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<1>
Accession Number
614490762
Author
Ozturk N.K.; Baki E.D.; Kavakli A.S.; Sahin A.S.; Ayoglu R.U.; Karaveli
A.; Emmiler M.; Inanoglu K.; Karsli B.
Institution
(Ozturk, Kavakli, Sahin, Karaveli, Inanoglu) Department of Anesthesiology
and Reanimation, Antalya Education and Research Hospital, Varlik
Mahallesi, Kazim Karabekir Cadde, Antalya 07100, Turkey
(Baki) Department of Anesthesiology and Reanimation, Afyon Kocatepe
University, Faculty of Medicine, Afyon, Turkey
(Ayoglu, Emmiler) Department of Cardiovascular Surgery, Antalya Education
and Research Hospital, Antalya 07100, Turkey
(Karsli) Department of Algology, Akdeniz University, Faculty of Medicine,
Antalya 07100, Turkey
Title
Comparison of transcutaneous electrical nerve stimulation and parasternal
block for postoperative pain management after cardiac surgery.
Source
Pain Research and Management. 2016 (no pagination), 2016. Article Number:
4261949. Date of Publication: 2016.
Publisher
Pulsus Group Inc. (410 Park Avenue, 15th Floor, 287 pmb, New York NY
10022, United States)
Abstract
Background. Parasternal block and transcutaneous electrical nerve
stimulation (TENS) have been demonstrated to produce effective analgesia
and reduce postoperative opioid requirements in patients undergoing
cardiac surgery. Objectives. To compare the effectiveness of TENS and
parasternal block on early postoperative pain after cardiac surgery.
Methods. One hundred twenty patients undergoing cardiac surgery were
enrolled in the present randomized, controlled prospective study. Patients
were assigned to three treatment groups: parasternal block, intermittent
TENS application, or a control group. Results. Pain scores recorded 4h, 5
h, 6 h, 7 h, and 8 h postoperatively were lower in the parasternal block
group than in the TENS and control groups. Totalmorphine consumption was
also lower in the parasternal block group than in the TENS and control
groups. It was also significantly lower in the TENS group than in the
control group. There were no statistical differences among the groups
regarding the extubation time, rescue analgesic medication, length of
intensive care unit stay, or length of hospital stay. Conclusions.
Parasternal block was more effective than TENS in the management of early
postoperative pain and the reduction of opioid requirements in patients
who underwent cardiac surgery through median sternotomy. This trial is
registered with Clinicaltrials.gov number NCT02725229.<br/>Copyright
&#xa9; 2016 Mathieu Gregoire et al.

<2>
Accession Number
611853500
Author
Ozturk N.K.; Baki E.D.; Kavakli A.S.; Sahin A.S.; Ayoglu R.U.; Karaveli
A.; Emmiler M.; Inanoglu K.; Karsli B.
Institution
(Ozturk, Kavakli, Sahin, Karaveli, Inanoglu) Department of Anesthesiology
and Reanimation, Antalya Education and Research Hospital, Varlyk
Mahallesi, Kazim Karabekir Cadde, Antalya 07100, Turkey
(Baki) Department of Anesthesiology and Reanimation, Afyon Kocatepe
University, Faculty of Medicine, Afyon, Turkey
(Ayoglu, Emmiler) Department of Cardiovascular Surgery, Antalya Education
and Research Hospital, Antalya 07100, Turkey
(Karsli) Department of Algology, Akdeniz University, Faculty of Medicine,
Antalya 07100, Turkey
Title
Comparison of transcutaneous electrical nerve stimulation and Parasternal
block for postoperative pain management after cardiac surgery.
Source
Pain Research and Management. 2016 (no pagination), 2016. Article Number:
4261949. Date of Publication: 2016.
Publisher
Pulsus Group Inc. (410 Park Avenue, 15th Floor, 287 pmb, New York NY
10022, United States)
Abstract
Background: Parasternal block and transcutaneous electrical nerve
stimulation (TENS) have been demonstrated to produce effective analgesia
and reduce postoperative opioid requirements in patients undergoing
cardiac surgery. Objectives: To compare the effectiveness of TENS and
parasternal block on early postoperative pain after cardiac surgery.
Methods: One hundred twenty patients undergoing cardiac surgery were
enrolled in the present randomized, controlled prospective study. Patients
were assigned to three treatment groups: parasternal block, intermittent
TENS application, or a control group. Results: Pain scores recorded 4h, 5
h, 6 h, 7 h, and 8 h postoperatively were lower in the parasternal block
group than in the TENS and control groups. Totalmorphine consumption was
also lower in the parasternal block group than in the TENS and control
groups. It was also significantly lower in the TENS group than in the
control group. There were no statistical differences among the groups
regarding the extubation time, rescue analgesic medication, length of
intensive care unit stay, or length of hospital stay. Conclusions:
Parasternal block was more effective than TENS in themanagement of early
postoperative pain and the reduction of opioid requirements in patients
who underwent cardiac surgery through median sternotomy.This trial is
registered with Clinicaltrials.gov number NCT02725229.<br/>Copyright
&#xa9; 2016 Nilgun Kavrut Ozturk et al.

<3>
Accession Number
366253423
Author
Stather D.R.; MacEachern P.; Chee A.; Dumoulin E.; Hergott C.A.; Tremblay
A.
Institution
(Stather, MacEachern, Chee, Tremblay) Department of Medicine, University
of Calgary, Calgary, AB, Canada
(Dumoulin) Department of Medicine, University of Sherbrooke, Sherbrooke,
QC, Canada
(Hergott) Airways Research Group, Division of Respirology, Critical Care
and Sleep Medicine, University of Saskatchewan, Saskatoon, SK, Canada
Title
Wet laboratory versus computer simulation for learning endobronchial
ultrasound: A randomized trial.
Source
Canadian Respiratory Journal. 19 (5) (pp 325-330), 2012. Date of
Publication: September-October 2012.
Publisher
Hindawi Limited
Abstract
Background: Linear endobronchial ultrasound with transbronchial needle
aspiration (EBUS-TBNA) is a revolutionary bronchoscopic procedure that is
challenging to learn. Objectives: To compare two methods used to teach
EBUS-TBNA: wet laboratory (lab) versus computer EBUS-TBNA simulation.
Methods: A prospective, randomized study of respirologists, thoracic
surgeons and trainees learning EBUS-TBNA at a two-day continuing medical
education course. All subjects received education via a series of lectures
and live cases, followed by randomization to learn EBUS-TBNA predominantly
either by wet lab simulation (n=6) or computer simulation (n=6). All
subjects then completed testing of their EBUS-TBNA skills via a previously
validated method using simulated cases on EBUS-TBNA simulators and
questionnaires evaluating learner preferences. Results: There were no
significant differences between the computer EBUS-TBNA simulator group and
the wet lab group in procedure time (25.3+/-6.1 min versus 25.2+/-2.5 min;
P=0.984) and percentage of successful biopsies (81.3+/-14.9% versus
74.0+/-17.3%; P=0.453). The computer simulator group performed
significantly better than the wet lab group in the percentage of lymph
nodes correctly identified (70.4+/-16.7% versus 42.9+/-19.9%; P=0.002).
Wet lab simulation was associated with increased learner confidence with
operating the real EBUS-TBNA bronchoscope. All subjects responded that wet
lab and computer EBUS-TBNA simulation offered important complementary
learning opportunities. Discusion: Computer EBUS-TBNA simulation leads to
improved skill at correctly identifying lymph nodes, while wet lab
simulation provided increased learner confidence due to increased realism.
Conclusion: Computer EBUS-TBNA simulation and wet lab simulation are
effective methods of learning basic EBUS-TBNA skills and appeared to be
complementary. &#xa9;2012 Pulsus Group Inc. All rights reserved.

<4>
Accession Number
616962752
Author
Cardona S.; Tsegka K.; Thourani V.H.; Halkos M.; Guyton R.A.; Pasquel
F.J.; Vellanki P.; Fayfman M.; Haw J.S.; Peng L.; Umpierrez G.E.
Institution
(Cardona, Tsegka, Thourani, Halkos, Guyton, Pasquel, Vellanki, Fayfman,
Haw, Peng, Umpierrez) Atlanta, GA, Decatur, GA
Title
Sitagliptin for the prevention of stress hyperglycemia in nondiabetic
patients undergoing cardiac surgery.
Source
Diabetes. Conference: 77th Scientific Sessions of the American Diabetes
Association, ADA 2017. United States. 66 (pp A341), 2017. Date of
Publication: June 2017.
Publisher
American Diabetes Association Inc.
Abstract
Stress hyperglycemia (SH), defined as a BG >180 mg/dl in patients without
diabetes (DM) is common after CABG surgery. Clinical guidelines recommend
treatment of SH with continuous insulin infusion (CII) in the ICU. This
pilot, prospective, randomized, double blinded, placebo-controlled study
aimed to determine if (a) treatment with sitagliptin can prevent SH and
reduce the need for CII in the ICU and (b) prevent the need for
subcutaneous (SQ) insulin after transition to the step-down unit. A total
of 60 patients with fasting BG <125 mg/dl, HbA<inf>1c</inf> <6.5% received
sitagliptin or placebo starting one day prior to surgery and daily during
the hospital stay. Patients who developed SH were treated with standard
insulin protocols. We observed no differences in the frequency of SH, need
for CII in the ICU or SQ insulin in step-down units; the total insulin
dose during CII was lower in sitagliptin group compared to placebo.
Conclusion: The use of sitagliptin did not reduce the frequency of SH;
however, it was associated with lower insulin requirements during CII in
the ICU. Large RCTs are needed to determine if sitagliptin can improve
glycemic control and reduce perioperative complications in non-DM patients
with stress hyperglycemia. (Table Presented).

<5>
Accession Number
616937637
Author
Moller A.; Nielsen H.; Wetterslev J.; Pedersen O.; Hellemann D.; Shahidi
S.
Institution
(Moller, Hellemann) Anaesthesia and Intensive Care, Slagelse Hospital,
Slagelse, Denmark
(Nielsen) Department of Anaesthesia, Abdominal Center, Copenhagen, Denmark
(Wetterslev) Department 7812, Copenhagen Trial Unit, Centre for Clinical
Intervention Research, Rigshospitalet, Copenhagen, Denmark
(Pedersen) Department of Clinical Immunology, Naestved Hospital, Naestved,
Denmark
(Shahidi) Department of General and Vascular Surgery, Slagelse Hospital,
Slagelse, Denmark
Title
Low vs high haemoglobin trigger for perioperative separation of red blood
cell transfusion in vascular surgery: A randomised, analyst blinded,
feasibility trial (the TV trial).
Source
Vox Sanguinis. Conference: 27th Regional Congress of the International
Society of Blood Transfusion, ISBT 2017. Denmark. 112 (pp 267-268), 2017.
Date of Publication: June 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Background: In the surgical patient with cardiac disease, the Danish
National Board of Health recommends administration of red blood cells
(RBC) when haemoglobin levels drop below 8 g/dl, while in the vascular
surgical patient, local guidelines often recommends higher triggers for
RBC transfusion. A decrease in haemoglobin levels may affect blood O2
transport with a potential for development of tissue ischaemia. Aims: To
assess whether two different haemoglobin triggers for RBC transfusion will
separate post-operative haemoglobin levels, affects the number of
transfused RBC units and the intraoperative tissue oxygenation determined
by near-infrared spectroscopy. We also assess the occurrence of severe
adverse events and evaluate post-operative coagulation competence by
rotational thromboelastometry (ROTEM). Methods: In a single-center,
open-label trial design, fifty-eight vascular surgical patients (>40 years
of age) awaiting open surgical repair of the infrarenal aorta or
infrainguinal arterial bypass surgery in general anaesthesia undergo a
web-based randomisation to one of two groups: perioperative RBC
transfusion when haemoglobin decreases to 8 g/dl or RBC transfusion
triggered by a haemoglobin 9.7 g/dl. Administration of fluid follows an
individualised goal-directed strategy by optimising cardiac stroke volume
and near-infrared spectroscopy determines regional oxygenation with
optodes placed on the forehead and on the upper arm. The trial is powered
to show a difference between the two groups for postoperative haemoglobin
of 1.0 mmol/l (primary outcome), for the number of RBC transfusions by two
units, and for tissue oxygenation by 6%. On the first and second
postoperative day, myocardial injury is suggested by an increase in
troponin-I above 45 ng/l. Renal failure is indicated by a
creatinine-increment >26.5 mmol/l (or 1.5 times the preoperative value) or
a drop in urine production <0.5 ml/kg/h over 6 h. Patients are followed up
thirty and ninety days after surgery. Results: Ninety days follow up on
the last patient was set for March 8th 2017. Results will be presented at
the 27th Regional Congress of the ISBT if the abstract were to be
accepted. Summary/Conclusions: This trial is expected to determine whether
a RBC transfusion trigger of haemoglobin 9.7 g/dl compared to haemoglobin
<8 g/dl results in adequate separation of postoperative haemoglobin
levels, transfusion of more RBC units, and maintains a higher tissue
oxygenation. The results are expected to provide information on the
feasibility and the design of a future multicenter trial for evaluation of
postoperative patient centered outcomes of mortality and serious adverse
events.

<6>
Accession Number
616935938
Author
Lorenzi M.; Pecoraro C.; Bordiga A.
Institution
(Lorenzi, Pecoraro, Bordiga) SC Banca Del Sangue, AOU Citta Della Salute E
Della Scienza, Torino, Italy
Title
Moving to centralized platelet production: Effects on wastage and
utilization.
Source
Vox Sanguinis. Conference: 27th Regional Congress of the International
Society of Blood Transfusion, ISBT 2017. Denmark. 112 (pp 93), 2017. Date
of Publication: June 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Reducing blood product wastage is a major focus for all
transfusion laboratories and blood bank. Platelet stock is at high risks
of wastage due to the short shelf life of platelet and the variable
clinical demand in hospital. In 2016 our Blood Transfusion Service has
externalised the production of whole blood derived platelets and apheresis
platelets in an other facility. This facility produces whole blood derived
platelets and apheresis platelets also for other Blood Transfusion
Services. The platelets had to be ordered from the blood supplier and
delivered via a dedicated courier. Aims: We studied indexes of efficiency
of platelet logistics and clinical use for ascertain the need to enhance
platelet inventory management operations. Methods: Our blood center serves
a community of three hospital including haematology departments,
cardiovascular surgery departments, a solid organ transplant program, a
trauma center and outpatient transfusion clinics. In 2015 our blood center
produced 5,063 whole blood derived platelets and 1,230 apheresis
platelets. In June 2016 the platelet production was outsourced. We
assessed wastage rates, transfusion rates of Rh positive platelets to Rh
negative patients, transfusion rates of AB0 mismatched platelets and days
of shelf life of transfused platelets. We reviewed the period 15 June
2015-01 March 2016 (in house platelet production) and 15 June 2016-01
March 2017 (outsourced platelet production). In the second period we
adopted a stringent policy for ordering platelet including an inventory
check twice a day. A dedicated educational program was offered to all
technician involved in platelets inventory management and issuing. A set
of predefined data extracted from the database (inventory, programmed
transfusions, crossmatched or washed platelets required, blood donor
drives scheduled) was implemented and easily derivable from our management
software in real time. Results: In the first period were delivered 4,311
platelets with a wastage rate of 9.9%. In the second period we assigned
4,618 platelets and the wastage rate, after a meaningful decline, has
increased to a final 10.3%. The rate of AB0 mismatched platelet issued was
unchanged (3.4%). The rate of Rh mismatches has declined in the last
period from 6 to 2%. Platelets issued in 2015/2016 in the first three day
of storage were 58%. Platelets delivered in the first three days of
storage increased to 68.2% in 2016/2017. The rate of platelets issued at
the fifth day of storage time was 4% in 2015/2016 and decreases to 0.2% in
2016/2017. Summary/Conclusions: Centralized production of platelets did
not reduce platelets wastage. To some extent a certain rate of wastage is
inevitable given the perishability of platelets and the often
unpredictable needs for surgery, trauma, transplants and outpatients. An
initial improvement of wastage rate was not confirmed in a longer period.
Besides a reinforcement of the current procedures, maybe could be useful
to adopt a bi-directional transfer between end users and production
facility. The measures adopted were useful in improving other important
areas of clinical practice: age of transfused products and AB0 or Rh
mismatches between platelets and patient.

<7>
Accession Number
616917150
Author
Khalaf Adeli E.; Pourfathollah A.; Alavi S.; Kiaeifar A.
Institution
(Khalaf Adeli, Pourfathollah) Blood Transfusion Research Center High
Institute for Research and Education in Transfusion Medicine, Iranian
Blood Transfusion Organization, Tehran, Iran, Islamic Republic of
(Alavi) Rajaie Cardiovascular Medical and Research Center, Iran University
of Medical Science, Tehran, Iran, Islamic Republic of
(Kiaeifar) Dadeh Rayanesh Abri Pardis, Tehran, Iran, Islamic Republic of
Title
Impact of protocol-based management using thromboelastometry on
transfusion requirements in cardiac surgery.
Source
Vox Sanguinis. Conference: 27th Regional Congress of the International
Society of Blood Transfusion, ISBT 2017. Denmark. 112 (pp 257), 2017. Date
of Publication: June 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Cardiac surgeries with cardiopulmonary bypass (CPB) are
associated with high rate of allogeneic blood transfusion. Because of the
complex and multifactorial nature of acquired coagulopathy during CPB,
decision for transfusion is often empirical and based on the clinical
judgments. However, Thromboelastometry has been introduced as a
coagulation point of care test for hemostatic management. . Aims: In this
study, we evaluated impact of using a thromboelastometry-based protocol on
transfusion requirements in patients undergoing combined coronary-valve
cardiac surgery. Methods: 80 patients scheduled for elective combined
coronary-valve surgery were included in a randomized clinical trial study.
Patients were randomly allocated to the Rotem (n = 40) or control groups
(n = 40). For all patients in the Rotem group, thromboelastometric tests
was performed before and after CPB using Rotem device. Hemostatic
management was conducted using blood products and fibrinogen or PCC
(prothrombin complex concentrate) according to a defined
thromboelastometry - based protocol. In the control group, hemostatic
management and transfusion was conducted according to the routine
practices including conventional coagulation testing and clinical
judgments. Finally, transfusion requirements were compared between groups
Results: Use of thromboelastometry- based protocol resulted in 67%
reduction in consumption of cumulative blood products as well as 23% in
the percentage of patients transfused. This reduction was especially
evident in relation to FFP and platelet consumption. In the Rotem group,
the percentage of patients who received FFP or platelet concentrates was
significantly lower in comparison to the control group (2.6% vs 31.8% and
2.6% vs 35.9%, respectively, P < 0.001). No significant differences were
found in the percentage of patients receiving RBC units (48% in the Rotem
group vs 53% in the control group, P > 0.05). Summary/Conclusions:
Considering with known and unknown adverse effects of allogeneic blood
transfusion, there is a concern that many transfusions are inappropriate.
Having an interventional protocol incorporated thromboelastometry tests
results in avoidance of inappropriate transfusion and decrease in
allogeneic blood consumption.

<8>
Accession Number
616917112
Author
Apelseth T.; Cap A.; Spinella P.; Hervig T.; Strandenes G.
Institution
(Apelseth, Hervig, Strandenes) Department of Immunology and Transfusion
Medicine, Haukeland University Hospital, Bergen, Norway
(Apelseth) Laboratory of Clinical Biochemistry, Haukeland University
Hospital, Bergen, Norway
(Cap) U.S. Army Institute of Surgical Research, FT Sam Houston, TX, United
States
(Spinella) Division of Critical Care, Department of Pediatrics, Washington
University in St Louis, MO, United States
(Hervig, Strandenes) Norwegian Armed Forces Medical Services, Oslo, Norway
Title
Cold stored vs room temperature stored platelets.
Source
Vox Sanguinis. Conference: 27th Regional Congress of the International
Society of Blood Transfusion, ISBT 2017. Denmark. 112 (pp 47-48), 2017.
Date of Publication: June 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Recognition of the success of whole blood (WB) transfusion in
military operational settings has engaged a debate on reintroduction of
cold-stored WB in treatment of critical bleeding in civilian health care.
The hemostatic function of the platelets contained in cold-stored WB has
been questioned. Aim: This presentation provides an overview of the
history of platelet cold storage, discussing the hemostatic properties,
clinical effects, and risk of complications associated with cold stored
platelet transfusion. Methods: In vitro studies of the effects of platelet
cold storage, whether in WB or platelet concentrates together with in vivo
studies on the effect of transfusing these platelet-containing products
will be reviewed and discussed. Results: Platelets were routinely stored
cold (4C) until the early 1980's, but practice switched to room
temperature (RT) storage due to the longer circulation of RT platelets,
thought to be optimal for prophylactic transfusion. Clinical experience,
in vitro, and in vivo data, however, suggested hemostatic superiority of
4C platelets in treatment of bleeding. Previous in vitro studies show
reduced risk of bacterial contamination and equal or superior hemostatic
qualities in 4C platelet concentrates when evaluated by metabolic
measures, aggregation response, and other tests of coagulation. With the
exception of an ongoing study, randomized clinical trials comparing
clinical outcomes of transfusion with 4C or RT platelet concentrates have
not been performed since the 1970's. Previous clinical studies in
thrombocytopenic patients indicate improved platelet aggregation and
reduced bleeding after transfusion with 4C platelet concentrates. Recent
in vitro investigations of platelet function in 4C WB during storage are
typically performed by use of viscoelastic tests (TEG/ROTEM) or Multiple
Electrode Aggregometry. Platelet function shows a decline during storage
for up to 21 days by both measures, but platelets in 4C WB show
superiority compared to RT WB over the storage period when evaluated by
the thromboelastography measure maximal amplitude, MA. Recent clinical
studies of WB focus on the feasibility of WB compared to component based
therapy in treatment of major bleeding, but studies comparing platelet
effects in 4C vs RT stored whole blood are scarce. A randomized controlled
trial in pediatric patients undergoing cardiac surgery showed reduced
blood loss and improved platelet function by aggregometry after
transfusion with 24-48 h stored 4C WB when compared to component based
therapy with RT platelets. Recent animal studies also suggest efficacy and
safety of 4C WB. With the exception of an ongoing trial, studies comparing
complication risks of 4C platelets with RT platelets have not been
identified. Summary/conclusions: Previous in vitro, in vivo and clinical
studies indicate that cold stored platelets may be beneficial in treatment
of critical bleeding. Cold storage of platelets may enable extended
storage time, facilitate improved availability of prehospital transfusion,
and allow shipment of platelet containing blood products to remote,
austere environments world-wide. Clinical studies should therefore be
performed to investigate the feasibility, safety and clinical efficacy of
cold stored platelet concentrates and WB transfusion.

<9>
Accession Number
614056515
Author
Dong Q.; Zhang K.; Cao S.; Cui J.
Institution
(Dong, Zhang, Cao, Cui) Harbin Medical University, Department of Thoracic
Surgery, The Fourth Affiliated Hospital, 37 Yiyuan Street, Nangang
District, Harbin, Heilongjiang 150001, China
Title
Fast-track surgery versus conventional perioperative management of lung
cancer-associated pneumonectomy: A randomized controlled clinical trial.
Source
World Journal of Surgical Oncology. 15 (1) (no pagination), 2017. Article
Number: 20. Date of Publication: 13 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The aim of this study is to investigate the effects of
fast-track surgery (FTS) on postoperative recovery, hospital stay, total
medical costs, and the complications of pneumonectomy in patients with
non-small cell lung cancer (NSCLC). Methods: Studies were performed
between June 2012 and March 2014 in 17 patients received FTS and 18
patients given conventional management (control) after pneumonectomy in
the Department of Thoracic Surgery, the Fourth Affiliated Hospital of
Harbin Medical University. Patients were evaluated based on their days to
achieve the first postoperative flatus, C-reactive protein (CRP) at
postoperative day (POD) 1-7, the length of hospital stay, the medical
costs, and postoperative complications. Results: The results showed that
in the FTS group, latency to the first postoperative flatus (1.5 +/- 0.6
versus 3.1 +/- 0.8 s in controls, P < 0.0001), CRP (71.36 +/- 5.48 versus
80.71 +/- 8.32 mg/L in at POD 7, P < 0.0001), the length of hospital stay
(18.1 +/- 1.4 versus 27.4 +/- 6.6 days, P < 0.0001), and the medical costs
(29.9 +/- 2.7 versus 37.2 +/- 3.6 thousand Chinese Yuan, P < 0.0001) were
significantly reduced compared to the group receiving conventional
management. FTS group also had a relatively lower postoperative
complication rate (23.5% of 17 versus 33.3% of 18 in control group)
although it was statistically insignificant (P = 0.711). Conclusions:
These results indicate that application of the FTS in NSCLC pneumonectomy
efficiently accelerates postoperative recovery, shortens hospital stay,
reduces the total medical costs of the patients and thus is more
acceptable than conventional management.<br/>Copyright &#xa9; 2017 The
Author(s).

<10>
Accession Number
615403211
Author
Tsu L.V.; Berry A.J.; Krunic N.; Penny S.; Le S.
Institution
(Tsu) Chapman University School of Pharmacy, 9401 Jeronimo Road, Irvine,
CA 92618, United States
(Berry) Banner University Medical Center, Phoenix, AZ, United States
(Krunic) Midwestern University College of Pharmacy-Glendale, Glendale, AZ,
United States
(Penny, Le) Midwestern University College of Pharmacy-Glendale, Chapman
University School of Pharmacy, United States
Title
A clinical review of surgical vs transcatheter aortic valve replacement in
geriatric patients.
Source
Consultant Pharmacist. 32 (4) (pp 202-214), 2017. Date of Publication:
April 2017.
Publisher
American Society of Consultant Pharmacists (1321 Duke Street, Alexandria
VA 22314-3563, United States)
Abstract
OBJECTIVE: To provide an up-to-date review of the available evidence
regarding management of elderly patients after transcatheter aortic valve
replacement (TAVR). DATA SOURCES: A PubMed search of articles published
(September 1969-December 2016) was done using a combination of the
following words: aortic valve stenosis, geriatric, elderly, transcatheter
aortic valve replacement, surgical aortic valve replacement, transcatheter
aortic valve implantation (TAVI), and dual antiplatelet therapy. STUDY
SELECTION/DATA EXTRACTION: Relevant original research, review articles,
and guidelines were assessed for the management of elderly patients after
TAVR. References from the above literature were also evaluated. Articles
were selected for inclusion based on relevance to the topic, detailed
methods, and complete results. DATA SYNTHESIS: Aortic valve stenosis is
common in the geriatric population. While patients were historically
treated with surgical aortic valve replacement (AVR), more patients are
now undergoing TAVR. This article reviews the current literature regarding
outcomes and pharmacotherapy between surgical and TAVR in the elderly
population. CONCLUSION: Appropriate management of pharmacotherapy after
surgical or TAVR can help improve outcomes in elderly patients, and
pharmacists can provide guidance regarding evidence-based
therapy.<br/>Copyright &#xa9; 2017 American Society of Consultant
Pharmacists, Inc. All rights reserved.

<11>
Accession Number
615112835
Author
Wen S.Y.B.; Peng A.Z.Y.; Boyle S.; Cai S.; Pope L.; Tran M.T.; Short T.G.;
Aneman A.; Jaeger M.; Chuan A.
Institution
(Wen, Peng) South West Sydney Clinical School, University of NSW, Sydney,
NSW, Australia
(Boyle, Cai, Pope, Tran, Aneman, Chuan) Department of Anaesthesia,
Liverpool Hospital, Sydney, NSW, Australia
(Short) Department of Anaesthesia, Auckland City Hospital, New Zealand
(Jaeger) South Western Sydney Clinical School, University of NSW, Sydney,
NSW, Australia
Title
A pilot study using preoperative cerebral tissue oxygen saturation to
stratify cardiovascular risk in major non-cardiac surgery.
Source
Anaesthesia and Intensive Care. 45 (2) (pp 202-209), 2017. Date of
Publication: March 2017.
Publisher
Australian Society of Anaesthetists (E-mail: aicsubscriptions@asa.org.au)
Abstract
This prospective pilot study evaluated whether low preoperative cerebral
tissue oxygen saturation is associated with unfavourable outcomes after
major elective non-cardiac surgery. Eighty-one patients over 60 years of
age, American Society of Anesthesiologists physical status 3 or 4, were
recruited. Resting cerebral tissue oxygen saturation was recorded on room
air, and after oxygen supplementation, using cerebral oximetry. The
primary outcome was 30-day major adverse event of combined mortality or
severe morbidity, and the secondary outcome was 30-day new disability.
Eleven patients (13.6%) suffered a major adverse event, and 28 patients
(34.6%) experienced new disability. Room air cerebral tissue oxygen
saturation was significantly different between patients who had a major
adverse event, 67% (95% confidence interval [CI] 65-70) versus unaffected,
71% (95% CI 70-72; P=0.04). No statistical difference was found between
patients for new disability (range 70%-74%; P=0.73). Room air cerebral
tissue oxygen saturation was significantly associated with major adverse
events (odds ratio 1.36 (95% CI 1.03-1.79), P=0.03). Saturation levels
=68% carried a positive likelihood ratio of 2.2 for death or severe
morbidity, P=0.04. A definitive trial is required to confirm if cerebral
oximetry can be used to stratify the cardiovascular risk of patients
presenting for non-cardiac surgery.

<12>
Accession Number
613993666
Author
Karagiannis C.; Savva C.; Mamais I.; Efstathiou M.; Monticone M.; Xanthos
T.
Institution
(Karagiannis, Savva, Mamais) European University of Cyprus, School of
Sciences, Department of Health Sciences, Nicosia, Cyprus
(Efstathiou) University of Nicosia, Department of Life and Health
Sciences, Nicosia, Cyprus
(Monticone) University of Cagliari, Department of Public Health, Clinical
and Molecular Medicine, Cagliari, Italy
(Xanthos) European University of Cyprus, School of Medicine, Nicosia,
Cyprus
Title
Eccentric exercise in ischemic cardiac patients and functional capacity: A
systematic review and meta-analysis of randomized controlled trials.
Source
Annals of Physical and Rehabilitation Medicine. 60 (1) (pp 58-64), 2017.
Date of Publication: 01 Jan 2017.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Background Eccentric (ECC) exercise is an "economical" type of exercise
with low energy requirements and does not cause early fatigue. Therefore,
it is used for cardiac patients, who have low physical activity and
exercise intolerance, as an easier kind of training. Objective This
systematic review aimed to investigate the efficacy of ECC exercise for
functional capacity (FC) in patients with ischemic heart disease. Design
Systematic review. Methods MEDLINE via PubMed and EBSCO databases were
searched for articles of randomized controlled trials of adults with
ischemic heart disease who underwent ECC training as compared with other
forms of exercise (concentric exercise) or no exercise and assessed FC.
The methodologic quality of studies was assessed by the PEDro scale. A
meta-analysis was performed with sufficient homogeneity between at least 2
studies in the pre-defined comparisons. Results Four studies,
investigating a total of 99 subjects, met the inclusion criteria. The
results of the studies did not clearly indicate whether ECC exercise could
improve FC better than traditional forms of exercise. However, the small
number of studies and their methodologic weaknesses do not allow for
drawing firm conclusions. Conclusions We found contradictory results about
the effectiveness of ECC as compared with concentric exercise in terms of
FC in ischemic cardiac patients. Further investigation with well-designed
randomized trials is needed to determine the effectiveness of this kind of
exercise for FC in such patients.<br/>Copyright &#xa9; 2016 Elsevier
Masson SAS

<13>
Accession Number
615509473
Author
Lonborg J.; Engstrom T.; Kelbaek H.; Helqvist S.; Klovgaard L.; Holmvang
L.; Pedersen F.; Jorgensen E.; Saunamaki K.; Clemmensen P.; De Backer O.;
Ravkilde J.; Tilsted H.-H.; Villadsen A.B.; Aaroe J.; Jensen S.E.;
Raungaard B.; Kober L.; Hofsten D.E.
Institution
(Lonborg, Engstrom, Helqvist, Klovgaard, Holmvang, Jorgensen, Saunamaki,
De Backer, Tilsted, Kober, Hofsten) Department of Cardiology,
Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100,
Denmark
(Kelbaek, Clemmensen) Department of Cardiology, Roskilde Hospital, Denmark
(Pedersen) Department of Cardiology, Nykoebing Falster Hospital, Denmark
(Ravkilde, Villadsen, Aaroe, Jensen, Raungaard) Department of Cardiology,
Aalborg University Hospital, Denmark
Title
Fractional Flow Reserve-Guided Complete Revascularization Improves the
Prognosis in Patients with ST-Segment-Elevation Myocardial Infarction and
Severe Nonculprit Disease.
Source
Circulation: Cardiovascular Interventions. 10 (4) (no pagination), 2017.
Article Number: e004460. Date of Publication: 01 Apr 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - The impact of disease severity on the outcome after complete
revascularization in patients with ST-segment-elevation myocardial
infarction and multivessel disease is uncertain. The objective of this
post hoc study was to evaluate the impact of number of diseased vessel,
lesion location, and severity of the noninfarct-related stenosis on the
effect of fractional flow reserve-guided complete revascularization.
Methods and Results - In the DANAMI-3-PRIMULTI study (Primary PCI in
Patients With ST-Elevation Myocardial Infarction and Multivessel Disease:
Treatment of Culprit Lesion Only or Complete Revascularization), we
randomized 627 ST-segment-elevation myocardial infarction patients to
fractional flow reserve-guided complete revascularization or
infarct-related percutaneous coronary intervention only. In patients with
3-vessel disease, fractional flow reserve-guided complete
revascularization reduced the primary end point (all-cause mortality,
reinfarction, and ischemia-driven revascularization; hazard ratio [HR],
0.33; 95% confidence interval [CI], 0.17-0.64; P=0.001), with no
significant effect in patients with 2-vessel disease (HR, 0.77; 95% CI,
0.47-1.26; P=0.29; P for interaction =0.046). A similar effect was
observed in patients with diameter stenosis >=90% of noninfarct-related
arteries (HR, 0.32; 95% CI, 0.18-0.62; P=0.001), but not in patients with
less severe lesions (HR, 0.72; 95% CI, 0.44-1.19; P=0.21; P for
interaction =0.06). The effect was most pronounced in patients with
3-vessel disease and noninfarct-related stenoses >=90%, and in this
subgroup, there was a nonsignificant reduction in the end point of
mortality and reinfarction (HR, 0.32; 95% CI, 0.08-1.32; P=0.09). Proximal
versus distal location did not influence the benefit from complete
revascularization. Conclusions - The benefit from fractional flow
reserve-guided complete revascularization in ST-segment-elevation
myocardial infarction patients with multivessel disease was dependent on
the presence of 3-vessel disease and noninfarct diameter stenosis >=90%
and was particularly pronounced in patients with both of these
angiographic characteristics. Clinical Trial Registration - URL:
http://www.clinicaltrials.gov. Unique identifier:
NCT01960933.<br/>Copyright &#xa9; 2017 American Heart Association, Inc.

<14>
Accession Number
607898218
Author
Amat-Santos I.J.; Cortes C.; Varela-Falcon L.H.
Institution
(Amat-Santos, Cortes, Varela-Falcon) Cardiology Department, Hospital
Clinico Universitario De Valladolid, Spain
Title
Delayed left anterior mitral leaflet perforation and infective
endocarditis after transapical aortic valve implantation-Case report and
systematic review.
Source
Catheterization and Cardiovascular Interventions. 89 (5) (pp 951-954),
2017. Date of Publication: April 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Aim: We aimed to illustrate the physiopathology of anterior mitral leaflet
perforation after TAVI in patients suffering from infective endocarditis
(IE). Methods and Results: The first known case of balloon-expandable
transapical case from our series suffering from this complication was
reported. In addition, a systematic electronic search of all published
cases reporting both entities was performed. Five transfemoral cases have
been published to the date, all males with mean age of 79.2 year (range:
66-88). Four were treated with self-expandable prostheses (deeply
implanted in the outflow tract). There was moderate residual aortic
regurgitation in four. Fever and positive blood cultures for typical
micoorganisms were present at certain time point in all cases between the
first week and up to 11 months (early IE). Three cases underwent cardiac
surgery with adequate outcomes and two others died during hospitalization.
Medical management in the case from our series allowed patient's survival
at 1-year follow up. Conclusions: Early suspicion of IE whenever anterior
mitral perforation is found after TAVI can be life-saving. The
hypothetical higher risk of this complication due to higher rate of aortic
regurgitation has to be prevented through adequate prosthesis depth and
careful sterile surgical technique. &#xa9; 2016 Wiley Periodicals,
Inc.<br/>Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<15>
Accession Number
614120537
Author
Steppich B.; Groha P.; Ibrahim T.; Schunkert H.; Laugwitz K.-L.;
Hadamitzky M.; Kastrati A.; Ott I.
Institution
(Steppich, Groha, Hadamitzky, Kastrati, Ott) Deutsches Herzzentrum der
Technischen Universitat Munchen, Lazarettstr. 36, Munich 80636, Germany
(Ibrahim, Schunkert, Laugwitz) Medizinische Klinik Klinikum rechts der
Isar der Technischen Universitat Munchen, Ismaningerstr. 22, Munich 81675,
Germany
Title
Effect of Erythropoietin in patients with acute myocardial infarction:
Five-year results of the REVIVAL-3 trial.
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 38. Date of Publication: 21 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Erythropoietin (EPO) has been suggested to promote cardiac
repair after MI. However, the randomized, double-blind, placebo controlled
REVIVAL-3 trial showed that short term high dose EPO in timely reperfused
myocardium does not improve left ventricular ejection fraction after 6
months. Moreover, the study raised safety concerns due to a trend towards
a higher incidence of adverse clinical events as well as a increase in
neointima formation after treatment with EPO. The present study therefore
aimed to assess the 5-year clinical outcomes. Methods: After successful
reperfusion 138 patients with STEMI were randomly assigned to receive
epoetin beta (3.33x10⁴ U, n = 68) or placebo (n = 70)
immediately, 24 and 48 h after percutaneous coronary intervention. The
primary outcome of the present study- the combined incidence of MACE 5
years after randomization - occurred in 25% of the patients assigned to
epoetin beta and 17% of the patients assigned to placebo (RR 1.5; 95% CI
0.8-3.5; p = 0.26). Target lesion revascularization was required in 15
patients (22.1%) treated with epoetin-s and 9 patients (12.9%) treated
with placebo (p = 0.15). Analysis of patients in the upper and lower
quartile of baseline hemoglobin as an indirect estimate of endogenous
erythropoietin levels revealed no significant impact of endogenous
erythropoietin on efficiency of exogen administered epoetin-s in terms of
death and MACE. Conclusion: These long-term follow-up data show that
epoetin beta does not improve clinical outcomes of patients with acute
myocardial infarction. Trial registration: URL www.clinicaltrials.gov ;
Unique identifier NCT00390832; trial registration date October 19th
2006<br/>Copyright &#xa9; 2017 The Author(s).

<16>
Accession Number
614206742
Author
Reyes-Umpierrez D.; Davis G.; Cardona S.; Pasquel F.J.; Peng L.; Jacobs
S.; Vellanki P.; Fayfman M.; Haw S.; Halkos M.; Guyton R.A.; Thourani
V.H.; Umpierrez G.E.
Institution
(Reyes-Umpierrez, Davis, Cardona, Pasquel, Jacobs, Vellanki, Fayfman, Haw,
Umpierrez) Department of Medicine, Diabetes and Endocrinology Section,
Grady Health System, Emory University, School of Medicine, 49 Jesse Hill
Jr. Drive, Atlanta, GA 30303, United States
(Peng) Rollins School of Public Health, Emory University, Atlanta, GA
30303, United States
(Halkos, Guyton, Thourani) Joseph B. Whitehead Department of Surgery,
Emory University, Atlanta, GA 30303, United States
Title
Inflammation and oxidative stress in cardiac surgery patients treated to
intensive versus conservative glucose targets.
Source
Journal of Clinical Endocrinology and Metabolism. 102 (1) (pp 309-315),
2017. Date of Publication: 01 Jan 2017.
Publisher
Endocrine Society (E-mail: mzendell@endo-society.org)
Abstract
Objective: We aimed to determine (a) longitudinal changes of inflammatory
and oxidative stress markers and (b) the association between markers of
inflammation and perioperative complications in coronary artery bypass
surgery (CABG) patients treated with intensive vs conservative blood
glucose (BG) control. Methods: Patients with diabetes (n = 152) and
without diabetes with hyperglycemia (n = 150) were randomized to intensive
(n = 151; BG: 100-140 mg/dL) or to conservative (n = 151; BG: 141-180
mg/dL) glycemic targets. Plasma cortisol, high-sensitivity C-reactive
protein (hsCRP), tumor necrosis factor-a, interleukin-6 (IL-6),
thiobarbituric acid-reactive substances, and 2'-7'-dichlorofluorescein
were measured prior to and at days 3, 5, and 30 after surgery. Results:
Intensive glycemic control resulted in lower mean BG (132 +/- 14 mg/dL vs
154 +/- 17 mg/dL, P < 0.001) in the intensive care unit. Plasma cortisol
and inflammatory markers increased significantly from baseline after the
third and fifth day of surgery (P < 0.001), and returned to baseline
levels at 1month of follow-up. Patients with perioperative complications
had higher levels of cortisol, hsCRP, IL-6, and oxidative stress markers
compared with those without complications. There were no significant
differences in inflammatory and oxidative stress markers between patients,
with or without diabetes or complications, treated with intensive or
conventional glucose targets. Conclusion: We report no significant
differences in circulating markers of acute inflammatory and oxidative
stress response in cardiac surgery patients, with or without diabetes,
treated with intensive (100-140 mg/dL) or conservative (141-180 mg/dL)
insulin regimens.<br/>Copyright &#xa9; 2017 by the Endocrine Society.

<17>
Accession Number
616414885
Author
Unal S.; Acar B.; Yayla C.; Balci M.M.; Ertem A.G.; Kara M.; Maden O.;
Temizhan A.; Tola M.; Balbay Y.
Institution
(Unal, Acar, Yayla, Balci, Ertem, Kara, Maden, Temizhan, Balbay) Turkiye
Yuksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara,
Turkey
(Tola) Turkiye Yuksek Ihtisas Training and Research Hospital, Radiology
Clinic, Ankara, Turkey
Title
Manual heating of the radial artery (Balbay maneuver) to facilitate radial
puncture prior to transradial coronary catheterization.
Source
Revista Portuguesa de Cardiologia. 36 (6) (pp 409-414), 2017. Date of
Publication: June 2017.
Publisher
Sociedade Portuguesa de Cardiologia (E-mail: secretariado@mail.spc.pt)
Abstract
Objective Transradial access is widely used for both diagnostic and
interventional cardiac procedures. The use of transradial access offers
several advantages, including decreased bleeding, fewer vascular
complications, and reduced length of hospital stay and cost. However, the
small size of the radial artery limits the size of the equipment that can
be used via this approach. In this study we sought to investigate whether
preprocedural manual heating of the radial artery facilitates radial
artery puncture. Methods Patients undergoing transradial cardiac
catheterization were randomized to subcutaneous nitroglycerin plus
diltiazem or manual heating. The study endpoint was puncture score (score
1: easiest - puncture at first attempt; score 2: second attempt; score 3:
third attempt; score 4: fourth attempt or more; score 5: puncture failed).
Results Ninety consecutive patients were enrolled in the study, 45
allocated to the drug treatment group and 45 to the heating group.
Patients underwent radial artery ultrasound before catheterization.
Complications were rare: one hematoma (drug treatment group) and one
radial artery occlusion (heating group). Baseline demographic and clinical
characteristics were similar. Baseline radial artery diameter was similar
in both groups (2.41+/-0.46 mm and 2.29+/-0.48 mm in the heating and drug
treatment groups, respectively). However, the median puncture score was
lower in the heating group (1; interquartile range 1-2) compared to the
drug treatment group (2; interquartile range 1-3; p=0.001). Conclusions
Preprocedural manual heating of the radial artery facilitates radial
artery puncture in patients undergoing transradial cardiac
catheterization.<br/>Copyright &#xa9; 2017 Sociedade Portuguesa de
Cardiologia

<18>
Accession Number
613206443
Author
Butter C.; Bramlage P.; Rudolph T.; Jacobshagen C.; Rothe J.; Treede H.;
Kerber S.; Frank D.; Seilerova L.; Schymik G.
Institution
(Butter) Department of Cardiology, Immanuel Clinic Bernau, Heart Center
Brandenburg, Ladeburger Strase 17, Bernau 16321, Germany
(Bramlage) Institute for Pharmacology and Preventive Medicine,
Cloppenburg, Germany
(Rudolph) Herzzentrum, Universitatsklinikum Koln, Cologne, Germany
(Jacobshagen) Herzzentrum, Universitatsklinikum Gottingen, Gottingen,
Germany
(Rothe) University Heart Center Freiburg-Bad Krozingen, Division of
Cardiology and Angiology II, Bad Krozingen, Germany
(Treede) Universitatsklinik und Poliklinik fur Herzchirurgie,
Universitatsklinikum Halle, Halle, Germany
(Kerber) Herz- und Gefas-Klinik, Bad Neustadt, Germany
(Frank) ZHK (German Centre for Cardiovascular Research), Partner Site
Kiel/Hamburg/Lubeck, Hamburg, Germany
(Frank) University Hospital Schleswig-Holstein, Department of Internal
Medicine III (Cardiology and Angiology), Campus Kiel, Germany
(Seilerova) Edwards Lifesciences, Prague, Czech Republic
(Schymik) Medical Clinic IV, Department of Cardiology, Municipal Hospital,
Karlsruhe, Germany
Title
Balloon expandable transcatheter aortic valve implantation via the
transfemoral route with or without pre-dilation of the aortic valve -
rationale and design of a multicentre registry (EASE-IT TF).
Source
BMC Cardiovascular Disorders. 16 (1) (no pagination), 2016. Article
Number: 223. Date of Publication: 15 Nov 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Transcatheter aortic valve implantation via the transfemoral
route (TF-TAVI) is commonly performed as a treatment for severe aortic
stenosis (AS) in patients at high surgical risk. Pre-deployment balloon
aortic valvuloplasty (BAV) has generally been considered an essential step
for preparing the valve landing zone for receipt of the prosthesis.
However, there is little evidence supporting the clinical value of BAV,
while several associated complications have been documented. This has
provoked several groups to evaluate the feasibility and safety of omitting
BAV form the TF-TAVI procedure (direct TF-TAVI), with encouraging results.
However, studies comparing the clinical outcomes of direct TF-TAVI to
standard TF-TAVI are lacking. Methods: EASE-IT TF is a prospective,
observational, two-armed, multicentre registry designed to gather data on
procedural aspects, adverse events and survival rates associated with
direct TF-TAVI using the Edwards SAPIEN 3 balloon-expandable prosthesis.
Discussion: EASE-IT-TF data will be analysed firstly to determine the
risks and benefits associated with direct TF-TAVI vs. standard TF-TAVI,
and secondly to identify associations between patient variables and
specific outcomes. This may assist identification of patients who stand to
benefit from direct TF-TAVI, therefore contributing to clinical reductions
in TF-TAVI-associated morbidity and mortality rates in high-risk AS
patients. Trial registrations: Clinictrials.gov: NCT02760771<br/>Copyright
&#xa9; 2016 The Author(s).

<19>
Accession Number
611873826
Author
Bundhun P.K.; Yanamala C.M.; Huang F.
Institution
(Bundhun, Huang) Institute of Cardiovascular Diseases, First Affiliated
Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
(Yanamala) EALING Hospital, University of Buckingham, Department of
Internal Medicine, Uxbridge road, Southall, London UB1 3HW, United Kingdom
Title
Should a prolonged duration of dual anti-platelet therapy be recommended
to patients with diabetes mellitus following percutaneous coronary
intervention? A systematic review and meta-analysis of 15 studies.
Source
BMC Cardiovascular Disorders. 16 (1) (no pagination), 2016. Article
Number: 161. Date of Publication: 30 Aug 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: This study aimed to compare the adverse clinical outcomes
associated with a short and a prolonged duration of Dual Anti-Platelet
Therapy (DAPT) in patients with Diabetes Mellitus (DM) after undergoing
Percutaneous Coronary Intervention (PCI). Methods: Medline/PubMed, EMBASE
and the Cochrane library were searched for studies comparing the short and
prolonged DAPT use in patients with DM. Adverse outcomes were considered
as the clinical endpoints in this analysis. Odds Ratios (OR) with 95 %
Confidence Intervals (CI) were used to express the pooled effect on
discontinuous variables and the pooled analyses were performed with RevMan
5.3. Results: Fifteen studies with a total number of 25,742 patients with
DM were included in this current analysis which showed no significant
differences in primary endpoints, net clinical outcomes, myocardial
infarction and stroke with OR: 1.03, 95 % CI: 0.65-1.64; P = 0.90, OR:
0.96, 95 % CI: 0.69-1.34; P = 0.81, OR: 0.85, 95 % CI: 0.70-1.04; P = 0.12
and OR: 0.94, 95 % CI: 0.65-1.36; P = 0.75 respectively. Revascularization
was also similar between these 2 groups of patients with DM. However, even
if mortality favored prolonged DAPT use, with OR: 0.87, 95 % CI:
0.76-1.00; P = 0.05, the result only approached significance. Also, stent
thrombosis insignificantly favored a prolonged DAPT duration with OR:
0.56, 95 % CI: 0.27-1.17; P = 0.12. Thrombolysis In Myocardial Infarction
(TIMI) defined major and minor bleeding were not significantly different
in these diabetic patients with OR: 0.91, 95 % CI: 0.60-1.37; P = 0.65 and
OR: 1.08, 95 % CI: 0.62-1.91; P = 0.78 respectively. However, bleeding
defined by the Bleeding Academic Research Consortium (BARC) classification
was significantly higher with a prolonged DAPT use in these diabetic
patients with OR: 1.92, 95 % CI: 1.58-2.34; P < 0.00001. Conclusion:
Following PCI, a prolonged DAPT use was associated with similar adverse
clinical outcomes but with a significantly increased BARC defined bleeding
compared to a short term DAPT use in these patients with DM. However, even
if mortality and stent thrombosis favored a prolonged DAPT use, these
outcomes only either reached statistical significance or were
insignificant respectively, showing that a clear decision about
recommending a prolonged duration of DAPT to patients with DM might not be
possible at this moment, warranting further research in this particular
subgroup.<br/>Copyright &#xa9; 2016 The Author(s).

<20>
Accession Number
612125933
Author
Galappatthy P.; Waniganayake Y.C.; Sabeer M.I.M.; Wijethunga T.J.;
Galappatthy G.K.S.; Ekanayaka R.A.I.
Institution
(Galappatthy) University of Colombo, Department of Pharmacology and
Pharmacy, Faculty of Medicine, Kynsey Road, PO Box 271, Colombo, Sri Lanka
(Waniganayake, Sabeer, Wijethunga, Galappatthy, Ekanayaka) National
Hospital of Sri Lanka, Institute of Cardiology, Colombo, Sri Lanka
Title
Leg edema with (S)-amlodipine vs conventional amlodipine given in triple
therapy for hypertension: A randomized double blind controlled clinical
trial.
Source
BMC Cardiovascular Disorders. 16 (1) (no pagination), 2016. Article
Number: 168. Date of Publication: 01 Sep 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Leg edema is a common adverse effect of dihydropyridine
Calcium Channel Blockers (CCB) that may need dose reduction or drug
withdrawal, adversely affecting the antihypertensive efficacy. Leg edema
is reported to occur less often with (S)-amlodipine compared to
conventional racemic amlodipine. We aimed to find the incidence of leg
edema as a primary outcome and antihypertensive efficacy with
(S)-amlodipine compared to conventional amlodipine. Methods: This
prospective, double-blind, controlled clinical trial randomized 172
hypertensive patients, not controlled on beta-blockers (BB) and
angiotensin converting enzyme inhibitors/angiotensin receptor blockers
(ACEI/ARB), to either conventional amlodipine (5-10 mg; n = 86) or
(S)-amlodipine (2.5-5 mg; n = 86), while continuing their previous
anti-hypertensive medications. Sample was sufficient to find a difference
in edema between the interventions with 80 % power at 5 % significance
level. Intension to treat analysis (ITT) for safety data and per protocol
analysis for efficacy data was performed. Fischer's exact test was applied
to observe difference between responder rates and proportions of subjects
having peripheral edema in the two groups. Pitting edema test scores were
compared using Mann-Whitney test. Results: Altogether 146 patients
(amlodipine, n = 76 and (S)-amlodipine, n = 70) completed 120 days
treatment. Demographic variables and treatment adherence were comparable
in the two groups. Incidence of new edema after randomization was 31.40 %
in test group and 46.51 % in control group [p = 0.03; absolute risk
reduction (ARR) = 15.1 %; Number Needed to Treat (NNT) = 7, ITT analysis].
Pitting edema score and patient rated edema score increased significantly
in the control compared to test group (p = 0.038 and 0.036 respectively)
after treatment period. Edema scores increased significantly in the
control group from baseline (p < 0.0001). Responders in blood pressure
were 98.57 % in test and 98.68 % in control group. Most common adverse
events (AE) were pitting edema and increased urinary frequency. Incidence
of all AEs other than edema was similar in both groups. Two serious AEs
occurred unrelated to therapy. Biochemical and ECG parameters in the two
groups were comparable. Conclusions: In hypertensive patients not
controlled on prior BB and ACEI/ARB therapy, addition of (S)-amlodipine
besylate at half the dose of conventional amlodipine provides better
tolerability with reduced incidence of peripheral edema, and equal
antihypertensive efficacy compared to amlodipine given at usual doses.
Trial registration: Sri Lanka Clinical Trials registry: www.slctr.lk,
SLCTR/2013/006<br/>Copyright &#xa9; 2016 The Author(s).

<21>
Accession Number
612939954
Author
Saxton A.T.; Poenaru D.; Ozgediz D.; Ameh E.A.; Farmer D.; Smith E.R.;
Rice H.E.
Institution
(Saxton, Smith, Rice) Duke Global Health Institute, Duke University
Medical Center, Durham, NC, United States
(Poenaru) McMaster Paediatric Surgery Research Collaborative, Dept. of
Surgery, McMaster University, Hamilton, Canada
(Ozgediz) Yale-New Haven Hospital, New Haven, CT, United States
(Ameh) Department of Surgery, National Hospital, Abuja, Nigeria
(Farmer) University of California-Davis Health System, Davis, CA, United
States
Title
Economic analysis of children's surgical care in low- and middle-income
countries: A systematic review and analysis.
Source
PLoS ONE. 11 (10) (no pagination), 2016. Article Number: e0165480. Date of
Publication: October 2016.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Understanding the economic value of health interventions is
essential for policy makers to make informed resource allocation
decisions. The objective of this systematic review was to summarize
available information on the economic impact of children's surgical care
in low- and middle-income countries (LMICs). Methods We searched MEDLINE
(Pubmed), Embase, and Web of Science for relevant articles published
between Jan. 1996 and Jan. 2015. We summarized reported cost information
for individual interventions by country, including all costs, disability
weights, health outcome measurements (most commonly disability-adjusted
life years [DALYs] averted) and costeffectiveness ratios (CERs). We
calculated median CER as well as societal economic benefits (using a human
capital approach) by procedure group across all studies. The
methodological quality of each article was assessed using the Drummond
checklist and the overall quality of evidence was summarized using a scale
adapted from the Agency for Healthcare Research and Quality. Findings We
identified 86 articles that met inclusion criteria, spanning 36 groups of
surgical interventions. The procedure group with the lowest median CER was
inguinal hernia repair ($15/ DALY). The procedure group with the highest
median societal economic benefit was neurosurgical procedures ($58,977).
We found a wide range of study quality, with only 35% of studies having a
Drummond score >=7. Interpretation Our findings show that many areas of
children's surgical care are extremely cost-effective in LMICs, provide
substantial societal benefits, and are an appropriate target for enhanced
investment. Several areas, including inguinal hernia repair, trichiasis
surgery, cleft lip and palate repair, circumcision, congenital heart
surgery and orthopedic procedures, should be considered "Essential
Pediatric Surgical Procedures" as they offer considerable economic value.
However, there are major gaps in existing research quality and methodology
which limit our current understanding of the economic value of surgical
care.<br/>Copyright &#xa9; 2016 Saxton 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.

<22>
Accession Number
613400989
Author
Li N.; Yang Y.-G.; Chen M.-H.
Institution
(Li, Yang, Chen) the First Affiliated Hospital of Guangxi Medical
University, Institute of Cardiovascular Diseases, Nanning, Guangxi 530027,
China
Title
Comparing the adverse clinical outcomes in patients with non-insulin
treated type 2 diabetes mellitus and patients without type 2 diabetes
mellitus following percutaneous coronary intervention: A systematic review
and meta-analysis.
Source
BMC Cardiovascular Disorders. 16 (1) (no pagination), 2016. Article
Number: 238. Date of Publication: 25 Nov 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Several studies showed Type 2 Diabetes Mellitus (T2DM) to be
associated with worse adverse clinical outcomes compared to non-T2DM (NDM)
following Percutaneous Coronary Intervention (PCI). In addition, patients
with insulin-treated T2DM (ITDM) showed worse clinical outcomes compared
to patients with non-insulin treated T2DM (NITDM). Since NITDM and NDM
have seldom been systematically analyzed, this study aimed to compare the
short and long term adverse clinical outcomes observed in patients with
NITDM and patients without T2DM following PCI. Methods: Medline/PubMed,
EMBASE and the Cochrane library were searched for Randomized Controlled
Trials (RCTs) and observational studies comparing patients with (including
ITDM and NITDM) and without T2DM following PCI. Endpoints included adverse
clinical outcomes reported during a short and a long term follow up
period. Odd Ratios (OR) and 95% Confidence Intervals (CI) in accordance
with either a fixed or a random effects model appropriately, were
calculated and the pooled analyses were performed with RevMan 5.3.
Results: Twelve studies consisting of a total number of 52,451 patients
(14,863 NITDM and 37,588 NDM) were included. Patients with NITDM were
found to have significantly higher short-term Major Adverse Cardiac Events
(MACEs) and mortality with OR: 1.63, 95% CI (1.17, 2.27); P = 0.004 and
OR: 1.71, 95% CI (1.40, 2.10), P < 0.00001 respectively and higher
long-term MACEs and mortality with OR: 1.25, 95% CI (1.12, 1.40), P =
0.0001 and OR: 1.32, 95% CI (1.19, 1.47), P < 0.00001 respectively
compared to NDM following PCI. In addition, compared to NDM, long-term
Target Vessel Revascularization (TVR) and Target Lesion Revascularization
(TLR) were significantly higher in the NITDM group with OR: 1.36, 95% CI
(1.18, 1.56), P < 0.0001 and OR: 1.32, 95% CI (1.10, 1.59), P = 0.003
respectively. However, even if an increased long-term stent thrombosis was
observed in the NITDM group with OR: 1.13; 95% CI (0.91, 1.40), P = 0.28,
the result was insignificant. Conclusion: Short and long term MACEs and
mortality were significantly higher in patients with NITDM compared to
patients without diabetes following PCI. Revascularization also
significantly favored patients without T2DM. However, stent thrombosis was
not significantly different.<br/>Copyright &#xa9; 2016 The Author(s).

<23>
Accession Number
612843323
Author
Kato T.S.; Nakamura H.; Murata M.; Kuroda K.; Suzuki H.; Yokoyama Y.;
Shimada A.; Matsushita S.; Yamamoto T.; Amano A.
Institution
(Kato, Nakamura, Murata, Kuroda, Yokoyama, Shimada, Matsushita, Yamamoto,
Amano) Heart Center, Juntendo University, Department of Cardiovascular
Surgery, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
(Suzuki) Juntendo University School of Medicine, Division of Nephrology,
Department of Internal Medicine, Bunkyo-ku, Tokyo, Japan
Title
The effect of tolvaptan on renal excretion of electrolytes and urea
nitrogen in patients undergoing coronary artery bypass surgery.
Source
BMC Cardiovascular Disorders. 16 (1) (no pagination), 2016. Article
Number: 181. Date of Publication: 13 Sep 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Adequate fluid management is an important component of patient
care following cardiac surgery. Our aim in this study was to determine the
benefits of tolvaptan, an oral selective vasopressin-2 receptor antagonist
that causes electrolyte-free water diuresis, in postoperative fluid
management. We prospectively examined the effect of tolvaptan on renal
excretion of electrolytes and urea nitrogen in cardiac surgery patients.
Methods: Patients undergoing coronary artery bypass surgery were
randomized to receive conventional loop diuretics (Group C, n = 30) or
conventional loop diuretic therapy plus tolvaptan (Group T, n = 27).
Fractional excretions of sodium (FENA), potassium (FEK) and urea nitrogen
(FEUN) were measured in both groups during post-surgical hospitalization.
Results: Urine output was greater with tolvaptan (Group T) than without it
(Group C), and some patients in Group C required intravenous as well as
oral loop diuretics. Serum sodium concentrations decreased after surgery
in Group C, but were unchanged in Group T (postoperative day [POD] 3,
139.8 +/- 3.5 vs. 142.3 +/- 2.6 mEq/L, p = 0.006). However, postoperative
FENA values in Group C did not decrease, and the values were similar in
both groups. Serum potassium levels remained lower and FEK values remained
higher than the preoperative values, but only in Group C (all p < 0.05).
BUN increased postoperatively in both groups, but it remained higher than
its preoperative value only in Group C (all p < 0.01). Group T showed an
initial increase in BUN, which peaked and then returned to its
preoperative value within a week. The FEUN increased postoperatively in
both groups, but the change was more pronounced in Group T (POD7, 52.7 +/-
9.3 vs. 58.2 +/- 6.5 %, p = 0.025). Conclusions: Renal excretion of sodium
and potassium reflects the changes in serum concentration in patients
treated with tolvaptan. Patients treated only with loop diuretics showed a
continuous excretion of sodium and potassium that led to electrolyte
imbalance, whereas the combination of loop diuretics and tolvaptan
increased renal urea nitrogen elimination. Tolvaptan therefore appears to
be an effective diuretic that minimally affects serum electrolytes while
adequately promoting the elimination of urea nitrogen from the kidneys in
patients undergoing coronary artery bypass surgery. Trial registration:
The present study is registered with the UMIN Clinical Trials Registry
(ID: UMIN000011039)<br/>Copyright &#xa9; 2016 The Author(s).

<24>
Accession Number
616957959
Author
Poon S.S.; Field M.; Gupta D.; Cameron D.
Institution
(Poon, Field) Thoracic Aortic Aneurysm Service, Department of Cardiac
Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
(Gupta) Interventional Cardiology, Department of Cardiology, Liverpool
Heart and Chest Hospital, Liverpool, United Kingdom
(Cameron) Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore,
MD, United States
Title
Surgical septal myectomy or alcohol septal ablation: which approach offers
better outcomes for patients with hypertrophic obstructive
cardiomyopathy?.
Source
Interactive Cardiovascular and Thoracic Surgery. 24 (6) (pp 951-961),
2017. Date of Publication: 01 Jun 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Summary A best evidence topic in cardiac surgery was written according to
a structured protocol. The question addressed was whether surgical septal
myectomy (SM) is more beneficial than alcohol septal ablation (ASA) in
patients with hypertrophic obstructive cardiomyopathy. Altogether 218
articles were found using the reported search, of which 15 studies
represented the best evidence to answer the clinical question. There were
14 observational studies and 1 meta-analysis study. The authors, journal,
date and country of publication, patient group studied, study type,
relevant outcomes and results of these articles are tabulated. Surgical SM
was generally performed in younger patients whereas percutaneous ASA was
favoured in patients with advanced age and significant co-morbidities. In
a large study comprising 716 patients, the reduction of median residual
left ventricular outflow tract (LVOT) gradient at 3 months was comparable
after ASA (102 +/- 52-10 mmHg) and SM (92 +/- 39-9 mmHg). The New York
Heart Association (NYHA) functional class and symptomatic improvement for
either approach was comparable. Findings from the meta-analysis study
showed that patients who underwent ASA had a higher incidence of
post-procedure device implantation (odds ratio 3.09; P < 0.00001), as
reported in 6 other studies. The risk of permanent pacemaker insertion
during follow-up (FU) varied between 2.4-12.5% in SM and 1.7-22.0% in ASA.
Isolated surgical myectomy and ASA are safe and effective in abolishing
outflow obstruction, although the resolution of LVOT pressure gradient is
more complete with surgery. The post-procedural and late mortality rates
between the 2 groups are consistently low and comparable in carefully
selected patients. Nonetheless, ASA is associated with the increased
likelihood of complications such as permanent pacemaker implantation,
early sustained-VT and VF, and re-intervention. Overall, when performed by
experienced cardiologists and surgeons, both techniques are safe and
effective in most cases and therefore treatment should be offered based on
patient choice.<br/>Copyright &#xa9; The Author 2017. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery.

<25>
Accession Number
616957660
Author
Zhao H.; Ma H.; Meng L.; Zhao Z.; Quan X.; Cheng Z.
Institution
(Zhao, Zhao, Quan, Cheng) Department of Cardiac Surgery, Henan Province
People's Hospital, No. 7 Weiwu Road, Zhengzhou 450003, China
(Ma) Special Service Center, Henan Province People's Hospital, Zhengzhou,
China
(Meng) Department of Cardiac Surgery, Zhengzhou People's Hospital, Henan
Province People's Hospital, Henan Province Chest Hospital, No. 7 Weiwu
Road, Zhengzhou 450003, China
Title
Application of autologous blood cell salvage in off-pump coronary artery
bypass graft operation.
Source
Heart Surgery Forum. 20 (3) (pp E107-E110), 2017. Date of Publication:
June 2017.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Objective: To analyze whether application of autologous blood cell salvage
can reduce the transfusion volume of allogeneic blood and complications of
blood transfusion in off-pump coronary artery bypass operations.Methods:
We randomly divided 120 patients into autologous blood cell salvage group
(experimental group, n = 60) and non-autologous blood cell salvage group
(control group, n = 60). Volume of perioperative allogeneic blood
transfusion of each patient was recorded. Moreover, complications and ICU
retention times (H) of each patient were also recorded.The data were
analyzed using t tests.Results: The volume of allogeneic blood transfusion
was significantly less in the experimental group than in the conotrol
group. Conclusion: Application of autologous blood cell salvage in
off-pump coronary artery bypass graft operation can reduce the volume of
allogeneic blood transfusion, alleviate blood shortage, and reduce the
incidence of postoperative complications, leading to medical, economic,
and social benefits.<br/>Copyright &#xa9; 2017 Forum Multimedia
Publishing, LLC.

<26>
Accession Number
616969434
Author
Gnanappa G.K.; Rashid I.; Celermajer D.; Ayer J.; Puranik R.
Institution
(Gnanappa, Rashid) Paediatrics, The Heart Centre for Children, The
Children's Hospital at Westmead and Cardiac MRI, Cardiovascular Magnetic
Resonance, Sydney, NSW, Australia
(Celermajer) Cardiology, Royal Prince Alfred Hospital, Sydney, NSW,
Australia
(Ayer) Paediatric Cardiology, The Heart Centre for Children, The
Children's Hospital at Westmead and The University of Sydney, Sydney, NSW,
Australia
(Puranik) Cardiology and Cardiac MR, Royal Prince Alfred Hospital, The
Heart Centre for Children, The Children's Hospital at Westmead and
Cardiovascular Magnetic Resonance, Sydney, NSW, Australia
Title
Reproducibility of Cardiac Magnetic Resonance Imaging (CMRI)-Derived Right
Ventricular Parameters in Repaired Tetralogy of Fallot (ToF).
Source
Heart Lung and Circulation. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier Ltd
Abstract
Background: Quantification of right ventricular (RV) volumes is
challenging owing to variable reproducibility and is especially so in
congenital heart disease. Cardiac magnetic resonance (CMR) has the ability
to more comprehensively survey the entire right ventricle and is currently
considered the gold standard. Aims: We aimed to determine the
inter-observer reproducibility of CMR-derived RV volumes generated by two
independent and experienced (SCMR Level III) observers in Tetralogy of
Fallot (ToF) patients with varying degrees of RV dilatation. Methods: We
performed a retrospective analysis of 120 consecutive patients with
repaired ToF who underwent CMR. Two blinded observers calculated RV
volumes in each oblique short axis slice independently. Bland-Altman
analysis and inter-observer correlation coefficients (ICC) were assessed.
Results: The coefficients of variation for RV parameters were: 2.9%, 8%
and 3.4% for right ventricular end diastolic volume (RVEDV), right
ventricular end systolic volume (RVESV) and right ventricular ejection
fraction (RVEF) respectively. For RVEDV the interobserver correlation was
0.992 demonstrating excellent volumetric correlation between observers.
The mean difference between the observers for right ventricular end
diastolic volume index (RVEDVi) was 2.5ml/m² (95% limits of
agreement -7.3 to 12.2ml/m²). For patients with mild-moderate
RV dilatation (RVEDVi <150ml/m²) the mean difference of RVEDVi
was 1.8ml/m² (95% limits of agreement -5.7 to
9.3ml/m²). For patients with severe RV dilatation
(RVEDVi>=150ml/m²) the mean difference was -3.4ml/m²
(95% limits of agreement -8.6 to 15.4ml/m²). Conclusions: In
patients with repaired ToF and variable degrees of RV dilatation, CMR
assessment of RV volumes and function has high inter-observer
reproducibility. This allows for optimal timing of pulmonary valve
replacement, based on progression of RV dilatation over
time.<br/>Copyright &#xa9; 2017 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ).

<27>
Accession Number
616940430
Author
Hengstenberg C.; Chandrasekhar J.; Sartori S.; Lefevre T.; Mikhail G.;
Meneveau N.; Tron C.; Jeger R.; Kupatt C.; Vogel B.; Farhan S.; Sorrentino
S.; Sharma M.; Snyder C.; Husser O.; Boekstegers P.; Hambrecht R.; Widder
J.; Hildick-Smith D.; De Carlo M.; Wijngaard P.; Deliargyris E.; Bernstein
D.; Baber U.; Mehran R.; Anthopoulos P.; Dangas G.
Institution
(Hengstenberg) Division of CardiologyDZHK (German Centre for
Cardiovascular Research), Partner Site Munich Heart AllianceMunich Germany
(Hengstenberg) Division of Cardiology, Deutsches Herzzentrum
MunchenTechnische Universitat MunchenMunich 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
(Mikhail) Division of CardiologyImperial College Healthcare NHS Trust,
Hammersmith HospitalLondon United Kingdom
(Meneveau) Division of CardiologyCHU Jean MinjozBesancon France
(Tron) Division of CardiologyCHU de RouenRouen France
(Jeger) Department of CardiologyUniversity Hospital Basel Switzerland
(Kupatt) Division of CardiologyLMU Munich Germany
(Husser) Division of CardiologyDeutsches Herzzentrum Munchen Germany
(Boekstegers) Division of CardiologyHelios Heart CenterSiegburg Germany
(Hambrecht) Department of Cardiology and AngiologyKlinikum Links der
WeserBremen Germany
(Widder) Department of Cardiology and AngiologyHannover Medical
SchoolHannover Germany
(Hildick-Smith) Division of CardiologySussex Cardiac Centre-Brighton and
Sussex University Hospitals NHS TrustBrighton, East Sussex United Kingdom
(De Carlo) Division of CardiologyAzienda Ospedaliero-Universitaria
PisanaPisa Italy
(Wijngaard, Anthopoulos) Division of CardiologyThe Medicines CompanyZurich
Switzerland
(Deliargyris, Bernstein) Division of CardiologyThe Medicines
CompanyParsippany, New Jersey
Title
Impact of pre-existing or new-onset atrial fibrillation on 30-day clinical
outcomes following 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: Prior studies have suggested that patients with atrial
fibrillation (AF) undergoing transcatheter aortic valve replacement (TAVR)
are at higher risk for adverse cardiovascular events. Whether procedural
bivalirudin compared with unfractionated heparin (UFH) has a beneficial
effect on early outcomes in these patients is unknown. We examined for the
effect of baseline or new-onset AF within 30 days of TAVR and explored for
the effect of bivalirudin versus UFH by AF status, on 30-day outcomes from
the BRAVO 3 trial. Methods: The BRAVO-3 trial multicenter randomized trial
included 802 patients undergoing transfemoral TAVR randomized to
bivalirudin or UFH. We compared AF and no-AF groups and examined for
30-day Bleeding Academic Research Consortium type >=3b bleeding, major
vascular complications and all ischemic endpoints. Adjusted outcomes were
analyzed using logistic regression methods. Results: Of the study
population, 41.4% (n=332) patients had baseline or new-onset AF within 30
days of TAVR, whereas 58.6% (n=470) had no AF. Patients with AF had
greater prevalence of renal dysfunction, lower left ventricular ejection
fraction, and higher euroSCORE I compared with their counterparts without
AF. Among AF and no-AF patients, there were no significant baseline
differences between bivalirudin and UFH groups. At 30 days the incidence
of death (6.0 vs. 4.5%, P=0.324) and stroke (3.9 vs. 2.6%, P=0.274) was
similar in AF vs. no-AF patients. However, new-onset AF (n=38) was
associated with significantly greater crude risk of 30-day stroke compared
with no AF (HR 4.49, 95% CI 1.37-14.67). Regardless of AF status, there
were no differences in 30-day death (P-int=0.652) or stroke (P-int=0.066)
by anticoagulation type. Conclusions: Prior or new-onset AF is noted in
more than one-third of patients undergoing transfemoral TAVR. Despite
greater baseline comorbidities than non-AF patients, AF was not associated
with significantly higher risk of adjusted 30-day outcomes. In the BRAVO 3
trial, early outcomes were similar regardless of anticoagulant strategy in
each group.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<28>
Accession Number
614114845
Author
Mahler S.A.; Stopyra J.P.; Apple F.S.; Riley R.F.; Russell G.B.; Hiestand
B.C.; Hoekstra J.W.; Lefebvre C.W.; Nicks B.A.; Cline D.M.; Askew K.L.;
Herrington D.M.; Burke G.L.; Miller C.D.
Institution
(Mahler, Stopyra, Hiestand, Hoekstra, Lefebvre, Nicks, Cline, Askew,
Miller) Department of Emergency Medicine, Wake Forest School of Medicine,
Winston-Salem, NC, United States
(Apple) Department Laboratory Medicine and Pathology, Hennepin County
Medical Center and University of Minnesota Medical School, Minneapolis,
MN, United States
(Riley) Division of Cardiology, University of Washington, Seattle, WA,
United States
(Russell, Burke) Division of Public Health Sciences, Wake Forest School of
Medicine, Winston-Salem, NC, United States
(Herrington) Department of Internal Medicine, Division of Cardiology, Wake
Forest School of Medicine, Winston-Salem, NC, United States
Title
Use of the HEART Pathway with high sensitivity cardiac troponins: A
secondary analysis.
Source
Clinical Biochemistry. 50 (7-8) (pp 401-407), 2017. Date of Publication:
May 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The HEART Pathway combines a decision aid and serial
contemporary cardiac troponin I (cTnI) measures to achieve > 99%
sensitivity for major adverse cardiac events (MACE) at 30 days and early
discharge rates > 20%. However, the impact of integrating high-sensitivity
troponin (hs-cTn) measures into the HEART Pathway has yet to be
determined. In this analysis we compare test characteristics of the HEART
Pathway using hs-cTnI, hs-cTnT, or cTnI. Design & methods A secondary
analysis of participants enrolled in the HEART Pathway RCT was conducted.
Each patient was risk stratified by the cTn-HEART Pathway (Siemens
TnI-Ultra at 0- and 3-h) and a hs-cTn-HEART Pathway using hs-cTnI (Abbott)
or hs-cTnT (Roche) at 3-h. The early discharge rate, sensitivity,
specificity, and negative predictive value (NPV) for MACE (death,
myocardial infarction, or coronary revascularization) at 30 days were
calculated. Results hs-cTnI measures were available on 133 patients. MACE
occurred in 11/133 (8%) of these patients. Test characteristics for the
HEART Pathway using serial cTnI vs 3 hour hs-cTnI were the same:
sensitivity (100%, 95%CI: 72-100%), specificity (49%, 95%CI: 40-58%), NPV
(100%, 95%CI: 94-100%), and early discharge rate (45%, 95%CI: 37-54%). The
HEART Pathway using hs-cTnT missed one MACE event (myocardial infarction):
sensitivity (91%, 95%CI: 59-100%), specificity (48%, 95%CI: 39-57%), NPV
(98%, 95%CI: 91-100%), and early discharge rate (45%, 95%CI: 37-54%).
Conclusions There was no difference in the test characteristics of the
HEART Pathway whether using cTnI or hs-cTnI, with both achieving 100%
sensitivity and NPV. Use of hs-cTnT with the HEART Pathway was associated
with one missed MACE.<br/>Copyright &#xa9; 2017 The Canadian Society of
Clinical Chemists

<29>
Accession Number
616800177
Author
Takagi H.; Ando T.; Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Title
Seizures associated with tranexamic acid for cardiac surgery: A
meta-analysis of randomized and non-randomized studies.
Source
Journal of Cardiovascular Surgery. 58 (4) (pp 633-641), 2017. Date of
Publication: August 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: The aim of this meta-analysis was to assess whether
tranexamic acid (TXA) therapy for adult cardiac surgery is associated with
an increase in the risk of seizures, and we performed a meta-analysis of
randomized controlled trials (RCTs) and non-randomized observational
studies. EVIDENCE ACQUISITION: MEDLINE and EMBASE were searched through
December 2016 using PubMed and OVID. Eligible studies were RCTs and
non-randomized observational studies on TXA versus control (no TXA,
placebo, or active control such as low-dose TXA, aprotinin, and epsilon
aminocaproic acid) enrolling adult patients undergoing cardiac surgery and
reporting the postoperative incidence of seizures as an outcome.
Study-specific estimates were combined using inverse variance-weighted
averages of logarithmic odds ratios (ORs) in the random-effects model.
EVIDENCE SYNTHESIS: Of 90 potentially relevant articles screened
initially, 16 reports of eligible studies were identified and included. A
pooled analysis of all 16 studies (enrolling 45,235 patients) demonstrated
that TXA therapy was associated with a statistically significant increase
in the seizures incidence (OR=4.13; 95% CI: 2.59 to 6.57; P<0.00001). A
subgroup analysis indicated a statistically significant increase in the
seizures incidence with TXA therapy in all subgroups of 5 RCTs, 5 adjusted
observational studies, and 6 unadjusted observational studies with no
statistically significant subgroup differences (P=0.36;
I²=1.5%). CONCLUSIONS: The results of the present meta-analysis
of 16 studies enrolling 45,235 patients confirmed that TXA therapy for
adult cardiac surgery is associated with a 4.1-fold increase in the risk
of seizure.<br/>Copyright &#xa9; 2017 EDIZIONI MINERVA MEDICA.

<30>
Accession Number
616800121
Author
Doenst T.; Lamelas J.
Institution
(Doenst) Department of Cardiothoracic Surgery, Jena University Hospital,
Friedrich Schiller University of Jena, Erlanger Allee 101, Jena 07747,
Germany
(Lamelas) Division of Cardiac Surgery, Mount Sinai Heart Institute, Mount
Sinai Medical Center, Miami Beach, FL, United States
Title
Do we have enough evidence for minimally-invasive cardiac surgery? A
critical review of scientific and non-scientific information.
Source
Journal of Cardiovascular Surgery. 58 (4) (pp 613-623), 2017. Date of
Publication: August 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Reducing surgical trauma by minimizing skin incisions has transformed
abdominal surgery resulting in significant improvements in outcome. In
cardiac surgery, such efforts have also been made, but similar benefits
could not be demonstrated. In addition, any potential benefit comes at the
cost of increased cardiopulmonary bypass and clamp times, leading to
questions regarding the safety of minimally invasive cardiac surgery
(MICS). Nevertheless, outcomes have been equivalent to matched sternotomy
cases and there is no doubt that the number of patients undergoing
minimally-invasive mitral or aortic procedures is slowly increasing. To
date almost half of all isolated mitral cases in Germany and roughly one
fourth in the USA are performed through a minimized access. These numbers
were less than half 10 years ago. So how can this development be
justified, if the evidence for it seems to be questionable or even
missing? We will attempt to provide some answers to this question by
critically reviewing the available publications and by looking at the
topic from other perspectives, including from a competitive and a patient
standpoint. We will conclude that there is enough evidence to support
minimally-invasive access as the primary approach to a valve in the
majority of patients. We will further suggest that modern cardiac surgery
may have difficulties to prevail in its full width, if these novel
techniques are not embraced. Finally, we will demonstrate that minimally
invasive cardiac surgery is associated with substantial improvements in
patient care, however, in areas that are unlikely to be tested with
randomized controlled trials.<br/>Copyright &#xa9; 2016 EDIZIONI MINERVA
MEDICA.

<31>
Accession Number
610067157
Author
Antonic M.; Lipovec R.; Gregorcic F.; Juric P.; Kosir G.
Institution
(Antonic, Lipovec, Gregorcic, Juric, Kosir) Department for Cardiac
Surgery, University Medical Center Maribor, Maribor, Slovenia
Title
Perioperative ascorbic acid supplementation does not reduce the incidence
of postoperative atrial fibrillation in on-pump coronary artery bypass
graft patients.
Source
Journal of Cardiology. 69 (1) (pp 98-102), 2017. Date of Publication: 01
Jan 2017.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background Atrial fibrillation is the most common arrhythmia following
cardiac surgery. It is associated with increased hemodynamic instability,
systemic embolization, and complications linked to anticoagulant therapy.
Oxidative stress and consequent electrophysiological remodeling have been
proposed as a cause of postoperative atrial fibrillation. Ascorbic acid
supplementation was suggested as a novel and effective preventive agent.
The aim of this study was to evaluate the capability of ascorbic acid to
reduce the incidence of postoperative atrial fibrillation in coronary
artery bypass grafting (CABG) patients. Methods A prospective randomized
single-center trial was conducted in patients scheduled for an elective
on-pump CABG surgery. Subjects in the ascorbic acid group received 2 g of
ascorbic acid 24 h and 2 h before the surgery and 1 g twice a day for five
days after the surgery. Postoperatively, the patients were monitored for
atrial fibrillation and other complications. Results The ascorbic acid
group consisted of 52 patients and the control group included 53 patients.
The groups were well matched for baseline demographics, preoperative
medications, comorbidities, and had similar intraoperative
characteristics. The incidence of atrial fibrillation in the ascorbic acid
group was 13.5% and 18.9% in the control group (p = 0.314). No difference
was found between groups in the time of occurrence of atrial fibrillation
(3.71 +/- 1.89 vs. 2.91 +/- 1.58 days after the surgery; p = 0.342). There
was also no difference in the other observed postoperative complications.
Conclusions The results of this study do not support the effectiveness of
ascorbic acid supplementation in reducing the incidence of postoperative
atrial fibrillation in elective on-pump CABG patients.<br/>Copyright
&#xa9; 2016 Japanese College of Cardiology

<32>
Accession Number
616800155
Author
Takagi H.; Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan
Title
Better midterm survival in women after transcatheter aortic valve
implantation.
Source
Journal of Cardiovascular Surgery. 58 (4) (pp 624-632), 2017. Date of
Publication: August 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: In previous meta-analyses demonstrating better midterm
overall survival in women undergoing transcatheter aortic valve
implantation (TAVI), unadjusted risk and odds ratios were combined. To
determine whether female gender is independently associated with better
survival after TAVI, we performed a meta-analysis pooling adjusted hazard
ratios (HRs) based on multivariate Cox proportional hazard regression.
EVIDENCE ACQUISITION: MEDLINE and EMBASE were searched through September
2015 using PubMed and OVID. Studies considered for inclusion met the
following criteria: the study population was patients undergoing TAVI; and
main outcomes included midterm (mean or median >=6 months) overall
survival or all-cause mortality in women and men. An unadjusted and/or
adjusted HR of all-cause mortality for women versus men was abstracted
from each individual study. EVIDENCE SYNTHESIS: Of 1347 potentially
relevant articles screened initially, 16 reports of eligible studies were
identified and included. A primary meta-analysis of the 9 adjusted HRs
demonstrated a significantly better midterm overall survival in women than
men (N.=6891; HR=0.80; 95% confidence interval [CI]: 0.65 to 0.97;
P=0.03). A secondary meta-analysis adding 5 statistically non-significant
unadjusted HR also indicated better survival in women (N.=8645; HR=0.83;
95% CI: 0.72 to 0.96; P=0.01). Although statistical tests for the primary
metaanalysis revealed funnel plot asymmetry in favor of women, the
secondary meta-analysis produced a symmetrical funnel plot. CONCLUSIONS:
Female gender may be independently associated with better midterm overall
survival after TAVI.<br/>Copyright &#xa9; 2016 EDIZIONI MINERVA MEDICA.

<33>
Accession Number
609612758
Author
Lester-Coll N.H.; Rutter C.E.; Bledsoe T.J.; Goldberg S.B.; Decker R.H.;
Yu J.B.
Institution
(Lester-Coll, Rutter, Bledsoe, Decker, Yu) Department of Therapeutic
Radiology, Yale University School of Medicine, New Haven, CT, United
States
(Goldberg) Department of Medicine (Medical Oncology), Yale University
School of Medicine, New Haven, CT, United States
Title
Cost-effectiveness of surgery, stereotactic body radiation therapy, and
systemic therapy for pulmonary oligometastases.
Source
International Journal of Radiation Oncology Biology Physics. 95 (2) (pp
663-672), 2016. Date of Publication: 01 Jun 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Introduction Pulmonary oligometastases have conventionally been managed
with surgery and/or systemic therapy. However, given concerns about the
high cost of systemic therapy and improvements in local treatment of
metastatic cancer, the optimal cost-effective management of these patients
is unclear. Therefore, we sought to assess the cost-effectiveness of
initial management strategies for pulmonary oligometastases. Methods and
Materials A cost-effectiveness analysis using a Markov modeling approach
was used to compare average cumulative costs, quality adjusted life years
(QALYs), and incremental cost-effectiveness ratios (ICERs) among 3 initial
disease management strategies: video-assisted thoracic surgery (VATS)
wedge resection, stereotactic body radiation therapy (SBRT), and systemic
therapy among 5 different cohorts of patient disease: (1) melanoma; (2)
non-small cell lung cancer adenocarcinoma without an EGFR mutation (NSCLC
AC); (3) NSCLC with an EGFR mutation (NSCLC EGFRm AC); (4) NSCLC squamous
cell carcinoma (NSCLC SCC); and (5) colon cancer. One-way sensitivity
analyses and probabilistic sensitivity analyses were performed to analyze
uncertainty with regard to model parameters. Results In the base case,
SBRT was cost effective for melanoma, with costs/net QALYs of
$467,787/0.85. In patients with NSCLC, the most cost-effective strategies
were SBRT for AC ($156,725/0.80), paclitaxel/carboplatin for SCC
($123,799/0.48), and erlotinib for EGFRm AC ($147,091/1.90). Stereotactic
body radiation therapy was marginally cost-effective for EGFRm AC compared
to erlotinib with an incremental cost-effectiveness ratio of
$126,303/QALY. For colon cancer, VATS wedge resection ($147,730/2.14) was
the most cost-effective strategy. Variables with the greatest influence in
the model were erlotinib-associated progression-free survival (EGFRm AC),
toxicity (EGFRm AC), cost of SBRT (NSCLC SCC), and patient utilities (all
histologies). Conclusions Video-assisted thoracic surgery wedge resection
or SBRT can be cost-effective in select patients with pulmonary
oligometastases, depending on histology, efficacy, and tolerability of
treatment and patient preferences.<br/>Copyright &#xa9; 2016 Elsevier Inc.
All rights reserved.

<34>
Accession Number
607488205
Author
Kubo T.; Shinke T.; Okamura T.; Hibi K.; Nakazawa G.; Morino Y.; Shite J.;
Fusazaki T.; Otake H.; Kozuma K.; Akasaka T.
Institution
(Kubo, Akasaka) Department of Cardiovascular Medicine, Wakayama Medical
University, Wakayama, Japan
(Shinke, Otake) Department of Internal Medicine, Division of
Cardiovascular and Respiratory Medicine, Kobe University Graduate School
of Medicine, Kobe, Japan
(Okamura) Division of Cardiology, Department of Medicine and Clinical
Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
(Hibi) Division of Cardiology, Yokohama City University Medical Center,
Yokohama, Japan
(Nakazawa) Division of Cardiology, Tokai University School of Medicine,
Isehara, Japan
(Morino, Fusazaki) Division of Cardiology, Iwate Medical University,
Morioka, Japan
(Shite) Division of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka,
Japan
(Kozuma) Division of Cardiology, Teikyo University School of Medicine,
Tokyo, Japan
Title
Optical frequency domain imaging vs. intravascular ultrasound in
percutaneous coronary intervention (OPINION trial): Study protocol for a
randomized controlled trial.
Source
Journal of Cardiology. 68 (5) (pp 455-460), 2016. Date of Publication: 01
Nov 2016.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background Optical coherence tomography is becoming increasingly
widespread as an adjunctive intravascular diagnostic technique in
percutaneous coronary intervention (PCI), because of its ability to
visualize coronary structures at high resolution. Several studies have
reported that intravascular ultrasound (IVUS) guidance in PCI might be
helpful to reduce subsequent stent thrombosis, restenosis, repeat
revascularization, myocardial infarction, and cardiac death. The OPtical
frequency domain imaging vs. INtravascular ultrasound in percutaneous
coronary InterventiON (OPINION) trial is aimed at evaluating the impact of
optical frequency domain imaging (OFDI) guidance in PCI on clinical
outcomes compared with IVUS guidance. Methods and design The OPINION trial
is a multicenter, prospective, randomized, controlled, open-label,
parallel group, non-inferiority trial in Japan. The eligible patients are
randomly assigned to receive either OFDI-guided PCI or IVUS-guided PCI.
PCI is performed using the biolimus-eluting stent in accordance with a
certain criteria of OFDI and IVUS for optimal stent deployment. All
patients will undergo a follow-up angiography at 8 months. The primary
endpoint is target vessel failure composed of cardiac death, myocardial
infarction attributed to the target vessel, and clinically-driven target
vessel revascularization at 12 months. Conclusion When completed, the
OPINION trial will contribute to define the clinical value of the OFDI
guidance in PCI.<br/>Copyright &#xa9; 2015 Japanese College of Cardiology

<35>
Accession Number
610570299
Author
Holcomb C.N.; Hollis R.H.; Graham L.A.; Richman J.S.; Valle J.A.; Itani
K.M.; Maddox T.M.; Hawn M.T.
Institution
(Holcomb, Hollis, Graham, Richman) Department of Surgery, University of
Alabama at Birmingham, United States
(Holcomb, Hollis, Graham, Richman) Center for Surgical, Medical Acute Care
Research and Transitions (C-SMART), Birmingham VA Hospital, Birmingham,
AL, United States
(Valle, Maddox) VA Eastern Colorado Health Care System, Denver, United
States
(Valle, Maddox) University of Colorado School of Medicine, Denver, United
States
(Itani) Department of Surgery, VA Boston Healthcare System, Boston
University and Harvard Medical School, Boston, MA, United States
(Hawn) Department of Surgery, Stanford School of Medicine, 300 Pasteur Dr,
M121 Always, Stanford, CA 94305, United States
Title
Association of coronary stent indication with postoperative outcomes
following noncardiac surgery.
Source
JAMA Surgery. 151 (5) (pp 462-469), 2016. Date of Publication: May 2016.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: Current guidelines for delaying surgery after coronary stent
placement are based on stent type. However, the indication for the stent
may be an important risk factor for postoperative major adverse cardiac
events (MACE). OBJECTIVE: To determine whether the clinical indication for
a coronary stent is associated with postoperativeMACE. DESIGN, SETTING,
AND PARTICIPANTS: Retrospective cohort study in patients at US Veterans
Affairs hospitals who had a coronary stent placed between January 1, 2000,
and December 31, 2010, and underwent noncardiac surgery within the
following 24 months. The association between the indication for stent and
postoperativeMACE rates was examined using logistic regression to control
for patient and procedure factors. EXPOSURES: Three subgroups of stent
indication were examined: (1)myocardial infarction (MI); (2) unstable
angina; and (3) revascularization not associated with acute coronary
syndrome (non-ACS). MAIN OUTCOMES AND MEASURES: Composite 30-day
postoperativeMACE rates including all-cause mortality, MI, or
revascularization. RESULTS: Among 26 661 patients (median [IQR] age, 68
[61.0-76.0] years; 98.4%male; 88.1%white) who underwent 41 815 surgical
procedures within 24 months following coronary stent placement, the stent
indication wasMI in 32.8%of the procedures, unstable angina in 33.8%, and
non-ACS in 33.4%. PostoperativeMACE rates were significantly higher in the
MI group (7.5%) compared with the unstable angina (2.7%) and non-ACS
(2.6%) groups (P < .001). When surgery was performed within 3 months of
percutaneous coronary intervention, adjusted odds of MACE were
significantly higher in the MI group compared with the non-ACS group (odds
ratio [OR] = 5.25; 95%CI, 4.08-6.75). This risk decreased over time,
although it remained significantly higher at 12 to 24 months from
percutaneous coronary intervention (OR = 1.95; 95%CI, 1.58-2.40). The
adjusted odds of MACE for the unstable angina group were similar to those
for the non-ACS group when surgery was performed within 3 months (OR =
1.11; 95%CI, 0.80-1.53) or between 12 and 24 months (OR = 1.08; 95% CI,
0.86-1.37) from stent placement. Stent type was not significantly
associated with MACE regardless of indication. CONCLUSIONS AND RELEVANCE:
Surgery in patients with a coronary stent placed forMI was associated with
increased postoperativeMACE rates compared with other stent indications.
The risk declined over time from PCI, and delaying surgery up to 6 months
in this cohort of patients with stents may be important regardless of
stent type.<br/>Copyright 2016 American Medical Association. All rights
reserved.

<36>
Accession Number
609108399
Author
Li Y.-L.; Qiao S.-B.; Wang J.-Y.; Chen Y.-M.; Luo J.; Zhang H.-F.
Institution
(Li, Luo, Zhang) Health Division of Guard Bureau, General staff Department
of Chinese PLA, Beijing, China
(Qiao) Department of Cardiology, The People's Hospital of Rizhao, Rizhao,
Shandong, China
(Wang) Department of Cardiovascular Surgery, The Second People's Hospital
of Yunnan Province, Kunming, Yunnan, China
(Chen) Department of Pediatrics, Beijing Chao-Yang Hospital, Capital
Medical University, Beijing, China
Title
Colchicine in addition to conventional therapy for pericarditis
recurrence: An update meta-analysis.
Source
Herz. 41 (7) (pp 630-638), 2016. Date of Publication: 01 Nov 2016.
Publisher
Urban und Vogel GmbH (E-mail: verlag@urban-vogel.de)
Abstract
Background: Randomized controlled trials (RCTs) have investigated the use
of colchicine and conventional therapy for reducing the recurrence of
pericarditis in patients with acute pericarditis or post-pericardiotomy
syndrome. However, the benefits of these treatments are variable. Methods:
Studies were retrieved from PubMed, the Cochrane Library, and the EMBASE
database. Results: We identified nine RCTs with 1832 patients and a mean
follow-up of 13.1 months. Overall, colchicine therapy significantly
decreased the risk of pericarditis recurrence (odds ratio, OR 0.42; 95 %
confidence interval, CI 0.33-0.52; P < 0.001; I² = 17.0 %).
Colchicine therapy was associated with significantly lower rates of
pericarditis-associated rehospitalization (OR 0.29; 95 % CI 0.16-0.53; P <
0.0001; I² = 0.0 %) and persistence of symptoms (OR 0.29; 95 %
CI, 0.21-0.41; P = 0.000; I² = 0.0 %) at 72 h. Adverse events
were higher in the colchicine group (relative risk, RR 1.48; 95 % CI,
1.06-2.07; P = 0.02; I² = 0.0 %). Subgroup analysis showed that
recurrence of pericarditis was significantly lower in the colchicine
therapy group, irrespective of prednisone use and the cause of
pericarditis. Conclusion: Colchicine significantly decreases the rate of
pericarditis recurrence, regardless of prednisone use and the cause of
pericarditis. Larger studies are needed to confirm this
effect.<br/>Copyright &#xa9; 2016, Springer Medizin Verlag.

<37>
Accession Number
610395015
Author
Deppe A.-C.; Weber C.; Zimmermann J.; Kuhn E.W.; Slottosch I.; Liakopoulos
O.J.; Choi Y.-H.; Wahlers T.
Institution
(Deppe, Weber, Zimmermann, Kuhn, Slottosch, Liakopoulos, Choi, Wahlers)
Department of Cardiothoracic Surgery, Heart Center of the University of
Cologne, Kerpener Strasse 62, Cologne 50924, Germany
(Choi) Center of Molecular Medicine Cologne, University of Cologne,
Cologne, Germany
Title
Point-of-care thromboelastography/thromboelastometry-based coagulation
management in cardiac surgery: A meta-analysis of 8332 patients.
Source
Journal of Surgical Research. 203 (2) (pp 424-433), 2016. Date of
Publication: 15 Jun 2016.
Publisher
Academic Press Inc. (E-mail: apjcs@harcourt.com)
Abstract
Objectives Severe bleeding related to cardiac surgery is associated with
increased morbidity and mortality. Thromboelastography (TEG) and
thromboelastometry (ROTEM) are point-of-care tests (POCT). Bedside
ROTEM/TEG can rapidly detect changes in blood coagulation and therefore
provide a goal-directed, individualized coagulation therapy. In this
meta-analysis, we aimed to determine the current evidence for or against
POCT-guided algorithm in patients with severe bleeding after cardiac
surgery. Methods We performed a meta-analysis of randomized controlled
trials and observational trials retrieved from a literature search in
PubMed, EMBASE, and Cochrane Library. Only trials comparing transfusion
strategy guided by TEG/ROTEM with a standard of care control group
undergoing cardiac surgery were included. In addition, at least one
clinical outcome had to be mentioned: mortality, surgical re-exploration
rate, sternal wound infection, and acute kidney injury (AKI). Also,
surrogate parameters such as transfusion requirements and amount of blood
loss were analyzed. The pooled treatment effects (odds ratio [OR] and 95%
confidence intervals [CI]) were assessed using a fixed or random-effects
model. Results The literature search retrieved a total of 17 trials (nine
randomized controlled trial and eight observational trials) involving 8332
cardiac surgery patients. POCT-guided transfusion management significantly
decreased the odds for patients to receive allogeneic blood products (OR
0.63, 95% CI 0.56-0.71; P < 0.00001) and the re-exploration rate due to
postoperative bleeding (OR 0.56, 95% CI 0.45-0.71; P < 0.00001).
Furthermore, the incidence of postoperative AKI (OR 0.77, 95% CI
0.61-0.98; P = 0.0278) and thromboembolic events (OR 0.44, 95% CI
0.28-0.70; P = 0.0006) was significantly decreased in the TEG/ROTEM group.
No statistical differences were found with regard to inhospital mortality,
cerebrovascular accident, or length of intensive care unit and hospital
stay. Conclusions TEG/ROTEM-based coagulation management decreases the
risk of allogeneic blood product exposure after cardiac surgery.
Furthermore, it results in significantly lower re-exploration rate,
decreased incidence of postoperative AKI, and thromboembolic events in
cardiac surgery patients. Results of this meta-analysis indicate that
POCT-guided transfusion therapy is superior to the current standard of
care.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<38>
Accession Number
610202542
Author
Madsen S.; Baczuk J.; Thorup K.; Barton R.; Patwari N.; Langell J.T.
Institution
(Madsen, Baczuk, Thorup, Patwari) Department of Electrical Engineering,
University of Utah, Salt Lake City, UT, United States
(Barton, Langell) Department of Surgery, University of Utah, Salt Lake
City, UT, United States
(Langell) Center for Medical Innovation, University of Utah, 10 North 1900
East Eccles Library, Room 15, Salt Lake City, UT 84132, United States
Title
A noncontact RF-based respiratory sensor: Results of a clinical trial.
Source
Journal of Surgical Research. 203 (1) (pp 1-5), 2016. Date of Publication:
01 Jun 2016.
Publisher
Academic Press Inc. (E-mail: apjcs@harcourt.com)
Abstract
Background: Respiratory rate (RR) is a critical vital signs monitored in
health care setting. Current monitors suffer from sensor-contact failure,
inaccurate data, and limited patient mobility. There is a critical need
for an accurate and reliable and noncontact system to monitor RR. We
developed a contact-free radio frequency (RF)-based system that measures
movement using WiFi signal diffraction, which is converted into
interpretable data using a Fourier transform. Here, we investigate the
system's ability to measure fine movements associated with human
respiration. Materials and methods: Testing was conducted on subjects
using visual cue, fixed-tempo instruction to breath at standard RRs.
Blinded instruction-based RRs were compared to RF-acquired data to
determine measurement accuracy. The RF-based technology was studied on
postoperative ventilator-dependent patients. Blinded ventilator
capnographic RR data were collected for each patient and compared to
RF-acquired data to determine measurement accuracy. Results: Respiratory
rate data collected from 10 subjects breathing at a fixed RR (14, 16, 18,
or 20) demonstrated 95.5% measurement accuracy between the patient's
actual rate and that measured by our RF technology. Ten patients were
enrolled into the clinical trial. Blinded ventilator capnographic RR data
were compared to RF-based acquired data. The RF-based data showed 88.8%
measurement accuracy with ventilator capnography. Conclusions: Initial
clinical pilot trials with our contact-free RF-based monitoring system
demonstrate a high degree of RR measurement accuracy when compared to
capnographic data. Based on these results, we believe RF-based systems
present a promising noninvasive, inexpensive, and accurate tool for
continuous RR monitoring.<br/>Copyright &#xa9; 2016 Elsevier Inc. All
rights reserved.

<39>
Accession Number
610567463
Author
Fink-Neuboeck N.; Lindenmann J.; Bajric S.; Maier A.; Riedl R.; Weinberg
A.M.; Smolle-Juettner F.M.
Institution
(Fink-Neuboeck, Lindenmann, Bajric, Maier, Smolle-Juettner) Division of
Thoracic and Hyperbaric Surgery, Medical University Graz, Graz, Austria
(Riedl) Institute for Medical Informatics, Statistics and Documentation,
Medical University Graz, Graz, Austria
(Weinberg) Department of Orthopedics and Orthopedic Surgery, Medical
University Graz, Graz, Austria
Title
Clinical impact of interleukin 6 as a predictive biomarker in the early
diagnosis of postoperative systemic inflammatory response syndrome after
major thoracic surgery: A prospective clinical trial.
Source
Surgery (United States). 160 (2) (pp 443-453), 2016. Date of Publication:
01 Aug 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Postoperative systemic inflammatory response syndrome and
sepsis are associated with high morbidity and mortality rates. Early
detection of postoperative systemic inflammatory response syndrome
improves the outcome. The aim of this study was to evaluate the
feasibility of interleukin 6 as a predictive biomarker in the early
diagnosis of postoperative systemic inflammatory response syndrome after a
major thoracic operation. Methods A total of 94 patients were enrolled in
this prospective, clinical, single-center study. The enrolled subjects
underwent either lung resection or esophageal operation. Interleukin 6,
procalcitonin, C-reactive protein, and leucocytes were measured
sequentially before, during, and after the operation. These levels were
compared between patients who developed postoperative systemic
inflammatory response syndrome and those who did not. Results The
enrollees who completed the study included of 55 males (79.7%) and 14
females (20.3%) with a mean age of 60.9 years. Twenty patients (29.0%)
developed systemic inflammatory response syndrome at a median time of 33.0
hours postoperatively. In cases of postoperative systemic inflammatory
response syndrome, interleukin 6 was the most predictive biomarker,
showing a striking increase on the day of operation and preceding the
median onset of postoperative systemic inflammatory response syndrome,
which occurred the next day (P <= .001). Peak procalcitonin and C-reactive
protein occurrence were significantly delayed at 24 hours (P = .012) and
48 hours (P = .012). There was no mortality 30 days postoperatively.
Conclusion Interleukin 6 is a reliable predictor of postoperative systemic
inflammatory response syndrome, and it is able to detect postoperative
system inflammatory response syndrome before the onset of related clinical
symptoms. When identifying patients at high risk, it would be beneficial
to include interleukin 6 in conventional postoperative monitoring,
particularly after extended surgical resection.<br/>Copyright &#xa9; 2016
Elsevier Inc.

<40>
Accession Number
608527890
Author
Lauschke J.; Schneider R.; Wissmann J.; Tischer T.; Bansch D.
Institution
(Lauschke, Schneider, Wissmann, Tischer, Bansch) Department of Cardiology,
University Medical Center, Ernst-Heydemann-Str. 6, Rostock 18059, Germany
Title
Single-catheter approach to pulmonary vein reisolation in selected
patients: Data from a prospective registry.
Source
Herz. 41 (7) (pp 625-629), 2016. Date of Publication: 01 Nov 2016.
Publisher
Urban und Vogel GmbH (E-mail: verlag@urban-vogel.de)
Abstract
Background: In addition to different types of single-tip ablation
catheters for pulmonary vein (PV) reisolation, a newly developed circular
mapping and ablation catheter (nMARQ) has been available since
2013 and is currently used only in initial PV isolation procedures. In
this prospective registry we present feasibility and efficacy data for PV
reisolation procedures with a single-catheter approach (nMARQ)
compared with a standard approach using a single-tip ablation catheter and
a circular mapping catheter. Methods: We included 35 carefully selected
patients in this prospective registry and assigned them in a 2:1 ratio to
undergo either PV reisolation with a single-tip ablation catheter together
with a steerable circular mapping catheter (group 1) or with the
nMARQcatheter only (group 2). The recurrence rate was
calculated for atrial tachyarrhythmias with a duration of > 30 s during a
mean follow-up of 12.7 months. Results: Reisolation of all PVs was
achieved in all patients of both groups. In group 2, all gaps could be
correctly identified with the nMARQ catheter. PV isolation was
clearly visible on the nMARQ catheter in all targeted veins.
With the nMARQ catheter the ablation time decreased
significantly (6.3 +/- 3.0 vs. 18.6 +/- 13.9 min, p < 0.05). The
recurrence rate of atrial fibrillation did not differ significantly
between the two groups (37.5 vs. 45.5 %, p = 0.66). Conclusion: In
selected patients, a complete PV reisolation procedure is feasible with a
singular circular mapping and ablation catheter. The 12-months success
rate is comparable to a classic approach with a combination of a
single-tip ablation catheter and a circular mapping
catheter.<br/>Copyright &#xa9; 2016, Springer Medizin Verlag.

<41>
Accession Number
613466701
Author
Ali Z.A.; Maehara A.; Genereux P.; Shlofmitz R.A.; Fabbiocchi F.; Nazif
T.M.; Guagliumi G.; Meraj P.M.; Alfonso F.; Samady H.; Akasaka T.; Carlson
E.B.; Leesar M.A.; Matsumura M.; Ozan M.O.; Mintz G.S.; Ben-Yehuda O.;
Stone G.W.
Institution
(Ali, Maehara, Nazif, Ben-Yehuda, Stone) New York Presbyterian Hospital
and Columbia University, New York, NY, United States
(Ali, Maehara, Genereux, Nazif, Matsumura, Ozan, Mintz, Ben-Yehuda, Stone)
Cardiovascular Research Foundation, New York, NY, United States
(Shlofmitz) St Francis Hospital, Roslyn, New York, NY, United States
(Fabbiocchi) Centro Cardiologico Monzino Istituto di Ricovero e Cura a
Carattere Scientifico, Milan, Italy
(Guagliumi) Ospedale Papa Giovanni XXIII, Bergamo, Italy
(Meraj) Northwell Health, Manhasset, New York, NY, United States
(Alfonso) Hospital Universitario de La Princesa, Madrid, Spain
(Samady) Emory University Hospital, Atlanta, GA, United States
(Akasaka) Wakayama Medical University, Wakayama, Japan
(Carlson) Eastern Cardiology, Greenville, NC, United States
(Leesar) University of Alabama, Birmingham, AB, United States
Title
Optical coherence tomography compared with intravascular ultrasound and
with angiography to guide coronary stent implantation (ILUMIEN III:
OPTIMIZE PCI): a randomised controlled trial.
Source
The Lancet. 388 (10060) (pp 2618-2628), 2016. Date of Publication: 26 Nov
2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Percutaneous coronary intervention (PCI) is most commonly
guided by angiography alone. Intravascular ultrasound (IVUS) guidance has
been shown to reduce major adverse cardiovascular events (MACE) after PCI,
principally by resulting in a larger postprocedure lumen than with
angiographic guidance. Optical coherence tomography (OCT) provides higher
resolution imaging than does IVUS, although findings from some studies
suggest that it might lead to smaller luminal diameters after stent
implantation. We sought to establish whether or not a novel OCT-based
stent sizing strategy would result in a minimum stent area similar to or
better than that achieved with IVUS guidance and better than that achieved
with angiography guidance alone. Methods In this randomised controlled
trial, we recruited patients aged 18 years or older undergoing PCI from 29
hospitals in eight countries. Eligible patients had one or more target
lesions located in a native coronary artery with a visually estimated
reference vessel diameter of 2.25-3.50 mm and a length of less than 40 mm.
We excluded patients with left main or ostial right coronary artery
stenoses, bypass graft stenoses, chronic total occlusions, planned
two-stent bifurcations, and in-stent restenosis. Participants were
randomly assigned (1:1:1; with use of an interactive web-based system in
block sizes of three, stratified by site) to OCT guidance, IVUS guidance,
or angiography-guided stent implantation. We did OCT-guided PCI using a
specific protocol to establish stent length, diameter, and expansion
according to reference segment external elastic lamina measurements. All
patients underwent final OCT imaging (operators in the IVUS and
angiography groups were masked to the OCT images). The primary efficacy
endpoint was post-PCI minimum stent area, measured by OCT at a masked
independent core laboratory at completion of enrolment, in all randomly
allocated participants who had primary outcome data. The primary safety
endpoint was procedural MACE. We tested non-inferiority of OCT guidance to
IVUS guidance (with a non-inferiority margin of 1.0 mm²),
superiority of OCT guidance to angiography guidance, and superiority of
OCT guidance to IVUS guidance, in a hierarchical manner. This trial is
registered with ClinicalTrials.gov, number NCT02471586. Findings Between
May 13, 2015, and April 5, 2016, we randomly allocated 450 patients (158
[35%] to OCT, 146 [32%] to IVUS, and 146 [32%] to angiography), with 415
final OCT acquisitions analysed for the primary endpoint (140 [34%] in the
OCT group, 135 [33%] in the IVUS group, and 140 [34%] in the angiography
group). The final median minimum stent area was 5.79 mm² (IQR
4.54-7.34) with OCT guidance, 5.89 mm² (4.67-7.80) with IVUS
guidance, and 5.49 mm² (4.39-6.59) with angiography guidance.
OCT guidance was non-inferior to IVUS guidance (one-sided 97.5% lower CI
-0.70 mm²; p=0.001), but not superior (p=0.42). OCT guidance
was also not superior to angiography guidance (p=0.12). We noted
procedural MACE in four (3%) of 158 patients in the OCT group, one (1%) of
146 in the IVUS group, and one (1%) of 146 in the angiography group (OCT
vs IVUS p=0.37; OCT vs angiography p=0.37). Interpretation OCT-guided PCI
using a specific reference segment external elastic lamina-based stent
optimisation strategy was safe and resulted in similar minimum stent area
to that of IVUS-guided PCI. These data warrant a large-scale randomised
trial to establish whether or not OCT guidance results in superior
clinical outcomes to angiography guidance. Funding St Jude
Medical.<br/>Copyright &#xa9; 2016 Elsevier Ltd

<42>
Accession Number
614261496
Author
Siegal D.M.; Savage W.J.
Institution
(Siegal, Savage) Division of Hematology and Thromboembolism, McMaster
University, 50 Charlton Avenue East, Hamilton, ON L8N 4A6, Canada
(Siegal, Savage) Brigham and Women's Hospital and Harvard Medical School,
Boston, MA, United States
Title
Plasma versus prothrombin complex concentrate for warfarin-associated
major bleeding: A systematic review.
Source
2015 (1) (pp 448-453), 2015. Date of Publication: 05 Dec 2015.
Publisher
Bulgarian Medical Society of Hematology

<43>
Accession Number
605795873
Author
Perez-Romero P.; Bulnes-Ramos A.; Torre-Cisneros J.; Gavalda J.; Aydillo
T.A.; Moreno A.; Montejo M.; Farinas M.C.; Carratala J.; Munoz P.; Blanes
M.; Fortun J.; Suarez-Benjumea A.; Lopez-Medrano F.; Barranco J.L.; Peghin
M.; Roca C.; Lara R.; Cordero E.; Alamo J.M.; Gasch A.; Gentil-Govantes
M.A.; Molina-Ortega F.J.; Lage E.; Martinez-Atienza J.; Sanchez M.; Rosso
C.; Arizon J.M.; Aguera M.; Cantisan S.; Montero J.L.; Paez A.; Rodriguez
A.; Santos S.; Vidal E.; Berasategui C.; Campins M.; Lopez-Meseguer M.;
Saez B.; Marcos M.A.; Sanclemente G.; Diez N.; Goikoetxea J.; Casafont F.;
Cobo-Belaustegy M.; Duran R.; Fabrega-Garcia E.; Fernandez-Rozas S.;
Gonzalez-Rico C.; Zurbano-Goni F.; Bodro M.; Niubo J.; Oriol S.; Sabe N.;
Anaya F.; Bouza E.; Catalan P.; Diez P.; Eworo A.; Kestler M.; Lopez-Roa
P.; Rincon D.; Rodriguez M.; Salcedo M.; Sousa Y.; Valerio M.;
Morales-Barroso I.; Aguado J.M.; Origuen J.
Institution
(Perez-Romero, Bulnes-Ramos, Aydillo, Roca, Cordero) Instituto de
Biomedicina de Sevilla (IBIS), University Hospital Virgen del
Rocio/CSIC/University of Sevilla, Seville, Spain
(Torre-Cisneros, Barranco, Lara) Reina Sofia University
Hospital-Maimonides Institute for Biomedical Research (IMIBIC), University
of Cordoba (UCO), Cordoba, Spain
(Gavalda, Peghin) Vall d'Hebron University Hospital-VHIR, Barcelona, Spain
(Moreno) University Clinic Hospital, Barcelona, Spain
(Montejo) University Hospital Cruces, Bilbao, Spain
(Farinas) University Hospital Marques de Valdecilla, Santander, Spain
(Carratala) University Hospital Belltvitge-IDIBELL, University of
Barcelona, Barcelona, Spain
(Munoz) General University Hospital Gregorio Maranon, Madrid, Spain
(Blanes) University Hospital La Fe, Valencia, Spain
(Fortun) University Hospital Ramon y Cajal, Madrid, Spain
(Suarez-Benjumea) University Hospital Virgen Macarena, Sevilla, Spain
(Lopez-Medrano) University Hospital 12 de Octubre, Madrid, Spain
(Alamo, Gasch, Gentil-Govantes, Molina-Ortega, Lage, Martinez-Atienza,
Sanchez, Rosso) University Hospital Virgen del Rocio-IBIS, Spain
(Arizon, Aguera, Cantisan, Montero, Paez, Rodriguez, Santos, Vidal)
University Hospital Reina Sofia-IMIBIC-UCO, Cordoba, Spain
(Berasategui, Campins, Lopez-Meseguer, Saez) Val d'Hebron Hospital,
Barcelona, Spain
(Marcos, Sanclemente) Clinic Hospital, Barcelona, Spain
(Diez, Goikoetxea) University Hospital Cruces, Bilbao, Spain
(Casafont, Cobo-Belaustegy, Duran, Fabrega-Garcia, Fernandez-Rozas,
Gonzalez-Rico, Zurbano-Goni) University Hospital Marques de Valdecilla,
Santander, Spain
(Bodro, Niubo, Oriol, Sabe) University Hospital Belltvitge-IDIBELL,
University of Barcelona, Barcelona, Spain
(Anaya, Bouza, Catalan, Diez, Eworo, Kestler, Lopez-Roa, Rincon,
Rodriguez, Salcedo, Sousa, Valerio) General University Hospital Gregorio
Maranon, Madrid, Spain
(Morales-Barroso) University Hospital Virgen Macarena, Seville, Spain
(Aguado, Origuen) Universty Hospital 12 de Octubre, Madrid, Spain
Title
Influenza vaccination during the first 6 months after solid organ
transplantation is efficacious and safe.
Source
Clinical Microbiology and Infection. 21 (11) (pp 1040.e11-1040.e18), 2015.
Date of Publication: November 2015.
Publisher
Elsevier B.V. (E-mail: customerservices@oxonblackwellpublishing.com)
Abstract
Preventing influenza infection early after transplantation is essential,
given the disease's high mortality. A multicentre prospective cohort study
in adult solid organ transplant recipients (SOTR) receiving the influenza
vaccine during four consecutive influenza seasons (2009-2013) was
performed to assess the immunogenicity and safety of influenza vaccination
in SOTR before and 6 months after transplantation. A total of 798 SOTR,
130 of them vaccinated within 6 months of transplantation and 668 of them
vaccinated more than 6 months since transplantation. Seroprotection was
similar in both groups: 73.1% vs. 76.5% for A/(H1N1)pdm (p 0.49), 67.5%
vs. 74.1% for A/H3N2 (p 0.17) and 84.2% vs. 85.2% for influenza B (p
0.80), respectively. Geometric mean titres after vaccination did not
differ among groups: 117.32 (95% confidence interval (CI) 81.52, 168.83)
vs. 87.43 (95% CI 72.87, 104.91) for A/(H1N1)pdm, 120.45 (95% CI 82.17,
176.57) vs. 97.86 (95% CI 81.34, 117.44) for A/H3N2 and 143.32 (95% CI
103.46, 198.53) vs. 145.54 (95% CI 122.35, 174.24) for influenza B,
respectively. After adjusting for confounding factors, time since
transplantation was not associated with response to vaccination. No cases
of rejection or severe adverse events were detected in patients vaccinated
within the first 6 months after transplantation. In conclusion, influenza
vaccination within the first 6 months after transplantation is as safe and
immunogenic as vaccination thereafter. Thus, administration of the
influenza vaccine can be recommended as soon as 1 month after
transplantation.<br/>Copyright &#xa9; 2015 European Society of Clinical
Microbiology and Infectious Diseases.

<44>
Accession Number
616915939
Author
Van Guilder G.P.; Trachte T.
Institution
(Van Guilder, Trachte) Vascular Protection Research Laboratory, Health and
Nutritional Sciences, South Dakota State University, Brookings, SD, United
States
Title
Increased cvd risk burden diminishes the protective effect of remote
ischemic preconditioning against endothelial ischemiareperfusion injury in
humans.
Source
FASEB Journal. Conference: Experimental Biology 2017, EB. United States.
31 (1 Supplement 1) (no pagination), 2017. Date of Publication: April
2017.
Publisher
FASEB
Abstract
Purpose A powerful treatment against endothelial ischemia-reperfusion
injury is remote ischemic preconditioning, which can trigger tissue
protection by exposing a limb to small cycles of vascular occlusion.
However, animal models of aging, diabetes, hyperlipidemia, and obesity
indicate that the protective benefits of ischemic preconditioning are
weakened. The extent to which a clinically relevant burden of CVD risk
factors interferes with remote preconditioning in humans is not clear. The
purpose of the present study was to determine the influence of CVD risk
factor burden on the capacity of remote ischemic preconditioning to
prevent endothelial reperfusion injury in adults. Methods Twenty-two (age:
45+/-14 yr) sedentary adults (12 lower burden: 0-2 risk factors; <1%
10-year FRS; 10 raised burden: 3-5 risk factors: >=1% 10-year FRS) were
studied using a 2x2 randomized cross-over design. Digital arterial
tonometry (EndoPAT 2000, Itamar Medical Inc.) was used to assess
endothelial vasodilation during reactive hyperemia before and after 65 min
of left arm endothelial ischemia-reperfusion injury (20 min brachial
artery ischemia followed by 45 min reperfusion) that was preceded by
remote ischemic preconditioning (right arm brachial artery: 3x5 min
ischemia/reperfusion) or sham. Experiments were conducted in accordance
with the Declaration of Helsinki for protection of human subjects.
Statistical Analysis Repeated measures ANOVA was used to assess group
differences between the reactive hyperemia index (RHI) before and after
endothelial reperfusion injury in the absence and presence of remote
ischemic preconditioning. Results In lower burden subjects, remote
preconditioning was able to prevent endothelial reperfusion injury (from
baseline: 2.1+/-0.4 to post endothelial injury: 2.5+/-0.5, P=0.072). In
contrast, in the raised burden subjects the RHI (baseline: 2.3+/-0.9) was
significantly reduced by 25% despite attempts to induce protection by
remote preconditioning (1.8+/-0.7; P<0.05). The capacity of remote
ischemic preconditioning to protect against endothelial reperfusion injury
was inversely related (r=-0.61; P=0.004) to CVD risk burden. Conclusions
Endothelial reperfusion injury was prevented when preceded by remote
ischemic preconditioning in the lower burden subjects but failed to
provide protection in the raised risk burden subjects. CVD risk factors
appear to disrupt the protective properties of remote ischemic
preconditioning in humans. These findings provide important critical
insight to explain why the large-scale multicenter RIPHeart and ERICCA
randomized trials of remote ischemic preconditioning failed to show
reductions in postoperative clinical events in patients undergoing
elective cardiac surgery.

<45>
Accession Number
616935006
Author
Wood E.M.; Crighton G.L.; Estcourt L.J.; McQuilten Z.K.; Stanworth S.J.
Institution
(Wood, Crighton, McQuilten) Monash University, Melbourne, Australia
(Estcourt, Stanworth) NHS Blood and Transplant, Oxford University
Hospitals NHS Trust, Oxford, United Kingdom
Title
An update on indications for platelet transfusion.
Source
Vox Sanguinis. Conference: 26th Regional Congress of the International
Society of Blood Transfusion in conjunction with the 6th Annual Conference
of the Indonesian Society of Transfusion Medicine. Indonesia. 109 (pp
22-23), 2015. Date of Publication: November 2015.
Publisher
Blackwell Publishing Ltd
Abstract
Platelet concentrates are the most commonly prescribed blood component
after red cells, and demand for platelet concentrates appears to be
increasing. Numerous clinical factors likely influence a patient's need
for platelet support; and patient factors, donor variables, and product
characteristics (such as methods of collection, preparation and storage)
all affect the outcomes from platelet transfusion. Most platelet
transfusions are administered to haemato-oncology patients, where these
serve as an important adjunctive therapy in treatment of hypoproliferative
thrombocytopenia secondary to chemotherapy or haematopoietic stem cell
transplantation (HSCT). International guidelines recommend prophylactic
platelet transfusions for hypoproliferative thrombocytopenia to reduce the
risk of spontaneous bleeding when platelet count is <10x109/l. A recent
Cochrane systematic review in this patient cohort found that, overall,
prophylactic platelet transfusions appeared to reduce bleeding events and
days with significant bleeding. However, the benefit from prophylactic
platelet transfusions differed between treatment groups, with autologous
HSCT patients deriving least benefit. Bleeding frequently occurs in these
patients despite prophylactic platelet transfusions, and other risk
factors such as fever, duration of thrombocytopenia, underlying disease
and treatment regimen should be considered in transfusion decision-making.
In thrombocytopenic patients, platelet concentrates may also be given
prophylactically prior to surgery or other invasive procedures. However,
the causes of thrombocytopenia are different between haemato-oncology and
other clinical contexts (e.g. cardiac surgery), and relationship between
platelet count and risk of bleeding in many of these settings is not
strong. Evidence to guide transfusion practice remains limited. There are
no randomised controlled trials (RCTs) to guide platelet transfusion prior
to invasive procedures. National guidelines vary. AABB recommends patients
are transfused at a platelet count of <20x109/l prior to elective CVC
insertion, or <50x109/l prior to elective lumbar puncture and major
non-neuroaxial surgery. Higher thresholds may be needed for surgery in
critical sites (eye, brain). Neonates in the neonatal intensive care unit
frequently become thrombocytopenic and intracranial haemorrhage (ICH) is a
major concern. However, many platelet transfusions are prescribed to treat
neonatal thrombocytopenia with little evidence to support this practice.
Guidelines directing neonatal platelet transfusion practice vary
considerably, and are generally consensus rather than evidence-based.
There has only been one RCT in preterm neonates; this found no difference
in the incidence of ICH between a liberal regimen (platelet transfusion
when platelet count <150x109/l) and a more restrictive regimen (platelet
count <50x109/l or clinical concern about bleeding). The Planet-2 RCT is
comparing a platelet transfusion threshold of 25 vs 50x109/l in neonates
<34 weeks in whom ICH has been excluded. Therapeutic platelet transfusions
are usually indicated in the setting of active bleeding when
thrombocytopenia or platelet dysfunction are contributing factors, or in
critical bleeding necessitating large-volume transfusion and with a
falling platelet count. However, platelet transfusions are not indicated
in all cases of thrombocytopenia. Importantly, conditions where platelet
transfusions are generally avoided unless critical bleeding is present
include immune-mediated thrombocytopenia, thrombotic microangiopathies and
congenital thrombocytopenias such as Glanzmann's thrombasthenia.

<46>
Accession Number
613760810
Author
Dipak N.K.; Venkatesh S.; Prabhu S.; Rao S.
Institution
(Dipak, Rao) Department of Neonatology, B J Wadia Hospital for Children,
Nowrosjee Wadia Maternity Hospital, Acharya Donde Marg, Parel, Mumbai,
Maharashtra, India
(Venkatesh, Prabhu) Department of Pediatric Cardiology, B J Wadia Hospital
for Children, Nowrosjee Wadia Maternity Hospital, Acharya Donde Marg,
Parel, Mumbai, Maharashtra, India
Title
Evolution of ventricular outpouching through the fetal and postnatal
periods: Unabating dilemma of serial observation or surgical correction.
Source
Journal of the Saudi Heart Association. 29 (3) (pp 203-210), 2017. Date of
Publication: July 2017.
Publisher
Elsevier B.V.
Abstract
Ventricular outpouching is a rare finding in prenatal sonography and the
main differential diagnoses are diverticulum, aneurysm, and pseudoaneurysm
in addition to congenital cysts and clefts. The various modes of fetal
presentation of congenital ventricular outpouching include an abnormal
four-chamber view on fetal two-dimensional echocardiogram, fetal
arrhythmia, fetal hydrops, and pericardial effusion. Left ventricular
aneurysm (LVA)/nonapical diverticula are usually isolated defects. Apical
diverticula are always associated with midline thoracoabdominal defects
(epigastric pulsating diverticulum or large omphalocele) and other
structural malformations of the heart. Most patients with LVA/congenital
ventricular diverticulum remain clinically asymptomatic but they can
potentially give rise to complications such as ventricular
tachyarrhythmias, systemic embolism, sudden death, spontaneous rupture,
and severe valvular regurgitation. The treatment of asymptomatic LVA and
isolated congenital ventricular diverticulum is still undefined. In this
review, our aim is to outline a systematic approach to a fetus detected
with ventricular outpouching. Starting with prevalence and its types,
issues in fetal management, natural course and evolution postbirth, and
finally the perpetual dilemma of serial observation or surgical correction
is discussed.<br/>Copyright &#xa9; 2016 The Authors

<47>
Accession Number
616799224
Author
Ozer E.; Yilmaz R.
Institution
(Ozer, Yilmaz) Clinic of Anesthesiology and Reanimation, Private TOBB ETU
Hospital, Ankara, Turkey
Title
Effect of different anesthetic techniques on mental outcome In elderly
patients undergoing off-pump coronary artery bypass graft surgery.
Source
Turkiye Klinikleri Cardiovascular Sciences. 29 (1) (pp 17-22), 2017. Date
of Publication: 2017.
Publisher
OrtadogAYu Reklam Tanitim Yayincilik Turizm Egitim Insaat Sanayi ve
Ticaret A.S. (Turkocagi Caddesi No. 30, Balgat 06520, Turkey. E-mail:
aysea@turkiyeklinikleri.com)
Abstract
Objective: In this article, we aimed to test the hypothesis that
maintenance of hemodynamic stability with anesthesia and no-touch aortic
technique in off-pump coronary artery bypass graft surgery (CABG) may
diminish postoperative mental complications in elderly patients. Material
and Methods: Between June 2009 and December 2009, 88 elderly patients (53
males, 35 females; mean age 71+/-7 years; range 64 to 78 years) with a
physical status of ASA II-III who underwent elective off-pump CABG surgery
in our hospital's operating rooms and cardiovascular and thoracic
intensive care units were included in this prospective randomized study
with signed informed consents. Patients undergoing off-pump CABG surgery
performed by a surgeon were randomly assigned into two groups, including
total intravenous anesthesia (group TIVA, n=40; mean age 66+/-4) or
inhalational anesthesia (group IA, n=40; mean age 69+/-3). The effect of
off-pump CABG surgery on mental outcome was assessed with S100 protein, a
neurochemical marker of brain injury under ischemic conditions. Comparison
of mental function before and after off-pump CABG surgery, hemodynamic
stability and time to discharge were the main outcomes of the study.
Results: Hemodynamic values were stable in both groups. None of the
patients showed marked increase in serum concentrations of S100
postoperatively (p<0.001). The mean total off-pump CABG time was 48+/-15
minutes in both groups. There was no difference between the groups in
terms of time to discharge. Conclusion: We believe that well-performed
hemodynamic stability with either intravenous or general anesthesia may
offer a well-controlled mental function in elderly patients undergoing
offpump CABG surgery.<br/>Copyright &#xa9; 2017 by Turkiye Klinikleri.

<48>
Accession Number
615667177
Author
Gerkens S.; Van Brabandt H.; Desomer A.; Leonard C.; Neyt M.
Institution
(Gerkens, Van Brabandt, Desomer, Leonard, Neyt) Belgian Health Care
Knowledge Centre (KCE), Belgium
Title
Cardiovascular screening of young athletes: A review of economic
evaluations.
Source
International Journal of Technology Assessment in Health Care. 33 (1) (pp
76-83), 2017. Date of Publication: 2017.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Objectives: Some experts have promoted preparticipative cardiovascular
screening programs for young athletes and have claimed that such programs
were cost-effective without performing a critical analysis of studies
supporting this statement. In this systematic review, a critical
assessment of economic evaluations on these programs is performed to
determine if they really provide value for money. Methods: A systematic
review of economic evaluations was performed on December 24, 2014. Web
sites of health technology assessment agencies, the Cochrane database of
systematic review, the National Health Service Economic Evaluation
Database of the Cochrane Library, EMBASE, Medline, Psychinfo, and EconLit
were searched to retrieve (reviews of) economic evaluations. No language
or time restrictions were imposed and predefined selection criteria were
used. Selected studies were critically assessed applying a structured data
extraction sheet. Results: Five relevant economic evaluations were
critically assessed. Results of these studies were mixed. However, those
in favor of screening made (methodological) incorrect choices, of which
the most important one was not taking into account a no-screening
alternative as comparator. Compared with no screening, other strategies
(history and physical examination or history and physical examination plus
electrocardiogram) were not considered cost-effective. Conclusions:
Results of primary economic evaluations should not be blindly copied
without critical assessment. Economic evaluations in this field lack the
support of robust evidence. Negative consequences of screening (false
positive findings, overtreatment) should also be taken into account and
may cause more harm than good. A mass screening of young athletes for
cardiovascular diseases does not provide value for money and should be
discouraged.<br/>Copyright &#xa9; Cambridge University Press 2017.

<49>
Accession Number
615618126
Author
Vierhout B.P.; Pol R.A.; El Moumni M.; Zeebregts C.J.
Institution
(Vierhout) Department of Surgery, Wilhelmina Ziekenhuis Assen,
Europaweg-Zuid 1, Assen 9401 RK, Netherlands
(Pol, El Moumni) Department of Surgery, University Medical Centre
Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB,
Netherlands
(Zeebregts) Department of Surgery, Division of Vascular Surgery,
University Medical Centre Groningen, University of Groningen, Hanzeplein
1, Groningen 9700 RB, Netherlands
Title
Editor's Choice - Arteriotomy Closure Devices in EVAR, TEVAR, and TAVR: A
Systematic Review and Meta-analysis of Randomised Clinical Trials and
Cohort Studies.
Source
European Journal of Vascular and Endovascular Surgery. 54 (1) (pp
104-115), 2017. Date of Publication: July 2017.
Publisher
W.B. Saunders Ltd
Abstract
Objectives Cardiac and vascular surgery benefit from percutaneous
interventions. Arteriotomy closure devices (ACDs) enable minimally
invasive access to the common femoral artery (CFA). The objective of this
review was to assess the differences between ACDs and surgical cut down
(SCD) of the CFA regarding the number of complications, duration of
surgery (DOS), and hospital length of stay (HLOS). Design A systematic
literature search with predefined search terms was performed using
MEDLINE, Embase, and the Cochrane Library (2000-2016). All studies
reporting on ACD and SCD for a puncture of the CFA of at least 12 French
(Fr.) were assessed for eligibility. Methods Included were randomised
controlled trials and cohort studies comparing both techniques. Patient
characteristics, exclusion criteria, and conversion rates were evaluated.
Complications, DOS, and HLOS were compared. Materials A total of 17
studies were included for meta-analysis, describing 7889 vascular access
sites; four studies were randomised trials, two studies reported from a
prospective database, and 11 studies reported retrospective cohorts.
Results ACD was associated with fewer post-operative seromas (odds ratio
[OR] 0.15, 95% confidence interval [CI] 0.06-0.35), less wound dehiscence
(OR 0.14, 95% CI 0.03-0.78), and fewer surgical site infections (OR 0.38,
95% CI 0.23-0.63). Post-operative pseudoaneurysms were significantly more
common in the ACD group (OR 3.83, 95% CI 1.55-9.44). In five of 17
studies, DOS and HLOS were not reduced in the ACD group. When all studies
reporting a mean DOS and/or HLOS were compared in a non-parametric
analysis, neither was significantly different. Conclusion This
meta-analysis favours ACD regarding the number of wound complications
compared with SCD in endovascular aneurysm repair, thoracic endovascular
aneurysm repair, and transcatheter aortic valve repair. Treatment duration
(DOS and HLOS) was not reduced in ACD. The differences are of limited
clinical significance and with this equivocal quality of evidence, the ACD
may be considered safe for CFA access in suitable patients.<br/>Copyright
&#xa9; 2017 European Society for Vascular Surgery

<50>
Accession Number
616335288
Author
Arora S.; Ramm C.J.; Strassle P.D.; Vaidya S.R.; Caranasos T.G.; Vavalle
J.P.
Institution
(Arora, Ramm, Vavalle) Division of Cardiology, University of North
Carolina School of Medicine, Chapel Hill, North Carolina, United States
(Arora, Vaidya) Division of Internal Medicine, Cape Fear Valley Medical
Center, Fayetteville, North Carolina, United States
(Strassle) Department of Epidemiology, University of North Carolina at
Chapel Hill, Chapel Hill, North Carolina, United States
(Strassle, Caranasos) Department of Surgery, University of North Carolina
at Chapel Hill, Chapel Hill, North Carolina, United States
Title
Review of Major Registries and Clinical Trials of Late Outcomes After
Transcatheter Aortic Valve Replacement.
Source
American Journal of Cardiology. 120 (2) (pp 331-336), 2017. Date of
Publication: 15 Jul 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The results of the Placement of AoRtic TraNscathetER Valves (PARTNER) 2
trial established the feasibility of transcatheter aortic valve
replacement (TAVR) for intermediate surgical risk patients. The expansion
of TAVR into the low-risk patient population will largely depend on its
durability outcomes due to the high life expectancy in low-risk patients.
Long-term follow-up results from low-risk clinical trials will take
several years to be reported. Given this, we performed a systematic review
of current long-term data to provide further insights into TAVR durability
and long-term patient survival. We searched MEDLINE, Embase, Google
Scholar, BIOSIS, and major conference abstracts for TAVR studies with
follow-up of at least 4 years. Abstracts were retrieved and independently
reviewed for eligibility. Final studies were selected irrespective of the
type of TAVR valve, route of vascular access, or surgical risk profile. A
total of 12 studies met the inclusion criteria. We reviewed data from
these studies with emphasis on long-term survival and echocardiographic
findings.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<51>
Accession Number
616746193
Author
Chaparro L.E.; Smith S.A.; Moore R.A.; Wiffen P.J.; Gilron I.
Institution
(Chaparro) Hospital Pablo Tobon Uribe, Anesthesiology Department,
Medellin, Colombia
(Smith) Queen's University, Department of Anesthesiology and Perioperative
Medicine, Kingston, ON, Canada
(Moore, Wiffen) University of Oxford, Pain Research and Nuffield
Department of Clinical Neurosciences (Nuffield Division of Anaesthetics),
Pain Research Unit, Churchill Hospital, Oxford, Oxfordshire OX3 7LE,
United Kingdom
(Gilron) Queen's University, Dept. of Anesthesiology and Perioperative
Medicine and Biomedical and Molecular Sciences, 76 Stuart Street, Victory
2 Pavillion, Kingston, ON K7L 2V7, Canada
Title
Pharmacotherapy for the prevention of chronic pain after surgery in
adults.
Source
Cochrane Database of Systematic Reviews. 2017 (6) (no pagination), 2013.
Article Number: CD008307. Date of Publication: 24 Jul 2013.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Chronic pain can often occur after surgery, substantially
impairing patients' health and quality of life. It is caused by complex
mechanisms that are not yet well understood. The predictable nature of
most surgical procedures has allowed for the conduct of randomized
controlled trials of pharmacological interventions aimed at preventing
chronic postsurgical pain. Objectives: The primary objective was to
evaluate the efficacy of systemic drugs for the prevention of chronic pain
after surgery by examining the proportion of patients reporting pain three
months or more after surgery. The secondary objective was to evaluate the
safety of drugs administered for the prevention of chronic pain after
surgery. Search methods: We identified randomized controlled trials (RCTs)
of various systemically administered drugs for the prevention of chronic
pain after surgery from CENTRAL, MEDLINE, EMBASE and handsearches of other
reviews and trial registries. The most recent search was performed on 17
July 2013. Selection criteria: Included studies were double-blind,
placebo-controlled, randomized trials involving adults and evaluating one
or more drugs administered systemically before, during or after surgery,
or both, which measured pain three months or more after surgery. Data
collection and analysis: Data collected from each study included the study
drug name, dose, route, timing and duration of dosing; surgical procedure;
proportion of patients reporting any pain three months or more after
surgery, reporting at least 4/10 or moderate to severe pain three months
or more after surgery; and proportion of participants dropping out of the
study due to treatment-emergent adverse effects. Main results: We
identified 40 RCTs of various pharmacological interventions including
intravenous ketamine (14 RCTs), oral gabapentin (10 RCTs), oral pregabalin
(5 RCTs), non-steroidal anti-inflammatories (3 RCTs), intravenous steroids
(3 RCTs), oral N-methyl-D-aspartate (NMDA) blockers (3 RCTs), oral
mexiletine (2 RCTs), intravenous fentanyl (1 RCT), intravenous lidocaine
(1 RCT), oral venlafaxine (1 RCT) and inhaled nitrous oxide (1 RCT).
Meta-analysis suggested a modest but statistically significant reduction
in the incidence of chronic pain after surgery following treatment with
ketamine but not gabapentin or pregabalin. Results with ketamine should be
viewed with caution since most of the included trials were small (that is
< 100 participants per treatment arm), which could lead to the
overestimation of treatment effect. Authors' conclusions: Additional
evidence from better, well designed, large-scale trials is needed in order
to more rigorously evaluate pharmacological interventions for the
prevention of chronic pain after surgery. Furthermore, available evidence
does not support the efficacy of gabapentin, pregabalin, non-steroidal
anti-inflammatories, intravenous steroids, oral NMDA blockers, oral
mexiletine, intravenous fentanyl, intravenous lidocaine, oral venlafaxine
or inhaled nitrous oxide for the prevention of chronic postoperative
pain.<br/>Copyright &#xa9; 2017 The Cochrane Collaboration. Published by
John Wiley & Sons, Ltd.

<52>
[Use Link to view the full text]
Accession Number
616934442
Author
De Sciscio P.; Brubert J.; De Sciscio M.; Serrani M.; Stasiak J.;
Moggridge G.D.
Institution
(De Sciscio) Departments of Engineering, United Kingdom
(De Sciscio, Brubert, Serrani, Stasiak, Moggridge) Chemical Engineering
and Biotechnology, University of Cambridge, Philippa Fawcett Dr, Cambridge
CB3 0AS, United Kingdom
(De Sciscio) Department of General Medicine, Royal Adelaide Hospital,
Internal Medicine Service, Royal Adelaide Hospital, Adelaide, Australia
Title
Quantifying the Shift Toward Transcatheter Aortic Valve Replacement in
Low-Risk Patients.
Source
Circulation: Cardiovascular Quality and Outcomes. 10 (6) (no pagination),
2017. Date of Publication: 01 Jun 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - In recent years, use of transcatheter aortic valve
replacement has expanded to include patients at intermediate- and low-risk
cohorts. We sought to determine disease prevalence and treatment
distribution including transcatheter aortic valve replacement eligibility
in low-risk patients across 37 advanced economies. Methods and Results -
Four systematic searches were conducted across MEDLINE, EMBASE, and the
Cochrane database for studies evaluating disease prevalence, severity,
decision making, and survival in patients with aortic stenosis. Estimates
of disease prevalence and treatment eligibility were calculated using
stochastic simulation and population data for the 37 countries comprising
the International Monetary Fund's advanced economies index. Fifty-six
studies comprising 42 965 patients were included across 5 domains:
prevalence, severity, symptom status, treatment modality, and outcome. The
pooled prevalence in the general population aged 60 to 74 years and >75
years was 2.8% (95% confidence interval [CI], 1.4%-4.1%) and 13.1% (95%
CI, 8.2%-17.9%), respectively - corresponding to an estimated 16.1 million
(95% CI, 12.2-20.3) people in 37 advanced economies. Of these, an
estimated 3.2 million (95% CI, 2.2-4.4) patients have severe aortic
stenosis with 1.9 million (95% CI, 1.3-2.6) eligible for surgical aortic
valve replacement. There are =485 230 (95% CI, 284 550-66 7350)
high-risk/inoperable patients, 152 690 (95% CI, 73 410-263 000)
intermediate-risk patients, and 378 890 (95% CI, 205 130-610 210) low-risk
patients eligible for transcatheter aortic valve replacement. Conclusions
- With a prevalence of 4.5%, an estimated 16.1 million people aged >=60
years across 37 advanced economies have aortic stenosis. Of these, there
are =1.9 million patients eligible for surgical aortic valve replacement
and 1.0 million patients eligible for transcatheter aortic valve
replacement.<br/>Copyright &#xa9; 2017 American Heart Association, Inc.

<53>
Accession Number
616903783
Author
Liao Y.-B.; Deng X.-X.; Meng Y.; Zhao Z.-G.; Xiong T.-Y.; Meng X.-J.; Zuo
Z.-L.; Li Y.-J.; Cao J.-Y.; Xu Y.-N.; Chen M.; Feng Y.
Institution
(Liao, Zhao, Xiong, Zuo, Li, Cao, Xu, Chen, Feng) Department of
Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street,
Chengdu 610041, China
(Deng) Department of General Family Medicine, West China Hospital, Sichuan
University, Chengdu, China
(Meng) Department of Urology Surgery, West China Hospital, Sichuan
University, Chengdu, China
(Meng) Department of Gastrointestinal Surgery, West China Hospital,
Sichuan University, Chengdu, China
Title
Predictors and outcome of acute kidney injury after transcatheter aortic
valve implantation: A systematic review and meta-analysis.
Source
EuroIntervention. 12 (17) (pp 2067-2074), 2017. Date of Publication: April
2017.
Publisher
EuroPCR
Abstract
Aims: The aim of this systematic review and meta-analysis was to
investigate the predictors and outcome of acute kidney injury (AKI) after
transcatheter aortic valve implantation (TAVI). Methods and results: There
were 35 articles recruiting 13,256 patients included in our study.
Hypertension (odds ratio [OR] 1.92, 95% CI: 1.44 to 2.56), diabetes
mellitus (OR 1.33, 95% CI: 1.20 to 1.47), peripheral artery disease (OR
1.28, 95% CI: 1.14 to 1.45) and a left ventricular ejection fraction <40%
(OR 1.50, 95% CI: 1.19 to 1.88) were identified as significant independent
predictors of AKI. In addition to the aforementioned comorbidities,
procedure-related/post-TAVI factors such as transapical access (OR 1.68,
95% CI: 1.44 to 1.97), major bleeding (OR 1.82, 95% CI: 1.37 to 2.40) and
transfusion (OR 1.30, 95% CI: 1.12 to 1.51) were also associated with a
higher risk of AKI. Importantly, the risk of short-term all-cause death
increased progressively with the aggravating severity of AKI (OR, 30 days:
stage 1: 3.41; stage 2: 4.0; stage 3: 11.02; one year: stage 1: 1.95;
stage 2: 2.82; stage 3: 7.34), as determined by a univariate analysis.
After eliminating confounders, AKI remained linked to a higher risk for
both short-term (30 days: HR 2.12, 95% CI: 1.59 to 2.83) and long-term (>3
years: HR 1.37, 95% CI: 1.27 to 1.48) all-cause mortality. Conclusions:
The reason for the occurrence of AKI was multifactorial, including
baseline characteristics, procedure-related and post-TAVI factors. It
appeared that even stage 1 AKI exerted detrimental effects on survival
within one year, and AKI was also independently linked to mortality beyond
three years.<br/>Copyright &#xa9; Europa Digital & Publishing 2017. All
rights reserved.

<54>
Accession Number
616892223
Author
You T.; Yi K.; Ding Z.-H.; Hou X.-D.; Liu X.-G.; Wang X.-K.; Ge L.; Tian
J.-H.
Institution
(You, Yi, Hou, Liu, Wang) Department of Cardiovascular Surgery, Gansu
Provincial Hospital, Lanzhou, China
(Ding) Department of Nursing, Gansu Provincial Hospital, Lanzhou, China
(Ge, Tian) Evidence-Based Medicine Center, Lanzhou University, Lanzhou,
China
Title
Transcatheter closure, mini-invasive closure and open-heart surgical
repair for treatment of perimembranous ventricular septal defects in
children: A protocol for a network meta-analysis.
Source
BMJ Open. 7 (6) (no pagination), 2017. Article Number: e015642. Date of
Publication: 01 Jun 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Both transcatheter device closure and surgical repair are
effective treatments with excellent midterm outcomes for perimembranous
ventricular septal defects (pmVSDs) in children. The mini-invasive
periventricular device occlusion technique has become prevalent in
research and application, but evidence is limited for the assessment of
transcatheter closure, mini-invasive closure and open-heart surgical
repair. This study comprehensively compares the efficacy, safety and costs
of transcatheter closure, mini-invasive closure and open-heart surgical
repair for treatment of pmVSDs in children using Bayesian network
meta-analysis. Methods and analysis A systematic search will be performed
using Chinese Biomedical Literature Database, China National Knowledge
Infrastructure, PubMed, EMBASE.com and the Cochrane Central Register of
Controlled Trials to include random controlled trials, prospective or
retrospective cohort studies comparing the efficacy, safety and costs of
transcatheter closure, mini-invasive closure and open-heart surgical
repair. The risk of bias for the included prospective or retrospective
cohort studies will be evaluated according to the risk of bias in
non-randomised studies of interventions (ROBINS-I). For random controlled
trials, we will use risk of bias tool from Cochrane Handbook version
5.1.0. A Bayesian network meta-analysis will be conducted using R-3.3.2
software. Ethics and dissemination Ethical approval and patient consent
are not required since this study is a network meta-analysis based on
published trials. The results of this network meta-analysis will be
submitted to a peer-reviewed journal for publication.<br/>Copyright &#xa9;
2017 Article author(s).

<55>
Accession Number
616876443
Author
Fabritius M.L.; Geisler A.; Petersen P.L.; Wetterslev J.; Mathiesen O.;
Dahl J.B.
Institution
(Fabritius, Dahl) Bispebjerg and Frederiksberg Hospitals, Department of
Anaesthesiology and Intensive Care, Bispebjerg bakke 23, Copenhagen, NV
2400, Denmark
(Geisler, Mathiesen) Zealand University Hospital, Department of
Anaesthesiology, Lykkebaekvej 1, Koge 4600, Denmark
(Petersen) Copenhagen University Hospital, Department of Anaesthesiology,
Centre of Head and Orthopaedics, Rigshospitalet, Blegdamsvej 9, Copenhagen
2100, Denmark
(Wetterslev) Copenhagen University Hospital, Copenhagen Trial Unit, Centre
for Clinical Intervention Research, Rigshospitalet, Blegdamsvej 9,
Copenhagen 2100, Denmark
Title
Gabapentin in procedure-specific postoperative pain management -
preplanned subgroup analyses from a systematic review with meta-analyses
and trial sequential analyses.
Source
BMC Anesthesiology. 17 (1) (no pagination), 2017. Article Number: 85. Date
of Publication: 21 Jun 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: It has been argued that postoperative pain treatment should be
"procedure-specific", since different analgesics may have specific effects
dependent on the surgical procedure. The aim of the present subgroup
analysis was to compare the beneficial and harmful effects of
perioperative gabapentin treatment in different surgical procedures.
Methods: Relevant databases were searched for randomized clinical trials
(RCTs) comparing gabapentin versus placebo. Two authors independently
screened titles and abstracts, extracted data and assessed risk of bias.
The primary outcomes were differences in 24-h morphine consumption, and
serious adverse events (SAE) between surgical procedures. These subgroup
analyses were predefined in a PRISMA compliant systematic review
registered at PROSPERO (ID: CRD42013006538). It was predefined that
conclusions should primarily be based on trials classified as overall low
risk of bias. Results: Seventy-four RCTs with 5645 patients were included,
assessing benefit and harm in cholecystectomy, hysterectomy, mastectomy,
and arthroplasty surgery, spinal surgery, and thoracic surgery. Only eight
of 74 trials were classified as overall low risk of bias limiting our
ability to conclude on the estimates in most meta-analyses. The
differences between surgical procedures in these trials were not
statistically significant when tested for subgroup differences. Fifteen
trials with 1377 patients reported a total of 59 SAEs, most of which were
observed in the thoracic surgery group. Conclusion: Both beneficial and
harmful effects in these subgroup analyses were influenced by bias and
insufficient data, limiting conclusions. With these limitations, we could
not adequately test for differences in beneficial or harmful outcomes
between six surgical subgroups undergoing perioperative gabapentin
treatment.<br/>Copyright &#xa9; 2017 The Author(s).

<56>
Accession Number
616876010
Author
Fujihara N.; Lark M.E.; Fujihara Y.; Chung K.C.
Institution
(Fujihara, Fujihara) International Research Fellow, Plastic Surgery
Section, University of Michigan, Ann Arbor, MI, United States
(Fujihara, Fujihara) Department of Hand Surgery, Nagoya University,
Nagoya, Japan
(Lark) Research Associate, University of Michigan Medical School, Ann
Arbor, MI, United States
(Chung) Professor of Surgery, Department of Surgery, Section of Plastic
Surgery, Assistant Dean for Faculty Affairs, University of Michigan
Medical School, Ann Arbor, MI, United States
Title
The effect of economic downturn on the volume of surgical procedures: A
systematic review.
Source
International Journal of Surgery. 44 (pp 56-63), 2017. Date of
Publication: August 2017.
Publisher
Elsevier Ltd
Abstract
Background Economic downturn can have a wide range of effects on medicine
at both individual and national levels. We aim to describe these effects
in relation to surgical volume to guide future planning for physician
specialization, patient expectations in the face of economic crises, or
estimating healthcare expenditure. We hypothesized that because of high
out-of-pocket costs, cosmetic procedure volumes would be most affected by
economic decline. Methods A systematic review was conducted using MEDLINE,
Embase, and ABI/INFORMS. The main search terms were "economic recession"
and "surgical procedures, operative". Studies were included if surgical
volumes were measured and economic indicators were used as predictors of
economic conditions. Results Twelve studies were included, and the most
common subject was cosmetic (n = 5), followed by orthopedic (n = 2) and
cardiac surgeries (n = 2). The majority of studies found that in periods
of economic downturn, surgical volume decreased. Among the eight studies
using Pearson's correlation analysis, there were no significant
differences between cosmetic procedures and other elective procedures,
indicating that cosmetic procedures may display trends similar to those of
non-cosmetic elective procedures in periods of economic downturn.
Conclusions Surgical volume generally decreased when economic indicators
declined, observed for both elective and non-elective surgery fields.
However, a few specific procedure volumes such as vasectomy and caesarean
section for male babies increased during the economic downturn. Knowledge
of these trends can be useful for future surgical planning and
distribution of healthcare resources.<br/>Copyright &#xa9; 2017 IJS
Publishing Group Ltd

<57>
Accession Number
616844552
Author
Suzumura E.A.; Ribeiro R.A.; Kawano-Dourado L.; de Barros e Silva P.G.;
Oliveira C.; Figueiro M.F.; Cavalcanti A.B.; Lopes R.D.; Berwanger O.
Institution
(Suzumura, Kawano-Dourado, de Barros e Silva, Oliveira, Figueiro,
Cavalcanti, Lopes, Berwanger) Hospital do Coracao (HCor), Research
Institute, Rua Abilio Soares 250, 12 andar, Sao Paulo, SP 04005-000,
Brazil
(Ribeiro) Federal University of Rio Grande do Sul, Graduate Program in
Epidemiology, Porto Alegre, Brazil
(Ribeiro) National Institute of Science, Technology for Health Technology
Assessment, CNPq, Brazil
(Ribeiro) Faculdade Meridional - IMED, School of Medicine, Passo Fundo,
Brazil
(Kawano-Dourado) Pulmonary Division - Heart Institute (InCor) University
of Sao Paulo Medical School, Sao Paulo, Brazil
(Lopes) Duke Clinical Research Institute (DCRI), Durham, NC, United States
(de Barros e Silva, Lopes) Brazilian Clinical Research Institute (BCRI),
Sao Paulo, Brazil
Title
Effects of perioperative statin use on cardiovascular complications in
patients submitted to non-cardiac surgery: Protocol for a systematic
review, meta-analysis, and trial sequential analysis.
Source
Systematic Reviews. 6 (1) (no pagination), 2017. Article Number: 116. Date
of Publication: 19 Jun 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Preliminary evidence suggests statins may reduce major
perioperative vascular events. However, evidence is limited to
observational studies, underpowered trials, and non-comprehensive
systematic reviews. This review aims to assess the effects of
perioperative statin use on cardiovascular complications in patients
submitted to non-cardiac surgery. Methods: We will search MEDLINE/PubMed,
EMBASE, LILACS, CENTRAL, Web of Science, and CINAHL for randomized
controlled trials assessing the effects of perioperative statin use in
adults undergoing non-cardiac surgery and reporting cardiovascular
complications. For patients already using statins for hyperlipidemia, a
preoperative loading dose of statin is required in the experimental group.
We will place no language or publication restriction on our search. Teams
of two reviewers will independently assess eligibility and risk of bias,
and will extract data from the included trials. Our primary outcome is a
combination of cardiovascular mortality or non-fatal myocardial
infarction. We will also assess the following outcomes: individual
components of the primary outcome, all-cause mortality, total myocardial
infarction, elevated troponin in the first seven postoperative days, total
stroke, total venous thromboembolism, postoperative atrial fibrillation,
elevation of creatine phosphokinase or liver enzymes, and rates of myalgia
or rhabdomyolysis. We will conduct meta-analyses using random-effects
model and will use trial sequential analysis to establish monitoring
boundaries to limit global type I error due to repetitive testing for our
primary outcome. We will rate the quality of evidence using the GRADE
system. Discussion: The results of this systematic review may help to
inform clinical practice and also the design of future large-scale
randomized trials. Systematic review registration: PROSPERO
CRD42016035987<br/>Copyright &#xa9; 2017 The Author(s).

<58>
Accession Number
616905246
Author
Kamali A.; Sanatkar A.; Sharifi M.; Moshir E.
Institution
(Kamali, Moshir) Department of Anesthesiology, Arak University of Medical
Sciences, Arak, Iran, Islamic Republic of
(Sanatkar, Sharifi) Department of Surgery, Arak University of Medical
Sciences, Arak, Iran, Islamic Republic of
Title
Evaluation of amiodarone versus metoprolol in treating atrial fibrillation
after coronary artery bypass grafting.
Source
Interventional Medicine and Applied Science. 9 (2) (pp 51-55), 2017. Date
of Publication: June 2017.
Publisher
Akademiai Kiado Rt. (E-mail: info@akkrt.hu)
Abstract
Introduction: Atrial fibrillation (AF) is the most common arrhythmia
affecting patients in open heart ICU after coronary artery bypass grafting
(CABG). Most cardiac surgery textbooks recommend beta blockers as the drug
of choice for treating such a condition while many experienced physicians
and a number of anesthesiology references offer amiodarone as the drug of
choice. Therefore, because of insufficient evidence and the aforementioned
controversy, we decided to conduct a study evaluating these two
antiarrhythmic medicines. Methods: This is a double-blind, randomized,
clinical trial performed on patients admitted for CABG at Amir al Momenin
hospital in Arak province, Iran, who developed new onset AF after surgery.
Based on the type of medication used, these patients were randomly divided
into two groups: Amiodarone (A) group and metoprolol (M) group. Each group
consisted of 73 cases. All data were analyzed via SPSS 19. Results: Among
the results achieved in this study, amiodarone was successful in treating
AF in 55 patients (73%), while metoprolol achieved normal rhythm in
treating AF in 69 patients (92%). With a p-value of 0.04, it seems that
metoprolol is more effective in treating AF. Conclusion: Metoprolol seems
to be a most efficacious medication for post-CABG AF (p-value =
0.004).<br/>Copyright &#xa9; 2017 The Author(s).

<59>
[Use Link to view the full text]
Accession Number
616914088
Author
Morray B.H.; McElhinney D.B.; Boudjemline Y.; Gewillig M.; Kim D.W.; Grant
E.K.; Bocks M.L.; Martin M.H.; Armstrong A.K.; Berman D.; Danon S.; Hoyer
M.; Delaney J.W.; Justino H.; Qureshi A.M.; Meadows J.J.; Jones T.K.
Institution
(Morray, Jones) Division of Cardiology, Seattle Children's Hospital,
University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105,
United States
(McElhinney) Department of Cardiothoracic Surgery, Lucille Packard
Children's Hospital at Stanford, Palo Alto, CA, United States
(Boudjemline) Necker Enfants Malades Hospital, Paris, France
(Gewillig) Pediatric and Congenital Cardiology, UZ Leuven, Belgium
(Kim, Grant) Division of Pediatric Cardiology, Children's Healthcare of
Atlanta, Emory University, Atlanta, GA, United States
(Bocks) Division of Pediatric Cardiology, Department of Pediatrics and
Communicable Diseases, University of Michigan C.S. Mott Children's
Hospital Congenital Heart Center, Ann Arbor, United States
(Martin) Division of Cardiology, Department of Pediatrics, University of
Utah, Salt Lake City, United States
(Armstrong) Department of Pediatric Cardiology, Nationwide Children's
Hospital, Columbus, OH, United States
(Berman) Division of Pediatric Cardiology, Washington University, School
of Medicine, St. Louis, MO, United States
(Danon) Division of Pediatric Cardiology, Riley Hospital for Children,
Indianapolis, IN, United States
(Hoyer) Division of Pediatric Cardiology, Department of Pediatrics,
University of Nebraska, Children's Hospital and Medical Center, Omaha,
United States
(Delaney, Qureshi) Lillie Frank Abercrombie Section of Pediatric
Cardiology, Texas Children's Hospital, Baylor College of Medicine,
Houston, United States
(Justino, Meadows) Division of Cardiology, UCSF Benioff Children's
Hospital, University of California, San Francisco, United States
Title
Multicenter Experience Evaluating Transcatheter Pulmonary Valve
Replacement in Bovine Jugular Vein (Contegra) Right Ventricle to Pulmonary
Artery Conduits.
Source
Circulation: Cardiovascular Interventions. 10 (6) (no pagination), 2017.
Article Number: e004914. Date of Publication: 01 Jun 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Follow-up of transcatheter pulmonary valve replacement (TPVR)
with the Melody valve has demonstrated good short-term and long-term
outcomes, but there are no published studies focused on valve performance
in the Contegra bovine jugular vein conduit. Methods and Results - This is
a retrospective, multicenter study of the short- and intermediate-term
outcomes of Melody TPVR within the Contegra conduit in the right ventricle
to pulmonary artery position. Data from 13 centers were included in the
analysis. During the study period, 136 patients underwent 139
catheterizations for attempted Melody TPVR with a median follow-up of 3
years (1 day to 9.1 years). Of the 136 patients, 117 underwent successful
Melody TPVR. Two patients underwent a second Melody TPVR. The majority of
patients underwent placement of >=1 stents before transcatheter pulmonary
valve implantation. There was a significant reduction in peak conduit
pressure gradient acutely after transcatheter pulmonary valve implantation
(39 versus 10 mm Hg; P<0.001). At most recent follow-up, the maximum
pulmonary valve gradient by echocardiogram remained significantly reduced
relative to prevalve implant measurements (65.9 versus 27.3 mm Hg;
P<0.001). The incidence of Melody transcatheter pulmonary valve stent
fracture (3.4%) and infectious endocarditis (4.3%) were both low. Serious
adverse events occurred in 3 patients. Conclusions - Melody TPVR in
Contegra conduits is safe and effective and can be performed in a wide
range of conduit sizes with preserved valve function and low incidence of
stent fracture and endocarditis.<br/>Copyright &#xa9; 2017 American Heart
Association, Inc.

<60>
Accession Number
616932400
Author
Dhooria S.; Sehgal I.S.; Prasad K.T.; Bal A.; Aggarwal A.N.; Behera D.;
Agarwal R.
Institution
(Dhooria, Sehgal, Prasad, Bal, Aggarwal, Behera, Agarwal) Departments of
aPulmonary Medicine and bHistopathology, Postgraduate Institute of Medical
Education and Research (PGIMER), Chandigarh, India
Title
A Randomized Trial of Antimicrobial Prophylaxis in Patients Undergoing
Medical Thoracoscopy (APT).
Source
Respiration. (pp 207-215), 2017. Date of Publication: 17 Jun 2017.
Publisher
S. Karger AG
Abstract
Background: There is no data on the role of prophylactic antibiotics in
patients undergoing medical thoracoscopy. Objective: In this study, we
evaluated the efficacy and safety of a single dose of intravenous
cefazolin in subjects undergoing medical thoracoscopy. Methods: Subjects
undergoing medical thoracoscopy were randomized 1:1 to receive either
intravenous cefazolin 2 g (antibiotic group) or intravenous saline
(control group). The primary outcome was the incidence of infections
(surgical site infections and empyema) in the study groups, while the
secondary outcomes were complications related to intravenous antibiotics.
Results: Of the 121 subjects screened, 100 (mean age +/- SD: 52.2 +/- 15.2
years; 38 [38%] women) were randomized to the study groups. The incidence
of postprocedural infections was not different between the antibiotic and
the control group (4 [8%] vs. 6 [12%], p = 0.28). Surgical site infection
occurred in 1 subject (2%) in the antibiotic group and 3 subjects (6%) in
the saline group (p = 0.62); empyema occurred in 3 subjects (6%) in each
group (p = 1.00). There was no association between age, comorbid illness
(diabetes mellitus or chronic kidney disease), study group allocation,
type of thoracoscope used, duration of procedure, histological diagnosis
(benign or malignant), and the occurrence of infections in the
postprocedural period. Conclusion: The use of a single dose of cefazolin
prior to medical thoracoscopy was not associated with a reduction in the
occurrence of postprocedural infection.<br/>Copyright &#xa9; 2017 S.
Karger AG, Basel

<61>
Accession Number
616899496
Author
Wang Y.; Zhu S.; Gao P.; Zhou J.; Zhang Q.
Institution
(Wang, Zhou, Zhang) Department of Cardiology, West China Hospital, Sichuan
University, 37 Guoxue Street, Chengdu, Sichuan 610041, China
(Zhu) Department of Epidemiology and Biostatistics, School of Public
Health, Sichuan University, Chengdu, Sichuan, China
(Gao) Department of Nephrology, West China Hospital, Sichuan University,
Chengdu, Sichuan, China
Title
Off-pump versus on-pump coronary surgery in patients with chronic kidney
disease: a meta-analysis.
Source
Clinical and Experimental Nephrology. (pp 1-11), 2017. Date of
Publication: 20 Jun 2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Background: Patients with chronic kidney disease (CKD) have worse adverse
cardiovascular outcomes after coronary artery bypass grafting (CABG).
However, the adverse cardiovascular outcomes between off-pump coronary
artery bypass grafting (OPCAB) versus on-pump coronary artery bypass
grafting (ONCAB) in these patients have been a subject of debate. Methods:
We undertook a comprehensive literature search of PubMed, Embase, and the
Cochrane Library database to identify all relevant studies comparing
techniques between OPCAB and ONCAB in CKD patients. We pooled the odds
ratios (ORs) and hazard ratios (HRs) from individual studies and conducted
heterogeneity, quality assessment, and publication bias analyses. Results:
This meta-analysis includes 17 studies with 201,889 patients. In CKD
patients, OPCAB was associated with significantly lower early mortality as
compared to ONCAB (OR 0.88; 95% CI 0.82-0.93; p < 0.0001). OPCAB was
associated with decreased risk of atrial fibrillation (OR 0.57; 95% CI
0.34-0.97; p = 0.04), cerebrovascular accident (OR 0.46; 95% CI 0.22-0.95;
p = 0.04), blood transfusion (OR 0.20; 95% CI 0.08-0.49; p = 0.0005),
pneumonia, prolonged ventilation, and shorter hospital stays. No
difference was found regarding long-term survival (HR 1.08; 95% CI
0.86-1.36; p = 0.51) or myocardial infarction (OR 0.65; 95% CI 0.30-1.38;
p = 0.26). Conclusions: Compared with ONCAB, OPCAB is associated with
superior postoperative morbidity and the early mortality in CKD patients.
Long-term survival is comparable between the two surgical
revascularizations.<br/>Copyright &#xa9; 2017 Japanese Society of
Nephrology

<62>
Accession Number
616895468
Author
Ashikhmina E.; Said S.; Smith M.M.; Rodriguez V.; Oliver W.C.; Nuttall
G.A.; Dearani J.A.; Schaff H.V.
Institution
(Ashikhmina, Smith, Oliver, Nuttall) Department of Anesthesiology and
Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
(Rodriguez) Department of Pediatric and Adolescent Medicine, Mayo Clinic,
Rochester, Minnesota
(Said, Dearani, Schaff) Department of Cardiovascular Surgery, Mayo Clinic,
Rochester, Minnesota
Title
Prothrombin Complex Concentrates in Pediatric Cardiac Surgery: The Current
State and the Future.
Source
Annals of Thoracic Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier USA
Abstract
Background: After decades of practice of pediatric cardiac surgery,
postoperative bleeding due to the immaturity of hemostasis, hemodilution,
and hypothermia remains a concern. Recently, a new approach for adult
coagulopathy after bypass has emerged. Prothrombin complex concentrates
(PCCs), designed to treat bleeding in hemophilia patients, are safely and
efficiently used off label for hemorrhage after bypass. However, optimal
dosing, indications and contraindications, and laboratory tests to assess
the efficacy of PCC use in children have not yet been established. This
literature review outlines the challenges of bypass-related coagulopathy,
the pharmacology, and the experience in use of PCCs, with a focus on their
potential in pediatric cardiac surgery. Methods: After a thorough
literature search of MEDLINE, Scopus, and Ovid databases using the term
"prothrombin complex concentrate AND pediatric," 23 relevant articles were
selected. Results: The data supporting successful use of PCCs in acquired
coagulopathy after cardiac surgery in adults have been increasing.
Although small volume, low immunogenicity, efficiency, and speed in
correcting coagulopathy are attractive qualities of PCCs for pediatric
practice, current evidence is only anecdotal. The main concerns are
unknown dosing regimens, the inability to closely monitor the effects of
PCCs in real time, and a possibility of thrombotic complications, which
can be particularly devastating in young congenital cardiac patients whose
lives frequently depend upon the patency of artificial shunts.
Conclusions: Extensive, high-quality research is warranted to fill in the
gaps of knowledge regarding using PCCs in pediatric cardiac
practice.<br/>Copyright &#xa9; 2017 The Society of Thoracic Surgeons.

<63>
Accession Number
616894755
Author
Pettersen T.; Haram P.M.; Winnerkvist A.; Karevold A.; Wahba A.; Stenvik
M.; Wiseth R.; Hegbom K.; Nordhaug D.O.
Institution
(Pettersen, Haram, Winnerkvist, Karevold, Wahba, Stenvik, Nordhaug)
Department of Cardiothoracic Surgery, St. Olav's University Hospital,
Trondheim, Norway
(Wiseth, Hegbom) Department of Cardiology, St. Olav's University Hospital,
Trondheim, Norway
(Pettersen, Wahba, Wiseth, Nordhaug) Department of Department of
Circulation and Medical Imaging, Faculty of Medicine, Norwegian University
of Science and Technology, Trondheim, Norway
Title
Pedicled Vein Grafts in Coronary Operation: Perioperative Data From a
Randomized Trial.
Source
Annals of Thoracic Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier USA
Abstract
Background: Less-than-optimal long-term patency of the saphenous vein is
one of the main obstacles for the success of coronary artery bypass
grafting (CABG). Results from the IMPROVE-CABG trial has shown that
harvesting the saphenous vein with a pedicle of perivascular tissue less
than 5 mm while using manual distention provides comparable occlusion
rates but significantly less intimal hyperplasia at early follow-up. The
impact of pedicled veins on duration of operations, leg wound infections,
and postoperative bleeding is unknown. Methods: One hundred patients
undergoing first-time elective CABG were randomly assigned to conventional
or pedicled vein harvesting. Perioperative and postoperative data were
collected prospectively during the hospital stay and at follow-up.
Results: Duration of extracorporeal circulation was significantly longer
in the pedicled vein group (mean: 76 min versus 65 min, p = 0.006);
however, no significant difference was found in the cross-clamp time. No
significant difference was found in intraoperative vein graft flow,
postoperative bleeding, or leg wound infections (4% in each group). No
reoperations were due to vein graft bleeding. Conclusions: Harvesting a
pedicled vein provides comparable postoperative bleeding and leg wound
infection rates in selected patients. The technique is associated with a
slightly longer duration of extracorporeal circulation than harvesting
conventional veins. Promising early results using the pedicled vein
technique may contribute to a change in standard vein harvesting technique
for CABG in selected patients.<br/>Copyright &#xa9; 2017 The Society of
Thoracic Surgeons.

<64>
Accession Number
616368812
Author
Virk S.A.; Tian D.H.; Sriravindrarajah A.; Dunn D.; Wolfenden H.D.; Suri
R.M.; Munkholm-Larsen S.; Cao C.
Institution
(Virk, Tian, Sriravindrarajah, Dunn, Munkholm-Larsen, Cao) The
Collaborative Research (CORE) Group, Macquarie University, Sydney,
Australia
(Tian) Royal North Shore Hospital, Sydney, Australia
(Wolfenden) Department of Cardiothoracic Surgery, Prince of Wales
Hospital, Sydney, Australia
(Suri) Department of Thoracic and Cardiovascular Surgery, Heart and
Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States
(Cao) Department of Cardiothoracic Surgery, St George Hospital, Sydney,
Australia
Title
Mitral valve surgery and coronary artery bypass grafting for
moderate-to-severe ischemic mitral regurgitation: Meta-analysis of
clinical and echocardiographic outcomes.
Source
Journal of Thoracic and Cardiovascular Surgery. 154 (1) (pp 127-136),
2017. Date of Publication: July 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective This meta-analysis was conducted to compare clinical and
echocardiographic outcomes following isolated coronary artery bypass
grafting (CABG) versus CABG and mitral valve (MV) surgery in patients with
moderate-to-severe ischemic mitral regurgitation (IMR). Methods Seven
databases were systematically searched to identify relevant studies. For
eligibility, studies were required to report on the primary endpoint of
perioperative or late mortality. Data were analyzed according to
predefined clinical endpoints. Results Four randomized controlled trials
(RCTs) (n = 505) and 15 observational studies (OS) (n = 3785) met the
criteria for inclusion. Compared with isolated CABG, concomitant CABG and
MV surgery was not associated with increased perioperative mortality
(RCTs: relative risk [RR] 0.89, 95% confidence interval [CI], 0.26-3.02;
OS: RR 1.40, 95% CI, 0.88-2.23). CABG and MV surgery was associated with
significantly lower incidence of moderate-to-severe MR at follow-up (RCTs:
RR 0.16, 95% CI, 0.04-0.75; OS: RR 0.20, 95% CI, 0.09-0.48). Late
mortality was similar between the surgical approaches in RCTs (hazard
ratio [HR] 1.20, 95% CI, 0.57-2.53) and OS (HR 0.99, 95% CI, 0.81-1.21).
There were no significant differences in echocardiographic outcomes. These
results remained consistent in subgroup analyses restricted to patients
with strictly moderate IMR. Conclusions In patients with
moderate-to-severe IMR, the addition of MV surgery to CABG was not
associated with increased perioperative mortality. Although concomitant MV
surgery reduced recurrence of moderate-to-severe MR at follow-up, this was
not associated with a reduction in late mortality. Larger trials with
longer follow-up duration are required to further assess long-term
survival and freedom from reintervention.<br/>Copyright &#xa9; 2017 The
American Association for Thoracic Surgery

<65>
Accession Number
614130504
Author
Racca V.; Bordoni B.; Castiglioni P.; Modica M.; Ferratini M.
Institution
(Racca, Bordoni, Modica, Ferratini) Cardiology Rehabilitation Center,
Santa Maria Nascente Institute-IRCCS, Don C. Gnocchi Foundation, Milan,
Italy
(Castiglioni) Biomedical Technology Department, Santa Maria Nascente
Institute-IRCCS, Don C. Gnocchi Foundation, Milan, Italy
Title
Osteopathic Manipulative Treatment Improves Heart Surgery Outcomes: A
Randomized Controlled Trial.
Source
Annals of Thoracic Surgery. 104 (1) (pp 145-152), 2017. Date of
Publication: July 2017.
Publisher
Elsevier USA
Abstract
Background Controlling sternal pain after heart surgery is important to
reduce the risk of postoperative complications, but pain is often
undertreated because of contraindications and side effects of analgesic
drugs. Recently, osteopathic manipulative treatment (OMT) was demonstrated
to reduce pain in different clinical contexts, suggesting its potential
utility after cardiac surgery. The aim of this open-label, controlled
study is to assess whether OMT contributes to sternal pain relief and
improves postoperative outcomes. Methods Eighty post-sternotomy adult
inpatients were randomly allocated one to one to receive a standardized
cardiorespiratory rehabilitation program alone (control group) or combined
with OMT. Pain intensity and respiratory functional capacity were
quantified by the Visual Analogue Scale score and by a standardized
breathing test, at the start and end of rehabilitation. Results At the
start of rehabilitation, the control group and the OMT group had similar
Visual Analogue Scale median scores (controls 4, interquartile range
[IQR]: 2 to 5; OMT 4, IQR: 3 to 5; p = not significant) and mean
inspiratory volumes (controls 825 +/- 381 mL; OMT 744 +/- 291 mL; p = not
significant). At the end of rehabilitation, the OMT group had a lower
Visual Analogue Scale median score (controls 3, IQR: 2 to 4; OMT 1, IQR: 1
to 2; p < 0.01) and higher mean inspiratory volume (controls 1,400 +/- 588
mL; OMT 1,781 +/- 633 mL; p < 0.01). The analgesic drug intake was similar
in the two groups. The hospitalization was shorter in the OMT group than
in the control group (19.1 +/- 4.8 versus 21.7 +/- 6.3 days; p < 0.05).
Conclusions The combination of standard care with OMT is effective in
inducing pain relief and functional recovery, and significantly improves
the management of patients after heart surgery with
sternotomy.<br/>Copyright &#xa9; 2017 The Society of Thoracic Surgeons

<66>
Accession Number
614130404
Author
Posenau J.T.; Wojdyla D.M.; Shaw L.K.; Alexander K.P.; Ohman E.M.; Patel
M.R.; Smith P.K.; Rao S.V.
Institution
(Posenau) Cardiovascular Division, Washington University School of
Medicine, St. Louis, Missouri, United States
(Wojdyla, Shaw, Alexander, Ohman, Patel, Rao) Duke Clinical Research
Institute, Durham, North Carolina, United States
(Smith) Division of Cardiovascular and Thoracic Surgery, Duke University
Medical Center, Durham, North Carolina, United States
Title
Revascularization Strategies and Outcomes in Elderly Patients With
Multivessel Coronary Disease.
Source
Annals of Thoracic Surgery. 104 (1) (pp 107-115), 2017. Date of
Publication: July 2017.
Publisher
Elsevier USA
Abstract
Background Balancing risks and benefits of revascularization in elderly
patients with multivessel coronary artery disease (CAD) is challenging.
The appropriate revascularization strategy for elderly patients with
multivessel CAD is unclear. Methods We used the Duke Databank for
Cardiovascular Disease to identify patients aged 75 years or more who had
multivessel disease and treatment with percutaneous coronary intervention
or coronary artery bypass graft surgery (CABG) within 30 days of the index
catheterization between October 1, 2003, and June 30, 2013. The primary
outcome was a composite of all-cause death, myocardial infarction, and
coronary revascularization through latest follow-up. Associations between
bare-metal stents (BMS), drug-eluting stents (DES), CABG, and outcomes
were determined using multivariable Cox proportional hazards modeling,
adjusting for potential confounders with CABG as the reference.
Comparisons between BMS and DES were done using BMS as the reference.
Results We identified 763 patients who met the criteria (BMS, n = 202;
DES, n = 411; CABG, n = 150). The median age was 79 years (interquartile
range, 76 to 82), and the median follow-up was 6.28 years. After
adjustment, both BMS and DES were associated with a higher risk of the
primary outcome. The BMS versus CABG hazard ratio was 1.58 (95% confidence
interval: 1.15 to 2.19, p = 0.01). The DES versus CABG hazard ratio was
1.45 (95% confidence interval: 1.08 to 1.95, p = 0.01). The adjusted
hazard ratio for DES versus BMS (0.92, 95% confidence interval: 0.71 to
1.19, p = 0.51) was not statistically significant. Conclusions In this
single-center analysis of 763 elderly patients with multivessel disease,
CABG was associated with the best overall clinical outcomes, but was
selected for a minority of patients. An adequately powered, randomized
trial should be considered to define the best treatment strategy for this
population.<br/>Copyright &#xa9; 2017 The Society of Thoracic Surgeons

<67>
Accession Number
616608924
Author
Gjeraa K.; Mundt A.S.; Spanager L.; Hansen H.J.; Konge L.; Petersen R.H.;
Ostergaard D.
Institution
(Gjeraa, Mundt, Konge, Ostergaard) Copenhagen Academy for Medical
Education and Simulation, Capital Region of Denmark and University of
Copenhagen, Copenhagen, Denmark
(Spanager) Department of General Surgery, Nordsjaellands Hospital,
Hillerod, Denmark
(Hansen, Petersen) Department of Cardiothoracic Surgery, University
Hospital of Copenhagen, Copenhagen, Denmark
Title
Important Non-Technical Skills in Video-Assisted Thoracoscopic Surgery
Lobectomy: Team Perspectives.
Source
Annals of Thoracic Surgery. 104 (1) (pp 329-335), 2017. Date of
Publication: July 2017.
Publisher
Elsevier USA
Abstract
Background Safety in the operating room is dependent on the team's
non-technical skills. The importance of non-technical skills appears to be
different for minimally invasive surgery as compared with open surgery.
The aim of this study was to identify which non-technical skills are
perceived by team members to be most important for patient safety, in the
setting of video-assisted thoracoscopic surgery (VATS) lobectomy. Methods
This was an explorative, semistructured interview-based study with 21
participants from all four thoracic surgery centers in Denmark that
perform VATS lobectomy. Data analysis was deductive, and directed content
analysis was used to code the text into the Oxford Non-Technical Skills
system for evaluating operating teams' non-technical skills. Results The
most important non-technical skills described by the VATS teams were
planning and preparation, situation awareness, problem solving,
leadership, risk assessment, and teamwork. These non-technical skills
enabled the team to achieve shared mental models, which in turn
facilitated their efforts to anticipate next steps. This was viewed as
important by the participants as they saw VATS lobectomy as a high-risk
procedure with complementary and overlapping scopes of practice between
surgical and anesthesia subteams. Conclusions This study identified six
non-technical skills that serve as the foundation for shared mental models
of the patient, the current situation, and team resources. These findings
contribute three important additions to the shared mental model construct:
planning and preparation, risk assessment, and leadership. Shared mental
models are crucial for patient safety because they enable VATS teams to
anticipate problems through adaptive patterns of both implicit and
explicit coordination.<br/>Copyright &#xa9; 2017 The Society of Thoracic
Surgeons

<68>
Accession Number
615371991
Author
Sandri A.; Petersen R.H.; Decaluwe H.; Moons J.; Ferguson M.K.; Hansen
H.J.; Brunelli A.
Institution
(Sandri, Brunelli) Department of Thoracic Surgery, St James's University
Hospital, Leeds, United Kingdom
(Petersen, Hansen) Department of Cardio-thoracic Surgery, Copenhagen
University Hospital, Copenhagen, Denmark
(Decaluwe, Moons) Department of Thoracic Surgery UZ Leuven, Leuven,
Belgium
(Ferguson) Department of Surgery and The Comprehensive Cancer Center, The
University of Chicago, Chicago, Ill, United States
Title
Coronary artery disease is associated with an increased mortality rate
following video-assisted thoracoscopic lobectomy.
Source
Journal of Thoracic and Cardiovascular Surgery. 154 (1) (pp 352-357),
2017. Date of Publication: July 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective To compare the incidence of major adverse cardiac events (MACE)
and mortality following video-assisted thoracoscopic surgery (VATS)
lobectomy in patients with and without coronary artery disease (CAD).
Methods Multicentre retrospective analysis of 1699 patients undergoing
VATS lobectomy (January 2012-March 2015). CAD definition: previous acute
myocardial infarct (AMI), angina, percutaneous coronary intervention (PCI)
or coronary artery bypass graft (CABG). MACE definition: postoperative
acute myocardial ischemia, cardiac arrest or any cardiac death. Propensity
score analysis was performed to match patients with and without CAD.
Outcomes of the 2 matched groups were compared. Results The incidence of
MACE and mortality for the entire population was 0.4% (7 patients) and
1.7% (29 patients); 218 patients (13%) had a history of CAD: 106 previous
AMI, 55 angina, 32 CABG, and 81 PCI. The propensity score yielded 2
well-balanced groups of 218 pairs with and without CAD. MACE (CAD 2 [0.9%]
vs no-CAD 1 [0.5%]; P = 1), cardiovascular and pulmonary complications
(CAD 61 [28%] vs no-CAD 51 [23%]; P =.3) and postoperative stay (CAD 7.3
days vs no-CAD 6.2 days; P =.3) were not different between the groups. The
incidence of atrial fibrillation (CAD 31 [14%] vs no-CAD 18 [8.2%]; P
=.07), 30-day mortality (CAD: 11 [5%] vs no-CAD 2 [0.9%]; P =.02) and
death among complicated patients (CAD 18% vs no-CAD 3.9%; P =.009) were
higher in the CAD group. Conclusions The incidence of MACE following VATS
lobectomy in patients with CAD is low and similar to patients without CAD.
However, their risk of postoperative mortality is fivefold higher compared
with non-CAD patients, warranting refined preoperative functional
evaluation and more intense postoperative monitoring.<br/>Copyright &#xa9;
2017 The American Association for Thoracic Surgery

<69>
Accession Number
615369098
Author
Jung D.M.; Ahn H.J.; Jung S.-H.; Yang M.; Kim J.A.; Shin S.M.; Jeon S.
Institution
(Jung, Ahn, Yang, Kim, Jeon) Department of Anesthesiology and Pain
Medicine, Samsung Medical Centre, Sungkyunkwan University School of
Medicine, Seoul, South Korea
(Shin) Department of Thoracic and Cardiovascular Surgery, Samsung Medical
Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
(Jung) Biostatistics and Clinical Epidemiology Centre, Research Institute
for Future Medicine, Samsung Medical Centre, Seoul, South Korea
Title
Apneic oxygen insufflation decreases the incidence of hypoxemia during
one-lung ventilation in open and thoracoscopic pulmonary lobectomy: A
randomized controlled trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 154 (1) (pp 360-366),
2017. Date of Publication: July 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective Hypoxemia is common during one-lung ventilation (OLV) for
thoracic surgery. When hypoxemia occurs, surgery is interrupted for rescue
ventilation. Apneic oxygen insufflation (AOI), which provides
O<inf>2</inf> without applying pressure, may prevent hypoxemia and does
not interrupt surgery. The aim of this study was to determine the
effectiveness of the AOI technique for preventing hypoxemia during OLV in
thoracic surgery. Methods Patients undergoing open or thoracoscopic
pulmonary lobectomy from September to December 2015 were included.
Patients were assigned randomly to a non-AOI group or an AOI group (n = 45
each). OLV was initiated and at the 15-minute mark (OLV15), patients in
the AOI group received oxygen insufflation at 3 L/min to the nonventilated
lung for 30 minutes (OLV45). The primary endpoint was the occurrence of
hypoxemia (SaO<inf>2</inf> <90%) during OLV. Results The demographic and
operative data were similar between the 2 groups. The incidence of
hypoxemia was greater in the non-AOI than the AOI group (18% vs 0%; P
=.009). DELTAPaO<inf>2</inf> (the difference in partial pressure of oxygen
in arterial blood between OLV 45 and 15 minutes) was smaller in the AOI
than the non-AOI group (-29 mm Hg vs -69 mm Hg; P =.005). Duration of
surgery and incidence of complications did not vary between groups.
Conclusions AOI decreases the incidence of hypoxemia and improves arterial
oxygenation during OLV for open and thoracoscopic surgery. AOI may be a
valuable option to prevent hypoxemia. It can be used before relying on
continuous positive airway pressure or intermittent two-lung ventilation
and result in fewer interruptions in surgery.<br/>Copyright &#xa9; 2017
The American Association for Thoracic Surgery

<70>
Accession Number
616885408
Author
Nelson G.; Altman A.D.
Institution
(Nelson) Tom Baker Cancer Centre, Calgary, AB, Canada
(Altman) Winnipeg Health Sciences Centre, Winnipeg, MB, Canada
Title
Enhanced recovery after surgery interactive audit system for gynecologic
oncology surgery: Importance of measuring protocol element compliance (you
don't know what you don't measure)!.
Source
Gynecologic Oncology. Conference: 48th Annual Meeting on Women's Cancer of
the Society of Gynecologic Oncology, SGO 2017. United States. 145 (pp
191-192), 2017. Date of Publication: June 2017.
Publisher
Academic Press Inc.
Abstract
Objective: Implementation of enhanced recovery after surgery (ERAS)
pathways outside gynecology has resulted in a reduction in hospital length
of stay (LOS) and surgical complications, the net result being cost
savings to the health care system. With the recent publication of ERAS
guidelines in gynecologic/oncology, centers are looking to obtain similar
benefits with implementation. Auditing compliance, however, has proven to
be essential to successful implementation of an ERAS program. The ERAS
Interactive Audit System has been developed to measure compliance with the
new guidelines. The objective of this study was to evaluate the new audit
system and report on clinical outcomes and protocol compliance from 2
centers actively implementing an ERAS program. Method: Data from 52
patients undergoing laparotomy (26 debulking [Db]; 26 staging [Stg]) at 2
cancer centerswere entered into EIAS. A total of 120 data fields were
captured per patient spanning the pre-, intra-, and postoperative phases
of surgical care. Average LOS, complications, and compliance with the
guidelines were reported. Results: Average LOS for the Db and Stg groups
was 10 and 5 days, respectively.More complicationswere observed in the Db
group than in the Stg group (higher surgical, cardiovascular, and
infectious complications). Only 1 patient in the Db group required
intensive care unit admission. For the groups combined, high-level
compliance was observed for the following ERAS protocol elements:
avoidance of bowel preparation (96.2%), avoidance of preoperative sedative
medication (100%), thrombosis prophylaxis (80.8%), aggressive
postoperative nausea/vomiting prophylaxis (95.7%), and avoidance of
resection site drainage (96.2%). Poor compliance was observed for early
termination of urinary drainage (57.7%), mobilization on day of surgery
(61.5%), early termination of intravenous fluids (11.5%), and introduction
of solid food on day of surgery (25%). Conclusion: Despite formal
implementation of an enhanced recovery protocol, audit of compliance with
protocol elements showed widespread differences in uptake. This study
emphasizes the importance of continued audit and feedback allowing the
clinical team to iterate toward improved protocol compliance that
theoretically should translate into improved patient outcomes.

<71>
Accession Number
616777963
Author
Brainard J.; Scott B.K.; Sullivan B.L.; Fernandez-Bustamante A.; Piccoli
J.R.; Gebbink M.G.; Bartels K.
Institution
(Brainard, Scott, Sullivan, Fernandez-Bustamante, Bartels) Department of
Anesthesiology, University of Colorado School of Medicine, 12401 E. 17th
Avenue, Leprino Office Building, 7th Floor, MS B-113, Aurora, CO 80045,
United States
(Piccoli, Gebbink) Department of Respiratory Care, University of Colorado
Hospital, 12605 East 16th Avenue, MS F-764, Aurora, CO 80045, United
States
Title
Heated humidified high-flow nasal cannula oxygen after thoracic surgery -
A randomized prospective clinical pilot trial.
Source
Journal of Critical Care. 40 (pp 225-228), 2017. Date of Publication: 01
Aug 2017.
Publisher
W.B. Saunders
Abstract
Background Thoracic surgery patients are at high-risk for adverse
pulmonary outcomes. Heated humidified high-flow nasal cannula oxygen
(HHFNC O<inf>2</inf>) may decrease such events. We hypothesized that
patients randomized to prophylactic HHFNC O<inf>2</inf> would develop
fewer pulmonary complications compared to conventional O<inf>2</inf>
therapy. Methods and patients Fifty-one patients were randomized to HHFNC
O<inf>2</inf> vs. conventional O<inf>2</inf>. The primary outcome was a
composite of postoperative pulmonary complications. Secondary outcomes
included oxygenation and length of stay. Continuous variables were
compared with t-test or Mann-Whitney-U test, categorical variables with
Fisher's Exact test. Results There were no differences in postoperative
pulmonary complications based on intention to treat [two in HHFNC
O<inf>2</inf> (n = 25), two in control (n = 26), p = 0.680], and after
exclusion of patients who discontinued HHFNC O<inf>2</inf> early [one in
HHFNC O<inf>2</inf> (n = 18), two in control (n = 26), p = 0.638].
Discomfort from HHFNC O<inf>2</inf> occurred in 11/25 (44%); 7/25 (28%)
discontinued treatment. Conclusions Pulmonary complications were rare
after thoracic surgery. Although HHFNC O<inf>2</inf> did not convey
significant benefits, these results need to be interpreted with caution,
as our study was likely underpowered to detect a reduction in pulmonary
complications. High rates of patient-reported discomfort with HHFNC
O<inf>2</inf> need to be considered in clinical practice and future
trials.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<72>
Accession Number
616479978
Author
Anand V.; Bates A.; Featherstone R.; Murthy S.
Institution
(Anand, Featherstone) University of Alberta, Edmonton, Canada
(Bates) University of Pennsylvania, Philadelphia, United States
(Murthy) University of British Columbia, 4500 Oak Street, Vancouver,
Canada
Title
Perioperative antibiotics in pediatric cardiac surgery: Protocol for a
systematic review.
Source
Systematic Reviews. 6 (1) (no pagination), 2017. Article Number: 107. Date
of Publication: 30 May 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Post-operative infections in pediatric cardiac surgery are an
ongoing clinical challenge, with rates between 1 and 20%. Perioperative
antibiotics remain the standard for prevention of surgical-site
infections, but the type of antibiotic and duration of administration
remain poorly defined. Current levels of practice variation through
informal surveys are very high. Rates of antibiotic-resistant organisms
are increasing steadily around the world. Methods/design: We will identify
all controlled observational studies and randomized controlled trials
examining prophylactic antibiotic use in pediatric cardiac surgery. Data
sources will include MEDLINE, EMBASE, CENTRAL, and proceedings from recent
relevant scientific meetings. For each included study, we will conduct
duplicate independent data extraction, risk of bias assessment, and
evaluation of quality of evidence using the GRADE approach. Discussion: We
will report the results of this review in agreement with the PRISMA
statement and disseminate our findings at relevant critical care and
cardiology conferences and through publication in peer-reviewed journals.
We will use this systematic review to inform clinical guidelines, which
will be disseminated in a separate stand-alone publication. Study
registration number: PROSPERO CRD42016052978C<br/>Copyright &#xa9; 2017
The Author(s).

<73>
Accession Number
616464043
Author
Bavry A.A.; Park K.E.; Choi C.Y.; Mahmoud A.N.; Wen X.; Elgendy I.Y.
Institution
(Bavry, Park, Choi, Mahmoud, Wen, Elgendy) Department of Medicine,
University of Florida, Gainesville, FL, United States
(Bavry, Park, Choi) North Florida/South Georgia Veterans Health System,
Gainesville, FL, United States
(Wen) Health Outcomes, College of Pharmacy, University of Rhode Island,
Kingston, RI, United States
Title
Improvement of Subjective Well-Being by Ranolazine in Patients with
Chronic Angina and Known Myocardial Ischemia (IMWELL Study).
Source
Cardiology and Therapy. 6 (1) (pp 81-88), 2017. Date of Publication: 01
Jun 2017.
Publisher
Springer Healthcare (E-mail: kathleen.burke@springer.com)
Abstract
Introduction: We aimed to assess if ranolazine would improve angina
symptoms among patients with documented myocardial ischemia. Methods:
Eligible subjects had chronic stable angina and at least one coronary
stenosis with fractional flow reserve (FFR) <=0.80 or at least one chronic
total occlusion (CTO) without attempted revascularization. Subjects were
randomized to oral ranolazine 500 mg twice daily for 1 week, then
ranolazine 1000 mg twice daily for 15 weeks versus matching placebo. The
primary end point was change in angina at 16 weeks as assessed by the
Seattle Angina Questionnaire (SAQ). Results: Between September 2014 and
January 2016, 25 subjects were randomized to ranolazine versus 25 to
placebo. The most common reason for eligibility was CTO (72%), while the
remainder had myocardial ischemia documented by low FFR. The mean FFR was
0.57 +/- 0.12. Sixty-eight percent of subjects were on two or more
anti-angina medications at baseline. Study medication was discontinued in
32% (eight of 25) of the ranolazine group versus 36% (nine of 25) of the
placebo group. By intention-to-treat, 46 subjects had baseline and
follow-up SAQ data completed. Ranolazine was not associated with an
improvement in angina compared with placebo at 16 weeks. The results were
similar among 33 subjects that completed study medication. The incidence
of ischemia-driven hospitalization or catheterization was 12% (three of
25) of the ranolazine group versus 20% (five of 25) in the placebo group
(p > 0.05). Conclusions: In subjects with chronic stable angina and
documented myocardial ischemia, ranolazine did not improve angina symptoms
at 16 weeks. Funding: Gilead. Clinical trial registration: The study was
registered at ClinicalTrials.gov (NCT02265796).<br/>Copyright &#xa9; 2016,
The Author(s).

<74>
Accession Number
616464036
Author
Caimmi P.P.; Sabbatini M.; Kapetanakis E.I.; Cantone S.; Ferraz M.V.;
Cannas M.; Tesler U.F.
Institution
(Caimmi) Department of Cardiac Surgery, University Hospital of Novara
"Maggiore della Carita", Novara, Italy
(Caimmi, Cannas) Department of Science Health, UPO University, Novara,
Italy
(Caimmi, Tesler) "Policlinico di Monza" Hospital Group, Department Cardiac
Surgery, San Gaudenzio Clinic, Novara, Italy
(Sabbatini) Department of Science and Innovation Technology, UPO
University, Alessandria, Italy
(Kapetanakis) Department of Thoracic Surgery, "Sotiria" Chest Diseases
Hospital of Athens, Athens, Greece
(Cantone) "Policlinico di Monza" Health Care Group, Department Cardiac
Anaestehsiology, San Gaudenzio Clinic, Novara, Italy
(Ferraz) Department of Cardiac Surgery, Beneficencia Portouguesa Hospital,
Piracicaba, Brazil
Title
A Randomized Trial to Assess the Contribution of a Novel Thorax Support
Vest (Corset) in Preventing Mechanical Complications of Median Sternotomy.
Source
Cardiology and Therapy. 6 (1) (pp 41-51), 2017. Date of Publication: 01
Jun 2017.
Publisher
Springer Healthcare (E-mail: kathleen.burke@springer.com)
Abstract
Objectives: Mechanical complications of median sternotomy may cause
significant morbidity and mortality in cardiac surgical patients. This
study was aimed at assessing the role of Posthorax support vest (Epple,
Inc., Vienna, Austria) in the prevention of sternal complications and the
improvement of anatomical healing in patients at high risk for mechanical
sternal dehiscence after cardiac surgery by mean of median sternotomy.
Methods: A prospective, randomized, study was performed and 310 patients
with predisposing factors for sternal dehiscence after sternotomy for
cardiac surgery were included. The patients were divided into two groups:
patients who received the Posthorax support vest after surgery, and
patients who did not. Primary variables assessed included the incidence of
mechanical sternal complications, the quality of sternal healing, the rate
of re-operation, the duration of hospitalization, rate and duration of
hospital, re-admission for sternal complications. Secondary variables
assessed were the post-operative pain, the number of requests for
supplemental analgesia and the quality of life measured by means of the
EQ-5D format. Results: Patients using vest demonstrated a lower incidence
of mechanical sternal complications, a better anatomical sternum healing,
lower hospital stay, no re-operations for sternal dehiscence before
discharge and lower re-admissions for mechanical sternal complication. In
addition, patients using a vest reported a better quality of life with
better freedom from limitations in mobility, self-care, and pain.
Conclusions: Our findings demonstrate that the use of the Posthorax vest
reduces post-sternotomy mechanical complications and improves the healing
of the sternotomy, the clinical course, and the post-operative quality of
life.<br/>Copyright &#xa9; 2016, The Author(s).

<75>
Accession Number
613133657
Author
Luni F.K.; Riaz H.; Khan A.R.; Riaz T.; Husnain M.; Riaz I.B.; Khan M.S.;
Taleb M.; Kanjwal Y.; Cooper C.J.; Khuder S.A.
Institution
(Luni, Taleb, Kanjwal) Mercy Saint Vincent Medical Center, Toledo, OH,
United States
(Riaz) Cleveland Clinic, Cleveland, OH, United States
(Khan) University of Louisville, Louisville, KY, United States
(Riaz) Bronx Lebanon Hospital, New York, NY, United States
(Husnain, Riaz) University of Arizona, Tucson, AZ, United States
(Khan) Dow University of Health Sciences, Karachi, Pakistan
(Cooper, Khuder) University of Toledo Medical Center, Toledo, OH, United
States
Title
Clinical outcomes associated with per-operative discontinuation of aspirin
in patients with coronary artery disease: A systematic review and
meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 89 (7) (pp 1168-1175),
2017. Date of Publication: 01 Jun 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Postoperative state is characterized by increased thrombotic
risk by virtue of platelet activation. Whether aspirin ameliorates this
risk in patients with established coronary artery disease undergoing
cardiac or noncardiac surgery is unknown. We conducted a systematic review
and meta-analysis to compare the risk of major adverse cardiac events
(MACE) and the risk of bleeding in patients with early (3-5 or more days
before surgery) vs. late discontinuation(<3-5 days)/no discontinuation of
aspirin. Methods: Multiple databases were searched from inception of these
databases until March 2015 to identify studies that reported
discontinuation of aspirin in patients undergoing surgery. The outcomes
measured were all cause mortality, nonfatal myocardial infarction and
other relevant thrombotic events (MACE) which also may include, fatal and
nonfatal MI, stent thrombosis and restenosis, stroke, perioperative
cardiovascular complications (heart failure, MI, VTE, acute stroke) and
perioperative bleeding during the perioperative period to up to 30 days
after surgery. Results: A total of 1,018 titles were screened, after which
six observational studies met the inclusion criteria. Our analysis
suggests that there is no difference in MACE with planned discontinuation
of aspirin (OR = 1.17, 95% CI = 0.76-1.81; P = 0.05; I² = 55%).
Early discontinuation of aspirin showed a decreased risk of peri-operative
bleeding (OR 0.82, 95% CI = 0.67-0.99; P = 0.04; I² = 42%).
Conclusion: Our analysis suggests that planned short-term discontinuation
in the appropriate clinical setting appears to be safe in the correct
clinical setting with no increased risk of thrombotic events and with a
decreased risk of bleeding. &#xa9; 2016 Wiley Periodicals,
Inc.<br/>Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<76>
Accession Number
616023486
Author
Ayoub C.; Erthal F.; Abdelsalam M.A.; Murad M.H.; Wang Z.; Erwin P.J.;
Hillis G.S.; Kritharides L.; Chow B.J.W.
Institution
(Ayoub, Abdelsalam) Department of Cardiovascular Medicine, Mayo Clinic,
Rochester, MN, United States
(Ayoub, Kritharides) University of Sydney, New South Wales, Australia
(Erthal, Chow) Department of Medicine (Cardiology), University of Ottawa
Heart Institute, Canada
(Murad, Wang) Evidence-based Practice Center, Robert D. and Patricia E.
Kern Center for the Science of Health Care Delivery, Mayo Clinic,
Rochester, MN, United States
(Erwin) Mayo Clinic Libraries, Rochester, MN, United States
(Hillis) Department of Cardiology, Royal Perth Hospital, University of
Western Australia, Australia
(Kritharides) Department of Cardiology, Concord Hospital, Sydney Local
Health District, New South Wales, Australia
(Chow) Department of Radiology, University of Ottawa, Canada
Title
Prognostic value of segment involvement score compared to other measures
of coronary atherosclerosis by computed tomography: A systematic review
and meta-analysis.
Source
Journal of Cardiovascular Computed Tomography. 11 (4) (pp 258-267), 2017.
Date of Publication: July 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background The segment involvement score (SIS) is a semiquantitative
measure of the extent of atherosclerosis burden by coronary computed
tomography angiography (CTA). We sought to evaluate by meta-analysis the
prognostic value of SIS, and to compare it with other CTA measures of
coronary artery disease (CAD). Methods Electronic databases from 1946 to
January 2016 were searched. Studies reporting SIS, or an equivalent
measure by coronary CTA, and clinical outcomes were included. Maximally
adjusted hazard ratios (HR), predominantly for clinical variables, were
extracted for SIS, obstructive CAD, Agatston coronary artery calcium
score, and plaque composition. These were pooled using DerSimonian-Laird
random effects models. Results Eleven nonrandomized studies with good
methodological quality enrolling 9777 subjects (mean age 61 +/- 11 years,
57% male, mean follow up 3.3 years) who had 472 (4.8%) MACE (cardiac or
all cause death, non-fatal myocardial infarction or late
revascularization), were included. SIS (per segment increase) had pooled
HR of 1.25 (95% CI: 1.16,1.35; I² = 71.4%, p < 0.001) for MACE.
HR for MACE was 1.37 (95% CI: 1.32,1.42; I² = 95.6%, p < 0.001)
for number of segments with stenosis (per segment increase), 3.39 (95% CI:
1.65,6.99; I² = 87.8%, p = 0.001) for obstructive CAD (binary
variable) and 1.00 (95% CI: 1.00,1.01; I² = 75.0%, p = 0.490)
for Agatston score (per unit increase). HRs by plaque composition
(calcified, non-calcified and mixed; per segment change) were 1.24 (95%
CI: 1.10,1.39; I² = 81.6%, p = 0.001), 1.20 (95% CI: 0.97,1.48;
I² = 92.9%, p = 0.093) and 1.27 (95% CI: 1.03,1.58;
I² = 89.8%, p = 0.029), respectively. Conclusion Despite
heterogeneity in endpoints, extent of CAD as quantified by SIS on coronary
CTA is a strong, independent predictor of cardiovascular
events.<br/>Copyright &#xa9; 2017 Society of Cardiovascular Computed
Tomography

<77>
Accession Number
616787646
Author
Serruys P.W.; Ormiston J.; Van Geuns R.-J.; De Bruyne B.; Dudek D.;
Christiansen E.; Chevalier B.; Smits P.; McClean D.; Koolen J.; Windecker
S.; Whitbourn R.; Meredith I.; Wasungu L.; Ediebah D.; Veldhof S.; Onuma
Y.
Institution
(Serruys) International Center for Circulatory Health, National Heart and
Lung Institute, Imperial College, London, United Kingdom
(Ormiston) Cardiology Department, Auckland City Hospital, Auckland, New
Zealand
(Van Geuns, Onuma) ThoraxCenter, Erasmus Medical Center, Rotterdam,
Netherlands
(De Bruyne) Cardiology Department, Onze-Lieve-Vrouwziekenhuis, Aalst,
Belgium
(Dudek) Jagiellonian University Institute of Cardiology, University
Hospital Krakow, Krakow, Poland
(Christiansen) Department of Cardiology B, Aarhus University Hospital,
Aarhus, Denmark
(Chevalier) Interventional Cardiology, Institut Hospital Jacques Cartier,
Massy, France
(Smits) Cardiologie, Maasstad Ziekenhuis, Rotterdam, Netherlands
(McClean) Interventional Cardiology, Christchurch Hospital, Christchurch,
New Zealand
(Koolen) Cardiologie, Catharina Ziekenhuis, Eindhoven, Netherlands
(Windecker) Universitatsklinik fur Kardiologie, Inselspital, Bern,
Switzerland
(Whitbourn) Cardiac Catheterisation Lab and Coronary Intervention, Saint
Vincent's Hospital Melbourne, Fitzroy, Australia
(Meredith) Monash Heart, Monash Medical Centre, Melbourne, Australia
(Wasungu, Ediebah, Veldhof) Clinical Development, Abbott Vascular, Diegem,
Belgium
Title
A polylactide bioresorbable scaffold eluting everolimus for treatment of
coronary stenosis 5-year follow-up.
Source
Journal of the American College of Cardiology. 67 (7) (pp 766-776), 2016.
Date of Publication: 23 Feb 2016.
Publisher
Elsevier USA
Abstract
Background Long-term benefits of coronary stenosis treatment with an
everolimus-eluting bioresorbable scaffold are unknown. Objectives This
study sought to evaluate clinical and imaging outcomes 5 years after
bioresorbable scaffold implantation. Methods In the ABSORB multicenter,
single-arm trial, 45 (B1) and 56 patients (B2) underwent coronary
angiography, intravascular ultrasound (IVUS), and optical coherence
tomography (OCT) at different times. At 5 years, 53 patients without
target lesion revascularization underwent final imaging. Results Between 6
months/1 year and 5 years, angiographic luminal late loss remained
unchanged (B1: 0.14 +/- 19 mm vs. 0.13 +/- 0.33 mm; p = 0.7953; B2: 0.23
+/- 0.28 mm vs. 0.18 +/- 0.32 mm; p = 0.5685). When patients with a target
lesion revascularization were included, luminal late loss was 0.15 +/-
0.20 mm versus 0.15 +/- 0.24 mm (p = 0.8275) for B1 and 0.30 +/- 0.37 mm
versus 0.32 +/- 0.48 mm (p = 0.8204) for B2. At 5 years, in-scaffold and
-segment binary restenosis was 7.8% (5 of 64) and 12.5% (8 of 64). On
IVUS, the minimum lumen area of B1 decreased from 5.23 +/- 0.97
mm² at 6 months to 4.89 +/- 1.81 mm² at 5 years (p =
0.04), but remained unchanged in B2 (4.95 +/- 0.91 mm² at 1
year to 4.84 +/- 1.28 mm² at 5 years; p = 0.5). At 5 years,
struts were no longer discernable by OCT and IVUS. On OCT, the minimum
lumen area in B1 decreased from 4.51 +/- 1.28 mm² at 6 months
to 3.65 +/- 1.39 mm² at 5 years (p = 0.01), but remained
unchanged in B2, 4.35 +/- 1.09 mm² at 1 year and 4.12 +/- 1.38
mm² at 5 years (p = 0.24). Overall, the 5-year major adverse
cardiac event rate was 11.0%, without any scaffold thrombosis. Conclusions
At 5 years, bioresorbable scaffold implantation in a simple stenotic
lesion resulted in stable lumen dimensions and low restenosis and major
adverse cardiac event rates.<br/>Copyright &#xa9; 2016 American College of
Cardiology Foundation.

<78>
Accession Number
615253668
Author
van Houwelingen K.G.; Lam M.K.; Lowik M.M.; Danse P.W.; Tjon Joe Gin R.M.;
Jessurun G.A.; Anthonio R.L.; Sen H.; Linssen G.C.; IJzerman M.J.; Doggen
C.J.; von Birgelen C.
Institution
(van Houwelingen, Lam, Lowik, Sen) Cardiology Department, Thoraxcentrum
Twente, Medisch Spectrum Twente, Enschede, The Netherlands
(Danse, Tjon Joe Gin) Cardiology Department, Rijnstate Hospital, Arnhem,
The Netherlands
(Jessurun, Anthonio) Cardiology Department, Treant Zorggroep Location
Scheper, Emmen, The Netherlands
(Linssen) Cardiology Department, Ziekenhuisgroep Twente, Almelo and
Hengelo, The Netherlands
(IJzerman, Doggen) Department Health Technology and Services Research,
MIRA - Institute for Biomedical Technology and Technical Medicine,
University of Twente, Enschede, The Netherlands
(von Birgelen) Cardiology Department, Thoraxcentrum Twente, Medisch
Spectrum Twente, Enschede, The Netherlands; Department Health Technology
and Services Research, MIRA - Institute for Biomedical Technology and
Technical Medicine, University of Twente, Enschede, The Netherlands.
Electronic address: c.vonbirgelen@mst.nl
Title
Outcome After Myocardial Infarction Treated With Resolute Integrity and
Promus Element Stents: Insights From the DUTCH PEERS (TWENTE II)
Randomized Trial.
Source
Revista espanola de cardiologia (English ed.). 69 (12) (pp 1152-1159),
2016. Date of Publication: 01 Dec 2016.
Abstract
INTRODUCTION AND OBJECTIVES: In acute myocardial infarction (MI), novel
highly deliverable drug-eluting stents (DES) may be particularly valuable
as their flexible stent designs might reduce device-induced traumas to
culprit lesions. The aim of the study was to assess the safety and
efficacy of percutaneous coronary interventions with 2 novel durable
polymer-coated DES in patients with acute MI.
METHODS: The prospective, randomized DUTCH PEERS (TWENTE II) multicenter
trial compares Resolute Integrity and Promus Element stents in 1811
all-comer patients, of whom 817 (45.1%) were treated for ST-segment
elevation MI or non-ST-segment elevation MI and the 2-year outcome is
available in 99.9%. The primary clinical endpoint is target vessel failure
(TVF), a composite of cardiac death, target vessel related MI, or target
vessel revascularization.
RESULTS: Of all 817 patients treated for acute MI, 421 (51.5%) were
treated with Resolute Integrity and 396 (48.5%) with Promus Element
stents. At the 2-year follow-up, the rates of TVF (7.4% vs 6.1%; P = .45),
target lesion revascularization (3.1% vs 2.8%; P = .79), and definite
stent thrombosis (1.0% vs 0.5%; P = .69) were low for both stent groups.
Consistent with these findings in all patients with acute MI, outcomes for
the 2 DES were favorable and similar in both, with 370 patients with
ST-segment elevation MI (TVF, 5.1% vs 4.9%; P = .81) and 447 patients with
non-ST-segment elevation MI (TVF, 9.0% vs 7.5%; P = .56).
CONCLUSIONS: Resolute Integrity and Promus Element stents were both safe
and efficacious in treating patients with acute MI. The present 2-year
follow-up data underline the safety of using these devices in this
particular clinical setting.<br/>Copyright A&#xa9; 2016 Sociedad Espanola
de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.

<79>
Accession Number
616890841
Author
Mendirichaga R.; Singh V.; Blumer V.; Rivera M.; Rodriguez A.P.; Cohen
M.G.; O'Neill W.W.; Elmariah S.
Institution
(Mendirichaga, Blumer, Rivera, Rodriguez, Cohen) Cardiovascular Division,
University of Miami Miller School of Medicine, Miami, Florida
(Singh, Elmariah) Structural Heart Diseases, Cardiology Division,
Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts
(O'Neill) Structural Heart Diseases, Cardiology Division, Henry Ford
Hospital, Detroit, Michigan
Title
Transcatheter Mitral Valve Repair With MitraClip for Symptomatic
Functional Mitral Valve Regurgitation.
Source
American Journal of Cardiology. (no pagination), 2017. Date of
Publication: February 17, 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Transcatheter edge-to-edge mitral valve repair (TMVr) with MitraClip has
proved to be safe and effective for high-risk surgical patients with
severe symptomatic degenerative mitral regurgitation. There is paucity of
data regarding its use in functional mitral regurgitation (FMR). The
objective of this study was to evaluate the use of MitraClip in patients
with symptomatic moderate or severe FMR and a high surgical risk. Medical
libraries were systematically searched for studies assessing the use of
MitraClip for patients with symptomatic moderate or severe FMR and a high
surgical risk. Studies reporting safety and efficacy outcomes at 12 months
were included in the analysis. A total of 12 studies including 1,695
patients (age 73 [interquartile range [IQR] 70.5 to 74], 69.8% men, left
ventricular ejection fraction 32.5% [IQR 29.5 to 36], New York Heart
Association class II to IV) who underwent TMVr with MitraClip were
included in the analysis. Acute procedural success was 89% (IQR 85.5 to
92). Ischemic cardiomyopathy was the most common cause of left ventricular
dysfunction. Over 2/3 of patients had known coronary artery disease, 35% a
previous myocardial infarction, and 38.5% had a previous cardiac surgery.
Survival to hospital discharge was 98% (IQR 97 to 100) and 30-day survival
97% (IQR 96 to 98). Overall survival at 12 months was 82% (IQR 77 to 87).
Mitral valve re-intervention at 12 months was infrequent (3%; IQR 2 to
6.5). In conclusion, our pooled analysis suggests that TMVr with MitraClip
is feasible, safe, and carries a low rate of mitral valve re-intervention
at 12 months in patients with symptomatic moderate or severe FMR and a
high surgical risk.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<80>
Accession Number
609717562
Author
Gabel B.C.; Schnell E.C.; Dettori J.R.; Jeyamohan S.; Oskouian R.
Institution
(Gabel, Jeyamohan, Oskouian) Swedish Neuroscience Institute, 1600 E.
Jefferson Street Jefferson Tower Suite 101, Seattle, WA 98122, United
States
(Schnell, Dettori) Spectrum Research Inc, Tacoma, WA, United States
Title
Pulmonary complications following thoracic spinal surgery: A systematic
review.
Source
Global Spine Journal. 6 (3) (pp 296-303), 2016. Date of Publication: 01
Jul 2016.
Publisher
Thieme Medical Publishers, Inc. (E-mail: custserv@thieme.com)
Abstract
Study Design Systematic review Objective To determine the frequency of
pulmonary effusion, pneumothorax, and hemothorax in adult patients
undergoing thoracic corpectomy or osteotomy for any condition and to
determine if these frequencies vary by surgical approach (i.e., anterior,
posterior, or lateral). Methods Electronic databases and reference lists
of key articles were searched through September 21, 2015, to identify
studies specifically evaluating the frequency of pulmonary effusion,
pneumothorax, and hemothorax in patients undergoing thoracic spine
surgery. Results Fourteen studies, 13 retrospective and 1 prospective, met
inclusion criteria. The frequency across studies of pulmonary effusion
ranged from 0 to 77%; for hemothorax, 0 to 77%; and for pneumothorax, 0 to
50%. There was no clear pattern of pulmonary complications with respect to
surgical approach. Conclusions There is insufficient data to determine the
risk of pulmonary complications following anterior, posterior, or lateral
approaches to the thoracic spine. Methods for assessing pulmonary
complications were not well reported, and data is sparse.<br/>Copyright
&#xa9; 2016 Georg Thieme Verlag KG.

<81>
Accession Number
616072832
Author
den Boer S.L.; du Marchie Sarvaas G.J.; Klitsie L.M.; van Iperen G.G.;
Tanke R.B.; Helbing W.A.; Backx A.P.C.M.; Rammeloo L.A.J.; Dalinghaus M.;
ten Harkel A.D.J.
Institution
(den Boer, Helbing, Dalinghaus) Departments of Pediatrics, Division of
Pediatric Cardiology, Sophia Children's Hospital, Erasmus University
Medical Center, Rotterdam, Netherlands
(du Marchie Sarvaas) Departments of Pediatrics, Division of Pediatric
Cardiology, Beatrix Children's Hospital, University Medical Center
Groningen, Groningen, Netherlands
(Klitsie, ten Harkel) Departments of Pediatrics, Division of Pediatric
Cardiology, Leiden University Medical Center, Leiden, Netherlands
(van Iperen) Departments of Pediatrics, Division of Pediatric Cardiology,
Wilhelmina Children's Hospital, University Medical Center Utrecht,
Utrecht, Netherlands
(Tanke) Departments of Pediatrics, Division of Pediatric Cardiology,
Radboud University Medical Center, Nijmegen, Netherlands
(Backx) Departments of Pediatrics, Division of Pediatric Cardiology, Emma
Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
(Rammeloo) Departments of Pediatrics, Division of Pediatric Cardiology,
Free University Medical Center, Amsterdam, Netherlands
Title
Distribution of strain patterns in children with dilated cardiomyopathy.
Source
Echocardiography. 34 (6) (pp 881-887), 2017. Date of Publication: June
2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: This study aimed to evaluate the predicting value of
quantitative and qualitative dyssynchrony parameters as assessed by
two-dimensional speckle tracking echocardiography (STE) on outcome in
children with dilated cardiomyopathy (DCM). Furthermore, the
reproducibility of these parameters was investigated. Background: In
previous studies in adults with heart failure, several dyssynchrony
parameters have been shown to be a valuable predictor of clinical outcome.
Methods: This multicenter, prospective study included 75 children with DCM
and 75 healthy age-matched controls. Using STE, quantitative (time to
global peak strain and parameters describing intraventricular time
differences) and qualitative dyssynchrony parameters (pattern analysis) of
the apical four-chamber, three-chamber, two-chamber views, and the short
axis of the left ventricle were assessed. Cox regression was used to
identify risk factors for the primary endpoints of death or heart
transplantation. Inter-observer and intra-observer variability were
described. Results: During a median of 21 months follow-up, 10 patients
(13%) reached an endpoint. Although quantitative dyssynchrony measures
were higher in patients as compared to controls, the inter-observer and
intra-observer variability were high. Pattern analysis showed mainly
reduced strain, instead of dyssynchronous patterns. Conclusions: In this
study, quantitative dyssynchrony parameters were not reproducible,
precluding their use in children. Qualitative pattern analysis showed
predominantly reduced strain, suggesting that in children with DCM
dyssynchrony may be a minor problem.<br/>Copyright &#xa9; 2017, Wiley
Periodicals, Inc.

<82>
Accession Number
616803975
Author
Begtrup K.M.; Krag A.E.; Hvas A.-M.
Institution
(Begtrup, Krag, Hvas) Centre for Haemophilia and Thrombosis, Department of
Clinical Biochemistry, Aarhus University Hospital, Denmark
Title
No impact of fish oil supplements on bleeding risk: A systematic review.
Source
Danish Medical Journal. 64 (5) (no pagination), 2017. Article Number:
A5366. Date of Publication: May 2017.
Publisher
Danish Medical Association (E-mail: lwe@dadl.dk)
Abstract
Introduction: Fish oil supplementation may inhibit platelet aggregation
and can potentially increase the risk of bleeding. The aim of the present
systematic review was to evaluate the effect of fish oil supplements on
haemostasis and bleeding risk, and to provide recommendations on whether
it is necessary to discontinue fish oil supplementation prior to surgery.
Methods: Studies were identified through PubMed and Embase searches and by
reviewing the reference lists of the included papers. The Preferred
Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)
guidelines were used. Included in the review were publications including a
minimum of 20 healthy subjects and studies on patients who were undergoing
surgery and who had fish oil exposure. Results: In total, 52 publications
were included; 32 publications on healthy subjects and 20 publications on
patients undergoing surgery. The majority of the included studies were
randomised controlled trials or included a control group. Overall, fish
oil supplements reduced platelet aggregation in healthy subjects. Fish oil
exposure in surgical patients did not increase bleeding or blood
transfusions either during or after surgery. Conclusion: Fish oil
supplements reduced platelet aggregation in healthy subjects. This
biochemical effect was not reflected in increased bleeding risk during or
after surgery evaluated in randomised controlled trials. Consequently,
this systematic review does not support the need for discontinuation of
fish oil supplements prior to surgery or other invasive
procedures.<br/>Copyright &#xa9; 2017, Danish Medical Association. All
rights reserved.

<83>
Accession Number
615332267
Author
Glantz H.; Johansson M.C.; Thunstrom E.; Guron C.W.; Uzel H.; Saygin M.;
Herlitz J.; Peker Y.
Institution
(Glantz) Dept. of Internal Medicine, Skaraborg Hospital, Lidkoping, Sweden
(Johansson, Guron) Dept. of Molecular and Clinical Medicine/Clinical
Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
(Thunstrom, Peker) Dept. of Molecular and Clinical Medicine/Cardiology,
Sahlgrenska Academy, University of Gothenburg, Sweden
(Thunstrom) Dept. of Cardiology, Sahlgrenska University Hospital/Ostra,
Gothenburg, Sweden
(Uzel) Dept. of Cardiology, Sahlgrenska University Hospital/Molndal,
Gothenburg, Sweden
(Saygin) Dept. of Physiology, Faculty of Medicine, Suleyman Demirel
University, Isparta, Turkey
(Herlitz) Center of Prehospital Care of Western Sweden, University College
of Boras, Sweden
(Peker) Dept. of Pulmonary Medicine, Marmara University, Istanbul, Turkey
Title
Effect of CPAP on diastolic function in coronary artery disease patients
with nonsleepy obstructive sleep apnea: A randomized controlled trial.
Source
International Journal of Cardiology. 241 (pp 12-18), 2017. Date of
Publication: 15 Aug 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Obstructive sleep apnea (OSA) has been associated with worse
diastolic function in patients with coronary artery disease (CAD). This
analysis determined whether continuous positive airway pressure (CPAP)
treatment would improve diastolic function in CAD patients with nonsleepy
OSA. Methods Between December 2005 and November 2010, 244 revascularized
CAD patients with nonsleepy OSA (apnea-hypopnea index (AHI) >= 15/h,
Epworth Sleepiness Scale [ESS] score < 10) were randomly assigned to CPAP
or no-CPAP. Echocardiographic measurements were obtained at baseline, and
after 3 and 12 months. Results A total of 171 patients with preserved left
ventricular ejection fraction (>= 50%), no atrial fibrillation or severe
valve abnormalities, and technically adequate echocardiograms at baseline
and follow-up visits were included (CPAP, n = 87; no-CPAP, n = 84). In the
intention-to-treat analysis, CPAP had no significant effect on
echocardiographic parameters of mild (enlarged left atrium or decreased
diastolic relaxation velocity) or worse (increased E/e filling index
[presumed elevated left ventricular filling pressure]) diastolic function.
Post-hoc analysis revealed a significant association between CPAP usage
for >= 4 h/night and an increase in diastolic relaxation velocity at 12
months' follow-up (odds ratio 2.3, 95% confidence interval 1.0-4.9; p =
0.039) after adjustment for age, sex, body mass index, and left atrium
diameter at baseline. Conclusions CPAP did not improve diastolic
dysfunction in CAD patients with nonsleepy OSA. However, good CPAP
adherence was significantly associated with an increase in diastolic
relaxation velocity after one year.<br/>Copyright &#xa9; 2017 Elsevier
Ireland Ltd

<84>
Accession Number
616787601
Author
Bundhun P.K.; Bhurtu A.; Yuan J.
Institution
(Bundhun) Institute of Cardiovascular Diseases, First Affiliated Hospital,
Guangxi Medical University, Nanning, Guangxi, China
(Bhurtu) Guangxi Medical University, Nanning, Guangxi, China
(Yuan) Department of Cardiology, People's Hospital of Guangxi Zhuang
Autonomous Region, Nanning, Guangxi 530021, China
Title
Impact of type 2 diabetes mellitus on the long-term mortality in patients
who were treated by coronary artery bypass surgery.
Source
Medicine (United States). 96 (22) (no pagination), 2017. Article Number:
e7022. Date of Publication: 01 Jun 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Recent scientific reports have mainly focused on the
comparison between coronary artery bypass surgery (CABG) and percutaneous
coronary intervention. However, the impact of type 2 diabetes mellitus
(T2DM) on mortality in patients who were treated by CABG was often
ignored. Therefore, we aimed to compare the long-term mortality following
CABG in patients with and without T2DM. Methods: Studies comparing the
long-term adverse outcomes following CABG in patients with and without
T2DM were searched from electronic databases. Total number of deaths
(primary outcome) and events of myocardial infarction (MI), major adverse
cerebrovascular and cardiovascular events (MACCEs), stroke, and repeated
revascularization (secondary outcomes) were carefully extracted. An
analysis was carried out whereby odds ratios (ORs) and 95% confidence
intervals (CIs) were calculated using the RevMan 5.3 software. Results:
Eleven studies with a total number of 12,965 patients were included.
Current results showed that mortality was significantly higher in patients
with T2DM with OR: 1.54, 95% CI: 1.37 to 1.72, P<.00001; OR: 1.53, 95% CI:
1.36 to 1.72, P<.00001; and OR: 1.53, 95% CI: 1.26 to 1.87, P<.0001 at 1
to 15, 5 to 15, and 7 to 15 years, respectively. However, MI, repeated
revascularization, MACCEs, and stroke were not significantly different
with OR: 1.15, 95% CI: 0.81 to 1.64, P=.44; OR: 1.09, 95% CI: 0.88 to
1.36, P=.43; OR: 1.11, 95% CI: 0.83 to 1.48, P=.48; and OR: 1.69, 95% CI:
0.93 to 3.07, P=.08, respectively. Conclusion: Following CABG, a
significantly higher rate of mortality was continually observed in
patients with T2DM compared to patients without T2DM showing that the
former apparently has a high impact on the long-term mortality. However,
even if T2DM is an independent risk factor for mortality, it should not be
ignored that CABG remains the best revascularization strategy in these
patients.<br/>Copyright &#xa9; 2017 the Author(s). Published by Wolters
Kluwer Health, Inc.

<85>
Accession Number
616834912
Author
Corcoran T.; Kasza J.; Short T.G.; Chan M.T.V.; Forbes A.; Myles P.;
Wallace S.; Galagher W.; Farrington C.; Ditoro A.; Peyton P.; Baulch S.;
Sidiropoulos S.; Bulach R.; Bryant D.; O'Loughlin E.; Mitteregger V.;
Bolsin S.; Osborne C.; McRae R.; Backstrom M.; Leslie K.; Cotter R.; Paech
M.; March S.; Silbert B.; Said S.; Halliwell R.; Cope J.; Fahlbusch D.;
Crump D.; Thompson G.; Jefferies A.; McCulloch T.; Reeves M.; Buckley N.;
Tidyl T.; Schricker T.; Lattermann R.; Iannuzzi D.; Beattie S.; Carroll
J.; Jacka M.; Bryden C.; Badner N.; Chan M.; Tsang M.; Cheng B.; Fong A.;
Chu L.; Koo E.; Mohd N.; Ming L.E.; Yin Wang C.; Campbell D.; McAllister
D.; Walker S.; Olliff S.; Kennedy R.; Eldawlatly A.; Alzahrani T.; Chua
N.; Haller G.; Pichon I.; Sneyd R.; McMillan H.; Parkinson I.; Rousseau
G.; Brennan A.; Balaji P.; Cupitt J.; Nightingale J.; Kunst G.; Dickinson
M.; Saran T.; Subramaniam B.; Banner-Godspeed V.; Sessler D.; Liu J.; Kurz
A.; Hesler B.; Fu A.; Egan C.; Fiffick A.; Hutcherson M.; Turan A.; Naylor
A.; Obal D.; Cooke E.
Institution
(Corcoran, Paech) Department of Anaesthesia and Pain Medicine, Royal Perth
Hospital, Perth, WA, Australia
(Corcoran, O'Loughlin, Paech) School of Medicine and Pharmacology,
University of Western Australia, Perth, WA, Australia
(Corcoran) Western Australia Health Department, Perth, WA, Australia
(Corcoran, Kasza, Leslie, Forbes, Myles) Department of Epidemiology and
Preventive Medicine, Monash University, Melbourne, VIC, Australia
(Short) Department of Anaesthesia, Auckland City Hospital, Park Road,
Grafton, Auckland, New Zealand
(O'Loughlin) Department of Anaesthesia and Pain Medicine, Fiona Stanley
Hospital, Perth, WA, Australia
(Chan) Department of Anaesthesia and Intensive Care, Chinese University of
Hong Kong, Hong Kong Special Administrative Region, China
(Leslie) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, VIC, Australia
(Leslie) Anaesthesia Perioperative and Pain Medicine Unit, Department of
Pharmacology and Therapeutics, University of Melbourne, Melbourne, VIC,
Australia
(Myles) Department of Anaesthesia and Perioperative Medicine, Alfred
Hospital, Melbourne, VIC, Australia
(Wallace, Galagher, Farrington, Ditoro) AustinAustralia
(Peyton, Baulch, Sidiropoulos) DandenongAustralia
(Bulach, Bryant) Fremantle, Australia
(O'Loughlin, Mitteregger) Geelong Hospital, Australia
(Bolsin, Osborne) Monash Medical Centre, Australia
(McRae, Backstrom) Royal Melbourne Hospital, Australia
(Leslie, Cotter) Royal Perth Hospital, Australia
(Paech, March) St Vincent's Hospital, Australia
(Silbert, Said) Westmead Hospital, Australia
(Halliwell, Cope) Calvary WakefieldAustralia
(Fahlbusch, Crump) Peter MacCallum Cancer Centre, Australia
(Thompson) Western Hospital, Australia
(Jefferies) Royal Prince Alfred, Australia
(McCulloch) North West Regional Hosptial, Australia
(Reeves) McMaster University, Canada
(Buckley, Tidyl) Royal Victoria Hospital, Canada
(Schricker, Lattermann, Iannuzzi) Toronto General Hospital, Canada
(Beattie, Carroll) University of Alberta Hospital, Canada
(Jacka, Bryden) London Health Sciences, Canada
(Badner) Prince of Wales, Hong Kong
(Chan) ANZCA Trials Group Member, Hong Kong
(Tsang) Tuen Mun Hospital, Hong Kong
(Cheng, Fong) ACM Fong, Hong Kong
(Chu, Koo) Nethersole Eastern Hospital, Hong Kong
(Mohd, Ming) Hospital Kuala Lumpur, Malaysia
(Yin Wang) Malaya Medical Centre, Malaysia
(Campbell, McAllister) Auckland Hospital, New Zealand
(Walker, Olliff) Middlemore Hospital, New Zealand
(Kennedy) Christchurch Hospital, New Zealand
(Eldawlatly, Alzahrani) King Saud University Hospital, Saudi Arabia
(Chua) Tan Tock Seng Hospital, Singapore
(Haller, Pichon) Geneva University Hospital, Switzerland
(Sneyd, McMillan) Plymouth NHS Trust, France
(Parkinson) Royal Lancaster Infirmary, United Kingdom
(Rousseau) North Devon District Hospital, United Kingdom
(Brennan) Bradford Teaching Hospital, United Kingdom
(Balaji) Hull Royal Infirmary, United Kingdom
(Cupitt) Blackpool Victoria Hospital, United Kingdom
(Nightingale) Portsmouth Hospital, United Kingdom
(Kunst) King's College Hospital, United Kingdom
(Dickinson) Royal Surrey County Hospital, United Kingdom
(Saran) University Hospitals, Coventry and Warwickshire, United Kingdom
(Subramaniam, Banner-Godspeed) Beth Israel Deaconess Medical Center,
United States
(Sessler, Liu, Kurz, Hesler, Fu, Egan, Fiffick, Hutcherson, Turan, Naylor)
Cleveland Clinic, United States
(Obal, Cooke) Louisville Medical Centre, United States
Title
Intraoperative dexamethasone does not increase the risk of postoperative
wound infection: A propensity score-matched post hoc analysis of the
ENIGMA-II trial (EnDEX).
Source
British Journal of Anaesthesia. 118 (2) (pp 190-199), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Background. In a post hoc analysis of the ENIGMA-II trial, we sought to
determine whether intraoperative dexamethasone was associated with adverse
safety outcomes. Methods. Inverse probability weighting with estimated
propensity scores was used to determine the association of dexamethasone
administration with postoperative infection, quality of recovery, and
adverse safety outcomes for 5499 of the 7112 non-cardiac surgery subjects
enrolled in ENIGMA-II. Results. Dexamethasone was administered to 2178
(40%) of the 5499 subjects included in this analysis and was not
associated with wound infection [189 (8.7%) vs 275 (8.3%); propensity
score-adjusted relative risk (RR) 1.10; 95% confidence interval (CI)
0.89-1.34; P=0.38], severe postoperative nausea and vomiting on day 1 [242
(7.3%) vs 189 (8.7%); propensity score-adjusted RR 1.06; 95% CI 0.86-1.30;
P=0.59], quality of recovery score [median 14, interquartile range (IQR)
12-15, vs median 14, IQR 12-16, P=0.10), length of stay in the
postanaesthesia care unit [propensity score-adjusted median (IQR) 2.0
(1.3, 2.9) vs 1.9 (1.3, 3.1), P=0.60], or the primary outcome of the main
trial. Dexamethasone administration was associated with a decrease in
fever on days 1-3 [182 (8.4%) vs 488 (14.7%); RR 0.61; 95% CI 0.5-0.74;
P<0.001] and shorter lengths of stay in hospital [propensity
score-adjusted median (IQR) 5.0 (2.9, 8.2) vs 5.3 (3.1, 9.1), P<0.001].
Neither diabetes mellitus nor surgical wound contamination status altered
these outcomes. Conclusion. Dexamethasone administration to high-risk
non-cardiac surgical patients did not increase the risk of postoperative
wound infection or other adverse events up to day 30, and appears to be
safe in patients either with or without diabetes mellitus. Clinical trial
registration. NCT00430989.<br/>Copyright &#xa9; 2017 The Author.

<86>
Accession Number
616796483
Author
Helsen F.; Vandenberk B.; De Meester P.; Van De Bruaene A.; Gabriels C.;
Troost E.; Gewillig M.; Meyns B.; Willems R.; Budts W.
Institution
(Helsen, De Meester, Van De Bruaene, Gabriels, Troost, Willems, Budts)
Division of Cardiology, Department of Cardiovascular Sciences, KU
Leuven-University of Leuven, Leuven, Belgium
(Helsen, Vandenberk, De Meester, Van De Bruaene, Gabriels, Troost,
Willems, Budts) Department of Cardiovascular Diseases, University
Hospitals Leuven, Congenital and Structural Heart Disease Clinic, Leuven
B-3000, Belgium
(Vandenberk) Division of Experimental Cardiology, Department of
Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium
(Gewillig) Division of Cardiovascular Developmental Biology, Department of
Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium
(Gewillig) Department of Paediatrics, University Hospitals Leuven, Leuven,
Belgium
(Meyns) Division of Clinical Cardiac Surgery, Department of Cardiovascular
Sciences, KU Leuven-University of Leuven, Leuven, Belgium
(Meyns) Department of Cardiac Surgery, University Hospitals Leuven,
Leuven, Belgium
Title
Appearance of QRS fragmentation late after Mustard/Senning repair is
associated with adverse outcome.
Source
Heart. 103 (13) (pp 1036-1042), 2017. Date of Publication: 01 Jul 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To evaluate if development of fragmented QRS (fQRS) complexes, a
marker of inhomogeneous ventricular activation due to myocardial fibrosis,
is associated with adverse outcome in adults after Mustard/Senning repair
for d-transposition of the great arteries (d-TGA). Methods Adults with
atrial switch repair for d-TGA were selected from the database of a
tertiary care hospital. Exclusion criteria were systemic right ventricular
(RV) assist device or heart transplantation (HTx) before the age of 16, or
fQRS already present at first visit to the Adult Congenital Heart Disease
clinic. A blinded expert reader retrospectively analysed all available
ECGs after the age of 16 for the presence of fQRS. The appearance of fQRS
was modelled for each patient as a time-dependent variable. Cox regression
was performed to assess the relationship between covariates and the
composite endpoint of cardiovascular mortality, HTx or systemic RV assist
device. Results Records of 89 patients (34% female, 42% Mustard repair)
were analysed. At latest follow-up, fQRS was noted in 26 patients (29%).
Over a median follow-up time of 16.9 (IQR 12.6-22.9) years, the composite
endpoint occurred in nine patients (10%). In multivariable Cox analysis,
appearance of fQRS (HR 14.11; 95% CI 1.42 to 140.12) and development of
severe RV dysfunction (HR 11.36; 95% CI 2.08 to 62.17) were significantly
associated with the composite endpoint. Conclusions Appearance of fQRS
complexes on a 12-lead ECG is associated with adverse outcome in adults
after atrial switch repair for d-TGA. In this population, fQRS detection
might be a promising and easily implementable tool to identify patients at
risk for adverse events.<br/>Copyright &#xa9; Article author(s) 2017.