EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
610372611
Author
Ozaydin M.; Yucel H.; Kocyigit S.; Adali M.K.; Aksoy F.; Kahraman F.;
Uysal B.A.; Erdogan D.; Varol E.; Dogan A.
Institution
(Ozaydin, Kahraman, Erdogan, Varol) Department of Cardiology, Suleyman
Demirel University, Kardiyoloji AD, Cunur, Isparta TR'32200, Turkey
(Yucel) State Hospital, Manisa, Turkey
(Kocyigit) Servergazi State Hospital, Denizli, Turkey
(Adali) State Hospital, Bucak, Turkey
(Aksoy) State Hospital, Dinar, Turkey
(Uysal) State Hospital, Manavgat, Turkey
(Dogan) Katip Celebi University, Izmir, Turkey
Title
Nebivolol versus Carvedilol or Metoprolol in Patients Presenting with
Acute Myocardial Infarction Complicated by Left Ventricular Dysfunction.
Source
Medical Principles and Practice. 25 (4) (pp 316-322), 2016. Date of
Publication: 15 Jun 2016.
Publisher
S. Karger AG
Abstract
Objective: The aim of this study was to evaluate the efficacy of
nebivolol, carvedilol or metoprolol succinate on the outcome of patients
presenting with acute myocardial infarction (AMI) complicated by left
ventricular dysfunction. Subjects and Methods: Patients (n = 172, aged
28-87 years) with AMI and left ventricular ejection fraction <=0.45 were
randomized to the nebivolol (n = 55), carvedilol (n = 60) and metoprolol
succinate (n = 57) groups. Baseline demographic and clinical
characteristics and composite event rates of nonfatal MI, cardiovascular
mortality, hospitalization due to unstable angina pectoris or heart
failure, stroke or revascularization during the 12-month follow-up were
compared among the groups using the chi² test, t test or
log-rank test as appropriate. Results: Baseline demographic and clinical
characteristics were similar in the three groups. The composite end point
during follow-up was lower in the patients treated with nebivolol than
those treated with metoprolol (14.5 vs. 31.5%; p = 0.03). However, event
rates were similar between the patients treated with carvedilol and those
treated with the metoprolol (20.3 vs. 31.5%, p > 0.05) and between the
patients treated with nebivolol and carvedilol (14.5 vs. 20.3%, p > 0.05).
Conclusion: The patients treated with nebivolol experienced 12-month
cardiovascular events at a lower rate than those treated with metoprolol
succinate. However, event rates were similar between the carvedilol and
the metoprolol succinate groups and between the nebivolol and the
carvedilol groups.<br/>Copyright &#xa9; 2016 S. Karger AG, Basel.

<2>
Accession Number
609610960
Author
Bhavsar R.; Ryhammer P.K.; Greisen J.; Rasmussen L.A.; Jakobsen C.-J.
Institution
(Bhavsar, Ryhammer, Greisen, Rasmussen, Jakobsen) Department of
Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus,
Denmark, United States
Title
Remifentanil Compared With Sufentanil Does Not Enhance Fast-Track
Possibilities in Cardiac Surgery-A Randomized Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (5) (pp 1212-1220),
2016. Date of Publication: 01 Oct 2016.
Publisher
W.B. Saunders
Abstract
Objective Progressive cost containment has resulted in a growing interest
for fast-track cardiac surgery. Ventilation time and length of stay (LOS)
in the intensive care unit (ICU) are important factors in patient
turnover, a more efficient use of resources, and early patient
mobilization. However, LOS in ICU is not an objective measure because, in
addition to medical factors, patient discharge may be guided by logistics
and policy, and thus more objective measures are warranted. The authors
hypothesized that remifentanil compared with sufentanil would reduce
ventilation time and LOS in the ICU and that remifentanil would have
beneficial effects on the overall quality of recovery. Design A
randomized, prospective study. Participants Sixty patients scheduled for
elective coronary artery bypass grafting with or without aortic valve
replacement. Setting A university hospital. Interventions Patients were
assigned randomly to receive either remifentanil or sufentanil combined
with propofol. Measurements and Main Results Patients with ejection
fraction<0.3, myocardial infarction within the last 4 weeks, diabetes, and
severe pulmonary or arterial hypertension were excluded. The primary
outcome variables were ventilation time and time to eligibility of
discharge from the cardiac recovery unit. Secondary outcomes were actual
LOS in the cardiac recovery unit and quality of recovery. The groups were
comparable in selected demographics and perioperative parameters. There
were no differences in ventilation time or eligible ICU discharge time
between the groups. Remifentanil patients received more morphine than did
the sufentanil patients during recovery (20 mg v 10 mg; p = 0.040). No
difference was found in pharmacologic support or use of a pacemaker.
Conclusion In a fast-track protocol, remifentanil did not seem to be
superior to a standard moderate- to high-dose sufentanil
regimen.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<3>
Accession Number
617893418
Author
Ravishankar C.
Institution
(Ravishankar) Department of Pediatrics, Perelman School of Medicine,
University of Pennsylvania, Philadelphia, PA, United States
Title
The VAD update: The north american experience.
Source
Artificial Organs. Conference: 11th International Conference on Pediatric
Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary
Bypass. Italy. 39 (5) (pp A8), 2015. Date of Publication: May 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Ventricular Assist Devices (VAD) are being increasingly used in children
with decompensated heart failure both due to cardiomyopathy and congenital
heart defects. The choice of devices has expanded due to advances in
technology. The Berlin Heart Excor device, which is a paracorporeal
pneumatic device, is the most widely used VAD in North America and is
currently the only available device for infants and young children. 204
children across 47 centers in North America were supported with the Excor
device from 2007-2010. One-year survival was 75%; 64% survived to heart
transplantation, 6% recovered and 5% were alive on the device. In
multivariable analysis, lower weight at implantation, higher serum
bilirubin and need for biventricular support were independently associated
with early mortality. Higher bilirubin and renal dysfunction were
independently associated with late mortality. Neurologic event occurred in
nearly a third of subjects and was the leading cause of morbidity. This
device is currently approved by the FDA for use in children. Additional
analysis has revealed inferior outcomes for children weighing less than 10
kg, particularly for those with congenital heart defects. The choice of
devices is much wider in older children. The HeartMate II and HeartWare
are continuous flow intracorporeal devices that can be implanted in young
children with cardiomyopathy and congenital heart defects. VAD support
remains a challenge for patients with single ventricle heart defects
through all stages of surgical palliation. As VAD technology improves, we
remain in search of the ideal device to meet the unique needs of the
Pediatric population.

<4>
Accession Number
617893320
Author
Paola C.; Morelli S.; Polito A.; Ricci Z.; Testa G.; Rizza A.; Favia I.;
Carotti A.; Amodeo A.
Institution
(Paola, Morelli, Polito, Ricci, Testa, Rizza, Favia, Amodeo)
Cardiovascular Department, Catholic University, A. Gemelli Hospital, Rome,
Italy
(Carotti) Department of Pediatric Cardiology and Cardiac Surgery, Bambino
Gesu Children Hospital, Rome, Italy
Title
Intensive care management of prolonged pediatric mechanical life support.
Source
Artificial Organs. Conference: 11th International Conference on Pediatric
Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary
Bypass. Italy. 39 (5) (pp A3), 2015. Date of Publication: May 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Objective: The number of children in need of mechanical circulatory
support (MCS) has increased substantially, due to the technological
progress made in surgery and intensive care. In addition, primary
myocardial dysfunction related to myocarditis or dilated cardiomyopathy
may cause end-stage cardiac failure in children or infants, although not
as frequently as in adults. The need for MCS may be either temporary until
spontaneous myocardial recovery, or prolonged until heart transplantation
in the absence of recovery. Two types of mechanical circulatory devices
are suitable for the pediatric population: extracorporeal membrane
oxygenation (ECMO) for short-term support; and ventricular assist devices
for long-term support as a bridge to transplantation. ECMO is a rescue
therapy for life-threatening respiratory or circulatory failure. Although
outcomes are favorable with short-term ECMO therapy, data on the outcomes
of prolonged ECMO therapy as well as of prolonged MCS for cardiomyopathy
or irreversible heart failure in children are very limited. We aimed to
report morbidity and mortality associated with prolonged MCS in children
and the implication for their management. Methods: We retrospectively
analyzed the records of children presenting with prolonged MCS to our
institution between January 2006 and February 2015 and conducted a
systematic literature review. We recorded information on patient
demographic, diagnosis, indication for MCS, MCS support details, medical
and surgical history, organ dysfunction, complications, and patient
outcomes. The outcome variables included survival to MCS de-cannulation or
to heart transplant, survival to hospital discharge, and current survival
with emphasis on neurologic, renal, pulmonary, and other end organ
function. Results: Support following cardiac surgery. Remarkable recovery
of myocar-dial function has been observed after periods of support
extending to 2 weeks. Beyond 2 weeks, it is likely that the only hope for
these patients would be transitioning to ventricular assist device (VAD),
allowing long term support. The largest published case series of prolonged
ECMO support among children managed at a single institution over a 20
year-span showed that of the 22 ECMO runs exceeding 28 days, only four
patients survived to hospital dis-charge. All the survivors needed
dialysis after discharge, and only a single patient survived without
neurological injury. We performed 169 MCS over 9 years. Among them, 29
were ECMO runs longer than 14 days and 4 (19%) were transitioned to
ventricular assist devices (VAD). The mean duration was 22 +/- 10 days and
mortality was 71%.Twelve (57%) were post-surgery ECMO, seven (33%) were
ECPR and 10 (48%) required CVVH. Bleeding and coagulopathies were the most
dangerous complications. Primary myocardial dysfunction. In these
instances, either ECMO or VAD may be instituted. ECMO can be rapidly
deployed, is far less expensive, and may be used in the initial period of
support while the diagnosis is investigated and the condition of the
patient is reassessed. Beyond the first 2 weeks of support, ECMO has been
shown repeatedly to be inferior to VAD as a bridge to transplantation in
children. Over 9 years we admitted 43 children after VAD implantation at
our CICU, five of them (12%) required VAD after cardiac surgery. Mean +/-
SD duration of VAD was 111 +/- 130 days and mean age was 61 +/- 73months.
Mortality was 19%, one patient required CVVH and 6patients required more
than one MCS (3 patients transitioned from ECMO to VAD). Early extubation
and aggressive correction of coagulopathies played a significant role on
patient outcome. Conclusions: Prolonged MCS remains a high risk strategy
to support children with poor cardiac function. Transitioning appropriate
patients from ECMO to a VAD as soon as possible may be anoptionto reduce
morbidity and mortality. Optimization of cannulation strategies,
aggressive correction of non-heparin related coagulopathies and early
spontaneous breathing may help improve patient outcome.

<5>
Accession Number
617893311
Author
Caputo M.
Institution
(Caputo) Department of Congenital Heart Surgery, Rush University Medical
Center, Chicago, IL, United States
(Caputo) Bristol Heart Institute, University of Bristol, Bristol, United
Kingdom
Title
Myocardial protection in infants and children: Building an evidence-based
strategy.
Source
Artificial Organs. Conference: 11th International Conference on Pediatric
Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary
Bypass. Italy. 39 (5) (pp A1-A2), 2015. Date of Publication: May 2015.
Publisher
Blackwell Publishing Inc.
Abstract
Today there are a lot of different types of cardioplegia solutions and
cardio-pulmonary bypass (CPB) strategies and methods used in pediatric
cardiac surgery. Most of these strategies have been adopted from
techniques developed for adult cardiac surgery. The infant heart is at
high risk of damage from poor protection or wrong CPB strategy as a result
of preoperative hypertrophy, cyanosis, and ischemia. These factors may
also make the immature (pediatric) heart more sensitive to cardioplegic
arrest compared with the mature (adult) heart. Nevertheless no clear
recommendation concerning pediatric myocardial protection and CPB strategy
is available nowadays, as a result of the very few prospective randomized
studies that have been published. My lecture will describe the
experimental infrastructure and subsequent clinical applications of
cardioplegic and CPB strategies aiming at limiting intraoperative injury
and improving postoperative outcomes in pediatric patients undergoing
cardiac surgery. I will describe some of the relevant basic science and
small and large animal models used to validate myocardial protection
strategies. Furthermore I will present data from two major control
randomized trials, comparing normothermic vs hypothermic (THERMIC) and
hypoxic vs normoxic (OXIC) CPB in pediatric patients. The relationship
between chronic hypoxia and gene expression, and the molecular mechanisms
underlying the effects of re-oxygenation injury on organ dysfunction in
cyanotic heart patients undergoing surgical repair will also be explored.
Finally I will discuss the most recent international trends of myocardial
protection and CPB strategies in pediatric heart surgery. Applications of
these concepts should improve the safety of protection of the infant heart
and reduce postoperative morbidity and mortality.

<6>
Accession Number
617808736
Author
Hunter B.R.
Institution
(Hunter) Indiana University School of Medicine, Indianapolis, IN, United
States
Title
In patients with chest pain, HEART score-guided and usual care did not
differ for MACE or health care use.
Source
Annals of Internal Medicine. 167 (4) (pp JC22), 2017. Date of Publication:
15 Aug 2017.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<7>
Accession Number
617808606
Author
Cornell J.E.; Liao J.M.; Stack C.B.; Mulrow C.D.
Institution
(Cornell, Mulrow) University of Texas Health Science Center at San
Antonio, 7703 Merton Minter Boulevard, San Antonio, TX 78299, United
States
(Liao) Department of Medicine, University of Pennsylvania, 3400 Spruce
Street, Philadelphia, PA 19104, United States
(Stack) American College of Physicians, 190 N. Independence Mall West,
Philadelphia, PA 19106, United States
Title
Annals understanding clinical research: Evaluating the meaning of a
summary estimate in a meta-analysis.
Source
Annals of Internal Medicine. 167 (4) (pp 275-277), 2017. Date of
Publication: 15 Aug 2017.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<8>
Accession Number
605929753
Author
Huang S.; Peng W.P.; Tian X.; Liang H.; Jia Z.; Lo T.; He M.; Feng Y.
Institution
(Huang, Tian, Liang, He, Feng) Department of Anesthesiology, Peking
University People's Hospital, Beijing 100044, China
(Huang, Peng) Department of Anesthesiology, Ministry of Health Beijing
Hospital, Beijing 100730, China
(Jia) Department of Surgery, Beijing Oasis International Hospital, Beijing
100015, China
(Lo) Department of Anesthesiology, Ronald Reagan UCLA Medical Center, Los
Angeles, CA 90095-7403, United States
Title
Effects of transcutaneous electrical acupoint stimulation at different
frequencies on perioperative anesthetic dosage, recovery, complications,
and prognosis in video-assisted thoracic surgical lobectomy: a randomized,
double-blinded, placebo-controlled trial.
Source
Journal of Anesthesia. 31 (1) (pp 58-65), 2017. Date of Publication: 01
Feb 2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Background: Transcutaneous electrical acupoint stimulation (TEAS), a
non-invasive and non-pharmacological adjunctive intervention for
perioperative analgesia, may also reduce the incidence of postoperative
pulmonary complications. The effect of TEAS on video-assisted thoracic
surgical (VATS) patients is still unknown, however. The purpose of this
study was to investigate the effects of TEAS of different frequency on
perioperative anesthetic dosage, recovery, complications, and prognosis
for patients undergoing VATS lobectomy. Methods: Eighty VATS lobectomy
patients with no previous experience of TEAS or acupuncture were randomly
assigned to four groups: control (con), 2/100, 2, and 100 Hz. The last
three experimental groups received TEAS at the indicated frequencies for
30 min before induction, during the operation, and for another 30 min 24
and 48 h after surgery. 2/100 Hz is a type of alternating frequency which
goes between 2 and 100 Hz every 3 s. TEAS was administered over acupoints
Neiguan, Hegu, Lieque, and Quchi on the sick lateral. Electrodes were
applied to the patients in the control group, but no TEAS was used.
Anesthetic dosage, blood gas analysis results, lung function indexes
FEV<inf>1</inf> and FVC, post-anesthesia care unit (PACU) status,
postoperative complications, and quality of life scores were recorded and
analyzed statistically. Results: Intraoperative opioid consumption was
lowest in the 2/100 Hz group, with statistical significance (con, P <=
0.001; 2 Hz, P <= 0.001; 100 Hz, P = 0.026). Compared with preoperative
FEV<inf>1</inf> and FVC, postoperative FEV<inf>1</inf> and FVC were
significantly lower in all groups; during one-lung ventilation, arterial
oxygen partial pressure (PaO<inf>2</inf>) decreased more slowly in the
2/100 Hz group than in the con group (P = 0.042). Moreover, in the 2/100
Hz group extubation time was shorter (P = 0.038), visual analgesia scale
score lower (P = 0.047), and duration of PACU stay shorter (P = 0.043)
than in the con group. In the 100 Hz group incidence of postoperative
nausea and vomiting (PONV) was lower than the con group (P = 0.044). In
all groups mean postoperative physical component scores were significantly
lower than mean preoperative scores. Conclusions: TEAS is a safe
noninvasive adjunctive intervention for anesthesia management among
patients undergoing VATS lobectomy. TEAS at 2/100 Hz can reduce
intraoperative opioid dosage and slow the decrease of PaO<inf>2</inf>
during one-lung ventilation. It can also effectively reduce pain score,
extubation time, and PACU stay immediately after surgery. Further, 100 Hz
TEAS can reduce PONV morbidity.<br/>Copyright &#xa9; 2015, Japanese
Society of Anesthesiologists.

<9>
Accession Number
613853263
Author
Lin C.-Y.; Yaseri M.; Pakpour A.H.; Malm D.; Brostrom A.; Fridlund B.;
Burri A.; Webb T.L.
Institution
(Lin) Department of Rehabilitation Sciences, Faculty of Health and Social
Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
(Yaseri) Department of Epidemiology and Biostatistics, School of Public
Health, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Pakpour) Social Determinants of Health Research Center, Qazvin University
of Medical Sciences, Shahid Bahounar BLV, Qazvin 3419759811, Iran, Islamic
Republic of
(Pakpour, Malm, Brostrom) Department of Nursing, School of Health and
Welfare, Jonkoping University, Jonkoping, Sweden
(Malm) Department of Internal Medicine, Country Hospital Ryhov, Jonkoping,
Sweden
(Fridlund) School of Health and Welfare, Jonkoping University, Jonkoping,
Sweden
(Burri) Health and Rehabilitation Research Institute, Auckland University
of Technology, Auckland, New Zealand
(Burri) Department of Anaesthesia and Perioperative Medicine, Waitemata
Pain Service, North Shore Hospital, Auckland, New Zealand
(Webb) Department of Psychology, The University of Sheffield, Sheffield,
United Kingdom
Title
Can a Multifaceted Intervention Including Motivational Interviewing
Improve Medication Adherence, Quality of Life, and Mortality Rates in
Older Patients Undergoing Coronary Artery Bypass Surgery? A Multicenter,
Randomized Controlled Trial with 18-Month Follow-Up.
Source
Drugs and Aging. 34 (2) (pp 143-156), 2017. Date of Publication: 01 Feb
2017.
Publisher
Springer International Publishing
Abstract
Background: Patients undergoing coronary artery bypass graft (CABG)
surgery are required to take a complex regimen of medications for extended
periods, and they may have negative outcomes because they struggle to
adhere to this regimen. Designing effective interventions to promote
medication adherence in this patient group is therefore important.
Objective: The present study aimed to evaluate the long-term effects of a
multifaceted intervention (psycho-education, motivational interviewing,
and short message services) on medication adherence, quality of life
(QoL), and mortality rates in older patients undergoing CABG surgery.
Methods: Patients aged over 65 years from 12 centers were assigned to the
intervention (EXP; n = 144) or treatment-as-usual (TAU; n = 144) groups
using cluster randomization at center level. Medication adherence was
evaluated using the Medication Adherence Rating Scale (MARS), pharmacy
refill rate, and lipid profile; QoL was evaluated using Short Form-36.
Data were collected at baseline; 3, 6, and 18 months after intervention.
Survival status was followed up at 18 months. Multi-level regressions and
survival analyses for hazard ratio (HR) were used for analyses. Results:
Compared with patients who received TAU, the MARS, pharmacy refill rate,
and lipid profile of patients in the EXP group improved 6 months after
surgery (p < 0.01) and remained so 18 months after surgery (p < 0.01). QoL
also increased among patients in the EXP group as compared with those who
received TAU at 18 months post-surgery (physical component summary score p
= 0.02; mental component summary score p = 0.04). HR in the EXP group
compared with the TAU group was 0.38 (p = 0.04). Conclusion: The findings
suggest that a multifaceted intervention can improve medication adherence
in older patients undergoing CABG surgery, with these improvements being
maintained after 18 months. QoL and survival rates increased as a function
of better medication adherence. ClinicalTrials.gov
NCT02109523.<br/>Copyright &#xa9; 2016, Springer International Publishing
Switzerland.

<10>
Accession Number
614599511
Author
Wang J.; Yu W.; Jin Q.; Li Y.; Liu N.; Hou X.; Yu Y.
Institution
(Wang, Yu, Yu) Department of Cardiac Surgery, Beijing An Zhen Hospital
Capital Medical University, Beijing, China
(Wang, Jin, Li, Liu, Hou) Center for Cardiac Intensive Care, Beijing An
Zhen Hospital Capital Medical University, Beijing, China
Title
Risk Factors for Post-TAVI Bleeding According to the VARC-2 Bleeding
Definition and Effect of the Bleeding on Short-Term Mortality: A
Meta-analysis.
Source
Canadian Journal of Cardiology. 33 (4) (pp 525-534), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Pulsus Group Inc.
Abstract
Background In this study we investigated the effect of post-transcatheter
aortic valve implantation (TAVI) bleeding (per Valve Academic Research
Consortium-2 [VARC-2] bleeding criteria) on 30-day postoperative mortality
and examined the correlation between pre- or intraoperative variables and
bleeding. Methods Multiple electronic literature databases were searched
using predefined criteria, with bleeding defined per Valve Academic
Research Consortium-2 criteria. A total of 10 eligible articles with 3602
patients were included in the meta-analysis. Results The meta-analysis
revealed that post-TAVI bleeding was associated with a 323% increase in
30-day postoperative mortality (odds risk [OR]; 4.23, 95% confidence
interval [CI], 2.80-6.40; P < 0.0001) without significant study
heterogeneity or publication bias. In subgroup analysis we found that
patients with major bleeding/life-threatening bleeding showed a 410%
increase in mortality compared with patients without bleeding (OR, 5.10;
95% CI, 3.17-8.19; P < 0.0001). Transapical access was associated with an
83% increase in the incidence of bleeding compared with transfemoral
access (OR, 1.83; 95% CI, 1.43-2.33; P < 0.0001). Multiple logistic
regression analysis revealed that atrial fibrillation (AF) was
independently correlated with TAVI-associated bleeding (OR, 2.63; 95% CI,
1.33-5.21; P = 0.005). Meta-regression showed that potential modifiers
like the Society of Thoracic Surgeons (STS) score, mortality, the logistic
European System for Cardiac Operative Risk Evaluation (EuroSCORE), aortic
valve area, mean pressure gradient, left ventricular ejection fraction,
preoperative hemoglobin and platelet levels, and study design had no
significant effects on the results of the meta-analysis. Conclusions
Post-TAVI bleeding, in particular, major bleeding/life-threatening
bleeding, increased 30-day postoperative mortality. Transapical access was
a significant bleeding risk factor. Preexisting AF independently
correlated with TAVI-associated bleeding, likely because of AF-related
anticoagulation. Recognition of the importance and determinants of
post-TAVI bleeding should lead to strategies to improve
outcomes.<br/>Copyright &#xa9; 2016 Canadian Cardiovascular Society

<11>
Accession Number
614058179
Author
Bennett M.; Parkash R.; Nery P.; Senechal M.; Mondesert B.; Birnie D.;
Sterns L.D.; Rinne C.; Exner D.; Philippon F.; Campbell D.; Cox J.; Dorian
P.; Essebag V.; Krahn A.; Manlucu J.; Molin F.; Slawnych M.; Talajic M.
Institution
(Bennett, Krahn) University of British Columbia, Vancouver, British
Columbia, Canada
(Parkash, Cox) Faculty of Medicine, Dalhousie University, Halifax, Nova
Scotia, Canada
(Nery, Birnie) Ottawa Heart Institute, University of Ottawa, Ottawa,
Ontario, Canada
(Senechal, Philippon, Molin) Quebec Heart and Lung Institute, Laval
University, Quebec, Quebec, Canada
(Mondesert, Talajic) Montreal Heart Institute, University of Montreal,
Montreal, Quebec, Canada
(Sterns) Island Medical Program, University of British Columbia,
Vancouver, British Columbia, Canada
(Rinne) St Mary's General Hospital, Kitchener, Ontario, Canada
(Exner, Slawnych) Libin Cardiovascular Institute of Alberta, University of
Calgary, Calgary, Alberta, Canada
(Campbell) Kingston General Hospital, Kingston, Ontario, Canada
(Dorian) St Michael's Hospital, University of Toronto, Toronto, Ontario,
Canada
(Essebag) McGill University Health Centre, Montreal, Quebec, Canada
(Manlucu) London Cardiac Institute, University of Western Ontario, London,
Ontario, Canada
Title
Canadian Cardiovascular Society/Canadian Heart Rhythm Society 2016
Implantable Cardioverter-Defibrillator Guidelines.
Source
Canadian Journal of Cardiology. 33 (2) (pp 174-188), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Pulsus Group Inc.
Abstract
Sudden cardiac death is a major public health issue in Canada. However,
despite the overwhelming evidence to support the use of implantable
cardioverter defibrillators (ICDs) in the prevention of cardiac death
there remains significant variability in implantation rates across Canada.
Since the most recent Canadian Cardiovascular Society position statement
on ICD use in Canada in 2005, there has been a plethora of new scientific
information to assist physicians in their discussions with patients
considered for ICD implantation to prevent sudden cardiac death due to
ventricular arrhythmias. We have reviewed, critically appraised, and
synthesized the pertinent evidence to develop recommendations regarding:
(1) ICD implantation in the primary and secondary prevention of sudden
cardiac death in patients with and without ischemic heart disease; (2)
when it is reasonable to withhold ICD implantation on the basis of
comorbidities; (3) ICD implantation in patients listed for heart
transplantation; (4) implantation of a single- vs dual-chamber ICD; (5)
implantation of single- vs dual-coil ICD leads; (6) the role of
subcutaneous ICDs; and (7) ICD implantation infection prevention
strategies. We expect that this document, in combination with the
companion article that addresses the implementation of these guidelines,
will assist all medical professionals with the care of patients who have
had or at risk of sudden cardiac death.<br/>Copyright &#xa9; 2016 Canadian
Cardiovascular Society

<12>
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Accession Number
612362801
Author
Urbinati A.; Pellicori P.; Guerra F.; Capucci A.; Clark A.L.
Institution
(Urbinati, Pellicori, Guerra, Capucci, Clark) Castle Hill Hospital,
Cottingham, United Kingdom
(Urbinati, Pellicori, Guerra, Capucci, Clark) Ospedali Riuniti di Ancona,
Ancona, Italy
Title
Takotsubo syndrome in the paediatric population: A case report and a
systematic review.
Source
Journal of Cardiovascular Medicine. 18 (4) (pp 262-267), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
We describe the case of a takotsubo syndrome in a 12-year-old male patient
following an acute intracranial haemorrhage, which had a favourable
outcome. We also performed a systematic review of published case reports
in patients younger than 18 years. Although takotsubo syndrome is common
in postmenopausal women, in the paediatric population it equally affects
both sexes. Compared with adults, paediatric patients more commonly
present with heart failure symptoms or loss of consciousness. A higher
proportion of paediatric patients have ST segment depression on ECG.
Moreover, in younger patients, a high proportion has nonapical anatomical
variants and more severe left ventricular impairment. The increase in
troponin and the decrease in left ventricular ejection fraction, the
prevalence of neurological or psychological disorders, and in-hospital
outcome are similar between adults and children.<br/>Copyright &#xa9; 2017
Italian Federation of Cardiology. All rights reserved.

<13>
[Use Link to view the full text]
Accession Number
617588677
Author
Kim T.; Park S.Y.; Lee H.-J.; Kim S.-M.; Sung H.; Chong Y.P.; Lee S.-O.;
Choi S.-H.; Kim Y.S.; Woo J.H.; Kim S.-H.
Institution
(Kim, Lee, Kim, Chong, Lee, Choi, Kim, Woo, Kim) Department of Infectious
Diseases, Asan Medical Center, University of Ulsan, College of Medicine,
88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
(Kim) Division of Infectious Diseases, Department of Internal Medicine,
Gyeongsang National University Hospital, Gyeongsang National University,
School of Medicine, Jinju, South Korea
(Park) Division of Infectious Diseases, Department of Internal Medicine,
Soonchunhyang University, Seoul Hospital, College of Medicine, Seoul,
South Korea
(Sung) Department of Laboratory Medicine, Asan Medical Center, University
of Ulsan, College of Medicine, Seoul, South Korea
Title
Assessment of cytomegalovirus and cell-mediated immunity for predicting
outcomes in non-HIV-infected patients with Pneumocystis jirovecii
pneumonia.
Source
Medicine (United States). 96 (30) (no pagination), 2017. Article Number:
e7243. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The clinical importance of pulmonary cytomegalovirus (CMV) co-infection in
patients with Pneumocystis jirovecii pneumonia (PCP) is uncertain. We
therefore determined the association of CMV infection with outcomes in
non-HIV-infected patients with PCP by assessing CMV viral load and
CMV-specific T-cell response. We prospectively enrolled all
non-HIV-infected patients with confirmed PCP, over a 2-year period.
Real-time polymerase chain reaction from bronchoalveolar lavage was
performed to measure CMV viral load, and CMV enzyme-linked immunospot
assays of peripheral blood were used to measure CMV-specific T-cell
responses. The primary outcome was 30-day mortality. A total of 76
patients were finally analyzed. The mortality in patients with high BAL
CMV viral load (>2.52 log copies/mL, 6/32 [18%]) showed a nonsignificant
trend to be higher than in those with low CMV viral load (2/44 [5%],
P=.13). However, the mortality in patients with low CMV-specific T-cell
responses (<5spots/2.0x10⁵ PBMC, 6/29 [21%]) was significantly
higher than in patients with high CMV-specific T-cell response (2/47 [4%],
P=.048). Moreover, the 2 strata with high CMV viral load and low
CMV-specific T-cell responses (4/14 [29%]) and low CMV viral load and low
CMV-specific T-cell responses (2/15 [13%]) had poorer outcomes than the 2
strata with high CMV viral load and high CMV-specific T-cell responses
(2/18 [11%]) and low CMV viral load and high CMV-specific T-cell responses
(0/29 [0%]). These data suggest that the CMV replication and impaired
CMV-specific T-cell responses adversely affect the outcomes in non-
HIV-infected patients with PCP.<br/>Copyright &#xa9; 2017 the Author(s).
Published by Wolters Kluwer Health, Inc.

<14>
Accession Number
616133199
Author
Jahangirifard A.; Razavi M.R.; Ahmadi Z.H.; Forozeshfard M.
Institution
(Jahangirifard) Cardiac Anesthesiology, Tracheal Diseases Research Center,
NRITLD, Shaheed Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Razavi) Nursing Care Research Center, Semnan University of Medical
Sciences, Semnan, Iran, Islamic Republic of
(Ahmadi) Department of Surgery, Masih Daneshvari Hospital, Shaheed
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Forozeshfard) Cancer Research Center and Department of Anesthesiology,
Semnan University of Medical Sciences, Semnan, Iran, Islamic Republic of
Title
Effect of Desmopressin on the Amount of Bleeding and Transfusion
Requirements in Patients Undergoing Heart Transplant Surgery.
Source
Basic and Clinical Pharmacology and Toxicology. 121 (3) (pp 175-180),
2017. Date of Publication: September 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
One of the most common risks after a heart transplant is bleeding. In this
study, the effect of desmopressin administration on the amount of bleeding
and transfusion requirements after heart transplant surgery was
investigated. In a double-blind clinical trial, 48 patients who were
candidates for heart transplant surgery were randomly assigned to two
groups. In the intervention group, patients received desmopressin of 0.3
mug/kg, 30 min. before surgery. Patients in the control group received
normal saline at the same amount and time. Homeostasis was evaluated using
activated clotting time (ACT), PT, PTT and PLT before, 12 and 24 hr after
surgery, and also, chest tube drainage, blood products transfusion
requirements during the first day in both groups. No significant
differences were found between the groups in terms of ACT, PT, PTT and PLT
at all times. Transfusion of packed red blood cells and the mean drainages
of chest tube during the first 24 hr after surgery were significantly
lower in the desmopressin group compared to the saline group. Desmopressin
may reduce post-operative bleeding in patients undergoing heart transplant
surgery. Further studies are required to confirm the potential effect of
desmopressin on establishing haemostasis after heart
transplantation.<br/>Copyright &#xa9; 2017 Nordic Association for the
Publication of BCPT (former Nordic Pharmacological Society)

<15>
Accession Number
617795495
Author
Li Q.; Zhang X.; Wu J.; Xu M.
Institution
(Li, Zhang, Wu, Xu) Department of Anesthesiology of Shanghai Chest
Hospital, Shanghai Jiaotong University, Shanghai 200030, China
Title
Two-minute disconnection technique with a double-lumen tube to speed the
collapse of the non-ventilated lung for one-lung ventilation in
thoracoscopic surgery.
Source
BMC Anesthesiology. 17 (1) (no pagination), 2017. Article Number: 80. Date
of Publication: 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Thoracic surgery requires the effective collapse of the
non-ventilated lung. In the majority of cases, we accomplished,
accelerated lung collapse using a double-lumen tube (DLT). We hypothesized
that using the twominute disconnection technique with a DLT would improve
lung collapse during subsequent one-lung ventilation. Methods: Fifty
patients undergoing thoracoscopic surgery with physical classification I
or II according to the American Society of Anesthesiologists were randomly
divided into two groups for respiratory management of one-lung ventilation
(OLV). In group N, OLV was initiated after the DLT was disconnected for 2
min; the initiation time began when the surgeon made the skin incision. In
group C, OLV was initiated when the surgeon commenced the skin incision
and scored the quality of lung collapse (using a four-point ordinal
scale). The surgeon's satisfaction or comfort with the surgical conditions
was assessed using a visual analogue scale. rSO<inf>2</inf> level, mean
arterial pressure, pulse oxygen saturation, arterial blood gas analysis,
intraoperative hypoxaemia, intraoperative use of CPAP during OLV, and
awakening time were determined in patients at the following time points:
while inhaling air (T<inf>0</inf>), after anaesthesia induction
andinhaling 100% oxygen in the supine position under double lung
ventilation for five mins (T<inf>1</inf>), at two mins after skin incision
(T<inf>2</inf>), at ten mins after skin incision (T<inf>3</inf>), and
after the lung recruitment manoeuvres and inhaling 50% oxygen for five
mins (T<inf>4</inf>). Results: The two-minute disconnection technique was
associated with a significantly shorter time to total lung collapse
compared to that of the conventional OLV ventilation method (15 mins vs 22
mins, respectively; P < 0.001), and the overall surgeon's satisfaction was
higher (9 vs 7, respectively; P < 0.001). At T<inf>2</inf>, the
PaCO<inf>2</inf>, left rSO<inf>2</inf> and right rSO<inf>2</inf> were
higher in group N than in group C. There were no statistically significant
differences between the incidence of intraoperative hypoxaemia and
intraoperative use of CPAP during OLV (10% vs 5%, respectively; P =
1.000), duration of awakening (18 mins vs 19 mins, respectively; P =
0.616). Conclusions: A two-minute disconnection technique using a
double-lumen tube was used to speed the collapse of the non-ventilated
lung during one-lung ventilation for thoracoscopic surgery. The surgeon
was satisfied with the surgical conditions.<br/>Copyright &#xa9; The
Author(s). 2017.

<16>
Accession Number
617792696
Author
Zou H.; Hong Q.; Xu G.
Institution
(Zou) Medical Center of the Graduate School, Nanchang University,
Nanchang, China
(Hong) Science and Technology College, Jiangxi University of Traditional
Chinese Medicine, Nanchang, China
(Zou, Xu) Department of Nephrology, The Second Affiliated Hospital of
Nanchang University, No. 1, Minde Road, Donghu District, Nanchang 330006,
China
Title
Early versus late initiation of renal replacement therapy impacts
mortality in patients with acute kidney injury post cardiac surgery: A
meta-analysis.
Source
Critical Care. 21 (1) (no pagination), 2017. Article Number: 150. Date of
Publication: 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Acute kidney injury (AKI) is a common clinical complication of
cardiac surgery and increases mortality and hospitalization. We aimed to
explore and perform an updated meta-analysis of qualitative and
quantitative evaluations of the relationship between early renal
replacement therapy (RRT) and mortality. Methods: We searched the Chinese
Biomedical Database, the Cochrane Library, EMBASE, Global Health, MEDLINE
and PubMed. Results: Fifteen studies (five randomized controlled trials
(RCTs), one prospective cohort and nine retrospective cohorts) including
1479 patients were identified for detailed evaluation. The meta-analysis
suggested that early RRT initiation reduced 28-day mortality (odds ratio
(OR) 0.36; 95% confidence interval (CI) 0.23 to 0.57; I² 60%),
and shortened intensive care unit (ICU) length of stay (LOS) (mean
difference (MD) -2.50; 95% CI -3.53 to -1.47; I2 88%) and hospital LOS (MD
-0.69; 95% CI -1.13 to -0.25; I² 88%), and also reduced the
duration of RRT (MD -1.18; 95% CI -2.26 to -0.11; I² 69%),
especially when RRT was initiated early within 12 hours (OR 0.23; 95% CI
0.08 to 0.63; I² 73%) and within 24 hours (OR 0.52; 95% CI 0.28
to 0.95; I² 58%) in patients with AKI after cardiac surgery.
Conclusions: Early RRT initiation decreased 28-day mortality, especially
when it was started within 24 hours after cardiac surgery in patients with
AKI.<br/>Copyright &#xa9; The Author(s). 2017.

<17>
Accession Number
617808787
Author
Mojoli M.; Gersh B.J.; Barioli A.; Masiero G.; Tellaroli P.; D'Amico G.;
Tarantini G.
Institution
(Mojoli, Barioli, Masiero, D'Amico, Tarantini) Cardiology Unit, Department
of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical
School, Padua, Italy
(Gersh) Division of Cardiovascular Diseases, Mayo Clinic and Mayo Clinic
College of Medicine, Rochester, MN, United States
(Tellaroli) Epidemiology and Public Health Unit, Department of Cardiac,
Thoracic and Vascular Sciences, University of Padua Medical School, Padua,
Italy
Title
Impact of atrial fibrillation on outcomes of patients treated by
transcatheter aortic valve implantation: A systematic review and
meta-analysis.
Source
American Heart Journal. 192 (pp 64-75), 2017. Date of Publication: October
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Conflicting data have been reported related to the impact of
atrial fibrillation (AF) on the outcomes after transcatheter aortic valve
implantation (TAVI). We aimed to assess the prognosis of TAVI-treated
patients according to the presence of pre-existing or new-onset AF.
Methods Studies published between April 2002 and November 2016 and
reporting outcomes of pre-existing AF, new-onset AF, or sinus rhythm in
patients undergoing TAVI were identified with an electronic search.
Pairwise and network meta-analysis were performed. Outcomes of interest
were short- and long-term mortality, stroke, and major bleeding. Results
Eleven studies (11,033 individuals) were eligible. Compared to sinus
rhythm, short-term and long-term mortality were significantly higher in
new-onset AF (short-term OR 2.9, P = .002; long-term OR 2.3, P < .0001)
and pre-existing AF groups (short-term OR 2.7, P = .004; long-term OR 2.8,
P < .0001). Compared to sinus rhythm, new-onset AF increased the risk of
stroke at early (OR 2.1, P < .0001) and late follow-up (OR 1.92, P <
.0001), and the risk of early bleedings (OR 1.65, P = .002), while
pre-existing AF increased the risk of late stroke (OR 1.3, P = 0.03), but
not the risk of bleeding. Compared to pre-existing AF, new-onset AF
correlated with higher risk of early stroke (OR 1.7, P = .002) and major
bleedings (OR 1.7, P = .002). Conclusions AF is associated with impaired
outcomes after TAVI, including mortality, stroke and (limited to new-onset
AF) major bleedings. Compared to pre-existing AF, new-onset AF correlates
with higher risk of early stroke and major bleedings. Improved management
of AF in the TAVI setting, including tailored antithrombotic treatment
strategies, remains a relevant need.<br/>Copyright &#xa9; 2017 Elsevier
Inc.

<18>
Accession Number
617805363
Author
Prior D.L.; Stevens S.R.; Holly T.A.; Krejca M.; Paraforos A.; Pohost
G.M.; Byrd K.; Kukulski T.; Jones R.H.; Desvigne-Nickens P.; Varadarajan
P.; Amanullah A.; Lin G.; Al-Khalidi H.R.; Aldea G.; Santambrogio C.;
Bochenek A.; Berman D.S.
Institution
(Prior) Department of Medicine, St. Vincent's Hospital, University of
Melbourne, Melbourne, Australia
(Stevens, Byrd, Jones, Al-Khalidi) Duke Clinical Research Institute (SRS
RHJ, HRA), Department of Surgery Cardiothoracic (RHJ), Duke University
School of Medicine, Durham, NC, United States
(Holly) Department of Medicine-Cardiology, Northwestern University
Feinberg School of Medicine, Chicago, IL, United States
(Krejca, Bochenek) 1st Cardiac Surgery Department, Medical University of
Silesia, Katowice, Poland
(Paraforos) Department of Surgery-Cardiac, University of Trier, Trier,
Germany
(Pohost) Department of Medicine-Cardiology, University of Southern
California, Los Angeles, CA, United States
(Kukulski) Department of Cardiology, SMDZ in Zabrze, Medical University of
Silesia Katowice, Silesian Center for Heart Diseases, Zabrze, Poland
(Desvigne-Nickens) National Heart Lung and Blood Institute, National
Institutes of Health, Bethesda, MD, United States
(Varadarajan) Department of Medicine-Cardiology, Loma Linda University
Medical Center, Loma Linda, CA, United States
(Amanullah) Department of Medicine-Cardiology, Albert Einstein Medical
Center, Philadelphia, PA, United States
(Lin) Department of Medicine-Cardiology, Mayo Clinic, Rochester, NY,
United States
(Aldea) Department of Surgery-Cardiothoracic, University of Washington
Medical Center, Seattle, WA, United States
(Santambrogio) Department of Medicine-Cardiology, Policlinico San Donato,
Milan, Italy
(Berman) Department of Medicine-Nuclear Cardiology, Cedars-Sinai Medical
Center, Los Angeles, CA, United States
(Berman) Department of Cardiology, St. Vincent's Hospital, PO Box 2900,
Fitzroy, VIC 3065, Australia
Title
Regional left ventricular function does not predict survival in ischaemic
cardiomyopathy after cardiac surgery.
Source
Heart. 103 (17) (pp 1359-1367), 2017. Date of Publication: 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives To define the prognostic contribution of global and regional
left ventricular (LV) function measurements in patients with ischaemic
cardiomyopathy randomised to coronary artery bypass graft surgery (CABG)
with (n=501) or without (n=499) surgical ventricular reconstruction (SVR).
Methods Novel multivariable methods to analyse global and regional LV
systolic function were used to better formulate prediction models for
long-term mortality following CABG with or without SVR in the entire
cohort of 1000 randomised SVR hypothesis patients. Key clinical variables
were included in the analysis. Regional function was classified according
to the discreteness of anteroapical hypokinesia and akinesia into those
most likely to benefit from SVR, those least likely and those felt to have
intermediate likelihood of benefit from SVR. Results The most prognostic
clinical variables identified in multivariable models include creatinine,
LV end-systolic volume index (ESVI), age and NYHA (New York Heart
Association) class. Addition of LV ejection fraction, LV end-diastolic
volume index and regional function assessment did not contribute
additional power to the model. Subgroup analysis based on regional
function did not identify a cohort in which SVR improved mortality.
Conclusions ESVI is the single parameter of LV function most predictive of
mortality in patients with LV systolic dysfunction following CABG with or
without SVR in multivariable models that include all key clinical and LV
systolic function parameters. Assessment of regional cardiac function does
not enhance prediction of mortality nor identify a subgroup for which SVR
improves mortality. These results do not support elective addition of LV
reconstruction surgery in patients undergoing CABG. Trial registration
number NCT00023595.<br/>Copyright &#xa9; Article author(s) (or their
employer(s) unless otherwise stated in the text of the article) 2017. All
rights reserved. No commercial use is permitted unless otherwise expressly
granted.

<19>
Accession Number
617896668
Author
Mollmann H.; Linke A.; Holzhey D.M.; Walther T.; Manoharan G.; Schafer U.;
Heinz-Kuck K.; Van Boven A.J.; Redwood S.R.; Kovac J.; Butter C.;
Sondergaard L.; Lauten A.; Schymik G.; Worthley S.G.
Institution
(Mollmann) St. Johannes Hospital, Dortmund, Germany
(Linke, Holzhey) Herzzentrum Leipzig, Leipzig, Germany
(Walther) Kerckhoff Klinik, Bad Nauheim, Germany
(Manoharan) Royal Victoria Hospital, Belfast, United Kingdom
(Schafer) University Heart Center Hamburg, Hamburg, Germany
(Heinz-Kuck) Asklepios Kliniken, Hamburg, Germany
(Van Boven) MC Leeuwarden, Leeuwarden, Netherlands
(Redwood) St. Thomas' Hospital, London, United Kingdom
(Kovac) Glenfield Hospital, Leicester, United Kingdom
(Butter) Heart Center of Bernau, Bernau, Germany
(Sondergaard) Righospitalet University of Copenhagen, Copenhagen, Denmark
(Lauten) Department of Cardiology, Charite - Universitaetsmedizin Berlin,
Berlin, Germany
(Schymik) Medical Clinic IV, Department of Cardiology, Municipal Hospital
Karlsruhe, Karlsruhe, Germany
(Worthley) GenesisCare, Adelaide, Australia
Title
Implantation and 30-Day Follow-Up on All 4 Valve Sizes Within the Portico
Transcatheter Aortic Bioprosthetic Family.
Source
JACC: Cardiovascular Interventions. 10 (15) (pp 1538-1547), 2017. Date of
Publication: 14 Aug 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to evaluate the short-term safety and
performance of the full range of valve sizes offered within the Portico
transcatheter aortic valve replacement system. Background The Portico
transcatheter aortic heart valve is a fully resheathable, repositionable,
and self-expanding bioprosthesis designed to achieve optimal valve
position and hemodynamic performance and limit conduction disturbances.
Methods Patients (n = 222) with symptomatic (New York Heart Association
functional class >=II) severe aortic stenosis considered by a
multidisciplinary heart team to be at high surgical risk were recruited
between December 2011 and September 2015 in this prospective,
nonrandomized, multicenter study. Patients were implanted with the full
range of Portico heart valves (23, 25, 27, and 29 mm) using the
transfemoral approach. The primary endpoint was all-cause mortality at 30
days. Secondary endpoints included valve performance, improvement in
functional class, and procedural outcomes as defined by Valve Academic
Research Consortium criteria. Results A total of 220 patients (mean age
83.0 +/- 4.6 years, 74.3% women, mean Society of Thoracic Surgeons score
5.8%) had valves implanted. All resheathing and repositioning attempts (n
= 72) were successful. At 30 days, all-cause mortality was 3.6%.
Procedural outcomes included disabling (major) stroke (3.2%), major
vascular complications (7.2%), and permanent pacemaker implantation
(13.5%). Compared with baseline, 75.8% of patients improved by >=1 New
York Heart Association functional class at 30 days. The rate of moderate
paravalvular leak was 5.7%, with no severe paravalvular leak reported. No
differences in paravalvular leak incidence and severity were observed
among valve sizes (p = 0.24). Conclusions Across all valve sizes, use of
the repositionable Portico transcatheter aortic valve replacement system
resulted in safe and effective treatment of aortic stenosis in high-risk
patients.<br/>Copyright &#xa9; 2017

<20>
[Use Link to view the full text]
Accession Number
617894800
Author
Ruel M.; Kawajiri H.; Glineur D.; Grau J.; Gaudino M.; Verma S.
Institution
(Ruel, Kawajiri, Glineur, Grau) Division of Cardiac Surgery, University of
Ottawa Heart Institute, 3402-40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
(Gaudino) Department of Cardiothoracic Surgery, Weill-Cornell Medical
Center, New York City, NY, United States
(Verma) Department of Surgery, Division of Cardiac Surgery, St. Michael's
Hospital, Toronto, ON, Canada
Title
Left main coronary stenosis: Surgery still reigns.
Source
Current Opinion in Cardiology. 32 (5) (pp 590-593), 2017. Date of
Publication: 01 Sep 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose of review Coronary artery bypass grafting (CABG) has been regarded
as the mainstream treatment for unprotected left main coronary artery
(ULMCA) stenosis. However, the results of the Evaluation of XIENCE versus
Coronary Artery Bypass Surgery for Effectiveness of Left Main
Revascularization (EXCEL) trial, in which percutaneous coronary
intervention (PCI) was deemed noninferior to CABG, have raised a question
whether the guidelines should be changed. This article provides a critical
appraisal of recent randomized control trials (RCTs) on ULMCA stenosis.
Recent findings In contrast to EXCEL trial, another large RCT named the
Nordic-Baltic-British Left Main Revascularization trial showed that PCI is
inferior to CABG in patients treated for ULMCA stenosis. The reason for
the discrepancy between these two RCTs may be due to differences in study
design. In EXCEL trial, the adoption of new periprocedural myocardial
infarction definition, the noninclusion of target vessel revascularization
as a primary endpoint component, and the timeline of the study may have
helped claim that PCI is noninferior to CABG. Summary The long-term
efficacy of PCI for ULMCA stenosis has not yet been demonstrated. Further
studies and follow-up data are needed before the indications for PCI are
expanded in this scenario.<br/>Copyright &#xa9; 2017 Wolters Kluwer
Health, Inc. All rights reserved.

<21>
Accession Number
617901730
Author
Praz F.; Spargias K.; Chrissoheris M.; Bullesfeld L.; Nickenig G.; Deuschl
F.; Schueler R.; Fam N.P.; Moss R.; Makar M.; Boone R.; Edwards J.;
Moschovitis A.; Kar S.; Webb J.; Schafer U.; Feldman T.; Windecker S.
Institution
(Praz, Moschovitis, Windecker) Department of Cardiology, University
Hospital Bern, Bern, Switzerland
(Spargias, Chrissoheris) Department of Transcatheter Heart Valves, Hygeia
Hospital, Athens, Greece
(Bullesfeld) Department of Internal Medicine and Cardiology, GFO Hospitals
Bonn, Bonn, Germany
(Nickenig, Schueler) Department of Medicine II, Heart Center Bonn,
University Hospital Bonn, Bonn, Germany
(Deuschl, Schafer) Department of General and Interventional Cardiology,
University Heart Center Hamburg, Hamburg, Germany
(Fam, Edwards) St Michael's Hospital, Division of Cardiology, University
of Toronto, Toronto, ON, Canada
(Moss, Boone, Webb) St Paul's Hospital, University of British Columbia,
Vancouver, BC, Canada
(Makar, Kar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Feldman) Department of Cardiology, Evanston Hospital, NorthShore
University Health System, Evanston, IL, United States
Title
Compassionate use of the PASCAL transcatheter mitral valve repair system
for patients with severe mitral regurgitation: a multicentre, prospective,
observational, first-in-man study.
Source
The Lancet. 390 (10096) (pp 773-780), 2017. Date of Publication: 19 - 25
August 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Severe mitral regurgitation is associated with impaired
prognosis if left untreated. Using the devices currently available,
transcatheter mitral valve repair (TMVr) remains challenging in complex
anatomical situations. We report the procedural and 30-day results of the
first-in-man study of the Edwards PASCAL TMVr system. Methods In this
multicentre, prospective, observational, first-in-man study, we collected
data from seven tertiary care hospitals in five countries that had a
compassionate use programme in which patients underwent transcatheter
mitral valve repair using the Edwards PASCAL TMVr system. Eligible
patients were those with symptomatic, severe functional, degenerative, or
mixed mitral regurgitation deemed at high risk or inoperable. Safety and
efficacy of the procedure were prospectively assessed at device
implantation, discharge, and 30 days after device implantation. The key
study endpoints were technical success assessed at the end of the
procedure and device success 30 days after implantation using the Mitral
Valve Academic Research Consortium definitions. Findings Between Sept 1,
2016, and March 31, 2017, 23 patients (median age 75 years [IQR 61-82])
had treatment for moderate-to-severe (grade 3+) or severe (grade 4+)
mitral regurgitation using the Edwards PASCAL TMVr system. At baseline,
the median EuroScore II score was 7.1% (IQR 3.6-12.8) and the median
Society of Thoracic Surgeons predicted risk of mortality for mitral valve
repair was 4.8% (2.1-9.0) and 6.8% (2.9-10.1) for mitral valve
replacement. 22 (96%) of 23 patients were New York Heart Association
(NYHA) class III or IV at baseline. The implantation of at least one
device was successful in all patients, resulting in procedural residual
mitral regurgitation of grade 2+ or less in 22 (96%) patients. Six (26%)
of 23 patients had two implants. Periprocedural complications occurred in
two (9%) of 23 patients (one minor bleeding event and one transient
ischaemic attack). Despite the anatomical complexity of mitral
regurgitation in the patients in this compassionate use cohort, technical
success was achieved in 22 (96%) of 23 patients, and device success at 30
days was achieved in 18 (78%) patients. Three patients (13%) died during
the 30 day follow-up. 19 (95%) of 20 patients alive 30 days after
implantation were NYHA class I or II. Interpretation This study
establishes feasibility of the Edwards PASCAL TMVr system with a high rate
of technical success and reduction of mitral regurgitation severity.
Further research is needed on procedural and long-term clinical outcomes.
Funding None.<br/>Copyright &#xa9; 2017 Elsevier Ltd

<22>
Accession Number
617902108
Author
Hong S.S.; Alison J.A.; Milross M.A.; Robledo K.; Dignan R.
Institution
(Hong) Physiotherapy Department, Liverpool Hospital, Elizabeth Street,
Liverpool, Sydney, NSW 2170, Australia
(Alison, Milross) Discipline of Physiotherapy, University of Sydney,
Sydney, Australia
(Alison) Department of Physiotherapy, Royal Prince Alfred Hospital,
Australia
(Dignan) Department of Cardiothoracic Surgery, Liverpool Hospital and
University of New South Wales, Sydney, Australia
(Robledo) NHMRC Clinical Trials Centre, University of Sydney, Sydney,
Australia
Title
Does continuous infusion of local anaesthesia improve pain control and
walking distance after coronary artery bypass graft surgery? A randomised
controlled trial.
Source
Physiotherapy (United Kingdom). (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Objectives: To evaluate the effects of continuous infusion of ropivacaine
compared to sham infusion or usual care on pain scores before and after
physiotherapy treatment, distance walked and time to discharge from
physiotherapy, after coronary artery bypass graft (CABG) surgery. Design:
Prospective, randomised, double blind controlled trial. Setting and
participants: Seventy-five participants who underwent CABG surgery with
left internal mammary artery grafts were allocated, to the ropivacaine
group (n = 26), the sham group (n = 25), or usual care group (n = 24).
Participants in the ropivacaine group received 0.5% ropivacaine and
participants in the sham group received normal saline, both as continuous
infusions via two parasternally tunnelled catheters for 96. hours
continuously. The usual care group did not receive a device. All groups
had patient-controlled analgesia and/or oral analgesia. Results:
Seventy-two participants completed the study. There was no significant
between-group differences in pain scores, distance walked on any post
operative day (POD) or number of participants discharged from
physiotherapy by POD 4. For the group as a whole there was a significant
linear decrease in pain score from mean (SD) 42 (24) mm on POD1 to 15 (16)
mm on POD4 (p. <. 0.001), (MD 27. mm, 95% CI 22 to 32) and walking
distance increased from 1 (5) m on POD1 to 183 (239) m on POD4 (p. <.
0.001) MD 181. m, 95% CI 126 to 236). Conclusion: Infusion of ropivacaine
post CABG surgery was unable to reduce pain, increase distance walked or
reduce time to physiotherapy discharge compared to sham or usual
care.Trial registration number ACTRN12612001243808.<br/>Copyright &#xa9;
2017 Chartered Society of Physiotherapy.

<23>
Accession Number
617172990
Author
Huang P.; Yu Y.; Han X.; Yang Y.
Institution
(Huang, Han, Yang) State Key Laboratory of Cardiovascular Disease, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences & Peking Union Medical College, Beijing 100037, China
(Yu) National Clinical Research Center of Cardiovascular Diseases, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences & Peking Union Medical College, Beijing 100037, China
Title
Efficacy of Short-term Dual Antiplatelet Therapy after Implantation of
Second-generation Drug-eluting Stents: A Meta-analysis and Systematic
Review.
Source
Chinese Medical Sciences Journal. 32 (1) (pp 1-12), 2017. Date of
Publication: March 2017.
Publisher
Elsevier Ltd
Abstract
Objective The benefit of short-term dual antiplatelet therapy (DAPT)
following second-generation drug-eluting stents implantation has not been
systematically evaluated. To bridge the knowledge gap, we did a
meta-analysis to assess the efficacy of <=6 months versus >=12 months DAPT
among patients with second-generation drug-eluting stents. Methods We
searched online databases and identified randomized controlled trials that
assess the clinical impact of short-term DAPT (<=6 months) published
before March 3, 2016. The efficacy endpoints included the incidence of
all-cause death, myocardial infarction, cerebrovascular accidents, and
definite or probable stent thrombosis. Safety endpoint defined as major
bleeding was also evaluated and discussed. Results We included 5 trials
that randomized 9473 participants (49.8%, short-term DAPT duration vs.
50.2%, standard duration). A total of 9445 (99.7%) patients reported the
efficacy endpoints, and the safety endpoint was available from 4 studies
(n=8457). There was no significant difference in efficacy endpoints
between short-term and standard DAPT duration (>=12 months) [risk ratio
(RR) 0.96; 95% confidence intervals (CI), 0.80-1.15]. Short-term DAPT
duration did not significantly increase the individual risk of all-cause
death, myocardial infarction, cerebrovascular accidents, or definite or
probable stent thrombosis. Although short-term DAPT obviously reduced risk
of major bleeding compared with standard DAPT (RR 0.53; 95% CI,
0.29-0.96), significant publication bias was found when accessing the
safety endpoint of the 4 studies (Egger's test, P=0.009). Conclusions The
efficacy of short-term DAPT was comparable with that of standard duration
DAPT. DAPT less than 6 months may be appropriate for patients receiving
second-generation drug-eluting stents implantation.<br/>Copyright &#xa9;
2017 Chinese Academy Medical Sciences

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

<25>
Accession Number
615948942
Author
Koulaxouzidis G.; Toufektzian L.; Ashrafian L.; Veres K.
Institution
(Koulaxouzidis) Department of Cardiothoracic Surgery, Freeman Hospital,
Newcastle upon Tyne, United Kingdom
(Toufektzian, Ashrafian, Veres) Department of Thoracic Surgery, Guy's
Hospital, London, United Kingdom
Title
Does the addition of postoperative radiotherapy to adjuvant chemotherapy
offer any benefit in patients with non-small cell lung cancer and
mediastinal lymphadenopathy?.
Source
Interactive Cardiovascular and Thoracic Surgery. 24 (4) (pp 625-630),
2017. Date of Publication: 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether the addition of
postoperative radiotherapy (PORT) to adjuvant chemotherapy offers any
benefit in patients undergoing curative resection for non-small cell lung
cancer found to harbour mediastinal lymphadenopathy. A total of 77 papers
were identified using the reported search, of which 11 represented the
best evidence to answer the clinical question. Only studies reporting on
survival data of patients receiving adjuvant chemotherapy with and without
PORT were included in this analysis. The authors, date, journal, country,
study type, population, outcomes and key results are tabulated. Six
studies reported a statistically significant positive impact of PORT on
long-Term or disease-free survival (DFS) (P = 0.048-0.0001). Five more
studies found no difference in terms of survival between patients
receiving and not receiving PORT. Among the 11 studies, only two were
randomized controlled, with one of them reporting improved disease-free (P
= 0.041) but not overall survival (P = 0.073), while the other finding no
difference in survival. Furthermore, three more studies reported on DFS
and/or locoregional recurrence of the disease. One of these studies
reported a significantly improved DFS among patients receiving PORT (P =
0.003), while two of them reported a reduced rate of locoregional
recurrence in this group (P = 0.032-0.009). Many studies report a positive
effect of PORT when combined in parallel or sequentially with adjuvant
chemotherapy in terms of long-Term, disease free survival or locoregional
control of the disease in patients who have undergone surgical resection
of NSCLC and are found to harbour N2 disease. However, these reports are
counterbalanced by an almost equal number of studies which show no
difference between PORT and no PORT. Only one study reported significantly
increased radiation related adverse effects in patients undergoing
chemotherapy and PORT.<br/>Copyright &#xa9; 2016.The Author.

<26>
Accession Number
615948935
Author
Abdullahi Y.S.; Athanasopoulos L.V.; Casula R.P.; Moscarelli M.; Bagnall
M.; Ashrafian H.; Athanasiou T.
Institution
(Abdullahi, Athanasopoulos, Casula, Athanasiou) Department of
Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith
Hospital, Praed Street, London W2 1NY, United Kingdom
(Moscarelli) GVM Care and Research Unit, Anthea Hospital, Bari, Italy
(Bagnall, Ashrafian, Athanasiou) Department of Surgery and Cancer,
Imperial College London, London, United Kingdom
Title
Systematic review on the predictive ability of frailty assessment measures
in cardiac surgery.
Source
Interactive Cardiovascular and Thoracic Surgery. 24 (4) (pp 619-624),
2017. Date of Publication: 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES: Patient frailty is increasingly recognised as contributing to
adverse postoperative outcomes in cardiothoracic surgery. The goal of this
review is to evaluate the predictive ability of frailty scoring systems
and their limitations in risk assessment of patients undergoing cardiac
surgery. METHODS: Frailty studies were identified by searching electronic
databases. Studies in which the measuring instrument was defined as a
multidimensional tool focusing on a population undergoing cardiac
operations were included. The focus was on the predictive ability of
frailty in this population and a comparison with conventional risk scoring
systems. Unfortunately, the lack of a significant number of studies with
the same postoperative outcome precluded a formal meta-Analysis. RESULTS:
Of 783 studies identified in our initial search, 6 fulfilled our inclusion
criteria. Frailty was identified as a predictor of mortality, morbidity
and/or prolonged hospital stay in patients undergoing cardiac surgery. Our
systematic review revealed the increased application of frailty scores
compared to standardized risk stratification scores in cardiothoracic
patients. In approximately 50% of these studies, frailty scores continued
to be predictive even after adjusting for the conventional risk scoring
systems. CONCLUSIONS: The assessment of frailty may enhance the
preoperative workup and offer an optimized risk stratification measure in
patients undergoing cardiothoracic procedures even though the reporting
standards of calibration and classification measures have been relatively
poor.<br/>Copyright &#xa9; 2016.The Author.

<27>
Accession Number
616670877
Author
Fearon W.F.; Okada K.; Kobashigawa J.A.; Kobayashi Y.; Luikart H.; Sana
S.; Daun T.; Chmura S.A.; Sinha S.; Cohen G.; Honda Y.; Pham M.; Lewis
D.B.; Bernstein D.; Yeung A.C.; Valantine H.A.; Khush K.
Institution
(Fearon, Okada, Kobayashi, Luikart, Sinha, Cohen, Honda, Yeung, Valantine,
Khush) Stanford Cardiovascular Institute and Division of Cardiovascular
Medicine, Stanford, California, United States
(Chmura, Lewis) Department of Pediatrics, Division of Allergy, Immunology,
and Rheumatology, Stanford University School of Medicine, Stanford,
California, United States
(Bernstein) Department of Pediatrics, Division of Cardiology, Stanford
University School of Medicine, Stanford, California, United States
(Kobashigawa, Sana, Daun) Advanced Heart Disease Section, Cedars-Sinai
Heart Institute, Los Angeles, California, United States
(Fearon, Pham) Cardiology Section, Palo Alto Veterans Affairs Health Care
System, Palo Alto, California, United States
Title
Angiotensin-Converting Enzyme Inhibition Early After Heart
Transplantation.
Source
Journal of the American College of Cardiology. 69 (23) (pp 2832-2841),
2017. Date of Publication: 13 Jun 2017.
Publisher
Elsevier USA
Abstract
Background Cardiac allograft vasculopathy (CAV) remains a leading cause of
mortality after heart transplantation (HT). Angiotensin-converting enzyme
inhibitors (ACEIs) may retard the development of CAV but have not been
well studied after HT. Objectives This study tested the safety and
efficacy of the ACEI ramipril on the development of CAV early after HT.
Methods In this prospective, multicenter, randomized, double-blind,
placebo-controlled trial, 96 HT recipients were randomized to undergo
ramipril or placebo therapy. They underwent coronary angiography,
endothelial function testing; measurements of fractional flow reserve
(FFR) and coronary flow reserve (CFR) and the index of microcirculatory
resistance (IMR); and intravascular ultrasonography (IVUS) of the left
anterior descending coronary artery, within 8 weeks of HT. At 1 year, the
invasive assessment was repeated. Circulating endothelial progenitor cells
(EPCs) were quantified at baseline and 1 year. Results Plaque volumes at 1
year were similar between the ramipril and placebo groups (162.1 +/- 70.5
mm³ vs. 177.3 +/- 94.3 mm³, respectively; p = 0.73).
Patients receiving ramipril had improvement in microvascular function as
shown by a significant decrease in IMR (21.4 +/- 14.7 to 14.4 +/- 6.3; p =
0.001) and increase in CFR (3.8 +/- 1.7 to 4.8 +/- 1.5; p = 0.017), from
baseline to 1 year. This did not occur with IMR (17.4 +/- 8.4 to 21.5 +/-
20.0; p = 0.72) or CFR (4.1 +/- 1.8 to 4.1 +/- 2.2; p = 0.60) in the
placebo-treated patients. EPCs decreased significantly at 1 year in the
placebo group but not in the ramipril group. Conclusions Ramipril does not
slow development of epicardial plaque volume but does stabilize levels of
endothelial progenitor cells and improve microvascular function, which
have been associated with improved long-term survival after HT.
(Angiotensin Converting Enzyme [ACE] Inhibition and Cardiac Allograft
Vasculopathy; NCT01078363)<br/>Copyright &#xa9; 2017 American College of
Cardiology Foundation

<28>
Accession Number
615266779
Author
Sardar P.; Giri J.; Elmariah S.; Chatterjee S.; Kolte D.; Kundu A.;
Nairooz R.; Aronow W.S.; Owan T.; Mukherjee D.; Feldman D.N.; Abbott J.D.
Institution
(Sardar, Owan) Division of Cardiovascular Medicine, University of Utah,
Salt Lake City, Utah, United States
(Giri) Cardiovascular Division, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania, United States
(Elmariah) Cardiology Division, Department of Medicine, Massachusetts
General Hospital, Harvard Medical School, Boston, Massachusetts, United
States
(Chatterjee) Cardiology Division, Temple University School of Medicine,
Philadelphia, Pennsylvania, United States
(Kolte, Abbott) Division of Cardiology, Brown Medical School, Rhode Island
Hospital, Providence, Rhode Island, United States
(Kundu) Department of Medicine, University of Massachusetts Medical
School, Worcester, Massachusetts, United States
(Nairooz) Division of Cardiovascular Medicine, University of Arkansas for
Medical Sciences, Little Rock, Arizona, United States
(Aronow) Division of Cardiovascular Medicine, Westchester Medical
Center-New York Medical College, New York, New York, United States
(Mukherjee) Division of Cardiovascular Medicine, Texas Tech University
Health Sciences Center, El Paso, Texas, United States
(Feldman) Division of Cardiology, Weill Cornell Medical College, New York
Presbyterian Hospital, New York, New York, United States
Title
Meta-Analysis of Drug-Eluting Stents Versus Coronary Artery Bypass
Grafting in Unprotected Left Main Coronary Narrowing.
Source
American Journal of Cardiology. 119 (11) (pp 1746-1752), 2017. Date of
Publication: 01 Jun 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Patients with unprotected left main coronary artery (ULMCA) disease are
increasingly treated with percutaneous coronary intervention (PCI) using
new-generation drug-eluting stents (DES); however, the benefits of DES
compared with coronary artery bypass grafting (CABG) in ULMCA remain
controversial. This meta-analysis evaluated the effects of PCI with DES
compared with CABG for the treatment of ULMCA stenosis. Databases were
searched through November 30, 2016. Randomized controlled trials (RCTs)
comparing DES with PCI versus CABG for ULMCA stenosis were identified. We
calculated summary odds ratios (ORs) and 95% CIs with the random-effects
model. The primary outcome was major adverse cardiovascular events,
defined as a composite of death from any cause, stroke, or myocardial
infarction (MI). The analysis included 4,612 patients from 5 RCTs.
Compared with CABG, patients assigned to PCI had a similar rate of major
adverse cardiovascular events (OR 1.06, 95% CI 0.79 to 1.43), all-cause
mortality (OR 1.03, 95% CI 0.79 to 1.35), cardiovascular death (OR 1.03,
95% CI 0.73 to 1.45), stroke (OR 0.81, 95% CI 0.38 to 1.76), and MI (OR
1.47, 95% CI 0.87 to 2.47). The risk of any repeat revascularization was
significantly greater in the PCI group than that in the CABG group (OR
1.85, 95% CI 1.53 to 2.24). In conclusion, our meta-analysis of RCTs
suggest that PCI with DES results in comparable mortality, stroke, and MI
compared with CABG for revascularization of ULMCA stenosis, with PCI
associated with higher rates of repeat revascularization.<br/>Copyright
&#xa9; 2017 Elsevier Inc.

<29>
Accession Number
616602400
Author
Segal A.; Flugelman M.Y.; Khader N.; Rubinshtein R.; Lavi I.; Karmeli R.;
Jubran A.; Shiran A.; Jaffe R.
Institution
(Segal, Flugelman, Khader, Rubinshtein, Jubran, Shiran, Jaffe) Department
of Cardiology, The Lady Davis Carmel Medical Center and the Technion
Institute of Technology IIT, Haifa, Israel
(Lavi) Department of Community Medicine and Epidemiology, The Lady Davis
Carmel Medical Center and the Technion Institute of Technology IIT, Haifa,
Israel
(Karmeli) Department of Vascular Surgery, The Lady Davis Carmel Medical
Center and the Technion Institute of Technology IIT, Haifa, Israel
Title
Outcome of Stent Graft Implantation for Treatment of Access Site Bleeding
After Transfemoral Transcatheter Aortic Valve Replacement.
Source
American Journal of Cardiology. 120 (3) (pp 456-460), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Vascular complications are common after transcatheter aortic valve
replacement (TAVR) and are associated with increased morbidity and
mortality. Stent graft implantation enables percutaneous treatment of
access site bleeding; however, the efficacy and durability and of this
approach are unknown. We studied the immediate outcome of stent graft
implantation for control of access site bleeding and the need for repeat
vascular interventions after stenting, in a cohort of consecutive patients
with severe symptomatic aortic stenosis who underwent transfemoral TAVR.
Predictors of access site complications requiring percutaneous or surgical
vascular repair were identified. Transfemoral TAVR was performed in 194
patients. Access site complications requiring urgent vascular repair
occurred in 34 patients (18%). Stent graft implantation was performed in
31 patients and vascular surgery in 3 patients. When patients who required
surgical or percutaneous vascular repair were compared with those who did
not, increased body mass index (30 +/- 6 vs 28 +/- 5, p = 0.035) and
reduced activated clotting time (233 +/- 47 vs 252 +/- 47, p = 0.030) were
the only predictors of need for vascular repair. Stenting achieved
adequate hemostasis in all patients with a single minor vascular
complication. During median follow-up of 797 days (interquartile range 585
to 1,173), no clinically significant vascular complications were detected
after stenting. In conclusion, control of bleeding was achieved in all
patients who underwent stent graft implantation for treatment of access
site vascular complications after transfemoral TAVR. None of these
patients needed further vascular interventions during
follow-up.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<30>
Accession Number
615885281
Author
Johl M.M.; Malhotra P.; Kehl D.W.; Rader F.; Siegel R.J.
Institution
(Johl, Malhotra) Department of Medicine, Cedars-Sinai Medical Center, Los
Angeles, CA, United States
(Kehl, Rader, Siegel) Heart Institute, Cedars-Sinai Medical Center, 127 S
San Vincente Blvd, AHSP A3417, Los Angeles, CA 90048, United States
Title
Natriuretic peptides in the evaluation and management of degenerative
mitral regurgitation: A systematic review.
Source
Heart. 103 (10) (pp 738-744), 2017. Date of Publication: 01 May 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Progression of degenerative mitral regurgitation (MR) leads to
irreversible cardiac damage. Therefore, longitudinal follow up to
determine the optimal timing of surgery is critical. Current data
indicates that in addition to the standard of care - assessing for
symptoms and signs of left ventricular (LV) decompensation with routine
echocardiography - serial measurement of natriuretic peptides offers a
quantitative means to identify patients who may benefit from closer
supervision, if not surgery. Natriuretic peptide levels, and specifically
changes from baseline, identify both symptomatic patients and others
likely to develop cardiac dysfunction. Moreover, because natriuretic
peptides are complimentary to the echocardiographic assessment of MR.
Finally, changes in natriuretic peptides levels are predictive of pre- and
post-operative outcomes. In short, natriuretic peptides add objectivity to
the management of degenerative MR, which may aid practitioners in
identifying patients who could benefit from intensive monitoring, stress
testing, and perhaps mitral surgery.<br/>Copyright &#xa9; 2017 Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article). All rights reserved.

<31>
Accession Number
615591860
Author
Garg A.; Rao S.V.; Agrawal S.; Theodoropoulos K.; Mennuni M.; Sharma A.;
Garg L.; Ferrante G.; Meelu O.A.; Sargsyan D.; Reimers B.; Cohen M.;
Kostis J.B.; Stefanini G.G.
Institution
(Garg) Department of Medicine, St. Peter's University Hospital, Rutgers
Robert Wood Johnson Medical School, New Brunswick, New Jersey, United
States
(Garg, Sargsyan, Kostis) Division of Cardiology, Cardiovascular Institute,
Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey,
United States
(Rao) Division of Cardiology, Duke Clinical Research Institute, Durham,
North Carolina, United States
(Agrawal) Division of Cardiology, St. Luke's University Hospital,
Bethlehem, Pennsylvania, United States
(Theodoropoulos) Department of Medicine, James J. Peters Veterans Affairs
Medical Center, Bronx, New York, United States
(Mennuni, Ferrante, Reimers, Stefanini) Division of Cardiology, Cardio
Center, Humanitas Research Hospital, Rozzano, Milan, Italy
(Sharma) Department of Cardiovascular Medicine, State University of New
York Downstate Medical Center, Brooklyn, New York, United States
(Garg) Division of Cardiology, Lehigh Valley Hospital, Allentown,
Pennsylvania, United States
(Meelu) Division of Cardiology, Mount Sinai Heart, Icahn School of
Medicine at Mount Sinai Hospital, New York, New York, United States
(Cohen) Division of Cardiology, Newark Beth Israel Medical Center, Newark,
New Jersey, United States
(Stefanini) Department of Biomedical Sciences, Humanitas University,
Rozzano, Milan, Italy
Title
Meta-Analysis of Randomized Controlled Trials of Percutaneous Coronary
Intervention With Drug-Eluting Stents Versus Coronary Artery Bypass
Grafting in Left Main Coronary Artery Disease.
Source
American Journal of Cardiology. 119 (12) (pp 1942-1948), 2017. Date of
Publication: 15 Jun 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Few randomized controlled trials (RCTs) and observational studies had
shown acceptable short-term efficacy and safety of percutaneous coronary
intervention (PCI) with drug-eluting stents (DES) compared with coronary
artery bypass grafting (CABG) in selected patients with left main coronary
artery disease (LMCAD). We aimed to evaluate long-term outcomes of PCI
using DES compared with CABG in patients with LMCAD. On November 1, 2016,
we searched available databases for published RCTs directly comparing DES
PCI with CABG in patients with LMCAD. Odds ratios (ORs) were used as the
metric of choice for treatment effects using a random-effects model.
I-squared index was used to assess heterogeneity across trials.
Prespecified end points were all-cause mortality, cardiovascular
mortality, myocardial infarction (MI), stroke, and repeat
revascularization at maximal available follow-up. We identified 5 RCTs
including a total of 4,595 patients, with a median follow-up of 60 months.
The risk of all-cause mortality (OR 1.01; 95% confidence interval [CI]
0.76 to 1.34) and cardiovascular mortality (OR 1.02; 95% CI 0.73 to 1.42)
were comparable between PCI with DES and CABG. Similarly, there were no
statistically significant differences between PCI with DES and CABG for MI
(OR 1.45; 95% CI 0.87 to 2.40) and stroke (OR 0.87; 95% CI 0.38 to 1.98).
Conversely, repeat revascularization was significantly higher with PCI
compared with CABG (OR 1.82; 95% CI 1.51 to 2.21). In conclusion, in
patients with LMCAD, PCI with DES appears to be a viable alternative to
CABG at long-term follow-up, with similar risks of ischemic adverse events
(mortality, MI, and stroke) but a higher risk of repeat
revascularization.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<32>
Accession Number
614028466
Author
Vener D.F.; Gaies M.; Jacobs J.P.; Pasquali S.K.
Institution
(Vener) Department of Anesthesiology, Perioperative and Pain Medicine,
Pediatric Cardiovascular Anesthesia, Texas Children's Hospital, Baylor
College of Medicine, Houston, TX, United States
(Gaies, Pasquali) Department of Pediatric Cardiology, C. S. Mott
Children's Hospital, University of Michigan, Ann Arbor, MI, United States
(Jacobs) Cardiovascular Surgery, Johns Hopkins All Children's Hospital, St
Petersburg, FL, United States
Title
Clinical Databases and Registries in Congenital and Pediatric Cardiac
Surgery, Cardiology, Critical Care, and Anesthesiology Worldwide.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 8 (1) (pp
77-87), 2017. Date of Publication: 01 Jan 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
The growth in large-scale data management capabilities and the successful
care of patients with congenital heart defects have coincidentally
paralleled each other for the last three decades, and participation in
multicenter congenital heart disease databases and registries is now a
fundamental component of cardiac care. This manuscript attempts for the
first time to consolidate in one location all of the relevant databases
worldwide, including target populations, specialties, Web sites, and
participation information. Since at least 1,992 cardiac surgeons and
cardiologists began leveraging this burgeoning technology to create
multi-institutional data collections addressing a variety of specialties
within this field. Pediatric heart diseases are particularly well suited
to this methodology because each individual care location has access to
only a relatively limited number of diagnoses and procedures in any given
calendar year. Combining multiple institutions data therefore allows for a
far more accurate contemporaneous assessment of treatment modalities and
adverse outcomes. Additionally, the data can be used to develop outcome
benchmarks by which individual institutions can measure their progress
against the field as a whole and focus quality improvement efforts in a
more directed fashion, and there is increasing utilization combining
clinical research efforts within existing data structures. Efforts are
ongoing to support better collaboration and integration across data sets,
to improve efficiency, further the utility of the data collection
infrastructure and information collected, and to enhance return on
investment for participating institutions.<br/>Copyright &#xa9; 2016,
&#xa9; The Author(s) 2016.

<33>
Accession Number
615634989
Author
Khan A.R.; Golwala H.; Tripathi A.; Riaz H.; Kumar A.; Flaherty M.P.;
Bhatt D.L.
Institution
(Khan, Tripathi, Flaherty) Division of Cardiovascular Medicine, Department
of Internal Medicine, University of Louisville, Louisville, Kentucky,
United States
(Golwala, Bhatt) Brigham and Women's Hospital Heart and Vascular Center,
Harvard Medical School, Boston, Massachusetts, United States
(Riaz) Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio,
United States
(Kumar) Heart and Vascular Center, Cleveland Clinic, Cleveland, Ohio,
United States
Title
Meta-analysis of Percutaneous Coronary Intervention Versus Coronary Artery
Bypass Grafting in Left Main Coronary Artery Disease.
Source
American Journal of Cardiology. 119 (12) (pp 1949-1956), 2017. Date of
Publication: 15 Jun 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Despite the increase in use of percutaneous coronary intervention (PCI) in
left main coronary disease, its efficacy compared with coronary artery
bypass grafting (CABG) is unclear. We performed a meta-analysis of
randomized controlled trials to assess the optimal revascularization
strategy. Our search yielded 8 studies reporting relevant outcomes that
were pooled using the inverse variance method, and the hazard ratio (HR)
was calculated. The primary outcome was all-cause mortality, myocardial
infarction (MI), or stroke (major adverse cardiac events [MACE]), and the
secondary outcome was death/MI/stroke/repeat revascularization (expanded
MACE). Differences in outcomes classified by follow-up duration (early: 0
to 1 year; late: 3 to 5 years) or anatomical complexity of coronary artery
disease (SYNTAX score) were investigated. Our results suggest no
difference in either early or late MACE (early: HR 0.81; 95% confidence
interval [CI] 0.63 to 1.05; late: HR 1.12; 95% CI 0.80 to 1.56) or
expanded MACE (early: HR 1.03; 95% CI 0.69 to 1.52; late: HR 1.16; 95% CI
0.95 to 1.43) between the 2 groups. There was an increased risk of
expanded MACE with a high SYNTAX score for PCI (HR 1.47; 95% CI 1.13 to
1.92) at late follow-up. There were comparable rates of all-cause
mortality and nonprocedural MI between the 2 groups with increased rates
of repeat revascularization with PCI throughout the follow-up and higher
rates of stroke with coronary artery bypass grafting early in the
follow-up period. In conclusion, our analysis suggests that CABG may be
preferable in patients with left main disease and high SYNTAX scores,
assuming they are at low surgical risk, and PCI may be an acceptable
alternative in patients with low-intermediate SYNTAX scores.<br/>Copyright
&#xa9; 2017 Elsevier Inc.

<34>
Accession Number
616334258
Author
Shah R.; Morsy M.S.; Weiman D.S.; Vetrovec G.W.
Institution
(Shah, Morsy) Section of Cardiology, Department of Medicine, University of
Tennessee, School of Medicine, Memphis, Tennessee, United States
(Shah, Weiman) Department of Medicine, Veterans Affairs Medical Center,
Memphis, Tennessee, United States
(Weiman) Department of Cardiothoracic Surgery, University of Tennessee,
Memphis, Tennessee, United States
(Vetrovec) Section of Cardiology, Department of Medicine, Virginia
Commonwealth University, Richmond, Virginia, United States
Title
Meta-Analysis Comparing Coronary Artery Bypass Grafting to Drug-Eluting
Stents and to Medical Therapy Alone for Left Main Coronary Artery Disease.
Source
American Journal of Cardiology. 120 (1) (pp 63-68), 2017. Date of
Publication: 01 Jul 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Historically, coronary artery bypass graft (CABG) surgery has been the
standard revascularization method for unprotected left main coronary
artery (LMCA) disease. Over the last decade, several randomized controlled
trials (RCTs) have shown favorable results for percutaneous coronary
intervention (PCI) with drug-eluting stent (DES) compared with CABG;
however, no RCT has been conducted directly comparing DESs with medical
therapy alone (MTA). Furthermore, the 2 most recently reported larger
RCTs, using new-generation DESs reached somewhat conflicting conclusions
comparing the 2 revascularization strategies. Therefore, we performed a
traditional pairwise meta-analysis and Bayesian network meta-analysis to
compare the efficacies of the 3 currently available treatment strategies
(MTA, CABG, and DES) for unprotected LMCA disease. Scientific databases
and websites were searched to find RCTs. Data from 8 trials including
4,850 patients were analyzed. Overall PCI increased the risk of major
adverse cardiac and cerebrovascular events (MACCEs) driven by increased
rate of revascularization compared with CABG, but no differences in
all-cause mortality, cardiac mortality, and recurrent myocardial
infarction were found. However, early (i.e., within 30 days) PCI decreased
the risk of MACCEs and stroke compared with CABG. In the mixed-treatment
comparison models, both CABG and DESs were associated with better survival
compared with MTA, but no difference was found between them. In
conclusion, in patients with unprotected LMCA disease, PCI with DESs
yields similar all-cause and cardiac mortalities compared with CABG.
Furthermore, CABG increases early (i.e., within 30 days) MACCE rates,
driven by an increased risk of stroke. Over longer durations, PCI
increases MACCE rates because of increased recurrent
revascularization.<br/>Copyright &#xa9; 2017

<35>
[Use Link to view the full text]
Accession Number
616784831
Author
Elmi-Sarabi M.; Deschamps A.; Delisle S.; Ased H.; Haddad F.; Lamarche Y.;
Perrault L.P.; Lambert J.; Turgeon A.F.; Denault A.Y.
Institution
(Elmi-Sarabi, Deschamps, Ased, Denault) Department of Anesthesiology,
Montreal Heart Institute, Universite de Montreal, 5000 Belanger St,
Montreal, QC H1T 1C8, Canada
(Delisle) Intensive Care Unit, Hopital Sacre-Coeur de Montreal, Montreal,
QC, Canada
(Haddad) Stanford School of Medicine, Stanford, CA, United States
(Lamarche, Perrault) Department of Cardiac Surgery, Montreal Heart
Institute, Universite de Montreal, Montreal, QC, Canada
(Lambert) Department of Preventive and Social Medicine, Universite de
Montreal, Montreal, QC, Canada
(Turgeon) Department of Anesthesiology and Critical Care Medicine,
Division of Critical Care Medicine, Universite Laval, Quebec City, QC,
Canada
(Turgeon) CHU de Quebec-Universite Laval Research Centre, Population
Health and Optimal Health Research Unit, Quebec City, QC, Canada
(Denault) Division of Critical Care, Centre Hospitalier de l'Universite de
Montreal, Montreal, QC, Canada
Title
Aerosolized Vasodilators for the Treatment of Pulmonary Hypertension in
Cardiac Surgical Patients: A Systematic Review and Meta-analysis.
Source
Anesthesia and Analgesia. 125 (2) (pp 393-402), 2017. Date of Publication:
01 Aug 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: In cardiac surgery, pulmonary hypertension is an important
prognostic factor for which several treatments have been suggested over
time. In this systematic review and meta-analysis, we compared the
efficacy of inhaled aerosolized vasodilators to intravenously administered
agents and to placebo in the treatment of pulmonary hypertension during
cardiac surgery. We searched MEDLINE, CENTRAL, EMBASE, Web of Science, and
clinicaltrials.gov databases from inception to October 2015. The incidence
of mortality was assessed as the primary outcome. Secondary outcomes
included length of stay in hospital and in the intensive care unit, and
evaluation of the hemodynamic profile. METHODS: Of the 2897 citations
identified, 10 studies were included comprising a total of 434 patients.
RESULTS: Inhaled aerosolized agents were associated with a significant
decrease in pulmonary vascular resistance (-41.36 dyne.s/cm 5, P=.03) and
a significant increase in mean arterial pressure (8.24 mm Hg, P=.02) and
right ventricular ejection fraction (7.29%, P<.0001) when compared to
intravenously administered agents. No significant hemodynamically
meaningful differences were observed between inhaled agents and placebo;
however, an increase in length of stay in the intensive care unit was
shown with the use of inhaled aerosolized agents (0.66 days, P=.01). No
other differences were observed for either comparison. CONCLUSIONS: The
administration of inhaled aerosolized vasodilators for the treatment of
pulmonary hypertension during cardiac surgery is associated with improved
right ventricular performance when compared to intravenously administered
agents. This review does not support any benefit compared to placebo on
major outcomes. Further investigation is warranted in this area of
research and should focus on clinically significant outcomes.<br/>&#xa9;
Copyright 2017 International Anesthesia Research Society.

<36>
Accession Number
616521379
Author
Palmerini T.; Serruys P.; Kappetein A.P.; Genereux P.; Riva D.D.; Reggiani
L.B.; Christiansen E.; Holm N.R.; Thuesen L.; Makikallio T.; Morice M.C.;
Ahn J.-M.; Park S.-J.; Thiele H.; Boudriot E.; Sabatino M.; Romanello M.;
Biondi-Zoccai G.; Cavalcante R.; Sabik J.F.; Stone G.W.
Institution
(Palmerini, Riva, Reggiani, Sabatino, Romanello) Polo
Cardio-Toraco-Vascolare, Policlinico S. Orsola, Bologna, Italy
(Serruys) International Centre for Circulatory Health, NHLI, Imperial
College London, London, United Kingdom
(Kappetein) Department of Cardiothoracic Surgery, Erasmus Medical Center,
Rotterdam, Netherlands
(Genereux, Stone) Columbia University Medical Center and the
Cardiovascular Research Foundation, New York, NY, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
(Genereux) Morristown Medical Center, Morristown, NJ, United States
(Christiansen, Holm) Department of Cardiology, Aarhus University Hospital,
Skejby, Aarhus, Denmark
(Thuesen) Department of Cardiology, Aalborg University Hospital, Aalborg,
Denmark
(Makikallio) Department of Cardiology, Oulu University Hospital, Oulu,
Finland
(Morice) MC Moriec Ramsay Generale de Sante, ICPS, Massy, France
(Ahn, Park) The Heart Institute, University of Ulsan College of Medicine,
Asan Medical Center, Seoul, South Korea
(Thiele) University Heart Center Lubeck and the German Center for
Cardiovascular Research (DZHK), Lubeck, Germany
(Boudriot) Department of Internal Medicine/Cardiology, University Heart
Center, Leipzig, Germany
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, Italy
(Biondi-Zoccai) Department of AngioCardioNeurology, IRCCS Neuromed,
Pozzilli, Italy
(Cavalcante) Department of Interventional Cardiology, Thoraxcenter Erasmus
University Medical Center, Rotterdam, Netherlands
(Sabik) The Cleveland Clinic Foundation, Cleveland, OH, United States
Title
Clinical outcomes with percutaneous coronary revascularization vs coronary
artery bypass grafting surgery in patients with unprotected left main
coronary artery disease: A meta-analysis of 6 randomized trials and 4,686
patients.
Source
American Heart Journal. 190 (pp 54-63), 2017. Date of Publication: August
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Some but not all randomized controlled trials (RCT) have suggested that
percutaneous coronary intervention (PCI) with drug-eluting stents may be
an acceptable alternative to coronary artery bypass grafting (CABG)
surgery for the treatment of unprotected left main coronary artery disease
(ULMCAD). We therefore aimed to compare the risk of all-cause mortality
between PCI and CABG in patients with ULMCAD in a pairwise meta-analysis
of RCT. Methods Randomized controlled trials comparing PCI vs CABG for the
treatment of ULMCAD were searched through MEDLINE, EMBASE, Cochrane
databases, and proceedings of international meetings. Results Six trials
including 4,686 randomized patients were identified. After a median
follow-up of 39 months, there were no significant differences between PCI
vs CABG in the risk of all-cause mortality (hazard ratio [HR] 0.99, 95% CI
0.76-1.30) or cardiac mortality. However, a significant interaction for
cardiac mortality (P<inf>interaction</inf>=.03) was apparent between
randomization arm and SYNTAX score, such that the relative risk for
mortality tended to be lower with PCI compared with CABG among patients in
the lower SYNTAX score tertile, similar in the intermediate tertile, and
higher in the upper SYNTAX score tertile. Percutaneous coronary
intervention compared with CABG was associated with a similar long-term
composite risk of death, myocardial infarction, or stroke (HR 1.06, 95% CI
0.82-1.37), with fewer events within 30 days after PCI offset by fewer
events after 30 days with CABG (P<inf>interaction</inf> <.0001).
Percutaneous coronary intervention was associated with greater rates of
unplanned revascularization compared with CABG (HR 1.74, 95% CI
1.47-2.07). Conclusions In patients undergoing revascularization for
ULMCAD, PCI was associated with similar rates of mortality compared with
CABG at a median follow-up of 39 months, but with an interaction effect
suggesting relatively lower mortality with PCI in patients with low SYNTAX
score and relatively lower mortality with CABG in patients with high
SYNTAX score. Both procedures resulted in similar long-term composite
rates of death, myocardial infarction, or stroke, with PCI offering an
early safety advantage and CABG demonstrating greater
durability.<br/>Copyright &#xa9; 2017 Elsevier, Inc.

<37>
Accession Number
612686772
Author
Kappetein A.P.; Serruys P.W.; Sabik J.F.; Leon M.B.; Taggart D.P.; Morice
M.-C.; Gersh B.J.; Pocock S.J.; Cohen D.J.; Wallentin L.; Ben-Yehuda O.;
Van Es G.-A.; Simonton C.A.; Stone G.W.
Institution
(Kappetein) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, PO Box 2040, Rotterdam, CA 3000, Netherlands
(Serruys) International Centre for Circulatory Health, NHLI, Imperial
College London, London, United Kingdom
(Sabik) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic Foundation, Cleveland, OH, United States
(Leon, Ben-Yehuda, Stone) Department of Medicine, Columbia University
Medical Center, Cardiovascular Research Foundation, New York, NY, United
States
(Taggart) Department of Cardiac Surgery, John Radcliffe Hospital, Oxford,
United Kingdom
(Morice) Department of Cardiology, Institut Hospitalier Jacques Cartier,
Massy, France
(Gersh) Department of Cardiovascular Diseases, Mayo Clinic College of
Medicine, Mayo Clinic, Rochester, MN, United States
(Pocock) Department of Medical Statistics, London School of Hygiene and
Tropical Medicine, London, United Kingdom
(Cohen) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Wallentin) Department of Medical Sciences, Cardiology, Uppsala Clinical
Research Center, Uppsala University, Uppsala, Sweden
(Van Es) Cardialysis, Rotterdam, Netherlands
(Simonton) Abbott Vascular, Santa Clara, CA, United States
Title
Design and rationale for a randomised comparison of everolimus-eluting
stents and coronary artery bypass graft surgery in selected patients with
left main coronary artery disease: The EXCEL trial.
Source
EuroIntervention. 12 (7) (pp 861-872), 2016. Date of Publication:
September 2016.
Publisher
EuroPCR
Abstract
Aims: Coronary artery bypass graft (CABG) surgery is the standard of care
for revascularisation of patients with left main coronary artery disease
(LMCAD). Recent studies have suggested that percutaneous coronary
intervention (PCI) with drug-eluting stents (DES) may provide comparable
outcomes in selected patients with LMCAD without extensive CAD. We
therefore designed a trial to investigate whether PCI with XIENCE
cobalt-chromium everolimus-eluting stents (CoCr-EES) would result in
non-inferior or superior clinical outcomes to CABG in selected patients
with LMCAD. Methods and results: The Evaluation of XIENCE versus Coronary
Artery Bypass Surgery for Effectiveness of Left Main Revascularization
(EXCEL) trial is a prospective, open-label, multicentre, international
study of 1,900 randomised subjects. Patients with significant LMCAD with a
SYNTAX score <=32 and local Heart Team consensus that the subject is
appropriate for revascularisation by both PCI and CABG are consented and
randomised 1:1 to undergo PCI using CoCr-EES or CABG. All patients undergo
follow-up for five years. The primary endpoint is the three-year composite
rate of death, stroke or myocardial infarction, assessed at a median
follow-up of at least three years (with at least two-year follow-up in all
patients), powered for sequential non-inferiority and superiority testing.
Conclusions: The EXCEL study will define the contemporary roles of CABG
and PCI using XIENCE CoCr-EES in patients with LMCAD disease with low and
intermediate SYNTAX scores.<br/>Copyright &#xa9; 2016 Europa Digital &
Publishing. All rights reserved.

<38>
Accession Number
609912946
Author
Ando T.; Briasoulis A.; Holmes A.A.; Afonso L.; Schreiber T.; Kondur A.
Institution
(Ando, Briasoulis, Afonso, Schreiber, Kondur) Wayne State University,
Detroit Medical Center, Division of Cardiology, Detroit, MI 48226, United
States
(Holmes) Division of Cardiology, Montefiore Medical Center, Albert
Einstein College of Medicine, Bronx, NY 10467, United States
Title
Transcatheter aortic valve replacement versus surgical aortic valve
replacement in patients with previous coronary artery bypass surgery: A
systematic review and meta-analysis.
Source
International Journal of Cardiology. 215 (pp 14-19), 2016. Date of
Publication: 15 Jul 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Patients with severe aortic stenosis (AS) and previous coronary
artery bypass graft (CABG) surgery have increased risk for aortic valve
replacement. Whether surgical aortic valve replacement (SAVR) or
transcatheter aortic valve replacement (TAVR) offers better outcomes in
this population is unclear. We aimed to assess outcomes of TAVR and SAVR
in patients with previous CABG. Methods A systematic literature search of
Medline, EMBASE and Cochrane library was conducted. Studies that reported
clinical outcomes (perioperative or mid-term all-cause-mortality,
cardiovascular mortality, pacemaker implantation, hospital duration and
stroke) were included. Random-effect modeling was used to calculate odds
ratios (ORs) and 95% confidence intervals (CIs). Results Five cohort
studies including a total of 872 patients (423 in TAVR, 449 in SAVR) were
analyzed. STS scores were comparable between the two groups. No difference
in all-cause-mortality, cardiovascular mortality and stroke at 30 days, 1
year and total follow-up period was seen between the two groups. TAVR
patients had higher pacemaker implantation rates (OR 3.41, 95% CI
1.66-6.38, p < 0.001, I² = 21%) and shorter hospital stay (-
2.63 days, 95% CI - 5.20 to - 0.04, p = 0.05, I² = 43%).
Conclusions Patients with previous CABG who underwent TAVR had similar
perioperative and long-term survival while experiencing more pacemaker
implantations and shorter hospital stay compared to those who had SAVR
making TAVR a safe and efficacious alternative to SAVR.<br/>Copyright
&#xa9; 2016 Elsevier Ireland Ltd. All rights reserved.

<39>
Accession Number
611633165
Author
Rogers L.; Cochrane E.; Blundell D.; Zakkar M.
Institution
(Rogers, Zakkar) Department of Cardiothoracic Surgery, Bristol Heart
Institute, Bristol Royal Infirmary, Bristol BS2 8HW, United Kingdom
(Cochrane, Blundell) Department of Cardiac Surgery, Leeds General
Infirmary, Leeds, United Kingdom
Title
What is the optimum method of weaning intra-aortic balloon pumps?.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (2) (pp 310-313),
2016. Date of Publication: 01 Aug 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: is weaning an
intra-aortic balloon pump by volume superior to ratio reduction in terms
of failure of weaning, inotropic support and haemodynamic parameters? A
total of 667 papers were identified as a result of the search described
below. Six papers were relevant to the question asked. The author, date
and country of publication, patient group studied, study type, relevant
outcomes, results and study weaknesses of the papers are tabulated. Little
published evidence exists, although weaning by ratio is more common
particularly in high-volume centres. The published data highlight the
heterogeneity of weaning protocols not only between countries but also
between hospitals in the same country. Current evidence is unable to
establish any difference in clinical outcomes including mortality,
reinsertion of intra-aortic balloon pumps and requirement for inotropic
support between weaning by ratio, volume weaning and abrupt cessation.
Despite this, the only randomized trial demonstrates improved haemodynamic
profiles in those weaned by volume weaning. In addition, given the
difficulty in obtaining clear clinical outcomes, N-terminal pro-brain
natriuretic peptide and central venous oxygen saturation may be useful as
surrogate markers for successful weaning.<br/>Copyright &#xa9; 2016 The
Author 2016. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<40>
Accession Number
613404618
Author
Elmarsafawi A.G.; Abbassi M.M.; Elkaffas S.; Elsawy H.M.; Sabry N.A.
Institution
(Elmarsafawi, Abbassi, Sabry) Clinical Pharmacy and Pharmacy Practice,
Faculty of Pharmacy, Cairo University, Cairo, Egypt, Egypt
(Elkaffas) Cardiovascular Medicine Department, Faculty of Medicine, Cairo
University, Cairo, Egypt, Egypt
(Elsawy) Cardiac Surgery Department, National Heart Institute, Giza,
Egypt, Egypt
Title
Efficacy of Different Perioperative Statin Regimens on Protection Against
Post-Coronary Artery Bypass Grafting Major Adverse Cardiac and Cerebral
Events.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (6) (pp 1461-1470),
2016. Date of Publication: 01 Dec 2016.
Publisher
W.B. Saunders
Abstract
Objectives Comparing different perioperative statin regimens for the
prevention of post-coronary artery bypass grafting adverse events. Design
A randomized, prospective study. Setting Cardiothoracic surgical units in
a government hospital. Participants The study comprised 94 patients
scheduled for elective, isolated on- or off- pump coronary artery bypass
grafting. Interventions Patients were assigned randomly to 1 of the
following 3 treatment groups: group I (80 mg of atorvastatin/day for 2
days preoperatively), group II (40 mg of atorvastatin/day for 5-9 days
preoperatively), or group III (80 mg of atorvastatin/day for 5-9 days
preoperatively). The same preoperative doses were restarted
postoperatively and continued for 1 month. Measurements and Main Results
Cardiac troponin I, creatine kinase, and C-reactive protein (CRP) levels
were assayed preoperatively; at 8, 24, and 48 hours postoperatively; and
at discharge. CRP levels at 24 hours (p = 0.045) and 48 hours (p = 0.009)
were significantly lower in group III compared with the other 2 groups.
However, troponin I levels at 8 hours (p = 0.011) and 48 hours (p = 0.025)
after surgery were significantly lower in group II compared with group
III. The incidence of postoperative major adverse cardiac and
cerebrovascular events was assessed, and there was no significant
difference among the 3 groups. Conclusion The 3 regimens did not result in
any significant difference in outcomes, but only simple trends. The
higher-dose regimen resulted in a significant reduction in the CRP level.
Thus, more studies are needed to confirm the benefit of higher-dose
statins for the protection from post-coronary artery bypass grafting
adverse events.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<41>
Accession Number
610813235
Author
Nikrahan G.R.; Suarez L.; Asgari K.; Beach S.R.; Celano C.M.; Kalantari
M.; Abedi M.R.; Etesampour A.; Abbas R.; Huffman J.C.
Institution
(Nikrahan, Asgari, Kalantari) Department of Psychology, University of
Isfahan, Isfahan, Iran, Islamic Republic of
(Suarez, Beach, Celano, Huffman) Department of Psychology, Islamic Azad
University of Borujen, Borujen, Iran, Islamic Republic of
(Suarez, Beach, Celano, Huffman) Department of Psychiatry, Massachusetts
General Hospital, Boston, MA, United States
(Beach, Celano) Department of Psychiatry, Harvard Medical School, Boston,
MA, United States
(Abedi) Department of Consulting, University of Isfahan, Isfahan, Iran,
Islamic Republic of
(Etesampour) Department of Internal Medicine, Najafabad Islamic Azad
University, Najafabad, Iran, Islamic Republic of
(Abbas) Department of Immunology, Isfahan University of Medical Sciences,
Isfahan, Iran, Islamic Republic of
Title
Positive Psychology Interventions for Patients With Heart Disease: A
Preliminary Randomized Trial.
Source
Psychosomatics. 57 (4) (pp 348-358), 2016. Date of Publication: 01 Jul
2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Positive psychologic characteristics have been linked to
superior cardiac outcomes. Objective: Accordingly, in this exploratory
study, we assessed positive psychology interventions in patients who had
recently undergone a procedure to treat cardiovascular disease. Method:
Participants were randomly assigned to receive 1 of 3 different 6-week
face-to-face interventions or a wait-list control condition. We assessed
intervention feasibility and compared changes in psychologic outcome
measures postintervention (7 wk) and at follow-up (15 wk) between
intervention and control participants. Across the interventions, 74% of
assigned sessions were completed. Results: When comparing outcomes between
interventions and control participants (N = 55 total), there were no
between-group differences post-intervention, but at follow-up intervention
participants had greater improvements in happiness (beta = 14.43, 95% CI:
8.66-20.2, p < 0.001), depression (beta = -3.87, 95% CI: -7.72 to 0.02, p
= 0.049), and hope (beta = 7.12, 95% CI: 1.25-13.00, p =0.017), with
moderate-large effect sizes. Efficacy of the 3 interventions was similar.
Conclusions: Future studies are needed to identify an optimal positive
psychology intervention for cardiac patients.<br/>Copyright &#xa9; 2016
The Academy of Psychosomatic Medicine.

<42>
Accession Number
612012898
Author
Poon S.S.; Estrera A.; Oo A.; Field M.
Institution
(Poon, Oo, Field) Department of Cardiothoracic Surgery, Liverpool Heart
and Chest Hospital, Liverpool, United Kingdom
(Estrera) Department of Cardiothoracic and Vascular Surgery, Memorial
Hermann Heart and Vascular Institute, Houston, TX, United States
Title
Is moderate hypothermic circulatory arrest with selective antegrade
cerebral perfusion superior to deep hypothermic circulatory arrest in
elective aortic arch surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (3) (pp 462-468),
2016. Date of Publication: 01 Sep 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether moderate
hypothermia circulatory arrest with selective antegrade cerebral perfusion
(SACP) is more beneficial than deep hypothermic circulatory arrest in
elective aortic arch surgery. Altogether, 1028 papers were found using the
reported search, of which 6 represented the best evidence to answer the
clinical question. The authors, journal, date and country of publication,
patient group studied, study type, relevant outcomes and results of these
papers are tabulated. There were four retrospective observational studies,
one prospective randomized controlled trial and one meta-analysis study.
There were no local or neuromuscular complications related to axillary
arterial cannulation reported. In the elective setting, four studies
showed that the in-hospital mortality for moderate hypothermia is
consistently low, ranging from 1.0 to 4.3%. In a large series of hemiarch
replacement comparing 682 cases of deep hypothermia with 94 cases of
moderate hypothermia with SACP, 20 cases (2.8%) of permanent neurological
deficit were reported, compared to 3 cases (3.2%) in moderate hypothermia.
Three observational studies and a meta-analysis study did not identify an
increased risk of postoperative renal failure and dialysis following
either deep or moderate hypothermia although a higher incidence of stroke
was reported in the meta-analysis study with deep hypothermia (12.7 vs
7.3%). Longer cardiopulmonary bypass time and circulatory arrest time were
reported in four studies for deep hypothermia, suggesting an increased
time required for systemic cooling and rewarming in that group. Overall,
these findings suggested that in elective aortic arch surgery, moderate
hypothermia with selective antegrade cerebral perfusion adapted to the
duration of circulatory arrest can be performed safely with acceptable
mortality and morbidity outcomes. The risk of spinal cord and visceral
organ complications is low with the use of this cerebral adjunct. Current
studies did not identify an advantage in terms of postoperative bleeding
when compared with deep hypothermia. The moderate hypothermia strategy
reduced operative time without increasing the mortality and morbidity of
surgery.<br/>Copyright &#xa9; 2016 The Author 2016. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<43>
Accession Number
611338580
Author
Sanchis J.; Nunez E.; Barrabes J.A.; Marin F.; Consuegra-Sanchez L.;
Ventura S.; Valero E.; Roque M.; Bayes-Genis A.; del Blanco B.G.; Degano
I.; Nunez J.
Institution
(Sanchis, Nunez, Ventura, Valero, Nunez) Department of Cardiology,
Hospital Clinico Universitario, IncLIVA, Universitat de Valencia,
Valencia, Spain
(Barrabes, del Blanco) Department of Cardiology, Hospital Universitari
Vall d'Hebron, VHIR, Universitat Autonoma de Barcelona, Barcelona, Spain
(Marin) Department of Cardiology, Hospital Virgen Arrixaca, Murcia, Spain
(Consuegra-Sanchez) Department of Cardiology, Hospital Santa Lucia,
Cartagena, Spain
(Roque) Department of Cardiology, Hospital Clinic, Barcelona, Spain
(Bayes-Genis) Department of Cardiology, Hospital Universitari Germans
Trias i Pujol, Badalona, Spain
(Degano) IMIM (Hospital del Mar Medical Research Institute), Universitat
Autonoma de Barcelona, Barcelona, Spain
Title
Randomized comparison between the invasive and conservative strategies in
comorbid elderly patients with non-ST elevation myocardial infarction.
Source
European Journal of Internal Medicine. 35 (pp 89-94), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier B.V.
Abstract
Background Comorbid elderly patients with non-ST-elevation myocardial
infarction (non-STEMI) are underrepresented in randomized trials and
undergo fewer cardiac catheterizations according to registries. Our aim
was to compare the conservative and invasive strategies in these patients.
Methods Randomized multicenter study, including 106 patients (January
2012-March 2014) with non-STEMI, over 70 years and with comorbidities
defined by at least two of the following: peripheral artery disease,
cerebral vascular disease, dementia, chronic pulmonary disease, chronic
renal failure or anemia. Patients were randomized to invasive (routine
coronary angiogram, n = 52) or conservative (coronary angiogram only if
recurrent ischemia or heart failure, n = 54) strategy. Medical treatment
was identical. The main endpoint was the composite of all-cause mortality,
reinfarction and readmission for cardiac cause (postdischarge
revascularization or heart failure), at long-term (2.5-year follow-up).
Analysis of cumulative event rate (incidence rate ratio = IRR) and time to
first event (hazard ratio = HR), were performed. Results Cardiac
catheterization/revascularization rates were 100%/58% in the invasive
versus 20%/9% in the conservative arm. There were no differences between
groups in the main endpoint (invasive vs conservative: IRR = 0.946, 95% CI
0.466-1.918, p = 0.877) at long-term. The invasive strategy, however,
tended to improve 3-month outcomes in terms of mortality (HR = 0.348, 95%
CI 0.122-0.991, p = 0.048), and of mortality or ischemic events
(reinfarction or postdischarge revascularization) (HR = 0.432, 95% CI
0.190-0.984, p = 0.046). This benefit declined during follow-up.
Conclusions Invasive management did not modify long-term outcome in
comorbid elderly patients with non-STEMI. The finding of a tendency
towards an improvement in the short-term needs confirmation in larger
studies (clinicaltrials.govNCT1645943).<br/>Copyright &#xa9; 2016 European
Federation of Internal Medicine.

<44>
Accession Number
613084171
Author
Li M.; Xue L.; Sun H.; Xu S.
Institution
(Li, Xu) Department of Cardiovascular Surgery, The First Affiliated
Hospital of Medical College of Xi'an Jiaotong University, Xi'an Shaanxi,
China, China
(Xue) Department of Laboratory, The Second Affiliated Hospital of Medical
College of Xi'an Jiaotong University, Xi'an Shaanxi, China, China
(Sun) Tumour Hospital of Shaanxi Province, Xi'an Shaanxi, China, China
Title
Myocardial Protective Effects of L-Carnitine on Ischemia-Reperfusion
Injury in Patients With Rheumatic Valvular Heart Disease Undergoing
Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (6) (pp 1485-1493),
2016. Date of Publication: 01 Dec 2016.
Publisher
W.B. Saunders
Abstract
Objectives The authors used L-carnitine as an ingredient in cardioplegic
solution during valve replacement surgery to investigate the protective
effect of L-carnitine on myocardial ischemia-reperfusion injury (MIRI) and
its possible mechanism. Design Prospective, randomized study. Setting A
tertiary-care hospital. Participants The study comprised 90 patients
undergoing valve replacement under cardiopulmonary bypass. Interventions
Patients were divided randomly into 3 groups. L-carnitine was added to the
crystalloid cardioplegic solution for experimental group 1 (3 g/L) and
experimental group 2 (6 g/L), whereas no L-carnitine was used in the
control group. The remainder of the treatment was identical for all 3
groups. Measurements and Main Results Serum was collected from each
patient 1 hour before the surgery and at 2, 6, 24, and 72 hours after
unclamping the aorta, and tissue samples were obtained before cardiac
arrest and after unclamping the aorta. The postoperative levels of serum
aspartate aminotransferase, creatine kinase, creatine kinase-MB isozyme,
and lactic acid dehydrogenase and the apoptotic index were all lower in
the 2 experimental groups than those in the control group. In addition,
each of the aforementioned serum enzyme levels and the apoptotic index in
all 3 groups significantly increased after unclamping the aorta compared
with baseline levels taken before surgery. Bcl-2 expression was higher and
Bax was lower in the 2 experimental groups compared with those of the
control group after unclamping the aorta. However, there was no
significant difference in all the postoperative indices between the 2
experimental groups. Conclusion L-carnitine may reduce cardiopulmonary
bypass-induced myocardial apoptosis through modulating the expressions of
Bcl-2 and Bax, resulting in a protective effect from MIRI.<br/>Copyright
&#xa9; 2016 Elsevier Inc.

<45>
Accession Number
612728934
Author
Landoni G.; Zangrillo A.; Lomivorotov V.V.; Likhvantsev V.; Ma J.; De
Simone F.; Fominskiy E.
Institution
(Landoni, Zangrillo, De Simone, Fominskiy) Department of Anaesthesia and
Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60,
Milan 20132, Italy
(Landoni, Zangrillo) Vita-Salute San Raffaele University of Milan, Italy
(Lomivorotov, Fominskiy) Department of Anaesthesia and Intensive Care,
Academician en Meshalkin Novosibirsk, State Budget Research Institute of
Circulation Pathology, Novosibirsk, Russian Federation
(Likhvantsev) Moscow Regional Clinical and Research Institute, Moscow,
Russian Federation
(Ma) Centre for Anaesthesiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
Title
Cardiac protection with phosphocreatine: A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (4) (pp 637-646),
2016. Date of Publication: 01 Oct 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Phosphocreatine (PCr) plays an important role in the energy metabolism of
the heart and a decrease in its intracellular concentration results in
alteration of myocardium energetics and work. We conducted a meta-analysis
of all randomized and matched trials that compared PCr with placebo or
standard treatment in patients with coronary artery disease or chronic
heart failure or in those undergoing cardiac surgery. We systematically
searched PubMed/Medline, Embase, Cochrane Central Register of Controlled
Trials and Google Scholar up to 1 November 2015, for pertinent trials. The
primary outcome was all-cause mortality. Secondary outcomes included
inotrope use, ejection fraction (EF), peak creatinine kinase-myocardial
band (CK-MB) release and the incidence of major arrhythmias, as well as
spontaneous recovery of the heart performance in the subgroup of patients
undergoing cardiac surgery with cardiopulmonary bypass. We pooled odds
ratio (OR) and mean difference (MD) using fixed- and random effects
models. We identified 41 controlled trials, of them 32 were randomized.
Patients receiving PCr had lower all-cause mortality when compared with
the control group [61/1731 (3.5%) vs 177/1667 (10.6%); OR: 0.71, 95% CI:
0.51-0.99; P = 0.04; I² = 0%; with 3400 patients and 22 trials
included]. Phosphocreatine administration was associated with higher LVEF
(MD: 3.82, 95% CI: 1.18-6.46; P = 0.005; I² = 98%), lower peak
CK-MB release (MD: -6.08, 95% CI: -8.01, -4.15; P < 0.001; I² =
97%), lower rate of major arrhythmias (OR: 0.42; 95% CI: 0.27-0.66; P <
0.001; I² = 0%), lower incidence of inotropic support (OR:
0.39, 95% CI: 0.25-0.61; P < 0.001; I² = 56%) and a higher
level of spontaneous recovery of the heart performance after
cardiopulmonary bypass (OR: 3.49, 95% CI: 2.28-5.35; P < 0.001;
I² = 49%) when compared with the control group. In a mixed
population of patients with coronary artery disease, chronic heart failure
or in those undergoing cardiac surgery, PCr may reduce all-cause
short-term mortality. In addition, PCr administration was associated with
improved cardiac outcomes. Owing to the pharmacological plausibility of
this effect and to the concordance of the beneficial effects of PCr on
several secondary but important outcomes and survival, there is urgent
need for a large multicentre randomized trial to confirm these
findings.<br/>Copyright &#xa9; 2016 The Author 2016. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<46>
Accession Number
612718254
Author
Fominskiy E.; Nepomniashchikh V.A.; Lomivorotov V.V.; Monaco F.; Vitiello
C.; Zangrillo A.; Landoni G.
Institution
(Fominskiy, Nepomniashchikh, Monaco, Vitiello, Zangrillo, Landoni)
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Fominskiy, Lomivorotov) Department of Anesthesia and Intensive Care,
Academician EN Meshalkin Novosibirsk State Budget Research Institute of
Circulation Pathology, Novosibirsk, Russian Federation
(Zangrillo, Landoni) Vita-Salute San Raffaele University of Milan, Milan,
Italy
Title
Efficacy and Safety of Fibrinogen Concentrate in Surgical Patients: A
Meta-Analysis of Randomized Controlled Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (5) (pp 1196-1204),
2016. Date of Publication: 01 Oct 2016.
Publisher
W.B. Saunders
Abstract
Objectives To investigate the efficacy and safety of fibrinogen
concentrate (FC) in surgical patients. Design Meta-analysis of randomized
controlled studies (RCTs). Setting Perioperative. Participants Adult and
pediatric surgical patients. Interventions A search of PubMed/Medline,
Embase, Cochrane Central Register of Controlled Trials, Transfusion
Evidence Library, Google Scholar, and the proceedings from major
international anesthesiology meetings up to February 1, 2016 for RCTs that
compared FC with placebo or other comparators. Measurements and Main
Results The primary outcome was all-cause mortality. Pooled risk ratios
and mean differences (MDs) were computed with either fixed-effects or
random-effects models. The study included 14 RCTs comprising 1,035
patients; the majority of patients underwent cardiac surgery. All-cause
mortality was lower in the fibrinogen group (4/432 [0.9%] v 15/430 [3.5%];
risk ratio 0.26; 95% confidence interval [CI] 0.09-0.78; p = 0.02;
heterogeneity statistic (l2) = 0%). The use of FC was associated with
reduced bleeding (MD -127 mL; 95% CI -207 to -47; p = 0.002; I2= 54%) and
a lower number of red blood cells units transfused versus comparator (MD
-0.9; 95% CI -1.3 to -0.5; p<0.001; I2 = 42%). There were no differences
in the rates of thrombotic events and myocardial infarction. Conclusions
In surgical patients, FC was associated with reduced bleeding and a lower
number of red blood cell units transfused, and it also might reduce
mortality. However, none of the analyzed trials was powered for estimation
of survival and adverse events with FC use. Half of the included studies
were of high or moderate risk of bias. The evidence primarily came from
cardiac surgery settings.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<47>
Accession Number
613277917
Author
Saravanan P.; West A.L.; Bridgewater B.; Davidson N.C.; Calder P.C.;
Dobrzynsky H.; Trafford A.; O'Neill S.C.
Institution
(Saravanan, Dobrzynsky, Trafford, O'Neill) Institute of Cardiovascular
Sciences, University of Manchester, Manchester, United Kingdom
(West, Calder) Faculty of Medicine, University of Southampton, Southampton
General Hospital, Tremona Road, Southampton SO16 6YD, United Kingdom
(Bridgewater, Davidson) Department of Cardiology, University Hospital of
South Manchester, Manchester, United Kingdom
Title
Omega-3 fatty acids do not alter P-wave parameters in electrocardiogram or
expression of atrial connexins in patients undergoing coronary artery
bypass surgery.
Source
Europace. 18 (10) (pp 1521-1527), 2016. Date of Publication: 01 Oct 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims We previously reported omega-3 polyunsaturated fatty acids (n-3PUFAs)
supplementation does not reduce atrial fibrillation (AF) following
coronary artery bypass graft (CABG) surgery. The aim of the present study
is to evaluate the impact of n-3 PUFAs on electrocardiogram (ECG) atrial
arrhythmic markers and compare with expression of gap-junction proteins,
Connexins. Methods and results Subset of clinical trial subjects with
right atrial sampling during CABG surgery included. Twelve-lead ECG
performed at recruitment and at surgery [after supplementation with n-3
PUFA (~1.8 g/day) or matched placebo] for ~14 days. Electrocardiograms
analysed for maximum P-wave duration (P-max) and difference between P-max
and minimum P-wave duration, P-wave dispersion (PWD). Right atrial
specimens analysed for expression of Connexins 40 and 43 using real-time
quantitative polymerase chain reaction (qPCR) and western blot. Serum
levels of n-3 PUFA at baseline, at surgery, and atrial tissue levels at
surgery collated from file. Postoperative AF was quantified by analysing
data from stored continuous electrograms. A total of 61 patients (n-3 PUFA
34, Placebo 27) had ECG analysis and AF burden, of which 52 patients (26
in each group) had qPCR and 16 (8 in each group) had western blot analyses
for Connexins 40 and 43. No difference between the two groups in ECG
parameters or expression of Connexin 40 or 43. P-wave dispersion in the
preoperative ECG independently predicted occurrence of AF following CABG
surgery. Conclusions Omega-3 polyunsaturated fatty acids supplementation
does not alter pro-arrhythmic P-wave parameters in ECG or connexin
expression in human atrium with no effect on the incidence of AF following
CABG surgery.<br/>Copyright &#xa9; 2016 Published on behalf of the
European Society of Cardiology. All rights reserved. &#xa9; The Author
2016. For permissions please email: journals.permissions@oup.com.

<48>
Accession Number
613497694
Author
Liu X.; Zhang K.; Wang W.; Xie G.; Cheng B.; Wang Y.; Hu Y.; Fang X.
Institution
(Liu, Zhang, Wang, Xie, Cheng, Wang, Fang) Departments of Anesthesiology
and Intensive Care Unit, First Affiliated Hospital, School of Medicine,
Zhejiang University, Hangzhou, Zhejiang, China
(Hu) Anesthesiology, Children's Hospital, School of MedicineZhejiang
University, Hangzhou, Zhejiang, China
Title
Dexmedetomidine Versus Propofol Sedation Improves Sublingual
Microcirculation After Cardiac Surgery: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (6) (pp 1509-1515),
2016. Date of Publication: 01 Dec 2016.
Publisher
W.B. Saunders
Abstract
Objectives To compare the effects of dexmedetomidine and propofol on
sublingual microcirculation in patients after cardiac surgery. Design A
prospective, randomized, single-blind study. Setting University hospital.
Participants Adult patients undergoing elective valve surgery with
cardiopulmonary bypass. Interventions On arrival in the intensive care
unit (ICU), patients were assigned randomly to receive either
dexmedetomidine (0.2-1.5 mug/kg/h) or propofol (5-50 mug/kg/min) with
open-label titration to a target Richmond Agitation-Sedation Scale of 0 to
-3. Measurements and Main Results Sublingual microcirculation was recorded
using sidestream dark-field imaging at ICU admission (baseline [T1]) and 4
hours (T2) and 24 hours after ICU admission (T3). At T2, median changes in
perfused small-vessel density and the De Backer score from baseline were
significantly greater in the dexmedetomidine group (n = 29) than in the
propofol group (n = 32) (1.3 v 0 mm/mm², p = 0.025; 0.9 v
-0.1/mm, p = 0.005, respectively); median changes in small-vessel density
and the proportion of perfused small vessels from baseline also tended to
be higher in the dexmedetomidine group compared with the propofol group
(1.0 v -0.1 mm/mm², p = 0.050; 2.1% v 0.5%, p = 0.062,
respectively). At T3, there still was a trend toward greater improvements
in the small-vessel density, proportion of perfused small-vessels,
perfused small-vessel density, and De Backer score from baseline in the
dexmedetomidine group than in the propofol group. Conclusions This trial
demonstrated that dexmedetomidine sedation may be better able to improve
microcirculation in cardiac surgery patients during the early
postoperative period compared with propofol.<br/>Copyright &#xa9; 2016

<49>
Accession Number
613497553
Author
Ushio M.; Egi M.; Wakabayashi J.; Nishimura T.; Miyatake Y.; Obata N.;
Mizobuchi S.
Institution
(Ushio) Department of Anesthesia, Kakogawa West City Hospital, Kakogawa
City, Hyogo, Japan
(Egi, Wakabayashi, Nishimura, Obata, Mizobuchi) Department of
Anesthesiology, Kobe University Hospital, Kobe City, Hyogo, Japan
(Miyatake) Department of Surgery Related, Kobe University Graduate School
of Medicine, Kobe City, Hyogo 650-0017, Japan
Title
Impact of Milrinone Administration in Adult Cardiac Surgery Patients:
Updated Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (6) (pp 1454-1460),
2016. Date of Publication: 01 Dec 2016.
Publisher
W.B. Saunders
Abstract
Objective To determine the effects of milrinone on short-term mortality in
cardiac surgery patients with focus on the presence or absence of
heterogeneity of the effect. Design A systematic review and meta-analysis.
Setting and Participants Five hundred thirty-seven adult cardiac surgery
patients from 12 RCTs. Interventions Milrinone administration.
Measurements and Main Results The authors conducted a systematic Medline
and Pubmed search to assess the effect of milrinone on short-term
mortality in adult cardiac surgery patients. Subanalysis was performed
according to the timing for commencement of milrinone administration and
the type of comparators. The primary outcome was any short-term mortality.
Overall analysis showed no difference in mortality rates in patients who
received milrinone and patients who received comparators (odds ratio =
1.25, 95% CI 0.45-3.51, p = 0.67). In subanalysis for the timing to
commence milrinone administration and the type of comparators, odds ratio
for mortality varied from 0.19 (placebo as control drug, start of
administration after cardiopulmonary bypass) to 2.58 (levosimendan as
control drug, start of administration after cardiopulmonary bypass).
Conclusions Among RCTs to assess the effect of milrinone administration in
adult cardiac surgery patients, there are wide variations of the odds
ratios of administration of milrinone for short-term mortality according
to the comparators and the timing of administration. This fact may suggest
that a simple pooling meta-analysis is not applicable for assessing the
risk and benefit of milrinone administration in an adult cardiac surgery
cohort.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<50>
Accession Number
613497551
Author
Freiermuth D.; Mets B.; Bolliger D.; Reuthebuch O.; Doebele T.; Scholz M.;
Gregor M.; Haschke M.; Seeberger M.D.; Fassl J.
Institution
(Freiermuth, Bolliger, Gregor, Seeberger, Fassl) Department of
Anesthesiology and Intensive Care Medicine, University Hospital Basel,
Basel, Switzerland
(Mets) Department of Anesthesiology and Perioperative Medicine, Penn State
Hershey Medical Center, Hershey, PA, United States
(Reuthebuch, Doebele) Division of Cardiac Surgery, Department of Surgery,
University Hospital Basel, Basel, Switzerland
(Scholz) Institute of Medical Informatics, Statistics and Epidemiology,
University Leipzig, Leipzig, Germany
(Haschke) Division of Clinical Pharmacology and Toxicology, University
Hospital Basel, Basel, Switzerland
(Seeberger) Institute of Anesthesia and Intensive Care Medicine, Klinik
Hirslanden Zurich, Zurich, Switzerland
Title
Sevoflurane and Isoflurane-Pharmacokinetics, Hemodynamic Stability, and
Cardioprotective Effects During Cardiopulmonary Bypass.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (6) (pp 1494-1501),
2016. Date of Publication: 01 Dec 2016.
Publisher
W.B. Saunders
Abstract
Objectives This study aimed to evaluate the pharmacokinetic profiles of
sevoflurane and isoflurane during use of minimized extracorporeal
circulation to perform coronary artery bypass graft surgery. Furthermore,
cardiovascular stability during bypass and the postoperative release of
troponins were evaluated. Design Prospective, randomized study. Setting
University hospital. Participants The study comprised 31 adult patients
undergoing coronary artery bypass grafting. Interventions The
pharmacokinetic measurements of the concentration of the volatile
anesthetics in the arterial and venous blood, air inlet, air outlet, and
gas exhaust of the extracorporeal circulation were recorded. Secondary
end-points were cardiovascular stability during bypass, amount of
postoperative release of troponin, time to extubation, time to discharge
from the intensive care unit and the hospital, and 30-day mortality.
Measurements and Main Results Thirty patients completed the protocol. The
pharmacokinetics of isoflurane and sevoflurane were almost identical, with
a rapid wash-in (time to reach 50% of arterial steady state) concentration
of 0.87+/-0.97 minutes and 1.14+/-0.35 minutes for isoflurane and
sevoflurane, respectively, and a biphasic venous elimination with a
terminal half-life of approximately 10 minutes for both compounds. There
was a correlation between the gas inlet and the gas exhaust of the
extracorporeal circulation. No difference in cardiovascular stability was
found. High-sensitivity troponin concentrations on the first postoperative
morning were 0.355+/-0.312 micro&#32;g/mL and 0.225+/-0.111 micro&#32;g/mL
in the isoflurane and sevoflurane groups, respectively (p = 0.147).
Conclusions The study found similar pharmacokinetics regarding wash-in and
wash-out for sevoflurane and isoflurane. In addition, no difference in
cardiovascular stability was found. The markers of cardiac damage were not
different between the two anesthetics. Based on these data, sevoflurane
and isoflurane might be used equivalently in patients undergoing coronary
artery bypass graft surgery with extracorporeal circulation.<br/>Copyright
&#xa9; 2016 Elsevier Inc.

<51>
Accession Number
610053001
Author
Hu X.-L.; Chen Y.; Zhou Z.-D.; Ying J.; Hu Y.-H.; Xu G.-H.
Institution
(Hu, Chen, Zhou, Ying, Hu, Xu) Department of Anesthesiology, Second
Affiliated Hospital, Nanchang University, No. 1, Minde Road, Nanchang,
Jiangxi Province 330006, China
Title
Posterior pericardiotomy for the prevention of atrial fibrillation after
coronary artery bypass grafting: A meta-analysis of randomized controlled
trials.
Source
International Journal of Cardiology. 215 (pp 252-256), 2016. Date of
Publication: 15 Jul 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Posterior pericardiotomy (PP) has been shown to be effective in
patients after cardiac surgery complicated by a reduced the incidence of
atrial fibrillation (AF). However, the role of PP in patients following
coronary artery bypass graft (CABG) remains ambiguous. We aimed to
systematically evaluate the efficacy of PP in preventing postoperative AF
in adult patients after CABG. Methods Studies were identified by searching
multiple electronic databases (PubMed, Embase, and the Cochrane Library)
through February, 2016, and by reviewing reference lists of obtained
articles. The outcome measure was the incidence of postoperative AF. The
meta-analysis was performed with the fixed-effect model or random-effect
model according to heterogeneity. Results Ten randomized trials
incorporating 1648 patients were included in this meta-analysis (822 in
the PP group and 826 in the control group). The cumulative incidence of AF
was 10.6% in the PP group and 24.9% in the control group. Meta-analysis
with all studies using a random-effects model suggested that PP had
significant effect on the prevention of postoperative AF (I²
55%; P < 0.00001; OR, 0.36; 95% CI, 0.23-0.56; RR, 0.45; 95% CI,
0.31-0.64). Sensitivity analyses by methodological quality and surgical
technique yields similar results. Conclusions This meta-analysis indicates
that PP shows beneficial efficacy in preventing postoperative AF in adult
patients after CABG. This finding encourages the use of PP to prevent
postoperative AF after CABG, but, more high quality randomized controlled
trials are still warranted to confirm the safety.<br/>Copyright &#xa9;
2016 Elsevier Ireland Ltd. All rights reserved.

<52>
Accession Number
610188744
Author
Nikrahan G.R.; Laferton J.A.C.; Asgari K.; Kalantari M.; Abedi M.R.;
Etesampour A.; Rezaei A.; Suarez L.; Huffman J.C.
Institution
(Nikrahan, Asgari, Kalantari) Department of Psychology, University of
Isfahan, Isfahan, Iran, Islamic Republic of
(Nikrahan) Department of Psychology, Islamic Azad University of Borujen,
Borujen, Iran, Islamic Republic of
(Laferton) Department of Psychiatry, Brigham and Women's Hospital, Boston,
MA, United States
(Laferton, Suarez, Huffman) Department of Psychiatry, Harvard Medical
School, Boston, MA, United States
(Abedi) Department of Consulting, University of Isfahan, Isfahan, Iran,
Islamic Republic of
(Etesampour) Department of Internal Medicine, Najafabad Islamic Azad
University, Najafabad, Iran, Islamic Republic of
(Rezaei) Department of Immunology, Isfahan University of Medical Sciences,
Isfahan, Iran, Islamic Republic of
(Suarez, Huffman) Department of Psychiatry, Massachusetts General
Hospital, Boston, MA, United States
Title
Effects of Positive Psychology Interventions on Risk Biomarkers in
Coronary Patients: A Randomized, Wait-List Controlled Pilot Trial.
Source
Psychosomatics. 57 (4) (pp 359-368), 2016. Date of Publication: 01 Jul
2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Among cardiac patients, positive psychologic factors are
consistently linked with superior clinical outcomes and improvement in key
markers of inflammation and hypothalamic-pituitary-adrenal axis
functioning. Further, positive psychology interventions (PPI) have
effectively increased psychologic well-being in a wide variety of
populations. However, there has been minimal study of PPIs in cardiac
patients, and no prior study has evaluated their effect on key prognostic
biomarkers of cardiac outcome. Accordingly, we investigated the effect of
3 distinct PPIs on risk biomarkers in cardiac patients. Methods: In an
exploratory trial, 69 patients with recent coronary artery bypass graft
surgery or percutaneous intervention were randomized to (1) one of three
6-week in-person PPIs (based on the work of Seligman, Lyubomirsky, or
Fordyce) or (2) a wait-list control group. Risk biomarkers were assessed
at baseline, postintervention (7 weeks), and at 15-week follow-up.
Between-group differences in change from baseline biomarker levels were
examined via random effects models. Results: Compared with the control
group, participants randomized to the Seligman (B = -2.06; p = 0.02) and
Fordyce PPI (B = -1.54; p = 0.04) had significantly lower high-sensitivity
C-reactive protein levels at 7 weeks. Further, the Lyubomirsky PPI (B =
-245.86; p = 0.04) was associated with a significantly lower cortisol
awakening response at 7 weeks when compared with control participants.
There were no other significant between-group differences. Conclusion:
Despite being an exploratory pilot study with multiple between-group
comparisons, this initial trial offers the first suggestion that PPIs
might be effective in reducing risk biomarkers in high-risk cardiac
patients.<br/>Copyright &#xa9; 2016 The Academy of Psychosomatic Medicine.

<53>
Accession Number
613173107
Author
Biedrzycka A.; Kowalik M.; Pawlaczyk R.; Jagielak D.; Swietlik D.;
Szymanowicz W.; Lango R.
Institution
(Biedrzycka) Department of Anaesthesiology and Intensive Care, Medical
University of Gdansk, Gdansk, Poland
(Kowalik, Szymanowicz, Lango) Department of Cardiac Anaesthesia, Medical
University of Gdansk, Debinki Street 7, Gdansk 80-211, Poland
(Pawlaczyk, Jagielak) Department of Cardiac and Vascular Surgery, Medical
University of Gdansk, Gdansk, Poland
(Swietlik) Intrafaculty College of Medical Informatics and Biostatistics,
Medical University of Gdansk, Gdansk, Poland
Title
Aortic cross-clamping phase of cardiopulmonary bypass is related to
decreased microvascular reactivity after short-term ischaemia of the
thenar muscle both under intravenous and volatile anaesthesia: A
randomized trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (5) (pp 770-778),
2016. Date of Publication: 01 Nov 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES The purpose of the present study was to assess, by
near-infrared spectroscopy with an INVOS oximeter during the vascular
occlusion test (VOT), the influence of cardiopulmonary bypass (CPB) on
tissue saturation in the thenar muscle. The secondary aim was to compare
the effects of propofol and sevoflurane anaesthesia on tissue saturation.
METHODS This was a prospective, randomized, open-label study. Sixty
cardiac surgery patients received either propofol or sevoflurane
anaesthesia. Three-minute VOT was performed at the following time points:
30 min after anaesthesia induction, directly after sternotomy, 20 and 40
min after aortic cross-clamping, 20 min after aortic cross-clamp removal
and 45 min after weaning of cardiopulmonary bypass. Group and time effects
on tissue saturation were analysed with RM-ANOVA and the post hoc Tukey
test. RESULTS In both groups at baseline, the lowest and the highest
tissue saturation and the rate of saturation recovery during the
reperfusion phase of the vascular occlusion test were lower during aortic
cross-clamping in comparison to the values before CPB. Lower nadir tissue
saturation during ischaemia was observed under propofol in comparison to
sevoflurane anaesthesia (P = 0.018). CONCLUSIONS This study demonstrated
that the aortic cross-clamping phase of CPB cardiac surgery is associated
with lower values of tissue saturation and a decreased rate of saturation
recovery under both propofol and sevoflurane anaesthesia. Aortic
cross-clamp release is followed by accelerated tissue desaturation during
VOT. Propofol anaesthesia for CPB cardiac surgery results in greater
reduction of nadir tissue saturation during the ischaemic phase of VOT in
comparison to that of sevoflurane. TRIAL REGISTRATION NUMBER
NCT02593448<br/>Copyright &#xa9; 2016 The Author 2016. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<54>
Accession Number
613172839
Author
Gabriel J.; Gobolos L.; Miskolczi S.; Barlow C.
Institution
(Gabriel) Royal Bournemouth Hospital, Castle Lane East, Bournemouth,
Dorset BH7 7DW, United Kingdom
(Gobolos, Miskolczi, Barlow) Wessex Cardiothoracic Centre, Southampton
University Hospital, NHS Trust, Southampton, United Kingdom
Title
How safe is it to train residents to perform mitral valve surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (5) (pp 810-813),
2016. Date of Publication: 01 Nov 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic was constructed according to a structured protocol.
The enquiry: In [patients undergoing mitral valve surgery] are
[postoperative morbidity and mortality outcomes] acceptable when patients
are operated on by [residents]? Four hundred and twenty-three were
identified from the search strategy. Six articles selected as best
evidence were tabulated. All current published evidence, encompassing open
and minimally invasive mitral valve repair in addition to mitral valve
replacement, supports the involvement of trainees in mitral procedures.
Although trainees may experience longer aortic cross-clamp and
cardiopulmonary bypass times than specialist surgeons, they are not
associated with significantly worse perioperative or postoperative
outcomes in comparable mitral procedures. Important factors in the
viability of mitral valve training and its quality include the volume of
cases per institution and the expertise of the supervising surgeon, and
these remain largely unexplored. Overall, mitral valve surgery remains a
valuable potential training opportunity, one which is perhaps
underexploited.<br/>Copyright &#xa9; 2016 The Author 2016. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<55>
Accession Number
613172482
Author
Anastasiadis K.; Antonitsis P.; Vranis K.; Kleontas A.; Asteriou C.;
Grosomanidis V.; Tossios P.; Argiriadou H.
Institution
(Anastasiadis, Antonitsis, Vranis, Kleontas, Asteriou, Grosomanidis,
Tossios, Argiriadou) Cardiothoracic Department, AHEPA University Hospital,
S. Kyriakidi 1, Thessaloniki 546 36, Greece
Title
Effectiveness of prophylactic levosimendan in patients with impaired left
ventricular function undergoing coronary artery bypass grafting: A
randomized pilot study.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (5) (pp 740-747),
2016. Date of Publication: 01 Nov 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES Perioperative low cardiac output syndrome occurs in 3-14% of
patients undergoing isolated coronary artery bypass grafting (CABG),
leading to significant increase in major morbidity and mortality.
Considering the unique pharmacological and pharmacokinetic properties of
levosimendan, we conducted a prospective, double-blind, randomized pilot
study to evaluate the effectiveness of prophylactic levosimendan in
patients with impaired left ventricular function undergoing CABG. METHODS
Thirty-two patients undergoing CABG with low left ventricular ejection
fraction (LVEF <= 40%) were randomized to receive either a continuous
infusion of levosimendan at a dose of 0.1 mug/kg/min for 24 h without a
loading dose or a placebo. The primary outcome of the study was the change
in the LVEF assessed with transthoracic echocardiography on the seventh
postoperative day. Secondary outcomes included the physiological and
clinical effects of levosimendan. RESULTS All patients tolerated
preoperative infusion of levosimendan well. The LVEF improved in both
groups; this increase was statistically significant in the levosimendan
group (from 35.8 +/- 5% preoperatively to 42.8 +/- 7.8%, P = 0.001)
compared with the control group (from 37.5 +/- 3.4% preoperatively to 41.2
+/- 8.3%, P = 0.1). The cardiac index, SvO<inf>2</inf>, pulmonary
capillary wedge pressure and right ventricular stroke work index showed a
similar trend, which was optimized in patients treated with levosimendan.
Moreover, an increase in extravascular lung water was noticed in this
group during the first 24 h after surgery. CONCLUSIONS This pilot study
shows that prophylactic levosimendan infusion is safe and effective in
increasing the LVEF postoperatively in patients with impaired cardiac
function undergoing coronary surgery. This finding may be translated to
'optimizing' patients' status before surgery.<br/>Copyright &#xa9; 2016
The Author 2016. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<56>
Accession Number
617788567
Author
Chen P.T.; Ting C.K.; Lee M.Y.; Cheng H.W.; Chan K.H.; Chang W.K.
Institution
(Chen, Ting, Lee, Cheng, Chan, Chang) Department of Anesthesiology, Taipei
Veterans General Hospital, Taipei, Taiwan (Republic of China)
(Chen, Ting, Chan, Chang) Department of Anesthesiology, School of
Medicine, National Yang-Ming University, Taipei, Taiwan (Republic of
China)
(Chen) School of Nursing, Taipei Medical University, Taipei, Taiwan
(Republic of China)
(Chang) Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan (Republic of
China)
Title
A randomised trial comparing real-time double-lumen endobronchial tube
placement with the Disposcope with conventional blind
placement.
Source
Anaesthesia. 72 (9) (pp 1097-1106), 2017. Date of Publication: September
2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Double-lumen endobronchial tube placement is challenging. This study
compared double-lumen tube placement with the Disposcope, a
wireless videostylet allowing real-time visualisation, with conventional
blind placement. Patients undergoing elective thoracic surgery with normal
airways requiring one-lung ventilation were randomly allocated into two
groups (27 patients in each group). The Disposcope was used to assist
left-sided double-lumen tube placement in one group, and conventional
blind placement was performed in the control group. Placement in both
groups was checked with fibreoptic bronchoscopy. The Disposcope-assisted
group had a shorter total mean (SD) placement time (18.6 (2.5) s vs. 21.4
(2.9) s, p < 0.001), laryngoscopy to end of auscultation time (83.4 (3.0)
s vs. 93.9 (5.7) s, p < 0.001) and total operation time (130.7 (6.1) s vs.
154.5 (6.3) s, p < 0.001). In the Disposcope-assisted group, the
double-lumen tube was inserted in the correct side in all patients
(100.0%), whereas in the conventional group, the double-lumen tube was
placed in the correct side in 25 (92.6%) patients and in the wrong side in
2 (7.4%) patients; the difference was not significant (p = 0.150). In the
Disposcope-assisted group, the double-lumen tube was inserted to the
optimal depth in 24 (88.9%) patients, whereas in the conventional group it
was inserted to the optimal depth in one (4.0%) patient. The Disposcope
increased the success rate of double-lumen tube placement, and shortened
the total operation time when compared with standard placement with
confirmation using fibreoptic bronchoscopy, and may replace the
conventional method.<br/>Copyright &#xa9; 2017 The Association of
Anaesthetists of Great Britain and Ireland

<57>
Accession Number
617788523
Author
Hadi N.R.; Al-Amran F.G.; Naeem A.A.-H.; Abdalsaheb A.F.; Alturfy M.A.;
Fakher W.K.; Majeed Y.Q.
Institution
(Hadi) Department of Pharmacology and Therapeutics, Faculty of Medicine,
University of Kufa, Iraq
(Al-Amran, Alturfy, Fakher, Majeed) Al-Najaf Center for Cardiothoracic
Surgery, Iraq
(Naeem) Ministry of Health and Environment, Al-Najaf Health Directorate,
Iraq
(Abdalsaheb) Diwaniya Teaching Hospital, Diwaniya, Al Qadisiyah, Iraq
Title
Attenuation of acute systemic inflammatory response after valve surgery.
Source
World Heart Journal. 9 (1) (pp 45-50), 2017. Date of Publication: 2017.
Publisher
Nova Science Publishers, Inc. (E-mail: Journals@novapublishers.com)
Abstract
Background: Montelukast is a selective cysteinyl-leukotriene1 (CysLT1)
receptor antagonist. In recent years, several investigations have shown
that montelukast possesses both secondary anti-inflammatory activities and
antioxidant effects. Hence this study aimed to determine the possible
protective effect of montelukast in myocardial ischemia reperfusion injury
induced by cardiopulmonary bypass during valve replacement surgery.
Patients and methods: A total of 60 patients with valvular disease
undergoing elective valve surgery were enrolled in a randomized,
single-blind clinical trial. These patients were subdivided into two main
groups: Group 1 (montelukast-treated group) consisted of 30 patients who
underwent valve surgery; they were given montelukast sodium (10 mg tab) at
bedtime for 3 days before surgery. Group 2 (control group) consisted of 30
patients who underwent valve surgery without taking montelukast. For each
group, blood samples were collected at the following times: T0, after
anesthesia; T1, before aortic cross cl T2, after aortic cross cl and T3,
24 hours after surgery. The inflammatory biomarkers TNF-alpha, IL-6,
alpha2 macroglobulin/Creatinine ratio, CTnI and ALT were determined. For
each group, an echo study was undertaken to determine the ejection
fraction (EF) before surgery and three months after surgery. Results:
Concentrations of TNF-alpha, IL-6, alpha2 macroglobulin/ Creatinine ratio,
CTnI, and ALT were significantly higher (P < 0.05) in the control group
than in the montelukast-treated group at different sampling times. There
was no significant difference in EF between the two groups before surgery,
but EF was significantly higher (p < 0.05) in the montelukast-treated
group than in the control group after surgery. Conclusion: Montelukast
treatment is beneficial to patients who normally undergo a cardiopulmonary
bypass during valve replacement surgery.<br/>Copyright &#xa9; 2017 Nova
Science Publishers, Inc.

<58>
Accession Number
614202057
Author
Chatterjee S.; Kundu A.; Mukherjee D.; Sardar P.; Mehran R.; Bashir R.;
Giri J.; Abbott J.D.
Institution
(Chatterjee) Division of Cardiology, St. Luke's-Roosevelt Hospital Center
of the Mount Sinai Health System, New York, NY, United States
(Kundu) Department of Medicine, University of Massachusetts Medical
School, Worcester, MA, United States
(Mukherjee) Division of Cardiology, Texas Tech University Health Sciences
Center, El Paso, TX, United States
(Sardar) Division of Cardiovascular Medicine, University of Utah, Salt
Lake City, UT, United States
(Mehran) Director of Interventional Research, Icahn School of Medicine,
Mount Sinai Health System, New York, NY, United States
(Bashir) Division of Cardiology, Temple University School of Medicine,
Philadelphia, PA, United States
(Giri) Penn Cardiovascular Outcomes, Quality & Evaluative Research Center,
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,
United States
(Abbott) Warren Alpert School of Medicine and Brown University, Rhode
Island Hospital, Providence, RI, United States
Title
Risk of contrast-induced acute kidney injury in ST-elevation myocardial
infarction patients undergoing multi-vessel intervention-meta-analysis of
randomized trials and risk prediction modeling study using observational
data.
Source
Catheterization and Cardiovascular Interventions. 90 (2) (pp 205-212),
2017. Date of Publication: 01 Aug 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: Ascertaining risk of contrast induced acute kidney injury
(CI-AKI) in ST-segment elevation myocardial infarction (STEMI) patients
undergoing multi-vessel percutaneous coronary intervention (MV-PCI).
Background: Complete revascularization may improve outcomes in STEMI
patients with multi-vessel disease. However, a practice of MV-PCI may be
associated with a higher risk of CI-AKI. We aimed to evaluate the risk of
CI-AKI in patients with STEMI and MV-PCI and examine the accuracy of a
validated risk score. Methods: We searched PubMed, Cochrane Library,
EMBASE, EBSCO, Web of Science, and CINAHL databases from inception through
August 31, 2016 for randomized studies comparing CI-AKI rates with MV-PCI
and infarct-related artery (IRA) only PCI during index hospitalization. A
random effects model was used to estimate the risk ratio (RR) and
respective 95% confidence intervals (CI). We queried the Nationwide
Inpatient Sample (NIS) to assess the ability of the Mehran risk score to
accurately predict the incidence of CI-AKI in patients undergoing MV-PCI.
Results: Four randomized studies (N = 1,602) were included in the final
analysis. The risk of CI-AKI was low and no difference was observed with
MV-PCI (1.45%) compared with IRA-only (1.94%) (RR 0.73, 95% CI 0.34-1.57;
P = 0.57). From 2009 to 2012, excluding shock, there were 11,454 MV-PCI
for STEMI patients in the NIS. The Mehran risk score accurately
discriminated 78% of the patients who developed CI-AKI in this cohort
(c-statistic of 0.78, P = 0.002). Conclusions: MV-PCI in STEMI is not
associated with a higher risk of CI-AKI and the Mehran risk score can
identify patients at higher risk for this complication. &#xa9; 2017 Wiley
Periodicals, Inc.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<59>
Accession Number
614202053
Author
Chang M.; Lee C.W.; Ahn J.-M.; Cavalcante R.; Sotomi Y.; Onuma Y.; Han M.;
Park S.-W.; Serruys P.W.; Park S.-J.
Institution
(Chang) Seoul St. Mary's Hospital, The Catholic University of Korea,
Seoul, South Korea
(Lee, Ahn, Park, Park) Heart Institute, University of Ulsan College of
Medicine, Asan Medical Center, Seoul, South Korea
(Cavalcante, Onuma, Serruys) Erasmus University Medical Center, Rotterdam,
Netherlands
(Sotomi) Academic Medical Center, University of Amsterdam, Netherlands
(Han) Division of Biostatistics, University of Ulsan, Asan Medical Center,
Seoul, South Korea
(Serruys) Imperial College of London, International Center for Circulatory
Health, London, United Kingdom
Title
Predictors of long-term outcomes after bypass grafting versus drug-eluting
stent implantation for left main or multivessel coronary artery disease.
Source
Catheterization and Cardiovascular Interventions. 90 (2) (pp 177-185),
2017. Date of Publication: 01 Aug 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: We assessed predictors of long-term outcomes after coronary
artery bypass grafting (CABG) versus those after percutaneous coronary
intervention (PCI) with drug-eluting stents (DES) in 3,230 patients with
left main or multivessel coronary artery disease (CAD). Methods and
Results: Data were pooled from the BEST, PRECOMBAT, and SYNTAX trials.
Age, chronic kidney disease, chronic obstructive lung disease, left
ventricular dysfunction, and peripheral arterial disease (PAD) were common
predictors of all-cause mortality. Diabetes mellitus, previous myocardial
infarction (MI), and SYNTAX score were independent predictors of all-cause
mortality in the PCI group, but not in the CABG group. In the CABG group,
age was the only risk factor for MI; left ventricular dysfunction,
hypertension, and PAD were risk factors for stroke. On the other hand, in
the PCI group, incomplete revascularization and previous MI were risk
factors for MI; age and previous stroke for stroke. In addition, chronic
kidney disease significantly correlated with a composite outcome of death,
MI, or stroke in the CABG group, and incomplete revascularization and
previous MI in the PCI group. Conclusions: Simple clinical variables and
SYNTAX score differentially predict long-term outcomes after CABG versus
those after PCI with DES for left main or multivessel CAD. Those
predictors might help to guide the choice of revascularization strategy.
&#xa9; 2017 Wiley Periodicals, Inc.<br/>Copyright &#xa9; 2017 Wiley
Periodicals, Inc.

<60>
Accession Number
614328029
Author
Kalkman D.N.; Woudstra P.; Lu H.; Menown I.B.A.; den Heijer P.;
Suryapranata H.; Iniguez A.; Arkenbout K.E.; van't Hof A.W.J.; Muller P.;
Erglis A.; Tijssen J.G.; Beijk M.A.M.; de Winter R.J.
Institution
(Kalkman, Woudstra, Lu, Tijssen, Beijk, de Winter) Academic Medical Center
- University of Amsterdam, Amsterdam, Netherlands
(Menown) Craigavon Cardiac Centre, Craigavon, United Kingdom
(den Heijer) Amphia Hospital Breda, Breda, Netherlands
(Suryapranata) Radboud University Medical Center, Nijmegen, Netherlands
(Iniguez) Hospital Alvaro Cunqueiro - Complejo Hospitalario Universitario,
Vigo, Spain
(Arkenbout) Tergooi Ziekenhuis, Blaricum, Netherlands
(van't Hof) Isala Klinieken, Zwolle, Netherlands
(Muller) Institut National de Cardiochirurgie et de Cardiologie
Interventionnelle, Luxembourg
(Erglis) Pauls Stradins Clinical University Hospital, Riga, Latvia
Title
Evaluation of clinical outcomes after COMBO stent treatment in patients
presenting with acute coronary syndrome.
Source
Catheterization and Cardiovascular Interventions. 90 (2) (pp E31-E37),
2017. Date of Publication: 01 Aug 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Patients presenting with acute coronary syndrome (ACS) are at
increased risk of complications after percutaneous coronary intervention
with stent placement compared to patients with stable angina (SA) treated
in an elective setting. The novel pro-healing COMBO stent is a
bio-engineered drug eluting stent designed to promote vessel healing.
Therefore, the stent may reduce this difference in clinical outcomes
between elective and ACS-patients and prevent late stent thrombosis.
Methods and Results: The European, prospective, multicenter, 1000
all-comers patient REMEDEE registry evaluates clinical outcomes after
COMBO stent placement in ACS- and elective patients. The primary endpoint
at 12 months is target lesion failure (TLF), a composite of cardiac death,
target-vessel myocardial infarction and target lesion revascularization. A
total of 49.9% (n = 498) of patients presented with acute coronary
syndrome. TLF was 7.1% in ACS patients, definite and probable stent
thrombosis was observed in 0.5% of ACS patients and in all within 9 days
post stenting. We found no significant difference in TLF between ACS and
non-ACS patients and a low overall rate of TLF. Conclusions: The COMBO
stent is a safe and efficient device for patients presenting with ACS. Low
ST rate and only early stent thrombosis were observed. &#xa9; 2017 Wiley
Periodicals, Inc.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<61>
Accession Number
613739469
Author
Magalhaes M.A.; Minha S.; Lhermusier T.; Pendyala L.; Escarcega R.O.;
Baker N.C.; Torguson R.; Satler L.F.; Pichard A.; Waksman R.
Institution
(Magalhaes, Minha, Lhermusier, Pendyala, Escarcega, Baker, Torguson,
Satler, Pichard, Waksman) Department of Internal Medicine, MedStar
Washington Hospital Center, Washington, DC, United States
(Magalhaes, Minha, Lhermusier, Pendyala, Escarcega, Baker, Torguson,
Satler, Pichard, Waksman) Division of Cardiology, MedStar Washington
Hospital Center, Washington, DC, United States
(Magalhaes) Department of Cardiology/Division of Interventional
Cardiology, Hospital Alemao Oswaldo Cruz, Sao Paulo, Brazil
Title
Does direct stenting with drug-eluting stents improve outcome? A
meta-analysis of 10,900 patients.
Source
Catheterization and Cardiovascular Interventions. 90 (2) (pp 213-222),
2017. Date of Publication: 01 Aug 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: The aim of this study is to summarize the outcomes of patients
undergoing direct stenting (DS) with drug-eluting stents (DES) compared to
those who underwent balloon predilatation. Background: DS has been
associated with improved outcomes in the bare-metal stent era. Although DS
with DES implantation has been increasingly adopted in clinical practice,
its safety and effectiveness remain controversial. Methods: The search
criteria identified 546 studies in the Medline/PubMed, Cochrane, and
EMBASE databases from 2001 to July 2014. From these, seven studies
totaling 10,900 patients were selected. Summarized estimates [odds ratio
(OR) and 95% confidence intervals] were obtained using a random-effects
model. The primary outcomes were a composite of major adverse cardiac
events (MACE), including all-cause death, myocardial infarction (MI), and
repeat revascularization. The secondary outcomes included a composite of
death and MI and the rates of target lesion revascularization (TLR).
Results: Overall, 4101 (38%) and 6799 (62%) patients underwent DS with DES
and balloon pre-dilatation, respectively. DS with DES reduced the
likelihood of MACE (OR: 0.81 [0.71-0.93]). Additionally, DS with DES was
associated with reduced rates of death/MI (OR: 0.76 [0.62-0.92]), and TLR
(OR: 0.66 [0.44-0.98]). Conclusions: DS with DES is safe and may be
associated with better outcomes in selected patients. &#xa9; 2016 Wiley
Periodicals, Inc.<br/>Copyright &#xa9; 2016 Wiley Periodicals, Inc.

<62>
Accession Number
612731695
Author
Som A.; Maitra S.; Bhattacharjee S.; Baidya D.K.
Institution
(Som, Maitra, Bhattacharjee, Baidya) Department of Anaesthesiology, Pain
Medicine and Critical Care, All India Institute of Medical Sciences, New
Delhi 110029, India
Title
Goal directed fluid therapy decreases postoperative morbidity but not
mortality in major non-cardiac surgery: a meta-analysis and trial
sequential analysis of randomized controlled trials.
Source
Journal of Anesthesia. 31 (1) (pp 66-81), 2017. Date of Publication: 01
Feb 2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Background and aims: Optimum perioperative fluid administration may
improve postoperative outcome after major surgery. This meta-analysis and
systematic review has been aimed to determine the effect of dynamic goal
directed fluid therapy (GDFT) on postoperative morbidity and mortality in
non-cardiac surgical patients. Material and methods: Meta-analysis of
published prospective randomized controlled trials where GDFT based on
non-invasive flow based hemodynamic measurement has been compared with a
standard care. Data from 41 prospective randomized trials have been
included in this study. Results: Use of GDFT in major surgical patients
does not decrease postoperative hospital/30-day mortality (OR 0.70, 95 %
CI 0.46-1.08, p = 0.11) length of post-operative hospital stay (SMD -0.14;
95 % CI -0.28, 0.00; p = 0.05) and length of ICU stay (SMD -0.12; 95 % CI
-0.28, 0.04; p = 0.14). However, number of patients having at least one
postoperative complication is significantly lower with use of GDFT (OR
0.57; 95 % CI 0.43, 0.75; p < 0.0001). Abdominal complications (p =
0.008), wound infection (p = 0.002) and postoperative hypotension (p =
0.04) are also decreased with used of GDFT as opposed to a standard care.
Though patients who received GDFT were infused more colloid (p < 0.0001),
there is no increased risk of heart failure or pulmonary edema and renal
failure. Conclusion: GDFT in major non- cardiac surgical patients has
questionable benefit over a standard care in terms of postoperative
mortality, length of hospital stay and length of ICU stay. However,
incidence of all complications including wound infection, abdominal
complications and postoperative hypotension is reduced.<br/>Copyright
&#xa9; 2016, Japanese Society of Anesthesiologists.

<63>
Accession Number
617884737
Author
Williams B.; Bernstein W.
Institution
(Williams, Bernstein) Department of Anesthesiology, University of Maryland
School of Medicine, Baltimore, Maryland
Title
Review of Venoarterial Extracorporeal Membrane Oxygenation and Development
of Intracardiac Thrombosis in Adult Cardiothoracic Patients.
Source
The journal of extra-corporeal technology. 48 (4) (pp 162-167), 2016. Date
of Publication: 01 Dec 2016.
Abstract
Venoarterial extracorporeal membrane oxygenation (VA ECMO) has become an
indispensable treatment option for adult cardiothoracic patients
experiencing acute refractory cardiogenic shock. VA ECMO is not without
inherent complications as in-hospital mortality has ranged from 45% to 65%
(1-3). Intracardiac thrombosis (ICT) is a rare but life-threatening
complication associated with VA ECMO. VA ECMO cases complicated by ICT
were searched for using the MEDLINE (PubMed and OVID), Society of
Cardiovascular Anesthesiology Headquarters, and Google Scholar databases.
Twelve cases of VA ECMO-associated ICT were discovered for review.
Indications for VA ECMO were postcardiotomy cardiogenic shock and heart
failure. The primary location of thrombus was the left ventricle and
aortic root. Majority of the cases did not report subtherapeutic systemic
anticoagulation. Two patients survived after the development of ICT. VA
ECMO-associated ICT is a devastating consequence with high mortality. The
majority of ICT occurred in cases with perceived adequate anticoagulation,
but this may not result in complete suppression of the coagulation
response. Continued exposure to procoagulant stimuli and worsening
ventricular function and intracardiac stasis can shift the balance toward
a hypercoagulable state and development of thrombosis.

<64>
Accession Number
617774060
Author
Shroyer A.L.; Hattler B.; Wagner T.H.; Collins J.F.; Baltz J.H.; Quin
J.A.; Almassi G.H.; Kozora E.; Bakaeen F.; Cleveland J.C.; Bishawi M.;
Grover F.L.
Institution
(Shroyer, Bishawi) Northport Veterans Affairs (VA) Medical Center,
Northport, NY, United States
(Shroyer, Hattler, Baltz, Cleveland, Grover) Eastern Colorado Health Care
System, Department of Veterans Affairs, Denver, CO, United States
(Kozora) National Jewish Health, Denver, United States
(Hattler, Cleveland, Grover) University of Colorado School of Medicine,
Aurora, CO, United States
(Wagner) VA Health Economics Resource Center, Department of Surgery,
Stanford University, Palo Alto, CA, United States
(Collins) Cooperative Studies Program Coordinating Center, VA Medical
Center, Perry Point, MD, United States
(Quin) VA Boston Healthcare System, West Roxbury, MA, United States
(Almassi) Zablocki VA Medical Center, Medical College of Wisconsin,
Milwaukee, United States
(Bakaeen) Cleveland Clinic, Cleveland, United States
(Bakaeen) VA Pittsburgh Health Care System, Pittsburgh, United States
(Bishawi) Duke University Medical Center, Durham, NC, United States
Title
Five-year outcomes after on-pump and off-pump coronary-artery bypass.
Source
New England Journal of Medicine. 377 (7) (pp 623-632), 2017. Date of
Publication: 17 Aug 2017.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: Coronary-artery bypass grafting (CABG) surgery may be
performed either with cardiopulmonary bypass (on pump) or without
cardiopulmonary bypass (off pump). We report the 5-year clinical outcomes
in patients who had been included in the Veterans Affairs trial of on-pump
versus off-pump CABG. METHODS: From February 2002 through June 2007, we
randomly assigned 2203 patients at 18 medical centers to undergo either
on-pump or off-pump CABG, with 1-year assessments completed by May 2008.
The two primary 5-year outcomes were death from any cause and a composite
outcome of major adverse cardiovascular events, defined as death from any
cause, repeat revascularization (CABG or percutaneous coronary
intervention), or nonfatal myocardial infarction. Secondary 5-year
outcomes included death from cardiac causes, repeat revascularization, and
nonfatal myocardial infarction. Primary outcomes were assessed at a P
value of 0.05 or less, and secondary outcomes at a P value of 0.01 or
less. RESULTS: The rate of death at 5 years was 15.2% in the off-pump
group versus 11.9% in the on-pump group (relative risk, 1.28; 95%
confidence interval [CI], 1.03 to 1.58; P=0.02). The rate of major adverse
cardiovascular events at 5 years was 31.0% in the off-pump group versus
27.1% in the on-pump group (relative risk, 1.14; 95% CI, 1.00 to 1.30;
P=0.046). For the 5-year secondary outcomes, no significant differences
were observed: for nonfatal myocardial infarction, the rate was 12.1% in
the off-pump group and 9.6% in the on-pump group (P=0.05); for death from
cardiac causes, the rate was 6.3% and 5.3%, respectively (P=0.29); for
repeat revascularization, the rate was 13.1% and 11.9%, respectively
(P=0.39); and for repeat CABG, the rate was 1.4% and 0.5%, respectively
(P=0.02). CONCLUSIONS: In this randomized trial, off-pump CABG led to
lower rates of 5-year survival and event-free survival than on-pump
CABG.<br/>Copyright &#xa9; 2017 Massachusetts Medical Society.

<65>
Accession Number
617844859
Author
Antonopoulos A.S.; Latsios G.; Oikonomou E.; Aznaouridis K.; Papanikolaou
A.; Syrseloudis D.; Siasos G.; Vavuranakis M.; Toutouzas K.; Tousoulis D.
Institution
(Antonopoulos, Latsios, Oikonomou, Aznaouridis, Papanikolaou, Syrseloudis,
Siasos, Vavuranakis, Toutouzas, Tousoulis) 1st Cardiology Department,
Hippokration Hospital, University of Athens Medical School, Athens, Greece
Title
Long-term endothelial dysfunction after trans-radial catheterization: A
meta-analytic approach.
Source
Journal of Cardiac Surgery. 32 (8) (pp 464-473), 2017. Date of
Publication: August 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Following cardiac catheterization using radial artery (RA)
access, persistent endothelial dysfunction may limit the use of RA as a
conduit during coronary artery bypass graft (CABG) surgery. We reviewed
published literature to investigate the effects of transradial coronary
catheterization on RA endothelial function. Methods: We searched PubMed
from inception to April 2017 for published studies assessing RA
endothelial function late (>=1 month) after coronary catheterization. A
total of 12 eligible published studies (n = 490 patients) were included in
the final quantitative synthesis. Statistical heterogeneity among studies
was assessed by the I². A random effects model was used to
calculate the pooled estimate for standardized mean difference (SMD).
Meta-regression analysis was used to explore predictors of change in RA
endothelial function following catheterization. Results: In all studies, a
significant reduction in endothelium dependent response was observed
post-catheterization (SMD = -0.53, 95% confidence interval [CI]: -0.93 to
-0.13, P = 0.01) and a marginal, non-significant, reduction in endothelium
independent response (SMD = -0.38, 95%CI: -0.77, 0.01, P < 0.059). In
controlled studies, using the contralateral RA as a control, a significant
impairment in endothelial function was confirmed (SMD = -6.26, 95%CI:
-9.71 to -2.81, P < 0.0001), while the change in endothelium-independent
response was not significant (SMD = -4.46, 95%CI: -13.3 to 4.37, P =
0.32). In meta-regression analysis male gender (z = 2.36, P = 0.018) and
increasing time following catheterization (z = 2.62, P = 0.009) were
associated with less RA endothelial dysfunction. Conclusions: Transradial
catheterization impairs endothelium dependent vasodilatory properties of
the cannulated RA, which do not recover even several months
post-catheterization. Non-recovery of vasomotor function of cannulated RAs
may limit their use as arterial grafts during CABG surgery.<br/>Copyright
&#xa9; 2017 Wiley Periodicals, Inc.

<66>
Accession Number
617848569
Author
Ambardekar A.V.; Thibodeau J.T.; DeVore A.D.; Kittleson M.M.; Forde-McLean
R.C.; Palardy M.; Mountis M.M.; Cadaret L.; Teuteberg J.J.; Pamboukian
S.V.; Xie R.; Stevenson L.W.; Stewart G.C.
Institution
(Ambardekar) Division of Cardiology, University of Colorado, Aurora,
Colorado
(Thibodeau) Department of Internal Medicine and Cardiology, University of
Texas Southwestern, Dallas, Texas
(DeVore) Division of Cardiology, Duke University Medical School, Durham,
North Carolina
(Kittleson) Division of Cardiology, Cedars-Sinai Heart Institute, Los
Angeles, California
(Forde-McLean) Department of Medicine, University of Pennsylvania,
Philadelphia, Pennsylvania
(Palardy) Department of Internal Medicine and Cardiovascular Medicine,
University of Michigan, Ann Arbor, Michigan
(Mountis) Division of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, Ohio
(Cadaret) Division of Cardiology, University of Iowa, Iowa City, Iowa
(Teuteberg) Heart and Vascular Institute, University of Pittsburgh Medical
Center, Pittsburgh, Pennsylvania
(Pamboukian, Xie) Division of Cardiovascular Diseases, University of
Alabama at Birmingham, Birmingham, Alabama
(Stevenson, Stewart) Division of Cardiovascular Medicine, Brigham and
Women's Hospital, Boston, Massachusetts
Title
Discordant Perceptions of Prognosis and Treatment Options Between
Physicians and Patients With Advanced Heart Failure.
Source
JACC: Heart Failure. (no pagination), 2017. Date of Publication: 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study assessed patient and physician perceptions of heart
failure (HF) disease severity and treatment options. Background: The
prognosis for ambulatory patients with advanced HF on medical therapy is
uncertain, yet has important implications for decision making regarding
transplantation and left ventricular assist device (LVAD) placement.
Methods: Ambulatory patients with advanced HF (New York Heart Association
functional class III to IV, Interagency Registry for Mechanically Assisted
Circulatory Support profiles 4 to 7) on optimized medical therapy were
enrolled across 11 centers. At baseline, treating cardiologists rated
patients for perceived risk for transplant, LVAD, or death in the upcoming
year. Patients were also surveyed about their own perceptions of life
expectancy and willingness to undergo various interventions. Results: At
enrollment, physicians regarded 111 of 161 patients (69%) of the total
cohort to be at high risk for transplant, LVAD, or death, whereas only 23
patients (14%) felt they were at high risk. After a mean follow-up of 13
months, 61 patients (38%) experienced an endpoint of 33 deaths (21%), 13
transplants (8%), and 15 LVAD implants (9%). There was poor discrimination
between risk prediction among both patients and physicians. Among
physician-identified high-risk patients, 77% described willingness to
consider LVAD, but 63% indicated that they would decline 1 or more other
simpler forms of life-sustaining therapy such as ventilation, dialysis, or
a feeding tube. Conclusions: Among patients with advanced HF, physicians
identified most to be at high risk for transplantation, LVAD, or death,
whereas few patients recognized themselves to be at high risk. Patients
expressed inconsistent attitudes toward lifesaving treatments, possibly
indicating poor understanding of these therapies. Educational
interventions regarding disease severity and treatment options should be
introduced prior to the need for advanced therapies such as intravenous
inotropic therapy, transplantation, or LVAD.<br/>Copyright &#xa9; 2017
American College of Cardiology Foundation.

<67>
Accession Number
617838244
Author
Cabalka A.K.; Hellenbrand W.E.; Eicken A.; Kreutzer J.; Gray R.G.;
Bergersen L.; Berger F.; Armstrong A.K.; Cheatham J.P.; Zahn E.M.;
McElhinney D.B.
Institution
(Cabalka) Division of Pediatric Cardiology, Mayo Clinic, Rochester,
Minnesota
(Hellenbrand) Division of Pediatric Cardiology, Yale University School of
Medicine, New Haven, Connecticut
(Eicken) Deutsches Herzzentrum Munchen, Klinik fur Kinderkardiologie und
angeborene Herzfehler, Technische Universitat Munchen, Munich, Germany
(Kreutzer) Division of Pediatric Cardiology, University of Pittsburgh
School of Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh,
Pennsylvania
(Gray) Department of Pediatric Cardiology, University of Utah, Salt Lake
City, Utah
(Bergersen) Department of Cardiology, Boston Children's Hospital, Boston,
Massachusetts
(Berger) Department of Congenital Heart Disease/Pediatric Cardiology,
Deutsches Herzzentrum Berlin, Berlin, Germany
(Berger) German Center of Cardiovascular Research, Berlin, Germany
(Armstrong, Cheatham) The Heart Center, Nationwide Children's Hospital,
Columbus, Ohio
(Zahn) The Guerin Family Congenital Heart Program, The Heart Institute and
Department of Pediatrics, Cedars-Sinai Heart Institute, Los Angeles,
California
(McElhinney) Department of Cardiothoracic Surgery, Lucille Packard
Children's Hospital Stanford, Palo Alto, California
Title
Relationships Among Conduit Type, Pre-Stenting, and Outcomes in Patients
Undergoing Transcatheter Pulmonary Valve Replacement in the Prospective
North American and European Melody Valve Trials.
Source
JACC: Cardiovascular Interventions. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study sought to evaluate the incidence of and risk
factors for conduit and stent-related outcomes following transcatheter
pulmonary valve replacement (TPVR). Background: Stent fracture (SF) and
right ventricular outflow tract (RVOT) reintervention are among the most
important adverse outcomes after TPVR using the Melody valve (Medtronic,
Minneapolis, Minnesota). The conduit environment and conduit preparation
practices vary among patients who undergo TPVR. Methods: Data from 3
prospective Melody valve multicenter studies were pooled and analyzed. All
patients who had successful implant of a Melody valve that was present at
hospital discharge comprised the study cohort; patients who had TPVR into
a stentless conduit comprised the analysis cohort. SF was diagnosed using
protocol-specified or clinical fluoroscopy or radiography, and classified
as major or minor. Results: Of 358 patients who underwent catheterization
with intent to perform TPVR, 309 were discharged with the Melody valve in
place (study cohort) of which 251 patients had TPVR into a stentless
conduit (analysis cohort). Median follow-up was 5 years. New pre-stents
were placed in 68% of patients with a stentless conduit, and 22% received
multiple pre-stents. At 3 years, freedom from any SF and major SF was 74
+/- 3% and 85 +/- 2%, respectively, and freedom from RVOT reintervention
was 85 +/- 2%. New pre-stents were associated with longer freedom from SF
and RVOT reintervention than was no pre-stent. Conclusions: Risks of SF
and reintervention after TPVR with a Melody valve were reduced by
implantation of pre-stents, which has become standard practice. This study
supports pre-stenting as an important component of TPVR
therapy.<br/>Copyright &#xa9; 2017.

<68>
Accession Number
615889001
Author
Frobert O.; Gotberg M.; Angeras O.; Jonasson L.; Erlinge D.; Engstrom T.;
Persson J.; Jensen S.E.; Omerovic E.; James S.K.; Lagerqvist B.; Nilsson
J.; Karegren A.; Moer R.; Yang C.; Agus D.B.; Erglis A.; Jensen L.O.;
Jakobsen L.; Christiansen E.H.; Pernow J.
Institution
(Frobert) Orebro University, Faculty of Health, Department of Cardiology,
Orebro, Sweden
(Gotberg, Erlinge) Department of Cardiology, University Hospital Lund,
Lund, Sweden
(Angeras, Omerovic) Department of Cardiology, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Jonasson) Department of Cardiology, University Hospital Linkoping,
Linkoping, Sweden
(Engstrom) Department of Cardiology, Rigshospitalet, University of
Copenhagen, Copenhagen, Denmark
(Persson) Karolinska Institutet, Department of Clinical Sciences, Danderyd
University Hospital, Stockholm, Sweden
(Jensen) Department of Cardiology, Aalborg University Hospital, Aalborg,
Denmark
(James, Lagerqvist) Department of Cardiology, University Hospital Uppsala,
Uppsala, Sweden
(Nilsson) Cardiology, Heart Centre, department of Public Health and
Clinical Medicine, Umea University, Umea, Sweden
(Karegren) Department of Cardiology, Vesteras County Hospital, Vasteras,
Sweden
(Moer) The Feiring Clinic, Feiring, Norway
(Yang) Clinical Epidemiology and Biostatistics, School of Medical
Sciences, Orebro University, Orebro and Unit of Biostatistics, Institute
of Evironmental Medicine, Karolinska Institutet, Stockholm, Sweden
(Agus) University of Southern California, Lawrence J. Ellison Institute
for Transformative Medicine, CA, United States
(Erglis) Latvian Centre of Cardiology, Pauls Stradins Clinical University
Hospital, Riga, Latvia
(Jensen) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Jakobsen, Christiansen) Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark
(Pernow) Karolinska Institutet, Cardiology Unit, Department of Medicine,
Karolinska University Hospital, Stockholm, Sweden
Title
Design and rationale for the Influenza vaccination After Myocardial
Infarction (IAMI) trial. A registry-based randomized clinical trial.
Source
American Heart Journal. 189 (pp 94-102), 2017. Date of Publication: 01 Jul
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Registry studies and case-control studies have demonstrated
that the risk of acute myocardial infarction (AMI) is increased following
influenza infection. Small randomized trials, underpowered for clinical
end points, indicate that future cardiovascular events can be reduced
following influenza vaccination in patients with established
cardiovascular disease. Influenza vaccination is recommended by
international guidelines for patients with cardiovascular disease, but
uptake is varying and vaccination is rarely prioritized during
hospitalization for AMI. Methods/design The Influenza vaccination After
Myocardial Infarction (IAMI) trial is a double-blind, multicenter,
prospective, registry-based, randomized, placebo-controlled, clinical
trial. A total of 4,400 patients with ST-segment elevation myocardial
infarction (STEMI) or non-STEMI undergoing coronary angiography will
randomly be assigned either to in-hospital influenza vaccination or to
placebo. Baseline information is collected from national heart disease
registries, and follow-up will be performed using both registries and a
structured telephone interview. The primary end point is a composite of
time to all-cause death, a new AMI, or stent thrombosis at 1 year.
Implications The IAMI trial is the largest randomized trial to date to
evaluate the effect of in-hospital influenza vaccination on death and
cardiovascular outcomes in patients with STEMI or non-STEMI. The trial is
expected to provide highly relevant clinical data on the efficacy of
influenza vaccine as secondary prevention after AMI.<br/>Copyright &#xa9;
2017 The Author(s)

<69>
Accession Number
613811038
Author
Ongkasuwan J.; Ocampo E.; Tran B.
Institution
(Ongkasuwan) Department of Otolaryngology Head and Neck Surgery, Baylor
College of Medicine/Texas Children's Hospital, Texas, United States
(Ocampo) Department of Pediatric Cardiology, Texas Children's Hospital,
Houston, TX, United States
(Tran) Department of Pediatric Radiology, Texas Children's Hospital,
Houston, TX, United States
Title
Laryngeal ultrasound and vocal fold movement in the pediatric
cardiovascular intensive care unit.
Source
Laryngoscope. 127 (1) (pp 167-172), 2017. Date of Publication: 01 Jan
2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives/Hypothesis: Vocal fold motion impairment (VFMI) is a known
sequela of cardiovascular surgery. The gold standard for the evaluation of
vocal fold movement is flexible nasolaryngoscopy (FNL). Although safe, FNL
does cause measurable physiologic changes. Noxious stimuli in
cardiovascular intensive care unit (CVICU) neonates may cause imbalance
between the pulmonary and systemic circulations and potentially
circulatory collapse. The goals of this project were to determine the
accuracy of laryngeal ultrasound (LUS) compared to FNL to identify VFMI in
CVICU neonates and compare their physiologic impact. Study Type: Case
control. Design: Prospective case-control study. Methods: Forty-six
consecutive infants from the CVICU were recruited, 23 with VFMI and 23
without based on FNL findings. They then underwent LUS, which was
subsequently reviewed by two pediatric radiologists blinded to the FNL
results. Physiologic parameters were recorded before and after the
procedures. Data analysis was performed with Cohen's kappa and Wilcoxon
signed-rank test. Results: Agreement between LUS and FNL was substantial
(kappa = 0.78). Laryngeal ultrasound had a sensitivity of 0.84 and
specificity of 0.95 for identifying VFMI. In terms of physiologic impact,
LUS caused statistically significantly less change in diastolic blood
pressure (P = 0.01), pulse (P = 0.001), and O<inf>2</inf> saturation (P =
0.004) compared to FNL. Arytenoid rotation could be seen clearly, and the
vocal fold-arytenoid angle in abduction was most predictive of symmetry
and movement (P = 0.17). However, it was difficult to determine vocal fold
closure patterns with LUS. Conclusion: Laryngeal ultrasound is a
comparable to FNL for evaluating vocal fold mobility with less physiologic
impact. Level of Evidence: 3b. Laryngoscope, 127:167-172,
2017.<br/>Copyright &#xa9; 2016 The American Laryngological, Rhinological
and Otological Society, Inc.

<70>
Accession Number
610189145
Author
Xu W.; Wang Y.; Song J.; Mo L.; Jiang T.
Institution
(Xu, Wang, Song, Jiang) Department of Respiratory Medicine, The First
Affiliated Hospital of Chongqing Medical University, Chongqing 400016,
China
(Mo) Department of Respiratory Medicine, Dazu District People's Hospital,
Chongqing 400016, China
Title
One-port video-assisted thoracic surgery versus three-port video-assisted
thoracic surgery for primary spontaneous pneumothorax: a meta-analysis.
Source
Surgical Endoscopy and Other Interventional Techniques. 31 (1) (pp 17-24),
2017. Date of Publication: 01 Jan 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Objective: To further understand the effects of video-assisted thoracic
surgery (VATS) with one-port versus three-port VATS for primary
spontaneous pneumothorax (PSP). Methods: In this study, we searched
information from the PubMed, Cochrane Library, Embase, ScienceDirect, Web
of Science, China National Knowledge Infrastructure (CNKI), and Wanfang
Data databases from inception to September 2015 to collect data of
randomized controlled trials (RCTs) and cohort studies about one-port VATS
versus three-port VATS for PSP. Two independent authors were committed to
screen literature, extract data, and assess the risk of bias of related
studies. Then, we used the RevMan 5.20 software for a meta-analysis of
one-port VATS versus three-port VATS for PSP. Results: Six cohort studies
involving 310 patients were finally selected in this meta-analysis. The
results of our study indicate that one-port VATS had a shorter hospital
stay (SMD = -0.39, 95 % CI -0.69 to 0.09, P = 0.01), lower VAS score of
24-h post-operative pain (SMD = -0.78, 95 % CI -1.40 to -0.52, P <
0.00001), shorter chest drainage time (SMD = -0.68, 95 % CI -1.15 to
-0.22, P = 0.004), and lower incidence of post-operative paraesthesia (OR
= 0.13, 95 % CI 0.06 to 0.29, P < 0.00001) compared with three-port VATS.
However, one-port VATS had a lower patient satisfaction score at 24 h (SMD
= -0.65, 95 % CI -0.95 to -0.35, P < 0.0001) and 48 h (SMD = -0.46, 95 %
CI -0.71 to -0.21, P = 0.0002). No differences in the recurrence of
pneumothorax (OR = 0.58, 95 % CI 0.20 to 1.67, P = 0.32), the operation
time (SMD = 1.01, 95 % CI -4.63 to 2.60, P = 0.58), and the satisfaction
score at 72 h (SMD = -0.11, 95 % CI -0.44 to 0.22, P < 0.00001) were noted
between the groups. Conclusion: Current evidence suggests that one-port
VATS may have certain advantages over three-port VATS for PSP. More
large-scale and high-quality studies are needed for
authentication.<br/>Copyright &#xa9; 2016, Springer Science+Business Media
New York.

<71>
Accession Number
617433800
Author
Kolodziejczak M.; Andreotti F.; Kowalewski M.; Buffon A.; Ciccone M.M.;
Parati G.; Scicchitano P.; Uminska J.M.; De Servi S.; Bliden K.P.; Kubica
J.; Bortone A.; Crea F.; Gurbel P.; Navarese E.P.
Institution
(Kolodziejczak) Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus
University, Sklodowskiej-Curie Street No. 9, Bydgoszcz 85-094, Poland
(Andreotti, Buffon, Crea) Institute of Cardiology, Catholic University
Medical School, Via Massimi 96, Rome 00136, Italy
(Kowalewski) Department of Cardiac Surgery, Dr Antoni Jurasz Memorial
University Hospital, Sklodowskiej-Curie Street No. 9, Bydgoszcz 85-094,
Poland
(Ciccone, Scicchitano, Bortone) Department of Emergency and Organ
Transplantation, Section of Cardiovascular Diseases, School of Medicine,
University of Bari, Piazza G. Cesare 11, Bari 70124, Italy
(Parati) Department of Cardiovascular, Neural and Metabolic Sciences, S.
Luca Hospital, IRCCS Istituto Auxologico Italiano, Piazzale Brescia, 20,
Milan 20149, Italy
(Uminska, Kubica) Department of Cardiology and Internal Medicine, Ludwik
Rydygier Collegium Medicum, Nicolaus Copernicus University,
Sklodowskiej-Curie Street No. 9, Bydgoszcz 85-094, Poland
(De Servi) Department of Cardiology, Multimedica IRCCS, Via Milanese, 300,
Milan 20141, Italy
(Bliden, Gurbel, Navarese) Inova Center for Thrombosis Research and Drug
Development, Inova Heart and Vascular Institute, 3300 Gallows Road, Falls
Church, VA 22042, United States
Title
Implantable cardioverter-defibrillators for primary prevention in patients
with ischemic or nonischemic cardiomyopathy: A systematic review and
meta-analysis.
Source
Annals of Internal Medicine. 167 (2) (pp 103-111), 2017. Date of
Publication: 18 Jul 2017.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Background: Implantable cardioverter-defibrillators (ICDs) have a role in
preventing cardiac arrest in patients at risk for life-threatening
ventricular arrhythmias. Purpose: To compare ICD therapy with conventional
care for the primary prevention of death of various causes in adults with
ischemic or nonischemic cardiomyopathy. Data Sources: MEDLINE, Cochrane
Central Register of Controlled Trials, Google Scholar, and EMBASE
databases, as well as several Web sites, from 1 April 1976 through 31
March 2017. Study Selection: Randomized controlled trials, published in
any language, comparing ICD therapy with conventional care and reporting
mortality outcomes (all-cause, sudden, any cardiac, or noncardiac) in the
primary prevention setting. Data Extraction: 2 independent investigators
extracted study data and assessed risk of bias. Data Synthesis: Included
were 11 trials involving 8716 patients: 4 (1781 patients) addressed
nonischemic cardiomyopathy, 6 (4414 patients) ischemic cardiomyopathy, and
1 (2521 patients) both types of cardiomyopathy. Mean follow-up was 3.2
years. An overall reduction in all-cause mortality, from 28.26% with
conventional care to 21.37% with ICD therapy (hazard ratio [HR], 0.81 [95%
CI, 0.70 to 0.94]; P = 0.043), was found. The magnitude of reduction was
similar in the cohorts with nonischemic (HR, 0.81 [CI, 0.72 to 0.91]) and
ischemic (HR, 0.82 [CI, 0.63 to 1.06]) disease, although the latter
estimate did not reach statistical significance. The rate of sudden death
fell from 12.15% with conventional care to 4.39% with ICD therapy (HR,
0.41 [CI, 0.30 to 0.56]), with a similar magnitude of reduction in
patients with ischemic (HR, 0.39 [CI, 0.23 to 0.68]) and those with
nonischemic disease (HR, 0.44 [CI, 0.17 to 1.12]). Noncardiac and any
cardiac deaths did not differ significantly by treatment. Limitation:
Heterogeneous timing of ICD placement; heterogeneous pharmacologic and
resynchronization co-interventions; trials conducted in different eras;
adverse events and complications not reviewed. Conclusion: Overall,
primary prevention with ICD therapy versus conventional care reduced the
incidence of sudden and allcause death.<br/>Copyright &#xa9; 2017 American
College of Physicians. All Rights Reserved.

<72>
Accession Number
616335288
Author
Arora S.; Ramm C.J.; Strassle P.D.; Vaidya S.R.; Caranasos T.G.; Vavalle
J.P.
Institution
(Arora, Ramm, Vavalle) Division of Cardiology, University of North
Carolina School of Medicine, Chapel Hill, North Carolina, United States
(Arora, Vaidya) Division of Internal Medicine, Cape Fear Valley Medical
Center, Fayetteville, North Carolina, United States
(Strassle) Department of Epidemiology, University of North Carolina at
Chapel Hill, Chapel Hill, North Carolina, United States
(Strassle, Caranasos) Department of Surgery, University of North Carolina
at Chapel Hill, Chapel Hill, North Carolina, United States
Title
Review of Major Registries and Clinical Trials of Late Outcomes After
Transcatheter Aortic Valve Replacement.
Source
American Journal of Cardiology. 120 (2) (pp 331-336), 2017. Date of
Publication: 15 Jul 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The results of the Placement of AoRtic TraNscathetER Valves (PARTNER) 2
trial established the feasibility of transcatheter aortic valve
replacement (TAVR) for intermediate surgical risk patients. The expansion
of TAVR into the low-risk patient population will largely depend on its
durability outcomes due to the high life expectancy in low-risk patients.
Long-term follow-up results from low-risk clinical trials will take
several years to be reported. Given this, we performed a systematic review
of current long-term data to provide further insights into TAVR durability
and long-term patient survival. We searched MEDLINE, Embase, Google
Scholar, BIOSIS, and major conference abstracts for TAVR studies with
follow-up of at least 4 years. Abstracts were retrieved and independently
reviewed for eligibility. Final studies were selected irrespective of the
type of TAVR valve, route of vascular access, or surgical risk profile. A
total of 12 studies met the inclusion criteria. We reviewed data from
these studies with emphasis on long-term survival and echocardiographic
findings.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<73>
Accession Number
610112476
Author
Anantha Narayanan M.; Sundaram V.; Reddy Y.N.V.; Baskaran J.; Agnihotri
K.; Badheka A.; Patel N.; Deshmukh A.
Institution
(Anantha Narayanan) Department of Internal Medicine, Creighton University,
School of Medicine, Omaha, NE, United States
(Reddy, Deshmukh) Division of Cardiovascular Diseases, Mayo Clinic,
Rochester, MN, United States
(Sundaram) Division of Cardiovascular Diseases, University Hospitals, Case
Medical Center, Cleveland, OH, United States
(Reddy) Department of Internal Medicine, Boston University, Medical
Center, Boston, MA, United States
(Baskaran) Sri Venkateshwaraa Medical College Hospital and Research
Center, Puducherry, India
(Agnihotri) Department of Internal Medicine, Saint Peters University
Hospital, New Brunswick, NJ, United States
(Badheka) Department of Cardiology, Everett Clinic, Everett, WA, United
States
(Patel) Department of Cardiology, University of Miami, Miller School of
Medicine, Miami, FL, United States
Title
What is the optimal approach to a non- culprit stenosis after ST-elevation
myocardial infarction - Conservative therapy or upfront revascularization?
An updated meta-analysis of randomized trials.
Source
International Journal of Cardiology. 216 (pp 18-24), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Non-culprit percutaneous coronary intervention (PCI) during a
ST-segment elevation myocardial infarction (STEMI) remains controversial.
We performed a meta-analysis of the published literature comparing a
strategy of complete revascularization (CR) with culprit or target vessel
revascularization (TVR)-only after STEMI in patients with multi-vessel
disease. Methods We searched PubMed/Medline, Cochrane, EMBASE, Web of
Science, CINAHL, Scopus and Google-scholar databases from inception to
March-2016 for clinical trials comparing CR with TVR during PCI for STEMI.
Mantel-Haenszel risk ratio (MH-RR) with 95% confidence intervals (CI) for
individual outcomes was calculated using random-effects model. Results A
total of 7 randomized trials with 2004 patients were included in the final
analysis. Mean follow-up was 25.4 months. Major adverse cardiac events
(MACE) (MH-RR: 0.58, 95% CI: 0.43-0.78, P < 0.001), cardiac deaths (MH-RR:
0.42, 95% CI: 0.24-0.74, P = 0.003) and repeat revascularization (MH-RR:
0.36, 95% CI: 0.27-0.48, P < 0.001) were much lower in the CR group when
compared to TVR. However, there was no significant difference in the risk
of all-cause mortality (0.84, 95% CI: 0.57-1.25, P = 0.394) or recurrent
MI (MH-RR: 0.66, 95% CI: 0.34-1.26, P = 0.205) between the two groups. CR
appeared to be safe with no significant increase in adverse events
including stroke rates (MH-RR: 2.19, 95% CI: 0.59-8.12, P = 0.241),
contrast induced nephropathy (MH-RR: 0.73, 95% CI: 0.34-1.57, P = 0.423)
or major bleeding episodes (MH-RR: 0.72, 95% CI: 0.34-1.54, P = 0.399).
Conclusions CR strategy in STEMI patients with multivessel coronary artery
disease is associated with reduction in MACE, cardiac mortality and need
for repeat revascularization but with no decrease in the risk of
subsequent MI or all-cause mortality. CR was safe however, with no
increase in adverse events including stroke, stent thrombosis or contrast
nephropathy when compared to TVR.<br/>Copyright &#xa9; 2016 Elsevier
Ireland Ltd. All rights reserved.

<74>
Accession Number
610286491
Author
Li H.; Lin Y.-L.; Diao S.-L.; Ma B.-X.; Liu X.-L.
Institution
(Li, Lin, Diao, Ma) Department of Cardiology, Affiliated Hospital of
Binzhou Medical University, Binzhou, China
(Liu) Department of Cardiology, Qilu Hospital of Shandong University,
Jinan, Shandong Province, China
Title
Does short preoperative statin therapy prevent infectious complications in
adults undergoing cardiac or non-cardiac surgery?: A meta-analysis of 5
randomized placebo-controlled trials.
Source
Saudi Medical Journal. 37 (5) (pp 492-497), 2016. Date of Publication: May
2016.
Publisher
Saudi Arabian Armed Forces Hospital (E-mail: smjns.ksa@zajil.net)
Abstract
Objectives: To evaluate the effect of preoperative statin therapy on the
incidence of postoperative infection. Methods: This systematic review of
the literature was carried out in August 2015. Studies were retrieved via
PubMed, Embase, and the Cochrane Library (1980 to 2015), and the reference
files were limited to Englishlanguage articles. We used a standardized
protocol, and a meta-analysis was performed for data abstraction.
Systematic Review Results: Five studies comprising 1,362 patients
qualified for the analysis. The incidence of postoperative infections in
the statin group (1.1%) was not significantly lower than that in the
placebo group (2.4%), with a risk ratio (RR) of 0.56 (95% confidence
interval [CI] 0.24-1.33, p=0.19). Patients of 3 studies underwent cardiac
surgery. The aggregated results of these studies failed to show
significant differences in postoperative infection when a fixed effects
model was used (RR: 0.39; 95% CI: 0.08-1.97, p=0.26]. Conclusions: We
failed to find sufficient evidence to support the association between
statin use and postoperative infectious complications. The absence of any
evidence for a beneficial effect in available randomized trials reduces
the likelihood of a causal effect as reported in observational
studies.<br/>Copyright &#xa9; 2016, Saudi Arabian Armed Forces Hospital.
All rights reserved.

<75>
Accession Number
610114046
Author
Barbero U.; Iannaccone M.; D'Ascenzo F.; Barbero C.; Mohamed A.; Annone
U.; Benedetto S.; Celentani D.; Gagliardi M.; Moretti C.; Gaita F.
Institution
(Barbero, Iannaccone, D'Ascenzo, Mohamed, Annone, Benedetto, Celentani,
Gagliardi, Moretti, Gaita) Cardiology Department, Citta Della Salute,
Scienza Hospital, Turin, Italy
(Barbero) Cardiac Surgery Department, Citta Della Salute, Scienza
Hospital, Turin, Italy
Title
64 slice-coronary computed tomography sensitivity and specificity in the
evaluation of coronary artery bypass graft stenosis: A meta-analysis.
Source
International Journal of Cardiology. 216 (pp 52-57), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Elsevier Ireland Ltd
Abstract
A non-invasive approach to define grafts patency and stenosis in the
follow-up of coronary artery bypass graft (CABG) patients may be an
interesting alternative to coronary angiography. 64-slice-coronary
computed tomography is nowadays a diffused non-invasive method that
permits an accurate evaluation of coronary stenosis, due to a high
temporal and spatial resolution. However, its sensitivity and specificity
in CABG evaluation has to be clearly defined, since published studies used
different protocols and scanners. We collected all studies investigating
patients with stable symptoms and previous CABG and reporting the
comparison between diagnostic performances of invasive coronary
angiography and 64-slice-coronary computed tomography. As a result,
sensitivity and specificity of 64-slice-coronary computed tomography for
CABG occlusion were 0.99 (95% CI 0.97-1.00) and 0.99 (95% CI: 0.99-1.00)
with an area under the curve (AUC) of 0.99. 64-slice-coronary computed
tomography sensitivity and specificity for the presence of any CABG
stenosis > 50% were 0.98 (95% CI: 0.97-0.99) and 0.98 (95% CI: 0.96-0.98),
while AUC was 0.99. At meta-regression, neither the age nor the time from
graft implantation had effect on sensitivity and specificity of
64-slice-coronary computed tomography detection of significant CABG
stenosis or occlusion. In conclusion 64-slice-coronary computed tomography
confirmed its high sensitivity and specificity in CABG stenosis or
occlusion evaluation.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd. All
rights reserved.

<76>
Accession Number
607428768
Author
Kosour C.; Dragosavac D.; Antunes N.; Almeida de Oliveira R.A.R.; Martins
Oliveira P.P.; Wilson Vieira R.
Institution
(Kosour) Department of Nursing, Federal University of Alfenas, Alfenas,
Brazil
(Kosour, Dragosavac, Antunes, Martins Oliveira, Wilson Vieira) Department
of Surgery, School of Medical Sciences, State University of Campinas
(Unicamp), Campinas, Barao Geraldo, Brazil
(Almeida de Oliveira) Pontifical University Catholic of Campinas
(PUC-Campinas), Campinas, Brazil
Title
Effect of Ultrafiltration on Pulmonary Function and Interleukins in
Patients Undergoing Cardiopulmonary Bypass.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (4) (pp 884-890),
2016. Date of Publication: 01 Aug 2016.
Publisher
W.B. Saunders
Abstract
Objective To evaluate the effect of ultrafiltration on interleukins,
TNF-alpha levels, and pulmonary function in patients undergoing coronary
artery bypass grafting (CABG). Design Prospective, randomized, controlled
trial. Setting University hospital. Participants Forty patients undergoing
CABG were randomized into a group assigned to receive ultrafiltration (UF)
during cardiopulmonary bypass (CPB) or into another group (control) that
underwent the same procedure but without ultrafiltration. Methods
Interleukins and TNF-alpha levels, pulmonary gas exchange, and ventilatory
mechanics were measured in the preoperative, intraoperative, and
postoperative periods. Interleukins and TNF-alpha also were analyzed in
the perfusate of the test group. Measurements and Main Results There were
increases in IL-6 and IL-8 at 30 minutes after CPB and 6, 12, 24, and 36
hours after surgery, along with an increase in TNF-alpha at 30 minutes
after CPB and 24, 36, and 48 hours after surgery in both groups. IL-1
increased at 30 minutes after CPB and 12 hours after surgery, while IL-6
increased 24 and 36 hours after surgery in the UF group. The analysis of
the ultrafiltrate showed the presence of TNF-alpha and traces of IL-1beta,
IL-6, and IL-8. There were alterations in the oxygen index,
alveolar-arterial oxygen difference, deadspace, pulmonary static
compliance and airway resistance after anesthesia and sternotomy, as well
as in airway resistance at 6 hours after surgery in both groups, with no
difference between them. Conclusions Ultrafiltration increased the serum
level of IL-1 and IL-6, while it did not interfere with gas exchange and
pulmonary mechanics in CABG.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<77>
Accession Number
608719832
Author
Frymoyer A.; Su F.; Grimm P.C.; Sutherland S.M.; Axelrod D.M.
Institution
(Frymoyer, Su, Grimm, Sutherland, Axelrod) Department of Pediatrics,
Stanford University, Stanford, CA, United States
Title
Theophylline Population Pharmacokinetics and Dosing in Children Following
Congenital Heart Surgery With Cardiopulmonary Bypass.
Source
Journal of Clinical Pharmacology. 56 (9) (pp 1084-1093), 2016. Date of
Publication: 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Children undergoing cardiac surgery requiring cardiopulmonary bypass (CPB)
frequently develop acute kidney injury due to renal ischemia.
Theophylline, which improves renal perfusion via adenosine receptor
inhibition, is a potential targeted therapy. However, children undergoing
cardiac surgery and CPB commonly have alterations in drug
pharmacokinetics. To help understand optimal aminophylline (salt
formulation of theophylline) dosing strategies in this population, a
population-based pharmacokinetic model was developed using nonlinear
mixed-effects modeling (NONMEM) from 71 children (median age 5 months; 90%
range 1 week to 10 years) who underwent cardiac surgery requiring CPB and
received aminophylline as part of a previous randomized controlled trial.
A 1-compartment model with linear elimination adequately described the
pharmacokinetics of theophylline. Weight scaled via allometry was a
significant predictor of clearance and volume. In addition, allometric
scaled clearance increased with age implemented as a power maturation
function. Compared to prior reports in noncardiac children, theophylline
clearance was markedly reduced across age. In the final population
pharmacokinetic model, optimized empiric dosing regimens were developed
via Monte Carlo simulations. Doses 50% to 75% lower than those recommended
in noncardiac children were needed to achieve target serum concentrations
of 5 to 10 mg/L.<br/>Copyright &#xa9; 2016, The American College of
Clinical Pharmacology

<78>
Accession Number
617328917
Author
Sabato L.A.; Salerno D.M.; Moretz J.D.; Jennings D.L.
Institution
(Sabato) Heart Failure and Cardiac Transplantation, Department of
Pharmacy, UC Health-University of Cincinnati Medical Center, Cincinnati,
OH, United States
(Salerno) Solid Organ Transplantation, Department of Pharmacy,
NewYork-Presbyterian Hospital - Weill Cornell Medical Center, New York,
NY, United States
(Moretz) Ventricular Assist Devices, Department of Pharmacy, Vanderbilt
University Medical Center, Nashville, TN, United States
(Jennings) Heart Transplant and Mechanical Circulatory Support, Department
of Pharmacy, New York-Presbyterian Hospital - Columbia University Medical
Center, New York, NY, United States
Title
Inhaled Pulmonary Vasodilator Therapy for Management of Right Ventricular
Dysfunction after Left Ventricular Assist Device Placement and Cardiac
Transplantation.
Source
Pharmacotherapy. 37 (8) (pp 944-955), 2017. Date of Publication: August
2017.
Publisher
Pharmacotherapy Publications Inc.
Abstract
Right ventricular failure (RVF) after cardiac transplant (CTX) or
implantation of a continuous-flow left ventricular assist device (CF-LVAD)
is associated with significant postoperative morbidity and mortality. A
variety of modalities have been used to treat postoperative RVF, including
management of volume status, intravenous inotropes and vasodilators, and
right-sided mechanical support. Inhaled vasodilator agents are a unique
treatment option aimed at minimizing systemic absorption by delivering
therapy directly to the pulmonary vasculature. Current LVAD and CTX
guidelines endorse inhaled vasodilators for managing postoperative RVF;
however, no guidance is offered regarding agent selection, dosing, or
administration. A review of the current literature confirms that inhaled
pulmonary vasodilator agents have been shown to decrease pulmonary artery
pressure when used in the perioperative period of CF-LVAD implant or CTX.
However, the literature regarding the potential impact on clinical
outcomes (e.g., survival or risk of developing RVF) is lacking with these
medications. Based on our assessment of the literature, we suggest that
when RVF occurs in the setting of a normal pulmonary vascular resistance
(PVR), traditional inotropic therapy (e.g., dobutamine) should be used.
Conversely, if the PVR is elevated (> 250 dynes/sec/cm⁵ or 3
Wood units), or the patient has other evidence of a high right ventricular
afterload (i.e., a transpulmonary gradient > 12 mm Hg), then an inhaled
pulmonary vasodilator would be the preferred initial pharmacologic agent.
Drug selection depends largely on the institution's capacity to safely
prepare and administer the medication, along with formulary
considerations, such as the high costs associated with inhaled iloprost
and inhaled nitric oxide.<br/>Copyright &#xa9; 2017 Pharmacotherapy
Publications, Inc.

<79>
Accession Number
617767693
Author
Jones J.D.; Chew P.G.; Dobson R.; Wootton A.; Ashrafi R.; Khand A.
Institution
(Jones, Chew, Dobson, Khand) University Hospital Aintree NHS Foundation
Trust, Liverpool, United Kingdom
(Jones, Ashrafi, Khand) University of Liverpool, Liverpool, United Kingdom
(Wootton) RMIT University, Melbourne, VIC, Australia
(Ashrafi) Bristol Heart Institute, Bristol, United Kingdom
(Khand) Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
Title
The prognostic value of heart type fatty acid binding protein in patients
with suspected acute coronary syndrome: A systematic review.
Source
Current Cardiology Reviews. 13 (3) (pp 189-198), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Heart type fatty acid protein (HFABP) is a cytosolic protein
released early after acute coronary syndrome (ACS) even in the absence of
myocardial necrosis. Objectives: The purpose of this systematic review was
to determine whether HFABP levels in patients with suspected, or confirmed
ACS, improve risk stratification when added to established means of risk
assessment. Methods: We searched Medline, Pubmed and Embase databases from
inception to July 2015 to identify prospective studies with suspected or
confirmed ACS, who had HFABP measured during the index admission with at
least 1 month follow up data. A prognostic event was defined as all-cause
mortality or acute myocardial infarction (AMI). Results: 7 trials
providing data on 6935 patients fulfilled inclusion criteria. There were
considerable differences between studies and this was manifest in
variation in prognostic impact of elevated HFABP(Odds ratio range 1.2-15.2
for death). All studies demonstrated that HFABP provide unad-justed
prognostic information and in only one study this was negated after
adjusting for covariates. A combination of both negative troponin and
normal HFABP conferred a very low event rate. No study evaluated the
incremental value of HFABP beyond that of standard risk scores. Only one
study used a high sensitive troponin assay. Conclusion: There was marked
heterogeneity in prognostic impact of HFABP in ACS between studies
reflecting differences in sampling times and population risk. Prospective
studies of suspected ACS with early sampling of HFABP in the era of high
sensitivity troponin are necessary to determine the clinical value of
HFABP. HFABP should not currently be used clinically as a prognostic
marker in patients with suspected ACS.<br/>Copyright &#xa9; 2017 Bentham
Science Publishers.

<80>
Accession Number
614015633
Author
Bundhun P.K.; Soogund M.Z.S.; Huang W.-Q.
Institution
(Bundhun, Huang) Institute of Cardiovascular Diseases, First Affiliated
Hospital of Guangxi Medical University, Nanning, Guangxi, China
(Soogund) Guangxi Medical University, Nanning, Guangxi, China
Title
Same day discharge versus overnight stay in the hospital following
percutaneous coronary intervention in patients with stable coronary artery
disease: A systematic review and meta-analysis of randomized controlled
trials.
Source
PLoS ONE. 12 (1) (no pagination), 2017. Article Number: e0169807. Date of
Publication: January 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: New research in interventional cardiology has shown the demand
for percutaneous coronary interventions (PCI) to have increased
tremendously. Effective treatment with a lower hospital cost has been the
aim of several PCI capable centers. This study aimed to compare the
adverse clinical outcomes associated with same day discharge versus
overnight stay in the hospital following PCI in a population of randomized
patients with stable coronary artery disease (CAD). Methods: The National
Library of Medicine (MEDLINE/PubMed), the Cochrane Registry of Randomized
Controlled Trials and EMBASE databases were searched (from March to June
2016) for randomized trials comparing same-day discharge versus overnight
stay in the hospital following PCI. Main endpoints in this analysis
included adverse cardiovascular outcomes observed during a 30-day period.
Statistical analysis was carried out by the RevMan 5.3 software whereby
odds ratios (OR) and 95% confidence intervals (CIs) were calculated with
respect to a fixed or a random effects model. Results: Eight randomized
trials with a total number of 3081 patients (1598 patients who were
discharged on the same day and 1483 patients who stayed overnight in the
hospital) were included. Results of this analysis showed that mortality,
myocardial infarction (MI) and major adverse cardiac events (MACEs) were
not significantly different between same day discharge versus overnight
stay following PCI with OR: 0.22, 95% CI: 0.04-1.35; P = 0.10, OR: 0.68,
95% CI: 0.33-1.41; P = 0.30 and OR: 0.45, 95% CI: 0.20-1.02; P = 0.06
respectively. Blood transfusion and re-hospitalization were also not
significantly different between these two groups with OR: 0.64, 95% CI:
0.13-3.21; P = 0.59 and OR: 1.53, 95% CI: 0.88- 2.65; P = 0.13
respectively. Similarly, any adverse event, major bleeding and repeated
revascularization were also not significantly different between these two
groups of patients with stable CAD, with OR: 0.42, 95% CI: 0.05-3.97; P =
0.45, OR: 0.73, 95% CI: 0.15-3.54; P = 0.69 and OR: 0.67, 95% CI:
0.14-3.15; P = 0.61 respectively. Conclusion: In terms of adverse
cardiovascular outcomes, same day discharge was neither superior nor
inferior to overnight hospital stay following PCI in those patients with
stable CAD. However, future research will have to emphasize on the
long-term consequences.<br/>Copyright &#xa9; 2017 Bundhun et al. This is
an open access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<81>
Accession Number
614169767
Author
Li Z.; Zhou Y.; Xu Q.; Chen X.
Institution
(Li, Chen) Department of Cardiology, Affiliated Hospital Ningbo No. 1
Hospital, Zhejiang University, Ningbo, China
(Zhou) Department of Cardiology, First Affiliated Hospital, School of
Medicine, Zhejiang University, Ningbo, China
(Xu) Department of Nephrology, Affiliated Hospital Ningbo No. 1 Hospital,
Zhejiang University, Ningbo, China
Title
Staged versus one-time complete revascularization with percutaneous
coronary intervention in STEMI patients with multivessel disease: A
systematic review and meta-analysis.
Source
PLoS ONE. 12 (1) (no pagination), 2017. Article Number: e0169406. Date of
Publication: January 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Introduction: In patients with acute ST-elevation myocardial infarction
(STEMI), the preferred intervention is percutaneous coronary intervention
(PCI). Whether staged PCI (S-PCI) or one-time complete PCI (MV-PCI) is
more beneficial and safer in terms of treating the non-culprit vessel
during the primary PCI procedure is unclear. We performed a meta-analysis
of all randomized and non-randomized controlled trials comparing S-PCI
with MV-PCI in patients with acute STEMI and MVD. Methods: Studies of
STEMI with multivessel disease receiving primary PCI were searched in
PUBMED, EMBASE and The Cochrane Register of Controlled Trials from January
2004 to December 2014. The primary end points were long-term rates of
major adverse cardiovascular events and their components - mortality,
reinfarction, and target-vessel revascularization. Data were combined
using a fixed-effects model. Results: Of 507 citations, 10 studies (4
randomized, 6 nonrandomized; 820 patients, 562 staged PCI and 347
one-time, complete multi-vessel PCI) were included. S-PCI compared to
MV-PCI significantly reduced mortality both long-term (OR 0.44, 95% CI
0.29-0.66, P<0.0001,I² = 0%) and short-term (OR 0.23, 95% CI
0.1-0.51, P = 0.0003,I² = 0%). There was a trend toward reduced
risk of MACE with s-PCI compared with MV-PCI (OR 0.83, 0.62-1.12, P =
0.22,I2 = 0%). No difference between S-PCI and MV-PCI was observed in
reinfarction (OR 0.97, 0.61-1.55, P = 0.91, I² = 0%), or target
vessel revascularization (OR1.17, 95% CI 0.81-1.69, P = 0.40,
I² = 8%). Conclusions: The staged strategy for non-culprit
lesions improved short- and long-term survival and should remain the
standard approach to primary PCI in patients with STEMI; one-time complete
multivessel PCI may be associated with greater mortality risk. However,
additional large, randomized trials are required to confirm the optimal
timing of a staged procedure on the non-culprit vessel in
STEMI.<br/>Copyright &#xa9; 2017 Li et al. This is an open access article
distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any
medium, provided the original author and source are credited.

<82>
Accession Number
613853744
Author
El-Mashad A.E.-R.; El-Mahdy H.; El Amrousy D.; Elgendy M.
Institution
(El-Mashad, El-Mahdy, El Amrousy, Elgendy) Pediatric Department, Tanta
University Hospital, Elgeish street, Tanta, Egypt
Title
Comparative study of the efficacy and safety of paracetamol, ibuprofen,
and indomethacin in closure of patent ductus arteriosus in preterm
neonates.
Source
European Journal of Pediatrics. 176 (2) (pp 233-240), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
In this prospective study, we compared the efficacy and side effects of
indomethacin, ibuprofen, and paracetamol in patent ductus arteriosus (PDA)
closure in preterm neonates. Three hundred preterm neonates with
hemodynamically significant PDA (hs-PDA) admitted at our neonatal
intensive care unit were enrolled in the study. They were randomized into
three groups. Group I (paracetamol group) received 15 mg/kg/6 h IV
paracetamol infusion for 3 days. Group II (ibuprofen group) received 10
mg/kg IV ibuprofen infusion followed by 5 mg/kg/day for 2 days. Group III
(indomethacin group) received 0.2 mg/kg/12 h indomethacin IV infusion for
three doses. Laboratory investigations such as renal function test, liver
function test, complete blood count, and blood gases were conducted in
addition to echocardiographic examinations. All investigations were done
before and 3 days after treatment. There was no significant difference
between all groups regarding efficacy of PDA closure (P = 0.868). There
was a significant increase in serum creatinine levels and serum blood urea
nitrogen (BUN) in the ibuprofen and indomethacin groups (P < 0.001). There
was a significant reduction in platelet count and urine output (UOP) in
both ibuprofen and indomethacin groups (P < 0.001). There was a
significant increase in bilirubin levels in only the ibuprofen group (P =
0.003). No significant difference of hemoglobin (HB) level or liver
enzymes in all groups (P > 0.05). Ventilatory settings improved
significantly in patients with successful closure of PDA than those with
failed PDA closure (P < 0.001). Conclusion: Paracetamol is as effective as
indomethacin and ibuprofen in closure of PDA in preterm neonates and has
less side effects mainly on renal function, platelet count, and GIT
bleeding.What is Known:* Hemodynamically significant patent ductus
arteriosus has many complications for preterm and low birth weight
neonates and better to be closed. Many drugs were used for medical closure
of PDA e.g. indomethacin, ibuprofen and recently paracetamol. Many studies
compare safety and efficacy of paracetamol with either indomethacin or
ibuprofen.What is New:* It is the first large study that compares the
efficacy and side effects of the three drugs in one study.<br/>Copyright
&#xa9; 2016, Springer-Verlag Berlin Heidelberg.

<83>
Accession Number
615893012
Author
Benstoem C.; Stoppe C.; Liakopoulos O.J.; Ney J.; Hasenclever D.; Meybohm
P.; Goetzenich A.
Institution
(Benstoem, Goetzenich) University Hospital Aachen, Department of
Cardiothoracic Surgery, Pauwelsstrasse 30, Aachen, North Rhine Westphalia
52074, Germany
(Stoppe) RWTH Aachen University, Department of Intensive Care Medicine,
Pauwelsstrasse 30, Aachen, North Rhine Westphalia 52074, Germany
(Liakopoulos) Heart Center, University of Cologne, Department of
Cardiothoracic Surgery, Kerpener Str. 62, Cologne 50937, Germany
(Ney) University Hospital RWTH Aachen, Department of Anaesthesiology,
Pauwelsstrasse 30, Aachen, Germany
(Hasenclever) University of Leipzig, Institute for Medical Informatics,
Statistics and Epidemiology (IMISE), Haertelstrasse 16-18, Leipzig,
Germany
(Meybohm) University Hospital Frankfurt, Department of Anaesthesiology,
Intensive Care and Pain Therapy, Theodor-Stern-Kai 7, Frankfurt am Main
60590, Germany
Title
Remote ischaemic preconditioning for coronary artery bypass grafting (with
or without valve surgery).
Source
Cochrane Database of Systematic Reviews. 2017 (5) (no pagination), 2017.
Article Number: CD011719. Date of Publication: 05 May 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Despite substantial improvements in myocardial preservation
strategies, coronary artery bypass grafting (CABG) is still associated
with severe complications. It has been reported that remote ischaemic
preconditioning (RIPC) reduces reperfusion injury in people undergoing
cardiac surgery and improves clinical outcome. However, there is a lack of
synthesised information and a need to review the current evidence from
randomised controlled trials (RCTs). Objectives: To assess the benefits
and harms of remote ischaemic preconditioning in people undergoing
coronary artery bypass grafting, with or without valve surgery. Search
methods: In May 2016 we searched CENTRAL, MEDLINE, Embase and Web of
Science. We also conducted a search of ClinicalTrials.gov and the
International Clinical Trials Registry Platform (ICTRP). We also checked
reference lists of included studies. We did not apply any language
restrictions. Selection criteria: We included RCTs in which people
scheduled for CABG (with or without valve surgery) were randomly assigned
to receive RIPC or sham intervention before surgery. Data collection and
analysis: Two review authors independently assessed trials for inclusion,
extracted data and checked them for accuracy. We calculated mean
differences (MDs), standardised mean differences (SMDs) and risk ratios
(RR) using a random-effects model. We assessed quality of the trial
evidence for all primary outcomes using the GRADE methodology. We
completed a 'Risk of bias' assessment for all studies and performed
sensitivity analysis by excluding studies judged at high or unclear risk
of bias for sequence generation, allocation concealment and incomplete
outcome data. We contacted authors for missing data. Our primary endpoints
were 1) composite endpoint (including all-cause mortality, non-fatal
myocardial infarction or any new stroke, or both) assessed at 30 days
after surgery, 2) cardiac troponin T (cTnT, ng/L) at 48 hours and 72
hours, and as area under the curve (AUC) 72 hours (mug/L) after surgery,
and 3) cardiac troponin I (cTnI, ng/L) at 48 hours, 72 hours, and as area
under the curve (AUC) 72 hours (mug/L) after surgery. Main results: We
included 29 studies involving 5392 participants (mean age = 64 years, age
range 23 to 86 years, 82% male). However, few studies contributed data to
meta-analyses due to inconsistency in outcome definition and reporting. In
general, risk of bias varied from low to high risk of bias across included
studies, and insufficient detail was provided to inform judgement in
several cases. The quality of the evidence of key outcomes ranged from
moderate to low quality due to the presence of moderate or high
statistical heterogeneity, imprecision of results or due to limitations in
the design of individual studies. Compared with no RIPC, we found that
RIPC has no treatment effect on the rate of the composite endpoint with RR
0.99 (95% confidence interval (CI) 0.78 to 1.25); 2 studies; 2463
participants; moderate-quality evidence. Participants randomised to RIPC
showed an equivalent or better effect regarding the amount of cTnT release
measured at 72 hours after surgery with SMD -0.32 (95% CI -0.65 to 0.00);
3 studies; 1120 participants; moderate-quality evidence; and expressed as
AUC 72 hours with SMD -0.49 (95% CI -0.96 to -0.02); 3 studies; 830
participants; moderate-quality evidence. We found the same result in
favour of RIPC for the cTnI release measured at 48 hours with SMD -0.21
(95% CI -0.40 to -0.02); 5 studies; 745 participants; moderate-quality
evidence; and measured at 72 hours after surgery with SMD -0.37 (95% CI
-0.59 to -0.15); 2 studies; 459 participants; moderate-quality evidence.
All other primary outcomes showed no differences between groups (cTnT
release measured at 48 hours with SMD -0.14, 95% CI -0.33 to 0.06; 4
studies; 1792 participants; low-quality evidence and cTnI release measured
as AUC 72 hours with SMD -0.17, 95% CI -0.48 to 0.14; 2 studies; 159
participants; moderate-quality evidence). We also found no differences
between groups for all-cause mortality after 30 days, non-fatal myocardial
infarction after 30 days, any new stroke after 30 days, acute renal
failure after 30 days, length of stay on the intensive care unit (days),
any complications and adverse effects related to ischaemic
preconditioning. We did not assess many
patient-centred/salutogenic-focused outcomes. Authors' conclusions: We
found no evidence that RIPC has a treatment effect on clinical outcomes
(measured as a composite endpoint including all-cause mortality, non-fatal
myocardial infarction or any new stroke, or both, assessed at 30 days
after surgery). There is moderate-quality evidence that RIPC has no
treatment effect on the rate of the composite endpoint including all-cause
mortality, non-fatal myocardial infarction or any new stroke assessed at
30 days after surgery, or both. We found moderate-quality evidence that
RIPC reduces the cTnT release measured at 72 hours after surgery and
expressed as AUC (72 hours). There is moderate-quality evidence that RIPC
reduces the amount of cTnI release measured at 48 hours, and measured 72
hours after surgery. Adequately-designed studies, especially focusing on
influencing factors, e.g. with regard to anaesthetic management, are
encouraged and should systematically analyse the commonly used medications
of people with cardiovascular diseases.<br/>Copyright &#xa9; 2017 The
Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

<84>
Accession Number
617833310
Author
Li X.; Yang J.; Nie X.-L.; Zhang Y.; Li X.-Y.; Li L.-H.; Wang D.-X.; Ma D.
Institution
(Li, Zhang, Wang) Department of Anesthesiology and Critical Care Medicine,
Peking University First Hospital, Beijing, China
(Yang, Li) Department of Anesthesiology, Fuwai Hospital, National Center
for Cardiovascular Diseases, Chinese Academy of Medical Sciences and
Peking Union Medical College, Beijing, China
(Nie) Center for Clinical Epidemiology & Evidence-Based Medicine, Beijing
Children's Hospital, Capital Medical University, Beijing, China
(Li) Department of Biostatistics, Peking University First Hospital,
Beijing, China
(Ma) Section of Anaesthetics, Pain Management and Intensive Care,
Department of Surgery and Cancer, Imperial College London, Chelsea and
Westminster Hospital, London, United Kingdom
Title
Impact of dexmedetomidine on the incidence of delirium in elderly patients
after cardiac surgery: A randomized controlled trial.
Source
PloS one. 12 (2) (pp e0170757), 2017. Date of Publication: 2017.
Abstract
BACKGROUND: Delirium is a frequent complication after cardiac surgery and
its occurrence is associated with poor outcomes. The purpose of this study
was to investigate the impact of perioperative dexmedetomidine
administration on the incidence of delirium in elderly patients after
cardiac surgery.
METHODS: This randomized, double-blinded, and placebo-controlled trial was
conducted in two tertiary hospitals in Beijing between December 1, 2014
and July 19, 2015. Eligible patients were randomized into two groups.
Dexmedetomidine (DEX) was administered during anesthesia and early
postoperative period for patients in the DEX group, whereas normal saline
was administered in the same rate for the same duration for patients in
the control (CTRL) group. The primary endpoint was the incidence of
delirium during the first five days after surgery. Secondary endpoints
included the cognitive function assessed on postoperative days 6 and 30,
the overall incidence of non-delirium complications within 30 days after
surgery, and the all-cause 30-day mortality.
RESULTS: Two hundred eighty-five patients were enrolled and randomized.
Dexmedetomidine did not decrease the incidence of delirium (4.9% [7/142]
in the DEX group vs 7.7% [11/143] in the CTRL group; OR 0.62, 95% CI 0.23
to 1.65, p = 0.341). Secondary endpoints were similar between the two
groups; however, the incidence of pulmonary complications was slightly
decreased (OR 0.51, 95% CI 0.26 to 1.00, p = 0.050) and the percentage of
early extubation was significantly increased (OR 3.32, 95% CI 1.36 to
8.08, p = 0.008) in the DEX group. Dexmedetomidine decreased the required
treatment for intraoperative tachycardia (21.1% [30/142] in the DEX group
vs 33.6% [48/143] in the CTRL group, p = 0.019), but increased the
required treatment for postoperative hypotension (84.5% [120/142] in the
DEX group vs 69.9% [100/143] in the CTRL group, p = 0.003).
CONCLUSIONS: Dexmedetomidine administered during anesthesia and early
postoperative period did not decrease the incidence of postoperative
delirium in elderly patients undergoing elective cardiac surgery. However,
considering the low delirium incidence, the trial might have been
underpowered.
TRIAL REGISTRATION: ClinicalTrials.gov NCT02267538.

<85>
Accession Number
617835079
Author
Burton N.W.; Ademi Z.; Best S.; Fiatarone Singh M.A.; Jenkins J.S.; Lawson
K.D.; Leicht A.S.; Mavros Y.; Noble Y.; Norman P.; Norman R.; Parmenter
B.J.; Pinchbeck J.; Reid C.M.; Rowbotham S.E.; Yip L.; Golledge J.
Institution
(Burton) The University of Queensland School of Human Movement & Nutrition
Sciences, St Lucia, Brisbane, QLD, 4072, Australia
(Ademi) University of Basel Institute of Pharmaceutical Medicine, Basel,
Switzerland
(Ademi) University of Monash Department of Epidemiology and Preventive
Medicine, Melbourne, 3004, VIC, Australia
(Best, Pinchbeck, Yip, Golledge) Queensland Research Centre for Peripheral
Vascular Disease; College of Medicine and Dentistry, James Cook
University, Townsville, QLD, 4811, Australia
(Fiatarone Singh) Exercise, Health and Performance Faculty Research Group,
Faculty of Health Sciences, University of Sydney, Sydney, NSW, 2141,
Australia
(Jenkins) Vascular Surgery The Royal Brisbane and Women's Hospital,
Herston, QLD, 4059, Australia
(Lawson) Centre for Health Research, School of Medicine, Western Sydney
University, Sydney, NSW, 2753, Australia
(Lawson) Centre for Research Excellence in Chronic Disease Prevention,
Australian Institute for Public Health and Tropical Health and Medicine,
James Cook University, Townsville, QLD, 4811, Australia
(Leicht) Sport and Exercise Science, College of Healthcare Sciences, James
Cook University, Townsville, QLD, 4811, Australia
(Mavros, Noble) Exercise, Health and Performance Research Group, Faculty
of Health Sciences, University of Sydney, Sydney, NSW, 2141, Australia
(Norman) Surgery Fremantle Hospital, The University of Western Australia,
Crawley, WA, 6009, Australia
(Norman, Reid) School of Public Health, Curtin University, Perth, WA,
6845, Australia
(Parmenter) Department of Exercise Physiology, Faculty of Medicine,
University of New South Wales, Sydney, NSW, 2052, Australia
(Reid) School of Public Health and Preventive Medicine, Monash University,
Melbourne, VIC, 3004, Australia
(Rowbotham) The University of Queensland School of Medicine, Herston, QLD,
4006, Australia
(Rowbotham) The Royal Brisbane and Women's Hospital, Herston, QLD, 4029,
Australia
(Golledge) Department of Vascular and Endovascular Surgery, The Townsville
Hospital, Townsville, QLD, 4811, Australia
Title
Efficacy of brief behavioral counselling by allied health professionals to
promote physical activity in people with peripheral arterial disease
(BIPP): study protocol for a multi-center randomized controlled trial.
Source
BMC public health. 16 (1) (pp 1148), 2016. Date of Publication: 09 Nov
2016.
Abstract
BACKGROUND: Physical activity is recommended for people with peripheral
arterial disease (PAD), and can improve walking capacity and quality of
life; and reduce pain, requirement for surgery and cardiovascular events.
This trial will assess the efficacy of a brief behavioral counselling
intervention delivered by allied health professionals to improve physical
activity in people with PAD.
METHODS: This is a multi-center randomised controlled trial in four cities
across Australia. Participants (N=200) will be recruited from specialist
vascular clinics, general practitioners and research databases and
randomised to either the control or intervention group. Both groups will
receive usual medical care, a written PAD management information sheet
including advice to walk, and four individualised contacts from a
protocol-trained allied health professional over 3 months (weeks 1, 2, 6,
12). The control group will receive four 15-min telephone calls with
general discussion about PAD symptoms and health and wellbeing. The
intervention group will receive behavioral counselling via two 1-h
face-to-face sessions and two 15-min telephone calls. The counselling is
based on the 5A framework and will promote interval walking for 3x40
min/week. Assessments will be conducted at baseline, and 4, 12 and 24
months by staff blinded to participant allocation. Objectively assessed
outcomes include physical activity (primary), sedentary behavior, lower
limb body function, walking capacity, cardiorespiratory fitness,
event-based claudication index, vascular interventions, clinical events,
cardiovascular function, circulating markers, and anthropometric measures.
Self-reported outcomes include physical activity and sedentary behavior,
walking ability, pain severity, and health-related quality of life. Data
will be analysed using an intention-to-treat approach. An economic
evaluation will assess whether embedding the intervention into routine
care would likely be value for money. A cost-effectiveness analysis will
estimate change in cost per change in activity indicators due to the
intervention, and a cost-utility analysis will assess change in cost per
quality-adjusted life year. A full uncertainty analysis will be
undertaken, including a value of information analysis, to evaluate the
economic case for further research.
DISCUSSION: This trial will evaluate the efficacy and cost-effectiveness
of a brief behavioral counselling intervention for a common cardiovascular
disease with significant burden.
TRIAL REGISTRATION: ACTRN 12614000592640 Australian New Zealand Clinical
Trials Registry. Registration Date 4 June 2014.

<86>
Accession Number
617759020
Author
Kehler D.S.; Stammers A.N.; Tangri N.; Hiebert B.; Fransoo R.; Schultz
A.S.H.; Macdonald K.; Giacomontonio N.; Hassan A.; Legare J.-F.; Arora
R.C.; Duhamel T.A.
Institution
(Kehler, Stammers, Duhamel) Health, Leisure and Human Performance Research
Institute, Faculty of Kinesiology and Recreation Management, University of
Manitoba, Winnipeg, MB, Canada
(Kehler, Stammers, Duhamel) Institute of Cardiovascular Sciences, St.
Boniface Hospital Research Centre, Winnipeg, Canada
(Tangri) Seven Oaks Hospital Research Centre, Winnipeg, Canada
(Hiebert, Arora) Department of Surgery, University of Manitoba and Cardiac
Sciences Program, Winnipeg, Canada
(Fransoo) Department of Community Health Sciences and Manitoba Centre for
Health Policy, University of Manitoba, Winnipeg, Canada
(Schultz) College of Nursing, Faculty of Heath Sciences, University of
Manitoba, Winnipeg, Canada
(Macdonald) Seven Oaks Hospital Library, Winnipeg, Canada
(Giacomontonio) Division of Cardiology, Department of Medicine, Dalhousie
University, Halifax, Canada
(Hassan) Department of Cardiac Surgery, New Brunswick Heart Centre, Saint
John Regional Hospital, Saint John, MB, Canada
(Legare) Division of Cardiac Surgery, Department of Surgery, Dalhousie
University, Halifax, Canada
Title
Systematic review of preoperative physical activity and its impact on
postcardiac surgical outcomes.
Source
BMJ Open. 7 (8) (no pagination), 2017. Article Number: e015712. Date of
Publication: 01 Aug 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives The objective of this systematic review was to study the impact
of preoperative physical activity levels on adult cardiac surgical
patients' postoperative: (1) major adverse cardiac and cerebrovascular
events (MACCEs), (2) adverse events within 30 days, (3) hospital length of
stay (HLOS), (4) intensive care unit length of stay (ICU LOS), (5)
activities of daily living (ADLs), (6) quality of life, (7) cardiac
rehabilitation attendance and (8) physical activity behaviour. Methods A
systematic search of MEDLINE, Embase, AgeLine and Cochrane library for
cohort studies was conducted. Results Eleven studies (n=5733 patients) met
the inclusion criteria. Only self-reported physical activity tools were
used. Few studies used multivariate analyses to compare active versus
inactive patients prior to surgery. When comparing patients who were
active versus inactive preoperatively, there were mixed findings for
MACCE, 30 day adverse events, HLOS and ICU LOS. Of the studies that
adjusted for confounding variables, five studies found a protective,
independent association between physical activity and MACCE (n=1), 30-day
postoperative events (n=2), HLOS (n=1) and ICU LOS (n=1), but two studies
found no protective association for 30-day postoperative events (n=1) and
postoperative ADLs (n=1). No studies investigated if activity status
before surgery impacted quality of life or cardiac rehabilitation
attendance postoperatively. Three studies found that active patients prior
to surgery were more likely to be inactive postoperatively. Conclusion Due
to the mixed findings, the literature does not presently support that
self-reported preoperative physical activity behaviour is associated with
postoperative cardiac surgical outcomes. Future studies should objectively
measure physical activity, clearly define outcomes and adjust for
clinically relevant variables. Registration Trial registration number
NCT02219815. PROSPERO number CRD42015023606.<br/>Copyright &#xa9; Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article) 2017. All rights reserved.

<87>
Accession Number
617811393
Author
Cattoni M.; Vallieres E.; Brown L.M.; Sarkeshik A.A.; Margaritora S.;
Siciliani A.; Imperatori A.; Rotolo N.; Farjah F.; Wandell G.; Costas K.;
Mann C.; Hubka M.; Kaplan S.; Farivar A.S.; Aye R.W.; Louie B.E.
Institution
(Cattoni, Vallieres, Mann, Farivar, Aye, Louie) Division of Thoracic
Surgery, Swedish Cancer Institute, Seattle, Washington
(Brown, Sarkeshik) Section of General Thoracic Surgery, Department of
Surgery, UC Davis Medical Center, Sacramento, California
(Margaritora, Siciliani) Unit of Thoracic Surgery, Catholic University
Sacred Heart, Rome, Italy
(Imperatori, Rotolo) Center of Thoracic Surgery, University of Insubria,
Ospedale di Circolo, Varese, Italy
(Farjah, Wandell) Division of Cardiothoracic Surgery, University of
Washington Medical Center, Seattle, Washington
(Costas) Division of Thoracic Surgery, Providence Regional Medical Center,
Everett, Washington
(Hubka, Kaplan) Division of Thoracic Surgery, Virginia Mason Hospital and
Seattle Medical Center, Seattle, Washington
Title
External Validation of a Prognostic Model of Survival for Resected Typical
Bronchial Carcinoids.
Source
Annals of Thoracic Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier USA
Abstract
Background: This study aimed to assess the reliability and the validity of
a prognostic model of survival recently developed by the European Society
of Thoracic Surgery Neuroendocrine Tumor Working Group to predict 5-year
overall survival after surgical resection of pulmonary typical carcinoid.
Methods: We retrospectively collected data on 240 consecutive patients
(164 men, 76 women; median age, 58 years [interquartile range, 47 to 68])
who underwent curative lung resection for pulmonary typical carcinoid in
seven centers between 2000 and 2015. For each patient, we calculated the
corresponding risk class (A, B, C, D) using the following variables: male,
age, previous malignancy, Eastern Cooperative Oncology Group performance
status, peripheral tumor, TNM stage. Kaplan-Meier method, and Cox
proportional hazards model were used for the statistical analysis.
Results: During a median follow-up of 42 months (interquartile range, 11
to 84), the 5-year overall survival was 94.2% (95% confidence interval
[CI]: 90.2% to 98.2%); 15 of 240 patients died. A significantly decreasing
rate of survival was observed from class A to class D (p = 0.004) with
rates of 100% (95% CI: 100% to 100%), 96.3% (95% CI: 88.6% to 98.8%),
86.7% (95% CI: 63.0% to 95.7%), and 33.3% (95% CI: 0.9% to 77.4%),
respectively, for class A, B, C, and D. This difference persisted also
using clinical stage as a variable in the risk class calculation (p =
0.006). No differences were observed in term of overall survival among TNM
stage I, II, and III patients (p = 0.94). Conclusions: This prognostic
model of survival is easily applicable, it is validated by our independent
cohort, and it appears to stratify better than the traditional TNM
staging. Therefore, it may be useful in counseling patients about their
outcomes from surgical treatment and in tailoring treatment for high-risk
patients.<br/>Copyright &#xa9; 2017 The Society of Thoracic Surgeons.

<88>
Accession Number
617805238
Author
Hebra A.; Kelly R.E.; Ferro M.M.; Yuksel M.; Campos J.R.M.; Nuss D.
Institution
(Hebra) Nemours Children's Hospital, Orlando, FL, USA
(Kelly) Children's Hospital of the King's Daughters, Norfolk, VA, USA
(Ferro) Fundacion Hospitalaria Children's Hospital, Buenos Aires,
Argentina
(Yuksel) University of Sao Paulo, Sao Paulo, SP, Brazil
(Campos, Nuss) Marmara University, Istanbul, Turkey
Title
Life-threatening complications and mortality of minimally invasive pectus
surgery.
Source
Journal of Pediatric Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
W.B. Saunders
Abstract
The prevalence and type of life-threatening complications related to the
minimally invasive repair of pectus excavatum (MIRPE) and bar removal are
unknown and underreported. The purpose of this communication is to make
surgeons aware of the risk of these life threatening complications as well
as the modifications which have been developed to prevent them. Methods:
Data related to life-threatening complications of Pectus Excavatum (PE)
patients was obtained from four sources: 1. A survey of Chest Wall
International Group (CWIG) surgeons who specialize in repairing congenital
chest wall malformations, 2. Papers and case reports presented at CWIG
meetings, 3. Review of medico-legal cases from the USA and 4. A systematic
review of the literature related to major complications post MIRPE.
Results: From 1998 to 2016, we identified 27 published cases and 32
unreported life-threatening complications including: cardiac perforation,
hemothorax, major vessel injury, lung injury, liver injury,
gastrointestinal problems, and diaphragm injury. There were seven cases of
major complications with bar removal (reported and non-reported) with two
lethal outcomes. Mortality data with bar placement surgery: Four published
death cases and seven unpublished death cases. The overall incidence of
minor & major complications post MIRPE has been reported in the literature
to be 2-20%. The true incidence of life-threatening complications and
mortality is not known as we do not know the overall number of procedures
performed worldwide. However, based on data extrapolated from survey
information, the pectus bar manufacturer in the USA, literature reports,
and data presented at CWIG meetings as to the number of cases performed we
estimated that approximately fifty thousand cases have been performed and
that the incidence of life-threatening complications is less than 0.1%
with many occurring during the learning curve. Analysis of the cases
identified in our survey revealed that previous chest surgery, pectus
severity and inexperience were noted to be significant risk factors for
mortality. Conclusions: Published reports support the safety and efficacy
of MIRPE; however major adverse outcomes are underreported. Although major
complications with MIRPE and pectus bar removal surgery are very rare,
awareness of the risk and mortality of life-threatening complications is
essential to ensure optimal safety. Factors such as operative technique,
patient age, pectus severity and asymmetry, previous chest surgery, and
the surgeon's experience play a role in the overall incidence of such
events. These preventable events can be avoided with proper training,
mentoring, and the use of sternal elevation techniques. Type of study:
Treatment Study. Level of evidence: Level IV.<br/>Copyright &#xa9; 2017
Elsevier Inc.

<89>
Accession Number
617803497
Author
Koch C.G.; Sessler D.I.; Mascha E.J.; Sabik J.F.; Li L.; Duncan A.I.;
Zimmerman N.M.; Blackstone E.H.
Institution
(Koch, Duncan) Department of Cardiothoracic Anesthesiology, Anesthesiology
Institute, Cleveland Clinic, Cleveland, Ohio
(Sessler, Mascha, Zimmerman) Department of Outcomes Research,
Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
(Mascha, Li, Zimmerman, Blackstone) Department of Quantitative Health
Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
(Sabik, Blackstone) Department of Thoracic and Cardiovascular Surgery,
Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
Title
A Randomized Clinical Trial of Red Blood Cell Transfusion Triggers in
Cardiac Surgery.
Source
Annals of Thoracic Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier USA
Abstract
Background: Class I evidence supporting a threshold for transfusion in the
cardiac surgical setting is scarce. We randomly allocated patients to a
transfusion hematocrit trigger of 24% versus 28% to compare morbidity,
mortality, and resource use. Methods: From March 2007 to August 2014, two
centers randomly assigned 722 adults undergoing coronary artery bypass
graft surgery or valve procedures to a 24% hematocrit trigger (n = 363,
low group) or 28% trigger (n = 354, high group). One unit of red blood
cells was transfused if the hematocrit fell below the designated
threshold. The primary endpoint was a composite of postoperative
morbidities and mortality. Treatment effect was primarily assessed using
an average relative effect generalized estimating equation model. Results:
At the second planned interim analysis, the a priori futility boundary was
crossed, and the study was stopped. There was no detected treatment effect
on the composite outcome (average relative effect odds ratio, low versus
high, 0.86, 95% confidence interval: 0.29 to 2.54, p = 0.71). However, the
low group received fewer red blood cell transfusions than the high group
(54% versus 75%, p < 0.001), mostly administered in the operating room
(low group, 112 [31%]; high group, 208 [59%]), followed by intensive care
unit (low, 105 [31%]; high, 115 [34%]) and floor (low, 41 [12%]; high, 42
[13%]). The low group was exposed to lower hematocrits: median before
transfusion, 22% (Q1 = 21%, Q3 = 23%) versus 24% (Q1 = 22%, Q3 = 25%).
Conclusions: Negative exposures differed between treatment groups, with
lower hematocrit in the 24% trigger group and more red blood cells used in
the 28% group, but adverse outcomes did not differ. Because red blood cell
use was less with a 24% trigger without adverse effects, our randomized
trial results support aggressive blood conservation efforts in cardiac
surgery.<br/>Copyright &#xa9; 2017 The Society of Thoracic Surgeons.

<90>
Accession Number
617786680
Author
Kremke M.; Gissel M.S.; Jakobsen C.-J.
Institution
(Kremke, Gissel, Jakobsen) Department of Anaesthesiology and Intensive
Care Medicine, Aarhus University Hospital, Aarhus, Denmark
Title
Coronary artery bypass grafting related bleeding risks due to
pre-operative treatment with ticagrelor.
Source
Acta Anaesthesiologica Scandinavica. Conference: 34th Congress of the
Scandinavian Society of Anesthesiology and Intensive Care Medicine, SSA
2017. Sweden. 61 (8) (pp 1045), 2017. Date of Publication: September 2017.
Publisher
Blackwell Munksgaard
Abstract
Background: Pre-operative treatment with adenosine diphosphate (ADP)
receptor antagonists can cause excessive bleeding after cardiac surgery.
The new ADP-receptor antagonist ticagrelor was introduced in Denmark in
2013. We have analyzed bleeding complications associated with the use of
ticagrelor before coronary artery bypass grafting (CABG) surgery. Methods:
This is a multicenter cohort analysis of 2 596 CABG patients operated upon
during the period January 2013 through March 2017. Using propensity
scores, study patients preoperatively exposed to dual antiplatelet therapy
(DAPT) with aspirin and ticagrelor (n = 118) were matched with control
patients exposed to aspirin only (n = 2 478), resulting in 95 pairs of
patients. Outcome measures were chest tube drainage volume, re-operations
due to bleeding, and patients transfused with red blood cells. Results:
Compared with patients treated with aspirin only, pre-operative DAPT with
ticagrelor was associated with more chest tube bleeding (550 vs. 425 ml, P
= 0.011), more re-operations due to bleeding (13% vs. 3%, P = 0.035), and
more frequent transfusion of red blood cells (38% vs. 18%, P < 0.0001).
Conclusions: Pre-operative DAPT with ticagrelor and aspirin is associated
with higher risks for bleeding complications after cardiac surgery.

<91>
Accession Number
617786549
Author
Sumitomo N.; Miyazaki A.; Sakaguchi H.; Iwamoto M.; Ueda H.; Tokunaga C.;
Takamuro M.; Takigiku K.; Yoshimoto J.; Ohashi N.; Takahashi K.; Anze T.
Institution
(Sumitomo) SaitamaJapan
(Miyazaki, Sakaguchi) SuitaJapan
(Iwamoto, Ueda) YokohamaJapan
(Tokunaga) TsukubaJapan
(Takamuro) SapporoJapan
(Takigiku) AzuminoJapan
(Yoshimoto) ShizuokaJapan
(Ohashi) NagoyaJapan
(Takahashi) OkinawaJapan
(Anze) OsakaJapan
Title
A prospective multicenter, open-label study of landiolol for
tachyarrhythmias in children: Control of the heart rate in infant and
child arrhythmias using landiolol (heartful) study.
Source
Europace. Conference: World Congress in Cardiac Electrophysiology and
Cardiac Techniques 2016. France. 18 (pp i147), 2016. Date of Publication:
June 2016.
Publisher
Oxford University Press
Abstract
Introduction: Persistent tachycardia in pediatric patients with heart
failure sometimes deteriorates their hemodynamic condition, which requires
immediate intervention to control their heart rate. Particularly,
tachyarrhythmias after congenital heart surgery may sometimes become
fatal. In Japan, there are only a few intravenous anti-arrhythmic agents
that have been approved to control pediatric arrhythmias. Although,
treatment of tachyarrhythmias in young patients with cardiac dysfunction
are mandatory, there are no approved medications to treat them in these
patients. Consequently, novel and effective medications for these patients
are required. Landiolol, an ultra-short-acting beta-blocker was approved
in 2013 for tachyarrhythmias in adult patients with cardiac dysfunction.
However, its efficacy and safety in pediatrics remain unknown. Methods:
This study is a phase IIb/phase III study to investigate the efficacy and
safety of landiolol in pediatric patients with tachyarrhythmias (atrial
fibrillation, atrial flutter, and supraventricular tachycardia) and heart
failure. This study was designed as a prospective multicenter open-label
study. Successful heart rate control was defined as a >=20% reduction in
the heart rate or conversion to normal sinus rhythm within 2hr after
starting the intravenous administration of landiolol. This study was
started in April 2015 and will end within a few years. Conclusion: The
data from the HEARTFUL study may establish the efficacy and safety of
landiolol for various tachyarrhythmias in pediatric patients, even if the
patients have cardiac dysfunction.

<92>
Accession Number
617786516
Author
Sholevar D.; Tung S.; Kuriachan V.; Leong-Sit P.; Roukoz H.; Engel G.;
Kutalek S.P.; Akula D.; Christie M.; Ostanniy M.; Thompson A.; Molin F.
Institution
(Sholevar, Akula) CamdenUnited States
(Tung) New WestminsterCanada
(Kuriachan) CalgaryCanada
(Leong-Sit) LondonCanada
(Roukoz) MinneapolisUnited States
(Engel) Redwood CityUnited States
(Kutalek) PhiladelphiaUnited States
(Christie, Ostanniy, Thompson) Mounds ViewUnited States
(Molin) Quebec CityCanada
Title
Feasibility of extravascular pacing with a novel substernal electrode
configuration: Results from the multi-center substernal pacing acute
clinical evaluation (space) trial.
Source
Europace. Conference: World Congress in Cardiac Electrophysiology and
Cardiac Techniques 2016. France. 18 (pp i25), 2016. Date of Publication:
June 2016.
Publisher
Oxford University Press
Abstract
Purpose: Subcutaneous defibrillators offer a viable alternative to
intravascular transvenous defibrillators. However, because of
extra-thoracic lead placement, this system is limited by high
defibrillation thresholds and an inability to deliver anti-tachycardia
pacing. The SPACE trial evaluated the feasibility of cardiac pacing from
an extra-vascular substernal space. Method: This prospective feasibility
study enrolled adult patients ( pts) undergoing midline sternotomy surgery
or S-ICD implant. The primary endpoint was to assess the feasibility of
pacing through a decapolar EP catheter (Marinr, 7F, Medtronic) temporarily
placed via percutaneous subxiphoid access into the mediastinal tissues
under the sternum at or adjacent to the midline. Using fluoroscopy and a
malleable tunneling tool and introducer, the middle pair of electrodes was
centered over the right ventricle. Pacing capture data in 7 vectors (3
bipolar and 4 unipolar) were collected with constant current pacing up to
20 mA and pulse-width (PW) up to 10 ms. Summary of Results: Twenty-six pts
(21 males, 5 females; age 64.4 + 10.0 years) were studied at 8 sites in
the US and Canada. Parent procedures included one S-ICD implantation and
25 cardiothoracic surgeries. Catheter placement was accomplished in all 26
pts (mean placement time = 11.7 + 10.1 minutes). Eighteen out of 26 pts
had successful, consistent ventricular pacing capture (PC) in >= 1 tested
vector. The mean pacing thresholds at PW 10 ms, 3 ms, 1 ms were 7.3 + 4.2
mA (18 pts), 9.0 + 4.7 mA (13 pts), 11.8 + 4.5 mA (7 pts), respectively.
Failed PC in 8 pts was mostly associated with sub-optimal implant or
atrial PC. Among the 18 pts with PC, 10 pts had the best PC in bipolar vs
7 pts in unipolar (no difference in 1 pt). Among the 16 pts with bipolar
PC, widely spaced bipolar electrode pairs were consistently associated
with the lowest threshold in all pts. For the 16 pts with bipolar PC with
electrode spacing 19 mm and 10 ms PW, the median pacing threshold was 3.0
V (IQR: 2.3-8.1 V) or 4.2 mA (IQR: 3.0-10.5 mA). Conclusion: Preliminary
data demonstrates that pacing is feasible from this novel extravascular
substernal location. A bipolar substernal electrode configuration with
wide electrode spacing has the potential to provide pacing in a future
extravascular defibrillator.

<93>
Accession Number
617786424
Author
Rodrigues I.; Abreu A.; Oliveira M.; Cunha P.S.; Lousinha A.; Portugal G.;
Almeida Morais L.; Rio P.; Moreira R.I.; Ferreira R.C.
Institution
(Rodrigues, Abreu, Oliveira, Cunha, Lousinha, Portugal, Almeida Morais,
Rio, Moreira, Ferreira) LisboaPortugal
Title
The impact of different CRT response criteria in outcomes.
Source
Europace. Conference: World Congress in Cardiac Electrophysiology and
Cardiac Techniques 2016. France. 18 (pp i49), 2016. Date of Publication:
June 2016.
Publisher
Oxford University Press
Abstract
Background: There is a lack of consensus on definition of responder to
resynchronization therapy (CRT). Numerous primary response criteria had
been utilized in the literature. It is not clear which response criteria
may have more influence on cardiac events. Purpose: The aim of the present
study was to identify the CRT response criteria that most influence the
occurrence of major events in heart failure. Methods: Retrospective
analyses of patients ( pts) undergoing CRT in one center, between 2011 and
2014. The evaluated parameters included left ventricular (LV) ejection
fraction (LVEF), LV end diastolic and end systolic volumes (LVEDV, LVESV,
respectively), peak oxygen consumption (VO2peak), New York Heart
Association (NHYA) functional class and quality of life (QoL), measured at
baseline and at 6 months after CRT, to define responders to CRT. The
response criteria analyzed, cited in literature, included
"echocardiographic response" [ LVEF 5 (units); LVEF 15% (relative); LVEDV
15%; LVESV 15%)], "clinical response" [ NYHA-1; VO2peak. 10; QoL .5;
clinical composite (2/3 of: NYHA 1, QoL 0.5, peak VO2 10%)] and "combined
response" ( LVEF 5 and NYHA 1 or QoL >= 0.5). The outcome analyzed was a
composite endpoint of all cause mortality, cardiac transplant or heart
failure hospitalization. Results: A total of 115 pts submitted to CRT were
followed for a period of 25 + 13 months. During the follow-up period, the
composite endpoint occurred in 25% of the pts. In univariate Cox
regression analyses, the only response criteria that had a significant
relationship with the composite endpoint were LVEF 5 [hazard ratio (HR)=
0.45 (0.21-0.94), p , 0.05], LVEF 15% [HR = 0.43 (0.20-0.90), p , 0.05],
NYHA 1 [HR = 0.39 (0.18-0.83), p , 0.05] and combined response [HR = 0.47
(0.22-1.00), p , 0.05). Conclusions: Our study demonstrated that pts who
improved NYHA functional class or LVEF were those with lowest incidence of
mortality, cardiac transplant or heart failure hospitalizations, which may
favor these criteria, compared to others, to define CRT responder (Figure
Presented).

<94>
Accession Number
617786410
Author
Di Leoni Ferrari A.; Monteiro C.; Caramori P.R.A.; Marino M.; Carvalho
L.A.; Siqueira D.; Sao T.L.; Perin M.; Lima V.; Guerios E.; Fabio S.D.B.J.
Institution
(Di Leoni Ferrari, Monteiro, Caramori) Porto AlegreBrazil
(Marino, Carvalho, Siqueira, Sao, Perin, Lima, Guerios, Fabio) Sao
PauloBrazil
Title
The multicenter tavi brazilian registry & the need for permanent pacemaker
following transcatheter aortic valve implantation. Incidence, predictors
and clinical outcomes.
Source
Europace. Conference: World Congress in Cardiac Electrophysiology and
Cardiac Techniques 2016. France. 18 (pp i23), 2016. Date of Publication:
June 2016.
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has
demonstrated favorable clinical outcomes, although development of
high-degree atrioventricular block requiring permanent pacemaker (PPM)
implantation is a frequent complication. The aim of this study was to
evaluate the incidence, contributing factors and clinical outcomes of PPM
implantation after TAVI procedures. Methods: Data from 819 patients with
severe aortic stenosis from 22 centers included in the Brazilian TAVI
registry between January 2008 and January 2015 were reviewed. After
excluding patients who died during the procedure, those with a previous
PPM and those that implanted InovareTM prosthesis, 670 patients were
analyzed. Multivariate regression was performed to identify predictors of
PPM implantation following TAVI. ROC curve analysis was used to measure
the ability of the risk factors as predictors. Results: At 30 days, 135
patients (20.1%) required PPM implantation. There was a decline in the
rate of PPM implantation, from 25.5% in 2012 to 15.8% in 2015 (p= 0.005).
Patients requiring PPM were more likely to be older (82.5 vs. 81.1 years,
p= 0.047), and male (59.3%; p= 0.003), but with similar surgical risk
scores between groups. The majority of PPMs were implanted during the
first 7 days following the TAVI. Those in the PPM group more frequently
received CoreValveTM devices (88.1% vs. 70.8%, p= ,0.001), and had
previous right bundle branch block (RBBB, 27.3% vs. 6.6%, p= ,0.001). On
multivariate analysis baseline RBBB (OR, 6.19; 95% CI, 3.56-10.75; p=
,0.001), CoreValveTM vs. Sapien XTTM (OR, 3.16; 95% CI, 1.74-5.72; p=
,0.001), and mean trans-aortic gradient .50mmHg (OR, 1.86; 95% CI,
1.08-3.2; p= 0.025) were independent predictors of PPM implantation. The
estimated risk for PPM insertion is 4% when none of the current risk
factors are present, reaching up to almost 63% when all of them are
present (Figs. 1 & 2). The current model of predictors showed a good
ability to predict PPM implantation: 0.69 (95% CI, 0.64-0.74) in the ROC
curve. Hospital lenght of stay was significantly prolonged for the PPM
group (mean= 15.7 +/-25.7 days for the PPM group vs. 11.8 +/-22.9 days for
the no PPM group; p ,0.001), but neither all-cause death (26.7% PPM group
vs. 25.6% PPM group; p= 0.80) or cardiovascular death (14.1% vs. 14.8% PPM
group and no PPM group respectively; p= 0.84) were affected by PPM
implantation. Sub-study of echocardiograms during follow-up denoted
worsened recovery of systolic function over time in the PPM group compared
against their counterparts without PPM (p= 0.001 at 1 year). Conclusion:
The present study identified pre-existing RBBB, mean aortic gradient that
exceeds 50mmHg and CoreValveTM device implantation as independent
predictors of the need for PPM implantation at 30-days after TAVI. PPM
implantation occurred in approximately one of every 5 TAVI cases and
prolonged hospital length of stay, but did not affect all-cause or
cardiovascular mortality. PPM implantation was unfavorably associated with
worsened recovery of left ventricular ejection fraction, which deserves
further investigation (Table Presented).

<95>
Accession Number
617786317
Author
Trucco M.E.; Jose T.M.; Hernandez Madrid A.; Toquero J.; Merino J.L.; Osca
J.; Quesada A.; Martinez-Ferrer J.; Villuendas R.; Rodon J.P.; Mont L.
Institution
(Trucco, Jose, Rodon, Mont) BarcelonaSpain
(Hernandez Madrid) Hospital Universitario Ramon y Cajal, Madrid, Spain
(Toquero) Madrid/MajadahondaSpain
(Merino) MadridSpain
(Osca, Quesada) ValenciaSpain
(Martinez-Ferrer) Vitoria-GasteizSpain
(Villuendas) BadalonaSpain
Title
Early AV node ablation versus pharmacological rate control in patients
with CRT and AF. results of spare III, a randomized multicenter study.
Source
Europace. Conference: World Congress in Cardiac Electrophysiology and
Cardiac Techniques 2016. France. 18 (pp i76), 2016. Date of Publication:
June 2016.
Publisher
Oxford University Press
Abstract
Introduction: Maximum ventricular pacing (VP) is necessary for good CRT
response. In AF AV node ablation is recommended. The aim of the study was
to analyze whether early AV node ablation (EAVNA) in patients with AF
submitted to CRT improved response to therapy. Methods: A multicenter
randomized trial analyzed a cohort of patients with AF treated with CRT.
Inclusion criteria were: AF, NYHA III-IV, QRS .120 ms and LVEV >=35%.
Patients with AF and fast, uncontrolled heart rate (HR) or patients with
AF and slow heart rate requiring ventricular pacing were excluded. After
successful CRT implant, patients were randomized to EAVNA or medical
therapy (MT) to slow HR. All patients underwent clinical and
echocardiographic evaluation prior to implantation and at 6-and 12-month
follow-up. Responders were defined as survivors at 12 months post-implant
with >=10% LVESV reduction without requiring heart transplant. Results: A
group of 60 patients was randomized to EAVNA (30) or MT (30). The
percentage of VP at 6 and 12 months was 99% and 99% respectively, in the
EAVNA group and 95% and in the MT group ( p: NS). During follow-up, 20% of
patients from the MT crossed over to AV node ablation. At 12 months, there
was no difference between groups in the percentage of responders: 12/30
(40%) EAVNA vs. 10/30 (33%) MT (RR 1.2, 95% CI [0.6-2.3], p = 0.79). LVEF
improvement was similar too (figure 1). In each group 2/30 patients died
(6.6% mortality); 1 patient from EAVNA required heart transplant. Hospital
admissions were also similar between study groups: 8/30 (26.6%) EAVNA and
8/30 (26.6%) MT. Conclusions: Compared to MT a strategy of EAVNA in
patients with CRT and AF did not improve CRT response or clinical
improvement (Figure Presented).

<96>
Accession Number
617786294
Author
Rodriguez R.D.C.R.; Antonia R.R.; Alfonso M.F.
Institution
(Rodriguez, Antonia, Alfonso) Las Palmas de Gran CanariaSpain
Title
Sex and cardiac resynchronization therapy.
Source
Europace. Conference: World Congress in Cardiac Electrophysiology and
Cardiac Techniques 2016. France. 18 (pp i20), 2016. Date of Publication:
June 2016.
Publisher
Oxford University Press
Abstract
Purpose: To study the differences between both sexes in patients who
underwent CRT and to evaluate changes in clinical and echocardiographic
data, as well as, to evaluate long-term mortality. Methods:We evaluated
302patients(p) who had received CRT between 2003 and 2015 at one center.
Baseline assessment was comprised of the collection of medical history,
clinical examination, 12-lead electrocardiogram, estimation of New York
Heart Association (NYHA) functional class and echocardiographic
evaluation. In hospital follow-up examinations were scheduled at 1 month
and every 6 months thereafter. The average duration of follow up was 7,51
+ 2,73years. We evaluated changes clinical and echocardiographic
parameters at 1 year, and assessed all cause mortality, cardiovascular
mortality a long term follow-up with respect to sex. Remodeler is defined
as the increase in the ejection fraction greater than or equal to 5%
and/or greater reduction of systolic diameter 10mm.Responder is defined as
the improvement of functional class, no hospital admissions or no need of
cardiac transplant. Summary: There were 220(72,8%)men and
82(27,2%)women.There were 61(77,2%) female responders and 173(79,4%) male
responders, p = 0,69. There were 69 (85,2%) female remodelers vs
183(83,9%) male remodelers, p = 0,79. Baseline characteristics:Men and
women were similar age (67,05 + 10,19years vs 68,26 + 10,39; p = 0,36).
Men had more defibrillator than women (104(47,3%) vs19(23,2%); p =
0,001)). The most frequent side left ventricular lead position was the
lateral position similar in both sexes. Men had more ischemic heart
disease and women more dilated cardiomyopathy. Men had more atrial
fibrillation and they needed more insulin than women. The hospital
attendance was similar in both sexes, but men had less heart failure
compared to women (40,2% vs 60%, p = 0,9). 97 (41,6%)men died vs 34(41,5%)
women, p = 0,196 and heart failure was the main cause of death especially
in women. Men used more antiarrythmics than women. Women survive longer
than men but it was not significatvie ( long rank p = 0,455). Conclusion:
There was significant improvement in clinical, electrocardiographic and
echocardiographic readings in both groups. Survival was worse in men than
in women without being significant (Table Presented).

<97>
Accession Number
617786281
Author
Rodriguez R.D.C.R.; Antonia R.R.; Alfonso M.F.
Institution
(Rodriguez, Antonia, Alfonso) Las Palmas de Gran CanariaSpain
Title
Cardiac resyncrhonization therapy and survival according to sex.
Source
Europace. Conference: World Congress in Cardiac Electrophysiology and
Cardiac Techniques 2016. France. 18 (pp i20), 2016. Date of Publication:
June 2016.
Publisher
Oxford University Press
Abstract
Purpose: To study the differences between both sexes in patients who
underwent CRT and to evaluate changes in clinical y echocardiographic
data, as well as, to evaluate long-term mortality. Methods: We evaluated
302patients( p) who had received CRT between 2003 and 2015 at one center.
Remodeler is defined as the increase in the ejection fraction greater than
or equal to 5% and/or greater reduction of systolic diameter
10mm.Responder is defined as the improvement of functional class, no
hospital admissions or no need of cardiac transplant. Summary: There were
220(72,8%)men and 82(27,2%)women.There were 61(77,2%) female responders
and 173(79,4%) male responders, p = 0,69. There were 69 (85,2%) female
remodelers vs 183(83,9%) male remodelers, p = 0,79. Baseline
characteristics:Men and women were similar age (67,05 + 10,19years vs
68,26 + 10,39; p = 0,36). Men had more defibrillator than women
(104(47,3%) vs19(23,2%); p = 0,001)). The most frequent side left
ventricular lead position was the lateral position similar in both sexes.
Men had more ischemic heart disease and women more dilated cardiomyopathy.
Men had more atrial fibrillation and they needed more insulin than women.
The hospital attendance was similar in both sexes, but men had less heart
failure compared to women (40,2% vs 60%, p = 0,9). 97 (41,6%)men died vs
34(41,5%) women, p = 0,196 and heart failure was the main cause of death
especially in women. Men used more antiarrythmics than women. Conclusion:
There was significant improvement in clinical, electrocardiographic and
echocardiographic readings in both groups. Survival was worse in men than
in women without being significant. Ilustracion AClinical,
electrocardiographic and echocardiographic changes according sex (Table
Presented).

<98>
Accession Number
617786233
Author
Mazzone P.; D'Angelo G.; Regazzoli D.; Molon G.; Senatore G.; Sacca S.;
Canali G.; Amellone C.; Turri R.; Bella P.D.
Institution
(Mazzone, D'Angelo, Regazzoli, Bella) San Raffaele Hospital, Milano, Italy
(Molon, Canali) Sacro Cuore Hospital, Negrar (VR), Italy
(Senatore, Amellone) P.O. Riunito-Ospedale Civile, Cirie (TO), Italy
(Sacca, Turri) Mirano Hospital, Mirano (VE), Italy
Title
Percutaneous left atrial appendage closure with watchman device: Results
from the traps registry.
Source
Europace. Conference: World Congress in Cardiac Electrophysiology and
Cardiac Techniques 2016. France. 18 (pp i7), 2016. Date of Publication:
June 2016.
Publisher
Oxford University Press
Abstract
Purpose of the study: The WATCHMAN device for Left Atrial Appendage
occlusion (LAAO) has been found effective and non-inferior to the oral
anticoagulation (OAC) in patients with atrial fibrillation, and is now
adopted in clinical practice. Method used: The TRAPS registry is an
observational, multicenter registry involving 4 Italian centers. Patients
who underwent LAAO with WATCHMAN device were enrolled, and clinical,
demographic and procedural data were collected. Summary of results: In
this analysis we included 148 patients. Mean age was 73 + 8 years, 57% of
patients were male, 22% had heart failure, 10% had a history of transient
ischemic attack, 23% a history of ischemic stroke and 72% a history of
bleeding. The baseline CHADS2 score was 2.4 + 1.3, the CHADsVASc score was
3.9 + 2.8 and the HAS-BLED score was 3.3 + 1.1. 57% of the patients were
on OAC at the time of implantation. The device was successfully positioned
in all patients with no or minimal (, 5mm) leakage, assessed by
peri-procedural transesophageal echo. Following intra-procedural
complications were reported: 2 pericardial effusions treated with
pericardiocentesis, 1 device-associated thrombus formation treated with
aspiration, and 1 vascular access dissection. Moreover, device
embolization was reported in 1 patient early after the implantation and
the device was successfully snared in the iliac bifurcation. The overall
rate of adverse events within 7 days was therefore (5/148 = 3.3%). In the
present experience, device size was chosen >=20% greater than the LAA
diameter in 68% of patients. Comparing the first half with the second half
of the study cohort, the procedure duration decreased from 89min to 64min
(p , 0.0001). Conclusion: The success rate in LAAO with WATCHMAN was high,
and the rate of adverse events was low.We reported an experience-related
improvement in procedural duration.

<99>
Accession Number
617786093
Author
Romanov A.; Goscinska-Bis K.; Bis J.; Cherniavsky A.; Prokhorova D.;
Syrtceva Y.; Shabanov V.; Ponomarev D.; Alsov S.; Karaskov A.; Deja M.;
Krejca M.; Pokushalov E.
Institution
(Romanov, Cherniavsky, Prokhorova, Syrtceva, Shabanov, Ponomarev, Alsov,
Karaskov, Pokushalov) NovosibirskRussian Federation
(Goscinska-Bis, Bis, Deja, Krejca) KatowicePoland
Title
Cardiac resynchronization therapy combined with coronary artery bypass
grafting in ischemic heart failure patients: Long-term results of the
rescue study.
Source
Europace. Conference: World Congress in Cardiac Electrophysiology and
Cardiac Techniques 2016. France. 18 (pp i165), 2016. Date of Publication:
June 2016.
Publisher
Oxford University Press
Abstract
Aims: Totally epicardial cardiac resynchronization therapy (CRT) is a
novel treatment modality for patients with heart failure and systolic
dyssynchrony undergoing coronary artery bypass grafting (CABG). In this
study we have prospectively evaluated the long-term outcomes of totally
epicardial CRT. Methods: Between September 2007 and June 2009, one hundred
seventy eight patients were randomly assigned to the CABG alone group (n =
87) and CABG with concomitant epicardial CRT implantation (n = 91). The
primary endpoint of the study was all-cause mortality in the two groups
between the day of surgery and August 13, 2013 (common closing date). The
secondary outcomes included mode of death, adverse cardiac events and lead
performance. Results: The mean follow-up was 55 + 10.7 months. According
to per-protocol analysis with treatment as a time-dependent variable to
account for conversion from CABG to CABG + CRT, there were 24 deaths
(35.8%) in the CABG group and 17 deaths (15.3 %) in the CABG + CRT group.
As compared to CABG alone, concomitant CRT was associated with reduced
risk of both all-cause mortality (hazard ratio (HR) 0.43, 95% confidence
interval (CI) 0.23 to 0.84, p = 0.012) and cardiac death (HR 0.39, 95% CI
0.21 to 0.72, p = 0.002). Eleven (12.6%) sudden deaths were observed in
the CABG group in comparison to 4 (4.4%) in the CABG + CRT group (p =
0.048). Hospital re-admission was required for 9 (9.9%) patients in CABG +
CRT group and for 25 (28.7%) patients in CABG group (r = 0.001). There
were 4 (1.5%) epicardial lead failures. Conclusion: The results of our
study suggest that the procedure of coronary artery bypass grafting and
totally epicardial CRT system implantation is safe and significantly
improves the survival of patients with heart failure and dyssynchrony
during long-term follow up.

<100>
Accession Number
617785903
Author
Mora G.; Olaya A.
Institution
(Mora, Olaya) BogotaColombia
Title
Incidence of adverse events at 7, 30 y 90 days in colombian patients with
syncope according to risk score egsys.
Source
Europace. Conference: World Congress in Cardiac Electrophysiology and
Cardiac Techniques 2016. France. 18 (pp i81), 2016. Date of Publication:
June 2016.
Publisher
Oxford University Press
Abstract
Objective: To describe the incidence of adverse events at 7, 30, 90 days
in patients with syncope who have applied the risk scale EGSYS. Materials
and method: A cohort study was conducted; the two comparison groups were
patients at high and low risk according to EGSYS scale who consulted the
emergency department of five hospitals in Colombia with diagnosis of
syncope. At the time of the consultation a complete history of which data
were obtained for a score and classification according to EGSYS scale;
then were followed up at 7, 30, and 90 days for assessment of adverse
events. Statistical analysis: qualitative variables were described by
absolute and relative frequencies and quantitative variables by means and
standard deviations. Once patients at high and low risk were classified,
the cumulative incidence of adverse events (death, re-hospitalization,
recurrence, invasive cardiac procedures and neurological events) was
calculated and compared between groups using relative risks and Multiple
Correspondence Analysis (MCA). Additionally, the frequency of adverse
events according to the score obtained on the scale was described.
Results:We included 173 patients with a median age of 69 years (IQR 50-80
years old); 57.8% were women. The clinical variable considered in the most
common were the absence scale EGSYS prodrome and abnormal ECG. The most
frequent scores were above 2; 60% of patients were classified at high
risk. The incidence at 90 days of follow-averse events was 42 % for
high-risk group and 21 % in the low risk group (RR 1.94, 95% CI 1.17 to
3.21); The main events were cardiologic interventions (26.9 % versus
10.1%) being higher in the high risk group (RR 2.6 IC 95% 1.22 to 5.73)
This association was also observed in the MCA. The nonparametric analysis
showed significant differences between the high and low risk curves at 90
days (p = 0.013); Cox regression showed increased risk for any adverse
events in the group of patients with greater than or equal to 3 score (HR
= 2.05, 95% CI 1.14 to 3.70). This association was also observed in the
ACM. Conclusions: The classification of risk score EGSYS applied to
patients with syncope is related to the incidence of adverse events at 90
days follow-up. The Egsys score can assist decision-making on inpatient or
outpatient management and the rational use of diagnostic aids.

<101>
[Use Link to view the full text]
Accession Number
617717434
Author
Copik M.; Bialka S.; Daszkiewicz A.; Misiolek H.
Institution
(Copik, Bialka, Daszkiewicz, Misiolek) Department of Anaesthesiology and
Critical Care, School of Medicine, Division of Dentistry, Medical
University of Silesia, Zabrze, Poland
Title
Thoracic paravertebral block for postoperative pain management after renal
surgery: A randomised controlled trial.
Source
European Journal of Anaesthesiology. 34 (9) (pp 596-601), 2017. Date of
Publication: 01 Sep 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background: Thoracic paravertebral block (ThPVB) combined with general
anaesthesia is used in thoracic and general surgery. It provides effective
analgesia, reduces surgical stress response and the incidence of chronic
postoperative pain. Objective: To assess the efficacy of ThPVB in reducing
opioid requirements and decreasing the intensity of pain after renal
surgery. Design: A randomised, open label study. Setting: A single
university hospital. Study conducted from August 2013 to February 2014.
Participants: In total, 68 patients scheduled for elective renal surgery
(open nephrectomy or open nephron-sparing surgery). Interventions:
Preoperative ThPVB with 0.5% bupivacaine combined with general
anaesthesia, followed by postoperative oxycodone combined with nonopioid
analgesics as rescue drugs. Follow-up period: 48 h. Main Outcome Measures:
Total dose of postoperative oxycodone required, pain intensity, occurrence
of opioid related adverse events, ThPVB-related adverse events and patient
satisfaction. Results: A total of 68 patients were randomised into two
groups and, of these, 10 were subsequently excluded from analysis.
Patients in group paravertebral block (PVB; n = 27) had general
anaesthesia and ThPVB, and those in group general (anaesthesia) (GEN) (n =
31) formed a control group receiving general anaesthesia only. Compared
with patients in group GEN, patients who received ThPVB required 39% less
i.v. oxycodone over the first 48 h and had less pain at rest (P < 0.01)
throughout the first 24 h. Group PVB patients also experienced fewer
opioid-related adverse events and were less sedated during the first 12
postoperative hours. Patients in the PVB group had higher satisfaction
scores at 48 h compared with the control group. There were no serious
adverse events. Conclusion: In our study, preoperative ThPVB was an
effective part of a multimodal analgesia regimen for reducing opioid
consumption and pain intensity. Methods and drugs used in both groups were
well tolerated with no serious adverse events. Compared with the control
group, patients in the ThPVB group reported increased
satisfaction.<br/>Copyright &#xa9; 2017 European Society of
Anaesthesiology. All rights reserved.

<102>
Accession Number
617753898
Author
Sardella G.; Lucisano L.; Garbo R.; Pennacchi M.; Cavallo E.; Stio R.E.;
Calcagno S.; Ugo F.; Boccuzzi G.; Fedele F.; Mancone M.
Institution
(Sardella, Lucisano, Pennacchi, Cavallo, Stio, Calcagno, Fedele, Mancone)
Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology, and
Geriatric Sciences, "Sapienza" University of Rome, Rome, Italy
(Garbo, Ugo, Boccuzzi) Interventional Cardiology, San Giovanni Bosco
Hospital, Turin, Italy
Title
Single-Staged Compared With Multi-Staged PCI in Multivessel NSTEMI
Patients: The SMILE Trial.
Source
Journal of the American College of Cardiology. 67 (3) (pp 264-272), 2016.
Date of Publication: 26 January 2016.
Publisher
Elsevier USA
Abstract
Background A lack of clarity exists about the role of complete coronary
revascularization in patients presenting with non-ST-segment elevation
myocardial infarction. Objectives The aim of our study was to compare
long-term outcomes in terms of major adverse cardiovascular and
cerebrovascular events of 2 different complete coronary revascularization
strategies in patients with non-ST-segment elevation myocardial infarction
and multivessel coronary artery disease: 1-stage percutaneous coronary
intervention (1S-PCI) during the index procedure versus multistage
percutaneous coronary intervention (MS-PCI) complete coronary
revascularization during the index hospitalization. Methods In the SMILE
(Impact of Different Treatment in Multivessel Non ST Elevation Myocardial
Infarction Patients: One Stage Versus Multistaged Percutaneous Coronary
Intervention) trial, 584 patients were randomly assigned in a 1:1 manner
to 1S-PCI or MS-PCI. The primary study endpoint was the incidence of major
adverse cardiovascular and cerebrovascular events, which were defined as
cardiac death, death, reinfarction, rehospitalization for unstable angina,
repeat coronary revascularization (target vessel revascularization), and
stroke at 1 year. Results The occurrence of the primary endpoint was
significantly lower in the 1-stage group (1S-PCI: n = 36 [13.63%] vs.
MS-PCI: n = 61 [23.19%]; hazard ratio [HR]: 0.549 [95% confidence interval
(CI): 0.363 to 0.828]; p = 0.004). The 1-year rate of target vessel
revascularization was significantly higher in the MS-PCI group (1S-PCI: n
= 22 [8.33%] vs. MS-PCI: n = 40 [15.20%]; HR: 0.522 [95% CI: 0.310 to
0.878]; p = 0.01; p log-rank = 0.013). When the analyses were limited to
cardiac death (1S-PCI: n = 9 [3.41%] vs. MS-PCI: n = 14 [5.32%]; HR: 0.624
[95% CI: 0.270 to 1.441]; p = 0.27) and myocardial infarction (1S-PCI: n =
7 [2.65%] vs. MS-PCI: n = 10 [3.80%]; HR: 0.678 [95% CI: 0.156 to 2.657];
p = 0.46), no significant differences were observed between groups.
Conclusions In multivessel non-ST-segment elevation myocardial infarction
patients, complete 1-stage coronary revascularization is superior to
multistage PCI in terms of major adverse cardiovascular and
cerebrovascular events. (Impact of Different Treatment in Multivessel Non
ST Elevation Myocardial Infarction [NSTEMI] Patients: One Stage Versus
Multistaged Percutaneous Coronary Intervention [PCI] [SMILE]:
NCT01478984)<br/>Copyright &#xa9; 2016 American College of Cardiology
Foundation

<103>
Accession Number
617772603
Author
Bufarini C.; Leoni S.; Guglielmi S.; Caimmi S.; Bartolini G.; Ciaffi V.;
Sbaffo M.; Moriconi L.; Paolucci D.; Marinozzi A.
Institution
(Bufarini, Leoni, Guglielmi, Caimmi, Bartolini, Ciaffi, Marinozzi) AOU
Ospedali Riuniti Ancona, Clinical Pharmacy, Ancona, Italy
(Sbaffo, Moriconi, Paolucci) Loccioni Group, Department of Humancare, Moie
di Maiolati Spontini, Italy
Title
Centralised non-hazardous intravenous compounding: From theory to clinical
practice.
Source
European Journal of Hospital Pharmacy. Conference: 22nd Annual Congress of
the European Association of Hospital Pharmacists, EAHP 2017. France. 24
(pp A219-A220), 2017. Date of Publication: March 2017.
Publisher
BMJ Publishing Group
Abstract
Background After a preliminary study demonstrated its feasibility, a new
Central IntraVenous Additive Service (CIVAS) opened in April 2016
dedicated to the compounding of nontoxic injectable drugs (IV) in a new
class C cleanroom equipped with a robotic system. The following months
were dedicated to developing and improving the CIVAS pilot project,
increasing the number of hospital departments involved and enlarging the
IV productivity. Purpose This study presents the preliminary results of
the pilot CIVAS project in term of improvement in hospital workflow in the
pilot departments. Material and methods We examined 4 months of activity
involving 5 pilot hospital departments. All data were collected and
analysed through the APOTECAmanager software that manages the entire IV
production workflow of the hospital pharmacy. Results 7 drugs with
chemical stability >48 hours and prescribed in standard doses were
selected for the pilot study. The preparations identified in each unit
were: . Antibiotics: piperacillin-tazobactam (4.5 g and about 15
preparations/day) and ceftriaxone (1 g and 6 preparations/day); .
Haematology: palonosetron (250 mg and 14 preparations/day), ondansetron (8
mg, 6 preparations/day), zoledronic acid (4 mg, 5 preparations/week); .
Oncology: ondansetron (8 mg, 6 preparations/day), denosumab (120 mg, 5
preparations/week); . Cardiac surgery: cefazolin (1 g, 25
preparations/day); . Emergency medicine: piperacillin-tazobactam (4.5 g, 7
preparations/day). The automated compounding was performed in advance,
based on a daily consumption estimate for each unit. Therapies were stored
inside the refrigerator overnight. The day after, once the prescription
was confirmed, preparations were packed and delivered to the corresponding
unit. Average time per preparation was 2 min 30 s and dosage accuracy was
98.5%. Any preparation in excess remained in the refrigerator to be used
later as drug stability permitted. No wasted products were registered.
Conclusion The pilot results showed the desired outcomes of time saving
and drug waste reduction. The remaining challenge is not so much the
technology adoption as the organisational aspect in terms of production
planning and logistics. Future plans include continuing to enlarge the
number of drugs prepared and departments utilising this service,
demonstrating the benefits of this technology innovation more broadly
hospital-wide.

<104>
Accession Number
617772412
Author
Soler J.I.G.; De Vera A.P.R.; Casan V.A.; Molina O.M.G.; Comendador S.M.;
Lozano E.G.; Luz A.T.; Jimenez M.D.M.R.; Sanchez S.V.; De La Rubia Nieto
A.
Institution
(Soler, De Vera, Casan, Molina, Comendador, Lozano, Luz, Jimenez, Sanchez,
De La Rubia Nieto) Hospitalary Pharmacy, Murcia, Spain
Title
Descriptive analysis of active clinical trials in cardiology service.
Source
European Journal of Hospital Pharmacy. Conference: 22nd Annual Congress of
the European Association of Hospital Pharmacists, EAHP 2017. France. 24
(pp A78), 2017. Date of Publication: March 2017.
Publisher
BMJ Publishing Group
Abstract
Background Cardiovascular diseases are the leading cause of death in
Europe making it necessary to promote research projects. Purpose To
describe active cardiology clinical trials (CT) and the distribution of
included patients. To analyse investigational drugs (ID). Material and
methods This was a descriptive observational study in a tertiary hospital.
Active cardiology CT were considered from January 2015 to October 2016. ID
were classified into: New molecule, new indication and new scheme.
Collected data were: Number of CT and patients, medical conditions
included, ID and phase, trial design, location of study and promoter.
Results 26 CT with a total of 336 patients, and a mean of 13.4 patients
per CT (range 0-96) were studied. The number of CT/number of patients by
medical condition was: Chronic heart failure n=13/55 (50%/16.4%); acute
coronary syndrome n=4/110 (15.4%/32.7%); cardiomyopathy n=2/6 (7.7%/1.8%);
unstable angina n=1/32 (3.8%/9.5%); dyslipidaemia n=1/96 (3.8%/28.6%);
atrial fibrillation n=1/21 (3.8%/6.25%); pulmonary hypertension n=1/3
(3.8%/0.9%); platelet reactivity after transcatheter aortic valve
implantation n=1/11 (3.8%/3.3%); and patients with bicuspid aortic valve
and venous thromboembolism n=1/1 (3.8%/0.3%). Regarding the ID, the
distribution of CT/patient was: 12/211 new molecules (46.2%/68.8%), 12/90
new indications (46.2%/26.8%) and new schemes 2/35 (7.7%/10.4%). Depending
on the phase, the number of CT/number of patients was: 6/47 phase II
(23.1%/14%); 15/246 phase III (57.7%/73.2%); and 5/46 phase IV
(19.2%/13.7%). A total of 25 CT (96.1%) were multicentre and controlled;
20 (76.9%) double blind; 16 (64%) with placebo; and six (23.1%) were open
label. According to the study location, 21 (80.8%) were international. The
industry promoted 22 CT (84.6%). Conclusion There has been a predominance
of multicentre, randomised, phase III, double blind, placebo controlled
CT. Most were international and promoted by industry. There was a high
number of patients per cardiology CT, showing a predominance of those
included in phase III and acute coronary syndrome. However, the largest
number of trials was focused on chronic heart failure. No differences were
shown for the number of CT studying new drugs or new indications, although
more than two-thirds of patients were included in CT that were studying
new drugs.

<105>
Accession Number
617765110
Author
Sawhney V.; Domenichini G.; Baker V.; Gamble J.; Furniss G.; Panagopoulos
D.; Campbell N.; Lowe M.; Lambiase P.; Haywood G.; Rajappan K.; Sporton
S.; Earley M.; Dhinoja M.; Hunter R.; Betts T.; Schilling R.
Institution
(Sawhney, Domenichini, Baker, Lowe, Lambiase, Sporton, Earley, Dhinoja,
Hunter, Schilling) Barts Heart Centre, London, United Kingdom
(Gamble, Rajappan, Betts) John Radcliffe Hospital, Oxford, United Kingdom
(Furniss, Panagopoulos, Haywood) Plymouth Hospital NHS Trust, Plymouth,
United Kingdom
(Campbell) University Hospital of South Manchester NHS Foundation Trust,
Manchester, United Kingdom
Title
Thromboembolic events in left ventricular endocardial pacing: Long-term
outcomes from a multicentre UK Registry.
Source
Journal of Interventional Cardiac Electrophysiology. Conference: 13th
Annual Congress of the European Cardiac Arrhythmia Society, ECAS 2017.
Italy. 48 (pp S30-S31), 2017. Date of Publication: 2017.
Publisher
Springer New York LLC
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 throm-boembolic risk, and much of
the data has come from a small number of centres. We examined the safety
and efficacy of endocardial LV pacing across four UK centres to determine
the long-term thromboembolic risk. Methods and results: Independent
prospective registries from four UK centres were combined to include 68
consecutive patients from 2010 to 2015. Medical records were reviewed and
patients were contacted for follow-up. Thromboembolic events were
con-firmed on imaging. Baseline patient demographics are shown in Table 1.
Of the patients, 65% were already anticoagulated (39 AF, 1 DVT, 2
prosthetic valve, 2 previous LV thrombus). The mean CHADS2VASC2 score for
the cohort was 3.5. Forty-four per cent of patients had trans-ventricular
LV lead. The mean procedure and fluoroscopy times were 200+/-120 and
32+/-28 min. Seventy-five per cent had a silicone-insulated pacing lead.
Post-procedure, three patients had haematomas and one had tamponade
requiring pericardial drain. Functional improvement was noted with a
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.
Redo procedure due to lead displacement was required in two 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 in the appropriate territory, occurred in four patients
(6%), providing an annual event rate of 3.6%. In multivariate analyses,
the only significant correlation with the risk of CVA was sub-therapeutic
INRs (pBB =0.01, CI =0.02-0.68, HR = 0.12). There was no association
between lead material and mode of delivery (transatrial/ventricular) and
CVA. Fourteen patients died during follow-up, with mean time to death
post-procedure of 20 months. Cause of death was end-stage heart failure in
all patients, except three (pneumonia in two and knee sepsis in one).
Conclusion: Endocardial LV lead in heart failure patients has a good
success rate at 1.6 years follow-up. However, it is associated with a
modest thromboembolic risk largely due to sub-therapeutic anticoagulation.
These results have potential for improvement, and newer oral
anticoagulants might play a role in this setting.

<106>
Accession Number
617765280
Author
Anonymous
Title
13th Annual Congress of the European Cardiac Arrhythmia Society.
Source
Journal of Interventional Cardiac Electrophysiology. Conference: 13th
Annual Congress of the European Cardiac Arrhythmia Society, ECAS 2017.
Italy. 48 (no pagination), 2017. Date of Publication: 2017.
Publisher
Springer New York LLC
Abstract
The proceedings contain 165 papers. The topics discussed include: targeted
ablation of ectopy-triggering ganglionic plexi sites alone for paroxysmal
atrial fibrillation; the impact of obesity on atrial fibrillation
ablation: patient characteristics, long-term outcomes and complications;
incidence of classic atrial flutter in outpatients with paroxysmal atrial
fibrillation as identified with a new p-wave centric ECG monitor:
implications for the AF ablation procedure protocol; incidence of
pulmonary vein stenosis after radiofrequency catheter ablation of atrial
fibrillation; what do patients with incident atrial fibrillation and no
comorbidities at the time of diagnosis die of?; AV node ablation and
permanent his bundle pacing; his bundle pacing reduced mortality/morbidity
compared to right ventricular pacing in pacemaker population: long-term
follow-up; right ventricular high septal pacing vs. right ventricular
apical pacing following AV node ablation: 20 years follow-up;
thromboembolic events in left ventricular endocardial pacing: long-term
outcomes from a multicentre UK registry; predictors of long-term RV pacing
in patients post transcatheter aortic valve replacement with an Edwards
SAPIEN valve; and periprocedural management during left atrial ablation:
bridging, uninterrupted vitamin k antagonists or uninterrupted novel
anticoagulants?.

<107>
Accession Number
617764078
Author
Providencia R.; Barra S.; Papageorgiou N.; Falconer D.; Duehmke R.; Rehal
O.; Ahsan S.; Ezzat V.; Dhinoja M.; Ioannou A.; Segal O.; Sporton S.;
Rowland E.; Lowe M.; Lambiase P.; Agarwal S.; Chow A.W.
Institution
(Providencia, Papageorgiou, Ahsan, Ezzat, Dhinoja, Segal, Sporton,
Rowland, Lowe, Lambiase, Chow) Barts Health NHS Trust, London, United
Kingdom
(Barra, Duehmke) Papworth Hospital NHS Trust, Cambridge, United Kingdom
(Falconer) University College Hospital, London, United Kingdom
(Rehal) University College of Cardiology Hospital, NHS Trust, London,
United Kingdom
(Ioannou) Royal Free Hospital, London, United Kingdom
(Agarwal) Papworth Hospital NHS Trust, London, United Kingdom
Title
Bifocal right ventricular pacing in patients with failed coronary-sinus
lead implants: Long-term results from multicentre registry.
Source
Europace. Conference: Heart Rhythm Congress 2016. United Kingdom. 18 (pp
ii11), 2016. Date of Publication: October 2016.
Publisher
Oxford University Press
Abstract
Background: Bifocal right ventricular pacing (Bifocal-RV) has been
proposed as an alternative for patients with heart failure (HF) undergoing
cardiac resynchronization therapy (CRT) with a failure to deliver a
coronary sinus (CS) lead. Although short-term haemodynamic and
echocardiographic results of Bifocal-RV seem promising, no long-term
results on survival are currently available. Purpose: To assess the impact
of Bifocal-RV compared to CRT patients on all-cause mortality and/or heart
transplant in advanced HF patients undergoing CRT. Methods: Multicentre (3
centres) retrospective assessment of all bifocal-RV implants during a
13-year period. Patients with failed CS lead implant and treated with
Bifocal-RV were followed and assessed for the primary end point of
all-cause mortality and/or heart transplant. Secondary endpoints were:
freedom from sustained ventricular tachycardia/fibrillation, procedural
complications, infection, and lead-dislodgment. Comparisons were performed
with standard CRT implants matched controls. Results: 94 patients
implanted with bifocal-RV were compared with matched controls. The mean
age of these patients was 7045 +/- 9.6 years, 36.8% were women, mean LVEF
was 27 +/- 11%, NYHA was 2.7 +/- 0.7, and 63.2% were implanted with a
CRT-D (defibrillator). During a median of 1,719 days (IQR 753-2,408),
after adjustment for baseline differences, intention-to-treat analysis
showed that all-cause mortality and/or heart transplant was higher in the
Bifocal-RV group (adjusted HR = 1.78, 95%CI 1.27-2.50, P = 0.001). Three
patients in the Bifocal-RV group underwent transplant, and 13 crossed-over
to the CRT arm (2 transseptal LV lead, 8 successful CS lead implants, and
3 surgical-epicardial lead procedures) and 53.8% are currently still
alive. No significant differences were observed between the two groups in
all secondary endpoint comparisons. Conclusion: Our data suggest that
Bifocal-RV pacing leads to worse clinical outcomes and alternative CRT
options should be considered in patients with failed CS-lead implants.

<108>
Accession Number
613978918
Author
El-Tahan M.R.
Institution
(El-Tahan) Anesthesiology Department, King Fahd Hospital of the University
of Dammam, Dammam, Saudi Arabia
Title
Role of Thoracic Epidural Analgesia for Thoracic Surgery and Its
Perioperative Effects.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (4) (pp 1417-1426),
2017. Date of Publication: August 2017.
Publisher
W.B. Saunders

<109>
Accession Number
613973933
Author
Borde D.P.; Futane S.S.; Asegaonkar B.; Apsingekar P.; Khade S.; Khodve
B.; Puranik M.; George A.; Joshi S.
Institution
(Borde, Futane, Asegaonkar, Apsingekar, Khade, Khodve) Ozone Anesthesia
Group, Aurangabad, Maharashtra, India
(Puranik) Seth Nandlal Dhoot Hospital, Aurangabad, Maharashtra, India
(George) Fortis Hospitals, Bengaluru, Karnataka, India
(Joshi) Nayati Super-Speciality Hospital, Mathura, Uttar Pradesh, India
Title
Effect of Perioperative Pregabalin on Postoperative Quality of Recovery in
Patients Undergoing Off-Pump Coronary Artery Bypass Grafting (OPCABG): A
Prospective, Randomized, Double-Blind Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (4) (pp 1241-1245),
2017. Date of Publication: August 2017.
Publisher
W.B. Saunders
Abstract
Objectives Use of pregabalin is increasing in cardiac surgical patients.
However, studies using comprehensive scoring systems are lacking on the
drug's impact on postoperative recovery. The authors tested the hypothesis
that perioperative oral pregabalin improves the postoperative quality of
recovery as assessed using the Quality of Recovery (QoR-40) questionnaire
in patients undergoing off-pump coronary artery bypass grafting (OPCABG).
Design This was a randomized, double-blind, placebo-controlled study.
Settings Tertiary-care hospital. Participants Patients undergoing OPCABG.
Interventions Patients were assigned randomly to the following 2 groups:
the pregabalin group (those who received pregabalin, 150 mg capsule
orally, 1 hour before surgery and 2 days postoperatively [75 mg twice a
day] starting after extubation; n = 37); and the control group (those who
received 2 similar-looking multivitamin capsules at similar times; n =
34). The QoR-40 scores were noted preoperatively and 24 hours after
extubation. Measurements and Main Results Both groups were comparable in
terms of preoperative patient characteristics and baseline QoR-40 scores.
Global scores were significantly improved in the pregabalin group compared
with the control group in the postoperative period (177+/-9 v 170+/-9; p =
0.002). QoR-40 values in the dimensions of emotional state (p = 0.005),
physical comfort (p = 0.04), and pain (p = 0.02) were improved in the
pregabalin group. Conclusions Perioperative pregabalin improved
postoperative quality of recovery as assessed using the QoR-40
questionnaire in patients undergoing OPCABG. Perioperative pregabalin
offered advantages beyond better pain control, such as improved physical
comfort and better emotional state; therefore, the drug's use in the
perioperative period is recommended.<br/>Copyright &#xa9; 2017 Elsevier
Inc.

<110>
Accession Number
609692152
Author
Uretsky S.; Argulian E.; Supariwala A.; Agarwal S.K.; El-Hayek G.; Chavez
P.; Awan H.; Jagarlamudi A.; Puppala S.P.; Cohen R.; Rozanski A.
Institution
(Uretsky) Department of Cardiovascular Medicine, Morristown Medical
Center, Gagnon Cardiovascular Institute, 100 Madison Ave, Morristown, NJ
07960, United States
(Argulian, El-Hayek, Chavez, Awan, Jagarlamudi, Puppala, Cohen, Rozanski)
Division of Cardiology, Department of Medicine, Mount Sinai St. Luke's
Hospital, New York, NY, United States
(Supariwala) Northshore LIJ Southside Hospital, Hofstra School of
Medicine, NSLIJHS, Bayshore, NY, United States
(Agarwal) Department of Cardiovascular Medicine, University of Arkansas
for Medical Sciences, Little Rock, AR, United States
Title
Comparative effectiveness of coronary CT angiography vs stress cardiac
imaging in patients following hospital admission for chest pain work-up:
The Prospective First Evaluation in Chest Pain (PERFECT) Trial.
Source
Journal of Nuclear Cardiology. 24 (4) (pp 1267-1278), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Because the frequency of cardiac event rates is low among
chest pain patients following either performance of coronary CT
angiography (CCTA) or stress testing, there is a need to better assess how
these tests influence the central management decisions that follow from
cardiac testing. The present study was performed to assess the relative
impact of CCTA vs stress testing on medical therapies and downstream
resource utilization among patients admitted for the work-up of chest
pain. Methods: The admitted patients were randomized in a 1:1 ratio to
either cardiac imaging stress test or CCTA. Primary outcomes were time to
discharge, change in medication usage, and frequency of downstream
testing, cardiac interventions, and cardiovascular re-hospitalizations. We
randomized 411 patients, 205 to stress testing, and 206 to CCTA. Results:
There were no differences in time to discharge or initiation of new
cardiac medications at discharge. At 1 year follow-up, there was no
difference in the number of patients who underwent cardiovascular
downstream tests in the CCTA vs stress test patients (21% vs 15%, P = .1)
or cardiovascular hospitalizations (14% vs 16%, P = .5). However, there
was a higher frequency of invasive angiography in the CCTA group (11% vs
2%, P = .001) and percutaneous coronary interventions (6% vs 0%, P <
.001). Conclusions: Randomization of hospitalized patients admitted for
chest pain work-up to either CCTA or to stress testing resulted in similar
discharge times, change in medical therapies at discharge, frequency of
downstream noninvasive testing, and repeat hospitalizations. However, a
higher frequency of invasive coronary angiography and revascularization
procedures were performed in the CCTA arm. (ClinicalTrials.gov number,
NCT01604655.).<br/>Copyright &#xa9; 2016, American Society of Nuclear
Cardiology.

<111>
Accession Number
613851474
Author
Butler E.; Chin M.; Aneman A.
Institution
(Butler) Faculty of Medicine, University of New South Wales, Sydney,
Australia
(Chin, Aneman) Intensive Care Unit, Liverpool Hospital, Sydney, Australia
(Aneman) University of New South Wales, South Western Sydney Clinical
School, Sydney, Australia
(Aneman) Ingham Institute for Applied Medical Research, Sydney, Australia
Title
Peripheral Near-Infrared Spectroscopy: Methodologic Aspects and a
Systematic Review in Post-Cardiac Surgical Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (4) (pp 1407-1416),
2017. Date of Publication: August 2017.
Publisher
W.B. Saunders

<112>
Accession Number
617753769
Author
Templeton T.W.; Morris B.N.; Goenaga-Diaz E.J.; Forest D.J.; Hadley R.;
Moore B.A.; Bryan Y.F.; Royster R.L.
Institution
(Templeton, Morris, Goenaga-Diaz, Forest, Hadley, Moore, Bryan, Royster)
Department of Anesthesiology, Wake Forest School of Medicine,
Winston-Salem, NC, United States
Title
A Prospective Comparison of Intraluminal and Extraluminal Placement of the
9-French Arndt Bronchial Blocker in Adult Thoracic Surgery Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (4) (pp 1335-1340),
2017. Date of Publication: August 2017.
Publisher
W.B. Saunders
Abstract
Objective To compare the standard intraluminal approach with the placement
of the 9-French Arndt endobronchial blocker with an extraluminal approach
by measuring the time to positioning and other relevant intraoperative and
postoperative parameters. Design A prospective, randomized, controlled
trial. Setting University hospital. Participants The study comprised 41
patients (20 intraluminal, 21 extraluminal) undergoing thoracic surgery.
Intervention: Placement of a 9-French Arndt bronchial blocker either
intraluminally or extraluminally. Comparisons between the 2 groups
included the following: (1) time for initial placement, (2) quality of
isolation at 1-hour intervals during one-lung ventilation, (3) number of
repositionings during one-lung ventilation, and (4) presence or absence of
a sore throat on postoperative days 1 and 2 and, if present, its severity.
Measurements and Main Results Median time to placement (min:sec) in the
extraluminal group was statistically faster at 2:42 compared with 6:24 in
the intraluminal group (p < 0.05). Overall quality of isolation was
similar between groups, even though a significant number of blockers in
both groups required repositioning (extraluminal 47%, intraluminal 40%, p
> 0.05), and 1 blocker ultimately had to be replaced intraoperatively. No
differences in the incidence or severity of sore throat postoperatively
were observed. Conclusions A statistically significant reduction in time
to placement using the extraluminal approach without any differences in
the rate of postoperative sore throat was observed. Whether placed
intraluminally or extraluminally, a significant percentage of Arndt
endobronchial blockers required at least one intraoperative
repositioning.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<113>
Accession Number
617753766
Author
Chan M.J.; Chung T.; Glassford N.J.; Bellomo R.
Institution
(Chan, Chung, Glassford, Bellomo) Department of Intensive Care, Austin
Hospital, Heidelberg, Australia
(Chan, Glassford, Bellomo) The Australian and New Zealand Intensive Care
Research Centre, School of Public Health and Preventative Medicine, Monash
University Alfred Hospital, Melbourne, Australia
(Bellomo) School of Medicine, University of Melbourne, Melbourne,
Australia
Title
Near-Infrared Spectroscopy in Adult Cardiac Surgery Patients: A Systematic
Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (4) (pp 1155-1165),
2017. Date of Publication: August 2017.
Publisher
W.B. Saunders
Abstract
Objectives To identify the normal baseline preoperative range of cerebral
tissue oxygen saturation (SctO<inf>2</inf>) derived using near-infrared
spectroscopy (NIRS) and the efficacy of perioperative interventions
designed to modulate SctO<inf>2</inf> in cardiac surgical patients. Design
Systematic review and meta-analysis of relevant randomized controlled
trials (RCTs) extracted from the Medline, Embase, and Cochrane Central
Register of Controlled Trials databases. Setting Hospitals performing
cardiac surgery. Participants The study comprised 953 participants from 11
RCTs. Interventions Interventions included the following: (1)
SctO<inf>2</inf> monitoring protocol compared with no monitoring; (2) use
of cardiopulmonary bypass (CPB) compared with no CPB; (3) normothermic CPB
compared with hypothermic CPB; (4) glyceryl trinitrate during surgery
compared with placebo; (5) midazolam during induction of anesthesia
compared with propofol; (6) sevoflurane anesthesia compared with total
intravenous anesthesia; (7) sevoflurane anesthesia compared with
propofol-based anesthesia; and (8) norepinephrine during CPB compared with
phenylephrine. Measurements and Main Results Eleven RCTs with 953
participants measured baseline preoperative SctO<inf>2</inf> using NIRS.
The pooled mean baseline SctO<inf>2</inf> was 66.4% (95% CI 65.0-67.7),
generating a reference range of 51.0% to 81.8%. Four interventions (1, 3,
4, and 6 described in the Interventions section above) increased
intraoperative SctO<inf>2</inf> across the majority of reported time
points. Postoperative follow-up of SctO<inf>2</inf> occurred in only 1
study, and postoperative cognitive assessment correlating SctO<inf>2</inf>
with cognitive function was applied in only 4 studies using variable
methodology. Conclusions The authors have established that reference
values for baseline NIRS-derived SctO<inf>2</inf> in cardiac surgery
patients are varied and have identified interventions that modulate
SctO<inf>2</inf>. This information opens the door to standardized research
and interventional studies in this field.<br/>Copyright &#xa9; 2017

<114>
Accession Number
614103034
Author
Molstrom S.; Nielsen T.H.; Andersen C.; Nordstrom C.H.; Toft P.
Institution
(Molstrom, Toft) Department of Anesthesiology and Intensive Care, Odense
University Hospital, Odense, Denmark
(Nielsen, Nordstrom) Department of Neurosurgery, Odense University
Hospital, Odense, Denmark
(Andersen) Department of Anesthesiology and Intensive Care, Thorax
Anesthesiology Unit VITA, Odense University Hospital, Odense, Denmark
Title
Bedside Monitoring of Cerebral Energy State During Cardiac Surgery-A Novel
Approach Utilizing Intravenous Microdialysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (4) (pp 1166-1173),
2017. Date of Publication: August 2017.
Publisher
W.B. Saunders
Abstract
Objectives This study investigated whether the lactate-to-pyruvate (LP)
ratio obtained by microdialysis (MD) of the cerebral venous outflow
reflected a derangement of global cerebral energy state during
cardiopulmonary bypass (CPB). Design Interventional, prospective,
randomized study. Setting Single-center, university teaching hospital.
Participants The study included 10 patients undergoing primary, elective
coronary artery bypass grafting. Interventions Patients were randomized
blindly to low mean arterial pressure (MAP) (40-60 mmHg; n = 5) or high
MAP (60-80 mmHg; n = 5) during CPB. The MD catheters were positioned in a
retrograde direction into the jugular bulb, and a reference catheter was
inserted into the brachial artery. The correlations among LP ratio, MAP,
data obtained from bifrontal near-infrared spectroscopy (NIRS), and
postoperative neurologic outcome measures were assessed. Measurements and
Main Results The correlated difference between pooled LP ratio (low and
high MAP) of the jugular venous and the arterial blood was significant
(LP<inf>arterial</inf> 17 [15-20] v LP<inf>venous</inf> 26 [23-27]; p =
0.0001). No cerebral desaturations (decrease in rSO<inf>2</inf>>20% from
baseline) were observed in either group during CPB. In each group, 50% of
the patients showed significant cognitive decline (mini-mental state
examination, 3 points) 2 days after surgery. Conclusion The LP ratio of
cerebral venous blood increased significantly during CPB, indicating
compromised cerebral oxidative metabolism. Conventional monitoring of
rSO<inf>2</inf> by NIRS did not show a corresponding decrease in cerebral
oxygenation. As the patients exhibited decreased cognitive functions after
CPB, increases in jugular venous LP ratio may be a sensitive indicator of
impending cerebral damage.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<115>
Accession Number
617722383
Author
Kurfirst V.; Mokraaek A.; Aanadyova J.; Frana R.; Zeman P.
Institution
(Kurfirst, Mokraaek, Aanadyova, Frana, Zeman) Department of Cardiac
Surgery, Hospital of Aeske Budjovice, Bozeny Nemcove 54, Aeske Budjovice
37001, Czech Republic
Title
Epicardial clip occlusion of the left atrial appendage during cardiac
surgery provides optimal surgical results and long-term stability.
Source
Interactive Cardiovascular and Thoracic Surgery. 25 (1) (pp 37-40), 2017.
Date of Publication: 01 Jul 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES: Occlusion of the left atrial appendage (LAA) has become an
integral and important part of the surgical treatment of atrial
fibrillation. Different methods of surgical occlusion of the LAA have been
associated with varying levels of short- A nd long-term success for
closure. The purpose of this study was to evaluate long-term results of
epicardial placement and endocardial occlusion in patients undergoing
cardiac operative procedures. METHODS: A total of 101 patients (average
age 65.7 years) undergoing cardiac operative procedures with the
epicardial AtriClip Exclusion System of the LAA were enrolled in the
study. The AtriClip was placed via a sternotomy or a thoracotomy or from a
thoracoscopic approach. Postoperative variables, such as thromboembolic
events, clip stability and endocardial leakage around the device, were
examined by transoesophageal echocardiography (TEE) and/or computed
tomography. RESULTS: Perioperative clip implantation was achieved in 98%
of patients. TEE and/or computed tomography conducted during the follow-up
period, comprising 1873 patient-months with a mean duration of 18 +/- 11
months, revealed no clip migration, no leakage around the device and no
clot formation near the remnant cul-de-sac. During the follow-up period, 4
of the cardiac patients experienced transitory ischaemic attacks, whereas
no patient experienced a cerebrovascular attack. CONCLUSIONS: The
Epicardial AtriClip Exclusion System of the LAA appears to be a feasable
and safe operative method with a high success rate. Long-term follow-up
confirmed clip stability, complete occlussion of the LAA and absence of
any atrial fibrilation-related thromboembolic events. These results need
to be confirmed by a larger, multicentre study.<br/>Copyright &#xa9; 2017
The Author.

<116>
Accession Number
617722341
Author
Song Y.; Xu F.; Du J.; Zhang J.; Feng W.
Institution
(Song, Xu, Du, Zhang, Feng) Department of Cardiac Surgery, Fuwai Hospital
of Chinese Academy of Medical Sciences, Peking Union Medical College,
Beilishi Road No. 167, Beijing 100037, China
Title
Coronary endarterectomy with coronary artery bypass graft decreases graft
patency compared with isolated coronary artery bypass graft: A
meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 25 (1) (pp 30-36), 2017.
Date of Publication: 01 Jul 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES: This meta-analysis aims to assess the graft patency
quantitatively and statistically. METHODS: Eleven observational studies
were identified by systematic literature search, incorporating 3311
patients undergoing coronary endarterectomy (CE) + coronary artery bypass
graft (CABG) and 3990 undergoing isolated CABG, which were analysed using
random-effects modelling. Heterogeneity, quality of scoring and risk of
bias were assessed and reangiographic outcomes were documented. RESULTS:
Adjunctive CE decreased graft patency [odds ratios = 0.43, 95% confidence
interval [0.29-0.63], z = 4.33, P < 0.0001] with moderate heterogeneity,
while the baseline demographics differed considerably. CONCLUSIONS:
Whether CE remains a viable option to CABG requires novel studies
collecting corresponding data from bench to bedside. To achieve
satisfactory efficacy, surgeons should carefully weigh possible benefits
and adverse effects of CE and prepare the surgical strategy
adequately.<br/>Copyright &#xa9; 2017 The Author.