABG and AAA repair. Methods A
systematic search for relevant studies was performed in the PubMed/Medline
database. Short-term mortality (<30 days) and postoperative complications
were assessed from relevant case series from 1993 to 2013. We also
conducted a retrospective chart review of all patients undergoing the
combined procedure at our institution. Results Thirty case series with a
total of 369 patients averaged a 30-day mortality of 3.0%. Fourteen
percent and 6% of patients experienced a cardiovascular or respiratory
complication, respectively. Other postoperative events included acute
renal failure (7%) and superficial wound complications (5%). In our own
experience, 3 patients underwent combined CABG and AAA repair. The mean
age was 71 years, the average AAA size was 8.9 cm, and average operative
time was 328 min. None experienced any postoperative complications. Two
are still alive at 9 and 10 years after surgery, and 1 died of unrelated
causes 8 years postoperatively. Conclusions The results of this systematic
review suggest that combined CABG and AAA repair is a viable procedure
with low operative mortality. Patients with preserved ejection fractions,
large AAA, and limited comorbidities appear to receive the most benefit
from a combined approach based on reported data from the literature. We
have experienced promising results in our highly selected patient
population. More research is warranted to devise criteria to determine
which patients would be good surgical candidates for this combined
procedure.
Copyright &#xa9; 2016 Elsevier Inc. All rights reserved.

<4>
Accession Number
608106073
Author
den Harder A.M.; de Heer L.M.; Maurovich-Horvat P.; Merkely B.; de Jong
P.A.; Das M.; de Wit G.A.; Leiner T.; Budde R.P.J.
Institution
(den Harder, de Jong, Leiner) Department of Radiology, University Medical
Center, P.O. Box 85000, Utrecht 3508GA, Netherlands
(de Heer) Department of Cardiothoracic Surgery, University Medical Center,
P.O. Box 85000, Utrecht 3508GA, Netherlands
(Maurovich-Horvat, Merkely) MTA-SE Cardiovascular Imaging Research Group,
Heart and Vascular Center, Semmelweis University, 68 Varosmajor ut,
Budapest 1122, Hungary
(Das) Department of Radiology, Maastricht University Medical Center, P.O.
Box 5800, Maastricht 6202 AZ, Netherlands
(Das) CARIM School for Cardiovascular Diseases, Maastricht University
Medical Center, P.O. Box 5800, Maastricht 6202AZ, Netherlands
(de Wit) Department of Epidemiology, Julius Center for Health Sciences and
Primary Care, P.O. Box 85000, Utrecht 3508GA, Netherlands
(de Wit) National Institute of Public Health and the Environment, P.O. Box
1, Bilthoven 3720 BA, Netherlands
(Budde) Department of Radiology, Erasmus Medical Center, P.O. Box 2040,
Rotterdam 3000CA, Netherlands
Title
Ultra low-dose chest ct with iterative reconstructions as an alternative
to conventional chest x-ray prior to heart surgery (CRICKET study):
Rationale and design of a multicenter randomized trial.
Source
Journal of Cardiovascular Computed Tomography. 10 (3) (pp 242-245), 2016.
Date of Publication: 01 Jun 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background Stroke after cardiac surgery is a severe complication with a
persistently high incidence of 1.4 - 9.7%. Postoperative strokes are
mainly embolic and can be provoked by manipulation and clamping of the
aorta during cardiac surgery, resulting in the mobilization of
atherothrombotic material and calcifications from the aortic wall.
Computed tomography (CT) can offer preoperative visualization of aortic
calcifications with low radiation exposure. We hypothesize that
preoperative knowledge regarding the location and extent of aortic
calcifications can be used to optimize surgical strategy and decrease
postoperative stroke rate. Methods/design The CRICKET study (ultra
low-dose chest CT with iterative reconstructions as an alternative to
conventional chest x-ray prior to heart surgery) is a prospective
multicenter randomized clinical trial to evaluate whether non-contrast
chest CT before cardiac surgery can decrease postoperative stroke rate by
optimizing surgical strategy. Patients scheduled to undergo cardiac
surgery aged 18 years and older are eligible for inclusion. Exclusion
criteria are pregnancy, a chest/cardiac CT in the past three months,
emergency surgery, concomitant or prior participation in a study with
ionizing radiation and unwillingness to be informed about incidental
findings. Subjects (n = 1.724) are randomized between routine care,
including a chest x-ray, or routine care with an additional low dose chest
CT. The primary objective is to investigate whether the postoperative
in-hospital stroke rate is reduced in the CT arm compared to the routine
care arm of the randomized trial. The secondary outcome measures are
altered surgical approach based on CT findings and cost-effectiveness.
Copyright &#xa9; 2016 Society of Cardiovascular Computed Tomography

<5>
Accession Number
610056356
Author
Kim M.S.; Bracken J.; Eshuis P.; Chen S.Y.J.; Fullerton D.; Cleveland J.;
Messenger J.C.; Carroll J.D.
Institution
(Kim, Chen, Fullerton, Cleveland, Messenger, Carroll) University of
Colorado Denver, Anschutz Medical Campus, 12401 East 17th Avenue, B-132,
Aurora, CO 80045, United States
(Bracken) Philips Healthcare, Markham, ON, Canada
(Eshuis) Philips Healthcare, Best, Netherlands
Title
Use of short roll C-arm computed tomography and fully automated 3D
analysis tools to guide transcatheter aortic valve replacement.
Source
International Journal of Cardiovascular Imaging. 32 (7) (pp 1145-1152),
2016. Date of Publication: 01 Jul 2016.
Publisher
Springer Netherlands
Abstract
Determination of the coplanar view is a critical component of
transcatheter aortic valve replacement (TAVR). The safety and accuracy of
a novel reduced angular range C-arm computed tomography (CACT) approach
coupled with a fully automated 3D analysis tool package to predict the
coplanar view in TAVR was evaluated. Fifty-seven patients with severe
symptomatic aortic stenosis deemed prohibitive-risk for surgery and who
underwent TAVR were enrolled. Patients were randomized 2:1 to CACT vs.
angiography (control) in estimating the coplanar view. These approaches to
determine the coplanar view were compared quantitatively. Radiation doses
needed to determine the coplanar view were recorded for both the CACT and
control patients. Use of CACT offered good agreement with the actual
angiographic view utilized during TAVR in 34 out of 41 cases in which a
CACT scan was performed (83 %). For these 34 cases, the mean angular
magnitude difference, taking into account both oblique and cranial/caudal
angulation, was 1.3degree +/- 0.4degree, while the maximum difference was
7.3degree. There were no significant differences in the mean total
radiation dose delivered to patients between the CACT and control groups
as measured by either dose area product (207.8 +/- 15.2 Gy cm²
vs. 186.1 +/- 25.3 Gy cm², P = 0.47) or air kerma (1287.6 +/-
117.7 mGy vs. 1098.9 +/- 143.8 mGy, P = 0.32). Use of reduced-angular
range CACT coupled with fully automated 3D analysis tools is a safe,
practical, and feasible method by which to determine the optimal
angiographic deployment view for guiding TAVR procedures.
Copyright &#xa9; 2016, Springer Science+Business Media Dordrecht.

<6>
Accession Number
605243756
Author
Zhao D.; Song J.; Gao X.; Gao F.; Wu Y.; Lu Y.; Hou K.
Institution
(Zhao, Hou) Department of Neurosurgery, The First Hospital of Hebei
Medical University, Shijiazhuang, China
(Song, Wu) Department of Neurosurgery, Shijiazhuang, China
(Gao) Department of Neurology, The Second Hospital of Hebei Medical
University, Shijiazhuang, China
(Gao) Hebei Provincial Procurement Centers for Medical Drugs and Devices,
Shijiazhuang, China
(Lu) Department of Neurosurgery, The Second Hospital of Hebei Medical
University, Shijiazhuang, China
Title
Selective oropharyngeal decontamination versus selective digestive
decontamination in critically ill patients: A meta-analysis of randomized
controlled trials.
Source
Drug Design, Development and Therapy. 9 (pp 3617-3624), 2015. Date of
Publication: 14 Jul 2015.
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Background: Selective digestive decontamination (SDD) and selective
oropharyngeal decontamination (SOD) are associated with reduced mortality
and infection rates among patients in intensive care units (ICUs);
however, whether SOD has a superior effect than SDD remains uncertain.
Hence, we conducted a meta-analysis of randomized controlled trials (RCTs)
to compare SOD with SDD in terms of clinical outcomes and antimicrobial
resistance rates in patients who were critically ill. Methods: RCTs
published in PubMed, Embase, and Web of Science were systematically
reviewed to compare the effects of SOD and SDD in patients who were
critically ill. Outcomes included day-28 mortality, length of ICU stay,
length of hospital stay, duration of mechanical ventilation, ICU-acquired
bacteremia, and prevalence of antibiotic-resistant Gram-negative bacteria.
Results were expressed as risk ratio (RR) with 95% confidence intervals
(CIs), and weighted mean differences (WMDs) with 95% CIs. Pooled estimates
were performed using a fixed-effects model or random-effects model,
depending on the heterogeneity among studies. Results: A total of four
RCTs involving 23,822 patients met the inclusion criteria and were
included in this meta-analysis. Among patients whose admitting specialty
was surgery, cardiothoracic surgery (57.3%) and neurosurgery (29.7%) were
the two main types of surgery being performed. Pooled results showed that
SOD had similar effects as SDD in day-28 mortality (RR =1.03; 95% CI:
0.98, 1.08; P=0.253), length of ICU stay (WMD =0.00 days; 95% CI: -0.2,
0.2; P=1.00), length of hospital stay (WMD =0.00 days; 95% CI: -0.65,
0.65; P=1.00), and duration of mechanical ventilation (WMD =1.01 days; 95%
CI: -0.01, 2.02; P=0.053). On the other hand, compared with SOD, SDD had a
lower day-28 mortality in surgical patients (RR =1.11; 95% CI: 1.00, 1.22;
P=0.050), lower incidence of ICU-acquired bacteremia (RR =1.38; 95% CI:
1.24, 1.54; P=0.000), and lower rectal carriage of aminoglycosides (RR
=2.08; 95% CI: 1.68, 2.58; P=0.000), ciprofloxacin-resistant Gram-negative
bacteria (RR =1.84; 95% CI: 1.48, 2.29; P=0.000), and respiratory carriage
of third-generation cephalosporin-resistant Gram-negative bacteria (RR
=2.50; 95% CI: 1.78, 3.5; P=0.000). Conclusion: SOD has similar effects as
SDD in clinical outcomes, but has higher incidence of ICU-acquired
bacteremia, and higher carriage of antibiotic-resistant Gram-negative
bacteria. However, due to the high cost of SDD and the increased risk of
development of antibiotic resistance with the widespread use of
cephalosporins in SDD, we would recommend SOD as prophylactic antibiotic
regimens in patients in the ICU. More well-designed, large-scale RCTs are
needed to confirm our findings.
Copyright &#xa9; 2015 Zhao et al.

<7>
Accession Number
608566031
Author
De Maria G.L.; Cuculi F.; Patel N.; Dawkins S.; Fahrni G.; Kassimis G.;
Choudhury R.P.; Forfar J.C.; Prendergast B.D.; Channon K.M.; Kharbanda
R.K.; Banning A.P.
Institution
(De Maria, Cuculi, Patel, Dawkins, Fahrni, Kassimis, Forfar, Prendergast,
Channon, Kharbanda, Banning) Oxford Heart Centre, NIHR Biomedical Research
Centre, Oxford University Hospitals, Headley Way, Oxford OX39DU, United
Kingdom
(Cuculi) Department of Cardiology, LuzernerKantonsspital, Luzern,
Switzerland
(Choudhury) Acute Vascular Imaging Centre, Radcliffe Department of
Medicine, University of Oxford, Oxford, United Kingdom
(Choudhury) Division of Cardiovascular Medicine, BHF Centre of Research
Excellence, University of Oxford, Oxford, United Kingdom
Title
How does coronary stent implantation impact on the status of the
microcirculation during primary percutaneous coronary intervention in
patients with ST-elevation myocardial infarction?.
Source
European Heart Journal. 36 (45) (pp 3165-3177), 2015. Date of Publication:
2015.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims Primary percutaneous coronary intervention (PPCI) is the optimal
treatment for patients presenting with ST-elevation myocardial infarction
(STEMI). An elevated index of microcirculatory resistance (IMR) reflects
microvascular function and when measured after PPCI, it can predict an
adverse clinical outcome. We measured coronary microvascular function in
STEMI patients and compared sequential changes before and after stent
implantation. Methods and results In 85 STEMI patients, fractional flow
reserve, coronary flow reserve, and IMR were measured using a pressure
wire (Certus, St Jude Medical, St Paul, MN, USA) immediately before and
after stent implantation. Stenting significantly improved all of the
measured parameters of coronary physiology including IMR from 67.7
[interquartile range (IQR): 56.2 95.8] to 36.7 (IQR: 22.7 59.5), P, 0.001.
However, after stenting, IMR remained elevated (. 40) in 28 (32.9%)
patients. In 15 of these patients (17.6% of the cohort), only a partial
reduction in IMR occurred and these patients were more likely to be late
presenters (pain to wire time. 6 h). The extent of jeopardized myocardium
[standardized beta: 2 0.26 (IMR unit/Bypass Angioplasty Revascularization
Investigation score unit), P: 0.009] and pre-stenting IMR [standardized
beta: 2 0.34 (IMR unit), P: 0.001] predicted a reduction in IMR after
stenting (DIMR 14 post-stenting IMR 2 pre-stenting IMR), whereas
thrombotic burden [standardized beta: 0.24 (IMR unit/thrombus score unit),
P: 0.01] and deployed stent volume [standardized beta: 0.26 (IMR unit/mm3
of stent), P: 0.01] were associated with a potentially deleterious
increase in IMR. Conclusion Improved perfusion of the myocardium by stent
deployment during PPCI is not universal. The causes of impaired
microvascular function at the completion of PPCI treatment are
heterogeneous, but can reflect a later clinical presentation and/or the
location and extent of the thrombotic burden.
Copyright &#xa9; 2015 The Author.

<8>
Accession Number
606002893
Author
Ye W.; Brandle M.; Brown M.B.; Herman W.H.
Institution
(Ye, Brown) Department of Biostatistics, University of Michigan, 1415
Washington Heights, Ann Arbor, MI 48109-2029, United States
(Brandle) Division of Endocrinology and Diabetes, Kantonsspital St.
Gallen, St. Gallen, Switzerland
(Herman) Department of Internal Medicine, University of Michigan, Ann
Arbor, MI, United States
(Herman) Department of Epidemiology, University of Michigan, Ann Arbor,
MI, United States
Title
The Michigan Model for Coronary Heart Disease in Type 2 Diabetes:
Development and Validation.
Source
Diabetes Technology and Therapeutics. 17 (10) (pp 701-711), 2015. Date of
Publication: 01 Oct 2015.
Publisher
Mary Ann Liebert Inc. (E-mail: info@liebertpub.com)
Abstract
Objectives: The aim of this study was to develop and validate a computer
simulation model for coronary heart disease (CHD) in type 2 diabetes
mellitus (T2DM) that reflects current medical and surgical treatments.
Research Design and Methods: We modified the structure of the CHD submodel
in the Michigan Model for Diabetes to allow for revascularization
procedures before and after first myocardial infarction, for repeat
myocardial infarctions and repeat revascularization procedures, and for
congestive heart failure. Transition probabilities that reflect the direct
effects of medical and surgical therapies on outcomes were derived from
the literature and calibrated to recently published population-based
epidemiologic studies and randomized controlled clinical trials. Monte
Carlo techniques were used to implement a discrete-state and discrete-time
multistate microsimulation model. Performance of the model was assessed
using internal and external validation. Simple regression analysis
(simulated outcome=b<inf>0</inf>+b<inf>1</inf>xpublished outcome) was used
to evaluate the validation results. Results: For the 21 outcomes in the
six studies used for internal validation, R² was 0.99, and the
slope of the regression line was 0.98. For the 16 outcomes in the five
studies used for external validation, R² was 0.81, and the
slope was 0.84. Conclusions: Our new computer simulation model predicted
the progression of CHD in patients with T2DM and will be incorporated into
the Michigan Model for Diabetes to assess the cost-effectiveness of
alternative strategies to prevent and treat T2DM.
&#xa9; Copyright 2015, Mary Ann Liebert, Inc. 2015.

<9>
Accession Number
605510710
Author
Ho J.; Tangri N.; Komenda P.; Kaushal A.; Sood M.; Brar R.; Gill K.;
Walker S.; Macdonald K.; Hiebert B.M.; Arora R.C.; Rigatto C.
Institution
(Ho, Tangri, Komenda, Kaushal, Rigatto) Section of Nephrology, Department
of Internal Medicine, University of Manitoba, Winnipeg, MT, Canada
(Ho) Department of Immunology, University of Manitoba, Winnipeg, MT,
Canada
(Tangri, Komenda, Kaushal, Brar, Gill, Walker, Rigatto) Seven Oaks
Hospital Research Centre, Winnipeg, MT, Canada
(Tangri) Department of Community Health Sciences, University of Manitoba,
Winnipeg, MT, Canada
(Sood) Division of Nephrology, Department of Internal Medicine, University
of Ottawa, Winnipeg, MT, Canada
(Macdonald) Seven Oaks Hospital Library, University of Manitoba, Winnipeg,
MT, Canada
(Hiebert, Arora) Institute of Cardiac Sciences, St. Boniface General
Hospital, Winnipeg, MT, Canada
(Arora) Department of Surgery, University of Manitoba, Winnipeg, MT,
Canada
Title
Urinary, plasma, and serum biomarkers' utility for predicting acute kidney
injury associated with cardiac surgery in adults: A meta-analysis.
Source
American Journal of Kidney Diseases. 66 (6) (pp 993-1005), 2015. Date of
Publication: December 2015.
Publisher
W.B. Saunders
Abstract
Background Early accurate detection of acute kidney injury (AKI) occurring
after cardiac surgery may improve morbidity and mortality. Although
several novel biomarkers have been developed for the early detection of
AKI, their clinical utility in the critical intraoperative and immediate
postoperative period remains unclear. Study Design Systematic review and
meta-analysis. Setting & Population Adult patients having cardiac surgery.
Selection Criteria for Studies EMBASE, CINAHL, Cochrane Library, Scopus,
and PubMed from January 1990 until January 2015 were systematically
searched for cohort studies reporting the utility of novel biomarkers for
the early diagnosis of AKI after adult cardiac surgery. Reviewers
extracted data for study design, population, timing of biomarker
measurement and AKI occurrence, biomarker performance (area under the
receiver operating characteristic curve [AUROC]), and risk of bias. Index
Tests Novel urine, plasma, and serum AKI biomarkers, measured
intraoperatively and in the early postoperative period (<24 hours).
Reference Tests AKI was defined according to the RIFLE, AKIN, or 2012
KDIGO criteria. Results We found 28 studies reporting intraoperative
and/or early postoperative measurement of urine (n = 23 studies) or plasma
or serum (n = 12 studies) biomarkers. Only 4 of these studies measured
biomarkers intraoperatively. Overall, intraoperative discrimination by the
urine biomarkers neutrophil gelatinase-associated lipocalin (NGAL) and
kidney injury marker 1 (KIM-1) demonstrated AUROCs < 0.70, whereas
N-acetyl-beta-d-glucosaminidase (NAG) and cystatin C had AUROCs < 0.75. In
the immediate 24-hour postoperative period, the urine biomarkers NGAL (16
studies), KIM-1 (6 studies), and liver-type fatty acid binding protein (6
studies) exhibited composite AUROCs of 0.69 to 0.72. The composite AUROCs
for postoperative urine cystatin C, NAG, and interleukin 18 were <0.70.
Similarly, the composite AUROCs for postoperative plasma NGAL (6 studies)
and cystatin-C (5 studies) were <0.70. Limitations Heterogeneous AKI
definitions. Conclusions In adults, known urinary, plasma, and serum
biomarkers of AKI possess modest discrimination at best when measured
within 24 hours of cardiac surgery.
Copyright &#xa9; 2015 The Authors.

<10>
Accession Number
362576801
Author
Zerafa N.; Adami M.Z.; Galea J.
Institution
(Zerafa, Adami) Department of Pharmacy, University of Malta, Msida, Malta
(Galea) Department of Surgery, University of Malta and Consultant
Cardiothoracic Surgeon Mater Dei Hospital, B'Kara, Malta
Title
Impact of drugs counselling by an undergraduate pharmacist on cardiac
surgical patient's compliance to medicines.
Source
Pharmacy Practice. 9 (3) (pp 156-161), 2011. Date of Publication:
July-September 2011.
Publisher
Grupo de Investigacion en Atencion Farmaceutica (E-mail:
catedra@farmacare.com)
Abstract
Open heart surgery is a procedure which warrants patient education about
the complexity of drug regimens and lifestyle modifications. Patient
nonadherence is likely to have a considerable negative impact on the
patients' quality of life postcardiac surgery. Objective: To evaluate the
impact of pharmacist intervention on patients' adherence to medication and
lifestyle changes. Method: This case-controlled study was conducted at the
Cardiac Surgical Ward and Outpatients Clinic of Mater Dei Hospital, Malta.
Eighty consecutive patients who underwent coronary artery bypass or heart
valve surgery were interviewed on their day of discharge using the 'Past
Medical History Questionnaire'. The patients were then randomized to
receive pharmacist intervention or usual care. Those who received
intervention (40 patients) were given a chart with pictorial explanation
of the time of day together with a colorful photograph of each tablet
prescribed. This group of patients was also counselled to comply to oral
analgesia and exercise and also on the avoidance of alcohol and smoking
during the recovery period. The control patients received usual care
without the pharmacist intervention. All patients were re-interviewed
eight weeks after discharge using the 'Assessing Patient Compliance
Questionnaire'. Any differences between the control and experimental
groups were analysed using Chi-square, Three-Way Cross tabulation One-Way
ANOVA and Two-Way ANOVA tests using the SPSS software version 17.0.
Results: A statistically significant difference between the two groups in
the mean percentage compliance was registered following pharmacist
intervention (p<0.05). Patients in the experimental group had a higher
mean percentage compliance score (88%) than patients in the control group
(66%). Conclusion: The statistically significant difference in the mean
percentage compliance between the two groups following pharmacist
intervention shows conclusive evidence of the advantage patients gain when
offered this intervention. The pharmacist intervention provides patients
with sufficient information to help them achieve optimal benefit from the
medication prescribed.

<11>
Accession Number
615734043
Author
Wu M.; Sharma P.; Rajderkar D.
Institution
(Wu, Sharma, Rajderkar) University of Florida, Gainesville, FL, United
States
Title
Pediatric posttransplant lymphoproliferative disorder: Imaging approach
and review of literature.
Source
Pediatric Radiology. Conference: 60th Annual Meeting of the Society for
Pediatric Radiology, SPR 2017. Canada. 47 (pp S196-S197), 2017. Date of
Publication: May 2017.
Publisher
Springer Verlag
Abstract
Disclosures: All authors have disclosed no financial interests,
arrangements or affiliations in the context of this activity. Purpose or
Case Report: In this education exhibit we will review a variety of
presentations of posttransplant lymphoproliferative disorder (PTLD) and
review the approach to imaging these patients. We will include cases that
are atypical and discuss the pitfalls in imaging this population. We will
provide imaging guidelines after a review of the current literature.
(Figure Presented) Methods & Materials: Posttransplant lymphoproliferative
disorder (PTLD) is a serious complication following 10-20%of patients
following transplant.Most cases of pediatric PTLD area associated with the
Epstein Barr Virus (EBV) in this immunosuppressed population. Pathologic
classification of PTLD lesions range from uncontrolled proliferation of
the B lymphocytes to invasive malignant lymphoma. In recent years, the
complications from PTLD have decreased due to improved surveillance and
earlier diagnosis. Results: A multimodality approach with contrast
enhanced computed tomography (CECT), magnetic resonance imaging (MRI) and
positron emission tomography (PET/CT) is used in the diagnosis and
surveillance of treatment response in patients with PTLD. The most common
sites of PTLD remain the tonsils, cervical nodes, gastrointestinal tract
and the chest. Extrathoracic PTLD tends to present later than
intrathoracic PTLD. PTLD typically occurs within the allograft organ
itself, as well as in the adjacent anatomic regions. However, this is not
true after heart transplantation. The imaging appearance of PTLD is often
times nonspecific and can overlap with opportunistic infections leading to
diagnostic pitfalls. A variety of clinical treatment options exist,
including reduction of immunosuppression, anti-CD20 monoclonal antibodies,
alpha-interferon and chemotherapy. Furthermore, antiviral and early
detection measures are being used to prevent disease and improve outcomes.
Conclusions: PTLD is a perplexing entity in the pediatric post-transplant
population requiring multidisciplinary involvement. Early recognition of
symptoms, knowledge of the classic as well as atypical imaging
presentations and basic understanding of themultimodality use of the
Radiology service will allow referring clinicians to cater and optimize
treatment for the best outcomes. (Figure Presented).

<12>
Accession Number
614984569
Author
Leger C.S.; DeSouza J.F.X.
Institution
(Leger, DeSouza) Department of Psychology, Centre for Vision Research,
York University, Toronto, ON, Canada
(DeSouza) Neuroscience Diploma, York University, Toronto, ON, Canada
(DeSouza) Centre for Vision Research, York University, Toronto, ON, Canada
(DeSouza) Department of Biology, York University, Toronto, ON, Canada
(DeSouza) Canadian Action and Perception Network (CAPnet), Toronto, ON,
Canada
Title
Migraine modulation and debut after percutaneous atrial septal defect
closure: A review.
Source
Frontiers in Neurology. 8 (MAR) (no pagination), 2017. Article Number: 68.
Date of Publication: 20 Mar 2017.
Publisher
Frontiers Research Foundation (E-mail: info@frontiersin.org)
Abstract
Introduction: Change in migraine headache (MH)-preexisting MH change or
development of de novo MH-are known potential complications following
percutaneous closure of atrial septal defect (ASD), but consensus on a
causal trigger remains elusive. Objectives: To expose potential MH
triggers linked, mainly by timing and occurrence, to the emergence of de
novo MH or change in preexisting MH subsequent to percutaneous ASD closure
(pASDC). Methods: The literature was systematically searched for studies
available in English reporting MH status after pASDC published between
January 1, 1990 and November 15, 2015. We determined the number and
percentage of patients experiencing MH status change within 7 days post
procedure and the cumulative total by final follow-up (Mdn = 12 months).
Results: Twenty-five studies met the inclusion criteria, which accounted
for a total of 1,646 pASDC patients. Pre-procedure MH prevalence was 8%
(126/1,646). Change in preexisting MH occurred in a total of 72% (91/126),
12% (11/91) within 7-days after pASDC; within follow-up MH improved in 14%
(18/126), resolved in 37% (47/126), but persisted in 63% (79/126). De novo
MH incidence ranged between 10 (153/1,520) and 18.3% (153/836); 34%
incipience (52/153) was within 7-days of pASDC; females accounted for 80%
(63/79) of gender differentiated cases; of type distinguished cases, 42%
(51/122) were MH without aura (MO) and 58% (71/122) were MH with aura
(MA); MH improved in 10% (16/153), resolved in 24% (37/153) but persisted
beyond final follow-up in 76% (116/153). Antiplatelet agents were
effective modulators of MH in 44% (11/25) studies. Possible adverse
MH-predisposing traits were scarce: larger ASD size reported in ~2%
(39/1,646) of patients experiencing de novo MH or preexisting MH
exacerbation; short aortic rim reported in three de novo MH patients;
allergic response to occluder nickel alloy in four patients with MH status
change from baseline (de novo or preexisting MH change not specified).
Interpretation: Early intensification of MH status change but later
amelioration (virtually paralleling stages of endothelialization),
relatively high efficacy of antiplatelet agents, and the emergence of MA
as the dominant de novo MH type favor proinflammatory triggers of MH
status change after pASDC.
Copyright &#xa9; 2017 Leger and DeSouza.

<13>
Accession Number
614608021
Author
Bail D.H.L.
Institution
(Bail) Karl-Olga-Hospital, Stuttgart, Germany
Title
Treatment of functional mitral regurgitation by percutaneous annuloplasty
using the Carillon Mitral Contour System-Currently available data state.
Source
Journal of Interventional Cardiology. 30 (2) (pp 156-162), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: The purpose of this study is to provide a systematic review of
currently available data about the percutaneous trans-coronary-venous
mitral annuloplasty with the Carillon Mitral Contour System. Method: A
systematic literature search was conducted using the common medical and
scientific databases. The documented parameters included among others
grade of mitral regurgitation (MR), vena contracta (VC), effective
regurgitant orifice area (EROA), 6 minute-walk-test (6MWT),
NYHA-classification, and Quality of Life (QoL) at baseline, 30 days and in
the long-term follow-up. Results: The exact total number of successfully
implantations with available data remains unclear because so many
publications are either of the same institution or study group, or they
present overlapping results. Reduction of functional mitral regurgitation
(FMR) was associated with significant inverse left-ventricular (LV))
remodeling, improvement in 6MWT, QoL and NYHA-class during the 12-month
follow-up. In almost half of the enrolled patients, the Carillon System
could not be implanted or had to be removed due to coronary compromission.
Adverse advent rate (AE) ranged between 2.8-39%. Conclusions: Results with
regard to reduction of MR and inverse LV remodeling have been remarkable.
Indication and selection criteria for suitable patients, the expected
complications, and the long-term results with regard to survival and
quality of life still remain unclear. The available results do not
establish superiority of the Carillon Mitral Contour System and support
the lack of a clear benefit. The approach with the Carillon Mitral Contour
System should be limited to participants of prospective and randomized
trials.
Copyright &#xa9; 2017, Wiley Periodicals, Inc.

<14>
Accession Number
614767523
Author
Zhang W.; Sun Y.; Liu Y.; Qiu W.; Ye X.; Zhang G.; Zhang L.
Institution
(Zhang, Sun, Liu, Qiu, Zhang) Department of Cardiothoracic Surgery,
Changhai Hospital, Second Military Medical University, Shanghai, China
(Ye) Department of Health Statistics, Second Military Medical University,
Shanghai, China
(Zhang) Department of Nursing, Changhai Hospital, Second Military Medical
University, Shanghai, China
Title
A nursing protocol targeting risk factors for reducing postoperative
delirium in patients following coronary artery bypass grafting: Results of
a prospective before-after study.
Source
International Journal of Nursing Sciences. 4 (2) (pp 81-87), 2017. Date of
Publication: 10 Apr 2017.
Publisher
Chinese Nursing Association (E-mail: mahongying@hotmail.com)
Abstract
Objective The results of postoperative delirium (POD) warrant testing for
prevention. The purpose of this study was to determine whether a nursing
intervention targeting risk factors could decrease the incidence of POD
among patients who had coronary artery bypass grafting (CABG) in China.
Methods A prospective before-after study was conducted between April 2014
and April 2015. A nursing delirium intervention protocol targeting risk
factors for delirium was performed for 141 patients undergoing CABG in a
cardiothoracic ICU from November 2014 to April 2015. Intervention
consisted of screening for delirium risk factors, followed by targeted
risk factor modification, including pain control, early catheter removal,
patient orientation using the 5W1H procedure, increased family visits,
minimizing care-related interruptions, comfortable nursing and monitoring
for sleeping difficulties. Outcomes of the Intervention Group were
compared with those of the Control Group for 137 CABG patients from April
2014 to October 2014. Delirium was assessed using the confusion assessment
method for the intensive care unit (CAM-ICU). The sample size was
justified by PASS2000, based on previous data of delirium incidence in our
institution (30%). Main results Delirium incidence during the first seven
postoperative days was significantly lower in the Intervention Group at
13.48% (19/141) vs. 29.93% (41/137) for the Control Group (chi2 = 11.112,
P = 0.001). In addition, POD in the Intervention Group occurred between
the 3rd and 6th postoperative days, while POD in the Control Group mainly
occurred on the first three days postoperatively. Delirium in the
Intervention Group occurred later than delirium in the Control Group (chi2
= 12.743, P < 0.001). Length of ICU stay was reduced significantly (Z =
-6.026, P < 0.001). Conclusion The application of a nursing protocol
targeting risk factors in this study seems to be associated with a lower
incidence of POD in patients after CABG. This finding suggests that
managing the predictors properly is one of the effective strategies to
prevent delirium.
Copyright &#xa9; 2017 Chinese Nursing Association

<15>
Accession Number
615442933
Author
Costa Leme A.; Hajjar L.A.; Volpe M.S.; Fukushima J.T.; De Santis Santiago
R.R.; Osawa E.A.; Pinheiro De Almeida J.; Gerent A.M.; Franco R.A.;
Feltrim M.I.Z.; Nozawa E.; De Moraes Coimbra V.R.; De Moraes Ianotti R.;
Hashizume C.S.; Filho R.K.; Auler J.O.C.; Jatene F.B.; Galas F.R.B.G.;
Amato M.B.P.
Institution
(Costa Leme, Volpe, Fukushima, De Santis Santiago, Osawa, Pinheiro De
Almeida, Gerent, Franco, Feltrim, Nozawa, De Moraes Coimbra, De Moraes
Ianotti, Hashizume, Filho, Auler, Galas) Department of Anesthesia and
Intensive Care, Heart Institute (InCor), University of Sao Paulo, Sao
Paulo, Brazil
(Hajjar, Jatene, Amato) Cardio-Pulmonary Department, Heart Institute
(Incor), Hospital Das Clinicas da FMUSP - University of Sao Paulo, Avenue
Dr Arnaldo 455, Sao Paulo 01246-903, Brazil
(Volpe) Departament of Applied Physiotherapy, Federal University of
Triangulo Mineiro, Uberaba, Brazil
Title
Effect of intensive vs moderate alveolar recruitment strategies added to
lung-protective ventilation on postoperative pulmonary complications a
randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 317 (14) (pp
1422-1432), 2017. Date of Publication: 11 Apr 2017.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE Perioperative lung-protective ventilation has been recommended
to reduce pulmonary complications after cardiac surgery. The protective
role of a small tidal volume (VT) has been established, whereas the added
protection afforded by alveolar recruiting strategies remains
controversial. OBJECTIVE To determine whether an intensive alveolar
recruitment strategy could reduce postoperative pulmonary complications,
when added to a protective ventilation with small VT. DESIGN, SETTING, AND
PARTICIPANTS Randomized clinical trial of patients with hypoxemia after
cardiac surgery at a single ICU in Brazil (December 2011-2014).
INTERVENTIONS Intensive recruitment strategy (n=157) or moderate
recruitment strategy (n=163) plus protective ventilation with small VT.
MAIN OUTCOMES AND MEASURES Severity of postoperative pulmonary
complications computed until hospital discharge, analyzed with a common
odds ratio (OR) to detect ordinal shift in distribution of pulmonary
complication severity score (0-To-5 scale, 0, no complications; 5, death).
Prespecified secondary outcomes were length of stay in the ICU and
hospital, incidence of barotrauma, and hospital mortality. RESULTS All 320
patients (median age, 62 years; IQR, 56-69 years; 125 women [39%])
completed the trial. The intensive recruitment strategy group had a mean
1.8 (95%CI, 1.7 to 2.0) and a median 1.7 (IQR, 1.0-2.0) pulmonary
complications score vs 2.1 (95%CI, 2.0-2.3) and 2.0 (IQR, 1.5-3.0) for the
moderate strategy group. Overall, the distribution of primary outcome
scores shifted consistently in favor of the intensive strategy, with a
common OR for lower scores of 1.86 (95%CI, 1.22 to 2.83; P = .003). The
mean hospital stay for the moderate group was 12.4 days vs 10.9 days in
the intensive group (absolute difference, 1.5 days; 95% CI, 3.1 to 0.3; P
= .04). The mean ICU stay for the moderate group was 4.8 days vs 3.8 days
for the intensive group (absolute difference, 1.0 days; 95%CI, 1.6 to 0.2;
P = .01). Hospital mortality (2.5%in the intensive group vs 4.9% in the
moderate group; absolute difference, 2.4%, 95%CI, 7.1%to 2.2%) and
barotrauma incidence (0% in the intensive group vs 0.6% in the moderate
group; absolute difference, 0.6%; 95%CI, 1.8%to 0.6%; P = .51) did not
differ significantly between groups. CONCLUSIONS AND RELEVANCE Among
patients with hypoxemia after cardiac surgery, the use of an intensive vs
a moderate alveolar recruitment strategy resulted in less severe pulmonary
complications while in the hospital.

<16>
Accession Number
615494573
Author
Vasheghani Farahani A.; Yousefi Azar A.; Goodarzynejad H.R.; Khorrami E.;
Hosseinzadeh-Attar M.J.; Oshnouei S.; Alizadeh Ghavidel A.; Golfeshan E.;
Ghourban Pour F.
Institution
(Vasheghani Farahani) Department of Cardiology, School of Medicine, Tehran
Heart Center, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Yousefi Azar) Department of Operating Room Technology, Faculty of
Paramedical Sciences, Urmia University of Medical Sciences, Urmia, Iran,
Islamic Republic of
(Yousefi Azar) Rajaie Cardiovascular Medical & Research Center, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Goodarzynejad) Tehran Heart Center, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Khorrami, Hosseinzadeh-Attar) Department of Clinical Nutrition, School of
Nutritional Sciences and Dietetics, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Oshnouei) Reproductive Health Research Center, Urmia University of
Medical Sciences, Urmia, Iran, Islamic Republic of
(Alizadeh Ghavidel) Rajaie Cardiovascular Medical & Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Golfeshan) Qum University of Medical Sciences, Qum, Iran, Islamic
Republic of
(Ghourban Pour) Rajaie Cardiovascular Medical & Research Center, Tehran,
Iran, Islamic Republic of
Title
Fish oil supplementation for primary prevention of atrial fibrillation
after coronary artery bypass graft surgery: A randomized clinical trial.
Source
International Journal of Surgery. 42 (pp 41-48), 2017. Date of
Publication: 01 Jun 2017.
Publisher
Elsevier Ltd
Abstract
Background Atrial fibrillation (AF) after cardiac surgery is a common
complication that may influence patients' early and long term outcomes and
hospital costs. The purpose of this study was to assess the effect of fish
oil on occurrence of AF following coronary artery bypass graft surgery
(CABG). Methods This study was a single-center, randomized, double
blinded, placebo-controlled clinical trial. Four-hundred and one patients
undergoing coronary artery bypass graft surgery were randomly assigned to
receive 2 g/d fish oil or placebo (olive oil) for at least 5 days before
surgery. The primary end point was defined as time to AF improvement After
AF incidence following isolated CABG or a need for pharmacologic therapy
or cardioversion. Results The time to AF improvement in intervention group
was shorter than control group (HR: 2.05; 95% CI = 0.70-6.22, P = 0.20).
The incidence of AF in the intervention and control groups was 8.40% vs.
14.07% respectively (p = 0.07). Mean total duration of AF was 20.96 +/-
4.71 h in intervention groups and 46.87 +/- 7.44 h in control groups (p =
0.04). Mean duration of stay in the ICU and total hospital stay showed a
significant reduction in the intervention group (p = 0.003 and p = 0.04,
respectively). Conclusion The consumption of PUFA leads to a shorter time
to AF improvement, which was not statistically significant. The incidence
of AF in patients undergoing CABG surgery was decreased by approximately
5.7%; which was statistically on the borderline. Fish oil reduced median
length of stay in the ICU and hospital. Further well-designed studies are
needed to overcome the limitations of the existing trials and provide
conclusive conclusions.
Copyright &#xa9; 2017 IJS Publishing Group Ltd

<17>
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 &#xa9; 2017 Massachusetts Medical Society. All rights reserved.

<18>
Accession Number
614252359
Author
Harbaoui B.; Emsellem P.; Cassar E.; Besnard C.; Dauphin R.; Motreff P.;
Courand P.-Y.; Lantelme P.
Institution
(Harbaoui, Emsellem, Cassar, Besnard, Dauphin, Courand, Lantelme)
Cardiology Department, European Society of Hypertension Excellence Center,
Hopital de la Croix-Rousse, Hospices Civils de Lyon, Lyon 69004, France
(Harbaoui, Courand, Lantelme) Universite de Lyon, CREATIS, CNRS UMR5220,
INSERM U1044, INSA-Lyon, Universite Claude-Bernard Lyon 1, Hospices Civils
de Lyon, Lyon 69100, France
(Motreff) Universite d'Auvergne, Cardio-Vascular Interventional Therapy
and Imaging, Image Science for Interventional Techniques, UMR 6284,
Clermont-Ferrand 63000, France
(Motreff) University Hospital of Clermont-Ferrand, Cardiology Department,
Clermont-Ferrand 63000, France
Title
Primary angioplasty: Effect of deferred stenting on stent size.
Source
Archives of Cardiovascular Diseases. 110 (4) (pp 206-213), 2017. Date of
Publication: April 2017.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Background Primary angioplasty with immediate stenting (IS) is the gold
standard for ST-segment elevation myocardial infarction (STEMI). Deferred
stenting (DS) has been proposed to limit periprocedural complications, and
may influence stent size because of thrombus and spasm alleviation. Aim We
sought to study the effect of DS on stent size. Methods Over the study
period, 258 patients underwent primary angioplasty for STEMI (DS, n = 84;
IS, n = 174). An informative coronary angiogram run - i.e. allowing for
proper lesion analysis - was selected and anonymized by an independent
operator. Two experienced operators randomly analysed these runs, and
proposed stent dimensions after having measured vessel diameter and lesion
length by quantitative coronary analysis. The primary objective was the
variation in stent size between the two coronary angiograms. Results The
median delay between the two coronary angiograms was 2 days. Overall, the
stent length was shorter (-1.64 mm; P = 0.030) and its diameter was larger
(+0.13 mm; P < 0.001) during the second coronary angiogram, especially in
the right coronary arteries. Conclusions DS led to the implantation of a
larger and shorter stent; this is probably because DS allows for more
accurate assessment of the residual lesion after relief of spasm and
thrombus, and may have clinical consequences in terms of stent thrombosis
and restenosis.
Copyright &#xa9; 2016 Elsevier Masson SAS

<19>
Accession Number
615670824
Author
Moradian S.T.; Ghiasi M.S.; Mohamadpour A.; Siavash Y.
Institution
(Moradian, Ghiasi, Mohamadpour, Siavash) Nursing Faculty, Baqiyatallah
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Oral magnesium supplementation reduces the incidence of gastrointestinal
complications following cardiac surgery: A randomized clinical trial.
Source
Magnesium Research. 30 (1) (pp 28-34), 2017. Date of Publication:
January-February-March 2017.
Publisher
John Libbey Eurotext (127, avenue de la Republique, Montrouge 92120,
France. E-mail: contact@jle.com)
Abstract
Background. Gastrointestinal complications are common after coronary
artery bypass graft surgery. These complications are ranged from nausea
and vomiting to mesenteric ischemia and liver failure. It seems that
nausea, vomiting, and constipation are related to magnesium deficiency.
This study was designed to examine the effect of oral magnesium
supplementation on the incidence of gastrointestinal complications in
patients undergoing cardiac surgery. Method. In a single blinded
randomized clinical trial, 102 patients who were undergoing coronary
artery bypass graft surgery were randomly allocated into two groups, 52
patients in the intervention and 50 patients in control group. Patients in
the experimental group received 800 milligram magnesium oxide (2 tablets
each of them containing 240 mg elemental magnesium) daily from the
admission to discharge from hospital. The incidence of post-operative
nausea and vomiting, constipation, and atrial fibrillation was compared
between the groups. Results. Our results showed that postoperative
hypomagnesemia is present in 41.20 and 70.80 percent of the patients in
the intervention and control group patients, respectively. The overall
incidence of constipation was 62%. Patients who received magnesium
supplementation experienced less atrial fibrillation, nausea, vomiting,
and constipation. Conclusion. Our data showed that oral magnesium
supplementation could reduce the postoperative complications. Despite the
better status in the intervention group, the hypomagnesemia was present in
many of intervention group patients. It seems that supplementation with
higher doses is needed.
Copyright &#xa9; 2017 John Libbey Eurotext.

<20>
Accession Number
614458769
Author
Cousino M.K.; Rea K.E.; Schumacher K.R.; Magee J.C.; Fredericks E.M.
Institution
(Cousino, Schumacher, Fredericks) Department of Pediatrics, University of
Michigan Health System, Ann Arbor, MI, United States
(Cousino, Rea, Schumacher, Magee, Fredericks) University of Michigan
Transplant Center, Ann Arbor, MI, United States
(Magee) Department of Surgery, University of Michigan Health System, Ann
Arbor, MI, United States
(Fredericks) Child Health Evaluation and Research Center, University of
Michigan, Ann Arbor, MI, United States
Title
A systematic review of parent and family functioning in pediatric solid
organ transplant populations.
Source
Pediatric Transplantation. 21 (3) (no pagination), 2017. Article Number:
e12900. Date of Publication: 01 May 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
The process of pediatric solid organ transplantation (SOT) places new and
increased stressors on patients and family members. Measures of family
functioning may predict psychological and health outcomes for pediatric
patients and their families, and provide opportunity for targeted
intervention. This systematic review investigated parent and family
functioning and factors associated with poorer functioning in the
pediatric SOT population. Thirty-seven studies were identified and
reviewed. Studies featured a range of organ populations (eg, heart, liver,
kidney, lung, intestine) at various stages in the transplant process.
Findings highlighted that parents of pediatric SOT populations commonly
report increased stress and mental health symptoms, including
posttraumatic stress disorder. Pediatric SOT is also associated with
increased family stress and burden throughout the transplant process.
Measures of parent and family functioning were associated with several
important health-related factors, such as medication adherence, readiness
for discharge, and number of hospitalizations. Overall, findings suggest
that family stress and burden persists post-transplant, and parent and
family functioning is associated with health-related factors in SOT,
highlighting family-level functioning as an important target for future
intervention.
Copyright &#xa9; 2017 John Wiley & Sons A/S. Published by John Wiley &
Sons Ltd

<21>
Accession Number
615652513
Author
Kara I.; Erkin A.; Sacli H.; Demirtas M.; Percin B.; Diler M.S.; Kirali K.
Institution
(Kara) Sakarya University, Faculty of Medicine, Department of
Cardiovascular Surgery, Sakarya, Turkey
Title
The Effects of Near-Infrared Spectroscopy on the Neurocognitive Functions
in the Patients Undergoing Coronary Artery Bypass Grafting with
Asymptomatic Carotid Artery Disease: A Randomized Prospective Study.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. 21 (6) (pp
544-550), 2015. Date of Publication: 2015.
Abstract
PURPOSE: The purpose of this study was to research the use of
near-infrared spectroscopy (NIRS) on the neurocognitive functions in the
patients undergoing coronary artery bypass grafting (CABG) with
asymptomatic carotid artery disease.
METHODS: The study design was carried out with the participation of 79
patients in a prospective, randomized and double blind control method. The
patients were separated into two groups as NIRS (n = 43) and no NIRS (n =
36). A neurocognitive test was applied preoperatively and postoperatively
to all patients before discharge. Cognitive functions were evaluated by
applying the Montreal Cognitive Assessment test (MoCA).
RESULTS: The decrease in the postoperative score of mean MoCA in no NIRS
group was statistically significant when compared to preoperatively (p
<0.001). Postoperative mean MoCA score was found to be significantly
higher in NIRS group (NIRS: 26.8 +/- 1.9 vs. no NIRS: 23.6 +/- 2.5, p
<0.001). It has been determined that there was a moderately positive
significant correlation between the increase in the NIRS used patients (%)
and increase in the MoCA score of the patients (r = 0.59, p <0.001).
CONCLUSION: Intraoperative NIRS usage in the patients undergoing CABG with
carotid artery disease might be useful due to its postoperative positive
effects on the cognitive functions.

<22>
Accession Number
615736083
Author
Chavush M.A.; Yagar S.; Erturk A.; Ozgok A.
Institution
(Chavush, Yagar, Erturk, Ozgok) Turkiye Yuksek Ihtisas Training and
Research Hospital, Ankara, Turkey
Title
Preliminary investigation of preoperative pregabalin and total intravenous
anesthesia doses: A randomized controlled trial.
Source
Journal of Clinical Anesthesia. (no pagination), 2015. Date of
Publication: December 02, 2014.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective: To determine the efficacy of 2 different doses (150-300.
mg) of preoperative pregabalin on propofol and remifentanil doses for
total intravenous anesthesia in laparoscopic cholecystectomy. Design:
Prospective, randomized, placebo-controlled, double-blinded study.
Setting: Training and research hospital. Patients: Forty-eight adult,
American Society of Anesthesiologists physical status 1 and 2 patients.
Interventions: Patients were randomly assigned to 3 groups to receive
orally 1. hour before surgery, a placebo group (group 1), pregabalin 150.
mg (group 2), or pregabalin 300. mg (group 3). Measurements: In the
operating room, heart rate, systolic and diastolic blood pressures,
SpO<inf>2</inf>, bispectral index, and body temperature were recorded just
before anesthesia induction; 1 and 5minutes after induction; and at
minutes 10, 15, 20, 25, 30, 35, and 40 of the surgery. Required propofol
and remifentanil doses to obtain bispectral index value less than 60 were
also recorded. Main Results: The remifentanil doses used in the pregabalin
groups at minutes 10, 15, 20, 25, and 30 and propofol doses at minutes 15,
20, 25, and 30 were statistically significantly lower in comparison to the
placebo group. Conclusion: The observations provide preliminary evidence
that preoperative pregabalin may decrease anesthetic agent requirement in
total intravenous anesthesia patients.
Copyright &#xa9; 2015 Elsevier Inc.

<23>
Accession Number
610799349
Author
Levin D.N.; Taras J.; Taylor K.
Institution
(Levin) London School of Hygiene and Tropical Medicine and London School
of Economics, London, United Kingdom
(Levin) Department of Anesthesia, University of Toronto, Toronto, ON,
Canada
(Taras) Faculty of Medicine, University of Toronto, Toronto, ON, Canada
(Taylor) Department of Anesthesia, Hospital for Sick Children, Toronto,
ON, Canada
Title
The cost effectiveness of transesophageal echocardiography for pediatric
cardiac surgery: a systematic review.
Source
Paediatric Anaesthesia. 26 (7) (pp 682-693), 2016. Date of Publication: 01
Jul 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background: Intraoperative transesophageal echocardiography (ITEE) for
pediatric cardiac surgery has been described as clinically efficacious and
cost-effective. There are a small number of publications supporting these
claims. Aims: The objectives were to assess the quality of the research,
the variability of results across studies and, if possible, to make a
consensus statement based on the results. Methods: In March 2015, a
systematic search of MEDLINE and MEDLINE In-Process, EMBASE, and the
National Health Service Economic Evaluation Database was performed. The
search was supplemented with a review of Health Technology Assessment
reports through the Centre for Reviews and Dissemination database. English
language articles including any quantitative economic evaluation were
included. The quality of each study was assessed using the British Medical
Journal economic evaluation quality checklist. Data extracted included the
main outcomes from each study, study methodologies, itemized costs,
sensitivity ranges, biases, and delayed reoperation prevented with ITEE.
When possible, a cost-savings per ITEE was calculated to facilitate
comparison across studies and used to create a synthesis of the results.
Results: Seven studies met the inclusion criteria; of these, five were
included in the synthesis of results. The cost-savings per ITEE ranged
from $194 to $4910 with a mean of $1930 (95%CI: $845 to $3015) (2015 USD).
Prevented delayed reoperation rates using ITEE ranged from 2.8% to 10%.
Earlier studies were of poorer quality (scores 8-17) and more recent
studies were of higher quality (scores 22-25). Methodologies used were
either retrospective chart reviews (57%) or prospective observational
studies (43%) with a range of approaches to estimate costs. Conclusion:
ITEE for pediatric cardiac surgery is effective and cost-saving. This is a
validation of the current practice patterns. These finding may influence
the expansion of the use of this technology.
Copyright &#xa9; 2016 John Wiley & Sons Ltd

<24>
Accession Number
610799347
Author
Mattila I.; Patila T.; Rautiainen P.; Korpela R.; Nikander S.; Puntila J.;
Salminen J.; Suominen P.K.; Tynkkynen P.; Hiller A.
Institution
(Mattila, Patila, Puntila, Salminen) Division of Pediatric Surgery,
Hospital for Children and Adolescents, University of Helsinki and Helsinki
University Hospital, Helsinki, Finland
(Rautiainen, Korpela, Nikander, Suominen, Tynkkynen, Hiller) Division of
Anesthesiology, Hospital for Children and Adolescents, University of
Helsinki and Helsinki University Hospital, Helsinki, Finland
Title
The effect of continuous wound infusion of ropivacaine on postoperative
pain after median sternotomy and mediastinal drain in children.
Source
Paediatric Anaesthesia. 26 (7) (pp 727-733), 2016. Date of Publication: 01
Jul 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background: Postoperative pain after median sternotomy is usually treated
with i.v. opioids. We hypothesized that continuous wound infusion of
ropivacaine decreases postoperative morphine consumption and improves
analgesia in children who undergo cardiac surgery. Methods: This
randomized, double-blind study comprised 49 children aged 1-9 years who
underwent atrial septal defect (ASD) closure. Patients received continuous
local anesthetic wound infiltration either with 0.2% ropivacaine, 0.3-0.4
mg.kg^-1.h^-1 (Group R) or with saline (Group C).
Rescue morphine consumption, Objective Pain Scale (OPS), time to
mobilization, time to enteral food intake, and time to discharge were
recorded. Results: There were no statistically significant differences in
morphine consumption at 24, 48, and 72 h postsurgery between R and C
groups. There was a weak evidence for a difference in the time to the
first morphine administration after tracheal extubation to be longer for
Group R than Group C (186.2 vs 81.0 min; 95% CI (-236.5, 26.2), P =
0.114). The incidence of nausea and vomiting were comparable between the
groups. No signs or symptoms of local anesthetic toxicity were registered.
Conclusions: Contrary to our hypothesis, continuous ropivacaine wound
infusion did not reduce morphine consumption, pain score values, or nausea
and vomiting in children who underwent ASD closure with median sternotomy
and mediastinal drain.
Copyright &#xa9; 2016 John Wiley & Sons Ltd

<25>
[Use Link to view the full text]
Accession Number
615055053
Author
Chung M.J.; Novak E.; Brown D.L.
Institution
(Chung, Novak, Brown) Department of Medicine, Cardiovascular Division,
Washington University School of Medicine, St Louis, MO, United States
Title
Effect of prompt revascularization on outcomes in diabetic patients with
stable ischemic heart disease and previous myocardial infarction in the
Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D)
trial.
Source
Coronary Artery Disease. 28 (4) (pp 301-306), 2017. Date of Publication:
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background Survivors of a myocardial infarction (MI) are at a considerable
risk of developing further cardiovascular events, including recurrent MI,
heart failure, stroke, and death. Patients with type 2 diabetes mellitus
and stable ischemic heart disease (SIHD) have worse outcomes than their
nondiabetic counterparts, and those with previous MI may be at
particularly high risk. Yet, little is known about the effect of adding
prompt revascularization to intensive medical therapy in this high-risk
group. Patients and methods We carried out a post-hoc analysis of the
Bypass Angioplasty Revascularization Investigation 2 Diabetes trial, which
randomized patients with type 2 diabetes mellitus and SIHD to prompt
revascularization with percutaneous coronary intervention or coronary
artery bypass grafting in addition to intensive medical therapy or
intensive medical therapy alone. Previous MI status was defined by a
history of MI or pathologic Q-waves. The primary endpoints were death,
nonfatal or fatal MI, nonfatal or fatal stroke, congestive heart failure,
and a composite of death/MI/stroke. Results Of the 2280 patients with
evaluable data, 936 had previous MI. In these patients, there were no
differences in the 5-year event-free rates of all-cause death, MI, stroke,
congestive heart failure, or death/MI/stroke between those who were
randomized to prompt revascularization in addition to intensive medical
therapy and those who were randomized to intensive medical therapy alone.
Conclusion In diabetic patients with SIHD and previous MI, adding prompt
revascularization to intensive medical therapy yielded no benefit compared
with intensive medical therapy alone. These findings underscore the
importance of intensive medical therapy in mitigating further ischemic
events.
Copyright &#xa9; 2017 Wolters Kluwer Health, Inc. All rights reserved.

<26>
Accession Number
615438403
Author
Bagur R.; Solo K.; Alghofaili S.; Nombela-Franco L.; Kwok C.S.; Hayman S.;
Siemieniuk R.A.; Foroutan F.; Spencer F.A.; Vandvik P.O.; Schaufele T.G.;
Mamas M.A.
Institution
(Bagur, Alghofaili, Hayman) Division of Cardiology, Department of
Medicine, London Health Sciences Center, Western University, London, ON,
Canada
(Bagur, Solo) Department of Epidemiology and Biostatistics, Schulich
School of Medicine and Dentistry, Western University, 339 Windermere Rd,
London, ON N6A 5A5, Canada
(Bagur, Kwok, Mamas) Keele Cardiovascular Research Group, Institute of
Applied Clinical Science, Keele University and Royal Stoke Hospital,
Stoke-on-Trent, United Kingdom
(Nombela-Franco) Division of Cardiology, Hospital Clinico San Carlos,
Madrid, Spain
(Siemieniuk) Department of Medicine, University of Toronto, ON, Canada
(Foroutan) Department of Clinical Epidemiology and Biostatistics, McMaster
University, Hamilton, ON, Canada
(Spencer) Division of Cardiology, Department of Medicine, McMaster
University, Hamilton, ON, Canada
(Vandvik) Department of Medicine, Innlandet Hospital Trust, Gjovik, Norway
(Vandvik) Institute for Health and Society, Faculty of Medicine,
University of Oslo, Norway
(Schaufele) Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart,
Germany
Title
Cerebral Embolic Protection Devices during Transcatheter Aortic Valve
Implantation: Systematic Review and Meta-Analysis.
Source
Stroke. 48 (5) (pp 1306-1315), 2017. Date of Publication: 01 May 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background and Purpose - Silent ischemic embolic lesions are common after
transcatheter aortic valve implantation (TAVI). The use of embolic
protection devices (EPD) may reduce the occurrence of these embolic
lesions. Thus, a quantitative overview and credibility assessment of the
literature was necessary to draw a robust message about EPD. Therefore,
the aim of this meta-analysis was to study whether the use of EPD reduces
silent ischemic and clinically evident cerebrovascular events associated
with TAVI. Methods - We conducted a comprehensive search to identify
studies that evaluated patients undergoing TAVI with or without EPD.
Random-effects meta-analyses were performed to estimate the effect of EPD
compared with no-EPD during TAVI using aggregate data. Results - Sixteen
studies involving 1170 patients (865/305 with/without EPD) fulfilled the
inclusion criteria. The EPD delivery success rate was reported in all
studies and was achieved in 94.5% of patients. Meta-analyses evaluating
EPD versus without EPD strategies could not confirm or exclude any
differences in terms of clinically evident stroke (relative risk, 0.70;
95% confidence interval [CI], 0.38-1.29; P=0.26) or 30-day mortality
(relative risk, 0.58; 95% CI, 0.20-1.64; P=0.30). There were no
significant differences in new-single, multiple, or total number of
lesions. The use of EPD was associated with a significantly smaller
ischemic volume per lesion (standardized mean difference, -0.52; 95% CI,
-0.85 to -0.20; P=0.002) and smaller total volume of lesions (standardized
mean difference, -0.23; 95% CI, -0.42 to -0.03; P=0.02). Subgroup analysis
by type of valve showed an overall trend toward significant reduction in
new lesions per patient using EPD (standardized mean difference, -0.41;
95% CI, -0.82 to 0.00; P=0.05), driven by self-expanding devices.
Conclusions - The use of EPD during TAVI may be associated with smaller
volume of silent ischemic lesions and smaller total volume of silent
ischemic lesions. However, EPD may not reduce the number of new-single,
multiple, or total number of lesions. There was only very low quality of
evidence showing no significant differences between patients undergoing
TAVI with or without EPD with respect to clinically evident stroke and
mortality.
Copyright &#xa9; 2017 American Heart Association, Inc.

<27>
Accession Number
614696019
Author
Saw J.; Fahmy P.; Azzalini L.; Marquis J.-F.; Hibbert B.; Morillo C.;
Carrizo A.; Ibrahim R.
Institution
(Saw, Fahmy) Division of Cardiology, Vancouver General Hospital,
University of British Columbia, Vancouver, BC, Canada
(Azzalini, Ibrahim) Division of Cardiology, Montreal Heart Institute,
Montreal, QC, Canada
(Marquis, Hibbert) Division of Cardiology, Ottawa Heart Institute, Ottawa,
ON, Canada
(Morillo, Carrizo) Division of Cardiology, Hamilton General Hospital,
Hamilton, ON, Canada
Title
Early Canadian Multicenter Experience With WATCHMAN for Percutaneous Left
Atrial Appendage Closure.
Source
Journal of Cardiovascular Electrophysiology. 28 (4) (pp 396-401), 2017.
Date of Publication: April 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: There are limited data with WATCHMAN (Boston Scientific
Corporation, Natick, MA, USA) for left atrial appendage (LAA) closure in
patients with nonvalvular atrial fibrillation (AF) and contraindications
to anticoagulation. The purpose of this study was to evaluate the safety
and efficacy of WATCHMAN in our early Canadian experience. Methods: We
report our pooled consecutive series of patients who underwent WATCHMAN
implantation at four major Canadian centers. Indications for LAA closure
were CHADS<inf>2</inf> > 1 or CHA<inf>2</inf>DS<inf>2</inf>-VASc > 2, and
contraindication/intolerance to or failure on anticoagulation. Follow-up
imaging was typically performed 1-6 months postprocedure. Results: One
hundred and six patients underwent LAA closure with WATCHMAN from May 2013
to October 2015. The mean age was 74.8 +/- 7.7, mean CHADS<inf>2</inf>
score was 2.8 +/- 1.2, CHA<inf>2</inf>DS<inf>2</inf>-VASc score was 4.3
+/- 1.5, and HASBLED score was 3.2 +/- 1.2. Permanent AF was present in
67.9% and paroxysmal AF in 32.1%. Indications for LAA closure were prior
bleeding 89.6% (87 major bleeding and 8 minor bleeding), 9.4% were deemed
high risk for bleeding, and 0.9% with recurrent strokes on warfarin.
Procedural success was 97.2% (103 of 106), with one device embolization
(snared percutaneously), one implant failure due to inadequate LAA depth,
and one cardiac perforation requiring surgical repair before WATCHMAN
implantation. The composite major safety event-rate was 1.9% (1 death and
1 device embolization). Mean hospital stay was 1.8 +/- 4.7 days.
Antithrombotic therapy postimplant included dual antiplatelet therapy in
76 of 103 (73.8%). Mean follow-up was 210 +/- 182 days; there were two
transient ischemic attacks, with estimated 66% reduction in thromboembolic
events relative to CHADS<inf>2</inf> predicted risk. Conclusion: In our
early Canadian experience, WATCHMAN for LAA closure in patients
contraindicated to anticoagulation appeared safe and effective.
Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<28>
Accession Number
615733861
Author
Biro P.; Sermeus L.; Jankovic R.; Savic N.; Onutu A.H.; Ionescu D.;
Godoroja D.; Gurman G.M.
Institution
(Biro, Sermeus, Jankovic, Savic, Onutu, Ionescu, Godoroja, Gurman)
Institute of Anesthesiology, University Hospital Zurich, Zurich,
Switzerland
Title
The universal surgical invasiveness score (USIS). Is it useful?.
Source
Journal of Clinical Monitoring and Computing. Conference: 26th Congress of
the European Society for Computing and Technology in Anaesthesia and
Intensive Care, ESCTAIC 2016. Romania. 31 (3) (pp 497), 2017. Date of
Publication: June 2017.
Publisher
Springer Netherlands
Abstract
Besides the patients' underlying disease and morbidity, for investigations
of postoperative outcome it is important to have information about the
magnitude and invasiveness of the involved surgery. Unfortunately, there
is a lack of simple and universal denominator for the magnitude of
surgical invasiveness and there is no assessment tool that encompasses
both, spatial as well as temporal aspects of an intervention, as well as
qualitative distinction between different organs and tissues. A versatile
tool to assess the invasiveness of surgery-as the "Preliminary Universal
Surgical Invasiveness Score" (pUSIS) is intended to be-would necessarily
encompass all possible stressing effects of the intervention on the
targeted organs/tissues as well as on the whole body. The result should be
expressed in a numerical value and applicable on any kind of surgery. For
this scope pUSIS has been proposed (1). This purely observational
evaluation system has been created according plausible considerations and
experience, but has not yet been validated. This circumstance is the
reason why it has the term "preliminary" in its name. Therefore a 3-phased
plan for introduction of this new scoring system has been drawn: (1) this
recent pilot study is a first step to prove the feasibility of pUSIS on a
limited number of routine elective surgical cases, (2) a "Delphi Exercise"
with a group of experienced surgeons and anesthesiologists to discuss and
(re)-evaluate the components of pUSIS in the light of the results from
this pilot study, and finally (3) a prospective multi-center validation
study on a large number of cases which will obtain the final version of
the scoring system. In the 1st phase, the multicenter pilot study, pUSIS
values from all 80 surgeries ranged from 8 to 36. The lowest median pUSIS
value of 11.5 was found for laparoscopic chole-cystectomy, the highest was
24.5 for open thoracic surgery. As extremes we found the lowest score at 8
in laparoscopic cholecystectomy and the highest score at 36 in a total hip
replacement. The durations (mean+/-SD) of surgery ranged from 37+/- 15 min
for laparoscopic cholecystectomy to 162+/-45 min for laparoscopic sleeve
gastrectomy. We can conclude, that pUSIS promises to become a first step
in introducing of a useful, simply obtainable, universal assessment tool
for quantification of magnitude and stressing capacity of individual
surgical operations. Potential benefits of having a finally validated and
approved USIS are manifold in the context of decision making, outcome
research and evaluation of surgical performance. (Figure Presented).

<29>
Accession Number
615733820
Author
Neamtu A.
Institution
(Neamtu) Department of Anesthesiology and Perioperative Medicine,
Univeristy of Louisville, School of Medicine, United States
Title
Persistent postsurgical and postinjury pain-an update.
Source
Journal of Clinical Monitoring and Computing. Conference: 26th Congress of
the European Society for Computing and Technology in Anaesthesia and
Intensive Care, ESCTAIC 2016. Romania. 31 (3) (pp 491), 2017. Date of
Publication: June 2017.
Publisher
Springer Netherlands
Abstract
Persistent postsurgical (PPSP) and postinjury (PPIP) pain is a
debilitating condition and a major public health concern worldwide. PPSP
is mostly associated with amputation, thoracotomy, mastectomy, coronary
artery bypass graft (CABG), inguinal hernia repair, and Cesarean section
(1). Intraoperative pain may result in increased inflammatory processes
(via upregulation of cyclo-oxygenase-2 and interleukin-1Beta-sensitizing
first order neurons), which in turn may result in postoperative
hyperalgesia (especially when large doses of opioids are used during
surgery) and possibly chronic pain with neuropathic component (2). The
inflammatory and other processes activate N-methyl-D-aspartic acid (NMDA)
channels and microglia to result in neuroplasticity which may or may not
be reversible (2). In addition, epigenetic changes may explain in part the
transition of acute to chronic pain, for instance postthoracotomy (3).
Predictive factors for PPSP are usually divided in patient specific and
surgery specific (4). The patient specific factors can be further grouped
as preoperative (young females, prior chronic pain states, psychosocial
factors, and genetic predisposition); intraoperative (surgery and
anesthesia type, intraoperative pain control); postoperative (radiation
and chemotherapy, recurrent surgical disease, untreated acute
postoperative pain) (5). In view of the complexity of transition to
chronic pain, multimodal therapy is frequently advocated but it seems to
be working mostly for acute postoperative pain control (1, 4). To date,
there is no demonstrated reduction of PPSP incidence with multimodal
analgesia (6). Hence, PPSP prevention may be more important than treatment
(6, 7). Among the prevention methods are alternative surgical techniques,
regional anesthesia, drugs affecting central sensitization (ketamine,
gabapentin, pregabalin) (6, 7), good postoperative analgesia (8). However,
the arbitrary results of current studies do not allow development of
appropriate protocols. Attention should be directed towards early steps of
the inflammatory reaction, particularly its exacerbation induced by the
use of large doses of opioids intraoperatively (9). Multicenter studies of
acute perioperative pain quality of care (10, 11) should provide new
insights in identifying the risk factors and determining the best
strategies of management in order to diminish the incidence of PPSP.

<30>
Accession Number
615733868
Author
Margarson M.
Institution
(Margarson) St Richard's Hospital, Chichester, United Kingdom
Title
Nasal high flow oxygen therapy. What the anaesthetist should know.
Source
Journal of Clinical Monitoring and Computing. Conference: 26th Congress of
the European Society for Computing and Technology in Anaesthesia and
Intensive Care, ESCTAIC 2016. Romania. 31 (3) (pp 498), 2017. Date of
Publication: June 2017.
Publisher
Springer Netherlands
Abstract
High Flow Nasal Oxygen Cannula (HFNC), High Flow Nasal Oxygen Therapy
(HFNC) and Trans-nasal Humidified Rapid Insufflation Ventilatory Exchange
(THRIVE) are three terms used to describe the same oxygen delivery system.
The circuit comprises an air/oxygen blender, an active humidifier, a
heated circuit, and a single patient use nasal cannula. The system
delivers adequately heated and humidified oxygen at up to 60 L/min of
flow, coming close to matching peak inspiratory flow rates. This rate of
oxygen delivery is considered to have a number of physiological effects:
reduction of anatomical dead space, a PEEP effect, a high and relatively
constant fraction of inspired oxygen, and good humidification. Originally
the device was developed for paediatric and neonatal ICU practice, and
much of the early experience comes from this field; but over the past 5
years it has been gaining popularity in adult practice as an innovative
respiratory support for patients with modest respiratory failure. More
recently it has made the jump into the operating theatre and is now being
increasingly used during anaesthetic induction to extend the time before
desaturation in the apneic patient, ie to prolong the safe apnea time. The
precise mechanism by which HFNO has its effect is incompletely understood,
but four main areas exist. * High flow washes out carbon dioxide from the
anatomical dead space, effectively reducing that dead space * High flow
creates positive nasopharyngeal pressure. Although delivered through an
open system, positive pressures of between 2 and 4 cm H2O are created in
the naso-pharynx. * The difference between the inspiratory peak flow of
patients and delivered flow is small and FIO2 remains relatively constant.
* Because gas is generally warmed to 37degreeC and completely humidified,
mucociliary functions remain good and little discomfort is reported. It is
very well tolerated by patients (Roca et al. 2010) and the modest levels
of support allow respiratory rates to reduce, improving mechanical
function of the lungs. It has provided a useful support within the ICU,
both in reducing need for primary intubation and as a tool to reduce the
need for re-intubation (Hernandez et al., 2016)a useful review is
available here (Nishimura, 2015). Last year a French study of respiratory
failure patients randomised to HFNO vs NIV vs standard face mask oxygen
showed a survival benefit of HFNO (Frat et al., 2015). The increase in
lung volumes has been demonstrated by impedance plethysmography in
post-cardiac surgical patients (Corley et al., 2011). This group described
the benefit to be particularly marked in the obese, although this has not
been widely reported. The most exciting recent findings relate to the use
of HFNO to both pre-oxygenate and then to extend oxygenation following
induction and paralysis in the patient with the difficult airway. In a
series of 25 patients undergoing hypopharyngeal or laryngeal surgery,
median apnoeic periods of 14 min without desaturation were achieved, with
a rate of pCO<inf>2</inf> rise of around 0.15 kPa/minute (Patel and
Nouraei, 2015). The authors describes this application of HFNO as a
therapy that 'could change the nature of difficult intubations from a
hurried stopstart, potentially traumatic undertaking, to a smooth event
undertaken within an extended safe apnoeic window'. The Lecture will focus
particularly on this role of HFNO.

<31>
[Use Link to view the full text]
Accession Number
614824246
Author
Siscovick D.S.; Barringer T.A.; Fretts A.M.; Wu J.H.Y.; Lichtenstein A.H.;
Costello R.B.; Kris-Etherton P.M.; Jacobson T.A.; Engler M.B.; Alger H.M.;
Appel L.J.; Mozaffarian D.
Title
Omega-3 Polyunsaturated Fatty Acid (Fish Oil) Supplementation and the
Prevention of Clinical Cardiovascular Disease: A Science Advisory from the
American Heart Association.
Source
Circulation. 135 (15) (pp e867-e884), 2017. Date of Publication: 11 Apr
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Multiple randomized controlled trials (RCTs) have assessed the effects of
supplementation with eicosapentaenoic acid plus docosahexaenoic acid
(omega-3 polyunsaturated fatty acids, commonly called fish oils) on the
occurrence of clinical cardiovascular diseases. Although the effects of
supplementation for the primary prevention of clinical cardiovascular
events in the general population have not been examined, RCTs have
assessed the role of supplementation in secondary prevention among
patients with diabetes mellitus and prediabetes, patients at high risk of
cardiovascular disease, and those with prevalent coronary heart disease.
In this scientific advisory, we take a clinical approach and focus on
common indications for omega-3 polyunsaturated fatty acid supplements
related to the prevention of clinical cardiovascular events. We limited
the scope of our review to large RCTs of supplementation with major
clinical cardiovascular disease end points; meta-analyses were considered
secondarily. We discuss the features of available RCTs and provide the
rationale for our recommendations. We then use existing American Heart
Association criteria to assess the strength of the recommendation and the
level of evidence. On the basis of our review of the cumulative evidence
from RCTs designed to assess the effect of omega-3 polyunsaturated fatty
acid supplementation on clinical cardiovascular events, we update prior
recommendations for patients with prevalent coronary heart disease, and we
offer recommendations, when data are available, for patients with other
clinical indications, including patients with diabetes mellitus and
prediabetes and those with high risk of cardiovascular disease, stroke,
heart failure, and atrial fibrillation.
Copyright &#xa9; 2017 American Heart Association, Inc.

<32>
[Use Link to view the full text]
Accession Number
614341167
Author
Rao M.P.; Al-Khatib S.M.; Pokorney S.D.; She L.; Romanov A.; Nicolau J.C.;
Lee K.L.; Carson P.; Selzman C.H.; Stepinska J.; Cleland J.G.F.;
Tungsubutra W.; Desvigne-Nickens P.M.; Sueta C.A.; Siepe M.; Lang I.;
Feldman A.M.; Yii M.; Rouleau J.L.; Velazquez E.J.
Institution
(Rao, Al-Khatib, Pokorney, She, Lee, Velazquez) Duke Clinical Research
Institute, Duke University, School of Medicine, PO Box 17969, Durham, NC
27715, United States
(Lee) Departments of Biostatistics and Bioinformatics, Duke University
School of Medicine, Durham, United States
(Al-Khatib, Velazquez) Departments of Medicine, Duke University School of
Medicine, Durham, United States
(Romanov) State Research Institute of Circulation Pathology, Novosibirsk,
Russian Federation
(Nicolau) Heart Institute, University of Sao Paulo Medical School, Brazil
(Carson) Washington DC Veterans Affairs Medical Center, United States
(Selzman) Division of Cardiothoracic Surgery, University of Utah, Salt
Lake City, United States
(Stepinska) Institute of Cardiology, Warsaw, Poland
(Cleland) National Heart and Lung Institute, Royal Brompton and Harefield
Hospitals, Imperial College, London, United Kingdom
(Tungsubutra) Siriraj Hospital, Mahidol University, Bangkok, Thailand
(Desvigne-Nickens) Division of Cardiovascular Sciences, National Heart,
Lung, and Blood Institute, Bethesda, United States
(Sueta) University of North Carolina, Chapel Hill, United States
(Siepe) University Heart Center Freiburg-Bad Krozingen, Germany
(Lang) Medical University of Vienna, Austria
(Feldman) Department of Medicine, Temple University School of Medicine,
Philadelphia, United States
(Yii) St. Vincent's Hospital, University of Melbourne, Fitzroy, Australia
(Rouleau) Department of Medicine, Montreal Heart Institute, University of
Montreal, QC, Canada
Title
Sudden cardiac death in patients with ischemic heart failure undergoing
coronary artery bypass grafting: Results from the STICH randomized
clinical trial (Surgical Treatment for Ischemic Heart Failure).
Source
Circulation. 135 (12) (pp 1136-1144), 2017. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: The risk of sudden cardiac death (SCD) in patients with heart
failure after coronary artery bypass graft surgery (CABG) has not been
examined in a contemporary clinical trial of surgical revascularization.
This analysis describes the incidence, timing, and clinical predictors of
SCD after CABG. METHODS: Patients enrolled in the STICH trial (Surgical
Treatment of Ischemic Heart Failure) who underwent CABG with or without
surgical ventricular reconstruction were included. We excluded patients
with prior implantable cardioverter-defibrillator and those randomized
only to medical therapy. The primary outcome was SCD as adjudicated by a
blinded committee. A Cox model was used to examine and identify predictors
of SCD. The Fine and Gray method was used to estimate the incidence of SCD
accounting for the competing risk of other deaths. RESULTS: Over a median
follow-up of 46 months, 113 of 1411 patients who received CABG without (n
= 934) or with (n = 477) surgical ventricular reconstruction had SCD; 311
died of other causes. The mean left ventricular ejection fraction at
enrollment was 28-9%. The 5-year cumulative incidence of SCD was 8.5%.
Patients who had SCD and those who did not die were younger and had fewer
comorbid conditions than did those who died of causes other than SCD. In
the first 30 days after CABG, SCD (n=5) accounted for 7% of all deaths.
The numerically greatest monthly rate of SCD was in the 31- to 90-day time
period. In a multivariable analysis including baseline demographics, risk
factors, coronary anatomy, and left ventricular function, end-systolic
volume index and B-type natriuretic peptide were most strongly associated
with SCD. CONCLUSIONS: The monthly risk of SCD shortly after CABG among
patients with a low left ventricular ejection fraction is highest between
the first and third months, suggesting that risk stratification for SCD
should occur early in the postoperative period, particularly in patients
with increased preoperative end-systolic volume index or B-type
natriuretic peptide. CLINICAL TRIAL REGISTRATION: URL:
http://www.clinicaltrials.gov. Unique identifier: NCT0002359.
Copyright &#xa9; 2017 American Heart Association, Inc.

<33>
Accession Number
605329288
Author
Geukers V.G.; Dijsselhof M.E.; Jansen N.J.G.; Breur J.M.P.J.; Van Harskamp
D.; Schierbeek H.; Van Goudoever J.B.; Bos A.P.; Sauerwein H.P.
Institution
(Geukers, Bos) Pediatric Intensive Care Department H8-190, Emma Children's
Hospital (EKZ), Academic Medical Center (AMC), Meibergdreef 9, Amsterdam
1105 AZ, Netherlands
(Dijsselhof) Department of Clinical Nutrition, AMC, Amsterdam, Netherlands
(Jansen) Pediatric Intensive Care Department, Wilhelmina Children's
Hospital (WKZ), University Medical Center Utrecht (UMCUtrecht), Lundlaan
6, Utrecht 3584 EA, Netherlands
(Breur) Department of Pediatric Cardiology, WKZ, UMCUtrecht, Utrecht,
Netherlands
(Geukers, Van Harskamp, Schierbeek, Van Goudoever, Bos) Department of
Pediatrics, EKZ, AMC, Amsterdam, Netherlands
(Van Goudoever) Department of Pediatrics, VU University Medical Center,
Boelelaan 1117, Amsterdam 1081 HV, Netherlands
(Sauerwein) Department of Endocrinology and Metabolism, AMC, Amsterdam,
Netherlands
Title
The effect of short-term high versus normal protein intake on whole-body
protein synthesis and balance in children following cardiac surgery: A
randomized double-blind controlled clinical trial.
Source
Nutrition Journal. 14 (1) (no pagination), 2015. Article Number: 72. Date
of Publication: 28 Jul 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Infants undergoing cardiac surgery are at risk of a negative
protein balance, due to increased proteolysis in response to surgery and
the cardiopulmonary bypass circuit, and limited intake. The aim of the
study was to quantify the effect on protein kinetics of a short-term
high-protein (HP) diet in infants following cardiac surgery. Methods: In a
prospective, double-blinded, randomized trial we compared the effects of a
HP (5 g . kg^-1 . d^-1) versus normal protein (NP, 2 g
. kg^-1 . d^-1) enteral diet on protein kinetics in
children <24 months, on day 2 following surgical repair of congenital
heart disease. Valine kinetics and fractional albumin synthesis rate
(FSR<inf>alb</inf>) were measured with mass spectrometry using
[1-¹³C]valine infusion. The Mann-Whitney U test was used to
investigate differences between group medians. Additionally, the
Hodges-Lehmann procedure was used to create a confidence interval with a
point estimate of median differences between groups. Results: Twenty-eight
children (median age 9 months, median weight 7 kg) participated in the
study, of whom in only 20 subjects isotopic data could be used for final
calculations. Due to underpowering of our study, we could not draw
conclusions on the primary outcome parameters. We observed valine
synthesis rate of 2.73 (range: 0.94 to 3.36) and 2.26 (1.85 to 2.73) mumol
. kg^-1 . min^-1 in the HP and NP diet, respectively.
The net valine balance was 0.54 (-0.73 to 1.75) and 0.24 (-0.20 to 0.63)
mumol . kg^-1 . min^-1 in the HP and NP group. Between
groups, there was no difference in FSR<inf>alb</inf>. We observed
increased oxidation and BUN in the HP diet, compared to the NP diet, as a
plausible explanation of the metabolic fate of surplus protein.
Conclusions: It is plausible that the surplus protein in the HP group has
caused the increase of valine oxidation and ureagenesis, compared to the
NP group. Because too few patients had completed the study, we were unable
to draw conclusions on the effect of a HP diet on protein synthesis and
balance. We present our results as new hypothesis generating data. Trial
registration: Dutch Trial Register NTR2334.
Copyright &#xa9; 2015 Geukers et al.

<34>
Accession Number
604911874
Author
Ling Z.-G.; Wu Y.-B.; Ming M.-Y.; Cai S.-Q.; Chen Y.-Q.
Institution
(Ling, Wu, Cai, Chen) Institute of Respiratory Diseases, Guangxi Medical
University, Nanning, Guangxi, China
(Ming) Department of Respiratory Diseases, Guangxi Medical University,
Liuzhou, Guangxi, China
Title
The effect of pleural abrasion on the treatment of primary spontaneous
pneumothorax: A systematic review of randomized controlled trials.
Source
PLoS ONE. 10 (6) (no pagination), 2015. Article Number: e0127857. Date of
Publication: 04 Jun 2015.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: Pleural abrasion has been widely used to control the
recurrence of primary spontaneous pneumothorax (PSP). However, controversy
still exists regarding the advantages and disadvantages of pleural
abrasion compared with other interventions in preventing the recurrence of
PSP. Methods: The PubMed, Embase, and Cochrane Central Register of
Controlled Trials databases were searched up to December 15, 2014 to
identify randomized controlled trials (RCTs) that compared the effects of
pleural abrasion with those of other interventions in the treatment of
PSP. The study outcomes included the PSP recurrence rate and the
occurrence rate of adverse effects. Results: Mechanical pleural abrasion
and apical pleurectomy after thoracoscopic stapled bullectomy exhibited
similarly persistent postoperative air leak occurrence rates (p = 0.978)
and 1-year PSP recurrence rates (p = 0.821), whereas pleural abrasion led
to reduced residual chest pain and discomfort (p = 0.001) and a smaller
rate of hemothorax (p = 0.036) than did apical pleurectomy. However, the
addition of minocycline pleurodesis to pleural abrasion did not reduce the
pneumothorax recurrence rate compared with apical pleurectomy (3.8% for
both procedures) but was associated with fewer complications. There was no
statistical difference in the pneumothorax recurrence rate between
mechanical pleural abrasion and chemical pleurodesis with minocycline on
either an intention-to-treat basis (4 of 42 versus 0 of 42, p = 0.12;
Fisher exact test) or after exclusions (2 of 40 versus 0 of 42, p = 0.24;
Fisher exact test). Pleural abrasion plus minocycline pleurodesis also did
not reduce the pneumothorax recurrence rate compared with pleural abrasion
alone (p = 0.055). Moreover, pleural abrasion plus minocycline pleurodesis
was associated with more intense acute chest pain. The postoperative
overall recurrence rate in patients who underwent staple line coverage
with absorbable cellulose mesh and fibrin glue was similar to that with
mechanical abrasion after thoracoscopic bullectomy (13.8% vs. 14.2%,
respectively; p = 0.555), but staple line coverage resulted in less
postoperative residual pain than mechanical abrasion (0.4% vs.3.2%;
p<0.0001). Pleural abrasion after thoracoscopic wedge resection did not
decrease the recurrence of pneumothorax compared with wedge resection
alone (p = 0.791), but the intraoperative bleeding and postoperative
pleural drainage rates were higher when pleural abrasion was performed.
Conclusions: In addition to resulting in the same pneumothorax recurrence
rate, thoracoscopic pleural abrasion with or without minocycline
pleurodesis is safer than apical pleurectomy in the treatment of PSP.
However, minocycline pleurodesis with or without pleural abrasion is not
any more effective than pleural abrasion alone. Moreover, additional
mechanical abrasion is not safer than additional staple line coverage with
absorbable cellulose mesh and fibrin glue after thoracoscopic bullectomy
because of increased postoperative pain. Additionally, pleural abrasion
after thoracoscopic wedge resection should not be recommended for routine
application due to the greater incidence of adverse effects than wedge
resection alone. However, further large-scale, well-designed RCTs are
needed to confirm the best procedure.
Copyright &#xa9; 2015 Ling 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.

<35>
Accession Number
605592863
Author
dos Santos E.C.; Lunardi A.C.
Institution
(dos Santos, Lunardi) Universidade Cidade de Sao Paulo, Master's and
Doctoral Programs in Physical Therapy, Cesario Galeno Street, 448/475, Sao
Paulo 03071-000, Brazil
(dos Santos) Universidade Federal do Amapa, Department of Biological and
Health Sciences, Macapa, Brazil
(Lunardi) Universidade de Sao Paulo, Department of Physical Therapy,
School of Medicine, Sao Paulo, Brazil
Title
The effect of non-invasive positive airway pressure therapy following
thoracic surgical procedures: Protocol for a systematic review.
Source
Systematic Reviews. 4 (1) (no pagination), 2015. Article Number: 83. Date
of Publication: June 12, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Thoracic surgical procedures impair respiratory function,
decreasing ventilation and oxygenation and increasing the risk of acute
respiratory failure and pulmonary complications. To prevent these clinical
repercussions, positive airway pressure therapy is widely used to increase
pulmonary ventilation, decrease muscle overload, and ensure adequate
oxygenation; however, the benefit of this therapy remains unclear.
Methods/design: A systematic search of the literature including PubMed,
CINAHL, AMED, PsycINFO, LILACS, Scielo, Scopus, PEDro, and the Cochrane
Library will identify the randomized and quasi-randomized trials that used
CPAP, Bilevel, or IPPB compared with a control without intervention, a
sham treatment or other lung expansion techniques following thoracic
surgical procedures. From these trials, we will extract data on a
predefined list of outcomes, including oxygenation, ventilation,
respiratory failure, pulmonary complications, and time of resolution of
the clinical condition. The methodological quality of each trial included
will be assessed using the PEDro scale. The strength of the
recommendations will be summarized using the GRADE scale. Meta-analyses
will be performed, if appropriate. Discussion: This review aims to promote
greater knowledge regarding the efficiency of the use of non-invasive
positive airway pressure on recovery of respiratory function and on
prevention of pulmonary complications following thoracic surgical
procedures. This review could help health professionals improve the care
for patients undergoing thoracic surgical procedures. Systematic review
registration: PROSPERO CRD42015019004
Copyright &#xa9; 2015 dos Santos and Lunardi.

<36>
Accession Number
604521411
Author
Bavry A.A.; Elgendy I.Y.; Mahmoud A.; Jadhav M.P.; Huo T.
Institution
(Bavry) North Florida/South Georgia Veterans Health System, Gainesville,
FL, United States
(Bavry, Elgendy, Mahmoud, Jadhav, Huo) Department of Medicine, University
of Florida, Gainesville, FL, United States
Title
Critical appraisal of bivalirudin versus heparin for percutaneous coronary
intervention: A meta-analysis of randomized trials.
Source
PLoS ONE. 10 (5) (no pagination), 2015. Article Number: e0127832. Date of
Publication: 26 May 2015.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Percutaneous coronary intervention with bivalirudin plus bail-out
glycoprotein IIb/IIIa inhibitors has been shown to be as effective as
unfractionated heparin plus routine glycoprotein IIb/IIIa inhibitors in
preventing cardiac ischemic events, but with a lower bleeding risk. It is
unknown whether bivalirudin would have the same beneficial effects if
compared with heparin when the use of glycoprotein IIb/IIIa inhibitors was
similar between treatment arms. We searched the MEDLINE, Web of Science,
and Cochrane databases from inception until March 2015 for randomized
trials that compared bivalirudin to heparin in patients undergoing
percutaneous coronary intervention. We required that the intended use of
glycoprotein IIb/IIIa inhibitors was similar between the study groups.
Summary estimates were principally constructed by the Peto method. Fifteen
trials met our inclusion criteria, which yielded 25,824 patients.
Bivalirudin versus heparin was associated with an increased hazard of
stent thrombosis (odds ratio [OR] 1.49, 95% confidence interval [CI]
1.15-1.92, P = .002, I² = 16.9%), with a similar hazard of
myocardial infarction (OR 1.09, 95% CI 0.98-1.22, P = .11, I² =
35.8%), all-cause mortality (OR 0.88, 95% CI 0.72-1.08, P = .21,
I² = 31.5%) and major adverse cardiac events (OR 1.04, 95% CI
0.94-1.14, P = .46, I² = 53.9%). Bivalirudin was associated
with a reduced hazard of major bleeding (OR 0.80, 95% CI 0.70-0.92, P =
.001, I² = 63.5%). The dose of heparin in the control arm
modified this association; when the dose of unfractionated heparin in the
control arm was > 100 units/kg, bivalirudin was associated with a
reduction in major bleeding (OR 0.55, 95% CI 0.45-0.68, P < .0001), but
when the dose of unfractionated heparin was < 75 units/kg, bivalirudin was
not associated with reduction in bleeding (OR 1.09, 95% CI 0.91-1.31, P =
.36). Among patients undergoing PCI, bivalirudin was associated with an
increased hazard of stent thrombosis. Bivalirudin may be associated with a
reduced hazard of major bleeding; however, this benefit was no longer
apparent when compared with a dose of unfractionated heparin < 75
units/kg.
Copyright &#xa9; 2015, Public Library of Science. All rights reserved.

<37>
Accession Number
605951809
Author
Valsangkar N.P.; Zimmers T.A.; Kim B.J.; Blanton C.; Joshi M.M.; Bell
T.M.; Nakeeb A.; Dunnington G.L.; Koniaris L.G.
Institution
(Valsangkar, Zimmers, Kim, Blanton, Joshi, Bell, Nakeeb, Dunnington,
Koniaris) Department of Surgery, Indiana University School of Medicine,
Indianapolis, IN 46202, United States
Title
Determining the drivers of academic success in surgery: An analysis of
3,850 faculty.
Source
PLoS ONE. 10 (7) (no pagination), 2015. Article Number: e0131678. Date of
Publication: 15 Jul 2015.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Objective: Determine drivers of academic productivity within U.S.
departments of surgery. Methods: Eighty academic metrics for 3,850 faculty
at the top 50 NIH-funded university- and 5 outstanding hospital-based
surgical departments were collected using websites, Scopus, and NIH
RePORTER. Results: Mean faculty size was 76. Overall, there were
35.3%assistant, 27.8% associate, and 36.9% full professors. Women
comprised 21.8%; 4.9% were MD-PhDs and 6.1% PhDs. By faculty-rank, median
publications/citations were: assistant, 14/175, associate, 39/649 and
full-professor, 97/2250. General surgery divisions contributed the most
publications and citations. Highest performing sub-specialties per faculty
member were: research (58/1683), transplantation (51/1067), oncology
(41/777), and cardiothoracic surgery (48/860). Overall, 23.5% of faculty
were principal investigators for a current or former NIH grant, 9.5% for a
current or former R01/U01/P01. The 10 most cited faculty (MCF) within each
department contributed to 42% of all publications and 55% of all
citations. MCF were most commonly general (25%), oncology (19%), or
transplant surgeons (15%). Fifty-one-percent of MCF had current/former NIH
funding, compared with 20% of the rest (p<0.05); funding rates for
R01/U01/P01 grants was 25.1% vs. 6.8% (p<0.05). Rate of current-NIH MCF
funding correlated with higher total departmental NIH rank (p < 0.05).
Conclusions: Departmental academic productivity as defined by citations
and NIH funding is highly driven by sections or divisions of research,
general and transplantation surgery. MCF, regardless of subspecialty,
contribute disproportionally to major grants and publications. Approaches
that attract, develop, and retain funded MCF may be associated with
dramatic increases in total departmental citations and NIH-funding.
Copyright:
Copyright &#xa9; 2015 Valsangkar et al.

<38>
Accession Number
605514576
Author
Whiting P.; Al M.; Westwood M.; Ramos I.C.; Ryder S.; Armstrong N.; Misso
K.; Ross J.; Severens J.; Kleijnen J.
Institution
(Whiting, Westwood, Ryder, Armstrong, Misso, Ross) Kleijnen Systematic
Reviews Ltd, York, United Kingdom
(Al, Ramos, Severens) Institute of Health Policy and Management, Erasmus
University Rotterdam, Rotterdam, Netherlands
(Kleijnen) School for Public Health and Primary Care (CAPHRI), Maastricht
University, Maastricht, Netherlands
Title
Viscoelastic point-of-care testing to assist with the diagnosis,
management and monitoring of haemostasis: A systematic review and
cost-effectiveness analysis.
Source
Health Technology Assessment. 19 (58) (pp 1-228), 2015. Date of
Publication: 01 Jul 2015.
Publisher
NIHR Journals Library
Abstract
Background: Patients with substantive bleeding usually require transfusion
and/or (re-)operation. Red blood cell (RBC) transfusion is independently
associated with a greater risk of infection, morbidity, increased hospital
stay and mortality. ROTEM (ROTEM Delta, TEM International GmbH, Munich,
Germany; www.rotem.de), TEG (TEG 5000 analyser, Haemonetics Corporation,
Niles, IL, USA; www.haemonetics.com) and Sonoclot (Sonoclot coagulation
and platelet function analyser, Sienco Inc., Arvada, CO) are point-of-care
viscoelastic (VE) devices that use thromboelastometry to test for
haemostasis in whole blood. They have a number of proposed advantages over
standard laboratory tests (SLTs): they provide a result much quicker, are
able to identify what part of the clotting process is disrupted, and
provide information on clot formation over time and fibrinolysis.
Objectives: This assessment aimed to assess the clinical effectiveness and
cost-effectiveness of VE devices to assist with the diagnosis, management
and monitoring of haemostasis disorders during and after cardiac surgery,
trauma-induced coagulopathy and post-partum haemorrhage (PPH). Methods:
Sixteen databases were searched to December 2013: MEDLINE (OvidSP),
MEDLINE In-Process and Other Non-Indexed Citations and Daily Update
(OvidSP), EMBASE (OvidSP), BIOSIS Previews (Web of Knowledge), Science
Citation Index (SCI) (Web of Science), Conference Proceedings Citation
Index (CPCI-S) (Web of Science), Cochrane Database of Systematic Reviews
(CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), Database
of Abstracts of Reviews of Effects (DARE), Health Technology Assessment
(HTA) database, Latin American and Caribbean Health Sciences Literature
(LILACS), International Network of Agencies for Health Technology
Assessment (INAHTA), National Institute for Health Research (NIHR) HTA
programme, Aggressive Research Intelligence Facility (ARIF), Medion, and
the International Prospective Register of Systematic Reviews (PROSPERO).
Randomised controlled trials (RCTs) were assessed for quality using the
Cochrane Risk of Bias tool. Prediction studies were assessed using
QUADAS-2. For RCTs, summary relative risks (RRs) were estimated using
random-effects models. Continuous data were summarised narratively. For
prediction studies, the odds ratio (OR) was selected as the primary effect
estimate. The health-economic analysis considered the costs and
quality-adjusted life-years of ROTEM, TEG and Sonoclot compared with SLTs
in cardiac surgery and trauma patients. A decision tree was used to take
into account short-term complications and longer-term side effects from
transfusion. The model assumed a 1-year time horizon. Results: Thirty-one
studies (39 publications) were included in the clinical effectiveness
review. Eleven RCTs (n = 1089) assessed VE devices in patients undergoing
cardiac surgery; six assessed thromboelastography (TEG) and five assessed
ROTEM. There was a significant reduction in RBC transfusion [RR 0.88, 95%
confidence interval (CI) 0.80 to 0.96; six studies], platelet transfusion
(RR 0.72, 95% CI 0.58 to 0.89; six studies) and fresh frozen plasma to
transfusion (RR 0.47, 95% CI 0.35 to 0.65; five studies) in VE testing
groups compared with control. There were no significant differences
between groups in terms of other blood products transfused. Continuous
data on blood product use supported these findings. Clinical outcomes did
not differ significantly between groups. There were no apparent
differences between ROTEM or TEG; none of the RCTs evaluated Sonoclot.
There were no data on the clinical effectiveness of VE devices in trauma
patients or women with PPH. VE testing was cost-saving and more effective
than SLTs. For the cardiac surgery model, the cost-saving was 43 for
ROTEM, 79 for TEG and 132 for Sonoclot. For the trauma population, the
cost-savings owing to VE testing were more substantial, amounting to
per-patient savings of 688 for ROTEM compared with SLTs, 721 for TEG, and
818 for Sonoclot. This finding was entirely dependent on material costs,
which are slightly higher for ROTEM. VE testing remained cost-saving
following various scenario analyses. Conclusions: VE testing is
cost-saving and more effective than SLTs, in both patients undergoing
cardiac surgery and trauma patients. However, there were no data on the
clinical effectiveness of Sonoclot or of VE devices in trauma patients.
Study registration: This study is registered as PROSPERO CRD42013005623.
Funding: The NIHR Health Technology Assessment programme.
Copyright &#xa9; Queen's Printer and Controller of HMSO 2015.

<39>
Accession Number
603581959
Author
Hu R.-F.; Jiang X.-Y.; Hegadoren K.M.; Zhang Y.-H.
Institution
(Hu, Jiang) University Town, School of Nursing, Fujian Medical University,
1 Xue Yuan Road, Fuzhou 350108, China
(Hegadoren) University of Alberta, Faculty of Nursing, 11405 87 Avenue,
Edmonton, AB T6G 1C9, Canada
(Zhang) Fujian Province Hospital, Department of Nuclear Medicine, East
Street 134, Fuzhou 350001, China
Title
Effects of earplugs and eye masks combined with relaxing music on sleep,
melatonin and cortisol levels in ICU patients: A randomized controlled
trial.
Source
Critical Care. 19 (1) (no pagination), 2015. Article Number: 115. Date of
Publication: March 27, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Introduction: Intensive care unit (ICU) environmental factors such as
noise and light have been cited as important causes of sleep deprivation
in critically ill patients. Previous studies indicated that using earplugs
and eye masks can improve REM sleep in healthy subjects in simulated ICU
environment, and improve sleep quality in ICU patients. This study aimed
to determine the effects of using earplugs and eye masks with relaxing
background music on sleep, melatonin and cortisol levels in ICU patients.
Methods: Fifty patients who underwent a scheduled cardiac surgery and were
expected to stay at least 2 nights in Cardiac Surgical ICU (CSICU) were
included. They were randomized to sleep with or without earplugs and eye
masks combined with 30-minute relaxing music during the postoperative
nights in CSICU. Urine was analyzed for nocturnal melatonin and cortisol
levels. Subjective sleep quality was evaluated using the Chinese version
of Richards-Campbell Sleep Questionnaire (a visual analog scale, ranging
0-100). Results: Data from 45 patients (20 in intervention group, 25 in
control group) were analyzed. Significant differences were found between
groups in depth of sleep, falling asleep, awakenings, falling asleep again
after awakening and overall sleep quality (P < 0.05). Perceived sleep
quality was better in the intervention group. No group differences were
found in urinary melatonin levels and cortisol levels for the night before
surgery, and the first and second nights post-surgery (P > 0.05). The
urinary melatonin levels of the first and second postoperative nights were
significantly lower than those of the night before surgery (P = 0.01). The
opposite pattern was seen with urinary cortisol levels (P = 0.00).
Conclusion: This combination of non-pharmacological interventions is
useful for promoting sleep in ICU adult patients; however, any influence
on nocturnal melatonin levels and cortisol level may have been masked by
several factors such as the timing of surgery, medication use and
individual differences. Larger scale studies would be needed to examine
the potential influences of these factors on biological markers and
intervention efficacy on sleep. Trial registration: Chinese Clinical Trial
Registry: ChiCTR-IOR-14005511. Registered 21 November 2014.
Copyright &#xa9; Hu et al.; licensee BioMed Central.

<40>
Accession Number
604884032
Author
Pike K.; Nash R.L.; Murphy G.J.; Reeves B.C.; Rogers C.A.
Institution
(Pike, Nash, Reeves, Rogers) University of Bristol, Clinical Trials and
Evaluation Unit, School of Clinical Sciences, Bristol, United Kingdom
(Murphy) University of Leicester, Department of Cardiovascular Sciences,
Leicester, United Kingdom
Title
Transfusion Indication Threshold Reduction (TITRe2) randomized controlled
trial in cardiac surgery: Statistical analysis plan.
Source
Trials. 16 (1) (no pagination), 2015. Article Number: 54. Date of
Publication: February 22, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The Transfusion Indication Threshold Reduction (TITRe2) trial
is the largest randomized controlled trial to date to compare red blood
cell transfusion strategies following cardiac surgery. This update
presents the statistical analysis plan, detailing how the study will be
analyzed and presented. The statistical analysis plan has been written
following recommendations from the International Conference on
Harmonisation of Technical Requirements for Registration of
Pharmaceuticals for Human Use, prior to database lock and the final
analysis of trial data. Outlined analyses are in line with the
Consolidated Standards of Reporting Trials (CONSORT). Methods and design:
The study aims to randomize 2000 patients from 17 UK centres. Patients are
randomized to either a restrictive (transfuse if haemoglobin concentration
<7.5 g/dl) or liberal (transfuse if haemoglobin concentration <9 g/dl)
transfusion strategy. The primary outcome is a binary composite outcome of
any serious infectious or ischaemic event in the first 3 months following
randomization. Trial registration: ISRCTN70923932.
Copyright &#xa9; 2015 Pike et al.; licensee BioMed Central.

<41>
Accession Number
612335526
Author
Zheng L.; Fan Q.-M.; Wei Z.-Y.
Institution
(Zheng, Fan, Wei) Department of Cardiovascular Surgery, Yantai Yuhuangding
Hospital, No.20 Yuhuangding East Road, Yantai 264000, China
Title
Serum S-100beta and NSE levels after off-pump versus on-pump coronary
artery bypass graft surgery.
Source
BMC Cardiovascular Disorders. 15 (1) (no pagination), 2015. Article
Number: 70. Date of Publication: 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: We aimed to evaluate serum levels of S-100 beta (S-100beta)
and neuron specific enolase (NSE) in patients with coronary heart disease
(CHD) after off-pump versus on-pump coronary artery bypass graft (CABG)
surgery. Methods: The PubMed (~2013) and the Chinese Biomedical Database
(CBM) (1982 ~ 2013) were searched without language restrictions. After
extraction of relevant data from selected studies, meta-analyses were
conducted using STATA software (Version 12.0, Stata Corporation, College
Station, Texas USA). Possible sources of heterogeneity were examined
through univariate and multivariate meta-regression analyses and verified
by Monte Carlo Simulation. Results: Eleven studies with a total of 411 CHD
patients met the inclusion criteria. Our meta-analysis showed no
significant difference in serum S-100beta and NSE levels between the
on-pump group and the off-pump group before surgery. In the on-pump group,
there was a significant difference in serum S-100beta levels of CHD
patients between before and after surgery, especially within the first 24
h after surgery. Furthermore, in the on-pump group, there was a
significant difference in serum NSE levels of CHD patients between before
and after surgery, particularly at 0 h after surgery. In the off-pump
group, there was an obvious difference in serum S-100beta levels between
before and after surgery, especially within 24 h after surgery. Our
results also demonstrated that serum S-100beta and NSE levels of CHD
patients in the on-pump group were significantly higher than those of
patients in the off-pump group, especially within 24 h after surgery.
Conclusions: Our findings provide empirical evidence that off-pump and
on-pump CABG surgeries may increase serum S-100beta and NSE levels in CHD
patients, which was most prominent within 24 h after on-pump CABG surgery.
Copyright &#xa9; 2015 Zheng et al.

<42>
Accession Number
605092222
Author
Tang X.; Li R.; Jing Q.; Liu Y.; Liu P.
Institution
(Tang) Department of Cardiology, First Hospital of QinHuangDao,
Qinhuangdao, Hebei, China
(Li) Department of Emergency Medicine, First Hospital of QinHuangDao,
Qinhuangdao, Hebei, China
(Jing) Department of Cardiology, General Hospital of Shenyang Military
Area Command, Shenyang, Liaoning, China
(Liu, Liu) Department of Cardiology, Zhujiang Hospital, Southern Medical
University, Guangzhou, Guangdong, China
Title
Efficacy and safety of intracoronary versus intravenous administration of
tirofiban during percutaneous coronary intervention for acute coronary
syndrome: A meta-analysis of randomized controlled trials.
Source
PLoS ONE. 10 (6) (no pagination), 2015. Article Number: e0129718. Date of
Publication: 11 Jun 2015.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: Percutaneous coronary intervention (PCI) is known as the most
effective treatment for acute coronary syndrome (ACS). However, without
proper therapy and patient management, stent thrombosis after PCI may lead
to another myocardial infarction. In addition to aspirin and clopidogrel,
tirofiban is often used as an antiplatelet therapy in patients with ACS.
To date, there has been no comprehensive evaluation of the efficacy and
safety of intracoronary (IC) tirofiban administration for ACS patients
undergoing PCI compared with intravenous (IV) administration. Therefore,
this meta-analysis was conducted to investigate the clinical efficiency
and safety of IC versus intravenous (IV) tirofiban in ACS patients
undergoing PCI. Methods: We searched PubMed and Medline for randomized
controlled trials (RCTs) comparing IC versus IV administration of
tirofiban in ACS patients undergoing PCI. We evaluated the effects of
tirofiban on thrombolysis in myocardial infarction (TIMI) grade 3 flow
after PCI, TIMI myocardial perfusion grade 3 (TMP grade 3), left
ventricular ejection fraction (LVEF), major adverse cardiovascular events
(MACE), target vessel revascularization (TVR), death, reinfarction and
adverse drug effects (specifically bleeding events). Results: Seven trials
involving 1,027 patients were included in this meta-analysis. IC
administration of tirofiban significantly increased TIMI grade 3 flow (OR
2.11; 95% CI 1.02 to 4.37; P = 0.04) and TMP grade 3 (OR 2.67; 95% CI 1.09
to 6.49; P = 0.03, I² = 64%) while reducing MACE (OR 0.46, 95%
CI: 0.28 to 0.75; P = 0.002) compared with IV administration of tirofiban.
No significant differences were observed in the occurrence of TVR, death,
reinfarction and the incidence of bleeding events between the two groups.
Conclusions: This meta-analysis supports the use of IC over IV
administration of tirofiban in patients with ACS to improve TIMI flow, TMP
flow and MACE. However, there was no statistically significant difference
in the risk of bleeding complications between the two groups.
Copyright &#xa9; 2015 Tang et al.

<43>
Accession Number
615712486
Author
Zhang D.; Miao J.; Hu X.; Hu B.; Li H.
Institution
(Zhang, Miao, Hu, Hu, Li) Department of Thoracic Surgery, Beijing Chaoyang
Hospital, Capital Medical University, Beijing 100020, China
Title
A clinical study of efficacy of polyglycolic acid sleeve after
video-assisted thoracoscopic bullectomy for primary spontaneous
pneumothorax.
Source
Journal of Thoracic Disease. 9 (4) (pp 1093-1099), 2017. Date of
Publication: 01 Apr 2017.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Primary spontaneous pneumothorax (PSP) is a common disease in
thoracic surgery, and a prolonged postoperative air leakage is the most
frequent and troublesome early complication after videoassisted
thoracoscopic (VATS) bullectomy. This study aimed to explore the efficacy
of polyglycolic acid (PGA) sleeve in preventing postoperative air leakage
after a VATS bullectomy for PSP. Methods: This study was a prospectively
randomised clinical study. The patients who underwent a VATS bullectomy
were continuously enrolled from January 2015 to June 2016 in the Beijing
Chaoyang Hospital and were randomly assigned to the experimental and
control groups. The experimental group applied a PGA sleeve combined with
an automatic stapler in the bullectomy, while in the control group, the
bullae were resected using an automatic stapler alone during the
operation. In addition, the staple lines in both groups were covered with
an absorbable polyglycolic acid sheet and both groups performed pleural
abrasion after the resection. Useful clinical data were recorded,
including the number of cases there was no air leakage immediately after
the operation and air leakage lasted more than 3 days, the average
postoperative air leakage, the drainage tube removal time, the
postoperative hospital stay, the postoperative complications, and the
postoperative recurrence. Results: A total of 134 patients were enrolled
in this study. The experimental group consisted of 60 subjects, and there
were 74 in the control group. No operative related mortality was observed
in either group. In the experimental group, 44 of the 60 patients did not
have an air leakage immediately after the operation, which was
significantly higher than the control group (73.33% vs. 54.05%, P =
0.031). Compared with the control group, the average postoperative air
leakage (0.57 +/- 1.11 days), the chest tube removal time (3.03 +/- 0.92
days), and the postoperative hospital stay (3.98+/-0.92 days) were all
significantly shorter in the experimental group (P = 0.048, P = 0.012, and
P = 0.010, respectively). Moreover, the rate of postoperative
complications in the experimental group was lower than the control group
(3.33% vs. 16.22%, P = 0.021). No postoperative recurrence was observed in
either group during the follow-up period that ranged from 8 to 25 months.
Conclusions: The use of PGA sleeve during surgery for PSP might
effectively prevent early postoperative air leakage, as well as reduce the
postoperative drainage tube removal time and the postoperative hospital
stay.
Copyright &#xa9; 2017. Journal of Thoracic Disease.

<44>
Accession Number
615712482
Author
Deng H.-Y.; Shi C.-L.; Li G.; Luo J.; Wang Z.-Q.; Lin Y.-D.; Liu L.-X.;
Zhou Q.-H.
Institution
(Deng, Li, Luo, Wang, Lin, Liu) Department of Thoracic Surgery, West China
Hospital, Sichuan University, Chengdu 610041, China
(Deng, Zhou) Lung Cancer Center, West China Hospital, Sichuan University,
Chengdu 610041, China
(Shi) Department of Thoracic Surgery, The Central Hospital of Bazhong,
Bazhong 636000, China
Title
The safety profile of preoperative administration of heparin for
thromboprophylaxis in Chinese patients intended for thoracoscopic major
thoracic surgery: A pilot randomized controlled study.
Source
Journal of Thoracic Disease. 9 (4) (pp 1065-1072), 2017. Date of
Publication: 01 Apr 2017.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Patients undergoing major thoracic surgery especially for
cancers are at a high risk of perioperative thromboembolism. Current
guidelines recommended either heparin sodium (unfractionated heparin) or
low-molecular-weight heparin (LMWH) for those patients at high risk of
deep vein thrombosis (DVT). However, the rational timing of starting
heparin has not yet been well established, because DVT can be caused by
not only surgery but also comorbidities as well as prolonged hospital
stay, and thoracic surgeons always concerned about heparin-related
increased risk of intra- or post-operative bleeding. Therefore, this study
aimed to establish the safety profile of preoperative administration of
heparin for thromboprophylaxis in Chinese patients intended for
thoracoscopic major thoracic surgery. Methods: From June to August 2016,
patients intended for thoracoscopic lobectomy, esophagectomy, and
thymectomy were randomly assigned into two groups: the case group
(starting heparin sodium 5,000 U, bid preoperatively upon the admission
into our department) and the control group (starting heparin sodium 5,000
U, bid postoperatively from postoperative day 1). The baseline data
including demographic data and preoperative conditions were collected. The
end points included operation time, intraoperative bleeding volume,
postoperative chest tube drainage volume and duration as well as lab
coagulation function data. Results: A total of 58 qualified patients were
randomized into case group (29 patients) and control group (29 patients),
and after excluding 6 conversion patients, the case group and control
group each had 26 patients for analysis. The baseline data of the two
groups were comparable. Operation time (P=0.368), intraoperative bleeding
volume (P=0.231), postoperative drainage days (P=0.466), and mean drainage
volume per day (P=0.108) were not significantly increased in case group
compared with those of control group. Moreover, there were no significant
differences of perioperative coagulation function between these two
groups. Conclusions: Preoperative administration of heparin for
thromboprophylaxis in Chinese patients intended for thoracoscopic major
thoracic surgery was safe and feasible.
Copyright &#xa9; 2017. Journal of Thoracic Disease.

<45>
Accession Number
615712458
Author
Bertolaccini L.; Pardolesi A.; Solli P.
Institution
(Bertolaccini, Solli) Department of Thoracic Surgery, AUSL Romagna
Teaching Hospital, Ravenna, Italy
(Pardolesi, Solli) Department of Thoracic Surgery, AUSL Romagna Teaching
Hospital, Forli, Italy
Title
Tips and tricks of the propensity score methods in the thoracic surgery
research.
Source
Journal of Thoracic Disease. 9 (4) (pp 920-923), 2017. Date of
Publication: 01 Apr 2017.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Without randomization, the differences in the distribution of baseline
covariates can confound the evaluation of outcomes between the groups. To
estimate the causal effects of treatment on the results randomized
clinical trials (RCT) are routinely used. When RCT are not feasible for
cost, time, and ethical issues, the effect of treatment on an inevitable
outcome could be investigated by using a non-experimental study design.
The propensity score (PS) refers to the individual probability, for a
subject involved in a study, of receiving a new treatment rather than the
control treatment. PS matching is a valuable and increasingly popular tool
for dealing with observational data and non-random treatment assignment.
Nevertheless, surgeons need to proceed with caution and apply PS methods
appropriately.
Copyright &#xa9; 2017. Journal of Thoracic Disease.

<46>
Accession Number
615571524
Author
Karaaslan P.; Unlukaplan A.; Gokay B.V.; Darcin K.; Hizarci B.; Bozkaya
T.A.; Ozyuksel A.; Akcevin A.
Institution
(Karaaslan, Hizarci) Department of Anesthesiology and Reanimation, Medipol
University Hospital, Istanbul, Turkey
(Unlukaplan, Darcin) Department of Anesthesiology and Reanimation, Koc
University Hospital, Istanbul, Turkey
(Gokay) Department of Anesthesiology and Reanimation, Acibadem University
Hospital, Istanbul, Turkey
(Bozkaya) Department of Cardiovascular Surgery, Koc University Hospital,
Istanbul, Turkey
(Ozyuksel, Akcevin) Department of Cardiovascular Surgery, Medipol
University Hospital, Istanbul, Turkey
Title
Correlation between blood lactate and regional cerebral oxygen saturation
in complex cardiac pathology neonates and infants: The effect on
extubation time and ICU stay.
Source
Biomedical Research (India). 28 (7) (pp 3101-3107), 2017. Date of
Publication: 2017.
Publisher
Scientific Publishers of India (E-mail: qayyum@del3.vsnl.net.in)
Abstract
Background: The monitoring of regional cerebral O<inf>2</inf> saturation
(rSO<inf>2</inf>) with near-infrared spectroscopy (NIRS) is a noninvasive
technique to measure tissue oxygenation in the brain. It may be an
effective monitoring technique in the early diagnosis of pre-, intra- and
post-operative insufficient oxygen supply to the brain in surgery for
congenital heart diseases. In pediatric patients, a variety of clinical
and laboratory parameters, including serum lactate and regional cerebral
oxygen saturation, may be helpful in monitoring global tissue and cerebral
oxygen delivery and consumption. Aim: Our study was designed to
investigate whether there is a correlation between the NIRS scores and
serum lactate levels during congenital heart surgery. Our secondary
objective was to define the predictive value of this correlation on the
duration of extubation and intensive care unit stay. Method: A total of 82
successive neonatal and infant patients with complex cardiac pathologies
were enrolled in the study. Blood lactate levels and NIRS values were
measured during the phases of anesthesia induction, sternotomy,
cannulation, onset of CPB, the beginning of aortic cross-clamping and the
end of the CPB. Study design: Prospective randomized Results: Patients
with normal rSO<inf>2</inf> /normal lactate during the operation
represented the largest percentage of patients during anesthesia induction
(n=50, 60.9%) and sternotomy (n=54, 65.8%). The only negative correlation
between lactate and rSO<inf>2</inf> was detected during anesthesia
induction. The time to extubation and the stay in the intensive care unit
were longer in patients with low rSO<inf>2</inf> values during anesthesia
induction and sternotomy. In the same periods, elevated lactate levels
were associated with longer time to extubation and intensive care unit
stay than the patients with normal lactate levels. Conclusion: In our
study, no correlation was demonstrated between NIRS scores and serum
lactate levels in children during congenital heart surgery, except for
anesthesia induction. The only negative correlation between the decrease
in NIRS scores and the increase in serum lactate levels was observed
during anesthesia induction. This result indicated that cerebral NIRS
monitoring cannot be used as an indicator of global hypoperfusion in the
same way as lactate.
Copyright &#xa9; 2017, Scientific Publishers of India. All rights
reserved.

<47>
Accession Number
615571418
Author
Ahmad S.; Ahmad R.A.; Qureshi B.A.; Baig M.A.R.
Institution
(Ahmad, Ahmad) Anesthesia and Critical Care, CPE Institute of Cardiology
Multan, Multan, Pakistan
(Qureshi, Baig) CPE Institute of Cardiology Multan, Multan, Pakistan
Title
Myocardial protection with glucose-insulin-potassium infusion during adult
cardiac surgery.
Source
Pakistan Journal of Medical Sciences. 33 (2) (pp 325-329), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Professional Medical Publications (Raja Ghazanfar Ali Road, Saddar,
Karachi, Pakistan)
Abstract
Background & Objective: Recent meta-analysis reports have called for more
randomized trials to evaluate the effectiveness of GIK solution in
patients of cardiac surgery. So this study was conducted to evaluate the
effectiveness of Glucose-insulin-potassium (GIK) solutions in non-diabetic
patients undergoing coronary artery bypass grafting. Methods: A total
number of one hundred and sixty (160) patients were randomized into two
equal groups; GIK Group and non-GIK group. In GIK group, 5% dextrose
containing 70 IU/L regular insulin and 70 meq/L of potassium was
administered. The infusion was started at a rate of 30 ml/hour after
induction of anesthesia and before the start of cardiopulmonary bypass.
The infusion was started again after removal of aortic cross clamp and was
continued for six hours after the operation. Results: In early
post-operative period, peak CKMB levels were high in non-GIK group
48.50+/-19.79 IU/L versus 33.40+/-14.69 IU/L in GIK group (p-value
<0.001). There was no statistically significant difference in requirements
of inotropic support between the groups. The mean duration of inotropic
support in GIK group was only 5.50+/-6.88 hours in GIK group and
8.64+/-7.74 hours in non-GIK group (p-value 0.008). Mean ventilation time
in GIK group was 5.06+/-2.39 hours versus 6.55+/-3.58 hours in non-GIK
group (p-value 0.002). Similarly, ICU stay period was also shorter in GIK
group (p-value 0.01). We did not found any detrimental effect of GIK
infusion on non-cardiac complications e.g. renal, pulmonary and neurologic
complications. Conclusion: Glucose-insulin-potassium (GIK) infusion has a
beneficial role in myocardial protection and is associated with better
post-operative outcomes without increasing the risk of non-cardiac
complications.
Copyright &#xa9; 2017, Professional Medical Publications. All rights
reserved.

<48>
Accession Number
615712790
Author
Huang L.; Dalziel K.M.; Schilling C.; Celermajer D.S.; McNeil J.J.; Winlaw
D.; Gentles T.; Radford D.J.; Cheung M.; Bullock A.; Wheaton G.R.; Justo
R.N.; Selbie L.A.; Forsdick V.; Du Plessis K.; d'Udekem Y.
Institution
(Huang, Dalziel, Schilling) Centre for Health Policy, The University of
Melbourne, Melbourne, Australia
(Celermajer) Department of Medicine, The University of Sydney, Sydney,
Australia
(Celermajer, Forsdick) Department of Cardiology, Royal Prince Alfred
Hospital, Sydney, Australia
(McNeil) School of Public Health and Preventive Medicine, Monash
University, Melbourne, Australia
(Winlaw) Heart Centre for Children, The Children's Hospital at Westmead,
Sydney, Australia
(Winlaw) Westmead and Sydney Medical School, The University of Sydney,
Sydney, Australia
(Gentles) Green Lane Paediatric and Congenital Cardiac Service, Starship
Children's Hospital, Auckland, New Zealand
(Radford) Department of Cardiology, The Prince Charles Hospital, Brisbane,
Australia
(Radford) School of Medicine, The University of Queensland, Brisbane,
Australia
(Cheung) Department of Cardiology, Royal Children's Hospital, Melbourne,
Australia
(Cheung, Du Plessis, d'Udekem) Heart Research Group, Murdoch Childrens
Research Institute, Melbourne, Australia
(Bullock) Children's Cardiac Centre, Princess Margaret Hospital for
Children, Perth, Australia
(Wheaton) Department of Cardiology, Women's and Children's Hospital,
Adelaide, Australia
(Justo) Paediatric Cardiology, Queensland Paediatric Cardiac Service, Lady
Cilento Children's Hospital, Brisbane, Australia
(Selbie) HeartKids Australia, Sydney, Australia
(d'Udekem) Department of Cardiac Surgery, Royal Children's Hospital,
Melbourne, Australia
(d'Udekem) Department of Paediatrics, The University of Melbourne,
Melbourne, Australia
Title
Hospital costs and cost implications of co-morbid conditions for patients
with single ventricle in the period through to Fontan completion.
Source
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: January 24, 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Patients undergoing palliative surgeries for single-ventricle
conditions are affected by multiple comorbidities or non-cardiac
conditions. The prevalence, costs and the cost implications of these
conditions have not been assessed. Methods: Administrative costing records
from four hospitals in Australia and New Zealand were linked with the
Fontan registry database to analyze the inpatient resource use for
co-morbid or non-cardiac conditions. Inpatient costing records from the
birth year through to Fontan completion were available for 156 patients.
The most frequent primary diagnoses were hypoplastic left heart syndrome
(33%), double inlet left ventricle (13%), and tricuspid atresia (12%).
Results: During the staged surgical treatment period, children had a mean
of 10. +/-. 6 inpatient admissions and spent 85. +/-. 64. days in
hospital. Among these admissions, 3. +/-. 5 were for non-cardiac
conditions, totaling 21. +/-. 41 inpatient days. Whilst cardiac surgeries
were the major reason for resource use (77% of the total cost), other
cardiac care that is not surgical contributed 5% and non-cardiac
admissions 18% of the total cost. The three most prevalent non-cardiac
diagnostic admission categories were 'Respiratory system', 'Digestive
system', and 'Ear, nose, mouth and throat', affecting 28%, 21% and 34% of
the patients respectively. Multivariate regression estimated that
admissions for each of these categories resulted in an increased cost of
$34,563 (P = 0.08), $52,438 (P = 0.05) and $10,525 (P = 0.53) per patient
respectively for the staged surgical treatment period. Conclusions:
Non-cardiac admissions for single-ventricle patients are common and have
substantial resource implications. Further research assessing the causes
of admission and extent to which admissions are preventable is warranted.
Copyright &#xa9; 2017 Elsevier B.V.

<49>
Accession Number
615708965
Author
Issitt R.W.; Harvey I.; Walsh B.; Voegeli D.
Institution
(Issitt) Perfusion Department, Great Ormond Street Hospital for Children,
London, United Kingdom
(Issitt, Walsh, Voegeli) Faculty of Health Sciences, University of
Southampton, Southampton, United Kingdom
(Harvey) Perfusion Department, John Radcliffe Hospital, Oxford, United
Kingdom
Title
Quantification of Lipid Filtration and the Effects on Cerebral Injury
During Cardiopulmonary Bypass.
Source
Annals of Thoracic Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier USA
Abstract
Background: Lipid microemboli (LME) are formed in pericardial suction
blood which, when returned to the cardiopulmonary bypass (CPB) circuit,
can pass through filter materials and are returned to the arterial
cannula. LME have been observed to enter all major organs and have been
associated with small capillary arteriolar dilatations in the brains of
patients who have died after CPB. However, a causal relationship showing
correlation between LME and organ dysfunction has not been demonstrated,
or whether removal of LME results in improved organ function. Methods: A
prospective, single center, randomized controlled trial examined 30
patients (15 per group) undergoing coronary artery bypass grafting using
CPB with or without a lipid-depleting filter. The effects of LME
filtration on neurocognitive injury were assessed using neuron-specific
enolase (NSE). Results: The study group showed a significant reduction in
LME after filtration of the pericardial suction blood (p < 0.001), whereas
the control group exhibited a significant rise in LME (p < 0.001). There
was a significant reduction in peak NSE release (p = 0.013) and
significant attenuation throughout the postoperative period (p = 0.002).
Correlation and regression analyses showed a significant relationship
between the number of LME post-CPB and peak NSE release (r = 0.42, p =
0.02). Conclusions: Several methods of LME filtration have been proposed,
but none provided a suitable, efficacious method for use within the
clinical setting. The RemoweLL CPB system removes significant numbers of
LME from the cardiotomy suction. Furthermore, LME correlate to the release
of a known marker of neurologic injury.
Copyright &#xa9; 2017 The Society of Thoracic Surgeons.

<50>
Accession Number
615702807
Author
Velghe D.; Apers T.; Devriendt S.; Deblier I.; Hendriks B.; Nieuwendijk
R.; Rogiers P.
Institution
(Velghe) 1Department of Anesthesia and Reanimation, ZNA Middelheim
Hospital, Antwerpen, Belgium. 2Department of Cardiothoracic Surgery, ZNA
Middelheim Hospital, Antwerpen, Belgium. 3Department of Critical Care, ZNA
Middelheim Hospital, Antwerpen, Belgium.
Title
Atriobronchial Fistula Complicated by Septic Cerebral Air Emboli After
Pulmonary Vein Ablation.
Source
Critical Care Medicine. (no pagination), 2017. Date of Publication: 22 Apr
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
OBJECTIVE:: To describe a case of an infected atriobronchial fistula as a
late complication after pulmonary vein ablation, leading to septic air
emboli and requiring urgent cardiac surgery. DATA SOURCES:: Clinical
observation. STUDY SELECTION:: Case report. DATA EXTRACTION:: Relevant
clinical information. PubMed was searched for relevant literature. DATA
SYNTHESIS:: Given its high success and low complication rate, pulmonary
vein isolation is expected to be increasingly performed worldwide. Despite
its success, some of its rare complications are potentially devastating
and are difficult to diagnose early. In this report, we present the case
of a 32-year-old woman, who was readmitted to hospital 2 months after
pulmonary vein ablation. The clinical picture resembled meningococcemia
with spreading petechiae on legs and arms raising concern for
Waterhouse-Friderichsen syndrome. Further echocardiographic investigation
led to the discovery of massive amounts of intracardiac air which demanded
urgent lung isolation and sternotomy. Intraoperatively a small infected
left atrial perforation was oversewn and a fistula to the right main
bronchus was closed by means of an autologous pericardial patch. One month
later, still revalidating, she could be discharged home with only minor
neurologic sequelae. CONCLUSIONS:: Clinicians should be aware of the
dramatic complications of invasive antiarrhythmic procedures and their
atypical and late presentations. Better preprocedural appreciation of
cardiac wall thickness, early echocardiographic diagnosis, and swift
referral for cardiac surgery might impact outcome dramatically.
Copyright &#xa9; by 2017 by the Society of Critical Care Medicine and
Wolters Kluwer Health, Inc. All Rights Reserved.

<51>
Accession Number
615701978
Author
Hommel I.; van Gurp P.J.; Den Broeder A.A.; Wollersheim H.; Atsma F.;
Hulscher M.E.J.L.; Tack C.J.
Institution
(Hommel, van Gurp, Den Broeder, Wollersheim, Atsma, Hulscher, Tack)
Radboud University Medical Center, Radboud Institute for Health Sciences,
Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
(Hommel, van Gurp, Den Broeder, Wollersheim, Atsma, Hulscher, Tack)
Department of General Internal Medicine, Radboud University Medical
Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
(Hommel, van Gurp, Den Broeder, Wollersheim, Atsma, Hulscher, Tack)
Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The
Netherlands
Title
Reactive Rather than Proactive Diabetes Management in the Perioperative
Period.
Source
Hormone and Metabolic Research. (no pagination), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
As perioperative hyperglycemia is associated with poor postoperative
patient outcomes, clinical guidelines provide recommendations for optimal
perioperative glucose control. It is unclear to what extent recommended
glucose levels are met in daily practice, and little is known about
factors that influence these levels. We describe blood glucose levels
throughout the hospital care pathway in 375 non-critically ill patients
with diabetes who underwent major surgery (abdominal, cardiac, or
orthopedic) in 6 hospitals, examine determinants of these levels including
adherence to 9 quality indicators for optimal perioperative diabetes care,
and perform qualitative interviews to identify barriers for optimal care.
Virtually all patients (95%) experienced at least one hyperglycemic value
(>10 mmol/l); 9% had at least one value <4 mmol/l. Mean glucose increased
from preoperative to postoperative day (POD) 1 (+2.3 mmol/l, 5-95% CI
1.9-2.7), and then gradually decreased on POD 2-14 (+1.8 mmol/l, 5-95% CI
1.4-2.2). Insulin-treated patients (with or without oral agents) had
higher glucose levels (+1.7 mmol/l, 5-95% CI 0.5-3.0, and +1.2 mmol/l,
-0.1 to -2.5) than patients using oral agents only. Indicator adherence
tended to be associated with higher glucose levels. Barriers for optimal
care included a lack of formalized agreements on target glucose levels,
absence of directly obvious disadvantages of hyperglycemia, and concern
about inducing hypoglycemia. Hyperglycemia is common after major surgery,
in particular on POD1 and in insulin-treated patients. Our results suggest
that perioperative diabetes care is reactive rather than proactive, and
that current emphasis of professionals is on treating instead of
preventing postoperative hyperglycemia.
Copyright &#xa9; 2017, Georg Thieme Verlag KG. All rights reserved.

<52>
Accession Number
611333849
Author
Clemmensen T.S.; Logstrup B.B.; Eiskjaer H.; Poulsen S.H.
Institution
(Clemmensen, Logstrup, Eiskjaer, Poulsen) Department of Cardiology, Aarhus
University Hospital, Brendstrupgardsvej 100, Skejby 8200, Denmark
Title
Serial changes in longitudinal graft function and implications of acute
cellular graft rejections during the first year after heart
transplantation.
Source
European Heart Journal Cardiovascular Imaging. 17 (2) (pp 184-193), 2016.
Date of Publication: 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims The aim of this prospective study was to use left ventricular global
longitudinal strain (LV-GLS) as a non-invasive tool for the monitoring of
graft function in relation to acute cellular rejection (ACR) during the
first year after heart transplantation (HTX). Methods and results The
study population consisted of 36 patients undergoingHTXfrom November 2010
until October 2013. Patients were followed by comprehensive
echocardiography and biopsies at 2weeks and 1, 3, 6, and 12 months after
HTX. ACRs were classified based on the ISHLT classification (0R-3R).
Patientswere divided into two groups according to the presence of one or
more episodes of biopsy proven >grade 2R ACR during follow-up.We found
that LV-GLS and tricuspid annular plane systolic excursion (TAPSE) were
significantly related to ACR burden in a linear regression model. The
absolute difference in LV-GLS between patients in the ACR group (-14.4%)
and patients in the ACR-free group (-16.8%) was -2.4% (P<0.01) 12 months
after HTX. In the ACR group, patients' LV-GLS did not improve between 1
and 12 months, whereas an improvement of 22.9% was seen in the ACR-free
group in this period (P<0.01). The two groups appeared not to differ in
terms of diastolic Doppler parameters or LV ejection fraction, but TAPSE
was 15.3+/-2.8 mm in the ACR-free group vs. 13.2+/-2.1 mm ACR group,
P<0.05, 12 months after HTX. Conclusion Gradual improvement of
longitudinal LV and RV function was seen within the first year after HTX,
but the degree of recovery was strongly influenced by ACR episodes.
Copyright &#xa9; The Author 2015. Published on behalf of the European
Society of Cardiology. All rights reserved.

<53>
Accession Number
609834924
Author
Soylu E.; Harling L.; Ashrafian H.; Rao C.; Casula R.; Athanasiou T.
Institution
(Soylu, Harling, Ashrafian, Rao, Casula, Athanasiou) Department of Surgery
and Cancer, Imperial College, London, United Kingdom
Title
A systematic review of the safety and efficacy of distal coronary artery
anastomotic devices.
Source
European Journal of Cardio-thoracic Surgery. 49 (3) (pp 732-745), 2016.
Date of Publication: 01 Mar 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Interest in minimally invasive and off-pump cardiac surgical techniques
has promoted the development of automated distal anastomotic devices
(DADs) to facilitate construction of coronary artery anastomosis. Several
DADs have been proposed for potential use in coronary surgery. However, a
number of technical failures and uncertainty around both short-term
morbidity and long-term patency have limited the generalized uptake of
these devices. A systematic literature search identified 28 studies,
incorporating 970 patients who underwent coronary artery bypass grafting
using a DAD. Eight different devices were identified including Heartflo,
St Jude, U-clip, vessel closure system, C-port, magnetic vascular
positioner and coronary anastomosis coupler. Thirty-day mortality,
cardiac-specific mortality and myocardial infarction were equal between
DADs and hand-sewn cases (1.3, 0.3 and 0.8%, respectively). The overall
proportion of postoperative haemorrhage was higher in the anastomotic
device group (2.3%) than in the group with hand-sewn anastomoses (1.5%)
although not statistically significant. Overall graft patency was 97.2% at
< 1 month, 94.6% at 1-3 months and 92.3% at > 3 months. Of the currently
available systems, the U-clip device was found to provide the best overall
postoperative outcomes, which included a patency of 96.1% at > 3months.
The current literature is limited by its predominantly observational study
design and lack of directly comparative studies. Furthermore, inter-study
variation in patient selection, anticoagulation strategies and follow-up
periods prevents quantitative comparison. Future research necessitates
multicentre randomized, controlled studies to provide a direct comparison
of current and future anastomotic device systems with established
hand-sewn techniques in both the short and long term.
Copyright &#xa9; The Author 2015. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<54>
[Use Link to view the full text]
Accession Number
605325733
Author
Kragholm K.; Halim S.A.; Yang Q.; Schulte P.J.; Hochman J.S.; Melloni C.;
Mahaffey K.W.; Moliterno D.J.; Harrington R.A.; White H.D.; Armstrong
P.W.; Ohman E.M.; Van De Werf F.; Tricoci P.; Alexander J.H.; Giugliano
R.P.; Newby L.K.
Institution
(Kragholm, Halim, Yang, Schulte, Melloni, Ohman, Tricoci, Alexander,
Newby) Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715,
United States
(Hochman) Cardiovascular Clinical Research Center, Leon H. Charney
Division of Cardiology, New York University School of Medicine and NYU
Langone Medical Center, New York, NY, United States
(Mahaffey, Harrington) Department of Medicine, Stanford University,
Stanford, CA, United States
(Moliterno) Gill Heart Institute, Division of Cardiovascular Medicine,
University of Kentucky, Lexington, KY, United States
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Armstrong) Department of Medicine, University of Alberta, Edmonton,
Canada
(Van De Werf) Department of Cardiology, University Hospitals Leuven,
Leuven, Belgium
(Giugliano) Department of Cardiovascular Medicine, Brigham and Women's
Hospital, Boston, MA, United States
Title
Sex-Stratified Trends in Enrollment, Patient Characteristics, Treatment,
and Outcomes among Non-ST-Segment Elevation Acute Coronary Syndrome
Patients: Insights from Clinical Trials over 17 Years.
Source
Circulation: Cardiovascular Quality and Outcomes. 8 (4) (pp 357-367),
2015. Date of Publication: 23 Jul 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Adequate representation by sex in trials allows
generalizability of results. We examined representation of women in
clinical trials during a 17-year period in which inclusion criteria were
broadened and federal mandates for representativeness were launched.
Methods and Results - Using mixed models, we studied sex-stratified
temporal trends in enrollment, clinical characteristics, treatment, and
outcomes among 76 148 non-ST-segment elevation acute coronary syndrome
patients using patient-level data merged from 11 phase III trials
conducted from 1994 to 2010. Overall, 33.3% of patients were women, which
changed minimally over time. Women were consistently 4 to 5 years older
than men (median age 68 [interquartile range 61-75] versus 64
[interquartile range 56-72] years) and more frequently had diabetes
mellitus, hypertension, and heart failure; men more frequently had prior
myocardial infarction and revascularization. GRACE risk scores increased
over time for both sexes with the inclusion of older patients with more
comorbidities. Use of percutaneous coronary intervention, in-hospital and
discharge angiotensin-converting enzyme inhibitor/angiotensin II receptor
blockers, beta-blockers, and lipid-lowering drugs also increased among
both sexes. Kaplan-Meier estimates of 6-month mortality declined from 7.0%
[95% confidence interval 6.5%-7.6%] to 4.5% [95% confidence interval
4.0%-5.0%] among women and 6.3% [95% confidence interval 6.0%-6.7%] to
3.1% [95% confidence interval 2.9%-3.4%] among men during the 17-year
period. Conclusions - The relative proportion of women in non-ST-segment
elevation acute coronary syndrome trials changed minimally over time.
Nevertheless, in parallel with men, use of evidence-based care and
outcomes improved significantly over time among women.
Copyright &#xa9; 2015 American Heart Association, Inc.

<55>
Accession Number
604815948
Author
Davydow D.S.; Lease E.D.; Reyes J.D.
Institution
(Davydow) Department of Psychiatry and Behavioral Sciences, University of
Washington, Seattle, WA, United States
(Lease) Division of Pulmonary and Critical Care Medicine, Department of
Medicine, University of Washington, Seattle, WA, United States
(Reyes) Division of Transplant Surgery, Department of Surgery, University
of Washington, Seattle, WA, United States
Title
Posttraumatic stress disorder in organ transplant recipients: A systematic
review.
Source
General Hospital Psychiatry. 37 (5) (pp 387-398), 2015. Date of
Publication: 01 Sep 2015.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: To summarize and critically review the existing literature on
the prevalence of posttraumatic stress disorder (PTSD) following organ
transplantation, risk factors for posttransplantation PTSD and the
relationship of posttransplant PTSD to other clinical outcomes including
health-related quality of life (HRQOL) and mortality. Methods: We
conducted a systematic literature review using PubMed, CINAHL Plus, the
Cochrane Library and PsycInfo and a search of the online contents of 18
journals. Results: Twenty-three studies were included. Posttransplant, the
point prevalence of clinician-ascertained PTSD ranged from 1% to 16% (n =
738), the point prevalence of questionnaire-assessed substantial PTSD
symptoms ranged from 0% to 46% (n = 1024) and the cumulative incidence of
clinician-ascertained transplant-specific PTSD ranged from 10% to 17% (n =
482). Consistent predictors of posttransplant PTSD included history of
psychiatric illness prior to transplantation and poor social support
posttransplantation. Posttransplant PTSD was consistently associated with
worse mental HRQOL and potentially associated with worse physical HRQOL.
Conclusions: PTSD may impact a substantial proportion of organ transplant
recipients. Future studies should focus on transplant-specific PTSD and
clarify potential risk factors for, and adverse outcomes related to,
posttransplant PTSD.
Copyright &#xa9; 2015 Elsevier Inc.

<56>
Accession Number
604480627
Author
Ferguson M.K.; Thompson K.; Huisingh-Scheetz M.; Farnan J.; Hemmerich J.;
Acevedo J.; Small S.
Institution
(Ferguson) Department of Surgery, Section of Cardiac and Thoracic Surgery,
University of Chicago Medicine, 5841 S Maryland Ave, Chicago, IL MC5040,
United States
(Ferguson) Cancer Research Center, University of Chicago Medicine,
Chicago, IL, United States
(Thompson, Huisingh-Scheetz, Farnan, Hemmerich) Department of Medicine,
University of Chicago Medicine, Chicago, IL, United States
(Acevedo) Center for Research Informatics, University of Chicago Medicine,
Chicago, IL, United States
(Small) Department of Anesthesia and Critical Care, University of Chicago
Medicine, Chicago, IL, United States
(Small) Center for Simulation, University of Chicago Medicine, Chicago,
IL, United States
Title
The Impact of a Frailty Education Module on Surgical Resident Estimates of
Lobectomy Risk.
Source
Annals of Thoracic Surgery. 100 (1) (pp 235-241), 2015. Article Number:
28064. Date of Publication: 01 Jul 2015.
Publisher
Elsevier USA
Abstract
Background Frailty is a risk factor for adverse events after surgery.
Residents' ability to recognize frailty is underdeveloped. We assessed the
influence of a frailty education module on surgical residents' estimates
of lobectomy risk. Methods Traditional track cardiothoracic surgery
residents were randomly allocated to take an online short course on
frailty (experimental group) or to receive no training (control group).
Residents read a clinical vignette, made an initial risk estimate of major
complications for lobectomy, and rated clinical factors on their
importance to their estimates. They viewed a video of a standardized
patient portraying the patient in the vignette, randomly selected to
exhibit either vigorous or frail behavior, and provided a final risk
estimate. After rating five vignettes, they completed a test on their
frailty knowledge. Results Forty-one residents participated (20 in the
experimental group). Initial risk estimates were similar between the
groups. The experimental group rated clinical factors as "very important"
in their initial risk estimates more often than did the control group
(47.6% versus 38.5%; p < 0.001). Viewing videos resulted in a significant
change from initial to final risk estimates (frail 50% +/- 75% increase, p
= 0.008; vigorous 14% +/- 32% decrease, p = 0.043). The magnitude of
change in risk estimates was greater for the experimental group (10.0 +/-
8.1 versus 5.1 +/- 7.7; p < 0.001). The experimental group answered more
frailty test questions correctly (93.7% versus 75.2%; p < 0.001).
Conclusions A frailty education module improved resident knowledge of
frailty and influenced surgical risk estimates. Training in frailty may
help educate residents in frailty recognition and surgical risk
assessment.
Copyright &#xa9; 2015 The Society of Thoracic Surgeons.

<57>
Accession Number
605091854
Author
Song J.-C.; Lu Z.-J.; Jiao Y.-F.; Yang B.; Gao H.; Zhang J.; Yu W.-F.
Institution
(Song, Lu, Jiao, Gao, Zhang, Yu) Department of Anesthesiology, Eastern
Hepatobiliary Surgery Hospital, Second Military Medical University,
Shanghai, China
(Yang) Department of Anesthesiology, Shanghai first people's hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai, China
Title
Etomidate anesthesia during ERCP caused more stable haemodynamic responses
compared with propofol: A randomized clinical trial.
Source
International Journal of Medical Sciences. 12 (7) (pp 559-565), 2015. Date
of Publication: 03 Jul 2015.
Publisher
Ivyspring International Publisher (E-mail: info@ivyspring.com)
Abstract
Background: Propofol may result in hypotension and respiratory depression,
while etomidate is considered to be a safe induction agent for
haemodynamically unstable patients because of its low risk of hypotension.
We hypothesized that etomidate anesthesia during ERCP caused more stable
haemodynamic responses compared with propofol. The primary endpoint was to
compare the haemodynamic effects of etomidate vs. propofol in ERCP cases.
The secondary endpoint was overall survival. Methods: A total of 80
patients undergoing ERCP were randomly assigned to an etomidate or
propofol group. Patients in the etomidate group received etomidate
induction and maintenance during ERCP, and patients in the propofol group
received propofol induction and maintenance. Cardiovascular parameters and
procedure-related time were measured and recorded during ERCP. Results:
The average percent change to baseline in MBP was -8.4+/-7.8 and
-14.4+/-9.4 with P = 0.002, and in HR was 1.8+/-16.6 and 2.4+/-16.3 with P
= 0.874 in the etomidate group and the propofol group, respectively. MBP
values in the etomidate group decreased significantly less than those in
the propofol group (P0.05). The ERCP duration and recovery time in both
groups was similar. There was no significant difference in the survival
rates between groups (p = 0.942). Conclusions: Etomidate anesthesia during
ERCP caused more stable haemodynamic responses compared with propofol.
Copyright &#xa9; 2015 Ivyspring International Publisher.

<58>
Accession Number
604850136
Author
Booij H.G.; Damman K.; Warnica J.W.; Rouleau J.L.; van Gilst W.H.;
Westenbrink B.D.
Institution
(Booij, Damman, van Gilst, Westenbrink) Department of Cardiology,
University Medical Center Groningen, Hanzeplein 1, P O Box 30001,
Groningen 9700 RB, Netherlands
(Warnica) Foothills Hospital, University of Calgary, 1403-29 Street NW,
Calgary, AB T2N 2T9, Canada
(Rouleau) Institut de Cardiologie de Montreal, University of Montreal,
5000 Belanger St East, Montreal, QC H1T1C8, Canada
Title
beta-blocker Therapy is Not Associated with Reductions in Angina or
Cardiovascular Events After Coronary Artery Bypass Graft Surgery: Insights
from the IMAGINE Trial.
Source
Cardiovascular Drugs and Therapy. 29 (3) (pp 277-285), 2015. Date of
Publication: 03 Jun 2015.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: To evaluate whether beta-blockers were associated with a
reduction in cardiovascular events or angina after Coronary Artery Bypass
Graft (CABG) surgery, in otherwise stable low-risk patients during a
mid-term follow-up. Methods: We performed a post-hoc analysis of the
IMAGINE (Ischemia Management with Accupril post-bypass Graft via
Inhibition of angiotensin coNverting Enzyme) trial, which tested the
effect of Quinapril in 2553 hemodynamically stable patients with left
ventricular ejection fraction (LVEF) >40 %, after scheduled CABG. The
association between beta-blocker therapy and the incidence of
cardiovascular events (death, cardiac arrest, myocardial infarction,
revascularizations, angina requiring hospitalization, stroke or
hospitalization for heart failure) or angina that was documented to be due
to underlying ischemia was tested with Cox regression and propensity
adjusted analyses. Results: In total, 1709 patients (76.5 %) were using a
beta-blocker. Patients had excellent control of risk factors; with mean
systolic blood pressure being 121 +/- 14 mmHg, mean LDL cholesterol of 2.8
mmol/l, 59 % of patients received statins and 92 % of patients received
antiplatelet therapy. During a median follow-up of 33 months, beta-blocker
therapy was not associated with a reduction in cardiovascular events
(hazard ratio 0.97; 95 % confidence interval 0.74-1.27), documented angina
(hazard ratio 0.85; 95 % confidence interval 0.61-1.19) or any of the
individual components of the combined endpoint. There were no relevant
interactions for demographics, comorbidities or surgical characteristics.
Propensity matched and time-dependent analyses revealed similar results.
Conclusions: beta-blocker therapy after CABG is not associated with
reductions in angina or cardiovascular events in low-risk patients with
preserved LVEF, and may not be systematically indicated in such patients.
Copyright &#xa9; 2015, The Author(s).

<59>
[Use Link to view the full text]
Accession Number
605594356
Author
Hu F.-B.; Cui L.-Q.
Institution
(Hu, Cui) Department of Cardiology, Provincial Hospital Affiliated,
Shandong University, Jinan, Shandong Province, China
(Hu) Department of Cardiology, Jingjiang People's Hospital, No. 28
Zhongzhou Road, Jingjiang, Jiangsu Province 214500, China
Title
Short-term clinical outcomes after hybrid coronary revascularization
versus off-pump coronary artery bypass for the treatment of multivessel or
left main coronary artery disease: A meta-analysis.
Source
Coronary Artery Disease. 26 (6) (pp 526-534), 2015. Date of Publication:
08 Aug 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background Hybrid coronary revascularization (HCR) and off-pump coronary
artery bypass grafting (OPCABG) are both feasible, less invasive
techniques for coronary revascularization. Although both techniques
utilize the left internal mammary artery to left anterior descending
artery graft, HCR uses drug-eluting stents instead of saphenous vein
bypass. It remains unclear whether HCR is equal to, better or worse than
OPCABG. Methods and results A meta-analysis was carried out using a
random-effects model. Seven observational studies were included. There was
no significant difference either in in-hospital mortality [relative risk
(RR) 0.57, 95% confidence interval (CI) 0.13-2.59, P=0.47] or in the MACCE
rate (RR 0.63, 95% CI 0.24-1.64, P=0.34) between the HCR group and the
OPCABG group. A significant difference was observed between the two groups
in the length of hospitalization (RR 0.55, 95% CI 0.13-0.97, P=0.01),
length of ICU stay (RR 0.45, 95% CI 0.10-0.80, P<0.05), intubation time
(RR 0.48, 95% CI 0.13-0.84, P<0.01), need for red blood transfusion (RR
0.67, 95% CI 0.56-0.82, P<0.001), and total in-hospital costs (RR 0.90,
95% CI 0.39-1.42, P<0.01). Conclusion Compared with OPCABG, HCR did not
improve early survival but decreased the length of hospitalization, length
of ICU stay, intubation time, and need for red blood transfusion, and
increased total in-hospitalcosts.
Copyright &#xa9; 2015 Wolters Kluwer Health, Inc.

<60>
Accession Number
615611016
Author
Auer C.J.; Laferton J.A.C.; Shedden-Mora M.C.; Salzmann S.; Moosdorf R.;
Rief W.
Institution
(Auer, Laferton, Salzmann, Rief) Department of Clinical Psychology and
Psychotherapy, Philipps University of Marburg, Marburg, Germany
(Laferton) Department of Clinical Psychology and Psychotherapy,
Psychologische Hochschule Berlin, Berlin, Germany
(Shedden-Mora) Department of Psychosomatic Medicine and Psychotherapy,
University Medical Center Hamburg-Eppendorf, Hamburg, Germany
(Moosdorf) Clinic for Cardiac and Thoracic Vessel Surgery, Heart Center,
Philipps University of Marburg, Marburg, Germany
Title
Optimizing preoperative expectations leads to a shorter length of hospital
stay in CABG patients: Further results of the randomized controlled
PSY-HEART trial.
Source
Journal of Psychosomatic Research. 97 (pp 82-89), 2017. Date of
Publication: 01 Jun 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective To examine the effect of a preoperative expectation-optimizing
psychological intervention on length of stay in the hospital and time
spent in the Intensive Care Unit (ICU) in patients undergoing elective
cardiac surgery. Methods In a randomized controlled trial, 124 patients
prior to undergoing coronary artery bypass grafting (CABG) or CABG
combined with heart valve surgery were randomized to either a) standard
medical care alone (SMC) or an additional preoperative intervention, b) an
additional expectation manipulation intervention (EXPECT) to optimize
patients' expectations, or c) an additional supportive therapy (SUPPORT),
containing the same amount of therapeutic attention but without a specific
focus. Participants were followed-up post-operatively to assess their
length of hospital stay and the time spent in the ICU. Results Patients in
both psychological intervention groups spent significantly less days in
the hospital then patients in the SMC group (M(EXPECT) = 12.62, M(SUPPORT)
= 14.13, M(SMC) = 17.27, p = 0.028). There was a significant linear trend
(F(1112) = 7.68, p = 0.009) showing that the more specific the
intervention patients received the shorter they stayed in the hospital.
The effect of the intervention on time spent in the ICU was only
marginally significant (M(EXPECT) = 103.76, M(SUPPORT) = 103.10, M(SMC) =
158.45, p = 0.066). Conclusion Changing patients' preoperative
expectations via a psychological intervention leads to less days spent in
the hospital. The psychological interventions are associated with positive
cost-benefit ratios. Specific psychological mechanisms underlying the
effect of our intervention remain unclear and need to be investigated
further. Trial Registration: www.clinicaltrials.gov (NCT01407055).
Copyright &#xa9; 2017

<61>
Accession Number
615417859
Author
Ekizler A.; Aras D.; Cay S.; Ozeke O.; Ozcan F.; Topaloglu S.
Institution
(Ekizler, Aras, Cay, Ozeke, Ozcan, Topaloglu) Division of Cardiology,
Heart Rhythm Service, Kingston General Hospital, Queen's University,
Kingston, ON, Canada
(Ekizler, Aras, Cay, Ozeke, Ozcan, Topaloglu) Department of Mathematics
and Statistics, Queen's University, Kingston, ON, Canada
Title
Bonus vs no bonus cryoballoon isolation for paroxysmal atrial fibrillation
ablation.
Source
Journal of Atrial Fibrillation. 9 (5) (no pagination), 2017. Date of
Publication: February-March 2017.
Publisher
CardioFront LLC (E-mail: editors.office@jafib.com)
Abstract
Aim: To evaluate the benefit of Bonus freeze using second generation
cryoballoon after pulmonary vein isolation (PVI) for paroxysmal atrial
fibrillation (PAF) Methods: A bonus freeze is performed after proven
pulmonary vein isolation (PVI) for cryoballoon ablation of paroxysmal
atrial fibrillation (PAF) as standard. In the current study, no additional
freeze (No Bonus) after PVI was compared with additional freeze (Bonus)
after PVI using second generation cryoballoon. Results: A total of 136
patients (mean age 58 +/- 13 years, 76 male) were included. No Bonus and
Bonus groups had 56 and 80 patients, respectively. Follow-up
electrocardiography and Holter monitoring were performed at 1, 3, 6, 12
months, and biannually thereafter. The PVI rate was similar after the
initial ablation (82% in No Bonus group, 80% in Bonus group, p>0.05) and,
at the end of the procedure (99% in No Bonus group and 99% in Bonus group,
p>0.05). The median procedure and fluoroscopy times in No Bonus group were
67 (60-74) minutes and 13 (10-15) minutes, which were significantly
shorter than the median durations, 85 (76-90) minutes and 17 (15-21)
minutes in Bonus group, respectively (all p<0.001). Phrenic nerve palsy
was observed less frequently in No Bonus group compared to Bonus group (1
patient (2%) vs. 5 patients (6%), respectively) without statistically
significant difference. During a median follow-up of 13 (11-15) months,
the rates of patients free from AF were 82% in No Bonus group and 84% in
Bonus group, respectively (p>0.05). Conclusions: The rate of sinus rhythm
at 18 months was similar in patients with PAF who received bonus
cryoablation vs patients who did not receive bonus cryoablation.

<62>
Accession Number
615608566
Author
Heliczer N.; Gerber V.; Bruckmaier R.; Van Der Kolk J.H.; De Solis C.N.
Institution
(Heliczer, Gerber, Bruckmaier, Van Der Kolk) Swiss Institute of Equine
Medicine, Department of Veterinary Clinical Science and Veterinary
Physiology, Vetsuisse Faculty, University of Bern and Agroscope, Bern
CH-3012, Switzerland
(De Solis) Texas Veterinary Medical Center, Texas A&M University, College
Station, TX 77843, United States
Title
Cardiovascular findings in ponies with equine metabolic syndrome.
Source
Journal of the American Veterinary Medical Association. 250 (9) (pp
1027-1035), 2017. Date of Publication: 01 May 2017.
Publisher
American Veterinary Medical Association (E-mail: avmainfo@avma.org)
Abstract
OBJECTIVE To determine whether hypertension, high sympathetic tone,
resting and exercising arrhythmias, and echocardiographic changes
consistent with hypertensive cardiomyopathy were associated with equine
metabolic syndrome (EMS) in ponies. DESIGN Prospective case-control study.
ANIMALS 19 privately owned ponies with a diagnosis of EMS (history of
laminitis, body condition score > 7/9, cresty neck score > 3/5, and
abnormal oral sugar test result; cases) and 20 healthy control ponies.
PROCEDURES Heart rate (HR), noninvasively measured arterial blood pressure
(BP), markers of autonomic tone (splenic volume and HR variability),
24-hour and exercising ECGs, and echocardiograms were compared between
cases and controls. RESULTS Compared with controls, cases had a higher
mean +/- SD HR (44.5 +/- 7.5 beats/min vs 38.6 +/- 6.8 beats/min) and
median mean left ventricular wall thickness (2.0 cm vs 1.8 cm). No
differences were identified between groups in BP, splenic volume, HR
variability, and number of premature complexes in ECGs. Mean wall
thickness was correlated with BP (r = 0.54), high-frequency power (r =
-0.71), and ratio of low- to high-frequency power (rho = 0.66). Relative
wall thickness was correlated with serum insulin concentration (r = 0.71).
CONCLUSIONS AND CLINICAL RELEVANCE Ponies with EMS had myocardial
hypertrophy that was correlated with insulin response to an oral sugar
test, sympathetic and parasympathetic tone, and BP. The heterogeneity and
limited sample size of this preliminary study should be considered when
drawing conclusions. Cardiovascular changes associated with this syndrome
deserve further attention.
Copyright &#xa9; 2017, American Veterinary Medical Association. All rights
reserved.

<63>
Accession Number
605761051
Author
Radulovic V.; Laffin A.; Hansson K.M.; Backlund E.; Baghaei F.; Jeppsson
A.
Institution
(Radulovic, Baghaei) Department of Medicine/Hematology and Coagulation
Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
(Laffin, Backlund, Jeppsson) Department of Cardiothoracic Surgery,
Sahlgrenska University Hospital, Gothenburg, Sweden
(Hansson) AstraZeneca R AndD, Molndal, Sweden
(Jeppsson) Department of Molecular and Clinical Medicine, Institute of
Medicine, University of Gothenburg, Gothenburg, Sweden
Title
Heparin and protamine titration does not improve haemostasis after cardiac
surgery: A prospective randomized study.
Source
PLoS ONE. 10 (7) (no pagination), 2015. Article Number: e0130271. Date of
Publication: 02 Jul 2015.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: Bleeding complications are common in cardiac surgery.
Perioperative handling of heparin and protamine may influence the
haemostasis. We hypothesized that heparin and protamine dosing based on
individual titration curves would improve haemostasis in comparison to
standard dosing. Subjects and Methods: Sixty patients scheduled for first
time elective coronary artery bypass grafting or valve surgery were
included in a prospective randomized study. The patients were randomized
to heparin and protamine dosing with Hepcon HMS Plus device or to standard
weight and activated clotting time (ACT) based dosing. Blood samples were
collected before and 10 minutes, 2 hours and 4 hours after cardiopulmonary
bypass. Primary endpoint was endogenous thrombin potential in plasma 2
hours after surgery as assessed by calibrated automated thrombography.
Secondary endpoints included total heparin and protamine doses, whole
blood clot formation (thromboelastometry) and post-operative bleeding
volume and transfusions. Heparin effect was assessed by measuring anti-Xa
activity. Results: Endogenous thrombin potential and clot formation
deteriorated in both groups after surgery without statistically
significant intergroup difference. There were no significant differences
between the groups in total heparin and protamine doses, heparin effect,
or postoperative bleeding and transfusions at any time point. Significant
inverse correlations between anti- Xa activity and endogenous thrombin
potential were observed 10 min (r = -0.43, p = 0.001), 2 hours (r = -0.66,
p<0.001) and 4 hours after surgery (r = -0.58, p<0.001). Conclusion: In
conclusion, the results suggest that perioperative heparin and protamine
dosing based on individual titration curves does not improve haemostasis
after cardiac surgery. Postoperative thrombin generation capacity
correlates to residual heparin effect.
Copyright &#xa9; 2015 Radulovic et al.

<64>
Accession Number
611503967
Author
Payne R.E.; Aldwinckle J.; Storrow J.; Kong R.S.; Lewis M.E.
Institution
(Payne) Department of Trauma and Orthopaedic Surgery, University Hospital
Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, United
Kingdom
(Aldwinckle) Department of Cardiology, University Hospital Coventry and
Warwickshire, Coventry, United Kingdom
(Storrow) Intensive Care, Heartlands Hospital, Birmingham, United Kingdom
(Kong, Lewis) Cardiac Surgery, Royal Sussex County Hospital, Brighton,
United Kingdom
Title
RIPC remains a promising technique for protection of the myocardium during
open cardiac surgery: A meta-analysis and systematic review.
Source
Heart Surgery Forum. 18 (2) (pp E74-E80), 2015. Date of Publication: 2015.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Background: Remote ischemic preconditioning (RIPC) is the process of
inducing brief ischemia in a tissue to prevent ischemic damage in another.
This preconditioning can be induced simply by inflating a blood pressure
cuff on a limb. Previous randomized controlled trials (RCT) have suggested
that RIPC may infer myocardial protection during open cardiac surgery. One
method of assessing the degree of myocardial damage incurred in these
studies is to assay troponin concentration. Troponin is a cardiac enzyme
released by damaged myocardiocytes. With the recent publication of several
large RCTs in this area, a meta-analysis of the evidence was undertaken.
Methods: A systematic search of PubMed, EMBASE, and clinicaltrials.gov.uk
was conducted using MeSH terms "ischaemic preconditioning" and "cardiac
surgery." RCTs that examined post-surgery troponin concentrations were
included in this review. The primary outcome investigated was troponin
levels at six hours post-cardiac surgery. Secondary outcomes included six
to eight hour and twenty-four hour troponin release. Results: Thirteen
RCTs, comprising 1398 participants, were identified for inclusion in this
meta-analysis. Twelve hour postoperative troponin was significantly
reduced by RIPC, standardized mean difference 1.29 (95% CI 0.34-2.24). Six
to eight and twenty-four hour troponin were also significantly reduced,
standardized mean differences 1.23 (95% CI 0.62-1.84) and 1.25 (95% CI
0.31-2.19) respectively. Conclusion: The reduction in troponin
concentration suggests that RIPC reduces myocardial damage during open
cardiac surgery, however, the degree of bias in the studies assessed may
have had a significant impact on this result.
Copyright &#xa9; 2015 Forum Multimedia Publishing, LLC.

<65>
Accession Number
603278010
Author
Zhang S.; Wu X.; Guo H.; Ma L.
Institution
(Zhang, Guo, Ma) Department of Anesthesiology, General Hospital of Beijing
Military Region PLA, Beijing 100010, China
(Wu) Department of Anesthesiology, First Hospital, Peking University,
Beijing 100034, China
Title
Thoracic epidural anesthesia improves outcomes in patients undergoing
cardiac surgery: Meta-analysis of randomized controlled trials.
Source
European Journal of Medical Research. 20 (1) (no pagination), 2015.
Article Number: 25. Date of Publication: 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
To assess the efficacy of thoracic epidural anesthesia (TEA) with or
without general anesthesia (GA) versus GA in patients who underwent
cardiac surgery, PubMed, Embase, the Cochrane online database, and Web of
Science were searched with the limit of randomized controlled trials
(RCTs) relevant to 'thoracic epidural anesthesia' and 'cardiac surgery'.
Studies were identified and data were extracted by two reviewers
independently. The quality of included studies was also assessed according
to the Cochrane handbook. Outcomes of mortality, cardiac and respiratory
functions, and treatment-associated complications were pooled and
analyzed. The comprehensive search yielded 2,230 citations, and 25 of them
enrolling 3,062 participants were included according to the inclusion
criteria. Compared with GA alone, patients received TEA and GA showed
reduced risks of death, myocardial infarction, and stroke, though there
were no significant differences (P>0.05). With regard to treatment-related
complications, the pooled results for respiratory complications (risk
ratio (RR), 0.69; 95% CI: 0.51, 0.91, P<0.05), supraventricular
arrhythmias (RR, 0.61; 95% CI: 0.42, 0.87, P<0.05), and pain (mean
difference (MD), -1.27; 95% CI: -2.20, -0.35, P<0.05) were 0.69, 0.61, and
-1.27, respectively. TEA was also associated with significant reduction of
stays in intensive care unit (MD, -2.36; 95% CI: -4.20, -0.52, P<0.05) and
hospital (MD, -1.51; 95% CI: -3.03, 0.02, P>0.05) and time to tracheal
extubation (MD, -2.06; 95% CI:-2.68, -1.45, P<0.05). TEA could reduce the
risk of complications such as supraventricular arrhythmias, stays in
hospital or intensive care unit, and time to tracheal extubation in
patients who experienced cardiac surgery.
Copyright &#xa9; 2015 Zhang et al.; licensee BioMed Central.

<66>
Accession Number
603906647
Author
Liu J.; Li M.; Lu H.; Qiao W.; Xi D.; Luo T.T.; Xiong H.; Guo Z.
Institution
(Liu, Li, Lu, Xi, Luo, Xiong, Guo) Division of Cardiology, Nanfang
Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
(Qiao) Department of Gastroenterology, Nanfang Hospital, Southern Medical
University, Guangzhou, Guangdong 510515, China
Title
Effects of probucol on restenosis after percutaneous coronary intervention
a systematic review and meta-analysis.
Source
PLoS ONE. 10 (4) (no pagination), 2015. Article Number: e0124021. Date of
Publication: 21 Apr 2015.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: Restenosis after percutaneous coronary intervention (PCI) is a
remained clinical problem which limits long-term success of PCI. Although
there was recognition that probucol in treating restenosis after
percutaneous transluminal coronary angioplasty, the efficacy of probucol
on restenosis after stent-implantation is controversial. So this
meta-analysis was conducted to investigate the association between
probucol and late restenosis. Methods: Articles were assessed by four
trained investigators, with divergences resolved by consensus. PubMed,
EMBASE, ScienceDirect and the Cochrane Central Register of clinical trials
were searched for pertinent studies. Inclusion criteria were random
allocated to treatment and a comparison of probucol-treated patients and
control patients (not treated with lipid-lowering drug) undergoing PCI.
Results: Fifteen studies with 859 subjects were analyzed. Major outcome,
binary angiographic restenosis defined as >50% stenosis upon follow-up
angiography, was significantly decreased with probucol treatment (RR =
0.59 [0.43, 0.80] among vessels, P = 0.0007; and RR = 0.52 [0.40, 0.68]
among patients, P<0.00001). Probucol also increased the minimal luminal
diameter (SMD = 0.45 [0.30, 0.61], P< 0.00001) and decreased late loss
upon follow-up after 6 months (SMD = -0.41 [-0.60, -0.22], P<0.0001).
Moreover, there was a significantly lower incidence of major adverse
cardiac events (MACE) in the probucol group than control group (RR = 0.69
[0.51, 0.93], P = 0.01). Conclusion: Probucol is more than a
lipid-lowering drug. It is also effective in reducing the risk of
restenosis and incidence of MACE after PCI.
Copyright &#xa9; 2015 Liu et al.

<67>
Accession Number
615637222
Author
Wetz A.J.; Brauer A.; Quintel M.; Heise D.
Institution
(Wetz, Quintel, Heise) Department of Anesthesiology, Emergency and
Intensive Care Medicine, University of Goettingen, Robert-Koch-Str. 40,
Goettingen, 37075, Germany
(Brauer) Department of Anesthesiology, Emergency and Intensive Care
Medicine, University of Goettingen, Robert-Koch-Str. 40, Goettingen,
37075, Germany. abraeue@gwdg.de
Title
Does sodium bicarbonate infusion really have no effect on the incidence of
acute kidney injury after cardiac surgery? A prospective observational
trial.
Source
Critical care (London, England). 19 (pp 183), 2015. Date of Publication:
22 Apr 2015.
Abstract
INTRODUCTION: Postoperative acute kidney injury (AKI) is a frequently
observed phenomenon after cardiac surgery with cardio-pulmonary bypass
(CPB); this severe complication is associated with adverse patient
outcomes. There are multiple mechanisms involved in AKI during cardiac
surgery, including CPB-dependent hemolysis. An IV infusion of sodium
bicarbonate, which leads to urine alkalization, may play a role in
preventing AKI. Recently, several trials have investigated the effect of
sodium bicarbonate and reported controversial results. The purpose of this
investigation was to investigate the following question. Under what
circumstances can sodium bicarbonate prevent postoperative AKI?
METHODS: We analyzed data from 342 patients undergoing CPB surgery at the
University Hospital Goettingen, Germany. A total of 174 patients received
a preemptive dose of sodium bicarbonate. Directly after the induction of
anesthesia, the continuous infusion of 0.15 mmol/kg body weight/h was
started and continued until 2 pm on the first postoperative day. Patients
who were not treated with sodium bicarbonate formed the control group
(n=168). To verify the AKI risk configuration of each group, we surveyed
risk factors and determined the commonly used clinical predictive score
according to Thakar and colleagues. We recorded the concentration of free
hemoglobin (fhb) to estimate the amount of CPB-dependent hemolysis. The
definition of AKI was acquired by applying the AKI-network (AKIN)
classification over the course of five postoperative days.
RESULTS: Patients who received the sodium bicarbonate infusion showed a
significantly lower incidence (35.6 vs. 50%) of AKI than that of patients
who did not receive the infusion (p=0.01). AKIN levels 2 and 3 were also
more frequent when sodium bicarbonate was not administered. Particularly,
in the low-risk cohort (<3 Thakar points), the incidence of AKI was
significantly reduced (26 vs. 46%) when patients received sodium
bicarbonate (p=0.01), whereas in the high-risk patients, no significant
reduction was observed.
CONCLUSION: In this study, we observed that low-risk patients particularly
benefited from the preventive treatment with sodium bicarbonate. The
incidence of AKI was significantly reduced in low-risk patients while
there was no statistically significant difference in the high-risk patient
cohort.
TRIAL REGISTRATION: DRKS00007616, Registered 12 December 2014.

<68>
Accession Number
615636972
Author
Fiorentino F.; Angelini G.D.; Suleiman M.-S.; Rahman A.; Anderson J.;
Bryan A.J.; Culliford L.A.; Moscarelli M.; Punjabi P.P.; Reeves B.C.
Institution
(Fiorentino, Angelini, Rahman, Anderson, Moscarelli, Punjabi) National
Heart and Lung Institute, Cardiothoracic Surgery Department, Imperial
College London, Du Cane Road, W12 0NN, London, UK
(Angelini, Suleiman, Bryan, Culliford, Reeves) Bristol Heart Institute,
University of Bristol, Bristol Royal Infirmary, Marlborough Street, BS2
8HW, Bristol, UK
Title
Investigating the effect of remote ischaemic preconditioning on biomarkers
of stress and injury-related signalling in patients having isolated
coronary artery bypass grafting or aortic valve replacement using
cardiopulmonary bypass: study protocol for a randomized controlled trial.
Source
Trials. 16 (pp 181), 2015. Date of Publication: 23 Apr 2015.
Abstract
BACKGROUND: Ischaemia-reperfusion injury occurs during heart surgery that
uses cardiopulmonary bypass (CPB) and cardioplegic arrest. It is
hypothesised that remote ischaemic preconditioning (RIPC) protects the
heart against such injury. Despite the numerous studies investigating the
protective effects of RIPC, there is still uncertainty about the
interpretation of the findings as well as conflicting results between
studies. The objective of this trial is to investigate the
cardioprotective effect of RIPC in patients having coronary artery bypass
grafting (CABG) or aortic valve replacement surgery. This will be achieved
by estimating the effect of the intervention in the two groups of
pathologies and by investigating the signalling mechanisms that may
underpin the cardioprotective effect.
METHODS/DESIGN: A two-centre randomised controlled trial will be used to
investigate the effects of RIPC in two pathologies: patients having
isolated CABG and those having aortic valve replacement surgery (AVR) with
CPB. Participants will be randomised to RIPC or control (sham RIPC),
stratified by surgical stratum. The intervention will be delivered by a
research nurse. Data will be collected by a research nurse blinded to the
intervention. The patient and the theatre staff are also blinded to the
allocation. Markers of myocardial injury and inflammation will be measured
in myocardial biopsies and in blood samples at different times.
DISCUSSION: This trial is designed to investigate whether RIPC will reduce
myocardial injury and inflammation following heart surgery and whether
there is a difference in effect between participants having CABG or AVR.
This trial is a unique opportunity to study the mechanisms associated with
RIPC using human myocardial tissue and blood, and to relate these to the
extent of myocardial injury/protection.
TRIAL REGISTRATION: Current Controlled Trials ISRCTN33084113 (25 March
2013).

<69>
Accession Number
615590952
Author
Hasanin A.; Aiyad A.; Elsakka A.; Kamel A.; Fouad R.; Osman M.; Mokhtar
A.; Refaat S.; Hassabelnaby Y.
Institution
(Hasanin, Aiyad, Elsakka, Kamel, Osman, Mokhtar, Refaat, Hassabelnaby)
Cairo University, Department of Anesthesia and Critical Care Medicine,
Cairo, Egypt
(Fouad) Cairo University, Department of Obstetrics and Gynecology, Cairo,
Egypt
Title
Leg elevation decreases the incidence of post-spinal hypotension in
cesarean section: A randomized controlled trial.
Source
BMC Anesthesiology. 17 (1) (no pagination), 2017. Article Number: 60. Date
of Publication: 24 Apr 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Maternal hypotension is a common complication after spinal
anesthesia for cesarean section (CS). In this study we investigated the
role of leg elevation (LE) as a method for prevention of post-spinal
hypotension (PSH) for cesarean section. Methods: One hundred and fifty
full term parturients scheduled for CS were included in the study.
Patients were randomized into two groups: Group LE (leg elevation group,
n=75) and group C (Control group, n=75). Spinal block was performed in
sitting position after administration of 10mL/Kg Ringer's lactate as fluid
preload. After successful intrathecal injection of local anesthetic,
Patients were positioned in the supine position. Leg elevation was
performed for LE group directly after spinal anesthesia and maintained
till skin incision. Intraoperative hemodynamic parameters (Arterial blood
pressure and heart rate), intra-operative ephedrine consumption, incidence
of PSH, and incidence of nausea and vomiting were reported. Results: LE
group showed lower incidence of PSH (34.7% Vs 58.7%, P=0.005) compared to
the control group. Arterial blood pressure was higher in the LE group
compared to the control group in the first two readings after spinal
block. Other readings showed comparable arterial blood pressure and heart
rate values between both study groups; however, LE showed less ephedrine
consumption (4.9+/-7.8mg Vs 10+/-11mg, P=0.001). Conclusion: LE performed
immediately after spinal block reduced the incidence of PSH in parturients
undergoing CS. Trial registration: The study was registered at Pan African
Clinical Trials Registry system on 5/10/2015 with trial number
PACTR201510001295348.
Copyright &#xa9; 2017 The Author(s).

<70>
Accession Number
615579832
Author
Kirmani B.H.; Jones S.G.; Malaisrie S.C.; Chung D.A.; Williams R.J.N.N.
Institution
(Kirmani, Jones, Chung, Williams) Liverpool Heart and Chest Hospital,
Cardiothoracic Surgery, Thomas Drive, Liverpool, Merseyside L14 3PE,
United Kingdom
(Malaisrie) Northwestern University, Division of Cardiac Surgery, 201 E.
Huron Street, Galter 11-140, Chicago, IL 60611, United States
Title
Limited versus full sternotomy for aortic valve replacement.
Source
Cochrane Database of Systematic Reviews. 2017 (4) (no pagination), 2017.
Article Number: CD011793. Date of Publication: 10 Apr 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Aortic valve disease is a common condition that is easily
treatable with cardiac surgery. This is conventionally performed by
opening the sternum longitudinally down the centre ("median sternotomy")
and replacing the valve under cardiopulmonary bypass. Median sternotomy is
generally well tolerated, but as less invasive options have become
available, the efficacy of limited incisions has been called into
question. In particular, the effects of reducing the visibility and
surgical access has raised safety concerns with regards to the placement
of cannulae, venting of the heart, epicardial wire placement, and
de-airing of the heart at the end of the procedure. These difficulties may
increase operating times, affecting outcome. The benefits of smaller
incisions are thought to include decreased pain; improved respiratory
mechanics; reductions in wound infections, bleeding, and need for
transfusion; shorter intensive care stay; better cosmesis; and a quicker
return to normal activity. Objectives: To assess the effects of minimally
invasive aortic valve replacement via a limited sternotomy versus
conventional aortic valve replacement via median sternotomy in people with
aortic valve disease requiring surgical replacement. Search methods: We
performed searches of CENTRAL, MEDLINE, Embase, clinical trials
registries, and manufacturers' websites from inception to July 2016, with
no language limitations. We reviewed references of identified papers to
identify any further studies of relevance. Selection criteria: Randomised
controlled trials comparing aortic valve replacement via a median
sternotomy versus aortic valve replacement via a limited sternotomy. We
excluded trials that performed other minimally invasive incisions such as
mini-thoracotomies, port access, trans-apical, trans-femoral or robotic
procedures. Although some well-conducted prospective and retrospective
case-control and cohort studies exist, these were not included in this
review. Data collection and analysis: Two review authors independently
assessed trial papers to extract data, assess quality, and identify risk
of bias. A third review author provided arbitration where required. The
quality of evidence was determined using the GRADE methodology and results
of patient-relevant outcomes were summarised in a 'Summary of findings'
table. Main results: The review included seven trials with 511
participants. These included adults from centres in Austria, Spain, Italy,
Germany, France, and Egypt. We performed 12 comparisons investigating the
effects of minimally invasive limited upper hemi-sternotomy on aortic
valve replacement as compared to surgery performed via full median
sternotomy. There was no evidence of any effect of upper hemi-sternotomy
on mortality versus full median sternotomy (risk ratio (RR) 1.01, 95%
confidence interval (CI) 0.36 to 2.82; participants = 511; studies = 7;
moderate quality). There was no evidence of an increase in cardiopulmonary
bypass time with aortic valve replacement performed via an upper
hemi-sternotomy (mean difference (MD) 3.02 minutes, 95% CI -4.10 to 10.14;
participants = 311; studies = 5; low quality). There was no evidence of an
increase in aortic cross-clamp time (MD 0.95 minutes, 95% CI -3.45 to
5.35; participants = 391; studies = 6; low quality). None of the included
studies reported major adverse cardiac and cerebrovascular events as a
composite end point. There was no evidence of an effect on length of
hospital stay through limited hemi-sternotomy (MD -1.31 days, 95% CI -2.63
to 0.01; participants = 297; studies = 5; I² = 89%; very low
quality). Postoperative blood loss was lower in the upper hemi-sternotomy
group (MD -158.00 mL, 95% CI -303.24 to -12.76; participants = 297;
studies = 5; moderate quality). The evidence did not support a reduction
in deep sternal wound infections (RR 0.71, 95% CI 0.22 to 2.30;
participants = 511; studies = 7; moderate quality) or re-exploration (RR
1.01, 95% CI 0.48 to 2.13; participants = 511; studies = 7; moderate
quality). There was no change in pain scores by upper hemi-sternotomy
(standardised mean difference (SMD) -0.33, 95% CI -0.85 to 0.20;
participants = 197; studies = 3; I² = 70%; very low quality),
but there was a small increase in postoperative pulmonary function tests
with minimally invasive limited sternotomy (MD 1.98 % predicted FEV1, 95%
CI 0.62 to 3.33; participants = 257; studies = 4; I² = 28%; low
quality). There was a small reduction in length of intensive care unit
stays as a result of the minimally invasive upper hemi-sternotomy (MD
-0.57 days, 95% CI -0.93 to -0.20; participants = 297; studies = 5; low
quality). Postoperative atrial fibrillation was not reduced with minimally
invasive aortic valve replacement through limited compared to full
sternotomy (RR 0.60, 95% CI 0.07 to 4.89; participants = 240; studies = 3;
moderate quality), neither were postoperative ventilation times (MD -1.12
hours, 95% CI -3.43 to 1.19; participants = 297; studies = 5; low
quality). None of the included studies reported cost analyses. Authors'
conclusions: The evidence in this review was assessed as generally low to
moderate quality. The study sample sizes were small and underpowered to
demonstrate differences in outcomes with low event rates. Clinical
heterogeneity both between and within studies is a relatively fixed
feature of surgical trials, and this also contributed to the need for
caution in interpreting results. Considering these limitations, there was
uncertainty of the effect on mortality or extracorporeal support times
with upper hemi-sternotomy for aortic valve replacement compared to full
median sternotomy. The evidence to support a reduction in total hospital
length of stay or intensive care stay was low in quality. There was also
uncertainty of any difference in the rates of other, secondary outcome
measures or adverse events with minimally invasive limited sternotomy
approaches to aortic valve replacement. There appears to be uncertainty
between minimally invasive aortic valve replacement via upper
hemi-sternotomy and conventional aortic valve replacement via a full
median sternotomy. Before widespread adoption of the minimally invasive
approach can be recommended, there is a need for a well-designed and
adequately powered prospective randomised controlled trial. Such a study
would benefit from performing a robust cost analysis. Growing patient
preference for minimally invasive techniques merits thorough
quality-of-life analyses to be included as end points, as well as
quantitative measures of physiological reserve.
Copyright &#xa9; 2017 The Cochrane Collaboration. Published by John Wiley
& Sons, Ltd.

<71>
Accession Number
615665749
Author
Afilalo J.
Institution
(Afilalo) 1Centre for Clinical Epidemiology, Lady Davis Institute;
2Division of Cardiology, Jewish General Hospital, McGill University,
Montreal, QC
Title
The Clinical Frailty Scale: Upgrade Your Eyeball Test.
Source
Circulation. (no pagination), 2017. Date of Publication: 20 Apr 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
With the emergence of transcatheter aortic valve replacement (TAVR) as a
therapeutic option to treat high-risk older adults suffering from aortic
stenosis, the geriatric concept of frailty has assumed mainstream
relevance for cardiovascular practitioners. We have eagerly adopted tools
to objectify the definition of frailty and accordingly discern good and
bad candidates among a pool of complex octogenarians with multiple chronic
conditions - a daunting yet mission-critical task. Initial studies
published during the first half of this decade revealed that frailty
status was one of the top predictors of mid-term mortality and incident
disability after TAVR, leading to its integration in clinical care
pathways and predictive risk models. The encouraging findings from small
single-center studies are now being validated in larger multi-center
registries and trials, affirming the strengths and uncovering the
limitations of various frailty assessment tools.
Copyright &#xa9; 2017 by the American College of Cardiology Foundation and
the American Heart Association, Inc.

<72>
Accession Number
615665559
Author
Palermo J.; Dart A.B.; de Mello A.; Devarajan P.; Gottesman R.; Garcia
Guerra G.; Hansen G.; Joffe A.R.; Mammen C.; Majesic N.; Morgan C.;
Skippen P.; Pizzi M.; Palijan A.; Zappitelli M.
Institution
(Palermo) 1Divisions of Nephrology and Pediatric Critical Care Medicine,
Department of Pediatrics, Montreal Children's Hospital, McGill University
Health Centre, Montreal, Quebec, Canada. 2Section of Nephrology,
Department of Pediatrics and Child Health, University of Manitoba,
Winnipeg, Manitoba, Canada 3British Columbia Children's Hospital, Division
of Nephrology, University of British Columbia, Vancouver, BC, Canada.
4Nephrology and Hypertension, Cincinnati Children's Hospital Medical
Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
5Department of Pediatrics, University of Alberta, Women and Children's
Health Research Institute, Edmonton, AL, Canada. 6Section of Pediatric
Intensive Care, Department of Pediatrics and Child Health, University
Title
Biomarkers for Early Acute Kidney Injury Diagnosis and Severity
Prediction: A Pilot Multicenter Canadian Study of Children Admitted to the
ICU.
Source
Pediatric Critical Care Medicine. (no pagination), 2017. Date of
Publication: 20 Apr 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
OBJECTIVE:: Acute kidney injury occurs early in PICU admission and
increases risks for poor outcomes. We evaluated the feasibility of a
multicenter acute kidney injury biomarker urine collection protocol and
measured diagnostic characteristics of urine neutrophil
gelatinase-associated lipocalin, interleukin-18, and liver fatty acid
binding protein to predict acute kidney injury and prolonged acute kidney
injury. DESIGN:: Prospective observational pilot cohort study. SETTING::
Four Canadian tertiary healthcare PICUs. PATIENTS:: Eighty-one children 1
month to 18 years old. Exclusion criteria were as follows: cardiac
surgery, baseline severe kidney disease, and inadequate urine or serum for
PICU days 1-3. INTERVENTIONS:: PICUs performed standardized urine
collection protocol to obtain early PICU admission urine samples, with
deferred consent. MEASUREMENTS AND MAIN RESULTS:: Study barriers and
facilitators were recorded. Acute kidney injury was defined based on
Kidney Disease: Improving Global Outcomes serum creatinine criteria (acute
kidney injuryserum creatinine) and by serum creatinine and urine output
criteria (acute kidney injuryserum creatinine+urine output) Prolonged
acute kidney injury was defined as acute kidney injury duration of 48
hours or more. PICU days 1-3 neutrophil gelatinase-associated lipocalin,
interleukin-18, and liver fatty acid binding protein were evaluated for
acute kidney injury prediction (area under the curve). Biomarkers on the
first day of acute kidney injury attainment (day 1 acute kidney injury)
were evaluated for predicting prolonged acute kidney injury. Eighty-two to
95% of subjects had urine collected from PICU days 1-3. Acute kidney
injuryserum creatinine developed in 16 subjects (20%); acute kidney
injuryserum creatinine+urine outputdeveloped in 38 (47%). On PICU day 1,
interleukin-18 predicted acute kidney injuryserum creatinine with area
under the curve=0.82, but neutrophil gelatinase-associated lipocalin and
liver fatty acid binding protein predicted acute kidney injuryserum
creatinine with area under the curve of less than or equal to 0.69; on
PICU day 2, area under the curve was higher (not shown). Interleukin-18
and liver fatty acid binding protein on day 1 acute kidney injury
predicted prolonged acute kidney injuryserum creatinine (area under the
curve=0.74 and 0.83, respectively). When acute kidney injuryserum
creatinine+urine output was used to define acute kidney injury, biomarker
area under the curves were globally lower. CONCLUSIONS:: Protocol urine
collection to procure early admission samples is feasible. Individual
biomarker acute kidney injury prediction performance is highly variable
and modest. Larger studies should evaluate utility and cost effectiveness
of using early acute kidney injury biomarkers.
Copyright &#xa9;2017The Society of Critical Care Medicine and the World
Federation of Pediatric Intensive and Critical Care Societies

<73>
Accession Number
615665338
Author
Shimura T.; Yamamoto M.; Kano S.; Kagase A.; Kodama A.; Koyama Y.;
Tsuchikane E.; Suzuki T.; Otsuka T.; Kohsaka S.; Tada N.; Yamanaka F.;
Naganuma T.; Araki M.; Shirai S.; Watanabe Y.; Hayashida K.
Institution
(Shimura) 1Department of Cardiology, Toyohashi Heart Center, Toyohashi,
Japan; 2Department of Cardiology, Nagoya Heart Center, Nagoya, Japan;
3Department of Hygiene and Public Health, Nippon Medical School, Tokyo,
Japan; 4Center for Clinical Research, Nippon Medical School Hospital,
Tokyo, Japan; 5Department of Cardiology, Keio University School of
Medicine, Tokyo, Japan; 6Department of Cardiology, Sendai Kousei Hospital,
Sendai, Japan; 7Department of Cardiology, Shonan Kamakura General
Hospital, Kamakura, Japan; 8Department of Cardiology, New Tokyo Hospital,
Chiba, Japan; 9Department of Cardiology, Saiseikai Yokohama City Eastern
Hospital, Yokohama, Japan; 10Department of Cardiology, Kokura Memorial
Hospital, Kokura, Japan; 11Department of Cardiology, Teikyo University
School of Medicine, Tokyo, Ja
Title
Impact of the Clinical Frailty Scale on Outcomes After Transcatheter
Aortic Valve Replacement.
Source
Circulation. (no pagination), 2017. Date of Publication: 20 Apr 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND-: The semi-quantitative clinical frailty scale (CFS) is a
simple tool to assess patient's frailty and has been shown to correlate
with mortality in elderly patients even when evaluated by
non-geriatricians. The aim of the current study was to determine the
prognostic value of CFS in patients who underwent transcatheter aortic
valve replacement (TAVR). METHODS-: We utilized the Optimized CathEter
vAlvular iNtervention (OCEAN) Japanese multicenter registry to review data
of 1215 patients who underwent TAVR. Patients were categorized into 5
groups based on the CFS stages: CFS1-3, CFS4, CFS5, CFS6, and CFS>7. We
subsequently evaluated the relationship between CFS grading and other
indicators of frailty including body mass index (BMI), serum albumin, gait
speed, and mean hand grip. We also assessed differences in baseline
characteristics, procedural outcomes, and early and mid-term mortality
among the 5 groups. RESULTS-: Patient distribution into the 5 CFS groups
was as follows: 38.0% (CFS1-3), 32.9% (CFS4), 15.1% (CFS5), 10.0% (CFS6),
and 4.0% (CFS>7). The CFS grade showed significant correlation with BMI
(Spearman's rho=-0.077, p=0.007), albumin (rho=-0.22, p<0.001), gait speed
(rho=-0.28, p<0.001), and grip strength (rho=-0.26, p<0.001). Cumulative
1-year mortality increased with increasing CFS stage (7.2%, 8.6%. 15.7%,
16.9%, 44.1%, p<0.001). In a Cox regression multivariate analysis, the CFS
(per 1 category increase) was an independent predictive factor of
increased late cumulative mortality risk (hazard ratio: 1.28; 95%
confidence interval: 1.10-1.49; p<0.001). CONCLUSIONS-: In addition to
reflecting the degree of frailty, the CFS was a useful marker for
predicting late mortality in an elderly TAVR cohort.
Copyright &#xa9; 2017 by the American College of Cardiology Foundation and
the American Heart Association, Inc.

<74>
Accession Number
609835087
Author
Keyl C.; Schneider J.; Beyersdorf F.; Ruile P.; Siepe M.; Pioch K.;
Schneider R.; Jander N.
Institution
(Keyl, Pioch) Department of Anesthesiology, Heart Center Freiburg
University, Bad Krozingen, Germany
(Schneider, Ruile, Schneider, Jander) Department of Cardiology and
Angiology II, Heart Center Freiburg University, Bad Krozingen, Germany
(Beyersdorf, Siepe) Department of Cardiovascular Surgery, Heart Center
Freiburg University, Bad Krozingen, Germany
Title
Right ventricular function after aortic valve replacement: A pilot study
comparing surgical and transcatheter procedures using 3D echocardiography.
Source
European Journal of Cardio-thoracic Surgery. 49 (3) (pp 966-971), 2016.
Date of Publication: 01 Mar 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Previous studies have found that standard echocardiographic
measures of right ventricular (RV) function were impaired after surgical
replacement of the aortic valve (SAVR), but not after transcatheter aortic
valve implantation (TAVI). We used 3D echocardiography to gain further
insight into the changes of RV performance in patient undergoing SAVR or
TAVI. METHODS: We conducted a prospective non-randomized study with two
parallel groups and performed echocardiographic evaluation in 20 patients
with aortic stenosis undergoing SAVR (age 77 +/- 4 years), and in 20
patients undergoing TAVI via the transfemoral approach (age 83 +/- 6
years) 1 week before and between the fifth and seventh day after the
procedure. RESULTS: Tricuspid annular plane systolic excursion was
postoperatively markedly reduced in patients undergoing SAVR (13 +/- 2 vs
26 +/- 4 mm, post- vs preoperative, P < 0.001), but not in patients
undergoing TAVI (24 +/- 7 vs 24 +/- 5 mm, P = 0.90). Fractional shortening
of the RV midcavity transverse diameter, however, increased after SAVR (50
+/- 8 vs 31 +/- 11%, P < 0.001) in contrast to TAVI (33 +/- 10 vs 34 +/-
9%, P = 0.85). The RV ejection fraction, assessed by 3D echocardiography,
remained unchanged in both patient groups (SAVR, 55 +/- 6 vs 55 +/- 7%, P
= 0.52; TAVI, 56 +/- 8 vs 54 +/- 7%, P = 0.28). CONCLUSIONS: RV
longitudinal contraction decreased after SAVR, whereas RV transverse
contraction increased. Both parameters did not change after TAVI. RV
ejection fraction and RV stroke volume remained constant irrespective of
the technique of aortic valve replacement, thus indicating that global
systolic RV function is not compromised after SAVR.
Copyright &#xa9; The Author 2015. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<75>
Accession Number
608909645
Author
Iafrancesco M.; Ranasinghe A.M.; Dronavalli V.; Adam D.J.; Claridge M.W.;
Riley P.; McCafferty I.; Mascaro J.G.
Institution
(Iafrancesco, Ranasinghe, Dronavalli, Adam, Claridge, Mascaro) Department
of Cardiothoracic Surgery/Thoracic Aortic Multidisciplinary Team, Queen
Elizabeth University Hospital, NHS Foundation Trust, Birmingham, United
Kingdom
(Iafrancesco, Adam, Claridge) Vascular Surgery Department, Thoracic Aortic
Multidisciplinary Team, Heart of England NHS Foundation Trust, Birmingham,
United Kingdom
(Riley, McCafferty) Department of Interventional Radiology/Thoracic Aortic
Multidisciplinary Team, Queen Elizabeth University Hospital, NHS
Foundation Trust, Birmingham, United Kingdom
Title
Open aortic arch replacement in high-risk patients: The gold standard.
Source
European Journal of Cardio-thoracic Surgery. 49 (2) (pp 646-651), 2016.
Article Number: ezv149. Date of Publication: 01 Feb 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Open total aortic arch replacement (TAR) in high-risk patients
is considered by some to be associated with a prohibitively perioperative
risk. Recent reports describe hybrid techniques to treat this group. We
reviewed our outcomes of open surgery in a 'high-risk' group of patients.
METHODS: All patients who underwent open TAR between 2000 and 2013 were
identified from our prospectively maintained database. Patients comparable
with the ones who underwent hybrid repair in previous studies (logistic
EuroSCORE between 20 and 60 without intervention on the aortic root or on
the mitral/tricuspid valve) were selected for analysis. RESULTS:
Fifty-eight patients were identified. Median logistic EuroSCORE was 27.4
(range 20-57) and median age was 76 years (34.5% male). There were 11
resternotomies (18.9%) and 20 procedures were urgent/emergency (34.5%).
Preoperative comorbidities included chronic obstructive pulmonary disease
(31%), coronary artery disease (22.4%), peripheral vascular disease
(48.3%), previous stroke (5.2%), previous myocardial infarction (3.4%) and
left ventricular dysfunction (12%). Concomitant procedures included aortic
valve replacement/resuspension (58.7%), coronary artery bypass grafting
(22.4%), open descending aorta replacement (10.3%) and frozen elephant
trunk (19%). Overall in-hospital mortality, permanent stroke and spinal
cord injury rate were 6.9, 1.7 and 0%, respectively. There were no deaths
or stroke in the elective group. One-year, 5-year and 10-year estimates of
survival were 82.7, 70.0 and 37.8%, respectively. CONCLUSIONS: Open TAR
can be performed with low mortality and morbidity and excellent long-term
results even in high-risk patients. Total endovascular repair may
represent an option for patients not suitable for open surgery.
Copyright &#xa9; The Author 2015. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<76>
Accession Number
608909637
Author
Lang P.; Manickavasagar M.; Burdett C.; Treasure T.; Fiorentino F.; Barua
A.; Batchelor T.; Fewtrell J.; Fitzmaurice G.; Eaton D.; Froeschle P.;
Ghosh-Dastidar M.; Jenvey L.; Khan H.; Kirk A.; Lim E.; Lobo T.; McManus
K.; Mitchell J.; Mohamed T.; Naidu B.; Page R.; Powell A.-M.; Pullinger
D.; Slight R.; Tideswell J.; Viviano A.; Wren M.; Zeinah M.
Institution
(Lang, Manickavasagar) Department of Cardiac Surgery, Brighton and Sussex
University Hospitals NHS Trust, Brighton, United Kingdom
(Burdett) Cambridge Centre for Cardiovascular Research Excellence,
Cambridge, United Kingdom
(Treasure) Clinical Operational Research Unit, University College London,
London, United Kingdom
(Fiorentino) Department of Cardiothoracic Surgery, National Heart and Lung
Institute, Imperial College London, London, United Kingdom
Title
Suction on chest drains following lung resection: Evidence and practice
are not aligned.
Source
European Journal of Cardio-thoracic Surgery. 49 (2) (pp 611-616), 2016.
Article Number: ezv133. Date of Publication: 01 Feb 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: A best evidence topic in Interactive CardioVascular and
Thoracic Surgery (2006) looked at application of suction to chest drains
following pulmonary lobectomy. After screening 391 papers, the authors
analysed six studies (five randomized controlled trials [RCTs]) and found
no evidence in favour of postoperative suction in terms of air leak
duration, time to chest drain removal or length of stay. Indeed, suction
was found to be detrimental in four studies. We sought to determine
whether clinical practice is consistent with published evidence by
surveying thoracic units nationally and performing a meta-analysis of
current best evidence. METHODS: We systematically searched MEDLINE, EMBASE
and CENTRAL for RCTs, comparing outcomes with and without application of
suction to chest drains after lung surgery. A meta-analysis was performed
using RevMan. &#xa9; software. A questionnaire concerning chest drain
management and suction use was emailed to a clinical representative in
every thoracic unit. RESULTS: Eight RCTs, published 2001-13, with 31-500
participants, were suitable for meta-analysis. Suction prolonged length of
stay (weighted mean difference [WMD] 1.74 days; 95% confidence interval
[CI] 1.17-2.30), chest tube duration (WMD 1.77 days; 95% CI 1.47-2.07) and
air leak duration (WMD 1.47 days; 95% CI 1.45-2.03). There was no
difference in occurrence of prolonged air leak. Suction was associated
with fewer instances of postoperative pneumothorax. Twenty-five of 39
thoracic units responded to the national survey. Suction is routinely used
by all surgeons in 11 units, not by any surgeon in 5 and by some surgeons
in 9. Of the 91 surgeons represented, 62 (68%) routinely used suction.
Electronic drains are used in 15 units, 10 of which use them routinely.
Conclusions: Application of suction to chest drains following
non-pneumonectomy lung resection is common practice. Suction has an effect
in hastening the removal of air and fluid in clinical experience but a
policy of suction after lung resection has not been shown to offer
improved clinical outcomes. Clinical practice is not aligned with Level 1a
evidence.
Copyright &#xa9; The Author 2015. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<77>
Accession Number
608909559
Author
Singh A.; Schaff H.V.; Mori Brooks M.; Hlatky M.A.; Wisniewski S.R.; Frye
R.L.; Sako E.Y.
Institution
(Singh, Mori Brooks, Wisniewski) Department of Epidemiology, University of
Pittsburgh, Pittsburgh, PA, United States
(Schaff) Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN,
United States
(Hlatky) Department of Health Research and Policy, Stanford University,
School of Medicine, Stanford, CA, United States
(Frye) Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN,
United States
(Sako) Department of Cardiothoracic Surgery, University of Texas, Health
Science Center at San Antonio, San Antonio, TX, United States
Title
On-pump versus off-pump coronary artery bypass graft surgery among
patients with type 2 diabetes in the bypass angioplasty revascularization
investigation 2 diabetes trial.
Source
European Journal of Cardio-thoracic Surgery. 49 (2) (pp 406-416), 2016.
Article Number: ezv170. Date of Publication: 01 Feb 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Conclusive evidence is lacking regarding the benefits and
risks of performing off-pump versus on-pump coronary artery bypass graft
(CABG) for patients with diabetes. This study aims to compare clinical
outcomes after off-pump and on-pump procedures for patients with diabetes.
METHODS: The Bypass Angioplasty Revascularization Investigation 2 Diabetes
(BARI 2D) trial enrolled patients with type 2 diabetes and documented
coronary artery disease, 615 of whom underwent CABG during the trial. The
procedural complications, 30-day outcomes, long-term clinical and
functional outcomes were compared between the off-pump and on-pump groups
overall and within a subset of patients matched on propensity score.
RESULTS: On-pump CABG was performed in 444 (72%) patients, and off-pump
CABG in 171 (28%). The unadjusted 30-day rate of death/myocardial
infarction (MI)/stroke was significantly higher after off-pump CABG (7.0
vs 2.9%, P = 0.02) despite fewer complications (10.3 vs 20.7%, P = 0.003).
The long-term risk of death [adjusted hazard ratio (aHR): 1.41, P =
0.2197] and major cardiovascular events (death, MI or stroke) (aHR: 1.47,
P = 0.1061) did not differ statistically between the off-pump and on-pump
patients. Within the propensity-matched sample (153 pairs), patients who
underwent off-pump CABG had a higher risk of the composite outcome of
death, MI or stroke (aHR: 1.83, P = 0.046); the rates of procedural
complications and death did not differ significantly, and there were no
significant differences in the functional outcomes. CONCLUSIONS: Patients
with diabetes had greater risk of major cardiovascular events long-term
after off-pump CABG than after on-pump CABG.
Copyright &#xa9; The Author 2015. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<78>
Accession Number
606562996
Author
Redeker N.S.; Jeon S.; Andrews L.; Cline J.; Jacoby D.; Mohsenin V.
Institution
(Redeker, Jeon, Andrews) Yale University School of Nursing, PO Box 27399,
West Haven, CT 06516-7399, United States
(Cline, Jacoby, Mohsenin) Yale University School of Medicine, New Haven,
CT, United States
Title
Feasibility and efficacy of a self-management intervention for insomnia in
stable heart failure.
Source
Journal of Clinical Sleep Medicine. 11 (10) (pp 1109-1119), 2015. Date of
Publication: 2015.
Publisher
American Academy of Sleep Medicine (2510 N. Frontage Road, Darien IL
60561, United States)
Abstract
Background: Chronic insomnia is common among patients with heart failure
(HF) and may contribute to fatigue and poor function. However, to date
there have been no randomized controlled trials focused on treatment of
insomnia or daytime symptoms in this population. Objective: The purpose of
this study was to examine the preliminary effi cacy, feasibility, and
acceptability of a selfmanagement intervention (cognitive behavioral
therapy [CBT-I]) for insomnia among patients with stable HF. Methods: We
conducted a pilot randomized controlled trial (RCT) in which patients with
stable Class I-III HF (n = 25/52.1% women; mean age = 59 +/- 14.8 years)
were randomized in groups to CBT-I (n = 29) or an attention control
condition (HF self-management with sleep hygiene; n = 19). Participants
completed 2 weeks of wrist actigraphy, the insomnia severity index, and
measures of fatigue, depression, sleepiness, and functional performance at
baseline and follow-up. We computed the size of the effects on the
dependent variables and used MANOVA to evaluate the effects of CBT-I on
insomnia and fatigue. Results: CBT-I was feasible and acceptable and had a
statistically signifi cant effect on insomnia and fatigue, while
controlling for the effects of comorbidity and age. Conclusions: CBT-I has
short-term effi cacy as a treatment for chronic insomnia among patients
with stable HF. Future studies are needed to address its sustained
effects.

<79>
Accession Number
604230394
Author
Tan Q.; Wang Q.; Liu D.; Zhang S.; Zhang Y.; Li Y.
Institution
(Tan, Wang, Liu, Zhang, Zhang, Li) Department of Cardiology, Qinhuangdao
First Hospital, Hebei Medical University, Qinhuangdao, Hebei, China
Title
Intravascular ultrasound-guided unprotected left main coronary artery
stenting in the elderly.
Source
Saudi Medical Journal. 36 (5) (pp 549-553), 2015. Date of Publication:
2015.
Publisher
Saudi Arabian Armed Forces Hospital (E-mail: smjns.ksa@zajil.net)
Abstract
Objectives: To investigate whether intravascular ultrasound (IVUS) guided
percutaneous coronary intervention (PCI) could improve clinical outcomes
compared with angiography-guided PCI in the treatment of unprotected left
main coronary artery stenosis (ULMCA) in the elderly. Methods: This
controlled study was carried out between October 2009 and September 2012,
in Qinhuangdao First Hospital, Hebei Province, China. One hundred and
twenty-three consecutive patients with ULMCA, aged 70 or older, were
randomized to an IVUS-guided group and a control group. The occurrence of
major adverse cardiac events (MACE): death, non-fatal myocardial
infarction, or target lesion revascularizations) were recorded after 2
years of follow-up. Results: The IVUS-guided group had a lower rate of
2-year MACE than the control group (13.1% versus 29.3%, p=0.031). The
incidence of target lesion revascularization was lower in the IVUS-guided
group than in the control group (9.1% versus 24%, p=0.045). However, there
were no differences in death and myocardial infarction in the 2 groups. On
Cox proportional hazard analysis, distal lesion was the independent
predictor of MACE (hazard ratio [HR]: 1.99, confidence interval [CI]:
1.129-2.367; p=0.043); IVUS guidance was independent factor of survival
free of MACE (HR: 0.414, CI: 0.129-0.867; p=0.033). Conclusion: The use of
IVUS could reduce MACE in elderly patients undergoing ULMCA intervention.
Copyright &#xa9; 2015, Saudi Arabian Armed Forces Hospital. All rights
reserved.

<80>
Accession Number
603580668
Author
Xie Y.; Shen S.; Zhang J.; Wang W.; Zheng J.
Institution
(Xie) Department of Cardiothoracic surgery, Zhejiang Provincial People's
Hospital, Hangzhou, Zhejiang, China
(Shen, Wang) Department of Anesthesiology, Zhejiang Provincial People's
Hospital, Hangzhou, Zhejiang, China
(Zhang) Department of Orthopedics, Zhejiang Provincial People's Hospital,
Hangzhou, Zhejiang, China
(Zheng) Department of Probability and Statistics, School of Mathematical
Sciences, Beijing University, Beijing, China
Title
The efficacy, safety and cost-effectiveness of intra-operative cell
salvage in high-bleeding-risk cardiac surgery with cardiopulmonary bypass:
A prospective randomized and controlled trial.
Source
International Journal of Medical Sciences. 12 (4) (pp 322-328), 2015. Date
of Publication: 01 Apr 2015.
Publisher
Ivyspring International Publisher (E-mail: info@ivyspring.com)
Abstract
Objective: Intra-operative cell salvage (CS) was reported to be
ineffective, safe and not cost-effective in low-bleeding-risk cardiac
surgery with cardiopulmonary bypass (CPB), but studies in
high-bleeding-risk cardiac surgery are limited. The objective of this
study is to evaluate the efficacy, safety and cost-effectiveness of
intra-operative CS in high-bleeding-risk cardiac surgery with CPB.
Methods: One hundred and fifty patients were randomly assigned to either
with intra-operative CS group (Group CS) or without intra-operative CS
group (Group C). Study endpoints were defined as perioperative allogeneic
red blood cell (RBC) transfusion, perioperative impairment of blood
coagulative function, postoperative adverse events and costs of
transfusion-related. Results: Both the proportion and quantity of
perioperative allogeneic RBC transfusion were significantly lower in Group
CS than that in Group C (p=0.0002, <0.0001, respectively). The incidence
of residual heparin and total impairment of blood coagulative function in
the 24 hours after surgery, the incidence of postoperative excessive
bleeding, were significantly higher in Group CS than that in Group C
(p=0.018, 0.042, 0.034, respectively). Cost of both allogeneic RBC
transfusion and total allogeneic blood transfusion were significantly
lower in Group CS than that in Group C (p<0.001, =0.002, respectively).
Cost of total blood transfusion was significantly higher in Group CS than
that in Group C (p =0.001). Conclusion: Intra-operative CS in
high-bleeding-risk cardiac surgery with CPB is effective, generally safe,
and cost-effective in developed countries but not in China.
Copyright &#xa9; 2015 Ivyspring International Publisher.

<81>
Accession Number
603966381
Author
Florkiewicz P.; Musialowicz T.; Pitkanen O.; Lahtinen P.
Institution
(Florkiewicz, Musialowicz, Pitkanen, Lahtinen) Department of
Anesthesiology, Kuopio University Hospital, PL 100, Kuopio FI 70029,
Finland
Title
The effect of two different doses of remifentanil on postoperative pain
and opioid consumption after cardiac surgery - A randomized controlled
trial.
Source
Acta Anaesthesiologica Scandinavica. 59 (8) (pp 999-1008), 2015. Date of
Publication: 01 Sep 2015.
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background Remifentanil, an ultra-short-acting opioid, provides intensive
analgesia without prolonged respiratory depression and is widely used in
cardiac surgery. Diminished dosing may also offer stable hemodynamics,
even during sternotomy and sternal retraction. However, increased
postoperative pain and induced opioid tolerance after remifentanil dosing
during abdominal surgery was reported. We tested whether remifentanil 0.3
mug/kg/min infusion increased postoperative opioid consumption and pain
compared to 0.1 mug/kg/min dosing. Methods Ninety coronary artery bypass
grafting or heart valve surgery patients were randomized to remifentanil
0.1 mug/kg/min or 0.3 mug/kg/min infusions during surgery. All patients
received oxycodone bolus 0.15 mug/kg postoperatively, and
patient-controlled analgesia (PCA) with oxycodone thereafter.
Postoperative pain was estimated thrice daily by visual analogue scale,
and 48-h opioid consumption was recorded from the PCA-device. Results
Total remifentanil dosing was 64 mug/kg in the higher and 22 mug/kg in the
lower dosing group during the 3-h cardiac operations. Mean postoperative
opioid consumption was 107 (SD 36) mg in the lower and 104 (SD 33) mg in
the higher dose remifentanil groups. Postoperative pain did not differ
between groups, at rest or during deep breathing, at any time (P = 0.110
and 0.941, respectively). Conclusions Remifentanil 0.3 mug/kg/min infusion
did not increase postoperative pain or opioid consumption after cardiac
surgery compared to the 0.1 mug/kg/min infusion. Remifentanil infusion
0.1-0.3 mug/kg/min during cardiac surgery was safe, with no exaggerated
postoperative pain or opioid consumption.
Copyright &#xa9; 2015 The Acta Anaesthesiologica Scandinavica Foundation.
Published by John Wiley & Sons Ltd.

<82>
Accession Number
52963464
Author
Al Shehri A.M.; El-Tahan M.R.; Al Metwally R.; Qutub H.; El Ghoneimy Y.F.;
Regal M.A.; Zien H.
Institution
(Al Shehri) Department of Cardiology, King Fahd Hospital, University of
Dammam, Al Khubar, Saudi Arabia
(El-Tahan, Al Metwally, Zien) Department of Anaesthesia and Surgical ICU,
King Fahd Hospital, University of Dammam, Al Khubar, Saudi Arabia
(Qutub) Department of Pulmonology and Intensive Care Unit, King Fahd
Hospital, University of Dammam, Al Khubar, Saudi Arabia
(El Ghoneimy, Regal) Cardiothoracic Surgery, King Fahd Hospital,
University of Dammam, Al Khubar, Saudi Arabia
Title
Right ventricular function during one-lung ventilation: Effects of
pressure-controlled and volume-controlled ventilation.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 28 (4) (pp 892-896),
2014. Date of Publication: 01 Aug 2014.
Publisher
W.B. Saunders
Abstract
Objectives To test the effects of pressure-controlled (PCV) and
volume-controlled (VCV) ventilation during one-lung ventilation (OLV) for
thoracic surgery on right ventricular (RV) function. Design A prospective,
randomized, double-blind, controlled, crossover study. Setting A single
university hospital. Participants Fourteen pairs of consecutive patients
scheduled for elective thoracotomy. Interventions Patients were assigned
randomly to ventilate the dependent lung with PCV or VCV mode, each in a
randomized crossover order using tidal volume of 6 mL/kg, I: E ratio 1:
2.5, positive end-expiratory pressure (PEEP) of 5 cm H<inf>2</inf>O and
respiratory rate adjusted to maintain normocapnia. Measurements and Main
Results Intraoperative changes in RV function (systolic and early
diastolic tricuspid annular velocity (TAV), end-systolic volume (ESV),
end-diastolic volume (EDV) and fractional area changes (FAC)), airway
pressures, compliance and oxygenation index were recorded. The use of PCV
during OLV resulted in faster systolic (10.1+/-2.39 vs. 5.8+/-1.67 cm/s,
respectively), diastolic TAV (9.2+/-1.99 vs. 4.6+/-1.42 cm/s,
respectively) (p<0.001) and compliance and lower ESV, EDV and airway
pressures (p<0.05) than during the use of VCV. Oxygenation indices were
similar during the use of VCV and PCV. Conclusions The use of PCV offers
more improved RV function than the use of VCV during OLV for open
thoracotomy. These results apply specifically to younger patients with
good ventricular and pulmonary functions. &#xa9; 2014 Elsevier Inc.

<83>
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 &#xa9; 2017, The Japanese Association for Thoracic Surgery.

<84>
Accession Number
615347522
Author
Tao E.; Wan L.; Wang W.; Luo Y.; Zeng J.; Wu X.
Institution
(Tao, Wan, Wang, Zeng, Wu) Department of Cardiovascular Surgery, First
Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
(Luo) Department of Neurosurgery, First Affiliated Hospital of Nanchang
University, Nanchang, Jiangxi, China
Title
The prognosis of infective endocarditis treated with biological valves
versus mechanical valves: A meta-analysis.
Source
PLoS ONE. 12 (4) (no pagination), 2017. Article Number: e0174519. Date of
Publication: April 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Objective: Surgery remains the primary form of treatment for infective
endocarditis (IE). However, it is not clear what type of prosthetic valve
provides a better prognosis. We conducted a metaanalysis to compare the
prognosis of infective endocarditis treated with biological valves to
cases treated with mechanical valves. Methods: Pubmed, Embase and Cochrane
databases were searched from January 1960 to November 2016. Randomized
controlled trials, retrospective cohorts and prospective studies comparing
outcomes between biological valve and mechanical valve management for
infective endocarditis were analyzed. The Newcastle-Ottawa Scale(NOS) was
used to evaluate the quality of the literature and extracted data, and
Stata 12.0 software was used for the metaanalysis. Results: A total of 11
publications were included; 10,754 cases were selected, involving 6776
cases of biological valves and 3,978 cases of mechanical valves. The
all-cause mortality risk of the biological valve group was higher than
that of the mechanical valve group (HR = 1.22, 95% CI 1.03 to 1.44, P=
0.023), as was early mortality (RR = 1.21, 95% CI1.02 to 1.43, P = 0.033).
The recurrence of endocarditis (HR = 1.75, 95% CI1.26 to 2.42, P= 0.001),
as well as the risk of reoperation (HR = 1.79, 95% CI1.15 to 2.80, P=
0.010) were more likely to occur in the biological valve group. The
incidence of postoperative embolism was less in the biological valve group
than in the mechanical valve group, but this difference was not
statistically significant (RR = 0.90, 95% CI 0.76 to 1.07, P= 0.245). For
patients with prosthetic valve endocarditis (PVE), there was no
significant difference in survival rates between the biological valve
group and the mechanical valve group (HR = 0.91, 95% CI 0.68 to 1.21, P=
0.520). Conclusion: The results of our meta-analysis suggest that
mechanical valves can provide a significantly better prognosis in patients
with infective endocarditis. There were significant differences in the
clinical features of patients receiving a biological valve compared to
patients receiving a mechanical valve. A large, multicenter retrospective
study included in our meta-analysis suggested that any mortality risk of
the biological valve group was significant higher than that of the
mechanical valve group. However, the risk was no different after risk was
adjusted. So, we thought the reason for this result may be related to the
characteristics of the patient rather than valve dysfunction. It is still
necessary to future randomized studies to verify this conclusion.
Copyright &#xa9; 2017 Tao 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.

<85>
Accession Number
604431990
Author
Gao X.-F.; Chen Y.; Fan Z.-G.; Jiang X.-M.; Wang Z.-M.; Li B.; Mao W.-X.;
Zhang J.-J.; Chen S.-L.
Institution
(Gao, Fan, Jiang, Wang, Li, Mao, Zhang, Chen) Department of Cardiology,
Nanjing First Hospital, Nanjing Medical University, Nanjing, China
(Chen) Department of Neurology, Drum Tower Hospital, Nanjing Medical
University, Nanjing, China
(Gao, Zhang, Chen) Department of Cardiology, Nanjing Heart Center,
Nanjing, China
Title
Antithrombotic Regimens for Patients Taking Oral Anticoagulation after
Coronary Intervention: A Meta-analysis of 16 Clinical Trials and 9185
Patients.
Source
Clinical Cardiology. 38 (8) (pp 499-509), 2015. Date of Publication: 01
Aug 2015.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
The optimal antithrombotic regimen remains controversial in patients
taking oral anticoagulation (OAC) undergoing coronary stenting. This study
sought to compare efficacy and safety outcomes of triple therapy (OAC,
aspirin, and clopidogrel) vs dual therapy (clopidogrel with aspirin or
OAC) in these patients. We hypothesize OAC plus clopidogrel could be the
optimal regimen for patients with indications for OAC receiving stent
implantation. Medline, the Cochrane Library, and other Internet sources
were searched for clinical trials comparing the efficacy and safety of
triple vs dual therapy for patients taking OAC after coronary stenting.
Sixteen eligible trials including 9185 patients were identified. The risks
of major adverse cardiac events (odds ratio [OR]: 1.06, 95% confidence
interval [CI]: 0.82-1.39, P = 0.65), all-cause mortality (OR: 0.98, 95%
CI: 0.76-1.27, P = 0.89), myocardial infarction (OR: 1.01, 95% CI:
0.77-1.31, P = 0.97), and stent thrombosis (OR: 0.91, 95% CI: 0.49-1.69, P
= 0.75) were similar between triple and dual therapy. Compared with dual
therapy, triple therapy was associated with a reduced risk of ischemic
stroke (OR: 0.57, 95% CI: 0.35-0.94, P = 0.03) but with higher major
bleeding (OR: 1.52, 95% CI: 1.11-2.10, P = 0.01) and minor bleeding (OR:
1.59, 95% CI: 1.05-2.42, P = 0.03). Subgroup analysis indicated there were
similar ischemic stroke and major bleeding outcomes between triple therapy
and therapy with OAC plus clopidogrel. Treatment with OAC and clopidogrel
was associated with similar efficacy and safety outcomes compared with
triple therapy. Triple therapy could be replaced by OAC plus clopidogrel
without any concern about additional risk of thrombotic events.
Copyright &#xa9; 2015 Wiley Periodicals, Inc.

<86>
Accession Number
615635715
Author
Kandasamy A.; Simon H.A.; Murthy P.; Annadurai M.; Ali M.M.; Ramanathan G.
Institution
(Kandasamy, Simon, Murthy, Annadurai, Ali, Ramanathan) Department of
Cardiothoracic Anesthesia, SRM Medical College Hospital and Research
Centre, SRM University, Kattankulathur, Chennai, Tamil Nadu, India
Title
Comparison of Levosimendan versus Dobutamine in Patients with Moderate to
Severe Left Ventricular Dysfunction Undergoing Off-pump Coronary Artery
Bypass Grafting: A Randomized Prospective Study.
Source
Annals of Cardiac Anaesthesia. 20 (2) (pp 200-206), 2017. Date of
Publication: April-June 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Context: Recent upsurge in referral of patients with compromised left
ventricular (LV) function for cardiac surgery has led to an increasing use
inotropes to achieve improvement of tissue perfusion in the perioperative
period. Aims and Objectives: To compare the hemodynamic effects and
immediate postoperative outcomes with levosimendan and dobutamine in
patients with moderate to severe LV dysfunction undergoing off-pump
coronary artery bypass grafting (OPCAB). Settings and Design: University
teaching hospital, randomized control study. Materials and Methods: Eighty
patients were randomly divided into two groups of 40 each. Group I
received levosimendan at 0.1 mug/kg/min and Group II received dobutamine
at 5 mug/kg/min. Hemodynamic data were noted at 30 min, during obtuse
marginal grafting, 1, 6, 12, and 24 h after surgery. Heart rate (HR), mean
arterial pressure (MAP), pulmonary capillary wedge pressure (PCWP),
cardiac index (CI), systemic vascular resistance index (SVRI) and
pulmonary vascular resistance index (PVRI), left ventricular stroke work
index (LVSWI) and right ventricular stroke work index (RVSWI), mixed
venous oximetry (SvO<inf>2</inf>), and lactate were measured. Statistical
Analysis Used: Chi-square and Student's t-test. Results: The HR, MAP,
PCWP, SVRI, and PVRI were lower in Group I when compared to Group II.
Group I patients showed a statistically significant increase in LVSWI,
RVSWI, and CI, when compared to Group II. Comparatively, Group I patients
maintained higher SvO<inf>2</inf>and lower lactate levels. Duration of
ventilation, Intensive Care Unit (ICU), and hospital stay were lower in
Group I. Conclusions: Levosimendan was associated with statistically
significant increase in indices of contractility (CI, LVSWI, and RVSWI)
and decrease in PCWP during and after OPCAB. Levosimendan group had lower
incidence of atrial fibrillation, shorter length of ICU, and hospital
stay.
Copyright &#xa9; 2017 Annals of Cardiac Anaesthesia
Published by Wolters Kluwer - Medknow.

<87>
Accession Number
615635700
Author
Modak S.D.; Kane D.G.
Institution
(Modak) Department of Anaesthesiology, Lokmanya Tilak Municipal Medical
and General Hospital, Sion, Switzerland
(Kane) Department of Anaesthesiology, Seth G. S. Medical College, KEM
Hospital, Parel, Mumbai, Maharashtra, India
Title
Conscious sedation for balloon mitral valvotomy: A comparison of fentanyl
versus sufentanil.
Source
Annals of Cardiac Anaesthesia. 20 (2) (pp 163-168), 2017. Date of
Publication: April-June 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Context: Analgesia and sedation are required for the comfort of patient
and the cardiologist during balloon mitral valvotomy. Aims: In this study,
efficacy of analgesia, sedation, and patient satisfaction with sufentanil
was compared with fentanyl. Settings and Design: Single-centered,
prospective single-blind study of sixty patients. Materials and Methods:
Patients between 15 and 45 years of rheumatic mitral stenosis with valve
area of 0.8-1 cm² undergoing elective balloon mitral valvotomy,
randomly divided to receive bolus injection fentanyl 1 mcg/kg (Group 1, n
= 30) followed by infusion at 1 mcg/kg/h or bolus of injection sufentanil
0.1 mcg/kg (Group 2, n = 30) followed by continuous infusion at 0.1 mcg/h.
Both the groups received injection midazolam bolus 0.02 mg/kg followed by
infusion at 15 mcg/kg/h. Pain intensity (by visual analog score [VAS]),
level of sedation (by Ramsay sedation scale), overall patient and
operator's satisfaction, effect on cardiorespiratory parameters, and
discharge score (by modified Aldrete score) were assessed. Statistical
Analysis Used: Statistical analysis used Student's unpaired t-test and
Chi-square test. P < 0.05 was considered statistically significant.
Results: Mean number of bolus doses in fentanyl group was 0.9 versus 0.13
in sufentanil group (P < 0.01). The mean value of mean blood pressure in
fentanyl group was 83.52 mmHg versus 88 mmHg in sufentanil group (P <
0.05), but the value was within normal range in both the groups. The mean
VAS - patient's opinion in fentanyl group was 8.97 versus 9.53 in
sufentanil group (P < 0.05). Mean discharge score in fentanyl group was
17.87 versus 18.23 in sufentanil group (P < 0.05). No statistically
significant difference was found with respect to heart rate, respiratory
rate, oxygen saturation, PaCO<inf>2</inf>values, and anxiety scores.
Conclusion: Sufentanil was found to be better with respect to analgesia,
patient satisfaction, and recovery however not cost-effective for
continuous infusion technique.
Copyright &#xa9; 2017 Annals of Cardiac Anaesthesia
Published by Wolters Kluwer - Medknow.

<88>
Accession Number
615635697
Author
Kiran U.; Ladha S.; Makhija N.; Kapoor P.M.; Choudhury M.; Das S.; Gharde
P.; Malik V.; Airan B.
Institution
(Kiran, Ladha, Makhija, Kapoor, Choudhury, Das, Gharde, Malik, Airan)
Department of Cardiac Anaesthesia, Cardiothoracic Centre, All India
Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India
Title
The role of Rajyoga meditation for modulation of anxiety and serum
cortisol in patients undergoing coronary artery bypass surgery: A
prospective randomized control study.
Source
Annals of Cardiac Anaesthesia. 20 (2) (pp 158-162), 2017. Date of
Publication: April-June 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Introduction: Rajyoga meditation is a form of mind body intervention that
is promoted by the Brahma Kumaris World Spiritual University. This form of
meditation can be easily performed without rituals or mantras and can be
practiced anywhere at any time. The practice of Rajyoga meditation can
have beneficial effects on modulating anxiety and cortisol level in
patients undergoing major cardiac surgery. Materials and Methods: A
prospective randomized control study was carried out in a single tertiary
care center. One hundred and fifty patients undergoing elective coronary
artery bypass surgery were enrolled in the study. The patients were
randomized in two groups namely, Group 1 (Rajyoga group) and Group 2
(Control Group). Anxiety was measured on a visual analog scale 1-10 before
the start of Rajyoga training or patient counseling (T1), on the morning
of the day of surgery (T2), on the 2^nd postoperative day (T3),
and on the 5^th postoperative day (T4). The serum cortisol level
was measured in the morning of the day of surgery (T1), on the
2^nd postoperative day (T2) and on the 5^th
postoperative day (T3), respectively. Results: In the study, it was seen
that the anxiety level of the patients before the surgery (T<inf>1</inf>)
and on the day of surgery (T<inf>2</inf>) were comparable between the two
groups. However on the 2^nd postoperative day (T<inf>3</inf>),
the patients who underwent Rajyoga training had lower anxiety level in
comparison to the control group (3.12 +/- 1.45 vs. 6.12 +/- 0.14, P <
0.05) and on the 5^th postoperative day (T<inf>4</inf>) it was
seen that Rajyoga practice had resulted in significant decline in anxiety
level (0.69 +/- 1.1 vs. 5.6 +/- 1.38, P < 0.05). The serum cortisol level
was also favorably modulated by the practice of Rajyoga meditation.
Conclusion: Mindbody intervention is found to effective in reducing the
anxiety of the patients and modulating the cortisol level in patients
undergoing wellknown stressful surgery like coronary artery bypass
surgery.
Copyright &#xa9; 2017 Annals of Cardiac Anaesthesia
Published by Wolters Kluwer - Medknow.

<89>
Accession Number
615635694
Author
Hashemian M.; Ahmadinejad M.; Mohajerani S.A.; Mirkheshti A.
Institution
(Hashemian, Ahmadinejad) Department of Anesthesiology and Pain Medicine,
Kerman University of Medical Sciences, Kerman, Iran, Islamic Republic of
(Mohajerani, Mirkheshti) Department of Anesthesiology, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Impact of dexmedetomidine on hemodynamic changes during and after coronary
artery bypass grafting.
Source
Annals of Cardiac Anaesthesia. 20 (2) (pp 152-157), 2017. Date of
Publication: April-June 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objective: To determine the effect of dexmedetomidine (Dex) on hemodynamic
changes during cardiopulmonary pump and postoperative period in coronary
artery bypass grafting (CABG). Methods and Design: This study is designed
as a double-blinded, randomized clinical trial. Setting: University
hospital and single center. Participants: patients candidate for elective
CABG. Intervention: Dex 0.5 mug/kg/h or placebo was infused from the
initiation of anesthesia up to extubation in Intensive Care Unit (ICU).
Measurements: Heart rate (HR) and blood pressure (BP), pain score, and
total morphine dose requirement were monitored and compared during cardiac
pump up to 12 h postoperative in ICU. Results: Mean arterial pressure was
significantly higher in Dex group in postoperation period at 1 (P = 0.010)
and 2 h (P = 0.002) compared to control group. HR was significantly lower
in Dex group in postcardiopulmonary bypass (CPB) time at 0 h (P = 0.001),
1 h (P = 0.0016), and 2 h (P = 0.001), and then in postoperative period in
ICU at 1 h (P = 0.025), 2 h (P = 0.0012), and 4 h (P = 0.0025) compared to
control group. Postoperative pain score was significantly lower during 12
h after surgery. Conclusion: Dex could effectively blunt hemodynamic
response to surgical stress, particularly during CPB pump and afterward.
Infusion of Dex maintains BP at higher range and HR at lower range
compared to placebo.
Copyright &#xa9; 2017 Annals of Cardiac Anaesthesia
Published by Wolters Kluwer - Medknow.

<90>
Accession Number
615547777
Author
Zhang X.-L.; Zhu Q.-Q.; Yang J.-J.; Chen Y.-H.; Li Y.; Zhu S.-H.; Xie J.;
Wang L.; Kang L.-N.; Xu B.
Institution
(Zhang, Chen, Li, Zhu, Xie, Wang, Kang, Xu) Affiliated Drum Tower
Hospital, Nanjing University School of Medicine, Department of Cardiology,
321 Zhongshan Road, Nanjing, Jiangsu Province 210008, China
(Zhu) Jinling Hospital, Nanjing University School of Medicine, Department
of Respiratory Medicine, Nanjing, China
(Yang) Nanjing Drum Tower Hospital, Clinical College of Traditional
Chinese and Western Medicine, Nanjing University of Chinese Medicine,
Department of Traditional Chinese Medicine, Nanjing, China
Title
Percutaneous intervention versus coronary artery bypass graft surgery in
left main coronary artery stenosis: A systematic review and meta-analysis.
Source
BMC Medicine. 15 (1) (no pagination), 2017. Article Number: 84. Date of
Publication: 21 Apr 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The optimal revascularization technique in patients with left
main coronary artery disease (CAD) remains controversial. We aimed to
compare the long-term performance of percutaneous coronary intervention
(PCI) versus coronary artery bypass graft (CABG) surgery in treatment of
left main CAD. Methods: PubMed, EMBASE, and the Cochrane Library were
searched until November 16, 2016. Results: Six randomized controlled
trials and 22 matched observational studies including 22,487 patients and
90,167 patient-years of follow-up were included. PCI was associated with
an overall higher risk for the major adverse cardiac and cerebrovascular
events (hazard ratio (HR), 1.42; 95% confidence interval (CI), 1.14-1.77),
mainly driven by higher rates of myocardial infarction (HR, 1.69; 95% CI,
1.22-2.34) and revascularization (HR, 2.80; 95% CI, 1.86-4.22). The
overall risks for all-cause death (HR, 1.05; 95% CI, 0.93-1.20), cardiac
death (HR, 1.05; 95% CI, 0.69-1.59), stroke (HR, 0.64; 95% CI, 0.33-1.24),
and the composite safety endpoint of death, myocardial infarction, or
stroke (HR, 1.06; 95% CI, 0.97-1.16) were similar between PCI and CABG.
Stratified analysis based on stent types showed that the increased risk
for myocardial infarction associated with PCI was only evident in patients
with bare-metal stents or early-generation drug-eluting stents (DES), but
not newer-generation DES. Stratified analyses based on study designs
showed largely similar findings with the overall analyses, except for a
significantly higher incidence of myocardial infarction in adjusted
studies (HR, 2.01; 95% CI, 1.64-2.45) but a trend toward higher incidence
in randomized trials (HR, 1.39; 95% CI, 0.85-2.27) associated with PCI.
Conclusions: Compared with CABG, PCI with newer-generation DES might be a
safe alternative revascularization strategy for treatment of left main
CAD, but is associated with more repeat revascularization.
Copyright &#xa9; 2017 The Author(s).

<91>
Accession Number
615654699
Author
Paikin J.S.; Hirsh J.; Ginsberg J.S.; Weitz J.I.; Chan N.C.; Whitlock
R.P.; Pare G.; Eikelboom J.W.
Institution
(Paikin, Whitlock, Eikelboom) Hamilton General Hospital McMaster
UniversityHamilton, ON Canada
(Paikin, Hirsh, Ginsberg, Weitz, Pare, Eikelboom) Department of Medicine
McMaster UniversityHamilton, ON Canada
(Hirsh, Chan, Whitlock, Pare, Eikelboom) Population Health Research
Institute McMaster UniversityHamilton, ON Canada
(Ginsberg, Weitz) Thrombosis and Atherosclerosis Research Institute
McMaster University Hamilton, ON Canada
Title
Once versus twice daily aspirin after coronary bypass surgery: A
randomized trial.
Source
Journal of Thrombosis and Haemostasis. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Essentials: Coronary artery bypass graft (CABG) failure is associated with
myocardial infarction and death. We tested whether more frequent dosing
improves aspirin (ASA) response following CABG surgery. Twice-daily
compared with once-daily dosing reduces ASA hyporesponsiveness after CABG
surgery. The efficacy of twice-daily ASA needs to be tested in a trial
powered for clinical outcomes. Summary: Background: Acetyl-salicylic acid
(ASA) hyporesponsiveness occurs transiently after coronary artery bypass
graft (CABG) surgery and may compromise the effectiveness of ASA in
reducing thrombotic graft failure. A reduced response to ASA 81 mg
once-daily after CABG surgery is overcome by four times daily ASA dosing.
Objectives: To determine whether ASA 325 mg once-daily or 162 mg
twice-daily overcomes a reduced response to ASA 81 mg once-daily after
CABG surgery. Methods: Adults undergoing CABG surgery were randomized to
ASA 81 mg once-daily, 325 mg once-daily or 162 mg twice-daily. The primary
outcome was median serum thromboxane B<inf>2</inf> (TXB<inf>2</inf>) level
on postoperative day 4. We pooled the results with those of our earlier
study to obtain better estimates of the effect of ASA 325 mg once-daily or
in divided doses over 24 h. Results: We randomized 68 patients undergoing
CABG surgery. On postoperative day 4, patients randomized to receive ASA
81 mg once-daily had a median day 4 TXB<inf>2</inf> level of 4.2 ng
mL^-1 (Q1, Q3: 1.5, 7.5 ng mL^-1), which was higher
than in those randomized to ASA 162 mg twice-daily (1.1 ng
mL^-1; Q1, Q3: 0.7, 2.7 ng mL^-1) and similar to those
randomized to ASA 325 mg once-daily (1.9 ng mL^-1; Q1, Q3: 0.9,
4.7 ng mL^-1). Pooled data showed that the median
TXB<inf>2</inf> level on day 4 in groups receiving ASA 162 mg twice-daily
or 81 mg four times daily was 1.1 ng mL^-1 compared with 2.2 ng
mL^-1 in those receiving ASA 325 mg once-daily. Conclusions:
Multiple daily dosing of ASA is more effective than ASA 81 mg once-daily
or 325 mg once-daily at suppressing serum TXB<inf>2</inf> formation after
CABG surgery. A twice-daily treatment regimen needs to be tested in a
clinical outcome study.
Copyright &#xa9; 2017 International Society on Thrombosis and Haemostasis.

<92>
Accession Number
615636718
Author
Simeon S.; Flecher E.; Revest M.; Niculescu M.; Roussel J.-C.; Michel M.;
Leprince P.; Tattevin P.
Institution
(Simeon, Revest, Tattevin) Department of Infectious Diseases and Intensive
Care Unit, Pontchaillou University Hospital, Rennes, France
(Flecher) Department of Cardio-Thoracic and Vascular Surgery, Pontchaillou
University Hospital, Rennes, France
(Revest, Tattevin) Inserm U835, Rennes-1 University, France
(Niculescu) Anaesthesiology Department, Institut de Cardiologie, Groupe
Hospitalier Pitie-Salpetriere, Universite Pierre et Marie Curie,
Assistance Publique des Hopitaux de Paris, France
(Roussel) Department of Cardio-Thoracic and Vascular Surgery, Thorax
Institute, Laennec University Hospital, Nantes, France
(Michel) Department of Cardiovascular Diseases, Laennec University
Hospital, Nantes, France
(Leprince) Surgery Department, Institut de Cardiologie, Groupe Hospitalier
Pitie-Salpetriere, Universite Pierre et Marie Curie, Assistance Publique
des Hopitaux de Paris, France
Title
Left ventricular assist device-related infections: A multicentric study.
Source
Clinical Microbiology and Infection. (no pagination), 2017. Date of
Publication: December 06, 2016.
Publisher
Elsevier B.V. (E-mail: customerservices@oxonblackwellpublishing.com)
Abstract
Objectives: The implantable left ventricular assist device (LVAD) is a
major therapeutic development for end-stage heart failure in selected
patients. As their use is expanding, infectious complications are
emerging, with limited data available to guide their management. We aimed
to better characterize LVAD-related infections. Methods: We enrolled all
consecutive patients diagnosed with LVAD-related infections in three
referral centres in France, using a standardized definition of infections
in patients with LVAD. Data were collected from medical charts using a
standardized questionnaire. Results: Between 2007 and 2012, 159 patients
received LVAD for end-stage heart failure. Among them, 36 (22.6%; 5 women,
31 men) presented at least one infectious complication, after a median
time of 2.9 months from LVAD implantation (interquartile range, 1.8-7.5),
with a median follow up of 12 months (interquartile range 8-17). Main
co-morbidities were alcoholism (33%), diabetes (11%) and immunosuppression
(11%). Mean age at implantation was 51 (+/-11) years. LVAD were implanted
as bridge-to-transplantation (n = 22), bridge-to-recovery (n = 8),
destination therapy (n = 4), or unspecified (n = 2). LVAD-related
infections were restricted to the driveline exit site (n = 17), had
loco-regional extension (n = 13), or reached the internal pump (n = 3).
The main bacteria isolated were Staphylococcus aureus (n = 20),
coagulase-negative staphylococci (n = 7), Enterobacteriaceae (n = 14),
Pseudomonas aeruginosa (n = 10) and Corynebacterium sp. (n = 7), with
polymicrobial infections in 19 cases. LVAD could be retained in all
patients, with the use of prolonged antibacterial treatment in 34 (94%),
and debridement in 17 (47%). One patient died due to LVAD-associated
infection. Conclusions: LVAD-related infections are common after LVAD
implantation, and may be controlled by prolonged antibiotic treatment.
Copyright &#xa9; 2017 European Society of Clinical Microbiology and
Infectious Diseases.

<93>
Accession Number
615634989
Author
Khan A.R.; Golwala H.; Tripathi A.; Riaz H.; Kumar A.; Flaherty M.P.;
Bhatt D.L.
Institution
(Khan, Tripathi, Flaherty) Division of Cardiovascular Medicine, Department
of Internal Medicine, University of Louisville, Louisville, Kentucky
(Golwala, Bhatt) Brigham and Women's Hospital Heart and Vascular Center,
Harvard Medical School, Boston, Massachusetts
(Riaz) Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
(Kumar) Heart and Vascular Center, Cleveland Clinic, Cleveland, Ohio
Title
Meta-analysis of Percutaneous Coronary Intervention Versus Coronary Artery
Bypass Grafting in Left Main Coronary Artery Disease.
Source
American Journal of Cardiology. (no pagination), 2017. Date of
Publication: December 27, 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Despite the increase in use of percutaneous coronary intervention (PCI) in
left main coronary disease, its efficacy compared with coronary artery
bypass grafting (CABG) is unclear. We performed a meta-analysis of
randomized controlled trials to assess the optimal revascularization
strategy. Our search yielded 8 studies reporting relevant outcomes that
were pooled using the inverse variance method, and the hazard ratio (HR)
was calculated. The primary outcome was all-cause mortality, myocardial
infarction (MI), or stroke (major adverse cardiac events [MACE]), and the
secondary outcome was death/MI/stroke/repeat revascularization (expanded
MACE). Differences in outcomes classified by follow-up duration (early: 0
to 1 year; late: 3 to 5 years) or anatomical complexity of coronary artery
disease (SYNTAX score) were investigated. Our results suggest no
difference in either early or late MACE (early: HR 0.81; 95% confidence
interval [CI] 0.63 to 1.05; late: HR 1.12; 95% CI 0.80 to 1.56) or
expanded MACE (early: HR 1.03; 95% CI 0.69 to 1.52; late: HR 1.16; 95% CI
0.95 to 1.43) between the 2 groups. There was an increased risk of
expanded MACE with a high SYNTAX score for PCI (HR 1.47; 95% CI 1.13 to
1.92) at late follow-up. There were comparable rates of all-cause
mortality and nonprocedural MI between the 2 groups with increased rates
of repeat revascularization with PCI throughout the follow-up and higher
rates of stroke with coronary artery bypass grafting early in the
follow-up period. In conclusion, our analysis suggests that CABG may be
preferable in patients with left main disease and high SYNTAX scores,
assuming they are at low surgical risk, and PCI may be an acceptable
alternative in patients with low-intermediate SYNTAX scores.
Copyright &#xa9; 2017 Elsevier Inc.

<94>
Accession Number
613755577
Author
Morrison L.J.; Devlin S.M.; Kontos M.C.; Cheskes S.; Aufderheide T.P.;
Christenson J.; Ornato J.P.; Stiell I.G.; Rac V.E.; Thomas A.J.; Wigginton
J.G.; Dorian P.
Institution
(Morrison) Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital,
Division of Emergency Medicine, Department of Medicine, University of
Toronto, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
(Devlin) Department of Epidemiology and Biostatistics, Memorial
Sloan-Kettering Cancer Center, 307 East 63rd Street, 3rd Floor, New York,
NY, United States
(Kontos) Pauley Heart Center, Division of Cardiology, Virginia
Commonwealth University, Richmond, VA, United States
(Cheskes) Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital,
Sunnybrook Centre for Prehospital Medicine, Division of Emergency
Medicine, Department of Family and Community Medicine University of
Toronto, 77 Browns Line, Suite 100, Toronto, Ontario M8W 3S2, Canada
(Aufderheide) Medical College of Wisconsin, Department of Emergency
Medicine, 9200W. Wisconsin Avenue, Pavilion 1P, Milwaukee, WI 53226,
United States
(Christenson) University of British Columbia, Department of Emergency
Medicine, Room 3300 3rd Floor, 910 West 10th Avenue, Vancouver, British
Columbia V5Z 1M9, Canada
(Ornato) Department of Emergency Medicine, Virginia Commonwealth
University, Richmond, VA, United States
(Stiell) Department of Emergency Medicine, Ottawa Hospital Research
Institute, University of Ottawa, Clinical Epidemiology Unit, F6 1053
Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada
(Rac) THETA (Toronto Health Economics and Technology Assessment)
Collaborative, Toronto General Research Institute, University Health
Network and Leslie Dan Pharmacy Building, 6th Floor, Room 651, 144 College
Street, Toronto, Ontario M5S 3M2, Canada
(Thomas) School of Medicine, Oregon Health & Science University, 3181 SW
Sam Jackson Park Rd, Portland, OR 97239-3098, United States
(Wigginton) University of Texas Southwestern Medical Center, 5323 Harry
Hines Boulevard, Dallas, TX 75390, United States
(Dorian) Division of Cardiology, Department of Medicine, St Michael's
Hospital and University of Toronto, Toronto, Ontario, Canada
Title
The association of maximum Troponin values post out-of-hospital cardiac
arrest with electrocardiographic findings, cardiac reperfusion procedures
and survival to discharge: A sub-study of ROC PRIMED.
Source
Resuscitation. 111 (pp 82-89), 2017. Date of Publication: 01 Feb 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background The role of Troponin (Tn) levels in the management of patients
post out-of-hospital cardiac arrest (OHCA) is unclear. Methods All OHCA
patients enrolled in the Resuscitation Outcomes Consortium Prehospital
Resuscitation using an IMpedance valve and Early versus Delayed analysis
trial and admitted to hospital with a Tn level and a 12-lead
electrocardiogram were stratified by ST elevation (STE) or no STE in a
regression model for survival to discharge adjusted for Utstein predictors
and site. Results Of the 15,617 enrolled OHCA patients, 4118 (26%)
survived to admission to hospital; 17% (693) were STE and 77% (3188) were
no STE with 6% unknown; 83% (3460) had at least one Tn level. Reperfusion
rates were higher when Tn level >2 ng/ml (p > 0.1 ng/ml) improved with a
diagnostic cardiac catheterization (p < 0.001). Conclusions Elevated Tn
levels >2 ng/ml were associated with improved survival to discharge in
patients post OHCA with STE. Survival in patients with no STE and Tn
values >0.1 ng/ml was higher when associated with diagnostic cardiac
catheterization or treated with reperfusion or revascularization.
Copyright &#xa9; 2016 Elsevier Ireland Ltd

<95>
Accession Number
609835089
Author
Ruggieri V.G.; Anselmi A.; Chabanne C.; Lelong B.; Flecher E.; Verhoye
J.-P.; Leguerrier A.
Institution
(Ruggieri, Anselmi, Chabanne, Lelong, Flecher, Verhoye, Leguerrier)
Division of Thoracic and Cardiovascular Surgery, Pontchaillou University
Hospital, Rennes, France
Title
Three-year haemodynamic performance of the St Jude Trifecta bioprosthesis.
Source
European Journal of Cardio-thoracic Surgery. 49 (3) (pp 972-977), 2016.
Date of Publication: 01 Mar 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: To examine the haemodynamic performance of the St Jude
Trifecta valve for aortic valve replacement (AVR) at 3 years after
implantation. METHODS: In a single-centre, prospective, observational,
independent study, we enrolled 122 patients who had AVR using a Trifecta
bioprosthesis in the July 2010-June 2011 period. A clinical and
echocardiographic in-house follow-up was scheduled. RESULTS: In our
series, 14.7% of patients received a 19-mm, 28.7% had a 21-mm, 35.2% had a
23-mm and 21.3% had a greater-size prosthesis. There were no cases of
operative mortality or of valve-related complications both early and at
follow-up (except one sudden unexplained death). Completeness of the
3-year echocardiographic follow-up was 80% among survivors. The average
mean transvalvular gradient (mTVG) at 3 years was 14.2, 10.8, 8.6, 7.1 and
6.8 mmHg (sizes 19 to 27/29, respectively). There was no statistically
significant difference between average mTVGs measured immediately after
implantation versus at the 3-year follow-up in the overall population. The
average peak transvalvular gradient (pTVG) at 3 years was 25, 20, 16.8,
13.9 and 14.4 mmHg (sizes 19 to 27/29, respectively). The average indexed
effective orifice area (iEOA) at 3 years was 0.8, 0.9, 1, 1.3 and 1.3
cm²/m² (sizes 19-27, respectively). The rate of
moderate patient- prosthesis mismatch (PPM) at 3 years was 15.7%; there
were two instances of severe PPM (2.2%). All cases of PPM occurred in the
19, 21 and 23 mm size subgroups. CONCLUSIONS: The Trifecta valve retains
its excellent haemodynamic properties at the 3-year follow-up. The rate of
PPMis considerably low.
Copyright &#xa9; The Author 2015. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<96>
Accession Number
609834932
Author
Zhou F.; Luo Q.; Wang L.; Han L.
Institution
(Zhou, Luo, Wang, Han) Division of Nephrology, Ningbo No. 2 Hospital,
Affiliated Hospital of Ningbo University School of Medical, Ningbo,
Zhejiang, China
Title
Diagnostic value of neutrophil gelatinase-associated lipocalin for early
diagnosis of cardiac surgery-associated acute kidney injury: A
meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 49 (3) (pp 746-755), 2016.
Date of Publication: 01 Mar 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Neutrophil gelatinase-associated lipocalin (NGAL) has been identified as
one of the most sensitive and specific biomarkers for predicting cardiac
surgery-associated acute kidney injury (CSA-AKI); however, variable
performance characteristics have been reported. We therefore performed a
diagnostic meta-analysis to investigate the diagnostic accuracy of NGAL in
early (within 12 h postoperatively) diagnosis of CSA-AKI using established
guidelines. The search was carried out electronically with Medline
(through PubMed interface), Embase, Cochrane library, ISI Web of Science,
Scopus and ClinicalTrials.gov (up to 5 September 2014), and hand-searching
was also done. Two reviewers conducted study inclusion, data extractions
and quality assessment of the studies independently. The diagnostic
capacity of NGAL for CSA-AKI was assessed using pooled sensitivity and
specificity, diagnostic odds ratio (DOR), area under the summary receiver
operating characteristic curve (AUC). Meta-Disc 1.4 and STATA 12.0 were
used to investigate the source of heterogeneity and to perform the
meta-analysis. Twenty-four studies (33 data sets of 4066 patients) were
considered, which were all of good methodological quality. The overall
pooled sensitivity of NGAL for the diagnosis of AKI was 0.68 [95%
confidence interval (CI), 0.65-0.70], and specificity was 0.79 (95% CI,
0.77-0.80). The overall pooled positive likelihood ratio and negative
likelihood ratio were 3.98 (95% CI, 3.05-5.20) and 0.33 (95% CI,
0.24-0.45), respectively, with a DOR of 13.05 (95% CI, 7.85-21.70). The
receiver operating characteristic analysis showed an AUC [standard error
(SE)] of 0.86 (0.02) and with a Q*-value (SE) of 0.79 (0.02). Subgroup
analysis showed that NGAL had better predictive ability in
neonates/children compared with adults (DOR, 19.37; AUC, 0.89 vs DOR,
8.98; AUC, 0.83), and adults without pre-existing renal insufficiency
(PRI) had higher diagnostic value than adults without PRI to predict
CSA-AKI (DOR, 15.43; AUC, 0.87 vs DOR, 6.56; AUC, 0.81). Both plasma/serum
and urine NGAL had the highly predictive nature for early diagnosis of
CSA-AKI (DOR, 13.09; AUC, 0.85 vs DOR, 13.20; AUC, 0.88), while lower DOR
and AUC values were shown (DOR, 8.31; AUC, 0.81) when measured using
standardized clinical platforms, compared with research-based assays (DOR,
19.22; AUC, 0.89). I²-values showed substantial heterogeneity,
which mainly stems from characteristics of patient population (P = 0.037).
NGAL diagnostic accuracy in early detection of CSA-AKI is high, especially
in neonates/children or adults with normal baseline renal function.
Copyright &#xa9; The Author 2015. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<97>
Accession Number
612935616
Author
Silva J.D.A.; Ariente L.C.; Roza B.A.; Mucci S.
Institution
(Silva) Transplant and Organ Uptake Multiprofessional Program-COREMU,
Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
(Ariente) Hospital do Rim and Nephrology Department, Universidade Federal
de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
(Roza) Escola Paulista de Enfermagem, Universidade Federal de Sao Paulo,
Sao Paulo, Sao Paulo, Brazil
(Mucci) Psychiatry Department, Universidade Federal de Sao Paulo, Sao
Paulo, Sao Paulo, Brazil
Title
Evidence of the Association Between Psychology and Tissue and Organ
Transplantation in Brazil.
Source
Transplantation Proceedings. 48 (7) (pp 2258-2261), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier USA
Abstract
Background The addition of psychologists to organ transplant teams is
still new in Brazil. In seeking the efficient performance of this
professional, the knowledge of the scientific production and the
development of research in the area is fundamental. In this sense, this
study aims to survey the Brazilian scientific research that has
investigated the psychologic aspects involved in tissue and organ
transplantation. Methods A literature narrative review was performed with
the use of the "Transplante AND Psicologia" descriptors in the Biblioteca
Virtual em Saude and the CAPES Journal Portal. Results Fifty-three
articles were found, of which 22 met the inclusion criteria: publications
dating from 2000 to 2014 and the main topic of interest of the studies
being quality of life, followed by organ donation. The instruments used
most frequently were interviews developed by the researchers and the SF-36
Quality of Life Questionnaire. Conclusions Recent Brazilian studies on the
association between psychology and transplantation are still scarce,
possibly because of the recent addition of psychologists to
transplantation teams. Therefore, it is suggested that more scientific
research is made in the area and that the objects of study are more
varied, to ensure adequacy of the psychologist to meet the specific
demands of organ and tissue transplantation process.
Copyright &#xa9; 2016 Elsevier Inc.

<98>
Accession Number
608909540
Author
Jarral O.A.; Kidher E.; Patel V.M.; Nguyen B.; Pepper J.; Athanasiou T.
Institution
(Jarral, Kidher, Patel, Nguyen, Pepper, Athanasiou) Department of Surgery
and Cancer, Imperial College London, London, United Kingdom
Title
Quality of life after intervention on the thoracic aorta.
Source
European Journal of Cardio-thoracic Surgery. 49 (2) (pp 369-389), 2016.
Article Number: ezv119. Date of Publication: 01 Feb 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Surgery on the thoracic aorta is challenging and historically associated
with significant mortality and morbidity. In recent times, there has been
increased emphasis on the importance of health-related quality of life
(HRQOL) measures. It is seen as a development beyond isolated markers of
outcome such as operative mortality and is particularly applicable to
aortic surgery given the number of asymptomatic patients operated on (for
prognostic grounds), and rapidly advancing endovascular technologies which
require proper assessment. This systematic review provides an outline of
all available literature detailing HRQOL in patients receiving
intervention (both open and endovascular) on the thoracic aorta. In total,
30 studies were identified encompassing 4746 patients undergoing a variety
of procedures from aortic root replacement to thoracoabdominal aortic
aneurysm repair. While there were deficiencies in the underlying
literature such as lack of baseline HRQOL assessment, the majority of the
studies confirm that HRQOL after major aortic surgery (including on the
elderly and in emergency situations) is acceptable and compares well to
matched general populations. Strategies for improving the HRQOL in aortic
surgery are summarized and include the need for surgeons to plan cerebral
protection methods more carefully and to develop operative strategies to
avoid reoperation or reintervention, as this is associated with
deterioration of long-term HRQOL. Randomized studies measuring baseline
and follow-up HRQOL at specific set points are needed. Innovative research
methods could be employed in future studies with the aim of correlating
HRQOL with imaging or physiological/inflammation biomarkers, or other end
points such as aortic stiffness or wall shear stress to characterize
disease progression and prognosis.
Copyright &#xa9; The Author 2015. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<99>
Accession Number
605052691
Author
Akpinar M.B.; Atalay A.; Atalay H.; Dogan O.F.
Institution
(Akpinar) Izmir Sifa University Medical Faculty, Department of
Cardiovascular Surgery, Izmir, Turkey
(Atalay) Cukurova University Medical Facilty, Department of Cardiovascular
Surgery, Cukurova, Adana, Turkey
(Atalay) Mersin Private Middle-East Hospital, Department of Cardiovascular
Surgery, Mersin, Turkey
(Dogan) Adana Numune Education and Training Hospital, Department of
Cardiovascular Surgery, Adana, Turkey
Title
Ankaferd blood stopper decreases postoperative bleeding and number of
transfusions in patients treated with clopidogrel: A double-blind,
placebo-controlled, randomized clinical trial.
Source
Heart Surgery Forum. 18 (3) (pp E118-E123), 2015. Date of Publication: 01
Jun 2015.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Background: The risk of reoperation due to bleeding after open heart
surgery is 2.2%-4.2%. Extracorporeal circulation and emergency operations
are the important risk factors. In coronary artery bypass graft (CABG)
patients who are treated preoperatively with antiplatelets plus
clopidogrel are the sources of postoperative bleeding. The aim of this
study was to research the effect of local Ankaferd blood stopper (ABS) to
prevent mediastinal bleeding in on-pump CABG patients who were treated
with clopidogrel and acetylsalicylic acid (ASA) preoperatively. Methods:
Twenty-five emergency CABG patients premedicated with clopidogrel and ASA
were included in the study (Group 1). An additional twenty-five patients
who were premedicated with the same antiplatelet agents were selected as a
control group (Group 2). At the end of the surgery, 4-10 mL of ABS
solution was applied on the mediastinal and epicardial tissue following
protamine administration in Group 1. We compared postoperative total
mediastinal bleeding, reoperation rate and total blood and blood products
transfused between the two groups. Results: There was no mortality in
either of the two groups. Mean postoperative bleeding was 430 mL in the
ABS group, and 690 mL in the CG group (P = .044). In the ICU, bleeding in
groups 1 and 2 was 610 mL and 980 mL, respectively (P = .025); total
bleeding from the mediastinum was 830 mL and 1490 mL, respectively (P =
.001) and the amount of autotransfusion was 210 mL and 400 mL (P = .003).
Total transfusion of PRBCs in the operating room in groups 1 and 2 was 0.3
and 0.8, respectively (P = .003). No patients in the ABS group needed
surgical revision due to severe bleeding or cardiac tamponade. Conclusion:
The use of local ABS reduces bleeding, transfusion requirements of packed
red blood cells, platelets and total blood units in patients premedicated
with clopidogrel and ASA undergoing emergent CABG.
Copyright &#xa9; 2015 Forum Multimedia Publishing, LLC.

<100>
Accession Number
615632551
Author
Hosang S.; Bartels C.; Hansen M.; Herr M.; Schilling T.; Baraki H.;
Kutschka I.; Hadem J.
Institution
(Hosang, Bartels, Hansen, Herr, Schilling, Baraki, Kutschka, Hadem)
Otto-von-Guericke-Universitat Magdeburg, Germany
Title
Short-term cognitive function following coronary artery bypass grafting in
patients at high risk of cerebrovascular events - Preliminary results from
a prospective study.
Source
Internist. Conference: 123 Kongress der Deutschen Gesellschaft fur Innere
Medizin e.V., DGIM 2017. Germany. 58 (pp S36), 2017. Date of Publication:
March 2017.
Publisher
Springer Verlag
Abstract
Objectives: Short-term cognitive impairment following coronary artery
bypass grafting (CABG) has been attributed to older age and several other
risk factors associated with cerebrovascular disease. In an ongoing
prospective study, we aim to characterize perioperative alterations in
cognitive function as well as the management implications of regional
cerebral-tissue oxygenation (rSO2) monitoring in patients at high risk of
cerebrovascular events. Patients with symptomatic carotid stenosis and/or
previous cerebral infarctions were excluded. Methods: Clinical parameters
were collected prospectively at our institution (DRKS-ID: DRKS00008853).
Several cognitive domains were examined on the day preceding CABG and
again on postoperative day 5-7, using the Montreal Cognitive Assessment
(MoCA), Trail-making Test (TMT A/B), Regensburg Word Fluency Test (RWT),
and the Boston Naming Test (BNT). Patients were randomly assigned to a
control vs. an intervention group. The latter received intraoperative
frontal rSO2 monitoring as well as appropriate measures to optimize rSO2
in case of desaturations. Results are presented as medians (interquartile
ranges). Baseline and postoperative test results were compared by Wilcoxon
test. Results: Ten patients at high risk of cerebrovascular events were
included. Two out of 10 patients (20%) were female, and median age was 68
(62-77) years. Four patients (40%) received additional mitral valve
surgery. Length of cardiopulmonary bypass was 135 (100-191) min. Nine of
10 patients showed chronic kidney disease (CKD), and all patients suffered
from diabetes and/or CKD. Six patients (60%) had a reduced left
ventricular ejection fraction (> 50%). Sequential neuropsychological
testing revealed a modest short-term cognitive decline in 2 out of 5
assessments: MoCA 21 (17-26) vs. 22 (14-24, p = 0.122), TMT A 37 (31-44)
vs. 39 (28-47 sec, p = 0.721), TMT B 99 (88-117) vs. 112 (100-152 sec, p =
0.012), RWT 69 (59-83) vs. 63 (49-72, p = 0.066), BNT 29 (24-29) vs. 29
(26-30, p = 0.038). The rSO2 area under the curve (desaturations below
50%*time [min], mean value of left and right frontal channel) in those 5
patients randomly assigned to the rSO2 monitoring group was 1 (0-18) min%.
Patients were discharged from hospital after 9.5 (8-10) days. Conclusion:
These preliminary results suggest that patients at high risk of a
cerebrovascular event experience a modest short-term cognitive impairment
following cardiac surgery, but recover soon thereafter. This ongoing study
aims to characterize perioperative changes in cerebrovascular disease and
to clarify the potential benefits of intraoperative cerebral rSO2
monitoring.

<101>
[Use Link to view the full text]
Accession Number
615490049
Author
Zhu H.; Xu X.; Ding Y.; Zhou L.; Huang J.
Institution
(Zhu, Xu) Zhejiang Chinese Medical University, Nanjing Medical University,
Department of Cardiology, Hangzhou, Zhejiang, China
(Ding, Zhou, Huang) Hnagzhou First People's Hospital, Nanjing Medical
University, Department of Cardiology, Hangzhou, Zhejiang, China
Title
Effects of prostaglandin E1 on reperfusion injury patients.
Source
Medicine (United States). 96 (15) (no pagination), 2017. Article Number:
e6591. Date of Publication: 01 Apr 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Prostaglandin E1 (PGE1) is widely used as a pretreatment for
myocardial reperfusion injury in animal experiments. However, the
cardioprotective effects of PGE1 in patients have not been established. We
performed a meta-analysis to investigate whether PGE1 is cardioprotective,
based on the reduction of correlative reperfusion injury events (CRIE),
major adverse cardiac events (MACE), and biomarker release in patients
with ischemia reperfusion injury. Methods: The Medline, EMBASE, and
Cochrane databases were searched for randomized clinical trials confirming
the effects of PGE1. Two investigators independently selected suitable
trials, assessed trial quality, and extracted data. Results: Six studies
in patients undergoing percutaneous coronary intervention (4 studies) and
cardiac surgery (2 studies), comprising a total of 445 patients, were
included in this review. The results showed that PGE1 reduced the
incidence of CRIE (relative ratio 0.4 [95% confidence interval 0.43,
0.95]), the incidence of MACE (0.35 [0.17, 0.70]), and the level of
troponin T (standardized mean difference 20.28 [20.47, 20.09]), creatine
kinase-MB (-1.74 [-3.21, - 0.27]), interleukin-6 (-1.37 [-2.69, - 0.04]),
and interleukin-8 (-2.05 [-2.75, - 1.34]). Conclusion: PGE1 may have
beneficial effects on myocardial reperfusion injury in the clinic.
Copyright &#xa9; 2017 the Author(s). Published by Wolters Kluwer Health,
Inc.

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

<103>
Accession Number
605052649
Author
Ariturk C.; Ozgen S.U.; Okten M.; Danisan B.; Karabulut H.; Toraman F.
Institution
(Ariturk, Okten, Karabulut) Department of Cardiovascular Surgery, Acibadem
University, School of Medicine, Fenerbahce Mah. Haci Mehmet Sok. Ali Bey
D:14, Kadikoy-Istanbul 34000, Turkey
(Ozgen, Toraman) Department of Anesthesiology and Reanimation, Acibadem
University, School of Medicine, Istanbul, Turkey
(Danisan) Acibadem Healthcare Group, Kadikoy Hospital, Cardiovascular
Surgery Clinic, Istanbul 34000, Turkey
Title
Oxygen fraction adjustment according to body surface area during
extracorporeal circulation.
Source
Heart Surgery Forum. 18 (3) (pp E98-E102), 2015. Date of Publication: 01
Jun 2015.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States. E-mail: ijh@cjp.com)
Abstract
Background: The inspiratory oxygen fraction (FiO<inf>2</inf>) is usually
set between 60% and 100% during conventional extracorporeal circulation
(ECC). However, this strategy causes partial oxygen pressure
(PaO<inf>2</inf>) to reach hyperoxemic levels (>180 mmHg). During
anesthetic management of cardiothoracic surgery it is important to keep
PaO<inf>2</inf> levels between 80-180 mmHg. The aim of this study was to
assess whether adjusting FiO<inf>2</inf> levels in accordance with body
temperature and body surface area (BSA) during ECC is an effective method
for maintaining normoxemic PaO<inf>2</inf> during cardiac surgery.
Methods: After approval from the Ethics Committee of the University of
Acibadem, informed consent was given from 60 patients. FiO<inf>2</inf>
adjustment strategies applied to the patients in the groups were as
follows: FiO<inf>2</inf> levels were set as 0.21 x BSA during hypothermia
and 0.21 x BSA + 10 during rewarming in Group I; 0.18 x BSA during
hypothermia and 0.18 x BSA + 15 during rewarming in Group II; and 0.18 x
BSA during hypothermia and variable with body temperature during rewarming
in Group III. Arterial blood gas values and hemodynamic parameters were
recorded before ECC (T1); at the 10th minute of cross clamp (T2); when the
esophageal temperature (OT) reached 34degreeC (T3); when OT reached
36degree C (T4); and just before the cessation of ECC (T5). Results: Mean
PaO<inf>2</inf> was significantly higher in Group I than in Group II at T2
and T3 (P = .0001 and P = .0001, respectively); in Group I than in Group
III at T1 (P = .02); and in Group II than in Group III at T2, T3, and T4
(P = .0001 for all). Conclusion: Adjustment of FiO<inf>2</inf> according
to BSA rather than keeping it at a constant level is more appropriate for
keeping PaO<inf>2</inf> between safe level limits. However, since oxygen
consumption of cells vary with body temperature, it would be appropriate
to set FiO2 levels in concordance with the body temperature in the
rewarming period.
Copyright &#xa9; 2015 Forum Multimedia Publishing, LLC.

<104>
Accession Number
604707902
Author
Kuhn E.W.; Choi Y.-H.; Pyun J.-M.; Neef K.; Liakopoulos O.J.; Stamm C.;
Wittwer T.; Wahlers T.
Institution
(Kuhn, Choi, Pyun, Neef, Liakopoulos, Wittwer, Wahlers) Department of
Cardiothoracic Surgery, Heart Center of the University of Cologne,
Kerpener Strasse 62, Cologne 50924, Germany
(Choi, Neef, Wittwer, Wahlers) Center for Molecular Medicine Cologne,
University of Cologne, Kerpener Strasse 62, Cologne 50924, Germany
(Stamm) Department of Cardiothoracic Surgery, German Heart Institute
Berlin, Augustenburger Platz 1, Berlin 13353, Germany
Title
Endothelial injury associated with cold or warm blood cardioplegia during
coronary artery bypass graft surgery.
Source
BioMed Research International. 2015 (no pagination), 2015. Article Number:
256905. Date of Publication: 2015.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
The aim of this investigation was to analyze the impact of intermittent
cold blood cardioplegia (ICC) and intermittent warm blood cardioplegia
(IWC) on endothelial injury in patients referred to elective on-pump
coronary artery bypass graft (CABG) surgery. Patients undergoing CABG
procedures were randomized to either ICC or IWC. Myocardial injury was
assessed by CK-MB and cardiac troponin T (cTnT). Endothelial injury was
quantified by circulating endothelial cells (CECs), von Willebrand factor
(vWF), and soluble thrombomodulin (sTM). Perioperative myocardial injury
(PMI) and major adverse cardiac events (MACE) were recorded. Demographic
data and preoperative risk profile of included patients (ICC: n=32, IWC:
n=36) were comparable. No deaths, PMI, or MACE were observed. Levels of
CK-MB and cTnT did not show intergroup differences. Concentrations of CECs
peaked at 6 h postoperatively with significantly higher values for
IWC-patients at 1 h (ICC: 10.1 +/- 3.9/mL; IWC: 18.4 +/- 4.1/mL; P=0.012)
and 6 h (ICC: 19.3 +/- 6.2/mL; IWC: 29.2 +/- 6.7/mL; P<0.001).
Concentrations of vWF (ICC: 178.4 +/- 73.2 U/dL; IWC: 258.2 +/- 89.7 U/dL;
P<0.001) and sTM (ICC: 3.2 +/- 2.1 ng/mL; IWC: 5.2 +/- 2.4 ng/mL; P=0.011)
were significantly elevated in IWC-group at 1 h postoperatively. This
study shows that the use of IWC is associated with a higher extent of
endothelial injury compared to ICC without differences in clinical
endpoints.
Copyright &#xa9; 2015 Elmar W. Kuhn et al.

<105>
Accession Number
615417012
Author
Cios T.J.; Salamanca-Padilla Y.; Guvakov D.
Institution
(Cios, Salamanca-Padilla, Guvakov) Department of Anesthesiology and
Perioperative Medicine, Penn State Health Milton S. Hershey Medical
Center, Hershey, PA, United States
Title
An anti-coagulation conundrum: Implantation of total artificial heart in a
patient with heparin-induced thrombocytopenia type II.
Source
American Journal of Case Reports. 18 (pp 294-298), 2017. Article Number:
902320. Date of Publication: 23 Mar 2017.
Publisher
Medical Science International (E-mail: office@isl-science.com)
Abstract
Objective: Rare co-existance of disease or pathology Background:
Heparin-induced thrombocytopenia (HIT) is a rare but life-threatening
complication of heparin administration. It can present a major clinical
dilemma for physicians caring for patients requiring life-saving urgent or
emergent cardiac surgery. Studies have been published examining the use of
alternative anticoagulants for patients undergoing cardiopulmonary bypass
(CPB), however, evidence does not clearly support any particular approach.
Presently, there are no large-scale, prospective randomized studies
examining the impact of alternative anticoagulants on clinical outcomes
for HIT-positive patients requiring cardiac surgery. Case Report: We
present the case of a patient who underwent SynCardia Total Artificial
Heart (TAH) implantation following a recent left ventricular assist device
(LVAD) placement. The patient was receiving argatroban for type II HIT
with anuric renal failure, and developed a thrombus which occluded the
inflow cannula of the LVAD. Based on a published study and after
establishing consensus with the surgical, anesthesiology, perfusion, and
hematology teams, we decided to use tirofiban as an antiplatelet agent to
inhibit the platelet aggregation induced by heparin, and ultimately used
heparin as the anticoagulant for cardiopulmonary bypass. Conclusions: When
selecting anticoagulation for a HIT-positive patient requiring CPB, so
that benefits outweigh risks, it is of paramount importance that the
decision be based on a multitude of factors. The team caring for the
patient should have a shared mental model and be familiar with the
pharmacology, devices used, and local practices. These three elements
should be integrated with patient-specific comorbidities along with local
monitoring capabilities to ensure safe, efficient patient care.
Copyright &#xa9; Am J Case Rep, 2017.

<106>
Accession Number
615550152
Author
Feguri G.R.; De Lima P.R.L.; De Cerqueira Borges D.; Toledo L.R.; Batista
L.N.; E Silva T.C.; Segri N.J.; De Aguilar-Nascimento J.E.
Institution
(Feguri) Federal University of Mato Grosso, Cuiaba, Brazil
(Feguri, De Cerqueira Borges, Batista, E Silva) General University
Hospital, Cuiaba, Brazil
(Feguri) UNIC - University of Cuiaba, Cuiaba, Brazil
(De Lima) Cardiovascular Department, General University Hospital, Cuiaba,
Brazil
(Toledo) Nutrition Service, General University Hospital, Cuiaba, Brazil
(Segri) Department of Statistics, Federal University of Mato Grosso,
Cuiaba, Brazil
(De Aguilar-Nascimento) Federal University of Mato Grosso, UNIVAG Medical
School, Varzea Grande, Brazil
(Feguri) Rua Mal. Floriano Peixoto, 1520/503 - Duque de Caxias II, Cuiaba
CEP:78045-395, Brazil
Title
Preoperative carbohydrate load and intraoperatively infused omega-3
polyunsaturated fatty acids positively impact nosocomial morbidity after
coronary artery bypass grafting: A double-blind controlled randomized
trial.
Source
Nutrition Journal. 16 (1) (no pagination), 2017. Article Number: 24. Date
of Publication: 20 Apr 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: A strategy of limited preoperative fasting, with carbohydrate
(CHO) loading and intraoperative infusion of omega-3 polyunsaturated fatty
acids (omega-3 PUFA), has seldom been tried in cardiovascular surgery.
Brief fasting, followed by CHO intake 2 h before anesthesia, may improve
recovery from CABG procedures and lower perioperative vasoactive drug
requirements. Infusion of omega-3 PUFA may reduce occurrences of
postoperative atrial fibrillation (POAF) and shorten hospital stays. The
aim of this study was to assess morbidity (especially POAF) in ICU
patients after coronary artery bypass grafting (CABG)/cardiopulmonary
bypass (CPB) in combination, if preoperative fasts are curtailed in favor
of CHO loading, and omega-3 PUFA are infused intraoperatively. Methods:
Fifty-seven patients undergoing CABG were randomly assigned to receive
12.5% maltodextrin (200 ml, 2 h before anesthesia), without infusing
omega-3 PUFA (CHO, n = 14); water (200 ml, 2 h before anesthesia), without
infusing omega-3 PUFA (controls, n = 14); 12.5% maltodextrin (200 ml, 2 h
before anesthesia) plus intraoperative omega-3 PUFA (0.2 mcg/kg) (CHO +
W3, n = 15); or water (200 ml, 2 h before anesthesia) plus intraoperative
omega-3 PUFA (0.2 mcg/kg) (W3, n = 14). Perioperative clinical variables
and mortality were analyzed, examining the incidence of POAF, as well as
the need for inotropic vasoactive drugs during surgery and in ICU.
Results: Two deaths occurred (3.5%), but there were no instances of
bronchoaspiration and mediastinitis. Neither ICU stays nor total
postoperative stays differed by group (P > 0.05). Patients given
preoperative CHO loads (CHO and CHO + W3 groups) experienced fewer
instances of hospital infection (RR = 0.29, 95%CI 0.09-0.94; P = 0.023)
and were less reliant on vasoactive amines during surgery (RR = 0.60, 95%
CI 0.38-0.94; P = 0.020). Similarly, the number of patients requiring
vasoactive drugs while recovering in ICU differed significantly by group
(P = 0.008), showing benefits in patients given CHO loads. The overall
incidence of POAF was 29.8% (17/57), differing significantly by group (P =
0.009). Groups given omega-3 PUFA (W3 and CHO + W3 groups) experienced
significantly fewer instances of POAF (RR = 4.83, 95% CI 1.56-15.02; P =
0.001). Conclusion: Preoperative curtailment of fasting was safe in this
cohort. When implemented in conjunction with CHO loading and infusion of
omega-3 PUFA during surgery, expedited recovery from CABG with CPB was
observed. Trial registration: NCT: 03017001
Copyright &#xa9; 2017 The Author(s).

<107>
Accession Number
615618126
Author
Vierhout B.P.; Pol R.A.; El Moumni M.; Zeebregts C.J.
Institution
(Vierhout) Department of Surgery, Wilhelmina Ziekenhuis Assen,
Europaweg-Zuid 1, 9401 RK Assen, The Netherlands
(Pol, El Moumni) Department of Surgery, University Medical Centre
Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The
Netherlands
(Zeebregts) Department of Surgery, Division of Vascular Surgery,
University Medical Centre Groningen, University of Groningen, Hanzeplein
1, 9700 RB Groningen, The Netherlands
Title
Arteriotomy Closure Devices in EVAR, TEVAR, and TAVR: A Systematic Review
and Meta-analysis of Randomised Clinical Trials and Cohort Studies.
Source
European Journal of Vascular and Endovascular Surgery. (no pagination),
2017. Date of Publication: December 21, 2016.
Publisher
W.B. Saunders Ltd
Abstract
Objectives: Cardiac and vascular surgery benefit from percutaneous
interventions. Arteriotomy closure devices (ACDs) enable minimally
invasive access to the common femoral artery (CFA). The objective of this
review was to assess the differences between ACDs and surgical cut down
(SCD) of the CFA regarding the number of complications, duration of
surgery (DOS), and hospital length of stay (HLOS). Design: A systematic
literature search with predefined search terms was performed using
MEDLINE, Embase, and the Cochrane Library (2000-2016). All studies
reporting on ACD and SCD for a puncture of the CFA of at least 12 French
(Fr.) were assessed for eligibility. Methods: Included were randomised
controlled trials and cohort studies comparing both techniques. Patient
characteristics, exclusion criteria, and conversion rates were evaluated.
Complications, DOS, and HLOS were compared. Materials: A total of 17
studies were included for meta-analysis, describing 7889 vascular access
sites; four studies were randomised trials, two studies reported from a
prospective database, and 11 studies reported retrospective cohorts.
Results: ACD was associated with fewer post-operative seromas (odds ratio
[OR] 0.15, 95% confidence interval [CI] 0.06-0.35), less wound dehiscence
(OR 0.14, 95% CI 0.03-0.78), and fewer surgical site infections (OR 0.38,
95% CI 0.23-0.63). Post-operative pseudoaneurysms were significantly more
common in the ACD group (OR 3.83, 95% CI 1.55-9.44). In five of 17
studies, DOS and HLOS were not reduced in the ACD group. When all studies
reporting a mean DOS and/or HLOS were compared in a non-parametric
analysis, neither was significantly different. Conclusion: This
meta-analysis favours ACD regarding the number of wound complications
compared with SCD in endovascular aneurysm repair, thoracic endovascular
aneurysm repair, and transcatheter aortic valve repair. Treatment duration
(DOS and HLOS) was not reduced in ACD. The differences are of limited
clinical significance and with this equivocal quality of evidence, the ACD
may be considered safe for CFA access in suitable patients.
Copyright &#xa9; 2017 European Society for Vascular Surgery.

<108>
Accession Number
615615840
Author
Putzu A.; Gallo M.; Martino E.A.; Ferrari E.; Pedrazzini G.; Moccetti T.;
Cassina T.
Institution
(Putzu, Cassina) Department of Cardiovascular Anesthesia and Intensive
Care, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland
(Gallo, Ferrari) Department of Cardiac Surgery, Cardiocentro Ticino, Via
Tesserete 48, Lugano, Switzerland
(Martino) Department of Anesthesia and Intensive Care, San Gerardo
Hospital, Via Pergolesi 33, Monza, Italy
(Pedrazzini, Moccetti) Department of Cardiology, Cardiocentro Ticino, Via
Tesserete 48, Lugano, Switzerland
Title
Coronary artery bypass graft surgery versus percutaneous coronary
intervention with drug-eluting stents for left main coronary artery
disease: A meta-analysis of randomized trials.
Source
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: December 27, 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Despite several clinical studies, efficacy of coronary artery
bypass grafting (CABG) surgery versus percutaneous coronary intervention
(PCI) in patients with left main (LM) disease remains controversial. The
objective of this meta-analysis of randomized trials was to evaluate the
clinical outcome of CABG versus PCI with drug-eluting stents in LM
coronary disease. Methods: We systematically searched online databases up
to March 2017 for randomized trials comparing CABG to PCI with
drug-eluting stents. We calculated odds ratios (ORs) and 95% confidence
intervals (CIs). Results: We included data from 5 randomized trials and
4595 patients. At 30. days, CABG was associated with higher stroke (OR
2.54 [95% CI, 1.02-6.31]) and periprocedural myocardial infarction (OR
1.45 [95% CI, 1.00-2.10]), with no other significant differences compared
to PCI. At 1. year, CABG reduced repeat revascularization (OR 0.56 [95%
CI, 0.40-0.77]), but increased stroke (OR 5.11 [95% CI, 1.62-16.12]). At
3-5. years, CABG reduced repeat revascularization (OR 0.55 [95% CI,
0.45-0.67]) and non-periprocedural myocardial infarction (OR 0.45 [95% CI,
0.29-0.70]), without significant differences on other outcomes.
Conclusions: From the present updated meta-analysis of available studies
on LM coronary disease treatment, there were no differences in mortality,
myocardial infarction, and stroke rate at 3-5. years follow-up after CABG
or PCI, but CABG decreased the rate of repeat revascularization and
non-periprocedural infarction. However, at short-term follow-up, CABG
showed higher rate of stroke and periprocedural myocardial infarction, but
these effects attenuated over time. These findings merit further
investigation at longer follow-up.
Copyright &#xa9; 2017 Elsevier B.V.

<109>
Accession Number
615615786
Author
Suominen P.K.; Keski-Nisula J.; Ojala T.; Rautiainen P.; Jahnukainen T.;
Hastbacka J.; Neuvonen P.J.; Pitkanen O.; Niemela J.; Kaskinen A.;
Salminen J.; Lapatto R.
Institution
(Suominen, Keski-Nisula, Rautiainen, Hastbacka) Department of Anesthesia
and Intensive Care, Children's Hospital, Helsinki University Hospital and
University of Helsinki, Helsinki, Finland
(Ojala, Jahnukainen, Pitkanen, Niemela, Kaskinen, Lapatto) Department of
Pediatrics, Children's Hospital, Helsinki University Hospital and
University of Helsinki, Helsinki, Finland
(Neuvonen) Department of Clinical Pharmacology, University of Helsinki and
HUSLAB, Helsinki University Hospital, Helsinki, Finland
(Salminen) Department of Pediatric Surgery, Children's Hospital, Helsinki
University Hospital and University of Helsinki, Helsinki, Finland
Title
Stress-Dose Corticosteroid Versus Placebo in Neonatal Cardiac Operations:
A Randomized Controlled Trial.
Source
Annals of Thoracic Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier USA
Abstract
Background: Corticosteroids can improve the hemodynamic status of neonates
with postoperative low cardiac output syndrome after cardiac operations.
This study compared a prophylactically administered stress-dose
corticosteroid (SDC) regimen against placebo on inflammation,
adrenocortical function, and hemodynamic outcome. Methods: Forty neonates
undergoing elective open heart operations were randomized into two groups.
The SDC group received perioperatively 2 mg/kg methylprednisolone, and 6
hours after the operation, a hydrocortisone infusion (0.2 mg/kg/h) was
started with tapering doses for 5 days. Placebo was administered in a
similar fashion. An adrenocorticotropic hormone stimulation test was
performed after the therapy. The primary endpoint of the study was plasma
concentration of interleukin (IL-6). Secondary clinical outcomes included
plasma cortisol, IL-10, C-reactive protein, echocardiographic systemic
ventricle contractility evaluated by the Velocity Vector Imaging program,
the inotropic score, and time of delayed sternal closure. Results: The
IL-6 values of the SDC group were significantly lower postoperatively than
in the placebo group. Significantly lower inotropic scores (p < 0.05),
earlier sternal closure (p = 0.03), and less deterioration in the systemic
ventricle mean delta strain values between the preoperative and the first
postoperative assessment (p = 0.01) were detected for the SDC group. The
SDC therapy did not suppress the hypothalamic-pituitary-adrenal axis more
than placebo. The mean plasma cortisol level did not decline in the
placebo group after the operation. Conclusions: The SDC regimen for 5 days
postoperatively in neonates was safe and did not cause suppression of the
hypothalamic-pituitary-adrenal axis. Furthermore, the open heart operation
per se did not lead to adrenal insufficiency in neonates.
Copyright &#xa9; 2017 The Society of Thoracic Surgeons.

<110>
Accession Number
615612401
Author
Carter B.W.; Erasmus J.J.; Truong M.T.; Shepard J.A.O.; Hofstetter W.;
Clarke R.; Munden R.F.; Steele J.R.
Institution
(Carter, Erasmus, Truong) Department of Diagnostic Radiology, The
University of Texas MD Anderson Cancer Center, Houston, Texas
(Shepard) Department of Radiology, Massachusetts General Hospital, Boston,
Massachusetts
(Hofstetter) Department of Thoracic and Cardiovascular Surgery, The
University of Texas MD Anderson Cancer Center, Houston, Texas
(Clarke) Emory Healthcare, Atlanta, Georgia
(Munden) Department of Radiology, Wake Forest School of Medicine,
Winston-Salem, North Carolina
(Steele) Department of Interventional Radiology, The University of Texas
MD Anderson Cancer Center, Houston, Texas
Title
Quality and Value of Subspecialty Reinterpretation of Thoracic CT Scans of
Patients Referred to a Tertiary Cancer Center.
Source
Journal of the American College of Radiology. (no pagination), 2017. Date
of Publication: 2017.
Publisher
Elsevier B.V.
Abstract
Introduction: Patients referred to tertiary cancer centers often present
with imaging studies performed and interpreted at other health care
institutions. Although reinterpretation of imaging performed at another
health care institution can reduce repeat imaging, unnecessary radiation
dose, and cost, the benefit is uncertain. The purpose of this study is to
evaluate the quality of initial imaging studies of patients seeking a
second opinion at a tertiary cancer center, to compare the accuracy of
initial interpretations to reinterpretations performed by subspecialty
trained radiologists at a tertiary oncologic center, and to determine the
potential impact on patient management. Methods: An institutional review
board-approved retrospective, single-institution database review was
performed in 120 new patients presenting to the thoracic surgery clinics
at our institution from 2010 through 2013, with initial chest CTs
performed at another institution. Two thoracic radiologists blinded to the
interpretation independently assessed the quality and performed a
reinterpretation of 52 CTs. Fisher's exact tests were used to compare the
frequency with which clinically important staging parameters appeared in
the reinterpretations and initial reports. Discrepancies between the
reinterpretations and initial interpretations were adjudicated
independently by two thoracic radiologists at different tertiary cancer
institutions to determine which interpretations were more accurate. The
impact of discrepancies on clinical management was evaluated based on
National Comprehensive Cancer Network guidelines. Results: Of the 52 CTs,
32 (62%) were of inadequate image quality for staging. In 17 of 52 (33%),
discrepancies were identified between reinterpretations and initial
interpretations. For discrepancies, the reinterpretation was judged to be
more accurate for staging than the initial interpretation. In nine of
these patients, staging parameters were omitted in the initial
interpretations that precluded adequate staging. In the remaining eight
patients, six were upstaged, one was downstaged, and one was unchanged by
the reinterpretation. Conclusions: Imaging studies from outside
institutions are of variable image quality and often not adequate for
appropriate staging of thoracic malignancies. Reinterpretation can
decrease repeat imaging and associated technical costs. Additionally, the
accuracy of staging is improved by reinterpretation of CTs by subspecialty
trained radiologists and can significantly impact clinical management.
Copyright &#xa9; 2017 American College of Radiology.