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<1>
Accession Number
610892281
Author
Barilla F.; Pannarale G.; Torromeo C.; Paravati V.; Acconcia M.C.;
Tanzilli G.; Mangieri E.; Dominici T.; Martino F.; Pannitteri G.; Gaudio
C.
Institution
(Barilla, Pannarale, Torromeo, Paravati, Acconcia, Tanzilli, Mangieri,
Dominici, Pannitteri, Gaudio) Department of Cardiovascular, Respiratory,
Nephrologic, Anaesthesiologic and Geriatric Sciences, Sapienza University
of Rome, Rome, Italy
(Martino) Department of Pediatrics and Child Neuropsychiatry, Sapienza
University of Rome, Rome, Italy
(Barilla) Cardiac Intensive Care Unit "B", Dipartimento Cuore e Grossi
Vasi "Attilio Reale", Sapienza University of Rome, Viale del Policlinico
155, Rome 00161, Italy
Title
Ivabradine in Patients with ST-Elevation Myocardial Infarction Complicated
by Cardiogenic Shock: A Preliminary Randomized Prospective Study.
Source
Clinical Drug Investigation. 36 (10) (pp 849-856), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Springer International Publishing
Abstract
Background and objective: An elevated heart rate (HR) is an independent
risk factor for mortality and morbidity in patients with acute heart
failure (HF). The purpose of this study was to evaluate the impact of
ivabradine, a selective HR-lowering agent, in patients with cardiogenic
shock (CS) complicating ST-elevation acute myocardial infarction (AMI).
Methods: Patients with post-AMI CS were randomized to standard treatment
(SDT, 28 patients) or to standard treatment plus ivabradine (I + SDT, 30
patients). In the presence of orotracheal intubation (OTI), ivabradine was
administered by nasogastric intubation. HR, BP, New York Heart Association
(NYHA) class, NT-proBNP, left ventricular ejection fraction (LVEF) and
diastolic function (LVDF) were monitored at specific times after the onset
of AMI. The primary (surrogate) end-point was the in-hospital halving of
plasma NT-proBNP levels. The secondary end-points were cardiovascular
death, hospital re-admission for worsening HF, and clinical and
haemodynamic improvement. Results: Treatment groups were statistically
similar with regard to age, gender distribution, cardiovascular risk
factors, number of diseased vessels and overall treated lesions, AMI site
and occurrence of OTI. In-hospital mortality was double in the SDT group
in comparison with the I + SDT group (14.3 vs. 6.7 %), but the difference
was not statistically significant. HR, BP, NT-proBNP and LVEF favorably
changed in both groups, but the change was more relevant in the I + SDT
group. LVDF significantly changed only in the I + SDT group (p < 0.01).
Patients in the I + SDT group did not experience adverse effects.
Conclusion: Ivabradine in CS complicating AMI is safe, is associated with
a short-term favourable outcome and can be effectively administered by
nasogastric intubation.<br/>Copyright &#xa9; 2016, Springer International
Publishing Switzerland.

<2>
Accession Number
608912186
Author
Rababa'h A.M.; Deo S.V.; Altarabsheh S.E.; De Caro J.; Tarboush N.A.;
Alzoubi K.H.; Ababneh M.; McConnell B.K.; Markowitz A.H.; Park S.J.
Institution
(Rababa'h, Alzoubi, Ababneh) Department of Clinical Pharmacy, Jordan
University of Science and Technology, Irbid, Jordan
(Deo, Markowitz, Park) Department of Cardiovascular Surgery, Case Western
Reserve University, Cleveland, OH, United States
(Altarabsheh) Department of Cardiac Surgery, Queen Alia Heart Institute,
Amman, Jordan
(De Caro) Cleveland Health Sciences Library, Case Western Reserve
University, Cleveland, OH, United States
(Tarboush) Department of Physiology and Biochemistry, Faculty of Medicine,
University of Jordan, Amman, Jordan
(McConnell) Department of Pharmacological and Pharmaceutical Sciences,
College of Pharmacy, University of Houston, Texas Medical Center, Houston,
TX, United States
Title
N-acetyl cysteine therapy does not prevent renal failure in high-risk
patients undergoing open-heart surgery.
Source
Heart Surgery Forum. 19 (1) (pp E16-E22), 2016. Date of Publication:
February 2016.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Background: Renal dysfunction is a common complication after
cardiovascular surgery. Controversial issues have been discussed regarding
the role of N-acetyl cysteine in the prevention of postoperative renal
dysfunction. The purpose of this meta-analysis is to assess whether
N-acetyl cysteine offers any protection against the development of acute
renal dysfunction after cardiac surgery. Methods: Multiple databases were
searched for randomized trials comparing the role of N-acetyl cysteine and
placebo in human patients undergoing cardiac surgery. Endpoints studied
were: the incidence of acute renal failure, hemodialysis, early mortality,
duration of hospital stay, and maximal change in creatinine values.
Dichotomous variables were compared using the risk difference (RD)
calculated with inverse weighting; continuous data was pooled as
(standardized) mean difference. Results are presented with 95% confidence
interval (P < .05 is significant); results are presented within 95%
confidence interval. Results: Thirteen randomized trials (713 and 707
patients in the N-acetyl cysteine and control groups, respectively) were
included in the present analysis; nine dealing with patients at high-risk
for acute renal failure. The incidence of postoperative acute renal
dysfunction was 23% and 36% in the N-acetyl cysteine and control cohorts,
respectively. N-acetyl cysteine therapy did not reduce acute renal
dysfunction in the high-risk cohort [RD -0.03 (-0.09 to 0.02); P = .22;
I² = 24%]. Maximal change in creatinine levels after surgery
was also comparable [standardized mean difference 0.07 (-0.23, 0.09); P =
.39]. Early mortality was 2.9% and 3.7% in the N-acetyl cysteine and
control cohorts respectively; [RD 0 (-0.03 to 0.02); P = .63;
I² = 20%]. Hospital stay (mean length of stay 10.4 and 10.1
days in the N-acetyl cysteine and control cohorts, respectively) was also
similar in both cohorts [WMD 0.17 (-0.02 to 0.37) days; P = .81].
Conclusion: Prophylactic N-acetyl cysteine therapy does not reduce the
incidence of renal dysfunction in high-risk patients undergoing cardiac
surgery.<br/>Copyright &#xa9; 2016 Forum Multimedia Publishing, LLC.

<3>
Accession Number
607178254
Author
Li Y.; Guo S.; Liu G.; Yuan Y.; Wang W.; Zheng Z.; Hu S.; Ji B.
Institution
(Li, Guo, Liu, Yuan, Ji) Department of Cardiopulmonary Bypass, State Key
Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for
Cardiovascular Disease, Chinese Academy of Medical Science and Peking
Union Medical College, Beijing, China
(Wang, Zheng, Hu) Department of Cardiac Surgery, State Key Laboratory of
Cardiovascular Medicine, Fuwai Hospital, National Center for
Cardiovascular Disease, Chinese Academy of Medical Science and Peking
Union Medical College, Beijing, China
(Li) Department of Cardiac Surgery, Lanzhou University Second Hospital,
Lanzhou, China
Title
Three Preservation Solutions for Cold Storage of Heart Allografts: A
Systematic Review and Meta-Analysis.
Source
Artificial Organs. 40 (5) (pp 489-496), 2016. Date of Publication: 01 May
2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Organ preservation solution has been designed to attenuate the detrimental
effects during the ischemic period. The aim of this study was to
systematically evaluate the evidence comparing preservation solutions for
heart preservation. Studies were searched in PubMed, Embase, the Cochrane
Library, the Transplant Library, and the International Clinical Trials
Registry Platform. The primary outcomes were patient survival and donor
heart dysfunction. The secondary outcomes were in-hospital mortality and
enzyme gene expression. The University of Wisconsin solution (UW) was
associated with a significantly improved survival at 30 days and 90 days
(hazard ratio=1.16, 95% confidence interval [CI]=1.11-1.22, P<0.00001;
risk difference [RD]=0.03, 95% CI=0.01-0.05, P=0.002), compared with
Celsior. Hearts preserved with UW exhibited less ischemic necrosis than
those preserved with Celsior (RD=-0.07, 95% CI=-0.08 to 0.05, P<0.00001).
UW was associated with better survival compared with
histidine-tryptophan-ketoglutarate solution (HTK). There was no
statistical difference in donor heart dysfunction and in-hospital
mortality outcomes when comparing HTK with Celsior solution. During static
cold storage preservation, this study suggests that UW solution has better
clinical outcomes for heart transplantation compared with the other two
organ preservation solutions. Besides, the protective effect of Celsior
solution is similar to HTK solution in donor heart
preservation.<br/>Copyright &#xa9; 2016 Wiley Periodicals, Inc. and
International Center for Artificial Organs and Transplantation.

<4>
Accession Number
611990335
Author
Mukete B.N.; Riehl R.A.; Alonso A.; Samson R.; Jaiswal A.; Le Jemtel T.H.
Institution
(Mukete, Alonso, Samson, Jaiswal, Le Jemtel) Division of Cardiology,
Department of Medicine, Tulane University School of Medicine, Heart and
Vascular Institute, 1430 Tulane Avenue, SL-48, New Orleans, LA 70112,
United States
(Riehl) Tulane University School of Medicine, New Orleans, LA, United
States
Title
Multivessel Revascularization Does Not Increase Contrast-Induced Acute
Kidney Injury Incidence in Acute Myocardial Infarction: A Meta-Analysis.
Source
American Journal of Cardiovascular Drugs. 16 (6) (pp 419-426), 2016. Date
of Publication: 01 Dec 2016.
Publisher
Springer International Publishing
Abstract
Background: Recent studies and meta-analysis have shown that complete
revascularization (CR) compared with infarct-related artery
revascularization (IRA) during percutaneous coronary intervention for
ST-segment elevation myocardial infarction (STEMI) is associated with
decreased mortality. However, it is unclear if CR versus IRA in STEMI
during indexed hospitalization is associated with risk of contrast-induced
acute kidney injury (CI-AKI). Methods: A database search was conducted for
all randomized controlled trials that enrolled STEMI patients and compared
CR versus IRA and reported CI-AKI. Comprehensive Meta-Analysis Version 2.0
(Wiley, Chichester) was used to determine summary effect size with a
fixed-effect model and expressed as a risk ratio with 95 % confidence
intervals. Results: A total of four trials were identified and had a mean
follow-up of 24.5 +/- 9.9 months, a total sample size of 1537, a mean age
of 63.8 +/- 1.2 versus 64.2 +/- 2.1 years, 31.2 +/- 5.3 versus 30.1 +/-
4.7 % three-vessel disease, and 33.7 +/- 4.1 versus 37.2 +/- 4.5 %
anterior STEMI in the CR versus IRA groups, respectively. A total of 276.7
+/- 25.2 versus 186.7 +/- 15.3 mL contrast was used in the CR versus IRA
respectively (p = 0.006). There were no statistical significant
differences between the two groups in the reported incidence of CI-AKI
(1.3 % CR vs. 1.9 % IRA; p = 0.4), major bleeding (1.7 % CR vs. 2.5 % IRA;
p = 0.4) and stroke (1.1 % CR vs. 0.4 % IRA; p = 0.24). However, there was
a significantly increased incidence of cardiovascular death (2.0 % CR vs.
4.7 % IRA; p = 0.01) and ischemia-driven revascularization (6.2 % CR vs.
18.3 % IRA; p < 0.01). Conclusion: In the index hospitalization, CR in
STEMI patients is associated with significant risk reduction in cardiac
death and revascularization and a non-significant reduced trend of CI-AKI,
despite increased use of contrast when compared with IRA.<br/>Copyright
&#xa9; 2016, Springer International Publishing Switzerland.

<5>
Accession Number
609403801
Author
Andreassen A.K.; Andersson B.; Gustafsson F.; Eiskjaer H.; Radegran G.;
Gude E.; Jansson K.; Solbu D.; Karason K.; Arora S.; Dellgren G.;
Gullestad L.
Institution
(Andreassen, Gude, Arora, Gullestad) Department of Cardiology, Oslo
University Hospital Rikshospitalet, Oslo, Norway
(Andersson, Karason) Department of Cardiology, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Gustafsson) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Eiskjaer) Department of Cardiology, Aarhus University Hospital, Skejby,
Denmark
(Radegran) Section for Heart Failure and Valvular Disease, Skane
University Hospital, Department of Clinical Sciences, Cardiology, Lund
University, Lund, Sweden
(Jansson) Department of Cardiology, Heart and Medicine Center County
Council of Ostergotland, Linkoping University, Linkoping, Sweden
(Solbu) Novartis Norge AS, Oslo, Norway
(Dellgren) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Gullestad) K.G. Jebsen Cardiac Research Center, Center for Heart Failure
Research, Faculty of Medicine, University of Oslo, Oslo, Norway
Title
Everolimus Initiation with Early Calcineurin Inhibitor Withdrawal in de
Novo Heart Transplant Recipients: Three-Year Results from the Randomized
SCHEDULE Study.
Source
American Journal of Transplantation. 16 (4) (pp 1238-1247), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
In a randomized, open-label trial, de novo heart transplant recipients
were randomized to everolimus (3-6 ng/mL) with reduced-exposure
calcineurin inhibitor (CNI; cyclosporine) to weeks 7-11 after transplant,
followed by increased everolimus exposure (target 6-10 ng/mL) with
cyclosporine withdrawal or standard-exposure cyclosporine. All patients
received mycophenolate mofetil and corticosteroids. A total of 110 of 115
patients completed the 12-month study, and 102 attended a follow-up visit
at month 36. Mean measured GFR (mGFR) at month 36 was 77.4 mL/min
(standard deviation [SD] 20.2 mL/min) versus 59.2 mL/min (SD 17.4 mL/min)
in the everolimus and CNI groups, respectively, a difference of 18.3
mL/min (95% CI 11.1-25.6 mL/min; p < 0.001) in the intention to treat
population. Multivariate analysis showed treatment to be an independent
determinant of mGFR at month 36. Coronary intravascular ultrasound at 36
months revealed significantly reduced progression of allograft
vasculopathy in the everolimus group compared with the CNI group.
Biopsy-proven acute rejection grade >=2R occurred in 10.2% and 5.9% of
everolimus- and CNI-treated patients, respectively, during months 12-36.
Serious adverse events occurred in 37.3% and 19.6% of everolimus- and
CNI-treated patients, respectively (p = 0.078). These results suggest that
early CNI withdrawal after heart transplantation supported by everolimus,
mycophenolic acid and steroids with lymphocyte-depleting induction is safe
at intermediate follow-up. This regimen, used selectively, may offer
adequate immunosuppressive potency with a sustained renal
advantage.<br/>Copyright &#xa9; 2015 The American Society of
Transplantation and the American Society of Transplant Surgeons.

<6>
Accession Number
611158362
Author
Basciani R.; Kroninger F.; Gygax E.; Jenni H.; Reineke D.; Stucki M.;
Hagenbuch N.; Carrel T.; Eberle B.; Erdoes G.
Institution
(Basciani, Kroninger, Stucki, Eberle, Erdoes) Department of Anesthesiology
and Pain Therapy, Inselspital, Bern University Hospital, University of
Bern, Bern, Switzerland
(Gygax, Jenni, Reineke, Carrel) Department of Cardiovascular Surgery,
Swiss Cardiovascular Center, Inselspital, Bern University Hospital,
University of Bern, Bern, Switzerland
(Hagenbuch) Private Statistician, Spiez, Switzerland
Title
Cerebral Microembolization During Aortic Valve Replacement Using Minimally
Invasive or Conventional Extracorporeal Circulation: A Randomized Trial.
Source
Artificial Organs. 40 (12) (pp E280-E291), 2016. Date of Publication: 01
Dec 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
To compare intraoperative cerebral microembolic load between minimally
invasive extracorporeal circulation (MiECC) and conventional
extracorporeal circulation (CECC) during isolated surgical aortic valve
replacement (SAVR), we conducted a randomized trial in patients undergoing
primary elective SAVR at a tertiary referral hospital. The primary outcome
was the procedural phase-related rate of high-intensity transient signals
(HITS) on transcranial Doppler ultrasound. HITS rate was used as a
surrogate of cerebral microembolism in pre-defined procedural phases in
SAVR using MiECC or CECC with (+F) or without (-F) an oxygenator with
integrated arterial filter. Forty-eight patients were randomized in a 1:1
ratio to MiECC or CECC. Due to intraprocedural Doppler signal loss (n =
3), 45 patients were included in final analysis. MiECC perfusion regimen
showed a significantly increased HITS rate compared to CECC (by a factor
of 1.75; 95% confidence interval, 1.19-2.56). This was due to different
HITS rates in procedural phases from aortic cross-clamping until
declamping [phase 4] (P = 0.01), and from aortic declamping until stop of
extracorporeal perfusion [phase 5] (P = 0.05). Post hoc analysis revealed
that MiECC-F generated a higher HITS rate than CECC+F (P = 0.005), CECC-F
(P = 0.05) in phase 4, and CECC-F (P = 0.03) in phase 5, respectively. In
open-heart surgery, MiECC is not superior to CECC with regard to gaseous
cerebral microembolism. When using MiECC for SAVR, the use of oxygenators
with integrated arterial line filter appears highly advisable. Only with
this precaution, MiECC confers a cerebral microembolic load comparable to
CECC during this type of open heart surgery.<br/>Copyright &#xa9; 2016
International Center for Artificial Organs and Transplantation and Wiley
Periodicals, Inc.

<7>
[Use Link to view the full text]
Accession Number
610227434
Author
Arnuntasupakul V.; Van Zundert T.C.R.V.; Vijitpavan A.; Aliste J.;
Engsusophon P.; Leurcharusmee P.; Ah-Kye S.; Finlayson R.J.; Tran D.Q.H.
Institution
(Arnuntasupakul, Vijitpavan) Department of Anesthesia, Ramathibodi
Hospital, Mahidol University, Bangkok, Thailand
(Van Zundert, Aliste, Engsusophon, Ah-Kye, Finlayson, Tran) Department of
Anesthesia, Montreal General Hospital, McGill University, Montreal, QC,
Canada
(Leurcharusmee) Department of Anesthesia, Maharaj Nakorn Chiang Mai
Hospital, Chiang Mai University, Chiang Mai, Thailand
(Tran) Department of Anesthesia, Montreal General Hospital, 1650 Cedar
Ave, Montreal, QC H3G-1A4, Canada
Title
A randomized comparison between conventional and waveform-confirmed loss
of resistance for thoracic epidural blocks.
Source
Regional Anesthesia and Pain Medicine. 41 (3) (pp 368-373), 2016. Date of
Publication: 01 May 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background and Objectives Epidural waveform analysis (EWA) provides a
simple confirmatory adjunct for loss of resistance (LOR): when the needle
tip is correctly positioned inside the epidural space, pressure
measurement results in a pulsatile waveform. In this randomized trial, we
compared conventional and EWA-confirmed LOR in 2 teaching centers. Our
research hypothesis was that EWA-confirmed LOR would decrease the failure
rate of thoracic epidural blocks. Methods One hundred patients undergoing
thoracic epidural blocks for thoracic surgery, abdominal surgery, or rib
fractures were randomized to conventional LOR or EWA-LOR. The operator was
allowed as many attempts as necessary to achieve a satisfactory LOR (by
feel) in the conventional group. In the EWA-LOR group, LOR was confirmed
by connecting the epidural needle to a pressure transducer using a rigid
extension tubing. Positive waveforms indicated that the needle tip was
positioned inside the epidural space. The operator was allowed a maximum
of 3 different intervertebral levels to obtain a positive waveform. If
waveforms were still absent at the third level, the operator simply
accepted LOR as the technical end point. However, the patient was retained
in the EWA-LOR group (intent-to-treat analysis). After achieving a
satisfactory tactile LOR (conventional group), positive waveforms (EWA-LOR
group), or a third intervertebral level with LOR but no waveform (EWA-LOR
group), the operator administered a 4-mL test dose of lidocaine 2% with
epinephrine 5 mug/mL. Fifteen minutes after the test dose, a blinded
investigator assessed the patient for sensory block to ice. Results
Compared with LOR, EWA-LOR resulted in a lower rate of primary failure (2%
vs 24%; P = 0.002). Subgroup analysis based on experience level reveals
that EWA-LOR outperformed conventional LOR for novice (P = 0.001) but not
expert operators. The performance time was longer in the EWA-LOR group
(11.2 +/- 6.2 vs 8.0 +/- 4.6 minutes; P = 0.006). Both groups were
comparable in terms of operator's level of expertise, depth of the
epidural space, approach, and LOR medium. In the EWA-LOR group, operators
obtained a pulsatile waveform with the first level attempted in 60% of
patients. However, 40% of subjects required performance at a second or
third level. Conclusions Compared with its conventional counterpart,
EWA-confirmed LOR results in a lower failure rate for thoracic epidural
blocks (2% vs 24%) in our teaching centers. Confirmatory EWA provides
significant benefits for inexperienced operators.<br/>Copyright &#xa9;
2016 American Society of Regional Anesthesia and Pain Medicine.

<8>
Accession Number
606992249
Author
Schmitt K.R.L.; Fedarava K.; Justus G.; Redlin M.; Bottcher W.; Delmo
Walter E.M.; Hetzer R.; Berger F.; Miera O.
Institution
(Schmitt, Fedarava, Justus, Berger, Miera) Department of Congenital Heart
Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin,
Germany
(Redlin) Department of Anesthesiology, Deutsches Herzzentrum Berlin,
Berlin, Germany
(Bottcher, Delmo Walter, Hetzer) Department of Cardiothoracic and Vascular
Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
(Berger) Department of Pediatrics, Division of Cardiology,
Charite-Universitatsmedizin, Berlin, Germany
Title
Hypothermia During Cardiopulmonary Bypass Increases Need for Inotropic
Support but Does Not Impact Inflammation in Children Undergoing Surgical
Ventricular Septal Defect Closure.
Source
Artificial Organs. 40 (5) (pp 470-479), 2016. Date of Publication: 01 May
2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Minimizing the systemic inflammatory response caused by cardiopulmonary
bypass is a major concern. It has been suggested that the perfusion
temperature affects the inflammatory response. The aim of this prospective
study was to compare the effects of moderate hypothermia (32degreeC) and
normothermia (36degreeC) during cardiopulmonary bypass on markers of the
inflammatory response and clinical outcomes (time on ventilator) after
surgical closure of ventricular septal defects. During surgical closure of
ventricular septal defects under cardiopulmonary bypass, 20 children
(median age 4.9 months, range 2.3-38 months; median weight 7.2kg, range
5.2-11.7kg) were randomized to a perfusion temperature of either 32degreeC
(Group 1, n=10) or 36degreeC (Group 2, n=10). The clinical data and blood
samples were collected before cardiopulmonary bypass, directly after
aortic cross-clamp release, and 4 and 24h after weaning from
cardiopulmonary bypass. Time on ventilation as primary outcome did not
differ between the two groups. Other clinical outcome parameters like
fluid balance or length of stay in the intensive care were also similar in
the two groups. Compared with Group 2, Group 1 needed significantly higher
and longer inotropic support (P<0.001). In Group 1, two infants had
junctional ectopic tachycardia, and another had a pulmonary hypertensive
crisis. Perfusion temperature did not influence cytokine release, organ
injury, or coagulation. Cardiopulmonary bypass temperature does not
influence time on ventilation or inflammatory marker release. However, in
the present study, with a small patient cohort, patients operated under
hypothermic bypass needed higher and longer inotropic support. The use of
hypothermic cardiopulmonary bypass in infants and children should be
approached with care.<br/>Copyright &#xa9; 2016 Wiley Periodicals, Inc.
and International Center for Artificial Organs and Transplantation.

<9>
Accession Number
610315138
Author
Gutierrez J.A.; Harrington R.A.; Blankenship J.C.; Stone G.W.; Steg P.G.;
Gibson C.M.; Hamm C.W.; Price M.J.; Genereux P.; Prats J.; Deliargyris
E.N.; Mahaffey K.W.; White H.D.; Bhatt D.L.
Institution
(Gutierrez, Bhatt) Brigham and Women's Hospital Heart, Vascular Center,
Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States
(Harrington, Mahaffey) Stanford University Medical School, Stanford, CA,
United States
(Blankenship) Geisinger Medical Center, Danville, PA, United States
(Stone, Genereux) Columbia University Medical Center, Cardiovascular
Research Foundation, New York, NY, United States
(Steg) INSERM Unite 1148, Universite Paris-Diderot,
Assistance-Publique-Hopitaux de Paris, Paris, France
(Steg) NHLI, Imperial College, Royal Brompton Hospital, London, United
Kingdom
(Gibson) Beth Israel Deaconess Medical Center, Division of Cardiology,
Boston, MA, United States
(Hamm) Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
(Price) Scripps Clinic and Scripps Translational Science Institute, San
Diego, CA, United States
(Prats, Deliargyris) Medicines Company, Parsippany, NJ, United States
(White) Green Lane Cardiovascular Service, Auckland, New Zealand
Title
The effect of cangrelor and access site on ischaemic and bleeding events:
Insights from CHAMPION PHOENIX.
Source
European Heart Journal. 37 (14) (pp 1122-1130), 2016. Date of Publication:
07 Apr 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims To assess whether the use of the femoral or radial approach for
percutaneous coronary intervention (PCI) interacted with the efficacy and
safety of cangrelor, an intravenous P2Y<inf>12</inf> inhibitor, in
CHAMPION PHOENIX. Methods and results A total of 11 145 patients were
randomly assigned in a double-dummy, double-blind manner either to a
cangrelor bolus and 2-h infusion or to clopidogrel at the time of PCI. The
primary endpoint, a composite of death, myocardial infarction,
ischaemia-driven revascularization, or stent thrombosis, and the primary
safety endpoint, Global Use of Strategies to Open Occluded Coronary
Arteries (GUSTO) defined severe bleeding, were evaluated at 48 h. Of the
patients undergoing PCI and receiving study drug treatment, a total of
8064 (74%) and 2855 (26%) patients underwent femoral or radial PCI,
respectively. Among the femoral cohort, the primary endpoint rate was 4.8%
with cangrelor vs. 6.0% with clopidogrel (odds ratio, OR [95% confidence
interval, CI] = 0.79 [0.65-0.96]); among the radial cohort, the primary
endpoint was 4.4% with cangrelor vs. 5.7% with clopidogrel (OR [95% CI] =
0.76 [0.54-1.06]), P-interaction 0.83. The rate of GUSTO severe bleeding
in the femoral cohort was 0.2% with cangrelor vs. 0.1% with clopidogrel
(OR [95% CI] = 1.73 [0.51-5.93]). Among the radial cohort, the rate of
GUSTO severe bleeding was 0.1% with cangrelor vs. 0.1% with clopidogrel
(OR [95% CI] = 1.02 [0.14-7.28]), P-interaction 0.65. The evaluation of
safety endpoints with the more sensitive ACUITY-defined bleeding found
major bleeding in the femoral cohort to be 5.2% with cangrelor vs. 3.1%
with clopidogrel (OR [95% CI] = 1.69 [1.35-2.12]); among the radial cohort
the rate of ACUITY major bleeding was 1.5% with cangrelor vs. 0.7% with
clopidogrel (OR [95% CI] = 2.17 [1.02-4.62], P-interaction 0.54).
Conclusion In CHAMPION PHOENIX, cangrelor reduced ischaemic events with no
significant increase in GUSTO-defined severe bleeding. The absolute rates
of bleeding, regardless of the definition, tended to be lower when PCI was
performed via the radial artery.<br/>Copyright &#xa9; The Author 2015.
Published by Oxford University Press on behalf of the European Society of
Cardiology.

<10>
[Use Link to view the full text]
Accession Number
606696544
Author
Marti D.; Salido L.; Mestre J.L.; Esteban M.J.; Casas E.; Jimenez-Mena M.;
Pey J.; Sanmartin M.; Hernandez-Antolin R.; Zamorano J.L.
Institution
(Marti, Salido, Mestre, Esteban, Casas, Jimenez-Mena, Pey, Sanmartin,
Hernandez-Antolin, Zamorano) Interventional Cardiology Unit, Department of
Cardiology, Central Defense Hospital, University of Alcala, Glorieta del
Ejercito, S/N, Madrid 28047, Spain
Title
Impact of thrombus burden on procedural and mid-term outcomes after
primary percutaneous coronary intervention.
Source
Coronary Artery Disease. 27 (3) (pp 169-175), 2016. Date of Publication:
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective Angiographic thrombus burden (TB) can be assessed early and
enable a decision on intervention. The aim of this study was to analyze
its effect on the incidence of cardiac events after a primary percutaneous
coronary intervention. Patients and methods We carried out a prospective
study of 480 consecutive ST-segment elevation myocardial infarction
patients treated by systematic primary percutaneous coronary intervention.
Large TB was defined as thrombus length at least 2 vessel diameters or as
solid thrombus obtained through catheter aspiration. The primary outcome
measure was a composite of death, reinfarction, or target vessel
revascularization. Results A total of 205 (47%) patients fulfilled the
criteria for large TB. These patients were more frequently treated with
abciximab (62.0 vs. 35.8%, P<0.001), showed more angiographic
complications (26.6 vs. 13.7%, P=0.001), and had larger infarcts (peak
troponin I, 74 vs. 50 ng/ml, P=0.015). During a follow-up of 19+/- 5
months, the rates of primary outcome were similar between groups of small
and large TB (16.2 vs. 12.8%, hazard ratio: 0.88, 95% confidence interval:
0.46-1.67, P=0.691). There were no differences in the rates of definite
stent thrombosis (0.5 vs. 2.2%, P=0.190). Conclusion Large TB is
associated with larger infarct size, but not with worse mid-term outcomes.
Selective use of adjuvant therapies according to TB may be an effective
approach to reduce thrombotic complications.<br/>Copyright &#xa9; 2016
Wolters Kluwer Health, Inc. All rights reserved.

<11>
Accession Number
616611427
Author
Hamidreza D.
Title
Challenges in lung transplantation in Iran.
Source
Iranian Journal of Kidney Diseases. Conference: 3rd International Congress
of Organ Transplantation and 16th International Congress of Nephrology,
Dialysis, and Transplantation. Iran, Islamic Republic of. 11 (pp 17-18),
2017. Date of Publication: May 2017.
Publisher
Iranian Society of Nephrology
Abstract
Introductions. Lung transplantation is the treatment of choice for end
stage lung disease for more than 2 decades. It is a clinical practice with
3651 lung transplantation in more than 225 center registered lung in 2015.
How about IRAN and why we are still disappointed. Methods. As a general
thoracic surgeon who have been interested in lung transplantation since
1993 when I started thoracic fellowship, I would like to discuss major
challenging issues and little progress in lung transplant program in Iran.
I participated in first bilateral lobar living transplant and first heart
and lung transplant in Shiraz university before fellowship in lung
transplantation. I was a member of team for kidney and liver for six years
before lung transplant training. I was a surgeon and conducted first
bilateral lung transplant in Shiraz. I moved to capital and as a senior
surgeon I did 21 lung transplantation but still I am disappointed for
little progress and not well organized program. I would like to discuss
these issues in round table. Results. In our country kidney
transplantation has been done for 2 decades and liver transplantation for
one decade for annual 3000 kidneys and 500 liver transplantation per year.
Thoracic transplantation has been done for more than a decade with up to
600 hundred heart and more than 100 lung transplantations. The main issue
is why we are not having an active and continuing program. We had 1st lung
transplantation in Iran who is still alive for 14 years and is on waiting
list for second lung transplantation, Since the beginning lung
transplantation we had more than 80 lung transplantation in one center and
20 in other center with at least 3 center did 1 to 2 lung transplantation.
Are there a problem in technique, instrument, team work, or training.? We
started lung transplant program as compare with kidney and liver
transplant with less training team and in a substandard situation. There
are local and government issues such as organization, instruments,
training of all members of team, team work, leadership and socioeconomic
support of team and lung transplant candidate. Conclusions. Each country
needs native program but it is necessary to understand lung
transplantation is a special fellowship needs training not for surgeon but
for all members of team. Thoracic surgery ward needs to be standardized.
We need to close cooperation with international societies and academic
center to get their experience. It is our fault to have little progress in
lung transplant and not the complexity of lung transplantation.

<12>
Accession Number
616608220
Author
Sina B.; Masih S.; Shahrbanoo S.; Mahsa K.; Mohammad-Mahdi S.
Institution
(Sina, Masih, Shahrbanoo, Mahsa, Mohammad-Mahdi) Shiraz University of
Medical Sciences, Shiraz, Iran, Islamic Republic of
Title
Effect of remote ischemic preconditioning on incidence of acute kidney
injury in patients undergoing coronary artery bypass graft surgery.
Source
Iranian Journal of Kidney Diseases. Conference: 3rd International Congress
of Organ Transplantation and 16th International Congress of Nephrology,
Dialysis, and Transplantation. Iran, Islamic Republic of. 11 (pp 51),
2017. Date of Publication: May 2017.
Publisher
Iranian Society of Nephrology
Abstract
Introductions. Acute kidney injury (AKI), a common and serious
complication of coronary artery bypass graft (CABG) surgery with
cardiopulmonary bypass (CPB), is associated with inflammatory reactions
and ischemia-reperfusion injury. Remote ischemic preconditioning (RIPC)
which is transient ischemia and reperfusion of a limb, is reported to
reduce the risk of CPB-associated myocardial and acute kidney injury, but
uncertainty remains. Methods. We conducted a prospective, doubleblind,
randomized, controlled trial at the Namazi hospital, Shiraz, Iran, between
November, 2013, and February, 2016. 177 adult patients undergoing elective
or urgent on-pump CABG surgery were randomly assigned to either RIPC group
(n = 87) or control group (n = 90). The patients in RIPC group received
three cycles of 5 min ischemia and 5 min reperfusion in the upper arm
after induction of anesthesia. We placed an uninflated cuff on the arm for
30 min in the control group. The primary end point was incidence of acute
kidney injury defined as an elevation of serum creatinine of >= 0.3 mg/dl
or >= 50% within 72 h after surgery. Secondary end points included
duration of hospital stay and death. Results. There was no significant
difference in the incidence of AKI between groups (38 patients [43.7%] in
the RIPC group and 41 patients [45.6%] in the control group, P = 0.80). No
significant differences between groups were seen in the duration of
hospital or intensive care unit stay, and in-hospital mortality.
Conclusions. RIPC did not reduce the incidence of AKI in patients
undergoing on-pump CABG surgery.

<13>
Accession Number
616608160
Author
Nooshin D.; Alireza J.
Institution
(Nooshin) Department of Nephrology, ShahidLabbafinezhad Hospital,
ShahidBeheshti University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Alireza) Department of Cardiac Anesthesiology, MasihDaneshvari Hospital,
ShahidBeheshti University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Title
Effects of pentoxifyllineon reducing acute kidney injury, inflammation and
oxidative stress after cardiac surgery.
Source
Iranian Journal of Kidney Diseases. Conference: 3rd International Congress
of Organ Transplantation and 16th International Congress of Nephrology,
Dialysis, and Transplantation. Iran, Islamic Republic of. 11 (pp 33-34),
2017. Date of Publication: May 2017.
Publisher
Iranian Society of Nephrology
Abstract
Introductions. AKI is a common and serious post operative complication and
may occur in up to 50% of all patients undergoing cardiac surgery and is
associated with 8% mortality rate compared with 0.9% in non-affected
patients and remains a major factor for post surgery adverse outcomes.
Early interventions to prevent postoperative AKI can help decreasing
morbidity and mortality in these patients. Using cardiopulmonary bypass
during cardiac surgery triggers systemic inflammatory response and
recruits pro-inflammatory cytokines such as tumor necrosis factor,
interleukin-10 and IL-6 accompanying with production of free oxygen
radicals which provokes oxidative stress in the milieu of ischemic
reperfusion injury. Pentoxifylline as a non-specific phosphodiesterase
inhibitor, can suppress the production of some factors of inflammatory
response and oxidative stress, probably prevent post surgery AKI with
these mechanisms. We examined the effects of pentoxifylline on preventing
the development of AKI and reducing inflammatory and oxidative stress
responses in patients undergoing elective coronary artery bypass graft
surgery (CABG). Methods. We performed a double blind randomized
multicenter clinical trial, enrolling 100 consecutive patients undergoing
elective CABG. Patients randomly and within concealment method divided
into two groups, one to receive oral pentxifylline 400 mg every 8 hours
from three days before surgery and the other group received placebo. All
the intubation, surgery and weaning protocols were the same. Serum
interleukin levels (IL-6, IL-10) C-reactive protein, total leukocyte
count, erythrocyte sedimentation rate, serum albumin, plasma
malondialdehyde, reduced glutathione level and thiobarbituric reactive
substances as a marker of lipid peroxidation and urinary excretion of
15-F2-isoprostane and urine NGAL level measured before starting
intervention 6, 24 and 72 hours after surgery. RIFLE criteria for AKI and
timely clearance of creatinine measured before starting intervention and 6
and 24 and 72 hours after induction of anesthesia . Results. Both groups
did not differ significantly in demographic and baseline characteristics.
43 patients developed AKI 72 hours after surgery; 12 of them were in the
intervention group and 31 in the control group (P = 0.003). Postoperative
leukocyte count was also higher in the untreated placebo than in the
pentoxifylline-treated patients . Starting from normal values at base
line, CRP and IL-6 levels increased in both groups showing no
significantly differences but higher results of blood IL-10 were seen in
placebo-treated patients 72 hours post surgery . (46 +/- 8.1 versus 15.6
+/- 4.9, P < 0.005) . Pentoxifylline group also showed higher clinical
although not statistical significant (P = 0.1) reduction of lipid
peroxidation marker (thiobarbituric reactive substances).
Pentoxifyllinetreated patients showed 12.4% reduction in plasma
malondialdehyde and 3% increase in blood reduced glutathione level.
Conclusions. This study reveals improvements in inflammatory markers, and
oxidative stress by pentoxifylline, thus preventing some complications in
patients undergoing cardiac surgery. We demonstrated pre-operative use of
oral pentoxifylline can improve renal function and reduces post cardiac
surgery AKI without causing hemodynamic instability in this population .
Overall, we recommend future studies with larger sample size and longer
follow up periods to determine the different aspects of administrating
prophylactic pentoxifylline.

<14>
Accession Number
614608021
Author
Bail D.H.L.
Institution
(Bail) Karl-Olga-Hospital, Stuttgart, Germany
Title
Treatment of functional mitral regurgitation by percutaneous annuloplasty
using the Carillon Mitral Contour System-Currently available data state.
Source
Journal of Interventional Cardiology. 30 (2) (pp 156-162), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objective: The purpose of this study is to provide a systematic review of
currently available data about the percutaneous trans-coronary-venous
mitral annuloplasty with the Carillon Mitral Contour System. Method: A
systematic literature search was conducted using the common medical and
scientific databases. The documented parameters included among others
grade of mitral regurgitation (MR), vena contracta (VC), effective
regurgitant orifice area (EROA), 6 minute-walk-test (6MWT),
NYHA-classification, and Quality of Life (QoL) at baseline, 30 days and in
the long-term follow-up. Results: The exact total number of successfully
implantations with available data remains unclear because so many
publications are either of the same institution or study group, or they
present overlapping results. Reduction of functional mitral regurgitation
(FMR) was associated with significant inverse left-ventricular (LV))
remodeling, improvement in 6MWT, QoL and NYHA-class during the 12-month
follow-up. In almost half of the enrolled patients, the Carillon System
could not be implanted or had to be removed due to coronary compromission.
Adverse advent rate (AE) ranged between 2.8-39%. Conclusions: Results with
regard to reduction of MR and inverse LV remodeling have been remarkable.
Indication and selection criteria for suitable patients, the expected
complications, and the long-term results with regard to survival and
quality of life still remain unclear. The available results do not
establish superiority of the Carillon Mitral Contour System and support
the lack of a clear benefit. The approach with the Carillon Mitral Contour
System should be limited to participants of prospective and randomized
trials.<br/>Copyright &#xa9; 2017, Wiley Periodicals, Inc.

<15>
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.

<16>
Accession Number
610654032
Author
Biancari F.; D'Errigo P.; Rosato S.; Pol M.; Tamburino C.; Ranucci M.;
Seccareccia F.
Institution
(Biancari) Department of Surgery, Oulu University Hospital, Oulu, Finland
(D'Errigo, Rosato, Seccareccia) National Center for Epidemiology,
Surveillance and Health Promotion, Istituto Superiore di Sanita, Via Giano
della Bella 34, Rome 00161, Italy
(Pol) First Faculty of Medicine, Institute of Anatomy, Charles University
in Prague, Prague, Czech Republic
(Tamburino) Division of Cardiology, Ferrarotto Hospital, University of
Catania, Catania, Italy
(Ranucci) Department of Cardiothoracic and Vascular Anesthesia, ICU-IRCCS
Policlinico San Donato, San Donato Milanese, Milan, Italy
Title
Transcatheter aortic valve replacement in nonagenarians: early and
intermediate outcome from the OBSERVANT study and meta-analysis of the
literature.
Source
Heart and Vessels. 32 (2) (pp 157-165), 2017. Date of Publication: 01 Feb
2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
The purpose of this study was to evaluate the outcome of nonagenarians
after transcatheter aortic valve replacement (TAVR) from the OBSERVANT
study and to pool the results of the literature on this topic. Aortic
stenosis is the most common acquired valvular heart disease in the Western
countries, and its prevalence is linked to the phenomenon of population
aging. TAVR can be considered as a wise approach to treat nonagenarians,
but data on its safety and effectiveness are scarce. Data on 80 patients
aged >90 years who underwent TAVR from OBSERVANT study were analyzed. A
systematic review and meta-analysis of published data were performed.
Thirty-day mortality in the OBSERVANT series was 6.3 %. None of these
patients experienced stroke. Permanent pacemaker implantation was
necessary in 20 % of patients. Paravalvular regurgitation was observed in
57.5 %. Survival at 1, 2, and 3 years was 79.6, 71.9, and 61.5 %. Ten
series provided data on 1227 nonagenarians who underwent TAVR. Pooled
30-day mortality rate was 7.1 %, stroke 2.8 %, vascular access
complication 8.8 %, and permanent pacemaker implantation 10.6 %.
Paravalvular regurgitation was observed in 60.1 % of patients. Pooled 1-,
2-, and 3-year survival rates were 79.2, 68.2, and 55.6 %. Transapical
TAVR was associated with a significantly higher risk of early mortality
compared with transfemoral TAVR. The results of OBSERVANT study and
aggregate data meta-analysis suggest that in nonagenarians, TAVR is
associated with low postoperative morbidity and excellent intermediate
survival. Transapical TAVR in these very elderly is associated with high
postoperative mortality.<br/>Copyright &#xa9; 2016, Springer Japan.

<17>
Accession Number
609923760
Author
Hu J.; Liu S.; Jia P.; Xu X.; Song N.; Zhang T.; Chen R.; Ding X.
Institution
(Hu, Liu, Jia, Xu, Song, Zhang, Chen, Ding) Fudan University, Division of
Nephrology, Zhongshan Hospital, No. 180, Fenglin Road, Xuhui District,
Shanghai 200032, China
(Hu, Liu, Jia, Xu, Song, Zhang, Chen, Ding) Shanghai Institute of Kidney
and Dialysis, Shanghai 200032, China
(Hu, Liu, Jia, Xu, Song, Zhang, Chen, Ding) Shanghai Key Laboratory of
Kidney and Blood Purification, Shanghai 200032, China
(Zhang) General Hospital of Ningxia Medical University, Department of
Nephrology, Ningxia 750004, China
Title
Protection of remote ischemic preconditioning against acute kidney injury:
A systematic review and meta-analysis.
Source
Critical Care. 20 (1) (no pagination), 2016. Article Number: 111. Date of
Publication: 20 Apr 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Remote ischemic preconditioning (RIPC) is a promising approach
to preventing acute kidney injury (AKI), but its efficacy is
controversial. Methods: A systematic review of 30 randomized controlled
trials was conducted to investigate the effects of RIPC on the incidence
and outcomes of AKI. Random effects model meta-analyses and
meta-regressions were used to generate summary estimates and explore
sources of heterogeneity. The primary outcome was incidence of AKI and
hospital mortality. Results: The total pooled incidence of AKI in the RIPC
group was 11.5 %, significantly less than the 23.3 % incidence in the
control group (P = 0.009). Subgroup analyses indicated that RIPC
significantly reduced the incidence of AKI in the contrast-induced AKI
(CI-AKI) subgroup from 13.5 % to 6.5 % (P = 0.000), but not in the
ischemia/reperfusion-induced AKI (IR-AKI) subgroup (from 29.5 % to 24.7 %,
P = 0.173). Random effects meta-regression indicated that RIPC tended to
strengthen its renoprotective effect (q = 3.95, df = 1, P = 0.047) in
these trials with a higher percentage of diabetes mellitus. RIPC had no
significant effect on the incidence of stages 1-3 AKI or renal replacement
therapy, change in serum creatinine and estimated glomerular filtration
rate (eGFR), hospital or 30-day mortality, or length of hospital stay. But
RIPC significantly increased the minimum eGFR in the IR-AKI subgroup (P =
0.006) compared with the control group. In addition, the length of ICU
stay in the RIPC group was significantly shorter than in the control group
(2.6 vs 2.0 days, P = 0.003). Conclusions: We found strong evidence to
support the application of RIPC to prevent CI-AKI, but not
IR-AKI.<br/>Copyright &#xa9; 2016 Hu et al.

<18>
[Use Link to view the full text]
Accession Number
610463543
Author
Beck-Schimmer B.; Bonvini J.M.; Braun J.; Seeberger M.; Neff T.A.; Risch
T.J.; Stuber F.; Vogt A.; Weder W.; Schneiter D.; Filipovic M.; Puhan M.
Institution
(Beck-Schimmer, Bonvini) Institute of Anesthesiology, University Hospital
Zurich, Raemistrasse 100, Zurich CH-8091, Switzerland
(Weder, Schneiter) Department of Thoracic Surgery, University Hospital
Zurich, Zurich, Switzerland
(Beck-Schimmer) Institute of Physiology, Zurich Center for Integrative
Human Physiology, University of Zurich, Zurich, Switzerland
(Braun, Puhan) Epidemiology,Biostatistics and Prevention Institute,
University of Zurich, Zurich, Switzerland
(Beck-Schimmer) Department of Anesthesiology, University of Illinois,
College of Medicine, Chicago, IL, United States
(Seeberger) Department of Anesthesia, Surgical Intensive Care, Prehospital
Emergency Medicine and Pain Therapy, University Hospital Basel, Basel,
Switzerland
(Neff, Risch) Department of Anesthesiology and Intensive Care Medicine,
Kantonsspital Muensterlingen (Cantonal Hospital of Muensterlingen),
Muensterlingen, Switzerland
(Stuber, Vogt) Department of Anesthesiology and Pain Medicine, University
Hospital Bern, Bern, Switzerland
(Filipovic) Division of Anesthesiology, Intensive Care, Rescue and Pain
Medicine, Kantonsspital St. Gallen (Cantonal Hospital of St. Gallen), St.
Gallen, Switzerland
(Seeberger) Institute of Anesthesia and Intensive Care, Klinik Hirslanden
Zurich, Zurich, Switzerland
Title
Which anesthesia regimen is best to reduce morbidity and mortality in lung
surgery?.
Source
Anesthesiology. 125 (2) (pp 313-321), 2016. Date of Publication: 01 Aug
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: One-lung ventilation during thoracic surgery is associated
with hypoxia-reoxygenation injury in the deflated and subsequently
reventilated lung. Numerous studies have reported volatile
anesthesia-induced attenuation of inflammatory responses in such
scenarios. If the effect also extends to clinical outcome is yet
undetermined. We hypothesized that volatile anesthesia is superior to
intravenous anesthesia regarding postoperative complications. Methods:
Five centers in Switzerland participated in the randomized controlled
trial. Patients scheduled for lung surgery with one-lung ventilation were
randomly assigned to one of two parallel arms to receive either propofol
or desflurane as general anesthetic. Patients and surgeons were blinded to
group allocation. Time to occurrence of the first major complication
according to the Clavien-Dindo score was defined as primary (during
hospitalization) or secondary (6-month follow-up) endpoint. Cox regression
models were used with adjustment for prestratification variables and age.
Results: Of 767 screened patients, 460 were randomized and analyzed (n =
230 for each arm). Demographics, disease and intraoperative
characteristics were comparable in both groups. Incidence of major
complications during hospitalization was 16.5% in the propofol and 13.0%
in the desflurane groups (hazard ratio for desflurane vs. propofol, 0.75;
95% CI, 0.46 to 1.22; P = 0.24). Incidence of major complications within 6
months from surgery was 40.4% in the propofol and 39.6% in the desflurane
groups (hazard ratio for desflurane vs. propofol, 0.95; 95% CI, 0.71 to
1.28; P = 0.71). Conclusions: This is the first multicenter randomized
controlled trial addressing the effect of volatile versus intravenous
anesthetics on major complications after lung surgery. No difference
between the two anesthesia regimens was evident.<br/>Copyright &#xa9;
2016, the American Society of Anesthesiologists, Inc. Wolters Kluwer
Health, Inc.

<19>
Accession Number
610362890
Author
Vedel A.G.; Holmgaard F.; Rasmussen L.S.; Paulson O.B.; Thomsen C.;
Danielsen E.R.; Langkilde A.; Goetze J.P.; Lange T.; Ravn H.B.; Nilsson
J.C.
Institution
(Vedel, Holmgaard, Ravn, Nilsson) University of Copenhagen, Department of
Cardiothoracic Anaesthesiology, Heart Centre, Rigshospitalet, Blegdamsvej
9, Copenhagen DK-2100, Denmark
(Rasmussen) University of Copenhagen, Department of Anaesthesia, Centre of
Head and Orthopaedics, Rigshospitalet, Blegdamsvej 9, Copenhagen DK-2100,
Denmark
(Paulson) University of Copenhagen, Neurobiology Research Unit,
Neuroscience Centre, Rigshospitalet, Blegdamsvej 9, Copenhagen DK-2100,
Denmark
(Thomsen, Danielsen, Langkilde) University of Copenhagen, Department of
Radiology, Diagnostic Centre, Rigshospitalet, Blegdamsvej 9, Copenhagen
DK-2100, Denmark
(Goetze) University of Copenhagen, Department of Clinical Biochemistry,
Diagnostic Centre, Rigshospitalet, Blegdamsvej 9, Copenhagen DK-2100,
Denmark
(Lange) University of Copenhagen, Department of Biostatistics, Oster
Farimagsgade 5, Copenhagen DK-2100, Denmark
Title
Perfusion Pressure Cerebral Infarct (PPCI) trial - the importance of mean
arterial pressure during cardiopulmonary bypass to prevent cerebral
complications after cardiac surgery: Study protocol for a randomised
controlled trial.
Source
Trials. 17 (1) (no pagination), 2016. Article Number: 247. Date of
Publication: 17 May 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Debilitating brain injury occurs in 1.6-5 % of patients
undergoing cardiac surgery with cardiopulmonary bypass. Diffusion-weighted
magnetic resonance imaging studies have reported stroke-like lesions in up
to 51 % of patients after cardiac surgery. The majority of the lesions
seem to be caused by emboli, but inadequate blood flow caused by other
mechanisms may increase ischaemia in the penumbra or cause watershed
infarcts. During cardiopulmonary bypass, blood pressure can be below the
lower limit of cerebral autoregulation. Although much debated, the
constant blood flow provided by the cardiopulmonary bypass system is still
considered by many as appropriate to avoid cerebral ischaemia despite the
low blood pressure. Methods/design: The Perfusion Pressure Cerebral
Infarct trial is a single-centre superiority trial with a blinded outcome
assessment. The trial is randomising 210 patients with coronary vessel
and/or valve disease and who are undergoing cardiac surgery with the use
of cardiopulmonary bypass. Patients are stratified by age and surgical
procedure and are randomised 1:1 to either an increased mean arterial
pressure (70-80 mmHg) or 'usual practice' (40-50 mmHg) during
cardiopulmonary bypass. The cardiopulmonary bypass pump flow is fixed and
set at 2.4 L/minute/m² body surface area plus 10-20 % in both
groups. The primary outcome measure is the volume of the new ischaemic
cerebral lesions (in mL), expressed as the difference between a baseline,
diffusion-weighted, magnetic resonance imaging scan and an equal scan
conducted 3-6 days postoperatively. Secondary endpoints are the total
number of new ischaemic cerebral lesions, postoperative cognitive
dysfunction at discharge and 3 months postoperatively, diffuse cerebral
injury evaluated by magnetic resonance spectroscopy and selected
biochemical markers of cerebral injury. The sample size will enable us to
detect a 50 % reduction in the primary outcome measure in the intervention
compared to the control group at a significance level of 0.05 and with a
power of 0.80. Discussion: This is the first clinical randomised study to
evaluate whether the mean arterial pressure level during cardiopulmonary
bypass influences the development of brain injuries that are detected by
diffusion-weighted magnetic resonance imaging. Trial registration:
ClinicalTrials.gov, NCT02185885. Registered on 7 July 2014.<br/>Copyright
&#xa9; 2016 Vedel et al.

<20>
Accession Number
608827005
Author
Montalescot G.; Van 'T Hof A.W.; Bolognese L.; Cantor W.J.; Cequier A.;
Chettibi M.; Collet J.-P.; Goodman S.G.; Hammett C.J.; Huber K.; Janzon
M.; Lapostolle F.; Lassen J.F.; Licour M.; Merkely B.; Salhi N.; Silvain
J.; Storey R.F.; Ten Berg J.M.; Tsatsaris A.; Zeymer U.; Vicaut E.; Hamm
C.W.; Bougherbal R.; Bouafia M.T.; Nibouche D.; Moklati A.; Benalia A.;
Kaid O.; Krim M.; Hammett C.; Garrahy P.; Jayasinghe R.; Rashford S.;
Neunteufl T.; Brussee H.; Alber H.; Weidinger F.; Brunner M.; Sipoetz J.;
Prause G.; Baubin M.; Sebald D.; Cantor W.; Vijayaraghavan R.; Bata I.;
Lavoie A.; Ravkilde J.; Jensen L.O.; Christensen A.Mo.; Toftegaard M.;
Kohler D.; Ducrocq G.; Danchin N.; Henry P.; Livarek B.; Berthier R.;
Hovasse T.; Garot P.; Payot L.; Benamer H.; Esteve J.B.; Elhadad S.;
Teiger E.; Bonnet J.L.; Paganelli F.; Cottin Y.; Schiele F.; Thuaire C.;
Cayla G.; Coste P.; Ohlmann P.; Cudraz E.B.; Lantelme P.; Perret T.; Tron
C.; De Labriolle A.; Aptecar E.; Beliard O.; Varenne O.; El Mahmoud R.;
Filippi-Codaccioni E.; Angoulvant D.; Peycher P.; Poitrineau O.; Tabone
X.; Ecollan P.; Broche C.; Lambert Y.; Briole N.; Beruben A.; Porcher N.;
Auffray J.-P.; Freysz M.; Depardieu F.; Poubel D.; De La Cousaye J.-E.;
Bartier J.-C.; Jardel B.; Boulanger B.; Labourel H.; Soulat L.-C.; Julie
V.; Thicoipe M.; Capel O.; Stibbe O.; Carli P.; Tazarourte K.; Alcouffe
F.; Aboucaya D.; Aubert G.; Kierzek G.; Cahun-Giraud S.; Hamm C.; Dengler
T.; Prondzinsky R.; Biever P.M.; Schafer A.; Seyfarth M.; Lemke B.; Werner
G.; Nef H.; Steiger H.; Leschke M.; Munzel T.; Dell Orto M.C.; Loges C.;
Schinke M.; Koberne F.; Reiffen H.P.; Tiroch K.; Wierich D.; Kneussel M.;
Little S.; Sauer H.; Laufenberg-Feldmann R.; Ungi I.; Horvath I.; Edes I.;
Martai I.; Berti S.; Chiarella F.; Calabria P.; Fineschi M.; Galvani M.;
Valgimigli M.; Moretti L.; Tespili M.; Mando M.; Bermano F.; Biagioni R.;
Fabbri A.; Ricciardelli A.; Petroni M.R.; Vatteroni U.R.; Palumbo F.;
Willems F.F.; Al Mafragi A.; Heestermans T.A.A.C.M.; Van Eck M.J.; Heutz
W.M.J.M.; Meppelder H.H.; Jong A.R.-D.; Van De Pas H.; Fillat A.C.; Tenas
M.S.; Ferrer J.M.; Penaranda A.S.; Ferrer J.A.; Del Blanco B.G.; Guardiola
F.M.; Ruiz Nodar J.M.; Romo A.I.; Gonzalez N.V.; Nouche R.T.; De La Llera
L.D.; Hernandez Garcia J.M.; Rivero-Crespo F.; Hernandez F.H.; Zamorano
Gomez J.L.; Farega X.J.; Fernandez G.A.; Toboso J.L.; Carrasco M.;
Barreiro V.; Iglesias Vazquez J.A.; Montero M.D.M.R.; Ortiz F.R.; Escudero
G.G.; Ingelmo V.S.-B.; Garcia A.L.; Oldgren J.; Calais F.; Kastberg R.;
Bergsten P.-A.; Blomberg H.; Thorn K.; Skoog G.; Zaman A.; Gerber R.;
Ryding A.; Spence M.; Swanson N.; Been M.; Grosser K.; Schofield P.;
Mackin D.; Fell P.; Quinn T.; Foster T.; McManus D.; Carson A.
Institution
(Montalescot, Collet, Silvain) Universite Paris 6, ACTION Study Group,
Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire
Pitie-Salpetriere, INSERM UMRS 1166, 47 Boulevard de lHopital, Paris
75013, France
(Van 'T Hof) Department of Cardiology, Isala Clinics, Zwolle, Netherlands
(Bolognese) Cardiovascular and Neurological Department, Azienda
Ospedaliera Arezzo, Arezzo, Italy
(Cantor) Southlake Regional Health Centre, University of Toronto,
Newmarket, ON, Canada
(Cequier) Heart Disease Institute, Hospital Universitario de Bellvitge,
University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
(Chettibi) Centre Hospito-Universitaire Frantz Fanon, Blida, Algeria
(Goodman) Canadian Heart Research Centre, Division of Cardiology, St.
Michael's Hospital, University of Toronto, Toronto, Canada
(Hammett) Department of Cardiology, Royal Brisbane and Women's Hospital,
Brisbane, QLD, Australia
(Huber) 3rd Department of Medicine, Cardiology and Intensive Care
Medicine, Wilhelminenhospital, Vienna, Austria
(Janzon) Department of Cardiology, Linkoping University, Linkoping, Sweden
(Lapostolle) SAMU 93 Hopital Avicenne, Bobigny, France
(Lassen) Department of Cardiology B, Aarhus University Hospital, Aarhus N,
Denmark
(Licour, Tsatsaris) AstraZeneca, Rueil Malmaison, France
(Merkely) Heart and Vascular Center, Semmelweis University, Budapest,
Hungary
(Salhi) AstraZeneca, Luton, United Kingdom
(Storey) Department of Cardiovascular Science, University of Sheffield,
Sheffield, United Kingdom
(Ten Berg) Department of Cardiology, St. Antonius Hospital Nieuwegein,
Nieuwegein, Netherlands
(Zeymer) Klinikum Ludwigshafen, Institut fur Herzinfarktforschung
Ludwigshafen, Ludwigshafen, Germany
(Vicaut) Unite de Recherche Clinique, Universite Paris 7, Hopital
Lariboisiere, ACTION Study Group, Paris, France
(Hamm) Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim,
Germany
Title
Effect of Pre-Hospital Ticagrelor during the First 24 h after Primary
Percutaneous Coronary Intervention in Patients with ST-Segment Elevation
Myocardial Infarction the ATLANTIC-H²⁴ Analysis.
Source
JACC: Cardiovascular Interventions. 9 (7) (pp 646-656), 2016. Date of
Publication: 11 Apr 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this landmark exploratory analysis,
ATLANTIC-H²⁴, was to evaluate the effects of pre-hospital
ticagrelor during the first 24 h after primary percutaneous coronary
intervention (PCI) in the ATLANTIC (Administration of Ticagrelor in the
cath Lab or in the Ambulance for New ST elevation myocardial infarction to
open the Coronary artery) study. Background The ATLANTIC trial in patients
with ongoing ST-segment elevation myocardial infarction showed that
pre-hospital ticagrelor was safe but did not improve pre-PCI coronary
reperfusion compared with in-hospital ticagrelor. We hypothesized that the
effect of pre-hospital ticagrelor may not have manifested until after PCI
due to the rapid transfer time (31 min). Methods The
ATLANTIC-H²⁴ analysis included 1,629 patients who underwent
PCI, evaluating platelet reactivity, Thrombolysis In Myocardial Infarction
flow grade 3, >=70% ST-segment elevation resolution, and clinical
endpoints over the first 24 h. Results Following PCI, largest
between-group differences in platelet reactivity occurred at 1 to 6 h;
coronary reperfusion rates numerically favored pre-hospital ticagrelor,
and the degree of ST-segment elevation resolution was significantly
greater in the pre-hospital group (median, 75.0% vs. 71.4%; p = 0.049). At
24 h, the composite ischemic endpoint was lower with pre-hospital
ticagrelor (10.4% vs. 13.7%; p = 0.039), as were individual endpoints of
definite stent thrombosis (p = 0.0078) and myocardial infarction (p =
0.031). All endpoints except death (1.1% vs. 0.2%; p = 0.048) favored
pre-hospital ticagrelor, with no differences in bleeding events.
Conclusions The effects of pre-hospital ticagrelor became apparent after
PCI, with numerical differences in platelet reactivity and immediate
post-PCI reperfusion, associated with reductions in ischemic endpoints,
over the first 24 h, whereas there was a small excess of mortality.
(Administration of Ticagrelor in the cath Lab or in the Ambulance for New
ST elevation myocardial infarction to open the Coronary artery [ATLANTIC,
NCT01347580])<br/>Copyright &#xa9; 2016 American College of Cardiology
Foundation.

<21>
Accession Number
610566626
Author
Liu Y.; Li P.; Cheng X.; Yu W.; Yang L.; Zhu H.
Institution
(Liu, Li, Cheng, Yu, Yang, Zhu) Renji Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai 200127, China
Title
Plasma MicroRNA-21 Predicts Postoperative Pulmonary Complications in
Patients Undergoing Pneumoresection.
Source
Mediators of Inflammation. 2016 (no pagination), 2016. Article Number:
3591934. Date of Publication: 2016.
Publisher
Hindawi Publishing Corporation (410 Park Avenue, 15th Floor, 287 pmb, New
York NY 10022, United States)
Abstract
Postoperative pulmonary complication (PPC) remains the most common
postoperative complication in patients undergoing noncardiac thoracic
surgery. We conducted the clinical study to determine the diagnostic role
of miRNA-21 in noncardiac thoracic surgery. 368 patients undergoing
noncardiac thoracic surgery were recruited. Blood samples were collected
before anesthesia and 2 hours after incision during surgery for RT-PCR
measurement of miRNA-21. PPC occurrence, extrapulmonary complications,
duration of ICU stay, and death within 1 year were evaluated. The overall
rate of PPCs following surgery was 10.32%. A high relative miRNA-21 level
was an independent risk factor for PPCs within 7 days (OR, 2.69; 95% CI,
1.25-5.66; and P<0.001). High miRNA-21 was also associated with an
increased risk of extrapulmonary complications (OR, 3.62; 95% CI,
2.26-5.81; and P<0.001), prolonged ICU stay (OR, 6.54; 95% CI, 2.26-18.19;
and P<0.001), increased death within 30 days (OR, 6.17; 95% CI,
2.11-18.08; and P<0.001), and death within 1 year (OR, 7.30; 95% CI,
2.76-19.28; and P<0.001). In summary, plasma miRNA-21 may serve as a novel
biomarker of PPCs for patients undergoing noncardiac thoracic
surgery.<br/>Copyright &#xa9; 2016 Yaling Liu et al.

<22>
Accession Number
616595776
Author
Lin Y.; Xu L.; Huang X.; Jiang F.; Lin F.; Ye Q.; Lin J.
Institution
(Lin) Cardiac Surgical Ward of Fujian Medical University Union Hospital,
Fuzhou, Fujian Province, China
Title
Cardiac Valve Noise Reduction by Non-Drug Interventions Improves the Sleep
Quality of Patients after Mechanical Cardiac Valve Implantation.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. 22 (2) (pp
69-75), 2016. Date of Publication: 2016.
Abstract
PURPOSE: To investigate the effects of non-drug interventions on the sleep
quality of patients after mechanical cardiac valve implantation.
METHODS: In this prospective, randomized, controlled trial, 64 patients
scheduled for mechanical mitral valve replacement were recruited. Patients
underwent cognitive behavioral therapy and wore noise cancelling earplugs
and eye mask. Sleep quality was evaluated on the 4th after admission and
the 5th days after operation. The primary outcome was the total sleep
quality score differences between the 4th day after admission and the 5th
day after operation.
RESULTS: All patients had been suffering from poor sleep quality for a
month before admission. There was no difference between both groups on the
4th day after admission. Overall sleep quality in the intervention group
was better than in the control group on the 5th day after operation. The
subjective sleep quality of the patients in each group was significantly
lower on the 5th day after the operation than on the 4th day after
admission (P <0.05).
CONCLUSION: Non-drug intervention could improve the sleep quality of
patients after mechanical cardiac valve implantation and help the
postoperative recovery of the patients. (
TRIAL REGISTRATION: ChiCTR-TRC-14004405, 21 March 2014.).

<23>
Accession Number
616521379
Author
Palmerini T.; Serruys P.; Kappetein A.P.; Genereux P.; Riva D.D.; Reggiani
L.B.; Christiansen E.; Holm N.R.; Thuesen L.; Makikallio T.; Morice M.C.;
Ahn J.-M.; Park S.-J.; Thiele H.; Boudriot E.; Sabatino M.; Romanello M.;
Biondi-Zoccai G.; Cavalcante R.; Sabik J.F.; Stone G.W.
Institution
(Palmerini, Riva, Reggiani, Sabatino, Romanello) Polo
Cardio-Toraco-Vascolare, Policlinico S. Orsola, Bologna, Italy
(Serruys) International Centre for Circulatory Health, NHLI, Imperial
College London, London, United Kingdom
(Kappetein) Department of Cardiothoracic Surgery, Erasmus Medical Center,
Rotterdam, Netherlands
(Genereux, Stone) Columbia University Medical Center and the
Cardiovascular Research Foundation, New York, NY, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
(Genereux) Morristown Medical Center, Morristown, NJ, United States
(Christiansen, Holm) Department of Cardiology, Aarhus University Hospital,
Skejby, Aarhus, Denmark
(Thuesen) Department of Cardiology, Aalborg University Hospital, Aalborg,
Denmark
(Makikallio) Department of Cardiology, Oulu University Hospital, Oulu,
Finland
(Morice) MC Moriec Ramsay Generale de Sante, ICPS, Massy, France
(Ahn, Park) The Heart Institute, University of Ulsan College of Medicine,
Asan Medical Center, Seoul, South Korea
(Thiele) University Heart Center Lubeck and the German Center for
Cardiovascular Research (DZHK), Lubeck, Germany
(Boudriot) Department of Internal Medicine/Cardiology, University Heart
Center, Leipzig, Germany
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Biondi-Zoccai) Department of AngioCardioNeurology, IRCCS Neuromed,
Pozzilli, Italy
(Cavalcante) Department of Interventional Cardiology, Thoraxcenter Erasmus
University Medical Center, Rotterdam, Netherlands
(Sabik) The Cleveland Clinic Foundation, Cleveland, OH, United States
Title
Clinical outcomes with percutaneous coronary revascularization vs coronary
artery bypass grafting surgery in patients with unprotected left main
coronary artery disease: A meta-analysis of 6 randomized trials and 4,686
patients.
Source
American Heart Journal. 190 (pp 54-63), 2017. Date of Publication: August
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Some but not all randomized controlled trials (RCT) have suggested that
percutaneous coronary intervention (PCI) with drug-eluting stents may be
an acceptable alternative to coronary artery bypass grafting (CABG)
surgery for the treatment of unprotected left main coronary artery disease
(ULMCAD). We therefore aimed to compare the risk of all-cause mortality
between PCI and CABG in patients with ULMCAD in a pairwise meta-analysis
of RCT. Methods Randomized controlled trials comparing PCI vs CABG for the
treatment of ULMCAD were searched through MEDLINE, EMBASE, Cochrane
databases, and proceedings of international meetings. Results Six trials
including 4,686 randomized patients were identified. After a median
follow-up of 39 months, there were no significant differences between PCI
vs CABG in the risk of all-cause mortality (hazard ratio [HR] 0.99, 95% CI
0.76-1.30) or cardiac mortality. However, a significant interaction for
cardiac mortality (P<inf>interaction</inf>=.03) was apparent between
randomization arm and SYNTAX score, such that the relative risk for
mortality tended to be lower with PCI compared with CABG among patients in
the lower SYNTAX score tertile, similar in the intermediate tertile, and
higher in the upper SYNTAX score tertile. Percutaneous coronary
intervention compared with CABG was associated with a similar long-term
composite risk of death, myocardial infarction, or stroke (HR 1.06, 95% CI
0.82-1.37), with fewer events within 30 days after PCI offset by fewer
events after 30 days with CABG (P<inf>interaction</inf> <.0001).
Percutaneous coronary intervention was associated with greater rates of
unplanned revascularization compared with CABG (HR 1.74, 95% CI
1.47-2.07). Conclusions In patients undergoing revascularization for
ULMCAD, PCI was associated with similar rates of mortality compared with
CABG at a median follow-up of 39 months, but with an interaction effect
suggesting relatively lower mortality with PCI in patients with low SYNTAX
score and relatively lower mortality with CABG in patients with high
SYNTAX score. Both procedures resulted in similar long-term composite
rates of death, myocardial infarction, or stroke, with PCI offering an
early safety advantage and CABG demonstrating greater
durability.<br/>Copyright &#xa9; 2017 Elsevier, Inc.

<24>
Accession Number
616511082
Author
Chan V.; Chu M.W.A.; Leong-Poi H.; Latter D.A.; Hall J.; Thorpe K.E.; De
Varennes B.E.; Quan A.; Tsang W.; Dhingra N.; Yared K.; Teoh H.; Chu F.V.;
Chan K.-L.; Mesana T.G.; Connelly K.A.; Ruel M.; Juni P.; Mazer C.D.;
Verma S.
Institution
(Chan, Mesana, Ruel) Division of Cardiac Surgery, University of Ottawa
Heart Institute, Ottawa, ON, Canada
(Chan, Ruel) School of Epidemiology Public Health and Preventive Medicine,
University of Ottawa, Ottawa, ON, Canada
(Chu) Division of Cardiac Surgery, London Health Sciences Center,
University of Western Ontario, London, ON, Canada
(Leong-Poi, Connelly) Division of Cardiology, St Michael's Hospital,
Toronto, ON, Canada
(Leong-Poi, Quan, Teoh, Connelly, Verma) Keenan Research Centre for
Biomedical Science, St Michael's Hospital, Toronto, ON, Canada
(Leong-Poi, Quan, Teoh, Connelly, Mazer, Verma) Li Ka Shing Knowledge
Institute, St Michael's Hospital, Toronto, ON, Canada
(Leong-Poi, Tsang, Connelly, Mazer) Department of Medicine, University of
Toronto, Toronto, ON, Canada
(Latter, Quan, Dhingra, Teoh, Verma) Division of Cardiac Surgery, St
Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Latter, Verma) Department of Surgery, University of Toronto, Toronto, ON,
Canada
(Hall, Thorpe, Juni) Applied Health Research Centre, St Michael's
Hospital, Toronto, ON, Canada
(Thorpe) Dalla Lana School of Public Health, University of Toronto,
Toronto, ON, Canada
(De Varennes) Division of Cardiac Surgery, Royal Victoria Hospital, McGill
University Health Center, Montreal, QC, Canada
(Tsang) Division of Cardiology, University Health Network, Toronto, ON,
Canada
(Yared) Division of Cardiology, Scarborough Hospital, Toronto, ON, Canada
(Teoh) Division of Endocrinology and Metabolism, St Michael's Hospital,
Toronto, ON, Canada
(Chu) Department of Cardiac Surgery, McMaster University, Hamilton, ON,
Canada
(Chan) Division of Cardiology, University of Ottawa Heart Institute,
Ottawa, ON, Canada
(Juni) Institute of Health Policy Management and Evaluation, University of
Toronto, Toronto, ON, Canada
(Mazer) Department of Anesthesia, St Michael's Hospital, Toronto, ON,
Canada
Title
Randomised trial of mitral valve repair with leaflet resection versus
leaflet preservation on functional mitral stenosis (The CAMRA CardioLink-2
Trial).
Source
BMJ Open. 7 (5) (no pagination), 2017. Article Number: 015032. Date of
Publication: 01 May 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background The gold-standard treatment of severe mitral regurgitation (MR)
due to degenerative disease is valve repair, which is surgically performed
with either a leaflet resection or leaflet preservation approach. Recent
data suggest that functional mitral stenosis (MS) may occur following
valve repair using a leaflet resection strategy, which adversely affects
patient prognosis. A randomised comparison of these two approaches to
mitral repair on functional MS has not been conducted. Methods and
analysis This is a prospective, multicentre randomised controlled trial
designed to test the hypothesis that leaflet preservation leads to better
preservation of mitral valve geometry, and therefore, will be superior to
leaflet resection for the primary outcome of functional MS as assessed by
12-month mean mitral valve gradient at peak exercise. Eighty-eight
patients with posterior leaflet prolapse will be randomised
intraoperatively once deemed by the operating surgeon to feasibly undergo
mitral repair using either a leaflet resection or leaflet preservation
approach. Secondary end points include comparison of repair strategies
with regard to mitral valve orifice area, leaflet coaptation height, 6 min
walk test and a composite major adverse event end point consisting of
recurrent MR >=2+, death or hospital readmission for congestive heart
failure within 12 months of surgery. Ethics and dissemination
Institutional ethics approval has been obtained from all enrolling sites.
Overall, there remains clinical equipoise regarding the mitral valve
repair strategy that is associated with the least likelihood of functional
MS. This trial hopes to introduce high-quality evidence to help surgical
decision making in this context. Trial registration number
NCT02552771.<br/>Copyright &#xa9; Article author(s) (or their employer(s)
unless otherwise stated in the text of the article) 2017. All rights
reserved.

<25>
Accession Number
616583985
Author
Vandenbogaart E.; Doering L.; Chen B.; Saltzman A.; Chaker T.; Creaser
J.W.; Rourke D.; Cheng R.W.; Fonarow G.C.; Deng M.
Institution
(Vandenbogaart, Chaker, Creaser, Rourke, Cheng, Deng) Department of
Medicine, Division of Cardiology, University of California Los Angeles,
100 Medical Plaza, Suite 630E, Los Angeles, CA, 90095, USA
(Doering, Chen) UCLA School of Nursing, 700 Tiverton Ave, Los Angeles, CA,
90095, USA
(Saltzman) Cardiopulmonary Rehabilitation Center, Ronald Regan UCLA
Medical Center, 200 UCLA Medical Plaza, Suite 206C, Los Angeles, CA 90095,
USA
(Fonarow) Department of Medicine, Division of Cardiology, University of
California Los Angeles, 10833 LeConte Ave A2-237 CHS, Los Angeles CA,
90095, USA
Title
Evaluation of the SIPAT instrument to assess psychosocial risk in heart
transplant candidates: A retrospective single center study.
Source
Heart and Lung: Journal of Acute and Critical Care. (no pagination), 2017.
Date of Publication: July 31, 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: We evaluated the reliability of the Stanford Integrated
Psychosocial Assessment for Transplantation (SIPAT) in heart transplant
(HT) recipients and explored its usefulness in predicting post-transplant
outcomes. Background: Pre-transplant psychosocial and behavioral risk is
associated with post-transplant clinical outcomes. SIPAT is a risk
assessment tool created for pre-transplant psychosocial evaluation.
Methods: Via retrospective chart review, three examiners applied the SIPAT
to 51 adult HT recipients. Examiners blinded to SIPAT scores extracted
data and interviewed clinicians for one-year post-transplant outcomes.
Analysis included Intra-class correlation coefficient (ICC), Pearson's
correlation coefficient and Chi-square. Results: SIPAT demonstrated strong
inter-rater reliability (ICC = 0.89, 95% CI = 0.76-0.96). Compared to
those with SIPAT ratings of "Excellent/Good", the "Minimally Acceptable
Candidate/High Risk" group was more likely to miss clinic visits (p =
0.004). Conclusions: The SIPAT tool had strong IRR. Less favorable SIPAT
ratings were associated with nonadherence to clinic visits. Further study
is warranted to determine association of SIPAT ratings to clinical
outcomes.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<26>
Accession Number
616575776
Author
Buckley J.R.; Graham E.M.; Gaies M.; Alten J.A.; Cooper D.S.; Costello
J.M.; Domnina Y.; Klugman D.; Pasquali S.K.; Donohue J.E.; Zhang W.;
Scheurer M.A.
Institution
(Buckley, Graham, Scheurer) Department of Pediatrics, Division of
Pediatric Cardiology, Medical University of South Carolina, Charleston,
South Carolina, United States of America
(Gaies, Pasquali) Department of Pediatrics and Communicable Diseases,
Division of Cardiology, C.S. Mott Children's Hospital, University of
Michigan Medical School, Ann Arbor, Michigan, United States of America
(Alten) Department of Pediatrics, Division of Pediatric Cardiology,
University of Alabama at Birmingham, Birmingham, Alabama, United States of
America
(Cooper) The Heart Institute, Cincinnati Children's Hospital Medical
Center, Cincinnati, Ohio, United States of America
(Costello) Department of Pediatrics, Division of Cardiology, Ann & Robert
H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg
School of Medicine, Chicago, Illinois, United States of America
(Domnina) Department of Critical Care Medicine, Division of Cardiac
Intensive Care, Children's Hospital of Pittsburgh, University of
Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of
America
(Klugman) Department of Critical Care Medicine and Cardiology, Children's
National Medical Center, Washington, District of Columbia, United States
of America
(Donohue, Zhang) Michigan Congenital Heart Outcomes Research and Discovery
Unit, University of Michigan Congenital Heart Center, Ann Arbor, Michigan,
United States of America
Title
Clinical epidemiology and centre variation in chylothorax rates after
cardiac surgery in children: a report from the Pediatric Cardiac Critical
Care Consortium.
Source
Cardiology in the Young. (pp 1-8), 2017. Date of Publication: 29 May 2017.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Introduction: Chylothorax after paediatric cardiac surgery incurs
significant morbidity; however, a detailed understanding that does not
rely on single-centre or administrative data is lacking. We described the
present clinical epidemiology of postoperative chylothorax and evaluated
variation in rates among centres with a multicentre cohort of patients
treated in cardiac ICU. Methods: This was a retrospective cohort study
using prospectively collected clinical data from the Pediatric Cardiac
Critical Care Consortium registry. All postoperative paediatric cardiac
surgical patients admitted from October, 2013 to September, 2015 were
included. Risk factors for chylothorax and association with outcomes were
evaluated using multivariable logistic or linear regression models, as
appropriate, accounting for within-centre clustering using generalised
estimating equations. Results: A total of 4864 surgical hospitalisations
from 15 centres were included. Chylothorax occurred in 3.8% (n=185) of
hospitalisations. Case-mix-adjusted chylothorax rates varied from 1.5 to
7.6% and were not associated with centre volume. Independent risk factors
for chylothorax included age <1 year, non-Caucasian race, single-ventricle
physiology, extracardiac anomalies, longer cardiopulmonary bypass time,
and thrombosis associated with an upper-extremity central venous line (all
p<0.05). Chylothorax was associated with significantly longer duration of
postoperative mechanical ventilation, cardiac ICU and hospital length of
stay, and higher in-hospital mortality (all p<0.001). Conclusions:
Chylothorax after cardiac surgery in children is associated with
significant morbidity and mortality. A five-fold variation in chylothorax
rates was observed across centres. Future investigations should identify
centres most adept at preventing and managing chylothorax and disseminate
best practices.<br/>Copyright &#xa9; Cambridge University Press 2017

<27>
Accession Number
613833926
Author
Bavishi C.; Sardar P.; Chatterjee S.; Khan A.R.; Shah A.; Ather S.; Lemos
P.A.; Moreno P.; Stone G.W.
Institution
(Bavishi, Chatterjee, Shah, Moreno) Mount Sinai St Luke's & Mount Sinai
West Hospitals, New York, NY, United States
(Sardar) University of Utah, Salt Lake City, UT, United States
(Khan) University of Louisville, Louisville, KY, United States
(Ather) University of Alabama at Birmingham, Birmingham, AL, United States
(Lemos) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Stone) Columbia University Medical Center, New York-Presbyterian Hospital
and the Cardiovascular Research Foundation, New York, NY, United States
Title
Intravascular ultrasound-guided vs angiography-guided drug-eluting stent
implantation in complex coronary lesions: Meta-analysis of randomized
trials.
Source
American Heart Journal. 185 (pp 26-34), 2017. Date of Publication: 01 Mar
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
The relative outcomes of intravascular ultrasound (IVUS)-guided
percutaneous coronary intervention (PCI) compared with angiography-guided
PCI with drug-eluting stent (DES) in complex lesions have not been
established. We sought to compare the efficacy and safety of IVUS-guided
PCI with angiography-guided PCI in patients with complex coronary lesions
treated with DES. Methods Electronic databases were searched to identify
all randomized trials comparing IVUS-guided vs angiography-guided DES
implantation. We evaluated major adverse cardiac events (MACE), all-cause
and cardiovascular death, myocardial infarction, target lesion
revascularization (TLR), target vessel revascularization (TVR), and stent
thrombosis outcomes at the longest reported follow-up. Random-effects
modeling was used to calculate pooled relative risk (RR) and 95% CIs.
Results Eight trials comprising 3,276 patients (1,635 IVUS-guided and
1,641 angiography-guided) enrolling only patients with complex lesions
were included. Mean follow-up was 1.4 +/- 0.5 years. Compared with
angiography-guided PCI, patients undergoing IVUS-guided PCI had
significantly lower MACE (RR 0.64, 95% CI 0.51-0.80, P = .0001), TLR (RR
0.62, 95% CI 0.45-0.86, P = .004), and TVR (RR 0.60, 95% CI 0.42-0.87, P =
.007). There were no significant differences for stent thrombosis,
cardiovascular death, or all-cause death. In meta-regression analysis,
IVUS-guided PCI was of greatest benefit in reducing MACE in patients with
acute coronary syndromes, diabetes, and long lesions. Conclusions The
present meta-analysis demonstrates a significant reduction in MACE, TVR,
and TLR with IVUS-guided DES implantation in complex coronary
lesions.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<28>
Accession Number
613365639
Author
Windecker S.; Tijssen J.; Giustino G.; Guimaraes A.H.C.; Mehran R.;
Valgimigli M.; Vranckx P.; Welsh R.C.; Baber U.; van Es G.-A.; Wildgoose
P.; Volkl A.A.; Zazula A.; Thomitzek K.; Hemmrich M.; Dangas G.D.
Institution
(Windecker, Valgimigli) Bern University Hospital, Bern, Switzerland
(Windecker, Tijssen, Valgimigli, Vranckx, van Es) European Cardiovascular
Research Institute (ECRI), Rotterdam, Netherlands
(Tijssen) Academic Medical Center-University of Amsterdam, Amsterdam,
Netherlands
(Giustino, Mehran, Baber, Dangas) The Zena and Michael A. Wiener
Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New
York City, NY, United States
(Guimaraes, van Es) Cardialysis, Clinical Research Organization,
Rotterdam, Netherlands
(Vranckx) Hartcentrum Hasselt, Hasselt, Belgium
(Welsh) Mazankowski Alberta Heart Institute, University of Alberta,
Edmonton, Canada
(Wildgoose, Volkl) Janssen Pharmaceuticals Inc, Raritan, NJ, United States
(Zazula) Bayer, Sao Paulo, Brazil
(Thomitzek, Hemmrich) Bayer Pharma AG, Berlin, Germany
Title
Trial design: Rivaroxaban for the prevention of major cardiovascular
events after transcatheter aortic valve replacement: Rationale and design
of the GALILEO study.
Source
American Heart Journal. 184 (pp 81-87), 2017. Date of Publication: 01 Feb
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Optimal antithrombotic treatment after transcatheter aortic
valve replacement (TAVR) is unknown and determined empirically. The direct
factor Xa inhibitor rivaroxaban may potentially reduce TAVR-related
thrombotic complications and premature valve failure. Design GALILEO is an
international, randomized, open-label, event-driven, phase III trial in
more than 1,520 patients without an indication for oral anticoagulation
who underwent a successful TAVR (ClinicalTrials.gov NCT02556203). Patients
are randomized (1:1 ratio), 1 to 7 days after a successful TAVR, to either
a rivaroxaban-based strategy or an antiplatelet-based strategy. In the
experimental arm, subjects receive rivaroxaban (10 mg once daily [OD])
plus acetylsalicylic acid (ASA, 75-100 mg OD) for 90 days followed by
rivaroxaban alone. In the control arm, subjects receive clopidogrel (75 mg
OD) plus ASA (as above) for 90 days followed by ASA alone. In case
new-onset atrial fibrillation occurs after randomization, full oral
anticoagulation will be implemented with maintenance of the original
treatment assignment. The primary efficacy end point is the composite of
all-cause death, stroke, myocardial infarction, symptomatic valve
thrombosis, pulmonary embolism, deep venous thrombosis, and systemic
embolism. The primary safety end point is the composite of
life-threatening, disabling, and major bleeding, according to the Valve
Academic Research Consortium definitions. Conclusions GALILEO will test
the hypothesis that a rivaroxaban-based antithrombotic strategy reduces
the risk of thromboembolic complications post-TAVR with an acceptable risk
of bleeding compared with the currently recommended antiplatelet
therapy-based strategy in subjects without need of chronic oral
anticoagulation.<br/>Copyright &#xa9; 2016 The Authors

<29>
Accession Number
613543511
Author
Voora D.; Coles A.; Lee K.L.; Hoffmann U.; Wingrove J.A.; Rhees B.; Huang
L.; Daniels S.E.; Monane M.; Rosenberg S.; Shah S.H.; Kraus W.E.; Ginsburg
G.S.; Douglas P.S.
Institution
(Voora, Ginsburg) Duke Center for Applied Genomics & Precision Medicine,
Duke University School of Medicine, Durham, NC, United States
(Voora, Shah, Kraus, Ginsburg, Douglas) Department of Medicine, Duke
University School of Medicine, Durham, NC, United States
(Coles, Lee, Shah, Douglas) Duke Clinical Research Institute, Duke
University School of Medicine, Durham, NC, United States
(Hoffmann) Massachusetts General Hospital, Harvard Medical School, Boston,
MA, United States
(Wingrove, Rhees, Huang, Daniels, Monane, Rosenberg) CardioDx, Inc.,
Redwood City, CA, United States
Title
An age- and sex-specific gene expression score is associated with
revascularization and coronary artery disease: Insights from the
Prospective Multicenter Imaging Study for Evaluation of Chest Pain
(PROMISE) trial.
Source
American Heart Journal. 184 (pp 133-140), 2017. Date of Publication: 01
Feb 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Identifying predictors of coronary artery disease (CAD)-related
procedures and events remains a priority. Methods We measured an age- and
sex-specific gene expression score (ASGES) previously validated to detect
obstructive CAD (oCAD) in symptomatic nondiabetic patients in the PROMISE
trial. The outcomes were oCAD (>=70% stenosis in >=1 vessel or >=50% left
main stenosis on CT angiography [CTA]) and a composite endpoint of death,
myocardial infarction, revascularization, or unstable angina. Results The
ASGES was determined in 2370 nondiabetic participants (47.5% male, median
age 59.5 years, median follow-up 25 months), including 1137 with CTA data.
An ASGES >15 was associated with oCAD (odds ratio 2.5 [95% CI 1.6-3.8], P
< .001) and the composite endpoint (hazard ratio [HR] 2.6 [95% CI
1.8-3.9], P < .001) in unadjusted analyses. After adjustment for
Framingham risk, an ASGES >15 remained associated with the composite
endpoint (P = .02); the only component that was associated was
revascularization (adjusted HR 2.69 [95% CI 1.52-4.79], P < .001).
Compared to noninvasive testing, the ASGES improved prediction for the
composite (increase in c-statistic = 0.036; continuous net
reclassification index = 43.2%). Patients with an ASGES <=15 had a
composite endpoint rate no different from those with negative noninvasive
test results (3.2% vs. 2.6%, P = .29). Conclusions A blood-based genomic
test for detecting oCAD significantly predicts near-term revascularization
procedures, but not non-revascularization events. Larger studies will be
needed to clarify the risk with non-revascularization
events.<br/>Copyright &#xa9; 2016 The Authors

<30>
Accession Number
613243000
Author
Shah R.; Yow E.; Jones W.S.; Kohl L.P.; Kosinski A.S.; Hoffmann U.; Lee
K.L.; Fordyce C.B.; Mark D.B.; Lowe A.; Douglas P.S.; Patel M.R.
Institution
(Shah, Yow, Jones, Kosinski, Lee, Fordyce, Mark, Lowe, Douglas, Patel)
Duke Clinical Research Institute, Duke University School of Medicine,
Durham, NC, United States
(Jones, Mark, Douglas, Patel) Division of Cardiology, Department of
Medicine, Duke University School of Medicine, Durham, NC, United States
(Kohl) Hennepin County Medical Center, Minneapolis, MN, United States
(Hoffmann) Massachusetts General Hospital and Harvard Medical School,
Boston, MA, United States
Title
Comparison of visual assessment of coronary stenosis with independent
quantitative coronary angiography: Findings from the Prospective
Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial.
Source
American Heart Journal. 184 (pp 1-9), 2017. Date of Publication: 01 Feb
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
The outcomes in patients by visual assessment and quantitative coronary
angiography (QCA) for obstructive coronary artery disease (CAD) are not
known. Our objectives were to compare visual and QCA estimates of
obstructive CAD and to assess their relationship to outcomes in stable
patients with symptoms of CAD. Methods The PROMISE trial randomized 10,003
patients with CAD symptoms to anatomical or functional testing. Site
reports of invasive angiography detailing visual stenosis and independent,
blinded QCA were performed for obstructive CAD (>=50% stenosis).
Disagreement between methods was determined and compared with outcomes
(death, myocardial infarction, unstable angina hospitalization, or major
procedural complications). Results Of 929 patients (9.3% of PROMISE
cohort) with angiograms assessed by sites and QCA, 593 (64%) had
obstructive CAD per site reports, whereas 428 (46%) had stenosis >=50% per
QCA. Results differed in 177 patients (disagreement rate 19.1%, kappa =
0.63), of whom 171 had CAD per sites but not per QCA. One-year unadjusted
Kaplan-Meier event rates were highest (5.1%) when QCA and visual
assessment agreed for CAD, lowest (0.9%) when the 2 agreed for no
obstructive CAD, and intermediate (3.1%) for patients who had CAD per
visual assessment but not per QCA. Conclusions Visual estimation of
angiograms results in more frequent diagnosis of obstructive CAD as
compared with QCA. Concordance of results for presence or absence of
obstructive CAD was associated with high and low event rates,
respectively. Disagreement was associated with intermediate event rates,
suggesting that cardiologists integrated clinical information into routine
visual assessment of angiograms.<br/>Copyright &#xa9; 2016

<31>
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.

<32>
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.

<33>
Accession Number
609603089
Author
Heatley G.; Sood P.; Goldstein D.; Uriel N.; Cleveland J.; Middlebrook D.;
Mehra M.R.
Institution
(Heatley, Sood, Middlebrook) St. Jude Medical, 23 Fourth Avenue,
Burlington, MA 01803, United States
(Goldstein) Department of Cardiothoracic Surgery, Montefiore Medical
Center, New York, NY, United States
(Uriel) Division of Cardiology, University of Chicago, Chicago, IL, United
States
(Cleveland) Department of Surgery, University of Colorado, Anschutz
Medical Center, Denver, CO, United States
(Mehra) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, Ma, United States
Title
Clinical trial design and rationale of the Multicenter Study of MagLev
Technology in Patients Undergoing Mechanical Circulatory Support Therapy
with HeartMate 3 (MOMENTUM 3) investigational device exemption clinical
study protocol.
Source
Journal of Heart and Lung Transplantation. 35 (4) (pp 528-536), 2016. Date
of Publication: 01 Apr 2016.
Publisher
Elsevier USA
Abstract
The HeartMate 3 left ventricular assist system (LVAS; St. Jude Medical,
Inc., formerly Thoratec Corporation, Pleasanton, CA) was recently
introduced into clinical trials for durable circulatory support in
patients with medically refractory advanced-stage heart failure. This
centrifugal, fully magnetically levitated, continuous-flow pump is
engineered with the intent to enhance hemocompatibility and reduce shear
stress on blood elements, while also possessing intrinsic pulsatility.
Although bridge-to-transplant (BTT) and destination therapy (DT) are
established dichotomous indications for durable left ventricular assist
device (LVAD) support, clinical practice has challenged the
appropriateness of these designations. The introduction of novel LVAD
technology allows for the development of clinical trial designs to keep
pace with current practices. The prospective, randomized Multicenter Study
of MagLev Technology in Patients Undergoing Mechanical Circulatory Support
Therapy With HeartMate 3 (MOMENTUM 3) clinical trial aims to evaluate the
safety and effectiveness of the HeartMate 3 LVAS by demonstrating
non-inferiority to the HeartMate II LVAS (also St. Jude Medical, Inc.).
The innovative trial design includes patients enrolled under a single
inclusion and exclusion criteria, regardless of the intended use of the
device, with outcomes ascertained in the short term (ST, at 6 months) and
long term (LT, at 2 years). This adaptive trial design includes a
pre-specified safety phase (n = 30) analysis. The ST cohort includes the
first 294 patients and the LT cohort includes the first 366 patients for
evaluation of the composite primary end-point of survival to transplant,
recovery or LVAD support free of debilitating stroke (modified Rankin
score >3), or re-operation to replace the pump. As part of the adaptive
design, an analysis by an independent statistician will determine whether
sample size adjustment is required at pre-specified times during the
study. A further 662 patients will be enrolled to reach a total of 1,028
patients for evaluation of the secondary end-point of pump replacement at
2 years.<br/>Copyright &#xa9; 2016 International Society for Heart and
Lung Transplantation.

<34>
Accession Number
613663919
Author
Tang J.Y.; Ally M.S.; Chanana A.M.; Mackay-Wiggan J.M.; Aszterbaum M.;
Lindgren J.A.; Ulerio G.; Rezaee M.R.; Gildengorin G.; Marji J.; Clark C.;
Bickers D.R.; Epstein E.H.
Institution
(Tang, Ally, Chanana, Lindgren, Rezaee, Gildengorin, Epstein) Children's
Hospital of Oakland Research Institute, Oakland, CA, United States
(Tang, Ally) Department of Dermatology Stanford University School of
Medicine, Stanford, CA, United States
(Mackay-Wiggan, Ulerio, Marji, Clark, Bickers) Department of Dermatology,
Herbert Irving Comprehensive Cancer Center, Columbia University Medical
Center, New York, NY, United States
(Aszterbaum) Department of Dermatology University of California, Irvine,
CA, United States
Title
Inhibition of the hedgehog pathway in patients with basal-cell nevus
syndrome: final results from the multicentre, randomised, double-blind,
placebo-controlled, phase 2 trial.
Source
The Lancet Oncology. 17 (12) (pp 1720-1731), 2016. Date of Publication: 01
Dec 2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Aberrant hedgehog signalling underlies the development of
basal-cell carcinomas. We previously reported the interim analysis of a
multicentre, randomised, double-blind, placebo-controlled, phase 2 trial
in patients with the basal-cell nevus (Gorlin) syndrome indicating that
the smoothened inhibitor vismodegib reduces basal-cell carcinoma tumour
burden and prevents new basal-cell carcinoma growth in patients with
basal-cell nevus syndrome. We report the final results of this 36 month
trial. Methods In our multicentre, randomised, double-blind,
placebo-controlled, phase 2 trial we enrolled patients aged 35-75 years
with basal-cell nevus syndrome with at least ten surgically eligible
basal-cell carcinomas at the Children's Hospital Oakland, Columbia
University outpatient dermatology clinic (NY, USA) and a private practice
outpatient dermatology office in Newport Beach (CA, USA). Patients were
assigned to vismodegib or placebo (2:1) according to a randomisation
sequence generated by computer code. The primary endpoint of the trial of
41 patients was to compare the effect of oral vismodegib (150 mg/day)
versus placebo on the incidence of new surgically eligible basal-cell
carcinomas after 3 months of treatment. In the subsequent, open-label
phase (n=37) patients continued vismodegib at two sites for as long as
month 36 (n=25) and at the third site were monitored up to month 36
(n=12). Additional endpoints for this phase were: whether continuous
versus interrupted dosing differentially affected tumour burden; time to
reach various levels of reduction in tumour burden; reduction in tumour
size in patients who took less than 50% of the expected number of
vismodegib tablets; reduction in the number of surgical excisions required
per year before, during, and after treatment; and the effect of vismodegib
on hedgehog target gene expression. We monitored patients at visits every
3 months for up to 36 months. The primary endpoint was analysed on a
modified intention-to-treat basis. This trial is registered with
ClinicalTrials.gov, number NCT00957229. Findings Between Sept 22, 2009,
and Jan 24, 2011, 41 patients were monitored for a median of 36 months
(IQR 36-36). Patients treated with vismodegib (n=26) had a mean reduced
rate of new surgically eligible basal-cell carcinomas compared with
patients randomly assigned to placebo (n=15; two [SD 0.12] new surgically
eligible basal-cell carcinomas per patient per year vs 34 [1.32] new
surgically eligible basal-cell carcinomas per patient per year, p<0.0001).
In the 11 patients initially assigned to placebo, mean cross over to
vismodegib reduced the development of new surgically eligible basal-cell
carcinomas compared with placebo (0.4 [SD 0.2] new surgically eligible
basal-cell carcinomas per patient per year vs 30.0 [7.8] new surgically
eligible basal-cell carcinomas per patient per year, p<0.0001). Only three
(17%) of 18 patients tolerated vismodegib continuously for the full 36
months. Fewer new surgically eligible basal-cell carcinomas developed in
patients receiving vismodegib continuously than in those who interrupted
dosing (mean 0.6 [0.72] new surgically eligible basal-cell carcinomas per
patient per year vs 1.7 [1.8] new surgically eligible basal-cell
carcinomas per patient per year, p<0.0001). Treatment-related grade 3-4
adverse events included weight loss of 20% or more (n=6) and muscle cramps
(n=2). Two patients died during the course of the trial, one each from
laryngeal and metastatic prostate cancer, deemed probably unrelated to
drug. Interpretation Vismodegib reduces basal-cell carcinoma tumour burden
in patients with basal-cell nevus syndrome. Adverse events associated with
vismodegib frequently led to interruption of treatment, which is followed
by basal-cell carcinoma recurrence. Funding Genentech
investigator-initiated trial funding, Clinical and Translational Science
Award from the National Institutes of Health, National Institute of
Arthritis and Musculoskeletal and Skin Diseases, National Cancer
Institute, Damon Runyon Cancer Research Foundation Clinical Investigator
Award, Swim across America Foundation, and Michael J Rainen Family
Foundation.<br/>Copyright &#xa9; 2016 Elsevier Ltd

<35>
Accession Number
608301986
Author
Ali-Hassan-Sayegh S.; Mirhosseini S.J.; Shahidzadeh A.; Mahdavi P.;
Tahernejad M.; Haddad F.; Lotfaliani M.R.; Sabashnikov A.; Popov A.-F.
Institution
(Ali-Hassan-Sayegh, Mirhosseini, Shahidzadeh, Mahdavi, Tahernejad, Haddad,
Lotfaliani) Cardiovascular Research Center, Shahid Sadoughi University of
Medical Sciences, Yazd, Iran, Islamic Republic of
(Sabashnikov, Popov) Department of Cardiothoracic Transplantation and
Mechanical Circulatory Support, Royal Brompton and Harefield NHS
Foundation Trust, London, United Kingdom
Title
Administration of low molecular weight and unfractionated heparin during
percutaneous coronary intervention.
Source
Indian Heart Journal. 68 (2) (pp 213-224), 2016. Date of Publication: 01
Mar 2016.
Publisher
Elsevier B.V.
Abstract
This systematic review with meta-analysis sought to determine the efficacy
and safety of unfractionated heparin (UFH) and low molecular weight
heparin (LMWH) on clinical outcomes following percutaneous coronary
intervention. Medline, Embase, Elsevier, and web of knowledge as well as
Google scholar literature were used for selecting appropriate studies with
randomized controlled design. After screening 445 studies, a total of 23
trials (including a total of 43,912 patients) were identified that
reported outcomes. Pooled analysis revealed that LMWH compared to UFH
could significantly increase thrombolysis in myocardial infarction grade 3
flow (p < 0.001), which was associated with similar target vessel
revascularization (p = 0.6), similar incidence of stroke (p = 0.7), and
significantly lower incidence of re-myocardial infarction (p < 0.001),
major bleeding (p = 0.02) and mortality (p < 0.001). Overall, LMWH was
shown to be a useful type of heparin for patients with MI undergoing PCI,
due to its higher efficacy and lower rate of complication compared to UFH.
It is also associated with increased myocardial perfusion, decreased major
hemorrhage, and mortality.<br/>Copyright &#xa9; 2016 Cardiological Society
of India. Published by Elsevier B.V. All rights reserved.

<36>
[Use Link to view the full text]
Accession Number
607842776
Author
Kinnaird T.; Anderson R.; Ossei-Gerning N.; Mamas M.A.; Ludman P.; Moat N.
Institution
(Kinnaird, Anderson, Ossei-Gerning) Department of Cardiology, University
Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom
(Mamas) Cardiovascular Research Group, Institute of Cardiovascular
Sciences, University of Manchester, Manchester, United Kingdom
(Ludman) Department of Cardiology, Queen Elizabeth Hospital, Birmingham,
United Kingdom
(Moat) Department of Cardiothoracic Surgery, Royal Brompton Hospital,
Sidney Street, London, United Kingdom
Title
Revascularization for left anterior descending artery stenosis: A review
of the evidence that supports practice.
Source
Cardiology in Review. 24 (3) (pp 136-140), 2016. Date of Publication:
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Disease of the proximal left anterior descending (LAD) artery is a common
pathological finding often combined with disease in other coronary
arteries. In this article, we review specifically the evidence (and the
guidelines arising from the data) for lesions isolated to the proximal LAD
only. Critical review of the data reveals limitations with few trials that
reflect contemporary practice. Much of the data are observational rather
than from randomized trials, and therefore subject to bias. We identified
2 randomized trials of drug-eluting stents versus left internal mammary
artery grafting for isolated lesions of the proximal LAD. One reported no
difference in major adverse cardiovascular events, but at an early
timepoint (6 months), which is likely to be too early to reveal treatment
differences. In the second trial, target lesion revascularization excess
was noted in the drug-eluting stent arm. Therefore, at the current time,
there are little data available to inform interventional cardiologists as
to the best revascularization strategy for isolated lesions of the
proximal LAD. Further randomized, controlled trials are
needed.<br/>Copyright &#xa9; 2016 Wolters Kluwer Health, Inc. All rights
reserved.

<37>
Accession Number
611062628
Author
Gao F.; Yang L.-H.; He H.-R.; Ma X.-C.; Lu J.; Zhai Y.-J.; Guo L.-T.; Wang
X.; Zheng J.
Institution
(Gao, Yang, He, Ma, Lu, Zheng) Clinical Research Center, The First
Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road,
Xi'an, Shaanxi, China
(Ma) Department of Psychiatry, The First Affiliated Hospital of Xi'an
Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China
(Zhai) Department of Pharmacy, The First Affiliated Hospital of Xi'an
Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China
(Guo, Wang) Department of Critical Care Medicine, The First Affiliated
Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an,
Shaanxi, China
Title
The effect of reintubation on ventilator-associated pneumonia and
mortality among mechanically ventilated patients with intubation: A
systematic review and meta-analysis.
Source
Heart and Lung: Journal of Acute and Critical Care. 45 (4) (pp 363-371),
2016. Date of Publication: 01 Jul 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: This meta-analysis summarized the risks that reintubation
impose on ventilator-associated pneumonia (VAP) and mortality. Background:
Extubation failure increases the probability of poor clinical outcomes
pertaining to mechanical ventilation. Methods: Literature published during
a 15-year period was retrieved from PubMed, Web of Knowledge databases,
the Embase (Excerpa Medica database), and the Cochrane Library. Data
involving reintubation, VAP, and mortality were extracted for a
meta-analysis. Results: Forty-one studies involving 29,923 patients were
enrolled for the analysis. The summary odds ratio (OR) between VAP and
reintubation was 7.57 (95% confidence interval [CI] = 3.63-15.81). The
merged ORs for mortality in hospital and intensive care unit were 3.33
(95% CI = 2.02-5.49) and 7.50 (95% CI = 4.60-12.21), respectively.
Conclusions: Reintubation can represent a threat to survival and increase
the risk of VAP. The risk of mortality after reintubation differs between
planned and unplanned extubation. Extubation failure is associated with a
higher risk of VAP in the cardiac surgery population than in the general
population.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<38>
Accession Number
609925457
Author
Ather S.; Bavishi C.P.; Bhatia V.; Bajaj N.S.; Leesar M.A.
Institution
(Ather, Bhatia, Bajaj, Leesar) Division of Cardiology, University of
Alabama at Birmingham, Birmingham, AL, United States
(Bavishi) Department of Medicine, Mount Sinai St Luke's-Roosevelt Hospital
Center, New York, NY, United States
Title
Comparison of failure rates of crossing side branch with pressure vs.
coronary guidewire: A meta-analysis.
Source
European Journal of Clinical Investigation. 46 (5) (pp 448-459), 2016.
Date of Publication: 01 May 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Objectives: The aim of this study was to compare the failure rates of
crossing side branch (SB) with pressure guidewire vs. coronary guidewire
after main vessel (MV) stenting in coronary bifurcation lesions (CBL).
Background: Percutaneous coronary intervention of CBL is technically
difficult. The European Bifurcation Club recommends performing either
fractional flow reserve (FFR) estimation of the SB or final kissing
balloon inflation (FKBI) after the MV stenting when a significant SB
ostial stenosis is present. Even though FFR is recommended in CBL, there
is concern about SB crossing with pressure guidewire among
interventionists. Materials and methods: We undertook a comprehensive
literature search to identify all relevant studies reporting the failure
rates of SB crossing after MV stenting with either pressure or coronary
guidewire. A random effects model was used to compare the failure rates
between the two approaches. Results: Our search identified six studies
that reported failure rates of SB crossing with a pressure guidewire (n =
648) and 11 studies that reported failure rates of SB crossing with a
coronary guide-wire (n = 2601). Estimated pooled failure rate was 3.9%
(95% CI: 1.5% to 9.6%) for inability to cross SB with pressure guidewire.
Estimated pooled failure rate of SB crossing with coronary guidewire was
3.1% (95% CI: 1.5% to 6.2%). There was no significant difference between
the failure rates in the two groups (P = 0.70). Conclusion: The failure
rates of SB crossing after MV stenting are low with both pressure and
coronary guidewire procedures, with no significant difference between the
two approaches.<br/>Copyright &#xa9; 2016 Stichting European Society for
Clinical Investigation Journal Foundation. Published by John Wiley & Sons
Ltd.

<39>
[Use Link to view the full text]
Accession Number
609900249
Author
Uhlig C.; Bluth T.; Schwarz K.; Deckert S.; Heinrich L.; De Hert S.;
Landoni G.; Neto A.S.; Schultz M.J.; Pelosi P.; Schmitt J.; De Abreu M.G.
Institution
(Uhlig, Bluth, De Abreu) Department of Anesthesiology and Intensive Care
Medicine, Pulmonary Engineering Group, Technische Universitat Dresden,
Fetscherstr. 74, Dresden 01307, Germany
(Uhlig) Division of Health Care Sciences, Center for Clinical Research and
Management Education, Dresden International University, Dresden, Germany
(Schwarz, Deckert, Heinrich, Schmitt) Center for Evidence-Based
Healthcare, University Hospital Dresden, Technische Universitat Dresden,
Dresden, Germany
(De Hert) Department of Anesthesiology, Faculty of Medicine and Health
Sciences, Ghent University, Ghent, Belgium
(Landoni) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
(Neto) Department of Critical Care Medicine, Hospital Israelita Albert
Einstein, Program of Post-Graduation,Research and Innovation, Sao Paulo,
Brazil
(Schultz) Department of Intensive Care, Academic Medical Center,
Amsterdam, Netherlands
(Pelosi) Department of Surgical Sciences and Integrated Diagnostics, IRCCS
San Martino IST, University of Genoa, Genoa, Italy
Title
Effects of volatile anesthetics on mortality and postoperative pulmonary
and other complications in patients undergoing surgery: A systematic
review and meta-analysis.
Source
Anesthesiology. 124 (6) (pp 1230-1245), 2016. Date of Publication: 01 Jun
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: It is not known whether modern volatile anesthetics are
associated with less mortality and postoperative pulmonary or other
complications in patients undergoing general anesthesia for surgery.
Methods: A systematic literature review was conducted for randomized
controlled trials fulfilling following criteria: (1) population: adult
patients undergoing general anesthesia for surgery; (2) intervention:
patients receiving sevoflurane, desflurane, or isoflurane; (3) comparison:
volatile anesthetics versus total IV anesthesia or volatile anesthetics;
(4) reporting on: (a) mortality (primary outcome) and (b) postoperative
pulmonary or other complications; (5) study design: randomized controlled
trials. The authors pooled treatment effects following Peto odds ratio
(OR) meta-analysis and network meta-analysis methods. Results: Sixty-eight
randomized controlled trials with 7,104 patients were retained for
analysis. In cardiac surgery, volatile anesthetics were associated with
reduced mortality (OR = 0.55; 95% CI, 0.35 to 0.85; P = 0.007), less
pulmonary (OR = 0.71; 95% CI, 0.52 to 0.98; P = 0.038), and other
complications (OR = 0.74; 95% CI, 0.58 to 0.95; P = 0.020). In noncardiac
surgery, volatile anesthetics were not associated with reduced mortality
(OR = 1.31; 95% CI, 0.83 to 2.05, P = 0.242) or lower incidences of
pulmonary (OR = 0.67; 95% CI, 0.42 to 1.05; P = 0.081) and other
complications (OR = 0.70; 95% CI, 0.46 to 1.05; P = 0.092). Conclusions:
In cardiac, but not in noncardiac, surgery, when compared to total IV
anesthesia, general anesthesia with volatile anesthetics was associated
with major benefits in outcome, including reduced mortality, as well as
lower incidence of pulmonary and other complications. Further studies are
warranted to address the impact of volatile anesthetics on outcome in
noncardiac surgery.<br/>Copyright &#xa9; 2016, the American Society of
Anesthesiologists, Inc. Wolters Kluwer Health, Inc.

<40>
Accession Number
610208799
Author
Bajaj A.; Sethi A.; Rathor P.; Sehgal V.; Pancholy S.
Institution
(Bajaj, Pancholy) Wright Center for Graduate Medical Education, Scranton,
PA, United States
(Sethi) St.Luke's Cardiology Associates, Bethlehem, PA, United States
(Rathor) Zhengzhou University, China
(Sehgal) University of Tennessee, Memphis, United States
Title
Impact of previous cardiac surgery on patients undergoing transcatheter
aortic valve implantation: A meta-analysis.
Source
Heart and Lung: Journal of Acute and Critical Care. 45 (4) (pp 350-358),
2016. Date of Publication: 01 Jul 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
The objective of our meta-analysis is to evaluate the impact of previous
cardiac surgery in patients undergoing transcatheter aortic valve
implantation (TAVI). We did a systemic search of databases, including
Pubmed, EMBASE and Cochrane to identify relevant studies. We included
studies comparing clinical outcomes in patients undergoing TAVI, with and
without previous cardiac surgery. The 30 days as well as 1 year mortality
was not significantly different between the two groups: 30 days (RR, 0.95;
95% CI, 0.82-1.09, I² = 0%), 1 year (RR, 0.94; 95% CI,
0.86-1.02, I² = 0%). The risk of acute myocardial infarction
was significantly higher in patients with previous cardiac surgery and the
risk of major vascular complications was lower in patients with previous
cardiac surgery. Our meta-analysis suggests that the presence of previous
cardiac surgery does not impair outcomes after TAVI, making this subset of
patients particularly applicable for this evolving approach.<br/>Copyright
&#xa9; 2016 Elsevier Inc.

<41>
[Use Link to view the full text]
Accession Number
610354209
Author
Hovaguimian F.; Myles P.S.
Institution
(Hovaguimian) Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Victoria, Australia
(Myles) Department of Anesthesia and Perioperative Medicine, Alfred
Hospital and Monash University, Melbourne, Victoria, Australia
(Hovaguimian) Current Position: Division of Anesthesiology, University
Hospital of Zurich, Zurich, Switzerland
Title
Restrictive versus Liberal Transfusion Strategy in the Perioperative and
Acute Care Settings: A Context-specific Systematic Review and
Meta-analysis of Randomized Controlled Trials.
Source
Anesthesiology. 125 (1) (pp 46-61), 2016. Date of Publication: 01 Jul
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Blood transfusions are associated with morbidity and
mortality. However, restrictive thresholds could harm patients less able
to tolerate anemia. Using a context-specific approach (according to
patient characteristics and clinical settings), the authors conducted a
systematic review to quantify the effects of transfusion strategies.
Methods: The authors searched MEDLINE, EMBASE, CENTRAL, and grey
literature sources to November 2015 for randomized controlled trials
comparing restrictive versus liberal transfusion strategies applied more
than 24 h in adult surgical or critically ill patients. Data were
independently extracted. Risk ratios were calculated for 30-day
complications, defined as inadequate oxygen supply (myocardial, cerebral,
renal, mesenteric, and peripheral ischemic injury; arrhythmia; and
unstable angina), mortality, composite of both, and infections.
Statistical combination followed a context-specific approach. Additional
analyses explored transfusion protocol heterogeneity and cointerventions
effects. Results: Thirty-one trials were regrouped into five
context-specific risk strata. In patients undergoing cardiac/vascular
procedures, restrictive strategies seemed to increase the risk of events
reflecting inadequate oxygen supply (risk ratio [RR], 1.09; 95% CI, 0.97
to 1.22), mortality (RR, 1.39; 95% CI, 0.95 to 2.04), and composite events
(RR, 1.12; 95% CI, 1.01 to 1.24 - 3322, 3245, and 3322 patients,
respectively). Similar results were found in elderly orthopedic patients
(inadequate oxygen supply: RR, 1.41; 95% CI, 1.03 to 1.92; mortality: RR,
1.09; 95% CI, 0.80 to 1.49; composite outcome: RR, 1.24; 95% CI, 1.00 to
1.54 - 3465, 3546, and 3749 patients, respectively), but not in critically
ill patients. No difference was found for infections, although a
protective effect may exist. Risk estimates varied with
successful/unsuccessful transfusion protocol implementation. Conclusions:
Restrictive transfusion strategies should be applied with caution in
high-risk patients undergoing major surgery.<br/>Copyright &#xa9; 2016,
the American Society of Anesthesiologists, Inc.

<42>
Accession Number
616063785
Author
Gaudino M.; Di Franco A.; Weltert L.; Benedetto U.; Lau C.; Gambardella
I.; De Paulis R.; Girardi L.N.
Institution
(Gaudino, Di Franco, Lau, Gambardella, Girardi) Department of
Cardio-Thoracic Surgery, Weill-Cornell Medical Center, New York City, NY,
United States
(Weltert, De Paulis) Department of Cardiac Surgery, European Hospital,
Rome, Italy
(Benedetto) Bristol Heart Institute, University of Bristol, Bristol,
United Kingdom
Title
The role of neo-sinus reconstruction in aortic valve-sparing surgery.
Source
Journal of Cardiac Surgery. 32 (6) (pp 328-333), 2017. Date of
Publication: June 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Aims: The aim of this study was to evaluate the clinical and
echocardiographic results and the predictors of outcomes in patients
undergoing valve-sparing operation (VSO) at two aortic centers. In
addition, we sought to evaluate the potential effect of recreation of the
sinuses of Valsalva (SV) on the outcome of valve-sparing procedures.
Methods: During a 14-year period, 328 patients underwent aortic
valve-sparing root replacement at two institutions. Clinical and echo
evaluation was performed 6 months after surgery and every year thereafter
or in case of clinical symptoms. Propensity weighting and
propensity-weighted risk competing analysis were used. Results: No
operative mortality was reported; the most common complication was
revision for bleeding, occurring in 15 patients (4.6%). At a mean
follow-up of 30.0 +/- 33.9 months, two patients died (0.6%). Recurrent
aortic insufficiency (AI) >2+ was found in 11 patients (3.3%); five (1.5%)
underwent reoperation. Recreation of the SV did not affect clinical
outcome and aortic valve status. Need for aortic valve repair was the only
independent predictor of recurrent AI, whereas a bicuspid aortic valve was
a protective factor. Conclusions: Re-creation of the SV does not affect
short-term outcomes following VSO.<br/>Copyright &#xa9; 2017 Wiley
Periodicals, Inc.

<43>
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 Surgery, Weill Cornell Medicine, New York,
NY, United States
(Benedetto) Bristol Heart Institute, School of Clinical Sciences,
University of Bristol, Bristol, United Kingdom
(Barili) Department of Cardiovascular Surgery, S. Croce e Carle Hospital,
Cuneo, Italy
Title
Endoscopic versus open radial artery harvesting: A meta-analysis of
randomized controlled and propensity matched studies.
Source
Journal of Cardiac Surgery. 32 (6) (pp 334-341), 2017. Date of
Publication: June 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.

<44>
Accession Number
615150250
Author
Wang N.; Lal S.
Institution
(Wang, Lal) University of Sydney, Sydney, NSW, Australia
(Wang, Lal) Royal Prince Alfred Hospital, Camperdown, NSW, Australia
Title
Post-dilation in transcatheter aortic valve replacement: A systematic
review and meta-analysis.
Source
Journal of Interventional Cardiology. 30 (3) (pp 204-211), 2017. Date of
Publication: June 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: The aim of this study was to perform a meta-analysis to
compare the outcomes of patients undergoing TAVR with and without balloon
post-dilation (PD). Background: PD is a commonly used technique in TAVR to
minimize paravalvular regurgitation (PVR), albeit supported by little
evidence. Methods: Systematic review and meta-analysis of 6 studies
comparing 889 patients who had PD compared to 4118 patients without PD.
Results: Patients undergoing PD were more likely male (OR 1.92; 95% CI,
1.41-2.61; P < 0.001) and to have coronary artery disease (OR 1.31; 95%
CI, 1.03-1.68; P = 0.03) than those patients not requiring PD. There were
no significant differences in 30-day mortality (OR 1.24; 95% CI,
0.88-1.74; P = 0.22) and myocardial infarction (OR 0.93; 95% CI,
0.46-1.90; P = 0.85). Patients undergoing TAVR did not have higher 1-year
mortality rates (OR 0.98; 95% CI, 0.61-1.56; P = 0.92). The incidence of
stroke was significantly greater in patients with PD (OR, 1.71; 95% CI,
1.10-2.66). PD was able to reduce the incidence of moderate-severe PVR by
15 fold (OR 15.0; 95% CI, 4.2-54.5; P < 0.001), although rates of
moderate-severe PVR were still higher after PD than patients who did not
require PD (OR 3.64; 95% CI, 1.96-6.75; P < 0.001). Conclusions: PD
significantly improves rates of PVR, however careful patient selection is
needed to minimize increased risk of strokes.<br/>Copyright &#xa9; 2017,
Wiley Periodicals, Inc.

<45>
Accession Number
616577999
Author
Ray I.B.; Monlezun D.; Schwing G.; Middour T.; Katikitala K.; Koranne K.;
Giorgberidze I.; Afshar H.; Cheng J.; Martin-Schild S.; Lam W.; Cassidy
M.; Saeed M.
Institution
(Ray, Monlezun, Schwing, Middour, Katikitala, Koranne, Giorgberidze,
Afshar, Cheng, Martin-Schild, Lam, Cassidy, Saeed) Texas Heart Institute,
Baylor CHI St Luke's Medical Center, Baylor College of Medicine, 6770
Bertner Ave C350, Houston, TX 77030, United States
Title
Complex left appendage morphology is an independent risk factor for
cryptogenic stroke.
Source
Journal of Cardiovascular Electrophysiology. Conference: 22nd Annual
International Atrial Fibrillation Symposium 2017. United States. 28 (5)
(pp 602-603), 2017. Date of Publication: May 2017.
Publisher
Blackwell Publishing Inc.
Abstract
Introduction and Objectives: The cause of cryptogenic stroke is unknown.
Even long-term rhythm monitoring has failed to reveal atrial fibrillation.
We hypothesized that complex left atrial appendage morphology is
independent risk factor for cryptogenic stroke. Methods: This is a
single-center, retrospective case control study of patients with and
without stroke who were imaged by 2D-TEE from 2009 to 2016. A total of 114
patients were enrolled. Patients with mitral stenosis, artificial heart
valves, or poor image quality were excluded. Left atrial appendage
morphology, SLA2M versus CLA2M, was independently characterized by a pair
of Cardiologists blinded to the etiology. Stroke etiology was determined
using the causative classification system by a vascular neurologist.
Results: Of the 97 subjects meeting study criteria, 45 (46.4%) had CLA2M.
In multivariable regression, CLA2M significantly increased the odds of
cryptogenic stroke (OR 5.00, 95%CI 1.05-23.73, P = 0.043) even adjusting
for age and CHADVASC score (Table). Conclusions: CLA2M is associated with
increased risk of cryptogenic strokes indicating that complex LAA
morphology may be a nidus for generating thrombus and thus increased
stroke risk. Further studies are indicated to understand the complex
relation between CLA2M and cryptogenic stroke without atrial fibrillation.
Newer therapeutic modalities like LAA closure may become relevant to treat
in such cases.

<46>
Accession Number
616577981
Author
Bagge L.; Probst J.; Blomstrom P.; Thelin S.; Blomstrom-Lundqvist C.
Institution
(Bagge, Probst, Blomstrom, Thelin, Blomstrom-Lundqvist) Uppsala University
Hospital, Department of Cardiology, Uppsala 751 85, Sweden
Title
Quality of life is not significantly improved by adding epicardial left
atrial cryoablation to mitral valve surgery than if performed alone.
Source
Journal of Cardiovascular Electrophysiology. Conference: 22nd Annual
International Atrial Fibrillation Symposium 2017. United States. 28 (5)
(pp 589-590), 2017. Date of Publication: May 2017.
Publisher
Blackwell Publishing Inc.
Abstract
Introduction and Objectives: Concomitant surgical ablation for elimination
of atrial fibrillation in patients undergoing mitral valve surgery has
almost become routine despite the scarce information about the effects on
quality of life. To evaluate the quality of life, a sub study of the
randomized double blind multicenter SWEDMAF study was conducted. Methods:
Fifty-six out of 69 patients, with permanent atrial fibrillation, who
underwent mitral valve surgery with or without epicardial left atrial
cryoablation replied to the quality of life questionnaire (Short Form 36
survey) at 12 months. Results: The quality-of-life scores at 12-month
follow-up did not differ significantly between patients undergoing mitral
valve surgery with cryoablation versus those undergoing mitral valve
surgery alone (Fig.). Sinus rhythm was achieved in 80.8% (21/26) of
patients treated with the combined mitral valve surgery and ablation
versus in 40.0% (12/30, P <0.01) of patients treated with mitral valve
surgery only, at 12 months follow-up. When comparing patients being in
sinus rhythm (n = 33) with those in atrial fibrillation (n = 23), there
was no significant difference in quality of life at 12 months follow-up,
irrespective of type of surgery (Physical Component Summary, mean CI 95%
46.3 [42.3-50.3] versus 40.0 [33.0-47.0] P = 0.660, Mental Component
Summary, mean CI 95% 50.7 [47.0-54.4] versus 50.8 [44.3-57.2] P = 1.00).
Conclusions: In patients with permanent atrial fibrillation undergoing
mitral valve surgery, the conversion to sinus rhythm achieved by adding
left atrial cryoablation does not result in a significantly improved
health-related quality of life. (Figure Presented).

<47>
Accession Number
613193506
Author
Barba-Navarro R.; Tapia-Silva M.; Garza-Garcia C.; Lopez-Giacoman S.;
Melgoza-Toral I.; Vazquez-Rangel A.; Bazua-Valenti S.; Bobadilla N.;
Wasung de Lay M.; Baranda F.; Chawla L.S.; Gamba G.; Madero M.
Institution
(Barba-Navarro, Tapia-Silva, Garza-Garcia, Lopez-Giacoman, Melgoza-Toral,
Vazquez-Rangel, Wasung de Lay, Baranda, Madero) Departamento de
Nefrologia, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City,
Mexico
(Bazua-Valenti, Bobadilla, Gamba) Departamento de Nefrologia y Metabolismo
Mineral, Instituto Nacional de Ciencias Medicas y Nutricion Salvador
Zubiran, Mexico City, Mexico
(Chawla) Division of Intensive Care Medicine and Nephrology, Department of
Medicine, Veterans Affairs Medical Center, Washington, DC, United States
(Bazua-Valenti, Bobadilla, Gamba) Molecular Physiology Unit, Instituto de
Investigaciones Biomedicas, Universidad Nacional Autonoma de Mexico,
Mexico City, Mexico
Title
The Effect of Spironolactone on Acute Kidney Injury After Cardiac Surgery:
A Randomized, Placebo-Controlled Trial.
Source
American Journal of Kidney Diseases. 69 (2) (pp 192-199), 2017. Date of
Publication: 01 Feb 2017.
Publisher
W.B. Saunders
Abstract
Background Cardiac surgery-related acute kidney injury (AKI) is a common
postoperative complication that greatly increases morbidity and mortality.
There are currently no effective interventions to prevent AKI associated
with cardiac surgery. Experimental data have shown that administration of
the mineralocorticoid receptor blocker spironolactone prevents renal
injury induced by ischemia-reperfusion in rats. The objective of this
study was to test whether short-term perioperative administration of oral
spironolactone could reduce the incidence of AKI in cardiac surgical
patients. Study Design Randomized, double-blinded, placebo-controlled
trial. Setting & Participants Data were collected from April 2014 through
July 2015 at the National Heart Institute in Mexico. 233 patients were
included; 115 and 118 received spironolactone or placebo, respectively.
Intervention Spironolactone or placebo once at a dose of 100 mg 12 to 24
hours before surgery and subsequently 3 further doses of 25 mg in
postoperative days 0, 1, and 2 were administered. Outcomes Patients were
followed up for 7 days or until discharge from the intensive care unit
(ICU). The primary end point was AKI incidence defined by KDIGO criteria.
Secondary end points included requirement of renal replacement therapy,
ICU length of stay, and ICU mortality. Data were analyzed according to the
intention-to-treat principle. Results Mean age was 53.2 +/- 15 years, mean
serum creatinine level was 0.9 +/- 0.2 mg/dL, median Thakar score for
estimation of AKI risk was 2 (IQR, 1-3), and 25% had diabetes. The
incidence of AKI was higher for the spironolactone group (43% vs 29%; P =
0.02). No significant differences were found for secondary end points.
Limitations Single center, AKI was mostly driven by AKI stage 1, planned
sample size was not achieved, and there was no
renin-angiotensin-aldosterone system washout period. Conclusions Our trial
demonstrated that spironolactone was not protective for AKI associated
with cardiac surgery and there may be a trend toward risk.<br/>Copyright
&#xa9; 2016 National Kidney Foundation, Inc.

<48>
Accession Number
615634989
Author
Khan A.R.; Golwala H.; Tripathi A.; Riaz H.; Kumar A.; Flaherty M.P.;
Bhatt D.L.
Institution
(Khan, Tripathi, Flaherty) Division of Cardiovascular Medicine, Department
of Internal Medicine, University of Louisville, Louisville, Kentucky,
United States
(Golwala, Bhatt) Brigham and Women's Hospital Heart and Vascular Center,
Harvard Medical School, Boston, Massachusetts, United States
(Riaz) Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio,
United States
(Kumar) Heart and Vascular Center, Cleveland Clinic, Cleveland, Ohio,
United States
Title
Meta-analysis of Percutaneous Coronary Intervention Versus Coronary Artery
Bypass Grafting in Left Main Coronary Artery Disease.
Source
American Journal of Cardiology. 119 (12) (pp 1949-1956), 2017. Date of
Publication: 15 Jun 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Despite the increase in use of percutaneous coronary intervention (PCI) in
left main coronary disease, its efficacy compared with coronary artery
bypass grafting (CABG) is unclear. We performed a meta-analysis of
randomized controlled trials to assess the optimal revascularization
strategy. Our search yielded 8 studies reporting relevant outcomes that
were pooled using the inverse variance method, and the hazard ratio (HR)
was calculated. The primary outcome was all-cause mortality, myocardial
infarction (MI), or stroke (major adverse cardiac events [MACE]), and the
secondary outcome was death/MI/stroke/repeat revascularization (expanded
MACE). Differences in outcomes classified by follow-up duration (early: 0
to 1 year; late: 3 to 5 years) or anatomical complexity of coronary artery
disease (SYNTAX score) were investigated. Our results suggest no
difference in either early or late MACE (early: HR 0.81; 95% confidence
interval [CI] 0.63 to 1.05; late: HR 1.12; 95% CI 0.80 to 1.56) or
expanded MACE (early: HR 1.03; 95% CI 0.69 to 1.52; late: HR 1.16; 95% CI
0.95 to 1.43) between the 2 groups. There was an increased risk of
expanded MACE with a high SYNTAX score for PCI (HR 1.47; 95% CI 1.13 to
1.92) at late follow-up. There were comparable rates of all-cause
mortality and nonprocedural MI between the 2 groups with increased rates
of repeat revascularization with PCI throughout the follow-up and higher
rates of stroke with coronary artery bypass grafting early in the
follow-up period. In conclusion, our analysis suggests that CABG may be
preferable in patients with left main disease and high SYNTAX scores,
assuming they are at low surgical risk, and PCI may be an acceptable
alternative in patients with low-intermediate SYNTAX scores.<br/>Copyright
&#xa9; 2017 Elsevier Inc.

<49>
Accession Number
615591860
Author
Garg A.; Rao S.V.; Agrawal S.; Theodoropoulos K.; Mennuni M.; Sharma A.;
Garg L.; Ferrante G.; Meelu O.A.; Sargsyan D.; Reimers B.; Cohen M.;
Kostis J.B.; Stefanini G.G.
Institution
(Garg) Department of Medicine, St. Peter's University Hospital, Rutgers
Robert Wood Johnson Medical School, New Brunswick, New Jersey, United
States
(Garg, Sargsyan, Kostis) Division of Cardiology, Cardiovascular Institute,
Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey,
United States
(Rao) Division of Cardiology, Duke Clinical Research Institute, Durham,
North Carolina, United States
(Agrawal) Division of Cardiology, St. Luke's University Hospital,
Bethlehem, Pennsylvania, United States
(Theodoropoulos) Department of Medicine, James J. Peters Veterans Affairs
Medical Center, Bronx, New York, United States
(Mennuni, Ferrante, Reimers, Stefanini) Division of Cardiology, Cardio
Center, Humanitas Research Hospital, Rozzano, Milan, Italy
(Sharma) Department of Cardiovascular Medicine, State University of New
York Downstate Medical Center, Brooklyn, New York, United States
(Garg) Division of Cardiology, Lehigh Valley Hospital, Allentown,
Pennsylvania, United States
(Meelu) Division of Cardiology, Mount Sinai Heart, Icahn School of
Medicine at Mount Sinai Hospital, New York, New York, United States
(Cohen) Division of Cardiology, Newark Beth Israel Medical Center, Newark,
New Jersey, United States
(Stefanini) Department of Biomedical Sciences, Humanitas University,
Rozzano, Milan, Italy
Title
Meta-Analysis of Randomized Controlled Trials of Percutaneous Coronary
Intervention With Drug-Eluting Stents Versus Coronary Artery Bypass
Grafting in Left Main Coronary Artery Disease.
Source
American Journal of Cardiology. 119 (12) (pp 1942-1948), 2017. Date of
Publication: 15 Jun 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Few randomized controlled trials (RCTs) and observational studies had
shown acceptable short-term efficacy and safety of percutaneous coronary
intervention (PCI) with drug-eluting stents (DES) compared with coronary
artery bypass grafting (CABG) in selected patients with left main coronary
artery disease (LMCAD). We aimed to evaluate long-term outcomes of PCI
using DES compared with CABG in patients with LMCAD. On November 1, 2016,
we searched available databases for published RCTs directly comparing DES
PCI with CABG in patients with LMCAD. Odds ratios (ORs) were used as the
metric of choice for treatment effects using a random-effects model.
I-squared index was used to assess heterogeneity across trials.
Prespecified end points were all-cause mortality, cardiovascular
mortality, myocardial infarction (MI), stroke, and repeat
revascularization at maximal available follow-up. We identified 5 RCTs
including a total of 4,595 patients, with a median follow-up of 60 months.
The risk of all-cause mortality (OR 1.01; 95% confidence interval [CI]
0.76 to 1.34) and cardiovascular mortality (OR 1.02; 95% CI 0.73 to 1.42)
were comparable between PCI with DES and CABG. Similarly, there were no
statistically significant differences between PCI with DES and CABG for MI
(OR 1.45; 95% CI 0.87 to 2.40) and stroke (OR 0.87; 95% CI 0.38 to 1.98).
Conversely, repeat revascularization was significantly higher with PCI
compared with CABG (OR 1.82; 95% CI 1.51 to 2.21). In conclusion, in
patients with LMCAD, PCI with DES appears to be a viable alternative to
CABG at long-term follow-up, with similar risks of ischemic adverse events
(mortality, MI, and stroke) but a higher risk of repeat
revascularization.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<50>
Accession Number
616501045
Author
Crowle C.; Walker K.; Galea C.; Novak I.; Badawi N.
Institution
(Crowle, Walker, Badawi) Grace Centre for Newborn Care, The Children's
Hospital Westmead, Sydney, Australia
(Crowle, Walker, Novak, Badawi) University of Sydney, Sydney, Australia
(Walker, Galea, Novak, Badawi) Cerebral Palsy Alliance Research Institute,
Sydney, Australia
Title
General movement trajectories and neurodevelopment at 3 months of age
following neonatal surgery.
Source
Early Human Development. 111 (pp 42-48), 2017. Date of Publication: August
2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Neonates who undergo major surgery are at risk of
neurodevelopmental disability. The General Movements Assessment (GMA) is a
valid and reliable method to predict neurodevelopment, however, there are
minimal data on the applicability among infants post-surgery. Aim To
describe GMs trajectories following neonatal surgery. Study design
Prospective cohort study. Subjects 217 infants following major cardiac and
non-cardiac neonatal surgery. Outcome measures Infants were assessed
following surgery at term age (mean 40 weeks, SD 2.3), and at 3 months of
age (mean 12 weeks, SD 1.6) using the GMA and the Bayley Scales of Infant
and Toddler Development III. GMA videos were independently scored by three
advanced trained assessors, two blinded to infant details. Results The
most common result in the writhing period was 'poor repertoire' (n = 117,
54%), however, 99 (84%) of these infants had normal fidgety movements. For
infants with normal writhing (n = 75, 34%), only four had absent fidgety
movements. Cramped synchronised movements were seen in 10 infants, and
three of these were rated as absent fidgety. There was no significant
difference between the surgical groups. In total, 24 infants (11%) had
absent fidgety movements and lower scores on average in all subtests of
the BSID-III than those with normal fidgety movements. Conclusions This is
the first report describing GMs trajectories in infants who have undergone
neonatal surgery. Similar to other high risk infant populations, this
group showed a high proportion of poor repertoire writhing movements,
however, most infants demonstrated normal fidgety movements and
development at 3 months of age.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<51>
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, Netherlands
(Jacob, Suyker) Department of Cardiothoracic Surgery, University Medical
Center Utrecht, Utrecht, Netherlands
(van Dijk, Dieleman) Department of Anesthesiology and Intensive Care,
University Medical Center Utrecht, Utrecht, Netherlands
Title
Determinants of the postpericardiotomy syndrome: a systematic review.
Source
European Journal of Clinical Investigation. 47 (6) (pp 456-467), 2017.
Date of Publication: June 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

<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
616492247
Author
Bahlmann E.; Cramariuc D.; Minners J.; Lonnebakken M.T.; Ray S.;
Gohlke-Baerwolf C.; Nienaber C.A.; Jander N.; Seifert R.; Chambers J.B.;
Kuck K.H.; Gerdts E.
Institution
(Bahlmann, Kuck) Department of Cardiology, Asklepios Clinic St. Georg, II.
Medical Clinic, Lohmuhlenstrasse 5, Hamburg 20099, Germany
(Cramariuc, Seifert) Department of Heart Disease, Haukeland University
Hospital, Bergen, Norway
(Minners, Gohlke-Baerwolf, Jander) Department of Cardiology, Herz-Zentrum
Bad Krozingen, Bad Krozingen, Germany
(Lonnebakken, Gerdts) Department of Clinical Science, University of
Bergen, Bergen, Norway
(Ray) Manchester Academic Health Sciences Centre, Manchester, United
Kingdom
(Nienaber) Imperial College, Royal Brompton and Harefield Trust,
Cardiology and Aortic Centre, London, United Kingdom
(Chambers) Cardiothoracic Centre, Guys and St. Thomas Hospitals, London,
United Kingdom
Title
Small aortic root in aortic valve stenosis: Clinical characteristics and
prognostic implications.
Source
European Heart Journal Cardiovascular Imaging. 18 (4) (pp 404-412), 2017.
Date of Publication: 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims In aortic valve stenosis (AS), having a small aortic root may
influence both the assessment of AS severity and the treatment strategy.
The aim was to test the prognostic implications of having a small aortic
root in AS within a large prospective study. Methods and results We used
data from 4.3-year follow-up of 1560 patients with asymptomatic, initially
mostly moderate AS enrolled in the Simvastatin and Ezetimibe in Aortic
Stenosis study. A small aortic root was defined as inner aortic
sinotubular junction diameter indexed for body height <1.4 cm/m in women
and <1.5 cm/m in men. A small aortic root was found in 270 patients
(17.3%) at baseline. Having a small aortic root was associated with larger
aortic root wall thickness, higher pressure recovery, lower systemic
arterial compliance, left ventricular mass index, and female sex in a
multivariable logistic regression analysis (all P < 0.05). In the Cox
regression analysis, having a small aortic root at baseline was associated
with higher hazard rates of ischaemic cardiovascular events (n = 268; HR
1.55, 95% CI 1.16-2.06), non-haemorrhagic stroke (n = 55; HR 1.88, 95% CI
1.04-3.41), and cardiovascular death (n = 81; HR 2.08, 95% CI 1.28-3.39)
(all P < 0.05) after adjusting for confounders, including randomized study
treatment, sex, hypertension, AS severity, and aortic valve replacement.
Conclusion In AS patients without known cardiovascular disease or
diabetes, having a small aortic root was associated with increased
ischaemic cardiovascular events and mortality. The results suggest a
relation between the presence of a small aortic root and that of
subclinical atherosclerosis. All rights reserved.<br/>Copyright &#xa9; The
Author 2016.

<54>
Accession Number
612225174
Author
Avgousti S.; Christoforou E.G.; Panayides A.S.; Voskarides S.; Novales C.;
Nouaille L.; Pattichis C.S.; Vieyres P.
Institution
(Avgousti) Cyprus University of Technology, Nursing Department, School of
Health and Science, 30 Archbishop Kyprianou Street, Limassol 3036, Cyprus
(Christoforou) University of Cyprus, Department of Electrical and Computer
Engineering, 75 Kalipoleos Street, P.O. BOX 20537, Nicosia 1678, Cyprus
(Panayides) Imperial College, Department of Electrical and Electronic
Engineering, South Kensington Campus, London SW7 2AZ, United Kingdom
(Voskarides) Cyprus University of Technology, Department of Electrical
Engineering, Computer Engineering and Informatics, 30 Archbishop Kyprianou
Street, Lemesos 3036, Cyprus
(Novales, Nouaille, Vieyres) Laboratoire PRISME-Universite d'Orleans, 63
Avenue de Lattre de Tassigny, Bourges 18020, France
(Panayides, Pattichis) University of Cyprus, Department of Computer
Science, 75 Kalipoleos Street, P.O. BOX 20537, Nicosia 1678, Cyprus
Title
Medical telerobotic systems: Current status and future trends.
Source
BioMedical Engineering Online. 15 (1) (no pagination), 2016. Article
Number: 96. Date of Publication: 12 Aug 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Teleoperated medical robotic systems allow procedures such as surgeries,
treatments, and diagnoses to be conducted across short or long distances
while utilizing wired and/or wireless communication networks. This study
presents a systematic review of the relevant literature between the years
2004 and 2015, focusing on medical teleoperated robotic systems which have
witnessed tremendous growth over the examined period. A thorough insight
of telerobotics systems discussing design concepts, enabling technologies
(namely robotic manipulation, telecommunications, and vision systems), and
potential applications in clinical practice is provided, while existing
limitations and future trends are also highlighted. A representative
paradigm of the short-distance case is the da Vinci Surgical System which
is described in order to highlight relevant issues. The long-distance
telerobotics concept is exemplified through a case study on diagnostic
ultrasound scanning. Moreover, the present review provides a
classification into short- and long-distance telerobotic systems,
depending on the distance from which they are operated. Telerobotic
systems are further categorized with respect to their application field.
For the reviewed systems are also examined their engineering
characteristics and the employed robotics technology. The current status
of the field, its significance, the potential, as well as the challenges
that lie ahead are thoroughly discussed.<br/>Copyright &#xa9; 2016 The
Author(s).

<55>
Accession Number
616564189
Author
Ma N.; Cameron A.; Tivey D.; Grae N.; Roberts S.; Morris A.
Institution
(Ma, Cameron, Tivey) Royal Australasian College of Surgeons, Adelaide,
South Australia, Australia
(Grae) New Zealand Health Quality & Safety Commission, Wellington, New
Zealand
(Roberts, Morris) Auckland District Health Board, Auckland, New Zealand
Title
Systematic review of a patient care bundle in reducing staphylococcal
infections in cardiac and orthopaedic surgery.
Source
ANZ journal of surgery. 87 (4) (pp 239-246), 2017. Date of Publication: 01
Apr 2017.
Abstract
Surgical site infections (SSIs) are serious adverse events hindering
surgical patients' recovery. In Australia and New Zealand, SSIs are a huge
burden to patients and healthcare systems. A bundled approach, including
pre-theatre nasal and/or skin decolonization has been used to reduce the
risk of staphylococcal infection. The aim of this review is to assess the
effectiveness of the bundle in preventing SSIs for cardiac and orthopaedic
surgeries. The review was conducted according to the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses statement. Published
literature was searched in PubMed, Embase and Cochrane Library of
Systematic reviews. Identified articles were selected and extracted based
on a priori defined Population-Intervention-Comparator-Outcome and
eligibility criteria. Data of randomized controlled trials (RCTs) and
comparative observational studies were synthesized by meta-analyses.
Quality appraisal tools were used to assess the evidence quality. The
review included six RCTs and 19 observational studies. The bundled
treatment regimens varied substantially across all studies. RCTs showed a
trend of Staphylococcus aureus SSIs reduction due to the bundle (relative
risk = 0.59, 95% confidence interval (CI) = 0.33, 1.06) with moderate
heterogeneity. Observational studies showed statistically significant
reduction in all-cause and S. aureus SSIs, with 51% (95% CI = 0.41, 0.59)
and 47% (95% CI = 0.35, 0.65), respectively. No publication biases were
detected. SSIs in major cardiac and orthopaedic surgeries can be
effectively reduced by approximately 50% with a pre-theatre patient care
bundle approach.<br/>Copyright &#xa9; 2017 Royal Australasian College of
Surgeons.

<56>
Accession Number
616563290
Author
Sawatzky J.-A.V.; Kehler D.S.; Ready A.E.; Lerner N.; Boreskie S.; Lamont
D.; Luchik D.; Arora R.C.; Duhamel T.A.
Institution
(Sawatzky) Faculty of Nursing, University of Manitoba, Winnipeg, Canada
(Kehler) Health, Leisure, and Human Performance Research Institute,
Faculty of Kinesiology and Recreation Management, University of Manitoba,
Winnipeg, Canada Institute of Cardiovascular Sciences, St. Boniface
Hospital Research Centre, Winnipeg, Canada
(Ready) Health, Leisure, and Human Performance Research Institute, Faculty
of Kinesiology and Recreation Management, University of Manitoba,
Winnipeg, Canada
(Lerner, Boreskie, Lamont, Luchik) Reh-Fit Centre, Winnipeg, Canada
(Arora) Department of Surgery (Cardiac Surgery), University of Manitoba,
Winnipeg, Canada
(Duhamel) Health, Leisure, and Human Performance Research Institute,
Faculty of Kinesiology and Recreation Management, University of Manitoba,
Winnipeg, Canada Institute of Cardiovascular Sciences, St. Boniface
Hospital Research Centre, Winnipeg, Canada Department of Physiology,
University of Manitoba, Winnipeg, Canada
Title
Prehabilitation program for elective coronary artery bypass graft surgery
patients: a pilot randomized controlled study.
Source
Clinical rehabilitation. 28 (7) (pp 648-657), 2014. Date of Publication:
01 Jul 2014.
Abstract
OBJECTIVE: To determine the feasibility of a cardiac prehabilitation
(Prehab) program for patients waiting for elective coronary artery bypass
graft (CABG).
DESIGN: A two-group parallel randomized controlled trial.
SETTING: Medical fitness facility.
SUBJECTS: Seventeen preoperative elective CABG surgery patients were
randomized to standard care (n = 9) or Prehab (n = 8).
INTERVENTION: Standard care: three-hour preassessment appointment. Prehab:
exercise and education classes for 60 minutes/day, twice weekly for at
least four weeks.
MAIN MEASURES: Data were collected at baseline, one week preoperatively,
and three months postoperatively. The primary outcome measure was walking
distance using a 6-minute walk test. Secondary outcome variables included
5-meter gait speed, and cardiac rehabilitation attendance three months
postoperatively.
RESULTS: Fifteen patients (standard care, n = 7; Prehab, n = 8) completed
the study. No Prehab patients developed cardiac symptoms during study
participation. Walking distance remained unchanged in the standard care
group; whereas, the Prehab group increased their walking distance to mean
+/- SD 474 +/-101 and 487 +/-106 m at the preoperative and three month
postoperative assessments (p < 0.05). Gait speed was unchanged in the
standard care group, but improved in the Prehab group by 27% and 33%
preoperatively and three months postoperatively, respectively (p < 0.05).
Enrollment in cardiac rehabilitation three months postoperatively was
higher for Prehab participants (100%) than standard care participants
(43%; p < 0.05).
CONCLUSION: These data provide evidence for the feasibility of a Prehab
intervention to improve the health status of patients waiting for elective
CABG surgery. A larger trial of 92 patients will be utilized to
demonstrate the safety and efficacy of Prehab.<br/>Copyright &#xa9; The
Author(s) 2014.

<57>
Accession Number
616549163
Author
Totonchi Z.; Hajimiresmaiel S.J.; Azarfarin R.; Pazoki-Toroudi H.; Mahdavi
M.; Korbi M.; Dehaki M.G.; Soltani B.; Gorjipour F.
Institution
(Gorjipour, Dehaki, Totonchi, Azarfarin, Mahdavi, Korbi, Dehaki, Soltani)
Department of Cardiac Surgery, Rajaei Cardiovascular Medical and Research
Center, Iran University of Medical Sciences, Vali-Asr Av., Tehran, Iran,
Islamic Republic of
(Hajimiresmaiel) Department of Cardiology, Faculty of Medicine, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Pazoki-Toroudi) Physiology Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Gorjipour) Cellular and Molecular Research Center, Iran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Inflammatory cytokine response and cardiac troponin i changes in
cardiopulmonary bypass using two cardioplegia solutions; Del Nido and
modified St. Thomas': A randomized controlled trial.
Source
Perfusion (United Kingdom). 32 (5) (pp 394-402), 2017. Date of
Publication: 01 Jul 2017.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Long intervals of del Nido (DN) solution administration, 90
minutes, may result in rewarming of the myocardial tissue and elevate
metabolic demand and hypoxia. This will potentially increase inflammatory
response due to ischemia-reperfusion injury. We conducted this study to
compare the inflammatory response between patients receiving DN and
multi-dose St Thomas' cardioplegia solution (MST) in cardiopulmonary
bypass (CPB) surgery for the correction of tetralogy of Fallot (TF).
Methods: Fifty-nine pediatric patients undergoing TF total correction
surgery were randomly assigned into two groups: DN and MST. The patients'
demographic data, blood chemistry parameters, hemodynamics and other
clinical variables were recorded. TNF-a, IL-6, IL-8, IL-10 and cTnI were
measured after anesthesia induction (before skin incision), immediately
after cross-clamp removal and 24 hours after admission to the intensive
care unit (ICU). Results: Thirty-two patients of a mean age of 28.0+/-16.4
months received DN and 27 patients of a mean age of 24.2+/-15.9 months
received MST. Perioperative clinical parameters were not significantly
different between the two groups. Cytokine levels for all patients were
significantly increased after surgery. Inter-group comparisons of cytokine
levels demonstrated no significant differences in TNF-alpha, IL-6 and IL-8
cytokines levels. IL-10 level showed a moderately significant increase in
the MST group compared to the DN group after surgery (2.94+/-0.9 vs.
2.46+/-0.61 log10 pg/mL, respectively; p=0.039). Postoperative lactate
level was significantly different between two groups (2.475+/-1.29 vs
1.63+/-0.82 mg/dL in DN and MST groups, respectively; p=0.007). CTnI
levels increased after surgery and remained constant until 24 hours after
surgery. Significant differences between the MST and DN groups, at all
times, were not detected. Conclusions: The anti-inflammatory cytokine
response in the MST group is significantly better than in the DN group.
This may be due to shorter intervals of the MST cardioplegia solution
administration, which prevents rewarming of the myocardium, increased
metabolic demand and hypoxia. Decreasing the intervals of DN
administration may improve its cardioprotective properties.<br/>Copyright
&#xa9; The Author(s) 2016.

<58>
Accession Number
616549002
Author
Ghijselings I.; Himpe D.; Rex S.
Institution
(Ghijselings, Rex) Department of Anaesthesiology, University Hospitals
Leuven, Herestraat 49, Leuven 3000, Belgium
(Himpe) Department of Anaesthesiology, ZNA Middelheim, Antwerp, Belgium
(Rex) Department of Cardiovascular Sciences, University Hospitals of
Leuven, KU Leuven, Leuven, Belgium
Title
Safety of gelatin solutions for the priming of cardiopulmonary bypass in
cardiac surgery: A systematic review and meta-analysis.
Source
Perfusion (United Kingdom). 32 (5) (pp 350-362), 2017. Date of
Publication: 01 Jul 2017.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
This systematic review and meta-analysis was conducted to evaluate the
safety of gelatin versus hydroxyethyl starches (HES) and crystalloids when
used for cardiopulmonary bypass (CPB)-priming in cardiac surgery. MEDLINE
(Pubmed), Embase and CENTRAL were searched. We included only randomized,
controlled trials comparing CPB-priming with gelatin with either
crystalloids or HES-solutions of the newest generation. The primary
endpoint was the blood loss during the first 24 hours. Secondary outcomes
included perioperative transfusion requirements, postoperative kidney
function, postoperative ventilation times and length of stay on the
intensive care unit. Sixteen studies were identified, of which only ten
met the inclusion criteria, representing a total of 824 adult patients: 4
studies compared gelatin with crystalloid, and 6 studies gelatin with HES
priming. Only 2 of the studies comparing HES and gelatin reported
postoperative blood loss after 24 hours. No significant difference in
postoperative blood loss was found when results of both studies were
pooled (SMD -0.12; 95% CI: -0.49, 0.25; P=0.52). Likewise, the pooled
results of 3 studies comparing gelatin and crystalloids as a priming
solution could not demonstrate significant differences in postoperative
bleeding after 24 hours (SMD -0.07; 95% CI: -0.40, 0.26; P=0.68). No
differences regarding any of the secondary outcomes could be identified.
This systematic review suggests gelatins to have a safety profile which is
non-inferior to modern-generation tetrastarches or crystalloids. However,
the grade of evidence is rated low owing to the poor methodological
quality of the included studies, due to inconsistent outcome reporting and
lack of uniform endpoint definitions.<br/>Copyright &#xa9; The Author(s)
2016.

<59>
Accession Number
616545379
Author
Kurlansky P.; Herbert M.; Prince S.; Mack M.
Institution
(Kurlansky) Department of Surgery, Columbia University, New York, NY,
United States
(Herbert, Prince) Medical City Dallas Hospital, Dallas, TX, United States
(Mack) Department of Cardiac Surgery, Baylor Health Care System, Plano,
TX, United States
Title
Coronary bypass versus percutaneous intervention: Sex matters. The impact
of gender on long-term outcomes of coronary revascularization.
Source
European Journal of Cardio-thoracic Surgery. 51 (3) (pp 554-561), 2017.
Date of Publication: 01 Mar 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Objectives: Women have a higher mortality than men following coronary
artery bypass grafting (CABG). The influence of patient sex on outcomes of
percutaneous coronary interventions (PCI) is controversial. Since patient
selection for randomized clinical trials may not reflect clinical
practice, we investigated the impact of sex on outcomes of CABG versus PCI
in a comprehensive registry of coronary revascularization (CR). METHODS:
All patients undergoing CR in a network of eight community hospitals were
enrolled. Follow-up was obtained after 5 years (median, 79.7 months).
ST-elevation myocardial infarction (MI) patients were excluded.
Propensity-score matching accounted for differences between groups.
RESULTS: There were 2162 men (673 CABG, 1489 PCI) and 991 women (294 CABG,
697 PCI). Survival free from major adverse cardiac events (MACE)-all cause
mortality, nonfatal MI, re-intervention at 5 years for PCI versus CABG was
77.1 +/- 1.1 vs. 83.1 +/- 1.5, hazard ratio (HR) 0.588 (95% confidence
interval [CI]: 0.491-0.704; P < 0.001) for men, but 75.0 +/- 1.6 vs. 74.5
+/- 2.5, HR 0.869 (95% CI: 0.687-1.100; P = 0.24) for women. After
matching, MACE-free survival for men remained significantly different,
69.5 +/- 2.2 vs. 79.5 +/- 2.0, HR 0.548 (95% CI: 0.424-0.682; P < 0.001)
but not for women, 68.1 +/- 3.4 vs. 69.4 +/- 3.4, HR 0.752 (95% CI:
0.540-1.049; P = 0.093). Conclusions: In a 'real world' unselected cohort
of CR patients, men enjoy improved survival and reduced MACE with CABG
versus PCI. Outcomes for women are worse than for men and are equivalent
with either procedure, emphasizing importance of accounting for sex in
assessing outcomes of comparative CR procedures.<br/>Copyright &#xa9; The
Author 2016. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<60>
Accession Number
616479978
Author
Anand V.; Bates A.; Featherstone R.; Murthy S.
Institution
(Anand, Featherstone) University of Alberta, Edmonton, Canada
(Bates) University of Pennsylvania, Philadelphia, United States
(Murthy) University of British Columbia, 4500 Oak Street, Vancouver,
Canada
Title
Perioperative antibiotics in pediatric cardiac surgery: Protocol for a
systematic review.
Source
Systematic Reviews. 6 (1) (no pagination), 2017. Article Number: 107. Date
of Publication: 30 May 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Post-operative infections in pediatric cardiac surgery are an
ongoing clinical challenge, with rates between 1 and 20%. Perioperative
antibiotics remain the standard for prevention of surgical-site
infections, but the type of antibiotic and duration of administration
remain poorly defined. Current levels of practice variation through
informal surveys are very high. Rates of antibiotic-resistant organisms
are increasing steadily around the world. Methods/design: We will identify
all controlled observational studies and randomized controlled trials
examining prophylactic antibiotic use in pediatric cardiac surgery. Data
sources will include MEDLINE, EMBASE, CENTRAL, and proceedings from recent
relevant scientific meetings. For each included study, we will conduct
duplicate independent data extraction, risk of bias assessment, and
evaluation of quality of evidence using the GRADE approach. Discussion: We
will report the results of this review in agreement with the PRISMA
statement and disseminate our findings at relevant critical care and
cardiology conferences and through publication in peer-reviewed journals.
We will use this systematic review to inform clinical guidelines, which
will be disseminated in a separate stand-alone publication. Study
registration number: PROSPERO CRD42016052978C<br/>Copyright &#xa9; 2017
The Author(s).

<61>
Accession Number
616464036
Author
Caimmi P.P.; Sabbatini M.; Kapetanakis E.I.; Cantone S.; Ferraz M.V.;
Cannas M.; Tesler U.F.
Institution
(Caimmi) Department of Cardiac Surgery, University Hospital of Novara
"Maggiore della Carita", Novara, Italy
(Caimmi, Cannas) Department of Science Health, UPO University, Novara,
Italy
(Caimmi, Tesler) "Policlinico di Monza" Hospital Group, Department Cardiac
Surgery, San Gaudenzio Clinic, Novara, Italy
(Sabbatini) Department of Science and Innovation Technology, UPO
University, Alessandria, Italy
(Kapetanakis) Department of Thoracic Surgery, "Sotiria" Chest Diseases
Hospital of Athens, Athens, Greece
(Cantone) "Policlinico di Monza" Health Care Group, Department Cardiac
Anaestehsiology, San Gaudenzio Clinic, Novara, Italy
(Ferraz) Department of Cardiac Surgery, Beneficencia Portouguesa Hospital,
Piracicaba, Brazil
Title
A Randomized Trial to Assess the Contribution of a Novel Thorax Support
Vest (Corset) in Preventing Mechanical Complications of Median Sternotomy.
Source
Cardiology and Therapy. 6 (1) (pp 41-51), 2017. Date of Publication: 01
Jun 2017.
Publisher
Springer Healthcare (E-mail: kathleen.burke@springer.com)
Abstract
Objectives: Mechanical complications of median sternotomy may cause
significant morbidity and mortality in cardiac surgical patients. This
study was aimed at assessing the role of Posthorax support vest (Epple,
Inc., Vienna, Austria) in the prevention of sternal complications and the
improvement of anatomical healing in patients at high risk for mechanical
sternal dehiscence after cardiac surgery by mean of median sternotomy.
Methods: A prospective, randomized, study was performed and 310 patients
with predisposing factors for sternal dehiscence after sternotomy for
cardiac surgery were included. The patients were divided into two groups:
patients who received the Posthorax support vest after surgery, and
patients who did not. Primary variables assessed included the incidence of
mechanical sternal complications, the quality of sternal healing, the rate
of re-operation, the duration of hospitalization, rate and duration of
hospital, re-admission for sternal complications. Secondary variables
assessed were the post-operative pain, the number of requests for
supplemental analgesia and the quality of life measured by means of the
EQ-5D format. Results: Patients using vest demonstrated a lower incidence
of mechanical sternal complications, a better anatomical sternum healing,
lower hospital stay, no re-operations for sternal dehiscence before
discharge and lower re-admissions for mechanical sternal complication. In
addition, patients using a vest reported a better quality of life with
better freedom from limitations in mobility, self-care, and pain.
Conclusions: Our findings demonstrate that the use of the Posthorax vest
reduces post-sternotomy mechanical complications and improves the healing
of the sternotomy, the clinical course, and the post-operative quality of
life.<br/>Copyright &#xa9; 2016, The Author(s).

<62>
Accession Number
616517309
Author
Sun S.L.; Tian J.H.; Yang K.; Liu R.; Li J.
Institution
(Li, Tian, Yang, Li) Lanzhou University, Evidence-Based Medicine Center,
School of Basic Medical Sciences, No. 199, Donggang West Road, Lanzhou
City, Gansu 730000, China
(Li) Key Laboratory of Evidence Based Medicine and Knowledge Translation
of Gansu Province, Lanzhou City, Gansu Province, China
(Sun) Liaocheng People's Hospital, Vascular Surgery, No. 67, Dongchang
West Road, Liaocheng City, Shandong Province 252000, China
(Tian, Yang) Lanzhou University, Key Laboratory of Evidence Based Medicine
and Knowledge Translation of Gansu Province, Lanzhou City, China
(Liu) Lanzhou Univeristy, Radiation Oncology Centre of Gansu Tumour
Hospital, No. 2, Xioaxihu East Road, Lanzhou City, Gansu 730050, China
Title
Cell salvage in emergency trauma surgery.
Source
Cochrane Database of Systematic Reviews. 2017 (6) (no pagination), 2015.
Article Number: CD007379. Date of Publication: 23 Jan 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Trauma is the leading cause of death in people under the age
of 45 years. Over the past 20 years, intraoperative autologous
transfusions (obtained by cell salvage, also known as intraoperative blood
salvage (IBS)) have been used as an alternative to blood products from
other individuals during surgery because of the risk of
transfusion-related infections such as hepatitis and human
immunodeficiency virus (HIV). In this review, we sought to assess the
effects and cost of cell salvage in individuals undergoing abdominal or
thoracic surgery. Objectives: To compare the effect and cost of cell
salvage with those of standard care in individuals undergoing abdominal or
thoracic trauma surgery. Search methods: We ran the search on 25 November
2014. We searched the Cochrane Injuries Group's Specialised Register,
Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane
Library), Ovid MEDLINE, Ovid MEDLINE In-Process & Other Non-Indexed
Citations, Ovid MEDLINE Daily and Ovid OLDMEDLINE, EMBASE Classic + EMBASE
(OvidSP), PubMed, and ISI Web of Science (SCI-Expanded & CPSI-SSH). We
also screened reference lists and contacted principal investigators.
Selection criteria: Randomised controlled trials comparing cell salvage
with no cell salvage (standard care) in individuals undergoing abdominal
or thoracic trauma surgery. Data collection and analysis: Two authors
independently extracted data from the trial reports. We used the standard
methodological procedures expected by The Cochrane Collaboration. Main
results: Only one small study (n = 44) fulfilled the inclusion criteria.
Results suggested that cell salvage did not affect mortality overall
(death rates were 67% (14/21 participants) in the cell salvage group and
65% (15/23) in the control group) (odds ratio (OR) 1.07, 95% confidence
interval (CI) 0.31 to 3.72). For individuals with abdominal injury,
mortality was also similar in both groups (OR 0.48, 95% CI 0.11 to 2.10).
Less donor blood was needed for transfusion within the first 24 hours
postinjury in the cell salvage group compared with the control group (mean
difference (MD) -4.70 units, 95% CI -8.09 to -1.31). Adverse events,
notably postoperative sepsis, did not differ between groups (OR 0.54, 95%
CI 0.11 to 2.55). Cost did not notably differ between groups (MD -177.81,
95% CI -452.85 to 97.23, measured in GBP in 2002). Authors' conclusions:
Evidence for the use of cell salvage in individuals undergoing abdominal
or thoracic trauma surgery remains equivocal. Large, multicentre,
methodologically rigorous trials are needed to assess the relative
efficacy, safety and cost-effectiveness of cell salvage in different
surgical procedures in the emergency context.<br/>Copyright &#xa9; 2015
The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

<63>
Accession Number
616517301
Author
Mostafaie K.; Bedenis R.; Harrington D.
Institution
(Mostafaie) David Geffen School of Medicine at UCLA, Department of
Medicine, 1000 West Carson, Torrance, CA 92604, United States
(Bedenis) University of Edinburgh, Centre for Population Health Sciences,
Edinburgh EH8 9AG, United Kingdom
(Harrington) David Geffen School of Medicine at UCLA, Los Angeles, CA,
United States
Title
Beta-adrenergic blockers for perioperative cardiac risk reduction in
people undergoing vascular surgery.
Source
Cochrane Database of Systematic Reviews. 2017 (6) (no pagination), 2015.
Article Number: CD006342. Date of Publication: 14 Jan 2015.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: People undergoing major vascular surgery have an increased
risk of postoperative cardiac complications. Beta-adrenergic blockers
represent an important and established pharmacological intervention in the
prevention of cardiac complications in people with coronary artery
disease. It has been proposed that this class of drugs may reduce the risk
of perioperative cardiac complications in people undergoing major
non-cardiac vascular surgery. Objectives: To review the efficacy and
safety of perioperative beta-adrenergic blockade in reducing cardiac or
all-cause mortality, myocardial infarction, and other cardiovascular
safety outcomes in people undergoing major non-cardiac vascular surgery.
Search methods: The Cochrane Peripheral Vascular Diseases Group Trials
Search Co-ordinator searched the Specialised Register (January 2014) and
the Cochrane Central Register of Controlled Trials (CENTRAL; 2013, Issue
12). We searched trials databases and checked reference lists of relevant
articles. Selection criteria: We included prospective, randomised
controlled trials of perioperative beta-adrenergic blockade of people over
18 years of age undergoing non-cardiac vascular surgery. Data collection
and analysis: Two review authors independently performed study selection
and data extraction. We resolved disagreements through discussion. We
performed meta-analysis using a fixed-effect model with odds ratios (ORs)
and 95% confidence intervals (CIs). Main results: We included two studies
in this review, both of which were double-blind, randomised controlled
trials comparing perioperative beta-adrenergic blockade (metoprolol) with
placebo, on cardiovascular outcomes in people undergoing major non-cardiac
vascular surgery. We included 599 participants receiving beta-adrenergic
blockers (301 participants) or placebo (298 participants). The overall
quality of studies was good. However, one study did not report random
sequence generation or allocation concealment techniques, indicating
possible selection bias, and the other study did not report outcome
assessor blinding and was possibly underpowered. It should be noted that
several of the outcomes were only reported in a single study and neither
of the studies reported on vascular patency/graft occlusion, which reduces
the quality of evidence to moderate. There was no evidence that
perioperative beta-adrenergic blockade reduced all-cause mortality (OR
0.62, 95% CI 0.03 to 15.02), cardiovascular mortality (OR 0.34, 95% CI
0.01 to 8.32), non-fatal myocardial infarction (OR 0.83, 95% CI 0.46 to
1.49; P value = 0.53), arrhythmia (OR 0.70, 95% CI 0.26 to 1.88), heart
failure (OR 1.71, 95% CI 0.40 to 7.23), stroke (OR 2.67, 95% CI 0.11 to
67.08), composite cardiovascular events (OR 0.87, 95% CI 0.55 to 1.39; P
value = 0.57) or re-hospitalisation at 30 days (OR 0.86, 95% CI 0.48 to
1.52). However, there was strong evidence that beta-adrenergic blockers
increased the odds of intra-operative bradycardia (OR 4.97, 95% CI 3.22 to
7.65; P value < 0.00001) and intra-operative hypotension (OR 1.84, 95% CI
1.31 to 2.59; P value = 0.0005). Authors' conclusions: This meta-analysis
currently offers no clear evidence that perioperative beta-adrenergic
blockade reduces postoperative cardiac morbidity and mortality in people
undergoing major non-cardiac vascular surgery. There is evidence that
intra-operative bradycardia and hypotension are more likely in people
taking perioperative beta-adrenergic blockers, which should be weighed
with any benefit.<br/>Copyright &#xa9; 2015 The Cochrane Collaboration.
Published by John Wiley & Sons, Ltd.

<64>
Accession Number
616556827
Author
Zakaria D.; Rettiganti M.; Gossett J.M.; Gupta P.
Institution
(Zakaria, Gupta) Department of Pediatrics Division of Pediatric Cardiology
University of Arkansas for Medical Sciences Little Rock, AR USA
(Rettiganti, Gossett) Biostatistics Program Department of Pediatrics
University of Arkansas for Medical Sciences Little Rock, AR USA
Title
Factors associated with early extubation after superior cavopulmonary
connection: Analysis from single ventricle reconstruction trial.
Source
Acta Anaesthesiologica Scandinavica. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: To evaluate the landscape of early extubation, and identify
factors associated with early extubation (<= 24 h) after superior
cavopulmonary connection (stage 2 operation) among children with single
ventricle anatomy. Methods: Patients undergoing stage 2 operation after
Norwood operation from the Pediatric Heart Network Single Ventricle
Reconstruction (SVR) trial public-use dataset were included. Elastic net
regularized logistic regression models were fitted to evaluate the factors
associated with early extubation after stage 2 operation. Results: In
total, 390 patients from 15 North American centers qualified for
inclusion. Of these, 42 patients (10.8%) were extubated in operating room,
151 patients (38.7%) were extubated outside the operating room within the
first 24 h after stage 2 operation, and the remaining 197 patients (50.5%)
required mechanical ventilation for > 24 h. In adjusted models, factors
associated with early extubation after stage 2 operation were elective
timing of stage 2 operation, lower incidence of post-Norwood
complications, shorter CPB duration for stage 2 operation, and no cardiac
catheterization after Stage 2 operation. We also performed multiple other
alternative analyses to identify factors associated with early extubation
that demonstrated same associations as the primary model. The mean
hospital length of stay after Stage 2 operation was 20% shorter among
patients with early extubation. Conclusions: Data from this large
multicenter study demonstrate that approximately one-half of the patients
undergoing operation for superior cavopulmonary connection are extubated
within 24 h after heart operation. Furthermore, early extubation is
associated with shorter hospital length of stay.<br/>Copyright &#xa9; 2017
The Acta Anaesthesiologica Scandinavica Foundation.

<65>
Accession Number
616556363
Author
Rodes-Cabau J.; Masson J.-B.; Welsh R.C.; Garcia del Blanco B.; Pelletier
M.; Webb J.G.; Al-Qoofi F.; Genereux P.; Maluenda G.; Thoenes M.; Paradis
J.-M.; Chamandi C.; Serra V.; Dumont E.; Cote M.
Institution
(Rodes-Cabau, Paradis, Chamandi, Dumont, Cote) Quebec Heart and Lung
Institute, Laval University, Quebec City, Quebec, Canada
(Masson) Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec,
Canada
(Welsh) Mazankowski Alberta Heart Institute and University of Alberta,
Edmonton, Alberta, Canada
(Garcia del Blanco, Serra) Hospital Universitari Vall d'Hebron, Barcelona,
Spain
(Pelletier) Saint John's Regional Hospital, Saint John, New Brunswick,
Canada
(Webb) St. Paul's Hospital, Vancouver, British Columbia, Canada
(Al-Qoofi) Foothills Hospital, Calgary, Alberta, Canada
(Genereux) Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
(Maluenda) Hospital San Borja Arriaran, Santiago de Chile, Chile
(Thoenes) Leman Research Institute, Geneva, Switzerland
Title
Aspirin Versus Aspirin Plus Clopidogrel as Antithrombotic Treatment
Following Transcatheter Aortic Valve Replacement With a Balloon-Expandable
Valve. The ARTE (Aspirin Versus Aspirin + Clopidogrel Following
Transcatheter Aortic Valve Implantation) Randomized Clinical Trial.
Source
JACC: Cardiovascular Interventions. (no pagination), 2017. Date of
Publication: April 10, 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective: The aim of this study was to compare aspirin plus clopidogrel
with aspirin alone as antithrombotic treatment following transcatheter
aortic valve replacement (TAVR) for the prevention of ischemic events,
bleeding events, and death. Background: Few data exist on the optimal
antithrombotic therapy following TAVR. Methods: This was a randomized
controlled trial comparing aspirin (80 to 100 mg/day) plus clopidogrel (75
mg/day) (dual-antiplatelet therapy [DAPT]) versus aspirin alone
(single-antiplatelet therapy [SAPT]) in patients undergoing TAVR with a
balloon-expandable valve. The primary endpoint was the occurrence of
death, myocardial infarction (MI), stroke or transient ischemic attack, or
major or life-threatening bleeding (according to Valve Academic Research
Consortium 2 definitions) within the 3 months following the procedure. The
trial was prematurely stopped after the inclusion of 74% of the planned
study population. Results: A total of 222 patients were included, 111
allocated to DAPT and 111 to SAPT. The composite of death, MI, stroke or
transient ischemic attack, or major or life-threatening bleeding tended to
occur more frequently in the DAPT group (15.3% vs. 7.2%, p = 0.065). There
were no differences between groups in the occurrence of death (DAPT, 6.3%;
SAPT, 3.6%; p = 0.37), MI (DAPT, 3.6%; SAT, 0.9%; p = 0.18), or stroke or
transient ischemic attack (DAPT, 2.7%; SAPT, 0.9%; p = 0.31) at 3 months.
DAPT was associated with a higher rate of major or life-threatening
bleeding events (10.8% vs. 3.6% in the SAPT group, p = 0.038). There were
no differences between groups in valve hemodynamic status post-TAVR.
Conclusions: This small trial showed that SAPT (vs. DAPT) tended to reduce
the occurrence of major adverse events following TAVR. SAPT reduced the
risk for major or life-threatening events while not increasing the risk
for MI or stroke. Larger studies are needed to confirm these results.
(Aspirin Versus Aspirin + Clopidogrel Following Transcatheter Aortic Valve
Implantation: The ARTE Trial [ARTE], NCT01559298; Aspirin Versus
Aspirin+Clopidogrel as Antithrombotic Treatment Following TAVI [ARTE],
NCT02640794).<br/>Copyright &#xa9; 2017 American College of Cardiology
Foundation.

<66>
Accession Number
616541696
Author
Avidan M.S.; Maybrier H.R.; Abdallah A.B.; Jacobsohn E.; Vlisides P.E.;
Pryor K.O.; Veselis R.A.; Grocott H.P.; Emmert D.A.; Rogers E.M.; Downey
R.J.; Yulico H.; Noh G.-J.; Lee Y.H.; Waszynski C.M.; Arya V.K.; Pagel
P.S.; Hudetz J.A.; Muench M.R.; Fritz B.A.; Waberski W.; Inouye S.K.;
Mashour G.A.
Institution
(Avidan, Maybrier, Abdallah, Emmert, Muench, Fritz) Department of
Anesthesiology, Washington University School of Medicine, Saint Louis, MO,
USA
(Jacobsohn) Department of Anesthesiology and Department of Internal
Medicine, University of Manitoba, Winnipeg, MB, Canada
(Grocott) Department of Anesthesia and Perioperative Medicine, University
of Manitoba, Winnipeg, MB, Canada
(Vlisides, Mashour) Department of Anesthesiology, University of Michigan,
Ann Arbor, MI, USA
(Pryor, Rogers) Department of Anesthesiology, Weill Cornell Medicine, New
York City, NY, US
(Veselis) Department of Neuroanesthesiology, Memorial Sloan Kettering
Cancer Center, New York City, NY, USA
(Downey) Department of Surgery, Memorial Sloan Kettering Cancer Center,
New York City, NY, USA
(Yulico) Department of Anesthesiology, Memorial Sloan Kettering Cancer
Center, New York City, NY, USA
(Noh, Lee) Department of Anesthesiology, Asan Medical Center, Seoul, South
Korea
(Waszynski) Department of Medicine, Hartford Hospital, Hartford, CT, USA
(Arya) Department of Anaesthesiology and Intensive Care, Postgraduate
Institute of Medical Education and Research, Chandigarh, India
(Pagel, Hudetz) Department of Anesthesiology, Medical College of
Wisconsin, Milwaukee, WI, USA
(Waberski) Department of Anesthesiology, Hartford Hospital, Hartford,
Connecticut, USA
(Inouye) Department of Medicine, Beth Israel Deaconess Medical Center,
Harvard Medical School, and Institute for Aging Research, Hebrew
SeniorLife, Boston, MA, USA
Title
Intraoperative ketamine for prevention of postoperative delirium or pain
after major surgery in older adults: An international, multicentre,
double-blind, randomised clinical trial.
Source
The Lancet. (no pagination), 2017. Date of Publication: 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Delirium is a common and serious postoperative complication.
Subanaesthetic ketamine is often administered intraoperatively for
postoperative analgesia, and some evidence suggests that ketamine prevents
delirium. The primary purpose of this trial was to assess the
effectiveness of ketamine for prevention of postoperative delirium in
older adults. Methods: The Prevention of Delirium and Complications
Associated with Surgical Treatments [PODCAST] study is a multicentre,
international randomised trial that enrolled adults older than 60 years
undergoing major cardiac and non-cardiac surgery under general
anaesthesia. Using a computer-generated randomisation sequence we randomly
assigned patients to one of three groups in blocks of 15 to receive
placebo (normal saline), low-dose ketamine (0.5 mg/kg), or high dose
ketamine (1.0 mg/kg) after induction of anaesthesia, before surgical
incision. Participants, clinicians, and investigators were blinded to
group assignment. Delirium was assessed twice daily in the first 3
postoperative days using the Confusion Assessment Method. We did analyses
by intention-to-treat and assessed adverse events. This trial is
registered with clinicaltrials.gov, number NCT01690988. Findings: Between
Feb 6, 2014, and June 26, 2016, 1360 patients were assessed, and 672 were
randomly assigned, with 222 in the placebo group, 227 in the 0.5 mg/kg
ketamine group, and 223 in the 1.0 mg/kg ketamine group. There was no
difference in delirium incidence between patients in the combined ketamine
groups and the placebo group (19.45% vs 19.82%, respectively; absolute
difference 0.36%, 95% CI -6.07 to 7.38, p=0.92). There were more
postoperative hallucinations (p=0.01) and nightmares (p=0.03) with
increasing ketamine doses compared with placebo. Adverse events
(cardiovascular, renal, infectious, gastrointestinal, and bleeding),
whether viewed individually (p value for each >0.40) or collectively
(36.9% in placebo, 39.6% in 0.5 mg/kg ketamine, and 40.8% in 1.0 mg/kg
ketamine groups, p=0.69), did not differ significantly across groups.
Interpretation: A single subanaesthetic dose of ketamine did not decrease
delirium in older adults after major surgery, and might cause harm by
inducing negative experiences. Funding: National Institutes of Health and
Cancer Center Support.<br/>Copyright &#xa9; 2017 Elsevier Ltd.

<67>
Accession Number
616540448
Author
Stavrakis S.; Humphrey M.B.; Scherlag B.; Iftikhar O.; Parwani P.; Abbas
M.; Filiberti A.; Fleming C.; Hu Y.; Garabelli P.; McUnu A.; Peyton M.; Po
S.S.
Institution
(Stavrakis, Humphrey, Scherlag, Iftikhar, Parwani, Abbas, Filiberti,
Fleming, Hu, Garabelli, McUnu, Peyton, Po) Heart Rhythm Institute,
University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
Title
Low-Level Vagus Nerve Stimulation Suppresses Post-Operative Atrial
Fibrillation and Inflammation. A Randomized Study.
Source
JACC: Clinical Electrophysiology. (no pagination), 2017. Date of
Publication: January 19, 2017.
Publisher
Elsevier Inc
Abstract
Objectives: This study sought to examine the efficacy of low-level vagus
nerve stimulation (LLVNS) in suppressing post-operative atrial
fibrillation (POAF) and inflammatory cytokines in patients undergoing
cardiac surgery. Background: POAF often complicates cardiac surgery.
Methods: Patients undergoing cardiac surgery were randomized to active or
sham LLVNS. In all patients, a bipolar wire was sutured to the vagus nerve
pre-ganglionic fibers alongside the lateral aspect of the superior vena
cava. High-frequency (20 Hz) stimulation, 50% below the threshold for
slowing the heart rate, was delivered for 72 h in the LLVNS group. The
development of POAF was monitored continuously during the entire hospital
stay by use of telemetry. Blood was collected on arrival in the intensive
care unit and at 24 and 72 h for measurement of inflammatory cytokines.
Patients were followed up within 1 month after cardiac surgery. Results: A
total of 54 patients were randomized to either active LLVNS (n = 26) or
sham control (n = 28). The baseline characteristics of the patients were
balanced in the 2 groups. POAF occurred in 3 patients (12%) in the LLVNS
group and 10 patients (36%) in the control group (hazard ratio: 0.28; 95%
confidence interval: 0.10 to 0.85; p = 0.027). None of the patients
developed any complications as a result of wire placement. At 72 h, serum
tumor necrosis factor-alpha and interleukin-6 levels were significantly
lower in the LLVNS group than in the control group. Conclusions: These
data suggest that LLVNS suppresses POAF and attenuates inflammation in
patients undergoing cardiac surgery. Further studies are
warranted.<br/>Copyright &#xa9; 2017 American College of Cardiology
Foundation.

<68>
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.

<69>
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.

<70>
Accession Number
615342823
Author
Takagi H.; Ando T.; Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Title
A meta-analysis of effects of transcatheter versus surgical aortic valve
replacement on left ventricular ejection fraction and mass.
Source
International Journal of Cardiology. 238 (pp 31-36), 2017. Date of
Publication: 01 Jul 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives To determine which procedure, transcatheter aortic valve
implantation (TAVI) or surgical aortic valve replacement (SAVR), for
severe aortic stenosis (AS) improves follow-up left ventricular (LV)
function or hypertrophy more effectively, we performed the first
meta-analysis of comparative studies reporting LV ejection fraction (LVEF)
or mass (LVM) after TAVI versus SAVR. Methods Studies considered for
inclusion met the following criteria: the article was written in English;
the design was a comparative study; the study population was patients with
severe AS; patients were assigned to TAVI versus SAVR; and outcomes
included follow-up (6-12-month) LVEF or LVM. For each study, data
regarding fractional changes in LVEF or LVM in both the TAVI and SAVR
groups were used to generate mean differences (MDs) and 95% confidence
intervals (CIs). Results Our search identified 8 eligible studies. Two
studies with baseline LVEF < 40% demonstrated significantly greater
fractional changes in LVEF after TAVI than after SAVR. A pooled analysis
of 6 studies demonstrated no statistically significant difference in
fractional changes in LVEF between TAVI and SAVR (MD, 3.25%; 95% CI,
-1.30% to 7.80%; p = 0.16). Another pooled analysis of 5 studies
demonstrated significantly greater fractional changes (i.e. less
fractional "reductions") in LVM after TAVI than after SAVR (MD, 4.75%; 95%
CI, 2.18% to 7.32%; p = 0.0003). Conclusions For patients with severe AS,
SAVR may be associated with greater improvement in LVM, probably not in
LVEF, at 6-12 months. For limited patients with reduced LVEF, TAVI might
be associated with greater improvement in LVEF.<br/>Copyright &#xa9; 2017
Elsevier B.V.

<71>
Accession Number
616474436
Author
Palmisano P.; Aspromonte V.; Ammendola E.; Dell'era G.; Ziacchi M.; Guerra
F.; Aquilani S.; Maglia G.; Del Giorno G.; Giubertoni A.; Boriani G.;
Capucci A.; Ricci R.P.; Accogli M.
Institution
(Palmisano, Accogli) Cardiology Unit, 'Card. G. Panico' Hospital, Via S.
Pio X, 4, Tricase 73039, Italy
(Aspromonte, Maglia) Cardiology - Coronary Care Unit, Pugliese-Ciaccio
Hospital, Catanzaro, Italy
(Ammendola, Del Giorno) Department of Cardiology, Monaldi Hospital, Second
University of Naples, Naples, Italy
(Dell'era, Giubertoni) Division of Cardiology, University of Eastern
Piedmont, Maggiore della Carita Hospital, Novara, Italy
(Ziacchi, Boriani) Institute of Cardiology, University of Bologna, S.
Orsola-Malpighi University Hospital, Bologna, Italy
(Guerra, Capucci) Cardiology and Arrhythmology Clinic, Marche Polytechnic
University, University Hospital 'Umberto I - Lancisi - Salesi', Ancona,
Italy
(Aquilani, Ricci) Department of Cardiology, San Filippo Neri Hospital,
Rome, Italy
(Boriani) Cardiology Department, University of Modena and Reggio Emilia,
Policlinico di Modena, Modena, Italy
Title
Effect of fixed-rate vs. Rate-RESPONSIve pacing on exercise capacity in
patients with permanent, refractory atrial fibrillation and left
ventricular dysfunction treated with atrioventricular junction aBLation
and bivEntricular pacing (RESPONSIBLE): A prospective, multicentre,
randomized, single-blind study.
Source
Europace. 19 (3) (pp 414-420), 2017. Date of Publication: 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims: Atrioventricular junction (AVJ) ablation followed by biventricular
pacing is an established strategy for improving symptoms and morbidity in
patients with permanent atrial fibrillation (AF), reduced left ventricular
ejection fraction (LVEF), and uncontrolled ventricular rate. There is no
clear evidence that such patients benefit from rate-responsive (RR)
pacing. Methods and results: This prospective, randomized, single-blind,
multicentre study was designed as an intra-patient comparison and enrolled
60 patients (age 69.5 +/- 11.8 years, males 63.3%, NYHA 3.0 +/-0.6) with
refractory AF and reduced LVEF (mean 32.4+/-8.3%) treated with AVJ
ablation and biventricular pacing. Two 6-minute walking tests (6MWT) were
performed 1 week apart: one during VVI 70/min biventricular pacing and the
other during VVIR 70-130/min biventricular pacing; patients were randomly
and blindly assigned to Group A (n = 29, first 6MWT in VVIR mode) or B (n
= 31, first 6MWT in VVI mode). Rate-responsive activation determined an
increase of 18.8+/-24.4 m in the distance walked during the 6MWT (P <
0.001). The increase was similar in both groups (P = 0.571). A >5%
increase in the distance walked was observed in 76.7% of patients. The
increase in the distance walked was linearly correlated with the increase
in heart rate recorded during the 6MWT in the VVIR mode (r = 0.54; P <
0.001). Conclusion: In permanent AF patients with uncontrolled rate and
reduced LVEF who had undergone AVJ ablation and biventricular pacing, RR
pacing yields a significant gain in exercise capacity, which seems to be
related to the RR-induced frequency during effort.<br/>Copyright &#xa9;
The Author 2016.

<72>
Accession Number
616527419
Author
Steinberg Z.L.; Dominguez-Islas C.P.; Otto C.M.; Stout K.K.; Krieger E.V.
Institution
(Steinberg, Otto, Stout, Krieger) Division of Cardiology, Department of
Medicine, University of Washington School of Medicine, Seattle,
Washington, United States
(Dominguez-Islas) Medical Research Council Biostatistics Unit, School of
Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
Title
Maternal and Fetal Outcomes of Anticoagulation in Pregnant Women With
Mechanical Heart Valves.
Source
Journal of the American College of Cardiology. 69 (22) (pp 2681-2691),
2017. Date of Publication: 06 Jun 2017.
Publisher
Elsevier USA
Abstract
Background Anticoagulation for mechanical heart valves during pregnancy is
essential to prevent thromboembolic events. Each regimen has drawbacks
with regard to maternal or fetal risk. Objectives This meta-analysis
sought to estimate and compare the risk of adverse maternal and fetal
outcomes in pregnant women with mechanical heart valves who received
different methods of anticoagulation. Methods Studies were identified
using a Medline search including all publications up to June 5, 2016.
Study inclusion required reporting of maternal death, thromboembolism, and
valve failure, and/or fetal spontaneous abortion, death, and congenital
defects in pregnant women treated with any of the following: 1) a vitamin
K antagonist (VKA) throughout pregnancy; 2) low-molecular-weight heparin
(LMWH) throughout pregnancy; 3) LMWH for the first trimester, followed by
a VKA (LMWH and VKA); or 4) unfractionated heparin for the first
trimester, followed by a VKA (UFH and VKA). Results A total of 800
pregnancies from 18 publications were included. Composite maternal risk
was lowest with VKA (5%), compared with LMWH (16%; ratio of averaged risk
[RAR]: 3.2; 95% confidence interval [CI]: 1.5 to 7.5), LMWH and VKA (16%;
RAR: 3.1; 95% CI: 1.2 to 7.5), or UFH and VKA (16%; RAR: 3.1; 95% CI: 1.5
to 7.1). Composite fetal risk was lowest with LMWH (13%; RAR: 0.3; 95% CI:
0.1 to 0.8), compared with VKA (39%), LMWH and VKA (23%), or UFH and VKA
(34%). No significant difference in fetal risk was observed between women
taking <=5 mg daily warfarin and those with an LMWH regimen (RAR: 0.9; 95%
CI: 0.3 to 2.4). Conclusions VKA treatment was associated with the lowest
risk of adverse maternal outcomes, whereas the use of LMWH throughout
pregnancy was associated with the lowest risk of adverse fetal outcomes.
Fetal risk was similar between women taking <=5 mg warfarin daily and
women treated with LMWH.<br/>Copyright &#xa9; 2017 The Authors

<73>
Accession Number
616527394
Author
Atz A.M.; Zak V.; Mahony L.; Uzark K.; D'agincourt N.; Goldberg D.J.;
Williams R.V.; Breitbart R.E.; Colan S.D.; Burns K.M.; Margossian R.;
Henderson H.T.; Korsin R.; Marino B.S.; Daniels K.; McCrindle B.W.
Institution
(Atz) Medical University of South Carolina, Charleston, South Carolina,
United States
(Zak, D'agincourt) New England Research Institutes, Watertown,
Massachusetts, United States
(Mahony) University of Texas Southwestern Medical Center, Dallas, Texas,
United States
(Uzark) University of Michigan, Ann Arbor, Michigan, United States
(Goldberg) Children's Hospital of Philadelphia, Philadelphia,
Pennsylvania, United States
(Williams, Daniels) University of Utah, Salt Lake City, Utah, United
States
(Breitbart, Colan, Margossian) Boston Children's Hospital, Boston,
Massachusetts, United States
(Burns) National Heart, Lung, and Blood Institute, Bethesda, Maryland,
United States
(Henderson) Duke University Medical Center, Durham, North Carolina, United
States
(Korsin) Columbia University Medical Center, New York, New York, United
States
(Marino) Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio,
United States
(McCrindle) University of Toronto, The Hospital for Sick Children,
Toronto, Ontario, Canada
Title
Longitudinal Outcomes of Patients With Single Ventricle After the Fontan
Procedure.
Source
Journal of the American College of Cardiology. 69 (22) (pp 2735-2744),
2017. Date of Publication: 06 Jun 2017.
Publisher
Elsevier USA
Abstract
Background Multicenter longitudinal objective data for survival into
adulthood of patients who have undergone Fontan procedures are lacking.
Objectives This study sought to describe transplant-free survival and
explore relationships between laboratory measures of ventricular
performance and functional status over time. Methods Exercise testing,
echocardiography, B-type natriuretic peptide, functional health
assessment, and medical history abstraction were repeated 9.4 +/- 0.4
years after the Fontan Cross-Sectional Study (Fontan 1) and compared with
previous values. Cox regression analysis explored risk factors for interim
death or cardiac transplantation. Results From the original cohort of 546
subjects, 466 were contacted again, and 373 (80%) were enrolled at 21.2
+/- 3.5 years of age. Among subjects with paired testing, the percent
predicted maximum oxygen uptake decreased (69 +/- 14% vs. 61 +/- 16%; p <
0.001; n = 95), ejection fraction decreased (58 +/- 11% vs. 55 +/- 10%; p
< 0.001; n = 259), and B-type natriuretic peptide increased (median
[interquartile range] 13 [7 to 25] pg/mol vs. 18 [9 to 36] pg/mol; p <
0.001; n = 340). At latest follow-up, a lower Pediatric Quality of Life
Inventory physical summary score was associated with poorer exercise
performance (R² adjusted = 0.20; p < 0.001; n = 274).
Cumulative complications since the Fontan procedure included additional
cardiac surgery (32%), catheter intervention (62%), arrhythmia treatment
(32%), thrombosis (12%), and protein-losing enteropathy (8%). Since Fontan
1, 54 subjects (10%) have received a heart transplant (n = 23) or died
without transplantation (n = 31). The interval risk of death or/cardiac
transplantation was associated with poorer ventricular performance and
functional health status assessed at Fontan 1, but it was not associated
with ventricular morphology, the subject's age, or the type of Fontan
connection. Conclusions Interim transplant-free survival over 12 years in
this Fontan cohort was 90% and was independent of ventricular morphology.
Exercise performance decreased and was associated with worse functional
health status. Future interventions might focus on preserving exercise
capacity. (Relationship Between Functional Health Status and Ventricular
Performance After Fontan-Pediatric Heart Network;
NCT00132782)<br/>Copyright &#xa9; 2017 American College of Cardiology
Foundation

<74>
Accession Number
616478038
Author
Landoni G.; Lomivorotov V.; Pisano A.; Nigro Neto C.; Benedetto U.; Biondi
Zoccai G.; Gemma M.; Frassoni S.; Agro F.E.; Baiocchi M.; Barbosa Gomes
Galas F.R.; Bautin A.; Bradic N.; Carollo C.; Crescenzi G.; Elnakera A.M.;
El-Tahan M.R.; Fominskiy E.; Farag A.G.; Gazivoda G.; Gianni S.; Grigoryev
E.; Guarracino F.; Hanafi S.; Huang W.; Kunst G.; Kunstyr J.; Lei C.;
Lembo R.; Li Z.-J.; Likhvantsev V.; Lozovskiy A.; Ma J.; Monaco F.;
Navalesi P.; Nazar B.; Pasyuga V.; Porteri E.; Royse C.; Ruggeri L.; Riha
H.; Santos Silva F.; Severi L.; Shmyrev V.; Uvaliev N.; Wang C.B.; Wang
C.-Y.; Winterton D.; Yong C.-Y.; Yu J.; Bellomo R.; Zangrillo A.
Institution
(Landoni, Gemma, Frassoni, Gianni, Lembo, Monaco, Ruggeri, Winterton,
Zangrillo) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Via Olgettina 60, Milan 20132, Italy
(Lomivorotov, Shmyrev) Siberian Biomedical Research Center, Department of
Anesthesiology and Intensive Care, Novosibirsk, Russian Federation
(Pisano) Cardiac Anesthesia and Intensive Care Unit, Monaldi Hospital
A.O.R.N. "Dei Colli", Via L. Bianchi Naples 80131, Italy
(Nigro Neto) Anesthesia Section of Cardiothoracic Surgery, Dante Pazzanese
Institute of Cardiology, Sao Paulo, Brazil
(Benedetto) University of Bristol, School of Clinical Sciences, Bristol
Heart Institute, Bristol, United Kingdom
(Biondi Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Agro) Anaesthesia, Intensive Care and Pain Management Department,
University School of Medicine Campus Bio-Medico, Rome, Italy
(Baiocchi) Anesthesia and Intensive Care, S. Orsola-Malpighi University
Hospital, Bologna, Italy
(Barbosa Gomes Galas) Anesthesia and Intensive care, Heart Institute,
University of Sao Paulo, Sao Paulo, Brazil
(Bautin) Department of Anesthesiology and Intensive Care, Federal Almazov
North-West Medical Research Centre, Saint-Petersburg, Russian Federation
(Bradic) Department of Cardiovascular Anesthesiology and Cardiac Intensive
Medicine, University Hospital Dubrava, Zagreb, Croatia
(Carollo) Department of Medicine, Anesthesia and Intensive Care Unit,
Padova University Hospital, Via Cesare Battisti 256, Padova 35128, Italy
(Crescenzi) Anestesia e Terapia Intensiva Cardiochirurgica, Humanitas
Research Hospital, Rozzano, Italy
(Elnakera) Anesthesia and Intensive Care, Faculty of Medicine, Zagazig
University, Zagazig, Egypt
(El-Tahan) Cardiothoracic Anaesthesia & Surgical Intensive Care, King Fahd
Hospital, University of Dammam, Al Khobar, Saudi Arabia
(Fominskiy) Department of Anaesthesia and Intensive Care, Siberian
Biomedical Research Center of the Ministry of Health, Novosibirsk, Russian
Federation
(Farag) Department of Anaesthesia and Intensive Care, King Abdullah
Medical City in Holy Capital "KAMC-HC", Makkah, Saudi Arabia
(Gazivoda) Department of Anesthesiology and Intensive Care, Cardiovascular
Institute `Dedinje`, Belgrade, Serbia
(Grigoryev) Deputy Director for Clinical and Scientific Affairs,
Scientific Research Institute of Complex Issues of Cardiovascular Disease,
Kemerovo, Russian Federation
(Guarracino) Department of Anaesthesia and Critical Care Medicine, Azienda
Ospedaliero-Universitaria Pisana, Via Paradisa 2, Pisa 56123, Italy
(Hanafi) Department of Anaesthesiology and Intensive Care, Sarawak General
Hospital, Kuching, Sarawak, Malaysia
(Huang) Department of Anesthesiology, Wuhan Asia Heart Hospital, Wuhan,
China
(Kunst) Department of Anaesthetics, King's College Hospital NHS Foundation
Trust, London, United Kingdom
(Kunstyr) Department of Anesthesiology and Intensive Care, First Faculty
of Medicine, General University Hospital in Prague, Prague, Czech Republic
(Lei) Department of Anesthesiology and Perioperative Medicine, 1st
Affiliative Hospital (Xijing Hospital), Fourth Military Medical
University, Xi'an, China
(Li) Department of Anesthesiology, The Second Xiangya Hospital of Central
South University, Changsha, China
(Likhvantsev) Anesthesiology and Intensive Care Department, Moscow
Clinical Regional Research Institute, Shepkina st., 61/2, Moscow, Russian
Federation
(Lozovskiy) Department of Anesthesiology and Intensive Care, Ural
Institute of Cardiology, Ekaterinburg, Russian Federation
(Ma, Wang) Center for Anesthesiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
(Navalesi) Anesthesia and Intensive Care, Dipartimento Scienze Mediche e
Chirurgiche, Universita della Magna Graecia, Catanzaro, Italy
(Nazar) Cardiothoracic ICU and Anaesthesia, MKCC, West Riffa, Bahrain
(Pasyuga) Department of Cardiac Aneasthesia and Intensive Care, Astrakhan
Federal Centre for Cardiac Surgery, Astrakhan, Russian Federation
(Porteri) Dipartimento Cardiotoracico, Azienda Ospedaliera Spedali Civili,
Brescia, Italy
(Royse) Department of Surgery, The University of Melbourne, Level 6
Clinical Medical Research Building, Melbourne, Australia
(Riha) Cardiothoracic Anesthesiology and Intensive Care, Institute for
Clinical and Experimental Medicine, Prague, Czech Republic
(Santos Silva) Anesthetic Department, Hospital de Santa Maria, Lisboa,
Portugal
(Severi) Anesthesia and Intensive Care, Azienda Ospedaliera San Camillo
Forlanini, Roma, Italy
(Uvaliev) Department-Anesthesia and Intensive Care, ACIBADEM City Clinic
Burgas, Burgas, Bulgaria
(Wang) Anaesthesia and Intensive Care, University of Malaya, Kuala Lumpur,
Malaysia
(Yong) Anaesthesia and Intensive Care, Hospital Pulau Pinang, Georgetown,
Malaysia
(Yu) Department of Anesthesiology, Qilu Hospital of Shandong University,
Shandong, China
(Bellomo) The University of Melbourne, Melbourne, Victoria, Australia
(Biondi Zoccai) Department of AngioCardioNeurology, IRCCS Neuromed,
Pozzilli, Italy
Title
MortalitY in caRdIAc surgery (MYRIAD): A randomizeD controlled trial of
volatile anesthetics. Rationale and design.
Source
Contemporary Clinical Trials. 59 (pp 38-43), 2017. Date of Publication:
August 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective There is initial evidence that the use of volatile anesthetics
can reduce the postoperative release of cardiac troponin I, the need for
inotropic support, and the number of patients requiring prolonged
hospitalization following coronary artery bypass graft (CABG) surgery.
Nevertheless, small randomized controlled trials have failed to
demonstrate a survival advantage. Thus, whether volatile anesthetics
improve the postoperative outcome of cardiac surgical patients remains
uncertain. An adequately powered randomized controlled trial appears
desirable. Design Single blinded, international, multicenter randomized
controlled trial with 1:1 allocation ratio. Setting Tertiary and
University hospitals. Interventions Patients (n = 10,600) undergoing
coronary artery bypass graft will be randomized to receive either volatile
anesthetic as part of the anesthetic plan, or total intravenous
anesthesia. Measurements and main results The primary end point of the
study will be one-year mortality (any cause). Secondary endpoints will be
30-day mortality; 30-day death or non-fatal myocardial infarction
(composite endpoint); cardiac mortality at 30 day and at one year;
incidence of hospital re-admission during the one year follow-up period
and duration of intensive care unit, and hospital stay. The sample size is
based on the hypothesis that volatile anesthetics will reduce 1-year
unadjusted mortality from 3% to 2%, using a two-sided alpha error of 0.05,
and a power of 0.9. Conclusions The trial will determine whether the
simple intervention of adding a volatile anesthetic, an intervention that
can be implemented by all anesthesiologists, can improve one-year survival
in patients undergoing coronary artery bypass graft surgery.<br/>Copyright
&#xa9; 2017 Elsevier Inc.

<75>
Accession Number
607326472
Author
Sher-i-Murtaza M.; Rizvi H.M.F.A.; Baig M.A.R.; Hamid W.; Zaman H.
Institution
(Sher-i-Murtaza, Rizvi, Baig, Hamid, Zaman) Department of Cardiac Surgery,
Chaudary Pervaiz Elahi Institute of Cardiology, Multan, Pakistan
Title
Myocardial protection with multiport antegrade cold blood cardioplegia and
continuous controlled warm shot through vein grafts during proximal ends
anastomosis in conventional coronary artery bypass graft.
Source
Journal of the Pakistan Medical Association. 66 (1) (pp 53-58), 2016. Date
of Publication: January 2016.
Publisher
Pakistan Medical Association
Abstract
Objective: To evaluate the benefits of simultaneous aortic root and vein
graft cold blood cardioplegia and continuous controlled warm blood
perfusion through vein grafts during proximal aortocoronary anastomosis in
conventional coronary artery bypass graft surgery in patients with
multi-vessel coronary artery disease. Methods: The prospective randomised
study was conducted at Chaudary Pervaiz Elahi Institute of Cardiology,
Multan, Pakistan, from April 2013 to June 2014, and comprised patients of
isolated conventional coronary artery bypass graft surgery. The patients
were randomised into 2 groups; Group I had patients in whom multiperfusion
set was used for cardioplegia and continuous warm blood perfusion through
vein grafts during proximal ends anastomosis, and Group II had patients in
whom routine aortic root antegrade cardioplegia was used with no warm
blood perfusion during proximal anastomosis of vein grafts. Data was
analysed using SPSS 20. Results: There were 434 patients in the study,
with Group 1 having 215(49.5%) being the study group, and Group II having
219(50.5%)being the Control group. The groups showed no significant
difference in the number of grafts, and aortic cross-clamp time (p>0.05
each). Total bypass time was significantly prolonged in the Control Group
(p=0.001). Incidence of intra-operative arrhythmias,
peri-operativemyocardial infarction, need for inotropic support and
intra-aortic balloon counter-pulsation and operative mortality were
significantly higher in the Control group (p<0.05 each). Conclusions:
Simultaneous aortic root and vein graft cold blood cardioplegia and
continuous controlled warm blood perfusion was beneficial for myocardial
protection and early patient outcome.<br/>Copyright &#xa9; 2016, Pakistan
Medical Association. All rights reserved.

<76>
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.

<77>
Accession Number
616310257
Author
Lincoff A.M.; Nicholls S.J.; Riesmeyer J.S.; Barter P.J.; Brewer H.B.; Fox
K.A.A.; Gibson C.M.; Granger C.; Menon V.; Montalescot G.; Rader D.; Tall
A.R.; McErlean E.; Wolski K.; Ruotolo G.; Vangerow B.; Weerakkody G.;
Goodman S.G.; Conde D.; McGuire D.K.; Nicolau J.C.; Leiva-Pons J.L.;
Pesant Y.; Li W.; Kandath D.; Kouz S.; Tahirkheli N.; Mason D.; Nissen
S.E.
Institution
(Lincoff, Menon, McErlean, Wolski, Mason, Nissen) Cleveland Clinic
Coordinating Center for Clinical Research (C5Research), Department of
Cardiovascular Medicine, Cleveland Clinic, Cleveland, QLD, Australia
(Nicholls) South Australian Heart and Medical Research Institute,
University of Adelaide, Adelaide, SA, Australia
(Barter) School of Medical Sciences, University of New South Wales,
Sydney, NSW, Australia
(Riesmeyer, Ruotolo, Vangerow, Weerakkody) Eli Lilly, Indianapolis, IN,
United States
(Brewer) Washington Cardiovascular Associates, Medstar Research Institute,
Washington, DC, United States
(Fox) Centre for Cardiovascular Science, University of Edinburgh,
Edinburgh, United Kingdom
(Gibson) Beth Israel Deaconess Medical Center, Boston, United States
(Granger) Duke University Medical Center, Durham, NC, United States
(Montalescot) Universite Sorbonne Paris 6, ACTION Study Group, Hopital
Pitie-Salpetriere, Assistance Publique-Hopitaux de Paris, Institut de
Cardiologie, Paris, France
(Rader) Penn Heart and Vascular Center, Philadelphia, United States
(Tall) Columbia University, New York, NY, United States
(Kandath) Saratoga Cardiology Associates, Saratoga Springs, NY, United
States
(Goodman) St. Michael's Hospital, Toronto, ON, Canada
(Pesant) Recherche Medicale Saint-Jerome, Saint-Jerome, QC, Canada
(Kouz) Centre de Sante et de Services Sociaux du Nord de Lanaudiere-Centre
Hospitalier Regional de Lanaud, Saint-Charles-Borromee, QC, Canada
(Conde) Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
(McGuire) University of Texas Southwestern Medical Center, Dallas, TX,
United States
(Nicolau) Heart Institute (InCor)-University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Leiva-Pons) Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi,
Mexico
(Li) Harbin Medical University, Harbin, China
(Tahirkheli) South Oklahoma Heart Research, Oklahoma City, OK, United
States
Title
Evacetrapib and Cardiovascular Outcomes in High-Risk Vascular Disease.
Source
New England Journal of Medicine. 376 (20) (pp 1933-1942), 2017. Date of
Publication: 18 May 2017.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: The cholesteryl ester transfer protein inhibitor evacetrapib
substantially raises the high-density lipoprotein (HDL) cholesterol level,
reduces the low-density lipoprotein (LDL) cholesterol level, and enhances
cellular cholesterol efflux capacity. We sought to determine the effect of
evacetrapib on major adverse cardiovascular outcomes in patients with
high-risk vascular disease. METHODS: In a multicenter, randomized,
double-blind, placebo-controlled phase 3 trial, we enrolled 12,092
patients who had at least one of the following conditions: an acute
coronary syndrome within the previous 30 to 365 days, cerebrovascular
atherosclerotic disease, peripheral vascular arterial disease, or diabetes
mellitus with coronary artery disease. Patients were randomly assigned to
receive either evacetrapib at a dose of 130 mg or matching placebo,
administered daily, in addition to standard medical therapy. The primary
efficacy end point was the first occurrence of any component of the
composite of death from cardiovascular causes, myocardial infarction,
stroke, coronary revascularization, or hospitalization for unstable
angina. RESULTS: At 3 months, a 31.1% decrease in the mean LDL cholesterol
level was observed with evacetrapib versus a 6.0% increase with placebo,
and a 133.2% increase in the mean HDL cholesterol level was seen with
evacetrapib versus a 1.6% increase with placebo. After 1363 of the planned
1670 primary end-point events had occurred, the data and safety monitoring
board recommended that the trial be terminated early because of a lack of
efficacy. After a median of 26 months of evacetrapib or placebo, a primary
end-point event occurred in 12.9% of the patients in the evacetrapib group
and in 12.8% of those in the placebo group (hazard ratio, 1.01; 95%
confidence interval, 0.91 to 1.11; P = 0.91). CONCLUSIONS: Although the
cholesteryl ester transfer protein inhibitor evacetrapib had favorable
effects on established lipid biomarkers, treatment with evacetrapib did
not result in a lower rate of cardiovascular events than placebo among
patients with high-risk vascular disease.<br/>Copyright &#xa9; 2017
Massachusetts Medical Society.

<78>
Accession Number
616510006
Author
Sun H.; Du B.; Liu X.; Yang S.; Yang P.
Institution
(Sun, Du, Yang) Department of Cardiology, China-Japan Union Hospital of
Jilin University, Changchun, China
(Liu, Yang) Liaquat National Hospital, Institute for Postgraduate Medical
Studies and Health Science, Karachi, Pakistan
Title
Warfarin continuation vs interruption during procedures of cardiac rhythm
devices: A Meta-analysis of randomized controlled trials.
Source
JPMA. The Journal of the Pakistan Medical Association. 66 (4) (pp
458-465), 2016. Date of Publication: 01 Apr 2016.
Abstract
To compare the safetyand efficacy of warfarin treatment continuation and
heparin-bridging therapy during cardiac rhythm device (CRD) implantation
in patients chronically treated with anticoagulants.We performed a search
and analysis of peer-reviewed studies Four randomized controlled trials
(RCTs)were included in our analysis with 941 patients. The bleeding risk
in patients continuing warfarin perioperatively was lower than those
interrupting warfarin and using a heparin-bridge (RD -0.08, 95% CI -0.17
to 0.02, p< 0.05). There was no significant difference in ischaemic risk
between two methods (RD 0, 95% CI -0.01 to 0.02, p=1.00). Hence, in
patients undergoing long-term warfarin therapy, continuation of warfarin
treatment is a safe and efficacious perioperative strategy for during CRD
implantations, while interruption of warfarin with a heparin bridge may
increase the bleeding risk in these patients.

<79>
Accession Number
613116790
Author
Rimac G.; Fearon W.F.; De Bruyne B.; Ikeno F.; Matsuo H.; Piroth Z.;
Costerousse O.; Bertrand O.F.
Institution
(Rimac, Costerousse, Bertrand) Cardiology Department, Quebec Heart-Lung
Institute, Quebec, Quebec, Canada
(Fearon, Ikeno) Stanford University Medical Center, Stanford, CA, United
States
(De Bruyne) Cardiovascular Center Aalst OLV Clinic, Aalst, Belgium
(Matsuo) Department of Cardiovascular Medicine, Gifu Heart Center, Gifu,
Japan
(Piroth) Hungarian Institute of Cardiology, Budapest, Hungary
Title
Clinical value of post-percutaneous coronary intervention fractional flow
reserve value: A systematic review and meta-analysis.
Source
American Heart Journal. 183 (pp 1-9), 2017. Date of Publication: 01 Jan
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Fractional flow reserve (FFR) prior to percutaneous coronary
intervention (PCI) is useful to guide treatment. Whether post-PCI FFR
assessment might have clinical impact is controversial. The aim of this
study is to evaluate the range of post-PCI FFR values and analyze the
relationship between post-PCI FFR and clinical outcomes. Methods We
systematically searched the PubMed, EMBASE, and Cochrane Library databases
with cross-referencing of articles reporting post-PCI FFR and correlating
post-PCI FFR values and clinical outcomes. The outcomes of interest were
the immediate post-PCI FFR values and the correlations between post-PCI
FFR and the incidence of repeat intervention and major adverse cardiac
events (MACE). Results From 1995 to 2015, a total of 105 studies (n =
7470) were included, with 46 studies reporting post-PCI FFR and 59 studies
evaluating relationship between post-PCI and clinical outcomes up to 30
months after PCI. Overall, post-PCI FFR values demonstrated a normal
distribution with a mean value of 0.90 +/- 0.04. There was a positive
correlation between the percentage of stent use and post-PCI FFR (P <
.0001). Meta-regression analysis indicated that higher post-PCI FFR values
were associated with reduced rates of repeat intervention (P < .0001) and
MACE (P = .0013). A post-PCI FFR >=0.90 was associated with significantly
lower risk of repeat PCI (odds ratio 0.43, 95% CI 0.34-0.56, P < .0001)
and MACE (odds ratio 0.71, 95% CI 0.59-0.85, P = .0003). Conclusions FFR
measurement after PCI was associated with prognostic significance. Further
investigation is required to assess the role of post-PCI FFR and validate
cutoff values in contemporary clinical practice.<br/>Copyright &#xa9; 2016

<80>
Accession Number
611108445
Author
Makroo R.N.; Agrawal S.; Chowdhry M.
Institution
(Makroo, Agrawal, Chowdhry) Department of Transfusion Medicine,
Indraprastha Apollo Hospitals, New Delhi, India
Title
Rh and Kell Phenotype Matched Blood Versus Randomly Selected and
Conventionally Cross Matched Blood on Incidence of Alloimmunization.
Source
Indian Journal of Hematology and Blood Transfusion. 33 (2) (pp 264-270),
2017. Date of Publication: 01 Jun 2017.
Publisher
Springer India (E-mail: sanjiv.goswami@springer.co.in)
Abstract
There is paucity of literature regarding efficacy of transfusion of Rh and
Kell matched blood in reducing alloimmunization risk among non-chronically
transfused patients. A prospective study to compare efficacy of Rh and
Kell phenotype matched blood over randomly selected and conventionally
cross-matched blood on the incidence of alloimmunization in patients
undergoing cardiac surgery was carried out in the Department of
Transfusion Medicine at Indraprastha Apollo Hospitals, New Delhi, from 1st
September, 2013 to 31st December, 2014. Two groups, A and B of 250 each
were studied. Group A received ABO, Rh and Kell phenotype matched units.
Group B received units matched only for ABO and Rh D. Retrospective
analysis for antigenic exposures was done. Alloimmunization rate was
evaluated for both groups after 72 h and 4 weeks and compared. A p value
<=0.05 was considered statistically significant. None of the patients in
Group A were alloimmunized. In Group B, 119 patients received antigenic
stimulus (single antigen stimuli- 93; multiple- 26). The probability of a
patient being exposed was 52.4 %. At 6 weeks post transfusion, one patient
developed 'Anti-E' and had received 'E' stimulus once. The rate of
alloimmunization was 0.4 % in group B, 0.8 % overall and the risk of
alloimmunization per unit transfused was 0.17 %. Non responders were 99.16
%. The study did not reach statistical significance (p = 0.238). Majority
of our population are non-responders therefore, the resources and time can
be reserved for providing Rh and Kell matched units for multiply
transfused patients.<br/>Copyright &#xa9; 2016, Indian Society of
Haematology & Transfusion Medicine.

<81>
Accession Number
610617670
Author
Camaro C.; Damen S.A.J.; Brouwer M.A.; Kedhi E.; Lee S.W.; Verdoia M.;
Barbieri L.; Rognoni A.; Van T'Hof A.W.J.; Ligtenberg E.; De Boer M.-J.;
Suryapranata H.; De Luca G.
Institution
(Camaro, Damen, Brouwer, De Boer, Suryapranata) Department of Cardiology,
Radboud University Medical Center, P.O. Box 9101, Nijmegen 6500 HB,
Netherlands
(Kedhi, Van T'Hof) Department of Cardiology, Isala Hospital, Zwolle,
Netherlands
(Lee) Department of Cardiology, University of Hong Kong, Queen Mary
Hospital, Hong Kong
(Verdoia, Barbieri, Rognoni, De Luca) Department of Cardiology, AOU
Maggiore della Carita, Eastern Piedmont University, Novara, Italy
(Ligtenberg) OrbusNeich Medical Inc., Fort Lauderdale, United States
Title
Randomized evaluation of short-term dual antiplatelet therapy in patients
with acute coronary syndrome treated with the COMBO dual therapy stent:
Rationale and design of the REDUCE trial.
Source
American Heart Journal. 178 (pp 37-44), 2016. Date of Publication: 01 Aug
2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background The optimal duration of dual antiplatelet therapy (DAPT) in
acute coronary syndrome (ACS) patients treated with drug eluting stents
(DES) is still under debate. Recent meta-analyses on <=6 months versus 12
months DAPT suggest that bleeding rates can be reduced, without a higher
rate of thrombotic complications. In particular, the COMBO dual therapy
stent, being associated with early re-endothelialization, may allow for a
reduction of the duration of DAPT without increasing the thrombotic risk,
while reducing the risk of bleeding complications. Aim The aim of the
REDUCE trial is to demonstrate the non-inferiority of a combined efficacy
and safety endpoint of a short-term 3 months DAPT strategy as compared to
standard 12-month DAPT strategy in ACS patients treated with the COMBO
stent. Design A prospective, multicenter, randomized study designed to
enroll 1500 patients with ACS treated with the COMBO stent. Patients will
be randomized before discharge in a 1:1 fashion to either 3 or 12 months
of DAPT. A clinical follow-up is scheduled at 3, 6, 12, and 24 months. The
primary endpoint is the time to event as defined by the occurrence of one
of the following: all cause mortality, myocardial infarction, stent
thrombosis, stroke, target vessel revascularization or bleeding (Bleeding
Academic Research Council type II, III and V) within 12 months. The study
has recruited patients since July 2014, and the results are expected in
2017. Summary A reduction of the DAPT duration in ACS patients after PCI
without affecting the thrombotic risk is an attractive option with regard
to the associated bleeding risk. The REDUCE trial will be the first to
investigate the efficacy and safety of a 3-month DAPT strategy compared to
a 12-month DAPT strategy in an ACS only population treated with the COMBO
stent.<br/>Copyright &#xa9; 2016 Elsevier, Inc.

<82>
Accession Number
610461101
Author
Akerblom A.; Clare R.M.; Lokhnygina Y.; Wallentin L.; Held C.; Van De Werf
F.; Moliterno D.J.; Patel U.D.; Leonardi S.; Armstrong P.W.; Harrington
R.A.; White H.D.; Aylward P.E.; Mahaffey K.W.; Tricoci P.
Institution
(Akerblom, Clare, Lokhnygina, Patel, Tricoci) Duke Clinical Research
Institute, Durham, NC, United States
(Akerblom, Wallentin, Held) Department of Medical Sciences, Cardiology,
Uppsala University, Uppsala, Sweden
(Akerblom, Wallentin, Held) Uppsala Clinical Research Center, Uppsala,
Sweden
(Van De Werf) Department of Cardiology, University of Leuven, Leuven,
Belgium
(Moliterno) Gill Heart Institute and Division of Cardiovascular Medicine,
University of Kentucky, Lexington, KY, United States
(Leonardi) Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
(Armstrong) Division of Cardiology, University of Alberta, Edmonton,
Canada
(Harrington, Mahaffey) Department of Medicine, Stanford University,
Stanford, CA, United States
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Aylward) South Australian Health and Medical Research Institute, Flinders
University and Medical Centre, Adelaide, Australia
Title
Albuminuria and cardiovascular events in patients with acute coronary
syndromes: Results from the TRACER trial.
Source
American Heart Journal. 178 (pp 1-8), 2016. Date of Publication: 01 Aug
2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Albuminuria is associated with cardiovascular (CV) outcomes. We
evaluated albuminuria, alone and in combination with estimated glomerular
filtration rate (EGFR), as a predictor of mortality and CV morbidity in
12,944 patients with non-ST-segment elevation acute coronary syndromes.
Methods Baseline serum creatinine and urinary dipsticks were obtained,
with albuminuria stratified into no/trace albuminuria, microalbuminuria
(>=30 but <300 mg/dL), or macroalbuminuria (>=300 mg/dL). Kaplan-Meier
rates and proportional Cox hazards models of CV death, overall mortality,
CV death or myocardial infarction (MI), and bleeding were calculated.
Incidence of acute kidney injury, identified by adverse event reporting
and creatinine increase (absolute >=0.3 mg/dL or relative >=50%), was
descriptively reported. Results Both dipstick albuminuria and creatinine
values were available in 9473 patients (73.2%). More patients with
macroalbuminuria, versus no/trace albuminuria, had diabetes (66% vs 27%)
or hypertension (86% vs 68%). Rates for CV death and overall mortality per
strata were 3.1% and 4.8% (no/trace albuminuria); 5.8% and 9.0%
(microalbuminuria); and 7.7% and 12.6% (macroalbuminuria) at 2 years of
follow-up. Corresponding rates for CV death or MI were 12.2%, 16.9%, and
23.5%, respectively. Observed acute kidney injury rates were 0.6%, 1.2%,
and 2.9% (n = 79), respectively. Adjusted HRs for macroalbuminuria on CV
mortality were 1.65 (95% CI 1.15-2.37), and after adjustment with EGFR,
1.37 (95% CI 0.93-2.01). Corresponding HRs for overall mortality were 1.82
(95% CI 1.37-2.42) and 1.47 (95% CI 1.08-1.98). Conclusions High-risk
patients with non-ST-segment elevation acute coronary syndromes and
albuminuria have increased morbidity and increased overall mortality
independent of EGFR.<br/>Copyright &#xa9; 2016 Elsevier, Inc.

<83>
Accession Number
610461100
Author
Rao C.; Du J.; Li X.; Li J.; Zhang H.; Zhao Y.; Hu S.; Jiang L.; Zheng Z.
Institution
(Rao, Du, Li, Li, Zhang, Zhao, Hu, Jiang, Zheng) National Clinical
Research Center of Cardiovascular Diseases, State Key Laboratory of
Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences, Peking Union Medical
College, Beijing, China
(Li, Zhang, Hu, Zheng) Department of Cardiovascular Surgery, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences, Peking Union Medical College, Beijing, China
Title
Rationale and design of a randomized cluster trial to improve
guideline-adherence of secondary preventive drugs prescription after
coronary artery bypass grafting in China: Measurement and Improvement
Studies of Surgical Coronary Revascularization: Secondary Prevention
(MISSION-1) Study.
Source
American Heart Journal. 178 (pp 9-18), 2016. Date of Publication: 01 Aug
2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives The benefits of secondary preventive drugs after coronary
artery bypass grafting have been thoroughly established. However, the
prescription rates of these drugs are low at discharge in China. We sought
to evaluate the effectiveness of continuous quality improvement with
mobile-based interventions for clinicians on improving the
guideline-adherence of secondary preventive drugs prescription. Methods
and Results The quality MISSION-1 study is a cluster-randomized controlled
trial. We enrolled 60 hospitals with a bypass surgery volume of more than
30 a year and randomly assigned them into the intervention group or the
control group in a 1:1 ratio using minimized random grouping. The
intervention group undertakes a series of mobile-based interventions,
while the control group maintains a routine practice pattern. All sites
consecutively register patients who underwent isolated coronary artery
bypass grafting and submit in-hospital data. We require supporting
documents regarding prescription information at discharge to adjudicate
the outcome measures. The estimated sample size of enrolled patients is
9,600. The primary outcome measure is the prescription rate of statins for
eligible patients at discharge. The secondary outcome measures are
beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin
receptor blockers, and optimal medical therapy. MISSION-1 study is now
recruiting patients. Conclusions The MISSION-1 study has the potential to
identify the effectiveness of interventions on improving secondary
prevention adherence at discharge after bypass surgery in China and
further disseminate findings to other settings to improve the quality of
care. (Am Heart J 2016;0:1-10.).<br/>Copyright &#xa9; 2016 Published by
Elsevier Inc.

<84>
Accession Number
611001962
Author
Stillman A.E.; Gatsonis C.; Lima J.A.C.; Black W.C.; Cormack J.; Gareen
I.; Hoffmann U.; Liu T.; Mavromatis K.; Schnall M.D.; Udelson J.E.;
Woodard P.K.
Institution
(Stillman) Department of Radiology and Imaging Sciences, Emory University,
Atlanta, GA, United States
(Stillman, Mavromatis) Division of Cardiology, Emory University, Atlanta,
GA, United States
(Gatsonis, Cormack, Gareen, Liu) Center for Statistical Sciences, Brown
University, Providence, RI, United States
(Gatsonis, Liu) Department of Biostatistics, Brown University School of
Public Health, Providence, RI, United States
(Lima) Departments of Medicine and Radiology, Johns Hopkins University,
Baltimore, MD, United States
(Black) Department of Radiology, Dartmouth-Hitchcock Medical Center,
Lebanon, NH, United States
(Hoffmann) Department of Radiology, Massachusetts General Hospital,
Boston, MA, United States
(Schnall) Department of Radiology, University of Pennsylvania,
Philadelphia, PA, United States
(Udelson) Division of Cardiology, Tufts-New England Medical Center,
Boston, MA, United States
(Woodard) Department of Radiology, Mallinckrodt Institute of Radiology,
Washington University, St. Louis, MO, United States
(Gareen) Department of Epidemiology, United States
Title
Rationale and design of the Randomized Evaluation of patients with Stable
angina Comparing Utilization of noninvasive Examinations (RESCUE) trial.
Source
American Heart Journal. 179 (pp 19-28), 2016. Date of Publication: 01 Sep
2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
RESCUE is a phase III, randomized, controlled, multicenter, comparative
efficacy study, designed to compare two diagnostic imaging/treatment
paradigms that use coronary computed tomography angiography (CCTA) or
single photon emission computed tomography myocardial perfusion imaging
(SPECT MPI) for assisting in the diagnosis of ischemic heart disease in
patients with stable angina symptoms, and guiding subsequent treatment.
The study is based on the hypothesis that CCTA as a diagnostic tool is
associated with no increase in cardiac risk, decreased cost, and reduced
radiation exposure compared with SPECT MPI. The RESCUE trial was funded by
the Agency for Healthcare Research and Quality (AHRQ) and the American
College of Radiology Imaging Network (ACRIN) Fund for Imaging Innovation,
began in 2011, and completed in 2014.<br/>Copyright &#xa9; 2015 Elsevier,
Inc.

<85>
Accession Number
610300649
Author
Zangrillo A.; Alvaro G.; Pisano A.; Guarracino F.; Lobreglio R.; Bradic
N.; Lembo R.; Gianni S.; Calabro M.G.; Likhvantsev V.; Grigoryev E.;
Buscaglia G.; Pala G.; Auci E.; Amantea B.; Monaco F.; De Vuono G.;
Corcione A.; Galdieri N.; Cariello C.; Bove T.; Fominskiy E.; Auriemma S.;
Baiocchi M.; Bianchi A.; Frontini M.; Paternoster G.; Sangalli F.; Wang
C.-Y.; Zucchetti M.C.; Biondi-Zoccai G.; Gemma M.; Lipinski M.J.;
Lomivorotov V.V.; Landoni G.
Institution
(Zangrillo, Lembo, Gianni, Calabro, Monaco, Bove, Fominskiy, Gemma,
Landoni) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Landoni) Vita-Salute San Raffaele University, Milan, Italy
(Zangrillo) Anesthesia and Intensive Care, Policlinico Universitario Magna
Grecia, Catanzaro, Italy
(Alvaro, Amantea, De Vuono) Cardiac Anesthesia and Intensive Care Unit,
Monaldi Hospital A.O.R.N. Dei Colli, Naples, Italy
(Pisano, Galdieri) Department of Anaesthesia and Critical Care Medicine,
Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
(Guarracino, Cariello) Department of Anaesthesia and Critical Care
Medicine, Citta della Salute e della Scienza, Torino, Italy
(Lobreglio) Clinic of Anesthesiology and Intensive Care Medicine,
University Hospital, Dubrava, Zagreb, Croatia
(Bradic) Anesthesiology and Intensive Care Department Moscow Regional
Clinical, Research Institute, Moscow, Russian Federation
(Likhvantsev) Department of Intensive Care, Research Institute for Complex
Issues of Cardiovascular Diseases, Kemerovo, Russian Federation
(Grigoryev) Anesthesia and Intensive Care, A.O.U. IRCSS IST San Martino,
Genova, Italy
(Buscaglia) Cardiac Anesthesia and Intensive Care, Ospedale Civile SS.
Annunziata, Sassari, Italy
(Pala) Anesthesia and Intensive Care, Azienda Ospedaliera Universitaria
Santa Maria della Misericordia, Udine, Italy
(Corcione) Department of Anesthesia and Critical Care, AORN Dei Colli,
Naples, Italy
(Auci, Auriemma) Department of Cardiac Surgery, Ospedale S.Bortolo, Viale
Rodolfi 37, Vicenza, Italy
(Baiocchi) Anesthesia and Intensive Care, S.Orsola-Malpighi University
Hospital, Bologna, Italy
(Bianchi) Anesthesia and Intensive Care, Azienda Ospedaliera Ordine
Mauriziano, Torino, Italy
(Frontini) Anesthesia and Intensive Care, Azienda Ospedaliera Spedali
Civili, Brescia, Italy
(Paternoster) Departement of Cardiovascular Anaesthesia and Intensive Care
Azienda Ospedaliera S. Carlo, Potenza, Italy
(Sangalli) Anesthesia and Intensive Care, Ospedale S. Gerardo, Monza,
Italy
(Wang) Department of Anaesthesiology, Faculty of Medicine, University of
Malaya, Kuala Lumpur, Malaysia
(Zucchetti) Anesthesia and Intensive Care Azienda Ospedaliera
Papardo-Piemonte, Messina, Italy
(Biondi-Zoccai) Department of Medico-Surgical Sciences, Biotechnologies
Sapienza University of Rome, Latina, Italy
(Biondi-Zoccai) Department of AngioCardioNeurology, IRCCS, Neuromed,
Pozzilli, Italy
(Lipinski) Division of Cardiology, Medstar Washington Hospital Center,
Washington, DC, United States
(Lomivorotov) Department of Anesthesiology and Intensive Care, State
Research Institute of Circulation Pathology, Novosibirsk, Russian
Federation
Title
A randomized controlled trial of levosimendan to reduce mortality in
high-risk cardiac surgery patients (CHEETAH): Rationale and design.
Source
American Heart Journal. 177 (pp 66-73), 2016. Date of Publication: 01 Jul
2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective Patients undergoing cardiac surgery are at risk of perioperative
low cardiac output syndrome due to postoperative myocardial dysfunction.
Myocardial dysfunction in patients undergoing cardiac surgery is a
potential indication for the use of levosimendan, a calcium sensitizer
with 3 beneficial cardiovascular effects (inotropic, vasodilatory, and
anti-inflammatory), which appears effective in improving clinically
relevant outcomes. Design Double-blind, placebo-controlled, multicenter
randomized trial. Setting Tertiary care hospitals. Interventions Cardiac
surgery patients (n = 1,000) with postoperative myocardial dysfunction
(defined as patients with intraaortic balloon pump and/or high-dose
standard inotropic support) will be randomized to receive a continuous
infusion of either levosimendan (0.05-0.2 mug/[kg min]) or placebo for
24-48 hours. Measurements and main results The primary end point will be
30-day mortality. Secondary end points will be mortality at 1 year, time
on mechanical ventilation, acute kidney injury, decision to stop the study
drug due to adverse events or to start open-label levosimendan, and length
of intensive care unit and hospital stay. We will test the hypothesis that
levosimendan reduces 30-day mortality in cardiac surgery patients with
postoperative myocardial dysfunction. Conclusions This trial is planned to
determine whether levosimendan could improve survival in patients with
postoperative low cardiac output syndrome. The results of this
double-blind, placebo-controlled randomized trial may provide important
insights into the management of low cardiac output in cardiac surgery.

<86>
Accession Number
611244355
Author
Sorgaard M.; Linde J.J.; Hove J.D.; Petersen J.R.; Jorgensen T.B.S.;
Abdulla J.; Heitmann M.; Kragelund C.; Hansen T.F.; Udholm P.M.; Pihl C.;
Kuhl J.T.; Engstrom T.; Jensen J.S.; Hofsten D.E.; Kelbaek H.; Kofoed K.F.
Institution
(Sorgaard, Linde, Udholm, Pihl, Kuhl, Engstrom, Hofsten, Kofoed)
Department of Cardiology, The Heart Centre, University of Copenhagen,
Rigshospitalet, Copenhagen, Denmark
(Hove) Department of Cardiology, Hvidovre Hospital, University of
Copenhagen, Copenhagen, Denmark
(Petersen, Jorgensen) Department of Cardiology, Amager Hospital,
Copenhagen, University of Copenhagen, Copenhagen, Denmark
(Abdulla) Department of Medicine, Division of Cardiology, Glostrup
Hospital, University of Copenhagen, Copenhagen, Denmark
(Heitmann) Department of Cardiology, Bispebjerg Hospital, University of
Copenhagen, Copenhagen, Denmark
(Kragelund) Department of Cardiology, Herlev Hospital, University of
Copenhagen, Copenhagen, Denmark
(Hansen, Jensen) Department of Cardiology, Gentofte Hospital, University
of Copenhagen, Copenhagen, Denmark
(Kelbaek) Department of Cardiology, Roskilde Sygehus, University of
Copenhagen, Copenhagen, Denmark
(Kofoed) Department of Radiology, The Diagnostic Centre, University of
Copenhagen, Rigshospitalet, Copenhagen, Denmark
Title
Myocardial perfusion 320-row multidetector computed tomography-guided
treatment strategy for the clinical management of patients with recent
acute-onset chest pain: Design of the CArdiac cT in the treatment of acute
CHest pain (CATCH)-2 randomized controlled trial.
Source
American Heart Journal. 179 (pp 127-135), 2016. Date of Publication: 01
Sep 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Patients admitted with chest pain are a diagnostic challenge because the
majority does not have coronary artery disease (CAD). Assessment of CAD
with coronary computed tomography angiography (CCTA) is safe,
cost-effective, and accurate, albeit with a modest specificity. Stress
myocardial computed tomography perfusion (CTP) has been shown to increase
the specificity when added to CCTA, without lowering the sensitivity. This
article describes the design of a randomized controlled trial, CATCH-2,
comparing a clinical diagnostic management strategy of CCTA alone against
CCTA in combination with CTP. Methods Patients with acute-onset chest pain
older than 50 years and with at least one cardiovascular risk factor for
CAD are being prospectively enrolled to this study from 6 different
clinical sites since October 2013. A total of 600 patients will be
included. Patients are randomized 1:1 to clinical management based on CCTA
or on CCTA in combination with CTP, determining the need for further
testing with invasive coronary angiography including measurement of the
fractional flow reserve in vessels with coronary artery lesions. Patients
are scanned with a 320-row multidetector computed tomography scanner.
Decisions to revascularize the patients are taken by the invasive
cardiologist independently of the study allocation. The primary end point
is the frequency of revascularization. Secondary end points of clinical
outcome are also recorded. Discussion The CATCH-2 will determine whether
CCTA in combination with CTP is diagnostically superior to CCTA alone in
the management of patients with acute-onset chest pain.<br/>Copyright
&#xa9; 2015 Elsevier Inc.

<87>
Accession Number
610732822
Author
Tabbalat R.A.; Hamad N.M.; Alhaddad I.A.; Hammoudeh A.; Akasheh B.F.;
Khader Y.
Institution
(Tabbalat, Hamad, Akasheh) Khalidi Hospital and Medical Centre, Ibn
Khaldoun St, Amman 11183, Jordan
(Alhaddad) Jordan Hospital, Amman, Jordan
(Hammoudeh) Istishari Hospital, Amman, Jordan
(Khader) Jordan University of Science and Technology, Irbid, Jordan
Title
Effect of ColchiciNe on the InciDence of Atrial Fibrillation in Open Heart
Surgery Patients: END-AF Trial.
Source
American Heart Journal. 178 (pp 102-107), 2016. Date of Publication: 01
Aug 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Atrial fibrillation (AF) is a common arrhythmia in patients
undergoing cardiac surgery and may result in significant morbidity and
increased hospital stay. This study was conducted to determine if
colchicine administered preoperatively to patients undergoing cardiac
surgery and continued during hospitalization is effective in reducing the
incidence of postoperative AF. Methods In this multicenter prospective
randomized open-label study, consecutive patients with no history of AF
and scheduled to undergo elective cardiac surgery (n = 360) were
randomized to colchicine (n = 179) or no-colchicine (n = 181). Main
exclusion criteria were history of AF or supraventricular arrhythmias or
absence of sinus rhythm at enrolment, and contraindications to colchicine.
Colchicine was orally administered 12 to 24 hours preoperatively and
continued until hospital discharge. The primary efficacy end point was
documented AF lasting more than 5 minutes. Safety end point was colchicine
adverse effects. Results In-hospital mortality was 3.3%. The primary end
point of AF occurred in 63 patients (17.5%): 26 (14.5%) in the colchicine
group and 37 (20.5%) in the no-colchicine group (relative risk reduction
29.3% [P =.14]). Diarrhea occurred in 54 patients, 44 (24.6%) on
colchicine and 10 (5.5%) on no-colchicine (P <.001). Diarrhea led to
discontinuation of colchicine in 23 (52%) of the 44 patients. Conclusion
Colchicine administered preoperatively to patients undergoing cardiac
surgery and continued until hospital discharge failed to significantly
reduce the incidence of early postoperative AF. Diarrhea was the most
common adverse effect of colchicine leading to its discontinuation in more
than half of the patients with this adverse effect.<br/>Copyright &#xa9;
2016 Elsevier, Inc. All rights reserved.

<88>
Accession Number
607694057
Author
Tarigopula M.; Genereux P.; Madhavan M.V.; Parvataneni R.; Weisz G.;
Mehran R.; Stone G.W.
Institution
(Tarigopula, Genereux, Parvataneni, Weisz, Mehran, Stone) Cardiovascular
Research Foundation, Columbia University Medical Center, 111 E. 59th St.,
New York, NY 10022, United States
(Tarigopula) University of Illinois at Chicago, Chicago, IL, United States
(Genereux, Madhavan, Weisz, Stone) NewYork-Presbyterian Hospital, Columbia
University Medical Center, New York, NY, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Universite de Montreal,
Montreal, Canada
(Weisz) Shaare Zedek Medical Center, Jerusalem, Israel
(Mehran) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
Title
Revascularization Strategies for Calcified Lesions in Patients Presenting
with Acute Coronary Syndromes (From the Acute Catheterization and Urgent
Intervention Triage StrategY [ACUITY] Trial).
Source
Journal of Invasive Cardiology. 28 (1) (pp 10-16), 2016. Date of
Publication: January 2016.
Publisher
HMP Communications
Abstract
BACKGROUND: Revascularization of calcified coronary lesions has been shown
to be associated with suboptimal outcomes. The optimal revascularization
strategy for calcified lesions in patients presenting with non-ST segment
elevation acute coronary syndromes (NSTEACS) has yet to be defined.
METHODS: Outcomes in patients presenting with NSTEACS and moderately or
severely calcified target lesions in native coronary vessels, as assessed
by an independent angiographic core lab, were examined according to
revascularization strategy (percutaneous coronary intervention [PCI] vs
coronary artery bypass graft [CABG] surgery) from the large-scale,
prospective ACUITY trial. Propensity-adjusted multivariable analysis was
used to identify the independent predictors of events at 30 days. RESULTS:
Of 1315 NSTEACS patients with moderately and severely calcified lesions in
whom revascularization was performed, a total of 334 (25%) and 981 (75%)
underwent CABG and PCI, respectively. CABG patients had more severe
baseline comorbidities and coronary artery disease. By propensity-adjusted
multivariable analysis, the CABG group had higher 30-day rates of
reinfarction, composite death or reinfarction, major bleeding, and
thrombocytopenia. CONCLUSIONS: In this large-scale study of patients
presenting for NSTEACS, 30-day adverse events were more frequent after
revascularization of calcified coronary lesions with CABG rather than PCI.
Further studies are warranted to evaluate means of improving early safety
outcomes in this high-risk patient group with complex coronary disease.

<89>
Accession Number
611113283
Author
de Waha A.; Sandner S.; von Scheidt M.; Boening A.; Koch-Buettner K.;
Hammel D.; Hambrecht R.; Danner B.C.; Schondube F.A.; Goerlach G.;
Fischlein T.; Schmoeckel M.; Oberhoffer M.; Schulz R.; Walther T.;
Ziegelhoffer T.; Knosalla C.; Schonrath F.; Beyersdorf F.; Siepe M.;
Attmann T.; Misfeld M.; Mohr F.-W.; Sievers H.-H.; Joost A.; Putman L.M.;
Laufer G.; Hamm C.; Zeymer U.; Kastrati A.; Radke P.W.; Lange R.; Cremer
J.; Schunkert H.
Institution
(de Waha, von Scheidt, Koch-Buettner, Kastrati, Schunkert) German Heart
Center Munich, Technische Universitat Munchen, Munich, Germany
(de Waha, von Scheidt, Koch-Buettner, Kastrati, Schunkert) DZHK (German
Center for Cardiovascular Research), Partner site Munich Heart Alliance,
Munich, Germany
(Sandner, Laufer) Department of Cardiac Surgery, Vienna General Hospital,
Medical University of Vienna, Vienna, Austria
(Boening, Goerlach) Department of Cardiovascular Surgery, Justus-Liebig
University, Giesen, Germany
(Hammel) Department of Cardiac Surgery, Klinikum Links der Weser, Bremen,
Germany
(Hambrecht) Department of Cardiology and Angiology, Klinikum Links der
Weser, Bremen, Germany
(Danner, Schondube) Department of Thoracic and Cardiovascular Surgery,
Georg-August-University Goettingen, Goettingen, Germany
(Fischlein) Department of Cardiac Surgery, Paracelsus Medical University,
Klinikum Nurnberg, Germany
(Schmoeckel, Oberhoffer) Department of Cardiac Surgery, Asklepios Klinik
St. Georg/Cardioclinic, Harburg, Hamburg, Germany
(Schulz) Institute of Physiology, Justus-Liebig University, Giessen,
Germany
(Walther, Ziegelhoffer) Department of Cardiac Surgery, Kerckhoff Heart and
Thorax Center, Bad Nauheim, Germany
(Knosalla, Schonrath) Department of Cardiothoracic and Vascular Surgery,
German Heart Institute, Berlin, Germany
(Schonrath) DZHK (German Center for Cardiovascular research)-partner side
Berlin, Germany
(Beyersdorf, Siepe, Cremer) Department of Cardiovascular Surgery, Heart
Center Freiburg University, Freiburg, Germany
(Attmann) Department of Cardiovascular Surgery, University Hospital
Schleswig-Holstein, Kiel, Germany
(Misfeld, Mohr) Department of Cardiac Surgery, Heart Center Leipzig,
University of Leipzig, Leipzig, Germany
(Sievers) Department of Cardiac and Thoracic Vascular Surgery, University
of Lubeck, Lubeck, Germany
(Joost, Putman) Medical Clinic II, Cardiology, Angiology and Intensive
Care Medicine, University Hospital Schleswig-Holstein, Campus Lubeck,
Lubeck, Germany
(Hamm) Department of Cardiology, Kerckhoff Heart and Thorax Center,
Germany Justus Liebig University of Giessen, Department of Internal
Medicine I, Giesen, Germany
(Zeymer) Department of Cardiology, Heart Center Ludwigshafen, Ludwigshafen
am Rhein, Germany
(Radke) Klinik fur Innere Medizin, Schon Klinik Neustadt, Neustadt i.H.,
Germany
(Lange) Department of Cardiovascular Surgery, German Heart Center, Munich,
Germany
Title
A randomized, parallel group, double-blind study of ticagrelor compared
with aspirin for prevention of vascular events in patients undergoing
coronary artery bypass graft operation: Rationale and design of the
Ticagrelor in CABG (TiCAB) trial: An Investigator-Initiated trial.
Source
American Heart Journal. 179 (pp 69-76), 2016. Date of Publication: 01 Sep
2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
For patients with coronary artery disease undergoing coronary bypass
surgery, acetylsalicylic acid (ASA) currently represents the gold standard
of antiplatelet treatment. However, adverse cardiovascular event rates in
the first year after coronary artery bypass grafting (CABG) still exceed
10%. Graft failure, which is predominantly mediated by platelet
aggregation, has been identified as a major contributing factor in this
context. Therefore, intensified platelet inhibition is likely to be
beneficial. Ticagrelor, an oral, reversibly binding and direct-acting
P2Y<inf>12</inf> receptor antagonist, provides a rapid, competent, and
consistent platelet inhibition and has shown beneficial results compared
with clopidogrel in the subset of patients undergoing bypass surgery in a
large previous trial. Hypothesis Ticagrelor is superior to ASA for the
prevention of major cardiovascular events within 1 year after CABG. Study
design The TiCAB trial (NCT01755520) is a multicenter, phase III,
double-blind, double-dummy, randomized trial comparing ticagrelor with ASA
for the prevention of major cardiovascular events within 12 months after
CABG. Patients undergoing CABG will be randomized in a 1:1 fashion to
either ticagrelor 90 mg twice daily or ASA 100 mg once daily. The study
medication will be started within 24 hours after surgery and maintained
for 12 months. The primary end point is the composite of cardiovascular
death, myocardial infarction, stroke, and repeat revascularization at 12
months after CABG. The sample size is based on an expected event rate of
13% of the primary end point within the first 12 months after
randomization in the control group, a 2-sided alpha level of .0492 (to
preserve the overall significance level of .05 after planned interim
analysis), a power of 0.80%, 2-sided testing, and an expected relative
risk of 0.775 in the active group compared with the control group and a
dropout rate of 2%. According to power calculations based on a superiority
design for ticagrelor, it is estimated that 3,850 patients should be
enrolled. Summary There is clinical equipoise on the issue of optimal
platelet inhibition after CABG. The TiCAB trial will provide a pivotal
comparison of the efficacy and safety of ticagrelor compared with ASA
after CABG.<br/>Copyright &#xa9; 2016

<90>
Accession Number
616388373
Author
Duan X.; Wu Q.; Zhu X.; Shi Y.
Institution
(Duan) Department of Cardiac Surgery ICU, Tenth People's Hospital of
Tongji University, Shanghai, China
(Wu, Zhu, Shi) Department of Nursing Administration, Tenth People's
Hospital of Tongji University, Shanghai, China
Title
Improving sleep quality relieves occupational stress in nurses of cardiac
surgical intensive care unit.
Source
Biomedical Research (India). 28 (9) (pp 3934-3940), 2017. Date of
Publication: 2017.
Publisher
Scientific Publishers of India (E-mail: qayyum@del3.vsnl.net.in)
Abstract
Background: This study aimed to investigate the status and correlation
between occupational stress and sleep quality of the nurses working in the
cardiac surgical Intensive Care Unit (ICU). Methods: Sixty cardiac
surgical ICU nurses from two central hospitals in Shanghai were
investigated by a general information questionnaire and the Occupational
Stress Inventory Revised Edition OSI-R (OSI-R) and Pittsburgh Sleep
Quality Index (PSQI) from October 2013 to February 2014. The Pearson's
correlation was used to analyse the data. Results: The total score of
Occupational Stress Inventory Revised Edition (OSI-R) was 401.76 +/-
24.98. The scores of occupational role, personal strain and personal
resource questionnaires were 147.88 +/- 17.65, 90.78 +/- 12.59 and 114.78
+/- 19.76, respectively. The total score of PSQI was 6.26 +/- 3.41, which
was significantly higher than that of the normal population of China
(P<0.01). The occupational role of cardiac surgical ICU nurses was
negatively correlated with sleep efficiency (P<0.05), and positively
correlated with daytime dysfunction (P<0.01) and SQI (P<0.05). The
individual stress response was negatively correlated with sleep duration
(P<0.05), and positively correlated with daytime dysfunction (P<0.01).
Personal resources were negatively correlated with sleep quality, time to
fall asleep and sleep duration (P<0.05), and positively correlated with
sleep efficiency and sleep quality index (P<0.05). Conclusions: The
occupational stress level and sleep quality of cardiac surgical ICU nurses
are below the average level, and certain correlation exists between
occupational stress and sleep quality. Improving the sleep quality of
cardiac surgical ICU nurses is an effective way to relieve the
occupational stress.<br/>Copyright &#xa9; 2017, Scientific Publishers of
India. All rights reserved.

<91>
[Use Link to view the full text]
Accession Number
612823614
Author
Pollmann A.G.E.; Frederiksen M.; Prescott E.
Institution
(Pollmann, Frederiksen, Prescott) Department of Cardiology, Bispebjerg
Hospital, University of Copenhagen, Bldg 67, Bispebjerg Bakke 23,
Copenhagen DK-2400, Denmark
Title
Cardiac Rehabilitation after Heart Valve Surgery: IMPROVEMENT in EXERCISE
CAPACITY and MORBIDITY.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. 37 (3) (pp
191-198), 2017. Date of Publication: 01 May 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
PURPOSE: Evidence of the effect of cardiac rehabilitation (CR) after heart
valve surgery is scarce, but nevertheless CR is recommended for this group
of patients. Therefore, this study assessed the effect of CR on exercise
capacity, cardiovascular risk factors, and long-term mortality and
morbidity, as well as predictors for enrolment in or failing to complete
CR. METHODS: A review of medical records identified 250 patients who
underwent heart valve surgery between January 2009 and August 2013. Of
these, 211 patients eligible for CR were identified. Effect of CR was
assessed by peak oxygen uptake (o<inf>2</inf> <inf>peak</inf>) or 6-minute
walk test (6MWT). A composite endpoint of all-cause mortality and hospital
admission due to myocardial infarction, stroke, heart failure,
endocarditis, revascularization, or reoperation was used to assess the
hazard ratio between CR attenders and nonattenders. Multivariable logistic
regression was used to find predictors for CR attendance and CR
completion. RESULTS: A total of 146 patients completed CR. o<inf>2</inf>
<inf>peak</inf> improved by 16% from 21.6 to 24.8 mL/kg/min (P <.0001) and
6MWT distance by 13% from 349 to 393 m (P =.0016). Rate of clinical events
was higher among nonattenders with an adjusted hazard ratio of 2.46 (95%
CI, 1.26-4.80). Age >75 years was predictive for not attending (adjusted
OR, 2.99; 95% CI,.37-6.53), whereas ethnic minorities were less likely to
complete CR (adjusted OR, 4.88; 95% CI, 1.58-15.06). CONCLUSIONS: CR after
heart valve surgery improved exercise capacity and was associated with
reduced morbidity. Elderly and ethnic minorities were less likely to
attend or complete CR and deserve special attention.<br/>Copyright &#xa9;
2017 Wolters Kluwer Health, Inc. All rights reserved.

<92>
Accession Number
616395848
Author
Blair J.E.A.; Atri P.; Friedman J.L.; Thomas J.D.; Brummel K.; Sweis R.N.;
Mikati I.; Malaisrie S.C.; Davidson C.J.; Flaherty J.D.
Institution
(Blair) Section of Cardiology, Department of Medicine, University of
Chicago Medicine, Chicago, Illinois, United States
(Atri) Scripps Clinic, La Jolla, California, United States
(Friedman, Thomas, Brummel, Sweis, Mikati, Malaisrie, Davidson, Flaherty)
Division of Cardiology, Department of Medicine, Feinberg School of
Medicine, Bluhm Cardiovascular Institute of Northwestern University,
Chicago, Illinois, United States
Title
Diastolic Function and Transcatheter Aortic Valve Replacement.
Source
Journal of the American Society of Echocardiography. 30 (6) (pp 541-551),
2017. Date of Publication: June 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Little is known about baseline diastolic dysfunction and
changes in diastolic dysfunction grade after transcatheter aortic valve
replacement (TAVR) for aortic stenosis (AS) and its impact on overall
outcomes. The aim of this study was to describe baseline diastolic
dysfunction and changes in diastolic dysfunction grade that occur with
TAVR and their relationship to mortality and rehospitalization. Methods
This was a single-center study evaluating all TAVRs from January 2012 to
June 2014. We compared parameters of diastolic dysfunction grade on
pre-TAVR and 1 month post-TAVR echocardiograms for all patients undergoing
the procedure. Descriptive statistics, Kaplan-Meier time-to-event
analysis, and multivariate logistic regression were used. Results Of a
sample size of 120 patients undergoing TAVR for symptomatic severe AS, 90
were included in the final analysis after excluding significant mitral
valve disease. There were improvements in individual parameters of
diastolic dysfunction grade such as lateral e' velocity, E/lateral e', and
left atrial volume index (nonsignificant trend) in the setting of
improvement in aortic valve area and gradients and functional class pre-
and post-TAVR. Multivariate analysis revealed that baseline diastolic
dysfunction grade, but not post-TAVR or changes in diastolic dysfunction
grade, was associated with 1-year death (hazard ratio, 1.163; 95% CI,
1.049-1.277, P =.005) and combined death/cardiovascular hospitalization
(hazard ratio, 1.174; 95% CI, 1.032-1.318; P =.018). Conclusions In this
single-center retrospective study of patients with symptomatic severe AS
who underwent TAVR, several diastolic function parameters improved on
echocardiography, but baseline diastolic dysfunction grade remained the
most important echocardiographic factor associated with adverse 1-year
outcomes.<br/>Copyright &#xa9; 2017 American Society of Echocardiography

<93>
Accession Number
616332470
Author
Milojevic M.; Head S.J.; Andrinopoulou E.-R.; Serruys P.W.; Mohr F.W.;
Tijssen J.G.; Kappetein A.P.
Institution
(Milojevic, Head, Andrinopoulou, Kappetein) Department of Cardiothoracic
Surgery, Erasmus University Medical Center, 's-Gravendijkwal 230,
Rotterdam 3015 CE, Netherlands
(Andrinopoulou) Department of Biostatistics, Erasmus University Medical
Center, Rotterdam, Netherlands
(Serruys) Department of Cardiology, Erasmus University Medical Center,
Rotterdam, Netherlands
(Mohr) Department of Cardiovascular Surgery, Herzzentrum Universitat
Leipzig, Leipzig, Germany
(Tijssen) Academic Medical Center, Amsterdam, Netherlands
Title
Hierarchical testing of composite endpoints: Applying the win ratio to
percutaneous coronary intervention versus coronary artery bypass grafting
in the SYNTAX trial.
Source
EuroIntervention. 13 (1) (pp 106-114), 2017. Date of Publication: 2017.
Publisher
EuroPCR
Abstract
Aims: The goal of the study was to compare long-term outcomes of
percutaneous coronary intervention (PCI) versus coronary artery bypass
grafting (CABG), accounting for the clinical impact of individual
components in the composite endpoints and prioritising these using the win
ratio (Rw). Methods and results: The win ratio was compared with
conventional methods of analyses (hazard ratio [HR] and relative risk) in
the SYNTAX trial (n=1, 800). For the composite of death/stroke/myocardial
infarction (MI), the win ratio favoured CABG and was 1.37 (95% CI:
1.10-1.77) for matched analysis, 1.28 (95% CI: 1.11-1.53) for unmatched
analysis, while the conventional HR was 1.29 (95% CI: 1.11-1.53). The
largest number of winners in favour of CABG over PCI were based on MI
(n=39 vs. n=19, respectively). Death was significantly reduced with CABG
in matched (Rw=1.39, 95% CI: 1.04-1.86) and unmatched win ratio analyses
(Rw=1.27, 95% CI: 1.01-1.42) as compared with non-significant conventional
analysis (HR 1.19, 95% CI: 0.92-1.56). In subgroups, matched win ratio
analyses had a larger treatment effect in favour of CABG compared with
conventional analyses, especially in patients with three-vessel disease
and intermediate SYNTAX scores, while unmatched win ratios had a smaller
point estimate, but with narrower confidence intervals than matched
analyses findings. Conclusions: This re-analysis of the SYNTAX trial using
the win ratio shows that the most important benefit of CABG treatment is
the reduction of hard clinical endpoints such as mortality and MI. Future
trials using this approach can expect to maintain similar statistical
power with smaller sample sizes, and thereby reduce the cost of a trial.
ClinicalTrials.gov Identifier: NCT00114972.<br/>Copyright &#xa9; Europa
Digital & Publishing 2017. All rights reserved.

<94>
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.

<95>
Accession Number
614558803
Author
Tabarsi N.; Guan M.; Simmonds J.; Toma M.; Kiess M.; Tsang V.; Ruygrok P.;
Konstantinov I.; Shi W.; Grewal J.
Institution
(Tabarsi, Guan, Toma, Kiess, Grewal) Division of Cardiology, St. Paul's
Hospital, University of British Columbia, Vancouver, British Columbia,
Canada
(Simmonds, Tsang) Division of Cardiology, Great Ormond Street Hospital for
Children, London, United Kingdom
(Ruygrok) Division of Cardiology, Auckland City Hospital, Auckland, New
Zealand
(Konstantinov, Shi) Division of Cardiothoracic Surgery, Royal Children's
Hospital, Melbourne, Australia
Title
Meta-Analysis of the Effectiveness of Heart Transplantation in Patients
With a Failing Fontan.
Source
American Journal of Cardiology. 119 (8) (pp 1269-1274), 2017. Date of
Publication: 15 Apr 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The Fontan procedure is increasingly being used to palliate univentricular
physiology. It is a complex anatomic and physiologic repair that can fail
at any age, often leaving heart transplantation as the only remaining
solution. A meta-analysis was performed to achieve the aim of
systematically evaluating the existing evidence for survival after heart
transplantation in patients who have undergone a Fontan palliation.
MEDLINE, Embase, PubMed, and Web of Science were searched for original
research studies. The primary outcome was mortality at 1 and 5 years after
transplantation. Five hundred eighty-two records were screened, after the
removal of duplicates, 12 retrospective observational studies were
selected for inclusion in our meta-analysis. This encompassed a total of
351 Fontan patients undergoing heart transplantation. Mean age was 14
years (range 7 to 24 years) and 65% were men. One- and 5-year survival
rates after heart transplantation were found to be 80.3% (95% CI 75.9% to
84.2%) and 71.2% (95% CI 66.3% to 75.7%), respectively. No significant
association was found between age, gender, and pulmonary pressures and
1-year mortality. In conclusion, in the largest analysis to date, we found
that heart transplantation in younger patients after Fontan procedure has
an acceptable early and mid-term mortality. It is comparable to published
mortality data of heart transplantation for other forms of congenital
heart disease. Heart transplantation in the younger failing Fontan
population appears to be a reasonable option when all other avenues have
been exhausted and appropriate screening has taken place.<br/>Copyright
&#xa9; 2017 Elsevier Inc.

<96>
Accession Number
613955627
Author
Sun Y.; Liu X.; He Y.; Tang M.; Zhu Q.; Xu X.; Guo D.; Shi K.; Hu P.; Wang
L.; Kong H.; Jiang J.; Lin X.; Xu Q.; Gao F.; Wang J.
Institution
(Sun, Zhu, Xu, Guo, Shi, Wang) Zhejiang University School of Medicine,
Hangzhou, China
(Liu, He, Tang, Hu, Wang, Kong, Jiang, Lin, Xu, Gao, Wang) Department of
Cardiology, Second Affiliated Hospital Zhejiang University School of
Medicine, Hangzhou, China
Title
Meta-Analysis of Impact of Diabetes Mellitus on Outcomes After
Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 119 (4) (pp 623-629), 2017. Date of
Publication: 15 Feb 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
To date, the impact of diabetes mellitus (DM) on prognosis after
transcatheter aortic valve implantation (TAVI) is still contradictory and
thus merits further investigation. The purpose of this meta-analysis was
to evaluate the impact of DM on outcomes after TAVI. A systematic search
of the PubMed database was performed. Primary end points were 30-day and
1-year all-cause mortality after TAVI. Risk ratios (RRs) and 95% CIs were
calculated using the random-effect or fixed-effect model, depending on
heterogeneity between studies, and p values <0.05 was considered
significant. A total of 16 studies involving 13,253 patients were included
in our meta-analysis. There was no significant difference between the
groups with DM and without DM regarding 30-day (RR 1.07, 95% CI 0.90 to
1.27, p = 0.45) or 1-year (RR 1.04, 95% CI 0.94 to 1.15, p = 0.42)
all-cause mortality. The risks of 30-day complications, including
myocardial infarction, stroke, major vascular complications, major
bleeding, and acute kidney injury, were similar between patients with and
without DM. In conclusion, DM neither affected short- or mid-term
all-cause mortality nor short-term complications after TAVI.<br/>Copyright
&#xa9; 2016 Elsevier Inc.

<97>
Accession Number
613943790
Author
Koskinas K.C.; Taniwaki M.; Rigamonti F.; Heg D.; Roffi M.; Tuller D.;
Muller O.; Vuillomenet A.; Cook S.; Weilenmann D.; Kaiser C.; Jamshidi P.;
Juni P.; Windecker S.; Pilgrim T.
Institution
(Koskinas, Taniwaki, Windecker, Pilgrim) Department of Cardiology, Swiss
Cardiovascular Center, University Hospital, Bern, Switzerland
(Rigamonti, Roffi) Department of Cardiology, University Hospital, Geneva,
Switzerland
(Heg) Institute of Social and Preventive Medicine and Clinical Trials
Unit, Bern University Hospital, Bern, Switzerland
(Tuller) Department of Cardiology, Triemlispital, Zurich, Switzerland
(Muller) Department of Cardiology, University Hospital, Lausanne,
Switzerland
(Vuillomenet) Department of Cardiology, Kantonsspital, Aarau, Switzerland
(Cook) Department of Cardiology, University Hospital, Fribourg,
Switzerland
(Weilenmann) Department of Cardiology, Kantonsspital, St. Gallen,
Switzerland
(Kaiser) Department of Cardiology, University Hospital, Basel, Switzerland
(Jamshidi) Department of Cardiology, Kantonsspital, Luzern, Switzerland
(Juni) Applied Health Research Centre (AHRC), St. Michael's Hospital,
Toronto, Ontario, Canada
Title
Impact of Patient and Lesion Complexity on Long-Term Outcomes Following
Coronary Revascularization With New-Generation Drug-Eluting Stents.
Source
American Journal of Cardiology. 119 (4) (pp 501-507), 2017. Date of
Publication: 15 Feb 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Long-term clinical outcomes of new-generation drug-eluting stents in
complex anatomic and clinical settings are not well defined. This study
assessed the impact of patient and lesion complexity on 2-year outcomes
after coronary revascularization with ultrathin strut
biodegradable-polymer (BP) sirolimus-eluting stents (SES) versus
durable-polymer (DP) everolimus-eluting stents (EES). In a prespecified
analysis of the BIOSCIENCE randomized trial (NCT01443104), complex
patients (911 of 2,119; 43%) were defined by the presence of acute
ST-elevation myocardial infarction (MI); left ventricular ejection
fraction <=30%; renal dysfunction; insulin-treated diabetes; treatment of
ostial lesion, bypass graft, unprotected left main lesion; or 3-vessel
intervention. The primary end point was target lesion failure (TLF), a
composite of cardiac death, target vessel MI, and clinically indicated
target lesion revascularization. At 2 years, complex compared with simple
patients had a greater risk of TLF (14.5% vs 7.4%, risk ratio 2.05, 95%
confidence interval 1.56 to 2.69; p <0.001). The difference was sustained
beyond 1 year on landmark analysis. Complex patients had higher rates of
the patient-oriented composite end point of death, any MI, or any
revascularization (23% vs 14.4%; p <0.001) as well as definite stent
thrombosis (1.6% vs 0.4%, p = 0.006). There were no differences in TLF and
patient-oriented composite end point between the BP-SES versus DP-EES,
consistently among simple and complex patients. In conclusion, patient and
lesion complexity had a durable adverse impact on clinical outcomes
throughout 2 years of follow-up in this all-comers randomized trial.
Safety and efficacy of new-generation BP-SES and DP-EES were comparable,
irrespective of complexity status.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<98>
Accession Number
613981795
Author
Naqvi S.Y.; Klein J.; Saha T.; McCormick D.J.; Goldberg S.
Institution
(Naqvi, Klein, Saha) Department of Internal Medicine, Pennsylvania
Hospital, University of Pennsylvania Health System, Philadelphia,
Pennsylvania, United States
(McCormick, Goldberg) Department of Cardiology, Pennsylvania Hospital,
University of Pennsylvania Health System, Philadelphia, Pennsylvania,
United States
Title
Comparison of Percutaneous Coronary Intervention Versus Coronary Artery
Bypass Grafting for Unprotected Left Main Coronary Artery Disease.
Source
American Journal of Cardiology. 119 (4) (pp 520-527), 2017. Date of
Publication: 15 Feb 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Coronary artery bypass grafting (CABG) decreases mortality in patients
with significant left main (LM) coronary artery disease and for years
remained the therapy of choice for patients with this ominous lesion.
Advances in percutaneous coronary intervention (PCI) have enabled it to
become an alternative to CABG. The results of observational registries and
randomized comparisons have shown the safety and efficacy of PCI in
appropriately selected patients with low or intermediate angiographic risk
scores. Furthermore, the use of physiological measures of flow limitation
and the use of intracoronary imaging techniques has added benefit and
improved outcomes. The use of fractional flow reserve to more accurately
evaluate the significance of intermediate lesions and guide the extent of
revascularization has been an important refinement. Intravascular
ultrasound and optical coherence tomography assessment of optimal stent
deployment has led to reductions in restenosis. Newer generation stents,
combined with improvements in specific techniques, especially at the LM
bifurcation have extended PCI to more complex anatomic scenarios. The
availability of left ventricular support devices in patients with complex
coronary anatomy and severely depressed left ventricular function has
added a margin of safety to LM and multivessel intervention. Randomized
comparisons of CABG with PCI in carefully selected patients, using
contemporaneous surgical and interventional techniques and optimal medical
therapy, will further aid heart teams in the decision-making process. In
conclusion, this review will give a concise overview of the management of
unprotected LM disease.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<99>
Accession Number
614472931
Author
Takagi H.
Institution
(Takagi) Alice (All-Literature Investigation of Cardiovascular Evidence)
Group, Department of Cardiovascular Surgery, Shizuoka Medical Center,
762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan
Title
Vitamins and abdominal aortic aneurysm.
Source
International Angiology. 36 (1) (pp 21-30), 2017. Date of Publication:
February 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: To summarize the association of vitamins (B6, B12, C, D, and
E) and abdominal aortic aneurysm (AAA), we reviewed clinical studies with
a comprehensive literature research and meta-analytic estimates. EVIDENCE
ACQUISITION: To identify all clinical studies evaluating the association
of vitamins B6/B12/C/D/E and AAA, databases including MEDLINE, EMBASE, and
the Cochrane Central Register of Controlled Trials were searched through
April 2015, using Web-based search engines (PubMed and OVID). For each
case-control study, data regarding vitamin levels in both the AAA and
control groups were used to generate standardized mean differences (SMDs)
and 95% confidence intervals (CIs). EVIDENCE SYNTHESIS: Pooled analyses of
the 4 case-control studies demonstrated significantly lower circulating
vitamin B6 levels (SMD, -0.33; 95% CI, -0.55 to -0.11; P=0.003) but
non-significantly lower vitamin B12 levels (SMD, -0.42; 95% CI, -1.09 to
0.25; P=0.22) in patients with AAA than subjects without AAA. Pooled
analyses of the 2 case-control studies demonstrated significantly lower
levels of circulating vitamins C (SMD, -0.71; 95% CI, -1.23 to -0.19;
P=0.007) and E (SMD, -1.76; 95% CI, -2.93 to 0.60; P=0.003) in patients
with AAA than subjects without AAA. Another pooled analysis of the 3
case-control studies demonstrated significantly lower circulating Vitamin
D (25-hydroxyVitamin D) levels (SMD, -0.25; 95% CI, -0.50 to -0.01;
P=0.04) in patients with AAA than subjects without AAA. In a double-blind
controlled trial, 4.0-year treatment with a high-dose folic acid and
vitamin B6/B12 multivitamin in kidney transplant recipients did not reduce
a rate of AAA repair despite significant reduction in homocysteine level.
In another randomized, double-blind, placebo-controlled trial, 5.8-year
supplementation with alpha-tocopherol (Vitamin E) had no preventive effect
on large AAA among male smokers. CONCLUSIONS: In clinical setting,
although low circulating vitamins B6/C/D/E (not B12) levels are associated
with AAA presence, vitamins B6/B12/E supplementation may not reduce AAA
incidence.<br/>Copyright &#xa9; 2015 EDIZIONI MINERVA MEDICA.

<100>
Accession Number
613998401
Author
Rief W.; Shedden-Mora M.C.; Laferton J.A.C.; Auer C.; Petrie K.J.;
Salzmann S.; Schedlowski M.; Moosdorf R.
Institution
(Rief, Laferton, Auer, Salzmann) University of Marburg, Division of
Clinical Psychology, Gutenbergstrasse 18, Marburg 35032, Germany
(Shedden-Mora) University Medical Center Hamburg Eppendorf, Department of
Psychosomatic Medicine and Psychotherapy, Hamburg, Germany
(Petrie) University of Auckland, Department of Psychological Medicine,
Auckland, New Zealand
(Schedlowski) Institute of Medical Psychology and Behavioral
Immunobiology, University Hospital Essen, Essen, Germany
(Moosdorf) University of Marburg, Department of Cardiac and Thoracic
Vessel Surgery, Heart Centre, Marburg, Germany
Title
Preoperative optimization of patient expectations improves long-term
outcome in heart surgery patients: Results of the randomized controlled
PSY-HEART trial.
Source
BMC Medicine. 15 (1) (no pagination), 2017. Article Number: 4. Date of
Publication: 10 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Placebo effects contribute substantially to outcome in most
fields of medicine. While clinical trials typically try to control or
minimize these effects, the potential of placebo mechanisms to improve
outcome is rarely used. Patient expectations about treatment efficacy and
outcome are major mechanisms that contribute to these placebo effects. We
aimed to optimize these expectations to improve outcome in patients
undergoing coronary artery bypass graft (CABG) surgery. Methods: In a
prospective three-arm randomized clinical trial with a 6 month follow-up,
124 patients scheduled for CABG surgery were randomized to either a brief
psychological pre-surgery intervention to optimize outcome expectations
(EXPECT); or a psychological control intervention focusing on emotional
support and general advice, but not on expectations (SUPPORT); or to
standard medical care (SMC). Interventions were kept brief to be feasible
with a heart surgery environment; "dose" of therapy was identical for both
pre-surgery interventions. Primary outcome was disability 6 months after
surgery. Secondary outcomes comprised further clinical and immunological
variables. Results: Patients in the EXPECT group showed significantly
larger improvements in disability (-12.6; -17.6 to -7.5) than the SMC
group (-1.9; -6.6 to +2.7); patients in the SUPPORT group (-6.7; -11.8 to
1.7) did not differ from the SMC group. Comparing follow-up scores and
controlling for baseline scores of EXPECT versus SUPPORT on the variable
disability only revealed a trend in favor of the EXPECT group (P = 0.09).
Specific advantages for EXPECT compared to SUPPORT were found for mental
quality of life and fitness for work (hours per week). Both psychological
pre-surgery interventions induced less pronounced increases in
pro-inflammatory cytokine concentrations reflected by decreased
interleukin-8 levels post-surgery compared to changes in SMC patients and
lower interleukin-6 levels in patients of the EXPECT group at follow-up.
Both pre-surgery interventions were characterized by great patient
acceptability and no adverse effects were attributed to them. Considering
the innovative nature of this approach, replication in larger, multicenter
trials is needed. Conclusions: Optimizing patients' expectations
pre-surgery helps to improve outcome 6 months after treatment. This
implies that making use of placebo mechanisms has the potential to improve
long-term outcome of highly invasive medical interventions. Further
studies are warranted to generalize this approach to other fields of
medicine. Trial registration: Ethical approval for the study was obtained
from the IRB of the Medical School, University of Marburg, and the trial
was registered at (NCT01407055) on July 25, 2011.<br/>Copyright &#xa9;
2017 The Author(s).

<101>
[Use Link to view the full text]
Accession Number
614172646
Author
Wolff G.; Dimitroulis D.; Andreotti F.; Kolodziejczak M.; Jung C.;
Scicchitano P.; Devito F.; Zito A.; Occhipinti M.; Castiglioni B.; Calveri
G.; Maisano F.; Ciccone M.M.; De Servi S.; Navarese E.P.
Institution
(Wolff, Dimitroulis, Andreotti, Kolodziejczak, Jung, Scicchitano, Devito,
Zito, Occhipinti, Ciccone, De Servi, Navarese) Systematic Investigation
and Research on Interventions and Outcomes (SIRIO), MEDICINE Research
Network, Milan, Italy
(Wolff, Dimitroulis, Jung) Department of Internal Medicine, Division of
Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University,
Dusseldorf, Germany
(Andreotti) Institute of Cardiology, Catholic University, Rome, Italy
(Kolodziejczak) Collegium Medicum in Bydgoszcz, University of Nicolaus
Copernicus, Torun, Poland
(Scicchitano, Devito, Zito, Ciccone) Department of Emergency and Organ
Transplantation, Section of Cardiovascular Diseases, School of Medicine,
University of Bari, Italy
(Occhipinti, Castiglioni, Calveri) Department of Heart Science, Ospedale
di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
(Maisano) Department of Cardiosurgery, University of Zurich, Switzerland
(De Servi, Navarese) Department of Cardiology, Multimedica IRCCS Via
Milanese 300, Milan 20099, Italy
Title
Survival Benefits of Invasive Versus Conservative Strategies in Heart
Failure in Patients with Reduced Ejection Fraction and Coronary Artery
Disease: A Meta-Analysis.
Source
Circulation: Heart Failure. 10 (1) (no pagination), 2017. Article Number:
e003255. Date of Publication: 01 Jan 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Heart failure with reduced ejection fraction caused by
ischemic heart disease is associated with increased morbidity and
mortality. It remains unclear whether revascularization by either coronary
artery bypass grafting (CABG) or percutaneous coronary intervention (PCI)
carries benefits or risks in this group of stable patients compared with
medical treatment. Methods and Results - We performed a meta-analysis of
available studies comparing different methods of revascularization (PCI or
CABG) against each other or medical treatment in patients with coronary
artery disease and left ventricular ejection fraction <=40%. The primary
outcome was all-cause mortality; myocardial infarction, revascularization,
and stroke were also analyzed. Twenty-one studies involving a total of 16
191 patients were included. Compared with medical treatment, there was a
significant mortality reduction with CABG (hazard ratio, 0.66; 95%
confidence interval, 0.61-0.72; P<0.001) and PCI (hazard ratio, 0.73; 95%
confidence interval, 0.62-0.85; P<0.001). When compared with PCI, CABG
still showed a survival benefit (hazard ratio, 0.82; 95% confidence
interval, 0.75-0.90; P<0.001). Conclusions - The present meta-analysis
indicates that revascularization strategies are superior to medical
treatment in improving survival in patients with ischemic heart disease
and reduced ejection fraction. Between the 2 revascularization strategies,
CABG seems more favorable compared with PCI in this particular clinical
setting.<br/>Copyright &#xa9; 2017 American Heart Association, Inc.

<102>
Accession Number
614132184
Author
Altarabsheh S.E.; Deo S.V.; Dunlay S.M.; Erwin P.J.; Obeidat Y.M.; Navale
S.; Markowitz A.H.; Park S.J.
Institution
(Altarabsheh) Division of Cardiovascular Surgery, Queen Alia Heart
Institute, Amman, Jordan
(Deo, Markowitz, Park) Division of Cardiovascular Surgery, University
Hospitals, Harrington Heart and Vascular Institute, Case Western Reserve
University, Cleveland, Ohio, United States
(Dunlay) Division of Cardiovascular Diseases, Mayo Clinic, Rochester,
Minnesota, United States
(Erwin) Mayo Clinic Libraries, Rochester, Minnesota, United States
(Obeidat) Department of Cardiac Surgery, AlMana General Hospital,
Alkhobar, Saudi Arabia
(Navale) Division of Epidemiology and Biostatistics, Case Western Reserve
University, Cleveland, Ohio, United States
Title
Meta-Analysis of Usefulness of Concomitant Mitral Valve Repair or
Replacement for Moderate Ischemic Mitral Regurgitation With Coronary
Artery Bypass Grafting.
Source
American Journal of Cardiology. 119 (5) (pp 734-741), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Moderate ischemic mitral regurgitation (MR) is often present in patients
undergoing coronary artery bypass grafting (CABG). However, the clinical
benefit of repairing moderate MR during CABG is unproven. We searched
multiple databases to identify original studies comparing isolated CABG
versus combined CABG and MR surgery (mitral valve surgery with coronary
artery bypass grafting [MVCABG]); survival (either early or midterm) was
the primary end point. Risk ratio (RR) or standardize mean difference was
selected as the effect estimates; survival was compared by pooling hazard
ratios. All results are presented with 95% CIs; p <0.05 is statistically
significant. Eleven studies (7 retrospective and 4 randomized controlled
trials; 547 MVCABG and 900 CABG patients) were included in our
meta-analysis. Concomitant mitral valve repair significantly prolonged
surgical duration (p <0.01). Early mortality (MVCABG 6.9% and CABG 6%) was
comparable (RR 1.3 [0.9 to 1.8]; p = 0.11). At follow-up, the MVCABG
patients had similar New York Heart Association class (standardize mean
difference -0.73 (-1.64 to 0.18; p = 0.11). However, patients who
underwent concomitant mitral valve surgery had less MR at follow-up
(recurrent significant MR, RR 0.37 [0.22 to 0.62]; p = 0.001; mean MR
grade, mean difference = 0.39 [0.26 to 0.59]; p <0.001). Midterm survival
rate (mean follow-up 5 years) was comparable in both groups (hazard ratio
for mortality in the MVCABG cohort 1.1 [0.9 to 1.3]; p = 0.38). In
conclusion, concomitant repair of moderate ischemic MR leads to improved
mitral valve competence at follow-up; however, this was not translated
into any functional or survival benefit for adding valve repair to CABG
for these patients at 5 years of follow-up.<br/>Copyright &#xa9; 2016
Elsevier Inc.

<103>
Accession Number
609626697
Author
Uddin J.; Zwisler A.-D.; Lewinter C.; Moniruzzaman M.; Lund K.; Tang L.H.;
Taylor R.S.
Institution
(Uddin) Department of Cardiac Surgery, Ibrahim Cardiac Hospital and
Research Institute, Bangladesh
(Uddin, Zwisler, Taylor) National Institute of Public Health, University
of Southern Denmark, Denmark
(Lewinter) Department of Cardiology, Vejle Hospital, Vejle, Denmark
(Moniruzzaman) Non-communicable Disease Unit, World Health Organization
(WHO), Country Office for Bangladesh, Dhaka, Bangladesh
(Lund) Department of Physiotherapy and Occupational Therapy, Holbaek
Hospital, Denmark
(Tang) Heart Centre, Copenhagen University Hospital, Rigshospitalet,
Copenhagen, Denmark
(Tang) CopenRehab, Section of Social Medicine, Department of Public
Health, University of Copenhagen, Denmark
(Tang) Bachelor's Degree Programme in Physiotherapy, Dept. of
Rehabilitation and Nutrition, Faculty of Health and Technology,
Metropolitan University College, Copenhagen, Denmark
(Taylor) Department of Health Services Research, Institute of Health
Research, University of Exeter Medical School, South Cloisters, St Lukes
Campus, Heavitree Road, Exeter EX1 2LU, United Kingdom
Title
Predictors of exercise capacity following exercise-based rehabilitation in
patients with coronary heart disease and heart failure: A meta-regression
analysis.
Source
European Journal of Preventive Cardiology. 23 (7) (pp 683-693), 2015. Date
of Publication: 2015.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background The aim of this study was to undertake a comprehensive
assessment of the patient, intervention and trial-level factors that may
predict exercise capacity following exercise-based rehabilitation in
patients with coronary heart disease and heart failure. Design
Meta-analysis and meta-regression analysis. Methods Randomized controlled
trials of exercise-based rehabilitation were identified from three
published systematic reviews. Exercise capacity was pooled across trials
using random effects meta-analysis, and meta-regression used to examine
the association between exercise capacity and a range of patient (e.g.
age), intervention (e.g. exercise frequency) and trial (e.g. risk of bias)
factors. Results 55 trials (61 exercise-control comparisons, 7553
patients) were included. Following exercise-based rehabilitation compared
to control, overall exercise capacity was on average 0.95 (95% CI:
0.76-1.41) standard deviation units higher, and in trials reporting
maximum oxygen uptake (VO<inf>2</inf>max) was 3.3 ml/kg.min^-1
(95% CI: 2.6-4.0) higher. There was evidence of a high level of
statistical heterogeneity across trials (I² statistic > 50%).
In multivariable meta-regression analysis, only exercise intervention
intensity was found to be significantly associated with VO<inf>2</inf>max
(P = 0.04); those trials with the highest average exercise intensity had
the largest mean post-rehabilitation VO<inf>2</inf>max compared to
control. Conclusions We found considerable heterogeneity across randomized
controlled trials in the magnitude of improvement in exercise capacity
following exercise-based rehabilitation compared to control among patients
with coronary heart disease or heart failure. Whilst higher exercise
intensities were associated with a greater level of post-rehabilitation
exercise capacity, there was no strong evidence to support other
intervention, patient or trial factors to be predictive.<br/>Copyright
&#xa9; The European Society of Cardiology 2015.

<104>
Accession Number
365402101
Author
Kim J.-C.; Shim J.-K.; Lee S.; Yoo Y.-C.; Yang S.-Y.; Kwak Y.-L.
Institution
(Kim) Department of Anesthesiology and Pain Medicine, Kyungpook National
University Hospital, Daegu, South Korea
(Shim, Yoo, Yang, Kwak) Department of Anesthesiology and Pain Medicine,
Anesthesia and Pain Research Institute, Yonsei University College of
Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, South Korea
(Lee) Division of Cardiovascular Surgery, Yonsei University College of
Medicine, Seoul, South Korea
(Kwak) Severance Biomedical Science Institute, Yonsei University College
of Medicine, Seoul, South Korea
Title
Effect of combined remote ischemic preconditioning and postconditioning on
pulmonary function in valvular heart surgery.
Source
Chest. 142 (2) (pp 467-475), 2012. Date of Publication: August 2012.
Publisher
American College of Chest Physicians (3300 Dundee Road, Northbrook IL
60062-2348, United States)
Abstract
Background: The aim of this study was to evaluate the lung-protective
effect of combined remote ischemic preconditioning (RIPCpre) and
postconditioning (RIPCpost ) in patients undergoing complex valvular heart
surgery. Methods: In this randomized, placebo-controlled, double-blind
trial, 54 patients were assigned to an RIPCpre plus RIPCpost group or a
control group (1:1). Patients in the RIPCpre plus RIPCpost group received
three 10-min cycles of right-side lower-limb ischemia of 250 mm Hg at both
10 min after anesthetic induction and weaning from cardiopulmonary bypass.
The primary end point was to compare postoperative
Pa<inf>O2</inf>/F<inf>IO2</inf>. Secondary end points were to compare
pulmonary variables, incidence of acute lung injury, and inflammatory
cytokines. Results: In both groups, Pa<inf>O2</inf>/F<inf>IO2</inf> at 24
h postoperation was significantly decreased compared with each
corresponding baseline value. However, intergroup comparisons of pulmonary
variables, including Pa<inf>O2</inf>/F<inf>IO2</inf> and incidence of
acute lung injury, revealed no significant differences. Serum levels of
IL-6, IL-8, IL-10, and tumor necrosis factor-alpha were all significantly
increased in both groups compared with each corresponding baseline value,
without any significant intergroup differences. There were also no
significant differences in transpulmonary gradient of IL-6, IL-10, and
tumor necrosis factor- a between the groups. Conclusions: RIPC pre plus
RIPCpost as tested in this randomized controlled trial did not provide
significant pulmonary benefit following complex valvular cardiac surgery.
Trial registry: ClinicalTrials.gov; No.: NCT01427621; URL:
www.clinicaltrials.gov. &#xa9; 2012 American College of Chest Physicians.

<105>
Accession Number
365402089
Author
Carteaux G.; Lyazidi A.; Cordoba-Izquierdo A.; Vignaux L.; Jolliet P.;
Thille A.W.; Richard J.-C.M.; Brochard L.
Institution
(Carteaux, Cordoba-Izquierdo, Thille, Brochard) Reanimation Medicale,
Groupe Hospitalier Albert Chenevier-Henri Mondor, Universite Paris EST,
Creteil, France
(Carteaux, Lyazidi, Cordoba-Izquierdo, Thille, Brochard) INSERM Unite 955
(Equipe 13), Universite Paris EST, Creteil, France
(Vignaux, Brochard) Department of Intensive Care, Geneva University
Hospital, Geneva University, Geneva, Switzerland
(Jolliet) Service de Medecine Intensive Adulte et Centre des Brules,
Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
(Jolliet) Faculte de Biologie et de Medicine, Universite de Lausanne,
Lausanne, Switzerland
(Richard) Reanimation Medicale, Centre Hospitalier Universitaire Charles
Nicolle, Rouen, France
Title
Patient-ventilator asynchrony during noninvasive ventilation: A bench and
clinical study.
Source
Chest. 142 (2) (pp 367-376), 2012. Date of Publication: August 2012.
Publisher
American College of Chest Physicians (3300 Dundee Road, Northbrook IL
60062-2348, United States)
Abstract
Background: Different kinds of ventilators are available to perform
noninvasive ventilation (NIV) in ICUs. Which type allows the best
patient-ventilator synchrony is unknown. The objective was to compare
patient-ventilator synchrony during NIV between ICU, transport - both with
and without the NIV algorithm engaged - and dedicated NIV ventilators.
Methods: First, a bench model simulating spontaneous breathing efforts was
used to assess the respective impact of inspiratory and expiratory leaks
on cycling and triggering functions in 19 ventilators. Second, a clinical
study evaluated the incidence of patient-ventilator asynchronies in 15
patients during three randomized, consecutive, 20-min periods of NIV using
an ICU ventilator with and without its NIV algorithm engaged and a
dedicated NIV ventilator. Patient-ventilator asynchrony was assessed using
flow, airway pressure, and respiratory muscles surface electromyogram
recordings. Results: On the bench, frequent auto-triggering and delayed
cycling occurred in the presence of leaks using ICU and transport
ventilators. NIV algorithms unevenly minimized these asynchronies, whereas
no asynchrony was observed with the dedicated NIV ventilators in all
except one. These results were reproduced during the clinical study: The
asynchrony index was significantly lower with a dedicated NIV ventilator
than with ICU ventilators without or with their NIV algorithm engaged
(0.5% [0.4%-1.2%] vs 3.7% [1.4%-10.3%] and 2.0% [1.5%-6.6%], P < .01),
especially because of less auto-triggering. Conclusions: Dedicated NIV
ventilators allow better patient-ventilator synchrony than ICU and
transport ventilators, even with their NIV algorithm. However, the NIV
algorithm improves, at least slightly and with a wide variation among
ventilators, triggering and/or cycling off synchronization. &#xa9; 2012
American College of Chest Physicians.

<106>
Accession Number
616468503
Author
Wu H.-L.; Xu Y.-H.; Shi J.-H.
Institution
(Wu, Xu) Nursing Department of Cardiothoracic-Surgery, Affiliated Hospital
of Nantong University, Nantong City, Jiangsu Province, China
(Shi) Department of Cardiothoracic-Surgery, Affiliated Hospital of Nantong
University, Nantong City, Jiangsu Province, China. Electronic address:
happysjh167@163.com
Title
5% NaHCO3 Is Appropriate for Skin Cleaning With Central Venous Catheters.
Source
The American journal of the medical sciences. 353 (1) (pp 12-16), 2017.
Date of Publication: 01 Jan 2017.
Abstract
OBJECTIVES: The purpose of this study was to compare the effects of skin
cleaning with 5% NaHCO3 to 75% alcohol on the removal of skin grease and
pain of patients with central venous catheters (CVC).
MATERIALS AND METHODS: This was a randomized, controlled, single-blinded
and prospective study. From January-September 2015, 143 consecutive
patients who met the inclusion and exclusion criteria and who underwent
elective cardiovascular surgery with placement of a CVC were selected.
Patients were randomly divided into 2 groups according to the disinfection
preparation procedure: experimental group (n = 60), in which 5% NaHCO3 and
distilled water solution at 40-45degreeC were used, and the control group
(n = 66), in which 75% alcohol was used. Main outcome measures were verbal
rating scale pain score, satisfaction and bacterial count after 2 minutes
of iodine disinfection.
RESULTS: The verbal rating scale pain scores were lower in the
experimental group than in the control group (P < 0.001). In the control
group, 4.5% of patients and 43% of nurses were satisfied with 75% alcohol
cleaning before disinfection procedure, compared to 74% and 78%,
respectively, in the experimental group. The bacterial count did not show
any difference between these 2 groups after iodine disinfection (P =
0.455).
CONCLUSIONS: Cleaning of the CVC before disinfection with 5% NaHCO3 and
distilled water at 40-45degreeC alleviated pain and improved patient and
nurse satisfaction compared with using 75% alcohol.<br/>Copyright &#xa9;
2017 Southern Society for Clinical Investigation. Published by Elsevier
Inc. All rights reserved.

<107>
Accession Number
616452185
Author
Terra R.M.; Araujo P.H.; Lauricella L.L.; Campos J.R.; Costa H.F.;
Pego-Fernandes P.M.
Institution
(Terra, Campos, Pego-Fernandes) Disciplina de Cirurgia Toracica, Instituto
do Coracao, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo
(SP) Brasil
(Araujo, Lauricella, Costa) Instituto do Cancer do Estado de Sao Paulo -
ICESP - Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao
Paulo, Sao Paulo (SP) Brasil
Title
Robotic pulmonary lobectomy for lung cancer treatment: program
implementation and initial experience.
Source
Jornal brasileiro de pneumologia : publicacao oficial da Sociedade
Brasileira de Pneumologia e Tisilogia. 42 (3) (pp 185-190), 2016. Date of
Publication: 01 May 2016.
Abstract
OBJECTIVE: To describe the implementation of a robotic thoracic surgery
program at a public tertiary teaching hospital and to analyze its initial
results.
METHODS: This was a planned interim analysis of a randomized clinical
trial aimed at comparing video-assisted thoracoscopic surgery and robotic
surgery in terms of the results obtained after pulmonary lobectomy. The
robotic surgery program developed at the Instituto do Cancer do Estado de
Sao Paulo, in the city of Sao Paulo, Brazil, is a multidisciplinary
initiative involving various surgical specialties, as well as
anesthesiology, nursing, and clinical engineering teams. In this analysis,
we evaluated the patients included in the robotic lobectomy arm of the
trial during its first three months (from April to June of 2015).
RESULTS: Ten patients were included in this analysis. There were eight
women and two men. The mean age was 65.1 years. All of the patients
presented with peripheral tumors. We performed right upper lobectomy in
four patients, right lower lobectomy in four, and left upper lobectomy in
two. Surgical time varied considerably (range, 135-435 min). Conversion to
open surgery or video-assisted thoracoscopic surgery was not necessary in
any of the cases. Intraoperative complications were not found. Only the
first patient required postoperative transfer to the ICU. There were no
deaths or readmissions within the first 30 days after discharge. The only
postoperative complication was chest pain (grade 3), in two patients.
Pathological examination revealed complete tumor resection in all cases.
CONCLUSIONS: When there is integration and proper training of all of the
teams involved, the implementation of a robotic thoracic surgery program
is feasible and can reduce morbidity and mortality.
OBJETIVO: Descrever a implantacao de um programa de cirurgia toracica
robotica em um hospital terciario publico universitario e analisar seus
resultados iniciais.
METODOS: Este estudo e uma analise interina planejada de um ensaio clinico
aleatorizado cujo objetivo e comparar resultados da lobectomia pulmonar
por videotoracoscopia com a robotica. O programa de cirurgia robotica do
Instituto do Cancer do Estado de Sao Paulo, localizado na cidade de Sao
Paulo (SP), foi uma iniciativa multidisciplinar que envolveu diversas
especialidades cirurgicas e equipes de anestesia, enfermagem e engenharia
clinica. Nesta analise, avaliamos os pacientes incluidos no braco
lobectomia robotica durante os primeiros tres meses do estudo (de abril a
junho de 2015).
RESULTADOS: Dez pacientes foram incluidos nesta analise. Eram oito
mulheres e dois homens. A media de idade foi de 65,1 anos. Todos
apresentavam tumores perifericos. Foram realizadas lobectomia superior
direita, em quatro pacientes; lobectomia inferior direita, em quatro; e
lobectomia superior esquerda, em dois. Os tempos cirurgicos variaram
bastante (variacao, 135-435 min). Nao foi necessaria a conversao para
tecnica aberta ou videotoracoscopica em nenhum paciente. Nao foram
observadas complicacoes intraoperatorias. Apenas o primeiro paciente foi
encaminhado a UTI no pos-operatorio. Nao houve mortalidade nem
reinternacoes em 30 dias apos a alta. A unica complicacao pos-operatoria
observada foi dor toracica (grau 3), em dois pacientes. O exame
anatomopatologico revelou a resseccao completa do tumor em todos os casos.
CONCLUSOES: A implantacao de um programa de cirurgia toracica robotica,
quando ha integracao e treinamento adequado de todas as equipes
envolvidas, e factivel e pode reduzir a morbidade e a mortalidade.

<108>
Accession Number
616450204
Author
Montebugnoli L.; Venturi M.; Cervellati F.; Servidio D.; Vocale C.; Pagan
F.; Landini M.P.; Magnani G.; Sambri V.
Institution
(Montebugnoli, Venturi, Cervellati, Servidio) Section of Oral Science,
Department of Biomedical and Neuromotor Sciences, University of Bologna,
Bologna, Italy
(Vocale, Pagan, Landini) Unit of Microbiology, Regional Reference Centre
for Microbiological Emergencies, St. Orsola Malpighi University Hospital,
Bologna, Italy
(Magnani) Cardiovascular Department, University of Bologna, Bologna, Italy
(Sambri) Unit of Clinical Microbiology, The Hub Laboratory of the Greater
Romagna Area, Pievesestina, Cesena, Italy
Title
Peri-Implant Response and Microflora in Organ Transplant Patients 1 Year
after Prosthetic Loading: A Prospective Controlled Study.
Source
Clinical implant dentistry and related research. 17 (5) (pp 972-982),
2015. Date of Publication: 01 Oct 2015.
Abstract
BACKGROUND: A recent study conducted in humans demonstrated for the first
time that bone loss in the immediate period after implant insertion before
loading did not significantly differ in organ transplant recipients with
respect to normal subjects.
PURPOSE: The purpose of this study is to evaluate bone and periodontal
response and peri-implant microflora in a group of organ-transplanted
patients 1 year after prosthetic loading.
MATERIALS AND METHODS: The study population included 13 consecutive
organ-transplanted (11 hearts, two livers) patients and 13 normal
(healthy) control subjects who received 29 and 28 submerged dental
implants, respectively. Crestal bone level, peri-implant probing depth
(PIPD), and bleeding on probing were evaluated at prosthetic loading and
after 1 year. Samples for microbiological testing were taken from the
subgingival microbiota of each implant 1 year after loading and analyzed
with polymerase chain reaction. All samples were examined for the presence
of five microorganisms: Treponema denticola, Porphyromonas gingivalis,
Prevotella intermedia, Tannarella forsythensis, and Actinobacillus
actinomycetemcomitans.
RESULTS: A mean bone loss of 0.17 +/- 0.10 and 0.20 +/- 0.10 mm at 1 year
was observed in the group of transplant recipients and in controls,
respectively (N.S.). Similar results were obtained considering PIPD
changes at 1 year (respectively 0.06 +/- 0.71 mm in transplants vs 0.11
+/- 0.74 mm in controls). Detection frequencies of pathogens were not
statistically different between normal and transplanted patients.
CONCLUSIONS: The present pilot study seems to indicate that bone and
periodontal response and microbiological status around submerged dental
implants in immunocompromised organ-transplanted patients do not differ 1
year after loading from those observed in control patients and that this
particular population of patients may be successfully rehabilitated with
dental implants.<br/>Copyright &#xa9; 2014 Wiley Periodicals, Inc.

<109>
Accession Number
616449816
Author
Olmos Rodriguez M.; Ballester Hernandez J.A.; Arteta Barcenas M.T.;
Rodriguez Cerezo A.; Vidarte Ortiz de Artinano M.A.; Veiga Alameda C.
Institution
(Olmos Rodriguez, Ballester Hernandez, Arteta Barcenas, Rodriguez Cerezo,
Vidarte Ortiz de Artinano, Veiga Alameda) Servicio de
Anestesia-Reanimacion, Hospital Universitario de Basurto, Bilbao, Vizcaya,
Espana
Title
Effect of priming solution and ultrafiltration on post-operative bleeding
and blood transfusion in cardiac surgery. Randomized controlled trial.
Source
Revista espanola de anestesiologia y reanimacion. 62 (2) (pp 81-89), 2015.
Date of Publication: 01 Feb 2015.