EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 62

Results Generated From:
Embase <1980 to 2017 Week 32>
Embase <2017> (updates since 2017-07-28)

<1>
Accession Number
614744919
Author
Frerker C.; Bestehorn K.; Schluter M.; Bestehorn M.; Hamm C.W.; Mollmann
H.; Katus H.A.; Kuck K.-H.
Institution
(Frerker, Kuck) Department of Cardiology, Asklepios Klinik St. Georg,
Lohmuhlenstr. 5, Hamburg 20099, Germany
(Bestehorn) Technische Universitat Dresden, Dresden, Germany
(Schluter) Asklepios Proresearch, Hamburg, Germany
(Bestehorn) ProMedCon GmbH, Ebenhausen, Germany
(Hamm) Department of Medical Clinic I, University of Giessen, Giessen,
Germany
(Hamm) Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim,
Germany
(Mollmann) Department of Cardiology, St. Johannes Hospital, Dortmund,
Dortmund, Germany
(Katus) Center for Internal Medicine, Heidelberg University Hospital,
Heidelberg, Germany
Title
In-hospital mortality in propensity-score matched low-risk patients
undergoing routine isolated surgical or transfemoral transcatheter aortic
valve replacement in 2014 in Germany.
Source
Clinical Research in Cardiology. 106 (8) (pp 610-617), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Aims: Recent randomized trials have documented the superiority of
TAVR-particularly via transfemoral access-over SAVR in patients with
severe aortic stenosis considered to have a high or intermediate operative
risk of death. We sought to assess in-hospital outcomes of patients with
severe aortic stenosis and a low risk of operative mortality undergoing
routine surgical aortic valve replacement (SAVR) or transcatheter aortic
valve replacement (TAVR). Methods and results: We performed a
propensity-score matched comparison of all patients undergoing first-time
treatment by SAVR or transfemoral TAVR (TF-TAVR) in 2014 in Germany who
had a logistic EuroSCORE (logES) <= 10%, considered to reflect low
surgical risk. The primary endpoint of our analysis was in-hospital
mortality. Of 7624 SAVR and 9969 TF-TAVR procedures, 6844 (89.8%) and 2751
patients (27.6%), respectively, were considered low risk with a logES
between 1.505 and 10.0%. Matching yielded 805 TF-TAVR/SAVR patient pairs
with identical propensity scores and no difference in pertinent baseline
characteristics, except for the logES, which was significantly higher in
TF-TAVR patients (6.8 +/- 1.7 vs. 4.2 +/- 1.3% in SAVR patients, P <
0.001). Observed in-hospital mortalities were 1.7% (95% confidence
interval, 1.1-3.0%) in SAVR and 2.0% (1.3-3.3%) in TF-TAVR patients (P =
0.85). Conclusion: Our finding of no difference in in-hospital mortality
in propensity-score matched low-surgical-risk patients treated by SAVR or
TF-TAVR in a routine clinical setting indicates that TF-TAVR can be
offered safely to individual patients, despite their operative risk being
low. This finding needs to be confirmed in a randomized
trial.<br/>Copyright &#xa9; 2017, Springer-Verlag Berlin Heidelberg.

<2>
Accession Number
616999765
Author
Sun Y.; Liu X.; Chen Z.; Fan J.; Jiang J.; He Y.; Zhu Q.; Hu P.; Wang L.;
Xu Q.; Lin X.; Wang J.
Institution
(Sun, Liu, Fan, Jiang, He, Zhu, Hu, Wang, Xu, Lin, Wang) Department of
Cardiology, Second Affiliated Hospital, Zhejiang University School of
Medicine, Hangzhou, China
(Chen) Department of Clinical Epidemiology and Biostatistics, Second
Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou,
China
(Wang) Zhejiang University School of Medicine, Hangzhou, China
Title
Meta-analysis of Predictors of Early Severe Bleeding in Patients Who
Underwent Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 120 (4) (pp 655-661), 2017. Date of
Publication: 15 Aug 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Severe bleeding (SB) in patients who underwent transcatheter aortic valve
implantation (TAVI) could be fatal. Although multiple independent
predictors of bleeding post-TAVI have been identified, the definitions of
bleeding and predictors vary across studies. This study aimed to provide
summary effect estimates for predictors of SB within 30 days post-TAVI. A
systematic review of studies that reported the incidence of bleeding
post-TAVI with raw data for predictors of interest was performed. Data on
characteristics of study, patient, and procedure were extracted. Crude
risk ratios (RRs) and 95% confidence intervals were calculated using
random-effect model. Fifteen predictors on 65,209 patients from 47 studies
were analyzed. The median rate of SB was 11% across studies. Seven factors
(3 patient related and 4 procedure related) were recognized as predictors
of early SB post-TAVI. Age >=90 years (RR 1.17; p = 0.008), female (RR
1.13; p = 0.01), and sheath diameter >19 Fr (RR 1.19; p = 0.04) were weak
predictors. Chronic kidney disease (RR 1.94; p <0.001) and transapical
(TA) (RR 1.82; p <0.001) were moderate predictors that were almost
associated with twofold risk. Vascular complication (RR 2.97; p <0.001)
and circulatory support (RR 3.39; p <0.001) were strong predictors that
were nearly associated with threefold risk. In conclusion, age, gender,
chronic kidney disease, TA, sheath diameter, vascular complication, and
circulatory support were all predictors of early SB post-TAVI in this
meta-analysis, which provided possible guidance for prevention and
management of SB related to TAVI.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<3>
Accession Number
616890841
Author
Mendirichaga R.; Singh V.; Blumer V.; Rivera M.; Rodriguez A.P.; Cohen
M.G.; O'Neill W.W.; Elmariah S.
Institution
(Mendirichaga, Blumer, Rivera, Rodriguez, Cohen) Cardiovascular Division,
University of Miami Miller School of Medicine, Miami, Florida, United
States
(Singh, Elmariah) Structural Heart Diseases, Cardiology Division,
Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, United States
(O'Neill) Structural Heart Diseases, Cardiology Division, Henry Ford
Hospital, Detroit, Michigan, United States
Title
Transcatheter Mitral Valve Repair With MitraClip for Symptomatic
Functional Mitral Valve Regurgitation.
Source
American Journal of Cardiology. 120 (4) (pp 708-715), 2017. Date of
Publication: 15 Aug 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Transcatheter edge-to-edge mitral valve repair (TMVr) with MitraClip has
proved to be safe and effective for high-risk surgical patients with
severe symptomatic degenerative mitral regurgitation. There is paucity of
data regarding its use in functional mitral regurgitation (FMR). The
objective of this study was to evaluate the use of MitraClip in patients
with symptomatic moderate or severe FMR and a high surgical risk. Medical
libraries were systematically searched for studies assessing the use of
MitraClip for patients with symptomatic moderate or severe FMR and a high
surgical risk. Studies reporting safety and efficacy outcomes at 12 months
were included in the analysis. A total of 12 studies including 1,695
patients (age 73 [interquartile range [IQR] 70.5 to 74], 69.8% men, left
ventricular ejection fraction 32.5% [IQR 29.5 to 36], New York Heart
Association class II to IV) who underwent TMVr with MitraClip were
included in the analysis. Acute procedural success was 89% (IQR 85.5 to
92). Ischemic cardiomyopathy was the most common cause of left ventricular
dysfunction. Over 2/3 of patients had known coronary artery disease, 35% a
previous myocardial infarction, and 38.5% had a previous cardiac surgery.
Survival to hospital discharge was 98% (IQR 97 to 100) and 30-day survival
97% (IQR 96 to 98). Overall survival at 12 months was 82% (IQR 77 to 87).
Mitral valve re-intervention at 12 months was infrequent (3%; IQR 2 to
6.5). In conclusion, our pooled analysis suggests that TMVr with MitraClip
is feasible, safe, and carries a low rate of mitral valve re-intervention
at 12 months in patients with symptomatic moderate or severe FMR and a
high surgical risk.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<4>
Accession Number
617515495
Author
Arruda A.P.N.; Ayala A.P.; Lopes L.C.; Bergamaschi C.C.; Guimaraes C.;
Grossi M.D.; Righesso L.A.R.; Agarwal A.; Dib R.E.
Institution
(Arruda) Department of Surgery and Orthopedics, Botucatu Medical School,
UNESP - Universidade Estadual Paulista, Botucatu, Sao Paulo, Brazil
(Ayala) Instruction and Faculty Liaison Librarian, Gerstein Science
Information Centre, University of Toronto Libraries, University of
Toronto, Toronto, ON, Canada
(Lopes, Bergamaschi, Guimaraes, Grossi) Ciencias Biologicas e da Saude,
University of Sorocaba, Sorocaba, Sao Paulo, Brazil
(Lopes) Faculdade de Ciencias Farmaceuticas, Universidade Estadual
Paulista, Araraquara, Sao Paulo, Brazil
(Righesso) Department of Oral and Maxillofacial Surgery, University
Medical Center Mainz, Mainz, Renania, Germany
(Agarwal) Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, ON, Canada
(Agarwal) School of Medicine, University of Toronto, Toronto, ON, Canada
(Dib) Department of Anesthesiology, Botucatu Medical School, UNESP -
Universidade Estadual Paulista, Botucatu, Sao Paulo, Brazil
(Dib) Institute of Urology, McMaster University, St. Joseph's Healthcare,
Hamilton, ON, Canada
(Dib) Department of Biosciences and Oral Diagnosis, Institute of Science
and Technology, UNESP - Universidade Estadual Paulista, Sao Jose Dos
Campos, Sao Paulo, Brazil
Title
Herbal medications for surgical patients: A systematic review protocol.
Source
BMJ Open. 7 (7) (no pagination), 2017. Article Number: e014290. Date of
Publication: 01 Jul 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Postoperative nausea and vomiting (PONV) affect approximately
80% of surgical patients and is associated with increased length of
hospital stay and systemic costs. Preoperative and postoperative pain,
anxiety and depression are also commonly reported. Recent evidence
regarding their safety and effectiveness has not been synthesised. The aim
of this systematic review is to evaluate the efficacy and safety of herbal
medications for the treatment and prevention of anxiety, depression, pain
and PONV in patients undergoing laparoscopic, obstetrical/gynaecological
and cardiovascular surgical procedures. Methods and analysis The following
electronic databases will be searched up to 1 October 2016 without
language or publication status restrictions: CENTRAL, MEDLINE, EMBASE,
CINAHL, Web of Science and LILACS. Randomised clinical trials enrolling
adult surgical patients undergoing laparoscopic,
obstetrical/gynaecological and cardiovascular surgeries and managed with
herbal medication versus a control group (placebo, no intervention or
active control) prophylactically or therapeutically will be considered
eligible. Outcomes of interest will include the following: anxiety,
depression, pain, nausea and vomiting. A team of reviewers will complete
title and abstract screening and full-text screening for identified hits
independently and in duplicate. Data extraction, risk of bias assessments
and evaluation of the overall quality of evidence for each relevant
outcome reported will be conducted independently and in duplicate using
the Grading of Recommendations Assessment Development and Evaluation
classification system. Dichotomous data will be summarised as risk ratios;
continuous data will be summarised as standard average differences with
95% CIs. Ethics and dissemination This is one of the first efforts to
systematically summarise existing evidence evaluating the use of herbal
medications in laparoscopic, obstetrical/gynaecological and cardiovascular
surgical patients. The findings of this review will be disseminated
through peer-reviewed publications and conference presentations.
Systematic review registration PROSPERO CRD42016042838.<br/>Copyright
&#xa9; 2017 Article author(s) (or their employer(s) unless otherwise
stated in the text of the article). All rights reserved.

<5>
Accession Number
617582064
Author
Yin R.; Zhang R.; Wang J.; Yuan L.; Hu L.; Jiang S.; Chen C.; Cao Y.
Institution
(Yin, Zhang, Wang, Yuan, Hu, Jiang, Chen, Cao) Department of Neonatology,
Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai
201102, China
Title
Effects of somatostatin/octreotide treatment in neonates with congenital
chylothorax.
Source
Medicine (United States). 96 (29) (no pagination), 2017. Article Number:
e7594. Date of Publication: 01 Jul 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The influence of somatostatin/octreotide treatment on outcomes of neonates
with congenital chylothorax remains controversial. We retrospectively
reviewed our experience with somatostatin/octreotide therapy in neonates
with this very rare disease. Fourteen neonates with congenital chylothorax
who were treated with somatostatin (3.5-7mug/kg/h, before 2016) or
octreotide (1-6mug/kg/h, after January 2016), along with traditional
management between 2013 and 2016, were retrospectively reviewed in this
observational study. Their daily volumes of pleural drainage and
parameters of respiratory support were recorded, and the potential side
effects of somatostatin/octreotide were screened. Four patients (28.6%)
had a unilateral presentation of pleural effusion, whereas 10 patients
(71.4%) had a bilateral presentation. Twelve patients (85.7%) survived
until discharge without later recurrence or death, whereas 2 patients
(14.3%) died within the first 3 days after birth. Somatostatin/octreotide
treatment was maintained for a median period of 6 days (range 1-16 days).
The chest tube was removed after a median duration of 14 days (range 2-51
days), and no patient needed pleurodesis or thoracic duct ligation
surgery. The average daily drain output within 3 days post-treatment
(median 62mL, range 10-651mL) was significantly lower than that before
treatment (median 133mL, range 70-620mL) (P=.002). The need for
ventilation support was reduced in most patients (85.7%) after the
initiation of somatostatin/octreotide therapy. No serious side effects
were identified. Somatostatin/octreotide treatment reduced pleural
drainage and respiratory support without significant side effects. Further
randomized controlled studies with more patients are necessary to
ascertain the benefits of somatostatin/octreotide in neonates with
congenital chylothorax.<br/>Copyright &#xa9; 2017 the Author(s). Published
by Wolters Kluwer Health, Inc.

<6>
Accession Number
617592053
Author
Reddy S.K.; Bailey M.J.; Beasley R.W.; Bellomo R.; Mackle D.M.; Psirides
A.J.; Young P.J.
Institution
(Reddy, Beasley, Mackle, Young) Medical Research Institute of New Zealand,
Wellington, New Zealand
(Bailey, Bellomo) Australian and New Zealand Intensive Care Research
Centre, Monash University, Melbourne, VIC, Australia
(Bellomo) Intensive Care Unit, Austin Hospital, Melbourne, VIC, Australia
(Psirides, Young) Intensive Care Unit, Wellington Regional Hospital,
Wellington, New Zealand
Title
Effect of 0.9% Saline or Plasma-Lyte 148 as Crystalloid Fluid Therapy in
the Intensive Care Unit on Blood Product Use and Postoperative Bleeding
After Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objective: To evaluate the effect of Plasma-Lyte 148 (PL-148) compared
with 0.9% saline (saline) on blood product use and postoperative bleeding
in patients admitted to the intensive care unit (ICU) following cardiac
surgery. Design: A post hoc subgroup analysis conducted within a
multicenter, double-blind, cluster-randomized, double-crossover study
(study 1) and a prospective, single-center nested-cohort study (study 2).
Setting: Tertiary-care hospitals. Participants: Adults admitted to the ICU
after cardiac surgery requiring crystalloid fluid therapy as part of the
0.9% saline vs. PL-148 for ICU fluid therapy (SPLIT) trial. Interventions:
Blinded saline or PL-148 for 4 alternating 7-week blocks. Measurements and
Main Results: 954 patients were included in study 1; 475 patients received
PL-148, and 479 received saline. 128 of 475 patients (26.9%) in the PL-148
group received blood or a blood product compared with 94 of 479 patients
(19.6%) in the saline group (OR [95% confidence interval], 1.51
[1.11-2.05]; p = 0.008). In study 2, 131 patients were allocated to PL-148
and 120 patients were allocated to saline. There were no differences
between groups in chest drain output from the time of arrival in the ICU
until 12 hours postoperatively (geometric mean, 566 mL for the PL-148
group v 547 mL in the saline group; p = 0.60). Conclusions: The findings
did not support the hypothesis that using PL-148 for fluid therapy in ICU
following cardiac surgery reduces transfusion requirements compared to
saline. The significantly increased proportion of patients receiving blood
or blood product with allocation to PL-148 compared to saline was
unexpected and requires verification through further
research.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<7>
Accession Number
617589568
Author
Kumar A.; Puri G.D.; Bahl A.
Institution
(Kumar, Puri) Department of Anaesthesia and Intensive Care, Post Graduate
Institute of Medical Education and Research, Chandigarh, India
(Bahl) Department of Cardiology, Post Graduate Institute of Medical
Education and Research, Chandigarh, India
Title
Transesophageal Echocardiography, 3-Dimensional and Speckle Tracking
Together as Sensitive Markers for Early Outcome in Patients With Left
Ventricular Dysfunction Undergoing Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objective: Speckle tracking, when combined with 3-dimensional (3D) left
ventricular ejection fraction, might prove to be a more sensitive marker
for postoperative ventricular dysfunction. This study investigated early
outcomes in a cohort of patients with left ventricular dysfunction
undergoing cardiac surgery. Design: Prospective, blinded, observational
study. Setting: University hospital; single institution. Participants: The
study comprised 73 adult patients with left ventricular ejection fraction
<50% undergoing cardiac surgery using cardiopulmonary bypass.
Interventions: Routine transesophageal echocardiography before and after
bypass. Measurements and Main Results: Global longitudinal strain using
speckle tracking and 3D left ventricular ejection fraction were computed
using transesophageal echocardiography. Mean prebypass global longitudinal
strain and 3D left ventricle ejection fraction were significantly lower in
patients with postoperative low-cardiac-output syndrome compared with
patients who did not develop low cardiac output (global longitudinal
strain -7.5% v -10.7% and 3D left ventricular ejection fraction 29% v 39%,
respectively; p < 0.0001). The cut-off value of global longitudinal strain
predicting postoperative low-cardiac-output syndrome was -6%, with 95%
sensitivity and 68% specificity; and 3D left ventricular ejection fraction
was 19% with 98% sensitivity and 81% specificity. Conclusions:
Preoperative left ventricular global longitudinal strain (-6%) and 3D left
ventricular ejection fraction (19%) together could act as predictor of
postoperative low-cardiac-output states with high sensitivity (99.9%) in
patients undergoing cardiac surgery.<br/>Copyright &#xa9; 2017 Elsevier
Inc.

<8>
Accession Number
617433627
Author
Karjalainen P.; Paana T.; Ylitalo A.; Sia J.; Nammas W.
Institution
(Karjalainen, Paana, Ylitalo, Nammas) Heart Center, Satakunta Central
Hospital, Sairaalantie 3, Pori FIN-28500, Finland
(Sia) Heart Center, Kokkola Central Hospital, Kokkola, Finland
Title
Optical coherence tomography follow-up 18 months after
titanium-nitride-oxide-coated versus everolimus-eluting stent implantation
in patients with acute coronary syndrome.
Source
Acta Radiologica. 58 (9) (pp 1077-1084), 2017. Date of Publication: 01 Sep
2017.
Publisher
SAGE Publications Inc. (E-mail: info@sagepub.co.uk)
Abstract
Background Inadequate neointimal coverage of stent struts is associated
with late stent thrombosis. Purpose To demonstrate the extent of
neointimal coverage and strut malapposition in
titanium-nitride-oxide-coated bioactive stents (BAS) versus
everolimus-eluting stents (EES) by optical coherence tomography (OCT)
performed at 18-month follow-up. Material and Methods In the BASE-ACS
trial, 827 patients presenting with acute coronary syndrome were
randomized to receive either BAS or EES. Forty patients (20 BAS, 20 EES)
underwent OCT at 18-month follow-up for evaluation of stent strut
coverage, malapposition, and neointimal hyperplasia (NIH). Primary
endpoint was binary stent strut coverage (ratio of covered struts to all
analyzed struts multiplied by 100). Co-primary endpoint was the percentage
of malapposed struts. Results We analyzed 3465 struts in 330
cross-sections of BAS and 3327 struts in 316 cross-sections of EES. Binary
stent strut coverage, based on strut-level analysis, was higher with BAS
versus EES (99.5% versus 94.2%, respectively; P < 0.001), the strut-level
percentage of malapposed struts was lower with BAS (0.6% versus 2.5%,
respectively; P < 0.001). Yet, the mean NIH thickness was greater with BAS
(237 +/- 125 versus 108 +/- 62 mum, respectively; P < 0.001). Conclusion
In the current post-hoc analysis with OCT performed at 18 months, binary
strut coverage, based on strut-level analysis, was higher with BAS versus
EES; strut-level malapposed struts were fewer with BAS; yet, BAS induced
thicker NIH.<br/>Copyright &#xa9; The Foundation Acta Radiologica.

<9>
Accession Number
613173404
Author
Sannino A.; Gargiulo G.; Schiattarella G.G.; Perrino C.; Stabile E.; Losi
M.-A.; Galderisi M.; Izzo R.; De Simone G.; Trimarco B.; Esposito G.
Institution
(Sannino, Gargiulo, Schiattarella, Perrino, Stabile, Losi, Galderisi,
Izzo, Trimarco, Esposito) Division of Cardiology, Department of Advanced
Biomedical Sciences, Federico II University, Via Pansini 5, Naples 80131,
Italy
(Perrino, Stabile, Losi, Galderisi, Izzo, De Simone, Trimarco, Esposito)
Hypertension Research Center, Federico II University, Naples, Italy
Title
A meta-analysis of the impact of pre-existing and new-onset atrial
fibrillation on clinical outcomes in patients undergoing transcatheter
aortic valve implantation.
Source
EuroIntervention. 12 (8) (pp e1047-e1056), 2016. Date of Publication:
October 2016.
Publisher
EuroPCR
Abstract
Aims: Little is known about the prognostic role of pre-existing atrial
fibrillation (AF) and new-onset AF (NOAF) in transcatheter aortic valve
implantation (TAVI). Therefore, the aim of this meta-analysis was to
compare the short-and long-term clinical outcomes of patients undergoing
TAVI with and without preexisting and new-onset AF. Methods and results:
Twenty-six studies, enrolling 14,078 patients undergoing TAVI, of whom
33.4% had pre-existing AF and 17.5% had NOAF, were analysed for early and
long-term all-cause mortality, cardiovascular mortality and
cerebrovascular events (CVE). In patients with pre-existing AF, 30-day
all-cause mortality was similar to patients in sinus rhythm (SR).
Conversely, long-term all-cause and cardiovascular mortality were
significantly greater in pre-existing AF patients than in patients with SR
(20 studies; 8,743 patients; HR: 1.68; p<0.00001, and three studies; 1,138
patients; HR: 2.07; p=0.01, respectively). Pre-existing AF was not a
predictor of CVE at long-term follow-up. NOAF patients showed similar
shortand long-term all-cause mortality when compared to patients in SR,
whereas they experienced a significantly higher incidence of CVE at
short-term follow-up (six studies; 2,025 patients; HR: 2.86; p<0.00001). A
non-significant increase in the incidence of CVE was observed at long-term
follow-up. Conclusions: Pre-existing AF is a predictor of all-cause
mortality in patients undergoing TAVI. NOAF is related to the occurrence
of CVE at short-term follow-up. Similarly to surgical aortic valve
replacement (SAVR), the optimal management and risk stratification of
these patients should be further investigated.<br/>Copyright &#xa9; 2016
Europa Digital & Publishing. All rights reserved.

<10>
Accession Number
617551091
Author
Droc I.; Milleret R.
Institution
(Droc) Central Military Hospital, Bucharest, Romania
(Milleret) Vascular Surgery Department, Clinique Saint Jean, Montpellier,
France
Title
Endovascular treatment of varicose veins using steam ablation.
Source
Vascular. Conference: ISEVS Congress for Central and Eastern Europe the
East Meets West Congress 2017. Romania. 25 (1 Supplement 1) (pp 21), 2017.
Date of Publication: July 2017.
Publisher
SAGE Publications Ltd
Abstract
Introduction: Steam is the latest of the thermal endovenous techniques to
enter clinical use. It was introduced in 2008 as a cheaper but as
effective alternative to laser and radio-frequency. The principle is to
inject in the vein pulses of water vapors at 120C, each pulse delivering
60 joules of energy in the lumen. Steam is injected under pressure: the
first pulse dislodges the blood, the next ones heat the vein wall. A
stainless-steel catheter of 5F gauge is used, it is flexible enough to
navigate through tortuosities without using a guide wire. Two lateral
holes close to the tip eject the steam, avoiding the risk of heating deep
veins when heating the junctions. A comparative animal study by S. Thomis
and all. showed that immediate shrinking was more pronounced with steam
than with Closure Fast radio frequency catheter and 1470 nm TULIP
fiber laser. Perivenous damage was less seen, although the
number of cases was not sufficient to obtain statistical significance.
R.Milleret published the results of a multicenter study performed in
France. Obliteration rate at 6 months was 96%. A multicenter study of
tributary ablation showed, with less pigmentation and inflammatory
reactions than after foam sclerotherapy with 97% closure rate at 6 months.
A second generation device allows elective ablation of tributaries and
reticular veins (Miravas). Materials and methods: We present a
retrospective study on one year period (jan.2015-jan 2016) in one single
center (Army's center for cardiovascular surgery, Bucharest) on 46 pat.,
with the mean age of 42. The veins treated were internal saphenos vein 39
pat (84.8%), external saph.vein 4(8.7%) and reinterventions 3(6,5%). The
follow up was at 7days, 3 months, 6 months and one year by duplex scan.
96% of veins treated were occluded at one year. Conclusion: Steam ablation
is a safe alternative to other thermal techniques. It can be applied to
treat great saphenous vein or small saphenous vein, as well as tributaries
or reinterventions after surgery.

<11>
Accession Number
617550976
Author
Droc I.; Deaconu S.; Dumitru E.; Buzila C.; Murgu V.; Stan L.
Institution
(Droc, Deaconu, Dumitru, Buzila, Murgu, Stan) Central Military Hospital,
Bucharest, Romania
Title
Surgical treatment in combined carotid and coronary disease.
Source
Vascular. Conference: ISEVS Congress for Central and Eastern Europe the
East Meets West Congress 2017. Romania. 25 (1 Supplement 1) (pp 17), 2017.
Date of Publication: July 2017.
Publisher
SAGE Publications Ltd
Abstract
Introduction: Lacking randomised trials, a major controversy remains the
optimal management of patients who present concomitant carotid and
coronary artery disease. Objective: The main question is whether staged or
simultaneous endarterectomy (CEA) will reduce peri-operative morbidity and
mortality after cardiac surgery. The reported results were encouraging
using either of the two strategies, but there is no consensus as to which
is preferable. Recently carotid artery angioplasty with stenting (CAS)
represents a potential alternative to CEA mostly in 'high-risk for CEA
patients. CAS offers a less invasive, safer therapeutic option for cardiac
patients who underwent or will underwent CABG. In some particular
situations a strategy of CAS-CABG might be harmful. In particular, the
need for dual antiplatelet therapy after CAS can be balanced with avoiding
unnecessary bleeding complications after cardiac surgery. Material and
method: During a 1-year period, between 01.01.2012-31.12.2012, 375
consecutive patients were referred for coronary surgery. 49 patients
(13.3%) were found to have combined carotid and coronary disease. 37
patients (10%) underwent staged carotid endarterectomy (CEA) and coronary
artery bypass grafting (CABG), with a mean of 30+/-6 days between the
interventions, and 12 patients (3.3%) underwent CABG and CEA
simultaneously. Outcomes were assessed in both groups in terms of
morbidity and all-cause mortality. Results: The mean age was 62.8+/-4.7
years and 32 patients (65%) were males. The majority of the cases (82%)
presented triple vessel disease and 16.7% had left main disease. The
carotid disease was unilateral in 43 patients (87.7%) and bilateral in 2
(4%). 36 patients (74.0%) were neurologically asymptomatic. In the staged
CEA-CABG group 1 patient had a stroke (2.7%), 2 patients myocardial
infarction (5.4%) and 2 patients died of other causes (5.4%). In the
combined CEA-CABG group 1 patient (8.5%) died of non-cardiovascular
related causes. The reported overall morbidity and mortality after staged
procedures is 19.2%(Randall, 2006) and after simultaneous procedure is
17.4% (Rutherford 2005). Conclusion: In conclusion, the presence of
carotid stenosis is per se a marker of risk. Previous or simultaneous
CEA/CABG prevents stroke better than delayed CEA. An individual surgical
approach based on specific risk profiles is recommended. There is a need
for a randomized controlled trial focusing on combined or staged surgical
approach or endovascular therapy.

<12>
Accession Number
617553250
Author
Caobelli F.; Popescu C.; Laudicella R.; Comis A.; Pignata S.; Sara R.;
Rossetti C.; Aimn Y.
Institution
(Aimn) Italian Association of Nuclear Medicine, Milan, Italy
(Popescu, Sara) Department of Nuclear, Medicine Niguarda Hospital Milan,
Milan, Italy
(Rossetti) Ospedale Niguarda, Milano, Italy
(Caobelli) University Hospital Basel, Basel, Switzerland
(Laudicella, Comis, Pignata) Nuclear Medicine Unit, Department of
Biomedical Sciences and Morphological and Functional Images, University of
Messina, Messina, Italy
Title
Predictive and prognostic value of left ventricular mechanical
dyssynchrony assessed by myocardial perfusion SPECT in asymptomatic
Patients under hemodialysis.
Source
Journal of Nuclear Medicine. Conference: Society of Nuclear Medicine and
Molecular Imaging Annual Meeting, SNMMI 2017. United States. 58 (no
pagination), 2017. Date of Publication: May 2017.
Publisher
Society of Nuclear Medicine Inc.
Abstract
Objectives: Patients with end-stage kidney disease under hemodialysis have
an increased risk of adverse cardio-cerebrovascular events. In these
patients, myocardial perfusion scintigraphy (MPS) provides useful
prognostic information at short-term follow-up. Left ventricular
mechanical dyssynchrony (LVMD) has been proven to predict the onset of
major adverse cardiac events (MACEs) at short-time follow-up in patients
with chronic kidney disease. It remains unclear, whether the same
prognostic value pertains also to patients under hemodialysis at longer
follow-up. Methods: Seventy patients under hemodialysis (duration range
1-8 years) with neither history nor symptoms of coronary artery disease
(CAD) at the time of MPS were retrospectively evaluated from a multicentre
database. All underwent clinical evaluation and MPS with pharmacologic
stress test with dipyridamole. MPS were reprocessed to derive LV ejection
fraction (EF), perfusion scores (SSS and SDS), and LVMD [phase histogram
bandwidth (PHB) and phase standard deviation (PSD)]. MACEs were assessed
at 2-year follow-up (median 29 months) and defined as nonfatal myocardial
infarction, hospitalisation due to cardiac symptoms, new developed
ischaemia or coronary revascularisation. Statistical analysis was
performed using univariate and multivariate analysis on clinical and
scintigraphic data. The rate of MACEs was evaluated with Kaplan-Meyer
curves and Log-Rank test. Results: MACEs were reported in 8 patients
(11.4%). Two of 8 had a myocardial infarction and 6 of 8 underwent
coronary revascularisation. At univariate analysis, a correlation was
demonstrated between MACEs and PSD (p=0.02), PHB (p=0.01) and the presence
of peripheral artery disease (p=0.04). At multivariate analysis, only PSD
and PHB were proven independent predictors of MACEs (p=0.03 and 0.001,
respectively). At survival analysis, patients with abnormal values of PSD
and PHB had a significantly shorter event-free survival (for PSD-Odd Ratio
[OR] 16.8, 95% confidence interval (CI) 3.3-84.5, p<0.001; for PHB-OR 5.4,
95% CI 1.2-24.6, p=0.03, fig. 1). Perfusion scores were not proven to be
predictors of the onset of MACEs (p=0.18 for SSS and p=0.20 for SDS,
respectively). Conclusion: In asymptomatic patients under hemodialysis
without known CAD, LVMD is highly predictive of the onset of MACEs at
2-year follow-up. Perfusion scores showed no predictive value. As such, a
phase analysis on gated MPS should be routinely performed in these
patients in order to yield useful prognostic information.

<13>
Accession Number
617553174
Author
Calais J.; Touati A.; Grall N.; Benali K.; Mahida B.; Hyafil F.; Iung B.;
Duval X.; LeGuludec D.; Rouzet F.
Institution
(Iung) Department of Cardiology, AP-HP Bichat University Hospital, Paris,
France
(Duval) Clinical Investigation Center, AP-HP Bichat University Hospital,
Paris, France
(Grall) Department of Microbiology, Department AP-HP Bichat, University
Hospital, Paris, France
(Calais, Touati, Benali, Mahida, Hyafil, LeGuludec, Rouzet) Department of
Nuclear Medicine, AP-HP Bichat University Hospital, Paris, France
Title
Diagnostic impact of FDG PET/CT and WBC SPECT/CT in suspicion of cardiac
electronic devices chronic infection.
Source
Journal of Nuclear Medicine. Conference: Society of Nuclear Medicine and
Molecular Imaging Annual Meeting, SNMMI 2017. United States. 58 (no
pagination), 2017. Date of Publication: May 2017.
Publisher
Society of Nuclear Medicine Inc.
Abstract
Objectives: The modified Duke score has a lower sensitivity in cardiac
implantable electronic devices (CIED) infection than in infective
endocarditis. It is particularly challenging in populations at
low/intermediate prevalence. Although the role of nuclear imaging in the
management of cardiovascular infections is acknowledged, its diagnostic
value in CIEDs infection remains debated. In the ESC guidelines, the role
of nuclear imaging is suggested in "difficult cases". Prior studies showed
good diagnostic values of both FDG PET/CT and radiolabelled WBC scan in
patients with high prevalence of the disease. The aim of the study was to
determine the respective role of both techniques in a population with
intermediate prevalence of CIEDs infection and inconclusive
echocardiography. Methods: Our institution's database has been reviewed
over a 3-year period to identify patients with a suspicion of CIEDs
infection who underwent both FDG PET/CT and radiolabelled WBC scan in a
time span of <1 month. Whole-body PET/CT was acquired 1 h after injection
of FDG. SPECT/CT acquisitions were performed 4 and 24 hours after
reinjection of 99mTc-HMPAO labelled WBC, included planar and SPECT/CT. The
final diagnosis of CIEDs infection was based on the on the pathological
and clinical modified Duke-Li criteria after 3-month follow-up (rated as:
definite, possible or rejected) with the following additional criteria for
device infection: clinically patent pocket infection and positive culture
of the extracted material as major criteria; presence of multiple
pulmonary emboli on CT as a minor criterion. The readers of PET/CT and WBC
scan were blinded to the results of the other technique and to the
clinical record. Each scan was rated for diagnosis of infection as
positive or negative. Semi quantitative analysis was performed using
several Semi quantitative ratios (SQR). Results: 48 consecutive patients
were included (age 70+/-11 years; female: 50%; prosthetic heart valve:
60%; Staphylococcus: 38 %). The delay between CIED implantation and
imaging was 79+/-86 months for both modalities. Thirty-two (67%) patients
were receiving antibiotic therapy at the time of imaging, for a mean
duration of 7+/-12 weeks. The final diagnosis of CIED infection was:
definite in 31%, possible in 23% and rejected in 46%. The diagnostic
sensitivity, specificity, VPN, VPP and accuracy of FDG PET/CT were
respectively: 80 %, 91%, 86%, 87%, 86%, of combined Duke-Li classification
and FDG PET/CT: 100%, 59%, 75%, 100%, 76%, of FDG PET/CT in Patients with
Possible CIED infection: 100%, 86%, 83%, 100%, 92%, of WBC SPECT/CT: 60%,
100%, 100%, 79%, 84%, of combined Duke-Li classification and WBC SPECT/CT:
93%, 64%, 82%, 100%, 76%, and of WBC SPECT/CT in Patients with Possible
CIED infection: 80%, 100%, 100%, 89%, 92%. None of the SQR were
significantly different between definite and rejected CIED infection
patients. Conclusion: This study in a population with intermediate
prevalence of chronic CIEDs infection and inconclusive echocardiography
confirmed the high sensitivity of FDG PET/CT and the high specificity of
WBC SPECT/CT for the diagnosis of chronic CIED infection although
sensitivity may have been decreased by prior antibiotherapy (from one week
duration). Nuclear imaging allowed reducing by more than a half the number
of patients with initial possible CIED infection. Combining Duke-Li
classification and nuclear imaging results improve the diagnostic
performances and accuracy.

<14>
Accession Number
613858239
Author
McQuilten Z.K.; Zatta A.J.; Andrianopoulos N.; Aoki N.; Stevenson L.;
Badami K.G.; Bird R.; Cole-Sinclair M.F.; Hurn C.; Cameron P.A.; Isbister
J.P.; Phillips L.E.; Wood E.M.
Institution
(McQuilten, Zatta, Aoki, Phillips, Wood) Transfusion Research Unit, Monash
University, Melbourne, Australia
(McQuilten, Zatta) Australian and New Zealand Intensive Care Research
Centre (ANZIC-RC), Monash University, Melbourne, Australia
(Andrianopoulos, Cameron) Department of Epidemiology and Preventive
Medicine, Monash University, Melbourne, Australia
(Stevenson) Barwon Health, University Hospital Geelong, Geelong, Australia
(Badami) New Zealand Blood Service, Christchurch, New Zealand
(Bird) Princess Alexandra Hospital, Brisbane, QLD, Australia
(Bird) School of Medicine, Griffith University, Brisbane, Australia
(Cole-Sinclair) Department of Haematology, St Vincent's Hospital,
Melbourne, Australia
(Isbister) Royal North Shore Hospital, The University of Sydney, Sydney,
Australia
(Hurn) School of Medicine, University of Queensland, Brisbane, Australia
Title
Evaluation of clinical coding data to determine causes of critical
bleeding in patients receiving massive transfusion: a bi-national,
multicentre, cross-sectional study.
Source
Transfusion Medicine. 27 (2) (pp 114-121), 2017. Date of Publication: 01
Apr 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Objectives: To evaluate the use of routinely collected data to determine
the cause(s) of critical bleeding in patients who receive massive
transfusion (MT). Background: Routinely collected data are increasingly
being used to describe and evaluate transfusion practice.
Materials/methods: Chart reviews were undertaken on 10 randomly selected
MT patients at 48 hospitals across Australia and New Zealand to determine
the cause(s) of critical bleeding. Diagnosis-related group (DRG) and
International Classification of Diseases (ICD) codes were extracted
separately and used to assign each patient a cause of critical bleeding.
These were compared against chart review using percentage agreement and
kappa statistics. Results: A total of 427 MT patients were included with
complete ICD and DRG data for 427 (100%) and 396 (93%), respectively. Good
overall agreement was found between chart review and ICD codes (78.3%;
kappa = 0.74, 95% CI 0.70-0.79) and only fair overall agreement with DRG
(51%; kappa = 0.45, 95% CI 0.40-0.50). Both ICD and DRG were sensitive and
accurate for classifying obstetric haemorrhage patients (98% sensitivity
and kappa > 0.94). However, compared with the ICD algorithm, DRGs were
less sensitive and accurate in classifying bleeding as a result of
gastrointestinal haemorrhage (74% vs 8%; kappa = 0.75 vs 0.1), trauma (92%
vs 62%; kappa = 0.78 vs 0.67), cardiac (80% vs 57%; kappa = 0.79 vs 0.60)
and vascular surgery (64% vs 56%; kappa = 0.69 vs 0.65). Conclusion:
Algorithms using ICD codes can determine the cause of critical bleeding in
patients requiring MT with good to excellent agreement with clinical
history. DRG are less suitable to determine critical bleeding
causes.<br/>Copyright &#xa9; 2016 British Blood Transfusion Society

<15>
Accession Number
615579832
Author
Kirmani B.H.; Jones S.G.; Malaisrie S.C.; Chung D.A.; Williams R.J.N.N.
Institution
(Kirmani, Jones, Chung, Williams) Liverpool Heart and Chest Hospital,
Cardiothoracic Surgery, Thomas Drive, Liverpool, Merseyside L14 3PE,
United Kingdom
(Malaisrie) Northwestern University, Division of Cardiac Surgery, 201 E.
Huron Street, Galter 11-140, Chicago, IL 60611, United States
Title
Limited versus full sternotomy for aortic valve replacement.
Source
Cochrane Database of Systematic Reviews. 2017 (4) (no pagination), 2017.
Article Number: CD011793. Date of Publication: 10 Apr 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Aortic valve disease is a common condition that is easily
treatable with cardiac surgery. This is conventionally performed by
opening the sternum longitudinally down the centre ("median sternotomy")
and replacing the valve under cardiopulmonary bypass. Median sternotomy is
generally well tolerated, but as less invasive options have become
available, the efficacy of limited incisions has been called into
question. In particular, the effects of reducing the visibility and
surgical access has raised safety concerns with regards to the placement
of cannulae, venting of the heart, epicardial wire placement, and
de-airing of the heart at the end of the procedure. These difficulties may
increase operating times, affecting outcome. The benefits of smaller
incisions are thought to include decreased pain; improved respiratory
mechanics; reductions in wound infections, bleeding, and need for
transfusion; shorter intensive care stay; better cosmesis; and a quicker
return to normal activity. Objectives: To assess the effects of minimally
invasive aortic valve replacement via a limited sternotomy versus
conventional aortic valve replacement via median sternotomy in people with
aortic valve disease requiring surgical replacement. Search methods: We
performed searches of CENTRAL, MEDLINE, Embase, clinical trials
registries, and manufacturers' websites from inception to July 2016, with
no language limitations. We reviewed references of identified papers to
identify any further studies of relevance. Selection criteria: Randomised
controlled trials comparing aortic valve replacement via a median
sternotomy versus aortic valve replacement via a limited sternotomy. We
excluded trials that performed other minimally invasive incisions such as
mini-thoracotomies, port access, trans-apical, trans-femoral or robotic
procedures. Although some well-conducted prospective and retrospective
case-control and cohort studies exist, these were not included in this
review. Data collection and analysis: Two review authors independently
assessed trial papers to extract data, assess quality, and identify risk
of bias. A third review author provided arbitration where required. The
quality of evidence was determined using the GRADE methodology and results
of patient-relevant outcomes were summarised in a 'Summary of findings'
table. Main results: The review included seven trials with 511
participants. These included adults from centres in Austria, Spain, Italy,
Germany, France, and Egypt. We performed 12 comparisons investigating the
effects of minimally invasive limited upper hemi-sternotomy on aortic
valve replacement as compared to surgery performed via full median
sternotomy. There was no evidence of any effect of upper hemi-sternotomy
on mortality versus full median sternotomy (risk ratio (RR) 1.01, 95%
confidence interval (CI) 0.36 to 2.82; participants = 511; studies = 7;
moderate quality). There was no evidence of an increase in cardiopulmonary
bypass time with aortic valve replacement performed via an upper
hemi-sternotomy (mean difference (MD) 3.02 minutes, 95% CI -4.10 to 10.14;
participants = 311; studies = 5; low quality). There was no evidence of an
increase in aortic cross-clamp time (MD 0.95 minutes, 95% CI -3.45 to
5.35; participants = 391; studies = 6; low quality). None of the included
studies reported major adverse cardiac and cerebrovascular events as a
composite end point. There was no evidence of an effect on length of
hospital stay through limited hemi-sternotomy (MD -1.31 days, 95% CI -2.63
to 0.01; participants = 297; studies = 5; I² = 89%; very low
quality). Postoperative blood loss was lower in the upper hemi-sternotomy
group (MD -158.00 mL, 95% CI -303.24 to -12.76; participants = 297;
studies = 5; moderate quality). The evidence did not support a reduction
in deep sternal wound infections (RR 0.71, 95% CI 0.22 to 2.30;
participants = 511; studies = 7; moderate quality) or re-exploration (RR
1.01, 95% CI 0.48 to 2.13; participants = 511; studies = 7; moderate
quality). There was no change in pain scores by upper hemi-sternotomy
(standardised mean difference (SMD) -0.33, 95% CI -0.85 to 0.20;
participants = 197; studies = 3; I² = 70%; very low quality),
but there was a small increase in postoperative pulmonary function tests
with minimally invasive limited sternotomy (MD 1.98 % predicted FEV1, 95%
CI 0.62 to 3.33; participants = 257; studies = 4; I² = 28%; low
quality). There was a small reduction in length of intensive care unit
stays as a result of the minimally invasive upper hemi-sternotomy (MD
-0.57 days, 95% CI -0.93 to -0.20; participants = 297; studies = 5; low
quality). Postoperative atrial fibrillation was not reduced with minimally
invasive aortic valve replacement through limited compared to full
sternotomy (RR 0.60, 95% CI 0.07 to 4.89; participants = 240; studies = 3;
moderate quality), neither were postoperative ventilation times (MD -1.12
hours, 95% CI -3.43 to 1.19; participants = 297; studies = 5; low
quality). None of the included studies reported cost analyses. Authors'
conclusions: The evidence in this review was assessed as generally low to
moderate quality. The study sample sizes were small and underpowered to
demonstrate differences in outcomes with low event rates. Clinical
heterogeneity both between and within studies is a relatively fixed
feature of surgical trials, and this also contributed to the need for
caution in interpreting results. Considering these limitations, there was
uncertainty of the effect on mortality or extracorporeal support times
with upper hemi-sternotomy for aortic valve replacement compared to full
median sternotomy. The evidence to support a reduction in total hospital
length of stay or intensive care stay was low in quality. There was also
uncertainty of any difference in the rates of other, secondary outcome
measures or adverse events with minimally invasive limited sternotomy
approaches to aortic valve replacement. There appears to be uncertainty
between minimally invasive aortic valve replacement via upper
hemi-sternotomy and conventional aortic valve replacement via a full
median sternotomy. Before widespread adoption of the minimally invasive
approach can be recommended, there is a need for a well-designed and
adequately powered prospective randomised controlled trial. Such a study
would benefit from performing a robust cost analysis. Growing patient
preference for minimally invasive techniques merits thorough
quality-of-life analyses to be included as end points, as well as
quantitative measures of physiological reserve.<br/>Copyright &#xa9; 2017
The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

<16>
Accession Number
615706060
Author
Richards S.H.; Anderson L.; Jenkinson C.E.; Whalley B.; Rees K.; Davies
P.; Bennett P.; Liu Z.; West R.; Thompson D.R.; Taylor R.S.
Institution
(Richards) University of Leeds, Leeds Institute of Health Sciences,
Charles Thackrah Building, 101 Clarendon Road, Leeds LS2 9LJ, United
Kingdom
(Richards, Jenkinson) University of Exeter Medical School, Primary Care,
St Luke's Campus, Magdalen Road, Exeter, Devon EX1 2LU, United Kingdom
(Anderson, Taylor) University of Exeter Medical School, Institute of
Health Research, Veysey Building, Salmon Pool Lane, Exeter EX2 4SG, United
Kingdom
(Whalley) University of Plymouth, School of Psychology, Plymouth, United
Kingdom
(Rees) Warwick Medical School, University of Warwick, Division of Health
Sciences, Coventry CV4 7AL, United Kingdom
(Davies) University of Bristol, School of Social and Community Medicine,
Canynge Hall, Bristol BS8 2PS, United Kingdom
(Bennett) University of Swansea, Department of Psychology, Singleton Park,
Swansea SA2 8PP, United Kingdom
(Liu) University of Birmingham, Institute of Applied Health Research,
College of Medical and Dental Sciences, Birmingham, United Kingdom
(West) Wales Heart Research Institute, Cardiff University, Heath Park,
Cardiff CF14 4XN, United Kingdom
(Thompson) University of Melbourne, Department of Psychiatry, St Vincent's
Hospital, Melbourne, VIC 3000, Australia
Title
Psychological interventions for coronary heart disease.
Source
Cochrane Database of Systematic Reviews. 2017 (4) (no pagination), 2017.
Article Number: CD002902. Date of Publication: 28 Apr 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Coronary heart disease (CHD) is the most common cause of death
globally, although mortality rates are falling. Psychological symptoms are
prevalent for people with CHD, and many psychological treatments are
offered following cardiac events or procedures with the aim of improving
health and outcomes. This is an update of a Cochrane systematic review
previously published in 2011. Objectives: To assess the effectiveness of
psychological interventions (alone or with cardiac rehabilitation)
compared with usual care (including cardiac rehabilitation where
available) for people with CHD on total mortality and cardiac mortality;
cardiac morbidity; and participant-reported psychological outcomes of
levels of depression, anxiety, and stress; and to explore potential
study-level predictors of the effectiveness of psychological interventions
in this population. Search methods: We updated the previous Cochrane
Review searches by searching the following databases on 27 April 2016:
CENTRAL in the Cochrane Library, MEDLINE (Ovid), Embase (Ovid), PsycINFO
(Ovid), and CINAHL (EBSCO). Selection criteria: We included randomised
controlled trials (RCTs) of psychological interventions compared to usual
care, administered by trained staff, and delivered to adults with a
specific diagnosis of CHD. We selected only studies estimating the
independent effect of the psychological component, and with a minimum
follow-up of six months. The study population comprised of adults after: a
myocardial infarction (MI), a revascularisation procedure (coronary artery
bypass graft (CABG) or percutaneous coronary intervention (PCI)), and
adults with angina or angiographically defined coronary artery disease
(CAD). RCTs had to report at least one of the following outcomes:
mortality (total- or cardiac-related); cardiac morbidity (MI,
revascularisation procedures); or participant-reported levels of
depression, anxiety, or stress. Data collection and analysis: Two review
authors independently screened titles and abstracts of all references for
eligibility. A lead review author extracted study data, which a second
review author checked. We contacted study authors to obtain missing
information. Main results: This review included 35 studies which
randomised 10,703 people with CHD (14 trials and 2577 participants added
to this update). The population included mainly men (median 77.0%) and
people post-MI (mean 65.7%) or after undergoing a revascularisation
procedure (mean 27.4%). The mean age of participants within trials ranged
from 53 to 67 years. Overall trial reporting was poor, with around a half
omitting descriptions of randomisation sequence generation, allocation
concealment procedures, or the blinding of outcome assessments. The length
of follow-up ranged from six months to 10.7 years (median 12 months). Most
studies (23/35) evaluated multifactorial interventions, which included
therapies with multiple therapeutic components. Ten studies examined
psychological interventions targeted at people with a confirmed
psychopathology at baseline and two trials recruited people with a
psychopathology or another selecting criterion (or both). Of the remaining
23 trials, nine studies recruited unselected participants from cardiac
populations reporting some level of psychopathology (3.8% to 53% with
depressive symptoms, 32% to 53% with anxiety), 10 studies did not report
these characteristics, and only three studies excluded people with
psychopathology. Moderate quality evidence showed no risk reduction for
total mortality (risk ratio (RR) 0.90, 95% confidence interval (CI) 0.77
to 1.05; participants = 7776; studies = 23) or revascularisation
procedures (RR 0.94, 95% CI 0.81 to 1.11) with psychological therapies
compared to usual care. Low quality evidence found no risk reduction for
non-fatal MI (RR 0.82, 95% CI 0.64 to 1.05), although there was a 21%
reduction in cardiac mortality (RR 0.79, 95% CI 0.63 to 0.98). There was
also low or very low quality evidence that psychological interventions
improved participant-reported levels of depressive symptoms (standardised
mean difference (SMD) -0.27, 95% CI -0.39 to -0.15; GRADE = low), anxiety
(SMD -0.24, 95% CI -0.38 to -0.09; GRADE = low), and stress (SMD -0.56,
95% CI -0.88 to -0.24; GRADE = very low). There was substantial
statistical heterogeneity for all psychological outcomes but not clinical
outcomes, and there was evidence of small-study bias for one clinical
outcome (cardiac mortality: Egger test P = 0.04) and one psychological
outcome (anxiety: Egger test P = 0.012). Meta-regression exploring a
limited number of intervention characteristics found no significant
predictors of intervention effects for total mortality and cardiac
mortality. For depression, psychological interventions combined with
adjunct pharmacology (where deemed appropriate) for an underlying
psychological disorder appeared to be more effective than interventions
that did not (beta = -0.51, P = 0.003). For anxiety, interventions
recruiting participants with an underlying psychological disorder appeared
more effective than those delivered to unselected populations (beta =
-0.28, P = 0.03). Authors' conclusions: This updated Cochrane Review found
that for people with CHD, there was no evidence that psychological
treatments had an effect on total mortality, the risk of revascularisation
procedures, or on the rate of non-fatal MI, although the rate of cardiac
mortality was reduced and psychological symptoms (depression, anxiety, or
stress) were alleviated; however, the GRADE assessments suggest
considerable uncertainty surrounding these effects. Considerable
uncertainty also remains regarding the people who would benefit most from
treatment (i.e. people with or without psychological disorders at
baseline) and the specific components of successful interventions. Future
large-scale trials testing the effectiveness of psychological therapies
are required due to the uncertainty within the evidence. Future trials
would benefit from testing the impact of specific (rather than
multifactorial) psychological interventions for participants with CHD, and
testing the targeting of interventions on different populations (i.e.
people with CHD, with or without psychopathologies).<br/>Copyright &#xa9;
2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

<17>
Accession Number
615207343
Author
Anderson L.; Nguyen T.T.; Dall C.H.; Burgess L.; Bridges C.; Taylor R.S.
Institution
(Anderson, Nguyen, Taylor) University of Exeter Medical School, Institute
of Health Research, Veysey Building, Salmon Pool Lane, Exeter EX2 4SG,
United Kingdom
(Dall) Bispebjerg Hospital, University of Copenhagen, Dept. of Cardiology,
Dept. of Physical Therapy and IOC Sports Institute Copenhagen, Bispebjerg
Bakke 23, Copenhagen, Denmark
(Burgess) Wythenshawe Hospital, University Hospital of South Manchester
NHS Foundation Trust, Cardiac Rehabilitation, Manchester, United Kingdom
(Bridges) University College London, Farr Institute of Health Informatics
Research, 222 Euston Road, London NW1 2DA, United Kingdom
Title
Exercise-based cardiac rehabilitation in heart transplant recipients.
Source
Cochrane Database of Systematic Reviews. 2017 (4) (no pagination), 2017.
Article Number: CD012264. Date of Publication: 04 Apr 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Heart transplantation is considered to be the gold standard
treatment for selected patients with end-stage heart disease when medical
therapy has been unable to halt progression of the underlying pathology.
Evidence suggests that aerobic exercise training may be effective in
reversing the pathophysiological consequences associated with cardiac
denervation and prevent immunosuppression-induced adverse effects in heart
transplant recipients. Objectives: To determine the effectiveness and
safety of exercise-based rehabilitation on the mortality, hospital
admissions, adverse events, exercise capacity, health-related quality of
life, return to work and costs for people after heart transplantation.
Search methods: We searched the Cochrane Central Register of Controlled
Trials (CENTRAL) in the Cochrane Library, MEDLINE (Ovid), Embase (Ovid),
CINAHL (EBSCO) and Web of Science Core Collection (Thomson Reuters) to
June 2016. We also searched two clinical trials registers and handsearched
the reference lists of included studies. Selection criteria: We included
randomised controlled trials (RCTs) of parallel group, cross-over or
cluster design, which compared exercise-based interventions with (i) no
exercise control (ii) a different dose of exercise training (e.g. low-
versus high-intensity exercise training); or (iii) an active intervention
(i.e. education, psychological intervention). The study population
comprised adults aged 18 years or over who had received a heart
transplant. Data collection and analysis: Two review authors independently
screened all identified references for inclusion based on pre-specified
inclusion criteria. Disagreements were resolved by consensus or by
involving a third person. Two review authors extracted outcome data from
the included trials and assessed their risk of bias. One review author
extracted study characteristics from included studies and a second author
checked them against the trial report for accuracy. Main results: We
included 10 RCTs that involved a total of 300 participants whose mean age
was 54.4 years. Women accounted for fewer than 25% of all study
participants. Nine trials which randomised 284 participants to receive
exercise-based rehabilitation (151 participants) or no exercise (133
participants) were included in the main analysis. One cross-over RCT
compared high-intensity interval training with continued
moderate-intensity training in 16 participants. We reported findings for
all trials at their longest follow-up (median 12 weeks). Exercise-based
cardiac rehabilitation increased exercise capacity (VO<inf>2peak</inf>)
compared with no exercise control (MD 2.49 mL/kg/min, 95% CI 1.63 to 3.36;
N = 284; studies = 9; moderate quality evidence). There was evidence from
one trial that high-intensity interval exercise training was more
effective in improving exercise capacity than continuous
moderate-intensity exercise (MD 2.30 mL/kg/min, 95% CI 0.59 to 4.01; N =
16; 1 study). Four studies reported health-related quality of life (HRQoL)
measured using SF-36, Profile of Quality of Life in the Chronically Ill
(PLC) and the World Health Organization Quality Of Life (WHOQoL) - BREF.
Due to the variation in HRQoL outcomes and methods of reporting we were
unable to meta-analyse results across studies, but there was no evidence
of a difference between exercise-based cardiac rehabilitation and control
in 18 of 21 HRQoL domains reported, or between high and moderate intensity
exercise in any of the 10 HRQoL domains reported. One adverse event was
reported by one study. Exercise-based cardiac rehabilitation improves
exercise capacity, but exercise was found to have no impact on
health-related quality of life in the short-term (median 12 weeks
follow-up), in heart transplant recipients whose health is stable. There
was no evidence of statistical heterogeneity across trials for exercise
capacity and no evidence of small study bias. The overall risk of bias in
included studies was judged as low or unclear; more than 50% of included
studies were assessed at unclear risk of bias with respect to allocation
concealment, blinding of outcome assessors and declaration of conflicts of
interest. Evidence quality was assessed as moderate according to GRADE
criteria. Authors' conclusions: We found moderate quality evidence
suggesting that exercise-based cardiac rehabilitation improves exercise
capacity, and that exercise has no impact on health-related quality of
life in the short-term (median 12 weeks follow-up), in heart transplant
recipients. Cardiac rehabilitation appears to be safe in this population,
but long-term follow-up data are incomplete and further good quality and
adequately-powered trials are needed to demonstrate the longer-term
benefits of exercise on safety and impact on both clinical and
patient-related outcomes, such as health-related quality of life, and
healthcare costs.<br/>Copyright &#xa9; 2017 The Cochrane Collaboration.
Published by John Wiley & Sons, Ltd.

<18>
Accession Number
612365074
Author
Cavalcante R.; Sotomi Y.; Zeng Y.; Lee C.W.; Ahn J.-M.; Collet C.;
Tenekecioglu E.; Suwannasom P.; Onuma Y.; Park S.-J.; Serruys P.W.
Institution
(Cavalcante, Zeng, Tenekecioglu, Suwannasom, Onuma) Erasmus University
Medical Center, Rotterdam, Netherlands
(Cavalcante) Heart Institute (InCor), University of Sao Paulo Medical
School, Sao Paulo, Brazil
(Sotomi, Collet, Suwannasom) Academic Medical Center, University of
Amsterdam, Amsterdam, Netherlands
(Lee, Ahn, Park) Heart Institute, University of Ulsan College of Medicine,
Asan Medical Center, Seoul, South Korea
(Serruys) International Center for Circulatory Health, Imperial College
London, London, United Kingdom
Title
Coronary bypass surgery versus stenting in multivessel disease involving
the proximal left anterior descending coronary artery.
Source
Heart. 103 (6) (pp 428-433), 2017. Date of Publication: 01 Mar 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective In patients with multivessel disease and proximal left anterior
descending artery (LAD) involvement, the best revascularisation strategy
is still unclear. We assess outcomes after coronary artery bypass graft
surgery (CABG) and percutaneous coronary intervention (PCI) with
drug-eluting stents in a pooled analysis of individual patient-level data
of the SYNTAX and BEST randomised trials. Design Proximal LAD involvement
was defined by any lesion >= 50% diameter stenosis in the arterial segment
starting from the left-main bifurcation up to (and including) the origin
of the first major septal branch. The primary endpoint was the composite
of all-cause death, myocardial infarction (MI) or stroke at 5 years of
follow-up. Results The present study population comprises 1166 patients of
which 577 were randomised to PCI and 589 to CABG. Baseline characteristics
were well balanced across study arms. The primary endpoint occurred in 94
(16.3%) patients in the PCI arm and in 68 (11.5%) patients in the CABG arm
(HR 1.43; 95%CI 1.05 to 1.95; p=0.026). CABG was also associated with a
significantly lower rate of cardiac death (p=0.007), MI (p<0.001),
all-cause revascularisation (p<0.001) and major adverse cardiovascular and
cerebrovascular events (all-cause death, MI, stroke, revascularisation)
(p<0.001). The rates of all-cause mortality (p=0.06) and stroke (p=0.09)
were not statistically different between the two groups. The overall study
results for the primary outcome were consistent across several subgroups.
Conclusions In patients with multivessel disease with proximal LAD
involvement, CABG is associated with lower rates of the safety composite
endpoint of death, MI or stroke as compared with PCI with drug-eluting
stents at 5 years of follow-up (number needed to treat=21).<br/>Copyright
&#xa9; Published by the BMJ Publishing Group Limited.

<19>
Accession Number
613214183
Author
Bahit M.C.; Lopes R.D.; Wojdyla D.M.; Held C.; Hanna M.; Vinereanu D.;
Hylek E.M.; Verheugt F.; Goto S.; Alexander J.H.; Wallentin L.; Granger
C.B.
Institution
(Bahit) INECO Neurociencias Orono, Rosario, Santa Fe, Argentina
(Lopes, Wojdyla, Alexander, Granger) Duke Clinical Research Institute,
Duke University School of Medicine, Durham, NC, United States
(Held, Wallentin) Uppsala Clinical Research Center, Uppsala University,
Uppsala, Sweden
(Hanna) Bristol-Myers Squibb, Princeton, NJ, United States
(Vinereanu) University of Medicine and Pharmacy Carol Davila, Bucharest,
Romania
(Hylek) Boston University Medical Center, Boston, MA, United States
(Verheugt) Heartcenter, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam,
Netherlands
(Goto) Tokai University School of Medicine, Isehara, Japan
Title
Non-major bleeding with apixaban versus warfarin in patients with atrial
fibrillation.
Source
Heart. 103 (8) (pp 623-628), 2017. Date of Publication: 01 Apr 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: non-major bleeding and clinical outcomes in patients with
atrial fibrillation (AF) receiving anticoagulation therapy enrolled in
Apixaban for Reduction in Stroke and other Thromboembolic Events in Atrial
Fibrillation (ARISTOTLE). Methods: We included patients who received >=1
dose of study drug (n=18 140). Non-major bleeding was defined as the first
bleeding event considered to be clinically relevant non-major (CRNM) or
minor bleeding, and not preceded by a major bleeding event. Results:
Non-major bleeding was three times more common than major bleeding (12.1%
vs 3.8%). Like major bleeding, non-major bleeding was less frequent with
apixaban (6.4 per 100 patient-years) than warfarin (9.4 per 100
patient-years) (adjusted HR 0.69, 95% CI 0.63 to 0.75). The most frequent
sites of non-major bleeding were haematuria (16.4%), epistaxis (14.8%),
gastrointestinal (13.3%), haematoma (11.5%) and bruising/ecchymosis
(10.1%). Medical or surgical intervention was similar among patients with
non-major bleeding on warfarin versus apixaban (24.7% vs 24.5%). A change
in antithrombotic therapy (58.6% vs 50.0%) and permanent study drug
discontinuation (5.1% (61) vs 3.6% (30), p=0.10) was numerically higher
with warfarin than apixaban. CRNM bleeding was independently associated
with an increased risk of overall death (adjusted HR 1.70, 95% CI 1.32 to
2.18) and subsequent major bleeding (adjusted HR 2.18, 95% CI 1.56 to
3.04). Conclusions: In ARISTOTLE, non-major bleeding was common and
substantially less frequent with apixaban than with warfarin. CRNM
bleeding was independently associated with a higher risk of death and
subsequent major bleeding. Our results highlight the importance of any
severity of bleeding in patients with AF treated with anticoagulation
therapy and suggest that non-major bleeding, including minor bleeding,
might not be minor. Trial registration number: NCT00412984;
post-results.<br/>Copyright &#xa9; 2017, BMJ Publishing Group. All rights
reserved.

<20>
Accession Number
614485541
Author
Chang Y.-S.; Wang J.-X.; Chang D.-W.
Institution
(Chang) Department of Cardiovascular Surgery, The First Affiliated
Hospital of Xi'an Jiaotong University, Xi'an, China
(Wang) Department of Surgery, The First Affiliated Hospital of Zhengzhou
University, Zhengzhou, China
(Chang) Faculty of Mathematics and Information Science, Shaanxi Normal
University, Xi'an, China
Title
Outcomes of Coronary Artery Bypass and Stents for Unprotected Left Main
Coronary Stenosis.
Source
Annals of Thoracic Surgery. 104 (2) (pp 630-637), 2017. Date of
Publication: August 2017.
Publisher
Elsevier USA
Abstract
Background This study assessed the short-, medium-, and long-term outcomes
of coronary artery bypass grafting vs stenting for patients with
unprotected left main coronary artery disease through a meta-analysis of
randomized controlled trials. Methods PubMed, Embase, Scopus, Web of
Science, Cochrane Library, and major conference proceedings databases were
systematically searched for randomized controlled trials of coronary
artery bypass grafting compared with stents in unprotected left main
coronary artery disease. End points assessed were all-cause death,
myocardial infarction, major adverse cardiac and cerebrovascular events,
target vessel revascularization, and cerebral stroke. A meta-analysis was
conducted according to predefined clinical end points. Results All-cause
death and stroke were similar between stenting and coronary artery bypass
grafting at 1 year and at follow-up beyond 1 year. The incidence of
myocardial infarction was similar between stenting and coronary artery
bypass grafting at each separate time point. The incidence of repeat
revascularization was similar between the two groups at 30 days but was
higher for stenting at 1 year and beyond. There was a trend toward fewer
major adverse cardiac and cerebrovascular events after stenting compared
with coronary artery bypass grafting at 30 days, but this difference was
no longer significant at 1 year and reversed at follow-up beyond 1 year.
Conclusions The early advantages of stenting over coronary artery bypass
grafting have been shown to progressively shift to coronary artery bypass
grafting over time. Further larger sample randomized controlled trials are
warranted to confirm the results.<br/>Copyright &#xa9; 2017 The Society of
Thoracic Surgeons

<21>
Accession Number
617475673
Author
Barnwal N.K.; Umbarkar S.R.; Sarkar M.; Dias R.
Institution
(Barnwal, Umbarkar, Sarkar) Department of Cardiac Anesthesiology, Seth GS
Medical College and KEM Hospital, 2/7, Stone Building, B. J. Marg,
Byculla, Mumbai, Maharashtra 400 011, India
(Dias) Department of Pediatric Anesthesiology, Seth GS Medical College and
KEM Hospital, Mumbai, Maharashtra, India
Title
Randomized comparative study of intravenous infusion of three different
fixed doses of milrinone in pediatric patients with pulmonary hypertension
undergoing open heart surgery.
Source
Annals of Cardiac Anaesthesia. 20 (3) (pp 318-322), 2017. Date of
Publication: July-September 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: Pulmonary hypertension secondary to congenital heart disease
is a common problem in pediatric patients presenting for open heart
surgery. Milrinone has been shown to reduce pulmonary vascular resistance
and pulmonary artery pressure in pediatric patients and neonates
postcardiac surgery. We aimed to evaluate the postoperative outcome in
such patients with three different fixed maintenance doses of milrinone.
Methodology: Patients were randomized into three groups. All patients
received fixed bolus dose of milrinone 50 mug/kg on pump during rewarming.
Following this, patients in low-dose group received infusion of milrinone
at the rate of 0.375 mug/kg/min, medium-dose group received 0.5
mug/kg/min, and high-dose group received 0.75 mug/kg/min over 24 h. Heart
rate, mean arterial pressure (MAP), mean airway pressure (MaP),
oxygenation index (OI), and central venous pressure (CVP) were compared at
baseline and 24 h postoperatively. Dose of inotropic requirement, duration
of ventilatory support and Intensive Care Unit (ICU) stay were noted.
Results: MAP, MaP, OI, and CVP were comparable in all three groups
postoperatively. All patients in the low-dose group required low inotropic
support while 70% of patients in the high-dose group needed high inotropic
support to manage episodes of hypotension (P = 0.000). Duration of
ventilatory support and ICU stay in all three groups was comparable (P =
0.412, P = 0.165). Conclusion: Low-dose infusions while having a clinical
impact were more beneficial in avoiding adverse events and decreasing
inotropic requirement without affecting duration of ventilatory support
and duration of ICU stay.<br/>Copyright &#xa9; 2017 Annals of Cardiac
Anaesthesia Published by Wolters Kluwer - Medknow.

<22>
Accession Number
617475668
Author
Soliman R.; Mofeed M.; Momenah T.
Institution
(Soliman) Department of Cardiac Anesthesia, Prince Sultan Cardiac Centre,
Riyadh, Saudi Arabia
(Soliman) Department of Anesthesia, Faculty of Medicine, Cairo University,
Egypt
(Mofeed) Department of Cardiology, Madinah Cardiac Center, Al Madinah Al
Monourah, Saudi Arabia
(Mofeed) Department of Pediatric Cardiology, Sohag University, Egypt
(Momenah) Department of Pediatric Cardiology, Prince Sultan Cardiac
Centre, Riyadh, Saudi Arabia
Title
Propofol versus Ketofol for Sedation of Pediatric Patients Undergoing
Transcatheter Pulmonary Valve Implantation: A Double-blind Randomized
Study.
Source
Annals of Cardiac Anaesthesia. 20 (3) (pp 313-317), 2017. Date of
Publication: July-September 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objective: The study was done to compare propofol and ketofol for sedation
of pediatric patients scheduled for elective pulmonary valve implantation
in a catheterization laboratory. Design: This was a double-blind
randomized study. Setting: This study was conducted in Prince Sultan
Cardiac Centre, Saudi Arabia. Patients and Methods: The study included 60
pediatric patients with pulmonary regurge undergoing pulmonary valve
implantation. Intervention: The study included sixty patients, classified
into two groups (n = 30). Group A: Propofol was administered as a bolus
dose (1-2 mg/kg) and then a continuous infusion of 50-100 mug/kg/min
titrated as needed. Group B: Ketofol was administered 1-2 mg/kg and then
infusion of 20-60 mug/kg/min. The medication was prepared by the nursing
staff and given to anesthetist blindly. Measurements: The monitors
included heart rate, mean arterial blood pressure, respiratory rate,
temperature, SPO<inf>2</inf>and PaCO<inf>2</inf>, Michigan Sedation Score,
fentanyl dose, antiemetic medications, and Aldrete score. Main Results:
The comparison of heart rate, mean arterial pressure, respiratory rate,
temperature, SPO<inf>2</inf>and PaCO<inf>2</inf>, Michigan Sedation Score,
and Aldrete score were insignificant (P > 0.05). The total fentanyl
increased in Group A more than Group B (P = 0.045). The required
antiemetic drugs increased in Group A patients more than Group B (P =
0.020). The durations of full recovery and in the postanesthesia care unit
were longer in Group A than Group B (P = 0.013, P < 0.001, respectively).
Conclusion: The use of propofol and ketofol is safe and effective for
sedation of pediatric patients undergoing pulmonary valve implantation in
a catheterization laboratory. However, ketofol has many advantages more
than the propofol. Ketofol has a rapid onset of sedation, a rapid recovery
time, decreased incidence of nausea and vomiting and leads to rapid
discharge of patients from the postanesthesia care unit.<br/>Copyright
&#xa9; 2017 Annals of Cardiac Anaesthesia Published by Wolters Kluwer -
Medknow.

<23>
Accession Number
617475655
Author
Kanchi M.; Manjunath R.; Massen J.; Vincent L.; Belani K.
Institution
(Kanchi) Department of Anesthesia and Intensive Care, Narayana Hrudayalaya
Hospital, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bengaluru,
Karnataka, India
(Manjunath) Department of Anesthesia, Narayana Hrudayalaya Hospital,
Bengaluru, Karnataka, India
(Massen) Department of Cardiothoracic Surgery, Maastricht University
Medical Center, Maastricht, Netherlands
(Vincent) Department of Nephrology, Narayana Hrudayalaya Hospital,
Bengaluru, Karnataka, India
(Belani) Department of Anesthesiology, Medicine and Pediatrics, University
of Minnesota, Minneapolis, MN, United States
Title
Neutrophil gelatinase-associated lipocalin as a biomarker for predicting
acute kidney injury during off-pump coronary artery bypass grafting.
Source
Annals of Cardiac Anaesthesia. 20 (3) (pp 297-302), 2017. Date of
Publication: July-September 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: Acute kidney injury (AKI) following cardiac surgery is a major
complication resulting in increased morbidity, mortality, and economic
burden. In this study, we assessed the usefulness of estimating serum
neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker in
predicting AKI in patients with stable chronic kidney disease (CKD) and
undergoing off-pump coronary artery bypass grafting (OP-CABG). Patients
and Methods: We prospectively studied sixty nondialysis-dependent CKD
patients with estimated glomerular filtration rate <60 ml/min/1.73
m² who required elective OP-CABG. Patients were randomized into
two groups, Group D received dopamine infusion at 2 mug/kg/min following
anesthesia induction till the end of the surgery and Group P did not
receive any intervention. Serum creatinine, NGAL, brain natriuretic
peptide, and troponin-I were estimated at specified intervals before,
during, and after surgery. The results of the study patients were also
compared to a simultaneous matched cohort control of thirty patients
(Group A) without renal dysfunction who underwent OP-CABG. Results: No
patient required renal replacement therapy, and no mortality was observed
during perioperative and hospitalization period. Six patients from control
group (n = 30), ten patients from placebo group (n = 30), and 12 patients
from dopamine group (n = 30) developed stage 1 AKI. However, we did not
observe any stage 2 and stage 3 AKI among all the groups. There was a
significant increase in serum NGAL levels at the end of surgery and 24 h
postoperatively in placebo and dopamine groups as compared to the control.
Conclusion: The measurement of NGAL appears to predict the occurrence of
AKI after OP-CAB surgery. However, large multicentric studies may be
required to confirm the findings of this study.<br/>Copyright &#xa9; 2017
Annals of Cardiac Anaesthesia Published by Wolters Kluwer - Medknow.

<24>
Accession Number
617429741
Author
Yin Y.; Lv L.; Wang W.
Institution
(Yin, Lv, Wang) Department of Geriatric Cardiology, Nanjing Jinling
Hospital, Nanjing, Jiangsu, China
Title
Impact of different dose and duration of clopidogrel on the postoperative
efficacy of drug-eluting stent implantation in patients with coronary
heart disease and diabetic mellitus.
Source
International Journal of Clinical and Experimental Medicine. 10 (7) (pp
10704-10710), 2017. Article Number: IJCEM0055718. Date of Publication: 30
Jul 2017.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Objective: To study the effect of different dose and duration of
clopidogrel on the efficacy of drug-eluting stent (DES) implantation in
coronary heart disease patients complicated with diabetes mellitus.
Methods: A total of 345 coronary heart disease patients admitted to our
hospital from January 2014 to December 2016 were included in this study
and randomly divided into the normal treatment group, double dose group
and double courses group. Patients in the normal treatment group were
given 300 mg clopidogrel 2 hours before operation and 75 mg per day
postoperatively for 1 year; patients in the double dose group were given
600 mg clopidogrel 2 hours before operation and 150 mg per day
postoperatively for 1 year; patients in the double courses group were
given 300 mg clopidogrel for 2 hours before operation and 75 mg per day
postoperatively for 2 years. The clinical data and 2-year major cardiac
adverse events (MACEs), 1-year vascular restenosis rate and the rate of
platelet aggregation inhibition and adverse effect after the surgery were
compared and analyzed in patients of each group. Results: Compared with
the normal treatment group, the double courses group and double dose group
showed significantly reduction in the 2-year MACEs of the subjects after
DES implantation (P=0.005, P=0.008). Besides, the double dose clopidogrel
could obviously increase postoperative platelet aggregation inhibition
rate (P=0.013) and decrease the 1-year postoperative vascular restenosis
rate (P=0.007), which showed no apparent change when applied clopidogrel
for two courses (P=0.524, P=0.479). There was no statistically significant
difference in the incidence of 2-year MACEs between the two clopidogrel
treatment groups (P=0.137), but the difference was statistically
significant in the inhibition of platelet aggregation (P=0.015) and the
1-year vascular restenosis rate after operation (P=0.004). Meanwhile, the
basic clinical data, the relevant characteristics of stent implantation
and adverse effect between the three groups presented no statistically
significant difference. Conclusion: The long-term use of clopidogrel after
DES implantation is effective and safe. It can achieve a better long-term
result by increasing the dosage and course appropriately.<br/>Copyright
&#xa9; 2017, E-Century Publishing Corporation. All rights reserved.

<25>
[Use Link to view the full text]
Accession Number
617535199
Author
Park C.; Kim J.Y.; Kim C.; Chang C.H.
Institution
(Park, Kim, Kim, Chang) Department of Anesthesiology and Pain Medicine and
Anesthesia, Pain Research Institute, Gangnam Severance Hospital, Yonsei
University, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, South Korea
Title
Nicardipine Effects on Renal Function during Spine Surgery.
Source
Clinical Spine Surgery. 30 (7) (pp E954-E958), 2017. Date of Publication:
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Study Design: Single-center, prospective, randomized, and single-blinded
clinical trial was conducted in patients (n=64) undergoing anterior or
posterior spinal interbody fusion. Objective: To investigate the renal
protective effect of nicardipine during deliberate hypotension for spine
surgery by measuring creatinine clearance (Ccr), serum cystatin C, urine
output, and fractional excretion of sodium (FE Na). Summary of Background
Data: Deliberate hypotension during spine surgery may result in ischemic
tissue damage of the kidney. Nicardipine is reported to dilate the renal
artery and increase glomerular filtration rate. Previous studies reported
the renal protective effect of nicardipine during cardiac surgery under
cardiopulmonary bypass and robot-assisted laparoscopic surgery. Materials
and Methods: Patients were randomized to receive nicardipine (nicardipine
group, n=32) or normal saline (control group, n=32). Deliberate
hypotension of mean arterial pressure at 50-65 mm Hg was maintained during
surgery. Ccr, serum cystatin C, urine output, and FE Na were measured
before surgery, after surgery, and postoperative day 1 (POD1). The RIFLE
(risk, injury, failure, loss, and end stage renal disease) criteria of the
patients were evaluated. Results: In the nicardipine group, Ccr at POD1
was increased compared with that after surgery. In both groups, serum
cystatin C at POD1 was decreased compared with that before surgery and
urine output at POD1 was decreased compared with that after surgery. FE Na
at POD1 in the control group was higher than that in the nicardipine group
and was increased compared with that after surgery. Using RIFLE criteria,
6 patients in the control group and 2 patients in the nicardipine group
were classified as having acute kidney injury. Conclusions: Nicardipine
increased Ccr and attenuated the increase in FE Na at POD1 in patients
undergoing spine surgery under deliberate hypotension.<br/>Copyright
&#xa9; 2016 Wolters Kluwer Health, Inc.

<26>
Accession Number
617521944
Author
Hayashida K.; Yasuda S.; Matsumoto T.; Amaki M.; Mizuno S.; Tobaru T.;
Jujo K.; Ootomo T.; Yamaguchi J.; Fukuda K.; Saito S.; Foster E.; Qasim
A.; Kitakaze M.; Yozu R.; Takayama M.
Institution
(Hayashida, Fukuda, Yozu) Keio University School of Medicine, Tokyo, Japan
(Yasuda, Amaki, Kitakaze) National Cerebral and Cardiovascular Center,
Suita, Japan
(Matsumoto, Ootomo) Sendai Kousei Hospital, Sendai, Japan
(Mizuno, Saito) Shonan Kamakura General Hospital, Kanagawa, Japan
(Tobaru, Takayama) Sakakibara Heart Institute, Tokyo, Japan
(Jujo, Yamaguchi) Tokyo Women's Medical University Hospital, Tokyo, Japan
(Foster, Qasim) University of California at San Francisco, CA, United
States
Title
AVJ-514 trial: Baseline characteristics and 30-day outcomes following
mitraclip treatment in a Japanese cohort.
Source
Circulation Journal. 81 (8) (pp 1116-1122), 2017. Date of Publication:
2017.
Publisher
Japanese Circulation Society
Abstract
Background: The MitraClip system is a transcatheter-based therapeutic
option for patients with chronic mitral regurgitation (MR) who are at high
risk for surgery. A prospective, multicenter, single-arm study was
initiated to confirm the transferability of this system to Japan. Methods
and Results: Patients with symptomatic chronic moderate-to-severe (3+) or
severe (4+) functional or degenerative MR with a Society of Thoracic
Surgery (STS) score >=8%, or the presence of 1 predefined risk factor were
enrolled. Patients with left ventricular (LV) ejection fraction (EF) <30%
were excluded. MR severity and LV function were assessed by an independent
echocardiography core lab. Primary outcome included major adverse events
(MAE) at 30 days and acute procedural success (APS). A total of 30
patients (age: 80+/-7 years; STS score: 10.3%+/-6.6%) were treated with
the MitraClip. At baseline, all patients had MR 3+/4+ with 53%/47%
patients with degenerative/functional etiology with mean LVEF of
50.2+/-12.8%, and 37% of patients were NYHA class III/IV. APS was achieved
in 86.7% with no occurrence of MAE. At 30 days, 86.7% of patients had MR
<=2+ and 96.7% were NYHA class I/II. Conclusions: The MitraClip procedure
resulted in clinically meaningful improvements in MR severity, function
and quality of life measures, and low MAE rates. These early results
suggest the transferability of this therapy to appropriately selected
Japanese patients. (Trial Registration: clinicaltrials.gov Identifier
NCT02520310.)<br/>Copyright &#xa9; 2017, Japanese Circulation Society. All
rights reserved.

<27>
Accession Number
614326645
Author
Marwali E.M.; Boom C.E.; Budiwardhana N.; Fakhri D.; Roebiono P.S.;
Santoso A.; Sastroasmoro S.; Slee A.; Portman M.A.
Institution
(Marwali, Boom, Budiwardhana) Pediatric Cardiac Intensive Care and
Anesthesiology Division, National Cardiovascular Center Harapan Kita,
Jakarta, Indonesia
(Fakhri) Pediatric Cardiac Surgery Division, National Cardiovascular
Center Harapan Kita, Jakarta, Indonesia
(Roebiono, Santoso) Pediatric Cardiology and Congenital Heart Disease
Division, National Cardiovascular Center Harapan Kita and Department of
Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Indonesia, Jakarta, Indonesia
(Sastroasmoro) Center for Clinical Epidemiology and Evidence Based
Medicine, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas
Indonesia, Jakarta, Indonesia
(Slee) Axio Research, Seattle, Washington, United States
(Portman) Seattle Children's Hospital and Research Institute, University
of Washington, Seattle, Washington, United States
Title
Oral Triiodothyronine for Infants and Children Undergoing Cardiopulmonary
Bypass.
Source
Annals of Thoracic Surgery. 104 (2) (pp 688-695), 2017. Date of
Publication: August 2017.
Publisher
Elsevier USA
Abstract
Background This study evaluated the efficacy and safety of oral
triiodothyronine (T3; Tetronine, Dalim BioTech, Korea) for infants and
children undergoing cardiopulmonary bypass in an Indonesian population.
Methods We performed a single-center, randomized, double-blind, and
placebo-controlled trial in children aged 3 years and younger undergoing
congenital heart disease operations with cardiopulmonary bypass. We
administered oral T3 (1 mug/kg per body weight/dose) or placebo (saccharum
lactis) by nasogastric tube every 6 hours for 60 hours after induction of
anesthesia. The primary end point, time to extubation, was compared with
Cox regression. Results The modified intention-to-treat group included 101
placebo and 104 treated patients. The stratified log-rank test did not
show a significant treatment difference (p = 0.061) for time to
extubation, but after adjustment for age, the nutritional Z score, and
Aristotle surgical complexity, the hazard ratio was 1.33 (95% confidence
interval, 1.00 to 1.76; p = 0.049). The effect of T3 was stronger in the
strata aged 5 months and younger (hazard ratio, 1.86; 95% confidence
interval 1.02 to 3.39; p = 0.043). Median intubation time was 47.3 hours
for the placebo and 32.1 hours for the T3 group in aged 5 months and
younger. Adverse events rates, including arrhythmia, were similar between
groups, although sepsis was more frequent with placebo. Conclusions Oral
T3 supplementation may shorten time to extubation in children undergoing
congenital heart disease operations, particularly infants aged 5 months or
younger. Administration is relatively safe, simple and
inexpensive.<br/>Copyright &#xa9; 2017 The Society of Thoracic Surgeons

<28>
Accession Number
611361998
Author
Cho Y.J.; Lee S.Y.; Kim T.K.; Hong D.M.; Jeon Y.
Institution
(Cho, Lee, Kim, Hong, Jeon) Department of Anesthesiology and Pain
Medicine, Seoul National University Hospital, Seoul, South Korea
Title
Effect of prewarming during induction of anesthesia on microvascular
reactivity in patients undergoing off-pump coronary artery bypass surgery:
A randomized clinical trial.
Source
PLoS ONE. 11 (7) (no pagination), 2016. Article Number: e0159772. Date of
Publication: 01 Jul 2016.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: General anesthesia may induce inadvertent hypothermia and this
may be related to perioperative cardiovascular complications.
Microvascular reactivity, measured by the recovery slope during a vascular
occlusion test, is decreased during surgery and is also related to
postoperative clinical outcomes. We hypothesized that microvascular
changes during surgery may be related to intraoperative hypothermia. To
evaluate this, we conducted a randomized study in patients undergoing
off-pump coronary artery bypass surgery, in which the effect of prewarming
on microvascular reactivity was evaluated. Methods: Patients scheduled for
off-pump coronary artery bypass surgery were screened. Enrolled patients
were randomized to the prewarming group to receive forced-air warming
during induction of anesthesia or to the control group. Measurement of
core and skin temperatures and vascular occlusion test were conducted
before anesthesia induction, 1, 2, and 3 h after induction, and at the end
of surgery. Results: In total, 40 patients were enrolled and finished the
study (n = 20 in the prewarming group and n = 20 in the control group).
During the first 3 h of anesthesia, core temperature was higher in the
prewarming group than the control group (p < 0.001). The number of
patients developing hypothermia was lower in the prewarming group than the
control group (4/20 vs. 13/20, p = 0.004). However, tissue oxygen
saturation and changes in recovery slope following a vascular occlusion
test at 3 h after anesthesia induction did not differ between the groups.
There was no difference in clinical outcome, including perioperative
transfusion, wound infection, or hospital stay, between the groups.
Conclusions: Prewarming during induction of anesthesia decreased
intraoperative hypothermia, but did not reduce the deterioration in
microvascular reactivity in patients undergoing off-pump coronary artery
bypass surgery. Trial Registration: ClinicalTrials.gov
NCT02186210.<br/>Copyright &#xa9; 2016 Cho 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.

<29>
Accession Number
611884744
Author
Coca S.G.; Nadkarni G.N.; Garg A.X.; Koyner J.; Thiessen-Philbrook H.;
McArthur E.; Shlipak M.G.; Parikh C.R.; Raman J.; Jeevanandam V.; Akhter
S.; Edelstein C.; Passik C.; Nagy J.; Swaminathan M.; Chu M.; Goldbach M.;
Guo L.R.; McKenzie N.; Myers M.L.; Novick R.; Quantz M.; Zappitelli M.;
Palijan A.; Dewar M.; Darr U.; Hashim S.; Elefteriades J.; Geirsson A.;
Garwood S.; Butrymowicz I.; Krumholz H.
Institution
(Coca, Nadkarni) Division of Nephrology, Department of Medicine, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Garg, Thiessen-Philbrook, McArthur, Chu, Goldbach, Guo, McKenzie, Myers,
Novick, Quantz) Division of Nephrology, Department of Medicine, Western
University, London, ON, Canada
(Koyner, Raman, Jeevanandam, Akhter) Section of Nephrology, Department of
Medicine, University of Chicago, Pritzker School of Medicine, Chicago, IL,
United States
(Shlipak) Division of General Internal Medicine, San Francisco VA Medical
Center, University of California, San Francisco, CA, United States
(Parikh) Program of Applied Translational Research, Department of Internal
Medicine, Yale University School of Medicine, New Haven, CT, United States
(Parikh) Section of Nephrology, Department of Medicine, Yale University
School of Medicine, VA CT Healthcare System, Program of Applied
Translational Research, New Haven, CT, United States
(Edelstein) U of Colorado, United States
(Passik, Nagy) Danbury Hospital, United States
(Swaminathan) Duke University, United States
(Zappitelli, Palijan) Montreal Children's, United States
(Dewar, Darr, Hashim, Elefteriades, Geirsson, Garwood, Butrymowicz,
Krumholz) Yale-New Haven, United States
Title
First post-operative urinary kidney injury biomarkers and association with
the duration of AKI in the TRIBE-AKI cohort.
Source
PLoS ONE. 11 (8) (no pagination), 2016. Article Number: e0161098. Date of
Publication: August 2016.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: We previously demonstrated that assessment of the duration of
AKI, in addition to magnitude of rise in creatinine alone, adds prognostic
information for long-term survival. We evaluated whether post-operative
kidney injury biomarkers in urine collected immediately after cardiac
surgery associate with duration of serum creatinine elevation. Methods: We
studied 1199 adults undergoing cardiac surgery in a prospective cohort
study (TRIBEAKI) and examined the association between the levels of five
urinary biomarkers individually at 0-6 hours after surgery: interleukin-18
(IL-18), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury
molecule-1 (KIM-1), liver fatty acid binding protein (L-FABP) and albumin
with duration of serum creatinine-based AKIN criteria for AKI (0 (no AKI),
1-2, 3-6, >7 days). Results: Overall, 407 (34%) patients had at least
stage 1 AKI, of whom 251 (61.7%) had duration of 1-2 days, 118 (28.9%) had
duration 3-6 days, and 38 (9.3%) had duration of >7 days. Higher
concentrations of all biomarkers (per log increase) were independently
associated with a greater odds of a longer duration of AKI; odds ratios
and 95%confidence intervals using ordinal logistic regression were the
following: IL-18: 1.22, 1.13-1.32; KIM-1: 1.36, 1.21-1.52; albumin 1.20,
1.09-1.32; L-FABP 1.11, 1.04-1.19; NGAL 1.06, 1.00-1.14). AKI duration of
7 days or longer was associated with a 5-fold adjusted risk of mortality
at 3 years. Conclusions: There was an independent dose-response
association between urinary levels of injury biomarkers immediately after
cardiac surgery and longer duration of AKI. Duration of AKI was also
associated with long term mortality. Future studies should explore the
potential utility of these urinary kidney injury biomarkers to enrich
enrollment of patients at risk for longer duration of AKI into trials of
interventions to prevent or treat post-operative AKI.<br/>Copyright &#xa9;
2016 Coca 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.

<30>
Accession Number
610947098
Author
Zhang Q.; Zhao X.-H.; Gu H.-F.; Xu Z.-R.; Yang Y.-M.
Institution
(Zhang, Zhao, Gu, Xu, Yang) Department of Geriatrics, First Affiliated
Hospital, School of Medicine, Zhejiang University, Hangzhou, China
Title
Clinical Outcomes of Coronary Artery Bypass Grafting vs Percutaneous
Coronary Intervention in Octogenarians With Coronary Artery Disease.
Source
Canadian Journal of Cardiology. 32 (9) (pp 1166.e21-1166.e28), 2016. Date
of Publication: 01 Sep 2016.
Publisher
Pulsus Group Inc.
Abstract
Background The number of elderly people receiving treatment for coronary
artery disease (CAD) is increasing, and there are few studies that
compared the outcomes of coronary artery bypass grafting (CABG) and
percutaneous coronary intervention (PCI) in the elderly. The objective of
this study was to compare outcomes of CABG and PCI in octogenarians with
CAD. Methods We conducted a search to identify articles that reported the
results of 2-arm studies that compared CABG with PCI in octogenarians. The
primary outcomes were short-term mortality and overall survival, and
secondary outcomes included length of hospital stay and cerebrovascular
accident (CVA) and myocardial infarction (MI) rates. Results Seven studies
that enrolled 1879 patients who received CABG and 1432 treated with PCI
were included. Short-term mortality was significantly less for patients in
the PCI arms (odds ratio [OR], 1.47; 95% confidence interval [CI],
1.05-2.06; P = 0.02), as was duration of hospital stay (difference in
means, 6.07; 95% CI, 2.81-9.34; P < 0.001). Patients in the CABG arms had
longer overall survival (hazard ratio, 0.81; 95% CI, 0.73-0.89; P <
0.001). CVA and MI rates were similar (CVA: OR, 1.06; 95% CI, 0.57-1.95; P
= 0.86; MI: OR, 0.70; 95% CI, 0.42-1.17; P = 0.17). Conclusions The
results suggest that physicians should consider not only the clinical
features of CAD, but also the elderly patients future health outlook when
choosing a revascularization procedure.<br/>Copyright &#xa9; 2016 Canadian
Cardiovascular Society

<31>
Accession Number
613171590
Author
Chevalier B.; Onuma Y.; Van Boven A.J.; Piek J.J.; Sabate M.; Helqvist S.;
Baumbach A.; Smits P.C.; Kumar R.; Wasungu L.; Serruys P.W.
Institution
(Chevalier) Ramsay Generale de Sante, Institut Cardiovasculaire Paris Sud,
Massy, France
(Onuma) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Van Boven) Medical Center Leeuwarden, Leeuwarden, Netherlands
(Piek) AMC Heart Center, Academic Medical Center, Amsterdam, Netherlands
(Sabate) Thorax Institute, Hospital Clinic, University of Barcelona,
Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS),
Barcelona, Spain
(Helqvist) Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Baumbach) Bristol Heart Institute, Bristol, United Kingdom
(Smits) Department of Cardiology, Maasstad Hospital, Rotterdam,
Netherlands
(Kumar, Wasungu) Abbott Vascular, Diegem, Belgium
(Serruys) International Centre for Cardiovascular Health, Imperial
College, South Kensington Campus, London SW7 2AZ, United Kingdom
Title
Randomised comparison of a bioresorbable everolimuseluting scaffold with a
metallic everolimus-eluting stent for ischaemic heart disease caused by de
novo native coronary artery lesions: The 2-year clinical outcomes of the
ABSORB II trial.
Source
EuroIntervention. 12 (9) (pp 1102-1107), 2016. Date of Publication:
October 2016.
Publisher
EuroPCR
Abstract
Aims: The one-year randomised data of the ABSORB II trial showed that the
everolimus-eluting bioresorbable scaffold and the everolimus-eluting
metallic stent were comparable for the composite secondary clinical
outcomes of patient-oriented composite endpoint (PoCE) and device-oriented
composite endpoint (DoCE)/target lesion failure (TLF), MACE and TVF. This
report describes the two-year clinical outcomes of the ABSORB II trial.
Methods and results: Patients were randomly assigned in a 2:1 ratio to
receive treatment with an everolimus-eluting bioresorbable scaffold
(Absorb; Abbott Vascular, Santa Clara, CA, USA) or treatment with an
everolimus-eluting metallic stent (XIENCE; Abbott Vascular). The trial
enrolled 501 patients. Clinical follow-up at two years was available in
320 patients in the Absorb BVS arm and 160 patients in the XIENCE arm. At
two years, the PoCE for the Absorb and XIENCE arms was 11.6% and 12.8%
(p=0.70) and the DoCE/TLF was 7.0% and 3.0% (p=0.07), respectively. The
hierarchical ID-MACE rate was 7.6% vs. 4.3% (p=0.16) and the rate of TVF
was 8.5% vs. 6.7% (p=0.48). The definite/probable thrombosis rate was 1.5%
in the Absorb arm vs. 0% in the XIENCE arm (p=0.17). Thirty-six percent
and 34% of patients remained on DAPT at two years, respectively.
Ninety-two percent of patients in both arms remained on aspirin.
Conclusions: Two-year clinical results demonstrate sustained low rates of
PoCE, MACE, DoCE and TVF with the Absorb BVS as compared to the XIENCE
stent.<br/>Copyright &#xa9; 2016 Europa Digital & Publishing. All rights
reserved.

<32>
Accession Number
611884723
Author
Min J.J.; Lee J.-H.; Kang S.H.; Kim E.; Lee S.M.; Cho J.H.; Kim H.K.
Institution
(Min, Lee, Kang, Kim, Lee) Department of Anesthesiology and Pain Medicine,
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
South Korea
(Cho, Kim) Department of Thoracic and Cardiovascular Surgery, Samsung
Medical Center, Sungkyunkwan University School of Medicine, Seoul, South
Korea
Title
The Fast and Easy Way for Double-Lumen Tube Intubation: Individual Angle-
Modification.
Source
PLoS ONE. 11 (8) (no pagination), 2016. Article Number: e0161434. Date of
Publication: August 2016.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
To find the faster and easier way than the existing intubating technique
for double-lumen tube, we modified the angle of double-lumen tube
according to an individual's upper airway anatomy and compared the time
needed and the number of attempts for successful intubation between
individually angle-modified and non-modified double-lumen tubes. Adult
patients undergoing elective thoracic surgery were randomly allocated in
either non-anglemodified (Group N, n = 54) or angle-modified (Group M, n =
54) groups. During mask ventilation in the sniffing position,
angle-modification was performed in Group M as follows: The distal tip of
the tube was placed at the level of the cricoid cartilage and the shaft
was bent at the intersection of the oral and pharyngeal axes estimated
from the patient's surface anatomy. The time needed and the number of
attempts for successful intubation and Cormack and Lehane (C-L) grade were
recorded. Overall median intubation time (sec) was significantly shorter
in Group M than in Group N [10.2 vs. 15.1, P<0.001]. In addition, Group M
showed the shorter median intubation time (sec) in C-L grades I-III [8.2
vs. 11.1 in C-L grade I, (P = 0.003), 10.3 vs. 15.3 in II, (P = 0.001),
and 11.8 vs. 27.9 in III, (P<0.001), respectively]. Moreover, all
intubation was successfully performed at the first attempt in patients
with C-L grades I-III in Group M (P = 0.027). Our study showed an
individual angle-modification would be useful for the fast and easy
intubation of double-lumen tube in patients with C-L grades
I-III.<br/>Copyright &#xa9; 2016 Min 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.

<33>
Accession Number
617520718
Author
Buckert D.; Witzel S.; Cieslik M.; Tibi R.; Rottbauer W.; Bernhardt P.
Institution
(Buckert, Witzel, Cieslik, Tibi, Rottbauer) University of Ulm, Department
of Internal Medicine II, Albert-Einstein-Allee 23, Ulm 89081, Germany
(Bernhardt) Heart Clinic Ulm, Ulm, Germany
Title
Magnetic resonance Adenosine perfusion imaging as Gatekeeper of invasive
coronary intervention (MAGnet): Study protocol for a randomized controlled
trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 358. Date of
Publication: 28 Jul 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Current guidelines for the diagnosis and management of
patients with stable coronary artery disease (CAD) recommend functional
stress testing for risk stratification prior to revascularization
procedures. Cardiac magnetic resonance imaging (CMR) is a modality of
choice for stress testing because of its capability to detect myocardial
ischemia sensitively and specifically. Nevertheless, evidence from
randomized trials evaluating a CMR-based management of stable CAD patients
in comparison to a more common angiography-based approach still is
limited. Methods/design: Patients presenting themselves with symptoms
indicating a stable CAD and a class I or IIa indication for diagnostic
coronary angiography are prospectively screened and enrolled in the study.
All subjects receive a basic cardiological work-up and guideline-directed
medical therapy. A 1:1 randomization in two groups is being performed.
Patients in group 1 undergo diagnostic coronary angiography and subsequent
revascularization according to current guidelines. Subjects in group 2
undergo adenosine stress CMR and in case of myocardial ischemia are sent
to coronary angiography. Follow-up is planned for 3 years. During this
time, the number of primary endpoints (defined as cardiac death and
non-fatal myocardial infarction) and unplanned invasive procedures will be
documented. Furthermore, symptom burden and quality of life will be
assessed by use of the Seattle Angina Questionnaire. Sample size is
calculated to prove non-inferiority of the CMR-based approach. Discussion:
In case this study is able to accomplish its aim to prove non-inferiority
of the CMR-based management in patients with stable CAD; the importance of
this emerging modality may further increase. Trial registration:
ClinicalTrials.gov, identifier: NCT02580851. Registered on 14 October
2015. Unique Protocol ID: 237/11.<br/>Copyright &#xa9; 2017 The Author(s).

<34>
Accession Number
617562324
Author
Bongiovanni D.; Kuhl C.; Bleiziffer S.; Stecher L.; Poch F.; Greif M.;
Mehilli J.; Massberg S.; Frey N.; Lange R.; Laugwitz K.-L.; Schymik G.;
Frank D.; Kupatt C.
Institution
(Bongiovanni, Poch, Laugwitz, Kupatt) I. Medizinische Klinik und
Poliklinik, Klinikum rechts der Isar, Technical University of Munich,
Munich, Germany
(Bongiovanni, Laugwitz, Kupatt) DZHK (German Center for Cardiovascular
Research), Partner Site Munich Heart Alliance, Munich, Germany
(Kuhl, Frey, Frank) Klinik fur Innere Medizin III, Universitatsklinikum
Schleswig-Holstein, Kiel, Germany
(Kuhl, Frey, Frank) DZHK (German Center for Cardiovascular Research),
Partner Site Hamburg/Kiel/Lubeck, Lubeck, Germany
(Bleiziffer, Lange) Clinic for Cardiovascular Surgery, German Heart Center
Munich, Munich, Germany
(Stecher) Institut fur Medizinische Statistik und Epidemiologie, Technical
University of Munich, Munich, Germany
(Greif, Mehilli, Massberg) Medizinische Klinik und Poliklinik I, Klinikum
Groshadern, LMU University, Munich, Germany
(Schymik) Medizinische Klinik IV, Stadtisches Klinikum Karlsruhe,
Karlsruhe, Germany
Title
Emergency treatment of decompensated aortic stenosis.
Source
Heart. (no pagination), 2017. Date of Publication: May 30, 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: The optimal treatment of patients with acute and severe
decompensation of aortic stenosis is unclear due to recent advances in
transcatheter interventions and supportive therapies. Our aim was to
assess the early outcome of emergency transcatheter aortic valve
implantation (eTAVI) versus emergency balloon aortic valvuloplasty (eBAV)
followed by TAVI under elective circumstances.Methods: Emergency
conditions were defined as: cardiogenic shock with requirement of
catecholamine therapy, severe acute dyspnoea (NYHA IV), cardiac
resuscitation or mechanic respiratory support. The data were collected
according to the Valve Academic Research Consortium 2 (VARC-2)
criteria.Results: In five German centres, 23 patients (logistic Euroscore
37.7%+/-18.1) underwent eTAVI and 118 patients underwent eBAV (logistic
Euroscore 35.3%+/-20.8). In the eTAVI group, immediate procedural
mortality was 8.7%, compared with 20.3% for the eBAV group (p=0.19). After
30 days, cardiovascular mortality for the eTAVI group was 23.8% and for
the eBAV group 33.0% (p=0.40). Analyses adjusting for potential
confounders did not provide evidence of a difference between groups. Of
note, the elective TAVI performed after eBAV (n=32, logistic Euroscore
25.9%+/-13.9) displayed an immediate procedural mortality of 9.4% and a
cardiovascular mortality after 30 days of 15.6%. Major vascular
complications were significantly more likely to occur after eTAVI (p=0.01)
as well as stroke (p=0.01).Conclusion: In this multicentre cohort,
immediate procedural and 30-day mortality of eTAVI and eBAV were high, and
mortality of secondary TAVI subsequent to eBAV was higher than expected.
Randomised study data are required to define the role of emergency TAVI in
tertiary care centres with current device generations.<br/>Copyright
&#xa9; Article author(s) (or their employer(s) unless otherwise stated in
the text of the article) 2017.

<35>
Accession Number
617562276
Author
Wassef A.W.A.; Alnasser S.; Rodes-Cabau J.; Webb J.G.; Barbanti M.; Liu
Y.; Munoz-Garcia A.J.; Tamburino C.; Dager A.E.; Serra V.; Amat-Santos
I.J.; Al Lawati H.; Urena M.; Alonso Briales J.H.; Benitez L.M.; del
Blanco B.G.; Roman A.S.; Bagai A.; Buller C.E.; Peterson M.D.; Cheema A.N.
Institution
(Wassef, Alnasser, Liu, Al Lawati, Bagai, Buller, Peterson, Cheema) St.
Michael's Hospital, Toronto, Ontario, Canada
(Rodes-Cabau, Urena) Quebec Heart and Lung Institute, Laval University,
Quebec City, Quebec, Canada
(Webb) St-Paul's hospital, University of British Columbia, Vancouver,
British Columbia, Canada
(Barbanti, Tamburino) Ferrarotto Hospital, University of Catania, Italy
(Munoz-Garcia, Alonso Briales) Hospital Universitario Virgen de la
Victoria, Universidad de Malaga, Spain
(Dager, Benitez) Clinica de Occidente de Cali, Colombia
(Serra, del Blanco) Hospital Universitari Vall d'Hebron, Universitat
Autonoma de Barcelona, Barcelona, Spain
(Amat-Santos, Roman) Hospital Clinico Universitario de Valladolid,
Valladolid, Spain
Title
Institutional experience and outcomes of transcatheter aortic valve
replacement: Results from an international multicentre registry.
Source
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Despite rapidly increasing use of TAVR across institutions,
limited data is available for the effect of procedural experience on TAVR
outcomes. We investigate the relationship between institutional experience
and TAVR outcomes. Methods: 1953 patients undergoing TAVR at 8
international sites were grouped into chronological quantiles (Q) to
assess temporal changes on procedural and clinical outcomes and
multivariate logistic regression performed to determine predictors of
device success, early safety and all-cause mortality. Results: The mean
age of patients was 81. +/-. 7. years and 991 (51%) were female. The
quantiles comprised of first 62 cases for Q1, 63-133 for Q2, 134 to 242
for Q3 and 243 to 476 for Q4. Device success increased from Q1 to Q4 (78%
vs 89%, p. <. 0.001) with significant improvement in the early safety
endpoint (19% vs 10%, p. <. 0.001). All cause mortality reduced by half in
Q4 compared to Q1 (8% vs 4%, p = 0.01) and rates of major vascular
complications, major bleeding and valve embolization decreased with
increasing experience. The multivariate analysis identified TAVR in Q3 and
Q4 to be independently associated with higher device success and lower
risk of complications. TAVR in Q4 was independently associated with lower
mortality (OR 0.36 95% CI 0.19-0.70, p = 0.002). Conclusions: Greater
institutional experience with TAVR procedures improves device success and
clinical outcomes. An experience of >. 242 cases is independently
associated with lower mortality. These findings have important
implications for defining minimum volume criteria for institutions and
training standards for TAVR procedure.<br/>Copyright &#xa9; 2017.

<36>
Accession Number
617562274
Author
Buttar S.N.; Yan T.D.; Taggart D.P.; Tian D.H.
Institution
(Buttar, Yan, Tian) The Collaborative Research (CORE) Group, Macquarie
University, Sydney, Australia
(Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital,
University of Sydney, Sydney, Australia
(Taggart) Nuffield Department of Surgical Sciences, University of Oxford,
John Radcliffe Hospital, Oxford, UK
(Tian) Royal North Shore Hospital, Sydney, Australia
Title
Long-term and short-term outcomes of using bilateral internal mammary
artery grafting versus left internal mammary artery grafting: A
meta-analysis.
Source
Heart. (no pagination), 2017. Date of Publication: June 23, 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background: A substantial body of evidence demonstrates that myocardial
revascularisation using bilateral internal mammary arteries (BIMA)
improves long-term survival compared with single/left internal mammary
artery (LIMA) grafting. To date, limited analyses have been made regarding
other short-term and long-term outcomes in BIMA strategy.Objectives: The
primary aim of the present review is to update the difference in long-term
survival between BIMA and LIMA grafting and to thoroughly investigate
other secondary short-term and long-term clinical outcomes between these
two grafting procedures.Methods: Electronic searches were performed using
three databases from their inception to November 2015. Relevant studies
comparing long-term survival between BIMA and LIMA grafting were
identified. Data were extracted by two independent reviewers and analysed
according to predefined clinical outcomes.Results: Twenty-nine
observational studies were identified, with a total of 89 399 patients.
Overall, BIMA cohort had significantly improved long-term survival
compared with LIMA cohort (HR 0.78; p<0.00001). BIMA cohort also had
significantly reduced hospital mortality rates (1.2% vs 2.1%, p=0.04),
cerebrovascular accidents (1.3% vs 2.9%, p=0.0003) and need for
revascularisation (4.8% vs 10%, p=0.005), although the incidence of deep
sternal wound infection (DSWI) was increased (1.8% vs 1.4%, p=0.0008) in
this grafting strategy. Long-term cardiac-free, myocardial infarction-free
and angina-free survivals were also superior for the BIMA
cohort.Conclusions: BIMA grafting is associated with enhanced overall
long-term outcomes compared with LIMA grafting. While the BIMA cohort
demonstrates an increased incidence of DSWI, the survival benefits and
other morbidity advantages outweigh this short-term risk.<br/>Copyright
&#xa9; Article author(s) (or their employer(s) unless otherwise stated in
the text of the article) 2017.

<37>
Accession Number
617558114
Author
Barbanti M.; Buccheri S.; Rodes-Cabau J.; Gulino S.; Genereux P.; Pilato
G.; Dvir D.; Picci A.; Costa G.; Tamburino C.; Leon M.B.; Webb J.G.
Institution
(Barbanti, Buccheri, Gulino, Pilato, Picci, Costa, Tamburino) Division of
Cardiology, Ferrarotto Hospital, University of Catania, Italy
(Rodes-Cabau) Division of Cardiology, Quebec Heart and Lung Institute,
Quebec City, Quebec, Canada
(Genereux) Division of Cardiology, Hopital du Sacre-Coeur de Montreal,
Universite de Montreal, Montreal, Quebec, Canada
(Dvir, Webb) Division of Cardiology, St. Paul's Hospital, University of
British Columbia, Vancouver, British Columbia, Canada
(Leon) Division of Cardiology, Columbia University Medical Center/New
York-Presbyterian Hospital, New York, USA
Title
Transcatheter aortic valve replacement with new-generation devices: A
systematic review and meta-analysis.
Source
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Objective: The aim of this study was to conduct a weighted meta-analysis
to determine the rates of acute (<=. 30. days) major outcomes after (TAVR)
with second-generation devices. Methods: A comprehensive search of
multiple electronic databases from January 2011 to May 2017 was conducted
using predefined criteria. New-generation TAVR devices were defined as any
device which received CE mark approval or is still under evaluation for CE
marking after CoreValve and SAPIEN XT prostheses. Results: A total of 37
studies including 10,822 patients met inclusion criteria and were included
in the analysis. Devices investigated in the studies were the following:
SAPIEN 3 (n = 5423, 45.9%), Lotus Valve (n = 3007, %), Portico (n = 130,
1.1%), JenaValve (n = 345, 2.9%), Symetis Acurate (n = 1314, 11,1%), and
Evolut R (n = 1603, 13.6%). Thirty-day all-cause and cardiovascular 30-day
death were 2.2% (95% CI: 1.6% to 2.8%) and 1.6% (95% CI: 0.9% to 2.3%),
respectively; Any stroke and major/disabling stroke occurred at a pooled
estimate rate of 2.6% (95% CI: 2.0% to 3.3%) and 0.9% (95% CI: 0.2% to
1.6%), respectively; life-threatening bleeding, 3.9% (95% CI: 2.9% to
5.0%); major vascular complications, 4.5% (95% CI: 3.7% to 5.4%);
pacemaker implantation, 16.2% (95% CI: 12.7% to 19.6%); more than mild
aortic regurgitation, 1.6% (95% CI: 0.9 to 2.3). Conclusions:
Second-generation TAVR devices are associated with very low mortality and
major complications rates at 30-day, and improved prosthesis performance
with <. 2% of patients having more than mild post-procedural aortic
regurgitation. On the other hand, the need for pacemaker implantation
seems to remain an unresolved issue, and warrants further
investigation.<br/>Copyright &#xa9; 2017 Elsevier Ireland Ltd.

<38>
Accession Number
617548707
Author
Yi B.; Wang J.; Yi D.; Zhu Y.; Jiang Y.; Li Y.; Mo S.; Liu Y.; Rong J.
Institution
(Yi) Department of Cardiothoracic SurgeryHeart Center, the First
Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on
Assisted Circulation, Ministry of HealthGuangzhouChina
(Yi, Zhu, Jiang, Li, Mo, Rong) Department of Extracorporeal
CirculationHeart Center, the First Affiliated Hospital, Sun Yat-Sen
University, and Key Laboratory on Assisted Circulation, Ministry of
HealthGuangzhouChina
(Wang) Department of AnesthesiologyState Key Laboratory of Cardiovascular
Disease, Fuwai Hospital, National Center for Cardiovascular Disease,
Chinese Academy of Medical Sciences and Peking Union Medical
CollegeBeijingChina
(Yi) Department of Cardiac Surgerythe Second Xiangya Hospital, Central
South UniversityChangshaChina
(Liu) Department of Anesthesiologythe First Affiliated Hospital, Sun
Yat-Sen UniversityGuangzhou China
Title
Remote Ischemic Preconditioning and Clinical Outcomes in On-Pump Coronary
Artery Bypass Grafting: A Meta-Analysis of 14 Randomized Controlled
Trials.
Source
Artificial Organs. (no pagination), 2017. Date of Publication: 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
The purpose of this article is to perform the first pooled analysis on
remote ischemic preconditioning (RIPC) used for the improvement of
clinical outcomes of patients only undergoing on-pump coronary artery
bypass grafting (CABG) in randomized controlled trials (RCTs). A
systematic search was performed using PubMed, the Cochrane Library, and
the Web of Science to identify studies that described the effect of RIPC
on postoperative mortality in patients only undergoing on-pump CABG. The
outcomes included postoperative mortality, postoperative morbidity
(including incidence of myocardial infarction, atrial fibrillation,
stroke, acute kidney injury, and renal replacement therapy), mechanical
ventilation (MV), intensive care unit length of stay (ICU LOS), and
hospital length of stay (HLOS). A total of 14 RCTs (2830 participants)
were included. Our meta-analysis found that RIPC failed to reduce the
postoperative mortality in patients only undergoing on-pump CABG compared
with control individuals (odds ratio, 0.81; 95% confidence interval,
[0.40, 1.64]; P=0.55; I²=25%). Moreover, there were no
differences in postoperative morbidity, ICU LOS, and HLOS between the two
groups. However, MV in the RIPC group was shorter than that in control
individuals (standard mean difference, -0.41; 95% confidence interval,
[-0.80, -0.01]; P=0.04; I²=73%). The present meta-analysis
found that RIPC failed to improve most of clinical outcomes in patients
only undergoing on-pump CABG; however, MV was reduced. Adequately powered
trials are warranted to provide more evidence in the future.<br/>Copyright
&#xa9; 2017 International Center for Artificial Organs and Transplantation
and Wiley Periodicals, Inc.

<39>
Accession Number
617530449
Author
Talamali A.; Heddi S.; Feliachi S.; Makhdoul I.; Haddak M.; Adjeroud N.
Institution
(Talamali, Heddi, Feliachi, Makhdoul) Hopital Central de l'Armee,
Cardiologie, Kouba, Algeria
(Haddak, Adjeroud) Clinique Alger Centre, Alger, Algeria
Title
The stress hyperglycemia in the acute phase of a STEMI: A residual risk in
the era of primary angioplasty?.
Source
Archives of Cardiovascular Diseases Supplements. Conference: 27es Journees
Europeennes de la Societe Francaise de Cardiologie. France. 9 (1) (pp 27),
2017. Date of Publication: January 2017.
Publisher
Elsevier Masson SAS
Abstract
Introduction Hyperglycemia observed at the admission of a STEMI is
associated with a poor prognosis. This association has been reported
before and after the era of coronary revascularization in particular in
non-diabetic patients and would be sharper and more important in the era
of primary angioplasty. Aim Compare the impact of admission hyperglycemia
in STEMI on in-hospital mortality in patients undergoing primary
angioplasty to those with no reperfusion therapy. Population and Method A
prospective, multicenter study with a recruitment of 1222 consecutive
patients without a prior history of diabetes and HbA1C < 6.5% in the first
24 hours of STEMI. Results The average age of the population was 60.28 yo
+/- 13 yo, the mean glycemia on admission was 1,39g/l +/- 0.333, 56.2% of
the patients benefit from early coronary reperfusion, the in-hospital
mortality was 7.2%. The results showed a linear correlation between the
level of glycemia on admission and inhospital mortality, an increase of
10mg/l of serum glucose was associated to an increased mortality of 2,6%
(2,0-3,3), p<0,001. The mortality was higher in the population of patients
who haven't receive any reperfusion therapy 12,2% versus 3,3% (p<0,001).
But the impact of the glycemia on-admission seems more important on the
population of reperfused patient adjusted OR a 5,2 (1,5-17,5), p=0,008
versus adjusted OR 2,7 (1,3-5,38), p=0,005. Conclusion Hyperglycemia on
admission is an independent predictive factor of short term mortality in
non-diabetic patients during the acute phase of STEMI, its impact is more
important in patients who benefit from a revascularization therapy at an
early stage.

<40>
Accession Number
617530316
Author
Amara W.; Naccache S.; Akret C.; Cheggour S.; M'Zoughi S.; Galuscan G.;
Dompnier A.
Institution
(Amara, Naccache) GHI le Raincy-Montfermeil, Cardiologie, Montfermeil,
France
(Akret, Dompnier) CH Annecy, Annecy, France
(Cheggour, M'Zoughi) CH Avignon, Avignon, France
(Galuscan) CH Andre Mignot, Versailles, France
Title
Safety of device implantation under antipatelet therapy with ticagrelor:
About 20 cases.
Source
Archives of Cardiovascular Diseases Supplements. Conference: 27es Journees
Europeennes de la Societe Francaise de Cardiologie. France. 9 (1) (pp 78),
2017. Date of Publication: January 2017.
Publisher
Elsevier Masson SAS
Abstract
Introduction Management of antiplatelet therapy at the time of device
implantation remains controversial. This study aimed to assess the risk of
bleeding complications in patients receiving Ticagrelor at the time of
cardiac device surgery. Methods We performed a multicentre (n=4),
retrospective study from January 2015 to January 2016. The survey included
all patients (pts) treated with ticagrelor before undergoing pacemaker,
implantable-cardioverter defibrillator (ICD) implantation or generator
replacement. We report haemorrhagic post-procedural complications at 1
month. A significant bleeding complication was defined as pocket hematoma
requiring a surgical evacuation or prolonged hospitalization, hemothorax,
pericardial effusion, or tamponade. Results A total of 20 patients
underwent a permanent pacemaker or ICD implantation while taking a
combination of antipatelet therapy with ticagrelor and aspirin. The mean
age of the patients was 65+/-9 years, 95% were male, 25% of patients were
diabetics, 55% had hypertension and 50% presented a history of heart
failure. All the patients had a history of acute coronary syndrome (6
(4-26) months before the procedure). The majority of implanted devices
were ICDs (17, 85%) with 5 single chamber, 4 dual chambers and 9 triple
chambers ICDs. Subclavian venous approach was utilized in 9 patients. The
mean duration of procedure was 60 minutes. One per-procedure bleeding was
described due to high venous pressure, without post-procedure hematoma. A
post-procedure pocket hematoma has been experienced by one patient. The
subclavian approach was used for the 2 patients. No blood transfusion was
needed for these 2 cases. Conclusion Ticagrelor treatment at the time of
heart rhythm device procedures doesn't seem to be associated with an
increased risk of significant bleeding complications. In our study, 2
patients experienced non-significant bleeding complications.

<41>
Accession Number
617538890
Author
McGehee E.; Reisch J.; Dowell J.; Gerber D.E.
Institution
(McGehee, Reisch, Dowell, Gerber) University of Texas Southwestern
Internal Medicine Residency, Dallas, TX; University of Texas Southwestern,
Dallas, TX; The University of Texas Southwestern, Irving, TX; The
University of Texas Southwestern Medical Center, Dallas, TX
Title
Treatment and outcomes of primary pericardial mesothelioma: A systematic
review.
Source
Journal of Clinical Oncology. Conference: 2017 Annual Meeting of the
American Society of Clinical Oncology, ASCO. United States. 35 (15
Supplement 1) (no pagination), 2017. Date of Publication: 20 Jun 2017.
Publisher
American Society of Clinical Oncology
Abstract
Background: Primary pericardial mesothelioma (PPM) is a rare cancer, for
which there is no consensus on treatment. We performed a retrospective
systematic review of recently published PPM cases to characterize risk
factors, treatment patterns, and clinical outcomes. Methods: Published
literature from 2000-2016 was searched using the terms "primary
pericardial mesothelioma", "pericardial mesothelioma" and "malignant
pericardial mesothelioma". T-tests, Chi-square, and multivariable stepwise
logistic regression were employed to correlate demographics, disease
characteristics, and treatment with mortality. Results: We identified 6
case series and 84 case reports for a total of 103 PPM cases. Median age
at diagnosis was 55; age range was 19 to 87. 39% were female and 61% were
male. The mean time from diagnosis to death was 5.6 months. Tobacco
exposure and asbestos exposure were reported in 15% and 25%, respectively.
Neither exposure was predictive of mortality. 46% of patients underwent
surgery, 8% received radiation, 37% received chemotherapy and 23% received
no treatment. For 13% of patients, the treatment received, if any, was
unknown. Radiation treatment was not associated with a mortality benefit
(p = 0.54). A mortality benefit was seen for patients who had resection of
their tumor (46% alive at last follow-up, p = 0.0061) but not in patients
who had pericardiectomy (25% alive at last follow-up, p = 0.44). A
mortality benefit was noted in those who received chemotherapy (p =
0.0022), specifically pemetrexed (p = 0.0038) or platinum agents (p =
0.003). Gemcitabine was not associated with a mortality benefit (p =
0.101). Conclusions: To the authors' knowledge, this is the first
comprehensive analysis of published PPM cases in the modern era. In this
retrospective systematic review, a mortality benefit was seen with tumor
resection and chemotherapy. Selection bias may account for some of this
effect. However, given the inability to perform prospective studies in
this population due to small patient numbers, it seems reasonable to offer
surgical and medical therapy to eligible patients with PPM.

<42>
Accession Number
616204717
Author
Guerrero Orriach J.L.; Galan Ortega M.; Ramirez Fernandez A.; Ramirez
Aliaga M.; Moreno Cortes M.I.; Ariza Villanueva D.; Florez Vela A.;
Alcaide Torres J.; Santiago Fernandez C.; Matute Gonzalez E.; Alsina
Marcos E.; Escalona Belmonte J.J.; Rubio Navarro M.; Garrido Sanchez L.;
Cruz Manas J.
Institution
(Guerrero Orriach, Galan Ortega, Ramirez Fernandez, Ramirez Aliaga, Moreno
Cortes, Ariza Villanueva, Florez Vela, Escalona Belmonte, Rubio Navarro,
Cruz Manas) Department of Cardio-Anaesthesiology, University Hospital
Virgen de la Victoria, Malaga, Spain
(Guerrero Orriach) Instituto de Investigaciones Biomedicas de Malaga
(IBIMA), University Hospital Virgen de la Victoria, Malaga, Spain
(Alcaide Torres, Santiago Fernandez) CIBER Unidad de Gestion Clinica de
Endocrinologia y Nutricion, Malaga, Spain
(Matute Gonzalez) Department of Anesthesia, Hospital Universitario Sanitas
La Moraleja, Spain
(Alsina Marcos) Department of Anesthesia, Hospital Universitario La Paz,
Madrid, Spain
(Garrido Sanchez) CIBER Fisiologia de la Obesidad y Nutricion (CIBEROBN),
Instituto de Salud Carlos III, Malaga, Spain
(Garrido Sanchez) Unidad de Gestion Clinica de Endocrinologia y Nutricion,
Spain
Title
Cardioprotective efficacy of sevoflurane vs. propofol during induction
and/or maintenance in patients undergoing coronary artery
revascularization surgery without pump: A randomized trial.
Source
International Journal of Cardiology. 243 (pp 73-80), 2017. Date of
Publication: 15 Sep 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Purpose Pre and post-operative administration of sevoflurane in myocardial
revascularization surgery provides enhanced cardioprotective effects
exerted by pharmacologic pre- and post-conditioning, as compared to
propofol. The identification of the enzymes involved in conditioning
mechanisms is crucial to the understanding of the effects of sevoflurane
in cardiac surgery patients. The impact of sevoflurane on another crucial
target organ-the kidney-was also assessed. Methods Ninety patients
undergoing off-pump myocardial revascularization surgery were allocated to
receive either intra- and postoperative sevoflurane (SS), intraoperative
sevoflurane and postoperative propofol (SP), or intra- and postoperative
propofol (PP)). Troponin I and hemodynamic parameters were monitored
during the first 48 postoperative hours; blood and urine samples were
collected at baseline and at 24 h to determine Akt, ERK1/2, PKG, iNO,
bradykinin receptor, caspase 3, NT proBNP and urinary NGAL. Results The
enzymes were overexpressed in the SS group, remained unchanged in the SP
group, and decreased in the PP group. Renal function was best preserved in
the SS group. Conclusions The overexpression of enzymes induced by
intraoperative anesthesia and postoperative sedation with sevoflurane
reduces myocardial damage and improves renal function in patients
undergoing off-pump myocardial revascularization surgery.<br/>Copyright
&#xa9; 2017

<43>
Accession Number
617490472
Author
Shi Y.-J.; Lv J.; Han X.-T.; Luo G.-G.
Institution
(Shi) Department of Neurology, Xi'an Jiaotong University, Xi'an, China
(Lv, Luo) Department of Neurology, The First Affiliated Hospital of Xi'an
Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi 710061, China
(Han) Department of Stomatology, Xi'an Jiaotong University, Xi'an, China
Title
Migraine and percutaneous patent foramen ovale closure: A systematic
review and meta-analysis.
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 203. Date of Publication: 26 Jul 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The association between patent foramen ovale (PFO) and
migraine with aura (MA) is well established. However, the benefits of PFO
closure are less certain in patients with migraine without aura (MwoA).
Methods: We systematically searched Pubmed for pertinent clinical studies
published from January 2000 to July 2015. The primary end-point was the
elimination or significant improvement of migraine symptoms after PFO
closure. Results: Upon screening an initial list of 315 publications, we
identified eight studies that included 546 patients. Overall, our analysis
indicated a significant improvement of migraine in 81% of MA cases
compared to only 63% of MwoA cases. The summary odds ratio was 2.5 (95%
confidence interval 1.09-5.73), and the benefits of PFO closure were
significantly greater for patients with MA compared to patients with MwoA
(P = 0.03). Conclusions: The presence of aura provides a reference
standard for the clinical selection of patients with migraine for PFO
closure intervention.<br/>Copyright &#xa9; 2017 The Author(s).

<44>
[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.

<45>
Accession Number
617434089
Author
Jackson E.; Eagle K.A.
Institution
(Jackson, Eagle) University of Michigan, Ann Arbor, MI, United States
Title
Evolocumab reduced CV events in patients with atherosclerotic CV disease
taking high- or moderate-intensity statins.
Source
Annals of Internal Medicine. 167 (2) (pp JC7), 2017. Date of Publication:
18 Jul 2017.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<46>
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.

<47>
Accession Number
617457938
Author
Sales A.H.A.; Barz M.; Bette S.; Wiestler B.; Ryang Y.-M.; Meyer B.;
Bretschneider M.; Ringel F.; Gempt J.
Institution
(Sales, Barz, Ryang, Meyer, Ringel, Gempt) Technical University of Munich,
Department of Neurosurgery, Klinikum rechts der Isar, Ismaninger Str. 22,
Munich 81675, Germany
(Bette, Wiestler) Technical University of Munich, Department of
Neuroradiology, Klinikum rechts der Isar, Ismaninger Str. 22, Munich
81675, Germany
(Bretschneider) Technical University of Munich, Department of
Anesthesiology, Klinikum rechts der Isar, Ismaninger Str. 22, Munich
81675, Germany
(Ringel) Universitatsmedizin Mainz, Department of Neurosurgery,
Langenbeckstr. 1, Mainz 55131, Germany
Title
Impact of ischemic preconditioning on surgical treatment of brain tumors:
A single-center, randomized, double-blind, controlled trial.
Source
BMC Medicine. 15 (1) (no pagination), 2017. Article Number: 137. Date of
Publication: 25 Jul 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative ischemia is a frequent phenomenon in patients
with brain tumors and is associated with postoperative neurological
deficits and impaired overall survival. Particularly in the field of
cardiac and vascular surgery, the application of a brief ischemic stimulus
not only in the target organ but also in remote tissues can prevent
subsequent ischemic damage. We hypothesized that remote ischemic
preconditioning (rIPC) in patients with brain tumors undergoing elective
surgical resection reduces the incidence of postoperative ischemic tissue
damage and its consequences. Methods: Sixty patients were randomly
assigned to two groups, with 1:1 allocation, stratified by tumor type
(glioma or metastasis) and previous treatment with radiotherapy. rIPC was
induced by inflating a blood pressure cuff placed on the upper arm three
times for 5min at 200mmHg in the treatment group after induction of
anesthesia. Between the cycles, the blood pressure cuff was released to
allow reperfusion. In the control group no preconditioning was performed.
Early postoperative magnetic resonance images (within 72h after surgery)
were evaluated by a neuroradiologist blinded to randomization for the
presence of ischemia and its volume. Results: Fifty-eight of the 60
patients were assessed for occurrence of postoperative ischemia. Of these
58 patients, 44 had new postoperative ischemic lesions. The incidence of
new postoperative ischemic lesions was significantly higher in the control
group (27/31) than in the rIPC group (17/27) (p=0.03). The median infarct
volume was 0.36cm³ (interquartile range (IR): 0.0-2.35) in the
rIPC group compared with 1.30cm³ (IR: 0.29-3.66) in the control
group (p=0.09). Conclusions: Application of rIPC was associated with
reduced incidence of postoperative ischemic tissue damage in patients
undergoing elective brain tumor surgery. This is the first study
indicating a benefit of rIPC in brain tumor surgery. Trial registration:
German Clinical Trials Register, DRKS00010409. Retrospectively registered
on 13 October 2016.<br/>Copyright &#xa9; 2017 The Author(s).

<48>
Accession Number
617543252
Author
Van Mieghem N.M.; Walton A.; Oh J.K.; Qiao H.; Grube E.; Windecker S.;
Sinhal A.; Gooley R.; Walton T.; Yong G.; Bosmans J.; Webb J.; Chu M.;
Radhakrishnan S.; Dager A.; Branny M.; Tchetche D.; Modine T.; Teiger E.;
Chevalier B.; Himbert D.; Schymik G.; Zeus T.; Jensen C.; Rassaf T.;
Fichtlscherer S.; Nickenig G.; Linke A.; Bleiziffer S.; Kempfert J.;
Scholtz W.; Harnath A.; Strasser R.; Frerker C.; Spargias K.; Merkely
B.P.; Finkelstein A.; Tamburino C.; Colombo A.; Petronio A.S.; Fiorina C.;
Bedogni F.; Amoroso G.; van der Heijden J.; Van Mieghem N.; Tonino P.;
Echeverria Beliz P.; Witkowski A.; Gama Ribeiro V.; Al Abdullah M.; Weich
H.; Trillo R.; Hernandez Garcia J.M.; Moris C.; Jonsson A.L.; Malkin C.J.;
Khogali S.; Hildick-Smith D.; Manoharan G.
Institution
(Grube) Department of Medicine, University of Bonn, Bonn, Germany
(Van Mieghem) Department of Cardiology, Erasmus Medical Centre Rotterdam,
Rotterdam, Netherlands
(Bleiziffer) Department of Cardiovascular Surgery, German Heart Center,
Munich, Germany
(Modine) Department of Cardiovascular Surgery, Lille University Hospital,
Lille, France
(Bosmans) Department of Cardiology, University Hospital Antwerp, Antwerp,
Belgium
(Manoharan) Regional Cardiology Department, Royal Victoria Hospital,
Belfast, United Kingdom
(Linke) Department of Internal Medicine/Cardiology, Heart Centre,
University of Leipzig, Leipzig, Germany
(Scholtz) Department of Interventional Cardiology, Heart and Diabetes
Centre, NRW Bad Oeynhausen, Bad Oeynhausen, Germany
(Tchetche) Department of Cardiology, Clinique Pasteur Toulouse, Toulouse,
France
(Finkelstein) Department of Cardiology, Tel Aviv Sourasky Medical Center,
Tel Aviv, Israel
(Trillo) Department of Cardiology, Complejo Hospitalario Universitario de
Santiago de Compostela, Santiago de Compostela, Spain
(Fiorina) Cardiothoracic Department, Spedali Civili Brescia, Brescia,
Italy
(Walton) Department of Cardiology, The Alfred Hospital, Melbourne,
Victoria, Australia
(Malkin) Department of Cardiology, Leeds General Infirmary, Leeds, United
Kingdom
(Oh) Mayo Clinic, Rochester, Minnesota, United States
(Qiao) Statistical Services, Medtronic Minneapolis, Minnesota, United
States
(Windecker) Department of Cardiology, University Hospital Bern, Bern,
Switzerland
Title
Clinical Outcomes With a Repositionable Self-Expanding Transcatheter
Aortic Valve Prosthesis: The International FORWARD Study.
Source
Journal of the American College of Cardiology. 70 (7) (pp 845-853), 2017.
Date of Publication: 15 August 2017.
Publisher
Elsevier USA
Abstract
Background Clinical outcomes in large patient populations from real-world
clinical practice with a next-generation self-expanding transcatheter
aortic valve are lacking. Objectives This study sought to document the
clinical and device performance outcomes of transcatheter aortic valve
replacement (TAVR) with a next-generation, self-expanding transcatheter
heart valve (THV) system in patients with severe symptomatic aortic
stenosis (AS) in routine clinical practice. Methods The FORWARD (CoreValve
Evolut R FORWARD) study is a prospective, single-arm, multinational,
multicenter, observational study. An independent clinical events committee
adjudicated safety endpoints based on Valve Academic Research Consortium-2
definitions. An independent echocardiographic core laboratory evaluated
all echocardiograms. From January 2016 to December 2016, TAVR with the
next-generation self-expanding THV was attempted in 1,038 patients with
symptomatic, severe AS at 53 centers on 4 continents. Results Mean age was
81.8 +/- 6.2 years, 64.9% were women, the mean Society of Thoracic
Surgeons Predicted Risk of Mortality was 5.5 +/- 4.5%, and 33.9% of
patients were deemed frail. The repositioning feature of the THV was
applied in 25.8% of patients. A single valve was implanted in the proper
anatomic location in 98.9% of patients. The mean aortic valve gradient was
8.5 +/- 5.6 mm Hg, and moderate or severe aortic regurgitation was 1.9% at
discharge. All-cause mortality was 1.9%, and disabling stroke occurred in
1.8% at 30 days. The expected-to-observed early surgical mortality ratio
was 0.35. A pacemaker was implanted in 17.5% of patients. Conclusions TAVR
using the next-generation THV is clinically safe and effective for
treating older patients with severe AS at increased operative risk.
(CoreValve Evolut R FORWARD Study [FORWARD]; NCT02592369)<br/>Copyright
&#xa9; 2017 American College of Cardiology Foundation

<49>
Accession Number
617524481
Author
Alsawas M.; Zaiem F.; Larrea-Mantilla L.; Almasri J.; Erwin P.J.; Upchurch
G.R.; Murad M.H.
Institution
(Alsawas, Zaiem, Larrea-Mantilla, Almasri, Murad) Evidence-based Practice
Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science
of Health Care Delivery, Mayo Clinic, Rochester, Minn
(Erwin) Mayo Clinic Libraries, Mayo Clinic, Rochester, Minn
(Upchurch) Division of Vascular and Endovascular Surgery, University of
Virginia, Charlottesville, Va
Title
Effectiveness of surgical interventions for thoracic aortic aneurysms: A
systematic review and meta-analysis.
Source
Journal of Vascular Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: A systematic review and meta-analysis was conducted to evaluate
the effectiveness of thoracic endovascular aortic repair (TEVAR) and open
repair in patients with descending thoracic aortic aneurysms (TAAs).
Methods: PubMed, Ovid MEDLINE, Ovid Embase, EBSCO Cumulative Index to
Nursing and Allied Health Literature, and Scopus were searched from each
database's inception to January 29, 2016. We selected studies that
compared the two approaches in adults with TAAs and reported 30-day
mortality or procedure complications. Two reviewers independently
extracted data, and conflicts were resolved by consensus. Random-effects
meta-analysis was used to estimate odds ratios (ORs) and 95% confidence
intervals (CIs). The main outcomes and measures were all-cause 30-day
mortality, 30-day paraplegia or spinal cord ischemia, stroke, pulmonary
complications, and length of hospital and intensive care unit (ICU) stay.
Results: Twenty-seven studies of moderate methodologic quality were
included. TEVAR was associated with lower 30-day mortality in ruptured
(OR, 0.58; 95% CI, 0.38-0.88) and intact (OR, 0.6; 95% CI, 0.36-0.99)
aneurysms. Paraplegia or spinal cord ischemia (OR, 0.35; 95% CI, 0.2-0.61)
and pulmonary complications (OR, 0.41; 95% CI, 0.37-0.46) were reduced in
patients undergoing TEVAR, whereas a reduction in stroke risk was not
statistically significant (OR, 0.89; 95% CI, 0.76-1.03). Pooled mean
difference in length of hospital and ICU stay was lower for TEVAR by -5.17
days (95% CI, -7.77 to -2.57) and -5.89 days (95% CI, -9.65 to -2.12),
respectively. Three studies showed that compared with open repair, a
hybrid approach reduced hospital stay (pooled mean difference, -8.83 days;
95% CI, -14.37 to -3.29) and ICU stay (pooled mean difference, -3.17 days
(95% CI, -5.54 to -0.97), with minimal evidence on other outcomes studied.
Conclusions: Observational evidence at high risk of confounding suggests
that compared with open repair for TAA, TEVAR reduced risk of mortality,
paraplegia, spinal cord ischemia, and pulmonary complications within 30
days of intervention. Patients undergoing TEVAR also had shorter length of
hospital and ICU stay compared with patients undergoing open
repair.<br/>Copyright &#xa9; 2017 Society for Vascular Surgery.

<50>
Accession Number
617384012
Author
Tamura T.; Yatabe T.; Yokoyama M.
Institution
(Tamura, Yatabe, Yokoyama) Department of Anesthesiology and Intensive Care
Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku City, Kochi
783-8505, Japan
Title
Prevention of atrial fibrillation after cardiac surgery using low-dose
landiolol: A systematic review and meta-analysis.
Source
Journal of Clinical Anesthesia. 42 (pp 1-6), 2017. Date of Publication:
November 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective Atrial fibrillation (AF) is associated with mortality
after cardiac surgery. Several studies have reported that landiolol might
help to prevent postoperative AF. The objective of this study was to
investigate whether low-dose landiolol is useful in terms of balance of
benefit and risk. Design We conducted a meta-analysis after systematically
searching the PubMed, the Cochrane library and the ICHUSHI to identify
randomized, controlled trials investigating the preventive effect of
landiolol on incidence of AF after cardiac surgery. Patients Six
randomized trial with 571 patients were included. Measurements The primary
outcome was incidence of AF after surgery, while secondary outcomes were
mortality and complications. Main results Incidence of AF within 1 week
after surgery was significantly lower in the landiolol group than in the
control group (odds ratio, 0.27; 95% confidence interval, 0.18-0.42; p <
0.001). Three of the 6 studies reported data regarding in-hospital
mortality and complications, showing no significant differences between
groups (0.7 vs 3.0%; OR, 0.45; 95% CI, 0.07-2.74; p = 0.39; and 4.5 vs
9.7%; OR, 0.45; 95% CI, 0.16-1.23; p = 0.12, respectively). Conclusions
Our systematic review revealed that low-dose landiolol might help to
prevent AF after cardiac surgery and further large trials are needed to
evaluate safety because mortality and morbidity rate were very low in
included studies.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<51>
Accession Number
617416017
Author
Salih M.; Smer A.; Charnigo R.; Ayan M.; Darrat Y.H.; Traina M.; Morales
G.X.; DiBiase L.; Natale A.; Elayi C.S.
Institution
(Salih) University of Kentucky, Department of Internal Medicine,
Lexington, KY, United States
(Smer) Creighton University School of Medicine, Department of
Cardiovascular Medicine, Omaha, NE, United States
(Charnigo) University of Kentucky, Departments of Biostatistics and
Statistics, Lexington, KY, United States
(Ayan) University of Arkansas Medical Science, Department of
Cardiovascular Medicine, Little Rock, AR, United States
(Darrat, Morales, Elayi) University of Kentucky, Gill Heart Institute and
VAMC, Department of Cardiovascular Medicine, Lexington, KY, United States
(Traina) Cleveland Clinic Abu Dhabi, Department of Cardiovascular
Medicine, Abu Dhabi, United Arab Emirates
(DiBiase, Natale) Texas Cardiac Arrhythmia Institute at St. David's
Medical Center, Austin, TX, United States
Title
Colchicine for prevention of post-cardiac procedure atrial fibrillation:
Meta-analysis of randomized controlled trials.
Source
International Journal of Cardiology. 243 (pp 258-262), 2017. Date of
Publication: 15 Sep 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Development of atrial fibrillation after certain cardiac
procedures is a common medical problem. The inflammatory process plays an
important role in the pathogenesis of post-cardiac procedure atrial
fibrillation (PCP-AF). Colchicine, a potent anti-inflammatory agent, has
been used in several studies to reduce the risk of PCP-AF. This
meta-analysis of randomized controlled trials (RCTs) was conducted to
assess the efficacy of colchicine in prevention of PC-PAF. Methods We
searched PubMed, EMBASE, Web of Science, Cochrane Library database and
Google Scholar for RCTs, using terms "Atrial fibrillation, atrial, or
fibrillation and colchicine". The primary end-point was the occurrence of
AF post cardiac procedure, which includes cardiac surgery or pulmonary
vein isolation. The safety end point was the occurrence of any side
effects. Estimated odds ratios (OR) and 95% confidence intervals (CI) were
evaluated. Results A total of six RCTs were included in this
meta-analysis, enrolling a total of 1257 patients. Colchicine
significantly reduced the odds of PCP-AF (OR 0.52; 95% CI, 0.40-0.68, P <
0.001, I² = 0%). However, occurrence of side effects was
significantly higher with colchicine when compared to placebo (OR 2.10;
95% CI, 1.34-3.30, P < 0.001, I² = 0%). The number needed to
treat is 7 and the number needed to harm is 11.2. The proportion of
patients discontinuing treatment was 16%. Conclusion This meta-analysis
shows that colchicine is an effective drug for prevention of PCP-AF.
Colchicine could be considered as a prophylaxis to reduce PCP-AF, with
some risk of treatment discontinuation due to the poor gastrointestinal
tolerance (diarrhea).<br/>Copyright &#xa9; 2017 Elsevier B.V.

<52>
Accession Number
617433519
Author
Anjan V.Y.; Herrmann H.C.; Pibarot P.; Stewart W.J.; Kapadia S.; Tuzcu
E.M.; Babaliaros V.; Thourani V.H.; Szeto W.Y.; Bavaria J.E.; Kodali S.;
Hahn R.T.; Williams M.; Miller D.C.; Douglas P.S.; Leon M.B.
Institution
(Anjan, Herrmann) Cardiovascular Division, Hospital of the University of
Pennsylvania, 9038 Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104,
United States
(Pibarot) Department of Medicine, Laval University, Quebec City, QC,
Canada
(Stewart, Kapadia, Tuzcu) Department of Cardiovascular Medicine, Cleveland
Clinic, Cleveland, OH, United States
(Babaliaros) Department of Medicine, Emory University, Atlanta, GA, United
States
(Thourani) Department of Surgery, Emory University, Atlanta, GA, United
States
(Szeto, Bavaria) Division of Cardiothoracic Surgery, University of
Pennsylvania, Philadelphia, PA, United States
(Kodali, Hahn, Leon) Department of Medicine, Columbia University Medical
Center, New York, NY, United States
(Williams) Division of Cardiac Surgery, New York University Langone
Medical Center, New York, NY, United States
(Miller) Department of Cardiothoracic Surgery, Stanford University,
Stanford, CA, United States
(Douglas) Department of Medicine, Duke Clinical Research Institute, Duke
University Medical Center, Durham, NC, United States
Title
Evaluation of flow after transcatheter aortic valve replacement in
patients with low-flow aortic stenosis: A secondary analysis of the
PARTNER randomized clinical trial.
Source
JAMA Cardiology. 1 (5) (pp 481-489), 2016. Date of Publication: August
2016.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Low-flow (LF) severe aortic stenosis (AS) is an independent
predictor of mortality in patients undergoing aortic valve replacement
(AVR). Little is known about improvement in flow after AVR and its effects
on survival. Objective: To determine whether higher flow (left-ventricular
stroke volume index [LVSVI]) after transcatheter AVR (TAVR) would indicate
better clinical outcomes in this at-risk population. Design, Setting, and
Participants: A substudy analysis of data from the Placement of Aortic
Transcatheter Valves (PARTNER) randomized clinical trial and
continued-access registry was conducted. A total of 984 participants with
evaluable echocardiograms and baseline LF AS (LVSVI<=35 mL/m²)
were included. The trial was conducted at 26 sites in the United States
and Canada. Patients were stratified after TAVR into tertiles by discharge
LVSVI status (severe low flow [SLF], moderate low flow [MLF], and normal
flow [(NF]). The present study was conducted from May 11, 2007, to January
9, 2012, with data analysis performed from April 25, 2014, to January 21,
2016. Main Outcomes and Measures: The primary end pointwas all-cause
mortality at 1 year. Results: Baseline characteristics of 984 patients
with LF AS included mean (SD) age, 84 (7) years; 582 (59.1%) men; mean
Society of Thoracic Surgeons (STS) score, 11.4%(4.0%); and mean LVSVI,
27.6 (5.0) mL/m². The discharge LVSVI values by group were SLF,
23.1 (3.5) mL/m²; MLF, 31.7 (2.2) mL/m²; and NF,
43.1 (7.0). All-cause mortality at 1 year was SLF, 26.5%; MLF, 20.1%; and
NF, 19.6%(P = .045). Mean LVSVI normalized by 6 months in the MLF (35.9
[9.3] mL/m²) and NF (38.8 [11.1] mL/m²) groups, but
remained low in the SLF group at 6 months and 1 year (31.4 [8.4] and 33.0
[8.3] mL/m²], respectively) (P < .001 for all groups). Reported
as multivariate hazard ratio, mortality at 1 year was higher in the SLF
group compared with the other groups (1.61; 95%CI, 1.17-2.23; P = .004).
In addition to SLF, sex (1.59; 95%CI, 1.18-2.13; P = .002), presence of
atrial fibrillation (1.41; 95%CI, 1.06-1.87; P = .02), STS score (1.03;
95%CI, 1.01-1.06; P = .02), presence of moderate or severe mitral
regurgitation at discharge (1.65; 95%CI, 1.21-2.26; P = .001), pre-TAVR
mean transvalvular gradient (0.98; 95%CI, 0.97-0.99; P = .004), and
effective orifice area index (1.87; 95%CI, 1.09-3.19; P = .02) were
independent predictors of 1-year mortality. Conclusions and Relevance:
Severe LF at discharge is associated with an increased risk of mortality
following TAVR in patients with severe AS and preexisting LF. The
identification of remedial causes of persistent LF after TAVR may
represent an opportunity to improve the outcome of these
patients.<br/>Copyright &#xa9; 2016 American Medical Association. All
rights reserved.

<53>
Accession Number
617500027
Author
Alten J.A.; Klugman D.; Raymond T.T.; Cooper D.S.; Donohue J.E.; Zhang W.;
Pasquali S.K.; Gaies M.G.
Institution
(Alten) 1Department of Pediatric Cardiology, Section of Cardiac Critical
Care Medicine, University of Alabama at Birmingham, Birmingham, AL.
2Departments of Pediatric Critical Care Medicine and Pediatric Cardiology,
Children's National Health System, Washington, D.C. 3Department of
Pediatric Cardiology, Medical City Children's Hospital, Dallas, TX.
4Department of Pediatric Cardiology, Heart Institute, Cincinnati
Children's Hospital Medical Center, Cincinnati, OH. 5Department of
Pediatrics and Communicable Diseases, Division of Cardiology, C. S. Mott
Children's Hospital and University of Michigan Medical School, Ann Arbor,
MI.
Title
Epidemiology and Outcomes of Cardiac Arrest in Pediatric Cardiac ICUs.
Source
Pediatric Critical Care Medicine. (no pagination), 2017. Date of
Publication: 21 Jul 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
OBJECTIVES:: In-hospital cardiac arrest occurs in 2.6-6% of children with
cardiac disease and is associated with significant morbidity and
mortality. Much remains unknown about cardiac arrest in pediatric cardiac
ICUs; therefore, we aimed to describe cardiac arrest epidemiology in a
contemporary multicenter cardiac ICU cohort. DESIGN:: Retrospective
analysis within the Pediatric Cardiac Critical Care Consortium clinical
registry. SETTING:: Cardiac ICUs within 23 North American hospitals.
PATIENTS:: All cardiac medical and surgical patients admitted from August
2014 to July 2016. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS::
There were 15,908 cardiac ICU encounters (6,498 medical, 9,410 surgical).
3.1% had cardiac arrest; rate was 4.8 cardiac arrest per 1,000 cardiac ICU
days. Medical encounters had 50% higher rate of cardiac arrest compared
with surgical encounters. Observed (unadjusted) cardiac ICU cardiac arrest
prevalence varied from 1% to 5.5% among the 23 centers; cardiac arrest per
1,000 cardiac ICU days varied from 1.1 to 10.4. Over half cardiac arrest
occur within 48 hours of admission. On multivariable analysis,
prematurity, neonatal age, any Society of Thoracic Surgeons preoperative
risk factor, and Society of Thoracic Surgeons-European Association for
Cardio-Thoracic Surgery mortality category 4, 5 had strongest association
with surgical encounter cardiac arrest. In medical encounters, independent
cardiac arrest risk factors were acute heart failure, prematurity, lactic
acidosis greater than 3 mmol/dL, and invasive ventilation 1 hour after
admission. Median cardiopulmonary resuscitation duration was 10 minutes,
return of spontaneous circulation occurred in 64.5%, extracorporeal
cardiopulmonary resuscitation in 27.2%. Unadjusted survival was 53.2% in
encounters with cardiac arrest versus 98.2% without. Medical encounters
had lower survival after cardiac arrest (37.7%) versus surgical encounters
(62.5%); Norwood patients had less than half the survival after cardiac
arrest (35.6%) compared with all others. Unadjusted survival after cardiac
arrest varied greatly among 23 centers. CONCLUSIONS:: We provide
contemporary epidemiologic and outcome data for cardiac arrest occurring
in the cardiac ICU from a multicenter clinical registry. As detailed
above, we highlight high-risk patient cohorts and periods of time that may
serve as targets for research and quality improvement initiatives aimed at
cardiac arrest prevention.<br/>Copyright &#xa9;2017The Society of Critical
Care Medicine and the World Federation of Pediatric Intensive and Critical
Care Societies

<54>
Accession Number
617433874
Author
Kraal J.J.; Elske Van Den Akker-Van Marle M.; Abu-Hanna A.; Stut W.; Peek
N.; Kemps H.M.C.
Institution
(Kraal, Abu-Hanna) Department of Medical Informatics, Academic Medical
Center, Meibergdreef 9, AZ Amsterdam 1105, Netherlands
(Elske Van Den Akker-Van Marle) Department of Medical Decision Making,
Leiden University Medical Center, Netherlands
(Stut) Personal Health Department, Philips Research, Netherlands
(Peek) Health EResearch Centre, University of Manchester, United Kingdom
(Kemps) Department of Cardiology, Maxima Medical Center Veldhoven,
Netherlands
Title
Clinical and cost-effectiveness of home-based cardiac rehabilitation
compared to conventional, centre-based cardiac rehabilitation: Results of
the FIT@Home study.
Source
European Journal of Preventive Cardiology. 24 (12) (pp 1260-1273), 2017.
Date of Publication: 01 Aug 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Aim Although cardiac rehabilitation improves physical fitness after a
cardiac event, many eligible patients do not participate in cardiac
rehabilitation and the beneficial effects of cardiac rehabilitation are
often not maintained over time. Home-based training with telemonitoring
guidance could improve participation rates and enhance long-term
effectiveness. Methods and results We randomised 90 low-to-moderate
cardiac risk patients entering cardiac rehabilitation to three months of
either home-based training with telemonitoring guidance or centre-based
training. Although training adherence was similar between groups,
satisfaction was higher in the home-based group (p = 0.02). Physical
fitness improved at discharge (p < 0.01) and at one-year follow-up (p <
0.01) in both groups, without differences between groups (home-based p =
0.31 and centre-based p = 0.87). Physical activity levels did not change
during the one-year study period (centre-based p = 0.38, home-based p =
0.80). Healthcare costs were statistically non-significantly lower in the
home-based group (437 per patient, 95% confidence interval -562 to 1436, p
= 0.39). From a societal perspective, a statistically non-significant
difference of 3160 per patient in favour of the home-based group was found
(95% confidence interval -460 to 6780, p = 0.09) and the probability that
it was more cost-effective varied between 97% and 75% (willingness-to-pay
of 0 and 100,000 per quality-adjusted life-years, respectively).
Conclusion We found no differences between home-based training with
telemonitoring guidance and centre-based training on physical fitness,
physical activity level or health-related quality of life. However,
home-based training was associated with a higher patient satisfaction and
appears to be more cost-effective than centre-based training. We conclude
that home-based training with telemonitoring guidance can be used as an
alternative to centre-based training for low-to-moderate cardiac risk
patients entering cardiac rehabilitation.<br/>Copyright &#xa9; European
Society of Cardiology.

<55>
Accession Number
616517874
Author
Arroyo D.; Gendre G.; Schukraft S.; Kallinikou Z.; Muller O.; Baeriswyl
G.; Stauffer J.-C.; Goy J.-J.; Togni M.; Cook S.; Puricel S.
Institution
(Arroyo, Gendre, Schukraft, Kallinikou, Baeriswyl, Stauffer, Goy, Togni,
Cook, Puricel) Hospital & University Fribourg, Fribourg, Switzerland
(Muller) Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
Title
Comparison of everolimus- and biolimus-eluting coronary stents with
everolimus-eluting bioresorbable vascular scaffolds: Two-year clinical
outcomes of the EVERBIO II trial.
Source
International Journal of Cardiology. 243 (pp 121-125), 2017. Date of
Publication: 15 Sep 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Data from randomized controlled trials have shown that the
ABSORB BVS is non-inferior to Cobalt Chromium everolimus-eluting stents at
2 years. Methods & results The EVERBIO II trial (Comparison of Everolimus-
and Biolimus-Eluting Coronary Stents with Everolimus-Eluting Bioresorbable
Vascular Scaffold) is a single-center, assessor-blind, randomized
controlled trial enrolling 240 patients with an allocation ration of 1:1:1
conducted at University and Hospital Fribourg, Switzerland. The studied
devices were an everolimus-eluting persistent polymer stent (EES), a
biolimus-eluting stent with bioabsorbable polymer (BES) and a fully
bioresorbable vascular scaffold (BVS). Clinical end points collected at 9
months, 12 months, and 2 years, were academic research consortium defined
composites, device thrombosis and target-vessel revascularization.
Clinical follow-up at 2 years was available in 96% (N = 77) of patients in
the EES group, in 100% (N = 80) in the BES and 99% (N = 77) in the BVS
group. The device-oriented composite end point of cardiac death,
target-vessel myocardial infarction and target-lesion revascularization
occurred in 13 (16%) patients treated with EES, in 7 (9%) patients treated
with BES and in 16 (21%) patients treated with BVS. There was no
significant difference when the metallic stents were compared to the BVS
(p = 0.12). There was one late scaffold thrombosis throughout the trial in
the BVS group, and no definite stent thrombosis in either EES or BES
treated patients. Conclusions The current analysis shows no significant
differences with regard to clinical outcomes at 2 years between BVS and
the best-in-class metallic DES. Event rates were numerically higher in
BVS-treated patients. However, when BVS were compared to BES alone, the
occurrence of device related adverse events was significantly
increased.<br/>Copyright &#xa9; 2017

<56>
Accession Number
616633961
Author
Giannini C.; De Carlo M.; Tamburino C.; Ettori F.; Latib A.M.; Bedogni F.;
Bruschi G.; Presbitero P.; Poli A.; Fabbiocchi F.; Violini R.; Trani C.;
Giudice P.; Barbanti M.; Adamo M.; Colombo P.; Benincasa S.; Agnifili M.;
Petronio A.S.
Institution
(Giannini, De Carlo, Petronio) Azienda Ospedaliero-Universitaria Pisana,
Pisa, Italy
(Tamburino, Barbanti) Ferrarotto Hospital, University of Catania, Catania,
Italy
(Ettori, Adamo) Ospedali Civili, Brescia, Italy
(Latib, Benincasa) Scientific Institute S. Raffaele, Milan, Italy
(Bedogni, Agnifili) Policlinico San Donato, San Donato, Italy
(Bruschi, Colombo) "De Gasperis" Cardio Center ASST Niguarda Metropolitan
Hospital, Milan, Italy
(Presbitero) Clinical Institute Humanitas, Rozzano, Milan, Italy
(Poli) Ospedale Civile, Legnano, Italy
(Fabbiocchi) Centro Cardiologico Monzino, IRCCS, Milan, Italy
(Violini) San Camillo Forlanini Hospital, Rome, Italy
(Trani) Institute of Cardiology, Catholic University of Sacred Heart,
Rome, Italy
(Giudice) Giovanni Di Dio e Ruggi D'Aragona University Hospital, Salerno,
Italy
Title
Transcathether aortic valve implantation with the new repositionable
self-expandable Evolut R versus CoreValve system: A case-matched
comparison.
Source
International Journal of Cardiology. 243 (pp 126-131), 2017. Date of
Publication: 15 Sep 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Despite promising results following transcatheter aortic valve
implantation (TAVI), several relevant challenges still remain. To overcome
these issues, new generation devices have been developed. The purpose of
the present study was to determine whether TAVI with the new
self-expanding repositionable Evolut R offers potential benefits compared
to the preceding CoreValve, using propensity matching. Methods Between
June 2007 and November 2015, 2148 consecutive patients undergoing TAVI
either CoreValve (n = 1846) or Evolut R (n = 302) were prospectively
included in the Italian TAVI ClinicalService project. For the purpose of
our analysis 211 patients treated with the Evolut R were matched to 211
patients treated with the CoreValve. An independent core laboratory
reviewed all angiographic procedural data and an independent clinical
events committee adjudicated all events. Results Patients treated with
Evolut R experienced higher 1-year overall survival (log rank test p =
0.045) and a significantly lower incidence of major vascular access
complications, bleeding events and acute kidney injury compared to
patients treated with the CoreValve. Recapture manoeuvres to optimize
valve deployment were performed 44 times, allowing a less implantation
depth for the Evolut R. As a consequence, the rate of more than mild
paravalvular leak and new permanent pacemaker was lower in patients
receiving the Evolut R. Conclusion In this matched comparison of high
surgical risk patients undergoing TAVI, the use of Evolut R was associated
with a significant survival benefit at 1 year compared with the CoreValve.
This was driven by lower incidence of periprocedural complications and
higher rates of correct anatomic positioning.<br/>Copyright &#xa9; 2017
Elsevier B.V.

<57>
Accession Number
617472324
Author
Elgendy H.; Helmy H.A.R.
Institution
(Elgendy) HAMAD Medical Corporation, Doha, Qatar
(Elgendy) Anesthesia Dept., Assiut University Hospitals, Egypt
(Helmy) Cardiology Dept., Assiut University Hospitals, Egypt
Title
Intrathecal morphine improves hemodynamic parameters and analgesia in
patients undergoing aortic valve replacement surgery: A prospective,
double-blind, randomized trial.
Source
Pain Physician. 20 (5) (pp 405-412), 2017. Date of Publication: 2017.
Publisher
American Society of Interventional Pain Physicians (E-mail:
editor@painphysicianjournal.com)
Abstract
Background: Intrathecal morphine (ITM) has been used in hopes of providing
good postoperative analgesia in cardiac surgery. Little is known about its
use in isolated aortic valve replacement surgery. Objectives: To evaluate
the effects of 7 mu/kg ITM administration in aortic valve replacement in
regards to hemodynamics, pain score, and postoperative complications when
compared to general anesthesia alone. Study Design: A randomized,
double-blind trial. Setting: Academic medical center. Methods: Forty-four
patients, who underwent aortic valve replacement, were randomly assigned
to receive ITM, before the induction of general anesthesia (ITM group, n =
22) or no intrathecal injection i.e., general anesthesia alone (control
group, n = 22). Induction of anesthesia was done with fentanyl, propofol,
and isoflurane. Pain scores, determined by visual analog scale (VAS), were
recorded immediately after extubation, at the first, sixth, twelfth,
eighteenth, and twenty-fourth hour after extubation. Hemodynamics, heart
rate, mean arterial pressure, central venous pressure, pulmonary capillary
wedge pressure, and cardiac index were recorded intra-operatively and up
to 24 hours post-operatively. Results: VAS scores were lower in the ITM
group at each measured time than control group (P < 0.01). The cumulative
fentanyl consumption during the first 24 hours after extubation was
significantly reduced by 35% in the ITM group (951 micro&#32;g/first 24
hours) as compared to the control group (1463.6 micro&#32;g/first 24
hours), (P < 0.001). The mean time to first request for rescue analgesia
was significantly prolonged in the ITM group (20.11 +/- 4.24 hours, P <
0.001) compared with the control group (0.60 +/- 0.44 hours). The mean
tramadol consumption dose was significantly reduced in the ITM group
(279.33 +/- 61.35 mg), compared with the control group (895 +/- 106.42
mg), (P < 0.001). Hemodynamic parameters exhibited a significant decrease
in HR and MAP in the ITM group, but no significant difference was found in
regards to CVP, PCWP, and CI. Glyceryl trinitrate consumption in the first
24 hours was significantly reduced by 43% in the ITM group (28.3 mg/first
24 hours) when compared to the control group (145.5 mg/first 24 hours), (P
< 0.001). Extubation time (4.5 +/- 7.5 vs. 5.3 +/- 1.0 hours, P < 0.05)
and intensive care unit length of stay (3.7 +/- 1.0 vs. 5.6 +/- 1.6 days,
P < 0.01) were shorter in the ITM group. Limitations: Small sample size.
Conclusions: In valvular heart disease patients undergoing aortic
replacement surgery, ITM is a good adjunct to general anesthesia as a safe
and effective analgesic alternative. It provides better hemodynamic
control, earlier tracheal extubation, and shorter ICU stay.<br/>Copyright
&#xa9; 2017, American Society of Interventional Pain Physicians. All
rights reserved.

<58>
[Use Link to view the full text]
Accession Number
617417903
Author
Mohananey D.; Jobanputra Y.; Kumar A.; Krishnaswamy A.; Mick S.; White
J.M.; Kapadia S.R.
Institution
(Mohananey, Krishnaswamy) Department of Hospital Medicine, Cleveland
Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States
(Jobanputra, Kumar, White, Kapadia) Department of Cardiovascular Medicine,
Cleveland Clinic, OH, United States
(Mick) Department of Cadiothoracic Surgery, Cleveland Clinic, OH, United
States
Title
Clinical and Echocardiographic Outcomes Following Permanent Pacemaker
Implantation after Transcatheter Aortic Valve Replacement: Meta-Analysis
and Meta-Regression.
Source
Circulation: Cardiovascular Interventions. 10 (7) (no pagination), 2017.
Article Number: e005046. Date of Publication: 01 Jul 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Transcatheter aortic valve replacement has become the
procedure of choice for inoperable, high-risk, and many intermediate-risk
patients with aortic stenosis. Conduction abnormalities are a common
finding after transcatheter aortic valve replacement and often result in
permanent pacemaker (PPM) implantation. Data pertaining to the clinical
impact of PPM implantation are controversial. We used meta-analysis
techniques to summarize the effect of PPM implantation on clinical and
echocardiographic outcomes after transcatheter aortic valve replacement.
Methods and Results - Data were summarized as Mantel-Haenszel relative
risk (RR) and 95% confidence intervals (CIs) for dichotomous variables and
as standardized mean difference and 95% CI for continuous variables We
used the Higgins I² statistic to evaluate heterogeneity. We
found that patients with and without PPM have similar all-cause mortality
(RR, 0.85; 95% CI, 0.70-1.03), cardiovascular mortality (RR, 0.84; 95% CI,
0.59-1.18), myocardial infarction (RR, 0.47; 95% CI, 0.20-1.11), and
stroke (RR, 1.26; 95% CI, 0.70-2.26) at 30 days. The groups were also
comparable in all-cause mortality (RR, 1.03; 95% CI, 0.92-1.16),
cardiovascular mortality (RR, 0.69; 95% CI, 0.39-1.24), myocardial
infarction (RR, 0.58; 95% CI, 0.30-1.13), and stroke (RR, 0.70; 95% CI,
0.47-1.04) at 1 year. We observed that the improvement in left ventricular
ejection fraction was significantly greater in the patients without PPM
(standardized mean difference, 0.22; 95% CI, 0.12-0.32). Conclusions - PPM
implantation is not associated with increased risk of all-cause mortality,
cardiovascular mortality, stroke, or myocardial infarction both at short-
and long-term follow-up. However, PPM is associated with impaired left
ventricular ejection fraction recovery post-transcatheter aortic valve
replacement.<br/>Copyright &#xa9; 2017 American Heart Association, Inc.

<59>
[Use Link to view the full text]
Accession Number
617399445
Author
Palla M.; Briasoulis A.; Siddiqui F.; Alesh I.; Afonso L.
Institution
(Palla, Briasoulis, Siddiqui, Alesh, Afonso) Division of Cardiology,
Detroit Medical Center, Wayne State University, Detroit, MI 48226, United
States
Title
Long (>12 Months) and Short (<6 Months) Versus Standard Duration of Dual
Antiplatelet Therapy after Coronary Stenting: A Systematic Review and
Meta-Analysis.
Source
American Journal of Therapeutics. 24 (4) (pp e468-e476), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Dual antiplatelet therapy (DAPT) is recommended for 6-12 months after
drug-eluting stent (DES) implantation to prevent ischemic events and late
stent thrombosis. The optimal duration of DAPT has not been established.
We performed a meta-analysis of the comparative effects of short and long
versus standard duration DAPT duration on adverse cardiovascular and major
bleeding. We conducted an EMBASE and MEDLINE search for studies in which
patients were randomized to treatment with a different duration of DAPT.
We included studies that provided data on DES selection, DAPT regimen and
duration, and incidence of the selected endpoints at the end of the
follow-up period. We identified 5 prospective randomized studies comparing
short versus standard duration DAPT and 3 comparing long versus standard
duration DAPT with a total of 28,343 patients. Short-term DAPT has similar
incidence of stent thrombosis, MI, and death compared to standard duration
DAPT, whereas major bleeding was significantly lower in short duration
DAPT. Long-term DAPT was associated with lower rates of stent thrombosis
and MI but significantly increased major bleeding and all-cause mortality
compared to standard duration DAPT. In this meta-analysis of prospective
controlled studies we found that short duration DAPT is safer and as
effective as standard duration DAPT in patients with second-generation
DES. Extended DAPT is associated with less ischemic events at the expense
of high bleeding and mortality rates.<br/>Copyright &#xa9; 2015 Wolters
Kluwer Health, Inc. All rights reserved.

<60>
Accession Number
617350858
Author
Lee J.; Jung C.-W.; Jeon Y.; Kim T.K.; Cho Y.J.; Koo C.-H.; Choi Y.H.; Kim
K.-B.; Hwang H.Y.; Kim H.-R.; Park J.-Y.
Institution
(Lee, Jung, Jeon, Kim, Cho, Koo, Choi) Department of Anesthesiology and
Pain Medicine, Seoul National University College of Medicine, Seoul
National University Hospital, Seoul, South Korea
(Kim, Hwang) Department of Thoracic and Cardiovascular Surgery, Seoul
National University College of Medicine, Seoul National University
Hospital, Seoul, South Korea
(Kim) Department of Anatomy and Cell Biology, Department of Biomedical
Sciences, BK21 Plus Biomedical Science Project, Seoul National University
College of Medicine, Seoul, South Korea
(Park) FACS Core Facility, Seoul National University College of Medicine,
Seoul, South Korea
(Lee) Department of Anesthesiology and Pain Medicine, Keimyung University
College of Medicine, Dongsan Medical Center, Daegu, South Korea
Title
Effects of preoperative aspirin on perioperative platelet activation and
dysfunction in patients undergoing off-pump coronary artery bypass graft
surgery: A prospective randomized study.
Source
PLoS ONE. 12 (7) (no pagination), 2017. Article Number: e0180466. Date of
Publication: July 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
The benefit of aspirin use after coronary artery bypass graft surgery has
been well proven. However, the effect of preoperative aspirin use in
patients undergoing off-pump coronary artery bypass graft surgery (OPCAB)
has not been evaluated sufficiently. To evaluate platelet function changes
during OPCAB due to preoperative aspirin use, we conducted a randomized
controlled trial using flow cytometry and the Multiplate
analyzer. Forty-eight patients scheduled for elective OPCAB were
randomized to the aspirin continuation (100 mg/day until operative day)
and discontinuation (4 days before the operative day) groups. Platelet
function was measured using the platelet activation markers CD62P, CD63,
and PAC-1 by flow cytometry, and platelet aggregation was measured using
the Multiplate analyzer, after the induction of anesthesia
(baseline), at the end of the operation, and 24 and 48 h postoperatively.
Findings of conventional coagulation assays, thromboelastography by
ROTEM assays, and postoperative bleeding-related clinical
outcomes were compared between groups. No significant change in CD62P,
CD63, or PAC-1 was observed at the end of the operation or 24 or 48 h
postoperatively compared with baseline in either group. The area under the
curve for arachidonic acid-stimulated platelet aggregation, measured by
the Multiplate analyzer, was significantly smaller in the
aspirin continuation group (P < 0.01). However, chest tube drainage and
intraoperative and postoperative transfusion requirements did not differ
between groups. Our study showed that preoperative use of aspirin for
OPCAB did not affect perioperative platelet activation, but it impaired
platelet aggregation, which did not affect postoperative bleeding, by
arachidonic acid.<br/>Copyright &#xa9; 2017 Lee 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.

<61>
Accession Number
617346021
Author
Silva M.; Carneiro M.; Nunes J.; da Silva A.; de Sousa M.
Institution
(Silva) Inteventional Cardiology Department, Hospital Universitario
Ciencias Medicas, Belo Horizonte 30140-073, Brazil
(Carneiro, Nunes, da Silva) Inteventional Cardiology Department, Hospital
Sao Jose do Avai, Itaperuna 28300-000, Brazil
(de Sousa) Post Graduation Program in Adult Health Sciences Division of
Cardiology and Cardiovascular Surgery, Hospital das Clinicas, School of
Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
Title
Systematic Review and Meta-analysis of Prevalence of Coronary Artery
Disease in Adult Patients with Cardiac Myxomas.
Source
F1000Research. 4 (no pagination), 2015. Article Number: 194. Date of
Publication: 2015.
Publisher
Faculty of 1000 Ltd (E-mail: info@f1000.com)
Abstract
Background: Studies have reported varied prevalence estimates of coronary
artery disease (CAD) in cardiac myxoma patients. We performed a systematic
review and meta-analysis of observational studies to summarize the point
prevalence of CAD in adults with cardiac myxomas. Methods and Results: Two
independent investigators searched MEDLINE and LILACS databases using the
terms " Myxoma", " Coronary Angiography" and " Coronary Disease" from
inception through December 2014 for all relevant studies. We included 6
observational studies. Publication bias was evaluated through Egger's test
and Trim and Fill method. A pooled estimate of CAD prevalence with
corresponding 95% confidence interval (CI) was calculated based on a
random-effects model. The pooled CAD prevalence in adult cardiac myxoma
patients was 20.7% with low heterogeneity (I 2 = 14.86%). Conclusions: It
is a matter of debate if preoperative coronary angiography must be done as
a routine procedure. Although coronary disease and angiographically
detectable neovascularity can alter surgical management, more studies are
needed to evaluate this question.<br/>Copyright &#xa9; 2015 Silva M et al.

<62>
Accession Number
617493096
Author
Hage A.; Voisine P.; Erthal F.; Larose E.; Glineur D.; Chow B.; Tremblay
H.; Fortier J.; Ko G.; Une D.; Farkouh M.; Mesana T.G.; LeMay M.; Kulik
A.; Ruel M.
Institution
(Hage, Voisine, Tremblay) Division of Cardiac Surgery, Quebec Heart and
Lung Institute, Quebec City, Quebec, Canada
(Larose) Division of Cardiology, Quebec Heart and Lung Institute, Quebec
City, Quebec, Canada
(Erthal, Chow, LeMay) Division of Cardiology, University of Ottawa Heart
Institute, Ottawa, Ontario, Canada
(Glineur, Fortier, Ko, Mesana, Ruel) Division of Cardiac Surgery,
University of Ottawa Heart Institute, Ottawa, Ontario, Canada
(Une) Division of Cardiovascular Surgery, Yamato Seiwa Hospital, Yamato,
Japan
(Farkouh) Division of Cardiology, Mount Sinai Hospital, New York, NY
(Kulik) Division of Cardiovascular Surgery, Lynn Heart and Vascular
Institute, Boca Raton, Fla
Title
Eight-year follow-up of the Clopidogrel After Surgery for Coronary Artery
Disease (CASCADE) trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: In this 8 years' follow-up study, we evaluated the long-term
outcomes of the addition of clopidogrel to aspirin during the first year
after coronary artery bypass grafting, versus aspirin plus placebo, with
respect to survival, major adverse cardiac, or major cerebrovascular
events, including revascularization, functional status, graft patency, and
native coronary artery disease progression. Methods: In the initial
Clopidogrel After Surgery for Coronary Artery Disease trial, 113 patients
were randomized to receive either daily clopidogrel (n = 56) or placebo (n
= 57), in addition to aspirin, in a double-blind fashion for 1 year after
coronary artery bypass grafting. All patients were re-evaluated to collect
long-term clinical data. Surviving patients with a glomerular filtration
rate > 30 mL/min were asked to undergo a coronary computed tomography
angiogram to evaluate the late saphenous vein graft patency and native
coronary artery disease progression. Results: At a median follow-up of 7.6
years, survival rate was 85.5% +/- 3.8% (P = .23 between the 2 groups). A
trend toward enhanced freedom from all-cause death or major adverse
cardiac or cerebrovascular events, including revascularization, was
observed in the aspirin-clopidogrel group (P = .11). No difference in
functional status or freedom from angina was observed between the 2 groups
(P > .57). The long-term patency of saphenous vein graft was 89.11% in the
aspirin-clopidogrel group versus 91.23% in the aspirin-placebo group (P =
.79). A lower incidence of moderate to severe native disease progression
was observed in the aspirin-clopidogrel group versus the aspirin-placebo
group (7 out of 122 vs 13 out of 78 coronary segments that showed
progression, respectively [odds ratio, 0.3 +/- 0.2; 95% confidence
interval, 0.1-0.8; P = .02]). Conclusions: At 8 years' follow-up, the
addition of clopidogrel to aspirin during the first year after coronary
artery bypass grafting exhibited a lower incidence of moderate to severe
progression of native coronary artery disease and a trend toward higher
freedom from major adverse cardiac or cerebrovascular events, including
revascularization, or death in the aspirin-clopidogrel group. Clinical
Trial Registration: http://www.clinicaltrials.gov. Unique identifier:
NCT00228423.<br/>Copyright &#xa9; 2017 The American Association for
Thoracic Surgery.