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<1>
Accession Number
615701978
Author
Hommel I.; Van Gurp P.J.; Den Broeder A.A.; Wollersheim H.; Atsma F.;
Hulscher M.E.J.L.; Tack C.J.
Institution
(Hommel, Wollersheim, Atsma, Hulscher) Radboud University Medical Center,
Radboud Institute for Health Sciences, Scientific Institute for Quality of
Healthcare, PO Box 9101, Nijmegen 6500 HB, Netherlands
(Van Gurp, Tack) Department of General Internal Medicine, Radboud
University Medical Center, Radboud Institute for Health Sciences,
Nijmegen, Netherlands
(Den Broeder) Department of Rheumatology, Sint Maartenskliniek, Nijmegen,
Netherlands
Title
Reactive Rather than Proactive Diabetes Management in the Perioperative
Period.
Source
Hormone and Metabolic Research. 49 (7) (pp 527-533), 2017. Date of
Publication: 01 Jul 2017.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
As perioperative hyperglycemia is associated with poor postoperative
patient outcomes, clinical guidelines provide recommendations for optimal
perioperative glucose control. It is unclear to what extent recommended
glucose levels are met in daily practice, and little is known about
factors that influence these levels. We describe blood glucose levels
throughout the hospital care pathway in 375 non-critically ill patients
with diabetes who underwent major surgery (abdominal, cardiac, or
orthopedic) in 6 hospitals, examine determinants of these levels including
adherence to 9 quality indicators for optimal perioperative diabetes care,
and perform qualitative interviews to identify barriers for optimal care.
Virtually all patients (95%) experienced at least one hyperglycemic value
(>10 mmol/l); 9% had at least one value <4 mmol/l. Mean glucose increased
from preoperative to postoperative day (POD) 1 (+2.3 mmol/l, 5-95% CI
1.9-2.7), and then gradually decreased on POD 2-14 (+1.8 mmol/l, 5-95% CI
1.4-2.2). Insulin-treated patients (with or without oral agents) had
higher glucose levels (+1.7 mmol/l, 5-95% CI 0.5-3.0, and +1.2 mmol/l,
-0.1 to -2.5) than patients using oral agents only. Indicator adherence
tended to be associated with higher glucose levels. Barriers for optimal
care included a lack of formalized agreements on target glucose levels,
absence of directly obvious disadvantages of hyperglycemia, and concern
about inducing hypoglycemia. Hyperglycemia is common after major surgery,
in particular on POD1 and in insulin-treated patients. Our results suggest
that perioperative diabetes care is reactive rather than proactive, and
that current emphasis of professionals is on treating instead of
preventing postoperative hyperglycemia.<br/>Copyright &#xa9; Georg Thieme
Verlag KG Stuttgart, New York.

<2>
Accession Number
610849441
Author
Piccioni F.; Bernasconi F.; Tramontano G.T.A.; Langer M.
Institution
(Piccioni, Langer) Department of Anesthesia, Intensive Care and Palliative
Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1,
Milan 20133, Italy
(Bernasconi, Tramontano) School of Anesthesia and Intensive Care,
University of Milan, Via Festa del Perdono 7, Milan 20122, Italy
(Langer) Department of Pathophysiology and Transplantation, University of
Milan, Via Festa del Perdono 7, Milan 20122, Italy
Title
A systematic review of pulse pressure variation and stroke volume
variation to predict fluid responsiveness during cardiac and thoracic
surgery.
Source
Journal of Clinical Monitoring and Computing. 31 (4) (pp 677-684), 2017.
Date of Publication: 01 Aug 2017.
Publisher
Springer Netherlands
Abstract
This systematic review aims to summarize the published data on the
reliability of pulse pressure variation (PPV) and stroke volume variation
(SVV) to predict fluid responsiveness in an open-chest setting during
cardio-thoracic surgery. The analysis included studies reporting receiver
operating characteristics or correlation coefficients between PPV/SVV and
change in any hemodynamic variables after a fluid challenge test in
open-chest conditions. The literature search included seven studies.
Increase in cardiac index and stroke volume index after a fluid challenge
were the most adopted end-point variables. PPV and SVV showed similar area
under the receiver operating characteristic curve values but high
heterogeneity among studies. Cardiac and thoracic studies did not differ
between PPV/SVV pooled area under the receiver operating characteristic
curve. Studies exploring correlation between dynamic indices and end-point
variable increase after fluid challenge showed conflicting results. The
great heterogeneity between studies was due to small sample size and
differences among protocol designs (different monitor devices, mechanical
ventilation settings, fluid challenge methodologies, surgical incisions,
and end-point variables). PPV and SVV seem to be inaccurate in predicting
fluid responsiveness in an open-chest setting during cardio-thoracic
surgery. Given the high heterogeneity of published data, more studies are
needed to define the role of PPV/SVV in this context.<br/>Copyright &#xa9;
2016, Springer Science+Business Media Dordrecht.

<3>
Accession Number
615145662
Author
Wang J.; Yu W.; Zhou Y.; Yang Y.; Li C.; Liu N.; Hou X.; Wang L.
Institution
(Wang, Yu, Wang) Department of Cardiac Surgery, Beijing An Zhen Hospital
Capital Medical University, Beijing, China
(Wang, Zhou, Yang, Li, Liu, Hou) Center for Cardiac Intensive Care,
Beijing An Zhen Hospital Capital Medical University, Beijing, China
Title
Independent Risk Factors Contributing to Acute Kidney Injury According to
Updated Valve Academic Research Consortium-2 Criteria After Transcatheter
Aortic Valve Implantation: A Meta-analysis and Meta-regression of 13
Studies.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (3) (pp 816-826),
2017. Date of Publication: June 2017.
Publisher
W.B. Saunders
Abstract
Objectives This study aimed to examine the risk factors for transcatheter
aortic valve implantation (TAVI)-associated acute kidney injury (AKI)
according to the AKI definition from the Valve Academic Research
Consortium-2 (VARC-2). Setting A meta-analysis. Participants A total of
661 patients with post-TAVI AKI according to the VARC-2 definition and
2,012 controls were included in the meta-analysis. Interventions Patients
undergoing TAVI were included in this meta-analysis. Measurements and Main
Results Multiple electronic databases were searched using predefined
criteria. The diagnosis of AKI was based on the VARC-2 classification. The
authors found that preoperative New York Heart Association class IV (odds
ratio [OR], 7.77; 95% confidence interval [CI], 3.81-15.85), previous
chronic renal disease (CKD) (OR, 2.81; 95% CI, 1.96-4.03), and requirement
for transfusion (OR, 2.03; 95% CI, 1.59-2.59) were associated
significantly with an increased risk for post-TAVI AKI. Furthermore,
previous peripheral vascular disease (PVD), hypertension, atrial
fibrillation, congestive heart failure, diabetes mellitus, and stroke were
also risk factors for TAVI-associated AKI. Additionally, transfemoral
access significantly correlated with a reduced risk for post-TAVI AKI (OR,
0.43; 95% CI, 0.33-0.57). The potential confounders, including Society of
Thoracic Surgeons Score, the logistic European System for Cardiac
Operative Risk Evaluation, aortic valve area, mean pressure gradient, left
ventricular ejection fraction, age, body mass index, contrast volume, and
valve type, had no impact on the association between the risk factors and
post-TAVI AKI. Subgroup analysis of the eligible studies presenting
multivariate logistic regression analysis on the independent risk factors
for post-TAVI AKI revealed that previous CKD, previous PVD, and
transapical access were independent risk factors for TAVI-associated AKI.
Conclusions The current meta-analysis suggested that previous CKD,
previous PVD, and transapical access may be independent risk factors for
TAVI-associated AKI.<br/>Copyright &#xa9; 2017

<4>
Accession Number
615124595
Author
Garijo J.M.; Wijeysundera D.N.; Munro J.C.; Meineri M.
Institution
(Garijo, Wijeysundera, Munro, Meineri) Department of Anesthesia and Pain
Management, Toronto General Hospital, Toronto, ON, Canada
Title
Correlation Between Transhepatic and Subcostal Inferior Vena Cava Views to
Assess Inferior Vena Cava Variation: A Pilot Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (3) (pp 973-979),
2017. Date of Publication: June 2017.
Publisher
W.B. Saunders
Abstract
Objectives To assess the feasibility and reliability of transthoracic
echocardiography to measure inferior vena cava (IVC) diameter variation
using a transhepatic view. Design Prospective cohort study. Setting
Single-center hospital. Patients Forty consecutive patients undergoing
elective cardiac surgery. Interventions Bedside transthoracic
echocardiography. Measurements and Main Results Correlation between the
two views was measured using Pearson R, while agreement was measured using
the intraclass correlation coefficient (ICC). In a nested sub-study of 16
randomly selected participants, all images were re-rated by the same
rater, who was blinded to the original measurement results, and by a
second blinded operator. Correlation between the subcostal and
transhepatic views was moderate when assessing maximum (R 0.46; 95%
confidence interval [CI], 0.18-0.68), and minimum (R 0.55; CI, 0.29-0.74)
IVC diameter. Correlation when measuring IVC diameter variation was higher
(R 0.70; CI, 0.49-0.83). Agreement between the two views for IVC diameter
variation measurement was substantial (ICC 0.73; CI, 0.49-0.85).
Intra-rater reliability was excellent (ICC 0.95-0.99). Conclusions
Agreement between subcostal and transhepatic views was substantial for the
assessment of IVC diameter variation; however, the magnitude of agreement
was less than anticipated. Further research is needed to determine if the
transhepatic view can be used reliably in the assessment of fluid
responsiveness.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<5>
Accession Number
616235956
Author
Preda G.; Bige N.; Bonsey M.; Joffre J.; Ait-Oufella H.; Maury E.; Vezzani
A.; Manca T.; Brusasco C.; Santori G.; Cantadori L.; Ramelli A.; Gonzi G.;
Nicolini F.; Gherli T.; Corradi F.
Institution
(Preda) Intensive Care Unit, Hopital Delafontaine, Centre Hospitalier de
Saint Denis, 2 rue docteur Delafontaine, Saint Denis 93200, France
(Bige, Bonsey, Joffre, Ait-Oufella, Maury) Medical Intensive Care Unit,
Hopital Saint-Antoine, Assistance Publique-Hopitaux de Paris, 184 rue du
Faubourg Saint-Antoine, Paris Cedex 12 75571, France
(Joffre, Ait-Oufella, Maury) Paris-Sorbonne and Pierre-and-Marie Curie
Universities (UPMC), Paris, France
(Vezzani, Manca, Ramelli, Nicolini, Gherli) Department of Surgery,
University Hospital of Parma, Parma, Italy
(Brusasco, Corradi) Anaesthesia and Intensive Care Unit, E.O. Ospedali
Galliera, Genoa, Italy
(Santori) Department of Surgical Sciences and Integrated Diagnostics,
University of Genoa, Genoa, Italy
(Cantadori) Department of Emergency Medicine, Fidenza Hospital, Health
Organization of Parma (AUSL), Parma, Italy
(Gonzi) Department of Cardiology, University Hospital of Parma, Parma,
Italy
Title
Discussion on "A randomized clinical trial of ultrasound-guided
infra-clavicular cannulation of the subclavian vein in cardiac surgical
patients: short-axis versus long-axis approach".
Source
Intensive Care Medicine. 43 (8) (pp 1169-1170), 2017. Date of Publication:
01 Aug 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)

<6>
Accession Number
615985103
Author
Bai A.D.; Steinberg M.; Showler A.; Burry L.; Bhatia R.S.; Tomlinson G.A.;
Bell C.M.; Morris A.M.
Institution
(Bai) Department of Medicine, Queen's University, Kingston, Ontario,
Canada
(Steinberg, Burry, Bell, Morris) Sinai Health System, Toronto, Ontario,
Canada
(Showler, Tomlinson, Bell, Morris) Department of Medicine, University of
Toronto, Toronto, Ontario, Canada
(Burry) Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto,
Ontario, Canada
(Bhatia) Women's College Hospital Institute for Health Systems Solutions
and Virtual Care, Toronto, Ontario, Canada
(Tomlinson, Bell, Morris) University Health Network, Toronto, Ontario,
Canada
(Bell) Institute for Clinical Evaluative Sciences, Toronto, Ontario,
Canada
Title
Diagnostic Accuracy of Transthoracic Echocardiography for Infective
Endocarditis Findings Using Transesophageal Echocardiography as the
Reference Standard: A Meta-Analysis.
Source
Journal of the American Society of Echocardiography. 30 (7) (pp
639-646.e8), 2017. Date of Publication: July 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Echocardiography is important for the diagnosis of infective
endocarditis (IE), for which transesophageal echocardiography (TEE) is
superior to transthoracic echocardiography (TTE). Methods A systematic
review and meta-analysis of observational studies was performed with the
objective of evaluating diagnostic properties of TTE, with transesophageal
findings of IE as the reference standard in patients with suspected IE.
Results The literature search yielded 377 unique articles, of which 16 met
the inclusion criteria. The 16 studies included 2,807 patients, of whom
793 (28%) had vegetations on TEE. For detecting vegetations, harmonic TTE
had sensitivity of 61% (95% CI, 45%-75%) and specificity of 94% (95% CI,
85%-98%) with a negative likelihood ratio (NLR) of 0.42 (95% CI,
0.26-0.61). NLR for harmonic TTE can be improved by including only
patients without prosthetic valves (NLR = 0.36; 95% CI, 0.22-0.55) or by
having strict criteria for conclusively negative results on TTE (NLR =
0.17; 95% CI, 0.10-0.28). In the setting of patients without prosthetic
valves, harmonic TTE had likelihood ratios of 0.14 (95% CI, 0.09-0.23) for
a conclusively negative result, 0.66 (95% CI, 0.53-0.81) for an
indeterminate result, and 14.60 (95% CI, 3.37-70.40) for a positive
result. Conclusions Modern harmonic TTE still has the potential to miss
many vegetations detected on TEE. When limited to patients without
prosthetic valves, a conclusively negative TTE under optimal view greatly
decreases likelihood of IE. All other transthoracic results are not useful
for ruling out IE, and subsequent TEE is almost always
required.<br/>Copyright &#xa9; 2017 American Society of Echocardiography

<7>
Accession Number
617243610
Author
Kikuchi K.; Mori M.
Institution
(Kikuchi) Department of Cardiac Surgery, Wuhan Asia Heart Hospital, No.753
Jinghan Ave, Wuhan 430022, China
(Mori) Section of Cardiac Surgery, Yale School of Medicine, New Haven, CT,
United States
Title
Minimally invasive coronary artery bypass grafting: A systematic review.
Source
Asian Cardiovascular and Thoracic Annals. 25 (5) (pp 364-370), 2017. Date
of Publication: 01 Jun 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
To minimize surgical morbidity in coronary artery bypass grafting,
minimally invasive cardiac surgery has gained popularity. Minimally
invasive coronary artery bypass grafting offers unique advantages compared
to conventional off-pump coronary artery bypass or minimally invasive
direct coronary artery bypass in that it enables the surgeon to harvest
and graft bilateral internal thoracic arteries via a small thoracotomy
while being conducted completely off-pump. This review focuses on current
evidence behind off-pump coronary artery bypass, multi-arterial
revascularization, patient populations that would most benefit from
bilateral internal thoracic artery minimally invasive coronary artery
bypass grafting, the surgical technique, and early outcomes. By overcoming
the perceived inability to utilize bilateral internal thoracic arteries in
minimally invasive coronary artery bypass grafting, the new technique
further expands the armamentarium of surgeons and cardiologists. Hybrid
coronary revascularization with bilateral internal thoracic artery
minimally invasive coronary artery bypass grafting further augments the
appeal of the next generation of minimally invasive cardiac
surgery.<br/>Copyright &#xa9; The Author(s) 2016.

<8>
Accession Number
614877547
Author
Clemmensen T.S.; Holm N.R.; Eiskjaer H.; Logstrup B.B.; Christiansen E.H.;
Dijkstra J.; Barkholt T.O.; Terkelsen C.J.; Maeng M.; Poulsen S.H.
Institution
(Clemmensen, Holm, Eiskjaer, Logstrup, Christiansen, Barkholt, Terkelsen,
Maeng, Poulsen) Department of Cardiology, Aarhus University Hospital,
Skejby, Denmark
(Dijkstra) Division of Image Processing, Leiden University Medical Centre,
Leiden, Netherlands
Title
Layered Fibrotic Plaques Are the Predominant Component in Cardiac
Allograft Vasculopathy: Systematic Findings and Risk Stratification by
OCT.
Source
JACC: Cardiovascular Imaging. 10 (7) (pp 773-784), 2017. Date of
Publication: July 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aims of this study were to characterize cardiac allograft
vasculopathy (CAV) phenotypes using optical coherence tomography (OCT) and
to evaluate the prognostic significance of OCT-determined CAV severity.
Background Intravascular OCT enables in vivo characterization of CAV
microstructure after heart transplantation. Methods Sixty-two patients
undergoing heart transplantation were enrolled at routine angiography from
September 2013 through October 2015 and prospectively followed until
censoring on May 27, 2016. Optical coherence tomographic acquisitions
aimed for the longest possible pull-backs, including proximal segments of
all 3 major vessels. Plaques and bright spots were analyzed by delineating
circumferential borders and measuring the angulation of total
circumference. Layers were contoured for absolute and relative estimates.
Nonfatal CAV progression (NFCP) during follow-up was registered. NFCP
included occluded vessels or severe (>=70%) new angiographic coronary
stenosis or percutaneous coronary intervention. Results A total of 172
vessels were categorized as follows: no CAV, n = 111; mild to moderate CAV
(<70% stenosis), n = 40; and severe CAV (>=70% stenosis), n = 21. Layered
fibrotic plaque (LFP) was the most prevalent plaque component, and the
extent increased with angiographic CAV severity (p < 0.01). During
follow-up, 22 of 172 vessels (13%) experienced NFCP. Median follow-up was
633 days (interquartile range: 432 to 808 days). The extent of LFP (hazard
ratio: 5.0; 95% confidence interval: 2.1 to 12.4; p < 0.0001) and the
extent of bright spots (hazard ratio: 6.2; 95% confidence interval: 2.4 to
15.8, p < 0.001) were strong predictors of NFCP. By combining LFP and
bright spots, a strong NFCP predictive model was obtained (hazard ratio:
8.9; 95% confidence interval: 2.6 to 29.9; p < 0.0001). Conclusions OCT
enables the detection of CAV-associated plaque compositions and allows
early detection and differentiation of vessel wall disease not visible on
angiography. LFP was the most prevalent plaque component, was strongly
associated with NFCP, and may be associated with stepwise CAV progression
caused by organizing mural thrombi. (The GRAFT Study: Evaluation of Graft
Function, Rejection and Cardiac Allograft Vasculopathy in First Heart
Transplant Recipients; NCT02077764)<br/>Copyright &#xa9; 2017 American
College of Cardiology Foundation

<9>
[Use Link to view the full text]
Accession Number
615137499
Author
Morris N.P.; Body R.
Institution
(Morris, Body) University of Manchester and Central Manchester NHS
Foundation Trust, Manchester Royal Infirmary Emergency Department, Oxford
Road, Manchester M13 9WL, United Kingdom
Title
The de Winter ECG pattern: Morphology and accuracy for diagnosing acute
coronary occlusion: Systematic review.
Source
European Journal of Emergency Medicine. 24 (4) (pp 236-242), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The De Winter ECG pattern has been reported to indicate acute left
anterior descending coronary artery occlusion and is often considered to
be an 'ST elevation myocardial infarction (STEMI) equivalent'. We aimed to
investigate the morphology of the 'De Winter ECG pattern' and evaluate the
test characteristics of the De Winter pattern for the diagnosis of acute
coronary occlusion. We identified papers through the Medline, EMBASE and
COCHRANE databases and screened for bias using QUADAS-2. First,
measurements were recorded from every ECG reported in the literature and
aggregated. Second, diagnostic accuracy data from eligible cohort studies
were extracted. The primary outcome was defined as at least 70%
angiographic stenosis of a major epicardial vessel. Thirteen papers
reported data relevant to question 1 and three papers reported data
relevant to question 2. All ECGs showed maximal up-sloping ST depression
in lead V3 with a median amplitude of 0.3 mV (interquartile range: 0.2-4
mV). T-wave height peaked in lead V3 with a median amplitude 0.9 mV
(interquartile range: 0.8-1.1 mV). The De Winter pattern had positive
predictive values of 95.2% (95% confidence interval: 76.2-99.9%), 100%
(69.2-100.0%) and 100% (51.7-100%) in the three respective diagnostic
studies. There is limited evidence that the De Winter ECG pattern is a
'STEMI equivalent'. The available data suggest that the pattern has high
positive predictive value for acute occlusion. Further research is
required to evaluate specificity and to determine whether rapid
revascularization improves mortality.<br/>Copyright &#xa9; 2017 Wolters
Kluwer Health, Inc. All rights reserved.

<10>
Accession Number
617088123
Author
Leclercq F.; Robert P.; Labour J.; Lattuca B.; Akodad M.; Macia J.-C.;
Gervasoni R.; Roubille F.; Gandet T.; Schmutz L.; Nogue E.; Nagot N.;
Albat B.; Cayla G.
Institution
(Leclercq, Robert, Labour, Akodad, Macia, Gervasoni, Roubille) University
Hospital of Montpellier, Department of Cardiology, Montpellier, France
(Gandet, Albat) University Hospital of Montpellier, Department of
Cardiovascular Surgery, Montpellier, France
(Lattuca, Schmutz, Cayla) University Hospital of Nimes, Department of
Cardiology, Nimes, France
(Nogue, Nagot) University Hospital of Montpellier, Department of Medical
Information, Montpellier, France
(Leclercq) University of Montpellier, Department of Cardiology, Arnaud de
Villeneuve Hospital, Avenue du doyen Giraud, Montpellier cedex 5 34295,
France
Title
Prior balloon valvuloplasty versus DIRECT transcatheter Aortic Valve
Implantation (DIRECTAVI): Study protocol for a randomized controlled
trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 303. Date of
Publication: 04 Jul 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Balloon predilatation of the aortic valve has been regarded as
an essential step during the transcatheter aortic valve implantation
(TAVI) procedure. However, recent evidence has suggested that aortic
valvuloplasty may cause complications and that high success rates may be
obtained without prior dilatation of the valve. We hypothesize that TAVI
performed without predilatation of the aortic valve and using
new-generation balloon-expandable transcatheter heart valves is associated
with a better net clinical benefit than TAVI performed with predilatation.
Methods/design: The transcatheter aortic valve implantation without prior
balloon dilatation (DIRECTAVI) trial is a randomized controlled open label
trial that includes 240 patients randomized to TAVI performed with prior
balloon valvuloplasty (control arm) or direct implantation of the valve
(test arm). All patients with an indication for TAVI will be included
excepting those requiring transapical access. The trial tests the
hypothesis that the strategy of direct implantation of the new-generation
balloon-expandable SAPIEN 3 valve is noninferior to current medical
practice using predilatation of the valve. The primary endpoint assessing
efficacy and safety of the procedure consists of immediate procedural
success and secondary endpoints include complications at 30-day follow-up
(VARC-2 criteria). A subgroup analysis evaluates neurological ischemic
events with cerebral MRI imaging (25 patients in each strategy group)
performed before and between 1 and 3 days after the procedure. Discussion:
This prospective randomized study is designed to assess the efficacy and
safety of TAVI performed without prior dilatation of the aortic valve
using new-generation balloon-expandable transcatheter heart valves. We aim
to provide robust evidence of the advantages of this strategy to allow the
interventional cardiologist to use it in everyday practice. Trial
registration: ClinicalTrials.gov identifier: NCT02729519. Registered on 15
July 2016.<br/>Copyright &#xa9; 2017 The Author(s).

<11>
Accession Number
617175060
Author
Spitzer S.G.; Andresen D.; Kuck K.-H.; Seidl K.; Eckardt L.; Ulbrich M.;
Brachmann J.; Gonska B.-D.; Hoffmann E.; Bauer A.; Hochadel M.; Senges J.
Institution
(Spitzer) Praxisklinik Herz und Gefase, Akademische Lehrpraxisklinik der
TU Dresden, Forststrase 3, Dresden 01099, Germany
(Spitzer) Brandenburgische Technische Universitat Cottbus-Senftenberg,
Senftenberg, Germany
(Andresen) Klinikum Am Urban, Berlin, Germany
(Kuck) Asklepios Klinik St Georg, Hamburg, Germany
(Seidl) Klinikum Ludwigshafen GGmbH, Ludwigshafen am Rhein, Germany
(Eckardt) University Hospital, Munster, Germany
(Ulbrich) Klinikum Groshadern, Munich, Germany
(Brachmann) Klinikum Coburg GmbH, Coburg, Germany
(Gonska) Vincentius Hospital, Karlsruhe, Germany
(Hoffmann) Klinikum Munchen Bogenhausen, Munich, Germany
(Bauer) Diakonie-Klinikum Schwabisch Hall GGmbH, Schwabisch Hall, Germany
(Hochadel, Senges) Stiftung Institut fur Herzinfarktforschung,
Ludwigshafen, Germany
Title
Long-term outcomes after event-free cardioverter defibrillator
implantation: Comparison between patients discharged within 24 h and
routinely hospitalized patients in the German DEVICE registry.
Source
Europace. 19 (6) (pp 968-975), 2017. Date of Publication: 01 Jun 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims To analyse the long-term safety of implantable cardioverter
defibrillators (ICDs) in patients discharged within 24 h or after 2- 5-day
hospitalization, respectively, after complication-free implantation, in
circumstances of actual care. Methods and results Patients in the
multicentre, nationwide German DEVICE registry were contacted 12-15 months
after their first ICD implantation or device replacement. Data were
collected on complications, potential arrhythmic events, syncope,
resuscitation, ablation procedures, cardiac events, hospitalizations,
heart failure status, change of medication, and quality of life. Of 2356
patients from 43 centres, 527 patients were discharged within 24 h and
1829 were hospitalized routinely for >24 h after complication-free
implantations. The disease profiles and rates of co-morbidities were
similar at baseline for both cohorts. During between 384 and 543 days of
follow-up, there were no significant differences between the groups in
terms of complications, hospitalizations, or quality of life. One-year
rates of death were 4.5% in patients discharged early compared with 7.2%
in hospitalized patients (hazard ratio 0.65; 95% confidence interval
0.42-1.02; P = 0.052). Rates of major adverse cardiovascular events or
defibrillator events were not higher in patients discharged after 24 h. In
both groups, a high rate of patients declared that they would opt for the
procedure again in the same situation. Conclusion Data from a large-scale
registry reflecting current day-to-day practice in Germany suggest that
most patients can be discharged safely within 24 h of successful ICD
implantation if there are no procedure-related events. Follow-up data up
to 1.5 years after implantation did not raise long-term safety
concerns.<br/>Copyright &#xa9; The Author 2016.

<12>
Accession Number
617172990
Author
Huang P.; Yu Y.; Han X.; Yang Y.
Institution
(Huang, Han, Yang) State Key Laboratory of Cardiovascular Disease, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences & Peking Union Medical College, Beijing 100037, China
(Yu) National Clinical Research Center of Cardiovascular Diseases, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences & Peking Union Medical College, Beijing 100037, China
Title
Efficacy of Short-term Dual Antiplatelet Therapy after Implantation of
Second-generation Drug-eluting Stents: A Meta-analysis and Systematic
Review.
Source
Chinese Medical Sciences Journal. 32 (1) (pp 1-12), 2017. Date of
Publication: March 2017.
Publisher
Elsevier Ltd
Abstract
Objective The benefit of short-term dual antiplatelet therapy (DAPT)
following second-generation drug-eluting stents implantation has not been
systematically evaluated. To bridge the knowledge gap, we did a
meta-analysis to assess the efficacy of <=6 months versus >=12 months DAPT
among patients with second-generation drug-eluting stents. Methods We
searched online databases and identified randomized controlled trials that
assess the clinical impact of short-term DAPT (<=6 months) published
before March 3, 2016. The efficacy endpoints included the incidence of
all-cause death, myocardial infarction, cerebrovascular accidents, and
definite or probable stent thrombosis. Safety endpoint defined as major
bleeding was also evaluated and discussed. Results We included 5 trials
that randomized 9473 participants (49.8%, short-term DAPT duration vs.
50.2%, standard duration). A total of 9445 (99.7%) patients reported the
efficacy endpoints, and the safety endpoint was available from 4 studies
(n=8457). There was no significant difference in efficacy endpoints
between short-term and standard DAPT duration (>=12 months) [risk ratio
(RR) 0.96; 95% confidence intervals (CI), 0.80-1.15]. Short-term DAPT
duration did not significantly increase the individual risk of all-cause
death, myocardial infarction, cerebrovascular accidents, or definite or
probable stent thrombosis. Although short-term DAPT obviously reduced risk
of major bleeding compared with standard DAPT (RR 0.53; 95% CI,
0.29-0.96), significant publication bias was found when accessing the
safety endpoint of the 4 studies (Egger's test, P=0.009). Conclusions The
efficacy of short-term DAPT was comparable with that of standard duration
DAPT. DAPT less than 6 months may be appropriate for patients receiving
second-generation drug-eluting stents implantation.<br/>Copyright &#xa9;
2017 Chinese Academy Medical Sciences

<13>
Accession Number
615245057
Author
Mauthner O.; Claes V.; Deschodt M.; Jha S.R.; Engberg S.; Macdonald P.S.;
Newton P.J.; De Geest S.
Institution
(Mauthner, Claes, Deschodt, De Geest) Institute of Nursing Science,
Faculty of Medicine, University of Basel, Switzerland
(Claes, Deschodt, De Geest) Academic Centre for Nursing and Midwifery,
Department of Public Health and Primary Care, KU Leuven, Belgium
(Jha, Macdonald) Heart Transplant Program, St Vincent's Hospital, Sydney,
Australia
(Jha, Newton) Centre for Cardiovascular and Chronic Care, Faculty Health,
University of Technology Sydney, Australia
(Engberg) School of Nursing, University of Pittsburgh, United States
(Macdonald) Victor Chang Cardiac Research Institute, Sydney, NSW,
Australia
Title
Handle with care: A systematic review on frailty in cardiac care and its
usefulness in heart transplantation.
Source
Transplantation Reviews. 31 (3) (pp 218-224), 2017. Date of Publication:
July 2017.
Publisher
W.B. Saunders
Abstract
Background There is growing consensus that frailty, a state of
vulnerability and a decline in functioning across multiple physiological
body systems, is a valuable criterion to guide clinicians' risk prediction
for poor outcomes in adult transplant candidates. In its 2016 listing
criteria for heart transplantation the International Society for Heart
Lung Transplantation recommends frailty assessment. We aimed to summarize
the usefulness of frailty assessment in heart transplant candidates or
recipients reported throughout the literature. Methods We performed a
systematic literature search in PubMed to identify papers reporting on
frailty in transplantation, chronic heart failure, and ventricualr assist
device implantation published over the last 10 years in English.
Additionally, a hand search was conducted, including manually searching
the reference lists and a citation search of relevant papers. Results
Eleven primary research articles were included in this systematic review.
Frailty is a risk factor for morbidity, hospitalization, and mortality in
patients with advanced heart failure and individuals being considered for
ventricualr assist device implantation. Of the patients being considered
for transplantation, 33% are frail. The Frailty Phenotype by Fried is a
particularly useful tool to quickly identify higher risk patients for
adverse outcomes. Conclusion A lack of standardization and limited
evidence on frailty in transplantation limit its use as a definitive
listing criterion. Future research efforts should focus on systematic
integration of frailty measures in transplant practice.<br/>Copyright
&#xa9; 2017 Elsevier Inc.

<14>
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Accession Number
617243480
Author
Mehta N.M.; Skillman H.E.; Irving S.Y.; Coss-Bu J.A.; Vermilyea S.;
Farrington E.A.; McKeever L.; Hall A.M.; Goday P.S.; Braunschweig C.
Institution
(Mehta) Division of Critical Care Medicine, Department of Anesthesiology,
Perioperative and Pain Medicine, Boston Children's Hospital, Harvard
Medical School, Boston, MA, United States
(Skillman) Clinical Nutrition Department, Children's Hospital Colorado,
Aurora, CO, United States
(Irving) Critical Care, Children's Hospital of Philadelphia, University of
Pennsylvania School of Nursing, Philadelphia, PA, United States
(Coss-Bu) Section of Critical Care, Department of Pediatrics, Baylor
College of Medicine, Texas Children's Hospital, Houston, TX, United States
(Vermilyea) Division of Nutrition Therapy, Cincinnati Children's Hospital
Medical Center, Cincinnati, OH, United States
(Farrington) Department of Pharmacy, Betty H. Cameron Women's and
Children's Hospital, New Hanover Regional Medical Center, Wilmington, NC,
United States
(McKeever) Department of Kinesiology and Nutrition, University of Illinois
at Chicago, Chicago, IL, United States
(Hall) Biostatistics, Department of Anesthesiology, Perioperative and Pain
Medicine, Boston Children's Hospital, Boston, MA, United States
(Goday) Pediatric Gastroenterology and Nutrition, Medical College of
Wisconsin, Milwaukee, WI, United States
(Braunschweig) Department of Kinesiology and Nutrition, Division of
Epidemiology and Biostatistics, University of Illinois, Chicago, IL,
United States
Title
Guidelines for the Provision and Assessment of Nutrition Support Therapy
in the Pediatric Critically Ill Patient: Society of Critical Care Medicine
and American Society for Parenteral and Enteral Nutrition.
Source
Pediatric Critical Care Medicine. 18 (7) (pp 675-715), 2017. Date of
Publication: 01 Jul 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
This document represents the first collaboration between two
organizations, American Society of Parenteral and Enteral Nutrition and
the Society of Critical Care Medicine, to describe best practices in
nutrition therapy in critically ill children. The target of these
guidelines is intended to be the pediatric (> 1 mo and < 18 yr) critically
ill patient expected to require a length of stay greater than 2 or 3 days
in a PICU admitting medical, surgical, and cardiac patients. In total,
2,032 citations were scanned for relevance. The PubMed/Medline search
resulted in 960 citations for clinical trials and 925 citations for cohort
studies. The EMBASE search for clinical trials culled 1,661 citations. In
total, the search for clinical trials yielded 1,107 citations, whereas the
cohort search yielded 925. After careful review, 16 randomized controlled
trials and 37 cohort studies appeared to answer one of the eight
preidentified question groups for this guideline. We used the Grading of
Recommendations, Assessment, Development and Evaluation criteria to adjust
the evidence grade based on assessment of the quality of study design and
execution. These guidelines are not intended for neonates or adult
patients. The guidelines reiterate the importance of nutritional
assessment, particularly the detection of malnourished patients who are
most vulnerable and therefore potentially may benefit from timely
intervention. There is a need for renewed focus on accurate estimation of
energy needs and attention to optimizing protein intake. Indirect
calorimetry, where feasible, and cautious use of estimating equations and
increased surveillance for unintended caloric underfeeding and overfeeding
are recommended. Optimal protein intake and its correlation with clinical
outcomes are areas of great interest. The optimal route and timing of
nutrient delivery is an area of intense debate and investigations. Enteral
nutrition remains the preferred route for nutrient delivery. Several
strategies to optimize enteral nutrition during critical illness have
emerged. The role of supplemental parenteral nutrition has been
highlighted, and a delayed approach appears to be beneficial.
Immunonutrition cannot be currently recommended. Overall, the pediatric
critical care population is heterogeneous, and a nuanced approach to
individualizing nutrition support with the aim of improving clinical
outcomes is necessary.<br/>Copyright &#xa9; 2017 by the Society of
Critical Care Medicine and the World Federation of Pediatric Intensive and
Critical Care Societies.

<15>
[Use Link to view the full text]
Accession Number
617243460
Author
Tume L.N.; Baines P.B.; Guerrero R.; Hurley M.A.; Johnson R.; Kalantre A.;
Ramaraj R.; Ritson P.C.; Walsh L.; Arnold P.D.
Institution
(Tume, Baines, Ritson, Walsh) PICU, Alder Hey Children's NHS Foundation
Trust, Liverpool, United Kingdom
(Tume, Hurley) University of Central Lancashire, College of Health and
Wellbeing, Preston, United Kingdom
(Guerrero, Johnson, Kalantre, Ramaraj, Arnold) Alder Hey Children's NHS
Foundation Trust, Liverpool, United Kingdom
Title
Pilot Study Comparing Closed Versus Open Tracheal Suctioning in
Postoperative Neonates and Infants with Complex Congenital Heart Disease.
Source
Pediatric Critical Care Medicine. 18 (7) (pp 647-654), 2017. Date of
Publication: 01 Jul 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: To determine the hemodynamic effect of tracheal suction method
in the first 36 hours after high-risk infant heart surgery on the PICU and
to compare open and closed suctioning techniques. Design: Pilot randomized
crossover study. Setting: Single PICU in United Kingdom. Participants:
Infants undergoing surgical palliation with Norwood Sano, modified
Blalock-Taussig shunt, or pulmonary artery banding in the first 36 hours
postoperatively. Interventions: Infants were randomized to receive open or
closed (in-line) tracheal suctioning either for their first or second
study tracheal suction in the first 36 hours postoperatively. Measurements
and Main Results: Twenty-four infants were enrolled over 18 months, 11
after modified Blalock-Taussig shunt, seven after Norwood Sano, and six
after pulmonary artery banding. Thirteen patients received the open
suction method first followed by the closed suction method second, and 11
patients received the closed suction method first followed by the open
suction method second in the first 36 hours after their surgery. There
were statistically significant larger changes in heart rate (p = 0.002),
systolic blood pressure (p = 0.022), diastolic blood pressure (p = 0.009),
mean blood pressure (p = 0.007), and arterial saturation (p = 0.040) using
the open suction method, compared with closed suctioning, although none
were clinically significant (defined as requiring any intervention).
Conclusions: There were no clinically significant differences between
closed and open tracheal suction methods; however, there were
statistically significant greater changes in some hemodynamic variables
with open tracheal suctioning, suggesting that closed technique may be
safer in children with more precarious physiology.<br/>Copyright &#xa9;
2017 by the Society of Critical Care Medicine and the World Federation of
Pediatric Intensive and Critical Care Societies.

<16>
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Accession Number
617243445
Author
Flores S.; Fitzgerald M.R.; Iliopoulos I.; Daily J.A.; Rodriguez M.;
Nelson D.P.; Wong H.R.; Menon K.; Cooper D.S.
Institution
(Flores) Section of Critical Care Medicine, Texas Children's Hospital,
Baylor College of Medicine, Houston, TX, United States
(Flores, Wong) Division of Critical Care Medicine, Cincinnati Children's
Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United
States
(Fitzgerald) Division of Emergency Medicine, Cincinnati Children's
Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United
States
(Iliopoulos, Daily, Nelson, Cooper) Heart Institute, Cincinnati Children's
Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United
States
(Daily) Division of Cardiology, Arkansas Children's Hospital, University
of Arkansas for Medical Sciences, Little Rock, AR, United States
(Rodriguez) Department of Pediatrics, Cincinnati Children's Hospital
Medical Center, University of Cincinnati, Cincinnati, OH, United States
(Menon) Division of Pediatric Critical Care, Children's Hospital of
Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
Title
An International Survey of Corticosteroid Use for the Management of Low
Cardiac Output Syndrome.
Source
Pediatric Critical Care Medicine. 18 (7) (pp 630-637), 2017. Date of
Publication: 01 Jul 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: Limited evidence exists on use of corticosteroids in low
cardiac output syndrome following cardiac surgery. We sought to determine
physicians' practices and beliefs with regard to corticosteroids therapy
for low cardiac output syndrome. Design: Multinational internet-based
survey. Setting: Pediatric Cardiac Intensive Care Society member database.
Subjects: Pediatric cardiac intensive care physicians. Interventions:
None. Measurements and Main Results: We received 188 responses from 85
centers throughout the world including 57 U.S. congenital heart centers,
eight Canadian centers, and 20 international centers. The majority of
respondents (51%) reported performing at least 200 bypass cases per year
and had separate dedicated cardiac ICUs (57%). Most physicians (89%)
rarely or never prescribe corticosteroids for mild low cardiac output
syndrome (single vasoactive agent and mildly decreased perfusion), whereas
94% of those surveyed sometimes or always administer corticosteroids to
patients with severe low cardiac output syndrome (two or more vasoactive
agents and persistent hypotension). Hydrocortisone was the most commonly
used corticosteroids (88%), but there was no consensus on dosage used.
There was a variable approach to cortisol level measurement and cortisol
stimulation testing to inform therapy with corticosteroids. A majority of
respondents (75%) stated that they would be willing to randomize patients
with severe low cardiac output syndrome into a trial of corticosteroids
efficacy. Conclusions: Our survey demonstrates considerable practice
variability with regard to the type of patients in whom corticosteroids
are administered, adrenal axis testing is performed, and dosage of
hydrocortisone used. The majority of physicians, however, stated their
willingness to randomize patients with severe low cardiac output syndrome
in a corticosteroids trial. This survey identified multiple areas for
future research on use of corticosteroids for low cardiac output
syndrome.<br/>Copyright &#xa9; 2017 by the Society of Critical Care
Medicine and the World Federation of Pediatric Intensive and Critical Care
Societies.

<17>
[Use Link to view the full text]
Accession Number
617243399
Author
Bundhun P.K.; Bhurtu A.; Huang F.
Institution
(Bundhun, Huang) Institute of Cardiovascular Diseases, First Affiliated
Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
(Bhurtu) Guangxi Medical University, Nanning, Guangxi, China
Title
Worse clinical outcomes following percutaneous coronary intervention with
a high SYNTAX score: A systematic review and meta-analysis.
Source
Medicine (United States). 96 (24) (no pagination), 2017. Article Number:
e7140. Date of Publication: 01 Jun 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: The synergy between percutaneous coronary intervention (PCI)
with TAXUS and Cardiac Surgery (SYNTAX) score is an angiographic tool
which is used to determine the complexity of coronary artery disease
(CAD). We aimed to compare PCI versus coronary artery bypass surgery
(CABG) in patients with a high SYNTAX score in order to confirm with
evidence whether the former is really association with worse clinical
outcomes. Methods: The National database of medical research articles
(MEDLINE/PubMed), EMBASE database, and the Cochrane library were searched
for publications comparing PCI versus CABG in patients with a high SYNTAX
score, respectively. Death, myocardial infarction (MI), stroke, repeated
revascularization, and a combined outcome death/stroke/MI were considered
as the clinical endpoints. RevMan software was used to analyze the data,
whereby odds ratios (OR) with 95% confidence intervals (CI) were used as
the statistical parameters. Results: A total number of 1074 patients were
included (455 patients with a high SYNTAX score were classified in the PCI
group and 619 other patients with a high SYNTAX score were classified in
the CABG group). A SYNTAX score cut-off value of >=33 was considered
relevant. Compared with CABG, mortality was significantly higher with a
high SYNTAX score following PCI with OR: 1.79, 95% CI: 1.18 to 2.70; P =
.006, I² = 0%. The combined outcome death/stroke/MI was also
significantly higher following PCI with a high SYNTAX score, with OR:
1.69, 95% CI: 1.24 to 2.30; P = .0009, I 2 = 0%. In addition, PCI was also
associated with significantly higher MI and repeated revascularization
when compared with CABG, with OR: 3.72, 95% CI: 1.75 to 7.89; P = .0006,
I² = 0% and OR: 4.33, 95% CI: 1.71 to 10.94; P = .002,
I² = 77%, respectively. However, stroke was not significantly
different. Conclusions: Compared with CABG, worse clinical outcomes were
observed following PCI in patients with a high SYNTAX score, confirming
with evidence, published clinical literatures. Therefore, CABG should be
recommended to CAD patients who have been allotted a high SYNTAX
score.<br/>&#xa9; Copyright 2017 the Author(s). Published by Wolters
Kluwer Health, Inc.

<18>
[Use Link to view the full text]
Accession Number
617243251
Author
Buentzel J.; Straube C.; Heinz J.; Roever C.; Beham A.; Emmert A.;
Hinterthaner M.; Danner B.C.
Institution
(Buentzel, Straube) Department of Haematology and Oncology, University of
Goettingen, University Medical Center Goettingen, Goettingen, Germany
(Heinz, Roever) Department of Medical Statistics, University of
Goettingen, University Medical Center Goettingen, Goettingen, Germany
(Beham) Department of General, Visceral and Pediatric Surgery, University
of Goettingen, University Medical Center Goettingen, Goettingen, Germany
(Emmert) Westklinikum Hamburg, Department of General and Visceral Surgery,
Hamburg, Germany
(Emmert, Hinterthaner, Danner) Department of Thoracic and Cardiovascular
Surgery, University of Goettingen, University Medical Center Goettingen,
Robert-Koch-Str. 40, Gottingen D-37075, Germany
Title
Thymectomy via open surgery or robotic video assisted thoracic surgery:
Can a recommendation already be made?.
Source
Medicine (United States). 96 (24) (no pagination), 2017. Article Number:
e7161. Date of Publication: 01 Jun 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Robot-assisted minimally invasive surgery (RVATS) is a
relatively new technique applied for thymectomies. Only few studies
directly compare RVATS to the mainstay therapy, open surgery (sternotomy).
Methods: A systematic search of the literature was performed in October
2016. The meta-analysis includes studies comparing robotassisted and open
thymectomy regarding operation time, length of hospitalization,
intraoperative blood loss, and chest-in-tube days, postoperative
complications, reoperation, arrhythmic events, pleural effusion, and
postoperative bleeding. Results: Of 626 studies preliminary screened, 7
articles were included. There were no significant differences in
comparison of operation time (-3.19 minutes [95% confidence interval, 95%
CI -112.43 to 106.05]; P = .94), but patients undergoing RVATS spent
significantly less time in hospital (-4.06 days [95% CI -7.98 to -0.13], P
= .046). There were fewer chests-in-tube days (-2.50 days [95% CI -15.01
to 10.01]; P = .24) and less intraoperative blood loss (-256.84 mL [95% CI
-627.47 to 113.80]; P = .10) observed in the RVATS group; due to a small
number of studies, these results were not statistically significant. There
were also less post-operative complications in the RVATS group (12
complications in 209 patients vs 51 complications in 259 patients);
however, this difference was not statistical significant (odds ratio 0.27,
95% CI 0.07-1.12; P = .06). Conclusions: Patients undergoing RVATS spent
less time in hospital than patients treated by open surgery (sternotomy).
These patients tended to have less postoperative complications, less
intraoperative blood loss, and fewer chest-in-tube days. We found evidence
for the safety and feasibility of RVATS compared with open surgery, which
has to be further confirmed in randomised controlled trials.<br/>&#xa9;
Copyright 2017 the Author(s). Published by Wolters Kluwer Health, Inc.

<19>
Accession Number
617254818
Author
Filardo G.; Pollock B.D.; da Graca B.; Phan T.K.; Sass D.M.; Ailawadi G.;
Thourani V.; Damiano R.
Institution
(Filardo, Pollock, da Graca, Phan, Sass) Office of the Chief Quality
Officer, Baylor Scott and White Health, Dallas, Tex
(Filardo) The Heart Hospital Baylor Plano, Plano, Tex
(Ailawadi) Division of Thoracic and Cardiovascular Surgery, University of
Virginia, Charlottesville, Va
(Thourani) Division of Cardiothoracic surgery, Emory University, Atlanta,
Ga
(Damiano) Department of Cardiac Surgery, Washington University School of
Medicine and Barnes-Jewish Hospital, St Louis, Mo
Title
Underestimation of the incidence of new-onset post-coronary artery bypass
grafting atrial fibrillation and its impact on 30-day mortality.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Inconsistent definitions of atrial fibrillation after coronary
artery bypass grafting have caused uncertainty about its incidence and
risk. We examined the extent to which limiting the definition to
post-coronary artery bypass grafting atrial fibrillation events requiring
treatment underestimates its incidence and impact on 30-day mortality.
Methods: We assessed in-hospital atrial fibrillation and 30-day mortality
in 9268 consecutive patients without preoperative atrial fibrillation who
underwent isolated coronary artery bypass grafting at 5 US hospitals
(2004-2010). Patients who experienced 1 or more episode of post-coronary
artery bypass grafting atrial fibrillation detected via continuous
in-hospital electrocardiogram/telemetry monitoring were divided into those
for whom Society of Thoracic Surgeons data (applying the definition
"atrial fibrillation/flutter requiring treatment") also indicated atrial
fibrillation versus those for whom it did not. Risk-adjusted 30-day
mortality was compared between these 2 groups and with patients without
post-coronary artery bypass grafting atrial fibrillation. Results:
Risk-adjusted incidence of post-coronary artery bypass grafting atrial
fibrillation incidence was 33.4% (27.0% recorded in Society of Thoracic
Surgeons data, 6.4% missed). Patients with post-coronary artery bypass
grafting atrial fibrillation missed by Society of Thoracic Surgeons data
had a significantly greater risk of 30-day mortality (odds ratio, 2.08,
95% confidence interval, 1.17-3.69) than those captured. By applying the
significant underestimation of post-coronary artery bypass grafting atrial
fibrillation incidence we observed (odds ratio [Society of Thoracic
Surgeons vs missed], 0.78; 95% confidence interval, 0.72-0.83) to the
approximately 150,000 patients undergoing isolated coronary artery bypass
grafting in the United States each year estimates this increased risk of
mortality is carried by 9600 patients (95% confidence interval, 9420-9780)
annually. Conclusions: Defining post-coronary artery bypass grafting
atrial fibrillation as episodes requiring treatment significantly
underestimates incidence and misses patients at a significantly increased
risk for mortality. Further research is needed to determine whether this
increased risk carries over into long-term outcomes and whether it is
mediated by differences in treatment and management.<br/>Copyright &#xa9;
2017 The American Association for Thoracic Surgery.

<20>
Accession Number
617242698
Author
Afilalo J.; Lauck S.; Kim D.H.; Lefevre T.; Piazza N.; Lachapelle K.;
Martucci G.; Lamy A.; Labinaz M.; Peterson M.D.; Arora R.C.; Noiseux N.;
Rassi A.; Palacios I.F.; Genereux P.; Lindman B.R.; Asgar A.W.; Kim C.A.;
Trnkus A.; Morais J.A.; Langlois Y.; Rudski L.G.; Morin J.-F.; Popma J.J.;
Webb J.G.; Perrault L.P.
Institution
(Afilalo, Rudski) Division of Cardiology, Jewish General Hospital, McGill
University, Montreal, Quebec, Canada
(Afilalo, Trnkus) Centre for Clinical Epidemiology, Jewish General
Hospital, Lady Davis Institute for Medical Research, Montreal, Quebec,
Canada
(Lauck, Webb) Centre for Heart Valve Innovation, St. Paul's Hospital,
University of Vancouver, Vancouver, British Columbia, Canada
(Kim, Kim) Division of Gerontology, Beth Israel Deaconess Medical Center,
Harvard University, Boston, Massachusetts
(Lefevre) Division of Cardiology, Institut Cardiovasculaire Paris Sud,
Hopital Prive Jacques Cartier, Massy, France
(Piazza, Martucci) Division of Cardiology, McGill University Health
Centre, Montreal, Quebec, Canada
(Lachapelle) Division of Cardiac Surgery, McGill University Health Centre,
Montreal, Quebec, Canada
(Lamy) Division of Cardiac Surgery, Hamilton Health Sciences, Population
Health Research Institute, McMaster University, Hamilton, Ontario, Canada
(Labinaz) Division of Cardiology, University of Ottawa Heart Institute,
Ottawa, Ontario, Canada
(Peterson) Division of Cardiac Surgery, St. Michael's Hospital, University
of Toronto, Toronto, Ontario, Canada
(Arora) Division of Cardiac Surgery, St. Boniface Hospital, University of
Manitoba, Winnipeg, Manitoba, Canada
(Noiseux) Division of Cardiac Surgery, Centre Hospitalier de l'Universite
de Montreal, Centre de Recherche du CHUM, Montreal, Quebec, Canada
(Rassi, Palacios) Division of Cardiology, Massachusetts General Hospital,
Harvard University, Boston, Massachusetts
(Genereux) Division of Cardiology, Hopital du Sacre-Coeur, Universite de
Montreal, Montreal, Quebec, Canada
(Lindman) Division of Cardiology, Washington University School of
Medicine, St. Louis, Missouri
(Asgar) Division of Cardiology, Institut de Cardiologie de Montreal,
Universite de Montreal, Montreal, Quebec, Canada
(Morais) Division of Geriatric Medicine, McGill University Health Centre,
Montreal, Quebec, Canada
(Langlois, Morin) Division of Cardiac Surgery, Jewish General Hospital,
McGill University, Montreal, Quebec, Canada
(Popma) Division of Cardiology, Beth Israel Deaconess Medical Center,
Harvard University, Boston, Massachusetts
(Perrault) Division of Cardiac Surgery, Institut de Cardiologie de
Montreal, Universite de Montreal, Montreal, Quebec, Canada
Title
Frailty in Older Adults Undergoing Aortic Valve Replacement. The
FRAILTY-AVR Study.
Source
Journal of the American College of Cardiology. (no pagination), 2017. Date
of Publication: 2017.
Publisher
Elsevier USA
Abstract
Background: Frailty is a geriatric syndrome that diminishes the potential
for functional recovery after a transcatheter aortic valve replacement
(TAVR) or surgical aortic valve replacement (SAVR) procedure; however, its
integration in clinical practice has been limited by a lack of consensus
on how to measure it. Objectives: This study sought to compare the
incremental predictive value of 7 different frailty scales to predict poor
outcomes following TAVR or SAVR. Methods: A prospective cohort of older
adults undergoing TAVR or SAVR was assembled at 14 centers in 3 countries
from 2012 to 2016. The following frailty scales were compared: Fried,
Fried+, Rockwood, Short Physical Performance Battery, Bern, Columbia, and
the Essential Frailty Toolset (EFT). Outcomes of interest were all-cause
mortality and disability 1 year after the procedure. Results: The cohort
was composed of 1,020 patients with a median age of 82 years. Depending on
the scale used, the prevalence of frailty ranged from 26% to 68%. Frailty
as measured by the EFT was the strongest predictor of death at 1 year
(adjusted odds ratio [OR]: 3.72; 95% confidence interval [CI]: 2.54 to
5.45) with a C-statistic improvement of 0.071 (p < 0.001) and integrated
discrimination improvement of 0.067 (p < 0.001). Moreover, the EFT was the
strongest predictor of worsening disability at 1 year (adjusted OR: 2.13;
95% CI: 1.57 to 2.87) and death at 30 days (adjusted OR: 3.29; 95% CI:
1.73 to 6.26). Conclusions: Frailty is a risk factor for death and
disability following TAVR and SAVR. A brief 4-item scale encompassing
lower-extremity weakness, cognitive impairment, anemia, and
hypoalbuminemia outperformed other frailty scales and is recommended for
use in this setting. (Frailty Assessment Before Cardiac Surgery &
Transcatheter Interventions; NCT01845207).<br/>Copyright &#xa9; 2017
American College of Cardiology Foundation.

<21>
Accession Number
615439359
Author
Kwiatkowski D.M.; Goldstein S.L.; Cooper D.S.; Nelson D.P.; Morales
D.L.S.; Krawczeski C.D.
Institution
(Kwiatkowski, Goldstein, Cooper, Nelson, Morales, Krawczeski) Heart
Institute, Department of Pediatrics, Cincinnati Children's Hospital
Medical Center, Cincinnati, OH, United States
(Kwiatkowski, Krawczeski) Division of Cardiology, Department of
Pediatrics, Stanford University, 750Welch Rd, Palo Alto, CA 94304, United
States
(Goldstein, Cooper, Nelson) Center for Acute Care Nephrology, Department
of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati,
OH, United States
Title
Peritoneal Dialysis vs Furosemide for prevention of fluid overload in
infants after cardiac surgery a randomized clinical trial.
Source
JAMA Pediatrics. 171 (4) (pp 357-364), 2017. Date of Publication: 01 Apr
2017.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE Fluid overload after congenital heart surgery is frequent and a
major cause of morbidity and mortality among infants. Many programs have
adopted the use of peritoneal dialysis (PD) for fluid management; however,
its benefits compared with those of traditional diuretic administration
are unknown. OBJECTIVE To determine whether infants randomized to PD vs
furosemide for the treatment of oliguria have a higher incidence of
negative fluid balance on postoperative day 1, as well as avoidance of 10%
fluid overload; shorter duration of mechanical ventilation, intensive care
unit stay, and inotrope use; and fewer electrolyte abnormalities. DESIGN,
SETTING, AND PARTICIPANTS This single-center, unblinded, randomized
clinical trial compared methods of fluid removal after cardiac surgery
from October 1, 2011, through March 13, 2015, in a large tertiary
pediatric hospital in Ohio. The parents or guardians of all eligible
infants (aged <6 months) undergoing cardiac surgery with catheter
placement for PD were approached for inclusion. No patients were withdrawn
for adverse effects. Recruitment was powered for the primary outcome, and
analysis was based on intention to treat. Patients randomized to PD were
hypothesized to have superior outcomes. INTERVENTIONS Infants received
intravenous furosemide (1mg/kg every 6 hours) or a standardized PD
regimen. MAIN OUTCOMES AND MEASURES The primary end pointwas incidence of
negative fluid balance on postoperative day 1. Secondary end points
included incidence of fluid overload, duration of mechanical ventilation
and intensive care unit stay, electrolyte abnormalities and repletion
doses, duration of inotropic administration, and mortality. RESULTS
Seventy-three patients (47 boys [64%]and 26 girls [35%]; median age, 8
[interquartile range (IQR), 6-14] days) received treatment and completed
the trial. No differencewas found between the PD and furosemide groups in
the incidence of negative fluid balance on the first postoperative day.
The furosemide groupwas 3 times more likely to have 10% fluid overload
(odds ratio [OR], 3.0; 95%CI, 1.3-6.9),was more likely to have prolonged
ventilator use (OR, 3.1; 95%CI, 1.2-8.2), and had a longer duration of
inotrope use (median, 5.5 [IQR, 4-8] vs 4.0[IQR, 3-6] days) and higher
electrolyte abnormality scores (median, 6 [IQR, 4-7] vs 3 [IQR, 2-5])
compared with the PD group.No statistically significant differences in
mortality (3 patients [9.4%] in the furosemide group vs 1 patient [3.1%]
in the PD group) or length of cardiac intensive care unit (median, 7 [IQR,
6-12] vs 9 [IQR, 5-15] days) or hospital (15 [IQR, 10-28] vs 14 [IQR,
9-22] days) staywere observed. No serious complicationswere observed.
Dialysiswas discontinued early in 9 of 41 patients in the PD group for
pleural-peritoneal communication. CONCLUSIONS AND RELEVANCE Use of PD is
safe and allows for superior fluid management with improved clinical
outcomes compared with diuretic administration. Use of PD should be
strongly considered among infants at high risk for postoperative acute
kidney injury and fluid overload.<br/>Copyright &#xa9; 2017 American
Medical Association.

<22>
Accession Number
616899098
Author
Chen M.Y.; Rochitte C.E.; Arbab-Zadeh A.; Dewey M.; George R.T.; Miller
J.M.; Niinuma H.; Yoshioka K.; Kitagawa K.; Sakuma H.; Laham R.; Vavere
A.L.; Cerci R.J.; Mehra V.C.; Nomura C.; Kofoed K.F.; Jinzaki M.;
Kuribayashi S.; Scholte A.J.; Laule M.; Tan S.Y.; Hoe J.; Paul N.; Rybicki
F.J.; Brinker J.A.; Arai A.E.; Matheson M.B.; Cox C.; Clouse M.E.; Di
Carli M.F.; Lima J.A.C.
Institution
(Chen, Arai) Laboratory of Cardiac Energetics, National Heart Lung and
Blood Institute, National Institutes of Health, Bethesda, MD, United
States
(Rochitte) InCor Heart In stitute, University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Arbab-Zadeh, George, Miller, Vavere, Cerci, Mehra, Brinker, Lima) Johns
Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524,
Baltimore, MD 21287, United States
(Dewey, Laule) Department of Radiology, Charite Medical School-Humboldt,
Berlin, Germany
(Niinuma, Yoshioka) Memorial Heart Center, Iwate Medical University,
Morioka, Japan
(Niinuma) Department of Radiology, St. Luke's International Hospital,
Tokyo, Japan
(Kitagawa, Sakuma) Department of Radiology, Mie University Hospital, Tsu,
Japan
(Laham, Clouse) Department of Radiology, Beth Israel Deaconess Medical
Center, Harvard University, Boston, MA, United States
(Nomura) Radiology Sector, Hospital Israelita Albert Einstein, Sao Paulo,
Brazil
(Kofoed) Department of Cardiology, Rigshospitalet, University of
Copenhagen, Denmark
(Jinzaki, Kuribayashi) Keio University School of Medicine, Tokyo, Japan
(Scholte) Department of Cardiology, Leiden University Medical Center,
Leiden, Netherlands
(Tan) Department of Cardiology, National Heart Centre, Singapore
(Hoe) Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore
(Paul) Department of Medical Imaging, Toronto General Hospital, Toronto,
ON, Canada
(Rybicki) Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
(Matheson, Cox) Department of Epidemiology, Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD, United States
(Di Carli) Department of Nuclear Medicine and Cardiovascular Imaging,
Brigham and Women's Hospital, Boston, MA, United States
Title
Prognostic value of combined CT angiography and myocardial perfusion
imaging versus invasive coronary angiography and nuclear stress perfusion
imaging in the prediction of major adverse cardiovascular events: The
CORE320 multicenter study.
Source
Radiology. 284 (1) (pp 55-65), 2017. Date of Publication: July 2017.
Publisher
Radiological Society of North America Inc. (820 Jorie Boulevard, Oak Brook
IL 60523-2251, United States)
Abstract
Purpose: To compare the prognostic importance (time to major adverse
cardiovascular event [MACE]) of combined computed tomography (CT)
angiography and CT myocardial stress perfusion imaging with that of
combined invasive coronary angiography (ICA) and stress single photon
emission CT myocardial perfusion imaging. Materials and Methods: This
study was approved by all institutional review boards, and written
informed consent was obtained. Between November 2009 and July 2011, 381
participants clinically referred for ICA and aged 45-85 years were
enrolled in the Combined Noninvasive Coronary Angiography and Myocardial
Perfusion Imaging Using 320-Detector Row Computed Tomography (CORE320)
prospective multicenter diagnostic study. All images were analyzed in
blinded independent core laboratories, and a panel of physicians
adjudicated all adverse events. MACE was defined as revascularization (>30
days after index ICA), myocardial infarction, or cardiac death;
hospitalization for chest pain or congestive heart failure; or arrhythmia.
Late MACE was defined similarly, except for patients who underwent
revascularization within the first 182 days after ICA, who were excluded.
Comparisons of 2-year survival (time to MACE) used standard Kaplan-Meier
curves and restricted mean survival times bootstrapped with 2000
replicates. Results: An MACE (49 revascularizations, five myocardial
infarctions, one cardiac death, nine hospitalizations for chest pain or
congestive heart failure, and one arrhythmia) occurred in 51 of 379
patients (13.5%). The 2-year MACE-free rates for combined CT angiography
and CT perfusion findings were 94% negative for coronary artery disease
(CAD) versus 82% positive for CAD and were similar to combined ICA and
single photon emission CT findings (93% negative for CAD vs 77% positive
for CAD, P < .001 for both). Event-free rates for CT angiography and CT
perfusion versus ICA and single photon emission CT for either positive or
negative results were not significantly different for MACE or late MACE (P
> .05 for all). The area under the receiver operating characteristic curve
(AUC) for combined CT angiography and CT perfusion (AUC = 68; 95%
confidence interval [CI]: 62, 75) was similar (P = .36) to that for
combined ICA and single photon emission CT (AUC = 71; 95% CI: 65, 79) in
the identification of MACE at 2-year follow-up. Conclusion: Combined CT
angiography and CT perfusion enables similar prediction of 2-year MACE,
late MACE, and event-free survival similar to that enabled by ICA and
single photon emission CT.<br/>Copyright &#xa9; 2017 RSNA.

<23>
Accession Number
616453874
Author
Kokkinidis D.G.; Oikonomou E.K.; Papanastasiou C.A.; Theochari C.A.;
Giannakoulas G.
Institution
(Kokkinidis, Oikonomou, Papanastasiou, Theochari, Giannakoulas)
ThessalonikiGreece
Title
Methodological Remarks in the Meta-Analysis on the Impact of Baseline
Pulmonary Hypertension on Post-Transcatheter Aortic Valve Implantation
Outcomes.
Source
American Journal of Cardiology. 120 (3) (pp 513-514), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)

<24>
Accession Number
616632445
Author
Chang M.; Lee C.W.; Ahn J.-M.; Cavalcante R.; Sotomi Y.; Onuma Y.; Han M.;
Park D.-W.; Kang S.-J.; Lee S.-W.; Kim Y.-H.; Park S.-W.; Serruys P.W.;
Park S.-J.
Institution
(Chang) Seoul St. Mary's Hospital, The Catholic University of Korea,
Seoul, South Korea
(Lee, Ahn, Park, Kang, Lee, Kim, Park, Park) Heart Institute, Asan Medical
Center, University of Ulsan College of Medicine, Seoul, South Korea
(Cavalcante, Onuma, Serruys) Erasmus University Medical Center, Rotterdam,
Netherlands
(Sotomi) Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
(Han) Division of Biostatistics, Asan Medical Center, University of Ulsan,
Seoul, South Korea
(Serruys) International Center for Circulatory Health, Imperial College of
London, London, United Kingdom
Title
Comparison of Outcome of Coronary Artery Bypass Grafting Versus
Drug-Eluting Stent Implantation for Non-ST-Elevation Acute Coronary
Syndrome.
Source
American Journal of Cardiology. 120 (3) (pp 380-386), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
There is limited data comparing effectiveness of coronary artery bypass
grafting (CABG) versus percutaneous coronary intervention (PCI) with
drug-eluting stents in patients with non-ST-elevation acute coronary
syndromes (NSTE-ACS). We compared the long-term outcomes of the 2
revascularization strategies in 1,246 patients presented with NSTE-ACS for
left main or multivessel coronary artery disease. Data were pooled from
the Randomized Comparison of Coronary Artery Bypass Surgery and
Everolimus-Eluting Stent Implantation in the Treatment of Patients with
Multivessel Coronary Artery Disease (BEST) trial, the Premier of
Randomized Comparison of Bypass Surgery versus Angioplasty Using
Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease
(PRECOMBAT) trial, and the Synergy between PCI with Taxus and Cardiac
Surgery (SYNTAX) trial. The primary outcome was a composite of death from
any causes, myocardial infarction, or stroke. The baseline characteristics
were similar between the 2 study groups. During the median follow-up of 60
months, the rate of the primary outcome was significantly lower with CABG
than with PCI (hazard ratio [HR] 0.74; 95% confidence interval [CI] 0.56
to 0.98; p = 0.036). This difference was mainly attributed to a
significant reduction in the rate of myocardial infarction (HR 0.50; 95%
CI 0.31 to 0.82, p = 0.006). The superiority of CABG over PCI was
consistent across the major subgroups. The individual risks of death from
any causes or stroke were not different between the 2 groups. In contrast,
the rate of repeat revascularization was significantly lower in the CABG
group than in the PCI group (HR 0.56; 95% CI 0.41 to 0.75, p <0.001). In
this study, among patients with NSTE-ACS for left main or multivessel
coronary artery disease, CABG significantly reduces the risk of death from
any causes, myocardial infarction, or stroke compared with PCI with
drug-eluting stents.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<25>
Accession Number
616556827
Author
Zakaria D.; Rettiganti M.; Gossett J.M.; Gupta P.
Institution
(Zakaria, Gupta) Department of Pediatrics, Division of Pediatric
Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR,
United States
(Rettiganti, Gossett) Biostatistics Program, Department of Pediatrics,
University of Arkansas for Medical Sciences, Little Rock, AR, United
States
Title
Factors associated with early extubation after superior cavopulmonary
connection: analysis from single ventricle reconstruction trial.
Source
Acta Anaesthesiologica Scandinavica. 61 (7) (pp 722-729), 2017. Date of
Publication: August 2017.
Publisher
Blackwell Munksgaard (E-mail: info@mks.blackwellpublising.com)
Abstract
Background: To evaluate the landscape of early extubation, and identify
factors associated with early extubation (<= 24 h) after superior
cavopulmonary connection (stage 2 operation) among children with single
ventricle anatomy. Methods: Patients undergoing stage 2 operation after
Norwood operation from the Pediatric Heart Network Single Ventricle
Reconstruction (SVR) trial public-use dataset were included. Elastic net
regularized logistic regression models were fitted to evaluate the factors
associated with early extubation after stage 2 operation. Results: In
total, 390 patients from 15 North American centers qualified for
inclusion. Of these, 42 patients (10.8%) were extubated in operating room,
151 patients (38.7%) were extubated outside the operating room within the
first 24 h after stage 2 operation, and the remaining 197 patients (50.5%)
required mechanical ventilation for > 24 h. In adjusted models, factors
associated with early extubation after stage 2 operation were elective
timing of stage 2 operation, lower incidence of post-Norwood
complications, shorter CPB duration for stage 2 operation, and no cardiac
catheterization after Stage 2 operation. We also performed multiple other
alternative analyses to identify factors associated with early extubation
that demonstrated same associations as the primary model. The mean
hospital length of stay after Stage 2 operation was 20% shorter among
patients with early extubation. Conclusions: Data from this large
multicenter study demonstrate that approximately one-half of the patients
undergoing operation for superior cavopulmonary connection are extubated
within 24 h after heart operation. Furthermore, early extubation is
associated with shorter hospital length of stay.<br/>Copyright &#xa9; 2017
The Acta Anaesthesiologica Scandinavica Foundation. Published by John
Wiley & Sons Ltd

<26>
Accession Number
617220855
Author
Mohananey D.; Mick S.; Krishnaswamy A.; Tuzcu E.M.; Kapadia S.
Institution
(Mohananey, Mick, Krishnaswamy, Tuzcu, Kapadia) Cleveland Clinic,
Cleveland, OH, United States
Title
Clinical outcomes of patients with pacemaker implantation after
transcatheter aortic valve replacement: Meta-analysis and meta-regression.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1312), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Conduction abnormalities and need for permanent pacemaker
(PPM) are frequent complications of transcatheter aortic valve replacement
(TAVR). While the incidence and predictors of PPM implantation have been
well studied, data is conflicting on its clinical impact. Methods: A
comprehensive search of the PubMed, EMBASE and Google scholar was
performed. Risk ratio (RR) or Standardized mean difference (SMD) was
calculated for each outcome using fixed effects model unless heterogeneity
was >25%, in which case a random effects model was used. Results: We
identified 20 observational studies with a total of 10,724 patients. We
found no significant difference in all-cause mortality at 30 days [RR 0.82
(0.66 - 1.03)], 1 year [RR 1.04 (0.92 - 1.20)] or at longest follow up [RR
1.05 (0.90-1.21)]. Risk of stroke at 30 days [RR 1.3 (0.71 - 2.39)],
stroke at 1 year [RR 0.61 (0.31 - 1.21)], myocardial infarction (MI) at 30
days [RR 0.61 (0.23 - 1.60)], MI at 1 year [RR 0.98 (0.40 -2.43)] and
major bleeding at 30 days [RR 0.87 (0.38 - 1.99)] was also similar between
the two groups. Improvement in left ventricular ejection fraction (LVEF)
on follow up was significantly greater in patients without PPM [SMD -0.3
(-0.46- -0.15)]. There was no impact of age, Euroscore, LVEF, gender and
type of prosthesis on all-cause mortality at 30 days or 1 year using
meta-regression techniques. Conclusions: Patients with PPM do not have an
increased risk of all-cause mortality, stroke or MI but have a decreased
improvement in LVEF after TAVR. (Figure presented).

<27>
Accession Number
617220829
Author
Sankaramangalam K.; Banerjee K.; Jones B.; Kandregula K.; Jobanputra Y.;
Svensson L.; Kapadia S.
Institution
(Sankaramangalam, Banerjee, Jones, Kandregula, Jobanputra, Svensson,
Kapadia) Cleveland Clinic, Cleveland, OH, United States
Title
Impact of active coronary artery disease on the early and 1 year mortality
of patients undergoing transcatheter aortic valve replacement: A
systematic review and meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1226), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: The impact of Coronary artery disease (CAD) on the outcome
after Transcatheter Aortic Valve Replacement (TAVR) is not understood
well. Finding an optimum revascularization strategy for the TAVR patients
who have concomitant CAD is also an ongoing debate. We sought to evaluate
the outcomes in patients with active CAD undergoing TAVR. Methods: TAVR
studies published between 2002 and October 2016 were reviewed. Out of the
initial 1104 citations, 11 studies (7067 patients) reporting outcomes in
patients with significant coronary lesions at the time of TAVR were
included. Meta-analysis using pooled estimates was conducted. Results: Out
of the total 7067 patients who underwent TAVR, 3417 (48.35 %) had
concomitant CAD. All-cause 30 day and 1 year mortality was 7.37% & 20.43%
in patients with CAD and that for the patients without CAD were 6.67% &
14.95% respectively. Meta-analysis showed no significant difference
between patients with or without concomitant CAD for 30 day mortality
[Odds ratio (OR) - 1.05; Confidence interval (CI) - 0.74-1.49, p=0.318],
but 1 year mortality was higher in the patients with CAD (OR: 1.38; CI:
1.09-1.74, p <0.001). Conclusions: Even though the Co-existing active CAD
does not have an impact on the 30 day mortality of TAVR patients, it does
have a negative impact on the long term outcome after TAVR. Further
studies need to be done to find out how the revascularization strategies
will impact the outcome of the patients after TAVR. (Table Presented).

<28>
Accession Number
617220804
Author
Van Mourik M.S.; Van Kesteren F.; Wiegerinck E.M.A.; Planken R.N.; Baan
J.; Vis M.
Institution
(Van Mourik, Van Kesteren, Wiegerinck, Planken, Baan, Vis)
Heartcenter-Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
Title
Prevention of contrast-induced nephropathy for computed tomography
(CT)-scanning in TAVR work-up: One-hour hydration with sodium bicarbonate
is not inferior to 24-hour saline hydration.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1513), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Computed tomography-angiography (CTA) is required in work-up
for Transcatheter Aortic Valve Replacement (TAVR). In patients with
impaired renal function CTA can cause contrast-induced nephropathy (CIN).
The standard protocol for prevention of CIN in patients with heart failure
is iv hydration with 24-h saline (NaCl). We hypothesized that hydration
with 1-h sodium bicarbonate (NaHCO3) could be beneficial in reducing
dyspnea caused by hydration while maintaining renal function. Methods:
Between Jan-2015 and Aug-2016, this open-label single-center randomized
trial included 83 consecutive patients and was designed to show
non-inferiority of 1-hour NaHCO3 (1.4%, 3 ml/kg/h) compared to 24-h
hydration with NaCl (0.9%, 1 ml/kg/h). Patients were randomized on a 1:1
ratio; 39 saline, 43 sodium bicarbonate. Patients were stratified on eGFR:
45-60 (n=51), 30-45 (n=23), 15-30 (n=9). Primary outcome was relative
change in serum creatinine (sCreat) 2-5 days after CTA. Secondary outcomes
were the level of dyspnea (10-point BORG scale), CIN (increase in sCreat
of >25%/or 44umol [0.5g/dL]) and use of dialysis. Netherlands Trial
Register NTR5014. Results: The relative increase in sCreat was 1.5% (95%CI
2.3-5.3%) versus 4.5% (95%CI 1.9-7.1%) for patients hydrating with saline
and sodium bicarbonate respectively. On the predefined equivalence limit
difference of 10% for the relative sCreat increase, non-inferiority
testing was significant (99%CI -8.86-2.95, p<0.01). Mean increase in
sCreat was 0.3 (95%CI -5.4-6.0) umol/L in saline vs 5.7 (95%CI 2.4-9.1)
umol/L in sodium bicarbonate (p=0.091). Mean hydration volume was 1763 (SD
299) ml vs 234 (SD 43) ml in saline and sodium bicarbonate respectively
(p<0.001). A BORG scale increase of at least 1 point was described more by
patients hydrating with saline (20.6 vs 2.6% OR=9.852, RR=8.029, p=0.022).
CIN and dialysis did not occur. Conclusions: We demonstrate that for CTA
in TAVR work-up, 1-h hydration with sodium bicarbonate is not inferior to
standard 24-h saline hydration. This short protocol may replace standard
hydration since this will shorten the length-of-stay, and may decrease the
risk of decompensation.

<29>
Accession Number
617220783
Author
Cremer P.; Rodriguez L.L.; Zhang Y.; Alu M.; Lindman B.; Zajarias A.; Hahn
R.; Lerakis S.; Malaisrie S.C.; Douglas P.; Pibarot P.; Svensson L.; Leon
M.; Jaber W.
Institution
(Cremer, Rodriguez, Zhang, Alu, Lindman, Zajarias, Hahn, Lerakis,
Malaisrie, Douglas, Pibarot, Svensson, Leon, Jaber) Cleveland Clinic,
Cleveland, OH, United States
Title
Worsening tricuspid regurgitation and increased mortality after aortic
valve replacement: Insights from PARTNER2A.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1222), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Worsening tricuspid regurgitation (TR) has been described
after surgical aortic valve replacement (SAVR), but a comparison of the
incidence of worsening TR in SAVR vs. transcatheter aortic valve
replacement (TAVR) and any association with increased mortality has not
been reported. Methods: Patients from PARTNER2A with a core lab
echocardiogram at baseline and 30 days after valve replacement were
included. The primary outcomes were worsening TR, defined as an increase
in TR by at least one grade from baseline to 30 days, and cardiac death
from 30 days to 2 years. Univariable associations with worsening TR were
assessed with t-tests and multivariable analysis was performed with
stepwise logistic regression. Survival analysis was assessed via the
Kaplan-Meier method and with multivariable Cox proportional hazards
models. A two-sided p value <0.05 was considered statistically
significant. Results: In 1,375 patients, worsening TR was more common in
SAVR (26.2%) vs. TAVR (16.7%) (p <0.001). On multivariable analysis,
patients with TAVR were also less likely to have worsening TR (OR 0.55,
95% CI 0.40-0.78). Worsening TR was also associated with increased hazard
of cardiac death on Kaplan-Meier analysis (Log-Rank p <0.001, Figure) and
in a multivariable model (HR 2.71, 95% CI 1.68-4.37). Conclusions: Among
intermediate-risk patients with severe aortic stenosis, worsening TR was
more common in patients randomized to SAVR. In all patients, worsening TR
was associated with higher mortality. (Figure Presented).

<30>
Accession Number
617220764
Author
Bajaj N.S.; Arora G.; Patel N.; Kalra R.; Vohra S.; Ahmad A.; Arora P.
Institution
(Bajaj, Arora, Patel, Kalra, Vohra, Ahmad, Arora) University of Alabama at
Birmingham, Birmingham, AL, USA, Brigham and Women's Hospital, Boston, MA,
USA
Title
Risk of adverse outcomes in treatment modalities for severe aortic
stenosis in randomized control trials: Direct and indirect comparisons.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1309), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Rates of adverse outcomes in patients undergoing treatment for
severe aortic stenosis (AS) utilizing different treatment modalities
(DTMs) are not well known. We compared 1-year risk of stroke, permanent
pacemaker placement (PPM) and moderate/severe paravalvular aortic
insufficiency (PAI) in patients with severe AS treated with DTMs. Methods:
Randomized control trials (RCTs) reporting 1-year adverse outcome rates in
patients with severe AS across DTMs were identified using SCOPUS. Network
meta-analyses (NMA) using multivariate random effects modeling were
conducted to compare DTMs including CoreValve (CV), Edwards Sapien valve
(ES), Edwards XT valve (EXT), Surgical aortic valve replacement (SAVR) and
Standard medical therapy (SMT). SMT included 57% patients with balloon
valvuloplasty. Results: Seven RCTs with 4,914 patients were included. CV,
ES, EXT, SAVR and SMT were studied in 652, 803, 1416, 1864 and 179
patients respectively (Figure, panel A). Higher 1-year stroke risk was
observed in ES as compared to CV group (Figure, panel B). We observed
higher PAI rates and a trend towards higher 1-year rates of PPM placement
in CV group as compared to other modalities. Several of these differences
among DTMs were statistically significant (Figure, panel C, D).
Conclusions: Higher 1-year stroke risk was observed in ES as compared to
CV. Higher PAI rates and a trend towards higher PPM was seen in CV group
as compared to other modalities. RCTs are needed to directly compare DTMs.
(Figure presented).

<31>
Accession Number
617220708
Author
Chaikriangkrai K.; Shantha G.P.S.; Abdulhak A.B.; Tandon R.; Alqasrawi M.;
Jhun H.Y.; Sigurdsson G.
Institution
(Chaikriangkrai, Shantha, Abdulhak, Tandon, Alqasrawi, Jhun, Sigurdsson)
University of Iowa Hospitals and Clinics, Iowa City, IA, United States
Title
Diagnostic accuracy of coronary computed tomography angiography in aortic
stenosis patients referred for aortic valve replacement: Systematic review
and meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1507), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: The objective of this study is to investigate the diagnostic
accuracy of coronary computed tomography angiography (CCTA) in patients
referred for surgical aortic valve replacement (SAVR) or transcatheter
aortic valve replacement (TAVR) using invasive coronary angiography (ICA)
as gold standard. Methods: We search databases for all diagnostic studies
of CCTA in patients referred for SAVR or TAVR which reported diagnostic
testing characteristics. Significant coronary artery disease (CAD) in both
CCTA and ICA is defined by >50% stenosis in any coronary artery. Results:
Twelve studies evaluated 1446 patients (mean age = 78 years, 45% men, 76%
TAVR) with the pooled prevalence of previous percutaneous coronary
intervention and coronary artery bypass graft surgery of 32% and 18%
respectively. The pooled prevalence of significant CAD determined by ICA
is 43%. Hierarchical summary receiver operating characteristics shows a
summary area under curve of 0.95. The pooled sensitivity, specificity,
positive and negative likelihood ratios of CCTA in identifying significant
CAD determined by ICA are 95%, 80%, 4.81 and 0.06 respectively. In
subgroup analysis, the diagnostic profiles of CCTA are comparable between
SAVR and TAVR. Conclusions: CCTA has good diagnostic accuracy in patients
with aortic valve stenosis, despite of high prevalence of coronary artery
disease, and could reliable rule out significant coronary stenosis prior
to valve surgery.

<32>
Accession Number
617220620
Author
Worku B.M.; Kampaktsis P.; Gulkarov I.; Wong S.-C.; Chang R.; Aftab A.;
Salemi A.
Institution
(Worku, Kampaktsis, Gulkarov, Wong, Chang, Aftab, Salemi) New York
Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA, New
York Methodist Hospital, Brooklyn, NY, USA
Title
Transcatheter aortic valve implantation is safe in patients with left
atrial thrombus or spontaneous echo contrast.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1304), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Left atrial thrombus (LAT) and spontaneous echo contrast (SEC)
are risk markers for cardioembolization. LAT was an exclusion criterion in
the transcatheter aortic valve replacement (TAVR) trials although such
patients undergo TAVR in the "real-world" setting. In this study we
analyze outcomes after TAVR in patients with LAT or SEC. Methods: All
patients undergoing TAVR at our institution between March 2009 and
December 2014 were analyzed. Preoperative, intraoperative, and
postoperative variables were collected prospectively. The presence of LAT
or SEC was determined via retrospective chart review. Primary outcomes
include 30-day and one-year neurologic events and mortality. Results:
Between March 2009 and December 2014, 369 patients underwent TAVR at our
institution. Of these, 3.8% (14) were found to have LAT and 6.8% (25) were
found to have SEC. Significant differences were noted between patients
with LAT, SEC, or neither with regards to preoperative renal function,
atrial fibrillation (AF), and ejection fraction. Preoperative AF was the
only independent predictor of LAT (OR 8.7; CI 1.9-40.1; p=.006). No
perioperative complications were associated with the presence of LAT or
SEC. Specifically, no patient with LAT or SEC experienced a postoperative
neurologic event. Kaplan-meier analysis revealed increased overall
mortality in patients with LAT (log-rank p=0044). However, independent
predictors of 30-day and one-year survival included preoperative AF
(30-day OR .04; CI .003-.45; p=.01; 1-year OR .02; CI .001-.29; p=.004),
as well as postoperative neurologic events, life threatening bleeding
complications, and moderate-severe aortic regurgitation, but not LAT.
Conclusions: The current study suggests that TAVR may be performed in
patients with LAT and SEC with a low risk of embolic complications. LAT is
associated with increased long-term mortality, although this is likely a
function of its association with AF. Larger, randomized studies are needed
to better study this phenomenon.

<33>
Accession Number
617220608
Author
Bagur R.; Solo K.; Nombela-Franco L.; Kwok C.S.; Mamas M.
Institution
(Bagur, Solo, Nombela-Franco, Kwok, Mamas) Western University, London,
Canada
Title
Meta-analysis on cerebral embolic protection devices during transcatheter
aortic valve implantation.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1303), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Silent ischemic embolic lesions are common following
transcatheter aortic valve implantation (TAVI). It has been speculated
that the use of embolic protection devices (EPD) may reduce the occurrence
of these embolic lesions. The aim of this meta-analysis is to study
whether EPD use reduces silent ischemic and clinical cerebrovascular
events associated with TAVI. Methods: We conducted a comprehensive search
of MEDLINE and EMBASE to identify studies that evaluated patients
undergoing TAVI with or without EPD. Random-effects meta-analyses were
performed to estimate the effect of EPD compared with no-EPD during TAVI
using aggregate data. Results: Fifteen studies involving 807 patients
(621/186 with/without EPD) fulfilled the inclusion criteria. The
EPD-delivery success rate was reported in all studies and was achieved in
94.5% of patients. Meta-analyses evaluating EPD versus without EPD
strategies could not confirm or exclude any differences in terms of
clinically evident stroke (RR: 0.84, 95%CI: 0.32-2.23, P=0.73) or 30-day
mortality (RR: 0.52, 95%Cl: 0.14-1.87, P=0.31). There were no significant
differences in number of patients with new-silent ischemic lesions (RR:
0.98, 95%CI: 0.89-1.07, P=0.60) or number of lesions per patient (SMD:
-0.19, 95%CI: -0.92,0.54; P=0.61). The use of EPD was associated with a
significantly smaller ischemic volume per lesion (SMD: -0.52, 95%CI:
-0.85, -0.20; P=0.002) and smaller total volume of lesions (SMD: -0.36,
95%CI: -0.62, -0.09; P=0.008). Conclusions: The use of EPD during TAVI may
be associated with smaller volume of silent ischemic lesions and smaller
total volume of silent ischemic lesions. However, EPD may not reduce the
number of new-single, multiple or total number of lesions. Moreover, there
was only very low quality of evidence showing no significant differences
between patients undergoing TAVI with or without EPD with respect to
clinically evident stroke and mortality. Further randomized and
adequately-powered studies are needed to ascertain differences in
patientimportant outcomes before EPD should be incorporated into routine
TAVI practice.

<34>
Accession Number
617220475
Author
Sugahara M.; McNamara D.; Briller J.; Cooper L.; Damp J.; Drazner M.; Fett
J.; Hsich E.; Rajagopalan N.; Gorcsan J.
Institution
(Sugahara, McNamara, Briller, Cooper, Damp, Drazner, Fett, Hsich,
Rajagopalan, Gorcsan) University of Pittsburgh Medical Center, Pittsburgh,
PA, United States
Title
Racial differences in left ventricular recovery in patients with
peripartum cardiomyopathy assessed by global longitudinal strain.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1463), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Racial differences between Black and Non-black women with
peripertum cardiomyopathy (PPCM) have been observed. The aim was to test
the hypothesis that racial differences in degree of left ventricular (LV)
dysfunction at presentation and recovery occur in PPCM using strain
imaging. Methods: We studied 100 PPCM patients in the multicenter
Investigation in Pregnancy Associated Cardiomyopathy study [LV ejection
fraction (EF) <45% within 2 months of delivery]. Speckle tracking echo
from 3 apical views for global longitudinal strain (GLS) was done at
entry, 6-month-follow and 1-year. Patients with lack of LV recovery were
predefined as LVEF < 50% at 1 year, death, heart transplant or LV assist
device (LVAD). Results: PPCM patients with Black race had greater degree
of LV dysfunction at each time point: LVEF was 31.7+/-1.8%* vs.35.9+/-1.1%
at entry, *p=0.048; 47.0+/-2.2%* vs. 53.0+/-1.4% at 6 mo, *p=0.024; and
47.6+/-2.2%* vs. 55.4+/-1.3% at 1 year, *p=0.003. GLS (absolute values)
was also lower in Black vs. Non-black patients: 10.0+/-0.8%* vs.
12.4+/-0.5% at entry, *p=0.014; 16.5+/-1.0%* vs. 19.0+/-0.6% at 6 mo.,
p=0.040*; 16.8+/-1.1%* vs. 19.4+/-0.6% at 1 yr, p=0.043). Conclusions:
Racial differences in degree of LV dysfunction and recovery were observed
in PPCM with Black patients having comparatively greater LV dysfunction by
both EF and GLS.

<35>
Accession Number
617220467
Author
Anonymous
Title
66th Annual Scientific Session of the American College of Cardiology and
i2 Summit: Innovation in Intervention, ACC.17.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(no pagination), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
The proceedings contain 1541 papers. The topics discussed include:
outcomes of the different flow/gradient patterns of aortic stenosis after
aortic valve replacement: insights from partner 2A trial; association of
coronary epicardial endothelial dysfunction with low endothelial shear
stress in patients with mild coronary atherosclerosis who presented with
chest pain; prosthetic surgical tissue valve enlargement using a
high-pressure balloon (fracturing the ring) to facilitate transcatheter
valve-in-valve implantation; predictors of true ST-segment elevation
myocardial infarction in cocaine positive patients; initial results and
long-term follow-up of percutaneous mitral valvuloplasty in patients with
pulmonary hypertension; prognostic value of baseline n-terminal prohormone
type natriuretic peptide measurement in chronic lung disease patients with
severe aortic stenosis undergoing transcatheter aortic valve replacement;
trends in incidence and mortality associated with acute kidney injury in
patients undergoing PCI for acute coronary syndrome; intensity of statin
therapy and outcomes after transcatheter aortic valve replacement; five
year outcomes of fractional flow reserve guided versus intravascular
ultrasound guided percutaneous coronary intervention in intermediate
coronary artery disease; assessment of the safety of performing coronary
angioplasty without interrupting oral anticoagulants; left atrial
appendage occlusion in patients with atrial fibrillation and previous
major gastrointestinal bleeding: insight from the amplatzer cardiac plug
multicenter registry; QRS duration alterations after left ventricular
assist device implantation in patients with advanced heart disease; and
morphologic patterns of in-stent chronic total occlusions: an
intravascular ultrasound study.

<36>
Accession Number
617220448
Author
Verdoia M.; Barbieri L.; Marino P.; Suryapranata H.; De Luca G.
Institution
(Verdoia, Barbieri, Marino, Suryapranata, De Luca) AOU Maggiore della
Carita, Universita del Piemonte Orientale, Novara, Italy
Title
Dual antiplatelet therapy versus single antiplatelet regimen with or
without anticoagulation in transcatheter aortic valve replacement:
Indirect comparison and meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1207), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Uncertainty still exists on the correct management of
antithrombotic therapies after Transcatheter Aortic Valve Replacement
(TAVR). Dual antiplatelet therapy (DAPT) is currently recommended on
empirical basis, although having been claimed to increase bleedings
without offering enhanced ischemic protection. Therefore, the aim of
present meta-analysis was to assess the safety and effectiveness of DAPT
in patients undergoing TAVR. Methods: Literature archives and main
scientific sessions were scanned for studies comparing different
antithrombotic regimes after TAVR. Primary efficacy endpoint was 30-days
overall mortality. Secondary endpoints were stroke and major bleedings
(per protocol definition). Results: We included 9 studies, 5 comparing
DAPT with ASA monotherapy, while 4 DAPT with mono-antiplatelet therapy
(MAPT) + oral anticoagulation (OAC). In a total population of 7991
patients, 72% were on DAPT. Transfemoral approach was preferred for TAVI.
DAPT duration ranged from 3 to 6 months. Median follow-up was 3.5 months.
Death occurred in 12.8% of patients, with a significant lower mortality in
the DAPT group (12.2% vs 14.4%, OR[95%CI]=0.81[0.70-0.93], p=0.003,
phet=0.93). Similar benefits were observed against ASA monotherapy
(OR[95%CI]=0.80[0.69-0.93], p=0.004, phet=0.60), while not reaching
statistical significance for MAPT+OAC (OR[95%CI]=0.86[0.55-1.35], p=0.51,
phet=0.97). A similar trend for benefit with DAPT was observed for stroke
(OR[95%CI]=0.83[0.63-1.10], p=0.20, phet=0.67), with no significant
increase in the rate of major bleedings (OR[95%CI]=1.69[0.86-3.31],
p=0.13, phet<0.0001). By indirect comparison analysis, no benefit in
survival, stroke or bleedings was identified for additional
anticoagulation as compared to MAPT alone. Conclusions: Present
meta-analysis provides evidence for the current recommendation of DAPT as
the preferred antithrombotic strategy in patients undergoing TAVR. In
fact, DAPT provided a significant reduction in mortality and a slight
benefit in stroke, with no increase in major bleedings, as compared to
MAPT. The strategy of ASA and anticoagulation did not provide significant
benefits as compared to MAPT or DAPT.

<37>
Accession Number
617220358
Author
Elmaraezy A.; Abushouk A.I.; Ismail A.; Althaher F.; Aboelmakarem A.H.;
Abdallah A.R.; Eltoomy M.; Hassan H.M.; Saad M.M.; Elmareazy A.G.;
Aboelfotoh A.M.; Shaheen M.A.; Abdelaty O.M.; Ali S.S.; Althaher M.
Institution
(Elmaraezy, Abushouk, Ismail, Althaher, Aboelmakarem, Abdallah, Eltoomy,
Hassan, Saad, Elmareazy, Aboelfotoh, Shaheen, Abdelaty, Ali, Althaher)
Faculty of Medicine, Al-Azhar University, Cairo, Egypt, NOVA-Med Medical
Research Association, Cairo, Egypt
Title
Transcatheter aortic valve replacement versus surgical aorticvalve
replacement in aortic stenosis patients at low to moderate risk of
surgery: A meta-analysis of 25,737 patients' data.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 2096), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: The efficacy of Transcatheter Aortic Valve Replacement (TAVR)
has been established for aortic stenosis patients at high surgical risk.
However, there is a lack in class one evidence about the efficacy and
safety of TAVR in aortic stenosis patients at low to moderate risk of
surgery. Therefore, we conducted a meta-analysis of published studies to
provide a clear-cut evidence regarding the efficacy and safety of TAVR
compared with surgical aortic value replacement (SAVR) for aortic stenosis
patients at low to moderate surgical risk. Methods: A computer literature
search of PubMed, Embase, Cochrane (Central), Scopus, and web of science
was conducted using the relevant keywords. Records were screened for
eligible studies and data were extracted to an online data extraction
form. Outcomes of short term and long term (all-cause mortality) incidence
of stroke, aortic regurgitation (AR), permanent pacemaker implantation
(PPI), and vascular access complications were pooled as relative risk (RR)
in the DerSimonian random effect model using Review Manager (version 5.3)
software for windows. Results: Fourteen studies (n=25737 patients) were
included in the final analysis. There was no difference between TAVR and
SAVR in terms of short-term (RR 1.12, 95% CI [0.87 to 1.45]) and
long-term-all-cause mortality (RR 1.02, 95% CI [0.87 to 1.20]). In terms
of safety, SAVR was associated with less complications than TAVR (stroke:
RR 1.21, 95% CI [1.02 to 1.43], AR: RR 6.39, 95% CI [4.00 to 10.21], PPI:
RR 3.49, 95% CI [1.93 to 6.30], and vascular access complications: RR
10.14, 95% CI [2.44 to 42.19]). Conclusions: TARV was associated with
similarly low rates of short and long term all-cause mortality compared to
SAVR in aortic stenosis patients at low to moderate risk of surgery.
However, due to the higher incidence of stroke, aortic regurgitation,
permanent pacemaker implantation, and vascular access complications in the
TARV group, we do not recommend this approach to be performed in aortic
stenosis patients at low to moderate surgical risk.

<38>
Accession Number
617220302
Author
Drudi L.; Ades M.; Mancini R.; Bendayan M.; Trnkus A.; Afilalo J.
Institution
(Drudi, Ades, Mancini, Bendayan, Trnkus, Afilalo) McGill University,
Montreal, Canada
Title
Non-femoral access is associated with 30-day mortality in frail patients
undergoing transcatheter aortic valve replacement.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1356), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: We hypothesized that frail older adults may be less capable of
tolerating the operative stress associated with non-femoral transcatheter
aortic valve replacement (TAVR) and face a higher risk of 30-day mortality
as compared to robust patients. Methods: This study was a post hoc
analysis of older adults that underwent TAVR in the FRAILTY-AVR
multicenter study. To determine the effect of access site on 30-day
mortality, multivariable logistic regression models were stratified
according to frailty status and adjusted for the STS-predicted risk of
mortality and peripheral arterial disease. Frailty was assessed using the
short physical performance battery (SPPB), with scores of <=5 indicative
of frailty. Effect modification was calculated on the additive and
multiplicative scales. Results: The cohort consisted of 638 adults with a
mean age of 84 +/- 6 years, of which 492 (77%) had femoral access and 146
(23%) had non-femoral access. In frail patients with low SPPB score <=5
(42%), non-femoral access was associated with increased 30-day mortality
(OR 3.54, 95% CI 1.43, 8.76); whereas in patients with SPPB >5 (58%),
non-femoral access had no effect (OR 1.04, 95% CI 0.28, 3.88). There was
evidence of effect modification between frailty and access site on the
additive scale and a trend on the multiplicative scale. Conclusions: The
risk of mortality is 3-fold higher when frail older adults undergo TAVR
via a non-femoral access route, while robust patients' survival do not
appear to be influenced by access route. (Figure Presented).

<39>
Accession Number
617220090
Author
Yousman W.; Lee J.; Wong W.X.; Sargeant J.; Howe C.; Nyotowidjojo I.;
Pasha A.; Fortuin D.; Lee K.
Institution
(Yousman, Lee, Wong, Sargeant, Howe, Nyotowidjojo, Pasha, Fortuin, Lee)
University of Arizona, College of Medicine, Tucson, AZ, USA, Mayo Clinic
Arizona, Phoenix, AZ, USA
Title
Comparison of two-year outcomes in drug-eluting stents versus coronary
artery bypass grafting for treatment of unprotected left main coronary
artery disease in elderly patients: A meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1153), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: The increase in life expectancy has led to increasingly higher
numbers of coronary artery bypass grafts (CABG) and percutaneous coronary
artery placement with drug-eluting stents (DES) being performed in elderly
patients each year. We aim to compare the outcome of CABG and DES in
elderly patients with unprotected left main (ULM) disease. Methods: A
systematic literature search of PubMed, EMBASE, Scopus, Web of Science and
the Cochrane Central Register of Controlled Trials yielded 5 eligible
non-randomized registry studies comparing DES and CABG for the treatment
of ULM disease in elderly patients (aged >= 70 years). In all studies,
first generation drug eluting stents were used. In all CABG, left internal
mammary vessels were used whenever possible. Primary outcome was two-year
mortality. Results: Data from 5 studies yielded a total of 1149 patients
aged >= 70 years, with 527 treated with DES and 622 treated with CABG. The
composite two-year mortality was 15.6% in DES-treated patients and 13.1%
in CABG-treated patients (p=0.52). The incidence of two-year target lesion
revascularization (TLR) was 19.4% in DES-treated patients and 4.1% in
CABG-treated patients (p=0.004). Clinical characteristics and outcome data
are displayed in the table below. Conclusions: Elderly patients with ULM
disease who undergo multi-vessel revascularization experienced similar
mortality and myocardial infarction rates for CABG and DES placement to
two years. However, the rate of TLR was higher in the DES group. (Table
Presented).

<40>
Accession Number
617220017
Author
Iribarne A.; DiScipio A.; Robich M.; Eisenhauer A.; Leavitt B.; Baribeau
Y.; Ver Lee P.; Flynn J.; Huang Y.-L.; Malenka D.
Institution
(Iribarne, DiScipio, Robich, Eisenhauer, Leavitt, Baribeau, Ver Lee,
Flynn, Huang, Malenka) Northern New England Cardiovascular Disease Study
Group, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
Title
Is CABG the best revascularization strategy among all diabetics subgroups
with multi-vessel disease in the modern era? A multi-center analysis.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1149), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: To assess the comparative effectiveness of coronary artery
bypass grafting (CABG) versus percutaneous coronary intervention (PCI)
among major diabetic subgroups. Methods: Study design: multi-center,
retrospective analysis of all CABGs (n=18,292) and PCIs (n=55,438) from
2004-2014. Inclusion criteria: diabetes, 2 or 3 vessel disease (VD).
Exclusion criteria: prior PCI or CABG, left main >= 50%, STEMI, or within
24 hours of a MI. Baseline co-morbidities were balanced using inverse
probability weighting for a matched cohort of 3,286 CABGs and 3,446 PCIs.
Primary end point: all-cause mortality. Results: The mean duration of
follow-up was 4.5 +/- 3.2 years. The rate of drug-eluting stent (DES) was
78.8 % (n=2715). Groups were well matched on age, gender, BSA, baseline
co-morbidities, number of diseased vessels, and ejection fraction.
Compared to PCI, CABG was associated with: improved long-term survival (HR
0.73 [0.66-0.81], p<0.01), decreased risk of repeat revascularization
(CABG 3.7% (n=122), PCI 12.5% (n=430), p<0.001), but increased risk of
stroke (CABG 0.9% (n=29), PCI 0.09% (n=3), p<0.001). CABG was associated
with improved survival across major subgroups of diabetic patients, and
the survival advantage was not influenced by era or stent type (Table).
Conclusions: Among patients with diabetes and multi-vessel disease, CABG
was associated with greater long-term survival when compared to PCI, and
this survival advantage was observed across major patient subgroups.
(Table Presented).

<41>
Accession Number
617220011
Author
Khera R.; Pandey A.; Nallamothu B.; Das S.; Drazner M.H.; Jessen M.;
Kirtane A.; Bhatt D.; De Lemos J.A.; Kumbhani D.
Institution
(Khera, Pandey, Nallamothu, Das, Drazner, Jessen, Kirtane, Bhatt, De
Lemos, Kumbhani) University of Texas, Southwestern Medical Center, Dallas,
TX, United States
Title
Role of hospital volume in identifying low and high-performing surgical
valve centers in the United States.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1291), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Hospital volume is used as a surrogate for quality among
cardiac surgical patients but data are mainly for revascularization
procedures. We assessed volume among low- and high-performing hospitals
for isolated aortic valve replacement (AVR) and mitral valve
repair/replacement (MVR), identified based on risk-standardized
in-hospital mortality rates (RSMR). Methods: We assessed annual volume
using a hospital identifier-linked Nationwide Inpatient Sample
(2007-2011). RSMR were calculated using hierarchical models with empirical
Bayes techniques. Results: We identified 651 hospitals; median annual
volume 45 (IQR 26-79) for AVR, 22 (IQR 12-40) for MVR. Median RSMR were
4.6% (IQR 3.9-5.4) for AVR and 5.6% (IQR 5.1- 6.6) for MVR. There was a
weak inverse volume-RSMR association for AVR (rho -0.16) and MVR (rho
-0.15) (p <0.001 both). There was wide variation in RSMR among highest and
lowest hospital volume quartiles for both AVR/MVR (Figure). Proportion of
hospitals with above-median RSMR in the highest volume quartile: 42% AVR,
44% MVR; similarly, proportion with below-median RSMR in the lowest volume
quartile: 44% AVR, 49% MVR. If volume rather than RSMR was used to define
quality, 21% AVR and 24% MVR hospitals would be misclassified. Discussion:
A pure volume-based metric has the potential to misclassify a substantial
proportion of low- and high-performing US hospitals for AVR and MVR. It
may be more valuable to focus on risk-adjusted outcomes than on volume
thresholds alone to determine quality. (Figure presented).

<42>
Accession Number
617219939
Author
Forrest J.K.; Mangi A.; Popma J.; Khabbaz K.; Reardon M.; Kleiman N.;
Yakubov S.; Watson D.; Kodali S.; George I.; Tadros P.; Zorn G.; Brown J.;
Kipperman R.; Staniloae C.; Williams M.
Institution
(Forrest, Mangi, Popma, Khabbaz, Reardon, Kleiman, Yakubov, Watson,
Kodali, George, Tadros, Zorn, Brown, Kipperman, Staniloae, Williams)
Yale-New Haven Hospital, New Haven, CT, United States
Title
Initial use of the evolut pro self-expanding transcatheter aortic valve.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1288), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Self-expanding TAVR using the CoreValve platform has been
associated with lower mean gradients, larger EOAs, and improved survival
in randomized studies vs surgical AVR. While technological advances
continue to improve TAVR outcomes, surgical AVR has continued to show
superiority with regards to paravalvular leak (PVL). The Medtronic TAVR
2.0 US Clinical Study is evaluating the Medtronic Evolut Pro System. Like
its predecessor the Evolut R, the Evolut Pro can be recaptured or
repositioned if initial positioning is suboptimal. In addition, on the Pro
system an external porcine pericardial wrap has been added to the valve
inflow with the intent of providing enhanced sealing to diminish the
incidence of PVL. We plan to report 30-day outcomes. Methods: The
multicenter, non-randomized Medtronic TAVR 2.0 Clinical Study will include
60 patients implanted with a 23, 26 or 29 mm valve at 8 sites in the US.
Experience implanting the Evolut R TAV was required. Inclusion criteria
were an AVA <1.0 cm² (or AVAi <0.6
cm²/m²) by the continuity equation and a mean AV
gradient >40 mmHg, or max AV velocity >4.0 m/sec at rest; symptoms of AS
and NYHA class >=II, and an STS score of >=8% or documented heart team
agreement the patient is >=high surgical risk due to frailties or
comorbidities. An independent Screening Committee confirmed patient
eligibility and anatomical suitability. The aortic annuli sizing
recommendations did not differ from Evolut R. The new valve is delivered
via a 16F-equivalent In-Line Sheath through vessels >=5.5 mm in diameter.
The primary safety endpoints are the rates of any death and disabling
stroke at 30 days. The primary efficacy endpoint is the proportion of
patients with none/trace prosthetic regurgitation at 30 days by echo.
Prosthetic regurgitation is assessed based on the following degrees of
severity; none, trace, mild, mild-moderate, moderate, moderate-severe, and
severe. An independent Clinical Events Committee is adjudicating all
endpoint-related adverse events according to VARC-2 definitions and an
independent echo core laboratory is assessing valve hemodynamics. Results:
Enrollment will be completed soon and we plan to present primary endpoint
results at the time of the meeting.

<43>
Accession Number
617219902
Author
Koltowski L.; Kochman J.; Parma R.; Ochala A.; Huczek Z.; Witkowski A.;
Scislo P.; Grygier M.; Lesiak M.; Grube E.; Zembala M.
Institution
(Koltowski, Kochman, Parma, Ochala, Huczek, Witkowski, Scislo, Grygier,
Lesiak, Grube, Zembala) Medical University of Warsaw, Warsaw, Poland
Title
Transcatheter aortic valve implantation in patients with bicuspid aortic
valve stenosis utilizing the next generation fully retrievable and
repositionable valve system: Early results from the multicenter POL-TAVI
registry.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1286), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: The aim of this study was to evaluate the outcomes of
transcatheter aortic valve implantation (TAVI) in bicuspid aortic valve
(BiAV) stenosis using a mechanically expanded LotusTM device. The BiAV has
been excluded from landmark clinical trials and is considered as relative
contraindication to TAVI. The prior experience with first-generation
devices has shown disappointing device success rates resulting mainly from
increased prevalence of aortic regurgitation (AR) that exceeded those
observed in tricuspid stenosis. Methods: We collected baseline,
in-hospital and 30-day follow-up data from the POL-TAVI database, which is
an obligatory registry of all patients undergoing TAVI in Poland. The
study group comprised 29 patients who underwent TAVI with LotusTM valve.
Results: The mean age was 73.5 years and the mean EuroSCORE 2 was 4.35 +/-
2.56. MDCT analysis revealed Type 1 BiAV in 75% of patients. The mean
gradient decreased from 60.1 +/- 18.3 mm Hg to 15 +/- 6.4 mm Hg, the AVA
increased from 0.6 +/- 0.19 cm² to 1.7 +/- 0.21 cm².
No intraprocedural death was observed. There was no severe AR and the rate
of moderate AR equaled 8% (n=2). Device success was achieved in 83% and
the 30-day safety endpoint was 17%. Conclusions: The TAVI in selected BAV
patients using the LotusTM is feasible and characterized by encouraging
valve performance and clinical outcomes. (Figure presented).

<44>
Accession Number
617219897
Author
Chandrasekhar J.; Linke A.; Hengstenberg C.; Farhan S.; Tron C.; Fach A.;
Windecker S.; Jeger R.; Sardella G.; Webb J.; Schafer U.; Lefevre T.;
Kupatt C.; Tchetche D.; Dumonteil N.; Colombo A.; Deliargyris E.; Baber
U.; Mehran R.; Anthopoulos P.; Dangas G.
Institution
(Chandrasekhar, Linke, Hengstenberg, Farhan, Tron, Fach, Windecker, Jeger,
Sardella, Webb, Schafer, Lefevre, Kupatt, Tchetche, Dumonteil, Colombo,
Deliargyris, Baber, Mehran, Anthopoulos, Dangas) Icahn School of Medicine
at Mount Sinai, New York, NY, United States
Title
Effect of bivalirudin versus unfractionated heparin in transcatheter
aortic valve replacement with self-expanding valves: From the bravo-3
randomized trial.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1240), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Selection of valve and sheath type may impact on procedural
complications in transcatheter aortic valve replacement (TAVR). Whether
bivalirudin (BIV) reduces bleeding compared with unfractionated heparin
(UFH) specifically with self-expanding (SE) TAVR is unknown. We sought to
compare outcomes with BIV vs UFH in patients undergoing SE-TAVR. Methods:
The BRAVO 3 trial included 282 patients undergoing transfemoral SE-TAVR
who were randomized to receive BIV vs UFH. The primary endpoint was 48h
Bleeding Academic Research Consortium (BARC) type >=3b bleeding. Major
adverse cardiovascular events (MACE) were a composite of death, myocardial
infarction or stroke. Net adverse cardiovascular events (NACE) were a
composite of MACE or BARC >=3b bleeding. Results: Of the study cohort, 140
pts received BIV and 142 pts received UFH. Mean patient age was 82.9+/-6.1
yr, mean EuroScore I was 17.9+/-10.5; 45% were women. There were no
significant baseline differences between groups but BIV treated patients
had numerically greater baseline atrial fibrillation (38.6 vs 28.2%). The
prevalence of sheath size <=18Fr (90.6 vs 89.2%) was similar in BIV vs UFH
patients. Clinical outcomes are shown in the Table. Conclusions: Patients
undergoing TAVI with SE valves had lower MACE and NACE at 48h with BIV vs
UFH but these differences were attenuated at 30 days and no longer
significant. Although no differences were observed in BARC major bleeding,
TIMI major bleeding was significantly lower at both 48 hours and 30 days
with BIV. (Figure presented).

<45>
Accession Number
617219889
Author
Ochiai T.; Saito S.; Yamanaka F.; Shishido K.; Tanaka Y.; Shirai S.; Tada
N.; Araki M.; Naganuma T.; Watanabe Y.; Yamamoto M.; Hayashida K.
Institution
(Ochiai, Saito, Yamanaka, Shishido, Tanaka, Shirai, Tada, Araki, Naganuma,
Watanabe, Yamamoto, Hayashida) Shonankamakura General Hospital, Kamakura,
Japan
Title
Impact of renin-angiotensin system blockade therapy after transcatheter
aortic valve implantation for severe aortic stenosis: Insights from the
ocean-TAVI multicenter registry.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1344), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: In patients who underwent surgical aortic valve replacement
for severe aortic stenosis, postoperative renin-angiotensin system (RAS)
blockade therapy with angiotensin-converting enzyme inhibitors (ACEIs) or
angiotensin-receptor blockers (ARBs) has been shown to reduce left
ventricular (LV) hypertrophy and improve survival, but its effect after
transcatheter aortic valve implantation (TAVI) remains unclear. This study
sought to investigate the effect of RAS blockade therapy on LV hypertrophy
and mortality in patients undergoing TAVI. Methods: Between October 2013
and April 2016, 1215 patients undergoing TAVI at any of nine participating
centers were prospectively enrolled in the OCEAN-TAVI registry. This
cohort was stratified according to postoperative usage of RAS blockade
therapy with ACEIs or ARBs. Patients who had at least two prescriptions
dispensed 180 days apart and at least a 6-month follow-up constituted the
RAS blockade group (n=371), while those not prescribed any ACEIs or ARBs
were included in the no RAS blockade group (n=189). LV mass index
regression and all-cause mortality were analyzed. Results: At 6 months
postoperatively, there was significantly greater LV mass index regression
in the RAS blockade group than in the no RAS blockade group (-7+/-22% vs.
-2+/-24%, p=0.037). After adjusting for confounding factors, RAS blockade
therapy was associated with significantly lower all-cause mortality
(hazard ratio: 0.45; 95% confidence interval: 0.22 to 0.91; p=0.025).
Conclusions: In patients undergoing TAVI for severe aortic stenosis,
postoperative RAS blockade therapy should be considered, as it is
associated with greater LV mass index regression and reduced all-cause
mortality.

<46>
Accession Number
617219828
Author
Yashima F.; Yamamoto M.; Tanaka M.; Yanagisawa R.; Arai T.; Fukuda K.;
Watanabe Y.; Naganuma T.; Shirai S.; Araki M.; Tada N.; Yamanaka F.;
Hayashida K.
Institution
(Yashima, Yamamoto, Tanaka, Yanagisawa, Arai, Fukuda, Watanabe, Naganuma,
Shirai, Araki, Tada, Yamanaka, Hayashida) Keio University, School of
Medicine, Tokyo, Japan
Title
Transcatheter aortic valve implantation in patients with an extremely
small annulus.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1341), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has been
reported to be advantageous over surgical aortic valve replacement owing
to the low incidence of prosthesis-patient mismatch (PPM) and large
effective orifice area (EOA). However, data on TAVI for an extremely small
annulus are limited. The present study aimed to compare post-procedural
hemodynamics and morphology between 20- mm and 23-mm Sapien XT (SXT)
transcatheter heart valves (THVs) with an extremely small annulus (<314
mm²) using post-procedural echocardiography and multidetector
computed tomography. Methods: All patients with severe aortic stenosis
treated with TAVI at 8 Japanese centers between October 2013 and January
2016 were prospectively included in the Optimized CathEter vAlvular
iNtervention (OCEAN-TAVI) registry. In the overall cohort of 20-mm (19
patients) and 23-mm SXTs (492 patients) with an extremely small annulus,
the patient groups were matched one-to-one by using propensity scores, and
post-procedural echocardiography and multidetector computed tomography
data were compared for 18 matched patients from each group (matched
cohort). Results: In the matched cohort, the mean gradient was higher
(15.4+/-4.1 vs. 12.2+/-4.8 mmHg, p=0.04), EOA was lower (1.22+/-0.25 vs.
1.44+/-0.37 cm², p=0.02), and THV area was lower (245.6+/-19.1
vs. 298.5+/-33.3 mm², p<0.01) in the 20-mm group than in the
23-mm group. However, these appeared to be subclinical. Although moderate
PPM was more prevalent in the 20-mm group than in the 23-mm group (31.6%
vs. 7.9%, p<0.01), the incidence of severe PPM was low and similar between
the groups (0% vs. 0.4%, p=1.00) in the overall cohort. Conclusions: In
patients with an extremely small native aortic annulus, the transvalvular
gradient is higher, EOA is lower, and THV area is lower with a 20-mm SXT
than with a 23-mm SXT, even after matching. However, the differences
appear to be subclinical, and the incidence of severe PPM, which can
influence prognosis, might be very low. Therefore, the 20-mm SXT appears
to be effective in patients who require such a small bioprosthesis.

<47>
Accession Number
617219800
Author
Jia X.; Wong D.; Hamzeh I.; Virani S.; Lakkis N.; Alam M.
Institution
(Jia, Wong, Hamzeh, Virani, Lakkis, Alam) Baylor College of Medicine,
Houston, TX, United States
Title
Clinical outcomes of patients with human immune deficiency virus after
coronary revascularization: A systematic review and meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1389), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Human immune deficiency virus (HIV) infection is thought to
confer increased risk of coronary artery disease and acute coronary
syndrome, with an increasing number of HIV+ patients requiring
revascularization. Current data on outcomes of HIV+ patients after
coronary revascularization have yielded mixed conclusions and are limited
by modest sample sizes. Methods: A systematic review was performed,
screening for studies on percutaneous coronary intervention and coronary
artery bypass grafting outcomes in HIV+ and HIV- patients. Baseline
characteristics and outcomes data were appraised and pooled. Random effect
model computing odds ratios (OR) with 95% confidence intervals (CI) was
used to estimate effect size for major adverse cardiac events (MACE),
in-hospital mortality, overall mortality and target vessel
revascularization (TVR). Results: Seven studies encompassing 955 patients
were identified. Baseline characteristics were mostly similar between the
two groups except for younger age and less diabetes in the HIV+ compared
to the HIV- group, (52.4 vs 55.1, p=0.0015) and (21.8% vs 29.9%, p =
0.0301), respectively. Meta-analysis showed statistically significant
increase of MACE in HIV+ patients compared with HIV- patients (OR 1.47, CI
1.04-2.07), which appears to be driven by poorer outcomes after bypass
surgery. There was no significant difference in MACE between the two
groups when percutaneous coronary intervention was analyzed alone (OR
1.34, CI 0.93-1.94). Moreover, there was no statistically significant
difference between HIV+ and HIV- patients in overall mortality (OR 1.63,
CI 0.81-3.26), in-hospital mortality (OR 1.15, CI 0.43-3.06) or TVR (OR
1.23, CI 0.80-1.91). Conclusions: No significant mortality difference was
observed between HIV+ and HIV- patients. HIV infection was associated with
increased cardiovascular events after coronary revascularization, which
was primarily driven by worse outcomes seen after bypass surgery. However,
the number of studies in this group was limited.

<48>
Accession Number
617219785
Author
Pellegrini C.; Kim W.-K.; Holzamer A.; Walther T.; Mayr P.N.; Michel J.;
Rheude T.A.; Joner M.; Trenkwalder T.; Kasel A.M.; Kastrati A.; Schunkert
H.; Hilker M.; Mollmann H.; Hengstenberg C.; Husser O.
Institution
(Pellegrini, Kim, Holzamer, Walther, Mayr, Michel, Rheude, Joner,
Trenkwalder, Kasel, Kastrati, Schunkert, Hilker, Mollmann, Hengstenberg,
Husser) German Heart Center, Munich, Germany
Title
Multicenter evaluation of prosthesis oversizing for the sapien 3
transcatheter heart valve-impact on new pacemaker implantations.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1339), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Prosthesis sizing in transcatheter aortic valve replacement
(TAVR) uses certain prosthesis oversizing (OS) to achieve device success.
However, an increase in OS may increase the need for permanent pacemaker
implantations (PPI). Although there are recommendations for OS for the
SAPIEN 3 transcatheter heart valve (S3-THV), the influence of OS on PPI
has not been evaluated. Methods: Between January 2014 and January 2016,
709 patients without prior pacemaker were treated with S3-THV at three
TAVR centers in Germany. OS was calculated on Multislice CT as (nominal
prosthesis area/patient aortic annular area -1)*100 and categorized into 7
categories: (-5% and under; -4% to 0%; +1% to +5%; +6% to +10%; +11% to
+15%; +16% to +20%; and over +20%) with -4% to 0% as the reference.
Results: The incidence of new PPI was 15% (108/709). Median OS was
significantly larger in patients with PPI (9% [2.5-15] vs. 7% [0-14];
p=0.043). In the multivariable analysis OS was an independent predictor of
PPI (OR 1.027 95%CI [1.004-1.049]; p=0.023, per % increase). Rates of PPI
showed a stepwise increase with each category of OS. In the reference
category, PPI rate was 10%. Compared to the reference OS category, the
adjusted risk of PPI was significantly elevated from +3% OS throughout the
entire sizing range (see Figure). Conclusions: An increase in OS increases
need for PPI using the S3-THV.

<49>
Accession Number
617219757
Author
Chandrasekhar J.; Mehran R.; Hengstenberg C.; Vogel B.; Asgar A.; Berg
J.T.; Mikhail G.; Meneveau N.; Widder J.; Violini R.; Hildick-Smith D.;
Boekstegers P.; Eric V.B.; Husser O.; Hink H.U.; Wijngaard P.; Grube E.;
Baber U.; Deliargyris E.; Anthopoulos P.; Dangas G.
Institution
(Chandrasekhar, Mehran, Hengstenberg, Vogel, Asgar, Berg, Mikhail,
Meneveau, Widder, Violini, Hildick-Smith, Boekstegers, Eric, Husser, Hink,
Wijngaard, Grube, Baber, Deliargyris, Anthopoulos, Dangas) Icahn School of
Medicine at Mount Sinai, New York, NY, United States
Title
Incidence of acute kidney injury with bivalirudin or unfractionated
heparin following transcatheter aortic valve replacement: Results from the
bravo-3 randomized trial.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1387), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Acute kidney injury (AKI) is not uncommon in patients
undergoing transcatheter aortic valve replacement (TAVR). The impact of
procedural bivalirudin (BIV) or unfractionated heparin (UFH) on post-TAVR
AKI is undetermined. Methods: We sought to examine the incidence of AKI
from the BRAVO 3 trial (n=802) in patients randomized to BIV or UFH,
defined using the RIFLE criteria 48 hrs post-TAVR. Outcomes were evaluated
in the intention-to-treat (ITT) and per-protocol (PP) cohorts. Results:
The trial population had a mean age of 81.8+/-6.7 years including 51%
women with mean EuroScore I 16.5+/-10.2; 404 patients were randomized to
BIV and 398 to UFH without any baseline differences between the groups.
AKI occurred in 11.3% of all patients. In the ITT cohort, the rate of AKI
was significantly higher with BIV vs. UFH (10.9 vs 6.5%, p = 0.03)
(Table). When examined by estimated glomerular filtration rate (eGFR), AKI
was significantly greater with BIV vs. UFH in patients presenting with
eGFR < 30ml/min (38.9% vs. 9.1%, p = 0.02) but similar in patients with
GFR >=30ml/min (Table). In the PP cohort, rates of AKI were similar in BIV
and UFH groups (10.7 vs 7.1%, p =0.08). Conclusions: Bivalirudin even
though not known to be associated with any nephrotoxicity was associated
with a higher rate of AKI compared to UFH in the BRAVO-3 randomized trial,
which was predominantly stage 1 AKI and driven by patients with eGFR
<30ml/min. Dedicated studies are warranted to examine this effect of
bivalirudin to guide optimal use in TAVR. (Table Presented).

<50>
Accession Number
617219695
Author
Patel J.; Fearon W.; Elmariah S.; Kim J.; Kapadia S.; Kumbhani D.; Gillam
L.; Whisenant B.; Quader N.; Welt F.; Maniar H.; Bavry A.; Zajarias A.;
Piana R.; Melby S.; Coylewright M.; Vatterott A.; Stassi K.; Novak E.;
Lindman B.
Institution
(Patel, Fearon, Elmariah, Kim, Kapadia, Kumbhani, Gillam, Whisenant,
Quader, Welt, Maniar, Bavry, Zajarias, Piana, Melby, Coylewright,
Vatterott, Stassi, Novak, Lindman) Washington University, Cardiology,
Saint Louis, MO, United States
Title
Depression as a potential therapeutic target to improve quality of life
after transcatheter aortic valve replacement.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1337), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Cognitive function and mood are rarely assessed in patients
with aortic stenosis (AS) prior to transcatheter aortic valve replacement
(TAVR). The prevalence of cognitive impairment and depression and their
respective associations with quality of life (QoL) after TAVR are unknown.
Methods: We included patients undergoing TAVR for AS from a prospective,
real-world registry including 11 centers across the United States. Prior
to TAVR, subjects completed short validated tests for cognition (Mini-Cog)
and mood (PHQ2). The primary outcome was QoL 30 days after TAVR as
assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall
summary score (scale 0-100, higher is better; minimal clinically important
difference is 5 points). Results: Among 537 patients, the average age was
82 years, 44% were female, the average STS score was 7+/-5, and 86% had a
transfemoral approach. Cognitive impairment (CI) was identified in 174
(32%) and depression in 54-101 (10-19%) using specific or sensitive PHQ2
cut-points, respectively. Compared to those without CI, those with CI had
a similar QoL at baseline, 30 days after TAVR, and increase between those
time points (p=NS). In contrast, while depressed patients did experience
an improvement in QoL after TAVR (+16 point change, 95% CI 6-25), it was
less than those without depression (+25 point change, 95% CI 22-27)
(p=0.04). Compared to non-depressed patients, depressed patients had worse
QoL at 30 days after adjustment for age, sex, and baseline KCCQ (30 day
KCCQ 17 points lower, 95% CI 10 to 24, p<0.001), despite no difference
between groups in pre-TAVR NYHA class or TAVR approach. A more sensitive
cut-point for depression yielded a similar, but less pronounced,
difference (30 day KCCQ 10 points lower, 95% CI 5 to 15, p<0.001).
Conclusions: CI was present in one-third of patients undergoing TAVR, but
not associated with QoL before or after TAVR. In contrast, depression was
identified in 10-19% of patients undergoing TAVR; compared to
non-depressed patients, depressed patients had less improvement in QoL
from TAVR and had a markedly worse QoL 30 days after TAVR. Whether
attempts to identify and treat depression will improve QoL after TAVR
requires further study.

<51>
Accession Number
617219665
Author
Power J.E.; Barrett M.; Power J.
Institution
(Power, Barrett, Power) Allegheny General Hospital, Pittsburgh, PA, USA,
University of Pittsburgh Medical Center, Pittsburgh, PA, USA
Title
In an era of TAVR how can cardiology fellow auscultation skills be
improved.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 2487), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Clinical diagnosis skills for aortic stenosis(AS) have become
increasingly important in a era of trans-catheter aortic valve replacement
(TAVR) and increasing health care costs. Advances in trans-catheter
treatment of AS provides new therapies for patients, but physicians,
especially cardiology fellows who will soon be independently practicing
cardiologists, must be able to detect valvular problems in a timely and
cost efficient manner for their patients to maximally benefit from these
advances. Recent published studies have suggested that only 1 in 3
echocardiograms performed results in a change in patient management. In
addition, auscultation is a core competency requirement for cardiology
fellows. In our study we evaluated the efficacy of an on-line auscultation
program with high quality audio on how well it improved auscultation
skills for diagnosing aortic stenosis. Methods: 743 cardiology fellows
participated in a double blind study evaluating auscultation skills over 5
years. A high quality audio program consisting of both basic and advanced
murmurs was utilized. Murmur recordings were randomized in a pre-test
consisting of images of the auscultation site along with the audio murmur.
After the pre-test, participants completed a 30 minute learning module ,
which consisted of listening to each of the murmurs for 100 repetitions.
Following completion of the learning module, participants completed a
post-test with another randomized set of murmurs. Following completion of
the program, participants were re-tested with a random set of murmurs.
Results: Baseline accuracy for all murmurs was 61% and for aortic stenosis
was 58%. Following the educational auscultation program, accuracy for
murmurs in general improved to 91% (P<0.001) and accuracy for aortic
stenosis improved to 88% (P<0.001). Conclusions: A high quality audio
program with at least 100 repetitions per murmur can significantly
increase auscultatory accuracy for cardiology trainees for both general
murmurs and AS. Improvement in identifying AS severity needs to be
pursued, to utilize healthcare resources optimally and to streamline TAVR
referral processes.

<52>
Accession Number
617219613
Author
Chang H.-Y.; Liu Y.-W.
Institution
(Chang, Liu) National Cheng Kung University Hospital, Tainan, Taiwan
(Republic of China)
Title
The impact of echocardiography parameter on the outcome in patients
receiving non-cardiac surgery.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1831), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Because patients undergoing major noncardiac surgery are at
risk for adverse cardiovascular events, it is recommended to do thorough
perioperative assessments. However, echocardiography is recommended to
evaluate the valve condition and the left ventricular (LV) systolic
function when patients have heart failure symptoms or dyspnea on unknown
cause. Nevertheless, it is shown that those patients having asymptomatic
LV systolic dysfunction have high the major cardiovascular event (MACE)
rate. The role of echocardiography study for preoperative risk evaluation
is not well-illustrated. Therefore, we conducted this prospective study to
investigate prognostic value of preoperative echocardiographic study for
patients scheduled to undergo noncardiac surgery. Methods: From February
2013 to June 2016, we enrolled 2,280 patients (male 45.1%, age 69.2+/-15.3
years) undergoing scheduled noncardiac surgery in 2 university hospitals
in Tainan, Taiwan. They all received pre-operative echocardiography. All
the patients were followed-up for 56 days after surgery. The primary
outcome was major adverse events (MAEs), defined as all-cause mortality
and MACEs, i.e. cardiovascular death, cardiac hospitalization, and stroke.
Multivariate Cox regression analysis was used to investigate risk factors
for MAEs and MACEs. Results: Forty-one patients (1.8%) reached primary
outcome. Using multi-variate Cox regression analyses, increased left
atrial volume (LAV) index (p < 0.001) and LV end-diastolic volume (EDV)
index (p = 0.049) were independent predictors of MAEs. The predictors of
MACEs were atrial fibrillation and severe mitral regurgitation.
Conclusions: Preoperative echocardiographic study could identify the high
risk patients of peri-operative cardiovascular events. LAV index and LVEDV
index provided prognostic information beyond standard risk factors for
scheduled noncardiac surgery patients.

<53>
Accession Number
617219610
Author
Kandregula K.; Banerjee K.; Jones B.; Jobanputra Y.; Krishnaswamy A.; Mick
S.; Navia J.; Popovic Z.; Svensson L.; Tuzcu E.M.; Kapadia S.
Institution
(Kandregula, Banerjee, Jones, Jobanputra, Krishnaswamy, Mick, Navia,
Popovic, Svensson, Tuzcu, Kapadia) Cleveland Clinic, Cleveland, OH, United
States
Title
Outcomes of transcatheter aortic valve replacement without balloon
predilation: A systematic review and meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1232), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: BPD is deemed essential before Transcatheter Aortic Valve
Replacement (TAVR) with unclear impact on outcomes. Thus, we want to study
the outcomes of TAVR without balloon predilation (BPD). Methods: TAVR
studies published between 2002 and October 2016 were reviewed. From 1217
initial citations, 22 studies reporting on 4530 patients were analyzed for
outcomes post-TAVR using the random effects model. Results: The 30 day
mortality is 4.88% vs 5.91%, 1 year mortality is 14.33% vs 14.11%, device
success is 89.88% vs 88.32% in no BPD group vs BPD group respectively. The
mean procedure time and mean contrast volume were significantly lower by
39 min and 24 ml respectively in no BPD group as compared to BPD group.
Meta-analysis showed no significant difference for all-cause mortality at
30-days [Odds Ratio (OR)-0.83; 95% Confidence interval (CI):0.60-1.14] or
1-year (OR-0.81; 95%CI:0.51-1.28) with significantly higher device success
(OR-1.65; 95%CI:1.20-2.26) in no BPD group as compared to BPD group. The
incidence of moderate/severe residual Paravalvular leakage (PVL) (OR-0.48;
95%CI:0.27-0.87), major vascular complications (OR-0.68; 95%CI:0.51-0.91),
need for conversion to surgery (OR-0.42; 95%CI:0.19-0.93) were
significantly lower in the no BPD group as compared to BPD group.
Conclusions: TAVR without BPD showed better outcomes in terms of device
success, PVL, major vascular complications, need for conversion to surgery
with lower total procedure time and contrast volume. (Figure presented).

<54>
Accession Number
617219607
Author
Ahmad T.A.; Kozak M.; Peterson B.; Chan E.; Yadav P.
Institution
(Ahmad, Kozak, Peterson, Chan, Yadav) Penn State Milton Hershey Medical
Center, Hershey, PA, United States
Title
Transcatheter tricuspid valve replacement-"forgotten valve", challenging
management with limited treatment options-time to gather evidence.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 2182), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Patients with symptomatic tricuspid valve (TV) disease have
limited treatment options, especially with previous sternotomies and
presence of right heart dysfunction. Case: 62-year-old female hospitalized
with refractory right heart failure with complete heart block and syncope.
Medical history was significant for degenerative bioprosthetic tricuspid
valve (31-mm Biocor porcine valve surgically implanted 4 years ago,
developed severe regurgitation with severe stenosis within 3 months of
surgery). Workup with transthoracic echocardiogram, right heart
catheterization confirmed the above findings and showed dilated right
ventricle (RV) with reduced systolic function. Additionally, she had left
sided Superior Vena Cava with severely enlarged coronary sinus.
Decision-Making: Two problems needed treatment: tricuspid valve and
complete heart block. Dilemma was the best approach and sequence. Surgical
team deemed her high risk candidate due to comorbidities, early failure of
previous bioprosthesis with unclear etiology and RV dysfunction.
Transcatheter options were reviewed but the need for permanent pacemaker
complicated the decision process. Any lead across the new TV would
jeopardize the valve, coronary sinus lead may not be stable (large sinus),
sandwiching the lead between surgical bioprosthesis and transcatheter
valve would prohibit lead extraction (in case this young woman develops
lead infection in future). We successfully performed Transcatheter
Tricuspid Valve-in-valve Replacement (TTVR) using a 29 mm Sapien 3 valve
via the right femoral venous approach. Rapid pacing for the valve
deployment was done via the coronary artery (0.014' wire in the 1st septal
perforator). Epicardial ventricular pacing lead was placed via mini
thoracotomy. Patient was discharged on Warfarin to prevent leaflet
thrombosis ("frozen leaflet"). At 1 month followup, functional class
improved, right ventricle was normal in size & function with
well-functioning TV. Conclusions: TTVR for failed bioprosthesis/
annuloplasty rings appears feasible, however data is limited and only in
the form of case reports/series. Multicenter prospective registry is
needed to assess long term outcomes.

<55>
Accession Number
617219564
Author
Goldfarb M.; Lauck S.; Webb J.; Hyun Kim D.; Popma J.; Piazza N.; Martucci
G.; Labinaz M.; Lamy A.; Peterson M.; Noiseux N.; Rassi A.; Lindman B.;
Genereux P.; Arora R.; Morais J.; Asgar A.; Perrault L.; Afilalo J.
Institution
(Goldfarb, Lauck, Webb, Hyun Kim, Popma, Piazza, Martucci, Labinaz, Lamy,
Peterson, Noiseux, Rassi, Lindman, Genereux, Arora, Morais, Asgar,
Perrault, Afilalo) Jewish General Hospital, Montreal, Canada
Title
Serum albumin as an incremental predictor of mortality in older adults
undergoing transcatheter aortic valve replacement: Results from the
multicenter frailty-AVR study.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1331), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Hypoalbuminemia is a biomarker for malnutrition and chronic
inflammation that has been implicated in the pathobiology of frailty, and
been shown to be a risk factor for mortality and morbidity in general
medical and surgical cohorts. Data from single-center retrospective series
suggests that hypoalbuminemia may be a risk factor in older adults
undergoing transcatheter aortic valve replacement (TAVR) but its
incremental value has yet to be confirmed in a prospective study that
collected and adjusted for clinical frailty parameters. Methods and
Results: We conducted a pre-planned analysis of the prospective
Frailty-AVR cohort study enrolling older adults >=70 years from 14 centers
in 3 countries (2012-2015). After excluding one center that did not
measure serum albumin, 402 out of 489 patients had a documented pre-TAVR
serum albumin that was recorded as a continuous variable. The primary
endpoint was 1-year all-cause mortality. We used multivariable logistic
regression and adjusted for age, sex, body mass index, glomerular
filtration rate, comorbid conditions including cirrhosis, ejection
fraction, disability, and frailty according to Fried's scale. Compared to
patients in the highest albumin tertile (>=40 g/L), those in the lowest
tertile (<35 g/L) had more marked weight loss, anemia, inactivity,
disability, and frailty, and a higher risk of mortality at 30 days (7.9%
vs. 1.9%) and 1 year (21.3% vs. 7.9%). Following adjustment, serum albumin
was the strongest independent predictor of 1-year mortality (OR 0.53 for
every 10 g/L or 1 g/dL, 95% CI 0.34 to 0.82, P=0.005), resulting in an
integrated discrimination improvement of 0.02 and an increase in model
c-statistic from 0.69 to 0.72. The optimal cutoff favoring specificity was
serum albumin <30 g/L (OR 2.73, 95% CI 1.34 to 5.99; sensitivity 28%,
specificity 89%). Conclusions: Hypoalbuminemia is a powerful predictor of
post-TAVR mortality, which adds incremental value above existing risk
models and clinical frailty scales. Further research is warranted testing
the effect of nutritional interventions targeted to frail older adults
with low serum albumin.

<56>
Accession Number
617219547
Author
Ferreiro R.G.; Otero D.L.; Munoz-Garcia A.J.; Avanzas P.; Pascual I.;
Briales J.H.A.; Nouche R.T.; Chinchay F.P.; Navarro M.J.; Garcia J.M.H.;
Moris C.; Juanatey J.R.G.
Institution
(Ferreiro, Otero, Munoz-Garcia, Avanzas, Pascual, Briales, Nouche,
Chinchay, Navarro, Garcia, Moris, Juanatey) Complexo Hospitalario
Universitario De Santiago De Compostela, Santiago de Compostela, Spain
Title
Effect of body mass index on mortality after transcatheter aortic valve
implantation: J-shaped curve.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 1229), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: In the context of established cardiovascular disease, obesity
is protective factor (obesity paradox). The aim of our study is to
determine if the body mass index (BMI) is a prognostic factor in patients
undergoing transcatheter aortic valve implantation (TAVI). Methods: A
retrospective study was carried out in three centers.770 patients
undergoing TAVI between 2008-2014, were distributed according to their BMI
in 3 groups: normal weight, overweight and obesity. The study endpoint was
to assess the value of BMI to predict all-cause mortality during
follow-up. Results: A total of 155 patients died during follow-up
(2,7+/-1,8 years). The overweight group (n=302,38,97%) has a lower
mortality rate compared with normal weight and obese groups (15,9% vs
25,7% y 21,0%; log-rank p-value 0,036). After multivariate Cox regression
analysis, overweight was independent protective factor for mortality (HR:
0.63 [95% CI: 0.42 to 0.94], p=0.024), not obesity (HR: 0.92 [95% CI: 0.63
to 1.35], p=0.664). In our study we describe for the first time a
"J"-shaped regression, that relates the BMI with long-term mortality
(figure 1). Thus, patients at the extremes of the curve (underweight and
extreme obesity) has the worst prognosis, whereas patients who are
overweight have the most favorable prognosis. Conclusions: BMI has
prognostic value in patients with severe aortic stenosis undergoing TAVI,
with a "J"-shaped curve. Overweight was associated with lower long-term
motality rate. (Figure presented).

<57>
Accession Number
617217058
Author
Anonymous
Title
British Congenital Cardiac Association, Annual Meeting.
Source
Heart. Conference: British Congenital Cardiac Association Annual Meeting ,
BCCA 2017. United Kingdom. 103 (no pagination), 2017. Date of Publication:
April 2017.
Publisher
BMJ Publishing Group
Abstract
The proceedings contain 25 papers. The topics discussed include:
congenitally corrected transposition of the great arteries: indications
for CRT?; suitability of univentricular patients for cardiac
resynchronisation therapy; implantable loop recorders in adult congenital
heart disease: a single-center experience; postoperative interventricular
septal hematoma following tetralogy of fallot repair and perimembranous
ventricular septal defect repair; long-term outcomes of adults with ALCAPA
repair; long-term outcomes of adults with Williams syndrome in an adult
congenital heart disease center; and personalized warfarin dosing in
children after congenital heart surgery: a randomized, prospective,
cross-over, pilot study at Glenfield Hospital, Leicester.

<58>
Accession Number
617217028
Author
Shepherd E.; Witter T.; Lakhani R.; Morgan G.
Institution
(Shepherd) Bristol Royal Hospital for Children, United Kingdom
(Shepherd, Witter, Lakhani) Evelina London Children's Hospital, United
Kingdom
(Shepherd) University of Bristol, United Kingdom
(Morgan) Children's Hospital of Colorado, University Hospital Colorado,
United States
Title
Establishing a UK wide model to collate cardiac catheter lab morbidity and
drive quality improvement.
Source
Heart. Conference: British Congenital Cardiac Association Annual Meeting ,
BCCA 2017. United Kingdom. 103 (pp A7), 2017. Date of Publication: April
2017.
Publisher
BMJ Publishing Group
Abstract
Background Congenital catheterisation in the UK currently has no effective
method of collating, benchmarking and acting on morbidity. Although NICOR
has started to pay attention to quality measures in cardiac
catheterisation within the UK, its remit does not allow it to adequately
explore and assess models for morbidity and quality assessment. In the USA
two specific quality assessment tools (C3PO database^1,2 and
CRISP score^3,4) for quality assessment in congenital cardiac
catheterisation have been developed using retrospective data from several
thousand congenital catheterisations mainly from the USA, but including
our institution. Although UK and USA are developed countries with modern
healthcare systems, they work in different ways and the application of any
quality measures across both countries must be performed with caution.
Methods We retrospectively analysed morbidity and mortality data from
diagnostic and interventional congenital cardiac catheter cases within a
UK major congenital heart disease centre between June 2015 and September
2016. All electrophysiology catheters and those diagnostic catheters
indicated as a work up for patient anaesthetic safety assessments were
excluded. A retrospective cardiac catheter CRISP risk score3,4 and
associated risk category, calculated using 8 parameter points, was then
applied to each case and comparisons made with observed congenital cardiac
catheterisation complications. Results A total of 306 congenital cardiac
catheterisation procedures were analysed; diagnostic 43 (14.0%),
interventional 249 (81.4%) and hybrid 14 (4.6%). Cardiac catheter urgency
included elective 246 (80.4%), urgent (within 1 week) 39 (12.7%) and
emergency (within 24 hours) 21 (6.9%) procedures. Patients included were
aged 0 to 86.25 years. Figure 1 displays the CRISP Risk categories and
associated serious adverse event complication rates for our patient
cohort. There were 2 catastrophic cardiac catheter related complications,
one case in each of the two highest CRISP Risk categories; death in
cardiac catheterisation lab due to vessel rupture during pulmonary artery
stenting for a CRISP Risk category 4 patient and death in PICU the day
after balloon dilatation for aortic coarctation due to necrotising
enterocolitis for a CRISP Risk category 5 patient. Conclusions
Quantitative data has shown important links between the CRISP risk score
and congenital cardiac catheterisation complication rates. Qualitatively,
we have found that the CRISP scoring tool is applicable to UK
catheterisation practice, providing a meaningful tool for risk assessment,
case planning and benchmarking for morbidity and complications. Expansion
of the data set to a further 4 congenital centres within the UK and
Ireland is currently in process, to allow a meta-analysis to produce
logical and relevant morbidity and quality scores to augment the overview
data collected by NICOR.

<59>
Accession Number
617217018
Author
Al-Metwali B.; Yong S.; O'Hare L.J.; Bowcutt S.; McCann M.; Sadagopan S.;
Rivers P.; Mulla H.
Institution
(Al-Metwali, Yong, O'Hare, Bowcutt, McCann, Mulla) University Hospitals of
Leicester, Glenfield Hospital, United Kingdom
(Al-Metwali, Rivers) Leicester School of Pharmacy, De Montfort University,
United Kingdom
(Sadagopan) University Hospital of Southampton, Southampton General
Hospital, United Kingdom
Title
Personalised Warfarin dosing in children after congenital heart surgery: A
randomised, prospective, cross-over, pilot study at Glenfield hospital,
Leicester.
Source
Heart. Conference: British Congenital Cardiac Association Annual Meeting ,
BCCA 2017. United Kingdom. 103 (pp A5), 2017. Date of Publication: April
2017.
Publisher
BMJ Publishing Group
Abstract
After cardiac surgery (eg, Fontan repair, valve replacement), children are
at an increased risk of thrombosis and therefore long-term oral
anti-coagulation is essential to prevent morbidity and mortality. Warfarin
is commonly used, but optimising the dose and maintaining a therapeutic
INR is challenging for clinicians due to considerable inter-and
intra-individual variability in its pharmacokinetics (PK) and
pharmacodynamics (PD). The PK/PD is affected by both patient related (such
as genetic polymorphisms of the metabolic enzymes) and environmental (eg,
diet) factors. To improve the accuracy and consistency of warfarin dosing,
a novel PK/PD (pharmacological) based model incorporating pharmacogenomics
has been developed to assist clinicians in predicting initial and
maintenance warfarin doses in post-operative cardiac children.1 The aim of
the study is to compare warfarin dose management using pharmacological
model with the traditional, 'trial and error' approach. The study is
prospective and observational and involves 2 groups: In Group 1 (warfarin
naive) patients, loading and maintenance warfarin doses are estimated
using the pharmacological model over 6 month duration and compared to
historical case matched controls dosed according to the traditional
approach. Group 2 patients already established on maintenance warfarin
therapy entered a randomised cross-over study comparing pharmacological
model-estimated dose adjustments with the traditional approach, over a 12
month period. The study also seeks to explore the views of children,
parents and medical staff about the new model based approach. The study
commenced in October 2015 and recruitment stopped in December 2016. Group
1 (n=5) and Group 2 (n=29) participants are currently being followed up
for their warfarin dosing and monitoring.

<60>
Accession Number
614668124
Author
Hummel J.; Rucker G.; Stiller B.
Institution
(Hummel, Stiller) Heart Center, University of Freiburg, Department of
Congenital Heart Defects and Pediatric Cardiology, Mathildenstr. 1,
Freiburg 79106, Germany
(Rucker) Faculty of Medicine and Medical Center - University of Freiburg,
Institute for Medical Biometry and Statistics, Stefan-Meier-Str. 26,
Freiburg 79104, Germany
Title
Prophylactic levosimendan for the prevention of low cardiac output
syndrome and mortality in paediatric patients undergoing surgery for
congenital heart disease.
Source
Cochrane Database of Systematic Reviews. 2017 (3) (no pagination), 2017.
Article Number: CD011312. Date of Publication: 06 Mar 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Low cardiac output syndrome remains a serious complication,
and accounts for substantial morbidity and mortality in the postoperative
course of paediatric patients undergoing surgery for congenital heart
disease. Standard prophylactic and therapeutic strategies for low cardiac
output syndrome are based mainly on catecholamines, which are effective
drugs, but have considerable side effects. Levosimendan, a calcium
sensitiser, enhances the myocardial function by generating more
energy-efficient myocardial contractility than achieved via adrenergic
stimulation with catecholamines. Thus potentially, levosimendan is a
beneficial alternative to standard medication for the prevention of low
cardiac output syndrome in paediatric patients after open heart surgery.
Objectives: To review the efficacy and safety of the postoperative
prophylactic use of levosimendan for the prevention of low cardiac output
syndrome and mortality in paediatric patients undergoing surgery for
congenital heart disease. Search methods: We identified trials via
systematic searches of CENTRAL, MEDLINE, Embase, and Web of Science, as
well as clinical trial registries, in June 2016. Reference lists from
primary studies and review articles were checked for additional
references. Selection criteria: We only included randomised controlled
trials (RCT) in our analysis that compared prophylactic levosimendan with
standard medication or placebo, in infants and children up to 18 years of
age, who were undergoing surgery for congenital heart disease. Data
collection and analysis: Two review authors independently extracted data
and assessed risk of bias according to a pre-defined protocol. We obtained
additional information from all but one of the study authors of the
included studies. We used the five GRADE considerations (study
limitations, consistency of effect, imprecision, indirectness, and
publication bias) to assess the quality of evidence from the studies that
contributed data to the meta-analyses for the prespecified outcomes. We
created a 'Summary of findings' table to summarise the results and the
quality of evidence for each outcome. Main results: We included five
randomised controlled trials with a total of 212 participants in the
analyses. All included participants were under five years of age. Using
GRADE, we assessed there was low-quality evidence for all analysed
outcomes. We assessed high risk of performance and detection bias for two
studies due to their unblinded setting. Levosimendan showed no clear
effect on risk of mortality (risk ratio (RR) 0.47, 95% confidence interval
(CI) 0.12 to 1.82; participants = 123; studies = 3) and no clear effect on
low cardiac output syndrome (RR 0.64, 95% CI 0.39 to 1.04; participants =
83; studies = 2) compared to standard treatments. Data on time-to-death
were not available from any of the included studies. There was no
conclusive evidence on the effect of levosimendan on the secondary
outcomes. The levosimendan groups had shorter length of intensive care
unit stays (mean difference (MD) 0.33 days, 95% CI -1.16 to 1.82;
participants = 188; studies = 4; I2 = 35%), length of hospital stays (0.26
days, 95% CI -3.50 to 4.03; participants = 75; studies = 2), and duration
of mechanical ventilation (MD -0.04 days, 95% CI -0.08 to 0.00;
participants = 208; studies = 5; I2 = 0%). The risk of mechanical
circulatory support or cardiac transplantation favoured the levosimendan
groups (RR 1.49, 95% CI 0.19 to 11.37; participants = 60; studies = 2).
Published data about adverse effects of levosimendan were limited. A
meta-analysis of hypotension, one of the most feared side effects of
levosimendan, was not feasible because of the heterogeneous expression of
blood pressure values. Authors' conclusions: The current level of evidence
is insufficient to judge whether prophylactic levosimendan prevents low
cardiac output syndrome and mortality in paediatric patients undergoing
surgery for congenital heart disease. So far, no significant differences
have been detected between levosimendan and standard inotrope treatments
in this setting. The authors evaluated the quality of evidence as low,
using the GRADE approach. Reasons for downgrading were serious risk of
bias (performance and detection bias due to unblinded setting of two
RCTs), serious risk of inconsistency, and serious to very serious risk of
imprecision (small number of included patients, low event
rates).<br/>Copyright &#xa9; 2017 The Cochrane Collaboration. Published by
John Wiley & Sons, Ltd.

<61>
Accession Number
616556363
Author
Rodes-Cabau J.; Masson J.-B.; Welsh R.C.; Garcia del Blanco B.; Pelletier
M.; Webb J.G.; Al-Qoofi F.; Genereux P.; Maluenda G.; Thoenes M.; Paradis
J.-M.; Chamandi C.; Serra V.; Dumont E.; Cote M.
Institution
(Rodes-Cabau, Paradis, Chamandi, Dumont, Cote) Quebec Heart & Lung
Institute, Laval University, Quebec City, Quebec, Canada
(Masson) Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec,
Canada
(Welsh) Mazankowski Alberta Heart Institute and University of Alberta,
Edmonton, Alberta, Canada
(Garcia del Blanco, Serra) Hospital Universitari Vall d'Hebron, Barcelona,
Spain
(Pelletier) Saint John's Regional Hospital, Saint John, New Brunswick,
Canada
(Webb) St. Paul's Hospital, Vancouver, British Columbia, Canada
(Al-Qoofi) Foothills Hospital, Calgary, Alberta, Canada
(Genereux) Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
(Maluenda) Hospital San Borja Arriaran, Santiago de Chile, Chile
(Thoenes) Leman Research Institute, Geneva, Switzerland
Title
Aspirin Versus Aspirin Plus Clopidogrel as Antithrombotic Treatment
Following Transcatheter Aortic Valve Replacement With a Balloon-Expandable
Valve: The ARTE (Aspirin Versus Aspirin + Clopidogrel Following
Transcatheter Aortic Valve Implantation) Randomized Clinical Trial.
Source
JACC: Cardiovascular Interventions. 10 (13) (pp 1357-1365), 2017. Date of
Publication: 10 Jul 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to compare aspirin plus clopidogrel
with aspirin alone as antithrombotic treatment following transcatheter
aortic valve replacement (TAVR) for the prevention of ischemic events,
bleeding events, and death. Background Few data exist on the optimal
antithrombotic therapy following TAVR. Methods This was a randomized
controlled trial comparing aspirin (80 to 100 mg/day) plus clopidogrel (75
mg/day) (dual antiplatelet therapy [DAPT]) versus aspirin alone
(single-antiplatelet therapy [SAPT]) in patients undergoing TAVR with a
balloon-expandable valve. The primary endpoint was the occurrence of
death, myocardial infarction (MI), stroke or transient ischemic attack, or
major or life-threatening bleeding (according to Valve Academic Research
Consortium 2 definitions) within the 3 months following the procedure. The
trial was prematurely stopped after the inclusion of 74% of the planned
study population. Results A total of 222 patients were included, 111
allocated to DAPT and 111 to SAPT. The composite of death, MI, stroke or
transient ischemic attack, or major or life-threatening bleeding tended to
occur more frequently in the DAPT group (15.3% vs. 7.2%, p = 0.065). There
were no differences between groups in the occurrence of death (DAPT, 6.3%;
SAPT, 3.6%; p = 0.37), MI (DAPT, 3.6%; SAT, 0.9%; p = 0.18), or stroke or
transient ischemic attack (DAPT, 2.7%; SAPT, 0.9%; p = 0.31) at 3 months.
DAPT was associated with a higher rate of major or life-threatening
bleeding events (10.8% vs. 3.6% in the SAPT group, p = 0.038). There were
no differences between groups in valve hemodynamic status post-TAVR.
Conclusions This small trial showed that SAPT (vs. DAPT) tended to reduce
the occurrence of major adverse events following TAVR. SAPT reduced the
risk for major or life-threatening events while not increasing the risk
for MI or stroke. Larger studies are needed to confirm these results.
(Aspirin Versus Aspirin + Clopidogrel Following Transcatheter Aortic Valve
Implantation: The ARTE Trial [ARTE], NCT01559298; Aspirin Versus
Aspirin+Clopidogrel as Antithrombotic Treatment Following TAVI [ARTE],
NCT02640794)<br/>Copyright &#xa9; 2017 American College of Cardiology
Foundation

<62>
Accession Number
617134974
Author
Anderson L.; Brown J.P.R.; Clark A.M.; Dalal H.; Rossau H.K.; Bridges C.;
Taylor R.S.
Institution
(Anderson, Taylor) University of Exeter Medical School, Institute of
Health Research, Veysey Building, Salmon Pool Lane, Exeter EX2 4SG, United
Kingdom
(Brown) BC Women's Hospital, Department of Anesthesia, 4500 Oak Street,
Vancouver, BC, BC V6H 3N1, Canada
(Clark) University of Alberta, Faculty of Nursing, Level 3 CSB, Edmonton,
AB T63 2G3, Canada
(Dalal) University of Exeter Medical School, Truro Campus, Knowledge Spa,
Royal Cornwall Hospitals Trust, Department of Primary Care, Truro TR1 3HD,
United Kingdom
(Rossau) University of Southern Denmark and Region of Southern Denmark,
Danish Knowledge Centre for Rehabilitation and Palliative Care,
Copenhagen, Denmark
(Bridges) University College London, Farr Institute of Health Informatics
Research, 222 Euston Road, London NW1 2DA, United Kingdom
Title
Patient education in the management of coronary heart disease.
Source
Cochrane Database of Systematic Reviews. 2017 (6) (no pagination), 2017.
Article Number: CD008895. Date of Publication: 28 Jun 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Coronary heart disease (CHD) is the single most common cause
of death globally. However, with falling CHD mortality rates, an
increasing number of people live with CHD and may need support to manage
their symptoms and improve prognosis. Cardiac rehabilitation is a complex
multifaceted intervention which aims to improve the health outcomes of
people with CHD. Cardiac rehabilitation consists of three core modalities:
education, exercise training and psychological support. This is an update
of a Cochrane systematic review previously published in 2011, which aims
to investigate the specific impact of the educational component of cardiac
rehabilitation. Objectives: 1. To assess the effects of patient education
delivered as part of cardiac rehabilitation, compared with usual care on
mortality, morbidity, health-related quality of life (HRQoL) and
healthcare costs in patients with CHD. 2. To explore the potential study
level predictors of the effects of patient education in patients with CHD
(e.g. individual versus group intervention, timing with respect to index
cardiac event). Search methods: We updated searches from the previous
Cochrane review, by searching the Cochrane Central Register of Controlled
Trials (CENTRAL) (Cochrane Library, Issue 6, 2016), MEDLINE (Ovid), Embase
(Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) in June 2016. Three trials
registries, previous systematic reviews and reference lists of included
studies were also searched. No language restrictions were applied.
Selection criteria: 1. Randomised controlled trials (RCTs) where the
primary interventional intent was education delivered as part of cardiac
rehabilitation. 2. Studies with a minimum of six-months follow-up and
published in 1990 or later. 3. Adults with a diagnosis of CHD. Data
collection and analysis: Two review authors independently screened all
identified references for inclusion based on the above inclusion criteria.
One author extracted study characteristics from the included trials and
assessed their risk of bias; a second review author checked data. Two
independent reviewers extracted outcome data onto a standardised
collection form. For dichotomous variables, risk ratios and 95% confidence
intervals (CI) were derived for each outcome. Heterogeneity amongst
included studies was explored qualitatively and quantitatively. Where
appropriate and possible, results from included studies were combined for
each outcome to give an overall estimate of treatment effect. Given the
degree of clinical heterogeneity seen in participant selection,
interventions and comparators across studies, we decided it was
appropriate to pool studies using random-effects modelling. We planned to
undertake subgroup analysis and stratified meta-analysis, sensitivity
analysis and meta-regression to examine potential treatment effect
modifiers. We used the Grading of Recommendations Assessment, Development
and Evaluation (GRADE) approach to evaluate the quality of the evidence
and the GRADE profiler (GRADEpro GDT) to create summary of findings
tables. Main results: This updated review included a total of 22 trials
which randomised 76,864 people with CHD to an education intervention or a
'no education' comparator. Nine new trials (8215 people) were included for
this update. We judged most included studies as low risk of bias across
most domains. Educational 'dose' ranged from one 40 minute face-to-face
session plus a 15 minute follow-up call, to a four-week residential stay
with 11 months of follow-up sessions. Control groups received usual
medical care, typically consisting of referral to an outpatient
cardiologist, primary care physician, or both. We found evidence of no
difference in effect of education-based interventions on total mortality
(13 studies, 10,075 participants; 189/5187 (3.6%) versus 222/4888 (4.6%);
random effects risk ratio (RR) 0.80, 95% CI 0.60 to 1.05; moderate quality
evidence). Individual causes of mortality were reported rarely, and we
were unable to report separate results for cardiovascular mortality or
non-cardiovascular mortality. There was evidence of no difference in
effect of education-based interventions on fatal and/or non fatal
myocardial infarction (MI) (2 studies, 209 participants; 7/107 (6.5%)
versus 12/102 (11.8%); random effects RR 0.63, 95% CI 0.26 to 1.48; very
low quality of evidence). However, there was some evidence of a reduction
with education in fatal and/or non-fatal cardiovascular events (2 studies,
310 studies; 21/152 (13.8%) versus 61/158 (38.6%); random effects RR 0.36,
95% CI 0.23 to 0.56; low quality evidence). There was evidence of no
difference in effect of education on the rate of total revascularisations
(3 studies, 456 participants; 5/228 (2.2%) versus 8/228 (3.5%); random
effects RR 0.58, 95% CI 0.19 to 1.71; very low quality evidence) or
hospitalisations (5 studies, 14,849 participants; 656/10048 (6.5%) versus
381/4801 (7.9%); random effects RR 0.93, 95% CI 0.71 to 1.21; very low
quality evidence). There was evidence of no difference between groups for
all cause withdrawal (17 studies, 10,972 participants; 525/5632 (9.3%)
versus 493/5340 (9.2%); random effects RR 1.04, 95% CI 0.88 to 1.22; low
quality evidence). Although some health-related quality of life (HRQoL)
domain scores were higher with education, there was no consistent evidence
of superiority across all domains. Authors' conclusions: We found no
reduction in total mortality, in people who received education delivered
as part of cardiac rehabilitation, compared to people in control groups
(moderate quality evidence). There were no improvements in fatal or non
fatal MI, total revascularisations or hospitalisations, with education.
There was some evidence of a reduction in fatal and/or non-fatal
cardiovascular events with education, but this was based on only two
studies. There was also some evidence to suggest that education-based
interventions may improve HRQoL. Our findings are supportive of current
national and international clinical guidelines that cardiac rehabilitation
for people with CHD should be comprehensive and include educational
interventions together with exercise and psychological therapy. Further
definitive research into education interventions for people with CHD is
needed.<br/>Copyright &#xa9; 2017 The Cochrane Collaboration. Published by
John Wiley & Sons, Ltd.

<63>
Accession Number
617127511
Author
Neugarten J.; Sandilya S.; Singh B.; Golestaneh L.
Institution
(Neugarten, Sandilya, Singh, Golestaneh) Nephrology Division, Department
of Medicine, Montefiore Medical Center, Albert Einstein College of
Medicine, Bronx, NY, United States
Title
Sex and the risk of AKI following cardio-thoracic surgery: A
meta-analysis.
Source
Clinical Journal of the American Society of Nephrology. 11 (12) (pp
2113-2122), 2016. Date of Publication: 2016.
Publisher
American Society of Nephrology (E-mail: email@asn-online.org)
Abstract
Background and objectives Being awoman is awell established risk factor
for the development of cardiothoracic surgery-associated AKI. In striking
contrast, women are less likely to develop AKI associated with noncardiac
surgical procedures than men. In an attempt to ascertain why being a woman
might be protective for ischemic AKI after general surgery but deleterious
in patients undergoing cardiothoracic surgery, we examined cardiothoracic
surgery-associated AKI in greater detail. Design, setting, participants, &
measurements We performed a systematic review and meta-analysis of
cardiothoracic surgery-associated AKI studies published between January of
1978 and December of 2015 to further explore the relationship between sex
and cardiothoracic surgery-associated AKI. Results Sixty-four studies were
identified that provided sex-specific data regarding the incidence of
cardiothoracic surgery-associated AKI among 1,057,412 subjects. Using
univariate analysis, womenwere more likely than men to develop AKI
postoperatively (odds ratio, 1.21; 95% confidence interval, 1.09 to 1.33;
P,0.001). However, when the analysis was restricted to the 120,464
subjects reported in 29 studies that used the Acute Kidney Injury Network
criteria, the RIFLE criteria, or the Kidney Disease Improving Global
Outcomes criteria to define AKI, there was no significant sex-related
difference in risk. Seventeen studies used multivariate analysis to assess
risk factors for cardiothoracic surgery-associated AKI and provided
sex-specific odd ratios. Among the 1,587,181 individuals included in these
studies, the risk of developing cardiothoracic surgery-associated AKI was
not significantly associated with sex (odds ratio, 1.04; 95% confidence
interval, 0.92 to 1.19; P=0.51). However, when the analysis was restricted
to the 5106 subjects reported in four studies that used the Acute Kidney
Injury Network criteria to define AKI, the risk of developing AKI was
significantly lower in women compared with in men (odds ratio, 0.75; 95%
confidence interval, 0.65 to 0.87; P,0.001). Conclusions Our systematic
review and meta-analysis contradict the generally held consensus that
being a woman is an independent risk factor for the development of
cardiothoracic surgery-associated AKI.<br/>Copyright &#xa9; 2016 by the
American Society of Nephrology.

<64>
[Use Link to view the full text]
Accession Number
617212620
Author
Bundhun P.K.; Bhurtu A.; Huang F.
Institution
(Bundhun) aInstitute of Cardiovascular Diseases, the First Affiliated
Hospital of Guangxi Medical University bGuangxi Medical University,
Nanning, Guangxi, P.R. China
Title
Worse clinical outcomes following percutaneous coronary intervention with
a high SYNTAX score: A systematic review and meta-analysis.
Source
Medicine. 96 (24) (pp e7140), 2017. Date of Publication: 01 Jun 2017.
Abstract
BACKGROUND: The synergy between percutaneous coronary intervention (PCI)
with TAXUS and Cardiac Surgery (SYNTAX) score is an angiographic tool
which is used to determine the complexity of coronary artery disease
(CAD). We aimed to compare PCI versus coronary artery bypass surgery
(CABG) in patients with a high SYNTAX score in order to confirm with
evidence whether the former is really association with worse clinical
outcomes.
METHODS: The National database of medical research articles
(MEDLINE/PubMed), EMBASE database, and the Cochrane library were searched
for publications comparing PCI versus CABG in patients with a high SYNTAX
score, respectively. Death, myocardial infarction (MI), stroke, repeated
revascularization, and a combined outcome death/stroke/MI were considered
as the clinical endpoints. RevMan software was used to analyze the data,
whereby odds ratios (OR) with 95% confidence intervals (CI) were used as
the statistical parameters.
RESULTS: A total number of 1074 patients were included (455 patients with
a high SYNTAX score were classified in the PCI group and 619 other
patients with a high SYNTAX score were classified in the CABG group). A
SYNTAX score cut-off value of >=33 was considered relevant. Compared with
CABG, mortality was significantly higher with a high SYNTAX score
following PCI with OR: 1.79, 95% CI: 1.18 to 2.70; P = .006, I = 0%. The
combined outcome death/stroke/MI was also significantly higher following
PCI with a high SYNTAX score, with OR: 1.69, 95% CI: 1.24 to 2.30; P =
.0009, I = 0%. In addition, PCI was also associated with significantly
higher MI and repeated revascularization when compared with CABG, with OR:
3.72, 95% CI: 1.75 to 7.89; P = .0006, I = 0% and OR: 4.33, 95% CI: 1.71
to 10.94; P = .002, I = 77%, respectively. However, stroke was not
significantly different.
CONCLUSIONS: Compared with CABG, worse clinical outcomes were observed
following PCI in patients with a high SYNTAX score, confirming with
evidence, published clinical literatures. Therefore, CABG should be
recommended to CAD patients who have been allotted a high SYNTAX score.

<65>
[Use Link to view the full text]
Accession Number
617212776
Author
Buentzel J.; Straube C.; Heinz J.; Roever C.; Beham A.; Hinterthaner M.;
Danner B.C.; Emmert A.
Institution
(Buentzel) aDepartment of Haematology and Oncology bDepartment of Medical
Statistics cDepartment of General, Visceral and Pediatric Surgery,
University of Goettingen, University Medical Center Goettingen, Goettingen
dWestklinikum Hamburg, Department of General and Visceral Surgery, Hamburg
eDepartment of Thoracic and Cardiovascular Surgery, University of
Goettingen, University Medical Center Goettingen, Gottingen, Germany
Title
Thymectomy via open surgery or robotic video assisted thoracic surgery:
Can a recommendation already be made?.
Source
Medicine. 96 (24) (pp e7161), 2017. Date of Publication: 01 Jun 2017.
Abstract
BACKGROUND: Robot-assisted minimally invasive surgery (RVATS) is a
relatively new technique applied for thymectomies. Only few studies
directly compare RVATS to the mainstay therapy, open surgery (sternotomy).
METHODS: A systematic search of the literature was performed in October
2016. The meta-analysis includes studies comparing robotassisted and open
thymectomy regarding operation time, length of hospitalization,
intraoperative blood loss, and chest-in-tube days, postoperative
complications, reoperation, arrhythmic events, pleural effusion, and
postoperative bleeding.
RESULTS: Of 626 studies preliminary screened, 7 articles were included.
There were no significant differences in comparison of operation time
(-3.19 minutes [95% confidence interval, 95% CI -112.43 to 106.05]; P =
.94), but patients undergoing RVATS spent significantly less time in
hospital (-4.06 days [95% CI -7.98 to -0.13], P = .046). There were fewer
chests-in-tube days (-2.50 days [95% CI -15.01 to 10.01]; P = .24) and
less intraoperative blood loss (-256.84 mL [95% CI -627.47 to 113.80]; P =
.10) observed in the RVATS group; due to a small number of studies, these
results were not statistically significant. There were also less
post-operative complications in the RVATS group (12 complications in 209
patients vs 51 complications in 259 patients); however, this difference
was not statistical significant (odds ratio 0.27, 95% CI 0.07-1.12; P =
.06).
CONCLUSIONS: Patients undergoing RVATS spent less time in hospital than
patients treated by open surgery (sternotomy). These patients tended to
have less postoperative complications, less intraoperative blood loss, and
fewer chest-in-tube days. We found evidence for the safety and feasibility
of RVATS compared with open surgery, which has to be further confirmed in
randomised controlled trials.

<66>
Accession Number
617143069
Author
Nakamura M.; Uno K.; Hirayama A.; Ako J.; Nohara A.; Arai H.; Harada-Shiba
M.
Institution
(Nakamura) Division of Cardiovascular Medicine, Toho University Ohashi
Medical Center, Tokyo, Japan
(Uno) Cardiovascular Medical, Diabetes and Cardiovascular Medical
Operations, Sanofi, Tokyo, Japan
(Hirayama) Division of Cardiology, Nihon University School of Medicine,
Tokyo, Japan
(Ako) Department of Cardiovascular Medicine, Kitasato University,
Kanagawa, Japan
(Nohara) Department of Lipidology, Kanazawa University of Graduate School
of Medical Sciences, Kanazawa, Japan
(Arai) National Center for Geriatrics and Gerontology, Aichi, Japan
(Harada-Shiba) Department of Molecular Innovation in Lipidology, National
Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
Title
Exploration into lipid management and persistent risk in patients
hospitalised for acute coronary syndrome in Japan (EXPLORE-J): Protocol
for a prospective observational study.
Source
BMJ Open. 7 (6) (no pagination), 2017. Article Number: e014427. Date of
Publication: 01 Jun 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction The present study is the largest registry study ever
conducted in Japan exploring the prevalence of familial
hypercholesterolaemia (FH) among patients with acute coronary syndrome
(ACS). Our study aims to (1) evaluate the status of lipid management and
the subsequent risk of major cardiovascular events following
hospitalisation of Japanese patients with ACS in real-world clinical
practice; (2) determine the proportion of Japanese patients with ACS who
achieve the lipid management goal and have a reduction of event risks with
strict lipid management (low-density lipoprotein-cholesterol <1.81
mmol/L); (3) determine the prevalence of FH and (4) investigate the
clinical significance of proprotein convertase subtilisin kexin 9 (PCSK9)
level. Methods and analysis We will conduct a multicentre, prospective,
observational study of approximately 2000 Japanese patients with ACS
with/without FH hospitalised between April 2015 and August 2016. The
primary end point is the incidence of major adverse cardiovascular events
(MACEs) after initial hospitalisation. The secondary end points are (1)
MACE developed from visit 1 to visit 2 (day 30); (2) MACE developed from
visit 2 (day 30) to visit 5 (day 730); (3) treatment rate by
lipid-lowering therapies (any statin or intensive, PCSK9 inhibitor,
fibrates and ezetimibe); (4) incidence of events by the addition of the
following outcomes to the primary end point: coronary revascularisation
due to myocardial ischaemia, revascularisation other than coronary artery,
inpatient treatment for occurrence or exacerbation of heart failure,
transient ischaemic attack, acute arterial occlusion, central retinal
artery occlusion and other adverse events prolonging or requiring
hospitalisation and (5) proportion of subjects achieving target lipid
levels. Ethics and dissemination The study protocol was submitted to the
ethical review committee of each participating centre for approval.
Participation in the study is voluntary and anonymous. The study findings
will be disseminated in international peer-reviewed journals and presented
at relevant conferences.<br/>Copyright &#xa9; 2017 Article author(s).

<67>
Accession Number
617068654
Author
Seccareccia F.; Tarantini G.; Bedogni F.; Berti S.; Santoro G.; Tamburino
C.; Ussia G.P.; Barbanti M.; Baiocchi M.; Ranucci M.; D'Errigo P.; Rosato
S.; Musumeci G.
Institution
(Seccareccia, D'Errigo, Rosato) Centro Nazionale per la Salute Globale,
Istituto Superiore di Sanita, Via Giano della Bella 34, Roma 00162, Italy
(Tarantini) Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari,
Policlinico Universitario, Padova, Italy
(Bedogni, Ranucci) Cardiologia Interventistica, IRCCS Policlinico San
Donato, San Donato Milanese (MI), Italy
(Berti) U.O. Cardiologia Diagnostica Ed Interventistica, Fondazione CNR
Regione Toscana G. Monasterio - Ospedale Del Cuore, Massa, Italy
(Santoro) Cardiologia Interventistica, AOU Careggi, Firenze, Italy
(Tamburino, Barbanti) U.O. Cardiologia, Azienda Ospedaliero-Universitaria
Policlinico Vittorio Emanuele, Ospedale Ferrarotto, Catania, Italy
(Ussia) Dipartimento Medicina Dei Sistemi, Universita degli Studi 'Tor
Vergata', Roma, Italy
(Baiocchi) Policlinico S. Orsola, Bologna, Italy
(Musumeci) S.C. Cardiologia, Ospedale Santa Croce e Carle, Cuneo, Italy
Title
OBSERVANT II: Observational study of effectiveness of transcatheter aortic
valve implantation with new generation devices for severe aortic stenosis
treatment. Study protocol.
Source
Giornale Italiano di Cardiologia. 18 (6 Supplement 1) (pp 14S-26S), 2017.
Date of Publication: June 2017.
Publisher
Il Pensiero Scientifico Editore s.r.l. (Via Giovanni Valdarno 8, Roma
00138, Italy)
Abstract
Background. The rapid spread of transcatheter aortic valve implantation
(TAVI) for the treatment of severe symptomatic aortic stenosis in the last
decade in Italy has led to a gradually increasing use of TAVI procedures
also in patients potentially eligible for aortic valve replacement (AVR).
For this subset of patients, the OBSERVANT study (2011-2012) evaluated the
short- and medium term outcome of TAVI vs AVR, at least for the first
generations of TAVI devices, but failed to gather information on all the
technological innovations occurred in recent years. The launch of a phase
II of the study will allow to recruit a new series of TAVI, with different
risk profiles compared with the historical OBSERVANT TAVI cohort, in order
to assess whether and how much the use of new-generation devices mitigate
the differences in outcomes recorded in the OBSERVANT study. Methods.
OBSERVANT II is an observational multicenter, prospective, cohort study
collecting data on patients with severe symptomatic aortic stenosis
undergoing TAVI in Italian hospitals since December 15, 2016, for at least
12 months. For each patient, data on demographic characteristics, health
status, type of intervention and presence of comorbidities will be
collected. Mortality and incidence of in-hospital major adverse cardiac
and cerebrovascular events (MACCE) within 36 months of intervention will
be the primary adverse outcome. Secondary outcomes will include 30-day
mortality and the incidence of MACCE at 12 and 24 months. The statistical
hypotheses were formulated considering the results from the OBSERVANT
study. Testing these hypotheses will require the recruitment of at least
823 new TAVI. The risk/propensity- adjustment techniques will be used to
comparatively evaluate the effectiveness of TAVI vs AVR. Expected results.
Safety and efficacy profiles of the new-generation TAVI prosthesis;
comparative effectiveness of the new TAVI prosthesis as compared to TAVI
procedures of the OBSERVANT historical cohort; comparative effectiveness
of the new TAVI prosthesis as compared to AVR procedures of the OBSERVANT
historical cohort. Conclusions. The results of OBSERVANT II will provide
information on the effectiveness of TAVI employing new-generation devices
and will be a valuable support to give professionals and policy
makersevidence-based results useful for decision-making
processes.<br/>Copyright &#xa9; 2017 Il Pensiero Scientifico Editore.

<68>
Accession Number
617221023
Author
Singh T.P.; Morris D.R.; Smith S.; Moxon J.V.; Golledge J.
Institution
(Singh, Morris, Smith, Moxon, Golledge) Queensland Research Centre for
Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook
University, Townsville, Australia
(Golledge) The Department of Vascular and Endovascular Surgery, The
Townsville Hospital, Townsville, QLD, Australia
Title
Systematic Review and Meta-Analysis of the Association Between C-Reactive
Protein and Major Cardiovascular Events in Patients with Peripheral Artery
Disease.
Source
European Journal of Vascular and Endovascular Surgery. (no pagination),
2017. Date of Publication: 2017.
Publisher
W.B. Saunders Ltd
Abstract
Background: Patients with peripheral artery disease (PAD) are at
substantial risk of cardiovascular events. There is interest in using
blood markers, such as C-reactive protein (CRP), to monitor prognosis and
treatment efficacy in PAD patients. The aim of this meta-analysis was to
assess the association between CRP and major cardiovascular events in PAD
patients. Method: Studies evaluating the association between CRP and major
cardiovascular events (myocardial infarction, stroke, cardiac
revascularisation and mortality) were identified using MEDLINE and the
Cochrane library. Studies that did not include participants with PAD,
measure CRP, or follow-up patients for cardiovascular events were
excluded. Meta-analyses of published adjusted hazard ratios (HR) were
conducted using an inverse variance-weighted random effects model, and
heterogeneity was assessed with the I² index. Results: A total
of 16 studies involving 5041 participants met the inclusion criteria for
the systematic review. Eight studies were included in the meta-analyses.
Summary effect estimates were reported as HR comparing higher and lower
quantiles, and HR per unit increase in log<inf>e</inf>CRP. PAD patients
with higher CRP had a significantly greater risk of major cardiovascular
events compared with those with lower CRP (HR 2.26, 95% CI 1.65-3.09, p <
0.001). The HR for major cardiovascular events was 1.38 (95% CI 1.16-1.63,
p < 0.001) per unit increase in log<inf>e</inf>CRP. Conclusions: The
present findings suggest that high circulating CRP is predictive of major
cardiovascular events in PAD patients.<br/>Copyright &#xa9; 2017.

<69>
Accession Number
617215622
Author
Krishnamoorthy B.; Critchley W.R.; Thompson A.J.; Payne K.; Morris J.;
Venkateswaran R.V.; Caress A.L.; Fildes J.E.; Yonan N.
Institution
(Krishnamoorthy) 1Department of Cardiothoracic Surgery, University
Hospital of South Manchester NHS Foundation Trust, Manchester, United
Kingdom; 2Manchester Centre for Collaborative Research, School of
Translational Medicine, University of Manchester, Manchester, United
Kingdom; 3Manchester Centre for Health Economics, The University of
Manchester, Manchester, United Kingdom; 4Department of Medical Statistics,
University Hospital of South Manchester NHS Foundation Trust, Manchester,
United Kingdom; 5School of Nursing and Midwifery, The University of
Manchester, Manchester, United Kingdom; 6Faculty of Health and Social
Care, Edge Hill University, Ormskirk, Lancashire, United Kingdom
Title
A Study Comparing Vein Integrity and Clinical Outcomes (VICO) in Open Vein
Harvesting and Two Types of Endoscopic Vein Harvesting for Coronary Artery
Bypass Grafting: The VICO Randomised Clinical Trial.
Source
Circulation. (no pagination), 2017. Date of Publication: 01 Jul 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND-: Current consensus statements maintain that endoscopic vein
harvesting (EVH) should be standard care in coronary artery bypass surgery
(CABG) but vein quality and clinical outcomes have been questioned. The
Vein Integrity and Clinical Outcome (VICO) trial was designed to assess
the impact of different vein harvesting methods on vessel damage and if
this contributes to clinical outcomes following CABG. METHODS-: A single
centre, randomised clinical trial of patients undergoing CABG with an
internal mammary artery, and with one to four vein grafts were recruited.
All the veins were harvested by a single experienced practitioner. We
randomly allocated n=300 patients into: closed tunnel CO2 EVH (CT-EVH)
(n=100), open tunnel CO2 EVH (OT-EVH) (n=100) and traditional open vein
harvesting (OVH) (n=100) groups. The primary end-point was endothelial
integrity and muscular damages of the harvested vein. Secondary end-points
included clinical outcomes (major adverse cardiac events, MACE), use of
healthcare resources and impact on health status (quality-adjusted life
years, QALYs). RESULTS-: The OVH group demonstrated marginally better
endothelial integrity in random samples (85% vs. 88% vs. 93% for CT-EVH,
OT-EVH and OVH, p<0.001). CT-EVH displayed the lowest longitudinal
hypertrophy (1% vs. 13.5% vs. 3%, p=0.001). However, no differences in
endothelial stretching were observed between groups (37% vs. 37% vs. 31%,
p=0.62). Secondary clinical outcomes demonstrated no significant
differences in composite MACE scores at each time point up to 48 months.
The QALY gain per patient was: 0.11 (p<0.001) for closed tunnel CO2 EVH
and 0.07 (p=0.003) for open tunnel CO2 EVH compared with open vein
harvesting. The likelihood of being cost-effective, at a pre-defined
threshold of 20,000 per QALY gained was: 75% for closed tunnel, 19% for
open tunnel and 6% for open vein harvesting. CONCLUSIONS-: Our study
demonstrates that harvesting techniques do impact upon integrity of
different vein layers, albeit with only a small effect. Secondary outcomes
suggest that histological findings do not directly contribute to MACE
outcomes. Gains in health status were observed and cost-effectiveness was
better with CT-EVH. High level experience with endoscopic harvesting
performed by a dedicated specialist practitioner gives optimal results
which is comparable to open vein harvesting. CLINICAL TRIAL REGISTRATION-:
URL: https://www.isrctn.com Unique Identifier: ISRCTN:
91485426<br/>Copyright &#xa9; 2017 by the American College of Cardiology
Foundation and the American Heart Association, Inc.

<70>
Accession Number
610583378
Author
Karjalainen P.P.; Airaksinen J.K.E.; de Belder A.; Romppanen H.; Kervinen
K.; Sia J.; Laine M.; Nammas W.
Institution
(Karjalainen, Nammas) Heart Center, Satakunta Central Hospital, Pori,
Finland
(Airaksinen) Heart Center, Turku University Hospital, Turku, Finland
(de Belder) Department of Cardiology, Brighton and Sussex University
Hospital NHS Trust, Brighton, United Kingdom
(Romppanen, Kervinen) Medical Research Center, Oulu University Hospital,
and University of Oulu, Oulu, Finland
(Sia) Department of Cardiology, Kokkola Central Hospital, Kokkola, Finland
(Laine) Helsinki University Hospital, Helsinki, Finland
Title
Long-term outcome of early percutaneous coronary intervention in diabetic
patients with acute coronary syndrome: insights from the BASE ACS trial.
Source
Annals of Medicine. 48 (5) (pp 376-383), 2016. Date of Publication: 03 Jul
2016.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Background: The BASE ACS trial demonstrated an outcome of
titanium-nitride-oxide-coated bioactive stents (BAS) that was non-inferior
to everolimus-eluting stents (EES) in patients with acute coronary
syndrome (ACS). We performed a post-hoc analysis of diabetic versus
non-diabetic patients from the trial. Methods: We randomised 827 patients
(1:1) with ACS to receive either BAS or EES. The primary endpoint was
major adverse cardiac events (MACE): a composite of cardiac death,
non-fatal myocardial infarction (MI) or ischaemia-driven target lesion
revascularisation (TLR). Follow-up was planned yearly through 7 years.
Results: Of 827 patients, 140 (16.9%) were diabetic; of these, 36 (25.7%)
were insulin-treated. Mean follow-up duration was 4.2 +/- 1.9 years. MACE
was more frequent in diabetics versus non-diabetics (23.6% versus 13.7%,
respectively, p = 0.003), mainly driven by more frequent cardiac death
(7.9% versus 2.2%, respectively, p = 0.002). The rates of non-fatal MI,
ischaemia-driven TLR were comparable (p > 0.05 for all). In diabetic
patients, MACE was comparable between the two stent arms (18.5% versus
28.0%, for BAS versus EES, respectively, p = 0.18). Conclusions: Diabetic
patients treated with early percutaneous coronary intervention for ACS had
worse long-term outcome, compared with non-diabetics, mainly driven by
more frequent cardiac death. The long-term outcome of BAS was comparable
to EES in diabetics. Key Messages Diabetic patients presenting with acute
coronary syndrome who were treated with early percutaneous coronary
intervention had worse long-term clinical outcome, compared with
non-diabetics, mainly driven by a high incidence of cardiac death. Age
independently predicted both major adverse cardiac events and cardiac
death in diabetic patients. The long-term clinical outcome of
titanium-nitride-oxide-coated bioactive stents was comparable to that of
everolimus-eluting stents in the diabetic, as well as in the non-diabetic
subgroup.<br/>Copyright &#xa9; 2016 Informa UK Limited, trading as Taylor
& Francis Group.

<71>
Accession Number
612097776
Author
Vroomen M.; Pison L.
Institution
(Vroomen, Pison) Department of Cardiology, Maastricht University Medical
Center, PO Box 5800, Maastricht, Netherlands
(Vroomen, Pison) Cardiovascular Research Institute Maastricht, Maastricht,
Netherlands
Title
Hybrid ablation for atrial fibrillation: a systematic review.
Source
Journal of Interventional Cardiac Electrophysiology. 47 (3) (pp 265-274),
2016. Date of Publication: 01 Dec 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Hybrid ablation for AF is performed in a growing number of
centers. Due to absence of guidelines, operative approaches and
perioperative care differ per center. In this review, an overview of
findings from published studies on hybrid ablations is given, and related
topics are discussed (e.g., one- and two-stage approaches, lesion sets,
and patient management). Methods: A systematic literature search was
performed in the PubMed and Embase databases. All identified articles were
screened and checked for eligibility by the two authors. Results: Twelve
studies describing a total of 563 patients were selected. Due to
substantial differences in approaches (one-stage, two-stage, sequential),
surgical techniques (bilateral or monolateral thoracoscopy, subxiphoideal,
transabdominal), energy sources (unipolar, bipolar), lesion sets (applying
left or right atrial lesions), periprocedural care and endpoints
(monitoring, definition of recurrence), and success rates (sinus rhythm
after a mean of 26 months) are difficult to compare and varied from 27 %
(without antiarrhythmic drugs, AADs) to 94 % (with AADs). For studies
using bipolar devices, success rates with the use of antiarrhythmic drugs
were at least 71 %. Major complications such as bleeding, sternotomy, and
death occurred in 7 % of the total population (of which ten complications,
16 %, occurred in the concomitant cardiac surgery hybrid group).
Conclusion: The field of AF ablation has dramatically changed over the
past years, with one of the most recent developments the hybrid AF
ablation. Lack of matching data hinders drawing conclusions and creating
guidelines. Early results however are encouraging. More data are awaiting
and needed.<br/>Copyright &#xa9; 2016, The Author(s).

<72>
Accession Number
616767996
Author
Abd El Baser I.I.; Sharkawy R.A.
Institution
(Abd El Baser, Sharkawy) Department of Anesthesia and Surgical Intensive
Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Title
Effects of phentolamine infusion during normoxic cardiopulmonary bypass on
the outcome of cardiac surgery in children with cyanotic heart disease.
Source
Egyptian Journal of Anaesthesia. 33 (3) (pp 239-243), 2017. Date of
Publication: July 2017.
Publisher
Central Society of Egyptian Anaesthesiologists (P.O. Box 167, Panorama
October 11811, Nasr City, Cairo, Egypt)

<73>
Accession Number
617072607
Author
Poldervaart J.M.; Reitsma J.B.; Backus B.E.; Koffijberg H.; Veldkamp R.F.;
Ten Haaf M.E.; Appelman Y.; Mannaerts H.F.J.; Van Dantzig J.-M.; Van Den
Heuvel M.; El Farissi M.; Rensing B.J.W.M.; Ernst N.M.S.K.J.; Dekker
I.M.C.; Den Hartog F.R.; Oosterhof T.; Lagerweij G.R.; Buijs E.M.; Van
Hessen M.W.J.; Landman M.A.J.; Van Kimmenade R.R.J.; Cozijnsen L.; Bucx
J.J.J.; Van Ofwegen-Hanekamp C.E.E.; Cramer M.-J.; Six A.J.; Doevendans
P.A.; Hoes A.W.
Institution
(Poldervaart, Reitsma, Koffijberg, Lagerweij, Hoes) Julius Center for
Health Sciences and Primary Care, University Medical Center Utrecht,
Straat 6.101, AB Utrecht 3508, Netherlands
(Backus) Department of Emergency Medicine, Haaglanden Medical Center,
Lijnbaan 32, VA The Hague 2512, Netherlands
(Veldkamp) Department of Cardiology, Haaglanden Medical Center, Lijnbaan
32, VA The Hague 2512, Netherlands
(Ten Haaf, Appelman) Department of Cardiology, Vu University Medical
Center, De Boelelaan 1117, HV Amsterdam 1081, Netherlands
(Mannaerts) Department of Cardiology, Amstelland Hospital, Amstelveen,
Netherlands
(Van Dantzig, Van Den Heuvel, El Farissi) Department of Cardiology,
Catharina Hospital, Michelangelolaan 9, AZ Eindhoven 5623, Netherlands
(Rensing) Dr. Rensing: Department of Cardiology, St. Antonius Hospital,
Koekoekslaan 1, CM Nieuwegein 3435, Netherlands
(Ernst, Dekker) Department of Cardiology, Zuyderland Hospital, Heerlen,
Netherlands
(Den Hartog, Oosterhof) Department of Cardiology, Gelderse Vallei
Hospital, Willy Brandtlaan 10, RP Ede 6716, Netherlands
(Buijs) Department of Cardiology, Tergooi Hospital, Rijksstraatweg 1, AN
Hilversum 1261, Netherlands
(Van Hessen) Department of Cardiology, Groene Hart Hospital, Bleuland Weg
10, HH Gouda 2803, Netherlands
(Landman) Department of Cardiology, Meander Medical Center, Maatweg 3, TZ
Amersfoort 3813, Netherlands
(Van Kimmenade) Radboud University Medical Center, Geert Grooteplein Zuid
10, GA Nijmegen 6525, Netherlands
(Cozijnsen) Department of Cardiology, Gelre Hospital, PO Box 9014, DS
Apeldoorn 7300, Netherlands
(Bucx, Van Ofwegen-Hanekamp) Department of Cardiology, Diakonessenhuis
Utrecht, Bosboomstraat 1, KE Utrecht 3582, Netherlands
(Cramer, Doevendans) Department of Cardiology, University Medical Center
Utrecht, Heidelberglaan 100, GA Utrecht 3508, Netherlands
(Six) Department of Cardiology, Zuwe Hofpoort Hospital, Sterrenburg 1, GN
Woerden 3447, Netherlands
Title
Effect of using the HEART score in patients with chest pain in the
emergency department: A Stepped-wedge, cluster randomized trial.
Source
Annals of Internal Medicine. 166 (10) (pp 689-697), 2017. Date of
Publication: 16 May 2017.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Background: The HEART (History, Electrocardiogram, Age, Risk factors, and
initial Troponin) score is an easy-to-apply instrument to stratify
patients with chest pain according to their short-term risk for major
adverse cardiac events (MACEs), but its effect on daily practice is
unknown. Objective: To measure the effect of use of the HEART score on
patient outcomes and use of health care resources. Design: Stepped-wedge,
cluster randomized trial. (Clinical Trials.gov: NCT01756846) Setting:
Emergency departments in 9 Dutch hospitals. Patients: Unselected patients
with chest pain presenting at emergency departments in 2013 and 2014.
Intervention: All hospitals started with usual care. Every 6 weeks, 1
hospital was randomly assigned to switch to "HEART care," during which
physicians calculated the HEART score to guide patient management.
Measurements: For safety, a noninferiority margin of a 3.0% absolute
increase in MACEs within 6 weeks was set. Other outcomes included use of
health care resources, quality of life, and cost-effectiveness. Results: A
total of 3648 patients were included (1827 receiving usual care and 1821
receiving HEART care). Six-week incidence of MACEs during HEART care was
1.3% lower than during usual care (upper limit of the 1-sided 95% CI, 2.1%
[within the noninferiority margin of 3.0%]). In low-risk patients,
incidence of MACEs was 2.0% (95% CI, 1.2% to 3.3%). No statistically
significant differences in early discharge, readmissions, recurrent
emergency department visits, outpatient visits, or visits to general
practitioners were observed. Limitation: Physicians were hesitant to
refrain from admission and diagnostic tests in patients classified as low
risk by the HEART score. Conclusion: Using the HEART score during initial
assessment of patients with chest pain is safe, but the effect on health
care resources is limited, possibly due to nonadherence to management
recommendations.<br/>Copyright &#xa9; 2017 American College of Physicians.

<74>
Accession Number
610342682
Author
Zhao S.-J.; Zhong Z.-S.; Qi G.-X.; Shi L.-Y.; Chen L.; Tian W.
Institution
(Zhao, Qi, Shi, Chen, Tian) Department of Geriatric Cardiology, First
Affiliated Hospital, China Medical University, Shenyang, China
(Zhong) Department of Respiratory, Central Hospital, Shenyang Medical
College, Shenyang, China
Title
Effect of pioglitazone in preventing in-stent restenosis after
percutaneous coronary intervention in patients with type 2 diabetes: A
meta-analysis.
Source
PLoS ONE. 11 (5) (no pagination), 2016. Article Number: e0155273. Date of
Publication: 01 May 2016.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: The benefits of pioglitazone in patients with type 2 diabetes
mellitus (T2DM) after percutaneous coronary intervention (PCI) is unclear.
Objectives: To evaluate the effect of pioglitazone on prevention of
in-stent restenosis (ISR) in patients with T2DM after PCI. Methods: All
full-text published relevant studies compared the effect of pioglitazone
with control group (placebo or no pioglitazone treatment) on ISR in
patients with T2DM after PCI were identified by searching the databases
including PubMed, EMBASE, Cochrane Library and ISI Web of Science through
October 2015. The endpoints were defined as the rate of ISR, late lumen
loss, in-stent neointimal volume, target lesion revascularization (TLR)
and major adverse cardiac events (MACE). Results: Six studies (5 RCTs and
1 retrospective study), comprising 503 patients, were included into this
meta-analysis. In the pioglitazone group, as compared with the control
group, the risk ratio for ISR was 0.48 (I² = 14.5%, P = 0.322;
95%CI 0.35 to 0.68, P<0.001), the risk ratio for TLR was 0.58
(I² = 6.0%, P = 0.363; 95%CI 0.38 to 0.87, P = 0.009). The
result showed there was no association between the use of pioglitazone and
the events of MACE (I² = 36.7%, P = 0.209; RR 0.56, 95%CI 0.30
to 1.05, P = 0.071). For the considerable heterogeneity, further analysis
was not suitable for the endpoints of late lumen loss (I² =
81.9%, P<0.001) and neointimal volume (I² = 75.9%, P = 0.016).
Conclusions: The treatment of pioglitazone was associated with a reduction
in ISR and TLR in T2DM patients suffering from PCI, except the incidence
of MACE.<br/>Copyright &#xa9; 2016 Zhao 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.

<75>
Accession Number
617202393
Author
Mihos C.G.; Yucel E.; Santana O.
Institution
(Mihos, Yucel) Cardiac Ultrasound Laboratory, Massachusetts General
Hospital, Harvard Medical School, Boston, MA, United States
(Santana) The Division of Cardiology at Columbia University, Mount Sinai
Heart Institute, Miami Beach, FL, United States
Title
The role of papillary muscle approximation in mitral valve repair for the
treatment of secondary mitral regurgitation.
Source
European Journal of Cardio-thoracic Surgery. 51 (6) (pp 1023-1030), 2017.
Date of Publication: 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Secondary mitral regurgitation (MR) is present in up to half of patients
with dilated cardiomyopathy, and is associated with a poor prognosis. It
primarily results from progressive left ventricular remodelling, papillary
muscle displacement and tethering of the mitral valve leaflets. Mitral
valve repair with an undersized ring annuloplasty is the reparative
procedure of choice in the treatment of secondary MR. However, this
technique is associated with a 30-60% incidence of recurrent moderate or
greater MR at mid-term follow-up, which results in progressive
deterioration of left ventricular function and increased morbidity.
Combined mitral valve repair and papillary muscle approximation has been
applied in order to address both the annular and subvalvular dysfunction
that coexist in secondary MR, which include graft and suture-based
techniques. Herein, we provide a systematic review of the published
literature regarding the technical aspects, clinical application, and
outcomes of mitral valve repair with combined ring annuloplasty and
papillary muscle approximation for the treatment of secondary
MR.<br/>Copyright &#xa9; The Author 2017. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.

<76>
Accession Number
617171955
Author
O'Byrne M.L.; Kim S.; Hornik C.P.; Yerokun B.A.; Matsouaka R.A.; Jacobs
J.P.; Jacobs M.L.; Jonas R.A.
Institution
(O'Byrne) 1Division of Cardiology Children's National Health System,
Department of Pediatrics George Washington University of Health Sciences,
Washington DC; 2Duke Clinical Research Institute, Duke University School
of Medicine, Durham, NC; 3Department of Pediatrics, Duke University School
of Medicine, Durham, NC; 4Department of Biostatistics and Bioinformatics,
Duke University, Durham, NC; 5Division of Cardiovascular Surgery, Johns
Hopkins All Children's Heart Institute, Johns Hopkins University School of
Medicine, St. Petersburg, FL; 6Division of Cardiac Surgery, Johns Hopkins
University School of Medicine, Baltimore, MD; 7Division of Cardiothoracic
Surgery Children's National Health System, Department of Surgery George
Washington University of Health Sciences, Washington DC
Title
Effect of Obesity and Underweight Status on Perioperative Outcomes of
Congenital Heart Operations in Children, Adolescents, and Young Adults: An
Analysis of Data from the Society of Thoracic Surgeons Database.
Source
Circulation. (no pagination), 2017. Date of Publication: 30 Jun 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND-: Extreme BMI (either very high or very low) has been
associated with increased risk of adverse perioperative outcome in adults
undergoing cardiac surgery. The effect of body-mass index (BMI) on
perioperative outcomes in congenital heart disease patients has not been
evaluated. METHODS-: A multicenter retrospective cohort study was
performed studying patients 10-35 years undergoing a congenital heart
disease operation in the Society of Thoracic Surgeons Congenital Heart
Surgery Database between 1/1/2010-12/31/2015. The primary outcomes were
operative mortality and a composite outcome (one or more of operative
mortality, major adverse event, prolonged hospital length of stay, and
wound infection/dehiscence). The associations between age and sex-adjusted
BMI percentiles and these outcomes were assessed, adjusting for patient
level risk factors, using multivariate logistic regression. RESULTS-: Of
18,337 patients (118 centers), 16% were obese, 15% overweight, 53% normal
weight, 7% underweight and 9% were severely underweight. Observed risks of
operative mortality (p=0.04) and composite outcome (p<0.0001) were higher
in severely underweight and obese subjects. Severely underweight BMI was
associated with increased unplanned cardiac operation and reoperation for
bleeding. Obesity was associated with increased risk of wound infection.
In multivariable analysis, the association between BMI and operative
mortality was no longer significant. Obese (OR: 1.28 p=0.008), severely
underweight (OR: 1.29 p<0.0001) and underweight subjects (OR: 1.39
p=0.002) subjects were associated with increased risk of composite
outcome. CONCLUSIONS-: Obesity and underweight BMI were associated with
increased risk of composite adverse outcome independent of other risk
factors. Further research is necessary to determine whether BMI represents
a modifiable risk factor for perioperative outcome.<br/>Copyright &#xa9;
2017 by the American College of Cardiology Foundation and the American
Heart Association, Inc.

<77>
Accession Number
611147882
Author
Dogan Y.; Eren G.A.; Tulubas E.; Oduncu V.; Sahin A.; Ciftci S.
Institution
(Dogan, Oduncu, Sahin, Ciftci) Department of Cardiology, Fatih Medical
Park Hospital, Bahcesehir Medical University, Istanbul, Turkey
(Eren, Tulubas) Bakirkoy Dr. Sadi Konuk Education and Research Hospital,
Department of Anaesthesiology and Intensive Care, Istanbul, Turkey
Title
The effect of sedation during transoesophageal echocardiography on heart
rate variability: A comparison of hypnotic sedation with medical sedation.
Source
Kardiologia Polska. 74 (6) (pp 591-597), 2016. Date of Publication: 15 Jun
2016.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland)
Abstract
Background: There is no ideal sedation technique that can be used during
transoesophageal echocardiography (TEE), and the data concerning the
effects of available sedation techniques on heart rate variability (HRV)
are limited. Aim: To compare the effects of sedation through hypnotherapy
with medical sedation achieved by midazolam on HRV. Methods: We recruited
76 patients with an indication of TEE; the age range was 18-83 years. In
Group T there were 26 patients who had the procedure under topical
pharyngeal anaesthesia, in Group D there were 23 patients who received
midazolam, and in Group H there were 27 patients receiving hypnosis. All
patients had an IV access; throughout the procedure heart rate, rhythm
electrocardiography, and peripheric O2 saturation were monitored with a
non-invasive monitor, and blood pressure measurements were taken every 3
min. Rhythm Holter recordings were obtained from all patients and TEE was
performed. Results: When time domain parameters for HRV were compared in
all three groups, the hypnosis group had significant increases in pNN50
and RMSSD compared to Groups D and T (p < 0.05). As concerns frequency
domain parameters, there were no significant differences between groups
where low frequency (LF) was decreased in hypnosis group and high
frequency (HF) was increased (p > 0.05). However, LF/HF was decreased
statistically significantly (p < 0.05) when compared with the midazolam
group. Conclusions: Contrary to standard sedation in TEE patients, when
hypnosis is used autonomic cardiac tone is modified to a significant
extent. Hypnotic sedation achieves this by increasing the parasympathetic
activity, decreasing the sympathetic activity, and changing the
sympathovagal interaction balance.<br/>Copyright &#xa9; Polskie
Towarzystwo Kardiologiczne 2016.

<78>
Accession Number
610270625
Author
Bendixen M.; Jorgensen O.D.; Kronborg C.; Andersen C.; Licht P.B.
Institution
(Bendixen, Jorgensen, Licht) Department of Cardiothoracic Surgery, Odense
University Hospital, Odense, Denmark
(Andersen) Department of Cardiothoracic Anaesthesia, Odense University
Hospital, Odense, Denmark
(Kronborg) Centre of Health Economics Research (COHERE), University of
Southern Denmark, Odense, Denmark
(Licht) Odense Patient data Explorative Network (OPEN), University of
Southern Denmark, Odense, Denmark
Title
Postoperative pain and quality of life after lobectomy via video-assisted
thoracoscopic surgery or anterolateral thoracotomy for early stage lung
cancer: a randomised controlled trial.
Source
The Lancet Oncology. 17 (6) (pp 836-844), 2016. Date of Publication: 01
Jun 2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Video-assisted thoracoscopic surgery (VATS) is used
increasingly as an alternative to thoracotomy for lobectomy in the
treatment of early-stage non-small-cell lung cancer, but remains
controversial and worldwide adoption rates are low. Non-randomised studies
have suggested that VATS reduces postoperative morbidity, but there is
little high-quality evidence to show its superiority over open surgery. We
aimed to investigate postoperative pain and quality of life in a
randomised trial of patients with early-stage non-small-cell lung cancer
undergoing VATS versus open surgery. Methods We did a randomised
controlled patient and observer blinded trial at a public university-based
cardiothoracic surgery department in Denmark. We enrolled patients who
were scheduled for lobectomy for stage I non-small-cell lung cancer. By
use of a web-based randomisation system, we assigned patients (1:1) to
lobectomy via four-port VATS or anterolateral thoracotomy. After surgery,
we applied identical surgical dressings to ensure masking of patients and
staff. Postoperative pain was measured with a numeric rating scale (NRS)
six times per day during hospital stay and once at 2, 4, 8, 12, 26, and 52
weeks, and self-reported quality of life was assessed with the EuroQol 5
Dimensions (EQ5D) and the European Organisation for Research and Treatment
of Cancer (EORTC) 30 item Quality of Life Questionnaire (QLQ-C30) during
hospital stay and 2, 4, 8, 12, 26, and 52 weeks after discharge. The
primary outcomes were the proportion of patients with clinically relevant
moderate-to-severe pain (NRS >=3) and mean quality of life scores. These
outcomes were assessed longitudinally by logistic regression across all
timepoints. Data for the primary analysis were analysed by modified
intention to treat (ie, all randomised patients with pathologically
confirmed non-small-cell lung cancer). This trial is registered with
ClinicalTrials.gov, number NCT01278888. Findings Between Oct 1, 2008, and
Aug 20, 2014, we screened 772 patients, of whom 361 were eligible for
inclusion and 206 were enrolled. We randomly assigned 103 patients to VATS
and 103 to anterolateral thoracotomy. 102 patients in the VATS group and
99 in the thoracotomy group were included in the final analysis. The
proportion of patients with clinically relevant pain (NRS >=3) was
significantly lower during the first 24 h after VATS than after
anterolateral thoracotomy (VATS 38%, 95% CI 0.28-0.48 vs thoracotomy 63%,
95% CI 0.52-0.72, p=0.0012). During 52 weeks of follow-up, episodes of
moderate-to-severe pain were significantly less frequent after VATS than
after anterolateral thoracotomy (p<0.0001) and self-reported quality of
life according to EQ5D was significantly better after VATS (p=0.014). By
contrast, for the whole study period, quality of life according to QLQ-C30
was not significantly different between groups (p=0.13). Postoperative
surgical complications (grade 3-4 adverse events) were similar between the
two groups, consisting of prolonged air leakage over 4 days (14 patients
in the VATS group vs nine patients in the thoracotomy group), re-operation
for bleeding (two vs none), twisted middle lobe (one vs three) or
prolonged air leakage over 7 days (five vs six), arrhythmia (one vs one),
or neurological events (one vs two). Nine (4%) patients died during the
follow-up period (three in the VATS group and six in the thoracotomy
group). Interpretation VATS is associated with less postoperative pain and
better quality of life than is anterolateral thoracotomy for the first
year after surgery, suggesting that VATS should be the preferred surgical
approach for lobectomy in stage I non-small-cell lung cancer. Funding
Simon Fougner Hartmanns Familiefond, Guldsmed AL & D Rasmussens Mindefond,
Karen S Jensens legat, The University of Southern Denmark, The Research
Council at Odense University Hospital, and Department of Cardiothoracic
Surgery, Odense University Hospital.<br/>Copyright &#xa9; 2016 Elsevier
Ltd

<79>
Accession Number
617152334
Author
Ollgaard J.; Gaede P.; Rossing P.; Parving H.H.; Pedersen O.
Institution
(Ollgaard, Gaede) Slagelse Hospital, Denmark
(Rossing) Steno Diabetes Center, Denmark
(Parving) Rigshospitalet, Denmark
(Pedersen) University of Copenhagen, Copenhagen, Denmark
Title
Increased survival and reduced macrovascular disease with 7.8 years of
intensified, multifactorial intervention in patients with type 2 diabetes
and microalbuminuria in the steno-2 study.
Source
Endocrine Reviews. Conference: 99th Annual Meeting of the Endocrine
Society, ENDO 2017. United States. 38 (3 Supplement 1) (no pagination),
2017. Date of Publication: June 2017.
Publisher
Endocrine Society
Abstract
Introduction: Intensified multifactorial intervention for 7.8 years in
patients with type 2 diabetes mellitus and microalbuminuria reduced risk
of macro-and microvascular complications. Here we seek to investigate the
durability of this approach with a total of 21 years follow-up in a post
hoc analysis including endpoints as recommended in FDA-guidelines.
Methods: 160 patients with type 2 diabetes and microalbuminuria were
assigned to conventional or intensified, multi-factorial therapy targeting
multiple risk factors. Mean treatment duration was 7.8 years. After 7.8
years the study continued as an observational follow-up with all patients
treated as the original intensive-therapy group. Time to event was
modelled using Cox-regressions adjusted for age and sex. The primary
endpoint was survival time after randomization and survival time before
first CVD event. The secondary endpoint was the relative risk reduction in
a 3 point MACE defined as death of CVD, coronary artery disease (CAD:
non-fatal or fatal acute myocardial infarction or cardiac
revascularization) and cerebrovascular disease (defined as non-fatal and
fatal ischemic or hemorrhagic stroke) analyzed both as a composite-and
separate endpoints. Results: Overall median survival time was 7.9 [95% CI
2.2-9.6; p = 0.005] years longer in the original intensive-therapy group
compared to standard treatment. Time before first CVD-event was 8.1
[4.0-12.6; p = 0.001] years longer in the intensive therapy group. Hazard
rates of both the composite and separate secondary endpoints were all
decreased with intensified therapy. HR of the composite endpoint was 0.36
[95 % CI 0.23-0.57; p < 0.001], of CAD 0.43 [0.23-0.77; p = 0.005] and
cerebrovascular disease 0.26 [0.12-0.55; p < 0.001]. In addition, the risk
of recurrent events was significantly decreased in the intensive-therapy
group (p = 0.049 for CAD and p = 0.003 for stroke). Conclusions: At 21.2
years of follow up of 7.8 years of intensified, multifactorial, target
driven treatment of type 2 diabetes mellitus with microalbuminuria, we
demonstrate significantly increased life span and reduced risk of
macrovascular complications.

<80>
Accession Number
617014427
Author
Hosseini S.H.; Rafiei A.; Gaemian A.; Tirgari A.; Zakavi A.; Yazdani J.;
Bolhari J.; Golzari M.; Douki Z.E.; Vaezzadeh N.
Institution
(Hosseini) Psychiatry and Behavioral Sciences Research Center, Addiction
Institute, Mazandaran University of Medical Sciences, Sari, Iran, Islamic
Republic of
(Hosseini) Department of Psychosomatic, Imam Khomeini Hospital, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Rafiei) Molecular and Cell Biology Research Center, Faculty of medicine,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Gaemian) Department of Cardiology, Faculty of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Tirgari) Department of Psychiatry, Member of Psychiatry and Behavioral
Sciences Research Center, Sari, Iran, Islamic Republic of
(Zakavi) Department of Islamic Thought, Faculty of Medicine, Mazandaran
University of Medical Science, Sari, Iran, Islamic Republic of
(Yazdani) Department of Biostatistics, Faculty of Health, Health Sciences
Research Center, Mazandaran University of Medical Sciences, Sari, Iran,
Islamic Republic of
(Bolhari) Mental Health Research Center (MHRC), Tehran Psychiatric
Institute, Iran University of Medical Sciences (IUMS), Tehran, Iran,
Islamic Republic of
(Golzari) Faculty of Psychology and Educational Sciences, Allame Tabatabai
University, Tehran, Iran, Islamic Republic of
(Douki, Vaezzadeh) Department of Pediatric Nursing, Faculty of Nursing and
Midwifery, Mazandaran University of Medical Sciences, Sari, Iran, Islamic
Republic of
Title
Comparison of the effects of Religious Cognitive Behavioral Therapy
(RCBT), Cognitive Behavioral Therapy (CBT), and sertraline on depression
and anxiety in patients after coronary artery bypass graft surgery: Study
protocol for a randomized controlled trial.
Source
Iranian Journal of Psychiatry. 12 (3) (pp 206-213), 2017. Date of
Publication: 2017.
Publisher
Tehran University of Medical Sciences (E-mail: irjp@tums.ac.ir)
Abstract
Objective: The present study aimed at comparing the effects of Religious
Cognitive Behavioral Therapy (RCBT), Cognitive Behavioral Therapy (CBT),
and sertraline on depression, anxiety, biomarker levels, and quality of
life in patients after coronary artery bypass graft (CABG) surgery.
Method: This was a randomized controlled trial with parallel groups. A
total of 160 patients after CABG surgery will be screened for anxiety and
depression according to clinical interviews based on Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria
and Hospital Anxiety Depression Scale (HADS) scores (<= 8). To assess
religious attitude, Golriz and Baraheni's Religious Attitude questionnaire
will be used. Participants will be randomly allocated to 4 groups of 40
including 3 intervention groups (RCBT, CBT, and sertraline) and 1 control
group (usual care). RCBT and CBT programs will consist of 12 one-hour
weekly sessions. The participants in the pharmacological intervention
group will receive 25-200 mg/d of sertraline for 3 months. The Short
Form-36 Health Survey (SF-36) will be administered to assess the patients'
quality of life. Blood samples will be taken and biomarker levels will be
determined using the enzyme-linked immunosorbent assay (ELISA). The
primary outcome will be reduction in anxiety and depression scores after
the interventions. The secondary outcomes will be increase in quality of
life scores and normalized biomarker levels after the interventions.
Discussion: If RCBT is found to be more effective than the other methods;
it can be used to improve patients' health status after CABG surgery.

<81>
Accession Number
614312762
Author
Arora S.; Strassle P.D.; Ramm C.J.; Rhodes J.A.; Vaidya S.R.; Caranasos
T.G.; Vavalle J.P.
Institution
(Arora, Ramm, Caranasos, Vavalle) Division of Cardiology, University of
North Carolina, Chapel Hill, NC, United States
(Strassle) Division of Epidemiology, University of North Carolina, Chapel
Hill, NC, United States
(Rhodes) Campbell University School of Osteopathic Medicine, Buies Creek,
NC, United States
(Vaidya) Department of Internal Medicine, Cape Fear Valley Medical Center,
Fayetteville, NC, United States
Title
Transcatheter Versus Surgical Aortic Valve Replacement in Patients With
Lower Surgical Risk Scores: A Systematic Review and Meta-Analysis of Early
Outcomes.
Source
Heart Lung and Circulation. 26 (8) (pp 840-845), 2017. Date of
Publication: August 2017.
Publisher
Elsevier Ltd
Abstract
Background The results from the PARTNER 2 trial showed the feasibility of
transcatheter aortic valve replacement (TAVR) in intermediate surgical
risk patients. Although low risk clinical trials will take time to
conclude, some data has emerged comparing TAVR with surgical aortic valve
replacement (SAVR) in lower risk patients. Methods A Medline search was
conducted using standard methodology to search for studies reporting
results comparing TAVR and SAVR. Studies were included if the overall mean
Society of Thoracic Surgeons Score was less than 4% (or equivalent
Euroscore). A meta-analysis comparing the 30-day risk of clinical outcomes
between TAVR and SAVR in the lower surgical risk population was conducted.
Results A total of four studies, including one clinical trial and three
propensity-matched cohort studies met the inclusion criteria. Compared to
SAVR, TAVR had a lower risk of 30-day mortality (RR 0.67, 95% CI 0.41,
1.10), stroke (RR 0.60, 95% CI 0.30, 1.22), bleeding complications (RR
0.51, 95% CI 0.40, 0.67) and acute kidney injury (RR 0.66, 95% CI 0.47,
0.94). However, a higher risk of vascular complications (RR 11.72, 95% CI
3.75, 36.64), moderate or severe paravalvular leak (RR 5.04, 95% CI 3.01,
8.43), and permanent pacemaker implantations (RR 4.62, 95% CI 2.63, 8.12)
was noted for TAVR. Conclusion Among lower risk patients, TAVR and SAVR
appear to be comparable in short term outcomes. Additional high quality
studies among patients classified as low risk are needed to further
explore the feasibility of TAVR in all surgical risk
patients.<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)

<82>
Accession Number
614529437
Author
Ip W.T.K.; Chandramouli C.; Smith J.A.; McLennan P.L.; Pepe S.; Delbridge
L.M.D.
Institution
(Ip, Chandramouli, Delbridge) Cardiac Phenomics Laboratory, Department of
Physiology, University of Melbourne, Melbourne, Vic, Australia
(Smith) Department of Cardiothoracic Surgery, Monash Health, Monash
University, Melbourne, Vic, Australia
(Smith) Department of Surgery, School of Clinical Sciences at Monash
Health, Monash University, Melbourne, Vic, Australia
(McLennan) Graduate School of Medicine, Centre for Human Applied
Physiology, University of Wollongong, Sydney, NSW, Australia
(Pepe) Murdoch Children's Research Institute, Department of Paediatrics,
University of Melbourne, Royal Children's Hospital, Melbourne, Vic,
Australia
Title
A Small Cohort Omega-3 PUFA Supplement Study: Implications of Stratifying
According to Lipid Membrane Incorporation in Cardiac Surgical Patients.
Source
Heart Lung and Circulation. 26 (8) (pp 846-855), 2017. Date of
Publication: August 2017.
Publisher
Elsevier Ltd
Abstract
Background Epidemiological studies and randomised clinical trials (RCTs)
report disparate findings in relation to omega-3 polyunsaturated fatty
acids (n-3 PUFA) benefit for cardiac patients. With RCTs interpretation is
potentially confounded by background n-3 PUFA intake. The goal of this
pilot, small cohort, pre-surgical supplementation study was to evaluate
postoperative atrial fibrillation (AF) and cardiac molecular expression
profiles employing two data analysis approaches - by treatment
randomisation and by stratification using measured n-3 PUFA. Methods
Patients (n = 20) received 3 g/day of fish or placebo oil (FO vs PO) in a
double blind randomised protocol prior to elective coronary artery graft
and valve surgery. Groups were matched for age, gender, and mean treatment
duration (~20 days). Resected atrial myocardium was sampled for assay of
viability metabolic markers, and blood obtained for erythrocyte membrane
lipid measurement. Results There was substantial overlap of cell membrane
n-3 PUFA content across PO and FO groups, and no group treatment effects
on AF incidence or myocardial molecular marker levels were detected. In
contrast, data stratification using membrane n-3 PUFA content (at 8% total
membrane lipid) achieved significant separation of patients (by n-6:n-3
PUFA ratio), a significant differential cardiac expression of the marker
peroxisomal proliferator-activated receptor, but no difference in AF
incidence. Conclusions This small n-3 PUFA case study demonstrates that
the same cohort may yield differing findings when evaluated using
randomisation or stratification approaches based on direct molecular
measures in cell membranes.<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)

<83>
Accession Number
616986660
Author
Testa L.; Latib A.; Bollati M.; Montone R.A.; Colombo A.; Crea F.; Bedogni
F.
Institution
(Testa, Bollati, Montone, Bedogni) Dept. of Cardiology, IRCCS Pol S.
Donato, Milan, Italy
(Latib, Colombo) Interventional Cardiology Unit, San Raffaele Scientific
Institute, EMO GVM Centro Cuore Columbus, Milan, Italy
(Crea) Dept of Cardiology, Catholic Univ. of the Sacred Heart, Rome, Italy
Title
Unprotected left main revascularization: Percutaneous coronary
intervention versus coronary artery bypass. An updated systematic review
and meta-analysis of randomised controlled trials.
Source
PLoS ONE. 12 (6) (no pagination), 2017. Article Number: e0179060. Date of
Publication: June 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background The optimal treatment of unprotected left main (UPLM) with
either PCI or CABG remains uncertain. Aim The purpose of this study was to
determine the comparative safety and efficacy of PCI versus CABG in
patients with UPLM disease. Methods Search of BioMedCentral, CENTRAL,
mRCT, PubMed, major cardiological congresses proceedings and references
cross-check (updated November 2016). Outcomes were the rate of MACE [all
cause death, MI, stroke], the rates of the individual components of MACE
and the rate of target vessel revascularisation (TVR). Results We
identified 6 Randomised Controlled Trials totalling 4717 patients
allocated to PCI or CABG. At 1 year follow up, PCI and CABG were
substantially equivalent with respect to the rates of MACE [PCI 8.5% vs
CABG 8.9%, OR 1.02,(0.76-1.36), p = 0.9], death [PCI 5.4% vs CABG 6.6%, OR
0.81,(0.63-1.03),p = 0.08] and MI [PCI 3.4% vs CABG 4.3%, OR 0.80
(0.59-1.07), p = 0.14]. Notably, PCI was associated with a significantly
lower rate of stroke [PCI 0.6% vs CABG 1.8%, OR 0.36,(0.17-0.79), p =
0.01] and with a significantly higher rate of TVR [PCI 8.7% vs CABG 4.5%,
OR 2.00(1.46-2.75), p<0.01]. At a median follow up of 5years, the rates of
MACE were similar between the two strategies: PCI 14.6% vs CABG 13.8%, OR
1.02(0.76-1.38), p = 0.89. Likewise, the rates of death [PCI 8% and CABG
7.7%, OR 1(0.77-1.31), P = 0.9], MI [PCI 6.1% vs CABG 5%, OR
1.41(0.85-2.34), P = 0.19, I²59%], and stroke [PCI 2% vs CABG
2.2%, OR 0.85(0.42-1.81), p = 0.65,] were similar while PCI was associated
with a significantly higher rate of TVR [14.5% vs CABG 8.9%, OR
1.73(1.41-2.13), p<0.01]. Conclusion In patients with UPLM disease, PCI
and CABG are associated with similar rates of MACE and mortality at 1 year
as well as after 5 years. Differences can be detected for individual end
points at both short and long term FU.<br/>Copyright &#xa9; 2017 Testa 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.

<84>
Accession Number
617046939
Author
Mihos C.G.; Xydas S.; Yucel E.; Capoulade R.; Williams R.F.; Mawad M.;
Garcia G.; Santana O.
Institution
(Mihos, Yucel, Capoulade) Cardiac Ultrasound Laboratory, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, United States
(Xydas, Williams, Mawad) Columbia University Division of Cardiac Surgery,
Mount Sinai Heart Institute, Miami Beach, FL, United States
(Garcia) Department of Anesthesia, Mount Sinai Medical Center, Miami
Beach, FL, United States
(Santana) Columbia University Division of Cardiology, Mount Sinai Heart
Institute, Miami Beach, FL, United States
Title
Mitral valve repair and subvalvular intervention for secondary mitral
regurgitation: A systematic review and meta-analysis of randomized
controlled and propensity matched studies.
Source
Journal of Thoracic Disease. 9 (pp S582-S594), 2017. Date of Publication:
01 Jun 2017.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Combining a ring annuloplasty (Ring) with a mitral subvalvular
intervention (Ring + subvalvular) in patients with secondary mitral
regurgitation (MR) may improve mitral valve (MV) repair durability.
However, the outcomes of this strategy compared with a Ring only, have not
been clearly defined. Methods: A systematic review and meta-analysis was
performed utilizing randomized controlled and propensity matched studies
which compared a Ring + subvalvular versus Ring MV repair for the
treatment of secondary MR. Risk ratio (RR), weighted mean difference (MD),
and the 95% confidence interval (CI) were calculated by the
Mantel-Haenszel and inverse-variance methods, for clinical outcomes and
echocardiographic measures of follow-up MR, left ventricular (LV) reverse
remodeling, and MV apparatus geometry. Results: Five studies were
identified, with a total of 397 patients. Baseline characteristics were
similar between groups, and all patients had moderate to severe secondary
MR, with the vast majority in the setting of ischemic cardiomyopathy. A
Ring + subvalvular repair consisted of papillary muscle approximation
(n=2), papillary muscle relocation (n=2), or secondary chordal cutting
(n=1). Follow-up ranged from 10.1 (mean range =0.25-42) to 69
[interquartile range (IQR) =23-82] months. When compared with Ring only at
last follow-up, a Ring + subvalvular MV repair was associated with: (I) a
smaller MR grade (MD =-0.44, 95% CI -0.69 to -0.19; P=0.0005); (II) a
reduced risk of moderate or greater recurrent MR (RR =0.43, 95% CI,
0.27-0.66; P=0.0002); (III) a smaller mean LV end-diastolic diameter (MD
=-3.56 mm, 95% CI -5.40 to -1.73; P=0.0001) and a greater ejection
fraction (MD =2.64%, 95% CI, 0.13-5.15; P=0.04); and, (IV) an improved MV
apparatus geometry. There were no differences in operative mortality,
post-operative morbidity, or follow-up survival between surgical
approaches. Conclusions: When compared with Ring only, a Ring +
subvalvular MV repair is associated with greater LV reverse remodeling and
systolic function, less recurrence of moderate or greater MR, and an
improved geometry of the MV apparatus at short and mid-term
follow-up.<br/>Copyright &#xa9; Journal of Thoracic Disease. All rights
reserved.

<85>
Accession Number
617046938
Author
Santana O.; Xydas S.; Williams R.F.; LaPietra A.; Mawad M.; Wigley J.C.;
Beohar N.; Mihos C.G.
Institution
(Santana, Beohar) The Columbia University Division of Cardiology, Mount
Sinai Medical Center, Miami Beach, FL, United States
(Xydas, Williams, LaPietra, Mawad) The Division of Cardiac Surgery, Mount
Sinai Medical Center, Miami Beach, FL, United States
(Wigley) The Department of Anesthesia, Mount Sinai Medical Center, Miami
Beach, FL, United States
(Mihos) Cardiac Ultrasound Laboratory, Massachusetts General Hospital,
Harvard Medical School, Boston, MA, United States
Title
Percutaneous coronary intervention followed by minimally invasive valve
surgery compared with median sternotomy coronary artery bypass graft and
valve surgery in patients with prior cardiac surgery.
Source
Journal of Thoracic Disease. 9 (pp S575-S581), 2017. Date of Publication:
01 Jun 2017.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: In patients with prior cardiac surgery requiring re-operative
coronary and valve surgery, a hybrid approach of percutaneous coronary
intervention followed by minimally invasive valve surgery (PCI + MIVS) may
be an alternative to the standard median sternotomy coronary artery bypass
and valve surgery (CABG + valve). Methods: The outcomes of patients with
prior cardiac surgery, presenting with coronary artery and valvular
disease, who underwent PCI + MIVS (N=39) were retrospectively compared
with those who underwent CABG + valve (N=28) via a repeat median
sternotomy, between February 2009 and April 2014. Results: The mean age
for the PCI + MIVS versus CABG + valve group was 75+/-9 and 72+/-11 years
(P=0.54), respectively. The baseline characteristics were similar between
groups, with the exception of a greater prevalence of 1-vessel coronary
artery disease and clopidogrel or dual antiplatelet therapy at the time of
surgery in the PCI + MIVS group, and more 3-vessel coronary artery disease
in those undergoing CABG + valve surgery. The PCI + MIVS approach was
associated with a decreased aortic cross-clamp (94 vs. 131 minutes,
P=0.001) and cardiopulmonary bypass (128 vs. 190 minutes, P < 0.001)
times, fewer intraoperative packed red blood transfusions (1.3 vs. 3.8
units, P=0.001), shorter intensive care unit length of stay (41 vs. 71
hours, P < 0.001), and decreased incidence of prolonged mechanical
ventilation (12.8% vs. 35.7%, P=0.03), re-intubation (2.6% vs. 17.9%,
P=0.04), when compared with CABG + valve. The thirtyday and two-year
mortality were similar, being 7.7% vs. 7.1% (P=0.66), and 12.8% vs. 10.7%
(P=0.55), in the PCI + MIVS vs. CABG + valve group, respectively.
Conclusions: Hybrid PCI + MIVS in patients with prior cardiac surgery is
associated with shorter operative times and intensive care unit length of
stay, less need for intraoperative blood cell transfusions, decreased use
of mechanical ventilation, and similar short-term and follow-up survival,
when compared with CABG + valve surgery via median sternotomy. Randomized
trials and multicenter registries are needed to further evaluate this
approach.<br/>Copyright &#xa9; Journal of Thoracic Disease. All rights
reserved.

<86>
Accession Number
617032362
Author
Coca S.G.; Zabetian A.; Ferket B.S.; Zhou J.; Testani J.M.; Garg A.X.;
Parikh C.R.
Institution
(Coca) Division of Nephrology, Icahn School of Medicine at Mount Sinai,
One Gustave L. Levy Place, New York, NY 10029, United States
(Zabetian, Testani, Parikh) Program of Applied Translational Research,
Department of Internal Medicine, Yale University School of Medicine, New
Haven, CT, United States
(Ferket, Zhou) Institute for Healthcare Delivery Science, Department of
Population Health Science and Policy, Icahn School of Medicine at Mount
Sinai, New York, NY, United States
(Garg) Division of Nephrology, Department of Medicine, Western University,
London, ON, Canada
Title
Evaluation of short-term changes in serum creatinine level as a meaningful
end point in randomized clinical trials.
Source
Journal of the American Society of Nephrology. 27 (8) (pp 2529-2542),
2016. Date of Publication: 2016.
Publisher
American Society of Nephrology (E-mail: email@asn-online.org)
Abstract
Observational studies have shown that acute change in kidney function
(specifically, AKI) is a strong risk factor for poor outcomes. Thus, the
outcome of acute change in serum creatinine level, regardless of
underlying biology or etiology, is frequently used in clinical trials as
both efficacy and safety end points.We performed ameta-analysis of
clinical trials to quantify the relationship between positive or negative
short-term effects of interventions on change in serum creatinine level
and more meaningful clinical outcomes. After a thorough literature
search,we included 14 randomized trials of interventions that altered risk
for an acute increase in serum creatinine level and had reported
between-group differences in CKD and/or mortality rate 3 months after
randomization. Seven trials assessed interventions that, compared with
placebo, increased risk of acute elevation in serum creatinine level
(pooled relative risk, 1.52; 95% confidence interval, 1.22 to 1.89), and
seven trials assessed interventions that, compared with placebo, reduced
risk of acute elevation in serumcreatinine level (pooled relative risk,
0.57; 95%confidence interval, 0.44 to 0.74). However, pooled risks for CKD
andmortality associated with interventions did not differ fromthose with
placebo in either group. In conclusion, several interventions that affect
risk of acute, mild to moderate, often temporary elevation in serum
creatinine level in placebo-controlled randomized trials showed no
appreciable effect on CKD or mortalitymonths later, raising questions
about the value of using small to moderate changes in serum creatinine
level as end points in clinical trials.<br/>Copyright &#xa9; 2016 by the
American Society of Nephrology.

<87>
Accession Number
617144942
Author
Castleberry C.; Ziniel S.; Almond C.; Auerbach S.; Hollander S.A.; Lal
A.K.; Fenton M.; Pahl E.; Rossano J.W.; Everitt M.D.; Daly K.P.
Institution
(Castleberry) Washington University in St. Louis St. Louis, MO USA
(Ziniel, Daly) Boston Children's Hospital Harvard Medical School Boston,
MA USA
(Ziniel) University of Colorado Anschutz Medical Campus Aurora, CO USA
(Almond, Hollander) Stanford University School of Medicine Palo Alto, CA
USA
(Auerbach, Everitt) Children's Hospital Colorado Aurora, CO USA
(Lal) Primary Children's Hospital Salt Lake City, UT USA
(Fenton) Great Ormond Street Hospital for Children London UK
(Pahl) Ann and Robert H. Lurie Children's Hospital of Chicago Chicago, IL
USA
(Rossano) Children's Hospital of Philadelphia Philadelphia, PA USA
Title
Clinical practice patterns are relatively uniform between pediatric heart
transplant centers: A survey-based assessment.
Source
Pediatric Transplantation. (no pagination), 2017. Date of Publication:
2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Clinical practice variations are a barrier to the study of pediatric heart
transplants and coordination of multicenter RCTs in this patient
population. We surveyed centers to describe practice patterns, understand
areas of variation, and willingness to modify protocol. Pediatric heart
transplant centers were identified, and one survey was completed per
center. Simple descriptive statistics were used. The response rate was 77%
(40 responses from 52 contacted centers, 37 with complete responses).
Median center volume of respondents was eight transplants/year (IQR 3-19).
Most centers reported tacrolimus (36/38, 95%) and mycophenolate mofetil
(36/38, 95%) as maintenance immunosuppression. Other immunosuppression
agents reported were cyclosporine (7/38, 18%), everolimus or sirolimus
(3/38, 8%), and azathioprine (2/38, 5%). Overall, respondents answered
similarly for questions regarding clinical practices including induction
therapy, maintenance immunosuppression, and rejection treatment threshold
(>85% agreement for all). Additionally, willingness to change clinical
practices was over 70% for all practices surveyed (35 total respondents),
and 97% of centers (36/37) were willing to participate in a RCT of
maintenance immunosuppression. In conclusion, we found many similar
clinical practice protocols. Most centers are willing to collaborate on a
common protocol in order to participate in a RCT and support a trial
investigating maintenance immunosuppression.<br/>Copyright &#xa9; 2017
John Wiley & Sons A/S.

<88>
Accession Number
605718051
Author
Yalcinkaya A.; Diken A.I.; Aksoy E.; Lafci G.; Cicek O.F.; Kadirogullari
E.; Ulusar U.D.; Cagli K.
Institution
(Yalcinkaya, Lafci, Cicek, Kadirogullari, Cagli) Hitit University Corum
Education, Research Hospital, Turkey Yuksek Ihtisas Education and Research
Hospital, Department of Cardiovascular Surgery, Bahcelievler Mah. Camllk
Cad. No: 2, Corum 19100, Turkey
(Diken) Hitit University Corum Education and Research Hospital, Department
of Cardiovascular Surgery, Corum, Turkey
(Aksoy) Kartal Kosuyolu Education and Research Hospital, Department of
Cardiovascular Surgery, Istanbul, Turkey
(Ulusar) Akdeniz University, Faculty of Engineering, Department of
Computer Engineering, Antalya, Turkey
Title
Effect of Left Atrial Reduction on Restoration and Maintenance of Sinus
Rhythm in Patients Undergoing Mitral Valve Replacement: A Pilot Study.
Source
Thoracic and Cardiovascular Surgeon. 64 (5) (pp 441-446), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Background This pilot study aimed to evaluate the effectiveness of
posterior left atrial wall plication (T-plasty) in patients with
persistent atrial fibrillation (AF) (> 7 days) undergoing mitral valve
surgery. Materials and Methods A total of 60 patients who were scheduled
for mitral valve replacement were randomly allocated into two groups: one
would receive (Group 1; n = 32, mean age; 49.37 +/- 9.00) and one would
not receive (Group 2; n = 28; mean age 48.64 +/- 8.6) left atrial size
reduction using T-plasty technique. Patients with a clear indication for
combined procedures other than tricuspid valve disease, aortic valve
disease, and coronary artery stenosis were not included. Follow-up was
performed at 6th, 12th, and 18th months after the operation. Results After
the operation, 21 patients (65.6%) in Group 1 and 13 patients (46.4%) in
Group 2 regained sinus rhythm (p = 0.13). Mortality did not occur. AF
recurrence rates were not significantly different between the groups in
three follow-ups. Restoration of sinus rhythm was significantly more
common in Group 1 patients than in Group 2 patients during follow-up.
Patients in Group 1 had lower left atrial volume indexes than those in
Group 2 at the 6th and 12th months, whereas the difference at the 18th
month was at the limit of significance. Conclusion We achieved
satisfactory results using the T-plasty technique for left atrial size
reduction in terms of mid-term restoration and preservation of normal
sinus rhythm in patients undergoing mitral valve surgery. Further study
may be justified to reveal the prognostic importance of the technique
described herein.<br/>Copyright &#xa9; Georg Thieme Verlag Stuttgart. New
York.

<89>
Accession Number
612328834
Author
Okumura N.; Jhund P.S.; Gong J.; Lefkowitz M.P.; Rizkala A.R.; Rouleau
J.L.; Shi V.C.; Swedberg K.; Zile M.R.; Solomon S.D.; Packer M.; Mcmurray
J.J.V.
Institution
(Okumura, Jhund, Mcmurray) BHF Cardiovascular Research Centre, University
of Glasgow, 126 University Pl, Glasgow G12 8TA, United Kingdom
(Gong, Lefkowitz, Rizkala, Shi) Novartis Pharmaceutical Corporation, East
Hanover, NJ, United States
(Rouleau) Institut de Cardiologie de Montreal, Universitede Montreal,
Montreal, QC, Canada
(Swedberg) Department of Molecular and Clinical Medicine, University of
Gothenburg, Gothenburg, Sweden
(Swedberg) National Heart and Lung Institute, Imperial College, London,
United Kingdom
(Zile) Medical University of South Carolina, RHJ Department of Veterans
Administration Medical Center, Charleston, SC, United States
(Solomon) Cardiovascular Medicine, Brigham and Women's Hospital, Boston,
MA, United States
(Packer) Baylor Heart and Vascular Institute, Baylor University Medical
Center, Dallas, TX, United States
Title
Effects of sacubitril/valsartan in the PARADIGM-HF trial (Prospective
Comparison of ARNI with ACEI to Determine Impact on Global Mortality and
Morbidity in Heart Failure) according to background therapy.
Source
Circulation: Heart Failure. 9 (9) (no pagination), 2016. Article Number:
003212. Date of Publication: 01 Sep 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - In the PARADIGM-HF trial (Prospective Comparison of ARNI with
ACEI to Determine Impact on Global Mortality and Morbidity in Heart
Failure), the angiotensin receptor neprilysin inhibitor
sacubitril/valsartan was more effective than the angiotensin-converting
enzyme inhibitor enalapril in patients with heart failure and reduced
ejection fraction. We examined whether this benefit was consistent
irrespective of background therapy. Methods and Results - We examined the
effect of study treatment in the following subgroups: diuretics (yes/no),
digitalis glycoside (yes/no), mineralocorticoid receptor antagonist
(yes/no), and defibrillating device (implanted defibrillating device,
yes/no). We also examined the effect of study drug according to
beta-blocker dose (>=50% and <50% of target dose) and according to whether
patients had undergone previous coronary revascularization. We analyzed
the primary composite end point of cardiovascular death or heart failure
hospitalization, as well as cardiovascular death. Most randomized patients
(n=8399) were treated with a diuretic (80%) and beta-blocker (93%); 47% of
those taking a beta-blocker were treated with >=50% of the recommended
dose. In addition, 4671 (56%) were treated with a mineralocorticoid
receptor antagonist, 2539 (30%) with digoxin, and 1243 (15%) had a
defibrillating device; 2640 (31%) had undergone coronary
revascularization. Overall, the sacubitril/valsartan versus enalapril
hazard ratio for the primary composite end point was 0.80 (95% confidence
interval, 0.73-0.87; P<0.001) and for cardiovascular death was 0.80
(0.71-0.89; P<0.001). The effect of sacubitril/valsartan was consistent
across all subgroups examined. The hazard ratio for primary end point
ranged from 0.74 to 0.85 and for cardiovascular death ranged from 0.75 to
0.89, with no treatment-by-subgroup interaction. Conclusions - The benefit
of sacubitril/valsartan, over an angiotensin-converting enzyme inhibitor,
was consistent regardless of background therapy and irrespective of
previous coronary revascularization or beta-blocker dose.<br/>Copyright
&#xa9; 2016 American Heart Association, Inc.

<90>
Accession Number
608885303
Author
Saw J.; Wong G.C.; Mayo J.; Bernstein V.; Mancini G.B.J.; Ye J.; Skarsgard
P.; Starovoytov A.; Cairns J.
Institution
(Saw, Wong, Bernstein, Mancini, Starovoytov, Cairns) Divisions of
Cardiology, University of British Columbia, Vancouver General Hospital,
2775 Laurel Street, Level 9, Vancouver, BC V5Z1M9, Canada
(Mayo) Divisions of Radiology, Vancouver General Hospital, St Paul's
Hospital, University of British Columbia, Vancouver, BC, Canada
(Ye, Skarsgard) Divisions of Cardiovascular Surgery, Vancouver General
Hospital, St Paul's Hospital, University of British Columbia, Vancouver,
BC, Canada
Title
Ticagrelor and aspirin for the prevention of cardiovascular events after
coronary artery bypass graft surgery.
Source
Heart. 102 (10) (pp 763-769), 2016. Date of Publication: 01 May 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background: Ticagrelor was shown to reduce mortality in patients who
underwent coronary artery bypass grafting (CABG), but its effect on graft
patency is unknown. Methods: We performed a prospective, randomised,
double-blind, placebo-controlled trial, comparing ticagrelor 90 mg twice
daily versus placebo for 3 months added to aspirin 81 mg/day, following
isolated CABG. Aspirin was started within 12 h, and study medication
within 72 h after CABG. Primary outcome was graft occlusion on CT
angiography (CTA) performed 3 months post CABG. Patients were followed to
12 months for death, myocardial infarction, stroke, repeat
revascularisation and bleeding. Results: The study was terminated
prematurely after randomising 70 patients between September 2011 and
August 2014 because of slow recruitment. CTA was performed in 56 patients
who completed >1 month of study drug. Graft occlusion occurred in 7/25
(28.0%) patients on ticagrelor and 17/31 (48.3%) on placebo, p=0.044. Of
207 analysable grafts, graft occlusion occurred in 9/87 (10.3%) with
ticagrelor and 22/120 (18.3%) with placebo, p=0.112. Graft occlusion or
stenosis >=50% occurred in 10/87 (11.5%) ticagrelor vs 32/120 (26.7%)
placebo, p=0.007. There was no major bleeding, but minor bleeding was
higher with ticagrelor (31.4% vs 2.9%, p=0.003). In univariate analysis,
ticagrelor use reduced graft occlusion (OR 0.32, 95% CI 0.10 to 0.97,
p=0.047), which remained significant on multivariable analysis (OR 0.25,
95% CI 0.073 to 0.873, p=0.03). Conclusions: Ticagrelor added to aspirin
after CABG reduced the proportion of patients with graft occlusion, and
was a significant univariate and multivariable predictor of graft
occlusion. These results are hypothesis-generating and should be confirmed
in larger studies. Trial registration number: NCT01373411:
Results.<br/>Copyright &#xa9; 2016, BMJ Publishing Group. All rights
reserved.

<91>
Accession Number
608648800
Author
Narayanan M.A.; Haddad T.M.; Kalil A.C.; Kanmanthareddy A.; Suri R.M.;
Mansour G.; Destache C.J.; Baskaran J.; Mooss A.N.; Wichman T.; Morrow L.;
Vivekanandan R.
Institution
(Narayanan, Haddad, Mansour) Department of Internal Medicine, Creighton
University School of Medicine, Omaha, Nebraska 68154, United States
(Kalil) Division of Infectious Diseases, University of Nebraska School of
Medicine, Omaha, Nebraska, United States
(Kanmanthareddy, Mooss) Division of Cardiology, Creighton University
School of Medicine, Omaha, Nebraska, United States
(Suri) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, Ohio, United States
(Destache) School of Pharmacy and Health Professions and School of
Medicine, Creighton University, Omaha, Nebraska, United States
(Baskaran) University of Texas Southwestern at Dallas, Dallas, Texas,
United States
(Wichman, Morrow) Division of Pulmonary Critical Care and Sleep Medicine,
Creighton University School of Medicine, Omaha, Nebraska, United States
(Vivekanandan) Division of Infectious Diseases, Creighton University
School of Medicine, Omaha, Nebraska, United States
Title
Early versus late surgical intervention or medical management for
infective endocarditis: A systematic review and meta-analysis.
Source
Heart. 102 (12) (pp 950-957), 2016. Date of Publication: 15 Jun 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective Infective endocarditis is associated with high morbidity and
mortality and optimal timing for surgical intervention is unclear. We
performed a systematic review and meta-analysis to compare early surgical
intervention with conservative therapy in patients with infective
endocarditis. Methods PubMed, Cochrane, EMBASE, CINAHL and Google-scholar
databases were searched from January 1960 to April 2015. Randomised
controlled trials, retrospective cohorts and prospective observational
studies comparing outcomes between early surgery at 20 days or less and
conservative management for infective endocarditis were analysed. Results
A total of 21 studies were included. OR of allcause mortality for early
surgery was 0.61 (95% CI 0.50 to 0.74, p<0.001) in unmatched groups and
0.41 (95% CI 0.31 to 0.54, p<0.001) in the propensity-matched groups
(matched for baseline variables). For patients who had surgical
intervention at 7 days or less, OR of all-cause mortality was 0.61 (95% CI
0.39 to 0.96, p=0.034) and in those who had surgical intervention within
8-20 days, the OR of mortality was 0.64 (95% CI 0.48 to 0.86, p=0.003)
compared with conservative management. In propensity-matched groups, the
OR of mortality in patients with surgical intervention at 7 days or less
was 0.30 (95% CI 0.16 to 0.54, p<0.001) and in the subgroup of patients
who underwent surgery between 8 and 20 days was 0.51 (95% CI 0.35 to 0.72,
p<0.001). There was no significant difference in in-hospital mortality,
embolisation, heart failure and recurrence of endocarditis between the
overall unmatched cohorts. Conclusion The results of our meta-analysis
suggest that early surgical intervention is associated with significantly
lower risk of mortality in patients with infective endocarditis.

<92>
Accession Number
605076639
Author
Liu Z.; He R.; Wu C.; Xia Y.
Institution
(Liu, He, Wu, Xia) Department of Cardiovascular Surgery, Zhejiang
Hospital, No.12 Lingyin Road, Hangzhou 310013, China
Title
Transfemoral versus Transapical Aortic Implantation for Aortic Stenosis
Based on No Significant Difference in Logistic EuroSCORE: A Meta-Analysis.
Source
Thoracic and Cardiovascular Surgeon. 64 (5) (pp 374-381), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Background Transcatheter aortic valve implantation (TAVI) has gained
increasing acceptance for patients with severe aortic stenosis (AS). The
present meta-Analysis was performed to assess if the transapical (TA)
approach has any benefit in reduction of mortality and complications
relative to the transfemoral (TF) approach for patients with AS. Methods
All relevant studies comparing TF-TAVI and TA-TAVI from January 2002 to
November 2013 were retrieved from Medline and Embase databases. The
relative risk (RR) and 95% confidence interval (CI) were used to evaluate
the difference between two groups. Heterogeneity assumption was assessed
by an I ² test. The random-effect model or fixed-effect model
was used to estimate summary effect based on I ² test. Results
Nine studies conformed to the predefined criteria, including 666 patients
in the TF-TAVI group and 457 patients in the TA-TAVI group. No difference
was found in all-cause mortality at 30 days and beyond 1 year between the
two groups (30 days: 9.2% versus 11.4%; RR, 0.72; 95% CI, 0.47 to 1.11; p
= 0.14 and beyond 1 year: RR, 0.96; 95% CI, 0.59 to 1.56; p = 0.86). There
was a trend toward increased incidence of stroke in patients in the
TF-TAVI group (4.7% versus 2.6%; RR, 1.64; 95% CI, 0.75 to 3.58; p =
0.21), and the incidence of vascular complication and postoperative heart
block were significantly increased in patients having TF-TAVI (vascular
complications: 14.7% versus 7.1%; RR, 2.04; 95% CI, 1.15 to 3.61; p = 0.01
and heart block: 13.4% versus 4.6%; RR, 2.53; 95% CI, 1.10 to 5.83; p =
0.03). Additionally, more patients in the TF-TAVI group required permanent
pacemaker relative to the TA-TAVI group (10.8% versus 3.4%; RR, 2.74; 95%
CI, 1.41 to 5.32; p = 0.003). Conclusions Among patients with AS with no
significant difference in logistic EuroSCORE, TA-TAVI has a lower risk of
vascular complication and postoperative heart block but a similar
incidence of stroke and mortality compared with TF-TAVI. Accordingly, TA
approach is a promising and feasible option for the patients with severe
AS.<br/>Copyright &#xa9; 2016 Georg Thieme Verlag KG Stuttgart.New York.

<93>
Accession Number
607115891
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
A Meta-Analysis of Sutureless or Rapid-Deployment Aortic Valve
Replacement.
Source
Thoracic and Cardiovascular Surgeon. 64 (5) (pp 400-409), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Objective To summarize the safety of sutureless or rapid-deployment aortic
valve replacement (AVR), we performed a systematic review and
meta-analysis of single-arm studies. Methods MEDLINE and EMBASE were
searched through December 2014. Studies considered for inclusion met the
following criteria: the design was a single-arm study enrolling >=50
participants; the study population consisted of patients undergoing
sutureless/rapid-deployment AVR; and main outcomes included early
(in-hospital or 30-day) mortality and/or overall survival. Results Of 250
potentially relevant articles screened initially, 11 eligible studies
enrolling a total of 2,066 patients were identified and included. The
Enable, Intuity, and Perceval bioprostheses were used in three, two, and
six studies, respectively. Mean age of patients was 77.6 years, and 56.9%
of patients were women. Mean logistic European System for Cardiac
Operative Risk Evaluation I and II were 10.5 and 7.4%, respectively.
Aortic cross-clamp times in overall patients, patients undergoing isolated
AVR, those undergoing AVR with any concomitant procedures, and those
undergoing AVR with coronary artery bypass grafting were 44.7, 41.9, 56.2,
and 51.3 minutes, respectively. Arithmetic mean of early mortality was
2.6%, and fixed-effects combined early mortality was 3.2% (95% confidence
interval, 2.5-4.2%). Arithmetic mean of 1-year survival was 89.7%, and
fixed-effects combined 1-year mortality was 10.4% (9.0-12.1%). Conclusion
Sutureless/rapid-deployment AVR is feasible and safe with approximate 3
and 10% of early and 1-year mortality, respectively. Large-size randomized
controlled trials, however, are needed to determine whether
sutureless/rapid-deployment AVR improves mortality compared with
conventional AVR.<br/>Copyright &#xa9; 2016 Georg Thieme Verlag Stuttgart.
New York.

<94>
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.

<95>
Accession Number
616989523
Author
Zhou R.-H.; Yin X.-R.; Li Q.; Yu H.; Chen C.; Xiong J.-Y.; Qin Z.; Luo M.;
Tan Z.-X.; Liu T.
Institution
(Zhou, Yu, Yin, Li, Yu, Yu, Chen, Xiong, Qin, Luo, Tan, Liu) Department of
Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041,
China
(Yu) Department of Cardiovascular Surgery, West China Hospital, Sichuan
University, Chengdu, China
Title
Effect of intralipid postconditioning on myocardial injury in patients
undergoing valve replacement surgery: A randomised controlled trial.
Source
Heart. 103 (14) (pp 1122-1127), 2017. Date of Publication: 01 Jul 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: This study was conducted to determine whether the
administration of intralipid just before aortic cross-unclamping would
reduce myocardial injury in patients undergoing valve replacement surgery.
Methods: Seventy-three adult patients, scheduled for elective aortic or
mitral valve surgery without significant coronary stenosis (>70%), were
randomly assigned to the intralipid postconditioning (ILPC) group (n=37)
or control group (n=36): the ILPC group received an intravenous infusion
of 20% intralipid (2 mL/kg) just 10 min before aortic cross-unclamping,
and the control group received an equivalent volume of normal saline.
Serum cardiac troponin T (cTnT) and creatine kinase-MB (CK-MB) was
measured before surgery and at 4, 12, 24, 48 and 72 hours after surgery.
The primary end points were the 72-hour area under the curve (AUC) for
cTnT and CK-MB. Results: No significant difference between the ILPC and
control arm was observed, including the age, sex or number of aortic
versus mitral valves or left ventricular ejection fraction at baseline.
The total 72-hour AUC of cTnT and CK-MB in patients assigned to ILPC were
significantly reduced by 32.3% (p=0.004) and 26.4% (p=0.0185) compared
with control, respectively. None of the treated patients had abnormal
blood lipid metabolism, abnormal renal or hepatic function or significant
related complications. Conclusion: The protective effect of postischaemic
administration of intralipid prior to aortic cross-unclamping on
reperfusion injury was found when determined by biomarkers of myocardial
injury but not by cardiac function or other clinical outcomes in patients
undergoing valve replacement surgery. Hence, clinical benefits of this
protection need larger clinical trials to confirm. Trial registration
number ClinicalTrials.gov ID: ChiCTR-IOR-14005318.<br/>Copyright &#xa9;
2017 Article author(s). All rights reserved.

<96>
Accession Number
614895150
Author
Kransdorf E.P.; Kittleson M.M.; Patel J.K.; Pando M.J.; Steidley D.E.;
Kobashigawa J.A.
Institution
(Kransdorf, Kittleson, Patel, Kobashigawa) Cedars-Sinai Heart Institute,
Cedars-Sinai Medical Center, Los Angeles, California, United States
(Pando) Division of Laboratory Medicine and Pathology, Mayo Clinic
Arizona, Phoenix, Arizona, United States
(Steidley) Division of Cardiovascular Diseases, Mayo Clinic Arizona,
Phoenix, Arizona, United States
Title
Calculated panel-reactive antibody predicts outcomes on the heart
transplant waiting list.
Source
Journal of Heart and Lung Transplantation. 36 (7) (pp 787-796), 2017. Date
of Publication: July 2017.
Publisher
Elsevier USA
Abstract
Background Sensitized heart transplant candidates spend more time and have
higher mortality on the waiting list. Although the calculated
panel-reactive antibody (CPRA) value is used to assign allocation priority
to kidney transplant candidates in the United States, the relationship
between CPRA and outcomes on the heart transplant waiting list is unknown.
Methods A data set of patients listed for heart transplant with
unacceptable human leukocyte antigens (HLA) entered was obtained from the
United Network for Organ Sharing. The study cohort was composed of 3,855
adult candidates listed for heart transplant between 2006 and 2013 with
active waiting time. The cohort was divided into 5 groups by increasing
CPRA. Outcomes were assessed using competing risks and sub-hazard
regression analyses. Results In each group of successively higher CPRA,
the percentage of candidates who received a transplant decreased, whereas
the percentage of those who were still waiting for a transplant increased,
as did the percentage of those removed from the waiting list or had died.
The group of candidates with a CPRA >80% displayed a markedly decreased
incidence of transplantation (hazard ratio 0.37) and an increased risk of
removal from the waiting list or death (hazard ratio 2.18) as compared to
those with CPRA of <=10%. Conclusions Sensitized heart transplant
candidates are at high risk of adverse outcomes on the heart transplant
waiting list. Clinicians should strive to minimize the CPRA by maximizing
specificity in the selection of HLA antigens to exclude. The optimal
clinical approach for candidates with high CPRA requires further
study.<br/>Copyright &#xa9; 2017 International Society for the Heart and
Lung Transplantation

<97>
Accession Number
613880897
Author
Sundermann S.H.; Czesla M.; Kempfert J.; Walther T.; Nataf P.; Raanani E.;
Jacobs S.; Alfieri O.; Maisano F.; Falk V.
Institution
(Sundermann, Kempfert, Jacobs, Falk) Department of Cardiothoracic and
Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1,
Berlin 13353, Germany
(Sundermann, Jacobs, Falk) DZHK (German Centre for Cardiovascular
Research), Partner Site Berlin, Berlin, Germany
(Czesla) Klinikum Passau, Department of Cardiac Surgery. Innstrasse 76,
Passau 94032, Germany
(Walther) Department of Cardiac Surgery, Kerckhoff-Klinik, Benekestr. 2-8,
Bad Nauheim 61231, Germany
(Nataf) Department of Cardiac Surgery, Assistance Publique-Hopitaux de
Paris, Bichat Hospital, Paris, France
(Raanani) Department of Cardiac Surgery, Sheba Medical Center,
Tel-Hashomer, Israel
(Alfieri) Department of Cardiovascular Surgery, San Raffaele Hospital,
Milan, Italy
(Maisano) University Hospital of Zurich, Heart Center, Zurich, Switzerland
(Falk) Charite, Universitatsmedizin Berlin, Berlin, Germany
Title
Results of mitral valve repair with an adjustable annuloplasty ring 2
years after implantation.
Source
Heart and Vessels. 32 (7) (pp 843-849), 2017. Date of Publication: 01 Jul
2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Abstract: We aimed to investigate the safety and medium-term durability of
an adjustable mitral annuloplasty ring in patients undergoing surgery for
mitral valve regurgitation. Forty-five patients requiring mitral valve
repair were enrolled into this prospective, multicentre study between May
2012 and May 2013 in six hospitals in Europe and Israel. Study endpoints
evaluated the performance and safety of the device assessed using
inter-individual comparisons. Implantation was performed through a
sternotomy in ten patients and mini-thoracotomy in 35 patients. The ring
was adjusted after declamping and weaning from cardio-pulmonary bypass
under echocardiographic guidance if the coaptation surface was not
optimal, or in cases of residual mitral regurgitation. Follow-up was
performed up to 2 years post-procedure. Mean age was 61 +/- 12 years. Ring
adjustment was performed in 71% of patients to optimise the results of
mitral valve repair. Following the procedure, 11/45 patients (24%) who had
had mild residual mitral regurgitation had no mitral regurgitation
following ring adjustment. Two patients with severe mitral regurgitation
post-procedure had mild regurgitation following ring adjustment.
Coaptation length increased significantly after adjustment. One patient
died before hospital discharge due to complications unrelated to the
adjustable ring. One patient had to undergo re-operation at 39 days
post-procedure due to endocarditis. At 2 years of follow-up, 78% of
patients had no residual mitral regurgitation and 22% had mild residual
mitral regurgitation. Adjustable mitral annuloplasty ring implantation was
safe in all patients. Mitral valve repair with the adjustable ring was
durable in all patients who reached 2 years follow-up. Clinical Trial
Registration: NCT01617720.<br/>Copyright &#xa9; 2016, Springer Japan.

<98>
Accession Number
613898873
Author
Tan X.-F.; Shi J.-X.; Chen M.-H.
Institution
(Tan, Shi, Chen) Institute of Cardiovascular Diseases, The First
Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi
530027, China
Title
Prolonged and intensive medication use are associated with the obesity
paradox after percutaneous coronary intervention: A systematic review and
meta-analysis of 12 studies.
Source
BMC Cardiovascular Disorders. 16 (1) (no pagination), 2016. Article
Number: 125. Date of Publication: 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Obesity paradox is defined as the unexpected decrease in the
total number of death which has been observed among patients who are
overweight and obese compared to patients with normal weight after
undergoing revascularization by percutaneous coronary intervention (PCI).
Despite of so many recent studies which showed the existence of this
phenomenon, prolonged and intensive medication use were only suggested to
be among the reasons responsible for this 'obesity paradox' but it was
never confirmed whether this hypothesis should really be considered true
or not. Therefore, this study aimed to investigate whether prolonged and
intensive medication use were associated with this obesity paradox after
PCI. Methods: Medline, PubMed, EMBASE and the Cochrane Library were
searched for studies showing the existence of this 'obesity paradox' in
patients who underwent coronary revascularization by PCI and only articles
comprising of medication use among the patients analyzed were considered
relevant for this research. Medication use among the different subgroups
of patients was calculated. Mortality was considered as the clinical
endpoint in this study. Risk Ratio (RR) with 95 % Confidence Interval (CI)
was used to express the pooled effect on discontinuous variables and the
pooled analyses were performed with RevMan 5.3. Results: Twelve studies
consisting of a total number of 91,582 patients was included in this
meta-analysis. An intensive medication use after the hospital discharge
and during the follow up period after PCI was observed in the subgroup of
obese patients, followed by the overweight patients and the normal weight
patients respectively. Our results showed that the short-term (30 days)
mortality in overweight and obese patients was significantly lower
compared to the normal weight patients with RR: 0.72; 95 % CI: 0.56-0.92,
p = 0.008 and RR: 0.47, 95 % CI: 0.34-0.65; p < 0.00001 respectively. The
long-term (>= one year) mortality was also significantly lower in the
overweight and the obese groups with RR: 0.74, 95 % CI: 0.67-0.82; p <
0.00001 and RR: 0.63, 95 % CI: 0.55-0.72; p < 0.00001 respectively.
Conclusion: Our study has confirmed to some extent, that prolonged and
intensive use of medications which were more prominent in patients who
were overweight and obese during the follow up period, might apparently be
among the reasons responsible for this obesity paradox after
PCI.<br/>Copyright &#xa9; 2016 The Author(s).

<99>
Accession Number
613101998
Author
Douglas P.S.; De Bruyne B.; Pontone G.; Patel M.R.; Norgaard B.L.; Byrne
R.A.; Curzen N.; Purcell I.; Gutberlet M.; Rioufol G.; Hink U.; Schuchlenz
H.W.; Feuchtner G.; Gilard M.; Andreini D.; Jensen J.M.; Hadamitzky M.;
Chiswell K.; Cyr D.; Wilk A.; Wang F.; Rogers C.; Hlatky M.A.
Institution
(Douglas, Patel, Chiswell, Cyr) Duke Clinical Research Institute, Duke
University School of Medicine, Durham, North Carolina, United States
(De Bruyne) Cardiovascular Centre Aalst, Aalst, Belgium
(Pontone, Andreini) Cardiovascular CT Unit, Centro Cardiologico Monzino,
IRCCS, University of Milan, Milan, Italy
(Norgaard, Jensen) Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark
(Byrne, Hadamitzky) Deutsches Herzzentrum Munchen, Technische Universitat
Munchen, Munich, Germany
(Curzen) University Hospital Southampton NHS Trust, Southampton, United
Kingdom
(Purcell) Freeman Hospital, Newcastle upon Tyne, United Kingdom
(Gutberlet) University of Leipzig Heart Centre, Leipzig, Germany
(Rioufol) Hospices Civils de Lyon and CARMEN INSERM 1060, Lyon, France
(Hink) Department of Cardiology, Johannes Gutenberg University Hospital,
Mainz, Germany
(Schuchlenz) LKH Graz West, Graz, Austria
(Feuchtner) Department of Radiology, Innsbruck Medical University,
Innsbruck, Austria
(Gilard) Department of Cardiology, Cavale Blanche Hospital, Brest, France
(Wilk, Wang, Rogers) HeartFlow, Redwood City, California, United States
(Hlatky) Department of Health Research and Policy and Department of
Medicine, Stanford University School of Medicine, Stanford, California,
United States
Title
1-Year Outcomes of FFR<inf>CT</inf>-Guided Care in Patients With Suspected
Coronary Disease: The PLATFORM Study.
Source
Journal of the American College of Cardiology. 68 (5) (pp 435-445), 2016.
Date of Publication: 02 Aug 2016.
Publisher
Elsevier USA
Abstract
Background Coronary computed tomographic angiography (CTA) plus estimation
of fractional flow reserve using CTA (FFR<inf>CT</inf>) safely and
effectively guides initial care over 90 days in patients with stable chest
pain. Longer-term outcomes are unknown. Objectives The study sought to
determine the 1-year clinical, economic, and quality-of-life (QOL)
outcomes of using FFR<inf>CT</inf> instead of usual care. Methods
Consecutive patients with stable, new onset chest pain were managed by
either usual testing (n = 287) or CTA (n = 297) with selective
FFR<inf>CT</inf> (submitted in 201, analyzed in 177); 581 of 584 (99.5%)
completed 1-year follow-up. Endpoints were adjudicated major adverse
cardiac events (MACE) (death, myocardial infarction, unplanned
revascularization), total medical costs, and QOL. Results Patients
averaged 61 years of age with a mean 49% pre-test probability of coronary
artery disease. At 1 year, MACE events were infrequent, with 2 in each arm
of the planned invasive group and 1 in the planned noninvasive cohort
(usual care strategy). In the planned invasive stratum, mean costs were
33% lower with CTA and selective FFR<inf>CT</inf> ($8,127 vs. $12,145
usual care; p < 0.0001); in the planned noninvasive stratum, mean costs
did not differ when using an FFR<inf>CT</inf> cost weight of zero ($3,049
FFR<inf>CT</inf> vs. $2,579; p = 0.82), but were higher when using an
FFR<inf>CT</inf> cost weight equal to CTA. QOL scores improved overall at
1 year (p < 0.001), with similar improvements in both groups, apart from
the 5-item EuroQOL scale scores in the noninvasive stratum (mean change of
0.12 for FFR<inf>CT</inf> vs. 0.07 for usual care; p = 0.02). Conclusions
In patients with stable chest pain and planned invasive coronary
angiography, care guided by CTA and selective FFR<inf>CT</inf> was
associated with equivalent clinical outcomes and QOL, and lower costs,
compared with usual care over 1-year follow-up. (The PLATFORM Study:
Prospective LongitudinAl Trial of FFRct: Outcome and Resource IMpacts
[PLATFORM]; NCT01943903)<br/>Copyright &#xa9; 2016 American College of
Cardiology Foundation

<100>
Accession Number
610079864
Author
Fu G.W.; Nie Y.F.; Jiao Z.Y.; Zhao W.Z.
Institution
(Fu, Nie, Jiao, Zhao) Department of Cardiovascular Surgery, The First
Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
Title
Clinical applications of retrograde autologous priming in cardiopulmonary
bypass in pediatric cardiac surgery.
Source
Brazilian Journal of Medical and Biological Research. 49 (5) (no
pagination), 2016. Article Number: e5138. Date of Publication: 26 Apr
2016.
Publisher
Associacao Brasileira de Divulgacao Cientifica (E-mail:
bjournal@fmrp.usp.br)
Abstract
Retrograde autologous priming (RAP) has been routinely applied in cardiac
pediatric cardiopulmonary bypass (CPB). However, this technique is
performed in pediatric patients weighing more than 20 kg, and research
about its application in pediatric patients weighing less than 20 kg is
still scarce. This study explored the clinical application of RAP in CPB
in pediatric patients undergoing cardiac surgery. Sixty pediatric patients
scheduled for cardiac surgery were randomly divided into control and
experimental groups. The experimental group was treated with CPB using
RAP, while the control group was treated with conventional CPB (priming
with suspended red blood cells, plasma and albumin). The hematocrit (Hct)
and lactate (Lac) levels at different perioperative timepoints, mechanical
ventilation time, hospitalization duration, and intraoperative and
postoperative blood usage were recorded. Results showed that Hct levels at
15 min after CPB beginning (T2) and at CPB end (T3), and number of
intraoperative blood transfusions were significantly lower in the
experimental group (Po0.05). There were no significant differences in CPB
time, aortic blocking time, T2-Lac value or T3-Lac between the two groups
(P40.05). Postoperatively, there were no significant differences in Hct (2
h after surgery), mechanical ventilation time, intensive care unit time,
or postoperative blood transfusion between two groups (P40.05). RAP can
effectively reduce the hemodilution when using less or not using any
banked blood, while meeting the intraoperative perfusion conditions, and
decreasing the perioperative blood transfusion volume in pediatric
patients.<br/>Copyright &#xa9; 2016, Associacao Brasileira de Divulgacao
Cientifica. All Rights Reserved.

<101>
Accession Number
611117589
Author
Zheng X.-Y.; Wang Y.; Chen Y.; Wang X.; Chen L.; Li J.; Zheng Z.-G.
Institution
(Zheng, Wang, Chen, Wang, Chen, Li, Zheng) China-Japan Friendship
Hospital, Department of Senior Official Ward, 2 Yinghua Dongjie, Beijing
100029, China
Title
The effectiveness of intra-aortic balloon pump for myocardial infarction
in patients with or without cardiogenic shock: A meta-analysis and
systematic review.
Source
BMC Cardiovascular Disorders. 16 (1) (no pagination), 2016. Article
Number: 148. Date of Publication: 08 Jul 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Conflicting reports on the efficacy of intra-aortic balloon
pump (IABP) during percutaneous coronary intervention (PCI) incited us to
evaluate the utility of IABP in patients with acute myocardial infarction
(AMI). Methods: Randomized clinical trials comparing patients, who
received IABP vs. control (no IABP) during PCI, were hand-searched from
MEDLINE, Cochrane, and EMBASE databases using the terms "intra-aortic
balloon pump, percutaneous coronary intervention, myocardial infarction,
acute coronary syndrome". Mortality rate (30-day and 6-month mortality)
was the primary outcome, while the secondary outcomes included 30-day
bleeding rate, reinfarction rate, revascularization rate and stroke rate.
Results: Pooled results of the seven trials identified indicated that the
30-day and 6-month mortality rate were not significantly different between
the IABP and control groups. However, in patients with MI, but without
cardiogenic shock (CS), IABP was associated with lower odds of 30-day
mortality (OR = 0.35, p = 0.015) and 6-month mortality (OR = 0.41, p =
0.020). The pooled results of 30-day bleeding rate was not significantly
higher in patients with IABP than the control group, but for the patients
with high risk PCI without CS, it was higher in patients with IABP than
the control group (OR = 1.58, p = 0.009). The re-infarction,
revascularization, and the stroke rate at 30 days of follow-up were not
significantly different between the two groups. Conclusions: The present
results do not favor the clinical utility of IABP in patients suffering
high-risk PCI without CS and AMI complicated with CS. However, in patients
with AMI, but without CS, IABP may reduce the 30-day and 6-month mortality
rate.<br/>Copyright &#xa9; 2016 The Author(s).

<102>
Accession Number
613497700
Author
Bundhun P.K.; Yanamala C.M.; Huang F.
Institution
(Bundhun, Huang) The First Affiliated Hospital of Guangxi Medical
University, Institute of Cardiovascular Diseases, Nanning, Guangxi 530027,
China
(Yanamala) EALING Hospital, University of Buckingham, Department of
Internal Medicine, Uxbridge road, Southall, London UB1 3HW, United Kingdom
Title
Comparing the adverse clinical outcomes associated with fraction flow
reserve-guided versus angiography-guided percutaneous coronary
intervention: A systematic review and meta-analysis of randomized
controlled trials.
Source
BMC Cardiovascular Disorders. 16 (1) (no pagination), 2016. Article
Number: 249. Date of Publication: 03 Dec 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Recently published randomized controlled trials have shown
different results compared to the Fraction Flow Reserve Versus Angiography
for Multi-vessel Evaluation (FAME) study. Therefore, this current analysis
aimed to compare the adverse clinical outcomes associated with Fraction
Flow Reserve (FFR)-guided versus standard angiography-guided Percutaneous
Coronary Intervention (PCI) using a large number of randomized patients.
Methods: PubMed/Medline, EMBASE and the Cochrane library were searched for
studies comparing FFR-guided with angiography-guided PCI. Mortality,
Myocardial Infarction (MI), repeated revascularization and Major Adverse
Cardiac Events (MACEs) at any follow up period following PCI were
considered as the clinical endpoints in this analysis. Odds Ratios (OR)
with 95% Confidence Intervals (CIs) were calculated and the analyses were
carried out by the RevMan 5.3 software. Ethical approval was not necessary
for this type of study. Results: A total number of 2138 patients (1080
patients with FFR-guided versus 1058 patients with angiography-guided PCI)
were included. Results of this analysis showed mortality not to be
significantly different between FFR-guided and angiography-guided PCI with
OR: 0.70, 95% CI: 0.39 - 1.25; P = 0.22, I² = 0%. Total
repeated revascularization and Target Lesion Revascularization were also
similarly manifested with OR: 0.82, 95% CI: 0.60 - 1.13; P = 0.22,
I² = 0% and OR: 0.88, 95% CI: 0.43 - 1.80; P = 0.73,
I² = 0% respectively. In addition, MACEs were also not
significantly lower in the FFR-guided PCI group with OR: 0.82, 95% CI:
0.64 - 1.06; P = 0.13, I² = 0%. However, FFR-guided PCI was
associated with a significantly lower rate of re-infarction with OR: 0.67,
95% CI: 0.47 - 0.96; P = 0.03, I² = 0%. Conclusion: FFR-guided
PCI was not associated with significantly higher adverse clinical outcomes
when compared to angiography-guided PCI. A significantly lower rate of
re-infarction associated with FFR-guided PCI could show an important
benefit. However, due to the limited number of patients analyzed, this
hypothesis should further be confirmed in future trials.<br/>Copyright
&#xa9; 2016 The Author(s).