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<1>
Accession Number
610008229
Author
Zajac P.; Zycinski P.; Qawoq H.; Jankowski L.; Peruga J.; Wcislo T.;
Pagorek P.; Peruga J.Z.; Kasprzak J.D.; Plewka M.
Institution
(Zajac, Zycinski, Qawoq, Jankowski, Wcislo, Pagorek, Peruga, Kasprzak,
Plewka) Department and Chr. of Cardiology, Medical University of Lodz, ul.
Kniaziewicza 1/5, Lodz 91-347, Poland
(Peruga) Cardiology Service, Ludwik Perzyna Regional Specialist Hospital,
Kalisz, Poland
Title
Outcomes of percutaneous coronary intervention in Patients after previous
coronary artery bypass surgery.
Source
Kardiologia Polska. 74 (4) (pp 322-330), 2016. Date of Publication: 2016.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland)
Abstract
Background: Patients after previous coronary artery bypass grafting (CABG)
often require repeat percutaneous revascularisation due to poor patency
rates of saphenous vein grafts (SVG) and higher risk of re-CABG. Few data
are available to evaluate different percutaneous revascularisation
strategies in patients after previous CABG. Aim: To evaluate outcomes of
percutaneous coronary intervention (PCI) in patients after previous CABG,
including the effect of treatment on the quality of life and symptoms, and
secondly to assess the relation between angiographic factors and treatment
outcomes Methods: This was a prospective observational study which
included 78 patients after previous CABG. Following coronary angiography,
the patients were assigned to one of three groups: group A (n = 20), PCI
of a SVG (PCI SVG); group B (n = 29), PCI of a native coronary artery (PCI
NA); group C (n = 29), control group that received medical treatment (MT)
only. Duration of follow-up was 12 months. Results: Compared to MT
patients, patients treated with PCI had significantly higher Canadian
Cardiovascular Society (CCS) class (2.75 vs. 2.41, p = 0.03) and more
frequently had coronary angiography performed due to unstable angina (57%
vs. 31%, p = 0.04). Patients in the PCI SVG group had significantly older
SVG conduits compared to the PCI NA group (13.4 years vs. 8.2 years, p =
0.005). At 12 months of follow-up, we found a significant improvement in
the EQ-5D index of the quality of life, and a significant reduction in CCS
class in the PCI SVG group (0.66 vs. 0.7, p = 0.0003, and 2.75 vs. 1.9, p
< 0.001, respectively) and in the PCI NA group (0.65 vs. 0.72, p < 0.001,
and 2.75 vs. 2.17, p < 0.001, respectively), but no improvement in the MT
group. Treatment outcomes did not differ significantly between the three
groups (combined endpoint rate 20% vs. 13% vs. 27.5%, p = 0.37). In
multivariate analysis, SVG age > 11 years was identified as a significant
predictor of poor outcomes in patients treated with PCI after previous
CABG. Conclusions: PCI in patients after previous CABG does not improve
prognosis but significantly improves the quality of life and reduces
symptom severity.<br/>Copyright &#xa9; Polskie Towarzystwo Kardiologiczne
2016.

<2>
Accession Number
612707053
Author
Navarra E.; Mosala Nezhad Z.; Bollen X.; Gielen C.-E.; Mastrobuoni S.; De
Kerchove L.; Raucent B.; Astarci P.
Institution
(Navarra, Mosala Nezhad, Gielen, Mastrobuoni, De Kerchove, Astarci)
Cardiovascular and Thoracic Surgery Department, Saint-Luc Hospital,
Catholic University of Louvain, Brussels, Belgium
(Bollen, Raucent) Center for Research in Mechatronics, Catholic University
of Louvain, Leuven la Neuve, Belgium
Title
Endovascular resection of the native aortic valve before transcatheter
aortic valve implantation: State of the art and review.
Source
European Journal of Cardio-thoracic Surgery. 50 (3) (pp 406-410), 2016.
Article Number: ezw027. Date of Publication: 01 Sep 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Transcatheter aortic valve implantation was introduced into clinical
practice in 2002 as a rescue approach in patients presenting with
symptomatic severe aortic stenosis but not eligible for conventional
aortic valve replacement. This technique allows implantation of a balloon
expandable bioprosthesis without resection of the native aortic valve.
Several complications are described as a consequence of the residual
highly calcified valve being squeezed against the aortic wall by the stent
of the implant. This can result in deformation of the metal stent and
paravalvular leakage, risk of occlusion of the coronary ostia, or central
and peripheral embolization of valvular debris. To avoid these
complications, many authors suggest the possibility to resect and remove
the native aortic valve before transcatheter aortic valve implantation. In
this field, different authors have described possible techniques and
different sources of energy to resect the calcified valve. In this
article, we review the development of these experimental techniques and
discuss future prospects in this field.<br/>Copyright &#xa9; The Author
2016. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<3>
Accession Number
606559818
Author
Karaman T.; Demir S.; Dogru S.; Sahin A.; Tapar H.; Karaman S.; Kaya Z.;
Suren M.; Arici S.
Institution
(Karaman, Dogru, Sahin, Tapar, Karaman, Kaya, Suren, Arici) Department of
Anesthesiology and Reanimation, Gaziosmanpasa University School of
Medicine, Tokat 60100, Turkey
(Demir) Department of Ophthalmology, Gaziosmanpasa University School of
Medicine, Tokat, Turkey
Title
The effect of anesthesia depth on the oculocardiac reflex in strabismus
surgery.
Source
Journal of Clinical Monitoring and Computing. 30 (6) (pp 889-893), 2016.
Date of Publication: 01 Dec 2016.
Publisher
Springer Netherlands
Abstract
The aim of this study was to investigate the effect of the bispectral
index (BIS) guided depth of anesthesia to inhibition of the oculocardiac
reflex (OCR) during pediatric strabismus surgery. Patients between the
ages of 3 and 16 years who were scheduled for elective strabismus surgery
were randomly assigned to two groups. In Group 1 (n: 32), the BIS values
of the patients were maintained at <50; in Group 2 (n: 28), the BIS values
of the patients were maintained at levels greater than or equal to 50 with
4-7 % desflurane in a 50 % O<inf>2</inf>-air mixture by titrating the
concentration during the surgery. The heart rates, presence of
dysrhythmia, anticholinergic drug usage and the type of the operated extra
ocular muscle were recorded. The incidence of OCR was 25 % in Groups 1 and
64.3 % in Group 2, (p < 0.05). Moreover, the incidence of OCR in group 2
was higher in medial rectus (MR) traction (78.9 %) than in lateral rectus
(LR) traction (33.3 %) (p = 0.035), with no significant difference in
Group 1 between MR (21.1 %) and LR (26.7 %) tractions (p = 0.83). We found
that the lower BIS values are associated with the lower incidence of OCR
in pediatric patients undergoing strabismus surgery. And our findings
confirmed that the deeper anesthesia has a protective effect against the
OCR.<br/>Copyright &#xa9; 2015, Springer Science+Business Media New York.

<4>
Accession Number
606557648
Author
Shoushtarian M.; McGlade D.P.; Delacretaz L.J.; Liley D.T.J.
Institution
(Shoushtarian, Delacretaz, Liley) Cortical Dynamics Ltd., P.O. Box 317,
North Perth, WA 6906, Australia
(McGlade) Department of Anaesthesia and Acute Pain Medicine, St. Vincent'
Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia
(Liley) Brain and Psychological Sciences Research Centre, Swinburne
University of Technology, P.O. Box 218, Hawthorn, VIC 3122, Australia
Title
Evaluation of the brain anaesthesia response monitor during anaesthesia
for cardiac surgery: a double-blind, randomised controlled trial using two
doses of fentanyl.
Source
Journal of Clinical Monitoring and Computing. 30 (6) (pp 833-844), 2016.
Date of Publication: 01 Dec 2016.
Publisher
Springer Netherlands
Abstract
The brain anaesthesia response (BAR) monitor uses a method of EEG
analysis, based on a model of brain electrical activity, to monitor the
cerebral response to anaesthetic and sedative agents via two indices,
composite cortical state (CCS) and cortical input (CI). It was
hypothesised that CCS would respond to the hypnotic component of
anaesthesia and CI would differentiate between two groups of patients
receiving different doses of fentanyl. Twenty-five patients scheduled to
undergo elective first-time coronary artery bypass graft surgery were
randomised to receive a total fentanyl dose of either 12 mug/kg (fentanyl
low dose, FLD) or 24 mug/kg (fentanyl moderate dose, FMD), both
administered in two divided doses. Propofol was used for anaesthesia
induction and pancuronium for intraoperative paralysis. Hemodynamic
management was protocolised using vasoactive drugs. BIS, CCS and CI were
simultaneously recorded. Response of the indices (CI, CCS and BIS) to
propofol and their differences between the two groups at specific points
from anaesthesia induction through to aortic cannulation were
investigated. Following propofol induction, CCS and BIS but not CI showed
a significant reduction. Following the first dose of fentanyl, CI, CCS and
BIS decreased in both groups. Following the second dose of fentanyl, there
was a significant reduction in CI in the FLD group but not the FMD group,
with no significant change found for BIS or CCS in either group. The BAR
monitor demonstrates the potential to monitor the level of hypnosis
following anaesthesia induction with propofol via the CCS index and to
facilitate the titration of fentanyl as a component of balanced
anaesthesia via the CI index.<br/>Copyright &#xa9; 2015, Springer
Science+Business Media New York.

<5>
Accession Number
606556898
Author
Moerman A.; Meert F.; De Hert S.
Institution
(Moerman, Meert, De Hert) Department of Anesthesiology, Ghent University
Hospital, De Pintelaan 185, Ghent 9000, Belgium
Title
Cerebral near-infrared spectroscopy in the care of patients during
cardiological procedures: a summary of the clinical evidence.
Source
Journal of Clinical Monitoring and Computing. 30 (6) (pp 901-909), 2016.
Date of Publication: 01 Dec 2016.
Publisher
Springer Netherlands
Abstract
Patients undergoing cardiological procedures generally have significant
cardiovascular morbidity, and therefore these patients might be at risk
for major periprocedural complications. The ability to closely monitor the
hemodynamic status would present a major advantage to optimize patient
care in this setting. The aim of this review is to assess the available
evidence for the use of near-infrared spectroscopy (NIRS) in the care of
patients during cardiological procedures. A systematic literature search
was conducted using electronic bibliographic databases (MEDLINE, PubMed,
EMBASE) from their first available date using the following search
strategy: (spectroscopy, near-infrared OR infrared spectroscopy OR NIRS OR
cerebral oxygen*) AND (interventional OR electrophysiological OR
catheterization OR ablation OR ICD OR defibrillator). Inclusion criteria
were limited to human studies, English language and cardiac patients. All
manuscripts concerning the use of NIRS in every area of catheterization
and electrophysiology were included. The literature search yielded eleven
observational studies and five case reports concerning the research
question. No randomized trials could be retrieved. Six studies evaluated
NIRS during supraventricular and ventricular arrhythmias, one during
transcatheter aortic valve implantations, and four studies assessed the
use of NIRS in pediatric catheterization procedures. Overall, the studies
demonstrated that NIRS provides a very quick representation of cerebral
oxygen saturation and that it might identify changes that could not be
predicted from standard hemodynamic monitoring. However, the evidence is
currently too low to conclude that NIRS can optimize patient care during
cardiological procedures.<br/>Copyright &#xa9; 2015, Springer
Science+Business Media Dordrecht.

<6>
Accession Number
616180586
Author
Elmaraezy A.; Ebraheem Morra M.; Tarek Mohammed A.; Al-Habaa A.; Elgebaly
A.; Abdelmotaleb Ghazy A.; Khalil A.M.; Tien Huy N.; Hirayama K.
Institution
(Elmaraezy, Ebraheem Morra, Tarek Mohammed, Elgebaly) Faculty of Medicine,
Al-Azhar University, Cairo 11884, Egypt
(Elmaraezy) Online Research Club, Nagasaki University, Nagasaki, Japan
(Al-Habaa) Department of Cardiology, Faculty of Medicine, Al-Azhar
University, Cairo, Egypt
(Abdelmotaleb Ghazy) Department of Cadiology, Shebin El-Kom Teaching
Hospital, Menofia 31515, Egypt
(Khalil) Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
(Tien Huy) Evidence Based Medicine Research Group & Faculty of Applied
Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam
(Tien Huy) Department of Clinical Product Development, Institute of
Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate
School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto,
Nagasaki 852-8523, Japan
(Hirayama) Department of Immunogenetics, Institute of Tropical Medicine
(NEKKEN), Leading Graduate School Program, and Graduate School of
Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki
852-8523, Japan
Title
Risk of cataract among interventional cardiologists and catheterization
lab staff: A systematic review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 90 (1) (pp 1-9), 2017.
Date of Publication: 01 Jul 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: We performed a systematic review and meta-analysis to assess
the risk of developing a radiation-induced cataract in interventional
cardiologists (ICs). Background: ICs are forced to radiation exposure
during cardiac catheterization procedures. Since the eye lens is one of
the most radiosensitive organs in the body, ICs are highly susceptible to
develop a radiation-induced cataract. Method: We performed a systematic
literature search of nine electronic databases to retrieve studies that
report cataract among interventional cardiologists. Records were screened
for eligibility and data were extracted and analyzed using review manager
(RevMan) for windows. Results: Eight studies involving 2559 subjects
(exposed ICs = 1224) were included. Posterior lens opacity was
significantly higher in ICs relative to the control group (RR= 3.21, 95%
CI [2.14, 4.83], P < 0.00001). In contrast, there was no significant
difference between both groups in cortical lens opacity (RR= 0.69, 95% CI
[0.46, 1.06], P = 0.09) and nuclear opacity (RR= 0.85, 95% CI [0.71,
1.02], P = 0.08). Conclusion: Interventional cardiologists are at high
risk of developing radiation-induced cataract; therefore, protective
measures with high safety rates should be implied. &#xa9; 2017 Wiley
Periodicals, Inc.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

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

<8>
[Use Link to view the full text]
Accession Number
615702807
Author
Velghe D.; Apers T.; Devriendt S.; Deblier I.; Hendriks B.; Nieuwendijk
R.; Rogiers P.
Institution
(Velghe) Department of Anesthesia and Reanimation, ZNA Middelheim
Hospital, Antwerpen, Belgium
(Apers, Devriendt, Deblier) Department of Cardiothoracic Surgery, ZNA
Middelheim Hospital, Antwerpen, Belgium
(Hendriks, Nieuwendijk, Rogiers) Department of Critical Care, ZNA
Middelheim Hospital, Antwerpen, Belgium
Title
Atriobronchial fistula complicated by septic cerebral air emboli after
pulmonary vein ablation.
Source
Critical Care Medicine. 45 (8) (pp e867-e871), 2017. Date of Publication:
01 Aug 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: To describe a case of an infected atriobronchial fistula as a
late complication after pulmonary vein ablation, leading to septic air
emboli and requiring urgent cardiac surgery. Data Sources: Clinical
observation. Study Selection: Case report. Data Extraction: Relevant
clinical information. PubMed was searched for relevant literature. Data
Synthesis: Given its high success and low complication rate, pulmonary
vein isolation is expected to be increasingly performed worldwide. Despite
its success, some of its rare complications are potentially devastating
and are difficult to diagnose early. In this report, we present the case
of a 32-year-old woman, who was readmitted to hospital 2 months after
pulmonary vein ablation. The clinical picture resembled meningococcemia
with spreading petechiae on legs and arms raising concern for
Waterhouse-Friderichsen syndrome. Further echocardiographic investigation
led to the discovery of massive amounts of intracardiac air which demanded
urgent lung isolation and sternotomy. Intraoperatively a small infected
left atrial perforation was oversewn and a fistula to the right main
bronchus was closed by means of an autologous pericardial patch. One month
later, still revalidating, she could be discharged home with only minor
neurologic sequelae. Conclusions: Clinicians should be aware of the
dramatic complications of invasive antiarrhythmic procedures and their
atypical and late presentations. Better preprocedural appreciation of
cardiac wall thickness, early echocardiographic diagnosis, and swift
referral for cardiac surgery might impact outcome
dramatically.<br/>Copyright &#xa9; 2017 by the Society of Critical Care
Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

<9>
Accession Number
613473672
Author
Sukul D.; Seth M.; Dixon S.R.; Zainea M.; Slocum N.K.; Pielsticker E.J.;
Gurm H.S.
Institution
(Sukul, Seth, Gurm) Division of Cardiovascular Medicine, Department of
Medicine, University of Michigan, Ann Arbor, MI, United States
(Dixon) Division of Cardiology, Department of Medicine, Beaumont Hospital,
Royal Oak, MI, United States
(Zainea) McLaren Macomb Hospital, Roseville, MI, United States
(Slocum) Traverse Heart and Vascular, Traverse City, MI, United States
(Pielsticker) Michigan Heart, St Joseph Mercy Health System, Jackson, MI,
United States
(Gurm) Veterans Affairs Medical Center, Ann Arbor, MI, United States
Title
Clinical outcomes of percutaneous coronary intervention in patients turned
down for surgical revascularization.
Source
Catheterization and Cardiovascular Interventions. 90 (1) (pp 94-101),
2017. Date of Publication: 01 Jul 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: We examined clinical outcomes following percutaneous coronary
intervention (PCI) in patients turned down for surgical revascularization
across a broad population. Background: Prior studies suggest that surgical
ineligibility is associated with increased mortality in patients with
unprotected left main or multivessel coronary artery disease undergoing
PCI. Methods: This study included consecutive patients who underwent PCI
in a multicenter registry in Michigan from January 2010 to December 2014.
Surgical ineligibility required documentation indicating that a cardiac
surgeon deemed the patient ineligible for surgery. In-hospital outcomes
included mortality (primary outcome), cardiogenic shock, cerebrovascular
accident, contrast-induced nephropathy (CIN), and a new requirement for
dialysis (NRD). Results: Of 99,370 patients at 33 hospitals with on-site
surgical backup, 1,922 (1.9%) were surgically ineligible. The rate of
ineligibility did not vary by hospital (range: 1.5-2.5%; P = 0.79).
Overall, there were no major differences in baseline characteristics or
outcomes between surgically ineligible patients and the rest (i.e.,
nonineligible patients): mortality (0.52% vs. 0.52%; P > 0.5), cardiogenic
shock (0.68% vs. 0.73%; P > 0.5), cerebrovascular accident (0.05% vs.
0.19%; P = 0.28), NRD (0.16% vs. 0.19%; P > 0.5), CIN (2.7% vs. 2.3%; P =
0.27). Among 1,074 patients who underwent unprotected left main PCI, 20
(1.9%) were surgically ineligible and experienced increased rates of
mortality (20.0% vs. 5.3%; P = 0.022; adjusted OR = 7.38; P < 0.001) and
other complications as compared to the remainder. Conclusions: PCI in a
broad population of surgically ineligible patients is generally safe.
However, among patients who underwent unprotected left main PCI, those
deemed surgically ineligible experienced significantly worse outcomes as
compared to the rest. &#xa9; 2016 Wiley Periodicals, Inc.<br/>Copyright
&#xa9; 2016 Wiley Periodicals, Inc.

<10>
Accession Number
613715117
Author
Zaman S.; McCormick L.; Gooley R.; Rashid H.; Ramkumar S.; Jackson D.; Hui
S.; Meredith I.T.
Institution
(Zaman, McCormick, Gooley, Rashid, Ramkumar, Jackson, Hui, Meredith)
Monash Cardiovascular Research Centre, Department of Medicine (Monash
Medical Centre), School of Clinical Sciences, Monash University, Australia
(Zaman, McCormick, Gooley, Meredith) Cardiovascular Division, Monash
Heart, Monash Medical Centre, Melbourne, VIC, Australia
Title
Incidence and predictors of permanent pacemaker implantation following
treatment with the repositionable LotusTM transcatheter aortic valve.
Source
Catheterization and Cardiovascular Interventions. 90 (1) (pp 147-154),
2017. Date of Publication: 01 Jul 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To determine the incidence and predictors of permanent
pacemaker (PPM) requirement following transcatheter aortic valve
replacement (TAVR) with the mechanically expanded Lotus^TM Valve
System (Boston Scientific). Background: Pacemaker implantation is the most
common complication following TAVR. Predictors of pacing following TAVR
with the Lotus valve have not been systematically assessed. Methods:
Consecutive patients with severe aortic stenosis who underwent Lotus valve
implantation were prospectively recruited at a single-centre. Patients
with a pre-existing PPM were excluded. Baseline ECG, echocardiographic and
multiple detector computed tomography as well as procedural telemetry and
depth of implantation were independently analyzed in a blinded manner. The
primary endpoint was 30-day incidence of pacemaker requirement (PPM
implantation or death while pacing-dependent). Multivariate analysis was
performed to identify independent predictors of the primary endpoint.
Results: A total of 104 consecutive patients underwent TAVR with the Lotus
valve with 9/104 (9%) with a pre-existing PPM excluded. New or worsened
procedural LBBB occurred in 78%. Thirty-day incidence of the primary
pacing endpoint was 28%. The most common indication for PPM implantation
was complete heart block (CHB) (69%). Independent predictors of the
primary endpoint included pre-existing RBBB (hazard ratio [HR] 2.8, 95% CI
1.1-7.0; P = 0.032) and depth of implantation below the noncoronary cusp
(NCC) (HR 2.4, 95% CI 1.0-5.7; P = 0.045). Conclusions: Almost a third of
Lotus valve recipients require pacemaker implantation within 30 days. The
presence of pre-existing RBBB and the depth of prosthesis implantation
below the NCC were significant pacing predictors. &#xa9; 2016 Wiley
Periodicals, Inc.<br/>Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<11>
Accession Number
617344289
Author
Rogers T.S.; Fung M.K.; Harm S.K.
Institution
(Rogers, Fung, Harm) Pathology and Laboratory Medicine, University of
Vermont Medical Center, Burlington, VT, United States
Title
Adiposity and age are risk factors for febrile nonhemolytic transfusion
reactions.
Source
Transfusion. Conference: AABB Annual Meeting 2016. United States. 56 (pp
14A), 2016. Date of Publication: September 2016.
Publisher
Blackwell Publishing Inc.
Abstract
Background/Case Studies: Febrile nonhemolytic transfusion reactions
(FNHTRs) are a common complication of allogeneic blood product
transfusions. FNHTRs are perpetuated by pro-inflammatory cytokines,
including tumor necrosis factor alpha (TNF-a) and interleukin-6 (IL-6).
Adipose tissue is an endogenous source of TNF-a and IL-6 thus we
hypothesize that overweight patients, defined as body mass index (BMI)
>/525, are over-represented in the population of transfusion recipients
who experience a FNHTR. Study Design/Methods: This retrospective case
control study included adult (>18 years old) transfusion recipients of red
blood cells (RBC) or platelet (PLT) products on the hematology oncology,
cardiothoracic surgery, and orthopedic surgery services who experienced an
FNHTR between 2011 through 2015. Transfusion recipients on the same
services who had no FNHTR were randomly selected from the first week of
each month between 2011 through 2015 and served as controls. Recipient
age, gender, number of RBC and PLT products transfused within prior 24
hours, and BMI were assessed. Proportion of recipients with BMI >/525 and
FNHTR was compared to proportion with BMI <25 and FNHTR to determine if
overweight recipients are over-represented in FNHTR to RBC and PLT
products. Results/Findings: Data from 69 transfusion recipients with FNHTR
and 106 transfusion recipients without FNHTR were collected and reviewed
(Table). The two groups did not differ significantly in terms of gender
and total number of RBC and PLT products transfused within prior 24 hours.
The FNHTR group was significantly younger with a higher BMI than controls.
Linear regression analysis showed no relationship between age and BMI (R
square50.005). The proportion of transfusion recipients with BMI >/525 who
experienced a FNHTR was 0.45 [95% CI 0.37-0.55] com-pared to 0.28 [95% CI
0.18-0.40] in recipients with BMI <25. Odds ratio of FNHTR in recipients
with BMI >/525 was 1.6 [p50.024]. Conclusion: Transfusion recipients with
BMI >/525 are at increased risk of FNHTR after RBC or PLT transfusion
compared to recipients with BMI <25 suggesting that adiposity may be a
risk factor for developing a FNHTR. Additionally, younger age was
identified as an independent risk factor for FNHTR.

<12>
Accession Number
617344159
Author
Crabtree A.M.; Welsby I.; Alberts M.; Schroder J.; Gaca J.; Lombard W.;
Hoffman M.
Institution
(Crabtree, Welsby, Alberts, Schroder, Gaca, Lombard, Hoffman) Duke
University, Durham, NC, United States
(Crabtree, Hoffman) Durham VA Medical Center, Durham, NC, United States
Title
A controlled trial of plateletpheresis during cardiac surgery.
Source
Transfusion. Conference: AABB Annual Meeting 2016. United States. 56 (pp
31A), 2016. Date of Publication: September 2016.
Publisher
Blackwell Publishing Inc.
Abstract
Background/Case Studies: Cardiothoracic surgery consumes up to 12% of the
U.S. platelet (PLT) supply. We have previously shown that it is feasible
to collect autologous PLTs by apheresis prior to surgery for
post-operative reinfusion. The current study tests the hypothesis that
this strategy will reduce the need for allogeneic PLT transfusion. Study
Design/Methods: Patients in this study underwent surgery requiring
cardiopulmonary bypass (CPB). They were randomized to receive either
allogeneic (control,n523) or autologous (TRIMA group,n517) platelets. PLT
apheresis was performed after induction of anesthesia. In compliance with
AABB standards, autolo-gous PLTs were maintained at 20-24 degrees C in the
operating suite, and reinfused within 4 hours of collection. The decision
to transfuse was made by the surgeon, who was blinded to group. Blood
samples were collected into hirudin tubes at 4 times: A) at baseline prior
to plateletpheresis; B) upon separation from CPB, prior to administration
of PLTs; C) at end of surgery after administration of PLTs; and D) post-op
day 1 (POD1). A sample from each PLT product was collected from the tubing
through which it was infused. Platelet function in each sample was tested
on the Multiplate instrument (DiaPharma) within 2 hours of collection,
with the following agonists: TRAP (thrombin receptor agonist peptide),
ADP, and COL(collagen). For testing PLT products, each sample was diluted
to 100 x10#sup#3#/sup#/mL in hirudi-nized plasma. Results/Findings: After
PLT collection, TRIMA patients' PLT counts decreased significantly from
187676 x10#sup#3#/sup# (sample A) to 88636 x10#sup#3#/sup#/mL (sample B,
P<0.01). After reinfusion of autologous platelets (sample C), the PLT
count increased to 122664 x 10#sup#3#/sup#/ml and was 103641 x
10#sup#3#/sup#/ml the next day (sample D). Controls were 183660 x
10#sup#3#/sup#/mL (sample A), 119638 x 10#sup#3#/sup# (sample B), 138632 x
10#sup#3#/sup# (sample C), and 121633 x 103 (sample D). PLT counts in the
TRIMA group were significantly lower than controls in samples B, but PLT
reactivity was not different between the groups. Contrary to our
expectations, PLT function did not decline following CBP and surgery. In
fact, PLT reactivity to TRAP and COL was higher on POD1 in TRIMA and
control groups. The autologous (TRIMA) PLT products had significantly
better function in response to all agonists (p<0.05) than did banked PLTs.
Conclusion: We found that only 24% of the TRIMA patients needed allogeneic
PLTand only 35% needed plasma or cryo, versus 65% of the controls who
received allogeneic PLTs and 59% who needed plasma or cryo. This result
suggests that pre-op collection of autologous PLTs and reinfusion after
cardiothoracic surgery could reduce the demand for PLT products, as well
as patient exposure to allogeneic blood. Furthermore, freshly harvested
autologous PLT had better function than allogeneic PLT products which had
been stored for one or more days after collection.

<13>
Accession Number
617344486
Author
Strandenes G.; Kristoffersen E.K.; Bjerkvig C.K.; Fosse T.K.; Hervig T.;
Haaverstad R.; Kvalheim V.L.; Cap A.P.; Lunde T.F.; Braathen H.; Sivertsen
J.; Apelseth T.
Institution
(Strandenes) Norwegian Naval Special Operations Command, Bergen, Norway
(Kristoffersen, Hervig, Lunde, Braathen, Sivertsen, Apelseth) Department
of Immunology and Transfusion Medicine, Haukeland University Hospital,
Bergen, Norway
(Kristoffersen, Hervig, Haaverstad, Kvalheim) Institute of Clinical
Science, School of Medicine and Dentistry, University of Bergen, Bergen,
Norway
(Bjerkvig, Fosse) Department of Anaesthesia and Intensive Care, Haukeland
University Hospital, Bergen, Norway
(Haaverstad, Kvalheim) Department of Hearth Disease, Section of
Cardiothoracic Surgery, Haukeland University Hospital, Bergen, Norway
(Cap) U.S. Army Institute of Surgical Research, Ft Sam Houston, TX, United
States
(Apelseth) Laboratory of Clinical Biochemistry, Haukeland University
Hospital, Bergen, Norway
Title
Cold-stored apheresis platelets in treatment of postoperative bleeding in
cardiothoracic surgery.
Source
Transfusion. Conference: AABB Annual Meeting 2016. United States. 56 (pp
16A), 2016. Date of Publication: September 2016.
Publisher
Blackwell Publishing Inc.
Abstract
Background/Case Studies: Platelet storage has undergone changes since the
1950s. Platelets were initially stored under refrigeration, but a practice
shift towards room temperature storage began in the 1970s in order to
optimize circulation time for prophylactic transfusion. Cold storage,
however, continued until the 1980s, due to superior hemostatic properties.
Split inventories pose logistical challenges for transfusion services, but
as Personalized Medicine advances, reevaluation of the hemostatic
properties of cold stored platelets in bleeding patients is warranted.
Study Design/Methods: A two-armed randomized pilot study was designed to
evaluate if leukore-duced apheresis platelets in PAS stored for up to 7
days cold (4CPLT) or at room temperature (RTPLT) are equally effective in
treatment of postoperative bleeding in patients undergoing major
cardiothoracic surgery. The primary objective is to compare coagulation
responses by change in platelet aggregation measured by impedance
aggregometry (Multiplate#sup#TM#/sup#). The secondary objectives are to
compare postoperative blood loss until day 1 after surgery, to analyze
biochemical and hemostatic changes as well as complications. Patients are
enrolled prior to surgery, and we aim to include 60 patients receiving
platelet transfusion. Statistical analysis is performed by use of
Independent samples T-test (SPSS version 22), and results presented as
mean6SD. Results/Findings: By 1#sup#st#/sup# of April 2016, 65 patients
have been enrolled in the study. 11 out of 15 women and 15 out of 49 men
have received platelet transfusion according to protocol. 14 patients
received 4CPLT and 12 received RTPLT. The Multiplate#sup#TM#/sup# results
from first transfusion episode (average 2 units in both arms) are as
follows: Changes in ADP Area Under the Curve (AUC, units) immediate after
transfusion are 28.57615.05 (4CPLT) and 14.58617.99 (RTPLT) (p50.045).
Measured ratios DADP/DTPK are 0.5060.55 (4CPLT) and 0.2960.38 (RTPLT)
(p50.259). Platelet counts before 124x10#sup#9#/sup#/L654 (4CPLT) vs
118x10#sup#9#/sup#/ L678 (RTPLT) and after transfusion
167x10#sup#9#/sup#/L648 (4CPLT) vs 164x10#sup#9#/sup#/ L671 (RTPLT) are
similar in the two groups. No significant difference in total number of
platelet units given 2.160.7 (4CPLT) vs 2.861.3 (RTPLT) or postoperative
bleeding (chest drain output after chest closure) 775 ml6 534 (4CPLT) vs
1055 ml6677 (RTPLT) are observed. 24-hour platelet counts are similar
140x10#sup#9#/sup#/L673 (4CPLT) vs 155x10#sup#9#/sup#/L680 (RTPLT).
Conclusion: Preliminary data from 26 patients shows that the change in
Multiplate ADP-induced platelet aggregation is higher in patients
receiving cold-stored platelets. There is a trend towards lesser
postoperative bleeding. Preliminary results indicate that transfusion of
cold-stored apheresis platelets is efficient in treatment of postoperative
bleeding in patients undergoing major cardiothoracic surgery.

<14>
Accession Number
617344393
Author
Taye Makuria A.; Pearson R.; Eskra T.
Institution
(Taye Makuria, Pearson, Eskra) Hospital Operation, VMC, Greenville, NC,
United States
Title
Impact of restrictive transfusion guidelines on red blood cell transfusion
incidence.
Source
Transfusion. Conference: AABB Annual Meeting 2016. United States. 56 (pp
111A), 2016. Date of Publication: September 2016.
Publisher
Blackwell Publishing Inc.
Abstract
Background/Case Studies: Current consensus Red Blood Cell (RBC)
transfusion guideline recommends restrictive over liberal transfusions and
a single unit transfusion, in the absence of acute hemorrhage. Our study
analyzes the impact of implementation of an evidence based transfusion
guideline by comparing Pre-guideline implementation (Pre-GI) to
Post-guideline implementation (Post-GI) data. Study Design/Methods: In
01/2014, at a tertiary care center, a restrictive RBC transfusion
guideline was imple-mented and indications updated in the electronic
health record (EHR) for providers to choose an indication when ordering. A
retrospective-prospective observational study focused on RBC transfusion
practice change was then conducted. Data from 03/2013 was compared to
03/2014 from randomly selected patients with one of eight disease
categories (malig-nancy, cardiac, chronic illness, infection, orthopedics,
resuscitated-trauma and vascular). RBC transfusion for hemoglobin(Hgb)
level >8gm/dL in cardiac and post-operative patients and Hgb >7gm/dL in
all other patients as well as transfusions of more than one unit, in the
absence of hemorrhage were considered excess/unnecessary. Patient
demographics, transfusion indica-tion, pre-transfusion Hgb level, total
number and excess transfused unit data were retrieved from EHR.
Results/Findings: The mean age of patients was significantly higher in the
Post-GI period (67-years) than Pre-GI (60-years), P50.00. For all disease
categories, with the exception of cardiac and resuscitated-trauma, more
patients were transfused in the Post-GI, n5157(79.3%), than Pre-GI,
n5133(67.2%) period. However, in the Pre-GI period more cardiac,
n541(20.7%), and resuscitated-trauma patients, n524(12.1%), were
transfused than Post-GI period, n529(14.7%) and n512(6.1%), respectively.
The mean pre-transfusion Hgb level significantly reduced in the Post-GI
period (from 8.01gm/dL to 7.8gm/dL), P50.002. Although not significant,
the incidence of excess transfused units also reduced in the Post-GI (66%)
from Pre-GI (70%), P50.30. Conclusion: The study highlights the impact of
guideline implementation on RBC transfusion ordering practices, as shown
by a significant decline in pre-transfusion Hgb threshold. There were more
cardiac and resuscitated-trauma patients transfused in the Pre-GI period.
Although not demonstrated in this study the next step would be to
demonstrate those patients would not have qualified for RBC transfusions
if current guideline was applied. In summary, this observa-tional study
shows that implementation of an evidence based restrictive guideline is an
effective initial step in reducing RBC transfusion incidence. Continued
education on appropriate transfusions, could further curtail
excess/unnecessary RBC transfusions with potential long term benefit of
improved patient outcome and reduced hospital cost.

<15>
Accession Number
617343885
Author
Roubinian N.; Escobar G.; Gardner M.; Triulzi D.J.; Hendrickson J.E.;
Gottschall J.; Murphy E.
Institution
(Roubinian, Murphy) Blood Systems Research Institute, San Francisco, CA,
United States
(Roubinian, Murphy) UCSF, San Francisco, CA, United States
(Escobar, Gardner) Kaiser Permanente Northern California Division of
Research, Oakland, CA, United States
(Hendrickson) Yale University, New Haven, CT, United States
(Gottschall) Blood Center of Wisconsin, Milwaukee, WI, United States
(Triulzi) Institute for Transfusion Medicine, Pittsburgh, PA, United
States
Title
Epidemology of platelet transfusion in hospitalized patients: Data from an
integrated health care delivery system.
Source
Transfusion. Conference: AABB Annual Meeting 2016. United States. 56 (pp
168A-169A), 2016. Date of Publication: September 2016.
Publisher
Blackwell Publishing Inc.
Abstract
Background/Case Studies: Few studies have reported the epidemiology of
platelet transfusion. Our objective was to characterize inpatient platelet
utilization from data available in an integrated healthcare delivery
system. Study Design/Methods: Using comprehensive electronic medical
record data from 21 community hospitals between January 2009 and August
2013, we conducted a retrospective cohort study of hospitalized adult
patients receiving platelet transfusions. Principal diag-noses were
calculated using ICD-9 codes. Indications for transfusion were extracted
from electronic orders for platelet transfusion. Means and interquartile
ranges (IQR) were calculated Results/Findings: 62,491 doses of platelets
were transfused to 13,276 patients. The median age was 62 (interquartile
range (IQR) 48-73) years, and 57% of patients were male. The platelet
transfusion incidence per hospitaliza-tion increased from 1.7% in 2009 to
2.1% in 2013 (p <0.001). Platelet transfusion occurred in 44% of
hospitalizations where platelet counts fell below 50 K/uL. The median
pre-transfusion and post transfusion platelet counts were 22 K/uL (IQR
11-62) and 49 K/uL (IQR 24-101), respectively. The majority of transfused
patients had non-surgical admission conditions (69%) and was in intensive
care (59%) during their hospitalization. Pre-transfusion platelet
thresholds were lower in medical (17 K/uL; IQR 10-38) compared to surgical
(64 K/uL; IQR 32-105) patients (p<0.001). Most patients (72.7%) also
received red cell transfusions and 36.8% also received plasma. 25% of
transfusions were given for a platelet count > 50 K/uL and 17% for a
platelet count > 100 K/uL. Clinician designated indications for
transfusion where the pre-transfusion platelet count was > 50 K/uL
included: "Bleeding" (39%), "Thrombocytopenia" (31%), "Procedure" (16%),
and "Platelet Dysfunction" (14%). Conclu-sion: These data describe the
current epidemiology of platelet utilization in a large community hospital
network. Platelet transfusion occurred in a significant proportion of
thrombocytopenic patients, and the incidence of platelet transfusion
increased in both medical and surgical patients from 2009 to 2013. Higher
pre-transfusion thresholds were seen in both medical and surgical
cardiovascular admissions as well as conditions associated with bleeding.
Further studies incorporating patient diagnoses and clinician designated
indications for platelet transfusion will be helpful in understanding
transfusion practice outside of guidelines.

<16>
Accession Number
617294893
Author
Shehada S.-E.; Elhmidi Y.; Puluca N.; Ozturk O.; Demircioglu E.; Wendt D.;
Jakob H.; Thielmann M.
Institution
(Shehada, Demircioglu, Wendt, Jakob, Thielmann) Department of Thoracic and
Cardiovascular Surgery, West-German Heart and Vascular Center Essen,
University of Duisburg-Essen, Hufelandstrase 55, Essen 45147, Germany
(Elhmidi, Puluca) Department of Cardiovascular Surgery, German Heart
Center Munich, Munich, Germany
(Ozturk) Department of Cardiovascular Surgery, Klinikum Bogenhausen,
Munich, Germany
Title
Impact of previous cardiac surgery in patients undergoing transcatheter
aortic valve implantation: A systematic review.
Source
Journal of Cardiovascular Surgery. 58 (5) (pp 787-793), 2017. Date of
Publication: October 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: Redo surgical aortic valve replacement after prior cardiac
surgery is usually related to a higher risk of mortality and morbidity.
Transcatheter aortic valve implantation (TAVI) became an alternative
therapy for those patients in the past couple of years. EVIDENCE
ACQUISITION: We aimed in this study to analyze the outcomes of patients
undergoing TAVI after a prior cardiac surgery especially those who
underwent coronary artery bypass grafting (CABG) and to see if TAVI offers
any advantages for those patients than conventional surgical aortic valve
replacement. EVIDENCE SYNTHESIS: We searched for relevant articles in
Medline and abstracted clinical information based on pre-defined criteria
and endpoints. Data of nine studies including the baseline
characteristics, implantation data, postoperative outcomes and major
adverse cardiac complications, which were published between 2011 and 2015
were collected and evaluated. From all reviewed studies, 769 patients had
a prior cardiac surgery and underwent TAVI for symptomatic severe aortic
stenosis. Of these, 738 patients (96%) had prior CABG. Patients' age
ranged from 78+/-3 to 82+/-5.8 years. The STS and EuroSCORE ranged from
4.5+/-3% to 14.7+/-12.3% and 25.6+/-16.2% to 37+/-18%, respectively. In
all reviewed studies the 30-day mortality was about 5.6% and was not
significantly higher compared to patients with no history of prior cardiac
surgery. The total incidence of stroke was about 3.6%, myocardial
infarction was 1.7%, acute kidney injury was 13.8% and permanent pacemaker
implantation was about 14.2%. CONCLUSIONS: However, patients presented
with severe aortic valve disease after a previous cardiac surgery
exhibited a higher preoperative STS and EuroSCORE than those without
previous cardiac surgery. The 30-day mortality was not significantly
higher in comparison to those patients without history of prior cardiac
surgery. According to that, transcatheter aortic valve implantation should
be considered as an attractive alternative for those
patients.<br/>Copyright &#xa9; 2016 Edizioni Minerva Medica.

<17>
Accession Number
617294877
Author
Mihos C.G.; Yucel E.; Santana O.
Institution
(Mihos, Yucel) Cardiac Ultrasound Laboratory, Massachusetts General
Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02140,
United States
(Santana) Division of Cardiology at Columbia University, Mount Sinai Heart
Institute, Miami Beach, FL, United States
Title
A systematic review and meta-analysis of chordal replacement versus
leaflet resection for isolated posterior mitral valve prolapse.
Source
Journal of Cardiovascular Surgery. 58 (5) (pp 779-786), 2017. Date of
Publication: October 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION: Chordal replacement (Chord MVr) for isolated posterior
mitral valve prolapse allows for preservation of the native mitral valve
apparatus. The potential benefits of this approach, as compared with
leaflet resection (Resection), are not clearly defined. EVIDENCE
ACQUISITION: A systematic review and meta-analysis was conducted on
operative, clinical, and echocardiographic outcomes. Risk ratios (RR) were
calculated by the Mantel-Haenszel method under a fixed or random effects
model, as appropriate. EVIDENCE SYNTHESIS: Eight studies were included,
with a total of 1922 patients (Chord MVr, N.=835; Resection, N.=1087).
Baseline characteristics were similar, except for a higher incidence of
atrial fibrillation in the Chord MVr group (15.5% versus 9.9%, P=0.03),
and a slightly greater mitral regurgitation grade in the Resection group
(3.5 versus 3.4, P=0.008). P2 segment prolapse was the most common
pathology, however, patients undergoing Chord MVr had a higher incidence
of multi-segment prolapse (32.1% versus 13.9%, P=0.0006). There was no
difference in operative mortality (1.1% for both) or perioperative
complications. At a mean follow-up of 2.9+/-2.8 years (median=2.8 years,
IQR 1.6-4.4), Chord MVr was associated with a lower risk of reoperation
(1.1% versus 4.3%; RR 0.26, 95% CI 0.12-0.56, P=0.0007), and similar
survival and recurrence of moderate mitral regurgitation, when compared
with Resection. Finally, a lower transmitral gradient (2.5 versus 2.8
mmHg, P=0.0004) and larger orifice area (3.2 versus 3.0 cm2, P=0.002) were
observed with Chord MVr. CONCLUSIONS: At 2.9-year follow-up, Chord MVr for
isolated posterior mitral valve prolapse was associated with a lower
reoperation rate and favorable valve hemodynamics, when compared with
leaflet resection.<br/>Copyright &#xa9; 2016 Edizioni Minerva Medica.

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

<19>
Accession Number
616541696
Author
Grocott H.P.; Lee Y.H.; Waszynski C.M.; Waberski W.; Apakama G.P.; Aquino
K.G.; Arya V.K.; Avidan M.S.; Abdallah A.B.; Dicks R.S.; Downey R.J.;
Emmert D.A.; Escallier K.E.; Fritz B.A.; Fardous H.; Funk D.J.; Gipson
K.E.; Girardi L.N.; Grocott H.; Gruber A.T.; Hudetz J.A.; Inouye S.K.;
Ivascu N.S.; Jacobsohn E.; Jayant A.; Kashani H.H.; Kavosh M.S.; Kunkler
B.S.; Lee Y.; Lenze E.J.; Mashour G.A.; Maybrier H.R.; McKinney A.S.;
McKinnon S.L.; Mickle A.M.; Monterola M.; Muench M.R.; Murphy M.R.; Noh
G.-J.; Pagel P.S.; Pryor K.O.; Rogers E.M.; Redko M.; Schmitt E.M.;
Sivanesan L.; Steinkamp M.L.; Tellor B.; Thomas S.; Upadhyayula R.T.;
Veselis R.A.; Vlisides P.E.; Waszynski C.; Yulico H.
Institution
(Avidan, Maybrier, Abdallah, Emmert, Muench, Fritz) Department of
Anesthesiology, Washington University School of Medicine, Saint Louis, MO,
United States
(Jacobsohn) Department of Anesthesiology and Department of Internal
Medicine, University of Manitoba, Winnipeg, MB, Canada
(Grocott) Department of Anesthesia and Perioperative Medicine, University
of Manitoba, Winnipeg, MB, Canada
(Vlisides, Mashour) Department of Anesthesiology, University of Michigan,
Ann Arbor, MI, United States
(Pryor, Rogers) Department of Anesthesiology, Weill Cornell Medicine, New
York City, NY, United States
(Veselis) Department of Neuroanesthesiology, Memorial Sloan Kettering
Cancer Center, New York City, NY, United States
(Downey) Department of Surgery, Memorial Sloan Kettering Cancer Center,
New York City, NY, United States
(Yulico) Department of Anesthesiology, Memorial Sloan Kettering Cancer
Center, New York City, NY, United States
(Noh, Lee) Department of Anesthesiology, Asan Medical Center, Seoul, South
Korea
(Waszynski) Department of Medicine, Hartford Hospital, Hartford, CT,
United States
(Arya) Department of Anaesthesiology and Intensive Care, Postgraduate
Institute of Medical Education and Research, Chandigarh, India
(Pagel, Hudetz) Department of Anesthesiology, Medical College of
Wisconsin, Milwaukee, WI, United States
(Waberski) Department of Anesthesiology, Hartford Hospital, Hartford,
Connecticut, United States
(Inouye) Department of Medicine, Beth Israel Deaconess Medical Center,
Harvard Medical School, Institute for Aging Research, Hebrew SeniorLife,
Boston, MA, United States
Title
Intraoperative ketamine for prevention of postoperative delirium or pain
after major surgery in older adults: an international, multicentre,
double-blind, randomised clinical trial.
Source
The Lancet. 390 (10091) (pp 267-275), 2017. Date of Publication: 15 - 21
July 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Delirium is a common and serious postoperative complication.
Subanaesthetic ketamine is often administered intraoperatively for
postoperative analgesia, and some evidence suggests that ketamine prevents
delirium. The primary purpose of this trial was to assess the
effectiveness of ketamine for prevention of postoperative delirium in
older adults. Methods The Prevention of Delirium and Complications
Associated with Surgical Treatments [PODCAST] study is a multicentre,
international randomised trial that enrolled adults older than 60 years
undergoing major cardiac and non-cardiac surgery under general
anaesthesia. Using a computer-generated randomisation sequence we randomly
assigned patients to one of three groups in blocks of 15 to receive
placebo (normal saline), low-dose ketamine (0.5 mg/kg), or high dose
ketamine (1.0 mg/kg) after induction of anaesthesia, before surgical
incision. Participants, clinicians, and investigators were blinded to
group assignment. Delirium was assessed twice daily in the first 3
postoperative days using the Confusion Assessment Method. We did analyses
by intention-to-treat and assessed adverse events. This trial is
registered with clinicaltrials.gov, number NCT01690988. Findings Between
Feb 6, 2014, and June 26, 2016, 1360 patients were assessed, and 672 were
randomly assigned, with 222 in the placebo group, 227 in the 0.5 mg/kg
ketamine group, and 223 in the 1.0 mg/kg ketamine group. There was no
difference in delirium incidence between patients in the combined ketamine
groups and the placebo group (19.45% vs 19.82%, respectively; absolute
difference 0.36%, 95% CI -6.07 to 7.38, p=0.92). There were more
postoperative hallucinations (p=0.01) and nightmares (p=0.03) with
increasing ketamine doses compared with placebo. Adverse events
(cardiovascular, renal, infectious, gastrointestinal, and bleeding),
whether viewed individually (p value for each >0.40) or collectively
(36.9% in placebo, 39.6% in 0.5 mg/kg ketamine, and 40.8% in 1.0 mg/kg
ketamine groups, p=0.69), did not differ significantly across groups.
Interpretation A single subanaesthetic dose of ketamine did not decrease
delirium in older adults after major surgery, and might cause harm by
inducing negative experiences. Funding National Institutes of Health and
Cancer Center Support.<br/>Copyright &#xa9; 2017 Elsevier Ltd

<20>
Accession Number
615430352
Author
Peterson S.; Su J.A.; Szmuszkovicz J.R.; Johnson R.; Sargent B.
Institution
(Peterson) Division of Pediatric Rehabilitation Medicine, Physical
Therapy, Children's Hospital Los Angeles, Los Angeles, CA, United States
(Peterson, Sargent) Division of Biokinesiology & Physical Therapy, Herman
Ostrow School of Dentistry, University of Southern California, Los
Angeles, CA, United States
(Su, Szmuszkovicz) Division of Cardiology, Department of Pediatrics,
Children's Hospital Los Angeles, Los Angeles, CA, United States
(Johnson) Norris Medical Library, University of Southern California, Los
Angeles, CA, United States
Title
Exercise capacity following pediatric heart transplantation: A systematic
review.
Source
Pediatric Transplantation. 21 (5) (no pagination), 2017. Article Number:
e12922. Date of Publication: August 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Pediatric HTs account for 13% of all HTs with >60% of recipients surviving
at least 10 years post-HT. The purpose of this systematic review is to
synthesize the literature on exercise capacity of pediatric HT recipients
to improve understanding of the mechanisms that may explain the decreased
exercise capacity. Six databases were searched for studies that compared
the exercise capacity of HT recipients <=21 years old with a control group
or normative data. Sixteen studies were included. Pediatric HT recipients,
as compared to controls or normative data, exhibit significantly higher
resting HR, and at peak exercise exhibit significantly decreased HR,
VO<inf>2</inf>, power, work, minute ventilation, and exercise duration.
Peak VO<inf>2</inf> appears to improve within the first 2.5 years post-HT;
peak work remains constant; and there is inconclusive evidence that peak
HR, HR recovery, and HR reserve improve with time since HT. These results
are discussed in the context of the mechanisms that may explain the
impaired exercise capacity of pediatric HT recipients, including
chronotropic incompetence, graft dysfunction, side effects of
immunosuppression therapy, and deconditioning. In addition, the limited
literature on rehabilitation after pediatric HT is
summarized.<br/>Copyright &#xa9; 2017 John Wiley & Sons A/S. Published by
John Wiley & Sons Ltd

<21>
Accession Number
615011816
Author
Ueki C.; Sakaguchi G.; Akimoto T.; Ohashi Y.; Sato H.
Institution
(Ueki, Sakaguchi, Akimoto, Ohashi, Sato) Department of Cardiovascular
Surgery, Shizuoka General Hospital, Shizuoka, Japan
Title
On-pump beating-heart technique is associated with lower morbidity and
mortality following coronary artery bypass grafting: A meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 50 (5) (pp 813-821), 2016.
Date of Publication: 01 Nov 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
A hybrid procedure of beating-heart coronary artery bypass grafting (CABG)
with the concomitant use of cardiopulmonary bypass termed on-pump
beating-heart CABG (ON-BH CABG) has emerged as an alternative for
high-risk patient populations. Although several studies have reported the
advantage of ON-BH CABG in high-risk patients, the clinical benefit of
ON-BH CABG is still under discussion. Here, we performed a meta-analysis
of the data derived from published studies comparing the clinical outcomes
of ON-BH CABG with that of conventional arrested heart CABG. Medline,
Embase and Scopus databases were searched for relevant publications up to
March 2015. A systematic review of the published literature identified 14
published studies incorporating 2040 patients (884 ON-BH CABG and 1156
conventional CABG). Odds ratios (ORs) for binary variables or weighted
mean difference for continuous variables were combined using the inverse
variance method in a fixed-effects model. Study heterogeneity was tested
using Cochran's Q test and the publication bias was assessed using Begg's
and Egger's tests. The fixed-effects meta-analysis for early mortality
showed that ON-BH CABG provided a 45% lower risk of early mortality
compared with conventional CABG (OR 0.553; 95% confidence interval [CI]
0.376-0.815; P = 0.003). There was minimal heterogeneity in the included
studies (P = 0.29) and no evidence of significant publication bias. A
sensitivity analysis, including a random-effects meta-analysis (OR 0.552;
95% CI 0.356-0.856; P = 0.008) and a one-study-removed meta-analysis,
supported the validity of the primary analysis for early mortality. There
was significantly lower perioperative morbidity associated with ON-BH
CABG, including myocardial infarction (OR 0.294; 95% CI 0.141-0.613; P =
0.001), renal failure (OR 0.362; 95% CI 0.209-0.626; P < 0. 001) and low
output syndrome (OR 0.330; 95% CI 0.197-0.551; P < 0.001) with no
significant heterogeneity. In conclusion, current evidence from
comparative studies indicates that ON-BH CABG is associated with
significantly lower early morbidity and mortality. The ON-BH CABG could be
an attractive planned alternative for high-risk patient
populations.<br/>Copyright &#xa9; The Author 2016. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<22>
Accession Number
617292209
Author
Ziehm S.; Rosendahl J.; Barth J.; Strauss B.M.; Mehnert A.; Koranyi S.
Institution
(Ziehm, Mehnert, Koranyi) University Hospital of Leipzig, Institute of
Medical Psychology and Medical Soziology, Philipp-Rosenthal-Strase 55,
Leipzig, Saxony 4103, Germany
(Rosendahl, Strauss) University Hospital of Jena, Institute of
Psychosocial Medicine and Psychotherapy, Stoystrasse 3, Jena, Thuringia
07743, Germany
(Barth) University of Bern, Institute of Social and Preventive Medicine,
Niesenweg 6, Bern CH-3012, Switzerland
Title
Psychological interventions for acute pain after open heart surgery.
Source
Cochrane Database of Systematic Reviews. 2017 (7) (no pagination), 2017.
Article Number: CD009984. Date of Publication: 13 Jul 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: This is an update of a Cochrane review previously published in
2014. Acute postoperative pain is one of the most disturbing complaints in
open heart surgery, and is associated with a risk of negative
consequences. Several trials investigated the effects of psychological
interventions to reduce acute postoperative pain and improve the course of
physical and psychological recovery of participants undergoing open heart
surgery. Objectives: To compare the efficacy of psychological
interventions as an adjunct to standard care versus standard care alone or
standard care plus attention control in adults undergoing open heart
surgery for pain, pain medication, psychological distress, mobility, and
time to extubation. Search methods: For this update, we searched the
Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase,
Web of Science, and PsycINFO for eligible studies up to February 2017. We
used the 'related articles' and 'cited by' options of eligible studies to
identify additional relevant studies. We checked lists of references of
relevant articles and previous reviews. We searched the ProQuest
Dissertations and Theses Full Text Database, ClinicalTrials and the WHO
International Clinical Trials Registry Platform to identify any
unpublished material or ongoing trials. We also contacted the authors of
primary studies to identify any unpublished material. In addition, we
wrote to all leading heart centres in Germany, Switzerland, and Austria to
check whether they were aware of any ongoing trials. Selection criteria:
Randomised controlled trials comparing psychological interventions as an
adjunct to standard care versus standard care alone or standard care plus
attention in adults undergoing open heart surgery. Data collection and
analysis: Two review authors (SZ and SK) independently assessed trials for
eligibility, estimated the risk of bias and extracted all data. We
calculated effect sizes for each comparison (Hedges' g) and meta-analysed
data using a random-effects model. We assessed the evidence using GRADE
and created 'Summary of findings' tables. Main results: We added six
studies to this update. Overall, we included 23 studies (2669
participants). For the majority of outcomes (two-thirds), we could not
perform a meta-analysis since outcomes were not measured, or data were
provided by one trial only. No study reported data on the number of
participants with pain intensity reduction of at least 50% from baseline.
Only one study reported data on the number of participants below 30/100 mm
on the Visual Analogue Scale (VAS) in pain intensity (very low-quality
evidence). Psychological interventions did not reduce pain intensity in
the short-term interval (g 0.39, 95% CI -0.18 to 0.96, 2 studies, 104
participants, low-quality evidence), medium-term interval (g -0.02, 95% CI
-0.24 to 0.20, 4 studies, 413 participants, moderate-quality evidence) or
in the long-term interval (g 0.05, 95% CI -0.20 to 0.30, 2 studies, 200
participants, moderate-quality evidence). No study reported data on median
time to re-medication or on number of participants re-medicated. Only two
studies provided data on postoperative analgesic use in the short-term
interval, showing that psychological interventions did not reduce the use
of analgesic medication (g 1.18, 95% CI -2.03 to 4.39, 2 studies, 104
participants, low-quality evidence). Studies revealed that psychological
interventions reduced mental distress in the medium-term (g 0.37, 95% CI
0.13 to 0.60, 13 studies, 1388 participants, moderate-quality evidence)
and likewise in the long-term interval (g 0.32, 95% CI 0.10 to 0.53, 14
studies, 1586 participants, moderate-quality evidence). Psychological
interventions did not improve mobility in the medium-term interval (g
0.23, 95% CI -0.22 to 0.67, 3 studies, 444 participants, low-quality
evidence), nor in the long-term interval (g 0.09, 95% CI -0.10 to 0.28, 4
studies, 458 participants, moderate-quality evidence). Only two studies
reported data on time to extubation, indicating that psychological
interventions reduced the time to extubation (g 0.56, 95% CI 0.08 to 1.03,
2 studies, 154 participants, low-quality evidence). Overall, the very low
to moderate quality of the body of evidence on the efficacy of
psychological interventions for acute pain after open heart surgery cannot
be regarded as sufficient to draw robust conclusions. Most 'Risk of bias'
assessments were low or unclear. We judged selection bias (random sequence
generation) and attrition bias to be mostly low risk for included studies.
However, we judged the risk of selection bias (allocation concealment),
performance bias, detection bias and reporting bias to be mostly unclear.
Authors' conclusions: In line with the conclusions of our previous review,
there is a lack of evidence to support or refute psychological
interventions in order to reduce postoperative pain in participants
undergoing open heart surgery. We found moderate-quality evidence that
psychological interventions reduced mental distress in participants
undergoing open heart surgery. Given the small numbers of studies, it is
not possible to draw robust conclusions on the efficacy of psychological
interventions on outcomes such as analgesic use, mobility, and time to
extubation respectively on adverse events or harms of psychological
interventions.<br/>Copyright &#xa9; 2017 The Cochrane Collaboration.
Published by John Wiley & Sons, Ltd.

<23>
Accession Number
617341487
Author
Tomoaki S.
Institution
(Tomoaki) Department of Cardiovascular Surgery, Shiga University of
Medical Science, Setatsukinowa, Otsu, Shiga 520-2192, Japan
Title
Optimal use of arterial grafts during current coronary artery bypass
surgery.
Source
Surgery Today. (pp 1-10), 2017. Date of Publication: 13 Jul 2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Multiple arterial grafting, including the use of the bilateral internal
thoracic arteries (ITAs), has strong benefits on patient clinical outcomes
after coronary artery bypass grafting (CABG) but is far from commonly
accepted at present. We reviewed the previous randomized and leading
observational studies and assembled an up-to-date profile on multiple
arterial grafting. Many of the previous trials successfully showed the
beneficial effects of arterial grafting after CABG. Although many of these
were retrospective studies, the data presented, mostly from world-famous
surgeons, show that multiple arterial grafting does have advantages with
regard to the long-term patient outcome without increasing rates of early
mortality or morbidity. However, it is true that some surgeons experience
a certain amount of stress when using multiple arterial conduits. Multiple
arterial reconstruction has a strong advantage for patients undergoing
CABG and is now a standard worldwide strategy. Surgeons nowadays need to
make efforts to master arterial conduit techniques properly to provide
state-of-the-art CABG to patients.<br/>Copyright &#xa9; 2017 Springer
Japan KK

<24>
Accession Number
614027351
Author
van Diepen S.; Fuster V.; Verma S.; Hamza T.H.; Siami F.S.; Goodman S.G.;
Farkouh M.E.
Institution
(van Diepen) Department of Critical Care and Division of Cardiology,
University of Alberta, Edmonton, Alberta, Canada
(van Diepen, Goodman) Canadian VIGOUR Centre, University of Alberta,
Edmonton, Alberta, Canada
(Fuster) Icahn School of Medicine at Mount Sinai, New York, New York,
United States
(Verma) Division of Cardiac Surgery, St. Michael's Hospital, University of
Toronto, Toronto, Ontario, Canada
(Hamza, Siami) New England Research Institutes Inc., Watertown,
Massachusetts, United States
(Goodman) Terrence Donnelly Heart Centre, Division of Cardiology, St.
Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
(Farkouh) Peter Munk Cardiac Centre and the Heart and Stroke Richard Lewar
Centre, University of Toronto, Toronto, Ontario, Canada
Title
Dual Antiplatelet Therapy Versus Aspirin Monotherapy in Diabetics With
Multivessel Disease Undergoing CABG: FREEDOM Insights.
Source
Journal of the American College of Cardiology. 69 (2) (pp 119-127), 2017.
Date of Publication: 17 Jan 2017.
Publisher
Elsevier USA
Abstract
Background Clinical practice guidelines recommend post-operative dual
antiplatelet therapy (DAPT) in patients who undergo coronary artery bypass
grafting (CABG) following acute coronary syndromes (ACS). Objectives The
authors have evaluated DAPT utilization rates and associated outcomes
among post-CABG patients with diabetes. Methods In a post hoc,
nonrandomized analysis from the FREEDOM (Future REvascularization
Evaluation in patients with Diabetes mellitus: Optimal management of
Multivessel disease) trial, we compared patients receiving DAPT (aspirin
plus thienopyridine) and aspirin monotherapy at 30 days post-operatively.
The primary outcome was the risk adjusted 5-year FREEDOM composite of
all-cause mortality, nonfatal myocardial infarction, or stroke. Safety
outcomes included major bleeding, blood transfusion, and hospitalization
for bleeding. Results At 30 days post-CABG, 544 (68.4%) patients received
DAPT and 251 (31.6%) patients received aspirin alone. The median (25th,
75th percentile) duration of clopidogrel therapy was 0.98 (0.23 to 1.91)
years. There was no significant difference in the 5-year primary composite
outcome between DAPT- and aspirin-treated patients (12.6% vs. 16.0%;
adjusted hazard ratio [HR]: 0.83; 95% confidence interval [CI]: 0.54 to
1.27; p = 0.39). The 5-year primary composite outcomes were similar for
patients receiving DAPT versus aspirin monotherapy respectively, in
subgroups with pre-CABG ACSs (15.2% vs. 16.5%; HR: 1.06; 95% CI: 0.53 to
2.10; p = 0.88) and those with stable angina (11.6% vs. 15.8%; HR: 0.82;
95% CI: 0.50 to 1.343; p = 0.42). The composite outcomes of both treatment
groups were also similar by SYNTAX score, duration of DAPT therapy,
completeness of revascularization, and in off-pump CABG. No
treatment-related differences in major bleeding (5.6% vs. 5.7%; HR: 1.00;
95% CI: 0.50 to 1.99; p = 0.99), blood transfusions (4.8% vs. 4.5%; HR:
1.09; 95% CI: 0.51 to 2.34; p = 0.82), or hospitalization for bleeding
(2.6% vs. 3.3%; HR: 0.85; 95% CI: 0.34 to 2.17; p = 0.74) were observed
between aspirin- and DAPT-treated patients, respectively. Conclusions The
use of DAPT in patients with diabetes post-CABG in our cohort was high.
Compared with aspirin monotherapy, no associated differences were observed
in cardiovascular or bleeding outcomes, suggesting that routine use of
DAPT may not be clinically warranted. (Future REvascularization Evaluation
in patients with Diabetes mellitus: Optimal management of Multivessel
disease [FREEDOM]; NCT00086450)<br/>Copyright &#xa9; 2017 American College
of Cardiology Foundation

<25>
Accession Number
609363714
Author
Bazoukis G.; Tsimos K.; Korantzopoulos P.
Institution
(Bazoukis) Department of Internal Medicine, General Hospital of Athens,
Athens, Elpis, Greece
(Tsimos, Korantzopoulos) First Department of Cardiology, University of
Ioannina, Medical School, Ioannina 45110, Greece
Title
Episodic Left Bundle Branch Block - A Comprehensive Review of the
Literature.
Source
Annals of Noninvasive Electrocardiology. 21 (2) (pp 117-125), 2016. Date
of Publication: 01 Mar 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Episodic (transient/ intermittent) left bundle branch block (LBBB) has
been associated with different conditions such as bradycardia,
tachycardia, anesthesia, acute pulmonary embolism, changes in
intrathoracic pressure, chest trauma, cardiac interventional procedures,
mad honey poisoning, and in other clinical settings. Of note, exclusion of
an acute coronary syndrome in the setting of episodic LBBB is of great
importance. Moreover, episodic LBBB is sometimes symptomatic and may be
associated with left ventricular systolic and/or diastolic dysfunction or
conduction disturbances leading to syncope. This review article provides a
comprehensive overview of the conditions associated with episodic LBBB and
discusses the clinical impact of this phenomenon.<br/>Copyright &#xa9;
2016 Wiley Periodicals, Inc.

<26>
Accession Number
614484093
Author
Moreno R.
Institution
(Moreno) University Hospital La Paz, Paseo de la Castellana, 261, Madrid
28046, Spain
Title
Antithrombotic Therapy After Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiovascular Drugs. 17 (4) (pp 265-271), 2017. Date
of Publication: 01 Aug 2017.
Publisher
Springer International Publishing
Abstract
Current guidelines for patients who are undergoing transcatheter aortic
valve implantation but who do not require anticoagulation recommend double
antiplatelet therapy for 3-6 months after the procedure, followed by
aspirin indefinitely. However, these guidelines are based on expert
consensus rather than clinical trials. Several randomized trials are
currently evaluating alternative antithrombotic strategies, and
recommendations will likely change when their results become
available.<br/>Copyright &#xa9; 2017, Springer International Publishing
Switzerland.

<27>
Accession Number
617271317
Author
Huang S.-Q.; Zhang J.; Zhang X.-X.; Liu L.; Yu Y.; Kang X.-H.; Wu X.-M.;
Zhu S.-M.
Institution
(Huang, Zhang, Zhang, Liu, Yu, Kang, Zhu) Department of Anesthesiology,
The First Affiliated Hospital, College of Medicine, Zhejiang University,
Hangzhou, Zhejiang 310000, China
(Wu) Department of Anesthesiology, Zhejiang Provincial People's Hospital,
People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014,
China
Title
Can dexmedetomidine improve arterial oxygenation and intrapulmonary shunt
during one-lung ventilation in adults undergoing thoracic surgery? A
meta-analysis of randomized, placebo-controlled trials.
Source
Chinese Medical Journal. 130 (14) (pp 1707-1714), 2017. Date of
Publication: 20 Jul 2017.
Publisher
Chinese Medical Association
Abstract
Background: One-lung ventilation (OLV) is a common ventilation technology
during thoracic surgery that can cause serious clinical problems. We aimed
to conduct a meta-analysis to compare oxygenation and intrapulmonary shunt
during OLV in adults undergoing thoracic surgery with dexmedetomidine
(Dex) versus placebo to assess the influence and safety of using Dex.
Methods: Randomized controlled trials comparing lung protection in
patients who underwent thoracic surgery with Dex or a placebo were
retrieved from PubMed, EMBASE, MEDLINE, Cochrane Library, and China CNKI
database. The following information was extracted from the paper: arterial
oxygen partial pressure (PaO<inf>2</inf>), PaO<inf>2</inf>/inspired oxygen
concentration (PaO<inf>2</inf>/FiO<inf>2</inf>, oxygenation index [OI]),
intrapulmonary shunt (calculated as Qs/Qt), mean arterial pressure (MAP),
heart rate (HR), tumor necrosis factor-alpha (TNF-alpha), interleukin
(IL)-6, superoxide dismutase (SOD), and malondialdehyde (MDA). Results:
Fourteen randomized controlled trials were included containing a total of
625 patients. Compared with placebo group, Dex significantly increased
PaO<inf>2</inf>/FiO<inf>2</inf> (standard mean difference [SMD] = 0.98,
95% confidence interval [CI] [0.72, 1.23], P < 0.00001). Besides, Qs/Qt
(SMD= -1.22, 95% CI [-2.20, -0.23], P = 0.020), HR (SMD= -0.69, 95% CI
[-1.20, 0.17], P = 0.009), MAP (SMD= -0.44, 95% CI [-0.84, 0.04], P =
0.030), the concentrations of TNF-alpha (SMD = -1.55, 95% CI [-2.16,
-0.95], P <0.001), and IL-6 (SMD = -1.53, 95% CI [-2.37, -0.70], P =
0.0003) were decreased in the treated group, when compared to placebo
group. No significant difference was found in MDA (SMD = -1.14, 95% CI
[-3.48, 1.20], P = 0.340) and SOD (SMD = 0.41, 95% CI [-0.29, 1.10], P =
0.250) between the Dex group and the placebo group. Funnel plots did not
detect any significant publication bias. Conclusions: Dex may improve OI
and reduce intrapulmonary shunt during OLV in adults undergoing thoracic
surgery. However, this conclusion might be weakened by the limited number
of pooled studies and patients.<br/>Copyright &#xa9; 2017 Chinese Medical
Journal.

<28>
Accession Number
613498993
Author
Diab M.; Bilkhu R.; Soppa G.; McGale N.; Hirani S.P.; Newman S.P.;
Jahangiri M.
Institution
(Diab, Bilkhu, Soppa, Jahangiri) Department of Cardiothoracic Surgery, St.
George's University of London, London, United Kingdom
(McGale, Hirani, Newman) Centre for Health Services Research, School of
Health Sciences, City University London, London, United Kingdom
Title
Quality of Life in Relation to Length of Intensive Care Unit Stay After
Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (3) (pp 1080-1090),
2017. Date of Publication: June 2017.
Publisher
W.B. Saunders

<29>
Accession Number
614078988
Author
Smits P.C.; Assaf A.; Richardt G.; Omerovic E.; Abdel-Wahab M.; Neumann
F.-J.
Institution
(Smits, Assaf) Maasstad Ziekenhuis, Rotterdam, Netherlands
(Richardt, Abdel-Wahab) Herzzentrum Segeberger Kliniken, Bad Segeberg,
Germany
(Omerovic) University of Gothenburg, Goteborg, Sweden
(Neumann) Herzzentrum Bad Krozingen, Bad Krozingen, Germany
Title
Design and rationale of the COMPARE-ACUTE trial: Fractional flow
reserve-guided primary multivessel percutaneous coronary intervention to
improve guideline indexed actual standard of care for treatment of
ST-elevation myocardial infarction in patients with multivessel coronary
disease.
Source
American Heart Journal. 186 (pp 21-28), 2017. Date of Publication: 01 Apr
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
What the best strategy is for nonculprit lesions in ST-elevation
myocardial infarction (STEMI) patients presenting with multivessel disease
remains a clinical dilemma. Based on recent clinical studies suggesting
that complete revascularization in the acute phase is beneficial, the
European Society of Cardiology and American College of Cardiology/American
Heart Association guidelines have been recently changed from class 3
discouragement to a class 2B recommendation concerning the treatment of
the nonculprit lesions in the acute index procedure. However, in these
recent studies, nonculprit lesion treatment was guided by angiography,
which is known for its poor accuracy in determining ischemia. Fractional
flow reserve (FFR) guidance for treatment of nonculprit vessels seems to
be a reasonable approach, and in the acute setting of STEMI, it is not yet
investigated. The COMPARE-ACUTE trial aims to investigate FFR-guided
complete revascularization in comparison to a culprit lesion
treatment-only strategy in STEMI patients with multivessel disease
presenting for primary percutaneous coronary intervention. Methods and
results COMPARE-ACUTE is an investigator-initiated, prospective
multicenter randomized controlled trial. After successful primary
percutaneous coronary intervention, patients will be randomized in a 1:2
fashion toward FFR-guided complete revascularization or culprit lesion
treatment-only strategies. The chosen primary end point is a composite of
all-cause mortality, nonfatal myocardial infarction, any
revascularization, and cerebrovascular events (major adverse cardiac and
cerebrovascular events) at 12 months, with 3-year follow-up. Based on
estimated event rates, a sample size of 885 patients is needed to show
superiority of the FFR-guided revascularization with 80% power. Conclusion
The aim of the COMPARE-ACUTE trial is to assess whether FFR-guided
complete revascularization in the acute setting is superior to culprit
lesion treatment-only therapy.<br/>Copyright &#xa9; 2017 The Authors

<30>
Accession Number
613645680
Author
Browndyke J.N.; Berger M.; Harshbarger T.B.; Smith P.J.; White W.; Bisanar
T.L.; Alexander J.H.; Gaca J.G.; Welsh-Bohmer K.; Newman M.F.; Mathew J.P.
Institution
(Browndyke, Welsh-Bohmer) Geriatric Behavioral Health Division, Department
of Psychiatry and Behavioral Sciences, Duke University Medical Center,
Durham, NC, United States
(Browndyke) Institute for Brain Sciences, Duke University, Durham, NC,
United States
(Browndyke, Harshbarger) Brain Imaging and Analysis Center, Duke
University, Durham, NC, United States
(Berger) Division of Neuroanesthesiology, Department of Anesthesiology,
Duke University Medical Center, Durham, NC, United States
(Harshbarger) Department of Radiology, Duke University Medical Center,
Durham, NC, United States
(Smith) Behavioral Medicine Division, Department of Psychiatry and
Behavioral Sciences, Duke University Medical Center, Durham, NC, United
States
(White, Bisanar, Newman, Mathew) Department of Anesthesiology, Duke
University Medical Center, Durham, NC, United States
(Alexander) Division of Cardiology, Department of Medicine, Duke
University Medical Center, Durham, NC, United States
(Gaca) Division of Cardiothoracic Surgery, Department of Surgery, Duke
University Medical Center, Durham, NC, United States
Title
Resting-State Functional Connectivity and Cognition After Major Cardiac
Surgery in Older Adults without Preoperative Cognitive Impairment:
Preliminary Findings.
Source
Journal of the American Geriatrics Society. 65 (1) (pp e6-e12), 2017. Date
of Publication: 01 Jan 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: To look for changes in intrinsic functional brain connectivity
associated with postoperative changes in cognition, a common complication
in seniors undergoing major surgery, using resting-state functional
magnetic resonance imaging. Design: Objective cognitive testing and
functional brain imaging were prospectively performed at preoperative
baseline and 6 weeks after surgery and at the same time intervals in
nonsurgical controls. Setting: Academic medical center. Participants:
Older adults undergoing cardiac surgery (n = 12) and nonsurgical older
adult controls with a history of coronary artery disease (n = 12); no
participants had cognitive impairment at preoperative baseline
(Mini-Mental State Examination score >27). Measurements: Differences in
resting-state functional connectivity (RSFC) and global cognitive change
relationships were assessed using a voxel-wise intrinsic connectivity
method, controlling for demographic factors and pre- and perioperative
cerebral white matter disease volume. Analyses were corrected for multiple
comparisons (false discovery rate P <.01). Results: Global cognitive
change after cardiac surgery was significantly associated with intrinsic
RSFC changes in regions of the posterior cingulate cortex and right
superior frontal gyrus-anatomical and functional locations of the brain's
default mode network (DMN). No statistically significant relationships
were found between global cognitive change and RSFC change in nonsurgical
controls. Conclusion: Clinicians have long known that some older adults
develop postoperative cognitive dysfunction (POCD) after anesthesia and
surgery, yet the neurobiological correlates of POCD are not well defined.
The current results suggest that altered RSFC in specific DMN regions is
positively correlated with global cognitive change 6 weeks after cardiac
surgery, suggesting that DMN activity and connectivity could be important
diagnostic markers of POCD or intervention targets for potential POCD
treatment efforts.<br/>&#xa9; 2016, Copyright the Authors Journal
compilation &#xa9; 2016, The American Geriatrics Society

<31>
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

<32>
Accession Number
614848100
Author
De Caterina R.; Renda G.; Carnicelli A.P.; Nordio F.; Trevisan M.; Mercuri
M.F.; Ruff C.T.; Antman E.M.; Braunwald E.; Giugliano R.P.
Institution
(De Caterina, Renda) Institute of Cardiology and Center of Excellence on
Aging, G. d'Annunzio University, Chieti, Italy
(Carnicelli, Nordio, Trevisan, Ruff, Antman, Braunwald, Giugliano)
Cardiovascular Medicine Division, Brigham and Women's Hospital, Boston,
Massachusetts, United States
(Mercuri) Pharma Development, Daiichi-Sankyo, Parsippany, New Jersey,
United States
Title
Valvular Heart Disease Patients on Edoxaban or Warfarin in the ENGAGE
AF-TIMI 48 Trial.
Source
Journal of the American College of Cardiology. 69 (11) (pp 1372-1382),
2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background The use of non-vitamin K antagonist oral anticoagulants (NOACs)
instead of vitamin K antagonists (VKAs) in patients with atrial
fibrillation (AF) and coexisting valvular heart disease (VHD) is of
substantial interest. Objectives This study explored outcomes in patients
with AF with and without VHD in the ENGAGE AF-TIMI 48 (Effective
Anticoagulation with factor Xa Next Generation in Atrial
Fibrillation-Thrombolysis In Myocardial Infarction 48) trial, comparing
edoxaban with warfarin. Methods Valvular heart disease was defined as
history or baseline echocardiography evidence of at least moderate
aortic/mitral regurgitation, aortic stenosis, or prior valve surgery
(bioprosthesis replacement, valve repair, valvuloplasty). Patients with
moderate to severe mitral stenosis or mechanical heart valves were
excluded from the trial. Comparisons were made of rates of stroke/systemic
embolic event (SSEE), major bleeding, additional efficacy and safety
outcomes, as well as net clinical outcomes, in patients with or without
VHD treated with edoxaban or warfarin, using adjusted Cox proportional
hazards. Results After adjustment for multiple baseline characteristics,
compared with no-VHD patients (n = 18,222), VHD patients (n = 2,824) had a
similar rate of SSEE but higher rates of death (hazard ratio [HR]: 1.40;
95% confidence interval [CI]:1.26 to 1.56; p <0.001), major adverse
cardiovascular events (HR: 1.29; 95% CI: 1.16 to 1.43; p <0.001), and
major bleeding (HR: 1.21; 95% CI: 1.03 to 1.42; p = 0.02). Higher-dose
edoxaban regimen had efficacy similar to warfarin in the presence of VHD
(for SSEE, HR: 0.69; 95% CI: 0.44 to 1.07, in patients with VHD, and HR:
0.91; 95% CI: 0.77 to 1.07, in patients without VHD; p interaction
[p<inf>int</inf>] = 0.26; and for less major bleeding, HR: 0.74; 95% CI:
0.53 to 1.02 in patients with VHD, and HR: 0.82; 95% CI: 0.71 to 0.94, in
patients with no VHD; p<inf>int</inf> = 0.57). Conclusions The presence of
VHD increased the risk of death, major adverse cardiovascular events, and
major bleeding but did not affect the relative efficacy or safety of
higher-dose edoxaban versus warfarin in AF. (Global Study to Assess the
Safety and Effectiveness of Edoxaban (DU-176b) vs. Standard Practice of
Dosing With Warfarin in Patients With Atrial Fibrillation [ENGAGE AF-TIMI
48]; NCT00781391)<br/>Copyright &#xa9; 2017 The Authors

<33>
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.

<34>
[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.

<35>
Accession Number
614279210
Author
Lee S.-E.; Lin F.Y.; Lu Y.; Chang H.-J.; Min J.K.
Institution
(Lee, Chang) Division of Cardiology, Severance Cardiovascular Hospital,
Integrative Cardiovascular Imaging Center, Yonsei University College of
Medicine, Yonsei University Health System, Seoul, South Korea
(Lin, Lu, Min) Dalio Institute of Cardiovascular Imaging, New
York-Presbyterian Hospital and Weill Cornell Medical College, New York,
NY, United States
Title
Rationale and design of the Coronary Computed Tomographic Angiography for
Selective Cardiac Catheterization: Relation to Cardiovascular Outcomes,
Cost Effectiveness and Quality of Life (CONSERVE) trial.
Source
American Heart Journal. 186 (pp 48-55), 2017. Date of Publication: 01 Apr
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Although coronary computed tomography angiography (CCTA) has shown promise
as a "gatekeeper" to invasive coronary angiography (ICA) in longitudinal
cohort studies, it remains unknown whether the strategy of selective ICA
by initial performance of CCTA is either safe or effective when compared
with a direct ICA strategy in patients with an American Heart Association
(AHA)/American College of Cardiology (ACC) guideline-directed indication
for ICA. Objectives The CONSERVE trial is a prospective randomized
multicenter trial to determine the clinical effectiveness of "selective
catheterization" vs "direct catheterization" strategies for stable
patients with suspected but without known coronary artery disease, who
meet AHA/ACC guideline indication for ICA. Methods Patients being referred
for clinically indicated nonemergent ICA with an AHA/ACC class II
guideline indication for ICA will be randomized to either direct
catheterization or selective catheterization strategy. Patients in the
direct catheterization arm will proceed directly to ICA as planned,
whereas patients in the select catheterization arm will undergo initial
CCTA, followed by ICA at the discretion of the site physician. All CCTAs
and ICAs will be interpreted on site. Follow-up testing and/or therapy
after CCTA or ICA will be at the discretion of the site physician. Results
This trial will report a primary clinical end point of noninferiority
rates of major adverse cardiac events, as defined by the composite of
death, nonfatal myocardial infarction, unstable angina, stroke, urgent or
emergent coronary revascularization, or cardiac hospitalization.
Conclusion The CONSERVE trial will determine whether selective
catheterization strategy, based on initial CCTA in patients being referred
to ICA, is safe and effective.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<36>
Accession Number
615011844
Author
Conrotto F.; D'Ascenzo F.; D'Onofrio A.; Agrifoglio M.; Chieffo A.; Cioni
M.; Regesta T.; Tarantini G.; Gabbieri D.; Saia F.; Tamburino C.;
Ribichini F.; Cugola D.; Aiello M.; Sanna F.; Iadanza A.; Pompei E.;
Stolcova M.; Cappai A.; Minati A.; Cassese M.; Martinelli G.L.;
Agostinelli A.; Gerosa G.; Gaita F.; Rinaldit M.; Salizzoni S.
Institution
(Conrotto, D'Ascenzo, Gaita) Division of Cardiology, Citta della Salute e
della Scienza Hospital, Torino, Italy
(D'Onofrio, Tarantini, Gerosa) Department of Cardiac, Thoracic and
Vascular Sciences, University of Padova, Padova, Italy
(Agrifoglio) Centro Cardiologico Monzino, Department of Clinical Sciences
and Community, University of Milano, Milano, Italy
(Chieffo, Cioni) Ospedale San Raffaele, Milano, Italy
(Regesta) Divisione di Cardiochirurgia, IRCCS San Martino-IST, Genova,
Italy
(Gabbieri) Hesperia Hospital, Modena, Italy
(Saia) AOU Policlinico S. Orsola-Malpighi, Bologna, Italy
(Tamburino) Ospedale Ferrarotto, Universita di Catania, Catania, Italy
(Ribichini) AOU Integrata Verona, Verona, Italy
(Cugola) AO Papa Giovanni XXIII, Bergamo, Italy
(Aiello) IRCCS Policinico S. Matteo, Pavia, Italy
(Sanna) AO Brotzu, Cagliari, Italy
(Iadanza) AOU Policlinico Le Scotte, Siena, Italy
(Pompei) AOUD Santa Maria della Misericordia, Udine, Italy
(Stolcova) AOU Careggi, Firenze, Italy
(Cappai) Humanitas Research Hospital, Rozzano, Italy
(Minati) Ospedale Cattinara, Trieste, Italy
(Cassese, Martinelli) Clinica S. Maria, Bari, Italy
(Agostinelli) Ospedale Maggiore, Parma, Italy
(Rinaldit, Salizzoni) Department of Surgical Sciences, Citta della Salute
e della Scienza Hospital, Torino, Italy
Title
Predictive ability of the CHADS<inf>2</inf> and
CHA<inf>2</inf>DS<inf>2</inf>-VASc scores for stroke after transcatheter
aortic balloon-expandable valve implantation: An Italian Transcatheter
Balloon-Expandable Valve Implantation Registry (ITER) sub-analysis.
Source
European Journal of Cardio-thoracic Surgery. 50 (5) (pp 867-873), 2016.
Date of Publication: 01 Nov 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Stroke incidence after transcatheter aortic valve implantation
(TAVI) still represents a concern. This multicentre study aimed at
investigating the hypothesis that CHADS2 and CHA2DS2-VASc scores may be
used to predict perioperative stroke after TAVI. METHODS: The Italian
Transcatheter Balloon-Expandable Valve Implantation Registry (ITER) is a
multicentre, prospective registry of patients undergoing
balloon-expandable TAVI using Edwards Sapien and Sapien XT prosthesis
between 2007 and 2012. The primary endpoint of this study was the 30-day
stroke rate. Secondary safety end-points were all the major adverse events
based on Valve Academic Research Consortium (VARC-2) criteria. RESULTS:
One thousand nine hundred and four patients were enrolled in the registry.
Mean age was 81.6 +/- 6.2 years and 1147 (60.2%) patients were female;
mean CHADS<inf>2</inf> and CHA<inf>2</inf>DS<inf>2</inf>-VASc scores were
2.2 +/- 0.8 and 4.4 +/- 1.1, respectively. Fifty-four (2.8%) patients had
a stroke within 30 days. At multivariable logistic regression analysis,
CHA2DS<inf>2</inf>-VASc (OR: 1.35, 95% CI: 1.03-1.78; P = 0.031) and
previous cardiac surgery (OR: 1.96, 95% CI: 1.06-3.6; P = 0.033) but not
CHADS<inf>2</inf> (OR: 1.05, 95% CI: 0.76-1.44; P = 0.77) were found to be
independent predictors of in-hospital stroke. A
CHA<inf>2</inf>DS<inf>2</inf>-VASc score >=5 was strongly related to the
occurrence of in-hospital stroke (OR: 2.51, 95% CI: 1.38-4.57; P= 0.001).
However, CHA<inf>2</inf>DS<inf>2</inf>-VASc score showed only poor
accuracy for in-hospital stroke with a trend for better accuracy when
compared with CHADS<inf>2</inf> score (area under the curve: 0.61, 95% CI:
0.59-0.63 vs 0.51; 95% CI: 0.49-0.54, respectively, P = 0.092).
CONCLUSIONS: In TAVI patients, CHA<inf>2</inf>DS<inf>2</inf>-VASc provided
a strong correlation for in-hospital stroke but with low accuracy.
Dedicated scores to properly tailor procedures and preventive strategies
are needed.<br/>Copyright &#xa9; The Author 2016. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<37>
Accession Number
617323362
Author
Anonymous
Title
Corrigendum to: Impact of antioxidant supplementations on cardio-renal
protection in cardiac surgery: an updated and comprehensive meta-analysis
and systematic review (Cardiovascular Therapeutics, (2016), 34, 5,
(360-370), 10.1111/1755-5922.12207).
Source
Cardiovascular Therapeutics. 35 (4) (no pagination), 2017. Article Number:
e12287. Date of Publication: August 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
In the article titled "Impact of antioxidant supplementations on
cardio-renal protection in cardiac surgery: an updated and comprehensive
meta-analysis and systematic review," the name of the first author was
incorrectly submitted as Sadegh Ali-Hassan-Sayegh. The author's name
should have been written as Sadeq Ali-Hasan-Al-Saegh.<br/>Copyright &#xa9;
2017 John Wiley & Sons Ltd

<38>
Accession Number
617321758
Author
Woodward C.; Taylor R.; Son M.; Taeed R.; Jacobs M.L.; Kane L.; Jacobs
J.P.; Husain S.A.
Institution
(Woodward, Taylor, Son, Taeed) Department of Pediatrics, University of
Texas Health Science Center-San Antonio, San Antonio, TX, United States
(Jacobs) Department of Surgery, Johns Hopkins School of Medicine,
Broadway, Baltimore, MD, United States
(Kane) Division of Congenital Heart Surgery, Baylor College of Medicine,
Houston, TX, United States
(Jacobs) Division of Cardiovascular Surgery, Johns Hopkins All Children's
Heart Institute, St Petersburg, FL, United States
(Husain) Division of Cardiothoracic Surgery, University of Texas Health
Science Center-San Antonio, San Antonio, TX, United States
Title
Multicenter Quality Improvement Project to Prevent Sternal Wound
Infections in Pediatric Cardiac Surgery Patients.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 8 (4) (pp
453-459), 2017. Date of Publication: 01 Jul 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Children undergoing cardiac surgery are at risk for sternal
wound infections (SWIs) leading to increased morbidity and mortality.
Single-center quality improvement (QI) initiatives have demonstrated
decreased infection rates utilizing a bundled approach. This multicenter
project was designed to assess the efficacy of a protocolized approach to
decrease SWI. Methods: Pediatric cardiac programs joined a collaborative
effort to prevent SWI. Programs implemented the protocol, collected
compliance data, and provided data points from local clinical registries
using Society of Thoracic Surgery Congenital Heart Surgery Database
harvest-compliant software or from other registries. Results: Nine
programs prospectively collected compliance data on 4,198 children. Days
between infections were extended from 68.2 days (range: 25-82) to 130 days
(range: 43-412). Protocol compliance increased from 76.7% (first quarter)
to 91.3% (final quarter). Ninety (1.9%) children developed an SWI
preprotocol and 64 (1.5%) postprotocol, P =.18. The 657 (15%) delayed
sternal closure patients had a 5% infection rate with 18 (5.7%) in year 1
and 14 (4.3%) in year 2 P =.43. Delayed sternal closure patients
demonstrated a trend toward increased risk for SWI of 1.046 for each day
the sternum remained open, P =.067. Children who received appropriately
timed preop antibiotics developed less infections than those who did not,
1.9% versus 4.1%, P =.007. Conclusion: A multicenter QI project to reduce
pediatric SWIs demonstrated an extension of days between infections and a
decrease in SWIs. Patients who received preop antibiotics on time had
lower SWI rates than those who did not.<br/>Copyright &#xa9; 2017, &#xa9;
The Author(s) 2017.

<39>
Accession Number
617321678
Author
Russell R.A.; Rettiganti M.; Brundage N.; Jeffries H.E.; Gupta P.
Institution
(Russell) Division of Pediatric Critical Care, Department of Pediatrics,
Medical College of Wisconsin, Milwaukee, WI, United States
(Rettiganti) Section of Biostatistics, Department of Pediatrics,
University of Arkansas for Medical Sciences, Little Rock, AR, United
States
(Brundage) Virtual PICU Systems, LLC, Los Angeles, CA, United States
(Jeffries) Division of Pediatric Critical Care, Department of Pediatrics,
Seattle Children's Hospital, University of Washington, School of Medicine,
Seattle, WA, United States
(Gupta) Division of Pediatric Cardiology, Department of Pediatrics,
College of Medicine, Arkansas Children's Hospital, University of Arkansas
for Medical Sciences, Little Rock, AR, United States
Title
Performance of Pediatric Risk of Mortality Score Among Critically Ill
Children With Heart Disease.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 8 (4) (pp
427-434), 2017. Date of Publication: 01 Jul 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objective: To evaluate the performance of the Pediatric Risk of Mortality
3 (PRISM-3) score in critically ill children with heart disease. Methods:
Patients <18 years of age admitted with cardiac diagnoses (cardiac medical
and cardiac surgical) to one of the participating pediatric intensive care
units in the Virtual Pediatric Systems, LLC, database were included.
Performance of PRISM-3 was evaluated with discrimination and calibration
measures among both cardiac surgical and cardiac medical patients.
Results: The study population consisted of 87,993 patients, of which 49%
were cardiac medical patients (n = 43,545) and 51% were cardiac surgical
patients (n = 44,448). The ability of PRISM-3 to distinguish survivors
from nonsurvivors was acceptable for the entire cohort (c-statistic 0.86).
However, PRISM-3 did not perform as well when stratified by varied
severity of illness categories. Pediatric Risk of Mortality 3
underpredicted mortality among patients with lower severity of illness
categories (quintiles 1-4) whereas it overpredicted mortality among
patients with greatest severity of illness category (fifth quintile). When
stratified by Society of Thoracic Surgeons-European Association for
Cardiothoracic Surgery (STS-EACTS) categories, PRISM-3 overpredicted
mortality among the STS-EACTS mortality categories 1, 2, and 3 and
underpredicted mortality among the STS-EACTS mortality categories 4 and 5.
Pediatric Risk of Mortality 3 overpredicted mortality among centers with
high cardiac surgery volume whereas it underpredicted mortality among
centers with low cardiac surgery volume. Conclusion: Data from this large
multicenter study do not support the use of PRISM-3 in cardiac surgical or
cardiac medical patients. In this study, the ability of PRISM-3 to
distinguish survivors from nonsurvivors was fair at best, and the accuracy
with which it predicted death was poor.<br/>Copyright &#xa9; 2017, &#xa9;
The Author(s) 2017.

<40>
Accession Number
617279769
Author
Krzysztof S.; Wojciech P.; Zbigniew S.; Mariusz K.; Remigiusz T.; Damian
P.; Magdalena S.; Marta T.; Lech A.; Alina B.
Institution
(Krzysztof, Magdalena, Marta, Alina) Department of Clinical
Neuropsychology, Nicolaus Copernicus University, Collegium Medicum,
Bydgoszcz, Poland
(Wojciech, Mariusz, Remigiusz, Damian, Lech) Department of Cardiac
Surgery, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz,
Poland
(Zbigniew) Department of Radiology, Nicolaus Copernicus University,
Collegium Medicum, Bydgoszcz, Poland
Title
CArbon dioxide surgical field flooding and aortic NO-touch off-pump
coronary artery bypass grafting to reduce Neurological injuries after
surgical coronary revascularisation (CANON): Protocol for a randomised,
controlled, investigator and patient blinded single-centre superiority
trial with three parallel arms.
Source
BMJ Open. 7 (7) (no pagination), 2017. Article Number: e016785. Date of
Publication: 01 Jul 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Neurological injuries remain a major concern following
coronary artery bypass grafting (CABG) that offsets survival benefit of
CABG over percutaneous coronary interventions. Among numerous efforts to
combat this issue is the development of off-pump CABG (OPCABG) that
obviates the need for extracorporeal circulation and is associated with
improved neurological outcomes. The objective of this study is to examine
whether the neuroprotective effect of OPCABG can be further pronounced by
the use of two state-of-the-art operating techniques. Methods and analysis
In this randomised, controlled, investigator and patient blinded
single-centre superiority trial with three parallel arms, a total of 360
patients will be recruited. They will be allocated in a 1:1:1 ratio to two
treatment arms and one control arm. Treatment arms undergoing either
aortic no-touch OPCABG or OPCABG with partial clamp applying carbon
dioxide surgical field flooding will be compared against control arm
undergoing OPCABG with partial clamp. The primary endpoint will be the
appearance of new lesions on control brain MRI 3 days after surgery.
Secondary endpoints will include the prevalence of new focal neurological
deficits in the first 7 days after surgery, the occurrence of
postoperative cognitive dysfunction at either 1 week or 3 months after
surgery and the incidence of delirium in the first 7 days after surgery.
Data will be analysed on intention-to-treat principles and a per protocol
basis. Ethics and dissemination Ethical approval has been granted for this
study. Results will be disseminated through peer-reviewed
media.<br/>Copyright &#xa9; Article author(s) (or their employer(s) unless
otherwise stated in the text of the article) 2017. All rights reserved.

<41>
Accession Number
617328917
Author
Sabato L.A.; Salerno D.M.; Moretz J.D.; Jennings D.L.
Institution
(Sabato) Heart Failure and Cardiac Transplantation Department of Pharmacy
UC Health-University of Cincinnati Medical Center Cincinnati, Ohio
(Salerno) Solid Organ Transplantation Department of Pharmacy
NewYork-Presbyterian Hospital - Weill Cornell Medical Center New York, New
York
(Moretz) Ventricular Assist Devices Department of Pharmacy Vanderbilt
University Medical Center Nashville, Tennessee
(Jennings) Heart Transplant and Mechanical Circulatory Support Department
of Pharmacy New York-Presbyterian Hospital - Columbia University Medical
Center New York, NY
Title
Inhaled Pulmonary Vasodilator Therapy for Management of Right Ventricular
Dysfunction after Left Ventricular Assist Device Placement and Cardiac
Transplantation.
Source
Pharmacotherapy. (no pagination), 2017. Date of Publication: 2017.
Publisher
Pharmacotherapy Publications Inc.
Abstract
Right ventricular failure (RVF) after cardiac transplant (CTX) or
implantation of a continuous-flow left ventricular assist device (CF-LVAD)
is associated with significant postoperative morbidity and mortality. A
variety of modalities have been used to treat postoperative RVF, including
management of volume status, intravenous inotropes and vasodilators, and
right-sided mechanical support. Inhaled vasodilator agents are a unique
treatment option aimed at minimizing systemic absorption by delivering
therapy directly to the pulmonary vasculature. Current LVAD and CTX
guidelines endorse inhaled vasodilators for managing postoperative RVF;
however, no guidance is offered regarding agent selection, dosing, or
administration. A review of the current literature confirms that inhaled
pulmonary vasodilator agents have been shown to decrease pulmonary artery
pressure when used in the perioperative period of CF-LVAD implant or CTX.
However, the literature regarding the potential impact on clinical
outcomes (e.g., survival or risk of developing RVF) is lacking with these
medications. Based on our assessment of the literature, we suggest that
when RVF occurs in the setting of a normal pulmonary vascular resistance
(PVR), traditional inotropic therapy (e.g., dobutamine) should be used.
Conversely, if the PVR is elevated (> 250 dynes/sec/cm⁵ or 3
Wood units), or the patient has other evidence of a high right ventricular
afterload (i.e., a transpulmonary gradient > 12 mm Hg), then an inhaled
pulmonary vasodilator would be the preferred initial pharmacologic agent.
Drug selection depends largely on the institution's capacity to safely
prepare and administer the medication, along with formulary
considerations, such as the high costs associated with inhaled iloprost
and inhaled nitric oxide.<br/>Copyright &#xa9; 2017 Pharmacotherapy
Publications, Inc.

<42>
Accession Number
617170179
Author
Han Z.; Chen Z.; Lan R.; Di W.; Li X.; Yu H.; Ji W.; Zhang X.; Xu B.; Xu
W.
Institution
(Han, Chen, Lan, Di, Li, Yu, Ji, Zhang, Xu, Xu) Department of Cardiology,
Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital,
Nanjing, China
Title
Sex-specific mortality differences in heart failure patients with ischemia
receiving cardiac resynchronization therapy.
Source
PLoS ONE. 12 (7) (no pagination), 2017. Article Number: e0180513. Date of
Publication: July 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Recent studies have reported prognosis differences between male
and female heart failure patients following cardiac resynchronization
therapy (CRT). However, the potential clinical factors that underpin these
differences remain to be elucidated. Methods A meta-analysis was performed
to investigate the factors that characterize sex-specific differences
following CRT. This analysis involved searching the Medline (Pubmed
source) and Embase databases in the period from January 1980 to September
2016. Results Fifty-eight studies involving 33445 patients (23.08% of whom
were women) were analyzed as part of this study. Only patients receiving
CRT with follow-up greater than six months were included in our analysis.
Compared with males, females exhibited a reduction of 33% (hazard ratio,
0.67; 95% confidence interval, 0.62-0.73; P < 0.0001) and 42% (hazard
ratio, 0.58; 95% confidence interval, 0.46-0.74; P = 0.003) in all-cause
mortality and heart failure hospitalization or heart failure,
respectively. Following a stratified analysis of all-cause mortality, we
observed that ischemic causes (p = 0.03) were likely to account for most
of the sex-specific differences in relation to CRT. Conclusion These data
suggest that women have a reduced risk of all-cause mortality and heart
failure hospitalization or heart failure following CRT. Based on the
results from the stratified analysis, we observed more optimal outcomes
for females with ischemic heart disease. Thus, ischemia are likely to play
a role in sex-related differences associated with CRT in heart failure
patients. Further studies are required to determine other indications and
the potential mechanisms that might be associated with sex-specific CRT
outcomes.<br/>Copyright &#xa9; 2017 Han 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.

<43>
[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.

<44>
[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.

<45>
Accession Number
617307370
Author
Kamali A.; Rostami A.; Modir H.; Shokrpour M.
Institution
(Kamali, Modir) Department of Anesthesiology, Arak University of Medical
Sciences, Arak, Iran, Islamic Republic of
(Rostami) Department of Cardiac Surgery, Arak University of Medical
Sciences, Arak, Iran, Islamic Republic of
(Shokrpour) Department of Gynecology, Arak University of Medical Sciences,
Arak, Iran, Islamic Republic of
Title
Studying the effects of BIS monitoring (depth of anesthesia) in early
extubation of patients candidated for non-emergency CABG.
Source
Biomedical and Pharmacology Journal. 10 (1) (pp 199-206), 2017. Date of
Publication: 2017.
Publisher
Oriental Scientific Publishing Company
Abstract
Early extubated of open heart surgery patients (T <8hr) benefits for the
patient so that led to reduced hospital stay, reduced need for nursing
care, reduced length of stay in the ICU and reduce the risk of
ventilator-associated pneumonia is. Therefore the effect of BIS monitoring
on the patients after open heart surgery are extubated early. This study
is a randomized, double blind, randomized clinical trial on patients
undergoing elective CABG were done in hospitals Amir. A total of 120
patients were randomized into two groups and monitoring (B) BIS and
monitoring (N) BIS groups. The duration of extubated patients after open
heart ICU admission were compared between the 2 groups. The mean BIS
Monitor blood pressure before induction of anesthesia before surgery,
2.5-/ + 115 and without Monitor 3.6-/ + 121, respectively. The heart rate
monitors in group BIS 5/ 4-/ + 72 and without Monitor 6.4-/ + 70. The mean
extubation time in hours at the monitor BIS 6/ 3-/ + 4/5 hours at no
monitor BIS 3/4-/ + 2/6 hours. Given that no significant difference was
seen between the two groups P d" 0/05. The use of monitoring BIS (Depth of
Anesthesia) during CABG surgery resulted in a reduction of patients
extubated in the ICU, open heart, reducing the pain score at 12 and 24
hours after the operation.

<46>
Accession Number
617300999
Author
Mannhardt I.; Eder A.; Dumotier B.; Prondzynski M.; Kr-amer E.; Traebert
M.; Flenner F.; Stathopoulou K.; Lemoine M.D.; Carrier L.; Christ T.;
Eschenhagen T.; Hansen A.
Institution
(Mannhardt, Eder, Prondzynski, Kr-amer, Traebert, Flenner, Stathopoulou,
Lemoine, Carrier, Christ, Eschenhagen, Hansen) Department of Experimental
Pharmacology and Toxicology, Cardiovascular Research Center, University
Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
(Mannhardt, Eder, Prondzynski, Kr-amer, Traebert, Flenner, Stathopoulou,
Lemoine, Carrier, Christ, Eschenhagen, Hansen) DZHK (German Center for
Cardiovascular Research), Partner Site Hamburg/Kiel/Lu- beck, Hamburg
20246, Germany
(Dumotier) Novartis Pharma AG, Basel CH-4002, Switzerland
(Lemoine) Department of Cardiology-Electrophysiology, University Heart
Center, Hamburg 20246, Germany
Title
Blinded contractility analysis in hipsc-cardiomyocytes in engineered heart
tissue format: Comparison with human atrial trabeculae.
Source
Toxicological Sciences. 158 (1) (pp 164-175), 2017. Article Number:
kfx081. Date of Publication: 01 Jul 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CM) may
serve as a new assay for drug testing in a human context, but their
validity particularly for the evaluation of inotropic drug effects remains
unclear. In this blinded analysis, we compared the effects of 10 indicator
compounds with known inotropic effects in electrically stimulated (1.5Hz)
hiPSC-CM-derived 3-dimensional engineered heart tissue (EHT) and human
atrial trabeculae (hAT). Human EHTs were prepared from iCell hiPSCCM, hAT
obtained at routine heart surgery. Mean intra-batch variation coefficient
in baseline forcemeasurement was 17% for EHT and 49% for hAT. The
PDE-inhibitormilrinone did not affect EHT contraction force, but increased
force in hAT. Citalopram (selective serotonin reuptake inhibitor),
nifedipine (LTCC-blocker) and lidocaine (Na+ channel-blocker) had negative
inotropic effects on EHT and hAT. Formoterol (beta-2 agonist) had positive
lusitropic but no inotropic effect in EHT, and positive clinotropic,
lusitropic, and inotropic effects in hAT. Tacrolimus
(calcineurin-inhibitor) had a negative inotropic effect in EHTs, but no
effect in hAT. Digoxin (Na⁺-K⁺-ATPase-inhibitor)
showed a positive inotropic effect only in EHTs, but no effect in hAT
probably due to short incubation time. Ryanodine (ryanodine
receptor-inhibitor) reduced contraction force in bothmodels. Rolipram and
acetylsalicylic acid showed noninterpretable results in hAT. Contraction
amplitude and kinetics were more stable over time and less variable in
hiPSC-EHTs than hAT. HiPSC-EHT faithfully detected cAMP-dependent and
-independent positive and negative inotropic effects, but limited beta-2
adrenergic or PDE3 effects, compatible with an immature CM
phenotype.<br/>Copyright &#xa9; The Author 2017. Published by Oxford
University Press on behalf of the Society of Toxicology. All rights
reserved.

<47>
Accession Number
617299562
Author
Cavalcante R.; Sotomi Y.; Mancone M.; Whan Lee C.; Ahn J.-M.; Onuma Y.;
Lemos P.A.; Van Geuns R.-J.; Park S.-J.; Serruys P.W.
Institution
(Cavalcante, Mancone, Onuma, Van Geuns) Thoraxcenter, Erasmus University
Medical Center, 's-Gravendijkwal 230, Rotterdam 3015 CE, Netherlands
(Cavalcante, Lemos) Department of Interventional Cardiology, Heart
Institute (InCor), University of Sao Paulo Medical School, Av. Dr. Eneas
de Carvalho Aguiar, 44 - Pinheiros, Sao Paulo - SP, Brazil
(Sotomi) Academic Medical Center, University of Amsterdam, Meibergdreef 9,
Amsterdam-Zuidoost 1105 AZ, Netherlands
(Mancone) Department of Cardiovascular, Respiratory, Nephrologic,
Anesthesiological and Geriatric Sciences, Sapienza University of Rome,
Policlinico Umberto i, Viale del Policlinico 155, Rome 00161, Italy
(Whan Lee, Ahn, Park) Department of Cardiology, Heart Institute,
University of Ulsan College of Medicine, Asan Medical Center,
Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea
(Serruys) Imperial College London, London, United Kingdom
Title
Impact of the SYNTAX scores i and II in patients with diabetes and
multivessel coronary disease: A pooled analysis of patient level data from
the SYNTAX, PRECOMBAT, and BEST trials.
Source
European Heart Journal. 38 (25) (pp 1969-1977), 2017. Date of Publication:
01 Jul 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims To assess the impact of the SYNTAX scores I and II in outcomes after
percutaneous coronary intervention (PCI) and coronary artery bypass graft
(CABG) for patients with diabetes and multivessel disease (MVD). Methods
and results We performed a patient-level pooled analysis of three large
randomized trials of patients with MVD. The impact of coronary anatomic
complexity as measured by the SYNTAX score in the differences in outcomes
following PCI and CABG was assessed at a median follow-up of 5 years. We
also assessed the performance of the SYNTAX II score model in patients
with and without diabetes. From the 3280 patients enrolled in the three
trials, a total of 1068 (32.6%) had diabetes. The rate of the composite of
death, myocardial infarction (MI), or stroke was similar in the PCI and
CABG arms in patients with low-intermediate (<=32) SYNTAX scores (15.1%
vs. 14.9%, respectively; P = 0.93) while it was significantly higher in
the PCI arm in patients with high (>=33) SYNTAX scores (24.5% vs. 13.2%,
respectively; P = 0.018). The SYNTAX score II showed good calibration and
moderate discrimination ability in patients with diabetes (c-index = 0.68)
as well as in those without (c-index = 0.67). Conclusions Differences in 5
years outcomes following PCI and CABG for patients with MVD and diabetes
were influenced by anatomic complexity as measured by the SYNTAX score.
The SYNTAX score II mortality prediction model showed similar performance
regardless of the diabetes status.<br/>Copyright &#xa9; The Author 2017.
All rights reserved.

<48>
Accession Number
617299526
Author
Pellicano M.; De Bruyne B.; Toth G.G.; Casselman F.; Wijns W.; Barbato E.
Institution
(Pellicano, De Bruyne, Toth, Casselman, Wijns, Barbato) Cardiovascular
Research Center Aalst, OLV Clinic, Moorselbaan n 164, Aalst B 9300,
Belgium
(Pellicano, Barbato) Division of Cardiology, Department of Advanced
Biomedical Sciences, University of Naples Federico II, Naples, Italy
(Toth) University Heart Center Graz, Medical University Graz, Graz,
Austria
(Wijns) Lambe Institute for Translational Medicine and Curam, National
University of Ireland, Galway and Saolta University Healthcare Group,
Galway, Ireland
Title
Fractional flow reserve to guide and to assess coronary artery bypass
grafting.
Source
European Heart Journal. 38 (25) (pp 1959-1968), 2017. Date of Publication:
01 Jul 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
The aim of this review is to highlight the role of invasive functional
evaluation in patients in whom coronary artery bypass graft (CABG) is
indicated, and to examine the clinical evidence available in favour of
fractional flow reserve (FFR) adoption in these patients, outline
appropriate use, as well as point out potential pitfalls. FFR after CABG
will also be reviewed, highlighting its correct interpretation and
adoption when applied to both native coronary arteries and bypass grafts.
Practice European guidelines support the use of FFR to complement coronary
angiography with the highest degree of recommendation (Class IA) for the
assessment of coronary stenosis before undertaking myocardial
revascularization when previous non-invasive functional evaluation is
unavailable or not conclusive. As a result, FFR has been adopted in
routine clinical practice to guide clinicians decision as to whether or
not perform a revascularization. Of note, due to the increasing confidence
of the interventional cardiologists, FFR guidance is also being
implemented to indicate or guide CABG. This is in anticipation of
supportive clear-cut evidence, since recommendations for FFR adoption were
based on randomized clinical trials investigating percutaneous coronary
intervention (PCI) strategies in which patients with typical indications
for CABG were excluded (e.g. left main disease, valvular disease, and
coronary anatomy unsuitable for PCI). Based on the critical appraisal of
the literature, FFR can play an important role in risk stratification and
determining management strategy of patients either before or after
CABG.<br/>Copyright &#xa9; The Author 2016. All rights reserved.

<49>
Accession Number
617315797
Author
Benedetto U.; Caputo M.; Guida G.; Bucciarelli-Ducci C.; Thai J.; Bryan
A.; Angelini G.D.
Institution
(Benedetto, Caputo, Guida, Bucciarelli-Ducci, Thai, Bryan, Angelini)
Bristol Heart Institute, University of Bristol, School of Clinical
Sciences, Bristol, UK
Title
Carbon Dioxide Insufflation During Cardiac Surgery: A Meta-analysis of
Randomized Controlled Trials.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Despite the widespread use of carbon dioxide insufflation (CDI) in cardiac
surgery, there is still paucity of evidence to prove its benefit in terms
of neurologic protection. Therefore, we conducted a meta-analysis of
available randomized controlled trials comparing CDI vs standard de-airing
maneuvers. Electronic searches were performed to identify relevant
randomized controlled trials. Primary outcomes investigated were
postoperative stroke, neurocognitive deterioration, and in-hospital
mortality. Risk difference (RD) was used as summary statistic. Pooled
estimates were obtained by means of random-effects model to account for
possible clinical diversity and methodological variation between studies.
Eight studies were identified with 668 patients randomized to CDI (n =
332) vs standard de-airing maneuvers (n = 336). In-hospital mortality was
2.1% vs 3.0% in the CDI and control group, respectively (RD 0%; 95%
confidence interval [CI] -2% to 2%; P = 0.87; I² = 0%).
Incidence of stroke was similar between the 2 groups (1.0% vs 1.2% in the
CDI and control group, respectively; RD 0%; 95% CI -1% to 2%; P = 0.62;
I² = 0%). Neurocognitive deterioration rate was 12% vs 21% in
the CDI and control group, respectively, but this difference was not
statistically significant (RD: -7%; 95% CI -0.22% to 8%; P = 0.35;
I² = 0%). The present meta-analysis did not find any
significant protective effect from the use of CDI when compared with
manual de-airing maneuvers in terms of clinical outcomes, including
postoperative neurocognitive decline.<br/>Copyright &#xa9; 2017 Elsevier
Inc.

<50>
Accession Number
617315753
Author
Vida V.L.; Zanotto L.; Stellin G.; Padalino M.; Sarris G.; Protopapas E.;
Prospero C.; Pizarro C.; Woodford E.; Tlaskal T.; Berggren H.; Kostolny
M.; Omeje I.; Asfour B.; Kadner A.; Carrel T.; Schoof P.H.; Nosal M.;
Fragata J.; Kozlowski M.; Maruszewski B.; Vricella L.A.; Cameron D.E.;
Sojak V.; Hazekamp M.; Salminen J.; Mattila I.P.; Cleuziou J.; Myers P.O.;
Hraska V.
Institution
(Vida, Zanotto, Zanotto, Stellin) Paediatric and Congenital Cardiac
Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences,
University of Padua, Padua, Italy
(Vida, Zanotto, Zanotto, Stellin) Department of Statistical Sciences,
University of Padua, Padua, Italy
(Padalino, Sarris, Protopapas, Prospero, Pizarro, Woodford, Tlaskal,
Berggren, Kostolny, Omeje, Asfour, Kadner, Carrel, Schoof, Nosal, Fragata,
Kozlowski, Maruszewski, Vricella, Cameron, Sojak, Hazekamp, Salminen,
Mattila, Cleuziou, Myers, Hraska) Paediatric and Congenital Cardiac
Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences,
University of Padua, Padua, Italy
(Padalino, Sarris, Protopapas, Prospero, Pizarro, Woodford, Tlaskal,
Berggren, Kostolny, Omeje, Asfour, Kadner, Carrel, Schoof, Nosal, Fragata,
Kozlowski, Maruszewski, Vricella, Cameron, Sojak, Hazekamp, Salminen,
Mattila, Cleuziou, Myers, Hraska) Athens Heart Surgery Institute and
Department of Pediatric and Congenital Cardiac Surgery, Iaso Children's
Hospital, Athens, Greece
(Padalino, Sarris, Protopapas, Prospero, Pizarro, Woodford, Tlaskal,
Berggren, Kostolny, Omeje, Asfour, Kadner, Carrel, Schoof, Nosal, Fragata,
Kozlowski, Maruszewski, Vricella, Cameron, Sojak, Hazekamp, Salminen,
Mattila, Cleuziou, Myers, Hraska) Nemours Cardiac Center, Alfred I. duPont
Hospital for Children, Wilmington, Delaware, USA
(Padalino, Sarris, Protopapas, Prospero, Pizarro, Woodford, Tlaskal,
Berggren, Kostolny, Omeje, Asfour, Kadner, Carrel, Schoof, Nosal, Fragata,
Kozlowski, Maruszewski, Vricella, Cameron, Sojak, Hazekamp, Salminen,
Mattila, Cleuziou, Myers, Hraska) Children's Heart Centre, University
Hospital Motol, Prague, Czech Republic
(Padalino, Sarris, Protopapas, Prospero, Pizarro, Woodford, Tlaskal,
Berggren, Kostolny, Omeje, Asfour, Kadner, Carrel, Schoof, Nosal, Fragata,
Kozlowski, Maruszewski, Vricella, Cameron, Sojak, Hazekamp, Salminen,
Mattila, Cleuziou, Myers, Hraska) Department of Molecular and Clinical
Medicine, Children's Heart Center, The Queen Silvia's Children's Hospital,
Goteborg, Sweden
(Padalino, Sarris, Protopapas, Prospero, Pizarro, Woodford, Tlaskal,
Berggren, Kostolny, Omeje, Asfour, Kadner, Carrel, Schoof, Nosal, Fragata,
Kozlowski, Maruszewski, Vricella, Cameron, Sojak, Hazekamp, Salminen,
Mattila, Cleuziou, Myers, Hraska) Great Ormond Street Hospital,
Cardiothoracic Unit, London, UK
(Padalino, Sarris, Protopapas, Prospero, Pizarro, Woodford, Tlaskal,
Berggren, Kostolny, Omeje, Asfour, Kadner, Carrel, Schoof, Nosal, Fragata,
Kozlowski, Maruszewski, Vricella, Cameron, Sojak, Hazekamp, Salminen,
Mattila, Cleuziou, Myers, Hraska) Herma Heart Center, Medical College of
Wisconsin, Wisconsin, USA
(Padalino, Sarris, Protopapas, Prospero, Pizarro, Woodford, Tlaskal,
Berggren, Kostolny, Omeje, Asfour, Kadner, Carrel, Schoof, Nosal, Fragata,
Kozlowski, Maruszewski, Vricella, Cameron, Sojak, Hazekamp, Salminen,
Mattila, Cleuziou, Myers, Hraska) Department for Cardiovascular Surgery,
University of Bern, Bern, Switzerland
(Padalino, Sarris, Protopapas, Prospero, Pizarro, Woodford, Tlaskal,
Berggren, Kostolny, Omeje, Asfour, Kadner, Carrel, Schoof, Nosal, Fragata,
Kozlowski, Maruszewski, Vricella, Cameron, Sojak, Hazekamp, Salminen,
Mattila, Cleuziou, Myers, Hraska) University Medical Center Utrecht,
Utrecht, Netherlands
(Padalino, Sarris, Protopapas, Prospero, Pizarro, Woodford, Tlaskal,
Berggren, Kostolny, Omeje, Asfour, Kadner, Carrel, Schoof, Nosal, Fragata,
Kozlowski, Maruszewski, Vricella, Cameron, Sojak, Hazekamp, Salminen,
Mattila, Cleuziou, Myers, Hraska) Childrens Heart Centre Slovak Republic,
Bratislava, Slovakia
(Padalino, Sarris, Protopapas, Prospero, Pizarro, Woodford, Tlaskal,
Berggren, Kostolny, Omeje, Asfour, Kadner, Carrel, Schoof, Nosal, Fragata,
Kozlowski, Maruszewski, Vricella, Cameron, Sojak, Hazekamp, Salminen,
Mattila, Cleuziou, Myers, Hraska) Department of Cardiothoracic Surgery,
Hospital de Santa Marta and Nova Medical School, Lisbon, Portugal
(Padalino, Sarris, Protopapas, Prospero, Pizarro, Woodford, Tlaskal,
Berggren, Kostolny, Omeje, Asfour, Kadner, Carrel, Schoof, Nosal, Fragata,
Kozlowski, Maruszewski, Vricella, Cameron, Sojak, Hazekamp, Salminen,
Mattila, Cleuziou, Myers, Hraska) Children's Memorial Health Institute
Varsavia, Poland
(Padalino, Sarris, Protopapas, Prospero, Pizarro, Woodford, Tlaskal,
Berggren, Kostolny, Omeje, Asfour, Kadner, Carrel, Schoof, Nosal, Fragata,
Kozlowski, Maruszewski, Vricella, Cameron, Sojak, Hazekamp, Salminen,
Mattila, Cleuziou, Myers, Hraska) Division of Cardiac Surgery, Johns
Hopkins University, Baltimore, USA
(Padalino, Sarris, Protopapas, Prospero, Pizarro, Woodford, Tlaskal,
Berggren, Kostolny, Omeje, Asfour, Kadner, Carrel, Schoof, Nosal, Fragata,
Kozlowski, Maruszewski, Vricella, Cameron, Sojak, Hazekamp, Salminen,
Mattila, Cleuziou, Myers, Hraska) Department of Cardiothoracic Surgery,
Leiden University Medical Center, Leiden, Netherlands
(Padalino, Sarris, Protopapas, Prospero, Pizarro, Woodford, Tlaskal,
Berggren, Kostolny, Omeje, Asfour, Kadner, Carrel, Schoof, Nosal, Fragata,
Kozlowski, Maruszewski, Vricella, Cameron, Sojak, Hazekamp, Salminen,
Mattila, Cleuziou, Myers, Hraska) Division of Pediatric Surgery,
Department of Children and Adolescents, Helsinki University Hospital,
Helsinki, Finland
(Padalino, Sarris, Protopapas, Prospero, Pizarro, Woodford, Tlaskal,
Berggren, Kostolny, Omeje, Asfour, Kadner, Carrel, Schoof, Nosal, Fragata,
Kozlowski, Maruszewski, Vricella, Cameron, Sojak, Hazekamp, Salminen,
Mattila, Cleuziou, Myers, Hraska) Department of Cardiovascular Surgery,
German Heart Center Munich Technische Universitat Munchen, Munich, Germany
(Padalino, Sarris, Protopapas, Prospero, Pizarro, Woodford, Tlaskal,
Berggren, Kostolny, Omeje, Asfour, Kadner, Carrel, Schoof, Nosal, Fragata,
Kozlowski, Maruszewski, Vricella, Cameron, Sojak, Hazekamp, Salminen,
Mattila, Cleuziou, Myers, Hraska) Divison of cardiovascular Surgery,
Geneva University Hospitals, Geneva, Switzerland
(Padalino, Sarris, Protopapas, Prospero, Pizarro, Woodford, Tlaskal,
Berggren, Kostolny, Omeje, Asfour, Kadner, Carrel, Schoof, Nosal, Fragata,
Kozlowski, Maruszewski, Vricella, Cameron, Sojak, Hazekamp, Salminen,
Mattila, Cleuziou, Myers, Hraska) Herma Heart Center, Medical College of
Wisconsin, Milwaukee, WI, USA
Title
Left-Sided Reoperations After Arterial Switch Operation: A European
Multicenter Study.
Source
Annals of Thoracic Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier USA
Abstract
Background: We sought to report the frequency, types, and outcomes of
left-sided reoperations (LSRs) after an arterial switch operation (ASO)
for patients with D-transposition of the great arteries (D-TGA) and
double-outlet right ventricle (DORV) TGA-type. Methods: Seventeen centers
belonging to the European Congenital Heart Surgeons Association (ECHSA)
contributed to data collection. We included 111 patients who underwent
LSRs after 7,951 ASOs (1.4%) between January 1975 and December 2010.
Original diagnoses included D-TGA (n = 99) and DORV TGA-type (n = 12).
Main indications for LSR were neoaortic valve insufficiency (n = 52 [47%])
and coronary artery problems (CAPs) (n = 21 [19%]). Results: Median age at
reoperation was 8.2 years (interquartile range [IQR], 2.9-14 years). Seven
patients died early after LSRs (6.3%); 4 patients with D-TGA (5.9%) and 3
patients with DORV TGA-type (25%) (p = 0.02). Median age at last follow-up
was 16.1 years (IQR, 9.9-21.8 years). Seventeen patients (16%) required
another reoperation, which was more frequent in patients with DORV- TGA
type (4 of 9 [45%]) than in patients with D-TGA (13 of 95 [14%]). Late
death occurred in 4 patients (4 of 104 [3.8%]). The majority of survivors
were asymptomatic at last clinical examination (84 of 100 [84%]).
Conclusions: Reoperations for residual LSRs are infrequent but may become
necessary late after an ASO, predominantly for neoaortic valve
insufficiency and CAPs. Risk at reoperation is not negligible, and DORV
TGA-type anatomy, as well as procedures on the coronary arteries, were
significantly associated with a higher morbidity and a lower overall
survival. Recurrent reoperations after LSRs may be required.<br/>Copyright
&#xa9; 2017 The Society of Thoracic Surgeons.

<51>
Accession Number
617305902
Author
Takagi H.; Ando T.; Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Title
Perioperative depression or anxiety and postoperative mortality in cardiac
surgery: a systematic review and meta-analysis.
Source
Heart and Vessels. (pp 1-11), 2017. Date of Publication: 13 Jul 2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
We performed a systematic review and meta-analysis to determine whether
perioperative depression and anxiety are associated with increased
postoperative mortality in patients undergoing cardiac surgery. MEDLINE
and EMBASE were searched through January 2017 using PubMed and OVID, to
identify observational studies enrolling patients undergoing cardiac
surgery and reporting relative risk estimates (RREs) (including odds,
hazard, or mortality ratios) of short term (30 days or in-hospital) and/or
late all-cause mortality for patients with versus without perioperative
depression or anxiety. Study-specific estimates were combined using
inverse variance-weighted averages of logarithmic RREs in the
random-effects models. Our search identified 16 eligible studies. In
total, the present meta-analysis included data on 236,595 patients
undergoing cardiac surgery. Pooled analysis demonstrated that
perioperative depression was significantly associated with increased both
postoperative early (RRE, 1.44; 95% confidence interval [CI] 1.01-2.05; p
= 0.05) and late mortality (RRE, 1.44; 95% CI 1.24-1.67; p < 0.0001), and
that perioperative anxiety significantly correlated with increased
postoperative late mortality (RRE, 1.81; 95% CI 1.20-2.72; p = 0.004). The
relation between anxiety and early mortality was reported in only one
study and not statistically significant. In the association of depression
with late mortality, there was no evidence of significant publication bias
and meta-regression indicated that the effects of depression are not
modulated by the duration of follow-up. In conclusion, perioperative
depression and anxiety may be associated with increased postoperative
mortality in patients undergoing cardiac surgery.<br/>Copyright &#xa9;
2017 Springer Japan KK

<52>
Accession Number
615794674
Author
Borji R.; Ahmadi S.H.; Barkhordari K.; Meysami A.P.; Karimi A.A.;
Mortazavi S.H.; Dadlani P.; Ayatollah Zadeh Esfahani F.; Khatami S.M.R.
Institution
(Borji) Internal Medicine Department, Imam Khomeini Hospital, Iran,
Islamic Republic of
(Meysami) Community and Preventive Medicine Department, Medical Faculty,
Iran, Islamic Republic of
(Ahmadi, Barkhordari, Karimi, Mortazavi, Dadlani, Ayatollah Zadeh
Esfahani) Tehran Heart Center, Iran, Islamic Republic of
(Khatami) Nephrology Research Center, Tehran University of Medical
Sciences, PO Box 1419733141, Tehran, Iran, Islamic Republic of
Title
Effect of Prophylactic Dialysis on Morbidity and Mortality in
Non-Dialysis-Dependent Patients after Coronary Artery Bypass Grafting: A
Pilot Study.
Source
Nephron. 136 (3) (pp 226-232), 2017. Date of Publication: 01 Jul 2017.
Publisher
S. Karger AG
Abstract
Background/Aims: Coronary artery bypass grafting (CABG) is associated with
an increased risk of morbidity and mortality in patients with pre-existing
renal dysfunction. Numerous measures have been implemented to overcome
this problem; however, no improvement in outcomes has been achieved. This
study was aimed at investigating the effects of prophylactic dialysis on
mortality and morbidity in these patients. Methods: This
randomized-controlled clinical trial enrolled 88 non-dialysis-dependent
patients with chronic kidney disease awaiting CABG surgery. Thirty-nine
randomly selected patients received dialysis 3 times prior to surgery, and
49 patients formed the control group. Kaplan-Meier analysis and Cox
proportional-hazards models were used to identify factors associated with
survival. Results: There was no significant difference in the development
of morbidities between the groups (p = 0.413). A significant difference
was evident in the average survival time (p = 0.037). Cox
proportional-hazards models determined that the hazard ratio of death
after surgery was 10.854-fold greater in non-dialysis patients than in
patients who received dialysis (hazard ratio = 2). Conclusion:
Prophylactic dialysis prior to CABG decreases mortality, but does not
affect morbidity, in patients with renal insufficiency.<br/>Copyright
&#xa9; 2017 S. Karger AG, Basel.

<53>
Accession Number
617243710
Author
Furat C.; Dogan R.; Ilhan G.; Bayar E.; Ozpak B.; Kara H.; Bozok S.
Institution
(Furat, Dogan) Department of Cardiovascular Surgery, Faculty of Medicine,
Hacettepe University, Ankara, Turkey
(Ilhan) Department of Cardiovascular Surgery, Faculty of Medicine, Recep
Tayyip Erdogan University, Rize, Turkey
(Bayar) Department of Cardiovascular Surgery, Zonguldak Ataturk State
Hospital, Zonguldak, Turkey
(Ozpak) Department of Cardiovascular Surgery, Faculty of Medicine, Katip
Celebi University, Turkey
(Kara) Department of Cardiovascular Surgery, Ada Hospital, Giresun, Turkey
(Bozok) Department of Cardiovascular Surgery, Faculty of Medicine,
Bahcesehir University, Istanbul, Turkey
Title
Telmisartan decreases microalbuminuria in patients with type 2 diabetes
mellitus following coronary artery bypass grafting.
Source
Cardiovascular Journal of Africa. 28 (3) (pp 191-195), 2017. Date of
Publication: May 2017.
Publisher
Clinics Cardive Publishing (PTY)Ltd (PO Box 1013, Durbanville 7551, South
Africa)
Abstract
Objective: This prospective study aimed to investigate the effects of the
selective angiotensin receptor antagonist, telmisartan, on
microalbuminuria after coronary artery bypass surgery in patients with
diabetes mellitus. Methods: Patients were divided into two groups with
block randomisation, using the sealed envelope technique: group T
(telmisartan group) consisted of patients who received the angiotensin
receptor blocking agent telmisartan 80 mg daily for at least six months in
the pre-operative period; group N-T (non-Telmisartan group) consisted of
patients who received no telmisartan treatment. Clinical and demographic
characteristics, operative and postoperative features, microalbuminuria
and high-sensitivity C-reactive protein levels were compared. Results:
Forty patients met the eligibility criteria for the study. The groups did
not differ with regard to clinical and demographic characteristics, and
operative and postoperative features. Microalbuminuria levels between the
groups differed significantly in the pre-operative period, first hour
postoperatively and fifth day postoperatively. C-reactive protein levels
between the groups differed significantly on the fifth day
postoperatively. Conclusion: Telmisartan was useful for decreasing
systemic inflammation and levels of urinary albumin excretion in patients
who had type 2 diabetes mellitus and had undergone coronary artery bypass
surgery.

<54>
Accession Number
616602400
Author
Segal A.; Flugelman M.Y.; Khader N.; Rubinshtein R.; Lavi I.; Karmeli R.;
Jubran A.; Shiran A.; Jaffe R.
Institution
(Segal, Flugelman, Khader, Rubinshtein, Jubran, Shiran, Jaffe) Department
of Cardiology, The Lady Davis Carmel Medical Center and the Technion
Institute of Technology IIT, Haifa, Israel
(Lavi) Department of Community Medicine and Epidemiology, The Lady Davis
Carmel Medical Center and the Technion Institute of Technology IIT, Haifa,
Israel
(Karmeli) Department of Vascular Surgery, The Lady Davis Carmel Medical
Center and the Technion Institute of Technology IIT, Haifa, Israel
Title
Outcome of Stent Graft Implantation for Treatment of Access Site Bleeding
After Transfemoral Transcatheter Aortic Valve Replacement.
Source
American Journal of Cardiology. 120 (3) (pp 456-460), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Vascular complications are common after transcatheter aortic valve
replacement (TAVR) and are associated with increased morbidity and
mortality. Stent graft implantation enables percutaneous treatment of
access site bleeding; however, the efficacy and durability and of this
approach are unknown. We studied the immediate outcome of stent graft
implantation for control of access site bleeding and the need for repeat
vascular interventions after stenting, in a cohort of consecutive patients
with severe symptomatic aortic stenosis who underwent transfemoral TAVR.
Predictors of access site complications requiring percutaneous or surgical
vascular repair were identified. Transfemoral TAVR was performed in 194
patients. Access site complications requiring urgent vascular repair
occurred in 34 patients (18%). Stent graft implantation was performed in
31 patients and vascular surgery in 3 patients. When patients who required
surgical or percutaneous vascular repair were compared with those who did
not, increased body mass index (30 +/- 6 vs 28 +/- 5, p = 0.035) and
reduced activated clotting time (233 +/- 47 vs 252 +/- 47, p = 0.030) were
the only predictors of need for vascular repair. Stenting achieved
adequate hemostasis in all patients with a single minor vascular
complication. During median follow-up of 797 days (interquartile range 585
to 1,173), no clinically significant vascular complications were detected
after stenting. In conclusion, control of bleeding was achieved in all
patients who underwent stent graft implantation for treatment of access
site vascular complications after transfemoral TAVR. None of these
patients needed further vascular interventions during
follow-up.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<55>
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

<56>
Accession Number
617084032
Author
Di Biase L.; Burkhardt J.D.; Mohanty P.; Mohanty S.; Sanchez J.E.; Trivedi
C.; Gunes M.; Gokoglan Y.; Gianni C.; Horton R.P.; Themistoclakis S.;
Gallinghouse G.J.; Bailey S.; Zagrodzky J.D.; Hongo R.H.; Beheiry S.;
Santangeli P.; Casella M.; Dello Russo A.; Al-Ahmad A.; Hranitzky P.;
Lakkireddy D.; Tondo C.; Natale A.
Institution
(Di Biase) Texas Cardiac Arrhythmia Institute at St. David's Medical
Center, Austin, Texas; Albert Einstein College of Medicine at Montefiore
Hospital, New York, New York; Department of Biomedical Engineering,
University of Texas, Austin, Texas; Department of Cardiology, University
of Foggia, Foggia, Italy
(Burkhardt, Mohanty, Mohanty, Sanchez, Trivedi, Gunes, Gokoglan, Gianni,
Horton, Gallinghouse, Bailey, Zagrodzky, Al-Ahmad, Hranitzky) Texas
Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas
(Themistoclakis) Ospedale dell'Angelo, Mestre, Venice, Italy
(Hongo, Beheiry) California Pacific Medical Center, San Francisco,
California
(Santangeli) Texas Cardiac Arrhythmia Institute at St. David's Medical
Center, Austin, Texas; Department of Cardiology, University of Foggia,
Foggia, Italy
(Casella, Dello Russo, Tondo) Cardiac Arrhythmia Research Centre, Centro
Cardiologico Monzino IRCCS, Milan, Italy
(Lakkireddy) Section of Electrophysiology, University of Kansas, Kansas
City, Missouri
(Natale) Texas Cardiac Arrhythmia Institute at St. David's Medical Center,
Austin, Texas; Department of Biomedical Engineering, University of Texas,
Austin, Texas; Division of Cardiology, Stanford University, Palo Alto,
California; Section of Electrophysiology, Case Western Reserve University,
Cleveland, Ohio; Interventional Electrophysiology, Scripps Clinic, San
Diego, California; Department of Medicine, Dell Medical School, Austin,
Texas
Title
Left Atrial Appendage Isolation in Patients With Longstanding Persistent
AF Undergoing Catheter Ablation: BELIEF Trial.
Source
Journal of the American College of Cardiology. 68 (18) (pp 1929-1940),
2016. Date of Publication: 01 Nov 2016.
Abstract
BACKGROUND: Longstanding persistent (LSP) atrial fibrillation (AF) is the
most challenging type of AF. In addition to pulmonary vein isolation,
substrate modification and triggers ablation have been reported to improve
freedom from AF in patients with LSPAF.
OBJECTIVES: This study sought to assess whether the empirical electrical
isolation of the left atrial appendage (LAA) could improve success at
follow-up.
METHODS: This was an open-label, randomized study assessing the
effectiveness of empirical electrical left atrial appendage isolation for
the treatment of LSPAF. Patients were randomly assigned to undergo
empirical electrical left atrial appendage isolation along with extensive
ablation (group 1; n = 85) or extensive ablation alone (group 2; n = 88).
Recurrence of atrial arrhythmias was the primary endpoint. Secondary
endpoints included cardiac-related hospitalization, all-cause mortality,
and stroke at follow-up.
RESULTS: Major clinical characteristics were not different between the 2
groups. At 12-month follow-up, 48 (56%) patients in group 1 and 25 (28%)
in group 2 were recurrence free after a single procedure (unadjusted
hazard ratio [HR] for recurrence with standard ablation: 1.92; 95%
confidence interval [CI]: 1.3 to 2.9; log-rank p = 0.001). After adjusting
for age, sex, and left atrial size, standard ablation was predictive of
recurrence (HR: 2.22; 95% CI: 1.29 to 3.81; p = 0.004). During repeat
procedures, empirical electrical left atrial appendage isolation was
performed in all patients. After an average of 1.3 procedures, cumulative
success at 24-month follow-up was reported in 65 (76%) in group 1 and in
49 (56%) in group 2 (unadjusted HR: 2.24; 95% CI: 1.3 to 3.8; log-rank p =
0.003).
CONCLUSIONS: This randomized study showed that both after a single
procedure and after redo procedures in patients with LSPAF, empirical
electrical isolation of the LAA improved long-term freedom from atrial
arrhythmias without increasing complications. (Effect of Empirical Left
Atrial Appendage Isolation on Long-term Procedure Outcome in Patients With
Persistent or Longstanding Persistent Atrial Fibrillation Undergoing
Catheter Ablation [BELIEF]; NCT01362738).<br/>Copyright &#xa9; 2016
American College of Cardiology Foundation. Published by Elsevier Inc. All
rights reserved.

<57>
Accession Number
617221471
Author
Desborough M.J.; Oakland K.; Brierley C.; Bennett S.; Doree C.; Trivella
M.; Hopewell S.; Stanworth S.J.; Estcourt L.J.
Institution
(Desborough, Oakland, Estcourt) NHS Blood and Transplant,
Haematology/Transfusion Medicine, Oxford, United Kingdom
(Brierley) John Radcliffe Hospital, Department of Haematology, Headley
Way, Oxford OX3 9DU, United Kingdom
(Bennett) University of Ottawa, Department of Surgery, 501 Smyth Road,
Ottawa, ON K1M 1R4, Canada
(Doree) NHS Blood and Transplant, Systematic Review Initiative, John
Radcliffe Hospital, Oxford OX3 9BQ, United Kingdom
(Trivella) University of Oxford, Centre for Statistics in Medicine, Botnar
Research Centre, Windmill Road, Oxford OX3 7LD, United Kingdom
(Hopewell) University of Oxford, Oxford Clinical Trials Research Unit,
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal
Sciences, Windmill Road, Oxford, Oxfordshire OX3 7LD, United Kingdom
(Stanworth) Oxford University Hospitals NHS Foundation Trust and
University of Oxford, National Institute for Health Research (NIHR) Oxford
Biomedical Research Centre, John Radcliffe Hospital, Headley Way,
Headington, Oxford OX3 9BQ, United Kingdom
Title
Desmopressin use for minimising perioperative blood transfusion.
Source
Cochrane Database of Systematic Reviews. 2017 (7) (no pagination), 2017.
Article Number: CD001884. Date of Publication: 10 Jul 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Blood transfusion is administered during many types of
surgery, but its efficacy and safety are increasingly questioned.
Evaluation of the efficacy of agents, such as desmopressin (DDAVP;
1-deamino-8-D-arginine-vasopressin), that may reduce perioperative blood
loss is needed. Objectives: To examine the evidence for the efficacy of
DDAVP in reducing perioperative blood loss and the need for red cell
transfusion in people who do not have inherited bleeding disorders. Search
methods: We searched for randomised controlled trials (RCTs) in the
Cochrane Central Register of Controlled Trials (2017, issue 3) in the
Cochrane Library, MEDLINE (from 1946), Embase (from 1974), the Cumulative
Index to Nursing and Allied Health Literature (CINAHL) (from 1937), the
Transfusion Evidence Library (from 1980), and ongoing trial databases (all
searches to 3 April 2017). Selection criteria: We included randomised
controlled trials comparing DDAVP to placebo or an active comparator (e.g.
tranexamic acid, aprotinin) before, during, or immediately after surgery
or after invasive procedures in adults or children. Data collection and
analysis: We used the standard methodological procedures expected by
Cochrane. Main results: We identified 65 completed trials (3874
participants) and four ongoing trials. Of the 65 completed trials, 39
focused on adult cardiac surgery, three on paediatric cardiac surgery, 12
on orthopaedic surgery, two on plastic surgery, and two on vascular
surgery; seven studies were conducted in surgery for other conditions.
These trials were conducted between 1986 and 2016, and 11 were funded by
pharmaceutical companies or by a party with a commercial interest in the
outcome of the trial. The GRADE quality of evidence was very low to
moderate across all outcomes. No trial reported quality of life. DDAVP
versus placebo or no treatment Trial results showed considerable
heterogeneity between surgical settings for total volume of red cells
transfused (low-quality evidence) and for total blood loss (very
low-quality evidence) due to large differences in baseline blood loss.
Consequently, these outcomes were not pooled and were reported in
subgroups. Compared with placebo, DDAVP may slightly decrease the total
volume of red cells transfused in adult cardiac surgery (mean difference
(MD) -0.52 units, 95% confidence interval (CI) -0.96 to -0.08 units; 14
trials, 957 participants), but may lead to little or no difference in
orthopaedic surgery (MD -0.02, 95% CI -0.67 to 0.64 units; 6 trials, 303
participants), vascular surgery (MD 0.06, 95% CI -0.60 to 0.73 units; 2
trials, 135 participants), or hepatic surgery (MD -0.47, 95% CI -1.27 to
0.33 units; 1 trial, 59 participants). DDAVP probably leads to little or
no difference in the total number of participants transfused with blood
(risk ratio (RR) 0.96, 95% CI 0.86 to 1.06; 25 trials; 1806 participants)
(moderate-quality evidence). Whether DDAVP decreases total blood loss in
adult cardiac surgery (MD -135.24 mL, 95% CI -210.80 mL to -59.68 mL; 22
trials, 1358 participants), orthopaedic surgery (MD -285.76 mL, 95% CI
-514.99 mL to -56.53 mL; 5 trials, 241 participants), or vascular surgery
(MD -582.00 mL, 95% CI -1264.07 mL to 100.07 mL; 1 trial, 44 participants)
is uncertain because the quality of evidence is very low. DDAVP probably
leads to little or no difference in all-cause mortality (Peto odds ratio
(pOR) 1.09, 95% CI 0.51 to 2.34; 22 trials, 1631 participants) or in
thrombotic events (pOR 1.36, 95% CI, 0.85 to 2.16; 29 trials, 1984
participants) (both low-quality evidence). DDAVP versus placebo or no
treatment for people with platelet dysfunction Compared with placebo,
DDAVP may lead to a reduction in the total volume of red cells transfused
(MD -0.65 units, 95% CI -1.16 to -0.13 units; 6 trials, 388 participants)
(low-quality evidence) and in total blood loss (MD -253.93 mL, 95% CI
-408.01 mL to -99.85 mL; 7 trials, 422 participants) (low-quality
evidence). DDAVP probably leads to little or no difference in the total
number of participants receiving a red cell transfusion (RR 0.83, 95% CI
0.66 to 1.04; 5 trials, 258 participants) (moderate-quality evidence).
Whether DDAVP leads to a difference in all-cause mortality (pOR 0.72, 95%
CI 0.12 to 4.22; 7 trials; 422 participants) or in thrombotic events (pOR
1.58, 95% CI 0.60 to 4.17; 7 trials, 422 participants) is uncertain
because the quality of evidence is very low. DDAVP versus tranexamic acid
Compared with tranexamic acid, DDAVP may increase the volume of blood
transfused (MD 0.6 units, 95% CI 0.09 to 1.11 units; 1 trial, 40
participants) and total blood loss (MD 142.81 mL, 95% CI 79.78 mL to
205.84 mL; 2 trials, 115 participants) (both low-quality evidence).
Whether DDAVP increases or decreases the total number of participants
transfused with blood is uncertain because the quality of evidence is very
low (RR 2.42, 95% CI 1.04 to 5.64; 3 trials, 135 participants). No trial
reported all-cause mortality. Whether DDAVP leads to a difference in
thrombotic events is uncertain because the quality of evidence is very low
(pOR 2.92, 95% CI 0.32 to 26.83; 2 trials, 115 participants). DDAVP versus
aprotinin Compared with aprotinin, DDAVP probably increases the total
number of participants transfused with blood (RR 2.41, 95% CI 1.45 to
4.02; 1 trial, 99 participants) (moderate-quality evidence). No trials
reported volume of blood transfused or total blood loss and the single
trial that included mortality as an outcome reported no deaths. Whether
DDAVP leads to a difference in thrombotic events is uncertain because the
quality of evidence is very low (pOR 0.98, 95% CI 0.06 to 15.89; 2 trials,
152 participants). Authors' conclusions: Most of the evidence derived by
comparing DDAVP versus placebo was obtained in cardiac surgery, where
DDAVP was administered after cardiopulmonary bypass. In adults undergoing
cardiac surgery, the reduction in volume of red cells transfused and total
blood loss was small and was unlikely to be clinically important. It is
less clear whether DDAVP may be of benefit for children and for those
undergoing non-cardiac surgery. A key area for researchers is examining
the effects of DDAVP for people with platelet dysfunction. Few trials have
compared DDAVP versus tranexamic acid or aprotinin; consequently, we are
uncertain of the relative efficacy of these interventions.<br/>Copyright
&#xa9; 2017 The Cochrane Collaboration. Published by John Wiley & Sons,
Ltd.

<58>
Accession Number
617118597
Author
Roehrborn F.; Dohle D.-S.; Waack I.N.; Tsagakis K.; Jakob H.; Teloh J.K.
Institution
(Roehrborn, Waack, Teloh) Institute of Physiological Chemistry, University
Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, Essen,
North Rhine-Westphalia 45147, Germany
(Dohle, Tsagakis, Jakob) Department of Thoracic and Cardiovascular
Surgery, West German Heart Center, University Hospital Essen,
Hufelandstrasse 55, Essen, North Rhine-Westphalia 45147, Germany
Title
Postoperative Compensatory Ammonium Excretion Subsequent to Systemic
Acidosis in Cardiac Patients.
Source
BioMed Research International. 2017 (no pagination), 2017. Article Number:
5383574. Date of Publication: 2017.
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Background. Postoperative acid-base imbalances, usually acidosis,
frequently occur after cardiac surgery. In most cases, the human body, not
suffering from any severe preexisting illnesses regarding lung, liver, and
kidney, is capable of transient compensation and final correction. The aim
of this study was to correlate the appearance of postoperatively occurring
acidosis with renal ammonium excretion. Materials and Methods. Between
07/2014 and 10/2014, a total of 25 consecutive patients scheduled for
elective isolated coronary artery bypass grafting with cardiopulmonary
bypass were enrolled in this prospective observational study. During the
operative procedure and the first two postoperative days, blood gas
analyses were carried out and urine samples collected. Urine samples were
analyzed for the absolute amount of ammonium. Results. Of all patients,
thirteen patients developed acidosis as an initial disturbance in the
postoperative period: five of respiratory and eight of metabolic origin.
Four patients with respiratory acidosis but none of those with metabolic
acidosis subsequently developed a base excess > +2 mEq/L. Conclusion.
Ammonium excretion correlated with the increase in base excess. The
acidosis origin seems to have a large influence on renal compensation in
terms of ammonium excretion and the possibility of an
overcorrection.<br/>Copyright &#xa9; 2017 Friederike Roehrborn et al.

<59>
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.

<60>
Accession Number
617172936
Author
Mahmud E.; Naghi J.; Ang L.; Harrison J.; Behnamfar O.; Pourdjabbar A.;
Reeves R.; Patel M.
Institution
(Mahmud, Naghi, Ang, Harrison, Behnamfar, Pourdjabbar, Reeves, Patel)
Division of Cardiovascular Medicine, University of California San Diego,
Sulpizio Cardiovascular Center, La Jolla, California, United States
Title
Demonstration of the Safety and Feasibility of Robotically Assisted
Percutaneous Coronary Intervention in Complex Coronary Lesions: Results of
the CORA-PCI Study (Complex Robotically Assisted Percutaneous Coronary
Intervention).
Source
JACC: Cardiovascular Interventions. 10 (13) (pp 1320-1327), 2017. Date of
Publication: 10 Jul 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aims of this study were to evaluate the feasibility and
technical success of robotically assisted percutaneous coronary
intervention (R-PCI) for the treatment of coronary artery disease (CAD) in
clinical practice, especially in complex lesions, and to determine the
safety and clinical success of R-PCI compared with manual percutaneous
coronary intervention (M-PCI). Background R-PCI is safe and feasible for
simple coronary lesions. The utility of R-PCI for complex coronary lesions
is unknown. Methods All consecutive PCI procedures performed robotically
(study group) or manually (control group) over 18 months were included.
R-PCI technical success, defined as the completion of the procedure
robotically or with partial manual assistance and without a major adverse
cardiovascular event, was determined. Procedures ineligible for R-PCI
(i.e., atherectomy, planned 2-stent strategy for bifurcation lesion,
chronic total occlusion requiring hybrid approach) were excluded for
analysis from the M-PCI group. Clinical success, defined as completion of
the PCI procedure without a major adverse cardiovascular event, procedure
time, stent use, and fluoroscopy time were compared between groups.
Results A total of 315 patients (mean age 67.7 +/- 11.8 years; 78% men)
underwent 334 PCI procedures (108 R-PCIs, 157 lesions, 78.3% type B2/C;
226 M-PCIs, 336 lesions, 68.8% type B2/C). Technical success with R-PCI
was 91.7% (rate of manual assistance 11.1%, rate of manual conversion
7.4%, rate of major adverse cardiovascular events 0.93%). Clinical success
(99.1% with R-PCI vs. 99.1% with M-PCI; p = 1.00), stent use (stents per
procedure 1.59 +/- 0.79 with R-PCI vs. 1.54 +/- 0.75 with M-PCI; p =
0.73), and fluoroscopy time (18.2 +/- 10.4 min with R-PCI vs. 19.2 +/-
11.4 min with M-PCI; p = 0.39) were similar between the groups, although
procedure time was longer in the R-PCI group (44:30 +/- 26:04 min:s vs.
36:34 +/- 23:03 min:s; p = 0.002). Propensity-matched analysis confirmed
that procedure time was longer in the robotic group (42:59 +/- 26:14 min:s
with R-PCI vs. 34:01 +/- 17:14 min:s with M-PCI; p = 0.007), although
clinical success remained similar (98.8% with R-PCI vs. 100% with M-PCI; p
= 1.00). Conclusions This study demonstrates the feasibility, safety, and
high technical success of R-PCI for the treatment of complex coronary
disease. Furthermore, comparable clinical outcomes, without an adverse
effect on stent use or fluoroscopy time, were observed with R-PCI and
M-PCI.<br/>Copyright &#xa9; 2017 American College of Cardiology Foundation

<61>
Accession Number
617262764
Author
Johnson J.T.; Marino B.S.; Klugman D.; Shamszad P.
Institution
(Johnson) 1Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago,
IL. 2Children's National Health System, Washington, DC. 3Children's
Hospital of Philadelphia, Philadelphia, PA.
Title
National Variation in the Use of Tracheostomy in Patients With Congenital
Heart Disease.
Source
Pediatric Critical Care Medicine. (no pagination), 2017. Date of
Publication: 06 Jul 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
OBJECTIVES:: The postsurgical care of children with congenital heart
disease may be complicated by the need for cardiorespiratory support,
including tracheostomy. The variation of the use of tracheostomy across
multiple pediatric cardiac surgical centers has not been defined. We
describe multicenter variation in the use of tracheostomy in children
undergoing congenital heart surgery. DESIGN:: We retrospectively analyzed
a multicenter cohort. SETTING:: Pediatric Health Information Systems
database retrospective cohort. PATIENTS:: Children less than 18 years who
underwent both tracheostomy and cardiac surgery (1/04-6/14).
INTERVENTIONS:: Univariate and multivariate statistics were performed,
stratifying by high (>= 75th percentile) and low (<= 25th percentile)
tracheostomy volume and adjusting for patient characteristics in
multivariate models. MEASUREMENTS AND MAIN RESULTS:: Out of 123,510
hospitalizations involving cardiac surgery, 1,292 tracheostomies (1.2%)
were performed (46 hospitals). The rate of tracheostomy placement ranged
from 0.3% to 2.5% with no difference in the rate of tracheostomy placement
between high and low tracheostomy use centers (p = 0.8). The median time
to tracheostomy was 63 days (interquartile range, 36-100), and there was
no difference between high- and low-tracheostomy centers.
High-tracheostomy centers had $420,000 lower hospital charges than
low-volume centers (p = 0.03). Tracheostomy day greater than the median
(63 d), Risk Adjustment for Congenital Heart Surgery-1 score 6, and
extracorporeal membrane oxygenation were significantly associated with
adjusted increased odds of mortality. Later hospital day of tracheostomy
was associated with a $13,000/d increase in total hospital charges (p <
0.001). CONCLUSIONS:: Variation in the usage of tracheostomy in infants
and children undergoing congenital heart surgery exists across the
country. High-tracheostomy centers had lower hospital charges. Late
tracheostomy placement, higher congenital heart disease surgical risk, and
extracorporeal membrane oxygenation use are independent predictors of
in-hospital mortality in this population.<br/>Copyright &#xa9;2017The
Society of Critical Care Medicine and the World Federation of Pediatric
Intensive and Critical Care Societies