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Accession Number
607382497
Author
Rodrigues G.; De Araujo Goncalves P.; Madeira S.; Rodrigues R.; Santos
M.B.; Brito J.; Raposo L.; Gabriel H.M.; Teles R.C.; Almeida M.; Mendes M.
Institution
(Rodrigues, De Araujo Goncalves, Madeira, Rodrigues, Santos, Brito,
Raposo, Gabriel, Teles, Almeida, Mendes) Hospital de Santa Cruz, Centro
Hospitalar de Lisboa Ocidental, Lisbon, Portugal
(De Araujo Goncalves, Almeida) CEDOC, Nova Medical School, Lisbon,
Portugal
Title
Impact of complete revascularization in patients with ST-elevation
myocardial infarction: Analysis of a 10-year all-comers prospective
registry.
Source
Coronary Artery Disease. 27 (2) (pp 122-127), 2016. Date of Publication:
28 Jan 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background The benefit of complete revascularization (CR) during a primary
percutaneous coronary intervention (PCI) in patients with multivessel
disease (MVD) is still not clear. The aim of the present study was to
evaluate the impact of CR in a nonselected population from an allcomers
prospective registry of patients with ST-elevation myocardial infarction
(STEMI) over a long period of time. Methods and results Between 2004 and
2014, 671 noncardiogenic shock STEMI patients with MVD were included in
the present study, of whom 522 were subjected to incomplete
revascularization and 149 were subjected to CR. Patients in the CR group
were younger [61 (SD 12) vs. 64 (SD 12.4) years old, P=0.001], more often
subjected to femoral access (79.4 vs. 67.1%, P=0.002), and had a lower
number of segments with lesion [2 (2.2) vs. 3 (3.4), P=0.001]. The CR
group tended to have a lower 1-year major adverse cardiac event (MACE)
rate (17.8 vs. 25.7%; P=0.05) that reached statistical significance at 2
years (19.4 vs. 28.5%, P=0.03). The rates of the individual endpoints were
not different between groups. Independent predictors of 2-year MACE were
age, femoral access, and previous PCI. Index CR was associated with lower
MACE (hazard ratio 0.5, 0.36-0.79). MACE-free survival was higher in the
CR group throughout the 2 years of follow-up. Conclusion In patients with
STEMI and MVD undergoing culprit lesion PCI, preventive PCI in noninfarct
coronary arteries with significant stenosis was associated with a lower
risk of MACE compared with incomplete revascularization in this all-comers
prospective registry.
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Accession Number
612036279
Author
Gargiulo G.; Sannino A.; Capodanno D.; Barbanti M.; Buccheri S.; Perrino
C.; Capranzano P.; Indolfi C.; Trimarco B.; Tamburino C.; Esposito G.
Institution
(Gargiulo, Perrino, Trimarco, Esposito) Department of Advanced Biomedical
Sciences, Division of Cardiology, Federico II University of Naples, Via
Pansini 5, Naples 80131, Italy
(Sannino) Baylor Research Institute, Baylor Heart and Vascular Hospital,
621 North Hall Street, Dallas, TX 75226, United States
(Capodanno, Barbanti, Buccheri, Capranzano, Tamburino) Department of
General Surgery and Medical-Surgical Specialties, University of Catania,
C/o Ospedale Ferrarotto, Via Salvatore Citelli 31, Catania 95124, Italy
(Indolfi) Department of Medical and Surgical Sciences and URT Consiglio
Nazionale delle Ricerche, Magna Graecia University, Viale Europa,
Catanzaro 88100, Italy
Title
Transcatheter aortic valve implantation versus surgical aortic valve
replacement: A Systematic review and meta-analysis.
Source
Annals of Internal Medicine. 165 (5) (pp 334-344), 2016. Date of
Publication: 06 Sep 2016.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Background: The comparative benefits and harms of transcatheter aortic
valve implantation (TAVI) and surgical aortic valve replacement (SAVR) for
patients with aortic stenosis are unclear. Purpose: To compare clinical
outcomes, including early (<30- day) and midterm (<1-year) mortality, in
adults with severe aortic stenosis undergoing either TAVI or SAVR. Data
Sources: MEDLINE, Cochrane, and Scopus databases (without language
restrictions) from April 2002 to 5 April 2016; multiple registries and Web
sites; scientific meeting presentations. Study Selection: Five randomized
trials and 31 observational matched studies comparing mortality outcomes
after TAVI or SAVR. Data Extraction: Two investigators independently
extracted study data and rated risk of bias. Data Synthesis: 16 638
patients were analyzed. Overall, there was no statistically significant
difference between TAVI and SAVR in early (odds ratio [OR], 1.01 [95% CI,
0.81 to 1.26]) or midterm (OR, 0.96 [CI, 0.81 to 1.14]) all-cause
mortality. Analyses restricted to trials (early: OR, 0.80 [CI, 0.51 to
1.25]; midterm: OR, 0.90 [CI, 0.64 to 1.26]) were inconclusive, with wide
CIs, whereas analyses of matched studies were similar to the overall
results. Transfemoral TAVI provided mortality benefits over SAVR in
trials. Analyses restricted to studies of patients at low to intermediate
risk showed statistically nonsignificant reductions in early (OR, 0.67
[CI, 0.42 to 1.07]) and midterm (OR, 0.91 [CI, 0.67 to 1.23]) mortality
with TAVI. Incidence of periprocedural myocardial infarction, major
bleeding, acute kidney injury, and newonset atrial fibrillation was lower
with TAVI, but risk for pacemaker implantation, vascular complications,
and paravalvular leak increased. Overall, there was a statistically
nonsignificant increased risk in long-term (2- To 5-year) all-cause
mortality with TAVI (OR, 1.28 [CI, 0.97 to 1.69]), whereas long-term
mortality outcomes in patients at low to intermediate risk were
inconclusive, with wide CIs (OR, 1.06 [CI, 0.59 to 1.91]). Limitation: The
number of trials was limited, and study designs and patient
characteristics were heterogeneous. Conclusion: Compared with SAVR, TAVI
may have similar or better early and midterm outcomes for adults with
aortic stenosis, including those at low to intermediate risk.
Copyright © 2016 American College of Physicians.

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Accession Number
608746128
Author
Tan W.-F.; Guo B.; Ma H.; Li X.-Q.; Fang B.; Lv H.-W.
Institution
(Tan, Guo, Ma, Li, Fang, Lv) Department of Anaesthesiology, The First
Hospital of China Medical University, Shenyang, China
Title
Changes in postoperative night bispectral index of patients undergoing
thoracic surgery with different types of anaesthesia management: A
randomized controlled trial.
Source
Clinical and Experimental Pharmacology and Physiology. 43 (3) (pp
304-311), 2016. Date of Publication: 01 Mar 2016.
Publisher
Blackwell Publishing (E-mail: info@asia.blackpublishing.com.au)
Abstract
Summary: This study hypothesized that different types of anaesthesia
management would result in similar postoperative sleep quality. In this
prospective single-blind investigation, 219 patients undergoing elective
thoracic surgery were randomized into three arms: general anaesthesia, as
the control group (group C); general anaesthesia combined with thoracic
epidural anaesthesia (TEA) (group E); and general anaesthesia combined
with infusion of 1 mug/kg dexmedetomidine (group D). Plasma samples were
obtained to measure the amine and inflammatory cytokine concentrations.
All patients underwent assessment with the bispectral index (BIS) for
sleep quality and the visual analogue scale (VAS) for pain. The primary
outcomes were inflammatory cytokine [interleukin-6 (IL-6) and tumor
necrosis factor alpha (TNF-alpha)] secretion and postoperative sleep
quality on the first and second postoperative nights. The secondary
outcomes were amine (adrenaline and noradrenaline) secretion during the
surgical period and haemodynamic stability. The postoperative BIS area
under the curve was significantly lower in group E (75.7%) than in group C
(87.3%) or group D (86.5%). Patients in group E had the highest BIS of
sleep efficiency index (29.2%, P < 0.05) and the lowest VAS scores (3.5, P
< 0.05). Group E had lower IL-6 levels than the other two groups 24 h
after surgery (P < 0.05). Patients given TEA may show reduced sleep
disturbances on the first night after surgery, perhaps due to better pain
management and inhibition of IL-6 release.
Copyright © 2016 John Wiley & Sons Australia, Ltd.

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Accession Number
607664968
Author
Chaudhary R.K.; Nepal C.; Khanal N.; Pathak R.; Giri S.; Bhatt V.R.
Institution
(Chaudhary) Department of Medicine, Institute of Medicine, Tribhuvan
University, Kathmandu, Nepal
(Nepal) Department of Medicine, Woodhull Medical and Mental Health Center,
New York City, NY, United States
(Khanal) Department of Internal Medicine, Creighton University Medical
Center, Omaha, NE, United States
(Pathak) Department of Medicine, Reading Health System, Reading, PA,
United States
(Giri) Department of Medicine, University of Tennessee Health Science
Center, Memphis, TN, United States
(Bhatt) Department of Internal Medicine, Division of Hematology and
Oncology, University of Nebraska Medical Center, Omaha, NE, United States
Title
Management and outcome of heparin-induced thrombocytopenia in pregnancy: A
systematic review.
Source
Cardiovascular and Hematological Agents in Medicinal Chemistry. 13 (2) (pp
92-97), 2015. Date of Publication: 01 Dec 2015.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Objective: Safety and efficacy of therapeutic agents used for
heparin-induced thrombocytopenia are not established in pregnancy.
Methods: MEDLINE database was searched in November 2014 to identify all
patients who received therapy for HIT during pregnancy. Results: A total
of 12 patients with the median age of 28 years (range 21-39) were
diagnosed with HIT at the median gestational age of 20 weeks (range 5-34).
Clinical probability (4T) score for HIT was high (50%) or intermediate
(50%) and associated with thrombosis in 50%. Patients were initially
managed with lepirudin (33%), argatroban (25%), danaparoid (25%) or
fondaparinux (17%) and ultimately bridged to vitamin K antagonist or
maintained on lepirudin. All patients had resolution of HIT. Complications
included therapeutic abortion prior to valve replacement for valve
thrombosis (8%), preterm delivery (18%) and preeclampsia (8%). Except for
one instance of hypoplastic lung related to preterm delivery, none of the
other newborns had any complications during delivery. Conclusion:
Confirmed cases of HIT in pregnant patients appear to be rare. Within the
limits of retrospective analysis, the use of argatroban, danaparoid,
fondaparinux and lepirudin may be effective in preventing the thrombotic
complications of HIT in pregnancy. The effect of HIT or its therapy on
obstetrical complications cannot be determined based on this study since
many of the obstetrical complications are common in otherwise healthy
pregnancies. Although this study did not identify any fetal teratogenicity
except hypoplastic lung related to preterm delivery, small number of cases
treated with various therapies precludes any definite conclusion
Copyright © 2015 Bentham Science Publishers.

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Accession Number
607612801
Author
Weinberg L.; Miles L.F.; Allaf M.; Pillai P.; Peyton P.; Doolan L.
Institution
(Weinberg) Department of Anesthesia, Centre for Anesthesia, Perioperative
and Pain Medicine, University of Melbourne, VIC, Australia
(Miles, Allaf, Pillai, Peyton) Department of Anesthesia, Intensive Care,
Austin Hospital, Heidelberg, VIC, Australia
(Doolan) Department of Intensive Care, Austin Hospital, Heidelberg, VIC,
Australia
Title
Video Fluoroscopy for Positioning of Pulmonary Artery Catheters in
Patients Undergoing Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 29 (6) (pp 1511-1516),
2015. Date of Publication: 01 Dec 2015.
Publisher
W.B. Saunders
Abstract
Objectives To determine whether video fluoroscopy combined with
traditional pressure waveform analyses facilitates optimal pulmonary
artery catheter (PAC) flotation and final positioning compared with the
traditional pressure waveform flotation technique alone. Design
Prospective, single-center, randomized, controlled trial. Setting
Single-center university teaching hospital. Participants The study
included 50 cardiac surgery patients at higher risk for PAC complications.
Interventions Use of video fluoroscopy to facilitate optimal PAC flotation
and positioning. Measurements and Main Results The primary outcome was the
time taken to float and position the PAC balloon in the pulmonary artery
as confirmed by transesophageal echocardiography. Secondary outcomes
included number of attempts at flotation, ventricular rhythm disturbances,
and catheter malposition. Patients were evenly matched in baseline
demographics, New York Heart Association symptoms of heart failure,
severity of left and right ventricular dysfunction, end-diastolic
pressures and dimensions, severity of tricuspid valvular disease, and
atrial and pulmonary artery pressures. Mean (SD) time to float the PAC was
significantly shorter in the video fluoroscopy group than in the usual
care group: 73 seconds (SD, 65.1) versus 176 seconds (SD, 180.6),
respectively; p = 0.014. The median (interquartile range [IQR]) number of
attempts to successful flotation was fewer in the video fluoroscopy group
than in the usual care group: 1 (IQR 1:2) attempt versus 2 (IQR 1:4)
attempts, respectively; p = 0.007. The composite complication rate
(malposition and arrhythmias) was lower in the video fluoroscopy group
than in the usual care group (16% v 52%, respectively; p = 0.01).
Conclusions In cardiac surgery patients at higher risk for PAC
complications, video fluoroscopy facilitated faster and safer catheter
flotation and positioning compared with the traditional pressure waveform
flotation technique.
Copyright © 2015 The Authors.

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Accession Number
607576306
Author
Hurley E.T.; O'Sullivan K.E.; Segurado R.; Hurley J.P.
Institution
(Hurley, O'Sullivan, Hurley) Heart Team, Mater Private Hospital, Eccles
St., Dublin 7, Ireland
(Segurado) CSTAR Centre for Statistical Training and Research, University
College, Dublin, Ireland
Title
A meta-analysis examining differences in short-term outcomes between
sutureless and conventional aortic valve prostheses.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 10 (6) (pp 375-382), 2015. Date of Publication: 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective: Sutureless aortic valve prostheses are anchored by radial force
in a mechanism similar to that of transcatheter aortic valve implantation.
Transcatheter aortic valve implantation is associated with an increased
permanent pacemaker (PPM) requirement in a significant proportion of
patients. We undertook a meta-analysis to examine the incidence of PPM
insertion associated with sutureless compared with conventional surgical
aortic valve replacement. Methods: A systematic review was conducted in
accordance with the Prisma guidelines.1 All searches were
performed on August 10, 2014. Studies between 2007 and 2014 were included
in the search. Results: A total of 832 patients were included in the
sutureless group and 3,740 in the conventional group. Aortic cross-clamp
(39.8 vs 62.4 minutes; P < 0.001) and cardiopulmonary bypass (64.9 vs 86.7
minutes; P = 0.002) times were shorter in the sutureless group. Permanent
pacemaker implantation rate was higher in the sutureless cohort (9.1% vs
2.4%; P = 0.025). Conclusions: Sutureless aortic valve prostheses are
associated with significantly shorter cardiopulmonary bypass and aortic
cross-clamp times and a higher incidence of PPM insertion than
conventional. Further investigation of the prognostic significance is
required.
Copyright © 2015 by the International Society for Minimally Invasive
Cardiothoracic Surgery.

<7>
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Accession Number
607321519
Author
Valdis M.; Chu M.W.A.; Schlachta C.M.; Kiaii B.
Institution
(Valdis, Chu, Kiaii) Division of Cardiac Surgery, Department of Surgery,
Western University, London Health Sciences Centre, 339 Windermere Rd.,
London, ON N6A 5A5, Canada
(Schlachta) Division of General Surgery, Department of Surgery, Western
University, London Health Sciences Centre, London, ON, Canada
Title
Validation of a novel virtual reality training curriculum for robotic
cardiac surgery a randomized trial.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 10 (6) (pp 383-388), 2015. Date of Publication: 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective: Robotic cardiac surgery training has relied entirely on
classical methods of surgical teaching. We sought to evaluate the impact
of a virtual reality (VR) simulation curriculum to improve skill
acquisition in robotic cardiac surgery. Methods: We randomly assigned 20
surgical trainees to undergo a 9-exercise VR curriculum on a robotic
surgical simulator or a control group that received no additional
training. The trainees were then evaluated in a blinded fashion by
assessing their de-identified video recordings of the following: (1)
standardized robotic internal thoracic artery harvest and (2) mitral valve
annuloplasty performed in porcine models, using a validated time-based
scoring system and an objective intraoperative scoring tool.
Postintervention assessments were compared to baseline. Results: Trainees
randomized to the VR group were faster than the control group for both the
internal thoracic artery harvest (957.3 T 98.9 vs. 749.1 T 171.9; P =
0.004) and mitral annuloplasty (580.4 T 14.4 vs. 463.8 T 86.4; P G 0.001)
and scored significantly higher with the intraoperative scoring tool (22.8
T 2.7 vs. 11.0 T 4.5; P G 0.001). Additionally, the VR group achieved a
proficiency level similar to our experts for both time-based scores (P =
0.624 and P = 0.967), and the intraoperative assessment (P = 0.110),
whereas the control group was not able to meet this level of proficiency
for any of the primary outcomes. The average duration of training to
successfully complete all required tasks was 9.3 hours. Conclusions: We
have demonstrated that a VR simulation curriculum can significantly
improve the efficiency and quality of learning in robotic cardiac surgery.
Further evaluation of this curriculum is required for its widespread
implementation in surgical training (ClinicalTrials.gov, NCT#02357056).
Copyright © 2015 by the International Society for Minimally Invasive
Cardiothoracic Surgery.

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Accession Number
607225562
Author
Celano C.M.; Millstein R.A.; Bedoya C.A.; Healy B.C.; Roest A.M.; Huffman
J.C.
Institution
(Celano, Millstein, Bedoya, Huffman) Department of Psychiatry,
Massachusetts General Hospital, 55 Fruit Street/Blake 11, Boston, MA,
United States
(Celano, Millstein, Bedoya, Healy) Harvard Medical School, Boston, MA,
United States
(Healy, Huffman) Department of Neurology, Massachusetts General Hospital,
Boston, MA, United States
(Roest) Interdisciplinary Center Psychopathology and Emotion Regulation,
Department of Psychiatry, University of Groningen, University Medical
Center Groningen, Groningen, Netherlands
Title
Association between anxiety and mortality in patients with coronary artery
disease: A meta-analysis.
Source
American Heart Journal. 170 (6) (pp 1105-1115), 2015. Date of Publication:
01 Dec 2015.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Depression and anxiety are common in patients with coronary
artery disease (CAD). Although depression clearly has been associated with
mortality in this population, the relationship between anxiety and
mortality is less clear. Accordingly, we performed a series of
meta-analyses to (1) examine the relationship between anxiety and
mortality in patients with established CAD and (2) determine if this
relationship differs in patients with stable CAD compared to those who
have just had an acute coronary syndrome (ACS). Methods and results
Systematic literature searches identified 44 articles (total N = 30,527)
evaluating the prospective relationship between anxiety and mortality in
individuals with established CAD. A series of 8 adjusted and unadjusted
meta-analyses were performed to examine this relationship across all
patients, with sensitivity analyses completed in post-ACS and stable CAD
cohorts. In unadjusted analyses, anxiety was associated with a moderate
increase in mortality risk (odds ratio 1.21 per SD increase in anxiety).
However, when adjusting for covariates, nearly all associations became
nonsignificant. In sensitivity analyses, anxiety was associated with an
increased risk of poor outcomes in the stable CAD - but not post-ACS -
cohort. Conclusions These analyses confirm that anxiety is associated with
increased risk of mortality in patients with CAD; however, this
relationship is not as strong as that of depression and may be explained
partly by other clinical factors. If anxiety screening is performed, it
should be performed during a period of clinical stability and should
target anxiety disorders rather than anxiety symptoms alone.
Copyright © 2015 Elsevier Inc.

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Accession Number
614483231
Author
Nicolosi G.L.
Institution
(Nicolosi) Cardiologia, A.R.C., Policlinico S.Giorgio, Via F. De Sanctis
n.7, Cordenons (Pordenone) 33084, Italy
Title
Potential uselessness and futility of left atrial appendage occlusion and
patent foramen ovale closure in cardioembolic stroke.
Source
Journal of Cardiovascular Medicine. 18 (6) (pp 393-397), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
International guidelines indicate that interventional closure of left
atrial appendage and patent foramen ovale may be considered in selected
patients for stroke prevention. These procedures appear, however, from the
published literature, at high risk of uselessness and futility in the
single case, if not even capable to induce harm and adverse events. In
fact, all reported systematic reviews and meta-analyses have not shown in
a convincing manner the superiority of these procedures in stroke
prevention, taking into account the occurrence of possible complications
also, as compared with alternative medical treatment. On the basis of
these considerations, it becomes very difficult to define always and
unequivocally how adequate and complete was the information when given to
each single candidate patient before the procedure by the Heart Team, the
left atrial appendage occlusion Team or patent foramen ovale closure Team,
potentially involved in conflict of interest. Before indicating these
procedures, a complete diagnostic work-up should then be planned for each
single patient to identify and treat not only one, but all concomitant
risk factors and potential different cardioembolic sources. It could also
be suggested to have, for each single candidate patient, a second
independent opinion from physicians not involved in the procedure and
possibly not operating in the same institution. This prudential approach
could reduce in each single case the risk of uselessness, futility and
even potential harm and adverse events of those procedures.
Copyright © 2017 Italian Federation of Cardiology.

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Accession Number
613545299
Author
Hallgren O.; Svenmarker S.; Appelblad M.
Institution
(Hallgren, Svenmarker, Appelblad) Department of Public Health and Clinical
Medicine, Heart Centre, Umea University, Umea, Sweden
Title
Implementing a Statistical Model for Protamine Titration: Effects on
Coagulation in Cardiac Surgical Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (2) (pp 516-521),
2017. Date of Publication: April 2017.
Publisher
W.B. Saunders
Abstract
Objectives To implement a statistical model for protamine titration.
Design Prospective randomized trial. Setting University hospital.
Participants Sixty (n = 30+30) patients scheduled for elective coronary
artery bypass surgery were randomly assigned to 2 groups. Interventions
Protamine dose calculated according to an algorithm established from a
statistical model or to a fixed protamine-heparin dose ratio (1:1).
Measurements and Main Results Both groups demonstrated comparable patient
demographics and intraoperative data. Coagulation effects were evaluated
using rotational thromboelastometry. Using the statistical model reduced
(p<0.01) the protamine dose from 426+/-43 mg to 251+/-66 mg, followed by
significantly (p<0.01) shorter intrinsic clotting time (208+/-29 seconds
versus 244+/-52 seconds) and stronger clot firmness (p = 0.01), and
effects on indices of extrinsic or fibrinogen coagulation pathways were
insignificant. Test of residual heparin was negative in all patients after
protamine administration, aligned with insignificant (p = 0.27) intergroup
heparinase-verified clotting time differences. Conclusions The statistical
model for protamine titration is clinically feasible and protects the
patient from exposure to excessive doses of protamine, with advantageous
effects on coagulation as measured using rotational thromboelastometry.
Significance regarding clinical outcome is yet to be defined.
Copyright © 2017 Elsevier Inc.

<11>
Accession Number
609871338
Author
Norgaard B.L.; Hjort J.; Gaur S.; Hansson N.; Botker H.E.; Leipsic J.;
Mathiassen O.N.; Grove E.L.; Pedersen K.; Christiansen E.H.; Kaltoft A.;
Gormsen L.C.; Maeng M.; Terkelsen C.J.; Kristensen S.D.; Krusell L.R.;
Jensen J.M.
Institution
(Norgaard, Hjort, Gaur, Hansson, Botker, Mathiassen, Grove, Pedersen,
Christiansen, Kaltoft, Maeng, Terkelsen, Kristensen, Krusell, Jensen)
Department of Cardiology, Aarhus University Hospital Skejby, Aarhus,
Denmark
(Leipsic) Department of Radiology, St. Paul's Hospital, University of
British Columbia, British Columbia, Canada
(Grove) Faculty of Health, Institute of Clinical Medicine, Aarhus
University, Aarhus, Denmark
(Gormsen) Department of Nuclear Medicine, Aarhus University Hospital
Skejby, Aarhus, Denmark
Title
Clinical Use of Coronary CTA-Derived FFR for Decision-Making in Stable
CAD.
Source
JACC: Cardiovascular Imaging. 10 (5) (pp 541-550), 2017. Date of
Publication: May 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The goal of this study was to assess the real-world clinical
utility of fractional flow reserve (FFR) derived from coronary computed
tomography angiography (FFR<inf>CT</inf>) for decision-making in patients
with stable coronary artery disease (CAD). Background FFR<inf>CT</inf> has
shown promising results in identifying lesion-specific ischemia. The
real-world feasibility and influence on the diagnostic work-up of
FFR<inf>CT</inf> testing in patients suspected of having CAD are unknown.
Methods We reviewed the complete diagnostic work-up of nonemergent
patients referred for coronary computed tomography angiography over a
12-month period at Aarhus University Hospital, Denmark, including all
patients with new-onset chest pain with no known CAD and with
intermediate-range coronary lesions (lumen reduction, 30% to 70%) referred
for FFR<inf>CT</inf>. The study evaluated the consequences on downstream
diagnostic testing, the agreement between FFR<inf>CT</inf> and invasively
measured FFR or instantaneous wave-free ratio (iFR), and the short-term
clinical outcome after FFR<inf>CT</inf> testing. Results Among 1,248
patients referred for computed tomography angiography, 189 patients (mean
age 59 years; 59% male) were referred for FFR<inf>CT</inf>, with a
conclusive FFR<inf>CT</inf> result obtained in 185 (98%). FFR<inf>CT</inf>
was <0.80 in 31% of patients and 10% of vessels. After FFR<inf>CT</inf>
testing, invasive angiography was performed in 29%, with FFR measured in
19% and iFR in 1% of patients (with a tendency toward declining FFR-iFR
guidance during the study period). FFR<inf>CT</inf> <0.80 correctly
classified 73% (27 of 37) of patients and 70% (37 of 53) of vessels using
FFR <0.80 or iFR <0.90 as the reference standard. In patients with
FFR<inf>CT</inf> >0.80 being deferred from invasive coronary angiography,
no adverse cardiac events occurred during a median follow-up period of 12
(range 6 to 18 months) months. Conclusions FFR<inf>CT</inf> testing is
feasible in real-world symptomatic patients with intermediate-range
stenosis determined by coronary computed tomography angiography.
Implementation of FFR<inf>CT</inf> for clinical decision-making may
influence the downstream diagnostic workflow of patients. Patients with an
FFR<inf>CT</inf> value >0.80 being deferred from invasive coronary
angiography have a favorable short-term prognosis.
Copyright © 2017 American College of Cardiology Foundation

<12>
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 © 2017 The Author(s).

<13>
Accession Number
615827984
Author
Sedighinejad A.; Imantalab V.; Mirmansouri A.; Mohammadzadeh Jouryabi A.;
Nassiri Sheikhani N.; Naderi Nabi B.; Haghighi M.; Biazar G.;
Atrkarroushan Z.
Institution
(Sedighinejad, Imantalab, Mirmansouri, Mohammadzadeh Jouryabi, Haghighi,
Biazar) Anesthesiology Research Center, Guilan University of Medical
Sciences (GUMS), Rasht, Iran, Islamic Republic of
(Nassiri Sheikhani) Department of Cardaic Surgery, Guilan University of
Medical Sciences, Rasht, Iran, Islamic Republic of
(Naderi Nabi) Anesthesiology Department, Anesthesiology Research Center,
Guilan University of Medical Sciences, Rasht, Iran, Islamic Republic of
(Atrkarroushan) Guilan University of Medical Sciences (GUMS), Rasht, Iran,
Islamic Republic of
Title
Effect of selenium on ischemia-reperfusion injury in the coronary artery
bypass graft surgery: A clinical trial study.
Source
Iranian Red Crescent Medical Journal. 19 (4) (no pagination), 2017.
Article Number: e42562. Date of Publication: April 2017.
Publisher
Kowsar Medical Publishing Company (E-mail: ircmj@irmj.ir)
Abstract
Background: In patients with coronary artery stenosis, coronary artery
bypass graft surgery (CABG) is the most effective strategy to limit
infarct size and improving outcomes. However, the rapid restoring of
bloodflowto the tissue can paradoxically induce cardiac damage. This
phenomenon termed as myocardial ischemic/reperfusion (I/R) injury which is
exacerbated under cardiopulmonary bypass (CPB) and is the cause of poor
clinical outcomes. Therefore, it is essential to search for novel
strategies with further cardio protective effects. Objectives: In the
current study, we investigated the effects of selenium (Se) administration
on I/R injury in CABG patients. Methods: This randomized double-blind
clinical trial was conducted in the department of cardiac surgery of a
university hospital in North of Iran from May 2015 to September 2015. One
hundred and ten patients undergoing an elective isolated CABG surgery were
divided into two groups using randomized fixed quadripartite blocks. They
received either intravenous Se before induction of anesthesia, or normal
saline as placebo. Cardiac troponin I (CTnI) and creatine kinase-MB (CKMB)
were measured as biomarkers at four measurement point times, before the
intervention (T0), at 6, 12, 24 and 48 hours after the surgery (T1-T4).
Results: Finally, data from 104 patients were analyzed, the Se (n = 53)
and control (n = 51) groups. There was no significant difference between
the two groups regarding the baseline characteristics. In both groups CPB
caused a markedly increase in CKMB and CTnI plasma concentrations compared
to the baseline (P = 0.0001). Based on CKMB, there was no significant
difference between the two groups at any point times, T0 (P = 0.357), T1
(P = 0.751), T2 (P = 0.46), T3 (P = 0.16) and T4 (P = 0.053). According to
CTnI, there was just a significant difference between the two groups at T1
(P = 0.011) but not at T2 (P = 0.116), T3 (P = 0.09) and T4 (P = 0.634).
No adverse effect was recorded linked to our intervention. Conclusions:
Selenium can alleviate I/R injury in short time. Further well-planned
trials are needed to find the optimized administration method to achieve
the most beneficial effects to the patients.
Copyright © 2016, Iranian Red Crescent Medical Journal.

<14>
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
University, Hamilton, ON, Canada
(Paikin, Hirsh, Ginsberg, Weitz, Pare, Eikelboom) Department of Medicine,
McMaster University, Hamilton, ON, Canada
(Hirsh, Chan, Whitlock, Pare, Eikelboom) Population Health Research
Institute, McMaster University, Hamilton, 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. 15 (5) (pp 889-896), 2017. Date of
Publication: May 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 © 2017 International Society on Thrombosis and Haemostasis

<15>
Accession Number
615096208
Author
Tran K.C.; Leung A.A.; Tang K.L.; Quan H.; Khan N.A.
Institution
(Tran, Khan) Division of General Internal Medicine, University of British
Columbia, Vancouver, British Columbia, Canada
(Leung, Tang) Department of Medicine, University of Calgary, Calgary,
Alberta, Canada
(Leung, Quan) Department of Community Health Sciences, University of
Calgary, Calgary, Alberta, Canada
(Khan) Center for Health Evaluation and Outcome Sciences, Vancouver,
British Columbia, Canada
Title
Efficacy of Calcium Channel Blockers on Major Cardiovascular Outcomes for
the Treatment of Hypertension in Asian Populations: A Meta-analysis.
Source
Canadian Journal of Cardiology. 33 (5) (pp 635-643), 2017. Date of
Publication: May 2017.
Publisher
Pulsus Group Inc.
Abstract
Background Whether calcium channel blockers exert a greater effect on
cardiovascular risk reduction in Asian populations than other
antihypertensive agents is unclear. We conducted a meta-analysis of
hypertension trials of dihydropyridine calcium channel blockers in Asian
populations to clarify this association. Methods EMBASE, MEDLINE, and
Cochrane databases were searched (from inception to August 2016) for
randomized controlled trials on cardiovascular death, major adverse
cardiovascular events, stroke, congestive heart failure, and coronary
revascularization in Asian persons with hypertension. We identified 9
trials that reported data specific to Asian populations (N = 29,643).
These trials included 1 placebo-controlled trial and 8 active comparator
trials; of these, 5 had angiotensin receptor blockers as the active
comparator. Results One placebo-controlled trial (n = 9711) showed
significantly reduced cardiovascular mortality, major adverse
cardiovascular events, and stroke with calcium channel blockers. Among 8
active comparator trials (n = 19,932), there were no significant
differences in mortality (relative risk [RR], 1.10; 95% confidence
interval [CI], 0.72-1.67; I2 = 0.0%), major adverse
cardiovascular events (RR, 1.02; 95% CI, 0.90-1.15; I2 = 0.0%),
stroke (RR, 0.97; 95% CI, 0.80-1.17; I2 = 0.0%), congestive
heart failure (RR, 1.01; 95% CI, 0.51-2.00; I2 = 53.7), or
coronary revascularization rates (RR, 0.98; 95% CI, 0.76-1.25;
I2 = 0.0%) in the calcium channel blocker group compared with
other antihypertensive agents. When restricting the meta-analysis to
angiotensin receptor blocker comparators (n = 10,384), there were no
significant differences in cardiovascular outcomes. Conclusions There is
no evidence that dihydropyridine calcium channel blockers are superior to
other antihypertensive agents in Asian populations for the treatment of
hypertension.
Copyright © 2017 Canadian Cardiovascular Society

<16>
Accession Number
615411194
Author
Zhai M.; Kang F.; Han M.; Huang X.; Li J.
Institution
(Zhai, Li) School of Medicine, Shandong University, Ji nan, Shandong,
China
(Zhai, Kang, Han, Huang, Li) Department of Anesthesiology, Anhui
Provincial Hospital, Anhui Medical University, Hefei, Anhui, China
Title
The effect of dexmedetomidine on renal function in patients undergoing
cardiac valve replacement under cardiopulmonary bypass: A double-blind
randomized controlled trial.
Source
Journal of Clinical Anesthesia. 40 (pp 33-38), 2017. Date of Publication:
01 Aug 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective We attempted to explore the effect of Dex on renal
function in patients with cardiac valve replacement under cardiopulmonary
bypass (CPB). Design We designed a prospective, randomized,
placebo-controlled, single-center, parallel-arm double-blind trial.
Setting Operating room. Patients Seven-two eligible patients were randomly
divided into Dex group and placebo group. Interventions Dexmedetomidine
(Dex) (0.6 mug.kg- 1) was administered in patients of Dex group
at 15 min before anesthesia induction, followed by a treatment of 0.2
mug.kg- 1.h- 1 Dex until the end of operation.
Patients in placebo group were treated with normal saline equally.
Measurements The levels of serum urea nitrogen (BUN), creatinine (Cr),
neutrophil gelatinase-associated lipocalin (NGAL), urine interleukin-8
(IL-18) and superoxide dismutase (SOD) activity were tested before
anesthesia induction (T1) and after operation at 0, 12 h, 24 h and 72 h
(T2-5). The urine output during operation and the post-operative
complication of acute kidney injury (AKI) were recorded. Main results The
levels of BUN and Cr were significantly increased at T5, and similar
findings were found in the levels of NGAL and urine IL-18 at T3 and T4.
The SOD activity was significantly declined at T2 and T3 in the two
groups. The levels of BUN and Cr at T5 and the NGAL level at T3 and T4
were significantly lower in Dex group, comparable to placebo group. The
intraoperative urine output was significantly increased and the
postoperative incidence of AKI was significantly lower in Dex group.
Conclusions Dex may attenuate the renal injury and decrease the incidence
of AKI in patients undergoing cardiac valve replacement under CPB.
Copyright © 2017 Elsevier Inc.

<17>
Accession Number
614998047
Author
Lee A.; Mu J.L.; Joynt G.M.; Chiu C.H.; Lai V.K.W.; Gin T.; Underwood M.J.
Institution
(Lee, Mu, Joynt, Chiu, Lai, Gin) Department of Anaesthesia and Intensive
Care, Chinese University of Hong Kong, Hong Kong, Hong Kong
(Underwood) Division of Cardiothoracic Surgery, Department of Surgery,
Chinese University of Hong Kong, Hong Kong, Hong Kong
Title
Risk prediction models for delirium in the intensive care unit after
cardiac surgery: A systematic review and independent external validation.
Source
British Journal of Anaesthesia. 118 (3) (pp 391-399), 2017. Date of
Publication: 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Numerous risk prediction models are available for predicting delirium
after cardiac surgery, but few have been directly compared with one
another or been validated in an independent data set.We conducted a
systematic review to identify validated risk prediction models of
delirium(using the Confusion Assessment Method-Intensive Care Unit tool)
after cardiac surgery and assessed the transportability of the risk
prediction models on a prospective cohort of 600 consecutive patients
undergoing cardiac surgery at a university hospital in Hong Kong from July
2013 to July 2015. The discrimination (c-statistic), calibration (GiViTI
calibration belt), and clinical usefulness (decision curve analysis) of
the risk predictionmodels were examined in a stepwisemanner. Three
published high-quality intensive care unit deliriumrisk prediction models
(n5939) were identified: Katznelson, the original PRE-DELIRIC, and the
international recalibrated PRE-DELIRIC model. Deliriumoccurred in 83
patients (13.8%, 95% CI: 11.2-16.9%). After updating the intercept and
regression coefficients in the Katznelsonmodel, there was fair
discrimination (0.62, 95% CI: 0.58-0.66) and good calibration. As the
original PRE-DELIRIC model was already validated externally and
recalibrated in six countries, we performed a logistic calibration on the
recalibrated model and found acceptable discrimination (0.75, 95% CI:
0.72-0.79) and good calibration. Decision curve analysis demonstrated that
the recalibrated PREDELIRIC riskmodel was marginally more clinically
useful than the Katznelsonmodel. Current models predict deliriumrisk in
the intensive care unit after cardiac surgery with only fair to moderate
accuracy and are insufficient for routine clinical use.
Copyright © The Author 2017.

<18>
Accession Number
608042393
Author
Shinjo D.; Fushimi K.
Institution
(Shinjo, Fushimi) Department of Health Policy and Informatics, Tokyo
Medical and Dental University Graduate School, Tokyo, Japan
Title
Preoperative factors affecting cost and length of stay for isolated
off-pump coronary artery bypass grafting: Hierarchical linear model
analysis.
Source
BMJ Open. 5 (11) (no pagination), 2015. Article Number: e008750. Date of
Publication: 2015.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: To determine the effect of preoperative patient and hospital
factors on resource use, cost and length of stay (LOS) among patients
undergoing offpump coronary artery bypass grafting (OPCAB). Design:
Observational retrospective study. Settings: Data from the Japanese
Administrative Database. Participants: Patients who underwent isolated,
elective OPCAB between April 2011 and March 2012. Primary outcome
measures: The primary outcomes of this study were inpatient cost and LOS
associated with OPCAB. A two-level hierarchical linear model was used to
examine the effects of patient and hospital characteristics on inpatient
costs and LOS. The independent variables were patient and hospital
factors. Results: We identified 2491 patients who underwent OPCAB at 268
hospitals. The mean cost of OPCAB was $40 665 +/-7774, and the mean LOS
was 23.4+/-8.2 days. The study found that select patient factors and
certain comorbidities were associated with a high cost and long LOS. A
high hospital OPCAB volume was associated with a low cost (-6.6%; p=0.024)
as well as a short LOS (-17.6%, p<0.001). Conclusions: The hospital OPCAB
volume is associated with efficient resource use. The findings of the
present study indicate the need to focus on hospital elective OPCAB volume
in Japan in order to improve cost and LOS.

<19>
Accession Number
607878205
Author
Belletti A.; Musu M.; Silvetti S.; Saleh O.; Pasin L.; Monaco F.; Hajjar
L.A.; Fominskiy E.; Finco G.; Zangrillo A.; Landoni G.
Institution
(Belletti, Silvetti, Saleh, Pasin, Monaco, Zangrillo, Landoni) Department
of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Musu, Finco) Department of Medical Sciences M. Aresu, Cagliari
University, Cagliari, Italy
(Hajjar) Surgical Intensive Care Unit, Department of Cardiopneumology,
University of Sao Paulo, Sao Paulo, Brazil
(Fominskiy) Department of Anaesthesiology and Intensive Care, Academician
EN Meshalkin Novosibirsk State Budget Research, Institute of Circulation
Pathology, Novosibirsk, Russian Federation
(Zangrillo, Landoni) Vita-Salute San Raffaele University, Milan, Italy
Title
Non-adrenergic vasopressors in patients with or at risk for vasodilatory
shock. A systematic review and meta-analysis of randomized trials.
Source
PLoS ONE. 10 (11) (no pagination), 2015. Article Number: e0142605. Date of
Publication: 01 Nov 2015.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Introduction: Hypotensive state is frequently observed in several critical
conditions. If an adequate mean arterial pressure is not promptly
restored, insufficient tissue perfusion and organ dysfunction may develop.
Fluids and catecholamines are the cornerstone of critical hypotensive
states management. Catecholamines side effects such as increased
myocardial oxygen consumption and development of arrhythmias are well
known. Thus, in recent years, interest in catecholamine-sparing agents
such as vasopressin, terlipressin and methylene blue has increased;
however, few randomized trials, mostly with small sample sizes, have been
performed. We therefore conducted a meta-analysis of randomized trials to
investigate the effect of non-catecholaminergic vasopressors on mortality.
Methods: PubMed, BioMed Central and Embase were searched (update December
31st, 2014) by two independent investigators. Inclusion
criteria were: random allocation to treatment, at least one group
receiving a non-catecholaminergic vasopressor, patients with or at risk
for vasodilatory shock. Exclusion criteria were: crossover studies,
pediatric population, nonhuman studies, studies published as abstract
only, lack of data on mortality. Studied drugs were vasopressin,
terlipressin and methylene blue. Primary endpoint was mortality at the
longest follow-up available. Results: A total of 1,608 patients from 20
studies were included in our analysis. The studied settings were sepsis
(10/20 studies [50%]), cardiac surgery (7/20 [35%]), vasodilatory shock
due to any cause (2/20 [19%]), and acute traumatic injury (1/20 [5%]).
Overall, pooled estimates showed that treatment with non-catecholaminergic
agents improves survival (278/810 [34.3%] versus 309/798 [38.7%], risk
ratio = 0.88, 95%confidence interval = 0.79 to 0.98, p = 0.02). None of
the drugs was associated with significant reduction inmortality when
analyzed independently. Results were not confirmed when analyzing studies
with a low risk of bias. Conclusions: Catecholamine-sparing agents in
patients with or at risk for vasodilatory shock may improve survival.
Further researches on this topic are needed to confirm the finding.
Copyright © 2015 Belletti 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.

<20>
Accession Number
607050225
Author
Maghbooli Z.; Hossein-Nezhad A.
Institution
(Maghbooli) Endocrinology and Metabolism Research Center, Endocrinology
and Metabolism Clinical Sciences Institute, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Hossein-Nezhad) Osteoporosis Research Center, Endocrinology and
Metabolism Clinical Sciences Institute, Tehran University of Medical
Sciences, 5th Floor Shariati Hospital, North Kargar Avenue, Tehran
1411413137, Iran, Islamic Republic of
(Hossein-Nezhad) Department of Medicine, Section of Endocrinology,
Nutrition, and Diabetes, Vitamin D, Skin and Bone Research Laboratory,
Boston University Medical Center, Boston, MA, United States
Title
Transcriptome and molecular endocrinology aspects of epicardial adipose
tissue in cardiovascular diseases: A systematic review and meta-analysis
of observational studies.
Source
BioMed Research International. 2015 (no pagination), 2015. Article Number:
926567. Date of Publication: 2015.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
The objective of this study was to perform a systematic review of
published literature on differentially expressed genes (DEGs) in human
epicardial adipose tissue (EAT) to identify molecules associated with
CVDs. A systematic literature search was conducted in PubMed, SCOPUS, and
ISI Web of Science literature databases for papers published before
October 2014 that addressed EAT genes and cardiovascular diseases (CVDs).
We included original papers that had performed gene expressions in EAT of
patients undergoing open-heart surgery. The Reporting Recommendations for
Tumor Marker Prognostic Studies (PRIMARK) assessment tool was also used
for methodological quality assessment. From the 180 papers identified by
our initial search strategy, 40 studies met the inclusion criteria and
presented DEGs in EAT samples from patients with and without CVDs. The
included studies reported 42 DEGs identified through comparison of
EAT-specific gene expression in patients with and without CVDs. Among the
42 DEGs, genes involved in regulating apoptosis had higher enrichment
scores. Notably, interleukin-6 (IL-6) and tumor protein p53 (TP53) were
the main hub genes in the network. The results suggest that regulation of
apoptosis in EAT is critical for CVD development. Moreover, IL-6 and TP53
as hub genes could serve as biomarkers and therapeutic targets for CVDs.
Copyright © 2015 Zhila Maghbooli and Arash Hossein-nezhad.

<21>
Accession Number
606904852
Author
Nelson S.; Muzyk A.J.; Bucklin M.H.; Brudney S.; Gagliardi J.P.
Institution
(Nelson) Critical Care, Hospital Pharmacy Services, Mayo Clinic,
Rochester, MN 55905, United States
(Muzyk) Department of Pharmacy Practice, Campbell University, School of
Pharmacy and Health Sciences, Buies Creek, NC 27506, United States
(Muzyk, Gagliardi) Department of Psychiatry and Behavioral Sciences, Duke
University, Durham, NC 27710, United States
(Bucklin) Department of Clinical Pharmacy, University of Tennessee Medical
Center, Knoxville, TN 37920, United States
(Brudney) Departments of Anesthesiology and Medicine, Duke University
Medical Center, Durham VAMC, Durham, NC 27710, United States
(Gagliardi) Department of Medicine, Duke University, Durham, NC 27710,
United States
Title
Defining the role of dexmedetomidine in the prevention of delirium in the
intensive care unit.
Source
BioMed Research International. 2015 (no pagination), 2015. Article Number:
635737. Date of Publication: 2015.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Dexmedetomidine is a highly selective alpha 2 agonist used as a sedative
agent. It also provides anxiolysis and sympatholysis without significant
respiratory compromise or delirium. We conducted a systematic review to
examine whether sedation of patients in the intensive care unit (ICU) with
dexmedetomidine was associated with a lower incidence of delirium as
compared to other nondexmedetomidine sedation strategies. A search of
PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews yielded
only three trials from 1966 through April 2015 that met our predefined
inclusion criteria and assessed dexmedetomidine and outcomes of delirium
as their primary endpoint. The studies varied in regard to population,
comparator sedation regimen, delirium outcome measure, and dexmedetomidine
dosing. All trials are limited by design issues that limit our ability
definitively to conclude that dexmedetomidine prevents delirium. Evidence
does suggest that dexmedetomidine may allow for avoidance of deep sedation
and use of benzodiazepines, factors both observed to increase the risk for
developing delirium. Our assessment of currently published literature
highlights the need for ongoing research to better delineate the role of
dexmedetomidine for delirium prevention.
Copyright © 2015 S. Nelson et al.

<22>
Accession Number
606662094
Author
Omar A.S.; Sudarsanan S.; Hanoura S.; Osman H.; Sivadasan P.C.; Shouman
Y.; Tuli A.K.; Singh R.; Al Khulaifi A.
Institution
(Omar, Sudarsanan, Hanoura, Osman, Sivadasan, Shouman, Tuli, Al Khulaifi)
Department of Cardiothoracic Surgery, Cardiac Anaesthesia and ICU Section,
Heart Hospital, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
(Omar) Department of Critical Care Medicine, Beni Suef University,
Beni-Suef 62511, Egypt
(Hanoura, Osman) Department of Anesthesia, Al-Azhar University, Cairo
11651, Egypt
(Singh) Department of Medical Research, Hamad Medical Corporation, P.O.
Box 3050, Doha, Qatar
Title
Kinetics of Highly Sensitive Troponin T after Cardiac Surgery.
Source
BioMed Research International. 2015 (no pagination), 2015. Article Number:
574546. Date of Publication: 2015.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Perioperative myocardial infarction (PMI) confers a considerable risk in
cardiac surgery settings; finding the ideal biomarker seems to be an ideal
goal. Our aim was to assess the diagnostic accuracy of highly sensitive
troponin T (hsTnT) in cardiac surgery settings and to define a diagnostic
level for PMI diagnosis. This was a single-center prospective
observational study analyzing data from all patients who underwent cardiac
surgeries. The primary outcome was the diagnosis of PMI through a specific
level. The secondary outcome measures were the lengths of mechanical
ventilation (LOV), stay in the intensive care unit (LOSICU), and
hospitalization. Based on the third universal definition of PMI, patients
were divided into two groups: no PMI (Group I) and PMI (Group II). Data
from 413 patients were analyzed. Nine patients fulfilled the diagnostic
criteria of PMI, while 41 patients were identified with a 5-fold increase
in their CK-MB (>120 U/L). Using ROC analysis, a hsTnT level of 3,466 ng/L
or above showed 90% sensitivity and 90% specificity for the diagnosis of
PMI. Secondary outcome measures in patients with PMI were significantly
prolonged. In conclusion, the hsTnT levels detected here paralleled those
of CK-MB and a cut-off level of 3466 ng/L could be diagnostic of PMI.
Copyright © 2015 Amr S. Omar et al.

<23>
Accession Number
606840443
Author
Song F.; Brown T.J.; Blyth A.; Maskrey V.; McNamara I.; Donell S.
Institution
(Song, Brown, Blyth, Maskrey, McNamara, Donell) University of East Anglia,
Norwich Medical School, Faculty of Medicine and Health Science, Norwich,
Norfolk, United Kingdom
(McNamara, Donell) Norfolk and Norwich University Hospital, Orthopaedic
Department, Norwich, Norfolk, United Kingdom
Title
Identifying and recruiting smokers for preoperative smoking cessation-a
systematic review of methods reported in published studies.
Source
Systematic Reviews. 4 (1) (no pagination), 2015. Article Number: 157. Date
of Publication: November 11, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Smoking cessation before surgery reduces postoperative
complications, and the benefit is positively associated with the duration
of being abstinent before a surgical procedure. A key issue in providing
preoperative smoking cessation support is to identify people who smoke as
early as possible before elective surgery. This review aims to summarise
methods used to identify and recruit smokers awaiting elective surgery.
Methods: We searched MEDLINE, EMBASE, CINAHL, and PsycINFO, and references
of relevant reviews (up to May 2014) to identify prospective studies that
evaluated preoperative smoking cessation programmes. One reviewer
extracted and a second reviewer checked data from the included studies.
Data extracted from included studies were presented in tables and
narratively described. Results: We included 32 relevant studies, including
18 randomised controlled trials (RCTs) and 14 non-randomised studies
(NRS). Smokers were recruited at preoperative clinics (n = 18), from
surgery waiting lists (n = 6), or by general practitioners (n = 1), and
the recruitment methods were not explicitly described in seven studies.
Time points of preoperative recruitment of smokers was unclear in four
studies, less than 4 weeks before surgery in 17 studies, and at least 4
weeks before surgery in only 11 studies. The recruitment rate tended to be
lower in RCTs (median 58.2 %, range 9.1 to 90.9 %) than that in NRS
(median 99.1 %, range 12.3 to 100 %) and lower in preoperative
clinic-based RCTs (median 54.4 %, range 9.1 to 82.4 %) than that in
waiting list-based RCTs (median 70.1 %, range 36.8 to 85.0 %). Smokers
were recruited at least 4 weeks before surgery in four of the six waiting
list-based studies and in only three of the 18 preoperative clinic-based
studies. Conclusions: Published studies often inadequately described the
methods for recruiting smokers into preoperative smoking cessation
programmes. Although smoking cessation at any time is beneficial, many
programmes recruited smokers at times very close to scheduled surgery so
that the benefit of preoperative smoking cessation may have not been fully
effected. Optimal delivery of preoperative smoking cessation remains
challenging, and further research is required to develop effective
preoperative cessation programmes for smokers awaiting elective
operations.
Copyright © 2015 Song et al.

<24>
Accession Number
615896725
Author
Salavati M.; Fallahinia G.; Vardanjani A.E.; Rafiei H.; Mousavi S.;
Torkamani M.
Institution
(Salavati) School of Nursing and Midwifery, Hamedan University of Medical
Sciences, Hamedan, Iran.
Title
Comparison Between Effects of Home Based Cardiac Rehabilitation Programs
Versus Usual Care on the Patients' Health Related Quality of Life After
Coronary Artery Bypass Graft.
Source
Global journal of health science. 8 (4) (pp 196-202), 2015. Date of
Publication: 19 Aug 2015.
Abstract
BACKGROUND & AIM: To compare home-based cardiac rehabilitation with usual
care on the patients' Health Related Quality of Life (HRQoL) after
coronary artery bypass graft in patients with coronary artery bypass graft
(CABG) surgery.
METHODS: In a randomized controlled clinical conducted from March 2013 to
June 2013, 110 patients with CABG surgery were randomly assigned into two
groups. While patients in group I, were received usual care and patients
in group II, in addition to the usual care were received home-based
cardiac rehabilitation programs. The 27-item MacNew Heart Disease HRQoL
questionnaire was used to evaluate the patient's HRQoL under and over 2
months after intervention.
RESULTS: At the time of 0, mean score of HRQoL was 67.86+/-7.5 and
64.76+/-8.4 in patients in group I and group II, respectively (P> 0.05).
Although mean score of HRQoL in all patients in both groups increased two
month after intervention, but this increase in patients in group II were
higher than patients in group I (154.93+/-4.6 vs 134.20+/-8.2). This
difference were statistically significant (P< 0.05).
CONCLUSION: Quality of Life (QoL) can be considered as a quality indicator
of health care systems. Results of present study showed that home-based
cardiac rehabilitation program improved patients HRQoL after CABG surgery.

<25>
Accession Number
615931784
Author
Erden S.; Senol Celik S.
Institution
(Erden) a Department of Nursing, Faculty of Health Sciences , Cukurova
University , Adana , Turkey
(Senol Celik) b Faculty of Nursing , Hacettepe University , Ankara ,
Turkey
Title
The effect of transcutaneous electrical nerve stimulation on
post-thoracotomy pain.
Source
Contemporary nurse. 51 (2-3) (pp 163-170), 2015. Date of Publication: 01
Oct 2015.
Abstract
BACKGROUND: Pain guidelines suggest transcutaneous electrical nerve
stimulation (TENS) as a reliable analgesic method in postoperative pain.
OBJECTIVES: This study was conducted as a randomized controlled study to
determine the effect of TENS on postoperative pain and analgesic
consumption in patients who have undergone posterolateral thoracotomy
(PLT).
DESIGN: The study was conducted in the Thoracic Surgery Clinic of a
university hospital with 40 patients (test group: 20, control group: 20)
and its power was 99%. While, test group patients were administered TENS,
the control group patients were not. The pain assessment and analgesic
consumption in both groups were recorded.
RESULTS: The pain levels and analgesic consumption of the test group were
lower than that of the control group (p<.05).
CONCLUSIONS: TENS reduced PLT pain and analgesic consumption. Thus, TENS
can be recommended as an easy and reliable analgesic method in PLT.

<26>
Accession Number
615899096
Author
Chernyavskiy A.; Volkov A.; Lavrenyuk O.; Terekhov I.; Kareva Y.
Institution
(Chernyavskiy) Novosibirsk Research Institute of Circulation Pathology,
Rechkunovskaja str. 15, 630055, Novosibirsk, Russia. amchern@mail.ru
(Volkov, Terekhov) Novosibirsk Research Institute of Circulation
Pathology, Rechkunovskaja str. 15, 630055, Novosibirsk, Russia
(Lavrenyuk, Kareva) Novosibirsk Research Institute of Circulation
Pathology, Rechkunovskaja str. 15, 630055, Novosibirsk, Russia.
julia11108@mail.ru
(Kareva) , Stroiteley str., 9, 46, Novosibirsk, Russia. julia11108@mail.ru
Title
Comparative results of endoscopic and open methods of vein harvesting for
coronary artery bypass grafting: a prospective randomized parallel-group
trial.
Source
Journal of cardiothoracic surgery. 10 (pp 163), 2015. Date of Publication:
12 Nov 2015.
Abstract
BACKGROUND: We compared wound complications between endoscopic and open
great saphenous vein harvesting for coronary artery bypass surgery.
METHODS: A total of 228 consecutive patients were prospectively randomized
into two groups: open vein harvesting (OVH), 115 patients; and endoscopic
vein harvesting (EVH), 113 patients. Each group was assessed for
post-operative wound complications, pain intensity, and neuropathy in the
early post-surgical period. Lymphoscintigraphy of the lower limbs as well
as morphological studies of vein walls using light and electron scanning
microscopy were performed.
RESULTS: Vein harvesting time was shorter for EVH than OVH: 31.8+/-6.2 min
and 40.3+/-15.8 min, respectively (p<0.01). There were fewer complications
after vein harvesting in the EVH group (11.5 %) than in the OVH group
(44.4 %) (p=0.001). Multivariate analysis showed that diabetes mellitus
was the only risk factor for post-surgical complications after OVH (odds
ratio=3.95 %; 95 % confidence interval 1.03-8.6). Lymphoscintigraphic data
in the EVH group did not demonstrate considerable disturbances in lymph
drainage after surgery. In the OVH group, the accumulation of
radiopharmaceutical drugs in the lymphatic nodes reduced two-fold
(p<0.001). Histological evaluation of vein samples did not show
considerable damage to the vein wall in either group.
CONCLUSIONS: Using electron microscopy of vein fragments, this study
demonstrated that EVH reduces wound complications and provides
good-quality conduits.

<27>
Accession Number
615827653
Author
Hausenloy D.; Candilio L.
Institution
(Hausenloy, Candilio) The Hatter Cardiovascular Institute, Institute of
Cardiovascular Science, University College London, London, United Kingdom
(Hausenloy, Candilio) The National Inst. of Health Research-University
College London Hospitals Biomedical Research Centre, London, United
Kingdom
(Hausenloy) Barts Heart Centre, St Bartholomew's Hospital, London, United
Kingdom
(Hausenloy) Cardiovascular and Metabolic Disorders Program, Duke-National
University of Singapore Medical School, Singapore, Singapore
(Hausenloy) National Heart Research Institute Singapore, National Heart
Centre, Singapore, Singapore
(Hausenloy) Yong Loo Lin School of Medicine, National University
Singapore, Singapore, Singapore
Title
Is there a role for ischaemic conditioning in cardiac surgery?.
Source
F1000Research. 6 (no pagination), 2017. Article Number: 563. Date of
Publication: 2017.
Publisher
Faculty of 1000 Ltd (E-mail: info@f1000.com)
Abstract
Coronary artery disease (CAD) is a major cause of morbidity and mortality
worldwide. Coronary artery bypass graft (CABG) surgery is the
revascularisation strategy of choice in patients with diabetes mellitus
and complex CAD. Owing to a number of factors, including the ageing
population, the increased complexity of CAD being treated, concomitant
valve and aortic surgery, and multiple comorbidities, higher-risk patients
are being operated on, the result of which is an increased risk of
sustaining perioperative myocardial injury (PMI) and poorer clinical
outcomes. As such, new treatment strategies are required to protect the
heart against PMI and improve clinical outcomes following cardiac surgery.
In this regard, the heart can be endogenously protected from PMI by
subjecting the myocardium to one or more brief cycles of ischaemia and
reperfusion, a strategy called "ischaemic conditioning". However, this
requires an intervention applied directly to the heart, which may be
challenging to apply in the clinical setting. In this regard, the strategy
of remote ischaemic conditioning (RIC) may be more attractive, as it
allows the endogenous cardioprotective strategy to be applied away from
the heart to the arm or leg by simply inflating and deflating a cuff on
the upper arm or thigh to induce one or more brief cycles of ischaemia and
reperfusion (termed "limb RIC"). Although a number of small clinical
studies have demonstrated less PMI with limb RIC following cardiac
surgery, three recently published large multicentre randomised clinical
trials found no beneficial effects on short-term or long-term clinical
outcomes, questioning the role of limb RIC in the setting of cardiac
surgery. In this article, we review ischaemic conditioning as a
therapeutic strategy for endogenous cardioprotection in patients
undergoing cardiac surgery and discuss the potential reasons for the
failure of limb RIC to improve clinical outcomes in this setting.
Crucially, limb RIC still has the therapeutic potential to protect the
heart in other clinical settings, such as acute myocardial infarction, and
it may also protect other organs against acute ischaemia/reperfusion
injury (such as the brain, kidney, and liver).
Copyright © 2017 Candilio L and Hausenloy D.

<28>
Accession Number
615950231
Author
Bignami E.; Guarnieri M.; Franco A.; Gerli C.; De Luca M.; Monaco F.;
Landoni G.; Zangrillo A.
Institution
(Bignami, Guarnieri, Franco, Gerli, De Luca, Monaco, Landoni, Zangrillo)
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific
Institute, Via Olgettina 60, Milan 20132, Italy
(Landoni, Zangrillo) Vita-Salute San Raffaele University, Milan, Italy
Title
Esmolol before cardioplegia and as cardioplegia adjuvant reduces cardiac
troponin release after cardiac surgery. A randomized trial.
Source
Perfusion (United Kingdom). 32 (4) (pp 313-320), 2017. Date of
Publication: 01 May 2017.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Cardioplegic solutions are the standard in myocardial
protection during cardiac surgery, since they interrupt the
electro-mechanical activity of the heart and protect it from ischemia
during aortic cross-clamping. Nevertheless, myocardial damage has a strong
clinical impact. We tested the hypothesis that the short-acting
beta-blocker esmolol, given immediately before cardiopulmonary bypass and
as a cardioplegia additive, would provide an extra protection to
myocardial tissue during cardiopulmonary bypass by virtually reducing
myocardial activity and, therefore, oxygen consumption to zero. Materials
and methods: This was a single-centre, double-blind, placebo-controlled,
parallel-group phase IV trial. Adult patients undergoing elective valvular
and non-valvular cardiac surgery with end diastolic diameter >60 mm and
ejection fraction <50% were enrolled. Patients were randomly assigned to
receive either esmolol, 1 mg/kg before aortic cross-clamping and 2 mg/kg
with Custodiol crystalloid cardioplegia or equivolume placebo.
The primary end-point was peak postoperative troponin T concentration.
Troponin was measured at Intensive Care Unit arrival and at 4, 24 and 48
hours. Secondary endpoints included ventricular fibrillation after
cardioplegic arrest, need for inotropic support and intensive care unit
and hospital stay. Results: We found a reduction in peak postoperative
troponin T, from 1195 ng/l (690-2730) in the placebo group to 640 ng/l
(544-1174) in the esmolol group (p=0.029) with no differences in Intensive
Care Unit stay [3 days (1-6) in the placebo group and 3 days (2-5) in the
esmolol group] and hospital stay [7 days (6-10) in the placebo group and 7
days (6-12) in the esmolol group]. Troponin peak occurred at 24 hours for
12 patients (26%) and at 4 hours for the others (74%). There were no
differences in other secondary end-points. Conclusions: Adding esmolol to
the cardioplegia in high-risk patients undergoing elective cardiac surgery
reduces peak postoperative troponin levels. Further investigation is
necessary to assess esmolol effects on major clinical outcomes.
Copyright © 2017 SAGE Publications.

<29>
[Use Link to view the full text]
Accession Number
615949831
Author
Kleiman A.M.; Forkin K.T.; Bechtel A.J.; Collins S.R.; Ma J.Z.; Nemergut
E.C.; Huffmyer J.L.
Institution
(Kleiman, Forkin, Bechtel, Collins, Nemergut, Huffmyer) Departments of
Anesthesiology, University of Virginia, PO Box 800710, Charlottesville, VA
22908, United States
(Ma) Departments of Public Health Sciences, University of Virginia,
Charlottesville, VA, United States
Title
Generative retrieval improves learning and retention of cardiac anatomy
using transesophageal echocardiography.
Source
Anesthesia and Analgesia. 124 (5) (pp 1440-1444), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Transesophageal echocardiography (TEE) is a valuable monitor
for patients undergoing cardiac and noncardiac surgery as it allows for
evaluation of cardiovascular compromise in the perioperative period. It is
challenging for anesthesiology residents and medical students to learn to
use and interpret TEE in the clinical environment. A critical component of
learning to use and interpret TEE is a strong grasp of normal
cardiovascular ultrasound anatomy. METHODS: Fifteen fourth-year medical
students and 15 post-graduate year (PGY) 1 and 2 anesthesiology residents
without prior training in cardiac anesthesia or TEE viewed normal
cardiovascular anatomy TEE video clips; participants were randomized to
learning cardiac anatomy in generative retrieval (GR) and standard
practice (SP) groups. GR participants were required to verbally identify
each unlabeled cardiac anatomical structure within 10 seconds of the TEE
video appearing on the screen. Then a correctly labeled TEE video clip was
shown to the GR participant for 5 more seconds. SP participants viewed the
same TEE video clips as GR but there was no requirement for SP
participants to generate an answer; for the SP group, each TEE video image
was labeled with the correctly identified anatomical structure for the 15
second period. All participants were tested for intermediate (1 week) and
late (1 month) retention of normal TEE cardiovascular anatomy. Improvement
of intermediate and late retention of TEE cardiovascular anatomy was
evaluated using a linear mixed effects model with random intercepts and
random slopes. RESULTS: There was no statistically significant difference
in baseline score between GR (49% +/- 11) and SP (50% +/- 12), with mean
difference (95% CI) -1.1% (-9.5, 7.3%). At 1 week following the
educational intervention, GR (90% +/- 5) performed significantly better
than SP (82% +/- 11), with mean difference (95% CI) 8.1% (1.9, 14.2%); P =
.012. This significant increase in scores persisted in the late posttest
session at one month (GR: 83% +/- 12; SP: 72% +/- 12), with mean
difference (95% CI) 10.2% (1.3 to 19.1%); P = .026. Mixed effects analysis
showed significant improvements in TEE cardiovascular anatomy over time,
at 5.9% and 3.5% per week for GR and SP groups respectively (P = .0003),
and GR improved marginally faster than SP (P = .065). CONCLUSIONS: Medical
students and anesthesiology residents inexperienced in the use of TEE
showed both improved learning and retention of basic cardiovascular
ultrasound anatomy with the incorporation of GR into the educational
experience.
Copyright © 2017 International Anesthesia Research Society.

<30>
[Use Link to view the full text]
Accession Number
615949778
Author
Gabel E.; Hofer I.S.; Satou N.; Grogan T.; Shemin R.; Mahajan A.;
Cannesson M.
Institution
(Gabel, Hofer, Satou, Grogan, Shemin, Mahajan, Cannesson) University of
California Los Angeles, David Geffen School of Medicine, 757 Westwood
Plaza, Los Angeles, CA 90095, United States
Title
Creation and validation of an automated algorithm to determine
postoperative ventilator requirements after cardiac surgery.
Source
Anesthesia and Analgesia. 124 (5) (pp 1423-1430), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: In medical practice today, clinical data registries have
become a powerful tool for measuring and driving quality improvement,
especially among multicenter projects. Registries face the known problem
of trying to create dependable and clear metrics from electronic medical
records data, which are typically scattered and often based on unreliable
data sources. The Society for Thoracic Surgery (STS) is one such example,
and it supports manually collected data by trained clinical staff in an
effort to obtain the highest-fidelity data possible. As a possible
alternative, our team designed an algorithm to test the feasibility of
producing computerderived data for the case of postoperative mechanical
ventilation hours. In this article, we study and compare the accuracy of
algorithm-derived mechanical ventilation data with manual data extraction.
METHODS: We created a novel algorithm that is able to calculate mechanical
ventilation duration for any postoperative patient using raw data from our
EPIC electronic medical record. Utilizing nursing documentation of airway
devices, documentation of lines, drains, and airways, and respiratory
therapist ventilator settings, the algorithm produced results that were
then validated against the STS registry. This enabled us to compare our
algorithm results with data collected by human chart review. Any
discrepancies were then resolved with manual calculation by a research
team member. RESULTS: The STS registry contained a total of 439 University
of California Los Angeles cardiac cases from April 1, 2013, to March 31,
2014. After excluding 201 patients for not remaining intubated,
tracheostomy use, or for having 2 surgeries on the same day, 238 cases met
inclusion criteria. Comparing the postoperative ventilation durations
between the 2 data sources resulted in 158 (66%) ventilation durations
agreeing within 1 hour, indicating a probable correct value for both
sources. Among the discrepant cases, the algorithm yielded results that
were exclusively correct in 75 (93.8%) cases, whereas the STS results were
exclusively correct once (1.3%). The remaining 4 cases had inconclusive
results after manual review because of a prolonged documentation gap
between mechanical and spontaneous ventilation. In these cases, STS and
algorithm results were different from one another but were both within the
transition timespan. This yields an overall accuracy of 99.6% (95%
confidence interval, 98.7%-100%) for the algorithm when compared with
68.5% (95% confidence interval, 62.6%-74.4%) for the STS data (P < .001).
CONCLUSIONS: There is a significant appeal to having a computer algorithm
capable of calculating metrics such as total ventilator times, especially
because it is labor intensive and prone to human error. By incorporating 3
different sources into our algorithm and by using preprogrammed clinical
judgment to overcome common errors with data entry, our results proved to
be more comprehensive and more accurate, and they required a fraction of
the computation time compared with manual review.
Copyright © 2017 International Anesthesia Research Society.

<31>
Accession Number
615948942
Author
Koulaxouzidis G.; Toufektzian L.; Ashrafian L.; Veres K.
Institution
(Koulaxouzidis) Department of Cardiothoracic Surgery, Freeman Hospital,
Newcastle upon Tyne, United Kingdom
(Toufektzian, Ashrafian, Veres) Department of Thoracic Surgery, Guy's
Hospital, London, United Kingdom
Title
Does the addition of postoperative radiotherapy to adjuvant chemotherapy
offer any benefit in patients with non-small cell lung cancer and
mediastinal lymphadenopathy?.
Source
Interactive Cardiovascular and Thoracic Surgery. 24 (4) (pp 625-630),
2017. Date of Publication: 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether the addition of
postoperative radiotherapy (PORT) to adjuvant chemotherapy offers any
benefit in patients undergoing curative resection for non-small cell lung
cancer found to harbour mediastinal lymphadenopathy. A total of 77 papers
were identified using the reported search, of which 11 represented the
best evidence to answer the clinical question. Only studies reporting on
survival data of patients receiving adjuvant chemotherapy with and without
PORT were included in this analysis. The authors, date, journal, country,
study type, population, outcomes and key results are tabulated. Six
studies reported a statistically significant positive impact of PORT on
long-Term or disease-free survival (DFS) (P = 0.048-0.0001). Five more
studies found no difference in terms of survival between patients
receiving and not receiving PORT. Among the 11 studies, only two were
randomized controlled, with one of them reporting improved disease-free (P
= 0.041) but not overall survival (P = 0.073), while the other finding no
difference in survival. Furthermore, three more studies reported on DFS
and/or locoregional recurrence of the disease. One of these studies
reported a significantly improved DFS among patients receiving PORT (P =
0.003), while two of them reported a reduced rate of locoregional
recurrence in this group (P = 0.032-0.009). Many studies report a positive
effect of PORT when combined in parallel or sequentially with adjuvant
chemotherapy in terms of long-Term, disease free survival or locoregional
control of the disease in patients who have undergone surgical resection
of NSCLC and are found to harbour N2 disease. However, these reports are
counterbalanced by an almost equal number of studies which show no
difference between PORT and no PORT. Only one study reported significantly
increased radiation related adverse effects in patients undergoing
chemotherapy and PORT.
Copyright © 2016.The Author.

<32>
Accession Number
615948935
Author
Abdullahi Y.S.; Athanasopoulos L.V.; Casula R.P.; Moscarelli M.; Bagnall
M.; Ashrafian H.; Athanasiou T.
Institution
(Abdullahi, Athanasopoulos, Casula, Athanasiou) Department of
Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith
Hospital, Praed Street, London W2 1NY, United Kingdom
(Moscarelli) GVM Care and Research Unit, Anthea Hospital, Bari, Italy
(Bagnall, Ashrafian, Athanasiou) Department of Surgery and Cancer,
Imperial College London, London, United Kingdom
Title
Systematic review on the predictive ability of frailty assessment measures
in cardiac surgery.
Source
Interactive Cardiovascular and Thoracic Surgery. 24 (4) (pp 619-624),
2017. Date of Publication: 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES: Patient frailty is increasingly recognised as contributing to
adverse postoperative outcomes in cardiothoracic surgery. The goal of this
review is to evaluate the predictive ability of frailty scoring systems
and their limitations in risk assessment of patients undergoing cardiac
surgery. METHODS: Frailty studies were identified by searching electronic
databases. Studies in which the measuring instrument was defined as a
multidimensional tool focusing on a population undergoing cardiac
operations were included. The focus was on the predictive ability of
frailty in this population and a comparison with conventional risk scoring
systems. Unfortunately, the lack of a significant number of studies with
the same postoperative outcome precluded a formal meta-Analysis. RESULTS:
Of 783 studies identified in our initial search, 6 fulfilled our inclusion
criteria. Frailty was identified as a predictor of mortality, morbidity
and/or prolonged hospital stay in patients undergoing cardiac surgery. Our
systematic review revealed the increased application of frailty scores
compared to standardized risk stratification scores in cardiothoracic
patients. In approximately 50% of these studies, frailty scores continued
to be predictive even after adjusting for the conventional risk scoring
systems. CONCLUSIONS: The assessment of frailty may enhance the
preoperative workup and offer an optimized risk stratification measure in
patients undergoing cardiothoracic procedures even though the reporting
standards of calibration and classification measures have been relatively
poor.
Copyright © 2016.The Author.

<33>
Accession Number
615953793
Author
Kang S.H.; Lee C.W.; Baek S.; Lee P.H.; Ahn J.-M.; Park D.-W.; Kang S.-J.;
Lee S.-W.; Kim Y.-H.; Park S.-W.; Park S.-J.
Institution
(Kang) Department of Cardiology, CHA Bundang Medical Center, CHA
University, Seongnam, Korea
(Lee, Lee, Ahn, Park, Kang, Lee, Kim, Park, Park) Division of Cardiology,
Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
(Baek) Department of Clinical Epidemiology and Biostatistics, Asan Medical
Center, University of Ulsan College of Medicine, Seoul, Korea
Title
Comparison of Outcomes of Coronary Artery Bypass Grafting Versus
Drug-Eluting Stent Implantation in Patients With Severe Left Ventricular
Dysfunction.
Source
American Journal of Cardiology. (no pagination), 2017. Date of
Publication: December 29, 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The optimal revascularization strategy for patients with significant
coronary artery disease (CAD) and severe left ventricular (LV) dysfunction
(ejection fraction <35%) remains unclear. We compared the effects of
coronary artery bypass surgery (CABG, n = 442) versus percutaneous
coronary intervention (PCI) with drug-eluting stents (n = 469) on
long-term mortality in 911 patients with significant CAD and severe LV
dysfunction using large real-world registry data. Databases of 3
real-world registries were merged for a patient-level meta-analysis.
Primary outcome was death from any cause; secondary outcomes were death
from cardiac causes, myocardial infarction, stroke, or repeat
revascularization. At a median follow-up of 37.3 months, the risk of
all-cause death (adjusted hazard ratio [HR] 0.43; 95% confidence interval
[CI] 0.31 to 0.61; p <0.001) was significantly lower in the CABG group
than in the PCI group after adjustment. Similar findings were observed
with regard to the risks of death from cardiac cause (adjusted HR 0.49;
95% CI 0.33 to 0.73; p <0.001) and repeat revascularization (adjusted HR
0.08; 95% CI 0.03 to 0.20; p <0.001). However, there were no significant
differences in the risks of myocardial infarction and stroke between the 2
groups. The superiority of CABG over PCI was particularly pronounced in
patients receiving beta blockers and angiotensin-converting enzyme
inhibitor or angiotensin receptor blockers than those who are not. In
conclusion, among patients with significant CAD and severe LV dysfunction,
CABG showed a lower risk of all-cause death, cardiac-cause death, and
repeat revascularization compared with PCI with drug-eluting stents.
Copyright © 2017 Elsevier Inc.

<34>
Accession Number
609613559
Author
Patel A.N.; Henry T.D.; Quyyumi A.A.; Schaer G.L.; Anderson R.D.; Toma C.;
East C.; Remmers A.E.; Goodrich J.; Desai A.S.; Recker D.; DeMaria A.
Institution
(Patel) University of Utah Health Care, Salt Lake City, UT, United States
(Henry) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
(Quyyumi) Emory University Hospital, Atlanta, GA, United States
(Schaer) Rush University Medical Center, Chicago, IL, United States
(Anderson) University of Florida, Gainesville, FL, United States
(Toma) University of Pittsburgh, Pittsburgh, PA, United States
(East) Baylor University Medical Center, Dallas, TX, United States
(Remmers, Goodrich, Recker) Vericel Corporation, Cambridge, MA, United
States
(Desai) Brigham & Women's Hospital, Boston, MA, United States
(DeMaria) University of California San Diego, San Diego, CA, United States
Title
Ixmyelocel-T for patients with ischaemic heart failure: a prospective
randomised double-blind trial.
Source
The Lancet. 387 (10036) (pp 2412-2421), 2016. Date of Publication: 11 Jun
2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Ixmyelocel-T is an expanded, multicellular therapy produced
from a patient's own bone marrow by selectively expanding two key types of
bone marrow mononuclear cells: CD90+ mesenchymal stem cells and CD45+
CD14+ auto-fluorescent+ activated macrophages. Early phase clinical trials
suggest that intramyocardial delivery of ixmyelocel-T might improve
clinical, functional, symptomatic, and quality-of-life outcomes in
patients with heart failure due to ischaemic dilated cardiomyopathy. We
aimed to assess the safety and efficacy of catheter-based transendocardial
injection of ixmyelocel-T cell therapy in patients with heart failure and
reduced ejection fractions. Methods In this randomised, double-blind,
placebo-controlled phase 2B trial (ixCELL-DCM), patients from 31 sites in
North America with New York Heart Association class III or IV symptomatic
heart failure due to ischaemic dilated cardiomyopathy, who had left
ventricular ejection fraction 35% or less, an automatic implantable
cardioverter defibrillator, and who were ineligible for revascularisation
procedures were randomly assigned (1:1) to receive ixmyelocel-T or placebo
at the time of bone marrow aspiration and followed for 12 months.
Randomisation was done through an interactive (voice/web) response system.
The pharmacist, treating physician, and coordinator at each site were
unblinded, but the the follow-up team was completely blinded. The primary
endpoint was a composite of all-cause death, cardiovascular admission to
hospital, and unplanned clinic visits to treat acute decompensated heart
failure based on the blinded adjudication of an independent clinical
endpoint committee. Primary efficacy endpoint analyses and safety analyses
were done by modified intention to treat. This trial is registered with
ClinicalTrials.gov, number NCT01670981. Findings Between April 2, 2013,
and Jan 28, 2015, 126 participants were randomly assigned to receive
either ixmyelocel-T (n=66) or placebo (n=60). 114 (90%) patients comprised
the modified intention-to-treat population and 109 (87%) patients were
included in the per-protocol primary efficacy analysis (58 in the
ixmyelocel-T group and 51 in the placebo group). The primary efficacy
endpoint was observed in 47 patients: 50 events in 25 (49%) of 51 patients
in the placebo group and 38 events in 22 (38%) of 58 patients in the
ixmyelocel-T group, which represents a 37% reduction in cardiac events
compared with placebo (risk ratio 0.63 [95% CI 0.42-0.97]; p=0.0344). 41
(75%) of 51 participants in the placebo group had serious adverse events
versus 31 (53%) of 58 in the ixmyelocel-T group (p=0.0197). Interpretation
To the best of our knowledge, ixCELL-DCM is the largest cell therapy study
done in patients with heart failure so far. The transendocardial delivery
of ixmyelocel-T in patients with heart failure and reduced ejection
fraction due to ischaemic dilated cardiomyopathy resulted in a significant
reduction in adjudicated clinical cardiac events compared with placebo
leading to improved patient outcomes. Funding Vericel Corporation.
Copyright © 2016 Elsevier Ltd

<35>
Accession Number
607196090
Author
Papachristofi O.; Sharples L.D.; Mackay J.H.; Nashef S.A.M.; Fletcher
S.N.; Klein A.A.
Institution
(Papachristofi) MRC Biostatistics Unit, Institute of Public Health,
Cambridge, United Kingdom
(Sharples) Clinical Trials Research Unit, University of Leeds, Leeds,
United Kingdom
(Mackay, Klein) Department of Anaesthesia and Intensive Care, Papworth
Hospital, Cambridge, United Kingdom
(Nashef) Department of Cardiothoracic Surgery, Papworth Hospital,
Cambridge, United Kingdom
(Fletcher) Departments of Anaesthesia and Critical Care, St Georges
University Hospital, London, United Kingdom
(Klein) Association of Cardiothoracic Anaesthetists, Society of
Cardiothoracic Surg., Manchester, United Kingdom
Title
The contribution of the anaesthetist to risk-adjusted mortality after
cardiac surgery.
Source
Anaesthesia. 71 (2) (pp 138-146), 2016. Date of Publication: 01 Feb 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
It is widely accepted that the performance of the operating surgeon
affects outcomes, and this has led to the publication of surgical results
in the public domain. However, the effect of other members of the
multidisciplinary team is unknown. We studied the effect of the
anaesthetist on mortality after cardiac surgery by analysing data
collected prospectively over ten years of consecutive cardiac surgical
cases from ten UK centres. Casemix-adjusted outcomes were analysed in
models that included random-effects for centre, surgeon and anaesthetist.
All cardiac surgical operations for which the EuroSCORE model is
appropriate were included, and the primary outcome was in-hospital death
up to three months postoperatively. A total of 110 769 cardiac surgical
procedures conducted between April 2002 and March 2012 were studied, which
included 127 consultant surgeons and 190 consultant anaesthetists. The
overwhelming factor associated with outcome was patient risk, accounting
for 95.75% of the variation for in-hospital mortality. The impact of the
surgeon was moderate (intra-class correlation coefficient 4.00% for
mortality), and the impact of the anaesthetist was negligible (0.25%).
There was no significant effect of anaesthetist volume above ten cases per
year. We conclude that mortality after cardiac surgery is primarily
determined by the patient, with small but significant differences between
surgeons. Anaesthetists did not appear to affect mortality. These findings
do not support public disclosure of cardiac anaesthetists' results, but
substantially validate current UK cardiac anaesthetic training and
practice. Further research is required to establish the potential effects
of very low anaesthetic caseloads and the effect of cardiac anaesthetists
on patient morbidity.
Copyright © 2015 The Authors. Anaesthesia published by John Wiley &
Sons Ltd on behalf of Association of Anaesthetists of Great Britain and
Ireland.

<36>
Accession Number
604434239
Author
Sorensen H.; Grocott H.P.; Secher N.H.
Institution
(Sorensen, Secher) Department of Anesthesia, Rigshospitalet, University of
Copenhagen, Copenhagen, Denmark
(Grocott) Department of Anesthesia & Perioperative Medicine, University of
Manitoba, Winnipeg, MB, Canada
Title
Near infrared spectroscopy for frontal lobe oxygenation during
non-vascular abdominal surgery.
Source
Clinical Physiology and Functional Imaging. 36 (6) (pp 427-435), 2016.
Date of Publication: 01 Nov 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Purpose: Cerebral deoxygenation, as determined by near infrared
spectroscopy (NIRS), seems to predict postoperative complications
following cardiac surgery. We identify the type of non-vascular abdominal
surgery associated with cerebral deoxygenation and/or hyperoxygenation,
how such deviations affect patient outcome, and whether maintained
cerebral oxygenation improves outcome. Methods: A systematic literature
search was performed on PubMed, EMBASE, Web of Science and
Clinicaltrials.gov. Results: A total of 901 patients from 24 publications
are described. A decrease in NIRS (>15% relative to baseline) manifested
with reverse Trendelenburg's positioning and in 24% (median) of especially
elderly patients undergoing open surgery and demonstrated a correlation to
hospital stay (LOS). However, if cerebral deoxygenation was reversed
promptly, improved postoperative cognitive function (28 versus 26;
mini-mental state examination) and reduced LOS (14 versus 23 days) were
seen. Also, during liver transplantation (LTx), impaired cerebral
autoregulation (25%), cerebral deoxygenation in the anhepatic phase (36%)
and cerebral hyperoxygenation with reperfusion of the grafted liver (14%)
were identified by NIRS and could lead to adverse neurological outcome,
that is seizures, transient hemiparesis and stroke. Conclusion: NIRS seems
important for predicting neurological complications associated with LTx.
Also, surgery in reverse Trendelenburg's position and in other types of
abdominal surgery about one-fourth of the patients are subjected to
episodes of cerebral deoxygenation that seems to predict a poor outcome.
Although there are currently only few studies available for patients going
through abdominal surgery, the available evidence points to that it is an
advantage to maintain the NIRS-determined cerebral oxygenation.
Copyright © 2015 Scandinavian Society of Clinical Physiology and
Nuclear Medicine. Published by John Wiley & Sons Ltd

<37>
Accession Number
610455316
Author
Florian S.; De Waha S.; Eitel I.; Desch S.; Fuernau G.; Thiele H.
Institution
(Florian) University of Leipzig, Heart Center, Leipzig, Germany
(De Waha, Eitel, Desch, Fuernau, Thiele) Medical Clinic II -
Cardiology/Angiology/Intensive Care Medicine, University Heart Center
Lubeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160,
Lubeck 23538, Germany
Title
Interventional post-myocardial infarction ventricular septal defect
closure: A systematic review of current evidence.
Source
EuroIntervention. 12 (1) (pp 94-102), 2016. Date of Publication: May 2016.
Publisher
EuroPCR
Abstract
Aims: Interventional closure of post-myocardial infarction ventricular
septal defects (VSD) is an alternative treatment option to surgical
repair. However, only limited evidence exists concerning the
interventional closure of a VSD. This review seeks to establish an
overview of the existing literature and to carry out a systematic analysis
of the success rate and clinical outcome of this procedure. Methods and
results: We conducted a comprehensive systematic literature search to
evaluate the existing evidence of percutaneous device closure of
post-infarction VSD. Patient series with fewer than five reported cases
were excluded. In total, 13 series were identified, with an overall
inclusion of 273 patients. Mean patient age was 70 years. Cardiogenic
shock was present in 48% of cases at the time of intervention. Device
closure within the first 14 days (acute phase) after VSD detection was
performed in 42% of cases. Technical success rate was high (>75%).
Successful device implantation rate was 89%. Overall inhospital/30-day
mortality was 32%. Major complications included device embolisation,
ventricular perforation and arrhythmias. Conclusions: Percutaneous device
closure of post-myocardial infarction VSD is a valuable alternative to
surgical repair, with the advantage of immediate shunt reduction to
prevent haemodynamic deterioration. A high rate of technically successful
percutaneous procedures can be achieved; however, the mortality rate
remains high, especially in cardiogenic shock patients.
Copyright © Europa Digital & Publishing 2016. All rights reserved.

<38>
Accession Number
610455247
Author
Schmitt B.; Spriestersbach H.; O H-Ici D.; Radtke T.; Bartosch M.; Peters
H.; Sigler M.; Frese L.; Dijkman P.E.; Baaijens F.P.T.; Hoerstrup S.P.;
Berger F.
Institution
(Schmitt, Spriestersbach, O H-Ici, Radtke, Bartosch, Peters, Berger)
Department of Congenital Heart Disease and Paediatric Cardiology,
Deutsches Herzzentrum Berlin, Augustenburger Platz 1, Berlin 13353,
Germany
(Sigler) Department of Paediatric Cardiology and Paediatric Intensive Care
Medicine, Georg-August University, Gottingen, Germany
(Frese, Dijkman, Hoerstrup) Division of Surgical Research, University and
University Hospital Zurich, Zurich, Switzerland
(Baaijens) Department of Biomedical Engineering, Eindhoven University of
Technology, Eindhoven, Netherlands
Title
Percutaneous pulmonary valve replacement using completely
tissue-engineered off-the-shelf heart valves: Six-month in vivo
functionality and matrix remodelling in sheep.
Source
EuroIntervention. 12 (1) (pp 62-70), 2016. Date of Publication: May 2016.
Publisher
EuroPCR
Abstract
Aims: The objective was to implant a stented decellularised
tissue-engineered heart valve (sdTEHV) percutaneously in an animal model,
to assess its in vivo functionality and to examine the repopulation and
remodelling of the valvular matrix by the recipient's autologous cells.
Methods and results: Prototypes of sdTEHV were cultured in vitro,
decellularised and percutaneously implanted into the pulmonary position in
15 sheep. Functionality was assessed monthly by intracardiac
echocardiography (ICE). Valves were explanted after eight, 16 or 24 weeks
and analysed macroscopically, histologically and by electron microscopy.
Implantation was successful in all animals. Valves showed normal pressure
gradients throughout the study. Due to a suboptimal design with small
coaptation area, stent ovality led to immediate regurgitation which
continuously increased during follow-up. Analyses revealed complete
endothelialisation and rapid cellular repopulation and remodelling of the
entire matrix. Valves were free from endocarditis, calcification and graft
rejection. Conclusions: sdTEHV can be safely implanted percutaneously. The
fast autologous recellularisation and the extensive matrix remodelling
demonstrate the valve's potential as a next-generation percutaneous
prosthesis with the capacity for tissue self-maintenance and longevity.
Regurgitation may be prevented by valve design optimisation.
Copyright © Europa Digital & Publishing 2016. All rights reserved.

<39>
Accession Number
610455014
Author
Chieffo A.; Hildick-Smith D.
Institution
(Chieffo) Interventional Cardiology Unit, San Raffaele Scientific
Institute, Via Olgettina 60, Milan 20132, Italy
(Hildick-Smith) Sussex Cardiac Centre, Brighton and Sussex University,
Hospitals NHS Trust, Brighton, United Kingdom
Title
The European Bifurcation Club Left Main Study (EBC MAIN): Rationale and
design of an international, multicentre, randomised comparison of two
stent strategies for the treatment of left main coronary bifurcation
disease.
Source
EuroIntervention. 12 (1) (pp 47-52), 2016. Date of Publication: May 2016.
Publisher
EuroPCR
Abstract
Aims: Our aim is to investigate clinical outcomes following single versus
dual stenting strategies for the treatment of true bifurcation distal left
main coronary artery lesions. Methods and results: The EBC MAIN study is a
prospective, multinational, randomised clinical study of left main stem
true bifurcation lesions (type 1,1,1 or 0,1,1: both left anterior
descending and circumflex artery >2.75 mm diameter). The study hypothesis
is that left main coronary bifurcation lesions are best treated with a
planned single-stent strategy rather than a planned dual-stent strategy,
with respect to death, target lesion revascularisation and myocardial
infarction at one year. A total of 450 patients will be enrolled and
treated either with a planned single or a planned dual zotarolimus-eluting
stent strategy according to randomisation. The primary study endpoint is a
composite of death, myocardial infarction and target lesion
revascularisation at 12 months. Secondary endpoints are: death, myocardial
infarctions, and target lesion revascularisation, each at 12 months;
angina status, stent thrombosis, death, myocardial infarction, target
lesion revascularisation at three- and five-year clinical follow-up.
Conclusions: EBC MAIN will be the first randomised clinical trial to
compare single versus dual stenting strategies for the treatment of true
bifurcation distal left main coronary artery lesions.
Copyright © Europa Digital & Publishing 2016. All rights reserved.

<40>
Accession Number
607220730
Author
Niebler R.A.; Woods K.J.; Murkowski K.; Ghanayem N.S.; Hoffman G.;
Mitchell M.E.; Punzalan R.C.; Scott J.P.; Simpson P.; Tweddell J.S.
Institution
(Niebler, Woods, Murkowski, Ghanayem) Section of Critical Care, Medical
College of Wisconsin, Milwaukee, WI, United States
(Punzalan, Scott) Section of Hematology, Medical College of Wisconsin,
Milwaukee, WI, United States
(Simpson) Section of Quantitative Health Sciences, Department of
Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
(Hoffman) Department of Anesthesiology, Medical College of Wisconsin,
Milwaukee, WI, United States
(Mitchell, Tweddell) Department of Cardiothoracic Surgery, Medical College
of Wisconsin, Milwaukee, WI, United States
(Niebler, Ghanayem, Hoffman, Mitchell, Tweddell) Herma Heart Center at
Children's Hospital of Wisconsin, Milwaukee, WI, United States
Title
A Pilot Study of Antithrombin Replacement Prior to Cardiopulmonary Bypass
in Neonates.
Source
Artificial Organs. 40 (1) (pp 80-85), 2016. Date of Publication: 01 Jan
2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Neonates have low levels of antithrombin. Inadequate anticoagulation
during cardiopulmonary bypass (CPB) due to low antithrombin activity may
result in a poor preservation of the coagulation system during bypass. We
hypothesize that antithrombin replacement to neonates prior to CPB will
preserve the hemostatic system and result in less postoperative bleeding.
A randomized, double-blinded, placebo-controlled pilot study of
antithrombin replacement to neonates prior to CPB was conducted.
Preoperative antithrombin levels determined the dose of recombinant
antithrombin or placebo to be given. Antithrombin levels were measured
following the dosing of the antithrombin/placebo, after initiation of
bypass, near the completion of bypass, and upon intensive care unit
admission. Eight subjects were enrolled. No subject had safety concerns.
Mediastinal exploration occurred in two antithrombin subjects and one
placebo subject. Antithrombin activity levels were significantly higher in
the treated group following drug administration; levels continued to be
higher than preoperatively but not different from the placebo group at all
other time points. Total heparin administration was less in the
antithrombin group; measurements of blood loss were similar in both
groups. A single dose of recombinant antithrombin did not maintain 100%
activity levels throughout the entire operation. Although no safety
concerns were identified in this pilot study, a larger trial is necessary
to determine clinical efficacy.
Copyright © 2016 Wiley Periodicals, Inc. and International Center for
Artificial Organs and Transplantation.

<41>
[Use Link to view the full text]
Accession Number
606695285
Author
Pesonen E.J.; Suominen P.K.; Keski-Nisula J.; Mattila I.P.; Rautiainen P.;
Jahnukainen T.
Institution
(Pesonen, Suominen, Keski-Nisula, Rautiainen) Department of Anesthesiology
and Intensive Care Medicine, Helsinki University Hospital, University of
Helsinki, Helsinki, Finland
(Mattila) Department Of Pediatric Cardiac and Transplantation Surgery,
Children's Hospital, University of Helsinki, Helsinki, Finland
(Jahnukainen) Department of Pediatric Nephrology and Transplantation,
Children's Hospital, University of Helsinki, Helsinki, Finland
Title
The Effect of Methylprednisolone on Plasma Concentrations of Neutrophil
Gelatinase-Associated Lipocalin in Pediatric Heart Surgery.
Source
Pediatric Critical Care Medicine. 17 (2) (pp 121-127), 2016. Date of
Publication: 01 Feb 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: Plasma neutrophil gelatinase-associated lipocalin is a kidney
injury marker used in pediatric heart surgery. Neutrophil
gelatinase-associated lipocalin is also a constituent of specific granules
of neutrophils. Corticosteroids are widely used in pediatric heart
surgery. Methylprednisolone inhibits degranulation of neutrophil-specific
granules. Use of corticosteroids has not been taken into account in
studies of neutrophil gelatinase-associated lipocalin in pediatric heart
surgery. We studied the influence of systemically administered
methylprednisolone on plasma neutrophil gelatinase-associated lipocalin
concentrations in pediatric heart surgery. Design: Two separate
double-blinded randomized trials. Setting: PICU at a university-affiliated
hospital. Patients: Forty neonates undergoing open-heart surgery and 45
children undergoing ventricular and atrioventricular septal defect
correction. Interventions: First trial (neonate trial), 40 neonates
undergoing open-heart surgery received either 30 mg/kg IV
methylprednisolone (n = 20) or placebo (n = 20). Second trial (ventricular
septal defect trial), 45 children undergoing ventricular or
atrioventricular septal defect correction received one of the following:
30 mg/kg of methylprednisolone IV after anesthesia induction (n = 15), 30
mg/kg methylprednisolone in the cardiopulmonary bypass prime solution (n =
15), or placebo (n = 15). Measurements and Main Results: Plasma neutrophil
gelatinase-associated lipocalin and creatinine were measured in both
series. Lactoferrin levels were measured as a marker of
neutrophil-specific granules in the ventricular septal defect trial only.
No differences in creatinine levels occurred between the groups of either
trial. Preoperative, neutrophil gelatinase-associated lipocalin did not
differ between the study groups of either trial. Preoperatively
administered methylprednisolone in the neonate trial reduced neutrophil
gelatinase-associated lipocalin by 41% at 6 hours postoperatively (p =
0.002). Preoperatively administered methylprednisolone in the ventricular
septal defect trial reduced neutrophil gelatinase-associated lipocalin by
47% (p = 0.010) and lactoferrin by 52% (p = 0.013) 6 hours
postoperatively. Lactoferrin levels in the ventricular septal defect trial
correlated with neutrophil gelatinase-associated lipocalin (R = 0.492; p =
0.001) preoperatively and after weaning from cardiopulmonary bypass (R =
0.471; p = 0.001). Conclusions: Preoperatively administered
methylprednisolone profoundly decreases plasma neutrophil
gelatinase-associated lipocalin levels. Neutrophil gelatinase-associated
lipocalin seems to originate to a significant extent from activated
neutrophils. Preoperative methylprednisolone is a confounding factor when
interpreting plasma neutrophil gelatinase-associated lipocalin levels as a
kidney injury marker in pediatric heart surgery.
Copyright © 2016 by the Society of Critical Care Medicine and the
World Federation of Pediatric Intensive and Critical Care Societies.

<42>
Accession Number
607429946
Author
Gargiulo G.; Capodanno D.; Sannino A.; Barbanti M.; Perrino C.; Capranzano
P.; Stabile E.; Indolfi C.; Trimarco B.; Tamburino C.; Esposito G.
Institution
(Gargiulo, Sannino, Perrino, Stabile, Trimarco, Esposito) Division of
Cardiology, Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy
(Capodanno, Barbanti, Capranzano, Tamburino) Cardio-toracic-vascular
Department, Ferrarotto Hospital, University of Catania, Via Citelli, 6,
Catania 95124, Italy
(Indolfi) Laboratory of Molecular and Cellular Cardiology, Cardiovascular
Institute, Magna Graecia University, Italy
(Indolfi) URT-CNR, Magna Graecia University, Catanzaro, Italy
Title
New-onset atrial fibrillation and increased mortality after transcatheter
aortic valve implantation: A causal or spurious association?.
Source
International Journal of Cardiology. 203 (pp 264-266), 2016. Date of
Publication: 2016.
Publisher
Elsevier Ireland Ltd

<43>
[Use Link to view the full text]
Accession Number
613408824
Author
Gibson C.M.; Korjian S.; Tricoci P.; Daaboul Y.; Yee M.; Jain P.;
Alexander J.H.; Steg P.G.; Lincoff A.M.; Kastelein J.J.P.; Mehran R.;
D'Andrea D.M.; Deckelbaum L.I.; Merkely B.; Zarebinski M.; Ophuis T.O.;
Harrington R.A.
Institution
(Gibson, Korjian, Daaboul, Yee, Jain) PERFUSE Study Group, Cardiovascular
Division, Department of Medicine, Beth Israel Deaconess Medical Center,
Harvard Medical School, 330 Brookline Avenue, Overland 540, Boston, MA
02215, United States
(Tricoci, Alexander) Duke Clinical Research Institute, Cardiovascular
Division, Department of Medicine, Duke University Health, Durham, NC,
United States
(Steg) INSERM-Unite 1148, France Assistance Publique-Hopitaux de Paris,
Hopital Bichat, France Universite Paris-Diderot, Sorbonne- Paris Cite,
France National Heart and Lung Institute, Paris, France
(Steg) Imperial College London, UK Institute of Cardiovascular Medicine
and Science, Royal Brompton Hospital, London, United Kingdom
(Lincoff) Department of Cardiovascular Medicine, Cleveland Clinic
Foundation, Cleveland, OH, United States
(Kastelein) Department of Vascular Medicine, Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
(Mehran) Cardiovascular Institute, Mount Sinai Medical Center, Icahn
School of Medicine at Mount Sinai, New York, United States
(D'Andrea, Deckelbaum) CSL Behring, LLC, King of Prussia, PA, United
States
(Merkely) Heart and Vascular Center, Semmelweis University, Budapest,
Hungary
(Zarebinski) Department of Cardiology, Warsaw Medical University, Warsaw,
Poland
(Ophuis) Department of Cardiology, Canisius Wilhelmina Ziekenhuis,
Nijmegen, Netherlands
(Harrington) Department of Medicine, Stanford University, Stanford, CA,
United States
Title
Safety and Tolerability of CSL112, a Reconstituted, Infusible,
Plasma-Derived Apolipoprotein A-I, after Acute Myocardial Infarction: The
AEGIS-I Trial (ApoA-I Event Reducing in Ischemic Syndromes I).
Source
Circulation. 134 (24) (pp 1918-1930), 2016. Date of Publication: 13 Dec
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Human or recombinant apolipoprotein A-I (apoA-I) has been
shown to increase high-density lipoprotein-mediated cholesterol efflux
capacity and to regress atherosclerotic disease in animal and clinical
studies. CSL112 is an infusible, plasma-derived apoA-I that has been
studied in normal subjects or those with stable coronary artery disease.
This study aimed to characterize the safety, tolerability,
pharmacokinetics, and pharmacodynamics of CSL112 in patients with a recent
acute myocardial infarction. Methods: The AEGIS-I trial (Apo-I Event
Reducing in Ischemic Syndromes I) was a multicenter, randomized,
double-blind, placebo-controlled, dose-ranging phase 2b trial. Patients
with myocardial infarction were stratified by renal function and
randomized 1:1:1 to CSL112 (2 g apoA-I per dose) and high-dose CSL112 (6 g
apoA-I per dose), or placebo for 4 consecutive weekly infusions. Coprimary
safety end points were occurrence of either a hepatic safety event (an
increase in alanine transaminase >3 times the upper limit of normal or an
increase in total bilirubin >2 times the upper limit of normal) or a renal
safety event (an increase in serum creatinine >1.5 times the baseline
value or a new requirement for renal replacement therapy). Results: A
total of 1258 patients were randomized, and 91.2% received all 4
infusions. The difference in incidence rates for an increase in alanine
transaminase or total bilirubin between both CSL112 arms and placebo was
within the protocol-defined noninferiority margin of 4%. Similarly, the
difference in incidence rates for an increase in serum creatinine or a new
requirement for renal replacement therapy was within the protocol-defined
noninferiority margin of 5%. CSL112 was associated with increases in
apoA-I and ex vivo cholesterol efflux similar to that achieved in patients
with stable coronary artery disease. In regard to the secondary efficacy
end point, the risk for the composite of major adverse cardiovascular
events among the groups was similar. Conclusions: Among patients with
acute myocardial infarction, 4 weekly infusions of CSL112 are feasible,
well tolerated, and not associated with any significant alterations in
liver or kidney function or other safety concern. The ability of CSL112 to
acutely enhance cholesterol efflux was confirmed. The potential benefit of
CSL112 to reduce major adverse cardiovascular events needs to be assessed
in an adequately powered phase 3 trial.
Copyright © 2016 The Authors.

<44>
Accession Number
607178677
Author
Palma A.; Viegas J.; Manlhiot C.; McCrindle B.; Benson L.
Institution
(Palma, Viegas, Manlhiot, McCrindle, Benson) Department of Pediatrics,
Division of Cardiology, Labatt Family Heart Centre, Cardiac Diagnostic and
Interventional Unit, Hospital for Sick Children, University of Toronto
School of Medicine, Toronto, ON, Canada
Title
Use of local anesthetic (0.25% bupivacaine) for pain control after
pediatric cardiac catheterization: A randomized controlled trial.
Source
Catheterization and Cardiovascular Interventions. 87 (2) (pp 318-323),
2016. Date of Publication: 01 Feb 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives To investigate the effects of local infiltration of 0.25%
bupivacaine on post-operative pain and analgesic use in children
undergoing cardiac catheterization procedures. Background In pediatric
catheterization procedures performed under general anesthesia, a local
anesthetic is often used prior to femoral sheath removal. There are no
published reports of the impact of local anesthetic infiltration on pain
after pediatric procedures, and mixed reports on its effectiveness in
adults. Methods A randomized controlled trial was undertaken of 140
children, aged 7-18 years undergoing cardiac catheterization under general
anesthesia via the femoral vein or artery. Participants received a
subcutaneous infiltration of 0.25% bupivacaine at the access site prior to
sheath removal, or usual care without bupivacaine. Outcomes included
patient reported pain scores and analgesic use up to 6 hr after the
procedure. Results Pain scores were similar between groups through the
6-hr post-procedure period. The proportion of children reporting a maximal
pain score of <2/10 was higher in the bupivacaine group (64% vs. 44%, P =
0.03). A significantly higher proportion of children in the control group
required IV morphine (18.8% vs. 4.5%, P = 0.02). Conclusions Morphine use
can be reduced with the use of 0.25% bupivacaine given prior to femoral
sheath removal and should be considered for post-procedural pain control
for pediatric patients undergoing cardiac catheterization. This study is
the first to contribute evidence to the effectiveness of 0.25% bupivacaine
after pediatric cardiac catheterization.
Copyright © 2015 Wiley Periodicals, Inc.

<45>
Accession Number
607430268
Author
Zhao B.-C.; Deng W.-T.; Li B.-C.; Deng Q.-W.; Xia Z.-Q.; Li Y.-Y.; Liu
K.-X.
Institution
(Zhao, Deng, Li, Deng, Xia, Li, Liu) Department of Anesthesiology, First
Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road,
Guangzhou 510080, China
Title
Remote ischemic preconditioning for preventing acute kidney injury
following cardiovascular surgery: A meta-analysis with trial sequential
analysis.
Source
International Journal of Cardiology. 203 (pp 842-844), 2016. Date of
Publication: 15 Jan 2016.
Publisher
Elsevier Ireland Ltd

<46>
Accession Number
607232935
Author
Zhang H.; Liu Y.; Qiu S.; Liang W.; Jiang L.
Institution
(Zhang, Liu) Southern Medical University, Guangzhou, Guangdong, China
(Qiu) Department of Medical Ultrasound, The Second Affiliated Hospital of
Guangzhou Medical University, Guangzhou, Guangdong, China
(Liang, Jiang) Department of Medical Ultrasound, The Third Affiliated
Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
Title
Short-term and long-term survival after revascularization with or without
mitral valve surgery of patients with ischemic mitral valve regurgitation:
A meta-analysis.
Source
Medical Science Monitor. 21 (pp 3784-3791), 2015. Date of Publication: 04
Dec 2015.
Publisher
International Scientific Literature Inc. (E-mail: msi@medscimonit.com)
Abstract
Background: There is no consensus on whether mitral valve repair or
replacement (MVRR) must be performed to treat ischemic mitral
regurgitation (MVR) after myocardial infarction. Our objective in this
study was to investigate the efficacy of coronary artery bypass grafting
(CABG) combined with or without MVRR for the ischemic MVR.
Material/Methods: An article search was performed in OvidSP, PubMed,
Cochrane Library, and Embase. In these articles, researchers compared the
efficacy of CABG with or without MVRR in treating patients with ischemic
MVR after acute coronary syndrome (ACS). We performed a meta-analysis to
compare the differences in the short-term and longterm survival rates of
patients treated with CABG only and those treated with both CABG and MVRR.
Secondary outcomes were compared with the preoperative and postoperative
degree of MVR, left ventricular end-systolic volume (LVESV), left
ventricular ejection fraction (LVEF), and New York Heart Association
(NYHA) class. Results: Out of the 1183 studies, we selected only 5
articles. A total of 3120 patients were enrolled; the CABG and MVRR group
included 575 patients, while the CABG only group included 2545 patients.
Long-term survival was higher in the CABG only group (hazard ratio [HR],
1.34; 95% confidence interval [CI] 1.15-1.58, P=0.003). Hospital mortality
was similar in both the groups (odds ratio [OR], 2.54; 95% CI, 0.65-9.95;
P=0.18). No differences were found in the degree of residual MVR, the mean
of LVESV, LVEF, or NYHA class. Conclusions: In patients with ischemic MVR,
the short-term survival rate was similar in both groups. Moreover, there
was no significant improvement in the long-term survival rates of patients
treated with both CAG and MVRR.
Copyright © Med Sci Monit, 2015.

<47>
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. © 2014 Elsevier Inc.

<48>
Accession Number
610760824
Author
Biagini E.; Pazzi C.; Olivotto I.; Musumeci B.; Limongelli G.; Boriani G.;
Pacileo G.; Mastromarino V.; Bacchi Reggiani M.L.; Lorenzini M.; Lai F.;
Berardini A.; Mingardi F.; Rosmini S.; Resciniti E.; Borghi C.; Autore C.;
Cecchi F.; Rapezzi C.
Institution
(Biagini, Pazzi, Boriani, Bacchi Reggiani, Lorenzini, Lai, Berardini,
Mingardi, Rosmini, Resciniti, Borghi, Rapezzi) Cardiology, Department of
Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum,
University of Bologna, Bologna, Italy
(Olivotto, Cecchi) Cardiothoracovascular Department, Referral Center for
Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence,
Italy
(Musumeci, Mastromarino, Autore) Department of Clinical and Molecular
Medicine, Sapienza University of Rome, Rome, Italy
(Limongelli, Pacileo) Department of Cardiology, Monaldi Hospital,
University of Naples, Naples, Italy
Title
Usefulness of Electrocardiographic Patterns at Presentation to Predict
Long-term Risk of Cardiac Death in Patients With Hypertrophic
Cardiomyopathy.
Source
American Journal of Cardiology. (no pagination), 2016. Date of
Publication: February 25, 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The objective of this study was to investigate the prognostic significance
of 12-lead electrocardiogram (ECG) patterns in a large multicenter cohort
of patients with hypertrophic cardiomyopathy; 1,004 consecutive patients
with hypertrophic cardiomyopathy and a recorded standard ECG (64% men,
mean age 50 +/- 16 years) were evaluated at 4 Italian centers. The study
end points were sudden cardiac death (SCD) or surrogates, including
appropriate implanted cardiac defibrillator discharge and resuscitated
cardiac arrest and major cardiovascular events (including SCD or
surrogates and death due to heart failure, cardioembolic stroke, or heart
transplantation). Prevalence of baseline electrocardiographic
characteristics was: normal ECG 4%, ST-segment depression 56%,
pseudonecrosis waves 33%, "pseudo-ST-segment elevation myocardial
infarction (STEMI)" pattern 17%, QRS duration >120 ms 17%, giant inverted
T waves 6%, and low QRS voltages 3%. During a mean follow-up of 7.4 +/-
6.8 years, 77 patients experienced SCD or surrogates and 154 patients
experienced major cardiovascular events. Independent predictors of SCD or
surrogates were unexplained syncope (hazard ratio [HR] 2.5, 95% confidence
interval [CI] 1.4 to 4.5, p = 0.003), left ventricular ejection fraction
<50% (HR 3.5, 95% CI 1.9 to 6.7, p = 0.0001), nonsustained ventricular
tachycardia (HR 1.7, 95% CI 1.1 to 2.6, p = 0.027), pseudo-STEMI pattern
(HR 2.3, 95% CI 1.4 to 3.8, p = 0.001), QRS duration >120 ms (HR 1.8, 95%
CI 1.1 to 3.0, p = 0.033), and low QRS voltages (HR 2.3, 95% CI 1.01 to
5.1, p = 0.048). Independent predictors of major cardiovascular events
were age (HR 1.02, 95% CI 1.01 to 1.03, p = 0.0001), LV ejection fraction
<50% (HR 3.73, 95% CI 2.39 to 5.83, p = 0.0001), pseudo-STEMI pattern (HR
1.66, 95% CI 1.13 to 2.45, p = 0.010), QRS duration >120 ms (HR 1.69, 95%
CI 1.16 to 2.47, p = 0.007), and prolonged QTc interval (HR 1.68, 95% CI
1.21 to 2.34, p = 0.002). In conclusion, a detailed qualitative and
quantitative electrocardiographic analyses provide independent predictors
of prognosis that could be integrated with the available score systems to
improve the power of the current model.
Copyright © 2016 Elsevier Inc.

<49>
Accession Number
615705362
Author
Madan R.; Penkert R.; Dara J.; Lamour J.; Herold B.; Hurwitz J.
Institution
(Madan, Dara, Lamour, Herold) Pediatrics, Albert Einstein College of
Medicine, Children's Hospital at Montefiore, Bronx, NY, United States
(Penkert, Hurwitz) Infectious Diseases, St Jude Children's Research
Hospital, Memphis, TN, United States
Title
Hypogammaglobulinemia in pediatric heart transplant candidates is not
corrected by transplantation.
Source
American Journal of Transplantation. Conference: 17th American Transplant
Congress, ATC 2017. United States. 17 (pp 649), 2017. Date of Publication:
April 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Introduction: Hypogammaglobulinemia (HG) is associated with poor outcomes
in adult heart transplant recipients but is not well studied in pediatric
recipients. We therefore investigated longitudinal immunoglobulin (Ig)
levels in 15 pediatric heart transplant cases. Methods: Sera were
collected from 15 recipients at a median of 3.2 mo (visit 1), 8.5 mo
(visit 2), and 22.3 mo (visit 3) post transplant and from 9/15 candidates
pre transplant. IgG subclasses 1-4, IgM, and IgA were quantified by
bead-based multiplex immunoassay. Total IgG was calculated by summation of
subclasses, using scoreable values or the assay's lower limit of
detection. HG was defined as Ig level below the lower limit of the 95% CI
for age. Results: Median age at transplant was 12.9 yrs (1.4-21yrs); 5/15
required ECMO or LVAD pre transplant. Induction consisted of ATG and
solumedrol, followed by maintenance tacrolimus and MMF. No participant
received anti-CD20 mAb or IVIG. All 9 transplant candidates had HG pre
transplant (mean IgG 306 +/-144 mg/dL), which was attributed primarily to
low IgG1 (8, 1, 4, and 6 candidates had IgG1, IgG2, IgG3, and IgG4 <95%CI
for age, respectively). HG persisted post transplant, with mean IgG levels
of 332 +/- 142 at visit 1, 324 +/- 133 at visit 2, and 390 +/- 162 at
visit 3. Low IgG again reflected primarily low IgG1; 11, 3, 3, and 8
participants had IgG1, IgG2, IgG3 and IgG4 <95% CI for age, respectively.
In addition, at least 50% of participants had low IgM and/or IgA at visits
1-3. Only 1 child with pre transplant HG had normal levels of all isotypes
by visit 3. 2 candidates had bacteremia, and 1 had fungemia pre
transplant. 6 children had opportunistic infection post transplant (4 CMV,
1 EBV, 1 adenovirus). Conclusions: Studies in adult solid organ transplant
recipients suggest that HG is medication-induced. However we found that HG
began prior to transplant and persisted until at least 2 years post
transplant. HG reflected low levels of IgG1, which may result in recurrent
infections and impaired vaccine responses. The mechanisms contributing to
both pre transplant HG and persistent HG beyond the early post transplant
period require further investigation. If confirmed in larger studies,
these data may provide a rationale for randomized trials of IVIG
replacement in pediatric SOT recipients.

<50>
Accession Number
615705231
Author
Teuteberg J.; Shullo M.; Rinde-Hoffman D.; Wigger M.; Wang Y.; Wolf T.;
Arnold P.; Sninsky J.; Berman P.
Institution
(Teuteberg, Shullo) University of Pittsburgh Medical Center, Pittsburgh,
PA, United States
(Rinde-Hoffman, Berman) Tampa General Hospital, Tampa, FL, United States
(Wigger) Vanderbilt Heart and Vascular Institution, Nashville, TN, United
States
(Wang, Wolf, Arnold, Sninsky) CareDx, Brisbane, CA, United States
Title
Routine surveillance of heart transplant recipients with gene expression
profiling: Lack of an impact of race on outcomes.
Source
American Journal of Transplantation. Conference: 17th American Transplant
Congress, ATC 2017. United States. 17 (pp 647-648), 2017. Date of
Publication: April 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Purpose: Patients of African descent have been reported to have less
favorable outcomes after heart transplantation than patients of European
descent. However, the impact of race on outcomes in patients who are
followed clinically with gene expression profiling (GEP) has not been well
described. Methods: Heart transplant patients from the 31 transplant
centers in Outcomes AlloMap Registry (OAR) were studied. We compared the
time of first visit using gene expression profiling (GEP) as the primary
surveillance method, panel reactive antibodies (PRA) and
pre-transplantation mechanical circulatory support (MCS), and allograft
rejections in patients of African descent and of European descent. GEP
scores (AlloMap) were analyzed upon first and subsequent
post-transplantation visits. Results: Of the 1049 patients, 760 are of
European descent (ED) and 195 are of African descent (AD). At baseline
there was no significant difference in PRA 6% v 7%, p=0.42 or use of MCS
53% v 57%, p=0.32 for ED and AD, respectively. There was also no
difference between ED and AD in the mean time post-transplant the patients
were enrolled (12.9 v 10.5 months, p=0.16). GEP scores are comparable
across groups. GEP scores show equivalence between European descent and
African American patients in both first visits (mean 26.8 for Caucasian,
27.4 for African American; p-value 0.31 between the two groups) and across
all post-transplantation visits to date (p-value 0.13). 715 patients had
1983 visits of where biopsy results are available, there were fewer Grade
>2R rejection events in AD compared to ED 2.26% and 6.13%, respectively,
but it did not reach statistical significance, p-value 0.12. Conclusions:
Patients of African descent had similar application of GEP surveillance
and were not different from patients of European descent in the risk
factors for rejection and outcomes. Further, the GEP scores for African
descent patients were comparable to those for European patients. For those
who are candidates for surveillance with GEP, race of the patient does not
appear to have an impact on outcomes.

<51>
Accession Number
615705109
Author
Mital D.; Petruccione M.; Brown J.; Vasquez S.; Wheaton S.; Johnson W.;
Desai C.; Chhabra D.; Kinzler G.; Sankary H.; Lawrecki T.; Pappas P.;
Tatooles A.; Bresticker M.; Cotts W.; Bhat G.
Institution
(Mital, Petruccione, Brown, Vasquez, Wheaton, Johnson, Desai, Chhabra,
Kinzler, Sankary, Lawrecki) Kidney Transplant Program, General Surgery,
Advocate Christ Medical Center, Oak Lawn, IL, United States
(Lawrecki, Pappas, Tatooles, Bresticker, Cotts, Bhat) Heart Failure and
Transplant Program, Advocate Christ Medical Center, Oak Lawn, IL, United
States
Title
Sequential surgical strategy for heart-kidney transplantation.
Source
American Journal of Transplantation. Conference: 17th American Transplant
Congress, ATC 2017. United States. 17 (pp 646), 2017. Date of Publication:
April 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Purpose: To describe a unique sequential surgical strategy for
heart-kidney transplantation. Methods: We reviewed all 6 patients who
received combined heart-kidney transplants at our institution between
2013-2016. We waited 16-39 hours after the cardiac transplant before
transplanting the kidney. The donor kidney was preserved with pulsatile
perfusion. This allowed us to stabilize the hemodynamics, and control any
coagulopathy and bleeding from the thorax. Demographics: The 6 recipients
were males, ages 54-67 years (62.7 +/- 5.7). Their HLA mismatches were
5-6. Heart failure was ischemic in 3 patients. 5 patients had one or more
LVAD's pre-transplant. 2 patients were on dialysis. The kidney failure was
associated with diabetes in 3 patients, hypertension in 6 patients, and
hepatitis C in 1. The donors were all males, ages 26-32 years (29 +/-
2.5). All donors but 1 died of a CVA. Their initial serum creatinine was
1.00-1.23 mg/dl, and terminal serum creatinine was 0.6-1.68 mg/dl. Only 1
donor had hypertension. The cold ischemic time was 16-39 hours (26.3 +/-
8.7) for the kidney transplant. Results: We had excellent outcomes with
immediate renal allograft function, with 100% patient and allograft
survival. This is in contrast to previous reports with higher mortality in
simultaneous heart-kidney transplant patients. The immunosuppression
included Thymoglobulin induction and Tacrolimus, MMF, Prednisone
maintenance. 5 of the 6 patients had no acute cellular rejection at
anytime. 1 patient had 5 episodes of 1 R rejection, 2 of which were
treated with IV Methylprednisolone followed by an oral Prednisone taper.
There was no hemodynamic compromise or antibody mediated rejection.
Conclusions: Our unique strategy allows us to transplant the donor kidney
once the patient is stable. This avoids exposing the kidney to nephrotoxic
byproducts of cardiopulmonary bypass like plasma-free hemoglobin, as well
as acute tubular necrosis from hypotension and pressors in the immediate
post-cardiac transplant period. We feel this technique will result in
better patient and renal allograft survival in the long-term. Randomized
clinical trials are warranted to further examine this surgical strategy.

<52>
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 © 2017 The Author(s).

<53>
[Use Link to view the full text]
Accession Number
615319883
Author
Chi D.; Chen C.; Shi Y.; Wang W.; Ma Y.; Zhou R.; Yu H.; Liu B.
Institution
(Chi, Chen, Shi, Wang, Ma, Zhou, Yu, Liu) Department of Anesthesiology,
West China Hospital, Sichuan University, Chengdu, Sichuan, China
Title
Ventilation during cardiopulmonary bypass for prevention of respiratory
insufficiency: A meta-analysis of randomized controlled trials.
Source
Medicine (United States). 96 (12) (no pagination), 2017. Article Number:
e6454. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Cardiopulmonary bypass (CPB) is necessary for most cardiac
surgery, which may lead to postoperative lung injury. The objective of
this paper is to systematically evaluate whether ventilation during CPB
would benefit patients undergoing cardiac surgery. Methods: We searched
randomized controlled trials (RCTs) through PubMed, Embase, and Cochrane
Library from inception to October 2016. Eligible studies compared clinical
outcomes of ventilation versus nonventilation during CPB in patients
undergoing cardiac surgery. The primary outcome includes oxygenation index
(PaO2/FiO2 ratio) or alveolar to arterial oxygen tension difference
(AaDO2) immediately after weaning from bypass. The secondary outcomes
include postoperative pulmonary complications (PPCs), shunt fraction
(Qs/Qt), hospital stay, and AaDO2 4hours after CPB. Results: Seventeen
trials with 1162 patients were included in this meta-analysis. Ventilation
during CPB significantly increased post-CPB PaO2/FiO2 ratio (mean
difference [MD]=21.84; 95% confidence interval [CI]=1.30 to 42.37; P=0.04;
I2=75%) and reduced post-CPB AaDO2 (MD=-50.17; 95% CI=-71.36 to -28.99;
P<0.00001; I2=74%). Qs/Qt immediately after weaning from CPB showed a
significant difference between groups (MD=-3.24; 95% CI=-4.48 to -2.01;
P<0.00001; I2=0%). Incidence of PPCs (odds ratio [OR]=0.79; 95% CI=0.42 to
1.48; P=0.46; I2=37%) and hospital stay (MD=0.09; 95% CI=-23 to 0.41;
P=0.58; I2=37%) did not differ significantly between groups. Conclusion:
Ventilation during CPB might improve post-CPB oxygenation and gas exchange
in patients who underwent cardiac surgery. However, there is no sufficient
evidence to show that ventilation during CPB could influence long-term
prognosis of these patients. The beneficial effects of ventilation during
CPB are requisite to be evaluated in powerful and well-designed RCTs.
© Copyright 2017 the Author(s). Published by Wolters Kluwer Health,
Inc.

<54>
Accession Number
614599465
Author
Kurnaz P.; Sungur Z.; Camci E.; Sivrikoz N.; Orhun G.; Senturk M.; Sayin
O.; Tireli E.; Gurvit H.
Institution
(Kurnaz, Sungur, Camci, Sivrikoz, Orhun, Senturk, Sayin) Istanbul
University Istanbul Medical Faculty, Department of Anesthesiology,
Istanbul, Turkey
(Tireli) Istanbul University Istanbul Medical Faculty, Department of
Cardiac Surgery, Istanbul, Turkey
(Gurvit) Istanbul University Istanbul Medical Faculty, Department of
Neurology, Istanbul, Turkey
Title
The effect of two different glycemic management protocols on postoperative
cognitive dysfunction in coronary artery bypass surgery.
Source
Brazilian Journal of Anesthesiology. 67 (3) (pp 258-265), 2017. Date of
Publication: May 2017.
Publisher
Elsevier Editora Ltda
Abstract
Introduction Postoperative cognitive dysfunction (POCD) is an adverse
outcome of surgery that is more common after open heart procedures. The
aim of this study is to investigate the role of tightly controlled blood
glucose levels during coronary artery surgery on early and late cognitive
decline. Methods 40 patients older than 50 years undergoing elective
coronary surgery were randomized into two groups. In the "Tight Control"
group (GI), the glycemia was maintained between 80 and 120
mg.dL-1 while in the "Liberal" group (GII), it ranged between
80-180 mg.dL-1. A neuropsychological test battery was performed
three times: baseline before surgery and follow-up first and 12th weeks,
postoperatively. POCD was defined as a drop of one standard deviation from
baseline on two or more tests. Results At the postoperative first week,
neurocognitive tests showed that 10 patients in the GI and 11 patients in
GII had POCD. The incidence of early POCD was similar between groups.
However the late assessment revealed that cognitive dysfunction persisted
in five patients in the GII whereas none was rated as cognitively impaired
in GI (p = 0.047). Conclusion We suggest that tight perioperative glycemic
control in coronary surgery may play a role in preventing persistent
cognitive impairment.
Copyright © 2016 Sociedade Brasileira de Anestesiologia

<55>
Accession Number
614664038
Author
Qian C.; Feng H.; Cao J.; Wei B.; Wang Y.
Institution
(Qian, Feng, Cao, Wei, Wang) Department of Cardiology, Zhongnan Hospital
of Wuhan University, Wuhan University, Wuhan, China
(Wang) Medical Research Institute of Wuhan University, Wuhan University,
Wuhan, China
Title
Meta-Analysis of Randomized Control Trials Comparing Drug-Eluting Stents
Versus Coronary Artery Bypass Grafting for Significant Left Main Coronary
Narrowing.
Source
American Journal of Cardiology. 119 (9) (pp 1338-1343), 2017. Date of
Publication: 01 May 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Previous meta-analyses showed that drug-eluting stent (DES) implantation
may serve as an alternative to coronary artery bypass grafting (CABG) for
unprotected left main coronary artery (ULMCA) stenosis, largely driven by
data from registries. Hence, we performed a meta-analysis of randomized
controlled trials (RCTs) to overcome this limitation. PubMed, the Cochrane
Library, and Scopus were systematically searched through October 2016 to
identify eligible RCTs. The primary outcomes were major adverse cardiac
and cerebrovascular events (MACCE) at 1-year and long-term (>3 years)
follow-ups. This meta-analysis included 5 RCTs, totaling 4,595 patients
with ULMCA disease. Compared with CABG, DES showed similar 1-year rates of
MACCE (risk ratio [RR] 1.14, 95% confidence interval [CI] 0.91-1.42),
all-cause death, and myocardial infarction, with a higher incidence of
revascularization (RR 1.68, 95% CI 1.24-2.27) and lower incidence of stoke
(RR 0.43, 95% CI 0.23-0.78). At long-term follow-up, DES placement was
inferior to CABG in terms of MACCE (RR 1.27, 95% CI 1.13-1.43) and
revascularization (RR 1.70, 95% CI 1.43-2.01). There was no difference in
long-term risk of other outcomes between these 2 strategies. In
conclusion, DES stenting and CABG for ULMCA disease yield comparable rates
of MACCE at 1-year follow-up; however, CABG is associated with a decreased
risk of long-term MACCE compared with DES, exclusively driven by the
considerable reduction in revascularization events.
Copyright © 2017 Elsevier Inc.

<56>
Accession Number
614641045
Author
Maitra S.; Baidya D.K.; Bhattacharjee S.; Som A.
Institution
(Maitra, Baidya, Bhattacharjee, Som) All India Institute of Medical
Sciences, Department of Anaesthesiology & Intensive Care, New Delhi, India
Title
Perioperative gabapentin and pregabalin in cardiac surgery: a systematic
review and meta-analysis.
Source
Brazilian Journal of Anesthesiology. 67 (3) (pp 294-304), 2017. Date of
Publication: May 2017.
Publisher
Elsevier Editora Ltda
Abstract
Objectives Sternotomy for cardiac surgeries causes significant
postoperative pain and when not properly managed may cause significant
morbidity. As neuropathic pain is a significant component here, gabapentin
and pregabalin may be effective in these patients and may reduce
postoperative opioid consumption. The purpose of this systematic review
was to find out efficacy of gabapentin and pregabalin in acute
postoperative pain after cardiac surgery. Methods Published prospective
human randomized clinical trials, which compared preoperative and/or
postoperative gabapentin/pregabalin with placebo or no treatment for
postoperative pain management after cardiac surgery has been included in
this review. Results Four RCTs each for gabapentin and pregabalin have
been included in this systematic review. Three gabapentin and two
pregabalin studies reported decrease in opioid consumption in cardiac
surgical patients while one gabapentin and two pregabalin studies did not.
Three RCTs each for gabapentin and pregabalin reported lower pain scores
both during activity and rest. The drugs are not associated with any
significant complications. Conclusion Despite lower pain scores in the
postoperative period, there is insufficient evidence to recommend routine
use of gabapentin and pregabalin to reduce opioid consumption in the
cardiac surgical patients.
Copyright © 2016 Sociedade Brasileira de Anestesiologia

<57>
Accession Number
615000470
Author
Woolf-King S.E.; Anger A.; Arnold E.A.; Weiss S.J.; Teitel D.
Institution
(Woolf-King) Department of Psychology, Syracuse University, Syracuse, NY,
United States
(Woolf-King, Arnold, Weiss) Department of Medicine, University of
California, San Francisco, San Francisco, CA, United States
(Anger) Department of Community Health Systems, School of Nursing,
University of California, San Francisco, San Francisco, CA, United States
(Anger, Teitel) Department of Pediatrics, Pediatric Heart Center,
University of California, San Francisco, San Francisco, CA, United States
Title
Mental health among parents of children with critical congenital heart
defects: A systematic review.
Source
Journal of the American Heart Association. 6 (2) (no pagination), 2017.
Article Number: e004862. Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Parents of children with critical congenital heart defects
(PCCHDs) may be at high risk for mental health morbidity; however, the
literature is not well characterized. Given that compromised parental
mental health can lead to long-term cognitive, health-related, and
behavioral problems in children, a systematic review of this literature
could provide informed recommendations for continued research and enhance
the care of families of children living with critical congenital heart
defects. Methods and Results-We conducted a systematic review using the
Preferred Reporting Items for Systematic Reviews and Meta- Analyses
guidelines that resulted in 30 studies on the mental health of PCCHDs. The
literature revealed that PCCHDs are at an elevated risk for psychological
problems, particularly in the immediate weeks and months following cardiac
surgery. Up to 30% of PCCHDs have symptoms consistent with a diagnosis of
posttraumatic stress disorder, with over 80% presenting with clinically
significant symptoms of trauma; 25% to 50% of PCCHDs reported clinically
elevated symptoms of depression and/or anxiety, and 30% to 80% reported
experiencing severe psychological distress. There was high variability in
measurements used to assess study outcomes, methodological quality, and
sociocultural composition of the parents included in the studies.
Conclusions-There is an urgent need for additional research on the
severity, course, persistence, and moderators of these mental health
problems over time, and for the development and testing of screening
approaches and interventions that can be feasibly delivered in the context
of ongoing pediatric cardiac care.
Copyright © 2017 The Authors.

<58>
Accession Number
615000456
Author
Pierce B.; Bole I.; Patel V.; Brown D.L.
Institution
(Pierce, Bole, Patel) Hospitalist Division, Washington University School
of Medicine, St. Louis, MO, United States
(Brown) Cardiovascular Division, Washington University School of Medicine,
St. Louis, MO, United States
Title
Clinical outcomes of remote ischemic preconditioning prior to cardiac
surgery: A meta-analysis of randomized controlled trials.
Source
Journal of the American Heart Association. 6 (2) (no pagination), 2017.
Article Number: e004666. Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Multiple randomized controlled trials of remote ischemic
preconditioning (RIPC) prior to cardiac surgery have failed to demonstrate
clinical benefit. The aim of this updated meta-analysis was to evaluate
the effect of RIPC on outcomes following cardiac surgery. Methods and
Results-Searches of PubMed, Cochrane, EMBASE, and Web of Science databases
were performed for 1970 to December 13, 2015. Randomized controlled trials
comparing RIPC with a sham procedure prior to cardiac surgery performed
with cardiopulmonary bypass were assessed. All-cause mortality, acute
kidney injury (AKI), and myocardial infarction were the primary outcomes
of interest. We identified 21 trials that randomized 5262 patients to RIPC
or a sham procedure prior to undergoing cardiac surgery. The majority of
patients were men (72.6%) and the mean or median age ranged from 42.3 to
76.3 years. Of the 9 trials that evaluated mortality, 188 deaths occurred
out of a total of 4210 randomized patients, with 96 deaths occurring in
2098 patients (4.6%) randomized to RIPC and 92 deaths occurring in 2112
patients (4.4%) randomized to a sham control procedure, demonstrating no
significant reduction in all-cause mortality (risk ratio [RR], 0.987; 95%
CI, 0.653-1.492, P=0.95). Twelve studies evaluated AKI in 4209 randomized
patients. In these studies, AKI was observed in 516 of 2091 patients
(24.7%) undergoing RIPC and in 577 of 2118 patients (27.2%) randomized to
a sham procedure. RIPC did not result in a significant reduction in AKI
(RR, 0.839; 95% CI, 0.703-1.001 [P=0.052]). In 6 studies consisting of
3799 randomized participants, myocardial infarction occurred in 237 of
1891 patients (12.5%) randomized to RIPC and in 282 of 1908 patients
(14.8%) randomized to a sham procedure, resulting in no significant
reduction in postoperative myocardial infarction (RR, 0.809; 95% CI,
0.615-1.064 [P=0.13]). A subgroup analysis was performed a priori based on
previous studies suggesting that propofol may mitigate the protective
benefits of RIPC. Three studies randomized patients undergoing cardiac
surgery to RIPC or sham procedure in the absence of propofol anesthesia.
Most of these patients were men (60.3%) and the mean or median age ranged
from 57.0 to 70.6 years. In this propofol-free subgroup of 434 randomized
patients, 71 of 217 patients (32.7%) who underwent RIPC developed AKI
compared with 103 of 217 patients (47.5%) treated with a sham procedure.
In this cohort, RIPC resulted in a significant reduction in AKI (RR,
0.700; 95% CI, 0.527-0.930 [P=0.014]). In studies of patients who received
propofol anesthesia, 445 of 1874 (23.7%) patients randomized to RIPC
developed AKI compared with 474 of 1901 (24.9%) who underwent a sham
procedure. The RR for AKI was 0.928 (95% CI, 0.781-1.102; P=0.39) for RIPC
versus sham. There was no significant interaction between the two
subgroups (P=0.098). Conclusions-RIPC does not reduce morbidity or
mortality in patients undergoing cardiac surgery with cardiopulmonary
bypass. In the subgroup of studies in which propofol was not used, a
reduction in AKI was seen, suggesting that propofol may interact with the
protective effects of RIPC. Future studies should evaluate RIPC in the
absence of propofol anesthesia.
Copyright © 2017 The Authors.

<59>
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 © 2017, Professional Medical Publications. All rights
reserved.

<60>
Accession Number
607898218
Author
Amat-Santos I.J.; Cortes C.; Varela-Falcon L.H.
Institution
(Amat-Santos, Cortes, Varela-Falcon) Cardiology Department, Hospital
Clinico Universitario De Valladolid, Spain
Title
Delayed left anterior mitral leaflet perforation and infective
endocarditis after transapical aortic valve implantation-Case report and
systematic review.
Source
Catheterization and Cardiovascular Interventions. 89 (5) (pp 951-954),
2017. Date of Publication: April 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Aim: We aimed to illustrate the physiopathology of anterior mitral leaflet
perforation after TAVI in patients suffering from infective endocarditis
(IE). Methods and Results: The first known case of balloon-expandable
transapical case from our series suffering from this complication was
reported. In addition, a systematic electronic search of all published
cases reporting both entities was performed. Five transfemoral cases have
been published to the date, all males with mean age of 79.2 year (range:
66-88). Four were treated with self-expandable prostheses (deeply
implanted in the outflow tract). There was moderate residual aortic
regurgitation in four. Fever and positive blood cultures for typical
micoorganisms were present at certain time point in all cases between the
first week and up to 11 months (early IE). Three cases underwent cardiac
surgery with adequate outcomes and two others died during hospitalization.
Medical management in the case from our series allowed patient's survival
at 1-year follow up. Conclusions: Early suspicion of IE whenever anterior
mitral perforation is found after TAVI can be life-saving. The
hypothetical higher risk of this complication due to higher rate of aortic
regurgitation has to be prevented through adequate prosthesis depth and
careful sterile surgical technique. © 2016 Wiley Periodicals, Inc.
Copyright © 2016 Wiley Periodicals, Inc.

<61>
Accession Number
615824135
Author
Cordero E.; Roca-Oporto C.; Bulnes-Ramos A.; Aydillo T.; Gavalda J.;
Moreno A.; Torre-Cisneros J.; Montejo J.M.; Fortun J.; Munoz P.; Sabe N.;
Farinas M.C.; Blanes-Julia M.; Lopez-Medrano F.; Suarez-Benjumea A.;
Martinez-Atienza J.; Rosso-Fernandez C.; Perez-Romero P.
Institution
(Cordero, Roca-Oporto, Bulnes-Ramos, Aydillo, Martinez-Atienza,
Rosso-Fernandez, Perez-Romero) Clinical Unit of Infectious
Diseases,Microbiology and Preventive Medicine, Institute of Biomedicine of
Seville, University Hospitals Virgen Del Rocio, CSIC, University of
Seville, Avda Manuel Siurot s/n, Sevilla 41013, Spain
(Gavalda) Vall d'Hebron University Hospital, Barcelona, Spain
(Moreno) University Clinic Hospital, Barcelona, Spain
(Torre-Cisneros) Maimonides Biomedical Research Institute of Cordoba,
Reina Sofia University Hospital, University of Cordoba, Spain
(Montejo) Cruces University Hospital, Bizkaia, Spain
(Fortun) University Hospital Ramon y Cajal, Madrid, Spain
(Munoz) Gregorio Maranon University Hospital, Instituto de Investigacion
Sanitaria Hospital Gregorio Maranon, CIBER Enfermedades
Respiratorias-CIBERES, Department of Medicine, School of Medicine,
Universidad Complutense de Madrid, Madrid, Spain
(Sabe) University Hospital of Bellvitge, Infectious Diseases Research
Group, L'Hospitalet de Llobregat, Barcelona, Spain
(Farinas) University Hospital Marques de Valdecilla, Santander, Spain
(Blanes-Julia) University Hospital la Fe, Valencia, Spain
(Lopez-Medrano) University Hospital 12 de Octubre, Instituto de
Investigacion Biomedica I+12, Madrid, Spain
(Suarez-Benjumea) University Hospital Virgen Macarena, Seville, Spain
Title
Two doses of inactivated influenza vaccine improve immune response in
solid organ transplant recipients: Results of TRANSGRIPE 1-2, a randomized
controlled clinical trial.
Source
Clinical Infectious Diseases. 64 (7) (pp 829-838), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Background. Influenza vaccine effectiveness is not optimal in solid organ
transplant recipients (SOTR). We hypothesized that a booster dose might
increase it. Methods. TRANSGRIPE 1-2 is a phase 3, randomized, controlled,
multicenter, open-label clinical trial. Patients were randomly assigned
(1:1 stratified by study site, type of organ, and time since
transplantation) to receive 1 dose (control group) or 2 doses (booster
group) of the influenza vaccine 5 weeks apart. Results. A total of 499
SOTR were enrolled. Although seroconversion at 10 weeks did not meet
significance in the modified intention-to-treat population, seroconversion
rates were significantly higher in the booster arm for the per-protocol
population (53.8% vs 37.6% for influenza A(H1N1)pdm; 48.1% vs 32.3% for
influenza A(H3N2); and 90.7% vs 75% for influenza B; P < .05).
Furthermore, seroprotection at 10 weeks was higher in the booster group:
54% vs 43.2% for A(H1N1)pdm; 56.9% vs 45.5% for A(H3N2); and 83.4% vs
71.8% for influenza B (P < .05). The number needed to treat to seroprotect
1 patient was <10. The clinical efficacy (99.2% vs 98.8%) and serious
adverse events (6.4% vs 7.5%) were similar for both groups. Conclusions.
In SOTR, a booster strategy 5 weeks after standard influenza vaccination
is safe and effective and induces an increased antibody response compared
with standard influenza vaccination consisting of a single dose.
Copyright © The Author 2017. Published by Oxford University Press for
the Infectious Diseases Society of America.

<62>
Accession Number
615776562
Author
Belczak S.Q.; Silva E.S.; Klajner R.; Puech-Leao P.; De Luccia N.
Institution
(Belczak, Silva, Puech-Leao, De Luccia) Department of Vascular Surgery,
School of Medicine, Sao Paulo University, Sao Paulo, SP, Brazil
(Klajner) Department of Vascular Surgery, Sao Camilo University, Sao
Paulo, SP, Brazil
Title
Type II Endoleaks, Left-Arm Complications, and Need of Revascularization
after Left Subclavian Artery Coverage for Thoracic Aortic Aneurysms
Endovascular Repair: A Systematic Review.
Source
Annals of Vascular Surgery. 41 (pp 294-299), 2017. Date of Publication:
May 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background The status of the left arm, the need of revascularization, and
the occurrence of type II endoleakes from de left subclavian artery (LSA)
after intention LSA coverage for thoracic aortic aneurysm endovascular
repair need to be better understood. This systematic review was developed
for contributing with such issue. Methods Systematic literature review of
studies published from January 2000 through December 2015 identified 7
studies comprising 201 patients submitted to elective endovascular repair
for thoracic aortic aneurysms requiring intentional LSA coverage. Outcomes
of interest included left-arm complications (ischemia, symptoms of
claudication, and subclavian steal syndrome [SSS]) requiring postoperative
revascularization of LSA, as well as endoleaks from the subclavian artery
requiring postoperative embolization of LSA. Results Left-arm complication
rate was 4.5% (9 patients), requiring postoperative revascularization of
LSA in 1 case (0.5%) of SSS. Type II endoleaks from the subclavian artery
requiring postoperative embolization of LSA were reported in 2 cases
(1.0%). Conclusions Low-quality evidence suggests very low rates of arm
complications with need of LSA revascularization and of type II endoleaks
requiring embolization in elective endovascular treatment of thoracic
aortic aneurysms with intentional coverage of LSA without prophylactic
revascularization of LSA.
Copyright © 2017 Elsevier Inc.

<63>
Accession Number
615774808
Author
Moodley Y.; Govender K.
Institution
(Moodley) Discipline of Anaesthesiology and Critical Care Medicine,
University of KwaZulu-Natal, Durban, South Africa
(Govender) Nelson R. Mandela School of Medicine, University of
KwaZulu-Natal, Durban, South Africa
Title
An HIV-positive status and short term perioperative mortality a systematic
review.
Source
Southern African Journal of Epidemiology and Infection. 32 (1) (pp 7-11),
2017. Date of Publication: 2017.
Publisher
Medpharm Publications (PO Box 14804, Lyttelton, Gauteng 0157, South
Africa)
Abstract
Background: A contemporary summary describing the impact of an
HIV-positive status on short term perioperative mortality is lacking.
Objective: To collate and summarise published data related to short term
perioperative mortality from studies comparing HIVpositive and
HIV-negative patient groups. Method: We conducted a systematic review of
the published literature by performing structured searches of two medical
literature databases. Pre-defned inclusion/exclusion criteria were used to
identify potentially relevant manuscripts. Further screening of the
reference lists of eligible manuscripts, as well as a prior systematic
review was also performed to identify any additional manuscripts that may
have been relevant. Data retrieved from eligible manuscripts included,
amongst other variables: study and population descriptions, surgical
category (cardiac or noncardiac surgery), as well the incidence of short
term perioperative mortality. Crude odds ratios were calculated for each
eligible manuscript to describe the association between HIV status and
short term perioperative mortality. Results: Our systematic review
consisted of 12 manuscripts describing 12 studies. The majority of
manuscripts described studies conducted in countries with a low burden of
HIV infection. Most manuscripts described fndings from a noncardiac
surgery setting. Crude associations between an HIV-positive status and a
higher odds of short term perioperative mortality were noted for data from
2 of the 12 manuscripts, while the association was unclear in the
remaining 10 manuscripts. Conclusion: Evidence supporting a higher odds of
short term perioperative mortality in patients with an HIV-positive status
is unconvincing. Further research is required to adequately investigate
this.
Copyright © 2017 The Author(s).

<64>
Accession Number
615706060
Author
Richards S.H.; Anderson L.; Jenkinson C.E.; Whalley B.; Rees K.; Davies
P.; Bennett P.; Liu Z.; West R.; Thompson D.R.; Taylor R.S.
Institution
(Richards) University of Leeds, Leeds Institute of Health Sciences,
Charles Thackrah Building, 101 Clarendon Road, Leeds LS2 9LJ, United
Kingdom
(Richards, Jenkinson) University of Exeter Medical School, Primary Care,
St Luke's Campus, Magdalen Road, Exeter, Devon EX1 2LU, United Kingdom
(Anderson, Taylor) University of Exeter Medical School, Institute of
Health Research, Veysey Building, Salmon Pool Lane, Exeter EX2 4SG, United
Kingdom
(Whalley) University of Plymouth, School of Psychology, Plymouth, United
Kingdom
(Rees) Warwick Medical School, University of Warwick, Division of Health
Sciences, Coventry CV4 7AL, United Kingdom
(Davies) University of Bristol, School of Social and Community Medicine,
Canynge Hall, Bristol BS8 2PS, United Kingdom
(Bennett) University of Swansea, Department of Psychology, Singleton Park,
Swansea SA2 8PP, United Kingdom
(Liu) University of Birmingham, Institute of Applied Health Research,
College of Medical and Dental Sciences, Birmingham, United Kingdom
(West) Wales Heart Research Institute, Cardiff University, Heath Park,
Cardiff CF14 4XN, United Kingdom
(Thompson) University of Melbourne, Department of Psychiatry, St Vincent's
Hospital, Melbourne, VIC 3000, Australia
Title
Psychological interventions for coronary heart disease.
Source
Cochrane Database of Systematic Reviews. 2017 (4) (no pagination), 2017.
Article Number: CD002902. Date of Publication: 28 Apr 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Coronary heart disease (CHD) is the most common cause of death
globally, although mortality rates are falling. Psychological symptoms are
prevalent for people with CHD, and many psychological treatments are
offered following cardiac events or procedures with the aim of improving
health and outcomes. This is an update of a Cochrane systematic review
previously published in 2011. Objectives: To assess the effectiveness of
psychological interventions (alone or with cardiac rehabilitation)
compared with usual care (including cardiac rehabilitation where
available) for people with CHD on total mortality and cardiac mortality;
cardiac morbidity; and participant-reported psychological outcomes of
levels of depression, anxiety, and stress; and to explore potential
study-level predictors of the effectiveness of psychological interventions
in this population. Search methods: We updated the previous Cochrane
Review searches by searching the following databases on 27 April 2016:
CENTRAL in the Cochrane Library, MEDLINE (Ovid), Embase (Ovid), PsycINFO
(Ovid), and CINAHL (EBSCO). Selection criteria: We included randomised
controlled trials (RCTs) of psychological interventions compared to usual
care, administered by trained staff, and delivered to adults with a
specific diagnosis of CHD. We selected only studies estimating the
independent effect of the psychological component, and with a minimum
follow-up of six months. The study population comprised of adults after: a
myocardial infarction (MI), a revascularisation procedure (coronary artery
bypass graft (CABG) or percutaneous coronary intervention (PCI)), and
adults with angina or angiographically defined coronary artery disease
(CAD). RCTs had to report at least one of the following outcomes:
mortality (total- or cardiac-related); cardiac morbidity (MI,
revascularisation procedures); or participant-reported levels of
depression, anxiety, or stress. Data collection and analysis: Two review
authors independently screened titles and abstracts of all references for
eligibility. A lead review author extracted study data, which a second
review author checked. We contacted study authors to obtain missing
information. Main results: This review included 35 studies which
randomised 10,703 people with CHD (14 trials and 2577 participants added
to this update). The population included mainly men (median 77.0%) and
people post-MI (mean 65.7%) or after undergoing a revascularisation
procedure (mean 27.4%). The mean age of participants within trials ranged
from 53 to 67 years. Overall trial reporting was poor, with around a half
omitting descriptions of randomisation sequence generation, allocation
concealment procedures, or the blinding of outcome assessments. The length
of follow-up ranged from six months to 10.7 years (median 12 months). Most
studies (23/35) evaluated multifactorial interventions, which included
therapies with multiple therapeutic components. Ten studies examined
psychological interventions targeted at people with a confirmed
psychopathology at baseline and two trials recruited people with a
psychopathology or another selecting criterion (or both). Of the remaining
23 trials, nine studies recruited unselected participants from cardiac
populations reporting some level of psychopathology (3.8% to 53% with
depressive symptoms, 32% to 53% with anxiety), 10 studies did not report
these characteristics, and only three studies excluded people with
psychopathology. Moderate quality evidence showed no risk reduction for
total mortality (risk ratio (RR) 0.90, 95% confidence interval (CI) 0.77
to 1.05; participants = 7776; studies = 23) or revascularisation
procedures (RR 0.94, 95% CI 0.81 to 1.11) with psychological therapies
compared to usual care. Low quality evidence found no risk reduction for
non-fatal MI (RR 0.82, 95% CI 0.64 to 1.05), although there was a 21%
reduction in cardiac mortality (RR 0.79, 95% CI 0.63 to 0.98). There was
also low or very low quality evidence that psychological interventions
improved participant-reported levels of depressive symptoms (standardised
mean difference (SMD) -0.27, 95% CI -0.39 to -0.15; GRADE = low), anxiety
(SMD -0.24, 95% CI -0.38 to -0.09; GRADE = low), and stress (SMD -0.56,
95% CI -0.88 to -0.24; GRADE = very low). There was substantial
statistical heterogeneity for all psychological outcomes but not clinical
outcomes, and there was evidence of small-study bias for one clinical
outcome (cardiac mortality: Egger test P = 0.04) and one psychological
outcome (anxiety: Egger test P = 0.012). Meta-regression exploring a
limited number of intervention characteristics found no significant
predictors of intervention effects for total mortality and cardiac
mortality. For depression, psychological interventions combined with
adjunct pharmacology (where deemed appropriate) for an underlying
psychological disorder appeared to be more effective than interventions
that did not (beta = -0.51, P = 0.003). For anxiety, interventions
recruiting participants with an underlying psychological disorder appeared
more effective than those delivered to unselected populations (beta =
-0.28, P = 0.03). Authors' conclusions: This updated Cochrane Review found
that for people with CHD, there was no evidence that psychological
treatments had an effect on total mortality, the risk of revascularisation
procedures, or on the rate of non-fatal MI, although the rate of cardiac
mortality was reduced and psychological symptoms (depression, anxiety, or
stress) were alleviated; however, the GRADE assessments suggest
considerable uncertainty surrounding these effects. Considerable
uncertainty also remains regarding the people who would benefit most from
treatment (i.e. people with or without psychological disorders at
baseline) and the specific components of successful interventions. Future
large-scale trials testing the effectiveness of psychological therapies
are required due to the uncertainty within the evidence. Future trials
would benefit from testing the impact of specific (rather than
multifactorial) psychological interventions for participants with CHD, and
testing the targeting of interventions on different populations (i.e.
people with CHD, with or without psychopathologies).
Copyright © 2017 The Cochrane Collaboration. Published by John Wiley
& Sons, Ltd.

<65>
Accession Number
615135913
Author
Martin E.T.; Kaye K.S.; Knott C.; Nguyen H.; Santarossa M.; Evans R.;
Bertran E.; Jaber L.
Institution
(Martin, Evans) Department of Epidemiology, University of Michigan, School
of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029,
United States
(Kaye) Division of Infectious Diseases, Wayne State University, Detroit
Medical Center, Detroit, MI, United States
(Knott, Nguyen, Santarossa, Bertran, Jaber) Department of Pharmacy
Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne
State University, Detroit, MI, United States
Title
Diabetes and risk of surgical site infection: A systematic review and
meta-analysis.
Source
Infection Control and Hospital Epidemiology. 37 (1) (pp 88-99), 2016. Date
of Publication: 2016.
Publisher
Cambridge University Press (E-mail: subscriptions@press.uchicago.edu)
Abstract
OBJECTIVE To determine the independent association between diabetes and
surgical site infection (SSI) across multiple surgical procedures. DESIGN
Systematic review and meta-analysis. METHODS Studies indexed in PubMed
published between December 1985 and through July 2015 were identified
through the search terms risk factors or glucose and surgical site
infection. A total of 3,631 abstracts were identified through the initial
search terms. Full texts were reviewed for 522 articles. Of these, 94
articles met the criteria for inclusion. Standardized data collection
forms were used to extract study-specific estimates for diabetes, blood
glucose levels, and body mass index (BMI). A random-effects meta-analysis
was used to generate pooled estimates, and meta-regression was used to
evaluate specific hypothesized sources of heterogeneity. RESULTS The
primary outcome was SSI, as defined by the Centers for Disease Control and
Prevention surveillance criteria. The overall effect size for the
association between diabetes and SSI was odds ratio (OR)=1.53 (95%
predictive interval [PI], 1.11-2.12; I2, 57.2%). SSI class,
study design, or patient BMI did not significantly impact study results in
a meta-regression model. The association was higher for cardiac surgery
2.03 (95% PI, 1.13-4.05) compared with surgeries of other types (P=.001).
CONCLUSIONS These results support the consideration of diabetes as an
independent risk factor for SSIs for multiple surgical procedure types.
Continued efforts are needed to improve surgical outcomes for diabetic
patients.
Copyright © 2015 by The Society for Healthcare Epidemiology of
America. All rights reserved.

<66>
[Use Link to view the full text]
Accession Number
606498133
Author
Wang J.; Gu C.; Yu W.; Gao M.; Yu Y.
Institution
(Wang, Gu, Yu, Gao, Yu) Department of Cardiac Surgery, Beijing An Zhen
Hospital, Capital Medical University, Beijing 100029, China
Title
Short-and long-term patient outcomes from combined coronary endarterectomy
and coronary artery bypass grafting: A meta-analysis of 63,730 patients
(PRISMA).
Source
Medicine (United States). 94 (41) (no pagination), 2015. Article Number:
e1781. Date of Publication: 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
This meta-analysis aimed to compare the short-and longterm outcomes in
patients undergoing combined coronary endarterectomy and coronary artery
bypass grafting (CE + CABG) versus isolated CABG, and particularly to
examine subgroup patients with high-risk profile and patients with diffuse
disease in the left anterior descending artery (LAD). Studies published
between January 1, 1970 and May 31, 2015 were searched in the literature
databases, including Ovid Medline, Embase, PubMed, and ISI Web of Science.
A total of 30 eligible studies including 63,730 patients were analyzed.
Five authors extracted data from the included studies independently.
Meta-analysis on the total patients revealed that CE + CABG was associated
with significantly increased 30-day postoperative all-cause mortality
compared with isolated CABG (OR=1.86, 95% CI: 1.66- 2.08, z=10.99,
P<0.0001). Subgroup analysis on patients with highrisk profile and
patients with diffuse disease in the LAD showed that 30-day mortality
after CE + CABG was 2.6 folds (OR=2.60, 95% CI: 1.39-4.86, z=2.99,
P=0.003) and 3.93 folds (OR=3.93, 95% CI: 1.40-11.0, z=2.60, P=0.009) of
that after isolated CABG in the respective subgroup. In contrast, the
mortality was comparable in CE + off-pump CABG and CE + on-pump CABG
groups (OR=0.53, 95% CI: 0.18-1.55, z=1.16, P=0.248). In addition, the
incidences of perioperative myocardial infarction (MI) and 30-day
postoperative complications, including low output syndrome (LOS), MI,
ventricular tachycardia (VT), and renal dysfunction after CE + CABG were
significantly higher than those after isolated CABG (all P<0.05). In
high-risk patient subgroup, CE + CABG significantly increased the
incidences of postoperative LOS, MI, and renal function compared with
isolated CABG (all P<0.05). The incidence of perioperative myocardial
after CE + CABG was 2.86 and 2.92 times of that after isolated CABG in
high-risk patients and patients with diffuse disease in LAD, respectively.
Analysis on the recent reports (published later than 2000) showed
consistent results as the analysis including all the eligible reports.
Long-term survival was comparable in CE + CABG and isolated CABG groups
(hazardous ratio=1.16, 95% CI: 0.32-4.22, z=0.23, P=0.819). CE + CABG
appears to be associated with poor short-term outcomes, particularly in
high-risk patients and patients with diffuse disease in the LAD.
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

<67>
Accession Number
607111818
Author
Steyers C.M.; Khera R.; Bhave P.
Institution
(Steyers, Khera) Department of Internal Medicine, University of Iowa
Carver College of Medicine, Iowa City, IA, United States
(Bhave) Division of Cardiovascular Medicine, Department of Internal
Medicine, University of Iowa Carver College of Medicine, Iowa City, IA,
United States
Title
Pacemaker dependency after cardiac surgery: A systematic review of current
evidence.
Source
PLoS ONE. 10 (10) (no pagination), 2015. Article Number: e0140340. Date of
Publication: 15 Oct 2015.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Severe postoperative conduction disturbances requiring
permanent pacemaker implantation frequently occur following cardiac
surgery. Little is known about the long-term pacing requirements and risk
factors for pacemaker dependency in this population. Methods We performed
a systematic review of the literature addressing rates and predictors of
pacemaker dependency in patients requiring permanent pacemaker
implantation after cardiac surgery. Using a comprehensive search of the
Medline, Web of Science and EMBASE databases, studies were selected for
review based on predetermined inclusion and exclusion criteria. Results A
total of 8 studies addressing the endpoint of pacemaker-dependency were
identified, while 3 studies were found that addressed the recovery of
atrioventricular (AV) conduction endpoint. There were 10 unique studies
with a total of 780 patients. Mean follow-up ranged from 6-72 months.
Pacemaker dependency rates ranged from 32%-91% and recovery of AV
conduction ranged from 16%-42%. There was significant heterogeneity with
respect to the definition of pacemaker dependency. Several patient and
procedure-specific variables were found to be independently associated
with pacemaker dependency, but these were not consistent between studies.
Conclusions Pacemaker dependency following cardiac surgery occurs with
variable frequency. While individual studies have identified various
perioperative risk factors for pacemaker dependency and non-resolution of
AV conduction disease, results have been inconsistent. Well-conducted
studies using a uniform definition of pacemaker dependency might identify
patients who will benefit most from early permanent pacemaker implantation
after cardiac surgery.
Copyright © 2015 Steyers 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.

<68>
[Use Link to view the full text]
Accession Number
607023658
Author
Fan M.-K.; Su Y.-M.; Cai X.-X.; Gu Z.-S.; Geng H.-H.; Pan H.-Y.; Zhu
J.-H.; Pan M.
Institution
(Fan, Su, Cai, Gu, Geng, Pan, Zhu, Pan) Department of Cardiology,
Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, China
Title
Clinical outcomes of revascularization strategies for patients with
MVD/LMCA disease.
Source
Medicine (United States). 94 (42) (pp e1745), 2015. Date of Publication:
01 Oct 2015.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Hybrid coronary revascularization (HCR), a new minimally invasive
procedure for patients requiring revascularization for multivessel
coronary lesions, combines coronary artery bypass grafting (CABG) for left
anterior descending (LAD) lesions and percutaneous coronary intervention
(PCI) for non-LAD coronary lesions. However, available data related to
outcomes comparing the 3 revascularization therapies is limited to small
studies. We conducted a search in MEDLINE, EMBASE, and the Cochrane
Library of Controlled Trials up to December 31, 2014, without language
restriction. A total of 16 randomized trials (n=4858 patients) comparing
HCR versus PCI or off-pump CABG (OPCAB) were included in this
meta-Analysis. The primary outcomes were major adverse cardiac and
cerebrovascular events (MACCE), all-cause death, myocardial infarction
(MI), cerebrovascular events (CVE), and target vessel revascularization
(TVR). Odds ratios (OR) and 95% confidence intervals (CI) were calculated
using random-effect and fixed-effect models. Ranking probabilities were
used to calculate a summary numerical value: the surface under the
cumulative ranking (SUCRA) curve. No significant differences were seen
between the HCR and PCI in short term (in hospital and 30 days) with
regard to MACCE (odds ratio [OR] = 0.51, 95% confidence interval [CI]
0.00-2.35), all-cause death (OR = 2.09, 95% CI 0.34-7.66), MI (OR = 1.02,
95% CI 0.19-2.95), CVE (OR = 4.45, 95% CI 0.39-19.16), and TVR (OR = 6.99,
95% CI 0.17-39.39). However, OPCAB had lower MACCE than HCR (OR = 0.19,
95% CI 0.00-0.95). In midterm (1 year and 3 year), in comparison with HCR,
PCI had higher all-cause death (OR = 5.66, 95% CI 0.00- 13.88) and CVE (OR
= 4.40, 95% CI 0.01-5.68), and lower MI (OR = 0.51, 95%CI 0.00-2.86), TVR
(OR=0.53, 95%CI 0.05-2.26), and thus theMACCE(OR=0.51, 95%CI 0.00-2.35).
Off-pumpCABGpresented a better outcome than HCR with significant lower
MACCE (OR = 0.17, 95% CI 0.01-0.68). Surface under the cumulative ranking
probabilities showed that HCR may be the superior strategy for MVD and
LMCA disease when regarded to MACCE (SUCRA=0.84), MI (SUCRA= 0.76) in
short term, and regarded to MACCE (SUCRA=0.99), MI (SUCRA=0.94), and CVE
(SUCRA=0.92) in midterm. Hybrid coronary revascularization seemed to be a
feasible and acceptable option for treatment of LMCA disease and MVD. More
powerful evidences are required to precisely evaluate risks and benefits
of the 3 therapies for patients who have different clinical
characteristics.
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

<69>
Accession Number
610970933
Author
Ho K.M.; Bham E.; Pavey W.
Institution
(Ho) Department of Intensive Care, Royal Perth Hospital, Perth, WA,
Australia
(Ho) School of Population Health, University of Western Australia, Perth,
WA, Australia
(Ho, Pavey) School of Veterinary and Life Sciences, Murdoch University,
Perth, WA, Australia
(Bham, Pavey) Department of Anesthesia, Fiona Stanley Hospital, Perth, WA,
Australia
Title
Incidence of venous thromboembolism and benefits and risks of
thromboprophylaxis after cardiac surgery: A systematic review and
meta-analysis.
Source
Journal of the American Heart Association. 4 (10) (no pagination), 2015.
Article Number: e002652. Date of Publication: 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--Optimal thromboprophylaxis after cardiac surgery is uncertain.
This systematic review aimed to define the incidence and risk factors for
deep vein thrombosis (DVT), fatal and nonfatal pulmonary embolism (PE),
and assess whether venous thromboembolism (VTE) prophylaxis was effective
in reducing VTE without complications after cardiac surgery. Methods and
Results--Two reviewers independently searched and assessed the quality and
outcomes of randomized, controlled trials (RCTs) and observational studies
on VTE after cardiac surgery in the MEDLINE, EMBASE, and Cochrane
controlled trial register (1966 to December 2014). Sixty-eight studies
provided data on VTE outcomes or complications related to
thromboprophylaxis after cardiac surgery. The majority of the studies were
observational studies (n=49), 16 studies were RCTs, and 3 were
meta-analyses. VTE prophylaxis was associated with a reduced risk of PE
(relative risk [RR], 0.45; 95% confidence interval [CI], 0.28-0.72;
P=0.0008) or symptomatic VTE (RR, 0.44; 95% CI, 0.28-0.71; P=0.0006)
compared to the control without significant heterogeneity. Median
incidence (interquartile range) of symptomatic DVT, PE, and fatal PE were
3.2% (0.6-8.1), 0.6% (0.3-2.9), and 0.3% (0.08-1.7), respectively.
Previous history of VTE, obesity, left or right ventricular failure, and
prolonged bed rest, mechanical ventilation, or use of a central venous
catheter were common risk factors for VTE. Bleeding or cardiac tamponade
requiring reoperation owing to pharmacological VTE prophylaxis alone,
without systemic anticoagulation, was not observed. Conclusions--Unless
proven otherwise by adequately powered RCTs, initiating pharmacological
VTE prophylaxis as soon as possible after cardiac surgery for patients who
have no active bleeding is highly recommended.
Copyright © 2015 The Authors.

<70>
Accession Number
606515694
Author
Reinohl J.; Kaier K.; Gutmann A.; Sorg S.; von zur Muhlen C.; Siepe M.;
Baumbach H.; Moser M.; Geibel A.; Zirlik A.; Blanke P.; Vach W.;
Beyersdorf F.; Bode C.; Zehender M.
Institution
(Reinohl, Kaier, Gutmann, von zur Muhlen, Moser, Geibel, Zirlik, Bode,
Zehender) Heart Center Freiburg University, Department of Cardiology and
Angiology I, Hugstetter Str. 55, Freiburg 79106, Germany
(Sorg, Siepe, Beyersdorf) Heart Center Freiburg University, Department of
Cardiovascular Surgery, Freiburg, Germany
(Blanke) Medical Center-University of Freiburg, Department of Diagnostic
Radiology, Freiburg, Germany
(Baumbach) Robert-Bosch-Krankenhaus Stuttgart, Department of
Cardiovascular Surgery, Stuttgart, Germany
(Kaier, Vach) Medical Center-University of Freiburg, Center for Medical
Biometry and Medical Informatics, Freiburg, Germany
Title
In-hospital resource utilization in surgical and transcatheter aortic
valve replacement.
Source
BMC Cardiovascular Disorders. 15 (1) (no pagination), 2015. Article
Number: 132. Date of Publication: October 22, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Little is known about preoperative predictors of resource
utilization in the treatment of high-risk patients with severe symptomatic
aortic valve stenosis. We report results from the prospective,
medical-economic "TAVI Calculation of Costs Trial". Methods: In-hospital
resource utilization was evaluated in 110 elderly patients (age > 75
years) treated either with transfemoral (TF) or transapical (TA)
transcatheter aortic valve implantation (TAVI, N = 83), or surgical aortic
valve replacement (AVR, N = 27). Overall, 22 patient-specific baseline
parameters were tested for within-group prediction of resource use.
Results: Baseline characteristics differed between groups and reflected
the non-randomized, real-world allocation of treatment options. Overall
procedural times were shortest for TAVI, intensive care unit (ICU) length
of stay (LoS) was lowest for AVR. Length of total hospitalization since
procedure (THsP) was lowest for TF-TAVI; 13.4 +/- 11.4 days as compared to
15.7 +/- 10.5 and 21.2 +/- 15.4 days for AVR and TA-TAVI, respectively.
For TAVI and AVR, EuroScore I remained the main predictor for prolonged
THsP (p <0.01). Within the TAVI group, multivariate regression analyses
showed that TA-TAVI was associated with a substantial increase in THsP (55
to 61 %, p <0.01). Additionally, preoperative aortic valve area (AVA) was
identified as an independent predictor of prolonged THsP in TAVI patients,
irrespective of risk scores (p <0.05). Conclusions: Our results
demonstrate significant heterogeneity in patients baseline characteristics
dependent on treatment and corresponding differences in resource
utilization. Prolonged ThsP is not only predicted by risk scores but also
by baseline AVA, which might be useful in stratifying TAVI patients. Trial
registration: German Clinical Trial Register Nr. DRKS00000797.
Copyright © 2015 Reinohl et al.

<71>
Accession Number
615862771
Author
Agamez Medina G.L.; Gonzalez-Arevalo A.; Gomez-Arnau J.I.; Garcia del
Valle S.; Rubio J.A.; Esteban E.; Perez E.
Institution
(Agamez Medina) Departamento de Anestesiologia y Reanimacion, Hospital
Universitario Fundacion Alcorcon, Alcorcon, Madrid, Espana. Electronic
address: agamezgabriela@gmail.com
(Gonzalez-Arevalo, Gomez-Arnau, Garcia del Valle) Departamento de
Anestesiologia y Reanimacion, Hospital Universitario Fundacion Alcorcon,
Alcorcon, Madrid, Espana
(Rubio, Esteban) Unidad de Cardiologia, Hospital Universitario Fundacion
Alcorcon, Alcorcon, Madrid, Espana
(Perez) Research Institute, Hospital Universitario Fundacion Alcorcon,
Alcorcon, Madrid, Espana
Title
Effects of droperidol and ondansetron on dispersion of ventricular
repolarization: A randomized double-blind clinical study in anesthetized
adult patients.
Source
Revista espanola de anestesiologia y reanimacion. 62 (9) (pp 495-501),
2015. Date of Publication: 01 Nov 2015.
Abstract
BACKGROUND AND OBJECTIVE: Droperidol and ondansetron prolong QT interval,
a circumstance that has raised some concerns regarding the possibility of
inducing torsades de pointes (TdP). However drug-induced spatial
dispersion of ventricular repolarization has been shown to be the
principal arrhythmogenic substrate for TdP. The aim of this study is to
explore the effects of droperidol and ondansetron on the dispersion of
repolarization, measured using the T peak-to-end interval (Tp-e) and
Tp-e/QT and Tp-e/RR(1/2) ratios in surgical anesthetized patients.
METHODS: A randomized, double-blind study carried out on sixty-three adult
patients without cardiac disease or factors favoring QT prolongation and
undergoing non-cardiac surgery were randomly assigned to the droperidol or
ondansetron group. Under propofol anesthesia, a 12-lead EKG was obtained,
and 1.25mg droperidol or 4mg ondansetron was injected. Five minutes later,
a new 12-lead EKG was recorded. EKG analyses were independently performed
by two cardiologists blinded to the state of the traces or group
allocation. QT, RR and Tp-e intervals were measured by averaging five
successive beats in leadII (QT) or V5 (Tp-e). The mean value for each
measurement was calculated for statistical analysis.
RESULTS: Thirty-two patients (19 women) received droperidol, and 31 (22
women) ondansetron. Droperidol and ondansetron prolonged the QTcF interval
(Fridericia formula) by 6.8 and 7.2ms (mean values) respectively, but
neither droperidol nor ondansetron increased the Tp-e interval or Tp-e/QT
and Tp-e/RR(1/2) ratios.
CONCLUSION: At antiemetic doses, neither ondansetron (4mg) nor droperidol
(1.25mg) increases the dispersion of ventricular repolarization in healthy
adult patients anesthetized with propofol.
Copyright © 2014 Sociedad Espanola de Anestesiologia, Reanimacion y
Terapeutica del Dolor. Publicado por Elsevier Espana, S.L.U. All rights
reserved.

<72>
Accession Number
615877767
Author
Petrovic I.; Nezic D.; Peric M.; Milojevic P.; Djokic O.; Kosevic D.;
Tasic N.; Djukanovic B.; Otasevic P.
Institution
(Petrovic, Nezic, Peric, Otasevic) Dedinje Cardiovascular Institute and
Belgrade University School of Medicine, Belgrade, Serbia
(Milojevic) Dedinje Cardiovascular Institute and Belgrade University
School of Medicine, Belgrade, Serbia. pedja@ikvbd.com
(Djokic) Dedinje Cardiovascular Institute and Belgrade University School
of Medicine, Belgrade, Serbia. oljaisara@gmail.com
(Kosevic) Dedinje Cardiovascular Institute and Belgrade University School
of Medicine, Belgrade, Serbia. otasp@yahoo.com
(Tasic) Dedinje Cardiovascular Institute and Belgrade University School of
Medicine, Belgrade, Serbia. nebtasa@yahoo.com
(Djukanovic) Dedinje Cardiovascular Institute and Belgrade University
School of Medicine, Belgrade, Serbia. dedinje@ikvbd.com
Title
Radial artery vs saphenous vein graft used as the second conduit for
surgical myocardial revascularization: long-term clinical follow-up.
Source
Journal of cardiothoracic surgery. 10 (pp 127), 2015. Date of Publication:
15 Oct 2015.
Abstract
BACKGROUND: There is ongoing debate regarding the efficacy of the radial
artery (RA) as an aortocoronary conduit, with few solid data regarding
long-term clinical results. We sought to determine if the use of the RA as
the second arterial conduit, beside left internal thoracic artery (LITA),
would improve long-term clinical outcome after CABG as compared to
saphenous vein graft (SVG).
METHODS: Between March 2001 and November 2003, 200 patients underwent
isolated CABG and were randomized in 1:1 fashion to receive either LITA
and RA grafts or LITA and SVGs. The primary end point was composite of
cardiovascular mortality, non-fatal myocardial infarction and need for
repeat myocardial revascularization (either surgical or percutaneous).
RESULTS: There was no significant difference in absolute survival, with 12
deaths in each group during the study period (log rank=0.01, p=0.979).
There were 3 and 2 cardiac deaths in RA and SVG groups, respectively.
There was no difference in long-term clinical outcome between the groups
(log rank=0.450, p=0.509). Eleven patients in RA group had one or more
non-fatal events; 7 patients suffered a myocardial infarction, 9 patients
underwent percutaneous coronary angioplasty, and 1 patient required redo
coronary surgery. Likewise, 13 patients in SVG group had non-fatal event;
7 patients had myocardial infarction, 13 patients had percutaneous
coronary intervention and 3 patients required redo coronary surgery.
Angiograms were performed in 23 patients in RA group (patency rate 92 %)
and 24 in SVG group (patency rate 86 %) (p=0.67).
CONCLUSION: In this small randomised study our data indicate that there is
no difference in the 8 year clinical outcomes in relatively young patients
between those having a RA or a saphenous vein graft used as a second
conduit, beside LITA, for surgical myocardial revascularisation.

<73>
Accession Number
615921300
Author
Ostadal P.; Rokyta R.; Kruger A.; Vondrakova D.; Janotka M.; Smid O.;
Smalcova J.; Hromadka M.; Linhart A.; Belohlavek J.
Institution
(Ostadal, Kruger, Vondrakova, Janotka) Department of Cardiology, Na
Homolce Hospital, Prague, Czech Republic
(Rokyta, Hromadka) Department of Cardiology, University Hospital and
Faculty of Medicine Pilsen, Charles University, Czech Republic
(Smid, Smalcova, Linhart, Belohlavek) 2nd Department of Medicine -
Department of Cardiovascular Medicine, First Faculty of Medicine, Charles
University and General University Hospital, Prague, Czech Republic
Title
Extra corporeal membrane oxygenation in the therapy of cardiogenic shock
(ECMO-CS): rationale and design of the multicenter randomized trial.
Source
European Journal of Heart Failure. 19 (pp 124-127), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Aims: Extracorporeal membrane oxygenation (ECMO) in veno-arterial
configuration represents an increasingly used method for circulatory
support. ECMO in cardiogenic shock offers rapid improvement of circulatory
status and significant increase in tissue perfusion. Current evidence on
the use of ECMO in cardiogenic shock remains insufficient. The aim of the
ECMO-CS trial is to compare two recognized therapeutic approaches in the
management of severe cardiogenic shock: early conservative therapy and
early implantation of veno-arterial ECMO on the background of standard
care. Methods: Eligible patients have either rapidly deteriorating or
severe cardiogenic shock, defined using echocardiography, hemodynamic and
metabolic criteria. Patients are randomized to the one of two arms:
immediate veno-arterial ECMO therapy or early conservative therapy. All
other diagnostic and therapeutic procedures are performed as per current
standard of care, including other cardiovascular interventions (i.e.
percutaneous coronary intervention or cardiac surgery). Follow-up includes
visits at 30 days, 6 months and 12 months. Primary endpoint is a composite
of death from any cause, resuscitated circulatory arrest, and implantation
of another mechanical circulatory support device at 30 days. The sample
size of 120 individuals (60 in each arm) provides 80% power to detect 50%
reduction of primary endpoint, at alpha = 0.05. Patient recruitment
started in October 2014. Conclusion: The results of the ECMO-CS trial may
significantly influence current practice in the management of patients
with severe and rapidly deteriorating cardiogenic shock. ECMO-CS trial
registration number is NCT02301819.
Copyright © 2017 The Authors. European Journal of Heart Failure
© 2017 European Society of Cardiology

<74>
Accession Number
615921235
Author
Meani P.; Gelsomino S.; Natour E.; Johnson D.M.; Rocca H.-P.B.L.;
Pappalardo F.; Bidar E.; Makhoul M.; Raffa G.; Heuts S.; Lozekoot P.; Kats
S.; Sluijpers N.; Schreurs R.; Delnoij T.; Montalti A.; Sels J.W.; van de
Poll M.; Roekaerts P.; Poels T.; Korver E.; Babar Z.; Maessen J.; Lorusso
R.
Institution
(Meani, Rocca, Delnoij, Sels) Cardiology Department Maastricht University
Medical Center +, Maastricht, Netherlands
(Gelsomino, Natour, Johnson, Bidar, Makhoul, Heuts, Lozekoot, Kats,
Sluijpers, Schreurs, Poels, Korver, Babar, Maessen, Lorusso) Department of
Cardiothoracic Surgery, Maastricht University Medical Center +,
Maastricht, Netherlands
(Pappalardo) Cardiac Surgery Intensive Care Unit, San Raphael Hospital,
Milan, Italy
(Delnoij, Montalti, Sels, van de Poll, Roekaerts) Intensive Care
Department, Maastricht University Medical Center +, Maastricht,
Netherlands
(Raffa) Cardiac Surgery and Heart Transplantation Unit; Department for the
Treatment and Study of Cardiothoracic Diseases and Cardiothoracic
Transplantation, Mediterranean Institute for Transplantation and Advanced
Specialized Therapies (ISMETT), Palermo, Italy
Title
Modalities and Effects of Left Ventricle Unloading on Extracorporeal Life
support: a Review of the Current Literature.
Source
European Journal of Heart Failure. 19 (pp 84-91), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Introduction/Aim: Veno-arterial extracorporeal membrane oxygenation (V-A
ECMO) support is increasingly used in refractory cardiogenic shock and
cardiac arrest, but is characterized by a rise in afterload of the left
ventricle (LV) which may ultimately either further impair or delay cardiac
contractility improvement. The aim of this study was to provide a
comprehensive overview regarding the different LV venting techniques and
results currently available in the literature. Methods: A systematic
literature search was performed in the PubMed database: 207 articles
published between 1993 and 2016 were included. Papers dealing with
pre-clinical studies, overlapping series, and association with other
assist devices were excluded from the review, with 45 published papers
finally selected. Heterogeneous indications for LV unloading were
reported. The selected literature was divided into subgroups, according to
the location or the performed procedure for LV venting. Results: Case
reports or case series accounted for 60% of the papers, while
retrospective study represented 29% of them. Adult series were present in
67%, paediatric patients in 29%, and a mixed population in 4%. LV
unloading was performed percutaneously in 84% of the cases. The most
common locations of unloading was the left atrium (31%), followed by
indirect unloading (intra-aortic balloon pump) (27%), trans-aortic (27%),
LV (11%), and pulmonary artery (4%). Percutaneous trans-septal approach
was reported in 22%. Finally, the unloading was conducted surgically in
16%,with open chest surgery in 71%, and minimally invasive surgery in 29%
of surgical cases. Conclusion: Nowadays, only a few data are available
about left heart unloading in V-A ECMO support. Despite the well-known
controversy, IABP remains widely used in combination with V-A ECMO.
Percutaneous approaches utilizing unloading devices is becoming an
increasingly used option. However, further studies are required to
establish the optimal LV unloading method.
Copyright © 2017 The Authors. European Journal of Heart Failure
© 2017 European Society of Cardiology

<75>
Accession Number
615912001
Author
Omar A.S.; Hanoura S.; Al-Janubi H.; Mahfouz A.
Institution
(Omar, Hanoura) Cardiac Anesthesia and Intensive Care Unit, Department of
Cardiothoracic Surgery, Heart Hospital, Hamad Medical Corporation, Doha
3050, Qatar
(Omar) Department of Critical Care Medicine, Beni Suef University, Beni
Suef, Egypt
(Omar, Hanoura) Weill Cornell Medical College in Qatar, Ar-Rayyan, Qatar
(Hanoura) Department of Anesthesia, Al-Azhar University, Il Cairo, Egypt
(Al-Janubi, Mahfouz) Department of Clinical Pharmacy, Hamad Medical
Corporation, Doha, Qatar
Title
Statins in critical care: To give or not to give?.
Source
Minerva Anestesiologica. 83 (5) (pp 502-511), 2017. Date of Publication:
May 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Owing to their immune modulatory, anti-inflammatory, antioxidant,
antithrombotic, and endothelial action, statins are widely used in the
critical care setting in several disease scenarios. The present review
focuses on the evidence supporting an even wider utilization of statins in
intensive care practice for diverse indications. Asearch of the literature
was carried out in PubMed, Cochrane and EMBASE databases up to January
2016. Review articles, meta-analyses, and original trials on the effects
of statin therapy in the intensive care unit (ICU) were included, by
combining the following MeSH terms: "statins," "intensive care," "cardiac
surgery," "sepsis," "acute respiratory distress syndrome," "pneumonia,"
"subarachnoid hemorrhage," "traumatic brain injury," and "critical
illness." Case reports were excluded. No language restriction was applied.
References were also searched for other potentially useful articles. It
was concluded that beneficial effects of statins are observed in cardiac
surgery; however, no robust evidence supports their effectiveness in
diverse critical care settings. The decision to discontinue statins in
native users should be taken in consideration of particular clinical
circumstances.
Copyright © 2017 EDIZIONI MINERVA MEDICA.

<76>
Accession Number
615890839
Author
Shen L.; Tabaie S.; Ivascu N.
Institution
(Shen, Tabaie, Ivascu) Department of Anesthesiology, Weill Cornell Medical
College, New York, NY, United States
Title
Viscoelastic testing inside and beyond the operating room.
Source
Journal of Thoracic Disease. 9 (pp S299-S308), 2017. Date of Publication:
01 Apr 2017.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Hemorrhage is a major contributor to morbidity and mortality during the
perioperative period. Current methods of diagnosing coagulopathy have
various limitations including long laboratory runtimes, lack of
information on specific abnormalities of the coagulation cascade, lack of
in vivo applicability, and lack of ability to guide the transfusion of
blood products. Viscoelastic testing offers a promising solution to many
of these problems. The two most-studied systems, thromboelastography (TEG)
and rotational thromboelastometry (ROTEM), offer similar graphical and
numerical representations of the initiation, formation, and lysis of clot.
In systematic reviews on the clinical efficacy of viscoelastic tests, the
majority of trials analyzed were in cardiac surgery patients. Reviews of
the literature suggest that transfusions of packed red blood cells (pRBC),
plasma, and platelets are all decreased in patients whose transfusions
were guided by viscoelastic tests rather than by clinical judgement or
conventional laboratory tests. Mortality appears to be lower in the
viscoelastic testing groups, despite no difference in surgical
re-intervention rates and massive transfusion rates. Cost-effectiveness
studies also seem to favor viscoelastic testing. Viscoelastic testing has
also been investigated in small studies in other clinical contexts, such
as sepsis, obstetric hemorrhage, inherited bleeding disorders,
perioperative thromboembolism risk assessment, and management of
anticoagulation for patients on mechanical circulatory support systems or
direct oral anticoagulants (DOACs). While the results are intriguing, no
systematic, larger trials have taken place to date. Viscoelastic testing
remains a relatively novel method to assess coagulation status, and
evidence for its use appears favorable in reducing blood product
transfusions, especially in cardiac surgery patients.
Copyright © Journal of Thoracic Disease. All rights reserved.

<77>
Accession Number
615804795
Author
Huang J.; Liu W.; Zhan Y.; Hou B.; Chen S.
Institution
(Huang, Liu, Zhan, Hou, Chen) The First Affiliated Hospital of Nanchang
University, Nanchang 330006, China
Title
The effects of dexmedetomidine on inflammatory responses in patients
undergoing valve replacement surgery with cardiopulmonary bypass.
Source
International Journal of Clinical and Experimental Medicine. 10 (4) (pp
6482-6488), 2017. Article Number: IJCEM0044763. Date of Publication: 30
Apr 2017.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Objective: This prospective study was designed to research the effect of
dexmedetomidine (DEX) on reducing the inflammation responses of valve
replacement surgery patients under cardiopulmonary bypass (CPB) and
explore the safety, efficacy and clinical significance of DEX used in this
kind of cardiac surgery. Method: 30 patients were randomly divided into
two groups: patients in one group (Group D, n=15) received dexmedetomidine
0.5 mug.kg-1.h-1 before incision and 0.5
mug.kg-1.h-1 intra-operatively, while the control
group (Group C, n=15) received the same volume of saline. Venous blood was
collected at several time points for the serum content detection of
TNF-alpha, IL-6, SOD and MDA. Results: Compared with group C, the content
of TNF-alpha in group D declined significantly at time point
T<inf>2</inf>, T<inf>3</inf>, T<inf>4</inf>, T<inf>5</inf>. The content of
serum IL-6 in group D declined significantly at time point T<inf>4</inf>
and T<inf>5</inf>. Meanwhile, the serum SOD content in group D was
obviously elevated with a significant difference at time point
T<inf>2</inf>, T<inf>3</inf>, T<inf>4</inf> (P<0.05) and the content of
MDA in group D declined significantly at time point T<inf>3</inf>,
T<inf>4</inf> and T<inf>5</inf> (P<0.05). Furthermore, the extu-bation
time and the ICU care duration of group D were both significantly shorten
compared with group C (P<0.05). Conclusion: The continuous administration
of dexmedetomidine during valve replacement surgery with CPB suppressed
intraoperative and post-operative cytokine secretion, and improved
post-operative inflammatory response indices in the present study. These
results can be attributed to the anti-inflammatory effects of
dexmedetomidine.
Copyright © 2017, E-Century Publishing Corporation. All rights
reserved.

<78>
Accession Number
610345907
Author
Giustino G.; Mehran R.; Bansilal S.; Feit F.; Lincoff M.; Deliargyris
E.N.; Kirtane A.J.; Genereux P.; Redfors B.; Prats J.; Bernstein D.;
Brener S.J.; Skerjanec S.; Lansky A.J.; Francese D.P.; Dangas G.D.; Stone
G.W.
Institution
(Giustino, Mehran, Bansilal, Dangas) Interventional Cardiovascular
Research and Clinical Trials, Icahn School of Medicine at Mount Sinai, New
York, NY, United States
(Mehran, Kirtane, Genereux, Redfors, Francese, Dangas, Stone) Clinical
Trials Center, Cardiovascular Research Foundation, New York, NY, United
States
(Feit) Department of Cardiology, New York University Medical Center, New
York, NY, United States
(Lincoff) Department of Medicine, Cleveland Clinic, Lerner College of
Medicine of Case Western Reserve University, Cleveland, OH, United States
(Deliargyris, Prats, Bernstein, Skerjanec) Medicines Company, Parsippany,
NJ, United States
(Kirtane, Genereux, Stone) Division of Cardiology, NewYork-Presbyterian
Hospital, Columbia University Medical Center, New York, NY, United States
(Genereux) Department of Cardiology, Hopital du Sacre-Coeur de Montreal,
Montreal, QC, Canada
(Brener) Department of Medicine, New York Methodist Hospital, Brooklyn,
NY, United States
(Lansky) Division of Cardiology, Yale University School of Medicine, New
Haven, CT, United States
Title
Safety and efficacy of bivalirudin in patients with diabetes mellitus
undergoing percutaneous coronary intervention: From the REPLACE-2, ACUITY
and HORIZONS-AMI trials.
Source
American Journal of Cardiology. 118 (1) (pp 6-16), 2016. Date of
Publication: 01 Jul 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Optimal antithrombotic pharmacotherapy in patients affected by diabetes
mellitus (DM) undergoing percutaneous coronary intervention is unclear. We
sought to evaluate the safety and efficacy of bivalirudin compared with
heparin plus a glycoprotein IIb/IIIa inhibitor (GPI) in patients with DM
undergoing percutaneous coronary intervention. We pooled patient-level
data from the Randomized Evaluation of PCI Linking Angiomax to Reduced
Clinical Events-2, Acute Catheterization and Urgent Intervention Triage
strategy, and Harmonizing Outcomes with Revascularization and Stents in
Acute Myocardial Infarction trials. The primary efficacy end point was the
incidence of major adverse cardiac events, defined as the composite of
death, myocardial infarction, or unplanned revascularization at 30 days.
The primary safety end point was the incidence of 30-day non-coronary
artery bypass graft-related major bleeding. All-cause mortality was
reported at 30 days and 1 year. Of the 14,737 patients included in the
pooled database, 3,641 (24.7%) had DM. Patients with DM had higher rates
of 30-day major bleeding and 30-day and 1-year all-cause mortality. There
were no differences in 30-day major adverse cardiac events between
bivalirudin versus heparin plus GPI in patients with DM (6.9% vs 7.8%;
relative risk [RR] 0.89, 95% CI 0.71 to 1.12) or without DM (7.5% vs 6.7%;
RR 1.11, 95% CI 0.97 to 1.27; p<inf>interaction</inf> = 0.10). Bivalirudin
treatment was associated with reduced risk of major bleeding in similar
magnitude in patients with DM (4.3% vs 6.6% RR 0.68, 95% CI 0.51 to 0.89)
or without DM (3.2% vs 6.1%; RR 0.51, 95% CI 0.43 to 0.61;
p<inf>interaction</inf> = 0.15). The hemorrhagic benefit of bivalirudin
was noted for both access site- and non-access site-related bleeding.
Overall, bivalirudin treatment was associated with a significant 1-year
mortality benefit (2.7% vs 3.3%; RR 0.82, 95% CI 0.68 to 0.98; p = 0.03),
which was consistent between patients with or without DM
(p<inf>interaction</inf> = 0.30). In conclusion, compared with heparin
plus GPI, bivalirudin was associated with similar 30-day antithrombotic
efficacy and better 30-day freedom from bleeding and 1-year mortality,
irrespective of diabetic status.
Copyright © 2016 Elsevier Inc. All rights reserved.

<79>
Accession Number
610345737
Author
Chang M.; Lee C.W.; Ahn J.-M.; Cavalcante R.; Sotomi Y.; Onuma Y.; Zeng
Y.; Park D.-W.; Kang S.-J.; Lee S.-W.; Kim Y.-H.; Park S.-W.; Serruys
P.W.; Park S.-J.
Institution
(Chang, Lee, Ahn, Park, Kang, Lee, Kim, Park, Park) Department of
Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan
Medical Center, Seoul, South Korea
(Cavalcante, Onuma, Zeng, Serruys) Thoraxcenter, Erasmus University
Medical Center, Rotterdam, Netherlands
(Sotomi) Heart Center, Academic Medical Center, University of Amsterdam,
Amsterdam, Netherlands
(Serruys) International Center for Circulatory Health, Imperial College of
London, London, United Kingdom
Title
Coronary artery bypass grafting versus drug-eluting stents implantation
for previous myocardial infarction.
Source
American Journal of Cardiology. 118 (1) (pp 17-22), 2016. Date of
Publication: 01 Jul 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Patients with previous myocardial infarction (MI) have a high risk of
recurrence. Little is known about the effectiveness of coronary artery
bypass grafting (CABG) versus percutaneous coronary intervention (PCI)
with drug-eluting stents (DES) in patients with a previous MI and left
main or multivessel coronary artery disease (CAD). We compared long-term
outcomes of these 2 strategies in 672 patients with previous MI and left
main or multivessel CAD, who underwent CABG (n = 349) or PCI with DES (n =
323). A pooled database from the BEST, PRECOMBAT, and SYNTAX trials was
analyzed, and the primary outcome was a composite of death from any
causes, MI, or stroke. Baseline characteristics were similar between the 2
groups. The median follow-up duration was 59.8 months. The rate of the
primary outcome was significantly lower with CABG than PCI (hazard ratio
[HR] 0.59, 95% CI 0.42 to 0.82; p = 0.002). This difference was driven by
a marked reduction in the rate of MI (HR 0.29, 95% CI 0.16 to 0.55, p
<0.001). The benefit of CABG over PCI was consistent across all major
subgroups. The individual risks of death from any causes or stroke were
comparable between the 2 groups. Conversely, the rate of repeat
revascularization was significantly lower with CABG than PCI (HR 0.34, 95%
CI 0.22 to 0.51, p <0.001). In conclusion, in the patients with previous
MI and left main or multivessel CAD, compared to PCI with DES, CABG
significantly reduces the risk of death from any causes, MI, or stroke.
Copyright © 2016 Elsevier Inc. All rights reserved.

<80>
[Use Link to view the full text]
Accession Number
606579721
Author
Elhoff J.J.; Chowdhury S.M.; Zyblewski S.C.; Atz A.M.; Bradley S.M.;
Graham E.M.
Institution
(Elhoff, Chowdhury, Zyblewski, Atz, Graham) Division of Pediatric
Cardiology, Department of Pediatrics, Medical University of South
Carolina, Charleston, SC, United States
(Bradley) Division of Pediatric Cardiothoracic Surgery, Department of
Surgery, Medical University of South Carolina, Charleston, SC, United
States
Title
Intraoperative Steroid Use and Outcomes Following the Norwood Procedure:
An Analysis of the Pediatric Heart Network's Public Database.
Source
Pediatric Critical Care Medicine. 17 (1) (pp 30-35), 2016. Date of
Publication: 01 Jan 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: Data supporting the use of perioperative steroids during
cardiac surgery are conflicting, and most pediatric studies have been
limited by small sample sizes and/or diverse cardiac diagnoses. The
objective of this study was to determine if intraoperative steroid
administration improved outcomes following the Norwood procedure. Design:
A retrospective analysis was performed on the 549 neonates who underwent a
Norwood procedure in the publicly available datasets from the Pediatric
Heart Network's Single Ventricle Reconstruction trial. Groups were
compared to determine if outcomes differed between intraoperative steroid
recipients (n = 498, 91%) and nonrecipients (n = 51, 9%). Setting: Fifteen
North American centers. Subjects: Infants enrolled in the Single Ventricle
Reconstruction trial. Interventions: None. Measurements and Main Results:
Baseline characteristics and intraoperative variables were similar between
groups with the exception of a shorter duration of cross clamp and
cardiopulmonary bypass time in the group that received steroids. Subjects
who did not receive intraoperative steroids had improved hospital survival
(94% vs 83%, p = 0.03) but longer ICU stays (16 d; interquartile range,
12-33 vs 14 d; interquartile range, 9-28; p = 0.04) and hospital stays (29
d; interquartile range, 21-50 vs 23 d; interquartile range, 15-40; p =
0.01) than steroid recipients. In multivariate analysis, lengths of stay
associations were no longer significant, but hospital survival trended
toward favoring the nonsteroid group with an odds ratio of 3.52 (95% CI,
0.98-12.64; p = 0.054). Conclusions: In the large multicentered Single
Ventricle Reconstruction trial, there was widespread use of intraoperative
steroids. Intraoperative steroid administration was not associated with an
improvement in outcomes and may be associated with a reduction in hospital
survival in neonates undergoing the Norwood procedure. This study
highlights the need for a randomized control trial.
Copyright © 2016 by the Society of Critical Care Medicine and the
World Federation of Pediatric Intensive and Critical Care Societies.

<81>
Accession Number
607429745
Author
Zhou X.; Zhang W.; Lv W.; Zhou Q.; Li Y.; Zhang L.; Lu Y.; Zhang J.; Xing
Q.; Wang H.; Tang B.
Institution
(Zhou, Zhang, Lv, Zhou, Li, Zhang, Lu, Zhang, Xing, Wang, Tang) Pacing and
Electrophysiological Division, First Affiliated Hospital of Xinjiang
Medical University, Urumqi, Xinjiang 830011, China
Title
Left atrial appendage occlusion in atrial fibrillation for stroke
prevention: A systemic review.
Source
International Journal of Cardiology. 203 (pp 55-59), 2016. Date of
Publication: 15 Jan 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Atrial fibrillation (AF) is an arrthymia characterized by
increased risk of ventricle arrthymias and thromboembolism especially
ischemic stroke. Most thrombus originated in the left atrial appendage,
thus left atrial occlusion (LAAO) may be an effective alternative for
stroke prevention in atrial fibrillation. Objective To assess the effect
and safety of left atrial occlusion for stroke prevention in atrial
fibrillation. Methods and results We searched Pub Med, CENTRAL in The
Cochrane Library, Embase, CBM-Disk, CNKI for published trials,
ClinicalTrials.gov, ISI Proceedings for conference abstracts, and WHO
International Clinical Trial registration Platform for ongoing studies.
The search results were extracted, and then the quality of included
studies was assessed. By RevMan 5.3, meta analysis was used if there was
low heterogeneity. Three randomized controlled clinical trials involving
1165 participants were included (percutaneous 1114 in 2 trials, surgical
51 in 1 trial). The current data suggest that left atrial occlusion may be
as efficacious as warfarin in stroke prevention (RR 0.78 [0.33, 1.84]) and
mortality reduction (RR 0.68 [0.40, 1.16]) for AF. Conclusion In contrast
to warfarin left atrial occlusion with Watchman device may have the same
effectivity in stroke reduction. Surgical LAAO may also get positive
outcomes compared with warfarin, but owing to the small sample size the
evidence is less powerful. Total outcomes of percutaneous and surgical
LAAO support this approach.
Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

<82>
Accession Number
608560478
Author
Duraes A.R.; de Souza Roriz P.; de Almeida Nunes B.; Albuquerque F.P.; de
Bulhoes F.V.; de Souza Fernandes A.M.; Aras R.
Institution
(Duraes, de Souza Roriz, de Almeida Nunes, Albuquerque, de Bulhoes, de
Souza Fernandes, Aras) Hospital Ana Nery/UFBa, Rua Saldanha Marinho, S/N,
Caixa D'Agua, Salvador, Brazil
Title
Dabigatran Versus Warfarin After Bioprosthesis Valve Replacement for the
Management of Atrial Fibrillation Postoperatively: DAWA Pilot Study.
Source
Drugs in R and D. 16 (2) (pp 149-154), 2016. Date of Publication: 01 Jun
2016.
Publisher
Springer International Publishing
Abstract
Objectives: Dabigatran is a direct thrombin inhibitor shown to be an
effective alternative to warfarin in patients with non-valvular atrial
fibrillation (AF). We evaluated the use of dabigatran in patients with
bioprosthetic mitral and/or aortic valve replacement and AF. Methods: We
selected 34 and randomized 27 patients in a 1:1 ratio to receive
dabigatran or warfarin. The primary endpoint was the presence of a new
intracardiac thrombus at 90 days, by transesophageal echocardiogram (TEE).
Secondary endpoints included the development of dense spontaneous echo
contrast (SEC) and incidence of stroke (ischemic or hemorrhagic),
myocardium infarction, valve thrombosis and peripheral embolic events.
Results: The trial was terminated prematurely because of low enrollment.
There were 27 patients in total: 15 patients placed in the dabigatran
group and 12 in the warfarin group. After 90 days, one patient (8.3 %) in
the warfarin group and none in the dabigatran group had developed a new
intracardiac thrombus. In the dabigatran group, two patients (13.3 %)
developed dense SEC versus one patient (8.3 %) in the warfarin group. In
the warfarin group, one patient (8.3 %) presented ischemic stroke, and
none did in the dabigatran group. We observed no cases of hemorrhagic
stroke, valve thrombosis, embolic events or myocardial infarction in
either group throughout the study. However, one patient (6.7 %) in the
dabigatran group had a fully recovered transient ischemic attack and one
patient in the warfarin group died of heart failure. Conclusions: The use
of dabigatran appears to be similar to warfarin in preventing the
formation of intracardiac thrombus. Trial Registration: Clinicaltrials.gov
NCT01868243.
Copyright © 2016, The Author(s).

<83>
Accession Number
610469774
Author
Saji M.; Lim D.S.; Ragosta M.; LaPar D.J.; Downs E.; Ghanta R.K.; Kern
J.A.; Dent J.M.; Ailawadi G.
Institution
(Saji, Lim, Ragosta, Dent) Division of Cardiovascular Medicine, Department
of Medicine, Advanced Cardiac Valve Center, University of Virginia,
Charlottesville, VA, United States
(Saji) Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
(LaPar, Downs, Ghanta, Kern, Ailawadi) Division of Cardiothoracic Surgery,
Department of Surgery, Advanced Cardiac Valve Center, University of
Virginia, Charlottesville, VA, United States
Title
Usefulness of Psoas Muscle Area to Predict Mortality in Patients
Undergoing Transcatheter Aortic Valve Replacement.
Source
American Journal of Cardiology. 118 (2) (pp 251-257), 2016. Date of
Publication: 15 Jul 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Frailty has become high-priority theme in cardiovascular diseases because
of aging and increasingly complex nature of patients. Low muscle mass is
characteristic of frailty, in which invasive interventions are avoided if
possible because of decreased physiological reserve. This study aimed to
determine if the psoas muscle area (PMA) could predict mortality and to
investigate its utility in patients who underwent transcatheter aortic
valve replacement (TAVR). We retrospectively reviewed 232 consecutive
patients who underwent TAVR. Cross-sectional areas of the psoas muscles at
the level of fourth lumbar vertebra were measured by computed tomography
and normalized to body surface area. Patients were divided into tertiles
according to the normalized PMA for each gender (men: tertile 1, 1,708 to
1,178 mm2/m2; tertile 2, 1,176 to 1,011
mm2/m2; and tertile 3, 1,009 to 587
mm2/m2; women: tertile 1, 1,436 to 962
mm2/m2; tertile 2, 952 to 807
mm2/m2; and tertile 3, 806 to 527
mm2/m2). Smaller normalized PMA was independently
correlated with women and higher New York Heart Association
classification. After adjustment for multiple confounding factors, the
normalized PMA tertile was independently associated with mortality at 6
months (adjusted hazard ratio 1.53, 95% confidence interval 1.06 to 2.21).
Kaplan-Meier analysis showed that tertile 3 had higher mortality rates
than tertile 1 at 6 months (14% and 31%, respectively, p = 0.029).
Receiver-operating characteristic analysis showed that normalized PMA
provided the increase of C-statistics for predicting mortality for a
clinical model and gait speed. In conclusion, PMA is an independent
predictor of mortality after TAVR and can complement a clinical model and
gait speed.
Copyright © 2016 Elsevier Inc.

<84>
Accession Number
613485579
Author
Piccolo R.; Galasso G.; Eitel I.; Dominguez-Rodriguez A.; Iversen A.Z.; Gu
Y.L.; Abreu-Gonzalez P.; de Smet B.J.G.L.; Esposito G.; Windecker S.;
Thiele H.; Piscione F.
Institution
(Piccolo, Windecker) Department of Cardiology, Bern University Hospital,
Bern, Switzerland
(Galasso, Piscione) Department of Medicine and Surgery, University of
Salerno, Salerno, Italy
(Eitel, Thiele) University Heart Center Lubeck, Medical Clinic II,
University of Lubeck, Lubeck, Germany
(Dominguez-Rodriguez) Hospital Universitario de Canarias, Facultad de
Ciencias de la Salud, Department of Cardiology, Universidad Europea de
Canarias Tenerife, Spain
(Iversen) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Gu) Department of Cardiology, Thorax Center, University Medical Center
Groningen, Groningen, Netherlands
(Abreu-Gonzalez) Department of Physiology, Universidad de La Laguna,
Tenerife, Spain
(de Smet) Department of Cardiology, Meander Medisch Centrum, Amersfoort,
Netherlands
(Esposito) Division of Cardiology, Department of Advanced Biomedical
Sciences, Federico II University, Naples, Italy
Title
Pooled Analysis Comparing the Efficacy of Intracoronary Versus Intravenous
Abciximab in Smokers Versus Nonsmokers Undergoing Primary Percutaneous
Coronary Revascularization for Acute ST-Elevation Myocardial Infarction.
Source
American Journal of Cardiology. 118 (12) (pp 1798-1804), 2016. Date of
Publication: 15 Dec 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Cigarette smokers with ST-segment elevation myocardial infarction (STEMI)
may present different response to potent antithrombotic therapy compared
to nonsmokers. We assessed the impact of smoking status and intracoronary
abciximab in patients with STEMI undergoing primary percutaneous coronary
intervention (PCI). We pooled data from 5 randomized trials comparing
intracoronary versus intravenous abciximab bolus in patients undergoing
primary PCI. The primary end point was the composite of death or
reinfarction at a mean follow-up of 292 +/- 138 days. Of 3,158
participants, 1,369 (43.3%) were smokers, and they had a lower risk of the
primary end point in crude, but not in adjusted analyses (hazard ratio
[HR] 0.87, 95% confidence interval [CI] 0.63 to 1.21, p = 0.405).
Intracoronary versus intravenous abciximab was associated with a
significant reduction in the risk of primary end point among smokers (3.6%
vs 8.0%; HR 0.43, 95% CI 0.26 to 0.72, p = 0.001), but not in nonsmokers
(10.2% vs 9.9%; HR 0.99, 95% CI 0.72 to 1.36, p = 0.96), with a
significant interaction (p = 0.009). Furthermore, intracoronary abciximab
decreased the risk of reinfarction in smokers (HR 0.30, 95% CI 0.15 to
0.62, p = 0.001), with no difference in nonsmokers (HR 1.20, 95% CI 0.71
to 2.01, p = 0.50). Stent thrombosis was lowered by intracoronary
abciximab in smokers (HR 0.28, 95% CI 0.06 to 0.66, p = 0.009), but was
ineffective in nonsmokers (HR 1.04, 95% CI 0.54 to 2.00, p = 0.903).
Interaction testing showed heterogeneity in treatment effect for
reinfarction (p = 0.002) and stent thrombosis (p = 0.018) according to
smoking status. In conclusion, among patients with STEMI undergoing
primary PCI, smoking status did not affect the adjusted risk of clinical
events. Intracoronary abciximab bolus improved clinical outcomes by
reducing the risk of death or reinfarction.
Copyright © 2016 Elsevier Inc.

<85>
Accession Number
612620607
Author
Watanabe Y.; Kozuma K.; Hioki H.; Kawashima H.; Nara Y.; Kataoka A.;
Shirai S.; Tada N.; Araki M.; Takagi K.; Yamanaka F.; Yamamoto M.;
Hayashida K.
Institution
(Watanabe, Kozuma, Hioki, Kawashima, Nara, Kataoka) Department of
Cardiology, Teikyo University School of Medicine, Tokyo, Japan
(Shirai) Department of Cardiology, Kokura Memorial Hospital, Fukuoka,
Japan
(Tada) Department of Cardiology, Sendai Kousei Hospital, Miyagi, Japan
(Araki) Department of Cardiology, Saiseikai Yokohama City Eastern
Hospital, Kanagawa, Japan
(Takagi) Department of Cardiology, New Tokyo Hospital, Chiba, Japan
(Yamanaka) Department of Cardiology, Shonan Kamakura General Hospital,
Kanagawa, Japan
(Yamamoto) Department of Cardiology, Toyohashi Heart Center, Aichi, Japan
(Yamamoto) Department of Cardiology, Nagoya Heart Center, Aichi, Japan
(Hayashida) Department of Cardiology, Keio University School of Medicine,
Tokyo, Japan
Title
Comparison of Results of Transcatheter Aortic Valve Implantation in
Patients With Versus Without Active Cancer.
Source
American Journal of Cardiology. 118 (4) (pp 572-577), 2016. Date of
Publication: 15 Aug 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The aim of this study was to evaluate postprocedural and midterm outcomes
of transcatheter aortic valve implantation (TAVI) in patients with aortic
stenosis and active cancer. From October 2013 to August 2015, a total of
749 patients undergoing TAVI using the Edwards Sapien XT prosthesis
(Edwards Lifesciences, Irvine, California) were prospectively included in
the OCEAN-TAVI registry from 8 Japanese centers. A total of 47 patients
(44.7% men; median age 83 years) had active cancer. The transfemoral
approach was implemented in 85.1% of patients in the cancer group and
78.1% in the noncancer group (p = 0.22). The occurrence of major vascular
complication (4.3% vs 7.5%, p = 0.24), life-threatening bleeding (2.1% vs
7.1%, p = 0.15), and major bleeding (8.5% vs 13%, p = 0.38) was similar
between the cancer and noncancer groups. No significant differences were
observed regarding device success (100% vs 96.2%, p = 0.17) or 30-day
survival (95.7% vs 97.3%, p = 0.38). No difference in midterm survival was
found between the patients with cancer and without cancer (log-rank, p =
0.42), regardless of advanced or limited cancer (log-rank, p = 0.68). In a
multivariable Cox proportional hazard regression analysis, cancer
metastasis was one of the most significant predictors of late mortality
(hazard ratio 4.73, 95% CI 1.12 to 20.0; p = 0.035). In conclusion,
patients with cancer with severe aortic stenosis who underwent TAVI had
similar acute outcomes and midterm survival rates compared with patients
without cancer. Cancer metastasis was associated with increased mortality
after TAVI.
Copyright © 2016 Elsevier Inc.

<86>
Accession Number
612620587
Author
Skelding K.A.; Yakubov S.J.; Kleiman N.S.; Reardon M.J.; Adams D.H.; Huang
J.; Forrest J.K.; Popma J.J.
Institution
(Skelding) Department of Cardiology, Geisinger Health System, Danville,
Pennsylvania, United States
(Yakubov) Department of Cardiology, Riverside Methodist Hospital,
Columbus, Ohio, United States
(Kleiman) Department of Cardiology, Houston-Methodist-Debakey Heart and
Vascular Center, Houston, Texas, United States
(Reardon) Department of Cardiothoracic Surgery, Houston-Methodist-Debakey
Heart and Vascular Center, Houston, Texase, United States
(Adams) Department of Cardiothoracic Surgery, Mount Sinai Medical Center,
New York, New York, United States
(Huang) Coronary and Structural Heart Department, Statistics Medtronic,
Mounds View, Minnesota, United States
(Forrest) Department of Cardiology, Yale University School of Medicine,
New Haven, Connecticut, United States
(Popma) Department of Cardiology, Beth Israel Deaconess Medical Center,
Boston, Massachusetts, United States
Title
Transcatheter Aortic Valve Replacement Versus Surgery in Women at High
Risk for Surgical Aortic Valve Replacement (from the CoreValve US High
Risk Pivotal Trial).
Source
American Journal of Cardiology. 118 (4) (pp 560-566), 2016. Date of
Publication: 15 Aug 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The objective of this study was to compare outcomes in women after
surgical aortic valve replacement (SAVR) versus transcatheter aortic valve
replacement (TAVR) using a self-expanding prosthesis in patients with
severe aortic stenosis who were at high risk for SAVR. Although registries
and meta-analyses have suggested that TAVR is of considerable benefit in
women, perhaps even more so than in men, a rigorous evaluation of TAVR
with a self-expanding valve versus SAVR in women from a randomized trial
has not been performed. Patients with severe aortic stenosis were
randomized 1:1 to either TAVR or SAVR. Outcomes at 1 year are reported.
Treatment was attempted in a total of 353 women (183 TAVR and 170 SAVR).
Baseline characteristics and predicted risk of the 2 groups were
comparable, although the frequency of diabetes mellitus was lower in
patients undergoing TAVR (33.3% vs 45.3%; p = 0.02). TAVR-treated patients
experienced a statistically significant 1-year survival advantage compared
with SAVR patients (12.7% vs 21.8%; p = 0.03). The composite all-cause
mortality or major stroke rate also favored TAVR (14.9% vs 24.2%; p =
0.04). Quality of life, as measured by the Kansas City Cardiomyopathy
Questionnaire summary score, for both the TAVR and SAVR groups increased
significantly from baseline to 1 year. In conclusion, female TAVR patients
had lower 1-year mortality and lower 1-year all-cause mortality or major
stroke compared with women undergoing SAVR, with both cohorts experiencing
improved quality of life. Further studies specifically in women are
warranted to validate these findings.
Copyright © 2016 Elsevier Inc.

<87>
Accession Number
614921635
Author
Karjalainen P.P.; Nammas W.
Institution
(Karjalainen, Nammas) Heart Center, Satakunta Central Hospital, Pori,
Finland
Title
Percutaneous revascularization of coronary chronic total occlusion: Toward
a reappraisal of the available evidence.
Source
Journal of Cardiology. 69 (6) (pp 799-807), 2017. Date of Publication:
June 2017.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Chronic total occlusion (CTO) is a challenging subset of coronary artery
disease that is commonly encountered in real-world practice; it is
associated with worse long-term prognosis. Observational studies suggest
that percutaneous coronary intervention (PCI) for CTO is associated with
reduction in myocardial ischemia and improvement in quality of life and
left ventricular function. Some observational studies suggested that
CTO-PCI is associated with improvement of the 'hard' clinical endpoints;
others did not. Nearly all these studies compared the clinical outcome of
successful versus failed PCI, rather than comparing the outcome of a whole
CTO-PCI cohort versus a 'true' control group. Interestingly, in
observational studies that compared the outcome of CTO-PCI versus optimal
medical treatment, long-term mortality was comparable between the two
strategies. In patients with multi-vessel disease and CTO, complete
revascularization is more often achieved by coronary artery bypass
grafting than by PCI; the SYNTAX score of these patients often favors
surgical revascularization according to the current guidelines. The
current guidelines reflect the divergence of opinion on the
usefulness/benefit of CTO-PCI, mainly due to the lack of randomized
trials. Evidence is awaited from three ongoing randomized controlled
trials comparing PCI versus optimal medical treatment in the setting of
CTO.
Copyright © 2016 Japanese College of Cardiology

<88>
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 © 2017 The Author(s).

<89>
Accession Number
615775379
Author
Samanta A.; Kaja A.K.; Afzal M.R.; Zuba-Surma E.K.; Dawn B.
Institution
(Samanta) Department of Medicine, University of Missouri-Kansas City,
Kansas City, MO, United States
(Kaja, Dawn) Division of Cardiovascular Diseases, Cardiovascular Research
Institute, Midwest Stem Cell Therapy Center, University of Kansas Medical
Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, United States
(Afzal) Division of Cardiology, Ohio State University Wexner Medical
Center, Columbus, OH, United States
(Zuba-Surma) Department of Cell Biology, Faculty of Biochemistry,
Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
Title
Bone marrow cells for heart repair: Clinical evidence and perspectives.
Source
Minerva Cardioangiologica. 65 (3) (pp 299-313), 2017. Date of Publication:
June 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
More than 15 years ago, bone marrow cell (BMC) therapy for cardiac repair
was hailed as a highly promising and revolutionary treatment approach that
was poised to benefit countless patients with ischemic heart disease (IHD)
and heart failure. The ensuing years have unfortunately witnessed endless
controversy not only about the mechanisms of action of cardiac repair with
cell therapy, but also regarding the efficacy of such approach. Somewhat
discordant results from smaller clinical trials with diverse study
designs, BMC types, routes of injection, timing after myocardial
infarction (MI), and other key study variables have been less than
conclusive. Because of this uncertainty regarding outcomes of BMC therapy,
a large number of meta-analyses have been performed, also with dissimilar
findings. Although the field continues to evolve with emergence of data
from newer and larger clinical trials with more stringent design, the
overall evidence does support efficacy of BMC injection in patients with
IHD with regard to improvement in cardiac parameters as well as patient
outcomes. Given the limitless potential of adult stem cell therapy in
general, at this juncture, a careful appraisal of the cumulative evidence
is critically necessary to appreciate the true impact of BMC therapy on
injured heart. This review will discuss the clinical evidence and
perspectives from trials and meta-analyses of BMC therapy in patients with
IHD that have accumulated in published literature.
Copyright © 2016 EDIZIONI MINERVA MEDICA.

<90>
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 © 2017 The Cochrane Collaboration. Published by John Wiley
& Sons, Ltd.

<91>
Accession Number
615137717
Author
Da Silva Guimaraes S.; De Souza Cruz W.; Da Silva L.; MacIel G.; Huguenin
A.B.; De Carvalho M.; Costa B.; Da Silva G.; Da Costa C.; D'Ippolito J.A.;
Colafranceschi A.; Scalco F.; Boaventura G.
Institution
(Da Silva Guimaraes, De Souza Cruz, MacIel, Huguenin, De Carvalho, Costa,
Da Silva, Da Costa, Boaventura) Experimental Nutrition Laboratory, College
of Nutrition, Fluminense Federal University, Rio de Janeiro 24020-140,
Brazil
(Colafranceschi) National Institute of Cardiology, Department of Surgical
Procedures, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
(De Souza Cruz, Scalco) Laboratory of Inborn Errors of Metabolism
(LABEIM), Rio de Janeiro Federal University, Rio de Janeiro, Brazil
(De Souza Cruz) College of Medicine, Rio de Janeiro Federal University,
Rio de Janeiro, Brazil
(Da Silva) Istitute of Mathematics, Fluminense Federal University, Rio de
Janeiro, Brazil
(D'Ippolito) Clinical Pathology Service, Fluminense Federal University,
Rio de Janeiro, Brazil
Title
Effect of L-Carnitine Supplementation on Reverse Remodeling in Patients
with Ischemic Heart Disease Undergoing Coronary Artery Bypass Grafting: A
Randomized, Placebo-Controlled Trial.
Source
Annals of Nutrition and Metabolism. 70 (2) (pp 106-110), 2017. Date of
Publication: 01 Apr 2017.
Publisher
S. Karger AG
Abstract
During cardiac failure, cardiomyocytes have difficulty in using the
substrates to produce energy. L-carnitine is a necessary nutrient for the
transport of fatty acids that are required for generating energy. Coronary
artery graft surgery reduces the plasma levels of L-carnitine and
increases the oxidative stress. This study demonstrates the effect of
L-carnitine supplementation on the reverse remodeling of patients
undergoing coronary artery bypass graft. Patients with ischemic heart
failure who underwent coronary graft surgery were randomized to group A -
supplemented with L-carnitine or group B controls. Left ventricular
ejection fraction, left ventricular systolic and diastolic diameters were
assessed preoperatively, 60 and 180 days after surgery. Our study included
28 patients (26 [93.0%] males) with a mean age +/- SD of 58.1 +/- 10.5
years. The parameters for the evaluation of reverse remodeling did not
improve after 60 and 180 days of coronary artery bypass grafting in
comparison between groups (p > 0.05). Evaluation within the L-carnitine
group showed a 37.1% increase in left ventricle ejection fraction (p =
0.002) and 14.3% (p = 0.006) and 3.3% (p > 0.05) reduction in systolic and
diastolic diameters, respectively. L-carnitine supplementation at a dose
of 50 mg/kg combined with artery bypass surgery did not demonstrate any
additional benefit in reverse remodeling. However, evaluation within the
L-carnitine group may indicate a clinical benefit of L-carnitine
supplementation.
Copyright © 2017 S. Karger AG, Basel.

<92>
Accession Number
606088652
Author
Gosselt A.N.C.; Slooter A.J.C.; Boere P.R.Q.; Zaal I.J.
Institution
(Gosselt, Slooter, Boere, Zaal) University Medical Center Utrecht,
Department of Intensive Care Medicine, Heidelberglaan 100, Utrecht 3584
CX, Netherlands
Title
Risk factors for delirium after on-pump cardiac surgery: A systematic
review.
Source
Critical Care. 19 (1) (no pagination), 2015. Article Number: 346. Date of
Publication: September 23, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Introduction: As evidence-based effective treatment protocols for delirium
after cardiac surgery are lacking, efforts should be made to identify risk
factors for preventive interventions. Moreover, knowledge of these risk
factors could increase validity of etiological studies in which
adjustments need to be made for confounding variables. This review aims to
systematically identify risk factors for delirium after cardiac surgery
and to grade the evidence supporting these associations. Method: A prior
registered systematic review was performed using EMBASE, CINAHL, MEDLINE
and Cochrane from 1990 till January 2015
(http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014007371).
All studies evaluating patients for delirium after cardiac surgery with
cardiopulmonary bypass (CPB) using either randomization or multivariable
data analyses were included. Data was extracted and quality was scored in
duplicate. Heterogeneity impaired pooling of the data; instead a
semi-quantitative approach was used in which the strength of the evidence
was graded based on the number of investigations, the quality of studies,
and the consistency of the association reported across studies. Results:
In total 1462 unique references were screened and 34 were included in this
review, of which 16 (47 %) were graded as high quality. A strong level of
evidence for an association with the occurrence of postoperative delirium
was found for age, previous psychiatric conditions, cerebrovascular
disease, pre-existent cognitive impairment, type of surgery,
peri-operative blood product transfusion, administration of risperidone,
postoperative atrial fibrillation and mechanical ventilation time.
Postoperative oxygen saturation and renal insufficiency were supported by
a moderate level of evidence, and there is no evidence that gender,
education, CPB duration, pre-existent cardiac disease or heart failure are
risk factors. Conclusion: Of many potential risk factors for delirium
after cardiac surgery, for only 11 there is a strong or moderate level of
evidence. These risk factors should be taken in consideration when
designing future delirium prevention strategies trials or when controlling
for confounding in future etiological studies.
Copyright © 2015 Gosselt et al.

<93>
Accession Number
606118757
Author
Li F.; Yuan Y.
Institution
(Li) First People's Hospital, Department of Anesthesia, Yancheng, Jiangsu
Province 224000, China
(Yuan) First People's Hospital, Department of Otolaryngology,
Yancheng,Jiangsu Province 224000, China
Title
Meta-analysis of the cardioprotective effect of sevoflurane versus
propofol during cardiac surgery.
Source
BMC Anesthesiology. 15 (1) (no pagination), 2015. Article Number: 128.
Date of Publication: September 24, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: To evaluate the cardioprotective effects of sevoflurane versus
propofol anesthesia in patients undergoing cardiac surgery. Methods:
Studies were retrieved through searching several databases. Study quality
was evaluated by Jadad scale. Meta-analysis was performed with RevMan5.0
software. Publication bias was tested by funnel plot. Results: As a
result, 15 studies were included. Compared with propofol, sevoflurane
anesthesia significantly improved postoperative (WMD (weighted mean
difference) = 0.62, 95% CI: 0.33 to 0.92; P < 0.0001) and postoperative 12
hour cardiac index (WMD = 0.18, 95% CI: 0.03 to 0.33; P = 0.02),
postoperative cardiac output (WMD = 1.14, 95% CI: 0.74 to 1.54; P <
0.00001), and reduced postoperative 24 hour cardiac troponin I
concentration (WMD = -0.86, 95% CI:-1.49 to -0.22; P = 0.008),
postoperative inotropic drug usage (OR (odds ratio) = 0.31, 95% CI: 0.22
to 0.44; P < 0.00001), vasoconstrictor drug usage (OR = 0.30, 95% CI:0.21
to 0.43; P < 0.00001), ICU stay (WMD = -15.53, 95% CI: -24.29 to -6.58; P
= 0.0007) and a trial fibrillation incidence (OR = 0.25, 95% CI: 0.07 to
0.85; P = 0.03). However, no significant differences were found in other
indexes. Subgroup analysis indicated the similar results. Discussion: The
sevoflurane-induced cTnI reduction is associated with lower incidence of
late adverse cardiac events, accounting for its roles in cardiac
protection. Several limitations existed such as the small sample size and
the lack use of blind design. Conclusions: Sevoflurane may exhibit a more
favorable cardioprotective effect during cardiac surgery than propofol.
Copyright © 2015 Li and Yuan.

<94>
Accession Number
606304442
Author
Bundhun P.K.; Qin T.; Chen M.-H.
Institution
(Bundhun, Qin, Chen) The First Affiliated Hospital of Guangxi Medical
University, Institute of Cardiovascular Diseases, Nanning, Guangxi 530027,
China
Title
Comparing the effectiveness and safety between triple antiplatelet therapy
and dual antiplatelet therapy in type 2 diabetes mellitus patients after
coronary stents implantation: A systematic review and meta-analysis of
randomized controlled trials.
Source
BMC Cardiovascular Disorders. 15 (1) (no pagination), 2015. Article
Number: 118. Date of Publication: October 09, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Since antiplatelet therapy in type 2 diabetes mellitus (T2DM)
patients is very important after intracoronary stenting, and because the
most commonly used therapies have been the dual antiplatelet therapy
(DAPT) consisting of aspirin and clopidogrel and the triple antiplatelet
therapy (TAPT) consisting of aspirin, clopidogrel and cilostazol, we aim
to compare the effectiveness and safety between triple antiplatelet
therapy and dual antiplatelet therapy in T2DM patients. Methods:
Systematic literature search was done from the databases of PubMed,
Cochrane, Embase, China National Knowledge Infrastructure (CNKI) and
WanFang. Randomized controlled trials (RCTs) comparing the effectiveness
and safety between triple therapy and dual therapy in T2DM patients after
coronary stents placement were included. Endpoints included major adverse
cardiac effects (MACEs), target lesion revascularization (TLR), target
vessel revascularization (TVR), death, stent thrombosis, bleeding and
adverse drug reactions during a 9-12 months period, as well as platelet
activities. Results: Four studies including 1005 patients reporting the
adverse clinical outcomes and six studies including 519 patients reporting
the platelet activities, with a total of 1524 patients have been analyzed
in this meta-analysis. The pooling analysis shows that TAPT has
significantly decreased the occurrence of MACEs (RR: 0.55; 95% CI:
0.36-0.86, P=0.009), TLR (RR 0.41; 95% CI: 0.21-0.80, P=0.008), TVR (RR
0.55; 95% CI: 0.34-0.88, P=0.01) and the overall incidence of Death/
Myocardial Infarction (MI)/TVR (RR 0.54; 95% CI: 0.31-0.94, P=0.03) during
this 9 to 12months follow up period after stents implantation. Stent
thrombosis was almost similar in both groups. Bleeding seemed to favor
DAPT but the result was not statistically significant. Platelet
aggregation, platelet reactivity index (PRI) and platelet reactivity unit
(PRU) were also reduced with Weight Mean Difference (WMD) of (-13.80; 95%
CI: -17.03 to -10.56, P<0.00001), (-22.87; 95% CI: -23.66 to -22.07,
P<0.00001) and (-44.17; 95% CI: -58.56 to -29.77, P<0.00001) respectively.
Conclusion: Since MACEs have been significantly decreased in the triple
group, TAPT appears to be more effective than DAPT in T2DM patients after
intracoronary stenting. No significant difference in stent thrombosis and
bleeding risks between these 2 groups shows TAPT to be almost as safe as
DAPT in these diabetic patients.
Copyright © 2015 Bundhun et al.

<95>
Accession Number
606316278
Author
Al Tmimi L.; Van de Velde M.; Herijgers P.; Meyns B.; Meyfroidt G.;
Milisen K.; Fieuws S.; Coburn M.; Poesen K.; Rex S.
Institution
(Al Tmimi, Van de Velde, Rex) University Hospitals of Leuven, Department
of Anesthesiology, KU Leuven - University of Leuven, Herestraat 49, Leuven
B-3000, Belgium
(Van de Velde, Herijgers, Meyns, Rex) KU Leuven - University of Leuven,
Department of Cardiovascular Sciences, Leuven B-3000, Belgium
(Herijgers, Meyns) University Hospitals of Leuven, Department of Cardiac
Surgery, KU Leuven - University of Leuven, Herestraat 49, Leuven B-3000,
Belgium
(Meyfroidt) University Hospitals Leuven, Department of Intensive Care
Medicine, KU Leuven - University of Leuven, Herestraat 49, Leuven B-3000,
Belgium
(Meyfroidt) KU Leuven - University of Leuven, Department of Intensive Care
Medicine and Cellular and Molecular Medicine, Herestraat 49, Leuven
B-3000, Belgium
(Milisen) KU Leuven - University of Leuven, Department of Public Health
and Primary Care, Leuven B-3000, Belgium
(Fieuws) KU Leuven - University of Leuven, I-Biostat, Leuven B-3000,
Belgium
(Coburn) University Hospital of the RWTH Aachen, Department of
Anesthesiology, Aachen, Germany
(Poesen) University Hospitals Leuven, Laboratory Medicine, KU Leuven -
University of Leuven, Herestraat 49, Leuven B-3000, Belgium
(Poesen) KU Leuven - University of Leuven, Department of Neurosciences,
Laboratory for Molecular Neurobiomarker Research, Herestraat 49, Leuven
B-3000, Belgium
Title
Xenon for the prevention of postoperative delirium in cardiac surgery:
Study protocol for a randomized controlled clinical trial.
Source
Trials. 16 (1) (no pagination), 2015. Article Number: 449. Date of
Publication: October 09, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative delirium (POD) is a manifestation of acute
postoperative brain dysfunction that is frequently observed after cardiac
surgery. POD is associated with short-term complications such as an
increase in mortality, morbidity, costs and length of stay, but can also
have long-term sequelae, including persistent cognitive deficits, loss of
independence, and increased mortality for up to 2 years. The noble gas
xenon has been demonstrated in various models of neuronal injury to
exhibit remarkable neuroprotective properties. We therefore hypothesize
that xenon anesthesia reduces the incidence of POD in elderly patients
undergoing cardiac surgery with the use of cardiopulmonary bypass.
Methods/Design: One hundred and ninety patients, older than 65 years, and
scheduled for elective cardiac surgery, will be enrolled in this
prospective, randomized, controlled trial. Patients will be randomized to
receive general anesthesia with either xenon or sevoflurane. Primary
outcome parameter will be the incidence of POD in the first 5
postoperative days. The occurrence of POD will be assessed by trained
research personnel, blinded to study group, with the validated 3-minute
Diagnostic Confusion Assessment Method (3D-CAM) (on the intensive care
unit in its version specifically adapted for the ICU), in addition to
chart review and the results of delirium screening tools that will be
performed by the bedside nurses). Secondary outcome parameters include
duration and severity of POD, and postoperative cognitive function as
assessed with the Mini-Mental State Examination. Discussion: Older
patients undergoing cardiac surgery are at particular risk to develop POD.
Xenon provides remarkable hemodynamic stability and has been suggested in
preclinical studies to exhibit neuroprotective properties. The present
trial will assess whether the promising profile of xenon can be translated
into a better outcome in the geriatric population. Trial registration:
EudraCT Identifier: 2014-005370-11(13 May 2015).
Copyright © 2015 Al Tmimi et al.

<96>
Accession Number
611047628
Author
Xiong T.-Y.; Liao Y.-B.; Zhao Z.-G.; Xu Y.-N.; Wei X.; Zuo Z.-L.; Li
Y.-J.; Cao J.-Y.; Tang H.; Jilaihawi H.; Feng Y.; Chen M.
Institution
(Xiong, Liao, Zhao, Xu, Wei, Zuo, Li, Cao, Tang, Feng, Chen) Department of
Cardiology, West China Hospital, Sichuan University, Chengdu, China
(Jilaihawi) Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, CA, United States
Title
Causes of death following transcatheter aortic valve replacement: A
systematic review and meta-analysis.
Source
Journal of the American Heart Association. 4 (9) (no pagination), 2015.
Article Number: e002096. Date of Publication: 01 Sep 2015.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Transcatheter aortic valve replacement (TAVR) is an effective
alternative to surgical aortic valve replacement in patients at high
surgical risk. However, there is little published literature on the exact
causes of death. Methods and Results-The PubMed database was
systematically searched for studies reporting causes of death within and
after 30 days following TAVR. Twenty-eight studies out of 3934 results
retrieved were identified. In the overall analysis, 46.4% and 51.6% of
deaths were related to noncardiovascular causes within and after the first
30 days, respectively. Within 30 days of TAVR, infection/ sepsis (18.5%),
heart failure (14.7%), and multiorgan failure (13.2%) were the top 3
causes of death. Beyond 30 days, infection/sepsis (14.3%), heart failure
(14.1%), and sudden death (10.8%) were the most common causes. All
possible subgroup analyses were made. No significant differences were seen
for proportions of cardiovascular deaths except the comparison between
moderate (mean STS score 4 to 8) and high (mean STS score >8) -risk
patients after 30 days post-TAVR (56.0% versus 33.5%, P=0.005).
Conclusions-Cardiovascular and noncardiovascular causes of death are
evenly balanced both in the perioperative period and at long-term
follow-up after TAVR. Infection/sepsis and heart failure were the most
frequent noncardiovascular and cardiovascular causes of death. This study
highlights important areas of clinical focus that could further improve
outcomes after TAVR. 2015 The Authors.

<97>
Accession Number
615857257
Author
Rab T.; Sheiban I.; Louvard Y.; Sawaya F.J.; Zhang J.J.; Chen S.L.
Institution
(Rab) Division of Cardiology, Emory University School of Medicine,
Atlanta, Georgia
(Sheiban) Division of Cardiology, University of Turin, Turin, Italy
(Louvard) Divsion of Cardiology, Institut Cardiovasculaire Paris Sud,
Massy, France
(Sawaya) Division of Cardiology, American University of Beirut, Beirut,
Lebanon
(Zhang, Chen) Division of Cardiology, Nanjing Medical University, Nanjing,
China
Title
Current Interventions for the Left Main Bifurcation.
Source
JACC: Cardiovascular Interventions. 10 (9) (pp 849-865), 2017. Date of
Publication: 08 May 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Contemporary clinical trials, registries, and meta-analyses, supported by
recent results from the EXCEL (Everolimus-Eluting Stents or Bypass Surgery
for Left Main Coronary Artery Disease) and NOBLE (Percutaneous Coronary
Angioplasty Versus Coronary Artery Bypass Grafting in Treatment of
Unprotected Left Main Stenosis) trials, have established percutaneous
coronary intervention of left main coronary stenosis as a safe alternative
to coronary artery bypass grafting in patients with low and intermediate
SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and
Cardiac Surgery) scores. As left main percutaneous coronary intervention
gains acceptance, it is imperative to increase awareness for patient
selection, risk scoring, intracoronary imaging, vessel preparation, and
choice of stenting techniques that will optimize procedural and patient
outcomes.
Copyright © 2017 American College of Cardiology Foundation

<98>
Accession Number
615857172
Author
Secemsky E.A.; Yeh R.W.; Kereiakes D.J.; Cutlip D.E.; Steg P.G.; Massaro
J.M.; Apruzzese P.K.; Mauri L.
Institution
(Secemsky) Division of Cardiology, Department of Medicine, Massachusetts
General Hospital, Boston, Massachusetts, United States
(Secemsky, Mauri) Division of Cardiology and Center for Clinical
Biometrics, Department of Medicine, Brigham and Women's Hospital, Boston,
Massachusetts, United States
(Secemsky, Yeh, Cutlip, Massaro, Apruzzese, Mauri) Baim Institute for
Clinical Research, Boston, Massachusetts, United States
(Secemsky, Yeh) Smith Center for Outcomes Research in Cardiology, Beth
Israel Deaconess Medical Center, Boston, Massachusetts, United States
(Kereiakes) The Christ Hospital Heart and Vascular Center and The Lindner
Center for Research and Education, Cincinnati, Ohio, United States
(Steg) Universite Paris-Diderot, INSERM U-1148, Hopital Bichat,
Departement Hospitalo-Universitaire Fibrosis, Inflammation, and
Remodelling, Assistance Publique-Hopitaux de Paris, Paris, France
(Steg) National Heart and Lung Institute, Institute of Cardiovascular
Medicine and Science, Royal Brompton Hospital, Imperial College, London,
United Kingdom
Title
Extended Duration Dual Antiplatelet Therapy After Coronary Stenting Among
Patients With Peripheral Arterial Disease: A Subanalysis of the Dual
Antiplatelet Therapy Study.
Source
JACC: Cardiovascular Interventions. 10 (9) (pp 942-954), 2017. Date of
Publication: 08 May 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study sought to determine whether patients with peripheral
arterial disease (PAD) experience different reductions in ischemic event
and increases in bleeding events with extended duration dual antiplatelet
therapy versus those without PAD. Background Patients with PAD have
increased ischemic and bleeding risks after coronary stenting. Methods The
DAPT (Dual Antiplatelet Therapy) study randomized 11,648 patients free
from ischemic and bleeding events 12 months after coronary stenting to
continued thienopyridine plus aspirin therapy for an additional 18 months
versus aspirin therapy alone. The effects of continued thienopyridine on
myocardial infarction (MI) or stent thrombosis, major adverse
cardiovascular and cerebrovascular events (death, MI, or stroke) and
bleeding (GUSTO [Global Utilization of t-PA and Streptokinase for Occluded
Coronary Arteries] moderate or severe) were assessed among those with
versus without PAD. Results Among 11,648 randomized patients, 649 (5.57%)
had PAD. Between 12 and 30 months, randomized patients with PAD had higher
rates of MI/stent thrombosis (6.03% vs. 2.92%; p < 0.001), major adverse
cardiovascular and cerebrovascular events (11.65% vs. 4.62%; p < 0.001),
and bleeding (4.86% vs. 1.74%; p < 0.001). Continued thienopyridine versus
placebo was associated with consistent treatment effects for MI/stent
thrombosis (with PAD, HR: 0.63; 95% CI: 0.32 to 1.22; without PAD, HR:
0.53; 95% CI: 0.42, 0.66; interaction p = 0.631), major adverse
cardiovascular and cerebrovascular events (with PAD, HR: 1.06; 95% CI:
0.67 to 1.67; without PAD, HR: 0.70; 95% CI: 0.59 to 0.84; interaction p =
0.103), and bleeding (with PAD, HR, 1.82; 95% CI: 0.87 to 3.83; without
PAD, HR: 1.66; 95% CI: 1.23 to 2.24; interaction p = 0.811). Conclusions
Among patients undergoing coronary stenting, those with PAD have more
ischemic and bleeding events versus those without PAD. Extended duration
dual antiplatelet therapy is associated with consistent ischemic benefit
and bleeding harm among patients with and without PAD.
Copyright © 2017 American College of Cardiology Foundation

<99>
Accession Number
615878879
Author
Toikkanen V.; Rinne T.; Laurikka J.; Porkkala H.; Tarkka M.; Mennander A.
Institution
(Toikkanen, Laurikka, Tarkka, Mennander) Department of Cardiothoracic
Surgery, Heart Center, Tampere University Hospital and University of
Tampere, Tampere, Finland
(Rinne, Porkkala) Division of Cardiac Anesthesia, Heart Center, Tampere
University Hospital, Tampere, Finland
Title
Pulmonary vascular resistance index during coronary artery bypass surgery
with aprotinin.
Source
Scandinavian Journal of Clinical and Laboratory Investigation. (pp 1-6),
2017. Date of Publication: 02 May 2017.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Low pulmonary vascular resistance index (PVRI) reflects favorable
redundant pulmonary circulation following coronary artery bypass grafting
with cardiopulmonary bypass surgery (CPB). This randomized study
investigated whether aprotinin given in different modalities impacts PVRI
after coronary artery bypass grafting. A total of 40 patients undergoing
coronary artery bypass grafting were randomized to four groups according
to aprotinin dose: (1) high dose, (2) early low dose, (3) late low dose,
and (4) without aprotinin. Oxygenation index, pulmonary shunt,
alveolar-arterial oxygen gradient and PVRI were determined. PVRI was
calculated as the transpulmonary pressure gradient divided by cardiac
index multiplied by 80. The results showed that PVRI remained relative low
in all patients provided aprotinin regardless of treatment dosage; PVRI
increased at 4h after restarting ventilation after CPB in patients without
aprotinin as compared with aprotinin (266+/-137, 266+/-115, 244+/-86 vs.
386+/-121, dynes-s-cm-5, respectively, p=.047).
Elevated postoperative PVRI was predictive for patients without aprotinin
(AUC 0.668; SE 0.40; p<.0001; CI 0.590-0.746). There were no statistical
differences in oxygenation index, pulmonary shunt or alveolar-arterial
oxygen gradient between the groups. In conclusion, aprotinin maintains a
low PVRI in elective patients with healthy lungs during CPB. We suggest
that aprotinin maintains pulmonary arterial endothelial integrity.
Copyright © 2017 Medisinsk Fysiologisk Forenings Forlag (MFFF)

<100>
Accession Number
615868878
Author
Nazer R.I.; Albarrati A.M.
Institution
(Nazer) Department of Cardiac Science, King Fahad Cardiac Center, College
of Medicine, King Saud University, Riyadh, Saudi Arabia
(Albarrati) Department of Rehabilitation Science, College of Applied
Medical Science, King Saud University, Riyadh, Saudi Arabia
Title
Topical Ice Slush Adversely Affects Sniff Nasal Inspiratory Force After
Coronary Bypass Surgery.
Source
Heart Lung and Circulation. (no pagination), 2017. Date of Publication:
January 31, 2017.
Publisher
Elsevier Ltd
Abstract
Background: Topical cooling with ice slush as an adjunct for myocardial
protection during cardiac surgery has been shown to cause freezing injury
of the phrenic nerves. This can cause diaphragmatic dysfunction and
respiratory complications. Methods: Twenty (n = 20) male patients between
the ages of 40 and 60 years were equally randomised to undergo elective
coronary artery bypass grafting (CABG) with either cold cardioplegic
arrest with topical ice slush cooling or cold cardioplegic arrest without
the use of ice slush. The sniff nasal inspiratory force (SNIF) was used to
compare inspiratory muscle strength. Results: There was no difference in
the preoperative SNIF in the two randomised groups. In the immediate
postoperative period, the ice slush group had worse SNIF (33.5. +/-. 9.6.
cm H2O versus 47.8. +/-. 12.2. cm H2O; p = 0.009). The pre-home discharge
SNIF was still significantly lower for the ice slush group despite a noted
improvement in SNIF recovery in both groups (38.3. +/-. 10.6. cm H2O
versus 53.5. +/-. 13.2. cm H2O; p = 0.011). Two patients in the ice slush
group had left diaphragmatic dysfunction with none in the control group.
Conclusion: The use of topical ice slush is associated with freezing
injury of the phrenic nerves. This will adversely affect the inspiratory
muscle force which may lead to respiratory complications after surgery.
Copyright © 2017 Australian and New Zealand Society of Cardiac and
Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New
Zealand (CSANZ).

<101>
Accession Number
615868858
Author
Singh K.; Carson K.; Rashid M.K.; Jayasinghe R.; AlQahtani A.; Dick A.;
Glover C.; Labinaz M.
Institution
(Singh, Carson, Jayasinghe) Griffith University, Brisbane, Qld, Australia
(Singh) Gold Coast University Hospital, Brisbane, Qld, Australia
(Rashid, AlQahtani, Dick, Glover, Labinaz) University of Ottawa Heart
Institute, Ottawa, Ontario, Canada
Title
Transcatheter Aortic Valve Implantation in Intermediate Surgical Risk
Patients with Severe Aortic Stenosis: A Systematic Review and
Meta-Analysis.
Source
Heart Lung and Circulation. (no pagination), 2017. Date of Publication:
May 26, 2016.
Publisher
Elsevier Ltd
Abstract
Background: Recent data from randomised and observational studies have
reported non-inferior outcomes for transcatheter aortic valve implantation
(TAVI) compared to surgical aortic valve replacement (SAVR) in
intermediate-risk patients. We performed a systematic review to evaluate
the mortality of TAVI compared to SAVR in intermediate-risk patients.
Methods: A comprehensive search of four major databases (EMBASE, Ovid
MEDLINE, PubMed, and Google Scholar) was performed from their inception to
29 April 2016. We included original research studies reporting data on
TAVI and SAVR in intermediate-risk patients. We compared the outcomes of
TAVI to SAVR. Results: A total of 2,375 and 2,377 intermediate-risk
patients underwent TAVI and SAVR respectively. The 30-day all-cause (p =
0.07), 30-day cardiac (p = 0.53), and 12-month all-cause mortality (p =
0.34) was similar between the two groups. However, TAVI through
transfemoral access had a significantly lower mortality than SAVR (OR
0.58, p = 0.006). The incidence of >moderate aortic incompetence (p. <.
0.00001) and pacemaker implantation (p. <. 0.0001) was higher in the TAVI
group. Conclusions: In the intermediate-risk patients, the 30-day and
12-month mortality are similar between TAVI and SAVR. Increased operator
experience and improved device technology have led to a significant
reduction in mortality in intermediate-risk patients undergoing TAVI.
Copyright © 2017 Australian and New Zealand Society of Cardiac and
Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New
Zealand (CSANZ).

<102>
Accession Number
608878276
Author
Petrou P.; Dias S.
Institution
(Petrou) Health Insurance Organization, Cyprus
(Dias) School of Social and Community Medicine, University of Bristol,
United Kingdom
Title
A mixed treatment comparison for short- and long-term outcomes of
bare-metal and drug-eluting coronary stents.
Source
International Journal of Cardiology. 202 (pp 448-462), 2016. Date of
Publication: 01 Jan 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background: The increasing use of drug eluting stents in interventional
cardiology calls for assessment of their efficacy and safety, both among
drug-eluting and bare-metal stents, in the context of rational decision
making. Methods: We searched for papers that compared any of the
sirolimus-eluting stent, paclitaxel-eluting stent, drug- eluting stent,
biodegradable stent, everolimus-eluting stent, zotarolimus-resolute
eluting stent, biolimus- eluting stent, bare-metal stent and
zotarolimus-eluting stent. The search was contacted through Medline, the
Cochrane database, Embase, TCTMD, ClinicalTrials.gov, Clinical Trial
Results, CardioSource, abstracts and presentations from major
cardiovascular meetings. We also searched for further articles cited by
selected papers. Furthermore, important conferences and relevant
proceedings and abstracts, such as the American Heart Association,
American College of Cardiology, Transcatheter Cardiovascular Therapeutics,
Society of Cardiovascular Angiography and Intervention, European Society
of Cardiology, and Euro-PCR, were also searched. Inclusion criteria were:
randomised controlled trials (RCTs), size of study (> 100 patients),
duration more than 6 months and definition of reported endpoints (target
vessel revascularization, thrombosis, myocardial infarction and cardiac
death). Analysis of the data was performed for short-term (less than a
year) and long-term outcomes (more than a year). A mixed treatment
comparison approach was utilised for the data analysis. Conclusions: Based
on the rankings of each treatment, a distinct difference between the 2nd
and 1st generation stents was identified. We can conclude that everolimus,
zotarolimus-resolute and biolimus eluting stents carry the highest
probabilities of being superior for all endpoints.
Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

<103>
Accession Number
607672174
Author
Lu C.; Filion K.B.; Eisenberg M.J.
Institution
(Lu, Filion, Eisenberg) Faculty of Medicine, McGill University, Montreal,
QC, Canada
(Filion, Eisenberg) Division of Clinical Epidemiology, Lady Davis
Institute, Jewish General Hospital, McGill University, Montreal, QC,
Canada
(Filion, Eisenberg) Department of Epidemiology, Biostatistics, and
Occupational Health, McGill University, Montreal, QC, Canada
(Eisenberg) Division of Cardiology, Jewish General Hospital, McGill
University, Montreal, QC, Canada
Title
The Safety and Efficacy of Absorb Bioresorbable Vascular Scaffold: A
Systematic Review.
Source
Clinical Cardiology. 39 (1) (pp 48-55), 2016. Date of Publication: 01 Jan
2016.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Bioresorbable stents are novel devices designed to overcome the long-term
limitations of permanent stent implantation. The Absorb bioresorbable
vascular scaffold (BVS; Abbott Vascular, Santa Clara, CA) was the first
bioresorbable stent with Conformite Europeenne mark approval in coronary
vessels and has been the subject of multiple clinical studies. Despite its
potential advantages, the safety and efficacy of BVS remain unclear. To
address this, we conducted a systematic review to examine the safety and
efficacy of BVS. The MEDLINE, Embase, Current Index to Nursing & Allied
Health Literature (CINAHL), Cochrane, and Science Citation Index Expanded
(SCIE) databases were searched for studies examining BVS safety and
efficacy. Our search was restricted to studies published in English or
French. Outcomes of interest include cardiac death, myocardial infarction,
target-lesion revascularization, restenosis, and composite endpoints.
Eleven studies met our inclusion criteria (n = 2990), which included 1
randomized controlled trial and 10 cohort studies (2 controlled). These
studies varied in size (11-1189) and follow-up duration (1-60 months). The
incidence of major adverse cardiac events ranged from 2.6% to 15.5%, with
no statistically significant difference between BVS and control in studies
that included a comparison group. Although available data are limited,
current evidence is promising and suggests that the use of BVS is not
associated with a significant increase in major cardiac events in the
short term. Numerous randomized controlled trials are currently in
progress that will further improve our understanding of the safety and
efficacy of this device.
Copyright © 2015 Wiley Periodicals, Inc.

<104>
Accession Number
606092705
Author
Yumun G.; Aydin U.; Ata Y.; Toktas F.; Pala A.A.; Ozyazicioglu A.F.; Turk
T.; Yavuz S.
Institution
(Yumun, Yavuz) Department of Cardiovascular Surgery, Namik Kemal
University, Tekirdag, Turkey
(Aydin, Ata, Toktas, Pala, Ozyazicioglu, Turk) Department of
Cardiovascular Surgery, Bursa Yuksek Ihtisas Education and Research
Hospital, Bursa, Turkey
Title
Analysis of clinical outcomes of intra-aortic balloon pump use during
coronary artery bypass surgery.
Source
Cardiovascular Journal of Africa. 26 (4) (pp 155-158), 2015. Date of
Publication: 01 Jul 2015.
Publisher
Clinics Cardive Publishing (PTY)Ltd (PO Box 1013, Durbanville 7551, South
Africa)
Abstract
Aim: The mortality rate of coronary artery bypass surgery increases with
advanced patient age. This intra-aortic balloon pump (IABP) study was
conducted to compare older patients (above 65 years of age) with younger
patients (below 65 years of age) who had undergone coronary artery bypass
surgery and had had an IABP inserted, with regard to hospital stay,
clinical features, intensive care unit stay, postoperative complications,
and mortality and morbidity rates. Methods: One hundred and ninety
patients who had undergone coronary artery bypass surgery and had required
IABP support were enrolled in this study. Patients younger than 65 years
of age were considered younger, and the others were considered older.
Ninety-two patients were in younger group and 98 patients were older
group. The mortality rates, pre-operative clinical characteristics,
postoperative complications, and duration of intensive care unit and
hospital stay of the groups were compared. The risk factors for mortality
and complications were analysed. Results: One hundred and thirty-eight of
the patients were male, and the mean age was 62.7 +/- 9.9 years. The
mortality rate was higher in the older patient group than the younger
group [34 (37.7%) and 23 (23.4 %), respectively (p = 0.043)]. The
crossclamp time, mean ejection fraction, cardiopulmonary bypass time, and
length of stay in the intensive care unit were similar between the two
groups (p > 0.05). Cardiopulmonary bypass time was the unique independent
risk factor for mortality in both groups. Conclusion: In this study, high
mortality rates in the postoperative period were similar to those in prior
studies regarding IABP support. The complication rates were higher in the
older patient group. Prolonged cardiopulmonary bypass time and advanced
age were determined to be significant risk factors for mortality.

<105>
Accession Number
606578651
Author
Sharma V.K.; Joshi S.; Joshi A.; Kumar G.; Arora H.; Garg A.
Institution
(Sharma) Department of Cardiothoracic Anesthesiology, Military Hospital
(Cardiothoracic Center), Armed Forces Medical College, Pune, Maharashtra,
India
(Joshi, Kumar, Arora) Military Hospital (Cardiothoracic Center), Armed
Forces Medical College, Pune, Maharashtra, India
(Joshi) Department of Anesthesiology and Critical Care, Armed Forces
Medical College, Pune, Maharashtra, India
(Garg) Department of Cardiothoracic Surgery, Military Hospital
(Cardiothoracic Center), Armed Forces Medical College, Pune, Maharashtra,
India
Title
Does intravenous sildenafil clinically ameliorate pulmonary hypertension
during perioperative management of congenital heart diseases in
children?-A prospective randomized study.
Source
Annals of Cardiac Anaesthesia. 18 (4) (pp 510-516), 2015. Date of
Publication: 01 Oct 2015.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: Pulmonary hypertension (PHT), if present, can be a significant
cause of increased morbidity and mortality in children undergoing surgery
for congenital heart diseases (CHD). Various techniques and drugs have
been used perioperatively to alleviate the effects of PHT. Intravenous
(IV) sildenafil is one of them and not many studies validate its clinical
use. Aims and Objectives: To compare perioperative PaO <inf>2</inf>-FiO
<inf>2</inf> ratio peak filling rate (PFR), systolic pulmonary artery
pressure (PAP)-systolic aortic pressure (AoP) ratio, extubation time, and
Intensive Care Unit (ICU) stay between two groups of children when one of
them is administered IV sildenafil perioperatively during surgery for
CHDs. Materials and Methods: Patients with ventricular septal defects and
proven PHT, <14 years of age, all American Society of Anesthesiologists
physical status III, undergoing cardiac surgery, were enrolled into two
groups-Group S (IV sildenafil) and Group C (control)-over a period of 14
months, starting from October 2013. Independent t-test and Mann-Whitney
U-test were used to compare the various parameters between two groups.
Results: PFR was higher throughout, perioperatively, in Group S. PAP/AoP
was 0.3 and 0.4 in Group S and Group C, respectively. In Group S, mean
group extubation time was 7 +/- 7.34 h, whereas in Group C it was 22.1 +/-
10.6. Postoperative ICU stay in Group S and Group C were 42.3 +/- 8.8 h
and 64.4 +/- 15.9 h, respectively. Conclusion: IV sildenafil, when used
perioperatively, in children with CHD having PHT undergoing corrective
surgery, improves not only PaO <inf>2</inf>-FiO <inf>2</inf> ratio and
PAP-AoP ratio but also reduces extubation time and postoperative ICU stay.

<106>
Accession Number
606578524
Author
Samir A.; Gandreti N.; Madhere M.; Khan A.; Brown M.; Loomba V.
Institution
(Samir, Gandreti, Madhere, Khan, Brown, Loomba) Department of Anesthesia,
Henry Ford Hospital, 2799 W, Grand Blvd., Detroit, MI 48202, United States
Title
Anti-inflammatory effects of propofol during cardiopulmonary bypass: A
pilot study.
Source
Annals of Cardiac Anaesthesia. 18 (4) (pp 495-501), 2015. Date of
Publication: 01 Oct 2015.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Introduction: Propofol has been suggested as a useful adjunct to
cardiopulmonary bypass (CPB) because of its potential protective effect on
the heart mediated by a decrease in ischemia-reperfusion injury and
inflammation at clinically relevant concentrations. In view of these
potentially protective properties, which modulate many of the deleterious
mechanism of inflammation attributable to reperfusion injury and CPB, we
sought to determine whether starting a low dose of propofol infusion at
the beginning of CPB would decrease inflammation as measured by
pro-inflammatory markers. Materials and Methods: We enrolled 24 patients
undergoing elective coronary artery bypass graft (CABG). The study group
received propofol at rate of 120 mcg/kg/min immediately after starting CPB
and was maintained throughout the surgery and for the following 6 hours in
the intensive care unit (ICU). The control group received propofol dose of
30-50 mcg/kg/min which was started at the time of chest closure with wires
and continued for the next 6 hours in the ICU. Interleukins (IL)-6,-8
and-10 and tumor necrosis factor alpha (TNFalpha) were assayed. Result:
The most significant difference was in the level of IL-6 which had a P
value of less than 0.06. Starting a low dose propofol early during the CPB
was not associated with significant hemodynamic instability in comparison
with the control group. Conclusion: Our study shows that propofol may be
suitable as an anti-inflammatory adjunct for patients undergoing CABG.

<107>
Accession Number
606557434
Author
dos Santos L.; Barroso J.J.; Macau E.E.N.; de Godoy M.F.
Institution
(dos Santos) Universidade do Vale do Paraiba - UNIVAP, Sao Jose dos
Campos, Sao Paulo, Brazil
(Barroso, Macau) Instituto Nacional de Pesquisas Espacias - INPE, Sao Jose
dos Campos, Sao Paulo, Brazil
(de Godoy) Sao Jose do Rio PretoSao PauloBrazil
Title
Assessment of heart rate variability by application of central tendency
measure.
Source
Medical and Biological Engineering and Computing. 53 (11) (pp 1231-1237),
2015. Date of Publication: 22 Sep 2015.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
The heart rate variability (HRV) is an indicator of the subject
homeostasis alterations. For a healthy individual, the HRV shows a
nonlinear behavior, thus requiring a nonlinear approach to provide
additional information about HRV dynamics. In this work, the nonlinear
techniques, central tendency measure (CTM) and second-order difference
plot, are applied to HRV analysis using the successive difference of RR
intervals in a time series. In total are analyzed 170 tachograms collected
by Polar monitor and then classified into three groups according to a
cardiologist: healthy young adults, adults in preoperative evaluation for
coronary artery bypass grafting for severe coronary disease and premature
newborns. This approach identified the tachograms with high and low
variability, which demonstrates the ability of CTM to classify and
quantitatively characterize cardiac RR intervals.
Copyright © 2015, International Federation for Medical and Biological
Engineering.

<108>
Accession Number
613926582
Author
Iyengar S.S.; Gupta R.; Ravi S.; Thangam S.; Alexander T.; Manjunath C.N.;
Keshava R.; Patil C.B.; Sheela A.; Sawhney J.P.S.
Institution
(Iyengar) Manipal Hospital, Bangalore, India
(Gupta) Eterna Heart Care Centre and Research Institute, Jaipur, India
(Ravi) Lotus Clinical Research Academy, Bangalore, India
(Thangam) Norwich Clinical Services, Bangalore, India
(Alexander) Kovai Medical Center and Hospital, Coimbatore, India
(Manjunath) Sri Jaideva Institute of Cardiovascular Sciences and Research,
Bangalore, India
(Keshava) Fortis Hospital, Bangalore, India
(Patil) St Philomena Hospital, Bangalore, India
(Sheela) PS Mission Hospital, Ernakulam, India
(Sawhney) Sir Gangaram Hospital, New Delhi, India
Title
Premature coronary artery disease in India: coronary artery disease in the
young (CADY) registry.
Source
Indian Heart Journal. 69 (2) (pp 211-216), 2017. Date of Publication:
March 2017.
Publisher
Elsevier B.V.
Abstract
Background Coronary artery disease (CAD) occurs at younger age in India
but only a limited number of studies have evaluated risk factors and
management status. This is a multisite observational registry to assess
risk factors and treatment patterns in young patients presenting with
acute coronary syndrome (ACS) and stable ischemic heart disease (IHD).
Methods We recruited 997 young patients (men <55, women <65 y) presenting
with ACS or stable IHD successively at 22 centers across India. Details of
baseline risk factors and management status were obtained. Descriptive
statistics are reported. Results Mean age of participants was 49.1 +/- 8y,
72% were men and 68% had ACS. Family history of CAD was in 50%, diabetes
44%, hypertension 49%, history of dyslipidemia 11%, smoking/tobacco use
39%, and sedentary habits in 20%. 1.3% had "possible familial
hypercholesterolemia". Metabolic risk factors (high BMI, diabetes and
hypertension) were significantly greater in women (p < 0.01). Women were
older at diagnosis of CAD and presented more often with non-ST elevation
ACS. In the study cohort antiplatelet use was in 85%, beta-blockers 38%,
statins 63% and ACE inhibitors/ARBs in 41% while in ACS patients it was
80.5%, 54.6%, 80.8% and 40.8%, respectively. 35.9% patients underwent
percutaneous coronary intervention while coronary bypass surgery was
performed in 10.4%. Conclusions Conventional risk factors including family
history continue to play a pivotal role in premature CAD in Indians. Women
have more of metabolic risk factors, present at a later age and have
non-ST elevation ACS more often. There is a need to focus on improving use
of evidence-based drug therapies and interventions.
Copyright © 2016

<109>
[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 © 2017 the Author(s). Published by Wolters Kluwer Health,
Inc.

<110>
Accession Number
613768398
Author
Erden I.; Golcuk E.; Bozyel S.; Erden E.C.; Balaban Y.; Yalin K.; Turan B.
Institution
(Erden, Erden, Balaban) Department of Cardiology, VM Medicalpark Kocaeli
Hospital, Kocaeli, Turkey
(Golcuk, Bozyel, Turan) Department of Cardiology, Kocaeli Derince Training
and Research Hospital, Kocaeli, Turkey
(Yalin) Department of Cardiology, Bayrampasa Kolan Hospital, Istanbul,
Turkey
Title
Effectiveness of Handmade "Jacky-Like Catheter" As a Single Multipurpose
Catheter in Transradial Coronary Angiography: A Randomized Comparison With
Conventional Two-Catheter Strategy.
Source
Journal of Interventional Cardiology. 30 (1) (pp 24-32), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: To investigate safety and efficacy of specialized hand-modified
"Jacky-Like" catheter (JLC) as a single dual-purpose catheter in
transradial coronary angiography. Methods: Patients over 18 years
undergoing diagnostic CAG through right radial artery (RRA) were
prospectively enrolled. Procedures were performed with a single JLC
modified from a left Judkins (JL) 3.5 catheter or by using 2-catheter
approach (2C). Procedures with coronary artery bypass grafts or
ventricular angiographies were excluded from the study. Three hundred and
eighty-seven transradial procedures were performed successfully. One
hundred and ninety-four procedures were performed with 2C and 193
procedures with a JLC. Inability to use intended catheters, total
fluoroscopic time in minutes, the consumption of contrast medium in
milliliter, development of radial artery spasm (RAS), and radial artery
occlusion (RAO) were evaluated. Results: In the 2C group, angiography was
successfully performed on the RCA of 191 patients (98.9%) and on LCA in
192 patients (99.4%). In the JLC group, angiography was successfully
performed on the RCA and LCA of 193 (99.4%) and 174 (89.6%) patients,
respectively. Utilization of supplemental catheters was significantly
greater in the JLC group (21; 10.8%) versus the 2C group (3; 1.5% P =
0.001). Mean fluoroscopy time was shorter in the JLC group (2.0 +/- 2.3
min vs. 2.3 +/- 1.5 min; P = 0.043). Mean procedure time was also
decreased with JLC but did not reach statistical significance (5.7 +/- 3.1
min vs. 6.2 +/- 2.5 min; P = 0.081). When additional time for reshaping
the JLC was not taken into account, mean procedure time was significantly
decreased in the JLC group (5.6 +/- 2.9 min vs. 6.2 +/- 2.4 min; P =
0.031). There was a trend toward lower incidence of consumption of
contrast medium in the 2C group (49 +/- 13 mL vs. 52 +/- 18 mL; P =
0.061). RAS was observed more frequently in the 2C group (11.3% vs. 21.7%,
P = 0.005). There was a trend toward high incidence of RAO in the 2C group
(4.1 vs. 8.3% P = 0.064). Conclusion: In transradial procedures from RRA,
a JLC catheter can be very effective when dedicated dual-purpose catheter
is not available.
Copyright © 2016, Wiley Periodicals, Inc.

<111>
Accession Number
615121613
Author
Smits P.C.; Abdel-Wahab M.; Neumann F.-J.; Boxma-De Klerk B.M.; Lunde K.;
Schotborgh C.E.; Piroth Z.; Horak D.; Wlodarczak A.; Ong P.J.; Hambrecht
R.; Angeras O.; Richardt G.; Omerovic E.
Institution
(Smits, Boxma-De Klerk) Department of Cardiology, Maasstad Hospital,
Maasstadweg 21, Rotterdam 3079 DZ, Netherlands
(Schotborgh) Department of Cardiology, Haga Ziekenhuis, The Hague,
Netherlands
(Abdel-Wahab, Richardt) Department of Cardiology, Heart Center, Segeberger
Kliniken, Bad Segeberg, Germany
(Neumann) Department of Cardiology, University Heart Center Freiburg-Bad
Krozingen, Bad Krozingen, Germany
(Hambrecht) Department of Cardiology, Klinikum Links der Weser, Bremen,
Germany
(Lunde) Department of Cardiology, Rigshospitalet, University of Oslo,
Oslo, Norway
(Piroth) Department of Cardiology, Gyorgy Hungarian Institute of
Cardiology, Budapest, Hungary
(Horak) Department of Cardiology, Liberec Regional Hospital, Liberec,
Czech Republic
(Wlodarczak) Department of Cardiology, Miedziowe Centrum Zdrowia, Lubin,
Poland
(Ong) Department of Cardiology, Tan Tock Seng Hospital, Singapore
(Angeras, Omerovic) Department of Cardiology, Gothenburg University
Hospital, Gothenburg, Sweden
Title
Fractional flow reserve-guided multivessel angioplasty in myocardial
infarction.
Source
New England Journal of Medicine. 376 (13) (pp 1234-1244), 2017. Date of
Publication: 30 Mar 2017.
Publisher
Massachussetts Medical Society
Abstract
Background: In patients with ST-segment elevation myocardial infarction
(STEMI), the use of percutaneous coronary intervention (PCI) to restore
blood flow in an infarct-related coronary artery improves outcomes. The
use of PCI in non-infarct-related coronary arteries remains controversial.
Methods: We randomly assigned 885 patients with STEMI and multivessel
disease who had undergone primary PCI of an infarct-related coronary
artery in a 1:2 ratio to undergo complete revascularization of
non-infarct-related coronary arteries guided by fractional flow reserve
(FFR) (295 patients) or to undergo no revascularization of
non-infarct-related coronary arteries (590 patients). The FFR procedure
was performed in both groups, but in the latter group, both the patients
and their cardiologist were unaware of the findings on FFR. The primary
end point was a composite of death from any cause, nonfatal myocardial
infarction, revascularization, and cerebrovascular events at 12 months.
Clinically indicated elective revascularizations performed within 45 days
after primary PCI were not counted as events in the group receiving PCI
for an infarct-related coronary artery only. Results: The primary outcome
occurred in 23 patients in the complete-revascularization group and in 121
patients in the infarct-artery-only group that did not receive complete
revascularization, a finding that translates to 8 and 21 events per 100
patients, respectively (hazard ratio, 0.35; 95% confidence interval [CI],
0.22 to 0.55; P<0.001). Death occurred in 4 patients in the
complete-revascularization group and in 10 patients in the
infarct-artery-only group (1.4% vs. 1.7%) (hazard ratio, 0.80; 95% CI,
0.25 to 2.56), myocardial infarction in 7 and 28 patients, respectively
(2.4% vs. 4.7%) (hazard ratio, 0.50; 95% CI, 0.22 to 1.13),
revascularization in 18 and 103 patients (6.1% vs. 17.5%) (hazard ratio,
0.32; 95% CI, 0.20 to 0.54), and cerebrovascular events in 0 and 4
patients (0 vs. 0.7%). An FFR-related serious adverse event occurred in 2
patients (both in the group receiving infarct-related treatment only).
Conclusions: In patients with STEMI and multivessel disease who underwent
primary PCI of an infarct-related artery, the addition of FFR-guided
complete revascularization of non-infarct-related arteries in the acute
setting resulted in a risk of a composite cardiovascular outcome that was
lower than the risk among those who were treated for the infarct-related
artery only. This finding was mainly supported by a reduction in
subsequent revascularizations.
© Copyright 2017 Massachusetts Medical Society.

<112>
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 © 2017 American Heart Association, Inc.

<113>
Accession Number
615123560
Author
Sian K.; Li S.; Selvakumar D.; Mejia R.
Institution
(Sian, Li, Mejia) Department of Cardiothoracic Surgery, John Hunter
Hospital, New Lambton Heights, NSW, Australia
(Selvakumar) Faculty of Health and Medicine, University of Newcastle,
Newcastle, NSW, Australia
Title
Early results of the Sorin Perceval S sutureless valve: Systematic review
and meta-analysis.
Source
Journal of Thoracic Disease. 9 (3) (pp 711-724), 2017. Date of
Publication: 01 Mar 2017.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Minimally invasive aortic valve replacement (MAVR) has
demonstrated a benefit with respect to increased patient satisfaction due
to minimised pain and earlier recovery. Sutureless valves may benefit MAVR
and conventional aortic valve replacement (AVR) by reducing operative
times and blood transfusion requirements. The Perceval valve (Sorin,
Salluggia, Italy) is a self-expanding prosthesis made from bovine
pericardium mounted in a nitinol stent, designed to simplify the
implantation of an aortic valve. This metaanalysis evaluates the clinical,
haemodynamic, and survival outcomes of the Perceval sutureless valve.
Methods: An electronic search of 4 databases was performed from January
2000 to December 2016. Primary outcomes included mortality and stroke.
Secondary outcomes included minimally invasive access, paravalvular leak,
overall long-term survival, postoperative echocardiographic findings, and
functional class improvement. Results: After the application of inclusion
and exclusion criteria, 14 of 66 relevant articles were selected for
assessment. Of these 14 studies, a total number of 2,505 patients were
included. The current evidence on the Perceval valve for aortic valve
disease is limited to observational studies only. Minimally invasive
surgery was performed in 976 patients, of which 336 were via the right
anterior thoracotomy approach. The Perceval M and L sutureless valves were
the most frequently used, 782 and 770 respectively. The incidence of major
adverse events included 30-day mortality (0 to 4.9%), cerebrovascular
accident (0 to 3%), permanent pacemaker insertion (0 to 17%), moderate to
severe paravalvular leak (0 to 8.6%), and re-operation (0 to 4.8%).
Post-operative mean aortic valve gradient ranged from 9 to 15.9 mmHg and
post-operative New York Heart Association (NYHA) Class I or II ranged from
82% to 96%. The 1-year survival ranged from 86% to 100%; and 5-year
survival was 71.3% to 85.5% in two studies. Conclusions: The Perceval
valve is associated with excellent post-operative results in MAVR and in
conventional AVR. Larger randomised controlled studies are required to
evaluate the long-term efficacy of the prosthesis.

<114>
Accession Number
615731043
Author
Kuck K.-H.; Tilz R.R.; Deneke T.; Hoffmann B.A.; Ventura R.; Hansen P.S.;
Zarse M.; Hohnloser S.H.; Kautzner J.; Willems S.
Institution
(Kuck, Tilz) Department of Cardiology, Asklepios Klinik St. Georg,
Lohmuhlenstr. 5, Hamburg 20099, Germany
(Deneke) University Heart Center, University Hospital Bergmannsheil,
Bochum, Germany
(Hoffmann, Ventura, Willems) University Heart Center, Department of
Cardiology - Electrophysiology, Hamburg, Germany
(Hansen) Department of Cardiology, Aarhus University Hospital, Denmark
(Zarse) University of Witten-Herdecke, Germany
(Hohnloser) University Hospital Frankfurt, Germany
(Kautzner) Institute for Clinical and Experimental Medicine, Prague, Czech
Republic
(Tilz) Medical Clinic II, University Heart Center Lubeck, Germany
(Deneke) Klinik fur Kardiologie II, Herz- und Gefasklinik GmbH, Bad
Neustadt/Saale, Germany
(Hansen) Heart Center Varde, Denmark
Title
Impact of substrate modification by catheter ablation on implantable
cardioverter-defibrillator interventions in patients with unstable
ventricular arrhythmias and coronary artery disease: Results from the
multicenter randomized controlled SMS (Substrate Modification Study).
Source
Circulation: Arrhythmia and Electrophysiology. 10 (3) (no pagination),
2017. Article Number: e004422. Date of Publication: 01 Mar 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - The implantable cardioverter-defibrillator (ICD) is the
standard therapy to prevent sudden cardiac death in patients with coronary
artery disease and unstable ventricular tachyarrhythmias. The prospective
multinational SMS (Substrate Modification Study) was designed to assess
whether prophylactic ablation of the arrhythmogenic substrate reduces or
prevents the recurrence of ventricular tachycardia/ventricular
fibrillation in such patients. Methods and Results - Of 111 patients
included in an intention-to-treat analysis, 54 were randomly assigned
catheter ablation plus ICD implantation (ablation group: 68+/-8 years; 47
men), whereas 57 were assigned ICD implantation without catheter ablation
(ICD-only group: 66+/-8 years; 46 men). Primary study end point was the
time to first recurrence of ventricular tachycardia/ventricular
fibrillation. ICD episodes were assessed and verified by an independent
board. Patients were followed up for 2.3+/-1.1 years. The primary end
point was reached by 25 ablation patients and 26 ICD-only patients.
Two-year event-free survival was estimated at 49.0% (95% confidence
interval, 33.3%-62.9%) in the former and 52.4% (36.7%-65.9%) in the latter
groups. Comparison of episode incidence revealed no significant difference
in the primary end point (P=0.84). In an Andersen-Gill regression model
with multiple end point recurrences, the difference between the study arms
significantly favored catheter ablation for both the primary end point and
all but one of the predefined subgroups of detected arrhythmia events.
Conclusions - SMS failed to meet the primary end point of time to first
ventricular tachycardia/ventricular fibrillation recurrence. However,
catheter ablation did reduce the total number of ICD interventions during
the duration of follow-up. Clinical Trial Registration -
https://clinicaltrials.gov. Unique identifier: NCT00170287.
Copyright © 2017 American Heart Association, Inc.

<115>
Accession Number
614405558
Author
Larsen P.D.; Holley A.S.; Sasse A.; Al-Sinan A.; Fairley S.; Harding S.A.
Institution
(Larsen, Holley) University of Otago, Wellington, New Zealand
(Larsen, Holley, Sasse, Fairley, Harding) Wellington Cardiovascular
Research Group, New Zealand
(Sasse, Al-Sinan, Fairley, Harding) Department of Cardiology, Wellington
Hospital, New Zealand
Title
Comparison of Multiplate and VerifyNow platelet function tests in
predicting clinical outcome in patients with acute coronary syndromes.
Source
Thrombosis Research. 152 (pp 14-19), 2017. Date of Publication: 01 Apr
2017.
Publisher
Elsevier Ltd
Abstract
Introduction This study examined the ability of two widely used "point of
care" platelet function assays, VerifyNow and Multiplate, to predict
adverse outcomes in patients with acute coronary syndromes (ACS). Methods
We examined platelet reactivity using VerifyNow and Multiplate
P2Y<inf>12</inf> assays in patients with ACS and the relationship between
platelet reactivity and both MACE (defined as a composite of death,
myocardial infarction, stroke, stent thrombosis and unplanned
revascularisation) and TIMI major bleeding at 1 year. Results In 619 ACS
patients, 65 patients (10.5%) had experienced MACE at 1 year and 6
patients (1%) had TIMI major bleeding events. The two measures of platelet
reactivity were only moderately correlated (Rho = 0.43, p = 0.0001). Both
measures demonstrated a statistically significant relationship with MACE,
with area under the curve for VerifyNow of 0.632 (0.001) and for
Multiplate of 0.577 (p = 0.04), and neither measure showed a significant
relationship with bleeding. Logistic regression analysis found that only
VerifyNow was a statistical predictor of MACE (p = 0.01). MACE occurred in
16% of those classified as having HPR using VerifyNow compared to 7% in
those without HPR (odds ratio of 2.6 (95% CI 1.5-4.4, p = 0.001). In those
classified as having HPR by the Multiplate assay, MACE occurred in 13%
compared to 9% of those without HPR (Odds ratio 1.5 95% CI 0.9-2.5, p =
0.11). Conclusion The two points of care platelet function tests examined
in this study were only moderately correlated. The VerifyNow assay
demonstrated a stronger relationship to MACE than the Multiplate assay.
Copyright © 2017 Elsevier Ltd

<116>
Accession Number
613939231
Author
Wang Y.; Shi X.; Du R.; Chen Y.; Zhang Q.
Institution
(Wang, Shi, Du, Chen, Zhang) Department of Cardiology, West China
Hospital, Sichuan University, 37 Guoxue Street, Chengdu, Sichuan 610041,
China
Title
Off-pump versus on-pump coronary artery bypass grafting in patients with
diabetes: a meta-analysis.
Source
Acta Diabetologica. 54 (3) (pp 283-292), 2017. Date of Publication: 01 Mar
2017.
Publisher
Springer-Verlag Italia s.r.l. (E-mail: springer@springer.it)
Abstract
Aims: The effects of off-pump CABG (OFF-CABG) versus on-pump CABG
(ON-CABG) in diabetic patients remain controversial. The aim of our study
was to compare mortality and postoperative morbidity between OFF-CABG and
ON-CABG for diabetic patients. Methods: Electronic databases including
PubMed, EMBASE and Cochrane Library for studies investigating clinical
outcomes of OFF-CABG versus ON-CABG in diabetic patients were searched,
collecting data from inception until June 2016. We pooled the odds ratios
from individual studies and performed heterogeneity, quality assessment
and publication bias analysis. Results: A total of 543,220 diabetic
patients in 10 studies were included. The overall mortality (OR, 0.87; 95%
CI, 0.58-1.31; p = 0.50) was comparable between the OFF-CABG and ON-CABG.
OFF-CABG was associated with significantly fewer cerebrovascular accidents
(OR, 0.45; 95% CI, 0.31-0.65; p < 0.0001), bleeding complications (OR,
0.59; 95% CI, 0.43-0.80; p < 0.001) and pulmonary complications. However,
no differences in myocardial infarction (OR, 0.76; 95% CI, 0.52-1.12; p =
0.16), renal failure (OR, 0.74; 95% CI, 0.50-1.11; p = 0.14) and other
postoperative morbidity outcomes were found. Conclusions: OFF-CABG
significantly reduces the incidence of postoperative cerebrovascular
accidents and bleeding complications compared with ON-CABG in diabetic
patients. No differences were found regarding mortality, myocardial
infarction and renal failure between these two techniques. Our study
suggests that OFF-CABG may be an optimal strategy for diabetic patients
although adequately powered randomized trials are needed to further verify
the finding.
Copyright © 2016, Springer-Verlag Italia.

<117>
Accession Number
615147071
Author
Layland J.; Rauhalammi S.; Lee M.M.Y.; Ahmed N.; Carberry J.; May V.T.Y.;
Watkins S.; McComb C.; Mangion K.; McClure J.D.; Carrick D.; O'Donnell A.;
Sood A.; McEntegart M.; Oldroyd K.G.; Radjenovic A.; Berry C.
Institution
(Layland, Lee, Ahmed, Watkins, Mangion, Carrick, O'Donnell, McEntegart,
Oldroyd, Berry) West of Scotland Heart and Lung Centre, Golden Jubilee
National Hospital, Glasgow, United Kingdom
(Layland, Rauhalammi, Lee, Ahmed, Carberry, May, McComb, Mangion, McClure,
Carrick, Radjenovic, Berry) BHF Glasgow Cardiovascular Research Centre,
Institute of Cardiovascular and Medical Sciences, University of Glasgow,
United Kingdom
(Sood) Hairmyres Hospital, East Kilbride, United Kingdom
Title
Diagnostic accuracy of 3.0-T magnetic resonance T1 and T2 mapping and
T2-weighted dark-blood imaging for the infarct-related coronary artery in
Non-ST-segment elevation myocardial infarction.
Source
Journal of the American Heart Association. 6 (4) (no pagination), 2017.
Article Number: e004759. Date of Publication: 01 Apr 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--Patients with recent non-ST-segment elevation myocardial
infarction commonly have heterogeneous characteristics that may be
challenging to assess clinically. Methods and Results--We prospectively
studied the diagnostic accuracy of 2 novel (T1, T2 mapping) and 1
established (T2-weighted short tau inversion recovery [T2W-STIR]) magnetic
resonance imaging methods for imaging the ischemic area at risk and
myocardial salvage in 73 patients with non-ST-segment elevation myocardial
infarction (mean age 57+/-10 years, 78% male) at 3.0-T magnetic resonance
imaging within 6.5+/-3.5 days of invasive management. The infarct-related
territory was identified independently using a combination of
angiographic, ECG, and clinical findings. The presence and extent of
infarction was assessed with late gadolinium enhancement imaging
(gadobutrol, 0.1 mmol/kg). The extent of acutely injured myocardium was
independently assessed with native T1, T2, and T2W-STIR methods. The mean
infarct size was 5.9+/-8.0% of left ventricular mass. The infarct zone T1
and T2 times were 1323+/-68 and 575 ms, respectively. The diagnostic
accuracies of T1 and T2 mapping for identification of the infarct-related
artery were similar (P=0.125), and both were superior to T2W-STIR (P <
0.001). The extent of myocardial injury (percentage of left ventricular
volume) estimated with T1 (15.8+/-10.6%) and T2 maps (16.0+/-11.8%) was
similar (P=0.838) and moderately well correlated (r=0.82, P < 0.001). Mean
extent of acute injury estimated with T2W-STIR (7.8+/-11.6%) was lower
than that estimated with T1 (P < 0.001) or T2 maps (P < 0.001).
Conclusions--In patients with non-ST-segment elevation myocardial
infarction, T1 and T2 magnetic resonance imaging mapping have higher
diagnostic performance than T2W-STIR for identifying the infarct-related
artery. Compared with conventional STIR, T1 and T2 maps have superior
value to inform diagnosis and revascularization planning in non-ST-segment
elevation myocardial infarction.
Copyright © 2017 The Authors.

<118>
Accession Number
614159417
Author
Stanger O.; Gahl B.; Grabherr M.; Krausler R.; Longnus S.; Meinitzer A.;
Cadamuro J.
Institution
(Stanger) Surgical Department, Saint John of God Hospital, Kajetanerplatz
1, Salzburg 5010, Austria
(Gahl, Grabherr, Longnus) Inselspital University Hospital and University
of Berne, Berne, Switzerland
(Krausler) University Department of Cardiac Surgery, Salzburg Paracelsus
Medical University, Salzburg, Austria
(Meinitzer) Department of Laboratory Medicine, Graz Auenbrugger University
Hospital, Austria
(Cadamuro) Department of Laboratory Medicine, Paracelsus Medical
University, Salzburg, Austria
Title
Freedom SOLO-Associated Thrombocytopaenia is Valve-Dependent and Not Due
to In Vitro Pseudothrombocytopaenia.
Source
Heart Lung and Circulation. 26 (3) (pp 268-275), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Ltd
Abstract
Background Use of the Freedom SOLO (FS) stentless aortic bioprosthesis is
limited by a unique and as yet unexplained severe decrease in
postoperative platelet count in the absence of FS-related excess bleeding
or thromboembolism. We investigated whether anticoagulant-associated
pseudothrombocytopaenia could explain this complication. Methods Thirty
consecutive patients (mean age 75.4+/-7.7 years, 11 [36.7%] female)
underwent elective aortic valve replacement (AVR) with either the stented
bovine Mitroflow (MF, n=18) or the stentless bovine FS (n=12) aortic valve
bioprostheses. Serial platelet counts were performed simultaneously with
sampling tubes containing tripotassium (K<inf>3</inf>-)-EDTA, trisodium
(Na<inf>3</inf>)-citrate, or novel alternative magnesium sulfate
(MgSO<inf>4</inf>, ThromboExactTM)-based anticoagulant, respectively.
Results Postoperative platelet counts decreased compared with preoperative
values in all patients (p<0.001), but were significantly lower in patients
receiving FS compared to MF at all measurement time points until the end
of observation (day 9). Lowest platelet counts were seen on the first
postoperative day for MF (mean reduction: -41.5%) and on the second
postoperative day for FS (mean reduction: -59.9%). Postoperative platelet
counts did not correlate with any of the anticoagulants, thereby
indicating no pseudothrombocytopaenia in the study population. There was
no interaction between anticoagulant and type of valve. Only 1% of
variance in platelet counts was caused by the anticoagulant, 46% by the
day of measurement relative to baseline, and 20% was caused by the type of
valve. Conclusions The platelet-lowering effect in patients receiving the
FS is valve-dependent and is not caused by systemic preanalytical
(laboratory) measurement error such as anticoagulant-dependent
pseudothrombocytaemia, particularly with EDTA and citrate.
Copyright © 2016 Australian and New Zealand Society of Cardiac and
Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New
Zealand (CSANZ)

<119>
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 © 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.

<120>
Accession Number
615250033
Author
Reardon M.J.; Van Mieghem N.M.; Popma J.J.; Kleiman N.S.; Sondergaard L.;
Mumtaz M.; Adams D.H.; Deeb G.M.; Maini B.; Gada H.; Chetcuti S.; Gleason
T.; Heiser J.; Lange R.; Merhi W.; Oh J.K.; Olsen P.S.; Piazza N.;
Williams M.; Windecker S.; Yakubov S.J.; Grube E.; Makkar R.; Lee J.S.;
Conte J.; Vang E.; Nguyen H.; Chang Y.; Mugglin A.S.; Serruys P.W.J.C.;
Kappetein A.P.
Institution
(Reardon, Kleiman) Methodist DeBakey Heart and Vascular Center, 6550
Fannin St., Houston, TX 77030, United States
(Van Mieghem, Serruys, Kappetein) Erasmus University Medical Center,
Rotterdam, Netherlands
(Popma) Beth Israel Deaconess Medical Center, Boston, PA, United States
(Sondergaard, Olsen) Rigshospitalet Heart Center, Copenhagen, PA, Denmark
(Mumtaz, Gada) PinnacleHealth Hospitals, Harrisburg, PA, United States
(Gleason, Lee) University of Pittsburgh Medical Center, Pittsburgh, PA,
United States
(Adams, Williams) Mount Sinai Health System, United States
(Deeb) New York University Langone Medical Center, New York, MI, United
States
(Chetcuti) University of Michigan, Ann Arbor, MI, United States
(Heiser, Merhi) Spectrum Health Hospitals, Grand Rapids, MI, United States
(Maini) Tenet Healthcare, Delray Beach, FL, United States
(Lange) German Heart Center Munich, Munich, Germany
(Grube) Siegburg Heart Center, Siegburg, Germany
(Oh) Mayo Clinic, Rochester, United States
(Vang, Nguyen, Chang) Medtronic, Minneapolis, United States
(Mugglin) Paradigm Biostatistics, Anoka, MN, United States
(Piazza) McGill University Medical Centre, Montreal, Canada
(Windecker) University Hospital Bern, Bern, Switzerland
(Yakubov) Riverside Methodist Hospital, Columbus, OH, United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, United States
(Conte) Johns Hopkins University, Baltimore, United States
Title
Surgical or transcatheter aortic-valve replacement in intermediate-risk
patients.
Source
New England Journal of Medicine. 376 (14) (pp 1321-1331), 2017. Date of
Publication: 06 Apr 2017.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Although transcatheter aortic-valve replacement (TAVR) is an
accepted alternative to surgery in patients with severe aortic stenosis
who are at high surgical risk, less is known about comparative outcomes
among patients with aortic stenosis who are at intermediate surgical risk.
METHODS We evaluated the clinical outcomes in intermediate-risk patients
with severe, symptomatic aortic stenosis in a randomized trial comparing
TAVR (performed with the use of a self-expanding prosthesis) with surgical
aortic-valve replacement. The primary end point was a composite of death
from any cause or disabling stroke at 24 months in patients undergoing
attempted aortic-valve replacement. We used Bayesian analytical methods
(with a margin of 0.07) to evaluate the noninferiority of TAVR as compared
with surgical valve replacement. RESULTS A total of 1746 patients
underwent randomization at 87 centers. Of these patients, 1660 underwent
an attempted TAVR or surgical procedure. The mean (?}SD) age of the
patients was 79.8?}6.2 years, and all were at intermediate risk for
surgery (Society of Thoracic Surgeons Predicted Risk of Mortality,
4.5?}1.6%). At 24 months, the estimated incidence of the primary end point
was 12.6% in the TAVR group and 14.0% in the surgery group (95% credible
interval [Bayesian analysis] for difference, -5.2 to 2.3%; posterior
probability of noninferiority, >0.999). Surgery was associated with higher
rates of acute kidney injury, atrial fibrillation, and transfusion
requirements, whereas TAVR had higher rates of residual aortic
regurgitation and need for pacemaker implantation. TAVR resulted in lower
mean gradients and larger aortic-valve areas than surgery. Structural
valve deterioration at 24 months did not occur in either group.
CONCLUSIONS TAVR was a noninferior alternative to surgery in patients with
severe aortic stenosis at intermediate surgical risk, with a different
pattern of adverse events associated with each procedure. (Funded by
Medtronic; SURTAVI ClinicalTrials.gov number, NCT01586910.).

<121>
Accession Number
613216203
Author
Burrage M.; Moore P.; Cole C.; Cox S.; Lo W.C.; Rafter A.; Garlick B.;
Garrahy P.; Mundy J.; Camuglia A.
Institution
(Burrage, Moore, Cole, Cox, Lo, Garrahy, Mundy, Camuglia) Department of
Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
(Burrage, Moore, Cole, Cox, Lo, Rafter, Garlick, Garrahy, Mundy, Camuglia)
University of Queensland, Brisbane, QLD, Australia
(Cox, Rafter, Garlick, Camuglia) The Wesley Hospital, Brisbane, QLD,
Australia
Title
Transcatheter Aortic Valve Replacement is Associated with Comparable
Clinical Outcomes to Open Aortic Valve Surgery but with a Reduced Length
of In-Patient Hospital Stay: A Systematic Review and Meta-Analysis of
Randomised Trials.
Source
Heart Lung and Circulation. 26 (3) (pp 285-295), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Ltd
Abstract
Background Aortic valve replacement is indicated in patients with severe
symptomatic aortic stenosis (AS). Transcatheter aortic valve replacement
(TAVR) has evolved as a potential strategy in a growing proportion of
patients in preference to surgical aortic valve replacement (SAVR). This
meta-analysis aims to assess the differential outcomes of TAVR and SAVR in
patients enrolled in published randomised controlled trials (RCTs).
Methods A systematic literature search of Cochrane Library, EMBASE, OVID,
and PubMed MEDLINE was performed. Randomised controlled trials of patients
with severe AS undergoing TAVR compared with SAVR were included. Clinical
outcomes and procedural complications were assessed. Results Five RCTs
with a total of 3,828 patients (1,928 TAVR and 1,900 SAVR) were analysed.
There was no statistically significant difference in combined rates of
all-cause mortality and stroke at 30-days for TAVR vs SAVR (6.3% vs 7.5%;
OR 0.83; 95% CI: 0.64-1.08; P = 0.17) or at 12 months (17.2% vs 19.2%; OR
0.87; 95% CI: 0.73-1.03; P = 0.29). No statistically significant
difference was seen for death or stroke separately at any time point
although a numerical trend in favour of TAVR for both was recorded. Length
of in-patient stay was significantly less with TAVR vs SAVR (9.6 +/- 7.7
days vs 12.2 +/- 8.8 days; OR -2.94; 95% CI: -4.64 to -1.24; P = 0.0007).
Major vascular complications were more frequent in patients undergoing
TAVR vs SAVR (8.2% vs. 4.0%; OR 2.15; 95% CI: 1.62-2.86; P <0.00001) but
major bleeding was more common among SAVR patients (20.5% vs 44.2%; OR
0.34; 95% CI: 0.22-0.52; P = <0.00001). Conclusions Transcatheter aortic
valve replacement and SAVR are associated with overall similar rates of
death and stroke among patients in intermediate to high-risk cohorts but
with reduced length of in-patient hospital stay.
Copyright © 2016

<122>
Accession Number
605717101
Author
Mouton R.; Pollock J.; Soar J.; Mitchell D.C.; Rogers C.A.
Institution
(Mouton, Soar) Southmead Hospital, Department Anaesthesia, Bristol BS10
5NB, United Kingdom
(Pollock) University of the West of England, Faculty of Health and Life
Sciences, Glenside Campus, Blackberry Hill, Bristol BS16 1DD, United
Kingdom
(Mitchell) Southmead Hospital, Department Vascular Surgery, Bristol BS10
5NB, United Kingdom
(Rogers) University of Bristol, Clinical Trials and Evaluation Unit,
School of Clinical Sciences, Level 7, Bristol Royal Infirmary, Bristol BS2
8HW, United Kingdom
Title
Remote ischaemic preconditioning versus sham procedure for abdominal
aortic aneurysm repair: An external feasibility randomized controlled
trial.
Source
Trials. 16 (1) (no pagination), 2015. Article Number: 377. Date of
Publication: August 25, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Despite advances in perioperative care, elective abdominal
aorta aneurysm (AAA) repair carries significant morbidity and mortality.
Remote ischaemic preconditioning (RIC) is a physiological phenomenon
whereby a brief episode of ischaemia-reperfusion protects against a
subsequent longer ischaemic insult. Trials in cardiovascular surgery have
shown that RIC can protect patients' organs during surgery. The aim of
this study was to investigate whether RIC could be successfully introduced
in elective AAA repair and to obtain the information needed to design a
multi-centre RCT. Methods: Consecutive patients presenting for elective
AAA repair, using an endovascular (EVAR) or open procedure, in a single
large city hospital in the UK were assessed for trial eligibility.
Patients who consented to participate were randomized to receive RIC
(three cycles of 5 min ischaemia followed by 5 min reperfusion in the
upper arm immediately before surgery) or a sham procedure. Patients were
followed up for 6 months. We assessed eligibility and consent rates, the
logistics of RIC implementation, randomization, blinding, data capture,
patient and staff opinion, and variability and frequency of clinical
outcome measures. Results: Between January 2010 and December 2012, 98
patients were referred for AAA repair, 93 were screened, 85 (91 %) were
eligible, 70 were approached for participation and 69 consented to
participate; 34 were randomized to RIC and 35 to the sham procedure. There
was a greater than expected variation in the complexity of EVAR that
impacted the outcomes. Acute kidney injury occurred in 28 (AKIN 1: 23 %;
AKIN 2: 15 % and AKIN 3: 3 %) and 7 (10 %) had a perioperative myocardial
infarction. Blinding was successful, and interviews with participants and
staff indicated that the procedure was acceptable. There were no adverse
events secondary to the intervention in the 6 months following the
intervention. Conclusions: This study provided essential information for
the planning and design of a multi-centre RCT to assess effectiveness of
RIC for improving clinical outcomes in elective AAA repair. Patient
consent was high, and the RIC intervention was carried out with minimal
disruption to clinical care. The allocation scheme for a definite trial
should take into account both the surgical procedure and its complexity to
avoid confounding the effect of the RIC, as was observed in this study.
Trial registration: Current Controlled Trials ISRCTN19332276(date of
registration: 16 March 2012). The trial protocol is available from the
corresponding author.
Copyright © 2015 Mouton et al.

<123>
Accession Number
606624474
Author
Liu X.; Qu X.; Zheng J.; Zhang L.
Institution
(Liu, Zheng, Zhang) College of Stomatology, Shanghai Jiao Tong University,
School of Medicine, Shanghai, China
(Qu) Shanghai Key Laboratory of Orthopedic Implant, Shanghai Ninth
People's Hospital, Shanghai Jiao Tong University, School of Medicine,
Shanghai, China
(Zheng) Department of Oral and Maxillofacial Surgery, Shanghai Ninth
People's Hospital, Shanghai Jiao Tong University, School of Medicine,
Shanghai, China
Title
Effectiveness and safety of oral propranolol versus other treatments for
infantile hemangiomas: A meta-analysis.
Source
PLoS ONE. 10 (9) (no pagination), 2015. Article Number: e0138100. Date of
Publication: 16 Sep 2015.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: Epidemiological studies evaluating treatments for infantile
hemangiomas have produced inconsistent results. A meta-analysis of
published data was conducted to investigate the effectiveness and safety
of oral propranolol versus other treatments for infantile hemangiomas.
Methods: A meta-analysis was conducted based on literature (published from
1960 to December 1, 2014) found on the PubMed, EMBASE, and OVID search
engines. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were
estimated for the outcome measures. Heterogeneity, publication bias and
subgroup analysis were performed. Results: A total of 61 studies involving
5,130 participants met the inclusion criteria. Propranolol was found to be
a more effective modality in treating IHs (ORs = 0.92; 95%CI, 0.89-0.95)
and had fewer complications compared to the other treatments including
systemic steroids (ORs = 0.68; 95% CI, 0.59-0.76); laser ablation (ORs =
0.55; 95% CI, 0.43-0.67); other beta-adrenergic blockers (ORs = 0.56; 95%
CI, 0.50-0.61) and surgery (ORs = 0.55; 95% CI, 0.28-0.81). A subgroup
analysis of propranolol showed that a dose of 2 mg/kg/day or more yielded
better outcomes (ORs = 0.92; 95% CI, 0.88-0.95; ORs = 0.95; 95% CI,
0.89-1.00), and IHs that had not been previously treated had better
responses to propranolol treatment (ORs = 0.95; 95% CI, 0.91-0.98).
Conclusions: The meta-analysis demonstrated that propranolol was more
effective and safer than other therapies in treating IHs. It provides
strong evidence for supporting the use of propranolol as a first-line
therapy for IHs.
Copyright © 2015 Liu et al.

<124>
Accession Number
606057400
Author
Zangrillo A.; Musu M.; Greco T.; Di Prima A.L.; Matteazzi A.; Testa V.;
Nardelli P.; Febres D.; Monaco F.; Calabro M.G.; Ma J.; Finco G.; Landoni
G.
Institution
(Zangrillo, Di Prima, Matteazzi, Testa, Nardelli, Febres, Monaco, Calabro,
Landoni) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Zangrillo, Greco, Landoni) Vita-Salute San Raffaele University, Milan,
Italy
(Musu, Finco) Department of Medical Sciences M. Aresu, Cagliari
University, Cagliari, Italy
(Ma) Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
Title
Additive effect on survival of anaesthetic cardiac protection and remote
ischemic preconditioning in cardiac surgery: A Bayesian network
meta-analysis of randomized trials.
Source
PLoS ONE. 10 (7) (no pagination), 2015. Article Number: e0134264. Date of
Publication: 31 Jul 2015.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Introduction: Cardioprotective properties of volatile agents and of remote
ischemic preconditioning have survival effects in patients undergoing
cardiac surgery. We performed a Bayesian network meta-analysis to confirm
the beneficial effects of these strategies on survival in cardiac surgery,
to evaluate which is the best strategy and if these strategies have
additive or competitive effects. Methods: Pertinent studies were
independently searched in BioMedCentral, MEDLINE/PubMed, Embase, and the
Cochrane Central Register (updated November 2013). A Bayesian network
meta-analysis was performed. Four groups of patients were compared: total
intravenous anesthesia (with or without remote ischemic preconditioning)
and an anesthesia plan including volatile agents (with or without remote
ischemic preconditioning). Mortality was the main investigated outcome.
Results: We identified 55 randomized trials published between 1991 and
2013 and including 6,921 patients undergoing cardiac surgery. The use of
volatile agents (posterior mean of odds ratio = 0.50, 95% CrI 0.28-0.91)
and the combination of volatile agents with remote preconditioning
(posterior mean of odds ratio = 0.15, 95% CrI 0.04-0.55) were associated
with a reduction in mortality when compared to total intravenous
anesthesia. Posterior distribution of the probability of each treatment to
be the best one, showed that the association of volatile anesthetic and
remote ischemic preconditioning is the best treatment to improve shortand
long-term survival after cardiac surgery, suggesting an additive effect of
these two strategies. Conclusions: In patients undergoing cardiac surgery,
the use of volatile anesthetics and the combination of volatile agents
with remote preconditioning reduce mortality when compared to TIVA and
have additive effects. It is necessary to confirm these results with
large, multicenter, randomized, double-blinded trials comparing these
different strategies in cardiac and non-cardiac surgery, to establish
which volatile agent is more protective than the others and how to best
apply remote ischemic preconditioning.
Copyright © 2015 Zangrillo 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.

<125>
Accession Number
606945941
Author
Zhang Y.; Ma X.-J.; Shi D.-Z.
Institution
(Zhang) Graduate School, Beijing University of Chinese Medicine, Beijing,
China
(Zhang, Ma, Shi) China Heart Institute of Chinese Medicine, China Academy
of Chinese Medical Sciences, Beijing, China
(Zhang, Ma, Shi) Cardiovascular Diseases Center, Xiyuan Hospital, China
Academy of Chinese Medical Sciences, Beijing, China
Title
Effect of trimetazidine in patients undergoing percutaneous coronary
intervention: A meta-analysis.
Source
PLoS ONE. 10 (9) (no pagination), 2015. Article Number: e0137775. Date of
Publication: 14 Sep 2015.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Optimizing the metabolism of the myocardium is a new strategy for patients
with ischemic heart disease. Many studies have reported beneficial effects
of trimetazidine (TMZ) on the clinical prognosis of patients with ischemic
heart disease, but whether these beneficial effects are extended to
patients undergoing percutaneous coronary intervention (PCI) remains
uncertain. A meta-analysis was performed to evaluate the effect of TMZ on
patients undergoing PCI. We conducted an electronic search of PubMed,
Cochrane databases, the China National Knowledge Infrastructure, and
Chinese Biological Medicine Database to identify randomized controlled
trials. Methodological quality was assessed according to the Jadad scale
score, and the meta-analysis was performed using Cochrane Collaboration
RevMan 5.2 and Comprehensive Meta-Analysis. Dichotomous data were analyzed
using relative risk (RR) or odds ratio (OR) with effect size indicated by
the 95% confidence interval (CI), and continuous variables were analyzed
using weighted mean differences (WMD) with effect size indicated by the
95% CI. Sensitivity analysis was performed by changing the statistical
methods and effect model. Nine studies involving a total of 778 patients
were included in this meta-analysis. Additional use of TMZ significantly
improved the left ventricular ejection fraction (WMD: 3.11, 95% CI: [2.26,
3.96]) and reduced elevated cardiac troponin Ic level (RR: 0.69, 95% CI:
[0.48, 0.99]), angina attacks during PCI (OR: 0.16, 95% CI: [0.07, 0.38]),
and ischemic ST-T changes on the echocardiogram during PCI (RR: 0.76, 95%
CI: [0.59, 0.98]). However, no significant difference was observed in
serum BNP level 30 days after PCI between the experimental and control
group. Additional use of TMZ for patients undergoing PCI may reduce
myocardial injury during the procedure and improve cardiac function.
Copyright © 2015 Zhang et al.

<126>
Accession Number
606980382
Author
Rothnie K.J.; Yan R.; Smeeth L.; Quint J.K.
Institution
(Rothnie, Quint) Respiratory Epidemiology, Occupational Medicine and
Public Health, National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Rothnie, Smeeth, Quint) Faculty of Epidemiology and Population Health,
London School of Hygiene and Tropical Medicine, London, United Kingdom
(Yan) Medical School, Faculty of Medical Sciences, University College
London, London, United Kingdom
Title
Risk of myocardial infarction (MI) and death following MI in people with
chronic obstructive pulmonary disease (COPD): A systematic review and
meta-analysis.
Source
BMJ Open. 5 (9) (no pagination), 2015. Article Number: e007824. Date of
Publication: 2015.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives: Cardiovascular disease is an important comorbidity in patients
with chronic obstructive pulmonary disease (COPD). We aimed to
systematically review the evidence for: (1) risk of myocardial infarction
(MI) in people with COPD; (2) risk of MI associated with acute
exacerbation of COPD (AECOPD); (3) risk of death after MI in people with
COPD. Design: Systematic review and meta-analysis. Methods: MEDLINE,
EMBASE and SCI were searched up to January 2015. Two reviewers screened
abstracts and full text records, extracted data and assessed studies for
risk of bias. We used the generic inverse variance method to pool effect
estimates, where possible. Evidence was synthesised in a narrative review
where meta-analysis was not possible. Results: Searches yielded 8362
records, and 24 observational studies were included. Meta-analysis showed
increased risk of MI associated with COPD (HR 1.72, 95% CI 1.22 to 2.42)
for cohort analyses, but not in case-control studies: OR 1.18 (0.80 to
1.76). Both included studies that investigated the risk of MI associated
with AECOPD found an increased risk of MI after AECOPD (incidence rate
ratios, IRR 2.27, 1.10 to 4.70, and IRR 13.04, 1.71 to 99.7).
Meta-analysis showed weak evidence for increased risk of death for
patients with COPD in hospital after MI (OR 1.13, 0.97 to 1.31). However,
meta-analysis showed an increased risk of death after MI for patients with
COPD during follow-up (HR 1.26, 1.13 to 1.40). Conclusions: There is good
evidence that COPD is associated with increased risk of MI; however, it is
unclear to what extent this association is due to smoking status. There is
some evidence that the risk of MI is higher during AECOPD than stable
periods. There is poor evidence that COPD is associated with increased in
hospital mortality after an MI, and good evidence that longer term
mortality is higher for patients with COPD after an MI.

<127>
Accession Number
615847496
Author
Almond C.S.; Hoen H.; Rossano J.W.; Castleberry C.; Auerbach S.R.; Yang
L.; Lal A.K.; Everitt M.D.; Fenton M.; Hollander S.A.; Pahl E.; Pruitt E.;
Rosenthal D.N.; McElhinney D.B.; Daly K.P.; Desai M.
Institution
(Almond, Hollander, Rosenthal, McElhinney) Department of Pediatrics
(Cardiology), Stanford University, Palo Alto, California, USA
(Hoen, Yang, Desai) Department of Medicine - Quantitative Sciences Unit,
Stanford University, Palo Alto, California, USA
(Rossano) Department of Cardiology Children's Hospital of Philadelphia,
Philadelphia, Pennsylvania, USA
(Castleberry) Division of Pediatric Cardiology, St. Louis Children's
Hospital, St. Louis, Missouri, USA
(Auerbach, Everitt) Division of Pediatric Cardiology, The Children's
Hospital Colorado, Aurora, Colorado, USA
(Lal) Division of Pediatric Cardiology, Primary Children's Hospital, Salt
Lake City, Utah, USA
(Fenton) Great Ormond Street Hospital, London, UK
(Pahl) Pediatric Heart Transplant Study Group, University of Alabama at
Birmingham, Birmingham, Alabama, USA
(Pruitt) Department of Cardiology, Lurie Children's Hospital, Chicago,
Illinois, USA
(Daly, Desai) Department of Cardiology, Boston Children's Hospital,
Boston, Massachusetts, USA
Title
Development and validation of a major adverse transplant event (MATE)
score to predict late graft loss in pediatric heart transplantation.
Source
Journal of Heart and Lung Transplantation. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier USA
Abstract
Background: There is inadequate power to perform a valid clinical trial in
pediatric heart transplantation (HT) using a conventional end-point,
because the disease is rare and hard end-points, such as death or graft
loss, are infrequent. We sought to develop and validate a surrogate
end-point involving the cumulative burden of post-transplant complications
to predict death/graft loss to power a randomized clinical trial of
maintenance immunosuppression in pediatric HT. Methods: Pediatric Heart
Transplant Study (PHTS) data were used to identify all children who
underwent an isolated orthotopic HT between 2005 and 2014 who survived to
6 months post-HT. A time-varying Cox model was used to develop and
evaluate a surrogate end-point comprised of 6 major adverse transplant
events (MATEs) (acute cellular rejection [ACR], antibody-mediated
rejection [AMR], infection, cardiac allograft vasculopathy [CAV],
post-transplant lymphoproliferative disease [PTLD] and chronic kidney
disease [CKD]) occurring between 6 and 36 months, where individual events
were defined according to international guidelines. Two thirds of the
study cohort was used for score development, and one third of the cohort
was used to test the score. Results: Among 2,118 children, 6.4% underwent
graft loss between 6 and 36 months post-HT, whereas 39% developed CKD, 34%
ACR, 34% infection, 9% AMR, 4% CAV and 2% PTLD. The best predictive score
involved a simple MATE score sum, yielding a concordance probability
estimate (CPE) statistic of 0.74. Whereas the power to detect
non-inferiority (NI), assuming the NI hazard ratio of 1.45 in graft
survival was 10% (assuming 200 subjects and 6% graft loss rate), the power
to detect NI assuming a 2-point non-inferiority margin was >85% using the
MATE score. Conclusion: The MATE score reflects the cumulative burden of
MATEs and has acceptable prediction characteristics for death/graft loss
post-HT. The MATE score may be useful as a surrogate end-point to power a
clinical trial in pediatric HT.
Copyright © 2017.

<128>
Accession Number
609161278
Author
Krishnaswami A.; Goh A.C.H.; Go A.S.; Lundstrom R.J.; Zaroff J.; Jang
J.J.; Allen E.
Institution
(Krishnaswami, Jang) Division of Cardiology, Kaiser Permanente San Jose
Medical Center, San Jose, CA, United States
(Goh, Lundstrom, Zaroff) Division of Cardiology, Kaiser Permanente San
Francisco Medical Center, San Francisco, CA, United States
(Go) Division of Research, Kaiser Permanente Northern California, Oakland,
CA, United States
(Go, Allen) Department of Epidemiology and Biostatistics, University of
California, San Francisco, San Francisco, CA, United States
(Go) Department of Medicine, University of California, San Francisco, San
Francisco, CA, United States
(Go) Department of Health Research and Policy, Stanford University,
Stanford, CA, United States
Title
Effectiveness of percutaneous coronary intervention versus coronary artery
bypass grafting in patients with end-stage renal disease.
Source
American Journal of Cardiology. 117 (10) (pp 1596-1603), 2016. Date of
Publication: 15 May 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The optimal coronary revascularization strategy (coronary artery bypass
grafting [CABG] or percutaneous coronary intervention [PCI]) in patients
with end-stage renal disease (ESRD) remains uncertain. We performed an
updated systematic review and meta-analysis of observational studies
comparing CABG and PCI in patients with ESRD using a random-effects model
for the primary outcome of long-term all-cause mortality. Our review
registered through PROSPERO included observational studies published after
2011 to ensure overlap with previous studies and identified 7 new studies
for a total of 23. We found that the median sample size in the selected
studies was 125 patients (25 to 15,784) with a large variation in the
covariate risk adjustment and only 3 studies reporting the indications for
the revascularization strategy. CABG was associated with a small reduction
in mortality (relative risk 0.92, 95% CI 0.89 to 0.96) with significant
heterogeneity demonstrated (p = 0.005, I2 = 48.6%). Subgroup
analysis by categorized "year of study initiation" (<1990, 1991 to 2003,
>2004) further confirmed the summary estimate trending toward survival
benefit of CABG along with a substantial decrease in heterogeneity after
2004 (p = 0.64, I2 = 0%). In conclusion, our updated systematic
review and meta-analysis demonstrated that in patients with ESRD referred
for coronary revascularization, CABG was associated with a small decrease
in the relative risk of long-term mortality compared with PCI. The
generalizability of the finding to all patients with ESRD referred for
coronary revascularization is limited because of a lack of known
indications for coronary revascularization, substantial variation in
covariate risk adjustment, and lack of randomized clinical trial data.
Copyright © 2016 Elsevier Inc. All rights reserved.

<129>
[Use Link to view the full text]
Accession Number
612076428
Author
Resor C.D.; Nathan A.; Kereiakes D.J.; Yeh R.W.; Massaro J.M.; Cutlip
D.E.; Steg P.G.; Hsieh W.-H.; Mauri L.
Institution
(Resor, Mauri) Department of Medicine, Division of Cardiology, Center for
Clinical Biometrics, Harvard Medical School, Cardiovascular Medicine,
Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, United
States
(Yeh, Cutlip, Hsieh, Mauri) Harvard Clinical Research Institute, Boston,
MA, United States
(Yeh, Mauri) Harvard Medical School, Boston, MA, United States
(Nathan) Division of Cardiology, University of Pennsylvania Medical
Center, Philadelphia, United States
(Yeh, Cutlip) Smith Center for Outcomes Research in Cardiology, Beth
Israel Deaconess Medical Center, Boston, MA, United States
(Massaro) Department of Biostatistics, Boston University School of Public
Heath, MA, United States
(Kereiakes) Christ Hospital Heart and Vascular Center, Lindner Center for
Research and Education, Cincinnati, OH, United States
(Steg) Universite Paris-Diderot, INSERM U-1148, Hopital Bichat,
Departement Hospitalo-Universitaire Fibrosis, Inflammation, and
Remodeling, Assistance Publique-Hopitaux de Paris, Paris, France
(Steg) National Heart and Lung Institute, Institute of Cardiovascular
Medicine and Science, Royal Brompton Hospital, Imperial College, London,
United Kingdom
Title
Impact of Optimal Medical Therapy in the Dual Antiplatelet Therapy Study.
Source
Circulation. 134 (14) (pp 989-998), 2016. Date of Publication: 04 Oct
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Continued dual antiplatelet therapy and optimal medical
therapy (OMT) improve outcomes in selected patient populations with
established coronary heart disease, but whether OMT modifies the treatment
effect of dual antiplatelet therapy is unknown. Methods: The DAPT (Dual
Antiplatelet Therapy) Study, a double-blind trial, randomly assigned 11
648 patients who had undergone coronary stenting and completed 1 year of
dual antiplatelet therapy without major bleeding or ischemic events to an
additional 18 months of continued thienopyridine or placebo. OMT was
defined as a combination of statin, beta-blocker, and
angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use
in patients with an American College of Cardiology/American Heart
Association class I indication for each medication. Per protocol, all
patients were treated with 75 to 325 mg aspirin daily. End points included
myocardial infarction, major adverse cardiovascular and cerebrovascular
events, and Global Utilization of Streptokinase and Tissue Plasminogen
Activator for Occluded Arteries moderate or severe bleeding events.
Results: Of 11 643 randomly assigned patients with complete medication
data, 63% were on OMT. Between 12 and 30 months, continued thienopyridine
reduced myocardial infarction in comparison with placebo in both groups
(on OMT 2.1% versus 3.3%, hazard ratio [HR], 0.64; 95% confidence interval
[CI], 0.48-0.86; P=0.003; off OMT 2.2% versus 5.2%, HR, 0.41; CI,
0.29-0.58; P<0.001; interaction P=0.103). Comparing continued
thienopyridine versus placebo, rates of major adverse cardiovascular and
cerebrovascular events were 4.2% versus 5.0% among patients on OMT (HR,
0.82; CI, 0.66-1.02; P=0.077) and 4.5% versus 7.0% among those off OMT
(HR, 0.63; CI, 0.49-0.82; P<0.001; interaction P=0.250); rates of bleeding
for thienopyridine versus placebo in patients on OMT were 2.2% versus 1.0%
(HR, 2.13; CI, 1.43-3.17; P<0.001), and in patients off OMT were 2.8%
versus 2.2% (HR, 1.30; CI, 0.88-1.92; P=0.189; interaction P=0.073).
Overall, patients on OMT had lower rates of myocardial infarction (2.7%
versus 3.7%, P=0.003), major adverse cardiovascular and cerebrovascular
events (4.6% versus 5.7%, P=0.007), and bleeding (1.6% versus 2.5%,
P<0.001) in comparison with patients off OMT. Rates of stent thrombosis
(0.8% versus 1.0%, P=0.171) and death (1.6% versus 1.9%, P=0.155) did not
differ. Conclusions: Continued thienopyridine therapy reduced the rate of
myocardial infarction regardless of OMT status and had consistent effects
on reduction in major adverse cardiovascular and cerebrovascular events
and increased bleeding.
Copyright © 2016 American Heart Association, Inc.

<130>
Accession Number
605929771
Author
Elkomy M.H.; Drover D.R.; Glotzbach K.L.; Galinkin J.L.; Frymoyer A.; Su
F.; Hammer G.B.
Institution
(Elkomy, Drover, Hammer) Department of Anesthesiology, Perioperative and
Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive,
Stanford, CA 94305-5117, United States
(Elkomy) Department of Pharmaceutics and Industrial Pharmacy, Beni Suef
University, Beni Suef, Egypt
(Glotzbach) Division of Pediatric Critical Care Medicine, Duke University
Medical Center, Durham, NC, United States
(Frymoyer, Su, Hammer) Department of Pediatrics, Stanford University
School of Medicine, Stanford, CA, United States
(Galinkin) Department of Anesthesiology, University of Colorado, Anschutz
Medical Campus, Aurora, CO, United States
Title
Pharmacokinetics of Morphine and Its Metabolites in Infants and Young
Children After Congenital Heart Surgery.
Source
AAPS Journal. 18 (1) (pp 124-133), 2016. Date of Publication: 01 Jan 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The objective of this study was to characterize morphine glucuronidation
in infants and children following cardiac surgery for possible treatment
individualization in this population. Twenty children aged 3 days to 6
years, admitted to the cardiovascular intensive care unit after congenital
heart surgery, received an intravenous (IV) loading dose of morphine (0.15
mg/kg) followed by subsequent intermittent IV bolus doses based on a
validated pain scale. Plasma samples were collected over 6 h after the
loading dose and randomly after follow-up doses to measure morphine and
its major metabolite concentrations. A population pharmacokinetic model
was developed with the non-linear mixed effects software NONMEM. Parent
disposition was adequately described by a linear two-compartment model.
Effect of growth (size and maturation) on morphine parameters was
accounted for by allometric body weight-based models. An intermediate
compartment with Emax model best characterized glucuronide concentrations.
Glomerular filtration rate was identified as a significant predictor of
glucuronide formation time delay and maximum concentrations. Clearance of
morphine in children with congenital heart disease is comparable to that
reported in children without cardiac abnormalities of similar age.
Children 1-6 months of age need higher morphine doses per kilogram to
achieve an area under concentration-time curve comparable to that in older
children. Pediatric patients with renal failure receiving morphine therapy
are at increased risk of developing opioid toxicity due to accumulation of
morphine metabolites.
Copyright © 2015, American Association of Pharmaceutical Scientists.

<131>
Accession Number
613090494
Author
Sullivan P.G.; Wallach J.D.; Ioannidis J.P.A.
Institution
(Sullivan, Wallach, Ioannidis) Department of Health Research and Policy,
Meta-Research Innovation Center at Stanford, Stanford University,
Stanford, California, United States
(Ioannidis) Departments of Medicine and Statistics, Stanford University,
Stanford, California, United States
Title
Meta-Analysis Comparing Established Risk Prediction Models (EuroSCORE II,
STS Score, and ACEF Score) for Perioperative Mortality During Cardiac
Surgery.
Source
American Journal of Cardiology. 118 (10) (pp 1574-1582), 2016. Date of
Publication: 15 Nov 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
A wide variety of multivariable risk models have been developed to predict
mortality in the setting of cardiac surgery; however, the relative utility
of these models is unknown. This study investigated the literature related
to comparisons made between established risk prediction models for
perioperative mortality used in the setting of cardiac surgery. A
systematic review was conducted to capture studies in cardiac surgery
comparing the relative performance of at least 2 prediction models cited
in recent guidelines (European System for Cardiac Operative Risk
Evaluation [EuroSCORE II], Society for Thoracic Surgeons 2008 Cardiac
Surgery Risk Models [STS] score, and Age, Creatinine, Ejection Fraction
[ACEF] score) for the outcomes of 1-month or inhospital mortality. For
articles that met inclusion criteria, we extracted information on study
design, predictive performance of risk models, and potential for bias.
Meta-analyses were conducted to calculate a summary estimate of the
difference in AUCs between models. We identified 22 eligible studies that
contained 33 comparisons among the above models. Meta-analysis of
differences in AUCs revealed that the EuroSCORE II and STS score performed
similarly (with a summary difference in AUC = 0.00), while outperforming
the ACEF score (with summary differences in AUC of 0.10 and 0.08,
respectively, p <0.05). Other metrics of discrimination and calibration
were presented less consistently, and no study presented any metric of
reclassification. Small sample size and absent descriptions of missing
data were common in these studies. In conclusion, the EuroSCORE II and STS
score outperform the ACEF score on discrimination.
Copyright © 2016

<132>
Accession Number
613090414
Author
Popovic B.; Girerd N.; Rossignol P.; Agrinier N.; Camenzind E.; Fay R.;
Pitt B.; Zannad F.
Institution
(Popovic, Girerd, Camenzind, Zannad) CHU Nancy, Departement de
Cardiologie, Nancy, France
(Girerd, Rossignol, Fay, Zannad) INSERM, Centre d'Investigation Clinique
CIC-P 9501, Nancy, France
(Agrinier) CHU Nancy, Epidemiologie et Evaluation Cliniques, Nancy, France
(Pitt) University of Michigan School of Medicine, Ann Arbor, Michigan,
United States
Title
Prognostic Value of the Thrombolysis in Myocardial Infarction Risk Score
in ST-Elevation Myocardial Infarction Patients With Left Ventricular
Dysfunction (from the EPHESUS Trial).
Source
American Journal of Cardiology. 118 (10) (pp 1442-1447), 2016. Date of
Publication: 15 Nov 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The Thrombolysis in Myocardial Infarction (TIMI) risk score remains a
robust prediction tool for short-term and midterm outcome in the patients
with ST-elevation myocardial infarction (STEMI). However, the validity of
this risk score in patients with STEMI with reduced left ventricular
ejection fraction (LVEF) remains unclear. A total of 2,854 patients with
STEMI with early coronary revascularization participating in the
randomized EPHESUS (Epleronone Post-Acute Myocardial Infarction Heart
Failure Efficacy and Survival Study) trial were analyzed. TIMI risk score
was calculated at baseline, and its predictive value was evaluated using
C-indexes from Cox models. The increase in reclassification of other
variables in addition to TIMI score was assessed using the net
reclassification index. TIMI risk score had a poor predictive accuracy for
all-cause mortality (C-index values at 30 days and 1 year <0.67) and
recurrent myocardial infarction (MI; C-index values <0.60). Among TIMI
score items, diabetes/hypertension/angina, heart rate >100 beats/min, and
systolic blood pressure <100 mm Hg were inconsistently associated with
survival, whereas none of the TIMI score items, aside from age, were
significantly associated with MI recurrence. Using a constructed
predictive model, lower LVEF, lower estimated glomerular filtration rate
(eGFR), and previous MI were significantly associated with all-cause
mortality. The predictive accuracy of this model, which included LVEF and
eGFR, was fair for both 30-day and 1-year all-cause mortality (C-index
values ranging from 0.71 to 0.75). In conclusion, TIMI risk score
demonstrates poor discrimination in predicting mortality or recurrent MI
in patients with STEMI with reduced LVEF. LVEF and eGFR are major factors
that should not be ignored by predictive risk scores in this population.
Copyright © 2016 Elsevier Inc.

<133>
Accession Number
609245960
Author
Liao Y.-B.; Meng Y.; Zhao Z.-G.; Zuo Z.-L.; Li Y.-J.; Xiong T.-Y.; Cao
J.-Y.; Xu Y.-N.; Feng Y.; Chen M.
Institution
(Liao, Zhao, Zuo, Li, Xiong, Cao, Xu, Feng, Chen) Department of
Cardiology, West China Hospital, Sichuan University, Chengdu, China
(Meng) Department of Urology Surgery, West China Hospital, Sichuan
University, Chengdu, China
Title
Meta-analysis of the effectiveness and safety of transcatheter aortic
valve implantation without balloon predilation.
Source
American Journal of Cardiology. 117 (10) (pp 1629-1635), 2016. Date of
Publication: 15 May 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Evidence regarding the safety and feasibility of transcatheter aortic
valve implantation without balloon predilation (BP) is scarce. A
literature search of PubMed, EMBASE, CENTRAL, and major conference
proceedings was performed from January 2002 to July 2015. There were 18
studies incorporating 2,443 patients included in the present study. No
differences were observed in the baseline characteristics between patients
without BP (no-BP) and with BP. Compared with BP, no-BP had a shorter
procedure time (no-BP vs BP, 124.2 vs 138.8 minutes, p = 0.008), used
less-contrast medium (no-BP vs BP, 126.3 vs 156.3 ml, p = 0.0005) and had
a higher success rate (odds ratio [OR] 2.24, 95% CI 1.40 to -3.58). In
addition, no-BP was associated with lower incidences of permanent
pacemaker implantation (OR 0.45, 95% CI 0.3 to 0.67), grade 2 or greater
paravalvular leakage (OR 0.55, 95% CI 0.37 to 0.83), and stroke (OR 0.57,
95% CI 0.32 to 1.0). Furthermore, no-BP was associated with a 0.6-fold
decreased risk for 30-day all-cause mortality (OR 0.60, 95% CI 0.39 to
0.92). However, the difference in the risk for permanent pacemaker
implantation, grade 2, or higher aortic regurgitation, stroke was noted to
be significant only in the subgroup of the CoreValve-dominating studies.
In conclusion, no-BP before transcatheter aortic valve implantation was
not only safe and feasible but was also associated with fewer
complications and short-term mortality in selected patients especially
using self-expandable valve.
Copyright © 2016 Elsevier Inc. All rights reserved.

<134>
Accession Number
612609477
Author
Bonaa K.H.; Mannsverk J.; Wiseth R.; Aaberge L.; Myreng Y.; Nygard O.;
Nilsen D.W.; Klow N.-E.; Uchto M.; Trovik T.; Bendz B.; Stavnes S.;
Bjornerheim R.; Larsen A.-I.; Slette M.; Steigen T.; Jakobsen O.J.; Bleie
O.; Fossum E.; Hanssen T.A.; Dahl-Eriksen O.; Njolstad I.; Rasmussen K.;
Wilsgaard T.; Nordrehaug J.E.
Institution
(Bonaa, Njolstad, Wilsgaard) Department of Community Medicine, Norway
(Steigen, Hanssen, Rasmussen) Department of Clinical Medicine, University
of Tromso, Arctic University of Norway, Norway
(Mannsverk, Trovik, Steigen, Hanssen, Dahl-Eriksen, Rasmussen) Department
of Cardiology, University Hospital of North Norway, Tromso, Norway
(Bonaa) Departments of Public Health and General Medicine, Norway
(Wiseth) Department of Circulation and Medical Imaging, Norwegian
University of Science and Technology, Norway
(Bonaa, Wiseth, Slette) Clinic for Heart Disease, St. Olav's University
Hospital, Trondheim N 7006, Norway
(Aaberge, Bendz, Fossum) Department of Cardiology, Norway
(Klow) Department of Radiology, Norway
(Bjornerheim) Department of Heart Disease, Oslo University Hospital,
Norway
(Klow, Bendz) Faculty of Medicine, University of Oslo, Oslo, Norway
(Myreng, Stavnes) Department of Cardiology, Feiring Heart Clinic, Feiring,
Norway
(Nygard, Bleie) Department of Heart Disease, Haukeland University
Hospital, Norway
(Nygard, Nilsen, Larsen, Nordrehaug) Department of Clinical Science,
University of Bergen, Bergen, Norway
(Nilsen, Larsen, Nordrehaug) Department of Cardiology, Stavanger
University Hospital, Stavanger, Norway
(Uchto, Jakobsen) Department of Medicine, Sorlandet Hospital, Arendal,
Norway
Title
Drug-eluting or bare-metal stents for coronary artery disease.
Source
New England Journal of Medicine. 375 (13) (pp 1242-1252), 2016. Date of
Publication: 29 Sep 2016.
Publisher
Massachussetts Medical Society
Abstract
Background Limited data are available on the long-term effects of
contemporary drug-eluting stents versus contemporary bare-metal stents on
rates of death, myocardial infarction, repeat revascularization, and stent
thrombosis and on quality of life. METHODS We randomly assigned 9013
patients who had stable or unstable coronary artery disease to undergo
percutaneous coronary intervention (PCI) with the implantation of either
contemporary drug-eluting stents or bare-metal stents. In the group
receiving drug-eluting stents, 96% of the patients received either
everolimus-or zotarolimus-eluting stents. The primary outcome was a
composite of death from any cause and nonfatal spontaneous myocardial
infarction after a median of 5 years of follow-up. Secondary outcomes
included repeat revascularization, stent thrombosis, and quality of life.
RESULTS At 6 years, the rates of the primary outcome were 16.6% in the
group receiving drug-eluting stents and 17.1% in the group receiving
bare-metal stents (hazard ratio, 0.98; 95% confidence interval [CI], 0.88
to 1.09; P=0.66). There were no significant between-group differences in
the components of the primary outcome. The 6-year rates of any repeat
revascularization were 16.5% in the group receiving drug-eluting stents
and 19.8% in the group receiving bare-metal stents (hazard ratio, 0.76;
95% CI, 0.69 to 0.85; P<0.001); the rates of definite stent thrombosis
were 0.8% and 1.2%, respectively (P=0.0498). Quality-of-life measures did
not differ significantly between the two groups. CONCLUSIONS In patients
undergoing PCI, there were no significant differences between those
receiving drug-eluting stents and those receiving bare-metal stents in the
composite outcome of death from any cause and nonfatal spontaneous
myocardial infarction. Rates of repeat revascularization were lower in the
group receiving drugeluting stents.
Copyright © 2016 Massachusetts Medical Society.

<135>
Accession Number
607664965
Author
Bhatt V.R.; Dahal S.; Verma V.; Shukla P.; Khanal N.; Pathak R.; Giri S.
Institution
(Bhatt) University of Nebraska Medical Center, Department of Internal
Medicine, Division of Hematology- Oncology, Omaha, NE, United States
(Dahal) Department of Internal Medicine, Interfaith Medical Center, NY,
United States
(Verma) Department of Radiation Oncology, University of Nebraska Medical
Center, Omaha, NE, United States
(Shukla) Department of Medicine, Institute of Medicine, Tribhuvan
University, Kathmandu, Nepal
(Khanal) Department of Internal Medicine, Creighton University Medical
Center, Omaha, NE, United States
(Pathak) Department of Medicine, Reading Health System, Reading, PA,
United States
(Giri) Department of Medicine, University of Tennessee Health Science
Center, Memphis, TN, United States
Title
Fondaparinux for Management of Heparin-induced Thrombocytopenia after
Cardiovascular Intervention: A systematic review.
Source
Cardiovascular and Hematological Agents in Medicinal Chemistry. 13 (2) (pp
82-86), 2015. Date of Publication: 01 Dec 2015.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Objectives: The efficacy and safety of fondaparinux, an emerging
therapeutic option for heparin-induced thrombocytopenia (HIT), remain
unclear in cardiac surgery patients with HIT. Methods: Using several
search criteria, we reviewed all cases of fondaparinux use in patients who
developed HIT after any cardiovascular intervention and were indexed in
MEDLINE by August 2014. Based on pre-specified criteria, cases were
divided into confirmed HIT, probable HIT and possible HIT. The outcome of
fondaparinux use in each group was compared using Chi-square test.
Results: Of 43 total cases, 22 had confirmed HIT and 21 had possible HIT.
Valve replacement or repair (39%) and heart transplant or ventricular
assist device placement (21%) were the most common preceding
cardiovascular interventions. Creatinine clearance <30 ml was present in
27% and 52% of confirmed and possible HIT respectively. Overall the risk
of new thrombosis and bleeding with fondaparinux were 4.6% and 7%
respectively, without any differences in the two subgroups. The majority
(86%) of cases improved clinically; of the remainder patients, similar
percentage of cases with possible HIT and confirmed HIT died (24% vs. 5%;
p= 0.102). None of the deaths were attributed to HIT or complications of
bleeding. Conclusion: Within the limitations of this study, the risk of
thrombosis and bleeding with fondaparinux use in cardiac surgery patients
with HIT are low and largely comparable to outcomes reported in literature
with other agents.
Copyright © 2015 Bentham Science Publishers.

<136>
Accession Number
606705145
Author
Lemos P.A.; Abizaid A.A.C.; Meireles G.C.; Sarmento-Leite R.; Prudente M.;
Cantarelli M.; Dourado A.D.; Mariani J.; Perin M.A.; Costantini C.; Costa
R.A.; Costa J.R.; Chamie D.; Campos C.A.; Ribeiro E.
Institution
(Lemos, Campos, Ribeiro) Heart Institute (InCor), University of Sao Paulo
Medical School, Sao Paulo SP, Brazil
(Abizaid, Costa, Costa, Chamie) Instituto Dante Pazzanese de Cardiologia,
Sao Paulo SP, Brazil
(Meireles) Hospital do Servidor Publico Estadual - IAMSPE, Sao Paulo SP,
Brazil
(Sarmento-Leite) Institute of Cardiology/Fundacao, Universitaria de
Cardiologia de Porto Alegre, Porto Alegre RS, Brazil
(Prudente) Hospital Encore, Aparecida de Goiania GO, Brazil
(Cantarelli) Hospital Bandeirantes, Sao Paulo SP, Brazil
(Dourado) Hospital Santa Izabel, Salvador BA, Brazil
(Mariani) Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo, Sao
Paulo SP, Brazil
(Perin) Hospital Santa Marcelina, Sao Paulo SP, Brazil
(Costantini) Hospital Cardiologico Costantini, Curitiba PR, Brazil
Title
Metallic Limus-Eluting Stents Abluminally Coated with Biodegradable
Polymers: Angiographic and Clinical Comparison of a Novel Ultra-Thin
Sirolimus Stent Versus Biolimus Stent in the DESTINY Randomized Trial.
Source
Cardiovascular Therapeutics. 33 (6) (pp 367-371), 2015. Date of
Publication: December 2015.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Aims: To evaluate the outcomes of patients treated with a new drug-eluting
stent formulation with low doses of sirolimus, built in an
ultra-thin-strut platform coated with biodegradable abluminal coating.
Methods: This study is a randomized trial that tested the main hypothesis
that the angiographic late lumen loss of the novel sirolimus-eluting stent
is noninferior compared with commercially available biolimus-eluting
stent. A final study population comprising 170 patients with one or two de
novo lesions was randomized in the ratio 2:1 for sirolimus-eluting stent
or biolimus-eluting stent, respectively. The primary endpoint was 9-month
angiographic in-stent late lumen loss. Adverse clinical events were
prospectively collected for 1 year. Results: After 9 months, the novel
sirolimus-eluting stent was shown noninferior compared with the biolimus
stent for the primary endpoint (angiographic in-stent late lumen loss:
0.20 +/- 0.29 mm vs. 0.15 +/- 0.20 mm, respectively; P value for
noninferiority <0.001). The 1-year incidence of death, myocardial
infarction, repeat revascularization, and stent thrombosis remained low
and not significantly different between the groups. Conclusions: The
present randomized trial demonstrates that the tested novel
sirolimus-eluting stent was angiographically noninferior in comparison
with a last-generation biolimus-eluting stent.
Copyright © 2015 John Wiley and Sons Ltd.

<137>
Accession Number
606705131
Author
Alsidawi S.; Effat M.; Rahman S.; Abdallah M.; Leesar M.
Institution
(Alsidawi, Effat, Rahman, Abdallah) Division of Cardiovascular Health and
Diseases, University of Cincinnati College of Medicine, Cincinnati, OH,
United States
(Leesar) Division of Cardiovascular Diseases, University of Alabama,
Birmingham, AL, United States
Title
The Role of Vascular Imaging in Guiding Routine Percutaneous Coronary
Interventions: A Meta-Analysis of Bare Metal Stent and Drug-Eluting Stent
Trials.
Source
Cardiovascular Therapeutics. 33 (6) (pp 360-366), 2015. Date of
Publication: December 2015.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background: The routine use of vascular imaging including intravascular
ultrasound (IVUS) and optical coherence tomography (OCT) in guiding
percutaneous coronary interventions (PCI) is still controversial
especially when using drug-eluting stents. A meta-analysis of trials using
bare metal stents was previously published. Methods: We conducted a
meta-analysis of available published trials that compared imaging-guided
PCI and angiography-guided PCI in patients undergoing routine PCI only.
Trials that enrolled patients with acute coronary syndrome were excluded
to decrease heterogeneity. We aimed to study both drug-eluting stents
(DES) as well as bare metal stents (BMS). We identified seven randomized
controlled trials on IVUS-guided bare metal stents. We also identified
three randomized controlled trials on IVUS-guided drug-eluting stents. To
improve the power of the drug-eluting stent data, we identified, and
included, nine registries that compared IVUS-guided PCI to
angiography-guided PCI in the drug-eluting stent era. Nonrandomized
registries that included BMS only were excluded as there are multiple
previous meta-analyses that studied these patients. Finally, we identified
one registry that compared OCT-guided PCI to angiography-guided PCI using
either a BMS or a DES. A total of 14,197 patients were studied overall.
The meta-analysis was conducted using a random effect model. Results:
Imaging guidance was associated with a significantly larger
postintervention minimal luminal diameter (SMD: 0.289. 95% CI:
0.213-0.365. P < 0.01). Imaging-guided stenting was associated with a
significant decrease in the major adverse cardiac events (MACE) in the DES
patients (odds ratio: 0.810. 95% CI: 0.719-0.912. P < 0.01) and combined
DES and BMS patients (odds ratio: 0.782. 95% CI: 0.686-0.890. P < 0.01).
Imaging guidance was associated with significantly lower events of death
from all causes in DES patients (odds ratio: 0.654. 95% CI: 0.468-0.916. P
< 0.01) and in the combined DES and BMS patients (odds ratio: 0.727. 95%
CI: 0.540-0.980. P < 0.01). The risk of myocardial infarction (MI) was
significantly lower with imaging guidance in both, DES patients (odds
ratio: 0.551. 95% CI: 0.363-0.837. P < 0.01) and combined DES and BMS
patients (odds ratio: 0.589. 95% CI: 0.425-0.816. P < 0.01). This may, in
part, be explained by the significantly lower risk of stent thrombosis in
imaging-guided DES patients (odds ratio: 0.651. 95% CI: 0.499-0.850. P <
0.01) and combined DES and BMS patients (odds ratio: 0.665. 95% CI:
0.513-0.862. P < 0.01). Patients who received a DES showed no difference
between imaging guidance and angiography guidance in repeated target
lesion revascularization, while the analysis of BMS alone and the DES and
BMS combined showed significant superiority of the imaging-guided PCI
group. Conclusion: Imaging-guided PCI significantly lowered the risk of
death, MI, stent thrombosis, and the combined MACE in DES-implanted
patients and all stented patients (DES or BMS). However, imaging guidance
had no significant effect on repeated target vessel or target lesion
revascularization in patients who received DES, likely due to the effect
of the drug in the stent.© 2015 John Wiley
Copyright & Sons Ltd.

<138>
Accession Number
614117388
Author
Lau J.K.; Pennings G.J.; Yong A.; Kritharides L.
Institution
(Lau, Yong, Kritharides) Department of Cardiology, Concord Hospital,
University of Sydney, Sydney, NSW, Australia
(Lau, Pennings, Yong, Kritharides) ANZAC Research Institute, University of
Sydney, Sydney, NSW, Australia
(Yong) Faculty of Medicine and Health Sciences, Macquarie University,
Sydney, NSW, Australia
Title
Cardiac Remote Ischaemic Preconditioning: Mechanistic and Clinical
Considerations.
Source
Heart Lung and Circulation. 26 (6) (pp 545-553), 2017. Date of
Publication: June 2017.
Publisher
Elsevier Ltd
Abstract
Brief, non-harmful ischaemic insults to an organ remote from the heart,
remote ischaemic preconditioning (RIPC), has been proposed to confer
protection to the heart against ischaemia-reperfusion injury. While most
clinical trials of RIPC during coronary interventions (PCI) suggest
benefit, recent large, multicentre trials in coronary artery bypass
surgery suggest a lack of efficacy. Mechanistically, RIPC most likely
promotes the release of circulating factors which modulate multiple
cellular pathways in the heart, promoting cell survival. This review
explores potential mechanisms underlying RIPC and includes a contemporary
evaluation of clinical studies in PCI and cardiac surgery, highlighting
methodological differences which may explain discrepant findings between
these two clinical groups.
Copyright © 2016

<139>
Accession Number
615590996
Author
Mellouk Aid K.; Tchala Vignon Zomahoun H.; Soulaymani A.; Lebascle K.;
Silvera S.; Astagneau P.; Misset B.
Institution
(Mellouk Aid, Soulaymani) Ibn Tofail University, Laboratory of Genetics
and Biometrics, Faculty of Sciences, Kenitra, Morocco
(Mellouk Aid) Clinical Research Centre, Foundation Hospital Saint-Joseph,
185 Rue Raymond Losserand, Paris 75014, France
(Tchala Vignon Zomahoun) Universite Laval, Quebec SPOR-SUPPORT Unit
Research Centre of CHU de Quebec, Quebec City, QC, Canada
(Lebascle) Centre for Control of Healthcare-Associated Infections, Paris,
France
(Silvera) Foundation Hospital Saint-Joseph, 185 Rue Raymond Losserand,
Paris 75014, France
(Astagneau) Sorbonne Universities, Centre for Control of Healthcare,
Associated Infections and Pierre and Marie Curie Faculty of Medicine,
Paris, France
(Misset) Foundation Hospital Saint-Joseph, Department of Intensive Care
and Clinical Research Centre, 185 Rue Raymond Losserand, Paris 75014,
France
(Misset) Paris Descartes University, Paris, France
(Misset) Department of Intensive Care, Rouen, France
(Misset) University of Rouen, Rouen University Hospital, Rouen, France
Title
Mortality and infectious complications of therapeutic endovascular
interventional radiology: A systematic and meta-analysis protocol.
Source
Systematic Reviews. 6 (1) (no pagination), 2017. Article Number: 89. Date
of Publication: 24 Apr 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Endovascular interventional radiology (EIR) is an increasingly
popular, mini invasive treatment option for patient with symptomatic
vascular disease. The EIR practiced by qualified hands is an effective,
well-tolerated procedure that offers relief of patient's symptoms with a
low risk of complications. During acute post procedural period, immediate
complications may relate to vascular access, restenosis, thromboembolic
events, uterine ischemia, infection, necrosis, sepsis, ICU stay, surgical
recovery, pain management, treatment failure, and death. Moreover,
additional non-life-threatening complications exist, but they are not well
described and represent disparate information. Methods/design: A range of
databases will be screened consulted to identify the relevant studies:
PubMed, EMBASE, The Cochrane Library, NosoBase, and Google Scholar (to
identify articles not yet indexed). Scientist librarian used Medical
Subject Headings (MeSH) and free terms to construct the search strategy in
PubMed. This search strategy will be adapted in other databases. Two
coauthors will independently select the relevant studies, extract the
relevant data, and assess the risk of bias in the included studies. Any
disagreements between the two authors will be solved by a third author.
Discussion: This systematic review will provide a synthesis of EIR
complications. The spotlighted results will be analyzed in order to
provide a state-of-knowledge synopsis of the current evidence base in
relation to the epidemiology of the infectious complications after EIR. In
the event of conclusive results, our findings will serve as a reference
background to assess guidelines on reality of the problem of the
infections linked to endovascular interventional radiology and to
formulate of assumptions and propose preventive measures, based on the
results of our investigations. These propositions will aim to reduce the
risk and/or the severity of these complications in the concerned
population in favor a positive medical economics report. It will also aim
to decrease the antibio-resistance and in fine will improve health status
and security of patients. Systematic review registration: PROSPERO
CRD42015025594
Copyright © 2017 The Author(s).

<140>
Accession Number
614039898
Author
Myles P.S.; Smith J.A.; Forbes A.; Silbert B.; Jayarajah M.; Painter T.;
Cooper D.J.; Marasco S.; McNeil J.; Bussieres J.S.; McGuinness S.; Byrne
K.; Chan M.T.V.; Landoni G.; Wallace S.
Institution
(Myles, Cooper, Marasco, Wallace) Department of Anaesthesia and
Perioperative Medicine, Alfred Hospital, Commercial Rd., Melbourne, VIC
3004, Australia
(Myles, Smith, Forbes, Jayarajah, Cooper, Marasco, Wallace) Monash
University, Melbourne, VIC, Australia
(Silbert) St. Vincent's Hospital, Fitzroy, VIC, Australia
(Painter) Royal Adelaide Hospital, Adelaide, SA, Australia
(McNeil) South West Cardiac Centre, Derriford Hospital, Plymouth, United
Kingdom
(Bussieres) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Quebec, QC, Canada
(McGuinness) Auckland Hospital, Auckland, New Zealand
(Byrne) Waikato Hospital, Hamilton, New Zealand
(Chan) Chinese University of Hong Kong, Hong Kong, Hong Kong
(Landoni) Istituto di Ricovero e Cura A Carattere Scientifico San Raffaele
and Vita-Salute, San Raffaele University, Milan, Italy
Title
Tranexamic acid in patients undergoing coronary-artery surgery.
Source
New England Journal of Medicine. 376 (2) (pp 136-148), 2017. Date of
Publication: 12 Jan 2017.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Tranexamic acid reduces the risk of bleeding among patients
undergoing cardiac surgery, but it is unclear whether this leads to
improved outcomes. Furthermore, there are concerns that tranexamic acid
may have prothrombotic and proconvulsant effects. METHODS In a trial with
a 2-by-2 factorial design, we randomly assigned patients who were
scheduled to undergo coronary-artery surgery and were at risk for
perioperative complications to receive aspirin or placebo and tranexamic
acid or placebo. The results of the tranexamic acid comparison are
reported here. The primary outcome was a composite of death and thrombotic
complications (nonfatal myocardial infarction, stroke, pulmonary embolism,
renal failure, or bowel infarction) within 30 days after surgery. RESULTS
Of the 4662 patients who were enrolled and provided consent, 4631
underwent surgery and had available outcomes data; 2311 were assigned to
the tranexamic acid group and 2320 to the placebo group. A primary outcome
event occurred in 386 patients (16.7%) in the tranexamic acid group and in
420 patients (18.1%) in the placebo group (relative risk, 0.92; 95%
confidence interval, 0.81 to 1.05; P = 0.22). The total number of units of
blood products that were transfused during hospitalization was 4331 in the
tranexamic acid group and 7994 in the placebo group (P<0.001). Major
hemorrhage or cardiac tamponade leading to reoperation occurred in 1.4% of
the patients in the tranexamic acid group and in 2.8% of the patients in
the placebo group (P = 0.001), and seizures occurred in 0.7% and 0.1%,
respectively (P = 0.002 by Fisher's exact test). CONCLUSIONS Among
patients undergoing coronary-artery surgery, tranexamic acid was
associated with a lower risk of bleeding than was placebo, without a
higher risk of death or thrombotic complications within 30 days after
surgery. Tranexamic acid was associated with a higher risk of
postoperative seizures. (Funded by the Australian National Health and
Medical Research Council and others; ATACAS Australia New Zealand Clinical
Trials Registry number, ACTRN12605000557639.).
Copyright © 2017 Massachusetts Medical Society.

<141>
Accession Number
613241007
Author
Zhang W.; Wei Y.; Jiang H.; Xu J.; Yu D.
Institution
(Zhang, Wei, Jiang, Xu, Yu) The second affiliated hospital of Nanchang
University, Department of Cardiothoracic surgery, 1 Minde Rd, Nanchang,
Jiangxi Province 330006, China
Title
Thoracotomy is better than thoracoscopic lobectomy in the lymph node
dissection of lung cancer: A systematic review and meta-analysis.
Source
World Journal of Surgical Oncology. 14 (1) (no pagination), 2016. Article
Number: 290. Date of Publication: 17 Nov 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The aim of this study was to investigate which surgical method
is better in lymph node (LN) dissection of lung cancer. Methods: A
comprehensive search of PubMed, Ovid MEDLINE, EMBASE, Web of Science,
ScienceDirect, the Cochrane Library, Scopus, and Google Scholar was
performed to identify studies comparing thoracoscopic lobectomy
(video-assisted thoracic surgery (VATS) group) and thoracotomy (open
group) in LN dissection. Results: Twenty-nine articles met the inclusion
criteria and involved 2763 patients in the VATS group and 3484 patients in
the open group. The meta-analysis showed that fewer total LNs (95%
confidence interval [CI] -1.52 to -0.73, p<0.0001) and N2 LNs (95% CI
-1.25 to -0.10, p=0.02) were dissected in the VATS group. A similar number
of total LN stations, N2 LN stations, and N1 LNs were harvested in both
groups. Only one study reported that fewer N1 LN stations were dissected
in the VATS group (1.4+/-0.5 vs. 1.6+/-0.6, p=0.04). Conclusions: Open
lobectomy could achieve better LN dissection efficacy than thoracoscopic
lobectomy in the treatment of lung cancer, especially in the N2 LNs
dissection. These findings require validation by high-quality, large-scale
randomized controlled trials.
Copyright © 2016 The Author(s).

<142>
Accession Number
611188162
Author
Zarpelon C.S.; Netto M.C.; Jorge J.C.M.; Fabris C.C.; Desengrini D.;
Jardim M.S.; da Silva D.G.
Institution
(Zarpelon, Netto, Jorge, Fabris, Desengrini, Jardim, da Silva) Irmandade
da Santa Casa de Misericordia de Curitiba, Curitiba, PR, Brazil
Title
Colchicine to reduce atrial fibrillation in the postoperative period of
myocardial revascularization.
Source
Arquivos Brasileiros de Cardiologia. 107 (1) (pp 4-8), 2016. Date of
Publication: July 2016.
Publisher
Arquivos Brasileiros de Cardiologia (E-mail: arquivos@cardiol.br)
Abstract
Background: The high prevalence of atrial fibrillation (AF) in the
postoperative period of myocardial revascularization surgery increases
morbidity and mortality. Objective: To assess the efficacy of colchicine
to prevent AF in the postoperative period of myocardial revascularization
surgery, the impact of AF on hospital length of stay and death, and to
identify its risk factors. Methods: Between May 2012 and November 2013,
140 patients submitted to myocardial revascularization surgery were
randomized, 69 to the control group and 71 to the colchicine group.
Colchicine was used at the dose of 1 mg orally, twice daily,
preoperatively, and of 0.5 mg, twice daily, until hospital discharge. A
single dose of 1 mg was administered to those admitted 12 hours or less
before surgery. Results: The primary endpoint was AF rate in the
postoperative period of myocardial revascularization surgery. Colchicine
group patients showed no reduction in AF incidence as compared to control
group patients (7.04% versus 13.04%, respectively; p = 0.271). There was
no statistically significant difference between the groups regarding death
from any cause rate (5.6% versus 10.1%; p = 0,363) and hospital length of
stay (14.5 +/- 11.5 versus 13.3 +/- 9.4 days; p = 0.490). However,
colchicine group patients had a higher infection rate (26.8% versus 8.7%;
p = 0.007). Conclusion: The use of colchicine to prevent AF after
myocardial revascularization surgery was not effective in the present
study. Brazilian Registry of Clinical Trials number RBR-556dhr.
Copyright © 2016, Arquivos Brasileiros de Cardiologia. All rights
reserved.

<143>
Accession Number
608764719
Author
Hemkens L.G.; Contopoulos-Ioannidis D.G.; Ioannidis J.P.A.
Institution
(Hemkens, Ioannidis) Stanford Prevention Research Center, Department of
Medicine, Stanford University School of Medicine, Stanford, CA 94305,
United States
(Hemkens) Basel Institute for Clinical Epidemiology and Biostatistics,
University Hospital Basel, Basel, Switzerland
(Contopoulos-Ioannidis) Department of Pediatrics, Division of Infectious
Diseases, Stanford University School of Medicine, Stanford, CA, United
States
(Contopoulos-Ioannidis, Ioannidis) Meta-Research Innovation Center at
Stanford (METRICS), Stanford University School of Medicine, Stanford, CA,
United States
(Ioannidis) Department of Health Research and Policy, Stanford University
School of Medicine, Stanford, CA, United States
(Ioannidis) Department of Statistics, Stanford University School of
Humanities and Sciences, Stanford, CA, United States
Title
Agreement of treatment effects for mortality from routinely collected data
and subsequent randomized trials: Meta-epidemiological survey.
Source
BMJ (Online). 352 (no pagination), 2016. Article Number: i493. Date of
Publication: 08 Feb 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To assess differences in estimated treatment effects for
mortality between observational studies with routinely collected health
data (RCD; that are published before trials are available) and subsequent
evidence from randomized controlled trials on the same clinical question.
Design Meta-epidemiological survey. Data sources PubMed searched up to
November 2014. Methods Eligible RCD studies were published up to 2010 that
used propensity scores to address confounding bias and reported
comparative effects of interventions for mortality. The analysis included
only RCD studies conducted before any trial was published on the same
topic. The direction of treatment effects, confidence intervals, and
effect sizes (odds ratios) were compared between RCD studies and
randomized controlled trials. The relative odds ratio (that is, the
summary odds ratio of trial(s) divided by the RCD study estimate) and the
summary relative odds ratio were calculated across all pairs of RCD
studies and trials. A summary relative odds ratio greater than one
indicates that RCD studies gave more favorable mortality results. Results
The evaluation included 16 eligible RCD studies, and 36 subsequent
published randomized controlled trials investigating the same clinical
questions (with 17 275 patients and 835 deaths). Trials were published a
median of three years after the corresponding RCD study. For five (31%) of
the 16 clinical questions, the direction of treatment effects differed
between RCD studies and trials. Confidence intervals in nine (56%) RCD
studies did not include the RCT effect estimate. Overall, RCD studies
showed significantly more favorable mortality estimates by 31% than
subsequent trials (summary relative odds ratio 1.31 (95% confidence
interval 1.03 to 1.65; I2=0%)). Conclusions Studies of
routinely collected health data could give different answers from
subsequent randomized controlled trials on the same clinical questions,
and may substantially overestimate treatment effects. Caution is needed to
prevent misguided clinical decision making.
Copyright © BMJ Publishing Group Ltd 2015.

<144>
Accession Number
610470841
Author
Shaw C.; Nitsch D.; Lee J.; Fogarty D.; Sharpe C.C.
Institution
(Shaw) UK Renal Registry, Southmead Hospital, Bristol, London, United
Kingdom
(Shaw, Sharpe) Department of Renal Medicine, Kings College London, London,
United Kingdom
(Nitsch) London School of Hygiene and Tropical Medicine, London, United
Kingdom
(Lee) Department of Renal Medicine, Guy's and St Thomas' NHS Foundation
Trust, London, United Kingdom
(Fogarty) Department of Renal Medicine, Belfast Health and Social Care
Trust, Belfast, United Kingdom
Title
Impact of an early invasive strategy versus conservative strategy for
unstable angina and non-ST elevation acute coronary syndrome in patients
with chronic kidney disease: A systematic review.
Source
PLoS ONE. 11 (5) (no pagination), 2016. Article Number: e0153478. Date of
Publication: 01 May 2016.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: Clinical practice guidelines support an early invasive
approach after NSTE-ACS in patients with chronic kidney disease (CKD).
There is no direct randomised controlled trial evidence in the CKD
population, and whether the benefit of an early invasive approach is
maintained across the spectrum of severity of CKD remains controversial.
Methods: We conducted a systematic review to evaluate the association
between an early invasive approach and all-cause mortality in patients
with CKD. We searched MEDLINE and EMBASE (1990-May 2015) and article
reference lists. Data describing study design, participants, invasive
management strategies, renal function, all-cause mortality and risk of
bias were extracted. Results: 3,861 potentially relevant studies were
identified. Ten studies, representing data on 147,908 individuals with
NSTE-ACS met the inclusion criteria. Qualitative heterogeneity in the
definitions of early invasive approach, comparison groups and renal
dysfunction existed. Meta-analysis of the RCT derived and observational
data were generally supportive of an early invasive approach in CKD
(RR0.76 (95% CI 0.49-1.17) and RR0.50 (95%CI 0.42-0.59) respectively).
Meta-analysis of the observational studies demonstrated a large degree of
heterogeneity (I2 79%) driven in part by study size and
heterogeneity across various kidney function levels. Conclusions: The
observational data support that an early invasive approach after NSTE-ACS
confers a survival benefit in those with early-moderate CKD. Local
opportunities for quality improvement should be sought. Those with severe
CKD and the dialysis population are high risk and under-studied. Novel and
inclusive approaches for CKD and dialysis patients in cardiovascular
clinical trials are needed.
Copyright © 2016 Shaw 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.

<145>
Accession Number
605572770
Author
Tian Y.; Li H.; Liu P.; Xu J.-M.; Irwin M.G.; Xia Z.; Tian G.
Institution
(Tian, Tian) Department of Anesthesiology, Haikou Municipal Hospital,
Affiliated Haikou Hospital Xiangya School of Medicine, Central South
University, Haikou 570208, China
(Li, Irwin, Xia) Department of Anesthesiology, University of Hong Kong,
Hong Kong, Hong Kong
(Liu) Department of Anesthesiology, Hainan Municipal Corps Hospital,
Chinese People's Armed Police Force, Haikou 570203, China
(Xu) Department of Anesthesiology, Second Xiangya Hospital, Central South
University, Changsha, Hunan 410011, China
(Xia) Department of Anesthesiology, Affiliated Hospital of Guangdong
Medical College, Zhanjiang 524023, China
Title
Captopril pretreatment produces an additive cardioprotection to isoflurane
preconditioning in attenuating myocardial ischemia reperfusion injury in
rabbits and in humans.
Source
Mediators of Inflammation. 2015 (no pagination), 2015. Article Number:
819232. Date of Publication: 2015.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Background. Pretreatment with the angiotensin-converting inhibitor
captopril or volatile anesthetic isoflurane has, respectively, been shown
to attenuate myocardial ischemia reperfusion (MI/R) injury in rodents and
in patients. It is unknown whether or not captopril pretreatment and
isoflurane preconditioning (Iso) may additively or synergistically
attenuate MI/R injury. Methods and Results. Patients selected for heart
valve replacement surgery were randomly assigned to five groups: untreated
control (Control), captopril pretreatment for 3 days (Cap3d), or single
dose captopril (Cap1hr, 1 hour) before surgery with or without Iso
(Cap3d+Iso and Cap1hr+Iso). Rabbit MI/R model was induced by occluding
coronary artery for 30 min followed by 2-hour reperfusion. Rabbits were
randomized to receive sham operation (Sham), MI/R (I/R), captopril (Cap,
24 hours before MI/R), Iso, or the combination of captopril and Iso
(Iso+Cap). In patients, Cap3d+Iso but not Cap1hr+Iso additively reduced
postischemic myocardial injury and attenuated postischemic myocardial
inflammation. In rabbits, Cap or Iso significantly reduced postischemic
myocardial infarction. Iso+Cap additively reduced cellular injury that was
associated with improved postischemic myocardial functional recovery and
reduced myocardial apoptosis and attenuated oxidative stress. Conclusion.
A joint use of 3-day captopril treatment and isoflurane preconditioning
additively attenuated MI/R by reducing oxidative stress and inflammation.
Copyright © 2015 Yi Tian et al.

<146>
Accession Number
605572759
Author
Xia R.; Xu J.; Yin H.; Wu H.; Xia Z.; Zhou D.; Xia Z.-Y.; Zhang L.; Li H.;
Xiao X.
Institution
(Xia, Yin) Department of Anesthesiology, First Affiliated Hospital,
Yangtze University, Jingzhou 434000, China
(Xu, Xia) Department of Anesthesiology, Wuhan University Renmin Hospital,
Wuhan 430060, China
(Wu) Department of Cardiothoracic Surgery, Fifth Affiliated Hospital of
Zunyi Medical College, Zhuhai 519100, China
(Xia) Department of Anesthesiology, Second Affiliated Hospital and Yuying
Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000,
China
(Xia, Zhang, Li) Department of Anesthesiology, Affiliated Hospital of
Guangdong Medical College, Zhanjiang, Guangdong 524001, China
(Xia, Zhang, Li) Department of Anesthesiology, University of Hong Kong,
Hong Kong, Hong Kong
(Zhou, Xiao) Department of Anesthesiology, Guangdong No. 2 Provincial
People's Hospital, Guangdong Provincial Emergency Hospital, Guangzhou,
Guangdong 510317, China
Title
Intravenous infusion of dexmedetomidine combined isoflurane inhalation
reduces oxidative stress and potentiates hypoxia pulmonary
vasoconstriction during one-lung ventilation in patients.
Source
Mediators of Inflammation. 2015 (no pagination), 2015. Article Number:
238041. Date of Publication: 2015.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Inhalation anesthetic isoflurane inhibits hypoxia pulmonary
vasoconstriction (HPV), while dexmedetomidine (Dex) could reduce the dose
of isoflurane inhalation and potentiate HPV, but the mechanism is unclear.
Inhibition of reactive oxygen species (ROS) production can favor HPV
during one-lung ventilation (OLV). Similarly, nitric oxide (NO), an
important endothelium-derived vasodilator in lung circulation, can
decrease the regional pulmonary vascular resistance of ventilated lung and
reduce intrapulmonary shunting. We hypothesized that Dex may augment HPV
and improve oxygenation during OLV through inhibiting oxidative stress and
increasing NO release. Patients undergoing OLV during elective thoracic
surgery were randomly allocated to either isoflurane + saline (NISO, n =
24) or isoflurane + dexmedetomidine (DISO, n = 25) group. Anesthesia was
maintained with intravenous remifentanil and inhalational isoflurane
(1.0-2.0%), with concomitant infusion of dexmedetomidine 0.7
gkg-1h-1 in DISO and saline 0.25 mL
kg-1h-1 in NISO group. Hemodynamic variables or
depth of anesthesia did not significantly differ between groups.
Administration of Dex significantly reduced Qs/Qt and increased
PaO<inf>2</inf> after OLV, accompanied with reduced lipid peroxidation
product malondialdehyde and higher levels of SOD activity as well as serum
NO (all P < 0.05 DISO versus NISO). In conclusion, reducing oxidative
stress and increasing NO release during OLV may represent a mechanism
whereby Dex potentiates HPV.
Copyright © 2015 Rui Xia et al.

<147>
Accession Number
606057755
Author
Van Der Heijden M.J.E.; Araghi S.O.; Van Dijk M.; Jeekel J.; Hunink M.G.M.
Institution
(Van Der Heijden) Department of Pediatrics, Erasmus MC, Rotterdam,
Netherlands
(Araghi, Jeekel) Department of Neuroscience, Erasmus MC, Rotterdam,
Netherlands
(Van Dijk) Department of Pediatrics, Division of Neonatology, Department
of Pediatric Surgery, Intensive Care Erasmus MC, Rotterdam, Netherlands
(Hunink) Department of Epidemiology, Erasmus MC, Rotterdam, Netherlands
(Hunink) Department of Radiology, Erasmus MC, Rotterdam, Netherlands
(Hunink) Department of Health Policy and Management, Harvard T.H. Chan
School of Public Health, Boston, MA, United States
Title
The effects of perioperative music interventions in pediatric surgery: A
systematic review and meta-analysis of randomized controlled trials.
Source
PLoS ONE. 10 (8) (no pagination), 2015. Article Number: e0133608. Date of
Publication: 06 Aug 2015.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Objective: Music interventions are widely used, but have not yet gained a
place in guidelines for pediatric surgery or pediatric anesthesia. In this
systematic review and meta-analysis we examined the effects of music
interventions on pain, anxiety and distress in children undergoing
invasive surgery. Data Sources: We searched 25 electronic databases from
their first available date until October 2014. Study Selection: Included
were all randomized controlled trials with a parallel group, crossover or
cluster design that included pediatric patients from 1 month to 18 years
old undergoing minimally invasive or invasive surgical procedures, and
receiving either live music therapy or recorded music. Data Extraction and
Synthesis: 4846 records were retrieved from the searches, 26 full text
reports were evaluated and data was extracted by two independent
investigators. Main Outcome Measures: Pain was measured with the Visual
Analogue Scale, the Coloured Analogue Scale and the Facial Pain Scale.
Anxiety and distress were measured with an emotional index scale (not
validated), the Spielberger short State Trait Anxiety Inventory and a
Facial Affective Scale. Results: Three RCTs were eligible for inclusion
encompassing 196 orthopedic, cardiac and day surgery patients (age of 1
day to 18 years) receiving either live music therapy or recorded music.
Overall a statistically significant positive effect was demonstrated on
postoperative pain (SMD -1.07; 95%CI-2.08; -0.07) and on anxiety and
distress (SMD -0.34 95% CI -0.66; -0.01 and SMD -0.50; 95% CI -0.84; -
0.16. Conclusions and Relevance: This systematic review and meta-analysis
indicates that music interventions may have a statistically significant
effect in reducing post-operative pain, anxiety and distress in children
undergoing a surgical procedure. Evidence from this review and other
reviews suggests music therapy may be considered for clinical use.
Copyright © 2015 van der Heijden 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.

<148>
Accession Number
605480313
Author
Qi W.-W.; Liu T.; Xu G.; Li L.-F.; Liang Y.-Z.; Ye L.; Li G.-P.
Institution
(Qi, Liu, Xu, Li, Liang, Ye, Li) Tianjin Key Laboratory of Ionic-Molecular
Function of Cardiovascular disease, Department of Cardiology, Tianjin
Institute of Cardiology, Second Hospital of Tianjin Medical University,
Tianjin 300211, China
Title
Upstream therapeutic strategies of Valsartan and Fluvastatin on
Hypertensive patients with non-permanent Atrial Fibrillation (VF-HT-AF):
Study protocol for a randomized controlled trial.
Source
Trials. 16 (1) (no pagination), 2015. Article Number: 336. Date of
Publication: August 07, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Previous studies regarding rhythm control in patients with
atrial fibrillation (AF) could not sufficiently demonstrate the efficacy
of available anti-arrhythmic drugs. 'Upstream therapy' has emerged as a
potential strategy for the prevention and treatment of AF. The use of
angiotensin II receptor blockers and statins has been suggested to
decrease new-onset AF, but which remains inadequately explored. This study
was designed to examine whether valsartan or fluvastatin can reduce the
risk of non-permanent AF in patients with hypertension. Methods/design:
The VF-HT-AF study is a multicenter, randomized, open-label, four-arm
parallel group study with comparative evaluation of valsartan and
fluvastatin as upstream therapies for the treatment of non-permanent AF
complicated by hypertension. The primary outcome measure is change in the
development of paroxysmal AF into persistent or permanent AF, the
development of persistent AF to permanent AF, and change in incidence of
overall and persistent AF recurrence, as evaluated by 7-days ambulatory
electrocardiograph monitoring (Holter) and patients' diaries during 2
years' follow-up. Secondary outcome measures of this study include the
occurrence of: (1) fatal and nonfatal myocardial infarction; (2) heart
failure (New York Heart Association stage III or IV); (3) cardiogenic
shock; (4) serious bleeding necessitating hospitalization; (5) malignant
ventricular arrhythmia; (6) revascularization therapy; (7) radiofrequency
catheter ablation of AF; (8) changes of left atrial dimension, as measured
by ultrasound echocardiography; (9) stroke; (10) cardiovascular mortality;
and (11) all-cause mortality. A total of 1879 patients will be
investigated from 15 medical centers throughout China to obtain the
relevant information. Discussion: This is the first study in hypertensive
patients complicated non-permanent AF in the Chinese population. Results
of this study will inform the use of upstream therapies of AF.
Copyright © 2015 Qi et al.

<149>
Accession Number
605984872
Author
Ker K.; Roberts I.
Institution
(Ker, Roberts) Clinical Trials Unit, London School of Hygiene and Tropical
Medicine, London, United Kingdom
Title
Exploring redundant research into the effect of tranexamic acid on
surgical bleeding: Further analysis of a systematic review of randomised
controlled trials.
Source
BMJ Open. 5 (8) (no pagination), 2015. Article Number: e009460. Date of
Publication: 2015.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives: We examined whether apparent redundancy in a cumulative
meta-analysis of trials is justified by concern about bias, random error
or generalisability of the results. Design: Cumulative meta-analysis, risk
of bias assessment, trial sequential analysis, description of study
participants over time and a review of rationales for conducting trials.
Data source: 126 randomised trials included in a systematic review
assessing of tranexamic acid on blood transfusion in surgery. Results: The
cumulative meta-analysis including all trials shows that the pooled
estimate first reached statistical significance after the second trial in
1993. When the analysis was limited to the 38 high-quality trials and
adjusted to account for potential systematic and random errors, the
uncertainty was resolved after the 22nd trial in 2008. When the analysis
was restricted to the two high-quality, prospectively registered trials,
the cumulative z-curve crossed p=0.05 but not the monitoring boundary,
suggesting an early potentially spurious statistically significant result.
As precision of the pooled estimate increased, the number of trials
initiated increased, although trial activity appeared to move to other
surgery types. Most (62%) reports cited at least one systematic review. Of
118 reports examined, concern about generalisability was the reason for
initiating the trial in 60%. Other reasons were to address a question
other than the effect on bleeding (26%) and to confirm previously observed
results (4%). Unawareness of previous research was apparent in 4% trials,
while the rationale was unclear in 3%. Conclusions: Our results indicate
that poor quality is a more important cause of redundant research than the
failure to review existing evidence. Concerns about generalisability of
results is the main motivation for new trials. Contrary to previous
claims, our results suggest that systematic reviews showing treatment
effects can stimulate an increase in trial activity rather than reduce it.

<150>
Accession Number
605568364
Author
Katzenellenbogen J.M.; Woods J.A.; Teng T.-H.K.; Thompson S.C.
Institution
(Katzenellenbogen, Woods, Teng, Thompson) The University of Western
Australia (M706), Western Australian Centre for Rural Health, 35 Stirling
Highway, Crawley, WA 6009, Australia
(Katzenellenbogen) The University of Western Australia (M431), School of
Population Health, 35 Stirling Highway, Crawley, WA 6009, Australia
Title
Atrial fibrillation in the Indigenous populations of Australia, Canada,
New Zealand, and the United States: A systematic scoping review.
Source
BMC Cardiovascular Disorders. 15 (1) (no pagination), 2015. Article
Number: 87. Date of Publication: August 13, 2015.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The epidemiology of atrial fibrillation (AF) among Indigenous
minorities in affluent countries is poorly delineated, despite the high
cardiovascular disease burden in these populations. We undertook a
systematic scoping review examining the epidemiology of AF in the
Indigenous populations of Australia, Canada, New Zealand (NZ) and the
United States (US). Methods: PubMed, Scopus, EMBASE and CINAHL-Plus
databases were systematically searched in May 2014. Supplementary
full-text searches of Google Scholar and government website searches were
also undertaken. Results: Key findings from 27 publications with diverse
aims and methods were included. Small studies from Canada and NZ suggest
higher AF prevalence in Indigenous than other populations. However, this
was not reflected in a large sample of US male military veterans. No data
were identified on community-based incidence rates of AF in Indigenous
populations. Australian and Canadian studies indicate higher first-ever
and overall AF hospitalisation rates among Indigenous than other
populations, at younger ages and with more comorbidity. Studies in stroke,
heart failure and other clinical groups demonstrate AF as a common
comorbidity, with AF possibly more prevalent at younger ages in Indigenous
people. Indigenous patients have similar early post-hospitalisation
adjusted mortality but higher 1-year risk-adjusted mortality than
non-Indigenous patients. Conclusions: No clear epidemiological pattern of
AF frequency across the considered Indigenous populations emerges from the
limited available evidence. AF should be included in key conditions
reported in national surveillance reports, although Indigenous identifiers
are required in administrative data from Canada and the US. Sufficiently
powered, community-based studies of AF epidemiology in diverse Indigenous
populations are needed.
Copyright © 2015 Katzenellenbogen et al.

<151>
Accession Number
606945754
Author
Tang E.Y.H.; Harrison S.L.; Errington L.; Gordon M.F.; Visser P.J.; Novak
G.; Dufouil C.; Brayne C.; Robinson L.; Launer L.J.; Stephan B.C.M.
Institution
(Tang, Harrison, Robinson, Stephan) Institute of Health and Society,
Newcastle University Institute of Ageing, Newcastle University, Newcastle
upon Tyne NE2 4AX, United Kingdom
(Errington) Medical School, Newcastle University, Newcastle upon Tyne NE2
4HH, United Kingdom
(Gordon) Boehringer Ingelheim Pharmaceuticals, Inc., 900 Ridgebury Road,
Ridgefield, Connecticut 06877, United States
(Visser) Maastricht University, Department of Psychiatry and
Neuropsychology, School for Mental Health and Neuroscience, Maastricht,
Netherlands
(Visser) VU University Medical Centre, Department of Neurology, Alzheimer
Centre, Neuroscience Campus, Amsterdam, Netherlands
(Novak) Janssen Pharmaceutical Research and Development, 1125
Trenton-Harbourton Road, Titusville, New Jersey 08560, United States
(Dufouil) Inserm Research Centre (U897), Team Neuroepidemiology, Bordeaux
F-33000, France
(Brayne) Department of Public Health and Primary Care, Cambridge
University, Cambridge CB2 0SR, United Kingdom
(Launer) Laboratory of Epidemiology, Demography and Biometry, National
Institute on Aging, National Institutes of Health (NIH), Bethesda,
Maryland, United States
Title
Current developments in dementia risk prediction modelling: An updated
systematic review.
Source
PLoS ONE. 10 (9) (no pagination), 2015. Article Number: e0136181. Date of
Publication: 03 Sep 2015.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: Accurate identification of individuals at high risk of
dementia influences clinical care, inclusion criteria for clinical trials
and development of preventative strategies. Numerous models have been
developed for predicting dementia. To evaluate these models we undertook a
systematic review in 2010 and updated this in 2014 due to the increase in
research published in this area. Here we include a critique of the
variables selected for inclusion and an assessment of model prognostic
performance. Methods: Our previous systematic review was updated with a
search from January 2009 to March 2014 in electronic databases (MEDLINE,
Embase, Scopus, Web of Science). Articles examining risk of dementia in
non-demented individuals and including measures of sensitivity,
specificity or the area under the curve (AUC) or c-statistic were
included. Findings: In total, 1,234 articles were identified from the
search; 21 articles met inclusion criteria. New developments in dementia
risk prediction include the testing of non-APOE genes, use of
non-traditional dementia risk factors, incorporation of diet, physical
function and ethnicity, and model development in specific subgroups of the
population including individuals with diabetes and those with different
educational levels. Four models have been externally validated. Three
studies considered time or cost implications of computing the model.
Interpretation: There is no one model that is recommended for dementia
risk prediction in populationbased settings. Further, it is unlikely that
one model will fit all. Consideration of the optimal features of new
models should focus on methodology (setting/sample, model development and
testing in a replication cohort) and the acceptability and cost of
attaining the risk variables included in the prediction score. Further
work is required to validate existing models or develop new ones in
different populations as well as determine the ethical implications of
dementia risk prediction, before applying the particular models in
population or clinical settings.

<152>
Accession Number
615814888
Author
Lu J.; Meng H.; Meng Z.; Sun Y.; Pribis J.P.; Zhu C.; Li Q.
Institution
(Lu, Li) Department of Anesthesiology, Shanghai East Hospital, Tongji
University School of Medicine Shanghai, China
(Meng, Sun) First Clinical Medical College of Nanjing Medical University
Nanjing, China
(Meng) Department of Surgery, Xinyi People's Hospital Xinyi, China
(Pribis, Zhu) Department of Surgery, University of Pittsburgh Medical
Center Pittsburgh, PA, USA
Title
Epsilon aminocaproic acid reduces blood transfusion and improves the
coagulation test after pediatric open-heart surgery: a meta-analysis of 5
clinical trials.
Source
International journal of clinical and experimental pathology. 8 (7) (pp
7978-7987), 2015. Date of Publication: 2015.
Abstract
BACKGROUND: Excessive postoperative blood loss after cardiopulmonary
bypass is a common problem, especially in patients suffering from
congenital heart diseases. The efficacy of epsilon aminocaproic acid
(EACA) as a prophylactic treatment for postoperative bleeding after
pediatric open-heart surgery has not been determined. This meta-analysis
investigates the efficacy of EACA in the minimization of bleeding and
blood transfusion and the maintenance of coagulation tests after pediatric
open-heart surgery.
METHODS: A comprehensive literature search was performed to identify all
randomized clinical trials on the subject. PubMed, Embase, the Cochrane
Library, and the Chinese Medical Journal Network were screened. The
primary outcome used for the analysis was postoperative blood loss.
Secondary outcomes included postoperative blood transfusion,
re-exploration rate and postoperative coagulation tests. The mean
difference (MD) and risk ratio (RR) with 95% confidence intervals (CI)
were used as summary statistics.
RESULTS: Five trials were included in this meta-analysis of 515 patients.
Prophylactic EACA was associated with a reduction in postoperative blood
loss, but this difference did not reach statistical significance (MD:
-7.08; 95% CI: -16.11 to 1.95; P = 0.12). Patients treated with EACA
received fewer postoperative blood transfusions, including packed red
blood cells (MD: -8.36; 95% CI: -12.63 to -4.09; P = 0.0001), fresh frozen
plasma (MD: -3.85; 95% CI: -5.63 to -2.08; P < 0.0001), and platelet
concentrate (MD: -10.66; 95% CI: -18.45 to -2.87; P = 0.007), and had a
lower re-exploration rate (RR: 0.46; 95% CI: 0.23 to 0.92; P = 0.03).
Prophylactic EACA also improved coagulation tests 6 hours after open-heart
surgery.
CONCLUSIONS: Prophylactic EACA minimizes postoperative blood transfusion
and helps maintain coagulation in pediatric patients undergoing open-heart
surgery. Therefore, the results of this study indicate that adjunctive
EACA is a good choice for the prevention of postoperative blood
transfusion following pediatric cardiac surgery.

<153>
Accession Number
615802372
Author
Zadeh F.J.; Nour M.G.
Institution
(Zadeh) Department of Cardiac Anesthesia, Ahvaz Anesthesiology and Pain
Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz,
Iran, Islamic Republic of
(Zadeh) Atherosclerosis Research Center, Ahvaz Jundishapur University of
Medical Sciences, Ahvaz, Iran, Islamic Republic of
(Nour) Department of Cardiac Surgery, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
Title
A study on the outcomes of modified tight glucose control for the
management of glycemic control in diabetic patients undergoing cardiac
surgery.
Source
Journal of Pharmacy Research. 10 (11) (pp 764-770), 2016. Date of
Publication: 01 Nov 2016.
Publisher
JPR Solutions (E-mail: editorparial@gmail.com)
Abstract
Background and Objective: Diabetes mellitus is associated with increased
surgical morbidity and mortality. Its relatively high risk may be related
to the level of perioperative hyperglycemia. Thisstudy was aimed to
compare the outcomes of patients undergoing open cardiac surgery byglucose
control in two ways: modified tight versus conventional method. Methods:
This open-labeled, randomized control trial was conducted on 75diabetic
patients (18-70 years old) with ASA II- III undergoing open cardiac
surgery from Shahid Faghihi Hospital, Shiraz, Iran. The patients were
randomly divided into modified tight control(Blood Sugar maintained
between 100-120 mg/dl) and conventional method (Blood Sugar < 200mg/dl).
Primary end points included: hospitalmortality, sternal wound infection,
duration of mechanical ventilation, cardiacarrhythmia, cerebrovascular
attack and acute renal failure. The secondary end point waslength of ICU
staying. Complications after 30 days of surgery were recorded. We used
student's t test, chi-squareand repeated measurement tests. Results:
Although the trend of change in blood glucose during surgery and in ICU
was notsignificantly different between groups, blood sugar measurement
showed a significantdifference at the different times (P < 0.001). In
terms of primary end pointsandsecondary end pointwere not significantly
different between two groups. The occurrence of hypoglycemiawas low in
both groups (one patient in each group) and were not significantly
different between two groups. Hypokalemia was the most prominent
sideeffect in the 34 patients of modified tight control group compared
with eight patients in theconventional group (P < 0.001). After 30 days
sternal wound infection was seen in1 patient oftreatment group versus 7 in
control group (P < 0.05), which was significant. Conclusion: Modified
tight control of blood glucose close tonormal values during cardiac
surgery was associated with decreased occurrence of episodes of
hypoglycemia andhyperglycemic complications.

<154>
Accession Number
615794674
Author
Borji R.; Ahmadi S.H.; Barkhordari K.; Meysami A.P.; Karimi A.A.;
Mortazavi S.H.; Dadlani P.; Ayatollah Zadeh Esfahani F.; Khatami S.M.R.
Institution
(Borji, Ahmadi, Barkhordari, Meysami, Karimi, Mortazavi, Dadlani,
Ayatollah Zadeh Esfahani, Khatami) aInternal Medicine Department, Imam
Khomeini Hospital, bCommunity and Preventive Medicine Department, Medical
Faculty, cTehran Heart Center, and dNephrology Research Center, Tehran
University of Medical Sciences, Tehran, Iran
Title
Effect of Prophylactic Dialysis on Morbidity and Mortality in
Non-Dialysis-Dependent Patients after Coronary Artery Bypass Grafting: A
Pilot Study.
Source
Nephron. (no pagination), 2017. Date of Publication: 22 Apr 2017.
Publisher
S. Karger AG
Abstract
Background/Aims: Coronary artery bypass grafting (CABG) is associated with
an increased risk of morbidity and mortality in patients with pre-existing
renal dysfunction. Numerous measures have been implemented to overcome
this problem; however, no improvement in outcomes has been achieved. This
study was aimed at investigating the effects of prophylactic dialysis on
mortality and morbidity in these patients. Methods: This
randomized-controlled clinical trial enrolled 88 non-dialysis-dependent
patients with chronic kidney disease awaiting CABG surgery. Thirty-nine
randomly selected patients received dialysis 3 times prior to surgery, and
49 patients formed the control group. Kaplan-Meier analysis and Cox
proportional-hazards models were used to identify factors associated with
survival. Results: There was no significant difference in the development
of morbidities between the groups (p = 0.413). A significant difference
was evident in the average survival time (p = 0.037). Cox
proportional-hazards models determined that the hazard ratio of death
after surgery was 10.854-fold greater in non-dialysis patients than in
patients who received dialysis (hazard ratio = 2). Conclusion:
Prophylactic dialysis prior to CABG decreases mortality, but does not
affect morbidity, in patients with renal insufficiency.
Copyright © 2017 S. Karger AG, Basel

<155>
Accession Number
615772173
Author
He Z.M.; Schoebel C.; Penzel T.; Fietze I.; Ye Z.
Institution
(He, Ye) Department of Respiratory and Critical Care Medicine, Karamay
Central Hospital, Karamay, China
(Schoebel, Penzel, Fietze) Sleep Medicine Center, Charite University
Hospital, Luisenstr.13, Berlin 10117, Germany
Title
Sleep-disordered breathing and severe aortic stenosis.
Source
Somnologie. (pp 1-7), 2017. Date of Publication: 26 Apr 2017.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: Aortic stenosis (AS) has been associated with sleep-disordered
breathing (SDB), obstructive sleep apnea (OSA), and central sleep apnea
(CSA). In patients undergoing transcatheter aortic valve implantation
(TAVI), CSA may contribute to sudden cardiac death. Knowledge regarding
complications and management of patients with TAVI and CSA is limited.
This review defines the clinical manifestations of SDB, especially CSA,
associated with AS and TAVI therapy. Prevalence, mechanisms, risk factors,
and treatment options are reported. Methods: Pubmed, Medline, and the
Cochrane Database of Systematic Reviews were searched for prospective and
retrospective studies, as well as case reports, in which SDB in AS was
confirmed by polysomnography. Apnea was defined as a >90% reduction of
airflow from baseline for >10 s; hypopnea as a >30% reduction in airflow
with >4% O<inf>2</inf> desaturation; apnea-hypopnea index (AHI) as the
number of apnea and hypopnea episodes/h of sleep. AHI >5/h defined SDB. If
the recording showed more than 50% central apnea events, this was defined
as CSA; otherwise as OSA. Results: Five studies reporting on 299 patients
were included. Patients with severe AS had a high prevalence of SDB
(235/299; 78.6%). In AS patients, CSA had a prevalence of 105/251 (41.8%)
and OSA of 93/248 (37.5%). Studies reported a strong association with SDB
severity. TAVI for severe aortic valve stenosis improved CSA in two
studies but had no impact on OSA. Positive airway pressure therapy appears
the best treatment for CSA in patients with TAVI. Continuous positive
airway pressure (CPAP) may be ineffective in eliminating central apnea or
even increase CSA. Adaptive servo ventilation (ASV) and bilevel positive
airway pressure (BPAP) ventilation are alternative treatments. Conclusion:
The prevalence of SDB in AS patients ranges from 71 to 95%. The most
important risk factor for higher CSA severity in AS patients was heart
failure (HF). ASV and CPAP have demonstrated efficacy in treating SDB in
patients with HF. Limited data and clinical experience are available for
ASV treatment of patients with AS-associated SDB. Prospective studies on
quality life and ASV treatment in these patients are needed.
Copyright © 2017 Springer Medizin Verlag GmbH

<156>
Accession Number
615771861
Author
Ak A.; Porokhovnikov I.; Kuethe F.; Schulze P.C.; Noutsias M.; Schlattmann
P.
Institution
(Ak, Porokhovnikov, Schlattmann) Institute of Medical Statistics,
Informatics and Documentation (IMSID), Friedrich-Schiller University and
University Hospital Jena, Bachstrase 18, Jena 07743, Germany
(Kuethe, Schulze, Noutsias) Department of Internal Medicine I, Division of
Cardiology, Pneumology, Angiology and Intensive Medical Care, University
Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
Title
Transcatheter vs. surgical aortic valve replacement and medical treatment:
Systematic review and meta-analysis of randomized and non-randomized
trials.
Source
Herz. (pp 1-13), 2017. Date of Publication: 27 Apr 2017.
Publisher
Urban und Vogel GmbH (E-mail: verlag@urban-vogel.de)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has emerged as
the procedure of choice for patients with severe aortic stenosis (AS) and
high perioperative risk. We performed a meta-analysis to compare the
mortality related to TAVR with medical therapy (MT) and surgical aortic
valve replacement (SAVR). Methods: A systematic literature search was
conducted by two independent investigators from the database inception to
30 December 2014. Relative risk (RR) and odds ratio (OR) were calculated
and graphically displayed in forest plots. We used I2 for
heterogeneity (meta-regression) and Egger's regression test of asymmetry
(funnel plots). Results: We included 24 studies (n = 19 observational
studies; n = 5 randomized controlled trials), with a total of 7356
patients in this meta-analysis. Mean age had a substantial negative impact
on the long-term survival of AS patients (OR = 1.544; 95% CI: 1.25-1.90).
Compared with MT, TAVR showed a statistically significant benefit for
all-cause mortality at 12 months (OR = 0.68; 95% CI: 0.49-0.95). Both TAVR
and SAVR were associated with better outcomes compared with MT. TAVR
showed lower all-cause mortality over SAVR at 12 months (OR = 0.81; 95%
CI: 0.68-0.97). The comparison between SAVR and TAVR at 2 years revealed
no significant difference (OR = 1.09; 95% CI: 1.01-1.17). Conclusion: In
AS, both TAVR and SAVR provide a superior prognosis to MT and, therefore,
MT is not the preferred treatment option for AS. Furthermore, our data
show that TAVR is associated with lower mortality at 12 months compared
with SAVR. Further studies are warranted to compare the long-term outcome
of TAVR versus SAVR beyond a 2-year follow-up period.
Copyright © 2017 Springer Medizin Verlag GmbH

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