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Accession Number
613274162
Author
Etchill E.W.; Myers S.P.; Raval J.S.; Hassoune A.; Sengupta A.; Neal M.D.
Institution
(Etchill, Myers, Neal) Division of Trauma and Acute Care Surgery,
Department of Surgery, PUH 200 Lothrop Street, Pittsburgh, PA 15213,
United States
(Raval) University of North Carolina School of Medicine, Chapel Hill, NC,
United States
(Hassoune) American University of Beirut, Beirut, Lebanon
(Sengupta) Case Western Reserve University, Cleveland, OH, United States
Title
Platelet Transfusion in Critical Care and Surgery: Evidence-Based Review
of Contemporary Practice and Future Directions.
Source
Shock. 47 (5) (pp 537-549), 2017. Date of Publication: 01 May 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Thrombocytopenia is prevalent in critical care, surgical, and trauma
settings. Despite the fact that a significant proportion of these patients
receive platelet transfusion during their hospital course, much work
remains to be done with regard to development of platelet transfusion
guidelines. Given the wide variety of platelet transfusion practices and
the frequency with which patients present with thrombocytopenia, it is
paramount to understand standards of care and to identify deficiencies
that may exist. This review explores evidence and recommendations for
platelet transfusion thresholds and practices in a variety of critical
care and surgical settings with specific focus on the role of platelet
transfusion in trauma, management and reversal of anticoagulation, and
point of care laboratory assays. To this end, a literature review was
performed utilizing PubMed and Cochrane Central Register of Controlled
Trials to select 153 manuscripts that evaluate the current data supporting
platelet transfusions in surgical and critical care populations. Advances
in transfusion medicine and synthetic platelet substitutes that can be
engineered for potential future applications will also be
discussed.<br/>Copyright &#xa9; 2016 by the Shock Society.

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Accession Number
610988398
Author
Savage S.A.; Cibulas G.A.; Ward T.A.; Davis C.A.; Croce M.A.; Zarzaur B.L.
Institution
(Savage, Zarzaur) Indiana University-Purdue University, School of
Medicine, 1604 N. Capitol Ave, Indianapolis, IN, United States
(Ward, Davis, Croce) University of Tennessee Health Sciences Center,
Memphis, TN, United States
(Cibulas) University of Michigan Health System, Ann Arbor, MI, United
States
Title
Suction evacuation of hemothorax: A prospective study.
Source
Journal of Trauma and Acute Care Surgery. 81 (1) (pp 58-62), 2016. Date of
Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Although tube thoracostomy is a common procedure after
thoracic trauma, incomplete evacuation of fluid places the patient at risk
for retained hemothorax.As little as 300 to 500 cm³ of bloodmay
result in the need for an additional thoracostomy tube or, inmore severe
cases, lung entrapment and empyema.We hypothesized that suction evacuation
of the thoracic cavity before tube placement would decrease the incidence
of late complications. METHODS: Patients requiring tube thoracostomy
within 96 hours of admission were prospectively identified and underwent
suction evacuation of the pleural space (SEPS) before tube placement.
These patients were compared to historical controlswithout suction
evacuation. Demographics, admission vital signs, laboratory values,
details of chest tube placement, and outcomes were collected on all
patients. Multivariable logistic regression was used to compare outcomes
between groups. RESULTS: A total of 199 patients were identified,
consisting of 100 retrospective controls and 99 SEPS patients. Therewere
no differences in age, sex, admission injury severity score or chest
abbreviated injury score, admission laboratory values or vital signs, or
hospital length of stay.Mean (SD) volume of hemothorax in SEPS patientswas
220 (297)cm³; with only 48% having a volume greater than 100
cm³ at the time of tube placement. Three patients developed
empyema, and 19 demonstrated retained blood; there was no difference
between SEPS and control patients. Suction evacuation of the pleural space
was significantly protective against recurrent pneumothorax after chest
tube removal (odds ratio, 0.332; 95% confidence interval, 0.148-0.745).
CONCLUSION: Preemptive suction evacuation of the thoracic cavity did not
have a significant impact on subsequent development of retained hemothorax
or empyema. Suction evacuation of the pleural space significantly
decreased incidence of recurrent pneumothorax after thoracostomy removal.
Although the mechanism is unclear, such a benefit may make this simple
procedure worthwhile. A larger sample size is required for validation and
to determine if preemptive thoracic evacuation has a clinical
benefit.<br/>Copyright &#xa9; 2016 Wolters Kluwer Health, Inc. All rights
reserved.

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Accession Number
613120360
Author
Hoebers L.P.; Nijveldt R.; van Rossum A.C.; Elias J.; van Dongen I.M.;
Claessen B.E.P.M.; Tijssen J.G.; van der Schaaf R.; Tijssen J.G.P.;
Zijlstra F.; de Boer M.-J.; Michels R.; Agostoni P.; van Houwelingen K.G.;
Verberne H.J.; Hirsch A.; Henriques J.P.S.; Piek J.J.; de Winter R.J.;
Koch K.T.; Vis M.M.; Baan J.; Wykrzykowska J.; Ramunddal T.; Ioanes D.;
Laanmets P.; van der Schaaf R.J.; Slagboom T.; Amoroso G.; Eriksen E.;
Tuseth V.; Bax M.; Schotborgh C.E.; Suttorp M.J.; Strauss B.H.; Barbato
E.; Marques K.M.; Bertrand O.; Meuwissen M.; van der Ent M.; Koolen J.
Institution
(Henriques, Hoebers, Elias, van Dongen, Claessen, Tijssen) Academic
Medical Center, University of Amsterdam, Amsterdam, Netherlands
(Ramunddal, Ioanes) Sahlgrenska University Hospital, Gothenburg, Sweden
(Laanmets) North Estonia Medical Center, Tallinn, Estonia
(Eriksen) Haukeland University Hospital, Bergen, Norway
(Bax) Haga Teaching Hospital, The Hague, Netherlands
(Suttorp) Sint Antonius Ziekenhuis, Nieuwegein, Netherlands
(Strauss) Sunnybrook Health Sciences Centre, Toronto, Canada
(Barbato) Onze Lieve Vrouwe Ziekenhuis, Aalst, Belgium
(Nijveldt, van Rossum, Marques) VU University Medical Center, Amsterdam,
Netherlands
(van der Schaaf) Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
Title
Percutaneous Intervention for Concurrent Chronic Total Occlusions in
Patients With STEMI: The EXPLORE Trial.
Source
Journal of the American College of Cardiology. 68 (15) (pp 1622-1632),
2016. Date of Publication: 11 Oct 2016.
Publisher
Elsevier USA
Abstract
Background In 10% to 15% of patients with ST-segment elevation myocardial
infarction (STEMI), concurrent coronary chronic total occlusion (CTO) in a
non-infarct-related artery is present and is associated with increased
morbidity and mortality. Objectives The EXPLORE (Evaluating Xience and
Left Ventricular Function in Percutaneous Coronary Intervention on
Occlusions After ST-Elevation Myocardial Infarction) trial evaluated
whether patients with STEMI and concurrent CTO in a non-infarct-related
artery benefit from additional percutaneous coronary intervention (PCI) of
CTO shortly after primary PCI. Methods From November 2007 through April
2015, we enrolled 304 patients with acute STEMI who underwent primary PCI
and had concurrent CTO in 14 centers in Europe and Canada. A total of 150
patients were randomly assigned to early PCI of the CTO (CTO PCI), and 154
patients were assigned to conservative treatment without PCI of the CTO
(no CTO PCI). Primary outcomes were left ventricular ejection fraction
(LVEF) and left ventricular end diastolic volume (LVEDV) on cardiac
magnetic resonance imaging after 4 months. Results The
investigator-reported procedural success rate in the CTO PCI arm of the
trial was 77%, and the adjudicated success rate was 73%. At 4 months, mean
LVEF did not differ between the 2 groups (44.1 +/- 12.2% vs. 44.8 +/-
11.9%, respectively; p = 0.60). Mean LVEDV at 4 months was 215.6 +/- 62.5
ml in the CTO PCI arm versus 212.8 +/- 60.3 ml in the no-CTO PCI arm (p =
0.70). Subgroup analysis revealed that patients with CTO located in the
left anterior descending coronary artery who were randomized to the CTO
PCI strategy had significantly higher LVEF compared with patients
randomized to the no-CTO PCI strategy (47.2 +/- 12.3% vs. 40.4 +/- 11.9%;
p = 0.02). There were no differences in terms of 4-month major adverse
coronary events (5.4% vs. 2.6%; p = 0.25). Conclusions Additional CTO PCI
within 1 week after primary PCI for STEMI was feasible and safe. In
patients with STEMI and concurrent CTO, we did not find an overall benefit
for CTO PCI in terms of LVEF or LVEDV. The finding that early CTO PCI in
the left anterior descending coronary artery subgroup was beneficial
warrants further investigation. (Evaluating Xience and Left Ventricular
Function in Percutaneous Coronary Intervention on Occlusions After
ST-Segment Elevation Myocardial Infarction; NTR1108)<br/>Copyright &#xa9;
2016 American College of Cardiology Foundation

<4>
Accession Number
613651342
Author
Makikallio T.; Holm N.R.; Lindsay M.; Spence M.S.; Erglis A.; Menown
I.B.A.; Trovik T.; Eskola M.; Romppanen H.; Kellerth T.; Ravkilde J.;
Jensen L.O.; Kalinauskas G.; Linder R.B.A.; Pentikainen M.; Hervold A.;
Banning A.; Zaman A.; Cotton J.; Eriksen E.; Margus S.; Sorensen H.T.;
Nielsen P.H.; Niemela M.; Kervinen K.; Lassen J.F.; Maeng M.; Oldroyd K.;
Berg G.; Walsh S.J.; Hanratty C.G.; Kumsars I.; Stradins P.; Steigen T.K.;
Frobert O.; Graham A.N.J.; Endresen P.C.; Corbascio M.; Kajander O.;
Trivedi U.; Hartikainen J.; Anttila V.; Hildick-Smith D.; Thuesen L.;
Christiansen E.H.
Institution
(Makikallio, Niemela, Kervinen) Department of Cardiology, Oulu University
Hospital, Oulu, Finland
(Holm, Lassen, Maeng, Christiansen) Department of Cardiology, Aarhus
University Hospital, Skejby, Aarhus, Denmark
(Lindsay, Oldroyd, Berg) Department of Cardiology, Golden Jubilee National
Hospital, Clydebank, United Kingdom
(Spence, Walsh, Hanratty, Graham) Belfast Heart Centre, Belfast Trust,
Belfast, Ireland
(Erglis, Kumsars, Stradins) Latvia Centre of Cardiology, Paul Stradins
Clinical Hospital, Riga, Latvia
(Menown) Craigavon Cardiac Centre, Craigavon, Ireland
(Trovik, Steigen) Department of Cardiology, University of Northern Norway,
Tromso, Norway
(Endresen) Department of Cardiovascular Surgery, University of Northern
Norway, Tromso, Norway
(Eskola, Kajander) Heart Hospital, Tampere University Hospital, Tampere,
Finland
(Romppanen, Hartikainen) Heart Center, Kuopio University Hospital, Kuopio,
Finland
(Kellerth, Frobert) Department of Cardiology, Orebro University Hospital,
Orebro, Sweden
(Ravkilde, Thuesen) Department of Cardiology, Aalborg University Hospital,
Aalborg, Denmark
(Jensen) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Kalinauskas) Department of Cardiology, Vilnius University Hospital,
Vilnius, Lithuania
(Linder) Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
(Pentikainen) Heart and Lung Center, Helsinki University Hospital,
Helsinki, Finland
(Hervold) Department of Cardiology, Oslo University Hospital,
Rikshospitalet, Oslo, Norway
(Banning) Oxford Heart Centre, Oxford, United Kingdom
(Zaman) Department of Cardiology, Freeman Hospital and Institute of
Cellular Medicine, Newcastle, United Kingdom
(Cotton) Heart and Lung Centre, New Cross Hospital, Wolverhampton, United
Kingdom
(Eriksen) Department of Cardiology, Haukeland University Hospital, Bergen,
Norway
(Margus) Department of Cardiology, East Tallinn Hospital, Tallinn, Estonia
(Sorensen) Department of Clinical Epidemiology, Aarhus University
Hospital, Aarhus, Denmark
(Sorensen) Department of Health Research and Policy (Epidemiology),
Stanford University, Stanford, CA, United States
(Nielsen) Department of Cardiac Surgery, Aarhus University Hospital,
Skejby, Aarhus, Denmark
(Corbascio) Department of Cardiology, Karolinska University Hospital,
Huddinge, Stockholm, Sweden
(Anttila) Department of Cardiac Surgery, Oulu University Hospital, Finland
(Trivedi, Hildick-Smith) Sussex Cardiac Centre, Brighton and Sussex
University Hospital, Brighton, United Kingdom
Title
Percutaneous coronary angioplasty versus coronary artery bypass grafting
in treatment of unprotected left main stenosis (NOBLE): a prospective,
randomised, open-label, non-inferiority trial.
Source
The Lancet. 388 (10061) (pp 2743-2752), 2016. Date of Publication: 03 Dec
2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Coronary artery bypass grafting (CABG) is the standard
treatment for revascularisation in patients with left main coronary artery
disease, but use of percutaneous coronary intervention (PCI) for this
indication is increasing. We aimed to compare PCI and CABG for treatment
of left main coronary artery disease. Methods In this prospective,
randomised, open-label, non-inferiority trial, patients with left main
coronary artery disease were enrolled in 36 centres in northern Europe and
randomised 1:1 to treatment with PCI or CABG. Eligible patients had stable
angina pectoris, unstable angina pectoris, or non-ST-elevation myocardial
infarction. Exclusion criteria were ST-elevation myocardial infarction
within 24 h, being considered too high risk for CABG or PCI, or expected
survival of less than 1 year. The primary endpoint was major adverse
cardiac or cerebrovascular events (MACCE), a composite of all-cause
mortality, non-procedural myocardial infarction, any repeat coronary
revascularisation, and stroke. Non-inferiority of PCI to CABG required the
lower end of the 95% CI not to exceed a hazard ratio (HR) of 1.35 after up
to 5 years of follow-up. The intention-to-treat principle was used in the
analysis if not specified otherwise. This trial is registered with
ClinicalTrials.gov identifier, number NCT01496651. Findings Between Dec 9,
2008, and Jan 21, 2015, 1201 patients were randomly assigned, 598 to PCI
and 603 to CABG, and 592 in each group entered analysis by intention to
treat. Kaplan-Meier 5 year estimates of MACCE were 29% for PCI (121
events) and 19% for CABG (81 events), HR 1.48 (95% CI 1.11-1.96),
exceeding the limit for non-inferiority, and CABG was significantly better
than PCI (p=0.0066). As-treated estimates were 28% versus 19% (1.55,
1.18-2.04, p=0.0015). Comparing PCI with CABG, 5 year estimates were 12%
versus 9% (1.07, 0.67-1.72, p=0.77) for all-cause mortality, 7% versus 2%
(2.88, 1.40-5.90, p=0.0040) for non-procedural myocardial infarction, 16%
versus 10% (1.50, 1.04-2.17, p=0.032) for any revascularisation, and 5%
versus 2% (2.25, 0.93-5.48, p=0.073) for stroke. Interpretation The
findings of this study suggest that CABG might be better than PCI for
treatment of left main stem coronary artery disease. Funding Biosensors,
Aarhus University Hospital, and participating sites.<br/>Copyright &#xa9;
2016 Elsevier Ltd

<5>
Accession Number
612667786
Author
Puskas J.D.; Halkos M.E.; DeRose J.J.; Bagiella E.; Miller M.A.; Overbey
J.; Bonatti J.; Srinivas V.S.; Vesely M.; Sutter F.; Lynch J.; Kirkwood
K.; Shapiro T.A.; Boudoulas K.D.; Crestanello J.; Gehrig T.; Smith P.;
Ragosta M.; Hoff S.J.; Zhao D.; Gelijns A.C.; Szeto W.Y.; Weisz G.;
Argenziano M.; Vassiliades T.; Liberman H.; Matthai W.; Ascheim D.D.
Institution
(Puskas, Ascheim) Department of Cardiovascular Surgery, Icahn School of
Medicine at Mount Sinai Cardiovascular Institute, New York, New York,
United States
(Puskas) Mount Sinai Heart at Mount Sinai Beth Israel, New York, New York,
United States
(Halkos, Vassiliades, Liberman) Emory University, Atlanta, Georgia
(DeRose, Srinivas) Division of Cardiothoracic Surgery, Department of
Surgery, Montefiore-Einstein Heart Center, Bronx, New York, United States
(Bagiella, Overbey, Kirkwood, Gelijns, Ascheim) Department of Population
Health Science and Policy, Icahn School of Medicine at Mount Sinai, New
York, New York, United States
(Miller) National Heart, Lung, and Blood Institute, Bethesda, Maryland,
United States
(Bonatti) Department of Cardiothoracic Surgery, Cleveland Clinic Abu
Dhabi, Abu Dhabi, United Arab Emirates
(Vesely) Division of Cardiothoracic Surgery, Department of Surgery,
University of Maryland, Baltimore, Maryland, United States
(Sutter, Shapiro) Lankenau Hospital, Philadelphia, Pennsylvania, United
States
(Lynch, Boudoulas, Crestanello) Ohio State University, Columbus, Ohio,
United States
(Gehrig, Smith) Duke University, Durham, North Carolina, United States
(Ragosta) University of Virginia, Charlottesville, Virginia, United States
(Hoff) Vanderbilt Heart Institute, Nashville, Tennessee, United States
(Zhao) Wake Forest University, Winston-Salem, North Carolina, United
States
(Szeto, Matthai) University of Pennsylvania, Philadelphia, Pennsylvania,
United States
(Weisz, Argenziano) Columbia University, New York, New York, United States
(Vassiliades) Medtronic, Inc., Fridley, Minnesota, United States
Title
Hybrid Coronary Revascularization for the Treatment of Multivessel
Coronary Artery Disease: A Multicenter Observational Study.
Source
Journal of the American College of Cardiology. 68 (4) (pp 356-365), 2016.
Date of Publication: 26 Jul 2016.
Publisher
Elsevier USA
Abstract
Background Hybrid coronary revascularization (HCR) combines minimally
invasive surgical coronary artery bypass grafting of the left anterior
descending artery with percutaneous coronary intervention (PCI) of
non-left anterior descending vessels. HCR is increasingly used to treat
multivessel coronary artery disease that includes stenoses in the proximal
left anterior descending artery and at least 1 other vessel, but its
effectiveness has not been rigorously evaluated. Objectives This National
Institutes of Health-funded, multicenter, observational study was
conducted to explore the characteristics and outcomes of patients
undergoing clinically indicated HCR and multivessel PCI for
hybrid-eligible coronary artery disease, to inform the design of a
confirmatory comparative effectiveness trial. Methods Over 18 months, 200
HCR and 98 multivessel PCI patients were enrolled at 11 sites. The primary
outcome was major adverse cardiac and cerebrovascular events (MACCE)
(i.e., death, stroke, myocardial infarction, repeat revascularization)
within 12 months post-intervention. Cox proportional hazards models were
used to model time to first MACCE event. Propensity scores were used to
balance the groups. Results Mean age was 64.2 +/- 11.5 years, 25.5% of
patients were female, 38.6% were diabetic, and 4.7% had previous stroke.
Thirty-eight percent had 3-vessel coronary artery disease, and the mean
SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score was 19.7
+/- 9.6. Adjusted for baseline risk, MACCE rates were similar between
groups within 12 months post-intervention (hazard ratio [HR]: 1.063; p =
0.80) and during a median 17.6 months of follow-up (HR: 0.868; p = 0.53).
Conclusions These observational data from this first multicenter study of
HCR suggest that there is no significant difference in MACCE rates over 12
months between patients treated with multivessel PCI or HCR, an emerging
modality. A randomized trial with long-term outcomes is needed to
definitively compare the effectiveness of these 2 revascularization
strategies. (Hybrid Revascularization Observational Study;
NCT01121263)<br/>Copyright &#xa9; 2016 American College of Cardiology
Foundation

<6>
Accession Number
611507926
Author
Stratz C.; Bomicke T.; Younas I.; Kittel A.; Amann M.; Valina C.M.;
Nuhrenberg T.; Trenk D.; Neumann F.-J.; Hochholzer W.
Institution
(Stratz, Bomicke, Younas, Amann, Valina, Nuhrenberg, Trenk, Neumann,
Hochholzer) University Heart Center Freiburg Bad Krozingen, Department of
Cardiology and Angiology II, Bad Krozingen, Germany
(Kittel) Institute of Experimental and Clinical Pharmacology and
Toxicology, Friedrich-Alexander-Universitaet Erlangen-Nuernberg, Erlangen,
Germany
Title
Comparison of Immature Platelet Count to Established Predictors of
Platelet Reactivity During Thienopyridine Therapy.
Source
Journal of the American College of Cardiology. 68 (3) (pp 286-293), 2016.
Date of Publication: 19 Jul 2016.
Publisher
Elsevier USA
Abstract
Background Previous data suggest that reticulated platelets significantly
affect antiplatelet response to thienopyridines. It is unknown whether
parameters describing reticulated platelets can predict antiplatelet
response to thienopyridines. Objectives The authors sought to determine
the extent to which parameters describing reticulated platelets can
predict antiplatelet response to thienopyridine loading compared with
established predictors. Methods This study randomized 300 patients
undergoing elective coronary stenting to loading with clopidogrel 600 mg,
prasugrel 30 mg, or prasugrel 60 mg. Adenosine diphosphate (ADP)-induced
platelet reactivity was assessed by impedance aggregometry before loading
(intrinsic platelet reactivity) and again on day 1 after loading. Multiple
parameters of reticulated platelets were assessed by automated whole blood
flow cytometry: absolute immature platelet count (IPC), immature platelet
fraction, and highly fluorescent immature platelet fraction. Results Each
parameter of reticulated platelets correlated significantly with
ADP-induced platelet reactivity (p < 0.01 for all 3 parameters). In a
multivariable model including all 3 parameters, only IPC remained a
significant predictor of platelet reactivity (p < 0.001). In models
adjusting each of the 3 parameters for known predictors of on-treatment
platelet reactivity including cytochrome P450 2C19 (CYP2C19)
polymorphisms, age, body mass index, diabetes, and intrinsic platelet
reactivity, only IPC prevailed as an independent predictor (p = 0.001). In
this model, IPC was the strongest predictor of on-treatment platelet
reactivity followed by intrinsic platelet reactivity. Conclusions IPC is
the strongest independent platelet count-derived predictor of antiplatelet
response to thienopyridine treatment. Given its easy availability,
together with its even stronger association with on-treatment platelet
reactivity compared with known predictors, including the CYP2C19*2
polymorphism, IPC may become the preferred predictor of antiplatelet
response to thienopyridine treatment. (Impact of Extent of
Clopidogrel-Induced Platelet Inhibition During Elective Stent Implantation
on Clinical Event Rate-Advanced Loading Strategies [ExcelsiorLOAD];
DRKS00006102)<br/>Copyright &#xa9; 2016 American College of Cardiology
Foundation

<7>
Accession Number
612986975
Author
Cavalcante R.; Sotomi Y.; Lee C.W.; Ahn J.-M.; Farooq V.; Tateishi H.;
Tenekecioglu E.; Zeng Y.; Suwannasom P.; Collet C.; Albuquerque F.N.;
Onuma Y.; Park S.-J.; Serruys P.W.
Institution
(Cavalcante, Tateishi, Tenekecioglu, Zeng, Albuquerque, Onuma)
Thoraxcenter, Department of Interventional Cardiology, Erasmus University
Medical Center, Rotterdam, Netherlands
(Cavalcante) Heart Institute (InCor), University of Sao Paulo Medical
School, Sao Paulo, Brazil
(Sotomi, Suwannasom, Collet) Academic Medical Center, University of
Amsterdam, Amsterdam, Netherlands
(Lee, Ahn, Park) Heart Institute, University of Ulsan College of Medicine,
Asan Medical Center, Seoul, South Korea
(Farooq) Manchester Heart Centre, Manchester Royal Infirmary, Central
Manchester University Hospitals NHS Trust, Manchester, United Kingdom
(Serruys) International Center for Circulatory Health, Imperial College
London, London, United Kingdom
Title
Outcomes After Percutaneous Coronary Intervention or Bypass Surgery in
Patients With Unprotected Left Main Disease.
Source
Journal of the American College of Cardiology. 68 (10) (pp 999-1009),
2016. Date of Publication: 06 Sep 2016.
Publisher
Elsevier USA
Abstract
Background Currently available randomized data on the comparison between
percutaneous coronary intervention (PCI) and coronary artery bypass graft
(CABG) for the treatment of unprotected left main coronary disease (LMD)
lacks statistical power due to low numbers of patients enrolled.
Objectives This study assessed long-term outcomes of PCI and CABG for the
treatment of LMD in specific subgroups according to disease anatomic
complexity. Methods We conducted a pooled analysis of individual
patient-level data of the LMD patients included in the PRECOMBAT (Bypass
Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With
Left Main Coronary Artery Disease) and SYNTAX (Synergy Between PCI With
TAXUS and Cardiac Surgery) trials. Incidences of major adverse cardiac
events were assessed at 5 years follow-up. Results Study population
comprised 1,305 patients. The incidence of major adverse cardiac and
cerebrovascular events at 5 years was 28.3% in the PCI group and 23.0% in
the CABG group (hazard ratio [HR]: 1.23; 95% confidence interval [CI]:
1.01 to 1.55; p = 0.045). This difference is mainly driven by a higher
rate of repeat revascularization associated with PCI (HR: 1.85; 95% CI:
1.38 to 2.47; p < 0.001). The 2 strategies showed similar rates of the
safety composite endpoint of death, myocardial infarction, or stroke (p =
0.45). In patients with isolated LM or LM + 1-vessel disease, PCI was
associated with a 60% reduction in all-cause mortality (HR: 0.40; 95% CI:
0.20 to 0.83; p = 0.029) and 67% reduction in cardiac mortality (HR: 0.33;
95% CI: 0.12 to 0.88; p = 0.025) when compared with CABG. Conclusions In
patients with unprotected LMD, CABG, and PCI result in similar rates of
the safety composite endpoint of death, myocardial infarction, or stroke.
In patients with isolated LM or LM + 1-vessel disease, PCI is associated
with lower all-cause and cardiac mortality when compared to
CABG.<br/>Copyright &#xa9; 2016 American College of Cardiology Foundation

<8>
Accession Number
613088564
Author
Auffret V.; Regueiro A.; Del Trigo M.; Abdul-Jawad Altisent O.;
Campelo-Parada F.; Chiche O.; Puri R.; Rodes-Cabau J.
Institution
(Auffret, Regueiro, Del Trigo, Abdul-Jawad Altisent, Campelo-Parada,
Chiche, Puri, Rodes-Cabau) Quebec Heart & Lung Institute, Laval
University, Quebec City, Quebec, Canada
(Auffret) Rennes 1 University, Signal and Image Processing Laboratory,
Rennes, France
Title
Predictors of Early Cerebrovascular Events in Patients With Aortic
Stenosis Undergoing Transcatheter Aortic Valve Replacement.
Source
Journal of the American College of Cardiology. 68 (7) (pp 673-684), 2016.
Date of Publication: 01 Aug 2016.
Publisher
Elsevier USA
Abstract
Background Identifying transcatheter aortic valve replacement (TAVR)
patients at high risk for cerebrovascular events (CVE) is of major
clinical relevance. However, predictors have varied across studies.
Objectives The purpose of this study was to analyze the predictors of
30-day CVE post-TAVR. Methods A systematic review of studies that reported
the incidence of CVE post-TAVR while providing raw data for predictors of
interest was performed. Data on study, patient, and procedural
characteristics were extracted. Crude risk ratios (RRs) and 95% confidence
intervals for each predictor were calculated. Results Sixty-four studies
involving 72,318 patients (2,385 patients with a CVE within 30 days
post-TAVR) were analyzed. Incidence of CVE ranged from 1% to 11% (median
4%) without significant differences between single and multicenter
studies, or according to CVE adjudication availability. The summary RRs
indicated lower risk for men (RR: 0.82; p = 0.02) and higher risk for
patients with chronic kidney disease (RR: 1.29; p = 0.03) and with
new-onset atrial fibrillation post-TAVR (RR: 1.85; p = 0.005), and for
procedures performed within the first half of center experience (RR: 1.55;
p = 0.003). The use of balloon post-dilation tended to be associated with
a higher risk of CVE (RR: 1.43; p = 0.07). Valve type (balloon-expandable
vs. self-expandable, p = 0.26) and approach (transfemoral vs.
nontransfemoral, p = 0.81) did not predict CVE. Conclusions Female sex,
chronic kidney disease, enrollment date, and new-onset atrial fibrillation
were predictors of CVE post-TAVR. This study provides effect estimates to
identify high-risk TAVR patients for early CVE, providing possible
guidance for tailored preventive strategies.<br/>Copyright &#xa9; 2016
American College of Cardiology Foundation

<9>
Accession Number
612908478
Author
Ribeiro H.B.; Orwat S.; Hayek S.S.; Larose E.; Babaliaros V.; Dahou A.; Le
Ven F.; Pasian S.; Puri R.; Abdul-Jawad Altisent O.; Campelo-Parada F.;
Clavel M.-A.; Pibarot P.; Lerakis S.; Baumgartner H.; Rodes-Cabau J.
Institution
(Ribeiro, Larose, Dahou, Le Ven, Pasian, Puri, Abdul-Jawad Altisent,
Campelo-Parada, Clavel, Pibarot, Rodes-Cabau) Quebec Heart & Lung
Institute, Laval University, Quebec City, Quebec, Canada
(Orwat, Baumgartner) Division of Adult Congenital and Valvular Heart
Disease, Department of Cardiovascular Medicine, University Hospital
Muenster, Muenster, Germany
(Hayek, Babaliaros, Lerakis) Emory University School of Medicine, Atlanta,
Georgia, United States
Title
Cardiovascular Magnetic Resonance to Evaluate Aortic Regurgitation After
Transcatheter Aortic Valve Replacement.
Source
Journal of the American College of Cardiology. 68 (6) (pp 577-585), 2016.
Date of Publication: 09 Aug 2016.
Publisher
Elsevier USA
Abstract
Background Residual aortic regurgitation (AR) following transcatheter
aortic valve replacement (TAVR) is associated with greater mortality; yet,
determining AR severity post-TAVR using Doppler echocardiography remains
challenging. Cardiovascular magnetic resonance (CMR) is purported as a
more accurate means of quantifying AR; however, no data exist regarding
the prognostic value of AR as assessed by CMR post-TAVR. Objectives This
study sought to evaluate the effect of AR assessed with CMR on clinical
outcomes post-TAVR. Methods We included 135 patients from 3 centers. AR
was quantified using regurgitant fraction (RF) measured by phase-contrast
velocity mapping CMR at a median of 40 days post-TAVR, and using Doppler
echocardiography at a median of 6 days post-TAVR. Median follow-up was 26
months. Clinical outcomes included mortality and rehospitalization for
heart failure. Results Moderate-severe AR occurred in 17.1% and 12.8% of
patients as measured by echocardiography and CMR, respectively. Higher RF
post-TAVR was associated with increased mortality (hazard ratio: 1.18 for
each 5% increase in RF [95% confidence interval: 1.08 to 1.30]; p < 0.001)
and the combined endpoint of mortality and rehospitalization for heart
failure (hazard ratio: 1.19 for each 5% increase in RF; 95% confidence
interval: 1.15 to 1.23; p < 0.001). Prediction models yielded significant
incremental predictive value; CMR performed a median of 40 days post-TAVR
had a greater association with post-TAVR clinical events compared with
early echocardiography (p < 0.01). RF >=30% best predicted poorer clinical
outcomes (p < 0.001 for either mortality or the combined endpoint of
mortality and heart failure rehospitalization). Conclusions Worse
CMR-quantified AR was associated with increased mortality and poorer
clinical outcomes following TAVR. Quantifying AR with CMR may identify
patients with AR who could benefit from additional treatment
measures.<br/>Copyright &#xa9; 2016 American College of Cardiology
Foundation

<10>
Accession Number
612908445
Author
Van Belle E.; Hengstenberg C.; Lefevre T.; Kupatt C.; Debry N.; Husser O.;
Pontana F.; Kuchcinski G.; Deliargyris E.N.; Mehran R.; Bernstein D.;
Anthopoulos P.; Dangas G.D.
Institution
(Van Belle, Debry) Department of Cardiology, Centre Hospitalier Regional
Universitaire (CHRU) Lille and Unite Mixte de Recherche (UMR1011), Lille,
France
(Hengstenberg, Husser) Deutsches Herzzentrum Munchen, Technische
Universitat Munchen, Munich, Germany
(Hengstenberg) Deutsches Zentrum fur Herz-Kreislauf-Forschung E.V. (DZHK),
partner site Munich Heart Alliance, Munich, Germany
(Lefevre) Institut Cardio Vasculaire Paris Sud, Paris, France
(Kupatt) Ludwig Maximilian University of Munich (LMU) Munich, Munich,
Germany
(Pontana, Kuchcinski) Department of Radiology, CHRU Lille, Lille, France
(Deliargyris, Bernstein) The Medicines Company, Parsippany, New Jersey,
United States
(Mehran, Dangas) The Zena and Michael A. Wiener Cardiovascular Institute,
Icahn School of Medicine at Mount Sinai, New York, New York, United States
(Anthopoulos) The Medicines Company, Zurich, Switzerland
Title
Cerebral Embolism During Transcatheter Aortic Valve Replacement: The
BRAVO-3 MRI Study.
Source
Journal of the American College of Cardiology. 68 (6) (pp 589-599), 2016.
Date of Publication: 09 Aug 2016.
Publisher
Elsevier USA
Abstract
Background Cerebral embolization is a frequent complication after
transcatheter aortic valve replacement (TAVR). We hypothesized that
cerebral embolization may be reduced by anticoagulation with bivalirudin
during TAVR. Objectives This study sought to determine the proportion of
patients with new cerebral embolus after TAVR and to investigate whether
parenteral procedural anticoagulation strategies affect cerebral
embolization. Methods The BRAVO (Effect of Bivalirudin on Aortic Valve
Intervention Outcomes)-3 randomized trial compared bivalirudin with
unfractionated heparin in patients undergoing transfemoral TAVR. A
prospective cerebral magnetic resonance imaging (MRI) substudy was
conducted in 4 sites; 60 patients were imaged with brain MRI after TAVR.
Primary endpoint was proportion of patients with new cerebral emboli on
MRI. Secondary endpoints included quantitative MRI analyses of cerebral
lesions and neurological outcomes at 48 h and 30 days. Results Patients
were randomized to bivalirudin (n = 29) versus heparin (n = 31). The
proportion of patients with new cerebral emboli on MRI did not differ
between bivalirudin and heparin groups (65.5% vs. 58.1%; p = 0.55). Groups
were similar for median number of emboli per patient (1 [interquartile
range (IQR): 0 to 3] vs. 1 [IQR: 0 to 1]; p = 0.08), total volume of
emboli (45 [IQR: 0 to 175] mm³ vs. 33 [IQR: 0 to 133]
mm³; p = 0.86), or proportion of patients with a clinical
neurological deficit at 48 h or 30 days. All patients who presented
clinically with stroke had evidence of new emboli on MRI. Conclusions This
study documented cerebral embolization in nearly two-thirds of patients
during contemporary TAVR. There were no significant differences in
cerebral embolization for bivalirudin versus heparin anticoagulation
during TAVR. (Open-Label, Randomized Trial in Patients Undergoing TAVR to
Determine Safety and Efficacy of Bivalrudin vs. UFH [BRAVO-2/3];
NCT01651780)<br/>Copyright &#xa9; 2016 American College of Cardiology
Foundation

<11>
Accession Number
612902847
Author
Chaudhri M.S.; Shah M.U.A.; Asghar M.I.; Siddiqi R.; Janjua A.M.; Iqbal A.
Institution
(Chaudhri, Shah, Asghar, Janjua, Iqbal) Department of Cardiac Surgery,
Armed Forces Institute of Cardiology and National Institute of Heart
Diseases (AFIC-NIHD), Rawalpindi, Pakistan
(Siddiqi) Cardio-Thoracic Anesthesia, Armed Forces Institute of Cardiology
and National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi, Pakistan
Title
Skeletonization of left internal mammary artery in coronary artery bypass
grafting.
Source
Journal of the College of Physicians and Surgeons Pakistan. 26 (9) (pp
736-739), 2016. Date of Publication: September 2016.
Publisher
College of Physicians and Surgeons Pakistan (7th Central Street, Karachi
755000, Pakistan)
Abstract
Objective: To compare mean per-operative flow capacity between
skeletonized and pedicled left internal mammary artery (LIMA) in patients
undergoing coronary artery bypass grafting (CABG) surgery. Study Design:
Randomized control trial. Place and Duration of Study: Department of
Cardiac Surgery, Armed Forces Institute of Cardiology and National
Institute of Heart Diseases (AFIC-NIHD), Rawalpindi, Pakistan from
February to August, 2013. Methodology: Patients undergoing CABG for
coronary artery disease, under 80 years, excluded by the exclusion
criteria; and fulfilling the inclusion criteria were randomly assigned to
two groups of 70 each. One group underwent skeletonized and the other
underwent pedicled technique of LIMA harvesting. Free flow was checked
just before anastamosis of each LIMA to the LAD, manually in blood flow in
ml per minute during cardiopulmonary bypass by allowing it to bleed into a
100 ml container over 20 seconds. A specialized proforma was used to
record the age, gender, weight, disease, type of IMA used, and free flow
of the IMA. Data was analyzed using SPSS 18. Results: The mean age of the
patients was 57.16 years in 40 patients, ranging from 36 to 75 years.
Disease pattern analysis showed 5%, 10.7% and 84.3% single, double and
triple vessel coronary artery disease, respectively. There was
significantly higher free flow in the skeletonized group than the pedicled
group (p=0.04). Conclusion: Skeletonized IMA had superior flow to pedicled
IMA in addition to its traditional proven advantages, which justifies its
further use as a conduit for myocardial revascularization.

<12>
Accession Number
613231151
Author
Yoon S.-H.; Lefevre T.; Ahn J.-M.; Perlman G.Y.; Dvir D.; Latib A.;
Barbanti M.; Deuschl F.; De Backer O.; Blanke P.; Modine T.; Pache G.;
Neumann F.-J.; Ruile P.; Arai T.; Ohno Y.; Kaneko H.; Tay E.; Schofer N.;
Holy E.W.; Luk N.H.V.; Yong G.; Lu Q.; Kong W.K.F.; Hon J.; Kao H.-L.; Lee
M.; Yin W.-H.; Park D.-W.; Kang S.-J.; Lee S.-W.; Kim Y.-H.; Lee C.W.;
Park S.-W.; Kim H.-S.; Butter C.; Khalique O.K.; Schaefer U.; Nietlispach
F.; Kodali S.K.; Leon M.B.; Ye J.; Chevalier B.; Leipsic J.; Delgado V.;
Bax J.J.; Tamburino C.; Colombo A.; Sondergaard L.; Webb J.G.; Park S.-J.
Institution
(Yoon, Ahn, Park, Kang, Lee, Kim, Lee, Park, Park) Division of Cardiology,
University of Ulsan, Asan Medical Center, Seoul, Korea, United States
(Lefevre, Arai, Chevalier) Generale de Sante, Institut Cardiovasculaire
Paris Sud, Hopital Prive Jacques Cartier, Massy, France
(Perlman, Dvir, Blanke, Ye, Leipsic, Webb) Department of Cardiology, St
Paul's Hospital, University of British Columbia, Vancouver, British
Columbia, Canada
(Latib, Colombo) Interventional Cardiology Unit, EMO-GVM Centro Cuore
Columbus, San Raffaele Scientific Institute, Italy San Raffaele Hospital,
Milan, Italy
(Barbanti, Ohno, Tamburino) Division of Cardiology, Ferrarotto Hospital,
University of Catania, Catania, Italy
(Deuschl, Schofer, Schaefer) Department for General and Interventional
Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf
(UKE), Hamburg, Germany
(De Backer, Luk, Sondergaard) The Heart Centre, Rigshospitalet University
Hospital, Copenhagen, Denmark
(Modine) Department of Cardiovascular Surgery, Hospital Cardiologique,
Lille, France
(Pache) Department of Radiology, Section of Cardiovascular Radiology,
University of Freiburg, Bad Krozingen, Germany
(Neumann, Ruile) Department of Cardiology & Angiology II, University Heart
Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
(Kaneko, Butter) Heart Center Brandenburg in Bernau, Bernau, Germany
(Tay, Kong, Hon) Department of Cardiology, National University Heart
Centre, Singapore
(Holy, Nietlispach) University Heart Center, Cardiology and Cardiovascular
Surgery, University Hospital Zurich, Zurich, Switzerland
(Yong) Division of Cardiology, Royal Perth Hospital, Perth, Western
Australia, Australia
(Lu) Division of Vascular Surgery, Changhai Hospital, Shanghai, China
(Kong) Department of Cardiology, Leiden University Medical Center, Leiden,
Netherlands
(Kao, Delgado, Bax) Department of Internal Medicine, National Taiwan
University Hospital, Taipei, Taiwan (Republic of China)
(Lee) Division of Cardiology, Queen Elizabeth Hospital, Kowloon, Hong Kong
(Yin) Division of Cardiology, Heart Center, Cheng Hsin General Hospital,
Taipei, Taiwan (Republic of China)
(Kim) Department of Internal Medicine and Cardiovascular Center, Seoul
National University Hospital, Seoul, South Korea
(Khalique, Kodali, Leon) Columbia University Medical Center/New York
Presbyterian Hospital, New York, New York, United States
Title
Transcatheter Aortic Valve Replacement With Early- and New-Generation
Devices in Bicuspid Aortic Valve Stenosis.
Source
Journal of the American College of Cardiology. 68 (11) (pp 1195-1205),
2016. Date of Publication: 13 Sep 2016.
Publisher
Elsevier USA
Abstract
Background Few studies have evaluated the clinical outcomes of
transcatheter aortic valve replacement (TAVR) in patients with bicuspid
aortic valve stenosis (AS). Particularly, limited data exist comparing the
results of TAVR with new-generation devices versus early-generation
devices. Objectives This study sought to evaluate the clinical outcomes of
TAVR for bicuspid AS with early- and new-generation devices. Methods The
Bicuspid TAVR Registry is an international multicenter study enrolling
consecutive patients with bicuspid AS undergoing TAVR between April 2005
and May 2015. Results Of 301 patients, 199 patients (71.1%) were treated
with early-generation devices (Sapien XT [Edwards Lifesciences
Corporation, Irvine, California]: n = 87; CoreValve [Medtronic,
Minneapolis, Minnesota]: n = 112) and 102 with new-generation devices
(Sapien 3 [Edwards Lifesciences Corporation]: n = 91; Lotus [Boston
Scientific Corporation, Marlborough, Massachusetts]: n = 11). The mean
Society of Thoracic Surgeons score was 4.7 +/- 5.2 without significant
differences between groups (4.6 +/- 5.1 vs. 4.9 +/- 5.4; p = 0.57).
Overall, all-cause mortality rates were 4.3% at 30 days and 14.4% at 1
year. Moderate or severe paravalvular leak was absent and significantly
less frequent with new-generation compared to early-generation devices
(0.0% vs. 8.5%; p = 0.002), which resulted in a higher device success rate
(92.2% vs. 80.9%; p = 0.01). There were no differences between early- and
new-generation devices in stroke (2.5% vs. 2.0%; p > 0.99),
life-threatening bleeding (3.5% vs. 2.9%; p > 0.99), major vascular
complication (4.5% vs. 2.9%; p = 0.76), stage 2 to 3 acute kidney injury
(2.5% vs. 2.9%; p > 0.99), early safety endpoints (15.1% vs. 10.8%; p =
0.30), and 30-day all-cause mortality (4.5% vs. 3.9%; p > 0.99).
Conclusions The clinical outcomes of TAVR in patients with bicuspid AS
were favorable. New-generation devices were associated with less
paravalvular leak and, hence, a higher device success rate than
early-generation devices. (The Bicuspid Aortic Stenosis Following
Transcatheter Aortic Valve Replacement Registry [Bicuspid TAVR];
NCT02394184)<br/>Copyright &#xa9; 2016 American College of Cardiology
Foundation

<13>
Accession Number
613230136
Author
Clavel M.-A.; Tribouilloy C.; Vanoverschelde J.-L.; Pizarro R.; Suri R.M.;
Szymanski C.; Lazam S.; Oberti P.; Michelena H.I.; Jaffe A.;
Enriquez-Sarano M.
Institution
(Clavel, Suri, Michelena, Jaffe, Enriquez-Sarano) Department of
Cardiology, Division of Cardiovascular Diseases and Internal Medicine,
Mayo Clinic, Rochester, Minnesota, United States
(Tribouilloy, Szymanski) Department of Cardiology, INSERM, ERI-12,
University Hospital, Amiens, France
(Vanoverschelde, Lazam) Department of Cardiology, Universite Catholique de
Louvain, Brussels, Belgium
(Pizarro, Oberti) Department of Cardiology, Hospital Italiano, Buenos
Aires, Argentina
Title
Association of B-Type Natriuretic Peptide With Survival in Patients With
Degenerative Mitral Regurgitation.
Source
Journal of the American College of Cardiology. 68 (12) (pp 1297-1307),
2016. Date of Publication: 20 Sep 2016.
Publisher
Elsevier USA
Abstract
Background Studies suggesting that B-type natriuretic peptide (BNP) may
predict outcomes of mitral regurgitation (MR) are plagued by small size,
inconsistent etiologies, and lack of accounting for shifting normal BNP
ranges with age and sex. Objectives This study assessed the effect of BNP
activation on mortality in a large, multicenter cohort of patients with
degenerative MR. Methods In 1,331 patients with degenerative MR, BNP was
prospectively measured at diagnosis and expressed as BNPratio (ratio to
upper limit of normal for age, sex, and assay). Initial surgical
management was performed within 3 months of diagnosis in 561 patents.
Results The cohort had a mean age of 64 +/- 15 years, was 66% male, and
had a mean ejection fraction 64 +/- 9%, mean regurgitant volume 67 +/- 31
ml, and low mean Charlson comorbidity index of 1.09 +/- 1.76. Median
BNPratio was 1.01 (25th and 75th percentiles: 0.42 to 2.36). Overall,
BNPratio was a powerful, independent predictor of mortality (hazard ratio:
1.33 [95% confidence interval: 1.15 to 1.54]; p < 0.0001), whereas
absolute BNP was not (p = 0.43). In patients who were initially treated
medically (n = 770; 58%), BNPratio was a powerful, independent, and
incremental predictor of mortality after diagnosis (hazard ratio: 1.61
[95% confidence interval: 1.34 to 1.93]; p < 0.0001). Higher BNP
activation was associated with higher mortality (p < 0.0001). All
subgroups, particularly severe MR, incurred similar excess mortality with
BNP activation. After initial surgical treatment (n = 561, 42%) BNP
activation did not impose excess long-term mortality (p = 0.23).
Conclusions In patients with degenerative MR, BNPratio is a powerful,
independent, and incremental predictor of long-term mortality under
medical management. BNPratio should be incorporated into the routine
clinical assessment of patients with degenerative MR.<br/>Copyright &#xa9;
2016 American College of Cardiology Foundation

<14>
Accession Number
610403107
Author
McElroy I.; Sareh S.; Zhu A.; Miranda G.; Wu H.; Nguyen M.; Shemin R.;
Benharash P.
Institution
(McElroy, Sareh, Zhu, Miranda, Wu, Nguyen, Shemin, Benharash) Division of
Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at
UCLA, Los Angeles, CA, United States
(Benharash) Division of Cardiac Surgery, UCLA Center for Health Sciences,
10833 Le Conte Avenue, Los Angeles, CA 90095, United States
Title
Use of digital health kits to reduce readmission after cardiac surgery.
Source
Journal of Surgical Research. 204 (1) (pp 1-7), 2016. Date of Publication:
01 Jul 2016.
Publisher
Academic Press Inc. (E-mail: apjcs@harcourt.com)
Abstract
Background Unintended rehospitalizations after surgical procedures
represent a large percentage of readmissions and have been associated with
increased morbidity and cost of care. Beginning in 2017, Medicare will
expand diagnostic categories subject to financial penalties for excess
postoperative readmissions to include coronary revascularization
procedures. Arrhythmias and pulmonary complications comprise the largest
categories for readmission after cardiac surgery. Technologic advances in
remote monitoring have led to the use of web-based digital health kits
(DHK) aimed at reducing readmissions and improving postoperative outcomes.
The present study was performed to determine the added benefit of
incorporating DHK's into a formal readmissions reduction program (RRP) in
preventing 30-d readmissions and to evaluate patient and provider
satisfaction with the use of these devices. Materials and methods This was
a prospective study of all adult patients who underwent cardiac surgery at
our institution from March 2014 to June 2015. During the study period, 443
adult patients (mean age, 65 +/- 14, 33% female) were identified and
participated in the formal RRP, 27 of whom also received a DHK after
discharge (416 control group). In addition to providing a live video link
to a provider specializing in cardiac surgery, the DHK also allowed for
automatic daily transmission of weight, oxygen saturation, heart rate, and
blood pressure. Patients also completed a daily health survey targeting
symptoms concerning for heart failure, poor wound healing, poor
ambulation, and nonadherence to medications. Abnormal vitals or survey
responses triggered automatic notifications to the healthcare team.
Satisfaction surveys were administered to participants and members of the
healthcare team. Pearson chi² test and the Welch's t-test were
used to assess statistical differences in baseline characteristics and
outcome variables. Results During the study period, the readmission rate
for the DHK and control groups were similar (7.4% versus 9.9%, P = 0.65).
The use of DHKs led to 1649 alerts and 144 interventions, with the highest
number of alerts occurring during d 5-9. The majority of alerts (64%) were
prompted by abnormal biometric measurements, and a significant correlation
was noted between abnormal biometrics and required intervention (r = 0.62,
P < 0.001). No correlation was seen between alerts because of health
survey responses (r = 0.07, P = 0.71) or missed check-ins (r = 0.06, P =
0.76) and required interventions. Poststudy satisfaction surveys showed an
overall satisfaction rating of 4.9 +/- 0.5 for DHK patients and 4.9 +/-
0.2 for members of the care team (scale 1-5, 5 = agree). Conclusions In
our study, adding DHKs to a formal RRP was not associated with a
significant decrease in 30-d readmission rates. We also found that
notifications because of abnormal biometric measures were significantly
correlated with required interventions. In contrast, notifications due to
abnormal health survey responses were not associated with increased
interventions. Both patients and members of the healthcare team were
highly satisfied with this technology. DHKs appear to extend care beyond
the inpatient period and provide a portal for telemonitoring of surgical
patients. However, this modality is highly resource intensive and may not
significantly reduce readmissions. Further studies are warranted to
evaluate the efficacy of such kits in reducing readmissions and costs of
care.

<15>
Accession Number
613880897
Author
Sundermann S.H.; Czesla M.; Kempfert J.; Walther T.; Nataf P.; Raanani E.;
Jacobs S.; Alfieri O.; Maisano F.; Falk V.
Institution
(Sundermann, Kempfert, Jacobs, Falk) Department of Cardiothoracic and
Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1,
Berlin 13353, Germany
(Sundermann, Jacobs, Falk) DZHK (German Centre for Cardiovascular
Research), Partner Site Berlin, Berlin, Germany
(Czesla) Klinikum Passau, Department of Cardiac Surgery. Innstrasse 76,
Passau 94032, Germany
(Walther) Department of Cardiac Surgery, Kerckhoff-Klinik, Benekestr. 2-8,
Bad Nauheim 61231, Germany
(Nataf) Department of Cardiac Surgery, Assistance Publique-Hopitaux de
Paris, Bichat Hospital, Paris, France
(Raanani) Department of Cardiac Surgery, Sheba Medical Center,
Tel-Hashomer, Israel
(Alfieri) Department of Cardiovascular Surgery, San Raffaele Hospital,
Milan, Italy
(Maisano) University Hospital of Zurich, Heart Center, Zurich, Switzerland
(Falk) Charite, Universitatsmedizin Berlin, Berlin, Germany
Title
Results of mitral valve repair with an adjustable annuloplasty ring 2
years after implantation.
Source
Heart and Vessels. 32 (7) (pp 843-849), 2017. Date of Publication: 01 Jul
2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Abstract: We aimed to investigate the safety and medium-term durability of
an adjustable mitral annuloplasty ring in patients undergoing surgery for
mitral valve regurgitation. Forty-five patients requiring mitral valve
repair were enrolled into this prospective, multicentre study between May
2012 and May 2013 in six hospitals in Europe and Israel. Study endpoints
evaluated the performance and safety of the device assessed using
inter-individual comparisons. Implantation was performed through a
sternotomy in ten patients and mini-thoracotomy in 35 patients. The ring
was adjusted after declamping and weaning from cardio-pulmonary bypass
under echocardiographic guidance if the coaptation surface was not
optimal, or in cases of residual mitral regurgitation. Follow-up was
performed up to 2 years post-procedure. Mean age was 61 +/- 12 years. Ring
adjustment was performed in 71% of patients to optimise the results of
mitral valve repair. Following the procedure, 11/45 patients (24%) who had
had mild residual mitral regurgitation had no mitral regurgitation
following ring adjustment. Two patients with severe mitral regurgitation
post-procedure had mild regurgitation following ring adjustment.
Coaptation length increased significantly after adjustment. One patient
died before hospital discharge due to complications unrelated to the
adjustable ring. One patient had to undergo re-operation at 39 days
post-procedure due to endocarditis. At 2 years of follow-up, 78% of
patients had no residual mitral regurgitation and 22% had mild residual
mitral regurgitation. Adjustable mitral annuloplasty ring implantation was
safe in all patients. Mitral valve repair with the adjustable ring was
durable in all patients who reached 2 years follow-up. Clinical Trial
Registration: NCT01617720.<br/>Copyright &#xa9; 2016, Springer Japan.

<16>
Accession Number
617071692
Author
Morales-Conde S.; Ahmed A.; Stanbridge R.; Lim E.; Shackcloth M.; Legrand
M.; Himpens J.; Baste J.M.
Institution
(Morales-Conde) Universtiy Hospital Universitario Virgen Del Rocio,
SEVILLA, Spain
(Ahmed) Imperial College Healthcare NHS Trust, St. Mary's Hospital,
LONDON, United Kingdom
(Stanbridge) Imperial College Healthcare NHS Trust, Hammersmith Hospital,
LONDON, United Kingdom
(Lim) Royal Brompton Hospital, LONDON, United Kingdom
(Shackcloth) Liverpool Heart and Chest Hospital, LIVERPOOL, United Kingdom
(Legrand) CHR de Huy, HUY, Belgium
(Himpens) Edith Cavell Hospital, BRUXELLES, Belgium
(Baste) Rouen University Hospital, ROUEN CEDEX, France
Title
Interim results of staple line reinforcement with endo giaTM reinforced
reload during abdominal and thoracic surgery procedures.
Source
Surgical Endoscopy and Other Interventional Techniques. Conference: 24th
International Congress of the European Association for Endoscopic Surgery,
EAES 2016. Netherlands. 31 (2 Supplement 1) (pp S324), 2017. Date of
Publication: June 2017.
Publisher
Springer New York LLC
Abstract
Aims: Staple line reinforcement during surgical procedures is a practice
that may decrease morbidity and may reduce the risk of staple line leaks
and bleeding. The Endo GIA Reinforced Reload with Tri-Staple Technology
utilizes a pre-attached, porous, synthetic polymer buttress during
stapling and resection, and is used in multiple therapeutic areas.
Methods: This prospective, two-arm (abdominal and thoracic), multicenter,
post-market study includes 12 European hospitals evaluating the use of
Endo GIA TM Reinforced Reload with Tri-Staple Technology. The primary
endpoint is the incidence of reported device-related adverse events at 30
days. This interim analysis was planned at 50 patients consisting of
abdominal and thoracic procedures. Any required intervention to control
staple line bleeding was recorded and intraoperative leak testing was
conducted on each patient. Results: From May 2015 to August 2015, 51
patients were prospectively enrolled (mean age(+/-SD): 44 +/- 13 years for
group-A; 65 +/- 9 years for group-T). For group-A (19 patients; 9
Laparoscopic Sleeve Gastrectomy, and 10 Laparoscopic Roux-en-Y Gastric
Bypass), the median hospital stay was 2 [1-5] days. Of these patients, 6
minor bleedings (<50 CC) requiring clips and/or ligation were observed at
the staple line with no observed intraoperative leaks. Patients in group-T
(32 patients; 9 open and 23 VATS wedge and/or lobectomy) had a median
hospital stay of 4 [1-23] days with 2 observed minor bleedings at the
staple line (<50 CC), 1 which was treated by pressure, and 3 air leaks,
which required no intervention. During post-operative follow-up, 3
different patients from group-T required 8, 15 and 23 days of drainage for
prolonged air leaks that were not observed during surgery. In addition to
the 7 serious adverse events (SAEs) reported as unrelated to the device,
there was one SAE involving bleeding and removal of additional lung
tissue, wherein the device was released late, and thus not used in
accordance with manufacturer instructions. Conclusion: Interim results
demonstrate that the use of Endo GIA TM Reinforced Reload with Tri-Staple
Technology is safe for both abdominal and thoracic surgeries when observed
30-days post procedure. Once completed, a final assessment of the study
will be reported and further studies conducted.

<17>
Accession Number
617069919
Author
Ferreira De Lima S.; Knoblich M.; Borges C.; Pascoa J.
Institution
(Ferreira De Lima, Knoblich, Borges, Pascoa) Pediatric Surgery, Hospital
Dona Estefania, CHLC, Lisbon, Portugal
Title
Video-assisted thoracic surgery for pediatric spontaneous pneumothorax-a
tertiary children's hospital experience.
Source
Pediatric Pulmonology. Conference: 16th Congress of the International
Pediatric Pulmonology, CIPP 2017. Portugal. 52 (pp S158-S159), 2017. Date
of Publication: June 2017.
Publisher
John Wiley and Sons Inc.
Abstract
The aim of this study was to review a tertiary children's hospital's
experience with thoracic treatment of pediatric spontaneous pneumothorax
(SP). A retrospective review of all children undergoing Video-Assisted
Thoracic Surgery (VATS) for SP between 2011 and 2015 was performed and
data on demographics, diagnostic imaging, therapeutic approach, findings
at surgery and outcomes were reviewed. Ten patients, 7 males and 3
females, aged 13 to 17 years old (average 15.5) underwent VATS procedures
for SP in a five-year period. SP was primary in 5 patients and secondary
in 5 patients, in whom asthma was the primary disease in the majority.
Eighty percent of patients were found to have apical abnormalities of the
lung on CT scanning. The indications for surgery were as follows: a first
episode with persistent air leak in 60% of patients and a recurrent
ipsilateral pneumothorax in 40% of patients. Three different surgical
techniques were used as follows: apical wedge resection plus mechanical
pleurodesis (50%), apical wedge resection plus chemical pleurodesis with
talc (40%) and apical wedge resection plus mechanical and chemical
pleurodesis with talc (10%). Apical blebs were identified at the time of
VATS in 100% of patients. There was an additional VATS procedure for
contralateral pneumothoraces in 30% of patients. There were no recurrences
during the study period. Hospital mean length of stay was 8.4 days, and
postoperative chest tube duration was 3.6 days (range 2 to 6 days). Mean
follow-up was 19 months (range, 2 months to 3 years). There were no deaths
or postoperative complications. The thoracoscopic approach for treatment
of SP is safe and effective in children. Wedge resection plus either
mechanical, chemical pleurodesis or combination of these techniques were
all associated with acceptable outcomes. Due to a lack of evidence of
which surgical approach is superior in children, there is still no
agreement and consistency in pediatric spontaneous pneumothorax
management. Given the relatively low incidence, we suggest a multicenter
approach for future research in order to generate the evidence required
for informed management of SP in children.

<18>
Accession Number
617069862
Author
Anjos R.; Rato J.; Nogueira G.
Institution
(Anjos, Rato, Nogueira) Department of Pediatric Cardiology, Santa Cruz
Hospital Centro Hospitalar de Lisboa Ocidental Lisbon, Portugal
Title
Diagnosis and treatment of pediatric pulmonary hypertension.
Source
Pediatric Pulmonology. Conference: 16th Congress of the International
Pediatric Pulmonology, CIPP 2017. Portugal. 52 (pp S47-S49), 2017. Date of
Publication: June 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Introduction Pediatric pulmonary hypertension (PH) is a rare but
devastating disease that may present in all pediatric age groups. PH is a
pathophysiological disorder associated with multiple clinical conditions
which can complicate the majority of cardiovascular and respiratory
diseases. It is associated with considerable morbidity and mortality. In
pediatric patients, the more prevalent causes of PH are congenital heart
disease and idiopathic pulmonary arterial hypertension1. Connective tissue
diseases, portopulmonary hypertension, HIV infection or chronic
thromboembolism, which are the main causes of PH in adults are much less
frequent in children2,3. Pediatric PH is distinct from adult PH in several
ways. It is related to lung growth and development, including prenatal and
early postnatal influences. Impaired functional and structural adaptation
of the pulmonary circulation during transition from fetal to postnatal
life may cause neonatal PH. The timing of pulmonary vascular injury is
determinant of subsequent response of the developing lung to hypoxia,
hemodynamic stress and inflammation. A normal pulmonary vascular bed is
essential for a normal lung structure, metabolism and gas exchange and to
tolerate exercise workloads. Perinatal factors may contribute to an
increased risk for late development of PH in adulthood. Adult PH and
pediatric PH differ in vascular function and structure, genetics, natural
history, response of the right ventricle to an increased load and to PH
specific therapies4,5. Definition and Clinical Presentation PH is defined
as a mean pulmonary artery pressure of > 25 mmHg at rest, after 3 months
of age, measured by cardiac catheterization6. The Nice classification
categorizes pulmonary hypertension (PH) into pulmonary arterial
hypertension, PH due to left heart disease, PH due to lung diseases and/or
hypoxia, chronic thromboembolic PH and PH due to unclear multifactorial
mechanisms. Pulmonary arterial hypertension (PAH) describes a group of
patients with PH who have pre-capillary PH, with a normal pulmonary artery
wedge pressure (<15 mmHg) and a pulmonary vascular resistance index >3
Wood units (WU) m2(6). The Pulmonary Vascular Research Institute
introduced the term pediatric pulmonary hypertensive vascular disease
(PPHVD) in 20117. Their approach distinguishes between PH with and without
pulmonary vascular disease (PVD) and between single and biventricular
circulations. Patients with congenital heart disease (CHD) and single
ventricle physiology often do not meet the criteria as defined above, but
may benefit from similar pharmacological strategies. For patients with
Fontan-type hemodynamics, a pulmonary vascular resistance (PVR) index
>3WU2 or a transpulmonary gradient >6mm Hg has been suggested as a
definition of PPHVD7. Diagnosis and Monitoring Children with suspected or
confirmed PH should be referred to a specialist PH pediatric center.
Centralization of care and concentration of expertise is beneficial for
the management of these patients. A detailed medical history and careful
physical examination are essential. As the diagnostic criteria are
hemodynamic, cardiac and pulmonary artery catheterization is the gold
standard to establish the diagnosis and indeed the only method for direct
accurate measurement of pulmonary artery pressures. This is complemented
with acute vasodilator testing with inhaled nitric oxide4. PH patients
should have a complete assessment of hemodynamics using echocardiography,
ECG, chest X-ray, functional testing (lung function, cardiopulmonary
exercise), abdominal ultrasound and in some cases a contrast CT
angiography of the pulmonary arteries or a cardiac MRI. Laboratory
evaluation including routine biochemistry, hematology, immunology, HIV
testing and thyroid function is recommended in all patients with PAH to
identify specific associated conditions. Echocardiogram and ECG should be
repeated every 3 to 6 months or more frequently if there is clinical
deterioration. Pediatric Pulmonary Hypertension Treatment The management
of pulmonary hypertension has evolved dramatically in the last few years.
Many drugs are now approved for adult pulmonary hypertension, but in the
pediatric age group, therapy is frequently used off-label, adapted from
adult trials. Clinical trials on the pediatric population are under way
and their results will be extremely important for the management of
children with PH. Conventional Therapy The general management of PH
includes the treatment of right ventricular (RV) failure with drugs such
as loop diuretics and spironolactone. Diuretics should be used with
caution as these patients are preload dependent4. Some clinicians use
digitalis for improvement of RV function. Severe hypoxemia should be
treated with oxygen therapy. The use of anticoagulants is controversial,
but it is suggested in children with RV failure and dilation8. Physical
activity is encouraged, but strenuous exercises should be avoided.
Immunization plans should be followed strictly, particularly to avoid
respiratory infections. Targeted Therapy Development of pulmonary
hypertension involves several pathways leading to remodeling of the
pulmonary vascular bed. These are the targets for current pulmonary
hypertension drugs and include overexpression of endothelin, a potent
vasoconstrictor peptide, and decreased activity of vasodilator and
antiproliferative mediators such as prostacyclin and nitric oxide. Calcium
Channel Blockers (CCBs) Before initiation of targeted therapies, patients
should undergo acute vasodilator testing with inhaled nitric oxide. The
test is positive when there is a 20% fall in mean pulmonary artery
pressure, an increase or lack of decrease of cardiac output and no change
or decrease in the ratio of pulmonary vascular to systemic vascular
resistances4. This should lead to a trial of CCBs such as nifedipine,
amlodipine or diltiazem. CCBs cause relaxation of vascular smooth muscle
and should be used with caution in severe ventricular dysfunction as their
negative inotropic effect may further decrease cardiac contractility. They
are not recommended in the first year of life. Endothelin Receptor
Antagonists (ETRAs) Endothelin ismediated by two receptors, type A and B,
and its blockade is the mechanism for ETRAs. Bosentan is the oral dual
ETRA approved for pediatric use. It causes PAP and PVR decrease and
improves exercise capacity. Serious side effects include liver enzyme
elevation, anemia, impaired fertility and teratogenicity. Regular liver
function testing is recommended in children receiving bosentan4.
Ambrisentan, an oral ET A-receptor antagonist, has a once daily
formulation and no repercussion on liver enzymes8.Macitentan, a novel dual
ETRA, also showed no signs of hepatic toxicity and fewer drug interactions
than bosentan8. A phase III trial in pediatric patients is currently
ongoing. Phosphodiesterase Type 5 Inhibitors (PDE5i) Sildenafil is the
currently approved PDE5i for pediatric use. It acts by preventing the
breakdown of smooth muscle cell cyclic guanosine monophosphate, improving
pulmonary vasodilation, and shows antiproliferative effects. Oral
sildenafil should be used cautiously in the pediatric population, with
careful dosing according to weight and frequent assessments, due to
reports of increased mortality in patients using higher doses4. Side
effects include headache, flushing, nosebleeds and hypotension. Tadalafil
is a PDE5i with a longer duration of action. Its use in the pediatric
population is being studied8. Prostacyclin Analogs Prostacyclin acts by
increasing pulmonary vasodilation and inhibiting vascular remodeling. Its
analogs include epoprostenol, treprostinil, iloprost and selexipag. The
first two can be delivered through a continuous intravenous infusion, the
treatment of choice for severe pulmonary hypertension with RV failure4.
Epoprostenol is given through a central venous line, which places the
patient at risk for adverse events. Due to a short half-life, there is a
risk for rebound PH in case of interruption of administration. Its adverse
side effects include bradycardia, hypotension and thrombocytopenia, which
are dose-dependent. Treprostinil has a longer half-life that enables its
subcutaneous infusion through a mini pump. Iloprost is administered by
nebulization and can cause acute bronchospasm in some patients. Selexipag
is an oral selective prostacyclin receptor agonist and promising new
therapy, with a favorable side effect profile, which showed a significant
reduction of PVR in adults8. Treatment Strategy and Combination Therapy
Treatment of pediatric pulmonary hypertension aims to improve survival,
quality of life, exercise capacity and hemodynamics. It reduces the
overall risk by improving clinical echocardiographic and hemodynamic risk
factors. When these goals are not met on monotherapy, combination therapy
is used. Combination therapy may be more efficacious as it addresses
multiple pathophysiological pathways simultaneously. Whether this kind of
strategy should be initiated early on by use of two or more drugs or
sequentially by adding a second drug to a previous one is still under
study. In high risk patients, inhaled or intravenous prostacyclin should
be considered. If deterioration occurs despite maximal therapy, techniques
such as atrial septostomy or pulmonary-to-systemic shunts can be applied.
Lung or heart-lung transplantation is the last therapeutic resort (Figure
1). Special Situations Congenital Heart Disease Cardiac high-pressure,
high-flow lesions like ventricular septal defects can lead to PH. Children
with cyanotic congenital heart disease and pulmonary high-flow,
high-pressure defects are at highest risk. Patients considered operable
should undergo surgery at early stages, followed by targeted therapy if
needed4.

<19>
Accession Number
617042326
Author
Van Stipdonk A.; Ter Horst I.; Kloosterman M.; Rienstra M.; Prinzen F.W.;
Meine M.; Maass A.H.; Vernooy K.
Institution
(Van Stipdonk, Ter Horst, Kloosterman, Rienstra, Prinzen, Meine, Maass,
Vernooy) Maastricht University Medical Centre, Cardiology Dept.,
Maastricht, Netherlands, University Medical Centre Utrecht, Cardiology
Dept., Maastricht, Netherlands, University Medical Centre Groningen,
Cardiology Dept., Maastricht, Netherlands, Univ Medical Center Groningen,
Groningen, Netherlands, Maastricht University, Physiology Dept,
Maastricht, Netherlands, University Medical Center Utrecht, Cardiology
Dept, Utrecht, Netherlands, University Medical Center Groningen,
Cardiiology Dept, Groningen, Netherlands
Title
QRS<inf>AREA</inf> improves prediction of survival in cardiac
resynchronisation therapy compared to QRS duration and morphology.
Source
Heart Rhythm. Conference: 38th Annual Scientific Sessions of the Heart
Rhythm Society, Heart Rhythm 2017. United States. 14 (5 Supplement 1) (pp
S89-S90), 2017. Date of Publication: May 2017.
Publisher
Elsevier B.V.
Abstract
Background: Patient selection in cardiac resynchronisation therapy (CRT)
currently relies on QRS duration and morphology. Significant non-response
rates imply suboptimal patient selection. Small studies have suggested
that vectorcardiographically determined QRS<inf>AREA</inf> improves
patient selection. Objective: To compare the value of QRS<inf>AREA</inf>
to that of QRS duration and morphology in the prediction of survival in
CRT. Methods: In a retrospective multicentre cohort of 1.487 CRT patients.
QRS<inf>AREA</inf> was calculated by converting the digital 12- lead ECG
to VCG X-, Y- and Z-leads and calculating the square root of the sum of
squared QRS<inf>AREA</inf> in each direction. QRS morphology was defined
as left bundle branch block (LBBB) or non-LBBB. Primary endpoint was the
combination of all-cause mortality, left ventricular assist device
implantation and cardiac transplantation. Results: Follow-up time was
1.400 (+/- 882) days, during which 471 events (32%) occurred. At 10 year
follow-up , quartiles of QRS duration did not significantly differ in
survival rate (p 0.129) (Figure A). QRS<inf>AREA</inf> provided a
significantly better correlation with survival. Patients with
QRS<inf>AREA</inf> of 109-150muVs and >=151muVs had significantly less
events than those with QRS<inf>AREA</inf><75 muVs (HR 0.581 and 0.386,
resp.) (Figure B). Whereas QRS duration and LBBB morphology were
associated with survival in univariable analysis, multivariable analysis
showed QRS<inf>AREA</inf> (HR 0.524, p 0.000) and not QRS duration or
morphology (p 0.766 and 0.745 resp.) to be an independent predictor of the
primary endpoint. Conclusion: QRS<inf>AREA</inf> significantly improves
prediction of survival in patients eligible for CRT, and may therefore
improve patient selection for CRT. (Figure presented).

<20>
Accession Number
617042293
Author
Hayes D.L.; Freedman R.; Porterfeld J.G.; Porterfeld L.M.; Dinerman J.;
Styperek R.; Machell C.; Harrington N.; Curtis A.B.
Institution
(Hayes, Freedman, Porterfeld, Porterfeld, Dinerman, Styperek, Machell,
Harrington, Curtis) Mayo Clinic, Rochester, MN, University of Utah, Salt
Lake City, UT, Arrhythmia Consultants, PC, Memphis, TN, University of
Tennessee, Memphis, TN, Heart Center Research LLC, Huntsville, AL, Redmond
Regional Medical Center, Rome, GA, South Texas Cardiovascular Consultants,
San Antonio, TX, St. Jude Medical, Plano, TX, University at Buffalo,
Buffalo, NY
Title
DurataTM lead performance: Results from a prospective, multicenter study.
Source
Heart Rhythm. Conference: 38th Annual Scientific Sessions of the Heart
Rhythm Society, Heart Rhythm 2017. United States. 14 (5 Supplement 1) (pp
S345-S346), 2017. Date of Publication: May 2017.
Publisher
Elsevier B.V.
Abstract
Background: The Cardiac Lead Assessment study is a prospective,
multicenter study investigating externalized conductors (EC) and
electrical dysfunction (ED) in certain St. Jude Medical leads. Objective:
This analysis was limited specifically to OptimTM-insulated DurataTM ICD
leads. Methods: Patients implanted with Durata ICD leads from 2008 to 2010
were enrolled and will be followed for 3 years. Fluoroscopy was performed
in 3 views at enrollment and yearly thereafter. All images were
adjudicated for EC by a panel of experienced EPs. Leads were classified as
exhibiting EC based on defned criteria. Upon Lead revision, electrical
performance data were also adjudicated by a different panel to determine
the presence of ED based on predefned criteria. Results: A total of 893
patients implanted with Durata leads completed fuoroscopic evaluation at
enrollment. None of these 961 leads at enrollment exhibited EC. A total of
706 patients have completed 1 year follow-up with fuoroscopic evaluation,
and, one of these leads was adjudicated to have EC. Based on the images of
this lead, the externalization appears to be extravascular, under the
clavicle likely due to clavicular crush and normal electrical function. A
total of 498 patients have completed 2 years of follow-up with fuoroscopic
evaluation with one of these leads adjudicated to have EC. Based on
fuoroscopic images of this lead, the location of externalized conductors
is coincident with an annuloplasty tricuspid ring. Therefore, the
mechanism of externalization is likely to be external insulation abrasion
due to friction with the triscupid ring. The electrical function of this
lead continues to be normal. A total of 152 patients have completed 3
years of follow-up with fuoroscopic evaluation with no incidence of EC.
Over a follow-up of 27.3 +/- 11.3 months from enrollment, in patients that
have been implanted for 4.5 +/- 1.1 years, there have been 18 cases of ED,
none of which exhibited EC. Conclusion: In 961 Durata leads systematically
imaged at enrollment, none have exhibited EC, including 18 leads (1.9%)
monitored through 27.3+/- 11.3 months post-enrollment which exhibited
electrical dysfunction. During follow-up, only 2 leads exhibited evidence
of EC and in both cases they appeared to be due to external abrasion.

<21>
Accession Number
617042278
Author
Rocha M.S.; Filho M.M.; Siqueira S.F.; Hueb W.; Cesar L.A.M.; Peixoto
G.L.; Saccab M.G.M.; Hueb T.O.; Costa R.; Ramires J.A.F.
Institution
(Rocha, Filho, Siqueira, Hueb, Cesar, Peixoto, Saccab, Hueb, Costa,
Ramires) Heart Institute - Sao Paulo/Brazil, Sao Paulo, Brazil, InCor - HC
and FMUSP, Sao Paulo, Brazil, InCor - Heart Institute, Sao Paulo, Brazil,
Heart Institute (InCor) do Hospital das Clinicas da Universidade de Sao
Paulo, Sao Paulo, Brazil, InCor - Sao Paulo, Sao Paulo, Brazil
Title
Survival of patients with ischemic cardiomyopathy and severe systolic
dysfunction not undergoing implantable cardioverter defibrillator.
Source
Heart Rhythm. Conference: 38th Annual Scientific Sessions of the Heart
Rhythm Society, Heart Rhythm 2017. United States. 14 (5 Supplement 1) (pp
S301), 2017. Date of Publication: May 2017.
Publisher
Elsevier B.V.
Abstract
Background: Ischemic cardiomyopathy (ICM) and ventricular tachyarrhythmia
(VT) are markers of worse prognosis in patients with coronary artery
disease. Implantable cardioverter defibrillator (ICD) therapy showed
favorable impact on mortality rates in this population. Nevertheless,
scientific evidence on the ICD effectiveness date back more than ten
years, when medical therapy was underused in relation to the present.
Objective: This study was designed to assess the current mortality rates
of patients with ICM and systolic dysfunction (SD) not undergoing ICD,
identifying prognostic predictors. The study also aimed comparing its
findings with those of landmark studies. Methods: This is an observational
prospective cohort study collecting data from tertiary health care
hospital. Between August 2010 and September 2014, 573 consecutive patients
with ICM and severe SD were evaluated. Results: From the 573 patients, 67
were excluded and 506 were considered for statistical analysis. There were
386 (76.3%) men; mean age was 65.3+/-10.4 years. Most patients were in
NYHA Class I or II (79.4%) and in Canadian Cardiovascular Society grading
of angina class I or II (91.9%). The most prevalent comorbidity was
hypertension in 85.6%. The mean left ventricular ejection fraction was
0.29+/-0.05. The use of medications such as beta-blockers, ACEI/ARB's,
statins and antiplatelet agents were above 90%. During a mean follow-up
period of 2.36 years, there have been 74 deaths and four heart
transplantations. The most prevalent type of death was cardiac (63.5%).
The annual all-cause mortality rate was 6.2% and the arrhythmic mortality
rate 1.25% per year. These rates are lower than those found in ICD arm of
the Multicenter Automatic Defibrillator Implantation Trial (MADIT) I,
MADIT II and Sudden Cardiac Death in Heart Failure (SCD-HeFT) trials. The
presence of atrial fibrillation, diabetes, chronic kidney disease and male
sex were independent predictors of all-cause mortality. Conclusion:
All-cause and arrhythmic mortality rate were similar to findings of
landmark primary prevention studies, under ICD use. These findings may be
attributable to the advancement of therapeutic approach and suggests
reassessing the ICD use for SCD primary prevention in ICM patients.

<22>
Accession Number
617042245
Author
Sawhney V.; Domenichini G.; Gamble J.; John S.; Furniss G.; Panagopoulos
D.; Campbell N.; Lambiase P.; Haywood G.; Rajappan K.; Betts T.; Earley
M.; Sporton S.; Lowe M.; Dhinoja M.; Hunter R.; Schilling R.
Institution
(Sawhney, Domenichini, Gamble, John, Furniss, Panagopoulos, Campbell,
Lambiase, Haywood, Rajappan, Betts, Earley, Sporton, Lowe, Dhinoja,
Hunter, Schilling) St Bartholomew's Hospital, London, London, United
Kingdom, John Radcliffe Hospital, Oxford, United Kingdom, Plymouth
Hospitals NHS Trust, Plymouth, United Kingdom, Plymouth NHS Trust,
Plymouth, United Kingdom, University Hospital of South Manchester,
Manchester, United Kingdom, Plymouth Hospital NHS Trust, Plymouth, United
Kingdom
Title
Thromboembolic events in left ventricular endocardial pacing: Long - term
outcomes from a multicentre uk registry.
Source
Heart Rhythm. Conference: 38th Annual Scientific Sessions of the Heart
Rhythm Society, Heart Rhythm 2017. United States. 14 (5 Supplement 1) (pp
S86), 2017. Date of Publication: May 2017.
Publisher
Elsevier B.V.
Abstract
Background: Endocardial left ventricular(LV) pacing is an effective
alternative in patients with failed coronary sinus lead. However, the
major concern is the unknown long-term thromboembolic risk and much of the
data comes from small number of centres. We examined the safety and
efficacy of endocardial LV pacing across 4 UK centres to determine
longterm thromboembolic risk. Methods and Results: Independent prospective
registries from 4 UK centres were combined to include 68 consecutive
patients over 5 years. Medical records were reviewed and patients
contacted for follow-up. Thromboembolic events were confirmed on imaging.
The mean age of patients was 66.8+/-12.3 yrs, 82% men. 60% had ischaemic
cardiomyopathy with a mean LVEF of 27.4+/-7%. 63% were NYHA grade III and
27% grade IV. Mean intrinsic QRS was 159+/-26ms. 65% were already
anticoagulated (39 AF, 1 DVT, 2 prosthetic valve, 2 previous LV thrombus).
Mean CHADS2VASC2 score for the cohort was 3.5. 44% had trans-ventricular
LV lead. The mean procedure and fluoroscopy times were 200+/-120 and
32+/-28 min. 75% had silicone-insulated pacing lead. 3 patients had
haematomas and1had tamponade requiring a drain. Functional improvement was
noted with decrease in mean NYHA from 3.5+/-1 to 2.1+/-1.2 (p=0.001) and
increase in LVEF from 26.5+/-12 to 34+/-18.1(p=0.005) over a 20-month
follow-up. Re-do procedure due to lead displacement was required in 2
patients. One patient underwent system extraction and surgical epicardial
lead after device infection. The ischaemic stroke rate, defined as
transient or permanent loss of function associated with imaging
confirmation of a cerebral infarct, occurred in 4 patients (6%) providing
an annual event rate of 3.6%. In multivariate analyses, sub-therapeutic
INRs correlated with risk of CVA (p<0.01, CI 0.02-0.68, HR 0.12).14
patients died during follow-up with mean time to death postprocedure of 20
months. Cause of death was end-stage heart failure in all except three
(pneumonia in two, knee sepsis). Conclusion: Endocardial LV lead in heart
failure patients has a good success rate at 1.6 yr follow-up. However, it
is associated with a modest thromboembolic risk largely due to
subtherapeutic anticoagulation. These results can be improved and newer
oral anticoagulants might play a role in this setting. (Figure presented).

<23>
Accession Number
617042226
Author
Sawhney V.; Domenichini G.; Gamble J.; John S.; Furniss G.; Panagopoulos
D.; Campbell N.; Lambiase P.; Haywood G.; Rajappan K.; Betts T.; Earley
M.; Sporton S.; Lowe M.; Dhinoja M.; Hunter R.; Schilling R.
Institution
(Sawhney, Domenichini, Gamble, John, Furniss, Panagopoulos, Campbell,
Lambiase, Haywood, Rajappan, Betts, Earley, Sporton, Lowe, Dhinoja,
Hunter, Schilling) St Bartholomew's Hospital, London, London, United
Kingdom, John Radcliffe Hospital, Oxford, United Kingdom, Plymouth
Hospitals NHS Trust, Plymouth, United Kingdom, Plymouth NHS Trust,
Plymouth, United Kingdom, University Hospital of South Manchester,
Manchester, United Kingdom, Plymouth Hospital NHS Trust, Plymouth, United
Kingdom
Title
Thromboembolic events in left ventricular endocardial pacing: Long-term
outcomes from a multicentre UK registry.
Source
Heart Rhythm. Conference: 38th Annual Scientific Sessions of the Heart
Rhythm Society, Heart Rhythm 2017. United States. 14 (5 Supplement 1) (pp
S85), 2017. Date of Publication: May 2017.
Publisher
Elsevier B.V.
Abstract
Background: Endocardial left ventricular(LV) pacing is an effective
alternative in patients with failed coronary sinus lead. However, the
major concern is the unknown long-term thromboembolic risk and much of the
data comes from small number of centres. We examined the safety and
efficacy of endocardial LV pacing across 4 UK centres to determine
longterm thromboembolic risk. Methods and Results: Independent prospective
registries from 4 UK centres were combined to include 68 consecutive
patients over 5 years. Medical records were reviewed and patients
contacted for follow-up. Thromboembolic events were confirmed on imaging.
The mean age of patients was 66.8+/-12.3 yrs, 82% men. 60% had ischaemic
cardiomyopathy with a mean LVEF of 27.4+/-7%. 63% were NYHA grade III and
27% grade IV. Mean intrinsic QRS was 159+/-26ms. 65% were already
anticoagulated (39 AF, 1 DVT, 2 prosthetic valve, 2 previous LV thrombus).
Mean CHADS2VASC2 score for the cohort was 3.5. 44% had trans-ventricular
LV lead. The mean procedure and fluoroscopy times were 200+/-120 and
32+/-28 min. 75% had silicone-insulated pacing lead. 3 patients had
haematomas and1had tamponade requiring a drain. Functional improvement was
noted with decrease in mean NYHA from 3.5+/-1 to 2.1+/-1.2 (p=0.001) and
increase in LVEF from 26.5+/-12 to 34+/-18.1(p=0.005) over a 20-month
follow-up. Re-do procedure due to lead displacement was required in 2
patients. One patient underwent system extraction and surgical epicardial
lead after device infection. The ischaemic stroke rate, defined as
transient or permanent loss of function associated with imaging
confirmation of a cerebral infarct, occurred in 4 patients (6%) providing
an annual event rate of 3.6%. In multivariate analyses, sub-therapeutic
INRs correlated with risk of CVA (p<0.01, CI 0.02-0.68, HR 0.12).14
patients died during follow-up with mean time to death postprocedure of 20
months. Cause of death was end-stage heart failure in all except three
(pneumonia in two, knee sepsis). Conclusion: Endocardial LV lead in heart
failure patients has a good success rate at 1.6 yr follow-up. However, it
is associated with a modest thromboembolic risk largely due to
subtherapeutic anticoagulation. These results can be improved and newer
oral anticoagulants might play a role in this setting.

<24>
Accession Number
617042101
Author
Costanzo M.R.; Augostini R.; Ponikowski P.; Goldberg L.R.; Holcomb R.;
Javaheri S.; Kao A.; Oldenburg O.; Stellbrink C.; Abraham W.T.
Institution
(Costanzo, Augostini, Ponikowski, Goldberg, Holcomb, Javaheri, Kao,
Oldenburg, Stellbrink, Abraham) Advocate Heart Institute, Naperville, IL,
The Ohio State Univeristy, Columbus, OH, Fourth Military Hospital,
Wroclaw, Poland, University of Pennsylvania, Philadelphia, PA, Independent
Biostatistician, Minneapolis, MN, Bethesda North Hospital, Cincinnati, OH,
Mid America Heart Institute, KansasCity, MO, Bad Oeynhausen Heart and
Diabetes Center, Bad Oeynhausen, Germany, Bielefeld Medical Center,
Bielefeld, Germany, Ohio State University Heart Center, Columbus, OH
Title
Improvement in central sleep apnea with transvenous phrenic nerve
stimulation is sustained at 12 months: Data from the remede system pivotal
trial.
Source
Heart Rhythm. Conference: 38th Annual Scientific Sessions of the Heart
Rhythm Society, Heart Rhythm 2017. United States. 14 (5 Supplement 1) (pp
S129), 2017. Date of Publication: May 2017.
Publisher
Elsevier B.V.
Abstract
Background: Central sleep apnea (CSA) is a severe comorbidity in patients
with cardiovascular disease. The remede System has an implanted pulse
generator and lead (placed in left pericardiophrenic or right
brachiocephalic vein) that stimulates the phrenic nerve to produce
diaphragm contraction akin to normal breathing. In the remede System
Pivotal Trial, CSA patients were randomized 1: 1 to therapy initiated 1
month after implant (treatment) or delayed by 7 months (control). At 6
months post-therapy initiation, compared to control, the treatment group
had a statistically significant increased proportion of patients with
>=50% apnea/hypopnea index (AHI) associated with improvement in all
pre-specified hierarchically tested secondary endpoints. Objective: To
determine if effects of phrenic nerve stimulation persist at 12 months in
treatment patients. Methods: Six month results of the remede System
Pivotal Trial were published (Costanzo MR et al. Lancet 2016; 388: 974).
This analysis of longer-term data included 54/58 (93%) of per protocol
treatment patients with completed 12-month polysomnography. Results: A
>=50% AHI reduction occurred at 6 and 12 months, respectively, in 60% and
67% of treatment patients. Six-month improvements in sleep and QOL metrics
persisted at 1 year (Table). Freedom from SAEs from implant procedure,
device or therapy was 92% at 12 months. Four unrelated deaths occurred
through 12 months [cardiac surgery complications (1), pump failure (1),
sudden death (2)]. Conclusion: The sustained 12-month effectiveness and
safety results suggest that phrenic nerve stimulation can be a promising
and durable therapy for CSA. (Table presented).

<25>
Accession Number
617042068
Author
Haissaguerre M.; Hocini M.; Cheniti G.; Sacher F.; Denis A.; Martin R.;
Piot O.; Hermida J.S.; Pasquie J.L.; Derval N.; Pambrun T.; Jais P.;
Duchateau J.; Amraoui S.; Frontera A.; Thompson N.; Takigawa M.; Wolf M.;
Vlachos K.; Kitamura T.; Walton R.; Masouillie G.; Chaumeil A.; Klotz N.;
Nademanee W.; Bernus O.; Dubois R.
Institution
(Haissaguerre, Hocini, Cheniti, Sacher, Denis, Martin, Piot, Hermida,
Pasquie, Derval, Pambrun, Jais, Duchateau, Amraoui, Frontera, Thompson,
Takigawa, Wolf, Vlachos, Kitamura, Walton, Masouillie, Chaumeil, Klotz,
Nademanee, Bernus, Dubois) Hopital Haut-Leveque, Pessac, France
Title
Subclinical arrhythmogenic substrate as a cause of unexplained sudden
cardiac death.
Source
Heart Rhythm. Conference: 38th Annual Scientific Sessions of the Heart
Rhythm Society, Heart Rhythm 2017. United States. 14 (5 Supplement 1) (pp
S82-S83), 2017. Date of Publication: May 2017.
Publisher
Elsevier B.V.
Abstract
Background: Idiopathic Ventricular Fibrillation (VF) is a major cause of
unexplained sudden cardiac death (SCD) in people under 35 years.
Objective: To investigate arrhythmogenic substrate following unexplained
SCD using novel mapping method. Methods: We evaluated 18 patients (age
33+/-14) from 8 centers for recurrent episodes of VF (median 4) and normal
coronary arteries, cardiac MRI, ECG, ajmaline and isoproterenol tests.
Induced VF was mapped using multielectrode catheters and 252
body-surface-electrodes relative to biventricular geometry from CT scan.
Electrograms (EGMs) were acquired for 16+/-4seconds before defibrillation
and signal-processed to characterize organization, frequency, wave
propagation and source of origin (drivers). Drivers were further defined
as focal breakthroughs (centrifugal propagation with local unipolar QS
pattern) or reentry (sequential activation of local EGMs covering >75% of
VFCL). Catheter mapping of driver sites was performed endoand/ or
epicardially. Results: VF was initially organized with a limited number of
wavefronts which accelerated and disorganized after 5+/-4s. Focal and
reentrant sources fired intermittently (mean 3+/-1 impulses) with their
location and extent varying among individuals. Nine patients showed
diffuse reentry trajectories in both ventricles, whereas, surprisingly, 9
(50%) showed clustered driver sites, indicating localized substrate,
attracting reentry. Endo- or epicardial mapping revealed abnormal
depolarization signals at the sites of main drivers, in distinct parts of
RV or LV. There were no significant changes in RV abnormal signals on
ajmaline testing. A reanalysis of MRI imaging pointing to driver areas
could not identify any myocardial defect. Catheter ablation in 6 patients
eliminated abnormal signals with VF-free outcome in 5 patients at 8+/-6
months follow up. Conclusion: VF drivers are clustered at specific regions
in half of individuals with unexplained SCD. These areas may display
abnormal discrete signals indicating localized myocardial substrate
currently not identified by imaging techniques or pharmacological testing.

<26>
Accession Number
617041463
Author
Hu T.Y.; Tung R.; Vergara P.; Frankel D.S.; Di Biase L.; Nagashima K.; Yu
R.; Vangala S.; Tseng C.-H.; Choi E.-K.; Khurshid S.; Patel M.; Mathuria
N.; Nakahara S.; Tzou W.S.; Sauer W.H.; Vakil K.; Tedrow U.B.; Burkhardt
J.D.; Tholakanahalli V.N.; Saliaris A.; Dickfeld T.-M.; Weiss J.P.; Bunch
T.J.; Reddy M.; Kanmanthareddy A.; Callans D.J.; Lakkireddy D.R.; Natale
A.; Marchlinski F.E.; Stevenson W.G.; Bella P.D.; Shivkumar K.; Vaseghi M.
Institution
(Hu, Tung, Vergara, Frankel, Di Biase, Nagashima, Yu, Vangala, Tseng,
Choi, Khurshid, Patel, Mathuria, Nakahara, Tzou, Sauer, Vakil, Tedrow,
Burkhardt, Tholakanahalli, Saliaris, Dickfeld, Weiss, Bunch, Reddy,
Kanmanthareddy, Callans, Lakkireddy, Natale, Marchlinski, Stevenson,
Bella, Shivkumar, Vaseghi) University of California at Los Angeles School
of Medicine, Los Angeles, CA, San Raffaele Hospital, Milano, Italy,
Hospital of the University of Pennsylvania, Philadelphia, PA, Texas
Cardiac Arrhythmia Institute at St. David's Medical Center and Albert
Einstein College of Medicine at Montefiore Hospital, Austin, TX, Division
of Cardiology, Department of Medicine, Nihon University School of
Medicine, Tokyo, Japan, UCLA Department of Medicine Statistics Core, Los
Angeles, CA, Brigham and Women's Hospital, Boston, MA, Sparrow Hospital,
Cardiac EP, Lansing, MI, Baylor St. Luke's Medical Center/Texas Heart
Institute, Houston, TX, Department of Cardiology, Dokkyo University
Koshigaya Hospital, Koshigaya, Japan, University of Colorado Hospital,
Denver, CO, University of Colorado, Aurora, CO, University of Minnesota
Medical Center, Minneapolis VA Medical Center, Minneapolis, MN, Texas
Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX,
University of Minnesota, Minneapolis, MN, University of Maryland,
Baltimore, MD, Intermountain Heart Rhythm Specialists, Salt Lake City, UT,
Intermountain Medical Center - Intermountain Heart Rhythm Specialists,
Murray, UT, University of Kansas Medical Center, Kansas City, KS, The
University of Kansas Medical Center, Kansas City, KS, University of
Pennsylvania, Philadelphia, PA, Texas Cardiac Arrhythmia Institute,
Austin, TX, University of Pennsylvania Health System, Philadelphia, PA,
Ospedale San Raffaele, Milano, Italy, UCLA Cardiac Arrhythmia Center, Los
Angeles, CA
Title
Outcomes of catheter ablation of ventricular tachycardia by etiology in
non-ischemic heart disease.
Source
Heart Rhythm. Conference: 38th Annual Scientific Sessions of the Heart
Rhythm Society, Heart Rhythm 2017. United States. 14 (5 Supplement 1) (pp
S119-S120), 2017. Date of Publication: May 2017.
Publisher
Elsevier B.V.
Abstract
Background: Outcomes of catheter ablation of ventricular tachycardia (VT)
in patients with non-ischemic cardiomyopathy (NICM) are reported to be
less favorable than ischemic cardiomyopathy, which could be related to the
etiology of NICM. Objective: To characterize outcomes of catheter ablation
of VT across different NICM etiologies in a large multicenter experience.
Methods: Data from 2,061 consecutive patients with structural heart
disease referred for catheter ablation of scar-related VT from 12
international centers between 2002-2015 was retrospectively analyzed.
Clinical variables and outcomes at 1 year post-ablation were analyzed for
the 6 most common NICM etiologies. Results: Of 693 NICM patients with
reported etiology (56+/-14 years old, 19% female, LVEF 37+/-15%),
underlying prevalence was dilated idiopathic cardiomyopathy (DICM) in 63%,
arrhythmogenic right ventricular cardiomyopathy (ARVC) 14%, valvular
cardiomyopathy 7%, myocarditis 7%, hypertrophic cardiomyopathy (HCM) 5%,
and sarcoidosis 4%. One-year freedom from VT and freedom from VT, heart
transplantation, and death post-procedure were 71% and 66%, respectively.
On Kaplan Meier analysis, VT ablation in ARVC demonstrated superior
freedom from VT (87%) and VT free survival (85%) vs. DICM (p=0.02,
p<0.001, respectively) followed by myocarditis, figure. Valvular
cardiomyopathy had the poorest VT free survival at 54% vs. ARVC (P<0.01).
HCM (63%) and sarcoidosis (57%) had similar outcomes. Conclusion: Catheter
ablation of VT in NICM is effective. Patients with ARVC have significantly
better outcomes with ablation, while patients with valvular cardiomyopathy
had the least favorable VT free survival. (Figure presented).

<27>
Accession Number
617041178
Author
Sandhu A.; Collins K.K.; Kay J.; Khanna A.D.; Sauer W.H.; Nguyen D.T.
Institution
(Sandhu, Collins, Kay, Khanna, Sauer, Nguyen) University of Colorado,
Aurora, CO, United States
Title
Ventricular tachycardia characteristics in tetralogy of fallot patients
undergoing perioperative electrophysiology study.
Source
Heart Rhythm. Conference: 38th Annual Scientific Sessions of the Heart
Rhythm Society, Heart Rhythm 2017. United States. 14 (5 Supplement 1) (pp
S503), 2017. Date of Publication: May 2017.
Publisher
Elsevier B.V.
Abstract
Background: Ventricular tachyarrhythmias are the most common cause of
death in patients with repaired Tetralogy of Fallot (TOF).
Electrophysiological study (EPS) has been used to risk stratify patients
and guide surgical cryoablation during pulmonary valve replacement (PVR).
Characteristics of ventricular tachycardia (VT) in such patients have not
been described. Objective: We sought to describe VT characteristics in TOF
patients undergoing perioperative EPS. Methods: We evaluated all TOF
patients with planned PVR and EPS at two centers over the past 10 years.
Patients with pre- PVR EPS inducible for VT had subsequent cryoablation
with PVR and then underwent post-PVR EPS. Results: From 2006-2016, 69 TOF
patients underwent pre- PVR EPS. Of 33 patients (48%) with inducible,
ventricular tachyarrhythmias, the majority (23, 70%) had monomorphic VT.
Fifteen patients exhibited a left-bundle VT morphology and 8 had
right-bundle morphology. Most (74%) had an inferior axis. All underwent
cryoablation at the time of PVR and subsequent post-surgical EPS.
Post-cryoablation, EPS induced VT in 13 patients (57%), all of whom then
underwent ICD implantation. VT characteristics pre and post cryoablation
are shown in the Figure. Of 3 patients with appropriate device therapies
for VT thereafter, all had left-bundle inferior axis VT morphology at the
time of their EPS. Conclusion: A significant number of TOF patients with
positive pre-surgical EPS for VT remain inducible after cryoablation. The
most common VT morphology encountered both pre and post-surgery is
left-bundle with an inferior axis. A significant number had right bundle
or superior axis VT, which may be less expected given TOF physiology.
(Figuer Presented).

<28>
Accession Number
617041173
Author
Sandhu A.; Collins K.K.; Kay J.D.; Khanna A.D.; Sauer W.H.; Nguyen D.T.
Institution
(Sandhu, Collins, Kay, Khanna, Sauer, Nguyen) University of Colorado,
Aurora, CO, United States
Title
Perioperative electrophysiology study in tetralogy of fallot patients
undergoing pulmonary valve replacement will identify those at high risk
for subsequent ventricular tachycardia.
Source
Heart Rhythm. Conference: 38th Annual Scientific Sessions of the Heart
Rhythm Society, Heart Rhythm 2017. United States. 14 (5 Supplement 1) (pp
S220), 2017. Date of Publication: May 2017.
Publisher
Elsevier B.V.
Abstract
Background: Ventricular tachyarrhythmias (VTs) are the most common cause
of death in patients with repaired Tetralogy of Fallot (TOF).
Electrophysiological study (EPS) has been proposed to risk stratify TOF
patients and guide surgical cryoablation during pulmonary valve
replacement (PVR). Objective: We sought to evaluate a perioperative
EPS-guided approach to risk stratify TOF patients undergoing PVR. Methods:
All TOF patients with planned PVR and EPS at 2 centers over the past 10
years comprised the cohort. Patients with pre-PVR EPS inducible for VTs
had cryoablation in addition to PVR with repeat post-PVR EPS. Those
remaining inducible underwent ICD implantation. Results: From 2006-2016,
69 TOF patients underwent pre- PVR EPS. Of these, 33 (48%) had inducible,
sustained VTs: 23 monomorphic and 10 polymorphic. Of patients undergoing
cryoablation, 14 (47%) had an inducible VT post-cryoablation and underwent
ICD implantation (Figure). During an average follow-up period of 6 years,
3 patients (21%) had appropriate ICD shocks for symptomatic VT and one had
an inappropriate shock. There was an average of 2.3 shocks (range 1-4) per
patient and the mean time to first shock post-device placement was 1309
days (range 1063-1575). Of patients with negative pre or post-PVR EPS, one
patient (on amiodarone at time of her negative EPS) had VT requiring
radiofrequency ablation and subsequent ICD implant. Conclusion: Pre-PVR
EPS identified higher risk TOF patients undergoing PVR. Despite empiric VT
cryoablation at time of PVR, a large percentage of patients remained
inducible for VT. In this high-risk cohort, post-PVR EPS evaluation is
important to identify patients at risk of VT despite cryoablation. (Figure
presented).

<29>
Accession Number
617038063
Author
Brolese A.; Ciarleglio F.A.; Marcucci S.; Prezzi C.; Beltempo P.; Valduga
P.; Berlanda G.; Bondioli P.
Institution
(Brolese, Ciarleglio, Marcucci, Prezzi, Beltempo, Valduga, Berlanda,
Bondioli) General Surgery Unit II, HBP Surgical Center, Santa Chiara
Hospital, Trento, Italy
Title
Robotic liver resection for benign tumor in pediatric age: First report as
new era and new approach.
Source
Surgical Endoscopy and Other Interventional Techniques. Conference: 24th
International Congress of the European Association for Endoscopic Surgery,
EAES 2016. Netherlands. 31 (2 Supplement 1) (pp S503), 2017. Date of
Publication: June 2017.
Publisher
Springer New York LLC
Abstract
Background: Primary liver tumors are rare in the pediatric population with
an annual incidence of Mini invasive abdominal and thoracic surgery in
children has recently made substantial progress due to technical and
instrumental advances. Instead only few reports describes the safety and
feasibility of performing robot-assisted pediatric surgery using the da
Vinci Surgical System in a variety of surgical procedures. In PubMed
missing report describing effective liver resection robot assisted in
pediatric age. No manuscripts finded using keywords as laparoscopic liver
surgical resection, robotic liver surgery, pediatrics liver resection.
Case report: An 9-year-old boy presented for abdominal pain and nausea.
Two years was diagnosticated a liver mass. The patient had no other
significant medical history or medication use. Physical examination
demonstrated a tender right upper quadrant mass. On initial evaluation, he
was found to have a normal liver function with increased value of GGT (66
U/l; normal 8-55 U/L) and ALP, aspartate aminotransferase, total bilirubin
on range, and increased Ca 19.9. US examination accurately confirmed a
solid mass on left liver lobe with no hepatic and portal venous
involvement. At MRI examination, liver mass at segment 3 was homogeneous
and isointense/slightly hypointense to the liver on T1-weighted images and
isointense/slightly hyperintense on T2-weighted images with central scar
enhancement during the delayed phase. Cholangio MRI did not show any
biliary tree expansion. The patient underwent a a Robot assisted liver
resection (segmentectomy S3). We used Fluorescence (ICG) technology during
surgery for good planned surgical strategies. Liver mass had a good blood
perfusion at ICG test. The patient tollerated the procedure well with
stable postoperative condition. Operative console time was 291 min. No
conversions were required. Blood loss was\50 mL and hospital stay was 6
days. No postoperative morbidity related to the procedure was encountered.
Pathology report showed a Focal nodular hyperplasia. Conclusion: Robot
assisted liver resection for various pediatric liver tumors was found to
be technically feasible and safe in selected cases, and provided the
advantages of minimally invasive surgery. Long-term follow-up data and
prospective, randomized studies are necessary to validate the oncologic
safety and results.

<30>
Accession Number
613977244
Author
Yuan S.-M.; Wang G.-F.
Institution
(Yuan) Department of Cardiothoracic Surgery, The First Hospital of Putian,
Teaching Hospital, Fujian Medical University, Putian, Fujian Province
351100, China
(Wang) Department of Neurosurgery, The First Hospital of Putian, Teaching
Hospital, Fujian Medical University, Putian, Fujian Province 351100, China
Title
Cerebral mycotic aneurysm as a consequence of infective endocarditis: A
literature review.
Source
Cor et Vasa. 59 (3) (pp e257-e265), 2017. Date of Publication: June 2017.
Publisher
Elsevier Science B.V.
Abstract
Background Cerebral mycotic aneurysm (CMA) secondary to infective
endocarditis (IE) is rare. The clinical features of this entity have not
been sufficiently clarified. Methods The data source of this study was
based on comprehensive literature retrieval of articles published in
English 1990-2014 in the PubMED, Highwire Press and Google search engine.
The search terms were "infective endocarditis" and "intracranial/cerebral
mycotic aneurysm". Results The CMAs usually developed 2.1 months after the
onset of IE. Staphylococcus was the most frequent pathogen and
Streptococcus was more frequent as evidenced by blood culture. The most
common presentation on computed tomography was intraparenchymal
hemorrhage. Angiogram was a reliable diagnostic means for determining the
location of the aneurysm. The middle cerebral artery was the most commonly
affected, and the posterior cerebral artery was more commonly affected.
Interventional or surgical treatments of the CMAs were required in most
patients, while some were recovered under conservative treatment.
Univariant analysis revealed the development of hernination, parent vessel
involvement, aneurysm rupture and non-surgical/interventional treatment of
the aneurysms were significant predictive risk factors associated with
increased mortality. Conclusion The CMAs are risky due to their potential
consequences of cerebral hernia and aneurysmal rupture. The treatment of
this entity is always challenging as it is difficult to determine the
timing of the cerebral and cardiac operations concerning the necessity of
heparinization in cardiac surgery. Sufficient antibiotics have to be used
in IE patients in order to prevent from the potential consequence as CMAs.
The choices of treatment for CMAs depend on the conditions of CMAs. They
are curable to either conservative, endovascular or surgical management in
selected patients. At least a 2-week interval between clipping or surgical
excision of the aneurysm and the cardiac procedure is recommended in
patients with a ruptured CMA.<br/>Copyright &#xa9; 2016 The Czech Society
of Cardiology

<31>
Accession Number
613970653
Author
Bockeria O.L.; Shvartz V.A.; Akhobekov A.A.; Glushko L.A.; Le T.G.;
Kiselev A.R.; Prokhorov M.D.; Bockeria L.A.
Institution
(Bockeria, Shvartz, Akhobekov, Glushko, Le, Kiselev, Bockeria) Department
of Surgical Treatment for Interactive Pathology, Bakoulev Scientific
Center for Cardiovascular Surgery, Moscow, Russian Federation
(Prokhorov) Saratov Branch of the Institute of Radio Engineering and
Electronics of Russian Academy of Sciences, Saratov, Russian Federation
Title
Statin therapy in the prevention of atrial fibrillation in the early
postoperative period after coronary artery bypass grafting: A
meta-analysis.
Source
Cor et Vasa. 59 (3) (pp e266-e271), 2017. Date of Publication: June 2017.
Publisher
Elsevier Science B.V.
Abstract
Background Postoperative atrial fibrillation (POAF) is observed in the
early postoperative period in approximately every third patient after
coronary artery bypass grafting (CABG). The pathogenesis of POAF is
multifactorial and is not yet fully studied. In many studies,
postoperative inflammatory response has been extensively investigated as a
potential basic factor of POAF. It is known that statins have
anti-inflammatory properties. In some studies, pre- and perioperative use
of statins has shown the decrease of incidence of POAF after CABG.
Objective We conducted meta-analysis of randomized and observational
studies of efficiency of statin therapy for the prevention of POAF after
CABG. Material and methods The meta-analysis included 15 clinical trials
of statins in 9369 patients with performed CABG during the past 10 years.
5598 patients (59.75%) were taking statins and 3771 patients (40.25%) were
not taking statins. The following outcomes observed in the early
postoperative period were studied: incidence of POAF, total mortality
rate, total stroke rate, and total rate of myocardial infarction. The
duration of hospitalization and levels of inflammatory markers before and
after CABG were also assessed. Results The statin therapy reduced the
incidence of POAF after CABG (OR = 0.48, 95% CI: 0.35-0.67, P < 0.001).
Moreover, the statin therapy decreased the total length of hospital stay
and levels of inflammatory markers in the blood serum. Conclusion The
results of our meta-analysis leave no doubt in the presence of
anti-inflammatory and anti-arrhythmic effect of statin therapy. We
confirmed the overall positive role of using statins before CABG for POAF
prevention.<br/>Copyright &#xa9; 2016 The Czech Society of Cardiology

<32>
Accession Number
617068858
Author
Shroff G.R.; Herzog C.A.
Institution
(Shroff, Herzog) Division of Cardiology, Department of Medicine, Hennepin
County Medical Center, University of Minnesota, Minneapolis, MN, United
States
(Herzog) Chronic Disease Research Group, Minneapolis Medical Research
Foundation, 914 South Eighth Street, Minneapolis, MN 55404, United States
Title
Coronary revascularization in patients with CKD stage 5D: Pragmatic
considerations.
Source
Journal of the American Society of Nephrology. 27 (12) (pp 3521-3529),
2016. Date of Publication: December 2016.
Publisher
American Society of Nephrology (E-mail: email@asn-online.org)
Abstract
Coronary revascularization decisions for patients with CKD stage 5D
present a dilemma for clinicians because of high baseline risks of
mortality and future cardiovascular events. This population differs from
the general population regarding characteristics of coronary plaque
composition and behavior, accuracy of noninvasive testing, and response to
surgical and percutaneous revascularization, such that findings from the
general population cannot be automatically extrapolated. However, this
high-risk population has been excluded from all randomized trials
evaluating outcomes of revascularization. Observational studies have
attempted to address long-term outcomes after surgical versus percutaneous
revascularization strategies, but inherent selection bias may limit
accuracy. Compared with percutaneous strategies, surgical
revascularization seems to have long-term survival benefit on the basis of
observational data but associates with substantially higher short-term
mortality rates. Percutaneous revascularization with drug-eluting and bare
metal stents associates with a high risk of in-stent restenosis and need
for future revascularization, perhaps contributing to the higher long-term
mortality hazard. Off-pump coronary bypass surgery and the newest
generation of drug-eluting stent platforms offer no definitive benefits.
In this review, we address the nuances, complexities, and tradeoffs that
clinicians face in determining the optimal method of coronary
revascularization for this high-risk population.<br/>Copyright &#xa9; 2016
by the American Society of Nephrology.

<33>
Accession Number
617070931
Author
Mahmoud K.; Ammar A.; Kasemy Z.
Institution
(Mahmoud, Ammar, Kasemy) Minoufiya Faculty of Medicine, Minoufiya
University, Shebin Elkoam, Egypt
Title
Comparison Between Pressure-Regulated Volume-Controlled and
Volume-Controlled Ventilation on Oxygenation Parameters, Airway Pressures,
and Immune Modulation During Thoracic Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objectives: To compare 2 different ventilatory strategies:
pressure-regulated volume-controlled (PRVC) versus volume-controlled
ventilation during thoracotomy. Design: Prospective randomized study.
Setting: University hospital. Participants: The study comprised 70 adult
patients undergoing thoracic surgery. Interventions: Evaluation of
oxygenation parameters, airway pressures, and immune modulation.
Measurements and Main Results: The primary outcome was arterial oxygen
tension/fraction of inspired oxygen
(PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf>) ratio, whereas secondary
outcomes included arterial and central venous blood gases, deadspace
volume/tidal volume ratio, peak inspiratory pressure, mean inspiratory
pressure, and plateau inspiratory pressure obtained at the following 4
time points: 20 minutes after total lung ventilation (T<inf>0</inf>), 20
minutes after 1-lung ventilation (T<inf>1</inf>), 20 minutes after return
to total lung ventilation (T<inf>2</inf>), and at the end of surgery
(T<inf>3</inf>). Furthermore, alveolar and plasma levels of interleukin-8
and tumor necrosis factor-alpha and changes in alveolar albumin levels and
cell numbers were measured at the same time points. Oxygenation parameters
(PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> and PaO<inf>2</inf>) were
significantly better in the PRVC group
(PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> ratio at T<inf>1</inf> was 176
v 146 in the PRVC and volume-controlled groups, respectively, with a p
value of 0.004). Deadspace volume/tidal volume ratio and inspiratory
airway pressures were significantly lower in the PRVC group. Furthermore,
all inflammatory parameters (alveolar and plasma interleukins, alveolar
albumin levels, and cell numbers) were significantly lower in the PRVC
group. Conclusions: The PRVC mode during 1-lung ventilation in thoracic
surgery caused a favorable effect on oxygenation parameters, respiratory
mechanics, and immune modulation during thoracic surgery.<br/>Copyright
&#xa9; 2017 Elsevier Inc.

<34>
Accession Number
617068216
Author
Udesh R.; Natarajan P.; Jeevanantham V.; Gleason T.G.; Badhwar V.;
Thirumala P.D.
Institution
(Udesh, Natarajan, Jeevanantham, Gleason, Badhwar, Thirumala) aDepartment
of Neurological Surgery, University of Pittsburgh School of Medicine, and
bDepartment of Cardiothoracic Surgery, University of Pittsburgh Medical
Center, Pittsburgh, PA, cSaint Anthony Hospital, Oklahoma City, OK, and
dDivision of Cardiothoracic Surgery, West Virginia University, Morgantown,
WV, USA
Title
Perioperative Strokes Following Surgical Correction of Mitral Valves: A
Systematic Review and Meta-Analysis.
Source
European Neurology. (pp 63-70), 2017. Date of Publication: 24 Jun 2017.
Publisher
S. Karger AG
Abstract
Objective: The primary aim of this meta-analysis was to quantify the
impact of perioperative strokes on stroke-related mortality after open
mitral valve (MV) procedures were performed. Methods: An electronic search
of the PubMed, Embase, and the Web of Science databases was performed to
retrieve articles published up to December 2015, relevant to patients
undergoing MV procedures. Data were extracted from the final list of 25
studies to calculate a summary OR for 30-day stroke-related mortality.
Results: The stroke rate in the total sample population was 1.62%
(73/4,498). The 30-day all-cause mortality rate was 3.51% (158/4,498). The
percentage of total deaths caused by stroke was 6.87%. The summary OR of
stroke-related mortality following MV procedures was estimated to be 7.22
(95% CI 4.13-12.63, p < 0.0001). A subgroup analysis was done for studies
involving concomitant MV surgery and coronary artery bypass grafting. The
summary estimate of the subgroup showed an OR of 8.508 (95% CI
1.552-46.622, p = 0.0136). Conclusion: Perioperative strokes following
open MV procedures may be associated with more than 7 times greater odds
of 30-day stroke-related mortality. They appear to be more commonly
occurring than what is reported by current literature, making further
studies investigating possible mechanisms and preventive measures a
priority.<br/>Copyright &#xa9; 2017 S. Karger AG, Basel

<35>
Accession Number
607404276
Author
Takagi H.; Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
Title
Sutureless aortic valve replacement may improve early mortality compared
with transcatheter aortic valve implantation: A meta-analysis of
comparative studies.
Source
Journal of Cardiology. 67 (6) (pp 504-512), 2016. Date of Publication: 01
Jun 2016.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Objectives: To determine which improves clinical outcomes more, sutureless
(including rapid-deployment) aortic valve replacement (AVR) or
transcatheter aortic valve implantation (TAVI), we performed a
meta-analysis of comparative studies. Methods: MEDLINE and EMBASE were
searched through June 2015 using Web-based search engines (PubMed and
OVID). Studies considered for inclusion met the following criteria: the
design was a comparative study; the study population included patients
with severe aortic valve stenosis, patients were assigned to sutureless
AVR versus TAVI; and main outcomes included at least early (in-hospital or
30-day) all-cause mortality. Results: Of 87 potentially relevant articles
screened initially, no randomized controlled trials and 7 observational
comparative studies of sutureless AVR versus TAVI (enrolling a total of
945 patients) were identified and included. The first pooled analysis
demonstrated a statistically significant reduction in mortality with
sutureless AVR over TAVI [2.5% versus 7.3%; odds ratio (OR), 0.33; 95%
confidence interval (CI), 0.16 to 0.69; p = 0.003; risk difference (RD),
-5.23%; 95% CI, -8.12% to -2.33%; p = 0.0004]. The second pooled analyses
demonstrated no statistically significant difference in bleeding
complications, acute kidney injury, and conduction disturbance between
sutureless AVR and TAVI. The third pooled analysis demonstrated a
statistically significant reduction in paravalvular aortic regurgitation
(AR) with sutureless AVR over TAVI (3.5% versus 33.2%; OR, 0.09; 95% CI,
0.05 to 0.16, p < 0.00001; MD, -22.56%; 95% CI, -36.59% to -8.53%; p =
0.002). Conclusions: Compared with TAVI, sutureless AVR may be associated
with a reduction in early mortality and postoperative paravalvular
AR.<br/>Copyright &#xa9; 2015 Japanese College of Cardiology.

<36>
Accession Number
616378995
Author
Medbery R.L.; Force S.D.
Institution
(Medbery, Force) Section of General Thoracic Surgery, The Emory Clinic,
Division of Cardiothoracic Surgery, Department of Surgery, Emory
University School of Medicine, 1365 Clifton Road, Northeast, Building A,
Atlanta, GA 30322, United States
Title
Quality and Cost in Thoracic Surgery.
Source
Thoracic Surgery Clinics. 27 (3) (pp 267-277), 2017. Date of Publication:
August 2017.
Publisher
W.B. Saunders
Abstract
The value of health care is defined as health outcomes (quality) achieved
per dollars spent (cost). The current national health care landscape is
focused on minimizing spending while optimizing patient outcomes. With the
introduction of minimally invasive thoracic surgery, there has been
concern about added cost relative to improved outcomes. Moreover,
differences in postoperative hospital care further drive patient outcomes
and health care costs. This article presents a comprehensive literature
review on quality and cost in thoracic surgery and aims to investigate
current challenges with regard to achieving the greatest value for our
patients.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<37>
Accession Number
614312762
Author
Arora S.; Strassle P.D.; Ramm C.J.; Rhodes J.A.; Vaidya S.R.; Caranasos
T.G.; Vavalle J.P.
Institution
(Arora, Ramm, Caranasos, Vavalle) Division of Cardiology, University of
North Carolina, Chapel Hill, NC, United States
(Strassle) Division of Epidemiology, University of North Carolina, Chapel
Hill, NC, United States
(Rhodes) Campbell University School of Osteopathic Medicine, Buies Creek,
NC, United States
(Vaidya) Department of Internal Medicine, Cape Fear Valley Medical Center,
Fayetteville, NC, United States
Title
Transcatheter Versus Surgical Aortic Valve Replacement in Patients With
Lower Surgical Risk Scores: A Systematic Review and Meta-Analysis of Early
Outcomes.
Source
Heart Lung and Circulation. 26 (8) (pp 840-845), 2017. Date of
Publication: August 2017.
Publisher
Elsevier Ltd
Abstract
Background The results from the PARTNER 2 trial showed the feasibility of
transcatheter aortic valve replacement (TAVR) in intermediate surgical
risk patients. Although low risk clinical trials will take time to
conclude, some data has emerged comparing TAVR with surgical aortic valve
replacement (SAVR) in lower risk patients. Methods A Medline search was
conducted using standard methodology to search for studies reporting
results comparing TAVR and SAVR. Studies were included if the overall mean
Society of Thoracic Surgeons Score was less than 4% (or equivalent
Euroscore). A meta-analysis comparing the 30-day risk of clinical outcomes
between TAVR and SAVR in the lower surgical risk population was conducted.
Results A total of four studies, including one clinical trial and three
propensity-matched cohort studies met the inclusion criteria. Compared to
SAVR, TAVR had a lower risk of 30-day mortality (RR 0.67, 95% CI 0.41,
1.10), stroke (RR 0.60, 95% CI 0.30, 1.22), bleeding complications (RR
0.51, 95% CI 0.40, 0.67) and acute kidney injury (RR 0.66, 95% CI 0.47,
0.94). However, a higher risk of vascular complications (RR 11.72, 95% CI
3.75, 36.64), moderate or severe paravalvular leak (RR 5.04, 95% CI 3.01,
8.43), and permanent pacemaker implantations (RR 4.62, 95% CI 2.63, 8.12)
was noted for TAVR. Conclusion Among lower risk patients, TAVR and SAVR
appear to be comparable in short term outcomes. Additional high quality
studies among patients classified as low risk are needed to further
explore the feasibility of TAVR in all surgical risk
patients.<br/>Copyright &#xa9; 2017 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<38>
Accession Number
614529437
Author
Ip W.T.K.; Chandramouli C.; Smith J.A.; McLennan P.L.; Pepe S.; Delbridge
L.M.D.
Institution
(Ip, Chandramouli, Delbridge) Cardiac Phenomics Laboratory, Department of
Physiology, University of Melbourne, Melbourne, Vic, Australia
(Smith) Department of Cardiothoracic Surgery, Monash Health, Monash
University, Melbourne, Vic, Australia
(Smith) Department of Surgery, School of Clinical Sciences at Monash
Health, Monash University, Melbourne, Vic, Australia
(McLennan) Graduate School of Medicine, Centre for Human Applied
Physiology, University of Wollongong, Sydney, NSW, Australia
(Pepe) Murdoch Children's Research Institute, Department of Paediatrics,
University of Melbourne, Royal Children's Hospital, Melbourne, Vic,
Australia
Title
A Small Cohort Omega-3 PUFA Supplement Study: Implications of Stratifying
According to Lipid Membrane Incorporation in Cardiac Surgical Patients.
Source
Heart Lung and Circulation. 26 (8) (pp 846-855), 2017. Date of
Publication: August 2017.
Publisher
Elsevier Ltd
Abstract
Background Epidemiological studies and randomised clinical trials (RCTs)
report disparate findings in relation to omega-3 polyunsaturated fatty
acids (n-3 PUFA) benefit for cardiac patients. With RCTs interpretation is
potentially confounded by background n-3 PUFA intake. The goal of this
pilot, small cohort, pre-surgical supplementation study was to evaluate
postoperative atrial fibrillation (AF) and cardiac molecular expression
profiles employing two data analysis approaches - by treatment
randomisation and by stratification using measured n-3 PUFA. Methods
Patients (n = 20) received 3 g/day of fish or placebo oil (FO vs PO) in a
double blind randomised protocol prior to elective coronary artery graft
and valve surgery. Groups were matched for age, gender, and mean treatment
duration (~20 days). Resected atrial myocardium was sampled for assay of
viability metabolic markers, and blood obtained for erythrocyte membrane
lipid measurement. Results There was substantial overlap of cell membrane
n-3 PUFA content across PO and FO groups, and no group treatment effects
on AF incidence or myocardial molecular marker levels were detected. In
contrast, data stratification using membrane n-3 PUFA content (at 8% total
membrane lipid) achieved significant separation of patients (by n-6:n-3
PUFA ratio), a significant differential cardiac expression of the marker
peroxisomal proliferator-activated receptor, but no difference in AF
incidence. Conclusions This small n-3 PUFA case study demonstrates that
the same cohort may yield differing findings when evaluated using
randomisation or stratification approaches based on direct molecular
measures in cell membranes.<br/>Copyright &#xa9; 2017 Australian and New
Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac
Society of Australia and New Zealand (CSANZ)

<39>
Accession Number
613715002
Author
Rozencwajg S.; Desthieux C.; Szymkiewicz O.; Ynineb Y.; Fulgencio J.-P.;
Bonnet F.
Institution
(Rozencwajg, Desthieux, Szymkiewicz, Ynineb, Fulgencio, Bonnet) Service
d'anesthesie-reanimation, universite Pierre-et-Marie-Curie Paris VI,
hopital Tenon, groupe hospitalier universitaire Est-Parisien, 4, rue de la
Chine, cedex 20, Paris 75970, France
Title
The risk of atrial fibrillation after pneumonectomy is not impaired by
preoperative administration of dexamethasone. A cohort study.
Source
Anaesthesia Critical Care and Pain Medicine. 36 (3) (pp 185-189), 2017.
Date of Publication: June 2017.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Introduction Atrial fibrillation (AF) is one of the most frequent
complications occurring after thoracic surgery especially after lung
resection. It is associated with an increase in postoperative morbidity
and mortality. Recent data having documented the preventive role of
corticosteroids on the occurrence of AF in cardiac surgery, we sought to
evaluate the effect of preoperative administration of dexamethasone on the
incidence of AF after pneumonectomy. Methods We reviewed the files of all
consecutive patients who underwent a pneumonectomy in one single centre
between July 2004 and July 2012. For each patient, demographics, medical
status, the surgical procedure and treatments administered including
dexamethasone, were recorded. The data were analysed using a univariate
analysis and a multivariate logistic regression. Results Among them, 153
patients were included and analysed; 35 (23%) presented with at least one
episode of AF occurring within 48 hours after surgery. Mortality was
higher in these patients (26.5% versus 12.1%, P = 0.06). The univariate
analysis indicated that patients who had a postoperative course
complicated by the occurrence of AF were older (P = 0.003), had a higher
SAPS2 score (P = 0.002) and a higher CHADS score (P = 0.05). Older age (OR
= 1.08; P = 0.048) and preoperative treatment by anti-arrhythmics (OR =
3.9; P = 0.029) were documented as independent risk factors in the
multivariate analysis. Preoperative administration of dexamethasone 8-12
mg did not impair the incidence of AF. Discussion AF is a frequent
complication after pneumonectomy associated with increased mortality.
Whereas corticosteroids have been documented as preventing AF following
cardiac surgery, no such effect was found after
pneumonectomy.<br/>Copyright &#xa9; 2016 Societe francaise d'anesthesie et
de reanimation (Sfar)

<40>
Accession Number
616957959
Author
Poon S.S.; Field M.; Gupta D.; Cameron D.
Institution
(Poon, Field) Thoracic Aortic Aneurysm Service, Department of Cardiac
Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
(Gupta) Interventional Cardiology, Department of Cardiology, Liverpool
Heart and Chest Hospital, Liverpool, United Kingdom
(Cameron) Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore,
MD, United States
Title
Surgical septal myectomy or alcohol septal ablation: which approach offers
better outcomes for patients with hypertrophic obstructive
cardiomyopathy?.
Source
Interactive Cardiovascular and Thoracic Surgery. 24 (6) (pp 951-961),
2017. Date of Publication: 01 Jun 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Summary A best evidence topic in cardiac surgery was written according to
a structured protocol. The question addressed was whether surgical septal
myectomy (SM) is more beneficial than alcohol septal ablation (ASA) in
patients with hypertrophic obstructive cardiomyopathy. Altogether 218
articles were found using the reported search, of which 15 studies
represented the best evidence to answer the clinical question. There were
14 observational studies and 1 meta-analysis study. The authors, journal,
date and country of publication, patient group studied, study type,
relevant outcomes and results of these articles are tabulated. Surgical SM
was generally performed in younger patients whereas percutaneous ASA was
favoured in patients with advanced age and significant co-morbidities. In
a large study comprising 716 patients, the reduction of median residual
left ventricular outflow tract (LVOT) gradient at 3 months was comparable
after ASA (102 +/- 52-10 mmHg) and SM (92 +/- 39-9 mmHg). The New York
Heart Association (NYHA) functional class and symptomatic improvement for
either approach was comparable. Findings from the meta-analysis study
showed that patients who underwent ASA had a higher incidence of
post-procedure device implantation (odds ratio 3.09; P < 0.00001), as
reported in 6 other studies. The risk of permanent pacemaker insertion
during follow-up (FU) varied between 2.4-12.5% in SM and 1.7-22.0% in ASA.
Isolated surgical myectomy and ASA are safe and effective in abolishing
outflow obstruction, although the resolution of LVOT pressure gradient is
more complete with surgery. The post-procedural and late mortality rates
between the 2 groups are consistently low and comparable in carefully
selected patients. Nonetheless, ASA is associated with the increased
likelihood of complications such as permanent pacemaker implantation,
early sustained-VT and VF, and re-intervention. Overall, when performed by
experienced cardiologists and surgeons, both techniques are safe and
effective in most cases and therefore treatment should be offered based on
patient choice.<br/>Copyright &#xa9; The Author 2017. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery.

<41>
Accession Number
616876443
Author
Fabritius M.L.; Geisler A.; Petersen P.L.; Wetterslev J.; Mathiesen O.;
Dahl J.B.
Institution
(Fabritius, Dahl) Bispebjerg and Frederiksberg Hospitals, Department of
Anaesthesiology and Intensive Care, Bispebjerg bakke 23, Copenhagen, NV
2400, Denmark
(Geisler, Mathiesen) Zealand University Hospital, Department of
Anaesthesiology, Lykkebaekvej 1, Koge 4600, Denmark
(Petersen) Copenhagen University Hospital, Department of Anaesthesiology,
Centre of Head and Orthopaedics, Rigshospitalet, Blegdamsvej 9, Copenhagen
2100, Denmark
(Wetterslev) Copenhagen University Hospital, Copenhagen Trial Unit, Centre
for Clinical Intervention Research, Rigshospitalet, Blegdamsvej 9,
Copenhagen 2100, Denmark
Title
Gabapentin in procedure-specific postoperative pain management -
preplanned subgroup analyses from a systematic review with meta-analyses
and trial sequential analyses.
Source
BMC Anesthesiology. 17 (1) (no pagination), 2017. Article Number: 85. Date
of Publication: 21 Jun 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: It has been argued that postoperative pain treatment should be
"procedure-specific", since different analgesics may have specific effects
dependent on the surgical procedure. The aim of the present subgroup
analysis was to compare the beneficial and harmful effects of
perioperative gabapentin treatment in different surgical procedures.
Methods: Relevant databases were searched for randomized clinical trials
(RCTs) comparing gabapentin versus placebo. Two authors independently
screened titles and abstracts, extracted data and assessed risk of bias.
The primary outcomes were differences in 24-h morphine consumption, and
serious adverse events (SAE) between surgical procedures. These subgroup
analyses were predefined in a PRISMA compliant systematic review
registered at PROSPERO (ID: CRD42013006538). It was predefined that
conclusions should primarily be based on trials classified as overall low
risk of bias. Results: Seventy-four RCTs with 5645 patients were included,
assessing benefit and harm in cholecystectomy, hysterectomy, mastectomy,
and arthroplasty surgery, spinal surgery, and thoracic surgery. Only eight
of 74 trials were classified as overall low risk of bias limiting our
ability to conclude on the estimates in most meta-analyses. The
differences between surgical procedures in these trials were not
statistically significant when tested for subgroup differences. Fifteen
trials with 1377 patients reported a total of 59 SAEs, most of which were
observed in the thoracic surgery group. Conclusion: Both beneficial and
harmful effects in these subgroup analyses were influenced by bias and
insufficient data, limiting conclusions. With these limitations, we could
not adequately test for differences in beneficial or harmful outcomes
between six surgical subgroups undergoing perioperative gabapentin
treatment.<br/>Copyright &#xa9; 2017 The Author(s).

<42>
Accession Number
614484465
Author
Wolff G.; Lin Y.; Karathanos A.; Brockmeyer M.; Wolters S.; Nowak B.;
Furnkranz A.; Makimoto H.; Kelm M.; Schulze V.
Institution
(Wolff, Lin, Karathanos, Brockmeyer, Wolters, Furnkranz, Makimoto, Kelm,
Schulze) Division of Cardiology, Pulmonology and Vascular Medicine,
Department of Internal Medicine, Heinrich-Heine-University, Moorenstr. 5,
Dusseldorf 40225, Germany
(Nowak, Furnkranz) Cardioangiologisches Centrum Bethanien, Frankfurt am
Main, Germany
Title
Implantable cardioverter/defibrillators for primary prevention in dilated
cardiomyopathy post-DANISH: an updated meta-analysis and systematic review
of randomized controlled trials.
Source
Clinical Research in Cardiology. 106 (7) (pp 501-513), 2017. Date of
Publication: 01 Jul 2017.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: Sudden cardiac death (SCD) is frequent in patients with heart
failure due to dilated cardiomyopathy (DCM). Implantable
cardioverter/defibrillator (ICD) device therapy is currently used for
primary prevention. However, publication of the DANISH trial has recently
given reason for doubt, showing no significant improvement in all-cause
mortality in comparison to contemporary medical therapy. Methods: We
performed a meta-analysis of all randomized controlled trials comparing
ICD therapy to medical therapy (MT) for primary prevention in DCM. The
primary outcome was all-cause mortality; secondary analyses were performed
on sudden cardiac death, cardiovascular death and non-cardiac death.
Results: Five trials including a total of 2992 patients were included in
the pooled analysis. Compared to contemporary medical treatment there was
a significant mortality reduction with ICD device therapy [odds ratio (OR)
0.77, 95% confidence interval (CI) 0.64-0.93; p = 0.006]. SCD was
decreased significantly (OR 0.43, CI 0.27-0.69; p = 0.0004), while
cardiovascular death and non-cardiac death showed no differences.
Sensitivity analyses showed no influence of amiodarone therapy on overall
results. Analysis of MT details revealed the DANISH population to adhere
the most to current guideline recommendations. In addition, it was the
only study including a substantial amount of CRT devices (58%).
Conclusions: Our meta-analysis of all available randomized evidence shows
a survival benefit of ICD therapy for primary prevention in DCM. DANISH
results suggest an attenuation of this ICD advantage when compared to
contemporary medical and cardiac resynchronization therapy. Until larger
trials have confirmed this finding, ICD therapy should remain the
recommendation for primary prevention of SCD in DCM.<br/>Copyright &#xa9;
2017, Springer-Verlag Berlin Heidelberg.

<43>
Accession Number
613892570
Author
Owens R.E.; Kabra R.; Oliphant C.S.
Institution
(Owens) Department of Pharmacy: Clinical and Administrative Sciences,
University of Oklahoma College of Pharmacy, Oklahoma City, OK, United
States
(Kabra) Division of Cardiology, Department of Internal Medicine,
University of Tennessee Health Science Center, Methodist University
Hospital, Memphis, TN, United States
(Oliphant) Department of Clinical Pharmacy, University of Tennessee
College of Pharmacy, Methodist University Hospital, Memphis, TN, United
States
Title
Direct oral anticoagulant use in nonvalvular atrial fibrillation with
valvular heart disease: a systematic review.
Source
Clinical Cardiology. 40 (6) (pp 407-412), 2017. Date of Publication: June
2017.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Direct oral anticoagulants (DOACs) are indicated for stroke prevention in
patients with nonvalvular atrial fibrillation (NVAF), which, according to
the American College of Cardiology/American Heart Association/Heart Rhythm
Society atrial fibrillation (AF) guidelines, excludes patients with
rheumatic mitral stenosis, a mechanical or bioprosthetic heart valve, or
mitral valve repair. However, the data regarding use of DOACs in AF
patients with other types of valvular heart disease (VHD) are unclear. We
aimed to summarize and evaluate the literature regarding the safety and
efficacy of DOAC use in NVAF patients with other types of VHD. After an
extensive literature search, a total of 1 prospective controlled trial, 4
subanalyses, and 1 abstract were identified. Efficacy of the DOAC agents
in NVAF patients with VHD mirrored the overall trial results. Bleeding
risk was significantly increased in VHD patients treated with rivaroxaban,
but not for dabigatran or apixaban. Of the bioprosthetic valve patients
enrolled in the Apixaban for Reduction in Stroke and Other Thromboembolic
Events in Atrial Fibrillation (ARISTOTLE) trial, no safety or efficacy
concerns were identified. In conclusion, subanalyses of DOAC landmark AF
trials revealed that dabigatran, rivaroxaban, and apixaban may be safely
used in AF patients with certain types of VHD: aortic stenosis, aortic
regurgitation, and mitral regurgitation. More evidence is needed before
routinely recommending these agents for patients with bioprosthetic valves
or mild mitral stenosis. Patients with moderate to severe mitral stenosis
or mechanical valves should continue to receive warfarin, as these
patients were excluded from all landmark AF trials.<br/>Copyright &#xa9;
2016 Wiley Periodicals, Inc.

<44>
Accession Number
616937017
Author
Lopez M.G.; Pretorius M.; Shotwell M.S.; Deegan R.; Eagle S.S.; Bennett
J.M.; Sileshi B.; Liang Y.; Gelfand B.J.; Kingeter A.J.; Siegrist K.K.;
Lombard F.W.; Richburg T.M.; Fornero D.A.; Shaw A.D.; Hernandez A.;
Billings F.T.
Institution
(Lopez, Kingeter, Hernandez, Billings) Vanderbilt University Medical
Center, Division of Anesthesiology Critical Care Medicine, Department of
Anesthesiology, 1211 21st Avenue South, Suite 526, Nashville, TN 37212,
United States
(Pretorius, Deegan, Eagle, Bennett, Sileshi, Liang, Gelfand, Kingeter,
Siegrist, Lombard, Richburg, Shaw, Hernandez, Billings) Vanderbilt
University Medical Center, Division of Cardiothoracic Anesthesiology,
Department of Anesthesiology, 1211 21st Avenue South, Suite 526,
Nashville, TN 37212, United States
(Shotwell) Vanderbilt University Medical Center, Department of
Biostatistics, Nashville, TN, United States
(Fornero) Vanderbilt University Medical Center, Cardiovascular Perfusion
Technology Program, Nashville, TN, United States
Title
The Risk of Oxygen during Cardiac Surgery (ROCS) trial: Study protocol for
a randomized clinical trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 295. Date of
Publication: 26 Jun 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Anesthesiologists administer excess supplemental oxygen
(hyper-oxygenation) to patients during surgery to avoid hypoxia.
Hyper-oxygenation, however, may increase the generation of reactive oxygen
species and cause oxidative damage. In cardiac surgery, increased
oxidative damage has been associated with postoperative kidney and brain
injury. We hypothesize that maintenance of normoxia during cardiac surgery
(physiologic oxygenation) decreases kidney injury and oxidative damage
compared to hyper-oxygenation. Methods/design: The Risk of Oxygen during
Cardiac Surgery (ROCS) trial will randomly assign 200 cardiac surgery
patients to receive physiologic oxygenation, defined as the lowest
fraction of inspired oxygen (FIO<inf>2</inf>) necessary to maintain an
arterial hemoglobin saturation of 95 to 97%, or hyper-oxygenation
(FIO<inf>2</inf> = 1.0) during surgery. The primary clinical endpoint is
serum creatinine change from baseline to postoperative day 2, and the
primary mechanism endpoint is change in plasma concentrations of
F<inf>2</inf>-isoprostanes and isofurans. Secondary endpoints include
superoxide production, clinical delirium, myocardial injury, and length of
stay. An endothelial function substudy will examine the effects of oxygen
treatment and oxidative stress on endothelial function, measured using
flow mediated dilation, peripheral arterial tonometry, and wire tension
myography of epicardial fat arterioles. Discussion: The ROCS trial will
test the hypothesis that intraoperative physiologic oxygenation decreases
oxidative damage and organ injury compared to hyper-oxygenation in
patients undergoing cardiac surgery. Trial registration:
ClinicalTrials.gov, ID: NCT02361944. Registered on the 30th of January
2015.<br/>Copyright &#xa9; 2017 The Author(s).

<45>
Accession Number
616913400
Author
Katijjahbe M.A.; Denehy L.; Granger C.L.; Royse A.; Royse C.; Bates R.;
Logie S.; Clarke S.; El-Ansary D.
Institution
(Katijjahbe, Denehy, Granger, El-Ansary) Melbourne School of Health
Sciences, The University of Melbourne, Department of Physiotherapy,
Parkville, VIC 3053, Australia
(Katijjahbe) Hospital Cancelor Tuaku Mukhriz, Pusat Perubatan University
Kebangsaan Malaysia, Department of Physiotherapy, Kuala Lumpur 56000,
Malaysia
(Granger, Bates) The Royal Melbourne Hospital, Department of
Physiotherapy, Parkville, VIC 3050, Australia
(Royse, Royse) University of Melbourne, Department of Surgery, Parkville,
VIC 3010, Australia
(Royse, Royse) Royal Melbourne Hospital, Department of Surgery, Parkville,
VIC 3050, Australia
(Logie) Melbourne Private Hospital, Physiotherapy Department, Parkville,
VIC 3052, Australia
(Clarke) School of Mathematics and Statistics, The University of
Melbourne, Statistical Consulting Centre, Parkville, VIC 3010, Australia
Title
The Sternal Management Accelerated Recovery Trial (S.M.A.R.T) - standard
restrictive versus an intervention of modified sternal precautions
following cardiac surgery via median sternotomy: Study protocol for a
randomised controlled trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 290. Date of
Publication: 23 Jun 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The routine implementation of sternal precautions to prevent
sternal complications that restrict the use of the upper limbs is
currently worldwide practice following a median sternotomy. However,
evidence is limited and drawn primarily from cadaver studies and
orthopaedic research. Sternal precautions may delay recovery, prolong
hospital discharge and be overly restrictive. Recent research has shown
that upper limb exercise reduces post-operative sternal pain and results
in minimal micromotion between the sternal edges as measured by
ultrasound. The aims of this study are to evaluate the effects of modified
sternal precautions on physical function, pain, recovery and
health-related quality of life after cardiac surgery. Methods/design: This
study is a phase II, double-blind, randomised controlled trial with
concealed allocation, blinding of patients and assessors, and
intention-to-treat analysis. Patients (n = 72) will be recruited following
cardiac surgery via a median sternotomy. Sample size calculations were
based on the minimal important difference (two points) for the primary
outcome: Short Physical Performance Battery. Thirty-six participants are
required per group to counter dropout (20%). All participants will be
randomised to receive either standard or modified sternal precautions. The
intervention group will receive guidelines encouraging the safe use of the
upper limbs. Secondary outcomes are upper limb function, pain,
kinesiophobia and health-related quality of life. Descriptive statistics
will be used to summarise data. The primary hypothesis will be examined by
repeated-measures analysis of variance to evaluate the changes from
baseline to 4 weeks post-operatively in the intervention arm compared with
the usual-care arm. In all tests to be conducted, a p value <0.05
(two-tailed) will be considered statistically significant, and confidence
intervals will be reported. Discussion: The Sternal Management Accelerated
Recovery Trial (S.M.A.R.T.) is a two-centre randomised controlled trial
powered and designed to investigate whether the effects of modifying
sternal precautions to include the safe use of the upper limbs and trunk
impact patients' physical function and recovery following cardiac surgery
via median sternotomy. Trial registration: Australian and New Zealand
Clinical Trials Registry identifier: ACTRN12615000968572. Registered on 16
September 2015 (prospectively registered).<br/>Copyright &#xa9; 2017 The
Author(s).

<46>
Accession Number
617046939
Author
Mihos C.G.; Xydas S.; Yucel E.; Capoulade R.; Williams R.F.; Mawad M.;
Garcia G.; Santana O.
Institution
(Mihos, Yucel, Capoulade) Cardiac Ultrasound Laboratory, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, United States
(Xydas, Williams, Mawad) Columbia University Division of Cardiac Surgery,
Mount Sinai Heart Institute, Miami Beach, FL, United States
(Garcia) Department of Anesthesia, Mount Sinai Medical Center, Miami
Beach, FL, United States
(Santana) Columbia University Division of Cardiology, Mount Sinai Heart
Institute, Miami Beach, FL, United States
Title
Mitral valve repair and subvalvular intervention for secondary mitral
regurgitation: A systematic review and meta-analysis of randomized
controlled and propensity matched studies.
Source
Journal of Thoracic Disease. 9 (pp S582-S594), 2017. Date of Publication:
01 Jun 2017.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Combining a ring annuloplasty (Ring) with a mitral subvalvular
intervention (Ring + subvalvular) in patients with secondary mitral
regurgitation (MR) may improve mitral valve (MV) repair durability.
However, the outcomes of this strategy compared with a Ring only, have not
been clearly defined. Methods: A systematic review and meta-analysis was
performed utilizing randomized controlled and propensity matched studies
which compared a Ring + subvalvular versus Ring MV repair for the
treatment of secondary MR. Risk ratio (RR), weighted mean difference (MD),
and the 95% confidence interval (CI) were calculated by the
Mantel-Haenszel and inverse-variance methods, for clinical outcomes and
echocardiographic measures of follow-up MR, left ventricular (LV) reverse
remodeling, and MV apparatus geometry. Results: Five studies were
identified, with a total of 397 patients. Baseline characteristics were
similar between groups, and all patients had moderate to severe secondary
MR, with the vast majority in the setting of ischemic cardiomyopathy. A
Ring + subvalvular repair consisted of papillary muscle approximation
(n=2), papillary muscle relocation (n=2), or secondary chordal cutting
(n=1). Follow-up ranged from 10.1 (mean range =0.25-42) to 69
[interquartile range (IQR) =23-82] months. When compared with Ring only at
last follow-up, a Ring + subvalvular MV repair was associated with: (I) a
smaller MR grade (MD =-0.44, 95% CI -0.69 to -0.19; P=0.0005); (II) a
reduced risk of moderate or greater recurrent MR (RR =0.43, 95% CI,
0.27-0.66; P=0.0002); (III) a smaller mean LV end-diastolic diameter (MD
=-3.56 mm, 95% CI -5.40 to -1.73; P=0.0001) and a greater ejection
fraction (MD =2.64%, 95% CI, 0.13-5.15; P=0.04); and, (IV) an improved MV
apparatus geometry. There were no differences in operative mortality,
post-operative morbidity, or follow-up survival between surgical
approaches. Conclusions: When compared with Ring only, a Ring +
subvalvular MV repair is associated with greater LV reverse remodeling and
systolic function, less recurrence of moderate or greater MR, and an
improved geometry of the MV apparatus at short and mid-term
follow-up.<br/>Copyright &#xa9; Journal of Thoracic Disease. All rights
reserved.

<47>
Accession Number
617046938
Author
Santana O.; Xydas S.; Williams R.F.; LaPietra A.; Mawad M.; Wigley J.C.;
Beohar N.; Mihos C.G.
Institution
(Santana, Beohar) The Columbia University Division of Cardiology, Mount
Sinai Medical Center, Miami Beach, FL, United States
(Xydas, Williams, LaPietra, Mawad) The Division of Cardiac Surgery, Mount
Sinai Medical Center, Miami Beach, FL, United States
(Wigley) The Department of Anesthesia, Mount Sinai Medical Center, Miami
Beach, FL, United States
(Mihos) Cardiac Ultrasound Laboratory, Massachusetts General Hospital,
Harvard Medical School, Boston, MA, United States
Title
Percutaneous coronary intervention followed by minimally invasive valve
surgery compared with median sternotomy coronary artery bypass graft and
valve surgery in patients with prior cardiac surgery.
Source
Journal of Thoracic Disease. 9 (pp S575-S581), 2017. Date of Publication:
01 Jun 2017.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: In patients with prior cardiac surgery requiring re-operative
coronary and valve surgery, a hybrid approach of percutaneous coronary
intervention followed by minimally invasive valve surgery (PCI + MIVS) may
be an alternative to the standard median sternotomy coronary artery bypass
and valve surgery (CABG + valve). Methods: The outcomes of patients with
prior cardiac surgery, presenting with coronary artery and valvular
disease, who underwent PCI + MIVS (N=39) were retrospectively compared
with those who underwent CABG + valve (N=28) via a repeat median
sternotomy, between February 2009 and April 2014. Results: The mean age
for the PCI + MIVS versus CABG + valve group was 75+/-9 and 72+/-11 years
(P=0.54), respectively. The baseline characteristics were similar between
groups, with the exception of a greater prevalence of 1-vessel coronary
artery disease and clopidogrel or dual antiplatelet therapy at the time of
surgery in the PCI + MIVS group, and more 3-vessel coronary artery disease
in those undergoing CABG + valve surgery. The PCI + MIVS approach was
associated with a decreased aortic cross-clamp (94 vs. 131 minutes,
P=0.001) and cardiopulmonary bypass (128 vs. 190 minutes, P < 0.001)
times, fewer intraoperative packed red blood transfusions (1.3 vs. 3.8
units, P=0.001), shorter intensive care unit length of stay (41 vs. 71
hours, P < 0.001), and decreased incidence of prolonged mechanical
ventilation (12.8% vs. 35.7%, P=0.03), re-intubation (2.6% vs. 17.9%,
P=0.04), when compared with CABG + valve. The thirtyday and two-year
mortality were similar, being 7.7% vs. 7.1% (P=0.66), and 12.8% vs. 10.7%
(P=0.55), in the PCI + MIVS vs. CABG + valve group, respectively.
Conclusions: Hybrid PCI + MIVS in patients with prior cardiac surgery is
associated with shorter operative times and intensive care unit length of
stay, less need for intraoperative blood cell transfusions, decreased use
of mechanical ventilation, and similar short-term and follow-up survival,
when compared with CABG + valve surgery via median sternotomy. Randomized
trials and multicenter registries are needed to further evaluate this
approach.<br/>Copyright &#xa9; Journal of Thoracic Disease. All rights
reserved.

<48>
Accession Number
616989502
Author
Martins M.A.P.; Costa J.M.; Mambrini J.V.D.M.; Ribeiro A.L.P.; Benjamin
E.J.; Brant L.C.C.; Paasche-Orlow M.K.; Magnani J.W.
Institution
(Martins) Hospital das Clinicas, Faculdade de Farmacia, Universidade
Federal de Minas Gerais, Av. Antonio Carlos 6627, Campus Pampulha, Belo
Horizonte, Minas Gerais CEP 31270-901, Brazil
(Martins, Benjamin) Sections of Cardiovascular Medicine and Preventive
Medicine, Boston Medical Center, Boston University School of Medicine,
Boston, MA, United States
(Costa) Hospital Risoleta Tolentino Neves, Belo Horizonte, Minas Gerais,
Brazil
(Mambrini) Centro de Pesquisa Rene Rachou, Fundacao Oswaldo Cruz, Av.
Augusto de Lima, Barro Preto, Belo Horizonte, Minas Gerais, Brazil
(Ribeiro, Brant) Hospital das Clinicas, Faculdade de Medicina,
Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, Belo
Horizonte, Minas Gerais, Brazil
(Benjamin) Boston University, National Heart, Lung, and Blood Institute's
Framingham Heart Study, Framingham, MA, United States
(Benjamin) Department of Epidemiology, Boston University School of Public
Health, Boston, MA, United States
(Paasche-Orlow) General Internal Medicine, Boston University School of
Medicine, Boston, MA, United States
(Magnani) Department of Medicine, Division of Cardiology, UPMC Heart and
Vascular Institute, University of Pittsburgh, Pittsburgh, PA, United
States
Title
Health literacy and warfarin therapy at two anticoagulation clinics in
Brazil.
Source
Heart. 103 (14) (pp 1089-1095), 2017. Date of Publication: 01 Jul 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: Health literacy has been related to health-related conditions
and health outcomes. Studies examining the association of health literacy
and anticoagulation have had variable results. We sought to investigate
the relations of health literacy and percentage of time in therapeutic
range (TTR) in a vulnerable Brazilian cohort at two hospital-based
anticoagulation clinics. Methods: We measured health literacy with the
Short Assessment of Health Literacy for Portuguese-speaking Adults
(SAHLPA-18) in 2015-2016. We identified the demographic and clinical
characteristics associated with health literacy and related health
literacy to TTR. Results: We enrolled 422 adults prescribed chronic
warfarin therapy in our observational study (median age 62.1 years; 58.8%
women; monthly income $200.00). The prevalence of inadequate health
literacy (score 0-14 points) was 72.3% with a median score of 12
(quartiles, Q1=10; Q3=15) on the SAHLPA-18. The median TTR was 66.1%. In
the multivariable logistic analysis, cognitive impairment and assistance
with taking warfarin were associated with inadequate health literacy.
Prosthetic heart valves and more school years were associated with
adequate health literacy. Our analyses showed no significant relation
between health literacy and TTR, analysing health literacy as a
categorical (adjusted OR 1.05; 95% CI 0.65 to 1.70) or continuous variable
(Spearman's coefficient 0.02; p=0.70). Conclusions: Inadequate health
literacy was highly prevalent in this impoverished Brazilian cohort
receiving anticoagulation with warfarin. However, we did not identify an
association between health literacy and TTR. Future investigations may
consider the systemic factors that contribute towards successful
anticoagulation outcomes for vulnerable patient cohorts with inadequate
health literacy.<br/>Copyright &#xa9; 2017 Article author(s). All rights
reserved.

<49>
Accession Number
617018583
Author
Wasche A.; Kandulski A.; Malfertheiner P.; Riedel S.; Zardo P.; Hachenberg
T.; Schreiber J.
Institution
(Wasche, Riedel, Schreiber) Department of Pneumology, University Hospital
Magdeburg, Magdeburg, Germany
(Kandulski, Malfertheiner) Department of Gastroenterology, Hepatology and
Infectious Diseases, University Hospital Magdeburg, Magdeburg, Germany
(Zardo) Division of Cardiothoracic Surgery, University Hospital Magdeburg,
Magdeburg, Germany
(Hachenberg) Department of Anaesthesiology and Intensive Care Medicine,
University Hospital Magdeburg, Magdeburg, Germany
Title
Impact of thoracic surgery on esophageal motor function- Evaluation by
high resolution manometry.
Source
Journal of Thoracic Disease. 9 (6) (pp 1557-1564), 2017. Date of
Publication: 01 Jun 2017.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Alteration of esophageal function is a potential risk factor
for postoperative complications in thoracic surgery. This prospective
study investigates esophageal motility and function during and after
thoracic procedures via high resolution manometry (HRM) and impedance
technology with spatiotemporal representation of pressure data. Methods:
Twelve consecutive patients eligible for elective thoracic surgery
underwent preoperative and postoperative (48 hours and 7 days) esophageal
HRM. Swallowing acts were carried out with 5 mL of water, 10 mL of water
and 1 cm3 bread in physiological posture to evaluate distal contraction
integral (DCI). Length and location of contractile integrity breaks were
measured by investigators blinded to the form of surgical intervention.
The impact of surgical procedures on esophageal motility was quantified
according to current Chicago Classification (CC) criteria. Pre-, intra-
and postoperative 24-hour multi-channel impedance pH-metry (MII-pH) was
performed to further analyze gastroesophageal reflux patterns. Results:
All patients were investigated 48 hours prior to and 7 days after thoracic
procedures, with a total of n=675 swallowing acts being included in our
study. Increased motility patterns of the tubular esophagus occurred
temporally 48 hours postoperatively. DCI 48 hours after surgery increased
significantly (5 mL, P=0.049; solid, P=0.014) and returned to baseline
values after seven days (5 mL, P=0.039; solid, P=0.039). Break length was
significantly reduced 48 hours postoperatively, especially in the proximal
esophageal segment (transition zone). Follow-up measurements after another
week were comparable to preoperative baseline findings. The perioperative
MII-pH measurement showed numerous artifacts caused by intubation and
ventilation during surgery also with increasing short and frequent acidic
reflux episodes. Conclusions: Thoracic procedures cause a transient
modulation of esophageal peristalsis with postoperative increased
contractility of the tubular esophagus, presumably without affecting
intraesophageal reflex arcs. Although limited by the number of patients,
we can conclude on our data that postoperative esophageal hypomotility is
unlikely to promote secondary pulmonary complications.<br/>Copyright
&#xa9; Journal of Thoracic Disease. All rights reserved.

<50>
Accession Number
617014427
Author
Hosseini S.H.; Rafiei A.; Gaemian A.; Tirgari A.; Zakavi A.; Yazdani J.;
Bolhari J.; Golzari M.; Douki Z.E.; Vaezzadeh N.
Institution
(Hosseini) Psychiatry and Behavioral Sciences Research Center, Addiction
Institute, Mazandaran University of Medical Sciences, Sari, Iran, Islamic
Republic of
(Hosseini) Department of Psychosomatic, Imam Khomeini Hospital, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Rafiei) Molecular and Cell Biology Research Center, Faculty of medicine,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Gaemian) Department of Cardiology, Faculty of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Tirgari) Department of Psychiatry, Member of Psychiatry and Behavioral
Sciences Research Center, Sari, Iran, Islamic Republic of
(Zakavi) Department of Islamic Thought, Faculty of Medicine, Mazandaran
University of Medical Science, Sari, Iran, Islamic Republic of
(Yazdani) Department of Biostatistics, Faculty of Health, Health Sciences
Research Center, Mazandaran University of Medical Sciences, Sari, Iran,
Islamic Republic of
(Bolhari) Mental Health Research Center (MHRC), Tehran Psychiatric
Institute, Iran University of Medical Sciences (IUMS), Tehran, Iran,
Islamic Republic of
(Golzari) Faculty of Psychology and Educational Sciences, Allame Tabatabai
University, Tehran, Iran, Islamic Republic of
(Douki, Vaezzadeh) Department of Pediatric Nursing, Faculty of Nursing and
Midwifery, Mazandaran University of Medical Sciences, Sari, Iran, Islamic
Republic of
Title
Comparison of the effects of Religious Cognitive Behavioral Therapy
(RCBT), Cognitive Behavioral Therapy (CBT), and sertraline on depression
and anxiety in patients after coronary artery bypass graft surgery: Study
protocol for a randomized controlled trial.
Source
Iranian Journal of Psychiatry. 12 (3) (pp 206-213), 2017. Date of
Publication: 2017.
Publisher
Tehran University of Medical Sciences (E-mail: irjp@tums.ac.ir)
Abstract
Objective: The present study aimed at comparing the effects of Religious
Cognitive Behavioral Therapy (RCBT), Cognitive Behavioral Therapy (CBT),
and sertraline on depression, anxiety, biomarker levels, and quality of
life in patients after coronary artery bypass graft (CABG) surgery.
Method: This was a randomized controlled trial with parallel groups. A
total of 160 patients after CABG surgery will be screened for anxiety and
depression according to clinical interviews based on Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria
and Hospital Anxiety Depression Scale (HADS) scores (<= 8). To assess
religious attitude, Golriz and Baraheni's Religious Attitude questionnaire
will be used. Participants will be randomly allocated to 4 groups of 40
including 3 intervention groups (RCBT, CBT, and sertraline) and 1 control
group (usual care). RCBT and CBT programs will consist of 12 one-hour
weekly sessions. The participants in the pharmacological intervention
group will receive 25-200 mg/d of sertraline for 3 months. The Short
Form-36 Health Survey (SF-36) will be administered to assess the patients'
quality of life. Blood samples will be taken and biomarker levels will be
determined using the enzyme-linked immunosorbent assay (ELISA). The
primary outcome will be reduction in anxiety and depression scores after
the interventions. The secondary outcomes will be increase in quality of
life scores and normalized biomarker levels after the interventions.
Discussion: If RCBT is found to be more effective than the other methods;
it can be used to improve patients' health status after CABG surgery.

<51>
Accession Number
616973326
Author
Miura T.; Miyashita Y.; Motoki H.; Kobayashi H.; Kobayashi M.; Nakajima
H.; Kimura H.; Akanuma H.; Mawatari E.; Sato T.; Hotta S.; Kamiyoshi Y.;
Maruyama T.; Watanabe N.; Eizawa T.; Aso S.; Uchikawa S.; Hashizume N.;
Senda K.; Morita T.; Ebisawa S.; Izawa A.; Koyama J.; Ikeda U.
Institution
(Miura, Miyashita, Motoki, Hashizume, Ebisawa, Izawa, Koyama, Ikeda)
Department of Cardiovascular Medicine, Shinshu University School of
Medicine, 1-1-3 Asahi, Matsumoto 390-8621, Japan
(Kobayashi) Department of Cardiology, Shinshu Ueda Medical Center, Ueda,
Japan
(Kobayashi) Department of Cardiology, Matsumoto Kyoritsu Hospital,
Matsumoto, Japan
(Nakajima, Morita) Department of Cardiology, Nagano Matsushiro General
Hospital, Nagano, Japan
(Kimura) Department of Cardiology, Saku Central Hospital, Saku, Japan
(Akanuma) Department of Cardiology, Iida Municipal Hospital, Iida, Japan
(Mawatari) Department of Cardiology, Kita Alps Medical Center, Azumino,
Japan
(Sato, Maruyama) Department of Cardiology, Shinonoi General Hospital,
Nagano, Japan
(Hotta) Department of Cardiology, Ina Central Hospital, Ina, Japan
(Kamiyoshi, Aso) Department of Cardiology, Aizawa Hospital, Matsumoto,
Japan
(Watanabe) Department of Cardiology, Hokushin General Hospital, Nakano,
Japan
(Eizawa) Department of Cardiology, Komoro Kosei General Hospital, Komoro,
Japan
(Uchikawa) Department of Cardiology, Azumino Red Cross Hospital, Azumino,
Japan
(Senda) Department of Cardiology, Okaya Municipal Hospital, Okaya, Japan
Title
Comparison of mid-term outcomes between patients with and without atrial
fibrillation undergoing coronary stenting in the second-generation
drug-eluting stent era: from the SHINANO registry.
Source
Cardiovascular Intervention and Therapeutics. 32 (3) (pp 206-215), 2017.
Date of Publication: 01 Jul 2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Little is known about the mid-term outcomes of patients with atrial
fibrillation (AF) who undergo coronary stenting in the second-generation
drug-eluting stent (DES) era. We evaluated the 1-year outcomes of AF
patients undergoing percutaneous coronary intervention (PCI) with
second-generation DES. This retrospective cohort analysis used integrated
data from the SHINANO registry, a prospective observational multicenter
cohort study, which enrolled 1923 consecutive patients undergoing PCI for
any coronary artery disease. We retrospectively recruited 917 of these
patients (mean age, 71.3 +/- 10.0 years; male, 77 %) who received PCI with
2nd generation DES. The primary endpoint was net adverse clinical events
(NACE: cardiac death, stroke, MI, stent thrombosis, and major bleeding) at
1 year. The secondary endpoints were major adverse cardiovascular events
(MACE: cardiac death, stroke, and MI), stroke, MI, and major bleeding at 1
year. One-year follow-up was completed in 871 (94.9 %) patients, of whom
85 had AF. The incidence of NACE (15.4 vs. 7.3 %, P = 0.008), MACE (10.6
vs. 5.4 %, P = 0.047), and major bleeding (6.0 vs. 2.3 %, P = 0.049) were
all significantly higher in AF compared to non-AF patients. On
multivariate analysis, AF was an independent predictor of NACE (HR 2.32,
95 % CI 1.24-4.34, P = 0.008). In the second-generation DES era, patients
with AF undergoing PCI still have a poorer prognosis, with more thrombotic
and bleeding events, than those without AF. More attention should be paid
to the thrombotic and bleeding risk in AF patients undergoing
PCI.<br/>Copyright &#xa9; 2016, Japanese Association of Cardiovascular
Intervention and Therapeutics.

<52>
Accession Number
617056265
Author
Bai A.D.; Agarwal A.; Steinberg M.; Showler A.; Burry L.; Tomlinson G.A.;
Bell C.M.; Morris A.M.
Institution
(Bai) Department of Medicine, Queen's University, Kingston, Ontario,
Canada
(Agarwal) Faculty of Medicine, University of Toronto, Toronto, Ontario,
Canada
(Agarwal) Department of Clinical Epidemiology and Biostatistics, McMaster
University, Hamilton, Ontario, Canada
(Steinberg, Burry, Bell, Morris) Sinai Health System, Toronto, Ontario,
Canada
(Showler, Tomlinson, Bell, Morris) Department of Medicine, University of
Toronto, Toronto, Ontario, Canada
(Burry) Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto,
Ontario, Canada
(Tomlinson, Bell, Morris) University Health Network, Toronto, Ontario,
Canada
(Bell) Institute for Clinical Evaluative Sciences, Toronto, Ontario,
Canada
Title
Clinical predictors and clinical prediction rules to estimate initial
patient risk for infective endocarditis in Staphylococcus aureus
bacteraemia: A systematic review and meta-analysis.
Source
Clinical Microbiology and Infection. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier B.V. (E-mail: customerservices@oxonblackwellpublishing.com)
Abstract
Objectives: We conducted a meta-analysis to summarize diagnostic
properties of risk factors and clinical prediction rules for diagnosing
infective endocarditis (IE) in Staphylococcus aureus bacteraemia (SAB).
Methods: We searched MEDLINE, Embase, and the Cochrane Database from
inception to 6 January 2016 to identify studies evaluating risk factors
and clinical prediction rules for IE in SAB patients. Pooled estimates of
diagnostic properties for main risk factors were calculated using a
bivariate random effects model. Results: Of 962 articles identified, 30
studies were included. These involved 16 538 SAB patients including 1572
IE cases. Risk factors with positive likelihood ratio (PLR) greater than 5
included embolic events (PLR 12.7, 95% CI 9.2-17.7), pacemakers (PLR 9.7,
95% CI 3.7-21.2), history of previous IE (PLR 8.2, 95% CI 3.1-22.0),
prosthetic valves (PLR 5.7, 95% CI 3.2-9.5), and intravenous drug use (PLR
5.2, 95% CI 3.8-6.9). The only clinical factor with negative likelihood
ratio (NLR) less than 0.5 was documented clearance of bacteraemia within
72 hours (NLR range 0.32-0.35). Of the nine published clinical prediction
rules for ruling out IE, five had an NLR below 0.1. Conclusions: SAB
patients with high-risk features (embolic events, pacemakers, prosthetic
valves, previous IE, or intravenous drug use) should undergo a
trans-esophageal echocardiography (TEE) for IE. Clinical prediction rules
show promise in safely ruling out endocarditis, but require validation in
future studies.<br/>Copyright &#xa9; 2017 European Society of Clinical
Microbiology and Infectious Diseases.

<53>
Accession Number
617044344
Author
Kowalewski M.; Raffa G.M.; Szwed K.A.; Anisimowicz L.
Institution
(Kowalewski, Anisimowicz) Department of Cardiac Surgery, Dr Antoni Jurasz
Memorial University Hospital, Bydgoszcz, Poland
(Kowalewski) Department of Hygiene, Epidemiology and Ergonomics, Division
of Ergonomics and Physical Effort, Collegium Medicum UMK, Bydgoszcz,
Poland
(Szwed) Department of Clinical Neuropsychology, Collegium Medicum UMK,
Bydgoszcz, Poland
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo
per I Trapianti e Terapie ad alta specializzazione), Palermo, Italy
Title
Meta-analysis to assess the effectiveness of topically used vancomycin in
reducing sternal wound infections after cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)

<54>
Accession Number
617024692
Author
Omar H.R.; Charnigo R.; Guglin M.
Institution
(Omar) Internal Medicine Department, Mercy Medical Center, Clinton, Iowa
(Guglin) Division of Cardiovascular Medicine, Linda and Jack Gill Heart
Institute, University of Kentucky, Lexington, Kentucky
(Charnigo) Department of Biostatistics, University of Kentucky, Lexington,
Kentucky
Title
Prognostic Significance of Discharge Hyponatremia in Heart Failure
Patients With Normal Admission Sodium (from the ESCAPE Trial).
Source
American Journal of Cardiology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Hyponatremia in acute decompensated heart failure (HF) is indicative of a
poor prognosis and predicts morbidity and mortality. We explored the
predictive utility of hyponatremia at the time of hospital discharge among
HF patients with normal admission sodium (Na). Characteristics and
outcomes of HF patients enrolled in the Evaluation Study of Congestive
Heart Failure and Pulmonary Artery Catheterization Effectiveness trial,
who had normal Na on admission, were compared between those who were
hyponatremic (Na <135 meq/L) or normonatremic on discharge. Three hundred
six patients with normal admission Na had either hyponatremia (n = 86) or
normal Na (n = 220) on discharge. Compared with patients with normal Na on
discharge, hyponatremic patients were younger (p = 0.004), with lower
discharge systolic (p <0.001) and diastolic (p = 0.004) blood pressure,
higher discharge blood urea nitrogen (p = 0.011) despite similar
creatinine (p = 0.566), lower ejection fraction (p = 0.007), and higher
left ventricular end-diastolic (p = 0.028) and end-systolic (p = 0.007)
dimensions. Despite comparable congestion on hospital admission, patients
with discharge hyponatremia had a higher degree of decongestion throughout
hospitalization evident in the significantly greater admission to
discharge weight loss (p = 0.044) and admission to discharge reduction in
inferior vena cava diameter (p = 0.014). Despite longer initial
hospitalization (p = 0.004), total duration in hospital at 30 days (p =
0.004) and 6 months (p = 0.045), there were no significant differences
between patients with discharge hyponatremia versus normal Na on discharge
regarding rehospitalization (p = 0.386), all-cause mortality (p = 0.440),
and composite of death, cardiac rehospitalization, and cardiac transplant
(p = 0.799), all up to 6-month following randomization. Restricted cubic
spline analysis also showed no significant relationships between discharge
Na and the aforementioned 3 outcomes. Cox proportional hazards regressions
showed that discharge hyponatremia did not significantly predict any of
the 3 outcomes after adjustment for imbalances at baseline. Among patients
with discharge hyponatremia, a poor outcome was more likely if they were
also hyponatremic on admission: the composite end point occurred in 69.2%
of those also hyponatremic on admission versus 51.2% of those with normal
Na on admission but decreased Na on discharge (p = 0.045). Because the
median discharge Na level in the discharge hyponatremia group was 132
meq/L, our findings suggest a benign nature of mild discharge hyponatremia
in HF patients with normal admission Na.<br/>Copyright &#xa9; 2017
Elsevier Inc.

<55>
Accession Number
617023983
Author
Busch C.; Pfitzer C.; Raschzok S.; Miera O.; Berger F.; Schmitt K.R.
Institution
(Busch, Pfitzer, Raschzok, Miera, Berger, Schmitt) Department of Pediatric
Cardiology, Deutsches Herzzentrum Berlin, Germany
(Pfitzer) Berlin Institute of Health (BIH), Berlin, Germany
(Berger) Department of Pediatric Cardiology, Charite -
Universitaetsmedizin Berlin, Germany
(Berger) DZHK (German Centre for Cardiovascular Research), partner site
Berlin, Germany
Title
Clinical outcome and inflammatory response after transfusion of washed and
unwashed red blood cells in children following cardiovascular surgery.
Source
Progress in Pediatric Cardiology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Children frequently require red blood cell transfusion after cardiac
surgery, which can generate an inflammatory response that is associated
with increased morbidity and mortality. The aim of this study was to
evaluate the inflammatory response and clinical effect of RBC transfusion
in children.In a pediatric prospective controlled clinical trial 48
children were randomized to an unwashed or washed red blood cell
transfusion group after cardiac surgery. Red blood cells were washed using
an auto transfusion device with blood gas analyses of the packed red blood
cells performed before transfusion. Vital parameters, blood analyses, and
plasma concentrations of cytokines were measured before and 24. h after
transfusion.Forty-five children were included with 23 receiving unwashed
and 22 washed red blood cells. Washing reduced hemoglobin, potassium, and
glucose while increasing sodium concentration in the packed red blood
cells. Increased levels of hemoglobin, hematocrit, and erythrocyte counts
were observed in both groups after transfusion. Increased levels of
cytokine expression (IL-1alpha, IL-6, IL-8, MCP-1, and TARC) were detected
in the group receiving unwashed red blood cells, while IL-8 levels were
reduced in patients receiving washed red blood cells. Also, the percentage
increase of cytokine concentrations (IL-6, IL-8, MCP-1, and GP-VI) before
in comparison to after transfusion was lower in patients receiving washed
red blood cells.No significant differences in clinical outcome parameters
were observed between the two groups.Transfusion of red blood cells
induces a pro-inflammatory reaction which can be diminished by washing the
red blood cells before transfusion. Further clinical trials with larger
patient cohorts receiving multiple transfusions are needed to better
evaluate the clinical outcome.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<56>
Accession Number
614261496
Author
Siegal D.M.; Savage W.J.
Institution
(Siegal, Savage) Division of Hematology and Thromboembolism, McMaster
University, 50 Charlton Avenue East, Hamilton, ON L8N 4A6, Canada
(Siegal, Savage) Brigham and Women's Hospital and Harvard Medical School,
Boston, MA, United States
Title
Plasma versus prothrombin complex concentrate for warfarin-associated
major bleeding: A systematic review.
Source
2015 (1) (pp 448-453), 2015. Date of Publication: 05 Dec 2015.
Publisher
Bulgarian Medical Society of Hematology

<57>
Accession Number
616987308
Author
Sergiou A.; Haghollahi S.; Shantikumar S.
Institution
(Sergiou, Haghollahi) Warwick Medical School, University of Warwick,
Coventry, United Kingdom
(Shantikumar) Department of Health Sciences, University of Leicester,
Leicester, United Kingdom
Title
Circulating biomarkers for diagnosing acute kidney injury after paediatric
cardiac surgery: A systematic review and meta-analysis.
Source
Archives of Disease in Childhood. Conference: Annual Conference of the
Royal College of Paediatrics and Child Health, RCPCH 2017. United Kingdom.
102 (pp A177-A178), 2017. Date of Publication: May 2017.
Publisher
BMJ Publishing Group
Abstract
Background 30%-40% of post-cardiac surgery patients develop acute kidney
injury (AKI). AKI diagnosis uses raised serum creatinine levels which can
take several days to rise. Aim To systematically review the diagnostic
value of novel blood biomarkers of AKI in children post-cardiac surgery,
and identify those worthy of future research and inclusion into clinical
practise. Method Medline, EMBASE, CENTRAL and Web of Science were searched
in October 2016 using the search strategy: AKI, cardiac surgery and
biomarker. Two independent reviewers assessed the eligibility of the
reports in Endnote based on predefined inclusion criteria (novel
biomarker, clear definition of AKI, cardiac surgery in children [<18
year]) and exclusion criteria (no plasma/serum biomarker studied, no
patients without AKI, non-English reports) at title, abstract and full
paper screening stages. Eligible papers had data extracted into a
custom-designed Excel spreadsheet and risk of bias was assessed using the
Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. When
possible meta-analysis was performed using MedCalc v16 where reports
(n>=3) on the same biomarker had an AUROC and 95% CI or standard error.
Results Of 3898 independent reports found, 21 met the inclusion criteria.
2 biomarkers had enough reports (n>=3) to warrant independent comparison;
Cystatin C [n=7] and plasma neutrophil gelatinase-associated lipocalin
(pNGAL) [n=7]. Cystatin C had enough data to perform a meta-analysis
([n=5]; pooled AUROC=0.79 [95% CI: 0.73-0.85); I2=55%). pNGAL had
conflicting evidence for its efficacy (AUROC range: 0.45-0.95). All other
reported biomarkers showed varied performance, notably a combination of
urine NGAL+Cystatin C showed good discrimination (AUROC=0.90). QUADAS
analysis showed low risk of bias in all studies (score >8) as well as
uncertainty bias due to lack of reporting on examiner blinding and
participant withdrawals. Conclusion Cystatin C may be a useful early
diagnostic marker of AKI yet there is currently insufficient research for
using any novel biomarker of AKI diagnosis after paediatric cardiac
surgery. Large, multicentre studies with homogenous methodology should be
undertaken to address this and to identify how they evaluate patient
outcomes.

<58>
Accession Number
616987283
Author
Haghollahi S.; Sergiou A.; Shantikumar S.
Institution
(Haghollahi, Sergiou) Warwick Medical School, University of Warwick,
Coventry, United Kingdom
(Shantikumar) Department of Health Sciences, University of Leicester,
Leicester, United Kingdom
Title
Novel urinary biomarkers for the diagnosis of cardiac surgery-associated
acute kidney injury in paediatric patients: A systematic review and
meta-analysis.
Source
Archives of Disease in Childhood. Conference: Annual Conference of the
Royal College of Paediatrics and Child Health, RCPCH 2017. United Kingdom.
102 (pp A176-A177), 2017. Date of Publication: May 2017.
Publisher
BMJ Publishing Group
Abstract
Aim There is a high incidence of acute kidney injury (AKI) after cardiac
surgery in children, which is associated with significant morbidity and
mortality. Serum creatinine (sCr), currently used as an indicator of renal
function, only responds to significant kidney injury and following a time
delay, resulting in missed and late diagnoses of AKI post-cardiac surgery.
Novel biomarkers may provide a more sensitive and timely diagnosis of AKI.
The aim of this study was to systematically review the diagnostic value of
novel urinary biomarkers of AKI in children undergoing cardiac surgery.
Methods The databases Medline, EMBASE, Cochrane CENTRAL and Web of Science
were systematically searched for studies assessing the diagnostic value of
any non-creatinine biomarker in identifying AKI in children (<18 years)
undergoing any form of cardiac surgery. Screening for eligibility was
performed independently by two authors. Random effects meta-analyses were
performed where at least three separate studies reported an area under the
receiver operator characteristics curve (AUROC) with a 95% confidence
interval (CI) or standard error, for a single biomarker. Results
Twenty-five citations were included in the final review. Neutrophil
gelatinase-associated lipocalin (NGAL) and interleukin-18 (IL-18) were the
most frequently studied biomarkers, and were the only ones with sufficient
data for a meta-analysis. A summary of the pooled AUROC values (with 95%
CI) and study heterogeneity (I2) for NGAL, NGAL corrected for urine
creatinine (NGAL-uCr) and IL-18 are summarised in the table. There was
significant clinical and methodological heterogeneity between included
studies, as evidenced by the high I2 values. (Table Presented) Many other
biomarkers were only reported in a single, or a few, studies which meant
there were insufficient for a meta-analysis. These displayed a wide range
of diagnostic utility. Conclusion NGAL, NGAL-uCr and IL-18 are modest
discriminators of AKI when measured within 24 hours of surgery, although
other biomarkers (such as KIM-1 and L-FABP) are promising candidates for
further research. Larger studies are required to determine biomarker
diagnostic/prognostic performance in predicting AKI, and its
complications, in children after cardiac surgery.

<59>
Accession Number
616987863
Author
Weimar C.; Bilbilis K.; Rekowski J.; Beyersdorf F.; Breuer M.; Dahm M.;
Diegeler A.; Kowalski A.; Martens S.; Mohr F.W.; Ondrasek J.; Reiter B.;
Roth P.; Seipelt R.; Siggelkow M.; Steinhoff G.; Stock U.; Wilhelmi M.;
Wimmer-Greinecker G.; Knipp S.
Institution
(Weimar) Klinik fur Neurologie, Universitatsklinikum Essen, Essen, Germany
(Bilbilis) Universitatsklinikum Essen, Zentrum fur Klinische Studien
(ZKSE), Essen, Germany
(Rekowski) Institut fur Medizinische Informatik Biometrie und
Epidemiologie (IMIBE), Universitatsklinikum Essen, Essen, Germany
(Beyersdorf) Klinik fur Herz- und Gefaschirurgie, Universitats-Herzzentrum
Freiburg-Bad Krozingen, Freiburg, Germany
(Breuer) Klinik fur Herz- und Thoraxchirurgie, Universitats-Herzzentrum
Thuringen, Jena, Germany
(Dahm) Westpfalz-Klinikum, Klinik fur Thorax-, Herz- und Gefaschirurgie,
Kaiserslautern, Germany
(Diegeler) Herz- und Gefasklinik Bad Neustadt/Saale, Klinik fur
Kardiochirurgie, Bad Neustadt an der Saale, Germany
(Kowalski, Siggelkow) Klinik fur Herz- und Gefaschirurgie,
Universitatsklinikum Schleswig-Holstein, Kiel, Germany
(Martens) Klinik fur Herzchirurgie, Universitatsklinikum Munster, Munster,
Germany
(Mohr) Klinik fur Herzchirurgie, HELIOS Herzzentrum Leipzig, Leipzig,
Germany
(Ondrasek) Centrum Kardiovaskularni A Transplantacni Chirurgie, Center of
Cardiovascular Surgery and Transplantations, Brno, Czech Republic
(Reiter) Klinik und Poliklinik fur Herz-und Gefaschirurgie, Universitares
Herzzentrum Hamburg, Hamburg, Germany
(Roth) Universitatsklinikum Giesen und Marburg, Herz-, Kinderherz- und
Gefaschirurgie, Giessen, Germany
(Seipelt) Universitatsmedizin Gottingen, Abteilung fur Thorax-,Herz und
Gefaschirurgie, Gottingen, Germany
(Steinhoff) Klinik und Poliklinik fur Herzchirurgie, Universitat Rostock,
Rostock, Germany
(Stock) Klinik fur Thorax-,Herz- und Thorakale Gefaschirurgie, Johann
Wolfgang-Goethe-Universitat, Frankfurt, Germany
(Wilhelmi) Klinik fur Herz-, Thorax-, Transplantations- und
Gefaschirurgie, Medizinische Hochschule Hannover, Hannover, Germany
(Wimmer-Greinecker) Klinik fur Herz-Thorax-Chirurgie, Herz- und
Gefaszentrum Bad Bevensen, Bad Bevensen, Germany
(Knipp) Klinik fur Thorax und Kardiovaskulare Chirurgie,
Universitatsklinikum Essen, Essen, Germany
Title
A randomized comparison of synchronous CABG and carotid endarterectomy vs
isolated cabg in patients with asymptomatic high-grade carotid stenosis:
The cabacs trial.
Source
European Stroke Journal. Conference: 2nd European Stroke Organisation
Conference, ESOC 2016. Spain. 1 (1 Supplement 1) (pp 718-719), 2016. Date
of Publication: May 2016.
Publisher
SAGE Publications Ltd
Abstract
Background Rationale: Patients with asymptomatic high-grade carotid artery
stenosis undergoing coronary artery bypass graft (CABG) surgery are at
high risk of perioperative stroke or death. The benefit of synchronous
carotid endarterect-omy (CEA) in these patients remains controversial. We
therefore compared the safety and efficacy of isolated CABG versus
synchronous CABG and CEA in patients with asymptomatic high-grade carotid
artery stenosis. Methods Design: This was an investigator-initiated,
randomized, controlled, open, multicenter, group sequential trial with 2
parallel arms and outcome adjudication by blinded observers. Patients with
asymptomatic carotid artery stenosis >70% according to NASCET criteria
scheduled for elective CABG were randomly assigned to either isolated CABG
or synchronous CABG and CEA. The composite primary efficacy endpoint was
the number of strokes and deaths from any cause within 30 days after
operation. Results Results: After inclusion of 129 patients, the trial was
terminated early due to lack of funding. Mean age was 69.5 years and 17%
were women. In the intention-to-treat ana-lysis, the primary endpoint was
reached by 12/65 patients in the combined arm (CEA + CABG) and by 6/62
patients in the isolated arm (CABG only) (rate difference 0.0921,
confidence interval -0.0303, 0.2145). Ten perioperative strokes occurred
in the combined arm and 4 in the isolated arm. After 1 year, any stroke or
vascular death had occurred in 14 patients in the combined arm and 7 in
the isolated arm. Conclusions: Discussion: Although the primary endpoint
was not significant due to early termination of the trial, the high rate
of perioperative stroke in the combined arm does not seem to justify a
combined CEA and CABG intervention in these patients.

<60>
Accession Number
616876010
Author
Fujihara N.; Lark M.E.; Fujihara Y.; Chung K.C.
Institution
(Fujihara, Fujihara) International Research Fellow, Plastic Surgery
Section, University of Michigan, Ann Arbor, MI, United States
(Fujihara, Fujihara) Department of Hand Surgery, Nagoya University,
Nagoya, Japan
(Lark) Research Associate, University of Michigan Medical School, Ann
Arbor, MI, United States
(Chung) Professor of Surgery, Department of Surgery, Section of Plastic
Surgery, Assistant Dean for Faculty Affairs, University of Michigan
Medical School, Ann Arbor, MI, United States
Title
The effect of economic downturn on the volume of surgical procedures: A
systematic review.
Source
International Journal of Surgery. 44 (pp 56-63), 2017. Date of
Publication: August 2017.
Publisher
Elsevier Ltd
Abstract
Background Economic downturn can have a wide range of effects on medicine
at both individual and national levels. We aim to describe these effects
in relation to surgical volume to guide future planning for physician
specialization, patient expectations in the face of economic crises, or
estimating healthcare expenditure. We hypothesized that because of high
out-of-pocket costs, cosmetic procedure volumes would be most affected by
economic decline. Methods A systematic review was conducted using MEDLINE,
Embase, and ABI/INFORMS. The main search terms were "economic recession"
and "surgical procedures, operative". Studies were included if surgical
volumes were measured and economic indicators were used as predictors of
economic conditions. Results Twelve studies were included, and the most
common subject was cosmetic (n = 5), followed by orthopedic (n = 2) and
cardiac surgeries (n = 2). The majority of studies found that in periods
of economic downturn, surgical volume decreased. Among the eight studies
using Pearson's correlation analysis, there were no significant
differences between cosmetic procedures and other elective procedures,
indicating that cosmetic procedures may display trends similar to those of
non-cosmetic elective procedures in periods of economic downturn.
Conclusions Surgical volume generally decreased when economic indicators
declined, observed for both elective and non-elective surgery fields.
However, a few specific procedure volumes such as vasectomy and caesarean
section for male babies increased during the economic downturn. Knowledge
of these trends can be useful for future surgical planning and
distribution of healthcare resources.<br/>Copyright &#xa9; 2017 IJS
Publishing Group Ltd

<61>
Accession Number
616557551
Author
Ad N.; Holmes S.D.; Rongione A.J.; Massimiano P.S.; Fornaresio L.M.
Institution
(Ad, Holmes, Fornaresio) Department of Cardiovascular and Thoracic
Surgery, West Virginia University, Morgantown, West Virginia, United
States
(Rongione, Massimiano) Section of Cardiac Surgery, Washington Adventist
Hospital, Takoma Park, Maryland, United States
Title
Does Surgical Ablation Energy Source Affect Long-Term Success of the
Concomitant Cox Maze Procedure?.
Source
Annals of Thoracic Surgery. 104 (1) (pp 29-35), 2017. Date of Publication:
July 2017.
Publisher
Elsevier USA
Abstract
Background The Cox maze (CM) procedure is routinely performed using
surgical ablation technology. Reports are scarce on long-term outcomes of
CM, especially for a large series of patients. This study examined the
potential impact of surgical ablation energy source on safety and
long-term efficacy of concomitant CM procedures. Methods The study sample
consisted of 709 concomitant CM-treated patients operated on with
cryothermal energy only (group 1; n = 386) or combination of cryothermal
and bipolar radiofrequency (group 2; n = 323). Data were collected
prospectively on perioperative outcomes, rhythm status, survival, and
clinical events. Propensity score matching conducted by energy source
resulted in 298 patients per group. Results Perioperative outcomes
included stroke (n = 4), reoperation for bleeding (n = 23), renal failure
requiring temporary dialysis (n = 18), readmissions before 30 days (n =
86), and operative death before 30 days (n = 16; ratio of observed to
expected mortality [O/E ratio], 0.50). Independent predictors for 1-year
and 5-year rhythm success were a shorter history of atrial fibrillation
(1-year odds ratio [OR], 0.93, p = 0.001; 5-year OR, 0.93, p = 0.042) and
cryothermia alone (1-year OR=1.77, p = 0.020; 5-year OR = 2.29, p =
0.009). After matching, group 1 had significantly higher sinus rhythm
without antiarrhythmic drugs at 6 months (79% vs 70%; p = 0.016), 36
months (81% vs 69%; p = 0.010), and 60 months (75% vs 57%; p = 0.008).
Stroke incidence was lower for group 1 (0.7% vs 3%; p = 0.033), with no
difference in major bleeding (10% vs 11%; p = 0.597). Groups had similar
survival rates (log rank, 0.6; p = 0.452). Conclusions Concomitant CM
procedures performed with cryothermal energy alone or combined with
bipolar radiofrequency ablation are safe and exceedingly effective. The
association of cryothermal energy alone with higher rates of sinus rhythm
and stroke reduction should be investigated further.<br/>Copyright &#xa9;
2017 The Society of Thoracic Surgeons

<62>
Accession Number
616720001
Author
Costa M.
Institution
(Costa) Membro do Corpo Redatorial da Revista Portuguesa de Cardiologia,
Portugal
Title
Comment on "Evolocumab and Clinical Outcomes in Patients with
Cardiovascular Disease".
Source
Revista Portuguesa de Cardiologia. 36 (6) (pp 485-486), 2017. Date of
Publication: June 2017.
Publisher
Sociedade Portuguesa de Cardiologia (E-mail: secretariado@mail.spc.pt)

<63>
Accession Number
614130504
Author
Racca V.; Bordoni B.; Castiglioni P.; Modica M.; Ferratini M.
Institution
(Racca, Bordoni, Modica, Ferratini) Cardiology Rehabilitation Center,
Santa Maria Nascente Institute-IRCCS, Don C. Gnocchi Foundation, Milan,
Italy
(Castiglioni) Biomedical Technology Department, Santa Maria Nascente
Institute-IRCCS, Don C. Gnocchi Foundation, Milan, Italy
Title
Osteopathic Manipulative Treatment Improves Heart Surgery Outcomes: A
Randomized Controlled Trial.
Source
Annals of Thoracic Surgery. 104 (1) (pp 145-152), 2017. Date of
Publication: July 2017.
Publisher
Elsevier USA
Abstract
Background Controlling sternal pain after heart surgery is important to
reduce the risk of postoperative complications, but pain is often
undertreated because of contraindications and side effects of analgesic
drugs. Recently, osteopathic manipulative treatment (OMT) was demonstrated
to reduce pain in different clinical contexts, suggesting its potential
utility after cardiac surgery. The aim of this open-label, controlled
study is to assess whether OMT contributes to sternal pain relief and
improves postoperative outcomes. Methods Eighty post-sternotomy adult
inpatients were randomly allocated one to one to receive a standardized
cardiorespiratory rehabilitation program alone (control group) or combined
with OMT. Pain intensity and respiratory functional capacity were
quantified by the Visual Analogue Scale score and by a standardized
breathing test, at the start and end of rehabilitation. Results At the
start of rehabilitation, the control group and the OMT group had similar
Visual Analogue Scale median scores (controls 4, interquartile range
[IQR]: 2 to 5; OMT 4, IQR: 3 to 5; p = not significant) and mean
inspiratory volumes (controls 825 +/- 381 mL; OMT 744 +/- 291 mL; p = not
significant). At the end of rehabilitation, the OMT group had a lower
Visual Analogue Scale median score (controls 3, IQR: 2 to 4; OMT 1, IQR: 1
to 2; p < 0.01) and higher mean inspiratory volume (controls 1,400 +/- 588
mL; OMT 1,781 +/- 633 mL; p < 0.01). The analgesic drug intake was similar
in the two groups. The hospitalization was shorter in the OMT group than
in the control group (19.1 +/- 4.8 versus 21.7 +/- 6.3 days; p < 0.05).
Conclusions The combination of standard care with OMT is effective in
inducing pain relief and functional recovery, and significantly improves
the management of patients after heart surgery with
sternotomy.<br/>Copyright &#xa9; 2017 The Society of Thoracic Surgeons

<64>
Accession Number
615281695
Author
Faraoni D.; Van Der Linden P.
Institution
(Faraoni) Department of Anesthesiology, Centre Hospitalier Universitaire
(CHU) Brugmann - Queen Fabiola Children's University Hospital (QFCUH),
Brussels, Belgium -
Title
A systematic review of antifibrinolytics and massive injury.
Source
Minerva anestesiologica. 80 (10) (pp 1115-1122), 2014. Date of
Publication: 01 Oct 2014.
Abstract
Every year, more than a million people die as a result of trauma. This
huge mortality could be partially explained by the development of an acute
traumatic coagulopathy, present in a large part of all major trauma
patients, soon after injury, which contributes to ongoing hemorrhage. The
coagulopathy induced by trauma is independently associated with mortality,
increased transfusion requirements, multiple organ dysfunction,
infections, increased intensive care unit (ICU) length of stay, and costs.
The pathophysiological mechanisms implicated in this acute traumatic
coagulopathy are complexes and lead to generate a vicious circle leading
to the activation of different pathways: thrombin generation, plasmin
generation, inflammation activation. All of these processes will impair
the balance between clot formation and clot lysis, with an increased
tendency of hyperfibrinolysis. In 2010, the CRASH-2 trial demonstrated
that tranexamic acid (TXA) administration was associated with a reduction
in all cause mortality (14.5% vs. 16%, P=0.0035), including the risk of
death due to bleeding (4.9% vs. 5.8%, P=0.0077), without an increase in
fatal or non-fatal vascular occlusive events. Finally, the CRASH-3 trial
is now recruiting patients with traumatic brain injury without
extracranial bleeding. This study aims at determining the safety and
efficacy of TXA administration in this particular setting. Our experience
from the cardiac surgery setting highlighted a dose-dependent increased
seizure incidence associated with the administration of TXA. For this
reason, further studies are needed to better define the "optimal" dose
scheme based on pharmacokinetic and pharmacodynamic studies.

<65>
Accession Number
615282880
Author
Haas T.; Gorlinger K.; Grassetto A.; Agostini V.; Simioni P.; Nardi G.;
Ranucci M.
Institution
(Haas) Department of Paediatric Anaesthesia, University Children's
Hospital Zurich, Zurich, Switzerland -
Title
Thromboelastometry for guiding bleeding management of the critically ill
patient: a systematic review of the literature.
Source
Minerva anestesiologica. 80 (12) (pp 1320-1335), 2014. Date of
Publication: 01 Dec 2014.
Abstract
A systematic review of the published literature clearly demonstrates the
usefulness of thromboelastometry (ROTEM) in detecting coagulation
disorders in severe trauma, cardiac and aortic surgery, liver
transplantation, and postpartum haemorrhage reliably and within a
clinically acceptable turn-around time. In all of the above-mentioned
scenarios, the transfusion of any allogeneic blood products could be
reduced significantly using ROTEM-guided bleeding management, thereby
minimising or avoiding transfusion-related side effects. Based on the
current body of evidence as assessed by the GRADE system, the use of ROTEM
may be recommended in particular for management of severe bleeding after
trauma and during cardiac and aortic surgery. However, as laboratory
testing contributes only one part of severe bleeding management, the
implementation of safe and effective treatment algorithms must be ensured
at the same time.

<66>
Accession Number
617003265
Author
Wang J.; Shu C.; Wu Z.; Zhao J.; Ma Y.; Huang B.; Yuan D.; Yang Y.; Bian
H.; He Y.; Wang Z.
Institution
(Wang) *West China School of Medicine, West China Hospital, Sichuan
University, Chengdu, Sichuan Province, China +Department of Vascular
Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan
Province, China ++Department of Statistics, Population Health Research
Institute, McMaster University, Hamilton, Ontario, Canada Institute of
Genetics and Molecular Medicine, Western General Hospital, University of
Edinburgh, Edinburgh, UK PDepartment of Gastrointestinal Surgery, West
China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
Title
Percutaneous Vascular Interventions Versus Bypass Surgeries in Patients
With Critical Limb Ischemia: A Comprehensive Meta-analysis.
Source
Annals of Surgery. (no pagination), 2017. Date of Publication: 26 Jun
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
OBJECTIVE:: The aim of our study was to compare percutaneous vascular
interventions (PVI) versus bypass surgeries (BSX) in patients with
critical limb ischemia (CLI). BACKGROUND:: Previous relevant reviews with
limited numbers of included studies did not strictly confine the inclusion
criteria to CLI, also involving patients with severe claudication, which
may introduce bias in the decision-making of CLI revascularization.
Current treatment strategies for CLI still remain controversial. METHODS::
We performed a meta-analysis of all available randomized controlled trials
and observational clinical studies comparing PVI with BSX in CLI patients.
Primary endpoints included overall survival, amputation-free survival,
30-day mortality, and major adverse cardiovascular and cerebrovascular
events. RESULTS:: We identified 45 cohorts and 1 RCT in over 20,903
patients. In overall population, PVI reduced the risks of 30-day mortality
[odds ratio (OR) 0.69, 95% confidence interval (CI) 0.51-0.95), major
adverse cardiovascular and cerebrovascular events (OR 0.42, 95% CI
0.29-0.61), and surgical site infection (OR 0.31, 95% CI 0.19-0.51), but
increased the risks of long-term all-cause mortality [hazard ratio (HR)
1.16, 95% CI 1.05-1.27) and primary patency failure (HR 1.31, 95% CI
1.08-1.58). When compared with autogenous BSX, PVI was also associated
with additional increased risks of long-term death or amputation (HR 1.41,
95% CI 1.02-1.94) and secondary patency failure (HR 1.51, 95% CI
1.17-1.95). In patients with infrapopliteal lesions, we found PVI had
inferior primary patency (HR 1.39, 95% CI 1.10-1.75) compared with BSX.
CONCLUSION:: For patients in good physical condition with long
life-expectancy, BSX may represent a better choice compared with PVI,
particularly when autogenous bypass is available. While enhanced
perioperative care for cardiovascular events and surgical site should be
considered in patients underwent BSX to achieve comparable short-term
outcomes provided by PVI.<br/>Copyright &#xa9; 2017 Wolters Kluwer Health,
Inc. All rights reserved.

<67>
Accession Number
616999765
Author
Sun Y.; Liu X.; Chen Z.; Fan J.; Jiang J.; He Y.; Zhu Q.; Hu P.; Wang L.;
Xu Q.; Lin X.; Wang J.
Institution
(Sun, Liu, Fan, Jiang, He, Zhu, Hu, Wang, Xu, Lin, Wang) Department of
Cardiology, Second Affiliated Hospital, Zhejiang University School of
Medicine, Hangzhou, People's Republic of China
(Chen) Department of Clinical Epidemiology and Biostatistics, Second
Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou,
People's Republic of China
Title
Meta-analysis of Predictors of Early Severe Bleeding in Patients Who
Underwent Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Severe bleeding (SB) in patients who underwent transcatheter aortic valve
implantation (TAVI) could be fatal. Although multiple independent
predictors of bleeding post-TAVI have been identified, the definitions of
bleeding and predictors vary across studies. This study aimed to provide
summary effect estimates for predictors of SB within 30 days post-TAVI. A
systematic review of studies that reported the incidence of bleeding
post-TAVI with raw data for predictors of interest was performed. Data on
characteristics of study, patient, and procedure were extracted. Crude
risk ratios (RRs) and 95% confidence intervals were calculated using
random-effect model. Fifteen predictors on 65,209 patients from 47 studies
were analyzed. The median rate of SB was 11% across studies. Seven factors
(3 patient related and 4 procedure related) were recognized as predictors
of early SB post-TAVI. Age >=90 years (RR 1.17; p = 0.008), female (RR
1.13; p = 0.01), and sheath diameter >19 Fr (RR 1.19; p = 0.04) were weak
predictors. Chronic kidney disease (RR 1.94; p <0.001) and transapical
(TA) (RR 1.82; p <0.001) were moderate predictors that were almost
associated with twofold risk. Vascular complication (RR 2.97; p <0.001)
and circulatory support (RR 3.39; p <0.001) were strong predictors that
were nearly associated with threefold risk. In conclusion, age, gender,
chronic kidney disease, TA, sheath diameter, vascular complication, and
circulatory support were all predictors of early SB post-TAVI in this
meta-analysis, which provided possible guidance for prevention and
management of SB related to TAVI.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<68>
Accession Number
616967399
Author
Koga M.; Iguchi Y.; Ohara T.; Tahara Y.; Inoue Y.; Fukuda T.; Kajimoto K.;
Sakamoto Y.; Makita N.; Matsubara S.; Toyoda K.
Institution
(Koga) National Cerebral and Cardiovascular Center, Suita-Osaka, Japan
(Iguchi) Jikei University School of Medicine, Department of Neurology,
Tokyo, Japan
(Ohara) Kyoto Prefectural University of Medicine, Department of Neurology,
Kyoto, Japan
(Tahara) National Cerebral and Cardiovascular Center, Department of
Cardiovascular Medicine, Suita-Osaka, Japan
(Inoue) National Cerebral and Cardiovascular Center, Department of
Cardiovascular Surgery, Suita-Osaka, Japan
(Fukuda) National Cerebral and Cardiovascular Center, Department of
Radiology, Suita-Osaka, Japan
(Kajimoto) National Cerebral and Cardiovascular Center, Department of
Neurology, Suita-Osaka, Japan
(Sakamoto) Nippon Medical School Hospital, Department of Neurological
Science, Tokyo, Japan
(Makita, Matsubara, Toyoda) National Cerebral and Cardiovascular Center,
Department of Cerebrovascular Medicine, Suita-Osaka, Japan
Title
Nationwide survey of ischemic stroke caused by stanford type a aortic
dissection in Japan.
Source
European Stroke Journal. Conference: 3rd European Stroke Organisation
Conference, ESOC 2017. Czech Republic. 2 (1 Supplement 1) (pp 237), 2017.
Date of Publication: May 2017.
Publisher
SAGE Publications Ltd
Abstract
Background and Aims: Stanford type A aortic dissection (AAD) occasionally
causes ischemic stroke or transient ischemic attack (IS/TIA). The AAD
diagnosis could be delayed due to the consciousness disturbance or
cortical dysfunction such as aphasia. AAD patients with IS/TIA may have a
risk to receive intravenous rt-PA therapy inappropriately. We aimed to
reveal the status of this condition in Japan with a nationwide survey.
Method: We sent WEB-based questionnaires to 1517 hospitals with certified
neurologists, stroke physicians, cardiovascular physicians, emergency
physicians or cardiovascular surgeons in October, 2015. Results: Of all,
527 physicians (35%) who are responsible for AAD management and 545 (36%)
responsible for stroke management responded. Initial urgent care doctors
were mainly from neurology, neurosurgery or stroke medicine (43%),
followed by cardiology or cardiovascular surgery (27%) and emergency
medicine (25%). Twenty-eight hospitals (5.2%) had a written protocol with
emergency service to check chest/back pain and blood pressure laterality
in the prehospital stroke management. Of all, 430 hospitals (82%) managed
<=1 AAD patients (median 6, IQR 3-12) in the last year. Of these, the
median number of AAD patients with IS/TIA was 1 (0-2). Fourteen patients
from 13 hospitals (2.4%) were treated with rt-PA and 5 of them (36%) died
in the acute stage. Contrast-enhanced CT (94%), chest X-ray (61%),
transthoracic echocardiography (59%) and D-dimer (47%) but not carotid
ultrasound (8%) were commonly used as AAD screening tests. Conclusion:
Stroke physicians were most likely to initially manage AAD patients with
IS/TIA. The occurrence of rt-PA treatment in these patients were still not
negligible in Japan.

<69>
Accession Number
616892223
Author
You T.; Yi K.; Ding Z.-H.; Hou X.-D.; Liu X.-G.; Wang X.-K.; Ge L.; Tian
J.-H.
Institution
(You, Yi, Hou, Liu, Wang) Department of Cardiovascular Surgery, Gansu
Provincial Hospital, Lanzhou, China
(Ding) Department of Nursing, Gansu Provincial Hospital, Lanzhou, China
(Ge, Tian) Evidence-Based Medicine Center, Lanzhou University, Lanzhou,
China
Title
Transcatheter closure, mini-invasive closure and open-heart surgical
repair for treatment of perimembranous ventricular septal defects in
children: A protocol for a network meta-analysis.
Source
BMJ Open. 7 (6) (no pagination), 2017. Article Number: e015642. Date of
Publication: 01 Jun 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Both transcatheter device closure and surgical repair are
effective treatments with excellent midterm outcomes for perimembranous
ventricular septal defects (pmVSDs) in children. The mini-invasive
periventricular device occlusion technique has become prevalent in
research and application, but evidence is limited for the assessment of
transcatheter closure, mini-invasive closure and open-heart surgical
repair. This study comprehensively compares the efficacy, safety and costs
of transcatheter closure, mini-invasive closure and open-heart surgical
repair for treatment of pmVSDs in children using Bayesian network
meta-analysis. Methods and analysis A systematic search will be performed
using Chinese Biomedical Literature Database, China National Knowledge
Infrastructure, PubMed, EMBASE.com and the Cochrane Central Register of
Controlled Trials to include random controlled trials, prospective or
retrospective cohort studies comparing the efficacy, safety and costs of
transcatheter closure, mini-invasive closure and open-heart surgical
repair. The risk of bias for the included prospective or retrospective
cohort studies will be evaluated according to the risk of bias in
non-randomised studies of interventions (ROBINS-I). For random controlled
trials, we will use risk of bias tool from Cochrane Handbook version
5.1.0. A Bayesian network meta-analysis will be conducted using R-3.3.2
software. Ethics and dissemination Ethical approval and patient consent
are not required since this study is a network meta-analysis based on
published trials. The results of this network meta-analysis will be
submitted to a peer-reviewed journal for publication.<br/>Copyright &#xa9;
2017 Article author(s).

<70>
Accession Number
615369098
Author
Jung D.M.; Ahn H.J.; Jung S.-H.; Yang M.; Kim J.A.; Shin S.M.; Jeon S.
Institution
(Jung, Ahn, Yang, Kim, Jeon) Department of Anesthesiology and Pain
Medicine, Samsung Medical Centre, Sungkyunkwan University School of
Medicine, Seoul, South Korea
(Shin) Department of Thoracic and Cardiovascular Surgery, Samsung Medical
Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
(Jung) Biostatistics and Clinical Epidemiology Centre, Research Institute
for Future Medicine, Samsung Medical Centre, Seoul, South Korea
Title
Apneic oxygen insufflation decreases the incidence of hypoxemia during
one-lung ventilation in open and thoracoscopic pulmonary lobectomy: A
randomized controlled trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 154 (1) (pp 360-366),
2017. Date of Publication: July 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective Hypoxemia is common during one-lung ventilation (OLV) for
thoracic surgery. When hypoxemia occurs, surgery is interrupted for rescue
ventilation. Apneic oxygen insufflation (AOI), which provides
O<inf>2</inf> without applying pressure, may prevent hypoxemia and does
not interrupt surgery. The aim of this study was to determine the
effectiveness of the AOI technique for preventing hypoxemia during OLV in
thoracic surgery. Methods Patients undergoing open or thoracoscopic
pulmonary lobectomy from September to December 2015 were included.
Patients were assigned randomly to a non-AOI group or an AOI group (n = 45
each). OLV was initiated and at the 15-minute mark (OLV15), patients in
the AOI group received oxygen insufflation at 3 L/min to the nonventilated
lung for 30 minutes (OLV45). The primary endpoint was the occurrence of
hypoxemia (SaO<inf>2</inf> <90%) during OLV. Results The demographic and
operative data were similar between the 2 groups. The incidence of
hypoxemia was greater in the non-AOI than the AOI group (18% vs 0%; P
=.009). DELTAPaO<inf>2</inf> (the difference in partial pressure of oxygen
in arterial blood between OLV 45 and 15 minutes) was smaller in the AOI
than the non-AOI group (-29 mm Hg vs -69 mm Hg; P =.005). Duration of
surgery and incidence of complications did not vary between groups.
Conclusions AOI decreases the incidence of hypoxemia and improves arterial
oxygenation during OLV for open and thoracoscopic surgery. AOI may be a
valuable option to prevent hypoxemia. It can be used before relying on
continuous positive airway pressure or intermittent two-lung ventilation
and result in fewer interruptions in surgery.<br/>Copyright &#xa9; 2017
The American Association for Thoracic Surgery

<71>
[Use Link to view the full text]
Accession Number
616934442
Author
De Sciscio P.; Brubert J.; De Sciscio M.; Serrani M.; Stasiak J.;
Moggridge G.D.
Institution
(De Sciscio) Departments of Engineering, United Kingdom
(De Sciscio, Brubert, Serrani, Stasiak, Moggridge) Chemical Engineering
and Biotechnology, University of Cambridge, Philippa Fawcett Dr, Cambridge
CB3 0AS, United Kingdom
(De Sciscio) Department of General Medicine, Royal Adelaide Hospital,
Internal Medicine Service, Royal Adelaide Hospital, Adelaide, Australia
Title
Quantifying the Shift Toward Transcatheter Aortic Valve Replacement in
Low-Risk Patients.
Source
Circulation: Cardiovascular Quality and Outcomes. 10 (6) (no pagination),
2017. Date of Publication: 01 Jun 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - In recent years, use of transcatheter aortic valve
replacement has expanded to include patients at intermediate- and low-risk
cohorts. We sought to determine disease prevalence and treatment
distribution including transcatheter aortic valve replacement eligibility
in low-risk patients across 37 advanced economies. Methods and Results -
Four systematic searches were conducted across MEDLINE, EMBASE, and the
Cochrane database for studies evaluating disease prevalence, severity,
decision making, and survival in patients with aortic stenosis. Estimates
of disease prevalence and treatment eligibility were calculated using
stochastic simulation and population data for the 37 countries comprising
the International Monetary Fund's advanced economies index. Fifty-six
studies comprising 42 965 patients were included across 5 domains:
prevalence, severity, symptom status, treatment modality, and outcome. The
pooled prevalence in the general population aged 60 to 74 years and >75
years was 2.8% (95% confidence interval [CI], 1.4%-4.1%) and 13.1% (95%
CI, 8.2%-17.9%), respectively - corresponding to an estimated 16.1 million
(95% CI, 12.2-20.3) people in 37 advanced economies. Of these, an
estimated 3.2 million (95% CI, 2.2-4.4) patients have severe aortic
stenosis with 1.9 million (95% CI, 1.3-2.6) eligible for surgical aortic
valve replacement. There are =485 230 (95% CI, 284 550-66 7350)
high-risk/inoperable patients, 152 690 (95% CI, 73 410-263 000)
intermediate-risk patients, and 378 890 (95% CI, 205 130-610 210) low-risk
patients eligible for transcatheter aortic valve replacement. Conclusions
- With a prevalence of 4.5%, an estimated 16.1 million people aged >=60
years across 37 advanced economies have aortic stenosis. Of these, there
are =1.9 million patients eligible for surgical aortic valve replacement
and 1.0 million patients eligible for transcatheter aortic valve
replacement.<br/>Copyright &#xa9; 2017 American Heart Association, Inc.

<72>
Accession Number
616368812
Author
Virk S.A.; Tian D.H.; Sriravindrarajah A.; Dunn D.; Wolfenden H.D.; Suri
R.M.; Munkholm-Larsen S.; Cao C.
Institution
(Virk, Tian, Sriravindrarajah, Dunn, Munkholm-Larsen, Cao) The
Collaborative Research (CORE) Group, Macquarie University, Sydney,
Australia
(Tian) Royal North Shore Hospital, Sydney, Australia
(Wolfenden) Department of Cardiothoracic Surgery, Prince of Wales
Hospital, Sydney, Australia
(Suri) Department of Thoracic and Cardiovascular Surgery, Heart and
Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States
(Cao) Department of Cardiothoracic Surgery, St George Hospital, Sydney,
Australia
Title
Mitral valve surgery and coronary artery bypass grafting for
moderate-to-severe ischemic mitral regurgitation: Meta-analysis of
clinical and echocardiographic outcomes.
Source
Journal of Thoracic and Cardiovascular Surgery. 154 (1) (pp 127-136),
2017. Date of Publication: July 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective This meta-analysis was conducted to compare clinical and
echocardiographic outcomes following isolated coronary artery bypass
grafting (CABG) versus CABG and mitral valve (MV) surgery in patients with
moderate-to-severe ischemic mitral regurgitation (IMR). Methods Seven
databases were systematically searched to identify relevant studies. For
eligibility, studies were required to report on the primary endpoint of
perioperative or late mortality. Data were analyzed according to
predefined clinical endpoints. Results Four randomized controlled trials
(RCTs) (n = 505) and 15 observational studies (OS) (n = 3785) met the
criteria for inclusion. Compared with isolated CABG, concomitant CABG and
MV surgery was not associated with increased perioperative mortality
(RCTs: relative risk [RR] 0.89, 95% confidence interval [CI], 0.26-3.02;
OS: RR 1.40, 95% CI, 0.88-2.23). CABG and MV surgery was associated with
significantly lower incidence of moderate-to-severe MR at follow-up (RCTs:
RR 0.16, 95% CI, 0.04-0.75; OS: RR 0.20, 95% CI, 0.09-0.48). Late
mortality was similar between the surgical approaches in RCTs (hazard
ratio [HR] 1.20, 95% CI, 0.57-2.53) and OS (HR 0.99, 95% CI, 0.81-1.21).
There were no significant differences in echocardiographic outcomes. These
results remained consistent in subgroup analyses restricted to patients
with strictly moderate IMR. Conclusions In patients with
moderate-to-severe IMR, the addition of MV surgery to CABG was not
associated with increased perioperative mortality. Although concomitant MV
surgery reduced recurrence of moderate-to-severe MR at follow-up, this was
not associated with a reduction in late mortality. Larger trials with
longer follow-up duration are required to further assess long-term
survival and freedom from reintervention.<br/>Copyright &#xa9; 2017 The
American Association for Thoracic Surgery

<73>
Accession Number
616072832
Author
den Boer S.L.; du Marchie Sarvaas G.J.; Klitsie L.M.; van Iperen G.G.;
Tanke R.B.; Helbing W.A.; Backx A.P.C.M.; Rammeloo L.A.J.; Dalinghaus M.;
ten Harkel A.D.J.
Institution
(den Boer, Helbing, Dalinghaus) Departments of Pediatrics, Division of
Pediatric Cardiology, Sophia Children's Hospital, Erasmus University
Medical Center, Rotterdam, Netherlands
(du Marchie Sarvaas) Departments of Pediatrics, Division of Pediatric
Cardiology, Beatrix Children's Hospital, University Medical Center
Groningen, Groningen, Netherlands
(Klitsie, ten Harkel) Departments of Pediatrics, Division of Pediatric
Cardiology, Leiden University Medical Center, Leiden, Netherlands
(van Iperen) Departments of Pediatrics, Division of Pediatric Cardiology,
Wilhelmina Children's Hospital, University Medical Center Utrecht,
Utrecht, Netherlands
(Tanke) Departments of Pediatrics, Division of Pediatric Cardiology,
Radboud University Medical Center, Nijmegen, Netherlands
(Backx) Departments of Pediatrics, Division of Pediatric Cardiology, Emma
Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
(Rammeloo) Departments of Pediatrics, Division of Pediatric Cardiology,
Free University Medical Center, Amsterdam, Netherlands
Title
Distribution of strain patterns in children with dilated cardiomyopathy.
Source
Echocardiography. 34 (6) (pp 881-887), 2017. Date of Publication: June
2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: This study aimed to evaluate the predicting value of
quantitative and qualitative dyssynchrony parameters as assessed by
two-dimensional speckle tracking echocardiography (STE) on outcome in
children with dilated cardiomyopathy (DCM). Furthermore, the
reproducibility of these parameters was investigated. Background: In
previous studies in adults with heart failure, several dyssynchrony
parameters have been shown to be a valuable predictor of clinical outcome.
Methods: This multicenter, prospective study included 75 children with DCM
and 75 healthy age-matched controls. Using STE, quantitative (time to
global peak strain and parameters describing intraventricular time
differences) and qualitative dyssynchrony parameters (pattern analysis) of
the apical four-chamber, three-chamber, two-chamber views, and the short
axis of the left ventricle were assessed. Cox regression was used to
identify risk factors for the primary endpoints of death or heart
transplantation. Inter-observer and intra-observer variability were
described. Results: During a median of 21 months follow-up, 10 patients
(13%) reached an endpoint. Although quantitative dyssynchrony measures
were higher in patients as compared to controls, the inter-observer and
intra-observer variability were high. Pattern analysis showed mainly
reduced strain, instead of dyssynchronous patterns. Conclusions: In this
study, quantitative dyssynchrony parameters were not reproducible,
precluding their use in children. Qualitative pattern analysis showed
predominantly reduced strain, suggesting that in children with DCM
dyssynchrony may be a minor problem.<br/>Copyright &#xa9; 2017, Wiley
Periodicals, Inc.

<74>
Accession Number
616905265
Author
Totonchi Z.; Salajegheh S.; Reza Mohaghegh M.; Mesbah Kiaei M.; Shirvani
M.; Ghorbanlo M.
Institution
(Totonchi) Rajaie Cardiovascular Medical and Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Salajegheh) Shafa Hospital, School of Medicine, Kerman University of
Medical Sciences, Kerman, Iran, Islamic Republic of
(Reza Mohaghegh, Mesbah Kiaei, Ghorbanlo) Department of Anesthesiology and
Pain Medicine, Hasheminejad Hospital, Iran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Shirvani) Cardiac Anesthesiologist, Jamaran Hospital, Tehran, Iran,
Islamic Republic of
Title
Hemodynamic effect of intravenous lidocaine during aortic cannulation in
cardiac surgery.
Source
Interventional Medicine and Applied Science. 9 (2) (pp 56-60), 2017. Date
of Publication: June 2017.
Publisher
Akademiai Kiado Rt. (E-mail: info@akkrt.hu)
Abstract
Background: Dissection of aorta is a rare, but fatal complication of
aortic cannulation in cardiac surgery can be caused by the sudden rise in
blood pressure and hemodynamic variations. Methods: In this study, 90
patients aged 18 years or older undergoing cardiac surgery were divided
into two equal groups. Under similar conditions, trial group received 1.5
mg/kg of lidocaine for 90 s before cannulation and control group received
normal saline. Hemodynamic parameters of patients including systolic blood
pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure
(MAP), heart rate (HR), and central venous pressure before cannulation and
1, 3, and 5 min after cannulation were recorded in a form. Consumed
nitroglycerin (TNG) rate was also measured and recorded. Results: In the
lidocaine group, compared with the placebo group, mean SBP, DBP, and MAP
significantly reduced after cannulation (P < 0.05). During the follow-up
period, mean HR (P = 0.649) and TNG usage (P = 0.527) were similar in two
groups. Conclusion: Intravenous lidocaine, 1.5 mg/kg, 90 s before
cannulation leads to a reduction in SBP, DBP, and MAP, up to 5 min after
cannulation, so it can decrease risk of aortic dissection.<br/>Copyright
&#xa9; 2017 The Author(s).

<75>
Accession Number
616905246
Author
Kamali A.; Sanatkar A.; Sharifi M.; Moshir E.
Institution
(Kamali, Moshir) Department of Anesthesiology, Arak University of Medical
Sciences, Arak, Iran, Islamic Republic of
(Sanatkar, Sharifi) Department of Surgery, Arak University of Medical
Sciences, Arak, Iran, Islamic Republic of
Title
Evaluation of amiodarone versus metoprolol in treating atrial fibrillation
after coronary artery bypass grafting.
Source
Interventional Medicine and Applied Science. 9 (2) (pp 51-55), 2017. Date
of Publication: June 2017.
Publisher
Akademiai Kiado Rt. (E-mail: info@akkrt.hu)
Abstract
Introduction: Atrial fibrillation (AF) is the most common arrhythmia
affecting patients in open heart ICU after coronary artery bypass grafting
(CABG). Most cardiac surgery textbooks recommend beta blockers as the drug
of choice for treating such a condition while many experienced physicians
and a number of anesthesiology references offer amiodarone as the drug of
choice. Therefore, because of insufficient evidence and the aforementioned
controversy, we decided to conduct a study evaluating these two
antiarrhythmic medicines. Methods: This is a double-blind, randomized,
clinical trial performed on patients admitted for CABG at Amir al Momenin
hospital in Arak province, Iran, who developed new onset AF after surgery.
Based on the type of medication used, these patients were randomly divided
into two groups: Amiodarone (A) group and metoprolol (M) group. Each group
consisted of 73 cases. All data were analyzed via SPSS 19. Results: Among
the results achieved in this study, amiodarone was successful in treating
AF in 55 patients (73%), while metoprolol achieved normal rhythm in
treating AF in 69 patients (92%). With a p-value of 0.04, it seems that
metoprolol is more effective in treating AF. Conclusion: Metoprolol seems
to be a most efficacious medication for post-CABG AF (p-value =
0.004).<br/>Copyright &#xa9; 2017 The Author(s).

<76>
Accession Number
616899098
Author
Chen M.Y.; Rochitte C.E.; Arbab-Zadeh A.; Dewey M.; George R.T.; Miller
J.M.; Niinuma H.; Yoshioka K.; Kitagawa K.; Sakuma H.; Laham R.; Vavere
A.L.; Cerci R.J.; Mehra V.C.; Nomura C.; Kofoed K.F.; Jinzaki M.;
Kuribayashi S.; Scholte A.J.; Laule M.; Tan S.Y.; Hoe J.; Paul N.; Rybicki
F.J.; Brinker J.A.; Arai A.E.; Matheson M.B.; Cox C.; Clouse M.E.; Di
Carli M.F.; Lima J.A.C.
Institution
(Chen, Arai) Laboratory of Cardiac Energetics, National Heart Lung and
Blood Institute, National Institutes of Health, Bethesda, MD, United
States
(Rochitte) InCor Heart In stitute, University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Arbab-Zadeh, George, Miller, Vavere, Cerci, Mehra, Brinker, Lima) Johns
Hopkins Hospital and School of Medicine, 600 N Wolfe St, Blalock 524,
Baltimore, MD 21287, United States
(Dewey, Laule) Department of Radiology, Charite Medical School-Humboldt,
Berlin, Germany
(Niinuma, Yoshioka) Memorial Heart Center, Iwate Medical University,
Morioka, Japan
(Niinuma) Department of Radiology, St. Luke's International Hospital,
Tokyo, Japan
(Kitagawa, Sakuma) Department of Radiology, Mie University Hospital, Tsu,
Japan
(Laham, Clouse) Department of Radiology, Beth Israel Deaconess Medical
Center, Harvard University, Boston, MA, United States
(Nomura) Radiology Sector, Hospital Israelita Albert Einstein, Sao Paulo,
Brazil
(Kofoed) Department of Cardiology, Rigshospitalet, University of
Copenhagen, Denmark
(Jinzaki, Kuribayashi) Keio University School of Medicine, Tokyo, Japan
(Scholte) Department of Cardiology, Leiden University Medical Center,
Leiden, Netherlands
(Tan) Department of Cardiology, National Heart Centre, Singapore
(Hoe) Medi-Rad Associates, CT Centre, Mount Elizabeth Hospital, Singapore
(Paul) Department of Medical Imaging, Toronto General Hospital, Toronto,
ON, Canada
(Rybicki) Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
(Matheson, Cox) Department of Epidemiology, Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD, United States
(Di Carli) Department of Nuclear Medicine and Cardiovascular Imaging,
Brigham and Women's Hospital, Boston, MA, United States
Title
Prognostic value of combined CT angiography and myocardial perfusion
imaging versus invasive coronary angiography and nuclear stress perfusion
imaging in the prediction of major adverse cardiovascular events: The
CORE320 multicenter study.
Source
Radiology. 284 (1) (pp 55-65), 2017. Date of Publication: July 2017.
Publisher
Radiological Society of North America Inc. (820 Jorie Boulevard, Oak Brook
IL 60523-2251, United States)
Abstract
Purpose: To compare the prognostic importance (time to major adverse
cardiovascular event [MACE]) of combined computed tomography (CT)
angiography and CT myocardial stress perfusion imaging with that of
combined invasive coronary angiography (ICA) and stress single photon
emission CT myocardial perfusion imaging. Materials and Methods: This
study was approved by all institutional review boards, and written
informed consent was obtained. Between November 2009 and July 2011, 381
participants clinically referred for ICA and aged 45-85 years were
enrolled in the Combined Noninvasive Coronary Angiography and Myocardial
Perfusion Imaging Using 320-Detector Row Computed Tomography (CORE320)
prospective multicenter diagnostic study. All images were analyzed in
blinded independent core laboratories, and a panel of physicians
adjudicated all adverse events. MACE was defined as revascularization (>30
days after index ICA), myocardial infarction, or cardiac death;
hospitalization for chest pain or congestive heart failure; or arrhythmia.
Late MACE was defined similarly, except for patients who underwent
revascularization within the first 182 days after ICA, who were excluded.
Comparisons of 2-year survival (time to MACE) used standard Kaplan-Meier
curves and restricted mean survival times bootstrapped with 2000
replicates. Results: An MACE (49 revascularizations, five myocardial
infarctions, one cardiac death, nine hospitalizations for chest pain or
congestive heart failure, and one arrhythmia) occurred in 51 of 379
patients (13.5%). The 2-year MACE-free rates for combined CT angiography
and CT perfusion findings were 94% negative for coronary artery disease
(CAD) versus 82% positive for CAD and were similar to combined ICA and
single photon emission CT findings (93% negative for CAD vs 77% positive
for CAD, P < .001 for both). Event-free rates for CT angiography and CT
perfusion versus ICA and single photon emission CT for either positive or
negative results were not significantly different for MACE or late MACE (P
> .05 for all). The area under the receiver operating characteristic curve
(AUC) for combined CT angiography and CT perfusion (AUC = 68; 95%
confidence interval [CI]: 62, 75) was similar (P = .36) to that for
combined ICA and single photon emission CT (AUC = 71; 95% CI: 65, 79) in
the identification of MACE at 2-year follow-up. Conclusion: Combined CT
angiography and CT perfusion enables similar prediction of 2-year MACE,
late MACE, and event-free survival similar to that enabled by ICA and
single photon emission CT.<br/>Copyright &#xa9; 2017 RSNA.

<77>
Accession Number
616981371
Author
Kopriva P.; Griva M.; Tudos Z.
Institution
(Kopriva, Griva) Department of Cardiology, Tomas Bata Regional Hospital,
Zlin, Czech Republic
(Griva) Department of Internal Medicine I - Cardiology, Faculty of
Medicine and Dentistry, Palacky University Olomouc, University Hospital
Olomouc, Czech Republic
(Tudos) Department of Radiology, Faculty of Medicine and Dentistry,
Palacky University Olomouc, University Hospital Olomouc, Czech Republic
Title
Management of cardiac sarcoidosis - A practical guide.
Source
Cor et Vasa. (no pagination), 2017. Date of Publication: 2017.
Publisher
Elsevier Science B.V.
Abstract
Sarcoidosis is a multi-system granulomatous disorder of unclear etiology
which can affect any organ of the body including the heart. The heart is
involved in up to 25% of sarcoidosis patients. In rare cases, the heart
can be the only organ involved.Involvement of the heart, called cardiac
sarcoidosis, especially if symptomatic, significantly deteriorates the
prognosis for sarcoidosis patients, which is why cardiac sarcoidosis
should be not only considered, but also searched for actively. Despite
recent advances in this field, diagnosis, risk-stratification, and
treatment of cardiac sarcoidosis remains a challenging issue. Fortunately,
several recommendations have been recently formulated which provide
relatively clear guidance on the management of patients with cardiac
sarcoidosis. The cornerstone of management of these patients is a
multidisciplinary approach involving collaboration of cardiologists,
pulmonologists, radiologists, rheumatologists, and other
specialists.Currently, diagnosis of cardiac sarcoidosis is based on an
assessment of a patients' symptoms, physical examination and results of
standard ECG, Holter monitoring and echocardiography. This series of
examinations can identify individuals with possible cardiac sarcoidosis,
who should undergo, as the next step, cardiac magnetic resonance and
positron emission tomography, which are the techniques of choice for the
diagnosis of cardiac sarcoidosis. Histological verification, critical for
establishing a definitive diagnosis, is based - in cases with a typical
picture documented by imaging techniques - on an extracardiac biopsy. In
some cases, when an extracardiac biopsy is not feasible, an endomyocardial
biopsy is needed.The cornerstone of treatment remains corticosteroids, in
some cases in combination with other immunosuppressives, although data on
their efficacy and safety from randomized trials are lacking. As the most
frequent causes of death from cardiac sarcoidosis are heart rhythm
disorders, be it atrioventricular blocks or ventricular arrhythmias, an
irreplaceable role in the management of these patients is played by
implantation of pacemakers and implantable cardioverter/defibrillators
(ICD). One of the most critical issues is risk stratification of patients
who, while not meeting classic criteria for ICD implantation, continue to
be at high risk of sudden cardiac death and therefore should still be
considered for ICD implantation. The last option for patients with
advanced sarcoidosis is heart transplantation.The present paper is an
overview of presentation, diagnosis, and treatment of cardiac sarcoidosis,
with special emphasis on the use of algorithms applicable in routine
clinical practice.<br/>Copyright &#xa9; 2017 The Czech Society of
Cardiology.

<78>
Accession Number
616977707
Author
Rezk M.E.
Institution
(Rezk) Cardiothoracic Surgery Department, Benha University, Benha, Egypt
Title
Role of ascorbic acid in reduction of the incidence of the atrial
fibrillation in patients under B-blocker and undergoing coronary artery
bypass graft operation in early post-operative period.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. (no
pagination), 2017. Date of Publication: March 24, 2017.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: The study was done to project the important role of the
anti-inflammatory and anti -oxidant properties of Ascorbic acid (vitamin
C) in reducing the incidence of atrial fibrillation (AF) in the early
post-operative period after coronary artery bypass graft operation (CABG).
Methods: This prospective randomized study included 100 patients admitted
to cardio-thoracic surgery department, Benha University Hospital, Benha,
Egypt between 2011 and 2016. Those patients scheduled for CABG, were
randomized into two groups of patients: the first; group 1: A fifty CABG
patients were given beta -blocker (bisoprolol 5 mg o.d.) & ascorbic acid
(2 g daily in divided doses qds) for at least three days pre-operatively.
The second; group 2: A fifty CABG patients were given beta -blocker
(bisoprolol 5 mg o.d.) for at least three days pre-operatively. Patients
were followed up for AF after (CABG) for the short term of 3 weeks.
Results: The incidence of AF after CABG in1st 48 h and after 1 month was
statistically significantly lower in Group 1 than Group 2 with p value
0.022 and 0.025 respectively. Intensive care unit stay, need for inotropic
support and ventilator stay were also significantly decreased in Group1
than Group 2 with p value 0.035, 0.045 and 0.048 respectively.
Conclusions: The incidence of post CABG AF, intensive care unit stay, need
for inotropic support and ventilator stay were decreased by patients
intake of vitamin C in combination with beta -blockers
pre-operatively.<br/>Copyright &#xa9; 2017 The Egyptian Society of
Cardio-thoracic Surgery.

<79>
Accession Number
616973893
Author
Chava S.; Gentchos G.; Abernethy A.; Leavitt B.; Terrien E.; Dauerman H.L.
Institution
(Chava, Gentchos, Abernethy, Leavitt, Terrien, Dauerman) University of
Vermont Larner College of Medicine, Burlington, VT, United States
(Dauerman) Division of Cardiology, University of Vermont Medical Center,
111 Colchester Avenue, McClure 1, Burlington, VT 05401, United States
Title
Routine CT angiography to detect severe coronary artery disease prior to
transcatheter aortic valve replacement.
Source
Journal of Thrombosis and Thrombolysis. (pp 1-7), 2017. Date of
Publication: 23 Jun 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Patients undergoing TAVR undergo routine CT angiography (CTA) to assess
aorto-iliac pathology and annular dimensions. While coronary CTA may
exclude severe CAD in younger patients, its efficacy in defining CAD
severity prior to TAVR may be limited. We retrospectively studied 50
consecutive patients undergoing both invasive coronary angiography (ICA)
and routine pre-TAVR CTA. Severe CAD was defined as >=50% stenosis by
quantitative coronary angiography and compared to a blinded CTA visual
estimation of >=50% stenosis. The analysis was confined to four segments:
left main and three proximal to mid major coronaries to maximize
myocardial territory at risk. Coronary assessment was performed using
standard reconstructed ECG phases from pre-TAVR chest CTA on a Philips 256
iCT scanner. Nearly 3/4 of patients were >=75 years old, 57% were female,
half were diabetic and 45% had prior PCI. By ICA, 49% had significant
coronary calcification. The incidence of severe proximal to mid vessel CAD
by ICA was 39%. Similarly, a third of patients required PCI prior to TAVR.
CTA was unable to exclude severe proximal to mid vessel CAD in 88% of
patients in all four segments: non-diagnostic CTA readings were mainly due
to calcification (60%) or motion artifact (28%). Non-diagnostic coronary
CTA readings ranged from 25 to 72% according to segment analyzed: only the
left main segment had diagnostic quality CTA in the majority of patients
(p < 0.01). PCI is performed frequently prior to TAVR based upon invasive
coronary angiographic assessment. Routine chest CTA algorithms do not
provide adequate diagnostic information to exclude severe CAD, primarily
due to severe coronary calcification in the TAVR population.<br/>Copyright
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