EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
604373222
Author
Tsai Y.-C.; Phan K.; Munkholm-larsen S.; Tian D.H.; La meir M.; Yan T.D.
Institution
(Tsai) Department of Cardiothoracic Surgery, The Prince Charles Hospital,
Chermside, Australia
(Phan, Tian, Yan) The Collaborative Research (CORE) Group, Macquarie
University, Sydney, Australia
(Phan, Munkholm-larsen) Sydney Medical School, University of Sydney,
Sydney, Australia
(Munkholm-larsen) Department of Cardiology, Hvidovre University Hospital,
Copenhagen, Denmark
(La meir) Department of Cardiothoracic Surgery and Cardiology, Academic
Hospital Maastricht and Cardiovascular Research Institute Maastricht,
Maastricht, Netherlands
(La meir) University Hospital Brussels, Brussels, Belgium
(Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital,
University of Sydney, Sydney, Australia
Title
Surgical left atrial appendage occlusion during cardiac surgery for
patients with atrial fibrillation: A meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 47 (5) (pp 847-854), 2015.
Article Number: ezu291. Date of Publication: 19 Nov 2015.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Concomitant left atrial appendage occlusion (LAAO) during
surgical ablation has emerged as a potential treatment strategy to reduce
stroke and perioperative mortality in patients with atrial fibrillation
(AF). The present meta-analysis aims to assess current evidence on the
efficacy and safety between LAAO and LAA preservation cohorts for patients
undergoing cardiac surgery. METHODS: Electronic searches were performed
using six electronic databases from their inception to November 2013,
identifying all relevant comparative randomized and observational studies
comparing LAAO with non-LAAO in AF patients undergoing cardiac surgery.
Data were extracted and analysed according to predefined endpoints
including mortality, stroke, postoperative AF and reoperation for
bleeding. RESULTS: Seven relevant studies identified for qualitative and
quantitative analyses, including 3653 patients undergoing LAAO (n = 1716)
versus non-LAAO (n = 1937). Stroke incidence was significantly reduced in
the LAAO occlusion group at the 30-day follow-up [0.95 vs 1.9%; odds ratio
(OR) 0.46; P = 0.005] and the latest follow-up (1.4 vs 4.1%; OR 0.48; P =
0.01), compared with the non-LAAO group. Incidence of all-cause mortality
was significantly decreased with LAAO (1.9 vs 5%; OR 0.38; P = 0.0003),
while postoperative AF and reoperation for bleeding was comparable.
CONCLUSIONS: While acknowledging the limitations and inadequate
statistical power of the available evidence, this study suggests LAAO as a
promising strategy for stroke reduction perioperatively and at the
short-term follow-up without a significant increase in complications.
Larger randomized studies in the future are required, with clearer
surgical and anticoagulation protocols and adequate long-term follow-up,
to validate the clinical efficacy of LAAO versus non-LAAO
groups.<br/>Copyright &#xa9; The Author 2014. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<2>
Accession Number
604373209
Author
Zhang Y.; Ma L.
Institution
(Zhang, Ma) Department of Cardiothoracic Surgery, First Affiliated
Hospital of Zhejiang University, Hangzhou, China
Title
Effect of preoperative angiotensin-converting enzyme inhibitor on the
outcome of coronary artery bypass graft surgery.
Source
European Journal of Cardio-thoracic Surgery. 47 (5) (pp 788-795), 2015.
Article Number: ezu298. Date of Publication: 19 Nov 2015.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
The safety of the preoperative administration of angiotensin-converting
enzyme inhibitors (ACEIs) in patients undergoing coronary artery bypass
grafting (CABG) surgery is still uncertain. This systematic review thus
evaluated the effect of preoperative ACEIs on the clinical outcomes in
patients undergoing CABG surgery. We searched PubMed, the Cochrane Library
and the Web of Science for randomized control trials or observational
studies that compared the use of ACEIs with that of placebos before
isolated CABG. Thirteen studies (3 randomized control trials and 10
observational studies) that included 31 390 patients met the eligibility
criteria. Preoperative ACEI treatment increased the risk of hypotension
[risk ratio (RR) = 2.36, 95% confidence interval (CI) 1.11-5.02, P =
0.03], postoperative myocardial infarction (RR = 1.14, 95% CI 1.02-1.27, P
= 0.02) and postoperative renal dysfunction (RR = 1.26, 95% CI 1.00-1.60,
P = 0.05) in patients undergoing on-pump CABG, but had no significant
impact on the risk of postoperative atrial fibrillation (RR = 0.79, 95% CI
0.37-1.71, P = 0.56) or postoperative stroke (RR = 1.17, 95% CI 0.74-1.85,
P = 0.50), and did not influence the early mortality (RR = 1.21, 95% CI
0.95-1.54, P = 0.12) in patients undergoing on-pump CABG. Preoperative use
of ACEIs increased the risk of several postoperative complications in
patients undergoing CABG. Further randomized studies are needed to more
clearly elucidate the risks and benefits of ACEI therapy before
CABG.<br/>Copyright &#xa9; The Author 2014. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.

<3>
Accession Number
613979054
Author
Polites S.F.; Potter D.D.; Glasgow A.E.; Klinkner D.B.; Moir C.R.;
Ishitani M.B.; Habermann E.B.
Institution
(Polites, Potter, Klinkner, Moir, Ishitani) Division of Pediatric Surgery,
Mayo Clinic, Rochester, MN, United States
(Glasgow, Habermann) Robert D. and Patricia E. Kern Center for the Science
of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
Title
Rates and risk factors of unplanned 30-day readmission following general
and thoracic pediatric surgical procedures.
Source
Journal of Pediatric Surgery. 52 (8) (pp 1239-1244), 2017. Date of
Publication: August 2017.
Publisher
W.B. Saunders
Abstract
Background/Purpose Postoperative unplanned readmissions are costly and
decrease patient satisfaction; however, little is known about this
complication in pediatric surgery. The purpose of this study was to
determine rates and predictors of unplanned readmission in a
multi-institutional cohort of pediatric surgical patients. Methods
Unplanned 30-day readmissions following general and thoracic surgical
procedures in children < 18 were identified from the 2012-2014 National
Surgical Quality Improvement Program- Pediatric. Time-dependent rates of
readmission per 30 person-days were determined to account for varied
postoperative length of stay (pLOS). Patients were randomly divided into
70% derivation and 30% validation cohorts which were used for creation and
validation of a risk model for readmission. Results Readmission occurred
in 1948 (3.6%) of 54,870 children for a rate of 4.3% per 30 person-days.
Adjusted predictors of readmission included hepatobiliary procedures,
increased wound class, operative duration, complications, and pLOS. The
predictive model discriminated well in the derivation and validation
cohorts (AUROC 0.710 and 0.701) with good calibration between observed and
expected readmission events in both cohorts (p > .05). Conclusions
Unplanned readmission occurs less frequently in pediatric surgery than
what is described in adults, calling into question its use as a quality
indicator in this population. Factors that predict readmission including
type of procedure, complications, and pLOS can be used to identify at-risk
children and develop prevention strategies. Level of evidence
III.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<4>
Accession Number
614462584
Author
Tranbaugh R.F.; Schwann T.A.; Swistel D.G.; Dimitrova K.R.; Al-Shaar L.;
Hoffman D.M.; Geller C.M.; Engoren M.; Balaram S.K.; Puskas J.D.; Habib
R.H.
Institution
(Tranbaugh, Dimitrova, Hoffman, Geller, Puskas) Department of
Cardiovascular Surgery, Mount Sinai Beth Israel, New York, New York,
United States
(Schwann) Division of Cardiothoracic Surgery, University of Toledo Medical
Center, Toledo, Ohio, United States
(Swistel, Balaram) Division of Cardiothoracic Surgery, Mount Sinai St.
Luke's, New York, New York, United States
(Al-Shaar, Habib) Outcomes Research Unit and Vascular Medicine Program,
American University of Beirut Medical Center, Beirut, Lebanon
(Engoren) Division of Anesthesia, Mercy Saint Vincent Medical Center,
Toledo, Ohio, United States
Title
Coronary Artery Bypass Graft Surgery Using the Radial Artery, Right
Internal Thoracic Artery, or Saphenous Vein as the Second Conduit.
Source
Annals of Thoracic Surgery. 104 (2) (pp 553-559), 2017. Date of
Publication: August 2017.
Publisher
Elsevier USA
Abstract
Background It is not clear whether radial artery (RA), right internal
thoracic artery (RITA), or saphenous vein (SV) is the preferred second
bypass graft during coronary artery bypass graft surgery using the left
internal thoracic artery (LITA) in patients aged less or greater than 70
years. Methods Late survival data were collected for 13,324 consecutive,
isolated, primary coronary artery bypass graft surgery patients from three
hospitals. Cox regression analysis was performed on all patients grouped
by age. Results Adjusted Cox regression showed overall better RA versus SV
survival (hazard ratio [HR] 0.82, p < 0.001) and no difference in RITA
versus SV survival (HR 0.95, p = 0.35). However, the survival benefit of
RA versus SV was seen only in patients aged less than 70 years (HR 0.77, p
< 0.001); and RITA patients aged less than 70 years also had a survival
benefit compared with SV (HR 0.86, p = 0.03). There was no difference in
survival for RA versus RITA across all ages. Conclusions For patients aged
less than 70 years, the optimal grafting strategy is using either RA or
RITA as the second preferred graft. In patients aged 70 years or more, RA
and RITA grafting should be used selectively. Multiple arterial grafting
using either RA or RITA should be more widely utilized during coronary
artery bypass graft surgery for patients less than 70 years of
age.<br/>Copyright &#xa9; 2017 The Society of Thoracic Surgeons

<5>
Accession Number
614326645
Author
Marwali E.M.; Boom C.E.; Budiwardhana N.; Fakhri D.; Roebiono P.S.;
Santoso A.; Sastroasmoro S.; Slee A.; Portman M.A.
Institution
(Marwali, Boom, Budiwardhana) Pediatric Cardiac Intensive Care and
Anesthesiology Division, National Cardiovascular Center Harapan Kita,
Jakarta, Indonesia
(Fakhri) Pediatric Cardiac Surgery Division, National Cardiovascular
Center Harapan Kita, Jakarta, Indonesia
(Roebiono, Santoso) Pediatric Cardiology and Congenital Heart Disease
Division, National Cardiovascular Center Harapan Kita and Department of
Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Indonesia, Jakarta, Indonesia
(Sastroasmoro) Center for Clinical Epidemiology and Evidence Based
Medicine, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas
Indonesia, Jakarta, Indonesia
(Slee) Axio Research, Seattle, Washington, United States
(Portman) Seattle Children's Hospital and Research Institute, University
of Washington, Seattle, Washington, United States
Title
Oral Triiodothyronine for Infants and Children Undergoing Cardiopulmonary
Bypass.
Source
Annals of Thoracic Surgery. 104 (2) (pp 688-695), 2017. Date of
Publication: August 2017.
Publisher
Elsevier USA
Abstract
Background This study evaluated the efficacy and safety of oral
triiodothyronine (T3; Tetronine, Dalim BioTech, Korea) for infants and
children undergoing cardiopulmonary bypass in an Indonesian population.
Methods We performed a single-center, randomized, double-blind, and
placebo-controlled trial in children aged 3 years and younger undergoing
congenital heart disease operations with cardiopulmonary bypass. We
administered oral T3 (1 mug/kg per body weight/dose) or placebo (saccharum
lactis) by nasogastric tube every 6 hours for 60 hours after induction of
anesthesia. The primary end point, time to extubation, was compared with
Cox regression. Results The modified intention-to-treat group included 101
placebo and 104 treated patients. The stratified log-rank test did not
show a significant treatment difference (p = 0.061) for time to
extubation, but after adjustment for age, the nutritional Z score, and
Aristotle surgical complexity, the hazard ratio was 1.33 (95% confidence
interval, 1.00 to 1.76; p = 0.049). The effect of T3 was stronger in the
strata aged 5 months and younger (hazard ratio, 1.86; 95% confidence
interval 1.02 to 3.39; p = 0.043). Median intubation time was 47.3 hours
for the placebo and 32.1 hours for the T3 group in aged 5 months and
younger. Adverse events rates, including arrhythmia, were similar between
groups, although sepsis was more frequent with placebo. Conclusions Oral
T3 supplementation may shorten time to extubation in children undergoing
congenital heart disease operations, particularly infants aged 5 months or
younger. Administration is relatively safe, simple and
inexpensive.<br/>Copyright &#xa9; 2017 The Society of Thoracic Surgeons

<6>
Accession Number
616973893
Author
Chava S.; Gentchos G.; Abernethy A.; Leavitt B.; Terrien E.; Dauerman H.L.
Institution
(Chava, Gentchos, Abernethy, Leavitt, Terrien, Dauerman) University of
Vermont Larner College of Medicine, Burlington, VT, United States
(Dauerman) Division of Cardiology, University of Vermont Medical Center,
111 Colchester Avenue, McClure 1, Burlington, VT 05401, United States
Title
Routine CT angiography to detect severe coronary artery disease prior to
transcatheter aortic valve replacement.
Source
Journal of Thrombosis and Thrombolysis. 44 (2) (pp 154-160), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Patients undergoing TAVR undergo routine CT angiography (CTA) to assess
aorto-iliac pathology and annular dimensions. While coronary CTA may
exclude severe CAD in younger patients, its efficacy in defining CAD
severity prior to TAVR may be limited. We retrospectively studied 50
consecutive patients undergoing both invasive coronary angiography (ICA)
and routine pre-TAVR CTA. Severe CAD was defined as >=50% stenosis by
quantitative coronary angiography and compared to a blinded CTA visual
estimation of >=50% stenosis. The analysis was confined to four segments:
left main and three proximal to mid major coronaries to maximize
myocardial territory at risk. Coronary assessment was performed using
standard reconstructed ECG phases from pre-TAVR chest CTA on a Philips 256
iCT scanner. Nearly 3/4 of patients were >=75 years old, 57% were female,
half were diabetic and 45% had prior PCI. By ICA, 49% had significant
coronary calcification. The incidence of severe proximal to mid vessel CAD
by ICA was 39%. Similarly, a third of patients required PCI prior to TAVR.
CTA was unable to exclude severe proximal to mid vessel CAD in 88% of
patients in all four segments: non-diagnostic CTA readings were mainly due
to calcification (60%) or motion artifact (28%). Non-diagnostic coronary
CTA readings ranged from 25 to 72% according to segment analyzed: only the
left main segment had diagnostic quality CTA in the majority of patients
(p < 0.01). PCI is performed frequently prior to TAVR based upon invasive
coronary angiographic assessment. Routine chest CTA algorithms do not
provide adequate diagnostic information to exclude severe CAD, primarily
due to severe coronary calcification in the TAVR population.<br/>Copyright
&#xa9; 2017, Springer Science+Business Media, LLC.

<7>
Accession Number
614490443
Author
Moledina D.G.; Isguven S.; McArthur E.; Thiessen-Philbrook H.; Garg A.X.;
Shlipak M.; Whitlock R.; Kavsak P.A.; Coca S.G.; Parikh C.R.
Institution
(Moledina, Isguven, Thiessen-Philbrook, Parikh) Program of Applied
Translational Research, Department of Medicine, Yale School of Medicine,
New Haven, Connecticut, United States
(McArthur) Institute for Clinical Evaluative Sciences Western, London,
Ontario, Canada
(Garg) Division of Nephrology, Department of Medicine, Department of
Epidemiology and Biostatistics, University of Western Ontario, London,
Ontario, Canada
(Shlipak) Kidney Health Research Collaborative, San Francisco Veterans
Affairs Medical Center, University of California, San Francisco, San
Francisco, California, United States
(Whitlock) Division of Cardiac Surgery, Population Health Research
Institute, McMaster University, Hamilton, Ontario, Canada
(Kavsak) Department of Pathology and Molecular Medicine, McMaster
University, Hamilton, Ontario, Canada
(Coca) Department of Internal Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, United States
(Parikh) Department of Internal Medicine, Veterans Affairs Medical Center,
West Haven, Connecticut, United States
Title
Plasma Monocyte Chemotactic Protein-1 Is Associated With Acute Kidney
Injury and Death After Cardiac Operations.
Source
Annals of Thoracic Surgery. 104 (2) (pp 613-620), 2017. Date of
Publication: August 2017.
Publisher
Elsevier USA
Abstract
Background Monocyte chemotactic protein-1 (MCP-1; chemokine C-C ligand-2
[CCL-2]) is upregulated in ischemia-reperfusion injury and is a promising
biomarker of inflammation in cardiac operations. Methods We measured
preoperative and postoperative plasma MCP-1 levels in adults undergoing
cardiac operations to evaluate the association of perioperative MCP-1
levels with acute kidney injury (AKI) and death in Translational Research
Investigating Biomarker Endpoints in AKI (TRIBE-AKI), a prospective,
multicenter, observational cohort. Results Of the 972 participants in the
study, AKI developed in 329 (34%), and severe AKI developed in 45 (5%).
During a median follow-up of 2.9 years (interquartile range, 2.2 to 3.5
years), 119 participants (12%) died. MCP-1 levels were significantly
higher in those who developed AKI and died than in those without AKI and
death. Participants with a preoperative MCP-1 level in the highest tertile
(>196 pg/mL) had an increased AKI risk than those in the lowest tertile
(<147 pg/mL; odds ratio [OR], 1.43l; 95% confidence interval [CI], 1.00 to
2.05). The association appeared similar but was not significant for the
severe AKI outcome (OR, 1.48; 95% CI, 0.62 to 3.54). Compared with
participants with preoperative MCP-1 level in the lowest tertile, those in
the highest tertile had higher adjusted risk of death (hazard ratio, 1.82;
95% CI, 1.40 to 2.38). Similarly, participants in the highest tertile had
a higher adjusted risk of death (hazard ratio, 1.95; 95% CI, 1.09-3.49)
than those with a postoperative MCP-1 level in the lowest tertile.
Conclusions Higher plasma MCP-1 is associated with increased AKI and risk
of death after cardiac operations. MCP-1 could be used as a biomarker to
identify high-risk patients for potential AKI prevention strategies in the
setting of cardiac operations.<br/>Copyright &#xa9; 2017 The Society of
Thoracic Surgeons

<8>
Accession Number
614485541
Author
Chang Y.-S.; Wang J.-X.; Chang D.-W.
Institution
(Chang) Department of Cardiovascular Surgery, The First Affiliated
Hospital of Xi'an Jiaotong University, Xi'an, China
(Wang) Department of Surgery, The First Affiliated Hospital of Zhengzhou
University, Zhengzhou, China
(Chang) Faculty of Mathematics and Information Science, Shaanxi Normal
University, Xi'an, China
Title
Outcomes of Coronary Artery Bypass and Stents for Unprotected Left Main
Coronary Stenosis.
Source
Annals of Thoracic Surgery. 104 (2) (pp 630-637), 2017. Date of
Publication: August 2017.
Publisher
Elsevier USA
Abstract
Background This study assessed the short-, medium-, and long-term outcomes
of coronary artery bypass grafting vs stenting for patients with
unprotected left main coronary artery disease through a meta-analysis of
randomized controlled trials. Methods PubMed, Embase, Scopus, Web of
Science, Cochrane Library, and major conference proceedings databases were
systematically searched for randomized controlled trials of coronary
artery bypass grafting compared with stents in unprotected left main
coronary artery disease. End points assessed were all-cause death,
myocardial infarction, major adverse cardiac and cerebrovascular events,
target vessel revascularization, and cerebral stroke. A meta-analysis was
conducted according to predefined clinical end points. Results All-cause
death and stroke were similar between stenting and coronary artery bypass
grafting at 1 year and at follow-up beyond 1 year. The incidence of
myocardial infarction was similar between stenting and coronary artery
bypass grafting at each separate time point. The incidence of repeat
revascularization was similar between the two groups at 30 days but was
higher for stenting at 1 year and beyond. There was a trend toward fewer
major adverse cardiac and cerebrovascular events after stenting compared
with coronary artery bypass grafting at 30 days, but this difference was
no longer significant at 1 year and reversed at follow-up beyond 1 year.
Conclusions The early advantages of stenting over coronary artery bypass
grafting have been shown to progressively shift to coronary artery bypass
grafting over time. Further larger sample randomized controlled trials are
warranted to confirm the results.<br/>Copyright &#xa9; 2017 The Society of
Thoracic Surgeons

<9>
[Use Link to view the full text]
Accession Number
616784831
Author
Elmi-Sarabi M.; Deschamps A.; Delisle S.; Ased H.; Haddad F.; Lamarche Y.;
Perrault L.P.; Lambert J.; Turgeon A.F.; Denault A.Y.
Institution
(Elmi-Sarabi, Deschamps, Ased, Denault) Department of Anesthesiology,
Montreal Heart Institute, Universite de Montreal, 5000 Belanger St,
Montreal, QC H1T 1C8, Canada
(Delisle) Intensive Care Unit, Hopital Sacre-Coeur de Montreal, Montreal,
QC, Canada
(Haddad) Stanford School of Medicine, Stanford, CA, United States
(Lamarche, Perrault) Department of Cardiac Surgery, Montreal Heart
Institute, Universite de Montreal, Montreal, QC, Canada
(Lambert) Department of Preventive and Social Medicine, Universite de
Montreal, Montreal, QC, Canada
(Turgeon) Department of Anesthesiology and Critical Care Medicine,
Division of Critical Care Medicine, Universite Laval, Quebec City, QC,
Canada
(Turgeon) CHU de Quebec-Universite Laval Research Centre, Population
Health and Optimal Health Research Unit, Quebec City, QC, Canada
(Denault) Division of Critical Care, Centre Hospitalier de l'Universite de
Montreal, Montreal, QC, Canada
Title
Aerosolized Vasodilators for the Treatment of Pulmonary Hypertension in
Cardiac Surgical Patients: A Systematic Review and Meta-analysis.
Source
Anesthesia and Analgesia. 125 (2) (pp 393-402), 2017. Date of Publication:
01 Aug 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: In cardiac surgery, pulmonary hypertension is an important
prognostic factor for which several treatments have been suggested over
time. In this systematic review and meta-analysis, we compared the
efficacy of inhaled aerosolized vasodilators to intravenously administered
agents and to placebo in the treatment of pulmonary hypertension during
cardiac surgery. We searched MEDLINE, CENTRAL, EMBASE, Web of Science, and
clinicaltrials.gov databases from inception to October 2015. The incidence
of mortality was assessed as the primary outcome. Secondary outcomes
included length of stay in hospital and in the intensive care unit, and
evaluation of the hemodynamic profile. METHODS: Of the 2897 citations
identified, 10 studies were included comprising a total of 434 patients.
RESULTS: Inhaled aerosolized agents were associated with a significant
decrease in pulmonary vascular resistance (-41.36 dyne.s/cm 5, P=.03) and
a significant increase in mean arterial pressure (8.24 mm Hg, P=.02) and
right ventricular ejection fraction (7.29%, P<.0001) when compared to
intravenously administered agents. No significant hemodynamically
meaningful differences were observed between inhaled agents and placebo;
however, an increase in length of stay in the intensive care unit was
shown with the use of inhaled aerosolized agents (0.66 days, P=.01). No
other differences were observed for either comparison. CONCLUSIONS: The
administration of inhaled aerosolized vasodilators for the treatment of
pulmonary hypertension during cardiac surgery is associated with improved
right ventricular performance when compared to intravenously administered
agents. This review does not support any benefit compared to placebo on
major outcomes. Further investigation is warranted in this area of
research and should focus on clinically significant outcomes.<br/>&#xa9;
Copyright 2017 International Anesthesia Research Society.

<10>
Accession Number
617242698
Author
Afilalo J.; Lauck S.; Kim D.H.; Lefevre T.; Piazza N.; Lachapelle K.;
Martucci G.; Lamy A.; Labinaz M.; Peterson M.D.; Arora R.C.; Noiseux N.;
Rassi A.; Palacios I.F.; Genereux P.; Lindman B.R.; Asgar A.W.; Kim C.A.;
Trnkus A.; Morais J.A.; Langlois Y.; Rudski L.G.; Morin J.-F.; Popma J.J.;
Webb J.G.; Perrault L.P.
Institution
(Afilalo, Rudski) Division of Cardiology, Jewish General Hospital, McGill
University, Montreal, Quebec, Canada
(Afilalo, Trnkus) Centre for Clinical Epidemiology, Jewish General
Hospital, Lady Davis Institute for Medical Research, Montreal, Quebec,
Canada
(Lauck, Webb) Centre for Heart Valve Innovation, St. Paul's Hospital,
University of Vancouver, Vancouver, British Columbia, Canada
(Kim, Kim) Division of Gerontology, Beth Israel Deaconess Medical Center,
Harvard University, Boston, Massachusetts, United States
(Lefevre) Division of Cardiology, Institut Cardiovasculaire Paris Sud,
Hopital Prive Jacques Cartier, Massy, France
(Piazza, Martucci) Division of Cardiology, McGill University Health
Centre, Montreal, Quebec, Canada
(Lachapelle) Division of Cardiac Surgery, McGill University Health Centre,
Montreal, Quebec, Canada
(Lamy) Division of Cardiac Surgery, Hamilton Health Sciences, Population
Health Research Institute, McMaster University, Hamilton, Ontario, Canada
(Labinaz) Division of Cardiology, University of Ottawa Heart Institute,
Ottawa, Ontario, Canada
(Peterson) Division of Cardiac Surgery, St. Michael's Hospital, University
of Toronto, Toronto, Ontario, Canada
(Arora) Division of Cardiac Surgery, St. Boniface Hospital, University of
Manitoba, Winnipeg, Manitoba, Canada
(Noiseux) Division of Cardiac Surgery, Centre Hospitalier de l'Universite
de Montreal, Centre de Recherche du CHUM, Montreal, Quebec, Canada
(Rassi, Palacios) Division of Cardiology, Massachusetts General Hospital,
Harvard University, Boston, Massachusetts, United States
(Genereux) Division of Cardiology, Hopital du Sacre-Coeur, Universite de
Montreal, Montreal, Quebec, Canada
(Lindman) Division of Cardiology, Washington University School of
Medicine, St. Louis, Missouri, United States
(Asgar) Division of Cardiology, Institut de Cardiologie de Montreal,
Universite de Montreal, Montreal, Quebec, Canada
(Morais) Division of Geriatric Medicine, McGill University Health Centre,
Montreal, Quebec, Canada
(Langlois, Morin) Division of Cardiac Surgery, Jewish General Hospital,
McGill University, Montreal, Quebec, Canada
(Popma) Division of Cardiology, Beth Israel Deaconess Medical Center,
Harvard University, Boston, Massachusetts, United States
(Perrault) Division of Cardiac Surgery, Institut de Cardiologie de
Montreal, Universite de Montreal, Montreal, Quebec, Canada
Title
Frailty in Older Adults Undergoing Aortic Valve Replacement: The
FRAILTY-AVR Study.
Source
Journal of the American College of Cardiology. 70 (6) (pp 689-700), 2017.
Date of Publication: 8 August 2017.
Publisher
Elsevier USA
Abstract
Background Frailty is a geriatric syndrome that diminishes the potential
for functional recovery after a transcatheter aortic valve replacement
(TAVR) or surgical aortic valve replacement (SAVR) procedure; however, its
integration in clinical practice has been limited by a lack of consensus
on how to measure it. Objectives This study sought to compare the
incremental predictive value of 7 different frailty scales to predict poor
outcomes following TAVR or SAVR. Methods A prospective cohort of older
adults undergoing TAVR or SAVR was assembled at 14 centers in 3 countries
from 2012 to 2016. The following frailty scales were compared: Fried,
Fried+, Rockwood, Short Physical Performance Battery, Bern, Columbia, and
the Essential Frailty Toolset (EFT). Outcomes of interest were all-cause
mortality and disability 1 year after the procedure. Results The cohort
was composed of 1,020 patients with a median age of 82 years. Depending on
the scale used, the prevalence of frailty ranged from 26% to 68%. Frailty
as measured by the EFT was the strongest predictor of death at 1 year
(adjusted odds ratio [OR]: 3.72; 95% confidence interval [CI]: 2.54 to
5.45) with a C-statistic improvement of 0.071 (p < 0.001) and integrated
discrimination improvement of 0.067 (p < 0.001). Moreover, the EFT was the
strongest predictor of worsening disability at 1 year (adjusted OR: 2.13;
95% CI: 1.57 to 2.87) and death at 30 days (adjusted OR: 3.29; 95% CI:
1.73 to 6.26). Conclusions Frailty is a risk factor for death and
disability following TAVR and SAVR. A brief 4-item scale encompassing
lower-extremity weakness, cognitive impairment, anemia, and
hypoalbuminemia outperformed other frailty scales and is recommended for
use in this setting. (Frailty Assessment Before Cardiac Surgery &
Transcatheter Interventions; NCT01845207)<br/>Copyright &#xa9; 2017
American College of Cardiology Foundation

<11>
Accession Number
617376205
Author
Buccheri D.; Zambelli G.; Alfonso F.; Cortese B.
Title
Pulse on Spontaneous Coronary Artery Dissections: Experience-Based Survey.
Source
JACC: Cardiovascular Interventions. 10 (14) (pp 1469-1471), 2017. Date of
Publication: 24 Jul 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)

<12>
Accession Number
617376161
Author
Piccolo R.; Pilgrim T.; Franzone A.; Valgimigli M.; Haynes A.; Asami M.;
Lanz J.; Raber L.; Praz F.; Langhammer B.; Roost E.; Windecker S.;
Stortecky S.
Institution
(Piccolo, Pilgrim, Franzone, Valgimigli, Asami, Lanz, Raber, Praz,
Windecker, Stortecky) Department of Cardiology, Swiss Cardiovascular
Center Bern, Bern University Hospital, Bern, Switzerland
(Haynes) Institute of Social and Preventive Medicine and Clinical Trials
Unit, University of Bern, Bern, Switzerland
(Langhammer, Roost) Department of Cardiovascular Surgery, Swiss
Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland
Title
Frequency, Timing, and Impact of Access-Site and Non-Access-Site Bleeding
on Mortality Among Patients Undergoing Transcatheter Aortic Valve
Replacement.
Source
JACC: Cardiovascular Interventions. 10 (14) (pp 1436-1446), 2017. Date of
Publication: 24 Jul 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to examine the frequency, timing, and
association of access-site and non-access-site bleeding with mortality in
the setting of transcatheter aortic valve replacement (TAVR) during
long-term follow-up. Background Bleeding is frequent and associated with
impaired prognosis in patients undergoing TAVR. It is currently unknown
whether the site of bleeding differentially influences the outcomes of
TAVR patients. Methods In total, 926 consecutive patients undergoing TAVR
from 2007 through 2014 were evaluated. Bleeding was assessed according to
the Valve Academic Research Consortium 2 criteria. The primary outcome of
interest was all-cause mortality up to 5 years of follow-up. Results A
total of 285 patients (30.7%) experienced at least 1 (minor, major, or
life-threatening) bleeding event up to 5 years. Compared with patients not
experiencing bleeding, the adjusted risk for all-cause mortality was
significantly increased among patients with access-site (hazard ratio:
1.34; 95% confidence interval: 1.01 to 1.76; p = 0.04) and non-access-site
bleeding (hazard ratio: 2.08; 95% confidence interval: 1.60 to 2.71; p <
0.001). However, non-access-site bleeding conferred a significantly higher
risk for mortality compared with access-site bleeding (hazard ratio: 1.56;
95% confidence interval: 1.12 to 2.18; p = 0.009). At multivariate
analysis, female sex was a significant correlate of access-site bleeding,
whereas chronic kidney disease and the Society of Thoracic Surgeons score
were significantly associated with non-access-site bleeding. Conclusions
Among patients with severe aortic stenosis undergoing TAVR, access-site
and non-access-site bleeding were independently associated with an
increased risk for mortality, with the greatest risk related to
non-access-site bleeding during long-term follow-up.<br/>Copyright &#xa9;
2017

<13>
Accession Number
617472324
Author
Elgendy H.; Helmy H.A.R.
Institution
(Elgendy) HAMAD Medical Corporation, Doha, Qatar
(Elgendy) Anesthesia Dept., Assiut University Hospitals, Egypt
(Helmy) Cardiology Dept., Assiut University Hospitals, Egypt
Title
Intrathecal morphine improves hemodynamic parameters and analgesia in
patients undergoing aortic valve replacement surgery: A prospective,
double-blind, randomized trial.
Source
Pain Physician. 20 (5) (pp 405-412), 2017. Date of Publication: 2017.
Publisher
American Society of Interventional Pain Physicians (E-mail:
editor@painphysicianjournal.com)
Abstract
Background: Intrathecal morphine (ITM) has been used in hopes of providing
good postoperative analgesia in cardiac surgery. Little is known about its
use in isolated aortic valve replacement surgery. Objectives: To evaluate
the effects of 7 mu/kg ITM administration in aortic valve replacement in
regards to hemodynamics, pain score, and postoperative complications when
compared to general anesthesia alone. Study Design: A randomized,
double-blind trial. Setting: Academic medical center. Methods: Forty-four
patients, who underwent aortic valve replacement, were randomly assigned
to receive ITM, before the induction of general anesthesia (ITM group, n =
22) or no intrathecal injection i.e., general anesthesia alone (control
group, n = 22). Induction of anesthesia was done with fentanyl, propofol,
and isoflurane. Pain scores, determined by visual analog scale (VAS), were
recorded immediately after extubation, at the first, sixth, twelfth,
eighteenth, and twenty-fourth hour after extubation. Hemodynamics, heart
rate, mean arterial pressure, central venous pressure, pulmonary capillary
wedge pressure, and cardiac index were recorded intra-operatively and up
to 24 hours post-operatively. Results: VAS scores were lower in the ITM
group at each measured time than control group (P < 0.01). The cumulative
fentanyl consumption during the first 24 hours after extubation was
significantly reduced by 35% in the ITM group (951 micro&#32;g/first 24
hours) as compared to the control group (1463.6 micro&#32;g/first 24
hours), (P < 0.001). The mean time to first request for rescue analgesia
was significantly prolonged in the ITM group (20.11 +/- 4.24 hours, P <
0.001) compared with the control group (0.60 +/- 0.44 hours). The mean
tramadol consumption dose was significantly reduced in the ITM group
(279.33 +/- 61.35 mg), compared with the control group (895 +/- 106.42
mg), (P < 0.001). Hemodynamic parameters exhibited a significant decrease
in HR and MAP in the ITM group, but no significant difference was found in
regards to CVP, PCWP, and CI. Glyceryl trinitrate consumption in the first
24 hours was significantly reduced by 43% in the ITM group (28.3 mg/first
24 hours) when compared to the control group (145.5 mg/first 24 hours), (P
< 0.001). Extubation time (4.5 +/- 7.5 vs. 5.3 +/- 1.0 hours, P < 0.05)
and intensive care unit length of stay (3.7 +/- 1.0 vs. 5.6 +/- 1.6 days,
P < 0.01) were shorter in the ITM group. Limitations: Small sample size.
Conclusions: In valvular heart disease patients undergoing aortic
replacement surgery, ITM is a good adjunct to general anesthesia as a safe
and effective analgesic alternative. It provides better hemodynamic
control, earlier tracheal extubation, and shorter ICU stay.<br/>Copyright
&#xa9; 2017, American Society of Interventional Pain Physicians. All
rights reserved.

<14>
Accession Number
617472639
Author
Abdel-Salam Z.; Nammas W.
Institution
(Abdel-Salam, Nammas) Department of Cardiology, Faculty of Medicine, Ain
Shams University, Cairo, Egypt
Title
Incidence and predictors of atrial fibrillation after coronary artery
bypass surgery: Detection by event loop recorder monitoring from a
contemporary multicentre cohort.
Source
Acta Cardiologica. 72 (3) (pp 311-317), 2017. Date of Publication: 2017.
Publisher
Taylor and Francis Ltd. (E-mail: michael.wagreich@univie.ac.at)
Abstract
Background Atrial fibrillation (AF) is a frequent complication after
cardiac surgery. We explored the incidence and predictors of
post-operative AF at 30-day follow-up in an unselected multi-centre cohort
of patients undergoing elective coronary artery bypass grafting (CABG) in
contemporary practice. Methods and results We enrolled 740 consecutive
patients scheduled for elective CABG with or without valve surgery.
Cardiac rhythm was continuously monitored for 15 days after surgery by an
ambulatory event loop recorder. Clinical follow-up for the occurrence of
arrhythmias was performed for the next 15 days by office visits. The
primary end point was the incidence of AF at 30-day follow-up. Mean age
was 56.5 +/- 8.9 years; 69.5% were males; 80% had diabetes. All patients
completed 30-day follow-up. At the end of 30 days, AF occurred in 77
patients (10.4%). Most episodes (47 out of 77 episodes, 61%) of AF
occurred during post-operative day 2. Episodes of AF were very rare after
the first 5 post-operative days (3 out of 77 episodes, 3.9%).
Multi-variable regression analysis identified the following independent
predictors of AF at 30-day follow-up: the lack of beta blocker use (hazard
ratio 0.37, 95% confidence interval 0.21-0.64, P < 0.001), and the
preoperative left atrial volume index (hazard Ratio 2.21, 95% confidence
interval 1.79-2.74, P < 0.001). Conclusions In patients undergoing
elective CABG, the incidence of post-operative AF at 30-day follow-up is
rather low; the lack of beta blocker use in the perioperative period, and
the preoperative left atrial volume index independently predicted the
occurrence of AF at 30 days.<br/>Copyright &#xa9; 2017 Belgian Society of
Cardiology

<15>
Accession Number
617475673
Author
Barnwal N.K.; Umbarkar S.R.; Sarkar M.; Dias R.
Institution
(Barnwal, Umbarkar, Sarkar) Department of Cardiac Anesthesiology, Seth GS
Medical College and KEM Hospital, 2/7, Stone Building, B. J. Marg,
Byculla, Mumbai, Maharashtra 400 011, India
(Dias) Department of Pediatric Anesthesiology, Seth GS Medical College and
KEM Hospital, Mumbai, Maharashtra, India
Title
Randomized comparative study of intravenous infusion of three different
fixed doses of milrinone in pediatric patients with pulmonary hypertension
undergoing open heart surgery.
Source
Annals of Cardiac Anaesthesia. 20 (3) (pp 318-322), 2017. Date of
Publication: July-September 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: Pulmonary hypertension secondary to congenital heart disease
is a common problem in pediatric patients presenting for open heart
surgery. Milrinone has been shown to reduce pulmonary vascular resistance
and pulmonary artery pressure in pediatric patients and neonates
postcardiac surgery. We aimed to evaluate the postoperative outcome in
such patients with three different fixed maintenance doses of milrinone.
Methodology: Patients were randomized into three groups. All patients
received fixed bolus dose of milrinone 50 mug/kg on pump during rewarming.
Following this, patients in low-dose group received infusion of milrinone
at the rate of 0.375 mug/kg/min, medium-dose group received 0.5
mug/kg/min, and high-dose group received 0.75 mug/kg/min over 24 h. Heart
rate, mean arterial pressure (MAP), mean airway pressure (MaP),
oxygenation index (OI), and central venous pressure (CVP) were compared at
baseline and 24 h postoperatively. Dose of inotropic requirement, duration
of ventilatory support and Intensive Care Unit (ICU) stay were noted.
Results: MAP, MaP, OI, and CVP were comparable in all three groups
postoperatively. All patients in the low-dose group required low inotropic
support while 70% of patients in the high-dose group needed high inotropic
support to manage episodes of hypotension (P = 0.000). Duration of
ventilatory support and ICU stay in all three groups was comparable (P =
0.412, P = 0.165). Conclusion: Low-dose infusions while having a clinical
impact were more beneficial in avoiding adverse events and decreasing
inotropic requirement without affecting duration of ventilatory support
and duration of ICU stay.<br/>Copyright &#xa9; 2017 Annals of Cardiac
Anaesthesia Published by Wolters Kluwer - Medknow.

<16>
Accession Number
617475660
Author
Soroush A.; Komasi S.; Saeidi M.; Heydarpour B.; Carrozzino D.; Fulcheri
M.; Marchettini P.; Rabboni M.; Compare A.
Institution
(Soroush, Komasi, Saeidi, Heydarpour) Cardiac Rehabilitation Center, Imam
Ali Hospital, Kermanshah University of Medical Sciences, Iran, Islamic
Republic of
(Soroush) Lifestyle Modification Research Center, Imam Reza Hospital,
Kermanshah University of Medical Sciences, Iran, Islamic Republic of
(Komasi) Clinical Research Development Center, Imam Reza Hospital,
Kermanshah University of Medical Sciences, Kermanshah, Iran, Islamic
Republic of
(Carrozzino, Fulcheri) Department of Psychological, Health and Territorial
Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
(Marchettini) Department of Neurology, San Raffaele Hospital Milano and
Pain Center, Centro Diagnostico Italiano, Milano, Italy
(Rabboni) Department of Psychiatry, Papa Giovanni XXIII Hospital, Bergamo,
Italy
(Compare) Department of Human and Social Sciences, University of Bergamo,
Bergamo, Italy
Title
Coronary artery bypass graft patients' perception about the risk factors
of illness: Educational necessities of second prevention.
Source
Annals of Cardiac Anaesthesia. 20 (3) (pp 303-308), 2017. Date of
Publication: July-September 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: Patients' beliefs about the cause of cardiac disease
(perceived risk factors) as part of the global psychological presentation
are influenced by patients' health knowledge. Hence, the present study
aimed to assess the relationship between actual and perceived risk
factors, identification of underestimated risk factors, and indication of
underestimation of every risk factor. Materials and Methods: In this
cross-sectional study, data of 313 coronary artery bypass graft (CABG)
patients admitted to one hospital in the west of Iran were collected
through a demographic interview, actual risk factors' checklist, open
single item of perceived risk factors, and a life stressful events scale.
Data were analyzed by means of Spearman's correlation coefficients and
one-sample Z-test for proportions. Results: Although there are significant
relations between actual and perceived risk factors related to
hypertension, family history, diabetes, smoking, and substance abuse (P <
0.05), there is no relation between the actual and perceived risk factors,
and patients underestimate the role of actual risk factors in disease (P <
0.001). The patients underestimated the role of aging (98.8%), substance
abuse (95.2%), overweight and obesity (94.9%), hyperlipidemia (93.1%),
family history (90.3%), and hypertension (90%) more than diabetes (86.1%),
smoking (72.5%), and stress (54.7%). Conclusion: Cardiac patients seem to
underestimate the role of aging, substance abuse, obesity and overweight,
hyperlipidemia, family history, and hypertension more than other actual
risk factors. Therefore, these factors should be highlighted to patients
to help them to (i) increase the awareness of actual risk factors and (ii)
promote an appropriate lifestyle after CABG surgery.<br/>Copyright &#xa9;
2017 Annals of Cardiac Anaesthesia Published by Wolters Kluwer - Medknow.

<17>
Accession Number
617475655
Author
Kanchi M.; Manjunath R.; Massen J.; Vincent L.; Belani K.
Institution
(Kanchi) Department of Anesthesia and Intensive Care, Narayana Hrudayalaya
Hospital, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bengaluru,
Karnataka, India
(Manjunath) Department of Anesthesia, Narayana Hrudayalaya Hospital,
Bengaluru, Karnataka, India
(Massen) Department of Cardiothoracic Surgery, Maastricht University
Medical Center, Maastricht, Netherlands
(Vincent) Department of Nephrology, Narayana Hrudayalaya Hospital,
Bengaluru, Karnataka, India
(Belani) Department of Anesthesiology, Medicine and Pediatrics, University
of Minnesota, Minneapolis, MN, United States
Title
Neutrophil gelatinase-associated lipocalin as a biomarker for predicting
acute kidney injury during off-pump coronary artery bypass grafting.
Source
Annals of Cardiac Anaesthesia. 20 (3) (pp 297-302), 2017. Date of
Publication: July-September 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: Acute kidney injury (AKI) following cardiac surgery is a major
complication resulting in increased morbidity, mortality, and economic
burden. In this study, we assessed the usefulness of estimating serum
neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker in
predicting AKI in patients with stable chronic kidney disease (CKD) and
undergoing off-pump coronary artery bypass grafting (OP-CABG). Patients
and Methods: We prospectively studied sixty nondialysis-dependent CKD
patients with estimated glomerular filtration rate <60 ml/min/1.73
m² who required elective OP-CABG. Patients were randomized into
two groups, Group D received dopamine infusion at 2 mug/kg/min following
anesthesia induction till the end of the surgery and Group P did not
receive any intervention. Serum creatinine, NGAL, brain natriuretic
peptide, and troponin-I were estimated at specified intervals before,
during, and after surgery. The results of the study patients were also
compared to a simultaneous matched cohort control of thirty patients
(Group A) without renal dysfunction who underwent OP-CABG. Results: No
patient required renal replacement therapy, and no mortality was observed
during perioperative and hospitalization period. Six patients from control
group (n = 30), ten patients from placebo group (n = 30), and 12 patients
from dopamine group (n = 30) developed stage 1 AKI. However, we did not
observe any stage 2 and stage 3 AKI among all the groups. There was a
significant increase in serum NGAL levels at the end of surgery and 24 h
postoperatively in placebo and dopamine groups as compared to the control.
Conclusion: The measurement of NGAL appears to predict the occurrence of
AKI after OP-CAB surgery. However, large multicentric studies may be
required to confirm the findings of this study.<br/>Copyright &#xa9; 2017
Annals of Cardiac Anaesthesia Published by Wolters Kluwer - Medknow.

<18>
Accession Number
613411266
Author
Bainey K.R.; Welsh R.C.; Toklu B.; Bangalore S.
Institution
(Bainey, Welsh) Mazankowski Alberta Heart Institute, University of
Alberta, Edmonton, Alberta, Canada
(Toklu, Bangalore) Division of Cardiology, New York University School of
Medicine, New York, New York, United States
Title
Complete vs Culprit-Only Percutaneous Coronary Intervention in STEMI With
Multivessel Disease: A Meta-analysis and Trial Sequential Analysis of
Randomized Trials.
Source
Canadian Journal of Cardiology. 32 (12) (pp 1542-1551), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Pulsus Group Inc.
Abstract
Background Patients with ST-elevation myocardial infarction (STEMI) and
multivessel disease (MVD) most commonly are treated with culprit-only
percutaneous coronary intervention (PCI). However, this has been recently
challenged, suggesting benefit with complete revascularization (CR).
Still, these latest findings are largely based on clinical trials powered
for composite outcomes that frequently include "softer" end points. We
performed a meta-analysis comparing routine culprit-only PCI vs CR in
STEMI, with an emphasis on "hard" clinical end points. Methods MEDLINE,
EMBASE, ISI Web of Science, and CENTRAL were searched from 1996-May 2015.
Studies included patients with STEMI and MVD who received primary PCI. The
primary end point was long-term death/myocardial infarction (MI). Data
were combined using a fixed-effects model. Results Seven randomized trials
(2004 patients: 1065 CR and 939 culprit-only PCI procedures) were
included. Compared with culprit-only PCI, CR reduced the composite of
death/MI (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.52-0.96)
but not death (OR, 0.78; 95% CI, 0.53-1.15) or recurrent MI (OR, 0.85; 95%
CI, 0.58-1.24) alone. If CR was performed during the index
catheterization, a reduction in death/MI was observed (death/MI: OR, 0.41;
95% CI, 0.25-0.65; death: OR, 0.59; 95% CI, 0.34-1.00; recurrent MI: OR,
0.35; 95% CI, 0.18-0.69). If staged, no benefits were noted (death/MI: OR,
0.99; 95% CI, 0.67-1.45; death: OR, 0.95; 95% CI, 0.56-1.61; recurrent MI:
OR, 1.02; 95% CI, 0.61-1.70). However, when trial sequential analysis was
performed for the overall population, the cumulative z-curve did not cross
the monitoring boundary, suggesting a lack of evidence for reducing
death/MI with CR (similar for index catheterization). Conclusions In STEMI
with MVD, there is insufficient evidence to support a reduction in
death/MI with CR. Our results reinforce the need for larger clinical
trials powered for robust clinical end points.<br/>Copyright &#xa9; 2016
Canadian Cardiovascular Society

<19>
Accession Number
606743480
Author
Scalise A.; Calamita R.; Tartaglione C.; Pierangeli M.; Bolletta E.;
Gioacchini M.; Gesuita R.; Benedetto G.D.
Institution
(Scalise, Calamita, Tartaglione, Pierangeli, Bolletta, Gioacchini,
Benedetto) Department of Plastic and Reconstructive Surgery, Universita
Politecnica delle Marche, Ancona, Italy
(Gesuita) Interdepartmental Centre of Epidemiology, Biostatistics and
Medical Informatics (EBI Centre), Universita Politecnica delle Marche,
Ancona, Italy
Title
Improving wound healing and preventing surgical site complications of
closed surgical incisions: A possible role of incisional negative pressure
wound therapy. A systematic review of the literature.
Source
International Wound Journal. 13 (6) (pp 1260-1281), 2016. Date of
Publication: December 2016.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Advances in preoperative care, surgical techniques and technologies have
enabled surgeons to achieve primary closure in a high percentage of
surgical procedures. However, often, underlying patient comorbidities in
addition to surgical-related factors make the management of surgical
wounds primary closure challenging because of the higher risk of
developing complications. To date, extensive evidence exists, which
demonstrate the benefits of negative pressure dressing in the treatment of
open wounds; recently, Incisional Negative Pressure Wound Therapy (INPWT)
technology as delivered by PrevenaTM (KCI USA, Inc., San Antonio, TX) and
Pico (Smith & Nephew Inc, Andover, MA) systems has been the focus of a new
investigation on possible prophylactic measures to prevent complications
via application immediately after surgery in high-risk, clean, closed
surgical incisions. A systematic review was performed to evaluate INPWT's
effect on surgical sites healing by primary intention. The primary
outcomes of interest are an understanding of INPWT functioning and
mechanisms of action, extrapolated from animal and biomedical engineering
studies and incidence of complications (infection, dehiscence, seroma,
hematoma, skin and fat necrosis, skin and fascial dehiscence or
blistering) and other variables influenced by applying INPWT (re-operation
and re-hospitalization rates, time to dry wound, cost saving) extrapolated
from human studies. A search was conducted for published articles in
various databases including PubMed, Google Scholar and Scopus Database
from 2006 to March 2014. Supplemental searches were performed using
reference lists and conference proceedings. Studies selection was based on
predetermined inclusion and exclusion criteria and data extraction
regarding study quality, model investigated, epidemiological and clinical
characteristics and type of surgery, and the outcomes were applied to all
the articles included. 1 biomedical engineering study, 2 animal studies,
15 human studies for a total of 6 randomized controlled trials, 5
prospective cohort studies, 7 retrospective analyses, were included. Human
studies investigated the outcomes of 1042 incisions on 1003 patients. The
literature shows a decrease in the incidence of infection, sero-haematoma
formation and on the re-operation rates when using INPWT. Lower level of
evidence was found on dehiscence, decreased in some studies, and was
inconsistent to make a conclusion. Because of limited studies, it is
difficult to make any assertions on the other variables, suggesting a
requirement for further studies for proper recommendations on
INPWT.<br/>Copyright &#xa9; 2015 Medicalhelplines.com Inc and John Wiley &
Sons Ltd.

<20>
Accession Number
610824093
Author
Mosala Nezhad Z.; Poncelet A.; De Kerchove L.; Gianello P.; Fervaille C.;
El Khoury G.
Institution
(Mosala Nezhad, Poncelet, De Kerchove, El Khoury) Institute of
Experimental and Clinical Research (IREC), Division of Cardiovascular
Research (CARD), Universite catholique de Louvain, Department of
Cardiovascular and Thoracic Surgery, Saint-Luc University Hospital UCL,
Avenue Hippocrate 10, Brussels 1200, Belgium
(Mosala Nezhad, Poncelet, De Kerchove, El Khoury) Department of
Cardiovascular and Thoracic Surgery, Universite Catholique de Louvain,
Saint-Luc University Hospital, Brussels, Belgium
(Gianello) Institute of Experimental and Clinical Research (IREC),
Division of Experimental Surgery and Transplantation (CHEX), Universite
catholique de Louvain, Brussels, Belgium
(Fervaille) Laboratory of Anatomy Pathology, Universite catholique de
Louvain, Godinne University Hospital-CHU, Yvoir, Belgium
Title
Small intestinal submucosa extracellular matrix (CorMatrix) in
cardiovascular surgery: A systematic review.
Source
Interactive Cardiovascular and Thoracic Surgery. 22 (6) (pp 839-850),
2016. Date of Publication: 25 Jun 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Extracellular matrix (ECM) derived from small intestinal submucosa (SIS)
is widely used in clinical applications as a scaffold for tissue repair.
Recently, CorMatrix porcine SIS-ECM (CorMatrix Cardiovascular, Inc.,
Roswell, GA, USA) has gained popularity for 'next-generation'
cardiovascular tissue engineering due to its ease of use, remodelling
properties, lack of immunogenicity, absorbability and potential to promote
native tissue growth. Here, we provide an overview of the biology of
porcine SIS-ECM and systematically review the preclinical and clinical
literature on its use in cardiovascular surgery. CorMatrix has been used
in a variety of cardiovascular surgical applications, and since it is the
most widely used SIS-ECM, this material is the focus of this review. Since
CorMatrix is a relatively new product for cardiovascular surgery, some
clinical and preclinical studies published lack systematic reporting of
functional and pathological findings in sufficient numbers of subjects.
There are also emerging reports to suggest that, contrary to expectations,
an undesirable inflammatory response may occur in CorMatrix implants in
humans and longer-term outcomes at particular sites, such as the heart
valves, may be suboptimal. Large-scale clinical studies are needed driven
by robust protocols that aim to quantify the pathological process of
tissue repair.<br/>Copyright &#xa9; The Author 2016. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery.

<21>
Accession Number
610249694
Author
Dunne B.; Murphy M.; Skiba R.; Wang X.; Ho K.; Larbalestier R.; Merry C.
Institution
(Dunne, Murphy, Skiba, Wang, Ho, Larbalestier, Merry) Department of
Cardiothoracic Surgery, Western Australian Cardiothoracic Research and
Audit Group, Fiona Stanley Hospital, Perth, WA 6145, Australia
Title
Sternal cables are not superior to traditional sternal wiring for
preventing deep sternal wound infection.
Source
Interactive Cardiovascular and Thoracic Surgery. 22 (5) (pp 594-598),
2016. Date of Publication: 01 May 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES Deep sternal wound infection is a devastating complication of
cardiac surgery. In the current era of increasing patient comorbidity,
newer techniques must be evaluated in attempts to reduce the rates of deep
sternal wound infection. METHODS A randomized controlled trial comparing
sternal closure with traditional sternal wires in figure-8 formation with
the Pioneer cabling system from Medigroup after adult cardiac surgery was
performed. RESULTS A total of 273 patients were enrolled with 137 and 135
patients randomized to sternal wires and cables group, respectively.
Baseline characteristics between the two groups were well balanced. Deep
sternal wound infection occurred in 0.7% of patients in the wires group
and 3.7% of patients in the cables group (absolute risk difference =
-3.0%, 95% confidence interval: -7.7 to 0.9%; P = 0.12). Patients in the
cables group were extubated slightly earlier than those in the sternal
wires group postoperatively (9.7 vs 12.8 h; P = 0.03). There was, however,
no significant difference in hospital and follow-up pain scores or
analgesia requirements. CONCLUSIONS The Pioneer sternal cabling system
appears to facilitate early extubation after adult cardiac surgery, but it
does not reduce the rate of deep sternal infection
Australian.<br/>Copyright &#xa9; 2016 The Author 2016. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery.

<22>
Accession Number
610249080
Author
Mimic B.; Ilic S.; Vulicevic I.; Milovanovic V.; Tomic D.; Mimic A.;
Stankovic S.; Zecevic T.; Davies B.; Djordjevic M.
Institution
(Mimic, Ilic, Vulicevic, Milovanovic, Tomic, Zecevic) Department of
Cardiac Surgery, University Children's Hospital, Tirsova 10, Belgrade
11000, Serbia
(Mimic, Davies) Department of Cardiothoracic Surgery, Great Ormond Street
Hospital, London, United Kingdom
(Ilic, Djordjevic) School of Medicine, University of Belgrade, Belgrade,
Serbia
(Mimic) Department of Anaesthesiology, Clinical Centre of Serbia,
Belgrade, Serbia
(Stankovic) Centre for Medical Biochemistry, Clinical Centre of Serbia,
Belgrade, Serbia
(Djordjevic) Department of Urology, University Children's Hospital,
Belgrade, Serbia
Title
Comparison of high glucose concentration blood and crystalloid
cardioplegia in paediatric cardiac surgery: A randomized clinical trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 22 (5) (pp 553-560),
2016. Date of Publication: 01 May 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES This study investigates the effects of high glucose content on
patients undergoing cold crystalloid versus cold blood cardioplegia in
terms of early clinical results, functional myocardial recovery and
ischaemia-reperfusion injury in patients undergoing repair of acyanotic
cardiac lesions. METHODS Patients were randomly assigned to receive either
crystalloid (n = 31) or blood cardioplegia (n = 31). Early clinical
results were assessed. Changes in left ventricular fractional shortening,
arterial blood lactate levels, central venous saturation, cardiac Troponin
I release and blood glucose concentration were measured during the first
24 h after ischaemia. RESULTS There was no significant difference in
clinical outcomes and postoperative complication rates between groups. The
postoperative changes in left ventricular function, lactate levels,
central venous saturation and Troponin I were not significantly different
between groups. The use of crystalloid cardioplegia was associated with
significant increases in serum glucose compared with blood cardioplegia.
CONCLUSIONS A high glucose content blood cardioplegia does not show any
advantage compared with crystalloid cardioplegia in terms of clinical
outcomes, functional recovery and the degree of ischaemic injury in
infants and children undergoing repair of acyanotic heart lesions. High
glucose concentration of the cardioplegic solution might potentiate
ischaemia-reperfusion injury and diminish the beneficial effects of blood
cardioplegia.<br/>Copyright &#xa9; 2016 The Author 2016. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery.

<23>
Accession Number
612819573
Author
Goudar S.P.; Baker G.H.; Chowdhury S.M.; Reid K.J.; Shirali G.; Scheurer
M.A.
Institution
(Goudar, Reid, Shirali) Ward Family Heart Center, Children's Mercy
Hospital, Kansas City, MO, United States
(Baker, Chowdhury, Scheurer) Department of Pediatrics, Division of
Pediatric Cardiology, Medical University of South Carolina, Charleston,
SA, United States
Title
Interpreting measurements of cardiac function using vendor-independent
speckle tracking echocardiography in children: a prospective, blinded
comparison with catheter-derived measurements.
Source
Echocardiography. 33 (12) (pp 1903-1910), 2016. Date of Publication: 01
Dec 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Adult studies demonstrate that echocardiographic measurements
of cardiac function using speckle tracking correlate with invasive
measurements, but such data in the pediatric population are sparse. Our
aim was to compare speckle-derived measures of cardiac function to
measurements routinely obtained by cardiac catheterization in children.
Methods: Echocardiograms were performed on the day of cardiac
catheterization. Using Tomtec 2D Cardiac Performance Analysis,
longitudinal strain (LS), longitudinal strain rate (LSR), early diastolic
LSR, and ejection fraction (EF) for the right and left ventricle (RV and
LV) were calculated via speckle tracking. Global LS and LSR were
calculated for the LV. These results were compared to cardiac index,
maximum ventricular dp/dt (max dp/dt), ventricular end-diastolic pressure
(EDP), and pulmonary capillary wedge pressure (PCWP) obtained by
fluid-filled catheters. A blinded observer performed all echo
measurements. Results: Fifty studies were performed on 28 patients ages 4
months to 20 years old. Their diagnoses included cardiac transplant (48
studies), repaired AV septal defect (1), and dilated cardiomyopathy (1).
RVEDP ranged from 2 to 22 mm Hg (median=6) and PCWP ranged from 6 to 32
mmHg (median 10). LV global LS and LV 2-chamber LSR by speckle-tracking
negatively correlated with LV max dp/dt (LV global LS R=-.83, P=.001; LV
2-chamber LSR R=-.69, P=.009). RV LS weakly correlated with max dp/dt
(R=.363, P=.002). Early diastolic strain rate did not correlate with EDP
in either ventricle. Conclusion: Speckle-derived measurements of function
in the LV have stronger correlation than the RV to catheter-derived
measures. LV global LS has the strongest correlation with invasive
function measures in children.<br/>Copyright &#xa9; 2016, Wiley
Periodicals, Inc.

<24>
Accession Number
603013543
Author
Qi Z.; Liu S.; Lv X.; Duan F.; Wang H.; Gao Y.; Wang J.
Institution
(Qi, Lv, Duan, Wang, Gao, Wang) Department of Echocardiography, Fuwai
Hospital & Cardiovascular Institute, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences & Tsinghua University,
Peking Union Medical College, Beijing, China
(Liu) Department of Cardiovascular Surgery, Fuwai Hospital &
Cardiovascular Institute, National Center for Cardiovascular Diseases,
Chinese Academy of Medical Sciences & Tsinghua University, Peking Union
Medical College, Beijing, China
Title
Effects of Bone Marrow Mononuclear Cells Delivered through a Graft Vessel
for Patients with Previous Myocardial Infarction and Chronic Heart
Failure: An Echocardiographic Study of Left Atrium Function.
Source
Echocardiography. 33 (12) (pp 1835-1843), 2016. Date of Publication: 01
Dec 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: The graft of stem cells to treat ischemic cardiomyopathy is
popular in many clinical trials. The aim of this study was to evaluate the
effectiveness of isolated coronary artery bypass graft combined with bone
marrow mononuclear cells (BMMNC) delivered through the graft vessels to
improve left atrium (LA) function of patients with previous myocardial
infarction and chronic heart failure using echocardiography. Methods:
Forty-two patients with previous myocardial infarction and chronic heart
failure were randomly allocated to one of the two groups: coronary artery
bypass graft (CABG) only (18 in CABG group) or CABG with BMMNC
transplantation (24 in CABG + BMMNC group). Echocardiographic parameters
were measured on two-dimensional (2D) imaging, three-dimensional imaging,
2D strain, and strain rate imaging, eight parameters were measured
totally. Results: Postoperative LA global strain (LAGS) versus
Preoperative LAGS were 24.875 +/- 1.588% versus 14.250 +/- 1.281% (P <
0.05) in CABG + BMMMNC group and 17.556 +/- 1.834% versus 13.111 +/-
1.479% (P < 0.05) in CABG group, LVEF was 49.083 +/- 1.914% versus 36.042
+/- 1.185% (P < 0.05) in CABG + BMMMNC group and 41.389 +/- 2.210% versus
34.667 +/- 1.369% (P < 0.05) in CABG group, and LA volume (LAV) was 15.651
+/- 0.631 mL versus 23.894 +/- 0.831 mL (P < 0.05) in CABG + BMMMNC group
and 21.429 +/- 0.707 mL versus 22.379 +/- 0.959 mL (P < 0.05) in CABG
group. LAGS, LVEF, and LAV were significantly improved postoperatively in
both groups. The degree of the improvement was significantly different
between the two groups with the CABG + BMMNC group improved more versus
the group of CABG only (P < 0.05). Postoperative LVEDV and LVESV were
significantly improved compared with those obtained prior to operation in
CABG + BMMNC group (P < 0.05). Conclusions: The improvement of LA function
in CABG + BMMNC group is better than CABG group. 2D strain imaging is a
more sensitive tool to evaluate LA function.<br/>Copyright &#xa9; 2015,
Wiley Periodicals, Inc.

<25>
Accession Number
613283078
Author
Abreu J.S.; Tsutsui J.M.; Falcao S.N.R.; Feitosa J.A.; Rocha E.A.;
Oliveira I.M.; Diogenes T.C.; Paes J.N.; Sbano J.C.; Dallan L.A.; Filho
R.K.; Mathias W.
Institution
(Abreu) Public Health Department, State University of Ceara, Fortaleza,
Brazil
(Abreu, Feitosa, Rocha, Diogenes, Paes) Prontocardio Hospital, Fortaleza,
Brazil
(Abreu, Tsutsui, Sbano, Dallan, Filho, Mathias) Program in Cardiology,
Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
(Falcao, Oliveira) Messejana's Heart and Lung Hospital, Fortaleza, Brazil
Title
The impact of ligation of proximal side branches on blood flow and
functional status of the internal thoracic artery in coronary anastomosis.
Source
Echocardiography. 33 (11) (pp 1656-1664), 2016. Date of Publication: 01
Nov 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: The effect of proximal side branches on the patency of the
internal thoracic artery (ITA) is controversial. We used echocardiography
and Doppler to verify the effect of ligation of branches on the flow and
coronary flow reserve (CFR) of the grafted ITA in patients after coronary
artery bypass grafting (CABG). Methods: We prospectively investigated 53
patients with preserved left ventricular ejection fraction (LVEF >50%) who
underwent CABG of the ITA. In Group I (25 patients), major branches were
ligated during ITA anastomosis to the left anterior descending (LAD)
coronary artery, whereas no ligation was performed in Group II (28
patients). Systolic flow (SF), diastolic flow (DF), and total flow (TF =
SF + DF) were measured by Doppler echocardiography at the proximal level
of the ITA preoperatively, at early postoperative stage, and 6 months
after surgery. Dobutamine stress echocardiography (DSE) was performed at 6
months to determine CFR. Results: The ITA flow was predominantly systolic
before surgery and diastolic in the postoperative period. We found no
differences between the groups in DF. On DSE, SF (19.5+/-9 mL/min vs
32.7+/-19 mL/min; P=.003) and TF (79+/-21 mL/min vs 101+/-47 mL/min;
P=.037) were higher in Group II. There were no differences in CFR
(1.9+/-0.46 vs 2.11+/-0.56; P=.143). Conclusion: In patients with
preserved LVEF, ligation of major side branches during anastomosis to the
LAD does not alter ITA flow or CFR.<br/>Copyright &#xa9; 2016, Wiley
Periodicals, Inc.

<26>
Accession Number
612964723
Author
Kopjar T.; Gasparovic H.; Mestres C.A.; Milicic D.; Biocina B.
Institution
(Kopjar, Gasparovic, Biocina) University of Zagreb School of Medicine,
Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb,
Croatia
(Mestres) Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu
Dhabi, United Arab Emirates
(Milicic) University of Zagreb School of Medicine, Department of
Cardiovascular Diseases, University Hospital Centre Zagreb, Zagreb,
Croatia
Title
Meta-analysis of concomitant mitral valve repair and coronary artery
bypass surgery versus isolated coronary artery bypass surgery in patients
with moderate ischaemic mitral regurgitation.
Source
European Journal of Cardio-thoracic Surgery. 50 (2) (pp 212-222), 2016.
Article Number: ezw022. Date of Publication: 01 Aug 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Ischaemic mitral regurgitation (IMR) is a complication of coronary artery
disease with normal chordal and leaflet morphology. Controversy surrounds
the issue of appropriate surgical management of moderate IMR. With the
present meta-analysis, we aimed to determine whether the addition of
mitral valve (MV) repair to coronary artery bypass grafting (CABG)
improved clinical outcome over CABG alone in patients with moderate IMR.
Databases were searched for studies reporting on clinical outcomes after
CABG and MV repair or CABG alone for moderate IMR. Clinical end-points
were operative mortality, survival, New York Heart Association (NYHA)
class >=2 and MR grade >=2 at last follow-up. A total of five
observational and four randomized controlled trials (RCTs) were
identified. The mean follow-up was 2.7 years. An analysis of all studies
revealed increased operative risk in the concomitant CABG and MV repair
group (risk ratio [RR] 2.02 [95% confidence interval (CI) 1.15, 3.56], P =
0.01, I² = 0%). However, an analysis of RCTs only showed that
the operative risk was equivalent [RR 1.05 (95% CI 0.34, 3.30), P = 0.93,
I² = 0%]. Pooled hazard ratio (HR) on survival did not favour
either procedure [all studies: HR 1.08 (95% CI 0.77, 1.50), P = 0.66,
I² = 0%; RCTs only: HR 0.89 (95% CI 0.47, 1.70), P = 0.73,
I² = 0%]. The incidence of exercise intolerance quantified as
NYHA class >=2 was similar between groups (all studies: RR 0.72 (95% CI
0.42, 1.24), P = 0.24, I² = 77%; RCTs only: RR 0.61 (95% CI
0.24, 1.55), P = 0.30, I² = 83%]. Risk of residual MR grade >=2
was higher in the CABG only group [all studies: RR 0.30 (95% CI 0.16,
0.60), P < 0.001, I² = 83%; RCTs only: RR 0.20 (95% CI 0.04,
0.90), P = 0.04, I² = 72%]. There is neither increased
operative mortality nor survival benefit associated with concomitant CABG
and MV repair for IMR of moderate degree over CABG alone. Further studies
with long-term follow-up data and sub-group analyses of current data are
needed to define a subset of patients whose survival and functional status
may improve with the concomitant MV repair.<br/>Copyright &#xa9; The
Author 2016. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<27>
Accession Number
614067047
Author
Sumitomo N.; Horigome H.; Miura M.; Ono H.; Ueda H.; Takigiku K.;
Yoshimoto J.; Ohashi N.; Suzuki T.; Sagawa K.; Ushinohama H.; Takahashi
K.; Miyazaki A.; Sakaguchi H.; Iwamoto M.; Takamuro M.; Tokunaga C.;
Nagano T.
Institution
(Sumitomo) Department of Pediatric Cardiology, Saitama Medical University
International Medical Center, Saitama, Japan
(Horigome) Department of Child Health, Faculty of Medicine, University of
Tsukuba, Ibaraki, Japan
(Miura) Division of Cardiology, Tokyo Metropolitan Children's Medical
Center, Tokyo, Japan
(Ono) Division of Cardiology, National Center for Child Health and
Development, Tokyo, Japan
(Ueda) Department of Cardiology, Kanagawa Children's Medical Center,
Yokohama, Japan
(Takigiku) Department of Pediatric Cardiology, Nagano Children's Hospital,
Azumino, Japan
(Yoshimoto) Department of Pediatric Cardiology, Shizuoka Children's
Hospital, Shizuoka, Japan
(Ohashi) Department of Pediatric Cardiology, Japan Community Health Care
Organization Chukyo Hospital, Nagoya, Japan
(Suzuki) Department of Pediatric Electrophysiology, Osaka City General
Hospital, Osaka, Japan
(Sagawa, Ushinohama) Department of Pediatric Cardiology, Fukuoka
Children's Hospital Medical Center, Fukuoka, Japan
(Takahashi) Department of Pediatric Cardiology, Okinawa Children's Medical
Center, Okinawa, Japan
(Miyazaki, Sakaguchi) Department of Pediatric Cardiology, National
Cerebral and Cardiovascular Center, Osaka, Japan
(Iwamoto) Department of Pediatrics, Saiseikai Yokohamashi Tobu Hospital,
Yokohama, Japan
(Takamuro) Department of Pediatric Cardiology, Hokkaido Medical Center for
Child Health and Rehabilitation, Sapporo, Japan
(Tokunaga) Department of Cardiovascular Surgery, Faculty of Medicine,
University of Tsukuba, Tsukuba, Japan
(Nagano) Ono Pharmaceutical Co. Ltd., Osaka, Japan
Title
Study design for control of HEART rate in inFant and child tachyarrhythmia
with heart failure Using Landiolol (HEARTFUL): A prospective, multicenter,
uncontrolled clinical trial.
Source
Journal of Cardiology. 70 (3) (pp 232-237), 2017. Date of Publication:
September 2017.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background Persistent tachycardia in pediatric patients after congenital
heart surgery further deteriorates their hemodynamic condition, and may
become fatal. Therefore, immediate control of the tachycardia is mandatory
in these patients. For this purpose, quick-acting, short-acting,
titratable intravenous agents are required. However, there are no agents
with such characteristics among the drugs approved for control of
pediatric arrhythmias in Japan, and thus novel and effective medications
for these patients are awaited. Landiolol, an ultrashort-acting
beta-blocker, was approved in 2013 for tachyarrhythmias in adult patients
with heart failure. However, its efficacy and safety in pediatric patients
remain unclear. The aim of this prospective, multicenter, open-label phase
IIb/III study is to investigate the efficacy and safety of landiolol in
pediatric patients with tachyarrhythmias as well as heart failure. Methods
Eligible patients are aged >= 3 months and <15 years, and have
tachyarrhythmia (atrial fibrillation, atrial flutter, supraventricular
tachycardia) as well as heart failure. The primary endpoint of the study
is >=20% reduction from baseline heart rate or return to normal sinus
rhythm within 2 h after starting intravenous administration of landiolol.
Patients will receive intravenous infusion of landiolol, starting at 1
mug/kg/min. The dose will be increased by 1 mug/kg/min every 15-20 min
until the tachycardia rate has decreased by >20% or tachycardia has
terminated, and the dose will then be maintained or further increased
depending on the patient's condition. The study was started in April 2015
and will end within a few years. Conclusions The study was designed and
designated the "HEARTFUL study" in the hope of establishing a basis for
control of HEART rate in inFant and child tachyarrhythmia Using Landiolol
in children with heart failure.<br/>Copyright &#xa9; 2017 Japanese College
of Cardiology

<28>
Accession Number
616158852
Author
Spaccarotella C.; Mongiardo A.; De Rosa S.; Indolfi C.
Institution
(Spaccarotella, Mongiardo, De Rosa, Indolfi) Department of Medical and
Surgical Sciences, Magna Graecia University, Catanzaro, Italy
(Indolfi) URT of IFC of the CNR, Magna Graecia University, Catanzaro,
Italy
Title
Transcatheter aortic valve implantation in patients at intermediate
surgical risk.
Source
International Journal of Cardiology. 243 (pp 161-168), 2017. Date of
Publication: 15 Sep 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Transcatheter Aortic Valve Implantation (TAVI) has revolutionized the
treatment of elderly patients with symptomatic severe aortic stenosis
(AS). Initially tested in unoperable or high surgical risk patients, the
safety and efficacy of TAVI has progressively improved, with increasing
operators' experience and continuous technical refinements of the devices
and of the delivery systems. Hence, the extension of clinical indications
for TAVI to the intermediate-risk population has been attracting
cardiologists in recent years. This idea was supported by the results of
recent studies suggesting that transfemoral TAVI might be associated with
a survival benefit in both high- and intermediate-risk patients with
severe AS. Therefore, the aim of this review is to summarize the currently
available evidence from multiple observational studies, substudies from
large country registries, mached group comparisons, a substudy of
randomized studies, and randomized trials, as well as in recent
meta-analyses on the use of TAVI in patient at intermediate-risk for
surgery.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<29>
Accession Number
617460999
Author
Miceli A.
Institution
(Miceli) Istituto Clinico sant'Ambrogio, Gruppo Ospedaliero San Donato,
Milano, Italy
Title
Sutureless valve associated a minimally invasive approach covers the gap
between transcatheter aortic valve implantation and conventional aortic
valve replacement.
Source
Cardiology (Switzerland). Conference: 22nd World Congress on Heart Disease
International Academy of Cardiology Annual Scientific Sessions 2017.
Canada. 137 (pp 112), 2017. Date of Publication: 2017.
Publisher
S. Karger AG
Abstract
Aortic valve replacement with sutured stented valve is the treatment of
choice in patients with severe aortic valve stenosis. This surgical
approach has shown excellent mortality, morbidities and long-term
survival. Nevertheless, this procedure has been often denied to the
high-risk patients with severe aortic stenosis due to the advanced age,
numerous comorbidities and poor predicted outcomes. In this setting,
transcatheter aortic valve implantation (TAVI) has been considered a valid
option in the treatment of high-risk patients, as it has shown to be
superior to medical therapy and not inferior to conventional surgery in
terms of mortality and early survival. These enthusiastic results have
brought the cardiac community to increase the number of TAVI procedures,
with the aim of decreasing the invasiveness of surgical operations even in
lower risk patients. However, it has been reported that TAVI was
associated with higher incidence of neurological events, vascular
complications and paravalvular leakages when compared with the
conventional surgery. From the dualism between the surgical and
transcatheter approaches, a new valve technology has been developed as an
additional treatment option to the high-risk patient undergoing aortic
valve replacement to simplify and standardize the surgical procedure and
facilitate the minimally invasive approach. The sutureless and rapid
deployment aortic valves have been designed to avoid or minimize passing
stiches through the annulus and suture knotting to decrease the surgical
trauma to the aortic annulus and consequently reduce the operative times.
Many studies have reported excellent clinical results in terms of
postoperative outcomes, hemodynamic performances, structural valve
deterioration and freedom from reoperation up to 5 years. These results
have been confirmed even in the setting of minimally invasive surgery. As
consequence, these valves have been recommended for those patients
belonging to the "gray zone" between TAVI and conventional surgery. The
potential benefits of sutureless and rapid deployment valves when compared
with TAVI are the decreased paravalvular leak rate and decreased need for
postoperative pacemakers. Furthermore, the surgical approach has the
advantage of removing the calcified stenotic valve, a possible cause of
neurological events. A large European study reported excellent outcomes,
hemodynamic results and 1 year survival with sutureless and minimally
invasive aortic valve replacement with the sutureless valve through a
right minithoracotomy approach or ministernotomy. These outstanding
results have raised the hypothesis that the combination of minimally
invasive surgery with the sutureless technology might be considered the
"real alternative" to the TAVI technology in intermediate and high risk
operable patients. In this setting, a recent meta-analysis has shown that
sutureless valves are associated with a 70% reduction of early mortality
and 90% reduction of postoperative paravalvular leakage. Paravalvular
leakage is now considered a negative outcome, because it has been
demonstrated that even mild regurgitation is associated with lower
survival at 2 and 5 years. More studies and a proper randomized trial are
required to confirm these data. In conclusion, based on the current
literature data, TAVI is recommended for inoperable and very high-risk
patients whereas sutureless and rapid deployment valve in combination with
any minimally invasive approach are advised for medium risk operable
patients. The low risk patients may benefit of a minimally invasive
approach but still with a conventional sutured valve. In this setting, the
role of the "heart team" is essential for the correct indication,
minimizing the potential risks. While we are waiting some robust data and
recommendations from the American and European Societies, we will expect
that the future be without suture!!!

<30>
Accession Number
617460942
Author
Tung M.W.; Wang W.; Lee F.; Wang X.; Luo X.; Wang C.S.; Wei L.; Guo Y.Q.
Institution
(Tung, Wang, Lee, Wang, Luo) State Key Laboratory of Cardiovascular
Disease, Fuwai Hospital, Beijing, China
(Wang, Wei) Department of Cardiovascular Surgery, Zhongshan Hospital,
Fudan University, Shanghai, China
(Guo) Department of Cardiovascular Surgery, West China Hospital, Sichuan
University, Chengdu, China
Title
Transapical aortic valve implantation utilizing the J-Valve in patients
with aortic regurgitation: A one-year results of the multi-centre study.
Source
Cardiology (Switzerland). Conference: 22nd World Congress on Heart Disease
International Academy of Cardiology Annual Scientific Sessions 2017.
Canada. 137 (pp 300), 2017. Date of Publication: 2017.
Publisher
S. Karger AG
Abstract
Objectives: Transapical transcatheter aortic valve implantation (TA-TAVI)
has shown promising results in screened patients with high-risk profile.
In this study, we present the first multi-centre outcome of a new second-
generation TA-TAVI system, the J-ValveTM system, in patients with aortic
regurgitation (AR). Methods: This prospective study, was conducted at
three largest cardiac centres in China, enrolled 43 patients (mean age
73.8 +/- 5.7), the preoperative EuroSCORE II score was 11.01.0%. Clinical
and echocardiographic evaluations were performed at baseline,
post-procedure, discharge and 30 days, and also at 6 and 12 months. The
primary endpoint was a combined efficacy endpoint after 1 year, which
included all-cause mortality after more than 30 days and failure of
current therapy for AR requiring hospitalization for symptoms of
valve-related cardiac decompensation or prosthetic heart valve
dysfunction. Secondary endpoints were major stroke, and life-threatening,
disabling, or major bleeding during follow up. Results: TA-TAVI with the
J-ValveTM device was successful in 40/42 patients (procedural success rate
95.2%). The overall mortality at 30 days and 12months was 2.3% and 2.5%
respectively. Conversion to surgery was necessary in one patients (2.5%).
Pacemaker implantation for new onset conduction disorders was necessary in
two patients (5.0%). All patients with completed follow up (n=38) reported
improvements in at least one of the NYHA classes. None of the patients had
severe post-procedural aortic regurgitation (>2+). The combined ratio of
successful implantation without adverse events in our cohort was 88.1%.
Conclusions: Transapical J-ValveTM implantation was safe and effective in
the treatment of AI patients at high risk for surgery. Satisfactory
hemodynamic performance during the one year follow-up was demonstrated
with low peri- and post-operative complications.

<31>
Accession Number
617460931
Author
Shanmugasundaram M.
Institution
(Shanmugasundaram) University of Arizona, College of Medicine/ SAVAHCS,
Tucson, AZ, United States
Title
Percutaneous hemodynamic support devices in the current day cath lab.
Source
Cardiology (Switzerland). Conference: 22nd World Congress on Heart Disease
International Academy of Cardiology Annual Scientific Sessions 2017.
Canada. 137 (pp 154), 2017. Date of Publication: 2017.
Publisher
S. Karger AG
Abstract
There has been a significant progress in the field of interventional
devices that have improved the success rate of cardiac procedures
dramatically. Cardiologists are willing to tackle more complex cases,
thanks to these innovations. Hemodynamic support devices are commonly used
in patients presenting with acute myocardial infarction in cardiogenic
shock, acute decompensated heart failure or high-risk percutaneous
coronary intervention (PCI). The ideal hemodynamic support device should
satisfy the following criteria: easy to insert, simple to use and maintain
and provides maximal coronary support. Since its inception in 1968, intra
aortic balloon pump (IABP) has been the only device available to support
these patients, but in the past few years, devices that provide more
support such as ImpellaTM, Tandem HeartTM and veno arterial extra
corporeal membrane oxygenation (ECMO) have been introduced. One must have
a sound physiologic knowledge to understand the clinical application of
these devices. Despite the lack of prospective randomized trials
supporting the use of these devices, the interventional field has seen a
tremendous increase in the implantation of these devices. The " true
believers" of this technology argue that the trials consisted of a very
heterogeneous population and had significant limitations. It is generally
accepted that in patients with cardiogenic shock hemodynamic support is
beneficial, although the timing of placement of the device (before or
after PCI) is controversial. High risk PCI is currently the most common
indication for hemodynamic support, but the definition of high risk is
debatable. These devices are not without complications, although with
continued innovation their incidence has diminished. One has to look
beyond the randomized trials and have to rely on observational and
registry data to support its use. Professional societies have published
guidelines to help clinicians make better therapeutic decision.

<32>
Accession Number
617460893
Author
Perrault L.; Carrier M.; Bouchard D.; Cartier R.; Demers P.; Lamarche Y.;
El-Hamamsy I.; Tanguay D.; Terronne D.
Institution
(Perrault, Carrier, Bouchard, Cartier, Demers, Lamarche, El-Hamamsy,
Tanguay, Terronne) Montreal Heart Institute, Montreal, QC, Canada
Title
Duragraft vascular graft treatment in the prevention of patients
undergoing CABG.
Source
Cardiology (Switzerland). Conference: 22nd World Congress on Heart Disease
International Academy of Cardiology Annual Scientific Sessions 2017.
Canada. 137 (pp 148), 2017. Date of Publication: 2017.
Publisher
S. Karger AG
Abstract
Background: The principal mechanism thought to limit the benefits of CABG
is saphenous vein graft disease leading to vein graft failure (VGF).
Injury to the saphenous vein graft (SVG) endothelium during harvesting and
implantation promotes inflammation and neointimal hyperplasia that can
lead to subsequent graft atherosclerosis and occlusion. We investigated
the beneficial impact of a novel formulation SOMVC001 (DuraGraft) for
intraoperative SVG treatment on angiographic early (4-6 weeks and 3
months) graft wall thickness and late (12-month) lumen loss in patients
undergoing CABG Methods: This is an ongoing prospective randomized,
double-blinded study designed to compare within patient the impact of
DuraGraft vs. the standard of care heparinized dose saline (SOC). The
early endpoint evaluates the magnitude of change in the mean wall
thickness of paired grafts within patients at 4-6 weeks and 3 months after
CABG. The late endpoint evaluates the change from 4-6 weeks to 12 months
in mean lumen diameter over each graft plus the lumen diameter at maximal
stenosis within-person following CABG surgery. Graft structural changes
are evaluated using 64-slice or better multi-detector computed tomography
(MDCT) angiography. Results: Enrollment of 119 patients who received
treatment (mITT population) at 7 investigational sites was completed.
Baseline procedural characteristics are representative of a population of
subjects undergoing initial CABG with at least two SVG (Fig. 1). MDCT
angiographic follow-up showed the proportion of patients with mean
reductions or no change in wall thickness at 4-6 weeks and 3 months after
CABG was greater in the DuraGraft treated group when compared to SOC:
70.3% (95% CI: 62%-79%, p<0.0001) 67.0% (95% CI: 58%-76%, p<0.0003),
respectively. Conclusion: These results support the hypothesis that
pretreatment of SVG with DuraGraft prevents early increased wall thickness
as an expression of intimal hyperplasia. Evaluation of DuraGraft at 12
months and its potential to prevent graft lumen loss as an expression of
VGF in patients undergoing CABG surgery is pending.

<33>
Accession Number
617460689
Author
Cheema A.N.
Institution
(Cheema) University of Toronto, ON, Canada
Title
Tavr for all comers with aortic stenosis: A destination too far?.
Source
Cardiology (Switzerland). Conference: 22nd World Congress on Heart Disease
International Academy of Cardiology Annual Scientific Sessions 2017.
Canada. 137 (pp 117), 2017. Date of Publication: 2017.
Publisher
S. Karger AG
Abstract
Transcatheter Aortic Valve Replacement (TAVR) has revolutionized the
treatment of symptomatic aortic stenosis (AS) with several randomized
trials demonstrating efficacy in inoperable AS patients and equivalence to
conventional surgical aortic valve replacement (SAVR) for high and
intermediate surgical risk patients. In addition, transfemoral TAVR has
demonstrated mortality and stroke benefit compared to SAVR in high
surgical risk AS patients prompting a large increase in the number of TAVR
procedures being performed both in North America and elsewhere.
Furthermore, there have been significant advances in TAVR technology and
procedural techniques over the last few years with development of smaller
delivery catheters and improved valve design. This technological and
procedural optimization has improved the safety of TAVR procedures and
reduced the rates of paravalvular regurgitation. However, important issues
have been identified from the observational and randomized studies of TAVR
raising caution for an unrestricted application of TAVR in all patients
with AS. The most pertinent of these concerns include high pacemaker rates
post TAVR, unknown long term durability of transcatheter heart valves
(THV) and subclinical thrombus formation on THV leaflets. Although, there
is great enthusiasm for a less invasive approach such as transfemoral TAVR
compared to conventional valve surgery, the clinicians anxiously await the
results of ongoing studies examining latest iterations of TAVR technology
in low surgical risk patients. In addition, long term follow up on THV
hemodynamics and the optimum anticoagulation strategy to prevent
subclinical THV thrombosis are required before TAVR can be expanded to all
comers aortic stenosis.

<34>
Accession Number
617434124
Author
Mazer D.; Shehata N.; Fergusson D.; Whitlock R.; Thorpe K.; Mateo E.;
Carmona P.; Galan J.; Gonzalez A.; Gajate L.; Ors M.; Alonso-Coello P.;
Urrutia G.; Martinez-Zapata M.J.
Institution
(Mazer) St. Michael's Hospital, Toronto, ON, Canada
(Shehata) Mount Sinai Hospital, Toronto, ON, Canada
(Fergusson) Ottawa Hospital Research Institute, Ottawa, ON, Canada
(Whitlock) Population Health Research Institute, McMaster University,
Hamilton, ON, Canada
(Thorpe) University of Toronto, Canada
(Mateo) Consorcio Hospital General De Valencia, Barcelona, Spain
(Carmona) Instituto De Investigacion Sanitaria La Fe, Valencia, Spain
(Galan, Urrutia) Hospital De La Santa Creu I Sant Pau, Barcelona, Spain
(Gonzalez) Hospital Universitari La Vall D'Hebron, Barcelona, Spain
(Gajate) Hospital Ramon Y Cajal, Madrid, Spain
(Ors) Hospital La Princesa, Madrid, Spain
(Alonso-Coello, Urrutia, Martinez-Zapata) Public Health and Clinical
Epidemiology, Iberoamerican Cochrane Centre, IIB Sant Pau, Barcelona,
Spain
Title
Transfusion requirements in cardiac surgery iii (trics-iii): Clinical
trial protocol.
Source
Basic and Clinical Pharmacology and Toxicology. Conference: 29th Congress
of the Spanish Society for Clinical Pharmacology. Spain. 119 (pp 29),
2016. Date of Publication: October 2016.
Publisher
Blackwell Publishing Ltd
Abstract
Objective: Patients undergoing cardiac surgery receive a high proportion
of red blood cells transfusion to avoid the consequences of the anemia.
However transfusion is costly, often in short supply and it may also lead
to considerable morbidity and mortality. The threshold for transfusion
needs to be determined to balance the benefits and the risks of anemia and
transfusion. Our purpose is to asses if a restrictive transfusion strategy
is non-inferior to a liberal transfusion strategy in terms of
morbid-mortality. Method: Design: International, multicentre, open-label,
parallel, randomized clinical trial (RCT) Patients: It will be included
4500 adult high risk patients having cardiac surgery that need
cardiopulmonary bypass and accept to participate. It will be excluded
patients who are unable to receive or who refuse blood products, involved
in a preoperative autologous pre-donation program, patients who are having
a heart transplant or having surgery solely for an insertion of a
ventricular assist device; pregnancy or lactation; patients who are unable
to receive or who refuse blood products. Centres: 65 (distributed in
worldwide). Experimental intervention: Restrictive transfusion strategy.
Patients will receive a red cell transfusion if their haemoglobin is <75
g/L intraoperative and/or postoperatively. Control intervention: Liberal
transfusion strategy. Patients will receive a red cell transfusion if
their haemoglobin concentration is <95 g/L intraoperative, or
postoperatively in the intensive care unit; and/or <85 g/L on the ward.
Primary outcome: composite score of any one of the following occurring
from the start of surgery until hospital discharge or postoperative day
28, whichever comes first: (i) all-cause mortality; (ii) myocardial
infarction; (iii) new renal failure requiring dialysis; or (iv) new focal
neurological deficit. Follow-up: perioperative, until hospital discharge
or postoperative day 28 and at 6 months. Results and conclusions: This RCT
is running. We expect to find not-differences in morbid-mortality between
the two transfusion strategies.

<35>
Accession Number
614094607
Author
Muller D.W.M.; Grayburn P.A.; Stoler R.C.; Scalia G.M.; Muller D.; Jansz
P.; Shaw M.; Conellan M.; Spina R.; Pedersen W.; Sorajja P.; Farivar R.S.;
Bae R.; Sun B.; Walters D.; Clarke A.; Scalia G.; Grayburn P.; Stoler R.;
Hebeler R.; Dahle G.; Rein K.A.; Fiane A.; Guerrero M.; Pearson P.;
Feldman T.; Salinger M.; Smart S.; Kapadia S.; Gillinov M.; Mick S.;
Krishnaswamy A.; Pichard A.; Corso P.; Chuang M.; Popma J.; Leipsic J.;
Blanke P.; Carroll J.; George I.; Missov E.; Kiser A.
Institution
(Muller, Jansz, Shaw) Departments of Cardiology and Cardiothoracic
Surgery, St. Vincent's Hospital, Sydney, Australia
(Farivar, Bae, Sorajja) Center for Valve and Structural Heart Disease and
Cardiothoracic Surgery Service, Minneapolis Heart Institute at Abbott
Northwestern Hospital, Minneapolis, Minnesota, United States
(Walters, Clarke, Scalia) Departments of Cardiology and Cardiothoracic
Surgery, Prince Charles Hospital, Brisbane, Australia
(Grayburn, Stoler) Divisions of Cardiology and Cardiothoracic Surgery,
Baylor University Medical Center, Dallas, Texas, United States
(Dahle, Rein) Departments of Cardiology and Cardiothoracic Surgery, Oslo
University Hospital, Oslo, Norway
(Guerrero, Pearson) Divisions of Cardiology and Cardiothoracic Surgery,
Evanston Hospital, Evanston, Illinois, United States
(Kapadia, Gillinov) Departments of Cardiovascular Medicine and
Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio,
United States
(Pichard, Corso) Division of Cardiology and Department of Cardiothoracic
Surgery, Medstar Washington Hospital Center, Washington DC, United States
(Popma, Chuang) Beth Israel Deaconness Medical Center, Boston,
Massachusetts, United States
(Blanke, Leipsic) St. Paul's Hospital, Vancouver, British Columbia, Canada
Title
Transcatheter Mitral Valve Replacement for Patients With Symptomatic
Mitral Regurgitation: A Global Feasibility Trial.
Source
Journal of the American College of Cardiology. 69 (4) (pp 381-391), 2017.
Date of Publication: 31 Jan 2017.
Publisher
Elsevier USA
Abstract
Background Symptomatic mitral regurgitation (MR) is associated with high
morbidity and mortality that can be ameliorated by surgical valve repair
or replacement. Despite this, many patients with MR do not undergo
surgery. Transcatheter mitral valve replacement (TMVR) may be an option
for selected patients with severe MR. Objectives This study aimed to
examine the effectiveness and safety of TMVR in a cohort of patients with
native valve MR who were at high risk for cardiac surgery. Methods
Patients underwent transcatheter, transapical delivery of a self-expanding
mitral valve prosthesis and were examined in a prospective registry for
short-term and 30-day outcomes. Results Thirty patients (age 75.6 +/- 9.2
years; 25 men) with grade 3 or 4 MR underwent TMVR. The MR etiology was
secondary (n = 23), primary (n = 3), or mixed pathology (n = 4). The
Society of Thoracic Surgeons Predicted Risk of Mortality was 7.3 +/- 5.7%.
Successful device implantation was achieved in 28 patients (93.3%). There
were no acute deaths, strokes, or myocardial infarctions. One patient died
13 days after TMVR from hospital-acquired pneumonia. Prosthetic leaflet
thrombosis was detected in 1 patient at follow-up and resolved after
increased oral anticoagulation with warfarin. At 30 days, transthoracic
echocardiography showed mild (1+) central MR in 1 patient, and no residual
MR in the remaining 26 patients with valves in situ. The left ventricular
end-diastolic volume index decreased (90.1 +/- 28.2 ml/m² at
baseline vs. 72.1 +/- 19.3 ml/m² at follow-up; p = 0.0012), as
did the left ventricular end-systolic volume index (48.4 +/- 19.7
ml/m² vs. 43.1 +/- 16.2 ml/m²; p = 0.18).
Seventy-five percent of the patients reported mild or no symptoms at
follow-up (New York Heart Association functional class I or II).
Successful device implantation free of cardiovascular mortality, stroke,
and device malfunction at 30 days was 86.6%. Conclusions TMVR is an
effective and safe therapy for selected patients with symptomatic native
MR. Further evaluation of TMVR using prostheses specifically designed for
the mitral valve is warranted. This intervention may help address an unmet
need in patients at high risk for surgery. (Early Feasibility Study of the
Tendyne Mitral Valve System [Global Feasibility Study];
NCT02321514)<br/>Copyright &#xa9; 2017 American College of Cardiology
Foundation

<36>
Accession Number
614188784
Author
Nakagawa K.; Kim M.-K.; Kaneda H.; Mitsutake Y.; Vlachos H.A.; Waseda K.;
Detre K.M.; Kelsey S.F.; Thomas S.B.; Tyrrell K.S.; Rana J.S.; Averbach
F.; MacGregor J.M.; O'Neal S.M.; Pitluga K.; Sansing V.; Tranchine M.;
Crow S.W.; Bertolet M.M.; Kip K.; Lu J.; Janiszewski S.; Protivnak D.;
Reiser S.; Barton S.; Guo P.; Kushner Y.; Michael O.; Martin J.P.; Kania
C.; Kania M.; O'Donnell J.; Maxwell R.A.; Hueb W.; Ramires J.; Lopes N.;
Wajchenberg B.L.; Martinez E.E.; Oliveira S.A.; Ribeiro E.E.; Perin M.;
Betti R.; Schwartz L.; Steiner G.; Barolet A.; Groenewoud Y.; Mighton L.;
Camelon K.; O'Rourke R.; Blodgett J.; Sako E.; Nicastro J.; Prescott R.;
Rihal C.; Kennedy F.; Barsness G.; Basu A.; Clavell A.; Frye R.; Holmes
D.R.; Lerman A.; Mullaney C.; Reeder G.; Rizza R.; Schaff H.; Smith S.;
Somers V.; Sundt T.; Ting H.; Wright R.S.; Helgemoe P.; Lesmeister D.;
Rolbiecki D.; Lepe-Montoya L.; Escobedo J.; Barraza R.; Baleon R.; Campos
A.; Garcia P.; Lezama C.; Miramontes C.; Ocampo S.; Penafiel J.V.;
Valdespino A.; Verdin R.; Albarran H.; Ayala F.; Chavez E.; Murillo H.;
Buitron L.V.; Rico-Verdin B.; Angulo F.; Adler D.; Halle A.A.;
Ismail-Beigi F.; Paranjape S.; Mazzurco S.; Ridley K.; Solomon S.; Wall
B.; Weinman D.; Touchstone T.; Douglas L.; Bourassa M.; Tardif J.-C.;
Chiasson J.-L.; Lavoie M.A.; Rabasa-Lhoret R.; Langelier H.; Foucher S.;
Trudel J.; Monrad S.; Srinivas V.; Zonszein J.; Crandall J.; Duffy H.;
Vartolomei E.; Jacobs C.; Robertson D.; Porter M.; Eley M.; Nichols E.;
LaCorte J.; Rogers W.; Ovalle F.; Bell D.; Misra V.K.; Hillegass W.B.;
Aqel R.; Pierce P.; Smith M.; Saag L.; Vaughn A.; Smith D.; Grimes T.;
Rolli S.; Hill R.; Barrett B.D.; Morehead C.; Doss K.; Davidson C.J.;
Molitch M.; Beohar N.; Massaro E.; Goodreau L.; Arroyo F.; Neuzil P.;
Pavlickova L.; Stehlikova S.; Benedik J.; Coling L.; Davies R.; Glover C.;
LeMay M.; Mesana T.; Ooi T.C.; Silverman M.; Sorisky A.; Favreau C.;
McClinton S.; Weiss M.; Weiss I.; Saulle L.; Kannam H.; Kurylas J.C.; Vasi
L.; Douglas J.; Ghazzal Z.; Sperling L.; King S.; Dayamani P.; Gebhart S.;
Basu S.; Helmy T.; Tangpricha V.; Hyde P.; Jenkins M.; Grant B.P.; Kent
K.; Suddath W.; Magee M.; Julien-Williams P.; Reed V.; Nassar C.; Dagenais
G.; Garceau C.; Auger D.; Buller C.; Elliott T.; Ramanathan K.; Ricci D.;
Fox R.; Kolesniak D.; Attubato M.; Feit F.; Richardson S.; Sing I.P.;
Amendola A.; Vargas B.; Tsapatsaris N.; Woods B.; Cushing G.; Rutter M.;
Singh P.; DesRochers G.; Woodhead G.; Gannon D.; Campbell N.S.; Ragosta
M.; Sarembock I.; Powers E.; Barrett E.; Jahn L.; Murie K.; Das G.;
Sigurdsson G.; White C.; Bantle J.; Redmon J.B.; Kwong C.; Tamis-Holland
J.; Hochman J.S.; Slater J.; Wilentz J.; Frances S.; Tormey D.; Pepine C.;
Smith K.; Kennedy L.; Brezner K.; Curry T.; Bleyer F.; Albert S.;
Mooradian A.; Plummer S.; Fuentes F.; Robles R.; Lavis V.; Gomez J.;
Iliescu C.; Underwood C.; Fulton M.S.; Ramirez J.G.; Merta J.; Scott G.;
Krishnaswami A.; Dowdell L.; Berkheimer S.; Greenbaum A.; Whitehouse F.;
Pangilinan R.; Mann K.; Jacobs A.K.; Sternthal E.; Ebner S.; Nedeljkovic
Z.; Beardsley P.; Schneider D.; Pratley R.; Cefalu W.; Schnure J.; Tilton
L.; Niederman A.; Mata C.; Kellerman T.; Farmer J.; Garber A.J.; Kleiman
N.; Howard N.; Nichols D.; Pool M.; Granger C.; Feinglos M.; Adams G.;
Green J.; Druken B.; Underwood D.; Stafford J.L.; Donner T.; Laskey W.;
Beach D.; Lopez J.; Davis A.; Faxon D.; Reutrakul S.; Bayer E.; Marroquin
O.; Cohen H.; Korytkowski M.; Koerbel G.; Baxendell L.; Rosenfelder D.;
DeRiso L.; Farrell C.; Vita T.; McGill J.; Krone R.; Bach R.; Recklein C.;
Luepke K.M.; Clifton M.J.; Farkouh M.E.; Kim M.C.; Smith D.A.; Guzman I.;
Travis A.; O'Keefe J.; Forker A.; Isley W.; Moe R.; Kennedy P.; Rosson M.;
Long A.; Bates E.; Herman W.; Pop-Busui R.; Duvernoy C.; Stevens M.;
Luciano A.; Majors C.; Rodriguez A.; Herr M.; Williams D.; Smith R.J.;
Abbott J.D.; Laufgraben M.J.; Grogan M.; Muratori J.; Habib G.; Marcelli
M.; Mikati I.; Cordero E.; Caldwell G.; Schechter D.; Lorber D.; Brown M.;
Depree P.; Huber K.; Hanusch-Enserer U.; Jordanova N.; Cilesiz D.; Vogel
B.; McCallister B.; Kleerekoper M.; Mandagere K.; Urbanic R.; Bengston J.;
Kong B.K.; Pruitt A.; Sanfield J.; Carulli C.; Churley-Strom R.; Magorien
R.; Osei K.; Boyer C.C.; Lee R.; Palumbo P.; Wisbey J.; Alderman E.; Ikeno
F.; Michael Steffes A.S.; Nowicki M.; Bucksa J.; Chaitman B.; Eckstein J.;
Stocke K.; Hlatky M.A.; Boothroyd D.B.; Melsop K.A.; Sobel B.E.; Rowen M.;
Neimane D.; Iskandrian A.E.; Schaaf M.B.; Bongarno T.; August P.; Hultberg
K.; Gottlieb S.H.; Albu J.; Rosenhouse-Romeo H.; Orchard T.J.; Pambianco
G.; Lombardero M.; Mock M.; Frye R.L.; Brooks M.M.; Desvigne-Nickens P.;
Ershow A.; Genuth S.; Goldberg S.; Hardison R.; Jones T.L.Z.; Kelsey S.;
Nesto R.; Orchard T.; Paltoo D.; Rosenberg Y.; Ryan T.; Lebovitz H.; Brown
R.; Friesinger G.; Horton E.; Mason J.; Virmani R.; Wechsler L.;
Bairey-Merz C.N.; Kennedy J.W.; Gordon D.; Antman E.; Colwell J.; Fowler
S.; Furberg C.; Goldman L.; Jennings B.; Rankin S.
Institution
(Ikeno, Nakagawa, Kim, Kaneda, Mitsutake, Waseda, Hlatky) Division of
Cardiovascular Medicine, Stanford University School of Medicine, Stanford,
California, United States
(Brooks, Vlachos, Kelsey) Department of Epidemiology, University of
Pittsburgh, Pittsburgh, Pennsylvania, United States
(Schwartz) Division of Cardiology, University Health Network-Toronto
General Hospital, Toronto, Ontario, Canada
(Frye) Division of Cardiovascular Diseases, Mayo Clinic, Rochester,
Minnesota, United States
(Hlatky) Department of Health Research and Policy, Stanford University
School of Medicine, Stanford, California, United States
Title
SYNTAX Score and Long-Term Outcomes: The BARI-2D Trial.
Source
Journal of the American College of Cardiology. 69 (4) (pp 395-403), 2017.
Date of Publication: 31 Jan 2017.
Publisher
Elsevier USA
Abstract
Background The extent of coronary disease affects clinical outcomes and
may predict the effectiveness of coronary revascularization with either
coronary artery bypass graft (CABG) surgery or percutaneous coronary
intervention (PCI). The SYNTAX (Synergy Between Percutaneous Coronary
Intervention With Taxus and Cardiac Surgery) score quantifies the extent
of coronary disease. Objectives This study sought to determine whether
SYNTAX scores predicted outcomes and the effectiveness of coronary
revascularization compared with medical therapy in the BARI-2D (Bypass
Angioplasty Revascularization Investigation 2 Diabetes) trial. Methods
Baseline SYNTAX scores were retrospectively calculated for BARI-2D
patients without prior revascularization (N = 1,550) by angiographic
laboratory investigators masked to patient characteristics and outcomes.
The primary outcome was major cardiovascular events (a composite of death,
myocardial infarction, and stroke) over 5 years. Results A mid/high SYNTAX
score (>=23) was associated with a higher risk of major cardiovascular
events (hazard ratio: 1.36, confidence interval: 1.07 to 1.75, p = 0.01).
Patients in the CABG stratum had significantly higher SYNTAX scores: 36%
had mid/high SYNTAX scores compared with 13% in the PCI stratum (p <
0.001). Among patients with low SYNTAX scores (<=22), major cardiovascular
events did not differ significantly between revascularization and medical
therapy, either in the CABG stratum (26.1% vs. 29.9%, p = 0.41) or in the
PCI stratum (17.8% vs. 19.2%, p = 0.84). Among patients with mid/high
SYNTAX scores, however, major cardiovascular events were lower after
revascularization than with medical therapy in the CABG stratum (15.3% vs.
30.3%, p = 0.02), but not in the PCI stratum (35.6% vs. 26.5%, p = 0.12).
Conclusions Among patients with diabetes and stable ischemic heart
disease, higher SYNTAX scores predict higher rates of major cardiovascular
events and were associated with more favorable outcomes of
revascularization compared with medical therapy among patients suitable
for CABG. (Bypass Angioplasty Revascularization Investigation in Type 2
Diabetes; NCT00006305)<br/>Copyright &#xa9; 2017 American College of
Cardiology Foundation

<37>
Accession Number
614188736
Author
Kapadia S.R.; Mehran R.; Lazar R.M.; Zivadinov R.; Dwyer M.G.; Jilaihawi
H.; Virmani R.; Thourani V.H.; Chakravarty T.; Nakamura M.; McCabe J.M.;
Szeto W.Y.; Svensson L.; Alu M.C.; White R.M.; Kraemer C.; Parhizgar A.;
Leon M.B.; Makkar R.; Al-Jilaihawi H.; Kapadia S.; Krishnaswamy A.; Tuzcu
E.M.; Mick S.; Kodali S.; Nazif T.; Thourani V.; Babaliaros V.; Devireddy
C.; Mavromatis K.; Waksman R.; Satler L.; Pichard A.; Szeto W.; Anwaruddin
S.; Vallabhajosyula P.; Giri J.; Herrmann H.; Zajarias A.; Lasala J.;
Greenbaum A.; O'Neill W.; Eng M.; Rovin J.; Lin L.; Spriggs D.; Wong
S.-C.; Bergman G.; Salemi A.; Smalling R.; Kar B.; Loyalka P.; Lim D.S.;
Ragosta M.; Reisman M.; McCabe J.; Don C.; Sharma S.; Kini A.; Dangas G.;
Mahoney P.; Morse A.; Stankewicz M.; Rodriguez E.; Linke A.; Mangner N.;
Woitek F.; Frerker C.; Cohen D.
Institution
(Kapadia, Krishnaswamy, Mick, Svensson) Cleveland Clinic, Cleveland, Ohio,
United States
(Kodali, Lazar, Nazif, Alu, Leon) Columbia University Medical Center, New
York, New York, United States
(Makkar, Chakravarty, Nakamura) Cedars-Sinai Medical Center, Los Angeles,
California, United States
(Mehran) Mount Sinai School of Medicine, New York, New York, United States
(Zivadinov, Dwyer) Buffalo Neuroimaging Analysis Center, Buffalo, New
York, United States
(Jilaihawi) NYU Langone Medical Center, New York, New York, United States
(Virmani) CV Path Institute, Gaithersburg, Maryland, United States
(Anwaruddin, Szeto) University of Pennsylvania, Philadelphia,
Pennsylvania, United States
(Thourani) Emory University, Atlanta, Georgia
(Mangner, Woitek, Linke) Herzzentrum Leipzig GmbH-Universitatsklinik,
Leipzig, Germany
(McCabe) University of Washington, Seattle, Washington, United States
(Satler) Medstar Washington Hospital Center, Washington, DC, United States
(Zajarias) Washington University School of Medicine, St. Louis, Missouri,
United States
(White) Duke Clinical Research Institute, Durham, North Carolina, United
States
(Kraemer) NAMSA, Minneapolis, Minnesota, United States
(Parhizgar) Claret Medical, Inc., Santa Rosa, California, United States
(Linke) Leipzig Heart Institute, Leipzig, Germany
Title
Protection Against Cerebral Embolism During Transcatheter Aortic Valve
Replacement.
Source
Journal of the American College of Cardiology. 69 (4) (pp 367-377), 2017.
Date of Publication: 31 Jan 2017.
Publisher
Elsevier USA
Abstract
Background Neurological complications after transcatheter aortic valve
replacement (TAVR) may be reduced with transcatheter cerebral embolic
protection (TCEP). Objectives This study evaluated the safety and efficacy
of TCEP during TAVR. Methods Nineteen centers randomized 363 patients
undergoing TAVR to a safety arm (n = 123), device imaging (n = 121), and
control imaging (n = 119). The primary safety endpoint consisted of major
adverse cardiac and cerebrovascular events (MACCE) at 30 days, and the
primary efficacy endpoint was reduction in new lesion volume in protected
brain territories on magnetic resonance imaging scans at 2 to 7 days.
Patients underwent neurocognitive assessments, and the debris captured was
analyzed. Results The rate of MACCE (7.3%) was noninferior to the
performance goal (18.3%, p<inf>noninferior</inf> < 0.001) and not
statistically different from that of the control group (9.9%; p = 0.41).
New lesion volume was 178.0 mm³ in control subjects and 102.8
mm³ in the device arm (p = 0.33). A post hoc multivariable
analysis identified pre-existing lesion volume and valve type as
predictors of new lesion volume. Strokes at 30 days were 9.1% in control
subjects and 5.6% in patients with devices (p = 0.25) Neurocognitive
function was similar in control subjects and patients with devices, but
there was a correlation between lesion volume and neurocognitive decline
(p = 0.0022). Debris found within filters in 99% of patients included
thrombus, calcification, valve tissue, artery wall, and foreign material.
Conclusions TCEP was safe, captured embolic debris in 99% of patients, and
did not change neurocognitive function. Reduction in new lesion volume on
magnetic resonance scans was not statistically significant. (Cerebral
Protection in Transcatheter Aortic Valve Replacement [SENTINEL];
NCT02214277)<br/>Copyright &#xa9; 2017 American College of Cardiology
Foundation

<38>
Accession Number
614638989
Author
Menting T.P.; Wever K.E.; Ozdemir-van Brunschot D.M.; Van der Vliet
D.J.A.; Rovers M.M.; Warle M.C.
Institution
(Menting, Wever, Ozdemir-van Brunschot, Van der Vliet, Warle) Radboud
University Nijmegen Medical Centre, Department of Surgery, Geert
Grooteplein Zuid 10, Nijmegen, Gelderland 6525 GA, Netherlands
(Rovers) Radboud University Nijmegen Medical Centre, Department of
Operating Rooms, Hp 630, route 631, PO Box 9101, Nijmegen 6500 HB,
Netherlands
Title
Ischaemic preconditioning for the reduction of renal ischaemia reperfusion
injury.
Source
Cochrane Database of Systematic Reviews. 2017 (3) (no pagination), 2017.
Article Number: CD010777. Date of Publication: 04 Mar 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Ischaemia reperfusion injury can lead to kidney dysfunction or
failure. Ischaemic preconditioning is a short period of deprivation of
blood supply to particular organs or tissue, followed by a period of
reperfusion. It has the potential to protect kidneys from ischaemia
reperfusion injury. Objectives: This review aimed to look at the benefits
and harms of local and remote ischaemic preconditioning to reduce
ischaemia and reperfusion injury among people with renal ischaemia
reperfusion injury. Search methods: We searched Cochrane Kidney and
Transplant's Specialised Register to 5 August 2016 through contact with
the Information Specialist using search terms relevant to this review.
Selection criteria: We included all randomised controlled trials measuring
kidney function and the role of ischaemic preconditioning in patients
undergoing a surgical intervention that induces kidney injury. Kidney
transplantation studies were excluded. Data collection and analysis:
Studies were assessed for eligibility and quality; data were extracted by
two independent authors. We collected basic study characteristics: type of
surgery, remote ischaemic preconditioning protocol, type of anaesthesia.
We collected primary outcome measurements: serum creatinine and adverse
effects to remote ischaemic preconditioning and secondary outcome
measurements: acute kidney injury, need for dialysis, neutrophil
gelatinase-associated lipocalin, hospital stay and mortality. Summary
estimates of effect were obtained using a random-effects model, and
results were expressed as risk ratios (RR) and their 95% confidence
intervals (CI) for dichotomous outcomes, and mean difference (MD) and 95%
CI for continuous outcomes. Main results: We included 28 studies which
randomised a total of 6851 patients. Risk of bias assessment indicated
unclear to low risk of bias for most studies. For consistency regarding
the direction of effects, continuous outcomes with negative values, and
dichotomous outcomes with values less than one favour remote ischaemic
preconditioning. Based on high quality evidence, remote ischaemic
preconditioning made little or no difference to the reduction of serum
creatinine levels at postoperative days one (14 studies, 1022
participants: MD -0.02 mg/dL, 95% CI -0.05 to 0.02; I² = 21%),
two (9 studies, 770 participants: MD -0.04 mg/dL, 95% CI -0.09 to 0.02;
I² = 31%), and three (6 studies, 417 participants: MD -0.05
mg/dL, 95% CI -0.19 to 0.10; I² = 68%) compared to control.
Serious adverse events occurred in four patients receiving remote
ischaemic preconditioning by iliac clamping. It is uncertain whether
remote ischaemic preconditioning by cuff inflation leads to increased
adverse effects compared to control because the certainty of the evidence
is low (15 studies, 3993 participants: RR 3.47, 95% CI 0.55 to 21.76;
I² = 0%); only two of 15 studies reported any adverse effects
(6/1999 in the remote ischaemic preconditioning group and 1/1994 in the
control group), the remaining 13 studies stated no adverse effects were
observed in either group. Compared to control, remote ischaemic
preconditioning made little or no difference to the need for dialysis (13
studies, 2417 participants: RR 0.85, 95% CI 0.37 to 1.94; I² =
60%; moderate quality evidence), length of hospital stay (8 studies, 920
participants: MD 0.17 days, 95% CI -0.46 to 0.80; I² = 49%,
high quality evidence), or all-cause mortality (24 studies, 4931
participants: RR 0.86, 95% CI 0.54 to 1.37; I² = 0%, high
quality evidence). Remote ischaemic preconditioning may have slightly
improved the incidence of acute kidney injury using either the AKIN (8
studies, 2364 participants: RR 0.76, 95% CI 0.57 to 1.00; I² =
61%, high quality evidence) or RIFLE criteria (3 studies, 1586
participants: RR 0.91, 95% CI 0.75 to 1.12; I² = 0%, moderate
quality evidence). Authors' conclusions: Remote ischaemic preconditioning
by cuff inflation appears to be a safe method, and probably leads to
little or no difference in serum creatinine, adverse effects, need for
dialysis, length of hospital stay, death and in the incidence of acute
kidney injury. Overall we had moderate-high certainty evidence however the
available data does not confirm the efficacy of remote ischaemic
preconditioning in reducing renal ischaemia reperfusion injury in patients
undergoing major cardiac and vascular surgery in which renal ischaemia
reperfusion injury may occur.<br/>Copyright &#xa9; 2017 The Cochrane
Collaboration. Published by John Wiley & Sons, Ltd.

<39>
Accession Number
614830258
Author
Redden M.D.; Chin T.Y.; van Driel M.L.
Institution
(Redden) Ipswich Hospital, Ipswich, QLD, Australia
(Chin) The Prince Charles Hospital, Rode Road, Chermside, QLD 4032,
Australia
(Chin) The University of Queensland, School of Medicine, 288 Herston Road,
Brisbane, QLD 4006, Australia
(van Driel) The University of Queensland, Primary Care Clinical Unit,
Faculty of Medicine, Brisbane, QLD 4029, Australia
Title
Surgical versus non-surgical management for pleural empyema.
Source
Cochrane Database of Systematic Reviews. 2017 (3) (no pagination), 2017.
Article Number: CD010651. Date of Publication: 17 Mar 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Empyema refers to pus in the pleural space, commonly due to
adjacent pneumonia, chest wall injury, or a complication of thoracic
surgery. A range of therapeutic options are available for its management,
ranging from percutaneous aspiration and intercostal drainage to
video-assisted thoracoscopic surgery (VATS) or thoracotomy drainage.
Intrapleural fibrinolytics may also be administered following intercostal
drain insertion to facilitate pleural drainage. There is currently a lack
of consensus regarding optimal treatment. Objectives: To assess the
effectiveness and safety of surgical versus non-surgical treatments for
complicated parapneumonic effusion or pleural empyema. Search methods: We
searched the Cochrane Central Register of Controlled Trials (CENTRAL)
(2016, Issue 9), MEDLINE (Ebscohost) (1946 to July week 3 2013, July 2015
to October 2016) and MEDLINE (Ovid) (1 May 2013 to July week 1 2015),
Embase (2010 to October 2016), CINAHL (1981 to October 2016) and LILACS
(1982 to October 2016) on 20 October 2016. We searched ClinicalTrials.gov
and WHO International Clinical Trials Registry Platform for ongoing
studies (December 2016). Selection criteria: Randomised controlled trials
that compared a surgical with a non-surgical method of management for all
age groups with pleural empyema. Data collection and analysis: Two review
authors independently assessed trials for inclusion and risk of bias,
extracted data, and checked the data for accuracy. We contacted trial
authors for additional information. We assessed the quality of the
evidence using the GRADE approach. Main results: We included eight
randomised controlled trials with a total of 391 participants. Six trials
focused on children and two on adults. Trials compared tube thoracostomy
drainage (non-surgical), with or without intrapleural fibrinolytics, to
either VATS or thoracotomy (surgical) for the management of pleural
empyema. Assessment of risk of bias for the included studies was generally
unclear for selection and blinding but low for attrition and reporting
bias. Data analyses compared thoracotomy versus tube thoracostomy and VATS
versus tube thoracostomy. We pooled data for meta-analysis where
appropriate. We performed a subgroup analysis for children along with a
sensitivity analysis for studies that used fibrinolysis in non-surgical
treatment arms. The comparison of open thoracotomy versus thoracostomy
drainage included only one study in children, which reported no deaths in
either treatment arm. However, the trial showed a statistically
significant reduction in mean hospital stay of 5.90 days for those treated
with primary thoracotomy. It also showed a statistically significant
reduction in procedural complications for those treated with thoracotomy
compared to thoracostomy drainage. We downgraded the quality of the
evidence for length of hospital stay and procedural complications outcomes
to moderate due to the small sample size. The comparison of VATS versus
thoracostomy drainage included seven studies, which we pooled in a
meta-analysis. There was no statistically significant difference in
mortality or procedural complications between groups. This was true for
both adults and children with or without fibrinolysis. However, mortality
data were limited: one study reported one death in each treatment arm, and
seven studies reported no deaths. There was a statistically significant
reduction in mean length of hospital stay for those treated with VATS. The
subgroup analysis showed the same result in adults, but there was
insufficient evidence to estimate an effect for children. We could not
perform a separate analysis for fibrinolysis for this outcome because all
included studies used fibrinolysis in the non-surgical arms. We downgraded
the quality of the evidence to low for mortality (due to wide confidence
intervals and indirectness), and moderate for other outcomes in this
comparison due to either high heterogeneity or wide confidence intervals.
Authors' conclusions: Our findings suggest there is no statistically
significant difference in mortality between primary surgical and
non-surgical management of pleural empyema for all age groups.
Video-assisted thoracoscopic surgery may reduce length of hospital stay
compared to thoracostomy drainage alone. There was insufficient evidence
to assess the impact of fibrinolytic therapy. A number of common outcomes
were reported in the included studies that were not directly examined in
our primary and secondary outcomes. These included duration of chest tube
drainage, duration of fever, analgesia requirement, and total cost of
treatment. Future studies focusing on patient-centred outcomes, such as
patient functional scores, and other clinically relevant outcomes, such as
radiographic improvement, treatment failure rates, and amount of fluid
drainage, are needed to inform clinical decisions.<br/>Copyright &#xa9;
2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

<40>
Accession Number
614805231
Author
Al-Khudairy L.; Flowers N.; Wheelhouse R.; Ghannam O.; Hartley L.;
Stranges S.; Rees K.
Institution
(Al-Khudairy, Flowers, Wheelhouse, Ghannam, Hartley, Stranges, Rees)
Warwick Medical School, University of Warwick, Division of Health
Sciences, Coventry CV4 7AL, United Kingdom
Title
Vitamin C supplementation for the primary prevention of cardiovascular
disease.
Source
Cochrane Database of Systematic Reviews. 2017 (3) (no pagination), 2017.
Article Number: CD011114. Date of Publication: 16 Mar 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Vitamin C is an essential micronutrient and powerful
antioxidant. Observational studies have shown an inverse relationship
between vitamin C intake and major cardiovascular events and
cardiovascular disease (CVD) risk factors. Results from clinical trials
are less consistent. Objectives: To determine the effectiveness of vitamin
C supplementation as a single supplement for the primary prevention of
CVD. Search methods: We searched the following electronic databases on 11
May 2016: the Cochrane Central Register of Controlled Trials (CENTRAL) in
the Cochrane Library; MEDLINE (Ovid); Embase Classic and Embase (Ovid);
Web of Science Core Collection (Thomson Reuters); Database of Abstracts of
Reviews of Effects (DARE); Health Technology Assessment Database and
Health Economics Evaluations Database in the Cochrane Library. We searched
trial registers on 13 April 2016 and reference lists of reviews for
further studies. We applied no language restrictions. Selection criteria:
Randomised controlled trials of vitamin C supplementation as a single
nutrient supplement lasting at least three months and involving healthy
adults or adults at moderate and high risk of CVD were included. The
comparison group was no intervention or placebo. The outcomes of interest
were CVD clinical events and CVD risk factors. Data collection and
analysis: Two review authors independently selected trials for inclusion,
abstracted the data and assessed the risk of bias. Main results: We
included eight trials with 15,445 participants randomised. The largest
trial with 14,641 participants provided data on our primary outcomes.
Seven trials reported on CVD risk factors. Three of the eight trials were
regarded at high risk of bias for either reporting or attrition bias, most
of the 'Risk of bias' domains for the remaining trials were judged as
unclear, with the exception of the largest trial where most domains were
judged to be at low risk of bias. The composite endpoint, major CVD events
was not different between the vitamin C and placebo group (hazard ratio
(HR) 0.99, 95% confidence interval (CI) 0.89 to 1.10; 1 study; 14,641
participants; low-quality evidence) in the Physicians Health Study II over
eight years of follow-up. Similar results were obtained for all-cause
mortality HR 1.07, 95% CI 0.97 to 1.18; 1 study; 14,641 participants; very
low-quality evidence, total myocardial infarction (MI) (fatal and
non-fatal) HR 1.04 (95% CI 0.87 to 1.24); 1 study; 14,641 participants;
low-quality evidence, total stroke (fatal and non-fatal) HR 0.89 (95% CI
0.74 to 1.07); 1 study; 14,641 participants; low-quality evidence, CVD
mortality HR 1.02 (95% 0.85 to 1.22); 1 study; 14,641 participants; very
low-quality evidence, self-reported coronary artery bypass grafting
(CABG)/percutaneous transluminal coronary angioplasty (PTCA) HR 0.96 (95%
CI 0.86 to 1.07); 1 study; 14,641 participants; low-quality evidence,
self-reported angina HR 0.93 (95% CI 0.84 to 1.03); 1 study; 14,641
participants; low-quality evidence. The evidence for the majority of
primary outcomes was downgraded (low quality) because of indirectness and
imprecision. For all-cause mortality and CVD mortality, the evidence was
very low because more factors affected the directness of the evidence and
because of inconsistency. Four studies did not state sources of funding,
two studies declared non-commercial funding and two studies declared both
commercial and non-commercial funding. Authors' conclusions: Currently,
there is no evidence to suggest that vitamin C supplementation reduces the
risk of CVD in healthy participants and those at increased risk of CVD,
but current evidence is limited to one trial of middle-aged and older male
physicians from the USA. There is limited low- and very low-quality
evidence currently on the effect of vitamin C supplementation and risk of
CVD risk factors.<br/>Copyright &#xa9; 2017 The Cochrane Collaboration.
Published by John Wiley & Sons, Ltd.

<41>
Accession Number
617399337
Author
An R.; Pang Q.-Y.; Chen B.; Liu H.-L.
Institution
(An, Pang, Chen, Liu) Department of Anesthesiology, Chongqing Cancer
Institute, Hospital Cancer Center, Hanyu Road, 181, Shapingba District,
Chongqing City 400030, China
Title
Effect of anesthesia methods on postoperative major adverse cardiac events
and mortality after non-cardiac surgeries: A systematic review and
meta-analysis.
Source
Minerva Anestesiologica. 83 (7) (pp 749-761), 2017. Date of Publication:
July 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: Postoperative major adverse cardiac events (MACEs) are the
main cause of postoperative mortality, and controversies exist regarding
the effects of anesthesia methods on postoperative MACEs and mortality in
high-risk cardiac patients after non-cardiac surgeries. EVIDENCE
ACQUISITION: A Meta-analysis about the effect of anesthesia methods on
postoperative MACEs and mortality in high-risk cardiac patients undergoing
intermediate- or high-risk non-cardiac surgeries was conducted; Chinese
databases (SinoMed, CNKI, Wanfang, and VIP) and English databases
(Medline, EMBASE, PubMed, Springer, Ovid, the Cochrane Library, and Google
scholar) were searched. EVIDENCE SYNTHESIS: Twenty-seven randomized
controlled trials (RCTs) were included and 35340 patients were involved.
The cardiac troponin I level (cTnI) on postoperative day 1 (MD: -0.39, 95%
CI: -0.45-0.34, P<0.00001) and the incidence of myocardial ischaemia (OR:
0.43, 95% CI: 0.27-0.68, P=0.0004) within 3 postoperative days were
significantly lower after sevoflurane anesthesia than propofol anesthesia.
There were no differences in postoperative MACEs or in mortality within
either 30 days or 1 year between sevoflurane and propofol anesthesia, or
between N2O and non-N2O anesthesia. The cTnI on postoperative day 3 was
significantly lower from epidural anesthesia combined with general
anesthesia (GA) than from GA alone (MD: -0.61, 95% CI: -0.75-0.47,
P<0.00001). However, there were no differences in myocardial infarction or
mortality between epidural anesthesia combined with GA and GA alone, or
between spinal anesthesia alone and GA alone. CONCLUSIONS: Sevoflurane
anesthesia, or epidural combined with general anesthesia can provide
short-term myocardial protective effect in high-risk cardiac patients
undergoing intermediate- or high-risk non-cardiac surgeries.<br/>Copyright
&#xa9; 2016 EDIZIONI MINERVA MEDICA.

<42>
Accession Number
617279769
Author
Krzysztof S.; Wojciech P.; Zbigniew S.; Mariusz K.; Remigiusz T.; Damian
P.; Magdalena S.; Marta T.; Lech A.; Alina B.
Institution
(Krzysztof, Magdalena, Marta, Alina) Department of Clinical
Neuropsychology, Nicolaus Copernicus University, Collegium Medicum,
Bydgoszcz, Poland
(Wojciech, Mariusz, Remigiusz, Damian, Lech) Department of Cardiac
Surgery, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz,
Poland
(Zbigniew) Department of Radiology, Nicolaus Copernicus University,
Collegium Medicum, Bydgoszcz, Poland
Title
CArbon dioxide surgical field flooding and aortic NO-touch off-pump
coronary artery bypass grafting to reduce Neurological injuries after
surgical coronary revascularisation (CANON): Protocol for a randomised,
controlled, investigator and patient blinded single-centre superiority
trial with three parallel arms.
Source
BMJ Open. 7 (7) (no pagination), 2017. Article Number: e016785. Date of
Publication: 01 Jul 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Neurological injuries remain a major concern following
coronary artery bypass grafting (CABG) that offsets survival benefit of
CABG over percutaneous coronary interventions. Among numerous efforts to
combat this issue is the development of off-pump CABG (OPCABG) that
obviates the need for extracorporeal circulation and is associated with
improved neurological outcomes. The objective of this study is to examine
whether the neuroprotective effect of OPCABG can be further pronounced by
the use of two state-of-the-art operating techniques. Methods and analysis
In this randomised, controlled, investigator and patient blinded
single-centre superiority trial with three parallel arms, a total of 360
patients will be recruited. They will be allocated in a 1:1:1 ratio to two
treatment arms and one control arm. Treatment arms undergoing either
aortic no-touch OPCABG or OPCABG with partial clamp applying carbon
dioxide surgical field flooding will be compared against control arm
undergoing OPCABG with partial clamp. The primary endpoint will be the
appearance of new lesions on control brain MRI 3 days after surgery.
Secondary endpoints will include the prevalence of new focal neurological
deficits in the first 7 days after surgery, the occurrence of
postoperative cognitive dysfunction at either 1 week or 3 months after
surgery and the incidence of delirium in the first 7 days after surgery.
Data will be analysed on intention-to-treat principles and a per protocol
basis. Ethics and dissemination Ethical approval has been granted for this
study. Results will be disseminated through peer-reviewed
media.<br/>Copyright &#xa9; Article author(s) (or their employer(s) unless
otherwise stated in the text of the article) 2017. All rights reserved.

<43>
Accession Number
615794052
Author
Van Der Heijden L.C.; Kok M.M.; Lowik M.M.; Danse P.W.; Jessurun G.A.J.;
Hartmann M.; Stoel M.G.; Van Houwelingen K.G.; Hautvast R.W.M.; Linssen
G.C.; Doggen C.J.M.; Von Birgelen C.
Institution
(Van Der Heijden, Kok, Lowik, Hartmann, Stoel, Van Houwelingen, Von
Birgelen) Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum
Twente, Enschede, Netherlands
(Danse) Department of Cardiology, Rijnstate Hospital, Arnhem, Netherlands
(Jessurun) Department of Cardiology, Treant Zorggroep, Emmen, Netherlands
(Hautvast) Department of Cardiology, Medical Center Alkmaar, Alkmaar,
Netherlands
(Linssen) Department of Cardiology, Ziekenhuisgroep Twente, Netherlands
(Doggen, Von Birgelen) Department of Health Technology and Services
Research, MIRA, Institute for Biomedical Technology and Technical
Medicine, University of Twente, Koningsplein 1, Enschede NL-7512,
Netherlands
Title
Three-Year Clinical Outcome of Patients with Coronary Disease and
Increased Event Risk Treated with Newer-Generation Drug-Eluting Stents:
From the Randomized Dutch PEERS Trial.
Source
Cardiology (Switzerland). 137 (4) (pp 207-217), 2017. Date of Publication:
01 Jul 2017.
Publisher
S. Karger AG
Abstract
Objective: Limited data is available on the long-term outcome of patients
with increased cardiovascular event risk, treated with newer-generation
durable polymer drug-eluting stents (DES). Methods: We therefore assessed
3-year follow-up data of high-risk versus low-to intermediate-risk
patients of the randomized DUTCH PEERS trial (NCT01331707). In both risk
groups we also compared patients treated with Resolute Integrity versus
Promus Element DES. Patients were categorized as "high-risk" if they met
>=1 of the following criteria: (1) diabetes (17.9%); (2) previous
myocardial infarction (21.9%); (3) previous coronary revascularization
(25.8%); (4) chronic renal failure (3.5%); (5) left ventricular ejection
fraction <=30% (1.5%); and (6) age >=75 years (17.3%). Results: At the
3-year follow-up, the incidence of the composite endpoint target vessel
failure (TVF) (13.2 vs. 7.5%; logrank p < 0.001) and 2 of its
components-cardiac death (4.7 vs. 1.5%; logrank p < 0.001) and target
vessel revascularization (7.3 vs. 4.7%; logrank p = 0.03)-was higher in
high-risk (n = 957) versus low-to intermediate-risk patients (n = 854).
Among high-risk patients, treatment with Resolute Integrity (n = 481) and
Promus Element stents (n = 476) was similarly safe and efficacious (TVF:
13.3 vs. 13.1%; logrank p = 0.95; definite-or-probable stent thrombosis:
1.7 vs. 1.7%; logrank p = 1.00). Conclusions: The newer-generation
Resolute Integrity and Promus Element stents showed similar results in
terms of safety and efficacy for treating high-risk patients, who had
significantly higher event rates than patients with low-to-intermediate
risk.<br/>Copyright &#xa9; 2017 S. Karger AG, Basel.

<44>
Accession Number
617448862
Author
Hansen L.S.; Hjortdal V.E.; Jakobsen C.-J.; Heiberg J.; Maagaard M.; Sloth
E.
Institution
(Hansen) Aarhus University Hospital, Aarhus N, Denmark laurhans@rm.dk
(Hjortdal, Jakobsen, Heiberg, Maagaard, Sloth) Aarhus University Hospital,
Aarhus N, Denmark
Title
Early, dedicated follow-up and treatment of pleural effusions enhance the
recovery rate after open cardiac surgery: results from a randomized,
clinical trial.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 51 (1) (pp 58-66), 2017.
Date of Publication: 01 Jan 2017.
Abstract
OBJECTIVES: Recent studies conclude that cardiac surgery patients are
prone to both mortality and morbidity in the weeks after discharge.
Complications such as pleural and pericardial effusions may influence
physical recovery due to symptoms such as dyspnoea, chest pain and
fatigue. Dedicated follow-up and timely treatment of postoperative
complications are suggested.
METHODS: A randomized, controlled intervention trial including 76
patients, in the ratio of 1 : 1. Patients scheduled for elective on-pump
coronary artery bypass grafting and/or aortic valve replacement were
eligible for inclusion. Patients were randomized to either standard
postoperative care or complementary follow-up visits with clinical
examinations, focused chest sonography and protocol-driven thoracentesis
if applicable. Primary outcomes were the mean change in walking distance,
peak expiratory flow and EuroQOL from baseline to 30 days after surgery.
RESULTS: The mean difference in walking distance after 30 days was 15% (65
+/- 22 m) between groups, P = 0.017. No differences were found in the peak
expiratory flow or EuroQOL. In patients with pleural effusion, walking
distance improved by 22% after thoracentesis (81 +/- 42 m), P < 0.0001,
and peak expiratory flow improved by 26% (1.1 +/- 1.2 l/min), P < 0.001.
CONCLUSIONS: Supplemental dedicated follow-up and treatment of
postoperative effusions enhance recovery by 15% compared with standard
care, measured by improvement in the walking distance 1 month after
cardiac surgery.
CLINICAL TRIAL REGISTRATION:
https://clinicaltrials.gov/ct2/show/NCT02045641.
UNIQUE IDENTIFIER: NCT02045641.<br/>Copyright &#xa9; The Author 2016.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<45>
Accession Number
617449772
Author
Schimmer C.; Gross J.; Ramm E.; Morfeld B.-C.; Hoffmann G.; Panholzer B.;
Hedderich J.; Leyh R.; Cremer J.; Petzina R.
Institution
(Schimmer, Morfeld, Leyh) Department of Cardiothoracic and Thoracic
Vascular Surgery, University Hospital Wurzburg, Wurzburg, Germany
(Gross, Ramm, Hoffmann, Panholzer, Cremer, Petzina) Department of
Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus
Kiel, Kiel, Germany
(Hedderich) Institute of Medical Informatics and Statistics, University
Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
Title
Prevention of surgical site sternal infections in cardiac surgery: a
two-centre prospective randomized controlled study.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 51 (1) (pp 67-72), 2017.
Date of Publication: 01 Jan 2017.
Abstract
OBJECTIVES: Surgical site infection (SSI) of the sternum is a devastating
complication in cardiac surgery. The aim of this prospective randomized
controlled two-centre clinical study was to compare the use of a
gentamicin-collagen sponge (Genta-Coll resorb) and of a
cyanoacrylate-based microbial skin sealant (InteguSeal) on the SSI rate of
the sternum.
METHODS: We analysed data from 996 consecutive patients following isolated
coronary artery bypass grafting between 2012 and 2014. The patients were
randomized into three groups: standard group (S-group), Genta-Coll group
(G-group) and InteguSeal group (I-group). The primary study end-point was
to analyse the incidence of superficial and deep sternal SSI. The
secondary study end-point was to determine independent risk factors for an
increased SSI rate.
RESULTS: Of the 996 patients investigated, 332 patients were in S-group,
336 patients in G-group and 328 patients in I-group. The mean age was 67.7
+/- 9.4 years, 18.6% were women and the overall SSI rate was 6.2% with
2.2% deep sternal wound infections. SSI rates were 8.3% (S-group), 5.4%
(G-group) and 4.9% (I-group) (P 0.16). Multiple regression analysis
demonstrated a preoperative body mass index (BMI) of >30 kg/m2 (P 0.047),
re-thoracotomy for postoperative bleeding (P < 0.001) and sternum
instability (P < 0.001) as independent predictors for an increased SSI
rate.
CONCLUSIONS: The application of InteguSeal or Genta-Coll resorb had no
significant influence on the incidence of the sternal SSI rate in 996
consecutive cardiac surgery patients but demonstrated a trend towards a
benefit from using these prophylactic approaches. Multiple regression
analysis demonstrated a preoperative BMI of >30 kg/m2, re-thoracotomy for
bleeding and sternum instability as independent predictors for an
increased sternal SSI rate.<br/>Copyright &#xa9; The Author 2016.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<46>
Accession Number
617440357
Author
Borges D.L.; Silva M.G.; Silva L.N.; Fortes J.V.; Costa E.T.; Assuncao
R.P.; Lima C.M.; da Silva Nina V.J.; Bernardo-Filho M.; Caputo D.S.
Title
Effects of Aerobic Exercise Applied Early After Coronary Artery Bypass
Grafting on Pulmonary Function, Respiratory Muscle Strength, and
Functional Capacity: A Randomized Controlled Trial.
Source
Journal of physical activity & health. 13 (9) (pp 946-951), 2016. Date of
Publication: 01 Sep 2016.
Abstract
BACKGROUND: Physical activity is beneficial in several clinical situations
and recommended for patients with ischemic heart disease, as well as for
those undergoing cardiac surgery.
METHODS: In a randomized controlled trial, 34 patients underwent coronary
artery bypass grafting. A randomized control group (n = 15) submitted to
conventional physiotherapy. The intervention group (n = 19) received the
same protocol plus additional aerobic exercise with cycle ergometer.
Pulmonary function by spirometry, respiratory muscle strength by
manovacuometry, and functional capacity through 6-minute walking test was
assessed before surgery and at hospital discharge.
RESULTS: There was significant reduction in pulmonary function in both
groups. In both groups, inspiratory muscle strength was maintained while
expiratory muscle strength significantly decreased. Functional capacity
was maintained in the intervention group (364.5 [324.5 to 428] vs. 348
[300.7 to 413.7] meters, P = .06), but it decreased significantly in
control group patients (320 [288.5 to 393.0] vs. 292 [237.0 to 336.0]
meters, P = .01). A significant difference in functional capacity was also
found in intergroup analyses at hospital discharge (P = .03).
CONCLUSION: Aerobic exercise applied early on coronary artery bypass
grafting patients may promote maintenance of functional capacity, with no
impact on pulmonary function and respiratory muscle strength when compared
with conventional physiotherapy.

<47>
Accession Number
617416017
Author
Salih M.; Smer A.; Charnigo R.; Ayan M.; Darrat Y.H.; Traina M.; Morales
G.X.; DiBiase L.; Natale A.; Elayi C.S.
Institution
(Salih) University of Kentucky, Department of Internal Medicine,
Lexington, KY, United States
(Smer) Creighton University School of Medicine, Department of
Cardiovascular Medicine, Omaha, NE, United States
(Charnigo) University of Kentucky, Departments of Biostatistics and
Statistics, Lexington, KY, United States
(Ayan) University of Arkansas Medical Science, Department of
Cardiovascular Medicine, Little Rock, AR, United States
(Darrat, Morales, Elayi) University of Kentucky, Gill Heart Institute and
VAMC, Department of Cardiovascular Medicine, Lexington, KY, United States
(Traina) Cleveland Clinic Abu Dhabi, Department of Cardiovascular
Medicine, Abu Dhabi, United Arab Emirates
(DiBiase, Natale) Texas Cardiac Arrhythmia Institute at St. David's
Medical Center, Austin, TX, United States
Title
Colchicine for prevention of post-cardiac procedure atrial fibrillation:
Meta-analysis of randomized controlled trials.
Source
International Journal of Cardiology. 243 (pp 258-262), 2017. Date of
Publication: 15 Sep 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Development of atrial fibrillation after certain cardiac
procedures is a common medical problem. The inflammatory process plays an
important role in the pathogenesis of post-cardiac procedure atrial
fibrillation (PCP-AF). Colchicine, a potent anti-inflammatory agent, has
been used in several studies to reduce the risk of PCP-AF. This
meta-analysis of randomized controlled trials (RCTs) was conducted to
assess the efficacy of colchicine in prevention of PC-PAF. Methods We
searched PubMed, EMBASE, Web of Science, Cochrane Library database and
Google Scholar for RCTs, using terms "Atrial fibrillation, atrial, or
fibrillation and colchicine". The primary end-point was the occurrence of
AF post cardiac procedure, which includes cardiac surgery or pulmonary
vein isolation. The safety end point was the occurrence of any side
effects. Estimated odds ratios (OR) and 95% confidence intervals (CI) were
evaluated. Results A total of six RCTs were included in this
meta-analysis, enrolling a total of 1257 patients. Colchicine
significantly reduced the odds of PCP-AF (OR 0.52; 95% CI, 0.40-0.68, P <
0.001, I² = 0%). However, occurrence of side effects was
significantly higher with colchicine when compared to placebo (OR 2.10;
95% CI, 1.34-3.30, P < 0.001, I² = 0%). The number needed to
treat is 7 and the number needed to harm is 11.2. The proportion of
patients discontinuing treatment was 16%. Conclusion This meta-analysis
shows that colchicine is an effective drug for prevention of PCP-AF.
Colchicine could be considered as a prophylaxis to reduce PCP-AF, with
some risk of treatment discontinuation due to the poor gastrointestinal
tolerance (diarrhea).<br/>Copyright &#xa9; 2017 Elsevier B.V.

<48>
Accession Number
617384012
Author
Tamura T.; Yatabe T.; Yokoyama M.
Institution
(Tamura, Yatabe, Yokoyama) Department of Anesthesiology and Intensive Care
Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku City, Kochi
783-8505, Japan
Title
Prevention of atrial fibrillation after cardiac surgery using low-dose
landiolol: A systematic review and meta-analysis.
Source
Journal of Clinical Anesthesia. 42 (pp 1-6), 2017. Date of Publication:
November 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective Atrial fibrillation (AF) is associated with mortality
after cardiac surgery. Several studies have reported that landiolol might
help to prevent postoperative AF. The objective of this study was to
investigate whether low-dose landiolol is useful in terms of balance of
benefit and risk. Design We conducted a meta-analysis after systematically
searching the PubMed, the Cochrane library and the ICHUSHI to identify
randomized, controlled trials investigating the preventive effect of
landiolol on incidence of AF after cardiac surgery. Patients Six
randomized trial with 571 patients were included. Measurements The primary
outcome was incidence of AF after surgery, while secondary outcomes were
mortality and complications. Main results Incidence of AF within 1 week
after surgery was significantly lower in the landiolol group than in the
control group (odds ratio, 0.27; 95% confidence interval, 0.18-0.42; p <
0.001). Three of the 6 studies reported data regarding in-hospital
mortality and complications, showing no significant differences between
groups (0.7 vs 3.0%; OR, 0.45; 95% CI, 0.07-2.74; p = 0.39; and 4.5 vs
9.7%; OR, 0.45; 95% CI, 0.16-1.23; p = 0.12, respectively). Conclusions
Our systematic review revealed that low-dose landiolol might help to
prevent AF after cardiac surgery and further large trials are needed to
evaluate safety because mortality and morbidity rate were very low in
included studies.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<49>
Accession Number
617432074
Author
Edwards F.H.; Cohen D.J.; O'Brien S.M.; Peterson E.D.; Mack M.J.; Shahian
D.M.; Grover F.L.; Tuzcu E.M.; Thourani V.H.; Carroll J.; Brennan J.M.;
Brindis R.G.; Rumsfeld J.; Holmes D.R.
Institution
(Edwards) Department of Surgery, University of Florida, College of
Medicine-Jacksonville, 653 W Eighth St, Jacksonville, FL 32209, United
States
(Cohen) Department of Medicine, St. Luke's Mid America Heart Institute,
Kansas City, MO, United States
(O'Brien, Peterson, Brennan) Duke Clinical Research Institute, Durham, NC,
United States
(Mack) Department of Cardiovascular Disease, Baylor Scott and White Health
Care System, Plano, TX, United States
(Shahian) Department of Surgery, Center for Quality and Safety,
Massachusetts General Hospital, Boston, United States
(Grover) Department of Surgery, University of Colorado, School of
Medicine, Aurora, United States
(Tuzcu) Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
(Thourani) Division of Cardiothoracic Surgery, Emory University, School of
Medicine, Atlanta, GA, United States
(Carroll, Rumsfeld) Department of Medicine, University of Colorado, School
of Medicine, Anschutz Medical Campus, Aurora, United States
(Brindis) Department of Medicine, Philip R. Lee Institute for Health
Policy Studies, University of California, San Francisco, United States
(Holmes) Department of Medicine, Mayo Clinic, Rochester, MN, United States
Title
Development and validation of a risk prediction model for in-hospital
mortality after transcatheter aortic valve replacement.
Source
JAMA Cardiology. 1 (1) (pp 46-52), 2016. Date of Publication: April 2016.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: Patient selection for transcatheter aortic valve replacement
(TAVR) should include assessment of the risks of TAVR compared with
surgical aortic valve replacement (SAVR). Existing SAVR risk models
accurately predict the risks for the population undergoing SAVR, but
comparable models to predict risk for patients undergoing TAVR are
currently not available and should be derived from a population that
underwent TAVR. OBJECTIVE: To use a national population of patients
undergoing TAVR to develop a statistical model that will predict
in-hospital mortality after TAVR. DESIGN, SETTING, AND PARTICIPANTS:
Patient data were obtained from the Society of Thoracic Surgeons/American
College of Cardiology Transcatheter Valve Therapy (STS/ACC TVT) Registry.
The model was developed from 13 718 consecutive US patients undergoing
TAVR in centers participating in the STS/ACC TVT Registry from November
1,2011, to February 28,2014. Validation was conducted using 6868 records
of consecutive patients undergoing TAVR from March 1 to October 8,2014.
Covariates were selected through a process of expert opinion and
statistical analysis. The association between in-hospital mortality and
baseline covariates was estimated using logistic regression. The final set
of predictors was selected via stepwise variable selection. Data were
collected and analyzed from November 1,2011, to February 28,2014. MAIN
OUTCOMES AND MEASURES: In-hospital TAVR mortality. RESULTS: The
development sample included 13 718 patient records from 265 participant
sites (of 13 672 with data available, 6680 men [48.9%]; 6992 women
[51.1%]; mean [SD] age, 82.1 [8.3] years). The final validation cohort
included 6868 patients from 314 participating centers (3554 men [51.7%];
3314 women [48.3%]; mean [SD]age, 81.6 [8.8] years). In-hospital mortality
occurred in 730 patients (5.3%). The C statistic for discrimination was
0.67 (95% CI, 0.65-0.69) in the development group and 0.66 (95% CI,
0.62-0.69) in the validation group. The final model covariates (reported
as odds ratios; 95% CIs) were age (1.13; 1.06-1.20), glomerular filtration
rate per 5-U increments (0.93; 0.91-0.95), hemodialysis (3.25; 2.42-4.37),
New York Heart Association functional class IV (1.25; 1.03-1.52), severe
chronic lung disease (1.67; 1.35-2.05), nonfemoral access site (1.96;
1.65-2.33), and procedural acuity categories 2 (1.57; 1.20-2.05), 3 (2.70;
2.05-3.55), and 4 (3.34; 1.59-702). Calibration analysis demonstrated no
significant difference between the model (predicted vs observed)
calibration line (-0.18 and 0.97 for intercept and slope, respectively)
compared with the ideal calibration line. CONCLUSIONS AND RELEVANCE: Data
from the STS/ACC TVT Registry have been used to develop a predictive model
of in-hospital mortality for patients undergoing TAVR. Validation based on
a population of patient records not used in model development demonstrates
discrimination and calibration indices that are more favorable than other
models used in populations with TAVR. This model should be a valuable
adjunct for patient counseling, local quality improvement, and national
monitoring for appropriateness of selection of patients for
TAVR.<br/>Copyright 2016 American Medical Association. All rights
reserved.

<50>
Accession Number
617433519
Author
Anjan V.Y.; Herrmann H.C.; Pibarot P.; Stewart W.J.; Kapadia S.; Tuzcu
E.M.; Babaliaros V.; Thourani V.H.; Szeto W.Y.; Bavaria J.E.; Kodali S.;
Hahn R.T.; Williams M.; Miller D.C.; Douglas P.S.; Leon M.B.
Institution
(Anjan, Herrmann) Cardiovascular Division, Hospital of the University of
Pennsylvania, 9038 Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104,
United States
(Pibarot) Department of Medicine, Laval University, Quebec City, QC,
Canada
(Stewart, Kapadia, Tuzcu) Department of Cardiovascular Medicine, Cleveland
Clinic, Cleveland, OH, United States
(Babaliaros) Department of Medicine, Emory University, Atlanta, GA, United
States
(Thourani) Department of Surgery, Emory University, Atlanta, GA, United
States
(Szeto, Bavaria) Division of Cardiothoracic Surgery, University of
Pennsylvania, Philadelphia, PA, United States
(Kodali, Hahn, Leon) Department of Medicine, Columbia University Medical
Center, New York, NY, United States
(Williams) Division of Cardiac Surgery, New York University Langone
Medical Center, New York, NY, United States
(Miller) Department of Cardiothoracic Surgery, Stanford University,
Stanford, CA, United States
(Douglas) Department of Medicine, Duke Clinical Research Institute, Duke
University Medical Center, Durham, NC, United States
Title
Evaluation of flow after transcatheter aortic valve replacement in
patients with low-flow aortic stenosis: A secondary analysis of the
PARTNER randomized clinical trial.
Source
JAMA Cardiology. 1 (5) (pp 481-489), 2016. Date of Publication: August
2016.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Low-flow (LF) severe aortic stenosis (AS) is an independent
predictor of mortality in patients undergoing aortic valve replacement
(AVR). Little is known about improvement in flow after AVR and its effects
on survival. Objective: To determine whether higher flow (left-ventricular
stroke volume index [LVSVI]) after transcatheter AVR (TAVR) would indicate
better clinical outcomes in this at-risk population. Design, Setting, and
Participants: A substudy analysis of data from the Placement of Aortic
Transcatheter Valves (PARTNER) randomized clinical trial and
continued-access registry was conducted. A total of 984 participants with
evaluable echocardiograms and baseline LF AS (LVSVI<=35 mL/m²)
were included. The trial was conducted at 26 sites in the United States
and Canada. Patients were stratified after TAVR into tertiles by discharge
LVSVI status (severe low flow [SLF], moderate low flow [MLF], and normal
flow [(NF]). The present study was conducted from May 11, 2007, to January
9, 2012, with data analysis performed from April 25, 2014, to January 21,
2016. Main Outcomes and Measures: The primary end pointwas all-cause
mortality at 1 year. Results: Baseline characteristics of 984 patients
with LF AS included mean (SD) age, 84 (7) years; 582 (59.1%) men; mean
Society of Thoracic Surgeons (STS) score, 11.4%(4.0%); and mean LVSVI,
27.6 (5.0) mL/m². The discharge LVSVI values by group were SLF,
23.1 (3.5) mL/m²; MLF, 31.7 (2.2) mL/m²; and NF,
43.1 (7.0). All-cause mortality at 1 year was SLF, 26.5%; MLF, 20.1%; and
NF, 19.6%(P = .045). Mean LVSVI normalized by 6 months in the MLF (35.9
[9.3] mL/m²) and NF (38.8 [11.1] mL/m²) groups, but
remained low in the SLF group at 6 months and 1 year (31.4 [8.4] and 33.0
[8.3] mL/m²], respectively) (P < .001 for all groups). Reported
as multivariate hazard ratio, mortality at 1 year was higher in the SLF
group compared with the other groups (1.61; 95%CI, 1.17-2.23; P = .004).
In addition to SLF, sex (1.59; 95%CI, 1.18-2.13; P = .002), presence of
atrial fibrillation (1.41; 95%CI, 1.06-1.87; P = .02), STS score (1.03;
95%CI, 1.01-1.06; P = .02), presence of moderate or severe mitral
regurgitation at discharge (1.65; 95%CI, 1.21-2.26; P = .001), pre-TAVR
mean transvalvular gradient (0.98; 95%CI, 0.97-0.99; P = .004), and
effective orifice area index (1.87; 95%CI, 1.09-3.19; P = .02) were
independent predictors of 1-year mortality. Conclusions and Relevance:
Severe LF at discharge is associated with an increased risk of mortality
following TAVR in patients with severe AS and preexisting LF. The
identification of remedial causes of persistent LF after TAVR may
represent an opportunity to improve the outcome of these
patients.<br/>Copyright &#xa9; 2016 American Medical Association. All
rights reserved.

<51>
Accession Number
617455309
Author
Relbo Authen A.; Grov I.; Karason K.; Gustafsson F.; Eiskjaer H.; Radegran
G.; Gude E.; Jansson K.; Dellgren G.; Solbu D.; Arora S.; Andreassen A.K.;
Gullestad L.
Institution
(Relbo Authen, Grov, Gude, Arora, Andreassen, Gullestad) Department of
Cardiology Oslo University Hospital Rikshospitalet Oslo Norway
(Karason) Department of Cardiology Sahlgrenska University Hospital
Gothenburg Sweden
(Gustafsson) Department of Cardiology Rigshospitalet Copenhagen Denmark
(Eiskjaer) Department of Cardiology Aarhus University Hospital Aarhus
Denmark
(Radegran) The Section for Heart Failure and Valvular Disease, VO. Heart
and Lung medicine Skane University Hospital and Department of Clinical
Sciences Lund, Cardiology, Lund University Lund Sweden
(Jansson) Department of Cardiology and Clinical Physiology Institute of
Medicine and Health Sciences Linkoping University Linkoping Sweden
(Dellgren) Transplant Institute Sahlgrenska University Hospital Gothenburg
Sweden
(Solbu) Novartis Norge AS Oslo Norway
(Arora, Andreassen, Gullestad) Center for Heart Failure Research Faculty
of Medicine University of Oslo Oslo Norway
Title
Effect of everolimus vs calcineurin inhibitors on quality of life in heart
transplant recipients during a 3-year follow-up: Results of a randomized
controlled trial (SCHEDULE).
Source
Clinical Transplantation. (no pagination), 2017. Date of Publication:
2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
The Scandinavian heart transplant everolimus de novo study with early
calcineurin inhibitors avoidance (SCHEDULE) trial was a 12 month,
randomized, open-label, parallel-group trial that compared everolimus
(EVR; n=56) to conventional CsA (n=59) immunosuppression. Previously, we
reported that EVR outperformed CsA in improving renal function and
coronary artery vasculopathy, despite a higher rejection rate with EVR.
This study aimed to compare the effects of these treatments on quality of
life (QoL). Within five post-operative days, patients (mean age 50+/-13
years, 27% women) were randomized to EVR or a standard CsA dosage (CsA
group). This study assessed quality of life (QoL), based on the Short
Form-36, EuroQol-5D, and Beck Depression Inventory (BDI). Assessments were
performed pre-HTx and 12 and 36 months post-HTx. At 12 and 36 months, the
groups showed similar improvements in Short Form-36 measures (at pre-HTx,
12 and 36 months the values were as follows: Physical component summary:
EVR: 31.5+/-110.9, 49.1+/-9.7, and 47.9+/-10.6; P<.01; CsA: 32.5+/-8.2,
48.4+/-8.5, and 46.5+/-11.5; P<.01; mental component summary: EVR:
46.0+/-12.0, 51.7+/-11.9, and 52.1+/-13.0; P<.01; CsA: 38.2+/-12.5,
53.4+/-7.1, and 54.3+/-13.0; P<.01); similar decrease in mean BDI (EVR:
10.9+/-10.2, 5.4+/-4.7, and 8.1+/-9.0; P<.01; CsA: 11.8+/-7.1, 6.3+/-5.4,
and 6.2+/-6.5; P<.01); and similar Euro Qol-improvements. Thus, in this
small-sized study, EVR-based and conventional CsA immunosuppressive
strategies produced similar QoL improvements.<br/>Copyright &#xa9; 2017
John Wiley & Sons A/S.

<52>
Accession Number
617455253
Author
Linke A.; Chandrasekhar J.; Sartori S.; Lefevre T.; van Belle E.; Schaefer
U.; Tchetche D.; Sardella G.; Webb J.; Colombo A.; Windecker S.; Vogel B.;
Farhan S.; Sorrentino S.; Sharma M.; Snyder C.; Asgar A.; Dumonteil N.;
Tamburino C.; Hink U.; Violini R.; Stella P.; Bernstein D.; Deliargyris
E.; Hengstenberg C.; Baber U.; Mehran R.; Anthopoulos P.; Dangas G.
Institution
(Linke) Department of Internal Medicine/CardiologyUniversity of Leipzig,
Heart Centre Germany
(Chandrasekhar, Sartori, Vogel, Farhan, Sorrentino, Sharma, Snyder, Baber,
Mehran, Dangas) Division of CardiologyThe Zena and Michael A. Wiener
Cardiovascular Institute, Icahn School of Medicine at Mount SinaiNew York
(Lefevre) Division of CardiologyInstitut Hospitalier Jacques Cartier,
Ramsay Generale de SanteMassy France
(van Belle) Department of Cardiology and INSERM UMR 1011University
Hospital, and CHRU LilleLille France
(Schaefer) Division of CardiologyyUniversity Heart CenterHamburg Germany
(Schaefer) Division of CardiologyyAsklepios Clinics St. GeorgHamburg
Germany
(Tchetche, Dumonteil) Division of CardiologyyClinique Pasteur Toulouse
France
(Sardella) Division of CardiologyyPoliclinico Umberto IRome Italy
(Webb) Division of CardiologyySt. Paul's HospitalVancouver, British
Columbia Canada
(Colombo) Division of CardiologyySan Raffaele HospitalMilan Italy
(Windecker) Department of CardiologyBern University Hospital Switzerland
(Asgar) Division of CardiologyMontreal Heart InstituteMontreal Canada
(Tamburino) Division of CardiologyUniversity of Catania Italy
(Hink) Cardiology DepartmentJohannes Gutenberg University HospitalMainz
Germany
(Violini) Division of CardiologyAzienda Ospedaliera San Camillo-Forlanini
di Roma Italy
(Stella) Division of CardiologyUniversity Medical Center Utrecht The
Netherlands
(Bernstein, Deliargyris) Division of CardiologyThe Medicines
CompanyParsippany, New Jersey
(Hengstenberg) Division of CardiologyDZHK (German Centre for
Cardiovascular Research), partner site Munich Heart AllianceMunich Germany
(Hengstenberg) Division of CardiologyyDeutsches Herzzentrum Munchen,
Technische Universitat MunchenMunich Germany
(Anthopoulos) Division of CardiologyThe Medicines CompanyZurich
Switzerland
Title
Effect of valve design and anticoagulation strategy on 30-day clinical
outcomes in transcatheter aortic valve replacement: Results from the BRAVO
3 randomized trial.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2017.
Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Selection of valve type and procedural anticoagulant may
impact bleeding and vascular complications in transfemoral transcatheter
aortic valve replacement (TAVR). We sought to compare outcomes by valve
[balloon expandable (BE) or non-BE] and anticoagulant [bivalirudin vs.
unfractionated heparin (UFH)] type from the BRAVO-3 trial. Methods:
BRAVO-3 was a randomized multicenter trial including 500 BE-TAVR and 282
non-BE TAVR patients, randomized to bivalirudin versus UFH. Selection of
valve type was at the discretion of the operator but randomization was
stratified according to valve type. Total follow up was to 30 days. We
examined the incidence of Bleeding Academic Research Consortium type >=3b
bleeding, major vascular complications and all ischemic outcomes at
30-days. Outcomes were adjusted using logistic regression analysis.
Results: Of the trial cohort, 63.9% were treated with BE valves (n=251
bivalirudin vs. n=249 UFH) and 36.1% with non-BE valves (n=140 bivalirudin
vs. n=142 UFH). Patients treated with non-BE valves were older, with
higher euroSCORE I. At 30 days, there were nonsignificant differences
between the two valve types for adjusted risk of all-cause death (HR 2.07,
95% CI 0.91-4.70, P=0.084) and major vascular complications (HR 1.78, 95%
CI 0.97-3.26, P=0.062) with non-BE compared with BE valves, but all other
outcomes were similar. A significant interaction was observed between
valve and anticoagulant type, with lower risk of major vascular
complications with bivalirudin compared with UFH in non-BE TAVR
(P-interaction=0.039). Conclusions: Majority of patients in the BRAVO 3
trial received BE valves. At 30-days, adjusted risk of clinical outcomes
was similar with non-BE vs. BE valves. A significant interaction was
observed between valve type and procedural anticoagulant for lower risk of
major vascular complications with bivalirudin versus UFH in non-BE
TAVR.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<53>
Accession Number
617431503
Author
Jin S.; Zhou X.
Institution
(Jin) Department of Anesthesia, Jinan Central Hospital Affiliated to
Shandong University, Shandong Province, Jinan 250013, China
(Zhou) Medical Center Tsinghua University, Beijing 100084, China
Title
Influence of dexmedetomidine on cardiac complications in non-cardiac
surgery: a meta-analysis of randomized trials.
Source
International Journal of Clinical Pharmacy. (pp 1-12), 2017. Date of
Publication: 28 Jun 2017.
Publisher
Springer Netherlands
Abstract
Background The cardiac protection of dexmedetomidine (Dex) in
peri-operative period of patients with non-cardiac surgery is still
controversial. Aim of the Review We aimed to evaluate the influence of Dex
on cardiac complications in peri-operative period of non-cardiac surgery
by using a meta-analysis. Methods PubMed, Embase, the Cochrane library and
Springer databases were searched for relevant studies. Patients in the
eligible studies were divided into Dex group and placebo group. Relative
risk (RR) and the 95 % confidence interval (CI) were calculated to
evaluate the outcomes including all-cause mortality, myocardial
infarction, myocardial ischaemia, hypotension and bradycardia. Subgroup
analysis was performed based on the dosage of Dex. Publication bias was
assessed by Egger's test. Results Twenty double-blind randomized
controlled trials containing 1157 patients were included in this
meta-analysis. The pooled results showed no significant difference between
Dex group and placebo group in peri-operative myocardial infarction,
myocardial ischaemia and all-cause mortality. However, Dex group showed
higher risk of hypotension (RR = 1.46, 95 % CI 1.07, 2.01) and bradycardia
(RR = 1.98, 95 % CI 1.33, 2.95) than that of placebo group. In addition,
significant publication bias was found among studies involving hypotension
and bradycardia. In subgroup analysis, the risk of bradycardia was
significantly higher in 1.0 mug/kg Dex group than that in placebo group.
Besides, a higher risk of hypotension in 0.5 mug/kg Dex group than that in
placebo group was found. Conclusions Dex supplement might not reduce the
risk of cardiac complications but increases the risk of hypotension and
bradycardia in peri-operative period of patients who underwent non-cardiac
surgeries.<br/>Copyright &#xa9; 2017 Springer International Publishing

<54>
Accession Number
617431061
Author
Entenmann A.; Michel M.; Herberg U.; Haas N.; Kumpf M.; Gass M.; Egender
F.; Gebauer R.
Institution
(Entenmann, Michel) Department of Pediatrics, Innsbruck Medical
University, Anichstrasse 35, Innsbruck 6020, Austria
(Herberg) Department of Pediatric Cardiology, University of Bonn,
Adenauerallee 119, Bonn 53113, Germany
(Haas) Department of Pediatric Cardiology and Pediatric Intensive Care
Medicine, Ludwig-Maximilian University, Marchioninistrasse 15, Munich
81377, Germany
(Kumpf) Department of Pediatric Cardiology, University Children's Hospital
Tubingen, Hoppe-Seyler-Strasse 1, Tubingen 72076, Germany
(Gass) Department of Pediatric Cardiology, University Children's Hospital
Zurich, Steinwiesstrasse 75, Zurich 8032, Switzerland
(Egender) Department for Congenital Heart Disease and Pediatric
Cardiology, Schleswig-Holstein University Hospital, Arnold-Heller-Strasse
3, Kiel 24105, Germany
(Gebauer) Department of Pediatric Cardiology, University of Leipzig, Heart
Center, Strumpellstrasse 39, Leipzig 04289, Germany
Title
Management of postoperative junctional ectopic tachycardia in pediatric
patients: a survey of 30 centers in Germany, Austria, and Switzerland.
Source
European Journal of Pediatrics. (pp 1-10), 2017. Date of Publication: 21
Jul 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Postoperative junctional ectopic tachycardia (JET) is a frequent
complication after pediatric cardiac surgery. Current recommendations on
how and when to treat JET are inconsistent. We evaluated the management
strategies of postoperative JET in German-speaking countries. We sent an
online survey to 30 centers of pediatric cardiology that perform surgery
for congenital heart defects in Germany (24), Austria (4), and Switzerland
(2). The survey asked 18 questions about how and in what treatment
sequence postoperative JET was managed. All 30 centers completed the
survey (100% return rate). There was general agreement that the management
of JET is based on administration of antiarrhythmic drugs, body surface
cooling, and temporary pacing. Many centers presented treatment algorithms
based on published literature, all centers named amiodarone as the first
drug of choice. Significant disagreement was found concerning the timing
and sequential order of additional therapeutic measures and particularly
about the dosing of amiodarone and the role of R-wave synchronized atrial
pacing. Conclusion: This survey reveals that from center to center, the
treatment of postoperative JET may vary substantially. Future work should
focus on those treatment modalities where a high rate of variation is
found. Such studies may be of value to achieve commonly adopted treatment
recommendations.(Table presented.)<br/>Copyright &#xa9; 2017
Springer-Verlag GmbH Germany

<55>
[Use Link to view the full text]
Accession Number
614134407
Author
Karam D.; Arora R.
Institution
(Karam, Arora) Department of Internal Medicine, Chicago Medical School,
Capt James A Lovell Federal Health Care Centre, Chicago Medical
School/RFUMS, 3001 Green Bay Road, North Chicago, IL 60064, United States
Title
Perioperative beta-Blockers in Patients Undergoing Noncardiac
Surgery-Scientific Misconduct and Clinical Guidelines.
Source
American Journal of Therapeutics. 24 (4) (pp e435-e441), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: beta-blocker use in perioperative period of noncardiac
surgeries has been a topic of debate since many years. Earlier studies
conducted in the 90s showed decreased cardiac adverse events and improved
postoperative outcomes with beta-blocker use. Based on this, the ACCF and
ESC published guidelines strongly supporting beta-blocker use. But
contemporaneous studies conducted revealed conflicting evidence and have
also proven some of the earlier studies to be fraudulent. Although ACCF
guidelines have been updated to partially reflect the changes, ESC
guidelines continue to support beta-blocker use. Areas of Uncertainty: In
light of the ACCF and ESC guidelines supporting beta-blocker use in
perioperative period of noncardiac surgeries, our aim was to review the
available literature and consolidate evidence in this regard. Data
Sources: PubMed search was conducted to include relevant studies between
1950 and 2015. Results: We reviewed 24 eligible studies and few debates
conducted in this regard. Based on our review, our findings were as
follows: beta-blockers should be continued throughout perioperative period
in patients who were on beta-blockers before surgery for other indications
such as angina, hypertension, and symptomatic arrhythmias. Preoperative
beta-blockers are indicated in patients undergoing high risk vascular
surgery or those having high preoperative Cardiac Risk Index Score. In
patients with intermediate-to-low cardiac risk, the proven benefit is not
sufficient enough to suggest universal use. Conclusions: Based on our
review, we conclude that the use of beta-blockers in perioperative period
of noncardiac surgeries should be determined on an individual basis based
on risk-benefit analysis. Guideline organizations should update their
recommendations based on new evidence.<br/>Copyright &#xa9; 2017 Wolters
Kluwer Health, Inc. All rights reserved.

<56>
Accession Number
605198320
Author
Xu N.; Yu M.; Liu X.; Sun C.; Chen Z.; Liu Z.
Institution
(Xu, Liu, Sun, Chen, Liu) Department of Orthopaedics, Peking University
Third Hospital, 49 Huayuan North Road, Beijing 100191, China
(Yu) Peking University Spine Institute, 38 Xueyuan Road, Beijing 100191,
China
Title
A systematic review of complications in thoracic spine surgery for
ossification of the posterior longitudinal ligament.
Source
European Spine Journal. 26 (7) (pp 1803-1809), 2017. Date of Publication:
01 Jul 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: To answer two questions: (1) what are the common complications
associated with surgery for thoracic myelopathy caused by ossification of
the posterior longitudinal ligament, and (2) which surgical approach is
safer with regard to the incidence of post-operative complications.
Methods: Relevant literature searches were performed using the Cochrane
Central Register of Controlled Trials, PubMed, EMBASE, the Chinese
Biomedical Literature Database, the China National Knowledge
Infrastructure, KoreaMed, and the Japan CentraRevuoMedicina. Results: 15
studies met the inclusion criteria and were retrieved. They included a
total of 595 patients, 39 % of whom were male and 61 % female. The mean
patient age ranged from 52.6 to 60.9 years. The mean recovery rate from
each individual study varied between 24.7 and 77.6 % and the pooled
neurologic function recovery rate was 50.4 %. From these 15 studies, the
mean complication rate was 39.4 %. By far, two complications were more
common than the others: cerebrospinal fluid leakage (incidence rate 22.5
%) and post-operative neurologic deficit (incidence rate 13.9 %). 7.7 % of
patients from the indirect decompression group experienced cerebrospinal
fluid leakage, while it was reported in 25.6 % of those in the direct
decompression group. Neurologic deficit was reported in 8.4 % of patients
undergoing indirect decompression and 19.8 % of those undergoing direct
decompression. Conclusions: Cerebrospinal fluid leakage and neurologic
deficit were the two most common complications following surgical
decompression of the thoracic spine with ossification of the posterior
longitudinal ligament. Patients undergoing indirect decompression
surgeries had significantly lower complication rates compared with those
undergoing direct decompression surgeries.<br/>Copyright &#xa9; 2015,
Springer-Verlag Berlin Heidelberg.

<57>
Accession Number
617327302
Author
Bundhun P.K.; Gupta C.; Xu G.M.
Institution
(Bundhun) the First Affiliated Hospital of Guangxi Medical University,
Institute of Cardiovascular Diseases, Nanning, Guangxi 530027, China
(Gupta) Guangxi Medical University, Nanning, Guangxi 530027, China
(Xu) The People's Hospital of Guangxi Zhuang Autonomous Region, Department
of Cardiology, Nanning, Guangxi 530021, China
Title
Major adverse cardiac events and mortality in chronic obstructive
pulmonary disease following percutaneous coronary intervention: A
systematic review and meta-analysis.
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 191. Date of Publication: 17 Jul 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: We aimed to systematically compare Major Adverse Cardiac
Events (MACEs) and mortality following Percutaneous Coronary Intervention
(PCI) in patients with and without Chronic Obstructive Pulmonary Diseases
(COPD) through a meta-analysis. Methods: Electronic databases (Cochrane
library, EMBASE and Medline/PubMed) were searched for English publications
comparing in-hospital and long-term MACEs and mortality following PCI in
patients with a past medical history of COPD. Statistical analysis was
carried out by Revman 5.3 whereby Odds Ratio (OR) and 95% Confidence
Intervals (CI) were considered the relevant parameters. Results: A total
number of 72,969 patients were included (7518 patients with COPD and
65,451 patients without COPD). Results of this analysis showed that
in-hospital MACEs were significantly higher in the COPD group with OR:
1.40, 95% CI: 1.19-1.65; P = 0.0001, I² = 0%. Long-term MACEs
were still significantly higher in the COPD group with OR: 1.58, 95% CI:
1.38-1.81; P = 0.00001, I² = 29%. Similarly, in-hospital and
long-term mortality were significantly higher in patients with COPD, with
OR: 2.25, 95% CI: 1.78-2.85; P = 0.00001, I² = 0% and OR: 2.22,
95% CI: 1.33-3.71; P = 0.002, I² = 97% respectively. However,
the result for the long-term death was highly heterogeneous. Conclusion:
Since in-hospital and long-term MACEs and mortality were significantly
higher following PCI in patients with versus without COPD, COPD should be
considered a risk factor for the development of adverse clinical outcomes
following PCI. However, the result for the long-term mortality was highly
heterogeneous warranting further analysis.<br/>Copyright &#xa9; 2017 The
Author(s).

<58>
Accession Number
614517308
Author
Zhao D.F.; Edelman J.J.; Seco M.; Bannon P.G.; Wilson M.K.; Byrom M.J.;
Thourani V.; Lamy A.; Taggart D.P.; Puskas J.D.; Vallely M.P.
Institution
(Zhao, Edelman, Seco, Bannon, Byrom, Vallely) Sydney Medical School, The
University of Sydney, Sydney, New South Wales, Australia
(Zhao, Edelman, Seco, Bannon, Wilson, Byrom, Vallely) Baird Institute of
Applied Heart and Lung Surgical Research, Sydney, New South Wales,
Australia
(Edelman, Seco, Bannon, Wilson, Byrom, Vallely) Cardiothoracic Surgical
Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
(Bannon, Byrom, Vallely) Institute of Academic Surgery, Royal Prince
Alfred Hospital, Sydney, New South Wales, Australia
(Bannon, Wilson, Byrom, Vallely) Sydney Heart and Lung Surgeons, Sydney,
New South Wales, Australia
(Thourani) Division of Cardiothoracic Surgery, Emory University School of
Medicine, Atlanta, Georgia
(Lamy) Department of Surgery, McMaster University, Hamilton, Ontario,
Canada
(Taggart) Department of Cardiovascular Surgery, John Radcliffe Hospital,
University of Oxford, Oxford, United Kingdom
(Puskas) Department of Cardiac Surgery, Mt. Sinai Hospital, New York, New
York, United States
Title
Coronary Artery Bypass Grafting With and Without Manipulation of the
Ascending Aorta: A Network Meta-Analysis.
Source
Journal of the American College of Cardiology. 69 (8) (pp 924-936), 2017.
Date of Publication: 28 Feb 2017.
Publisher
Elsevier USA
Abstract
Background Coronary artery bypass grafting (CABG) remains the standard of
treatment for 3-vessel and left main coronary disease, but is associated
with an increased risk of post-operative stroke compared to percutaneous
coronary intervention. It has been suggested that CABG techniques that
eliminate cardiopulmonary bypass and reduce aortic manipulation may reduce
the incidence of post-operative stroke. Objectives A network meta-analysis
was performed to compare post-operative outcomes between all CABG
techniques, including anaortic off-pump CABG (anOPCABG), off-pump with the
clampless Heartstring device (OPCABG-HS), off-pump with a partial clamp
(OPCABG-PC), and traditional on-pump CABG with aortic cross-clamping.
Methods A systematic search of 6 electronic databases was performed to
identify all publications reporting the outcomes of the included
operations. Studies reporting the primary endpoint, 30-day post-operative
stroke rate, were included in a Bayesian network meta-analysis. Results
There were 13 included studies with 37,720 patients. At baseline, anOPCABG
patients had higher previous stroke than did the OPCABG-PC (7.4% vs. 6.5%;
p = 0.02) and CABG (7.4% vs. 3.2%; p = 0.001) patients. AnOPCABG was the
most effective treatment for decreasing the risk of post-operative stroke
(-78% vs. CABG, 95% confidence interval [CI]: 0.14 to 0.33; -66% vs.
OPCABG-PC, 95% CI: 0.22 to 0.52; -52% vs. OPCABG-HS, 95% CI: 0.27 to
0.86), mortality (-50% vs. CABG, 95% CI: 0.35 to 0.70; -40% vs. OPCABG-HS,
95% CI: 0.38 to 0.94), renal failure (-53% vs. CABG, 95% CI: 0.31 to
0.68), bleeding complications (-48% vs. OPCABG-HS, 95% CI: 0.31 to 0.87;
-36% vs. CABG, 95% CI: 0.42 to 0.95), atrial fibrillation (-34% vs.
OPCABG-HS, 95% CI: 0.49 to 0.89; -29% vs. CABG, 95% CI: 0.55 to 0.87; -20%
vs. OPCABG-PC, 95% CI: 0.68 to 0.97), and shortening the length of
intensive care unit stay (-13.3 h; 95% CI: -19.32 to -7.26; p < 0.0001).
Conclusions Avoidance of aortic manipulation in anOPCABG may decrease the
risk of post-operative stroke, especially in patients with higher stroke
risk. In addition, the elimination of cardiopulmonary bypass may reduce
the risk of short-term mortality, renal failure, atrial fibrillation,
bleeding, and length of intensive care unit stay.<br/>Copyright &#xa9;
2017 American College of Cardiology Foundation

<59>
[Use Link to view the full text]
Accession Number
617417976
Author
Anderson B.R.; Wallace A.S.; Hill K.D.; Gulack B.C.; Matsouaka R.; Jacobs
J.P.; Bacha E.A.; Glied S.A.; Jacobs M.L.
Institution
(Anderson) Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan
Stanley Children's Hospital, Columbia University Medical Center, 3959
Broadway, CH-2N, New York, NY 10032, United States
(Wallace) Duke Clinical Research Institute, Durham, NC, United States
(Hill) Department of Pediatrics, Duke Clinical Research Institute, United
States
(Gulack) Department of Surgery, Duke University Medical Center, Durham,
NC, United States
(Matsouaka) Department of Biostatistics and Bioinformatics, Duke
University, Durham, NC, United States
(Jacobs, Jacobs) Division of Cardiovascular Surgery, Department of
Surgery, Johns Hopkins All Children's Heart Institute, St. Petersburg, FL,
United States
(Jacobs, Jacobs) Division of Cardiac Surgery, Department of Surgery, Johns
Hopkins School of Medicine, Baltimore, MD, United States
(Bacha) Division of Cardiothoracic Surgery, Columbia University College of
Physicians and Surg., New York, NY, United States
(Glied) Robert F. Wagner Graduate School of Public Service, New York
University, United States
Title
Association of Surgeon Age and Experience with Congenital Heart Surgery
Outcomes.
Source
Circulation: Cardiovascular Quality and Outcomes. 10 (7) (no pagination),
2017. Article Number: e003533. Date of Publication: 01 Jul 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Surgeon experience concerns both families of children with
congenital heart disease and medical providers. Relationships between
surgeon seniority and patient outcomes are often assumed, yet there are
little data. Methods and Results - This national study used linked data
from the American Medical Association Physician Masterfile and the Society
of Thoracic Surgeons-Congenital Heart Surgery Database to examine
associations between surgeon years since medical school and major
morbidity/mortality for children undergoing cardiac surgery. Sensitivity
analyses explored the effects of patient characteristics,
institutional/surgeon volumes, and various measures of institutional
surgeon team experience. In secondary analyses, major morbidity and
mortality were examined as separate end points. We identified 206
congenital heart surgeons from 91 centers performing 62 851 index
operations (2010-2014). Median time from school was 25 years (range 9-55
years). A major morbidity/mortality occurred in 11.5% of cases. In
multivariable analyses, the odds of major morbidity/mortality were similar
for early-career (<15 years from medical school, =<40 years old),
midcareer (15-24 years, =40-50 years old), and senior surgeons (25-35
years, =50-60 years old). The odds of major morbidity/mortality were =25%
higher for operations performed by very senior surgeons (35-55 years from
school, =60-80 years old; n=9044 cases). Results were driven by
differences in morbidity. In extensive sensitivity analyses, these effects
remained constant. Conclusions - In this study of >200 congenital heart
surgeons, we found patient outcomes for surgeons with the fewest years of
experience to be comparable to those of their midcareer and senior
colleagues, within the context of existing referral and support practices.
Very senior surgeons had higher risk-adjusted odds of major
morbidity/mortality. Contemporary approaches to training, referral,
mentoring, surgical planning, and other support practices might contribute
to the observed outcomes of junior congenital heart surgeons being
comparable to those of more experienced colleagues. Understanding and
disseminating these practices might benefit the medical community at
large.<br/>Copyright &#xa9; 2017 American Heart Association, Inc, and
European Resuscitation Council.

<60>
[Use Link to view the full text]
Accession Number
617417903
Author
Mohananey D.; Jobanputra Y.; Kumar A.; Krishnaswamy A.; Mick S.; White
J.M.; Kapadia S.R.
Institution
(Mohananey, Krishnaswamy) Department of Hospital Medicine, Cleveland
Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States
(Jobanputra, Kumar, White, Kapadia) Department of Cardiovascular Medicine,
Cleveland Clinic, OH, United States
(Mick) Department of Cadiothoracic Surgery, Cleveland Clinic, OH, United
States
Title
Clinical and Echocardiographic Outcomes Following Permanent Pacemaker
Implantation after Transcatheter Aortic Valve Replacement: Meta-Analysis
and Meta-Regression.
Source
Circulation: Cardiovascular Interventions. 10 (7) (no pagination), 2017.
Article Number: e005046. Date of Publication: 01 Jul 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Transcatheter aortic valve replacement has become the
procedure of choice for inoperable, high-risk, and many intermediate-risk
patients with aortic stenosis. Conduction abnormalities are a common
finding after transcatheter aortic valve replacement and often result in
permanent pacemaker (PPM) implantation. Data pertaining to the clinical
impact of PPM implantation are controversial. We used meta-analysis
techniques to summarize the effect of PPM implantation on clinical and
echocardiographic outcomes after transcatheter aortic valve replacement.
Methods and Results - Data were summarized as Mantel-Haenszel relative
risk (RR) and 95% confidence intervals (CIs) for dichotomous variables and
as standardized mean difference and 95% CI for continuous variables We
used the Higgins I² statistic to evaluate heterogeneity. We
found that patients with and without PPM have similar all-cause mortality
(RR, 0.85; 95% CI, 0.70-1.03), cardiovascular mortality (RR, 0.84; 95% CI,
0.59-1.18), myocardial infarction (RR, 0.47; 95% CI, 0.20-1.11), and
stroke (RR, 1.26; 95% CI, 0.70-2.26) at 30 days. The groups were also
comparable in all-cause mortality (RR, 1.03; 95% CI, 0.92-1.16),
cardiovascular mortality (RR, 0.69; 95% CI, 0.39-1.24), myocardial
infarction (RR, 0.58; 95% CI, 0.30-1.13), and stroke (RR, 0.70; 95% CI,
0.47-1.04) at 1 year. We observed that the improvement in left ventricular
ejection fraction was significantly greater in the patients without PPM
(standardized mean difference, 0.22; 95% CI, 0.12-0.32). Conclusions - PPM
implantation is not associated with increased risk of all-cause mortality,
cardiovascular mortality, stroke, or myocardial infarction both at short-
and long-term follow-up. However, PPM is associated with impaired left
ventricular ejection fraction recovery post-transcatheter aortic valve
replacement.<br/>Copyright &#xa9; 2017 American Heart Association, Inc.

<61>
[Use Link to view the full text]
Accession Number
617417733
Author
Kang S.H.; Ahn J.-M.; Lee C.H.; Lee P.H.; Kang S.-J.; Lee S.-W.; Kim
Y.-H.; Lee C.W.; Park S.-W.; Park D.-W.; Park S.-J.
Institution
(Kang) Department of Cardiology, CHA Bundang Medical Center, CHA
University, Seongnam, South Korea
(Ahn, Lee, Lee, Kang, Lee, Kim, Lee, Park, Park, Park) Department of
Cardiology, Asan Medical Center, University of Ulsan College of Medicine,
388-1 Poongnapdong, Songpa-gu, Seoul 138-736, South Korea
Title
Differential Event Rates and Independent Predictors of Long-Term Major
Cardiovascular Events and Death in 5795 Patients with Unprotected Left
Main Coronary Artery Disease Treated with Stents, Bypass Surgery, or
Medication: Insights from a Large International Multicenter Registry.
Source
Circulation: Cardiovascular Interventions. 10 (7) (no pagination), 2017.
Article Number: e004988. Date of Publication: 01 Jul 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Identifying predictive factors for major cardiovascular
events and death in patients with unprotected left main coronary artery
disease is of great clinical value for risk stratification and possible
guidance for tailored preventive strategies. Methods and Results - The
Interventional Research Incorporation Society-Left MAIN Revascularization
registry included 5795 patients with unprotected left main coronary artery
disease (percutaneous coronary intervention, n=2850; coronary-artery
bypass grafting, n=2337; medication alone, n=608). We analyzed the
incidence and independent predictors of major adverse cardiac and
cerebrovascular events (MACCE; a composite of death, MI, stroke, or repeat
revascularization) and all-cause mortality in each treatment stratum.
During follow-up (median, 4.3 years), the rates of MACCE and death were
substantially higher in the medical group than in the percutaneous
coronary intervention and coronary-artery bypass grafting groups
(P<0.001). In the percutaneous coronary intervention group, the 3
strongest predictors for MACCE were chronic renal failure, old age (>=65
years), and previous heart failure; those for all-cause mortality were
chronic renal failure, old age, and low ejection fraction. In the
coronary-artery bypass grafting group, old age, chronic renal failure, and
low ejection fraction were the 3 strongest predictors of MACCE and death.
In the medication group, old age, low ejection fraction, and diabetes
mellitus were the 3 strongest predictors of MACCE and death. Conclusions -
Among patients with unprotected left main coronary artery disease, the key
clinical predictors for MACCE and death were generally similar regardless
of index treatment. This study provides effect estimates for clinically
relevant predictors of long-term clinical outcomes in real-world left main
coronary artery patients, providing possible guidance for tailored
preventive strategies. Clinical Trial Registration - URL:
https://clinicaltrials.gov. Unique identifier: NCT01341327.<br/>Copyright
&#xa9; 2017 American Heart Association, Inc.

<62>
Accession Number
617350858
Author
Lee J.; Jung C.-W.; Jeon Y.; Kim T.K.; Cho Y.J.; Koo C.-H.; Choi Y.H.; Kim
K.-B.; Hwang H.Y.; Kim H.-R.; Park J.-Y.
Institution
(Lee, Jung, Jeon, Kim, Cho, Koo, Choi) Department of Anesthesiology and
Pain Medicine, Seoul National University College of Medicine, Seoul
National University Hospital, Seoul, South Korea
(Kim, Hwang) Department of Thoracic and Cardiovascular Surgery, Seoul
National University College of Medicine, Seoul National University
Hospital, Seoul, South Korea
(Kim) Department of Anatomy and Cell Biology, Department of Biomedical
Sciences, BK21 Plus Biomedical Science Project, Seoul National University
College of Medicine, Seoul, South Korea
(Park) FACS Core Facility, Seoul National University College of Medicine,
Seoul, South Korea
(Lee) Department of Anesthesiology and Pain Medicine, Keimyung University
College of Medicine, Dongsan Medical Center, Daegu, South Korea
Title
Effects of preoperative aspirin on perioperative platelet activation and
dysfunction in patients undergoing off-pump coronary artery bypass graft
surgery: A prospective randomized study.
Source
PLoS ONE. 12 (7) (no pagination), 2017. Article Number: e0180466. Date of
Publication: July 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
The benefit of aspirin use after coronary artery bypass graft surgery has
been well proven. However, the effect of preoperative aspirin use in
patients undergoing off-pump coronary artery bypass graft surgery (OPCAB)
has not been evaluated sufficiently. To evaluate platelet function changes
during OPCAB due to preoperative aspirin use, we conducted a randomized
controlled trial using flow cytometry and the Multiplate
analyzer. Forty-eight patients scheduled for elective OPCAB were
randomized to the aspirin continuation (100 mg/day until operative day)
and discontinuation (4 days before the operative day) groups. Platelet
function was measured using the platelet activation markers CD62P, CD63,
and PAC-1 by flow cytometry, and platelet aggregation was measured using
the Multiplate analyzer, after the induction of anesthesia
(baseline), at the end of the operation, and 24 and 48 h postoperatively.
Findings of conventional coagulation assays, thromboelastography by
ROTEM assays, and postoperative bleeding-related clinical
outcomes were compared between groups. No significant change in CD62P,
CD63, or PAC-1 was observed at the end of the operation or 24 or 48 h
postoperatively compared with baseline in either group. The area under the
curve for arachidonic acid-stimulated platelet aggregation, measured by
the Multiplate analyzer, was significantly smaller in the
aspirin continuation group (P < 0.01). However, chest tube drainage and
intraoperative and postoperative transfusion requirements did not differ
between groups. Our study showed that preoperative use of aspirin for
OPCAB did not affect perioperative platelet activation, but it impaired
platelet aggregation, which did not affect postoperative bleeding, by
arachidonic acid.<br/>Copyright &#xa9; 2017 Lee et al. This is an open
access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<63>
Accession Number
617346226
Author
Bosnjak Z.J.; Ge Z.-D.
Institution
(Bosnjak, Ge) Department of Anesthesiology, Medical College of Wisconsin,
8701 Watertown Plank Road, Milwaukee, WI 53226, United States
(Bosnjak) Department of Physiology, Medical College of Wisconsin, 8701
Watertown Plank Road, Milwaukee, WI 53226, United States
Title
The application of remote ischemic conditioning in cardiac surgery.
Source
F1000Research. 6 (no pagination), 2017. Article Number: 928. Date of
Publication: 2017.
Publisher
Faculty of 1000 Ltd (E-mail: info@f1000.com)
Abstract
Perioperative myocardial ischemia and infarction are the leading causes of
morbidity and mortality following anesthesia and surgery. The discovery of
endogenous cardioprotective mechanisms has led to testing of new methods
to protect the human heart. These approaches have included ischemic
pre-conditioning, per-conditioning, post-conditioning, and remote
conditioning of the myocardium. Pre-conditioning and per-conditioning
include brief and repetitive periods of sub-lethal ischemia before and
during prolonged ischemia, respectively; and post-conditioning is applied
at the onset of reperfusion. Remote ischemic conditioning involves
transient, repetitive, non-lethal ischemia and reperfusion in one organ or
tissue (remote from the heart) that renders myocardium more resistant to
lethal ischemia/reperfusion injury. In healthy, young hearts, many
conditioning maneuvers can significantly increase the resistance of the
heart against ischemia/reperfusion injury. The large multicenter clinical
trials with ischemic remote conditioning have not been proven successful
in cardiac surgery thus far. The lack of clinical success is due to
underlying risk factors that interfere with remote ischemic conditioning
and the use of cardioprotective agents that have activated the endogenous
cardioprotective mechanisms prior to remote ischemic conditioning. Future
preclinical research using remote ischemic conditioning will need to be
conducted using comorbid models.<br/>Copyright &#xa9; 2017 Bosnjak ZJ and
Ge ZD.

<64>
[Use Link to view the full text]
Accession Number
617399445
Author
Palla M.; Briasoulis A.; Siddiqui F.; Alesh I.; Afonso L.
Institution
(Palla, Briasoulis, Siddiqui, Alesh, Afonso) Division of Cardiology,
Detroit Medical Center, Wayne State University, Detroit, MI 48226, United
States
Title
Long (>12 Months) and Short (<6 Months) Versus Standard Duration of Dual
Antiplatelet Therapy after Coronary Stenting: A Systematic Review and
Meta-Analysis.
Source
American Journal of Therapeutics. 24 (4) (pp e468-e476), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Dual antiplatelet therapy (DAPT) is recommended for 6-12 months after
drug-eluting stent (DES) implantation to prevent ischemic events and late
stent thrombosis. The optimal duration of DAPT has not been established.
We performed a meta-analysis of the comparative effects of short and long
versus standard duration DAPT duration on adverse cardiovascular and major
bleeding. We conducted an EMBASE and MEDLINE search for studies in which
patients were randomized to treatment with a different duration of DAPT.
We included studies that provided data on DES selection, DAPT regimen and
duration, and incidence of the selected endpoints at the end of the
follow-up period. We identified 5 prospective randomized studies comparing
short versus standard duration DAPT and 3 comparing long versus standard
duration DAPT with a total of 28,343 patients. Short-term DAPT has similar
incidence of stent thrombosis, MI, and death compared to standard duration
DAPT, whereas major bleeding was significantly lower in short duration
DAPT. Long-term DAPT was associated with lower rates of stent thrombosis
and MI but significantly increased major bleeding and all-cause mortality
compared to standard duration DAPT. In this meta-analysis of prospective
controlled studies we found that short duration DAPT is safer and as
effective as standard duration DAPT in patients with second-generation
DES. Extended DAPT is associated with less ischemic events at the expense
of high bleeding and mortality rates.<br/>Copyright &#xa9; 2015 Wolters
Kluwer Health, Inc. All rights reserved.

<65>
Accession Number
617423167
Author
Evison M.; Clive A.; Castle L.; Powell H.; Thomas R.; Buttery R.; Masani
V.; Harden S.; West D.; Woolhouse I.
Institution
(Evison) Manchester Thoracic Oncology Centre, University Hospital of South
Manchester, Manchester, United Kingdom
(Clive) North Bristol Lung Centre, Southmead Hospital, North Bristol
National Health Service Trust, Bristol, United Kingdom
(Castle) Department of Respiratory Medicine, Stoke Mandeville Hospital,
Buckinghamshire, United Kingdom
(Powell) Frimley Park Hospital National Health Service Foundation Trust,
Frimley, Surrey, United Kingdom
(Thomas) Lung Cancer Clinical Nurse Specialist and Palliative Care
Department, Guy's and St. Thomas' National Health Service Foundation
Trust, London, United Kingdom
(Buttery) Papworth Hospital National Health Service Foundation Trust,
Cambridge, United Kingdom
(Masani) Royal United Hospitals Bath National Health Service Foundation
Trust, Bath, United Kingdom
(Harden) Department of Clinical Oncology, Cambridge University Hospitals
National Health Service Foundation Trust, United Kingdom
(West) Department of Thoracic Surgery, University Hospitals Bristol
National Health Service Foundation Trust, Bristol, United Kingdom
(Woolhouse) Department of Respiratory Medicine, University Hospitals
Birmingham National Health Service Foundation Trust, Queen Elizabeth
Hospital Birmingham, Birmingham, United Kingdom
Title
Resectable Clinical N2 Non-Small Cell Lung Cancer; What Is the Optimal
Treatment Strategy? An Update by the British Thoracic Society Lung Cancer
Specialist Advisory Group.
Source
Journal of Thoracic Oncology. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier Inc (E-mail: agents@lww.com)
Abstract
Patients and clinicians are faced with uncertainty as to the optimal
treatment strategy for potentially resectable NSCLC in which there is
clinical evidence of involvement of the ipsilateral mediastinum.
Randomized controlled trials and meta-analyses have failed to demonstrate
superiority of one bimodality strategy over another (chemotherapy plus
surgery versus chemotherapy plus radiotherapy). One trial of trimodality
treatment with chemotherapy, radiotherapy, and surgery demonstrated an
improvement in progression-free, but not overall, survival versus
chemotherapy and radiotherapy. There are a number of limitations to the
data in this complex and heterogenous patient group. No randomized
controlled trial has specifically studied patients with single-station N2
disease versus multistation N2 disease. When discussing treatment for fit
patients with potentially resectable cN2 NSCLC, lung cancer teams should
consider trimodality treatment with chemotherapy, radiotherapy, and
surgery or bimodality treatment with chemotherapy and either surgery or
radiotherapy. We advocate that all patients see both a thoracic surgeon
and the oncology team to discuss these different approaches.<br/>Copyright
&#xa9; 2017.

<66>
Accession Number
617408818
Author
Halkos M.E.; Anderson A.; Binongo J.N.G.; Stringer A.; Lasanajak Y.;
Thourani V.H.; Lattouf O.M.; Guyton R.A.; Baio K.T.; Sarin E.; Keeling
W.B.; Cook N.R.; Carssow K.; Neill A.; Glas K.E.; Puskas J.D.
Institution
(Halkos, Thourani, Lattouf, Guyton, Baio, Keeling, Cook, Carssow, Neill)
Division of Cardiothoracic Surgery, Emory University School of Medicine,
Atlanta, Ga
(Anderson) Department of Neurology, Emory University School of Medicine,
Atlanta, Ga
(Stringer) Department of Rehabilitation Medicine, Emory University School
of Medicine, Atlanta, Ga
(Glas) Department of Anesthesiology, Emory University School of Medicine,
Atlanta, Ga
(Binongo, Lasanajak) Rollins School of Public Health, Emory University
School of Medicine, Atlanta, Ga
(Sarin) Department of Cardiothoracic Surgery, Inova Fairfax Healthcare
System, Falls Church, Va
(Puskas) Department of Cardiothoracic Surgery, Mount Sinai University
School of Medicine, New York, NY
Title
Operative strategies to reduce cerebral embolic events during on- and
off-pump coronary artery bypass surgery: A stratified, prospective
randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: To determine the impact of different aortic clamping strategies
on the incidence of cerebral embolic events during coronary artery bypass
grafting (CABG). Methods: Between 2012 and 2015, 142 patients with
low-grade aortic disease (epiaortic ultrasound grade I/II) undergoing
primary isolated CABG were studied. Those undergoing off-pump CABG were
randomized to a partial clamp (n = 36) or clampless facilitating device
(CFD; n = 36) strategy. Those undergoing on-pump CABG were randomized to a
single-clamp (n = 34) or double-clamp (n = 36) strategy. Transcranial
Doppler ultrasonography (TCD) was performed to identify high-intensity
transient signals (HITS) in the middle cerebral arteries during periods of
aortic manipulation. Neurocognitive testing was performed at baseline and
30-days postoperatively. The primary endpoint was total number of HITS
detected by TCD. Groups were compared using the Mann-Whitney U test.
Results: In the off-pump group, the median number of total HITS were
higher in the CFD subgroup (30.0; interquartile range [IQR], 22-43)
compared with the partial clamp subgroup (7.0; IQR, 0-16; P < .0001). In
the CFD subgroup, the median number of total HITS was significantly lower
for patients with 1 CFD compared with patients with >1 CFD (12.5 [IQR,
4-19] vs 36.0 [IQR, 25-47]; P = .001). In the on-pump group, the median
number of total HITS was 10.0 (IQR, 3-17) in the single-clamp group,
compared with 16.0 (IQR, 4-49) in the double-clamp group (P = .10). There
were no differences in neurocognitive outcomes across the groups.
Conclusions: For patients with low-grade aortic disease, the use of CFDs
was associated with an increased rate of cerebral embolic events compared
with partial clamping during off-pump CABG. A single-clamp strategy during
on-pump CABG did not significantly reduce embolic events compared with a
double-clamp strategy.<br/>Copyright &#xa9; 2017 The American Association
for Thoracic Surgery.

<67>
Accession Number
617294893
Author
Shehada S.-E.; Elhmidi Y.; Puluca N.; Ozturk O.; Demircioglu E.; Wendt D.;
Jakob H.; Thielmann M.
Institution
(Shehada, Demircioglu, Wendt, Jakob, Thielmann) Department of Thoracic and
Cardiovascular Surgery, West-German Heart and Vascular Center Essen,
University of Duisburg-Essen, Hufelandstrase 55, Essen 45147, Germany
(Elhmidi, Puluca) Department of Cardiovascular Surgery, German Heart
Center Munich, Munich, Germany
(Ozturk) Department of Cardiovascular Surgery, Klinikum Bogenhausen,
Munich, Germany
Title
Impact of previous cardiac surgery in patients undergoing transcatheter
aortic valve implantation: A systematic review.
Source
Journal of Cardiovascular Surgery. 58 (5) (pp 787-793), 2017. Date of
Publication: October 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: Redo surgical aortic valve replacement after prior cardiac
surgery is usually related to a higher risk of mortality and morbidity.
Transcatheter aortic valve implantation (TAVI) became an alternative
therapy for those patients in the past couple of years. EVIDENCE
ACQUISITION: We aimed in this study to analyze the outcomes of patients
undergoing TAVI after a prior cardiac surgery especially those who
underwent coronary artery bypass grafting (CABG) and to see if TAVI offers
any advantages for those patients than conventional surgical aortic valve
replacement. EVIDENCE SYNTHESIS: We searched for relevant articles in
Medline and abstracted clinical information based on pre-defined criteria
and endpoints. Data of nine studies including the baseline
characteristics, implantation data, postoperative outcomes and major
adverse cardiac complications, which were published between 2011 and 2015
were collected and evaluated. From all reviewed studies, 769 patients had
a prior cardiac surgery and underwent TAVI for symptomatic severe aortic
stenosis. Of these, 738 patients (96%) had prior CABG. Patients' age
ranged from 78+/-3 to 82+/-5.8 years. The STS and EuroSCORE ranged from
4.5+/-3% to 14.7+/-12.3% and 25.6+/-16.2% to 37+/-18%, respectively. In
all reviewed studies the 30-day mortality was about 5.6% and was not
significantly higher compared to patients with no history of prior cardiac
surgery. The total incidence of stroke was about 3.6%, myocardial
infarction was 1.7%, acute kidney injury was 13.8% and permanent pacemaker
implantation was about 14.2%. CONCLUSIONS: However, patients presented
with severe aortic valve disease after a previous cardiac surgery
exhibited a higher preoperative STS and EuroSCORE than those without
previous cardiac surgery. The 30-day mortality was not significantly
higher in comparison to those patients without history of prior cardiac
surgery. According to that, transcatheter aortic valve implantation should
be considered as an attractive alternative for those
patients.<br/>Copyright &#xa9; 2016 Edizioni Minerva Medica.

<68>
Accession Number
617294877
Author
Mihos C.G.; Yucel E.; Santana O.
Institution
(Mihos, Yucel) Cardiac Ultrasound Laboratory, Massachusetts General
Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02140,
United States
(Santana) Division of Cardiology at Columbia University, Mount Sinai Heart
Institute, Miami Beach, FL, United States
Title
A systematic review and meta-analysis of chordal replacement versus
leaflet resection for isolated posterior mitral valve prolapse.
Source
Journal of Cardiovascular Surgery. 58 (5) (pp 779-786), 2017. Date of
Publication: October 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: Chordal replacement (Chord MVr) for isolated posterior
mitral valve prolapse allows for preservation of the native mitral valve
apparatus. The potential benefits of this approach, as compared with
leaflet resection (Resection), are not clearly defined. EVIDENCE
ACQUISITION: A systematic review and meta-analysis was conducted on
operative, clinical, and echocardiographic outcomes. Risk ratios (RR) were
calculated by the Mantel-Haenszel method under a fixed or random effects
model, as appropriate. EVIDENCE SYNTHESIS: Eight studies were included,
with a total of 1922 patients (Chord MVr, N.=835; Resection, N.=1087).
Baseline characteristics were similar, except for a higher incidence of
atrial fibrillation in the Chord MVr group (15.5% versus 9.9%, P=0.03),
and a slightly greater mitral regurgitation grade in the Resection group
(3.5 versus 3.4, P=0.008). P2 segment prolapse was the most common
pathology, however, patients undergoing Chord MVr had a higher incidence
of multi-segment prolapse (32.1% versus 13.9%, P=0.0006). There was no
difference in operative mortality (1.1% for both) or perioperative
complications. At a mean follow-up of 2.9+/-2.8 years (median=2.8 years,
IQR 1.6-4.4), Chord MVr was associated with a lower risk of reoperation
(1.1% versus 4.3%; RR 0.26, 95% CI 0.12-0.56, P=0.0007), and similar
survival and recurrence of moderate mitral regurgitation, when compared
with Resection. Finally, a lower transmitral gradient (2.5 versus 2.8
mmHg, P=0.0004) and larger orifice area (3.2 versus 3.0 cm2, P=0.002) were
observed with Chord MVr. CONCLUSIONS: At 2.9-year follow-up, Chord MVr for
isolated posterior mitral valve prolapse was associated with a lower
reoperation rate and favorable valve hemodynamics, when compared with
leaflet resection.<br/>Copyright &#xa9; 2016 Edizioni Minerva Medica.

<69>
Accession Number
617294815
Author
Fiorina C.; Bruschi G.; Testa L.; De Carlo M.; De Marco F.; Coletti G.;
Bonardelli S.; Adamo M.; Curello S.; Scioti G.; Panisi P.; Bedogni F.;
Petronio A.S.; Ettori F.
Institution
(Fiorina, Coletti, Bonardelli, Adamo, Curello, Ettori) Cardiac
Catheterization Laboratory, Cardiothoracic Department, Spedali Civili
Brescia, Brescia, Italy
(Bruschi) Niguarda Ca'Granda Hospital, Milan, Italy
(Testa, De Marco, Panisi, Bedogni) IRCCS Policlinico S. Donato, Milan,
Italy
(De Carlo, Scioti, Petronio) Azienda Ospedaliero Universitaria Pisana,
Pisa, Italy
Title
Transaxillary versus transaortic approach for transcatheter aortic valve
implantation with CoreValve Revalving System: Insights from multicenter
experience.
Source
Journal of Cardiovascular Surgery. 58 (5) (pp 747-754), 2017. Date of
Publication: October 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: About one-third of candidates for transcatheter aortic valve
implantation (TAVI) suffer from severe peripheral artery disease, making
the routine femoral approach difficult or impossible. The aim was to
compare the transaxillary (TAx) and the transaortic (TAo) route for TAVI
with Medtronic CoreValve Revalving System (CRS). METHODS: Out of 1049
consecutive TAVI with 18F CRS, 242 (23%) were treated in 4 high-volume
Italian Centre through TAx (61%) and TAo (39%). RESULTS: The devices
success was similar (P=0.16) with a trend to a lower incidence of
significant paravalvular leak (6% vs. 14%, P=0.07) and a significant
reduction of permanent pacemaker (PPM) implantation (13% vs. 34%, P=0.017)
in the TAo. However, this route showed a higher incidence of acute kidney
injury (P=0.016) and a longer hospital stay after the index procedure
(days 10 [8-14] vs. 8 [7-12], P=0.001). By a multivariate analysis the
vascular access is an independent predictor for a longer hospital stay
(TAo route; OR=0.37, 95% CI: 0.18-0.75; P=0.006) and for PPM implantation
(TAx route; OR=3.7, 95% CI: 1.2-10.8; P=0.017). CONCLUSIONS: Although the
higher clinical risk profile of transaortic population, the TAo approach
showed an equally high device success with similar 30-day safety and 1year
efficacy, compared to TAx route. However, due to non-procedure-specific
complications post-TAo TAVI, this route requires a specialized
postoperative care and the treatment of patients in highly specialized and
experienced centers.<br/>Copyright &#xa9; 2016 Edizioni Minerva Medica.

<70>
Accession Number
613510698
Author
Altun D.; Cinar O.; Ozker E.; Turkoz A.
Institution
(Altun, Cinar, Turkoz) Department of Anesthesiology, Baskent University
Istanbul Training and Medical Research Center, Istanbul, Turkey
(Ozker) Department of Cardiovascular Surgery, Baskent University Istanbul
Training and Medical Research Center, Istanbul, Turkey
Title
The effect of tramadol plus paracetamol on consumption of morphine after
coronary artery bypass grafting.
Source
Journal of Clinical Anesthesia. 36 (pp 189-193), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study of objective To compare the effects of oral tramadol + paracetamol
combination on morphine consumption following coronary artery bypass
grafting (CABG) in the patient-controlled analgesia (PCA) protocol. Design
A prospective, double-blind, randomized, clinical study. Setting
Single-institution, tertiary hospital. Patients Fifty cardiac surgical
patients undergoing primary CABG surgery. Interventions After surgery, the
patients were allocated to 1 of 2 groups. Both groups received morphine
according to the PCA protocol after arrival to the coronary intensive care
unit (bolus 1 mg, lockout time 15 minutes). In addition to morphine
administration 2 hours before operation and postoperative 2nd, 6th, 12th,
18th, 24th, 30th, 36th, 42th, and 48th hours, group T received tramadol +
paracetamol (Zaldiar; 325 mg paracetamol, 37.5 mg tramadol) and group P
received placebo. Sedation levels were measured with the Ramsay Sedation
Scale, whereas pain was assessed with the Pain Intensity Score during
mechanical ventilation and with the Numeric Rating Scale after extubation.
If the Numeric Rating Scale score was >=3 and Pain Intensity Score was
>=3, 0.05 mg/kg morphine was administered additionally. Measurements
Preoperative patient characteristics, risk assessment, and intraoperative
data were similar between the groups. Main results Cumulative morphine
consumption, number of PCA demand, and boluses were higher in group P (P <
.01). The amount of total morphine (in mg) used as a rescue analgesia was
also higher in group P (5.06 +/- 1.0), compared with group T (2.37 +/-
0.52; P < .001). The patients who received rescue doses of morphine were 8
(32%) in group T and 18 (72%) in group P (P < .001). Duration of
mechanical ventilation in group P was longer than group T (P < .01).
Conclusion Tramadol + paracetamol combination along with PCA morphine
improves analgesia and reduces morphine requirement up to 50% after CABG,
compared with morphine PCA alone.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<71>
Accession Number
613158074
Author
Krieger E.V.; Lee J.; Branch K.R.; Hamilton-Craig C.
Institution
(Krieger, Lee, Branch, Hamilton-Craig) Division of Cardiology, Department
of Medicine, University of Washington, Seattle, WA, United States
(Krieger) Seattle Adult Congenital Heart Service, University of Washington
School of Medicine, Seattle, WA 98195, United States
(Hamilton-Craig) Department of Cardiology, University of Queensland,
Brisbane, QLD, Australia
(Hamilton-Craig) Department of Cardiology, Heart and Lung Institute,
Prince Charles Hospital, Brisbane, QLD, Australia
Title
Quantitation of mitral regurgitation with cardiac magnetic resonance
imaging: A systematic review.
Source
Heart. 102 (23) (pp 1864-1870), 2016. Date of Publication: 01 Dec 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
In this review discuss the application of cardiac magnetic resonance (CMR)
to the evaluation and quantification of mitral regurgitation and provide a
systematic literature review for comparisons with echocardiography. Using
the 2015 Preferred Reporting Items for Systematic Reviews and
Meta-Analyses methodology, we searched Medline and PubMed for original
research articles published since 2000 that provided data on the
quantification of mitral regurgitation by CMR. We identified 220 articles
of which 33 were included. Four main techniques of mitral regurgitation
quantification were identified. Reproducibility varied substantially
between papers but was high overall for all techniques. However,
quantification differed between the techniques studied. When compared with
two-dimensional echocardiography, mitral regurgitation fraction and
regurgitant volume measured by CMR were comparable but typically lower.
CMR has high reproducibility for the quantification of mitral
regurgitation in experienced centres, but further technological refinement
is needed. An integrated and standardised approach that combines multiple
techniques is recommended for optimal reproducibility and precise mitral
regurgitation quantification. Definitive outcome studies using CMR as a
basis for treatment are lacking but needed.

<72>
Accession Number
608676204
Author
Xu Z.; Fan J.; Luo X.; Zhang W.-B.; Ma J.; Lin Y.-B.; Ma S.-H.; Chen X.;
Wang Z.-P.; Ou J.-S.; Zhang X.
Institution
(Xu, Zhang, Ma, Ma, Wang, Ou, Zhang) Division of Cardiac Surgery, The
First Affiliated Hospital of Sun-Yat-sen University, Guangdong, China
(Fan, Luo, Chen) Division of Obstetrics and Gynecology, The First
Affiliated Hospital of Jinan University, China
(Lin) Guangdong Cardiovascular Institute, Guangdong Academy of Medical
Sciences, Guangdong General Hospital, China
Title
Anticoagulation Regimens During Pregnancy in Patients With Mechanical
Heart Valves: A Systematic Review and Meta-analysis.
Source
Canadian Journal of Cardiology. 32 (10) (pp 1248.e1-1248.e9), 2016. Date
of Publication: 01 Oct 2016.
Publisher
Pulsus Group Inc.
Abstract
Background Managing anticoagulation in pregnant women with mechanical
heart valves remains challenging. Our aim was to evaluate the
effectiveness and safety of 4 regimens in these women. Methods Relevant
studies published before June 2015 were collected in several databases and
analyzed with RevMan version 5.3 and SPSS version 19.0. Four regimens were
defined as follows: a regimen of a vitamin K antagonist (VKA) throughout
pregnancy; a heparin (H)/VKA regimen using VKAs except for unfractionated
heparin (UFH) or low molecular weight heparin (LMWH) during 6-12 weeks of
pregnancy; a LMWH regimen of adjusted LMWH doses throughout pregnancy; and
a UFH regimen of adjusted UFH doses throughout pregnancy. The low warfarin
dose in the VKA regimen was defined as 5 mg/d or less. Results Fifty-one
studies comprising 2113 pregnancies in 1538 women were included. The rate
of fetal wastage was significantly higher in the high warfarin dose
subgroup than in the low dose one. Compared with the H/VKA regimen, the
rate of maternal major thromboembolic event in the low-dose VKA regimen
group was significantly lower, although the fetal outcomes were similar.
Compared with the H/VKA regimen, the rate of fetal wastage in the LMWH
regimen group was significantly lower, and the maternal outcomes were
similar. The UFH regimen presented the worst maternal and fetal outcomes.
Conclusions In the absence of large prospective trials, this meta-analysis
showed that the VKA regimen should be best for pregnant women with a low
warfarin dose, and the H/VKA regimen might be reasonable for those with a
high warfarin dose. The LMWH regimen could be used for those who refuse
VKA.<br/>Copyright &#xa9; 2016 Canadian Cardiovascular Society

<73>
Accession Number
609716723
Author
Akgul A.; Guner B.; Cirak M.; Celik D.; Hergunsel O.; Bedirhan S.
Institution
(Akgul) Faculty of Health Science, Department of Gerontology, Faculty of
Health Sciences, Istanbul University, Istanbul 34740, Turkey
(Akgul) Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk
Training and Research Hospital, Istanbul, Turkey
(Guner, Hergunsel, Bedirhan) Department of Anesthesiology, Bakirkoy Dr.
Sadi Konuk Training and Research Hospital, Istanbul, Turkey
(Cirak) Department of Neurosurgery, Bakirkoy Dr. Sadi Konuk Training and
Research Hospital, Istanbul, Turkey
(Celik) Department of Physiotherapy and Rehabilitation, Faculty of Health
Sciences, Istanbul University, Istanbul, Turkey
Title
The Beneficial Effect of Hypnosis in Elective Cardiac Surgery: A
Preliminary Study.
Source
Thoracic and Cardiovascular Surgeon. 64 (7) (pp 581-588), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Background Single-session hypnosis has never been evaluated as a
premedication technique in patients undergoing coronary artery bypass
grafting (CABG). The aim of the present study was to evaluate the
beneficial effects of clinical hypnotherapy on perioperative anxiety, pain
perception, sedation, and necessity for ventilator assistance in patients
undergoing CABG. Methods Double-blind, randomized, clinical trial was
performed. Forty-four patients undergoing CABG surgery were randomized
into two groups. The patients in group A received preprocedural hypnosis
by an anesthesiologist. Patients in group B (control) had only information
on the surgical intervention by the same anesthesiologist.
State-Trait-Anxiety Index-I (STAI-I) and Beck Depression Inventory (BDI)
were performed preoperatively in both groups. Visual analog scale (VAS)
and Ramsay sedation scale (RSS) were evaluated on 0th, 1st, 2nd, 4th, 6th,
8th, 10th, 12th, and 24th hours, postoperatively. Postoperative anxiety
level, analgesic drug consumption, and duration of ventilator assistance
and intensive care unit (ICU) stay were also documented. Results When
anxiety and depression levels were compared, significantly lower STA-I and
BDI values were detected in group A after hypnotherapy (p = 0.001, p =
0.001, respectively). Significantly less total doses of remifentanil (34.4
+/- 11.4 vs. 50.0 +/- 13.6 mg) and morphine (4.9 +/- 3.3 vs. 13.6 +/- 2.7
mg) were administered in group A in the postoperative period. Ventilator
assistance duration (6.8 +/- 2.0 vs. 8.9 +/- 2.7 hours) was also shorter
in group A when compared with that in group B (p = 0.007). Conclusion
Hypnosis session prior to surgery was an effective complementary method in
decreasing presurgical anxiety, and it resulted in better pain control as
well as reduced ventilator assistance following CABG
surgery.<br/>Copyright &#xa9; Georg Thieme Verlag KGStuttgart . New York.

<74>
Accession Number
607221464
Author
Deininger S.; Hoenicka M.; Muller-Eising K.; Rupp P.; Liebold A.; Koenig
W.; Gorki H.
Institution
(Deininger, Hoenicka, Muller-Eising, Rupp, Liebold, Gorki) Department of
Cardio-Thoracic and Vascular Surgery, University of Ulm Medical Center,
Albert-Einstein-Allee 23, Ulm 89081, Germany
(Koenig) Department of Internal Medicine II - Cardiology, University of
Ulm Medical Center, Ulm, Germany
Title
Renal Function and Urinary Biomarkers in Cardiac Bypass Surgery: A
Prospective Randomized Trial Comparing Three Surgical Techniques.
Source
Thoracic and Cardiovascular Surgeon. 64 (7) (pp 561-568), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Background Cardiopulmonary bypass procedure is associated with an
increased risk of renal impairment. To which extent structural damage
causes functional decline is unknown. We evaluated perioperative kidney
injury and function in patients treated with conventional extracorporeal
circulation (CECC), minimized extracorporeal circulation (MECC), and
off-pump coronary artery bypass grafting (OPCAB). Methods Blood and urine
samples, collected at baseline and up to 72 hours after surgery from
patients of the HEPCON trial (DRKS00007580, 120 patients randomized for
heparin management and for surgical technique), were analyzed for
differences in renal injury and function. Neutrophil gelatinase-associated
lipocalin, alpha glutathione S-transferase, liver fatty acid-binding
protein, and kidney injury molecule-1 were measured as urinary protein
markers of renal tubular injury. Serum creatinine, blood urea levels, and
estimated glomerular filtration rate were determined to monitor renal
function. Results Markers of tubular injury differed significantly between
surgical technique groups early after surgery, indicating the most
detrimental effect in CECC. Hemolysis and hemodilution correlated with
these early changes. A late rise did not show intergroup differences. Time
courses of renal function parameters, as well as the development of acute
kidney injury in 15 patients (13.5%), were irrespective of surgical
technique. Heparin management did not influence renal parameters.
Conclusion During coronary artery bypass grafting, CECC temporarily
induces more tubular injury than MECC or OPCAB. However, late changes of
renal function parameters occur irrespective of extracorporeal perfusion
mode and even in off-pump surgery.<br/>Copyright &#xa9; Georg Thieme
Verlag KGStuttgart . New York.

<75>
Accession Number
611570779
Author
Sibilitz K.L.; Berg S.K.; Rasmussen T.B.; Risom S.S.; Thygesen L.C.; Tang
L.; Hansen T.B.; Johansen P.P.; Gluud C.; Lindschou J.; Schmid J.P.;
Hassager C.; KOber L.; Taylor R.S.; Zwisler A.-D.
Institution
(Sibilitz, Berg, Rasmussen, Risom, Tang, Hansen, Johansen, Hassager,
KOber, Zwisler) Department of Cardiology, Rigshospitalet, Copenhagen
University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark
(Sibilitz, Thygesen, Taylor, Zwisler) National Institute of Public Health,
University of Southern Denmark, Copenhagen, Denmark
(Berg, Rasmussen) Department of Cardiology, Gentofte Hospital, Gentofte,
Denmark
(Risom) Bachelor's Degree Programme in Nursing, Metropolitan University
College, Copenhagen, Denmark
(Tang) Bachelor's Degree Programme in Physiotherapy, Department of
Rehabilitation and Nutrition, Metropolitan University College, Copenhagen,
Denmark
(Tang) Section of Social Medicine, Department of Public Health, University
of Copenhagen, Copenhagen, Denmark
(Hansen) Zealand University Hospital, Department of Cardiology, KOgevej
7-13, Roskilde 4000, Denmark
(Johansen) Department of Cardiology, Bispebjerg Hospital, Copenhagen,
Denmark
(Gluud, Lindschou) Department 7812, Centre for Clinical Intervention
Research, Copenhagen University Hospital, Copenhagen, Denmark
(Schmid) Cardiology Clinic, Tiefenau Hospital, University of Bern, Bern,
Switzerland
(Taylor) Institute of Health Research, University of Exeter Medical
School, Exeter, United Kingdom
(Zwisler) Department of Cardiology, Holbaek Sygehus, Holbaek, Denmark
(Zwisler) National Centre of Rehabilitation and Palliation, University of
Southern Denmark, University Hospital of Odense, Odense, Denmark
Title
Cardiac rehabilitation increases physical capacity but not mental health
after heart valve surgery: A randomised clinical trial.
Source
Heart. 102 (24) (pp 1995-2003), 2016. Date of Publication: 15 Dec 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective The evidence for cardiac rehabilitation after valve surgery
remains sparse. Current recommendations are therefore based on patients
with ischaemic heart disease. The aim of this randomised clinical trial
was to assess the effects of cardiac rehabilitation versus usual care
after heart valve surgery. Methods The trial was an
investigator-initiated, randomised superiority trial (The CopenHeartVR
trial, VR; valve replacement or repair). We randomised 147 patients after
heart valve surgery 1:1 to 12 weeks of cardiac rehabilitation consisting
of physical exercise and monthly psycho-educational consultations
(intervention) versus usual care without structured physical exercise or
psycho-educational consultations (control). Primary outcome was physical
capacity measured by VO<inf>2</inf> peak and secondary outcome was
self-reported mental health measured by Short Form-36. Results 76% were
men, mean age 62 years, with aortic (62%), mitral (36%) or
tricuspid/pulmonary valve surgery (2%). Cardiac rehabilitation compared
with control had a beneficial effect on VO<inf>2</inf> peak at 4 months
(24.8 mL/kg/min vs 22.5 mL/kg/min, p=0.045) but did not affect Short
Form-36 Mental Component Scale at 6 months (53.7 vs 55.2 points, p=0.40)
or the exploratory physical and mental outcomes. Cardiac rehabilitation
increased the occurrence of self-reported non-serious adverse events
(11/72 vs 3/75, p=0.02). Conclusions Cardiac rehabilitation after heart
valve surgery significantly improves VO<inf>2</inf> peak at 4 months but
has no effect on mental health and other measures of exercise capacity and
self-reported outcomes. Further research is needed to justify cardiac
rehabilitation in this patient group.

<76>
Accession Number
611991426
Author
Vlahou A.; Diplaris K.; Ampatzidou F.; Karagounnis L.; Drossos G.
Institution
(Vlahou, Diplaris, Ampatzidou, Drossos) Department of Cardiothoracic
Surgery, General Hospital "George Papanikolaou", Exohi Thessalonikis,
Thessaloniki 57010, Greece
(Karagounnis) Departement of Cardiology, Interbalkan Medical Center,
Thessaloniki, Greece
Title
The Role of Blood Transfusion in the Development of Atrial Fibrillation
after Coronary Artery Bypass Grafting.
Source
Thoracic and Cardiovascular Surgeon. 64 (8) (pp 688-692), 2016. Article
Number: 154399oc. Date of Publication: 01 Dec 2016.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Objectives Atrial fibrillation (AF) is the most common complication after
coronary artery bypass grafting (CABG). It is associated with prolonged
hospital stay and increased cost. The aim of this study is to investigate
the relationship between transfusion of blood derivatives and occurrence
of postoperative paroxysmal AF. Materials and Methods From June 2012 to
February 2014, 446 patients undergoing CABG with cardiopulmonary bypass
(CPB) were prospectively evaluated for occurrence of postoperative AF.
Patients and procedural variables were recorded and were associated with
the development of new-onset AF with logistic regression analysis. Results
AF developed in 111 patients (24.9%). Preoperative factors associated with
the development of new-onset AF included age (p < 0.05), higher EuroSCORE
II (p < 0.05), carotid disease (p = 0.01), peripheral vascular disease (p
= 0.02), chronic obstructive pulmonary disease (p = 0.03), renal failure
(p = 0.05), and cardiac failure (p = 0.01). Intraoperative and
postoperative parameters included duration of CPB (p < 0.05), number of
grafts (p = 0.009), intubation time (p = 0.001), occurrence of
postoperative stroke (p = 0.01), transient ischemic attack (p = 0.02),
need for prolonged ventilation (p = 0.002), development of respiratory
tract infection (p = 0.02), need for noninvasive ventilation (p = 0.001),
reintubation (p = 0.02), development of postoperative acute kidney injury
(p = 0.002), and postoperative neurocognitive dysfunction (p = 0.002). The
number of red blood cell (RBC) units transfused during surgery (p = 0.7)
and the total number of RBC units transfused (p = 0.2) as well as units of
fresh frozen plasma (p = 0. 7) and platelets units transfused in total (p
= 0.3) were not found to increase the risk of postoperative AF. Conclusion
Intraoperative and postoperative blood products transfusion in patients
operated for CABG is not associated with increased risk of developing
postoperative AF.<br/>Copyright &#xa9; Georg Thieme Verlag KGStuttgart .
New York.

<77>
Accession Number
605474929
Author
Zheng S.; Zhang H.; Li Y.; Han J.; Jia Y.; Meng X.
Institution
(Zheng, Zhang, Li, Han, Jia, Meng) Department of Cardiac Surgery, Beijing
Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang
District, Beijing 100029, China
Title
Comparison of Left Atrial and Biatrial Maze Procedure in the Treatment of
Atrial Fibrillation: A Meta-Analysis of Clinical Studies.
Source
Thoracic and Cardiovascular Surgeon. 64 (8) (pp 661-671), 2016. Article
Number: 143952oc. Date of Publication: 01 Dec 2016.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Background The outcomes of atrial fibrillation (AF) between biatrial maze
(BAM) and left atrial maze (LAM) are still controversial. The purpose of
this study was to compare the clinical and rhythm outcomes between BAM and
LAM in patients with AF. Methods Electronic databases and article
references were systematically searched (1990-2014) to access relevant
studies. Odds ratio (OR) and weight mean difference (WMD) with 95%
confidence interval (CI) were reported. Results Fourteen studies with
2,075 patients were finally involved in the present meta-analysis. The
rate of restored sinus rhythm (SR) was similar in BAM and LAM groups (OR:
1.25, 95% CI: 0.91-1.72, p = 0.163). BAM reduced the prevalence of atrial
flutter during follow-up (OR: 0.12, 95% CI: 0.01-0.96, p = 0.046).
Compared with BAM, LAM shorten aortic cross-clamping time (WMD = 9.05
minutes, 95% CI: 1.28-16.82, p = 0.023) and cardiopulmonary bypass time
(WMD = 20.21 minutes, 95% CI: 7.40-33.03, p = 0.002). No significant
difference was found between groups in the risk of death (OR: 1.22, 95%
CI: 0.70-2.14, p = 0.233), cerebrovascular events (OR: 1.44, 95% CI:
0.51-4.06, p = 0.493), and reoperation for bleeding (OR: 1.34, 95% CI:
0.70-2.55, p = 0.374). However, the risk for implantation of permanent
pacemaker was significantly higher in BAM group (OR: 2.60, 95% CI:
1.09-6.20, p = 0.031). Conclusion No significant difference was found
between BAM and LAM in the rate of restored SR, the risk of death,
cerebrovascular events, and reoperation for bleeding. BAM is superior to
LAM in reducing the prevalence of atrial flutter during follow-up, but LAM
shortens the aortic cross-clamping time and cardiopulmonary bypass time,
and decreases the risk of permanent pacemaker implantation.<br/>Copyright
&#xa9; Georg Thieme Verlag KGStuttgart . New York.

<78>
Accession Number
616583985
Author
Vandenbogaart E.; Doering L.; Chen B.; Saltzman A.; Chaker T.; Creaser
J.W.; Rourke D.; Cheng R.W.; Fonarow G.C.; Deng M.
Institution
(Vandenbogaart, Chaker, Creaser, Rourke, Cheng, Deng) Department of
Medicine, Division of Cardiology, University of California Los Angeles,
100 Medical Plaza, Suite 630E, Los Angeles, CA 90095, United States
(Doering, Chen) UCLA School of Nursing, 700 Tiverton Ave, Los Angeles, CA
90095, United States
(Saltzman) Cardiopulmonary Rehabilitation Center, Ronald Regan UCLA
Medical Center, 200 UCLA Medical Plaza, Suite 206C, Los Angeles, CA 90095,
United States
(Fonarow) Department of Medicine, Division of Cardiology, University of
California Los Angeles, 10833 LeConte Ave A2-237 CHS, Los Angeles, CA
90095, United States
Title
Evaluation of the SIPAT instrument to assess psychosocial risk in heart
transplant candidates: A retrospective single center study.
Source
Heart and Lung: Journal of Acute and Critical Care. 46 (4) (pp 273-279),
2017. Date of Publication: July 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives We evaluated the reliability of the Stanford Integrated
Psychosocial Assessment for Transplantation (SIPAT) in heart transplant
(HT) recipients and explored its usefulness in predicting post-transplant
outcomes. Background Pre-transplant psychosocial and behavioral risk is
associated with post-transplant clinical outcomes. SIPAT is a risk
assessment tool created for pre-transplant psychosocial evaluation.
Methods Via retrospective chart review, three examiners applied the SIPAT
to 51 adult HT recipients. Examiners blinded to SIPAT scores extracted
data and interviewed clinicians for one-year post-transplant outcomes.
Analysis included Intra-class correlation coefficient (ICC), Pearson's
correlation coefficient and Chi-square. Results SIPAT demonstrated strong
inter-rater reliability (ICC = 0.89, 95% CI = 0.76-0.96). Compared to
those with SIPAT ratings of "Excellent/Good", the "Minimally Acceptable
Candidate/High Risk" group was more likely to miss clinic visits (p =
0.004). Conclusions The SIPAT tool had strong IRR. Less favorable SIPAT
ratings were associated with nonadherence to clinic visits. Further study
is warranted to determine association of SIPAT ratings to clinical
outcomes.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<79>
Accession Number
617379546
Author
Gale R.P.; Opelz G.
Institution
(Gale) Haematology Research Centre, Imperial College London, London,
United Kingdom
(Opelz) Institute of Immunology, University of Heidelberg, Heidelberg,
Germany
Title
Is there effective immune surveillance against chronic myeloid leukaemia?
No.
Source
Haematologica. Conference: 22th Congress of the European Hematology
Association. Spain. 102 (pp 233-234), 2017. Date of Publication: June
2017.
Publisher
Ferrata Storti Foundation
Abstract
Background: Immune surveillance refers to a process whereby the innate and
adoptive immune systems recognize and eliminate cancer cells on the basis
of cancer-specific or related antigens or other molecules. Substantial
data support the concept of immune surveillance in rodents but data in
humans are less convincing and apply mostly to virus-induced cancers.
However, considerable data indicate a strong anti-leukaemia effect in
persons with chronic myeloid leukaemia (CML) receiving an allogeneic
haematopoietic cell transplant. Most, if not all, of this anti-leukaemia
effect is confounded with graft-versus-host disease (GvHD) and whether
there is a allogeneic or host specific anti-leukaemia effect distinct from
GvHD is controversial. Another interesting observation is about 40 percent
of persons with CML and a deep molecular response to tyrosine
kinase-inhibitors (TKIs) remain in molecular remission when TKI-therapy is
stopped. Because TKI-therapy is very unlikely to eradicate every CML cell,
some ascribe this therapy-free remission (TFR) a result of immune
surveillance. Immune surveillance refers to a process whereby the innate
and adoptive immune systems recognize and eliminate cancer cells on the
basis of cancerspecific or related antigens or other molecules.
Substantial data support the concept of immune surveillance in rodents but
data in humans are less convincing and apply mostly to virus-induced
cancers. However, considerable data indicate a strong anti-leukaemia
effect in persons with chronic myeloid leukaemia (CML) receiving an
allogeneic haematopoietic cell transplant. Most, if not all, of this
anti-leukaemia effect is confounded with graft-versus-host disease (GvHD)
and whether there is a allogeneic or host specific anti-leukaemia effect
distinct from GvHD is controversial. Another interesting observation is
about 40 percent of persons with CML and a deep molecular response to
tyrosine kinase-inhibitors (TKIs) remain in molecular remission when
TKI-therapy is stopped. Because TKI-therapy is very unlikely to eradicate
every CML cell, some ascribe this therapy-free remission (TFR) a result of
immune surveillance. Immune surveillance refers to a process whereby the
innate and adoptive immune systems recognize and eliminate cancer cells on
the basis of cancerspecific or related antigens or other molecules.
Substantial data support the concept of immune surveillance in rodents but
data in humans are less convincing and apply mostly to virus-induced
cancers. However, considerable data indicate a strong anti-leukaemia
effect in persons with chronic myeloid leukaemia (CML) receiving an
allogeneic haematopoietic cell transplant. Most, if not all, of this
anti-leukaemia effect is confounded with graft-versus-host disease (GvHD)
and whether there is a allogeneic or host specific anti-leukaemia effect
distinct from GvHD is controversial. Another interesting observation is
about 40 percent of persons with CML and a deep molecular response to
tyrosine kinase-inhibitors (TKIs) remain in molecular remission when
TKI-therapy is stopped. Because TKI-therapy is very unlikely to eradicate
every CML cell, some ascribe this therapy-free remission (TFR) a result of
immune surveillance. Immune surveillance refers to a process whereby the
innate and adoptive immune systems recognize and eliminate cancer cells on
the basis of cancerspecific or related antigens or other molecules.
Substantial data support the concept of immune surveillance in rodents but
data in humans are less convincing and apply mostly to virus-induced
cancers. However, considerable data indicate a strong anti-leukaemia
effect in persons with chronic myeloid leukaemia (CML) receiving an
allogeneic haematopoietic cell transplant. Most, if not all, of this
anti-leukaemia effect is confounded with graft-versus-host disease (GvHD)
and whether there is a allogeneic or host specific anti-leukaemia effect
distinct from GvHD is controversial. Another interesting observation is
about 40 percent of persons with CML and a deep molecular response to
tyrosine kinase-inhibitors (TKIs) remain in molecular remission when
TKI-therapy is stopped. Because TKI-therapy is very unlikely to eradicate
every CML cell, some ascribe this therapy-free remission (TFR) a result of
immune surveillance. Immune surveillance refers to a process whereby the
innate and adoptive immune systems recognize and eliminate cancer cells on
the basis of cancerspecific or related antigens or other molecules.
Substantial data support the concept of immune surveillance in rodents but
data in humans are less convincing and apply mostly to virus-induced
cancers. However, considerable data indicate a strong anti-leukaemia
effect in persons with chronic myeloid leukaemia (CML) receiving an
allogeneic haematopoietic cell transplant. Most, if not all, of this
anti-leukaemia effect is confounded with graft-versus-host disease (GvHD)
and whether there is a allogeneic or host specific anti-leukaemia effect
distinct from GvHD is controversial. Another interesting observation is
about 40 percent of persons with CML and a deep molecular response to
tyrosine kinase-inhibitors (TKIs) remain in molecular remission when
TKI-therapy is stopped. Because TKI-therapy is very unlikely to eradicate
every CML cell, some ascribe this therapy-free remission (TFR) a result of
immune surveillance. Immune surveillance refers to a process whereby the
innate and adoptive immune systems recognize and eliminate cancer cells on
the basis of cancerspecific or related antigens or other molecules.
Substantial data support the concept of immune surveillance in rodents but
data in humans are less convincing and apply mostly to virus-induced
cancers. However, considerable data indicate a strong anti-leukaemia
effect in persons with chronic myeloid leukaemia (CML) receiving an
allogeneic haematopoietic cell transplant. Most, if not all, of this
anti-leukaemia effect is confounded with graft-versus-host disease (GvHD)
and whether there is a allogeneic or host specific anti-leukaemia effect
distinct from GvHD is controversial. Aims:Another interesting observation
is about 40 percent of persons with CML and a deep molecular response to
tyrosine kinase-inhibitors (TKIs) remain in molecular remission when
TKI-therapy is stopped. Because TKI-therapy is very unlikely to eradicate
every CML cell, some ascribe this therapy-free remission (TFR) a result of
immune surveillance. Methods: To test these hypotheses, we studied whether
there was an increased incidence in CML in persons receiving immune
suppression after solid organ transplants. IF immune surveillance is
important in CML we would expect an increased incidence in this setting.
We used a dataset from the Collaborative Transplant Study (CTS) which
collects information on recipients of solid organ trans plants beginning
in 1985 from >300 transplant centers worldwide. Cancer incidence data were
checked annually by questionnaire. Data for expected CML incidence were
obtained from a cohort of identical size matched for age and sex from
Cancer Incidence in Five Continents monitored for the same duration as the
transplant cohort. Data collection and processing were approved by the
Data Protection Agency in Germany and all participating centers complied
with local ethical and privacy regulations.The CTS dataset consisted of
441,332 recipients of kidney (N=355,606), liver (N=47,846) and heart
(N=37,880) transplants. Amongst kidney transplant recipients the
standardized incidence ratio (SIR) for developing CML was 1.54 (95%
confidence interval, 1.1, 2.1; p=0.01) representing 39 cases in 1,682,491
person-years atrisk vs. 25 expected (14 excess cases). Amongst liver
transplant recipients the SIR was 1.72 (0.6, 4.0; P=0.34) representing 5
cases in 182,833 person-years at-risk vs. 3 expected (2 excess cases).
Amongst heart transplant recipients the SIR was 3.47 (1.8, 6.1; p=0.0005)
representing 12 cases in 173,015 person-years at-risk vs. 3 expected (9
excess cases). Data from recipients of kidney and liver transplants
suggest immune-suppression does not increase risk of developing CML or
does so very slightly. The increase in SIR in kidney graft recipients is
generally-attributed to increased cancer surveillance including blood
testing. Although the SIR of CML was substantially-increased after heart
transplants, these persons receive high doses of ionizing radiations for
diagnostic radiological procedures such as computer tomography
(CT)-angiography. Ionizing radiations are a proved cause of CML which
might explain the increased SIR. Results: Our data, 25 excess cases of CML
in 2,038,339 person-years at-risk observation suggest the magnitude of
immune-surveillance do not support the hypothesis immune surveillance
operates to an important extent to prevent CML in humans.
Summary/Conclusions: Consequently, the anti-leukaemia effect associated
with allotransplants and the TFR observed after stopping TKI-therapy is
unlikely to result from effective immune surveillance against CML.

<80>
Accession Number
614951242
Author
Landray M.J.; REVEAL Collaborative Group
Institution
(Landray, REVEAL Collaborative Group) REVEAL Central Coordinating Office,
Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield
Department of Population Health, University of Oxford, United Kingdom
Title
Randomized Evaluation of the Effects of Anacetrapib through
Lipid-modification (REVEAL)-A large-scale, randomized, placebo-controlled
trial of the clinical effects of anacetrapib among people with established
vascular disease: Trial design, recruitment, and baseline characteristics.
Source
American Heart Journal. 187 (pp 182-190), 2017. Date of Publication: 01
May 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Patients with prior vascular disease remain at high risk for
cardiovascular events despite intensive statin-based treatment. Inhibition
of cholesteryl ester transfer protein by anacetrapib reduces low-density
lipoprotein (LDL) cholesterol by around 25% to 40% and more than doubles
high-density lipoprotein (HDL) cholesterol. However, it is not known if
these apparently favorable lipid changes translate into reductions in
cardiovascular events. Methods The REVEAL study is a randomized,
double-blind, placebo-controlled clinical trial that is assessing the
efficacy and safety of adding anacetrapib to effective LDL-lowering
treatment with atorvastatin for an average of at least 4 years among
patients with preexisting atherosclerotic vascular disease. The primary
assessment is an intention-to-treat comparison among all randomized
participants of the effects of allocation to anacetrapib on major coronary
events (defined as the occurrence of coronary death, myocardial
infarction, or coronary revascularization). Results Between August 2011
and October 2013, 30,449 individuals in Europe, North America, and China
were randomized to receive anacetrapib 100 mg daily or matching placebo.
Mean (SD) age was 67 (8) years, 84% were male, 88% had a history of
coronary heart disease, 22% had cerebrovascular disease, and 37% had
diabetes mellitus. At the randomization visit (after at least 8 weeks on a
protocol-defined atorvastatin regimen), mean plasma LDL cholesterol was 61
(15) mg/dL and HDL cholesterol was 40 (10) mg/dL. Interpretation The
REVEAL trial will provide a robust evaluation of the clinical efficacy and
safety of adding anacetrapib to an effective statin regimen. Results are
anticipated in 2017.<br/>Copyright &#xa9; 2017 The Authors

<81>
Accession Number
613271864
Author
Alsaied T.; Bokma J.P.; Engel M.E.; Kuijpers J.M.; Hanke S.P.; Zuhlke L.;
Zhang B.; Veldtman G.R.
Institution
(Alsaied, Hanke) Children's Heart Institute, Cincinnati Children's
Hospital Medical Center, Cincinnati, OH, United States
(Bokma, Kuijpers) Department of Cardiology, Academic Medical Center,
Amsterdam, Netherlands
(Bokma, Kuijpers) Netherlands Interuniversity Cardiology Institute of the
Netherlands - Netherlands Heart Institute, Utrecht, Netherlands
(Engel) Department of Medicine, Groote Schuur Hospital, Cape Town, South
Africa
(Zuhlke) Department of Paediatrics, Red Cross War Memorial Children's
Hospital, University of Cape Town, Cape Town, South Africa
(Zhang) Division of Biostatistics and Epidemiology, Cincinnati Children's
Hospital Medical Center, Cincinnati, OH, United States
(Veldtman) Adolescent and Adult Congenital Program, Children's Heart
Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet
Avenue, Cincinnati, OH 45229, United States
Title
Factors associated with long-term mortality after Fontan procedures: A
systematic review.
Source
Heart. 103 (2) (pp 104-110), 2017. Date of Publication: 15 Jan 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background Despite an ageing Fontan population, data on late outcomes are
still scarce. Reported outcome measures and determinants vary greatly
between studies making comprehensive appraisal of mortality hazard
challenging. Methods We conducted a systematic review to evaluate causes
and factors associated with late mortality in patients with Fontan
circulation. Late mortality was defined as mortality beyond the first
postoperative year. Studies were included if they had >=90 patients or
>=20 late mortalities and/or transplants. Studies with overlapping
patients were rationalised to include only the most recent studies to
avoid duplication. Results From 28 studies, a total of 6707 patients with
an average follow-up time of 8.23+/-5.42 years was identified. There were
1000 deaths. Causes of late death were reported in 697 cases. The five
most common causes were heart/Fontan failure (22%), arrhythmia (16%),
respiratory failure (15%), renal disease (12%) and thrombosis/bleeding
(10%). Factors associated with late mortality were evaluated and
classified into 9 categories. Conclusions Causes and factors associated
with late mortality after the Fontan operation are summarised in this
study. The presented information will aid in identifying patients at
highest risk for mortality and guide our risk stratification efforts in
this patient population.<br/>Copyright &#xa9; Published by the BMJ
Publishing Group Limited.

<82>
[Use Link to view the full text]
Accession Number
613247810
Author
Kugler C.; Markovic S.; Rottbauer W.; Wohrle J.
Institution
(Kugler, Markovic, Rottbauer, Wohrle) Department of Internal Medicine,
University of Ulm, Albert-Einstein-Allee 23, Ulm 89081, Germany
Title
Bioresorbable scaffolds compared with everolimus-eluting stents for the
treatment of chronic coronary total occlusion: Clinical and angiographic
results of a matched paired comparison.
Source
Coronary Artery Disease. 28 (2) (pp 120-125), 2017. Date of Publication:
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objectives Data on bioresorbable vascular scaffolds for recanalization of
chronic total occlusions (CTOs) are limited. We compared the bioresorbable
scaffold Absorb with everolimus-eluting stents for the treatment of true
CTO. Methods After recanalization of CTO, 15 lesions treated with the
bioresorbable scaffold Absorb were matched with 15 lesions receiving
everolimus-eluting stent (EES) (http://www.clinicaltrials.gov
NCT02162082). Match criteria were presence of diabetes mellitus, total
device length and maximal device diameter. Angiographic follow-up was
scheduled after 9 months and clinical follow-up after 12 months. Dual
antiplatelet therapy was administered for 12 months. Quantitative coronary
analysis was carried out before and after implantation and at angiographic
follow-up. All lesions were predilated. The Absorb scaffolds and
drug-eluting stents were carefully placed and postdilatated with
high-pressure balloons. Patients received dual antiplatelet therapy for 12
months. The baseline characteristics were similar between both the groups.
The mean scaffold length was 81.7+/-29.1 versus 79.3+/-27.4 mm for the
mean stent length (P=0.82). In-device late lumen loss at the 9-month
follow-up was 0.38+/-0.47 versus 0.46+/-0.60 mm (P=0.69). The
device-oriented composite endpoint was similar in both groups, with 6.7%
in the Absorb-group versus 13.3% in the EES group because of target lesion
revascularization (P=0.54). Conclusion In CTOs, the use of a bioresorbable
scaffold Absorb after recanalization showed similar 9-month angiographic
and 12-month clinical results compared with an EES with 12 months of dual
antiplatelet therapy.<br/>Copyright &#xa9; 2017 Wolters Kluwer Health,
Inc.

<83>
Accession Number
614346087
Author
Hare J.M.; DiFede D.L.; Rieger A.C.; Florea V.; Landin A.M.; El-Khorazaty
J.; Khan A.; Mushtaq M.; Lowery M.H.; Byrnes J.J.; Hendel R.C.; Cohen
M.G.; Alfonso C.E.; Valasaki K.; Pujol M.V.; Golpanian S.; Ghersin E.;
Fishman J.E.; Pattany P.; Gomes S.A.; Delgado C.; Miki R.; Abuzeid F.;
Vidro-Casiano M.; Premer C.; Medina A.; Porras V.; Hatzistergos K.E.;
Anderson E.; Mendizabal A.; Mitrani R.; Heldman A.W.
Institution
(Hare, DiFede, Rieger, Florea, Landin, Khan, Valasaki, Pujol, Gomes,
Delgado, Abuzeid, Vidro-Casiano, Premer, Medina, Porras, Hatzistergos)
Interdisciplinary Stem Cell Institute, University of Miami Miller School
of Medicine, Miami, Florida, United States
(Hare, Mushtaq, Lowery, Byrnes, Hendel, Cohen, Alfonso, Miki, Mitrani,
Heldman) Department of Medicine, University of Miami Miller School of
Medicine, Miami, Florida, United States
(El-Khorazaty, Anderson, Mendizabal) The Emmes Corporation, Rockville,
Maryland, United States
(Golpanian) Department of Surgery, University of Miami Miller School of
Medicine, Miami, Florida, United States
(Ghersin, Fishman, Pattany) Department of Radiology, University of Miami
Miller School of Medicine, Miami, Florida, United States
Title
Randomized Comparison of Allogeneic Versus Autologous Mesenchymal Stem
Cells for Nonischemic Dilated Cardiomyopathy: POSEIDON-DCM Trial.
Source
Journal of the American College of Cardiology. 69 (5) (pp 526-537), 2017.
Date of Publication: 07 Feb 2017.
Publisher
Elsevier USA
Abstract
Background Although human mesenchymal stem cells (hMSCs) have been tested
in ischemic cardiomyopathy, few studies exist in chronic nonischemic
dilated cardiomyopathy (NIDCM). Objectives The authors conducted a
randomized comparison of safety and efficacy of autologous (auto) versus
allogeneic (allo) bone marrow-derived hMSCs in NIDCM. Methods Thirty-seven
patients were randomized to either allo- or auto-hMSCs in a 1:1 ratio.
Patients were recruited between December 2011 and July 2015 at the
University of Miami Hospital. Patients received hMSCs (100 million) by
transendocardial stem cell injection in 10 left ventricular sites. Treated
patients were evaluated at baseline, 30 days, and 3-, 6-, and 12-months
for safety (serious adverse events [SAE]), and efficacy endpoints:
ejection fraction, Minnesota Living with Heart Failure Questionnaire,
6-min walk test, major adverse cardiac events, and immune biomarkers.
Results There were no 30-day treatment-emergent SAEs. Twelve-month SAE
incidence was 28.2% with allo-hMSCs versus 63.5% with auto-hMSCs (p =
0.1004 for the comparison). One allo-hMSC patient developed an elevated
(>80) donor-specific calculated panel reactive antibody level. The
ejection fraction increased in allo-hMSC patients by 8.0 percentage points
(p = 0.004) compared with 5.4 with auto-hMSCs (p = 0.116; allo vs. auto p
= 0.4887). The 6-min walk test increased with allo-hMSCs by 37.0 m (p =
0.04), but not auto-hMSCs at 7.3 m (p = 0.71; auto vs. allo p = 0.0168).
MLHFQ score decreased in allo-hMSC (p = 0.0022) and auto-hMSC patients (p
= 0.463; auto vs. allo p = 0.172). The major adverse cardiac event rate
was lower, too, in the allo group (p = 0.0186 vs. auto). Tumor necrosis
factor-alpha decreased (p = 0.0001 for each), to a greater extent with
allo-hMSCs versus auto-hMSCs at 6 months (p = 0.05). Conclusions These
findings demonstrated safety and clinically meaningful efficacy of
allo-hMSC versus auto-hMSC in NIDCM patients. Pivotal trials of allo-hMSCs
are warranted based on these results. (Percutaneous Stem Cell Injection
Delivery Effects on Neomyogenesis in Dilated Cardiomyopathy [PoseidonDCM];
NCT01392625)<br/>Copyright &#xa9; 2017 The Authors

<84>
Accession Number
614764383
Author
Kong D.F.; Saito S.; Nakamura S.; Mehran R.; Rowland S.M.; Handler A.;
Al-Khalidi H.R.; Krucoff M.W.
Institution
(Kong, Saito, Nakamura, Mehran, Rowland, Handler, Al-Khalidi, Krucoff)
Duke University Medical Center and Duke Clinical Research Institute,
Durham, NC, United States
Title
Rationale and design of the Japan-USA harmonized assessment by randomized,
multicenter study of OrbusNEich's combo StEnt (Japan-USA HARMONEE):
Assessment of a novel DES platform for percutaneous coronary
revascularization in patients with ischemic coronary disease and
non-ST-elevation acute coronary syndrome.
Source
American Heart Journal. 187 (pp 112-121), 2017. Date of Publication: 01
May 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Tissue trauma associated with stent implantation continues to generate
early thrombosis rates of 0.9% to 1.3% for both bare-metal and
drug-eluting stent platforms. The Combo sirolimus-eluting stent combines
an abluminal, bioabsorbable polymer with a luminal CD34+ antibody designed
to capture endothelial progenitor cells. This article describes the design
and methods of the HARMONEE trial (NCT02073565), which represents the
first randomized controlled trial of the Combo design against a
best-in-class contemporary everolimus-eluting stent. Up to 50 sites in
Japan and the United States will enroll 286 subjects (271 evaluable) in
each of 2 arms, for a total sample size of 572 subjects (542 evaluable).
The statistical plan includes both superiority to imputed bare-metal stent
control and noninferiority to everolimus-eluting stent on a primary
clinical end point of target vessel failure at 1 year. In addition,
fractional flow reserve assessment to evaluate the physiology of target
vessels in the entire population will augment the end point definition of
ischemia-driven target vessel revascularization. Finally, key safety
considerations will be evaluated with a subpopulation with optical
coherence tomography imaging for strut coverage, late strut malapposition,
and plaque volume, as well as serial human antimurine antibody
assessments. As the first international prospective randomized coronary
intervention study under the "Harmonization by Doing" program, this study
represents a unique collaboration between regulators and investigators in
Japan and the United States.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<85>
Accession Number
614764382
Author
Lemmert M.E.; Oldroyd K.; Barragan P.; Lesiak M.; Byrne R.A.; Merkulov E.;
Daemen J.; Onuma Y.; Witberg K.; van Geuns R.-J.
Institution
(Lemmert, Oldroyd, Barragan, Lesiak, Byrne, Merkulov, Daemen, Onuma,
Witberg, van Geuns) Thoraxcenter, Erasmus Medical Center, Rotterdam,
Netherlands
Title
Reduced duration of dual antiplatelet therapy using an improved
drug-eluting stent for percutaneous coronary intervention of the left main
artery in a real-world, all-comer population: Rationale and study design
of the prospective randomized multicenter IDEAL-LM trial.
Source
American Heart Journal. 187 (pp 104-111), 2017. Date of Publication: 01
May 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Continuous improvements in stent technology make percutaneous
coronary intervention (PCI) a potential alternative to surgery in selected
patients with unprotected left main coronary artery (uLMCA) disease. The
optimal duration of dual antiplatelet therapy (DAPT) in these patients
remains undetermined, and in addition, new stent designs using a
bioabsorbable polymer might allow shorter duration of DAPT. Study design
IDEAL-LM is a prospective, randomized, multicenter study that will enroll
818 patients undergoing uLMCA PCI. Patients will be randomized in a 1:1
fashion to intravascular ultrasound-guided PCI with the novel
everolimus-eluting platinum-chromium Synergy stent with a biodegradable
polymer (Boston Scientific, Natick, MA) followed by 4 months of DAPT or
the everolimus-eluting cobalt-chromium Xience stent (Abbott Vascular,
Santa Clara, CA) followed by 12 months of DAPT. The total follow-up period
will be 5 years. A subset of 100 patients will undergo optical coherence
tomography at 3 months. End points The primary end point will be major
adverse cardiovascular events (composite of all-cause mortality,
myocardial infarction, and ischemia-driven target vessel
revascularization) at 2 years. Secondary end points will consist of the
individual components of the primary end point, procedural success, a
device-oriented composite end point, stent thrombosis as per Academic
Research Consortium criteria, and bleeding as per Bleeding Academic
Research Consortium criteria. Summary IDEAL-LM is designed to assess the
safety and efficacy of the novel Synergy stent followed by 4 months of
DAPT vs the Xience stent followed by 12 months of DAPT in patients
undergoing uLMCA PCI. The study will provide novel insights regarding
optimal treatment strategy for patients undergoing PCI of uLMCA disease
(www.clinicaltrials.gov, NCT 02303717).<br/>Copyright &#xa9; 2017

<86>
Accession Number
616180586
Author
Elmaraezy A.; Ebraheem Morra M.; Tarek Mohammed A.; Al-Habaa A.; Elgebaly
A.; Abdelmotaleb Ghazy A.; Khalil A.M.; Tien Huy N.; Hirayama K.
Institution
(Elmaraezy, Ebraheem Morra, Tarek Mohammed, Elgebaly) Faculty of Medicine,
Al-Azhar University, Cairo 11884, Egypt
(Elmaraezy) Online Research Club, Nagasaki University, Nagasaki, Japan
(Al-Habaa) Department of Cardiology, Faculty of Medicine, Al-Azhar
University, Cairo, Egypt
(Abdelmotaleb Ghazy) Department of Cadiology, Shebin El-Kom Teaching
Hospital, Menofia 31515, Egypt
(Khalil) Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
(Tien Huy) Evidence Based Medicine Research Group & Faculty of Applied
Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam
(Tien Huy) Department of Clinical Product Development, Institute of
Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate
School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto,
Nagasaki 852-8523, Japan
(Hirayama) Department of Immunogenetics, Institute of Tropical Medicine
(NEKKEN), Leading Graduate School Program, and Graduate School of
Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki
852-8523, Japan
Title
Risk of cataract among interventional cardiologists and catheterization
lab staff: A systematic review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 90 (1) (pp 1-9), 2017.
Date of Publication: 01 Jul 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: We performed a systematic review and meta-analysis to assess
the risk of developing a radiation-induced cataract in interventional
cardiologists (ICs). Background: ICs are forced to radiation exposure
during cardiac catheterization procedures. Since the eye lens is one of
the most radiosensitive organs in the body, ICs are highly susceptible to
develop a radiation-induced cataract. Method: We performed a systematic
literature search of nine electronic databases to retrieve studies that
report cataract among interventional cardiologists. Records were screened
for eligibility and data were extracted and analyzed using review manager
(RevMan) for windows. Results: Eight studies involving 2559 subjects
(exposed ICs = 1224) were included. Posterior lens opacity was
significantly higher in ICs relative to the control group (RR= 3.21, 95%
CI [2.14, 4.83], P < 0.00001). In contrast, there was no significant
difference between both groups in cortical lens opacity (RR= 0.69, 95% CI
[0.46, 1.06], P = 0.09) and nuclear opacity (RR= 0.85, 95% CI [0.71,
1.02], P = 0.08). Conclusion: Interventional cardiologists are at high
risk of developing radiation-induced cataract; therefore, protective
measures with high safety rates should be implied. &#xa9; 2017 Wiley
Periodicals, Inc.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<87>
Accession Number
613474456
Author
Ohlow M.-A.; Farah A.; Richter S.; El-Garhy M.; von Korn H.; Lauer B.
Institution
(Ohlow, Richter, El-Garhy, Lauer) Department of Cardiology, Zentralklinik,
Bad Berka, Germany
(Farah) Department of Cardiology, Knappschaftskrankenhaus, Dortmund,
Germany
(von Korn) Medizinische Klinik, I, Hetzelstift, Neustadt, Weinstrasse,
Germany
Title
Comparative Case-Control analysis of a dedicated self-expanding Biolimus
A9-eluting Bifurcation stent versus provisional or mandatory side branch
intervention strategies in the treatment of coronary bifurcation lesions.
Source
Catheterization and Cardiovascular Interventions. 90 (1) (pp 39-47), 2017.
Date of Publication: 01 Jul 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: In a number of coronary bifurcation lesions, both the main
vessel and the side branch (SB) need stent coverage. Objectives: To
analyze the procedural performance and the impact on radiation times (RT)
and contrast medium consumption (CMC) of the AxxessTM stent system
(Biosensors, Switzerland) treating de novo bifurcation lesions (DBL).
Methods: One hundred and ten consecutive prospectively enrolled cases
(Axxess Group) and 110 age, sex, and lesion location matched controls
undergoing mandatory (Group A, n = 56) or provisional (Group B, n = 54) SB
intervention were analyzed. Results: Although more pre-dilatation was
performed in the Axxess Group (92.7% vs. 46.4% [Group A] vs. 24.1% [Group
B]), and more stents were used (2.4 vs. 1.2 vs. 1.05), RT and CMC were
significantly lower in the Axxess Group [7.9 min/129 ml vs. 14.2 min/209
ml vs. 7.8 min/152 ml; P < 0.001]. Final Thrombolysis In Myocardial
Infarction three flow in both branches was significantly more frequent in
the Axxess Group (98.2% vs. 94.6% vs. 88.9%; P = 0.02), and
post-interventional troponin T elevations were the lowest in the Axxess
Group. Eighty one percent of the Axxess-stents could be implanted without
technical difficulties. Difficult implantations procedures were mainly
related to coronary anatomy. There was no safety concerns (cardiac death,
stent-thrombosis) compared to controls. Cumulative 6-months MACE rates
were 11% versus 23% versus 25%. TLR rates at 6-months were 5%, 18%, and
15%, respectively. Conclusions: Axxess bifurcation stent system procedures
were associated with significantly less RT and CMC compared to
conventional DBL therapy strategies. Difficult coronary anatomy may hinder
successful implantation and a learning curve has to be considered. &#xa9;
2016 Wiley Periodicals, Inc.<br/>Copyright &#xa9; 2016 Wiley Periodicals,
Inc.

<88>
Accession Number
617221471
Author
Desborough M.J.; Oakland K.; Brierley C.; Bennett S.; Doree C.; Trivella
M.; Hopewell S.; Stanworth S.J.; Estcourt L.J.
Institution
(Desborough, Oakland, Estcourt) NHS Blood and Transplant,
Haematology/Transfusion Medicine, Oxford, United Kingdom
(Brierley) John Radcliffe Hospital, Department of Haematology, Headley
Way, Oxford OX3 9DU, United Kingdom
(Bennett) University of Ottawa, Department of Surgery, 501 Smyth Road,
Ottawa, ON K1M 1R4, Canada
(Doree) NHS Blood and Transplant, Systematic Review Initiative, John
Radcliffe Hospital, Oxford OX3 9BQ, United Kingdom
(Trivella) University of Oxford, Centre for Statistics in Medicine, Botnar
Research Centre, Windmill Road, Oxford OX3 7LD, United Kingdom
(Hopewell) University of Oxford, Oxford Clinical Trials Research Unit,
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal
Sciences, Windmill Road, Oxford, Oxfordshire OX3 7LD, United Kingdom
(Stanworth) Oxford University Hospitals NHS Foundation Trust and
University of Oxford, National Institute for Health Research (NIHR) Oxford
Biomedical Research Centre, John Radcliffe Hospital, Headley Way,
Headington, Oxford OX3 9BQ, United Kingdom
Title
Desmopressin use for minimising perioperative blood transfusion.
Source
Cochrane Database of Systematic Reviews. 2017 (7) (no pagination), 2017.
Article Number: CD001884. Date of Publication: 10 Jul 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Blood transfusion is administered during many types of
surgery, but its efficacy and safety are increasingly questioned.
Evaluation of the efficacy of agents, such as desmopressin (DDAVP;
1-deamino-8-D-arginine-vasopressin), that may reduce perioperative blood
loss is needed. Objectives: To examine the evidence for the efficacy of
DDAVP in reducing perioperative blood loss and the need for red cell
transfusion in people who do not have inherited bleeding disorders. Search
methods: We searched for randomised controlled trials (RCTs) in the
Cochrane Central Register of Controlled Trials (2017, issue 3) in the
Cochrane Library, MEDLINE (from 1946), Embase (from 1974), the Cumulative
Index to Nursing and Allied Health Literature (CINAHL) (from 1937), the
Transfusion Evidence Library (from 1980), and ongoing trial databases (all
searches to 3 April 2017). Selection criteria: We included randomised
controlled trials comparing DDAVP to placebo or an active comparator (e.g.
tranexamic acid, aprotinin) before, during, or immediately after surgery
or after invasive procedures in adults or children. Data collection and
analysis: We used the standard methodological procedures expected by
Cochrane. Main results: We identified 65 completed trials (3874
participants) and four ongoing trials. Of the 65 completed trials, 39
focused on adult cardiac surgery, three on paediatric cardiac surgery, 12
on orthopaedic surgery, two on plastic surgery, and two on vascular
surgery; seven studies were conducted in surgery for other conditions.
These trials were conducted between 1986 and 2016, and 11 were funded by
pharmaceutical companies or by a party with a commercial interest in the
outcome of the trial. The GRADE quality of evidence was very low to
moderate across all outcomes. No trial reported quality of life. DDAVP
versus placebo or no treatment Trial results showed considerable
heterogeneity between surgical settings for total volume of red cells
transfused (low-quality evidence) and for total blood loss (very
low-quality evidence) due to large differences in baseline blood loss.
Consequently, these outcomes were not pooled and were reported in
subgroups. Compared with placebo, DDAVP may slightly decrease the total
volume of red cells transfused in adult cardiac surgery (mean difference
(MD) -0.52 units, 95% confidence interval (CI) -0.96 to -0.08 units; 14
trials, 957 participants), but may lead to little or no difference in
orthopaedic surgery (MD -0.02, 95% CI -0.67 to 0.64 units; 6 trials, 303
participants), vascular surgery (MD 0.06, 95% CI -0.60 to 0.73 units; 2
trials, 135 participants), or hepatic surgery (MD -0.47, 95% CI -1.27 to
0.33 units; 1 trial, 59 participants). DDAVP probably leads to little or
no difference in the total number of participants transfused with blood
(risk ratio (RR) 0.96, 95% CI 0.86 to 1.06; 25 trials; 1806 participants)
(moderate-quality evidence). Whether DDAVP decreases total blood loss in
adult cardiac surgery (MD -135.24 mL, 95% CI -210.80 mL to -59.68 mL; 22
trials, 1358 participants), orthopaedic surgery (MD -285.76 mL, 95% CI
-514.99 mL to -56.53 mL; 5 trials, 241 participants), or vascular surgery
(MD -582.00 mL, 95% CI -1264.07 mL to 100.07 mL; 1 trial, 44 participants)
is uncertain because the quality of evidence is very low. DDAVP probably
leads to little or no difference in all-cause mortality (Peto odds ratio
(pOR) 1.09, 95% CI 0.51 to 2.34; 22 trials, 1631 participants) or in
thrombotic events (pOR 1.36, 95% CI, 0.85 to 2.16; 29 trials, 1984
participants) (both low-quality evidence). DDAVP versus placebo or no
treatment for people with platelet dysfunction Compared with placebo,
DDAVP may lead to a reduction in the total volume of red cells transfused
(MD -0.65 units, 95% CI -1.16 to -0.13 units; 6 trials, 388 participants)
(low-quality evidence) and in total blood loss (MD -253.93 mL, 95% CI
-408.01 mL to -99.85 mL; 7 trials, 422 participants) (low-quality
evidence). DDAVP probably leads to little or no difference in the total
number of participants receiving a red cell transfusion (RR 0.83, 95% CI
0.66 to 1.04; 5 trials, 258 participants) (moderate-quality evidence).
Whether DDAVP leads to a difference in all-cause mortality (pOR 0.72, 95%
CI 0.12 to 4.22; 7 trials; 422 participants) or in thrombotic events (pOR
1.58, 95% CI 0.60 to 4.17; 7 trials, 422 participants) is uncertain
because the quality of evidence is very low. DDAVP versus tranexamic acid
Compared with tranexamic acid, DDAVP may increase the volume of blood
transfused (MD 0.6 units, 95% CI 0.09 to 1.11 units; 1 trial, 40
participants) and total blood loss (MD 142.81 mL, 95% CI 79.78 mL to
205.84 mL; 2 trials, 115 participants) (both low-quality evidence).
Whether DDAVP increases or decreases the total number of participants
transfused with blood is uncertain because the quality of evidence is very
low (RR 2.42, 95% CI 1.04 to 5.64; 3 trials, 135 participants). No trial
reported all-cause mortality. Whether DDAVP leads to a difference in
thrombotic events is uncertain because the quality of evidence is very low
(pOR 2.92, 95% CI 0.32 to 26.83; 2 trials, 115 participants). DDAVP versus
aprotinin Compared with aprotinin, DDAVP probably increases the total
number of participants transfused with blood (RR 2.41, 95% CI 1.45 to
4.02; 1 trial, 99 participants) (moderate-quality evidence). No trials
reported volume of blood transfused or total blood loss and the single
trial that included mortality as an outcome reported no deaths. Whether
DDAVP leads to a difference in thrombotic events is uncertain because the
quality of evidence is very low (pOR 0.98, 95% CI 0.06 to 15.89; 2 trials,
152 participants). Authors' conclusions: Most of the evidence derived by
comparing DDAVP versus placebo was obtained in cardiac surgery, where
DDAVP was administered after cardiopulmonary bypass. In adults undergoing
cardiac surgery, the reduction in volume of red cells transfused and total
blood loss was small and was unlikely to be clinically important. It is
less clear whether DDAVP may be of benefit for children and for those
undergoing non-cardiac surgery. A key area for researchers is examining
the effects of DDAVP for people with platelet dysfunction. Few trials have
compared DDAVP versus tranexamic acid or aprotinin; consequently, we are
uncertain of the relative efficacy of these interventions.<br/>Copyright
&#xa9; 2017 The Cochrane Collaboration. Published by John Wiley & Sons,
Ltd.

<89>
Accession Number
617187892
Author
Fernandez-Garcia J.O.; Hernandez-Caballero K.; Vasquez-Marquez P.I.;
Villegas-Anzo F.; Zarazua-Juarez M.; Castellanos-Olivares A.
Institution
(Fernandez-Garcia, Hernandez-Caballero, Vasquez-Marquez, Villegas-Anzo,
Zarazua-Juarez, Castellanos-Olivares) U.M.A.E. Hospital de Especialidades,
Dr. Bernardo Sepulveda Gutierrez, Centro Medico Nacional Siglo XXI del
Instituto Mexicano del Seguro Social, Mexico
Title
Comparison of two halogenated in patients undergoing kidney
transplantation.
Source
Revista Mexicana de Anestesiologia. 40 (2) (pp 79-83), 2017. Date of
Publication: April-June 2017.
Publisher
Colegio Mexicano de Anestesiologia A.C. (CP 03810, Mexico D.F., Mexico)
Abstract
Introduction: Renal transplantation is a high-risk procedure, so integral
cardiac monitoring is essential. Objective: To compare cardiac output
(CO), cardiac index (CI), serum levels of brain natriuretic peptide (BNP),
central venous pressure (CVP) and urinary volumes with the use of two
inhaled anesthetic agents in the context of renal transplantation.
Material and methods: A controlled clinical trial was conducted; 42
patients undergoing kidney transplantation were studied. Two groups of 21
patients were formed each: group I received isoflurane and group D
received desflurane. Results: The groups were similar in their general
characteristics. Compared to BNP, the difference in T3 was 274.10 pg/mL
+/- 152.95 vs. 371.57 pg/mL +/- 146.64 (p = 0.041) and T5 250.48 pg/mL +/-
218.58 vs. 378.67 pg/mL +/- 129.39 (p = 0.026) for group I and group D
respectively. The following differences were observed in relation to CO
and CI: CO in T3 8.47 +/- 2.86 L/min vs. 11.43 +/- 3.13 L/min (p = 0.003),
CI in T3 5.24 +/- 1.70 L/min/m2vs. 6.86 +/- 1.85 L/min/m2(p = 0.005) for
group I and group D respectively. In relation to CVP, there were
differences in T2 14.43 +/- 5.10 cmH2O vs. 18.52 +/- 3.40 cmH2O (p =
0.004), in T3 12.67 +/- 4.46 cmH2O vs. 18.29 +/- 4.55 cmH2O (p = 0.000),
in T4 11.43 +/- 3.62 cmH2O vs. 15.71 +/- 5.11 cmH2O (p = 0.003) and in T5
10.67 +/- 4.93 cmH2O vs. 15.52 +/- 5.65 cmH2O (p = 0.005) for group I and
group D respectively. Urinary rates had the following differences: 5.91
+/- 2.28 mL/kg/h vs. 3.01 +/- 2.33 mL/kg/h (p = 0.000) for group I and
group D respectively. Conclusion: BNP levels and hemodynamic variations
were lower with isoflurane use. Urinary rates were higher with isoflurane
use.<br/>Copyright &#xa9; 2017, Colegio Mexicano de Anestesiologia A.C.
All rights reserved.

<90>
Accession Number
611708709
Author
Lu Y.; Wang L.; Liu N.; Dong T.; Li R.
Institution
(Lu, Wang, Liu, Dong, Li) Department of Anesthesiology, Affiliated
Hospital of Chengde Medical College, No. 36 NanYingzi Road, Chengde,
Heibei 067000, China
Title
Sevoflurane preconditioning in on-pump coronary artery bypass grafting: a
meta-analysis of randomized controlled trials.
Source
Journal of Anesthesia. 30 (6) (pp 977-986), 2016. Date of Publication: 01
Dec 2016.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Purpose: Sevoflurane preconditioning (SevoPreC) has been proved to prevent
organ ischemia/reperfusion (I/R) injury in various animal models and
preclinical studies. Clinical trials on cardioprotection by SevoPreC for
adult patients undergoing coronary artery bypass graft (CABG) revealed
mixed results. The aim of this meta-analysis was to evaluate the cardiac
effect of SevoPreC in on-pump CABG. Methods: Randomized controlled trials
(RCT) comparing the cardiac effect of SevoPreC (compared with control) in
adult patients undergoing CABG were searched from PubMed, Embase, and the
Cochrane Library (up to November 2015). The primary endpoints were
postoperative troponin levels. Additional endpoints were CK-MB levels,
mechanic ventilation (MV) duration, intensive care unit (ICU) stay, and
hospital length of stay (LOS). Results: Six trials with eight comparisons
enrolling a total of 384 study patients reporting postoperative troponin
levels were identified. Compared with controls, SevoPreC decreased
postoperative myocardial troponin levels [standardized mean difference
(SMD) = -0.38; 95 % CI, -0.74 to -0.03; P = 0.04; I² = 63.9 %].
However, no significant differences were observed in postoperative CK-MB
levels [weighted mean difference (WMD) = -1.71; P = 0.37; I² =
37.7 %], MV duration (WMD = -0.53; P = 0.47; I² = 0.0 %), ICU
stay (WMD = -0.91; P = 0.39; I² = 0.9 %), and hospital LOS (WMD
= 0.08; P = 0.86; I² = 8.0 %). Conclusion: Available evidence
from the present systematic review and meta-analysis suggests that
sevoflurane preconditioning may reduce troponin levels in on-pump CABG.
Future high-quality, large-scale clinical trials should focus on the early
and long-term clinical effect of SevoPreC in on-pump CABG.<br/>Copyright
&#xa9; 2016, Japanese Society of Anesthesiologists.

<91>
Accession Number
611738405
Author
Madeira M.; Teixeira R.; Costa M.; Goncalves L.; Klein A.L.
Institution
(Madeira, Teixeira, Costa, Goncalves) Servico de Cardiologia, Centro
Hospitalar e Universitario de Coimbra - Hospital Geral, Coimbra, Portugal
(Teixeira, Goncalves) Faculty of Medicine, University of Coimbra, Coimbra,
Portugal
(Klein) Heart and Vascular Institute, Center for the Diagnosis and
Treatment of Pericardial Diseases, Cleveland Clinic, Cleveland, OH, United
States
Title
Two-dimensional speckle tracking cardiac mechanics and constrictive
pericarditis: systematic review.
Source
Echocardiography. 33 (10) (pp 1589-1599), 2016. Date of Publication: 01
Oct 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Transthoracic echocardiography has a pivotal role in the diagnosis of
constrictive pericarditis (CP). In addition to the classic M-mode,
two-dimensional and Doppler indices, newer methodologies designed to
evaluate myocardial mechanics, such as two-dimensional speckle tracking
echocardiography (2DSTE), provide additional diagnostic and clinical
information in the context of CP. Research has demonstrated that cardiac
mechanics can improve echocardiographic diagnostic accuracy of CP and aid
in differentiating between constrictive and restrictive ventricular
physiology. 2DSTE can also be used to assess the success of
pericardiectomy and its impact on atrial and ventricular mechanics. In the
course of this review, we describe cardiac mechanics in patients with CP
and summarize the influence of pericardiectomy on atrial and ventricular
mechanics assessed using 2DSTE.<br/>Copyright &#xa9; 2016, Wiley
Periodicals, Inc.

<92>
Accession Number
617299562
Author
Cavalcante R.; Sotomi Y.; Mancone M.; Whan Lee C.; Ahn J.-M.; Onuma Y.;
Lemos P.A.; Van Geuns R.-J.; Park S.-J.; Serruys P.W.
Institution
(Cavalcante, Mancone, Onuma, Van Geuns) Thoraxcenter, Erasmus University
Medical Center, 's-Gravendijkwal 230, Rotterdam 3015 CE, Netherlands
(Cavalcante, Lemos) Department of Interventional Cardiology, Heart
Institute (InCor), University of Sao Paulo Medical School, Av. Dr. Eneas
de Carvalho Aguiar, 44 - Pinheiros, Sao Paulo - SP, Brazil
(Sotomi) Academic Medical Center, University of Amsterdam, Meibergdreef 9,
Amsterdam-Zuidoost 1105 AZ, Netherlands
(Mancone) Department of Cardiovascular, Respiratory, Nephrologic,
Anesthesiological and Geriatric Sciences, Sapienza University of Rome,
Policlinico Umberto i, Viale del Policlinico 155, Rome 00161, Italy
(Whan Lee, Ahn, Park) Department of Cardiology, Heart Institute,
University of Ulsan College of Medicine, Asan Medical Center,
Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea
(Serruys) Imperial College London, London, United Kingdom
Title
Impact of the SYNTAX scores i and II in patients with diabetes and
multivessel coronary disease: A pooled analysis of patient level data from
the SYNTAX, PRECOMBAT, and BEST trials.
Source
European Heart Journal. 38 (25) (pp 1969-1977), 2017. Date of Publication:
01 Jul 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims To assess the impact of the SYNTAX scores I and II in outcomes after
percutaneous coronary intervention (PCI) and coronary artery bypass graft
(CABG) for patients with diabetes and multivessel disease (MVD). Methods
and results We performed a patient-level pooled analysis of three large
randomized trials of patients with MVD. The impact of coronary anatomic
complexity as measured by the SYNTAX score in the differences in outcomes
following PCI and CABG was assessed at a median follow-up of 5 years. We
also assessed the performance of the SYNTAX II score model in patients
with and without diabetes. From the 3280 patients enrolled in the three
trials, a total of 1068 (32.6%) had diabetes. The rate of the composite of
death, myocardial infarction (MI), or stroke was similar in the PCI and
CABG arms in patients with low-intermediate (<=32) SYNTAX scores (15.1%
vs. 14.9%, respectively; P = 0.93) while it was significantly higher in
the PCI arm in patients with high (>=33) SYNTAX scores (24.5% vs. 13.2%,
respectively; P = 0.018). The SYNTAX score II showed good calibration and
moderate discrimination ability in patients with diabetes (c-index = 0.68)
as well as in those without (c-index = 0.67). Conclusions Differences in 5
years outcomes following PCI and CABG for patients with MVD and diabetes
were influenced by anatomic complexity as measured by the SYNTAX score.
The SYNTAX score II mortality prediction model showed similar performance
regardless of the diabetes status.<br/>Copyright &#xa9; The Author 2017.
All rights reserved.

<93>
Accession Number
617307370
Author
Kamali A.; Rostami A.; Modir H.; Shokrpour M.
Institution
(Kamali, Modir) Department of Anesthesiology, Arak University of Medical
Sciences, Arak, Iran, Islamic Republic of
(Rostami) Department of Cardiac Surgery, Arak University of Medical
Sciences, Arak, Iran, Islamic Republic of
(Shokrpour) Department of Gynecology, Arak University of Medical Sciences,
Arak, Iran, Islamic Republic of
Title
Studying the effects of BIS monitoring (depth of anesthesia) in early
extubation of patients candidated for non-emergency CABG.
Source
Biomedical and Pharmacology Journal. 10 (1) (pp 199-206), 2017. Date of
Publication: 2017.
Publisher
Oriental Scientific Publishing Company
Abstract
Early extubated of open heart surgery patients (T <8hr) benefits for the
patient so that led to reduced hospital stay, reduced need for nursing
care, reduced length of stay in the ICU and reduce the risk of
ventilator-associated pneumonia is. Therefore the effect of BIS monitoring
on the patients after open heart surgery are extubated early. This study
is a randomized, double blind, randomized clinical trial on patients
undergoing elective CABG were done in hospitals Amir. A total of 120
patients were randomized into two groups and monitoring (B) BIS and
monitoring (N) BIS groups. The duration of extubated patients after open
heart ICU admission were compared between the 2 groups. The mean BIS
Monitor blood pressure before induction of anesthesia before surgery,
2.5-/ + 115 and without Monitor 3.6-/ + 121, respectively. The heart rate
monitors in group BIS 5/ 4-/ + 72 and without Monitor 6.4-/ + 70. The mean
extubation time in hours at the monitor BIS 6/ 3-/ + 4/5 hours at no
monitor BIS 3/4-/ + 2/6 hours. Given that no significant difference was
seen between the two groups P d" 0/05. The use of monitoring BIS (Depth of
Anesthesia) during CABG surgery resulted in a reduction of patients
extubated in the ICU, open heart, reducing the pain score at 12 and 24
hours after the operation.

<94>
Accession Number
615794674
Author
Borji R.; Ahmadi S.H.; Barkhordari K.; Meysami A.P.; Karimi A.A.;
Mortazavi S.H.; Dadlani P.; Ayatollah Zadeh Esfahani F.; Khatami S.M.R.
Institution
(Borji) Internal Medicine Department, Imam Khomeini Hospital, Iran,
Islamic Republic of
(Meysami) Community and Preventive Medicine Department, Medical Faculty,
Iran, Islamic Republic of
(Ahmadi, Barkhordari, Karimi, Mortazavi, Dadlani, Ayatollah Zadeh
Esfahani) Tehran Heart Center, Iran, Islamic Republic of
(Khatami) Nephrology Research Center, Tehran University of Medical
Sciences, PO Box 1419733141, Tehran, Iran, Islamic Republic of
Title
Effect of Prophylactic Dialysis on Morbidity and Mortality in
Non-Dialysis-Dependent Patients after Coronary Artery Bypass Grafting: A
Pilot Study.
Source
Nephron. 136 (3) (pp 226-232), 2017. Date of Publication: 01 Jul 2017.
Publisher
S. Karger AG
Abstract
Background/Aims: Coronary artery bypass grafting (CABG) is associated with
an increased risk of morbidity and mortality in patients with pre-existing
renal dysfunction. Numerous measures have been implemented to overcome
this problem; however, no improvement in outcomes has been achieved. This
study was aimed at investigating the effects of prophylactic dialysis on
mortality and morbidity in these patients. Methods: This
randomized-controlled clinical trial enrolled 88 non-dialysis-dependent
patients with chronic kidney disease awaiting CABG surgery. Thirty-nine
randomly selected patients received dialysis 3 times prior to surgery, and
49 patients formed the control group. Kaplan-Meier analysis and Cox
proportional-hazards models were used to identify factors associated with
survival. Results: There was no significant difference in the development
of morbidities between the groups (p = 0.413). A significant difference
was evident in the average survival time (p = 0.037). Cox
proportional-hazards models determined that the hazard ratio of death
after surgery was 10.854-fold greater in non-dialysis patients than in
patients who received dialysis (hazard ratio = 2). Conclusion:
Prophylactic dialysis prior to CABG decreases mortality, but does not
affect morbidity, in patients with renal insufficiency.<br/>Copyright
&#xa9; 2017 S. Karger AG, Basel.

<95>
[Use Link to view the full text]
Accession Number
612362404
Author
Barile L.; Fominskiy E.; Di Tomasso N.; Alpizar Castro L.E.; Landoni G.;
De Luca M.; Bignami E.; Sala A.; Zangrillo A.; Monaco F.
Institution
(Barile, Di Tomasso, Landoni, De Luca, Bignami, Zangrillo, Monaco)
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific
Institute, Via Olgettina 60, Milano 20132, Italy
(Barile, Landoni, Sala, Zangrillo) Department of Cardiac Surgery,
Vita-Salute San Raffaele University, Milan, Italy
(Fominskiy) Department of Anesthesia and Intensive Care, Academician en
Meshalkin Novosibirsk State Budget Research Institute of Circulation
Pathology, Novosibirsk, Russian Federation
(Alpizar Castro) Department of Anesthesia, Mexico Hospital, San Jose,
Costa Rica
Title
Acute Normovolemic Hemodilution Reduces Allogeneic Red Blood Cell
Transfusion in Cardiac Surgery: A Systematic Review and Meta-analysis of
Randomized Trials.
Source
Anesthesia and Analgesia. 124 (3) (pp 743-752), 2017. Date of Publication:
01 Mar 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: To better understand the role of acute normovolemic
hemodilution (ANH) in a surgical setting with high risk of bleeding, we
analyzed all randomized controlled trials (RCTs) in the setting of cardiac
surgery that compared ANH with standard intraoperative care. The aim was
to assess the incidence of ANH-related number of allogeneic red blood cell
units (RBCu) transfused. Secondary outcomes included the rate of
allogeneic blood transfusion and estimated total blood loss. METHODS:
Twenty-nine RCTs for a total of 2439 patients (1252 patients in the ANH
group and 1187 in the control group) were included in our meta-analysis
using PubMed/MEDLINE, Cochrane Controlled Trials Register, and EMBASE.
RESULTS: Patients in the ANH group received fewer allogeneic RBCu
transfusions (mean difference = -0.79; 95% confidence interval [CI], -1.25
to -0.34; P =.001; I² = 95.1%). Patients in the ANH group were
overall transfused less with allogeneic blood when compared with controls
(356/845 [42.1%] in the ANH group versus 491/876 [56.1%] in controls; risk
ratio = 0.74; 95% CI, 0.62 to 0.87; P <.0001; I² = 72.5%), and
they experienced less postoperative blood loss (388 mL in ANH versus 450
mL in control; mean difference = -0.64; 95% CI, -0.97 to -0.31; P <.0001;
I² = 91.8%). CONCLUSIONS: ANH reduces the number of allogeneic
RBCu transfused in the cardiac surgery setting together with a reduction
in the rate of patients transfused with allogeneic blood and with a
reduction of bleeding.<br/>Copyright &#xa9; 2017 International Anesthesia
Research Society.