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<1>
Accession Number
613864913
Author
Likosky D.S.; Dickinson T.A.; Paugh T.A.
Institution
(Likosky, Paugh) Section of Health Services Research and Quality,
Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI,
United States
(Dickinson) Specialty Care, Nashville, Tennessee for the Michigan Society
of Thoracic and Cardiovascular Surgeons, Perfusion Measures and Outcomes
(PERForm) Registry, United States
Title
Blood conservation-a team sport.
Source
Journal of Extra-Corporeal Technology. 48 (3) (pp 99-104), 2016. Date of
Publication: 2016.
Publisher
American Society of Extra-Corporeal Technology (E-mail: donna@amsect.org)
Abstract
Cardiac surgery accounts for between 15% and 20% of all blood product
utilization in the United States. A body of literature suggests that
patients who are exposed to even small quantities of blood have an
increased risk of morbidity and mortality, even after adjusting for
pre-operative risk. Despite this body of literature supporting a
restrictive blood management strategy, wide variability in transfusion
rates exist across institutions. Recent blood management guidelines have
shed light on a number of potentially promising blood management
strategies, including acute normovolemic hemodilution (ANH) and retrograde
autologous priming (RAP).We evaluated the literature concerning ANH and
RAP, and the use of both techniques among centers participating in the
Perfusion Measures and outcomes (PERForm) registry. We leveraged data
concerning ANH and RAP among 10,203 patients undergoing isolated coronary
artery bypass grafting (CABG) procedures from 2010 to 2014 at 27 medical
centers. Meta-analyses have focused on the topic of ANH, with few studies
focusing specifically on cardiac surgery. Two meta-analyses have been
conducted to date on RAP, with many reporting higher intra-operative
hematocrits and reduced transfusions. The rate of red blood cell
transfusions in the setting of CABG surgery is 34.2%, although varied
across institutions from 16.8% to 57.6%. Overall use of ANH was 11.6%,
although the utilization varied from .0% to 75.7% across institutions. RAP
use was 71.4%, although varied from .0% to 99.0% across institutions. A
number of blood conservation strategies have been proposed, with varying
levels of evidence from meta-analyses. This uncertainty has likely
contributed to center-level differences in the utilization of these
practices as evidenced by our multi-institutional database. Perfusion
databases, including the PERForm registry, serve as a vehicle for
perfusionist's to track their practice, and contribute to
multidisciplinary team efforts aimed at assessing and improving the value
of cardiac surgical care.

<2>
Accession Number
610964577
Author
Erlebach M.; Head S.J.; Mylotte D.; Leon M.B.; Serruys P.W.; Pieter
Kappetein A.; Martucci G.; Genereux P.; Windecker S.; Lange R.; Piazza N.
Institution
(Erlebach, Lange, Piazza) Department of Cardiovascular Surgery, German
Heart Center Munich, Munich, Germany
(Head, Pieter Kappetein) Department of Cardiothoracic Surgery, Erasmus
University Medical Center, Rotterdam, Netherlands
(Mylotte, Martucci, Piazza) Department of Medicine, Division of Cardiology
Interventional Cardiology, McGill University Health Centre, 1001 Decarie
Boulevard, Montreal, QC H4A 3J1, Canada
(Mylotte) Department of Medicine, University Hospital Galway, Galway,
Ireland
(Leon, Genereux) Columbia University Medical Center, New York Presbyterian
Hospital, New York, NY, United States
(Serruys) Department of Interventional Cardiology, Thoraxcenter, Erasmus
Medical Center, Rotterdam, Netherlands
(Windecker) Department of Cardiology, Swiss Cardiovascular Center Bern,
Bern, Switzerland
Title
VARC endpoint definition compliance rates in contemporary transcatheter
aortic valve implantation studies.
Source
EuroIntervention. 12 (3) (pp 375-380), 2016. Date of Publication: June
2016.
Publisher
EuroPCR
Abstract
Aims: The Valve Academic Research Consortium (VARC) endpoint definitions
were established to standardise the reporting of clinical outcomes
following transcatheter aortic valve implantation (TAVI). It remains
unclear, however, to what extent and in which manner these definitions are
applied. Therefore, we sought to investigate the utilisation and adherence
to VARC guidelines since their introduction in 2011 across peerreviewed
TAVI-related publications. Methods and results: We performed a systematic
literature review to identify TAVI-related manuscripts published between
February 2011 and February 2014. Manuscripts were categorised into three
groups: a "compliant" group of manuscripts using only VARC-defined
endpoints, a "non-compliant" group of manu scripts with only
non-VARC-defined endpoints, and a "mixed compliant" group of manuscripts
with both VARC-and non-VARC-defined endpoints. Multivariate analyses were
performed to identify predictors of VARC use. Among 5,023 published
manuscripts, 498 were included in the final analysis. At least one VARC
definition was used in 275 (54%), while 223 (43%) did not use any VARC
definitions. After publication of the first VARC manuscript (VARC-1,
January 2011), VARC use increased from 31% (n=15) at six months to 69%
(n=84) at 36 months. Following the publication of VARC-2 (October 2012),
VARC-1 use declined (from 58% [n=47] to 36% [n=24]), while VARC-2 use
increased from 4% (n=3) at six months to 35% (n=23) at 18 months. Of the
manuscripts using VARC, 49 (10%) were classified as compliant and 226
(46%) as mixed compliant. The following endpoints were more often defined
using VARC vs. non-VARC: myocardial infarction (64% vs. 36%); stroke (56%
vs. 44%); bleeding (79% vs. 21%); vascular complications (70% vs. 30%);
acute kidney injury (63% vs. 37%); reintervention (67% vs. 33%); and
composite endpoints (52% vs. 48%). Mortality, valve dysfunction,
TAVI-related complications, and quality of life were more often defined
using non-VARC criteria. Conclusions: Implementation of VARC criteria in
peer-reviewed manuscripts has increased over time. There remain, however,
a considerable number (43%) of publications that do not report outcomes
according to VARC. These data will inform the future development of VARC
criteria.<br/>Copyright &#xa9; 2016 Europa Digital & Publishing. All
rights reserved.

<3>
Accession Number
610963848
Author
Banach M.; Serban M.-C.; Sahebkar A.; Garcia-Garcia H.M.; Mikhailidis
D.P.; Martin S.S.; Brie D.; Rysz J.; Toth P.P.; Jones S.R.; Hasan R.K.;
Mosteoru S.; Rifai M.A.; Pencina M.J.; Serruys P.W.
Institution
(Banach, Rysz) Department of Hypertension, Medical University of Lodz, WAM
University Hospital in Lodz, Zeromskiego 113, Lodz 90-549, Poland
(Serban) Department of Epidemiology, University of Alabama at Birmingham,
Birmingham, AL, United States
(Serban) Department of Functional Sciences, Discipline of Pathophysiology,
Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
(Sahebkar) Biotechnology Research Center, Imam Reza Hospital, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Sahebkar) Metabolic Research Centre, Royal Perth Hospital, School of
Medicine and Pharmacology, University of Western Australia, Perth,
Australia
(Garcia-Garcia) Department of Interventional Cardiology, Thoraxcenter,
Erasmus MC, Rotterdam, Netherlands
(Mikhailidis) Department of Clinical Biochemistry, Royal Free Campus,
University College London Medical School, University College London (UCL),
London, United Kingdom
(Martin, Toth, Jones, Hasan) Johns Hopkins Ciccarone Center for the
Prevention of Heart Disease, Baltimore, MD, United States
(Brie, Mosteoru, Rifai) Cardiology Department, Institute for
Cardiovascular Medicine Timisoara, University of Medicine and Pharmacy
Victor Babes, Timisoara, Romania
(Toth) Preventive Cardiology, CGH Medical Center, Sterling, IL, United
States
(Pencina) Duke Clinical Research Institute (DCRI), Biostatistics and
Bioinformatics, Duke University, Durham, NC, United States
(Serruys) International Centre for Cardiovascular Health, Imperial College
London, London, United Kingdom
Title
Comparison of clinical outcomes between bioresorbable vascular stents
versus conventional drug-eluting and metallic stents: A systematic review
and meta-analysis.
Source
EuroIntervention. 12 (2) (pp e175-e189), 2016. Date of Publication: June
2016.
Publisher
EuroPCR
Abstract
Aims: Several studies have suggested good procedural and similar clinical
outcomes between everolimus-eluting Absorb bioresorbable stents (BRS)
versus conventional drug-eluting stents (DES), but the evidence is not
definitive. Our aim was to perform a systematic review and meta-analysis
to investigate the effects of BRS versus conventional drug-eluting and
bare metallic stents on the cardiovascular endpoints and all-cause
mortality. Methods and results: The follow-up in the included studies was
up to 13 months. The following endpoints were evaluated: all-cause
mortality, cardiac death, patient-oriented major adverse cardiac events
(POCE), device-oriented major adverse cardiac events (DOCE), any-cause
myocardial infarction (MI), target vessel MI (TVMI), target vessel
revascularisation (TVR) and target lesion revascularisation (TLR). The
results of 10 studies with 5,773 subjects showed a statistically
significant increase in the risk of TVMI between BRS and conventional
stents (odds ratio [OR]: 1.45, 95% confidence interval [CI]: 1.03-2.05,
p=0.032). None of the other differences reached statistical significance:
all-cause mortality (OR: 0.67, 95% CI: 0.30-1.49, p=0.333), cardiac death
(OR: 1.00, 95% CI: 0.47-2.12, p=0.996), POCE (OR: 0.91, 95% CI: 0.68-1.22,
p=0.546), DOCE (OR: 1.12, 95% CI: 0.86-1.46, p=0.387), any-cause MI (OR:
1.34, 95% CI: 0.98-1.82, p=0.064), TVR (OR: 0.99, 95% CI: 0.73-1.33,
p=0.934) and TLR (OR: 0.92, 95% CI: 0.66-1.29, p=0.641). Similar results
were observed after restricting the meta-analysis to the comparison of BRS
vs. EES. Conclusions: Our meta-analysis suggests a significantly higher
risk of TVMI with BRS compared with conventional stents and no significant
differences in the rates of occurrence of the other outcomes during
one-year follow-up. Further studies with larger samples sizes, longer
follow-up, different clinical scenarios and more complex lesions are
required to confirm or refute our findings.<br/>Copyright &#xa9; 2016
Europa Digital & Publishing. All rights reserved.

<4>
Accession Number
610963841
Author
Wohrle J.; Markovic S.; Rottbauer W.; Muramatsu T.; Kadota K.;
Vazquez-Gonzalez N.; Odenstedt J.; Serra A.; Antoniucci D.; Varenne O.;
Saito S.; Wijns W.
Institution
(Wohrle, Markovic, Rottbauer) Department of Internal Medicine II,
University of Ulm, Albert-Einstein-Allee 23, Ulm 89081, Germany
(Muramatsu) Department of Cardiology, Saiseikai Yokohama City Eastern
Hospital, Kanagawa, Japan
(Kadota) Department of Cardiology, Kurashiki Central Hospital, Okayama,
Japan
(Vazquez-Gonzalez) Cardiac Catheterization Laboratory, Complexo
Hospitalario Universitario A Coruna, A Coruna, Spain
(Odenstedt) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Serra) Interventional Cardiology Unit, Hospital de la Santa Creu i Sant
Pau, Barcelona, Spain
(Antoniucci) Division of Cardiology, Careggi Hospital, Florence, Italy
(Varenne) Service de Cardiologie, Hopital Cochin, Paris, France
(Saito) Cardiology and Catheterization Laboratories, Shonan Kamakura
General Hospital, Kanagawa, Japan
(Wijns) Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
Title
Bioresorbable polymer sirolimus-eluting coronary stent compared with
permanent polymer everolimus-eluting coronary stent implantation for
treatment of small vessel coronary artery disease: CENTURY II trial.
Source
EuroIntervention. 12 (2) (pp e167-e174), 2016. Date of Publication: June
2016.
Publisher
EuroPCR
Abstract
Aims: CENTURY II is a prospective, multicentre, randomised, single-blind
trial comparing the bioresorbable polymer sirolimus-eluting Ultimaster
stent (BP-SES) with the permanent polymer everolimus-eluting XIENCE stent
(PP-EES). Here we present a pre-specified analysis of safety and efficacy
outcomes in a subgroup of patients with small vessel coronary artery
disease. Methods and results: CENTURY II included 525 patients with
lesions of reference diameter <=2.5 mm. Treatment was randomly assigned:
277 patients received BP-SES (399 lesions) and 248 patients received
PP-EES (377 lesions). The primary outcome was target lesion failure (TLF),
which is a composite of cardiac death, target vessel-related myocardial
infarction (MI) and target lesion revascularisation (TLR). There was no
significant difference between treatment groups in baseline or procedural
data. Mean pre-procedural reference diameter was similar (BP-SES
2.30+/-0.40 mm, PP-EES 2.31+/-0.42 mm, p=0.59). Stented length was
24.0+/-11.7 mm for BP-SES and 23.5+/-11.5 mm for PP-EES (p=0.45). At 12
months, there was no significant difference between the BP-SES and PP-EES
groups in TLF (6.9% vs. 7.7%; p=0.72), cardiac death (1.1% vs. 1.2%;
p=0.90), target vessel MI (1.8% vs. 3.2%; p=0.30), TLR (4.0% vs. 5.7%;
p=0.37), or definite or probable stent thrombosis (0.7% vs. 1.2%; p=0.57).
Conclusions: In the large-scale, randomised CENTURY II trial, use of
BP-SES and PP-EES for the treatment of small vessel coronary artery
disease resulted in similar outcomes at 12 months.<br/>Copyright &#xa9;
2016 Europa Digital & Publishing. All rights reserved.

<5>
Accession Number
613890533
Author
Gil R.J.; Bil J.; Grundeken M.J.; Kern A.; Garcia L.A.I.; Vassilev D.;
Pawlowski T.; Formuszewicz R.; Dobrzycki S.; Wykrzykowska J.J.; Serruys
P.W.
Institution
(Gil, Bil, Pawlowski) Department of Invasive Cardiology, Central Clinical
Hospital of the Ministry of Interior, 137 Woloska Street, Warsaw 02-507,
Poland
(Gil) Institute of Experimental and Clinical Medicine, Polish Academy of
Science, Warsaw, Poland
(Grundeken, Wykrzykowska) Heart Center, Academic Medical Center -
University of Amsterdam, Amsterdam, Netherlands
(Kern) Faculty of Medical Sciences, University of Varmia and Masuria,
Olsztyn, Poland
(Garcia) Costa Del Sol Hospital, Marbella, Spain
(Vassilev) Alexandrovska University Hospital, Sofia, Bulgaria
(Formuszewicz) 10th Clinical Military Hospital, Bydgoszcz, Poland
(Dobrzycki) Department of Invasive Cardiology, Medical University in
Bialystok, Bialystok, Poland
(Serruys) International Centre for Circulatory Health, NHLI, Imperial
College London, London, United Kingdom
Title
Regular drug-eluting stents versus the dedicated coronary bifurcation
sirolimus-eluting BiOSS LIM stent: The randomised, multicentre,
open-label, controlled POLBOS II trial.
Source
EuroIntervention. 12 (11) (pp e1404-e1412), 2016. Date of Publication:
December 2016.
Publisher
EuroPCR
Abstract
Aims: The aim of the POLBOS II randomised trial was to compare any regular
drug-eluting stents (rDES) with the dedicated bifurcation
sirolimus-eluting stent BiOSS LIM for the treatment of coronary
bifurcation lesions. The secondary aim was to study the effect of final
kissing balloon inflation (FKBI) on clinical outcomes. Methods and
results: Between December 2012 and December 2013, 202 patients with stable
coronary artery disease or non-ST-segment elevation acute coronary
syndrome were randomly assigned 1:1 to treatment of the coronary
bifurcation lesions either with the BiOSS LIM stent (n=102) or with an
rDES (n=100). Coronary re-angiography was performed at 12 months. The
primary endpoint was the composite of cardiac death, myocardial infarction
(MI), and target lesion revascularisation (TLR) at 12 months. The target
vessel was located in the left main in one third of the cases (35.3% in
BiOSS and 38% in rDES). Side branch treatment was required in 8.8% (rDES)
and 7% (BiOSS). At 12 months, the cumulative MACE incidence was similar in
both groups (11.8% [BiOSS] vs. 15% [rDES, p=0.08]), as was the TLR rate
(9.8% vs. 9% [p=0.8]). The binary restenosis rates were significantly
lower in the FKBI subgroup of the BiOSS group (5.9% vs. 11.8%, p<0.05).
Conclusions: MACE rates as well as TLR rates were comparable between the
BiOSS LIM and rDES. At 12 months, cumulative MACE incidence was similar in
both groups (11.8% vs. 15%), as was the TLR rate (9.8% vs. 9%).
Significantly lower rates of restenosis were observed in the FKBI subgroup
of the BiOSS group.<br/>Copyright &#xa9; Europa Digital & Publishing 2016.
All rights reserved.

<6>
Accession Number
613890402
Author
Pilgrim T.; Piccolo R.; Heg D.; Roffi M.; Tuller D.; Vuilliomenet A.;
Muller O.; Cook S.; Weilenmann D.; Kaiser C.; Jamshidi P.; Khattab A.A.;
Taniwaki M.; Rigamonti F.; Nietlispach F.; Blochlinger S.; Wenaweser P.;
Juni P.; Windecker S.
Institution
(Pilgrim, Piccolo, Khattab, Taniwaki, Nietlispach, Blochlinger, Wenaweser,
Windecker) Department of Cardiology, Bern University Hospital, Bern 3010,
Switzerland
(Heg) Institute of Social and Preventive Medicine, Clinical Trials Unit,
Bern University Hospital, Bern, Switzerland
(Roffi, Rigamonti) Department of Cardiology, University Hospital, Geneva,
Geneva, Switzerland
(Tuller) Department of Cardiology, Triemlispital, Zurich, Switzerland
(Vuilliomenet) Department of Cardiology, Kantonsspital, Aarau, Switzerland
(Muller) Department of Cardiology, University Hospital, Lausanne,
Switzerland
(Cook) Department of Cardiology, University Hospital, Fribourg,
Switzerland
(Weilenmann) Department of Cardiology, Kantonsspital, St. Gallen,
Switzerland
(Kaiser) Department of Cardiology, University Hospital, Basel, Switzerland
(Jamshidi) Department of Cardiology, Kantonsspital, Luzern, Switzerland
(Juni) Applied Health Research Centre (AHRC), Li Ka Shing Knowledge
Institute of St. Michael's Hospital, University of Toronto, Department of
Medicine, Toronto, Canada
(Juni) Institute of Primary Health Care, University of Bern, Bern,
Switzerland
Title
Biodegradable polymer sirolimus-eluting stents versus durable polymer
everolimus-eluting stents for primary percutaneous coronary
revascularisation of acute myocardial infarction.
Source
EuroIntervention. 12 (11) (pp e1343-e1354), 2016. Date of Publication:
December 2016.
Publisher
EuroPCR
Abstract
Aims: Our aim was to compare the safety and efficacy of a novel, ultrathin
strut, biodegradable polymer sirolimus-eluting stent (BP-SES) with a thin
strut, durable polymer everolimus-eluting stent (DP-EES) in a
pre-specified subgroup of patients with acute ST-segment elevation
myocardial infarction (STEMI) enrolled in the BIOSCIENCE trial. Methods
and results: The BIOSCIENCE trial is an investigator-initiated,
single-blind, multicentre, randomised non-inferiority trial (NCT01443104).
Randomisation was stratified according to the presence or absence of
STEMI. The primary endpoint, target lesion failure (TLF), is a composite
of cardiac death, target vessel myocardial infarction, and clinically
indicated target lesion revascularisation within 12 months. Between
February 2012 and May 2013, 407 STEMI patients were randomly assigned to
treatment with BP-SES or DP-EES. At one year, TLF occurred in seven (3.4%)
patients treated with BP-SES and 17 (8.8%) patients treated with DP-EES
(RR 0.38, 95% CI: 0.16-0.91, p=0.024). Rates of cardiac death were 1.5% in
the BP-SES group and 4.7% in the DP-EES group (RR 0.31, 95% CI: 0.08-1.14,
p=0.062); rates of target vessel myocardial infarction were 0.5% and 2.6%
(RR 0.18, 95% CI: 0.02-1.57, p=0.082), respectively, and rates of
clinically indicated target lesion revascularisation were 1.5% in the
BP-SES group versus 2.1% in the DP-EES group (RR 0.69, 95% CI: 0.16-3.10,
p=0.631). There was no difference in the risk of definite stent
thrombosis. Conclusions: In this pre-specified subgroup analysis, BP-SES
was associated with a lower rate of target lesion failure at one year
compared to DP-EES in STEMI patients. These findings require confirmation
in a dedicated STEMI trial.<br/>Copyright &#xa9; Europa Digital &
Publishing 2016. All rights reserved.

<7>
[Use Link to view the full text]
Accession Number
612344068
Author
Karkouti K.; Callum J.; Wijeysundera D.N.; Rao V.; Crowther M.; Grocott
H.P.; Pinto R.; Scales D.C.; Achen B.; Brar S.; Morrison D.; Wong D.;
Bussieres J.S.; De Waal T.; Harle C.; De Medicis E.; McAdams C.; Syed S.;
Tran D.; Waters T.
Institution
(Karkouti) Department of Anesthesia and Pain Management, Toronto General
Hospital, University Health Network, University of Toronto, 3EN, Toronto,
ON M5G 2C4, Canada
(Callum) Department of Laboratory Medicine and Pathobiology, Sunnybrook
Health Sciences Centre, University of Toronto, Canada
(Wijeysundera) Department of Anesthesia and Pain Management, Toronto
General Hospital, University Health Network, University of Toronto, Li Ka
Shing Knowledge Institute of St. Michael's Hospital, Canada
(Rao) Division of Cardiac Surgery, Department of Surgery, Toronto General
Hospital, University Health Network, University of Toronto, Canada
(Crowther) Department of Pathology and Molecular Medicine, McMaster
University, Hamilton, Canada
(Grocott) Department of Anesthesia and Perioperative Medicine, University
of Manitoba, Winnipeg, Canada
(Pinto) Department of Critical Care Medicine, Sunnybrook Health Sciences
Centre, University of Toronto, Canada
(Scales) Department of Critical Care Medicine, Sunnybrook Health Sciences
Centre, Interdepartmental Division of Critical Care, University of
Toronto, Canada
(Karkouti, Wijeysundera, Rao) Peter Munk Cardiac Centre, University Health
Network, Toronto, Canada
(Achen) Department of Anesthesia, University Hospital, Edmonton, AB,
Canada
(Brar, Morrison, Wong) Department of Anesthesia, Royal Columbian Hospital,
New Westminster, BC, Canada
(Bussieres) Department of Anesthesia, Institut Universitaire de
Cardiologie et de Pneumologie de Quebec, Quebec City, QC, Canada
(De Waal) Department of Anesthesia, Southlake Regional Health Centre,
Newmarket, ON, Canada
(Harle) Department of Anesthesia, London Health Sciences Centre (LHSC),
University Hospital, London, ON, Canada
(De Medicis) Department of Anesthesia, Sherbrooke Hopital Fleurimont
(CHUS), Sherbrooke, QC, Canada
(McAdams) Department of Anesthesia, Alberta Health Science Centre,
Calgary, AB, Canada
(Syed) Department of Anesthesia, Hamilton Health Sciences Centre (HHSC),
McMaster University, Hamilton, ON, Canada
(Tran) Department of Anesthesia, University of Ottawa Heart Institute,
Ottawa, ON, Canada
(Waters) Department of Anesthesia, VCH Vancouver Coastal Health (UBC),
Vancouver, BC, Canada
Title
Point-of-Care Hemostatic Testing in Cardiac Surgery: A Stepped-Wedge
Clustered Randomized Controlled Trial.
Source
Circulation. 134 (16) (pp 1152-1162), 2016. Date of Publication: 18 Oct
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Cardiac surgery is frequently complicated by coagulopathic
bleeding that is difficult to optimally manage using standard hemostatic
testing. We hypothesized that point-of-care hemostatic testing within the
context of an integrated transfusion algorithm would improve the
management of coagulopathy in cardiac surgery and thereby reduce blood
transfusions. Methods: We conducted a pragmatic multicenter stepped-wedge
cluster randomized controlled trial of a point-of-care-based transfusion
algorithm in consecutive patients undergoing cardiac surgery with
cardiopulmonary bypass at 12 hospitals from October 6, 2014, to May 1,
2015. Following a 1-month data collection at all participating hospitals,
a transfusion algorithm incorporating point-of-care hemostatic testing was
sequentially implemented at 2 hospitals at a time in 1-month intervals,
with the implementation order randomly assigned. No other aspects of care
were modified. The primary outcome was red blood cell transfusion from
surgery to postoperative day 7. Other outcomes included transfusion of
other blood products, major bleeding, and major complications. The
analysis adjusted for secular time trends, within-hospital clustering, and
patient-level risk factors. All outcomes and analyses were prespecified
before study initiation. Results: Among the 7402 patients studied, 3555
underwent surgery during the control phase and 3847 during the
intervention phase. Overall, 3329 (45.0%) received red blood cells, 1863
(25.2%) received platelets, 1645 (22.2%) received plasma, and 394 (5.3%)
received cryoprecipitate. Major bleeding occurred in 1773 (24.1%)
patients, and major complications occurred in 740 (10.2%) patients. The
trial intervention reduced rates of red blood cell transfusion (adjusted
relative risk, 0.91; 95% confidence interval, 0.85-0.98; P=0.02; number
needed to treat, 24.7), platelet transfusion (relative risk, 0.77; 95%
confidence interval, 0.68-0.87; P<0.001; number needed to treat, 16.7),
and major bleeding (relative risk, 0.83; 95% confidence interval,
0.72-0.94; P=0.004; number needed to treat, 22.6), but had no effect on
other blood product transfusions or major complications. Conclusions:
Implementation of point-of-care hemostatic testing within the context of
an integrated transfusion algorithm reduces red blood cell transfusions,
platelet transfusions, and major bleeding following cardiac surgery. Our
findings support the broader adoption of point-of-care hemostatic testing
into clinical practice. Clinical Trial Registration: URL:
http://www.clinicaltrials.gov. Unique identifier:
NCT02200419.<br/>Copyright &#xa9; 2016 American Heart Association, Inc.

<8>
Accession Number
611592814
Author
Kularatna S.; Byrnes J.; Mervin M.C.; Scuffham P.A.
Institution
(Kularatna, Byrnes, Mervin, Scuffham) Centre for Applied Health Economics,
School of Medicine, Griffith University, Australia
(Kularatna, Byrnes, Mervin, Scuffham) Population and Social Health
Research Program, Menzies Health Institute Queensland, Griffith
University, Australia
Title
Health technology assessments reporting cost-effectiveness of
transcatheter aortic valve implantation.
Source
International Journal of Technology Assessment in Health Care. 32 (3) (pp
89-96), 2016. Date of Publication: 2016.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Objectives: Made available since 2002, transcatheter aortic valve
implantation (TAVI) is a minimally invasive new intervention which can
provide significant survival improvement to patients with aortic stenosis.
However, TAVI is expensive and currently not reimbursed by many
governments. Some governments and institutions have been conducting health
technology assessments (HTAs) to inform their reimbursement decisions. The
aim of the present study is to review HTAs that have relied on a
cost-effectiveness analysis to inform reimbursement decisions of TAVI.
Methods: A systematic literature review was conducted among published
literature as well as reports released by HTA agencies. Predetermined
inclusion and exclusion criteria, following the Preferred Reporting System
for Systematic Reviews and Meta-Analysis guidelines, were used to select
relevant HTAs. The selected papers were assessed against the Consolidated
Health Economic Evaluation Reporting Standards. Results: HTAs on TAVI from
three countries were available for this review: Canada, Belgium, and the
United Kingdom. All three HTAs used the Placement of Aortic Transcatheter
Valve (PARTNER) trial data with Markov models to estimate the incremental
cost effectiveness ratio. The three HTAs recommended conditional
reimbursement for TAVI for otherwise inoperable patients. The HTAs did not
use clear methods to estimate the health-related utility which ultimately
affected their cost-effectiveness results. The UK HTA showed the best
value for money (US$20,416 per quality-adjusted life-year). Conclusion:
All studies found TAVI to be more costly and less effective for high-risk
patients suitable for surgery, whereas TAVI was consistently found to be
cost effective for otherwise inoperable patients.<br/>Copyright &#xa9;
Cambridge University Press 2016.

<9>
Accession Number
616708673
Author
Ursoniu S.; Mikhailidis D.P.; Serban M.-C.; Penson P.; Toth P.P.; Ridker
P.M.; Ray K.K.; Kees Hovingh G.; Kastelein J.J.; Hernandez A.V.; Manson
J.E.; Rysz J.; Banach M.
Institution
(Ursoniu) Department of Functional Sciences, Discipline of Public
HealthDiscipline of Public Health, "Victor Babes" University of Medicine
and Pharmacy, Timisoara, Romania
(Mikhailidis) Department of Clinical Biochemistry, Royal Free Campus,
University College London Medical School, University College London (UCL),
London, United Kingdom
(Serban) Department of Epidemiology, University of Alabama at Birmingham,
Birmingham, AL, United States
(Serban) Department of Functional Sciences, Discipline of
PathophysiologyDiscipline of Pathophysiology, "Victor Babes" University of
Medicine and Pharmacy, Timisoara, Romania
(Penson) School of Pharmacy and Biomolecular Sciences, Liverpool John
Moores University, Liverpool, United Kingdom
(Toth) Preventive Cardiology, CGH Medical Center, Sterling, Illinois,
United States
(Toth) The Johns Hopkins Ciccarone Center for the Prevention of Heart
Disease, Baltimore, MD, United States
(Ridker) Center for Cardiovascular Disease Prevention, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States
(Ray) Department of Primary Care and Public Health, School of Public
Health, Imperial College London, United Kingdom
(Kees Hovingh, Kastelein) Department of Vascular Medicine, Academic
Medical Center, Amsterdam, Netherlands
(Hernandez) Health Outcomes and Clinical Epidemiology Section, Department
of Quantitative Health Sciences, Lerner Research Institute, Cleveland
Clinic, Cleveland, OH, United States
(Hernandez) School of Medicine, Universidad Peruana de Ciencias Aplicadas
(UPC), Lima, Peru
(Manson) Division of Preventive Medicine, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Manson) Department of Epidemiology, Harvard T.H. Chan School of Public
Health, Boston, MA, United States
(Rysz, Banach) Department of Hypertension, Chair of Nephrology and
Hypertension, Medical University of Lodz, Poland
(Banach) Cardiovascular Research Centre, University of Zielona Gora,
Zielona Gora, Poland
(Banach) Polish Mother's Memorial Hospital Research Institute, Lodz,
Poland
Title
The effect of statins on cardiovascular outcomes by smoking status: A
systematic review and meta-analysis of randomized controlled trials.
Source
Pharmacological Research. 122 (pp 105-117), 2017. Date of Publication:
August 2017.
Publisher
Academic Press
Abstract
Smoking is an important risk factor for cardiovascular disease (CVD)
morbidity and mortality. The impact of statin therapy on CVD risk by
smoking status has not been fully investigated. Therefore we assessed the
impact of statin therapy on CVD outcomes by smoking status through a
systematic review of the literature and meta-analysis of available
randomized controlled trials (RCTs). The literature search included
EMBASE, ProQuest, CINAHL and PUBMED databases to 30 January 2016 to
identify RCTs that investigated the effect of statin therapy on cumulative
incidence of major CVD endpoints (e.g. non-fatal myocardial infarction,
revascularization, unstable angina, and stroke). Relative risks (RR)
ratios were calculated from the number of events in different treatment
groups for both smokers and non-smokers. Finally 11 trials with 89,604
individuals were included. The number of smokers and non-smokers in the
statin groups of the analyzed studies was 8826 and 36,090, respectively.
The RR for major CV events was 0.73 (95% confidence interval [CI]:
0.67-0.81; p < 0.001) in nonsmokers and 0.72 (95%CI: 0.64-0.81; p < 0.001)
in smokers. Moderate to high heterogeneity was observed both in
non-smokers (I² = 77.1%, p < 0.001) and in smokers
(I² = 51.6%, p = 0.024) groups. Smokers seemed to benefit
slightly more from statins than non-smokers according to the number needed
to treat (NNT) analysis (23.5 vs 26.8) based on RRs applied to the control
event rates. The number of avoided events per 1000 individuals was 42.5
(95%CI: 28.9-54.6) in smokers and 37.3 (95%CI: 27.2-46.4) in non-smokers.
In conclusion, this meta-analysis suggests that the effect of statins on
CVD is similar for smokers and non-smokers, but in terms of NNTs and
number of avoided events, smokers seem to benefit more although
non-significantly.<br/>Copyright &#xa9; 2017

<10>
[Use Link to view the full text]
Accession Number
610791883
Author
Pineda A.M.; Carvalho N.; Gowani S.A.; Desouza K.A.; Santana O.; Mihos
C.G.; Stone G.W.; Beohar N.
Institution
(Pineda, Carvalho, Gowani, Desouza, Santana, Mihos, Beohar) Division of
Cardiology, Columbia University, Mount Sinai Medical Center, Cardiac
Catheterization Laboratory, Miami Beach, FL 33140, United States
(Stone) Division of Cardiology, Columbia University Medical Center, New
York, NY, United States
Title
Managing Multivessel Coronary Artery Disease in Patients with ST-Elevation
Myocardial Infarction: A Comprehensive Review.
Source
Cardiology in Review. 25 (4) (pp 179-188), 2017. Date of Publication:
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Multivessel coronary artery disease (CAD) is found in up to 60% of the
patients presenting with an ST-elevation myocardial infarction (STEMI) and
worsens the prognosis proportional to the extent of CAD severity. However,
the 2013 American College of Cardiology/American Heart Association STEMI
guidelines, based on mostly observational data, had recommended against a
routine noninfarct-related artery percutaneous coronary intervention
(PCI). After these guidelines were published, a handful of randomized
trials became available, and they suggested that PCI of significant
lesions in a noninfarct-related artery at the time of primary PCI might
result in improved patient outcomes. The incidence of major adverse
cardiac events was significantly reduced by 55% at 1 year and 65% at 2
years in patients undergoing angiographically guided PCI of nonculprit
vessels at the time of primary PCI, in 2 different randomized trials.
Fractional flow reserve-guided PCI of nonculprit vessels in this setting
has also been shown to reduce cardiac events by 44% at 1 year.
Meta-analyses of both nonrandomized and randomized trials have also
suggested that complete revascularization at the time of STEMI
significantly improves outcomes, including long-term all-cause mortality.
In view of the emerging data, a focused update on primary PCI was
published in 2015 and suggested that PCI of noninfarct-related arteries
might be considered in selected patients. This article is a comprehensive
review of the literature on the treatment of multivessel CAD in patients
with STEMI, which provides the reader a critical analysis of the available
information to determine the best therapeutic approach.

<11>
Accession Number
616752452
Author
Zhang D.; Yin D.; Song C.; Zhu C.; Kirtane A.J.; Xu B.; Dou K.
Institution
(Zhang, Yin, Song, Zhu, Xu, Dou) State Key Laboratory of Cardiovascular
Disease, Cardiovascular Institute, Fuwai Hospital, National Center for
Cardiovascular Diseases, Beijing, China
(Zhang, Yin, Song, Zhu, Xu, Dou) Department of Cardiology, Cardiovascular
Institute, Chinese Academy of Medical Sciences, Peking Union Medical
College, Beijing, China
(Kirtane) Columbia University Medical Center, New York Presbyterian
Hospital, New York, NY, United States
Title
A randomised comparison of Conventional versus Intentional straTegy in
patients with high Risk prEdiction of Side branch OccLusion in coronary
bifurcation interVEntion: Rationale and design of the CIT-RESOLVE trial.
Source
BMJ Open. 7 (6) (no pagination), 2017. Article Number: e016044. Date of
Publication: 01 Jun 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction The intentional strategy (aggressive side branch (SB)
protection strategy: Elective two-stent strategy or jailed balloon
technique) is thought to be associated with lower SB occlusion rate than
conventional strategy (provisional two-stent strategy or jailed wire
technique). However, most previous studies showed comparable outcomes
between the two strategies, probably due to no risk classification of SB
occlusion when enrolling patients. There is still no randomised trial
compared the intentional and conventional strategy when treating
bifurcation lesions with high risk of SB occlusion. We aim to investigate
if intentional strategy is associated with significant reduction of SB
occlusion rate compared with conventional strategy in high-risk patients.
Methods and analysis The Conventional versus Intentional straTegy in
patients with high Risk prEdiction of Side branch OccLusion in coronary
bifurcation interVEntion (CIT-RESOLVE) is a prospective, randomised,
single-blind, multicentre clinical trial comparing the rate of SB
occlusion between the intentional strategy group and the conventional
strategy group (positive control group) in a consecutive cohort of
patients with high risk of side branch occlusion defined by V-RESOLVE
score, which is a validated angiographic scoring system to evaluate the
risk of SB occlusion in bifurcation intervention and used as one of the
inclusion criteria to select patients with high SB occlusion risk
(V-RESOLVE score >=12). A total of 21 hospitals from 10 provinces in China
participated in the present study. 566 patients meeting all
inclusion/exclusion criteria are randomised to either intentional strategy
group or conventional strategy group. The primary endpoint is SB occlusion
(defined as any decrease in thrombolysis in myocardial infarction flow
grade or absence of flow in SB after main vessel stenting). All patients
are followed up for 12-month postdischarge. Ethics and dissemination The
protocol has been approved by all local ethics committee. The ethics
committee have approved the study protocol, evaluated the risk to benefit
ratio, allowed operators with a minimum annual volume of 200 cases to
participate in the percutaneous coronary intervention procedure and
permitted them to perform both conventional and intentional strategies.
Written informed consent would be acquired from all participants. The
findings of the trial will be shared by the participant hospitals and
disseminated through peer-reviewed journals. Trial registration number
NCT02644434; Pre-results.<br/>Copyright &#xa9; 2017 Article author(s).

<12>
Accession Number
616800177
Author
Takagi H.; Ando T.; Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Title
Seizures associated with tranexamic acid for cardiac surgery: A
meta-analysis of randomized and non-randomized studies.
Source
Journal of Cardiovascular Surgery. 58 (4) (pp 633-641), 2017. Date of
Publication: August 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: The aim of this meta-analysis was to assess whether
tranexamic acid (TXA) therapy for adult cardiac surgery is associated with
an increase in the risk of seizures, and we performed a meta-analysis of
randomized controlled trials (RCTs) and non-randomized observational
studies. EVIDENCE ACQUISITION: MEDLINE and EMBASE were searched through
December 2016 using PubMed and OVID. Eligible studies were RCTs and
non-randomized observational studies on TXA versus control (no TXA,
placebo, or active control such as low-dose TXA, aprotinin, and epsilon
aminocaproic acid) enrolling adult patients undergoing cardiac surgery and
reporting the postoperative incidence of seizures as an outcome.
Study-specific estimates were combined using inverse variance-weighted
averages of logarithmic odds ratios (ORs) in the random-effects model.
EVIDENCE SYNTHESIS: Of 90 potentially relevant articles screened
initially, 16 reports of eligible studies were identified and included. A
pooled analysis of all 16 studies (enrolling 45,235 patients) demonstrated
that TXA therapy was associated with a statistically significant increase
in the seizures incidence (OR=4.13; 95% CI: 2.59 to 6.57; P<0.00001). A
subgroup analysis indicated a statistically significant increase in the
seizures incidence with TXA therapy in all subgroups of 5 RCTs, 5 adjusted
observational studies, and 6 unadjusted observational studies with no
statistically significant subgroup differences (P=0.36;
I²=1.5%). CONCLUSIONS: The results of the present meta-analysis
of 16 studies enrolling 45,235 patients confirmed that TXA therapy for
adult cardiac surgery is associated with a 4.1-fold increase in the risk
of seizure.<br/>Copyright &#xa9; 2017 EDIZIONI MINERVA MEDICA.

<13>
Accession Number
616800121
Author
Doenst T.; Lamelas J.
Institution
(Doenst) Department of Cardiothoracic Surgery, Jena University Hospital,
Friedrich Schiller University of Jena, Erlanger Allee 101, Jena 07747,
Germany
(Lamelas) Division of Cardiac Surgery, Mount Sinai Heart Institute, Mount
Sinai Medical Center, Miami Beach, FL, United States
Title
Do we have enough evidence for minimally-invasive cardiac surgery? A
critical review of scientific and non-scientific information.
Source
Journal of Cardiovascular Surgery. 58 (4) (pp 613-623), 2017. Date of
Publication: August 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Reducing surgical trauma by minimizing skin incisions has transformed
abdominal surgery resulting in significant improvements in outcome. In
cardiac surgery, such efforts have also been made, but similar benefits
could not be demonstrated. In addition, any potential benefit comes at the
cost of increased cardiopulmonary bypass and clamp times, leading to
questions regarding the safety of minimally invasive cardiac surgery
(MICS). Nevertheless, outcomes have been equivalent to matched sternotomy
cases and there is no doubt that the number of patients undergoing
minimally-invasive mitral or aortic procedures is slowly increasing. To
date almost half of all isolated mitral cases in Germany and roughly one
fourth in the USA are performed through a minimized access. These numbers
were less than half 10 years ago. So how can this development be
justified, if the evidence for it seems to be questionable or even
missing? We will attempt to provide some answers to this question by
critically reviewing the available publications and by looking at the
topic from other perspectives, including from a competitive and a patient
standpoint. We will conclude that there is enough evidence to support
minimally-invasive access as the primary approach to a valve in the
majority of patients. We will further suggest that modern cardiac surgery
may have difficulties to prevail in its full width, if these novel
techniques are not embraced. Finally, we will demonstrate that minimally
invasive cardiac surgery is associated with substantial improvements in
patient care, however, in areas that are unlikely to be tested with
randomized controlled trials.<br/>Copyright &#xa9; 2016 EDIZIONI MINERVA
MEDICA.

<14>
Accession Number
616785293
Author
Henderson R.
Institution
(Henderson) Trent Cardiac Centre, Nottingham University Hospitals, City
Hospital Campus, Hucknall Road, Nottingham NG51PB, United Kingdom
Title
Early invasive strategy in patients with non-ST segment elevation acute
coronary syndrome delays death or MI by 18 months.
Source
Evidence-Based Medicine. 22 (3) (pp 97), 2017. Date of Publication: June
2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)

<15>
Accession Number
616775548
Author
Kulik A.; Abreu A.M.; Boronat V.; Ruel M.
Institution
(Kulik, Abreu, Boronat) Lynn Heart and Vascular Institute, Boca Raton
Regional Hospital and Charles E. Schmidt College of Medicine, Florida
Atlantic University, Boca Raton, FL, United States
(Ruel) University of Ottawa Heart Institute, Ottawa, Ontario, Canada
Title
Intensive versus moderate atorvastatin therapy and one-year graft patency
after CABG: Rationale and design of the ACTIVE (Aggressive Cholesterol
Therapy to Inhibit Vein Graft Events) randomized controlled trial
(NCT01528709).
Source
Contemporary Clinical Trials. 59 (pp 98-104), 2017. Date of Publication:
August 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Rationale Saphenous vein graft disease remains a major limitation of
coronary artery bypass graft surgery (CABG). Statin therapy inhibits the
development of vein graft disease and improves outcomes after CABG.
However, it is unclear whether treatment with high-dose statins will
further slow the process of vein graft disease and improve graft patency,
as compared to conventional moderate doses. Therefore, the goal of this
study will be to evaluate the efficacy of high-dose statin therapy versus
moderate-dose statin therapy for the prevention of saphenous vein graft
occlusion following CABG. Study design The Aggressive Cholesterol Therapy
to Inhibit Vein Graft Events (ACTIVE) trial is a multi-center double-blind
randomized controlled trial enrolling patients who have undergone
multi-vessel CABG with at least one saphenous vein graft. Patients will be
randomized to receive either atorvastatin 80 mg daily or atorvastatin 10
mg daily for one year starting within 5 days after surgery. The target
enrollment is 100 patients in each arm (200 patients total). Lipid levels
will be assessed every 3 months. After one year, patients will undergo
computed tomography (CT) coronary angiography to assess the incidence of
vein graft occlusion and stenosis. Conclusion This trial is the first
prospective study to evaluate the impact of early postoperative high-dose
statin therapy on graft patency after CABG. Should high-dose statin
therapy reduce the incidence of postoperative graft occlusion, the results
will add to the growing evidence supporting the role of high-intensity
statins for modern lipid management after coronary surgical
revascularization (ClinicalTrials.gov NCT01528709).<br/>Copyright &#xa9;
2017

<16>
Accession Number
614831848
Author
Bhatt D.L.; Steg P.G.; Brinton E.A.; Jacobson T.A.; Miller M.; Tardif
J.-C.; Ketchum S.B.; Doyle R.T.; Murphy S.A.; Soni P.N.; Braeckman R.A.;
Juliano R.A.; Ballantyne C.M.
Institution
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center and Harvard
Medical School, Boston, MA, United States
(Steg) FACT (French Alliance for Cardiovascular Trials), an F-CRIN
network, Departement Hospitalo-Universitaire FIRE, AP-HP, Hopital Bichat,
Universite Paris-Diderot, INSERM U-1148, Paris, France
(Steg) NHLI, Imperial College, Royal Brompton Hospital, London, United
Kingdom
(Brinton) Utah Foundation for Biomedical Research, and Utah Lipid Center,
Salt Lake City, United States
(Jacobson) Office of Health Promotion and Disease Prevention, Department
of Medicine, Emory University School of Medicine, Atlanta, GA, United
States
(Miller) Department of Medicine, University of Maryland School of
Medicine, Baltimore, United States
(Tardif) Montreal Heart Institute, Universite de Montreal, QC, Canada
(Ketchum, Doyle, Soni, Braeckman, Juliano) Amarin Pharma Inc., Bedminster,
NJ, United States
(Soni) Albireo Pharma, Boston, MA, United States
(Braeckman) KemPharm, Inc., Celebration, FL, United States
(Murphy) TIMI Study Group, Cardiovascular Division, Department of
Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston,
MA, United States
(Ballantyne) Department of Medicine, Baylor College of Medicine, and
Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and
Vascular Center, Houston, TX, United States
Title
Rationale and design of REDUCE-IT: Reduction of Cardiovascular Events with
Icosapent Ethyl-Intervention Trial.
Source
Clinical Cardiology. 40 (3) (pp 138-148), 2017. Date of Publication: 01
Mar 2017.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Residual cardiovascular risk persists despite statins, yet outcome studies
of lipid-targeted therapies beyond low-density lipoprotein cholesterol
(LDL-C) have not demonstrated added benefit. Triglyceride elevation is an
independent risk factor for cardiovascular events. High-dose
eicosapentaenoic acid (EPA) reduces triglyceride-rich lipoproteins without
raising LDL-C. Omega-3s have postulated pleiotropic cardioprotective
benefits beyond triglyceride-lowering. To date, no large, multinational,
randomized clinical trial has proved that lowering triglycerides on top of
statin therapy improves cardiovascular outcomes. The Reduction of
Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT;
NCT01492361) is a phase 3b randomized, double-blinded, placebo-controlled
trial of icosapent ethyl, a highly purified ethyl ester of EPA, vs
placebo. The main objective is to evaluate whether treatment with
icosapent ethyl reduces ischemic events in statin-treated patients with
high triglycerides at elevated cardiovascular risk. REDUCE-IT enrolled men
or women age >=45 years with established cardiovascular disease or age
>=50 years with diabetes mellitus and 1 additional risk factor.
Randomization required fasting triglycerides >=150 mg/dL and <500 mg/dL
and LDL-C >40 mg/dL and <=100 mg/dL with stable statin (+/- ezetimibe) >=4
weeks prior to qualifying measurements. The primary endpoint is a
composite of cardiovascular death, nonfatal myocardial infarction,
nonfatal stroke, coronary revascularization, or unstable angina. The key
secondary endpoint is the composite of cardiovascular death, nonfatal
myocardial infarction, or nonfatal stroke. Several secondary, tertiary,
and exploratory endpoints will be assessed. Approximately 8000 patients
have been randomized at approximately 470 centers worldwide. Follow-up
will continue in this event-driven trial until approximately 1612
adjudicated primary-efficacy endpoint events have occurred.<br/>Copyright
&#xa9; 2017 The Authors. Clinical Cardiology published by Wiley
Periodicals, Inc.

<17>
Accession Number
614990959
Author
Nerlekar N.; Cheshire C.J.; Verma K.P.; Ihdayhid A.-R.; McCormick L.M.;
Cameron J.D.; Bennett M.R.; Malaiapan Y.; Meredith I.T.; Brown A.J.
Institution
(Nerlekar, Cheshire, Verma, Ihdayhid, McCormick, Cameron, Malaiapan,
Meredith, Brown) Monash Cardiovascular Research Centre and MonashHeart,
Monash Health, Clayton, VIC 3168, Australia
(Bennett, Brown) Division of Cardiovascular Medicine, University of
Cambridge, Cambridge, United Kingdom
Title
Intravascular ultrasound guidance improves clinical outcomes during
implantation of both first-and secondgeneration drug-eluting stents: A
meta-analysis.
Source
EuroIntervention. 12 (13) (pp 1632-1642), 2017. Date of Publication: 2017.
Publisher
EuroPCR
Abstract
Aims: Our aim was to assess whether intravascular ultrasound (IVUS)
improves clinical outcomes during implantation of first-and
second-generation drug-eluting stents (DES). IVUS guidance is associated
with improved clinical outcomes during DES implantation, but it is unknown
whether this benefit is limited to either first-or second-generation
devices. Methods and results: MEDLINE, EMBASE and PubMed were searched for
studies comparing outcomes between IVUS-and angiography-guided PCI. Among
909 potentially relevant studies, 15 trials met the inclusion criteria.
The primary endpoint was MACE, defined as death, myocardial infarction,
target vessel/ lesion revascularisation (TVR/TLR) or stent thrombosis
(ST). Summary estimates were obtained using Peto modelling. In total,
9,313 patients from six randomised trials and nine observational studies
were included. First-generation DES were implanted in 6,156 patients
(3,064 IVUS-guided and 3,092 angiography-guided) and second-generation in
3,157 patients (1,528 IVUS-guided and 1,629 angiography-guided). IVUS
guidance was associated with a significant reduction in MACE (odds ratio
[OR] 0.73, 95% CI: 0.64-0.85, p<0.001), across both first-(OR 0.79, 95%
CI: 0.67-0.92, p=0.01) and second-generation DES (0.57, 95% CI: 0.43-0.77,
p<0.001). For second-generation DES, IVUS guidance was associated with
significantly lower rates of cardiac death (OR 0.33, 95% CI: 0.14-0.78,
p=0.02), TVR (OR 0.47, 95% CI: 0.28-0.79, p=0.006), TLR (OR 0.61, 95% CI:
0.42-0.90, p=0.01) and ST (OR 0.31, 95% CI: 0.12-0.78, p=0.02). Cumulative
meta-analysis highlighted progressive temporal benefit towards IVUS-guided
PCI to reduce MACE (OR 0.60, 95% CI: 0.48-0.75, p<0.001). Conclusions:
IVUS guidance is associated with a significant reduction in MACE during
implantation of both first-and second-generation DES platforms. These data
support the use of IVUS guidance in contemporary revascularisation
procedures using second-generation DES.<br/>Copyright &#xa9; Europa
Digital & Publishing 2017. All rights reserved.

<18>
[Use Link to view the full text]
Accession Number
612933994
Author
Royse C.F.; Saager L.; Whitlock R.; Ou-Young J.; Royse A.; Vincent J.;
Devereaux P.J.; Kurz A.; Awais A.; Panjasawatwong K.; Sessler D.I.
Institution
(Royse, Ou-Young, Royse) Department of Surgery, University of Melbourne,
PO Box 2135, Melbourne, VIC 3050, Australia
(Royse) Department of Anaesthesia and Pain Management, Australia
(Royse) Department of Cardiothoracic Surgery, Royal Melbourne Hospital,
Melbourne, VIC, Australia
(Saager, Royse, Kurz, Awais, Panjasawatwong, Sessler) Department of
Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland,
OH, United States
(Whitlock) Department of Surgery, United States
(Whitlock, Vincent, Devereaux) Population Health Research Institute,
Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
(Devereaux, Panjasawatwong) Department of Anesthesiology, Faculty of
Medicine, Chiang Mai University, Thailand
Title
Impact of Methylprednisolone on Postoperative Quality of Recovery and
Delirium in the Steroids in Cardiac Surgery Trial: A Randomized,
Double-blind, Placebo-controlled Substudy.
Source
Anesthesiology. 126 (2) (pp 223-233), 2017. Date of Publication: 01 Feb
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Inflammation after cardiopulmonary bypass may contribute to
postoperative delirium and cognitive dysfunction. The authors evaluated
the effect of high-dose methylprednisolone to suppress inflammation on the
incidence of delirium and postoperative quality of recovery after cardiac
surgery. Methods: Five hundred fifty-five adults from three hospitals
enrolled in the randomized, double-blind Steroids in Cardiac Surgery trial
were randomly allocated to placebo or 250 mg methylprednisolone at
induction and 250 mg methylprednisolone before cardiopulmonary bypass.
Each completed the Postoperative Quality of Recovery Scale before surgery
and on days 1, 2, and 3 and 1 and 6 months after surgery and the Confusion
Assessment Method scale for delirium on days 1, 2, and 3. Recovery was
defined as returning to preoperative values or improvement at each time
point. Results: Four hundred eighty-two participants for recovery and 498
participants for delirium were available for analysis. The quality of
recovery improved over time but without differences between groups in the
primary endpoint of overall recovery (odds ratio range over individual
time points for methylprednisolone, 0.39 to 1.45; 95% CI, 0.08-2.04 to
0.40-5.27; P = 0.943) or individual recovery domains (all P > 0.05). The
incidence of delirium was 10% (control) versus 8% (methylprednisolone; P =
0.357), with no differences in delirium subdomains (all P > 0.05). In
participants with normal (51%) and low baseline cognition (49%), there
were no significant differences favoring methylprednisolone in any domain
(all P > 0.05). Recovery was worse in patients with postoperative delirium
in the cognitive (P = 0.004) and physiologic (P < 0.001) domains.
Conclusions: High-dose intraoperative methylprednisolone neither reduces
delirium nor improves the quality of recovery in high-risk cardiac
surgical patients.

<19>
[Use Link to view the full text]
Accession Number
613247585
Author
Hajjar L.A.; Vincent J.L.; Barbosa Gomes Galas F.R.; Rhodes A.; Landoni
G.; Osawa E.A.; Melo R.R.; Sundin M.R.; Grande S.M.; Gaiotto F.A.;
Pomerantzeff P.M.; Dallan L.O.; Franco R.A.; Nakamura R.E.; Lisboa L.A.;
De Almeida J.P.; Gerent A.M.; Souza D.H.; Gaiane M.A.; Fukushima J.T.;
Park C.L.; Zambolim C.; Rocha Ferreira G.S.; Strabelli T.M.; Fernandes
F.L.; Camara L.; Zeferino S.; Santos V.G.; Piccioni M.A.; Jatene F.B.;
Costa Auler J.O.; Filho R.K.
Institution
(Hajjar, Barbosa Gomes Galas, Osawa, Melo, Sundin, Grande, Franco,
Nakamura, De Almeida, Gerent, Souza, Gaiane, Fukushima, Park, Zambolim,
Rocha Ferreira, Fernandes, Camara, Zeferino, Santos, Piccioni, Costa
Auler) Department of Cardiopneumology, InCor, Faculdade de Medicina da
Universidade de Sao Paulo, Universidade de Sao Paulo, Av Dr Eneas Carvalho
Aguiar 44, Sao Paulo, Brazil
(Gaiotto, Pomerantzeff, Dallan, Lisboa, Jatene) Division of Cardiovascular
Surgery, United States
(Strabelli) Division of Infectious Diseases, United States
(Filho) Division of Cardiology, Heart Institute (InCor), Hospital das
Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo,
Brazil
(Vincent) Department of Intensive Care, Erasme University Hospital,
Universite de Bruxelles, Brussels, Belgium
(Rhodes) Department of Intensive Care Medicine, St George's Healthcare NHS
Trust, St George's University of London, London, United Kingdom
(Landoni) Department of Anesthesia and Intensive Care, San Raffaele
Scientific Institute, Milan, Italy
(Landoni) Vita-Salute San Raffaele University, Milan, Italy
Title
Vasopressin versus Norepinephrine in Patients with Vasoplegic Shock after
Cardiac Surgery.
Source
Anesthesiology. 126 (1) (pp 85-93), 2017. Date of Publication: 01 Jan
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Vasoplegic syndrome is a common complication after cardiac
surgery and impacts negatively on patient outcomes. The objective of this
study was to evaluate whether vasopressin is superior to norepinephrine in
reducing postoperative complications in patients with vasoplegic syndrome.
Methods: This prospective, randomized, double-blind trial was conducted at
the Heart Institute, University of Sao Paulo, Sao Paulo, Brazil, between
January 2012 and March 2014. Patients with vasoplegic shock (defined as
mean arterial pressure less than 65 mmHg resistant to fluid challenge and
cardiac index greater than 2.2 l . min -2 . m -2) after cardiac surgery
were randomized to receive vasopressin (0.01 to 0.06 U/min) or
norepinephrine (10 to 60 mug/min) to maintain arterial pressure. The
primary endpoint was a composite of mortality or severe complications
(stroke, requirement for mechanical ventilation for longer than 48 h, deep
sternal wound infection, reoperation, or acute renal failure) within 30
days. Results: A total of 330 patients were randomized, and 300 were
infused with one of the study drugs (vasopressin, 149; norepinephrine,
151). The primary outcome occurred in 32% of the vasopressin patients and
in 49% of the norepinephrine patients (unadjusted hazard ratio, 0.55; 95%
CI, 0.38 to 0.80; P = 0.0014). Regarding adverse events, the authors found
a lower occurrence of atrial fibrillation in the vasopressin group (63.8%
vs. 82.1%; P = 0.0004) and no difference between groups in the rates of
digital ischemia, mesenteric ischemia, hyponatremia, and myocardial
infarction. Conclusions: The authors' results suggest that vasopressin can
be used as a first-line vasopressor agent in postcardiac surgery
vasoplegic shock and improves clinical outcomes.<br/>Copyright &#xa9; 2016
the American Society of Anesthesiologists, Inc. Wolters Kluwer Health,
Inc. All Rights Reserved.

<20>
Accession Number
616858592
Author
Li S.; Ma Q.; Yang Y.; Lu J.; Zhang Z.; Jin M.; Cheng W.
Institution
(Li, Yang, Lu, Jin, Cheng) Department of Anesthesiology, Beijing Anzhen
Hospital, Capital Medical University, Beijing Institute of Heart, Lung,
and Blood Vessel Disease, Beijing, China
(Ma, Zhang) Department of Anesthesiology, Duke University Medical Center,
Durham, North Carolina, USA
Title
Novel Goal-Directed Hemodynamic Optimization Therapy Based on Major
Vasopressor during Corrective Cardiac Surgery in Patients with Severe
Pulmonary Arterial Hypertension: A Pilot Study.
Source
The heart surgery forum. 19 (6) (pp E297-E302), 2016. Date of Publication:
22 Dec 2016.
Abstract
INTRODUCTION: Pulmonary arterial hypertension (PAH) is a common and fatal
complication of congenital heart disease (CHD). PAH-CHD increases the risk
for postoperative complications. Recent evidence suggests that
perioperative goal-directed hemodynamic optimization therapy (GDHOT)
significantly improves outcomes in surgery patients. Standard GDHOT is
based on major solution volume, vasodilators and inotropic therapy, while
novel GDHOT is based on major vasopressor and inotropic therapy.
Therefore, we tested whether standard or novel GDHOT improves surgical
outcomes in PAH-CHD patients.
METHODS: Forty PAH-CHD patients with a ventricular septal defect (VSD) and
mean pulmonary arterial pressure (mPAP) >50 mmHg, who were scheduled for
corrective surgery, were randomly assigned to 2 groups: SG (study group, n
= 20) and CG (control group, n = 20). SG patients received perioperative
hemodynamic therapy guided by novel GDHOT, while CG patients received
standard GDHOT. Outcome data were recorded up to 28 days postoperatively.
Ventilator time, length of ICU stay, and mortality were the primary
endpoints.
RESULTS: There were no significant differences in preoperative data,
surgical procedure, and hospital mortality rates between the 2 groups.
Time of mechanical ventilation and length of ICU stay were significantly
shorter in SG patients compared to CG patients (P < .05, n = 20). Patients
in SG showed a significantly increased systemic vascular resistance index
and decreased cardiac index, but no change in pulmonary vascular
resistance index at 12 and 24 hours after surgery compared to the controls
(P < .05). Patients in SG had significantly decreased PAP, pulmonary
arterial pressure/systemic arterial pressure (Pp/Ps), and RVSWI (right
ventricular stroke work index) at 12 and 24 hours after surgery (P < .05,
respectively). Patients in SG also showed significantly decreased central
venous pressure at 4, 12, and 24 hours after surgery compared to those
treated with standard protocol (P < .05).
CONCLUSION: Our study provides clinical evidence that perioperative
goal-directed hemodynamic optimization therapy based on major vasopressor
is associated with reduced duration of postoperative respiratory support,
and length of ICU stay in PAH-CHD patients undergoing elective surgery.
These outcomes, then, may be linked to improved hemodynamics and
preservation of right ventricular dynamic function.

<21>
Accession Number
611440414
Author
Weaver F.A.; Abraham W.T.; Little W.C.; Butter C.; Ducharme A.; Halbach
M.; Klug D.; Lovett E.G.; Madershahian N.; Muller-Ehmsen J.; Schafer J.E.;
Senni M.; Swarup V.; Wachter R.; Zile M.R.
Institution
(Weaver) Division of Vascular Surgery and Endovascular Therapy, Keck
School of Medicine, University of Southern California, Los Angeles,
California, United States
(Abraham) Division of Cardiovascular Medicine, The Ohio State University,
Columbus, Ohio, United States
(Little) Division of Cardiology, University of Mississippi Medical Center,
Jackson, Mississippi, United States
(Butter) Department of Cardiology, Immanuel Heart Center Bernau-Medical
School, Brandenburg, Bernau, Germany
(Ducharme) Montreal Heart Institute, University of Montreal, Montreal,
Quebec, Canada
(Halbach) Department of Internal Medicine III, University Hospital of
Cologne, Cologne, Germany
(Klug) Department of Cardiology, University HospitalLilleFrance
(Lovett) Department of Research, CVRx, Inc.%, Minneapolis, Minnesota,
United States
(Madershahian) Department of Cardiothoracic Surgery, Cologne University
Heart Centre, Cologne, Germany
(Muller-Ehmsen) Department of Medicine, Asklepios Klinik Altona, Hamburg,
Germany
(Schafer) Department of Statistics, NAMSA, Inc.%, Minneapolis, Minnesota,
United States
(Senni) Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo,
Italy
(Swarup) Department of Electrophysiology, Arizona Heart Hospital, Phoenix,
Arizona, United States
(Wachter) Clinic for Cardiology and Pneumology, German Cardiovascular
Research Center (DZHK), University Medicine Gottingen, Gottingen, Germany
(Zile) Medical University of South Carolina, Charleston, South Carolina,
United States
(Zile) Ralph H. Johnson Department of Veterans Affairs Medical Center,
Charleston, South Carolina, United States
Title
Surgical Experience and Long-term Results of Baroreflex Activation Therapy
for Heart Failure With Reduced Ejection Fraction.
Source
Seminars in Thoracic and Cardiovascular Surgery. 28 (2) (pp 320-328),
2016. Date of Publication: 02 Feb 2016.
Publisher
W.B. Saunders
Abstract
The purpose of this publication is to describe the intraoperative
experience along with long-term safety and efficacy of the
second-generation baroreflex activation therapy (BAT) system in patients
with heart failure (HF) and reduced ejection fraction HF (HFrEF). In a
randomized trial of New York Heart Association Class III HFrEF, 140
patients were assigned 1:1 to receive BAT plus medical therapy or medical
therapy alone. Procedural information along with safety and efficacy data
were collected and analyzed over 12 months. Within the cohort of 71
patients randomized to BAT, implant procedure time decreased with
experience, from 106 +/- 37 minutes on the first case to 83 +/- 32 minutes
on the third case. The rate of freedom from system- and procedure-related
complications was 86% through 12 months, with the percentage of days alive
without a complication related to system, procedure, or underlying
cardiovascular condition identical to the control group. The complications
that did occur were generally mild and short-lived. Overall, 12 months
therapeutic benefit from BAT was consistent with previously reported
efficacy through 6 months: there was a significant and sustained
beneficial treatment effect on New York Heart Association functional
Class, quality of life, 6-minute hall walk distance, plasma N-terminal
pro-brain natriuretic peptide, and systolic blood pressure. This was true
for the full trial cohort and a predefined subset not receiving cardiac
resynchronization therapy. There is a rapid learning curve for the
specialized procedures entailed in a BAT system implant. BAT system
implantation is safe with the therapeutic benefits of BAT in patients with
HFrEF being substantial and maintained for at least 1 year.<br/>Copyright
&#xa9; 2016 The Authors

<22>
Accession Number
612433655
Author
Rex C.E.; Heiberg J.; Klaaborg K.-E.; Hjortdal V.E.
Institution
(Rex, Heiberg, Klaaborg, Hjortdal) Deparment of Cardiothoracic & Vascular
Surgery, Aarhus University Hospital, Aarhus, Denmark
(Rex, Heiberg, Klaaborg, Hjortdal) Deparment of Clinical Medicine, Aarhus
University Hospital, Aarhus, Denmark
Title
Health-related quality-of-life after transapical transcatheter aortic
valve implantation.
Source
Scandinavian Cardiovascular Journal. 50 (5-6) (pp 377-382), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Purpose. Transcatheter aortic valve implantation (TA-TAVI) is a
well-established treatment for aortic valve stenosis in high-risk patients
and indications have been continuously expanding to also include
intermediate-risk patients. However, in low-risk patients, experiences are
still sparse and although clinical outcomes have been shown favorable
results, HRQoL has remained unexplored. The aim of this report was to
describe the long-term health-related quality-of-life (HRQoL) in low-risk
patients randomized to TA-TAVI or surgical aortic valve replacement
(SAVR). Methods. In a prospective, randomized trial, patients with aortic
valve stenosis were randomized to either TA-TAVI or SAVR. TA-TAVI was
performed through a mini thoracotomy with the introduction of prosthesis
via the apex of the heart and antegradely advancement over the pre-dilated
native valve. SAVR was performed during cardiopulmonary bypass with
resection of the native valve and replacement with a prosthesis valve
through a median sternotomy. Afterwards, patients were followed yearly
with echocardiography and HRQoL assessment. Results. A total of 58
patients were included; 29 patients for TA-TAVI and 29 patients for SAVR.
The only difference in HRQoL was found in the physical component summary
after 1 year; 44 +/- 9 in the TA-TAVI group compared with 36 +/- 9 in the
SAVR group, p =.03. There were no differences in any of the remaining
timepoints in neither physical nor mental component summary, p =.19 and p
=.98, respectively, and there were no differences in survival during the 5
years. Conclusions. In low-risk patients with aortic valve stenosis
undergoing TA-TAVI, no differences appeared in HRQoL compared with SAVR
during a 5-year follow-up period.<br/>Copyright &#xa9; 2016 Informa UK
Limited, trading as Taylor & Francis Group.

<23>
Accession Number
610300829
Author
Yamamoto M.; Shimura T.; Kano S.; Kagase A.; Kodama A.; Koyama Y.;
Watanabe Y.; Tada N.; Takagi K.; Araki M.; Shirai S.; Hayashida K.
Institution
(Yamamoto, Shimura, Kagase, Kodama) Department of Cardiology, Toyohashi
Heart Center, 21-1 Gohundori, Oyama-Cho, Toyohashi, Aichi 441-8530, Japan
(Yamamoto, Kano, Koyama) Department of Cardiology, Nagoya Heart Center,
Nagoya, Japan
(Watanabe) Department of Cardiology, Teikyo University, School of
Medicine, Tokyo, Japan
(Tada) Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan
(Takagi) Department of Cardiology, New Tokyo Hospital, Chiba, Japan
(Araki) Department of Cardiology, Saiseikai Yokohama City Eastern
Hospital, Yokohama, Japan
(Shirai) Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
(Hayashida) Department of Cardiology, Keio University, School of Medicine,
Tokyo, Japan
Title
Impact of preparatory coronary protection in patients at high anatomical
risk of acute coronary obstruction during transcatheter aortic valve
implantation.
Source
International Journal of Cardiology. 217 (pp 58-63), 2016. Date of
Publication: 15 Aug 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background This study aimed to assess the effectiveness of preparatory
coronary protection (CP) in patients considered at high risk of acute
coronary obstruction (ACO) after transcatheter aortic valve implantation
(TAVI). Methods The Optimized CathEter vAlvular iNtervention (OCEAN-TAVI)
Japanese multicenter registry enrolled 666 consecutive patients. All
patients were assessed by preprocedural multidetector computed tomography.
CP using a guide wire with or without a balloon was prospectively
performed according to the following criteria: 1) coronary height length
from the annulus < 10 mm, 2) evidence of ACO during balloon aortic
valvuloplasty with simultaneous aortic injection, and 3) shallow valsalva
or bulky calcification on the leaflet. The incidence of ACO and other
procedural outcomes were compared between the CP and non-CP groups.
Results CP was performed in 14.1% of all patients (94/666). ACO had an
incidence of 1.5% (10/666) and mainly occurred in women (70%) and the left
coronary artery (70%). The ACO rate was significantly higher in the CP
group than in the non-CP group (7.4% [7/94] vs. 0.5% [3/572]; p < 0.001),
although notably 30% of ACO were occurred in non-CP group. All 10 ACO
cases were successfully treated by catheter intervention, although
periprocedural myocardial injury occurred in 42.9% of patients with CP
group and 33.3% of those without CP group. Mortality and other
periprocedural complications did not significantly differ between the 2
groups. Conclusion The preparatory CP strategy was feasible for the
management of ACO during TAVI, but the complication of ACO was difficult
to predict completely.<br/>Copyright &#xa9; 2016 Published by Elsevier
Ireland Ltd.

<24>
Accession Number
610322849
Author
Gao L.; Chen L.; Fan L.; Gao D.; Liang Z.; Wang R.; Lu W.
Institution
(Gao, Gao, Liang, Wang, Lu) Department of Comprehensive Surgery, General
Hospital of Chinese People's Liberation Army, Beijing 100853, China
(Chen) Department of Thoracic Surgery, General Hospital of Chinese
People's Liberation Army, Beijing 100853, China
(Fan) Department of Geriatric Cardiology, General Hospital of Chinese
People's Liberation Army, Beijing 100853, China
Title
The effect of losartan on progressive aortic dilatation in patients with
Marfan's syndrome: A meta-analysis of prospective randomized clinical
trials.
Source
International Journal of Cardiology. 217 (pp 190-194), 2016. Date of
Publication: 15 Aug 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objective To assess the effect of losartan therapy on progressive aortic
dilatation and on clinical outcome in patients with Marfan's syndrome
(MFS). Methods The meta-analysis was instituted, which included studies
identified by a systematic review of MEDLINE of peer-reviewed
publications. Echocardiogram or MRI measurements of the aortic root
dimension and outcome measures of death, cardiovascular surgery and aortic
dissection or rupture were compared between patients who were treated and
untreated with losartan therapy. Results Six randomized trials with 1398
subjects met all the inclusion criteria and were included in the
meta-analysis. Compared with non-losartan treatment, losartan therapy
significantly decreased the rate of aortic dilatation (SMD = - 0.13 with
95% CI - 0.25 to 0.00, p = 0.04). The clinical outcome beneficial was not
observed in the losartan treatment group when compared with no losartan
treatment group (odds ratio = 1.04 with 95% CI of 0.57-1.87). Conclusion
Given the current results of the meta-analysis and together with the lack
of associated side effects, it would be reasonable to use losartan in MFS
patients with aortic root dilatation. However, no clinical outcome
benefits were observed in the losartan treatment group when compared with
no losartan treatment group.<br/>Copyright &#xa9; 2016 Elsevier Ireland
Ltd. All rights reserved.

<25>
Accession Number
610300828
Author
Phan K.; Khuong J.N.; Xu J.; Kanagaratnam A.; Yan T.D.
Institution
(Phan, Khuong, Xu, Kanagaratnam, Yan) Collaborative Research (CORE) Group,
Macquarie University, 2 Technology Place, Sydney, Australia
Title
Obesity and postoperative atrial fibrillation in patients undergoing
cardiac surgery: Systematic review and meta-analysis.
Source
International Journal of Cardiology. 217 (pp 49-57), 2016. Date of
Publication: 15 Aug 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Introduction Post-operative atrial fibrillation (POAF) is one of the most
common complications following cardiac surgery. However, it is unclear
whether there is a relationship between obesity and POAF. We thus assessed
all available evidence investigating the association between obesity and
POAF, also considering any link between POAF and other post-operative
conditions such as mortality, stroke, myocardial infarctions and
respiratory complications. Methods Five electronic databases were searched
and relevant studies were identified. Data was extracted and meta-analyzed
from the identified studies. Results We found that obese patients had
significantly higher odds of POAF when compared with non-obese patients (P
= 0.006). There was also significant heterogeneity among the identified
studies. POAF when compared with no-POAF was associated with an increased
risk of stroke (P < 0.0001), 30-day mortality (P = 0.005) and respiratory
complications (P < 0.00001). However, we found no significant link between
POAF and myocardial infarctions (P = 0.79). Conclusions Our findings
suggest that obesity is associated with a moderately higher risk of POAF.
While POAF is also associated with an increased incidence of stroke,
30-day mortality and respiratory complications, further studies must be
conducted before conclusions can be made about the long-term
outcomes.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd. All rights
reserved.

<26>
Accession Number
604475007
Author
Ansari M.T.; Ahmadzai N.; Coyle K.; Coyle D.; Moher D.
Institution
(Ansari, Ahmadzai, Moher) Ottawa Hospital Research Institute, Ottawa, ON,
Canada
(Coyle) Brunel University London, Uxbridge, Middlesex, United Kingdom
(Coyle) Department of Epidemiology and Community Medicine, University of
Ottawa, Ottawa, ON, Canada
Title
Mitral valve clip for treatment of mitral regurgitation: An evidence-based
analysis.
Source
Ontario Health Technology Assessment Series. 15 (12) (pp 1-104), 2015.
Date of Publication: 2015.
Publisher
Medical Advisory Secretariat (130 Bloor Street West, 10th floor, Toronto,
Ontario M5S 1N5, Canada. E-mail: keelee.kaulback@ontario.co)
Abstract
Background: Many of the 500,000 North American patients with chronic
mitral regurgitation may be poor candidates for mitral valve surgery.
Objective: The objective of this study was to investigate the comparative
effectiveness, harms, and cost-effectiveness of percutaneous mitral valve
repair using mitral valve clips in candidates at prohibitive risk for
surgery. Data Sources: We searched articles in MEDLINE, Embase, and the
Cochrane Library published from 1994 to February 2014 for evidence of
effectiveness and harms; for economic literature we also searched NHS EED
and Tufts CEA registry. Grey literature was also searched. Review Methods:
Primary studies were sought from existing systematic reviews that had
employed reliable search and screening methods. Newer studies were sought
by searching the period subsequent to the last search date of the review.
Two reviewers screened records and assessed study validity. We used the
Cochrane risk of bias tool for randomized, generic assessment for
non-randomized studies, and the Phillips checklist for economic studies.
Results: Ten studies including 1 randomized trial were included. The
majority of the direct comparative evidence compared the mitral valve clip
repair with surgery in patients not particularly at prohibitive surgical
risk. Irrespective of degenerative or functional chronic mitral
regurgitation etiology, evidence of effectiveness and harms is
inconclusive and of very low quality. Very-low-quality evidence indicates
that percutaneous mitral valve clip repair may provide a survival
advantage, at least during the first 1 to 2 years, particularly in
medically managed chronic functional mitral regurgitation. Because of
limitations in the design of studies, the cost-effectiveness of mitral
valve clips in patients at prohibitive risk for surgery also could not be
established. Limitations: Because of serious concerns of risk of bias,
indirectness, and imprecision, evidence is of very low quality.
Conclusions: No meaningful conclusions can be drawn about the comparative
effectiveness, harms, and cost-effectiveness of mitral valve clips in the
population with chronic mitral regurgitation who are at prohibitive risk
for surgery.<br/>Copyright &#xa9; 2015 Medical Advisory Secretariat. All
rights reserved.

<27>
Accession Number
615270224
Author
Ranucci M.
Institution
(Ranucci) Department of Cardiothoracic and Vascular Anesthesia and ICU,
IRCCS Policlinico San Donato, Milan, Italy
Title
The Hidden Traps of Meta-Analyses on Cardiac Surgery Mortality Risk
Scores.
Source
American Journal of Cardiology. 120 (2) (pp 337-338), 2017. Date of
Publication: 15 Jul 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)

<28>
Accession Number
616335288
Author
Arora S.; Ramm C.J.; Strassle P.D.; Vaidya S.R.; Caranasos T.G.; Vavalle
J.P.
Institution
(Arora, Ramm, Vavalle) Division of Cardiology, University of North
Carolina School of Medicine, Chapel Hill, North Carolina, United States
(Arora, Vaidya) Division of Internal Medicine, Cape Fear Valley Medical
Center, Fayetteville, North Carolina, United States
(Strassle) Department of Epidemiology, University of North Carolina at
Chapel Hill, Chapel Hill, North Carolina, United States
(Strassle, Caranasos) Department of Surgery, University of North Carolina
at Chapel Hill, Chapel Hill, North Carolina, United States
Title
Review of Major Registries and Clinical Trials of Late Outcomes After
Transcatheter Aortic Valve Replacement.
Source
American Journal of Cardiology. 120 (2) (pp 331-336), 2017. Date of
Publication: 15 Jul 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The results of the Placement of AoRtic TraNscathetER Valves (PARTNER) 2
trial established the feasibility of transcatheter aortic valve
replacement (TAVR) for intermediate surgical risk patients. The expansion
of TAVR into the low-risk patient population will largely depend on its
durability outcomes due to the high life expectancy in low-risk patients.
Long-term follow-up results from low-risk clinical trials will take
several years to be reported. Given this, we performed a systematic review
of current long-term data to provide further insights into TAVR durability
and long-term patient survival. We searched MEDLINE, Embase, Google
Scholar, BIOSIS, and major conference abstracts for TAVR studies with
follow-up of at least 4 years. Abstracts were retrieved and independently
reviewed for eligibility. Final studies were selected irrespective of the
type of TAVR valve, route of vascular access, or surgical risk profile. A
total of 12 studies met the inclusion criteria. We reviewed data from
these studies with emphasis on long-term survival and echocardiographic
findings.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<29>
Accession Number
616738390
Author
Wong S.G.; Maida E.; Harvey D.; Wagner N.; Sonnadara R.; Amin N.
Institution
(Wong, Wagner, Sonnadara, Amin) Department of Surgery, McMaster
University, Hamilton, ON, Canada
(Maida, Harvey) Department of Medicine, McMaster University, Hamilton, ON,
Canada
(Wagner, Sonnadara) Department of Psychology, Neuroscience and Behaviour,
McMaster University, Hamilton, ON, Canada
Title
Evaluation of a physiatrist-directed prehabilitation intervention in frail
patients with colorectal cancer: A randomised pilot study protocol.
Source
BMJ Open. 7 (6) (no pagination), 2017. Article Number: e015565. Date of
Publication: 01 Jun 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: Prehabilitation interventions have shown efficacy in the
orthopaedic and cardiothoracic surgical populations, but there has been
limited evidence for general surgical patients. We present the protocol
for a pilot trial of a novel prehabilitation intervention, consisting of a
physiatrist-directed preoperative assessment and treatment programme.
Methods and analysis: This is a single-centre pilot randomised controlled
trial investigating physiatrist-directed prehabilitation for a 4 to 6-week
preoperative period. We will block randomise 40-50 participants awaiting
surgery for colorectal cancer to prehabilitation versus control.
Participants in the prehabilitation arm will undergo assessment by a
physiatrist and enrol in a supervised exercise programme. The control
group will not undergo any prehabilitation interventions in the
preoperative period. Our primary outcome is feasibility, measured by
examining recruitment, refusal, retention and adherence rates as well as
participant satisfaction and feedback. Secondary outcomes include physical
fitness, functional ability, health-related quality of life, postoperative
complications, mortality, readmissions, length of stay, prehabilitation
interventions performed and exercise complications. Ethics and
dissemination: This study has been approved by the Hamilton Integrated
Research Ethics Board (HIREB reference number 2015-0090-GRA). The results
of this pilot study will be used to design a full-scale study and
published in peer-reviewed journals.<br/>Copyright &#xa9; 2017 Article
author(s).

<30>
Accession Number
616709453
Author
Amrane H.; Porta F.; Van Boven A.J.; Kappetein A.P.; Head S.J.;
Rodes-Cabau J.
Institution
(Amrane, Porta) Department of Cardiothoracic Surgery, Medisch Centrum
Leeuwarden, Postbus 888, Leeuwarden 8901 BR, Netherlands
(Van Boven) Department of Cardiology, Medisch Centrum Leeuwarden,
Leeuwarden, Netherlands
(Kappetein, Head) Department of Cardiothoracic Surgery, Erasmus Medical
Center, Rotterdam, Netherlands
(Rodes-Cabau) Quebec Heart and Lung Institute, Laval University, Quebec
City, QC, Canada
Title
A meta-analysis on clinical outcomes after transaortic transcatheter
aortic valve implantation by the heart team.
Source
EuroIntervention. 13 (2) (pp e168-e176), 2017. Date of Publication: June
2017.
Publisher
EuroPCR
Abstract
Aims: We aimed to perform a meta-analysis on transaortic (TAo)
transcatheter aortic valve implantation (TAVI) in order to gain more
insight into the safety and efficacy of the approach in addition to the
data available from selected centres with small numbers of patients.
Methods and results: PubMed and EMBASE were searched on 31 August 2016.
The search yielded 251 studies, of which 16 with 1,907 patients were
included in the meta-analysis. All were observational, single-arm studies.
The rate of conversion to sternotomy was 3.2% (95% CI: 2.3-3.5%;
I²=0) among nine studies. Device success among 10 studies was
91% (95% CI: 86.7-94.0%; I²=25.5). Major vascular complications
occurred at a rate of 3.1% (95% CI: 1.6-6.0%; I²=60.8).
Moderate or severe paravalvular leakage/ aortic valve regurgitation
(PVL/AR) was reported to be 6.7% (95% CI: 4.3-10.1%; I²=58.9).
Permanent pacemaker implantation was required in 11.7% (95% CI: 9.2-14.8%;
I²=26.5) of patients. Pooled 30-day post-TAVI complication
rates were 9.9% (95% CI: 8.6-11.3%; I²=0) for mortality, 3.7%
(95% CI: 2.4-5.6%; I²=28.7) for all stroke, and 1.0% for
myocardial infarction (95% CI: 0.5-1.7%; I²=0). The Valve
Academic Research Consortium-2 (VARC-2) composite safety endpoint occurred
at a pooled rate of 16.7% (95% CI: 10.6-25.3%; I²=58.7).
Conclusions: In this meta-analysis of observational studies, transaortic
TAVI appears to be a safe procedure with low complication
rates.<br/>Copyright &#xa9; Europa Digital & Publishing 2017. All rights
reserved.

<31>
Accession Number
616411702
Author
Lin H.; Zhang Y.-M.
Institution
(Lin, Zhang) Heart Center, First Affiliated Hospital of Xinjiang Medical
University, Urumqi, Xinjiang 830054, China
Title
The effect of Ezetimibe and Simvastatin Combination Therapy on
percutaneous coronary intervention patients.
Source
International Journal of Cardiology. 242 (pp 1-3), 2017. Date of
Publication: 01 Sep 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Aims Evaluating the short-term influence of Ezetimibe and Simvastatin
Combination Therapy on LDL-C, TG and hs-CRP expression level in patients
with percutaneous coronary intervention. Methods 57 cases of percutaneous
coronary intervention patients were selected, and randomly divided into
two groups: Simvastatin (40 mg/day) and Ezetimibe (10 mg/day) combination
therapy group (observation group) with 28 patients, Simvastatin (40
mg/day) group (control group) with 29 patients. Each group was treated for
10 days. After treatment, compare blood lipid LDL-C, TG, hs-CRP levels
with each other and the results before treatment. Results Comparison of
the results of the 10th day with the baseline: LDL-C, TG decreased
significantly (P < 0.01) in the observation group, while the control group
did not have a significantly change (P > 0.05). Comparison of observation
group and control group: after treatment, LDL-C and TG decreased more
significantly in the observation group than the control group (- 27.2% vs
- 14.6%, P < 0.05). Whether according to LDL-C < 2.07 mmol/L standard or
LDL-C < 1.8 mmol/L standard, the compliance rate of the observation group
was significantly better than the control group, the results were (69% vs
28.9%, P < 0.05) and (47.6% vs 13.2% P < 0.05), respectively. After 10
days treatment, comparing to baseline, hs-CRP was significantly lowered in
these two groups (P < 0.01). And there is no liver and kidney toxicity,
myopathy and other adverse reactions during treatment. Conclusions
Combination therapy of Ezetimibe (10 mg/day) and Simvastatin (40 mg/day)
was more effective than mono-therapy with Simvastatin (40 mg/day) on
reducing LDL-C, TG and hs-CRP level in percutaneous coronary intervention
patients, leading to more significant anti-inflammatory
effect.<br/>Copyright &#xa9; 2016

<32>
[Use Link to view the full text]
Accession Number
614298593
Author
Gilron I.; Vandenkerkhof E.; Katz J.; Kehlet H.; Carley M.
Institution
(Gilron) Departments of Anesthesiology and Perioperative Medicine and
Biomedical and Molecular Sciences, Kingston General Hospital, Queen's
University, 76 Stuart St, Kingston, ON K7L 2V7, Canada
(Vandenkerkhof, Carley) School of Nursing, Queen's University, Kingston,
Canada
(Katz) Department of Psychology, York University, Toronto, ON, Canada
(Kehlet) Section for Surgical Pathophysiology, Rigshospitalet Copenhagen
University, Copenhagen, Denmark
Title
Evaluating the Association between Acute and Chronic Pain after Surgery.
Source
Clinical Journal of Pain. 33 (7) (pp 588-594), 2017. Date of Publication:
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Aim/Objectives/Background: There is a need to predict chronic (Z3mo)
postsurgical pain (CPSP). Acute (<7 d) pain is a predictor, that is, more
severe pain is associated with higher CPSP risk. However, reported
associations vary widely. Methods: Using a systematic search, we examined
associations between 2 acute pain measures (pain at rest [PAR] and
movement-evoked pain [MEP]) and CPSP outcomes (considering severity vs.
any "nonzero" pain only) in 22 studies. Results: Seven studies reported
the relationship between CPSP and both PAR and MEP. Of these, 2/7 reported
no association, 3/7 reported significant associations for both PAR and
MEP, 1/7 reported an association for PAR only, and 1/7 reported an
association for MEP only. Six of another 7 studies reporting only the
association for MEP found a significant relationship. Three of the 5
studies that did not specify whether acute pain outcomes were PAR or MEP
reported a significant relationship. Another 3 studies reporting a
relationship with CPSP did not specify whether this was for PAR, MEP, or
both. All investigations incorporating severity of CPSP in their analyses
(n=7) demonstrated a significant relationship, whereas only 10 of the 15
studies that dichotomized CPSP outcome as "no pain" versus "any"/"nonzero
pain" were positive. Conclusions: Overall, evidence for an association
between acute and chronic pain is moderate at best. However, closer
attention to pain measurement methods will clarify the relationships
between acute pain and CPSP. We propose that future CPSP predictor studies
assess both PAR and MEP acutely and also incorporate CPSP severity in
their analyses.<br/>Copyright &#xa9; 2016 Wolters Kluwer Health, Inc. All
rights reserved.

<33>
[Use Link to view the full text]
Accession Number
616768342
Author
Liu Z.; He W.; Jia Q.; Yang X.; Liang S.; Wang X.
Institution
(Liu, Wang) Department of Anesthesiology, Third Hospital of Hebei Medical
University, No. 139 Ziqiang Road, Shijiazhuang Hebei 0500511, China
(He, Jia, Yang, Liang) Department of Anesthesiology, First Hospital of
Qinhuangdao, Qinhuangdao, Hebei, China
Title
A comparison of extraluminal and intraluminal use of the Uniblocker in
left thoracic surgery.
Source
Medicine (United States). 96 (21) (no pagination), 2017. Article Number:
e6966. Date of Publication: 01 May 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The aim of this study was to assess the feasibility and safety
issues concerning extraluminal use of the Uniblocker for one-lung
ventilation (OLV) in the left thoracic surgery. Methods: Forty patients
undergoing elective left thoracic surgery were included in this study, and
all patients were randomly allocated to extraluminal use of Uniblocker
group (E group, n = 20) or intraluminal use of Uniblocker group (I group,
n = 20). Time for intubation, time for verification of the correct
position of Uniblocker, incidence of Uniblocker displacement, index of
pulmonary collapse, mean arterial pressure, heart rate, peak airway
pressure, oxygen saturation in two-lung ventilation, and 30 minutes after
OLV, bronchial damage after OLV, sore throat, and hoarseness postoperative
were recorded. Results: The time for positioning Uniblocker was 112.6 +/-
31.2 seconds in intraluminal use group, whereas the time for positioning
Uniblocker was significantly shorter in extraluminal use group (63.4 +/-
15.8 seconds). The incidence of main bronchial injury, the time of
intubation, the incidence of Uniblocker malposition after initial
placement, the time of OLV, the degree of pulmonary collapse, mean
arterial pressure, heart rate, peak airway pressure, oxygen saturation in
two-lung ventilation, and 30 minutes after OLV, the incidence of sore
throat and hoarseness postoperative have no statistical significance (P >
.05). Conclusion: Extraluminal use of the Uniblocker was proved to be a
more rapid and more accurate method than conventional intraluminal use of
the Uniblocker for OLV in left thoracic surgery.<br/>Copyright &#xa9; 2017
the Author(s). Published by Wolters Kluwer Health, Inc.

<34>
Accession Number
616606442
Author
Joannidis M.; Druml W.; Forni L.G.; Groeneveld A.B.J.; Honore P.M.; Hoste
E.; Ostermann M.; Schetz M.
Institution
(Joannidis) Division of Intensive Care and Emergency Medicine, Department
of Internal Medicine, Medical University Innsbruck, Anichstasse 35,
Innsbruck 6020, Austria
(Druml) Department of Internal Medicine III, University Hospital Vienna,
Vienna, Austria
(Forni) Department of Clinical and Experimental Medicine, Faculty of
Health and Medical Sciences, University of Surrey and Surrey Perioperative
Anaesthesia and Critical Care Collaborative Research Group (SPACeR),
Intensive Care Unit, Royal Surrey County Hospital NHS Foundation Trust,
Egerton Road, Guildford GU2 7XX, United Kingdom
(Honore) Department of Intensive Care, Universitair Ziekenhuis Brussel,
Vrije Universiteit Brussel (VUB), Brussels, Belgium
(Hoste) Department of Intensive Care Medicine, Ghent University Hospital,
Ghent University, De Pintelaan 185, Ghent 9000, Belgium
(Ostermann) Department of Critical Care and Nephrology, Guy's and St
Thomas' Hospital, London, United Kingdom
(Oudemans-van Straaten) Department of Adult Intensive Care, VU University
Medical Centre, De Boelelaan 1118, Amsterdam 1081 HZ, Netherlands
(Schetz) Clinical Department and Laboratory of Intensive Care Medicine,
Division of Cellular and Molecular Medicine, KU Leuven University, Leuven,
Belgium
Title
Prevention of acute kidney injury and protection of renal function in the
intensive care unit: update 2017: Expert opinion of the Working Group on
Prevention, AKI section, European Society of Intensive Care Medicine.
Source
Intensive Care Medicine. 43 (6) (pp 730-749), 2017. Date of Publication:
01 Jun 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Background: Acute kidney injury (AKI) in the intensive care unit is
associated with significant mortality and morbidity. Objectives: To
determine and update previous recommendations for the prevention of AKI,
specifically the role of fluids, diuretics, inotropes,
vasopressors/vasodilators, hormonal and nutritional interventions,
sedatives, statins, remote ischaemic preconditioning and care bundles.
Method: A systematic search of the literature was performed for studies
published between 1966 and March 2017 using these potential protective
strategies in adult patients at risk of AKI. The following clinical
conditions were considered: major surgery, critical illness, sepsis,
shock, exposure to potentially nephrotoxic drugs and radiocontrast.
Clinical endpoints included incidence or grade of AKI, the need for renal
replacement therapy and mortality. Studies were graded according to the
international GRADE system. Results: We formulated 12 recommendations, 13
suggestions and seven best practice statements. The few strong
recommendations with high-level evidence are mostly against the
intervention in question (starches, low-dose dopamine, statins in cardiac
surgery). Strong recommendations with lower-level evidence include
controlled fluid resuscitation with crystalloids, avoiding fluid overload,
titration of norepinephrine to a target MAP of 65-70 mmHg (unless chronic
hypertension) and not using diuretics or levosimendan for kidney
protection solely. Conclusion: The results of recent randomised controlled
trials have allowed the formulation of new recommendations and/or increase
the strength of previous recommendations. On the other hand, in many
domains the available evidence remains insufficient, resulting from the
limited quality of the clinical trials and the poor reporting of kidney
outcomes.<br/>Copyright &#xa9; 2017, The Author(s).

<35>
[Use Link to view the full text]
Accession Number
613247328
Author
Luo M.; Liu X.; Ning L.; Sun Y.; Cai Y.; Shen S.
Institution
(Luo, Ning, Sun, Cai, Shen) Department of Anesthesiology, Xinhua Hospital,
School of Medicine, Shanghai Jiaotong University, 1665# Kongjiang Road,
Shanghai 200092, China
(Liu) Pain Management Center, Xinhua Hospital, School of Medicine,
Shanghai Jiaotong University, China
(Luo) Department of Anesthesiology, Huashan Hospital, School of Medicine,
Fudan University, Shanghai, China
Title
Comparison of Ultrasonography-guided Bilateral Intercostal Nerve Blocks
and Conventional Patient-controlled Intravenous Analgesia for Pain Control
after the Nuss Procedure in Children.
Source
Clinical Journal of Pain. 33 (7) (pp 604-610), 2017. Date of Publication:
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: Patients experience severe pain after pectus excavatum (PE)
surgery. The aim of this prospective, randomized study was to compare
analgesic effects of ultrasonography-guided bilateral intercostal nerve
blocks (UG-ICNBs) with those of conventional patient-controlled
intravenous analgesia (PCIA) on acute pain after the Nuss procedure for PE
repair in children. Methods: A prospective randomized study was performed
in children with PE who were scheduled for the Nuss procedure.
Participants were randomly assigned to receive either UG-ICNBs or PCIA for
postoperative analgesia. Faces Pain Scale-Revised scores, opioid
consumption, analgesia-associated side effects (respiratory depression,
pruritus, nausea, vomiting) during the first 24 hours, and lengths of stay
in the postanesthesia care unit (PACU) and hospital were recorded after
the surgery. Results: Sixty-two children undergoing the Nuss procedure
were enrolled in the trial. Faces Pain Scale-Revised scores were
significantly decreased in the UG-ICNBs group compared with the PCIA group
for up to 6 hours after surgery. The opioid doses required in the PACU and
during the first 24 hours after surgery were significantly greater in the
PCIA group compared with the UG-ICNBs group. Accordingly, patients in the
UG-ICNBs group showed a lower incidence of analgesia-associated side
effects and faster PACU discharge compared with the PCIA group.
Conclusions: Our study suggests that UG-ICNBs might be more effective than
PCIA for postoperative analgesia in children who undergo the Nuss
procedure for PE.<br/>Copyright &#xa9; 2016 Wolters Kluwer Health, Inc.
All rights reserved.

<36>
Accession Number
616837804
Author
Saberi K.; Salehi M.; Rahmanian M.; Bakhshandeh A.R.; Massoumi G.R.
Institution
(Saberi, Salehi, Rahmanian, Bakhshandeh) Imam Khomeini Medical and
Research Center, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Massoumi) Department of Anesthesiology, School of Medicine, Isfahan
University of Medical Sciences, Isfahan, Iran, Islamic Republic of
Title
Appropriate blood component therapy can reduce postcardiac surgery acute
kidney injury through packed cell transfusion reduction.
Source
Journal of Research in Medical Sciences. 22 (3) (no pagination), 2017.
Article Number: 81. Date of Publication: 2017.
Publisher
Isfahan University of Medical Sciences(IUMS) (Hezar Jerib Avenue, P.O. Box
81745-319, Isfahan, Iran, Islamic Republic of)
Abstract
Background: Acute kidney injury (AKI) can happen due to different factors
such as anemia. Packed cell (PC) transfusion is an important cause of AKI
occurrence. The aim of the study is to investigate whether appropriate
blood component (BC) therapy can reduce blood transfusion and it would
result in AKI decreasing. Materials and Methods: We conducted a cohort
study of 1388 patients who underwent cardiac surgery in one university
hospital. A serum creatinine higher than 2 mg/dl, renal disease history,
renal replacement therapy (chronic dialysis) were our exclusion criteria.
Results: from our 1088 samples, 701 (64.43%) patients had normal kidney
function, 277 (25.45%) were in the AKI-1 group, 84 (7.72%) had an AKI-2
function, and the rest of patients were classified as end stage. A mean of
more than three PC units were transfused for the second and third stage of
AKI, which was significantly higher than other AKI groups (P = 0.009);
this higher demand of blood product was also true about the fresh frozen
plasma, platelet, and fibrinogen. However, there were no needs of
fibrinogen in the patients with normal kidney function. The
cardiopulmonary bypass time had an average of 142 +/- 24.12, which
obviously was higher than other groups (P = 0.032). Total mortality rate
was 14 out of 1088 (1.28%), and expiration among the AKI stages 2 and 3
was meaningfully (P = 0.001) more than the other groups. Conclusion: A
more occurrence of AKI reported for the patients who have taken more units
of blood. However, BC indicated to be safer for compensating blood loss
because of low AKI occurrence among our patients.<br/>Copyright &#xa9;
2017 Journal of Research in Medical Sciences.

<37>
Accession Number
616844819
Author
Campo G.; Pavasini R.; Morciano G.; Lincoff A.M.; Gibson C.M.; Kitakaze
M.; Lonborg J.; Ahluwalia A.; Ishii H.; Frenneaux M.; Ovize M.; Galvani
M.; Atar D.; Ibanez B.; Cerisano G.; Biscaglia S.; Neil B.J.; Asakura M.;
Engstrom T.; Jones D.A.; Dawson D.; Ferrari R.; Pinton P.; Ottani F.
Institution
(Campo, Pavasini, Biscaglia, Ferrari) Cardiology Unit, Azienda
Ospedaliero-Universitaria di Ferrara, Cona, FE, Italy
(Morciano, Pinton) Department of Morphology, Surgery and Experimental
Medicine, Section of Pathology, Oncology and Experimental Biology,
University of Ferrara, Ferrara, Italy
(Lincoff) Cleveland Clinic Coordinating Center for Clinical Research
(C5Research), Cleveland, OH, USA
(Gibson, Neil) PERFUSE Study Group, Cardiovascular Division, Department of
Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School,
Boston, MA, USA
(Kitakaze, Asakura) Cardiovascular Division of Medicine, National
Cardiovascular Centre, Suita, Osaka, Japan
(Lonborg, Engstrom) Department of Cardiology, Rigshospitalet, Copenhagen,
Denmark
(Ahluwalia, Jones) Centre of Clinical Pharmacology, Barts NIHR
Cardiovascular Biomedical Research Unit, William Harvey Research
Institute, Barts and The London Medical School, Queen Mary University,
London, UK
(Ishii) Department of Cardiology, Nagoya University Graduate School of
Medicine, Nagoya, Japan
(Frenneaux) Norwich Medical School, University of East Anglia, Norwich, UK
(Ovize) Clinical Investigation Center of Lyon, Lyon, France
(Galvani, Ottani) Unita Operativa di Cardiologia, Ospedale GB Morgagni,
Forli, Italy
(Atar) Department of Cardiology B, Oslo University Hospital Ullevall, and
Faculty of Medicine, University of Oslo, Oslo, Norway
(Ibanez) Centro Nacional de Investigaciones Cardiovasculares Carlos III
(CNIC) and Instituto de Investigacion-Fundacion Jimenez Diaz Hospital,
Madrid, Spain
(Cerisano) Division of Cardiology, University of Florence, Careggi
Hospital, Florence, Italy
(Dawson) School of Medicine and Dentistry, University of Aberdeen,
Aberdeen, UK
(Ferrari) Maria Cecilia Hospital, GVM Care and Research, E.S.: Health
Science Foundation, Cotignola, Italy
Title
Clinical benefit of drugs targeting mitochondrial function as an adjunct
to reperfusion in ST-segment elevation myocardial infarction: A
meta-analysis of randomized clinical trials.
Source
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: March 27, 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Aims: To perform a systematic review and meta-analysis of randomized
clinical trials (RCT) comparing the effectiveness of drugs targeting
mitochondrial function vs. placebo in patients with ST-segment elevation
myocardial infarction (STEMI) undergoing mechanical coronary reperfusion.
Methods: Inclusion criteria: RCTs enrolling STEMI patients treated with
primary percutaneous coronary intervention (PCI) and comparing drugs
targeting mitochondrial function vs. placebo. Odds ratios (OR) were
computed from individual studies and pooled with random-effect
meta-analysis. Results: Fifteen studies were identified involving 5680
patients. When compared with placebo, drugs targeting mitochondrial
component/pathway were not associated with significant reduction of
cardiovascular and all-cause mortality (OR 0.9, 95% CI 0.7-1.17 and OR
0.92, 95% CI 0.69-1.23, respectively). However, these agents significantly
reduced hospital admission for heart failure (HF) (OR 0.64; 95% CI
0.45-0.92) and increased left ventricular ejection fraction (LVEF) (OR
1.44; 95% CI 1.15-1.82). After analysis for subgroups according to the
mechanism of action, drugs with direct/selective action did not reduce any
outcome. Conversely, those with indirect/unspecific action showed a
significant effect on cardiovascular mortality (0.65, 95% CI 0.46-0.92),
all-cause mortality (OR 0.69, 95% CI 0.52-0.92), hospital readmission for
HF (OR 0.41, 95% CI 0.28-0.6) and LVEF (OR 1.49, 95% CI 1.09-2.05).
Conclusions: Administration of drugs targeting mitochondrial function in
STEMI patients undergoing primary PCI appear to have no effect on
mortality, but may reduce hospital readmission for HF. The drugs with a
broad-spectrum mechanism of action seem to be more effective in reducing
adverse events.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<38>
Accession Number
616844327
Author
Tawfek A.; Abdelbary K.; Kotb M.; Refat A.M.
Institution
(Tawfek, Abdelbary, Kotb, Refat) Department of Cardiothoracic Surgery,
Zagazig University, Zagazig, Egypt
Title
Impact of obesity on the results of cardiac surgery in Egypt: Early
outcomes on heart valve surgery.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. (no
pagination), 2017. Date of Publication: December 28, 2016.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: Rheumatic heart disease is endemic in developing countries,
but obesity is worldwide increasing. The aim of this work was to evaluate
impact of obesity on the results of heart valve surgery. Methods: This
cohort prospective study was conducted on 500 patients with heart valve
diseases requiring valve surgery at two centers: Cardiothoracic Surgery
Department, Zagazig University Hospitals and General hospital in El Ahrar,
Zagazig, Egypt from August 2013 to August 2016. Heart valve surgery
patients were subdivided according body mass index (BMI) into 5 groups:
non-obese group: BMI < 25; overweight group: BMI 25-29.9; class I obese
group: BMI 30-34.9; class II obese group: BMI 35-39.9; and class III obese
group: BMI >= 40.Collected data were classified into:
preoperative,operative, postoperative and follow up data. Results: This
study showed that there was no significant difference between the 5 groups
regarding the following postoperative outcomes: exploration, arrhythmia,
pacemaker insertion, tracheostomy and renal impairment.On the other hand,
surgical site infection (SSI) had percentage in the 5 groups as follow:
0.9%, 5.4%, 7.4%, 9.1% and 50% respectively. A highly significant
difference was found between non-obese group versus class III obese group,
while there was significant difference between overweight group and class
I obese group versus class III obese group. Conclusions: This study found
no obesity association with higher postoperative morbidity or mortality
except for only SSI. So obesity had neutral effect on outcomes and the
term Obesity paradox should be changed since the impact of obesity was
just a parallax effect.<br/>Copyright &#xa9; 2017 The Egyptian Society of
Cardio-thoracic Surgery.

<39>
Accession Number
616842345
Author
Balogh A.L.; Petak F.; Fodor G.H.; Sudy R.; Babik B.
Institution
(Balogh, Sudy, Babik) Department of Anesthesiology and Intensive Therapy,
University of Szeged, Szeged, Hungary
(Balogh, Petak, Fodor, Sudy) Department of Medical Physics and
Informatics, University of Szeged, Szeged, Hungary
Title
Sevoflurane Relieves Lung Function Deterioration After Cardiopulmonary
Bypass.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objective: To investigate sevoflurane's potential to alleviate the
detrimental pulmonary changes after cardiopulmonary bypass (CPB). Design:
Prospective, randomized clinical investigation. Setting: University
hospital. Participants: One hundred ninety patients undergoing elective
cardiac surgery. Interventions: Ninety-nine patients under intravenous
anesthesia were administered 1 minimal alveolar concentration of
sevoflurane for 5 minutes after being weaned from CPB (group SEV);
intravenous anesthesia was maintained in the other 91 patients (group
CTRL). Measurements and Main Results: Measurements were performed with
open chest: before CPB, after CPB, and after intervention. The lungs'
mechanical impedance and capnogram traces were recorded, arterial and
central venous blood samples were analyzed, and lung compliance was
documented. Airway resistance, tissue damping, and elastance were obtained
from the impedance spectra. The capnogram phase III slope was determined
using linear regression. The partial pressure of oxygen in the arterial
blood/fraction of inspired oxygen ratio and shunt fraction were calculated
from blood gas parameters. After CPB, sevoflurane induced bronchodilation,
reflected in marked drops in airway resistance and smaller improvements in
lung tissue viscoelasticity indicated by decreases in tissue damping and
elastance. These changes were reflected in a decreased capnogram phase III
slope and shunt fraction and increased partial pressure of oxygen in the
arterial blood/fraction of inspired oxygen ratio and lung compliance. The
more severe deteriorations that occurred after CPB, the greater
improvements by sevoflurane were observed. Conclusions: Sevoflurane can
alleviate CPB-induced bronchoconstriction, compromised lung tissue
mechanics, and enhanced intrapulmonary shunt. This benefit has particular
importance in patients with severe CPB-induced lung function
deterioration.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<40>
Accession Number
616841676
Author
Gatti G.; Perrotti A.; Fiore A.; Bergoend E.; Chocron S.; Couetil J.-P.;
Sinagra G.; Pappalardo A.
Institution
(Gatti, Sinagra, Pappalardo) Cardiovascular department, Ospedali Riuniti
and university of Trieste, Trieste, Italy
(Perrotti, Chocron) Department of thoracic and cardiovascular surgery,
university hospital Jean-Minjoz, 25000 Besancon, France
(Fiore, Bergoend, Couetil) Department of cardiac and thoracic surgery,
university hospital Henri-Mondor, Assistance publique-Hopitaux de Paris,
94000 Creteil, France
Title
Is bilateral internal thoracic artery grafting a safe option for chronic
dialysis patients?.
Source
Archives of Cardiovascular Diseases. (no pagination), 2017. Date of
Publication: November 17, 2016.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Background: The use of bilateral internal thoracic artery (BITA) grafting
has been proposed for dialysis patients with multivessel coronary artery
disease, primarily because of hypothetical long-term survival benefits.
Aims: To investigate the outcome of BITA grafting in dialysis patients.
Methods: This was a retrospective analysis of the use of BITA grafting in
105 consecutive patients with end-stage renal failure on chronic dialysis
in three European centres with extensive experience in BITA. Baseline
patient characteristics, operative data, early postoperative complications
and late survival were reviewed. Outcomes of patients from one of the
three centres who underwent either BITA (n = 40) or single internal
thoracic artery (SITA) grafting (n = 19) were also analysed; a one-to-one
propensity score (PS)-matched analysis was performed. Results: There were
19 (18.1%) hospital deaths. Despite differences in preoperative patient
characteristics and surgical features, in each centre, hospital mortality
was greater than the 75th percentile of expected operative risk (EuroSCORE
II). Diseased ascending aorta and extracardiac arteriopathy were found to
be predictors of hospital death (odds ratio 9.7; P = 0.006) and
complicated hospital course (odds ratio 2.54; P = 0.035), respectively.
The 7-year non-parametric estimates of freedom from all-cause death and
cardiac or cerebrovascular death were 59% (95% confidence interval:
52.3-65.7%) and 75.6% (95% confidence interval: 71.2-80%), respectively.
There were no significant differences in early and late outcomes between
BITA and SITA PS-matched groups. Conclusions: BITA grafting remains a
risky operation for chronic dialysis patients, even when performed
routinely. No long-term survival benefits for the use of BITA versus SITA
were proven.<br/>Copyright &#xa9; 2017 Elsevier Masson SAS.

<41>
Accession Number
613133657
Author
Luni F.K.; Riaz H.; Khan A.R.; Riaz T.; Husnain M.; Riaz I.B.; Khan M.S.;
Taleb M.; Kanjwal Y.; Cooper C.J.; Khuder S.A.
Institution
(Luni, Taleb, Kanjwal) Mercy Saint Vincent Medical Center, Toledo, OH,
United States
(Riaz) Cleveland Clinic, Cleveland, OH, United States
(Khan) University of Louisville, Louisville, KY, United States
(Riaz) Bronx Lebanon Hospital, New York, NY, United States
(Husnain, Riaz) University of Arizona, Tucson, AZ, United States
(Khan) Dow University of Health Sciences, Karachi, Pakistan
(Cooper, Khuder) University of Toledo Medical Center, Toledo, OH, United
States
Title
Clinical outcomes associated with per-operative discontinuation of aspirin
in patients with coronary artery disease: A systematic review and
meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 89 (7) (pp 1168-1175),
2017. Date of Publication: 01 Jun 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Postoperative state is characterized by increased thrombotic
risk by virtue of platelet activation. Whether aspirin ameliorates this
risk in patients with established coronary artery disease undergoing
cardiac or noncardiac surgery is unknown. We conducted a systematic review
and meta-analysis to compare the risk of major adverse cardiac events
(MACE) and the risk of bleeding in patients with early (3-5 or more days
before surgery) vs. late discontinuation(<3-5 days)/no discontinuation of
aspirin. Methods: Multiple databases were searched from inception of these
databases until March 2015 to identify studies that reported
discontinuation of aspirin in patients undergoing surgery. The outcomes
measured were all cause mortality, nonfatal myocardial infarction and
other relevant thrombotic events (MACE) which also may include, fatal and
nonfatal MI, stent thrombosis and restenosis, stroke, perioperative
cardiovascular complications (heart failure, MI, VTE, acute stroke) and
perioperative bleeding during the perioperative period to up to 30 days
after surgery. Results: A total of 1,018 titles were screened, after which
six observational studies met the inclusion criteria. Our analysis
suggests that there is no difference in MACE with planned discontinuation
of aspirin (OR = 1.17, 95% CI = 0.76-1.81; P = 0.05; I² = 55%).
Early discontinuation of aspirin showed a decreased risk of peri-operative
bleeding (OR 0.82, 95% CI = 0.67-0.99; P = 0.04; I² = 42%).
Conclusion: Our analysis suggests that planned short-term discontinuation
in the appropriate clinical setting appears to be safe in the correct
clinical setting with no increased risk of thrombotic events and with a
decreased risk of bleeding. &#xa9; 2016 Wiley Periodicals,
Inc.<br/>Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<42>
Accession Number
616809798
Author
Imasanti A.; Radi B.; Dharma S.
Institution
(Imasanti, Radi, Dharma) Department of Cardiology and Vascular Medicine,
National Cardiovascular Center Harapan Kita Hospital, University of
Indonesia, Jakarta, Indonesia
Title
The effect of cardiac telemonitoring on home-based exercise adherence
program in post coronary artery bypass surgery patient.
Source
European Heart Journal, Supplement. Conference: 26th Annual Scientific
Meeting of Indonesian Heart Association, ASMIHA 2017. Indonesia. 19 (pp
E20), 2017. Date of Publication: May 2017.
Publisher
Oxford University Press
Abstract
Background: Cardiac rehabilitation (CR) program in patient who had
coronary artery bypass surgery (CABG) surgery could be institution-based
or home-based, but there were many barriers for home-based CR program that
influences the patient's adherence to the program. As an effort to
overcome the barrier of distance, confidence, and safe feeling,
electrocardiography telemonitoring (ECGTM) could be used. But there were
no data regarding the effect of the electrocardiography telemonitoring to
the adherence to the home-based CR program in Indonesia. Aim: To assess
the effect of electrocardiography telemonitoring to the adherence to
home-based CR program for the patients who have had CABG surgery. Methods:
Patients after having CABG surgery in National Cardiovascular Center
Harapan Kita Jakarta who have finished Phase II CR program were recruited
consecutively and were randomized to the intervention group which used
ECGTM and to the control group which did not use ECGTM for 3 months
home-based CR program. Homebased exercise was based on the result of
exercise stress testing using Bruce Protocol. Adherence was defined as
compliance to the minimum of 3 sessions per week for 12 weeks CR program.
Results: A total of 44 patients completed the study, The adherence to the
CR program of the intervention group (n=20) and control group (n=24) was
not different (95% vs. 70.8% P=0.054), and neither was the exercise
testing duration (57.9+/-81.1 vs. 21.7+/-61.2 s, P=0.099), and the
improvement of functional capacity (0.77+/-1.2 vs. 0.33+/-1.05 METS,
P=0.193) Conclusion: The application of electrocardiography telemonitoring
did not increase the patients adherence to home-based CR program.

<43>
Accession Number
616809785
Author
Elfa S.A.; Sariningrum A.; Ambari A.M.; Radi B.; Setianto B.
Institution
(Elfa, Sariningrum, Ambari, Radi, Setianto) Faculty of Medicine,
Diponegoro University, Semarang, Indonesia
(Elfa, Sariningrum, Ambari, Radi, Setianto) Department of Cardiology and
Vascular Medicine, National Cardiovascular Center Harapan Kita, University
of Indonesia, Jakarta, Indonesia
Title
The 6-minute walking test after mitral valve surgery profile and
cardiovascular events (post discharge) in National Cardiovascular Center
Harapan Kita.
Source
European Heart Journal, Supplement. Conference: 26th Annual Scientific
Meeting of Indonesian Heart Association, ASMIHA 2017. Indonesia. 19 (pp
E43), 2017. Date of Publication: May 2017.
Publisher
Oxford University Press
Abstract
Background: The 6-minute walk test is a simple, inexpensive, and
reproducible method for the assessment of exercise capacity. The 6MWT is a
common test used to assess cardiovascular events outcome of heart failure,
myocardial infarction, or death. The feasibility of 6MWT as a measure of
cardiac rehabilitation programme in patients undergoing cardiac
rehabilitation mitral valve surgery and admitted to in-hospital
rehabilitation unit has been described before. The aim of this study is to
describe profile, baseline characteristics and hospitalization (post
discharge) in patients undergoing cardiac rehabilitation programme after
mitral valve surgery. Methods: This was a descriptive analysis, take in
National Cardiovascular Center Harapan Kita during January 2013-January
2016. Subjects had cardiac rehabilitation programme after underwent mitral
valve surgery (repair or replacement). The 6MWT was taken in the first
visitation during phase 2 cardiac rehabilitation. Data about
hospitalization due to cardiovascular events were taken from the record.
Results: The study enrolled 99 patients who undergoing cardiac
rehabilitation programme after Mitral Valve Surgery during January
2013-January 2016. There are 57 patients (57.6%) men, and 42 patients
(42.4%) women with 39 patients (39.4%) with 6 MWT <300 m and 60 patients
(60.6%) with 6 MWT >300 meters. From the record (medical record and phone
calls) we find 20 case of hospitalization after the patients discharge,
between the patients, there were 6 patients (30%) with 6 MWT <300 m and 14
patients (70%) 6 MWT >300 m, 8 patients (40%) having cardiac events (heart
failure or arrhythmia) and 12 patients (60%) with hospitalization due to
another cause. There were 3 patients died due to noncardiovascular events.
Conclusion: There is no significant difference between profile and
characteristic and cardiovascular events in post discharge patients having
6 MWTafter mitral valve surgery.

<44>
Accession Number
616809754
Author
Dwiputra B.; Santoso A.; Lilyasari O.; Setianto B.; Radi B.; Ambari A.
Institution
(Dwiputra, Santoso, Lilyasari, Setianto, Radi, Ambari) Department of
Cardiology and Vascular Medicine, National Cardiovascular Center Harapan
Kita Hospital, University of Indonesia, Jakarta, Indonesia
Title
The effect of resistance training on pro-protein convertase subtilisin
kexin-9 level in post-coronary artery bypass graft surgery patients who
undergo Phase II cardiac rehabilitation.
Source
European Heart Journal, Supplement. Conference: 26th Annual Scientific
Meeting of Indonesian Heart Association, ASMIHA 2017. Indonesia. 19 (pp
E17), 2017. Date of Publication: May 2017.
Publisher
Oxford University Press
Abstract
Background: Pro-protein Convertase Subtilisin Kexin 9 (PCSK-9) is a
protein that plays a role in the process of degradation of low density
lipoprotein (LDL) receptor so that its drop can lower LDL levels and
cardiovascular risk. As part of secondary prevention, resistance training
is recommended in patients after coronary artery bypass surgery (CABG) as
a complement to aerobic exercise component. The safety and benefits in
muscle strength and endurance have been demonstrated. Nevertheless, there
are no studies that examined the effects of resistance training on PCSK-9
levels. Objective: To determine the effects of additional resistance
training on PCSK-9 levels and lipid profile in post-coronary artery bypass
graft surgery patients who undergo phase II cardiac rehabilitation.
Methods: A single-blinded randomized clinical trial was performed to 87
post-CABG patients, divided into 2 groups. The control group (n=43)
consisted of patients who received standard Phase II cardiac
rehabilitation program. In the another group, the intervention group
(n=44) consisted of patients who receive standard Phase II cardiac
rehabilitation program with an addition of supervised resistance training.
This incrimental training consisted of 3 phase during the program. PCSK-9
level and lipid profile examination were performed in every patients pre-
and post-training. Results: After completion of Phase II cardiac
rehabilitation, mean PCSK9 levels in intervention group decrease
significantly compared to control group (control vs. intervention, 377.1
(SD 125) vs. 316.6 (111.1) ng/mL, beta=-60.5 ng/mL, 95% CI-7.5 to -113.4),
P=0.026). Nonetheless, there are still no significant changes in terms of
LDL level (P=0.07), total cholesterol (P=0.99), high density lipoprotein
(P=0.44) and triglyseride levels (P=0.56) pre- and post-intervention
between two groups. Conclusion: The additional resistance training can
reduce significantly PCSK-9 levels in patients after coronary artery
bypass surgery who underwent phase II cardiac rehabilitation.

<45>
Accession Number
616809722
Author
Amalia M.R.; Wulandari P.; Callista M.A.; Tedjasukmana F.; Nofandra A.;
Radi B.
Institution
(Amalia) Department of Cardiology and Vascular, Diponegoro University,
Semarang, Indonesia
(Wulandari) Department of Cardiology and Vascular, University of Sebelas
Maret, Surakarta, Indonesia
(Callista, Tedjasukmana, Nofandra, Radi) Department of Cardiology and
Vascular, University of Indonesia, Jakarta, Indonesia
Title
Six-minute walk test as a predictor of maximum oxygen consumption after
coronary artery bypass graft surgery.
Source
European Heart Journal, Supplement. Conference: 26th Annual Scientific
Meeting of Indonesian Heart Association, ASMIHA 2017. Indonesia. 19 (pp
E28), 2017. Date of Publication: May 2017.
Publisher
Oxford University Press
Abstract
Background: Maximum oxygen consumption (Vo2max) is defined as a maximal
capacity of an individual to perform aerobic work, which is the product of
cardiac output (CO) and arteriovenous oxygen (AV O<inf>2</inf>) difference
at exhaustion. As the oxygen consumption increases after cardiac surgery,
cardiopulmonary exercise becomes an important tool to measure and to
assess functional capacity of the body. The purpose of this study is to
investigate the relation between post-operative oxygen consumption and the
functional exercise capacity by six-minute walk test in coronary artery
bypass graft (CABG) surgery. The distance walked during six-minute walk
test (6 MWD) in this study is used as a predictor to measure Vo2max in
patients undergone CABG surgery. Methods: Twenty-one patients that have
completed Phase I and Phase II cardiac rehabilitation with cardiopulmonary
exercise (CPX) in National Cardiovascular Center Harapan Kita Hospital
between 2015 and 2016 were analysed. VO2max (mL/kg/min) based on age and
gender is divided by excellent (>=90), good (70-90), average (30- 70),
fair (10-30), and poor (<=10). This is an observational study with
cross-sectional retrospective. Secondary data were taken from outpatient
medical record, and were presented as mean, median (minimum-maximum),
bivariate analysis using parametrics method if the data are normally
distributed (t-test) and non parametrics method if they are not normal
(Mann-Whitney test). Results: VO2max is higher in patients with 6 MWD in
early Phase II>500 m. As average group correlates significantly to
distance of 6 MWD>500 m in men (P=0.02) and women (P=0.01). Bivariate
analysis shows P-value of heart rate 0.001, VE/VCO2 0.03, BMI 0.12,
smoking 0.25, diabetes mellitus 0.35, dyslipidaemia 0.40, family history
of CAD 0.55, and hypertension 0.043. Conclusion: Six MWD in the beginning
of Phase II cardiac rehabilitation can predict the maximum capacity of
oxygen consumption measured by the cardiopulmonary exercise test, done at
the end of phase two.

<46>
Accession Number
616809679
Author
Tonang A.; Uddin I.; Budijitno S.; Fatah S.; Herry Y.
Institution
(Tonang, Uddin, Herry) Faculty of Medicine, Department of Cardiology and
Vascular Medicine, University of Diponegoro, Semarang, Indonesia
(Budijitno, Fatah) Departement of Surgery, Dr. Kariadi Hospital Semarang,
University of Diponegoro, Semarang, Indonesia
Title
Effect of atorvastatin on interleukin-4 expression in mitral valve of
rheumatic heart disease.
Source
European Heart Journal, Supplement. Conference: 26th Annual Scientific
Meeting of Indonesian Heart Association, ASMIHA 2017. Indonesia. 19 (pp
E26), 2017. Date of Publication: May 2017.
Publisher
Oxford University Press
Abstract
Background: Rheumatic heart disease is a chronic disease in heart valve
resulting after molecular mimicry of Streptococcus antigen. Progressivity
occurs because of diminished expression of anti-inflammatory cytokine
interleukin (IL)-4. Various therapeutic approaches attempt to delay the
progressivity of the disease. Statin has a pleiotropic effect as an
anti-inflammatory; nevertheless researches in rheumatic heart disease
remained scarce. Objective: To prove that there are differences in the
expression of IL-4 in patients with mitral valve rheumatic heart disease
using atorvastatin. Method: A quasi-experimental clinical study was done
in mitral valve rheumatic heart disease patients who underwent mitral
valve replacement (MVR) surgery from August to November 2015. Samples were
randomized to receive standard medical therapy alone or standard medical
therapy plus atorvastatin 40 mg/day for at least 2 weeks before MVR.
Native mitral valve was taken during MVR and quantitative
immunohistochemistry examination of IL-4 was performed. Result: During the
study period there were 37 MVR, and 32 of them caused by rheumatic heart
disease thus were subsequently randomized into two groups each of 16
samples. There were 1 sample dropped-out in the atorvastatin group, thus
31 samples were analysed. All samples completed the study period without
serious side effects. There was significant increase in IL-4 expression in
atorvastatin group vs. without atorvastatin (2.51%+/-1.52 vs.
1.52%+/-1.06; P=0.044, subsequently). Conclusion: Atorvastatin increase
the expression of cytokine IL-4 in patients with mitral valve rheumatic
heart disease.

<47>
Accession Number
616809676
Author
Hatta A.I.; Wilson A.
Institution
(Hatta) University of Melbourne, Australia
(Wilson) St. Vincent's Hospital Melbourne, Australia
Title
Radial artery vs. saphenous vein graft: Analysis of the rate of mortality
and morbidity in patients undergoing coronary artery bypass grafting.
Source
European Heart Journal, Supplement. Conference: 26th Annual Scientific
Meeting of Indonesian Heart Association, ASMIHA 2017. Indonesia. 19 (pp
E72-E73), 2017. Date of Publication: May 2017.
Publisher
Oxford University Press
Abstract
Background: Coronary artery bypass grafting (CABG) is one of the most
common major surgeries done in the world. Previous studies revealed that
saphenous vein (SV) grafts presented more occlusion compared to radial
artery (RA) grafts in one year follow up angiography. Moreover, long-term
follow up showed that RA grafts have significantly lesser rate of
functional and complete occlusion compared to SV grafts. This systematic
review aims to evaluate different grafts used in CABG particularly the RA
and SV grafts. The parameters that will be measured include the rate of
mortality and morbidities such as recurrent myocardial ischaemia, stroke,
and other cardiac-related events. Other parameters that will be assessed
include graft failure, patency, hospital readmission, and need of
revascularization Methods: Electronic literature searching was performed
on multiple online databases such as PubMed, Embase, SciDirect, Scopus,
CINAHL, The Cochrane Library and MEDLINE from October to November 2013 to
identify randomized controlled trials (RCTs) and cohort studies that were
published within the last 10 years (2003-2013). Retrieved articles will
undergo abstract and full-text screening. Methodological quality of the
included studies will be assessed using van Tulder criteria and Newcastle-
Ottawa scale for RCTs and cohort studies, respectively. Results: Twenty
studies were included in this review, which comprise of 10 RCTs and 10
retrospective cohort studies. Following assessment, 14 of the included
studies were deemed as a high quality while the others were of moderate.
The studies revealed that the use of radial artery grafts is significantly
associated with lower mortality rate and graft failure rate. SV grafts are
associated with higher need of revascularization. Meanwhile other
parameters failed to demonstrate a significant difference between two
grafts. Conclusion: It can be concluded that RA grafts are superior
compared to SV in terms of lower mortality and graft failure. Nonetheless
other factors may also influence graft performance thus decision of graft
choice should then be crafted specifically for each patient by the
surgeon.

<48>
Accession Number
616801223
Author
Giugliano G.; Sannino A.; Magliulo F.; Ferrone M.; Ilardi F.; Izzo R.;
Santoro M.; Piccolo R.; Franzone A.; Carotenuto G.; Trimarco B.; Esposito
G.
Institution
(Giugliano, Sannino, Magliulo, Ferrone, Ilardi, Izzo, Santoro, Piccolo,
Franzone, Carotenuto, Trimarco, Esposito) Division of Cardiology,
Department of Advanced Biomedical Sciences, University of Naples Federico
II, Naples, Italy
Title
Meta-analysis of effect of body mass index on outcomes after transcatheter
aortic valve implantation.
Source
High Blood Pressure and Cardiovascular Prevention. Conference: 15th
National Congress of the Italian Society of Cardiovascular Prevention,
SIPREC 2017. Italy. 24 (2) (pp 212), 2017. Date of Publication: June 2017.
Publisher
Springer International Publishing
Abstract
Introduction: Controversial data exist regarding the impact of body mass
index (BMI) on TAVI outcomes. Methods: Thirteen TAVI studies were included
and analyzed for the incidence of procedural complications, 30-day and
long-term all-cause mortality. Three comparisons were executed: 1.
underweight vs normal weight, 2. overweight vs normal weight and 3. obese
vs normal weight patients. Results: Underweight patients (BMI\20
kg/m²) had similar 30-day all-cause mortality when compared to
the normal, although they displayed a significant worse survival at
long-term follow-up (HR 1.68, 95% [CI]: 1.09-2.59, p = 0.02; Figure 1).
Underweight patients showed a higher incidence of major and
life-threatening bleedings (2566 patients, OR 1.64, 95% [CI]: 1.10-2.45, p
= 0.02) and of major vascular complications (2566 patients, OR 1.86, 95%
[CI]: 1.16-2.98, p = 0.01), compared to normal weight patients. Overweight
patients (BMI C25 and\30 kg/m²) display similar 30-day and
long-term all-cause mortality, as well as similar procedural complication
rate compared to normal weight patients. Obese patients (BMI [30
kg/m²) had similar 30-day all-cause mortality rates when
compared to the normal weight cat-egory, whereas they displayed a
significant better survival at long-term (HR 0.79, 95% [CI]: 0.67-0.93, p
= 0.004, Figure 2). Procedural complications did not differ between obese
and normal body weight patients. Conclusions: In conclusion, a low BMI is
linked to a significantly worse prognosis after TAVI. In conclusion, BMI
represents an important and handily tool that might be used in the risk
prediction of patients to be addressed for TAVI.

<49>
Accession Number
616801205
Author
De Vecchis R.; Ariano C.
Institution
(De Vecchis, Ariano) Cardiology Unit, Presidio Sanitario Intermedio Elena
d'Aosta, ASL Napoli 1 Centro, Naples, Italy
Title
Ranolazine alone or as an add-on to amiodarone for both prevention and
cardioversion of atrial fibrillation: A metaanalysis of the literature.
Source
High Blood Pressure and Cardiovascular Prevention. Conference: 15th
National Congress of the Italian Society of Cardiovascular Prevention,
SIPREC 2017. Italy. 24 (2) (pp 202), 2017. Date of Publication: June 2017.
Publisher
Springer International Publishing
Abstract
Introduction: Ranolazine use as a drug active against atrial fibrillation
(AF) has been investigated by recent studies. Methods: The rhythm control
strategy was adopted by the studies that used the ranolazine as a
therapeutic option against AF either alone or in combination with
amiodarone. In this meta-analysis both randomized controlled trials (RCTs)
and observational prospective cohort studies were admitted. The effect
size was expressed using the risk ratio, with 95% confidence intervals.
Results: Eight studies (6 RCTs and 2 prospective cohort studies) were
collected on the whole. 3 studies investigated the preventive effect
exerted by ranolazine against AF occurring in the clinical setting of a
recent coronary artery bypass graft (CABG), while 2 studies dealt with the
preventive effect against AF occurring in the absence of CABG. Besides, 4
RCTs investigated the therapeutic effect of ranolazine on the recent-onset
AF. Ranolazine was effective in preventing the occurrence of AF when
compared to controls (RR = 0.60; 95% CI 0.43-0.83; p = 0.002). Ranolazine
increased the chances of successful cardioversion when added to amiodarone
over amiodarone alone (RR 1.27; 95% CI 1.08-1.50; p = 0.004) and
significantly decreased the time to car-dioversion (SMD =-2.83 h; 95%
CI-4.69 to-0.97 h; p <0.001). Overall risks of death, adverse events, and
QTc prolongation were similar in ranolazine-treated patients versus
control group. Conclusions: Ranolazine proved to be an useful and
effective drug either for prophylaxis or conversion to sinus rhythm of AF
that occurs in patients with or without chronic heart failure.

<50>
Accession Number
616813057
Author
Deniz M.A.; Abreo M.; AL-Tamimi H.
Institution
(Deniz, Abreo, AL-Tamimi) Department of ObGyne, Women's Hospital, Hamad
Medical Corporation, Doha, Qatar
Title
Warfarin induced fetal subdural hematoma: Case report.
Source
Journal of Obstetrics and Gynaecology Research. Conference: 25th Asian and
Oceanic Congress of Obstetrics and Gynaecology. Hong Kong. 43 (pp 50-51),
2017. Date of Publication: June 2017.
Publisher
Blackwell Publishing
Abstract
Introduction: Warfarin-associated fetal bleeding is a rare problem;
Incidence of 4.3%. Our case is an example with a living baby, unlike
previous reports. Limited data suggest fetal complications may be dose
dependent, increased complications at > 5 mg daily. Case: 42 years
Jordanian G7P4A2, Mitral valve replacement (MVR) done in 2006 on warfarin
for 6 yrs. Booked at 14 weeks, she was switched to LMWH. Baseline
labs-Normal, anomaly scan at 19 weeks normal. At 27 weeks she developed
fever (UTI), LMWH changed to warfarin 10 mg once daily. Echo-Trivial MR,
Mod TR, LVEF-40% At 32 weeks she presented with less fetal movements;
admission fetal trace reactive, ultrasound revealed normal fetal growth
with sub-dural hematoma. Warfarin was withheld, due to need for urgent
delivery, but when? Labs-INR 4.7 had to be got to 1.5. 24 hours later
fetal trace was non-reactive, repeat scan showed increased hematoma size,
from 7x2 cm to 8x1.2 cm. Decision of termination made by a
multidisciplinary team- obstetrician, neonatologist, cardiology, and
hematology. With FFP transfusion the INR was 2.1,worsening fetal trace
mandated a cesarean delivery; done with blood loss of 700 ml, and baby boy
2010 gm, apgar = 2/5/8 at 1/5/10 minutes, normal cord gases with severe
anemia, umbilical cord Hb-4%,hematocrit-12%, transfused blood 30 ml
through umbilical vein and shifted to NICU,3 days later developed
sub-arachanoid and intraventricular hemorrhage and subsequent
periventricular leucomalacia and attending till date (3 yrs of age) in the
child rehabilitation unit for severe developmental delay, microcephaly and
spastic cerebral palsy. Discussion: Fetal subdural hemorrhage is
attributed to warfarin exposure since; warfarin can cross the placenta,
exposure occurred during 2nd trimester, no hemorrhagic foci prior to
starting warfarin. Excluding our case, most were stillborn/died within a
day. Some studies revealed, mothers on unfractionated heparin are prone to
stillbirth, spontaneous miscarriages and lower anticoagulant efficacy.
LMWH is used in 1st trimester and before delivery, when warfarin is
contraindicated. No randomized studies for full time use of LMWH are
available. Reducing Warfarin doses increases maternal complications.
Unfortunately there is no alternative therapy to replace warfarin in
pregnant women with mechanical heart valves.

<51>
Accession Number
613878529
Author
Zoumot Z.; Davey C.; Jordan S.; McNulty W.H.; Carr D.H.; Hind M.D.; Polkey
M.I.; Shah P.L.; Hopkinson N.S.
Institution
(Zoumot) NIHR Respiratory Disease, Biomedical Research Unit, Royal
Brompton and Harefield NHS Foundation Trust, Imperial College London,
London, United Kingdom
(Zoumot, Davey, Jordan, McNulty, Carr, Hind, Polkey, Shah, Hopkinson)
Respiratory and Critical Care Institute, Cleveland Clinic, Abu Dhabi,
United Arab Emirates
(Hopkinson) Royal Brompton Hospital, Fulham Road, London SW3 6NP, United
Kingdom
Title
Endobronchial valves for patients with heterogeneous emphysema and without
interlobar collateral ventilation: Open label treatment following the
BeLieVeR-HIFi study.
Source
Thorax. 72 (3) (pp 277-279), 2017. Date of Publication: 01 Mar 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Outcomes in early trials of bronchoscopic lung volume reduction using
endobronchial valves for the treatment of patients with advanced emphysema
were inconsistent. However improvements in patient selection with focus on
excluding those with interlobar collateral ventilation and homogeneous
emphysema resulted in significant benefits in the BeLieVeR-HIFi study
compared with sham treated controls. In this manuscript we present data
from the control patients in the BeLieVeR-HIFi study who went on to have
open label endobronchial valve treatment after completion of the clinical
trial (n=12), combined with data from those in the treatment arm who did
not have collateral ventilation (n=19). Three months after treatment
FEV<inf>1</inf> increased by 27.3 (36.4)%, residual volume reduced by 0.49
(0.76) L, the 6 min walk distance increased by 32.6 (68.7) m and the St
George Respiratory Questionnaire for COPD score improved by 8.2 (20.2)
points. These data extend the evidence for endobronchial valve placement
in appropriately selected patients with COPD.<br/>Copyright &#xa9; BMJ
Publishing Group Limited 2017.

<52>
[Use Link to view the full text]
Accession Number
613690606
Author
Takase S.; Matoba T.; Nakashiro S.; Mukai Y.; Inoue S.; Oi K.; Higo T.;
Katsuki S.; Takemoto M.; Suematsu N.; Eshima K.; Miyata K.; Yamamoto M.;
Usui M.; Sadamatsu K.; Satoh S.; Kadokami T.; Hironaga K.; Ichi I.; Todaka
K.; Kishimoto J.; Egashira K.; Sunagawa K.
Institution
(Takase, Matoba, Nakashiro, Higo, Egashira, Sunagawa) Department of
Cardiovascular Medicine, Kyushu University Hospital, 3-1-1, Maidashi,
Higashi-ku, Fukuoka 812-8582, Japan
(Takase, Matoba, Nakashiro, Mukai, Inoue, Oi, Higo, Katsuki, Takemoto,
Sunagawa) Department of Cardiovascular Medicine, Kyushu University
Hospital, Fukuoka, Japan
(Suematsu) Japanese Red Cross Fukuoka Hospital, Japan
(Eshima) St. Mary's Hospital, Kurume, Japan
(Miyata) Japan Community Health Care Organization, Kyushu Hospital,
Fukuoka, Japan
(Yamamoto) Harasanshin Hospital, Fukuoka, Japan
(Usui) Hamanomachi Hospital, Fukuoka, Japan
(Sadamatsu) Saga-ken Medical Centre Koseikan, Saga, Japan
(Satoh) National Hospital Organization Kyushu Medical Centre, Fukuoka,
Japan
(Kadokami) Saiseikai Futsukaichi Hospital, Chikushino, Japan
(Hironaga) Saiseikai Fukuoka General Hospital, Japan
(Hironaga) Fukuoka City Hospital, Japan
(Ichi) Graduate School of Humanities and Science, Ochanomizu University,
Tokyo, Japan
(Todaka, Kishimoto) Center for Clinical and Translational Research, Kyushu
University, Fukuoka, Japan
(Kishimoto) Department of Research and Development of Next Generation
Medicine, Kyushu University Faculty of Medical Sciences, Fukuoka, Japan
Title
Ezetimibe in combination with statins ameliorates endothelial dysfunction
in coronary arteries after stenting: the CuVIC trial (effect of
cholesterol absorption inhibitor usage on target vessel dysfunction after
coronary stenting), a multicenter randomized controlled trial.
Source
Arteriosclerosis, Thrombosis, and Vascular Biology. 37 (2) (pp 350-358),
2017. Date of Publication: 01 Feb 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives - We sought to investigate whether treatment with ezetimibe in
combination with statins improves coronary endothelial function in target
vessels in coronary artery disease patients after coronary stenting.
Approach and Results - We conducted a multicenter, prospective,
randomized, open-label, blinded-end point trial among 11 cardiovascular
treatment centers. From 2011 to 2013, 260 coronary artery disease patients
who underwent coronary stenting were randomly allocated to 2 arms (statin
monotherapy, S versus ezetimibe [10 mg/d]+statin combinational therapy,
E+S). We defined target vessel dysfunction as the primary composite
outcome, which comprised target vessel failure during treatment and at the
6- to 8-month follow-up coronary angiography and coronary endothelial
dysfunction determined via intracoronary acetylcholine testing performed
in cases without target vessel failure at the follow-up coronary
angiography. Coadministration of ezetimibe with statins further lowered
low-density lipoprotein cholesterol levels (83+/-23 mg/dL in S versus
67+/-23 mg/dL in E+S; P<0.0001), with significant decreases in oxidized
low-density lipoprotein and oxysterol levels. Among patients without
target vessel failure, 46 out of 89 patients (52%) in the S arm and 34 out
of 96 patients (35%) in the E+S arm were found to have coronary
endothelial dysfunction (P=0.0256), and the incidence of target vessel
dysfunction at follow-up was significantly decreased in the E+S arm
(69/112 (62%) in S versus 47/109 (43%) in E+S; P=0.0059). A post hoc
analysis of post-treatment low-density lipoprotein cholesterol-matched
subgroups revealed that the incidence of both target vessel dysfunction
and coronary endothelial dysfunction significantly decreased in the E+S
arm, with significant reductions in oxysterol levels. Conclusions - The
CuVIC trial (Effect of Cholesterol Absorption Inhibitor Usage on Target
Vessel Dysfunction after Coronary Stenting) has shown that ezetimibe with
statins, compared with statin monotherapy, improves functional prognoses,
ameliorating endothelial dysfunction in stented coronary arteries, and was
associated with larger decreases in oxysterol levels.<br/>Copyright &#xa9;
2016 American Heart Association, Inc.

<53>
Accession Number
615546686
Author
Guzzetta N.A.; Williams G.D.
Institution
(Guzzetta) Department of Anesthesiology, Emory University School of
Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
(Williams) Department of Anesthesiology, Stanford University School of
Medicine, Lucile Packard Children's Hospital, Palo Alto, CA, United States
Title
Current use of factor concentrates in pediatric cardiac anesthesia.
Source
Paediatric Anaesthesia. 27 (7) (pp 678-687), 2017. Date of Publication:
July 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Excessive bleeding following pediatric cardiopulmonary bypass is
associated with increased morbidity and mortality, both from the effects
of hemorrhage and the therapies employed to achieve hemostasis. Neonates
and infants are especially at risk because their coagulation systems are
immature, surgeries are often complex, and cardiopulmonary bypass
technologies are inappropriately matched to patient size and physiology.
Consequently, these young children receive substantial amounts of
adult-derived blood products to restore adequate hemostasis. Adult and
pediatric data demonstrate associations between blood product transfusions
and adverse patient outcomes. Thus, efforts to limit bleeding after
pediatric cardiopulmonary bypass and minimize allogeneic blood product
exposure are warranted. The off-label use of factor concentrates, such as
fibrinogen concentrate, recombinant activated factor VII, and prothrombin
complex concentrates, is increasing as these hemostatic agents appear to
offer several advantages over conventional blood products. However,
recognizing that these agents have the potential for both benefit and
harm, well-designed studies are needed to enhance our knowledge and to
determine the optimal use of these agents. In this review, our primary
objective was to examine the evidence regarding the use of factor
concentrates to treat bleeding after pediatric CPB and identify where
further research is required. PubMed, MEDLINE/OVID, The Cochrane Library
and the Cochrane Central Register of Controlled Trials (CENTRAL) were
systematically searched to identify existing studies.<br/>Copyright &#xa9;
2017 John Wiley & Sons Ltd

<54>
Accession Number
616132945
Author
Pagnesi M.; Montalto C.; Mangieri A.; Agricola E.; Puri R.; Chiarito M.;
Ancona M.B.; Regazzoli D.; Testa L.; De Bonis M.; Moat N.E.; Rodes-Cabau
J.; Colombo A.; Latib A.
Institution
(Pagnesi, Montalto, Mangieri, Ancona, Regazzoli, Colombo, Latib)
Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan,
Italy
(Agricola) Echocardiography Laboratory, San Raffaele Scientific Institute,
Milan, Italy
(Puri, Rodes-Cabau) Quebec Heart & Lung Institute, Laval University,
Quebec City, Canada
(Chiarito) Division of Clinical and Interventional Cardiology, Humanitas
Research Hospital, Milan, Italy
(Testa) Department of Cardiology, IRCCS Policlinico San Donato, Milan,
Italy
(De Bonis) Department of Cardiovascular and Thoracic Surgery, San Raffaele
Scientific Institute, Milan, Italy
(Moat) Department of Cardiothoracic Surgery, Royal Brompton Hospital,
London, United Kingdom
(Colombo) Vita-Salute San Raffaele University, Milan, Italy
(Colombo, Latib) Interventional Cardiology Unit, EMO-GVM Centro Cuore
Columbus, Milan, Italy
Title
Tricuspid annuloplasty versus a conservative approach in patients with
functional tricuspid regurgitation undergoing left-sided heart valve
surgery: A study-level meta-analysis.
Source
International Journal of Cardiology. 240 (pp 138-144), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Tricuspid valve (TV) repair at the time of left-sided valve
surgery is indicated in patients with either severe functional tricuspid
regurgitation (TR) or mild-to-moderate TR with coexistent tricuspid
annular dilation or right heart failure. We assessed the benefits of a
concomitant TV repair strategy during left-sided surgical valve
interventions, focusing on mortality and echocardiographic TR-related
outcomes. Methods A meta-analysis was performed of studies reporting
outcomes of patients who underwent left-sided (mitral and/or aortic) valve
surgery with or without concomitant TV repair. Primary endpoints were
all-cause and cardiac-related mortality; secondary endpoints were the
presence of more-than-moderate TR, TR progression, and TR severity grade.
All endpoints were evaluated at the longest available follow-up. Results
Fifteen studies were included for a total of 2840 patients. TV repair at
the time of left-sided valve surgery was associated with a significantly
lower risk of cardiac-related mortality (odds ratio [OR] 0.38; 95%
confidence interval [CI]: 0.25-0.58; p < 0.001), with a trend towards a
lower risk of all-cause mortality (OR 0.57; 95% CI: 0.32-1.05; p = 0.07)
at a mean weighted follow-up of 6 years. The presence of
more-than-moderate TR (OR 0.19; 95% CI: 0.12-0.30; p < 0.001), TR
progression (OR 0.03; 95% CI: 0.01-0.05; p < 0.001), and TR grade
(standardized mean difference - 1.11; 95% CI: - 1.57 to - 0.65; p < 0.001)
were significantly lower in the TV repair group at a mean weighted
follow-up of 4.7 years. Conclusions A concomitant TV repair strategy
during left-sided valve surgery is associated with a reduction in
cardiac-related mortality and improved echocardiographic TR outcomes at
follow-up.<br/>Copyright &#xa9; 2017 Elsevier Ireland Ltd

<55>
Accession Number
616800155
Author
Takagi H.; Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan
Title
Better midterm survival in women after transcatheter aortic valve
implantation.
Source
Journal of Cardiovascular Surgery. 58 (4) (pp 624-632), 2017. Date of
Publication: August 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: In previous meta-analyses demonstrating better midterm
overall survival in women undergoing transcatheter aortic valve
implantation (TAVI), unadjusted risk and odds ratios were combined. To
determine whether female gender is independently associated with better
survival after TAVI, we performed a meta-analysis pooling adjusted hazard
ratios (HRs) based on multivariate Cox proportional hazard regression.
EVIDENCE ACQUISITION: MEDLINE and EMBASE were searched through September
2015 using PubMed and OVID. Studies considered for inclusion met the
following criteria: the study population was patients undergoing TAVI; and
main outcomes included midterm (mean or median >=6 months) overall
survival or all-cause mortality in women and men. An unadjusted and/or
adjusted HR of all-cause mortality for women versus men was abstracted
from each individual study. EVIDENCE SYNTHESIS: Of 1347 potentially
relevant articles screened initially, 16 reports of eligible studies were
identified and included. A primary meta-analysis of the 9 adjusted HRs
demonstrated a significantly better midterm overall survival in women than
men (N.=6891; HR=0.80; 95% confidence interval [CI]: 0.65 to 0.97;
P=0.03). A secondary meta-analysis adding 5 statistically non-significant
unadjusted HR also indicated better survival in women (N.=8645; HR=0.83;
95% CI: 0.72 to 0.96; P=0.01). Although statistical tests for the primary
metaanalysis revealed funnel plot asymmetry in favor of women, the
secondary meta-analysis produced a symmetrical funnel plot. CONCLUSIONS:
Female gender may be independently associated with better midterm overall
survival after TAVI.<br/>Copyright &#xa9; 2016 EDIZIONI MINERVA MEDICA.

<56>
Accession Number
615615840
Author
Putzu A.; Gallo M.; Martino E.A.; Ferrari E.; Pedrazzini G.; Moccetti T.;
Cassina T.
Institution
(Putzu, Cassina) Department of Cardiovascular Anesthesia and Intensive
Care, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland
(Gallo, Ferrari) Department of Cardiac Surgery, Cardiocentro Ticino, Via
Tesserete 48, Lugano, Switzerland
(Martino) Department of Anesthesia and Intensive Care, San Gerardo
Hospital, Via Pergolesi 33, Monza, Italy
(Pedrazzini, Moccetti) Department of Cardiology, Cardiocentro Ticino, Via
Tesserete 48, Lugano, Switzerland
Title
Coronary artery bypass graft surgery versus percutaneous coronary
intervention with drug-eluting stents for left main coronary artery
disease: A meta-analysis of randomized trials.
Source
International Journal of Cardiology. 241 (pp 142-148), 2017. Date of
Publication: 15 Aug 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Despite several clinical studies, efficacy of coronary artery
bypass grafting (CABG) surgery versus percutaneous coronary intervention
(PCI) in patients with left main (LM) disease remains controversial. The
objective of this meta-analysis of randomized trials was to evaluate the
clinical outcome of CABG versus PCI with drug-eluting stents in LM
coronary disease. Methods We systematically searched online databases up
to March 2017 for randomized trials comparing CABG to PCI with
drug-eluting stents. We calculated odds ratios (ORs) and 95% confidence
intervals (CIs). Results We included data from 5 randomized trials and
4595 patients. At 30 days, CABG was associated with higher stroke (OR 2.54
[95% CI, 1.02-6.31]) and periprocedural myocardial infarction (OR 1.45
[95% CI, 1.00-2.10]), with no other significant differences compared to
PCI. At 1 year, CABG reduced repeat revascularization (OR 0.56 [95% CI,
0.40-0.77]), but increased stroke (OR 5.11 [95% CI, 1.62-16.12]). At 3-5
years, CABG reduced repeat revascularization (OR 0.55 [95% CI, 0.45-0.67])
and non-periprocedural myocardial infarction (OR 0.45 [95% CI,
0.29-0.70]), without significant differences on other outcomes.
Conclusions From the present updated meta-analysis of available studies on
LM coronary disease treatment, there were no differences in mortality,
myocardial infarction, and stroke rate at 3-5 years follow-up after CABG
or PCI, but CABG decreased the rate of repeat revascularization and
non-periprocedural infarction. However, at short-term follow-up, CABG
showed higher rate of stroke and periprocedural myocardial infarction, but
these effects attenuated over time. These findings merit further
investigation at longer follow-up.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<57>
Accession Number
615095875
Author
Singh V.; Yadav P.K.; Eng M.H.; Macedo F.Y.; Silva G.V.; Mendirichaga R.;
Badiye A.P.; Sakhuja R.; Elmariah S.; Inglessis I.; Alfonso C.E.;
Schreiber T.L.; Cohen M.; Palacios I.; O'Neill W.W.
Institution
(Singh, Sakhuja, Elmariah, Inglessis, Palacios) Massachusetts General
Hospital, Harvard Medical School, Boston, MA, United States
(Yadav) Penn State Milton S. Hershey Medical Center, Hershey, PA, United
States
(Eng, O'Neill) Henry Ford Hospital, Detroit, MI, United States
(Macedo, Silva) Baylor College of Medicine, Houston, TX, United States
(Silva) Texas Heart Institute, Houston, TX, United States
(Mendirichaga, Badiye, Alfonso, Cohen) University of Miami Miller School
of Medicine, Miami, FL, United States
(Schreiber) Detroit Medical Center and Wayne State University, Detroit,
MI, United States
Title
Outcomes of hemodynamic support with Impella in very high-risk patients
undergoing balloon aortic valvuloplasty: Results from the Global cVAD
Registry.
Source
International Journal of Cardiology. 240 (pp 120-125), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Reports on the role of hemodynamic support devices in patients
with severe aortic stenosis (AS) and left ventricular (LV) dysfunction
undergoing balloon aortic valvuloplasty (BAV) are limited. Methods
Patients were identified from the cVAD registry, an ongoing multicenter
voluntary registry at selected sites in North America that have used
Impella in > 10 patients. Results A total of 116 patients with AS who
underwent BAV with Impella support were identified. Mean age was 80.41 +/-
9.03 years and most patients were male. Mean STS score was 18.77% +/-
18.32, LVEF was 27.14% +/- 16.07, and 42% underwent concomitant PCI. In
most cases Impella was placed electively prior to BAV, whereas 26.7% were
placed as an emergency. The two groups had similar baseline
characteristics except for higher prevalence of CAD and lower LVEF in the
elective group, and higher STS score in the emergency group. Elective
strategy was associated higher 1-year survival compared to emergency
placement (56% vs. 29.2%, p = 0.003). One-year survival was higher when
BAV was used as a bridge to definitive therapy as opposed to palliative
treatment (90% vs. 28%, p < 0.001). On multivariate analysis, STS score
and aim of BAV (bridge to definitive therapy vs. palliative indication)
were independent predictors of mortality. Conclusion In this large cohort
of patients with AS and severe LV dysfunction undergoing BAV, our results
demonstrates feasibility and promising long-term outcomes using elective
Impella support with the intention to bridge to a definitive
therapy.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<58>
[Use Link to view the full text]
Accession Number
616769485
Author
Belze O.; Lepage E.; Bazin Y.; Kerourin P.; Fusciardi J.; Remerand F.;
Espitalier F.
Institution
(Belze, Lepage) Department of Anaesthesia, Hopital Foch, Suresnes, France
(Bazin, Kerourin, Fusciardi, Remerand, Espitalier) Department of
Anaesthesia, Pole Anesthesie Reanimation, Universite Francois-Rabelais,
CHRU de Tours, Tours Cedex 09, France
(Belze) Service d'Anesthe sie, Hopital Foch, 40, rue Worth, Suresnes
92151, France
Title
Glidescope versus Airtraq DL for double-lumen tracheal tube insertion in
patients with a predicted or known difficult airway.
Source
European Journal of Anaesthesiology. 34 (7) (pp 456-463), 2017. Date of
Publication: 01 Jul 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND Double-lumen tracheal tube (DLT) insertion can be managed with
videolaryngoscopes such as the Glidescope or indirect laryngoscopes like
the Airtraq DL. No study has compared both devices when a difficult
intubation is predicted. OBJECTIVE Our hypothesis was that the Glidescope
is superior to the Airtraq for double-lumen tube insertion in patients
with a predicted or known difficult airway. DESIGN Randomised study.
PATIENTS Adults scheduled for thoracic elective surgery, requiring
one-lung ventilation with a predicted difficult intubation score of at
least 7 (Arne risk index). INTERVENTION Between March 2014 and March 2015,
adult patients, scheduled for elective thoracic surgery, requiring
double-lumen tracheal tube placement, and with a predicted risk (evaluated
preoperatively using the Arne score) or a history of difficult intubation,
were allocated to a Glidescope or an Airtraq group. MAIN OUTCOME MEASURES
The primary outcome was the overall success rate of tracheal intubation
after two attempts. Secondary outcomes were success rates on the first
attempt, duration of intubation, need for laryngeal pressure, Cormack and
Lehane grade and side-effects. RESULTS Of 277 patients, 78 were predicted
to have a difficult airway. Finally, 72 patients were enrolled. Neither
the overall success rates of tracheal intubation [Glidescope group 31/36
(86%) versus Airtraq group 34/36 (94%), P = 0.43] nor the side-effects
differed between groups. There was no difference concerning visualisation
of the glottis using the Cormack and Lehane grade (P = 0.18) or intubation
time [Glidescope group 67 s (49 to 90) versus Airtraq group 81 s (59 to
101), P = 0.28]. All patients with a previous history of difficult
intubation were intubated successfully. CONCLUSION There is no difference
in success rates of tracheal intubation with a double-lumen tube in
patients with a predicted or known difficult airway when using either a
Glidescope or Airtraq device. TRIAL REGISTRATION National register of the
French National Agency for Medicines and Health Products Safety
No.<br/>Copyright &#xa9; 2016 European Society of Anaesthesiology. All
rights reserved.

<59>
Accession Number
616670877
Author
Fearon W.F.; Okada K.; Kobashigawa J.A.; Kobayashi Y.; Luikart H.; Sana
S.; Daun T.; Chmura S.A.; Sinha S.; Cohen G.; Honda Y.; Pham M.; Lewis
D.B.; Bernstein D.; Yeung A.C.; Valantine H.A.; Khush K.
Institution
(Fearon, Okada, Kobayashi, Luikart, Sinha, Cohen, Honda, Yeung, Valantine,
Khush) Stanford Cardiovascular Institute and Division of Cardiovascular
Medicine, Stanford, California, United States
(Chmura, Lewis) Department of Pediatrics, Division of Allergy, Immunology,
and Rheumatology, Stanford University School of Medicine, Stanford,
California, United States
(Bernstein) Department of Pediatrics, Division of Cardiology, Stanford
University School of Medicine, Stanford, California, United States
(Kobashigawa, Sana, Daun) Advanced Heart Disease Section, Cedars-Sinai
Heart Institute, Los Angeles, California, United States
(Fearon, Pham) Cardiology Section, Palo Alto Veterans Affairs Health Care
System, Palo Alto, California, United States
Title
Angiotensin-Converting Enzyme Inhibition Early After Heart
Transplantation.
Source
Journal of the American College of Cardiology. 69 (23) (pp 2832-2841),
2017. Date of Publication: 13 Jun 2017.
Publisher
Elsevier USA
Abstract
Background Cardiac allograft vasculopathy (CAV) remains a leading cause of
mortality after heart transplantation (HT). Angiotensin-converting enzyme
inhibitors (ACEIs) may retard the development of CAV but have not been
well studied after HT. Objectives This study tested the safety and
efficacy of the ACEI ramipril on the development of CAV early after HT.
Methods In this prospective, multicenter, randomized, double-blind,
placebo-controlled trial, 96 HT recipients were randomized to undergo
ramipril or placebo therapy. They underwent coronary angiography,
endothelial function testing; measurements of fractional flow reserve
(FFR) and coronary flow reserve (CFR) and the index of microcirculatory
resistance (IMR); and intravascular ultrasonography (IVUS) of the left
anterior descending coronary artery, within 8 weeks of HT. At 1 year, the
invasive assessment was repeated. Circulating endothelial progenitor cells
(EPCs) were quantified at baseline and 1 year. Results Plaque volumes at 1
year were similar between the ramipril and placebo groups (162.1 +/- 70.5
mm³ vs. 177.3 +/- 94.3 mm³, respectively; p = 0.73).
Patients receiving ramipril had improvement in microvascular function as
shown by a significant decrease in IMR (21.4 +/- 14.7 to 14.4 +/- 6.3; p =
0.001) and increase in CFR (3.8 +/- 1.7 to 4.8 +/- 1.5; p = 0.017), from
baseline to 1 year. This did not occur with IMR (17.4 +/- 8.4 to 21.5 +/-
20.0; p = 0.72) or CFR (4.1 +/- 1.8 to 4.1 +/- 2.2; p = 0.60) in the
placebo-treated patients. EPCs decreased significantly at 1 year in the
placebo group but not in the ramipril group. Conclusions Ramipril does not
slow development of epicardial plaque volume but does stabilize levels of
endothelial progenitor cells and improve microvascular function, which
have been associated with improved long-term survival after HT.
(Angiotensin Converting Enzyme [ACE] Inhibition and Cardiac Allograft
Vasculopathy; NCT01078363)<br/>Copyright &#xa9; 2017 American College of
Cardiology Foundation

<60>
Accession Number
615007132
Author
McIlroy D.; Murphy D.; Kasza J.; Bhatia D.; Wutzlhofer L.; Marasco S.
Institution
(McIlroy, Bhatia, Wutzlhofer) Department of Anaesthesia and Perioperative
Medicine, Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004,
Australia
(McIlroy, Marasco) Monash University, Commercial Road, Melbourne, VIC
3004, Australia
(Murphy) Intensive Care Unit, Alfred Hospital, Melbourne, VIC, Australia
(Kasza) Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, VIC, Australia
(Marasco) Department of Surgery, Alfred Hospital, Melbourne, VIC,
Australia
Title
Effects of restricting perioperative use of intravenous chloride on kidney
injury in patients undergoing cardiac surgery: the LICRA pragmatic
controlled clinical trial.
Source
Intensive Care Medicine. 43 (6) (pp 795-806), 2017. Date of Publication:
01 Jun 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: The administration of chloride-rich intravenous (IV) fluid and
hyperchloraemia have been associated with perioperative renal injury. The
aim of this study was to determine whether a comprehensive perioperative
protocol for the administration of chloride-limited IV fluid would reduce
perioperative renal injury in adults undergoing cardiac surgery. Methods:
From February 2014 through to December 2015, all adult patients undergoing
cardiac surgery within a single academic medical center received IV fluid
according to the study protocol. The perioperative protocol governed all
fluid administration from commencement of anesthesia through to discharge
from the intensive care unit and varied over four sequential periods, each
lasting 5 months. In periods 1 and 4 a chloride-rich strategy, consisting
of 0.9% saline and 4% albumin, was adopted; in periods 2 and 3, a
chloride-limited strategy, consisting of a buffered salt solution and 20%
albumin, was used. Co-primary outcomes were peak delta serum creatinine
(S<inf>Cr</inf>) within 5 days after the operation and KDIGO-defined stage
2 or stage 3 acute kidney injury (AKI) within 5 days after the operation.
Results: We enrolled and analysed data from 1136 patients, with 569
patients assigned to a chloride-rich fluid strategy and 567 to a
chloride-limited one. Compared with a chloride-limited strategy and
adjusted for prespecified covariates, there was no association between a
chloride-rich perioperative fluid strategy and either peak S<inf>Cr</inf>,
transformed to satisfy the assumptions of multivariable linear regression
[regression coefficient 0.03, 95% confidence interval (CI) -0.03 to 0.08);
p = 0.39], or stage 2 or 3 AKI (adjusted odds ratio 0.97, 95% CI
0.65-1.47; p = 0.90]. Conclusions: A perioperative fluid strategy to
restrict IV chloride administration was not associated with an altered
incidence of AKI or other metrics of renal injury in adult patients
undergoing cardiac surgery. Trial Registration: Clinicaltrials.gov
Identifier: NCT02020538.<br/>Copyright &#xa9; 2017, Springer-Verlag Berlin
Heidelberg and ESICM.

<61>
Accession Number
616743259
Author
Esperanza Q.P.
Institution
(Esperanza) Hospital Riotinto, Area de Gestion Sanitaria Norte de Hueva,
Spain
Title
Importance of medical oxygen in multiple therapeutic uses.
Source
European Journal of Clinical Pharmacy. 19 (2) (pp 125-133), 2017. Date of
Publication: March-April 2017.
Publisher
Rasgo Editorial S.A.
Abstract
Objective: To conduct a systematic review of the available information on
the therapeutic role of medical oxygen and its many therapeutic uses.
Method: A literature search was conducted on inhaled medical oxygen using
the PuBMed (Medline), Library Cochrane Plus and Cochrane Library
databases, without language restriction. The designated period was
2006-2016, using MeSH descriptor oxygen inhalation therapy, oxygen and
Therapeutic Uses and Respiratory Tract Diseases, indications continuous
home oxygen therapy and Oxygen Home Care Services)). It was completed with
manual search in Clinical Practice Guidelines for Respiratory Diseases
[Chronic Obstructive Pulmonary Disease (COPD) and chronic bronchiolitis],
Integrated Care Process of COPD and bronchiolitis, respiratory disease
journals and monographic documents of the Spanish Society of Pneumology
and Thoracic Surgery (SEPAR). Results: Twenty two significant results were
found in the literature search and complemented with those obtained in the
search in Clinical Practice Guidelines for Respiratory Diseases,
Integrated Healthcare Processes and Documents of the SEPAR. These outcomes
refer to the indications which have established the oxygen efficacy with
existing relevant scientific evidence (COPD), and to other therapeutic
uses where scientific evidence was not relevant or sufficient (pulmonary
interstitial disease, heart diseases, pneumonia in adults, bronchiolitis,
and others). Conclusion: The important role of oxygen is clearly defined
in respiratory diseases, but unlike patients with COPD, there is no
evidence showing that oxygen therapy affects long-term survival and
quality of life in other respiratory and non-respiratory diseases with
moderate or severe hypoxemia. Among these conditions, we refer to diffuse
interstitial lung disease, pulmonary hypertension, cystic fibrosis, heart
diseases and generally, any disease in which chronic hypoxemia is an
important factor. Despite the lack of evidence, in routine clinical
practice, COT must be recommended on an individual Basis in these patients
when PaO<inf>2</inf> is <60 mm Hg, adjusting the flow rate to maintain a
SaO<inf>2</inf> >90% (consistent recommendation, low quality of evidence).
Therefore, further studies are needed to back-up the role of medical
oxygen in this type of pathologies.

<62>
Accession Number
615175939
Author
Hahn J.-Y.; Choi S.-H.; Jeong J.-O.; Song Y.B.; Choi J.-H.; Park Y.H.;
Chun W.J.; Oh J.H.; Cho D.K.; Lim S.-H.; Choi Y.J.; Im E.-S.; Won K.-H.;
Lee S.Y.; Kim S.-W.; Gwon H.-C.
Institution
(Hahn, Choi, Song, Choi, Gwon) Division of Cardiology, Department of
Medicine, Samsung Medical Center, Sungkyunkwan University School of
Medicine, Seoul, South Korea
(Jeong) Chungnam National University Hospital, Daejeon, South Korea
(Park, Chun, Oh) Samsung Changwon Hospital, Sungkyunkwan University School
of Medicine, Changwon, South Korea
(Cho) Hanmaeum Hospital, Jeju, South Korea
(Lim) Dankook University Hospital, Cheonan, South Korea
(Choi) Eulji Medical Center, Eulji University, Daejeon, South Korea
(Im) Dongsuwon General Hospital, Suwon, South Korea
(Won) Seoul Medical Center, Seoul, South Korea
(Lee) Inje University Ilsan Paik Hospital, Goyang, South Korea
(Kim) Chung-Ang University Hospital, Seoul, South Korea
Title
Conservative versus aggressive treatment strategy with angiographic
guidance alone in patients with intermediate coronary lesions: The
SMART-CASE randomized, non-inferiority trial.
Source
International Journal of Cardiology. 240 (pp 114-119), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Although coronary angiography is still the technique most
widely used to guide percutaneous coronary intervention (PCI), the
appropriate angiographic indication of revascularization for intermediate
coronary lesions remains controversial. The aim of this study was to
compare conservative versus aggressive strategies with angiographic
guidance alone in patients with intermediate coronary lesions. Methods and
results A total of 899 patients with intermediate coronary lesions between
50% and 70% diameter stenosis by quantitative coronary analysis were
randomly assigned to the conservative group (n = 449) or the aggressive
group (n = 450). For intermediate lesions, PCI was performed using
everolimus-eluting stents in the aggressive group, but was deferred in the
conservative group. The primary end point was a composite of all-cause
death, myocardial infarction, or any revascularization at 1 year. The
number of treated lesions per patient was 0.8 +/- 0.9 in the conservative
group and 1.7 +/- 0.9 in the aggressive group (p < 0.001). The cumulative
rate of the primary endpoint was 7.3% in the conservative group and 6.8%
in the aggressive group (the upper limit of the one-sided 95% confidence
interval [CI], 3.4%; p = 0.006 for non-inferiority with a predefined
non-inferiority margin of 5.0%). The risk of death or myocardial
infarction (hazard ratio [HR] 0.50; 95% CI, 0.19-1.33; p = 0.17) and
revascularization (HR 1.42; 95% CI, 0.80-2.52; p = 0.23) was not
significantly different between the 2 groups. Conclusions Conservative
revascularization was non-inferior to aggressive revascularization for
intermediate coronary lesions. Revascularization of intermediate lesions
can be safely deferred in patients undergoing PCI with angiographic
guidance alone. Clinical trial registration: URL:
http://ClinicalTrials.gov. Unique identifier: NCT00743899.<br/>Copyright
&#xa9; 2017

<63>
Accession Number
616334258
Author
Shah R.; Morsy M.S.; Weiman D.S.; Vetrovec G.W.
Institution
(Shah, Morsy) Section of Cardiology, Department of Medicine, University of
Tennessee, School of Medicine, Memphis, Tennessee, United States
(Shah, Weiman) Department of Medicine, Veterans Affairs Medical Center,
Memphis, Tennessee, United States
(Weiman) Department of Cardiothoracic Surgery, University of Tennessee,
Memphis, Tennessee, United States
(Vetrovec) Section of Cardiology, Department of Medicine, Virginia
Commonwealth University, Richmond, Virginia, United States
Title
Meta-Analysis Comparing Coronary Artery Bypass Grafting to Drug-Eluting
Stents and to Medical Therapy Alone for Left Main Coronary Artery Disease.
Source
American Journal of Cardiology. 120 (1) (pp 63-68), 2017. Date of
Publication: 01 Jul 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Historically, coronary artery bypass graft (CABG) surgery has been the
standard revascularization method for unprotected left main coronary
artery (LMCA) disease. Over the last decade, several randomized controlled
trials (RCTs) have shown favorable results for percutaneous coronary
intervention (PCI) with drug-eluting stent (DES) compared with CABG;
however, no RCT has been conducted directly comparing DESs with medical
therapy alone (MTA). Furthermore, the 2 most recently reported larger
RCTs, using new-generation DESs reached somewhat conflicting conclusions
comparing the 2 revascularization strategies. Therefore, we performed a
traditional pairwise meta-analysis and Bayesian network meta-analysis to
compare the efficacies of the 3 currently available treatment strategies
(MTA, CABG, and DES) for unprotected LMCA disease. Scientific databases
and websites were searched to find RCTs. Data from 8 trials including
4,850 patients were analyzed. Overall PCI increased the risk of major
adverse cardiac and cerebrovascular events (MACCEs) driven by increased
rate of revascularization compared with CABG, but no differences in
all-cause mortality, cardiac mortality, and recurrent myocardial
infarction were found. However, early (i.e., within 30 days) PCI decreased
the risk of MACCEs and stroke compared with CABG. In the mixed-treatment
comparison models, both CABG and DESs were associated with better survival
compared with MTA, but no difference was found between them. In
conclusion, in patients with unprotected LMCA disease, PCI with DESs
yields similar all-cause and cardiac mortalities compared with CABG.
Furthermore, CABG increases early (i.e., within 30 days) MACCE rates,
driven by an increased risk of stroke. Over longer durations, PCI
increases MACCE rates because of increased recurrent
revascularization.<br/>Copyright &#xa9; 2017

<64>
Accession Number
610173163
Author
Sadhwani A.; Asaro L.A.; Goldberg C.; Ware J.; Butcher J.; Gaies M.; Smith
C.; Alexander J.L.; Wypij D.; Agus M.S.D.
Institution
(Sadhwani, Ware) Cardiac Neurodevelopmental Program, Boston Children's
Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115,
United States
(Sadhwani, Ware) Department of Psychiatry, Boston Children's Hospital,
Harvard Medical School, Boston, MA, United States
(Asaro, Wypij) Department of Cardiology, Boston Children's Hospital,
Harvard Medical School, Boston, MA, United States
(Goldberg, Gaies, Smith) Division of Cardiology, C.S. Mott Children's
Hospital, University of Michigan Medical School, Ann Arbor, MI, United
States
(Goldberg, Butcher, Gaies, Smith) Department of Pediatrics and
Communicable Diseases, C.S. Mott Children's Hospital, University of
Michigan Medical School, Ann Arbor, MI, United States
(Butcher) Division of Pediatric Psychology, C.S. Mott Children's Hospital,
University of Michigan Medical School, Ann Arbor, MI, United States
(Alexander, Agus) Division of Medicine Critical Care, Boston Children's
Hospital, Harvard Medical School, Boston, MA, United States
(Wypij) Department of Biostatistics, Harvard T.H. Chan School of Public
Health, Boston, MA, United States
Title
Impact of Tight Glycemic Control on Neurodevelopmental Outcomes at 1 Year
of Age for Children with Congenital Heart Disease: A Randomized Controlled
Trial.
Source
Journal of Pediatrics. 174 (pp 193-198.e2), 2016. Date of Publication: 01
Jul 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective To assess the association of postoperative tight glycemic
control and hypoglycemia in children undergoing cardiac surgery with
neurodevelopmental outcomes at 1 year of age. Study design A 2-center,
prospective, randomized trial of postoperative tight glycemic control vs
standard care was conducted in 980 children undergoing cardiac surgery.
Neurodevelopmental outcomes were assessed at nine to 18 months using the
Bayley Scales of Infant and Toddler Development, Third Edition
(Bayley-III), the Adaptive Behavior Assessment System, Second Edition, the
Ages and Stages Questionnaire, Third Edition, and the Brief Infant Toddler
Social-Emotional Assessment. Results Neurodevelopmental follow-up was
performed on 237 patients with a mean age of 13 months. No significant
treatment group differences were found in the Bayley-III and Adaptive
Behavior Assessment System, Second Edition composite scores or percentage
at risk based on the Ages and Stages Questionnaire, Third Edition and the
Brief Infant Toddler Social-Emotional Assessment. Patients who experienced
moderate to severe hypoglycemia (n = 8) had lower Bayley-III composite
scores compared with patients with no to mild hypoglycemia, even after
controlling for factors known to be associated with poorer
neurodevelopmental outcomes. Conclusion For infants undergoing cardiac
surgery, tight glycemic control did not impact neurodevelopmental outcomes
compared with standard care. These data suggest a possible association
between moderate to severe hypoglycemia and poorer neurodevelopmental
outcomes at 1 year of age.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<65>
Accession Number
616799224
Author
Ozer E.; Yilmaz R.
Institution
(Ozer, Yilmaz) Clinic of Anesthesiology and Reanimation, Private TOBB ETU
Hospital, Ankara, Turkey
Title
Effect of different anesthetic techniques on mental outcome In elderly
patients undergoing off-pump coronary artery bypass graft surgery.
Source
Turkiye Klinikleri Cardiovascular Sciences. 29 (1) (pp 17-22), 2017. Date
of Publication: 2017.
Publisher
OrtadogAYu Reklam Tanitim Yayincilik Turizm Egitim Insaat Sanayi ve
Ticaret A.S. (Turkocagi Caddesi No. 30, Balgat 06520, Turkey. E-mail:
aysea@turkiyeklinikleri.com)
Abstract
Objective: In this article, we aimed to test the hypothesis that
maintenance of hemodynamic stability with anesthesia and no-touch aortic
technique in off-pump coronary artery bypass graft surgery (CABG) may
diminish postoperative mental complications in elderly patients. Material
and Methods: Between June 2009 and December 2009, 88 elderly patients (53
males, 35 females; mean age 71+/-7 years; range 64 to 78 years) with a
physical status of ASA II-III who underwent elective off-pump CABG surgery
in our hospital's operating rooms and cardiovascular and thoracic
intensive care units were included in this prospective randomized study
with signed informed consents. Patients undergoing off-pump CABG surgery
performed by a surgeon were randomly assigned into two groups, including
total intravenous anesthesia (group TIVA, n=40; mean age 66+/-4) or
inhalational anesthesia (group IA, n=40; mean age 69+/-3). The effect of
off-pump CABG surgery on mental outcome was assessed with S100 protein, a
neurochemical marker of brain injury under ischemic conditions. Comparison
of mental function before and after off-pump CABG surgery, hemodynamic
stability and time to discharge were the main outcomes of the study.
Results: Hemodynamic values were stable in both groups. None of the
patients showed marked increase in serum concentrations of S100
postoperatively (p<0.001). The mean total off-pump CABG time was 48+/-15
minutes in both groups. There was no difference between the groups in
terms of time to discharge. Conclusion: We believe that well-performed
hemodynamic stability with either intravenous or general anesthesia may
offer a well-controlled mental function in elderly patients undergoing
offpump CABG surgery.<br/>Copyright &#xa9; 2017 by Turkiye Klinikleri.

<66>
Accession Number
616777963
Author
Brainard J.; Scott B.K.; Sullivan B.L.; Fernandez-Bustamante A.; Piccoli
J.R.; Gebbink M.G.; Bartels K.
Institution
(Brainard, Scott, Sullivan, Fernandez-Bustamante, Bartels) Department of
Anesthesiology, University of Colorado School of Medicine, 12401 E. 17th
Avenue, Leprino Office Building, 7th Floor, MS B-113, Aurora, CO 80045,
United States
(Piccoli, Gebbink) Department of Respiratory Care, University of Colorado
Hospital, 12605 East 16th Avenue, MS F-764, Aurora, CO 80045, United
States
Title
Heated humidified high-flow nasal cannula oxygen after thoracic surgery -
A randomized prospective clinical pilot trial.
Source
Journal of Critical Care. 40 (pp 225-228), 2017. Date of Publication: 01
Aug 2017.
Publisher
W.B. Saunders
Abstract
Background Thoracic surgery patients are at high-risk for adverse
pulmonary outcomes. Heated humidified high-flow nasal cannula oxygen
(HHFNC O<inf>2</inf>) may decrease such events. We hypothesized that
patients randomized to prophylactic HHFNC O<inf>2</inf> would develop
fewer pulmonary complications compared to conventional O<inf>2</inf>
therapy. Methods and patients Fifty-one patients were randomized to HHFNC
O<inf>2</inf> vs. conventional O<inf>2</inf>. The primary outcome was a
composite of postoperative pulmonary complications. Secondary outcomes
included oxygenation and length of stay. Continuous variables were
compared with t-test or Mann-Whitney-U test, categorical variables with
Fisher's Exact test. Results There were no differences in postoperative
pulmonary complications based on intention to treat [two in HHFNC
O<inf>2</inf> (n = 25), two in control (n = 26), p = 0.680], and after
exclusion of patients who discontinued HHFNC O<inf>2</inf> early [one in
HHFNC O<inf>2</inf> (n = 18), two in control (n = 26), p = 0.638].
Discomfort from HHFNC O<inf>2</inf> occurred in 11/25 (44%); 7/25 (28%)
discontinued treatment. Conclusions Pulmonary complications were rare
after thoracic surgery. Although HHFNC O<inf>2</inf> did not convey
significant benefits, these results need to be interpreted with caution,
as our study was likely underpowered to detect a reduction in pulmonary
complications. High rates of patient-reported discomfort with HHFNC
O<inf>2</inf> need to be considered in clinical practice and future
trials.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<67>
Accession Number
616823653
Author
Bikmoradi A.; Masmouei B.; Ghomeisi M.; Roshanaei G.; Masiello I.
Institution
(Bikmoradi) Department of health economics and management, School of
public health, Hamadan University of Medical Sciences, Hamadan, Iran
(Masmouei) Department of Medical Surgical Nursing, School of Nursing and
Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
(Ghomeisi) Department of Surgery, School of Medicine, Kermanshah
University of Medical Sciences, Kermanshah, Iran
(Roshanaei) Department of Epidemiology and Biostatistics, School of Public
Health, Hamadan University of Medical Sciences, Hamadan, Iran
(Masiello) Department of Clinical Science and Education, Karolinska
Institutet, Sodersjukhuset, Stockholm, Sweden
Title
Impact of telephone counseling on the quality of life of patients
discharged after coronary artery bypass grafts.
Source
Patient Education and Counseling. (no pagination), 2017. Date of
Publication: December 01, 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background: This study aimed to assess the impact of telephone counseling
on quality of life in patients with coronary artery bypass graft. Methods:
A quasi-experimental study was conducted with 71 discharged patients after
coronary artery bypass graft surgery at Ekbatan Edcuational hospital in
Hamadan, Iran, in 2014. The patients were randomly allocated into
intervention (n = 36) and control group (n = 35). The intervention group
received education and counseling about therapeutic plan via telephone
after discharge. Patients in the control group received only routines. All
patients completed the quality of life questionnaire before and after the
intervention period of five weeks. Results: There was no significant
difference between intervention and control group about quality of life
before intervention (p = 0.696). However, there was significant and
positive deference between the two groups in favor of the telephone
counseling after the intervention (P = 0.01) and control group (P = 0.04).
Quality of life in the intervention group was significantly better
compared to control group (P = 0.01). Conclusions: Telephone counseling
could be a cost-effective patient counseling plan for therapeutic
adherence after coronary artery bypass surgery in order to improve the
patients' quality of life. Practice implications: Telephone counseling is
feasible to implement and well accepted for patient counseling for many
diseases.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<68>
Accession Number
616797243
Author
Furlong-Dillard J.M.; Amula V.; Bailly D.K.; Bleyl S.B.; Wilkes J.;
Bratton S.L.
Institution
(Furlong-Dillard) 1Department of Pediatrics, Division Critical Care,
University of Utah School of Medicine, Salt Lake City, UT. 2Department of
Pediatrics, Division Genetics, University of Utah School of Medicine, Salt
Lake City, UT. 3Pediatric Clinical Program, Intermountain Healthcare, Salt
Lake City, UT.
Title
Use of Extracorporeal Membrane Oxygenation and Mortality in Pediatric
Cardiac Surgery Patients With Genetic Conditions: A Multicenter Analysis.
Source
Pediatric Critical Care Medicine. (no pagination), 2017. Date of
Publication: 09 Jun 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
OBJECTIVE:: Congenital heart disease is commonly a manifestation of
genetic conditions. Surgery and/or extracorporeal membrane oxygenation
were withheld in the past from some patients with genetic conditions. We
hypothesized that surgical care of children with genetic conditions has
increased over the last decade, but their cardiac extracorporeal membrane
oxygenation use remains lower and mortality greater. DESIGN::
Retrospective cohort study. SETTING:: Patients admitted to the Pediatric
Health Information System database 18 years old or younger with cardiac
surgery during 2003-2014. Genetic conditions identified by International
Classification of Diseases, 9th Edition codes were grouped as follows:
trisomy 21, trisomy 13 or 18, 22q11 deletion, and all "other" genetic
conditions and compared with patients without genetic condition.
PATIENTS:: A total of 95,253 patients met study criteria, no genetic
conditions (85%), trisomy 21 (10%), trisomy 13 or 18 (0.2%), 22q11
deletion (1%), and others (5%). INTERVENTIONS:: None. MEASUREMENTS AND
MAIN RESULTS:: Annual surgical cases did not vary over time. Compared to
patients without genetic conditions, trisomy 21 patients, extracorporeal
membrane oxygenation use was just over half (odds ratio, 0.54), but
mortality with and without extracorporeal membrane oxygenation were
similar. In trisomy 13 or 18 patients, extracorporeal membrane oxygenation
use was similar to those without genetic condition, but all five treated
with extracorporeal membrane oxygenation died. 22q11 patients compared
with those without genetic condition had similar extracorporeal membrane
oxygenation use, but greater odds of extracorporeal membrane oxygenation
mortality (odds ratio, 3.44). Other genetic conditions had significantly
greater extracorporeal membrane oxygenation use (odds ratio, 1.22),
mortality with extracorporeal membrane oxygenation (odds ratio, 1.42), and
even greater mortality odds without (odds ratio, 2.62). CONCLUSIONS:: The
proportion of children undergoing cardiac surgery who have genetic
conditions did not increase during the study. Excluding trisomy 13 or 18,
all groups of genetic conditions received and benefited from
extracorporeal membrane oxygenation, although extracorporeal membrane
oxygenation mortality was greater for those with 22q11 deletion and other
genetic conditions.<br/>Copyright &#xa9;2017The Society of Critical Care
Medicine and the World Federation of Pediatric Intensive and Critical Care
Societies

<69>
Accession Number
616545369
Author
Stevens L.-M.; Noiseux N.; Avezum A.; Ayapati D.R.; Chen X.; Lucchesee
F.A.; Cacheda H.; Parvathaneni S.; Ou Y.; Lamy A.
Institution
(Stevens, Noiseux) Department of Surgery, Division of Cardiac Surgery,
Centre Hospitalier de l'Universite de Montreal and Research Center,
Montreal, QC, Canada
(Avezum) Research Division, Dante Pazzanese Institute of Cardiology, Sao
Paulo, Brazil
(Ayapati) Department of Cardiothoracic Surgery, India Global Hospitals,
Hyderabad, India
(Chen) Department of Cardiothoracic Surgery, Nanjing First Hospital,
Nanjing, China
(Lucchesee) Department of Cardiovascular Surgery, Sao Francisco Hospital,
Porto Alegre, Brazil
(Cacheda) Department of Cardiothoracic Surgery, Institute of Cardiology of
Corrientes, Corrientes, Argentina
(Parvathaneni) Department of Cardiothoracic Surgery, Mercy Medical
Research Institute, St-Louis, MO, United States
(Ou, Lamy) Department of Surgery, Division of Cardiac Surgery, McMaster
University and Population Health Research Institute, Hamilton, ON, Canada
Title
Conversion after off-pump coronary artery bypass grafting: The CORONARY
trial experience.
Source
European Journal of Cardio-thoracic Surgery. 51 (3) (pp 539-546), 2017.
Date of Publication: 01 Mar 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Emergent and late conversions form OFF-to-ON pump coronary
artery bypass grafting (CABG) have been associated with worse outcomes,
however, it remains unclear as to which risk factors are associated with
conversion and how to prevent them. METHODS: Among 4718 patients who
randomly underwent off- or on-pump CABG, the incidence of off-pump to
on-pump cross-over, or 'OFF-to-ON conversion', was 7.9% (186/2356). The
primary outcome was a composite of death, stroke, myocardial infarction,
or new renal failure requiring dialysis. We assessed the risk factors and
outcomes of converted patients. RESULTS: Emergent OFF-to-ON conversions,
defined as conversions for hypotension or ischaemia, were required for
3.2% of patients (n = 75), while most elective conversions were due to
small or intramuscular coronaries (n = 83). OFF-to-ON converted patients
required increased surgery time, blood transfusions, intensive care unit
stay, and presented a higher incidence at 1 year of the composite outcome
compared with non-converted off-pump patients (all P < 0.01), especially
if the conversion was emergent. Conversely, elective conversions outcomes
were no different compared with non-converted off-pump patients (P =
0.35). Independent predictors of emergent conversions included higher
heart rate or chronic atrial fibrillation, urgent surgery, more grafts
planned and surgeon experience with off-pump CABG. CONCLUSION: Emergent
OFF-to-ON conversion is associated with worse outcomes compared with
elective conversion or no conversion. In the presence of risk factors for
emergent conversion, an early and elective conversion approach is a
judicious strategy.<br/>Copyright &#xa9; The Author 2016. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<70>
Accession Number
616534323
Author
Talwar S.; Gupta A.; Nehra A.; Makhija N.; Kapoor P.M.; Sreenivas V.;
Choudhary S.K.; Airan B.
Institution
(Talwar, Gupta, Choudhary, Airan) Departments of Cardiothoracic and
Vascular Surgery, All India Institute of Medical Sciences, New Delhi,
India
(Nehra) Clinical Neuropsychology, Neurosciences Centre, All India
Institute of Medical Sciences, New Delhi, India
(Makhija, Kapoor) Departments of Cardiac Anaesthesiology, All India
Institute of Medical Sciences, New Delhi, India
(Sreenivas) Departments of Biostatistics, All India Institute of Medical
Sciences, New Delhi, India
Title
Bidirectional superior cavopulmonary anastomosis with or without
cardiopulmonary bypass: A randomized study.
Source
Journal of Cardiac Surgery. 32 (6) (pp 376-381), 2017. Date of
Publication: June 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: This study aims to compare the bidirectional superior
cavopulmonary anastomosis (BDG) with or without cardiopulmonary bypass
(CPB). Methods: 100 patients undergoing BDG were randomized into two
groups: Off-CPB or on-CPB groups. All patients underwent near-infrared
spectrophotometry (NIRS) and bispectral index (BIS) monitoring and pre-
and postoperative serum 100 beta protein measurements (Sbeta100) and
neuro-cognitive evaluation. Postoperative intensive care unit (ICU)
parameters were also studied. Results: The median age of patients in the
on-CPB and off-CPB group were 42 and 48 months, respectively (p = 0.11).
Median weights in the on-CPB group and off-CPB group were 13.5 (5-50) kg
and 15 (7-36) kg, respectively (p = 0.927). There was a significant rise
in superior vena cava (SVC) pressure on SVC clamping in the off-CPB group
(23.12 +/- 6.84 vs 2.98 +/- 2.22 mmHg) on-CPB group (p < 0.001). There was
a significant fall in NIRS and BIS values from baseline in the off-CPB
group during the anastomosis but there was no statistically significant
change in serum Sbeta100from pre-clamp to post-clamp in either group.
Inotropic support, duration of ventilation, ICU stay, and hospital stay
were significantly less in the off-CPB group (p < 0.001). Assessment of
Social Adaptive Functioning revealed no adverse sequelae. There were
significant cost savings if surgery was performed off-CPB (p < 0.001).
Conclusion: Off CPB-BDG is an economical and safe procedure. Duration of
inotropic and mechanical ventilatory support, ICU, and hospital stay is
significantly less. We did not observe any early adverse neurologic
sequelae in patients undergoing off-CPB BDG.<br/>Copyright &#xa9; 2017
Wiley Periodicals, Inc.

<71>
Accession Number
615431818
Author
Kwok C.S.; Bagur R.; Rashid M.; Lavi R.; Cibelli M.; de Belder M.A.; Moat
N.; Hildick-Smith D.; Ludman P.; Mamas M.A.
Institution
(Kwok, Bagur, Rashid, Mamas) Cardiovascular Research Group, Keele
University, Stoke-on-Trent, United Kingdom
(Bagur) Division of Cardiology, London Health Sciences Centre, Department
of Medicine, Western University, London, Ontario, Canada
(Bagur) Department of Epidemiology and Biostatistics, Western University,
London, Ontario, Canada
(Lavi) Department of Anesthesia and Perioperative Medicine, London Health
Sciences Centre, Western University, London, Ontario, Canada
(Cibelli, Moat) Royal Brompton Hospital, London, United Kingdom
(de Belder) The James Cook University Hospital, Middlesbrough, United
Kingdom
(Hildick-Smith) Sussex Cardiac Centre, Brighton & Sussex University
Hospitals, Brighton, United Kingdom
(Ludman) Queen Elizabeth Hospital, Birmingham, United Kingdom
Title
Aortic stenosis and non-cardiac surgery: A systematic review and
meta-analysis.
Source
International Journal of Cardiology. 240 (pp 145-153), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Aortic stenosis (AS) poses a perioperative management dilemma
to physicians looking after patients who require non-cardiac surgery. The
objective of this review is to investigate mortality and adverse
cardiovascular events in patients with and without AS who underwent
non-cardiac surgery. Methods We searched MEDLINE and EMBASE for studies
that evaluated mortality and adverse cardiovascular events in patients
with and without AS who underwent non-cardiac surgery. Pooled risk ratios
for mortality and adverse outcomes (myocardial infarction, stroke, heart
failure, death) were calculated using the dichotomous analysis method and
subgroup analysis was performed considering the effect of severity of AS
and symptoms. Results We identified 9 relevant studies with 29,327
participants. Among studies of severe AS, there was no significant
difference in mortality (RR: 1.49, 95%CI:0.85-2.61; P = 0.16) associated
with non-cardiac surgery, but there was a significant increase in the
composite adverse outcome (RR: 2.30, 95%CI:1.33-3.97; P = 0.003). When the
analysis involved any other degree of AS, eight studies were included and
the pooled results showed a significant increase in composite adverse
outcome (RR: 1.64, 95%CI:1.23-2.19; P < 0.001) and myocardial infarction
(RR: 1.90, 95%CI:1.54-2.34; P < 0.001). When patients with asymptomatic AS
were considered, the pooled results of four studies suggested an increased
risk of composite adverse outcomes (RR: 1.59, 95%CI:1.19-2.12; P = 0.002)
but not mortality, myocardial infarction, heart failure or stroke.
Conclusions Patients with AS undergoing non-cardiac surgery have not been
shown to be at increased risk of mortality, but have significantly higher
rates of adverse cardiovascular events compared to patients without
AS.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<72>
Accession Number
616631334
Author
Bignami E.; Guarnieri M.; Saglietti F.; Maglioni E.M.; Scolletta S.;
Romagnoli S.; De Paulis S.; Paternoster G.; Trumello C.; Meroni R.;
Scognamiglio A.; Budillon A.M.; Pota V.; Zangrillo A.; Alfieri O.
Institution
(Bignami, Guarnieri, Saglietti, Meroni, Zangrillo) IRCCS San Raffaele
Scientific Institute, Department of Anaesthesia and Intensive Care, Via
Olgettina 60, Milan 20132, Italy
(Maglioni, Scolletta) Intensive Care and Medical Biotechnologies
University of Siena, Department of Anaesthesia, Siena, Italy
(Romagnoli) Azienda Ospedaliera Universitaria Careggi, Department of
Anaesthesiology and Intensive Care, Florence, Italy
(De Paulis) Catholic University of the Sacred Heart, Department of
Cardiovascular Sciences, Rome 00168, Italy
(Pota) Pineta Grande Private Hospital, Department of Anesthesia and
Intensive Care, Castelvolturno 80122, Italy
(Trumello) IRCCS San Raffaele Scientific Institute, Department of Cardiac
Surgery, Milan, Italy
(Budillon, Alfieri) Parma University Hospital, Department of Cardiac
Surgery, Parma, Italy
(Paternoster) Azienda Ospedaliera S. Carlo, Department of Cardiovascular
Anaesthesia and Intensive Care, Potenza, Italy
(Scognamiglio) University of Naples Federico II, Section of Anesthesia and
Intensive Care, Department of Neurosciences, Reproductive and
Odontostomatological Sciences, Via Pansini 16, Naples, Italy
Title
Different strategies for mechanical VENTilation during CardioPulmonary
Bypass (CPBVENT 2014): Study protocol for a randomized controlled trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 264. Date of
Publication: 07 Jun 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: There is no consensus on which lung-protective strategies
should be used in cardiac surgery patients. Sparse and small randomized
clinical and animal trials suggest that maintaining mechanical ventilation
during cardiopulmonary bypass is protective on the lungs. Unfortunately,
such evidence is weak as it comes from surrogate and minor clinical
endpoints mainly limited to elective coronary surgery. According to the
available data in the academic literature, an unquestionable standardized
strategy of lung protection during cardiopulmonary bypass cannot be
recommended. The purpose of the CPBVENT study is to investigate the
effectiveness of different strategies of mechanical ventilation during
cardiopulmonary bypass on postoperative pulmonary function and
complications. Methods/design: The CPBVENT study is a single-blind,
multicenter, randomized controlled trial. We are going to enroll 870
patients undergoing elective cardiac surgery with planned use of
cardiopulmonary bypass. Patients will be randomized into three groups: (1)
no mechanical ventilation during cardiopulmonary bypass, (2) continuous
positive airway pressure of 5 cmH<inf>2</inf>O during cardiopulmonary
bypass, (3) respiratory rate of 5 acts/min with a tidal volume of 2-3
ml/Kg of ideal body weight and positive end-expiratory pressure of 3-5
cmH<inf>2</inf>O during cardiopulmonary bypass. The primary endpoint will
be the incidence of a PaO<inf>2</inf>/FiO<inf>2</inf> ratio <200 until the
time of discharge from the intensive care unit. The secondary endpoints
will be the incidence of postoperative pulmonary complications and 30-day
mortality. Patients will be followed-up for 12 months after the date of
randomization. Discussion: The CPBVENT trial will establish whether, and
how, different ventilator strategies during cardiopulmonary bypass will
have an impact on postoperative pulmonary complications and outcomes of
patients undergoing cardiac surgery. Trial registration:
ClinicalTrials.gov, ID: NCT02090205. Registered on 8 March
2014.<br/>Copyright &#xa9; 2017 The Author(s).

<73>
Accession Number
616713766
Author
Itoh H.; Kurihara I.; Miyashita K.; Tanaka M.
Institution
(Itoh, Kurihara, Miyashita, Tanaka) Division of Endocrinology Metabolism,
and Nephrology, Department of Internal Medicine, School of Medicine, Keio
University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
Title
Clinical significance of cardiometabolic memory: A systematic review of
randomized controlled trials.
Source
Hypertension Research. 40 (6) (pp 526-534), 2017. Date of Publication: 01
Jun 2017.
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom. E-mail: office@jpnsh.org)
Abstract
Cardiometabolic memory has been proposed based on clinical evidence to
explain how, even after the cessation of a clinical trial, the superiority
of one treatment over the outcome persists. To understand the
cardiometabolic memory phenomenon, we performed a systematic review of
randomized controlled trials (RCTs) using PubMed in August 2016. The
search terms randomized controlled trial', post-trial follow-up' and
diabetes, hypertension or dyslipidemia' were used, and articles published
after the year 2000 were searched. We judged the memory phenomenon to be
positive when the cardiovascular outcome at the end of the post-trial
follow-up period in the intervention group was significantly superior even
though the favorable control of a risk factor (blood glucose, blood
pressure or lipid level) during the trial period was lost after the
cessation of the intervention. Among 907 articles retrieved in the initial
screening, 21 articles were judged as describing a positive memory
phenomenon. Eight, six and seven of the articles concerned diabetes,
hypertension and dyslipidemia, respectively. Transient intensive glucose
lowering rather easily induced memory for the suppression of diabetic
microangiopathies, while memory for the suppression of macroangiopathies
tended to be first evident in the post-trial follow-up period. Transient
intensive blood pressure lowering was generally effective in the formation
of memory for the suppression of cardiovascular events and had an
especially strong impact on risk reduction of chronic heart failure.
Transient intensive LDL cholesterol lowering clearly had a long-term
beneficial effect on risk reduction of cardiovascular events. Our
systematic review revealed the clinical relevance of cardiometabolic
memory.<br/>Copyright &#xa9; 2017 The Japanese Society of Hypertension All
rights reserved.

<74>
Accession Number
616787601
Author
Bundhun P.K.; Bhurtu A.; Yuan J.
Institution
(Bundhun) Institute of Cardiovascular Diseases, First Affiliated Hospital,
Guangxi Medical University, Nanning, Guangxi, China
(Bhurtu) Guangxi Medical University, Nanning, Guangxi, China
(Yuan) Department of Cardiology, People's Hospital of Guangxi Zhuang
Autonomous Region, Nanning, Guangxi 530021, China
Title
Impact of type 2 diabetes mellitus on the long-term mortality in patients
who were treated by coronary artery bypass surgery.
Source
Medicine (United States). 96 (22) (no pagination), 2017. Article Number:
e7022. Date of Publication: 01 Jun 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Recent scientific reports have mainly focused on the
comparison between coronary artery bypass surgery (CABG) and percutaneous
coronary intervention. However, the impact of type 2 diabetes mellitus
(T2DM) on mortality in patients who were treated by CABG was often
ignored. Therefore, we aimed to compare the long-term mortality following
CABG in patients with and without T2DM. Methods: Studies comparing the
long-term adverse outcomes following CABG in patients with and without
T2DM were searched from electronic databases. Total number of deaths
(primary outcome) and events of myocardial infarction (MI), major adverse
cerebrovascular and cardiovascular events (MACCEs), stroke, and repeated
revascularization (secondary outcomes) were carefully extracted. An
analysis was carried out whereby odds ratios (ORs) and 95% confidence
intervals (CIs) were calculated using the RevMan 5.3 software. Results:
Eleven studies with a total number of 12,965 patients were included.
Current results showed that mortality was significantly higher in patients
with T2DM with OR: 1.54, 95% CI: 1.37 to 1.72, P<.00001; OR: 1.53, 95% CI:
1.36 to 1.72, P<.00001; and OR: 1.53, 95% CI: 1.26 to 1.87, P<.0001 at 1
to 15, 5 to 15, and 7 to 15 years, respectively. However, MI, repeated
revascularization, MACCEs, and stroke were not significantly different
with OR: 1.15, 95% CI: 0.81 to 1.64, P=.44; OR: 1.09, 95% CI: 0.88 to
1.36, P=.43; OR: 1.11, 95% CI: 0.83 to 1.48, P=.48; and OR: 1.69, 95% CI:
0.93 to 3.07, P=.08, respectively. Conclusion: Following CABG, a
significantly higher rate of mortality was continually observed in
patients with T2DM compared to patients without T2DM showing that the
former apparently has a high impact on the long-term mortality. However,
even if T2DM is an independent risk factor for mortality, it should not be
ignored that CABG remains the best revascularization strategy in these
patients.<br/>Copyright &#xa9; 2017 the Author(s). Published by Wolters
Kluwer Health, Inc.

<75>
Accession Number
616790188
Author
Cerfolio R.; Louie B.E.; Farivar A.S.; Onaitis M.; Park B.J.
Institution
(Cerfolio) Division of Thoracic Surgery, New York University, New York, NY
(Louie, Farivar) Division of Thoracic Surgery, Swedish Cancer Institute,
Seattle, Wash
(Onaitis) Division of Thoracic Surgery, Duke University, Durham, NC
(Park) Thoracic Service, Department of Surgery, Memorial Sloan Kettering
Cancer Center, New York, NY
Title
Consensus statement on definitions and nomenclature for robotic thoracic
surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: September 13, 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: Robotic thoracic operations are increasing, and new robotic
systems are imminent. A definition of what constitutes a robotic thoracic
operation and a nomenclature to detail the technique used is needed to
accurately compare outcomes. Methods: The American Association of Thoracic
Surgeons Guideline Committee appointed an expert consensus writing
committee to construct definitions and nomenclature for robotic thoracic
surgery. A PubMed search was generated and after vetting and review of the
literature a consensus statement was reached. Results: The proposed
definition is: "A robotic thoracic operation is a minimally invasive
surgical procedure that does not spread, lift or remove any part of the
chest or abdominal wall and is characterized by: the surgeon and the
assistant's vision of the operative field is via a monitor only and the
patient's tissue is manipulated by robotic instruments that follow a slave
like mimic of human hands or thoughts via a computerized system." In
addition, a flexible nomenclature is proposed that should be applicable to
current and future robotic systems that details the number of robotic arms
used, the types of ports and/or incisions made, the use of insufflation,
and the operation performed. Conclusions: The American Association of
Thoracic Surgeons writing committee proposes a definition and nomenclature
for robotic thoracic surgery. Definitions are needed to ensure that future
studies accurately compare results and outcomes and nomenclatures allow
surgeons and scientists from diverse countries and cultures to use the
same language to allow accurate communication.<br/>Copyright &#xa9; 2017
The American Association for Thoracic Surgery.

<76>
Accession Number
616788760
Author
Maeno Y.; Yoon S.-H.; Abramowitz Y.; Watanabe Y.; Jilaihawi H.; Lin M.-S.;
Chan J.; Sharma R.; Kawashima H.; Israr S.; Kawamori H.; Miyasaka M.; Rami
T.; Kazuno Y.; Mangat G.; Kashif M.; Chakravarty T.; Kao H.-L.; Lee
M.K.Y.; Nakamura M.; Kozuma K.; Cheng W.; Makkar R.R.
Institution
(Maeno, Yoon, Abramowitz, Sharma, Israr, Kawamori, Miyasaka, Rami, Kazuno,
Mangat, Kashif, Chakravarty, Nakamura, Cheng, Makkar) Heart Institute,
Cedars-Sinai Medical Center, Los Angeles, United States
(Watanabe, Kawashima, Kozuma) Division of Cardiology, Department of
Internal Medicine, Teikyo University Hospital, Tokyo, Japan
(Jilaihawi) Department of Medicine, Cardiothoracic Surgery, New York
University Langone Medical Center, New York, United States
(Lin, Kao) Division of Cardiology, Heart Center, National Taiwan
University Hospital, Taipei, Taiwan
(Chan, Lee) Division of Cardiology, Queen Elizabeth Hospital, Kowloon,
Hong Kong
Title
Effect of ascending aortic dimension on acute procedural success following
self-expanding transcatheter aortic valve replacement. A multicenter
retrospective analysis.
Source
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: December 02, 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Aims: Self-expanding (SE) valves are characterized with long stent frame
design and the radial force of the device exists both in the inflow and
outflow level. Therefore, we hypothesized that device success of SE-valves
may be influenced by ascending aortic dimensions (AAD). The aim of this
study was to determine the influence of AAD on acute device success rates
following SE transcatheter aortic valve replacement (TAVR). Methods &
Results: In 4 centers in the United States and Asia, 214 consecutive
patients underwent SE-TAVR. Outcomes were assessed in line with Valve
Academic Research Consortium criteria. AAD was defined as the sum of the
short and long axis aortic diameter divided by 2. Overall, device success
rate was 85.0%. Multivariate analysis revealed that increased AAD (Odds
ratio 1.27) and % oversizing (Odds ratio 0.88) were found to be
independent predictors of unsuccessful device implantation. The
c-statistic of the model for device success was area under the curve 0.79,
sensitivity 81.3% and specificity 44.0%. Co-existence of several risk
factors was associated with an exponential fall to 64.2% in device success
rate. For a large AAD, however, optimally oversized SE-valves (threshold
16.2%) resulted with high device success rates compared to suboptimal
oversizing (88.6% vs. 64.2%, p = 0.005). Conclusions: Larger AAD and
smaller degrees of oversizing were confirmed to be the most relevant
predictors of unsuccessful device implantation following SE-valve
implantations. Optimal oversizing of great significance was noted,
particularly that with a large AAD.<br/>Copyright &#xa9; 2017 Elsevier
B.V.

<77>
Accession Number
616784831
Author
Elmi-Sarabi M.; Deschamps A.; Delisle S.; Ased H.; Haddad F.; Lamarche Y.;
Perrault L.P.; Lambert J.; Turgeon A.F.; Denault A.Y.
Institution
(Elmi-Sarabi) From the Departments of *Anesthesiology and Cardiac Surgery,
Montreal Heart Institute and Universite de Montreal, Montreal, Quebec,
Canada; +Intensive Care Unit, Hopital Sacre-Coeur de Montreal, Montreal,
Quebec, Canada; ++Stanford School of Medicine, Stanford, California;
||Department of Preventive and Social Medicine, Universite de Montreal,
Montreal, Quebec, Canada; PDepartment of Anesthesiology and Critical Care
Medicine, Division of Critical Care Medicine, Universite Laval, Quebec
City, Quebec, Canada; #CHU de Quebec-Universite Laval Research Centre,
Population Health and Optimal Health Research Unit, Quebec City, Quebec,
Canada; and **Division of Critical Care, Centre Hospitalier de l'Universit
Title
Aerosolized Vasodilators for the Treatment of Pulmonary Hypertension in
Cardiac Surgical Patients: A Systematic Review and Meta-analysis.
Source
Anesthesia and Analgesia. (no pagination), 2017. Date of Publication: 07
Jun 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND:: In cardiac surgery, pulmonary hypertension is an important
prognostic factor for which several treatments have been suggested over
time. In this systematic review and meta-analysis, we compared the
efficacy of inhaled aerosolized vasodilators to intravenously administered
agents and to placebo in the treatment of pulmonary hypertension during
cardiac surgery. We searched MEDLINE, CENTRAL, EMBASE, Web of Science, and
clinicaltrials.gov databases from inception to October 2015. The incidence
of mortality was assessed as the primary outcome. Secondary outcomes
included length of stay in hospital and in the intensive care unit, and
evaluation of the hemodynamic profile. METHODS:: Of the 2897 citations
identified, 10 studies were included comprising a total of 434 patients.
RESULTS:: Inhaled aerosolized agents were associated with a significant
decrease in pulmonary vascular resistance (-41.36 dyne.s/cm, P= .03) and a
significant increase in mean arterial pressure (8.24 mm Hg, P= .02) and
right ventricular ejection fraction (7.29%, P< .0001) when compared to
intravenously administered agents. No significant hemodynamically
meaningful differences were observed between inhaled agents and placebo;
however, an increase in length of stay in the intensive care unit was
shown with the use of inhaled aerosolized agents (0.66 days, P= .01). No
other differences were observed for either comparison. CONCLUSIONS:: The
administration of inhaled aerosolized vasodilators for the treatment of
pulmonary hypertension during cardiac surgery is associated with improved
right ventricular performance when compared to intravenously administered
agents. This review does not support any benefit compared to placebo on
major outcomes. Further investigation is warranted in this area of
research and should focus on clinically significant
outcomes.<br/>Copyright &#xa9; 2017 International Anesthesia Research
Society

<78>
Accession Number
616784189
Author
Amar D.; Zhang H.; Pedoto A.; Desiderio D.P.; Shi W.; Tan K.S.
Institution
(Amar) From the Departments of *Anesthesiology and Critical Care Medicine
and +Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer
Center, New York, New York.
Title
Protective Lung Ventilation and Morbidity After Pulmonary Resection: A
Propensity Score-Matched Analysis.
Source
Anesthesia and Analgesia. (no pagination), 2017. Date of Publication: 08
Jun 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND:: Protective lung ventilation (PLV) during one-lung ventilation
(OLV) for thoracic surgery is frequently recommended to reduce pulmonary
complications. However, limited outcome data exist on whether PLV use
during OLV is associated with less clinically relevant pulmonary morbidity
after lung resection. METHODS:: Intraoperative data were prospectively
collected in 1080 patients undergoing pulmonary resection with OLV,
intentional crystalloid restriction, and mechanical ventilation to
maintain inspiratory peak airway pressure <30 cm H2O. Other ventilator
settings and all aspects of anesthetic management were at the discretion
of the anesthesia care team. We defined PLV and non-PLV as <8 or >=8 mL/kg
(predicted body weight) mean tidal volume. The primary outcome was the
occurrence of pneumonia and/or acute respiratory distress syndrome (ARDS).
Propensity score matching was used to generate PLV and non-PLV groups with
comparable characteristics. Associations between outcomes and PLV status
were analyzed by exact logistic regression, with matching as cluster in
the anatomic and nonanatomic lung resection cohorts. RESULTS:: In the
propensity score-matched analysis, the incidence of pneumonia and/or ARDS
among patients who had an anatomic lung resection was 9/172 (5.2%) in the
non-PLV compared to the PLV group 7/172 (4.1%; odds ratio, 1.29; 95%
confidence interval, 0.48-3.45, P= .62). The incidence of pneumonia and/or
ARDS in patients who underwent nonanatomic resection was 3/118 (2.5%) in
the non-PLV compared to the PLV group, 1/118 (0.9%; odds ratio, 3.00; 95%
confidence interval, 0.31-28.84, P= .34). CONCLUSIONS:: In this
prospective observational study, we found no differences in the incidence
of pneumonia and/or ARDS between patients undergoing lung resection with
tidal volumes <8 or >=8 mL/kg. Our data suggest that when fluid
restriction and peak airway pressures are limited, the clinical impact of
PLV in this patient population is small. Future randomized trials are
needed to better understand the benefits of a small tidal volume strategy
during OLV on clinically important outcomes.<br/>Copyright &#xa9; 2017
International Anesthesia Research Society

<79>
Accession Number
616773284
Author
Serteser M.; Albert C.
Institution
(Serteser) Acibadem University, School of Medicine, Department of Medical
Biochemistry, Istanbul, Turkey
(Albert) Universitatsklinik fur Nieren- und
Hochdruckkrankheiten,Diabetologie und Endokrinologie, Otto-von-Guericke
Universitat Magdeburg, Germany
Title
Novel biomarkers in the assessment of glomerular damage.
Source
Clinical Chemistry and Laboratory Medicine. Conference: 22nd IFCC-EFLM
European Congress of Clinical Chemistry and Laboratory Medicine, 25th
Meeting of the Balkan Clinical Laboratory Federation, 15th National
Congress of GSCC-CB. Greece. 55 (pp S186-S187), 2017. Date of Publication:
June 2017.
Publisher
Walter de Gruyter GmbH
Abstract
Novel biomarkers in the assessment of glomerular damage: 1. Beta trace
protein as GFR marker in children - Can we establish a reference range? 2.
Monitoring acute tubular damage associated with acute kidney failure with
NGAL assay As incidence of renal failure escalates among populations,
there is a compelling need to understand the importance for early
detection of acute tubular damage to allow early intervention for better
clinical outcomes. The limitations of estimates of glomerular filtration
rate (GFR) based only on serum creatinine measurements have spurred an
interest in more sensitive markers of GFR, especially because the level
depends on the body's muscle mass, and its concentration is insensitive to
early changes of GFR. It appears that Schwartz-estimated GFR cannot be
accurate in patients with low muscle mass. Beta-trace protein (BTP) is a
low-molecular-weight glycoprotein freely filtered through the glomerular
basement membrane and with minimal non-renal elimination. Recent findings
suggest that beta-trace protein (BTP) is at least equal if not superior to
serum creatinine as a marker of glomerular filtration rate (GFR),
particularly since it is independent from height, gender, age, and muscle
mass. Laboratory reference intervals are of particular importance in
assessing pediatric patients where there may be marked changes in results
at different ages due to physiological causes .The aim of this discussion
is to review the establishment and verification of reliable pediatric
reference intervals for use in clinical laboratory medicine that are
necessary for pediatric clinical interpretation. (M.Serteser). Acute
kidney injury (AKI) is a frequent and severe complication in intensive
care patients, especially in connection with cardiac surgery. Globally >13
million acute kidney injury incidents occur each year. Serum creatinine is
currently considered as 'gold standard' for AKI, but levels start to rise
after 1-3 days when up to 50% of kidney functions might have already
declined. The persisting high prevalence of morbidity and mortality due to
AKI calls for novel, early and efficient biomarkers to identify early
tubular injury before non-reversible damage develops. Acute tubular damage
biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) has
been shown to precede functional AKI and has emerged as a promising
noninvasive biomarker to identify very early tubular damage. The aim of
this discussion is to review the current available evidence on NGAL
applicability in adult cardiac surgery patients. (C. Albert). Beta-trace
protein (BTP), also known as prostaglandin D synthase, is a
low-molecular-mass protein which belongs to the lipocalin protein family.
It was found to be increased in the serum of patients with renal diseases.
We have had a unique opportunity to collect reference interval data on an
unequivocally healthy cohort of normal children (>1 year through <16 years
of age). We conducted a prospective observational study to establish
pediatric reference range intervals by detecting GFR with Beta-trace
protein as compared to the traditional biomarkers Cystatin C, s-2-
Microglobulin and Creatinine. (M. Serteser). NGAL, a small protein of the
lipocalin family is primarily expressed by neutrophils and renal proximal
tubules. NGAL is one of the earliest and most rapidly increasing proteins
in plasma and urine in response to ischemic or nephrotoxic kidney injury.
A scoring system based on plasma or urine NGAL levels helps in
identification of cardiac-surgery associated tubular damage with the
potential to enable intervention and therapy earlier to reduce the
incidence of cardiac surgery-associated AKI. However, with accumulating
evidence, conflicting observations raise concern about the robustness of
NGAL as a biomarker. To address this issue, we performed a systematic
review and meta-analysis of observational studies to estimate the
diagnostic and prognostic accuracy of NGAL and to identify potential
confounders or effective modifiers of its value in AKI. We hypothesized
that NGAL level is of diagnostic and prognostic value both overall and
across a range of subgroups developing AKI, urine and plasma/ serum NGAL
levels are both valuable for the early diagnosis of AKI, NGAL performs
better in children and that there might be an advantage for standardized
measurement of NGAL with clinical laboratory platforms. (M. Albert) BTP
measurement in serum, plasma and/or urine can be used as an aid in
diagnosis and monitoring of kidney disease. Increased concentrations in
serum, plasma or urine are associated with glomerular or tubular disease.
The results of our pediatric reference interval study suggest that BTP may
be a useful and reliable urinary marker of renal dysfunction and may have
a place as an alternative marker for tubular damage and the magnitude of
renal impairment in pediatric patients with chronic kidney disease.
Laboratory reference intervals are of particular importance in assessing
pediatric patients where there may be marked changes in results at
different ages due to physiological causes. The availability of reference
intervals is essential for the practice of modern medicine-only by having
a feel for what is "normal" can a physician judge how "abnormal" a
laboratory result is. (M. Serteser). Acute tubular damage without
functional AKI (i.e., subclinical AKI) affects hard outcome measures, and
the recognition of its presence has the potential to facilitate the
earlier implementation of interventions or precautions to prevent further
damage and/or progression to functional AKI. We found NGAL level to be a
useful early predictor of AKI, both overall and across a range of clinical
settings. NGAL level had prognostic value for clinical outcomes. Early
detection of AKI could permit timely renal salvage therapies, which, with
associated monitoring of response to therapy, may result in preserved
renal function and avoidance of renal replacement therapy (RRT)
requirement and perhaps translate into improved patient morbidity and
mortality. In conclusion, we have constructed a bridge between science and
a possible clinical application for NGAL. It is time to recognize that for
a defined patient population at high risk for procedure-related functional
AKI, acute tubular damage may occur before dysfunction becomes apparent.
(M. Albert). Diagnostic testing continues to evolve improving quality and
consistency in results. In order to best assist physicians in the
diagnosis and management of patients with acute tubular damage, it is
important that clinicans and the laboratory are well-versed in innovative
biomarkers essential to achieve effective renal disease management and
improved outcomes.

<80>
Accession Number
616772585
Author
Berra L.; Lei C.; Rezoagli E.; Yu B.; Dong H.; Yu S.; Hou L.; Chen M.;
Chen W.; Wang H.; Zheng Q.; Shen J.; Jin Z.; Chen T.; Zhao R.; Christie
E.; Sabbisetti V.; Nordio F.; Bonventre J.; Xiong L.; Zapol W.
Institution
(Lei, Dong, Yu, Hou, Chen, Chen, Wang, Zheng, Shen, Jin, Chen, Zhao,
Xiong) Xijing Hospital, Xi'an, China
(Lei, Yu, Hou, Chen, Jin, Chen, Xiong) Fourth Military Medical University,
Xi'an, China
(Christie, Sabbisetti, Nordio, Bonventre) Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Berra, Rezoagli, Yu, Zapol) Massachusetts General Hospital, Harvard
Medical School, Boston, MA, United States
Title
Vascular damage from hemolysis: A role for therapeutic nitric oxide.
Source
Clinical Chemistry and Laboratory Medicine. Conference: 22nd IFCC-EFLM
European Congress of Clinical Chemistry and Laboratory Medicine, 25th
Meeting of the Balkan Clinical Laboratory Federation, 15th National
Congress of GSCC-CB. Greece. 55 (pp S21), 2017. Date of Publication: June
2017.
Publisher
Walter de Gruyter GmbH
Abstract
Hemoglobin (Hb) release from red cells into plasma causes Nitric Oxide
(NO) scavenging, vasoconstriction, inflammation and coagulation. We sought
a method to prevent the noxious effects of hemoglobin release during
cardiopulmonary bypass (CPB). Prolonged CPB (over 2 hours) injures red
cells, due to pumping, oxygenation and cardiotomy suction. Red cells
release large amounts of hemoglobin into plasma. Prolonged CPB is
associated with acute renal failure in about 30% of patients. In a
collaborative study in Xian, China we added either 80 parts per million
(ppm) of NO or pure N2 to the oxygenator gas during CPB. Post-operative
patients breathed either 80 ppm NO via a ventilator for up to 24 hours or
pure N2 was added. We randomized 217 patients undergoing elective multiple
valve replacements for rheumatic fever. One year follow-up visits were
completed in May 2016. We strategized that exposure to 80 ppm Nitric Oxide
would oxidize circulating ferrous Hb to ferric Hb and thereby prevent NO
scavenging. If the renal toxicity of CPB is partly due to NO scavenging by
circulating free ferrous Hb, NO treatment should reduce the incidence of
acute kidney injury (AKI). AKI was defined as a 50% increase of creatinine
within 7 days of surgery or increase in serum creatinine by 0.3 mg/dl
within 48 hours. Secondary endpoints included renal function and mortality
at 30 and 90 days and 1 year. AKI was significantly reduced with NO
treatment (52 of 105 patients for NO vs control 71 of 112 patients).
Plasma creatinine levels and eGFR were significantly improved in the NO
group at 30 days. No adverse events were reported with the use of NO.
Chinese patients undergoing cardiac surgery with prolonged CPB,
administration of NO decreased the incidence of acute kidney injury and
improved glomerular filtration rate at 1 year after surgery.

<81>
Accession Number
616777020
Author
Cirak Y.; Karahan Z.; Yilmaz Yelvar G.D.; Erden I.; Demirkilic U.
Institution
(Cirak, Yilmaz Yelvar) Turgut Ozal U, Fizik Tedavi ve Rehabil YO, Ankara,
Turkey
(Karahan, Erden, Demirkilic) Gulhane Askeri Tip Akademisi, Kalp Damar
Cerrahisi ABD, Ankara, Turkey
Title
Is physiotherapy effective on the ocurrence of postoperative pulmonary
complications in patients undergoing coronary artery bypass graft surgery
with different pulmonary complication risk profiles? A randomised
controlled trial.
Source
Fizyoterapi Rehabilitasyon. Conference: 5th Congress of National
Physiotherapy and Rehabilitation. Turkey. 26 (2) (pp S33), 2015. Date of
Publication: 2015.
Publisher
Turkish Physical Therapy Association
Abstract
Purpose: To evaluate the efficacy of a spesific physiotherapy protocol on
the occurrence of Postoperative pulmonary complications (PPC),
postoperative length of intensive care unit (ICU), hospital stay, duration
of intibutation in patients undergoing coronary artery bypass graft (CABG)
surgery who have different PPC risk profiles and to compare functional
capacity, quality of life (QoL), depression, anxiety level between
high-risk and low-risk patients following CABG surgery. Methods: 170
patients were divided two risk groups on the basis of their scores (low
risk <=1 point; or high risk >=2 point). The physiotherapy protocol
consisted four phases was performed. The incidence of PPC was scored by a
blinded evaluator on an ordinal scale of 1 to 4. Functional capacity was
evaluated using a six minute walk test (6MWT). Hospital Anxiety and
Depression Scale (HADS) for anxiety and depression and SF-36 for QoL were
applied. Results: The insidence of PPC grades, length of stay in the
hospital and ICU, duration of intubation were not significant in the
high-risk group as compared with the low-risk group (p>0.05). There was a
significant decrease in 6MWA distance from preoperative to discharge for
all patients but this decline was lower in high risk group. There was no
differences in QoL between groups after treatment (p>0.05). But anxiety of
the groups were different after treatment (p<0.05). Discussion: This
randomized, controlled trial demonstrated that physiotherapy helps
patients in high-risk group for faster recovery after CABG and
physiotherapy is much more important in high-risk group to get similar
results like the low-risk group.

<82>
Accession Number
606883944
Author
Zhang J.; Xu R.W.; Fan X.; Ye Z.; Liu P.
Institution
(Zhang, Xu, Fan, Ye, Liu) Department of Cardiovascular Surgery,
China-Japan Friendship Hospital, No. 2 Yinghua East Road, Beijing 100029,
China
Title
A Systematic Review of Early Results Following Synchronous or Staged
Carotid Artery Stenting and Coronary Artery Bypass Grafting.
Source
Thoracic and Cardiovascular Surgeon. 65 (4) (pp 302-310), 2017. Article
Number: 154228oc. Date of Publication: 01 Jun 2017.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Background The optimal management of patients with concomitant coronary
artery disease (CAD) and severe carotid artery stenosis remains a
controversy. We performed a systematic review of studies comparing early
outcomes of synchronous or staged carotid artery stenting (CAS) and
coronary artery bypass grafting (CABG) in the treatment of patients with
concomitant CAD and severe carotid artery stenosis. Methods Multiple
databases were systematically searched to identify studies of synchronous
or staged CAS and CABG in the treatment of concomitant severe carotid and
coronary artery disease published from 2005 to 2015. The quality of
studies was assessed using the MINORS scale. The demographic data, risk
factors, 30-day outcomes, and antiplatelet strategy were extracted.
Results 23 studies were identified with a total of 873 and 459 patients in
the staged and synchronous group, respectively. The observed overall
death/stroke/MI rate was 8.5% (95% CI: 7.6-9.4%) in staged group and 4.8%
(95% CI: 3.8-5.8%) in synchronous group. It seems that the synchronous
group has better 30-day outcomes, but these data could not be compared
statistically. Conclusion Our systematic review suggests either
synchronous or staged CAS and CABG can be chosen for the treatment of
concomitant carotid and coronary artery disease. It seems that the
synchronous approach is relatively convenient and the antiplatelet
strategy is relatively definite. For these patients, hybrid
revascularization by synchronous CAS and CABG might be a feasible and
promising therapeutic strategy. Our conclusions and the quality of the
existing data suggest that a randomized controlled trial is needed to
define the best treatment for patients with concomitant carotid and
coronary artery disease.<br/>Copyright &#xa9; Georg Thieme Verlag
KGStuttgart . New York.

<83>
Accession Number
616627141
Author
den Harder A.M.; Snoek A.M.; Leiner T.; Suyker W.J.; de Heer L.M.; Budde
R.P.J.; Lammers J.W.J.; de Jong P.A.; Gondrie M.J.A.
Institution
(den Harder, Snoek, Leiner, de Jong, Gondrie) Department of Radiology,
University Medical Center Utrecht, P.O. Box 85500, Utrecht 3508GA,
Netherlands
(Snoek) Department of Radiology, Sint Antonius Ziekenhuis, P.O. Box 2500,
Nieuwegein 3430EM, Netherlands
(Suyker, de Heer) Department of Cardiothoracic Surgery, University Medical
Center Utrecht, P.O. Box 85500, Utrecht 3508GA, Netherlands
(Budde) Department of Radiology, Erasmus Medical Center, P.O. Box 2040,
Rotterdam 3000CA, Netherlands
(Lammers) Department of Respiratory Medicine, University Medical Center
Utrecht, P.O. Box 85500, Utrecht 3508GA, Netherlands
Title
Can routine chest radiography be used to diagnose mild COPD? A nested
case-control study.
Source
European Journal of Radiology. 92 (pp 159-165), 2017. Date of Publication:
July 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives To determine whether mild stage chronic obstructive pulmonary
disease (COPD) can be detected on chest radiography without substantial
overdiagnosis. Methods A retrospective nested case-control study
(case:control, 1:1) was performed in 783 patients scheduled for
cardiothoracic surgery who underwent both spirometry and a chest
radiograph preoperative. Diagnostic accuracy of chest radiography for
diagnosing mild COPD was investigated using objective measurements and
overall appearance specific for COPD on chest radiography. Inter-observer
variability was investigated and variables with a kappa >0.40 as well as
baseline characteristics were used to make a diagnostic model which was
aimed at achieving a high positive predictive value (PPV). Results Twenty
percent (155/783) had COPD. The PPV of overall appearance specific for
COPD alone was low (37-55%). Factors in the diagnostic model were age,
type of surgery, gender, distance of the right diaphragm apex to the first
rib, retrosternal space, sternodiaphragmatic angle, maximum height right
diaphragm (lateral view) and subjective impression of COPD (using both
views). The model resulted in a PPV of 100%, negative predictive value
(NPV) of 82%, sensitivity of 10% and specificity of 100% with an area
under the curve of 0.811. Conclusions Detection of mild COPD without
substantial overdiagnosis was not feasible on chest radiographs in our
cohort.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<84>
Accession Number
616608978
Author
Yang S.; Song L.; Zhao L.; Dong P.; Lai L.; Wang H.
Institution
(Yang, Song, Dong, Lai, Wang) Department of Cardiology, The First
Affiliated Hospital and College of Clinical Medicine of Henan University
of Science and Technology, Luoyang 471003, China
(Zhao) Department of Pain, The First Affiliated Hospital and College of
Clinical Medicine of Henan University of Science and Technology, Luoyang
471003, China
Title
Predictive value of cystatin C in people with suspected or established
coronary artery disease: A meta-analysis.
Source
Atherosclerosis. 263 (pp 60-67), 2017. Date of Publication: August 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background and aims Circulating cystatin C has been recognized as an
independent predictor of cardiovascular and all-cause mortality in the
general population. We aimed to evaluate the prognostic value of baseline
circulating cystatin C levels in people with suspected or established
coronary artery disease (CAD) by conducting a meta-analysis. Methods We
searched Pubmed and Embase databases up to October 2016 for prospective
observational studies investigating the predictive value of elevated
circulating cystatin C levels in people with suspected or established CAD.
Adverse vascular outcomes included all-cause mortality, cardiovascular
mortality, or total adverse vascular events consisting of death,
myocardial infarction, revascularization, stroke, and heart failure.
Results Ten studies involving participants with known or suspected CAD
were included in this meta-analysis. When comparing the highest with the
lowest cystatin C levels, the pooled hazard ratio (HR) was 2.27 (95%
confidence interval [CI] 1.86-2.78) for all-cause mortality, 2.24 (95% CI
1.69-2.97) for cardiovascular mortality, and 1.87 (95% CI 1.57-2.24) for
total adverse vascular events, respectively. Subgroup analysis results
showed that this association was not influenced by follow-up duration,
region, or CAD type. Conclusions Elevated circulating cystatin C is
independently associated with adverse vascular outcomes in people with
suspected or established CAD in terms of all-cause mortality,
cardiovascular mortality, and total adverse vascular events. This
increased risk is probably independent of creatinine/estimated glomerular
filtration rate.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<85>
Accession Number
616588801
Author
Klompas M.
Institution
(Klompas) Department of Population Medicine, Harvard Medical School,
Harvard Pilgrim Health Care Institute, 401 Park Street, Suite 401, Boston,
MA 02215, United States
(Klompas) Department of Medicine, Brigham and Women's Hospital, Boston,
Massachusetts, United States
Title
Oropharyngeal Decontamination with Antiseptics to Prevent
Ventilator-Associated Pneumonia: Rethinking the Benefits of Chlorhexidine.
Source
Seminars in Respiratory and Critical Care Medicine. 38 (3) (pp 381-390),
2017. Article Number: 01282. Date of Publication: 01 Jun 2017.
Publisher
Thieme Medical Publishers, Inc. (E-mail: custserv@thieme.com)
Abstract
Daily oral care with chlorhexidine for mechanically ventilated patients is
ubiquitous in contemporary intensive care practice. The practice is
predicated upon meta-analyses suggesting that adding chlorhexidine to
daily oral care regimens can reduce ventilator-associated pneumonia (VAP)
rates by up to 40%. Close analysis, however, raises three concerns: (1)
the meta-analyses are dominated by studies in cardiac surgery patients in
whom average duration of mechanical ventilation is < 1 day and thus their
risk of VAP is very different from other populations, (2) diagnosing VAP
is subjective and nonspecific yet the meta-analyses gave equal weight to
blinded and nonblinded studies, potentially biasing them in favor of
chlorhexidine, and (3) there is circularity between diagnostic criteria
for VAP and chlorhexidine; as an antiseptic, chlorhexidine may decrease
the frequency of positive respiratory cultures but fewer cultures does not
necessarily mean fewer pneumonias. It is therefore important to look at
other outcomes for corollary evidence on whether or not oral chlorhexidine
benefits patients. An updated meta-analysis restricted to double-blinded
studies in noncardiac surgery patients showed no impact on VAP rates,
duration of mechanical ventilation, or intensive care unit length of stay.
Instead, there was a possible signal that oral chlorhexidine may increase
mortality rates. Observational data have raised similar concerns. This
article will review the theoretical basis for adding chlorhexidine to oral
care regimens, delineate potential biases in randomized controlled trials
comparing oral care regimens with and without chlorhexidine, explore the
unexpected mortality signal associated with oral chlorhexidine, and
provide practical recommendations.<br/>Copyright &#xa9; Thieme Medical
Publishers333 Seventh Avenue, New York, NY 10001, USA.

<86>
Accession Number
610067530
Author
Loladze G.; Kuehnel R.U.; Claus T.; Hartrumpf M.; Kuepper F.; Pohl M.;
Albes J.M.
Institution
(Loladze, Kuehnel, Claus, Hartrumpf, Kuepper, Albes) Department of
Cardiovascular Surgery, Heart Center Brandenburg, Bernau, Germany
(Pohl) Institute of Medical Physics and Biophysics, University Hospital
Charite, Berlin, Germany
Title
Double-Wire versus Single-Wire Sternal Closure in Obese Patients: a
Randomized Prospective Study.
Source
Thoracic and Cardiovascular Surgeon. 65 (4) (pp 332-337), 2017. Article
Number: 154307oc. Date of Publication: 01 Jun 2017.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Background Sternal instability after coronary artery bypass grafting
(CABG) is a serious complication. Obese patients are at high risk for
sternal instability after CABG. This study was conducted to assess the
positive impact of double-wire sternal closure on sternal instability.
Methods A total of 200 obese patients with a body mass index >= 30
kg/m² undergoing isolated CABG with left internal mammary
artery (LIMA) graft were randomly assigned to sternal closure either by
eight single wires (n = 100) or by a combination of four double wires and
four single wires. Results There was a total of 21 cases with sternal
instability: 5 cases (i.e., 5%) in the double-wire group versus 16 cases
(16%) in the single-wire group (p = 0.019). Logistic regression analysis
showed sternal closure via double wires as an independent protection
factor (odds ratio [OR]: 0.276; p = 0.029). Smoking (OR: 5.5; p = 0.006)
and postoperative delirium (OR: 3.5; p = 0.033) turned out to be
independent risk factors for the development of sternal instability.
Conclusion Double-wire sternal closure significantly reduces postoperative
sternal instability in obese patients undergoing isolated CABG with LIMA
graft.<br/>Copyright &#xa9; Georg Thieme Verlag KGStuttgart . New York.

<87>
Accession Number
616779934
Author
Kobashigawa J.; Khush K.; Colvin M.; Acker M.; Van Bakel A.; Eisen H.;
Naka Y.; Patel J.; Baran D.A.; Daun T.; Luu M.; Olymbios M.; Rogers J.;
Jeevanandam V.; Esmailian F.; Pagani F.D.; Lima B.; Stehlik J.
Institution
(Kobashigawa, Patel, Daun, Luu, Olymbios, Esmailian) Cedars-Sinai Heart
Institute Los Angeles, CA
(Khush) Stanford University Stanford, CA
(Colvin, Pagani) University of Michigan Ann Arbor, MI
(Acker) University of Pennsylvania Philadelphia, PA
(Van Bakel) Medical University of South Carolina Charleston, SC
(Eisen) Drexel University Philadelphia, PA
(Naka) Columbia University New York, NY
(Baran) Newark Beth Israel Medical Center Newark, NJ
(Rogers) Duke University Durham, NC
(Jeevanandam) University of Chicago Chicago, IL
(Lima) Baylor University Medical Center Dallas, TX
(Stehlik) University of Utah Salt Lake City, UT
Title
Report From the American Society of Transplantation Conference on Donor
Heart Selection in Adult Cardiac Transplantation in the United States.
Source
American Journal of Transplantation. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Cardiac transplantation remains the only definitive treatment for
end-stage heart failure. Transplantation rates are limited by a shortage
of donor hearts. This shortage is magnified because many hearts are
discarded because of strict selection criteria and concern for regulatory
reprimand for less-than-optimal posttransplant outcomes. There is no
standardized approach to donor selection despite proposals to liberalize
acceptance criteria. A donor heart selection conference was organized to
facilitate discussion and generate ideas for future research. The event
was attended by 66 participants from 41 centers with considerable
experience in cardiac donor selection. There were state-of-the-art
presentations on donor selection, with subsequent breakout sessions on
standardizing the process and increasing utilization of donor hearts.
Participants debated misconceptions and established agreement on donor and
recipient risk factors for donor selection and identified the components
necessary for a future donor risk score. Ideas for future initiatives
include modification of regulatory practices to consider extended criteria
donors when evaluating outcomes and prospective studies aimed at
identifying the factors leading to nonacceptance of available donor
hearts. With agreement on the most important donor and recipient risk
factors, it is anticipated that a consistent approach to donor selection
will improve rates of heart transplantation.<br/>Copyright &#xa9; 2017 The
American Society of Transplantation and the American Society of Transplant
Surgeons.

<88>
Accession Number
616775737
Author
Boitor M.; Gelinas C.; Richard-Lalonde M.; Thombs B.D.
Institution
(Boitor, Gelinas, Richard-Lalonde) Ingram School of Nursing, McGill
University, 3506 University Street, Montreal, H3A 2A7, Canada
(Boitor, Gelinas) Centre for Nursing Research and Lady Davis Institute,
Jewish General Hospital, 3755 Cote Ste-Catherine Road, Montreal H3T 1E2,
Canada
(Thombs) Lady Davis Institute for Medical Research, Jewish General
Hospital, 3755 Cote Ste-Catherine Road, Montreal H3T 1E2, Canada
(Thombs) Department of Psychiatry, McGill University, 1033 Pine Avenue
West, Montreal, H3A 1A1, Canada
(Thombs) Department of Epidemiology, Biostatistics, and Occupational
Health, McGill University, 1020 Pine Avenue West, Montreal, H3A 1A2,
Canada
(Thombs) Department of Medicine, McGill University, 1001 Decarie
Boulevard, Montreal, H4A 3J1, Canada
(Thombs) Department of Educational and Counselling Psychology, McGill
University, 3700 McTavish Street, Montreal, H3A 1Y2, Canada
(Thombs) Department of Psychology, McGill University, 1205 Dr Penfield
Avenue, Montreal, H3A 1B1, Canada
Title
The Effect of Massage on Acute Postoperative Pain in Critically and
Acutely Ill Adults Post-thoracic Surgery: Systematic Review and
Meta-analysis of Randomized Controlled Trials.
Source
Heart and Lung: Journal of Acute and Critical Care. (no pagination), 2017.
Date of Publication: February 08, 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Critical care practice guidelines identify a lack of clear evidence on the
effectiveness of massage for pain control. To assess the effect of massage
on acute pain in critically and acutely ill adults post-thoracic surgery.
Medline, Embase, CINAHL, PsychInfo, Web of Science, Scopus and Cochrane
Library databases were searched. Eligible studies were randomized
controlled trials (RCTs) evaluating the effect of massage compared to
attention control/sham massage or standard care alone on acute pain
intensity post-thoracic surgery. Twelve RCTs were included. Of these, nine
evaluated massage in addition to standard analgesia, including 2 that
compared massage to attention control/sham massage in the intensive care
unit (ICU), 6 that compared massage to standard analgesia alone early
post-ICU discharge, and 1 that compared massage to both attention control
and standard care in the ICU. Patients receiving massage with analgesia
reported less pain (0-10 scale) compared to attention control/sham massage
(3 RCTs; N = 462; mean difference -0.80, 95% confidence interval [CI]
-1.25 to -0.35; p < 0.001; I² = 13%) and standard care (7 RCTs;
N = 1087; mean difference -0.85, 95% CI -1.28 to -0.42; p < 0.001;
I² = 70%). Massage, in addition to pharmacological analgesia,
reduces acute post-cardiac surgery pain intensity.<br/>Copyright &#xa9;
2017 Elsevier Inc.