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<1>
Accession Number
615921300
Author
Ostadal P.; Rokyta R.; Kruger A.; Vondrakova D.; Janotka M.; Smid O.;
Smalcova J.; Hromadka M.; Linhart A.; Belohlavek J.
Institution
(Ostadal, Kruger, Vondrakova, Janotka) Department of Cardiology, Na
Homolce Hospital, Prague, Czech Republic
(Rokyta, Hromadka) Department of Cardiology, University Hospital and
Faculty of Medicine Pilsen, Charles University, Czech Republic
(Smid, Smalcova, Linhart, Belohlavek) 2nd Department of Medicine -
Department of Cardiovascular Medicine, First Faculty of Medicine, Charles
University and General University Hospital, Prague, Czech Republic
Title
Extra corporeal membrane oxygenation in the therapy of cardiogenic shock
(ECMO-CS): rationale and design of the multicenter randomized trial.
Source
European Journal of Heart Failure. 19 (pp 124-127), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Aims: Extracorporeal membrane oxygenation (ECMO) in veno-arterial
configuration represents an increasingly used method for circulatory
support. ECMO in cardiogenic shock offers rapid improvement of circulatory
status and significant increase in tissue perfusion. Current evidence on
the use of ECMO in cardiogenic shock remains insufficient. The aim of the
ECMO-CS trial is to compare two recognized therapeutic approaches in the
management of severe cardiogenic shock: early conservative therapy and
early implantation of veno-arterial ECMO on the background of standard
care. Methods: Eligible patients have either rapidly deteriorating or
severe cardiogenic shock, defined using echocardiography, hemodynamic and
metabolic criteria. Patients are randomized to the one of two arms:
immediate veno-arterial ECMO therapy or early conservative therapy. All
other diagnostic and therapeutic procedures are performed as per current
standard of care, including other cardiovascular interventions (i.e.
percutaneous coronary intervention or cardiac surgery). Follow-up includes
visits at 30 days, 6 months and 12 months. Primary endpoint is a composite
of death from any cause, resuscitated circulatory arrest, and implantation
of another mechanical circulatory support device at 30 days. The sample
size of 120 individuals (60 in each arm) provides 80% power to detect 50%
reduction of primary endpoint, at alpha = 0.05. Patient recruitment
started in October 2014. Conclusion: The results of the ECMO-CS trial may
significantly influence current practice in the management of patients
with severe and rapidly deteriorating cardiogenic shock. ECMO-CS trial
registration number is NCT02301819.<br/>Copyright &#xa9; 2017 The Authors.
European Journal of Heart Failure &#xa9; 2017 European Society of
Cardiology

<2>
Accession Number
615921235
Author
Meani P.; Gelsomino S.; Natour E.; Johnson D.M.; Rocca H.-P.B.L.;
Pappalardo F.; Bidar E.; Makhoul M.; Raffa G.; Heuts S.; Lozekoot P.; Kats
S.; Sluijpers N.; Schreurs R.; Delnoij T.; Montalti A.; Sels J.W.; van de
Poll M.; Roekaerts P.; Poels T.; Korver E.; Babar Z.; Maessen J.; Lorusso
R.
Institution
(Meani, Rocca, Delnoij, Sels) Cardiology Department Maastricht University
Medical Center +, Maastricht, Netherlands
(Gelsomino, Natour, Johnson, Bidar, Makhoul, Heuts, Lozekoot, Kats,
Sluijpers, Schreurs, Poels, Korver, Babar, Maessen, Lorusso) Department of
Cardiothoracic Surgery, Maastricht University Medical Center +,
Maastricht, Netherlands
(Pappalardo) Cardiac Surgery Intensive Care Unit, San Raphael Hospital,
Milan, Italy
(Delnoij, Montalti, Sels, van de Poll, Roekaerts) Intensive Care
Department, Maastricht University Medical Center +, Maastricht,
Netherlands
(Raffa) Cardiac Surgery and Heart Transplantation Unit; Department for the
Treatment and Study of Cardiothoracic Diseases and Cardiothoracic
Transplantation, Mediterranean Institute for Transplantation and Advanced
Specialized Therapies (ISMETT), Palermo, Italy
Title
Modalities and Effects of Left Ventricle Unloading on Extracorporeal Life
support: a Review of the Current Literature.
Source
European Journal of Heart Failure. 19 (pp 84-91), 2017. Date of
Publication: May 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Introduction/Aim: Veno-arterial extracorporeal membrane oxygenation (V-A
ECMO) support is increasingly used in refractory cardiogenic shock and
cardiac arrest, but is characterized by a rise in afterload of the left
ventricle (LV) which may ultimately either further impair or delay cardiac
contractility improvement. The aim of this study was to provide a
comprehensive overview regarding the different LV venting techniques and
results currently available in the literature. Methods: A systematic
literature search was performed in the PubMed database: 207 articles
published between 1993 and 2016 were included. Papers dealing with
pre-clinical studies, overlapping series, and association with other
assist devices were excluded from the review, with 45 published papers
finally selected. Heterogeneous indications for LV unloading were
reported. The selected literature was divided into subgroups, according to
the location or the performed procedure for LV venting. Results: Case
reports or case series accounted for 60% of the papers, while
retrospective study represented 29% of them. Adult series were present in
67%, paediatric patients in 29%, and a mixed population in 4%. LV
unloading was performed percutaneously in 84% of the cases. The most
common locations of unloading was the left atrium (31%), followed by
indirect unloading (intra-aortic balloon pump) (27%), trans-aortic (27%),
LV (11%), and pulmonary artery (4%). Percutaneous trans-septal approach
was reported in 22%. Finally, the unloading was conducted surgically in
16%,with open chest surgery in 71%, and minimally invasive surgery in 29%
of surgical cases. Conclusion: Nowadays, only a few data are available
about left heart unloading in V-A ECMO support. Despite the well-known
controversy, IABP remains widely used in combination with V-A ECMO.
Percutaneous approaches utilizing unloading devices is becoming an
increasingly used option. However, further studies are required to
establish the optimal LV unloading method.<br/>Copyright &#xa9; 2017 The
Authors. European Journal of Heart Failure &#xa9; 2017 European Society of
Cardiology

<3>
Accession Number
614424080
Author
Naito S.; Gross T.; Disha K.; von Kodolitsch Y.; Reichenspurner H.;
Girdauskas E.
Institution
(Naito, Gross, Reichenspurner, Girdauskas) Department of Cardiovascular
Surgery, University Heart Center Hamburg, Martinistrase 52, Hamburg 20246,
Germany
(Disha) Department of Cardiac Surgery, Central Hospital Bad Berka, Bad
Berka, Germany
(von Kodolitsch) Department of Cardiology, University Heart Center
Hamburg, Hamburg, Germany
Title
Late post-AVR progression of bicuspid aortopathy: link to hemodynamics.
Source
General Thoracic and Cardiovascular Surgery. 65 (5) (pp 252-258), 2017.
Date of Publication: 01 May 2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Background and aim of the study: The ascending aortic dilatation may
progress after aortic valve replacement (AVR) in bicuspid aortic valve
(BAV) patients. Our aim was to evaluate rheological flow patterns and
histological characteristics of the aneurysmal aorta in BAV patients at
the time of reoperative aortic surgery. Materials and Methods: 13 patients
(mean age: 42 +/- 9 years, 10 (77%) male) with significant progression of
proximal aortopathy after isolated AVR surgery for BAV disease (i.e., 16.7
+/- 8.1 years post-AVR) were identified by cardiac phase-contrast cine
magnetic resonance imaging (MRI) in our hospital. A total of nine patients
(69%) underwent redo aortic surgery. Based on the MRI data, the aortic
area of the maximal flow-induced stress (jet sample) and the opposite site
(control sample) were identified and corresponding samples were collected
intraoperatively. Histological sum-score values [i.e. aortic wall changes
were graded based on a summation of seven histological criteria (each
scored from 0 to 3)] were compared between these samples. Results: Mean
proximal aortic diameter at MRI follow-up was 55 +/- 6 mm (range 47-66mm).
Preoperative cardiac MRI demonstrated eccentric systolic flow pattern
directed towards right-lateral/right posterior wall of the proximal aorta
in 9/13 (69%) patients. Histological sum-score values were significantly
higher in the jet sample vs control sample (i.e., 8.3 +/- 3.8 vs 5.6 +/-
2.4, respectively, p = 0.04). Conclusions: Hemodynamic factors may still
be involved in the late progression of bicuspid aortopathy even after
isolated AVR surgery for BAV disease.<br/>Copyright &#xa9; 2017, The
Japanese Association for Thoracic Surgery.

<4>
Accession Number
614488845
Author
Friedland-Little J.M.; Uzark K.; Yu S.; Lowery R.; Aiyagari R.;
Hirsch-Romano J.C.
Institution
(Friedland-Little) Division of Pediatric Cardiology, University of
Washington School of Medicine, Seattle Children's Hospital, Seattle,
Washington, United States
(Uzark, Yu, Lowery, Aiyagari, Hirsch-Romano) Division of Pediatric
Cardiology, Department of Pediatrics and Communicable Disease, University
of Michigan, Ann Arbor, Michigan, United States
(Hirsch-Romano) Section of Pediatric Cardiac Surgery, Department of
Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, United
States
Title
Functional Status and Quality of Life in Survivors of Extracorporeal
Membrane Oxygenation After the Norwood Operation.
Source
Annals of Thoracic Surgery. 103 (6) (pp 1950-1955), 2017. Date of
Publication: June 2017.
Publisher
Elsevier USA
Abstract
Background Infants who require extracorporeal membrane oxygenation (ECMO)
support after a Norwood operation are at increased risk for early and late
death compared with patients who do not require ECMO post-Norwood. Little
is known about the effect that ECMO post-Norwood has on functional status
and quality of life among long-term survivors. Methods We prospectively
evaluated functional status and health-related quality of life in 12
surviving patients (cases) and 19 corresponding patients (controls) from a
previous retrospective case-control assessment of long-term survival in
patients requiring ECMO post-Norwood. Functional status was assessed with
the Vineland Adaptive Behavior Scale-II, and health-related quality of
life was assessed with the Pediatric Quality of Life Inventory (PedsQL)
core and cardiac modules. Results There were no differences in
demographics, extracardiac or genetic anomalies, or age at follow-up
assessment between ECMO cases and non-ECMO controls. The Vineland Adaptive
Behavior Scale-II scores were comparable between groups, with both groups
demonstrating function in the normal range in all four domains tested. The
only difference in PedsQL scores between cases and controls was perceived
physical appearance, which was lower among ECMO survivors by both patient
and proxy report. PedsQL scores of both groups were comparable to
published scores for patients with single-ventricle congenital heart
disease but generally lower than scores for the healthy population.
Conclusions The requirement for ECMO support after a Norwood operation
does not appear to significantly affect functional status or quality of
life among the subset of patients who achieve long-term
survival.<br/>Copyright &#xa9; 2017 The Society of Thoracic Surgeons

<5>
Accession Number
614524495
Author
Scholz-Kreisel P.; Spix C.; Blettner M.; Eckerle S.; Faber J.; Wild P.;
Merzenich H.; Hennewig U.
Institution
(Scholz-Kreisel, Blettner, Merzenich) Institute for Medical Biostatistics,
Epidemiology and Informatics, University Medicine of the Johannes
Gutenberg-University Mainz, Mainz, Germany
(Spix) German Childhood Cancer Registry at the Institute for Medical
Biostatistics, Epidemiology and Informatics, University Medicine of the
Johannes Gutenberg-University Mainz, Mainz, Germany
(Eckerle, Faber) Department of Pediatric Hematology/Oncology, University
Medicine of the Johannes Gutenberg-University Mainz, Mainz, Germany
(Wild) Preventive Cardiology and Preventive Medicine, Center for
Cardiology, University Medical Center of the Johannes Gutenberg-University
Mainz, Mainz, Germany
(Wild) Center for Thrombosis and Hemostasis, University Medical Center of
the Johannes Gutenberg-University Mainz, Mainz, Germany
(Wild) German Center for Cardiovascular Research (DZHK), Partner Site
RhineMain, Mainz, Germany
(Wild) Center for Translational Vascular Biology (CTVB), University
Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
(Hennewig) Department of Paediatric Haematology and Oncology, Center for
Paediatrics, University Hospital Giesen and Marburg, Giessen, Germany
Title
Prevalence of cardiovascular late sequelae in long-term survivors of
childhood cancer: A systematic review and meta-analysis.
Source
Pediatric Blood and Cancer. 64 (7) (no pagination), 2017. Article Number:
e26428. Date of Publication: July 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Cardiovascular diseases are well-known late effects of
childhood cancer and research on these late effects is a highly important
emerging field. We conducted a systematic review with a meta-analysis to
give an overview of the current evidence and the prevalence of late
cardiovascular events. Procedure: We included publications in which the
study populations were children and adolescents who survived cancer.
Outcome was defined as all cardiovascular clinical and subclinical
endpoints or diagnoses appearing at least one year after cancer diagnosis.
A systematic overview is presented for all included studies. A
quantitative meta-analysis was conducted for hypertension and stroke.
Results: Sixty-four papers were included in the review. The age range at
cancer diagnosis was 0-24 years; age at the end of follow-up ranged from 7
to 71 years. Prevalence of cardiovascular late effects varied from 0% for
stroke up to 70% for subclinical hypertension. Large heterogeneity was
found regarding study size, study design, definition of endpoints, and
investigation/examination method. The weighted average prevalence was
19.7% for hypertension and 2.3% for stroke. As no specific results for
gender, cancer therapy, or age at cancer diagnosis were present in most
papers, a detailed comparison and pooled analysis was difficult.
Conclusion: This review showed the vast range of cardiovascular late
effects after childhood or adolescent cancer therapy. The differences
between the papers prevented drawing a conclusive picture of the
prevalence of cardiovascular late effects. Large cohort studies and better
reporting are needed to improve the knowledge on this topic.<br/>Copyright
&#xa9; 2017 Wiley Periodicals, Inc.

<6>
Accession Number
613762011
Author
Sannino A.; Schiattarella G.G.; Toscano E.; Gargiulo G.; Giugliano G.;
Galderisi M.; Losi M.-A.; Stabile E.; Cirillo P.; Imbriaco M.; Grayburn
P.A.; Trimarco B.; Esposito G.
Institution
(Sannino, Schiattarella, Toscano, Gargiulo, Giugliano, Galderisi, Losi,
Stabile, Cirillo, Imbriaco, Trimarco, Esposito) Division of Cardiology,
Department of Advanced Biomedical Sciences, Federico II University,
Naples, Italy
(Sannino, Grayburn) Division of Cardiology, Baylor University Medical
Center, Dallas, Texas, United States
(Schiattarella) Department of Internal Medicine (Cardiology), University
of Texas Southwestern Medical Center, Dallas, Texas, United States
Title
Meta-Analysis of Effect of Body Mass Index on Outcomes After Transcatheter
Aortic Valve Implantation.
Source
American Journal of Cardiology. 119 (2) (pp 308-316), 2017. Date of
Publication: 15 Jan 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Controversial data exist regarding the impact of body mass index (BMI) on
TAVI outcomes. 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 versus normal
weight, (2) overweight versus normal weight, and (3) obese versus normal
weight patients. Underweight patients (BMI <20 kg/m²) had
similar 30-day all-cause mortality compared with the normal, although they
displayed a significant worse survival at long-term follow-up (hazard
ratio 1.68, 95% confidence interval (CI) 1.09 to 2.59, p = 0.02).
Underweight patients showed a higher incidence of major and
life-threatening bleedings (2,566 patients, odds ratio 1.64, 95% CI 1.10
to 2.45, p = 0.02) and of major vascular complications (2,566 patients,
odds ratio 1.86, 95% CI 1.16 to 2.98, p = 0.01), compared with normal
weight patients. Overweight patients (BMI >=25 and <30 kg/m²)
display similar 30-day and long-term all-cause mortality, as well as
similar procedural complication rate compared with normal weight patients.
Obese patients (BMI >30 kg/m²) had similar 30-day all-cause
mortality rates compared with the normal weight category, whereas they
displayed a significant better survival at long-term (hazard ratio 0.79,
95% CI 0.67 to 0.93, p = 0.004). Procedural complications did not differ
between obese and normal body weight patients. In conclusion, a low BMI is
linked to a significantly worse prognosis after TAVI. Therefore, BMI
represents an important and handily tool that might be used in the risk
prediction of patients to be addressed for TAVI.<br/>Copyright &#xa9; 2016
Elsevier Inc.

<7>
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Accession Number
615488589
Author
Murthy S.B.; Gupta A.; Merkler A.E.; Navi B.B.; Mandava P.; Iadecola C.;
Sheth K.N.; Hanley D.F.; Ziai W.C.; Kamel H.
Institution
(Murthy, Merkler, Navi, Iadecola, Kamel) Department of Neurology, 525 E
68th St, Room F610, New York, NY 10065, United States
(Murthy, Gupta, Merkler, Navi, Iadecola, Kamel) Clinical and Translational
Neuroscience Unit, Feil Family Brain and Mind Research Institute, United
States
(Gupta) Department of Radiology, Weill Cornell Medicine, New York, NY,
United States
(Mandava) Stroke Outcomes Laboratory, Department of Neurology, Baylor
College of Medicine and the Michael E. DeBakey VA Medical Center, Houston,
TX, United States
(Sheth) Division of Neurocritical Care and Emergency Neurology, Department
of Neurology, Yale University School of Medicine, New Haven, CT, United
States
(Hanley) Division of Brain Injury Outcomes, United States
(Ziai) Division of Neurosciences Critical Care, Johns Hopkins University
School of Medicine, Baltimore, MD, United States
Title
Restarting Anticoagulant Therapy after Intracranial Hemorrhage: A
Systematic Review and Meta-Analysis.
Source
Stroke. 48 (6) (pp 1594-1600), 2017. Date of Publication: 01 Jun 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background and Purpose-The safety and efficacy of restarting
anticoagulation therapy after intracranial hemorrhage (ICH) remain
unclear. We performed a systematic review and meta-Analysis to summarize
the associations of anticoagulation resumption with the subsequent risk of
ICH recurrence and thromboembolism. Methods-We searched published medical
literature to identify cohort studies involving adults with
anticoagulation-Associated ICH. Our predictor variable was resumption of
anticoagulation. Outcome measures were thromboembolic events (stroke and
myocardial infarction) and recurrence of ICH. After assessing study
heterogeneity and publication bias, we performed a meta-Analysis using
random-effects models to assess the strength of association between
anticoagulation resumption and our outcomes. Results-Eight studies were
eligible for inclusion in the meta-Analysis, with 5306 ICH patients.
Almost all studies evaluated anticoagulation with Vitamin K antagonists.
Reinitiation of anticoagulation was associated with a significantly lower
risk of thromboembolic complications (pooled relative risk, 0.34; 95%
confidence interval, 0.25-0.45; Q=5.12, P for heterogeneity=0.28). There
was no evidence of increased risk of recurrent ICH after reinstatement of
anticoagulation therapy, although there was significant heterogeneity
among included studies (pooled relative risk, 1.01; 95% confidence
interval, 0.58-1.77; Q=24.68, P for heterogeneity <0.001). No significant
publication bias was detected in our analyses. Conclusions-In
observational studies, reinstitution of anticoagulation after ICH was
associated with a lower risk of thromboembolic complications and a similar
risk of ICH recurrence. Randomized clinical trials are needed to determine
the true risk-benefit profile of anticoagulation resumption after
ICH.<br/>Copyright &#xa9; 2017 American Heart Association, Inc.

<8>
Accession Number
615802372
Author
Zadeh F.J.; Nour M.G.
Institution
(Zadeh) Department of Cardiac Anesthesia, Ahvaz Anesthesiology and Pain
Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz,
Iran, Islamic Republic of
(Zadeh) Atherosclerosis Research Center, Ahvaz Jundishapur University of
Medical Sciences, Ahvaz, Iran, Islamic Republic of
(Nour) Department of Cardiac Surgery, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
Title
A study on the outcomes of modified tight glucose control for the
management of glycemic control in diabetic patients undergoing cardiac
surgery.
Source
Journal of Pharmacy Research. 10 (11) (pp 764-770), 2016. Date of
Publication: 01 Nov 2016.
Publisher
JPR Solutions (E-mail: editorparial@gmail.com)
Abstract
Background and Objective: Diabetes mellitus is associated with increased
surgical morbidity and mortality. Its relatively high risk may be related
to the level of perioperative hyperglycemia. Thisstudy was aimed to
compare the outcomes of patients undergoing open cardiac surgery byglucose
control in two ways: modified tight versus conventional method. Methods:
This open-labeled, randomized control trial was conducted on 75diabetic
patients (18-70 years old) with ASA II- III undergoing open cardiac
surgery from Shahid Faghihi Hospital, Shiraz, Iran. The patients were
randomly divided into modified tight control(Blood Sugar maintained
between 100-120 mg/dl) and conventional method (Blood Sugar < 200mg/dl).
Primary end points included: hospitalmortality, sternal wound infection,
duration of mechanical ventilation, cardiacarrhythmia, cerebrovascular
attack and acute renal failure. The secondary end point waslength of ICU
staying. Complications after 30 days of surgery were recorded. We used
student's t test, chi-squareand repeated measurement tests. Results:
Although the trend of change in blood glucose during surgery and in ICU
was notsignificantly different between groups, blood sugar measurement
showed a significantdifference at the different times (P < 0.001). In
terms of primary end pointsandsecondary end pointwere not significantly
different between two groups. The occurrence of hypoglycemiawas low in
both groups (one patient in each group) and were not significantly
different between two groups. Hypokalemia was the most prominent
sideeffect in the 34 patients of modified tight control group compared
with eight patients in theconventional group (P < 0.001). After 30 days
sternal wound infection was seen in1 patient oftreatment group versus 7 in
control group (P < 0.05), which was significant. Conclusion: Modified
tight control of blood glucose close tonormal values during cardiac
surgery was associated with decreased occurrence of episodes of
hypoglycemia andhyperglycemic complications.

<9>
Accession Number
606669860
Author
Tang L.H.; Zwisler A.-D.; Taylor R.S.; Doherty P.; Zangger G.; Berg S.K.;
Langberg H.
Institution
(Tang, Zwisler, Zangger, Berg) Department of Cardiology, The Heart Centre,
Rigshospitalet - Copenhagen University Hospital, Denmark
(Tang, Langberg) CopenRehab, Section of Social Medicine, Department of
Public Health, University of Copenhagen, Denmark
(Tang) Department of Rehabilitation and Nutrition, Faculty of Health and
Technology, Metropolitan University College, Denmark
(Tang) The Centre for Physical Activity Research, Rigshospitalet,
University of Copenhagen, Denmark
(Zwisler) National Centre for Rehabilitation and Palliative Care,
University of Southern Denmark, Odense University Hospital, Denmark
(Taylor) Institute of Health Research, University of Exeter Medical
School, United Kingdom
(Taylor) National Institute of Public Health, University of Southern
Denmark, Denmark
(Doherty) Department of Health Sciences, University of York, United
Kingdom
Title
Self-rating level of perceived exertion for guiding exercise intensity
during a 12-week cardiac rehabilitation programme and the influence of
heart rate reducing medication.
Source
Journal of Science and Medicine in Sport. 19 (8) (pp 611-615), 2016. Date
of Publication: 01 Aug 2016.
Publisher
Elsevier Ltd
Abstract
Objectives: To investigate whether self-rating level of perceived exertion
can adequately guide exercise intensity during a 12-week cardiac
rehabilitation programme. Design: Linear regression analysis using
rehabilitation data from two randomised controlled trials. Methods:
Patients undergoing radiofrequency ablation for atrial fibrillation or
following heart valve surgery and participating in exercise-based
rehabilitation were included. The 12-week rehabilitation outpatient
programme comprised three weekly training sessions, each consisting of 20
min aerobic exercise divided into three steps. Patients were asked to base
their exercise intensity for each step on a predefined rating of perceived
exertion specified in a training diary. Exercise intensity was objectively
measured by heart rate during the last 2 min for each exercise step.
Comparative analysis and linear regression of the rating of perceived
exertion and heart rate were performed. Results: A total of 2622 ratings
of perceived exertion were collected from 874 training sessions in 97
patients. Heart rate and rating of perceived exertion were associated both
across all three exercise steps and individually for each step, with a
mean of 6 to7 bpm per 1-point difference in the rating of perceived
exertion (p < 0.001). Adjusting for rate-reducing medication slightly
improved the strength of the association. Conclusions: The association
between change in the rating of perceived exertion and change in heart
rate indicates that a diary-led and self-regulated model using rating of
perceived exertion can help guide exercise intensity in everyday clinical
practice among patients with heart disease, irrespective if they are
taking heart rate-reducing medication.<br/>Copyright &#xa9; 2015 Sports
Medicine Australia.

<10>
Accession Number
607756535
Author
Sabzi F.; Faraji R.
Institution
(Sabzi, Faraji) Preventive Cardiovascular Research Centre Kermanshah,
Kermanshah University of Medical Sciences, Kermanshah, Iran, Islamic
Republic of
Title
The effect of magnesium sulfate on post off-pump coronary artery bypass
grafting bleeding.
Source
Indian Heart Journal. 68 (3) (pp 349-354), 2016. Date of Publication: 01
May 2016.
Publisher
Elsevier B.V.
Abstract
Background Magnesium level alteration may cause coagulation abnormality
resulting in bleeding complication after off-pump coronary artery bypass
grafting. In this study, we investigated the effect of magnesium on the
postoperative coagulation profile and bleeding in OPCAB patients. Methods
In a double blind clinical trial, six hundred patients were randomly
allocated to two groups: group A (n = 150) and group B (n = 450). Group A
received 50 mg/kg of magnesium sulfate (MS) in 100 ml 0.9% NaCl solution
over 20 min before the anesthesia induction. Group B or control group
received only 100 ml 0.9% NaCl solution at the same time points. OPCAB was
performed with standard technique and device. Blood samples were collected
30 min before and 6 h after the surgery to analyze hemoglobin and blood
coagulation tests. Postoperative exploration for bleeding, blood
transfusion, and volume of transfusion was recorded. The two groups
compared with t-test and chi² tests and p-valve <0.05 were
considered as significant. Results However, postoperative hemoglobin was
statistically lower in group A compared with group B, but platelet, PT,
and aPTT tests were not statistically different between two groups. The
serum MS level, exploration for bleeding, volume of packed cell
transfusion, and volume of postoperative bleeding were statistically
different between group A vs group B. Conclusion Preoperative MS use may
be associated with the postoperative platelet dysfunction and increased
tendency to bleeding. This is an important risk factor for postoperative
bleeding in the OPCAB in absence of CPB use.<br/>Copyright &#xa9; 2015
Cardiological Society of India. Published by Elsevier B.V. All rights
reserved.

<11>
Accession Number
613335187
Author
Kinnaird T.; Kwok C.S.; Narain A.; Butler R.; Ossei-Gerning N.; Ludman P.;
Moat N.; Anderson R.; Mamas M.A.
Institution
(Kinnaird, Ossei-Gerning, Anderson) Department of Cardiology, University
Hospital of Wales, Cardiff, United Kingdom
(Kwok, Butler, Mamas) Academic Department of Cardiology, University
Hospital of North Midlands, Stoke-on-Trent, United Kingdom
(Kwok, Narain, Butler, Mamas) Cardiovascular Research Group, Keele
University, Stoke-on-Trent, United Kingdom
(Ludman) Department of Cardiology, Queen Elizabeth Hospital, Birmingham,
United Kingdom
(Moat) Department of Cardiothoracic Surgery, Royal Brompton Hospital,
United Kingdom
Title
Meta-Analysis of Percutaneous Coronary Intervention With Drug-Eluting
Stent Versus Coronary Artery Bypass Grafting for Isolated Proximal Left
Anterior Descending Coronary Disease.
Source
American Journal of Cardiology. 118 (8) (pp 1171-1177), 2016. Date of
Publication: 15 Oct 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
We performed a meta-analysis of the studies comparing the efficacy and
safety of coronary artery bypass surgery against percutaneous coronary
intervention with drug-eluting stents (PCI-DES) in patients with isolated
LAD disease. Because of the limited randomized trial data, the optimal
revascularization strategy for patients with isolated LAD disease remains
uncertain. Using MEDLINE and EMBASE to source data, 11 studies (3
randomized trials and 8 cohort studies) including 5,044 participants were
identified. No significant difference in mortality between PCI-DES and
coronary artery bypass surgery (CABG; 111 of 2,122 [5.2%] and 120 of 2,574
[4.7%]; relative risk [RR] 1.23; 95% confidence interval [CI] 0.90 to
1.69) was detected. For MACE, PCI-DES was associated with significant
increase in adverse events (RR 1.41; 95% CI 1.03 to 1.93, 8 studies, 4,230
participants). There were no significant differences in the risk of
myocardial infarction (RR 0.86; 95% CI 0.58 to 1.26) or stroke (RR 2.36;
95% CI 0.54 to 10.43) between the 2 groups. There were 239 target vessel
revascularization (TVR) events among 2,237 participants in the PCI-DES
group (10.7%) and 145 TVR events among 2,793 participants in the CABG
group (5.2%) with a significant increased risk of TVR in the PCI group (RR
2.52; 95% CI 1.69 to 3.77, 5,030 participants) compared with CABG. In
conclusion, for patients with isolated disease of the LAD, meta-analysis
of the available data suggests revascularization with a PCI-DES strategy
offers similar mortality, MI, and stroke rates to CABG at the expense of
increased TVR. Much of the data are derived from registries using
first-generation DES, and further randomized trials with more contemporary
platforms are needed.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<12>
Accession Number
611687943
Author
Visconti G.; Focaccio A.; Donahue M.; Golia B.; Marzano A.; Donnarumma E.;
Ricciardelli B.; Selvetella L.; Marino L.; Briguori C.
Institution
(Visconti, Focaccio, Donahue, Golia, Marzano, Ricciardelli, Briguori)
Laboratory of Interventional Cardiology, Department of Cardiology, Clinica
Mediterranea, Naples, Italy
(Donnarumma) IRCCS SDN, Naples, Italy
(Selvetella) Department of Vascular Surgery, Clinica Mediterranea, Naples,
Italy
(Marino) Department of Cardiac Surgery, Clinica Mediterranea, Naples,
Italy
Title
RenalGuard System for the prevention of acute kidney injury in patients
undergoing transcatheter aortic valve implantation.
Source
EuroIntervention. 11 (14) (pp e1658-e1661), 2016. Date of Publication:
April 2016.
Publisher
EuroPCR
Abstract
Aims: We aimed to assess whether the RenalGuardTM System is effective in
preventing acute kidney injury (AKI) following transcatheter aortic valve
implantation (TAVI). Methods and results: Forty-eight consecutive patients
with chronic kidney disease (CKD) scheduled for TAVI were assigned to: 1)
hydration with sodium bicarbonate solution (Control group), or 2)
hydration with RenalGuard Therapy (RenalGuard group). Hypotension was
defined as periprocedural mean blood pressure <55 mmHg. The primary
endpoint was the occurrence of AKI (i.e., an increase of >=0.3 mg/dL in
the serum creatinine concentration at seven days). AKI occurred in 10/26
(38.5%) patients in the Control group and in 1/22 (4.5%) patients in the
RenalGuard group (p=0.005, odds ratio [OR] 0.076, 95% confidence interval
[CI]: 0.009-0.66). RenalGuard Therapy protected against AKI (OR 0.71, 95%
CI: 0.07-0.775, p=0.026), whereas post-procedural hypotension (OR 3.88,
95% CI: 1.06-14.24, p=0.040), and contrast media volume (OR 3.65, 95% CI:
1.15-5.75, p=0.043) increased the risk of AKI. Conclusions: This
non-randomised pilot study suggests that RenalGuard Therapy may be
effective in preventing AKI in CKD patients undergoing TAVI.<br/>Copyright
&#xa9; Europa Digital & Publishing 2016. All rights reserved.

<13>
Accession Number
609164619
Author
Tariq N.; Tepper S.J.; Kriegler J.S.
Institution
(Tariq) Michigan Headache and Neurological Institute, Ringgold Standard
Institution Neurology, 3120 Professional Drive, Ann Arbor, MI, United
States
(Tepper) Dartmouth College, Geisel School of Medicine, Ringgold Standard
Institution - Neurology, Hanover, NH, United States
(Kriegler) Cleveland Clinic, Center for Neurological Restoration,
Cleveland, OH, United States
Title
Patent Foramen Ovale and Migraine: Closing the Debate - A Review.
Source
Headache. 56 (3) (pp 462-478), 2016. Date of Publication: 01 Mar 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background A link between patent foramen ovale (PFO) and migraine as well
as the utility of closure of PFO and its effect on migraine have been
subjects of debate. The present review is an effort to gather the
available evidence on this topic and formulate recommendations. Methods A
systematic search of electronic databases (Medline, Embase, Cochrane
Library) was performed. A separate search in associated reference lists of
identified studies was done. Observational studies and clinical trials
published in English using the International Headache Society criteria for
diagnosis of migraine were included in the analysis. The search was
performed in 3 categories: prevalence of migraine in patients with PFO,
prevalence of PFO in migraine patients, and effect of PFO closure and its
effect on migraine. The quality of evidence and strength of
recommendations during review of these studies was analyzed. Results About
14 observational studies with 2602 subjects who had PFO were identified.
Migraine prevalence ranged from 16% to 64%. Another 20 studies reported
2444 patients with migraine; the prevalence of PFO ranged from 15% to 90%.
About 20 observational studies (1194 patients) that examined the effect of
PFO closure on migraine were identified. Resolution of migraine was
reported in 10% to 83% of patients, improvement in 14% to 83%, no change
in 1% to 54%, and worsening in 4% to 8%. The overall quality of these
observational studies was poor. Finally, 3 randomized clinical trials
included a total of 238 patients who underwent PFO closure compared with
234 patients in the control groups. All 3 trials failed to meet their
primary end points defined as migraine resolution and greater than 50%
reduction in migraine days at 1 year. In 2 of the clinical trials, there
was some benefit noted in a small subset of migraine patients with aura,
but the numbers were too small to extrapolate the findings to the general
migraine population. Conclusions There is no good quality evidence to
support a link between migraine and PFO. Closure of PFO for migraine
prevention does not significantly reduce the intensity and severity of
migraine. We do not recommend the routine use of this procedure in current
practice.<br/>Copyright &#xa9; 2016 American Headache Society.

<14>
Accession Number
613430248
Author
Dora K.A.; Stanley C.P.; Jaaly E.A.; Fiorentino F.; Ascione R.; Reeves
B.C.; Angelini G.D.
Institution
(Dora, Stanley) Department of Pharmacology, University of Oxford, United
Kingdom
(Jaaly, Fiorentino, Angelini) Department of Cardiothoracic Surgery,
Hammersmith Hospital, Imperial College London, London, United Kingdom
(Ascione, Reeves, Angelini) Bristol Heart Institute, Bristol Royal
Infirmary, University of Bristol, United Kingdom
(Stanley) The Victor Chang Cardiac Research Institute, Sydney, Australia
Title
Isolated human pulmonary artery structure and function pre -and
post-cardiopulmonary bypass surgery.
Source
Journal of the American Heart Association. 5 (2) (no pagination), 2016.
Article Number: e002822. Date of Publication: 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Pulmonary dysfunction is a known complication after cardiac
surgery using cardiopulmonary bypass, ranging from subclinical functional
changes to prolonged postoperative ventilation, acute lung injury, and
acute respiratory distress syndrome. Whether human pulmonary arterial
function is compromised is unknown. The aim of the present study was to
compare the structure and function of isolated and cannulated human
pulmonary arteries obtained from lung biopsies after the chest was opened
(pre-cardiopulmonary bypass) to those obtained at the end of
cardiopulmonary bypass (post-cardiopulmonary bypass) from patients
undergoing coronary artery bypass graft surgery. Methods and
Results-Pre-and post-cardiopulmonary bypass lung biopsies were received
from 12 patients undergoing elective surgery. Intralobular small arteries
were dissected, cannulated, pressurized, and imaged using confocal
microscopy. Functionally, the thromboxane mimetic U46619 produced
concentration-dependent vasoconstriction in 100% and 75% of pre-and
post-cardiopulmonary bypass arteries, respectively. The
endothelium-dependent agonist bradykinin stimulated vasodilation in 45%
and 33% of arteries pre-and post-cardiopulmonary bypass, respectively.
Structurally, in most arteries smooth muscle cells aligned
circumferentially; live cell viability revealed that although 100% of
smooth muscle and 90% of endothelial cells from pre -cardiopulmonary
bypass biopsies had intact membranes and were considered viable, only 60%
and 58%, respectively, were viable from post-cardiopulmonary bypass
biopsies. Conclusions-We successfully investigated isolated pulmonary
artery structure and function in fresh lung biopsies from patients
undergoing heart surgery. Pulmonary artery contractile tone and
endothelium-dependent dilation were significantly reduced in
post-cardiopulmonary bypass biopsies. The decreased functional responses
were associated with reduced cell viability. Clinical Trial
Registration--URL: http://www.isrctn.com/ISRCTN34428459.<br/>Copyright
&#xa9; 2016 The Authors.

<15>
Accession Number
609671246
Author
Sharma K.K.; Gupta R.; Mathur M.; Natani V.; Lodha S.; Roy S.; Xavier D.
Institution
(Sharma, Mathur) Department of Pharmacology, SMS Medical College, Jaipur
302004, India
(Sharma, Gupta, Natani) Department of Medicine, Fortis Escorts Hospital,
Jaipur 302017, India
(Lodha) Department of Endocrinology, Fortis Escorts Hospital, Jaipur
302017, India
(Roy) Department of Cardiology, Fortis Escorts Hospital, Jaipur 302017,
India
(Gupta) Department of Medicine, Eternal Heart Care Centre and Research
Institute, Jaipur 302020, India
(Xavier) Department of Pharmacology, St John's Medical College, Bangalore
560068, India
Title
Non-physician health workers for improving adherence to medications and
healthy lifestyle following acute coronary syndrome: 24-month follow-up
study.
Source
Indian Heart Journal. 68 (6) (pp 832-840), 2016. Date of Publication: 01
Nov 2016.
Publisher
Elsevier B.V.
Abstract
Objective To evaluate usefulness of non-physician health workers (NPHW) to
improve adherence to medications and lifestyles following acute coronary
syndrome (ACS). Methods We randomized 100 patients at hospital discharge
following ACS to NPHW intervention (n = 50) or standard care (n = 50) in
an open label study. NPHW was trained for interventions to improve
adherence to medicines - antiplatelets, beta-blockers, renin-angiotensin
system (RAS) blockers and statins and healthy lifestyles. Intervention
lasted 12 months with passive follow-up for another 12. Both groups were
assessed for adherence using a standardized questionnaire. Results ST
elevation myocardial infarction (STEMI) was in 49 and non-STEMI in 51,
mean age was 59.0 +/- 11 years. 57% STEMI were thrombolyzed. On admission
majority were physically inactive (71%), consumed unhealthy diets (high
fat 77%, high salt 58%, low fiber 57%) and 21% were smokers/tobacco users.
Coronary revascularization was performed in 90% (percutaneous intervention
79%, bypass surgery 11%). Drugs at discharge were antiplatelets 100%,
beta-blockers 71%, RAS blockers 71% and statins 99%. Intervention and
control groups had similar characteristics. At 12 and 24 months,
respectively, in intervention vs control groups adherence (>80%) was: anti
platelets 92.0% vs 77.1% and 83.3% vs 40.9%, beta blockers 97.2% vs 90.3%
and 84.8% vs 45.0%), RAS blockers 95.1% vs 82.3% and 89.5% vs 46.1%, and
statins 94.0% vs 70.8% and 87.5% vs 29.5%; smoking rates were 0.0% vs
12.5% and 4.2% vs 20.5%, regular physical activity 96.0% vs 50.0%, and
37.5% vs 34.1%, and healthy diet score 5.0 vs 3.0, and 4.0 vs 2.0 (p <
0.01 for all). Intervention vs standard group at 12 months had
significantly lower mean systolic BP, heart rate, body mass index,
waist:hip ratio, total cholesterol, triglyceride, and LDL cholesterol (p <
0.01). Conclusions NPHW-led educational intervention for 12 months
improved adherence to evidence based medicines and healthy lifestyles.
Efficacy continued for 24 months with attrition.<br/>Copyright &#xa9; 2016
Cardiological Society of India

<16>
Accession Number
607945862
Author
Athappan G.; Gajulapalli R.D.; Tuzcu M.E.; Svensson L.G.; Kapadia S.R.
Institution
(Athappan) Department of Cardiovascular Medicine, Mount Sinai Hospital,
New York, NY, United States
(Gajulapalli, Tuzcu, Svensson, Kapadia) Department of Cardiovascular
Medicine, Heart and Vascular Institute, Cleveland Clinic, Cardiac
Catheterization Laboratory, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195,
United States
Title
A systematic review on the safety of second-generation transcatheter
aortic valves.
Source
EuroIntervention. 11 (9) (pp 1034-1043), 2016. Date of Publication:
January 2016.
Publisher
EuroPCR
Abstract
Aims: To review the outcomes of studies and the safety of newer
transcatheter aortic valves (THV). Methods and results: All studies
reporting on second-generation THV were identified and pooled using the
systematic review guidelines. Twenty-four reports on 1,708 patients and
eight THV were included in the analysis. The pooled 30-day event rate for
mortality after transcatheter aortic valve implantation (TAVI) was 5.7%
(95% CI: 4.0-7.8), myocardial infarction (MI) was 1.7% (95% CI: 1.1-2.6),
stage 3 acute kidney injury (AKI) was 3.4% (95% CI: 2.0-5.6),
life-threatening bleeding was 5.1% (95% CI: 3.3-7.8), major vascular
complications was 4.9% (95% CI: 3.5-6.6%), major bleeding was 10.5% (95%
CI: 5.1-20.4), major stroke was 2.4% (95% CI: 1.7-3.4), permanent
pacemaker utilisation was 13.5% (95% CI: 10.8-16.9), and coronary
obstruction was 1.2% (95% CI: 0.6%-2.4%). Moderate or severe aortic
insufficiency (AI) after TAVI was 4.2% (95% CI: 2.0-8.5). The pooled
30-day mean gradient and effective orifice area (EOA) were 11.63 mmHg (95%
CI: 10.19-13.07) and 1.60 cm2 (95% CI: 1.5-1.7), respectively. All
estimates compare favourably to events reported for first-generation
valves. Conclusions: Our findings suggest that the new THV have a low risk
of TAVI-related short-term complications.<br/>Copyright &#xa9; Europa
Digital & Publishing 2016. All rights reserved.

<17>
Accession Number
605975351
Author
Iliopoulos I.; Branco R.G.; Brinkhuis N.; Furck A.; Larovere J.; Cooper
D.S.; Pathan N.
Institution
(Iliopoulos, Branco, Brinkhuis, Furck, Larovere, Pathan) Paediatric
Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom
(Iliopoulos, Cooper) Cardiac Intensive Care Unit, Cincinnati Children's
Hospital Medical Center, MLC 2003, 3333 Burnet Avenue, Cincinnati, OH
45229-3026, United States
(Branco, Pathan) Paediatric Intensive Care Unit, Cambridge University
Hospitals NHS Trust, Cambridge, United Kingdom
(Larovere) Division of Cardiovascular Critical Care, Children's Hospital
Boston, United States
(Pathan) Department of Paediatrics, University of Cambridge, United
Kingdom
Title
Mesenteric near-infrared spectroscopy and risk of gastrointestinal
complications in infants undergoing surgery for congenital heart disease.
Source
Cardiology in the Young. 26 (4) (pp 772-780), 2016. Date of Publication:
01 Apr 2016.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
We hypothesised that lower mesenteric near-infrared spectroscopy values
would be associated with a greater incidence of gastrointestinal
complications in children weighing <10 kg who were recovering from cardiac
surgery. We evaluated mesenteric near-infrared spectroscopy, central
venous oxygen saturation, and arterial blood gases for 48 hours
post-operatively. Enteral feeding intake, gastrointestinal complications,
and markers of organ dysfunction were monitored for 7 days. A total of 50
children, with median age of 16.7 (3.2-31.6) weeks, were studied. On
admission, the average mesenteric near-infrared spectroscopy value was
71+/-18%, and the systemic oxygen saturation was 93+/-7.5%. Lower
admission mesenteric near-infrared spectroscopy correlated with longer
time to establish enteral feeds (r=-0.58, p<0.01) and shorter duration of
feeds at 7 days (r=0.48, p<0.01). Children with gastrointestinal
complications had significantly lower admission mesenteric near-infrared
spectroscopy (58+/-18% versus 73+/-17%, p=0.01) and higher mesenteric
arteriovenous difference of oxygen at admission [39 (23-47) % versus 19
(4-27) %, p=0.02]. Based on multiple logistic regression, admission
mesenteric near-infrared spectroscopy was independently associated with
gastrointestinal complications (Odds ratio, 0.95; 95% confidence interval,
0.93-0.97; p=0.03). Admission mesenteric near-infrared spectroscopy showed
an area under the receiver operating characteristic curve of 0.76 to
identify children who developed gastrointestinal complications, with a
suggested cut-off value of 72% (78% sensitivity, 68% specificity). In this
pilot study, we conclude that admission mesenteric near-infrared
spectroscopy is associated with gastrointestinal complications and enteral
feeding tolerance in children after cardiac surgery.<br/>Copyright &#xa9;
Cambridge University Press 2015.

<18>
Accession Number
610471206
Author
Pawliszak W.; Kowalewski M.; Raffa G.M.; Malvindi P.G.; Kowalkowska M.E.;
Szwed K.A.; Borkowska A.; Kowalewski J.; Anisimowicz L.
Institution
(Pawliszak, Kowalewski, Anisimowicz) Department of Cardiac Surgery, Dr
Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland
(Kowalewski) Division of Ergonomics and Physical Effort, Department of
Hygiene, Epidemiology and Ergonomics, Collegium Medicum UMK, Bydgoszcz,
Poland
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo
per I Trapianti e Terapie ad alta specializzazione), Palermo, Italy
(Malvindi) Wessex Cardiothoracic Centre, University Hospital Southampton
NHS Foundation Trust, Southampton, United Kingdom
(Kowalkowska) Department and Clinic of Obstetrics, Gynecology, and
Oncological Gynecology, Collegium Medicum, Bydgoszcz, Poland
(Szwed, Borkowska) Department of Clinical Neuropsychology, Collegium
Medicum, Bydgoszcz, Poland
(Szwed, Borkowska) Nicolaus Copernicus University, Torun, Poland
(Kowalewski) Lung Cancer and Thoracic Surgery Department, Collegium
Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
Title
Cerebrovascular events after no-touch off-pump coronary artery bypass
grafting, conventional side-clamp off-pump coronary artery bypass, and
proximal anastomotic devices: A meta-analysis.
Source
Journal of the American Heart Association. 5 (2) (no pagination), 2016.
Article Number: e002802. Date of Publication: 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--Off-pump coronary artery bypass (OPCAB) has been shown to
reduce the risk of neurologic complications as compared to coronary artery
bypass grafting performed with cardiopulmonary bypass. Side-clamping of
the aorta while constructing proximal anastomoses, however, still carries
substantial risk of cerebral embolization. We aimed to perform a
comprehensive meta-analysis of studies assessing 2 clampless techniques:
aortic "no-touch" and proximal anastomosis devices (PAD) for OPCAB.
Methods and Results--PubMed, CINAHL, CENTRAL, and Google Scholar databases
were screened for randomized controlled trials and observational studies
comparing "no-touch" and/or PAD with side-clamp OPCAB and reporting
short-term (=30 days) outcomes: cerebrovascular accident and all-cause
mortality. A total of 18 studies (3 randomized controlled trials)
enrolling 25 163 patients were included. Aortic "no-touch" was associated
with statistically lower risk of cerebrovascular accident as compared to
side-clamp OPCAB: risk ratio 95% CI: 0.41 (0.27-0.61); P<0.01; I2=0%.
Event rates were 0.36% and 1.28% for "no-touch" and sideclamp OPCAB,
respectively. No difference was seen between PAD and side-clamp OPCAB:
0.71 (0.33-1.55); P=0.39; I2=39%. A trend towards increased 30-day
all-cause mortality with PAD and no difference with "no-touch" were
observed when compared to side-clamp OPCAB. In a subset analysis,
"no-touch" consistently reduced the risk of cerebrovascular accident
regardless of patients' baseline risk characteristics. A benefit with PAD
was observed in low-risk patients. Conclusions--Aortic "no-touch"
technique was associated with nearly 60% lower risk of postoperative
cerebrovascular events as compared to conventional side-clamp OPCAB with
effect consistent across patients at different risk.<br/>Copyright &#xa9;
2016 The Authors.

<19>
Accession Number
612393394
Author
Mehta R.H.; Van Diepen S.; Meza J.; Bokesch P.; Leimberger J.D.;
Tourt-Uhlig S.; Swartz M.; Parrotta J.; Jankowich R.; Hay D.; Harrison
R.W.; Fremes S.; Goodman S.G.; Luber J.; Toller W.; Heringlake M.; Anstrom
K.J.; Levy J.H.; Harrington R.A.; Alexander J.H.
Institution
(Mehta, Meza, Leimberger, Tourt-Uhlig, Swartz, Harrison, Anstrom, Levy,
Alexander) Duke Clinical Research Institute, Duke University School of
Medicine, Durham, NC, United States
(Van Diepen, Parrotta, Fremes, Goodman) Canadian VIGOUR Centre, University
of Alberta, Edmonton, Canada, Canada
(Bokesch, Jankowich, Hay) Tenax Therapeutics, Morrisville, NC, United
States
(Luber) Franciscan Health System, Tacoma, WA, United States
(Toller) University of Graz, Graz, Austria
(Heringlake) University of Lubeck, Lubeck, Germany
(Harrington) Stanford University School of Medicine, Stanford, CA, United
States
Title
Levosimendan in patients with left ventricular systolic dysfunction
undergoing cardiac surgery on cardiopulmonary bypass: Rationale and study
design of the Levosimendan in Patients with Left Ventricular Systolic
Dysfunction Undergoing Cardiac Surgery Requiring Cardiopulmonary Bypass
(LEVO-CTS) trial.
Source
American Heart Journal. 182 (pp 62-71), 2016. Date of Publication: 01 Dec
2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Low cardiac output syndrome is associated with increased mortality and
occurs in 3% to 14% of patients undergoing cardiac surgery on
cardiopulmonary bypass (CPB). Levosimendan, a novel calcium sensitizer and
K<inf>ATP</inf> channel activator with inotropic, vasodilatory, and
cardioprotective properties, has shown significant promise in reducing the
incidence of low cardiac output syndrome and related adverse outcomes in
patients undergoing cardiac surgery on CPB. Methods LEVO-CTS is a phase 3
randomized, controlled, multicenter study evaluating the efficacy, safety,
and cost-effectiveness of levosimendan in reducing morbidity and mortality
in high-risk patients with reduced left ventricular ejection fraction
(<=35%) undergoing cardiac surgery on CPB. Patients will be randomly
assigned to receive either intravenous levosimendan (0.2 mug
kg^-1 min^-1 for the first hour followed by 0.1 mug/kg
for 23 hours) or matching placebo initiated within 8 hours of surgery. The
co-primary end points are (1) the composite of death or renal replacement
therapy through day 30 or perioperative myocardial infarction, or
mechanical assist device use through day 5 (quad end point tested at alpha
< .01), and (2) the composite of death through postoperative day 30 or
mechanical assist device use through day 5 (dual end point tested at alpha
< .04). Safety end points include new atrial fibrillation and death
through 90 days. In addition, an economic analysis will address the
cost-effectiveness of levosimendan compared with placebo in high-risk
patients undergoing cardiac surgery on CPB. Approximately 880 patients
will be enrolled at approximately 60 sites in the United States and Canada
between July 2014 and September 2016, with results anticipated in January
2017. Conclusion LEVO-CTS, a large randomized multicenter clinical trial,
will evaluate the efficacy, safety, and cost-effectiveness of levosimendan
in reducing adverse outcomes in high-risk patients undergoing cardiac
surgery on CPB. Clinical Trial Registration:ClinicalTrials.gov
(NCT02025621).<br/>Copyright &#xa9; 2016

<20>
Accession Number
606120389
Author
Meisner A.; Kerr K.F.; Thiessen-Philbrook H.; Coca S.G.; Parikh C.R.
Institution
(Meisner, Kerr) Department of Biostatistics, University of Washington,
Seattle, WA, United States
(Thiessen-Philbrook, Parikh) Section of Nephrology, Program of Applied
Translational Research, Department of Medicine, New Haven, CT, United
States
(Coca) Department of Medicine, Icahn School of Medicine at Mount Sinai,
New York, NY, United States
(Parikh) VA Medical Center, 60 Temple Street, New Haven, CT 06510, United
States
Title
Methodological issues in current practice may lead to bias in the
development of biomarker combinations for predicting acute kidney injury.
Source
Kidney International. 89 (2) (pp 429-438), 2016. Date of Publication: 01
Feb 2016.
Publisher
Elsevier B.V.
Abstract
Individual biomarkers of renal injury are only modestly predictive of
acute kidney injury (AKI). Using multiple biomarkers has the potential to
improve predictive capacity. In this systematic review, statistical
methods of articles developing biomarker combinations to predict AKI were
assessed. We identified and described three potential sources of bias
(resubstitution bias, model selection bias, and bias due to center
differences) that may compromise the development of biomarker
combinations. Fifteen studies reported developing kidney injury biomarker
combinations for the prediction of AKI after cardiac surgery (8 articles),
in the intensive care unit (4 articles), or other settings (3 articles).
All studies were susceptible to at least one source of bias and did not
account for or acknowledge the bias. Inadequate reporting often hindered
our assessment of the articles. We then evaluated, when possible (7
articles), the performance of published biomarker combinations in the
TRIBE-AKI cardiac surgery cohort. Predictive performance was markedly
attenuated in six out of seven cases. Thus, deficiencies in analysis and
reporting are avoidable, and care should be taken to provide accurate
estimates of risk prediction model performance. Hence, rigorous design,
analysis, and reporting of biomarker combination studies are essential to
realizing the promise of biomarkers in clinical practice.<br/>Copyright
&#xa9; 2015 International Society of Nephrology.

<21>
Accession Number
612825379
Author
Muralidharan A.; Thiagarajan K.; Van Ham R.; Gleason T.G.; Mulukutla S.;
Schindler J.T.; Jeevanantham V.; Thirumala P.D.
Institution
(Muralidharan) College of Literature, Science, and the Arts, University of
Michigan, Ann Arbor, Michigan, United States
(Thiagarajan, Thirumala) Department of Neurological Surgery, University of
Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
(Gleason) Department of Cardiothoracic Surgery, University of Pittsburgh
Medical Center, Pittsburgh, Pennsylvania, United States
(Van Ham, Thirumala) Department of Neurological Surgery, University of
Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
(Mulukutla, Schindler) Heart and Vascular Institute, University of
Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
(Jeevanantham) Saint Anthony Hospital, Oklahoma City, Oklahoma, United
States
Title
Meta-Analysis of Perioperative Stroke and Mortality in Transcatheter
Aortic Valve Implantation.
Source
American Journal of Cardiology. 118 (7) (pp 1031-1045), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Transcatheter aortic valve implantation (TAVI) is a rapidly evolving safe
method with decreasing incidence of perioperative stroke. There is a void
in literature concerning the impact of stroke after TAVI in predicting
30-day stroke-related mortality. The primary aim of this meta-analysis was
to determine whether perioperative stroke increases risk of stroke-related
mortality after TAVI. Online databases, using relevant keywords, and
additional related records were searched to retrieve articles involving
TAVI and stroke after TAVI. Data were extracted from the finalized studies
and analyzed to generate a summary odds ratio (OR) of stroke-related
mortality after TAVI. The stroke rate and stroke-related mortality rate in
the total patient population were 3.07% (893 of 29,043) and 12.27% (252 of
2,053), respectively. The all-cause mortality rate was 7.07% (2,053 of
29,043). Summary OR of stroke-related mortality after TAVI was estimated
to be 6.45 (95% confidence interval 3.90 to 10.66, p <0.0001). Subgroup
analyses were performed among age, approach, and valve type. Only 1
subgroup, transapical TAVI, was not significantly associated with
stroke-related mortality (OR 1.97, 95% confidence interval, 0.43 to 7.43,
p = 0.42). A metaregression was conducted among females, New York Heart
Association class III/IV status, previous stroke, valve type, and
implantation route. All failed to exhibit any significant associations
with the OR. In conclusion, perioperative strokes after TAVI are
associated with >6 times greater risk of 30-day stroke-related mortality.
Transapical TAVI is not associated with increased stroke-related mortality
in patients who suffer from perioperative stroke. Preventative measures
need to be taken to alleviate the elevated rates of stroke after TAVI and
subsequent direct mortality.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<22>
Accession Number
612630766
Author
Blazing M.A.; Giugliano R.P.; de Lemos J.A.; Cannon C.P.; Tonkin A.;
Ballantyne C.M.; Lewis B.S.; Musliner T.A.; Tershakovec A.M.; Lokhnygina
Y.; White J.A.; Reist C.; McCagg A.; Braunwald E.
Institution
(Blazing, Lokhnygina, White, Reist) Duke Clinical Research Institute, Duke
University School of Medicine, Durham, NC, United States
(Giugliano, Cannon, McCagg, Braunwald) TIMI Study Group, Boston, MA,
United States
(de Lemos) University of Texas Southwestern Medical Center, Dallas, TX,
United States
(Tonkin) Monash University, Melbourne, Victoria, Australia
(Ballantyne) Baylor College of Medicine and Houston Methodist DeBakey
Heart and Vascular Center, Houston, TX, United States
(Lewis) Lady Davis Carmel Medical Center, Haifa, Israel
(Musliner, Tershakovec) Merck & Co, Inc., Kenilworth, NJ, United States
Title
On-treatment analysis of the Improved Reduction of Outcomes: Vytorin
Efficacy International Trial (IMPROVE-IT).
Source
American Heart Journal. 182 (pp 89-96), 2016. Date of Publication: 01 Dec
2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background We aimed to determine the efficacy and safety of adding
ezetimibe (Ez) to simvastatin (S) in a post-acute coronary syndrome (ACS)
population in a prespecified on-treatment analysis. Methods We evaluated
17,706 post-ACS patients from the IMPROVE-IT trial who had low-density
lipoprotein cholesterol values between 50 and 125 mg/dL and who received
Ez 10 mg/d with S 40 mg/d (Ez/S) or placebo with simvastatin 40 mg/d
(P/S). The primary composite end point was cardiovascular death,
myocardial infarction, unstable angina, coronary revascularization >=30
days postrandomization, or stroke. The on-treatment analysis included
patients who received study drug for the duration of the trial or
experienced a primary end point or noncardiovascular death within 30 days
of drug discontinuation. Results Mean low-density lipoprotein cholesterol
values at 1 year were 71 mg/dL for P/S and 54 mg/dL for Ez/S (absolute
difference -17 mg/dL = -24%; P <.001). The 7-year Kaplan-Meier estimate of
the primary end point occurred in 32.4% in the P/S arm and 29.8% in the
Ez/S arm (absolute difference 2.6%; HR<inf>adj</inf> 0.92 [95% CI
0.87-0.98]; P =.01). The absolute treatment effect favoring Ez/S was 30%
greater than in the intention-to-treat analysis of IMPROVE-IT. Conclusions
This analysis provides additional support for the efficacy and safety of
adding Ez to S in this high-risk, post-ACS population.<br/>Copyright
&#xa9; 2016 Elsevier, Inc.

<23>
Accession Number
612630765
Author
Spitzer E.; Van Mieghem N.M.; Pibarot P.; Hahn R.T.; Kodali S.; Maurer
M.S.; Nazif T.M.; Rodes-Cabau J.; Paradis J.-M.; Kappetein A.-P.;
Ben-Yehuda O.; van Es G.-A.; Kallel F.; Anderson W.N.; Tijssen J.; Leon
M.B.
Institution
(Spitzer, Van Mieghem, Kappetein) Erasmus Medical Center, Rotterdam,
Netherlands
(Spitzer) Cardialysis Core Laboratories and Clinical Trial Management,
Rotterdam, Netherlands
(Pibarot, Rodes-Cabau, Paradis) Quebec Heart & Lung Institute, Laval
University, Quebec City, Quebec, Canada
(Hahn, Kodali, Maurer, Nazif, Leon) Columbia University Medical Center,
NY, United States
(Hahn, Kodali, Nazif, Ben-Yehuda, Leon) Cardiovascular Research
Foundation, NY, United States
(van Es, Tijssen) European Cardiovascular Research Institute, Rotterdam,
Netherlands
(Kallel) Edwards Lifesciences, Irvine, CA, United States
(Anderson) Independent Consultant, Lake Forest, CA, United States
Title
Rationale and design of the Transcatheter Aortic Valve Replacement to
UNload the Left ventricle in patients with ADvanced heart failure (TAVR
UNLOAD) trial.
Source
American Heart Journal. 182 (pp 80-88), 2016. Date of Publication: 01 Dec
2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Coexistence of moderate aortic stenosis (AS) in patients with
heart failure (HF) with reduced ejection fraction is not uncommon.
Moderate AS increases afterload, whereas pharmacologic reduction of
afterload is a pillar of contemporary HF management. Hypothesis Unloading
the left ventricle by reducing the transaortic gradient with transfemoral
transcatheter aortic valve replacement (TAVR) may improve clinical
outcomes in patients with moderate AS and HF with reduced ejection
fraction. Study design The TAVR UNLOAD (NCT02661451) is an international,
multicenter, randomized, open-label, clinical trial comparing the efficacy
and safety of TAVR with the Edwards SAPIEN 3 Transcatheter Heart Valve in
addition to optimal heart failure therapy (OHFT) vs OHFT alone in patients
with moderate AS (defined by a mean transaortic gradient >=20 mm Hg and
<40 mm Hg, and an aortic valve area >1.0 cm² and <=1.5
cm² at rest or after dobutamine stress echocardiography) and
reduced ejection fraction. A total of 600 patients will be randomized in a
1:1 fashion. Clinical follow-up is scheduled at 1, 6, and 12 months, and 2
years after randomization. The primary end point is the hierarchical
occurrence of all-cause death, disabling stroke, hospitalizations related
to HF, symptomatic aortic valve disease or nondisabling stroke, and the
change in the Kansas City Cardiomyopathy Questionnaire at 1 year.
Secondary end points capture effects on clinical outcome, biomarkers,
echocardiographic parameters, and quality of life. Summary The TAVR UNLOAD
trial aims to test the hypothesis that TAVR on top of OHFT improves
clinical outcomes in patients with moderate AS and HF with reduced
ejection fraction.<br/>Copyright &#xa9; 2016 Elsevier, Inc.

<24>
Accession Number
603966210
Author
Kaya M.; Utkusavas A.; Erkanli K.; Guler S.; Kyaruzi M.; Birant A.;
Karacalilar M.; Akkus M.; Bakir I.
Institution
(Kaya, Erkanli, Guler, Kyaruzi, Karacalilar, Bakir) Department of
Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and
Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
(Utkusavas) Department of Pulmonology, Istanbul Mehmet Akif Ersoy Thoracic
and Cardiovascular Surgery Training and Research Hospital, Istanbul,
Turkey
(Birant) Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and
Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
(Akkus) Department of Thoracic Surgery, Istanbul Mehmet Akif Ersoy
Thoracic and Cardiovascular Surgery Training and Research Hospital,
Istanbul, Turkey
Title
The Preventive Effects of Posterior Pericardiotomy with Intrapericardial
Tube on the Development of Pericardial Effusion, Atrial Fibrillation, and
Acute Kidney Injury after Coronary Artery Surgery: A Prospective,
Randomized, Controlled Trial.
Source
Thoracic and Cardiovascular Surgeon. 64 (3) (pp 217-224), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Background Pericardial effusion (PE), atrial fibrillation (AF), and acute
kidney injury (AKI) are commonly found after coronary artery surgery.
These adverse events may also be interwoven in the postoperative period.
In this prospective study, we investigated whether posterior
pericardiotomy (PP) with intrapericardial tube positioned along the right
atrium (pericardial space intervention) is effective in the prevention of
these adverse events. Methods The patients were randomly distributed to
the study and control groups. The study group consisted of patients with
pericardial space intervention, whereas the control group consisted of
patients without pericardial space interventions. In all patients, a
straight tube was placed in the anterior mediastinum and an angled tube
was placed into the left hemithorax. Results A total of 210 patients were
studied: 107 in the control group and 103 in the study group.
Statistically significant results were obtained in the amount of PE,
cardiac tamponade, AF (p = 0.019), and AKI during the postoperative
period, in favor of the study group. Length of hospital stay was
significantly shorter in the study group (6.11 +/- 2.31, p = 0.009).
Conclusion The PP with intrapericardial tube approach is safe, easy, and
effective in the prevention of PE, cardiac tamponade, and AF. The use of
this approach may reduce the risk of developing AKI during the
postoperative period. Besides, this technique also reduces the length of
hospital stay.<br/>Copyright &#xa9; 2016 Georg Thieme Verlag KG.

<25>
Accession Number
612333993
Author
Pressler A.; Christle J.W.; Lechner B.; Grabs V.; Haller B.; Hettich I.;
Jochheim D.; Mehilli J.; Lange R.; Bleiziffer S.; Halle M.
Institution
(Pressler, Christle, Lechner, Grabs, Halle) Department of Prevention,
Rehabilitation and Sports Medicine, Klinikum rechts der Isar, Technische
Universitat Munchen, Munich, Germany
(Haller) Institute for Medical Statistics and Epidemiology, Klinikum
rechts der Isar, Technische Universitat Munchen, Munich, Germany
(Hettich) Department of Pneumology, University Hospital Freiburg,
Freiburg, Germany
(Jochheim, Mehilli) Cardiology Department, Munich University Clinic,
Munich, Germany
(Mehilli, Halle) DZHK (German Center for Cardiovascular Research), partner
site Munich Heart Alliance, Munich, Germany
(Lange, Bleiziffer) Clinic for Cardiovascular Surgery, German Heart Center
Munich, Munich, Germany
(Halle) Else Kroner-Fresenius-Zentrum am Klinikum rechts der Isar,
Technische Universitat Munchen, Munich, Germany
Title
Exercise training improves exercise capacity and quality of life after
transcatheter aortic valve implantation: A randomized pilot trial.
Source
American Heart Journal. 182 (pp 44-53), 2016. Date of Publication: 01 Dec
2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Transcatheter aortic valve implantation (TAVI) is increasingly
applied for aortic stenosis in elderly patients with impaired mobility and
reduced quality of life. These patients may particularly benefit from
postinterventional exercise programs, but no randomized study has
evaluated the safety and efficacy of exercise in this population. Methods
In a prospective pilot study, 30 patients after TAVI (mean age, 81 +/- 6
years, 44% female, 83 +/- 34 days postintervention) were randomly
allocated 1:1 to a training group (TG) performing 8 weeks of supervised
combined endurance and resistance exercise or to usual care. The formal
primary efficacy end point was between-group difference in change in peak
oxygen uptake assessed by cardiopulmonary exercise testing; secondary end
points included muscular strength, 6-minute walk distance, and quality of
life (Kansas City Cardiomyopathy Questionnaire and Medical Outcomes Study
12-Item Short-Form Health Survey questionnaires). Safety was assessed by
documenting training-related adverse events, prosthesis, and renal
function. Results Significant changes in favor of TG were observed for
peak oxygen uptake (group difference, 3.7 mL/min per kg [95% CI, 1.1-6.3;
P = .007]), muscular strength (bench press, 6 kg [95% CI, 3-10; P = .002];
rowing, 7 kg [95% CI, 3-11; P < .001]; pulldown, 9 kg [95% CI, 4-14; P =
.001]; shoulder press, 5 kg [95% CI, 1-8; P = .008]; leg press, 17 kg [95%
CI 6-28; P = .005]), components of quality of life (Kansas City
Cardiomyopathy Questionnaire physical limitation, 19.2 [95% CI, 4.1-34.2;
P = .015]; symptom burden, 12.3 [95% CI, 0.5-24.0; P = .041]; clinical
summary, 12.4 [3.4-21.4; P = .009]), but not for other questionnaire
subscales and 6-minute walk distance (15 m [95% CI, -23 to 53; P = .428]).
Three dropouts unrelated to exercise occurred (TG = 2; usual care, = 1);
prosthesis and renal function were not affected by the exercise
intervention. Conclusions In patients after TAVI, exercise training
appears safe and highly effective with respect to improvements in exercise
capacity, muscular strength, and quality of life. Clinical Trial
Registration: Clinicaltrials.gov NCT01935297.<br/>Copyright &#xa9; 2016
Elsevier Inc.

<26>
Accession Number
368558845
Author
Carroll J.D.; Saver J.L.; Thaler D.E.; Smalling R.W.; Berry S.; MacDonald
L.A.; Marks D.S.; Tirschwell D.L.; Pelech A.N.
Institution
(Carroll) University of Colorado Denver, University of Colorado Hospital,
Aurora, CO, United States
(Saver) University of California Los Angeles, Los Angeles, CA, United
States
(Thaler) Tufts University, Tufts Medical Center, Boston, MA, United States
(Smalling) University of Texas, Memorial Hermann Heart and Vascular
Institute, Houston, TX, United States
(Berry) Berry Consultants, Austin, TX, United States
(MacDonald) South Denver Cardiology, Swedish Medical Center, Littleton,
CO, United States
(Marks) Medical College of Wisconsin Milwaukee, Milwaukee, WI, United
States
(Tirschwell) University of Washington, Seattle, WA, United States
Title
Closure of patent foramen ovale versus medical therapy after cryptogenic
stroke.
Source
New England Journal of Medicine. 368 (12) (pp 1092-1100), 2013. Date of
Publication: 21 Mar 2013.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: Whether closure of a patent foramen ovale is effective in the
prevention of recurrent ischemic stroke in patients who have had a
cryptogenic stroke is unknown. We conducted a trial to evaluate whether
closure is superior to medical therapy alone in preventing recurrent
ischemic stroke or early death in patients 18 to 60 years of age. METHODS:
In this prospective, multicenter, randomized, event-driven trial, we
randomly assigned patients, in a 1:1 ratio, to medical therapy alone or
closure of the patent foramen ovale. The primary results of the trial were
analyzed when the target of 25 primary end-point events had been observed
and adjudicated. RESULTS: We enrolled 980 patients (mean age, 45.9 years)
at 69 sites. The medical-therapy group received one or more antiplatelet
medications (74.8%) or warfarin (25.2%). Treatment exposure between the
two groups was unequal (1375 patient-years in the closure group vs. 1184
patient-years in the medical-therapy group, P=0.009) owing to a higher
dropout rate in the medical-therapy group. In the intention-to-treat
cohort, 9 patients in the closure group and 16 in the medical-therapy
group had a recurrence of stroke (hazard ratio with closure, 0.49; 95%
confidence interval [CI], 0.22 to 1.11; P=0.08). The between-group
difference in the rate of recurrent stroke was significant in the
prespecified per-protocol cohort (6 events in the closure group vs. 14
events in the medical-therapy group; hazard ratio, 0.37; 95% CI, 0.14 to
0.96; P=0.03) and in the as-treated cohort (5 events vs. 16 events; hazard
ratio, 0.27; 95% CI, 0.10 to 0.75; P=0.007). Serious adverse events
occurred in 23.0% of the patients in the closure group and in 21.6% in the
medical-therapy group (P=0.65). Procedure-related or device-related
serious adverse events occurred in 21 of 499 patients in the closure group
(4.2%), but the rate of atrial fibrillation or device thrombus was not
increased. CONCLUSIONS: In the primary intention-to-treat analysis, there
was no significant benefit associated with closure of a patent foramen
ovale in adults who had had a cryptogenic ischemic stroke. However,
closure was superior to medical therapy alone in the pre-specified
per-protocol and as-treated analyses, with a low rate of associated risks.
Copyright &#xa9; 2013 Massachusetts Medical Society.

<27>
Accession Number
604795763
Author
Nunes A.J.; MacArthur R.G.G.; Kim D.; Singh G.; Buchholz H.; Chatterley
P.; Klarenbach S.W.
Institution
(Nunes, MacArthur, Singh, Buchholz) Division of Cardiac Surgery,
Department of Surgery, Faculty of Medicine and Dentistry, Edmonton, AB,
Canada
(Kim) Division of Cardiology, Department of Medicine, Faculty of Medicine
and Dentistry, Edmonton, AB, Canada
(Chatterley) University of Alberta Libraries, Edmonton, AB, Canada
(Klarenbach) Division of Nephrology, Department of Medicine, Faculty of
Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
Title
A Systematic Review of the Cost-Effectiveness of Long-Term Mechanical
Circulatory Support.
Source
Value in Health. 19 (4) (pp 494-504), 2016. Date of Publication: 01 Jun
2016.
Publisher
Elsevier Ltd
Abstract
Background Mechanical circulatory support (MCS) is an option for the
treatment of medically intractable end-stage heart failure. MCS therapy,
however, is resource intensive. Objective The purpose of this report was
to systematically review the MCS cost-effectiveness literature as it
pertains to the treatment of adult patients in end-stage heart failure.
Methods We conducted a systematic search and narrative review of available
cost- effectiveness and cost-utility analyses of MCS in adult patients
with end-stage heart failure. Results Eleven studies analyzing the
cost-effectiveness or cost-utility of MCS were identified. Seven studies
focused on bridge to transplantation, three studies focused on destination
therapy, and one study presented analyses of both strategies. Two articles
evaluated the cost-effectiveness of the HeartMate II (Thoratec Corp.,
Pleasanton, CA). Incremental cost-effectiveness ratios between MCS and
medical management ranged between 85,025 and 200,166 for bridge to
transplantation and between 87,622 and 1,257,946 for destination therapy
(2012 Canadian dollars per quality-adjusted life-year). Sensitivity
analyses indicated that improvements in survival and quality of life and
reductions in device and initial hospital-stay costs may improve the
cost-effectiveness of MCS. Conclusions Current studies suggest that MCS is
likely not cost-effective with reference to generally accepted or
explicitly stated thresholds. Refined patient selection, complication
rates, achieved quality of life, and device/surgical costs, however, could
modify the cost-effectiveness of MCS.<br/>Copyright &#xa9; 2016
International Society for Pharmacoeconomics and Outcomes Research (ISPOR)

<28>
Accession Number
610047471
Author
Vilvanathan V.K.; Srinivas Prabhavathi Bhat B.C.; Nanjappa M.C.; Pandian
B.; Bagi V.; Kasturi S.; Bandimida S.K.
Institution
(Vilvanathan, Srinivas Prabhavathi Bhat, Nanjappa, Pandian, Bagi)
Department of Cardiology, Sri Jayadeva Institute of Cardiovascular
Sciences & Research, Bangalore, India
(Kasturi) Interventional Cardiologist, Sunshine Heart Institute,
Hyderabad, India
(Bandimida) Researcher, Sunshine Heart Institute, Hyderabad, India
Title
A randomized placebo-controlled trial with amiodarone for persistent
atrial fibrillation in rheumatic mitral stenosis after successful balloon
mitral valvuloplasty.
Source
Indian Heart Journal. 68 (5) (pp 671-677), 2016. Date of Publication: 01
Sep 2016.
Publisher
Elsevier B.V.
Abstract
Objective Atrial fibrillation is the most common sustained arrhythmia in
patients with rheumatic heart disease (RHD). This study was conducted to
determine the maintenance of sinus rhythm with amiodarone therapy
following DC cardioversion (DCCV), early after successful balloon mitral
valvuloplasty (BMV). Methods Patients were randomized to amiodarone group
and placebo group and their baseline characteristics were recorded. DCCV
was done 48 h after BMV. After cardioversion, oral amiodarone was started
initially 200 mg three times a day for 2 weeks, then 200 mg twice daily
for two weeks followed by 200 mg once daily for 12 months. Patients in
placebo group received DCCV alone without preloading amiodarone. After
DCCV, they were given placebo for 12 months. Results The 3 months
follow-up period was completed by 77 patients (95%). Of them, 31 (77.5%)
patients in amiodarone group and 14 (34.1%) in placebo group remained in
sinus rhythm (SR). The 12 months follow-up period was completed by 73
patients (90.1%). Of them, 22 (55%) patients in amiodarone group and 7
(17.1%) in placebo group remained in SR. Conclusion We conclude that
amiodarone is more effective than placebo in maintenance of SR at the end
of 3 months following successful cardioversion and more patients continued
to remain in SR even at the end of 12 months without major serious adverse
effects.<br/>Copyright &#xa9; 2016

<29>
Accession Number
608969554
Author
Huisman J.; Van Der Heijden L.C.; Kok M.M.; Danse P.W.; Jessurun G.A.J.;
Stoel M.G.; Van Houwelingen K.G.; Lowik M.M.; Hautvast R.W.M.; Ijzerman
M.J.; Doggen C.J.; Von Birgelen C.
Institution
(Huisman, Van Der Heijden, Kok, Stoel, Van Houwelingen, Lowik, Von
Birgelen) Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum
Twente, Enschede, Netherlands
(Danse) Department of Cardiology, Rijnstate Hospital, Arnhem, Netherlands
(Jessurun) Department of Cardiology, Treant Zorggroep, Emmen, Netherlands
(Hautvast) Department of Cardiology, Medical Center Alkmaar, Alkmaar,
Netherlands
(Ijzerman, Doggen, Von Birgelen) Health Technology and Services Research,
MIRA, Institute for Biomedical Technology and Technical Medicine,
University of Twente, Enschede, Netherlands
(Von Birgelen) Thoraxcentrum Twente, University of Twente, Medisch
Spectrum Twente (MST), Department of Cardiology, Postbus 50.000, Enschede
7500 KA, Netherlands
Title
Impact of severe lesion calcification on clinical outcome of patients with
stable angina, treated with newer generation permanent polymer-coated
drug-eluting stents A patient-level pooled analysis from TWENTE and DUTCH
PEERS (TWENTE II).
Source
American Heart Journal. 175 (pp 121-129), 2016. Date of Publication: 01
May 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background The outcome of percutaneous coronary intervention with newer
generation permanent polymer-coated drug-eluting stents (DES) in patients
with severely calcified lesions is greatly unknown. We assessed the impact
of severe lesion calcification on clinical outcome in patients with stable
angina who underwent percutaneous coronary intervention with newer
generation DES. Methods TWENTE and DUTCH PEERS randomized trials enrolled
1423 patients with stable angina, who were categorized into patients with
versus without severe target lesion calcification. A patient-level pooled
analysis assessed clinical outcome, including target vessel failure (TVF),
a composite of cardiac death, target vessel-related myocardial infarction,
or target vessel revascularization (TVR). Results Patients with severe
calcification (n = 342) were older (66.6 +/- 9.1 vs 64.2 +/- 9.8 years, P
<.001) and had more diabetes (25.7% vs 20.4%, P =.04) than other patients
(n = 1081). Patients with calcified lesions had higher rates of TVF (16.4%
vs 9.8%, pLogrank =.001), cardiac death (4.4% vs 1.5%, P =.03), target
vessel myocardial infarction (7.6% vs 3.4%, P =.001), and definite stent
thrombosis (1.8% vs 0.4%, P =.02). Multivariate analysis demonstrated that
severe calcification was an independent risk factor of 2-year TVF (HR
1.42, 95% CI: 1.02-1.99, pLogrank =.04); landmark analysis showed that
this was based on a difference during the first year (periprocedural: 5.8%
vs. 3.1%, pLogrank =.02; first year: 7.5% vs. 3.8%, pLogrank =.007; second
year: 4.1% vs. 3.3%, pLogrank =.54). Conclusion In patients with stable
angina, severe target lesion calcification is associated with an increased
risk of adverse cardiovascular events following treatment with newer
generation permanent polymer-coated DES. This increase in risk is
restricted to the first year of follow-up, which is an encouraging
finding.<br/>Copyright &#xa9; 2016 Elsevier, Inc. All rights reserved.

<30>
Accession Number
613139992
Author
Aldemir M.; Keles I.; Karalar M.; Tecer E.; Adali F.; Pektas M.B.; Parlar
A.I.; Darcin O.T.
Institution
(Aldemir, Tecer, Adali, Darcin) Department of Cardiovascular Surgery,
Afyon Kocatepe University, Afyonkarahisar, Turkey
(Keles, Karalar) Department of Urology, Afyon Kocatepe University,
Afyonkarahisar, Turkey
(Pektas) Department of Pharmacology, Faculty of Medicine, Afyon Kocatepe
University, Afyonkarahisar, Turkey
(Parlar) Department of Cardiovascular Surgery, Akut Kalp Damar Hospital,
Izmir, Turkey
Title
Nebivolol compared with metoprolol for erectile function in males
undergoing coronary artery bypass graft.
Source
Anatolian Journal of Cardiology. 16 (2) (pp 131-136), 2016. Date of
Publication: 2016.
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: The aim of this study was to evaluate erectile function in
males undergoing coronary artery bypass graft (CABG) while on two
different adrenoceptor beta-blocker regimens, namely nebivolol and
metoprolol. We hypothesize that the negative effects of cardiopulmonary
bypass on erectile function may be possibly attenuated by preferring a
vasodilating selective beta 1-blocker, nebivolol, to metoprolol as an
antiischemic and antiarrhythmic agent in males undergoing CABG. Methods:
This randomized, double-blind, prospective clinical study was conducted in
patients scheduled for CABG surgery between February 2012 and June 2014. A
total of 60 consecutive patients who met inclusion criteria were
randomized and divided into the following two groups: N group, which
received 5 mg of nebivolol orally for 2 weeks before surgery plus 12 weeks
after surgery or M group, which received 50 mg of metoprolol orally for
the same period. All patients were evaluated by the erectile function
domain of the International Index of Erectile Function-5 (IIEF-5) at the
time of admission (before starting the beta-blocker) and 3 months after
surgery. Results: In the metoprolol group, the mean IIEF-5 score decreased
significantly from a baseline of 15.2+/- 5.8 to 12.9+/- 5.8 (p< 0.001),
but in the nebivolol group, this difference was not significant (from a
baseline 12.9+/- 5.5 to 12.4+/- 5.5, p=0.053). In all patients, the mean
IIEF-5 score decreased significantly from a baseline of 14.0+/- 5.7 to
12.6+/- 5.6 (p< 0.001). Conclusion: Although erectile function in males
undergoing CABG surgery decreases when metoprolol is used, nebivolol
exerts protective effects on erectile function against the disruptive
effects of cardiopulmonary bypass in patients undergoing
CABG.<br/>Copyright &#xa9; 2016 by Turkish Society of Cardiology.

<31>
Accession Number
609900530
Author
Pierri M.D.; Crescenzi G.; Zingaro C.; D'Alfonso A.; Capestro F.; Scocco
V.; Brugia M.; Torracca L.
Institution
(Pierri, Zingaro, D'Alfonso, Capestro, Torracca) Division of Cardiac
Surgery of Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona,
Italy
(Crescenzi) Division of Postoperative Intensive Care of Azienda
Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
(Scocco, Brugia) Central Analysis Laboratory of Azienda
Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
Title
Prevention of atrial fibrillation and inflammatory response after on-pump
coronary artery bypass using different statin dosages: a randomized,
controlled trial.
Source
General Thoracic and Cardiovascular Surgery. 64 (7) (pp 395-402), 2016.
Date of Publication: 01 Jul 2016.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Background: This randomized controlled trial aimed to evaluate the effects
of seven-day preoperative treatment with two different dosages of
atorvastatin on the incidence of postoperative atrial fibrillation (POAF)
and release of inflammatory markers such as high-sensitive C-reactive
protein (hsCRP) and interleukin-6 in patients undergoing elective
first-time on-pump coronary artery bypass grafting (CABG). Methods: The
cohort study comprised 212 consecutive patients, already taking statins,
who underwent elective first-time CABG with cardiopulmonary bypass without
history of atrial fibrillation (AF). Patients were randomly divided into
two groups: those who received atorvastatin 40 mg (TOR40 group, 111
patients) and those who received 80 mg (TOR80 group, 101 patients) once a
day for 7 days before the planned operation. The primary endpoint was the
incidence of AF. The secondary endpoints were the postoperative variations
of inflammatory markers, hospital length of stay, and the incidence of
major adverse cardiac and clinical events. Results: A total of 26 patients
(23.6 %) pretreated with atorvastatin 40 mg and 16 (15.8 %) patients
pretreated with atorvastatin 80 mg had postoperative AF but the difference
did not reach the statistical significance (p = 0.157). Median values of
interleukin-6 and hsCRP at 12 and 24 h did not have differences between
the two groups. No statistically significant differences in the other
secondary endpoints were detected. Conclusions: According to our result,
7-day preoperative treatment with a high dose of atorvastatin is
associated with a trend to a decrease in the incidence of POAF compared
with treatment at a lower dose, although it does not impact on the level
of inflammatory markers. Clinical Trial Registration: European Clinical
Trials Database (EudraCT: 2006-005757-30).<br/>Copyright &#xa9; 2016, The
Japanese Association for Thoracic Surgery.

<32>
Accession Number
607178982
Author
De Waha S.; Allali A.; Buttner H.-J.; Toelg R.; Geist V.; Neumann F.-J.;
Khattab A.A.; Richardt G.; Abdel-Wahab M.
Institution
(De Waha, Allali, Toelg, Geist, Richardt, Abdel-Wahab) Department of
Cardiology and Angiology, Segeberger Kliniken - Heart Centre, Am Kurpark
1, Bad Segeberg 23795, Germany
(Buttner, Neumann) Department of Cardiology, University Heart Centre
Freiburg-Bad Krozingen, Bad Krozingen, Germany
(Khattab) Department of Cardiology, University of Bern, Bern, Switzerland
Title
Rotational atherectomy before paclitaxel-eluting stent implantation in
complex calcified coronary lesions: Two-year clinical outcome of the
randomized ROTAXUS trial.
Source
Catheterization and Cardiovascular Interventions. 87 (4) (pp 691-700),
2016. Date of Publication: 01 Mar 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background In the randomized ROTAXUS trial, routine lesion preparation of
complex calcified coronary lesions using rotational atherectomy (RA) prior
to paclitaxel-eluting stent implantation did not reduce the primary
endpoint of angiographic late lumen loss at 9 months compared to stenting
without RA. So far, no long-term data of prospective head-to-head
comparisons between both treatment strategies have been reported. Methods
and Results ROTAXUS randomly assigned patients with complex calcified
coronary lesions to RA followed by stenting (n = 120) or stenting without
RA (n = 120). The primary endpoint of the current analysis was the
occurrence of major adverse cardiac events (MACE) at 2-year follow-up
defined as the composite of death, myocardial infarction, and target
vessel revascularization (TVR). At 2 years, MACE occurred in 32 patients
in the RA group and 37 patients in the standard therapy group (29.4% vs.
34.3%, P = 0.47). The rates of death (8.3% vs. 7.4%, P = 1.00), myocardial
infarction (8.3% vs. 6.5%, P = 0.80), target lesion revascularization
(TLR, 13.8% vs. 16.7%, P = 0.58), and TVR (19.3% vs. 22.2%, P = 0.62) were
similar in both groups. Conclusion Despite high rates of initial
angiographic success, nearly one third of patients enrolled in ROTAXUS
experienced MACE within 2-year follow-up, with no differences between
patients treated with or without RA.<br/>Copyright &#xa9; 2015 Wiley
Periodicals, Inc.

<33>
Accession Number
613362981
Author
Harris S.K.; Roos M.G.; Landry G.J.
Institution
(Harris, Roos, Landry) Oregon Health and Science University, Portland,
Ore, United States
Title
Statin use in patients with peripheral arterial disease.
Source
Journal of Vascular Surgery. 64 (6) (pp 1881-1888), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Statins are recommended for use in patients with peripheral
arterial disease (PAD) to reduce cardiovascular events and mortality.
However, much of the data regarding benefits of statins stem from the
cardiovascular literature. Here, we review the literature regarding statin
use specifically in patients with PAD regarding its effects on
cardiovascular events and mortality, limb-related outcomes, statin use
after endovascular interventions, statin dosing, and concerns about
statins. Methods We performed a literature review using PubMed for
literature after the year 2000. Search terms included "statins,"
"peripheral arterial disease," "peripheral vascular disease,"
"lipid-lowering medication," and "cardiovascular disease." Results There
is good evidence of statins lowering cardiovascular events and
cardiovascular-related mortality in patients with PAD. Though
revascularization rates were reduced with statins, amputation rates and
amputation-free survival did not improve. Small randomized controlled
trials show that patients taking statins can slightly improve pain-free
walking distance or pain-free walking time, although the extent of the
effect on quality of life is unclear. Statin use for patients undergoing
endovascular interventions is recommended because of the reduction of
postoperative cardiovascular events. Not enough data exist to support
local effects of systemic statin therapy, such as prevention of
restenosis. For statin dosing, there is little increased benefit to
intense therapy compared with the adverse effects, whereas moderate-dose
therapy has significant benefits with very few adverse effects. Adverse
effects of moderate-dose statin therapy are rare and mild and are greatly
outweighed by the cardiovascular benefits. Conclusions There is strong
evidence to support use of statins in patients with PAD to reduce
cardiovascular events and mortality. Use in patients undergoing open and
endovascular interventions is also recommended. Statin use may reduce the
need for revascularization, but reductions in amputation have not been
shown. Moderate-dose statin therapy is safe, and the minor risks are
greatly outweighed by benefits.<br/>Copyright &#xa9; 2016 Society for
Vascular Surgery

<34>
Accession Number
608982968
Author
Udell J.A.; Bonaca M.P.; Collet J.-P.; Lincoff A.M.; Kereiakes D.J.; Costa
F.; Lee C.W.; Mauri L.; Valgimigli M.; Park S.-J.; Montalescot G.;
Sabatine M.S.; Braunwald E.; Bhatt D.L.
Institution
(Udell) Peter Munk Cardiac Centre and Cardiovascular Division, University
Health Network, Heart and Stroke Richard Lewar Centre of Excellence, 76
Grenville Street, Toronto, ON M5S1B1, Canada
(Udell) Department of Medicine, Women's College Hospital, University of
Toronto, Toronto, Canada
(Bonaca, Sabatine, Braunwald, Bhatt) TIMI Study Group, Brigham and Women's
Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115,
United States
(Collet, Montalescot) ACTION Study Group, INSERM, Universite Paris, Paris,
France
(Lincoff) Department of Cardiovascular Medicine, Cleveland Clinic,
Coordinating Center for Clinical Research, Cleveland, OH, United States
(Kereiakes) Lindner Center for Research and Education, Christ Hospital,
Cincinnati, OH, United States
(Costa, Valgimigli) Thoraxcenter, Erasmus Medical Center, Rotterdam 3015,
Netherlands
(Lee, Park) Heart Institute, University of Ulsan, College of Medicine,
Seoul, South Korea
(Mauri) Harvard Clinical Research Institute, Cardiovascular Division,
Harvard Medical School, Boston, MA, United States
(Valgimigli) University Hospital of Bern, Bern, Switzerland
Title
Long-term dual antiplatelet therapy for secondary prevention of
cardiovascular events in the subgroup of patients with previous myocardial
infarction: A collaborative meta-analysis of randomized trials.
Source
European Heart Journal. 37 (4) (pp 390-399), 2016. Date of Publication: 21
Jan 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Recent trials have examined the effect of prolonged dual antiplatelet
therapy (DAPT) in a variety of patient populations, with heterogeneous
results regarding benefit and safety, specifically with regard to
cardiovascular and non-cardiovascular mortality. We performed a
meta-analysis of randomized trials comparing more than a year of DAPT with
aspirin alone in high-risk patients with a history of prior myocardial
infarction (MI). Methods and results A total of 33 435 patients were
followed over a mean 31 months among one trial of patients with prior MI
(63.3% of total) and five trials with a subgroup of patients that
presented with, or had a history of, a prior MI (36.7% of total). Extended
DAPT decreased the risk of major adverse cardiovascular events compared
with aspirin alone (6.4 vs. 7.5%; risk ratio, RR 0.78, 95% confidence
intervals, CI, 0.67-0.90; P = 0.001) and reduced cardiovascular death (2.3
vs. 2.6%; RR 0.85, 95% CI 0.74-0.98; P = 0.03), with no increase in
non-cardiovascular death (RR 1.03, 95% CI 0.86-1.23; P = 0.76). The
resultant effect on all-cause mortality was an RR of 0.92 (95% CI
0.83-1.03; P = 0.13). Extended DAPT also reduced MI (RR 0.70, 95% CI
0.55-0.88; P = 0.003), stroke (RR 0.81, 95% CI 0.68-0.97; P = 0.02), and
stent thrombosis (RR 0.50, 95% CI 0.28-0.89; P = 0.02). There was an
increased risk of major bleeding (1.85 vs. 1.09%; RR 1.73, 95% CI
1.19-2.50; P = 0.004) but not fatal bleeding (0.14 vs. 0.17%; RR 0.91, 95%
CI 0.53-1.58; P = 0.75). Conclusion Compared with aspirin alone, DAPT
beyond 1 year among stabilized high-risk patients with prior MI decreases
ischaemic events, including significant reductions in the individual
endpoints of cardiovascular death, recurrent MI, and stroke. Dual
antiplatelet therapy beyond 1 year increases major bleeding, but not fatal
bleeding or non-cardiovascular death.<br/>Copyright &#xa9; 2015 The
Author.

<35>
Accession Number
610147444
Author
Steppich B.; Hadamitzky M.; Ibrahim T.; Groha P.; Schunkert H.; Laugwitz
K.-L.; Kastrati A.; Ott I.
Institution
(Steppich, Hadamitzky, Groha, Schunkert, Kastrati, Ott) Deutsches
Herzzentrum der Technischen Universitat Munchen, Munchen, Germany
(Ibrahim, Laugwitz) Klinikum rechts der Isar, 1. Medizinische Klinik,
Munchen, Germany
Title
Stem cell mobilisation by granulocyte-colony stimulating factor in
patients with acute myocardial infarction: Long-term results of the
REVIVAL-2 trial.
Source
Thrombosis and Haemostasis. 115 (4) (pp 864-868), 2016. Date of
Publication: April 2016.
Publisher
Schattauer GmbH (E-mail: info@schattauer.de)
Abstract
Treatment with granulocyte-colony stimulating factor (G-CSF) mobilises
cells from the bone marrow to the peripheral blood. Previous preclinical
and early clinical trials may suggest that treatment with G-CSF leads to
improved myocardial perfusion and function in acute or chronic ischaemic
heart disease. In the REVIVAL-2 study we found that stem cell mobilisation
by G-CSF does not influence infarct size, left ventricular function and
coronary restenosis in patients with acute myocardial infarction (MI) that
underwent successful percutaneous coronary intervention. The objective of
the present analysis was to assess the impact of G-CSF treatment on
seven-year clinical outcomes from the REVIVAL-2 trial. In the randomized,
double-blind, placebo-controlled REVIVAL-2 study, 114 patients with the
diagnosis of acute myocardial infarction were enrolled five days after
successful reperfusion by percutaneous coronary intervention. Patients
were assigned to receive 10 micro&#32;g/kg G-CSF (n=56) or placebo (n=58)
for five days. The primary endpoint for this long-term outcome analysis
was the composite of death, myocardial infarction or stroke seven years
after randomisation. The endpoint occurred in 14.3 % of patients in the
G-CSF group versus 17.2 % assigned to placebo (p=0.67). The combined
incidence of death or myocardial infarction occurred in 14.3 % of the
patients assigned to G-CSF and 15.5 % of the patients assigned to placebo
(p=0.85). In conclusion, these long-term follow-up data show that G-CSF
does not improve clinical outcomes of patients with acute myocardial
infarction.<br/>Copyright &#xa9; Schattauer 2016.

<36>
Accession Number
610123953
Author
Rashidi M.; Esmaily S.; Fiane A.E.; Gude E.; Atonseth K.; Ueland T.;
Gustafsson F.; Eiskjaer H.; Radegran G.; Dellgren G.
Institution
(Rashidi, Fiane) Department of Cardiothoracic Surgery, Oslo University
Hospital, Oslo, Norway
(Rashidi, Atonseth) Department of Plastic and Reconstructive Surgery, Oslo
University Hospital, Oslo, Norway
(Esmaily, Dellgren) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Fiane, Atonseth, Ueland) Faculty of Medicine, University of Oslo, Norway
(Gude) Department of Cardiology, Oslo University Hospital, Oslo, Norway
(Ueland) Research Institute of Internal Medicine, Oslo University
Hospital, Rikshospitalet, Oslo, Norway
(Ueland) K.G. Jebsen Inflammatory Research Center, University of Oslo,
Oslo, Norway
(Ueland) K.G. Jebsen Thrombosis Research and Expertise Center, University
of Tromso, Norway
(Gustafsson) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Eiskjaer) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(Radegran) Clinic for Heart Failure and Valvular Disease, Skane University
Hospital and Department of Clinical Sciences Lund, Cardiology, Lund
University, Lund, Sweden
Title
Wound complications and surgical events in de novo heart transplant
patients treated with everolimus: Post-hoc analysis of the SCHEDULE trial.
Source
International Journal of Cardiology. 210 (pp 80-84), 2016. Date of
Publication: 01 May 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives The use of mammalian target of rapamycin (mTOR) inhibitors have
been limited by adverse events (AE), including delayed wound healing. We
retrospectively reviewed all AE and serious AE (SAE) in The Scandinavian
heart transplant (HTx) everolimus (EVE) de novo trial with early
calcineurin (CNI) avoidance (SCHEDULE). The aim of the study was to
compare wound complications between EVE and CNI based regimen. Materials
and methods A total of 115 patients (mean age 51 +/- 13 years, 73% men)
were randomized within five days post-HTx to low dose EVE and reduced dose
Cyclosporine (CyA) followed by early CyA withdrawal (EVE group; n = 56) or
standard CyA regimen (CyA group; n = 59). All AE/SAEs were prospectively
recorded according to the SCHEDULE study protocol, and re-assessed
retrospectively by two independent reviewers. Wound complication as
primary endpoint was defined as any complication associated with failure
of tissue healing. Secondary endpoint was total number of events involving
surgical intervention. Results There were no significant differences
between the groups with regards to wound complications (EVE = 20, CyA =
12)(p = 0.08) or total surgical events (EVE = 38, CyA = 34) (p = 0.44).
Age > 54.5 years (median) was an overall risk factor for surgical wound
complications regardless of treatment group (p = 0.025). There was no
difference in the EVE versus CyA group with regards to other surgical
events. Majority of events were in 1/3 of the patients. Conclusion De novo
initiation of EVE and early CyA withdrawal in HTx patients did not show
any significant differences in wound complications or in total surgical
events. Majority of complications were seen in a small number of
patients.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd. All rights
reserved.

<37>
Accession Number
608853575
Author
Lin Z.; Xiaoyi Z.
Institution
(Lin, Xiaoyi) Department of Neurology, West China Hospital, Sichuan
University, No.37 Guoxuexiang, Chengdu 610041, China
Title
Tranexamic acid-associated seizures: A meta-analysis.
Source
Seizure. 36 (pp 70-73), 2016. Date of Publication: 01 Mar 2016.
Publisher
W.B. Saunders Ltd
Abstract
Purpose To investigate the incidence rate of tranexamic acid
(TXA)-associated seizures. Methods Two electronic databases (Medline and
Embase) were searched. We looked for additional studies in the references
of all identified publications. The cutoff day was 2015 Dec 06. Two
authors independently reviewed the titles and abstracts of the
publications identified firstly. Odds ratio (OR) and 95% confidence
interval (CI) were used to compare discontinuous variables. Results Ten
studies enrolling 26,079 patients with TXA exposure and 7395 patients with
non-TXA exposure were included. The cumulative incidence rate of
TXA-associated seizures is 2.7%. The odds ratio of seizure is 5.39 (95%CI:
3.29-8.85; I² = 0%; P < 0.001) in patients with TXA exposure vs
patients with non-TXA exposure. The incidence rate of TXA-associated
seizures increased when the dose levels increased. Conclusion The risk of
seizure increased in patients with TXA exposure and the incidence rate of
TXA-associated seizures increased when the dose levels
increased.<br/>Copyright &#xa9; 2016 British Epilepsy Association.
Published by Elsevier Ltd. All rights reserved.

<38>
Accession Number
608799841
Author
Shimada Y.J.; Cannon C.P.; Liu Y.; Wilson C.; Kupfer S.; Menon V.; Cushman
W.C.; Mehta C.R.; Bakris G.L.; Zannad F.; White W.B.
Institution
(Shimada, Cannon, Liu) Harvard Clinical Research Institute, 930
Commonwealth Avenue West, Boston, MA 02215, United States
(Shimada) Cardiology Division, Massachusetts General Hospital, Harvard
Medical School, Boston, MA, United States
(Shimada, Cannon) Cardiovascular Division, Department of Medicine, Brigham
and Women's Hospital, Harvard Medical School, Boston, MA, United States
(Liu) Department of Biostatistics, Boston University, Boston, MA, United
States
(Wilson, Kupfer) Takeda Development Center Americas, Deerfield, IL, United
States
(Menon) Department of Cardiovascular Medicine, Cleveland Clinic
Foundation, Cleveland, OH, United States
(Cushman) University of Tennessee College of Medicine, Memphis Veterans
Affairs Medical Center, Memphis, TN, United States
(Mehta) Harvard School of Public Health, Boston, MA, United States
(Bakris) University of Chicago Medicine, Chicago, IL, United States
(Zannad) Institut Lorrain du Coeur et des Vaisseaux, Centre
d'Investigation Clinique Inserm, Universite de Lorraine, CHU,
Vandoeuvre-Les-Nancy, France
(White) Calhoun Cardiology Center, University of Connecticut School of
Medicine, Farmington, CT, United States
Title
Ischemic cardiac outcomes and hospitalizations according to prior
macrovascular disease status in patients with type 2 diabetes and recent
acute coronary syndrome from the Examination of Cardiovascular Outcomes
with Alogliptin versus Standard of Care trial.
Source
American Heart Journal. 175 (pp 18-27), 2016. Date of Publication: 01 May
2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Concerns raised regarding adverse cardiovascular (CV) outcomes
with new therapies for type 2 diabetes mellitus (T2DM) have led to several
large-scale CV outcome trials. The EXAMINE trial confirmed noninferiority
of the dipeptidyl dipeptidase 4 inhibitor alogliptin to placebo on major
adverse cardiac event rates in a post-acute coronary syndrome (ACS) T2DM
population. We present data on additional ischemic cardiac events and CV
hospitalizations in EXAMINE. Methods: Patients with T2DM and an ACS event
in the previous 15 to 90 days were randomly assigned to alogliptin or
placebo on a background of standard treatment for diabetes. The incident
rates of a 5-component composite end point of CV death, stroke, myocardial
infarction, unstable angina, and coronary revascularization as well as CV
hospitalization were calculated in all participants and according to
macrovascular disease at baseline. Results: There were no significant
differences between alogliptin (n = 2,701) and placebo (n = 2,679) in the
event rate of the 5-component composite endpoint with median follow-up 533
days (21.0% vs 21.5%, hazard ratio [HR] 0.98 [0.87-1.10], P =.72). No
differences were observed in terms of CV hospitalization (25.0% vs 25.4%,
HR 0.98 [0.88-1.09], P =.70) or coronary revascularization (10.6% vs
10.2%, HR 1.05 [0.88-1.09], P =.60). No interactions were observed for
treatment and prior macrovascular disease. Conclusions: EXAMINE
demonstrates that there was no increase in the risk of cardiac ischemic
events and CV hospitalizations with alogliptin in a high-risk post-ACS
patient population. Because these are major driver of overall health care
costs, these data suggest that there would be no adverse impact on health
care resource utilization.<br/>Copyright &#xa9; 2016 Mosby, Inc.

<39>
Accession Number
613127821
Author
De Vecchis R.; Baldi C.; Palmisani L.
Institution
(De Vecchis) Cardiology Unit, Napoli, Italy
(Palmisani) Presidio Sanitario Intermedio "Elena d'Aosta", Napoli, Italy
(Baldi) Heart Department, Interventional Cardiology, A.O.U. "San Giovanni
di Dio e Ruggi D'Aragona", Salerno, Italy
Title
Protective effects of methotrexate against ischemic cardiovascular
disorders in patients treated for rheumatoid arthritis or psoriasis: Novel
therapeutic insights coming from a meta-analysis of the literature data.
Source
Anatolian Journal of Cardiology. 16 (1) (pp 2-9), 2016. Date of
Publication: 2016.
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: The association between chronic use of methotrexate and
decreased risk of ischemic cardiovascular events (CVE) among patients with
psoriatic or rheumatoid arthritis (RA) was investigated using a systematic
review and meta-analysis. Methods: The studies should have recruited
adults receiving methotrexate, followed up for at least one year.
Moreover, studies should have reported "hard" cardiovascular endpoints, by
evaluating the cardiovascular outcomes of the habitual users of the drug
or of new users compared with patients with the same disease who had never
used methotrexate. The outcome of interest was the overall pooled odds
ratio (OR) of major adverse cardiovascular events, i.e., a composite of
new- onset angina, acute coronary syndrome, need for percutaneous or
surgical coronary revascularization, stroke, and cardiovascular death. The
study was performed according to the PRISMA statement. Results: Seven
observational studies, mostly engaging patients with RA, were included in
the meta-analysis. The pooled odds ratio (OR) was 0.73 (95% CI=0.70- 0.77
p<0.001). When stratified meta-analysis models were assessed, the pooled
OR was 0.80 (95% CI=0.66-0.97; p=0.022) for studies adjusting for clinical
severity of RA. Furthermore, the OR was even more significant after
adjustment for concomitant use of other drugs specific for RA (OR=0.71,
95% CI=0.67-0.75, p<0.001). Conclusion: Methotrexate at low doses, such
those used for maintenance therapy of RA, predicted a decreased risk of
CVE. Since methotrexate doesn't interfere with blood lipids, platelet
aggregation or insulin resistance, the protective association may
originate from mechanisms other than those exerted by antiplatelet drugs
or statins.<br/>Copyright &#xa9; 2016 by Turkish Society of Cardiology.

<40>
Accession Number
610123936
Author
Benedetto U.; Gaudino M.; Ng C.; Biondi-Zoccai G.; D'Ascenzo F.; Frati G.;
Girardi L.N.; Angelini G.D.; Taggart D.P.
Institution
(Benedetto, Ng, Angelini) Bristol Heart Institute, University of Bristol,
School of Clinical Sciences, Upper Maudlin St, Bristol BS2 8HW, United
Kingdom
(Gaudino, Girardi) Division of Cardio-thoracic Surgery, Cornell
University, New York, NY, United States
(Biondi-Zoccai, Frati) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Biondi-Zoccai) Eleonora Lorillard Spencer Cenci Foundation, Rome, Italy
(D'Ascenzo) Dipartimento Di Scienze Mediche, Divisione di Cardiologia,
Citta della Salute e della Scienza, Turin, Italy
(Frati) Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli,
Italy
(Taggart) Nuffield Department of Surgical Sciences, Oxford University
Hospital, Oxford, United Kingdom
Title
Coronary surgery is superior to drug eluting stents in multivessel
disease. Systematic review and meta-analysis of contemporary randomized
controlled trials.
Source
International Journal of Cardiology. 210 (pp 19-24), 2016. Date of
Publication: 01 May 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objective Current randomized controlled trials (RCTs) comparing
percutaneous coronary intervention with drug eluting stent (DES-PCI) with
coronary artery bypass grafting (CABG) in multivessel disease are
underpowered to detect a difference in hard clinical end-points such as
mortality, myocardial infarction and stroke. We aimed to overcome this
limitation by conducting a meta-analysis of contemporary RCTs. Methods A
systematic literature search was conducted for all RCTs comparing DES-PCI
versus CABG in multivessel disease published through May 2015. Inverse
variance weighting was used to pool data from individual studies (< 1
favouring DES-PCI and > 1 CABG favouring surgery). Results A total of five
randomized trials including 4563 subjects were analysed. After an average
follow-up of 3.4 years, DES-PCI was associated with a significantly
increased risk of overall mortality (HR 1.51; 95%CI 1.23-1.84; P < 0.001),
MI (HR 2.02; 95%CI 1.57-2.58; P < 0.001) and repeat revascularization (HR
2.54; 95%CI 2.07-3.11; P = < 0.001). CABG marginally increased the risk of
stroke (HR 0.70; 95%CI 0.50-0.98; P = 0.04). The absolute risk reduction
for all-cause mortality (3.3%) and myocardial infarction (4.3%) with CABG
was larger than the absolute risk reduction for stroke (0.9%) with
DES-PCI. Conclusion In patients with multivessel coronary disease, CABG
was found to be superior to DES-PCI by reducing the risk of mortality and
subsequent myocardial infarction at the expense of a marginally increased
risk of stroke.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd. All rights
reserved.

<41>
Accession Number
608563751
Author
Bertolet M.; Brooks M.M.; Bittner V.
Institution
(Bertolet) Department of Epidemiology, Clinical and Translational
Sciences, University of Pittsburgh, Pittsburgh, PA, United States
(Brooks) Department of Epidemiology and Biostatistics, Clinical and
Translational Sciences, University of Pittsburgh, Pittsburgh, PA, United
States
(Bittner) Preventive Cardiology, University of Alabama at Birmingham,
Birmingham, AL, United States
Title
Tree-based identification of subgroups for time-varying covariate survival
data.
Source
Statistical Methods in Medical Research. 25 (1) (pp 488-501), 2016. Date
of Publication: 01 Feb 2016.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Classification and regression tree analyses identify subsets of a sample
that differ on an outcome. Discrimination of subsets is performed using
recursive binary splitting on a set of covariates, allowing for
interactions of variable subgroups not easily captured in standard model
building techniques. Using classification and regression tree with
epidemiological data can be problematic as there is often a need to adjust
for potential confounders and to account for time-varying covariates in
the context of right-censored survival data. While classification and
regression tree variations exist individually for survival analysis,
time-varying covariates and incorporating possible confounders, examples
of classification and regression tree using all three together are
lacking. We propose a method to identify subsets of time-varying covariate
risk factors that affect survival while adjusting for possible
confounders. The technique is demonstrated on data from the Bypass
Angioplasty Revascularization Investigation 2 Diabetes clinical trial to
find combinations of modifiable time-varying cardiac risk factors (e.g.
smoking status, blood pressure, lipid levels and HbA1c level) that are
associated with time-to-event clinical outcomes.<br/>Copyright &#xa9; SAGE
Publications 2012.

<42>
Accession Number
609705156
Author
Sharma P.; Patel K.; Baria K.; Lakhia K.; Malhotra A.; Shah K.; Patel S.
Institution
(Sharma, Patel, Baria, Lakhia, Malhotra) Department of Cardiovascular and
Thoracic Surgery, U N Mehta Institute of Cardiology and Research Center,
Asarwa, Ahmedabad, Gujarat, India
(Shah, Patel) Department of Research, U N Mehta Institute of Cardiology
and Research Center, Asarwa, Ahmedabad, Gujarat, India
Title
Procalcitonin level for prediction of postoperative infection in cardiac
surgery.
Source
Asian Cardiovascular and Thoracic Annals. 24 (4) (pp 344-349), 2016. Date
of Publication: 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background Diagnosing infection after cardiac surgery remains difficult
due to the systemic inflammatory response induced by cardiopulmonary
bypass. We compared procalcitonin levels with white blood cell counts as
predictors of infection after cardiac surgery. Methods We prospectively
enrolled 100 consecutive adult cardiac patients. Postoperative white blood
cell counts, serum procalcitonin levels, and blood cultures were examined.
Result The sensitivity and specificity of white blood cell count and
procalcitonin > 2 ng mL^-1 were 60% and 100%, 58.8% and 42.5%,
respectively. Procalcitonin > 7 ng mL^-1 had 95% sensitivity and
80% specificity. Receiver-operating characteristic analysis showed a
greater area under the curve for procalcitonin level (p < 0.0001) compared
to white blood cell count (p = 0.31). Patients with positive blood
cultures had significantly higher procalcitonin levels (51.97 +/- 39.62
vs. 6.67 +/- 10.73 ng mL^-1), Acute Physiology and Chronic
Health Evaluation-II scores (16.95 +/- 3.24 vs. 13.60 +/- 2.98), and
intensive care unit stay (6.35 +/- 3.42 vs. 4.6 +/- 2.2 days).
Non-survivors had significantly higher Acute Physiology and Chronic Health
Evaluation-II scores (19.09 +/- 1.30 vs. 13.67 +/- 2.97) and procalcitonin
levels (43.83 +/- 52.15 vs. 12.26 +/- 19.89 ng mL^-1) but on
logistic regression analysis, only Acute Physiology and Chronic Health
Evaluation-II score was an independent risk factor for mortality.
Conclusion The diagnostic accuracy of procalcitonin for bacterial
infection is fairly high. Acute Physiology and Chronic Health
Evaluation-II score is a better predictor of mortality and morbidity than
absolute procalcitonin level. Procalcitonin > 7 ng mL^-1 can
prognosticate and identify the high-risk group.<br/>Copyright &#xa9; SAGE
Publications.

<43>
Accession Number
613014793
Author
Pourier V.E.C.; de Borst G.J.
Institution
(Pourier, de Borst) Department of Vascular Surgery, University Medical
Center Utrecht, Utrecht, Netherlands
Title
Technical options for treatment of in-stent restenosis after carotid
artery stenting.
Source
Journal of Vascular Surgery. 64 (5) (pp 1486-1496), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective This review summarizes the available evidence and analyzes the
current trends on treatments for carotid in-stent restenosis (ISR) after
carotid artery stenting (CAS). Methods An update of a 2010 review of the
literature (which included 20 articles) was conducted using PubMed and
Embase. All studies published from inception until January 2016 reporting
original data on ISR treatments were included. Treatment trends before and
after 2005 were compared. Results We found 22 new articles reporting ISR
treatments in 138 patients, of which two (case series) were published
before 2005. With the inclusion of the 20 articles of the 2010 report (n =
96 patients), a total of 42 articles were included (23 case reports and 19
case series) reporting 239 interventions for ISR in 234 patients. Of these
42 studies, 14 (including 10 case series) were published before 2005. The
interventions were percutaneous transluminal angioplasty (PTA) in 136,
repeat CAS in 51, carotid endarterectomy in 39, carotid artery bypass in
10, or brachytherapy in 3. Compared with the articles published before
2005, PTA with regular balloon remains the most practiced treatment (26%
before 2005, 40% after 2005). PTA with drug-coated balloons started after
2005. Carotid endarterectomy with stent removal was the second most
reported treatment before 2005 but moved to the third place of reported
interventions after 2005 owing to an increase in repeat CAS treatment. Of
the treated patients, 140 were asymptomatic, 72 were symptomatic, and for
22 the symptomology was unclear. ISR treatment averaged 18 months after
CAS, and the follow-up thereafter was 16 months. Treatment for recurrent
ISR was performed in 48 of 239 treated arteries, mostly after PTA (n = 35)
and repeat CAS (n = 8). Conclusions The available evidence for ISR
treatment is still limited owing to methodologic heterogeneity; therefore,
no recommendation on the optimal intervention can be provided. Although
PTA is the common treatment for ISR, recurrent ISR seems to limit the
durability, leading to recurrent interventions and cost implications. A
uniform definition for ISR is needed with a standardized workup to compare
the treatment options based on individual patient data analysis.
Drug-eluting techniques are emerging and may become the preferred
treatment option, but long-term follow-up is needed to evaluate their
efficacy. Further study and understanding of the effect of drug-eluting
technologies on the brain and neurologic function is
warranted.<br/>Copyright &#xa9; 2016 Society for Vascular Surgery

<44>
Accession Number
610284261
Author
Kirmani B.H.; Brazier A.; Sriskandarajah S.; Azzam R.; Keenan D.J.
Institution
(Kirmani, Brazier, Sriskandarajah, Azzam, Keenan) Department of
Cardiothoracic Surgery, Manchester Royal Infirmary, Oxford Road,
Manchester M13 9WL, United Kingdom
Title
A meta-analysis of computerized tomography scan for reducing complications
following repeat sternotomy for cardiac surgery.
Source
Interactive Cardiovascular and Thoracic Surgery. 22 (4) (pp 472-479),
2016. Date of Publication: 01 Apr 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Cardiac reoperation carries additional risks compared with surgery in
patients who are sternotomy-naive. To identify if preoperative
computerized tomography (CT) can reduce this risk, we performed a
systematic review of the literature and meta-analysis. Literature search
identified 178 studies of which 4 retrospective cohort studies
incorporating 900 patients met inclusion criteria. There were no
statistically significant differences in the risk of death, re-entry
injury, renal failure or perfusion/ischaemic times. CT scan reduced the
risk of stroke by 0.42 [95% confidence interval (CI): 0.19-0.93, P = 0.03]
and a composite of major complications by 0.65 (95% CI: 0.47-0.88, P =
0.006). The use of preoperative cross-sectional imaging to reduce the risk
of complications following cardiac reoperation is advocated.<br/>Copyright
&#xa9; 2016 The Author 2016. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<45>
Accession Number
608546747
Author
Liao Y.-B.; He Z.-X.; Zhao Z.-G.; Wei X.; Zuo Z.-L.; Li Y.-J.; Xiong
T.-Y.; Xu Y.-N.; Feng Y.; Chen M.
Institution
(Liao, He, Zhao, Wei, Zuo, Li, Xiong, Xu, Feng, Chen) Department of
Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street,
Chengdu 610041, China
Title
The relationship between chronic obstructive pulmonary disease and
transcatheter aortic valve implantation - A systematic review and
meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 87 (pp 570-578), 2016.
Date of Publication: 01 Mar 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective The present study was performed to investigate the relationship
between chronic obstructive pulmonary disease (COPD) and transcatheter
aortic valve implantation (TAVI). Background: Controversies regarding the
relationship between COPD and TAVI have intensified. Methods: A literature
review of the PubMed online database was performed, and articles published
between January 1, 2002 and March 20, 2015 were analyzed. Random-effect
and fixed-effect models were used, depending on the between-study
heterogeneity. Results: A total of 28 studies, involving 51,530 patients,
were identified in our review. The burden of COPD ranged from 12.5% to
43.4%, and COPD negatively impacted both short-term and long-term
all-cause survival (30 days: odds ratio [OR], 1.43, 95% CI, 1.14-1.79; >2
years: hazard ratio [HR], 1.34, 95% CI, 1.12-1.61). COPD was also
associated with increased short-term and mid-term cardiac-cause mortality
(30 days: OR, 1.29, 95% CI, 1.02-1.64; 1 year: HR: 1.09, 1.02-1.17).
Moreover, COPD (OR, 1.97, 95% CI, 1.29-3.0) predicted post-TAVI acute
kidney disease. Importantly, chronic kidney disease (CKD) (HR, 1.2, 95%
CI, 1.1-1.32) and the distance of the 6 minute walk test (6MWT) (HR, 1.16,
1.06-1.27) predicted TAVI futility in patients with COPD. Conclusion: COPD
is common among patients undergoing TAVI, and COPD impacts both short- and
long-term survival. COPD patients, who had a lower BMI, shorter distance
of 6MWT and CKD, were at higher risk for TAVI futility.<br/>Copyright
&#xa9; 2016 Wiley Periodicals, Inc.

<46>
Accession Number
608492661
Author
Hillebrand J.; Rouhollahpour A.; Zierer A.; Moritz A.; Martens S.
Institution
(Hillebrand, Martens) Department of Cardiothoracic Surgery, Division of
Cardiac Surgery, University Hospital, Westfaelische Wilhelms-University
Muenster, Albert-Schweitzer-Campus 1, Muenster D-48159, Germany
(Rouhollahpour, Zierer, Moritz) Department of Thoracic and Cardiovascular
Surgery, Johann Wolfgang Goethe-University Hospital, Frankfurt am Main,
Germany
Title
Digital carotid compression: A simple method to reduce solid cerebral
emboli during cardiac surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (2) (pp 304-308),
2016. Date of Publication: 01 Apr 2016.
Publisher
W.B. Saunders
Abstract
Objectives Serious neurologic injury can be attributed to embolization of
solid particles into cerebral vessels during cardiac surgery. Previous
studies using transcranial Doppler (TCD) identified arterial cannulation
and aortic declamping to be associated with cerebral embolization. The
purpose of this study was to investigate the impact of transient
compression of the carotid arteries during these maneuvers on the embolic
load during cardiac surgery with cardiopulmonary bypass. Design
Prospective, randomized, clinical trial/pilot study. Setting Single-center
study at a university hospital. Participants Patients with multiple types
of procedures were included and they were prospectively, randomly assigned
to group I (n = 20, carotid compression during arterial cannulation and
aortic declamping) and group II (n = 20, no carotid compression).
Interventions Bilateral continuous monitoring of the middle cerebral
arteries was performed with a multirange, multifreqency transcranial
Doppler (DopplerBoxX, DWL, Singen, Germany), allowing for discrimination
between solid and gaseous emboli. For aortic cannulation the carotid
arteries were compressed for 5 seconds and for declamping for 3 seconds,
and microemboli signals were detected within the following 45 seconds.
Measurements and Main Results A reduction of intraoperative solid emboli
was detected in group I compared with group II (26+/-16 v 38+/-18; p =
0.04). Looking specifically at the maneuver of arterial cannulation, the
observed difference was 0.5+/-0.8 in group I versus 5.7+/-5.8 in group II
(p<0.0001). During aortic declamping, 6.6+/-6.2 emboli were encountered in
group I and 10.8+/-5.2 in group II (p = 0.02). The incidence of neurologic
events was not significantly different between groups (2 patients in group
II had pathologic changes on magnetic resonance imaging). Conclusions The
data of this preliminary trial demonstrated that transient compression of
the carotid arteries during arterial cannulation and aortic declamping led
to a decreased number of solid cerebral emboli. Further prospective,
randomized clinical studies should be undertaken to investigate the
influence of transient carotid artery compression during specific surgical
procedures.<br/>Copyright &#xa9; 2016 Elsevier Inc. Allrights reserved.

<47>
[Use Link to view the full text]
Accession Number
611321827
Author
Mihos C.G.; Pineda A.M.; Santana O.
Institution
(Mihos) Cardiac Ultrasound Laboratory, Massachusetts General Hospital,
Harvard Medical School, Boston, MA 02114, United States
(Pineda, Santana) Columbia University, Division of Cardiology, Mount Sinai
Heart Institute, Miami Beach, FL, United States
Title
A meta-analysis of early versus delayed surgery for valvular infective
endocarditis complicated by embolic ischemic stroke.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 11 (3) (pp 187-192), 2016. Date of Publication: 23 Aug 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective: An embolic ischemic stroke occurs in 10% to 40% of patients
with valvular infective endocarditis (IE) and confers significant
morbidity. The optimal timing of valve surgery in this population is not
well defined. Methods:With the use of PubMed, EMBASE, Ovid, and Cochrane
databases, a systematic review identified 14 studies through October 2015
that compared early versus delayed surgery for valvular IE complicated by
an ischemic stroke. Early surgery was defined as 3 days or less in one, 7
days or less in eight, and 14 days or less in five studies. Risk ratios
(RRs) were calculated by the Mantel-Haenszel method under a fixed- or
random-effects model, for the outcomes of perioperative stroke, operative
mortality, and 1-year survival. Results: A total of 833 patients (early
surgery, 330; delayed surgery, 503) were included. The majority of
operations were for aortic and/or mitral valve IE, with prosthetic valve
IE present in 0%to 60%. Infection with Staphylococcus aureus ranged from
19% to 66%, and heart failure prevalence at the time of operation was 24%
to 66%. Early surgery was associated with an increased risk of operative
mortality (RR, 1.72; 95% confidence interval [CI], 1.27-2.34; P = 0.0005),
which was significant regardless of surgery within the first 7 days (RR,
2.19; 95% CI, 1.45-3.31; P = 0.0002) or 14 days (RR, 1.72; 95% CI,
1.12-2.64; P = 0.01) after stroke. Surgical timing did not affect the risk
of perioperative ischemic or hemorrhagic stroke or 1-year survival.
Conclusions: In patients with valvular IE complicated by ischemic stroke,
early surgery is associated with an increased risk of operative mortality,
with no observed benefit in 1-year survival.<br/>Copyright &#xa9; 2016 by
the International Society for Minimally Invasive Cardiothoracic Surgery.

<48>
Accession Number
607673594
Author
Rajesh G.N.; Sreekumar P.; Haridasan V.; Sajeev C.G.; Bastian C.;
Vinayakumar D.; Kadermuneer P.; Mathew D.; George B.; Krishnan M.N.
Institution
(Rajesh, Bastian, Vinayakumar, Kadermuneer) Additional Professor,
Department of Cardiology, Government Medical College, Kozhikode, Kerala,
India
(Sreekumar) Senior Resident, Department of Cardiology, Government Medical
College, Kozhikode, Kerala, India
(Haridasan, Mathew) Assistant Professor, Department of Cardiology,
Government Medical College, Kozhikode, Kerala, India
(Sajeev) Professor, Department of Cardiology, Government Medical College,
Kozhikode, Kerala, India
(George) Assistant Professor, Department of Community Medicine, Government
Medical College, Kozhikode, Kerala, India
(Krishnan) Professor and Head, Department of Cardiology, Government
Medical College, Kozhikode, Kerala, India
Title
Effect of balloon mitral valvotomy on left ventricular function in
rheumatic mitral stenosis.
Source
Indian Heart Journal. 68 (5) (pp 612-617), 2016. Date of Publication: 01
Sep 2016.
Publisher
Elsevier B.V.
Abstract
Aim Mitral stenosis (MS) is found to produce left ventricular (LV)
dysfunction in some studies. We sought to study the left ventricular
function in patients with rheumatic MS undergoing balloon mitral valvotomy
(BMV). Ours is the first study to analyze effect of BMV on mitral annular
plane systolic excursion (MAPSE), and to quantify prevalence of
longitudinal left ventricular dysfunction in rheumatic MS. Methods In this
prospective cohort study, we included 43 patients with severe rheumatic
mitral stenosis undergoing BMV. They were compared to twenty controls
whose distribution of age and gender were similar to that of patients. The
parameters compared were LV ejection fraction (EF) by modified Simpson's
method, mitral annular systolic velocity (MASV), MAPSE, mitral annular
early diastolic velocity (E'), and myocardial performance index (MPI).
These parameters were reassessed immediately following BMV and after 3
months of procedure. Results MASV, MAPSE, E', and EF were significantly
lower and MPI was higher in mitral stenosis group compared to controls.
Impaired longitudinal LV function was present in 77% of study group. MAPSE
and EF did not show significant change after BMV while MPI, MASV, and E'
improved significantly. MASV and E' showed improvement immediately after
BMV, while MPI decreased only at 3 months follow-up. Conclusions There
were significantly lower mitral annular motion parameters including MAPSE
in patients with rheumatic mitral stenosis. Those with atrial fibrillation
had higher MPI. Immediately after BMV, there was improvement in LV long
axis function with a gradual improvement in global LV function. There was
no significant change of MAPSE after BMV.<br/>Copyright &#xa9; 2015
Cardiological Society of India

<49>
[Use Link to view the full text]
Accession Number
611547041
Author
Duerinckx N.; Burkhalter H.; Engberg S.J.; Kirsch M.; Klem M.-L.; Sereika
S.M.; De Simone P.; De Geest S.; Dobbels F.
Institution
(Duerinckx, De Geest, Dobbels) Academic Centre for Nursing and Midwifery,
Department of Public Health and Primary Care, KU Leuven, University of
Leuven, Belgium
(Duerinckx) Heart Transplantation Program, University Hospitals of Leuven,
Belgium
(Burkhalter) Centre of Sleep Medicine, Hirslanden Group Zurich,
Switzerland
(Engberg, Sereika) School of Nursing, University of Pittsburgh,
Pittsburgh, PA, United States
(Kirsch) Department of Anesthesiology, University Hospital of Basel,
Switzerland
(Klem) Health Sciences Library System, University of Pittsburgh,
Pittsburgh, PA, United States
(De Simone) Hepatobiliary Surgery and Liver Transplantation, University of
Pisa Medical School Hospital, Pisa, Italy
(De Geest, Dobbels) Institute of Nursing Science, University of Basel,
Faculty of Medicine, Bernoullistrasse 28, Basel 4056, Switzerland
Title
Correlates and Outcomes of Posttransplant Smoking in Solid Organ
Transplant Recipients: A Systematic Literature Review and Meta-Analysis.
Source
Transplantation. 100 (11) (pp 2252-2263), 2016. Date of Publication: 01
Nov 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background Despite smoking being an absolute or relative contraindication
for transplantation, about 11% to 40% of all patients continue or resume
smoking posttransplant. This systematic review with meta-analysis
investigated the correlates and outcomes associated with smoking after
solid organ transplantation. Methods We searched PubMed, EMBASE, CINAHL,
and PsycINFO from inception until January 2016, using state-of-the art
methodology. Pooled odds ratios (ORs) with 95% confidence intervals (CIs)
were computed for correlates/outcomes investigated 5 times or more.
Results Seventy-three studies (43 in kidney, 17 in heart, 12 in liver, 1
in lung transplantation) investigated 95 correlates and 24 outcomes, of
which 6 correlates and 4 outcomes could be included in the meta-analysis.
The odds of smoking posttransplant were 1.33 times higher in men (95% CI,
1.12-1.57). Older individuals were significantly less likely to smoke (OR,
0.48; 95% CI, 0.38-0.62), as were patients with a higher body mass index
(OR, 0.68; 95% CI, 0.52-0.89). Hypertension (OR, 1.16; 95% CI, 0.77-1.75),
diabetes mellitus (OR, 0.52; 95% CI, 0.15-1.78), and having a history of
cardiovascular disease (OR, 0.92; 95% CI, 0.77-1.09) were not significant
correlates. Posttransplant smokers had higher odds of newly developed
posttransplant cardiovascular disease (OR, 1.41; 95% CI, 1.02-1.95),
nonskin malignancies (OR, 2.58; 95% CI, 1.26-5.29), a shorter patient
survival time (OR, 0.59; 95% CI, 0.44-0.79), and higher odds of mortality
(OR, 1.74; 95% CI, 1.21-2.48). Conclusions Posttransplant smoking is
associated with poor outcomes. Our results might help clinicians to
understand which patients are more likely to smoke posttransplant, guide
interventional approaches, and provide recommendations for future
research.<br/>Copyright &#xa9; 2016 Wolters Kluwer Health, Inc. All rights
reserved.

<50>
Accession Number
616112943
Author
Rados D.V.; Pinto L.C.; Leitao C.B.; Gross J.L.
Institution
(Rados, Pinto, Leitao, Gross) Division of Endocrinology, Hospital de
Clinicas de Porto Alegre, Porto Alegre, Brazil
Title
Screening for coronary artery disease in patients with type 2 diabetes: A
meta-Analysis and trial sequential analysis.
Source
BMJ Open. 7 (5) (no pagination), 2017. Article Number: e015089. Date of
Publication: 01 May 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To evaluate the efficacy of coronary artery disease screening in
asymptomatic patients with type 2 diabetes and assess the statistical
reliability of the findings. Methods Electronic databases (MEDLINE,
EMBASE, Cochrane Library and clinicaltrials.org) were reviewed up to July
2016. Randomised controlled trials evaluating coronary artery disease
screening in asymptomatic patients with type 2 diabetes and reporting
cardiovascular events and/or mortality were included. Data were summarised
with Mantel-Haenszel relative risk. Trial sequential analysis (TSA) was
used to evaluate the optimal sample size to detect a 40% reduction in
outcomes. Main outcomes were all-cause mortality and cardiac events
(non-fatal myocardial infarction and cardiovascular death); secondary
outcomes were non-fatal myocardial infarction, myocardial
revascularisations and heart failure. Results One hundred thirty-five
references were identified and 5 studies fulfilled the inclusion criteria
and totalised 3315 patients, 117 all-cause deaths and 100 cardiac events.
Screening for coronary artery disease was not associated with decrease in
risk for all-cause deaths (RR 0.95(95% CI 0.66 to 1.35)) or cardiac events
(RR 0.72(95% CI 0.49 to 1.06)). TSA shows that futility boundaries were
reached for all-cause mortality and a relative risk reduction of 40%
between treatments could be discarded. However, there is not enough
information for firm conclusions for cardiac events. For secondary
outcomes no benefit or harm was identified; optimal sample sizes were not
reached. Conclusion Current available data do not support screening for
coronary artery disease in patients with type 2 diabetes for preventing
fatal events. Further studies are needed to assess the effects on cardiac
events. PROSPERO CRD42015026627.<br/>Copyright &#xa9; Article author(s)
(or their employer(s) unless otherwise stated in the text of the article)
2017. All rights reserved. No commercial use is permitted unless otherwise
expressly granted.

<51>
Accession Number
616333991
Author
da Costa M.A.C.; Lirani W.; Wippich A.C.; Lopes L.; de souza Tolentino E.;
Zampar B.; Schafranski M.D.
Institution
(da Costa, Lirani, Wippich, Lopes, de souza Tolentino, Zampar,
Schafranski) Universidade Estadual de Ponta Grossa, Ponta Grossa, PR,
Brazil
Title
Comparison of two central venous pressure control strategies to prevent
atrial fibrillation after coronary artery bypass grafting.
Source
Arquivos Brasileiros de Cardiologia. 108 (4) (pp 297-303), 2017. Date of
Publication: 2017.
Publisher
Arquivos Brasileiros de Cardiologia (E-mail: arquivos@cardiol.br)
Abstract
Background: Atrial fibrillation (AF) takes place in 10-40% of patients
undergoing coronary artery bypass grafting (CABG), and increases
cardiovascular mortality. Enlargement of atrial chambers is associated
with increased AF incidence, so patients with higher central venous
pressure (CVP) are expected to have larger atrial distension, which
increases AF incidence. Objective: To compare post-CABG AF incidence,
following two CVP control strategies. Methods: Interventional, randomized,
controlled clinical study. The sample comprised 140 patients undergoing
CABG between 2011 and 2015. They were randomized into two groups, G15 and
G20, with CVP maintained <= 15 cmH<inf>2</inf>O and <= 20
cmH<inf>2</inf>O, respectively. Results: 70 patients were included in each
group. The AF incidence in G15 was 8.57%, and in G20, 22.86%, with
absolute risk reduction of 14.28%, and number needed to treat (NNT) of 7
(p = 0.03). Mortality (G15 = 5.71%; G20 = 11.42%; p = 0.07), hospital
length of stay (G15 = 7.14 days; G20 = 8.21 days; p = 0.36), number of
grafts (median: G15 = 3, G2 = 2; p = 0.22) and cardiopulmonary bypass use
(G15 = 67.10%; G20 = 55.70%; p = 0.22) were statistically similar. Age (p
= 0.04) and hospital length of stay (p = 0.001) were significantly higher
in patients who developed AF in both groups. Conclusion: Keeping CVP low
in the first 72 post-CABG hours reduces the relative risk of AF, and may
be useful to prevent AF after CABG.<br/>Copyright &#xa9; 2017, Arquivos
Brasileiros de Cardiologia. All rights reserved.

<52>
Accession Number
616322435
Author
Droghetti A.; Marulli G.; Vannucci J.; Giovanardi M.; Bottoli M.C.; Ragusa
M.; Muriana G.
Institution
(Droghetti, Giovanardi, Bottoli, Muriana) Thoracic Surgery Division, Carlo
Poma Hospital, Mantova, Italy
(Marulli) Thoracic Surgery Division, University of Padova, Padova, Italy
(Vannucci, Ragusa) Thoracic Surgery Division, University of Perugia,
Perugia, Italy
Title
Cost analysis of pulmonary lobectomy procedure: Comparison of stapler
versus precision dissection and sealant.
Source
ClinicoEconomics and Outcomes Research. 9 (pp 201-206), 2017. Date of
Publication: 03 Apr 2017.
Publisher
Dove Medical Press Ltd (PO Box 300-008, Albany, 44 Corinthian Drive,
Albany,Auckland 0752, New Zealand. E-mail: angela@dovepress.com)
Abstract
Objective: We aimed to evaluate the direct costs of pulmonary lobectomy
hospitalization, comparing surgical techniques for the division of
interlobar fissures: stapler (ST) versus electrocautery and hemostatic
sealant patch (ES). Methods: The cost comparison analysis was based on the
clinical pathway and drawn up by collecting the information available from
the Thoracic Surgery Division medical team at Mantova Hospital. Direct
resource consumption was derived from a previous randomized controlled
trial including 40 patients. Use and maintenance of technology, equipment
and operating room; administrative plus general costs; and 30-day use of
postsurgery hospital resources were considered. The analysis was conducted
from the hospital perspective. Results: On the average, a patient
submitted to pulmonary lobectomy costs 9,744.29. This sum could vary from
9,027 (using ES) to 10,460 (using ST). The overall lower incidence (50% vs
95%, P=0.0001) and duration of air leakage (1.7 days vs 4.5 days,
P=0.0001) in the ES group significantly affects the mean time of hospital
stay (11.0 days vs 14.3 days) and costs. Cost saving in the ES group was
also driven by the lower incidence of complications. The main key cost
driver was staff employment (42%), then consumables (34%) and operating
room costs (12%). Conclusion: There is an overall saving of around
1,432.90 when using ES patch for each pulmonary lobectomy. Among patients
undergoing this surgical procedure, ES can significantly reduce air
leakage incidence and duration, as well as decrease hospitalization rates.
However, further multicenter research should be developed considering
different clinical and managerial settings.<br/>Copyright &#xa9; 2017
Droghetti et al.

<53>
Accession Number
616451313
Author
Kolokotroni S.M.; Toufektzian L.; Harling L.; Bille A.
Institution
(Kolokotroni, Toufektzian, Harling, Bille) Department of Thoracic Surgery,
Guy's Hospital, Great Maze Pond, London SE1 9RT, United Kingdom
Title
In patients undergoing lung resection is it safe to administer amiodarone
either as prophylaxis or treatment of atrial fibrillation?.
Source
Interactive Cardiovascular and Thoracic Surgery. 24 (5) (pp 783-788),
2017. Date of Publication: 01 May 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether the administration
of amiodarone is safe in patients undergoing lung resection either for
prophylaxis or treatment of de novo postoperative atrial fibrillation
(POAF). A total of 30 papers were identified, of which 13 represented the
best evidence to answer the clinical question. The authors, journal, date,
study type, country of publication, patient demographics, relevant
outcomes and results were tabulated. Among the identified papers, there
were 2 meta-Analyses, 1 best evidence topic and 3 randomized studies,
while the remainder were retrospective. When considering perioperative
amiodarone for the prophylaxis of POAF, 3 randomized studies reported no
significantly increased postoperative complications or amiodarone-related
side effects. Mortality and length of hospital stay were similar in
patients receiving amiodarone compared with either no amiodarone or other
prophylactic antiarrhythmic medication. When considering amiodarone for
the treatment of POAF, 1 study reported a significantly increased
incidence of ARDS after anatomical lung resection (P < 0.001). Two case
series reported that patients developing POAF after lung resection and
managed with amiodarone also had either none or acceptable rates of side
effects, with no serious respiratory complications. Two retrospective and
1 prospective observational study reported that amiodarone used either for
the treatment of POAF, or for prophylaxis against it, had similar rates of
postoperative respiratory complications, length of hospital stay and
mortality, compared with either no treatment or treatment with other
prophylactic or therapeutic agents. In accordance with the Society of
Thoracic Surgeons guidelines on prophylaxis and management of POAF in
general thoracic surgery, these data suggest that amiodarone is a safe
agent for the management of POAF after lung resection. Careful monitoring
in patients treated with amiodarone after pneumonectomy should be
considered because development of acute lung toxicity can increase length
of hospital stay, morbidity and mortality. Further studies may also be
needed to identify the subset of pneumonectomy patients at risk of
pulmonary toxicity after use of amiodarone.<br/>Copyright &#xa9; The
Author 2017. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<54>
Accession Number
616381451
Author
El Dib R.; Guimaraes Pereira J.E.; Agarwal A.; Gomaa H.; Ayala A.P.; Botan
A.G.; Braz L.G.; de Oliveira L.D.; Lopes L.C.; Mathew P.J.
Institution
(El Dib, Botan, de Oliveira) Institute of Science and Technology, Unesp -
Univ Estadual Paulista, Sao Jose dos Campos, Sao Paulo, Brazil
(El Dib, Guimaraes Pereira, Braz) Department of Anaesthesiology, Botucatu
Medical School, Unesp - Univ Estadual Paulista, Botucatu, Sao Paulo,
Brazil
(El Dib) McMaster Institute of Urology, McMaster University, Hamilton,
Ontario, Canada
(Agarwal) Faculty of Medicine, University of Toronto, Toronto, Canada
(Gomaa) Department of Pharmacy, Tanta Chest Hospital, Tanta, Egypt
(Ayala) Gerstein Science Information Centre, University of Toronto,
Toronto, Canada
(Lopes) Pharmaceutical Science Graduate Course, University of Sorocaba,
Sao Paulo, Brazil
(Mathew) Department of Anaesthesia and Intensive Care, Post Graduate
Institute of Medical Education and Research, Chandigarh, India
Title
Inhalation versus intravenous anaesthesia for adults undergoing on-pump or
off-pump coronary artery bypass grafting: A systematic review and
meta-analysis of randomized controlled trials.
Source
Journal of Clinical Anesthesia. 40 (pp 127-138), 2017. Date of
Publication: August 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective To compare the use of inhalation versus intravenous
anaesthesia for adults undergoing on-pump or off-pump coronary artery
bypass grafting. Design A systematic review. Setting A hospital-affiliated
university. Measurements The following databases were searched: the
Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 10),
MEDLINE, EMBASE, and LILACS (from inception to October 2016). We used the
GRADE approach to rate overall certainty of the evidence. Results In total
we included 58 studies with a total of 6105 participants. The
methodological quality was difficult to assess as it was poorly reported
in 35 included studies (three or more domains were rated as unclear risk
of bias). Two trials of sevoflurane showed a statistically significant
reduction in death within 180 to 365 days of surgery (on-pump) (RR 4.10,
95% CI 1.42 to 11.79; p = 0.009; I² = not applicable; high
quality of evidence). There was also a statistically significant
difference favouring sevoflurane compared to propofol on both inotropic
(RR 2.11, 95% CI 1.53 to 2.90; p < 0.00001; I² = 0%) and
vasoconstrictor support needed (RR 1.51, 95% CI 1.04 to 2.22; p = 0.03;
I² = 0%) after coronary artery bypass grafting on-pump. Two
trials of sevoflurane (MD - 0.22, 95% CI - 0.41 to - 0.03; p = 0.02;
I² = 0%) and two further trials of desflurane (MD - 0.33, 95%
CI - 0.45 to - 0.20; p < 0.00001; I² = 82%) showed a
statistically significant difference on cardiac index during and after
coronary artery bypass grafting on-pump, respectively. Conclusions There
is high quality evidence that sevoflurane reduces death within 180 to 365
days of surgery and, inotropic and vasoconstrictor support compared to
propofol for patients undergoing coronary artery bypass grafting. There is
also some evidence showing that the cardiac index is minimally influenced
by administration of sevoflurane and desflurane compared to
propofol.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<55>
Accession Number
616461523
Author
Labarrere C.A.; DiCarlo H.L.; Bammerlin E.; Hardin J.W.; Kim Y.M.;
Chaemsaithong P.; Haas D.M.; Kassab G.S.; Romero R.
Institution
(Labarrere) CBL Partners for Life, Indianapolis, IN, United States
(Labarrere, Kassab) California Medical Innovations Institute, San Diego,
CA, United States
(DiCarlo) Westside Regional Medical Center, Fort Lauderdale, FL, United
States
(Bammerlin) Indiana University Health Methodist Research Institute,
Indianapolis, IN, United States
(Haas) School of Medicine, Indianapolis, IN, United States
(Hardin) Department of Epidemiology and Biostatistics, University of South
Carolina, Columbia, SC, United States
(Kim) Department of Pathology, Haeundae Paik Hospital, Inje University
College of Medicine, Busan, South Korea
(Romero) Center for Molecular Medicine and Genetics, Detroit, MI, United
States
(Chaemsaithong) Department of Obstetrics and Gynecology, Wayne State
University, Detroit, MI, United States
(Romero) Perinatology Research Branch, Program for Perinatal Research and
Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver
National Institute of Child Health and Human Development, National
Institutes of Health, Bethesda, MD, and Detroit, MI, United States
(Romero) Department of Obstetrics and Gynecology, University of Michigan,
Ann Arbor, MI, United States
(Romero) Department of Epidemiology and Biostatistics, Michigan State
University, East Lansing, MI, United States
Title
Failure of physiologic transformation of spiral arteries, endothelial and
trophoblast cell activation, and acute atherosis in the basal plate of the
placenta.
Source
American Journal of Obstetrics and Gynecology. 216 (3) (pp
287.e1-287.e16), 2017. Date of Publication: 01 Mar 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Failure of physiologic transformation of spiral arteries has
been reported in preeclampsia, fetal growth restriction, fetal death, and
spontaneous preterm labor with intact or ruptured membranes. Spiral
arteries with failure of physiologic transformation are prone to develop
atherosclerotic-like lesions of atherosis. There are striking parallels
between preeclampsia and atherosclerotic disease, and between lesions of
atherosis and atherosclerosis. Endothelial activation, identified by
intercellular adhesion molecule-1 expression, is present in
atherosclerotic-like lesions of heart transplantation, and is considered a
manifestation of rejection. Similarly, endothelial activation/dysfunction
has been implicated in the pathophysiology of atherosclerosis and
preeclampsia. Intercellular adhesion molecule-1-overexpressing-activated
endothelial cells are more resistant to trophoblast displacement than
nonactivated endothelium, and may contribute to shallow spiral artery
trophoblastic invasion in obstetrical syndromes having failure of
physiologic transformation. Objective We sought to determine whether
failure of spiral artery physiologic transformation was associated with
activation of interstitial extravillous trophoblasts and/or spiral artery
endothelium and presence of acute atherosis in the placental basal plate.
Study Design A cross-sectional study of 123 placentas (19-42 weeks'
gestation) obtained from normal pregnancies (n = 22), preterm prelabor
rupture of membranes (n = 26), preterm labor (n = 23), preeclampsia (n =
27), intrauterine fetal death (n = 15), and small for gestational age (n =
10) was performed. Failure of spiral artery physiologic transformation and
presence of cell activation was determined using immunohistochemistry of
placental basal plates containing a median of 4 (minimum: 1; maximum: 9)
vessels per placenta. Endothelial/trophoblast cell activation was defined
by the expression of intercellular adhesion molecule-1. Investigators
examining microscopic sections were blinded to clinical diagnosis.
Pairwise comparisons among placenta groups were performed with Fisher
exact test and Wilcoxon rank sum test using a Bonferroni-adjusted level of
significance (.025). Results We found that 87% (94/108) of placentas
having spiral arteries with failure of physiologic transformation
(actin-positive and cytokeratin-negative) in the basal plate, and 0%
(0/15) of placentas having only spiral arteries with complete physiologic
transformation (cytokeratin-positive and actin-negative), had arterial
endothelial and/or interstitial extravillous trophoblasts reactive with
the intercellular adhesion molecule-1 activation marker (P < .001). A
significant correlation (R² = 0.84) was found between
expression of spiral artery endothelial and interstitial extravillous
trophoblast intercellular adhesion molecule-1 (P < .001) in activated
placentas. Lesions of atherosis were found in 31.9% (30/94) of placentas
with complete and/or partial failure of physiologic transformation of
spiral arteries that were intercellular adhesion molecule-1-positive, in
none of the 14 placentas with failure of physiologic transformation that
were intercellular adhesion molecule-1-negative, and in none of the 15
placentas with complete spiral artery physiologic transformation without
failure (P = .001). All placentas (30/30, 100%) with atherosis were
identified in placentas having concomitant spiral artery endothelial and
interstitial extravillous trophoblast activation. Conclusion Failure of
spiral artery physiologic transformation in the placental basal plate is
associated with interstitial extravillous trophoblast and arterial
endothelial activation along with increased frequency of spiral artery
atherosis. These findings may be used to improve the characterization of
different disorders of the placental bed such as in refining the existing
tools for the early prediction of risk for preterm, preeclamptic, and
other abnormal pregnancies.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<56>
Accession Number
616369006
Author
Mehta R.H.; Leimberger J.D.; Van Diepen S.; Meza J.; Wang A.; Jankowich
R.; Harrison R.W.; Hay D.; Fremes S.; Duncan A.; Soltesz E.G.; Luber J.;
Park S.; Argenziano M.; Murphy E.; Marcel R.; Kalavrouziotis D.; Nagpal
D.; Bozinovski J.; Toller W.; Heringlake M.; Goodman S.G.; Levy J.H.;
Harrington R.A.; Anstrom K.J.; Alexander J.H.
Institution
(Mehta, Leimberger, Meza, Wang, Harrison, Levy, Anstrom, Alexander) Duke
Clinical Research Institute, Duke University School of Medicine, 2400
Pratt St., Durham, NC 27705, United States
(Jankowich, Hay) Tenax Therapeutics, Morrisville, NC, United States
(Van Diepen, Goodman) Canadian VIGOUR Centre, University of Alberta,
Edmonton, Canada
(Fremes) Sunnybrook Health Sciences Centre, Toronto, Canada
(Kalavrouziotis) Quebec Heart and Lung Institute, London, QC, Canada
(Nagpal) Health Sciences Centre, London, ON, Canada
(Bozinovski) Victoria Heart Institute Foundation, Victoria, BC, Canada
(Duncan, Soltesz) Cleveland Clinic Foundation, Cleveland, United States
(Park) University Hospitals Cleveland Medical Center, Cleveland, United
States
(Luber) Franciscan Health System, Tacoma, WA, United States
(Argenziano) Columbia University Medical Center, New York, United States
(Murphy) Spectrum Health, Grand Rapids, MI, United States
(Marcel) Heart Hospital Baylor Plano, Plano, TX, United States
(Toller) Medical University of Graz, Graz, Austria
(Heringlake) University of Luebeck, Luebeck, Germany
(Harrington) Department of Medicine, Stanford University, Stanford, United
States
Title
Levosimendan in patients with left ventricular dysfunction undergoing
cardiac surgery.
Source
New England Journal of Medicine. 376 (21) (pp 2032-2042), 2017. Date of
Publication: 25 May 2017.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Levosimendan is an inotropic agent that has been shown in small
studies to prevent or treat the low cardiac output syndrome after cardiac
surgery. METHODS In a multicenter, randomized, placebo-controlled, phase 3
trial, we evaluated the efficacy and safety of levosimendan in patients
with a left ventricular ejection fraction of 35% or less who were
undergoing cardiac surgery with the use of cardiopulmonary bypass.
Patients were randomly assigned to receive either intravenous levosimendan
(at a dose of 0.2 mug per kilogram of body weight per minute for 1 hour,
followed by a dose of 0.1 mug per kilogram per minute for 23 hours) or
placebo, with the infusion started before surgery. The two primary end
points were a four-component composite of death through day 30,
renal-replacement therapy through day 30, perioperative myocardial
infarction through day 5, or use of a mechanical cardiac assist device
through day 5; and a two-component composite of death through day 30 or
use of a mechanical cardiac assist device through day 5. RESULTS A total
of 882 patients underwent randomization, 849 of whom received levosimendan
or placebo and were included in the modified intention-to-treat
population. The four-component primary end point occurred in 105 of 428
patients (24.5%) assigned to receive levosimendan and in 103 of 421
(24.5%) assigned to receive placebo (adjusted odds ratio, 1.00; 99%
confidence interval [CI], 0.66 to 1.54; P = 0.98). The two-component
primary end point occurred in 56 patients (13.1%) assigned to receive
levosimendan and in 48 (11.4%) assigned to receive placebo (adjusted odds
ratio, 1.18; 96% CI, 0.76 to 1.82; P = 0.45). The rate of adverse events
did not differ significantly between the two groups. CONCLUSIONS
Prophylactic levosimendan did not result in a rate of the short-term
composite end point of death, renal-replacement therapy, perioperative
myocardial infarction, or use of a mechanical cardiac assist device that
was lower than the rate with placebo among patients with a reduced left
ventricular ejection fraction who were undergoing cardiac surgery with the
use of cardiopulmonary bypass. (Funded by Tenax Therapeutics; LEVO-CTS
ClinicalTrials.gov number, NCT02025621.)<br/>Copyright &#xa9; 2017
Massachusetts Medical Society. All rights reserved.

<57>
Accession Number
616369005
Author
Landoni G.; Lomivorotov V.V.; Alvaro G.; Lobreglio R.; Pisano A.;
Guarracino F.; Calabro M.G.; Grigoryev E.V.; Likhvantsev V.V.;
Salgado-Filho M.F.; Bianchi A.; Pasyuga V.V.; Baiocchi M.; Pappalardo F.;
Monaco F.; Boboshko V.A.; Abubakirov M.N.; Amantea B.; Lembo R.; Brazzi
L.; Verniero L.; Bertini P.; Scandroglio A.M.; Bove T.; Belletti A.;
Michienzi M.G.; Shukevich D.L.; Zabelina T.S.; Bellomo R.; Zangrillo A.
Institution
(Landoni, Calabro, Pappalardo, Monaco, Lembo, Scandroglio, Bove, Belletti,
Zangrillo) Department of Anesthesia and Intensive Care, San Raffaele
Scientific Institute, Milan, Italy
(Landoni, Zangrillo) Vita-Salute San Raffaele University, Milan, Italy
(Alvaro, Amantea, Michienzi) Department of Anesthesia and Intensive Care,
Azienda Ospedaliero, Universitaria Mater Domini Germaneto, Catanzaro,
Italy
(Lobreglio, Brazzi) Department of Anesthesia and Intensive Care, Azienda
Ospedaliero, Universitaria Citta della Salute e della Scienza, Turin,
Italy
(Bianchi) Department of Cardiovascular Anesthesia and Intensive Care,
Azienda Ospedaliera Ordine Mauriziano, Turin, Italy
(Brazzi) Department of Surgical Sciences, University of Turin, Turin,
Italy
(Pisano, Verniero) Division of Cardiac Anesthesia and Intensive Care Unit,
Azienda Ospedaliera di Rilievo Nazionale Dei Colli-Monaldi Hospital,
Naples, Italy
(Guarracino, Bertini) Division of Cardiothoracic and Vascular Anesthesia
and Intensive Care, Department of Anesthesia and Critical Care Medicine,
Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
(Baiocchi) Department of Cardiothoracic and Vascular Anesthesia and
Intensive Care, University Hospital Policlinico S. Orsola, Bologna, Italy
(Lomivorotov, Boboshko, Abubakirov) Department of Anesthesiology and
Intensive Care, State Research Institute of Circulation Pathology,
Novosibirsk, Russian Federation
(Grigoryev, Shukevich) Department of Anesthesiology and Intensive Care,
State Research Institute for Complex Issues of Cardiovascular Disease,
Kemerovo, Russian Federation
(Likhvantsev, Zabelina) Department of Anesthesiology and Intensive Care,
Moscow Regional Clinical and Research Institute, Moscow, Russian
Federation
(Pasyuga) Department of Anesthesiology and Intensive Care, Federal Center
for Cardiovascular Surgery Astrakhan, Astrakhan, Russian Federation
(Salgado-Filho) Federal University of Juiz de for A, Juiz de Fora, Brazil
(Bellomo) Department of Intensive Care, Austin Hospital, Heidelberg,
University of Melbourne, Melbourne, VIC 3084, Australia
Title
Levosimendan for Hemodynamic Support after Cardiac Surgery.
Source
New England Journal of Medicine. 376 (21) (pp 2021-2031), 2017. Date of
Publication: 25 May 2017.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Acute left ventricular dysfunction is a major complication of
cardiac surgery and is associated with increased mortality. Meta-analyses
of small trials suggest that levosimendan may result in a higher rate of
survival among patients undergoing cardiac surgery. METHODS We conducted a
multicenter, randomized, double-blind, placebo-controlled trial involving
patients in whom perioperative hemodynamic support was indicated after
cardiac surgery, according to prespecified criteria. Patients were
randomly assigned to receive levosimendan (in a continuous infusion at a
dose of 0.025 to 0.2 mug per kilogram of body weight per minute) or
placebo, for up to 48 hours or until discharge from the intensive care
unit (ICU), in addition to standard care. The primary outcome was 30-day
mortality. RESULTS The trial was stopped for futility after 506 patients
were enrolled. A total of 248 patients were assigned to receive
levosimendan and 258 to receive placebo. There was no significant
difference in 30-day mortality between the levosimendan group and the
placebo group (32 patients [12.9%] and 33 patients [12.8%], respectively;
absolute risk difference, 0.1 percentage points; 95% confidence interval
[CI], -5.7 to 5.9; P = 0.97). There were no significant differences
between the levosimendan group and the placebo group in the durations of
mechanical ventilation (median, 19 hours and 21 hours, respectively;
median difference, -2 hours; 95% CI, -5 to 1; P = 0.48), ICU stay (median,
72 hours and 84 hours, respectively; median difference, -12 hours; 95% CI,
-21 to 2; P = 0.09), and hospital stay (median, 14 days and 14 days,
respectively; median difference, 0 days; 95% CI, -1 to 2; P = 0.39). There
was no significant difference between the levosimendan group and the
placebo group in rates of hypotension or cardiac arrhythmias. CONCLUSIONS
In patients who required perioperative hemodynamic support after cardiac
surgery, low-dose levosimendan in addition to standard care did not result
in lower 30-day mortality than placebo. (Funded by the Italian Ministry of
Health; CHEETAH ClinicalTrials.gov number, NCT00994825.).<br/>&#xa9;
Copyright 2017 Massachusetts Medical Society. All rights reserved.

<58>
Accession Number
616453874
Author
Kokkinidis D.G.; Oikonomou E.K.; Papanastasiou C.A.; Theochari C.A.;
Giannakoulas G.
Institution
(Kokkinidis, Oikonomou, Papanastasiou, Theochari, Giannakoulas)
Thessaloniki, Greece
Title
Methodological Remarks in the Meta-Analysis on the Impact of Baseline
Pulmonary Hypertension on Post-Transcatheter Aortic Valve Implantation
Outcomes.
Source
American Journal of Cardiology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)

<59>
Accession Number
616406349
Author
Mathews T.; Berger J.; Weintraub H.; Schwartzbard A.; Underberg J.; Newman
J.; Heffron S.; Schoenthaler A.; Fisher E.; Gianos E.
Institution
(Mathews, Berger, Weintraub, Schwartzbard, Underberg, Newman, Heffron,
Schoenthaler, Fisher, Gianos) New YorkNYUnited States
Title
Investigation of motivational interviewing and prevention consults to
achieve cardiovascular targets (IMPACT) trial attainment of national lipid
association guideline (NLA) Goals.
Source
Journal of Clinical Lipidology. Conference: 2017 Annual Scientific
Sessions of the National Lipid Association. United States. 11 (3) (pp
802-803), 2017. Date of Publication: May-June 2017.
Publisher
Elsevier Ltd
Abstract
Background/Synopsis: Patients undergoing cardiovascular (CV) procedures
often fail to attain CV risk factor and lifestyle goals despite guideline
recommendations for established cardiovascular disease (CVD). The NLA
recommends the use of high potency statins, achieving an LDL-C <70 mg/dl
and Non-HDL <100 mg/dl in individuals with established CVD.
Objective/Purpose: The aim of the current study is to determine the uptake
of NLA recommendations in the secondary prevention IMPACT trial population
through use of high potency statins and attainment of LDL-C <70 mg/dl and
Non-HDL <100 mg/dl in high-risk ASCVD patients. Methods: The IMPACT trial
is a prospective randomized, controlled clinical trial conducted in
patients undergoing a non-urgent CV procedure to evaluate the impact of
different prevention strategies on cardiovascular risk factors 6 months
post-procedure. 400 patients were randomized in a 1:1:1 fashion to usual
care (Group A), in-hospital prevention consult (Group B), or in-hospital
prevention consult plus behavioral intervention program [telephone-based
motivational interviewing and tailored text messages] (Group C). The
primary endpoint was non-HDL. Secondary endpoints included LDL-C, HDL,
triglycerides, blood pressure, HbA1c, body mass index, guideline-directed
medical therapy, and validated measures of lifestyle and quality of life
(QOL). The current study analyzed the number of patients achieving the
current NLA recommended goals. Results: The mean age was 64.6 +/- 10.8
years, 23.7% were female and 31.5% were non-white. Only 43 of 397 (8.7%)
and 43 (10.8%) patients were initially at goal for LDL-C and Non-HDL. At
6-months, there were no between-group differences in the intervention and
control arms (B and C vs A) for the primary end-point (non-HDL) with an
absolute reduction of -4.42 mg/dl, [95% CI (-12.7, 6.2) (p=0.29)].
Although there was a statistically significant increase in the number of
patients achieving LDL-C <70mg/dl and Non-HDL-C <100mg/dl in the overall
cohort 122 (30.7%) (P < 0.001) and 149 (37.5%) (P < 0.001) respectively,
there were no between group differences. Patients in the intervention
groups, however, were more likely to be on high intensity statins at 6
months than control group, (52.9% vs. 38.1%, p=0.01). Conclusions: At 6
months post cardiovascular procedures, patients at goal for LDL-C and
Non-HDL increased significantly in all groups, but the majority of
patients (>60%) remain above NLA lipid targets.

<60>
Accession Number
616160579
Author
Sumner J.; Harrison A.; Doherty P.
Institution
(Sumner, Harrison, Doherty) University of York, Department of Health
Sciences, York, United Kingdom
Title
The effectiveness of modern cardiac rehabilitation: A systematic review of
recent observational studies in non-attenders versus attenders.
Source
PLoS ONE. 12 (5) (no pagination), 2017. Article Number: e0177658. Date of
Publication: May 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background The beneficial effects of cardiac rehabilitation (CR) have been
challenged in recent years and there is now a need to investigate whether
current CR programmes, delivered in the context of modern cardiology,
still benefit patients. Methods A systematic review of non-randomised
controlled studies was conducted. Electronic searches of Medline, Embase,
CINAHL, science citation index (web of science), CIRRIE and Open Grey were
undertaken. Non-randomised studies investigating the effects of CR were
included when recruitment occurred from the year 2000 onwards in
accordance with significant CR guidance changes from the late 1990's.
Adult patients diagnosed with acute myocardial infarction (AMI) were
included. Non-English articles were considered. Two reviewers
independently screened articles according to pre-defined selection
criteria as reported in the PROSPERO database (CRD42015024021). Results
Out of 2,656 articles, 8 studies involving 9,836 AMI patients were
included. Studies were conducted in 6 countries. CR was found to reduce
the risk of all-cause and cardiac-related mortality and improve
Health-Related Quality of Life (HRQOL) significantly in at least one
domain. The benefits of CR in terms of recurrent MI were inconsistent and
no significant effects were found regarding re-vascularisation or
re-hospitalisation following AMI. Conclusion Recent observational evidence
draws different conclusions to the most current reviews of trial data with
respect to total mortality and re-hospitalisation, questioning the
representativeness of historic data in the modern cardiological era.
Future work should seek to clarify which patient and service level factors
determine the likelihood of achieving improved allcause and cardiac
mortality and reduced hospital re-admissions.<br/>Copyright &#xa9; This is
an open access article, free of all copyright, and may be freely
reproduced, distributed, transmitted, modified, built upon, or otherwise
used by anyone for any lawful purpose. The work is made available under
the Creative Commons CC0 public domain dedication.

<61>
Accession Number
616160343
Author
Gotberg M.; Christiansen E.H.; Gudmundsdottir I.J.; Sandhall L.;
Danielewicz M.; Jakobsen L.; Olsson S.-E.; Ohagen P.; Olsson H.; Omerovic
E.; Calais F.; Lindroos P.; Maeng M.; Todt T.; Venetsanos D.; James S.K.;
Karegren A.; Nilsson M.; Carlsson J.; Hauer D.; Jensen J.; Karlsson A.-C.;
Panayi G.; Erlinge D.; Frobert O.
Institution
(Gotberg, Todt, Nilsson, Erlinge) Department of Cardiology, Clinical
Sciences, Lund University, Skane University Hospital, Lund 222 41, Sweden
(Sandhall, Olsson) Departments of Cardiology and Radiology, Helsingborg
Hospital, Helsingborg, Sweden
(Danielewicz, Olsson) Department of Cardiology, Karlstad Hospital,
Karlstad, Sweden
(Ohagen) Uppsala Clinical Research Center, Uppsala University, Uppsala,
Sweden
(James) Department of Medical Sciences, Uppsala University, Uppsala,
Sweden
(Omerovic) Department of Cardiology, Sahlgrenska University Gothenburg,
Sweden
(Calais, Frobert) Department of Cardiology, Faculty of Health, Orebro
University, Orebro, Sweden
(Lindroos) Department of Cardiology, St. Goran Hospital, Stockholm, Sweden
(Jensen) Department of Clinical Science and Education, Sodersjukhuset,
Karolinska Institutet, Stockholm, Sweden
(Jensen) Unit of Cardiology, Capio St. Gorans Sjukhus, Stockholm, Sweden
(Venetsanos, Hauer, Panayi) Departments of Cardiology and of Medical and
Health Sciences, Linkoping University, Linkoping, Sweden
(Karegren) Department of Internal Medicine, Vastmanland Hospital Vasteras,
Vasteras, Sweden
(Carlsson) Department of Cardiology, Kalmar County Hospital, Linnaeus
University, Faculty of Health and Life Sciences, Kalmar, Sweden
(Jensen) Department of Medicine, Sundsvall Hospital, Sundsvall, Sweden
(Karlsson) Department of Cardiology, Halmstad Hospital, Halmstad, Sweden
(Christiansen, Jakobsen, Maeng) Department of Cardiology, Aarhus
University Hospital, Aarhus, Denmark
(Gudmundsdottir) Department of Cardiology, Reykjavik University Hospital,
Reykjavik, Iceland
Title
Instantaneous wave-free ratio versus fractional flow reserve to guide PCI.
Source
New England Journal of Medicine. 376 (19) (pp 1813-1823), 2017. Date of
Publication: 11 May 2017.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND The instantaneous wave-free ratio (iFR) is an index used to
assess the severity of coronary-artery stenosis. The index has been tested
against fractional flow reserve (FFR) in small trials, and the two
measures have been found to have similar diagnostic accuracy. However,
studies of clinical outcomes associated with the use of iFR are lacking.
We aimed to evaluate whether iFR is noninferior to FFR with respect to the
rate of subsequent major adverse cardiac events. METHODS We conducted a
multicenter, randomized, controlled, open-label clinical trial using the
Swedish Coronary Angiography and Angioplasty Registry for enrollment. A
total of 2037 participants with stable angina or an acute coronary
syndrome who had an indication for physiologically guided assessment of
coronary-artery stenosis were randomly assigned to undergo
revascularization guided by either iFR or FFR. The primary end point was
the rate of a composite of death from any cause, nonfatal myocardial
infarction, or unplanned revascularization within 12 months after the
procedure. RESULTS A primary end-point event occurred in 68 of 1012
patients (6.7%) in the iFR group and in 61 of 1007 (6.1%) in the FFR group
(difference in event rates, 0.7 percentage points; 95% confidence interval
[CI], -1.5 to 2.8; P = 0.007 for noninferiority; hazard ratio, 1.12; 95%
CI, 0.79 to 1.58; P = 0.53); the upper limit of the 95% confidence
interval for the difference in event rates fell within the prespecified
noninferiority margin of 3.2 percentage points. The results were similar
among major subgroups. The rates of myocardial infarction, target-lesion
revascularization, restenosis, and stent thrombosis did not differ
significantly between the two groups. A significantly higher proportion of
patients in the FFR group than in the iFR group reported chest discomfort
during the procedure. CONCLUSIONS Among patients with stable angina or an
acute coronary syndrome, an iFR-guided revascularization strategy was
noninferior to an FFR-guided revascularization strategy with respect to
the rate of major adverse cardiac events at 12 months.<br/>Copyright
&#xa9; 2017 Massachusetts Medical Society. All rights reserved.

<62>
Accession Number
610253343
Author
Seres D.S.; Ippolito P.R.
Institution
(Seres, Ippolito) Division of Preventive Medicine and Nutrition,
Department of Medicine, Columbia University Medical Center, New York, NY,
United States
(Seres) Institute of Human Nutrition, Columbia University Medical Center,
New York, NY, United States
Title
Pilot study evaluating the efficacy, tolerance and safety of a
peptide-based enteral formula versus a high protein enteral formula in
multiple ICU settings (medical, surgical, cardiothoracic).
Source
Clinical Nutrition. 36 (3) (pp 706-709), 2017. Date of Publication: June
2017.
Publisher
Churchill Livingstone
Abstract
Introduction Predigested, peptide-based enteral formulas are commonly used
to promote GI tolerance in critically ill patients, but studies comparing
these against polymeric enteral formulas are lacking. We performed a
prospective, randomized clinical comparison pilot study to assess safety,
tolerance and effectiveness of a peptide-based enteral product. Methods
Critically ill patients from ICUs, including medical, surgical, and
cardiothoracic, were randomized to either of two enteral feeding products:
Group A: Peptide-based, high Protein, high omega-3 fat (Vital
AF, Abbott Nutrition); Group B: high protein standard enteral
formula (Osmolite, Abbott Nutrition). Tolerance and
comorbidities as well as enteral feeding volume were collected at baseline
and then daily for up to 21 days, or until the patient was discharged from
the ICU. Results A total of 49 patients were included, 25 (51%) on group
A, 24 (49%) on group B. Adverse events and undesired gastrointestinal
events at baseline and mean intake (ml/d and percent of goal) post
baseline were not different between the groups. There were significantly
fewer days with adverse events (p = 0.0336, odds ratio = 3.02, standard
error = 1.60, n = 24 per group) and undesired gastrointestinal events (p =
0.0489, odds ratio = 2.79, standard error = 1.48, n = 24 per group) in
group A. There was no difference in other clinical outcomes. Conclusion
This pilot study suggests that feeding a peptide-based formula to ICU
patients may be associated with a statistically significant reduction in
the number of days during which adverse events occurred as compared to a
standard formula.<br/>Copyright &#xa9; 2016 Elsevier Ltd and European
Society for Clinical Nutrition and Metabolism

<63>
Accession Number
616209733
Author
Asher E.; Frydman S.; Katz M.; Regev E.; Sabbag A.; Mazin I.; Abu-Much A.;
Kukuy A.; Mazo A.; Erez A.; Berkovitch A.; Narodistky M.; Barbash I.;
Segev A.; Beigel R.; Matetzky S.
Institution
(Asher, Frydman, Katz, Regev, Sabbag, Mazin, Abu-Much, Kukuy, Mazo, Erez,
Berkovitch, Narodistky, Barbash, Segev, Beigel, Matetzky) Leviev Heart
Center, Sheba Medical Center Tel Hashomer, Israel
Title
Chewing versus swallowing ticagrelor to accelerate platelet inhibition in
acute coronary syndrome - the CHEERS study: For the PLATIS (Platelets and
Thrombosis in Sheba) study group.
Source
Thrombosis and Haemostasis. 117 (4) (pp 727-733), 2017. Date of
Publication: 2017.
Publisher
Schattauer GmbH (E-mail: info@schattauer.de)
Abstract
It was the study objective to evaluate whether chewing a 180 mg loading
dose of ticagrelor versus an equal dose of traditional oral
administration, enhances inhibition of platelet aggregation 1 hour (h)
after administering a ticagrelor loading dose in non-ST elevation
myocardial infarction (NSTEMI) patients. Dual anti-platelet therapy
represents standard care for treating NSTEMI patients. Ticagrelor is a
direct acting P2Y12 inhibitor and, unlike clopidogrel and prasugrel, does
not require metabolic activation. Fifty NSTEMI patients were randomised to
receive either a chewing loading dose of 180 mg ticagrelor or an equal
standard oral dose of ticagrelor. Platelet reactivity was evaluated by
VerifyNow at baseline, 1 and 4 h post-loading dose. Results are reported
in P2Y12 reaction units. Patients then continued to receive standard 90 mg
oral ticagrelor twice daily. Baseline characteristics did not differ
between the two groups. P2Y12 reaction units in the chewing group compared
with the standard group at 0, 1 and 4 h after ticagrelor loading dose
were: 245 vs 239 (p=0.59), 45 vs 130 (p=0.001) and 39 vs 60 (p=0.12),
respectively, corresponding to a relative inhibition of platelet
aggregation of 83 % vs only 47 % at 1 h (p< 0.001), and 84 % vs 77 %
(p=0.59) at 4 h. Major adverse cardiac and cardiovascular events at 30
days were low (2 %), occurring in only one patient in the standard group.
In conclusion, chewing a 180 mg ticagrelor loading dose is feasible and
facilitates both faster and improved early inhibition of platelet
aggregation in NSTEMI patients, compared with a standard oral-loading
dose.<br/>Copyright &#xa9; Schattauer 2017.

<64>
Accession Number
616266600
Author
Thongprayoon C.; Cheungpasitporn W.; Thamcharoen N.; Ungprasert P.;
Kittanamongkolchai W.; Mao M.A.; Sakhuja A.; Greason K.L.; Kashani K.
Institution
(Thongprayoon, Cheungpasitporn, Kittanamongkolchai, Mao, Kashani) Division
of Nephrology and Hypertension, Department of Internal Medicine, Mayo
Clinic, Rochester, MN, United States
(Thongprayoon, Thamcharoen) Department of Medicine, Bassett Medical
Center, Cooperstown, NY, United States
(Ungprasert) Division of Rheumatology, Department of Internal Medicine,
Mayo Clinic, Rochester, MN, United States
(Sakhuja, Kashani) Division of Pulmonary and Critical Care Medicine,
Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
(Greason) Division of Cardiovascular Surgery, Department of Surgery, Mayo
Clinic, Rochester, MN, United States
Title
Association of frailty status with acute kidney injury and mortality after
transcatheter aortic valve replacement: A systematic review and
meta-analysis.
Source
PLoS ONE. 12 (5) (no pagination), 2017. Article Number: e0177157. Date of
Publication: May 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Objective: Frailty is a common condition in patients with severe aortic
stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).
The aim of this systematic review was to assess the impact of frailty
status on acute kidney injury (AKI) and mortality after TAVR. Methods: A
systematic literature search was conducted using MEDLINE, EMBASE, and
Cochrane databases from the inception through November 2016. The protocol
for this study is registered with PROSPERO (International Prospective
Register of Systematic Reviews; no. CRD42016052350). Studies that reported
odds ratios, relative risks or hazard ratios comparing the risk of AKI
after TAVR in frail vs. non-frail patients were included. Mortality risk
was evaluated among the studies that reported AKI-related outcomes. Pooled
risk ratios (RR) and 95% confidence interval (CI) were calculated using a
random-effect, generic inverse variance method. Results: Eight cohort
studies with a total of 10,498 patients were identified and included in
the metaanalysis. The pooled RR of AKI after TAVR among the frail patients
was 1.19 (95% CI 0.97- 1.46, I² = 0), compared with non-frail
patients. When the meta-analysis was restricted only to studies with
standardized AKI diagnosis according to Valve Academic Research Consortium
(VARC)-2 criteria, the pooled RRs of AKI in frail patients was 1.16 (95%
CI 0.91-1.47, I² = 0). Within the selected studies, frailty
status was significantly associated with increased mortality (RR 2.01; 95%
CI 1.44-2.80, I² = 58). Conclusion: The findings from our study
suggest no significant association between frailty status and AKI after
TAVR. However, frailty status is associated with mortality after TAVR and
may aid appropriate patient selection for TAVR.<br/>Copyright &#xa9; 2017
Thongprayoon et al. This is an open access article distributed under the
terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.

<65>
Accession Number
613819482
Author
Langlois P.L.; Hardy G.; Manzanares W.
Institution
(Langlois) Department of Anesthesiology and Reanimation, Faculty of
Medicine and Health Sciences, Sherbrooke University Hospital, Sherbrooke,
Quebec, Canada
(Hardy) Ipanema Research Trust, Auckland, New Zealand
(Manzanares) Department of Critical Care, Intensive Care Unit, University
Hospital, Faculty of Medicine, UDELAR, Montevideo, Uruguay
Title
Omega-3 polyunsaturated fatty acids in cardiac surgery patients: An
updated systematic review and meta-analysis.
Source
Clinical Nutrition. 36 (3) (pp 737-746), 2017. Date of Publication: June
2017.
Publisher
Churchill Livingstone
Abstract
Background Omega-3 polyunsaturated fatty acids (omega-3 PUFA)
supplementation is an attractive therapeutic option for patients
undergoing open-heart surgery due to their anti-inflammatory and
anti-arrhythmic properties. Several randomized controlled trials (RCT)
have found contradictory results for perioperative omega-3 PUFA
administration. Therefore, we conducted an updated systematic review and
meta-analysis evaluating the effects of perioperative omega-3 PUFA on some
clinically important outcomes for cardiac surgery. Methods A systematic
literature search was conducted to find RCT evaluating clinical outcomes
after omega-3 PUFA therapy in adult patients undergoing cardiac surgery.
Intensive care unit (ICU) length of stay (LOS) was the primary outcome;
secondary outcomes were hospital LOS, postoperative atrial fibrillation
(POAF), mortality and duration of mechanical ventilation (MV). Predefined
subgroup analysis and sensibility analysis were performed. Results A total
of 19 RCT including 4335 patients met inclusion criteria. No effect of
omega-3 PUFA on ICU LOS was found (weighted mean difference WMD -2.95, 95%
confidence interval, CI -10.28 to 4.39, P = 0.43). However, omega-3 PUFA
reduced hospital LOS (WMD -1.37, 95% CI -2.41 to -0.33; P = 0.010) and
POAF incidence (Odds Ratio OR = 0.78, 95% CI 0.68 to 0.90; P = 0.004). No
effects were found on mortality or MV duration. Heterogeneity remained in
subgroup analysis and we found a significant POAF reduction when omega-3
PUFA doses were administered to patients exposed to extra-corporeal
circulation. Oral/enteral administration seemed to further reduce POAF.
Conclusions In patients undergoing cardiac surgery, omega-3 PUFA
supplementation by oral/enteral and parenteral route reduces hospital LOS
and POAF. Nonetheless considerable clinical and statistical heterogeneity
weaken our findings.<br/>Copyright &#xa9; 2016 Elsevier Ltd and European
Society for Clinical Nutrition and Metabolism

<66>
Accession Number
616112927
Author
Brindle M.E.; Roberts D.J.; Daodu O.; Haynes A.B.; Cauley C.; Dixon E.; La
Flamme C.; Bain P.; Berry W.
Institution
(Brindle, Daodu) Department of Surgery, University of Calgary, Calgary,
Canada
(Roberts) Departments of Surgery and Community Health Sciences, University
of Calgary and the Foothills Medical Centre, Calgary, Canada
(Haynes, Cauley) Department of Surgery, Massachusetts General Hospital,
Boston, MA, United States
(Haynes, Berry) Ariadne Labs, Boston, MA, United States
(Dixon) Department of Surgery, University of Calgary and the Foothills
Medical Centre, Calgary, Canada
(La Flamme) Sunnybrook Health Sciences Centre, Toronto, Canada
(Bain) Department of Countway Library, Harvard Medical School, Boston, MA,
United States
Title
Deriving literature-based benchmarks for surgical complications in
high-income countries: A protocol for a systematic review and
meta-Analysis.
Source
BMJ Open. 7 (5) (no pagination), 2017. Article Number: e013780. Date of
Publication: 01 May 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction To improve surgical safety, health systems must identify
preventable adverse outcomes and measure changes in these outcomes in
response to quality improvement initiatives. This requires understanding
of the scope and limitations of available population-level data. To derive
literature-based summary estimates of benchmarks of care, we will
systematically review and meta-Analyse rates of postoperative
complications associated with several common and/or high-risk operations
performed in five high-income countries (HICs). Methods and analysis An
electronic search of PubMed, Embase, Web of Science, Cochrane Central, the
NHS Economic Evaluations Database and Health Technology Assessment
database will be performed to identify studies reviewing national surgical
complication rates between 2000 and 2016. Two reviewers will screen titles
and abstracts and full texts of potentially relevant studies to determine
eligibility for inclusion in the systematic review. We will include
English-language publications using data from health databases in the USA,
Canada, the UK, Australia and New Zealand. We will include studies of
patients who underwent hip or knee arthoplasty, appendectomy,
cholecystectomy, oesophagectomy, abdominal aortic aneurysm repair, aortic
valve replacement or coronary artery bypass graft. Outcomes will include
mortality, length of hospital stay, pulmonary embolism, pneumonia, sepsis
or septic shock, reoperation, surgical site infection, wound
dehiscence/disruption, blood transfusion, bile duct injury, stroke and
myocardial infarction. We will calculate summary estimates of cumulative
incidence, incidence rate, prevalence and occurrence rate of complications
using DerSimonian and Laird random effects models. Heterogeneity in these
estimates will be examined using subgroup analyses and meta-regression. We
will correlate findings within contemporary clinical databases. Ethics and
dissemination This study of secondary data does not require ethics
approval. It will be presented internationally and published in the
peer-reviewed literature. Results will inform a future quality improvement
tool and provide benchmarks of surgical complication rates within HICs.
Trial registration International Prospective Register of Systematic
Reviews (PROSPERO). Registration number CRD42016037519.<br/>Copyright
&#xa9; Article author(s) (or their employer(s) unless otherwise stated in
the text of the article) 2017. All rights reserved. No commercial use is
permitted unless otherwise expressly granted.

<67>
Accession Number
616113042
Author
Siddiqu N.U.R.; Merchant Q.; Hasan B.S.; Rizvi A.; Amanullah M.; Rehmat
A.; Haq A.U.
Institution
(Siddiqu, Merchant, Hasan, Rizvi, Haq) Department of Pediatrics and Child
Health, Aga Khan University Hospital, Karachi, Pakistan
(Amanullah) Department of Surgery, Aga Khan University, Karachi, Pakistan
(Rehmat) Aga Khan University, Karachi, Pakistan
Title
Comparison of enteral versus intravenous potassium supplementation in
hypokalaemia in paediatric patients in intensive care post cardiac
surgery: Open-label randomised equivalence trial (EIPS).
Source
BMJ Open. 7 (5) (no pagination), 2017. Article Number: e011179. Date of
Publication: 01 May 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives The primary objective was to compare the efficacy of enteral
potassium replacement (EPR) and intravenous potassium replacement (IVPR)
as first-line therapy. Secondary objectives included comparison of adverse
effects and number of doses required to resolve the episode of
hypokalaemia. Trial design The EIPS trial is designed as a randomised,
equivalence trial between two treatment arms. Study setting The study was
conducted at the paediatric cardiac intensive care unit (PCICU) at Aga
Khan University Hospital, Karachi. Participants 41 patients (aged 1 month
to 15 years) who were admitted to PCICU post cardiac surgery were
recruited (23 IVPR arm and 18 EPR arm). Intervention Intervention arms
were block randomised on alternate weeks for IVPR and EPR. Outcome measure
Change in serum potassium levels in (mmol/L) and percentage change after
each event of potassium replacement by the intravenous or enteral route.
Results Both groups (41 patients) had similar baseline characteristics.
Mean age was 4.7 (SD+/-4) years while the most common surgical procedure
was ventricular septal defect repair (12 patients, 29.3%). No mortality
was observed in either arm. Four episodes of vomiting and one arrhythmia
were seen in the EPR group. After adjusting for age, potassium level at
the beginning of the episode, average urine output, inotropic score and
diuretic dose, it was found that there was no statistically significant
difference in change in potassium levels after EPR and IVPR: 0.86 mmol/L
(+/-0.8) and 0.82 mmol/L (+/-0.7) respectively (p=0.86, 95% CI-0.08 to
1.10), or percentage change in potassium level after enteral and
intravenous replacement: 26% (+/-30) and 24% (+/-20) (95% CI-3.42 to 4.03,
p=0.87). Conclusion EPR may be an equally efficacious alternative
first-line therapy in treating hypokalaemia after surgery in selective
patients with congenital heart disease. Ethics and dissemination This
study has been approved by Ethics Review Committee at AKU.<br/>Copyright
&#xa9; 2017 Article author(s) (or their employer(s) unless otherwise
stated in the text of the article) 2017. All rights reserved. No
commercial use is permitted unless otherwise expressly granted.

<68>
Accession Number
616160344
Author
Davies J.E.; Sen S.; Dehbi H.-M.; Al-Lamee R.; Petraco R.; Nijjer S.S.;
Bhindi R.; Lehman S.J.; Walters D.; Sapontis J.; Janssens L.; Vrints C.J.;
Khashaba A.; Laine M.; Van Belle E.; Krackhardt F.; Bojara W.; Going O.;
Harle T.; Indolfi C.; Niccoli G.; Ribichini F.; Tanaka N.; Yokoi H.;
Takashima H.; Kikuta Y.; Erglis A.; Vinhas H.; Canas Silva P.; Baptista
S.B.; Alghamdi A.; Hellig F.; Koo B.-K.; Nam C.-W.; Shin E.-S.; Doh J.-H.;
Brugaletta S.; Alegria-Barrero E.; Meuwissen M.; Piek J.J.; Van Royen N.;
Sezer M.; Di Mario C.; Gerber R.T.; Malik I.S.; Sharp A.S.P.; Talwar S.;
Tang K.; Samady H.; Altman J.; Seto A.H.; Singh J.; Jeremias A.; Matsuo
H.; Kharbanda R.K.; Patel M.R.; Serruys P.; Escaned J.
Institution
(Davies, Sen, Al-Lamee, Petraco, Nijjer, Malik, Serruys) Hammersmith
Hospital, Imperial College London, Cancer Research UK, London W12 OHS,
United Kingdom
(Di Mario) Royal Brompton Hospital, Imperial College London, Cancer
Research UK, London, United Kingdom
(Dehbi) University College London Cancer Trials Centre, London, United
Kingdom
(Gerber) Conquest Hospital, St. Leonards-on-Sea, United Kingdom
(Sharp) Royal Devon and Exeter Hospital, University of Exeter, Exeter,
United Kingdom
(Talwar) Royal Bournemouth General Hospital, Bournemouth, United Kingdom
(Tang) Essex Cardiothoracic Centre, Basildon, United Kingdom
(Tang) Anglia Ruskin University, Chelmsford, United Kingdom
(Kharbanda) John Radcliffe Hospital, Oxford University Hospitals
Foundation Trust, Oxford, United Kingdom
(Bhindi) Royal North Shore Hospital, Sydney, Australia
(Lehman) Flinders University, Adelaide, SA, Australia
(Walters) Prince Charles Hospital, Brisbane, QLD, Australia
(Sapontis) MonashHeart and Monash University, Melbourne, VIC, Australia
(Janssens) Imelda Hospital, Bonheiden, Belgium
(Vrints) Antwerp University Hospital, Antwerp, Belgium
(Khashaba) Ain Shams University, Cairo, Egypt
(Laine) Helsinki University Hospital, Helsinki, Finland
(Van Belle) Institut Coeur Poumon, Lille University Hospital, INSERM Unite
1011, Lille, France
(Krackhardt) Charite Campus Virchow Klinikum, Universitaetsmedizin,
Berlin, Germany
(Bojara) Gemeinschaftsklinikum Mittelrhein, Kemperhof Koblenz, Koblenz,
Germany
(Going) Sana Klinikum Lichtenberg, Lichtenberg, Germany
(Harle) Klinikum Oldenburg, European Medical School, Carl von Ossietzky
University, Oldenburg, Germany
(Indolfi) University Magna Graecia, Catanzaro, Italy
(Niccoli) Catholic University of the Sacred Heart, Rome, Italy
(Ribichini) University Hospital Verona, Verona, Italy
(Di Mario) University of Florence, Florence, Italy
(Tanaka) Tokyo Medical University, Tokyo, Japan
(Yokoi) Fukuoka Sannou Hospital, Fukuoka, Japan
(Takashima) Aichi Medical University Hospital, Aichi, Japan
(Kikuta) Fukuyama Cardiovascular Hospital, Fukuyama, Japan
(Matsuo) And Gifu Heart Center, Gifu, Japan
(Erglis) Pauls Stradins Clinical University Hospital, Riga, Latvia
(Vinhas) Hospital Garcia de Horta, Lisbon, Portugal
(Canas Silva) Hospital Santa Maria, Lisbon, Portugal
(Baptista) Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
(Alghamdi) King Abdulaziz Medical City Cardiac Center, Riyadh, Saudi
Arabia
(Hellig) Sunninghill Hospital, Johannesburg, South Africa
(Koo) Seoul National University Hospital, Seoul, South Korea
(Nam) Keimyung University Dongsan Medical Center, Daegu, South Korea
(Shin) Ulsan University Hospital, University of Ulsan, College of
Medicine, Ulsan, South Korea
(Doh) Inje University Ilsan Paik Hospital, Daehwa-Dong, South Korea
(Brugaletta) Cardiovascular Institute, Hospital Clinic, Institut
d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona,
Spain
(Alegria-Barrero) Hospital Universitario de Torrejon, Universidad
Francisco de Vitoria, Spain
(Escaned) Hospital Clinico San Carlos, Universidad Complutense de Madrid,
Madrid, Spain
(Meuwissen) Amphia Hospital, Breda, Netherlands
(Piek) AMC Heart Center, Academic Medical Center, Amsterdam, Netherlands
(Van Royen) VU University Medical Center, Amsterdam, Netherlands
(Sezer) Istanbul University, Istanbul Faculty of Medicine, Istanbul,
Turkey
(Samady) Emory University, Atlanta, United States
(Altman) Colorado Heart and Vascular, Lakewood, United States
(Seto) Veterans Affairs Long Beach Healthcare System, Long Beach, CA,
United States
(Singh) Washington University, School of Medicine, St. Louis, United
States
(Jeremias) Stony Brook University Medical Center, New York, United States
(Patel) Duke University, Durham, United States
Title
Use of the instantaneous wave-free ratio or fractional flow reserve in
PCI.
Source
New England Journal of Medicine. 376 (19) (pp 1824-1834), 2017. Date of
Publication: 11 May 2017.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Coronary revascularization guided by fractional flow reserve
(FFR) is associated with better patient outcomes after the procedure than
revascularization guided by angiography alone. It is unknown whether the
instantaneous wave-free ratio (iFR), an alternative measure that does not
require the administration of adenosine, will offer benefits similar to
those of FFR. METHODS We randomly assigned 2492 patients with coronary
artery disease, in a 1:1 ratio, to undergo either iFR-guided or FFR-guided
coronary revascularization. The primary end point was the 1-year risk of
major adverse cardiac events, which were a composite of death from any
cause, nonfatal myocardial infarction, or unplanned revascularization. The
trial was designed to show the noninferiority of iFR to FFR, with a margin
of 3.4 percentage points for the difference in risk. RESULTS At 1 year,
the primary end point had occurred in 78 of 1148 patients (6.8%) in the
iFR group and in 83 of 1182 patients (7.0%) in the FFR group (difference
in risk, -0.2 percentage points; 95% confidence interval [CI], -2.3 to
1.8; P<0.001 for noninferiority; hazard ratio, 0.95; 95% CI, 0.68 to 1.33;
P = 0.78). The risk of each component of the primary end point and of
death from cardiovascular or noncardiovascular causes did not differ
significantly between the groups. The number of patients who had adverse
procedural symptoms and clinical signs was significantly lower in the iFR
group than in the FFR group (39 patients [3.1%] vs. 385 patients [30.8%],
P<0.001), and the median procedural time was significantly shorter (40.5
minutes vs. 45.0 minutes, P = 0.001). CONCLUSIONS Coronary
revascularization guided by iFR was noninferior to revascularization
guided by FFR with respect to the risk of major adverse cardiac events at
1 year. The rate of adverse procedural signs and symptoms was lower and
the procedural time was shorter with iFR than with FFR.<br/>Copyright
&#xa9; 2017 Massachusetts Medical Society. All rights reserved.

<69>
Accession Number
614669025
Author
Andersen N.D.; Meza J.M.; Byler M.R.; Lodge A.J.; Hill K.D.; Hornik C.P.;
Jaquiss R.D.B.
Institution
(Andersen, Meza, Lodge, Jaquiss) Division of Cardiovascular and Thoracic
Surgery, Department of Surgery, Duke University Medical Center, Durham,
NC, United States
(Hill, Hornik) Division of Pediatric Cardiology, Department of Pediatrics,
Duke University Medical Center, Durham, NC, United States
(Meza, Hill, Hornik) Duke Clinical Research Institute, Durham, NC, United
States
(Meza) Hospital for Sick Children, The Congenital Heart Surgeons' Society
Data Center, Toronto, Ontario, Canada
(Byler) Department of Surgery, University of Virginia, Charlottesville,
Va, United States
Title
Comparison of right ventricle-pulmonary artery shunt position in the
Single Ventricle Reconstruction trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (6) (pp 1490-1500.e1),
2017. Date of Publication: June 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective Placement of a right ventricle-pulmonary artery shunt to the
left or right of the neoaorta may influence reinterventions, pulmonary
artery development, and survival after the Norwood procedure because of
differences in shunt and pulmonary artery geometry and blood flow. Methods
We analyzed the Pediatric Heart Network Single Ventricle Reconstruction
Trial public use dataset. Comparisons were made between patients who
received a left- or right-sided right ventricle-pulmonary artery shunt
during the Norwood procedure in both the overall (n = 274) and the
propensity score-matched (67 pairs) patient cohorts. Results A left-sided
shunt was placed in 168 patients (61%), and a right-sided shunt was placed
in 106 patients (39%). At the 12-month follow-up, there were no
differences in pulmonary artery measurements, hemodynamic measurements, or
pulmonary artery reinterventions between shunt groups. However, the
right-sided shunt was associated with fewer surgical shunt revisions in
both the overall (8.3 vs 1.9 events per 100 infants, P = .05) and the
propensity score-matched (17.9 vs 0 events per 100 infants, P < .001)
patient cohorts. In the propensity score-matched cohort only, right-sided
shunts were further associated with fewer serious adverse events (84 vs 46
events per 100 infants, P = .01) and improved transplantation-free
survival at 3 years follow-up (61% [95% confidence interval, 48-72] vs 80%
[95% confidence interval, 69-88], P = .04). Conclusions In the Single
Ventricle Reconstruction trial, right ventricle-pulmonary artery shunt
placement to the right of the neoaorta was associated with fewer shunt
revisions and may contribute to improved outcomes in select
patients.<br/>Copyright &#xa9; 2017 The American Association for Thoracic
Surgery

<70>
Accession Number
613977497
Author
Toeg H.; French D.; Gilbert S.; Rubens F.
Institution
(Toeg, Rubens) Division of Cardiac Surgery, University of Ottawa Heart
Institute, Ottawa, Ontario, Canada
(French, Gilbert) Division of Thoracic Surgery, University of Ottawa,
Ottawa, Ontario, Canada
Title
Incidence of sternal wound infection after tracheostomy in patients
undergoing cardiac surgery: A systematic review and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 153 (6) (pp 1394-1400.e7),
2017. Date of Publication: June 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Purpose This systematic review and meta-analysis was performed to
determine whether timing or type of tracheostomy was associated with
superficial or deep sternal wound infections after cardiac surgery.
Methods All studies reporting the incidence of sternal wound infection
after tracheostomy in patients undergoing cardiac surgery were collected
and analyzed. Subgroup analyses determined a priori included timing of
tracheostomy and type of procedure (open vs percutaneous). All analyses
used the random effects model. A meta-regression analysis was performed on
the proportion of sternal wound infection and number of days between
tracheostomy and initial cardiac surgery. Results A total of 13 studies
met inclusion criteria. The incidence of sternal wound infection across
all studies reported was 7% (95% confidence interval [CI], 4-10). The
percutaneous tracheostomy group had a sternal wound infection proportion
of 3% (95% CI, 1-8), and the open tracheostomy group had a sternal wound
infection proportion of 9% (95% CI, 5-14). The incidence of sternal wound
infection with early (<14 days) (7%; 95% CI, 3-11) versus late (>=14 days)
(7%; 95% CI, 4-10) tracheostomy was similar. Meta-regression demonstrated
no significant relationship between incidence of sternal wound infection
and number of days between tracheostomy and initial cardiac surgery
(R² = 6.13%, P = .72). Reported secondary outcomes included
30-day and 1-year mortality, which were high at 23% (95% CI, 19-28) and
63% (95% CI, 43-80), respectively. Conclusions The incidence of sternal
wound infection after tracheostomy in patients undergoing cardiac surgery
remains high at 7% (95% CI, 4-10). Open or percutaneous tracheostomy after
cardiac surgery is a feasible option because the incidence of sternal
wound infection and short-term mortality are comparable. Moreover, the
timing of tracheostomy (early or late) had comparable rates of sternal
wound infection and short-term mortality.<br/>Copyright &#xa9; 2016 The
American Association for Thoracic Surgery

<71>
[Use Link to view the full text]
Accession Number
616277624
Author
Santos E.; Cardoso D.; Neves H.; Cunha M.; Rodrigues M.; Apostolo J.
Institution
(Santos, Cardoso, Neves, Rodrigues, Apostolo) Health Sciences Research
Unit: Nursing, Nursing School of Coimbra, Portugal Centre for Evidence
Based Practice, Joanna Briggs Institute Centre of Excellence, Australia
(Santos) Emergency Department, Centro Hospitalar e Universitario de
Coimbra (CHUC), Coimbra, Portugal
(Cunha) Research and Development Unit, Centre of Studies in Education,
Health and Technology, Viseu, Portugal
Title
Effectiveness of haloperidol prophylaxis in critically ill patients with a
high risk of delirium: A systematic review.
Source
JBI Database of Systematic Reviews and Implementation Reports. 15 (5) (pp
1440-1472), 2017. Date of Publication: 01 May 2017.
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
EXECUTIVE SUMMARYBackground Delirium is associated with increased
intensive care unit and hospital length of stay, prolonged duration of
mechanical ventilation, unplanned removal of tubes and catheters, and
increased morbidity and mortality. Prophylactic treatment with low-dose
haloperidol may have beneficial effects for critically ill patients with a
high risk of delirium. Objectives To identify the effectiveness of
haloperidol prophylaxis in critically ill patients with a high risk for
delirium. Inclusion criteria Types of participants Patients with a
predicted high risk of delirium, aged 18 years or over, and in intensive
care units. Patients with a history of concurrent antipsychotic medication
use were excluded. Types of intervention(s)/phenomena of interest
Haloperidol prophylaxis for preventing delirium. Types of studies
Experimental and epidemiological study designs. Outcomes Primary outcome
is the incidence of delirium. Secondary outcomes are duration of
mechanical ventilation, incidence of re-intubation, incidence of
unplanned/accidental removal of tubes/lines and catheters, intensive care
unit and hospital length of stay, and re-admissions to both settings.
Search strategy An initial search of MEDLINE and CINAHL was undertaken,
followed by a second search for published and unpublished studies from
January 1967 to September 2015 in major healthcare-related electronic
databases. Studies in English, Spanish and Portuguese were included.
Methodological quality Two independent reviewers assessed the
methodological quality of five studies using the standardized critical
appraisal instrument from the Joanna Briggs Institute Meta-Analysis of
Statistics Assessment and Review Instrument. There was general agreement
among the reviewers to exclude one relevant study due to methodological
quality. Data extraction Data were extracted using the JBI data extraction
form for experimental studies and included details about the
interventions, populations, study methods and outcomes of significance to
the review questions. Data synthesis Significant differences were found
between participants, interventions, outcome measures (clinical
heterogeneity) and designs (methodological heterogeneity). For these
reasons, we were unable to perform a meta-analysis. Therefore, the results
have been described in a narrative format. Results Five studies met the
inclusion criteria. One of these studies was excluded due to poor
methodological quality. The remaining four original studies (total of 1142
patients) were included in this review. Three studies were randomized
controlled trials and one was a cohort study. Two studies confirmed the
effectiveness of haloperidol prophylaxis in critically ill patients with a
high risk of delirium. These studies showed that short-term prophylactic
administration of low-dose intravenous haloperidol significantly decreased
the incidence of delirium in elderly patients admitted to intensive care
units after non-cardiac surgery and in general intensive care unit
patients with a high risk of delirium. However, the two remaining studies
showed contradictory results in mechanically ventilated critically ill
adults, revealing that the administration of haloperidol reduced delirium
prevalence, delayed its occurrence, and/or shorten its duration.
Conclusions The evidence related to the effectiveness of haloperidol
prophylaxis in critically ill patients with a high risk of delirium is
contradictory. However, balancing the benefits and low side effects
associated with haloperidol prophylaxis, this preventive intervention may
be useful to reduce the incidence of delirium in critically ill adults in
intensive care units.<br/>Copyright &#xa9; 2017 THE JOANNA BRIGGS
INSTITUTE.

<72>
[Use Link to view the full text]
Accession Number
616268191
Author
Wang S.; Yao H.; Chen C.; Zhou R.; Wang R.; Yu H.; Liu B.
Institution
(Wang, Yao, Yu, Chen, Zhou, Wang, Yu, Liu) Department of Anesthesiology,
West China Hospital of Sichuan University, No. 37 Guoxuexiang, Chengdu,
China
Title
Effect of perioperative statin therapy on renal outcome in patients
undergoing cardiac surgery.
Source
Medicine (United States). 96 (19) (no pagination), 2017. Article Number:
e6883. Date of Publication: 01 May 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Acute renal injury (AKI) is a common renal complication after
cardiac surgery. The aim of this study was to determine the effect of
perioperative statin therapy (PST) on postoperative renal outcome in
patients undergoing cardiac procedures. Methods: We searched for the
reports that evaluating the effect of PST on renal outcomes after cardiac
surgery between March 1983 and June 2016 in the electronic database
Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE/PubMed,
and EMBASE/OVID. Results: Nine randomized controlled trials (RCTs)
enrolling 2832 patients, with 1419 in the PST group and 1413 in the
control group, were included in this meta-analysis. Our results suggested
that PST increased the incidence of postoperative renal complication
(relative risk [RR] 1.18, 95% confidence interval [CI] 1.01-1.36, P=.03)
with low heterogeneity (I 2 =30%, P=.18). Six studies with 3116 patients
detected no significant difference in severe renal complication between
PST and control groups (RR 1.23, 95%CI 0.84-1.79, P=.28). Postoperative
serum creatinine (sCr) at 48hours was shown to be higher in the PST group
(mean difference [MD] 0.03, 95% CI 0.03-0.03; P<.01). The length of
hospital stay was decreased slightly by 0.59 day in the PST group (95%
CI-0.85 to-0.33; P<.01). Conclusions: Perioperative statin therapy seems
to jeopardize short-term renal outcome in patients undergoing cardiac
surgery, but the occurrence of severe renal complication was not
affected.<br/>Copyright &#xa9; 2017 the Author(s).

<73>
Accession Number
616233070
Author
Mahboobi S.K.
Institution
(Mahboobi) Department of Anesthesiology, Lahey Hospital and Medical
Center, Burlington, MA, United States
Title
Dexmedetomidine and Renal Protection after Cardiac Surgery.
Source
Journal of Clinical Anesthesia. 40 (pp 121-122), 2017. Date of
Publication: August 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)

<74>
Accession Number
616226313
Author
Norlund F.; Olsson E.M.G.; Pingel R.; Held C.; Svardsudd K.; Gulliksson
M.; Burell G.
Institution
(Norlund, Olsson) Department of Women's and Children's Health, Uppsala
University, Box 564, Uppsala SE-751 22, Sweden
(Pingel, Svardsudd, Gulliksson, Burell) Department of Public Health and
Caring Sciences, Uppsala University, Sweden
(Held) Department of Medical Sciences, Cardiology, Uppsala Clinical
Research Centre, Uppsala University, Sweden
Title
Psychological mediators related to clinical outcome in cognitive
behavioural therapy for coronary heart disease: A sub-analysis from the
SUPRIM trial.
Source
European Journal of Preventive Cardiology. 24 (9) (pp 917-925), 2017. Date
of Publication: 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background The Secondary Prevention in Uppsala Primary Healthcare Project
(SUPRIM) was a randomized controlled trial of a group-based cognitive
behavioural therapy stress management programme for patients with coronary
heart disease. The project was successful in reducing the risk of fatal or
non-fatal first recurrent cardiovascular events. The aim of this study was
to analyse the effect of cognitive behavioural therapy on self-rated
stress, somatic anxiety, vital exhaustion and depression and to study the
associations of these factors with the reduction in cardiovascular events.
Methods A total of 362 patients were randomly assigned to intervention or
usual care groups. The psychological outcomes were assessed five times
during 24 months and analysed using linear mixed models. The mediating
roles of the outcomes were analysed using joint modelling of the
longitudinal and time to event data. Results The intervention had a
positive effect on somatic anxiety (p < 0.05), reflecting a beneficial
development over time compared with the controls. Stress, vital exhaustion
and depression did not differ between the groups over time. Mediator
analysis suggested that somatic anxiety may have mediated the effect of
treatment on cardiovascular events. Conclusions The intervention had a
small positive effect on somatic anxiety, but did not affect stress, vital
exhaustion or depression in patients with coronary heart disease. Somatic
anxiety was associated with an increased risk of cardiovascular events and
might act as a partial mediator in the treatment effect on cardiovascular
events. However, the mechanisms between the intervention and the
protective cardiovascular outcome remain to be identified.<br/>Copyright
&#xa9; European Society of Cardiology 2017.

<75>
Accession Number
616331806
Author
Petr X.O.; Brinjikji W.; Murad M.H.; Glodny B.; Lanzino G.
Institution
(Petr, Lanzino) Department of Neurologic Surgery, Mayo Clinic, 200 1st St
SW, Rochester, MN 55905, United States
(Brinjikji, Lanzino) Department of Radiology, Mayo Clinic, Rochester, MN,
United States
(Murad) Division of Preventive Medicine, Mayo Clinic, Rochester, MN,
United States
(Glodny) Department of Radiology, Medical University Innsbruck, Innsbruck,
Austria
(Petr) Department of Neurosurgery, Medical University Innsbruck,
Innsbruck, Austria
Title
Selective-versus-standard poststent dilation for carotid artery disease: A
systematic review and meta-analysis.
Source
American Journal of Neuroradiology. 38 (5) (pp 999-1005), 2017. Date of
Publication: May 2017.
Publisher
American Society of Neuroradiology (E-mail: ajnrinfo@asnr.org)
Abstract
BACKROUND: The safety and efficacy of standard poststent angioplasty in
patients undergoing carotid artery stent placement have not been
well-established. PURPOSE: We conducted a systematic review of the
literature to evaluate the safety and efficacy of carotid artery stent
placement and analyzed outcomes of standard-versus-selective poststent
angioplasty. DATA SOURCES: A systematic search of MEDLINE, EMBASE, Scopus,
and the Web of Science was performed for studies published between January
2000 and January 2015. STUDY SELECTION: We included studies with >30
patients describing standard or selective poststent angioplasty during
carotid artery stent placement. DATA ANALYSIS: A random-effects
meta-analysis was used to pool the following outcomes: periprocedural
stroke/TIA, procedurerelated neurologic/cardiovascular
morbidity/mortality, bradycardia/hypotension, long-term stroke at last
follow-up, long-term primary patency, and technical success. DATA
SYNTHESIS: We included 87 studies with 19,684 patients with 20,378 carotid
artery stenoses. There was no difference in clinical (P =.49) or
angiographic outcomes (P =.93) in carotid artery stent placement treatment
with selective or standard poststent balloon angioplasty. Both selective
and standard poststent angioplasty groups had a very high technical
success of >98% and a low procedurerelated mortality of 0.9%. There were
no significant differences between both groups in the incidence of
restenosis (P =.93) or procedurerelated complications (P =.37).
LIMITATIONS: No comparison to a patient group without poststent dilation
could be performed. CONCLUSIONS: Our meta-analysis demonstrated no
significant difference in angiographic and clinical outcomes among series
that performed standard poststent angioplasty and those that performed
poststent angioplasty in only select patients.<br/>&#xa9; Copyright 2016
Stryker.

<76>
Accession Number
616331618
Author
Kocaturk C.I.; Sezen C.B.; Aker C.; Kalafat C.E.; Bilen S.; Kutluk A.C.;
Karapinar K.; Erdogan S.; Saydam O.
Institution
(Kocaturk, Sezen, Aker, Kalafat, Bilen, Kutluk, Karapinar, Erdogan,
Saydam) Thoracic Surgery Department, Yedikule Chest Diseases and Thoracic
Surgery Training and Research Hospital, Istanbul 34020, Turkey
Title
Surgical approach to posterior mediastinal lesions and long-term outcomes.
Source
Asian Cardiovascular and Thoracic Annals. 25 (4) (pp 287-291), 2017. Date
of Publication: 01 May 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background Posterior mediastinal lesions are classified as solid lesions
and cysts. The treatment for both types is surgery. We evaluated the
surgical outcomes and recurrence rates after video-assisted thoracic
surgery and thoracotomy for posterior mediastinal lesions. Methods Data of
66 resections for posterior mediastinal masses between 2000 and 2014 were
reviewed retrospectively. Twenty-two patients were treated by
video-assisted thoracic surgery (group V) and 44 underwent thoracotomy
(group T); 29 (43.9%) were female and 37 (56.1%) were male, the mean age
was 45.9 +/- 14.7 years. Results Bronchogenic cyst was the most common
cystic lesion (10/12, 83.3%), and benign schwannoma was the most common
solid lesion (32/54, 59.2%). The mean diameter of solid lesions was 5.19
+/- 2.4 cm (group V 3.98 +/- 1.8 vs. group T 5.78 +/- 2.5 cm, p = 0.006).
The tumor diameter was 4.06 +/- 1.9 cm in asymptomatic patients and 6.93
+/- 2.2 cm (p < 0.001) in symptomatic patients. In group V, hospital stay
and duration of drainage were significantly shorter than in group T (p =
0.02, p = 0.01). Local recurrence was detected in 4 (6.1%) patients.
Cystic lesions had a higher recurrence rate than solid lesions (p = 0.01).
There was no significant difference in recurrence rates in groups V and T
(p = 0.59). Conclusion Video-assisted thoracic surgery is a safe method
for surgical treatment of posterior mediastinal lesions, with a shorter
drainage time and postoperative hospitalization and similar recurrence
rates. More recurrences are seen in patients with cystic
lesions.<br/>Copyright &#xa9; SAGE Publications.

<77>
Accession Number
614114845
Author
Mahler S.A.; Stopyra J.P.; Apple F.S.; Riley R.F.; Russell G.B.; Hiestand
B.C.; Hoekstra J.W.; Lefebvre C.W.; Nicks B.A.; Cline D.M.; Askew K.L.;
Herrington D.M.; Burke G.L.; Miller C.D.
Institution
(Mahler, Stopyra, Hiestand, Hoekstra, Lefebvre, Nicks, Cline, Askew,
Miller) Department of Emergency Medicine, Wake Forest School of Medicine,
Winston-Salem, NC, United States
(Apple) Department Laboratory Medicine and Pathology, Hennepin County
Medical Center and University of Minnesota Medical School, Minneapolis,
MN, United States
(Riley) Division of Cardiology, University of Washington, Seattle, WA,
United States
(Russell, Burke) Division of Public Health Sciences, Wake Forest School of
Medicine, Winston-Salem, NC, United States
(Herrington) Department of Internal Medicine, Division of Cardiology, Wake
Forest School of Medicine, Winston-Salem, NC, United States
Title
Use of the HEART Pathway with high sensitivity cardiac troponins: A
secondary analysis.
Source
Clinical Biochemistry. 50 (7-8) (pp 401-407), 2017. Date of Publication:
May 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The HEART Pathway combines a decision aid and serial
contemporary cardiac troponin I (cTnI) measures to achieve > 99%
sensitivity for major adverse cardiac events (MACE) at 30 days and early
discharge rates > 20%. However, the impact of integrating high-sensitivity
troponin (hs-cTn) measures into the HEART Pathway has yet to be
determined. In this analysis we compare test characteristics of the HEART
Pathway using hs-cTnI, hs-cTnT, or cTnI. Design & methods A secondary
analysis of participants enrolled in the HEART Pathway RCT was conducted.
Each patient was risk stratified by the cTn-HEART Pathway (Siemens
TnI-Ultra at 0- and 3-h) and a hs-cTn-HEART Pathway using hs-cTnI (Abbott)
or hs-cTnT (Roche) at 3-h. The early discharge rate, sensitivity,
specificity, and negative predictive value (NPV) for MACE (death,
myocardial infarction, or coronary revascularization) at 30 days were
calculated. Results hs-cTnI measures were available on 133 patients. MACE
occurred in 11/133 (8%) of these patients. Test characteristics for the
HEART Pathway using serial cTnI vs 3 hour hs-cTnI were the same:
sensitivity (100%, 95%CI: 72-100%), specificity (49%, 95%CI: 40-58%), NPV
(100%, 95%CI: 94-100%), and early discharge rate (45%, 95%CI: 37-54%). The
HEART Pathway using hs-cTnT missed one MACE event (myocardial infarction):
sensitivity (91%, 95%CI: 59-100%), specificity (48%, 95%CI: 39-57%), NPV
(98%, 95%CI: 91-100%), and early discharge rate (45%, 95%CI: 37-54%).
Conclusions There was no difference in the test characteristics of the
HEART Pathway whether using cTnI or hs-cTnI, with both achieving 100%
sensitivity and NPV. Use of hs-cTnT with the HEART Pathway was associated
with one missed MACE.<br/>Copyright &#xa9; 2017 The Canadian Society of
Clinical Chemists

<78>
Accession Number
616396927
Author
Wojtkowska I.; Stepinska J.; Stepien-Wojno M.; Sobota M.; Kopaczewski J.;
Reszka Z.; Kurzelewski M.; Medina J.
Institution
(Wojtkowska, Stepinska, Stepien-Wojno) Department of Intensive Cardiac
Care Clinic, Institute of Cardiology, ul. Alpejska 42, Warsaw 04-628,
Poland
(Sobota) Department of Cardiology, Autonomous Public Healthcare Complex,
Sandomierz, Poland
(Kopaczewski) Department of Cardiology with Unit of Pacemaker
Implantation, Provincial Hospital, Wloclawek, Poland
(Reszka) Deparment of Cardiology, Intensive Cardiac Unit, Provincial
Integrated Hospital, Elblag, Poland
(Kurzelewski) AstraZeneca Pharma Poland, Warsaw, Poland
(Medina) Medical Evidence and Observational Research, Global Medical
Affairs, AstraZeneca, Madrid, Spain
Title
Current patterns of antithrombotic and revascularisation therapy in
patients hospitalised for acute coronary syndromes. Data from the Polish
subset of the EPICOR study.
Source
Kardiologia Polska. 75 (5) (pp 445-452), 2017. Date of Publication: 17 May
2017.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland)
Abstract
Background: Cardiovascular disease is the leading cause of mortality and
morbidity in developed countries, including Poland. Antithrombotic drugs
play a crucial role in the management of acute coronary syndromes (ACS).
Recent clinical trials have demonstrated the efficacy and safety profiles
of new antiplatelet and anticoagulant agents, which may be used as add-on
therapy or replacements for older drugs. The long-TErm follow-uP of
antithrombotic management patterns In acute CORonary syndrome patients
(EPICOR) is a prospective international observational study (NCT01171404)
designed to describe the use of antithrombotic management strategies for
the treatment of ACS during the acute phase and over a follow-up period of
up to two years from the index event. A total of 608 patients from 26
hospitals in Poland were enrolled into the registry between September 2010
and March 2011. Aim: The aim of this work was to summarise data on
pre-hospital and in-hospital and revascularisation therapy in 608 patients
enrolled into the registry in Poland. Methods: The registry collected the
records of patients who were hospitalised for ACS within 24 h of symptom
onset and who had a final diagnosis of unstable angina (UA),
non-ST-segment elevation myocardial infarction (NSTEMI), or ST-segment
elevation myocardial infarction (STEMI), and survived to discharge.
Results: Among 608 enrolled patients, 291 had a final diagnosis of STEMI
and 317 had a final diagnosis of NSTEMI/UA. Patients with NSTEMI/UA were
generally at higher cardiovascular risk than patients with STEMI. Before
admission to the hospital antiplatelet drugs (acetylsalicylic acid [ASA]
and/or clopidogrel) were administered more frequently to STEMI than to
NSTEMI/UA patients. Glycoprotein (GP) IIb/IIIa inhibitors were used in
almost half of the STEMI patients and in nearly 10% of NSTEMI/UA patients.
The combinations of antiplatelet drugs included ASA + clopidogrel
(predominantly in NSTEMI/UA) or ASA + clopidogrel + GPIIb/IIIa inhibitor
(predominantly in STEMI), while other possible combinations were not used.
Almost all STEMI patients (96.2%) and the clear majority of NSTEMI/UA
patients (73.8%) were subjected to percutaneous coronary intervention
(PCI), while coronary artery bypass grafting was performed in only 2.5% of
the NSTEMI/UA patients. At the time of discharge from hospital almost all
patients with STEMI received ASA together with clopidogrel, but this
strategy was used only in 91.5% of patients with NSTEMI/UA (p < 0.05).
Unfractionated heparin was used in 62% of patients, low-molecular weight
heparin in 35%, fondaparinux in 0.7%, and bivalirudin in none of the
studied patients. Conclusions: Among patients with ACS enrolled to the
EPICOR study in Poland, antiplatelet therapy was started in the
pre-hospital phase in approximately one-Third of the STEMI patients and in
one out of ten of the NSTEMI/UA patients. The initial antiplatelet therapy
was mostly based on ASA + clopidogrel and was followed by a combination of
ASA + clopidogrel + GPIIb/IIIa inhibitor. Other drugs or combinations, as
well as novel antiplatelet drugs, were only used exceptionally. Almost 10%
of NSTEMI/UA patients did not receive dual antiplatelet therapy at
discharge. PCI plays a dominating role in the first-line treatment for the
patients enrolled to this registry in Poland.<br/>Copyright &#xa9;
European Society of Cardiology/Europejskie Towarzystwo Kardiologiczne
2017.

<79>
Accession Number
616205461
Author
Liu Z.; Norman G.; Iheozor-Ejiofor Z.; Wong J.K.F.; Crosbie E.J.; Wilson
P.
Institution
(Liu, Norman, Iheozor-Ejiofor) University of Manchester, Manchester
Academic Health Science Centre, Division of Nursing, Midwifery and Social
Work, School of Health Sciences, Faculty of Biology, Medicine and Health,
Jean McFarlane Building, Oxford Road, Manchester M13 9PL, United Kingdom
(Wong) University Hospital South Manchester, Plastic and Reconstructive
Surgery, Southmoor Road, Wythenshawe, Manchester M23 9LT, United Kingdom
(Crosbie) Faculty of Biology, Medicine and Health, University of
Manchester, Division of Molecular and Clinical Cancer Sciences, 5th Floor
- Research, St Mary's Hospital, Manchester M13 9WL, United Kingdom
(Crosbie) St Mary's Hospital, Department of Obstetrics and Gynaecology,
Manchester Academic Health Sciences Centre, Manchester, United Kingdom
(Wilson) University College London Hospitals NHS Foundation Trust,
Clinical Microbiology and Virology, 60 Whitfield Street, London W1T 4EU,
United Kingdom
Title
Nasal decontamination for the prevention of surgical site infection in
Staphylococcus aureus carriers.
Source
Cochrane Database of Systematic Reviews. 2017 (5) (no pagination), 2017.
Article Number: CD012462. Date of Publication: 18 May 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Surgical site infection rates in the month following surgery
vary from 1% to 5%. Due to the large number of surgical procedures
conducted annually, the costs of these surgical site infections (SSIs) can
be considerable in financial and social terms. Nasal decontamination using
antibiotics or antiseptics is performed to reduce the risk of SSIs by
preventing organisms from the nasal cavity being transferred to the skin
where a surgical incision will be made. Staphylococcus aureus (S aureus)
colonises the nasal cavity and skin of carriers and can cause infection in
open or unhealed surgical wounds. S aureus is the leading nosocomial
(hospital-acquired) pathogen in hospitals worldwide. The potential
effectiveness of nasal decontamination of S aureus is thought to be
dependent on both the antibiotic/antiseptic used and the dose of
application; however, it is unclear whether nasal decontamination actually
reduces postoperative wound infection in S aureus carriers. Objectives: To
assess the effects of nasal decontamination on preventing surgical site
infections (SSIs) in people who are S aureus carriers undergoing surgery.
Search methods: In September 2016 we searched the Cochrane Wounds
Specialised Register, the Cochrane Central Register of Controlled Trials
(CENTRAL) (the Cochrane Library), Ovid MEDLINE, Ovid MEDLINE (In-Process &
Other Non-Indexed Citations), Ovid Embase, and EBSCO CINAHL Plus. We also
searched three clinical trial registries and the references of included
studies and relevant systematic reviews. There were no restrictions based
on language, date of publication or study setting. Selection criteria:
Randomised controlled trials (RCTs) which enrolled S aureus carriers with
any type of surgery and assessed the use of nasal decontamination with
antiseptic/antibiotic properties were included in the review. Data
collection and analysis: Two review authors independently performed study
selection, data extraction, risk of bias assessment and GRADE assessment.
Main results: We located two studies (291 participants) for inclusion in
this review. The trials were clinically heterogeneous with differences in
duration of follow-up, and nasal decontamination regimens. One study
compared mupirocin (2% contained in a base of polyethylene glycol 400 and
polyethylene glycol 3350) with a placebo in elective cardiac surgery
patients; and one study compared Anerdian (iodine 0.45% to 0.57% (W/V),
chlorhexidine acetate 0.09% to 0.11% (W/V)) with no treatment also in
cardiac surgery patients. The trials reported limited outcome data on SSI,
adverse events and secondary outcomes (e.g. S aureus SSI, mortality).
Mupirocin compared with placebo This study found no clear difference in
SSI risk following use of mupirocin compared with placebo (1 trial, 257
participants); risk ratio (RR) 1.60, 95% confidence interval (CI) 0.79 to
3.25 based on 18/130 events in the mupirocin group and 11/127 in the
control group; low-certainty evidence (downgraded twice due to
imprecision). Anerdian compared with no treatment It is uncertain whether
there is a difference in SSI risk following treatment with Anerdian
compared with no treatment (1 trial, 34 participants); RR 0.89, 95% CI
0.06 to 13.08 based on 1/18 events in the Anerdian group and 1/16 in the
control group; very low certainty evidence (downgraded twice due to
imprecision and once due to risk of bias). Authors' conclusions: There is
currently limited rigorous RCT evidence available regarding the clinical
effectiveness of nasal decontamination in the prevention of SSI. This
limitation is specific to the focused question our review addresses,
looking at nasal decontamination as a single intervention in participants
undergoing surgery who are known S aureus carriers. We were only able to
identify two studies that met the inclusion criteria for this review and
one of these was very small and poorly reported. The potential benefits
and harms of using decontamination for the prevention of SSI in this group
of people remain uncertain.<br/>Copyright &#xa9; 2017 The Cochrane
Collaboration. Published by John Wiley & Sons, Ltd.

<80>
Accession Number
616274963
Author
Bouzia A.; Tassoudis V.; Karanikolas M.; Vretzakis G.; Petsiti A.;
Tsilimingas N.; Arnaoutoglou E.
Institution
(Bouzia) Intensive Care Unit, Medical School of Larissa, University of
Thessaly, Volos, Greece
(Tassoudis, Vretzakis, Petsiti, Arnaoutoglou) Department of
Anesthesiology, Medical School of Larissa, University of Thessaly, Volos,
Greece
(Karanikolas) Department of Anesthesiology, Washington University School
of Medicine, St. Louis, MO, United States
(Tsilimingas) Department of Cardiothoracic Surgery, Medical School of
Larissa, University of Thessaly, Volos, Greece
Title
Pregabalin Effect on Acute and Chronic Pain after Cardiac Surgery.
Source
Anesthesiology Research and Practice. 2017 (no pagination), 2017. Article
Number: 2753962. Date of Publication: 2017.
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Introduction. Pain after cardiac surgery affects long-term patient
wellness. This study investigated the effect of preoperative pregabalin on
acute and chronic pain after elective cardiac surgery with median
sternotomy. Methods. Prospective double blind study. 93 cardiac surgery
patients were randomly assigned into three groups: Group 1 received
placebo, Group 2 received oral pregabalin 75 mg, and Group 3 received oral
pregabalin 150 mg. Data were collected 8 hours, 24 hours, and 3 months
postoperatively. Results. Patients receiving pregabalin required fewer
morphine boluses (10 in controls versus 6 in Group 1 versus 4 in Group 2,
p=0.000) and had lower pain scores at 8 hours (4 versus 3 versus 3,
p=0.001) and 3 months (3 versus 2 versus 2, p=0.000) and lower morphine
consumption at 8 hours (14 versus 13 versus 12 mg, p=0.000) and 24 hours
(19.5 versus 16 versus 15 mg, p=0.000). Percentage of patients with sleep
disturbances or requiring analgesics was lower in the pregabalin group and
even lower with higher pregabalin dose (16/31 versus 5/31 versus 3/31,
p=0.000, and 26/31 versus 16/31 versus 10/31, p=0.000, resp.) 3 months
after surgery. Conclusion. Preoperative oral pregabalin 75 or 150 mg
reduces postoperative morphine requirements and acute and chronic pain
after cardiac surgery.<br/>Copyright &#xa9; 2017 Aik Bouzia et al.

<81>
Accession Number
616266882
Author
Kuk M.; Mitsouras D.; Dill K.E.; Rybicki F.J.; Dwivedi G.
Institution
(Kuk, Dwivedi) Division of Cardiology, Department of Medicine, University
of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada
(Mitsouras) Department of Radiology, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
(Dill) Department of Radiology, University of Massachusetts School of
Medicine, Worcester, MA, United States
(Rybicki) The Ottawa Hospital Research Institute and the Department of
Radiology, University of Ottawa Faculty of Medicine, Ottawa, ON, Canada
(Dwivedi) Harry Perkins Institute of Medical Research, University of
Western Australia, Perth, Australia
Title
3D Printing from Cardiac Computed Tomography for Procedural Planning.
Source
Current Cardiovascular Imaging Reports. 10 (7) (no pagination), 2017.
Article Number: 21. Date of Publication: 01 Jul 2017.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of Review: Computed tomography (CT)-based three-dimensional (3D)
printing is an emerging field in preoperative visualization of the cardiac
anatomy, procedure planning, and simulations of heart surgeries. This
article summarizes the uses of 3D-printed models in preoperative cardiac
procedure planning and intraprocedural navigation during surgeries
organized on a case-by-case basis. Recent Findings: The 3D models have
recently been shown to aid in a variety of procedures. Some of these
include valvular replacement or repair, management of paravalvular leaks,
left atrial appendage closure, myectomy in hypertrophic cardiomyopathy,
cardiac aneurysm repair, tumor resection, and surgical planning in
congenital heart lesions. Summary: We anticipate that 3D models will
become more accessible, and their utilization will increase in the near
future. However, CT-based 3D printing will require further assessment with
multicenter-based studies. Multicenter explorations will allow for
consensus and standardization of such potentially useful tools, given the
vast availability of printing and imaging techniques currently
available.<br/>Copyright &#xa9; 2017, Springer Science+Business Media New
York.

<82>
Accession Number
616406136
Author
Sotomi Y.; Onuma Y.; Cavalcante R.; Ahn J.-M.; Lee C.W.; Van Klaveren D.;
De Winter R.J.; Wykrzykowska J.J.; Farooq V.; Morice M.-C.; Steyerberg
E.W.; Park S.-J.; Serruys P.W.
Institution
(Sotomi, De Winter, Wykrzykowska) Academic Medical Center, University of
Amsterdam, Netherlands
(Onuma, Cavalcante) ThoraxCenter, Erasmus Medical Center, Rotterdam,
Netherlands
(Ahn, Lee, Park) Heart Institute, University of Ulsan College of Medicine,
Asan Medical Center, Seoul, South Korea
(Van Klaveren, Steyerberg) Department of Public Health, Erasmus Medical
Centre, Rotterdam, Netherlands
(Farooq) Institute of Cardiovascular Sciences, Manchester Academic Health
Sciences Centre, University of Manchester and Manchester Heart Centre,
United Kingdom
(Morice) Institut Cardiovasculaire Paris Sud, Generale de Sante, Hopital
Prive Jacques Cartier, Massy, France
(Serruys) International Centre for Circulatory Health, NHLI, Imperial
College London, London, United Kingdom
Title
Geographical Difference of the Interaction of Sex with Treatment Strategy
in Patients with Multivessel Disease and Left Main Disease: A
Meta-Analysis from SYNTAX (Synergy between PCI with Taxus and Cardiac
Surgery), PRECOMBAT (Bypass Surgery Versus Angioplasty Using
Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery
Disease), and BEST (Bypass Surgery and Everolimus-Eluting Stent
Implantation in the Treatment of Patients with Multivessel Coronary Artery
Disease) Randomized Controlled Trials.
Source
Circulation: Cardiovascular Interventions. 10 (5) (no pagination), 2017.
Article Number: e005027. Date of Publication: 01 May 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - The impact of sex on clinical outcomes of percutaneous
coronary intervention and coronary artery bypass graft for patients with
multivessel coronary disease and unprotected left main disease could be
dissimilar between Western and Asian populations. Methods and Results - To
assess clinical outcomes after percutaneous coronary intervention or
coronary artery bypass graft in women and men with multivessel coronary
disease and unprotected left main disease, a pooled analysis (n=3280) was
performed using the patient-level data from 3 large randomized trials:
SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery), PRECOMBAT
(Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in
Patients With Left Main Coronary Artery Disease), and BEST (Bypass Surgery
and Everolimus-Eluting Stent Implantation in the Treatment of Patients
with Multivessel Coronary Artery Disease) trials. The primary end point
was all-cause death. Of 3280 patients, 794 patients (24.2%) were women.
The median follow-up period was 1806 days (1611-1837 days). In women, a
high heterogeneity of the treatment effect among the 3 trials was found
for all-cause death (I²>50%), whereas in men, it was consistent
across the 3 trials. In the Western trial (SYNTAX), female sex favored
coronary artery bypass graft compared with percutaneous coronary
intervention (hazard ratio<inf>(percutaneous coronary intervention)</inf>
2.213; 95% confidence interval, 1.242-3.943; P=0.007), whereas in the
Asian women (PRECOMBAT and BEST), the treatment effect was neutral between
both strategies. Sex interaction with treatment strategy was evident in
the Western trial (P<inf>interaction</inf>=0.019) but not in the Asian
trials (PRECOMBAT P<inf>interaction</inf>=0.469 and BEST
P<inf>interaction</inf>=0.472; I²=58%). Conclusions - The
present meta-analysis suggested the presence of the heterogeneous
sex-treatment interaction across Asian and Western trials. Considering the
ongoing globalization of our medical practice, the heterogeneity of the
sex-treatment interaction needs to be well recognized and taken into
account during the decision making of the treatment strategy. Clinical
Trial Registrations - URL: https://www.clinicaltrials.gov. Unique
identifiers: NCT00114972, NCT00997828, NCT00422968.<br/>Copyright &#xa9;
2017 American Heart Association, Inc.

<83>
[Use Link to view the full text]
Accession Number
616404177
Author
Heusch G.
Institution
(Heusch) FRCP, Institute for Pathophysiology, West German Heart and
Vascular Center, University of Essen Medical School, Hufelandstrase 55,
Essen 45122, Germany
Title
Critical Issues for the Translation of Cardioprotection.
Source
Circulation Research. 120 (9) (pp 1477-1486), 2017. Date of Publication:
28 Apr 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The translation from numerous successful animal experiments on
cardioprotection beyond that by reperfusion to clinical practice has to
date been disappointing. Animal experiments often use reductionist
approaches and are mostly performed in young and healthy animals which
lack the risk factors, comorbidities, comedications which are
characteristics of patients suffering an acute myocardial infarction or
undergoing cardiovascular surgery. Conceptually, it is still unclear by
how much the time window for successful reperfusion is extended by
preconditioning, how long the duration of ischemia can be so that adjunct
cardioprotection by postconditioning at reperfusion still protects.
Experimental studies addressing long-term effects of adjunct
cardioprotection beyond infarct size reduction, that is, on repair,
remodeling, mortality, are lacking. Technically, reproducibility and
robustness of experimental studies are often limited. Grave faults in
design and conduct of clinical trials have also substantially contributed
to the failure of translation of cardioprotection to clinical practice.
Cardiovascular surgery with ischemic cardioplegic arrest is only a
surrogate of acute myocardial infarction and confounded by the choice of
anesthesia, hypothermia, cardioplegia, traumatic myocardial injury. Trials
in patients with acute myocardial infarction have been performed on
agents/interventions with no or inconsistent previous animal data and in
patients who had either some reperfusion already at admission or were
reperfused too late to expect any myocardial salvage. Of greatest concern
is the lack of adequate phase II dosing and timing studies when rushing
from promising proof-of-concept trials with surrogate end points such as
infarct size to larger clinical outcome trials. Future trials must focus
on interventions/agents with robust preclinical evidence, have solid phase
II dosing and timing data, recruit patients who have truly a chance to
benefit from adjunct cardioprotection.<br/>Copyright &#xa9; 2017 American
Heart Association, Inc.

<84>
Accession Number
616416602
Author
Yoon S.-H.; Bleiziffer S.; De Backer O.; Delgado V.; Arai T.;
Ziegelmueller J.; Barbanti M.; Sharma R.; Perlman G.Y.; Khalique O.K.;
Holy E.W.; Saraf S.; Deuschl F.; Fujita B.; Ruile P.; Neumann F.-J.; Pache
G.; Takahashi M.; Kaneko H.; Schmidt T.; Ohno Y.; Schofer N.; Kong W.K.F.;
Tay E.; Sugiyama D.; Kawamori H.; Maeno Y.; Abramowitz Y.; Chakravarty T.;
Nakamura M.; Kuwata S.; Yong G.; Kao H.-L.; Lee M.; Kim H.-S.; Modine T.;
Wong S.C.; Bedgoni F.; Testa L.; Teiger E.; Butter C.; Ensminger S.M.;
Schaefer U.; Dvir D.; Blanke P.; Leipsic J.; Nietlispach F.; Abdel-Wahab
M.; Chevalier B.; Tamburino C.; Hildick-Smith D.; Whisenant B.K.; Park
S.-J.; Colombo A.; Latib A.; Kodali S.K.; Bax J.J.; Sondergaard L.; Webb
J.G.; Lefevre T.; Leon M.B.; Makkar R.
Institution
(Yoon, Sharma, Kawamori, Maeno, Abramowitz, Chakravarty, Nakamura, Makkar)
Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los
Angeles, California, United States
(Bleiziffer, Ziegelmueller) Clinic for Cardiovascular Surgery, German
Heart Center Munich, Germany
(De Backer, Sondergaard) The Heart Centre, Rigshospitalet University
Hospital, Copenhagen, Denmark
(Delgado, Kong, Bax) Department of Cardiology, Leiden University Medical
Center, Leiden, Netherlands
(Arai, Chevalier, Webb, Lefevre) Generale de Sante, Institut
Cardiovasculaire Paris Sud, Hopital Prive Jacques Cartier, Massy, France
(Barbanti, Tamburino) Division of Cardiology, Ferrarotto Hospital,
University of Catania, Catania, Italy
(Perlman, Ohno, Dvir, Blanke, Leipsic) Department of Cardiology, St Paul's
Hospital, University of British Columbia, Vancouver, British Columbia,
Canada
(Khalique, Kodali, Leon) Columbia University Medical Center/New York
Presbyterian Hospital, New York, New York, United States
(Holy, Abdel-Wahab) Heart Center, Segeberger Kliniken GmbH, Academic
Teaching Hospital of the Universities of Kiel, Hamburg, and Lubeck, Bad
Segeberg, Germany
(Saraf, Hildick-Smith) Sussex Cardiac Centre, Brighton and Sussex
University Hospitals NHS Trust, Brighton, United Kingdom
(Deuschl, Schofer, Schaefer) Department of General and Interventional
Cardiology, University Heart Center, Hamburg, Germany
(Fujita, Ensminger) Department of Thoracic and Cardiovascular Surgery,
Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen,
Germany
(Ruile) Department of Cardiology & Angiology II, University Heart Center
Freiburg-Bad Krozingen, Bad Krozingen, Germany
(Neumann, Pache) Department of Radiology, Section of Cardiovascular
Radiology, University of Freiburg, Bad Krozingen, Germany
(Takahashi, Teiger) Department of Cardiology, Henri Mondor University
Hospital, Creteil, France
(Kaneko, Butter) Heart Center Brandenburg in Bernau, Bernau, Germany
(Schmidt) Department of Cardiology, Asklepios Klink St. Georg, Hamburg,
Germany
(Kong, Tay) Department of Cardiology, National University Heart Centre,
Singapore
(Sugiyama) Department of Preventive Medicine and Public Health, Keio
University, Tokyo, Japan
(Kuwata, Nietlispach) University Heart Center, University Hospital Zurich,
Zurich, Switzerland
(Yong) Division of Cardiology, Royal Perth Hospital, Perth, Western
Australia, Australia
(Kao) Department of Internal Medicine, National Taiwan University
Hospital, Taipei, Taiwan (Republic of China)
(Lee) Division of Cardiology, Queen Elizabeth Hospital, Kowloon, Hong Kong
(Kim) Department of Internal Medicine and Cardiovascular Center, Seoul
National University Hospital, Seoul, South Korea
(Modine) Department of Cardiovascular Surgery, Hospital Cardiologique,
Lille, France
(Wong) Greenberg Division of Cardiology, New York-Presbyterian Hospital,
Weil Cornell Medicine, New York, New York, United States
(Bedgoni, Testa) Department of Cardiology, IRCCS Pol San Donato, San
Donato Milanese, Milan, Italy
(Whisenant) Division of Cardiovascular Diseases, Intermountain Heart
Institute, Salt Lake City, Utah, United States
(Park) Division of Cardiology, University of Ulsan, Asan Medical Center,
Seoul, South Korea
(Colombo, Latib) Interventional Cardiology Unit, EMO-GVM Centro Cuore
Columbus & San Raffaele Scientific Institute, Milan, Italy San Raffaele
Hospital, Milan, Italy
Title
Outcomes in Transcatheter Aortic Valve Replacement for Bicuspid Versus
Tricuspid Aortic Valve Stenosis.
Source
Journal of the American College of Cardiology. 69 (21) (pp 2579-2589),
2017. Date of Publication: 30 May 2017.
Publisher
Elsevier USA
Abstract
Background Transcatheter aortic valve replacement (TAVR) is being
increasingly performed in patients with bicuspid aortic valve stenosis
(AS). Objectives This study sought to compare the procedural and clinical
outcomes in patients with bicuspid versus tricuspid AS from the Bicuspid
AS TAVR multicenter registry. Methods Outcomes of 561 patients with
bicuspid AS and 4,546 patients with tricuspid AS were compared after
propensity score matching, assembling 546 pairs of patients with similar
baseline characteristics. Procedural and clinical outcomes were recorded
according to Valve Academic Research Consortium-2 criteria. Results
Compared with patients with tricuspid AS, patients with bicuspid AS had
more frequent conversion to surgery (2.0% vs. 0.2%; p = 0.006) and a
significantly lower device success rate (85.3% vs. 91.4%; p = 0.002).
Early-generation devices were implanted in 320 patients with bicuspid and
321 patients with tricuspid AS, whereas new-generation devices were
implanted in 226 and 225 patients with bicuspid and tricuspid AS,
respectively. Within the group receiving early-generation devices,
bicuspid AS had more frequent aortic root injury (4.5% vs. 0.0%; p =
0.015) when receiving the balloon-expanding device, and moderate-to-severe
paravalvular leak (19.4% vs. 10.5%; p = 0.02) when receiving the
self-expanding device. Among patients with new-generation devices,
however, procedural results were comparable across different prostheses.
The cumulative all-cause mortality rates at 2 years were comparable
between bicuspid and tricuspid AS (17.2% vs. 19.4%; p = 0.28). Conclusions
Compared with tricuspid AS, TAVR in bicuspid AS was associated with a
similar prognosis, but lower device success rate. Procedural differences
were observed in patients treated with the early-generation devices,
whereas no differences were observed with the new-generation
devices.<br/>Copyright &#xa9; 2017 The Authors

<85>
Accession Number
616414885
Author
Unal S.; Acar B.; Yayla C.; Balci M.M.; Ertem A.G.; Kara M.; Maden O.;
Temizhan A.; Tola M.; Balbay Y.
Institution
(Unal, Acar, Yayla, Balci, Ertem, Kara, Maden, Temizhan, Balbay) Turkiye
Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara,
Turkey
(Tola) Turkiye Yuksek Ihtisas Training and Research Hospital, Radiology
Clinic, Ankara, Turkey
Title
Manual heating of the radial artery (Balbay maneuver) to facilitate radial
puncture prior to transradial coronary catheterization.
Source
Revista Portuguesa de Cardiologia. (no pagination), 2017. Date of
Publication: March 23, 2016.
Publisher
Sociedade Portuguesa de Cardiologia (E-mail: secretariado@mail.spc.pt)
Abstract
Objective: Transradial access is widely used for both diagnostic and
interventional cardiac procedures. The use of transradial access offers
several advantages, including decreased bleeding, fewer vascular
complications, and reduced length of hospital stay and cost. However, the
small size of the radial artery limits the size of the equipment that can
be used via this approach. In this study we sought to investigate whether
preprocedural manual heating of the radial artery facilitates radial
artery puncture. Methods: Patients undergoing transradial cardiac
catheterization were randomized to subcutaneous nitroglycerin plus
diltiazem or manual heating. The study endpoint was puncture score (score
1: easiest - puncture at first attempt; score 2: second attempt; score 3:
third attempt; score 4: fourth attempt or more; score 5: puncture failed).
Results: Ninety consecutive patients were enrolled in the study, 45
allocated to the drug treatment group and 45 to the heating group.
Patients underwent radial artery ultrasound before catheterization.
Complications were rare: one hematoma (drug treatment group) and one
radial artery occlusion (heating group). Baseline demographic and clinical
characteristics were similar. Baseline radial artery diameter was similar
in both groups (2.41+/-0.46 mm and 2.29+/-0.48 mm in the heating and drug
treatment groups, respectively). However, the median puncture score was
lower in the heating group (1; interquartile range 1-2) compared to the
drug treatment group (2; interquartile range 1-3; p=0.001). Conclusions:
Preprocedural manual heating of the radial artery facilitates radial
artery puncture in patients undergoing transradial cardiac
catheterization.<br/>Copyright &#xa9; 2017 Sociedade Portuguesa de
Cardiologia.

<86>
Accession Number
616403730
Author
Sidell D.R.; Koth A.M.; Bauser-Heaton H.; Mcelhinney D.B.; Wise-Faberowski
L.; Tracy M.C.; Hanley F.L.; Asija R.
Institution
(Sidell, Koth, Mcelhinney, Tracy, Asija) Department of PediatricsStanford
UniversityPalo Alto, California
(Sidell) Department of Otolaryngology, Head and Neck Surgery and the LPCH
Stanford Pediatric Aerodigestive ProgramStanford UniversityPalo Alto,
California
(Bauser-Heaton) Department of Pediatrics, Children's Healthcare of
AtlantaStanford UniversityPalo Alto, California
(Mcelhinney, Hanley) Department of Cardiothoracic SurgeryStanford
UniversityPalo Alto, California
(Wise-Faberowski) Department of AnesthesiaStanford UniversityPalo Alto,
California
Title
Bronchoscopy in children with tetralogy of fallot, pulmonary atresia, and
major aortopulmonary collaterals.
Source
Pediatric Pulmonology. (no pagination), 2017. Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: Children with Tetralogy of Fallot, Pulmonary Atresia, and Major
Aortopulmonary Collaterals (TOF/PA/MAPCAs) undergoing unifocalization
surgery are at risk for developing more postoperative respiratory
complications than children undergoing other types of congenital heart
surgery. Bronchoscopy is used in the perioperative period for diagnostic
and therapeutic purposes. In this study, we describe bronchoscopic
findings and identify factors associated with selection for bronchoscopy.
Design: Retrospective case-control. Patients and Methods: All patients
with TOF/PA/MAPCAs who underwent unifocalization surgery from September
2005 through March 2016 were included. Patients who underwent bronchoscopy
in the perioperative period were compared to a randomly selected cohort of
172 control patients who underwent unifocalization without bronchoscopy
during the study period. Results: Forty-three children underwent
perioperative bronchoscopy at a median of 9 days postoperatively. Baseline
demographics were similar in bronchoscopy patients and controls. Patients
who underwent bronchoscopy were more likely to have a chromosome 22q11
deletion and were more likely have undergone unifocalization surgery
without intracardiac repair. These patients had a longer duration of
mechanical ventilation, ICU duration, and length of hospitalization.
Abnormalities were detected on bronchoscopy in 35 patients (81%), and 20
(35%) of bronchoscopy patients underwent a postoperative intervention
related to abnormalities identified on bronchoscopy. Conclusion:
Bronchoscopy is a useful therapeutic and diagnostic instrument for
children undergoing unifocalization surgery, capable of identifying
abnormalities leading to an additional intervention in over one third of
patients. Special attention should be given to children with a 22q11
deletion to expedite diagnosis and intervention for possible airway
complications.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<87>
Accession Number
616402957
Author
Rahouma M.; Kamel M.; Benedetto U.; Ohmes L.B.; Di Franco A.; Lau C.;
Girardi L.N.; Tranbaugh R.F.; Barili F.; Gaudino M.
Institution
(Rahouma, Kamel, Ohmes, Di Franco, Lau, Girardi, Tranbaugh, Gaudino)
Department of Cardio-Thoracic SurgeryWeill Cornell MedicineNew York, NY
(Benedetto) Bristol Heart InstituteSchool of Clinical SciencesUniversity
of BristolBristolUnited Kingdom
(Barili) Department of Cardiovascular SurgeryS. Croce e Carle
HospitalCuneoItaly
Title
Endoscopic versus open radial artery harvesting: A meta-analysis of
randomized controlled and propensity matched studies.
Source
Journal of Cardiac Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: We sought to investigate the impact of radial artery
harvesting techniques on clinical outcomes using a meta-analytic approach
limited to randomized controlled trials and propensity-matched studies for
clinical outcomes, in which graft patency was analyzed. Methods: A
systematic literature review was conducted using PubMed and MEDLINE to
identify publications containing comparisons between endoscopic radial
artery harvesting (ERAH) and open harvesting (ORAH). Only randomized
controlled trials and propensity-matched series were included. Data were
extracted and analyzed with RevMan. The primary endpoint was wound
complication rate, while secondary endpoints were patency rate, early
mortality, and long-term cardiac mortality. Results: Six studies
comprising 743 patients were included in the meta-analysis. Of them 324
(43.6%) underwent ERAH and 419 (56.4%) ORAH. ERAH was associated with a
lower incidence of wound complications (odds ratio: 0.33, confidence
interval 0.14-0.77; p=0.01). There were no differences in graft patency,
and early and long-term cardiac mortality between the two techniques.
Conclusion: ERAH reduces wound complications and does not affect graft
patency, or short- and long-term mortality compared to ORAH.<br/>Copyright
&#xa9; 2017 Wiley Periodicals, Inc.

<88>
Accession Number
616402038
Author
van Osch D.; Nathoe H.M.; Jacob K.A.; Doevendans P.A.; van Dijk D.; Suyker
W.J.; Dieleman J.M.
Institution
(van Osch, Nathoe, Doevendans) Department of Cardiology University Medical
Center Utrecht Utrecht the Netherlands
(Jacob, Suyker) Department of Cardiothoracic SurgeryUniversity Medical
Center Utrecht Utrecht the Netherlands
(van Dijk, Dieleman) Department of Anesthesiology and Intensive Care
University Medical Center Utrecht Utrecht the Netherlands
Title
Determinants of the postpericardiotomy syndrome: A systematic review.
Source
European Journal of Clinical Investigation. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background: Postpericardiotomy syndrome (PPS) is a common complication
following cardiac surgery; however, the exact pathogenesis remains
uncertain. Identifying risk factors of PPS might help to better understand
the syndrome. The aim of this study was to provide an overview of existing
literature around determinants of PPS in adult cardiac surgery patients.
Material and methods: Two independent investigators performed a systematic
search in MEDLINE, EMBASE and the Cochrane Central Register. The search
aimed to identify studies published between January 1950 and December
2015, in which determinants of PPS were reported. Results: A total of 19
studies met the selection criteria. In these studies, 14 different
definitions of PPS were used. The median incidence of PPS was 16%. After
quality assessment, seven studies were considered eligible for this
review. Lower preoperative interleukin-8 levels and higher postoperative
complement conversion products were associated with a higher risk of PPS.
Among other clinical factors, a lower age, transfusion of red blood cells
and lower preoperative platelet and haemoglobin levels were associated
with a higher risk of PPS. Colchicine use decreased the risk of PPS.
Conclusion: We found that both the inflammatory response and perioperative
bleeding and coagulation may play a role in the development of PPS,
suggesting a multifactorial aetiology of the syndrome. Due to a lack of a
uniform definition of PPS in the past, study comparability was poor across
the studies.<br/>Copyright &#xa9; 2017 Stichting European Society for
Clinical Investigation Journal Foundation.

<89>
Accession Number
616378995
Author
Medbery R.L.; Force S.D.
Institution
(Medbery, Force) Section of General Thoracic Surgery, The Emory Clinic,
Division of Cardiothoracic Surgery, Department of Surgery, Emory
University School of Medicine, 1365 Clifton Road, Northeast, Building A,
Atlanta, GA 30322, USA
Title
Quality and Cost in Thoracic Surgery.
Source
Thoracic Surgery Clinics. (no pagination), 2017. Date of Publication:
2017.
Publisher
W.B. Saunders
Abstract
The value of health care is defined as health outcomes (quality) achieved
per dollars spent (cost). The current national health care landscape is
focused on minimizing spending while optimizing patient outcomes. With the
introduction of minimally invasive thoracic surgery, there has been
concern about added cost relative to improved outcomes. Moreover,
differences in postoperative hospital care further drive patient outcomes
and health care costs. This article presents a comprehensive literature
review on quality and cost in thoracic surgery and aims to investigate
current challenges with regard to achieving the greatest value for our
patients.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<90>
Accession Number
616389757
Author
Yanagisawa R.; Tanaka M.; Yashima F.; Yamada Y.; Arai T.; Shimizu H.;
Jinzaki M.; Fukuda K.; Watanabe Y.; Yamamoto M.; Kozuma K.; Suzuki T.;
Hayashida K.
Institution
(Yanagisawa, Tanaka, Yashima, Yamada, Arai, Shimizu, Jinzaki, Fukuda,
Hayashida) Keio University, School of Medicine, Japan
(Watanabe, Kozuma) Teikyo University Hospital, Japan
(Yamamoto, Suzuki) Toyohashi Heart Center, Japan
Title
Late recoil of balloon-expandable transcatheter aortic bioprosthesis:
Insights from the ocean-tavi registry.
Source
Journal of the American College of Cardiology. Conference: 22nd
Cardiovascular Summit: Transcatheter Cardiovascular Therapeutics Asia
Pacific, TCTAP 2017. South Korea. 69 (16 Supplement 1) (pp S85-S86), 2017.
Date of Publication: April 2017.
Publisher
Elsevier USA
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) was developed to
improve survival and quality of life of patients with severe symptomatic
aortic stenosis (AS) who are inoperable or at high risk of surgery.
Recently, the mid-term outcomes of TAVI are being studied in
intermediate-risk patients. The durability of transcatheter heart valves
(THV) should be evaluated properly before expanding the use of TAVI to
lower-risk and younger patients. Previous reports have identified several
types of THV failure such as THV thrombosis, prosthetic valve
endocarditis, and structural valve failure in the late phase. As is known
well in the coronary field, because the THV deployed on a calcified aortic
valve must have sufficient radial force to resist elastic recoil, THV
recoil may occur and affect valve hemodynamics, especially in a
balloon-expandable bioprosthesis. However, even though this could cause
failure of the bioprosthesis, relevant data has been obtained only in the
acute phase. This study sought to evaluate, in a prospective multicentre
registry, the incidence, predictors, and clinical impact of late THV
recoil after TAVI with the balloon-expandable bioprosthesis by using
multidetector computed tomography (MDCT). METHODS We analyzed data from
101 patients undergoing TAVI with balloon-expandable THVs in the Optimized
Transcatheter Valvular Intervention (OCEAN-TAVI, Japan) registry, which is
an on-going, prospective multicentre registry. We obtained follow-up
multidetector computed tomography before discharge and at 6 months along
with data on echocardiography and clinical outcomes including death, New
York Heart Association (NYHA) class, and aortic regurgitation (AR). Using
MDCT, we measured THV area at each follow-up and scored aortic valve
complex calcification from 0 to 3 at baseline. Significant late THV recoil
was defined as a percent decrease of >= 3% in an area during 6 months. We
divided the 101 patients into two groups according to the degree of the
interval change in THV area between the time of discharge versus at the
6-month follow-up (the recoil group; patients with significant THV recoil
and the no-recoil group; patients without significant THV recoil).
Furthermore, we compared the baseline characteristics and clinical
outcomes between the groups. RESULTS Significant late THV recoil was
observed in 13 of 101 patients (12.8%; the recoil group). Late absolute
and percent recoil was 18.1 mm² (interquartile range,
14.5-21.1) and 5.0% (4.1-6.0) with the recoil group; -4.5 mm²
(-7.6-0.8) and -1.3% (-2.0-0.4) with the norecoil group, respectively.
Patients in the recoil group had greater body mass index (24.4 +/- 4.8
kg/m² vs. 22.1 +/- 3.1 kg/m², p=0.02), higher rate
of atrial fibrillation (38.4% vs. 19.3%, p=0.02), smaller indexed aortic
valve area (0.37 (interquartile range, 0.32-0.43) vs. 0.45 (0.40-0.54)
cm², p=0.01) and larger annulus area (394 (368-443) vs. 365
(329-412) mm², p=0.04). The approach and bioprosthesis size
were similar between the groups. No significant differences were observed
in the frequency of pre-dilatation, underfilling, and postdilatation.
However, the annular area oversizing rate was lower in the Recoil group
(9.2 (3.4-16.8)% and 20.3 (13.0-29.6)%, respectively, p<0.01). Patients in
the recoil group had a higher degree of leaflet calcification in right and
left coronary cusp (p<0.01 and p=0.02, respectively) (Figure). No
significant differences were observed in valve hemodynamics including AR,
indexed effective orifice area, and mean aortic gradient and clinical
outcomes including death, NYHA class, and AR at 1 year between the groups.
CONCLUSION A certain degree of late THV recoil was shown in patients
undergoing TAVI with a balloon-expandable bioprosthesis. Patients with
heavily calcified leaflets may have an increased risk for THV recoil in
the late phase. However, the condition was subclinical and did not affect
valve hemodynamics at 1 year. (Figure Presented).

<91>
Accession Number
616393184
Author
Craft M.; Parthiban A.; Barnes A.; Li L.; Joseph N.; Shirali G.; Danford
D.; Kutty S.
Institution
(Craft, Li, Joseph, Danford, Kutty) University of Nebraska, Omaha, NE,
United States
(Parthiban, Barnes, Shirali) Children's Mercy Hospital, Kansas City, MO,
United States
Title
Biatrial phasic function after heart transplantation in children: A 3D
echocardiography study.
Source
Journal of the American Society of Echocardiography. Conference: 28th
Annual Scientific Sessions of the American Society of Echocardiography,
ASE 2017. United States. 30 (6) (pp B47), 2017. Date of Publication: June
2017.
Publisher
Mosby Inc.
Abstract
Background: We evaluated left and right atrial (LA and RA) phasic function
in asymptomatic pediatric heart transplant (HT) patients compared to
normal controls using three dimensional echocardiographic (3DE) speckle
tracking, and explored the relationship between phasic atrial function and
HT related clinical variables. Methods: Eighty-eight subjects (38 HT, mean
age 10 +/- 6 years, BSA 1 +/- 0.5 m2, and 50 age matched normal children)
were prospectively enrolled in two centers. 3DE examinations (n=57) were
performed in HT subjects (Vivid E9, GE and iE33, Philips) at a mean
interval of 5 years after HT. Clinical data included age at HT, bypass
time, ischemia time, donor age, and incidence of rejection. Atrial
deformation indices including strain () and strain rates (SR) were
measured using 3DE speckle tracking (4D RV 2.0, TomTec). Components of
phasic atrial function-reservoir (<inf>S</inf>, SRS), conduit
(<inf>E</inf>, SRE) and booster (<inf>A</inf>, SR<inf>A</inf>) were
calculated. Comparisons with controls were made using t-test or
Kruskal-Wallis test, and correlations explored for relation to clinical
variables. Results: The mean age and body surface area of HT subjects were
10 +/- 6 years and 1 +/- 0.5 m2. Atrial function indices are shown in the
table. The mean heart rates were higher in HT (95 +/- 17 vs. 88 +/- 21 in
controls, p=0.04). The mean age at HT, bypass time, ischemia time, and
donor age were 5 +/-5 years, 192 +/- 61 minutes, 148 +/- 64 minutes and
114 +/- 128 months respectively. There were 3 instances of rejection
within the first year of HT, and 14 instances after the first year (all
ISHLT grades 1R). There were reductions in RA and LA reservoir
(<inf>S</inf>, SRS), conduit (<inf>E</inf>, SRE) and booster
(<inf>A</inf>, SR<inf>A</inf>) function in HT compared to controls. No
differences in atrial functional indices were found between those subjects
who had history of rejection and those who did not. There was no relation
of LA and RA deformation indices with mean age at HT, bypass time,
ischemia time, or donor age. RA <inf>S</inf>, SRS, <inf>E</inf>, SRE
indicative of reservoir and conduit function showed association with
duration of HT ( p=0.02, p=0.004, p=0.03, p=0.005 respectively).
Conclusion: Pediatric HT recipients had altered atrial mechanics 5 years
after HT by 3DE. We speculate that reservoir, conduit and booster function
of both atria may be measurably disrupted by implantation into the
recipient.

<92>
Accession Number
616393108
Author
Joseph N.; Li L.; Parthiban A.; Barnes A.; Craft M.; Shirali G.; Danford
D.; Kutty S.
Institution
(Joseph, Li, Craft, Danford, Kutty) University of Nebraska, Omaha, NE,
United States
(Parthiban, Barnes, Shirali) Children's Mercy Hospital, Kansas City, MO,
United States
Title
3d echocardiographic evidence of reduced right ventricular function 5
years after pediatric heart transplant.
Source
Journal of the American Society of Echocardiography. Conference: 28th
Annual Scientific Sessions of the American Society of Echocardiography,
ASE 2017. United States. 30 (6) (pp B44-B45), 2017. Date of Publication:
June 2017.
Publisher
Mosby Inc.
Abstract
Background: Abnormal systolic function and early diastolic filling of the
right ventricle has been recognized in the first year following pediatric
heart transplantation (HT). We sought to evaluate if parameters of right
ventricular (RV) function remain abnormal in the medium term following
transplant. Methods: Eighty-eight subjects (38 HT, mean age 10 +/- 6
years, BSA 1 +/- 0.5 m2, and 50 age matched normal children) were
prospectively enrolled in two centers. Fift y-seven three-dimensional
echocardiographic (3DE) examinations were performed in HT subjects (Vivid
E9, GE and iE33, Philips) at a mean interval of 5 years after HT. Clinical
data included age at HT, bypass time, ischemia time, donor age, and
incidence of rejection. Functional RV indices consisting of end diastolic
volume (RV EDV), ejection fraction (EF), longitudinal strain (LS) of
septum and free wall, and circumferential strain were measured using 3DE
speckle tracking (4D RV 2.0, Tom Tec). Tricuspid annular plane systolic
excursion (TAPSE) and RV fractional area change (FAC) were also measured.
Comparisons between HT and normal subjects were made using t-test or
Kruskal-Wallis test. Results: RV functional indices are shown in the
table. Th e mean heart rates were higher in HT (95 +/- 17 vs. 88 +/- 21 in
controls, p=0.04). Th e mean age at HT, bypass time, ischemia time, and
donor age were 5 +/-6 years, 192 +/- 61 min, 148 +/- 64 min and 114 +/-
128 months respectively. Th ere were 3 instances of rejection within the
first year of HT, and 14 instances of rejection after the first year (all
ISHLT grades 1R). HT recipients had statistically significant reduction in
the indices of RV function compared to controls (Table). There was no
relation between RV functional indices and age at HT, bypass time,
ischemia time, donor age or time elapsed since transplant. No differences
in RV function were observed between HT subjects who had history of
rejection and those who did not. Conclusion: 3DE revealed differences in
RV volumetric and mechanistic indices from controls in the medium term
after pediatric HT, which were unrelated to episodes of rejection and time
elapsed since HT.

<93>
Accession Number
616393351
Author
Sherifi I.; Omar A.; Varghese M.; Anyanwu A.; Kovacic J.; Chaudhry F.;
Sharma S.; Kini A.; Sengupta P.
Institution
(Sherifi, Omar, Varghese, Anyanwu, Kovacic, Chaudhry, Sharma, Kini,
Sengupta) Mount Sinai Medical Center, New York, NY, United States
Title
Tranthoracic versus transesophgeal echocardiography guided transcatheter
aortic valve implantation under moderate sedation.
Source
Journal of the American Society of Echocardiography. Conference: 28th
Annual Scientific Sessions of the American Society of Echocardiography,
ASE 2017. United States. 30 (6) (pp B40), 2017. Date of Publication: June
2017.
Publisher
Mosby Inc.
Abstract
Background: The optimal choice of periprocedural imaging strategy during
transcathether aortic valve replacement (TAVR) performed under moderate
sedation is debated. Transthoracic echocardiography (TTE) provides
suboptimal views due to poorer resolution and patient positioning, whereas
use of transesophageal echocardiography (TEE) under moderate sedation is
not widely utilized. Aim: To compare the role of TTE and TEE guidance
under moderate sedation during TAVR. Methods: The study population
included 145 consecutive TAVR patients (September 2012 to October 2015)
who had either a TTE (n=96) or TEE (n=49). We compared procedural outcomes
using propensity score matching. Results: The mean age was 83+/-10 years,
ejection fraction (EF) 59+/-11% and mean aortic area (AVA) 0.7+/-0.12
cm². There were no significant inter-group differences in age,
sex, EF, AVA, pressure gradients, creatinine or the type of valve used.
The procedural time was significantly shorter in the TEE group (Table 1)
and associated with a lower need for periprocedural aortograms and a lower
occurrence of acute kidney injury (VARC-2 criteria). These results were
also confirmed aft er 1:1 propensity score matching. Conclusion: TEE
guidance during TAVR is associated with a lower fluoroscopic time and a
lower need for additional aortograms. The use of TEE may reduce post-TAVR
acute kidney injury, however, this needs confirmation in future
prospective randomized trials. (Table Presented).

<94>
Accession Number
616393335
Author
Shah C.A.; Lin B.A.; Tariq N.; Forrest J.K.; Cleman M.; LeVesque L.;
McManus S.; Bachand K.; Dillon C.; DaSilva P.; Kaplan R.; Sugeng L.
Institution
(Shah, Lin, Tariq, Forrest, Cleman, LeVesque, McManus, Bachand, Dillon,
DaSilva, Kaplan, Sugeng) Yale-New Haven Hospital, New Haven, CT, United
States
Title
Transthoracic versus transesophageal imaging in transcatheter aortic valve
replacement: the incidence of paravalvular regurgitation.
Source
Journal of the American Society of Echocardiography. Conference: 28th
Annual Scientific Sessions of the American Society of Echocardiography,
ASE 2017. United States. 30 (6) (pp B39), 2017. Date of Publication: June
2017.
Publisher
Mosby Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has
traditionally used transesophageal echocardiography (TEE) and general
anesthesia. There has been an increase in TAVR being performed with
transthoracic echocardiography (TTE) with monitored anesthesia care. This
minimally invasive approach is cost effective and reduces length of stay;
however, the occurrence of paravalvular leak (PVL) is unknown. The goal of
this study is to investigate the incidence of PVL in TAVR using a TTE
versus (vs) a TEE-guided approach. Methods: A retrospective study of 229
patients (mean age 82 +/- 9 and 55% male) who underwent TAVR with either a
Medtronic CoreValve Evolut (44%), Medtronic CoreValve (6%), Edwards Sapien
3 (42%), or Edwards Sapien (8%) at Yale New Haven Hospital from 2015 to
2016 via transfemoral (90%) or direct aortic (10%) approach was performed.
The majority had TAVR with TTE imaging (147 patients), while 82 had TAVR
with TEE-guidance. Paravalvular leak was assessed by TTE at 1-day
post-procedure, 30-days post-procedure and graded as either none/trivial,
mild, or moderate in severity. Chi-square and Fisher exact tests were used
for statistical analysis. Results: Patients with TEE-guided TAVR had a
higher incidence of peripheral vascular disease (40.2% vs 23.1%; p=0.007),
congestive heart failure (93.9% vs 79.6%; p=0.002), and lung disease
(42.6% vs 29.3%; p=0.038); but had a lower left ventricular ejection
fraction (53.5% vs 58.8%; p=0.004) (table 1). Patients with TTE-guided
TAVR had similar incidence of none-trivial PVL (73% vs 61%), mild PVL (25%
vs 34%), and moderate PVL (1.4% vs 3.7%) at post procedure day 1 compared
to TEE-guided TAVR (p=0.56) (figure 1). At post-procedure day 30, the
degree of PVL between both groups were similar (none-trivial 63% vs 57%;
mild 32% vs 31%; and moderate 2% vs 6.1%; p=0.49) (figure 1). Conclusion:
TTE-guided TAVR is not associated with an increase incidence of PVL, is
safe, and cost-effective when compared to TEE-guided TAVR. Multi-center
studies with a larger sample size are required to confirm these findings.
(Figure Presented).

<95>
Accession Number
616390008
Author
Jelic T.; Amaral A.C.; Chenkin J.
Institution
(Jelic, Amaral, Chenkin) Sunnybrook Health Sciences Centre, Toronto, ON,
Canada
Title
Carotid flow time as a predictor of volume responsiveness.
Source
Canadian Journal of Emergency Medicine. Conference: 2015 CAEP/ACMU.
Canada. 17 (pp S18-S19), 2015. Date of Publication: May 2015.
Publisher
Cambridge University Press
Abstract
Introduction: Fluid resuscitation is one of the cornerstones of shock
treatment. However, accurately determining fluid status and fluid
responsiveness are difficult tasks without the use of invasive (pulmonary
artery catheter [PAC]), expensive (arterial pulse contour analysis) or
technically difficult methods (echocardiography for aortic volume time
index). Measurement of carotid flow times (CFT) using point-of-care
ultrasound (POCUS) has recently been proposed as a non-invasive method of
determining fluid responsiveness. The purpose of this pilot study is to
determine the accuracy of CFT in detecting changes in cardiac output (CO)
as measured by a PAC. Methods: We recruited a convenience sample of
post-operative cardiac surgery patients with routine PACs in place. We
measured baseline CO in triplicate and changes in CO after a 60 second
passive leg raise test (PLRT). At the same time, baseline CFT and changes
after PLRT were recorded using POCUS. The ultrasonographer was blinded to
all CO readings. Patients were deemed volume responsive if there was a 10%
increase in the CO or CFT after the PLRT. Results: We enrolled 9 patients.
We excluded one patient from the study due to inaccurate PAC measurements
and analyzed data on 8 patients. Three patients were deemed volume
responders with both the PAC and the CFT demonstrating a change of at
least 10% between the pre and post PLRT. Five patients showed no evidence
of volume responsiveness after PLRT. This yields a sensitivity and
specificity of 100% and 100% (95% CI are 31.0-100 and 46.3-100,
respectively). Of the three volume responders, the average change in the
CO was 24.77% and CFT change was 20.33%. Conclusion: Data is very
preliminary, but in a small cohort of post cardiac surgery patients we
were able to demonstrate that CFT accurately predicted volume
responsiveness. Further patient recruitment is ongoing at this time.

<96>
Accession Number
616357542
Author
Baldea K.G.; Santos G.D.; Ellimoottil C.; Farooq A.; Mueller E.R.; Byram
S.; Turk T.M.
Institution
(Baldea, Santos, Ellimoottil) Ann ArborMIUnited States
(Farooq, Mueller, Byram, Turk) ChicagoILUnited States
Title
Paravertebral block for percutaneous nephrolithotomy: A prospective,
randomized, double-blind placebo-controlled study.
Source
Journal of Urology. Conference: 112th Annual Meeting of the American
Urological Association, AUA 2017. United States. 197 (4 Supplement 1) (pp
e1003), 2017. Date of Publication: April 2017.
Publisher
Elsevier Inc.
Abstract
INTRODUCTION AND OBJECTIVES: Percutaneous nephrolithotomy (PCNL) is
considered the gold standard minimally invasive treatment for large stone
burdens, but post-operative pain control remains challenging.
Paravertebral block (PVB) has been described for breast and thoracic
surgery as an effective pain control strategy, but is not being utilized
for PCNL. The objective of this study was to evaluate the effect of
paravertebral block on pain control and opioid use following PCNL.
METHODS: This was a prospective, randomized, double-blind,
placebo-controlled study. Willing patients undergoing unilateral PCNL for
stone disease were consented and randomized to receive either PVB or
placebo intervention in the preoperative area. The PVB consists of a
single injection of 20 mL of 0.5% bupivacaine into the T10 paravertebral
space under ultrasound guidance. For the placebo intervention, the
ultrasound probe is applied, the skin is infiltrated with lidocaine, and
pressure is held to mimic injection. The patient, surgeon, and anesthesia
team were blinded to the study group. Patients received patient-controlled
analgesia (PCA) following surgery. Outcomes were visual analog scale (VAS)
pain scores, intra-operative and post-operative opioid use, and
anti-emetic use. Statistical analysis was performed using paired t-tests
for continuous variables and chi-square tests for categorical variables.
RESULTS: The 45 patients enrolled in the study had no difference in
baseline characteristics. There were no complications attributed to the
PVB. The average VAS pain score was lower in the PVB group.
Intra-operative opioid use, post-operative opioid use, frequency of opioid
use, and anti-emetic use were significantly lower in the PVB group as
compared to the control group. The time from the conclusion of surgery to
the first administration of opioids was longer in the PVB group
CONCLUSIONS: To our knowledge, this is the first randomized, double-blind,
placebo-controlled trial investigating the use of PVB in PCNL. PVB prior
to PCNL improved average VAS pain scores and decreased both
intra-operative and post-operative opioid use. The reduction in opioid use
likely leads to improved nausea as reflected in decreased anti-emetic use.
PVB should be considered an effective strategy to reduce pain for patients
undergoing PCNL.

<97>
Accession Number
616353321
Author
Lee A.J.; Sheppard C.E.; Kent W.D.T.; Mewhort H.; Sikdar K.C.; Fedak
P.W.M.
Institution
(Lee) Department of Surgery, Division of Cardiac Surgery, University of
British Columbia, Vancouver, BC, Canada
(Sheppard, Kent, Mewhort, Sikdar, Fedak) Department of Cardiac Sciences,
Libin Cardiovascular Institute of Alberta, University of Calgary, Division
of Cardiac Surgery, C880, 1403-29 Street NW, Calgary, AB T2N 2T9, Canada
Title
Safety and efficacy of prophylactic negative pressure wound therapy
following open saphenous vein harvest in cardiac surgery: A feasibility
study.
Source
Interactive Cardiovascular and Thoracic Surgery. 24 (3) (pp 324-328),
2017. Date of Publication: 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Objectives: Surgical site complications following great saphenous vein
(GSV) harvest presents a significant risk of morbidity. Negative pressure
wound therapy (NPWT) has shown promise in the treatment and prophylaxis of
open wounds and surgical incisions but has not been studied following GSV
harvest. We performed a feasibility study examining the use of NPWT
following GSV harvest for coronary bypass surgery. Methods: Sixty-four
patients were recruited in this single-centre, single-blind, randomized
controlled trial. The primary endpoint assessed feasibility by examining
rates of device complication and malfunction. Secondary endpoints included
rates of surgical site infection, lower leg complications, discharge date,
and quality of life at discharge and 6 weeks. NPWT was delivered using the
Prevena NPWT device. Results: There were no complications associated with
NPWT which required intervention aside from discontinuation. NPWT was
tolerated in 91% (30/33) of patients for the duration of treatment with an
average of 4.8 days (+/-1.45 days). Device malfunction which required
discontinuation was 6% (2/33) and involved a malfunctioning pressure
sensor and did not affect patient care or present safety concerns. One
patient had allergic contact dermatitis to the adhesive and had the device
removed. NPWT patients had an earlier date of discharge (6 vs 10 days, P =
0.008), increased ability for self-care (P = 0.0234) and quality of life
(P = 0.039) at initial assessment, and increased mobility at initial and
follow-up assessment (P = 0.0117 and 0.0123). Conclusions: The use of NPWT
following GSV harvest is safe, well tolerated and improves postoperative
recovery with prolonged impact on mobility at 6 weeks.<br/>Copyright
&#xa9; The Author 2016.

<98>
Accession Number
616368812
Author
Virk S.A.; Tian D.H.; Sriravindrarajah A.; Dunn D.; Wolfenden H.D.; Suri
R.M.; Munkholm-Larsen S.; Cao C.
Institution
(Virk, Tian, Sriravindrarajah, Dunn, Munkholm-Larsen, Cao) The
Collaborative Research (CORE) Group, Macquarie University, Sydney,
Australia
(Tian) Royal North Shore Hospital, Sydney, Australia
(Wolfenden) Department of Cardiothoracic Surgery, Prince of Wales
Hospital, Sydney, Australia
(Suri) Department of Thoracic and Cardiovascular Surgery, Heart and
Vascular Institute, Cleveland Clinic, Cleveland, Ohio
(Cao) Department of Cardiothoracic Surgery, St George Hospital, Sydney,
Australia
Title
Mitral valve surgery and coronary artery bypass grafting for
moderate-to-severe ischemic mitral regurgitation: Meta-analysis of
clinical and echocardiographic outcomes.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: May 15, 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: This meta-analysis was conducted to compare clinical and
echocardiographic outcomes following isolated coronary artery bypass
grafting (CABG) versus CABG and mitral valve (MV) surgery in patients with
moderate-to-severe ischemic mitral regurgitation (IMR). Methods: Seven
databases were systematically searched to identify relevant studies. For
eligibility, studies were required to report on the primary endpoint of
perioperative or late mortality. Data were analyzed according to
predefined clinical endpoints. Results: Four randomized controlled trials
(RCTs) (n = 505) and 15 observational studies (OS) (n = 3785) met the
criteria for inclusion. Compared with isolated CABG, concomitant CABG and
MV surgery was not associated with increased perioperative mortality
(RCTs: relative risk [RR] 0.89, 95% confidence interval [CI], 0.26-3.02;
OS: RR 1.40, 95% CI, 0.88-2.23). CABG and MV surgery was associated with
significantly lower incidence of moderate-to-severe MR at follow-up (RCTs:
RR 0.16, 95% CI, 0.04-0.75; OS: RR 0.20, 95% CI, 0.09-0.48). Late
mortality was similar between the surgical approaches in RCTs (hazard
ratio [HR] 1.20, 95% CI, 0.57-2.53) and OS (HR 0.99, 95% CI, 0.81-1.21).
There were no significant differences in echocardiographic outcomes. These
results remained consistent in subgroup analyses restricted to patients
with strictly moderate IMR. Conclusions: In patients with
moderate-to-severe IMR, the addition of MV surgery to CABG was not
associated with increased perioperative mortality. Although concomitant MV
surgery reduced recurrence of moderate-to-severe MR at follow-up, this was
not associated with a reduction in late mortality. Larger trials with
longer follow-up duration are required to further assess long-term
survival and freedom from reintervention.<br/>Copyright &#xa9; 2017 The
American Association for Thoracic Surgery.

<99>
Accession Number
616352599
Author
Butts R.J.; Boyle G.J.; Deshpande S.R.; Gambetta K.; Knecht K.R.;
Prada-Ruiz C.A.; Richmond M.E.; West S.C.; Lal A.K.
Institution
(Butts) Pediatric Cardiology, Medical University of South Carolina,
Charleston, SC, United States
(Boyle, Prada-Ruiz) Pediatric Cardiology, Cleveland Clinic Children's
Hospital, Cleveland, OH, United States
(Deshpande) Pediatric Cardiology, Emory University Children's Healthcare
of Atlanta, Atlanta, GA, United States
(Gambetta) Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital
of Chicago, Chicago, IL, United States
(Knecht) Pediatric Cardiology, University of Arkansas for Medical
Sciences, Little Rock, AR, United States
(Richmond) Pediatric Cardiology, Columbia University Medical Center, New
York, NY, United States
(West) Pediatric Cardiology, Children's Hospital of Pittsburgh of UPMC,
Pittsburgh, PA, United States
(Lal) Pediatric Cardiology, Primary Children's Hospital, University of
Utah, Salt Lake City, UT, United States
(Butts) Department of Pediatric, 5323 Harry Hines Blvd, 9063, Dallas, TX
75390-9063, United States
Title
Characteristics of Clinically Diagnosed Pediatric Myocarditis in a
Contemporary Multi-Center Cohort.
Source
Pediatric Cardiology. (pp 1-8), 2017. Date of Publication: 23 May 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The objective of this study was to describe a contemporary cohort of
pediatric patients hospitalized for clinically suspected myocarditis. A
retrospective chart review was performed at seven tertiary pediatric
hospitals. Electronic medical records were searched between 2008 and 2012
for patients <=18 years admitted with an ICD-9 code consistent with
myocarditis. Patients were excluded if the admitting or consulting
cardiologist did not suspect myocarditis during the admission or an
alternative diagnosis was determined. One hundred seventy-one patients
were discharged or died with a primary diagnosis of myocarditis. Median
age was 13.1 years (IQR 2.1, 15.9), with a bimodal distribution; 24% <2
years and 46% between 13 and 18 years. Patients with moderate or severe
systolic dysfunction were younger, had higher BNPs at admission, but had
lower troponin. Mortality, heart transplantation, and readmission did not
differ between patients who received only IVIG, only steroids, IVIG and
steroids, and no immunotherapy. Ninety-four patients (55%) were discharged
on heart failure medications, 16 were transplanted, and seven died. The
presence at the time of admission of gastrointestinal (GI) symptoms (p =
0.01) and lower echo shortening fraction (SF) (p < 0.01) was associated
with death/transplant. Within one year 16% had a readmission, one
underwent heart transplant, and 39% received heart failure therapy.
Pediatric myocarditis has a bimodal age distribution. The use of IVIG and
steroids is not associated with mortality/heart transplantation. The
presence of GI symptoms and lower echo SF may identify patients at risk
for death and/or transplantation during the admission.<br/>Copyright
&#xa9; 2017 Springer Science+Business Media New York

<100>
Accession Number
608748329
Author
Sharma G.; Anantha Krishnan R.; Bohra V.; Ramakrishnan S.; Naik N.; Seth
S.; Juneja R.; Kalaivani M.; Bahl V.K.
Institution
(Sharma, Anantha Krishnan, Bohra, Ramakrishnan, Naik, Seth, Juneja, Bahl)
Department of Cardiology, All India Institute of Medical Sciences, New
Delhi 110029, India
(Kalaivani) Department of Biostatistics, All India Institute of Medical
Sciences, New Delhi 110029, India
Title
Evaluation of early direct current cardioversion for maintenance of sinus
rhythm in rheumatic atrial fibrillation following successful balloon
mitral valvotomy.
Source
Indian Heart Journal. (no pagination), 2016. Date of Publication: November
07, 2015.
Publisher
Elsevier
Abstract
Background: Patients with rheumatic mitral stenosis (MS) and atrial
fibrillation (AF) are at risk for thromboembolism and restoration of sinus
rhythm (SR) may be the preferred strategy. Percutaneous balloon mitral
valvotomy (PBMV) improves hemodynamics, but may not be enough to restore
SR. Methods: Prospective randomized study aimed at evaluating efficacy of
early direct current cardioversion (DCCV) following successful PBMV in
patients with long-standing AF. Group 1 (n = 20) had patients of rheumatic
MS with AF who underwent successful PBMV. Group 2 (n = 15) patients were
DC cardioverted and administered oral Amiodarone for 6 weeks. Primary
endpoint was maintenance of SR after 6 months. Secondary endpoints were
functional capacity, number of embolic episodes, adverse drug effects, and
all-cause mortality. Results: In Group 2, all patients underwent
successful cardioversion. At a mean follow-up of 7.6 months, 95% in Group
1 were in AF. In Group 2, 87% patients were in SR and 13% had reverted to
AF. Difference in rate of SR was 0.82 (95% CI 0.2, 1.01) (p = 0.001), with
relative risk of 7.1 (1.95, 25.9, 95% CI, p = 0.001) for patients to be in
AF who underwent only successful PBMV, i.e. Group 1. There was significant
improvement in quality of life (SF36) score in Group 2 (p = 0.001), with
no deaths, stroke, or adverse drug effects in either group. Conclusion: In
patients with rheumatic MS and AF, early DCCV and a short-duration oral
Amiodarone, following successful PBMV, may be a reasonable strategy to
attain long-term SR.<br/>Copyright &#xa9; 2016.

<101>
Accession Number
614321489
Author
Kvisvik B.; Morkrid L.; Rosjo H.; Cvancarova M.; Rowe A.D.; Eek C.; Bendz
B.; Edvardsen T.; Gravning J.
Institution
(Kvisvik, Rosjo, Cvancarova, Gravning) Department of Cardiology, Division
of Medicine, Akershus University Hospital, Lorenskog N-1478, Norway
(Kvisvik, Rosjo, Edvardsen, Gravning) Center for Heart Failure Research,
University of Oslo, Norway
(Morkrid, Rowe) Department of Medical Biochemistry, Oslo University
Hospital, Rikshospitalet, and Institute for Clinical Medicine, University
of Oslo, Norway
(Rowe) Norwegian National Unit for Newborn Screening, Womanand Children's
Division, Oslo University Hospital, Rikshospitalet, Norway
(Eek, Bendz, Edvardsen) Department of Cardiology, Oslo University
Hospital, Rikshospitalet, Norway
Title
High-sensitivity troponin T vs i in acute coronary syndrome: Prediction of
significant coronary lesions and long-term prognosis.
Source
Clinical Chemistry. 63 (2) (pp 552-562), 2017. Date of Publication:
February 2017.
Publisher
American Association for Clinical Chemistry Inc.
Abstract
BACKGROUND: High-sensitivity cardiac troponin (hscTn) T and I assays are
established as crucial tools for the diagnosis of acute myocardial
infarction (AMI), as they have been found superior to old troponin assays.
However, eventual differences between the assays in prediction of
significant coronary lesions and long-term prognosis in patients with
acute coronary syndrome (ACS) have not been fully unraveled. METHODS:
Serum concentrations of hs-cTnT (Roche), hs-cTnI (Abbott), and
amino-terminal pro-B-type natriuretic peptide (NT-proBNP; Roche) in 390
non-STelevation (NSTE) ACS patients were evaluated in relation to
significant coronary lesions on coronary angiography (defined as a
stenosis <50% of the luminal diameter, with need for revascularization)
and prognostic accuracy for cardiovascular mortality, all-cause mortality,
as well as the composite end point of cardiovascular mortality and
hospitalizations for AMI or heart failure. RESULTS: The mean (SD)
follow-up was 2921 (168) days. Absolute hs-cTnI concentrations were
significantly higher than the hs-cTnT concentrations. The relationship
between analyzed biomarkers and significant coronary lesions on coronary
angiography, as quantified by the area under the ROC curve (AUC), revealed
no difference between hs-cTnT [AUC, 0.81; 95% CI, 0.77- 0.86] and hs-cTnI
(AUC, 0.81; 95% CI, 0.76-0.86; P = NS). NT-proBNP was superior to both
hs-cTn assays regarding prognostic accuracy for both cardiovascular and
all-cause mortality and for the composite end point during follow-up, also
in multivariate analyses. CONCLUSIONS: The hs-cTnT and hs-cTnI assays
displayed a similar ability to predict significant coronary lesions in
NSTE-ACS patients. NT-proBNP was superior to both hscTn assays as a marker
of long-term prognosis in this patient group.<br/>Copyright &#xa9; 2016
American Association for Clinical Chemistry.

<102>
Accession Number
616332431
Author
Urena M.; Del Trigo M.; Altisent O.A.-J.; Campelo-Prada F.; Regueiro A.;
DeLarochelliere R.; Doyle D.; Mohammadi S.; Paradis J.-M.; Dagenais F.;
Dumont E.; Puri R.; Laroche V.; Rodes-Cabau J.
Institution
(Urena, Del Trigo, Altisent, Campelo-Prada, Regueiro, DeLarochelliere,
Paradis, Puri, Rodes-Cabau) Department of Cardiology, Quebec Heart and
Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, QC G1V
4G5, Canada
(Doyle, Mohammadi, Dagenais, Dumont) Department of Cardiac Surgery, Quebec
Heart and Lung Institute, Laval University, Quebec City, QC, Canada
(Laroche) Department of Hematology, Quebec Heart and Lung Institute, Laval
University, Quebec City, QC, Canada
Title
Combined erythropoietin and iron therapy for anaemic patients undergoing
transcatheter aortic valve implantation: The EPICURE randomised clinical
trial.
Source
EuroIntervention. 13 (1) (pp 44-52), 2017. Date of Publication: 2017.
Publisher
EuroPCR
Abstract
Aims: The aim of this study was to evaluate, in anaemic patients, the
efficacy of erythropoietin (EPO) in reducing red cell (RC) transfusion
rates post TAVI. Methods and results: This was a randomised double-blind
trial. Patients with severe symptomatic aortic stenosis and concomitant
anaemia with an indication for TAVI were randomised (1:1) to receive two
weight-based doses of EPO (darbepoetin alfa)+iron or placebo at days 10
(+/-4 days) and 1 (+/-1 day) pre TAVI. The primary outcome was the rate of
RC transfusions at 30 days. A total of 100 patients (mean age 81+/-7
years, male 49%) were included: 48 patients received EPO (+iron) and 52
patients received placebo. Baseline characteristics and procedural
findings were well balanced between groups except for baseline haemoglobin
levels, which were lower in those patients receiving EPO (10.7+/-1.2 vs.
11.3+/-1.1 g/dl, p=0.01). The rate of 30-day RC transfusion was similar in
both groups (27.1 vs. 25.0% in the EPO and placebo groups, respectively;
adjusted odds ratio 1.05, 95% CI: 0.42-2.64, p=0.92), and no differences
were observed in the number of RC units per transfused patient (1 [1-3]
vs. 2 [1-2] in the EPO and placebo groups, respectively, adjusted p=0.99).
Rates of 30-day mortality, stroke, new-onset atrial fibrillation, acute
kidney injury, and troponin peak were also similar between groups (p>0.20
for all). Conclusions: EPO (+iron) administration failed to reduce RC
transfusion rates or the per-patient number of transfusion units in
anaemic patients undergoing TAVI. ClinicalTrials.gov Identifier:
NCT02390102.<br/>Copyright &#xa9; Europa Digital & Publishing 2017. All
rights reserved.

<103>
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
(Arora, Vaidya) Division of Internal Medicine, Cape Fear Valley Medical
Center, Fayetteville, North Carolina
(Strassle) Department of Epidemiology, University of North Carolina at
Chapel Hill, Chapel Hill, North Carolina
(Strassle, Caranasos) Department of Surgery, University of North Carolina
at Chapel Hill, Chapel Hill, North Carolina
Title
Review of Major Registries and Clinical Trials of Late Outcomes After
Transcatheter Aortic Valve Replacement.
Source
American Journal of Cardiology. (no pagination), 2017. Date of
Publication: February 16, 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.

<104>
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
(Shah, Weiman) Department of Medicine, Veterans Affairs Medical Center,
Memphis, Tennessee
(Weiman) Department of Cardiothoracic Surgery, University of Tennessee,
Memphis, Tennessee
(Vetrovec) Section of Cardiology, Department of Medicine, Virginia
Commonwealth University, Richmond, Virginia
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. (no pagination), 2017. Date of
Publication: January 14, 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.