EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
607143255
Author
Lincoff A.M.; Mehran R.; Povsic T.J.; Zelenkofske S.L.; Huang Z.;
Armstrong P.W.; Steg P.G.; Bode C.; Cohen M.G.; Buller C.; Laanmets P.;
Valgimigli M.; Marandi T.; Fridrich V.; Cantor W.J.; Merkely B.;
Lopez-Sendon J.; Cornel J.H.; Kasprzak J.D.; Aschermann M.; Guetta V.;
Morais J.; Sinnaeve P.R.; Huber K.; Stables R.; Sellers M.A.; Borgman M.;
Glenn L.; Levinson A.I.; Lopes R.D.; Hasselblad V.; Becker R.C.; Alexander
J.H.
Institution
(Lincoff, Borgman) Cleveland Clinic Coordinating Center for Clinical
Research (C5Research), Department of Cardiovascular Medicine, Cleveland
Clinic, Cleveland, OH 44195, United States
(Mehran) Mount Sinai School of Medicine, New York, NY, United States
(Povsic, Huang, Sellers, Lopes, Hasselblad, Alexander) Duke Clinical
Research Institute, Duke Medicine, Durham, NC, United States
(Zelenkofske, Glenn) Regado Biosciences, Basking Ridge, NJ, United States
(Armstrong) Canadian VIGOUR Centre, University of Alberta, Edmonton, AB,
Canada
(Steg) Universite Paris-Diderot, Sorbonne Paris Cite, Paris, France
(Bode) University of Freiburg, Freiburg, Germany
(Cohen) University of Miami, Miller School of Medicine, Miami, FL, United
States
(Buller) St Michael's Hospital, Toronto, ON, Canada
(Laanmets, Marandi) North Estonia Medical Centre, Tallinn, Estonia
(Valgimigli) University Hospital of Ferrara, Institute of Cardiology,
Ferrara, Italy
(Fridrich) National Institute of Cardiovascular Diseases, Bratislava,
Slovakia
(Cantor) Southlake Regional Health Centre, Newmarket, ON, Canada
(Merkely) Semmelweis University Heart, Vascular Center, Budapest, Hungary
(Lopez-Sendon) Hospital Universitario la Paz, IdiPaz, Madrid, Spain
(Cornel) Medical Center Alkmaar, Alkmaar, Netherlands
(Kasprzak) Medical University of Lodz, Bieganski Hospital, Lodz, Poland
(Aschermann) General University Hospital, Prague, Czech Republic
(Guetta) Heart Institute Sheba Medical Center, Tel Aviv University, Tel
Hashomer, Israel
(Morais) Santo Andre's Hospital, Leiria, Portugal
(Sinnaeve) University Hospitals Leuven, Campus Gasthuisberg, Leuven,
Belgium
(Huber) Wilhelminen Hospital, Vienna, Austria
(Stables) Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
(Levinson) Perelman School of Medicine, University of Pennsylvania,
Philadelphia, PA, United States
(Becker) University of Cincinnati, College of Medicine, Cincinnati, OH,
United States
Title
Effect of the REG1 anticoagulation system versus bivalirudin on outcomes
after percutaneous coronary intervention (REGULATE-PCI): A randomised
clinical trial.
Source
The Lancet. 387 (10016) (pp 349-356), 2016. Date of Publication: 23 Jan
2016.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Summary Background REG1 is a novel anticoagulation system consisting of
pegnivacogin, an RNA aptamer inhibitor of coagulation factor IXa, and
anivamersen, a complementary sequence reversal oligonucleotide. We tested
the hypothesis that near complete inhibition of factor IXa with
pegnivacogin during percutaneous coronary intervention, followed by
partial reversal with anivamersen, would reduce ischaemic events compared
with bivalirudin, without increasing bleeding. Methods We did a
randomised, open-label, active-controlled, multicentre, superiority trial
to compare REG1 with bivalirudin at 225 hospitals in North America and
Europe. We planned to randomly allocate 13200 patients undergoing
percutaneous coronary intervention in a 1:1 ratio to either REG1
(pegnivacogin 1 mg/kg bolus [>99% factor IXa inhibition] followed by 80%
reversal with anivamersen after percutaneous coronary intervention) or
bivalirudin. Exclusion criteria included ST segment elevation myocardial
infarction within 48 h. The primary efficacy endpoint was the composite of
all-cause death, myocardial infarction, stroke, and unplanned target
lesion revascularisation by day 3 after randomisation. The principal
safety endpoint was major bleeding. Analysis was by intention to treat.
This trial is registered at ClinicalTrials.gov, identifier NCT01848106.
The trial was terminated early after enrolment of 3232 patients due to
severe allergic reactions. Findings 1616 patients were allocated REG1 and
1616 were assigned bivalirudin, of whom 1605 and 1601 patients,
respectively, received the assigned treatment. Severe allergic reactions
were reported in ten (1%) of 1605 patients receiving REG1 versus one (<1%)
of 1601 patients treated with bivalirudin. The composite primary endpoint
did not differ between groups, with 108 (7%) of 1616 patients assigned
REG1 and 103 (6%) of 1616 allocated bivalirudin reporting a primary
endpoint event (odds ratio [OR] 1.05, 95% CI 0.80-1.39; p=0.72). Major
bleeding was similar between treatment groups (seven [<1%] of 1605
receiving REG1 vs two [<1%] of 1601 treated with bivalirudin; OR 3.49, 95%
CI 0.73-16.82; p=0.10), but major or minor bleeding was increased with
REG1 (104 [6%] vs 65 [4%]; 1.64, 1.19-2.25; p=0.002). Interpretation The
reversible factor IXa inhibitor REG1, as currently formulated, is
associated with severe allergic reactions. Although statistical power was
limited because of early termination, there was no evidence that REG1
reduced ischaemic events or bleeding compared with bivalirudin. Funding
Regado Biosciences Inc.<br/>Copyright &#xa9; 2016 Elsevier Ltd.

<2>
Accession Number
614105213
Author
O'Brien E.O.; Newhouse B.J.; Cronin B.; Robbins K.; Nguyen A.P.; Khoche
S.; Schmidt U.
Institution
(O'Brien, Newhouse, Cronin, Robbins, Nguyen, Khoche, Schmidt) Department
of Anesthesiology, University of California, San Diego, CA, United States
Title
Hemodynamic Consequence of Hand Ventilation Versus Machine Ventilation
During Transport After Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (4) (pp 1246-1249),
2017. Date of Publication: August 2017.
Publisher
W.B. Saunders
Abstract
Objectives The hemodynamic consequences of ventilation of intubated
patients during transport either by hand or using a transport ventilator
have not been reported in patients after cardiac surgery. The authors
hypothesized that bag-mask ventilation would alter end-tidal
CO<inf>2</inf> during transport and hemodynamic parameters in patients
post-cardiac surgery. Design A prospective, randomized trial. Setting A
university-affiliated tertiary care hospital. Participants Cardiac surgery
patients. Interventions Thirty-six patients were randomized to hand
ventilation or machine ventilation. Hemodynamic variables including blood
pressure, heart rate, peripheral saturation of oxygen, and end-tidal
carbon dioxide (ETCO<inf>2</inf>) were measured in these patients prior to
transport, every 2 minutes during transport and upon arrival in the
intensive care unit (ICU). Pulmonary artery pressure (PA) pressures were
measured at origin and at destination. Measurements and Main Results
Outcomes were changes from baseline in end-tidal CO<inf>2</inf>,
hemodynamic changes from baseline and pulmonary artery pressure changes
from origin to destination. The average transport time between the 2
groups was not different: 5 minutes for patients ventilated by hand and
5.47 minutes for patients ventilated with a transport ventilator (p =
0.369 by 2-sided t-test). The difference in all measured changes in
ETCO<inf>2</inf> between hand-ventilated and machine-ventilated patients
during transport was 2.74 mmHg (p = 0.013). The difference between
operating room and ICU ETCO<inf>2</inf> from each cohort was 1.31 mmHg (p
= 0.067). The difference in PA<inf>mean</inf> measured at origin and
destination was 0.783 mmHg (p = 0.622). All other hemodynamic variables
were not different during transport. Conclusions Hand ventilation during
transport was associated with greater change from baseline of
ETCO<inf>2</inf> compared to machine ventilation during transport after
cardiac surgery, but this did not translate into any difference in
hemodynamic changes upon arrival in ICU. A hemodynamic benefit of machine
transport ventilation to cardiac patients was not
demonstrated.<br/>Copyright &#xa9; 2017 Elsevier Inc.

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

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

<5>
Accession Number
613851474
Author
Butler E.; Chin M.; Aneman A.
Institution
(Butler) Faculty of Medicine, University of New South Wales, Sydney,
Australia
(Chin, Aneman) Intensive Care Unit, Liverpool Hospital, Sydney, Australia
(Aneman) University of New South Wales, South Western Sydney Clinical
School, Sydney, Australia
(Aneman) Ingham Institute for Applied Medical Research, Sydney, Australia
Title
Peripheral Near-Infrared Spectroscopy: Methodologic Aspects and a
Systematic Review in Post-Cardiac Surgical Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (4) (pp 1407-1416),
2017. Date of Publication: August 2017.
Publisher
W.B. Saunders

<6>
Accession Number
617703160
Author
Zhang C.
Institution
(Zhang) University of Edinburgh, United Kingdom
Title
Does statin reloading before cardiac surgery improve postoperative
outcomes?.
Source
Anaesthesia. Conference: AAGBI GAT Annual Scientific Meeting 2017. United
Kingdom. 72 (pp 26), 2017. Date of Publication: July 2017.
Publisher
Blackwell Publishing Ltd
Abstract
A 75-year-old male is referred to you for elective cardiac surgery. He has
already been taking simvastatin for many years. You know that
pre-operative statin therapy improves postoperative outcomes in statin-
naive surgical patients. You consider whether you should prescribe him
additional pre-operative statin doses in an attempt to recapture this
benefit. A Best Evidence Topic was constructed to answer this question
[1]. Methods A MEDLINE search was conducted to November 2016 using the
OVID interface to address the following three-part question: In [cardiac
surgical patients], does [pre-operative statin reload in patients on
chronic statin therapy] improve [postoperative outcomes]? A total of 821
papers were found using the reported search. Studies without prior statin
use or which failed to perform subgroup analysis based on statin use prior
to study entry were excluded. In total, four papers were identified that
provided the best evidence to answer the question. Results Although statin
reloading is cardioprotective in animal models, there is little
translational evidence in humans. All included studies were small
randomised controlled trials consisting of low risk, elective patients.
The majority were not adequately powered to allow meaningful
interpretation of clinical endpoints. One study showed a 7.3% absolute
risk reduction for atrial fibrillation which did not reach significance. A
further study reported a reduction in proinflammatory cytokines but none
of the trials found a difference in markers of myocardial injury. There
was no difference in the length of hospital or intensive care stay.
Studies included statins of varying potency and duration with a high
degree of heterogeneity in baseline chronic statin therapy. No
complications of statin therapy were reported. Discussion Statin reloading
prior to percutaneous coronary intervention has been shown to
significantly reduce major adverse cardiac events [2]. However, there is
little published evidence on this topic in cardiac surgery despite this
being a more pragmatic approach. Current best evidence does not support a
strategy of pre-operative statin reloading in the context of chronic
therapy. There is need for a robust randomised controlled trial to
evaluate statin reloading in the context of cardiac surgery.

<7>
Accession Number
617681232
Author
Gastelurrutia P.; Galvez-Monton C.; Camara M.L.; Bustamante-Munguira J.;
Garcia-Pavia P.; Avanzas P.; Alberto San Roman J.; Pascual-Figal D.;
Teresa E.D.; Crespo-Leiro M.G.; Manito N.; Nunez J.; Fernandez-Aviles F.;
Caballero A.; Teis A.; Lupon J.; Brugada R.; Martin C.; Silva J.;
Revilla-Orodea A.; Canovas S.J.; Melero J.M.; Cuenca-Castillo J.J.;
Gonzalez-Pinto A.; Bayes-Genis A.
Institution
(Gastelurrutia, Galvez-Monton, Bayes-Genis) ICREC Research Program,
Fundacio Institut dInvestigacio en Ciencies de la Salut Germans Trias i
Pujol (IGTP), Badalona, Spain
(Gastelurrutia, Galvez-Monton, Bustamante-Munguira, Garcia-Pavia, Alberto
San Roman, Pascual-Figal, Teresa, Crespo-Leiro, Nunez, Fernandez-Aviles,
Lupon, Brugada, Revilla-Orodea, Melero, Cuenca-Castillo, Bayes-Genis)
CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
(Camara, Bustamante-Munguira, Caballero, Teis, Lupon, Bayes-Genis)
Hospital Universitari Germans Trias i Pujol, Badalona, Spain
(Bustamante-Munguira, Brugada) Hospital Universitari de Girona Josep
Trueta, Girona, Spain
(Garcia-Pavia, Martin) Hospital Universitario Puerta del Hierro, Madrid,
Spain
(Avanzas, Silva) Hospital Universitario Central de Asturias, Oviedo, Spain
(Alberto San Roman, Revilla-Orodea) Hospital Clinico Universitario,
Valladolid ICICORELAB, Valladolid, Spain
(Pascual-Figal, Canovas) Hospital Clinico Universitario Virgen de la
Arrixaca, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
(Teresa, Melero) Hospital Clinico Universitario Virgen de la Victoria de
Malaga, IDIMA, Malaga, Spain
(Crespo-Leiro, Cuenca-Castillo) Complejo Hospitalario Universitario A
Coruna (CHUAC), A Coruna, Spain
(Manito) Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat,
Spain
(Nunez) Hospital Clinic de Valencia, Valencia, Spain
(Fernandez-Aviles, Gonzalez-Pinto) Hospital General Universitario Gregorio
Maranon, Instituto de Investigacion Sanitaria Gregorio Maranon, Madrid,
Spain
(Lupon, Bayes-Genis) Department of Medicine, Universitat Autonoma de
Barcelona, Barcelona, Spain
Title
Rationale and design of a multicentre, prospective, randomised, controlled
clinical trial to evaluate the efficacy of the adipose graft transposition
procedure in patients with a myocardial scar: The AGTP II trial.
Source
BMJ Open. 7 (8) (no pagination), 2017. Article Number: e017187. Date of
Publication: 01 Aug 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Cardiac adipose tissue is a source of progenitor cells with
regenerative capacity. Studies in rodents demonstrated that the
intramyocardial delivery of cells derived from this tissue improves
cardiac function after myocardial infarction (MI). We developed a new
reparative approach for damaged myocardium that integrates the
regenerative properties of cardiac adipose tissue with tissue engineering.
In the adipose graft transposition procedure (AGTP), we dissect a
vascularised flap of autologous pericardial adipose tissue and position it
over the myocardial scarred area. Following encouraging results in acute
and chronic MI porcine models, we performed the clinical trial
(NCT01473433, AdiFLAP trial) to evaluate safety in patients with chronic
MI undergoing coronary artery bypass graft. The good safety profile and
trends in efficacy warranted a larger trial. Study design The AGTP II
trial (NCT02798276) is an investigator initiated, prospective, randomised,
controlled, multicentre study to assess the efficacy of the AGTP in 108
patients with non-revascularisable MI. Patients will be assigned to
standard clinical practice or the AGTP. The primary endpoint is change in
necrotic mass ratio by gadolinium enhancement at 91 and 365 days.
Secondary endpoints include improvement in regional contractibility by MRI
at 91 and 365 days; changes in functional MRI parameters (left ventricular
ejection fraction, left and right ventricular geometric remodelling) at 91
and 365 days; levels of N-terminal prohormone of brain natriuretic peptide
(NT-proBNP) at 7, 91 and 365 days; appearance of arrhythmias from 24 hour
Holter monitoring at 24 hours, and at 91 and 365 days; all cause death or
re-hospitalisation at 365 days; and cardiovascular death or
re-hospitalisation at 365 days. Ethics and dissemination The institutional
review board approved the trial which will comply with the Declaration of
Helsinki. All patients will provide informed consent. It may offer a
novel, effective and technically simple technique for patients with no
other therapeutic options. The results will be submitted to indexed
medical journals and national and international meetings.<br/>Copyright
&#xa9; Article author(s) (or their employer(s) unless otherwise stated in
the text of the article) 2017.

<8>
Accession Number
617431503
Author
Jin S.; Zhou X.
Institution
(Jin) Department of Anesthesia, Jinan Central Hospital Affiliated to
Shandong University, Jinan, Shandong Province 250013, China
(Zhou) Medical Center Tsinghua University, Beijing 100084, China
Title
Influence of dexmedetomidine on cardiac complications in non-cardiac
surgery: a meta-analysis of randomized trials.
Source
International Journal of Clinical Pharmacy. 39 (4) (pp 629-640), 2017.
Date of Publication: 01 Aug 2017.
Publisher
Springer Netherlands
Abstract
Background The cardiac protection of dexmedetomidine (Dex) in
peri-operative period of patients with non-cardiac surgery is still
controversial. Aim of the Review We aimed to evaluate the influence of Dex
on cardiac complications in peri-operative period of non-cardiac surgery
by using a meta-analysis. Methods PubMed, Embase, the Cochrane library and
Springer databases were searched for relevant studies. Patients in the
eligible studies were divided into Dex group and placebo group. Relative
risk (RR) and the 95 % confidence interval (CI) were calculated to
evaluate the outcomes including all-cause mortality, myocardial
infarction, myocardial ischaemia, hypotension and bradycardia. Subgroup
analysis was performed based on the dosage of Dex. Publication bias was
assessed by Egger's test. Results Twenty double-blind randomized
controlled trials containing 1157 patients were included in this
meta-analysis. The pooled results showed no significant difference between
Dex group and placebo group in peri-operative myocardial infarction,
myocardial ischaemia and all-cause mortality. However, Dex group showed
higher risk of hypotension (RR = 1.46, 95 % CI 1.07, 2.01) and bradycardia
(RR = 1.98, 95 % CI 1.33, 2.95) than that of placebo group. In addition,
significant publication bias was found among studies involving hypotension
and bradycardia. In subgroup analysis, the risk of bradycardia was
significantly higher in 1.0 mug/kg Dex group than that in placebo group.
Besides, a higher risk of hypotension in 0.5 mug/kg Dex group than that in
placebo group was found. Conclusions Dex supplement might not reduce the
risk of cardiac complications but increases the risk of hypotension and
bradycardia in peri-operative period of patients who underwent non-cardiac
surgeries.<br/>Copyright &#xa9; 2017, Springer International Publishing.

<9>
Accession Number
617753766
Author
Chan M.J.; Chung T.; Glassford N.J.; Bellomo R.
Institution
(Chan, Chung, Glassford, Bellomo) Department of Intensive Care, Austin
Hospital, Heidelberg, Australia
(Chan, Glassford, Bellomo) The Australian and New Zealand Intensive Care
Research Centre, School of Public Health and Preventative Medicine, Monash
University Alfred Hospital, Melbourne, Australia
(Bellomo) School of Medicine, University of Melbourne, Melbourne,
Australia
Title
Near-Infrared Spectroscopy in Adult Cardiac Surgery Patients: A Systematic
Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (4) (pp 1155-1165),
2017. Date of Publication: August 2017.
Publisher
W.B. Saunders
Abstract
Objectives To identify the normal baseline preoperative range of cerebral
tissue oxygen saturation (SctO<inf>2</inf>) derived using near-infrared
spectroscopy (NIRS) and the efficacy of perioperative interventions
designed to modulate SctO<inf>2</inf> in cardiac surgical patients. Design
Systematic review and meta-analysis of relevant randomized controlled
trials (RCTs) extracted from the Medline, Embase, and Cochrane Central
Register of Controlled Trials databases. Setting Hospitals performing
cardiac surgery. Participants The study comprised 953 participants from 11
RCTs. Interventions Interventions included the following: (1)
SctO<inf>2</inf> monitoring protocol compared with no monitoring; (2) use
of cardiopulmonary bypass (CPB) compared with no CPB; (3) normothermic CPB
compared with hypothermic CPB; (4) glyceryl trinitrate during surgery
compared with placebo; (5) midazolam during induction of anesthesia
compared with propofol; (6) sevoflurane anesthesia compared with total
intravenous anesthesia; (7) sevoflurane anesthesia compared with
propofol-based anesthesia; and (8) norepinephrine during CPB compared with
phenylephrine. Measurements and Main Results Eleven RCTs with 953
participants measured baseline preoperative SctO<inf>2</inf> using NIRS.
The pooled mean baseline SctO<inf>2</inf> was 66.4% (95% CI 65.0-67.7),
generating a reference range of 51.0% to 81.8%. Four interventions (1, 3,
4, and 6 described in the Interventions section above) increased
intraoperative SctO<inf>2</inf> across the majority of reported time
points. Postoperative follow-up of SctO<inf>2</inf> occurred in only 1
study, and postoperative cognitive assessment correlating SctO<inf>2</inf>
with cognitive function was applied in only 4 studies using variable
methodology. Conclusions The authors have established that reference
values for baseline NIRS-derived SctO<inf>2</inf> in cardiac surgery
patients are varied and have identified interventions that modulate
SctO<inf>2</inf>. This information opens the door to standardized research
and interventional studies in this field.<br/>Copyright &#xa9; 2017

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

<11>
[Use Link to view the full text]
Accession Number
617702283
Author
Yang J.-C.; Wang Q.-S.; Dang Q.-L.; Sun Y.; Xu C.-X.; Jin Z.-K.; Ma T.;
Liu J.
Institution
(Yang, Sun, Ma) Department of Transfusion Medicine, Shaanxi Provincial
People's Hospital, 256 Youyi West Road, Xi'an, China
(Wang) Department of Transfusion Medicine, Shengjing Hospital of China
Medical University, Shenyang, China
(Dang) Department of Dermatology, Shaanxi Provincial People's Hospital,
Xi'an, China
(Xu) Shaanxi Provincial Center for Clinical Laboratory, China
(Jin) Department of Orthopaedics, Shaanxi Provincial People's Hospital,
Xi'an, China
(Liu) Division of Transfusion Medicine, Johns Hopkins University, School
of Medicine, 600 N Wolfe Street, Baltimore, MD, United States
Title
Investigation of the status quo of massive blood transfusion in China and
a synopsis of the proposed guidelines for massive blood transfusion.
Source
Medicine (United States). 96 (31) (no pagination), 2017. Article Number:
e7690. Date of Publication: 01 Aug 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
The aim of this study was to provide an overview of massive transfusion in
Chinese hospitals, identify the important indications for massive
transfusion and corrective therapies based on clinical evidence and
supporting experimental studies, and propose guidelines for the management
of massive transfusion. This multiregion, multicenter retrospective study
involved a Massive Blood Transfusion Coordination Group composed of 50
clinical experts specializing in blood transfusion, cardiac surgery,
anesthesiology, obstetrics, general surgery, and medical statistics from
20 tertiary general hospitals across 5 regions in China. Data were
collected for all patients who received >=10 U red blood cell transfusion
within 24 hours in the participating hospitals from January 1 2009 to
December 31 2010, including patient demographics, pre-, peri-, and
post-operative clinical characteristics, laboratory test results before,
during, and after transfusion, and patient mortality at post-transfusion
and discharge. We also designed an in vitro hemodilution model to
investigate the changes of blood coagulation indices during massive
transfusion and the correction of coagulopathy through supplement blood
components under different hemodilutions. The experimental data in
combination with the clinical evidence were used to determine the optimal
proportion and timing for blood component supplementation during massive
transfusion. Based on the findings from the present study, together with
an extensive review of domestic and international transfusion-related
literature and consensus feedback from the 50 experts, we drafted the
guidelines on massive blood transfusion that will help Chinese hospitals
to develop standardized protocols for massive blood
transfusion.<br/>Copyright &#xa9; 2017 the Author(s). Published by Wolters
Kluwer Health, Inc.

<12>
Accession Number
617716751
Author
Iliadis C.; Lee S.; Kuhr K.; Metze C.; Matzik A.-S.; Michels G.; Rudolph
V.; Baldus S.; Pfister R.
Institution
(Iliadis, Lee, Metze, Matzik, Michels, Rudolph, Baldus, Pfister)
Department III of Internal Medicine, Heart Center, University of Cologne,
Kerpener Str. 62, Cologne 50937, Germany
(Kuhr) Institute of Medical Statistics, Informatics and Epidemiology,
University of Cologne, Cologne, Germany
Title
Functional status and quality of life after transcatheter mitral valve
repair: a prospective cohort study and systematic review.
Source
Clinical Research in Cardiology. (pp 1-13), 2017. Date of Publication: 07
Aug 2017.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: Estimating the quantitative effect of transcatheter mitral
valve repair on functional parameters and quality of life is important for
individual treatment decision-making. Methods: We combined data from a
prospective monocentric cohort study (N = 215) with data from a systematic
literature review (PubMed search term "mitraclip", till 30.04.2016) on
patients undergoing MitraClip with at least mortality after discharge
reported as an outcome. Effects on functional parameters were reported as
range of mean change. Results: 36 observational studies and 1 randomized
controlled trial were identified. Due to substantial heterogeneity of
effect estimates (I²-heterogeneity >75%) and inadequate quality
of studies with a lack of comparison group in 97.4% and lack of an
independent assessment of outcomes in 86.8%, no pooled estimates were
calculated. All studies reported improvements of mean New York Heart
Association (NYHA) class (0.5-1.9 classes), Short-Form (SF)-12/36 scores
(4.4-9.2 for physical component score, 2.6-8.9 for mental component
score), 6-min walk distance [(6MWD) 2-336 m] and Minnesota Living with
Heart failure questionnaire (MLWHFQ) score (-7 to -18 points), with
improvements regarded as clinically relevant in 20 of 29 studies for NYHA
class, in all of 7 studies for SF12/36, in 9 of 15 studies for 6MWD and in
all of 8 studies for MLWHFQ. Conclusion: MitraClip therapy provides
improvements in physical capacity, physical and mental functioning and
disease-specific quality of life in the majority of patients. However,
more comparative and high-quality studies are required for understanding
the heterogeneity of results, which is crucial for optimal patient
selection.<br/>Copyright &#xa9; 2017 Springer-Verlag GmbH Germany

<13>
Accession Number
617716543
Author
Stojanovic Stipic S.; Carev M.; Bajic Z.; Supe Domic D.; Roje Z.; Jukic
A.; Stipic T.
Institution
(Stojanovic Stipic, Carev) Department of Anesthesiology and Intensive
Care, University Hospital Split, Spinciceva 1, Split 21000, Croatia
(Bajic) Biometrika Healthcare Research, Zagreb, Croatia
(Supe Domic) Department of Medical Laboratory Diagnostics, University
Hospital Split, Split, Croatia
(Roje) The Private ENT Practice, Split, Croatia
(Jukic) Department of Internal Medicine, University Hospital Split, Split,
Croatia
(Stipic) Department of Dermatology, University Hospital Split, Split,
Croatia
Title
Increase of plasma S100B and neuron-specific enolase in children following
adenotonsillectomy: a prospective clinical trial.
Source
European Archives of Oto-Rhino-Laryngology. (pp 1-8), 2017. Date of
Publication: 07 Aug 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
S100B protein and neuron-specific enolase (NSE) can be considered the
markers of cerebral injury. To our knowledge the association of general
anesthesia for elective non-cardiac surgery in children with these markers
has not been studied before. The goal of this study was to find out
whether these markers change after adenotonsillectomy with general
anesthesia. The secondary goal was to determine whether different types of
anesthesia, gender, age and body mass index are associated with the change
of S100B and NSE after adenotonsillectomy with general anesthesia. This
study was designed as a prospective clinical trial. We did a simple
pre-post experiment with no control group. In 59 children (aged 6-13, ASA
I-II) undergoing adenotonsillectomy and randomized to TIVA or inhalational
general anesthesia, plasma S100B and NSE were measured during anesthesia
before and after the surgery which lasted a median (interquartile range)
of 16.5 (13.0-20.0) min. S100B and NSE assays were performed using the
electrochemiluminescence immunoassay. Significance of the differences was
assessed by two-tailed asymptotic Wilcoxon signed rank test. Main outcome
measures were differences in the levels of S100B and NSE before and after
the general anesthesia and surgery. There were significant increases in
S100B and NSE levels after the surgery. S100B was increased by 38% (P <
0.001) and NSE was increased by 10% (P < 0.001). Increase of S100B was
significantly negatively associated with age (P = 0.023). We have not
found significant association of S100B and NSE with any other of the
monitored variables. The values of neurological biomarkers S100B and NSE
were significantly increased after general anesthesia for elective
adenotonsillectomy in children.<br/>Copyright &#xa9; 2017 Springer-Verlag
GmbH Germany

<14>
Accession Number
616058674
Author
Bjornnes A.K.; Parry M.; Falk R.; Watt-Watson J.; Lie I.; Leegaard M.
Institution
(Bjornnes, Parry, Watt-Watson) Lawrence S. Bloomberg Faculty of Nursing,
University of Toronto, 155 College Street, Suite 130, Toronto, ON M5T 1P8,
Canada
(Bjornnes) Division of Emergencies and Critical Care, Department of
Research and Development, Oslo University Hospital, Oslo, Norway
(Falk) Oslo Centre for Biostatistics and Epidemiology, Research Support
Services, Oslo University Hospital, Oslo, Norway
(Lie) Division of Cardiovascular and Pulmonary Diseases, Department of
Cardiothoracic Surgery, Ulleval/Center for Patient Centered Heart- and
Lung Research, Oslo University Hospital, Oslo, Norway
(Leegaard) Faculty of Health Sciences, Institute of Nursing, Oslo and
Akershus University College of Applied Sciences, Oslo, Norway
Title
Impact of marital status and comorbid disorders on health-related quality
of life after cardiac surgery.
Source
Quality of Life Research. 26 (9) (pp 2421-2434), 2017. Date of
Publication: 01 Sep 2017.
Publisher
Springer International Publishing
Abstract
Purpose: To explore associations between HRQL, marital status, and
comorbid disorders in men and women following cardiac surgery. Method: A
secondary analysis was completed using data from a randomized controlled
trial in which 416 individuals (23% women) scheduled for elective coronary
artery bypass graft and/or valve surgery were recruited between March 2012
and September 2013. HRQL was assessed using the Health State Descriptive
System (15D) preoperatively, then at 2 weeks, and at 3, 6, and 12 months
following cardiac surgery. Linear mixed model analyses were performed to
explore associations between HRQL, social support, and comorbid disorders.
Results: The overall 15D scores for the total sample improved
significantly from 2 weeks to 3 months post surgery, with only a gradual
change observed from 3 to 12 months. Thirty percent (n = 92) of the total
sample reported a lower 15D total score at 12 months compared to
preoperative status, of whom 78% (n = 71) had a negative minimum important
differences (MID), indicating a worse HRQL status. When adjusted for age
and marital status, women had statistically significant lower 15D total
scores compared to men at 3, 6, and 12 months post surgery. Compared to
pre-surgery, improvement was demonstrated in 4 out of 15 dimensions of
HRQL for women, and in 6 out of 15 dimensions for men at 12 months post
surgery. Both men and women associated back/neck problems, depression, and
persistent pain intensity with lower HRQL; for women, not living with a
partner/spouse was associated with lower HRQL up to 12 months. Conclusion:
Women experienced decreased HRQL and a slower first-year recovery
following cardiac surgery compared to men. This study demonstrates a need
for follow-up and support to help women manage their symptoms and improve
their function within the first year after cardiac surgery. This was
particularly pronounced for those women living alone.<br/>Copyright &#xa9;
2017, Springer International Publishing Switzerland.

<15>
Accession Number
617743509
Author
Murphy M.; Ignea I.; Hingum A.; Barton J.
Institution
(Murphy, Ignea, Hingum, Barton) Portiuncula Hospital Ballinasloe (PHB),
Ireland
Title
The first application of a WiSE system in an Irish patient.
Source
Irish Journal of Medical Science. Conference: RAMI Intern Section Meeting
2017. Ireland. 186 (6 Supplement 1) (pp S272-S273), 2017. Date of
Publication: June 2017.
Publisher
Springer London
Abstract
Introduction: The Wireless Stimulation of the Endocardium (WiSE) system is
a novel alternative to conventional cardiac resynchronisation therapy
(CRT). Case Description. A 42 year old gentleman presented to the heart
failure clinic in PHB for routine follow-up. He was diagnosed with
hypertrophic cardiomyopathy (HCM) at 22 years of age (which has since
become dilated with poor ventricular systolic function) and atrial
fibrillation 12 years later. Repeat echocardiograms demonstrated moderate
to severe mitral regurgitation. An implantable cardioverter-defibrillator
(ICD) and pacemaker was inserted in 2008, and changed in 2014. At previous
outpatient appointments, he complained of worsening symptoms of heart
failure, despite optimal medical therapy, and had been referred for
consideration of heart transplantation. In May 2016 at St. Vincent's
University Hospital, Dublin, he was the first Irish patient to have a WiSE
system fitted. At this follow up outpatient appointment, six months later,
this gentleman noted a much improved quality of life. Measured exercise
tolerance and dyspnoea on exertion had both improved. Discussion: CRT has
been shown to reduce morbidity and mortality in select patient
populations. WiSE systems are an alternative for patients who either fail
to improve with conventional CRT or who suffer lead placement issues. This
innovative approach involves the insertion of a tiny electrode into the
left ventricular endocardium (replacing the traditional coronary sinus
lead), which then generates the desired electrical current when subjected
to ultrasonic waves from a transmitter, implanted in a left intercostal
space. The "Select-LV" trial², a non-randomised multi-centre
study of 35 patients, demonstrated the feasibility of direct, wireless
left ventricle pacing. Promising results were seen at one and six month
intervals, with 84% of participants clinically improved at six months.
Commercial implants of the WiSE system began in Europe in 2016.

<16>
Accession Number
617747452
Author
Masoumi N.; Soleimani M.; Lashay A.; Nooraie N.
Institution
(Masoumi, Soleimani, Lashay) Department of Urology, Modarres Hospital,
Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Nooraie) Department of Anesthesiology, Modarres Hospital, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Fibrinogen concentrate effect on perioperative bleeding in transurethral
resection of the prostate: A double blind placebocontrolled and randomized
study.
Source
BJU International. Conference: 70th Annual Scientific Meeting of the
Urological Society of Australia and New Zealand. Australia. 119 (pp 44),
2017. Date of Publication: March 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Introduction and Objectives: Hemorrhage during transurethral resection of
the prostate (TUR-P) has always been a concern. Several studies have shown
promising results of pre-operative administration of fibrinogen
concentrate in reducing hemorrhage in cardiac surgery. This study
investigated the hemostatic effect of fibrinogen concentrate
administration on reducing the bleeding amount during TUR-P in patients
with benign prostatic hyperplasia. Methods: Sixty men with benign
prostatic hyperplasia, who were candidate to undergo TUR-P, entered this
prospective randomized double-blind placebo-controlled pilot study. The
participants were randomly assigned into two groups: treatment (n = 31)
and placebo (n = 29).They received an infusion of 2 gr fibrinogen
concentrate (treatment group) or normal saline (placebo group) before
surgery. The bleeding amount, operation data and complications were
recorded and analyzed. Results: Both groups were statistically similar
regarding demographic and clinical characteristics. No significant
decrease in bleeding was observed during (521 ml vs. 557 ml, p = 0.9) and
after (291 mLvs. 341 ml, p = 0.8) surgery between the two groups. This
lack of difference was also seen in operation time (43 vs. 42 min, p =
0.86), irrigating fluid volume used during (17 vs. 19 liters, p = 0.43)
and after operation (29 vs. 28 liters, p = 0.8), and resected adenoma
volume (19 vs. 19 gr, p = 0.92). As a confounding factor in the bleeding
amount, mean blood pressure was also similar in both groups. Conclusions:
Preoperative administration of fibrinogen concentrate had no significant
influence on intra- and post-operative bleeding during TUR-P. (Table
presented).

<17>
Accession Number
615612401
Author
Carter B.W.; Erasmus J.J.; Truong M.T.; Shepard J.-A.O.; Hofstetter W.;
Clarke R.; Munden R.F.; Steele J.R.
Institution
(Carter, Erasmus, Truong) Department of Diagnostic Radiology, The
University of Texas MD Anderson Cancer Center, Houston, Texas, United
States
(Shepard) Department of Radiology, Massachusetts General Hospital, Boston,
Massachusetts, United States
(Hofstetter) Department of Thoracic and Cardiovascular Surgery, The
University of Texas MD Anderson Cancer Center, Houston, Texas, United
States
(Clarke) Emory Healthcare, Atlanta, Georgia
(Munden) Department of Radiology, Wake Forest School of Medicine,
Winston-Salem, North Carolina, United States
(Steele) Department of Interventional Radiology, The University of Texas
MD Anderson Cancer Center, Houston, Texas, United States
Title
Quality and Value of Subspecialty Reinterpretation of Thoracic CT Scans of
Patients Referred to a Tertiary Cancer Center.
Source
Journal of the American College of Radiology. 14 (8) (pp 1109-1118), 2017.
Date of Publication: August 2017.
Publisher
Elsevier B.V.
Abstract
Introduction Patients referred to tertiary cancer centers often present
with imaging studies performed and interpreted at other health care
institutions. Although reinterpretation of imaging performed at another
health care institution can reduce repeat imaging, unnecessary radiation
dose, and cost, the benefit is uncertain. The purpose of this study is to
evaluate the quality of initial imaging studies of patients seeking a
second opinion at a tertiary cancer center, to compare the accuracy of
initial interpretations to reinterpretations performed by subspecialty
trained radiologists at a tertiary oncologic center, and to determine the
potential impact on patient management. Methods An institutional review
board-approved retrospective, single-institution database review was
performed in 120 new patients presenting to the thoracic surgery clinics
at our institution from 2010 through 2013, with initial chest CTs
performed at another institution. Two thoracic radiologists blinded to the
interpretation independently assessed the quality and performed a
reinterpretation of 52 CTs. Fisher's exact tests were used to compare the
frequency with which clinically important staging parameters appeared in
the reinterpretations and initial reports. Discrepancies between the
reinterpretations and initial interpretations were adjudicated
independently by two thoracic radiologists at different tertiary cancer
institutions to determine which interpretations were more accurate. The
impact of discrepancies on clinical management was evaluated based on
National Comprehensive Cancer Network guidelines. Results Of the 52 CTs,
32 (62%) were of inadequate image quality for staging. In 17 of 52 (33%),
discrepancies were identified between reinterpretations and initial
interpretations. For discrepancies, the reinterpretation was judged to be
more accurate for staging than the initial interpretation. In nine of
these patients, staging parameters were omitted in the initial
interpretations that precluded adequate staging. In the remaining eight
patients, six were upstaged, one was downstaged, and one was unchanged by
the reinterpretation. Conclusions Imaging studies from outside
institutions are of variable image quality and often not adequate for
appropriate staging of thoracic malignancies. Reinterpretation can
decrease repeat imaging and associated technical costs. Additionally, the
accuracy of staging is improved by reinterpretation of CTs by subspecialty
trained radiologists and can significantly impact clinical
management.<br/>Copyright &#xa9; 2017 American College of Radiology

<18>
Accession Number
615736083
Author
Chavush M.A.; Yagar S.; Erturk A.; Ozgok A.
Institution
(Chavush, Yagar, Erturk, Ozgok) Turkiye Yuksek Ihtisas Training and
Research Hospital, Ankara, Turkey
Title
Preliminary investigation of preoperative pregabalin and total intravenous
anesthesia doses: a randomized controlled trial.
Source
Journal of Clinical Anesthesia. 41 (pp 137-140), 2017. Date of
Publication: September 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective To determine the efficacy of 2 different doses (150-300
mg) of preoperative pregabalin on propofol and remifentanil doses for
total intravenous anesthesia in laparoscopic cholecystectomy. Design
Prospective, randomized, placebo-controlled, double-blinded study. Setting
Training and research hospital. Patients Forty-eight adult, American
Society of Anesthesiologists physical status 1 and 2 patients.
Interventions Patients were randomly assigned to 3 groups to receive
orally 1 hour before surgery, a placebo group (group 1), pregabalin 150 mg
(group 2), or pregabalin 300 mg (group 3). Measurements In the operating
room, heart rate, systolic and diastolic blood pressures, SpO<inf>2</inf>,
bispectral index, and body temperature were recorded just before
anesthesia induction; 1 and 5 minutes after induction; and at minutes 10,
15, 20, 25, 30, 35, and 40 of the surgery. Required propofol and
remifentanil doses to obtain bispectral index value less than 60 were also
recorded. Main Results The remifentanil doses used in the pregabalin
groups at minutes 10, 15, 20, 25, and 30 and propofol doses at minutes 15,
20, 25, and 30 were statistically significantly lower in comparison to the
placebo group. Conclusion The observations provide preliminary evidence
that preoperative pregabalin may decrease anesthetic agent requirement in
total intravenous anesthesia patients.<br/>Copyright &#xa9; 2016 Elsevier
Inc.

<19>
Accession Number
617739208
Author
Brownlee B.; Ahmad S.; Grammer T.; Krempl G.
Institution
(Brownlee, Ahmad, Grammer, Krempl) Department of
OtorhinolaryngologyUniversity of Oklahoma Health Sciences CenterOklahoma
City, Oklahoma U.S.A
Title
Selective patient experience with the Blom-Singer Dual Valve voice
prosthesis.
Source
Laryngoscope. (no pagination), 2017. Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives/Hypothesis: This study compares the overall durability,
phonation effort, and speech quality achieved by the Blom-Singer Dual
Valve prosthesis to the same characteristics achieved by the single-valve
prosthesis used in a select population of total laryngectomy patients who
have demonstrated single-valve prosthesis failure within 3 months of
placement. Study Design: Prospective phase IV study. Methods: Fourteen
patients who had previously experienced early valve failure using a
single-valve prosthesis had a Dual Valve placed by a speech language
pathologist. A total of seventeen Dual Valves were inserted during routine
clinical visits for valve replacement. Time intervals from insertion to
replacement of the Dual Valve, as well as the average lifespan of
patients' three previous single valves were collected. Subjective,
categorical responses to speech quality and phonation effort for the Dual
Valve compared to the single valve were collected on a questionnaire upon
failure of the device. Results: The mean duration of the single valve was
60 days, with a median of 51 days, whereas the mean duration of the Dual
Valve was 164 days, with a median duration of 84 days. Both sets of data
were statistically significant, with a P value of .0131. Valve life was
increased in 86% of patients, with 43% experiencing greater than 150 days
improvement in valve duration when using the Dual Valve. Phonation effort
was increased in 14% of patients, and speech quality was not significantly
affected in any patients. Conclusions: In this select population, the Dual
Valve offers improved durability over the single valve without sacrificing
speech quality, making it a preferred prosthesis option for patients
experiencing single-valve failure in less than 3 months.<br/>Copyright
&#xa9; 2017 The American Laryngological, Rhinological and Otological
Society, Inc.

<20>
Accession Number
617739121
Author
Nassr A.A.; Shazly S.A.; Morris S.A.; Ayres N.; Espinoza J.; Erfani H.;
Olutoye O.A.; Sexson S.K.; Olutoye O.O.; Fraser C.D.; Belfort M.A.;
Shamshirsaz A.A.
Institution
(Nassr, Espinoza, Erfani, Belfort, Shamshirsaz) Department of Obstetrics
and Gynecology Baylor College of Medicine and Texas Children's Fetal
Center Houston, TX USA
(Nassr) Women's Health Hospital Assiut University Assiut Egypt
(Shazly) Department of Obstetrics and Gynecology Mayo Clinic College of
Medicine Rochester, MN USA
(Morris, Ayres, Sexson) Division of Pediatric Cardiology Baylor College of
Medicine and Texas Children's Fetal Center Houston, TX USA
(Olutoye) Division of Pediatric Anesthesia Baylor College of Medicine and
Texas Children's Fetal Center Houston, TX USA
(Olutoye) Division of Pediatric Surgery Baylor College of Medicine and
Texas Children's Fetal Center Houston, TX USA
(Fraser) Division of Congenital Heart Surgery Baylor College of Medicine
and Texas Children's Heart Center Houston, TX USA
Title
Prenatal management of fetal intrapericardial teratoma: A systematic
review.
Source
Prenatal Diagnosis. (no pagination), 2017. Date of Publication: 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Objectives: The purpose of this systematic review is to provide a
comprehensive overview on the clinical course, perinatal outcome, and
effectiveness of prenatal management options for pericardial teratoma.
Methods: A comprehensive search including Ovid MEDLINE, Ovid EMBASE, and
Scopus was conducted from inception to September 2016. All studies that
reported the prenatal course of pericardial teratoma in singleton or twin
gestations were considered eligible. Standardized forms were used for data
abstraction by two independent reviewers. Results: Out of 217 screened
abstracts, 59 studies reporting 67 fetuses with pericardial teratoma were
included. Twenty-three singleton fetuses and 3 fetuses in twin gestations
underwent prenatal treatment, and 20 (76.9%) of them were hydropic at the
time of intervention. Of those, 15/20 (75%) had a favorable outcome. In
the non-intervention group (n = 41), 26 (63.4%) developed hydrops, and out
of those, 8 (30.8%) had a favorable outcome. Conclusion: Prenatal fluid
drainage and other prenatal techniques have been utilized in the treatment
of intrapericardial teratoma. While most fetuses tolerated
pericardiocentesis, the neonatal benefit of this procedure is still
uncertain, and outcomes of other interventions had variable success.
Prenatal intervention for pericardial teratoma may be an option in
specialized units but, given the maternal and fetal risks, needs careful
consideration.<br/>Copyright &#xa9; 2017 John Wiley & Sons, Ltd.

<21>
Accession Number
617739032
Author
Conte J.V.; Hermiller J.; Resar J.R.; Deeb G.M.; Gleason T.G.; Adams D.H.;
Popma J.J.; Yakubov S.J.; Watson D.; Guo J.; Zorn G.L.; Reardon M.J.
Institution
(Conte, Resar) Departments of Surgery and Medicine, Johns Hopkins
University, Baltimore, Maryland
(Hermiller) St. Vincent's Heart Center of Indiana, Indianapolis, Indiana
(Deeb) Department of Surgery, University of Michigan, Ann Arbor, Michigan
(Gleason) Department of Surgery, University of Pittsburgh Medical Center,
Pittsburgh, Pennsylvania
(Adams) Department of Cardiovascular Surgery, Mount Sinai Medical Center,
New York, New York
(Popma) Department of Medicine, Beth Israel Deaconess Medical Center,
Boston, Massachusetts
(Yakubov, Watson) Riverside Methodist Hospital, Columbus, Ohio
(Guo) Medtronic, Minneapolis, Minnesota
(Zorn) Cardiovascular Research Institute, University of Kansas Hospital,
Kansas City, Kansas
(Reardon) Department of Surgery, Houston Methodist DeBakey Heart and
Vascular Center, Houston, Texas
Title
Complications After Self-expanding Transcatheter or Surgical Aortic Valve
Replacement.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Procedural complications following transcatheter aortic valve replacement
(TAVR) or surgical aortic valve replacement (SAVR) are usually reported as
retrospective analyses. We report the first comparison of complications
following SAVR or self-expanding TAVR from a prospectively randomized
study of high-risk SAVR patients. Three hundred ninety-five TAVR and 402
SAVR patients were prospectively enrolled and randomized 1:1 to TAVR with
a CoreValve bioprosthesis or a surgical bioprosthetic valve. The rates of
major procedural and vascular complications occurring (periprocedurally
(0-3 days) and early (4-30 days)) were compared for TAVR vs SAVR patients.
All-cause mortality, stroke, myocardial infarction, and major infection
were similar in both periods post procedure. Within 0-3 days, the major
vascular complication rate was significantly higher with TAVR (P = 0.003).
Life-threatening or disabling bleeding (P < 0.001), encephalopathy (P =
0.02), atrial fibrillation (P < 0.001), and acute kidney injury (P <
0.001) were significantly higher with SAVR. Non-iliofemoral TAVR
approaches had a higher incidence of major or life-threatening or
disabling bleeding at 0-3days (P < 0.05). Procedural complications unique
to TAVR included coronary occlusion 0.5% (2) and TAVR pop outs 2.8% (11)
with no valve embolizations. Pop outs were similar between iliofemoral
2.8% (9/324) and non-iliofemoral approaches 3.0% (2/66). Procedural
complications unique to SAVR included aortic dissection 0.8% (3/357) and
injury to other heart structures 2.0% (7/357). The procedural complication
profiles of TAVR and SAVR are unique. Intraoperative deaths were seen in
TAVR only. Mortality at 3 and 30 days was similar. The higher incidence of
some complications likely reflects the greater invasiveness of SAVR in
this aged high-risk population.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<22>
Accession Number
617433519
Author
Anjan V.Y.; Herrmann H.C.; Pibarot P.; Stewart W.J.; Kapadia S.; Tuzcu
E.M.; Babaliaros V.; Thourani V.H.; Szeto W.Y.; Bavaria J.E.; Kodali S.;
Hahn R.T.; Williams M.; Miller D.C.; Douglas P.S.; Leon M.B.
Institution
(Anjan, Herrmann) Cardiovascular Division, Hospital of the University of
Pennsylvania, 9038 Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104,
United States
(Pibarot) Department of Medicine, Laval University, Quebec City, QC,
Canada
(Stewart, Kapadia, Tuzcu) Department of Cardiovascular Medicine, Cleveland
Clinic, Cleveland, OH, United States
(Babaliaros) Department of Medicine, Emory University, Atlanta, GA, United
States
(Thourani) Department of Surgery, Emory University, Atlanta, GA, United
States
(Szeto, Bavaria) Division of Cardiothoracic Surgery, University of
Pennsylvania, Philadelphia, PA, United States
(Kodali, Hahn, Leon) Department of Medicine, Columbia University Medical
Center, New York, NY, United States
(Williams) Division of Cardiac Surgery, New York University Langone
Medical Center, New York, NY, United States
(Miller) Department of Cardiothoracic Surgery, Stanford University,
Stanford, CA, United States
(Douglas) Department of Medicine, Duke Clinical Research Institute, Duke
University Medical Center, Durham, NC, United States
Title
Evaluation of flow after transcatheter aortic valve replacement in
patients with low-flow aortic stenosis: A secondary analysis of the
PARTNER randomized clinical trial.
Source
JAMA Cardiology. 1 (5) (pp 481-489), 2016. Date of Publication: August
2016.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Low-flow (LF) severe aortic stenosis (AS) is an independent
predictor of mortality in patients undergoing aortic valve replacement
(AVR). Little is known about improvement in flow after AVR and its effects
on survival. Objective: To determine whether higher flow (left-ventricular
stroke volume index [LVSVI]) after transcatheter AVR (TAVR) would indicate
better clinical outcomes in this at-risk population. Design, Setting, and
Participants: A substudy analysis of data from the Placement of Aortic
Transcatheter Valves (PARTNER) randomized clinical trial and
continued-access registry was conducted. A total of 984 participants with
evaluable echocardiograms and baseline LF AS (LVSVI<=35 mL/m²)
were included. The trial was conducted at 26 sites in the United States
and Canada. Patients were stratified after TAVR into tertiles by discharge
LVSVI status (severe low flow [SLF], moderate low flow [MLF], and normal
flow [(NF]). The present study was conducted from May 11, 2007, to January
9, 2012, with data analysis performed from April 25, 2014, to January 21,
2016. Main Outcomes and Measures: The primary end pointwas all-cause
mortality at 1 year. Results: Baseline characteristics of 984 patients
with LF AS included mean (SD) age, 84 (7) years; 582 (59.1%) men; mean
Society of Thoracic Surgeons (STS) score, 11.4%(4.0%); and mean LVSVI,
27.6 (5.0) mL/m². The discharge LVSVI values by group were SLF,
23.1 (3.5) mL/m²; MLF, 31.7 (2.2) mL/m²; and NF,
43.1 (7.0). All-cause mortality at 1 year was SLF, 26.5%; MLF, 20.1%; and
NF, 19.6%(P = .045). Mean LVSVI normalized by 6 months in the MLF (35.9
[9.3] mL/m²) and NF (38.8 [11.1] mL/m²) groups, but
remained low in the SLF group at 6 months and 1 year (31.4 [8.4] and 33.0
[8.3] mL/m²], respectively) (P < .001 for all groups). Reported
as multivariate hazard ratio, mortality at 1 year was higher in the SLF
group compared with the other groups (1.61; 95%CI, 1.17-2.23; P = .004).
In addition to SLF, sex (1.59; 95%CI, 1.18-2.13; P = .002), presence of
atrial fibrillation (1.41; 95%CI, 1.06-1.87; P = .02), STS score (1.03;
95%CI, 1.01-1.06; P = .02), presence of moderate or severe mitral
regurgitation at discharge (1.65; 95%CI, 1.21-2.26; P = .001), pre-TAVR
mean transvalvular gradient (0.98; 95%CI, 0.97-0.99; P = .004), and
effective orifice area index (1.87; 95%CI, 1.09-3.19; P = .02) were
independent predictors of 1-year mortality. Conclusions and Relevance:
Severe LF at discharge is associated with an increased risk of mortality
following TAVR in patients with severe AS and preexisting LF. The
identification of remedial causes of persistent LF after TAVR may
represent an opportunity to improve the outcome of these
patients.<br/>Copyright &#xa9; 2016 American Medical Association. All
rights reserved.

<23>
Accession Number
617727775
Author
Egger F.; Zweiker D.; Geppert A.; Rohla M.; Luha O.; Lamm G.; Hammerer M.;
Maurer E.; Grund M.; Sturmberger T.; Zeindlhofer E.; Huber K.
Institution
(Egger, Zweiker, Geppert, Rohla, Luha, Lamm, Hammerer, Maurer, Grund,
Sturmberger, Zeindlhofer, Huber) Medizinische Abteilung mit Kardiologie,
Wilhelminenspital, Wien, Vienna, Austria Klinische Abteilung fur
Kardiologie, Medizinische Universitat Graz, Graz, Austria Klinische
Abteilung fur Innere Medizin 3, Universitatsklinikum St. Polten, St.
Polten, Austria Universitatsklinikum fur Innere Medizin II, Kardiologie
und internistische Intensivmedizin, Salzburg, Austria Abteilung fur Innere
Medizin II-Kardiologie, Intensivmedizin, Wels/Grieskirchen, Austria Klinik
fur Interne I-Kardiologie und internistische Intensivmedizin, Kepler
Universitatsklinikum, Linz, Austria Interne II-Kardiologie, Angiologie und
Interne Intensivmedizin, Elisabethinen Linz, Linz, Austria Interne
II-Kardiologie, Barmherzige Schwestern Linz, Linz, Austria
Title
The value of on-site cardiac surgery for patients undergoing transfemoral
transcatheter aortic valve implantation.
Source
Wiener Klinische Wochenschrift. Conference: Osterreichischen
Kardiologischen Gesellschaft zur Jahrestagung 2017. Austria. 129 (1
Supplement 1) (pp S100), 2017. Date of Publication: May 2017.
Publisher
Springer-Verlag Wien
Abstract
Background: To investigate the infuence of on-site cardiac surgery
departments (OSCS) on the outcome of patients undergoing transfemoral
transcatheter aortic valve implantation (TAVI). Methods and Results: In
this retrospective analysis of the prospective multicentre Austrian TAVI
registry, 1235 consecutive patients with high-grade aortic stenosis
undergoing trans-femoral (TF) TAVI between January 2011 and November 2015
were analysed. One hundred ninety-six of them (15.9%) underwent TAVI at
medical centres without OSCS but a visiting cardiac surgical team.
Peri-and postprocedural outcomes were compared in an unadjusted as well as
propensity score matched fashion for 196 patients. Patients treated in
hospitals without OSCS (no-OSCS group) were older (median 82 vs. 84 years;
p = 0.004), had a higher prevalence of coronary artery disease (61.2 vs
49.4%; p = 0.002) and previous percutaneous coronary intervention (49.0
vs. 30.5%; p = 0.001) and had a higher perioperative risk defned by the
logistic EuroSCORE (15.5 vs. 21.6%; p = 0.001) compared to OSCS patients.
Unmatched analysis revealed similar procedural (98.0 vs. 98.7%; p = 0.46)
and 30-day survival (93.9 vs. 95.5%; p = 0.33), but incidences of any
in-hospital complication (54.6 vs. 26.8%, p < 0.001*), major bleeding (9.2
vs. 3.6%, p = 0.002), pneumonia (4.6 vs. 1.0%, p = 0.001) and pacemaker
implantation (43.9 vs. 17.5%, p < 0.001) were signifcantly higher in
no-OSCS group compared to patients treated in institutions providing OSCS.
With respect to long-term survival, there was a tendency towards reduced
survival rates in no-OSCS patients (1-year survival 80.3 vs. 85.4%; p =
0.059; 2-year survival 74.0 vs. 76.9%; p = 0.214; 3-year survival 59.8 vs.
68.1%; p = 0.071). After matching, the procedural (98.0 vs. 98.5%; p =
0.70), 30-day (93.9 vs. 93.9%; p = 0.99) and long-term survival rates
(1-year survival 80.3 vs. 83.9%; p = 0.37; 2-year survival 74.0% vs.
73.7%; p = 0.870; 3-year survival rate 59.8% vs. 62.4%; p = 0.709) were
almost identical. Except for pacemaker implantation (no OSCS 43.9 vs.
matched OSCS 21.9%, p < 0.001), there were no signif-cant diferences in
in-hospital complications.

<24>
Accession Number
617727307
Author
Weber A.; Bertagnolli L.; Dinov B.; Sommer P.; Bollmann A.; Hindricks G.;
Arya A.
Institution
(Weber, Bertagnolli, Dinov, Sommer, Bollmann, Hindricks, Arya)
Rhythmologie, Herzzentrum Leipzig, Leipzig, Germany
Title
Safety of epicardial ablation of ventricular tachycardia: A large single
center experience.
Source
Wiener Klinische Wochenschrift. Conference: Osterreichischen
Kardiologischen Gesellschaft zur Jahrestagung 2017. Austria. 129 (1
Supplement 1) (pp S13-S14), 2017. Date of Publication: May 2017.
Publisher
Springer-Verlag Wien
Abstract
Background: Te presence of transmural or epicardial substrate in patients
with ventricular tachycardia often requires epicardial access to achieve
successful ablation. In previous studies a complication rate up to 20% is
reported. In two large multicenter studies major complication rates of
4.1% and 5.0% have been reported. Methods: 190 patients (109 male, mean
age 54) receiving 216 epicardial VT-ablations between 2008 and 2015 were
included in this investigation. Te underlying structural heart diseases
were ischemic cardiomyopathy (n = 29), arrhythmogenic right ventricular
cardiomyopathy (n = 17), and non-ischemic cardio-myopathy (n = 144).
Results: Epicardial access was obtained via subxyphoi-dal puncture in 208
procedures, fve of them with double percutaneous epicardial access, and
via surgical approach in 6 patients. Re-ablation was required in 28
(14.7%) patients. Te epicardium could not be accessed in 2 procedures.
Among 190 patients receiving epicardial ablation major complications were
seen in 2 patients with myocardial perforation requiring emergency cardiac
surgery. No patient died due to procedure related complications. Tree
patients had minor pericardial bleeding after procedure requiring draining
with a pigtail catheter. One patient developed a femoral aneurysm and had
to undergo vascular surgery. No coronary artery or phrenic nerve injury
were observed. Conclusions: Epicardial ablation in high volume center
performed by experienced operators has a low complication (2.7%) and
mortality (0.0%) rates.

<25>
Accession Number
617710235
Author
Luyster F.S.; Strollo P.J.; Thunstrom E.; Peker Y.
Institution
(Luyster) University of Pittsburgh, Pittsburgh, PA, United States
(Strollo) University of Pittsburgh School of Medicine, Pittsburgh, PA,
United States
(Thunstrom) University of Gothenburg, Gothenburg, Sweden
(Peker) Marmara University, Istanbul, Turkey
Title
Predictors of long-term adherence to auto-titrating positive airway
pressure therapy in coronary artery disease patients with non-sleepy and
sleepy obstructive sleep apnea.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2017. United
States. 195 (no pagination), 2017. Date of Publication: 2017.
Publisher
American Thoracic Society
Abstract
Introduction: Excessive daytime sleepiness (EDS) has been identified as a
predictor of continuous positive airway pressure (CPAP) adherence.
However, EDS is absent in many individuals with obstructive sleep apnea
(OSA) in cardiac populations, thus potentially compromising CPAP
acceptance and adherence. Few studies have evaluated CPAP adherence in
non-sleepy OSA patients. The aims of this study were to evaluate CPAP
discontinuation and long-term adherence and to identify predictors of CPAP
adherence in non-sleepy and sleepy OSA patients in a revascularized
coronary artery disease (CAD) cohort from the RICCADSA (Randomized
Intervention with CPAP in Coronary Artery Disease and Obstructive Sleep
Apnea) trial. Methods: Non-sleepy (Epworth Sleepiness Score (ESS) <10) OSA
patients randomized to auto-titrating CPAP (n = 122) and sleepy (ESS >=10)
OSA patients (n = 155) being provided CPAP were included in the current
substudy. CPAP adherence downloads were obtained at 1-, 3-, 6-, and
12-month follow-ups. Long-term CPAP adherence was defined as continued use
of the CPAP machine with an average cumulative use of >= 4 hours per night
at 12 months. Separate logistic regression analyses were conducted to
determine predictors of long-term CPAP adherence in non-sleepy and sleepy
patients. Age, sex, and variables found on univariate analyses to have a P
value < 0.20 were included in the multivariate analyses. Potential
predictors were BMI, ESS, apnea-hypopnea index, % of nighttime spent with
oxygen saturation < 90%, average hours of CPAP use per night at 1 month,
treated hypertension, diabetes, acute myocardial infarction at baseline,
coronary artery bypass grafting at baseline, and previous percutaneous
coronary intervention or CABG. Results: A significantly greater proportion
of non-sleepy patients had discontinued and returned their CPAP (14% by 1
month and 37% by 1 year vs. 6% by 1 month and 22% by 1 year, respectively)
and had not achieved long-term CPAP adherence compared to sleepy patients
(53% vs. 66%, respectively). Multivariate analyses revealed greater
average hours of CPAP use at 1 month as a predictor of long-term CPAP
adherence for both non-sleepy and sleepy patients. ESS at baseline was not
a predictor of CPAP adherence in either group. Conclusions: Initial
discontinuation of CPAP is problematic among CAD patients with non-sleepy
OSA. Early CPAP use is a critical determinant of long-term CPAP adherence
for both non-sleepy and sleepy patients. Interventions aimed at optimizing
patients' early experience with CPAP may help promote CPAP acceptance and
establish optimal adherence patterns that can be maintained long term.

<26>
Accession Number
617710112
Author
Welte T.; Ringshausen F.C.; De Roux A.; Barten G.; Diel R.; Gert E.; Naim
J.; Zurawski A.; Rademacher J.
Institution
(Welte, Ringshausen, Zurawski, Rademacher) Hannover Medical School, German
Center for Lung Research (DZL/BREATH), Hannover, Germany
(De Roux) Pneumologische Praxis at Schloss Charlottenburg, Berlin, Germany
(Barten, Naim) CAPNETZ STIFTUNG, German Center for Lung Research
(DZL/BREATH), Hannover, Germany
(Diel) University Hospital Schleswig-Holstein, German Center for Lung
Research (DZL/ARCN), Kiel, Germany
(Gert) Hannover Medical School, Hannover, Germany
Title
Prognosis-the german bronchiectasis registry: First results.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2017. United
States. 195 (no pagination), 2017. Date of Publication: 2017.
Publisher
American Thoracic Society
Abstract
Rational: bronchiectasis is a neglected and heterogeneous disease, for
which there is still no approved pharmacotherapy available. The objective
of PROGNOSIS ( (The Prospective German Non-CF-Bronchiectasis Registry; )
is to set-up a representative registry, which provides answers to the most
important, epidemiologic questions and real-life data regarding the
current management of bronchiectasis. Methods: prospective,
non-interventional and longitudinal register study with baseline and
follow-up data collection every year; sector overspanning recruiting.
Inclusion criteria: bronchiectasis proven by CT-scan, age >= 18 years, not
known CF, no lung transplantation, written consent [1]. Results: during
the first year 525 patients were recruited in 37 centers (14 practices, 13
specialized hospitals and 10 university hospitals) (figure 1; status: Sept
15, 2016). The first 250 validated data sets (66% from university
hospitals) showed: average age 57+/-15 years (60% female; 54%
never-smokers); median annual exacerbation and hospitalisation rate 2
(0-3) resp. 0 (0-1; 69% ever inpatient); on average moderate obstructive
ventilation deficiency (FEV1 67+/-27% v.S.; Tiffeneau 0,67+/-0,16);
average BMI 24+/-5 kg/m2; 38% with chronic rhino sinusitis; duration of
bronchiectasis in 46 % >10 years; most common ethiology: idiopathic (35%;
figure 2); most common relevant pathogen if clinically stable: Pseudomonas
aeruginosa (17%; figure 3; 38% ever); at least one eradication attempt for
Pseudomonas aeruginosa 71%. The radiologic distribution shown in figure 4;
90% of patients receive regular bronchiectasis therapy, esp.: respiratory
physiotherapy (78%), SABA/SAMA (70%), inhalative secretolytica (64%), LAMA
(49%), Azithromycin as long-term therapy (33%), ICS/LABA (31%), LABA (30%)
and inhalative antibiotics (26%). 12% with previous thoracic surgery.
Vaccination status: PSV23 50%, PCV13 38%, saisonal influenza 79%. 44% had
participated in a rehabilitation, 13 % in a clinical study.
Conclusion/Perspective: the structure of data will change with an
increasing number of patients from non-university hospitals. Shortly a
follow-up will be available. Pneumcocca vaccination and rehabilitation are
not commonly applied. Due to the lack of evidence for the treatment of
bronchiectasis there is an urgent need for more clinical studies, to
optimize the treatment. (Figure Presented).

<27>
Accession Number
617709974
Author
Kourouni I.; Levy S.; Chikwe J.; Omidvari K.
Institution
(Kourouni, Chikwe, Omidvari) Mount Sinai St. Luke's and Mount Sinai West,
Icahn School of Medicine at Mount Sinai, New York, NY, United States
(Levy) Mount Sinai St. Luke's, Icahn School of Medicine at Mount Sinai,
New York, NY, United States
Title
Hypoxemia caused by clevidipine complicating cardiac surgery.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2017. United
States. 195 (no pagination), 2017. Date of Publication: 2017.
Publisher
American Thoracic Society
Abstract
Introduction: Clevidipine is a third generation dihydropyridine calcium
channel blocker (DHP-CCB) used for managing hypertensive emergencies and
for acute preoperative, intraoperative and postoperative hypertension in
cardiothoracic patients. Refractory post-operative hypoxemia developed
after the initiation of clevidipine, and resolved completely after
discontinuation of the drug in four consecutive cases. One of these cases
is being presented. Case description: A 65-years-old patient underwent
coronary artery bypass graft surgery. The patient's preoperative
echocardiogram revealed an ejection fraction of 55%, and pulmonary artery
pressure of 25/14 mmHg. The patient had no history of pulmonary disease or
hypoxemia, required no oxygen supplementation prior to surgery, had no
alveolar consolidation at the time of surgery, and had no significant
intraoperative blood loss. Within 48 hours post-operatively, the patient
required medications for blood pressure control. Clevidipine was the first
line agent used. The hypoxemia was noted on routine arterial blood gases,
while the oxygen saturation from pulse oximetry remained acceptable at
greater than 91%. Chest radiography was unchanged and did not reveal
additional atelectasis or infiltrates compared to the studies prior to the
initiation of clevidipine. The dose titration was based on standard
recommendations. No physiologic or clinical parameters were found to
explain the development of hypoxia. At this point, the planned extubation
was cancelled and suspicion about pulmonary shunting caused by clevidipine
was raised based on the previous reports of the same phenomenon caused by
other DHP-CCB. The hypoxia resolved completely after clevidipine
discontinuation. The patient was then re-challenged three hours later with
clevidipine and again developed hypoxia requiring high dose supplemental
oxygen administration. The hypoxia again resolved completely with the
cessation of clevidipine (Graph). Discussion: Any therapy aimed at
hemodynamic control needs to avoid side effects such as compromising
oxygenation in this case. Clevidipine-induced pulmonary shunting is
reported only anecdotally in post marketing surveillance. The incidence of
the problem has not been well defined. Hypoxemia is seen more readily on
arterial oxygen partial pressure obtained by arterial blood gas samples
than pulse oximetry. Consequently, this side effect may remain unsuspected
by most clinicians who use this medication even if pulse oximetry is
applied for monitoring. The risk can be assessed with periodic arterial
blood gas testing. Clevidipine should be discontinued if significant
hypoxemia develops. Simple pulse oximetry may not be sufficient to monitor
oxygenation in these patients. Hypoxemia was probably due to clevidipine
based on Naranjo's Nomogram for adverse drug reaction causality. (Figure
Presnted).

<28>
Accession Number
617709785
Author
Wickstrom K.; Ateeli H.; L'Heureux D.
Institution
(Wickstrom) University of Arizona, Tucson, AZ, United States
(Ateeli) University of Arizona College of Medicine, Tucson, AZ, United
States
(L'Heureux) SAVAHCS, Tucson, AZ, United States
Title
The fourth biopsy is the charm.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2017. United
States. 195 (no pagination), 2017. Date of Publication: 2017.
Publisher
American Thoracic Society
Abstract
Introduction: Melanoma accounts for 1.5% of all cancers. The most common
site of primary melanoma is the skin. Typically melanoma found at other
sites is a consequence of metastasis. Primary melanoma of the mediastinum
is exceedingly rare. Mediastinal masses can be subdivided into anterior,
middle and posterior in origin. We present a unique case of a middle
mediastinal mass determined to be a primary melanoma after extensive
work-up. Case Description: A 67-year-old man with pertinent history of
right parotid atypical adenocarcinoma and tobacco abuse presented for a
barium swallow for dysphagia. Chest radiography performed during barium
swallow demonstrated a new lung nodule requiring cross-sectional imaging.
A referral was placed to Pulmonology after a right upper lung nodule and
right pericardial lymphadenopathy was noted on chest computed tomography
(CT) scan. The CT scan was additionally concerning for an exophytic nodule
on the left thyroid lobe. Patient was referred for biopsy of the lung and
thyroid lesion. Lung biopsy demonstrated necrotic tissue. Thyroid biopsy
demonstrated a colloid follicular cyst. Suspicion for active malignancy
remained high so a positron emission tomography (PET) scan was performed.
Results demonstrated a metabolically active right pericardiac node,
concerning for potential malignant disease, along with increased activity
in the prostate. There was no uptake in the previously biopsied lung or
thyroid lesions. Patient was referred for biopsy of the prostate which
revealed adenocarcinoma. Serial CT and PET scans demonstrated a persistent
pericardial density that doubled in size since initial scan. Patient was
referred to Cardiothoracic Surgery for pericardial mass biopsy which
demonstrated mediastinal melanoma, suspected to be metastatic. Oncology
was consulted and recommended work-up for the primary lesion including
brain MRI (negative), Ophthalmology referral (no ocular melanoma),
colonoscopy (negative), a complete skin exam by Dermatology (negative) and
Cardiothoracic Surgery consultation for resection. Complete resection of
the mass revealed a 4.5 x 3 x 2.5 cm malignant melanoma. Patient elected
to proceed with conservative management with serial PET-CT scans and is
now nearly seven years free of disease recurrence. Discussion: A PubMed
search of "mediastinal melanoma" and "primary" revealed 19 published cases
from 1959 to 2016. Most cases reported masses of the anterior mediastinum
and the majority of patients were less than 50 years old. Our case is
rather unique as it is one of the few cases of a middle mediastinal
primary melanoma and our patient had an excellent outcome, as his
resection was curative.

<29>
Accession Number
617709717
Author
Peker Y.; Glantz H.; Eulenburg C.; Thunstrom E.
Institution
(Peker) Marmara University, Istanbul, Turkey
(Glantz, Thunstrom) University of Gothenburg, Gothenburg, Sweden
(Eulenburg) University Medical Center Groningen, Groningen, Netherlands
Title
Cardiovascular outcomes in revascularized coronary artery disease patients
with obstructive sleep apnea syndrome on CPAP treatment: The observational
arm of the riccadsa cohort.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2017. United
States. 195 (no pagination), 2017. Date of Publication: 2017.
Publisher
American Thoracic Society
Abstract
Rationale: Coronary artery disease (CAD) patients with obstructive sleep
apnea (OSA) have increased risk for major adverse cardiovascular and
cerebrovascular events (MACCEs) compared to CAD patients without OSA.
Objectives: To address the impact of continuous positive airway pressure
(CPAP) treatment on risk for MACCEs in revascularized CAD patients with
sleepy OSA. Methods: This study was conducted as a parallel observational
arm of the RICCADSA randomized controlled trial in Sweden between December
2005 and November 2010. Consecutive patients with newly revascularized CAD
and OSA (apnea-hypopnea index [AHI] >=15/h) with daytime sleepiness (OSAS;
Epworth Sleepiness Scale score >=10) were offered auto-titrating CPAP
(n=155), and the CAD patients with no-OSA (AHI<5/h) were included as
controls (n=112). Measurements and Main Results: The primary endpoint was
the first event of repeat revascularization, myocardial infarction, stroke
or cardiovascular mortality by the end of May 2013. Median follow-up was
57 months. In the OSAS group, 71.8 % was on CPAP until the first event or
the end of the study. The incidence rate of MACCEs was 23.2% in OSA
patients compared to 16.1% in patients with no-OSA (adjusted hazard ratio
[HR] 0.95; 95% confidence interval [CI] 0.39-2.28 [P=0.904]). Age (HR
1.04; 95% CI 1.00-1.08; P=0.052) and former revascularization (HR 1.88;
95% CI 1.02-3.46; P=0.044) were associated with increased risk for MACCEs
whereas coronary artery bypass grafting at baseline was associated with
reduced risk (HR 0.38; 95% CI 0.15-0.95; P=0.040). Conclusions: The risk
for MACCEs was not increased in revascularized CAD patients with OSAS on
CPAP compared to the risk in CAD patients without OSA. Register: Clinical
trial registered with www.clinicaltrials.gov (NCT 00519597). Funding: This
study was supported by grants from the Swedish Research Council, the
Swedish Heart-Lung Foundation, the "Agreement concerning research and
education of doctors" of Vastra Gotalandsregionen, the Heart Foundation of
Karnsjukhuset, ResMed Foundation, and ResMed Ltd.

<30>
Accession Number
617708033
Author
Hsieh W.; Henry B.M.; Pekala J.; Graves M.; Pekala P.A.; Saganiak K.;
Tomaszewski K.; Walocha J.A.
Institution
(Hsieh) First Faculty of Medicine, Charles University in Prague, Prague,
Czech Republic
(Henry, Pekala, Graves, Pekala, Saganiak, Tomaszewski) Jagiellonian
University Medical College, Krakow, Poland
(Walocha) International Evidence-Based Anatomy Working Group, Krakow,
Poland
Title
Evidence-based assessment of the anatomy of the bronchial arteries.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2017. United
States. 195 (no pagination), 2017. Date of Publication: 2017.
Publisher
American Thoracic Society
Abstract
Background and objective: The bronchial arteries (BA) are the major
supplier of oxygenated blood to the lunch parenchyma. Detailed anatomical
knowledge regarding the BAs is essential for BA embolization, thoracic and
cardiac operations, and other procedures in the chest. Previous studies
have reported significant variability in the number, configuration,
origin, and morphometrics of the BAs. As such, this study aimed to provide
a comprehensive evidence based basement of the BA anatomy, to provide a
better understanding of these vessels for clinical practice. Material and
Methods: The major electronic databases PubMed, Science Direct, Web of
Science, SciELO, Embase and the China National Knowledge Infrastructure
(CNKI) databases were searched through October 2016 to identify relevant
articles for inclusion in the meta-analysis. All original astudies
containing extractable anatomical data on patients without congenital or
traumatic pathologies to the thorax and its contents were included in this
study. The extracted data was pooled into a meta-analysis using using
MetaXL version 5.0. or Comprehensive Meta-Analysis version 3.0. All
analyses were performed using a random effects model to calculate pooled
prevalence or pooled mean estimates. Heterogeneity of the pooled data was
assessed using the I2 statistic. Subgroup analysis was performed based on
type of study, gender, side (left vs. right), and geographical origin.
Results: A total of 29 studies (2352 patients) were included in the
meta-analysis. The most common number of total BAs per person was 3, with
a pooled prevalence estimate of 45.0%, followed by 2 BAs (32.8%), 4 BAs
(13.5%), and 1 BA (5.3%). Only 3.4% of the population had 5 or more BAs.
The most common configuration of 3 BAs was 1 right and 2 left vessels
(51.9%), followed by 2 right and 1 left vessel (48.1%). When 2 BAs were
present, the configuration was almost always 1 left and 1 right vessel
(97.8%). In total, 95.9% of BAs originated from the Aorta, with 59.7%
arising individually from the Aorta directly, 20.2% from a common
bronchial trunk, and 20.1% from an intercostobronchial trunk. The pooled
mean diameter of the BA was 1.96mm (95%CI:1.77-2.15). The diameter of the
BA was found to be greater on the right side than on the left (2.02mm vs.
1.75mm), albeit not significantly. Conclusions: The anatomy of the BAs is
highly variable in the population. A thorough understanding of the
anatomical variabilities is essential when performing procedures on or
near these vessels.

<31>
Accession Number
617707886
Author
Koltsida G.; Piccione J.; Tapia I.; Phinizy P.
Institution
(Koltsida, Piccione, Tapia, Phinizy) Children's Hospital of Philadelphia,
Philadelphia, PA, United States
Title
Novel approach to inflammatory myofibroblastic bronchial tumor: a case
report.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2017. United
States. 195 (no pagination), 2017. Date of Publication: 2017.
Publisher
American Thoracic Society
Abstract
Introduction:Inflammatory myofibroblastic tumors of the respiratory system
are rare neoplasms that usually present in school age children. Their
frequency is 0.04-0.05% and involvement of the trachea and bronchi
constitutes 6.7% of the cases. It is believed that IMTs are low grade
mesenchymal malignancies with generally good prognosis although cases of
local recurrence and distant metastases have been described.Their
presentation consists of upper or lower airway obstruction symptoms,
depending on their location. However, they are often misdiagnosed and
treated as asthma. A systematic review of airway IMT in children showed
that all reported cases have been treated with resection by interventional
rigid bronchoscopy or surgical resection via thoracotomy. Recently, these
tumors have been found to be positive for the ALK gene rearrangements. The
ALK gene is located on the chromosome 2p23 and codes for a tyrosine kinase
receptor that resists promotion of apoptosis. Herein, we report a case of
a 5 year old boy diagnosed with IMT originating from the right upper lobe
bronchus treated with resection by flexible bronchoscopy and crizotinib, a
novel ALK1 inhibitor. Description of the case:A 5 year old male with
recent diagnosis of asthma, presented to Children's Hospital of
Philadelphia with respiratory distress and radiographic findings of right
lung collapse concerning for pneumonia and foreign body aspiration. Rigid
and flexible bronchoscopy performed the 2nd day of his hospitalization
revealed an endobronchial mass originating from the right upper lobe (RUL)
extending to the carina and completely obstructing the proximal right
mainstem bronchus. Subsequent CTA was performed excluding endobronchial
hemangioma and patient was taken back to OR for endobronchial
biopsy.During the procedure, the tumor was resected using forceps.Only a
small ridge of residual tumor was seen originating from the RUL.Pathology
evaluation demonstrated an inflammatory myofibroblastic tumor with
molecular rearrangement of ALK gene determined by fluorescence in situ
hybridization (FISH).After discussion with hematology/oncology,CT and
thoracic surgery, and with the family, we decided to proceed with
treatment with oral crizotinib. Patient has tolerated the treatment well
thus far.Surveillance bronchoscopy after 3 months of initiation of
treatment showed tiny residual mucosa based tumor in the RUL.
Discussion:Our therapeutic approach has been well tolerated thus far,
without any immunosuppressive side effects,it has avoided thoracic surgery
and its complications and has targeted the specific genetic characteristic
of our patient. Thus, this case illustrates a novel individualized
approach to endobronchial tumors in children along with the paramount role
of interventional bronchoscopy.

<32>
Accession Number
617707840
Author
Bihari S.; Parke R.; Dixon D.L.; Gilder E.; Cavallaro E.C.; McGuinness S.;
Bersten A.D.
Institution
(Bihari, Dixon, Cavallaro, Bersten) Flinders Medical Centre, Flinders
University, Bedford Park, SA, Australia
(Parke, Gilder, McGuinness) Auckland City Hospital, Auckland, New Zealand
Title
Fluid resuscitation is associated with elevated angiopoietin-2 and length
of stay following cardiac surgery.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2017. United
States. 195 (no pagination), 2017. Date of Publication: 2017.
Publisher
American Thoracic Society
Abstract
Rationale: Restrictive fluids resulted in more ventilator free days and
lower angiopoietin-2 (Ang-2) levels, a pulmonary endothelial biomarker, in
patients with ARDS (Calfee et al. Critical care medicine 2012).
Consequently we hypothesized that bolus fluid administration following
cardiac surgery may lead to endothelial injury and increased length of
stay (LOS) following cardiac surgery. Methods: The endothelial biomarkers
Ang-2, Ang-1 (endothelial stabilization), and phospholipase (PLA2) were
measured in patients enrolled in a single-centre, prospectively randomised
interventional study of either liberal or conservative fluid resuscitation
strategy based on stroke volume variation-based algorithm (Parke et al.
British Journal of Anaesthesia 2015). The biomarkers were measured in
plasma at baseline, 6 hours and 24 hours after surgery. Data was examined
as liberal vs conservative (intention to treat) and high vs low fluid
group (actual treatment, based on a median 3250 ml of fluid administered),
and further sub classified as, EUROSCORE II >= 0.9 (high risk) or < 0.9
(low risk). The markers were examined with linear mixed modelling as an
interaction effect. Results: Over a 9 month period 144 patients were
randomised, 74 to the liberal arm and 70 to the conservative arm. Patients
in the liberal fluid arm had increased Ang-2 (p=.12) and had higher PLA2
(p=0.03). Based on actual fluid administered Ang-2 levels were higher, the
Ang-1/Ang-2 ratio lower and both the length of mechanical ventilation and
ICU stay longer in the high fluid group (all p<0.001). The highest levels
of Ang-2 and corresponding lowest Ang-1/Ang-2 ratio, along with increased
length of mechanical ventilation and ICU stay were found in the liberal
and high fluid group in patients with a EurSCORE II >= 0.9 (all p<0.01).
Conclusion Fluid resuscitation was associated with both pulmonary
endothelial injury and prolonged length of mechanical ventilation.

<33>
Accession Number
617707831
Author
Obagi A.; Carson M.; Khan U.
Institution
(Obagi, Carson, Khan) Jersey Shore University Medical Center, Neptune, NJ,
United States
Title
Type B aotic dissection identified following cardiac ablation procedure.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2017. United
States. 195 (no pagination), 2017. Date of Publication: 2017.
Publisher
American Thoracic Society
Abstract
INTRODUCTION: Aortic dissection is classified into two types: Stanford
Type A in which the tear originates from the ascending aorta and Type B
where the tear originates from the descending aorta. Our case describes a
type B aortic dissection identified following intravascular intervention.
CASE SUMMARY: a 52-year-old woman with non-ischemic cardiomyopathy (CM)
was admitted for electrophysiologic procedure to ablate the source of
premature ventricular contractions (PVC) that were felt to be the cause of
her CM. She underwent a successful mapping and ablation of the PVC focus.
The following day, she developed severe chest and abdominal discomfort. A
CT scan of the chest/abdomen/pelvis with contrast showed dissection of the
thoracic aorta ~3 cm distal to the left subclavian artery extending into
both common iliac arteries. It was not known if the dissection developed
as a consequence of the procedure, or if it was present and simply
exacerbated by the instrumentation. She was transferred to the ICU, repeat
CT scan 3 days later showed an unchanged dissection. The initial plan was
to manage her medically with control of blood pressure/heart rate, and
serial follow-up scans. Two months later, she presented with worsening
chest/abdominal pain despite optimal medical management. CTA showed new
aneurysmal dilatation at thoraco-abdominal junction measuring 3.3 x 3.0
cm, intimal flaps extending into both common iliac arteries. With this
clinical change, she underwent successful deployment of a percutaneous
stent graft in the abdominal aorta at the bifurcation site. CT scan 3 days
later showed decreased dissection, decreased false lumen size, and patent
stent graft without leak. DISCUSSION: The International Registry of Aortic
Dissection (IRAD) published retrospective survival rates for aortic
dissection based on the onset of symptoms: hyperacute (<24 hours) , acute
(1-7 days), subacute (8-30 days), and chronic (>30 days). For those with a
chronic dissection, 60-day-survival was highest with endovascular and
medical treatment (91%), vs. medical alone (87%), or open surgical (73%).
Secondary analysis of a randomized trial for stable Type B dissections
demonstrated that Thoracic Endovascular Aortic Repair (TEVAR), in addition
to optimal medical treatment, was associated with improved 5-year
aorta-specific survival and delayed disease progression when compared to
medical treatment alone. Recent data, and this case, support the utility
of early endovascular interventions to improve survival for patients with
Stanford Type B aortic dissections.

<34>
Accession Number
617705747
Author
Stringer K.A.; Schumacher K.R.; Caruthers R.L.; Nasr S.Z.; Myers J.L.
Institution
(Stringer, Schumacher, Caruthers, Nasr, Myers) University of Michigan, Ann
Arbor, MI, United States
Title
Study design: Phase II safety and efficacy of inhaled tissue plasminogen
activator (activase) for the treatment of acute pediatric plastic
bronchitis.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2017. United
States. 195 (no pagination), 2017. Date of Publication: 2017.
Publisher
American Thoracic Society
Abstract
Rationale: Plastic bronchitis (PB) is a rare, most often pediatric disease
in which obstructive casts, that are primarily composed of fibrin, form in
the airways. PB is most often associated with surgically palliated
congenital heart disease (CHD) and contributes to the morbidity and
mortality of these children. Presently, there is no FDA-approved
treatments for PB. We have previously demonstrated the utility of
aerosolized tissue plasminogen activator (tPA) to reduce PB cast burden ex
vivo but the clinical safety and efficacy of inhaled tPA is not known. We
will conduct a multi-center, open-label study of a 5mg every six hours,
4-day regimen of inhaled tPA in children with acute PB exacerbation to
assess its safety and efficacy. Methods: This is a multi-center,
open-label study of children (5-16 years old) with pathological evidence
of fibrin PB that present with an acute exacerbation requiring
hospitalization. The study will comply with Good Clinical Practices. Prior
to study drug administration, lab and pulmonary function tests (PFT) will
be performed and pulse oximetry and a chest x-ray acquired (Figure). Blood
and urine will also be collected for biomarker discovery metabolomics
assays. The study also includes standardized drug administration across
centers and patients will be closely monitored for signs and symptoms of
bleeding. Efficacy will be assessed by monitoring the frequency of cast
production, oxygenation, PFT, and the need for bronchoscopy. We hypothesis
that the tested regimen will not be associated with major bleeding events
and will improve oxygenation and reduce cast burden. In parallel, we will
collect blood and urine samples from sex and age-matched healthy and CHD
children without PB for metabolomics assays. We will also assess patient
centered-outcomes using a validated quality of life (QOL) using the CFQ-R
survey. Conclusions: We expect to enroll up to 24 children with fibrin PB
and gain knowledge of the safety and efficacy profile of inhaled tPA. In
addition, we anticipate identifying a panel of metabolites that are linked
to PB and gain understanding of metabolic changes associated with inhaled
tPA drug response. Collectively, these data will permit an optimally
designed phase III trial, further understanding of PB QOL (CFQR), and
advance the safe use of inhaled tPA for the treatment of children with PB.

<35>
Accession Number
617705572
Author
Batnyam U.; Rajasekaran A.; Mellone J.
Institution
(Batnyam, Rajasekaran, Mellone) University of Central Florida, Orlando,
FL, United States
Title
Short course of amiodarone-induced severe lung toxicity in post-cabg
patient.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2017. United
States. 195 (no pagination), 2017. Date of Publication: 2017.
Publisher
American Thoracic Society
Abstract
Post-operative tachyarrythmias are a well-established complication of
coronary artery bypass grafting (CABG), with up to 60% of patients
developing atrial flutter or fibrillation. Pulmonary toxicity in the form
of hypersensitivity and interstitial pneumonitis manifests in up to 17% of
patients, and is responsible for the most mortality due to amiodarone
therapy. 68 year old woman presented to the hospital ten days after
triple-vessel CABG with complaints of resting dyspnea. Her peri-operative
course had been complicated only by atrial fibrillation for which she
received bolus intravenous amiodarone, subsequently discharged on oral
form of 400 mg daily dosing. CT angiogram showed no evidence of pulmonary
embolism, however it did demonstrate ground glass infiltrates of the left
upper lobe and moderate left pleural effusion. The patient was started on
intravenous loop diuretic as well as broad-spectrum antibiotic coverage.
She subsequently developed profound hypoxemia with pO2 of 45 mmHg despite
maximal oxygen supplementation with a 100% non-rebreather mask,
unfortunately, she refused any non-invasive or invasive positive-pressure
ventilation. Echocardiogram demonstrated no evidence of extra-pulmonary
shunting, nor pulmonary hypertension to explain this degree of hypoxemia.
Repeat chest CT on the ninth day of admission showed worsening
interstitial infiltrate and alveolar consolidation with some increased
attenuation of parenchymal lesions suggestive of amiodarone toxicity.
Amiodarone was discontinued and the patient was started on high-dose
steroids with subsequent rapid clinical and radiographic improvement.
Repeat CT chest prior to discharge showed significant improvement of
alveolar and interstitial processes. Amiodarone pulmonary toxicity due to
non-specific presentation, is often difficult to distinguish from heart
failure, and diagnosis requires appropriate radiographic and
histopathologic findings in the setting of clinical suspicion. We believe
this presentation to be a rare example of acute amiodarone toxicity, which
has in fact been described in multiple case reports. In literature,
cumulative amiodarone doses range from 1.1g to 12.5g prior to symptom
onset over several weeks of treatment; our patient received a cumulative
amiodarone dose of 10.2g. While a 2006 meta-analysis did demonstrate
reduction of atrial fibrillation incidence, ventricular tachyarrythmias,
and stroke with amiodarone therapy in post-cardiac surgery patients, a
recent NEJM article has cast doubt on this strategy by demonstrating no
difference in complication rates as compared to a rate control strategy.
We propose that the decision to initiate rhythm control with amiodarone
rather than rate control be approached on a case-by-case basis in
post-cardiac surgery patients, given the potential for pulmonary toxicity
as detailed above.

<36>
Accession Number
617705164
Author
Denault M.-H.; Bouchard P.-A.; Simon M.; Lellouche F.
Institution
(Denault, Bouchard, Simon, Lellouche) Institut Universitaire de
Cardiologie et de Pneumologie de Quebec, QC, Canada
Title
Evaluation of the risk of hyperoxia-induced hypercapnia in obese cardiac
surgery patients.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2017. United
States. 195 (no pagination), 2017. Date of Publication: 2017.
Publisher
American Thoracic Society
Abstract
RATIONALE Noxious effects of hyperoxygenation have been described for more
than 60 years. Recent studies on stable obesity-hypoventilation syndrome
(OHS) patients have risen concern about hyperoxia-induced hypercapnia in
this population, but many questions remain unanswered. What is the risk of
hyperoxia-induced hypercapnia in obese patients in an acute setting? Is
there a risk in non-OHS obese patients as well? The aim of the study is to
evaluate the risk of hyperoxia-induced hypercapnia in post-op obese
cardiac surgery patients. METHODS With a cross-over design, we are
comparing two oxygenation strategies in the immediate post-extubation
period in terms of their effect on arterial partial pressure of carbon
dioxide (PaCO<inf>2</inf>): a SpO<inf>2</inf> target of>95 % achieved with
manual titration (usual practice) and a more conservative SpO<inf>2</inf>
target of 90 % achieved with automatic titration (FreeO<inf>2</inf>).
FreeO<inf>2</inf> is a closed-loop oxygen delivery system which adjusts
the oxygen flow according to the patient's real-time SpO<inf>2</inf> and a
target set by the physician. 15 obese patients (BMI>30) having coronary
artery bypass grafting (CABG) surgery are currently being recruited at the
Institut Universitaire de Cardiologie et de Pneumologie de Quebec after an
informed written consent has been obtained. After extubation, every
patient receives oxygen according to both strategies for 30 minutes each,
in a randomized order. SpO<inf>2</inf>, oxygen flow, heart and respiratory
rates are continuously recorded by FreeO<inf>2</inf> while hemodynamic
parameters and arterial blood gases are collected at the end of each
period. The primary outcome is the variation in PaCO<inf>2</inf> between
each period. RESULTS 4 patients have been recruited but we expect to
complete data collection within two months. 2 women and 2 men have been
studied, with an average age of 59 years and an average BMI of 34 kg/m2.
Analyses for the primary outcome are still ongoing, but results already
show that two very distinct oxygenation profiles are being studied (figure
1). Average SpO<inf>2</inf> for FreeO<inf>2</inf> period is 91,5% while it
is 98,0 % for protocol period. Average oxygen flow is 0,8 L/min for
FreeO<inf>2</inf> period (equivalent to < 24% FiO<inf>2</inf>) while
average FiO<inf>2</inf> is 50% for protocol period. Percentage of time
with oxygen is 50 % in FreeO<inf>2</inf> period compared to 100% in
protocol period. CONCLUSION FreeO<inf>2</inf> may be helpful to maintain
oxygenation within recommended targets. High SpO<inf>2</inf> values may be
problematic in obese patients after CABG, but more analyses are required
regarding their effect on PaCO<inf>2</inf>. [Graph Presented].

<37>
Accession Number
617705140
Author
Puch I.C.; Wiley B.M.; Klein H.G.; Welsh J.; Danner R.L.; Sun J.;
Eichacker P.; Natanson C.
Institution
(Puch, Wiley, Klein, Welsh, Danner, Sun, Eichacker, Natanson) National
Institutes of Health, Bethesda, MD, United States
Title
Restrictive red blood cell transfusion strategies in patients with
cardiovascular disease: A meta-analysis.
Source
American Journal of Respiratory and Critical Care Medicine. Conference:
American Thoracic Society International Conference, ATS 2017. United
States. 195 (no pagination), 2017. Date of Publication: 2017.
Publisher
American Thoracic Society
Abstract
Introduction: Recent guidelines suggest that a restrictive strategy of red
blood cell (RBC) transfusion (7-8 g/dL hemoglobin) is safe for all
patients including those with cardiovascular disease (CVD). However, some
studies have reported better outcomes using a more liberal transfusion
strategy (9-10 g/dL). We therefore performed a systematic review and
meta-analysis to assess the safety of restrictive versus liberal
transfusion strategies in CVD patients. Methods: Unrestricted searches of
multiple databases, including PubMed and EMBASE, and examination of prior
systematic reviews were performed to find randomized trials (RTs)
comparing liberal versus restrictive transfusion strategies in adults with
CVD. Data on death and acute coronary events (myocardial infarction and
unstable angina) were extracted and analyzed as outcome variables.
Results: Sixteen RTs were identified; seven RTs enrolled 3,469 patients
with known CVD undergoing cardiac interventions, i.e., cardiac surgery or
percutaneous cardiac interventions (PCI), while nine RTs enrolled patients
with either known or unknown CVD (2,153 and 3,515 patients respectively)
in non-cardiac surgery or non-PCI settings. In patients with CVD across
the 16 RTs, liberal versus restrictive transfusion strategies produced a
trend (p=0.11) toward decreased mortality risk [RR 0.86, 95% CI 0.72-1.03,
I²=0%]. Among eight studies comparing patients with and without
known CVD, the effect of a liberal versus restrictive strategy on
mortality was significantly different and opposite (p=0.05, qualitative
interaction). For known CVD patients, mortality was lower with a liberal
(11.7%) versus restrictive (13.3%) strategy. Conversely, in patients
without known CVD, mortality was higher with a liberal (19.2%) versus
restrictive (18.0%) strategy [Ratio of RR 0.73, 95% CI 0.53-1.00]. In
eight RTs enrolling patients with known CVD (hospitalized for cardiac
interventions or for other reasons), acute coronary events were lower
(p=0.01) with a liberal versus restrictive strategy [RR 0.57, 95% CI
0.36-0.88, I²=0%]. Among four RTs in patients with and without
known CVD, acute coronary events similarly (p=0.30, interaction) decreased
(p=0.02) with a liberal versus restrictive transfusion strategy [RR 0.59,
95% CI 0.39-0.91]. Conclusions: Based on available data, use of a
restrictive versus liberal transfusion trigger in patients with CVD is
associated with increased risks of death and acute coronary events.
Healthcare providers should use caution in applying restrictive
transfusion guidelines to patients with known CVD and possibly to those
with CVD risk factors. Based on the present findings, additional trials
comparing two fixed hemoglobin triggers may expose patients with either
known or unidentified CVD to increased risks and therefore lack equipoise.

<38>
Accession Number
617686579
Author
Baradari A.G.; Alipour A.; Habibi M.R.; Rashidaei S.; Zeydi A.E.
Institution
(Baradari, Habibi) Department of Anesthesiology, Faculty of Medicine,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Alipour) Department of Epidemiology, Faculty of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Rashidaei) Faculty of Medicine, Mazandaran University of Medical
Sciences, Sari, Iran, Islamic Republic of
(Zeydi) Department of Medical-Surgical Nursing, Faculty of Nursing and
Midwifery, Mazandaran University of Medical Sciences, Sari, Iran, Islamic
Republic of
(Zeydi) Department of Medical-Surgical Nursing, School of Nursing and
Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic
Republic of
(Habibi) Mazandaran Heart Center, Hazrat Fatima Hospital, Artesh
Boulevard, Sari Mazandaran, Iran, Islamic Republic of
Title
A randomized clinical trial comparing hemodynamic responses to
ketamine-propofol combination (ketofol) versus etomidate during anesthesia
induction in patients with left ventricular dysfunction undergoing
coronary artery bypass graft surgery.
Source
Archives of Medical Science. 13 (5) (pp 1102-1110), 2017. Date of
Publication: 2017.
Publisher
Termedia Publishing House Ltd. (Kleeberqa St.2, Poznan 61-615, Poland)
Abstract
Introduction: Anesthesia induction is often accompanied by a period of
hemodynamic instability, which could be a significant problem in patients
with compromised ventricular function. The aim of this study is to compare
the hemodynamic responses to etomidate versus a combination of ketamine
and propofol (ketofol) for anesthetic induction in patients with left
ventricular dysfunction undergoing coronary artery bypass graft (CABG)
surgery. Material and methods: In a double-blind randomized clinical
study, a total of 84 patients with ischemic left ventricular dysfunction
(EF < 40%) were randomly assigned to two groups (A and B). Patients in
group A received etomidate 0.2 mg/kg and a placebo (normal saline); group
B received a combination of ketamine (1 mg/kg) and propofol (1.5 mg/kg) at
the induction of anesthesia. Two minutes after induction, hemodynamic
variables, including systolic, diastolic, mean arterial pressure (SAP,
DAP, MAP) and heart rate (HR), were measured immediately before and after
the laryngoscopy, and before intubation and post-intubation at 1, 2, and 3
min. Results: The decrease in all hemodynamic parameters (SBP, DBP, MAP
and HR) from induction time to laryngoscopy was greater in the ketofol
group (group B) than in the etomidate group (group A) (p < 0.05). The
ephedrine prescription rate due to hemodynamic changes was 24.4% (10
patients) and 5% (2 patients) in group B and group A, respectively (p =
0.03). Conclusions: We found that etomidate provides superior hemodynamic
stability as compared to ketofol in patients with left ventricular
dysfunction undergoing CABG surgery under general
anesthesia.<br/>Copyright &#xa9; 2016 Termedia & Banach.

<39>
[Use Link to view the full text]
Accession Number
617686215
Author
Dadkhah S.; Almuwaqqat Z.; Sulaiman S.; Husein H.; Nguyen Q.; Ali S.;
Taskesen T.
Institution
(Dadkhah, Husein, Nguyen, Ali, Taskesen) Galvin Heart Center, Presence St
Francis Hospital, 333 Ridge Avenue, Evanston, IL 60202, United States
(Almuwaqqat) Department of Medicine, Emory School of Medicine, Atlanta,
GA, United States
(Sulaiman) Department of Medicine, Medical College of Wisconsin,
Milwaukee, WI, United States
Title
Sensitive Troponin i and Stress Testing in the Emergency Department for
the Early Management of Chest Pain Using 2-Hour Protocol.
Source
Critical Pathways in Cardiology. 16 (3) (pp 89-92), 2017. Date of
Publication: 01 Sep 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Despite improvements in identifying high-risk patients with
non-ST segment ACS (acute coronary syndrome), low risk patients presenting
with atypical chest pain and non-diagnostic Electrocardiogram (ECG)
continued to undergo unnecessary admissions and testing. Since 1992, our
chest pain protocol included using 4-hour serial biomarkers from ED
admission in combination with stress testing to evaluate these patients.
Our study aimed at determining whether a new accelerated diagnostic
protocol using sensitive cardiac troponin I (cTnI) 2 hours after admission
to the ED followed by stress testing is safe and effective in emergency
settings, allowing for appropriate triage, earlier discharge and reducing
costs. Methods: We conducted a single center randomized trial at Presence
St. Francis Hospital Chest pain center in Evanston, Illinois enrolling
sixty-four consecutive patients with atypical chest pain and
non-diagnostic ECG, participants were randomized to accelerated 2 hrs
protocol or our pre-existing 4-hrs protocol. Sixty patients completed the
protocol and were randomized to either a 2-hour (29 patients) or 4-hour
protocol using both I-STAT and PATHFAST cTnI (31 Patients). Troponin I was
evaluated at 0 and at 2 hours from ED presentation with and additional
draw for patients in the 4-hour rule out-group. Patients with normal
serial biomarkers were then evaluated with stress testing and qualified
for earlier discharge if the stress test was negative, while those with a
positive biomarker at any time were admitted. Thirty-six patients had
exercise treadmill stress test and 24 patients had either nuclear or Echo
stress test. Results: Fifty-three patients had a normal stress test and
were discharged home. One patient in the 4-hour group with normal serial
troponins developed ventricular tachycardia/fibrillation during the
recovery period of a regular stress test. Six patients had a positive
PATHFAST cTnI and a normal I-STAT cTnI at 2-hours. Two out of these six
patients evaluated by coronary angiography. One patient had severe
tortuous coronaries but no significant obstructive lesion and one had a
severe CAD who needed Coronary artery bypass grafting (CABG). Three of the
six patients had a normal stress test and one patient decided to leave
without further testing. None of the patients with a normal stress test
had a major cardiac event or adverse cardiac outcome at six-month follow
up. Conclusion: This study demonstrates that the 2 hours accelerated
protocol using high sensitivity Troponin assay at 0 and 2 hours with
comprehensive clinical evaluation and ECG followed by stress testing might
be successful in identifying low-risk patient population who may benefit
from early discharge from ED reducing associated costs and length of
stay.<br/>Copyright &#xa9; 2017 Wolters Kluwer Health, Inc. All rights
reserved.

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

<41>
Accession Number
617722380
Author
Li S.; Lv W.; Zhou K.; Che G.
Institution
(Li, Zhou, Che) Department of Thoracic Surgery, West China Hospital,
Sichuan University, Guoxue Alley No. 37, Chengdu, China
(Li, Lv) West China Medical Center, West China Hospital, Sichuan
University, Chengdu, China
(Lv) Department of Cardiology, West China Hospital, Sichuan University,
Chengdu, China
Title
Does the fissureless technique decrease the incidence of prolonged air
leak after pulmonary lobectomy?.
Source
Interactive Cardiovascular and Thoracic Surgery. 25 (1) (pp 122-124),
2017. Date of Publication: 01 Jul 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in cardiothoracic surgery was written according to a
structured protocol. The question addressed was whether the fissureless
technique can reduce the incidence of prolonged air leak (PAL) after
pulmonary lobectomy. Altogether 18 papers were found using the reported
search, of which 1 prospective randomized study and 4 retrospective cohort
studies represented the best evidence to answer the clinical question. The
authors, journal, date and country of publication, patient group studied,
study type, relevant outcomes and results of these papers are tabulated.
Four studies demonstrated that the fissureless technique used in pulmonary
lobectomy was superior to conventional lobectomy in terms of preventing
PAL and shortening the time to air leak cessation. One study showed no
difference in PAL formation between these 2 procedures. The definitions
for PAL as defined by duration was >5 days in 4 studies and >7 days in 1
study. Current evidence demonstrates that the fissureless technique can
significantly decrease the development of PAL and time to air leak
cessation after pulmonary lobectomy.<br/>Copyright &#xa9; 2017 The Author.

<42>
Accession Number
617722341
Author
Song Y.; Xu F.; Du J.; Zhang J.; Feng W.
Institution
(Song, Xu, Du, Zhang, Feng) Department of Cardiac Surgery, Fuwai Hospital
of Chinese Academy of Medical Sciences, Peking Union Medical College,
Beilishi Road No. 167, Beijing 100037, China
Title
Coronary endarterectomy with coronary artery bypass graft decreases graft
patency compared with isolated coronary artery bypass graft: A
meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 25 (1) (pp 30-36), 2017.
Date of Publication: 01 Jul 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES: This meta-analysis aims to assess the graft patency
quantitatively and statistically. METHODS: Eleven observational studies
were identified by systematic literature search, incorporating 3311
patients undergoing coronary endarterectomy (CE) + coronary artery bypass
graft (CABG) and 3990 undergoing isolated CABG, which were analysed using
random-effects modelling. Heterogeneity, quality of scoring and risk of
bias were assessed and reangiographic outcomes were documented. RESULTS:
Adjunctive CE decreased graft patency [odds ratios = 0.43, 95% confidence
interval [0.29-0.63], z = 4.33, P < 0.0001] with moderate heterogeneity,
while the baseline demographics differed considerably. CONCLUSIONS:
Whether CE remains a viable option to CABG requires novel studies
collecting corresponding data from bench to bedside. To achieve
satisfactory efficacy, surgeons should carefully weigh possible benefits
and adverse effects of CE and prepare the surgical strategy
adequately.<br/>Copyright &#xa9; 2017 The Author.

<43>
Accession Number
617722337
Author
Andreas M.; Muckenhuber M.; Hutschala D.; Kocher A.; Thalhammer F.; Vogt
P.; Fleck T.; Laufer G.
Institution
(Andreas, Muckenhuber, Kocher, Fleck, Laufer) Division of Cardiac Surgery,
Department of Surgery, Medical University of Vienna, Guertel 18-20, Vienna
1090, Austria
(Hutschala) Division of Cardiothoracic and Vascular Anesthesia and
Critical Care Medicine, Department of Anaesthesia, General Intensive Care
and Pain Management, Medical University of Vienna, Austria, Austria
(Thalhammer) Division of Infectious Diseases and Tropical Medicine,
Department of Internal Medicine i, Medical University of Vienna, Austria,
Austria
(Vogt) Cardiology and Vascular Centre Zurich, Hirslanden Group, Zuerich,
Switzerland
Title
Direct sternal administration of Vancomycin and Gentamicin during closure
prevents wound infection.
Source
Interactive Cardiovascular and Thoracic Surgery. 25 (1) (pp 6-10), 2017.
Date of Publication: 01 Jul 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES: Deep sternal wound infection is still a major complication in
patients undergoing cardiac surgery. We previously identified mammary
artery harvesting as a risk factor for decreased antibiotic tissue
penetration. In addition, other risk factors including diabetes may
inhibit sufficient tissue penetration of perioperative antibiotic
prophylaxis. A novel closure protocol applying 2 topical antibiotics and
further recommendations for sternal wiring was introduced at our
department to decrease the incidence of sternal wound infections. METHODS:
A 12-month period prior to (March 2013-February 2014) and after (July
2014-June 2015) the introduction of a novel sternal closure protocol was
studied. All sternal wound infections resulting from an operation during
this period were analysed. The closure protocol consisted of the
intra-sternal application of vancomycin and the subcutaneous application
of gentamicin. Furthermore, we increased the number of sternal wires for
more uniform distribution of lateral forces. RESULTS: Patients in both
groups were comparable regarding demographic data and risk factors.
Fifty-three out of 919 patients operated prior to the protocol change
developed an infection (5.8%). The introduction of the novel sternal
closure protocol reduced this number to 19 out of 932 patients (2.0%; P <
0.001). A binary regression including common risk factors revealed a
strong independent risk reduction by the novel protocol (OR 0.322, P <
0.001). The number of sternal wires was not significant in this analysis.
CONCLUSIONS: The topical application of 2 antibiotic agents significantly
reduced sternal wound infection. However, the results of this trial should
be confirmed in a randomized trial.<br/>Copyright &#xa9; 2017 The Author.

<44>
Accession Number
615007607
Author
Lambert L.M.; Trachtenberg F.L.; Pemberton V.L.; Wood J.; Andreas S.;
Schlosser R.; Barnard T.; Daniels K.; Harrington A.T.; Dagincourt N.;
Miller T.A.
Institution
(Lambert, Wood) Primary Children's Hospital, Division Cardiothoracic
Surgery, 100 North Mario Capecchi Dr., Salt Lake City, UT 84113, United
States
(Trachtenberg, Dagincourt) New England Research Institutes, Watertown, MA,
United States
(Pemberton) National Heart, Lung, and Blood Institute, Bethesda, MD,
United States
(Andreas, Schlosser) Texas Children's Hospital, Houston, TX, United States
(Barnard) Cincinnati Children's Hospital Medical Center, Cincinnati, OH,
United States
(Daniels, Harrington) Children's Hospital of Philadelphia, Philadelphia,
PA, United States
(Miller) University of Utah, Salt Lake City, UT, United States
Title
Passive range of motion exercise to enhance growth in infants following
the Norwood procedure: A safety and feasibility trial.
Source
Cardiology in the Young. 27 (7) (pp 1361-1368), 2017. Date of Publication:
01 Sep 2017.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Objective The aim of this study was to evaluate the safety and feasibility
of a passive range of motion exercise programme for infants with CHD.
Study design This non-randomised pilot study enrolled 20 neonates
following Stage I palliation for single-ventricle physiology. Trained
physical therapists administered standardised 15-20-minute passive range
of motion protocol, for up to 21 days or until hospital discharge. Safety
assessments included vital signs measured before, during, and after the
exercise as well as adverse events recorded through the pre-Stage II
follow-up. Feasibility was determined by the percent of days that >75% of
the passive range of motion protocol was completed. Results A total of 20
infants were enrolled (70% males) for the present study. The median age at
enrolment was 8 days (with a range from 5 to 23), with a median start of
intervention at postoperative day 4 (with a range from 2 to 12). The
median hospital length of stay following surgery was 15 days (with a range
from 9 to 131), with an average of 13.4 (with a range from 3 to 21)
in-hospital days per patient. Completion of >75% of the protocol was
achieved on 88% of eligible days. Of 11 adverse events reported in six
patients, 10 were expected with one determined to be possibly related to
the study intervention. There were no clinically significant changes in
vital signs. At pre-Stage II follow-up, weight-for-age z-score
(-0.84+/-1.20) and length-for-age z-score (-0.83+/-1.31) were higher
compared with historical controls from two earlier trials. Conclusion A
passive range of motion exercise programme is safe and feasible in infants
with single-ventricle physiology. Larger studies are needed to determine
the optimal duration of passive range of motion and its effect on somatic
growth.<br/>Copyright &#xa9; 2017 Cambridge University Press.

<45>
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)

<46>
Accession Number
616895258
Author
Nguyen A.V.; Thanh L.V.; Kamel M.G.; Abdelrahman S.A.M.; EL-Mekawy M.;
Mokhtar M.A.; Ali A.A.; Hoang N.N.N.; Vuong N.L.; Abd-Elhay F.A.-E.; Omer
O.A.; Mohamed A.A.; Hirayama K.; Huy N.T.
Institution
(Nguyen, Hoang) Pham Ngoc Thach University of Medicine, Ho Chi Minh City
70000, Vietnam
(Thanh, Vuong) University of Medicine and Pharmacy, Ho Chi Minh City
70000, Vietnam
(Kamel, Ali, Mohamed) Faculty of Medicine, Minia University, Minia 61519,
Egypt
(Abdelrahman, Abd-Elhay) Faculty of Medicine, Alexandria University,
Beheira 22762, Egypt
(EL-Mekawy) Faculty of Medicine, Cairo University, Cairo 13719, Egypt
(Mokhtar) Faculty of Medicine, Sohag University, Sohag 82738, Egypt
(Omer) Faculty of Medicine, Gezira University, 20, Wad Madani, Sudan
(Hirayama) Department of Immunogenetics, Institute of Tropical Medicine
(NEKKEN), Leading Graduate School Program, Graduate School of Biomedical
Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
(Huy) Evidence Based Medicine Research Group & Faculty of Applied
Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam
(Huy) Department of Clinical Product Development, Institute of Tropical
Medicine (NEKKEN), Leading Graduate School Program, Graduate School of
Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki
852-8523, Japan
Title
Optimal percutaneous coronary intervention in patients with ST-elevation
myocardial infarction and multivessel disease: An updated, large-scale
systematic review and meta-analysis.
Source
International Journal of Cardiology. 244 (pp 67-76), 2017. Date of
Publication: 01 Oct 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Our study aimed to compare three different percutaneous
coronary intervention (PCI) approaches: culprit-only (COR) and complete
(CR) revascularization - categorizing into immediate (ICR) or staged
(SCR). Methods We searched 13 databases for randomized controlled trials.
Articles were included if they compared at least two strategies. To have
more studies in each analysis, an adjusted analysis was performed using
person-years to incorporate follow-up durations and obtain pooled rate
ratios (RR), with their corresponding 95% confidence interval. Results
Thirteen trials were included with a population of 2830 patients. COR
significantly increased major adverse cardiac event (MACE) (adjusted RR
1.67, 95% CI: 1.27-2.19) and repeat revascularization (2.12, 1.67-2.69),
which was driven by repeat PCI, without any difference in all-cause
mortality and myocardial infarction (MI) compared to CR. When categorizing
CR into SCR and ICR, the trend repeated with COR increased MACE (1.99,
1.53-2.6 for ICR), cardiovascular mortality (2.06, 1.07-3.96 for ICR), MI
for ICR (1.72, 1.04-2.86), repeat revascularization and repeat PCI for
both ICR and SCR. Non-cardiovascular mortality, stroke, nephropathy,
re-hospitalization, stent thrombosis and bleeding were similar among all
approaches. Conclusions In MVD-STEMI patients, CR is better than COR in
terms of MACE, cardiovascular mortality, repeat revascularization with no
difference in safety outcomes. There was a trend towards to a reduction of
cardiovascular mortality and MI in ICR compared to SCR when each matched
with COR; even though there is no statistically significant difference
between ICR and SCR when compared together.<br/>Copyright &#xa9; 2017
Elsevier B.V.

<47>
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).

<48>
Accession Number
617683187
Author
Asakura M.; Kim J.; Asanuma H.; Hamasaki T.; Tsukahara K.; Higashino Y.;
Ishikawa T.; Nakama Y.; Koba S.; Maruyama Y.; Tsujimoto M.; Himeno H.;
Ohkusa T.; Fujino S.; Shimizu M.; Endo T.; Yoda S.; Muroya T.; Murohara
T.; Ohte N.; Suzuki H.; Kohno T.; Fukui K.; Shiono T.; Takase H.; Uzui H.;
Nagai Y.; Hashimoto Y.; Ikeda S.; Mizuno S.; Tamita K.; Fujita M.; Satake
K.; Kinoshita Y.; Nunohiro T.; Sakagami S.; Higaki J.; Morii I.; Sawada
R.; Hiasa Y.; Shigemasa T.; Nakahama M.; Sata M.; Doi O.; Ueda T.; Yamada
T.; Yamanouchi T.; Yamaguchi H.; Morita Y.; Hayashi H.; Kitakaze M.
Institution
(Asakura, Kim, Kitakaze) Department of Clinical Medicine and Development,
National Cerebral and Cardiovascular Center Suita, Osaka 565-8565, Japan
(Asakura, Kitakaze) Department of Cardiovascular Medicine, National
Cerebral and Cardiovascular Center, Osaka, Japan
(Asanuma) Department of Cell Biology, National Cerebral and Cardiovascular
Center, Osaka, Japan
(Asanuma) Cardiovascular Science and Technology, Kyoto Prefectural
University of Medicine, Kyoto, Japan
(Hamasaki) Department of Biomedical Statistics, Osaka University Graduate
School of Medicine, Suita, Japan
(Hamasaki) Department of Data Science, National Cerebral and
Cardiovascular Center, Osaka, Japan
(Tsukahara) Division of Cardiology, Yokohama City University Medical
Center, Kanagawa, Japan
(Higashino) Department of Cardiology, Higashi Takarazuka Satoh Hospital,
Hyogo, Japan
(Ishikawa) Department of Cardiology, Saitama Prefecture Cardiovascular and
Respiratory Center, Saitama, Japan
(Nakama) Department of Cardiology, Hiroshima City Hospital, Hiroshima,
Japan
(Koba) Division of Cardiology, Department of Medicine, Showa University
Hospital, Tokyo, Japan
(Maruyama) Department of Cardiology, Iwatsuki-minami Hospital, Saitama,
Japan
(Tsujimoto) Department of Cardiology, Cardiovascular Center, Veritas
Hospital, Hyogo, Japan
(Himeno) Division of Cardiology, Fujisawa City Hospital, Kanagawa, Japan
(Ohkusa) Department of Cardiology, Hokko Memorial Hospital, Hokkaido,
Japan
(Fujino) Department of Cardiology, Fukui Prefectural Hospital, Fukui,
Japan
(Shimizu) Department of Cardiology, International Goodwill Hospital,
Kanagawa, Japan
(Endo) Department of Cardiology, Saiseikai Yokohama City Southern
Hospital, Kanagawa, Japan
(Yoda) Division of Cardiology, Department of Internal Medicine, Nihon
University School of Medicine, Tokyo, Japan
(Muroya) Department of Cardiology, National Hospital Organization Ureshino
Medical Center, Saga, Japan
(Murohara) Department of Cardiology, Nagoya University Graduate School of
Medicine, Aichi, Japan
(Ohte) Department of Cardio-Renal Medicine and Hypertension, Nagoya City
University Graduate School of Medical Sciences, Aichi, Japan
(Suzuki) Division of Cardiology, Showa University Fujigaoka Hospital,
Kanagawa, Japan
(Kohno) Department of Cardiology, Tokyo Rinkai Hospital, Tokyo, Japan
(Kohno) Department of Cardiology, Kasukabe Municipal Hospital, Saitama,
Japan
(Fukui) Division of Cardiology, Kanagawa Cardiovascular Respiratory
Center, Kanagawa, Japan
(Shiono) Department of Cardiology, Kitasato University Medical Center,
Saitama, Japan
(Takase) Department of Internal Medicine, Enshu Hospital, Shizuoka, Japan
(Uzui) Department of Cardiology, Fukui University Hospital, Fukui, Japan
(Nagai) Department of Cardiology, Rinku General Medical Center, Osaka,
Japan
(Hashimoto) Department of Cardiology, Kameda Medical Center, Chiba, Japan
(Ikeda) Division of Cardiology, Uwajima City Hospital, Ehime, Japan
(Mizuno) Department of Cardiology, Fukui Cardiovascular Center, Fukui,
Japan
(Tamita) Department of Cardiology, Nishinomiya Watanabe Cardiovascular
Center, Hyogo, Japan
(Fujita) Department of Cardiovascular Division, Kansai Rosai Hospital,
Hyogo, Japan
(Satake) Department of Cardiology, Fukui General Clinic, Fukui, Japan
(Kinoshita) Kinoshita Clinic, Hiroshima, Japan
(Nunohiro) Department of Cardiology, Nagasaki Municipal Hospital,
Nagasaki, Japan
(Nunohiro) Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan
(Sakagami) Department of Cardiology, National Hospital Organization
Kanazawa Medical Center, Ishikawa, Japan
(Higaki) Department of Integrated Medicine and Informatics, Ehime
University Graduate School of Medicine, Ehime, Japan
(Morii) Department of Cardiology, Hokusetsu General Hospital, Osaka, Japan
(Sawada) Department of Cardiology, Hadano Red Cross Hospital, Kanagawa,
Japan
(Hiasa) Department of Cardiology, Tokushima Red Cross Hospital, Tokushima,
Japan
(Shigemasa) Department of Cardiovascular Medicine, International
University of Health and Welfare Atami Hospital, Shizuoka, Japan
(Nakahama) Department of Cardiology, Fukuyama City Hospital, Hiroshima,
Japan
(Sata) Department of Cardiovascular Medicine, University of Tokushima,
Tokushima, Japan
(Doi) Department of Cardiology, Shizuoka Prefectural General Hospital,
Shizuoka, Japan
(Ueda) Department of Cardiology, Tokyo Metropolitan Tama Medical Center,
Tokyo, Japan
(Yamada) Division of Cardiology, Osaka General Medical Center, Osaka,
Japan
(Yamanouchi) Department of Cardiology, Department of Internal Medicine,
Hitachi, Ltd. Hitachinaka General Hospital, Ibaraki, Japan
(Yamaguchi) Yamaguchi Clinic, Fukushima, Japan
(Morita) Department of Cardiology, National Hospital Organization
Sagamihara Hospital, Kanagawa, Japan
(Hayashi) Department of Internal Medicine, Hoetsu Hospital, Tokurshima,
Japan
Title
Does Treatment of Impaired Glucose Tolerance Improve Cardiovascular
Outcomes in Patients with Previous Myocardial Infarction?.
Source
Cardiovascular Drugs and Therapy. (pp 1-11), 2017. Date of Publication: 04
Aug 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: We evaluated the effects of an alpha-glucosidase inhibitor,
voglibose, on cardiovascular events in patients with a previous myocardial
infarction (MI) and impaired glucose tolerance (IGT). Methods: This
prospective, randomized, open, blinded-endpoint study was conducted in 112
hospitals and clinics in Japan in 3000 subjects with both previous MI and
IGT receiving voglibose (0.6 mg/day, n = 424) or no drugs (n = 435) for 2
years. The Data and Safety Monitoring Board (DSMB) recommended
discontinuation of the study in June 2012 after an interim analysis when
the outcomes of 859 subjects were obtained. The primary endpoint was
cardiovascular events including cardiovascular death, nonfatal MI,
nonfatal unstable angina, nonfatal stroke, and percutaneous coronary
intervention/coronary artery bypass graft. Secondary endpoints included
individual components of the primary endpoint in addition to all-cause
mortality and hospitalization due to heart failure. Results: The age,
ratio of males, and HbA<inf>1</inf>C were 65 vs. 65 years, 86 vs. 87%, and
5.6 vs. 5.5% in the groups with and without voglibose, respectively.
Voglibose improved IGT; however, Kaplan-Meier analysis showed no
significant between-group difference with respect to cardiovascular events
[12.5% with voglibose vs. 10.1% without voglibose for the primary endpoint
(95% confidence interval, 0.82-1.86)]; there were no significant
differences in secondary endpoints. Conclusion: Although voglibose
effectively treated IGT, no additional benefits for cardiovascular events
in patients with previous MI and IGT were observed. Voglibose may not be a
contributing therapy to the secondary prevention in patients with MI and
IGT. Trial Registration: Clinicaltrials.govnumber:
NCT00212017<br/>Copyright &#xa9; 2017 Springer Science+Business Media, LLC