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<1>
Accession Number
615096208
Author
Tran K.C.; Leung A.A.; Tang K.L.; Quan H.; Khan N.A.
Institution
(Tran, Khan) Division of General Internal Medicine, University of British
Columbia, Vancouver, British Columbia, Canada
(Leung, Tang) Department of Medicine, University of Calgary, Calgary,
Alberta, Canada
(Leung, Quan) Department of Community Health Sciences, University of
Calgary, Calgary, Alberta, Canada
(Khan) Center for Health Evaluation and Outcome Sciences, Vancouver,
British Columbia, Canada
Title
Efficacy of Calcium Channel Blockers on Major Cardiovascular Outcomes for
the Treatment of Hypertension in Asian Populations: A Meta-analysis.
Source
Canadian Journal of Cardiology. 33 (5) (pp 635-643), 2017. Date of
Publication: May 2017.
Publisher
Pulsus Group Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background Whether calcium channel blockers exert a greater effect on
cardiovascular risk reduction in Asian populations than other
antihypertensive agents is unclear. We conducted a meta-analysis of
hypertension trials of dihydropyridine calcium channel blockers in Asian
populations to clarify this association. Methods EMBASE, MEDLINE, and
Cochrane databases were searched (from inception to August 2016) for
randomized controlled trials on cardiovascular death, major adverse
cardiovascular events, stroke, congestive heart failure, and coronary
revascularization in Asian persons with hypertension. We identified 9
trials that reported data specific to Asian populations (N = 29,643).
These trials included 1 placebo-controlled trial and 8 active comparator
trials; of these, 5 had angiotensin receptor blockers as the active
comparator. Results One placebo-controlled trial (n = 9711) showed
significantly reduced cardiovascular mortality, major adverse
cardiovascular events, and stroke with calcium channel blockers. Among 8
active comparator trials (n = 19,932), there were no significant
differences in mortality (relative risk [RR], 1.10; 95% confidence
interval [CI], 0.72-1.67; I² = 0.0%), major adverse
cardiovascular events (RR, 1.02; 95% CI, 0.90-1.15; I² = 0.0%),
stroke (RR, 0.97; 95% CI, 0.80-1.17; I² = 0.0%), congestive
heart failure (RR, 1.01; 95% CI, 0.51-2.00; I² = 53.7), or
coronary revascularization rates (RR, 0.98; 95% CI, 0.76-1.25;
I² = 0.0%) in the calcium channel blocker group compared with
other antihypertensive agents. When restricting the meta-analysis to
angiotensin receptor blocker comparators (n = 10,384), there were no
significant differences in cardiovascular outcomes. Conclusions There is
no evidence that dihydropyridine calcium channel blockers are superior to
other antihypertensive agents in Asian populations for the treatment of
hypertension.<br/>Copyright &#xa9; 2017 Canadian Cardiovascular Society

<2>
Accession Number
615948879
Author
De Vries A.J.; Lansink-Hartgring A.O.; Fernhout F.-J.; Huet R.C.G.; Van
Den Heuvel E.R.
Institution
(De Vries, Huet) Department of Anesthesiology, University Medical Center
Groningen, University of Groningen, RB Groningen 9700, Netherlands
(Lansink-Hartgring) Department of Critical Care, University Medical Center
Groningen, University of Groningen, Groningen, Netherlands
(Fernhout) Department of Cardiothoracic Surgery, University Medical Center
Groningen, University of Groningen, Groningen, Netherlands
(Van Den Heuvel) Department of Mathematics and Computer Science, Eindhoven
University of Technology, PO box 30.001, Eindhoven, Netherlands
Title
The activated clotting time in cardiac surgery: Should Celite or kaolin be
used?.
Source
Interactive Cardiovascular and Thoracic Surgery. 24 (4) (pp 549-554),
2017. Date of Publication: 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES: Both kaolin- and Celite-activated clotting times (ACT) are
used to guide anticoagulation during cardiopulmonary bypass. It is unknown
whether these methods lead to similar management procedures for
anticoagulation in patients and are thus interchangeable in terms of bias,
precision and variability. METHODS: We randomized 97 patients undergoing
coronary artery bypass grafting or aortic valve replacement to either
kaolin- or Celite-guided anticoagulation. The ACT was measured
simultaneously with the other method. We administered 300 IU/kg heparin to
obtain initial ACT values greater than 400 s and additional heparin in
each group using the minimum value of duplicate measurements according to
a predefined protocol. The primary end point was the total heparin dose
and the number of heparin supplements. RESULTS: The total heparin dose per
patient in the 48 Celite-guided patients was 35 271 +/- 12 406 IU with 51
supplements and in the 49 kaolin-guided patients, 35 997 +/- 11 540 IU (P
= 0.77) with 56 supplements (P = 0.53). Postoperative thrombin generation
time, fibrinolytic response time, chest tube loss and transfusion
requirements were not different between the two groups. However, the
methods differed in individual patients with regard to supplemental
heparin (P = 0.002). Bias between methods at baseline was +10.3%, Celite
being higher, and changed to a value of -12.9% at 2 h bypass. The
coefficient of variation at baseline for individual patients was 2.6 times
larger with kaolin than with Celite (P < 0.001). Correlation between ACT
values at baseline was only 45%. CONCLUSIONS: Kaolin- and Celite-guided
management of anticoagulation is clinically not different, but the methods
are not interchangeable.<br/>Copyright &#xa9; The Author 2017. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<3>
Accession Number
615670824
Author
Moradian S.T.; Ghiasi M.S.; Mohamadpour A.; Siavash Y.
Institution
(Moradian, Ghiasi, Mohamadpour, Siavash) Nursing Faculty, Baqiyatallah
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Oral magnesium supplementation reduces the incidence of gastrointestinal
complications following cardiac surgery: A randomized clinical trial.
Source
Magnesium Research. 30 (1) (pp 28-34), 2017. Date of Publication:
January-February-March 2017.
Publisher
John Libbey Eurotext (127, avenue de la Republique, Montrouge 92120,
France. E-mail: contact@jle.com)
Abstract
Background. Gastrointestinal complications are common after coronary
artery bypass graft surgery. These complications are ranged from nausea
and vomiting to mesenteric ischemia and liver failure. It seems that
nausea, vomiting, and constipation are related to magnesium deficiency.
This study was designed to examine the effect of oral magnesium
supplementation on the incidence of gastrointestinal complications in
patients undergoing cardiac surgery. Method. In a single blinded
randomized clinical trial, 102 patients who were undergoing coronary
artery bypass graft surgery were randomly allocated into two groups, 52
patients in the intervention and 50 patients in control group. Patients in
the experimental group received 800 milligram magnesium oxide (2 tablets
each of them containing 240 mg elemental magnesium) daily from the
admission to discharge from hospital. The incidence of post-operative
nausea and vomiting, constipation, and atrial fibrillation was compared
between the groups. Results. Our results showed that postoperative
hypomagnesemia is present in 41.20 and 70.80 percent of the patients in
the intervention and control group patients, respectively. The overall
incidence of constipation was 62%. Patients who received magnesium
supplementation experienced less atrial fibrillation, nausea, vomiting,
and constipation. Conclusion. Our data showed that oral magnesium
supplementation could reduce the postoperative complications. Despite the
better status in the intervention group, the hypomagnesemia was present in
many of intervention group patients. It seems that supplementation with
higher doses is needed.<br/>Copyright &#xa9; 2017 John Libbey Eurotext.

<4>
Accession Number
612962869
Author
Kimmel S.E.; Troxel A.B.; French B.; Loewenstein G.; Doshi J.A.; Hecht
T.E.H.; Laskin M.; Brensinger C.M.; Meussner C.; Volpp K.
Institution
(Kimmel) Center for Therapeutic Effectiveness Research, University of
Pennsylvania, Philadelphia, PA, United States
(Kimmel, Troxel, French, Brensinger, Meussner) Department of Biostatistics
and Epidemiology, University of Pennsylvania, Philadelphia, PA, United
States
(Kimmel, Doshi, Hecht, Volpp) Department of Medicine, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, PA, United States
(Kimmel, Troxel, French, Loewenstein, Doshi, Volpp) Center for Health
Incentives and Behavioral Economics, Leonard Davis Institute of Health
Economics, University of Pennsylvania, Philadelphia, PA, United States
(Loewenstein) Department of Social and Decision Sciences, Carnegie Mellon
University, Pittsburgh, PA, United States
(Laskin) Department of Pharmacy Service, Hospital of the University of
Pennsylvania, Philadelphia, PA, United States
(Volpp) Center for Health Equity Research and Promotion, Philadelphia
Veterans Affairs Medical Center, Philadelphia, PA, United States
(Volpp) Department of Health Care Management, University of Pennsylvania,
Philadelphia, PA, United States
(Volpp) Department of Medical Ethics and Health Policy, University of
Pennsylvania, Philadelphia, PA, United States
Title
A randomized trial of lottery-based incentives and reminders to improve
warfarin adherence: the Warfarin Incentives (WIN2) Trial.
Source
Pharmacoepidemiology and Drug Safety. 25 (11) (pp 1219-1227), 2016. Date
of Publication: 01 Nov 2016.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Previous research has suggested that daily lottery incentives
could improve medication adherence. Such daily incentives include implicit
reminders. However, the comparative effectiveness of reminders alone
versus daily incentives has not been tested. Methods: A total of 270
patients on warfarin were enrolled in a four-arm, multi-center, randomized
controlled trial comparing a daily lottery-based incentive, a daily
reminder, and a combination of the two against a control group (usual
care). Results: Participants in the reminder group had the lowest
percentage of time out of target international normalized ratio (INR)
range, the primary outcome, with an adjusted odds of an out-of-range INR
36% lower than among those in the control group, 95%CI [7%, 55%]. No other
group had a statistically significant improvement in anticoagulation
control relative to the control group or to each other. The only group
that had significant improvement in incorrect adherence was the lottery
group (incorrect adherence: 12.1% compared with 23.7% in the control
group, difference of -7.4% 95%CI [-14%, -0.3%]). However, there was no
relationship between changes in adherence and anticoagulation control in
the lottery group. Conclusions: Automated reminders led to the largest
improvements in anticoagulation control, although without impacting
measured adherence. Lottery-based reminders improved measured adherence
but did not lead to improved anticoagulation control. Copyright &#xa9;
2016 John Wiley & Sons, Ltd.<br/>Copyright &#xa9; 2016 John Wiley & Sons,
Ltd.

<5>
Accession Number
610913535
Author
Liu T.; Korantzopoulos P.; Shao Q.; Zhang Z.; Letsas K.P.; Li G.
Institution
(Liu, Shao, Zhang, Li) Tianjin Key Laboratory of Ionic-Molecular Function
of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of
Cardiology, Second Hospital, Tianjin Medical University, No. 23 Pingjiang
Road, Hexi District, Tianjin 300211, China
(Korantzopoulos) First Department of Cardiology, University of Ioannina,
Medical School, Ioannina, Greece
(Letsas) Second Department of Cardiology, Laboratory of Cardiac
Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
Title
Mineralocorticoid receptor antagonists and atrial fibrillation: A
meta-analysis.
Source
Europace. 18 (5) (pp 672-678), 2016. Date of Publication: 24 May 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims Aldosterone has been implicated in atrial remodelling representing a
potential target for upstream therapies. Accumulating evidence suggests
that mineralocorticoid receptor blockade may have favourable effects on
atrial fibrillation (AF) development, although some controversial results
have been published. We, therefore, conducted a meta-analysis of
randomized clinical trials (RCTs) and observational studies in order to
examine the protective role of mineralocorticoid receptor antagonists
(MRAs) on AF. Methods and results Of the 1337 initially identified
records, 3 RCTs and 2 observational studies with 3640 patients were
finally analysed. The pooled analysis of the included studies demonstrated
that patients treated with MRAs have 31% lower risk of AF compared with
controls [relative ratio (RR): 0.69; 95% confidence interval (CI):
0.58-0.83] without any heterogeneity across the studies (I² =
0%). This effect was consistent across RCTs (RR: 0.72; 95% CI: 0.55-0.94)
and observational studies (RR: 0.67; 95% CI: 0.53-0.84) without
heterogeneity. Also, MRAs reduce the risk of AF in both heart failure (HF)
(RR: 0.63; 95% CI: 0.50-0.80) and after cardiac surgery (RR: 0.77; 95% CI:
0.61-0.98). Analysing the relative impact of eplerenone and
spironolactone, we showed that only eplerenone significantly reduces AF
burden (RR: 0.64; 95% CI: 0.44-0.90). Conclusion Our meta-analysis
suggests that MRAs may be effective in AF prevention especially in the HF
setting. However, there are insufficient data for the widespread use of
aldosterone antagonists solely for AF prevention. Larger RCTs with
long-term follow-up in different clinical settings are needed to clarify
the impact of MRAs on AF.<br/>Copyright &#xa9; The Author 2015.

<6>
Accession Number
610598217
Author
Stonier T.; Harrison M.; Choong A.M.T.L.
Institution
(Stonier) Royal Free Hospital, London, United Kingdom
(Stonier) University College London, School of Medicine, London, United
Kingdom
(Harrison) Deparment of Cardiology, Hammersmith Hospital, London, United
Kingdom
(Harrison) Imperial College School of Medicine, London, United Kingdom
(Choong) Department of Cardiac, Thoracic and Vascular Surgery, National
University Heart Centre, Level 9, 1E Kent Ridge Road, Singapore 119228,
Singapore
(Choong) School of Medicine, University of Queensland, Brisbane, QLD,
Australia
(Choong) School of Medicine, Griffith University, Gold Coast, QLD,
Australia
Title
A systematic review of transcatheter aortic valve implantation via carotid
artery access.
Source
International Journal of Cardiology. 219 (pp 41-55), 2016. Date of
Publication: 15 Sep 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background The carotid artery is a novel access route for transcatheter
aortic valve implantation (TAVI). This may represent a viable alternative
in patients unsuitable for TAVI via traditional transfemoral access, up to
20%, as well as other access routes such as subclavian, transapical and
aortic. This systematic review summarises the current evidence for its
safety and feasibility. Methods A systematic review was conducted as per
the Preferred Reporting Instructions for Systematic Reviews and
Meta-analysis (PRISMA) guidelines using five electronic databases. Results
16 studies were identified, including three prospective cohort studies,
one retrospective cohort study, three case series and eight case reports.
Data on 74 patients (mean age 76.9 years) was extracted including
pre-operative work-up, technical procedure details and outcomes. This
found 1 intraoperative death, 2 further deaths within 30 days, two
incidences of transient ischaemic attack, no incidences of stroke,
myocardial infarction, carotid access site complications or infection, 1
patient required new dialysis and 1 patient had an intraoperative
dissection which resolved. Follow-up from 30 days to 1 year showed
symptomatic improvement and echocardiographic improvement in line with
those seen in transfemoral TAVI. Conclusions The available data on TAVI
via carotid access demonstrate technical feasibility with comparable
outcomes to other traditional access routes. A low number of patients,
heterogeneous clinical endpoints and relatively short follow-up periods
limit formal meta-analysis and firmer conclusions. For patients in which
other access routes are impossible, TAVI via carotid access represents a
viable and potentially crucial alternative in patients who might otherwise
be untreatable.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd. All rights
reserved.

<7>
Accession Number
610900318
Author
Belgaid D.R.; Khan Z.; Zaidi M.; Hobbs A.
Institution
(Belgaid, Khan, Zaidi) Barts and the London School of Medicine and
Dentistry, London, United Kingdom
(Hobbs) William Harvey Research Institute, Barts and the London School of
Medicine and Dentistry, QMUL, Charterhouse Square, London EC1M 6BQ, United
Kingdom
Title
Prospective randomized evaluation of the watchman left atrial appendage
closure device in patients with atrial fibrillation versus long-term
warfarin therapy the PREVAIL trial.
Source
International Journal of Cardiology. 219 (pp 177-179), 2016. Date of
Publication: 15 Sep 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives Assessing the safety and effectiveness of left atrial appendage
(LAA) (pouch found in the upper chambers of the heart) occlusion, using
the Watchman device compared to long term warfarin therapy (drug that
reduces clot formation), in preventing the risk of stroke in patients with
atrial fibrillation (most common type of irregular heart beat). 90% of
strokes in atrial fibrillation arise from clots forming in this pouch. By
mechanically blocking it using the device less clots are suggested to be
formed. This is an alternative to taking warfarin especially in patients
who cannot take it. Setting and participants 50 sites in the United States
enrolled 407 participants. After being randomly allocated, the device
group had 269 participants and warfarin group (comparator)had 138
participants. Method Patients with atrial fibrillation and at high risk of
stroke were randomly allocated a group after they were deemed eligible.
Patients in the device group had to take warfarin and aspirin for 45 days
till the complete closure of the LAA. The oral anticoagulant was followed
by dual antiplatelet therapy until 6 months and then ASA. Patients in the
warfarin group have to take it for life and were continually monitored.
The study ran for 26 months. Main outcome measures The trial assessed the
rate of adverse events using three endpoints:Primary efficacy endpoint:
overall rates of stroke and death,Late ischemic primary efficacy endpoint:
stroke or systemic embolism > 1 week post-randomization,Early safety
primary endpoint: complications within 1 week of the procedure. Results
The PREVAIL trial was not designed to show superiority, but
non-inferiority. It met the safety endpoint and one efficacy endpoint for
the watchman device compared to long term warfarin for overall efficacy of
the device. The results established that LAA occlusion is not worse than
warfarin intake for the prevention of stroke more than 1 week after
randomization. Compared to previous trials, the safety of the device has
also improved. Conclusion LAA occlusion is a reasonable alternative to
chronic warfarin therapy in stroke prevention for patients with atrial
fibrillation.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd.

<8>
Accession Number
610853543
Author
Mishra A.; Kumar B.; Dutta V.; Arya V.K.; Mishra A.K.
Institution
(Mishra, Kumar, Dutta, Arya) Department of Anaesthesia and Intensive Care,
Post Graduate Institute of Medical Education and Research, Chandigarh
160012, India
(Mishra) Cardiothoracic and Vascular Surgery, Post Graduate Institute of
Medical Education and Research, Chandigarh, India
Title
Comparative Effect of Levosimendan and Milrinone in Cardiac Surgery
Patients with Pulmonary Hypertension and Left Ventricular Dysfunction.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (3) (pp 639-646),
2016. Date of Publication: 01 Jun 2016.
Publisher
W.B. Saunders
Abstract
Objective To compare the effects of levosimendan with milrinone in cardiac
surgical patients with pulmonary hypertension and left ventricular
dysfunction. Design A prospective, randomized study. Setting Tertiary care
teaching hospital. Participants The study included patients with valvular
heart disease and pulmonary artery hypertension undergoing valve surgery.
Interventions Forty patients were allocated randomly to receive either
milrinone, 50 mug/kg bolus followed by infusion at a rate of 0.5
mug/kg/min (group 1), or levosimendan, 10 mug/kg bolus followed by
infusion at a rate of 0.1 mug/kg/min (group 2) for 24 hours after surgery.
Measurements and Main Results Hemodynamic parameters were measured using a
pulmonary artery catheter, and biventricular functions were assessed using
echocardiography. Mean pulmonary artery pressures and the pulmonary
vascular resistance index were comparable between the 2 groups at several
time points in the intensive care unit. Biventricular function was
comparable between both groups. Postcardiopulmonary bypass right
ventricular systolic and diastolic functions decreased in both groups
compared with baseline, whereas 6 hours postbypass left ventricular
ejection fraction improved in patients with stenotic valvular lesions.
Levosimendan use was associated with higher heart rate, increased cardiac
index, decreased systemic vascular resistance index, and increased
requirement of norepinephrine infusion compared with milrinone.
Conclusions The results of this study demonstrated that levosimendan was
not clinically better than milrinone. Levosimendan therapy resulted in a
greater increase in heart rate, decrease in systemic vascular resistance,
and a greater need for norepinephrine than in patients who received
milrinone.<br/>Copyright &#xa9; 2016 Elsevier Inc. All rights reserved.

<9>
Accession Number
610853529
Author
Hori D.; Max L.; Laflam A.; Brown C.; Neufeld K.J.; Adachi H.; Sciortino
C.; Conte J.V.; Cameron D.E.; Hogue C.W.; Mandal K.
Institution
(Hori, Sciortino, Conte, Cameron, Mandal) Division of Cardiac Surgery,
Department of Surgery, Johns Hopkins Hospital, Sheikh Zayed Tower, 1800
Orleans St, Baltimore, MD 21287-4618, United States
(Max, Laflam, Brown, Hogue) Department of Anesthesiology and Critical Care
Medicine, United States
(Neufeld) Department of Psychiatry, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
(Adachi) Department of Cardiovascular Surgery, Saitama Medical Center,
Jichi Medical University, Saitama, Japan
Title
Blood Pressure Deviations from Optimal Mean Arterial Pressure during
Cardiac Surgery Measured with a Novel Monitor of Cerebral Blood Flow and
Risk for Perioperative Delirium: A Pilot Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (3) (pp 606-612),
2016. Date of Publication: 01 Jun 2016.
Publisher
W.B. Saunders
Abstract
Objective The aim of this study was to evaluate whether excursions of
blood pressure from the optimal mean arterial pressure during and after
cardiac surgery are associated with postoperative delirium identified
using a structured examination. Design Prospective, observational study.
Setting University hospital. Participants The study included 110 patients
undergoing cardiac surgery. Interventions Patients were monitored using
ultrasound-tagged near-infrared spectroscopy to assess optimal mean
arterial pressure by cerebral blood flow autoregulation monitoring during
cardiopulmonary bypass and the first 3 hours in the intensive care unit.
Measurements and Main Results The patients were tested preoperatively and
on postoperative days 1 to 3 with the Confusion Assessment Method or
Confusion Assessment Method for the Intensive Care Unit, the Delirium
Rating Scale-Revised-98, and the Mini Mental State Examination. Summative
presence of delirium on postoperative days 1 through 3, as defined by the
consensus panel following Diagnostic and Statistical Manual of Mental
Disorders-IV-TR criteria, was the primary outcome. Delirium occurred in 47
(42.7%) patients. There were no differences in blood pressure excursions
above and below optimal mean arterial pressure between patients with and
without summative presence of delirium. Secondary analysis showed blood
pressure excursions above the optimal mean arterial pressure to be higher
in patients with delirium (mean+/-SD, 33.2+/-26.51 mmHgxh v 23.4+/-16.13
mmHgxh; p = 0.031) and positively correlated with the Delirium Rating
Scale score on postoperative day 2 (r = 0.27, p = 0.011). Conclusions
Summative presence of delirium was not associated with perioperative blood
pressure excursions; but on secondary exploratory analysis, excursions
above the optimal mean arterial pressure were associated with the
incidence and severity of delirium on postoperative day 2.<br/>Copyright
&#xa9; 2016 Elsevier Inc. All rights reserved.

<10>
Accession Number
607327390
Author
Maeda T.; Sakurai R.; Nakagawa K.; Morishima K.; Maekawa M.; Furumoto K.;
Kono T.; Egawa A.; Kubota Y.; Kato S.; Okamura H.; Yoshitani K.; Ohnishi
Y.
Institution
(Maeda, Sakurai, Nakagawa, Morishima, Maekawa, Furumoto, Kono, Egawa,
Kubota, Kato, Yoshitani, Ohnishi) Department of Anesthesiology, National
Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka
565-8565, Japan
(Okamura) Department of Cardiovascular Medicine, Division of Arrhythmia,
National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
Title
Cardiac Resynchronization Therapy-Induced Cardiac Index Increase Measured
by Three-Dimensional Echocardiography Can Predict Decreases in Brain
Natriuretic Peptide.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (3) (pp 599-605),
2016. Date of Publication: 01 Jun 2016.
Publisher
W.B. Saunders
Abstract
Objectives First, to examine the perioperative association between
increased cardiac index (CI) measured using three-dimensional
echocardiography (CI<inf>3D</inf>), two-dimensional echocardiography
(CI<inf>2D</inf>), and FloTrac/Vigileo (CI<inf>FT</inf>) (Edwards
Lifesciences, Irvine, CA) after cardiac resynchronization therapy (CRT)
and decreased brain natriuretic peptide (BNP) 6 months after CRT. Second,
to evaluate the accuracy and tracking ability of CI<inf>2D</inf> and
CI<inf>FT</inf>. Design A prospective clinical study. Setting A cardiac
surgery operating room in a single cardiovascular center. Participants
Forty-five patients undergoing elective CRT lead implantation.
Interventions CI<inf>FT</inf> and CI<inf>2D</inf> were determined
simultaneously before and after CRT using CI<inf>3D</inf> as the reference
method. Measurements and Main Results BNP was measured before CRT and 6
months after CRT. Areas under the receiver operator characteristic curves
(AUCs) were calculated for each method of measurement to predict BNP
decrease. AUC was largest for CI<inf>3D</inf> (AUC = 0.735, p = 0.017).
Bland-Altman analysis revealed that the percentage error was 58% for
CI<inf>FT</inf> and 28% for CI<inf>2D.</inf> A polar plot analysis showed
that the mean angular bias was -7.26degree and 0.64degree, the radial
limits of agreement were 70degree and 29.4degree, and the concordance rate
was 67.7% and 93.8% for CI<inf>FT</inf> and CI<inf>2D,</inf> respectively.
Conclusions CI significantly increased after CRT in patients whose BNP
level decreased 6 months after CRT. However, only CI<inf>3D</inf> could
predict decreases in BNP 6 months after CRT. Although CI<inf>2D</inf> was
acceptable compared with CI<inf>3D</inf>, the tracking ability of CI
changes was just below acceptable. CI<inf>FT</inf> has a wide limit of
agreement with CI<inf>3D,</inf> with a poor tracking
ability.<br/>Copyright &#xa9; 2016 Elsevier Inc. All rights reserved.

<11>
Accession Number
615827395
Author
Bravo C.A.; Hirji S.A.; Bhatt D.L.; Kataria R.; Faxon D.P.; Ohman E.M.;
Anderson K.L.; Sidi A.I.; Sketch M.H.; Zarich S.W.; Osho A.A.; Gluud C.;
Kelbaek H.; Engstrom T.; Hofsten D.E.; Brennan J.M.
Institution
(Bravo) Albert Einstein College of Medicine, Montefiore Medical Center,
Montefiore Einstein Center for Heart and Vascular Care, 111 East 210th
Street, Bronx, NY 10467, United States
(Hirji) Brigham and Women's Hospital, Harvard Medical School, Department
of Surgery, 75 Francis Street, Boston, MA 02115, United States
(Bhatt) Brigham and Women's Hospital, Heart and Vascular Centre, 75
Francis Street, Boston, MA 02115, United States
(Kataria) Yale New Haven Health System, Department of Internal Medicine,
267 Grant Street, Bridgeport, CT 06610, United States
(Faxon) Brigham and Women's Hospital, Cardiovascular Medicine, Brigham
Circle, 1620, Boston, MA 02120-1613, United States
(Ohman) Division of Cardiovascular Medicine, Duke Heart Center, Ambulatory
Care, Programme for Advanced Coronary Diseases, Duke University Medical
Center, Box 3126, Room 8676A HAFS Building, Durham, NC 27710, United
States
(Anderson) Duke University, School of Medicine, 201 Trent Drive, Durham,
NC 27705, United States
(Sidi) University of North Carolina, Department of Biology, 201 Councilman
court, Morrisville, NC 27560, United States
(Sketch, Brennan) Duke University School of Medicine, Department of
Medicine/Cardiology, DUMC 3157, Durham, NC 27710, United States
(Zarich) Yale New Haven Health System, Department of Cardiology, 267 Grant
St, Bridgeport, CT 06610, United States
(Osho) Massachusetts General Hospital, General Surgery, 55 Fruit Street,
Boston, MA 02114, United States
(Gluud) Copenhagen Trial Unit, Centre for Clinical Intervention Research,
Department 7812, Rigshospitalet, Copenhagen University Hospital, The
Cochrane Hepato-Biliary Group, Blegdamsvej 9, Copenhagen DK-2100, Denmark
(Kelbaek) Zealand University, Roskilde Hospital, Cardiac Catheterization
Laboratory, Kogevej 7-13, Roskilde 4000, Denmark
(Engstrom, Hofsten) Copenhagen University Hospital, Rigshospitalet,
Department of Cardiology, Blegdamsvej 9, Copenhagen 2100, Denmark
Title
Complete versus culprit-only revascularisation in ST elevation myocardial
infarction with multi-vessel disease.
Source
Cochrane Database of Systematic Reviews. 2017 (5) (no pagination), 2017.
Article Number: CD011986. Date of Publication: 04 May 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Multi-vessel coronary disease in people with ST elevation
myocardial infarction (STEMI) is common and is associated with worse
prognosis after STEMI. Based on limited evidence, international guidelines
recommend intervention on only the culprit vessel during STEMI. This, in
turn, leaves other significantly stenosed coronary arteries for medical
therapy or revascularisation based on inducible ischaemia on provocative
testing. Newer data suggest that intervention on both the culprit and
non-culprit stenotic coronary arteries (complete intervention) may yield
better results compared with culprit-only intervention. Objectives: To
assess the effects of early complete revascularisation compared with
culprit vessel only intervention strategy in people with STEMI and
multi-vessel coronary disease. Search methods: We searched the Cochrane
Central Register of Controlled Trials, MEDLINE, Embase, World Health
Organization International Clinical Trials Registry Platform Search
Portal, and ClinicalTrials.gov. The date of the last search was 4 January
2017. We applied no language restrictions. We handsearched conference
proceedings to December 2016, and contacted authors and companies related
to the field. Selection criteria: We included only randomised controlled
trials (RCTs), wherein complete revascularisation strategy was compared
with a culprit-only percutaneous coronary intervention (PCI) for the
treatment of people with STEMI and multi-vessel coronary disease. Data
collection and analysis: We assessed the methodological quality of each
trial using the Cochrane 'Risk of bias' tool. We resolved the
disagreements by discussion among review authors. We followed standard
methodological approaches recommended by Cochrane. The primary outcomes
were long-term (one year or greater after the index intervention)
all-cause mortality, long-term cardiovascular mortality, long-term
non-fatal myocardial infarction, and adverse events. The secondary
outcomes were short-term (within the first 30 days after the index
intervention) all-cause mortality, short-term cardiovascular mortality,
short-term non-fatal myocardial infarction, revascularisation,
health-related quality of life, and cost. We analysed data using
fixed-effect models, and expressed results as risk ratios (RR) with 95%
confidence intervals (CI). We used GRADE criteria to assess the quality of
evidence and we conducted Trial Sequential Analysis (TSA) to control risks
of random errors. Main results: We included nine RCTs, that involved 2633
people with STEMI and multi-vessel coronary disease randomly assigned to
either a complete (n = 1381) versus culprit-only (n = 1252)
revascularisation strategy. The complete and the culprit-only
revascularisation strategies did not differ for long-term all-cause
mortality (65/1274 (5.1%) in complete group versus 72/1143 (6.3%) in
culprit-only group; RR 0.80, 95% CI 0.58 to 1.11; participants = 2417;
studies = 8; I² = 0%; very low quality evidence). Compared with
culprit-only intervention, the complete revascularisation strategy was
associated with a lower proportion of long-term cardiovascular mortality
(28/1143 (2.4%) in complete group versus 51/1086 (4.7%) in culprit-only
group; RR 0.50, 95% CI 0.32 to 0.79; participants = 2229; studies = 6;
I² = 0%; very low quality evidence) and long-term non-fatal
myocardial infarction (47/1095 (4.3%) in complete group versus 70/1004
(7.0%) in culprit-only group; RR 0.62, 95% CI 0.44 to 0.89; participants =
2099; studies = 6; I² = 0%; very low quality evidence). The
complete and the culprit-only revascularisation strategies did not differ
in combined adverse events (51/2096 (2.4%) in complete group versus
57/1990 (2.9%) in culprit-only group; RR 0.84, 95% CI 0.58 to 1.21;
participants = 4086; I² = 0%; very low quality evidence).
Complete revascularisation was associated with lower proportion of
long-term revascularisation (145/1374 (10.6%) in complete group versus
258/1242 (20.8%) in culprit-only group; RR 0.47, 95% CI 0.39 to 0.57;
participants = 2616; studies = 9; I² = 31%; very low quality
evidence). TSA of long-term all-cause mortality, long-term cardiovascular
mortality, and long-term non-fatal myocardial infarction showed that more
RCTs are needed to reach more conclusive results on these outcomes.
Regarding long-term repeat revascularisation more RCTs may not change our
present result. The quality of the evidence was judged to be very low for
all primary and the majority of the secondary outcomes mainly due to risk
of bias, imprecision, and indirectness. Authors' conclusions: Compared
with culprit-only intervention, the complete revascularisation strategy
may be superior due to lower proportions of long-term cardiovascular
mortality, long-term revascularisation, and long-term non-fatal myocardial
infarction, but these findings are based on evidence of very low quality.
TSA also supports the need for more RCTs in order to draw stronger
conclusions regarding the effects of complete revascularisation on
long-term all-cause mortality, long-term cardiovascular mortality, and
long-term non-fatal myocardial infarction.<br/>Copyright &#xa9; 2017 The
Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

<12>
Accession Number
613853500
Author
Abd-Elsayed A.; Mascha E.J.; Yang D.; Sessler D.I.; Duncan A.
Institution
(Abd-Elsayed) Department of Anesthesiology, University of Wisconsin School
of Medicine and Public Health, 600 Highland Ave. B6/319, Madison, WI
53792-3272, United States
(Abd-Elsayed) Outcomes Research Consortium, Cleveland, OH, United States
(Mascha, Yang) Department of Quantitative Health Sciences, Cleveland
Clinic, Cleveland, OH, United States
(Mascha, Yang, Sessler, Duncan) Department of Outcomes Research, Cleveland
Clinic, Cleveland, OH, United States
(Duncan) Department of Cardiothoracic Anesthesiology, Cleveland Clinic,
Cleveland, OH, United States
Title
Hyperinsulinemic normoglycemia decreases glucose variability during
cardiac surgery.
Source
Journal of Anesthesia. 31 (2) (pp 185-192), 2017. Date of Publication: 01
Apr 2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Purpose: Increased glucose variability may be associated with worse
outcomes in critically ill patients. Hyperinsulinemic normoglycemia
provides intensive glucose control during surgery and may reduce glucose
variability. Our objective was to compare glycemic variability between two
methods of glucose control in cardiac surgical patients: hyperinsulinemic
normoglycemia vs standard insulin infusion. We also assessed whether the
effect differed between patients with and without diabetes mellitus.
Methods: We compared measures of glycemic variability, including the
primary outcome, average real variability (ARV), and secondary outcomes,
within-patient standard deviation (SD) and glucose lability index (GLI),
in 252 patients who received hyperinsulinemic normoglycemia and 266
patients who received standard therapy. Data was randomly sampled from
each patient treated with hyperinsulinemic normoglycemia, so patients in
each group had a similar number of glucose measurements. The significance
level for each hypothesis was 0.05, and 0.025 within diabetic status.
Results: For nondiabetic patients, hyperinsulinemic normoglycemia reduced
mean glucose measure-to-measure variability for ARV by an estimated -0.23
(97.5% CI -0.30, -0.16) mg/dl/min (P < 0.001) versus standard care. There
was no difference in glycemic variability between groups for diabetic
patients, with difference in means (97.5% CI) of -0.10 (-0.20, 0.02)
mg/dl/min, P = 0.07. Mean SD was lower for hyperinsulinemic normoglycemia
patients overall, with difference in means (95% CI) of -19 (-22, -16), P <
0.001, with a stronger effect in nondiabetics (interaction P = 0.042). GLI
was also lower with hyperinsulinemic normoglycemia. Conclusion:
Hyperinsulinemic normoglycemia decreases glucose variability for cardiac
surgical patients with a stronger effect in nondiabetic
patients.<br/>Copyright &#xa9; 2016, Japanese Society of
Anesthesiologists.

<13>
Accession Number
609137589
Author
Hosten T.; Kus A.; Gumus E.; Yavuz S.; Irkil S.; Solak M.
Institution
(Hosten, Kus, Gumus, Yavuz, Solak) Department of Anesthesiology and
Reanimation, Kocaeli University of Medical Faculty, Umuttepe, Kocaeli,
Turkey
(Irkil) Department of Cardiovascular Surgery, Kocaeli University,
Umuttepe, Kocaeli, Turkey
Title
Comparison of intraoperative volume and pressure-controlled ventilation
modes in patients who undergo open heart surgery.
Source
Journal of Clinical Monitoring and Computing. 31 (1) (pp 75-84), 2017.
Date of Publication: 01 Feb 2017.
Publisher
Springer Netherlands
Abstract
Respiratory problems occur more frequently in patients who undergo open
heart surgery. Intraoperative and postoperative ventilation strategies can
prevent these complications and reduce mortality. We hypothesized that PCV
would have better effects on gas exchange, lung mechanics and hemodynamics
compared to VCV in CABG surgery. Our primary outcome was to compare the
PaO<inf>2</inf>/FiO<inf>2</inf> ratio. Patients were randomized into two
groups, (VCV, PCV) consisting of 30 individuals each. Two patients were
excluded from the study. I/E ratio was adjusted to 1:2 and, RR:10/min
fresh air gas flow was set at 3L/min in all patients. In the VCV group TV
was set at 8 mL/kg of the predicted body weight. In the PCV group, peak
inspiratory pressure was adjusted to the same tidal volume with the VCV
group. PaO2/FiO2 was found to be higher with PCV at the end of the
surgery. Time to extubation and ICU length of stay was shorter with PCV.
Ppeak was similar in both groups. Pplateau was lower and Pmean was higher
at the and of the surgery with PCV compared to VCV. The hemodynamic
effects of both ventilation modes were found to be similar. PVC may be
preferable to VCV in patients who undergo open heart surgery. However, it
would be convenient if our findings are supported by similar
studies.<br/>Copyright &#xa9; 2016, Springer Science+Business Media
Dordrecht.

<14>
Accession Number
614230602
Author
Tamura T.; Mori S.; Mori A.; Ando M.; Yokota S.; Shibata Y.; Nishiwaki K.
Institution
(Tamura, Yokota) Division of Anesthesia, Japanese Red Cross Nagoya Daiichi
Hospital, Nagoya, Japan
(Tamura, Shibata, Nishiwaki) Department of Anesthesiology, Nagoya
University Graduate School of Medicine, 65 Tsurumai-cho, Showa-Ku, Nagoya
466-8550, Japan
(Mori) Division of Thoracic Surgery, Japanese Red Cross Nagoya Daiichi
Hospital, Nagoya, Japan
(Mori) Department of Perioperative Management System, Nagoya University
Graduate School of Medicine, Nagoya, Japan
(Ando) Center for Advanced Medicine and Clinical Research, Nagoya
University Hospital, Nagoya, Japan
Title
A randomized controlled trial comparing paravertebral block via the
surgical field with thoracic epidural block using ropivacaine for
post-thoracotomy pain relief.
Source
Journal of Anesthesia. 31 (2) (pp 263-270), 2017. Date of Publication: 01
Apr 2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Purpose: We conducted a comparative study to evaluate analgesic efficacy
between paravertebral block via the surgical field (PVB-sf), in which the
catheter was inserted into the ventral side of the sympathetic trunk in
the paravertebral space by a thoracic surgeon under thoracoscopic
visualization, and epidural block (Epi) using ropivacaine for
post-thoracotomy pain relief. Methods: Lung cancer patients scheduled for
lobectomy via thoracotomy were randomly allocated to receive either PVB-sf
or Epi (n = 36 per group). Before thoracotomy closure, 0.375% ropivacaine
was administered as a bolus (PVB-sf, 20 mL; Epi, 5 mL), followed by a
300-mL continuous infusion of 0.2% ropivacaine at 5 mL/h. Postoperative
pain was assessed using a visual analog scale (VAS) score at various time
points, including the primary endpoint of 2 h after ropivacaine bolus
injection. Sensory block area, vital signs, serum ropivacaine
concentrations, and side effects were also evaluated. Results: The Epi
group showed significantly lower VAS scores and blood pressure and a wider
sensory block area than the PVB-sf group at all evaluation time points.
While the mean serum ropivacaine concentration in the PVB-sf group was
significantly higher than that in the Epi group until 1 h after injection
of the ropivacaine bolus, there was no significant difference at any
subsequent assessment point. The incidence of side effects was similar
between the groups. Conclusion: The Epi was superior to PVB-sf for the
management of post-thoracotomy pain in this patient cohort. The number of
dermatomes anaesthetized by Epi was greater than that anaesthetized by
PVB-sf. No difference in complication rates was observed between the two
groups.<br/>Copyright &#xa9; 2017, Japanese Society of Anesthesiologists.

<15>
Accession Number
617647937
Author
Serraino G.F.; Murphy G.J.
Institution
(Serraino, Murphy) Department of Cardiovascular Sciences, National
Institute for Health Research, Leicester Biomedical Research Unit in
Cardiovascular Medicine, University of Leicester, Clinical Sciences Wing,
Glenfield General Hospital, Leicester LE3 9QP, United Kingdom
Title
Routine use of viscoelastic blood tests for diagnosis and treatment of
coagulopathic bleeding in cardiac surgery: Updated systematic review and
meta-analysis.
Source
British Journal of Anaesthesia. 118 (6) (pp 823-833), 2017. Date of
Publication: 01 Jun 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Viscoelastic point-of-care tests are commonly used to provide prompt
diagnosis of coagulopathy and allow targeted treatments in bleeding
patients. We updated existing meta-analyses that have evaluated the
clinical effectiveness of viscoelastic point-of-care tests vs the current
standard of care for the management of cardiac surgery patients at risk of
coagulopathic bleeding. Randomized controlled trials comparing
viscoelastic point-of-care diagnostic testing with standard care in
cardiac surgery patients were sought. All-cause mortality, blood loss,
reoperation, blood transfusion, major morbidity, and intensive care unit
and hospital length of stay were analysed using random-effects modelling.
Fifteen trials that randomized a total of 8737 participants were included
for the analysis. None of the trials was classified as low risk of bias.
The use of thromboelastography-(TEG ) or thromboelastometry (ROTEM
)-guided algorithms did not reduce mortality [risk ratio (RR) 0.55, 95%
confidence interval (CI) 0.28-1.10] without heterogeneity (I²
=1%), reoperation for bleeding, stroke, ventilation time, or hospital
length of stay compared with standard care. Use of TEG or ROTEM resulted
in reductions in the frequency of red blood cell (Risk Ratio 0.88, 95%
Confidence Interval 0.79-0.97; I² =43%) and platelet
transfusion (Risk Ratio 0.78, 95% Confidence Interval 0.66-0.93;
I² =0%). Group Reading Assessment and Diagnostic Evaluation
(GRADE) assessment demonstrated that the quality of the evidence was low
or very low for all estimated outcomes. Routine use of viscoelastic
point-of-care tests did not improve important clinical outcomes beyond
transfusion in adults undergoing cardiac surgery.<br/>Copyright &#xa9;
2017 The Author.

<16>
Accession Number
617647927
Author
Kaufmann K.B.; Stein L.; Bogatyreva L.; Ulbrich F.; Kaifi J.T.; Hauschke
D.; Loop T.; Goebel U.
Institution
(Kaufmann, Stein, Ulbrich, Loop, Goebel) Department of Anaesthesiology and
Critical Care, Institute of Medical Biometry and Statistics, University of
Freiburg, Freiburg, Germany
(Bogatyreva, Hauschke) IMBI, Institute of Medical Biometry and Statistics,
University of Freiburg, Freiburg, Germany
(Kaifi) Department of Thoracic Surgery, Medical Centre-University of
Freiburg, Faculty of Medicine, Freiburg, Germany
Title
Oesophageal Doppler guided goal-directed haemodynamic therapy in thoracic
surgery-a single centre randomized parallel-arm trial.
Source
British Journal of Anaesthesia. 118 (6) (pp 852-861), 2017. Date of
Publication: 01 Jun 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Background: Postoperative pulmonary and renal complications are frequent
in patients undergoing lung surgery. Hyper-and hypovolaemia may contribute
to these complications. We hypothesized that goal-directed haemodynamic
management based on oesophageal Doppler monitoring would reduce
postoperative pulmonary complications in a randomized clinical
parallel-arm trial. Methods: One hundred patients scheduled for thoracic
surgery were randomly assigned to either standard haemodynamic management
(control group) or goal-directed therapy (GDT group) guided by an
oesophageal Doppler monitoring-based algorithm. The primary endpoint was
postoperative pulmonary complications, including spirometry. Secondary
endpoints included haemodynamic variables, renal, cardiac, and
neurological complications, and length of hospital stay. The investigator
assessing outcomes was blinded to group assignment. Results: Forty-eight
subjects of each group were analysed. Compared to the control group, fewer
subjects in the GDT group developed postoperative pulmonary complications
(6 vs. 15 patients; P = 0.047), while spirometry did not differ between
groups. Compared to the control group, patients of the GDT group showed
higher cardiac index (2.9 vs. 2.1 [l min^-1 m^-2]; P <
0.001) and stroke volume index (43 vs. 34 [ml m²]; P < 0.001)
during surgery. Renal, cardiac and neurological complications did not
differ between groups. Length of hospital stay was shorter in the GDT
compared to the control group (9 vs. 11 days; P = 0.005). Conclusions:
Compared to standard haemodynamic management, oesophageal Doppler
monitor-guided GDT was associated with fewer postoperative pulmonary
complications and a shorter hospital stay.<br/>Copyright &#xa9; 2017 The
Author.

<17>
Accession Number
609423107
Author
Finsterer J.; Stollberger C.
Institution
(Finsterer) Rudolfstiftung Hospital, Postfach 20, Vienna 1180, Austria
(Stollberger) Second Medical Department with Cardiology and Intensive Care
Medicine, Rudolfstiftung Hospital, Vienna, Austria
Title
Neurological complications of cardiac disease (heart brain disorders).
Source
Minerva Medica. 107 (1) (pp 14-25), 2016. Date of Publication: February
2016.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: Heart disease is a frequent cause of cerebral compromise. This
review aimed at summarising and discussing available data about heart
brain disorders. METHODS: We performed a literature search in conventional
databases. RESULTS: Frequent cerebral complications of cardiac disease
include embolic stroke, syncope, and intracerebral bleeding. Rare
complications are watershed infarction, brain abscess, meningitis,
metastasis, dementia, or aneurysm formation. The most frequent and most
well-known cardiac cause of neurological complications is cardiac
embolism. Cardiac emboli can be of different material and derive from the
left atrium, left atrial appendage, left ventricle, or the mitral or
aortic valves. Also arrhythmias such as atrial fibrillation or atrial
flutter may give rise to thrombus formation. Heart failure, myocardial
infarction, myocardial aneurysm, endocarditis/myocarditis, and
noncompaction are further causes of cerebral embolism. Another cardiac
cause of neurological complications is low output failure due to systolic
dysfunction, arrhythmias, or valve stenosis. Arrhythmias are not only
associated with intra-cardiac thrombus formation but may also lead to low
output failure and consecutively to watershed infarction, vertigo,
fainting, or syncope. Valve abnormalities can be another source of
neurological disease. CONCLUSION: The cardiologist must know about the
neurological complications of heart disease and the neurologist must know
about the cardiac causes of cerebral abnormalities. Heart-brain disorders
require a bidisciplinary diagnostic and therapeutic
approach.<br/>Copyright &#xa9; 2016 EDIZIONI MINERVA MEDICA.

<18>
Accession Number
609405528
Author
Berg D.D.; Bonaca M.P.; Braunwald E.; Corbalan R.; Goto S.; Kiss R.G.;
Murphy S.A.; Scirica B.M.; Spinar J.; Morrow D.A.
Institution
(Berg, Bonaca, Braunwald, Murphy, Scirica, Morrow) TIMI Study Group,
Cardiovascular Division, Department of Medicine, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States
(Corbalan) Department of Cardiology, Catholic University School of
Medicine, Santiago, Chile
(Goto) Department of Medicine, Tokai University School of Medicine,
Isehara, Japan
(Kiss) Department of Cardiology, Military Hospital, Budapest, Hungary
(Spinar) Department of Cardiology, University Hospital, Jihlavska, Brno,
Czech Republic
Title
Outcomes in stable patients with previous atherothrombotic events
receiving vorapaxar who experience a new acute coronary event (from
TRA2degreeP-TIMI 50).
Source
American Journal of Cardiology. 117 (7) (pp 1055-1058), 2016. Date of
Publication: 01 Apr 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Vorapaxar is a first-in-class protease-activated receptor-1 antagonist
indicated for secondary prevention in stable patients with previous
myocardial infarction (MI) or peripheral artery disease and no
cerebrovascular disease. Vorapaxar is not recommended for initiation in
the acute phase of acute coronary syndromes (ACS) because of an
unfavorable balance between bleeding and efficacy when started in that
setting. The aim of this analysis was to investigate outcomes in patients
who experienced a new ACS while receiving vorapaxar for long-term
secondary prevention. Thrombin Receptor Antagonist in Secondary Prevention
of Atherothrombotic ischemic Events-Thrombolysis In Myocardial Infarction
50 was a randomized, double-blind, placebo-controlled trial of vorapaxar
(n = 26,449). We evaluated bleeding and ischemic events during the acute
care of patients with a new ACS during the trial. During a median
follow-up of 30 months, 799 patients (8.9%) randomized to vorapaxar and
913 (10.0%) to placebo had a new ACS event (p = 0.003); 87% and 86%,
respectively, were on study therapy at the time of the event. In a
landmark analysis through 7 days after ACS, the rates of Global Use of
Strategies to Open Occluded Coronary Arteries (GUSTO) severe bleeding were
0.8% versus 0.8% (hazard ratio [HR] 0.99, 95% CI 0.33 to 2.94) and GUSTO
moderate/severe bleeding were 2.5% versus 1.6% (HR 1.59, 95% CI 0.78 to
3.24) with vorapaxar versus placebo. The effect of vorapaxar on
cardiovascular death, MI, or stroke (2.4% vs 4.4%; HR 0.54, 95% CI 0.31 to
0.93; p = 0.027) was consistent with the overall trial result. In
conclusion, in patients who experience a new ACS event while receiving
vorapaxar for secondary prevention, continuing therapy was associated with
favorable efficacy without excess severe bleeding during the period of
acute ACS management.<br/>Copyright &#xa9; 2016 Elsevier Inc. All rights
reserved.

<19>
Accession Number
609700069
Author
Wang Y.; Zhang J.; Zhang S.
Institution
(Wang, Zhang) Department of Anesthesiology, The First Affiliated Hospital
of Zhengzhou University, Zhengzhou 450052, China
(Zhang) Department of Hepatopancreatobiliary Surgery, The First Affiliated
Hospital of Zhengzhou University, Zhengzhou 450052, China
(Wang, Zhang, Zhang) Key-Disciplines Laboratory Clinical-Medicine Henan,
Zhengzhou 450052, China
Title
Influence of different anesthetic and analgesic methods on early cognitive
function of elderly patients receiving non-cardiac surgery.
Source
Pakistan Journal of Medical Sciences. 32 (2) (pp 369-372), 2016. Date of
Publication: 2016.
Publisher
Professional Medical Publications (Raja Ghazanfar Ali Road, Saddar,
Karachi, Pakistan)
Abstract
Objective: To discuss over influence of two different anesthetic and
analgesic methods on early cognitive function of elderly patients who
received non-cardiac surgery. Methods: Two hundred and six elderly
patients who underwent non-cardiac surgery were selected as research
subjects. They were randomly divided into observation group (103 cases)
and control group (103 cases). Patients in observation group were given
combined spinal and epidural anesthesia and epidural analgesia, while
patients in control group adopted general anesthesia and intravenous
analgesia. Neurological function test was carried out one day before
surgery and on the 7^th day after surgery. Moreover, changes of
postoperative pain degree, neuropsychological function and cognitive
function were observed and compared. Results: On the 7^th day
after surgery, incidence of cognition impairment in observation group and
control group was 48.50% (50/103 cases) and 44.70% (46/103 cases), and
difference between groups had no statistical significance. Visual Analogue
Scale (VAS) Score of observation group was much lower than control group
in the 12^th, 24^th and 48^th h after
surgery (p < 0.05). Logistic regression analysis suggested that, short
education years and general surgery were independent risk factors for
early cognition impairment. Conclusion: About 46.60% elderly patients
undergoing non-cardiac surgery developed cognition impairment, but
influence of different anesthetic and analgesic methods on incidence of
postoperative cognition impairment of elderly patients had no significant
difference.<br/>Copyright &#xa9; 2016, Professional Medical Publications.
All Rights Reserved.

<20>
Accession Number
616788760
Author
Maeno Y.; Yoon S.-H.; Abramowitz Y.; Watanabe Y.; Jilaihawi H.; Lin M.-S.;
Chan J.; Sharma R.; Kawashima H.; Israr S.; Kawamori H.; Miyasaka M.; Rami
T.; Kazuno Y.; Mangat G.; Kashif M.; Chakravarty T.; Kao H.-L.; Lee
M.K.-Y.; Nakamura M.; Kozuma K.; Cheng W.; Makkar R.R.
Institution
(Maeno, Yoon, Abramowitz, Sharma, Israr, Kawamori, Miyasaka, Rami, Kazuno,
Mangat, Kashif, Chakravarty, Nakamura, Cheng, Makkar) Heart Institute,
Cedars-Sinai Medical Center, Los Angeles, United States
(Watanabe, Kawashima, Kozuma) Division of Cardiology, Department of
Internal Medicine, Teikyo University Hospital, Tokyo, Japan
(Jilaihawi) Department of Medicine, Cardiothoracic Surgery, New York
University Langone Medical Center, New York, United States
(Lin, Kao) Division of Cardiology, Heart Center, National Taiwan
University Hospital, Taipei, Taiwan (Republic of China)
(Chan, Lee) Division of Cardiology, Queen Elizabeth Hospital, Kowloon,
Hong Kong
Title
Effect of ascending aortic dimension on acute procedural success following
self-expanding transcatheter aortic valve replacement: A multicenter
retrospective analysis.
Source
International Journal of Cardiology. 244 (pp 100-105), 2017. Date of
Publication: 01 Oct 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Aims Self-expanding (SE) valves are characterized with long stent frame
design and the radial force of the device exists both in the inflow and
outflow level. Therefore, we hypothesized that device success of SE-valves
may be influenced by ascending aortic dimensions (AAD). The aim of this
study was to determine the influence of AAD on acute device success rates
following SE transcatheter aortic valve replacement (TAVR). Methods &
Results In 4 centers in the United States and Asia, 214 consecutive
patients underwent SE-TAVR. Outcomes were assessed in line with Valve
Academic Research Consortium criteria. AAD was defined as the sum of the
short and long axis aortic diameter divided by 2. Overall, device success
rate was 85.0%. Multivariate analysis revealed that increased AAD (Odds
ratio 1.27) and % oversizing (Odds ratio 0.88) were found to be
independent predictors of unsuccessful device implantation. The
c-statistic of the model for device success was area under the curve 0.79,
sensitivity 81.3% and specificity 44.0%. Co-existence of several risk
factors was associated with an exponential fall to 64.2% in device success
rate. For a large AAD, however, optimally oversized SE-valves (threshold
16.2%) resulted with high device success rates compared to suboptimal
oversizing (88.6% vs. 64.2%, p = 0.005). Conclusions Larger AAD and
smaller degrees of oversizing were confirmed to be the most relevant
predictors of unsuccessful device implantation following SE-valve
implantations. Optimal oversizing of great significance was noted,
particularly that with a large AAD.<br/>Copyright &#xa9; 2017 Elsevier
Ireland Ltd

<21>
Accession Number
615878879
Author
Toikkanen V.; Rinne T.; Laurikka J.; Porkkala H.; Tarkka M.; Mennander A.
Institution
(Toikkanen, Laurikka, Tarkka, Mennander) Department of Cardiothoracic
Surgery, Heart Center, Tampere University Hospital and University of
Tampere, Tampere, Finland
(Rinne, Porkkala) Division of Cardiac Anesthesia, Heart Center, Tampere
University Hospital, Tampere, Finland
Title
Pulmonary vascular resistance index during coronary artery bypass surgery
with aprotinin.
Source
Scandinavian Journal of Clinical and Laboratory Investigation. 77 (5) (pp
315-320), 2017. Date of Publication: 04 Jul 2017.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Low pulmonary vascular resistance index (PVRI) reflects favorable
redundant pulmonary circulation following coronary artery bypass grafting
with cardiopulmonary bypass surgery (CPB). This randomized study
investigated whether aprotinin given in different modalities impacts PVRI
after coronary artery bypass grafting. A total of 40 patients undergoing
coronary artery bypass grafting were randomized to four groups according
to aprotinin dose: (1) high dose, (2) early low dose, (3) late low dose,
and (4) without aprotinin. Oxygenation index, pulmonary shunt,
alveolar-arterial oxygen gradient and PVRI were determined. PVRI was
calculated as the transpulmonary pressure gradient divided by cardiac
index multiplied by 80. The results showed that PVRI remained relative low
in all patients provided aprotinin regardless of treatment dosage; PVRI
increased at 4 h after restarting ventilation after CPB in patients
without aprotinin as compared with aprotinin (266 +/- 137, 266 +/- 115,
244 +/- 86 vs. 386 +/- 121, dynes-s-cm^- ⁵,
respectively, p =.047). Elevated postoperative PVRI was predictive for
patients without aprotinin (AUC 0.668; SE 0.40; p <.0001; CI 0.590-0.746).
There were no statistical differences in oxygenation index, pulmonary
shunt or alveolar-arterial oxygen gradient between the groups. In
conclusion, aprotinin maintains a low PVRI in elective patients with
healthy lungs during CPB. We suggest that aprotinin maintains pulmonary
arterial endothelial integrity.<br/>Copyright &#xa9; 2017 Medisinsk
Fysiologisk Forenings Forlag (MFFF).

<22>
Accession Number
617602232
Author
Moradian S.T.; Saeid Y.; Ebadi A.; Hemmat A.; Ghiasi M.S.
Institution
(Moradian, Hemmat, Ghiasi) Baqiyatallah University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Saeid) Nursing Faculty, Baqiyatallah University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Ebadi) Behavioral Sciences Research Center, Nursing Faculty, Baqiyatallah
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Adaptive support ventilation reduces the incidence of atelectasis in
patients undergoing coronary artery bypass grafting: A randomized clinical
trial.
Source
Anesthesiology and Pain Medicine. 7 (3) (no pagination), 2017. Article
Number: e44619. Date of Publication: June 2017.
Publisher
Kowsar Medical Publishing Company (E-mail: info@anesthpain.com)
Abstract
Background: Pulmonary complications are common following cardiac surgery
and can lead to increased morbidity, mortality, and healthcare costs.
Atelectasis is the most common respiratory complication following cardiac
surgery. One of the most important methods for reducing pulmonary
complications is supportive care with protective ventilation strategies.
In this study, we aimed to assess the effect of adaptive support
ventilation (ASV) on atelectasis in patients undergoing cardiac surgery.
Methods: In this single-blind randomized clinical trial, 115 patients,
undergoing coronary artery bypass grafting, were randomly allocated into 2
groups: 57 patients in the intervention and 58 patients in the control
group. Patients in the intervention group were weaned with ASV, while
patients in the control group were managed using synchronized intermittent
mandatory ventilation (SIMV) and pressure support. The incidence of
atelectasis, duration of mechanical ventilation, manual ventilator
setting, arterial blood gas measurements, and length of hospital stay were
compared between the groups. Results: The incidence of atelectasis, number
of changes in the manual ventilator setting, number of alarms, and length
of hospital stay reduced in the intervention group. However, duration of
mechanical ventilation and number of ABG measurements were not
significantly different between the groups. Conclusions: The ASV mode
could reduce the incidence of atelectasis and length of hospital stay.
However, it did not reduce the duration of mechanical ventilation. It
seems that ASV is not a superior mode for faster extubation.<br/>Copyright
&#xa9; 2017, Iranian Society of Regional Anesthesia and Pain Medicine
(ISRAPM).

<23>
Accession Number
617602162
Author
Ibrahim T.H.; Abdelrahman H.S.; Alharbi M.A.; Zabani I.A.; Ismail M.F.;
Kary H.
Institution
(Ibrahim, Abdelrahman, Alharbi, Zabani) Department of Anaesthesiology,
King Faisal Specialist Hospital and Research Centre (Jeddah Branch),
Jeddah, Saudi Arabia
(Ibrahim, Abdelrahman) Department of Anaesthesia and Intensive Care,
Faculty of Medicine, Ain Shams University, Cairo, Egypt
(Ismail) Department of Cardiovascular Diseases, King Faisal Specialist
Hospital and Research Centre (Jeddah Branch), Jeddah, Saudi Arabia
(Ismail) Department of Cardiothoracic Surgery, Mansoura University,
Mansoura, Egypt
(Kary) Department of Pathology and Laboratory Medicine, King Faisal
Specialist Hospital and Research Centre (Jeddah Branch), Jeddah, Saudi
Arabia
Title
Effect of ketamine on pro- and anti-inflammatory cytokine response in
paediatric cardiac surgery: A prospective randomised controlled study.
Source
Indian Journal of Anaesthesia. 61 (7) (pp 549-555), 2017. Date of
Publication: July 2017.
Publisher
Indian Society of Anaesthetists (Flat No 12/1A K Point, 68-BAPC Roy Road,
Kolkata 700009, India)
Abstract
Background and Aims: Paediatric cardiac surgery with cardiopulmonary
bypass (CPB) is associated with a marked inflammatory response and
triggers release of inflammatory cytokines. The aim of this study was to
study the effect of ketamine on the inflammatory response during
correction of congenital cyanotic heart diseases. Methods: Sixty-six
patients with congenital cyanotic heart diseases scheduled for cardiac
surgery were randomised into three groups. Group A patients did not
receive ketamine (control group), Group B patients received 2 mg/kg
ketamine intravenous (IV) and Group C patients received ketamine 2 mg/kg
IV and an IV infusion of ketamine (50 micro&#32;g/kg/min). Interleukin
(IL) levels for IL-6, IL-8, IL-10, C-reactive protein (CRP) and tumour
necrosis factor-alpha (TNF-alpha) levels were examined in the three groups
at four timings: pre-operative (baseline), intraoperative (after weaning
off the CPB) and post-operative (6 and 24 h after weaning off CPB). Paired
sample t-test and ANOVA test were used for statistical analysis and P <
0.05 was considered statistically significant. Results: Within each group,
the intra- and post-operative serum levels of IL-6, IL-8, IL-10 and CRP
were significantly elevated from the baseline, however, TNF-alpha was not
significantly elevated. There were no statistically significant
differences in the IL, CRP or TNF-alpha levels between the three groups.
Conclusion: Paediatric cardiac surgery for congenital cyanotic heart
disease is a triggering factor for the inflammatory response, yet we could
not detect any beneficial effect of ketamine on that response whether
given either as an IV induction dose or continued as an IV
infusion.<br/>Copyright &#xa9; 2017 Indian Journal of Anaesthesia. All
rights reserved.

<24>
[Use Link to view the full text]
Accession Number
617588677
Author
Kim T.; Park S.Y.; Lee H.-J.; Kim S.-M.; Sung H.; Chong Y.P.; Lee S.-O.;
Choi S.-H.; Kim Y.S.; Woo J.H.; Kim S.-H.
Institution
(Kim, Lee, Kim, Chong, Lee, Choi, Kim, Woo, Kim) Department of Infectious
Diseases, Asan Medical Center, University of Ulsan, College of Medicine,
88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
(Kim) Division of Infectious Diseases, Department of Internal Medicine,
Gyeongsang National University Hospital, Gyeongsang National University,
School of Medicine, Jinju, South Korea
(Park) Division of Infectious Diseases, Department of Internal Medicine,
Soonchunhyang University, Seoul Hospital, College of Medicine, Seoul,
South Korea
(Sung) Department of Laboratory Medicine, Asan Medical Center, University
of Ulsan, College of Medicine, Seoul, South Korea
Title
Assessment of cytomegalovirus and cell-mediated immunity for predicting
outcomes in non-HIV-infected patients with Pneumocystis jirovecii
pneumonia.
Source
Medicine (United States). 96 (30) (no pagination), 2017. Article Number:
e7243. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The clinical importance of pulmonary cytomegalovirus (CMV) co-infection in
patients with Pneumocystis jirovecii pneumonia (PCP) is uncertain. We
therefore determined the association of CMV infection with outcomes in
non-HIV-infected patients with PCP by assessing CMV viral load and
CMV-specific T-cell response. We prospectively enrolled all
non-HIV-infected patients with confirmed PCP, over a 2-year period.
Real-time polymerase chain reaction from bronchoalveolar lavage was
performed to measure CMV viral load, and CMV enzyme-linked immunospot
assays of peripheral blood were used to measure CMV-specific T-cell
responses. The primary outcome was 30-day mortality. A total of 76
patients were finally analyzed. The mortality in patients with high BAL
CMV viral load (>2.52 log copies/mL, 6/32 [18%]) showed a nonsignificant
trend to be higher than in those with low CMV viral load (2/44 [5%],
P=.13). However, the mortality in patients with low CMV-specific T-cell
responses (<5spots/2.0x10⁵ PBMC, 6/29 [21%]) was significantly
higher than in patients with high CMV-specific T-cell response (2/47 [4%],
P=.048). Moreover, the 2 strata with high CMV viral load and low
CMV-specific T-cell responses (4/14 [29%]) and low CMV viral load and low
CMV-specific T-cell responses (2/15 [13%]) had poorer outcomes than the 2
strata with high CMV viral load and high CMV-specific T-cell responses
(2/18 [11%]) and low CMV viral load and high CMV-specific T-cell responses
(0/29 [0%]). These data suggest that the CMV replication and impaired
CMV-specific T-cell responses adversely affect the outcomes in non-
HIV-infected patients with PCP.<br/>Copyright &#xa9; 2017 the Author(s).
Published by Wolters Kluwer Health, Inc.

<25>
Accession Number
617605577
Author
Shi R.; Tie H.-T.
Institution
(Shi) The First Affiliated Hospital of Chongqing Medical University,
Department of Cardiology, Chongqing 400016, China
(Tie) The First Affiliated Hospital of Chongqing Medical University,
Department of Cardiothoracic Surgery, Chongqing 400016, China
Title
Dexmedetomidine as a promising prevention strategy for cardiac
surgery-associated acute kidney injury: A meta-analysis.
Source
Critical Care. 21 (1) (no pagination), 2017. Article Number: 198. Date of
Publication: 03 Aug 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)

<26>
Accession Number
617639412
Author
Branch-Elliman W.; Ripollone J.E.; O'Brien W.J.; Itani K.M.F.; Schweizer
M.L.; Perencevich E.; Strymish J.; Gupta K.
Institution
(Branch-Elliman, Strymish, Gupta) Department of Medicine, VA Boston
Healthcare System, West Roxbury, MA, United States
(Branch-Elliman, Itani, Strymish) Harvard Medical School, Boston, MA,
United States
(Branch-Elliman, O'Brien, Gupta) VA Center for Healthcare Organization and
Implementation Research, VA Boston Healthcare System, West Roxbury, MA,
United States
(Ripollone) Boston University, School of Public Health, Boston, MA, United
States
(Itani, Gupta) Boston University, School of Medicine, Boston, MA, United
States
(Itani) Department of Surgery, VA Boston Healthcare System, West Roxbury,
MA, United States
(Schweizer, Perencevich) VA Comprehensive Access & Delivery Research &
Evaluation, Iowa City VA Health Care System, Iowa City, IA, United States
(Schweizer, Perencevich) Carver College of Medicine, University of Iowa,
Iowa City, IA, United States
Title
Risk of surgical site infection, acute kidney injury, and Clostridium
difficile infection following antibiotic prophylaxis with vancomycin plus
a beta-lactam versus either drug alone: A national
propensity-score-adjusted retrospective cohort study.
Source
PLoS Medicine. 14 (7) (no pagination), 2017. Article Number: e1002340.
Date of Publication: July 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: The optimal regimen for perioperative antimicrobial
prophylaxis is controversial. Use of combination prophylaxis with a
beta-lactam plus vancomycin is increasing; however, the relative risks and
benefits associated with this strategy are unknown. Thus, we sought to
compare postoperative outcomes following administration of 2
antimicrobials versus a single agent for the prevention of surgical site
infections (SSIs). Potential harms associated with combination regimens,
including acute kidney injury (AKI) and Clostridium difficile infection
(CDI), were also considered. Methods and findings: Using a multicenter,
national Veterans Affairs (VA) cohort, all patients who underwent cardiac,
orthopedic joint replacement, vascular, colorectal, and hysterectomy
procedures during the period from 1 October 2008 to 30 September 2013 and
who received planned manual review of perioperative antimicrobial
prophylaxis regimen and manual review for the 30-day incidence of SSI were
included. Using a propensity-adjusted log-binomial regression model
stratified by type of surgical procedure, the association between receipt
of 2 antimicrobials (vancomycin plus a beta-lactam) versus either single
agent alone (vancomycin or a beta-lactam) and SSI was evaluated. Measures
of association were adjusted for age, diabetes, smoking, American Society
of Anesthesiologists score, preoperative methicillin-resistant
Staphylococcus aureus (MRSA) status, and receipt of mupirocin. The 7-day
incidence of postoperative AKI and 90-day incidence of CDI were also
measured. In all, 70,101 procedures (52,504 beta-lactam only, 5,089
vancomycin only, and 12,508 combination) with 2,466 (3.5%) SSIs from 109
medical centers were included. Among cardiac surgery patients, combination
prophylaxis was associated with a lower incidence of SSI (66/6,953, 0.95%)
than single-agent prophylaxis (190/12,834, 1.48%; crude risk ratio [RR]
0.64, 95% CI 0.49, 0.85; adjusted RR 0.61, 95% CI 0.46, 0.83). After
adjusting for SSI risk, no association between receipt of combination
prophylaxis and SSI was found for the other types of surgeries evaluated,
including orthopedic joint replacement procedures. In MRSA-colonized
patients undergoing cardiac surgery, SSI occurred in 8/346 (2.3%) patients
who received combination prophylaxis versus 4/100 (4.0%) patients who
received vancomycin alone (crude RR 0.58, 95% CI 0.18, 1.88). Among
MRSA-negative and -unknown cardiac surgery patients, SSIs occurred in
58/6,607 (0.9%) patients receiving combination prophylaxis versus
146/10,215 (1.4%) patients who received a beta-lactam alone (crude RR
0.61, 95% CI 0.45, 0.83). Based on these associations, the number needed
to treat to prevent 1 SSI in MRSA-colonized patients is estimated to be
53, compared to 176 in non-MRSA patients. CDI incidence was similar in
both exposure groups. Across all types of surgical procedures, risk of AKI
was increased in the combination antimicrobial prophylaxis group
(2,971/12,508 [23.8%] receiving combination versus 1,058/5,089 [20.8%]
receiving vancomycin alone versus 7,314/52,504 [13.9%] receiving
beta-lactam alone). We found a significant association between absolute
risk of AKI and receipt of combination regimens across all types of
procedures. If the observed association is causal, the number needed to
harm for severe AKI following cardiac surgery would be 167. The major
limitation of our investigation is that it is an observational study in a
predominantly male population, which may limit generalizability and lead
to unmeasured confounding. Conclusions: There are benefits but also
unintended consequences of antimicrobial and infection prevention
strategies aimed at "getting to zero" healthcare-associated infections. In
our study, combination prophylaxis was associated with both benefits
(reduction in SSIs following cardiac surgical procedures) and harms
(increase in postoperative AKI). In cardiac surgery patients, the
difference in risk-benefit profile by MRSA status suggests that
MRSA-screening-directed prophylaxis may optimize benefits while minimizing
harms in this selected population. More information about long-term
outcomes and patient and societal preferences regarding risk of SSI versus
risk of AKI is needed to improve clinical decision-making.<br/>Copyright
&#xa9; 2017, Public Library of Science. All rights reserved.

<27>
Accession Number
617626868
Author
Egle D.; Brunner C.; Czech T.; Jaeger T.; Lang A.; Hager C.; Poisl C.;
Volgger B.; Marth C.
Institution
(Egle, Brunner, Czech, Jaeger, Lang, Hager, Poisl, Volgger, Marth)
Department of Obstetrics and Gynecology, Medical University of Innsbruck,
Innsbruck, Austria; Departement of Gynecology and Obstetrics, Innsbruck,
Austria; Universitaetsklinik Innsbruck, Innsbruck, Austria; LKH Feldkirch,
Feldkirch, Austria; Landeskrankenhaus Feldkirch, Feldkirch, Austria; KH
Dornbirn, Dornbirn, Austria; BKH LIENZ, Lienz, Austria; AGO-A and
Department of Obstetrics and Gynecology, Innsbruck Medical University,
Innsbruck, Austria
Title
Neoadjuvant treatment of HER2 positive breast cancer with concomitant
nonpegylated liposomal doxorubicin (NPLD), docetaxel and dual blockade
with trastuzumab and pertuzumab: A retrospective analysis of pCR and
cardiac safety.
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: Neoadjuvant treatment in HER2 overexpressing early breast
cancer (EBC) has increased considerably. The Neosphere study, in which
dual blockade of HER2 was combined with docetaxel resulted in favorable
pCR rates. The addition of anthracyclines could play an important role in
enhancing the effectiveness. The use of NPLD might be valuable in
combination with HER2 targeted therapies. Safety and efficacy of NPLD,
taxotere and trastuzumab was reported in the ABSCG 32 study. There is only
little data about the cardiac safety and efficacy in combination with dual
HER2 blockade. We report pCR-rate and cardiac safety of a single arm,
retrospective, multicenter analysis of neoadj. treatment for HER2+ EBC.
Methods: In this study 98 women with HER2+ EBC were investigated in 4
oncological departments in Austria. All patients were treated with NPLD
(50 mg/m²), docetaxel (75 mg/m²) concurrent with
trastuzumab and pertuzumab in standard dosage for 6 cycles as neoadjuvant
therapy. All patients were free of cardiovascular disease and had a left
ventricular ejection fraction (LVEF) of >=50%. Cardiac function was
measured by LVEF. All patients underwent surgery after neoadjuvant
chemotherapy. The absence of any residual invasive cancer in the breast
and axilla was defined as pathological complete response (pCR). Median
follow up was 1.7 years. Results: Median age was 49 years. pCR rate was
73%. In this cohort a negative estrogen-and progesteron receptor was
predictive for pCR (p<0.001). These patients achieved pCR in 89%. No
patient progressed during treatment. Only one patient(1%) suffered
symptomatic heart failure after surgery. Conclusions: We observed a
considerably high rate of pCR in HER2-positive EBC treated with a
combination of NPLD, docetaxel, trastuzumab and pertuzumab. Hormone
receptor negativity was highly predictive for pCR. The addition of NPLD
entails a very favorable cardiotoxicity profile. This regimen is a safe
and highly effective treatment option in patients with HER-2 positive EBC.

<28>
Accession Number
617597157
Author
Harky A.; Balmforth D.; Shipolini A.; Uppal R.
Institution
(Harky, Balmforth, Shipolini, Uppal) Department of Cardiothoracic Surgery,
Barts Heart Centre, St. Bartholomew's Hospital, London EC1A7BE, United
Kingdom
Title
Is endoscopic long saphenous vein harvesting equivalent to open harvesting
technique in terms of graft patency?.
Source
Interactive Cardiovascular and Thoracic Surgery. 25 (2) (pp 323-326),
2017. Date of Publication: 01 Aug 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic was written according to a structured protocol. The
question addressed was whether endoscopic vein harvesting (EVH) is
equivalent to open vein harvesting in terms of graft patency for patients
undergoing coronary artery bypass surgery. A total of 417 articles were
found using the reported search, of which 4 represented the best evidence
to answer the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these articles are tabulated. Reported outcomes were vein graft
failure or patency on coronary angiography or computed tomography
angiography at early, mid and long-term follow-up. Of the non-randomized
studies reviewed, those with greater patient numbers and longer follow-up
periods showed reduced patency rates in the EVH group. Two small early
randomized controlled trials demonstrated equivalent patency rates at up
to 6 months follow-up. However, a more recent randomized controlled trial
showed reduced patency with EVH in 63 patients at a median follow-up of
6.3 years. We conclude that high-quality evidence for the effects of
harvesting method on vein graft patency is lacking, with no large
randomized trials performed to date. The current evidence suggests that
although rates of vein graft failure seem to be similar within the first 6
months following surgery, EVH is associated with reduced graft patency
from 12 months onwards.<br/>Copyright &#xa9; VC The Author 2017.

<29>
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.

<30>
Accession Number
617542596
Author
Estcourt L.J.; Malouf R.; Hopewell S.; Trivella M.; Doree C.; Stanworth
S.J.; Murphy M.F.
Institution
(Estcourt) NHS Blood and Transplant, Haematology/Transfusion Medicine,
Level 2, John Radcliffe Hospital, Headington, Oxford OX3 9BQ, United
Kingdom
(Malouf) University of Oxford, National Perinatal Epidemiology Unit
(NPEU), Old Road Campus, Oxford OX3 7LF, United Kingdom
(Hopewell) University of Oxford, Oxford Clinical Trials Research Unit,
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal
Sciences, Windmill Road, Oxford, Oxfordshire OX3 7LD, United Kingdom
(Trivella) University of Oxford, Centre for Statistics in Medicine, Botnar
Research Centre, Windmill Road, Oxford OX3 7LD, United Kingdom
(Doree) NHS Blood and Transplant, Systematic Review Initiative, John
Radcliffe Hospital, Oxford OX3 9BQ, United Kingdom
(Stanworth) Oxford University Hospitals NHS Foundation Trust and
University of Oxford, National Institute for Health Research (NIHR) Oxford
Biomedical Research Centre, John Radcliffe Hospital, Headley Way,
Headington, Oxford OX3 9BQ, United Kingdom
(Murphy) Oxford University Hospitals NHS Foundation Trust and University
of Oxford, NHS Blood and Transplant National Inst. for Health Research
(NIHR) Oxford Biomedical Research Centre, John Radcliffe Hospital,
Headington, Oxford, United Kingdom
Title
Pathogen-reduced platelets for the prevention of bleeding.
Source
Cochrane Database of Systematic Reviews. 2017 (7) (no pagination), 2017.
Article Number: CD009072. Date of Publication: 30 Jul 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Platelet transfusions are used to prevent and treat bleeding
in people who are thrombocytopenic. Despite improvements in donor
screening and laboratory testing, a small risk of viral, bacterial, or
protozoal contamination of platelets remains. There is also an ongoing
risk from newly emerging blood transfusion-transmitted infections for
which laboratory tests may not be available at the time of initial
outbreak. One solution to reduce the risk of blood transfusion-transmitted
infections from platelet transfusion is photochemical pathogen reduction,
in which pathogens are either inactivated or significantly depleted in
number, thereby reducing the chance of transmission. This process might
offer additional benefits, including platelet shelf-life extension, and
negate the requirement for gamma-irradiation of platelets. Although
current pathogen-reduction technologies have been proven to reduce
pathogen load in platelet concentrates, a number of published clinical
studies have raised concerns about the effectiveness of pathogen-reduced
platelets for post-transfusion platelet count recovery and the prevention
of bleeding when compared with standard platelets. This is an update of a
Cochrane review first published in 2013. Objectives: To assess the
effectiveness of pathogen-reduced platelets for the prevention of bleeding
in people of any age requiring platelet transfusions. Search methods: We
searched for randomised controlled trials (RCTs) in the Cochrane Central
Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue
9), MEDLINE (from 1946), Embase (from 1974), CINAHL (from 1937), the
Transfusion Evidence Library (from 1950), and ongoing trial databases to
24 October 2016. Selection criteria: We included RCTs comparing the
transfusion of pathogen-reduced platelets with standard platelets, or
comparing different types of pathogen-reduced platelets. Data collection
and analysis: We used the standard methodological procedures expected by
Cochrane. Main results: We identified five new trials in this update of
the review. A total of 15 trials were eligible for inclusion in this
review, 12 completed trials (2075 participants) and three ongoing trials.
Ten of the 12 completed trials were included in the original review. We
did not identify any RCTs comparing the transfusion of one type of
pathogen-reduced platelets with another. Nine trials compared Intercept
pathogen-reduced platelets to standard platelets, two trials compared
Mirasol pathogen-reduced platelets to standard platelets; and one trial
compared both pathogen-reduced platelets types to standard platelets.
Three RCTs were randomised cross-over trials, and nine were parallel-group
trials. Of the 2075 participants enrolled in the trials, 1981 participants
received at least one platelet transfusion (1662 participants in Intercept
platelet trials and 319 in Mirasol platelet trials). One trial included
children requiring cardiac surgery (16 participants) or adults requiring a
liver transplant (28 participants). All of the other participants were
thrombocytopenic individuals who had a haematological or oncological
diagnosis. Eight trials included only adults. Four of the included studies
were at low risk of bias in every domain, while the remaining eight
included studies had some threats to validity. Overall, the quality of the
evidence was low to high across different outcomes according to GRADE
methodology. We are very uncertain as to whether pathogen-reduced
platelets increase the risk of any bleeding (World Health Organization
(WHO) Grade 1 to 4) (5 trials, 1085 participants; fixed-effect risk ratio
(RR) 1.09, 95% confidence interval (CI) 1.02 to 1.15; I² = 59%,
random-effect RR 1.14, 95% CI 0.93 to 1.38; I² = 59%;
low-quality evidence). There was no evidence of a difference between
pathogen-reduced platelets and standard platelets in the incidence of
clinically significant bleeding complications (WHO Grade 2 or higher) (5
trials, 1392 participants; RR 1.10, 95% CI 0.97 to 1.25; I² =
0%; moderate-quality evidence), and there is probably no difference in the
risk of developing severe bleeding (WHO Grade 3 or higher) (6 trials, 1495
participants; RR 1.24, 95% CI 0.76 to 2.02; I² = 32%;
moderate-quality evidence). There is probably no difference between
pathogen-reduced platelets and standard platelets in the incidence of
all-cause mortality at 4 to 12 weeks (6 trials, 1509 participants; RR
0.81, 95% CI 0.50 to 1.29; I² = 26%; moderate-quality
evidence). There is probably no difference between pathogen-reduced
platelets and standard platelets in the incidence of serious adverse
events (7 trials, 1340 participants; RR 1.09, 95% CI 0.88 to 1.35;
I² = 0%; moderate-quality evidence). However, no bacterial
transfusion-transmitted infections occurred in the six trials that
reported this outcome. Participants who received pathogen-reduced platelet
transfusions had an increased risk of developing platelet refractoriness
(7 trials, 1525 participants; RR 2.94, 95% CI 2.08 to 4.16; I²
= 0%; high-quality evidence), though the definition of platelet
refractoriness differed between trials. Participants who received
pathogen-reduced platelet transfusions required more platelet transfusions
(6 trials, 1509 participants; mean difference (MD) 1.23, 95% CI 0.86 to
1.61; I² = 27%; high-quality evidence), and there was probably
a shorter time interval between transfusions (6 trials, 1489 participants;
MD -0.42, 95% CI -0.53 to -0.32; I² = 29%; moderate-quality
evidence). Participants who received pathogen-reduced platelet
transfusions had a lower 24-hour corrected-count increment (7 trials, 1681
participants; MD -3.02, 95% CI -3.57 to -2.48; I² = 15%;
high-quality evidence). None of the studies reported quality of life. We
did not evaluate any economic outcomes. There was evidence of subgroup
differences in multiple transfusion trials between the two
pathogen-reduced platelet technologies assessed in this review (Intercept
and Mirasol) for all-cause mortality and the interval between platelet
transfusions (favouring Intercept). Authors' conclusions: Findings from
this review were based on 12 trials, and of the 1981 participants who
received a platelet transfusion only 44 did not have a haematological or
oncological diagnosis. In people with haematological or oncological
disorders who are thrombocytopenic due to their disease or its treatment,
we found high-quality evidence that pathogen-reduced platelet transfusions
increase the risk of platelet refractoriness and the platelet transfusion
requirement. We found moderate-quality evidence that pathogen-reduced
platelet transfusions do not affect all-cause mortality, the risk of
clinically significant or severe bleeding, or the risk of a serious
adverse event. There was insufficient evidence for people with other
diagnoses. All three ongoing trials are in adults (planned recruitment
1375 participants) with a haematological or oncological
diagnosis.<br/>Copyright &#xa9; 2017 The Cochrane Collaboration.

<31>
[Use Link to view the full text]
Accession Number
617616595
Author
Shi Y.; Yu H.; Yang X.-Y.
Institution
(Shi, Yu) Department of Anesthesiology, West China Hospital, Sichuan
University, Chengdu, China
(Yang) Department of Obstetrics and Gynecology, West China Second
Hospital, Sichuan University, Chengdu, China
Title
Letter by Shi et al Regarding Article, "Body Mass Index and Mortality
Among Adults Undergoing Cardiac Surgery: A Nationwide Study With a
Systematic Review and Meta-Analysis".
Source
Circulation. 136 (5) (pp 505-506), 2017. Date of Publication: 01 Aug 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)

<32>
Accession Number
617560028
Author
Clar C.; Al-Khudairy L.; Loveman E.; Kelly S.A.M.; Hartley L.; Flowers N.;
Germano R.; Frost G.; Rees K.
Institution
(Clar) Freelance, Hasenheide 67, Berlin 10967, Germany
(Al-Khudairy, Flowers, Rees) Warwick Medical School, University of
Warwick, Division of Health Sciences, Coventry CV4 7AL, United Kingdom
(Loveman) Effective Evidence LLP, 26 The Curve, Waterlooville, Hampshire
PO8 9SE, United Kingdom
(Kelly) University of Cambridge, Institute of Public Health, School of
Clinical Medicine, Forvie Site, Box 113 Cambridge Biomedical Campus,
Cambridge CB2 0SR, United Kingdom
(Hartley) RTI Health Solutions, Manchester M20 2LS, United Kingdom
(Germano) University of Naples Federico II, Division of Nutrition,
Department of Clinical Medicine and Surgery, Naples, Italy
(Frost) Hammersmith Hospital, Department of Nutrition and Dietetics,
Duncane Road, London W12 0HS, United Kingdom
Title
Low glycaemic index diets for the prevention of cardiovascular disease.
Source
Cochrane Database of Systematic Reviews. 2017 (7) (no pagination), 2017.
Article Number: CD004467. Date of Publication: 31 Jul 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: The glycaemic index (GI) is a physiological measure of the
ability of a carbohydrate to affect blood glucose. Interest is growing in
this area for the clinical management of people at risk of, or with,
established cardiovascular disease. There is a need to review the current
evidence from randomised controlled trials (RCTs) in this area. This is an
update of the original review published in 2008. Objectives: To assess the
effect of the dietary GI on total mortality, cardiovascular events, and
cardiovascular risk factors (blood lipids, blood pressure) in healthy
people or people who have established cardiovascular disease or related
risk factors, using all eligible randomised controlled trials. Search
methods: We searched CENTRAL, MEDLINE, Embase and CINAHL in July 2016. We
also checked reference lists of relevant articles. No language
restrictions were applied. Selection criteria: We selected RCTs that
assessed the effects of low GI diets compared to diets with a similar
composition but a higher GI on cardiovascular disease and related risk
factors. Minimum trial duration was 12 weeks. Participants included were
healthy adults or those at increased risk of cardiovascular disease, or
previously diagnosed with cardiovascular disease. Studies in people with
diabetes mellitus were excluded. Data collection and analysis: Two
reviewers independently screened and selected studies. Two review authors
independently assessed risk of bias, evaluated the overall quality of the
evidence using GRADE, and extracted data following the Cochrane Handbook
for Systematic Reviews of Interventions. We contacted trial authors for
additional information. Analyses were checked by a second reviewer.
Continuous outcomes were synthesized using mean differences and adverse
events were synthesized narratively. Main results: Twenty-one RCTs were
included, with a total of 2538 participants randomised to low GI
intervention (1288) or high GI (1250). All 21 included studies reported
the effect of low GI diets on risk factors for cardiovascular disease,
including blood lipids and blood pressure. Twenty RCTs (18 of which were
newly included in this version of the review) included primary prevention
populations (healthy individuals or those at high risk of CVD, with mean
age range from 19 to 69 years) and one RCT was in those diagnosed with
pre-existing CVD (a secondary prevention population, with mean age 26.9
years). Most of the studies did not have an intervention duration of
longer than six months. Difference in GI intake between comparison groups
varied widely from 0.6 to 42. None of the included studies reported the
effect of low GI dietary intake on cardiovascular mortality and
cardiovascular events such as fatal and nonfatal myocardial infarction,
unstable angina, coronary artery bypass graft surgery, percutaneous
transluminal coronary angioplasty, and stroke. The unclear risk of bias of
most of the included studies makes overall interpretation of the data
difficult. Only two of the included studies (38 participants) reported on
adverse effects and did not observe any harms (low-quality evidence).
Authors' conclusions: There is currently no evidence available regarding
the effect of low GI diets on cardiovascular disease events. Moreover,
there is currently no convincing evidence that low GI diets have a clear
beneficial effect on blood lipids or blood pressure
parameters.<br/>Copyright &#xa9; 2017 The Cochrane Collaboration.

<33>
Accession Number
617640317
Author
Kar S.
Institution
(Kar) Division of Cardiovascular MedicineTexas Tech University Health
Sciences Center at El Paso, Paul L. Foster School of MedicineEl Paso
79905Texas
Title
Transulnar cardiac catheterization and percutaneous coronary intervention:
Techniques, transradial comparisons, anatomical considerations, and
comprehensive literature review.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2017.
Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Ulnar arterial access for cardiac catheterization and intervention is an
alternative approach compared with radial or femoral access. Ulnar access
is infrequently performed since the radial artery is readily palpable and
is commonly used worldwide to minimize vascular complications from femoral
access. Nevertheless, ulnar access provides a suitable access site in
patients who are poor candidates for femoral access, have pre-existing
radial occlusion, radial artery hypoplasia or hyperplasia from prior
radial artery procedures, radial stenosis, radial loops, radial
tortuosity, small radial arteries, and/or have future need for radial
graft for dialysis or coronary artery bypass graft. Furthermore, femoral
access is the standard default option if radial access fails.
Consequently, learning ulnar access provides a suitable forearm
alternative to avoid femoral access when deemed high risk or undesirable.
This review discusses the techniques of ulnar access, advantages and
disadvantages of ulnar versus radial access, the clinical trials on ulnar
cardiac catheterization and its associated complications.<br/>Copyright
&#xa9; 2017 Wiley Periodicals, Inc.

<34>
Accession Number
617639906
Author
Gowda S.T.; Qureshi A.M.; Turner D.; Madan N.; Weigand J.; Lorber R.;
Singh H.R.
Institution
(Gowda, Madan, Weigand, Lorber, Singh) Pediatric CardiologyThe Children's
Hospital of San Antonio, Baylor College of MedicineSan Antonio, Texas
(Gowda, Turner, Singh) Pediatric CardiologyChildren's Hospital of
Michigan, Detroit Medical CenterDetroit, Michigan
(Qureshi) Pediatric CardiologyTexas Children's Hospital, Baylor College of
MedicineHouston, Texas
Title
Transseptal puncture using surgical electrocautery in children and adults
with and without complex congenital heart disease.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2017.
Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Atrial transseptal puncture (TSP) for cardiac catheterization
procedures remain challenging in children and adults with complex
congenital heart disease (CHD). Objectives: We sought to evaluate our
experience using radiofrequency (RF) current via surgical electrocautery
needle for TSP to facilitate diagnostic and interventional procedures.
Methods: Retrospective chart review of all patients (pts) who underwent
TSP using RF energy (10-25 W) via surgical electrocautery from three
centers from January 2011 to January 2017 were evaluated. Echocardiograms
were reviewed to define the atrial septum as normal and complex (thin
aneurysmal, thick/fibrotic, synthetic patch material, and extra cardiac
conduit). Results: A total of 54 pts underwent 55 successful TSP. Median
age was 12.5 years (1 day-54 years) and weight was 52.7 kg (2-162).
Indications for TSP included; EP study and ablation procedures in
structurally normal hearts (n=24) and in complex atrial septum/CHD and
structural heart disease pts (n=30): Electrophysiology study and ablation
in 4, diagnostic catheterization in 9, and interventional procedures in 17
pts were performed. Atrial TSP was successful in 54/55 (98%). Atrial
perforation with tiny-small pericardial effusion not requiring
intervention was noted in 2 pts. TSP was unsuccessful in one critically
ill neonate with unobstructed TAPVR and restricted atrial septum who
experienced cardiac arrest requiring CPR, ECMO, and emergent surgery.
Conclusions: RF current delivery using surgical electrocautery for TSP is
a feasible and an effective option in patients with complex CHD for
diagnostic, interventional, and electrophysiology
procedures.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<35>
Accession Number
617630025
Author
Perlman G.; Praz F.; Puri R.; Ofek H.; Ye J.; Philippon F.; Carrel T.;
Pibarot P.; Attinger A.; Htun N.M.; Dvir D.; Moss R.; Campelo-Parada F.;
Bedard E.; Reineke D.; Moschovitis A.; Lauck S.; Blanke P.; Leipsic J.;
Windecker S.; Rodes-Cabau J.; Webb J.
Institution
(Perlman, Ofek, Ye, Attinger, Htun, Dvir, Moss, Lauck, Blanke, Leipsic,
Webb) St. Paul's Hospital, Vancouver, British Columbia, Canada
(Perlman) Hadassah-Hebrew University Medical Center, Jerusalem, Israel
(Praz, Carrel, Reineke, Moschovitis, Windecker) Bern University Hospital,
Bern, Switzerland
(Puri, Philippon, Pibarot, Campelo-Parada, Bedard, Rodes-Cabau) Quebec
Heart and Lung Institute, Quebec City, Quebec, Canada
(Puri) Department of Medicine, University of Adelaide, Adelaide, Australia
(Puri) Cleveland Clinic Coordinating Center for Clinical Research,
Cleveland, Ohio
Title
Transcatheter Tricuspid Valve Repair With a New Transcatheter Coaptation
System for the Treatment of Severe Tricuspid Regurgitation. 1-Year
Clinical and Echocardiographic Results.
Source
JACC: Cardiovascular Interventions. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study sought to describe the 1-year experience with the
transcatheter FORMA system for severe tricuspid regurgitation (TR).
Background: Severe TR is associated with significant morbidity and
mortality. Novel transcatheter therapies have been recently developed.
Methods: Eighteen patients underwent device implantation at 3 centers in
Canada and Switzerland. Baseline characteristics, procedural, 30-day, and
1-year outcomes were prospectively evaluated using multimodality imaging
and hemodynamic and clinical assessments. Results: Procedural success was
achieved in 16 (89%) patients. Unsuccessful procedures were because of
right ventricular perforation requiring open surgery and device
dislocation. At 1 year there were no deaths, significant arrhythmias,
device infections, or dislocations. Thrombus was observed on 1 device at 4
months and there was 1 rehospitalization for heart failure. Among the 14
patients with successful device implantation and 1-year follow-up, 79%
were in New York Heart Association functional class I/II (p < 0.001), the
average 6-min-walk test increased by 84 m (p = 0.03), and the Kansas City
Cardiomyopathy Questionaire heart failure score improved by 18 points (p =
0.02) compared with baseline. Echocardiography showed a reduction of TR
from severe in 17 of 18 (94%) patients at baseline to moderate-severe or
less in 11 of 16 patients (69%) by 30 days (p = 0.001) and 6 of 13
patients (46%) by 1 year (p = 0.01). The diameters of the tricuspid
annulus and the right ventricle were reduced at 1 year (45.7 +/- 4.8 mm to
42.1 +/- 4.4 mm, p = 0.004; 54 +/- 5.3 mm to 49.9 +/- 4.3 mm, p = 0.02,
respectively). Conclusions: Implantation of the FORMA system in high-risk
patients with severe TR shows feasibility with a good mid-term safety
profile. At 1 year, despite variable success in reducing echocardiographic
TR grade, there were significant clinical improvements and reductions in
right ventricular dimensions.<br/>Copyright &#xa9; 2017 American College
of Cardiology Foundation.

<36>
Accession Number
617628053
Author
Elbassioni A.A.M.; Amr M.A.; Hassan H.S.; Eldomiaty H.A.
Institution
(Elbassioni, Amr, Hassan, Eldomiaty) Suez Canal University, Egypt
Title
Bridging saphenous vein harvesting versus conventional techniques in
patients undergoing coronary artery bypass grafting in Suez Canal
university hospital.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. (no
pagination), 2017. Date of Publication: 2017.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Ischemic heart disease (IHD) is a common cause of death, which encourages
us to improve continuously the techniques adopted for coronary artery
bypass grafting (CABG). Still the most commonly used graft is saphenous
vein harvested by different techniques. Methods: This prospective
randomized study included 60 patients with IHD in need of CABG classified
into two equal groups: group A (saphenous vein harvesting with
conventional technique) and group B (saphenous vein harvesting with lens
assisted bridging technique [LABT]). We compared the two groups in terms
of preoperative, intraoperative and postoperative data then we
statistically analysed the findings. Results: Our study showed that LABT
had significantly less pain, less infection, more cosmetic, less hospital
stay with more patient satisfaction and without any additional costs.
Conclusions: Our study showed that lens assisted bridging vein harvesting
was a good substitute for conventional technique.<br/>Copyright &#xa9;
2017 The Egyptian Society of Cardio-thoracic Surgery.

<37>
Accession Number
617599188
Author
Ikeme S.; Rock M.; Bin Sawad A.; Kuntze E.; Martin M.
Institution
(Ikeme) Baxter Healthcare Corporation, Deerfield, IL, United States
(Rock, Bin Sawad, Kuntze) Baxter Healthcare, Deerfield, IL, United States
(Martin) In Ventiv Health, London, United Kingdom
Title
Clinical and economic burden of bleeding in cardiac surgery: A systematic
review.
Source
Value in Health. Conference: ISPOR 22nd Annual European Congress. United
States. 20 (5) (pp A279), 2017. Date of Publication: May 2017.
Publisher
Elsevier Ltd
Abstract
OBJECTIVES: We conducted a systematic review to identify published
evidence from observational studies on the clinical and economic burden of
bleeding in cardiac surgery. METHODS: We searched Embase, Pubmed and the
Centre for Reviews and Dissemination (CRD) suite of databases for English
language articles and analyzed these qualitatively. The search was limited
to evidence published in the last 10 years (2006-2016). Relevant studies
were identified using a priori defined inclusion and exclusion criteria
relating to the burden of bleed in a mixed cardiac surgery population.
RESULTS: The review identified 13 publications all based on observational
study design. Majority of the studies examined patients undergoing
coronary artery bypass graft (CABG) (n=6) and aortic valve replacement
(AVR) (n=3). The rate of bleeding ranged from 94.2% in those requiring
re-exploration and 4.94% in those with more than one complication. On
average (n=6), bleeding and complications lead to significantly higher
rates of re-exploration (1.2% to 50%) compared to patients without
bleeding events or complications. The length of intensive care unit (ICU)
(n=3) and hospital (n=4) stay was significantly shorter in those with
no/minor bleeding compared to those who experienced major bleeding.
Post-operative ventilator use (n=6) ranged from 8.8% to 35.5% in those who
experienced bleeding. Mortality increased for patients who underwent
re-exploration or experienced uncontrolled bleeding; 1.9% to 21.1%
operative death and 3.1% to 22.4% 30-day mortality. Eleven publications
found significant higher average cost of cardiac surgery for those who
experienced peri-operative bleeding and re-operation due to bleeding.
CONCLUSIONS: Bleeding related complications and higher resource
utilization in cardiac surgery patients who experience uncontrolled
surgical bleeding pose substantial clinical burden to the patient and
economic consequence to the hospital/health system.

<38>
Accession Number
617599171
Author
Ikeme S.; Rock M.; Bin Sawad A.; Kuntze E.; Martin M.
Institution
(Ikeme, Rock) Baxter Healthcare Corporation, Deerfield, IL, United States
(Bin Sawad, Kuntze) Baxter Healthcare, Deerfield, IL, United States
(Martin) InVentiv Health, London, United Kingdom
Title
Clinical and economic burden of transfusion in cardiac surgery: A
systematic review.
Source
Value in Health. Conference: ISPOR 22nd Annual European Congress. United
States. 20 (5) (pp A279), 2017. Date of Publication: May 2017.
Publisher
Elsevier Ltd
Abstract
OBJECTIVES: We conducted a systematic review to identify published
evidence from observational studies on the clinical and economic burden of
transfusion in cardiac surgery. METHODS: We searched Embase, Pubmed and
the Centre for Reviews and Dissemination (CRD) suite of databases for
English language articles and analyzed these qualitatively. The search was
limited to evidence published in the last 10 years (2006-2016). RESULTS:
The review identified 16 publications and 15 were observational study
design. Majority of the studies examined patients undergoing coronary
artery bypass graft (CABG) and aortic valve replacement (AVR). The rate of
transfusion ranged from 15% to 84% in those patients who experienced
excessive bleeding after cardiac surgery. A significant reduction in
transfusion rates and red blood cell (RBC) usage was observed with
patients who did not experience bleeding, use blood conversation
strategies and less invasive surgical techniques (n=6). Platelet use
ranged from 9.8% to 84% and was significantly higher in patients who
experienced bleeding or underwent re-exploration (n=5). Fresh Frozen
Plasma (FFP) use ranged from 2.4% to 63% (n=5) and there was a significant
difference in units of FFP transfused in patients with post-operative
bleeding and re-exploration (n=2). Transfused cardiac surgery patients had
significantly longer hospital stays, were more frequently hospitalized and
utilized more ICU services. Total costs of blood and transfusions were
highest in the United States and correlated significantly with transfusion
rate. Mortality data (n=5) showed that patients who received transfusion
had higher in-hospital (1.7%-3.07%) and long-term (5.8%-6.4%) mortality
and a dose-dependent relationship between unit of packed RBC and higher
odds for post-operative mortality. CONCLUSIONS: Transfusion of blood
products and the resultant higher resource utilization in cardiac surgery
patients pose substantial clinical burden to the patient and economic
consequences to the hospital/health system. Reducing both factors has the
potential to reduce patient morbidity and healthcare cost.

<39>
Accession Number
617598674
Author
Avdeyev A.; Mendykulov S.; Mussayev S.; Albayev R.; Kaptagayeva A.; Sharip
B.; Tabarov A.; Zhanabekova L.; Gizatullina A.; Makalkina L.
Institution
(Avdeyev, Mendykulov, Mussayev, Albayev, Sharip, Tabarov, Zhanabekova,
Gizatullina) Hospital of the Medical Center, President's Affairs
Administration of the Republic of Kazakhstan, Astana, Kazakhstan
(Kaptagayeva) Ministry of Healthcare, Social Development of the Republic
of Kazakhstan, Astana, Kazakhstan
(Makalkina) Medical University Astana, Astana, Kazakhstan
Title
Simultaneous endovascular aneurysm repair and coronary artery bypass
grafting.
Source
Value in Health. Conference: ISPOR 22nd Annual European Congress. United
States. 20 (5) (pp A276), 2017. Date of Publication: May 2017.
Publisher
Elsevier Ltd
Abstract
OBJECTIVES: Simultaneous endovascular aneurysm repair (EVAR) and coronary
artery bypass grafting (CABG) includes two different surgical operations
doing by two teams of operating surgeons during one anaesthetic support.
Patients with concomitant aortic aneurismal disease and coronary artery
disease stay in group of high risk of perioperative aortic aneurism
rupture and myocardial infarction. Therefore, simultaneous EVAR/CABG can
reduce the incidence of late aortic aneurism rupture and myocardial
infarction and can improve survival in the short and long-term period.
This research aim is to evaluate clinical effectiveness, safety and
economic effectiveness of simultaneous EVAR/CABG compared with conducting
these surgical operations separately. METHODS: For opportunity to evaluate
clinical effectiveness, safety and economic effectiveness of simultaneous
EVAR/CABG the systematic literature search was conducted in databases of
evidence-based medicine named MEDLINE, EMBASE, Tripdatabase, Clinical
Trials. Publication date: nolaterthan 10 years (since 2007). RESULTS: As a
result of systematic search we found 12 articles; all of these articles
confirmed clinical effectiveness and safety of simultaneous EVAR/ CABG in
patients with large and/or symptomatic aortic aneurism and severe coronary
artery disease. Simultaneous EVAR/CABG can be viable procedure with low
operative mortality and acceptable rate of perioperative complications.
From the side of economic effectiveness conducting simultaneous EVAR/CABG
can reduce costs for 1
patienttreatmentbyameanof7.5%(1120USD)dueto1)reducing duration of hospital
stay and postoperative rehabilitation; 2) no need for additional
anaesthetic support; 3) decreasing in incidence of post-operative aortic
aneurism ruptures and myocardial infarctions in patients with concomitant
aortic aneurismal and coronary artery diseases. CONCLUSIONS: Simultaneous
endovascular aneurysm repair and coronary artery bypass grafting can be
viable procedure for patients with concomitant large and/or symptomatic
aortic aneurism and severe coronary artery disease with low operative
mortality, acceptable rate of perioperative complications and has some
economic advantages over conducting these surgical operations separately.

<40>
[Use Link to view the full text]
Accession Number
617549722
Author
Bundhun P.K.; Sookharee Y.; Bholee A.; Huang F.
Institution
(Bundhun, Huang) Institute of Cardiovascular Diseases, First Affiliated
Hospital of Guangxi Medical University, Nanning, Guangxi 530027, China
(Sookharee, Bholee) Tongji Hospital of Huazhong University of Science and
Technology, Wuhan, Hubei, China
Title
Application of the SYNTAX score in interventional cardiology.
Source
Medicine (United States). 96 (28) (no pagination), 2017. Article Number:
e7410. Date of Publication: 01 Jul 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Should the SYNTAX score be integrated in Interventional
Cardiology? Should it really be considered as a vital decision-making tool
in percutaneous coronary intervention (PCI)? To confirm the importance of
this score, we aimed to systematically compare the postinterventional
adverse cardiovascular outcomes which were observed in patients who were
allotted a low versus a high SYNTAX score. Methods: Randomized controlled
trials and observational studies which were published from January 2007 to
January 2017 were identified from MEDLINE, EMBASE, and the Cochrane
databases using the searched terms 'SYNTAX score and percutaneous coronary
intervention.' Adverse cardiovascular outcomes were considered as the
major endpoints. Risk ratios (RRs) with 95% confidence intervals (CIs)
were used as the statistical parameters, and the main analysis was carried
out by the RevMan 5.3 software. Results: Sixteen studies with a total
number of 19,751 participants (8589 participants with a low versus 11,162
participants with a high SYNTAX score) were included. Current results
showed mortality to be significantly higher with a higher SYNTAX score (RR
2.09, 95% CI 1.78-2.46, P=.00001). Cardiac death also significantly
favored a low SYNTAX score (RR 2.08, 95% CI 1.66-2.61, P=.00001.
Similarly, myocardial infarction, major adverse cardiac events, repeated
revascularization, and stent thrombosis were significantly higher
following a high SYNTAX score (RR 1.71, 95% CI 1.45-2.03, P=.00001; RR
2.03, 95% CI 1.81-2.26, P=.00001; RR 1.96, 95% CI 1.69-2.28, P=.00001; and
RR 3.16, 95% CI 2.17-4.59, P=.00001, respectively). Even when patients
with ST-segment elevation myocardial infarction were separately analyzed,
a low SYNTAX score was still significantly associated with lower adverse
outcomes. Conclusions: This analysis is a confirmatory piece of evidence
to show that the application of the SYNTAX score in Interventional
Cardiology is apparently relevant. The use of this scoring system to grade
patients with coronary artery disease and to further guide for
revascularization should be encouraged.<br/>Copyright &#xa9; 2017 the
Author(s). Published by Wolters Kluwer Health, Inc.

<41>
Accession Number
617619316
Author
van Wijk S.W.H.; van der Stelt F.; ter Heide H.; Schoof P.H.; Doevendans
P.A.F.M.; Meijboom F.J.; Breur J.M.P.J.
Institution
(van Wijk, van der Stelt, ter Heide, Doevendans, Meijboom, Breur)
Pediatric Cardiology, University Medical Center Utrecht, Utrecht, The
Netherlands
(Schoof) Pediatric Cardiothoracic Surgery, University Medical Center
Utrecht, Utrecht, The Netherlands
Title
Sudden Death Due to Coronary Artery Lesions Long-term After the Arterial
Switch Operation: A Systematic Review.
Source
Canadian Journal of Cardiology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Pulsus Group Inc.
Abstract
Background: The arterial switch operation (ASO) is the preferred procedure
for children with dextrotransposition of the great arteries or
Taussig-Bing anomaly. Short- as well as long-term outcome of ASO are
excellent, but coronary artery stenoses are reported as a common long-term
complication. It has been hypothesized that these might result in sudden
cardiac death late after ASO. Methods: A systematic search of PubMed and
EMBASE was conducted to evaluate sudden cardiac death because of coronary
complications late after ASO. Data on patients surviving >= 5 years
post-ASO were collected from selected studies, corrected for duplicate
data, and analyzed. Results: After duplicate data correction 52 studies
remained for data analysis. Among the 8798 survivors with follow-up, 27
patients died >= 5 years post-ASO (0.3%). Of these patients, 10 were known
with relevant residual lesions. Five late deaths were sudden, possibly
from a cardiac cause. None of the late sudden deaths were confirmed to be
coronary-related. Conclusions: Sudden cardiac death in asymptomatic
patients as a result of coronary artery stenosis or occlusion is extremely
rare, with 5 possible cases and no proven cases of coronary artery-related
sudden cardiac death in 8798 patients with 66,450 patient follow-up years.
Therefore, routine coronary imaging of asymptomatic, single-stage ASO
patients is not justified.<br/>Copyright &#xa9; 2017 Canadian
Cardiovascular Society.

<42>
[Use Link to view the full text]
Accession Number
617550584
Author
Jo Y.Y.; Kim J.Y.; Lee J.Y.; Choi C.H.; Chang Y.J.; Kwak H.J.
Institution
(Jo, Lee, Chang, Kwak) Department of Anesthesiology and Pain Medicine,
Gachon University Gil Medical Center, Namdong-daero 774 beon-gil,
Namdong-gu, Incheon 21565, South Korea
(Kim) Department of Anesthesiology and Pain Medicine, Anesthesia and Pain
Research Institute, Yonsei University College of Medicine, Seoul, South
Korea
(Choi) Department of Cardiovascular Surgery, Gachon University Gil Medical
Center, Incheon, South Korea
Title
The effect of intraoperative dexmedetomidine on acute kidney injury after
pediatric congenital heart surgery.
Source
Medicine (United States). 96 (28) (no pagination), 2017. Article Number:
e7480. Date of Publication: 01 Jul 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Dexmedetomidine has been reported to have a renal protective
effect after adult open heart surgery. The authors hypothesized that
intraoperative infusion of dexmedetomidine would attenuate the decrease in
renal function after pediatric open heart surgery. Methods: Twenty-nine
pediatric patients (1-6 years) scheduled for atrial or ventricular septal
defect repair were randomly assigned to receive either continuous infusion
of normal saline (control group, n=14) or dexmedetomidine (a bolus dose of
0.5mug/kg and then an infusion of 0.5mug/kg/h) (dexmedetomidine group,
n=15) from anesthesia induction to the end of cardiopulmonary bypass.
Serum creatinine (Scr) was measured before surgery (T0), 10minutes after
anesthesia induction (T1), 5minutes after cardiopulmonary bypass weaning
(T2), 2hours after T2 (T3), and after postoperative day 1 (POD1) and
postoperative day 2 (POD2) and estimated glomerular filtration rates
(eGFRs) were calculated. Renal biomarkers were measured at T1, T2, and T3.
Acute kidney injury (AKI) was defined as an absolute increase in Scr of >=
0.3mg/dL or a percent increase in Scr of >=50%. Results: The incidence of
AKI during the perioperative period was significantly higher in the
control group than in the dexmedetomidine group (64% [9/14] vs 27% [4/15],
P=.042). eGFR was significantly lower in the control group than in the
dexmedetomidine group at T2 (72.6+/-15.1 vs 83.9+/-13.5, P=.044) and T3
(73.4+/-15.4 vs 86.7+/-15.9, P=.03). Conclusion: Intraoperative infusion
of dexmedetomidine may reduce the incidence of AKI and suppress
post-bypass eGFR decline.<br/>Copyright &#xa9; 2017 the Author(s).
Published by Wolters Kluwer Health, Inc.

<43>
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).

<44>
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.

<45>
Accession Number
617604749
Author
Lips M.; Mraz M.; Klouckova J.; Kopecky P.; Dobias M.; Krizova J.; Lindner
J.; Diamant M.; Haluzik M.
Institution
(Lips, Kopecky, Dobias) Department of Anaesthesiology, Resuscitation and
Intensive Care, First Faculty of Medicine, Charles University and General
University Hospital Prague Czech Republic
(Mraz, Haluzik) Department of Diabetes, Diabetes Centre Institute for
Clinical and Experimental Medicine Prague Czech Republic
(Mraz, Klouckova, Haluzik) Institute of Medical Biochemistry and
Laboratory Diagnostics, First Faculty of Medicine, Charles University and
General University Hospital Prague Czech Republic
(Klouckova, Haluzik) Department of Experimental Diabetology, Centre for
Experimental Medicine, Institute for Clinical and Experimental Medicine
Prague Czech Republic
(Krizova) 3rd Department of Medicine - Department of Endocrinology and
Metabolism First Faculty of Medicine, Charles University and General
University Hospital Prague Czech Republic
(Lindner) 2nd Department of Surgery - Department of Cardiovascular Surgery
First Faculty of Medicine, Charles University and General University
Hospital Prague Czech Republic
(Diamant) VU University Medical Centre Amsterdam The Netherlands
(Haluzik) Department of Obesitology, Institute of Endocrinology Prague
Czech Republic
Title
Effect of continuous exenatide infusion on cardiac function and
peri-operative glucose control in patients undergoing cardiac surgery: A
single-blind, randomized controlled trial.
Source
Diabetes, Obesity and Metabolism. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
We performed a randomized controlled trial with the glucagon-like
peptide-1 (GLP-1) receptor agonist exenatide as add-on to standard
peri-operative insulin therapy in patients undergoing elective cardiac
surgery. The aims of the study were to intensify peri-operative glucose
control while minimizing the risk of hypoglycaemia and to evaluate the
suggested cardioprotective effects of GLP-1-based treatments. A total of
38 patients with decreased left ventricular systolic function (ejection
fraction <=50%) scheduled for elective coronary artery bypass grafting
(CABG) were randomized to receive either exenatide or placebo in a
continuous 72-hour intravenous (i.v.) infusion on top of standard
peri-operative insulin therapy. While no significant difference in
postoperative echocardiographic variables was found between the groups,
participants receiving exenatide showed improved peri-operative glucose
control as compared with the placebo group (average glycaemia 6.4+/-0.5 vs
7.3+/-0.8mmol/L; P<.001; percentage of time in target range of
4.5-6.5mmol/L 54.8%+/-14.5% vs 38.6%+/-14.4%; P=.001; percentage of time
above target range 39.7%+/-13.9% vs 52.8%+/-15.2%; P=.009) without an
increased risk of hypoglycaemia (glycaemia <3.3mmol/L: 0.10+/-0.32 vs
0.21+/-0.42 episodes per participant; P=.586). Continuous administration
of i.v. exenatide in patients undergoing elective CABG could provide a
safe option for intensifying the peri-operative glucose management of such
patients.<br/>Copyright &#xa9; 2017 John Wiley & Sons Ltd.

<46>
Accession Number
617595285
Author
Oezkur M.; Magyar A.; Thomas P.; Stork T.; Schneider R.; Bening C.; Stork
S.; Heuschmann P.U.; Leyh R.G.; Wagner M.
Institution
(Oezkur, Magyar, Thomas, Stork, Bening, Leyh) aDepartment of
Cardiovascular surgery, University Hospital Wurzburg, Wurzburg, Germany
(Oezkur, Magyar, Thomas, Stork, Heuschmann, Wagner) bInstitute of Clinical
Epidemiology and Biometry, University of Wurzburg, Wurzburg, Germany
(Schneider, Wagner) cDiv. of Nephrology, Dept. of Medicine I, University
Hospital Wurzburg, Wurzburg, Germany
(Stork, Heuschmann, Wagner) dComprehensive Heart Failure Center,
University of Wurzburg, Wurzburg, Germany
(Stork) eDiv of Cardiology, Dept. of Medicine I, University Hospital
Wurzburg, Wurzburg, Germany
(Heuschmann) fClinical Trial Center Wurzburg, University Hospital
Wurzburg, Wurzburg, Germany
Title
TIMP-2*IGFBP7 (Nephrocheck) Measurements at Intensive Care Unit Admission
After Cardiac Surgery are Predictive for Acute Kidney Injury Within 48
Hours.
Source
Kidney and Blood Pressure Research. (pp 456-467), 2017. Date of
Publication: 27 Jul 2017.
Publisher
S. Karger AG
Abstract
Background/Aims: Acute kidney injury (AKI) is a postoperative complication
after cardiac surgery with a high impact on mortality and morbidity.
Nephrocheck [TIMP-2*IGFBP7] determines markers of tubular stress, which
occurs prior to tubular damage. It is unknown at which time-point
[TIMP-2*IGFBP7] measurement should be performed to ideally predict AKI. We
investigated the association of [TIMP-2*IGFBP7] at various time-points
with the incidence of AKI in patients undergoing elective cardiac surgery
including cardio-pulmonary bypass. Methods: In a prospective cohort study,
serial blood and urine samples were collected from 150 patients:
pre-operative, at ICU-admission, 24h and 48h post-surgery. AKI was defined
as Serum-Creatinine rise >0.3 mg/dl within 48hrs. Urinary [TIMP-2*IGFBP7]
was measured at pre-operative, ICU-admission and 24h post-surgery; medical
staff was kept blinded to these results. Results: A total of 35 patients
(23.5%) experienced AKI, with a higher incidence in those with high
[TIMP-2*IGFBP7] values at ICU admission (57.1% vs. 10.1%, p<0.001). In
logistic regression [TIMP-2*IGFBP7] at ICU admission was independently
associated with the occurrence of AKI (Odds Ratio 11.83; p<0.001,
C-statistic= 0.74) after adjustment for EuroSCORE II and CBP-time.
Conclusions: Early detection of elevated [TIMP-2*IGFBP7] at ICU admission
was strongly predictive for postoperative AKI and appeared to be more
precise as compared to subsequent measurements.<br/>Copyright &#xa9; 2017
The Author(s). Published by S. Karger AG, Basel

<47>
Accession Number
617594862
Author
Cavalca V.; Rocca B.; Veglia F.; Petrucci G.; Porro B.; Myasoedova V.; De
Cristofaro R.; Turnu L.; Bonomi A.; Songia P.; Cavallotti L.; Zanobini M.;
Camera M.; Alamanni F.; Parolari A.; Patrono C.; Tremoli E.
Institution
(Cavalca, Veglia, Porro, Myasoedova, Turnu, Bonomi, Songia, Cavallotti,
Zanobini, Camera, Alamanni, Tremoli) Monzino Cardiology Center, IRCCSMilan
Italy
(Cavalca, Turnu, Songia, Camera, Alamanni) University of MilanMilan Italy
(Rocca, Petrucci, Patrono) Department of PharmacologyCatholic
UniversityRome Italy
(De Cristofaro) Department of HematologyCatholic UniversityRome Italy
(Parolari) Policlinico San Donato Hospital, IRCCSSan Donato Milanese Italy
Title
On-pump Cardiac Surgery Enhances Platelet Renewal and Impairs Aspirin
Pharmacodynamics: Effects of Improved Dosing Regimens.
Source
Clinical Pharmacology and Therapeutics. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
On-pump cardiac surgery may trigger inflammation and accelerate platelet
cyclooxygenase-1 renewal, thereby modifying low-dose aspirin
pharmacodynamics. Thirty-seven patients on standard aspirin 100 mg
once-daily were studied before surgery and randomized within 36 hours
postsurgery to 100 mg once-daily, 100 mg twice-daily, or 200 mg once-daily
for 90 days. On day 7 postsurgery, immature and mature platelets, platelet
mass, thrombopoietin, glycocalicin, leukocytes, C-reactive protein, and
interleukin-6 significantly increased. Interleukin-6 significantly
correlated with immature platelets. At day 7, patients randomized to 100
mg once-daily showed a significant increase in serum thromboxane
(TX)B<inf>2</inf> within the 24-hour dosing interval and urinary
TXA<inf>2</inf> metabolite (TXM) excretion. Aspirin 100 mg twice-daily
lowered serum TXB<inf>2</inf> and prevented postsurgery TXM increase (P <
0.01), without affecting prostacyclin metabolite excretion. After cardiac
surgery, shortening the dosing interval, but not doubling the once-daily
dose, rescues the impaired antiplatelet effect of low-dose aspirin and
prevents platelet activation associated with acute inflammation and
enhanced platelet turnover.<br/>Copyright &#xa9; 2017 American Society for
Clinical Pharmacology and Therapeutics.