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<1>
Accession Number
613279987
Author
Franco P.; Fiorentino A.; Dionisi F.; Fiore M.; Chiesa S.; Vagge S.;
Cellini F.; Caravatta L.; Tombolini M.; De Rose F.; Meattini I.;
Mortellaro G.; Apicella G.; Marino L.; Greto D.
Institution
(Franco) Department of Oncology-Radiation Oncology, University of Turin,
Via Genova 3, Turin 10126, Italy
(Fiorentino) Radiation Oncology, Ospedale Sacro Cuore-Don Calabria, Negrar
(Verona), Italy
(Dionisi) Department of Oncology, Proton Therapy Unit, Azienda Provinciale
per i Servizi Sanitari (APSS), Trento, Italy
(Fiore) Radiotherapy Unit, Campus Bio-Medico University, Rome, Italy
(Chiesa, Cellini) Radiation Oncology Department-Gemelli ART, Sacred Heart
Catholic University, Rome, Italy
(Vagge) Department of Radio-Oncology, IRCCS AOU San Martino IST, National
Institute for Cancer Research, Genoa, Italy
(Caravatta) Department of Radiation Oncology, Regional Oncological
Hospital, Cagliari, Italy
(Tombolini) Department of Sensory Organs, Institute of
Otorhinolaryngology, Audiology and Phoniatrics, Sapienza University, Rome,
Italy
(De Rose) Radiotherapy and Radiosurgery Department, Humanitas Clinical and
Research Center, Rozzano (Milan), Italy
(Meattini, Greto) Department of Sperimental and Clinical Biomedical
Sciences, Radiation Oncology, AOU Careggi, Florence, Italy
(Mortellaro) Radiation Oncology Department, ARNAS Civico Hospital,
Palermo, Italy
(Apicella) Radiotherapy Department, University Hospital Maggiore della
Carita, Novara, Italy
(Marino) Radiotherapy Department, Centro REM, Catania, Italy
Title
Combined modality therapy for thoracic and head and neck cancers: A review
of updated literature based on a consensus meeting.
Source
Tumori. 102 (5) (pp 459-471), 2016. Date of Publication: September-October
2016.
Publisher
Wichtig Publishing Srl
Abstract
Purpose: Combined modality therapy is a mainstay option for thoracic
malignancies and head and neck cancers. The integration of different
strategies is based on the multidisciplinary approach of modern clinical
oncology. Radiation oncologists have to be educated, trained, and updated
to provide state-of-the-art care to cancer patients and thus educational
meetings are crucial. Methods: The Italian Association of Radiation
Oncology Young Members Working Group (AIRO Giovani) organized its 8th
national meeting, focused on combination therapy in lung, esophageal, and
head and neck cancer (with a specific focus on larynx-preservation
strategies for larynx/hypopharynx tumors), involving young professionals
working in Italy. The meeting was addressed to young radiation
oncologists, presenting state-of-the-art knowledge, based on the latest
evidence in this field. We performed a review of the current literature
based on the highlights of the Congress. Results: The multimodality
approach of head and neck and thoracic malignancies includes surgery,
chemotherapy, and radiotherapy, but also has to take into account new
information and data coming from basic and translational research and
including molecular biology, genetics, and immunology. All these aspects
are crucial for the treatment of non-small-cell lung cancer and
esophageal, esophagogastric junction, and larynx/hypopharynx malignancies.
The integration of different treatments in the clinical decision-making
process to combine therapies is crucial. Conclusions: Combination therapy
has proved to be a consolidated approach in these specific oncologic
settings, highlighting the importance of multimodality management in
modern clinical oncology. Dedicated meetings on specific topics are
helpful to improve knowledge and skills of young professionals in
radiation oncology.

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Accession Number
612933593
Author
McCormick P.J.; Levin M.A.; Lin H.-M.; Sessler D.I.; Reich D.L.
Institution
(McCormick, Levin, Reich) Department of Anesthesiology, Icahn School of
Medicine at Mount Sinai, L. Levy Place Box 1010, New York, NY, United
States
(Levin) Department of Genetics and Genomic Sciences, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
(Lin) Department of Population Health Science and Policy, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
(Sessler) Department of Outcomes Research, Anesthesiology Institute,
Cleveland Clinic, Cleveland, OH, United States
Title
Effectiveness of an Electronic Alert for Hypotension and Low Bispectral
Index on 90-day Postoperative Mortality: A Prospective, Randomized Trial.
Source
Anesthesiology. 125 (6) (pp 1113-1120), 2016. Date of Publication: 01 Dec
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: We tested the hypothesis that an electronic alert for a
"double low" of mean arterial pressure less than 75 mmHg and a bispectral
index less than 45 reduces the primary outcome of 90-day mortality.
Methods: Adults having noncardiac surgery were randomized to receive
either intraoperative alerts for double-low events or no alerts.
Anesthesiologists were not blinded and not required to alter care based
upon the alerts. The primary outcome was all-cause 90-day mortality.
Results: Patients (20,239) were randomized over 33 months, and 19,092 were
analyzed. After adjusting for age, comorbidities, and perioperative
factors, patients with more than 60 min of cumulative double-low time were
twice as likely to die (hazard ratio, 1.99; 95% CI, 1.2 to 3.2; P =
0.005). The median number of double-low minutes (quartiles) was only
slightly lower in the alert arm: 10 (2 to 30) versus 12 (2 to 34) min.
Ninety-day mortality was 135 (1.4%) in the alert arm and 123 (1.3%) in the
control arm. The difference in percent mortality was 0.18% (99% CI, -0.25
to 0.61). Conclusions: Ninety-day mortality was not significantly lower in
patients cared for by anesthesiologists who received automated alerts to
double-low states. Prolonged cumulative double-low conditions were
strongly associated with mortality.<br/>Copyright &#xa9; 2016, the
American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc.
All Rights Reserved.

<3>
[Use Link to view the full text]
Accession Number
611215695
Author
McGuinness S.P.; Parke R.L.; Drummond K.; Willcox T.; Bailey M.
Institution
(McGuinness, Parke) CVICU Research, Auckland City Hospital, Grafton, PO
Box 110147, Auckland 1148, New Zealand
(McGuinness, Parke) Medical Research Institute of New Zealand, Wellington,
New Zealand
(McGuinness, Parke, Bailey) ANZIC-Research Centre, Department of
Epidemiology and Preventive Medicine, Monash University, Melbourne,
Australia
(Drummond) Royal Adelaide Hospital, Adelaide, SA, Australia
(Willcox) Clinical Perfusion, Green Lane Cardiothoracic Surgical Unit,
Auckland City Hospital, Auckland, New Zealand
(Willcox) Department of Anaesthesiology, University of Auckland, Auckland,
New Zealand
Title
A multicenter, randomized, controlled Phase IIb trial of avoidance of
hyperoxemia during cardiopulmonary bypass.
Source
Anesthesiology. 125 (3) (pp 465-473), 2016. Date of Publication: 01 Sep
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Cardiac surgery utilizing cardiopulmonary bypass (CPB) is one
of the most common forms of major surgery. Cardiac surgery-associated
multiorgan dysfunction (CSA-MOD) is well recognized and includes acute
kidney injury (AKI), hepatic impairment, myocardial damage, and
postoperative neurologic deficit. Pathophysiology of CSA-MOD involves
numerous injurious pathways linked to the use of CPB including oxidative
stress and formation of reactive iron species. During cardiac surgery with
CPB, arterial return blood is oxygenated to supranormal levels. This study
aimed to determine whether the avoidance of arterial hyperoxemia decreased
oxidative stress and reduced the severity of the multiorgan dysfunction in
patients undergoing cardiac surgery utilizing CPB. Methods: The study was
a multicenter, open-label, parallel-group, randomized controlled study of
the avoidance of arterial hyperoxemia versus usual care in patients
undergoing cardiac surgery involving CPB. Primary outcome was the
incidence and severity of AKI. Secondary outcomes included serum
biomarkers for CSA-MOD, duration of mechanical ventilation, and length of
intensive care and hospital stay. Results: A total of 298 patients were
randomized and analyzed at two hospitals in New Zealand and Australia.
Mean Pao 2 was significantly different between groups during CPB. There
was no difference in the development of AKI (intervention arm 72.0% vs.
usual care 66.2%; difference, -5.8% [95% CI, -16.1 to 4.7%]; P = 0.28),
other markers of organ damage, or intensive care unit and hospital length
of stay. Conclusions: Avoiding modest hyperoxemia during CPB failed to
demonstrate any difference in AKI, markers of organ damage, or length of
stay.<br/>Copyright &#xa9; 2016, the American Society of
Anesthesiologists, Inc. Wolters Kluwer Health, Inc.

<4>
Accession Number
607768298
Author
Islam A.K.M.M.; Majumder A.A.S.
Institution
(Islam) Department of Cardiology, Jessore Medical College, Jessore,
Bangladesh
(Majumder) National Institute of Cardiovascular Diseases, Dhaka, National
Centre for Control of Rheumatic Fever and Heart Diseases, Dhaka,
Bangladesh
Title
Rheumatic fever and rheumatic heart disease in Bangladesh: A review.
Source
Indian Heart Journal. 68 (1) (pp 88-98), 2016. Date of Publication: 01 Jan
2016.
Publisher
Elsevier B.V.
Abstract
Rheumatic fever (RF) and rheumatic heart disease (RHD) are the most-common
cardiovascular disease in young people aged <25 years, globally. They are
important contributors to cardiovascular morbidity and mortality in
Bangladesh. Classical risk factors, i.e. poverty, overcrowding, ignorance,
and insufficient health care services were responsible for the high
incidence and prevalence of these diseases over the last century. In
concert with the progresses in socioeconomic indicators, advances in
health sectors, improved public awareness, and antibiotic prophylaxis,
acute RF came into control. However, chronic RHD continues to be
prevalent, and the actual disease burden may be much higher. RHD
predominantly affects the young adults, seriously incapacitates them,
follows a protracted course, gets complicated because of delayed diagnosis
and is sometimes maltreated. The treatment is often palliative and
expensive. Large-scale epidemiological and clinical researches are needed
to formulate evidence-based national policy to tackle this important
public health issue in future.<br/>Copyright &#xa9; 2015 Cardiological
Society of India.

<5>
Accession Number
614738629
Author
Hascoet S.; Fournier E.; Jais X.; Le Gloan L.; Dauphin C.; Houeijeh A.;
Godart F.; Iriart X.; Richard A.; Radojevic J.; Amedro P.; Bosser G.;
Souletie N.; Bernard Y.; Moceri P.; Bouvaist H.; Mauran P.; Barre E.;
Basquin A.; Karsenty C.; Bonnet D.; Iserin L.; Sitbon O.; Petit J.; Fadel
E.; Humbert M.; Ladouceur M.
Institution
(Hascoet, Fournier, Petit) Department of congenital heart diseases, centre
de reference malformations cardiaques congenitales complexes M3C, hopital
Marie-Lannelongue, 133, avenue de la Resistance, Le Plessis-Robinson
92350, France
(Hascoet, Fournier, Petit) Faculte de medecine Paris-Sud, universite
Paris-Sud, universite Paris-Saclay, Paris, France
(Fournier, Iriart) Department of congenital heart diseases, centre de
competence M3C, CHU de Bordeaux, Bordeaux, France
(Jais, Sitbon, Humbert) Service de pneumologie, centre de reference de
l'hypertension pulmonaire severe, DHU thorax innovation, hopital Bicetre,
Le Kremlin-Bicetre, France
(Jais, Sitbon, Fadel, Humbert) UMR-S 999, Inserm, hopital
Marie-Lannelongue, universite Paris-Sud, universite Paris-Saclay, Paris,
France
(Le Gloan) Department of cardiology, centre de competence M3C, CHU de
Nantes, Nantes, France
(Dauphin) Department of cardiology, centre de competence M3C, CHU de
Clermont-Ferrand, Clermont-Ferrand, France
(Houeijeh, Godart) Department of paediatric cardiology, centre de
competence M3C, CHRU de Lille, Lille, France
(Richard) Paediatric and adult congenital heart diseases centre, cabinet
Intercard Vendome, Lille, France
(Radojevic) Fetal, paediatric and congenital cardiology, clinique de
l'Orangerie, Strasbourg, France
(Amedro) Paediatric and congenital cardiology department, M3C regional
reference centre, university hospital, physiology and experimental biology
of heart and muscles laboratory, PHYMEDEXP, UMR CNRS 9214-Inserm U1046,
university of Montpellier, Montpellier, France
(Bosser) Department of congenital heart diseases and paediatric
cardiology, centre de competence M3C, CHRU de Nancy, Nancy, France
(Souletie, Karsenty) Department of cardiology, centre de competence M3C,
CHU de Toulouse, Toulouse, France
(Bernard) Department of cardiology, centre de competence M3C, CHU de
Besancon, Besancon, France
(Moceri) Department of cardiology, centre de competence M3C, CHU de Nice,
Nice, France
(Bouvaist) Department of cardiology, centre de competence M3C, CHU de
Grenoble, Grenoble, France
(Mauran) Department of paediatric and congenital cardiology, centre de
competence M3C, American memorial hospital, CHU de Reims, Reims, France
(Barre) Department of paediatric and congenital cardiology, centre de
competence M3C, CHU de Rouen, Rouen, France
(Basquin) Department of cardiology, centre de competence M3C, CHU de
Rennes, Rennes, France
(Karsenty, Iserin, Ladouceur) Adult congenital heart diseases unit,
department of cardiology, centre de reference M3C, hopital europeen
Georges-Pompidou, Assistance publique-Hopitaux de Paris, Paris, France
(Karsenty, Iserin, Ladouceur) Paris cardiovascular research centre
(PARCC), Inserm U970, Paris Descartes University, Paris, France
(Bonnet, Ladouceur) Centre de reference malformations cardiaques
congenitales complexes M3C, hopital universitaire Necker-Enfants-Malades,
Assistance publique-Hopitaux de Paris, universite Paris Descartes,
Sorbonne Paris Cite, Paris, France
(Fadel) Department of thoracic surgery, hopital Marie-Lannelongue,
Plessis-Robinson, France
(Fadel) Faculte de medecine Paris-Sud, universite Paris Sud, universite
Paris-Saclay, Paris, France
Title
Outcome of adults with Eisenmenger syndrome treated with drugs specific to
pulmonary arterial hypertension: A French multicentre study.
Source
Archives of Cardiovascular Diseases. 110 (5) (pp 303-316), 2017. Date of
Publication: May 2017.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Background The relationship between pulmonary arterial
hypertension-specific drug therapy (PAH-SDT) and mortality in Eisenmenger
syndrome (ES) is controversial. Aims To investigate outcomes in patients
with ES, and their relationship with PAH-SDT. Methods Retrospective,
observational, nationwide, multicentre cohort study. Results We included
340 patients with ES: genetic syndrome (n = 119; 35.3%); pretricuspid
defect (n = 75; 22.1%). Overall, 276 (81.2%) patients received PAH-SDT:
monotherapy (endothelin receptor antagonist [ERA] or phosphodiesterase 5
inhibitor [PDE5I]) 46.7%; dual therapy (ERA + PDE5I) 40.9%; triple therapy
(ERA + PDE5I + prostanoid) 9.1%. Median PAH-SDT duration was 5.5 years
[3.0-9.1 years]. Events (death, lung or heart-lung transplantation)
occurred in 95 (27.9%) patients at a median age of 40.5 years [29.4-47.6].
The cumulative occurrence of events was 16.7% [95% confidence interval
12.8-21.6%] and 46.4% [95% confidence interval 38.2-55.4%] at age 40 and
60 years, respectively. With age at evaluation or time since PAH diagnosis
as time scales, cumulative occurrence of events was lower in patients
taking one or two PAH-SDTs (P = 0.0001 and P = 0.004, respectively), with
the largest differences in the post-tricuspid defect subgroup (P < 0.001
and P < 0.02, respectively) versus patients without PAH-SDT. By
multivariable Cox analysis, with time since PAH diagnosis as time scale,
New York Heart Association/World Health Organization functional class
III/IV, lower peripheral arterial oxygen saturation and pretricuspid
defect were associated with a higher risk of events (P = 0.002, P = 0.01
and P = 0.04, respectively), and one or two PAH-SDTs with a lower risk of
events (P = 0.009). Conclusions Outcomes are poor in ES, but seem better
with PAH-SDT. ES with pretricuspid defects has worse outcomes despite the
delayed disease onset.<br/>Copyright &#xa9; 2017 Elsevier Masson SAS

<6>
Accession Number
615615840
Author
Putzu A.; Gallo M.; Martino E.A.; Ferrari E.; Pedrazzini G.; Moccetti T.;
Cassina T.
Institution
(Putzu, Cassina) Department of Cardiovascular Anesthesia and Intensive
Care, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland
(Gallo, Ferrari) Department of Cardiac Surgery, Cardiocentro Ticino, Via
Tesserete 48, Lugano, Switzerland
(Martino) Department of Anesthesia and Intensive Care, San Gerardo
Hospital, Via Pergolesi 33, Monza, Italy
(Pedrazzini, Moccetti) Department of Cardiology, Cardiocentro Ticino, Via
Tesserete 48, Lugano, Switzerland
Title
Coronary artery bypass graft surgery versus percutaneous coronary
intervention with drug-eluting stents for left main coronary artery
disease: A meta-analysis of randomized trials.
Source
International Journal of Cardiology. 241 (pp 142-148), 2017. Date of
Publication: 15 Aug 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Despite several clinical studies, efficacy of coronary artery
bypass grafting (CABG) surgery versus percutaneous coronary intervention
(PCI) in patients with left main (LM) disease remains controversial. The
objective of this meta-analysis of randomized trials was to evaluate the
clinical outcome of CABG versus PCI with drug-eluting stents in LM
coronary disease. Methods We systematically searched online databases up
to March 2017 for randomized trials comparing CABG to PCI with
drug-eluting stents. We calculated odds ratios (ORs) and 95% confidence
intervals (CIs). Results We included data from 5 randomized trials and
4595 patients. At 30 days, CABG was associated with higher stroke (OR 2.54
[95% CI, 1.02-6.31]) and periprocedural myocardial infarction (OR 1.45
[95% CI, 1.00-2.10]), with no other significant differences compared to
PCI. At 1 year, CABG reduced repeat revascularization (OR 0.56 [95% CI,
0.40-0.77]), but increased stroke (OR 5.11 [95% CI, 1.62-16.12]). At 3-5
years, CABG reduced repeat revascularization (OR 0.55 [95% CI, 0.45-0.67])
and non-periprocedural myocardial infarction (OR 0.45 [95% CI,
0.29-0.70]), without significant differences on other outcomes.
Conclusions From the present updated meta-analysis of available studies on
LM coronary disease treatment, there were no differences in mortality,
myocardial infarction, and stroke rate at 3-5 years follow-up after CABG
or PCI, but CABG decreased the rate of repeat revascularization and
non-periprocedural infarction. However, at short-term follow-up, CABG
showed higher rate of stroke and periprocedural myocardial infarction, but
these effects attenuated over time. These findings merit further
investigation at longer follow-up.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<7>
Accession Number
613696392
Author
Panoulas V.F.; Montorfano M.; Taramasso M.; Giustino G.; La Canna G.;
Latib A.; Colombo A.
Institution
(Panoulas, Montorfano, Taramasso, Giustino, Latib, Colombo) Interventional
Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
(Panoulas, Giustino, Latib, Colombo) EMO-GVM Centro Cuore Columbus, Milan,
Italy
(Panoulas) Imperial College London, National Heart and Lung Institute,
London, United Kingdom
(La Canna) Cardiac surgery echocardiography unit, San Raffaele Scientific
Institute, Milan, Italy
Title
A tricky percutaneous paravalvular leak closure two years after
implantation of 3f enable sutureless bioprosthetic aortic valve.
Source
Hellenic Journal of Cardiology. 57 (1) (pp 41-44), 2016. Date of
Publication: 01 Jan 2016.
Publisher
Hellenic Cardiological Society
Abstract
Sutureless valves were designed in an attempt to simplify the aortic valve
replacement procedure and reduce extracorporeal circuit time, whilst
allowing complete excision of the calcified native valve using a minimally
invasive approach. Elderly patients with significant comorbidities are
considered to benefit the most, although randomized data are lacking. In
registries of patients treated with implantation of a 3f Enable sutureless
bioprosthetic aortic valve, all patients who developed paravalvular leak
have been treated with valve explantation. This is the first case report
describing a tricky yet successful percutaneous paravalvular leak closure
2 years after implantation of a 3f Enable sutureless aortic
bioprosthesis.<br/>Copyright &#xa9; 2016 Hellenic Cardiological Society.
All Right Reserved.

<8>
Accession Number
614410223
Author
Meyer-Saraei R.; de Waha S.; Eitel I.; Desch S.; Scheller B.; Bohm M.;
Lauer B.; Gawaz M.; Geisler T.; Gunkel O.; Bruch L.; Klein N.; Pfeiffer
D.; Schuler G.; Zeymer U.; Thiele H.
Institution
(Meyer-Saraei, de Waha, Eitel, Desch, Thiele) Department of Cardiology,
Angiology and Intensive Care Medicine, University Heart Centre Luebeck,
University Hospital Schleswig-Holstein, Luebeck, Germany
(Meyer-Saraei, de Waha, Eitel, Desch, Thiele) German Centre for
Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck,
Luebeck, Germany
(Scheller, Bohm) Department of Internal Medicine III, University of
Saarland, Homburg, Germany
(Lauer) Department of Cardiology, Zentralklinik Bad Berka, Germany
(Gawaz, Geisler) Department of Cardiology/Cardiovascular Medicine,
University of Tuebingen, Germany
(Gunkel) Department of Internal Medicine II, Klinikum Frankfurt/Oder,
Germany
(Bruch) Department of Internal Medicine, Unfallkrankenhaus Berlin, Germany
(Klein, Pfeiffer) Department of Internal Medicine I, University of
Leipzig, Germany
(Schuler) Department of Internal Medicine/Cardiology, University of
Leipzig Heart Centre, Germany
(Zeymer) Institut fur Herzinfarktforschung, Klinikum der Stadt
Ludwigshafen, Germany
Title
Thrombus aspiration in non-ST-elevation myocardial infarction - 12-month
clinical outcome of the randomised TATORT-NSTEMI trial.
Source
European Heart Journal: Acute Cardiovascular Care. 6 (1) (pp 10-17), 2017.
Date of Publication: 01 Feb 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: In the randomised TATORT-NSTEMI trial routine thrombus
aspiration in comparison with standard percutaneous coronary intervention
(PCI) did not reduce the primary endpoint of microvascular obstruction
assessed by cardiac magnetic resonance imaging in patients with
non-ST-elevation myocardial infarction (NSTEMI). So far, no data on
long-term outcome of head-to-head comparisons between both treatment
strategies in NSTEMI patients have been reported. Methods: The
prospective, controlled, multicentre, randomised, open-label TATORT-NSTEMI
trial assigned patients with NSTEMI and thrombus-containing lesions to
aspiration thrombectomy plus PCI (n=221) or standard PCI only (n=219). The
primary endpoint of the current analysis was the occurrence of major
adverse cardiac events defined as the composite of death, myocardial
reinfarction, target vessel revascularisation, and new congestive heart
failure at 12-month follow-up. In addition, functional outcome and quality
of life were assessed. Results: At one year, major adverse cardiac events
occurred in 19 patients in the thrombectomy arm and 29 patients in the
standard PCI group (8.7% vs. 13.4%, relative risk 0.63, 95% confidence
interval 0.35-1.12, p=0.11). The individual components of the combined
endpoint such as death (p=0.20), myocardial reinfarction (p=0.73), target
vessel revascularisation (p=0.42), and congestive heart failure (p=0.18)
were similar in both groups. Functional outcome and quality of life did
not differ significantly between both groups (Canadian Cardiovascular
Society class: p=0.68, New York Heart Association class: p=0.70 and
EuroQol5D score: p=0.96). Post-hoc analyses revealed consistent results
with regard to the occurrence of major adverse cardiac events across a
wide range of subgroups (all p>0.05). Conclusions: In this first
randomised trial on thrombectomy in NSTEMI patients, routine thrombus
aspiration before PCI did not improve clinical outcome at 12-month
follow-up.<br/>Copyright &#xa9; 2015, &#xa9; The European Society of
Cardiology 2015.

<9>
Accession Number
615012015
Author
Teng Z.; Ma X.; Zhang Q.; Yun Y.; Ma C.; Hu S.; Zou C.
Institution
(Ma, Zhang, Zou) Department of Cardiac Surgery, Shandong Provincial
Hospital, Affiliated to Shandong University, No.324 Jingwu Road, Jinan,
Shandong 250021, China
(Teng) Cardiovascular Center, Weihai Municipal Hospital, Weihai, China
(Ma, Yun, Ma, Zou) Shandong University, School of Medicine, Jinan, China
(Hu) Department of Postgraduate, Taishan Medical University, Taian, China
Title
Additional mitral valve procedure and coronary artery bypass grafting
versus isolated coronary artery bypass grafting in the management of
significant Functional ischemic mitral regurgitation: A meta-analysis.
Source
Journal of Cardiovascular Surgery. 58 (1) (pp 121-130), 2017. Date of
Publication: 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
NTRODUCTION: Functional ischemic mitral regurgitation (IMR) is commonly
present following acute myocardial infarction (AMI) and tightly associated
with a poorer prognosis. The optimal surgical strategy for the management
of significant IMR (.2+ grade) remains controversial and mitral valve
surgery (MVS) at the time of coronary artery bypass grafting (CABG) is
still debated. The primary objective of this meta-analysis was to clarify
the effects of additional MVS on the prognosis in the patients with
significant IMR, compared with isolated CABG. EVIDENCE ACQUISITION: A
meta-analysis of eligible studies, reporting concomitant MVS and CABG in
comparison with CABG alone in respects to in-hospital mortality, survival
and postoperative residual mitral regurgitation (MR) and cardiac
functional status, was carried out. The outcomes of interest included
in-hospital mortality, one-, three- and five-year survival and
postoperative New York Heart Association (NYHA) class, residual MR and
left ventricular ejection fraction (LVEF). EVIDENCE SYNTHESIS: Pooling 2
randomized controlled trials (RCTs) (N.=175) and 11 observational studies
(N.=2661) demonstrated that additional MVS did not significantly influence
in-hospital mortality (odds ratio [OR]=1.45, 95% confidence interval [CI]
0.93-2.28, P=0.10) and one-(OR=0.89, 95%CI 0.68-1.15, P=0.37),
three-(OR=1.10, 95%CI 0.79-1.55, P=0.56) and five-(OR=0.93, 95%CI
0.73-1.18, P=0.55) year survival in comparison with isolated CABG. And
pooling neither RCTs nor observational studies alone presented any
evidence of significant difference in in-hospital mortality and survival
between the two groups. Additionally, concomitant MVS was associated with
increased postoperative LVEF (standard mean differences [SMD]=0.28, 95%CI
0.10-0.46, P<0.01) and decreased postoperative residual MR (SMD=-4.22,
95%CI-6.48 to -1.97, P<0.0001). Similar outcomes were obtained when either
RCTs or observational studies were pooled alone. Additional MVS appeared
to decrease postoperative NYHA functional class (SMD=-0.48, 95%CI
-0.97-0.00, P=0.05) with evident heterogeneity (I²=87.5%,
P<0.0001). In the subgroup analysis, MVS significantly reduced
postoperative NYHA functional class in RCTs (SMD=-1.32, 95%CI -1.67 to
-0.97, P<0.0001) whereas it did not among observational studies
(SMD=-0.08, 95%CI -0.27-0.11, P=0.42), and heterogeneity was completely
eliminated (for RCTs, I2=0%, P=0.49; for observational studies, I2=0%,
P=0.40). CONCLUSIONS: Concomitant MVS at the time of CABG is associated
with greater improvement in postoperative residual MR and LVEF in the
patients with significant IMR. However, the evidence is still lacking of
advantages of combined surgery over CABG alone regarding in-hospital
mortality, survival and postoperative NYHA function class. Additional RCTs
are needed to assess the safety and efficacy outcomes of adding mitral
valve procedure in the surgical intervention of significant
IMR.<br/>Copyright &#xa9; 2016 EDIZIONI MINERVA MEDICA.

<10>
[Use Link to view the full text]
Accession Number
611807739
Author
Rasmussen K.C.; Secher N.H.; Pedersen T.
Institution
(Rasmussen, Secher) Department of Anesthesiology, Rigshospitalet,
Blegdamsvej 9, Copenhagen DK-2100, Denmark
(Pedersen) Center of Head and Orthopaedic Surgery, Rigshospitalet,
University of Copenhagen, Denmark
Title
Effect of perioperative crystalloid or colloid fluid therapy on
hemorrhage, coagulation competence, and outcome: A systematic review and
stratified meta-analysis.
Source
Medicine (United States). 95 (31) (no pagination), 2016. Article Number:
e4498. Date of Publication: 01 Aug 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: A meta-analysis concerning perioperative coagulation
competence, hemorrhage, and outcome was conducted including the use of
hydroxyethyl starches (HESs), dextran, or albumin versus administration of
a crystalloid as control to assess the efficacy and safety of colloids and
crystalloids for fluid administration during major elective surgery.
Surgery was restricted to cardiovascular and noncardiovascular surgery,
and HESs were stratified to HES 130/0.4 and HES 200/0.5. Methods: We
searched Cochrane Central Register of Controlled Trials, MEDLINE, ISI Web
of Science, EMBASE, conference proceedings, reference lists, and databases
of ongoing trials. Results: Thirty one primary clinical randomized
controlled trials included 2287 patients undergoing major surgery from
January 2000 to August 2015. The perioperative changes in coagulation
competence were measured by thromboelastography (TEG) maximum amplitude
(MA) in 9 studies administering crystalloids versus HES and in 4 studies
administering albumin versus HES. All studies but 1 disclosed increased
reduction in TEG-MA following HES administration (P = 0.0001 and 0.0002).
The total loss of blood was reported in 17 studies in which crystalloids
were compared to HES and 12 studies reported increased blood loss after
administration of HES (P < 0.003). When administering albumin versus HES,
6 studies reported reduced hemorrhage associated with albumin
administration (P = 0.005). Reoperation was not significantly reduced by
the use of crystalloids, but may be more frequent after HESs compared to
albumin (P < 0.03). In this analysis, more patients admitted to
administration of HESs were exposed to decrease coagulation competence,
compared to perioperative crystalloids and albumin administration.
Conclusion: This stratified meta-analysis showed that increased blood loss
was found in noncardiovascular surgery among patients receiving HES
compared with crystalloids, followed by a marked reduction in TEG-MA, and
infusion of 3rd-generation HES products did not influence the results
significantly.<br/>Copyright &#xa9; 2016 the Author(s). Published by
Wolters Kluwer Health, Inc. All rights reserved.

<11>
[Use Link to view the full text]
Accession Number
611807732
Author
Meybohm P.; Choorapoikayil S.; Wessels A.; Herrmann E.; Zacharowski K.;
Spahn D.R.
Institution
(Meybohm, Choorapoikayil, Wessels, Zacharowski) Department of
Anesthesiology, Intensive Care Medicine and Pain Therapy, University
Hospital Frankfurt, Germany
(Herrmann) Institute for Anesthesiology, University and University
Hospital Zurich, Zurich, Switzerland
(Spahn) Institute of Biostatistics and Mathematical Modelling, Goethe
University Frankfurt, Germany
Title
Washed cell salvage in surgical patients: A review and meta-analysis of
prospective randomized trials under PRISMA.
Source
Medicine (United States). 95 (31) (no pagination), 2016. Article Number:
e4490. Date of Publication: 01 Aug 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Cell salvage is commonly used as part of a blood conservation
strategy. However concerns among clinicians exist about the efficacy of
transfusion of washed cell salvage. Methods: We performed a meta-analysis
of randomized controlled trials in which patients, scheduled for all types
of surgery, were randomized to washed cell salvage or to a control group
with no cell salvage. Data were independently extracted, risk ratio (RR),
and weighted mean differences (WMD) with 95% confidence intervals (CIs)
were calculated. Data were pooled using a random effects model. The
primary endpoint was the number of patients exposed to allogeneic red
blood cell (RBC) transfusion. Results: Out of 1140 search results, a total
of 47 trials were included. Overall, the use of washed cell salvage
reduced the rate of exposure to allogeneic RBC transfusion by a relative
39% (RR = 0.61; 95% CI 0.57 to 0.65; P < 0.001), resulting in an average
saving of 0.20 units of allogeneic RBC per patient (weighted mean
differences [WMD] = -0.20; 95% CI -0.22 to -0.18; P < 0.001), reduced risk
of infection by 28% (RR = 0.72; 95% CI 0.54 to 0.97; P = 0.03), reduced
length of hospital stay by 2.31 days (WMD = -2.31; 95% CI -2.50 to -2.11;
P < 0.001), but did not significantly affect risk of mortality (RR = 0.92;
95% CI 0.63 to 1.34; P = 0.66). No statistical difference could be
observed in the number of patients exposed to re-operation, plasma,
platelets, or rate of myocardial infarction and stroke. Conclusions:
Washed cell salvage is efficacious in reducing the need for allogeneic RBC
transfusion and risk of infection in surgery.<br/>Copyright &#xa9; 2016
the Author(s). Published by Wolters Kluwer Health, Inc. All rights
reserved.

<12>
Accession Number
611807729
Author
Byun S.H.; Kang S.H.; Kim J.H.; Ryu T.; Kim B.J.; Jung J.Y.
Institution
(Byun, Kang, Kim, Ryu, Kim, Jung) Department of Anesthesiology and Pain
Medicine, School of Medicine, Catholic University of Daegu, 33,
Duryugongwonro 17-gil, Nam-gu, Daegu 42472, South Korea
Title
Comparison of a tube-holder (Rescuefix) versus tape-tying for minimizing
double-lumen tube displacement during lateral positioning in thoracic
surgery: A prospective, randomized controlled study.
Source
Medicine (United States). 95 (31) (no pagination), 2016. Article Number:
e4486. Date of Publication: 01 Aug 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Double-lumen endotracheal tubes (DLTs) are often displaced
during change from the supine to the lateral decubitus position. The aim
of this study was to determine whether Rescuefix, a recently developed
tube-holder device, is more effective than the traditional tape-tying
method for tube security during lateral positioning. Methods: Patients
were randomly assigned to a Rescuefix (R) group (n = 22) or a tape (T)
group (n = 22). After intubation with a left-sided DLT and adjustment of
the appropriate DLT position using a fiberoptic bronchoscope, the DLT was
fixed firmly at the side of the mouth by either Rescuefix or Durapore
tape. "Tracheal depth" (from the tracheal carina to the elbow connector of
the DLT) and "bronchial depth" (from the left bronchial carina to the
elbow connector of the DLT) were measured in the supine position using the
fiberoptic bronchoscope. After positional change, tracheal and bronchial
depths were measured as described above. As the primary endpoint,
displacement of the DLT during positional change was evaluated by
obtaining the difference in depths measured when the patient was in the
supine and lateral decubitus positions. In addition, after lateral
positioning of the patient, any requirement for repositioning the DLT was
recorded. Results: After lateral positioning, there were no significant
differences in changes in tracheal and bronchial depths between the groups
(tracheal depth 6.1 +/- 4.4 mm [R group] and 9.1 +/- 5.6 mm [T group], P =
0.058; bronchial depth 6.5 +/- 4.4 mm [R group], and 8.5 +/- 4.6 mm [T
group], P = 0.132). Although the amount of change in tracheal and
bronchial depths was not different between the groups, the need to
reposition the DLT was significantly lower in the R group than in the T
group (32% vs 68%, P = 0.016). Conclusion: This study demonstrated that
use of Rescuefix did not reduce the amount of DLT displacement, but it did
significantly lower the incidence of DLT repositioning compared with the
tape-tying method. Therefore, Rescuefix appears to be an effective
alternative to minimizing DLT displacement during lateral positioning in
thoracic surgery. Trial registration: http://cris.nih.go.kr identifier:
KCT0001949.<br/>Copyright &#xa9; 2016 the Author(s). Published by Wolters
Kluwer Health, Inc. All rights reserved.

<13>
[Use Link to view the full text]
Accession Number
610532532
Author
Zheng J.; Cheng J.; Zhang Q.; Qi C.; Wang T.; Xiao X.
Institution
(Zheng, Zhang, Qi, Wang, Xiao) Department of Endocrinology, Key Laboratory
of Endocrinology, Ministry of Health, Peking Union Medical College
Hospital, Diabetes Research Center of Chinese Academy of Medical Sciences,
Peking Union Medical College, Wangfujing Street, Dongcheng District,
Beijing 100730, China
(Cheng) Key Laboratory of Cardiovascular Remodeling and Function Research,
Chinese Ministry of Education and Chinese Ministry of Public Health,
Department of Cardiology, Qilu Hospital of Shandong University, Jinan,
China
Title
Association between glycosylated hemoglobin level and cardiovascular
outcomes in diabetic patients after percutaneous coronary intervention.
Source
Medicine (United States). 95 (19) (no pagination), 2016. Article Number:
e3696. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Glycosylated hemoglobin (HbA1c) is a critical measure of glycemic control,
which may be a reliable predictor of complications after percutaneous
coronary intervention (PCI). This systematic review and meta-analysis
evaluates the association between HbA1c levels and clinical outcomes in
diabetic patients after PCI. Pubmed, Embase, and Cochrane Library
databases (dated to December 2015) were screened for relevant studies.
Appropriate diabetic cases and controls, assessed using blood HbA1c
levels, were extracted, and statistical analysis was conducted using
RevMan 5.3 software. Summary odds ratios (ORs) with 95% confidence
intervals (CIs) were used to calculate the associations between HbA1c
levels and clinical outcomes in diabetic patients after PCI. Ethics review
and approval was not necessary because this systematic meta-analysis did
not involve any direct human trials or animal experiments. Eight studies
that reported HbA1c levels for a total of 3290 diabetic subjects after PCI
were included in this meta-analysis. Comprehensive integration and
analysis revealed a significant correlation between higher HbA1c levels
and the risk of target vessel revascularization progression (OR 1.36, 95%
CI 1.03-1.82) and nonfatal myocardial infarction after PCI (OR 2.47, 95%
CI 1.38-4.44). However, no significant association was found between HbA1c
levels and major adverse cardiovascular events (OR 1.02, 95% CI
0.83-1.27), all-cause mortality (OR 0.73, 95% CI 0.52-1.02), cardiac death
(OR 1.12, 95% CI 0.62-2.03), or in-stent thrombosis (OR 0.65, 95% CI
0.23-1.87) among diabetic patients after PCI. Sensitivity analysis
indicated a statistically robust result and revealed no publication bias.
Our meta-analysis demonstrated that blood HbA1c levels might be associated
with higher risks of target vessel revascularization progression and
nonfatal myocardial infarction among diabetic patients after PCI. However,
further studies with larger sample sizes are required to verify the
association.<br/>Copyright &#xa9; 2016 Wolters Kluwer Health, Inc. All
rights reserved.

<14>
Accession Number
616753711
Author
Wang X.-W.; Qu C.; Huang C.; Xiang X.-Y.; Lu Z.-Q.
Institution
(Wang, Xiang) Department of Cardiothoracic Surgery, The First Affiliated
Hospital of Chongqing Medical University, Chongqing, 400016, People's
Republic of China
(Wang, Lu) Department of Cardiothoracic Surgery, Shanghai Jiao Tong
University Affiliated Sixth People's Hospital, Shanghai, 200233, People's
Republic of China
(Qu) Department of Pharmacy, The First Affiliated Hospital of Chongqing
Medical University, Chongqing, 400016, People's Republic of China
(Huang) Department of Cardiothoracic Surgery, The First Affiliated
Hospital of Chongqing Medical University, Chongqing, 400016, People's
Republic of China. hcsurgery@163.com
Title
Minimally invasive direct coronary bypass compared with percutaneous
coronary intervention for left anterior descending artery disease: a
meta-analysis.
Source
Journal of cardiothoracic surgery. 11 (1) (pp 125), 2016. Date of
Publication: 05 Aug 2016.
Abstract
BACKGROUND: The clinical outcomes for left anterior descending (LAD)
coronary artery lesion between minimally invasive direct coronary artery
bypass (MIDCAB) and percutaneous coronary intervention (PCI) are still
controversial. The objective was to compare safety and efficacy between
MIDCAB and PCI for LAD.
METHODS: Electronic databases and article references were systematically
searched to access relevant studies. End points included mortality,
myocardial infarction, target vessel revascularization (TVR), major
adverse coronary events (MACE), angina recurrence, and stroke.
RESULTS: Fourteen studies with 941 patients were finally involved in the
present study. The mortality and incidence of myocardial infarction were
similar in MIDCAB and PCI groups at 30 days, 6 months, and at follow-up
beyond 1 year. Compared with PCI, MIDCAB decreased incidence of TVR and
MACE at 6 months and beyond 1 year follow-up. MIDCAB was associated with a
lower incidence of angina recurrence at 6 months compared with PCI. PCI
was associated with higher risk of restenosis in target vessel. No
significant difference was shown for stroke.
CONCLUSION: Our meta-analysis indicates that there are no significant
differences in the safety between MIDCAB and PCI in patients with LAD.
However MIDCAB is superior to PCI for TVR and MACE.

<15>
Accession Number
616245265
Author
Dedeilias P.; Baikoussis N.G.; Prappa E.; Asvestas D.; Argiriou M.;
Charitos C.
Institution
(Dedeilias, Baikoussis, Argiriou, Charitos) Cardiothoracic and Vascular
Surgery Department, "Evangelismos" General Hospital of Athens, 45-47
Ipsilantou Street, Kolonaki, Athens, Greece
(Prappa, Asvestas) Department of Cardiology, "Evangelismos" General
Hospital of Athens, Athens, Greece
Title
Aortic valve replacement in elderly with small aortic root and low body
surface area; the Perceval S valve and its impact in effective orifice
area.
Source
Journal of cardiothoracic surgery. 11 (1) (pp 54), 2016. Date of
Publication: 11 Apr 2016.
Abstract
BACKGROUND: The aim of this study is to see how the sutureless, stentless,
Perceval S aortic valves behave when implanted in elderly patients with
small aortic root and the comparison with a second group of patients with
similar characteristics where a conventional stented bioprosthesis was
implanted. This is a prospective randomized institutional study.
METHODS: Our material is composed from 25 patients who underwent aortic
valve replacement with sutureless self-anchoring Perceval S valve
implantation (LivaNova), compared with 25 patients with conventional
stented biological prosthesis implanted (soprano LivaNova group). The two
groups of patients have similar demographic and medical characteristics
with severe aortic stenosis. The study was conducted from January 2012 to
June 2014. Preoperative, intraoperative and postoperative parameters were
studied in order to investigate the utility of the Perceval S valves in
this group of patients.
RESULTS: The Perceval S valve implantation seems to be an interesting
biological valve with good hemodynamic characteristics as compared with
the typical biological prosthesis providing shorter ischemia time
(40+/-5.50 min vs 86+/-15.86 min; p<0.001), shorter extracorporeal
circulation time (73.75+/-8.12 min vs 120.36+/-28.31 min p<0.001), less
operation time (149.38+/-15.22 min vs 206.64+/-42.85 min; p<0.001) and
better postoperative recovery. The postoperative gradients were
23.5+/-19.20 mmHg vs 24.5+/-19.90 mmHg respectively. The postoperative
effective orifice area in these two groups were respectively 1.5 =/-0.19
cm(2) vs 1.1=/-0.5 cm(2) (p 0.002). Among the 25 patients of the Soprano
stented valve, 3 (12 %) came back in 6 months with New York Heart
Association (NYHA) 3. The PPM of these patients was the cause of
readmission in the Hospital required diuresis and supplementary treatment.
CONCLUSIONS: Aortic valve replacement with Perceval aortic valves in
geriatric patients with comorbidities and small aortic annulus seems to be
an alternative, safe and "fast" intervention with excellent short and
mid-term results which provides a better effective orifice area.

<16>
Accession Number
616743259
Author
Esperanza Q.P.
Institution
(Esperanza) Hospital Riotinto, Area de Gestion Sanitaria Norte de Hueva,
Spain
Title
Importance of medical oxygen in multiple therapeutic uses.
Source
European Journal of Clinical Pharmacy. 19 (2) (pp 125-133), 2017. Date of
Publication: March-April 2017.
Publisher
Rasgo Editorial S.A.
Abstract
Objective: To conduct a systematic review of the available information on
the therapeutic role of medical oxygen and its many therapeutic uses.
Method: A literature search was conducted on inhaled medical oxygen using
the PuBMed (Medline), Library Cochrane Plus and Cochrane Library
databases, without language restriction. The designated period was
2006-2016, using MeSH descriptor oxygen inhalation therapy, oxygen and
Therapeutic Uses and Respiratory Tract Diseases, indications continuous
home oxygen therapy and Oxygen Home Care Services)). It was completed with
manual search in Clinical Practice Guidelines for Respiratory Diseases
[Chronic Obstructive Pulmonary Disease (COPD) and chronic bronchiolitis],
Integrated Care Process of COPD and bronchiolitis, respiratory disease
journals and monographic documents of the Spanish Society of Pneumology
and Thoracic Surgery (SEPAR). Results: Twenty two significant results were
found in the literature search and complemented with those obtained in the
search in Clinical Practice Guidelines for Respiratory Diseases,
Integrated Healthcare Processes and Documents of the SEPAR. These outcomes
refer to the indications which have established the oxygen efficacy with
existing relevant scientific evidence (COPD), and to other therapeutic
uses where scientific evidence was not relevant or sufficient (pulmonary
interstitial disease, heart diseases, pneumonia in adults, bronchiolitis,
and others). Conclusion: The important role of oxygen is clearly defined
in respiratory diseases, but unlike patients with COPD, there is no
evidence showing that oxygen therapy affects long-term survival and
quality of life in other respiratory and non-respiratory diseases with
moderate or severe hypoxemia. Among these conditions, we refer to diffuse
interstitial lung disease, pulmonary hypertension, cystic fibrosis, heart
diseases and generally, any disease in which chronic hypoxemia is an
important factor. Despite the lack of evidence, in routine clinical
practice, COT must be recommended on an individual Basis in these patients
when PaO<inf>2</inf> is <60 mm Hg, adjusting the flow rate to maintain a
SaO<inf>2</inf> >90% (consistent recommendation, low quality of evidence).
Therefore, further studies are needed to back-up the role of medical
oxygen in this type of pathologies.

<17>
Accession Number
609371879
Author
Song Y.B.; Park T.K.; Hahn J.-Y.; Yang J.H.; Choi J.-H.; Choi S.-H.; Lee
S.H.; Gwon H.-C.
Institution
(Song, Park, Hahn, Yang, Choi, Choi, Lee, Gwon) Division of Cardiology,
Department of Internal Medicine, Heart Vascular and Stroke Institute,
Samsung Medical Center, Sungkyunkwan University, School of Medicine,
Seoul, South Korea
Title
Optimal Strategy for Provisional Side Branch Intervention in Coronary
Bifurcation Lesions: 3-Year Outcomes of the SMART-STRATEGY Randomized
Trial.
Source
JACC: Cardiovascular Interventions. 9 (6) (pp 517-526), 2016. Date of
Publication: 28 Mar 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study compared the long-term follow-up results of
conservative versus aggressive strategies for provisional side branch (SB)
intervention in coronary bifurcation lesions. Background The appropriate
criteria for provisional SB ballooning or stenting have not been
established. Methods A total of 258 patients with a large bifurcation
lesion were randomized to a conservative or aggressive SB intervention
strategy. Different criteria applied for the initiation of SB intervention
after main vessel stenting in the conservative and aggressive groups were
Thrombolysis In Myocardial Infarction flow grade lower than 3 versus a
stenosis diameter >75% for non-left main bifurcations, and a stenosis
diameter >75% versus a stenosis diameter >50% for left main bifurcations.
The primary endpoint was target vessel failure (TVF), defined as a
composite of cardiac death, spontaneous myocardial infarction, or target
vessel revascularization at 3 years. Results At 3 years, TVF occurred in
11.7% of the conservative group versus 20.8% of the aggressive group (p =
0.049). Although no significant differences were observed in the incidence
of TVF between groups at 1 year (9.4% vs. 9.2%; p = 0.97), landmark
analysis between 1 and 3 years showed significantly less TVF in patients
assigned to the conservative strategy (2.6% vs. 12.7%; p = 0.004). The
crossover to the 2-stent technique was an independent predictor of TVF
(hazard ratio: 5.42, 95% confidence interval: 2.03 to 14.5; p < 0.001).
There was no interaction between left main bifurcation and treatment
effects for TVF (p for interaction = 0.8). Conclusions A conservative
strategy compared with an aggressive strategy for provisional SB
intervention is associated with long-term benefits for patients with a
large bifurcation lesion. (Optimal Strategy for Side Branch Stenting in
Coronary Bifurcation Lesion; NCT00794014).<br/>Copyright &#xa9; 2016 by
the American College of Cardiology Foundation.

<18>
Accession Number
610375718
Author
Nappi F.; Lusini M.; Spadaccio C.; Nenna A.; Covino E.; Acar C.; Chello M.
Institution
(Nappi, Lusini, Spadaccio, Nenna, Covino, Chello) Department of
Cardiovascular Surgery, Universita Campus Bio-Medico di Roma, Rome, Italy
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord de
Saint-Denis, 36 Rue des Moulins Gemeaux, Saint-Denis 93200, France
(Spadaccio) Department of Cardiothoracic Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Acar) Department of Cardiothoracic Surgery, Hopital Pitie-Salpetriere,
Paris, France
Title
Papillary muscle approximation versus restrictive annuloplasty alone for
severe ischemic mitral regurgitation.
Source
Journal of the American College of Cardiology. 67 (20) (pp 2334-2346),
2016. Date of Publication: 24 May 2016.
Publisher
Elsevier USA
Abstract
Background Guidelines recommend surgery for patients with severe ischemic
mitral regurgitation (MR). Nonrandomized studies suggest that subvalvular
repair is associated with longer survival, but randomized studies are
lacking. Objectives This study sought to investigate the benefit of
papillary muscle surgery on long-term clinical outcomes of patients with
ischemic MR. Methods Ninety-six patients with severe ischemic MR were
randomized to either undersizing restrictive mitral annuloplasty (RA) or
papillary muscle approximation with undersizing restrictive mitral
annuloplasty (PMA) associated with complete surgical myocardial
revascularization. The primary endpoint was change in left ventricular
end-diastolic diameter (LVEDD) after 5 years, measured as the absolute
difference from baseline, which was evaluated by paired Student t tests.
Secondary endpoints included changes in echocardiographic parameters,
overall mortality, the composite cardiac endpoint (major adverse cardiac
and cerebrovascular events [MACCE]), and quality of life (QOL) during the
5-year follow-up. Results At 5 years, mean LVEDD was 56.5 +/- 5.7 mm with
PMA versus 60.6 +/- 4.6 mm with RA (mean change from baseline -5.8 +/- 4.1
mm and -0.2 +/- 2.3 mm, respectively; p < 0.001). Ejection fraction was
44.1 +/- 6% in the PMA group versus 39.9 +/- 3.9% in the RA group (mean
change from baseline 8.8 +/- 5.9% and 2.5 +/- 4.3%, respectively; p <
0.001). There was no statistically significant difference in mortality at
5 years, but freedom from MACCE favored PMA in the last year of follow-up.
PMA significantly reduced tenting height, tenting area, and interpapillary
distance soon after surgery and for the long-term, and significantly
lowered moderate-to-severe MR recurrence. No differences were found in QOL
measures. Conclusions Compared with RA only, PMA exerted a long-term
beneficial effect on left ventricular remodeling and more effectively
restored the mitral valve geometric configuration in ischemic MR, which
improved long-term cardiac outcomes, but did not produce differences in
overall mortality and QOL.<br/>Copyright &#xa9; 2016 American College of
Cardiology Foundation.

<19>
Accession Number
610350421
Author
Vranckx P.; White H.D.; Huang Z.; Mahaffey K.W.; Armstrong P.W.; Van De
Werf F.; Moliterno D.J.; Wallentin L.; Held C.; Aylward P.E.; Cornel J.H.;
Bode C.; Huber K.; Nicolau J.C.; Ruzyllo W.; Harrington R.A.; Tricoci P.
Institution
(Vranckx) Hartcentrum Hasselt, Hasselt, Belgium
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Huang, Tricoci) Duke Clinical Research Institute, 2400 Pratt Street,
Durham, NC 27705, United States
(Mahaffey, Harrington) Stanford University, Stanford, CA, United States
(Armstrong) Division of Cardiology, University of Alberta, Edmonton,
Canada
(Van De Werf) Department of Cardiology, University of Leuven, Leuven,
Belgium
(Moliterno) Gill Heart Institute, Division of Cardiovascular Medicine,
University of Kentucky, Lexington, KY, United States
(Wallentin, Held) Department of Medical Sciences, Cardiology, Uppsala
Clinical Research Center, Uppsala University, Uppsala, Sweden
(Aylward) SAHMRI, Flinders University and Medical Centre, Adelaide,
Australia
(Cornel) Department of Cardiology, Medisch Centrum Alkmaar, Alkmaar,
Netherlands
(Bode) Internal Medicine and Cardiology, Universitatsklinikum, Freiburg,
Germany
(Huber) 3rd Department of Medicine, Cardiology and Intensive Care
Medicine, Wilhelminen Hospital, Vienna, Austria
(Nicolau) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Ruzyllo) Department of Coronary Artery Disease, Cardiac Catheterization
Laboratory, Institute of Cardiology, Warsaw, Poland
Title
Validation of BARC Bleeding Criteria in Patients with Acute Coronary
Syndromes the TRACER Trial.
Source
Journal of the American College of Cardiology. 67 (18) (pp 2135-2144),
2016. Date of Publication: 10 May 2016.
Publisher
Elsevier USA
Abstract
Background The Bleeding Academic Research Consortium (BARC) scale has been
proposed to standardize bleeding endpoint definitions and reporting in
cardiovascular trials. Validation in large cohorts of patients is needed.
Objectives This study sought to investigate the relationship between
BARC-classified bleeding and mortality and compared its prognostic value
against 2 validated bleeding scales: TIMI (Thrombolysis In Myocardial
Infarction) and GUSTO (Global Use of Strategies to Open Occluded
Arteries). Methods We analyzed bleeding in 12,944 patients with acute
coronary syndromes without ST-segment elevation, with or without early
invasive strategy. The main outcome measure was all-cause death. Results
During follow-up (median: 502 days), noncoronary artery bypass graft
(CABG) bleeding occurred in 1,998 (15.4%) patients according to BARC
(grades 2, 3, or 5), 484 (3.7%) patients according to TIMI minor/major,
and 514 (4.0%) patients according to GUSTO moderate/severe criteria.
CABG-related bleeding (BARC 4) occurred in 155 (1.2%) patients. Patients
with BARC (2, 3, or 4) bleeding had a significant increase in risk of
death versus patients without bleeding (BARC 0 or 1); the hazard was
highest in the 30 days after bleeding (hazard ratio: 7.35; 95% confidence
interval: 5.59 to 9.68; p < 0.0001) and remained significant up to 1 year.
The hazard of mortality increased progressively with non-CABG BARC grades.
BARC 4 bleeds were significantly associated with mortality within 30 days
(hazard ratio: 10.05; 95% confidence interval: 5.41 to 18.69; p < 0.0001),
but not thereafter. Inclusion of BARC (2, 3, or 4) bleeding in the 1-year
mortality model with baseline characteristics improved it to an extent
comparable to TIMI minor/major and GUSTO moderate/severe bleeding.
Conclusions In patients with acute coronary syndromes without ST-segment
elevation, bleeding assessed with the BARC scale was significantly
associated with risk of subsequent death up to 1 year after the event and
risk of mortality increased gradually with higher BARC grades. Our results
support adoption of the BARC bleeding scale in ACS clinical
trials.<br/>Copyright &#xa9; 2016 American College of Cardiology
Foundation.

<20>
Accession Number
611170904
Author
Deeb G.M.; Reardon M.J.; Chetcuti S.; Patel H.J.; Grossman P.M.; Yakubov
S.J.; Kleiman N.S.; Coselli J.S.; Gleason T.G.; Lee J.S.; Hermiller J.B.;
Heiser J.; Merhi W.; Zorn G.L.; Tadros P.; Robinson N.; Petrossian G.;
Hughes G.C.; Harrison J.K.; Maini B.; Mumtaz M.; Conte J.; Resar J.;
Aharonian V.; Pfeffer T.; Oh J.K.; Qiao H.; Adams D.H.; Popma J.J.
Institution
(Deeb, Chetcuti, Patel, Grossman) University of Michigan Medical Center,
Ann Arbor, Michigan, United States
(Reardon, Kleiman) Houston Methodist DeBakey Heart & Vascular Center,
Houston, Texas, United States
(Yakubov) Riverside Methodist Hospital, Columbus, Ohio, United States
(Coselli) Texas Heart Institute at St. Luke's Medical Center, Houston,
Texas, United States
(Gleason, Lee) University of Pittsburgh Medical Center, Pittsburgh,
Pennsylvania, United States
(Hermiller) St. Vincent Medical Center, Indianapolis, Indiana, United
States
(Heiser, Merhi) Spectrum Health Hospitals, Grand Rapids, Michigan, United
States
(Zorn, Tadros) The University of Kansas Hospital, Kansas City, Kansas,
United States
(Robinson, Petrossian) St. Francis Hospital, Roslyn, New York, United
States
(Hughes, Harrison) Duke University Medical Center, Durham, North Carolina,
United States
(Maini, Mumtaz) Pinnacle Health, Wormleysburg, Pennsylvania, United States
(Conte, Resar) The Johns Hopkins Hospital, Baltimore, Maryland, United
States
(Aharonian, Pfeffer) Kaiser Permanente-Los Angeles Medical Center, Los
Angeles, California, United States
(Oh) Mayo Clinical Foundation, Rochester, Minnesota, United States
(Qiao) Medtronic, Minneapolis, Minnesota, United States
(Adams) Mount Sinai Health System, New York, New York, United States
(Popma) Beth Israel Deaconess Medical Center, Boston, Massachusetts,
United States
Title
3-Year Outcomes in High-Risk Patients Who Underwent Surgical or
Transcatheter Aortic Valve Replacement.
Source
Journal of the American College of Cardiology. 67 (22) (pp 2565-2574),
2016. Date of Publication: 07 Jun 2016.
Publisher
Elsevier USA
Abstract
Background In patients with severe aortic stenosis at increased risk for
surgery, self-expanding transcatheter aortic valve replacement (TAVR) is
associated with improved 2-year survival compared with surgery. Objectives
This study sought to determine whether this clinical benefit was sustained
over time. Methods Patients with severe aortic stenosis deemed at
increased risk for surgery by a multidisciplinary heart team were
randomized 1:1 to TAVR or open surgical valve replacement (SAVR).
Three-year clinical and echocardiographic outcomes were obtained in those
patients with an attempted procedure. Results A total of 797 patients
underwent randomization at 45 U.S. centers; 750 patients underwent an
attempted procedure. Three-year all-cause mortality or stroke was
significantly lower in TAVR patients (37.3% vs. 46.7% in SAVR; p = 0.006).
Adverse clinical outcome components were also reduced in TAVR patients
compared with SAVR patients, including all-cause mortality (32.9% vs.
39.1%, respectively; p = 0.068), all stroke (12.6% vs. 19.0%,
respectively; p = 0.034), and major adverse cardiovascular or
cerebrovascular events (40.2% vs. 47.9%, respectively; p = 0.025). At 3
years aortic valve hemodynamics were better with TAVR patients (mean
aortic valve gradient 7.62 +/- 3.57 mm Hg vs. 11.40 +/- 6.81 mm Hg in
SAVR; p < 0.001), although moderate or severe residual aortic
regurgitation was higher in TAVR patients (6.8% vs. 0.0% in SAVR; p <
0.001). There was no clinical evidence of valve thrombosis in either
group. Conclusions Patients with severe aortic stenosis at increased risk
for surgery had improved 3-year clinical outcomes after TAVR compared with
surgery. Aortic valve hemodynamics were more favorable in TAVR patients
without differences in structural valve deterioration. (Safety and
Efficacy Study of the Medtronic CoreValve System in the
Treatment of Symptomatic Severe Aortic Stenosis in High Risk and Very High
Risk Subjects Who Need Aortic Valve Replacement;
NCT01240902)<br/>Copyright &#xa9; 2016 American College of Cardiology
Foundation

<21>
Accession Number
609302060
Author
Chen H.-L.; Liu K.
Institution
(Chen) Nantong University, Nantong, China
(Liu) Department of Cardiothoracic Surgery, Affiliated Hospital of Nantong
University, Nantong, China
Title
Clinical outcomes for transcatheter valve-in-valve in treating surgical
bioprosthetic dysfunction: A meta-analysis.
Source
International Journal of Cardiology. 212 (pp 138-141), 2016. Date of
Publication: 01 Jun 2016.
Publisher
Elsevier Ireland Ltd

<22>
Accession Number
611235354
Author
Bonaca M.P.; Bhatt D.L.; Storey R.F.; Steg P.G.; Cohen M.; Kuder J.;
Goodrich E.; Nicolau J.C.; Parkhomenko A.; Lopez-Sendon J.; Dellborg M.;
Dalby A.; Spinar J.; Aylward P.; Corbalan R.; Abola M.T.B.; Jensen E.C.;
Held P.; Braunwald E.; Sabatine M.S.
Institution
(Bonaca, Bhatt, Kuder, Goodrich, Braunwald, Sabatine) TIMI Study Group,
Brigham and Women's Hospital Heart & Vascular Center, Boston,
Massachusetts, United States
(Storey) Department of Infection, Immunity and Cardiovascular Disease,
University of Sheffield, Sheffield, United Kingdom
(Steg) French Alliance for Cardiovascular Trials, Universite
Paris-Diderot, Paris, France
(Cohen) Cardiovascular Division, Newark Beth Israel Medical Center, Icahn
School of Medicine at Mount Sinai, New York, New York, United States
(Nicolau) Heart Institute (InCor)-University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Parkhomenko) Ukranian Strazhesko Institute of Cardiology, Kiev, Ukraine
(Lopez-Sendon) Hospital Universitario La Paz, Instituto de Investigacion
La Paz, Madrid, Spain
(Dellborg) Department of Molecular and Clinical Medicine, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
(Dalby) Life Fourways Hospital, Randburg, South Africa
(Spinar) University Hospital, Jihlavska, Brno, Czech Republic
(Aylward) Division of Medicine, Cardiac & Critical Care Services, Flinders
Medical Centre, South Australia, Australia
(Corbalan) Cardiovascular Division, Pontificia Universidad Catolica de
Chile, Santiago, Chile
(Abola) Philippine Heart Center, University of the Philippines College of
Medicine, Manila, Philippines
(Jensen, Held) AstraZeneca R&D, Molndal, Sweden
Title
Ticagrelor for Prevention of Ischemic Events After Myocardial Infarction
in Patients With Peripheral Artery Disease.
Source
Journal of the American College of Cardiology. 67 (23) (pp 2719-2728),
2016. Date of Publication: 2016.
Publisher
Elsevier USA
Abstract
Background Peripheral artery disease (PAD) is associated with heightened
ischemic and bleeding risk in patients with prior myocardial infarction
(MI). Objectives This study evaluated the efficacy and safety of
ticagrelor on major cardiovascular (CV) events and major adverse limb
events in patients with PAD and a prior MI. Methods PEGASUS-TIMI 54
(Prevention of Cardiovascular Events in Patients With Prior Heart Attack
Using Ticagrelor Compared to Placebo on a Background of
Aspirin-Thrombolysis In Myocardial Infarction 54) randomized 21,162
patients with prior MI (1 to 3 years) to ticagrelor 90 mg twice daily,
ticagrelor 60 mg twice daily, or placebo, all on a background of low-dose
aspirin. History of PAD was obtained at baseline. Occurrences of major
adverse cardiovascular events (MACE) (defined as CV death, MI, or stroke)
and major adverse limb events (MALE) (defined as acute limb ischemia or
peripheral revascularization for ischemia) were recorded in follow-up.
Results A total of 1,143 patients (5%) had known PAD. In the placebo arm,
those with PAD (n = 404) had higher rates of MACE at 3 years than those
without (n = 6,663; 19.3% vs. 8.4%; p < 0.001), which persisted after
adjusting for baseline differences (adjusted hazard ratio: 1.60; 95%
confidence interval: 1.20 to 2.13; p = 0.0013), and higher rates of acute
limb ischemia (1.0% vs. 0.1%) and peripheral revascularization procedures
(9.15% vs. 0.46%). Whereas the relative risk reduction in MACE with
ticagrelor was consistent, regardless of PAD, patients with PAD had a
greater absolute risk reduction of 4.1% (number needed to treat: 25) due
to their higher absolute risk. The absolute excess of TIMI major bleeding
was 0.12% (number needed to harm: 834). The 60-mg dose had particularly
favorable outcomes for CV and all-cause mortality. Ticagrelor (pooled
doses) reduced the risk of MALE (hazard ratio: 0.65; 95% confidence
interval: 0.44 to 0.95; p = 0.026). Conclusions Among stable patients with
prior MI, those with concomitant PAD have heightened ischemic risk. In
these patients, ticagrelor reduced MACE, with a large absolute risk
reduction, and MALE. (Prevention of Cardiovascular Events in Patients With
Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of
Aspirin [PEGASUS-TIMI 54]; NCT01225562)<br/>Copyright &#xa9; 2016 American
College of Cardiology Foundation

<23>
Accession Number
613410872
Author
Perdreau E.; Seguela P.-E.; Jalal Z.; Perdreau A.; Mouton J.-B.;
Nelson-Veniard M.; Guillet E.; Iriart X.; Ouattara A.; Roubertie F.;
Mauriat P.; Thambo J.-B.
Institution
(Perdreau, Seguela, Jalal, Perdreau, Mouton, Nelson-Veniard, Guillet,
Iriart, Ouattara, Roubertie, Mauriat, Thambo) Paediatric Cardiology Unit,
hopital Haut-Leveque, Bordeaux University Hospital, Bordeaux, France
Title
Postoperative assessment of left ventricular function by two-dimensional
strain (speckle tracking) after paediatric cardiac surgery.
Source
Archives of Cardiovascular Diseases. 109 (11) (pp 599-606), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Background Left ventricular (LV) dysfunction may complicate paediatric
cardiac surgery with cardiopulmonary bypass, notably after long aortic
cross-clamping (ACC). Assessment of occult myocardial injury by
conventional echocardiographic variables may be difficult in the
postoperative period. Aims To evaluate the feasibility of two-dimensional
(2D) strain in the postoperative period, and to assess the effect of ACC
duration on this variable. Methods Thirty-three paediatric patients (age <
18 years) with congenital heart disease undergoing cardiac surgery with
cardiopulmonary bypass were included in this prospective single-centre
study. Daily echocardiography was performed from the day before surgery to
the fifth postoperative day. LV ejection fraction and LV 2D strain were
measured. The cohort was divided into three groups according to ACC
duration (group 1: < 30 minutes; group 2: 30-80 minutes; group 3: > 80
minutes). Results Mean age and weight were 4.2 +/- 2.5 years and 15.1 +/-
5.2 kg, respectively. Feasibilities of longitudinal, circumferential and
radial strains were good, and quite similar to conventional variables.
Compared with conventional variables, intra- and interobserver agreements
regarding 2D strain were better (r = 0.916, P < 0.001 and r = 0.855, P <
0.001 for longitudinal strain versus r = 0.156, P = 0.54 and r = 0.064, P
= 0.80 for LV ejection fraction by Simpson's method). Postoperative
evolution of longitudinal and circumferential strains was significantly
different between the three groups (P < 0.001), whereas there was no
difference using conventional variables. Conclusion Postoperative LV 2D
strain is a feasible and reproducible method. Strain measurements seem to
indicate correlation with ACC duration.<br/>Copyright &#xa9; 2016 Elsevier
Masson SAS

<24>
Accession Number
606269009
Author
Denault A.Y.; Beaulieu Y.; Couture P.; Haddad F.; Shi Y.; Page P.;
Levesque S.; Tardif J.-C.; Lambert J.
Institution
(Denault, Couture) Department of Anesthesiology, and Division of Critical
Care, Montreal Heart Institute, Universite de Montreal, Canada
(Denault) Division of Critical Care, Centre Hospitalier de l'Universite de
Montreal, Canada
(Beaulieu) Department of Medicine and Critical Care Division, Hopital du
Sacre-Coeur, Universite de Montreal, Canada
(Haddad) Stanford Division of Cardiovascular Medicine, Stanford University
School of Medicine, United States
(Shi, Tardif) Department of Medicine, Montreal Heart Institute and
Universite de Montreal, Canada
(Page) Department of Cardiac Surgery, Montreal Heart Institute, Universite
de Montreal, Canada
(Levesque) Montreal Heart Institute Coordinating Center, Canada
(Lambert) Department of Preventive and Social Medicine, Universite de
Montreal, Canada
Title
Acute intraoperative effect of intravenous amiodarone on right ventricular
function in patients undergoing valvular surgery.
Source
European Heart Journal: Acute Cardiovascular Care. 4 (4) (pp 316-325),
2015. Date of Publication: 01 Apr 2015.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Amiodarone is commonly used in the acute care setting. However
the acute hemodynamic and echocardiographic effect of intravenous
amiodarone administered intraoperatively on right ventricular (RV)
systolic and diastolic function using transesophageal echocardiography
(TEE) has not been described. Methods: The study design was a randomized
controlled trial in elective cardiac surgical patients undergoing valvular
surgery. Patients received an intravenous loading dose of 300 mg of either
amiodarone or placebo in the operating room, followed by an infusion of 15
mg/kg for two days. Hemodynamic profiles, echocardiographic measurement of
RV and left ventricular (LV) dimensions, Doppler interrogation of
tricuspid and mitral valve, hepatic and pulmonary venous flow combined
with tissue Doppler imaging of the tricuspid and mitral valve annulus were
obtained before and after bolus. Results: Although more patients in the
placebo group had chronic obstructive lung disease (14 vs 6, p=0.05) and
diabetes (14 vs 5; p=0.0244), there was no difference in terms of baseline
hemodynamic, 2D and Doppler variables. After bolus, a significant increase
in pulmonary artery pressure, central venous pressure and pulmonary
vascular resistance index (p<0.05) was observed in the amiodarone group
with reduction in systolic to diastolic (S/D) ratio of the hepatic
(p=0.0247) and pulmonary venous (p=0.0052) velocity. Conclusion: Acute
administration of amiodarone is associated with alteration in RV diastolic
properties and has minimal negative inotropic effect on RV systolic
function in cardiac surgical patients with valvular disease.<br/>Copyright
&#xa9; The European Society of Cardiology 2014.

<25>
Accession Number
615245066
Author
Biancari F.; Dalen M.; Perrotti A.; Fiore A.; Reichart D.; Khodabandeh S.;
Gulbins H.; Zipfel S.; Al Shakaki M.; Welp H.; Vezzani A.; Gherli T.;
Lommi J.; Juvonen T.; Svenarud P.; Chocron S.; Verhoye J.P.; Bounader K.;
Gatti G.; Gabrielli M.; Saccocci M.; Kinnunen E.-M.; Onorati F.;
Santarpino G.; Alkhamees K.; Ruggieri V.G.; Dell'Aquila A.M.
Institution
(Biancari, Kinnunen) Department of Surgery, Oulu University Hospital,
Oulu, Finland
(Dalen, Khodabandeh, Svenarud) Department of Molecular Medicine and
Surgery, Department of Cardiothoracic Surgery and Anesthesiology,
Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
(Perrotti, Chocron) Department of Thoracic and Cardio-Vascular Surgery,
University Hospital Jean Minjoz, Besancon, France
(Fiore) Department of Cardiothoracic Surgery, Henri Mondor University
Hospital, AP-HP, Paris-Est University, Creteil, France
(Reichart, Gulbins, Zipfel) Hamburg University Heart Center, Hamburg,
Germany
(Al Shakaki, Welp, Dell'Aquila) Department of Cardiothoracic Surgery,
University Hospital Muenster, Muenster, Germany
(Vezzani, Gherli) Division of Cardiac Surgery, University of Parma, Parma,
Italy
(Lommi, Juvonen) Cardiac Surgery, Heart and Lung Center, Helsinki
University Central Hospital, Helsinki, Finland
(Verhoye, Bounader, Ruggieri) Division of Cardiothoracic and Vascular
Surgery, Pontchaillou University Hospital, Rennes, France
(Gatti, Gabrielli) Division of Cardiac Surgery, Ospedali Riuniti, Trieste,
Italy
(Saccocci) Department of Cardiac Surgery, Centro Cardiologico-Fondazione
Monzino IRCCS, University of Milan, Milan, Italy
(Onorati) Division of Cardiovascular Surgery, Verona University Hospital,
Verona, Italy
(Santarpino) Cardiovascular Center, Paracelsus Medical University,
Nuremberg, Germany
(Alkhamees) Saud Al-Babtain Cardiac Center, Ministry of Health, Dammam,
Saudi Arabia
Title
Venoarterial extracorporeal membrane oxygenation after coronary artery
bypass grafting: Results of a multicenter study.
Source
International Journal of Cardiology. 241 (pp 109-114), 2017. Date of
Publication: 15 Aug 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background The evidence of the benefits of using venoarterial
extracorporeal membrane oxygenation (VA-ECMO) after coronary artery bypass
grafting (CABG) is scarce. Methods We analyzed the outcomes of patients
who received VA-ECMO therapy due to cardiac or respiratory failure after
isolated CABG in 12 centers between 2005 and 2016. Patients treated
preoperatively with ECMO were excluded from this study. Results VA-ECMO
was employed in 148 patients after CABG for median of 5.0 days (mean, 6.4,
SD 5.6 days). In-hospital mortality was 64.2%. Pooled in-hospital
mortality was 65.9% without significant heterogeneity between the centers
(I² 8.6%). The proportion of VA-ECMO in each center did not
affect in-hospital mortality (p = 0.861). No patients underwent heart
transplantation and six patients received a left ventricular assist
device. Logistic regression showed that creatinine clearance (p = 0.004,
OR 0.98, 95% CI 0.97-0.99), pulmonary disease (p = 0.018, OR 4.42, 95% CI
1.29-15.15) and pre-VA-ECMO blood lactate (p = 0.015, OR 1.10, 95% CI
1.02-1.18) were independent baseline predictors of in-hospital mortality.
One-, 2-, and 3-year survival was 31.0%, 27.9%, and 26.1%, respectively.
Conclusions One third of patients with need for VA-ECMO after CABG survive
to discharge. In view of the burden of resources associated with VA-ECMO
treatment and the limited number of patients surviving to discharge,
further studies are needed to identify patients who may benefit the most
from this treatment.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<26>
Accession Number
615712790
Author
Huang L.; Dalziel K.M.; Schilling C.; Celermajer D.S.; McNeil J.J.; Winlaw
D.; Gentles T.; Radford D.J.; Cheung M.; Bullock A.; Wheaton G.R.; Justo
R.N.; Selbie L.A.; Forsdick V.; Du Plessis K.; d'Udekem Y.
Institution
(Huang, Dalziel, Schilling) Centre for Health Policy, The University of
Melbourne, Melbourne, Australia
(Celermajer) Department of Medicine, The University of Sydney, Sydney,
Australia
(Celermajer, Forsdick) Department of Cardiology, Royal Prince Alfred
Hospital, Sydney, Australia
(McNeil) School of Public Health and Preventive Medicine, Monash
University, Melbourne, Australia
(Winlaw) Heart Centre for Children, The Children's Hospital at Westmead,
Sydney, Australia
(Winlaw) Westmead and Sydney Medical School, The University of Sydney,
Sydney, Australia
(Gentles) Green Lane Paediatric and Congenital Cardiac Service, Starship
Children's Hospital, Auckland, New Zealand
(Radford) Department of Cardiology, The Prince Charles Hospital, Brisbane,
Australia
(Radford) School of Medicine, The University of Queensland, Brisbane,
Australia
(Cheung) Department of Cardiology, Royal Children's Hospital, Melbourne,
Australia
(Cheung, Du Plessis, d'Udekem) Heart Research Group, Murdoch Childrens
Research Institute, Melbourne, Australia
(Bullock) Children's Cardiac Centre, Princess Margaret Hospital for
Children, Perth, Australia
(Wheaton) Department of Cardiology, Women's and Children's Hospital,
Adelaide, Australia
(Justo) Paediatric Cardiology, Queensland Paediatric Cardiac Service, Lady
Cilento Children's Hospital, Brisbane, Australia
(Selbie) HeartKids Australia, Sydney, Australia
(d'Udekem) Department of Cardiac Surgery, Royal Children's Hospital,
Melbourne, Australia
(d'Udekem) Department of Paediatrics, The University of Melbourne,
Melbourne, Australia
Title
Hospital costs and cost implications of co-morbid conditions for patients
with single ventricle in the period through to Fontan completion.
Source
International Journal of Cardiology. 240 (pp 178-182), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Patients undergoing palliative surgeries for single-ventricle
conditions are affected by multiple comorbidities or non-cardiac
conditions. The prevalence, costs and the cost implications of these
conditions have not been assessed. Methods Administrative costing records
from four hospitals in Australia and New Zealand were linked with the
Fontan registry database to analyze the inpatient resource use for
co-morbid or non-cardiac conditions. Inpatient costing records from the
birth year through to Fontan completion were available for 156 patients.
The most frequent primary diagnoses were hypoplastic left heart syndrome
(33%), double inlet left ventricle (13%), and tricuspid atresia (12%).
Results During the staged surgical treatment period, children had a mean
of 10 +/- 6 inpatient admissions and spent 85 +/- 64 days in hospital.
Among these admissions, 3 +/- 5 were for non-cardiac conditions, totaling
21 +/- 41 inpatient days. Whilst cardiac surgeries were the major reason
for resource use (77% of the total cost), other cardiac care that is not
surgical contributed 5% and non-cardiac admissions 18% of the total cost.
The three most prevalent non-cardiac diagnostic admission categories were
'Respiratory system', 'Digestive system', and 'Ear, nose, mouth and
throat', affecting 28%, 21% and 34% of the patients respectively.
Multivariate regression estimated that admissions for each of these
categories resulted in an increased cost of $34,563 (P = 0.08), $52,438 (P
= 0.05) and $10,525 (P = 0.53) per patient respectively for the staged
surgical treatment period. Conclusions Non-cardiac admissions for
single-ventricle patients are common and have substantial resource
implications. Further research assessing the causes of admission and
extent to which admissions are preventable is warranted.<br/>Copyright
&#xa9; 2017 Elsevier B.V.

<27>
Accession Number
616132945
Author
Pagnesi M.; Montalto C.; Mangieri A.; Agricola E.; Puri R.; Chiarito M.;
Ancona M.B.; Regazzoli D.; Testa L.; De Bonis M.; Moat N.E.; Rodes-Cabau
J.; Colombo A.; Latib A.
Institution
(Pagnesi, Montalto, Mangieri, Ancona, Regazzoli, Colombo, Latib)
Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan,
Italy
(Agricola) Echocardiography Laboratory, San Raffaele Scientific Institute,
Milan, Italy
(Puri, Rodes-Cabau) Quebec Heart & Lung Institute, Laval University,
Quebec City, Canada
(Chiarito) Division of Clinical and Interventional Cardiology, Humanitas
Research Hospital, Milan, Italy
(Testa) Department of Cardiology, IRCCS Policlinico San Donato, Milan,
Italy
(De Bonis) Department of Cardiovascular and Thoracic Surgery, San Raffaele
Scientific Institute, Milan, Italy
(Moat) Department of Cardiothoracic Surgery, Royal Brompton Hospital,
London, United Kingdom
(Colombo) Vita-Salute San Raffaele University, Milan, Italy
(Colombo, Latib) Interventional Cardiology Unit, EMO-GVM Centro Cuore
Columbus, Milan, Italy
Title
Tricuspid annuloplasty versus a conservative approach in patients with
functional tricuspid regurgitation undergoing left-sided heart valve
surgery: A study-level meta-analysis.
Source
International Journal of Cardiology. 240 (pp 138-144), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Tricuspid valve (TV) repair at the time of left-sided valve
surgery is indicated in patients with either severe functional tricuspid
regurgitation (TR) or mild-to-moderate TR with coexistent tricuspid
annular dilation or right heart failure. We assessed the benefits of a
concomitant TV repair strategy during left-sided surgical valve
interventions, focusing on mortality and echocardiographic TR-related
outcomes. Methods A meta-analysis was performed of studies reporting
outcomes of patients who underwent left-sided (mitral and/or aortic) valve
surgery with or without concomitant TV repair. Primary endpoints were
all-cause and cardiac-related mortality; secondary endpoints were the
presence of more-than-moderate TR, TR progression, and TR severity grade.
All endpoints were evaluated at the longest available follow-up. Results
Fifteen studies were included for a total of 2840 patients. TV repair at
the time of left-sided valve surgery was associated with a significantly
lower risk of cardiac-related mortality (odds ratio [OR] 0.38; 95%
confidence interval [CI]: 0.25-0.58; p < 0.001), with a trend towards a
lower risk of all-cause mortality (OR 0.57; 95% CI: 0.32-1.05; p = 0.07)
at a mean weighted follow-up of 6 years. The presence of
more-than-moderate TR (OR 0.19; 95% CI: 0.12-0.30; p < 0.001), TR
progression (OR 0.03; 95% CI: 0.01-0.05; p < 0.001), and TR grade
(standardized mean difference - 1.11; 95% CI: - 1.57 to - 0.65; p < 0.001)
were significantly lower in the TV repair group at a mean weighted
follow-up of 4.7 years. Conclusions A concomitant TV repair strategy
during left-sided valve surgery is associated with a reduction in
cardiac-related mortality and improved echocardiographic TR outcomes at
follow-up.<br/>Copyright &#xa9; 2017 Elsevier Ireland Ltd

<28>
Accession Number
614877490
Author
Sciahbasi A.; Ferrante G.; Fischetti D.; Miklin D.J.; Sarandrea A.;
Schirripa V.; Guarracini F.; Arya A.; Loreni G.; Bruni A.; Rigattieri S.;
Marini M.; Vagnarelli S.; Scevola G.; Reimers B.; Hindricks G.; Cohen M.
Institution
(Sciahbasi, Rigattieri) Interventional Cardiology, Sandro Pertini
Hospital, ASL RM2, Rome, Italy
(Ferrante, Reimers) Humanitas Research Hospital, IRCCS, Rozzano, Italy
(Fischetti) Interventional Cardiology, Vito Fazzi Hospital, Lecce, Italy
(Miklin, Cohen) Cardiovascular Division, Department of Medicine,
University of Miami, FL, United States
(Sarandrea) HSE Management, Rome, Italy
(Schirripa) Department of Cardiology, Ospedale Grassi, Ostia, Rome, Italy
(Guarracini, Marini) Department of Cardiology, S. Chiara Hospital, Trento,
Italy
(Arya, Hindricks) Department of Electrophysiology, Heart Center,
University of Leipzig, Germany
(Loreni, Scevola) Interventional Radiology, Sandro Pertini Hospital, ASL
RM2, Rome, Italy
(Bruni, Vagnarelli) Interventional Radiology, San Giovanni Hospital, Rome,
Italy
Title
Radiation dose among different cardiac and vascular invasive procedures:
The RODEO study.
Source
International Journal of Cardiology. 240 (pp 92-96), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Interventional radiology and cardiology procedures contribute
significantly to the collective dose of radiation exposure from medical
interventions. Recent and dedicated studies comparing directly these
procedures in term of patient radiation exposure are lacking. Our aim was
to compare radiation exposure among different interventional procedures
performed under fluoroscopic guidance. Methods The RODEO study (NCT:
02972736) is an international observational retrospective multicenter
study enrolling all patients undergoing diagnostic or interventional
procedures performed by different interventional operators (i.e.
radiologists, interventional cardiologists or electrophysiologists) in 6
centers, without exclusion criteria. The primary end-point of the study
was the comparison of dose area product (DAP) among interventional
cardiology, electrophysiology or interventional radiology procedures.
Results A total of 17,711 procedures were included in the study: 13,522
interventional cardiology, 2352 electrophysiology and 1864 interventional
radiology procedures. The highest DAP values were observed for
interventional radiology procedures (74 Gy * cm² [Interquartile
range 27-178 Gy * cm²]), followed by interventional cardiology
(40 Gy * cm² [22-78 Gy * cm²]) and electrophysiology
procedures (13 Gy * cm² [4-44 Gy * cm²], p <
0.0001). In term of specific procedures, the highest DAP values were
observed in structural or valvular cardiac procedures (134 Gy *
cm² [51-260 Gy * cm²]) whereas the lowest DAP values
in pacemaker insertion (11 Gy * cm² [4-28 Gy *
cm²]). Conclusion In this large multicenter study, the highest
radiation exposure was observed in procedures performed by interventional
radiologists. However, among specific procedures, structural or valvular
cardiac procedures were associated with the highest radiation
exposure.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<29>
[Use Link to view the full text]
Accession Number
614979232
Author
Delaney M.; Stark P.C.; Suh M.; Triulzi D.J.; Hess J.R.; Steiner M.E.;
Stowell C.P.; Sloan S.R.
Institution
(Delaney) Medical Division, Department of Laboratory Medicine, Bloodworks
and University of Washington, 921 Terry Ave., Seattle, WA 98104, United
States
(Stark, Suh) Center for Epidemiological and Statistical Research, New
England Research Institutes (Data Coordinating Center), Watertown, MA,
United States
(Triulzi) Division of Transfusion Medicine, Department of Pathology,
University of Pittsburgh, Pittsburgh, PA, United States
(Hess) Harborview Medical Center, Department of Laboratory Medicine,
University of Washington, Seattle, WA, United States
(Steiner) Department of Pediatrics, University of Minnesota, Minneapolis,
MN, United States
(Stowell) Department of Pathology, Massachusetts General Hospital, Harvard
Medical School, Boston, MA, United States
(Sloan) Department of Laboratory Medicine, Boston Children's Hospital,
Boston, MA, United States
(Sloan) Department of Pathology, Harvard Medical School, Boston, MA,
United States
Title
Massive transfusion in cardiac surgery: The impact of blood component
ratios on clinical outcomes and survival.
Source
Anesthesia and Analgesia. 124 (6) (pp 1777-1782), 2017. Date of
Publication: 01 Jun 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Cardiac surgery is the most common setting for massive
transfusion in medically advanced countries. Studies of massive
transfusion after injury suggest that the ratios of administered plasma
and platelets (PLT) to red blood cells (RBCs) affect mortality. Data from
the Red Cell Storage Duration Study (RECESS), a large randomized trial of
the effect of RBC storage duration in patients undergoing complex cardiac
surgery, were analyzed retrospectively to investigate the association
between blood component ratios used in massively transfused patients and
subsequent clinical outcomes. METHODS: Massive transfusion was defined as
those who had >=6 RBC units or >=8 total blood components. For plasma,
high ratio was defined as >=1 plasma unit:1 RBC unit. For PLT transfusion,
high ratio was defined as >=0.2 PLT doses:1 RBC unit; PLT dose was defined
as 1 apheresis PLT or 5 whole blood PLT equivalents. The clinical outcomes
analyzed were mortality and the change in the Multiple Organ Dysfunction
Score (DELTAMODS) comparing the preoperative score with the highest
composite score through the earliest of death, discharge, or day 7.
Outcomes were compared between patients transfused with high and low
ratios. Linear and Cox regression were used to explore relationships
between predictors and continuous outcomes and time to event outcomes.
RESULTS: A total of 324 subjects met the definition of massive
transfusion. In those receiving high plasma:RBC ratio, the mean (SE) 7-
and 28-day DELTAMODS was 1.24 (0.45) and 1.26 (0.56) points lower, (P
=.007 and P =.024), respectively, than in patients receiving lower ratios.
In patients receiving high PLT:RBC ratio, the mean (SE) 7- and 28-day
DELTAMODS were 1.55 (0.53) and 1.49 (0.65) points lower (P =.004 and P
=.022), respectively. Subjects who received low-ratio plasma:RBC
transfusion had excess 7-day mortality compared with those who received
high ratio (7.2% vs 1.7%, respectively, P =.0318), which remained
significant at 28 days (P =.035). The ratio of PLT:RBCs was not associated
with differences in mortality. CONCLUSIONS: This analysis found that in
complex cardiac surgery patients who received massive transfusion, there
was an association between the composition of blood products used and
clinical outcomes. Specifically, there was less organ dysfunction in those
who received high-ratio transfusions (plasma:RBCs and PLT:RBCs), and lower
mortality in those who received high-ratio plasma:RBC
transfusions.<br/>&#xa9; Copyright 2017 International Anesthesia Research
Society.

<30>
Accession Number
615404941
Author
Anselmino M.; Garberoglio L.; Gili S.; Bertaglia E.; Stabile G.; Marazzi
R.; Themistoclakis S.; Solimene F.; Frea S.; Grosso Marra W.; Morello M.;
Scaglione M.; De Ponti R.; Gaita F.
Institution
(Anselmino, Garberoglio, Gili, Frea, Grosso Marra, Morello, Gaita)
Division of Cardiology, Department of Medical Sciences, "Citta della
Salute e della Scienza" Hospital, University of Turin, Italy
(Scaglione) Division of Cardiology, Department of Internal Medicine,
Cardinal Massaia Hospital, Asti, Italy
(Bertaglia) Department of Cardiac, Thoracic and Vascular Sciences,
University of Padova, Padova, Italy
(Stabile) Clinica Mediterranea, Naples, Italy
(Marazzi, De Ponti) Department of Heart and Vessels, Ospedale di Circolo e
Fondazone Macchi, University of Insubria, Varese, Italy
(Themistoclakis) Department of Cardiothoracic and Vascular Medicine,
Dell'Angelo Hospital, Mestre, Venice, Italy
(Solimene) Clinica Montevergine, Mercogliano, (AV), Italy
Title
Left atrial appendage thrombi relate to easily accessible clinical
parameters in patients undergoing atrial fibrillation transcatheter
ablation: A multicenter study.
Source
International Journal of Cardiology. 241 (pp 218-222), 2017. Date of
Publication: 15 Aug 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Transesophageal echocardiography (TEE) is routinely performed
before atrial fibrillation (AF) transcatheter ablation to exclude the
presence of left atrial (LA) or LA appendage (LAA) thrombi. The aim of the
study is to evaluate if easily accessible clinical parameters may relate
to the presence of LA or LAA thrombi to identify patients who could
potentially avoid TEE. Methods and results Between January 2012 and
September 2014, data from 1539 consecutive patients undergoing TEE, as a
work-up before AF transcatheter ablation, in six large volume centers were
collected. Baseline clinical features, CHA<inf>2</inf>DS<inf>2</inf>-VASc
score, transthoracic echocardiography and presence of thrombi at TEE were
recorded. Exclusion criteria were valvular, hypertrophic or dilated
cardiomyopathy, previous heart surgery or an ejection fraction <= 35%.
Mean age was 59.6 +/- 10.4 years, 1215 (78.9%) were males; 951 (62.9%)
presented in sinus rhythm (SR) on admission, 324 (21.1%) had undergone at
least one previous ablation and 900 (58.5%) had
CHA<inf>2</inf>DS<inf>2</inf>-VASc score 0-1. Thrombi were encountered in
12 patients (0.8%). SR at TEE independently related to the absence of
thrombi (OR 5.15, 95% CI 1.38-19.02, p = 0.015); in addition to this, no
patient with a CHA<inf>2</inf>DS<inf>2</inf>-VASc score 0-1 and SR on
admission presented thrombi at TEE (specificity 100%, p = 0.011).
Conclusion In a selected population of patients referred for AF ablation,
LA/LAA thrombi prevalence is low. No patients in SR with
CHA<inf>2</inf>DS<inf>2</inf>-VASc score 0-1 presented LAA thrombi at TEE,
identifying a significant subset of patients who could potentially safely
be spared from pre-procedural TEE.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<31>
Accession Number
615431818
Author
Kwok C.S.; Bagur R.; Rashid M.; Lavi R.; Cibelli M.; de Belder M.A.; Moat
N.; Hildick-Smith D.; Ludman P.; Mamas M.A.
Institution
(Kwok, Bagur, Rashid, Mamas) Cardiovascular Research Group, Keele
University, Stoke-on-Trent, United Kingdom
(Bagur) Division of Cardiology, London Health Sciences Centre, Department
of Medicine, Western University, London, Ontario, Canada
(Bagur) Department of Epidemiology and Biostatistics, Western University,
London, Ontario, Canada
(Lavi) Department of Anesthesia and Perioperative Medicine, London Health
Sciences Centre, Western University, London, Ontario, Canada
(Cibelli, Moat) Royal Brompton Hospital, London, United Kingdom
(de Belder) The James Cook University Hospital, Middlesbrough, United
Kingdom
(Hildick-Smith) Sussex Cardiac Centre, Brighton & Sussex University
Hospitals, Brighton, United Kingdom
(Ludman) Queen Elizabeth Hospital, Birmingham, United Kingdom
Title
Aortic stenosis and non-cardiac surgery: A systematic review and
meta-analysis.
Source
International Journal of Cardiology. 240 (pp 145-153), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Aortic stenosis (AS) poses a perioperative management dilemma
to physicians looking after patients who require non-cardiac surgery. The
objective of this review is to investigate mortality and adverse
cardiovascular events in patients with and without AS who underwent
non-cardiac surgery. Methods We searched MEDLINE and EMBASE for studies
that evaluated mortality and adverse cardiovascular events in patients
with and without AS who underwent non-cardiac surgery. Pooled risk ratios
for mortality and adverse outcomes (myocardial infarction, stroke, heart
failure, death) were calculated using the dichotomous analysis method and
subgroup analysis was performed considering the effect of severity of AS
and symptoms. Results We identified 9 relevant studies with 29,327
participants. Among studies of severe AS, there was no significant
difference in mortality (RR: 1.49, 95%CI:0.85-2.61; P = 0.16) associated
with non-cardiac surgery, but there was a significant increase in the
composite adverse outcome (RR: 2.30, 95%CI:1.33-3.97; P = 0.003). When the
analysis involved any other degree of AS, eight studies were included and
the pooled results showed a significant increase in composite adverse
outcome (RR: 1.64, 95%CI:1.23-2.19; P < 0.001) and myocardial infarction
(RR: 1.90, 95%CI:1.54-2.34; P < 0.001). When patients with asymptomatic AS
were considered, the pooled results of four studies suggested an increased
risk of composite adverse outcomes (RR: 1.59, 95%CI:1.19-2.12; P = 0.002)
but not mortality, myocardial infarction, heart failure or stroke.
Conclusions Patients with AS undergoing non-cardiac surgery have not been
shown to be at increased risk of mortality, but have significantly higher
rates of adverse cardiovascular events compared to patients without
AS.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<32>
Accession Number
615095875
Author
Singh V.; Yadav P.K.; Eng M.H.; Macedo F.Y.; Silva G.V.; Mendirichaga R.;
Badiye A.P.; Sakhuja R.; Elmariah S.; Inglessis I.; Alfonso C.E.;
Schreiber T.L.; Cohen M.; Palacios I.; O'Neill W.W.
Institution
(Singh, Sakhuja, Elmariah, Inglessis, Palacios) Massachusetts General
Hospital, Harvard Medical School, Boston, MA, United States
(Yadav) Penn State Milton S. Hershey Medical Center, Hershey, PA, United
States
(Eng, O'Neill) Henry Ford Hospital, Detroit, MI, United States
(Macedo, Silva) Baylor College of Medicine, Houston, TX, United States
(Silva) Texas Heart Institute, Houston, TX, United States
(Mendirichaga, Badiye, Alfonso, Cohen) University of Miami Miller School
of Medicine, Miami, FL, United States
(Schreiber) Detroit Medical Center and Wayne State University, Detroit,
MI, United States
Title
Outcomes of hemodynamic support with Impella in very high-risk patients
undergoing balloon aortic valvuloplasty: Results from the Global cVAD
Registry.
Source
International Journal of Cardiology. 240 (pp 120-125), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Reports on the role of hemodynamic support devices in patients
with severe aortic stenosis (AS) and left ventricular (LV) dysfunction
undergoing balloon aortic valvuloplasty (BAV) are limited. Methods
Patients were identified from the cVAD registry, an ongoing multicenter
voluntary registry at selected sites in North America that have used
Impella in > 10 patients. Results A total of 116 patients with AS who
underwent BAV with Impella support were identified. Mean age was 80.41 +/-
9.03 years and most patients were male. Mean STS score was 18.77% +/-
18.32, LVEF was 27.14% +/- 16.07, and 42% underwent concomitant PCI. In
most cases Impella was placed electively prior to BAV, whereas 26.7% were
placed as an emergency. The two groups had similar baseline
characteristics except for higher prevalence of CAD and lower LVEF in the
elective group, and higher STS score in the emergency group. Elective
strategy was associated higher 1-year survival compared to emergency
placement (56% vs. 29.2%, p = 0.003). One-year survival was higher when
BAV was used as a bridge to definitive therapy as opposed to palliative
treatment (90% vs. 28%, p < 0.001). On multivariate analysis, STS score
and aim of BAV (bridge to definitive therapy vs. palliative indication)
were independent predictors of mortality. Conclusion In this large cohort
of patients with AS and severe LV dysfunction undergoing BAV, our results
demonstrates feasibility and promising long-term outcomes using elective
Impella support with the intention to bridge to a definitive
therapy.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<33>
Accession Number
615339279
Author
Werner-Wasik M.
Institution
(Werner-Wasik) Radiation Oncology, Sidney Kimmel Cancer Center, Thomas
Jefferson University, Philadelphia, PA, United States
Title
Radiotherapy for sulcus superior tumors.
Source
Journal of Thoracic Oncology. Conference: 17th World Conference of the
International Association for the Study of Lung Cancer, IASLC 2016.
Austria. 12 (1 Supplement 1) (pp S110-S111), 2017. Date of Publication:
January 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Superior sulcus tumors (SST) are unique among lung cancer in that they
have a tendency for the invasion into the chest wall and a spread
superiorly outside the lungs, namely into the brachial plexus and the
sympathetic chain, therefore causing a well-defined constellation of
symptoms and signs, such as chest wall/arm/shoulder pain, Horner's
syndrome, spinal cord compression, upper extremity edema etc. A primary
surgical resection is rarely performed, and bi- or trimodality therapies
are most often implemented, depending on tumor stage. A comprehensive
evaluation of the tumor extent is mandatory before any intervention is
undertaken. Following tumor biopsy to establish a diagnosis of nonsmall
cell lung cancer, standard lung cancer staging studies need to be
obtained, such as the chest and upper abdomen computerized tomography (CT)
scan with intravenous contrast, a PET CT scan and contrastenhanced brain
imaging (CT or MRI). Routine blood work and pulmonary function testing are
standard as well. However, there are two additional radiographic studies
which are necessary for each superior sulcus tumors: (1) MRI scan of the
brachial plexus; (2) MRI scan of the cervical and thoracic spine. The
rationale for imaging of the brachial plexus is not to confirm that the
plexus is invaded (which is evident based on the presenting symptoms and a
physical examination), but rather to assess the degree of its vertical
involvement, since only the lowest trunks of the brachial plexus can be
safely resected without fear of causing paralysis of the upper extremity.
The MRI of the vertebral column serves a double purpose: (1) to assess the
degree (if any) of vertebral involvement and resulting resectability; (2)
to image the proximity of the tumor to the spinal cord, which is crucial
for radiation planning. SSTs can cause thecal sac or spinal cord
compression by extending into the spinal canal through neural foramina,
without apparent spine invasion, hence the need for the MRI, which
provides a superior image quality than a chest CT scan. The overall
treatment strategy depends on the nodal status ("N" stage). For those
patients without nodal involvement ("N0") or with involvement only of the
ipsilateral hilar lymph nodes ("N1"), a common approach is to use
concurrent induction chemo-radiotherapy, followed by the surgical
resection. If obvious mediastinal nodal involvement is seen ("N2 or N3"),
the recommendation is for definitive concurrent chemo-radiotherapy without
subsequent surgery. Therefore, invasive staging of the mediastinum, either
with mediastinoscopy or with EBUS, is mandatory, since it may result in
avoiding surgery as part of management. General thoracic radiation therapy
(RT) principles apply to the SSTs, such as: (1) use of the CT simulation
for tumor and normal tissue imaging; (2) use of 6-10 MV photon energies
(unless protons are applied); (3) careful definition of the GTV, Gross
Tumor Volume, to include the visible tumor on lung windows and the
abnormal lymph nodes on soft tissue windows; (4) adequate margins for the
CTV, Clinical Target Volume, and the PTV, Planning Target Volume. In
particular, a tendency to have very tight margins around the tumor which
is in close proximity to the spinal cord should be avoided at all cost,
since this may result in a marginal tumor failure. In comparison to lung
cancers in other locations, local tumor progression of a SST can have
devastating clinical consequences, resulting in unmanageable pain, limb
paralysis and a low quality of life. The commonly used total RT doses are:
45-60 Gy in trimodality therapy (chemo-RT, then surgery) or 60- 70 Gy in
bimodality therapy (chemo-RT) in 2 Gy daily fractions. The dose-limiting
normal structures are usually the spinal cord and brachial plexus. The
maximum allowed dose to the spinal cord may need to be higher (54-55 Gy)
in SSTs than in other lung cancers (50 Gy) in order not to compromise the
minimum dose prescribed to the PTV by attempting to "spare" spinal cord.
In patients presenting with severe pain, a simple field arrangement (such
as anterior and posterior opposed fields) treating the tumor with wide
margins is a good initial option allowing for a quick start, followed by a
more advanced planning technique, such as 3-dimensional RT, intensity
modulated RT (IMRT) or VMAT. The tolerance of brachial plexus was
classically described as a maximum dose of 65 Gy, with recent publications
suggesting that higher doses, up to 78 Gy result in 12% risk of Grade>=3
radiation-related brachial plexopathy, and that brachial plexopathy is
more common as a result of tumor progression than radiation damage. The
most quoted prospective clinical trial reporting on treatment outcomes of
SSTs is a landmark Phase II SWOG 9416 study, in which 95/110 enrolled
patients without disease progression (86%) received thoracic RT to 45 Gy
in 1.8 Gy fractions with concurrent cisplatin and etoposide chemotherapy,
followed by surgery and further adjuvant chemotherapy. Eligible patients
were those with T3-T4 primary tumors and N0 or N1 nodal status. The
resection rate was 80% and 75% achieved a complete (R0) resection. The
pathologic response rate (no tumor in the specimen or microscopic
residual) was 56%; the overall 5 yr survival rate was 44% for all patients
and 54% for those with a complete tumor resection. Since then, recognition
in the surgical community that operating after RT doses higher than 45 Gy
is safe, led to a more common use of the full RT dose, i.e. 60 Gy. If the
patient initially planned for trimodality therapy is no longer a surgical
candidate or refuses surgery, thoracic RT should continue to definitive
dose without interruption. Therefore, it is crucial to perform re-imaging
for response assessment in the last week of chemo-RT (if doses of <60 Gy
are used) rather than schedule those several weeks later.

<34>
Accession Number
615339170
Author
Mueller M.
Institution
(Mueller) Thoracic Surgery, Otto Wagner Teaching Hospital, Sigmund Freud
University, Vienna, Austria
Title
Surgery of early-stage NSCLC.
Source
Journal of Thoracic Oncology. Conference: 17th World Conference of the
International Association for the Study of Lung Cancer, IASLC 2016.
Austria. 12 (1 Supplement 1) (pp S40-S42), 2017. Date of Publication:
January 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
General considerations: Early stage lung cancer - a term in transition
generally early stage lung cancer is understood as stage I and stage II
non-small lung cancer. An alternative understanding of early stage lung
cancer is resectable disease. However, both definitions are imprecise and
subject to development and Expertise. 1. Defining early stage lung cancer
as resectable disease depends on regional philosophies and local expertise
and therefore is the most unreliable and variable definition. The term
resectability focuses on the T factor of the tumor and describes the
ability of the surgeon to achieve radical resection. In contrast
operability includes any potential regional and systemic spread and
focuses more on the N and M descriptors. 2. Defining early stage lung
cancer based on mediastinal nodal involvement neglects the fact, that
single station N2 (N2a) is associated with the same five-year survival as
multistation N1 (N1b). This touches on the term locally advanced disease,
which in fact also means different things for different people. For the
oncologist locally advanced disease usually means N2 involvement with the
consequent call for chemotherapy. For the surgeon locally advanced disease
primarily addresses the T factor and is used for T3 or T4 tumors,
indicating more extended resections in the absence of N2 disease. In
summary, terms like early stage, locally advanced stage or advanced stage
should be avoided since they do not properly describe a clinical situation
nor are they guiding therapy. If the term early stage lung cancer should
be maintained for any reason, there is need for revisions. The five-year
survival of stage I and stage II non-small lung cancer is a range of less
than 30 to more than 90% and the survival expectedly mainly depends on
nodal involvement. The estimated median five-year survival of patients
with screening detected T1N0 NSCLC is a reported 92%. Even nodal
negativeT3 tumors are associated with almost 60% five year survival
following radical resection. On the other hand involvement of multiple N1
lymph nodes results in a much worse prognosis of about 35%. However, for
this presentation the current definition of stage I and stage II non-small
lung cancer was used. Preoperative staging: Resectability of lung cancer
for technical reasons in general, and in early stage lung cancer in
particular, very rarely is an issue. Oncological operability has to be
defined preoperatively along international guidelines. The European
Society of Thoracic Surgeons (ESTS) recently has published revised
guidelines for preoperative mediastinal lymph nodes staging for non-small
cell lung cancer. Only one selected group of patients with tumors of less
than 3 cm in diameter (cT1) in the outer third of the lung without signs
of nodal involvement at CT scan, PET scan or PET CT (cN0) may directly
undergo surgical resection. All other clinical situations require invasive
preoperative staging by bronchoscopy plus EBUS/EUS. If the absence of
nodal involvement is verified by EBUS/EUS this patient may also directly
undergo surgery. In the presence of radiologically suspect mediastinal
lymph nodes and negative EBUS/EUS further confirmation is recommended
using mediastinoscopy or thoracoscopy. If mediastinal nodal involvement is
histologically verified by any means the patient has to undergo
multimodality treatment. All clinical findings are to be discussed in an
interdisciplinary tumor board for proper therapy planning.1 Surgical
therapy of early stage NSCLC: Surgery remains the cornerstone of treatment
of early stage nonsmall lung cancer for patients willing to accept the
procedure-related risks. Goal of any surgical intervention for early stage
lung cancer is the complete resection of the primary tumor together with
regional lymphatic nodes. The standard for any resection with curative
intent is defined by anatomical lung resection. In early stage lung cancer
the predominant type of resection is lobectomy or bilobectomy, sometimes
along with bronchoplastic or angioplastic procedures or extended
resections for locally invading T3 tumors. Pneumonectomy particularly in
the treatment of early stage lung cancer is rarely used. Gold standard of
surgical resection for lung cancer is lobectomy. This standard is based on
a prospective multi-institutional randomized trial comparing limited
resection with lobectomy for peripheral T1N0 non-small cell lung cancer
published in 1995.2 In the absence of more recent prospective randomized
trials lobectomy still must be considered the surgical procedure of choice
for patients with peripheral T1N0 nonsmall cell lung cancer. An extensive
body of literature mainly composed of retrospective studies supports the
use of radical anatomical segmentectomy for peripheral cT1N0M0 non-small
lung cancer with less than 2 cm in diameter, certainly for older patients
with limited cardiopulmonary function. However, caution should be taken to
promote a widespread indication for intentional segmentectomy in young
good surgical candidates until the results of the ongoing randomized
controlled trials become available.3,4 The role of minimally invasive
surgery: Minimally invasive anatomical resection for lung cancer carried
out by means of video-assisted thoracic surgery (VATS) has been
increasingly carried out during the past years. A systematic review and
meta-analysis of randomized and nonrandomized trials published in 2009
reported an improved five-year survival and reduced systemic recurrences
in patients who received VATS lobectomy.5 A multicentric
propensity-matched analysis of more than 1000 patients, of which 700 had
undergone VATS lobectomy confirms, that thoracoscopic lobectomy is
associated with lower morbidity as compared with thoracotomy. The positive
impact of minimally invasive surgery in the treatment of lung cancer
particularly applies to the elderly.6 Regarding long-term survival after
video-assisted thoracoscopic lobectomy a meta- showed a survival benefit
in the favor of VATS with a difference in survival of 5% at five years.
The reason for this observed survival benefit may be attributed to a less
pronounced compromise of the immunocompetence after the surgical trauma.7
The role of mediastinal lymph node dissection: The rationale for a formal
mediastinal lymph node dissection is multifold. The distribution pattern
of mediastinal lymph node metastasis is not predictable and skip
metastasis are seen in up to 30% of patients. Even small tumors may
present with unexpected N2 disease with an incidence of 6-10%. The
operative morbidity is not significantly influenced by a systematic
mediastinal lymph node dissection. Recommended standard of mediastinal
lymph node dissection is the removal of all mediastinal tissue containing
lymph nodes in a systematic Approach within anatomical landmarks. The most
recent randomized controlled trial published in 2011 did not find a
survival benefit by complete mediastinal lymphadenectomy in patients with
early stage lung cancer, but the results should not be generalized to
patients staged only radiographically or those with higher stage tumors.
The recommendation from this study is that a formal mediastinal en-bloc
dissection may still affect survival and certainly optimally stages
patients. In the subgroup analysis no difference between VATS and open
lobectomy was observed for number of lymph nodes harvested and regarding
long-term survival.8 As minimally invasive surgery along with unilateral
mediastinal lymphadenectomy generally prolongs operation times and the
requirement of single lung ventilation the advantages for the elderly
population has to be questioned and discussed individually. An alternative
to thoracoscopic unilateral lymphadenectomy is offered by video-assisted
mediastinal lymphadenectomy through the neck (VAMLA). The approach is
similar to transcervical mediastinoscopy and allows for a radical bloc
dissection of all mediastinal lymph node stations. Besides the benefit of
bilateral lung ventilation during this phase of the operation a bilateral
mediastinal lymphadenectomy offers improved surgical radicality.
Alternatives to surgical resection and the role of primary radiotherapy:
In patients unfit for surgery SABR is the treatment of choice for
peripherally located stage I non-small cell lung cancer. If SABR is not
available a hypofractionated radiotherapy is advocated. A systematic
Review comparing outcomes of SABR and surgery in patients with severe COPD
revealed a higher 30 day mortality following surgery but similar overall
survival at one and three years.9 In a meta-analysis of 19 out of 318
papers with the best evidence addressing a comparison of SABR and surgical
wedge resection both methods proved as reasonable alternatives to
lobectomy in high risk surgical patients. In this analysis SABR was
associated with reduced local recurrence compared to wedge resection and
should be considered when wedge resection is planned due to anatomical
location and size of the primary tumor in a patient who is high risk for
surgery.10 Although local tumor control may be comparable or even superior
to extra-anatomic surgical resection a quite high rate of late
radiological changes after stereotactic ablative radiotherapy for early
stage lung cancer has to be considered. At one year follow-up the
predicted probability of having expected or pronounced radiological
changes after SABR were 65 and 22%. These changes included phenomena like
mass-like appearance, radiation fibrosis, and rib fractures, which
sometimes are difficult to differentiate from tumor recurrence. Summary:
The ACCP guidelines address the question, who had to be considered a high
risk candidate for surgery. With the advent of minimally invasive
resection, the criteria to classify a patient as too ill to undergo an
anatomic lung resection are being redefined.

<35>
Accession Number
615338269
Author
Aigner C.
Institution
(Aigner) Thoracic Surgery, Ruhrlandklinik - University Clinic Essen,
Essen, Germany
Title
Muscle-sparing thoracotomy: Can it still be considered a standard?.
Source
Journal of Thoracic Oncology. Conference: 17th World Conference of the
International Association for the Study of Lung Cancer, IASLC 2016.
Austria. 12 (1 Supplement 1) (pp S122-S123), 2017. Date of Publication:
January 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Muscle sparing thoracotomy has been a standard approach in thoracic
surgery for a long time. Minimal invasive approaches have gained a
widespread acceptance recently and were included in the treatment
guidelines for early stage NSCLC by several societies. Prospective
randomized trials comparing minimal invasive approaches versus muscle
sparing thoracotomy in stage I NSCLC have already been performed more than
twenty years ago and demonstrated equal morbidity and mortality.
Nevertheless it took until 2013 that the American College of Chest
Physician guidelines recommended a VATS approach for clinical stage I
NSCLC over a thoracotomy in experienced centers.1 No recommendation is
made for more advanced stages. When analyzing national registry data still
a high percentage of procedures in performed in an open way. This means
that in current practice thoracotomy is still used as a standard approach
by many surgeons. Minimal invasive approaches-both videothoracoscopic and
robotic-are not different operations but different approaches towards
performing an operation. It has been proven in several studies that in
early stage lung cancer minimal invasive approaches in its various form
lead at least to equivalent or even better oncologic outcome compared to
an open approach. Nevertheless in more advanced stages this proof is
lacking. Experienced centers reported individual series of minimal
invasive approaches towards advanced procedures such as sleeve resection,
pneumonectomy, chest wall resection and Pancoast tumor resection. While
this is technically feasible no data on long-term outcome of larger
patient cohorts are available and an open approach is considered standard
in these cases. Thus for tumors with invasion of hilar structures or
sleeve resection a muscle sparing thoracotomy currently remains a standard
approach. Perceived advantages of minimal invasive approaches-VATS as well
as RATS-include less pain, fewer complications, shorter length of stay,
faster return to normal activity and higher rate of adjuvant chemotherapy
compliance. There are a few single center studies challenging these
assumptions2,3 as well as a recent analysis of Danish national data,4
however the majority of studies are in favor of minimal invasive
approaches. In summary muscle sparing thoracotomy remains a standard
approach for advanced stage tumors, whereas early stage lung cancer should
be treated minimally invasive in experienced centers.

<36>
Accession Number
615338086
Author
Culligan M.; Friedberg J.; Black L.; Wimbush S.; Norton C.; Burrows W.;
Carr S.; Donahue J.; Zubrow M.
Institution
(Culligan, Friedberg, Black, Wimbush, Norton, Burrows, Carr, Donahue)
Thoracic Surgery, University of Maryland Medical Center, Baltimore, MD,
United States
(Zubrow) Medicine, University of Maryland Medical Center, Baltimore, MD,
United States
Title
Telenursing: A thoracic surgery nursing initiative aimed at decreasing
hospital readmissions and increasing patient satisfaction.
Source
Journal of Thoracic Oncology. Conference: 17th World Conference of the
International Association for the Study of Lung Cancer, IASLC 2016.
Austria. 12 (1 Supplement 1) (pp S1097-S1098), 2017. Date of Publication:
January 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: In the USA there is a national initiative in healthcare to
decrease hospital readmissions, decrease the cost of care while patients
are hospitalized and to increase patient. A recent study evaluating
mortality rates in the lung cancer resection patients reported a 30- day
readmission was associated with a 6-fold increase in the 90-day mortality
of this patient population (14.4% vs 2.5%). This report not only forces
thoracic surgery teams to extend their operative mortality focus and
reporting beyond the traditional 30-day time period but it also emphasizes
the critical value and positive impact continued post-operative care for
the first three months after discharge can have on patient outcomes. The
expert care delivered by thoracic surgery nurses plays a critical role in
decreasing post-operative complications and ensuring patients are safely
discharged from the hospital. The valuable impact thoracic surgery nurses
have on preventing hospital readmissions and improving patient
satisfaction is the intended focus of this clinical trial. The positive
impact telehealth interventions have on multiple different disease
processes supports investigation of this care modality for the thoracic
surgery patient population. We have designed a clinical trial focused on
implementing a TeleNursing program with the specific aims of preventing
hospital readmissions and improving patient satisfaction. Methods: Our
thoracic surgery practice currently has a "day-after-discharge" follow-up
phone call program that is directed by the thoracic surgery nurses in the
practice. Pertinent clinical details of each patient's post-operative
course are relayed to the thoracic surgery nurses. The nurses call
patients 2-3 days after discharge and asked questions related to
medications, pain management, sign or symptoms of infection, activity
level and expectations, sleep, appetite and general understanding of all
discharge instructions. This interaction is documented in the electronic
medical record. This program has been expanded to compare the efficacy of
the phone calls vs scheduled video-calls between nurses and patients.
Patients are randomized to standard of care day after discharge phone
calls vs the TeleNursing follow-up video-call; discharge day 2, 1-month,
2-month and 3- month. All patients complete a patient satisfaction
questionnaire at predetermined time points. The primary objective is to
decrease hospital readmission rates and the secondary objective is to
improve patient satisfaction. Results: Although the results of this
clinical trial are pending, interim analysis indicates that patients are
willing to participate in this program and are pleased with the
nurse-patient interaction beyond their hospital stay. Conclusion: This
clinical investigation is ongoing.

<37>
Accession Number
615338066
Author
Culligan M.; Black L.; Norton C.; Wimbush S.; Wells C.; Jorshari F.; Dove
C.; Williams K.; South J.; Tigini L.; Friedberg J.; Burrows W.; Donahue
J.; Carr S.
Institution
(Culligan, Black, Norton, Wimbush, Friedberg, Burrows, Donahue, Carr)
Thoracic Surgery, University of Maryland Medical Center, Baltimore, MD,
United States
(Wells, Williams, Tigini) Respiratory and Physical Rehabilitation,
University of Maryland Medical Center, Baltimore, United States
(Jorshari, Dove, South) Nursing, University of Maryland Medical Center,
Baltimore, MD, United States
Title
Winners study: Does a formal interactive patient education program
positively impact patient outcomes and satisfaction after thoracic
surgery.
Source
Journal of Thoracic Oncology. Conference: 17th World Conference of the
International Association for the Study of Lung Cancer, IASLC 2016.
Austria. 12 (1 Supplement 1) (pp S1096-S1097), 2017. Date of Publication:
January 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Post-operative complications in the thoracic surgery patient
population can be costly to healthcare systems and devastating to patients
and their families. The most common complications are respiratory, cardiac
and gastrointestinal in nature. It is estimated that these complications
occur at a rate of 3-5%. In an effort to improve patient outcomes, a nurse
led multidisciplinary team developed and implemented the WINNERS Study
(Walking with INtegrated Nursing, Exercise, Respiratory/Rehab Services),
designed to determine if a formal pre-operative/perioperative interactive
patient education program would positively impact patient outcomes and
improve satisfaction following thoracic surgery. Methods: All general
thoracic surgery patients undergo informed consent and are randomized to
current standard of care verbal pre-operative teaching vs pre-operative/
perioperative interactive patient education program. The multidisciplinary
team developed formal patient educational materials, written and
audiovisual, used to educate and prepare patients for what they should
expect post-operatively with respect to the importance of secretion
management, ambulation, general aspects of what to expect after surgery
and the importance of their active participation in their post-operative
recovery. The study design is outlined in Figure 1. The endpoints include
length of stay, reintubation rates, pneumonia incidence, quality of life
measurements, physical function measurements (PFT / 6min walk / total
steps). Patient satisfaction is measures with the Quality of Life
Instrument, SF-36 at pre-determined time-points. Results: Patients are
currently actively enrolling into the study without any recruitment issues
or adverse events. The preliminary analysis demonstrates a favorable
impact on patient outcomes and improved patient satisfaction. Conclusion:
This study is ongoing. (Figuer Presented).

<38>
[Use Link to view the full text]
Accession Number
615665559
Author
Palermo J.; Dart A.B.; De Mello A.; Devarajan P.; Gottesman R.; Garcia
Guerra G.; Hansen G.; Joffe A.R.; Mammen C.; Majesic N.; Morgan C.;
Skippen P.; Pizzi M.; Palijan A.; Zappitelli M.
Institution
(Palermo, Gottesman, Pizzi, Palijan, Zappitelli) Divisions of Nephrology
and Pediatric Critical Care Medicine, Department of Pediatrics, Montreal
Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
(Dart) Section of Nephrology, Department of Pediatrics and Child Health,
University of Manitoba, Winnipeg, MB, Canada
(De Mello, Mammen) Division of Nephrology, British Columbia Children's
Hospital, University of British Columbia, Vancouver, BC, Canada
(Devarajan) Department of Nephrology and Hypertension, Cincinnati
Children's Hospital Medical Center, Cincinnati, OH, United States
(Garcia Guerra, Joffe) Department of Pediatrics, University of Alberta,
Women and Children's Health Research Institute, Edmonton, AL, Canada
(Hansen) Section of Pediatric Intensive Care, Department of Pediatrics and
Child Health, University of Manitoba, Children's Hospital, Winnipeg, MB,
Canada
(Majesic, Morgan) Division of Nephrology, Department of Pediatrics,
University of Alberta, Edmonton, AL, Canada
(Skippen) Pediatric Intensive Care Unit, Children's Heart Centre, British
Columbia Children's Hospital, Vancouver, BC, Canada
Title
Biomarkers for Early Acute Kidney Injury Diagnosis and Severity
Prediction: A Pilot Multicenter Canadian Study of Children Admitted to the
ICU.
Source
Pediatric Critical Care Medicine. 18 (6) (pp e235-e244), 2017. Date of
Publication: 01 Jun 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: Acute kidney injury occurs early in PICU admission and
increases risks for poor outcomes. We evaluated the feasibility of a
multicenter acute kidney injury biomarker urine collection protocol and
measured diagnostic characteristics of urine neutrophil
gelatinase-associated lipocalin, interleukin-18, and liver fatty acid
binding protein to predict acute kidney injury and prolonged acute kidney
injury. Design: Prospective observational pilot cohort study. Setting:
Four Canadian tertiary healthcare PICUs. Patients: Eighty-one children 1
month to 18 years old. Exclusion criteria were as follows: Cardiac
surgery, baseline severe kidney disease, and inadequate urine or serum for
PICU days 1-3. Interventions: PICUs performed standardized urine
collection protocol to obtain early PICU admission urine samples, with
deferred consent. Measurements and Main Results: Study barriers and
facilitators were recorded. Acute kidney injury was defined based on
Kidney Disease: Improving Global Outcomes serum creatinine criteria (acute
kidney injury<inf>serum creatinine</inf>) and by serum creatinine and
urine output criteria (acute kidney injury<inf>serum creatinine+urine
output</inf>) Prolonged acute kidney injury was defined as acute kidney
injury duration of 48 hours or more. PICU days 1-3 neutrophil
gelatinase-associated lipocalin, interleukin-18, and liver fatty acid
binding protein were evaluated for acute kidney injury prediction (area
under the curve). Biomarkers on the first day of acute kidney injury
attainment (day 1 acute kidney injury) were evaluated for predicting
prolonged acute kidney injury. Eighty-two to 95% of subjects had urine
collected from PICU days 1-3. Acute kidney injury<inf>serum
creatinine</inf> developed in 16 subjects (20%); acute kidney
injury<inf>serum creatinine+urine output</inf> developed in 38 (47%). On
PICU day 1, interleukin-18 predicted acute kidney injury<inf>serum
creatinine</inf> with area under the curve=0.82, but neutrophil
gelatinase-associated lipocalin and liver fatty acid binding protein
predicted acute kidney injury<inf>serum creatinine</inf> with area under
the curve of less than or equal to 0.69; on PICU day 2, area under the
curve was higher (not shown). Interleukin-18 and liver fatty acid binding
protein on day 1 acute kidney injury predicted prolonged acute kidney
injury<inf>serum creatinine</inf> (area under the curve=0.74 and 0.83,
respectively). When acute kidney injury<inf>serum creatinine+urine
output</inf> was used to define acute kidney injury, biomarker area under
the curves were globally lower. Conclusions: Protocol urine collection to
procure early admission samples is feasible. Individual biomarker acute
kidney injury prediction performance is highly variable and modest. Larger
studies should evaluate utility and cost effectiveness of using early
acute kidney injury biomarkers.<br/>Copyright &#xa9; 2017 by the Society
of Critical Care Medicine and the World Federation of Pediatric Intensive
and Critical Care Societies.

<39>
Accession Number
616587020
Author
John M.; Ely E.W.; Halfkann D.; Schoen J.; Sedemund-Adib B.; Klotz S.;
Radtke F.; Stehr S.; Hueppe M.
Institution
(John, Halfkann, Schoen, Sedemund-Adib, Stehr, Hueppe) Clinic for
Anaesthesiology and Intensive-Care Medicine UKSH Campus Luebeck,
Ratzeburger Allee 160, Luebeck 23538, Germany
(Ely) Pulmonary and Critical Care Medicine, Vanderbilt University,
Nashville, TN, United States
(Ely) Geriatric Research Education Clinical Center (GRECC) of the
Tennessee Valley Veterans Administration, Nashville, TN, United States
(Klotz) Department of Cardiac and Thoracic Vascular Surgery, UKSH Campus
Luebeck, Luebeck, Germany
(Radtke) Clinic for Anaesthesiology and Operative Intensive-Care Medicine,
Charite University Hospital Berlin, Berlin, Germany
Title
Acetylcholinesterase and butyrylcholinesterase in cardiosurgical patients
with postoperative delirium.
Source
Journal of Intensive Care. 5 (1) (no pagination), 2017. Article Number:
29. Date of Publication: 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Patients in intensive care units (ICU) are often diagnosed
with postoperative delirium; the duration of which has a relevant negative
impact on various clinical outcomes. Recent research found a potentially
important role of acetylcholinesterase (AChE) and butyrylcholinesterase
(BChE) in delirium of critically ill patients on nonsurgical ICU or in
non-cardiac-surgery patients. We tested the hypothesis that AChE and BChE
have an impact on patients after cardiac surgery with postoperative
delirium. Methods: After obtaining approval from the local ethics
committee, this mechanistic study gathered data of all 217 patients
included in a randomized controlled trial testing non-pharmacological
modifications of care in the cardiac surgical ICU to reduce delirium.
Delirium was assessed with the Confusion Assessment Method for the
Intensive Care Unit (CAM-ICU) and the Nursing Delirium Screening Scale
(Nu-DESC) twice a day for the first 3 days after surgery. Further outcome
variables were somatic laboratory parameters and variables regarding
surgery, anesthesia, and postsurgical recovery. 10 mul venous or arterial
blood was drawn and AChE and BChE were determined with ChE check mobile
from Securetec. Results: Of 217 patients, 60 (27.6%) developed
postsurgical delirium (POD). Patients with POD were older (p = 0.005), had
anemia (p = 0.01), and worse kidney function (p = 0.006). Furthermore,
these patients had lower intraoperative cerebral saturation (NIRS) (p <
0.001) and higher intraoperative need of catecholamines (p = 0.03).
Delirious patients showed more inflammatory response (p < 0.001). AChE and
BChE values were mainly inside the norm. Patients with values outside the
norm did not have POD more often than others. Regarding AChE and BChE
patients did not differ in having delirium or not (p > 0.10). Conclusions:
Postoperative measurement of AChE and BChE did not discern between
patients with and without POD. The effect of the cardiac surgical
procedure on AChE and BChE remains unclear. Further studies with patients
in cardiac surgery are needed to evaluate a possible combination of
delirium and the cholinergic transmitter system. There might be possible
interactions with AChE/BChE and blood products and the use of
cardiopulmonary bypass, which should be investigated more intensively.
Trial registration: German Clinical Trials Register,
DRKS00006217.<br/>Copyright &#xa9; 2017 The Author(s).

<40>
Accession Number
616552856
Author
Perrotta S.; Lentini S.
Institution
(Perrotta) Department of Cardiothoracic Surgery, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Lentini) Cardiovascular Department, Citta di Lecce Hospital, GVM Care and
Research, Lecce, Italy
Title
Surgical management of severe damage of the aortic annulus.
Source
Hellenic Journal of Cardiology. 57 (6) (pp 382-388), 2016. Date of
Publication: November 2016.
Publisher
Hellenic Cardiological Society
Abstract
Aortic annular erosion and abscess are serious complications of prosthetic
aortic valve endocarditis and can be treated with aortic valve
translocation and left ventricle outflow tract reconstruction. These two
surgical techniques seem to have similar early postoperative outcomes, and
their use can be considered an option after the failure of conventional
surgical methods.<br/>Copyright &#xa9; 2016 Hellenic Society of
Cardiology.

<41>
Accession Number
616732724
Author
Ahn H.C.; Nielsen N.-E.; Baranowski J.
Institution
(Ahn) Department of Cardiothoracic Surgery, University Hospital,
Institution of Medical and Health Sciences, Linkoping University,
Linkoping, Sweden
(Nielsen) Department of Cardiology, Linkoping University, Linkoping,
Sweden
(Baranowski) Department of Physiology, Linkoping University, Linkoping,
Sweden
Title
Can predilatation in transcatheter aortic valve implantation be omitted? -
a prospective randomized study.
Source
Journal of cardiothoracic surgery. 11 (1) (pp 124), 2016. Date of
Publication: 04 Aug 2016.
Abstract
BACKGROUND: The use of a balloon expandable stent valve includes balloon
predilatation of the aortic stenosis before valve deployment. The aim of
the study was to see whether or not balloon predilatation is necessary in
transcatheter aortic valve replacement (TAVI).
METHODS: Sixty consecutive TAVI patients were randomized to the standard
procedure or to a protocol where balloon predilatation was omitted.
RESULTS: There were no significant differences between the groups
regarding early hemodynamic results or complication rates.
CONCLUSIONS: TAVI can be performed safely without balloon predilatation
and with the same early results as achieved with the standard procedure
including balloon predilatation. The reduction in the number of pacing
periods required may be beneficial for the patient.

<42>
Accession Number
616709453
Author
Amrane H.; Porta F.; Van Boven A.J.; Kappetein A.P.; Head S.J.;
Rodes-Cabau J.
Institution
(Amrane, Porta) Department of Cardiothoracic Surgery, Medisch Centrum
Leeuwarden, Postbus 888, Leeuwarden 8901 BR, Netherlands
(Van Boven) Department of Cardiology, Medisch Centrum Leeuwarden,
Leeuwarden, Netherlands
(Kappetein, Head) Department of Cardiothoracic Surgery, Erasmus Medical
Center, Rotterdam, Netherlands
(Rodes-Cabau) Quebec Heart and Lung Institute, Laval University, Quebec
City, QC, Canada
Title
A meta-analysis on clinical outcomes after transaortic transcatheter
aortic valve implantation by the heart team.
Source
EuroIntervention. 13 (2) (pp e168-e176), 2017. Date of Publication: June
2017.
Publisher
EuroPCR
Abstract
Aims: We aimed to perform a meta-analysis on transaortic (TAo)
transcatheter aortic valve implantation (TAVI) in order to gain more
insight into the safety and efficacy of the approach in addition to the
data available from selected centres with small numbers of patients.
Methods and results: PubMed and EMBASE were searched on 31 August 2016.
The search yielded 251 studies, of which 16 with 1,907 patients were
included in the meta-analysis. All were observational, single-arm studies.
The rate of conversion to sternotomy was 3.2% (95% CI: 2.3-3.5%;
I²=0) among nine studies. Device success among 10 studies was
91% (95% CI: 86.7-94.0%; I²=25.5). Major vascular complications
occurred at a rate of 3.1% (95% CI: 1.6-6.0%; I²=60.8).
Moderate or severe paravalvular leakage/ aortic valve regurgitation
(PVL/AR) was reported to be 6.7% (95% CI: 4.3-10.1%; I²=58.9).
Permanent pacemaker implantation was required in 11.7% (95% CI: 9.2-14.8%;
I²=26.5) of patients. Pooled 30-day post-TAVI complication
rates were 9.9% (95% CI: 8.6-11.3%; I²=0) for mortality, 3.7%
(95% CI: 2.4-5.6%; I²=28.7) for all stroke, and 1.0% for
myocardial infarction (95% CI: 0.5-1.7%; I²=0). The Valve
Academic Research Consortium-2 (VARC-2) composite safety endpoint occurred
at a pooled rate of 16.7% (95% CI: 10.6-25.3%; I²=58.7).
Conclusions: In this meta-analysis of observational studies, transaortic
TAVI appears to be a safe procedure with low complication
rates.<br/>Copyright &#xa9; Europa Digital & Publishing 2017. All rights
reserved.

<43>
Accession Number
616713846
Author
Epstein N.
Institution
(Epstein) Department of Neurosurgical Spine/Education, Winthrop University
Hospital, Mineola, NY, United States
Title
Discrimination against female surgeons is still alive: Where are the full
professorships and chairs of departments?.
Source
Surgical Neurology International. 8 (1) (no pagination), 2017. Date of
Publication: 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: Although half of all medical students are now and women are
increasingly filling surgical residency positions, few ascend the academic
ladder to become chairman of their departments, much less full academic
professors. Methods: We queried PubMed to search for the number of women
surgeons in different subspecialties, and asked how many were chairman or
full academic professors? Results: Data coming out of largely general or
cardiothoracic surgery departments cited no substantial gains for women
surgeons over the years; there were few chairmanships or full
professorships. In one study of 54 female cardiothoracic surgeons, 60% of
academic appointments were at the instructor or assistant professor level;
only 18% were full professors. In another study looking at 12-year data
from major academic medical institutions in the US, women constituted only
9.2% of chairs, only 14.7% of full professors, and just 9.3% of deans. In
a third study, out of 270 female general surgeons, there were only three
who were chairman, and just 12.4% were tenured professors. In Great
Britain/Ireland, of 315 neurosurgeons (25 females), all 16 full professors
were males. Two medical/surgical series speculated it would take until
2096 or 2136 for females to attain 50% of full professorships. The
American Association of Neurological Surgery (U.S. 2017; personal
communication) showed that of 287 Board-certified female neurosurgeons,
there is just one female surgeons chairman. Conclusions: Few female
physicians/surgeons were chairs of departments or full professors at their
academic institutions. Do women in medicine/surgery really need to wait
until 2136 to achieve equality?

<44>
Accession Number
615442933
Author
Costa Leme A.; Hajjar L.A.; Volpe M.S.; Fukushima J.T.; De Santis Santiago
R.R.; Osawa E.A.; Pinheiro De Almeida J.; Gerent A.M.; Franco R.A.;
Feltrim M.I.Z.; Nozawa E.; De Moraes Coimbra V.R.; De Moraes Ianotti R.;
Hashizume C.S.; Filho R.K.; Auler J.O.C.; Jatene F.B.; Galas F.R.B.G.;
Amato M.B.P.
Institution
(Costa Leme, Volpe, Fukushima, De Santis Santiago, Osawa, Pinheiro De
Almeida, Gerent, Franco, Feltrim, Nozawa, De Moraes Coimbra, De Moraes
Ianotti, Hashizume, Filho, Auler, Galas) Department of Anesthesia and
Intensive Care, Heart Institute (InCor), University of Sao Paulo, Sao
Paulo, Brazil
(Hajjar, Jatene, Amato) Cardio-Pulmonary Department, Heart Institute
(Incor), Hospital Das Clinicas da FMUSP - University of Sao Paulo, Avenue
Dr Arnaldo 455, Sao Paulo 01246-903, Brazil
(Volpe) Departament of Applied Physiotherapy, Federal University of
Triangulo Mineiro, Uberaba, Brazil
Title
Effect of intensive vs moderate alveolar recruitment strategies added to
lung-protective ventilation on postoperative pulmonary complications a
randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 317 (14) (pp
1422-1432), 2017. Date of Publication: 11 Apr 2017.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE Perioperative lung-protective ventilation has been recommended
to reduce pulmonary complications after cardiac surgery. The protective
role of a small tidal volume (VT) has been established, whereas the added
protection afforded by alveolar recruiting strategies remains
controversial. OBJECTIVE To determine whether an intensive alveolar
recruitment strategy could reduce postoperative pulmonary complications,
when added to a protective ventilation with small VT. DESIGN, SETTING, AND
PARTICIPANTS Randomized clinical trial of patients with hypoxemia after
cardiac surgery at a single ICU in Brazil (December 2011-2014).
INTERVENTIONS Intensive recruitment strategy (n=157) or moderate
recruitment strategy (n=163) plus protective ventilation with small VT.
MAIN OUTCOMES AND MEASURES Severity of postoperative pulmonary
complications computed until hospital discharge, analyzed with a common
odds ratio (OR) to detect ordinal shift in distribution of pulmonary
complication severity score (0-To-5 scale, 0, no complications; 5, death).
Prespecified secondary outcomes were length of stay in the ICU and
hospital, incidence of barotrauma, and hospital mortality. RESULTS All 320
patients (median age, 62 years; IQR, 56-69 years; 125 women [39%])
completed the trial. The intensive recruitment strategy group had a mean
1.8 (95%CI, 1.7 to 2.0) and a median 1.7 (IQR, 1.0-2.0) pulmonary
complications score vs 2.1 (95%CI, 2.0-2.3) and 2.0 (IQR, 1.5-3.0) for the
moderate strategy group. Overall, the distribution of primary outcome
scores shifted consistently in favor of the intensive strategy, with a
common OR for lower scores of 1.86 (95%CI, 1.22 to 2.83; P = .003). The
mean hospital stay for the moderate group was 12.4 days vs 10.9 days in
the intensive group (absolute difference, 1.5 days; 95% CI, 3.1 to 0.3; P
= .04). The mean ICU stay for the moderate group was 4.8 days vs 3.8 days
for the intensive group (absolute difference, 1.0 days; 95%CI, 1.6 to 0.2;
P = .01). Hospital mortality (2.5%in the intensive group vs 4.9% in the
moderate group; absolute difference, 2.4%, 95%CI, 7.1%to 2.2%) and
barotrauma incidence (0% in the intensive group vs 0.6% in the moderate
group; absolute difference, 0.6%; 95%CI, 1.8%to 0.6%; P = .51) did not
differ significantly between groups. CONCLUSIONS AND RELEVANCE Among
patients with hypoxemia after cardiac surgery, the use of an intensive vs
a moderate alveolar recruitment strategy resulted in less severe pulmonary
complications while in the hospital.

<45>
Accession Number
608576405
Author
Zheng X.-W.; Zhao D.-H.; Peng H.-Y.; Fan Q.; Ma Q.; Xu Z.-Y.; Fan C.; Liu
L.-Y.; Liu J.-H.
Institution
(Zheng, Zhao, Peng, Fan, Ma, Xu, Fan, Liu) Department of Cardiology,
Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of
Heart Lung and Blood Vessel Diseases, Beijing 100029, China
(Liu) Key Laboratory of Soft Matter Physics, Institute of Physics, Chinese
Academy of Sciences, Beijing 100190, China
Title
Randomized comparison of the crush versus the culotte stenting for
coronary artery bifurcation lesions.
Source
Chinese Medical Journal. 129 (5) (pp 505-510), 2016. Date of Publication:
05 Mar 2016.
Publisher
Chinese Medical Association
Abstract
Background: The crush and the culotte stenting were both reported to be
effective for complex bifurcation lesion treatment. However, their
comparative performance remains elusive. Methods: A total of 300 patients
with coronary bifurcation lesions were randomly assigned to crush (n =
150) and culotte (n = 150) treatment. The primary endpoint was the
occurrence of major adverse cardiac events (MACEs) at 12 months including
cardiac death, myocardial infarction, stent thrombosis, and target vessel
revascularization. Index lesion restenosis at 12 months was a secondary
endpoint. The surface integrals of time-averaged wall shear stress at
bifurcation sites were also be quantified. Results: There were no
significant differences in MACE rates between the two groups at 12-month
follow-up: Crush 6.7%, culotte 5.3% (P = 0.48). The rates of index lesion
restenosis were 12.7% versus 6.0% (P = 0.047) in the crush and the culotte
groups, respectively. At 12-month follow-up, the surface integrals of
time-averaged wall shear stress at bifurcation sites in the crush group
were significantly lower than the culotte group ([5.01 +/- 0.95] x
10^-4 Newton and [6.08 +/- 1.16] x 10^-4 Newton,
respectively; P = 0.003). Conclusions: Both the crush and the culotte
bifurcation stenting techniques showed satisfying clinical and
angiographic results at 12-month follow-up. Bifurcation lesions treated
with the culotte technique tended to have lower restenosis rates and more
favorable flow patterns.<br/>Copyright &#xa9; 2016 Chinese Medical
Journal.

<46>
[Use Link to view the full text]
Accession Number
610502698
Author
Kim H.Y.; Choi J.M.; Lee Y.-H.; Lee S.; Yoo H.; Gwak M.
Institution
(Kim) Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart
Hospital, Hallym University College of Medicine, South Korea
(Choi, Lee, Lee, Yoo, Gwak) Department of Anesthesiology and Pain
Medicine, Asan Medical Center, University of Ulsan College of Medicine,
Seoul, South Korea
Title
Effects of the trendelenburg position and positive end-expiratory pressure
on the internal jugular vein cross-sectional area in children with simple
congenital heart defects.
Source
Medicine (United States). 95 (18) (pp e3525), 2016. Date of Publication:
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Catheterization of the internal jugular vein (IJV) remains difficult in
pediatric populations. Increasing the cross-sectional area (CSA) of the
IJV facilitates cannulation and decreases complications. We aimed to
evaluate the Trendelenburg position and the levels of positive
end-expiratory pressure (PEEP) at which the maximum increase of CSA of the
IJV occurred in children undergoing cardiac surgery. In this prospective
study, the CSA of the right IJV was assessed using ultrasound in 47
anesthetized pediatric patients with simple congenital heart defects. The
baseline CSA was obtained in response to a supine position with no PEEP
and compared with 5 different randomly ordered maneuvers, that is, a PEEP
of 5 and 10 cm H2O in a supine position and of 0, 5, and 10 cm H2O in a
108 Trendelenburg position. Hemodynamic variables, incluDing blood
pressure and heart rate, maximum and minimum diameters, and CSA, were
measured. All maneuvers increased the CSA of the right IJV with respect to
the control condition. In the supine position, the CSA was increased by
9.4% with a PEEP of 5 and by 19.5% with a PEEP of 10 cm H2O. The
Trendelenburg tilt alone increased the CSA by 19.0%, and combining the 108
Trendelenburg with a 10 cm H2O PEEP resulted in the largest IJV CSA
increase (33.3%) compared with the supine position with no PEEP.
Meanwhile, vital signs remained relatively steady during the experiment.
The application of the Trendelenburg position and a 10 cm H2O PEEP thus
significantly increases the CSA of the right IJV, perhaps improving the
chances of successful cannulation in pediatric patients with simple
congenital heart defects.<br/>Copyright &#xa9; 2016 Wolters Kluwer Health,
Inc. All rights reserved.

<47>
Accession Number
615546686
Author
Guzzetta N.A.; Williams G.D.
Institution
(Guzzetta) Department of Anesthesiology, Emory University School of
Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
(Williams) Department of Anesthesiology, Stanford University School of
Medicine, Lucile Packard Children's Hospital, Palo Alto, CA, United States
Title
Current use of factor concentrates in pediatric cardiac anesthesia.
Source
Paediatric Anaesthesia. 27 (7) (pp 678-687), 2017. Date of Publication:
July 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Excessive bleeding following pediatric cardiopulmonary bypass is
associated with increased morbidity and mortality, both from the effects
of hemorrhage and the therapies employed to achieve hemostasis. Neonates
and infants are especially at risk because their coagulation systems are
immature, surgeries are often complex, and cardiopulmonary bypass
technologies are inappropriately matched to patient size and physiology.
Consequently, these young children receive substantial amounts of
adult-derived blood products to restore adequate hemostasis. Adult and
pediatric data demonstrate associations between blood product transfusions
and adverse patient outcomes. Thus, efforts to limit bleeding after
pediatric cardiopulmonary bypass and minimize allogeneic blood product
exposure are warranted. The off-label use of factor concentrates, such as
fibrinogen concentrate, recombinant activated factor VII, and prothrombin
complex concentrates, is increasing as these hemostatic agents appear to
offer several advantages over conventional blood products. However,
recognizing that these agents have the potential for both benefit and
harm, well-designed studies are needed to enhance our knowledge and to
determine the optimal use of these agents. In this review, our primary
objective was to examine the evidence regarding the use of factor
concentrates to treat bleeding after pediatric CPB and identify where
further research is required. PubMed, MEDLINE/OVID, The Cochrane Library
and the Cochrane Central Register of Controlled Trials (CENTRAL) were
systematically searched to identify existing studies.<br/>Copyright &#xa9;
2017 John Wiley & Sons Ltd

<48>
Accession Number
610067530
Author
Loladze G.; Kuehnel R.U.; Claus T.; Hartrumpf M.; Kuepper F.; Pohl M.;
Albes J.M.
Institution
(Loladze, Kuehnel, Claus, Hartrumpf, Kuepper, Albes) Department of
Cardiovascular Surgery, Heart Center Brandenburg, Bernau, Germany
(Pohl) Institute of Medical Physics and Biophysics, University Hospital
Charite, Berlin, Germany
Title
Double-Wire versus Single-Wire Sternal Closure in Obese Patients: a
Randomized Prospective Study.
Source
Thoracic and Cardiovascular Surgeon. 65 (4) (pp 332-337), 2017. Article
Number: 154307oc. Date of Publication: 01 Jun 2017.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Background Sternal instability after coronary artery bypass grafting
(CABG) is a serious complication. Obese patients are at high risk for
sternal instability after CABG. This study was conducted to assess the
positive impact of double-wire sternal closure on sternal instability.
Methods A total of 200 obese patients with a body mass index >= 30
kg/m² undergoing isolated CABG with left internal mammary
artery (LIMA) graft were randomly assigned to sternal closure either by
eight single wires (n = 100) or by a combination of four double wires and
four single wires. Results There was a total of 21 cases with sternal
instability: 5 cases (i.e., 5%) in the double-wire group versus 16 cases
(16%) in the single-wire group (p = 0.019). Logistic regression analysis
showed sternal closure via double wires as an independent protection
factor (odds ratio [OR]: 0.276; p = 0.029). Smoking (OR: 5.5; p = 0.006)
and postoperative delirium (OR: 3.5; p = 0.033) turned out to be
independent risk factors for the development of sternal instability.
Conclusion Double-wire sternal closure significantly reduces postoperative
sternal instability in obese patients undergoing isolated CABG with LIMA
graft.<br/>Copyright &#xa9; Georg Thieme Verlag KGStuttgart . New York.

<49>
Accession Number
606883944
Author
Zhang J.; Xu R.W.; Fan X.; Ye Z.; Liu P.
Institution
(Zhang, Xu, Fan, Ye, Liu) Department of Cardiovascular Surgery,
China-Japan Friendship Hospital, No. 2 Yinghua East Road, Beijing 100029,
China
Title
A Systematic Review of Early Results Following Synchronous or Staged
Carotid Artery Stenting and Coronary Artery Bypass Grafting.
Source
Thoracic and Cardiovascular Surgeon. 65 (4) (pp 302-310), 2017. Article
Number: 154228oc. Date of Publication: 01 Jun 2017.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Background The optimal management of patients with concomitant coronary
artery disease (CAD) and severe carotid artery stenosis remains a
controversy. We performed a systematic review of studies comparing early
outcomes of synchronous or staged carotid artery stenting (CAS) and
coronary artery bypass grafting (CABG) in the treatment of patients with
concomitant CAD and severe carotid artery stenosis. Methods Multiple
databases were systematically searched to identify studies of synchronous
or staged CAS and CABG in the treatment of concomitant severe carotid and
coronary artery disease published from 2005 to 2015. The quality of
studies was assessed using the MINORS scale. The demographic data, risk
factors, 30-day outcomes, and antiplatelet strategy were extracted.
Results 23 studies were identified with a total of 873 and 459 patients in
the staged and synchronous group, respectively. The observed overall
death/stroke/MI rate was 8.5% (95% CI: 7.6-9.4%) in staged group and 4.8%
(95% CI: 3.8-5.8%) in synchronous group. It seems that the synchronous
group has better 30-day outcomes, but these data could not be compared
statistically. Conclusion Our systematic review suggests either
synchronous or staged CAS and CABG can be chosen for the treatment of
concomitant carotid and coronary artery disease. It seems that the
synchronous approach is relatively convenient and the antiplatelet
strategy is relatively definite. For these patients, hybrid
revascularization by synchronous CAS and CABG might be a feasible and
promising therapeutic strategy. Our conclusions and the quality of the
existing data suggest that a randomized controlled trial is needed to
define the best treatment for patients with concomitant carotid and
coronary artery disease.<br/>Copyright &#xa9; Georg Thieme Verlag
KGStuttgart . New York.

<50>
Accession Number
616582738
Author
Holmes A.A.; Bangalore S.
Institution
(Holmes, Bangalore) Leon H. Charney Division of Cardiology, New York
University Langone Medical Center, NYU School of Medicine, New York, NY,
United States
Title
PCI or CABG for severe unprotected left main coronary artery disease:
Making sense of the NOBLE and EXCEL trials.
Source
Journal of Thoracic Disease. 9 (5) (pp E451-E456), 2017. Date of
Publication: 01 May 2017.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)

<51>
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.

<52>
Accession Number
614312669
Author
Mihos C.G.; Capoulade R.; Yucel E.; Picard M.H.; Santana O.
Institution
(Mihos, Capoulade, Yucel, Picard) Cardiac Ultrasound Laboratory,
Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, United States
(Santana) Columbia University Division of Cardiology, Mount Sinai Heart
Institute, Miami Beach, Florida, United States
Title
Surgical Versus Medical Therapy for Prosthetic Valve Endocarditis: A
Meta-Analysis of 32 Studies.
Source
Annals of Thoracic Surgery. 103 (3) (pp 991-1004), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier USA
Abstract
Prosthetic valve endocarditis (PVE) is associated with significant
morbidity, and the optimal treatment strategy has not been clearly
defined. A systematic review and meta-analysis of 32 studies comparing
valve reoperation and medical therapy was performed; it included 2,636
patients, with a mean follow-up of 22 months. A valve reoperation was
associated with a lower risk of 30-day mortality, greater survival at
follow-up, and a similar rate of PVE recurrence. Prospective studies are
warranted to confirm these findings and to clarify clinical
decision-making regarding the timing and necessity of a valve reoperation,
as opposed to treatment with medical therapy alone.<br/>Copyright &#xa9;
2017 The Society of Thoracic Surgeons

<53>
Accession Number
616603492
Author
Garg A.; Rao S.V.; Visveswaran G.; Agrawal S.; Sharma A.; Garg L.; Mahata
I.; Garg J.; Singal D.; Cohen M.; Kostis J.B.
Institution
(Garg, Singal) Department of Medicine, Saint Peter's University Hospital,
Rutgers Robert Wood Johnson Medical School, 69 Duke Street, New Brunswick,
NJ 08901, United States
(Garg, Kostis) Cardiovascular Institute, Rutgers Robert Wood Johnson
Medical School, New Brunswick, NJ, United States
(Rao) Duke Clinical Research Institute, Durham, NC, United States
(Visveswaran, Cohen) Division of Cardiology, Newark Beth Israel Medical
Center, Newark, NJ, United States
(Agrawal) Division of Cardiology, St. Luke's University Hospital,
Bethlehem, PA, United States
(Sharma) Division of Cardiology, State University of New York Downstate,
Brooklyn, NY, United States
(Garg, Garg) Division of Cardiology, Lehigh Valley Hospital, Allentown,
PA, United States
(Mahata) Division of Cardiology, Tulane University, New Orleans, LA,
United States
Title
Transcatheter Aortic Valve Replacement Versus Surgical Valve Replacement
in Low-Intermediate Surgical Risk Patients: A Systematic Review and
Meta-Analysis.
Source
Journal of Invasive Cardiology. 29 (6) (pp 209-216), 2017. Date of
Publication: June 2017.
Publisher
HMP Communications
Abstract
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is a viable
alternative to surgical aortic valve replacement (SAVR) in patients with
severe aortic stenosis (SAS) who are at high risk for surgery. We sought
to evaluate the outcomes of TAVR vs SAVR in low-intermediate risk patients
with SAS. METHODS AND RESULTS: We performed random-effects meta-analysis
of randomized controlled trials (RCTs) and propensity-matched
observational studies comparing TAVR vs SAVR for low-intermediate risk
patients. Five RCTs and 5 observational studies with a total of 6891
patients (3489 TAVR patients; 3402 SAVR patients) were included. Pooled
data from RCTs showed no significant differences in all-cause mortality
between TAVR and SAVR at 30 days (risk ratio [RR], 1.04; 95% confidence
interval [CI], 0.73-1.47) and intermediate-term follow-up (RR, 0.86; 95%
CI, 0.67-1.10). A trend toward decreased mortality was found with TAVR
using the self-expandable vs balloon-expandable valves (RR, 0.77; 95% CI,
0.52-1.15 and RR, 1.91; 95% CI, 0.25-14.53, respectively) and transfemoral
vs transthoracic approach (RR, 0.74; 95% CI, 0.55-1.01 and RR, 2.09; 95%
CI, 0.40-11.03, respectively). Compared to SAVR, TAVR was associated with
similar risks of stroke (RR, 0.91; 95% CI, 0.74-1.11) and myocardial
infarction (RR, 1.00; 95% CI, 0.71-1.41). Furthermore, risks of major
vascular complications, moderate-severe paravalvular regurgitation, and
new permanent pacemaker implantation were higher with TAVR, whereas SAVR
was associated with higher rates of acute kidney injury, atrial
fibrillation, and major or life-threatening bleed. Finally, the above
results from RCTs were consistent with pooled analyses of observational
studies. CONCLUSION: TAVR appears to be a suitable alternative for
patients with SAS who are at low-intermediate risk for SAVR.

<54>
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.

<55>
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.

<56>
Accession Number
616686898
Author
Kuwata S.; Taramasso M.; Guidotti A.; Nietlispach F.; Maisano F.
Institution
(Kuwata, Taramasso, Guidotti, Nietlispach, Maisano) University Heart
Center Zurich, Zurich, Switzerland
Title
Ongoing and future directions in percutaneous treatment of mitral
regurgitation.
Source
Expert Review of Cardiovascular Therapy. 15 (6) (pp 441-446), 2017. Date
of Publication: 03 Jun 2017.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Mitral regurgitation (MR) is one of the major valvular
disease. Although surgical mitral valve (MV) repair is the standard of
care for patients with severe MR, an unmet need exists in the management
of patients with severe symptomatic MR and high surgical risk.
Transcatheter MV therapies are alternative treatment option in such
patients with moderate to severe and symptomatic MR. Areas covered:
Literatures to direct the reader to important further reading were
searched with relevant websites; www.ncbi.nlm.nih.gov/pubmed using search
word 'transcatheter mitral intervention'. Expert commentary: A variety of
transcatheter techniques have emerged for the percutaneous treatment of
MR. We should carefully select one or combination procedure for each
patient as an ideal tailor-made transcatheter MV therapy in order to
improve the outcomes.<br/>Copyright &#xa9; 2017 Informa UK Limited,
trading as Taylor & Francis Group.

<57>
[Use Link to view the full text]
Accession Number
616685525
Author
Takase S.; Matoba T.
Institution
(Takase, Matoba) Department of Cardiovascular Medicine, Kyushu University
Graduate, School of Medical Sciences, Higashi-ku, Fukuoka, Japan
Title
Response by takase and matoba to letter regarding article, "ezetimibe in
combination with statins ameliorates endothelial dysfunction in coronary
arteries after stenting: The cuvic trial (effect of cholesterol absorption
inhibitor usage on target vessel dysfunction after coronary stenting), a
multicenter randomized controlled trial".
Source
Arteriosclerosis, Thrombosis, and Vascular Biology. 37 (5) (pp e54), 2017.
Date of Publication: 01 May 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)

<58>
[Use Link to view the full text]
Accession Number
616685524
Author
Westerink J.; Visseren F.
Institution
(Westerink, Visseren) University Medical Center Utrecht, Vascular
Medicine, Netherlands
Title
Letter by westerink and visseren regarding article, "ezetimibe in
combination with statins ameliorates endothelial dysfunction in coronary
arteries after stenting: The cuvic trial (effect of cholesterol absorption
inhibitor usage on target vessel dysfunction after coronary stenting), a
multicenter randomized controlled trial".
Source
Arteriosclerosis, Thrombosis, and Vascular Biology. 37 (5) (pp e53), 2017.
Date of Publication: 01 May 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)

<59>
Accession Number
616588801
Author
Klompas M.
Institution
(Klompas) Department of Population Medicine, Harvard Medical School,
Harvard Pilgrim Health Care Institute, 401 Park Street, Suite 401, Boston,
MA 02215, United States
(Klompas) Department of Medicine, Brigham and Women's Hospital, Boston,
Massachusetts, United States
Title
Oropharyngeal Decontamination with Antiseptics to Prevent
Ventilator-Associated Pneumonia: Rethinking the Benefits of Chlorhexidine.
Source
Seminars in Respiratory and Critical Care Medicine. 38 (3) (pp 381-390),
2017. Article Number: 01282. Date of Publication: 01 Jun 2017.
Publisher
Thieme Medical Publishers, Inc. (E-mail: custserv@thieme.com)
Abstract
Daily oral care with chlorhexidine for mechanically ventilated patients is
ubiquitous in contemporary intensive care practice. The practice is
predicated upon meta-analyses suggesting that adding chlorhexidine to
daily oral care regimens can reduce ventilator-associated pneumonia (VAP)
rates by up to 40%. Close analysis, however, raises three concerns: (1)
the meta-analyses are dominated by studies in cardiac surgery patients in
whom average duration of mechanical ventilation is < 1 day and thus their
risk of VAP is very different from other populations, (2) diagnosing VAP
is subjective and nonspecific yet the meta-analyses gave equal weight to
blinded and nonblinded studies, potentially biasing them in favor of
chlorhexidine, and (3) there is circularity between diagnostic criteria
for VAP and chlorhexidine; as an antiseptic, chlorhexidine may decrease
the frequency of positive respiratory cultures but fewer cultures does not
necessarily mean fewer pneumonias. It is therefore important to look at
other outcomes for corollary evidence on whether or not oral chlorhexidine
benefits patients. An updated meta-analysis restricted to double-blinded
studies in noncardiac surgery patients showed no impact on VAP rates,
duration of mechanical ventilation, or intensive care unit length of stay.
Instead, there was a possible signal that oral chlorhexidine may increase
mortality rates. Observational data have raised similar concerns. This
article will review the theoretical basis for adding chlorhexidine to oral
care regimens, delineate potential biases in randomized controlled trials
comparing oral care regimens with and without chlorhexidine, explore the
unexpected mortality signal associated with oral chlorhexidine, and
provide practical recommendations.<br/>Copyright &#xa9; Thieme Medical
Publishers333 Seventh Avenue, New York, NY 10001, USA.

<60>
Accession Number
616691743
Author
Ando T.; Takagi H.; Briasoulis A.; Umemoto T.
Institution
(Ando) Detroit Medical Center, Division of Cardiology, Detroit, MI, USA
(Takagi, Umemoto) Shizuoka Medical Center, Division of Cardiovascular
Surgery, Shizuoka, Japan
(Briasoulis) Mayo Clinic, Division of Heart Failure, Rochester, MN, USA
Title
Does diabetes mellitus impact prognosis after transcatheter aortic valve
implantation? Insights from a meta-analysis.
Source
Journal of Cardiology. (no pagination), 2017. Date of Publication: October
24, 2016.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Diabetes mellitus (DM) is well known to increase mortality in
several cardiovascular diseases. However, the prognostic impact of DM
following transcatheter aortic valve implantation (TAVI) remains
controversial. We sought to assess the impact of DM on perioperative
(in-hospital or 30-day) complications and mid-term (>=1 year) all-cause
mortality after TAVI through meta-analysis. Methods: A comprehensive
literature search of PUBMED and EMBASE was conducted through January 1st
2002 to May 15th 2016. Articles that reported adjusted hazards ratio (HRs)
or unadjusted HR for mid-term all-cause mortality with 95% confidence
intervals (CIs) of DM or insulin dependent DM (IDDM) on mid-term all-cause
mortality post TAVI were included in the analysis. A meta-analysis was
performed with combination of both adjusted HR and un-adjusted HR.
Sensitivity analysis was performed with only the adjusted HR.
Random-effects model was used to calculate the pooled effect size.
Results: A total of 22 observational cohort studies were identified with
28,440 (8998 DM and 19,442 non-DM) patients. The risk of perioperative
complications (myocardial infarction, bleeding, major vascular
complications, stroke, and new-onset atrial fibrillation) was similar
between DM and non-DM cohorts. A meta-analysis of all-cause mortality of
DM (19 studies after excluding 3 studies that only reported HR of IDDM on
mid-term all-cause mortality, 8808 DM and 17,829 non-DM patients) resulted
in significantly worse outcome (HR 1.21, 95%CI 1.10-1.34, p =0.0002, I
² =53%) in DM patients compared to non-DM patients post-TAVI.
Sensitivity analysis showed consistent results. Subgroup analysis (4
studies with 267 IDDM versus 2161 non-IDDM) demonstrated that IDDM was
associated with higher all-cause mortality (HR 2.05, 95%CI 1.54-2.73, p
<0.00001, I ² =0%) following TAVI. Conclusions: DM was
associated with similar perioperative complications but was associated
with increased mid-term all-cause mortality after TAVI. Further study of
the causes of increased mortality during the follow-up may lead to
improved outcome.<br/>Copyright &#xa9; 2017 Japanese College of
Cardiology.

<61>
Accession Number
616682606
Author
Jansen F.; Werner N.
Institution
(Jansen, Werner) Medizinische Klinik und Poliklinik II,
Universitatsklinikum Bonn, Bonn 53105, Germany
Title
Interventional treatment of the aortic valve: Current evidence.
Source
Herz. (pp 1-6), 2017. Date of Publication: 07 Jun 2017.
Publisher
Urban und Vogel GmbH (E-mail: verlag@urban-vogel.de)
Abstract
Transcatheter aortic valve replacement (TAVR) has become a standard
treatment for patients with severe, symptomatic aortic stenosis. Whereas
its use was first limited to inoperable high-risk patients, recent studies
demonstrated that TAVR was not inferior to standard surgical aortic valve
replacement (SAVR) for intermediate-risk patients. Besides equivalent
outcomes, the type and rates of complications differ between the two
procedures. Here, we provide an overview of the latest randomized study
results comparing TAVR with SAVR and describe possible future directions
in transcatheter aortic valve treatment.<br/>Copyright &#xa9; 2017
Springer Medizin Verlag GmbH

<62>
Accession Number
616669989
Author
Noiseux N.; Stevens L.-M.; Chartrand-Lefebvre C.; Soulez G.; Prieto I.;
Basile F.; Mansour S.; Dyub A.M.; Kieser T.M.; Lamy A.
Institution
(Noiseux) *Research Center of the Centre Hospitalier de l'Universite de
Montreal (CRCHUM) +Division of Cardiac Surgery ++Department of Radiology
Division of Cardiology, Centre Hospitalier de l'Universite de Montreal,
Montreal, QC Division of Cardiac Surgery, McMaster University #Population
Health Research Institute (PHRI), Hamilton Health Sciences, Hamilton, ON
PUniversity of Calgary, Calgary, AB, Canada
Title
Off-pump Versus On-pump Coronary Artery Bypass Surgery: Graft Patency
Assessment With Coronary Computed Tomographic Angiography: A Prospective
Multicenter Randomized Controlled Pilot Study.
Source
Journal of Thoracic Imaging. (no pagination), 2017. Date of Publication:
05 Jun 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
PURPOSE:: A large multicenter randomized trial (RCT) is needed to assess
off-pump coronary artery bypass graft (CABG) patency when performed by
skilled surgeons. This prospective multicenter randomized pilot study
compares graft patency after on-pump and off-pump techniques and addresses
the feasibility of such an RCT. MATERIALS AND METHODS:: Consecutive
patients were prospectively recruited for >=64-slice computed tomography
angiography graft patency assessment 1 year after randomization to
off-pump or on-pump CABG. Blinded assessment of graft patency was
performed, and the results were categorized as normal, >=50% stenosis, or
occlusion. A multilevel model with random effects on the patient was used
to account for correlation of results in patients with multiple grafts.
RESULTS:: A total of 157 patients (3 centers, 84 off-pump and 73 on-pump
patients, 512 grafts, assessability rate 98.4%) were included. Patency
index (% nonoccluded grafts) was 89% for the off-pump technique and 95%
for the on-pump technique (P=0.09). Patency was similar for arterial and
vein grafts (both 92%; P=0.88), as well as between target territories (89%
to 94%; P=0.53). CONCLUSIONS:: In this pilot study, 1-year graft patency
results after off-pump and on-pump surgery were similar. This feasibility
trial demonstrates that a large multicenter RCT to compare CABG patency
after on-pump with that after off-pump techniques is feasible and can be
reliably undertaken using computed tomography angiography.<br/>Copyright
&#xa9; 2017 Wolters Kluwer Health, Inc. All rights reserved

<63>
Accession Number
616669892
Author
Ferlini M.; Musumeci G.; Demarchi A.; Grieco N.; Mafrici A.; de Servi S.;
Rossini R.; Sponzilli C.; Bognetti P.; Cardile A.; Frattini S.; Ielasi A.;
Russo A.; Vecchiato C.; Lettieri C.; Visconti L.O.
Institution
(Ferlini) aSC Cardiologia, Fondazione IRCCS, Policlinico San Matteo, Pavia
bSC Cardiologia, Ospedale Santa Croce e Carle, Cuneo cDipartimento di
Cardiologia, Grande Ospedale Metropolitano, Niguarda dASST Santi Paolo e
Carlo, Milano, Ospedale San Carlo Borromeo eUnita Coronarica, LSR
Sperimentazione Cardiologica, Fondazione IRCCS Policlinico San Matteo,
Pavia fUOC Cardiologia e UTIC, Polo Universitario San Paolo, ASST Santi
Paolo e Carlo, Milano gCardiologia ASST Bergamo Ovest, Treviglio
hCardiologia e UTIC, ASST Cremona, Cremona iDivisione di Cardiologia, ASST
Bergamo Est, Ospedale Bolognini, Seriate jUO Cardiologia ASST Valle Olona
Presidio Gallarate kUSC Cardiologia, ASST Lodi, Lodi lUO Cardiologia, ASST
Carlo Poma, Mantova mDipartimento di Cardiologia, ASST Papa Giovanni
XXIII, Bergamo, Ital
Title
Management of diabetic patients hospitalized for acute coronary syndromes:
a prospective multicenter registry.
Source
Journal of Cardiovascular Medicine. (no pagination), 2017. Date of
Publication: 05 Jun 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Patients with diabetes mellitus and acute coronary syndrome
(ACS) present an increased risk of adverse cardiovascular events. An
Italian Consensus Document indicated 'three specific must' to obtain in
this subgroup of patients: optimal oral antiplatelet therapy, early
invasive approach and a tailored strategy of revascularization for
unstable angina/non-ST-elevation-myocardial infarction (UA/NSTEMI);
furthermore, glycemia at admission should be managed with dedicated
protocols. AIM: To investigate if previous recommendations are followed,
the present multicenter prospective observational registry was carried out
in Lombardia during a 9-week period between March and May 2015. METHODS
AND RESULTS: A total of 559 consecutive ACS patients (mean age
68.7?+/-?11.3 years, 35% >=75 years, 50% STEMI), with 'known DM' (56%) or
'hyperglycemia', this last defined as blood glucose value >=?126?mg/dl at
admission, were included in the registry at 29 hospitals with an on-site
24/7 catheterization laboratory. Patients with known diabetes mellitus
received clopidogrel in 51% of the cases, whereas most patients with
hyperglycemia (72%) received a new P2Y12 inhibitor: according to clinical
presentation in case STEMI prasugrel/ticagrelor were more prescribed than
clopidogrel (70 vs. 30%, P?<?0.001); on the contrary, no significant
difference was found in case of UA/NSTEMI (48 vs. 52%, P?=?0.57).Overall,
96% of the patients underwent coronary angiography and 85% received a
myocardial revascularization (with percutaneous coronary intervention in
92% of cases) that was however performed in fewer patients with known
diabetes mellitus compared with hyperglycemia (79 vs. 90%,
P?=?0.001).Among UA/NSTEMI, 85% of patients received an initial invasive
approach, less than 72?h in 80% of the cases (51% <24?h); no difference
was reported comparing known diabetes mellitus to hyperglycemia. Despite
similar SYNTAX score, patients with known diabetes mellitus had a higher
rate of Heart Team discussion (29 vs. 12%, P?=?0.03) and received a
surgical revascularization in numerically more cases.Most investigators
(85%) followed a local protocol for glycemia management at admission, but
insulin was used in fewer than half of the cases; diabetes consulting was
performed in 25% of the patients and mainly in case of known diabetes
mellitus. CONCLUSION: Based on data of the present real world prospective
registry, patients with ACS and known diabetes mellitus are treated with
an early invasive approach in case of UA/NSTEMI and with a tailored
revascularization strategy, but with clopidogrel in more cases; glycemia
management is taken into account at admission.<br/>Copyright &#xa9; 2017
Italian Federation of Cardiology. All rights reserved.

<64>
Accession Number
611090957
Author
Corra U.
Institution
(Corra) Fondazione Maugeri, Italy
Title
Exercise oscillatory ventilation in heart failure.
Source
International Journal of Cardiology. 206 (pp S13-S15), 2016. Date of
Publication: 01 Mar 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Ventilation inefficiency has become a matter of interest for heart failure
(HF) specialists, the most remarkable being exertional oscillatory
ventilation (EOV). EOV is an abnormal ventilatory phenomenon, originally
described as anecdotal, but now considered a marker of disease severity
and worst prognosis in HF. EOV is a cyclic fluctuation of minute
ventilation (VE) and expired gas kinetics occurring during exercise: it is
a slow, prominent, consistent rather than random, fluctuation in VE that
may be evanescent or transient and can follow several distinct patterns.
In contrast to the periodic breathing observed in Cheyne-Stokes
respiration and central sleep apnea, the gradual increase and decrease in
minute ventilation (VE) are not spaced by periods of apnea. This review
will discuss EOV in HF and the overlap with Cheyne-Stokes
respiration.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd

<65>
Accession Number
616656834
Author
Purvis T.E.; Goodwin C.R.; De La Garza-Ramos R.; Ahmed A.K.; Lafage V.;
Neuman B.J.; Passias P.G.; Kebaish K.M.; Frank S.M.; Sciubba D.M.
Institution
(Purvis, Goodwin, De La Garza-Ramos, Ahmed, Sciubba) Department of
Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore,
United States
(Lafage) Department of Orthopedic Surgery, Hospital for Special Surgery,
New York, United States
(Neuman, Kebaish) Department of Orthopaedic Surgery, Johns Hopkins
University, School of Medicine, Baltimore, United States
(Passias) Division of Spinal Surgery, NYU Medical Center, Hospital for
Joint Diseases, New York, United States
(Frank) Department of Anesthesiology and Critical Care Medicine,
Interdisciplinary Blood Management Program, Baltimore, United States
Title
Economic impact and clinical outcomes of liberal blood transfusion in
spine surgery.
Source
Global Spine Journal. Conference: 2017 Global Spine Congress. Italy. 7 (2
Supplement 1) (pp 48S), 2017. Date of Publication: May 2017.
Publisher
Thieme Medical Publishers, Inc.
Abstract
Introduction: Blood loss is a major concern in spine surgery. Blood
transfusion promotes oxygen delivery and tissue perfusion during long,
complex surgeries, yet carries with it rare but notable risks. The
hemoglobin (Hb) trigger-the Hb value that initiates clinician
administration of packed red blood cells (PRBCs)-is frequently used to
evaluate physician compliance with existing transfusion guidelines.
Randomized clinical trials have demonstrated similar or improved outcomes
among patients receiving blood transfusions using a restrictive Hb
trigger-defined as an intraoperative Hb level of <10 g/dL intraoperatively
or <8 g/dL postoperatively-versus a liberal Hb trigger (>=10 g/dL
intraoperatively or >=8 g/dL postoperatively) in cardiac and hip surgery.
To the authors' knowledge, no study has examined the associated morbidity
and financial impact of liberal transfusions within spinal surgery. We
thus aimed to determine the perioperative clinical outcomes and costs
associated with liberal versus restrictive transfusion triggers among
spine surgery patients. Material and Methods: The surgical billing
database at our institution was queried for inpatients discharged
following spinal surgery between 2008 and 2015, yielding 33,043 patients.
Patients were stratified into eight groups according to the spine surgical
procedure performed. The values used were the reported institutional
acquisition cost ($220/unit) and a mean estimated activity-based cost
($760/unit) based on a Society for the Advancement of Blood Management
report. Outcomes considered included mortality, in-hospital morbidity,
total costs, and length of stay. Results: A total of 6,931 patients met
the inclusion criteria. PRBC transfusions occured in 2,374 patients (at
least 1 unit of PRBCs), yielding an overall transfusion rate of 34.3%.
Compared to the other surgical groups, most PRBC use occurred within
posterior lumbar fusion patients. The mean intraoperative Hb trigger was
10.1 (SD = 1.7) g/dL and the mean postoperative Hb trigger was 10.1 (SD =
2.1) g/dL. For the 2,374 patients that were transfused with PRBCs, 1420
(59.8%) received a postoperative PRBC transfusion with a liberal
postoperative Hb trigger (>=8 g/dL) while 529 (22.3%) received an
intraoperative PRBC transfusion with a liberal intraoperative Hb trigger
(>=10 g/dL). Logistic regression analysis revealed that patients with a
nadir Hb of 8-10 g/dL transfused with PRBC had an independently higher
risk of perioperative morbidity (odds ratio [OR] = 2.12; 95% confidence
interval [CI], 1.24-3.64; P = .006). The additional cost when comparing
restrictive and liberal transfusion triggers was estimated to be between
$1,330,439 and $4,596,062 (58.7% of the estimated total cost of PRBC
transfusion), with the cost varying by surgery type. When comparing
liberal and restrictive PRBC transfusion triggers, an estimated additional
$202,675 to $700,151 in institutional costs were incurred each year among
patients undergoing spine surgery. Conclusion: Patients with a nadir Hb of
8 to 10 g/dL who were transfused had higher perioperative morbidity, even
after adjusting for potential confounders. The additional cost incurred
from liberal transfusion trigger reliance ranged from an estimated
$202,675 to $700,151 annually. These findings point to a potential area
for clinicians and institutions to improve patient outcomes and reduce
costs.

<66>
Accession Number
616656640
Author
Wilson J.; Harrop J.; Fehlings M.; Grossman R.; Toups E.; Aarabi B.
Institution
(Wilson) Division of Neurosurgery, University of Toronto, St. Michael's
Hospital, Toronto, Canada
(Harrop) Division of Neurosurgery, Thomas Jefferson University,
Philadelphia, United States
(Fehlings) University of Toronto, Division of Neurosurgery, Toronto
Western Hospital, Toronto, Canada
(Grossman, Toups) Methodist Hospital, Department of Neurosurgery, Houston,
United States
(Aarabi) Department of Neurosurgery, University of Maryland, Baltimore,
United States
Title
Natural history, mortality, complications and impact of early surgical
decompression in thoracic spinal cord injury: A multicenter prospective
study from the North American clinical trials network and aospine spinal
cord injury knowledge forum.
Source
Global Spine Journal. Conference: 2017 Global Spine Congress. Italy. 7 (2
Supplement 1) (pp 121S), 2017. Date of Publication: May 2017.
Publisher
Thieme Medical Publishers, Inc.
Abstract
Introduction: Although less frequent than cervical injuries, thoracic
spinal cord injury (SCI) remains an important cause of disability amongst
the young; further, many studies, particularly those investigating
cellular transplantation, have focused investigation on this clinical
subgroup. Using a modern prospective multicenter SCI registry, our
objective was to quantify mortality, complications and long-term
neurological recovery in thoracic SCI. In addition, we aimed to
investigate how treatment related variables, including surgical timing and
administration of high-dose steroids, impact these outcomes. Methods: All
analyses were based on prospective data from the North American Clinical
Trials Network for SCI (NACTN), collected over a 10-year period
(2005-2016) from 8 North American centers. We included surgically treated
adult patients with an International Standards for Neurological
Classification of Spinal Cord Injury (ISNCSCI) exam performed within the
first week and a neurological level of injury (NLI) between T1 and T12.
Outcomes of interest included change in ASIA Motor Score (AMS) and ASIA
Impairment Scale (AIS) grade at 1, 3, 6 and >12 months follow-up, as well
as the incidence of acute in-patient pulmonary complications and
mortality. The effects of surgical timing (before or after 24-hours post
SCI) as well as intravenous Methylprednisolone (NASCIS II 24 hour
protocol) on these outcomes were investigated through use of bivariable
and multivariable statistics. Results: Of the 93 patients meeting
eligibility (mean age 40.4 +/-16.2), 58 (62.4%) were AIS A, 12 (12.9%) AIS
B, 14 (15.1%) AIS C and 9 (9.7%) AIS D; 48 patients (51.6%) had a NLI
between T1-4, 15 (16.1%) between T5-8 and 30 (32.3) between T9-12.
Although there were no acute inpatient mortalities, 53 pulmonary
complications were recorded during acute hospitalization (incidence
57.0%), with pleural effusion, pneumothorax and pneumonia the three most
commonly observed. Table 1 depicts neurological recovery at patients' last
available follow-up (mean 5 months). For AIS grade A patients, while 15%
converted at least one AIS grade at follow-up, improvement in motor
function was low (mean 2.2 points), consistent with previous reports. The
mean time to surgery was 57.2 hours with 48 patients (64.9%) undergoing
surgical decompression/fusion within 24 hours post SCI. Multivariable
analysis, adjusting for baseline AIS grade associated surgery before 24
hours with an additional 7 points of AMS recovery as compared to late
surgery (Estimate = 7.14, P = .03). Further, late surgical decompression
was associated with increased risk of inpatient respiratory complications
(IRR = 2.50, P = .04). There was no association between Methylprednisolone
administration and neurological or complication outcomes. Conclusion:
Consistent with historical reports, thoracic AIS grade A patients
experienced little motor recovery, with prognosis for incomplete patients
substantially better. Although administration of high-dose IV
Methylprednisolone had no effect on clinical outcomes, early surgical
decompression was independently associated with improved motor recovery
and reduced incidence of pulmonary complications. (Table Presented).

<67>
Accession Number
616656414
Author
Gaudin D.; Krafcik B.; Mansour T.; Alnemari A.A.
Institution
(Gaudin, Krafcik, Mansour, Alnemari) University of Toledo, College of
Medicine, Toledo, Ohio, United States
Title
Considerations in spinal fusion surgery for chronic lumbar pain:
Psychosocial factors, rating scales, and perioperative patient education:
A review of the literature.
Source
Global Spine Journal. Conference: 2017 Global Spine Congress. Italy. 7 (2
Supplement 1) (pp 268S-269S), 2017. Date of Publication: May 2017.
Publisher
Thieme Medical Publishers, Inc.
Abstract
Introduction: Despite widespread use of lumbar spinal fusion as a
treatment for back pain, outcomes remain variable. Optimizing patient
selection can help to reduce adverse outcomes. This research seeks to
conduct a literature review to better understand the factors associated
with optimal post-operative results following lumbar spinal fusion for
chronic back pain, and the current tools used for patient subjective
evaluation. Materials andMethods: The PubMed database was searched for
clinical trials related to psychosocial determinants of outcome following
lumbar spinal fusion surgery, evaluation of commonly used patient
subjective outcome measures, and perioperative cognitive, behavioral, and
educational therapies. The reference lists of included studies were also
searched by hand for additional studies meeting inclusion criteria.
English language and translated foreign language studies were included, as
were any studies published between 1985 and the present. A total of 49
studies were included in support of the research questions addressed in
this review. Results: Patients' perception of good health prior to surgery
and low cardiovascular comorbidity predict improved postoperative physical
functional capacity and greater patient satisfaction. Depression, tobacco
use, and involvement in litigation predict poorer outcomes following
lumbar fusion. Incorporation of cognitive-behavioral therapy
perioperatively can address these psychosocial risk factors and improve
outcomes. The SF-36, EQ-5D, visual analog pain scale, brief pain
inventory, and ODI can each provide specific feedback which can track
patient progress and are important to understand when evaluating the
current literature. Conclusions: The interplay of the various social and
psychological factors surrounding lumbar spinal fusion are not fully
understood when considering outcomes, and require further study. This
review provides a summary of the current available information and
explains commonly used assessment tools to guide clinicians in decision
making when caring for patients with chronic lower back pain.

<68>
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.

<69>
Accession Number
616477000
Author
Vilchinsky N.; Ginzburg K.; Fait K.; Foa E.B.
Institution
(Vilchinsky, Fait) Department of Psychology, Bar-Ilan University,
Ramat-Gan 52900, Israel
(Ginzburg) The Bob Shapell School of Social Work, Tel Aviv University,
Ramat-Aviv, Israel
(Foa) Center for the Treatment and Study of Anxiety, University of
Pennsylvania, Department of Psychiatry, Philadelphia, PA 19104, United
States
Title
Cardiac-disease-induced PTSD (CDI-PTSD): A systematic review.
Source
Clinical Psychology Review. 55 (pp 92-106), 2017. Date of Publication:
July 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The goal of the current systematic review was to provide an overview of
the findings in the field of Cardiac-Disease-Induced Posttraumatic Stress
Disorder (CDI-PTSD) in order to establish CDI-PTSD as a valid diagnostic
entity for a wide spectrum of cardiac diseases and related medical
procedures. In accordance with PRISMA guidelines, we conducted a
systematic electronic literature search. Of the 3202 citations identified,
150 studies meeting the selection criteria were reviewed. Our main
findings were that the prevalence of CDI-PTSD ranged between 0% and 38%
(averaging at 12%) and was highly dependent on the assessment tool used.
The most consistent risk factors are of a psychological nature (e.g.,
pre-morbid distress). The consequences of CDI-PTSD range from psychosocial
difficulties to lack of adherence and heightened mortality rates. Much
inconsistency in the field was found with regard to patients who present
with diagnoses other than acute coronary syndrome (e.g., cardiac arrest)
and who undergo potentially traumatic medical procedures (e.g.,
defibrillator implantation). Yet the current review seems to strengthen
the conceptualization of CDI-PTSD as a valid diagnostic entity, at least
with regard to acute cardiac events.<br/>Copyright &#xa9; 2017 Elsevier
Ltd

<70>
Accession Number
616389291
Author
Liu Q.; Liu C.-L.; Yang X.-Y.; Ji J.-W.; Peng S.
Institution
(Liu, Liu, Peng) Department of Anesthesiology, Seventh People's Hospital
of Shanghai University of TCM, Shanghai, China
(Yang) Department of Anesthesiology, Shanghai Municipal Hospital of
Traditional Chinese Medicine, Shanghai University of TCM, Shanghai, China
(Ji) Department of Anesthesiology, Shidong hospital, Shanghai, China
Title
Influence of sevoflurane anesthesia on postoperative recovery of the
cognitive disorder in elderly patients treated with non-cardiac surgery.
Source
Biomedical Research (India). 28 (9) (pp 4107-4110), 2017. Date of
Publication: 2017.
Publisher
Scientific Publishers of India (E-mail: qayyum@del3.vsnl.net.in)
Abstract
Objective: This study investigated the influence of sevoflurane anesthesia
on postoperative recovery of cognitive disorder in elderly patients
treated with non-cardiac surgery. Methods: A total of 112 elderly patients
treated with non-cardiac surgery from January 2015 to January 2016 were
chosen, and then divided into the observation group (n=56) and the control
group (n=56) randomly. The control group was treated with propofol and
remifentanil anesthesia, whereas the observation group was treated with
sevoflurane anesthesia. The postoperative cognitive functions of the two
groups were compared. Results: The two groups have no statistically
significant differences in terms of heart rate and blood pressure before
anesthesia, before the surgery, 30 min in the surgery, and after the
surgery (P>0.05). The Mini-Mental State Examination (MMSE) score (26.44
+/- 0.76) 24 h after the surgery of the observation group is significantly
lower than that of the control group (27.18 +/- 0.72), showing
statistically significant difference (P<0.05). However, no statistically
significant differences of the MMSE scores before anesthesia and 6, 24,
and 72 h after the surgery between the two groups have been observed
(P>0.05). The observation group has lower incidence of cognitive disorder
at 6 (3.57%) and 12 h (3.57%) after the surgery than the control group
(P<0.05). Nevertheless, the two groups have no statistically significant
difference in the incidence of cognitive disorder at 24 and 72 h after the
surgery (P<0.05). Conclusion: Sevoflurane anesthesia can shorten
anesthesia time for elderly patients in non-cardiac surgery and reduce
postoperative dysfunction in patients.<br/>Copyright &#xa9; 2017,
Scientific Publishers of India. All rights reserved.

<71>
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.

<72>
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.

<73>
Accession Number
616189476
Author
Zhang J.; Wang S.
Institution
(Zhang) Department of Anesthesia, East Area of the Central Hospital of
Xinxiang, No. 56 Jinsui Road, Xinxiang City 453000, China
(Wang) Quality and Technical Supervision and Inspection Center of
Xinxiang, Xinxiang, China
Title
Effects of sevoflurane on cardiopulmonary function in patients undergoing
coronary artery bypass.
Source
Journal of Biological Regulators and Homeostatic Agents. 30 (4) (pp
1079-1083), 2016. Date of Publication: 2016.
Publisher
Biolife s.a.s. (E-mail: biolife_sas@yahoo.it)
Abstract
The objective of the current study was to investigate effects of
sevoflurane on cardiopulmonary function in patients undergoing coronary
artery bypass grafting (CABG). In this study, 60 cases of patients with
coronary heart disease (CHD) were selected and randomly divided into the
sevoflurane group (group S) and the control group C (group C) with 30
cases in each group. The two groups received intravenous anesthesia. The
patients of group C were only given oxygen mask and physiological saline
to keep vein open; while the patients of group S were administered with 1%
sevoflurane immediately after the beginning of cardiopulmonary bypass
(CPB) until the end of the treatment. The cardiopulmonary functions at 30
min before operation (T<inf>0</inf>), postoperative 2 h (T<inf>1</inf>),
6h (T<inf>2</inf>), 24h (T<inf>3</inf>) and 48 (T<inf>4</inf>) were
observed. The mean arterial pressure (MAP) of the group S at
T<inf>1</inf>, T<inf>2</inf>, T<inf>3</inf> was lower than that of the
group C, as were the heart rate (HR) and left ventricular ejection
fraction (LVEF). The creatine kinase isoenzyme (CK-MB) during
T<inf>1</inf> to T<inf>4</inf> in the group S was less than that of the
group C, and there were significant differences between the two groups (P
< 0.05). The tidal volume (Vt), vital capacity (Vc) and oxygenation index
(PaO<inf>2</inf>/FiO<inf>2</inf>) of the two groups during T<inf>1</inf>
and T<inf>2</inf> were decreased, while respiratory frequency (RR) and
alveolar-arterial blood oxygen partial pressure (PA-aO<inf>2</inf>) were
increased and they began to decrease during T<inf>3</inf> and
T<inf>4</inf>. Vt and Vc of the group S were higher during T<inf>1</inf>
and T<inf>2</inf> periods than those of the group C, while RR was lower
than that of the group C; PaO<inf>2</inf>/FiO<inf>2</inf> during
T<inf>1</inf> to T<inf>4</inf> period of group S was higher than that of
group C, while PA-aO<inf>2</inf> was significantly lower than that of the
control group (P < 0.05). In conclusion, although LVEF was not improved in
the sevoflurane group, sevoflurane may contribute to stabilizing the
cardiopulmonary function and preventing from myocardial
injury.<br/>Copyright &#xa9; by BIOLIFE, s.a.s.

<74>
Accession Number
616666436
Author
Xie X.; Shi X.; Xun X.; Rao L.
Institution
(Xie) Department of Cardiology, West China Hospital, Sichuan University,
Chengdu, Sichuan, China
Title
Efficacy and Safety of Transcatheter Aortic Valve Implantation for
Bicuspid Aortic Valves: A Systematic Review and Meta-Analysis.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. 22 (4) (pp
203-215), 2016. Date of Publication: 23 Aug 2016.
Abstract
PURPOSE: To elucidate the performance of transcatheter aortic valve
implantation (TAVI) in bicuspid aortic valve (BAV) patients through a
systematic review and meta-analysis.
METHODS: A systematic literature review was performed by searching
eligible articles in PubMed, Medline, EMBASE, Google Scholar and CNKI.
Meta-analysis of included case-control/cohort studies was further
conducted. Relative risks (RRs) and the corresponding 95% confidence
intervals (CIs) were used to compare clinical outcomes of BAV patients and
non-BAV patients.
RESULTS: A total of 17 articles including eight case reports, four case
series and five case-control/cohort studies with 166 BAV patients were
analyzed. Device success rate achieved for TAVI in this cohort of BAV
patients was 95.2%. The 30-day mortality rate was 8.4%, and the
medium-term (range from 6 months to 2 years) mortality rate reported was
17.9%. Overall, the performance of TAVI in BAV patients was comparable to
that in non-BAV patients, as reported by the included case-control/cohort
studies (30-day mortality rate: RR = 1.05, 95%CI 0.57-1.95, p = 0.87;
Device success rate: RR = 1.00, 95%CI 0.95-1.05, p = 0.94; Incidence of
moderate to severe paravalvular regurgitation: RR = 1.25, 95%CI 0.85-1.84,
p = 0.25).
CONCLUSION: The present study suggested that TAVI may be a feasible and
safe treatment modality for BAV patients.

<75>
Accession Number
616659686
Author
Sezai A.; Osaka S.; Yaoita H.; Arimoto M.; Hata H.; Shiono M.; Sakino H.
Institution
(Sezai) Department of Cardiovascular Surgery, Nihon University School of
Medicine, Sekino Hospital, Tokyo, Japan
Title
Changeover Trial of Azilsartan and Olmesartan Comparing Effects on the
Renin-Angiotensin-Aldosterone System in Patients with Essential
Hypertension after Cardiac Surgery (CHAOS Study).
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. 22 (3) (pp
161-167), 2016. Date of Publication: 20 Jun 2016.
Abstract
BACKGROUND: Angiotensin II receptor blockers (ARBs) have been widely used
to treat hypertension and large-scale clinical studies have shown various
benefits. In this study, we compared olmesartan with azilsartan, the
newest ARB.
METHODS: The subjects were outpatients who were clinically stable after
cardiac surgery. Sixty patients were randomized to receive either
azilsartan or olmesartan for 1 year and were switched to the other drug
for the following 1 year. The primary endpoints were the levels of plasma
renin activity, angiotensin II, and aldosterone.
RESULTS: Home blood pressure exceeded 140/90 mmHg and additional
antihypertensive medication was administered to 12 patients (20 episodes)
in the azilsartan group versus 4 patients (4 episodes) in the olmesartan
group, with the number being significantly higher in the azilsartan group.
After 1 year of treatment, both angiotensin II and aldosterone levels were
significantly lower in the olmesartan group than the azilsartan group.
Left ventricular mass index was also significantly lower in the olmesartan
group than the azilsartan group.
CONCLUSION: This study showed that olmesartan reduces angiotensin II and
aldosterone levels more effectively than azilsartan. Accordingly, it may
be effective in patients with increased renin-angiotensin-aldosterone
system activity after cardiac surgery or patients with severe cardiac
hypertrophy.

<76>
Accession Number
616631334
Author
Bignami E.; Guarnieri M.; Saglietti F.; Maglioni E.M.; Scolletta S.;
Romagnoli S.; De Paulis S.; Paternoster G.; Trumello C.; Meroni R.;
Scognamiglio A.; Budillon A.M.; Pota V.; Zangrillo A.; Alfieri O.
Institution
(Bignami, Guarnieri, Saglietti, Meroni, Zangrillo) IRCCS San Raffaele
Scientific Institute, Department of Anaesthesia and Intensive Care, Via
Olgettina 60, Milan 20132, Italy
(Maglioni, Scolletta) Intensive Care and Medical Biotechnologies
University of Siena, Department of Anaesthesia, Siena, Italy
(Romagnoli) Azienda Ospedaliera Universitaria Careggi, Department of
Anaesthesiology and Intensive Care, Florence, Italy
(De Paulis) Catholic University of the Sacred Heart, Department of
Cardiovascular Sciences, Rome 00168, Italy
(Pota) Pineta Grande Private Hospital, Department of Anesthesia and
Intensive Care, Castelvolturno 80122, Italy
(Trumello) IRCCS San Raffaele Scientific Institute, Department of Cardiac
Surgery, Milan, Italy
(Budillon, Alfieri) Parma University Hospital, Department of Cardiac
Surgery, Parma, Italy
(Paternoster) Azienda Ospedaliera S. Carlo, Department of Cardiovascular
Anaesthesia and Intensive Care, Potenza, Italy
(Scognamiglio) University of Naples Federico II, Section of Anesthesia and
Intensive Care, Department of Neurosciences, Reproductive and
Odontostomatological Sciences, Via Pansini 16, Naples, Italy
Title
Different strategies for mechanical VENTilation during CardioPulmonary
Bypass (CPBVENT 2014): Study protocol for a randomized controlled trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 264. Date of
Publication: 07 Jun 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: There is no consensus on which lung-protective strategies
should be used in cardiac surgery patients. Sparse and small randomized
clinical and animal trials suggest that maintaining mechanical ventilation
during cardiopulmonary bypass is protective on the lungs. Unfortunately,
such evidence is weak as it comes from surrogate and minor clinical
endpoints mainly limited to elective coronary surgery. According to the
available data in the academic literature, an unquestionable standardized
strategy of lung protection during cardiopulmonary bypass cannot be
recommended. The purpose of the CPBVENT study is to investigate the
effectiveness of different strategies of mechanical ventilation during
cardiopulmonary bypass on postoperative pulmonary function and
complications. Methods/design: The CPBVENT study is a single-blind,
multicenter, randomized controlled trial. We are going to enroll 870
patients undergoing elective cardiac surgery with planned use of
cardiopulmonary bypass. Patients will be randomized into three groups: (1)
no mechanical ventilation during cardiopulmonary bypass, (2) continuous
positive airway pressure of 5 cmH<inf>2</inf>O during cardiopulmonary
bypass, (3) respiratory rate of 5 acts/min with a tidal volume of 2-3
ml/Kg of ideal body weight and positive end-expiratory pressure of 3-5
cmH<inf>2</inf>O during cardiopulmonary bypass. The primary endpoint will
be the incidence of a PaO<inf>2</inf>/FiO<inf>2</inf> ratio <200 until the
time of discharge from the intensive care unit. The secondary endpoints
will be the incidence of postoperative pulmonary complications and 30-day
mortality. Patients will be followed-up for 12 months after the date of
randomization. Discussion: The CPBVENT trial will establish whether, and
how, different ventilator strategies during cardiopulmonary bypass will
have an impact on postoperative pulmonary complications and outcomes of
patients undergoing cardiac surgery. Trial registration:
ClinicalTrials.gov, ID: NCT02090205. Registered on 8 March
2014.<br/>Copyright &#xa9; 2017 The Author(s).

<77>
Accession Number
616643553
Author
Scholtens A.M.; Swart L.E.; Kolste H.J.T.; Budde R.P.J.; Lam M.G.E.H.;
Verberne H.J.
Institution
(Scholtens) Department of Nuclear Medicine, Meander Medical Center,
Maatweg 3, Amersfoort 3813TZ, Netherlands
(Swart, Budde) Department of Radiology and Nuclear Medicine, Erasmus
Medical Center, Rotterdam, Netherlands
(Kolste) Department of Cardiology, VU Medical Center, Amsterdam,
Netherlands
(Lam) Department of Radiology and Nuclear Medicine, University Medical
Center, Utrecht, Netherlands
(Verberne) Department of Radiology and Nuclear Medicine, Academic Medical
Center, Amsterdam, Netherlands
Title
Standardized uptake values in FDG PET/CT for prosthetic heart valve
endocarditis: a call for standardization.
Source
Journal of Nuclear Cardiology. (pp 1-8), 2017. Date of Publication: 05 Jun
2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: The significance of and threshold values for the standardized
uptake value (SUV) in FDG PET/CT to diagnose prosthetic heart valve (PHV)
endocarditis (PVE) are unclear at present. Methods: A literature search
was performed in the PubMed and EMBASE medical databases, comprising the
following terms: (FDG OR *fluorode* OR *fluoro-de*) AND (endocarditis OR
prosthetic heart valve OR valve replacement). Studies reporting SUVs
correlated to the diagnosis of PVE were selected for analysis. Results: 8
studies were included, with a total of 330 PHVs assessed. SUVs for PVE
varied substantially across studies due to differences in acquisition,
reconstruction, and measurement protocols, with median SUVmax values for
rejected PVE ranging from 0.5 to 4.9 and for definite PVE ranging from 4.2
to 7.4. Conclusion: Reported SUV values for PVE are not interchangeable
between sites, and further standardization of quantification is desirable.
To this end, optimal protocols for patient preparation, image acquisition,
and reconstruction and measurement methods need to be standardized across
centers.<br/>Copyright &#xa9; 2017 The Author(s)

<78>
Accession Number
613702373
Author
Hu X.; Yuan L.; Wang H.; Li C.; Cai J.; Hu Y.; Ma C.
Institution
(Hu, Yuan, Wang, Li, Cai, Hu, Ma) Department of Anaesthesiology, The
Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
Title
Efficacy and safety of vitamin C for atrial fibrillation after cardiac
surgery: A meta-analysis with trial sequential analysis of randomized
controlled trials.
Source
International Journal of Surgery. 37 (pp 58-64), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Elsevier Ltd
Abstract
Objectives Antioxidant supplement is an option in preventing postoperative
atrial fibrillation (AF) after cardiac surgery. However, the benefits and
adverse effects of vitamin C have not been well assessed. We aimed to
systematically evaluate the efficacy and safety of vitamin C in preventing
postoperative AF in adult patients after cardiac surgery. Methods PubMed,
EMBASE, and the Cochrane library databases from inception to September
2016 were searched. Randomized controlled trials (RCTs) that evaluated the
efficacy and safety of vitamin C in preventing postoperative AF in adult
patients after cardiac surgery were identified. The primary outcome was
the incidence of postoperative AF. Secondary outcomes included the length
of intensive care unit (ICU) stay, length of hospital stay, and stroke
events. Results Eight RCTs incorporating 1060 patients were included.
Compared with placebo group, vitamin C treatment was associated with a
substantial reduction in postoperative AF (OR, 0.47; 95% CI, 0.36-0.62;
evidence rank: moderate), with no significant heterogeneity (I²
44%; P = 0.09). Trial sequential analysis showed that the cumulative
Z-curve crossed the trial sequential monitoring boundary for benefit,
establishing sufficient and conclusive evidence. In addition, vitamin C
administration was not associated with any length of stay, including in
the ICU (evidence rank: low) and hospital (evidence rank: low),
respectively. Conclusions Short-term treatment with vitamin C is safe, and
may reduce the incidence of postoperative AF after cardiac surgery. Future
studies as well as more high quality RCTs are still warranted to confirm
the effects of different durations of vitamin C on cardiac
surgery.<br/>Copyright &#xa9; 2016 IJS Publishing Group Ltd

<79>
Accession Number
614148608
Author
Derakhshan P.; Maleki M.H.; Kazemi T.; Sharifabad A.R.; Mashreghimoghadam
H.R.
Institution
(Derakhshan) Anesthesiology Department, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Maleki, Kazemi, Mashreghimoghadam) Atherosclerosis and Coronary Artery
Research Center, Birjand University of Medical Sciences, Birjand, Iran,
Islamic Republic of
(Sharifabad) Birjand University of Medical Sciences, Birjand, Iran,
Islamic Republic of
Title
Comparison of the effect of two left internal mammary artery harvesting
techniques (Skeletonization and pedicled) on post coronary artery bypass
surgery pain and bleeding.
Source
Research in Cardiovascular Medicine. 6 (1) (no pagination), 2017. Article
Number: e34207. Date of Publication: January 2017.
Publisher
KOWSAR Medical Publishing Company (E-mail: info@kowsarmed.com)
Abstract
Background: Recent evidence suggests that skeletonization of the left
internal mammary artery (LIMA) can improve the flow and length of the
flow, reduce deep sternal infections and postoperative pain. Objectives:
The present study aimed to investigate the effect of two LIMA harvesting
techniques (skeletonization and pedicled) on postoperative pain and
bleeding. Methods: This randomized double blind clinical trial study on
patients undergoing LIMA harvest in Birjand was conducted during years
2012 to 2014. The patients were divided to two (skeletonization N: 30 and
pedicled N: 30) groups according to the LIMA harvesting method. Their
demographic information and other relevant data were collected by means of
a questionnaire. Results: In total, 60 cases, who were candidates for
coronary artery bypass grafting (CABG) at the cardiac surgery department
of Valiasr hospital in Birjand, were studied. In the skeletonized group,
the conduit length was significantly longer (17.96 vs. 17.27, P < 0.001),
yet there was no significant difference between early and mid-term pain
scores (P values: 0.32 and 1.0, respectively) and early postoperative
bleeding (782.26 vs. 903.16, P = 0.657). Conclusions: The IMA skeletonized
collection resulted in the reduction of postoperative pain and increased
conduit length. Skeletonization could not decrease postoperative
bleeding.<br/>Copyright &#xa9; 2016 Rajaie Cardiovascular Medical and
Research Center, Iran University of Medical Sciences.

<80>
Accession Number
604232951
Author
Dalili M.; Vesal A.; Tabib A.; Khani-Tafti L.; Hosseini S.; Totonchi Z.
Institution
(Dalili, Vesal, Tabib, Hosseini, Totonchi) Rajaie Cardiovascular Medical
and Research Center, Iran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Khani-Tafti) Echocardiography Research Center, Rajaie Cardiovascular
Medical and Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
Title
Single dose corticosteroid therapy after surgical repair of fallot's
tetralogy; A randomized controlled clinical trial.
Source
Research in Cardiovascular Medicine. 4 (1) (no pagination), 2015. Article
Number: e25500. Date of Publication: 2015.
Publisher
KOWSAR Medical Publishing Company (E-mail: info@kowsarmed.com)
Abstract
Background: Infammatory reaction can produce several complications after
cardiac surgery. Many attempts have been made to reduce these
complications; perioperative corticosteroid therapy is one of the simplest
methods. Objectives: We conducted a randomized study to evaluate the
efcacy of single dose methylprednisolone, prescribed after surgery, for
reducing the complications. Repair of Tetralogy of Fallot was chosen as a
homogenous large group for the study. Patients and Methods: One hundred
children who underwent total repair of Tetralogy of Fallot were enrolled
in this study. After the surgery, all patients were transferred to
pediatric ICU and were randomized (in a double-blind fashion) in 2 groups
(A and B); a single dose of methylprednisolone (30 mg/kg of body weight)
was injected to participants of group "A" just at the time of ICU
entrance. Group "B" received no drug. Then, clinical outcomes and
laboratory data were compared between the two groups. Results: The only
significant differences were lower incidence of bacteremia and higher
incidence of hyperglycemia in the group who were used methylprednisolone.
Conclusions: Using a single postsurgical dose of methylprednisolone does
not signifcantly alter the clinical outcome after repairing Tetralogy of
Fallot.<br/>Copyright &#xa9; 2015, Rajaie Cardiovascular Medical and
Research Center, Iran University of Medical Sciences.

<81>
Accession Number
605470311
Author
Alizadehas A.; Ziyaeifard M.; Peighambari M.; Azarfarin R.; Golbargian G.;
Bakhshandeh H.
Institution
(Alizadehas, Ziyaeifard, Peighambari, Azarfarin, Golbargian, Bakhshandeh)
Rajaie Cardiovascular Medical and Research Center, Iran University of
Medical Sciences, Tehran, IR, Iran, Islamic Republic of
Title
Avoiding heparinization of arterial line and maintaining acceptable
arterial waveform after cardiac surgery: A randomized clinical trial.
Source
Research in Cardiovascular Medicine. 4 (3) (no pagination), 2015. Article
Number: e28086. Date of Publication: 01 Aug 2015.
Publisher
KOWSAR Medical Publishing Company (E-mail: info@kowsarmed.com)
Abstract
Invasive and continuous blood pressure (BP) monitoring is crucial after
cardiac surgery. Accuracy of BP measurement mostly depends on patency of
arterial catheter and acceptable waveform. Heparinized saline flush
usually used for this purpose may be accompanied by potential heparin
adverse effects. Objectives: The aim of this study was to compare
heparinized and non-heparinized saline flush to maintain acceptable
arterial waveform after cardiac surgery. Materials and Methods: In a
double blind randomized trial study, 100 patients undergoing elective
cardiac surgery were randomized to using heparinized (n=50) or
non-heparinized (normal) saline flush (n=50) to maintain patency of
arterial catheter after operation. Indwelling arterial catheters were
checked daily for acceptable arterial waveform for three days as primary
outcome measures. Results: Frequency of acceptable arterial waveform
ranged from 66% to 80%, in first, second and third postoperative days.
There were no statistically significant differences between heparinized
and non-heparinized saline groups regarding acceptable arterial waveforms
in all the three postoperative days (all P values>0.05). Conclusions:
Using non-heparinized normal saline is suitable to maintain acceptable
arterial waveform for short-term (three days) after adult cardiac surgery
considering potential adverse effects of heparin.<br/>Copyright &#xa9;
2015, Rajaie Cardiovascular Medical and Research Center, Iran University
of Medical Sciences.

<82>
Accession Number
368933406
Author
Kurien T.; Pearson R.G.; Scammell B.E.
Institution
(Kurien, Pearson, Scammell) Queen's Medical Centre, University of
Nottingham, Nottingham, United Kingdom
(Scammell) Division of Orthopaedic and Accident Surgery, Queen's Medical
Centre, University of Nottingham, Nottingham NG7 2UH, United Kingdom
Title
Bone graft substitutes currently available in orthopaedic practice: The
evidence for their use.
Source
Bone and Joint Journal. 95 B (5) (pp 583-597), 2013. Date of Publication:
May 2013.
Publisher
British Editorial Society of Bone and Joint Surgery (E-mail:
subs@jbjs.org.uk)
Abstract
We reviewed 59 bone graft substitutes marketed by 17 companies currently
available for implantation in the United Kingdom, with the aim of
assessing the peer-reviewed literature to facilitate informed
decision-making regarding their use in clinical practice. After critical
analysis of the literature, only 22 products (37%) had any clinical data.
Norian SRS (Synthes), Vitoss (Orthovita), Cortoss (Orthovita) and
Alpha-BSM (Etex) had Level I evidence. We question the need for so many
different products, especially with limited published clinical evidence
for their efficacy, and conclude that there is a considerable need for
further prospective randomised trials to facilitate informed
decision-making with regard to the use of current and future bone graft
substitutes in clinical practice. &#xa9; 2013 The British Editorial
Society of Bone & Joint Surgery.

<83>
Accession Number
616626249
Author
Gwon H.-C.; Jeon D.W.; Kang H.-J.; Jang J.-S.; Park D.-W.; Shin D.-H.;
Moon K.-W.; Kim J.-S.; Kim J.; Bae J.-W.; Hur S.-H.; Kim B.O.; Choi D.;
Han K.-R.; Kim H.-S.
Institution
(Gwon) Samsung Medical Center, Heart Vascular and Stroke Institute,
Sungkyunkwan University School of Medicine, Seoul, South Korea
(Jeon) Division of Cardiology, National Health Insurance Service Ilsan
Hospital, 100 Ilsan-ro, Ilsan-donggu, Goyang 10444, South Korea
(Kang, Kim) Department of Internal Medicine, Seoul National University
Hospital, Seoul, South Korea
(Jang) Division of Cardiology, University of Inje College of Medicine,
Busan Paik Hospital, Busan, South Korea
(Park) Division of Cardiology, Asan Medical Center, University of Ulsan
College of Medicine, Seoul, South Korea
(Shin, Kim, Choi) Division of Cardiology, Yonsei University College of
Medicine, Severance Cardiovascular Hospital, Seoul, South Korea
(Moon) Division of Cardiology, College of Medicine, Catholic University of
Korea, St. Vincent's Hospital, Suwon, South Korea
(Kim) Division of Cardiology, Heart Center of Chonnam National University
Hospital, Gwangju, South Korea
(Bae) Department of Internal Medicine, Chungbuk National University
College of Medicine, Cheongju, South Korea
(Hur) Division of Cardiology, Keimyung University Dongsan Medical Center,
Daegu, South Korea
(Kim) Division of Cardiology, University of Inje College of Medicine,
Sanggye-Paik Hospital, Seoul, South Korea
(Han) Department of Internal Medicine, Hallym University Medical Center,
Kangdong Sacred Heart Hospital, Seoul, South Korea
Title
The practice pattern of percutaneous coronary intervention in Korea -based
on year 2014 cohort of Korean percutaneous coronary intervention (K-PCI)
Registry.
Source
Korean Circulation Journal. 47 (3) (pp 320-327), 2017. Date of
Publication: May 2017.
Publisher
Korean Society of Circulation (E-mail: herz4@circulation.or.kr)
Abstract
Background and Objectives: Appropriate use criteria (AUC) was developed to
improve the quality of percutaneous coronary intervention (PCI). However,
these criteria should consider the current practice pattern in the country
where they are being applied. Materials and Methods: The algorithm for the
Korean PCI practice pattern (KP3) was developed by modifying the United
States-derived AUC in expert consensus meetings. KP3 class A was defined
as any strategy with evidence from randomized trials that was more
conservative for PCI than medical therapy or coronary artery bypass graft
(CABG). Class C was defined as any strategy with less evidence from
randomized trials and more aggressive for PCI than medical therapy or
CABG. Class B was defined as a strategy that was partly class A and partly
class C. We applied the KP3 classification system to the Korean PCI
registry. Results: The KP3 class A was noted in 67.7% of patients, class B
in 28.8%, and class C in 3.5%. The median proportion of class C cases per
center was 2.0%. The distribution of KP3 classes varied significantly
depending on clinical and angiographic characteristics. The proportion of
KP3 class C cases per center was not significantly dependent on PCI
volume, but rather on the percentage of ACS cases in each center.
Conclusion: We report the current PCI practice pattern by applying the new
KP3 classification in a nationwide PCI registry. The results should be
interpreted carefully with due regard for the complex relationships
between the determining variables and the healthcare system in
Korea.<br/>Copyright &#xa9; 2017 The Korean Society of Cardiology.

<84>
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.

<85>
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

<86>
Accession Number
615245764
Author
De Maria G.L.; Alkhalil M.; Oikonomou E.K.; Wolfrum M.; Choudhury R.P.;
Banning A.P.
Institution
(De Maria, Alkhalil, Wolfrum, Banning) Oxford Heart Centre, NIHR
Biomedical Research Centre, Oxford University Hospitals, Oxford, United
Kingdom
(Choudhury) Radcliffe Department of Medicine, Acute Vascular Imaging
Centre, University of Oxford, Oxford, United Kingdom
(Choudhury) Division of Cardiovascular Medicine, BHF Centre of Research
Excellence, University of Oxford, Oxford, United Kingdom
Title
Role of deferred stenting in patients with ST elevation myocardial
infarction treated with primary percutaneous coronary intervention: A
systematic review and meta-analysis.
Source
Journal of Interventional Cardiology. 30 (3) (pp 264-273), 2017. Date of
Publication: June 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: We conducted a meta-analysis of studies comparing deferred
stenting strategy versus the conventional approach with immediate stenting
in patients with ST elevation myocardial infarction. Background: Deferring
stent after mechanical flow restoration has been proposed as a strategy to
reduce the risk of "no reflow" in patients with STEMI undergoing primary
percutaneous coronary intervention (pPCI). Conflicting evidence is
available currently, especially after the recent publication of three
randomized clinical trials. Methods: Searches in electronic databases were
performed. Comparisons between the two strategies were performed for both
hard clinical endpoints (all cause-mortality, cardiovascular mortality,
unplanned revascularization, myocardial infarction and readmission for
heart failure) and surrogate angiographic endpoints (TIMI flow < 3 and
myocardial blush grade (MBG) < 2). Results: Eight studies (three
randomized and five non-randomized) were deemed eligible, accounting for a
total of 2101 patients. No difference in terms of hard clinical endpoints
was observed between deferred and immediate stenting (OR [95% CI]: 0.79
[0.54-1.15], for all-cause mortality; odds ratio (OR) [95% CI]: 0.79
[0.47-1.31] for cardiovascular mortality; OR [95% CI]: 0.95 [0.64-1.41]
for myocardial infarction; OR [95% CI]: 1.37 [0.87-2.16], for unplanned
revascularization and OR [95% CI]: 0.50 [0.21-1.17] for readmission for
heart failure). Notably, the deferred stenting approach was associated
with improved outcome of the surrogate angiographic endpoints (OR [95%
CI]: 0.43 [0.18-0.99] of TIMI flow < 3 and OR [95% CI]: 0.25 [0.11-0.57]
for MBG < 2. Conclusions: A deferred stenting strategy could be a feasible
alternative to the conventional approach with immediate stenting in
"selected" STEMI patients undergoing pPCI.<br/>Copyright &#xa9; 2017,
Wiley Periodicals, Inc.

<87>
Accession Number
616402957
Author
Rahouma M.; Kamel M.; Benedetto U.; Ohmes L.B.; Di Franco A.; Lau C.;
Girardi L.N.; Tranbaugh R.F.; Barili F.; Gaudino M.
Institution
(Rahouma, Kamel, Ohmes, Di Franco, Lau, Girardi, Tranbaugh, Gaudino)
Department of Cardio-Thoracic 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.

<88>
Accession Number
614408595
Author
Loomba R.S.; Buelow M.W.; Woods R.K.
Institution
(Loomba, Buelow, Woods) Division of Cardiology and Cardiothoracic Surgery,
Children's Hospital of Wisconsin/ Medical College of Wisconsin, 9000
Wisconsin Avenue, Milwaukee, WI 53226, United States
Title
Complete Repair of Tetralogy of Fallot in the Neonatal Versus Non-neonatal
Period: A Meta-analysis.
Source
Pediatric Cardiology. 38 (5) (pp 893-901), 2017. Date of Publication: 01
Jun 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
It is unclear if neonatal tetralogy of Fallot repair offers better
outcomes compared to repair later in infancy. We therefore conducted a
meta-analysis comparing outcomes of neonatal and non-neonatal repair.
Manuscripts were identified and reviewed for quality and bias with
favorably scored manuscripts being included in the final meta-analysis.
Several perioperative and postoperative variables were compared. A total
of 8 studies with 3858 patients were included in the analysis. Of these
patients, 19% underwent neonatal repair. Neonatal repair was associated
with increased mortality, longer intensive care unit stays, and longer
total hospital length of stay.<br/>Copyright &#xa9; 2017, Springer
Science+Business Media New York.

<89>
Accession Number
610187115
Author
Daudin M.; Tattevin P.; Lelong B.; Flecher E.; Lavoue S.; Piau C.; Ingels
A.; Chapron A.; Daubert J.-C.; Revest M.
Institution
(Daudin, Lelong, Flecher, Ingels, Daubert) Department of Cardio-Thoracic
and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
(Tattevin, Lavoue, Revest) Department of Infectious Disease and Intensive
Care Unit, Pontchaillou University Hospital, Rennes, France
(Tattevin, Revest) CIC Inserm 0203, Rennes-1 University, France
(Tattevin, Revest) Inserm U835, Rennes-1 University, France
(Piau) Department of Bacteriology, Pontchaillou University Hospital,
Rennes, France
(Chapron) Department of General Medicine, Pontchaillou University
Hospital, Rennes, France
Title
Characteristics and prognosis of pneumococcal endocarditis: a case-control
study.
Source
Clinical Microbiology and Infection. 22 (6) (pp 572.e5-572.e8), 2016. Date
of Publication: 01 Jun 2016.
Publisher
Elsevier B.V. (E-mail: customerservices@oxonblackwellpublishing.com)
Abstract
Case series have suggested that pneumococcal endocarditis is a rare
disease, mostly reported in patients with co-morbidities but no underlying
valve disease, with a rapid progression to heart failure, and high
mortality. We performed a case-control study of 28 patients with
pneumococcal endocarditis (cases), and 56 patients with non-pneumococcal
endocarditis (controls), not matched for sex and age, during the years
1991-2013, in one referral centre. Alcoholism (39.3% versus 10.7%; p
<0.01), smoking (60.7% versus 21.4%; p <0.01), the absence of previously
known valve disease (82.1% versus 60.7%; p 0.047), heart failure (64.3%
versus 23.2%; p <0.01) and shock (53.6% versus 23.2%; p <0.01) were more
common in pneumococcal than in non-pneumococcal endocarditis. Cardiac
surgery was required in 64.3% of patients with pneumococcal endocarditis,
much earlier than in patients with non-pneumococcal endocarditis (mean
time from symptom onset, 14.1 +/- 18.2 versus 69.0 +/- 61.1 days).
In-hospital mortality rates were similar (7.1% versus 12.5%).
Streptococcus pneumoniae causes rapidly progressive endocarditis requiring
life-saving early cardiac surgery in most cases.<br/>Copyright &#xa9; 2016
European Society of Clinical Microbiology and Infectious Diseases

<90>
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.

<91>
Accession Number
616274963
Author
Bouzia A.; Tassoudis V.; Karanikolas M.; Vretzakis G.; Petsiti A.;
Tsilimingas N.; Arnaoutoglou E.
Institution
(Bouzia) Intensive Care Unit, Medical School of Larissa, University of
Thessaly, Volos, Greece
(Tassoudis, Vretzakis, Petsiti, Arnaoutoglou) Department of
Anesthesiology, Medical School of Larissa, University of Thessaly, Volos,
Greece
(Karanikolas) Department of Anesthesiology, Washington University School
of Medicine, St. Louis, MO, United States
(Tsilimingas) Department of Cardiothoracic Surgery, Medical School of
Larissa, University of Thessaly, Volos, Greece
Title
Pregabalin Effect on Acute and Chronic Pain after Cardiac Surgery.
Source
Anesthesiology Research and Practice. 2017 (no pagination), 2017. Article
Number: 2753962. Date of Publication: 2017.
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Introduction. Pain after cardiac surgery affects long-term patient
wellness. This study investigated the effect of preoperative pregabalin on
acute and chronic pain after elective cardiac surgery with median
sternotomy. Methods. Prospective double blind study. 93 cardiac surgery
patients were randomly assigned into three groups: Group 1 received
placebo, Group 2 received oral pregabalin 75 mg, and Group 3 received oral
pregabalin 150 mg. Data were collected 8 hours, 24 hours, and 3 months
postoperatively. Results. Patients receiving pregabalin required fewer
morphine boluses (10 in controls versus 6 in Group 1 versus 4 in Group 2,
p=0.000) and had lower pain scores at 8 hours (4 versus 3 versus 3,
p=0.001) and 3 months (3 versus 2 versus 2, p=0.000) and lower morphine
consumption at 8 hours (14 versus 13 versus 12 mg, p=0.000) and 24 hours
(19.5 versus 16 versus 15 mg, p=0.000). Percentage of patients with sleep
disturbances or requiring analgesics was lower in the pregabalin group and
even lower with higher pregabalin dose (16/31 versus 5/31 versus 3/31,
p=0.000, and 26/31 versus 16/31 versus 10/31, p=0.000, resp.) 3 months
after surgery. Conclusion. Preoperative oral pregabalin 75 or 150 mg
reduces postoperative morphine requirements and acute and chronic pain
after cardiac surgery.<br/>Copyright &#xa9; 2017 Aik Bouzia et al.

<92>
Accession Number
616637803
Author
Krasopoulos G.; Falconieri F.; Benedetto U.; Newton J.; Sayeed R.;
Kharbanda R.; Banning A.
Institution
(Krasopoulos, Falconieri, Benedetto, Newton, Sayeed, Kharbanda, Banning)
Oxford Heart Centre, Oxford University Hospitals, Headley Way, Headington,
Oxford, OX3 9DU, UK
Title
European real world trans-catheter aortic valve implantation: systematic
review and meta-analysis of European national registries.
Source
Journal of cardiothoracic surgery. 11 (1) (pp 159), 2016. Date of
Publication: 29 Nov 2016.
Abstract
OBJECTIVE: Transcatheter aortic valve implantation (TAVI) has been adopted
rapidly in Europe. TAVI national registries can augment understanding of
technologies and represent real-world experience, providing further
clinical insights. We undertook a meta-analysis of published European
national TAVI registries to assess current results following TAVI in
Europe.
METHODS: Electronic databases were searched. The review focused on the
comparison of the following TAVI strategies: transfemoral (TF) and
transapical (TA) SAPIEN and CoreValve implantation. Individual event rates
for outcomes of interest were pooled using a mixed effect model.
RESULTS: Seven European national TAVI registries (UK, Swiss, Belgium,
Italy, Spain, France, Germany) were identified, including a total of 9786
patients who received TF-SAPIEN (n=2885), TA-SAPIEN (n=2252) and CoreValve
(n=4649) implantation. Pooled incidence of 30-day mortality was 0.08% [95%
Confidence Interval (CI): 0.05-0.11], 0.12% [95% CI: 0.07-0.19] and 0.06%
[95% CI: 0.03-0.11] for TF-SAPIEN, TA-SAPIEN and CoreValve respectively
(test for subgroup difference P=0.18); there was high heterogeneity across
European countries. Pooled incidence of stroke was comparable among the
TAVI strategies (test for subgroup difference P=0.79); the incidence of
post-procedural moderate paravalvular leak>=2 (P=0.9) was similar across
groups. CoreValve implantation was associated with an increased risk of
pacemaker implantation (0.22 [95% CI: 0.19-0.26]; test for subgroup
difference P<0.0001). The lowest 30-day mortality was associated with TAVI
performed in Spain (b coefficient -4.3; P=0.03), in Italy (b coefficient
-2.1; P<0.0001), in UK (b coefficient -1.95; P=0.01) and in France (b
coefficient -2.8; P=0.03). The German registry has the highest mortality
for every TAVI strategy amongst all other European registries and
especially for the TA-SAPIEN group.
CONCLUSIONS: Transarterial TAVI approaches were associated with a low
early mortality regardless of the type of device used. There was marked
heterogeneity among European countries for early mortality.

<93>
Accession Number
616640069
Author
Wang Y.; Shi X.; Wen M.; Chen Y.; Zhang Q.
Institution
(Wang, Shi, Wen, Chen, Zhang) Department of Cardiology, West China
Hospital, Sichuan University, Chengdu, China
Title
Repair or replace ischemic mitral regurgitation during coronary artery
bypass grafting? A meta-analysis.
Source
Journal of cardiothoracic surgery. 11 (pp 141), 2016. Date of Publication:
01 Sep 2016.
Abstract
BACKGROUND: No agreement has been reached for the best surgical treatment
for patients with chronic ischemic mitral regurgitation (IMR) undergoing
coronary artery bypass grafting (CABG). Our objective was to meta-analyze
the clinical outcomes of repair and replacement.
METHODS: A computerized search was performed using Pubmed, Embase, Ovid
medline and Cochrane Library. The search terms "ischemic or ischaemic" and
"mitral valve" and "repair or replacement or annuloplasty" and "coronary
artery bypass grafting" were entered as MeSH terms and keywords. The
primary outcomes were operative mortality and late mortality. Secondary
outcomes were 2+ or greater recurrence of mitral regurgitation and
reoperation rate.
RESULTS: Eleven studies were eligible for the final meta-analysis. These
studies included a total of 1750 patients, 60.4 % of whom received mitral
valve repair. All patients underwent concomitant coronary artery bypass
graft. No differences were found in operative mortality (summary odds
ratio [OR] 0.65; 95 % confidence interval [CI] 0.43-1.00; p=0.05), late
mortality (summary hazard ratio [HR] 0.87; 95 % confidence interval [CI]
0.67-1.14; p = 0.31) and reoperation (summary odds ratio [OR] 1.47; 95 %
confidence interval [CI] 0.90-2.38; p = 0.12). Regurgitation recurrence
was lower in the replacement group (summary odds ratio [OR] 5.41; 95 %
confidence interval [CI] 3.12-9.38; p<0.001).
CONCLUSION: In patients with chronic ischemic mitral regurgitation during
CABG, mitral valve replacement is associated with lower recurrence of
regurgitation. No differences were found regarding survival and
reoperation rates.

<94>
Accession Number
616212425
Author
Ersoy A.; Cakirgoz M.; Ervatan Z.; Kiran O.; Turkmen A.; Esenyel C.Z.
Institution
(Ersoy, Cakirgoz, Ervatan, Kiran, Turkmen) Okmeydani Training and Research
Hospital, Department of Anaesthesiology and Reanimation, Istanbul, Turkey
(Esenyel) Okmeydani Training and Research Hospital, Department of
Orthopaedic Surgery, Istanbul, Turkey
Title
Effects of positive end-expiratory pressure on arthroscopic shoulder
surgery under general anesthesia.
Source
Acta orthopaedica et traumatologica turcica. 50 (1) (pp 82-88), 2016. Date
of Publication: 2016.
Abstract
OBJECTIVE: Our study is a prospective, randomized study on patients
undergoing arthroscopic shoulder surgery in the beach-chair position to
evaluate the effects of positive end-expiratory pressure (PEEP) on
hemodynamic stability, providing a bloodless surgical field and surgical
satisfaction.
METHODS: Fifty patients were divided into two groups. Group I (n=25) had
zero end-expiratory pressure (ZEEP) administered under general anesthesia,
and group II (n=25) had +5 PEEP administered. During surgery,
intraarticular hemorrhage and surgical satisfaction were evaluated on a
scale of 0-10. During surgery, at the 5th, 30th, 60th, and 90th minutes
and at the end of surgery, heart rate, mean arterial pressure (MAP), and
positive inspiratory pressure were recorded. At the end of the surgery,
the amount of bleeding and duration of the operation were recorded.
RESULTS: In group I, the duration of operation and amount of bleeding were
found to be significantly greater than those in group II (p<0.05). The
surgical satisfaction score and clarity of the surgical field were found
to be significantly lower in group I than in group II (p<0.05). MAP values
in group I were significantly lower than those in group II. The SPO2
values in group I were significantly lower than those in group II.
CONCLUSION: Adding PEEP to the ventilation parameters of arthroscopic
shoulder surgery in the beach-chair position reduces the amount of
hemorrhage in the surgical field and thus increases surgical satisfaction
without requiring the creation of controlled hypotension.

<95>
[Use Link to view the full text]
Accession Number
616616928
Author
Castro R.E.; Guimaraes G.V.; Da Silva J.M.; Bocchi E.A.; Ciolac E.G.
Institution
(Castro) 1Exercise and Chronic Disease Research Laboratory, Physical
Education Department, School of Sciences, Sao Paulo State
University-UNESP, Bauru, BRAZIL; 2Heart Institute, Hospital das Clinicas
da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, BRAZIL
Title
Postexercise Hypotension after Heart Transplant: Water- versus Land-Based
Exercise.
Source
Medicine and science in sports and exercise. 48 (5) (pp 804-810), 2016.
Date of Publication: 01 May 2016.
Abstract
PURPOSE: Heart transplant recipients (HTx) have a high prevalence of
hypertension. Although exercise training promotes blood pressure (BP)
reduction in HTx, the effects of a single exercise bout are unknown. Thus,
we analyzed the acute effects of heated water-based exercise (HEx) versus
land-based exercise (LEx) on ambulatory BP (ABP) in HTx.
METHODS: Eighteen (six females) clinically stable HTx (time since surgery
= 5.0 +/- 0.7 yr) age 45.7 +/- 2.7 yr underwent 30 min of HEx (walking
inside the pool), LEx (walking on a treadmill), and nonexercise control
(CON) intervention in random order (2-5 d between interventions). HEx and
LEx intensity was set at 11-13 in the 6-20 RPE scale. Twenty-four-hour
(24-h) ABP monitoring was performed after each intervention.
RESULTS: No significant differences between interventions were found in
24-h and nighttime BP. However, daytime diastolic BP was significantly
lower after HEx than CON (-4 +/- 1.6 mm Hg, P = 0.03), and daytime
diastolic BP tended to be lower after LEx than CON (-2.3 +/- 1.1 mm Hg, P
= 0.052). Hourly analysis showed that systolic and diastolic BP values
were lower after HEx (average reductions of 6.6 to 12.3 mm Hg, P < 0.01)
and LEx (average reductions of 5 to 8.3 mm Hg, P < 0.05) than after CON in
several hours. No significant differences between HEx and LEx were found
in any ABP data.
CONCLUSION: HEx and LEx promoted similar reductions in ABP of heart
transplant recipients, which suggests that they may be a tool to
counteract hypertension in this high-risk population.

<96>
Accession Number
616632445
Author
Chang M.; Lee C.W.; Ahn J.-M.; Cavalcante R.; Sotomi Y.; Onuma Y.; Han M.;
Park D.-W.; Kang S.-J.; Lee S.-W.; Kim Y.-H.; Park S.-W.; Serruys P.W.;
Park S.-J.
Institution
(Chang) Seoul St. Mary's Hospital, The Catholic University of Korea,
Seoul, Korea
(Lee, Ahn, Park, Kang, Lee, Kim, Park, Park) Heart Institute, Asan Medical
Center, University of Ulsan College of Medicine, Seoul, Korea
(Cavalcante, Onuma, Serruys) Erasmus University Medical Center, Rotterdam,
The Netherlands
(Sotomi) Academic Medical Center, University of Amsterdam, Amsterdam, The
Netherlands
(Han) Division of Biostatistics, Asan Medical Center, University of Ulsan,
Seoul, Korea
(Serruys) International Center for Circulatory Health, Imperial College of
London, London, United Kingdom
Title
Comparison of Outcome of Coronary Artery Bypass Grafting Versus
Drug-Eluting Stent Implantation for Non-ST-Elevation Acute Coronary
Syndrome.
Source
American Journal of Cardiology. (no pagination), 2017. Date of
Publication: January 08, 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
There is limited data comparing effectiveness of coronary artery bypass
grafting (CABG) versus percutaneous coronary intervention (PCI) with
drug-eluting stents in patients with non-ST-elevation acute coronary
syndromes (NSTE-ACS). We compared the long-term outcomes of the 2
revascularization strategies in 1,246 patients presented with NSTE-ACS for
left main or multivessel coronary artery disease. Data were pooled from
the Randomized Comparison of Coronary Artery Bypass Surgery and
Everolimus-Eluting Stent Implantation in the Treatment of Patients with
Multivessel Coronary Artery Disease (BEST) trial, the Premier of
Randomized Comparison of Bypass Surgery versus Angioplasty Using
Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease
(PRECOMBAT) trial, and the Synergy between PCI with Taxus and Cardiac
Surgery (SYNTAX) trial. The primary outcome was a composite of death from
any causes, myocardial infarction, or stroke. The baseline characteristics
were similar between the 2 study groups. During the median follow-up of 60
months, the rate of the primary outcome was significantly lower with CABG
than with PCI (hazard ratio [HR] 0.74; 95% confidence interval [CI] 0.56
to 0.98; p = 0.036). This difference was mainly attributed to a
significant reduction in the rate of myocardial infarction (HR 0.50; 95%
CI 0.31 to 0.82, p = 0.006). The superiority of CABG over PCI was
consistent across the major subgroups. The individual risks of death from
any causes or stroke were not different between the 2 groups. In contrast,
the rate of repeat revascularization was significantly lower in the CABG
group than in the PCI group (HR 0.56; 95% CI 0.41 to 0.75, p <0.001). In
this study, among patients with NSTE-ACS for left main or multivessel
coronary artery disease, CABG significantly reduces the risk of death from
any causes, myocardial infarction, or stroke compared with PCI with
drug-eluting stents.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<97>
Accession Number
616621435
Author
Powell R.; Pelletier M.P.; Chu M.W.A.; Bouchard D.; Melvin K.N.; Adams C.
Institution
(Powell) From the *Faculty of Medicine, Memorial University of
Newfoundland, St. Johns, NL Canada; +Division of Cardiac Surgery, Brigham
and Women's Hospital, Harvard Medical School, Boston, MA USA; ++Division
of Cardiac Surgery, Department of Surgery, Western University, London, ON
Canada; Department of Surgery, Montreal Heart Institute, Montreal, PQ
Canada; and Division of Cardiac Surgery, Department of Surgery, Memorial
University of Newfoundland, St. John's, NL Canada.
Title
The Perceval Sutureless Aortic Valve: Review of Outcomes, Complications,
and Future Direction.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. (no pagination), 2017. Date of Publication: 31 May 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
ABSTRACT: Surgical aortic valve replacement with a stented prosthesis has
been the standard of care procedure for aortic stenosis. The Perceval
(LivaNova, London, United Kingdom) is a sutureless aortic valve
bioprosthesis currently implanted in more than 20,000 patients. The
purpose of this article was to review the literature available after 9
years of clinical experience of the Perceval aortic valve. PubMED, Embase,
and the Cochrane Library databases were searched. A meta-analysis of
summary statistics from individual studies was conducted. A total of 333
studies were identified and 84 studies were included. Thirty-day mortality
and 5-year survival ranged from 0% to 4.9% and 71.3% to 85.5%,
respectively. Compared with stented prosthesis, pooled analysis
demonstrated a statistically significant reduction in aortic cross-clamp
and cardiopulmonary bypass times (minutes) with Perceval (38.6 vs 63.3 and
61.4 vs 84.9, P < 0.00001, respectively). Compared with transcatheter
aortic valve implantation, pooled analysis demonstrated a statistically
significant reduction with Perceval in paravalvular leakage (1.26% vs
14.31%) and early mortality (2.3% vs 6.9%). Favorable hemodynamics,
acceptable valve durability, and ease of implantation in minimally
invasive cases were reported as benefits. A trend toward increased rates
of permanent pacemaker implantation and low postoperative platelet count
were identified. Special use and off-label procedures described included
bicuspid aortic valves, valve-in-valve for homograft and stentless
prosthesis failure, concomitant valvular procedures, porcelain aorta, and
endocarditis. The Perceval valve has shown safe clinical and hemodynamic
outcomes. Outcomes support its continued usage and potential
expansion.<br/>Copyright &#xa9;2017 by the International Society for
Minimally Invasive Cardiothoracic Surgery

<98>
Accession Number
616621125
Author
Chen T.K.; Appel L.J.; Grams M.E.; Tin A.; Choi M.J.; Lipkowitz M.S.;
Winkler C.A.; Estrella M.M.
Institution
(Chen) From the Divisions of Nephrology (T.K.C., M.E.G., M.J.C.) and
General Internal Medicine (L.J.A.), Department of Medicine, Johns Hopkins
University School of Medicine, Baltimore, MD; Welch Center for Prevention,
Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions,
Baltimore, MD (L.J.A., M.E.G., A.T.); Department of Epidemiology, Johns
Hopkins Bloomberg School of Public Health, Baltimore, MD (A.T.); Division
of Nephrology and Hypertension, Department of Medicine, Georgetown
University School of Medicine, Washington, DC (M.S.L.); Basic Research
Laboratory, Center for Cancer Research, National Cancer Institute,
National Institutes of Health and Leidos Biomedical, Frederick National
Laboratory, MD (C.A.W.); and Kidney Health Research Collaborative,
Department of Medicine, Sa
Title
APOL1 Risk Variants and Cardiovascular Disease: Results From the AASK
(African American Study of Kidney Disease and Hypertension).
Source
Arteriosclerosis, Thrombosis, and Vascular Biology. (no pagination), 2017.
Date of Publication: 01 Jun 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
OBJECTIVE-: Among black, the apolipoprotein L1 (APOL1) risk variants have
been associated with various types of kidney disease and chronic kidney
disease progression. We aimed to determine whether these same risk
variants also confer an increased risk for cardiovascular disease.
APPROACH AND RESULTS-: In a cohort of blacks with hypertension-attributed
chronic kidney disease followed for up to 12 years, we used Cox
proportional hazards models to estimate the relative hazard of a composite
cardiovascular disease outcome (cardiovascular death or hospitalization
for myocardial infarction, cardiac revascularization procedure, heart
failure, or stroke) for the APOL1 high- (2 risk variants) versus low-risk
(0-1 risk variant) genotypes. We adjusted for age, sex, ancestry, smoking,
heart disease history, body mass index, cholesterol, randomized treatment
groups, and baseline and longitudinal estimated glomerular filtration
rate, systolic blood pressure, and proteinuria. Among 693 participants
with APOL1 genotyping available (23% high risk), the high-risk group had
lower mean estimated glomerular filtration rate (44.7 versus 50.1 mL/min
per 1.73 m) and greater proteinuria (median 0.19 versus 0.06) compared
with the low-risk group at baseline. There was no significant association
between APOL1 genotypes and the composite cardiovascular disease outcome
in both unadjusted (hazard ratio=1.23; 95% confidence interval: 0.83-1.81)
and fully adjusted (hazard ratio=1.16; 95% confidence interval: 0.77-1.76)
models; however, in using an additive model, APOL1 high-risk variants were
associated with increased cardiovascular mortality. CONCLUSIONS-: Among
blacks with hypertension-attributed chronic kidney disease, APOL1 risk
variants were not associated with an overall risk for cardiovascular
disease although some signals for cardiovascular mortality were
noted.<br/>Copyright &#xa9; 2017 American Heart Association, Inc.

<99>
Accession Number
616608924
Author
Gjeraa K.; Mundt A.S.; Spanager L.; Hansen H.J.; Konge L.; Petersen R.H.;
Ostergaard D.
Institution
(Gjeraa, Mundt, Konge, Ostergaard) Copenhagen Academy for Medical
Education and Simulation, Capital Region of Denmark and University of
Copenhagen, Copenhagen, Denmark
(Spanager) Department of General Surgery, Nordsjaellands Hospital,
Hillerod, Denmark
(Hansen, Petersen) Department of Cardiothoracic Surgery, University
Hospital of Copenhagen, Copenhagen, Denmark
Title
Important Non-Technical Skills in Video-Assisted Thoracoscopic Surgery
Lobectomy: Team Perspectives.
Source
Annals of Thoracic Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier USA
Abstract
Background: Safety in the operating room is dependent on the team's
non-technical skills. The importance of non-technical skills appears to be
different for minimally invasive surgery as compared with open surgery.
The aim of this study was to identify which non-technical skills are
perceived by team members to be most important for patient safety, in the
setting of video-assisted thoracoscopic surgery (VATS) lobectomy. Methods:
This was an explorative, semistructured interview-based study with 21
participants from all four thoracic surgery centers in Denmark that
perform VATS lobectomy. Data analysis was deductive, and directed content
analysis was used to code the text into the Oxford Non-Technical Skills
system for evaluating operating teams' non-technical skills. Results: The
most important non-technical skills described by the VATS teams were
planning and preparation, situation awareness, problem solving,
leadership, risk assessment, and teamwork. These non-technical skills
enabled the team to achieve shared mental models, which in turn
facilitated their efforts to anticipate next steps. This was viewed as
important by the participants as they saw VATS lobectomy as a high-risk
procedure with complementary and overlapping scopes of practice between
surgical and anesthesia subteams. Conclusions: This study identified six
non-technical skills that serve as the foundation for shared mental models
of the patient, the current situation, and team resources. These findings
contribute three important additions to the shared mental model construct:
planning and preparation, risk assessment, and leadership. Shared mental
models are crucial for patient safety because they enable VATS teams to
anticipate problems through adaptive patterns of both implicit and
explicit coordination.<br/>Copyright &#xa9; 2017 The Society of Thoracic
Surgeons.

<100>
Accession Number
616588837
Author
Millan-Iturbe O.; Sawaya F.J.; Bieliauskas G.; Chow D.H.F.; De Backer O.;
Sondergaard L.
Institution
(Millan-Iturbe, Sawaya, Bieliauskas, Chow, De Backer, Sondergaard) The
Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
Title
Acute Aortic Arch Perforation During Transcatheter Aortic Valve
Replacement in Bicuspid Aortic Stenosis and a Gothic Aortic Arch.
Source
Canadian Journal of Cardiology. (no pagination), 2017. Date of
Publication: March 01, 2017.
Publisher
Pulsus Group Inc.
Abstract
Transcatheter aortic valve replacement (TAVR) has evolved from a novel
technology to an established therapy for high/intermediate-risk patients
with severe symptomatic aortic stenosis (AS). Although TAVR is used to
treat bicuspid severe AS, the large randomized trials typically excluded
bicuspid AS because of its unique anatomic features. This case report
describes an acute aortic perforation during delivery of a transcatheter
heart valve to treat a severe bicuspid AS with a "gothic aortic arch";
more careful evaluation of the preprocedural multislice computed
tomographic scan would have unveiled a sharply angulated aortic arch. This
life-threatening complication was successfully treated by thoracic
endovascular aortic repair.<br/>Copyright &#xa9; 2017 Canadian
Cardiovascular Society.