EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
601022479
Author
Manzano F.; Colmenero M.; Perez-Perez A.M.; Roldan D.; Jimenez-Quintana
M.M.; Manas M.R.; Sanchez-Moya M.A.; Guerrero C.; Moral-Marfil M.A.;
Sanchez-Cantalejo E.; Fernandez-Mondejar E.
Institution
(Manzano, Perez-Perez, Roldan, Jimenez-Quintana, Manas, Sanchez-Moya,
Guerrero, Moral-Marfil, Fernandez-Mondejar) Intensive Care Unit, Hospital
Universitario Virgen de las Nieves, C/Avenida de las Fuerzas Armadas, 2,
Granada 18014, Spain
(Colmenero) Intensive Care Unit, Hospital Universitario San Cecilio,
C/Avenida Dr. Oloriz 16, Granada 18012, Spain
(Sanchez-Cantalejo) Department of Statistics, Andalusian School of Public
Health, Granada, Spain
(Manzano, Colmenero, Perez-Perez, Roldan, Jimenez-Quintana, Manas,
Sanchez-Moya, Guerrero, Moral-Marfil, Sanchez-Cantalejo,
Fernandez-Mondejar) Instituto de Investigacion Biosanitario de Granada
(IBIG), Granada, Spain
Title
Comparison of two repositioning schedules for the prevention of pressure
ulcers in patients on mechanical ventilation with alternating pressure air
mattresses.
Source
Intensive Care Medicine. 40 (11) (pp 1679-1687), 2014. Date of
Publication: 15 Oct 2014.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: The objective was to compare the effectiveness of repositioning
every 2 or 4 h for preventing pressure ulcer development in patients in
intensive care unit under mechanical ventilation (MV).
Methods: This was a pragmatic, open-label randomized clinical trial in
consecutive patients on an alternating pressure air mattress (APAM)
requiring invasive MV for at least 24 h in a university hospital in Spain.
Eligible participants were randomly assigned to groups for repositioning
every 2 (n = 165) or 4 (n = 164) h. The primary outcome was the incidence
of a pressure ulcer of at least grade II during ICU stay.
Results: A pressure ulcer of at least grade II developed in 10.3 %
(17/165) of patients turned every 2 h versus 13.4 % (22/164) of those
turned every 4 h (hazard ratio [HR] 0.89, 95 % confidence interval [CI]
0.46-1.71, P = 0.73). The composite end point of device-related adverse
events was recorded in 47.9 versus 36.6 % (HR 1.50, CI 95 % 1.06-2.11, P =
0.02), unplanned extubation in 11.5 versus 6.7 % (HR 1.77, 95 % CI
0.84-3.75, P = 0. 13), and endotracheal tube obstruction in 36.4 versus
30.5 %, respectively (HR 1.44, 95 % CI 0.98-2.12, P = 0.065). The median
(interquartile range) daily nursing workload for manual repositioning was
21 (14-27) versus 11 min/patient (8-15) (P < 0.001).
Conclusions: A strategy aimed at increasing repositioning frequency (2
versus 4 h) in patients under MV and on an APAM did not reduce the
incidence of pressure ulcers. However, it did increase device-related
adverse events and daily nursing workload.<br/>Copyright &#xa9; 2014,
Springer-Verlag Berlin Heidelberg and ESICM.

<2>
Accession Number
618447435
Author
Apelseth T.O.; Kristoffersen E.K.; Kvalheim V.L.; Bjerkvig C.K.; Fosse
T.K.; Hervig T.A.; Cap A.P.; Haaverstad R.; Lunde T.H.F.; Braathen H.;
Sivertsen J.; Strandenes G.
Institution
(Apelseth) Laboratory of Clinical Biochemistry, Haukeland University
Hospital, Norway
(Apelseth, Kristoffersen, Hervig, Lunde, Braathen, Sivertsen, Strandenes)
Department of Immunology and Transfusion Medicine, Haukeland University
Hospital, Norway
(Kristoffersen, Kvalheim, Hervig, Haaverstad) School of Medicine and
Dentistry, University of Bergen, Norway
(Kvalheim, Haaverstad) Department of Hearth Disease, Haukeland University
Hospital, Norway
(Bjerkvig, Fosse) Department of Anaesthesia and Intensive Care, Haukeland
University Hospital, Norway
(Bjerkvig, Fosse) Norwegian Naval Special Operations Commando, Norway
(Cap) U.S. Army Institute of Surgical Research, United States
(Strandenes) Norwegian Armed Forces Medical Services, Norway
Title
Transfusion with cold stored platelets in patients undergoing complex
cardiothoracic surgery with cardiopulmonary bypass circulation: Effect on
bleeding and thromboembolic risk.
Source
Transfusion. Conference: AABB Annual Meeting 2017. United States. 57 (pp
3A-4A), 2017. Date of Publication: September 2017.
Publisher
Blackwell Publishing Inc.
Abstract
Background/Case Studies: Storage at 4oC shortens the circulation time of
platelets, but previous experience indicates better hemostatic function. A
randomized clinical pilot study is performed investigating the efficacy
and safety of cold stored platelets in treatment of bleeding in patients
undergoing complex cardiothoracic surgery with cardiopulmonary bypass
circulation. The study is a joint effort by Civilian and Military Health
Care Services. Study Design/Method: A two-armed randomized clinical pilot
study is designed to evaluate leukoreduced apheresis platelets in PAS
stored cold (4 degrees Celcius) for up to 7 days under constant agitation
(4CPLT) against standard room temperature storage (RTPLT). Patients are
enrolled prior to surgery and we aim to include a minimum of 20 transfused
patients in each study arm. We report on postoperative bleeding, total
blood usage, and laboratory measures of coagulation and blood cell counts
within day 1 after surgery in addition to thromboembolic events during
hospital stay for up to 28 days. Statistical analyzes are performed by
Independent samples T-test and Chi-Square test (SPSS version 23.0), and
results presented as mean6SEM. Results/Finding: By 3rd of April 2017, 17
patients have received 4CPLT vs. 22 RTPLT. There are no significant
differences in age, gender, weight, BMI, Cardiac Bypass Time, Euro SCORE,
or EF between the two groups. Significantly lower volume of postoperative
bleeding is observed in patients receiving cold stored platelets (chest
drain output after chest closure: 546 mul+/-61 (4CPLT) vs. 820 mul+/-109
(RTPLT)). Thromboembolic events are observed in 3 of 17 (18%) 4CPLT
patients and 7 of 22 (31%) of RTPLT, but no significant difference is
observed between the two groups. No differences are observed in measures
of coagulation prior to surgery, immediately after heparin reversal, and
the morning after surgery; INR (4CPLT: 1.3+/-0.1->1.5+/- 0.1->1.3+/-0.1
vs. RTPLT: 1.2+/-0.1->1.4+/-0.0->1.2+/-0.0), APTT (sec) (4CPLT:
40+/-2->43+/-2->40+/-2 vs. RTPLT: 40+/-1->44+/-2->39+/-1), fibrinogen
(g/L) (4CPLT: 3.8+/-0.3->2.6+/-0.2->3.8+/-0.2 vs. RTPLT: 3.9+/-
0.3->2.6+/-0.2->3.7+/-0.1). Similarly, no significant differences are
observed in platelet count (x 109/L) (4CPLT: 219+/-20->114+/-10->13+/-616
vs. RTPLT 232+/-25->110+/-13->154+/-17) or hemoglobin (g/dL) (4CPLT:
11.3+/-0.3->8.8+/-0.3->9.4+/-0.3 vs. RTPLT: 12.0+/-0.4->9.4+/-0.3->9.7+/-
0.2). Blood usage is similar in the two groups: Platelets 2.1+/-0.1
(4CPLT) vs. 2.3+/-0.2 (RTPLT), red blood cells 4.2+/-0.7 (4CPLT) vs.
4.7+/-1.0 (RTPLT), and SD pooled plasma 7.7+/-1.0 (4CPLT) vs. 9.5+/-1.0
(RTPLT). Conclusion: Preliminary data from 39 patients indicate that
transfusion of cold stored leukoreduced apheresis platelets in PAS is
effective in treatment of bleeding in patients undergoing complex
cardiothoracic surgery, and that cold stored platelets present no higher
risk of thromboembolic events. Larger studies are recommended to explore
the use of cold stored platelet transfusion in critical bleeding.

<3>
Accession Number
617302828
Author
Kanmanthareddy A.; Reddy M.; Anugula D.; Alla V.; Hunter C.; Mooss A.;
Lavu M.; Bommana S.; Atkins D.; Natale A.; Lakkireddy D.
Institution
(Kanmanthareddy, Reddy, Anugula, Alla, Hunter, Mooss, Lavu, Bommana,
Atkins, Natale, Lakkireddy) Creighton University School of Medicine,
Omaha, NE, United States
Title
Sotalol versus other anti-arrhythmic agents for prevention of
post-operative supraventricular arrhythmias after cardiac surgery:
Meta-analysis of randomized controlled studies.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 546), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Supraventricular arrhythmias such as atrial fbrillation(AF)
and atrial futter are common after cardiac surgery. Wecompared the effcacy
of Sotalol compared to other agents for the prevention of these
arrhythmias after cardiac surgery. Methods: We searched PubMed, Google
Scholar and EBSCO databases to identify studies comparing sotalol with
other antiarrhythmicmedications for the prevention of supraventricular
arrhythmias after cardiac surgery. We then synthesized the data using
STATA 13 software to estimate the risk ratio (RR) and 95% CI for
occurrence of these arrhythmias. Results: A total of 6 randomized
controlled studies with 1,328 patients were included. Sotalol versus
beta-blockers were compared in 5 studies and sotalol with amiodarone was
compared in 2 studies. Supraventricular arrhythmias occurred in 14% and
23% of the sotalol andbeta-blocker groups, respectively. Sotalol group had
a lower incidence of these arrhythmias compared to beta-blockers (RR
0.69,95% CI 0.53 - 0.91). The incidence of these arrhythmias was 28% and
23% in the sotalol and amiodarone groups, respectively. There was no
difference between sotalol and amiodarone groups (RR 1.18, 95% CI 0.78 -
1.78). Conclusions: Sotalol appears to be superior to beta-blockers but
similar in effcacy to amiodarone in preventing supra ventricular
tachyarrhythmias after cardiac surgery.

<4>
Accession Number
617291278
Author
Montero N.; Rovira A.; Hueso M.; Rama I.; Sbraga F.; Boza E.;
Vazquez-Reveron J.M.; Cruzado J.
Institution
(Boza) Anesthesiology, Hospital Universitari De Bellvitge, L'Hospitalet de
Llobregat, Spain
(Sbraga) Cardiac Surgery, Hospital Universitari De Bellvitge, L'Hospitalet
de Llobregat, Spain
(Vazquez-Reveron) Intensive Care, Hospital Universitari De Bellvitge,
L'Hospitalet de Llobregat, Spain
(Montero, Rovira, Hueso, Rama, Cruzado) Nephrology, Hospital Universitari
De Bellvitge, L'Hospitalet de Llobregat, Spain
Title
Nephrology intervention in patients awaiting cardiac surgery: A randomised
controlled trial.
Source
Nephrology Dialysis Transplantation. Conference: 54th Annual Congress of
the European Renal Association-European Dialysis and Transplant
Association, ERA-EDTA 2017. Spain. 32 (pp iii186-iii187), 2017. Date of
Publication: May 2017.
Publisher
Oxford University Press
Abstract
INTRODUCTION AND AIMS: Acute kidney injury(AKI) is a frequent complication
after cardiac surgery. Its incidence ranges from 19 to 44% depending on
the study and which definition is used. There are some well-known risk
factors associated with AKI, including baseline patient characteristics
(age and comorbidities), need of perioperative blood transfusion or
presence of previous chronic kidney disease. We wanted to evaluate if a
nephrologist management and control of potential risk factors of renal
disease can be used to prevent AKI, thereby minimizing the risk of need
RRT, reducing costs and improving survival in these patients. It will be
the first study focused on this intervention. The aim of this study is to
assess if a nephrology intervention before cardiac surgery can reduce the
postoperative incidence of AKI. METHODS: Unicentric prospective randomized
controlled trial of 108 participants. The inclusion criteria was patients
undergoing scheduled cardiac surgery of >18 years old. The exclusion
criteria was current outpatient management by a nephrologist or CKD stage
>3B (eGFR<45mL/min/1.73m² estimated by CKD-EPI equation) or a
requirement for renal replacement therapy before surgery. Clinical
Research Ethics Committee of Bellvitge have approved the study before
initiation. All patients have given written informed consent. We have done
an intention-to-treat analysis, continuous variables have been compared
between groups using Student's t test and categorical variables have been
compared using X2. RESULTS: Nephrology intervention before surgery,
included a preoperative study done minimum 1 month before the surgery to
optimise the patient' s overall condition by optimization of hydratation
state, remove or minimize dose of drugs that potentially deteriorate
kidney function and correct metabolic disorders. The characteristics of
the patients is shown at Table 1. The number of patients with AKI KDIGO
stage 1 was a total of 7 of which 3 were from the intervention arm and 4
were from the control arm (p=0.642), only one patients of the control
group reached a stage 2 and none of them required renal replacement
therapy. We found 0.019% of mortality (1 participant in the intervention
group and one in control group). We have not been able to make a
stratified analysis because the low incidence of AKI. Data at 1 year
follow-up (n= 21) showed no indicidence of kidney disease (creatinine in
intervention arm 90.6+/-41.5mumol/L and in control arm 72+/-20, p=0.1997)
without differences in albuminuria. CONCLUSIONS: In summary, we did not
find any difference in acute kidney injury and death when a nephrology
intervention is done to cardiac surgery patients, probably it would be
necessary to increase the sample size to make conclusions. The results at
1 year follow-up showed no kidney disease in these patients. We will
maintain the recruitment until a larger sample size is obtained. (Table
Presented).

<5>
Accession Number
617290109
Author
Wu V.-C.; Wang J.-J.; Wu K.-D.
Institution
(Wang) Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan (Republic
of China)
(Wu, Wu) Internal Medicine, National Taiwan University Hospital, Taipei,
Taiwan (Republic of China)
Title
Urinary biomarkers predicts advanced acute kidney injury after
cardiovascular surgery.
Source
Nephrology Dialysis Transplantation. Conference: 54th Annual Congress of
the European Renal Association-European Dialysis and Transplant
Association, ERA-EDTA 2017. Spain. 32 (pp iii173), 2017. Date of
Publication: May 2017.
Publisher
Oxford University Press
Abstract
INTRODUCTION AND AIMS: Acute kidney injury (AKI) after cardiovascular
surgeries were a serious complication. Less is known about whether novel
biomarkers adding to clinical risk scores could predict advanced AKI. We
validate clinical models adding on to the urinary biomarkers, devoted to
finding the best prediction model for advanced AKI or mortality after
cardiovascular surgery. METHODS: In this prospectively conducted
multicenter study, urine samples were collected from 149 adults at hours
3, 6, 12 and 24 after receiving cardiovascular surgery. Novel urine
protein,alpha-Glutathione S-transferases; urinary pi-Glutathione
Stransferases; Hemojuvelin; Kidney injury molecule-1 and Neutrophil
gelatinase associated lipocalin were illustrated as panel markers. Primary
outcome was advanced AKI, in term of AKIN stage 2, 3 and composite
outcomes were AKIN stage 2, 3 or mortality. RESULTS: Patients who had
advanced AKI had significant higher uHJV and uKIM1 at hours 3, 6 and 12
after operation. Normalized by the urine creatinine level, uKIM1 adding to
uHJV at hour 3 has the best prediction ability for advanced AKI and
composite outcomes (AUC was 0.898 and 0.905, respectively). Panel of
normalized uKIM1, uHJV at hour 3 after operation and Liano's score
performing the best to predict advanced AKI(AUC was 0.931 for advanced
AKI, category-free net reclassification improvement of 1.149, and P <
0.001). CONCLUSIONS: We showed that a panel of urine biomarkers, with
normalized uKIM1, uHJV at hour 3 after cardiovascular surgery adding to
clinical risk score improve risk stratification and identify patients at
higher risk for progression of advanced AKI and composite outcomes.

<6>
Accession Number
617289691
Author
Sanders P.; Anand R.; Kowal R.; Piorkowski C.; Rizwan Sohail M.; Kragten
H.; Moya A.; Stromberg K.; Rogers J.D.
Institution
(Sanders, Anand, Kowal, Piorkowski, Rizwan Sohail, Kragten, Moya,
Stromberg, Rogers) South Australian Health and Medical Research Institute,
University of Adelaide, Adelaide, Australia
Title
Insertion of a miniaturized insertable cardiac monitor outside the
traditional hospital setting: Results from the rio 2 international study.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 354), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: The vast majority of current insertable cardiac monitor (ICM)
procedures are performed in a cardiac catheterization (cath)/EP lab.
Miniaturization of ICMs may allow device insertion to be moved from these
traditional hospital setting to other "out-of-lab" less resource intensive
locations within the hospital, such as holding areas or procedure rooms.
Methods: The Reveal LINQ^TM in-Offce 2 (RIO 2) International
study is a single arm, multicenter, prospective study designed to assess
the safety of Reveal LINQ^TM ICM insertion procedures performed
outside the traditional hospital setting within the hospital. Patients
indicated for an ICM and willing to undergo device insertion outside the
cath/EP lab or operating room were eligible. The protocol required
maintaining an appropriate sterile technique during the days after
insertion, with visits 30 and 90 days post-procedure. The primary
objective was to estimate the rate of untoward events (a composite of
unsuccessful ICM insertion and complication related to ICM procedure)
associated with out-of-lab procedures. A complication was a adverse even
requiring invasive intervention such as system revision or intravenous
drug administration. Results: A total of 191 patients (45.5% female aged
63.8 + 26.9 years) underwent an ICM insertion attempt between September
2015 and May 2016, at 17 centers in Europe, Canada and Australia. All
procedures took place within the hospital but in out-of-lab settings and
were successful. The median visit duration was 106 min. Among the 191
patients, the rate of untoward events was 0.0% (95% CI: 0.0% - 2.1%). Four
patients presented with procedure related adverse events that did not
require invasive intervention (1 patient had insertion site pain, 2 had an
incision site hemorrhage, and 1 had vasovagal syncope following the
procedure). Non of the patients developed infections despite the fact that
56% of procedures were conducted without antibiotic prophylaxis.
Conclusions: The Reveal LINQ^TM ICM insertion procedure can be
safely performed outside of the traditional hospital settings.

<7>
Accession Number
617289628
Author
Cardoso R.; Rivera M.; Rivner H.; Mendirichaga R.; D'Avila A.
Institution
(Cardoso, Rivera, Rivner, Mendirichaga, D'Avila) University of Miami,
Jackson Memorial Hospital, Miami, FL, USA, Instituto de Pesquisa em
Arritmia Cardiaca, Hospital Cardiologico, Florianopolis, Brazil
Title
Percutaneous epicardial mapping and ablation of ventricular tachycardia: A
systematic review of safety outcomes.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 346), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Safety outcomes of percutaneous epicardial ventricular
tachycardia (VT) ablations vary widely in the literature. This is likely
related to small sample sizes and heterogeneous patient and substrate
characteristics between different studies. We aimed to perform a
systematic review of safety outcomes following percutaneous epicardial VT
procedures. Methods: PubMed, EMBASE, and Cochrane Central were searched
for studies that reported procedural complications of percutaneous
epicardial access and mapping or ablation for VT. There were no
restrictions with regards to the arrhythmogenic substrate. The overall
complication rates were calculated among all included studies. Results:
The search yielded 465 results. A total of 32 studies, 1,972 patients, and
2,047 procedures were included. Approximately 1/3 of substrates were
ischemic and 2/3 of patients were men. Successful percutaneous epicardial
access was achieved in 92.6% of cases. Table 1 reports the pooled
incidence of adverse events. Pericarditis was not reported due to its
ordinary occurrence after epicardial procedures. The most common
complication was right ventricular puncture (8.7%). Procedure-related
mortality was rare (0.7%). Conclusions: We report the pooled literature
rate of complications following percutaneous epicardial VT mapping or
ablation. These results can be used in a shared decision making process by
physicians for a discussion with patients about the overall risks of
percutaneous epicardial VT procedures.

<8>
Accession Number
617289627
Author
Scudeler T.; Hueb W.; De Soarez P.C.; Campolina A.G.; Rezende P.; Lima E.;
Garzillo C.L.; Freitas D.F.C.; Costa L.; Oikawa F.T.; Ramires J.; Filho
R.K.
Institution
(Scudeler, Hueb, De Soarez, Campolina, Rezende, Lima, Garzillo, Freitas,
Costa, Oikawa, Ramires, Filho) Heart Institute (InCor - HCFMUSP), Sao
Paulo, Brazil
Title
Cost-effectiveness analysis and quality of life of on-pump and off-pump
stable multivessel coronary artery bypass grafting: Mass III trial 5-year
follow-up.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 100), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Long-term costs and quality of life for patients who underwent
on-pump and off-pump coronary artery bypass graft surgery (CABG) are
unknown. Methods: Between 2001 and 2006, 308 patients with stable
multivessel coronary artery disease and preserved ventricular function
were randomized to on-pump CABG (n=153) or off-pump CABG (n=155). The 2
groups were well matched for baseline characteristics. Costs for
hospitalizations, physician services, outpatient care, and medications
were assigned using 2016 US dollars. Health state utilities were assessed
using the SF-6D questionnaire. Results: On-pump CABG patients received a
greater number of grafts per patient (2.97 versus 2.49; P<0.001) and had
less incomplete revascularization (42.5% versus 52.9%; P=0.052). QoL
improved similarly in both groups from baseline (0.781 vs 0.768, p=0.381)
to 6 months (0.817 vs 0.809, p=0.175), 12 months (0.832 vs 0.831,
p=0.696), 24 months (0.837 vs 0.827, p=0.349) and 60 months (0.829 vs
0.820, p=0.300). The cumulative QALY adjusted by baseline over 5-year
follow-up was higher in on-pump group (3.707; IC 95% 3.678-3.736 and
3.556; IC 95% 3.528-3.585), but not statistically signifcant. Total costs
for the index hospitalization per patient was higher in the off-pump CABG
group ($2966.72+/-381.45 vs $3046.39+/-890.81, p=0.293). Over the 5-year
follow-up, costs were similar between the two treatment groups.
Nonetheless, 5-year cumulative cost remained only $180.64 higher per
patient with on-pump CABG. Conclusions: Despite incomplete
revascularization following off-pump CABG, there was no difference in QoL
and cost-analysis between off-pump and on-pump procedures. QoL markedly
improved in both treatment groups over 5-year follow-up.

<9>
Accession Number
617289594
Author
Salam A.; Al Habib K.; Singh R.; Asaad N.; Suwaidi J.
Institution
(Salam, Al Habib, Singh, Asaad, Suwaidi) Second Gulf Registry of Acute
Coronary Events (Gulf RACE-2) Investigators, Hamad Medical Corporation,
Doha, Qatar
Title
Do women benefit from early coronary artery bypass graft and percutaneous
coronary interventions in acute coronary syndromes: Answers from the
second gulf registry of acute coronary events.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 98), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Objectives: Data is scarce about the benefts of coronary artery bypass
graft (CABG) in women when performed early during an acute coronary
syndrome (ACS) event and its impact on prognosis as compared to
percutaneous coronary interventions (PCI) and conservative management.
Accordingly, we examined that in a multicenter multinational ACS registry
from the Middle East. Methods: For a period of 9 months in 2008 to 2009,
1686 consecutive women with ACS were enrolled from 65 hospitals in 6
Middle East countries. Those undergoing early CABG during hospitalization
were compared to PCI and conservative medical management. Clinical
feature, coronary anatomy, in-hospital, and one-year mortality were
examined. Results: During the study period, 40 women (2.4%) underwent CABG
during the index hospitalization (group A), and 177 women (10.5%) were
submitted to PCI (group B) and 1469 women (87.1%) were not submitted to
mechanical revascularization (group C). Patients from group A more
frequently had diabetes mellitus, hypertension, and dyslipidemia (all P<
0.001) compared to groups B and C. They had signifcantly more severe
coronary anatomy: 3 vessel disease (72.5% vs. 22% vs. 5.3%, P<0.001) and
the culprit lesion was more frequently on the left main (30% versus 2.8%
versus 1.1%, P<0.001). There were no signifcant difference between the 3
groups in inhospital and one year mortality. Conclusions: the observed low
rates of early interventions in women with ACS in our region warrants
further study.

<10>
Accession Number
617289593
Author
Kuck K.-H.; Colombo A.; Alferi O.; Vahanian A.; Baldus S.; Nickenig G.;
Maisano F.; Von Bardeleben R.P.S.; Van Der Heyden J.; Hausleiter J.;
Kerner A.; Tamburino C.
Institution
(Kuck, Colombo, Alferi, Vahanian, Baldus, Nickenig, Maisano, Von
Bardeleben, Van Der Heyden, Hausleiter, Kerner, Tamburino) Department of
Cardiology, Asklepios Klnik St. Georg, Hamburg, Germany
Title
Multicenter trial of a transfemoral system for mitral valve annuloplasty:
Up-to-2-year follow-up results.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 994), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: The Cardioband system enables percutaneous implantation of an
adjustable "surgical-like" mitral annuloplasty ring using a transseptal
approach. The aim of this multicenter study was to evaluate feasibility,
safety and outcomes up to 24 months of Cardioband implantation in patients
with secondary mitral regurgitation (MR). Methods: Between February 2013
and June 2016, 59 high-risk patients with signifcant secondary MR were
enrolled at 11 European sites. All patients were screened by a heart team
using echocardiography and cardiac CT. Results: Mean patient age was 72
+/- 8 years; 43 (73%) were men. Mean EuroSCORE II was 7.2%. At baseline,
51 patients (86%) were in NYHA functional class III-IV, with a mean left
ventricular ejection fraction of 33 +/- 11%. Device implantation was
achieved in all patients. At discharge, 50 patients (85%) had MR <=2+.
After device cinching, an average 30% reduction in septolateral diameter
was observed (from 37 +/- 4 mm to 26 +/- 4 mm; p<0.01). Thirty-day
mortality was 3.4% (2 patients; death adjudicated as unrelated to the
device). At the 24-month follow-up, 11 (92%) of 12 patients had MR <=2+
and 9 (77%) presented in NYHA functional class I/II. A signifcant
improvement was observed in the mean quality of life score (Minnesota
Living with Heart Failure Questionnaire) from 38 to 22 (p<0.01); mean
six-minute walk distance changed from 325 to 333 m (p=0.86). Conclusions:
Transseptal mitral valve repair with the Cardioband device resulted in MR
reduction by reconstruction of the mitral annulus. Thirty-day mortality is
comparable to other transcatheter mitral valve procedures. MR severity
reduction and clinical beneft remain stable up to 24 months.

<11>
Accession Number
617289580
Author
Bockeriya O.; Kudzoeva Z.; Khugaev S.
Institution
(Bockeriya, Kudzoeva, Khugaev) Bakulev Center for Cardiovascular Surgery,
Moscow, Russian Federation
Title
Time-to-event meta-analysis for bypass grafting versus stenting in
multivessel disease in contemporary era.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 97), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Previous meta-analysis of coronary artery bypass grafting
(CABG) versus percutaneous coronary interventions (PCI) have shown higher
incidence of stroke for CABG during different follow-up periods and
similar results or prevalence of CABG for late outcomes. New data on
long-term results from numerous randomized trials appears in literature
over time. "Time-to-event" analysis was not previously used to avoid
potential data bias in long-term (5 years and more) follow-up. Aim: To
perform "time-to-event" meta-analysis for CABG versus PCI with drug
eluting stents (DES) during 5-year follow-up in multivessel disease
patient group. Materials and Methods: We included 8 randomized trials
(5499 patients in total) comparing CABG versus PCI with DES. End-points
were: repeat revascularization, death, MI and stroke. We performed
time-to-event analysis for the end-points results between two follow-up
periods: 12 and 13-60 months. Statistical analysis was performed using
Comprehensive Meta-Analysis V.2.0. For dichotomous outcomes odds ratio
(OR) and 95% confdence interval (CI) were calculated. Results: At 12
months follow-up MI and death rates were similar (OR 1.012, CI
0.692-1.483, p =0.951 and OR 1.060, CI 0.731-1.538, p =0.758); CABG had
lower repeat revascularization rate (OR = 0.745; 95% CI 0.647-0.858, p =
0.000) and higher stroke (OR = 1.040; 95% CI 0.646-1.675, p = 0.870). In
13-60 month follow-up - CABG had better survival, MI and repeat
revascularization rate (OR 0.736, CI 0.460-1.179, p = 0.202; OR 0.312, CI
0.115-0.849, p =0.022; OR = 0.491; 95% CI: [0.365-0.659]; p = 0.000) and
no differences in stroke (OR 1.055, CI 0.776-2.368, p=0.022) comparing to
PCI. Conclusions: Time-to-event analysis is a new tool for detailed
evaluation of the events in long-term follow-up. It provides more accurate
results and strengthens the evidence base. In this meta-analysis we found
the CABG prevalence in all end-points after the 1^st year in
multivessel disease. Stroke risk was similar at this time of follow-up.

<12>
Accession Number
617289486
Author
McHugh K.E.; Pasquali S.; Scheurer M.; Hall M.A.; Nathan M.
Institution
(McHugh, Pasquali, Scheurer, Hall, Nathan) Medical University of South
Carolina, Charleston, SC, USA, Children's Hospital Boston, Boston, MA, USA
Title
The association of technical performance with postoperative complications
and hospital costs for the norwood operation.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 596), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Technical performance scores (TPS) have been associated with
both clinical outcomes and hospital costs in the congenital heart surgery
population. However, the impact of TPS on costs in important subgroups,
such as single ventricle patients (who account for the highest costs
overall in this population) remains unclear. We evaluated the TPS-cost
relationship in a multicenter Norwood cohort. Methods: Clinical data from
the Single Ventricle Reconstruction (SVR) trial were linked with cost data
from Children's Hospital Association's CaseMix Database. TPS (optimal,
adequate, inadequate) was assigned based on pre-defned criteria using the
SVR dataset. The relationship of TPS with hospital costs was modeled,
adjusting for baseline patient characteristics. Postoperative
complications were also examined. Results: A total of 266/555 (48%) SVR
patients across 9 centers had both TPS and cost data available. Overall,
73% were classifed as optimal TPS, 13% adequate, and 14% inadequate. In
adjusted analysis, both total costs and the number of complications were
more than 2 times higher in those with inadequate vs. optimal TPS (ratio
between groups 2.3, 95% CI 1.6-3.3, p<.001, and 2.2, 95% CI 1.4-3.2,
p<.001, respectively). Adjusted costs across TPS groups are shown in
Figure 1. Conclusions: Patients with inadequate Norwood TPS had more
complications and higher hospital costs. These data suggest efforts geared
toward improving TPS may have the potential to improve outcomes and reduce
costs of care.

<13>
Accession Number
617289449
Author
Khand A.; Chew P.; Frost F.; Fisher M.; Ruth G.; Albouaini K.; Zadeh H.;
Dodd J.; Patel B.; Liam M.
Institution
(Khand, Chew, Frost, Fisher, Ruth, Albouaini, Zadeh, Dodd, Patel, Liam)
University Hospital Aintree NHS Trust, Liverpool, United Kingdom,
University of Liverpool, Liverpool, United Kingdom
Title
A direct comparison of accelerated discharge strategies utilising a single
high sensitivity troponin T in suspected acute coronary syndromes:
Prospective cohort study of undetectable troponin T versus low risk timi,
grace and heart scores (The macros study- mersey acute coronary syndrome
rule-out study).
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 237), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: A single undetectable high sensitivity troponin T (hstnT)
versus low risk scores as the optimum discharge tool for suspected acute
coronary syndromes (ACS) presentations remains untested. Methods:
Consecutive patients with a primary symptom of chest pain (CP) presenting
to the emergency room in a large English hospital were prospectively
defned. TIMI, GRACE and HEART scores were computed from presentation
details alone. Blinded, independent 2 consultant cardiologist adjudication
of type 1 myocardial infarction (MI) was undertaken for all biomarker
positive CP index and readmissions to any national hospital up to 1 year
post discharge. The primary outcome was MACE (type 1 MI, all cause death
and unplanned coronary revascularisation) at 42 days Results: Of 3054
presentations 1642 individual patients had both hstnT and an ECG
undertaken (suspected ACS cohort; median age 59, male 52%, previous MI
20%). 211 (12.9%) and 279 (17%) suspected ACS patients were adjudicated to
suffer MACE at 6 weeks and 1 year respectively. Only HEART<=3 (NPV MACE
99.3% type 1 MI 99.7%) and undetectable hstnT strategy (NPV MACE 99.7%
type 1 MI 99.7%) achieved pre-specifed negative predictive value (NPV)
>99% at 42 days with discharge potential of 54.4% and 40.7% respectively.
At 1 year NPV for both HEART<=3 ( MACE 97% type 1 MI 99.4%) and
undetectable hstnT (MACE 98.1% type 1 MI 99.4%) was acceptable Conclusion:
Heart <=3 and undetectable hstnT are optimum early discharge strategies
for suspected ACS population using a single hstnT.

<14>
Accession Number
617289386
Author
Kosiv K.; Gossett J.; Bai S.; Collins R.
Institution
(Kosiv, Gossett, Bai, Collins) University of Arkansas for the Medical
Sciences, Little Rock, AR, USA, Arkansas Children's Hospital, Little Rock,
AR, USA
Title
Congenital heart surgery in patients with trisomy 13 associated with lower
inhospital mortality.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 589), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Congenital heart disease (CHD) occurs in about 80% of patients
with Trisomy 13 (T13), but surgical repair has not been offered to these
patients in most centers because of low median survival. Data on
congenital heart surgery (CHS) for T13 are lacking. Methods: Nationally
distributed data from 44 pediatric hospitals in the 2004 to 2015 Pediatric
Health Information System (PHIS) database were used to identify patients
with hospital admissions with an International Classifcation of
Diseases-9^th Revision code for T13 and CHD. Data were
restricted to newborns admitted < 14 days of age. In-hospital mortality,
length of stay (LOS) and adjusted total costs were compared between
infants undergoing CHS and those treated medically. Results: Of 644
infants with T13 identifed, 471 had CHD (73%). Median age at admission was
<1 day (IQR: 0, 1). CHS was performed in 39/471 (8% with CHD). Median LOS
for the CHS group was 30 days (19, 68) versus 8 days (4, 19) in the
non-surgical group (p<0.001). Mortality was 49% lower in the CHS group
(28% versus 55%, p<0.001). Median hospital cost was 302% higher in the CHS
group ($133,858 versus $33,299, p<0.001). Conclusions: In-hospital
mortality occurs in greater than half of neonates with T13 by less than
one week of age. CHS in these patients is associated with decreased
in-hospital mortality. Hospital costs are signifcantly increased in those
who underwent CHS largely due to increased hospital LOS.

<15>
Accession Number
617289344
Author
Witberg G.; Regev E.; Chen S.; Assali A.; Barbash I.; Planer D.; Assa
H.V.; Guetta V.; Zeniou V.; Orvin K.; Danenberg H.; Segev A.; Kornowski R.
Institution
(Witberg, Regev, Chen, Assali, Barbash, Planer, Assa, Guetta, Zeniou,
Orvin, Danenberg, Segev, Kornowski) Rabin Medical Center, Petach-Tikva,
Israel
Title
The association of coronary artery disease severity and pre procedural
completeness of revasclarization on mortality in patients undergoing
transcatheter aortic valve replacement.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 983), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Coronary artery disease (CAD) is very common in patients
referred for Transcatheter Aortic Vavle Replacement (TAVR), however, data
regarding the prognostic signifcance of CAD in this population is
conficting. A few single center studies have suggested that only severe
CAD is associated with worse prognosis. Methods: We analyzed data on 1270
consecutive patients with severe Aortic Stenosis (AS) undergoing TAVR from
3 referral centers during 2008-2014. Patients were classifed as having 1)
no CAD 2) CAD with low SYNTAX Score (SS) - <22 3) CAD with medium/high SS
- >22. We examined the association of CAD severity with all cause
mortality following TAVR. In addition, we examined whether the
completeness of pre-procedural revascularization, as determined by the
residual SS (rSS) - >/< 8 is associated with post TAVR mortality using a
Cox proportional hazards ratio model adjusted for multiple prognostic
variables. Results: Of the 1270 patients 847 (67%) had no CAD, 366 (28%)
were in the low SS group and 57 (5%) were in the medium/high SS group.
Overall, CAD severity was associated with a higher burden of
comorbidities. The average SS and rSS were 7 vs. 29 and 5 vs.20 in the low
and medium/high SS strata, respectively. Over a median follow up of 1.9
years 426 (33.5%) patients had died, 253 (29.9%) in the no CAD, 141
(38.6%) in the low SS and 32 (55.4%) in the medium/high SS groups,
respectively (log rank p<0.001). the corresponding fgures according to rSS
strata were 104 (33.2%) and 59 (53.7%) for the more vs less complete
revascularization groups (log rank p<0.001).After multivariate adjustment,
both medium/high SS (HR=2.4,p<0.001) and high rSS (HR=1.9,p<0.001) were
associated with increased mortality whereas patients in the low SS or rSS
had similar mortality rates to patients without CAD (p=0.356 and p=0.244,
respectively). Conclusions: Our results show that severe CAD is associated
with increased mortality post TAVR whereas lower severity CAD is not. In
addition the data suggests that more complete revascularization pre TAVR
may attenuate the association of severe CAD and mortality and thereby may
be used to improve the outcomes of patients with severe CAD referred for
TAVR.

<16>
Accession Number
617289328
Author
O'Byrne M.L.; Kennedy K.; Kanter J.; Berger J.; Glatz A.
Institution
(O'Byrne, Kennedy, Kanter, Berger, Glatz) Children's National Medical
Center, Washington, DC, USA, The Children's Hospital of Philadelphia,
Philadelphia, PA, USA
Title
Risk of catastrophic outcome following cardiac catheterization for
pulmonary hypertension: An analysis of data from the impact registry.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 585), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Cardiac catheterization is the gold standard test for
hemodynamic assessment of patients with pulmonary hypertension (PH). The
risk of this procedure in children with PH is uncertain. PH registries
report mortality risks of 0-0.06%, while an estimate of the risk of
catastrophic adverse events <=1 day from catheterization using
administrative data from a broader range of pediatric hospitals was 3.5%.
We sought to utilize a national clinical registry to measure the risk of
catastrophic adverse outcome and identify risk factors for those events.
Methods: A multicenter retrospective cohort study was performed using data
from the IMPACT registry of subjects up to 21 years with PH undergoing
catheterization from 1/2011 to 12/2015. Subjects were identifed using a
combination of diagnostic codes and hemodynamic parameters. Using
multivariable logistic regression, the association between pre-specifed
covariates and the risk of a composite outcome (death within 1 day of
catheterization, cardiac arrest, or initiation of mechanical circulatory
support following cardiac catheterization) was assessed. Results: 9,010
procedures performed in 6,669 subjects with PH at 74 centers were studied.
Median age was 3 years (IQR: 0-11). The etiology of PH was primary
pulmonary hypertension in 23%, congenital heart disease 53%, status post
heart transplantation 16%, cardiomyopathy 6%, and pulmonary vein stenosis
6%. Median pulmonary vascular resistance was 4.1 WU m² (IQR:
2.6-6.5). 2% had undergone a cardiac operation in the prior 30 days, 14%
received mechanical ventilation, and 13% received inotropes. In terms of
procedural risk, 49% of procedures were in the lowest risk IMPACT risk
category. The observed risk of composite outcome was 1.2%, and death
before discharge was 4.7%. Younger age, lower systemic arterial oxygen
saturation, and receipt of inotropic agents were associated with increased
risk of adverse outcome. Conclusions: The risk of catastrophic adverse
outcome following cardiac catheterization in PH patients in IMPACT was
signifcantly higher than that reported from PH-specifc registries. Further
research is necessary to determine to degree to which this risk is
modifable.

<17>
Accession Number
617289286
Author
Stone G.W.; Cavalcante R.; Kappetein A.P.; Sabik J.; Banning A.; Taggart
D.; Sabate M.; Polmar J.; Boonstra P.; Lembo N.; Simonton C.; Onuma Y.;
Serruys P.W.
Institution
(Stone, Cavalcante, Kappetein, Sabik, Banning, Taggart, Sabate, Polmar,
Boonstra, Lembo, Simonton, Onuma, Serruys) Cardiovascular Research
Foundation, New York, NY, United States
Title
Sex differences in outcomes after stenting or bypass surgery for
unprotected left main disease.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 980), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: The impact of sex on outcomes of patients with unprotected
left-main disease (UPLMD) treated with up-to-date percutaneous coronary
intervention (PCI) and coronary bypass graft (CABG) techniques is still
unknown, and the existing literature harbors conficting data. In the
SYNTAX trial, female sex was an independent correlate of 4-year mortality
in the PCI arm, but not in the CABG arm. A signifcant interaction effect
was present between sex and CABG vs. PCI for that outcome. This fnding
lead to the inclusion of sex in the SYNTAX II score mortality prediction
model that provides guidance for the selection of the revascularization
strategy in patients with multivessel disease and/or UPLMD. Conversely,
this worse prognosis for women treated with PCI was not observed in the
BEST and PRECOMBAT trials. Methods: The Evaluation of XIENCE versus
Coronary Artery Bypass Surgery for Effectiveness of Left Main
Revascularization (EXCEL) trial randomized 1905 patients with UPLMD to
undergo CABG or PCI. The primary endpoint was the composite of all-cause
death, myocardial infarction or stroke at a median follow-up of 3 years.
The present study reports the pre-specifed sex subgroup analysis of the
trial. Results: Of the total population, 441 (23%) were female and 1464
(77%) were male patients. Compared to men, women were older and had a
worse baseline risk profle with a higher prevalences of hyperlipidemia,
hypertension, medically treated diabetes, and chronic kidney disease.
Regarding coronary anatomy, women had more ostial and less distal
bifurcation left main lesions, as well as lower anatomic SYNTAX scores and
fewer non left main diseased vessels, as compared to men. At the moment of
the submission of this abstract, outcomes data of the trial are still
under embargo. Conclusions: In the EXCEL trial, women had a worse baseline
risk profle but less complex coronary anatomy than men. At ACC 2017 we
intend to present all outcomes data of the trial according to sex and
treatment arm.

<18>
Accession Number
617289272
Author
Singh S.; Dhillon A.S.; Mirza M.; Arora R.
Institution
(Singh, Dhillon, Mirza, Arora) Chicago Medical School, North Chicago, IL,
United States
Title
Minimally invasive cabg reduces target vessel revascularizations in
comparison to pci without increased major adverse events: A meta-analysis
of randomized trials.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 28), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: The trials comparing Minimally Invasive Direct Coronary Artery
Bypass Graft (MIDCABG) with Percutaneous Coronary Intervention (PCI) for
proximal Left Anterior Descending Artery (LAD) stenosis show conficting
results. Methods: The PubMed, EMBASE, and Cochrane Central Register of
Controlled Trials were searched for randomized controlled trials reporting
clinical outcomes of MIDCABG vs PCI in patients with single vessel
proximal LAD coronary artery disease. The effect estimates were pooled
using Der-Simonian and Laird random-effects meta-analysis models. Results:
Eight randomized trials comprising of 1, 161 patients met inclusion
criteria. Median follow up was 18 months (range 6 months to 10 years).
Over 6 to 12 month follow up, need for any coronary intervention was
signifcantly lower in MIDCABG compared to PCI [ Risk Ratio (RR): 0.28; 95%
confdence intervals (CI): 0.16-0.49]. All-cause mortality, myocardial
infarction and recurrence of angina were not signifcantly different among
two groups over near or long term [Fig. 1]. Upon follow up of more than a
year, Target Vessel Revascularization (RR: 0.30; CI: 0.20-0.46) and need
for any coronary intervention (RR: 0.28; CI: 0.15-0.50) were signifcantly
lower in MIDCABG group. Conclusions: The MIDCABG reduces target vessel
revascularizations and need for any coronary intervention in comparison to
PCI for single vessel proximal LAD stenosis without increased all-cause
mortality, myocardial infarction and recurrence of angina.

<19>
Accession Number
617289266
Author
Abigail Simmons M.; Book W.; Shioda K.; Mori M.; Elder R.
Institution
(Abigail Simmons, Book, Shioda, Mori, Elder) Yale University School of
Medicine, New Haven, CT, USA, Emory University School of Medicine,
Atlanta, GA, USA
Title
Towards a better predictive model of adverse events in adult fontan
patients.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 633), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: The Fontan palliation causes chronic hepatic congestion and
carries a risk of late-adverse cardiac events. VAST and Model for
End-stage Liver Disease eXcluding INR (MELD-XI) scores are validated
risk-assessment tools in this group. This study investigates whether a
combination of these clinical (VAST) and lab-based models (MELD-XI) would
improve prediction of adverse cardiac events in Fontan patients. Methods:
Retrospective, two-center study of adult Fontan patients between 2001-16.
Adverse events were defned as cardiac death/heart transplantation. VAST
score (1 point each Varices, Ascites, Splenomegaly and Thrombocytopenia,
range 0-4), MELD-XI score [11.76 (loge creatinine) + 5.112 (loge total
bilirubin) + 9.44] and combined M-VAST score (range 0-5), for which a
MELD-XI >=13 was counted as a +1 to VAST score, were compared as
predictors of adverse events using receiver operating characteristics
(ROC) analysis. Optimal cut-off points were identifed using Yoden index.
Scores were calculated at a period of outpatient stability. Non-event
cohort was censored at last clinical evaluation. Results: VAST and MELD-XI
scores were available in 160 adult patients. After a mean follow-up of 22
yrs, 23 (14%) experienced an adverse event. The event cohort was older
(38.7 +/-10.3 vs. 31.6 +/-8.0 years, p=0.0049), had higher VAST scores
(2.2 +/-1.2 vs. 0.8 +/-1.0, p<0.0001) and higher MELD-XI scores (12.5
+/-3.3 vs. 11.1 +/-2.3, p=0.049) compared to non-event cohort. ROC curve
for VAST alone as a predictor of adverse events yielded an AUC of 0.80
with the optimal cutoff of >=2. ROC curve for MELD-XI score yielded an AUC
of 0.66 with the optimal cutoff of >=13. ROC curve for the M-VAST score
yielded an improved AUC of 0.82 with the optimal cutoff of M-VAST >=2.
Compared to VAST alone, M-VAST improved sensitivity from 0.70 to 0.78 but
decreased specifcity from 0.79 to 0.72. Kaplan-Meier analysis with strata
divided at M-VAST >=2 demonstrated improved event free survival of the
lower score strata (log rank =0.0002). Conclusions: Incorporating a
MELD-XI into the VAST score, thus combining laboratory and clinical
variables, improves the ability to predict death and cardiac transplant in
adult Fontan patients.

<20>
Accession Number
617289244
Author
Goldstone A.B.; Chiu P.; Baiocchi M.; Ligala B.; Boyd J.; Joseph Woo Y.
Institution
(Goldstone, Chiu, Baiocchi, Ligala, Boyd, Joseph Woo) Stanford University,
Stanford, CA, United States
Title
Effectiveness of a second arterial conduit for multi vessel coronary
bypass: A state-wide analysis of 60,897 patients.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 26), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Whether a second arterial conduit improves outcomes after
multi vessel coronary artery bypass grafting (CABG) remains unclear, and
some believe equipoise exists. Consequently, arterial conduits other than
the left internal mammary artery are seldom used in the United States.
Methods: We compared propensity score matched cohorts who underwent
primary, isolated multi vessel CABG at 127 hospitals in California between
2006 and 2011 with an internal mammary artery (IMA), and who either: A)
received an additional IMA or radial artery as a second conduit (N=5,988);
or B) received veins for remaining conduits (N=54,909). The primary
outcome was all-cause mortality; secondary outcomes included the competing
risks of repeat revascularization, myocardial infarction, and stroke.
Follow-up ended December 31, 2013. We also compared outcomes of recipients
of a second IMA (N=1,607) with matched recipients of a radial artery
(N=4,381) as a second conduit. Results: Second arterial conduit use
decreased from 10.9% in 2006 to 9.1% in 2011 (P<0.001). However, receipt
of a second arterial conduit signifcantly improved survival (HR 0.81, 95%
CI 0.74-0.89, P<0.001) and freedom from major adverse cardiovascular
events (HR 0.81, 95% CI 0.76-0.85, P<0.001) over the 8-year study period.
A second arterial conduit reduced the cumulative incidence of the
competing risks of repeat revascularization (HR 0.81, 95% CI 0.75-0.87,
P<0.001) and myocardial infarction (HR 0.80, 95% CI 0.72-0.89, P<0.001),
but not stroke. The age above which patients no longer beneftted from a
second arterial conduit was 73 years. In a comparison of arterial
conduits, overall survival (P=0.83) and freedom from major adverse
cardiovascular events (P=0.43) were equivalent between recipients of a
second IMA or a radial artery. Conclusions: The use of a second arterial
conduit in patients undergoing multi vessel CABG at a mix of community and
academic practices was associated with improved survival and lower risks
of repeat revascularization and myocardial infarction. This beneft may
extend to those >70 years old. The equipoise between venous and arterial
conduits as secondary grafts for CABG should be reconsidered.

<21>
Accession Number
617289176
Author
Erickson L.; Reid K.; Ricketts A.; Beaven B.; Goudar S.; Lay A.; Stroup
R.; O'Brien J.; Shirali G.
Institution
(Erickson, Reid, Ricketts, Beaven, Goudar, Lay, Stroup, O'Brien, Shirali)
Children's Mercy Kansas City, Kansas City, MO, United States
Title
Interstage resource utilization of infants with single ventricle: Results
of a crossover study.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 628), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Since 2014, we have monitored interstage infants with single
ventricle (SV) at home with CHAMP, a tablet PC with cloud-based instant
analytic algorithms. This study identifes predictors of high resource
utilization (HRU) readmissions. Methods: From 5/14 to 6/15, SV infants
were enrolled in a crossover study comparing traditional binder to CHAMP.
All were discharged with the binder; they were randomized to receive CHAMP
instead of binder 1 or 2 months after discharge. One month after
randomization, caregivers chose either binder or CHAMP for the remainder
of the interstage. Charts were reviewed for neonatal characteristics,
readmission data including events prior to readmission, length of stay
(LOS), ICU LOS and charges. High resource utilization (HRU) were defned as
the 25% of readmissions that were associated with the greatest ICU LOS,
and were compared to all others (Low resource utilization (LRU)). Results:
31 infants were monitored for 4911 interstage days. There were no
interstage deaths and 73 readmissions. HRU did not differ from LRU in
neonatal characteristics (Table). HRU were signifcantly more likely to be
unplanned, at a younger age, and associated with a longer delay from
clinical change to readmission. HRU had higher charges, LOS, and more
cardiac and general surgeries. Conclusions: Interstage SV infants are at
high risk for readmissions. Delays in care are associated with HRU; CHAMP
may help decrease delays. This study may provide the basis for predictive
analytic algorithms.

<22>
Accession Number
617289132
Author
Genereux P.; Serruys P.; Kappetein A.; Van Boven A.; Hickey M.; Kandzari
D.; Schampaert E.; Horkay F.; Ungi I.; Mansour S.; Pocock S.; Banning A.;
Taggart D.; Sabate M.; Gershlick A.; Boonstra P.; Lembo N.; Puskas J.;
Kosmidou I.; Morris Brown W.; Mehran R.; Ben-Yehuda O.; Simonton C.; Sabik
J.; Stone G.
Institution
(Genereux, Serruys, Kappetein, Van Boven, Hickey, Kandzari, Schampaert,
Horkay, Ungi, Mansour, Pocock, Banning, Taggart, Sabate, Gershlick,
Boonstra, Lembo, Puskas, Kosmidou, Morris Brown, Mehran, Ben-Yehuda,
Simonton, Sabik, Stone) Cardiovascular Research Foundation, New York, NY,
USA, Columbia University Medical Center, New York, N Y, USA
Title
Outcomes of pci versus cabg in left main disease according to syntax score
by site versus angiographic core laboratory assessment: Insights from the
excel trial.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 972), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Outcomes of revascularization with PCI vs. CABG in patients
with coronary artery disease (CAD) are dependent on the anatomic SYNTAX
score, a measure of CAD complexity. PCI is currently only recommended for
patients with a low or intermediate SYNTAX score (<=32), data generated
from angiographic core laboratory (ACL) assessment. However, sites tend to
under-estimate the SYNTAX score compared to ACL measures; the implications
of this on patient outcomes are unknown. Methods: In the Evaluation of
XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left
Main Revascularization (EXCEL) trial, 1905 patients with left main
coronary artery disease (LMCAD) and SYNTAX score <=32 based on site
assessment were randomized to CABG (n=957) vs. PCI with fuoropolymer-based
cobalt-chromium everolimus-eluting stents (n=948). The primary endpoint
was the 3-year composite rate of death, stroke or myocardial infarction
(MI), powered for noninferiority testing. Major secondary outcomes
included this endpoint at 30 days, and the composite rate of death,
stroke, MI or ischemia-driven revascularization at 3 years. The local
Heart Team consisting of an interventional cardiologist and cardiac
surgeon computed study eligibility SYNTAX scores. Qualifying baseline
angiograms were also analyzed at an independent ACL. Results: The median
SYNTAX score was higher by ACL read than by site assessment (mean 26.5 +/-
9.3 vs. 20.6 +/- 6.2, P<0.0001). By site assessment the SYNTAX score was
low (<=22) in 60.5% of patients and intermediate (23-32) in 39.5% of
patients. By ACL analysis the SYNTAX score was low, intermediate and high
(>=33) in 35.8%, 40.0% and 24.2% of patients respectively. Conclusions:
The EXCEL trial intended to enroll patients with LMCAD and low to
intermediate SYNTAX scores. However, by ACL analysis, ~25% of patients had
a high SYNTAX score. At ACC 2017 the reasons for this discrepancy will be
described, and the primary and secondary outcome measures in patients
randomized to PCI vs. CABG will be reported stratifed by site SYNTAX
score, ACL SYNTAX score using original tertiles, and by true EXCEL
population tertiles (results currently under embargo).

<23>
Accession Number
617289104
Author
O'Byrne M.L.; Kim S.; Hornik C.; Yerokun B.; Matsouaka R.; Jacobs J.;
Jacobs M.; Jonas R.
Institution
(O'Byrne, Kim, Hornik, Yerokun, Matsouaka, Jacobs, Jacobs, Jonas)
Children's National Medical Center, Washington, DC, USA, Duke University
School of Medicine, Durham, NC, USA
Title
Effect of obesity and underweight status on perioperative outcomes in
patients with congenital heart disease: An analysis of data from the
society of thoracic surgeons congenital heart surgery database.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 574), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Obesity is increasingly prevalent in the congenital heart
disease population. The effect of obesity and body-mass index (BMI) on
perioperative outcomes has not been evaluated. We sought to study the
association between BMI and perioperative outcomes following congenital
heart operations in children and young adults. Methods: A multicenter
retrospective cohort study was performed using data from the Society of
Thoracic Surgeons Congenital Heart Surgery Database of children and young
adults between 10-35 years undergoing any cardiac operation from 1/2010 to
12/2015. The primary exposure was BMI percentile, adjusted for age and
sex. The primary outcomes were operative mortality and composite outcome
(operative mortality, major complications, post-operative hospital length
of stay >14 days, and wound infection/dehiscence). The association between
BMI percentile and primary outcomes was assessed using multivariate mixed
effects models adjusting for demographic, preoperative and operative
factors including STS-EACTS Mortality Category. Results: Of 18,337
subjects undergoing index operations at 118 centers, 16% were obese (BMI
percentile>95%), 15% overweight (85-95%), 53% normal weight (15-85%), 7%
underweight (5-15%), and 9% were severely underweight (5^th
percentile). The observed risks of operative mortality (p=0.04) and
composite outcome (p<0.0001) were higher in severely underweight and obese
subjects than in normal weight subjects. Risk of unplanned cardiac
operation and reoperation for bleeding was higher with severely
underweight BMI. Risk of wound infection/dehiscence was higher in obese
subjects. In multivariate analysis, the association between BMI and
operative mortality was not signifcant. Obese (OR: 1.21, 95% CI:
1.05-1.39), underweight (OR: 1.33, 95% CI: 1.11-1.60), and severely
underweight subjects (OR: 1.53, 95% CI: 1.31-1.79) were at increased risk
of the composite outcome. Conclusions: Obese and underweight BMI were
associated with increased risk of composite adverse outcome independent of
other risk factors. Further research is necessary to determine whether BMI
represents a modifable risk factor for perioperative outcome.

<24>
Accession Number
617289008
Author
Pieter Kappetein A.; Milojevic M.; Serruys P.; Sabik J.; Head S.; Kandzari
D.; Schampaert E.; Taggart D.; Horkay F.; Laszlo K.I.; Mansour S.; Banning
A.; Sabate M.; Bochenek A.; Pomar J.; Lembo N.; Noiseux N.; Puskas J.;
Kosmidou I.; Mehran R.; Ben-Yehuda O.; Genereux P.; Simonton C.; Pocock
S.; Stone G.
Institution
(Pieter Kappetein, Milojevic, Serruys, Sabik, Head, Kandzari, Schampaert,
Taggart, Horkay, Laszlo, Mansour, Banning, Sabate, Bochenek, Pomar, Lembo,
Noiseux, Puskas, Kosmidou, Mehran, Ben-Yehuda, Genereux, Simonton, Pocock,
Stone) Erasmus MC, Rotterdam, Netherlands
Title
Treatment of left main coronary artery disease in patients with diabetes:
3-Year outcomes comparing cabg and PCI with everolimus-eluting stents from
the excel study.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 967), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: The optimal revascularization strategy in diabetic pts and
left main coronary artery disease (LMCAD) is unclear. We therefore
examined the effect of diabetes in pts with LMCAD randomized to
percutaneous coronary intervention (PCI) or coronary artery bypass surgery
(CABG) in the large-scale, international EXCEL trial. Methods: Pts
(N=1905) with LMCAD with SYNTAX score <=32 were randomized to receive
either PCI with everolimus-eluting stents or CABG. Randomization was
stratifed by diabetes, SYNTAX score, and center. The primary endpoint was
the 3-year composite rate of death, stroke or myocardial infarction (MI),
powered for noninferiority testing (margin 4.2%). Major secondary outcomes
included this endpoint at 30 days, and the composite rate of death,
stroke, MI or ischemia-driven revascularization at 3 years. Outcomes were
examined in subgroups with (N=554; 29.1%) and without (N=1351; 70.9%)
diabetes Results: Among the 554 diabetic pts, 286 (30.2%) were randomized
to PCI and 268 (28.0%) were randomized to CABG; 73 (7.7%) and 74 (7.7%) in
the PCI and CABG groups respectively were insulin-treated. The PCI and
CABG groups in the diabetes and non-diabetes cohorts were well-matched for
baseline characteristics. Three-year outcomes of pts with diabetes will be
available at the time of the presentation and will be compared to those
without diabetes, in all pts and per insulin-treatment and baseline SYNTAX
score. Conclusions: PCI is a potential treatment option for selected pts
with LMCAD, although diabetic pts often have more diffuse disease, smaller
vessels and other comorbidities that increase revascularization risk. This
pre-specifed analysis from the EXCEL trial will provide a treatment
algorithm for physicians to gauge clinical outcomes in this high-risk
cohort based on baseline characteristics, diabetes severity, and anatomic
complexity, enabling selection of the safest and most effective
revascularization option for each pt.

<25>
Accession Number
617288990
Author
Zhu S.; Zhang M.; Ni Q.; Sun Q.; Xuan J.
Institution
(Zhu, Zhang, Ni, Sun, Xuan) Sun Yat-Sen University, Guangzhou, China
Title
Hospitalization expenditure by New York Heart Association (NYHA)
classification in Heart Failure (HF) patients in China.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 718), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Heart failure patients are frequently hospitalized, leading to
signifcant treatment burden. The study aims to examine the treatment cost
of HF hospitalization by NYHA class to provide real-world data in
understanding the economic burden of HF inpatient care in China. Methods:
This is a multicenter chart review study with patient samples collected
from the cardiology/cardiac surgery departments of 8 hospitals in four
major cities in China. Adult patients with primary diagnosis of heart
failure, NYHA classifcation and >=1 hospitalization record from March
3^rd 2015 to May 24^th 2016 were included. Total
hospitalization expenditure by NYHA classifcation, length of stay (LOS),
and comorbidity condition were examined. Patients underwent surgeries
during hospitalization were analyzed in subgroup. Results: A total of 363
HF patients met the study criteria (mean age 69.65+/-13.28; 53.74% male).
27.30%, 19.25%, and 53.45% of patients were diagnosed as HF with reduced
ejection fraction (HFrEF), HF with mid-range ejection fraction (HFmrEF),
and HF with preserved ejection fraction (HFpEF) respectively. The average
expenditure per HF hospitalization was 39,064CNY, and was increased by
NYHA classifcation at 6,943CNY, 26,097CNY, 45,079CNY, 48,800CNY,
47,531CNY, 42,489CNY with NYHA I, II, II-III, III,III-IV and IV
respectively (ANOVA test: P<0.050). 25.34% of patients underwent surgeries
with average total hospitalization expenditure up to 102,268CNY. The mean
LOS was 14.07 days. 71.35% of patients had more than three comorbidities,
of which hypertension, coronary heart disease, and lung disease were most
prevalent. Conclusions: The mean cost per HF hospitalization much higher
than the average disposable annual income per capita in China in 2015
(21,966CNY) and is increased by NYHA class, imposing signifcant economic
burden to HF patients. Moreover, surgery is one major driver of the high
hospitalization expenditure. This study highlights the critical need to
introduce innovative therapy that effectively reduces hospitalization and
prevents worsening of symptoms for HF patients in China.

<26>
Accession Number
617288922
Author
Bytyci I.; Bajraktari G.; Bhatt D.L.; Morgan C.J.; Ahmed A.; Aronow W.S.;
Banach M.
Institution
(Bytyci, Bajraktari, Bhatt, Morgan, Ahmed, Aronow, Banach) Clinic of
Cardiology, Prishtina, Albania, Medical University of Lodz, Lodz, Poland
Title
Hydrophilic versus lipophilic statins in coronary artery disease
undergoing percutaneous coronary intervention: A meta-analysis of
randomized controlled trials.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 161), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Hydrophilic statins may be more benefcial than lipophilic
statins in patients with acute ischemia undergoing percutaneous coronary
intervention (PCI). In the current meta-analysis we examined the effect of
lipophilic in comparison with hydrophilic statins in patients with acute
coronary syndrome (ACS) and undergoing PCI. Methods: We systematically
searched selected electronic databases up to July 2016 in order to
identify randomized controlled trials (RCTs) which compared clinical
outcomes of hydrophilic vs. lipophilic statins in ACS patients. Primary
outcomes were major adverse cardiac events (MACE), myocardial infarction
(MI), cardiac revascularization, stroke, cardiovascular (CV)
hospitalization, cardiovascular (CV) and all-cause of mortality. Results:
A total of 8708 patients from 8 RCTs had been randomized to receive
lipophilic (n=4277) or hydrophilic statins (n=4431), with mean follow-up
12.4 months, and were included to the meta-analysis. In comparison to
hydrophilic statins, the lipophilic statins showed comparable risk
reduction of MACE (relative risk [RR]=1.05, 95% CI, 0.88 to 1.25, p=0.591;
Figure). Similar effects were observed on MI and CV death (Figure) and
other outcomes. Conclusions: We found no evidence of differential effect
on MACE or other outcomes between lipophilic and hydrophilic statins in
patients with ACS undergoing PCI.

<27>
Accession Number
617288915
Author
Pokorney S.; Granger C.; Anstrom K.; Kline-Rogers E.; Alberts M.;
Naccarelli G.; Berger P.; House J.A.; Vijapurkar U.; Davidson J.; Shah B.;
Hylek E.
Institution
(Pokorney, Granger, Anstrom, Kline-Rogers, Alberts, Naccarelli, Berger,
House, Vijapurkar, Davidson, Shah, Hylek) Duke University Medical Center,
Durham, NC, United States
Title
Rates of oral anticoagulant use, while improving over time, remain low
among hospitalized patients with atrial fibrillation.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 363), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Oral anticoagulant (OAC) under-treatment for stroke prevention
in atrial fbrillation (AF) has been demonstrated. Limited data are
available on treatment trends treatment over time, as non-vitamin K
antagonists (NOACs) were introduced. Methods: Included patients from the
Premier Health Database (representing 1 in 5 US discharges) were age >= 40
years, admitted January 2011 to June 2015 with a primary or secondary AF
diagnosis, CHA<inf>2</inf>DS<inf>2</inf>-VASc score >2, and length of stay
>1 day. Those with a mechanical heart valve, any bleed, major surgery
during admission; left against medical advice, hospice, transfer to
another acute care facility; or died in-hospital were excluded. The
primary measure, assessed quarterly, was OAC use at discharge, defned as
OAC the day before or day of discharge. Results: Among 1,579,456
admissions in 812 US hospitals, OAC use at discharge increased by 2% per
year from 42% in 2011 to 50% in 2015, with an increase in NOAC (3% in 2011
to 25% in 2015) and a decrease in warfarin use (Figure). Aspirin with OAC
increased from 12% in 2011 to 15% in 2015, while triple therapy remained
unchanged (6% in 2011 and 5% in 2015). Median age was 78 (IQR 69-85)
years, 53% female, and median CHA<inf>2</inf>DS<inf>2</inf>-VASc score was
4 (IQR 3-5). Conclusions: The proportion of AF patients treated with OAC
for stroke prevention increased by 2% per year from 2011 to 2015, however,
only 1 in 2 AF patients at risk for stroke were treated with OAC as of
2015. Initiatives to increase guideline directed stroke prevention in AF
are needed.

<28>
Accession Number
617288877
Author
Parikh V.; Lavu M.; Vuddanda V.L.K.; Jazayeri M.; Reddy V.; Yarlagadda B.;
Korra H.; Venkata R.; Bommana S.; Atkins D.; Reddy M.; Lakkireddy D.
Institution
(Parikh, Lavu, Vuddanda, Jazayeri, Reddy, Yarlagadda, Korra, Venkata,
Bommana, Atkins, Reddy, Lakkireddy) University of Kansas Hospital, Kansas
City, KS, United States
Title
Peri-procedural use of novel oral anticoagulation agents during cardiac
device implantation: Are they safe?.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 309), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Safety of peri-procedural use of novel oral anticoagulation
agents (NOACs) during cardiac device implantation has been suggested in
small observational studies. Larger data affrming its safety is lacking.
Methods: We performed a multicenter evaluation of safety of uninterrupted
anticoagulation with NOACs during cardiac device implantation procedures.
965 consecutive patients from 3 centers were included in the study.
Baseline demographics and complication rates were collected. Results: 553
(57%) patients were on warfarin and 412 (43%) patients were on NOACs. Out
of these, 511 (53%) had new device implantation, 285 (29.5%) had generator
change and 169 (17.6%) had device upgrade. Mean INR in warfarin group was
2.07 +/- 0.76. NOAC group included 93 (22.6 %) patients on dabigatran, 198
(48.2 %) patients on rivaroxaban, 119 (28.9%) patients on apixaban and 1
(0.2%) patient was on edoxaban. NOACs were continued un-interrupted in
majority and resumed within 24 hours of the procedure. There were no
signifcant differences in the total bleeding (5.1 % vs 6.6%; p=0..33) or
non-minor bleeding (2.3% vs 2.4%; p=0.79) rates between both the groups.
Results were consistent after adjusting for other variables using
multivariate logistic regression analysis. There were no thromboembolic
events or deaths in any of the groups. Conclusions: Peri-procedural use of
novel oral anticoagulation agents during cardiac device implantation
appears to be safe.

<29>
Accession Number
617288835
Author
Pepe M.; Masi F.; Signore N.; Bortone A.S.; Cecere A.; Tito A.; Zanna D.;
Quagliara D.; Favale S.
Institution
(Pepe, Masi, Signore, Bortone, Cecere, Tito, Zanna, Quagliara, Favale)
Cardiovascular Diseases Section, Department of Emergency & Organ
Transplantation, University of Bari, Bari, Italy, Institute of Cardiac
Surgery, University of Bari, Bari, Italy
Title
Time related benefit of antiplatelet therapy on coronary reperfusion in
ST-Elevation Myocardial Infarction (STEMI) patients.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 257), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: The goal of STEMI treatment is early reperfusion. The new oral
P2Y<inf>12</inf> inhibitors (P2Y<inf>12</inf>-I) prasugrel and ticagrelor
demonstrated to improve angiographic results of primary percutaneous
coronary intervention (pPCI) and clinical prognosis, but their onset of
action is signifcantly impaired in STEMI patients. Aim of our
observational study was to establish if the beneft of the
P2Y<inf>12</inf>-I loading dose (LD) administration is time related.
Methods: A total of 250 consecutive patients with STEMI (81.3% males,
65.5+/-12.5 years old, 33.5% diabetics) addressed to pPCI were enrolled.
Cardiogenic shock was an exclusion criterion. We divided our population
into three groups depending of the time interval from "P2Y<inf>12</inf>-I
LD administration to balloon": the frst group included patients receiving
P2Y<inf>12</inf>-I LD at least 60 minutes before pPCI, the second group
within the 60 minutes before pPCI, the third group at the moment of pPCI
after angiography. Two skilled interventional cardiologists evaluated the
TIMI fow grade (TFG) of the culprit artery in the frst angiogram
immediately prior to PCI and post pPCI in a double blinded fashion.
Results: Pre-pPCI TFG decreased throughout the groups proportionally to
the increasing "P2Y<inf>12</inf>-I LD administration to balloon" time; we
found the following rates of pre-pPCI TFG 0/1: 51.3% in the frst group,
62.1% in the second group, 83.2% in the third group (p< 0.001). Moreover
post-pPCI TFG was signifcantly different in the three groups (p<0.001): it
improved throughout the groups proportionally to the increasing "
P2Y<inf>12</inf>-I LD administration to balloon" time with the following
rates: 97.4% in the frst group, 88.4% in the second group, 82.2% in the
third Group. Conclusions: Despite rapid initiation is recommended,
absorption and effectiveness of P2Y<inf>12</inf>-I is known to be impaired
in STEMI patients. Our observational study is the frst evidence of a
progressive time-related angiographic beneft of P2Y<inf>12</inf>-I LD
administration: a longer time window between P2Y<inf>12</inf>-I
administration and pPCI signifcantly improves coronary reperfusion in
terms of both pre and post pPCI TFG; this fnding supports the relevance of
P2Y<inf>12</inf>-I LD administration as soon as possible at frst medical
contact.

<30>
Accession Number
617288818
Author
Ogunbayo G.; Olorunfemi O.; Elbadawi A.; Saheed D.; Guglin M.
Institution
(Ogunbayo, Olorunfemi, Elbadawi, Saheed, Guglin) University of Kentucky,
Lexington, KY, USA, Rochester General Hospital, Rochester, NY, USA
Title
Outcomes of intra-aortic balloon pump use in myocarditis complicated by
cardiogenic shock.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 860), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Temporary mechanical support may be necessary in patients with
myocarditis. Our study describes the outcomes of intra-aortic balloon pump
(IABP) use in patients with myocarditis complicated with cardiogenic
shock. Methods: We identifed patients with cardiogenic shock and a primary
diagnosis of myocarditis using ICD-9 codes in the National Inpatient
Sample Database. We compared outcomes in the patients who received IABP
and in those who did not. We also compared the effects of early (within 24
hours of admission) versus late (after 24 hours) IABP use on mortality,
length of stay and treatment cost. We performed logistic regression
analysis with mortality as the primary outcome. Results: We identifed
7,972 patients with primary diagnosis of myocarditis, 427 (5.4%) of whom
developed cardiogenic shock. Of these, 187 (42.8%) received an IABP. Both
groups (IABP and no IABP) were not different in terms of common
comorbidities (old myocardial infarction, chronic Ischemic heart disease,
congestive heart failure, diabetes mellitus and hypertension]. There was
signifcantly less incidence of stroke (1.1% vs. 5.0% p=.028), use of other
ventricular assist devices (11.2 vs. 20.8 p=.008) and occurrence of heart
transplant (0.5% vs. 4.2% p=.027) in the IABP group. Patients that died in
the IABP arm had more ventricular tachycardia (p= .047) and ventricular
fbrillation (p= .043). Overall, mortality did not signifcantly differ in
patients on IABP support versus no IABP (25.5 vs. 21.5; p=.334). However
there was signifcantly less mortality in this cohort when the IABP was
deployed within 24 hours of admission than after 24 hours (23.8% vs. 35.2%
p=.032). After adjusting for age, sex, race and comorbidities, this beneft
of early IABP use remained signifcant (OR= .57; 95%CI .34-.98; p value=
.041). Conclusions: The use of IABP in patients with cardiogenic shock is
fairly common. The early use of this device (within the frst 24 hours of
presentation) appears to offer a mortality beneft. This fnding needs to be
confrmed in randomized clinical trials.

<31>
Accession Number
617288801
Author
Kirolos I.; Derbal O.; Gadde R.; Yakoub D.; Alfonso C.; Chaparro S.;
Salerno T.; Cohen M.
Institution
(Kirolos, Derbal, Gadde, Yakoub, Alfonso, Chaparro, Salerno, Cohen)
University of Miami, Miami, FL, United States
Title
Perioperative administration of amiodarone or beta blockers in cardiac
surgery: Which is more effective in reducing postoperative atrial
fibrillation?.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 459), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Optimum prophylaxis for post-operative atrial fbrillation (AF)
in cardiac surgery patients is controversial. We aimed to compare the
utility of amiodarone (A) versus beta blockers (BB) in decreasing the
postoperative incidence of AF. Methods: Online search of PubMed, MEDLINE,
EMBASE, SCOPUS, COCHRANE, and GOOGLE SCHOLAR databases was performed (1988
- Present); key bibliographies were reviewed. Studies comparing use of
perioperative A to BB in cardiac surgery patients were included. Relative
risks with the corresponding 95% confdence intervals (CI) by random and
fxed effects models of pooled data were calculated. Study quality was
assessed using STROBE criteria. The primary outcome was postoperative
incidence of AF. Secondary outcomes included onset, duration of AF and
ventricular response rate (VRR). Results: Search strategy yielded 136
studies, 8 randomized controlled trials met our selection criteria. A
total of 1457 patients underwent either coronary artery bypass graft (n=
1397), valvular surgery (n=24) or both (n=36). There was no signifcant
difference between the two groups in age, sex, smoking status, number of
cardiac vessels involved or co-morbities. Median age was 62 yrs. M/F ratio
was 2.6/1. 722 patients received peri-operative A and 735 patients
received BB mostly metoprolol. Metaanalysis of included data showed
signifcantly less incidence of AF in the A group (RR 0.75; 95%
CI:0.58-0.97, p=0.029). The onset of AF was delayed in the BB group (SMD
0.43; CI:0.08-0.76, p=0.014). There was no signifcant difference between
the groups in duration of AF (SMD -0.28; 95% CI:-1.01 to 0.46, p=0.45) or
VRR (SMD 0.58; 95% CI:-0.51-1.68, p=0.29). Conclusions: Peri-operative use
of amiodarone in cardiac surgery patients is associated with lower yet
earlier incidence of AF compared to BB. Randomized clinical trials are
needed to validate this fnding and further investigate independent risk
factors associated with postoperative AF.

<32>
Accession Number
617288783
Author
Martin M.H.; Meadows J.; Goldstein B.; Bergersen L.; Qureshi A.;
Shahanavaz S.; Aboulhosn J.; Berman D.; Peng L.; Gillespie M.; Armstrong
A.; Weng C.; Gray R.
Institution
(Martin, Meadows, Goldstein, Bergersen, Qureshi, Shahanavaz, Aboulhosn,
Berman, Peng, Gillespie, Armstrong, Weng, Gray) University of Utah, Salt
Lake City, UT, USA, Primary Children's Hospital, Salt Lake City, UT, USA
Title
Safety and feasibility of melody transcatheter pulmonary valve replacement
in the native right ventricular outflow tract: A multicenter study.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 558), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Melody Transcatheter Pulmonary Valve Replacement (TPVR) is FDA
approved within right ventricular to pulmonary artery (RV-PA) conduits;
however, >80% of patients needing pulmonary valve replacement do not have
a conduit. Therefore, Melody TPVR has been adopted clinically to treat
native (non-conduit) right ventricular outfow tracts (nRVOT). Safety,
feasibility and factors associated with successful nRVOT TPVR have not
been studied. Methods: This is a multicenter, retrospective review of all
patients presenting for nRVOT TPVR. Pre-procedural imaging (MRI and echo)
and cath data were collected. Results: Of 229 patients (mean age 21 years,
range 4-67) from 11 centers, 132 (58%) had successful TPVR. The remaining
97 (42%) did not receive TPVR due to large nRVOT (n=67), aortic root or
coronary compression (n=18) and not clinically indicated (n=12). There
were no deaths and 5 (2%) serious complications: stent embolization
requiring surgery (4) and arrhythmia requiring cardioversion (1). Factors
associated with successful TPVR included higher TPVR volume center,
pre-cath pulmonary stenosis, and no prior transannular patch. Pre-cath MRI
measurements were signifcantly different in the implanted vs.
not-implanted groups (Table). Conclusions: TPVR in the nRVOT is safe,
however, nearly half the patients are found not to be candidates, mainly
due to large RVOT size. Improved understanding and use of MRI data as well
as availability of larger devices may improve success rates for nRVOT
TPVR.

<33>
Accession Number
617288738
Author
Brunetti M.; Retzloff L.B.; Lehrich J.L.; William Gaynor J.; Pasquali S.;
Bailly D.; Davis S.; Klugman D.; Koch J.; Lasa J.; Gaies M.
Institution
(Brunetti, Retzloff, Lehrich, William Gaynor, Pasquali, Bailly, Davis,
Klugman, Koch, Lasa, Gaies) Children's Hospital of Philadelphia,
Philadelphia, PA, USA, University of Michigan, Ann Arbor, MI, USA
Title
Characteristics, risk factors & outcomes of extracorporeal membrane
oxygenation use in the pediatric cardiac intensive care unit.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 556), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Extracorporeal Membrane Oxygenation (ECMO) is used to support
pediatric patients with medical and surgical cardiac disease. We aimed to
characterize ECMO use across a multicenter cohort. Methods: Retrospective
analysis of the Pediatric Cardiac Critical Care Consortium
(PC⁴) clinical registry was performed to describe ECMO
frequency and outcomes. Within strata of medical and surgical
hospitalizations, we identifed risk factors associated with ECMO use
through multivariate logistic regression. Results: Across 23 hospitals,
there were 14,526 eligible hospitalizations from 8/1/14-6/30/16, of which
449 (3.1%) included at least 1 ECMO course. ECMO was used in 120 (2.4%)
medical and 329 (3.5%) surgical hospitalizations. Low cardiac output was
the most common ECMO indication in both groups. Extracorporeal
cardiopulmonary resuscitation (E-CPR) was used in 42% of medical and 32%
of surgical ECMO courses. Risk factors associated with ECMO use in the
medical group included acute heart failure and higher vasoactive inotropic
score at admission (both p<0.0001). Stroke (15%) and renal failure (15%)
were the most common ECMO complications in the medical group. Risk factors
associated with post-operative ECMO use in the surgical group included
younger age, extra-cardiac anomalies, pre-operative morbidity, higher STAT
category, bypass time, and early post-operative mechanical ventilation and
arrhythmias (within 2 hours) (all p<0.05). Bleeding requiring re-operation
(25%) was the most common ECMO complication in the surgical group.
Hospital mortality was 63% in the medical group and 50% in the surgical
group with E-CPR mortality rates of 83% and 50%, respectively.
Conclusions: This is the frst multicenter study describing contemporary
ECMO use and outcomes in pediatric CICU patients with all forms of cardiac
disease. ECMO is a rare therapy, yet mortality remains high, highlighting
the importance of identifying levers to improve care. We identifed unique
high-risk subgroups to target for quality initiatives within medical and
surgical patients.

<34>
Accession Number
617958099
Author
Kelly S.A.M.; Hartley L.; Loveman E.; Colquitt J.L.; Jones H.M.;
Al-Khudairy L.; Clar C.; Germano R.; Lunn H.R.; Frost G.; Rees K.
Institution
(Kelly) University of Cambridge, Institute of Public Health, School of
Clinical Medicine, Forvie Site, Box 113 Cambridge Biomedical Campus,
Cambridge CB2 0SR, United Kingdom
(Hartley) RTI Health Solutions, Manchester M20 2LS, United Kingdom
(Loveman, Colquitt) Effective Evidence LLP, 26 The Curve, Waterlooville,
Hampshire PO8 9SE, United Kingdom
(Jones, Al-Khudairy, Lunn, Rees) Warwick Medical School, University of
Warwick, Division of Health Sciences, Coventry, United Kingdom
(Clar) Freelance, Hasenheide 67, Berlin 10967, Germany
(Germano) University of Naples Federico II, Division of Nutrition,
Department of Clinical Medicine and Surgery, Naples, Italy
(Frost) Hammersmith Hospital, Department of Nutrition and Dietetics,
Duncane Road, London W12 0HS, United Kingdom
Title
Whole grain cereals for the primary or secondary prevention of
cardiovascular disease.
Source
Cochrane Database of Systematic Reviews. 2017 (8) (no pagination), 2017.
Article Number: CD005051. Date of Publication: 24 Aug 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: There is evidence from observational studies that whole grains
can have a beneficial effect on risk for cardiovascular disease (CVD).
Earlier versions of this review found mainly short-term intervention
studies. There are now longer-term randomised controlled trials (RCTs)
available. This is an update and expansion of the original review
conducted in 2007. Objectives: The aim of this systematic review was to
assess the effect of whole grain foods or diets on total mortality,
cardiovascular events, and cardiovascular risk factors (blood lipids,
blood pressure) in healthy people or people who have established
cardiovascular disease or related risk factors, using all eligible RCTs.
Search methods: We searched CENTRAL (Issue 8, 2016) in the Cochrane
Library, MEDLINE (1946 to 31 August 2016), Embase (1980 to week 35 2016),
and CINAHL Plus (1937 to 31 August 2016) on 31 August 2016. We also
searched ClinicalTrials.gov on 5 July 2017 and the World Health
Organization International Clinical Trials Registry Platform (WHO ICTRP)
on 6 July 2017. We checked reference lists of relevant articles and
applied no language restrictions. Selection criteria: We selected RCTs
assessing the effects of whole grain foods or diets containing whole
grains compared to foods or diets with a similar composition, over a
minimum of 12 weeks, on cardiovascular disease and related risk factors.
Eligible for inclusion were healthy adults, those at increased risk of
CVD, or those previously diagnosed with CVD. Data collection and analysis:
Two review authors independently selected studies. Data were extracted and
quality-checked by one review author and checked by a second review
author. A second review author checked the analyses. We assessed treatment
effect using mean difference in a fixed-effect model and heterogeneity
using the I² statistic and the Chi² test of
heterogeneity. We assessed the overall quality of evidence using GRADE
with GRADEpro software. Main results: We included nine RCTs randomising a
total of 1414 participants (age range 24 to 70; mean age 45 to 59, where
reported) to whole grain versus lower whole grain or refined grain control
groups. We found no studies that reported the effect of whole grain diets
on total cardiovascular mortality or cardiovascular events (total
myocardial infarction, unstable angina, coronary artery bypass graft
surgery, percutaneous transluminal coronary angioplasty, total stroke).
All included studies reported the effect of whole grain diets on risk
factors for cardiovascular disease including blood lipids and blood
pressure. All studies were in primary prevention populations and had an
unclear or high risk of bias, and no studies had an intervention duration
greater than 16 weeks. Overall, we found no difference between whole grain
and control groups for total cholesterol (mean difference 0.07, 95%
confidence interval -0.07 to 0.21; 6 studies (7 comparisons); 722
participants; low-quality evidence). Using GRADE, we assessed the overall
quality of the available evidence on cholesterol as low. Four studies were
funded by independent national and government funding bodies, while the
remaining studies reported funding or partial funding by organisations
with commercial interests in cereals. Authors' conclusions: There is
insufficient evidence from RCTs of an effect of whole grain diets on
cardiovascular outcomes or on major CVD risk factors such as blood lipids
and blood pressure. Trials were at unclear or high risk of bias with small
sample sizes and relatively short-term interventions, and the overall
quality of the evidence was low. There is a need for well-designed,
adequately powered RCTs with longer durations assessing cardiovascular
events as well as cardiovascular risk factors.<br/>Copyright &#xa9; 2017
The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

<35>
Accession Number
612793078
Author
Cho Y.J.; Bae J.; Kim T.K.; Hong D.M.; Seo J.-H.; Bahk J.-H.; Jeon Y.
Institution
(Cho, Bae, Kim, Hong, Seo, Bahk, Jeon) Department of Anesthesiology and
Pain Medicine, Seoul National University Hospital, 101 Daehak-ro,
Jongno-gu, Seoul 03080, South Korea
Title
Microcirculation measured by vascular occlusion test during
desflurane-remifentanil anesthesia is superior to that in
propofol-remifentanil anesthesia in patients undergoing thoracic surgery:
subgroup analysis of a prospective randomized study.
Source
Journal of Clinical Monitoring and Computing. 31 (5) (pp 989-997), 2017.
Date of Publication: 01 Oct 2017.
Publisher
Springer Netherlands
Abstract
General anesthesia can affect microcirculatory properties. However,
differential effects on the microcirculation according to the anesthetic
technique used during thoracoscopic surgery have not been well documented.
We conducted a randomized clinical trial in which the effects of
desflurane and propofol, both with remifentanil, on systemic arterial
oxygenation during one-lung ventilation were compared in patients
undergoing thoracoscopic surgery. As a subgroup analysis, we compared the
effects of two commonly used anesthetic techniques,
desflurane-remifentanil (n = 52) and propofol-remifentanil (n = 48), on
tissue oxygen saturation using a vascular occlusion test in patients
undergoing thoracoscopic surgery. Tissue oxygen saturation was higher in
the desflurane than the propofol group (mean +/- standard deviation, 83
+/- 6 vs. 80 +/- 9, 84 +/- 6 vs. 76 +/- 10, and 87 +/- 7 vs. 77 +/- 10 %
at 30 and 60 min of one-lung ventilation and at two-lung ventilation;
adjusted p = 0.026, <0.001, and <0.001, respectively). The recovery slope
during the vascular occlusion test, reflecting microvascular reperfusion
adequacy, was higher in the desflurane than the propofol group during
surgery (mean difference, 0.5 %/s; 95 % CI 0.0-0.9 %/s; p = 0.037).
Desflurane-remifentanil anesthesia is associated with better
microcirculation than propofol-remifentanil anesthesia in patients
undergoing thoracoscopic surgery.<br/>Copyright &#xa9; 2016, Springer
Science+Business Media Dordrecht.

<36>
Accession Number
611533009
Author
Struck M.F.; Junemann T.; Reinhart K.; Schummer W.
Institution
(Struck) Department of Anaesthesiology and Intensive Care Medicine,
University Hospital Leipzig, Liebigstr. 20, Leipzig 04103, Germany
(Junemann) Department of Anaesthesiology and Intensive Care Medicine, SRH
Wald-Klinikum Gera, Strase des Friedens 122, Gera 07548, Germany
(Reinhart, Schummer) Department of Anaesthesiology and Intensive Care
Medicine, University Hospital Jena, Erlanger Allee 101, Jena 07747,
Germany
Title
Central venous catheter tip migration due to tracheal extubation: a
prospective randomized study.
Source
Journal of Clinical Monitoring and Computing. 31 (5) (pp 951-959), 2017.
Date of Publication: 01 Oct 2017.
Publisher
Springer Netherlands
Abstract
Considerable numbers of patients undergo central venous catheterization
(CVC) under mechanical ventilation. We hypothesized that the return of
spontaneous breathing and tracheal extubation could be associated with
distal CVC tip migration towards intracardiac positions due to decreasing
intrathoracic pressures and subsequent readjustment of mediastinal organs.
Patients scheduled for cardiac surgery were randomized for right or left
internal jugular vein (IJV) CVC placement under general anesthesia and
mechanical ventilation. CVC tips were positioned at the cavoatrial
junction and measured at the time of placement, postoperatively under
mechanical ventilation, and after tracheal extubation until 48 h after
surgery. Measurement methods included intravascular electrocardiography
(ECG) P-wave amplitude, transesophageal echocardiography, and chest
radiography (CXR). Out of 70 patients, 60 were eligible for final
statistical analysis (31 right and 29 left IJV CVC). According to ECG
interpretation, CVC tip positions remained below the pericardiac
reflection point in the distal superior vena cava over the course of the
three measurement intervals. The ECG revealed significant proximal
migration of CVC tips from the time of placement to the time of tracheal
extubation (1.19 +/- 0.55 vs. 0.62 +/- 0.31 mV; P < 0.001). A CXR using
CVC tip to carina distances revealed no significant tip migrations in the
time between postoperative assessment and following tracheal extubation
(5.1 +/- 1.7 vs. 5.3 +/- 1.5 cm; P = 0.196). In patients with CVCs
positioned at the cavoatrial junction, tracheal extubation was not
associated with significant postoperative CVC tip malposition, but tended
to undergo proximal migration. This trend should be considered
particularly in left-sided thoracocervical puncture approaches to avoid
unfavorable CVC tip positions.<br/>Copyright &#xa9; 2016, Springer
Science+Business Media Dordrecht.

<37>
Accession Number
618000529
Author
Hummel J.; Rucker G.; Stiller B.
Institution
(Hummel, Stiller) Heart Center, University of Freiburg, Department of
Congenital Heart Defects and Pediatric Cardiology, Mathildenstr. 1,
Freiburg 79106, Germany
(Rucker) Faculty of Medicine and Medical Center - University of Freiburg,
Institute for Medical Biometry and Statistics, Stefan-Meier-Str. 26,
Freiburg 79104, Germany
Title
Prophylactic levosimendan for the prevention of low cardiac output
syndrome and mortality in paediatric patients undergoing surgery for
congenital heart disease.
Source
Cochrane Database of Systematic Reviews. 2017 (8) (no pagination), 2017.
Article Number: CD011312. Date of Publication: 02 Aug 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Low cardiac output syndrome remains a serious complication,
and accounts for substantial morbidity and mortality in the postoperative
course of paediatric patients undergoing surgery for congenital heart
disease. Standard prophylactic and therapeutic strategies for low cardiac
output syndrome are based mainly on catecholamines, which are effective
drugs, but have considerable side effects. Levosimendan, a calcium
sensitiser, enhances the myocardial function by generating more
energy-efficient myocardial contractility than achieved via adrenergic
stimulation with catecholamines. Thus potentially, levosimendan is a
beneficial alternative to standard medication for the prevention of low
cardiac output syndrome in paediatric patients after open heart surgery.
Objectives: To review the efficacy and safety of the postoperative
prophylactic use of levosimendan for the prevention of low cardiac output
syndrome and mortality in paediatric patients undergoing surgery for
congenital heart disease. Search methods: We identified trials via
systematic searches of CENTRAL, MEDLINE, Embase, and Web of Science, as
well as clinical trial registries, in June 2016. Reference lists from
primary studies and review articles were checked for additional
references. Selection criteria: We only included randomised controlled
trials (RCT) in our analysis that compared prophylactic levosimendan with
standard medication or placebo, in infants and children up to 18 years of
age, who were undergoing surgery for congenital heart disease. Data
collection and analysis: Two review authors independently extracted data
and assessed risk of bias according to a pre-defined protocol. We obtained
additional information from all but one of the study authors of the
included studies. We used the five GRADE considerations (study
limitations, consistency of effect, imprecision, indirectness, and
publication bias) to assess the quality of evidence from the studies that
contributed data to the meta-analyses for the prespecified outcomes. We
created a 'Summary of findings' table to summarise the results and the
quality of evidence for each outcome. Main results: We included five
randomised controlled trials with a total of 212 participants in the
analyses. All included participants were under five years of age. Using
GRADE, we assessed there was low-quality evidence for all analysed
outcomes. We assessed high risk of performance and detection bias for two
studies due to their unblinded setting. Levosimendan showed no clear
effect on risk of mortality (risk ratio (RR) 0.47, 95% confidence interval
(CI) 0.12 to 1.82; participants = 123; studies = 3) and no clear effect on
low cardiac output syndrome (RR 0.64, 95% CI 0.39 to 1.04; participants =
83; studies = 2) compared to standard treatments. Data on time-to-death
were not available from any of the included studies. There was no
conclusive evidence on the effect of levosimendan on the secondary
outcomes. The length of intensive care unit stays (mean difference (MD)
0.33 days, 95% CI -1.16 to 1.82; participants = 188; studies = 4), length
of hospital stays (MD 0.26 days, 95% CI -3.50 to 4.03; participants = 75;
studies = 2), duration of mechanical ventilation (MD -0.04 days, 95% CI
-0.08 to 0.00; participants = 208; studies = 5), and the risk of
mechanical circulatory support or cardiac transplantation (RR 1.49, 95% CI
0.19 to 11.37; participants = 60; studies = 2) did not clearly differ
between the groups. Published data about adverse effects of levosimendan
were limited. A meta-analysis of hypotension, one of the most feared side
effects of levosimendan, was not feasible because of the heterogeneous
expression of blood pressure values. Authors' conclusions: The current
level of evidence is insufficient to judge whether prophylactic
levosimendan prevents low cardiac output syndrome and mortality in
paediatric patients undergoing surgery for congenital heart disease. So
far, no significant differences have been detected between levosimendan
and standard inotrope treatments in this setting. The authors evaluated
the quality of evidence as low, using the GRADE approach. Reasons for
downgrading were serious risk of bias (performance and detection bias due
to unblinded setting of two RCTs), serious risk of inconsistency, and
serious to very serious risk of imprecision (small number of included
patients, low event rates).<br/>Copyright &#xa9; 2017 The Cochrane
Collaboration. Published by John Wiley & Sons, Ltd.

<38>
Accession Number
618447189
Author
Hilfiker-Kleiner D.; Haghikia A.; Berliner D.; Vogel-Claussen J.; Schwab
J.; Franke A.; Schwarzkopf M.; Ehlermann P.; Pfister R.; Michels G.;
Westenfeld R.; Stangl V.; Kindermann I.; Kuhl U.; Angermann C.E.; Schlitt
A.; Fischer D.; Podewski E.; Bohm M.; Sliwa K.; Bauersachs J.
Institution
(Hilfiker-Kleiner, Haghikia, Berliner, Fischer, Podewski, Bauersachs)
Department of Cardiology and Angiology, Hannover Medical School,
Carl-Neuberg-Str. 1., Hannover D-30625, Germany
(Haghikia, Kuhl) Department of Cardiology, Charite-Universitatsmedizin
Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin 12203, Germany
(Vogel-Claussen) Institute for Diagnostic and Interventional Radiology,
Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
(Schwab) Univ. Klin. F. Inn. Med. 8-Schwerpunkt Kardiologie und Institut
fur Radiologie und Neuroradiologie, Klinikum Nurnberg Sud, Paracelsus,
Medizinische Privatuniversitat Nurnberg, Breslauer Str. 201, Nurnberg
90471, Germany
(Franke, Schwarzkopf) Faculty of Medicine, University Leipzig, Clinical
Trial Centre (KKS), Haertelstr. 16-18, Leipzig D-04103, Germany
(Ehlermann) Department of Cardiology Angiology, and Pneumology, University
of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany
(Pfister, Michels) Department of Cardiology Pulmonology, and Vascular
Medicine, University of Cologne, Kerpenerstr. 62, Koln 50937, Germany
(Westenfeld) Department of Cardiology Pulmonology, and Vascular Medicine,
Medical Faculty, University Duesseldorf, Duesseldorf, Germany
(Stangl) Department for Cardiology and Angiology Angiologie, Center for
Cardiovascular Research (CCR), Charite-Universitatsmedizin Berlin,
Chariteplatz 1, Berlin 10117, Germany
(Kindermann, Bohm) Department of Internal Medicine III, University
Hospital of the Saarland, Homburg/Saar 66421, Germany
(Angermann) Department of Internal Medicine i, University Hospital
Wuerzburg, Am Schwarzenberg 15, Wurzburg A1597078, Germany
(Schlitt) Department of Medicine III, Medizinische Fakultat der Martin
Luther-Universitat Halle-Wittenberg, Magdeburger Strabe 8, Halle 06108,
Germany
(Sliwa) Faculty of Health Sciences, Hatter Institute of Cardiology
Research in Africa, 2 Anzio Road, Observatory 7925, South Africa
Title
Bromocriptine for the treatment of peripartum cardiomyopathy: A
multicentre randomized study.
Source
European Heart Journal. 38 (35) (pp 2671-2679), 2017. Date of Publication:
2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims An anti-Angiogenic cleaved prolactin fragment is considered causal
for peripartum cardiomyopathy (PPCM). Experimental and first clinical
observations suggested beneficial effects of the prolactin release
inhibitor bromocriptine in PPCM. Methods and results In this multicentre
trial, 63 PPCM patients with left ventricular ejection fraction (LVEF)
<=35% were randomly assigned to short-Term (1W: bromocriptine, 2.5mg, 7
days) or long-Term bromocriptine treatment (8W: 5 mg for 2weeks followed
by 2.5mg for 6weeks) in addition to standard heart failure therapy.
Primary end point was LVEF change (delta) from baseline to 6months
assessed bymagnetic resonance imaging. Bromocriptinewas well tolerated.
Left ventricular ejection fraction increased from 28+/- 10% to 49+/- 12%
with a delta-LVEF of+21+/- 11% in the 1W-group, and from 27+/- 10% to 51
+/- 10% with a delta-LVEF of+24+/- 11% in the 8W-group (delta-LVEF: P =
0.381). Full-recovery (LVEF >=50%) was present in 52% of the 1W-and in 68%
of the 8W-groupwith no differences in secondary end points between both
groups (hospitalizations for heart failure: 1W: 9.7% vs. 8W: 6.5%, P =
0.651). The risk within the 8W-group to fail full-recovery after 6months
tended to be lower.No patient in the study needed heart transplantation,
LV assist device or died. Conclusion Bromocriptine treatment was
associated with high rate of full LV-recovery and low morbidity and
mortality in PPCM patients compared with other PPCM cohorts not treated
with bromocriptine. No significant differences were observed between 1W
and 8W treatment suggesting that 1-week addition of bromocriptine to
standard heart failure treatment is already beneficial with a trend for
better full-recovery in the 8W group. Clinical trial registration:
ClinicalTrials.gov, study number: NCT00998556.<br/>Copyright &#xa9; The
Author 2016.

<39>
[Use Link to view the full text]
Accession Number
618452850
Author
Lim J.Y.; Kim J.B.; Jung S.H.; Choo S.J.; Chung C.H.; Lee J.W.
Institution
(Lim, Kim, Jung, Choo, Chung, Lee) Departments of Thoracic and
Cardiovascular Surgery, Asan Medical Center, University of Ulsan College
of Medicine, 88, Olympic-ro 43 gil, Songpa-gu, Seoul 05505, South Korea
Title
Risk factor analysis for nonocclusive mesenteric ischemia following
cardiac surgery.
Source
Medicine (United States). 96 (37) (no pagination), 2017. Article Number:
e8029. Date of Publication: 01 Sep 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Although rare, postcardiac surgery nonocclusive mesenteric ischemia (NOMI)
is a life-threatening condition. Identifying the risk factors for NOMI
during immediate postoperative period may help early detection and
intervention, which leads to improved clinical outcomes. The objective of
this study was to identify the clinical features and risk factors of NOMI
for prognosis identification after cardiac surgery, focusing on immediate
postoperative parameters. Among 9445 patients who underwent cardiac
surgery over a span of 9 years, 40 NOMI cases (0.4%) requiring surgical
interventions were reviewed. Suspected NOMI was diagnosed by sigmoidoscopy
or computed tomography. To identify the risk factors, a control group
(case: control = 1:3 ratio) was randomly selected and compared using
logistic regression models. NOMI was diagnosed after a mean of 8.1 +/- 9.6
days following cardiac surgery. Age (odds ratio: 1.16, 95% confidence
interval: 1.08-1.25, P < .001), total vasoactive-inotropic score (VIS),
and the maximal lactate level at postoperative day 0 (1.003,
[1.001-1.005], P = .012), (1.23, [1.04-1.44], P = .011) were shown as risk
factors. NOMI cases showed persistent hyperlactatemia without washout
during the first 48 hours (P = .04). Thirty-four cases underwent
exploratory laparotomy within a median of 10 (2-356) hours after the
diagnosis, but only 17 patients (42.5%) survived. Compared with survivors,
nonsurvivors showed higher total VIS at diagnosis, higher lactate levels
during the first 24 hours postoperatively, and more frequently required
extensive bowel resection (P < .05). Old age, postoperative high-dose
vasoactive-inotropic use, and persistent high lactate level during the
first 24 hours postsurgery were identified as risk factors for NOMI.
Lactic acidosis and necrotic-bowel extent at surgical exploration were
associated with poor survival.<br/>&#xa9; Copyright 2017 the Author(s).
Published by Wolters Kluwer Health, Inc.

<40>
Accession Number
618451872
Author
Gambardella I.; Antoniou G.A.; Torella F.; Spadaccio C.; Oo A.Y.; Gaudino
M.; Nappi F.; Shaw M.A.; Girardi L.N.
Institution
(Gambardella, Oo) Department of Cardiothoracic Surgery, Liverpool Heart
and Chest Hospital, Liverpool, United Kingdom
(Shaw) Department, Liverpool Heart and Chest Hospital, Liverpool, United
Kingdom
(Antoniou) Department of Vascular and Endovascular Surgery, The Royal
Oldham Hospital, Manchester, United Kingdom
(Torella) Vascular and Endovascular Service, Royal Liverpool University
Hospital, Liverpool, United Kingdom
(Spadaccio) Department of Cardiothoracic Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Gaudino, Girardi) Department of Cardiothoracic Surgery, Weill Cornell
Medicine, New York, NY, United States
(Nappi) Cardiac Surgery Center, Cardiologique du Nord de Saint-Denis,
Paris, France
Title
Secondary open aortic procedure following thoracic endovascular aortic
repair: Meta-analytic state of the art.
Source
Journal of the American Heart Association. 6 (9) (no pagination), 2017.
Article Number: e006618. Date of Publication: 01 Sep 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Thoracic endovascular aortic repair is characterized by a
substantial need for reintervention. Secondary open aortic procedure
becomes necessary when further endoluminal options are exhausted. This
synopsis and quantitative analysis of available evidence aims to overcome
the limitations of institutional cohort reports on secondary open aortic
procedure. Methods and Results-Electronic databases were searched from
1994 to the present date with a prospectively registered protocol. Pooled
quantification of pre/intraoperative variables, and proportional
meta-analysis with random effect model of early and midterm outcomes were
performed. Subgroup analysis was conducted for patients who had early
mortality. Fifteen studies were elected for final analysis, encompassing
330 patients. The following values are expressed as "pooled mean, 95%
confidence interval." Type B dissection was the most common pathology at
index thoracic endovascular aortic repair (51.2%, 44.4-57.9). The most
frequent indication for secondary open aortic procedure was endoleak
(39.7%, 34.6-45.1). More than half of patients had surgery on the
descending aorta (51.2%, 45.8-56.6), and one fourth on the arch (25.2%,
20.8-30.1). Operative mortality was 10.6% (7.4-14.9). Neurological
morbidity was substantial between stroke (5.1%, 2.8-9.1) and paraplegia
(8.3%, 5.2-13.1). At 2-year follow-up, mortality (20.4%, 11.5-33.5) and
aortic adverse event (aortic death 7.7%, 4.3-13.3, tertiary aortic open
procedure 7.4%, 4.0-13.2) were not negligible. Conclusions-In the
secondary open aortic procedure population, type B dissection was both the
most common pathology and the one associated with the lowest early
mortality, whereas aortic infection and extra-anatomical bypass were
associated with the most ominous prognosis.<br/>Copyright &#xa9; 2017 The
Authors.

<41>
Accession Number
618450149
Author
Eljezi V.; Biboulet C.; Boby H.; Schoeffler P.; Pereira B.; Duale C.
Institution
(Eljezi, Biboulet, Boby, Schoeffler, Pereira, Duale) CHU Clermont-Ferrand,
Clermont-Ferrand, France
Title
The dose-dependent effects of ketoprofen on dynamic pain after open heart
surgery.
Source
Pain Physician. 20 (6) (pp 509-520), 2017. Date of Publication:
September-October 2017.
Publisher
American Society of Interventional Pain Physicians (E-mail:
editor@painphysicianjournal.com)
Abstract
Background: Non-steroidal anti-inflammatory drugs (NSAIDs) can reduce
postoperative pain, in both static (i.e., at rest) and dynamic contexts
(e.g., during coughing or mobilization), and reduced doses could improve
their efficacy/tolerance balance. Objectives: To test this hypothesis of
efficacy after open heart surgery, in which NSAIDs are poorly used,
particularly for safety concerns. Study Design: Randomized, double-blind
trial. Setting: Single-center, French university hospital. Methods:
Patients. One hundred patients at low risk of postoperative complications
undergoing scheduled open heart surgery (97 analyzed). Intervention. We
tested intravenous ketoprofen, at a dose of 0.5 mg/kg-1 every 6 hours
during the 48 hours following the end of sedation, after surgery. This
standard protocol was compared to a similar one in which half doses were
administered, to one with quarter doses, as well as to a placebo group.
Analgesia was supplemented by acetaminophen plus self- and
nurse-administered intravenous morphine. Measurement. The primary outcome
was the intensity of dynamic pain, assessed over 48 hours on an 11-point
numerical rating scale (NRS). Results: Only the full-dose ketoprofen group
showed reduced dynamic and static postoperative pain vs. placebo (P <
0.00001 for both). The evolution of dynamic pain suggested a delayed and
therefore non-significant effect with the low doses. Ketoprofen did not
affect either the postoperative morphine consumption or the tolerance
outcomes, such as the volumes of chest tube drainage and the renal
function. Limitations: This pilot trial was undersized to test major
tolerance outcomes. Conclusions: Although we failed to demonstrate any
analgesic effects with low doses of ketoprofen, we confirmed the good
efficacy/tolerance balance with this propionic NSAID of intermediate
COX<inf>2</inf>-selectivity. Lower doses of NSAIDs, potentiated by a
loading dose, should be tested in the future.<br/>Copyright &#xa9; 2017,
American Society of Interventional Pain Physicians. All rights reserved.

<42>
Accession Number
607380981
Author
Bolzan D.W.; Trimer R.; Begot I.; Nasrala M.L.S.; Forestieri P.; Mendez
V.M.F.; Arena R.; Gomes W.J.; Guizilini S.
Institution
(Bolzan, Begot, Nasrala, Forestieri, Mendez, Gomes, Guizilini)
Cardiovascular and Surgery Discipline, Sao Paulo Hospital, Escola Paulista
de Medicina, Federal University of Sao Paulo, Rua Napoleao Barros,715, 30,
Vila Clementino, Sao Paulo/SP CEP:04024-002, Brazil
(Guizilini) Department of Human Movement Sciences, Physiotherapy School,
Federal University of Sao Paulo, Sao Paulo, Brazil
(Trimer) Cardiopulmonary Physiotherapy Laboratory, Nucleus of Research in
Physical Exercise, Federal University of Sao Paulo, Sao Paulo, Brazil
(Arena) Department of Physical Therapy, Integrative Physiology Laboratory,
College of Applied Health Sciences, University of Illinois, Chicago,
Chicago, IL, United States
Title
Open-Lung Ventilation Improves Clinical Outcomes in Off-Pump Coronary
Artery Bypass Surgery: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (3) (pp 702-708),
2016. Date of Publication: 01 Jun 2016.
Publisher
W.B. Saunders
Abstract
Objective To compare pulmonary function, functional capacity, and clinical
outcomes among conventional mechanical ventilation (CMV), early open-lung
(EOL), and late open-lung (LOL) strategies after off-pump coronary artery
bypass surgery (OPCAB). Design Prospective, randomized, and double-blinded
study. Setting Two hospitals of the Federal University of Sao Paulo,
Brazil. Participants Ninety-three patients undergoing elective first-time
OPCAB. Interventions Patients were randomized into 3 groups: CMV (n=31);
LOL (n=32) initiated upon intensive care unit (ICU) arrival; EOL (n = 30)
initiated after intubation. Measuraments and Main Results Spirometry was
performed at bedside preoperatively and on postoperative days (PODs) 1, 3,
and 5. Partial pressure of arterial oxygen (PaO<inf>2</inf>) and pulmonary
shunt fraction were evaluated presurgically and on POD 1; 6-minute walk
test (6MWT) was performed presurgically and on POD 5. Both open-lung
groups demonstrated higher forced vital capacity and forced expiratory
volume in 1 second on PODs 1, 3 and 5 compared to the CMV group (p<0.05).
Similar results were found in relation to the 6MWT distance. Shunt
fraction was lower and PaO<inf>2</inf> was higher in both open-lung groups
(p<0.05). Open-lung groups had shorter intubation time and hospital stay
as well as fewer respiratory events (p<0.05). No statistical difference
was found relative to the aforementioned results when the EOL and LOL
groups were compared. Conclusions Both open-lung strategies were able to
promote higher pulmonary function preservation and greater recovery of
functional capacity with better clinical outcomes after OPCAB. No
difference in outcome was found when comparing initiation of OLS
intraoperatively or after ICU arrival.<br/>Copyright &#xa9; 2016 Elsevier
Inc. All rights reserved.

<43>
Accession Number
609111635
Author
Chaney M.A.; Devin Roberts J.; Wroblewski K.; Shahul S.; Gaudet R.;
Jeevanandam V.
Institution
(Chaney, Devin Roberts, Shahul, Gaudet) Department of Anesthesia and
Critical Care, University of Chicago Medical Center, 5841 S. Maryland Ave,
MC 4028, Chicago, IL 60637, United States
(Wroblewski) Department of Public Health Sciences, University of Chicago
Medical Center, Chicago, IL, United States
(Jeevanandam) Department of Cardiac and Thoracic Surgery, University of
Chicago Medical Center, Chicago, IL, United States
Title
Protamine Administration Via the Ascending Aorta May Prevent
Cardiopulmonary Instability.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (3) (pp 647-655),
2016. Date of Publication: 01 Jun 2016.
Publisher
W.B. Saunders
Abstract
Objective The method of protamine administration may influence adverse
reactions. The authors investigated the effects of 3 different methods of
protamine administration on cardiopulmonary function. Design Prospective,
randomized clinical study. Setting Single university hospital.
Participants Human volunteer patients. Interventions Ninety-five patients
undergoing cardiac surgery were randomized prospectively into 3 groups.
Group central vein control (CVC) and group central vein (CV) received
protamine via a central vein over 10 minutes and 2 minutes, respectively.
Group ascending aorta (AA) received protamine via the ascending aorta over
2 minutes. Hemodynamic parameters were assessed at 7 intraoperative time
points, and pulmonary parameters were assessed at 4 intraoperative time
points. Measurements and Main Results The groups were similar regarding
preoperative demographics, intraoperative care, and baseline
cardiopulmonary function. However, both the CVC and CV groups exhibited
decreased blood pressure and impaired pulmonary oxygenation after
protamine administration; these changes were not observed in the AA group.
Within-group changes in mean arterial blood pressure after protamine
administration were significant in the AA group (mean increase 6.5 mmHg; p
= 0.01) but not in the CVC (mean decrease 3.1 mmHg, p = 0.13) or CV (mean
decrease 4.3 mmHg, p = 0.14) groups. Within-group changes in arterial
oxygenation after protamine administration were significant in the CVC
(mean decrease 85 mmHg; p<0.001) and CV (mean decrease 47 mmHg; p = 0.009)
groups but not in the AA group (mean decrease 8 mmHg; p = 0.82).
Conclusions The results indicated that administration of protamine via the
ascending aorta may be the preferred route. The potential ability of
administering protamine via the ascending aorta to prevent cardiopulmonary
instability in patients undergoing cardiac surgery deserves further
clinical investigation.<br/>Copyright &#xa9; 2016 Elsevier Inc. All rights
reserved.

<44>
Accession Number
611903076
Author
Stefan V.; Ahmed A.K.; Didier C.; Pieter S.; Ton S.; Jozef B.; Yoshinobu
O.; Patrick W.S.
Institution
(Stefan, Patrick) Antwerp Cardiovascular Center, ZNA Middelheim, Antwerp,
Belgium
(Ahmed) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
(Didier) Service de Cardiologie, Centre Hospitalier Universitaire
Rangueil, Toulouse, France
(Pieter) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Ton) OLVG Amsterdam, Amsterdam, Netherlands
(Jozef) Cardiovascular Center, OLV Ziekenhuis Aalst, Aalst, Belgium
(Yoshinobu, Patrick) Erasmus Medical Center, Rotterdam, Netherlands
(Patrick) International Centre for Circulatory Health, NHLI, Imperial
College London, London, United Kingdom
Title
Direct implantation of rapamycin-eluting stents with bioresorbable drug
carrier technology utilising the svelte coronary stent-on-a-wire: The
direct II study.
Source
EuroIntervention. 12 (5) (pp e615-e622), 2016. Date of Publication: August
2016.
Publisher
EuroPCR
Abstract
Aims: Our aim was to demonstrate the safety and efficacy of the Svelte
sirolimus-eluting coronary stenton-a-wire Integrated Delivery System (IDS)
with bioresorbable drug coating compared to the Resolute Integrity
zotarolimus-eluting stent with durable polymer in patients with de novo
coronary artery lesions. Methods and results: Direct stenting,
particularly in conjunction with transradial intervention (TRI), has been
associated with reduced bleeding complications, procedure time, radiation
exposure and contrast administration compared to conventional stenting
with wiring and predilatation. The low-profile Svelte IDS is designed to
facilitate TRI and direct stenting, reducing the number of procedural
steps, time and cost associated with coronary stenting. DIRECT II was a
prospective, multicentre trial which enrolled 159 patients to establish
non-inferiority of the Svelte IDS versus Resolute Integrity using a 2:1
randomisation. The primary endpoint was angiographic in-stent late lumen
loss (LLL) at six months. Target vessel failure (TVF), as well as
secondary clinical endpoints, will be assessed annually up to five years.
At six months, in-stent LLL was 0.09+/-0.31 mm in the Svelte IDS group
compared to 0.13+/-0.27 mm in the Resolute Integrity group (p<0.001 for
non-inferiority). TVF at one year was similar across the Svelte IDS and
Resolute Integrity groups (6.5% vs. 9.8%, respectively). Conclusions:
DIRECT II demonstrated the non-inferiority of the Svelte IDS to Resolute
Integrity with respect to in-stent LLL at six months. Clinical outcomes at
one year were comparable between the two groups. ClinicalTrials.gov
Identifier: NCT01788150<br/>Copyright &#xa9; Europa Digital & Publishing
2016. All rights reserved.

<45>
Accession Number
618057972
Author
Chin A.; Ntsekhe M.; Viljoen C.; Rossouw J.; Pennel T.; Schwartz P.J.
Institution
(Chin, Ntsekhe, Viljoen, Schwartz) Division of Cardiology, Department of
Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town,
South Africa
(Rossouw, Pennel) Christiaan Barnard Division of Cardiothoracic Surgery,
Faculty of Health Sciences, University of Cape Town, Observatory, Cape
Town 7925, South Africa
(Schwartz) IRCCS Istituto Auxologico Italiano, Center for Cardiac
Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics,
Milan, Italy
Title
Rationale and design of a prospective study to assess the effect of left
cardiac sympathetic denervation in chronic heart failure.
Source
International Journal of Cardiology. 248 (pp 227-231), 2017. Date of
Publication: 01 Dec 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background The main causes of mortality in patients with chronic heart
failure include sudden cardiac death (SCD) and progressive heart failure.
Autonomic dysfunction plays a detrimental role in the progression of
chronic heart failure. Left cardiac sympathetic denervation (LCSD) is an
inexpensive and safe procedure which modifies autonomic innervation of the
heart and is associated with a significant antifibrillatory effect.
Whether LCSD reduces the risk of SCD, delays progression of heart failure
and improves quality of life in patients with heart failure with reduced
ejection fraction (HFrEF) is not known. Methods and design This is a
2-phased prospective, randomized trial to test the efficacy and safety of
LCSD as an adjunct to guideline recommended medical therapy for patients
with HFrEF. Once the safety and feasibility of conducting a large LCSD
study have been demonstrated in the pilot phase, a phase III efficacy
trial to assess the impact on ventricular arrhythmias, heart failure
outcomes, and mortality will be completed. Outcome data from the pilot
study will remain blinded and added to the results of phase III study for
analysis. Results To date the study has received approval from local and
national ethics and regulatory bodies and recruitment has commenced, and 4
patients have been randomized so far. Conclusion If LCSD is proven to be
safe, feasible and effective in this first ever study using this novel
approach in patients with HFrEF it may be a cost-effective alternative to
the implantable cardioverter defibrillator therapy especially in regions
where ICDs and cardiac transplantation are unavailable.<br/>Copyright
&#xa9; 2017 Elsevier B.V.

<46>
Accession Number
618420932
Author
Celani C.; Khraiche D.; Quartier P.; Bonnet D.; Bader-Meunier B.
Institution
(Celani, Quartier, Bader-Meunier) Unite d'Immunologie, Hematologie et
Rhumatologie Pediatriques, Hopital Necker, Paris, France
(Khraiche, Bonnet) Cardiologie Pediatrique, Hopital Necker, Paris, France
Title
Recurrent pericarditis: Clinical course and treatment in pediatric
patients.
Source
Pediatric Rheumatology. Conference: 24th Paediatric Rheumatology European
Society Congress. Greece. 15 (pp 28), 2017. Date of Publication: September
2017.
Publisher
BioMed Central Ltd.
Abstract
Introduction: Recurrent pericarditis is a common complication of acute
pericarditis and affects 15-30% of patients after an initial attack. The
etiology is poorly understood and about 80% of these recurrent
pericarditis are "idiopathic". However, some data suggest an autoimmune or
autoinflammatory mechanism. Colchicine associated with nonsteroidal
anti-inflammatory drugs (NSAIDs) is the treatment of choice and the use of
other treatments remains exceptional. Objectives: To analyze the clinical
findings, course and treatment of pediatric patients with recurrent
pericarditis. Methods: Retrospective monocentric study. Inclusion
Criteria:1) patients with at least twice recurrence of recurrent
pericarditis (RP); 2) followed at Necker hospital between 2006 and 2016.
Exclusion Criteria: 1)Known history of autoimmune or autoinflammatory
disease. Results: Thirteen patients (10 F and 3 M) with recurrent
pericarditis were included. The median age at disease onset (first episode
of pericarditis) was 11.3 years (range 8-17). Two groups of patients could
be identified: In group 1 (6 patients), the recurrent pericarditis
occurred after surgical correction of cardiac malformations; in group 2 (7
patients), there was no history of cardiac disease. During the episodes of
pericarditis, all patients showed fever, chest pain, electrocar-diographic
changes and increased white blood cell counts and C reactive protein (CRP
median 181 mg/l, polymorphonuclear cells 13619 g/l,) without differences
between the two groups. A family history of recurrent pericarditis was
noted in 2 patients from the first group. Six patients had pleuritis
anD/Or pneumonia with concomitant pleural effusion (3 patients in each
group). Patients in group 1 had more recurrences than in group 2 (median
2.8 vs 1.5) during the same follow-up period (one year). ANA > 1/640
(Anti-nuclear auto-antibodies) and anti-DNA were present in 2 patients of
each groups. The pericardial biopsy was performed in 5 patients and
displayed fi-brosis and showed[an inflammatory tissue with predominance of
neutrophils. Initial treatments was aspirin with anti-inflammatory dose,
alone (5 patients) or in combination with Colchicine (4 patients),
colchicine alone (1 patients) or in combination with ibuprofen (1 patient)
and antibiotic therapy (2 patients). To prevent recurrence, six of
patients were treated with NSAIDs associated to colchicine or indomethacin
alone. Corticotherapy was required in 2 patients in group 2. Anakinra was
introduced in one of them because of corti-codependence. Clinical
remission was obtained in all patients after discontinuation of the
treatment (10 patients) or under treatment (3patients). A heterozygous
mutation of R92Q for the TRAPS gene was found in 1 of the 6 patients
studied. No mutation in the MEFV gene was found. Conclusion: Recurrent
pericarditis can develop after cardiac surgery or can be isolated. The
presence of fever, inflammatory syndrome, pericardial neutrophilic
infiltrate, and the efficacy of anti-IL1 in some patients suggests that
some recurrent pericarditis could be considered as auto-inflammatory
disease. Furthermore the existence of fa-milial cases in two patients
suggests a genetic susceptibility. In conclusion early anti inflammatory
treatment should be considered in recurrent pericarditis associated with
an inflammatory syndrome, after rulling out an infection.

<47>
Accession Number
618420751
Author
Karim M.N.; Reid C.M.; Cochrane A.; Tran L.; Alramadan M.; Hossain M.N.;
Billah B.
Institution
(Karim, Reid, Tran, Alramadan, Hossain, Billah) School of Public Health
and Preventive Medicine, Monash University, Alfred Centre, 99 Commercial
Road, Melbourne, VIC 3004, Australia
(Reid) School of Public Health, Curtin University, Perth, Australia
(Cochrane) Department of Cardiothoracic Surgery, Monash Medical Centre,
Clayton, Australia
Title
Mortality risk prediction models for coronary artery bypass graft surgery:
Current scenario and future direction.
Source
Journal of Cardiovascular Surgery. 58 (6) (pp 931-942), 2017. Date of
Publication: December 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION? Many risk prediction models are currently in use for
predicting short-Term mortality following coronary artery bypass graft
(CABG) surgery. This review critically appraised the methods that were
used for developing these models to assess their applicability in current
practice setting as well as for the necessity of up-gradation. EVIDENCE
ACQUISITION? Medline via Ovid was searched for articles published between
1946 and 2016 and EMBASE via Ovid between 1974 and 2016 to identify risk
prediction models for CABG. Article selection and data extraction was
conducted using the CHARMS checklist for review of prediction model
studies. Association between model development methods and model's
discrimination was assessed using Kruskal-Wallis one-way analysis of
variance and Mann-Whitney U-Test. EVIDENCE SYNTHESIS? A total of 53 risk
prediction models for short-Term mortality following CABG were identified.
The review found a wide variation in development methodology of risk
prediction models in the field. Ambiguous predictor and outcome
definition, sub-optimum sample size, inappropriate handling of missing
data and inefficient predictor selection technique are major issues
identified in the review. Quantitative synthesis in the review showed
"missing value imputation" and "adopting machine learning algorithms" may
result in better discrimination power of the models. CONCLUSIONS? There
are aspects in current risk modeling, where there is room for improvement
to reflect current clinical practice. Future risk modelling needs to adopt
a standardized approach to defining both outcome and predictor variables,
rational treatment of missing data and robust statistical techniques to
enhance performance of the mortality risk prediction.<br/>Copyright &#xa9;
2016 EDIZIONI MINERVA MEDICA.

<48>
Accession Number
618377678
Author
Mauermann E.; Bolliger D.; Fassl J.; Grapow M.; Seeberger E.E.; Seeberger
M.D.; Filipovic M.; Lurati Buse G.A.L.
Institution
(Mauermann, Bolliger, Fassl, Seeberger, Lurati Buse) Department for
Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and
Pain Therapy, University Hospital Basel, Basel, Switzerland
(Grapow) Division of Cardiac Surgery, University Hospital Basel, Basel,
Switzerland
(Seeberger, Filipovic) University of Basel Medical School, Basel,
Switzerland
Title
Association of Troponin Trends and Cardiac Morbidity and Mortality After
On-Pump Cardiac Surgery.
Source
Annals of Thoracic Surgery. 104 (4) (pp 1289-1297), 2017. Date of
Publication: October 2017.
Publisher
Elsevier USA
Abstract
Background Elevated, single-measure, postoperative troponin is associated
with adverse events after cardiac surgery. We hypothesized that increases
in troponin from the first to the second postoperative day are also
associated with all-cause, 12-month mortality and major adverse cardiac
events (MACE). Methods This observational study included consecutive
adults undergoing on-pump cardiac surgery with cardiac arrest. Troponin T
was measured on the first and second postoperative day and was classified
as "increasing" (>10%), "unchanged" (10% to -10%), or "decreasing"
(<-10%). The primary endpoint was all-cause, 12-month mortality. Secondary
endpoints were all-cause 12-month mortality or MACE and both outcomes at
30 days. The main analysis was by multivariable Cox regression. Results Of
1,417 included patients, 99 (7.0%) died and 162 (11.4%) died or suffered
MACE at 12 months. A significant interaction (p < 0.001) between first
postoperative day troponin and the troponin trend from the first to the
second postoperative day on 12-month, all-cause mortality precluded an
analysis independent of first postoperative day troponin. Consequently, we
stratified patients by their first postoperative day troponin (cutoff, 0.8
mug/L). Increasing troponin was associated with higher mortality in
patients with first postoperative day troponin T >= 0.8 mug/L (hazard
ratio, 1.98; 95% CI, 1.09 to 3.59; p = 0.025). Conclusions Troponin
changes from the first to the second postoperative day should not be
interpreted without consideration of the first postoperative day troponin
concentration. For patients with a first postoperative day troponin >= 0.8
mug/L, an increase by more than 10% from the first to the second
postoperative day was significantly associated with all-cause, 12-month
mortality and other adverse events.<br/>Copyright &#xa9; 2017 The Society
of Thoracic Surgeons

<49>
Accession Number
618328586
Author
Song Y.; Soh S.; Shim J.-K.; Park K.-U.; Kwak Y.-L.
Institution
(Song, Soh, Shim, Park, Kwak) Department of Anesthesiology and Pain
Medicine, Yonsei University College of Medicine, Seodaemun-gu, Seoul,
South Korea
(Song, Soh, Shim, Kwak) Anesthesia and Pain Research Institute, Yonsei
University College of Medicine, Seodaemun-gu, Seoul, South Korea
(Song) Department of Anesthesiology and Pain Medicine, Yonsei University
College of Medicine, Gangnam Severance Hospital, Gangnam-gu, Seoul, South
Korea
Title
Skin perfusion pressure as an indicator of tissue perfusion in valvular
heart surgery: Preliminary results from a prospective, observational
study.
Source
PLoS ONE. 12 (9) (no pagination), 2017. Article Number: e0184555. Date of
Publication: September 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Hemodynamic management aims to provide adequate tissue perfusion, which is
often altered during cardiac surgery with cardiopulmonary bypass (CPB). We
evaluated whether skin perfusion pressure (SPP) can be used for monitoring
of adequacy of tissue perfusion in patients undergoing valvular heart
surgery. Seventy-two patients undergoing valve replacement were enrolled.
SPP and serum lactate level were assessed after anaesthesia induction
(baseline), during CPB, after CPB-off, end of surgery, arrival at
intensive care unit, and postoperative 6 h. Lactate was further measured
until postoperative 48 h. Association of SPP with lactate and 30-day
morbidity comprising myocardial infarction, acute kidney injury, stroke,
prolonged intubation, sternal infection, reoperation, and mortality was
assessed. Among the lactate levels, postoperative 6 h peak value was most
closely linked to composite of 30-day morbidity. The SPP value during CPB
and its % change from the baseline value were significantly associated
with the postoperative 6 h peak lactate (r = -0.26, P = 0.030 and r =
0.47, P = 0.001, respectively). Optimal cut-off of % decrease in SPP
during CPB from baseline value for the postoperative 6 h hyperlactatemia
was 48% (area under curve, 0.808; 95% confidence interval (CI),
0.652-0.963; P = 0.001). Decrease in SPP >48% during CPB from baseline
value was associated with a 12.8-fold increased risk of composite endpoint
of 30-day morbidity (95% CI, 1.48-111.42; P = 0.021) on multivariate
logistic regression. Large decrease in SPP during CPB predicts
postoperative 6 h hyperlactatemia and 30-day morbidity, which implicates a
promising role of SPP monitoring in the achievement of optimal perfusion
during CPB.<br/>Copyright &#xa9; 2017 Song et al. This is an open access
article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original author and source are credited.

<50>
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, United States
(Nassr) Women's Health Hospital, Assiut University, Assiut, Egypt
(Shazly) Department of Obstetrics and Gynecology, Mayo Clinic College of
Medicine, Rochester, MN, United States
(Morris, Ayres, Sexson) Division of Pediatric Cardiology, Baylor College
of Medicine and Texas Children's Fetal Center, Houston, TX, United States
(Olutoye) Division of Pediatric Anesthesia, Baylor College of Medicine and
Texas Children's Fetal Center, Houston, TX, United States
(Olutoye) Division of Pediatric Surgery, Baylor College of Medicine and
Texas Children's Fetal Center, Houston, TX, United States
(Fraser) Division of Congenital Heart Surgery, Baylor College of Medicine
and Texas Children's Heart Center, Houston, TX, United States
Title
Prenatal management of fetal intrapericardial teratoma: a systematic
review.
Source
Prenatal Diagnosis. 37 (9) (pp 849-863), 2017. Date of Publication:
September 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. &#xa9; 2017 John Wiley & Sons, Ltd.<br/>Copyright &#xa9;
2017 John Wiley & Sons, Ltd.

<51>
Accession Number
616894755
Author
Pettersen O.; Haram P.M.; Winnerkvist A.; Karevold A.; Wahba A.; Stenvik
M.; Wiseth R.; Hegbom K.; Nordhaug D.O.
Institution
(Pettersen, Haram, Winnerkvist, Karevold, Wahba, Stenvik, Nordhaug)
Department of Cardiothoracic Surgery, St. Olav's University Hospital,
Trondheim, Norway
(Wiseth, Hegbom) Department of Cardiology, St. Olav's University Hospital,
Trondheim, Norway
(Pettersen, Wahba, Wiseth, Nordhaug) Department of Circulation and Medical
Imaging, Faculty of Medicine, Norwegian University of Science and
Technology, Trondheim, Norway
Title
Pedicled Vein Grafts in Coronary Surgery: Perioperative Data From a
Randomized Trial.
Source
Annals of Thoracic Surgery. 104 (4) (pp 1313-1317), 2017. Date of
Publication: October 2017.
Publisher
Elsevier USA
Abstract
Background Less-than-optimal long-term patency of the saphenous vein is
one of the main obstacles for the success of coronary artery bypass
grafting (CABG). Results from the IMPROVE-CABG trial has shown that
harvesting the saphenous vein with a pedicle of perivascular tissue less
than 5 mm while using manual distention provides comparable occlusion
rates but significantly less intimal hyperplasia at early follow-up. The
impact of pedicled veins on duration of operations, leg wound infections,
and postoperative bleeding is unknown. Methods One hundred patients
undergoing first-time elective CABG were randomly assigned to conventional
or pedicled vein harvesting. Perioperative and postoperative data were
collected prospectively during the hospital stay and at follow-up. Results
Duration of extracorporeal circulation was significantly longer in the
pedicled vein group (mean: 76 min versus 65 min, p = 0.006); however, no
significant difference was found in the cross-clamp time. No significant
difference was found in intraoperative vein graft flow, postoperative
bleeding, or leg wound infections (4% in each group). No reoperations were
due to vein graft bleeding. Conclusions Harvesting a pedicled vein
provides comparable postoperative bleeding and leg wound infection rates
in selected patients. The technique is associated with a slightly longer
duration of extracorporeal circulation than harvesting conventional veins.
Promising early results using the pedicled vein technique may contribute
to a change in standard vein harvesting technique for CABG in selected
patients.<br/>Copyright &#xa9; 2017 The Society of Thoracic Surgeons

<52>
Accession Number
616750148
Author
Johnston L.E.; Downs E.A.; Hawkins R.B.; Quader M.A.; Speir A.M.; Rich
J.B.; Ghanta R.K.; Yarboro L.T.; Ailawadi G.
Institution
(Johnston, Downs, Hawkins, Ghanta, Yarboro, Ailawadi) Division of Thoracic
and Cardiovascular Surgery, Department of Surgery, University of Virginia,
Charlottesville, Virginia, United States
(Quader) Division of Cardiothoracic Surgery, Virginia Commonwealth
University, Richmond, Virginia, United States
(Speir) Inova Heart and Vascular Institute, Inova Fairfax Hospital,
Fairfax, Virginia, United States
(Rich) MidAtlantic Cardiothoracic Surgeons, Norfolk, Virginia, United
States
Title
Outcomes for Low-Risk Surgical Aortic Valve Replacement: A Benchmark for
Aortic Valve Technology.
Source
Annals of Thoracic Surgery. 104 (4) (pp 1282-1288), 2017. Date of
Publication: October 2017.
Publisher
Elsevier USA
Abstract
Background Two large, randomized trials are underway evaluating
transcatheter aortic valve replacement (AVR) against conventional surgical
AVR. We analyzed contemporary, real-world outcomes of surgical AVR in
low-risk patients to provide a practical benchmark of outcomes and cost
for evaluating current and future transapical AVR technology. Methods From
2010 to 2015, 2,505 isolated AVR operations were performed for severe
aortic stenosis at 18 statewide cardiac institutions. Of these, 2,138
patients had a Society of Thoracic Surgeons predicted risk of mortality of
less than 4%, and 1,119 met other clinical and hemodynamic criteria as
outlined in the PARTNER 3 (The Placement of Transcatheter Aortic Valves)
protocol. Patients with endocarditis, end-stage renal disease, ejection
fraction of less than 0.45, bicuspid valves, and previous valve
replacements were excluded. Outcomes of interest included operative death
and postoperative adverse events. Results The median Society of Thoracic
Surgeons predicted risk of mortality for the study-eligible patients was
1.44%, with a median age of 72 years (interquartile range [IQR], 65 to 78
years). Operative mortality was 1.3%, permanent stroke was 1.3%, and
pacemaker requirement was 4.2%. The most common adverse events were
transfusion of 2 or more units of red blood cells (18%) and atrial
fibrillation (28%). The median length of stay was 6 days (IQR, 5 to 8
days). Median total hospital cost was $37,999 (IQR, $30,671 to $46,138).
Examination of complications by age younger than 65 vs 65 or older
demonstrated a significantly lower need for transfusion (11.2%, p < 0.001)
and incidence of atrial fibrillation (17.1%, p < 0.001) but no difference
in operative mortality (2.2% vs 0.9%, p = 0.1), major morbidity (10.4% vs
12.6%, p = 0.3), or total hospital costs. Conclusions Low-risk patients
undergoing surgical AVR in the current era have excellent results. The
most common complications were atrial fibrillation and bleeding. These
real-world results should provide additional context for upcoming
transcatheter clinical trial data.<br/>Copyright &#xa9; 2017 The Society
of Thoracic Surgeons

<53>
Accession Number
617803497
Author
Koch C.G.; Sessler D.I.; Mascha E.J.; Sabik J.F.; Li L.; Duncan A.I.;
Zimmerman N.M.; Blackstone E.H.
Institution
(Koch, Duncan) Department of Cardiothoracic Anesthesiology, Anesthesiology
Institute, Cleveland Clinic, Cleveland, Ohio, United States
(Sessler, Mascha, Zimmerman) Department of Outcomes Research,
Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, United States
(Mascha, Li, Zimmerman, Blackstone) Department of Quantitative Health
Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio,
United States
(Sabik, Blackstone) Department of Thoracic and Cardiovascular Surgery,
Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United
States
Title
A Randomized Clinical Trial of Red Blood Cell Transfusion Triggers in
Cardiac Surgery.
Source
Annals of Thoracic Surgery. 104 (4) (pp 1243-1250), 2017. Date of
Publication: October 2017.
Publisher
Elsevier USA
Abstract
Background Class I evidence supporting a threshold for transfusion in the
cardiac surgical setting is scarce. We randomly allocated patients to a
transfusion hematocrit trigger of 24% versus 28% to compare morbidity,
mortality, and resource use. Methods From March 2007 to August 2014, two
centers randomly assigned 722 adults undergoing coronary artery bypass
graft surgery or valve procedures to a 24% hematocrit trigger (n = 363,
low group) or 28% trigger (n = 354, high group). One unit of red blood
cells was transfused if the hematocrit fell below the designated
threshold. The primary endpoint was a composite of postoperative
morbidities and mortality. Treatment effect was primarily assessed using
an average relative effect generalized estimating equation model. Results
At the second planned interim analysis, the a priori futility boundary was
crossed, and the study was stopped. There was no detected treatment effect
on the composite outcome (average relative effect odds ratio, low versus
high, 0.86, 95% confidence interval: 0.29 to 2.54, p = 0.71). However, the
low group received fewer red blood cell transfusions than the high group
(54% versus 75%, p < 0.001), mostly administered in the operating room
(low group, 112 [31%]; high group, 208 [59%]), followed by intensive care
unit (low, 105 [31%]; high, 115 [34%]) and floor (low, 41 [12%]; high, 42
[13%]). The low group was exposed to lower hematocrits: median before
transfusion, 22% (Q1 = 21%, Q3 = 23%) versus 24% (Q1 = 22%, Q3 = 25%).
Conclusions Negative exposures differed between treatment groups, with
lower hematocrit in the 24% trigger group and more red blood cells used in
the 28% group, but adverse outcomes did not differ. Because red blood cell
use was less with a 24% trigger without adverse effects, our randomized
trial results support aggressive blood conservation efforts in cardiac
surgery.<br/>Copyright &#xa9; 2017 The Society of Thoracic Surgeons

<54>
Accession Number
615615786
Author
Suominen P.K.; Keski-Nisula J.; Ojala T.; Rautiainen P.; Jahnukainen T.;
Hastbacka J.; Neuvonen P.J.; Pitkanen O.; Niemela J.; Kaskinen A.;
Salminen J.; Lapatto R.
Institution
(Suominen, Keski-Nisula, Rautiainen, Hastbacka) Department of Anesthesia
and Intensive Care, Children's Hospital, Helsinki University Hospital and
University of Helsinki, Helsinki, Finland
(Ojala, Jahnukainen, Pitkanen, Niemela, Kaskinen, Lapatto) Department of
Pediatrics, Children's Hospital, Helsinki University Hospital and
University of Helsinki, Helsinki, Finland
(Salminen) Department of Pediatric Surgery, Children's Hospital, Helsinki
University Hospital and University of Helsinki, Helsinki, Finland
(Neuvonen) Department of Clinical Pharmacology, University of Helsinki and
HUSLAB, Helsinki University Hospital, Helsinki, Finland
Title
Stress-Dose Corticosteroid Versus Placebo in Neonatal Cardiac Operations:
A Randomized Controlled Trial.
Source
Annals of Thoracic Surgery. 104 (4) (pp 1378-1385), 2017. Date of
Publication: October 2017.
Publisher
Elsevier USA
Abstract
Background Corticosteroids can improve the hemodynamic status of neonates
with postoperative low cardiac output syndrome after cardiac operations.
This study compared a prophylactically administered stress-dose
corticosteroid (SDC) regimen against placebo on inflammation,
adrenocortical function, and hemodynamic outcome. Methods Forty neonates
undergoing elective open heart operations were randomized into two groups.
The SDC group received perioperatively 2 mg/kg methylprednisolone, and 6
hours after the operation, a hydrocortisone infusion (0.2 mg/kg/h) was
started with tapering doses for 5 days. Placebo was administered in a
similar fashion. An adrenocorticotropic hormone stimulation test was
performed after the therapy. The primary endpoint of the study was plasma
concentration of interleukin (IL-6). Secondary clinical outcomes included
plasma cortisol, IL-10, C-reactive protein, echocardiographic systemic
ventricle contractility evaluated by the Velocity Vector Imaging program,
the inotropic score, and time of delayed sternal closure. Results The IL-6
values of the SDC group were significantly lower postoperatively than in
the placebo group. Significantly lower inotropic scores (p < 0.05),
earlier sternal closure (p = 0.03), and less deterioration in the systemic
ventricle mean delta strain values between the preoperative and the first
postoperative assessment (p = 0.01) were detected for the SDC group. The
SDC therapy did not suppress the hypothalamic-pituitary-adrenal axis more
than placebo. The mean plasma cortisol level did not decline in the
placebo group after the operation. Conclusions The SDC regimen for 5 days
postoperatively in neonates was safe and did not cause suppression of the
hypothalamic-pituitary-adrenal axis. Furthermore, the open heart operation
per se did not lead to adrenal insufficiency in neonates.<br/>Copyright
&#xa9; 2017 The Society of Thoracic Surgeons

<55>
Accession Number
618310957
Author
Shah B.; Ganguzza L.; Slater J.; Newman J.D.; Allen N.; Fisher E.;
Larigakis J.; Ujueta F.; Gianos E.; Guo Y.; Woolf K.
Institution
(Shah, Ganguzza, Slater, Newman, Allen, Fisher, Larigakis, Ujueta, Gianos)
Department of Medicine (Cardiology), New York University (NYU) School of
Medicine, New York, NY, United States
(Shah) Department of Medicine (Cardiology), Veterans Affairs New York
Harbor Healthcare System: Manhattan Campus, New York, NY, United States
(Guo) Department of Population Health (Biostatistics), NYU School of
Medicine, New York, NY, United States
(Woolf) Department of Nutrition and Food Studies, NYU Steinhardt, New
York, NY, United States
Title
The effect of a vegan versus AHA DiEt in coronary artery disease (EVADE
CAD) trial: Study design and rationale.
Source
Contemporary Clinical Trials Communications. 8 (pp 90-98), 2017. Date of
Publication: December 2017.
Publisher
Elsevier Inc
Abstract
Background Multiple studies demonstrate the benefit of a vegan diet on
cardiovascular risk factors when compared to no intervention or usual
dietary patterns. The aim of this study is to evaluate the effect of a
vegan diet versus the American Heart Association (AHA)-recommended diet on
inflammatory and glucometabolic profiles in patients with angiographically
defined coronary artery disease (CAD). Study design This study is a
randomized, open label, blinded end-point trial of 100 patients with CAD
as defined by >= 50% diameter stenosis in a coronary artery >=2 mm in
diameter on invasive angiography. Participants are randomized to 8 weeks
of either a vegan or AHA-recommended diet (March 2014 and February 2017).
Participants are provided weekly groceries that adhere to the guidelines
of their diet. The primary endpoint is high sensitivity C-reactive
concentrations. Secondary endpoints include anthropometric data, other
markers of inflammation, lipid parameters, glycemic markers, endothelial
function, quality of life data, and assessment of physical activity.
Endpoints are measured at each visit (baseline, 4 weeks, and 8 weeks).
Dietary adherence is measured by two weekly 24-h dietary recalls, a 4-day
food record during the week prior to each visit, and both plasma and urine
levels of trimethylamine-N-oxide at each visit. Conclusion This study is
the first to comprehensively assess multiple indices of inflammation and
glucometabolic profile in a rigorously conducted randomized trial of
patients with CAD on a vegan versus AHA-recommended diet.<br/>Copyright
&#xa9; 2017

<56>
Accession Number
614518941
Author
Liu X.; Xie G.; Zhang K.; Song S.; Song F.; Jin Y.; Fang X.
Institution
(Liu, Xie, Zhang, Song, Song, Jin, Fang) Department of Anesthesiology and
Intensive Care Medicine, the First Affiliated Hospital of Zhejiang
University School of Medicine, Hangzhou, China
Title
Dexmedetomidine vs propofol sedation reduces delirium in patients after
cardiac surgery: A meta-analysis with trial sequential analysis of
randomized controlled trials.
Source
Journal of Critical Care. 38 (pp 190-196), 2017. Date of Publication: 01
Apr 2017.
Publisher
W.B. Saunders
Abstract
Purpose It is uncertain whether dexmedetomidine is better than propofol
for sedation in postcardiac surgery patients. The purpose of this
meta-analysis was to compare the effects of dexmedetomidine and propofol
sedation on outcomes in adult patients after cardiac surgery. Methods
Randomized controlled trials comparing outcomes in cardiac surgery
patients sedated with dexmedetomidine or propofol were retrieved from
PubMed, Embase, Web of Science, the Cochrane Library, and
Clinicaltrials.Gov until May 23, 2016. Results A total of 969 patients in
8 studies met the selection criteria. The results revealed that
dexmedetomidine was associated with a lower risk of delirium (risk ratio,
0.40;95% confidence interval [CI], 0.24-0.64; P =.0002), a shorter length
of intubation (hours; mean difference, - 0.95; 95% CI, - 1.26 to - 0.64; P
<.00001), but a higher incidence of bradycardia (risk ratio 3.17; 95% CI,
1.41-7.10; P =.005) as compared to propofol. There were no statistical
differences in the incidence of hypotension or atrial fibrillation, or the
length of intensive care unit stay between dexmedetomidine and propofol
sedation regimens. Conclusions Dexmedetomidine sedation could reduce
postoperative delirium and was associated with shorter length of
intubation, but might increase bradycardia in patients after cardiac
surgery compared with propofol.<br/>Copyright &#xa9; 2016 The Authors

<57>
Accession Number
614518935
Author
Brascia D.; Garcia-Medina N.; Kinnunen E.-M.; Tauriainen T.; Airaksinen
J.; Biancari F.
Institution
(Brascia, Garcia-Medina, Kinnunen, Tauriainen, Biancari) Department of
Surgery, Oulu University Hospital, Oulu, Finland
(Airaksinen) Heart Center, Turku University Hospital, Turku, Finland
Title
Impact of transfusion on stroke after cardiovascular interventions:
Meta-analysis of comparative studies.
Source
Journal of Critical Care. 38 (pp 157-163), 2017. Date of Publication: 01
Apr 2017.
Publisher
W.B. Saunders
Abstract
Purpose To evaluate the impact of transfusion on the development of stroke
after cardiovascular interventions. Methods A literature search was
performed to identify comparative studies on the impact of blood
transfusion on the occurrence of stroke after adult cardiac surgery and
interventional cardiology procedures. Results Twenty-four studies compared
the outcome of 80 283 patients who received and 2 260 709 patients who did
not receive blood transfusion after cardiovascular interventions. Pooled
analysis showed that transfused patients had a higher risk of
postoperative stroke (2.1% vs 0.9%; P <.001; risk ratio [RR], 2.563; 95%
confidence interval [CI], 1.615-4.069; I² = 94%) compared with
patient who did not receive blood transfusion. The leave-one-out analysis
confirmed the consistency of the overall series (RR ranged from 2.367 [95%
CI, 1.978-2.834] to 2.676 [95% CI, 1.679-4.265]). Transfusion was
associated with increased risk of stroke after either interventional
cardiology interventions (3.2% vs 1.1%; RR, 3.325; 95% CI, 1.579-7.004) or
cardiac surgery (1.9% vs 0.8%; RR, 2.260; 95% CI, 1.845-2.769). Generic
inverse variance analysis of 11 studies reporting adjusted odds ratios for
baseline characteristics showed that transfusion after cardiovascular
interventions was an independent predictor of stroke (RR, 1.53; 95% CI,
1.10-2.14; I² = 0%). Conclusion Blood transfusion is associated
with a significantly increased risk of postoperative stroke in patients
undergoing cardiovascular interventions. Registration The present
meta-analysis is registered in PROSPERO, code
CRD42016046426.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<58>
Accession Number
614518928
Author
Zhu Y.; Yin H.; Zhang R.; Wei J.
Institution
(Zhu, Yin, Zhang) Department of Intensive Care Unit, Guangzhou Red Cross
Hospital, Medical College, Jinan University, Guangzhou, Guangdong 510220,
China
(Wei) Department of Cardiology, Guangzhou Red Cross Hospital, Medical
College, Jinan University, Guangzhou, Guangdong 510220, China
Title
High-flow nasal cannula oxygen therapy vs conventional oxygen therapy in
cardiac surgical patients: A meta-analysis.
Source
Journal of Critical Care. 38 (pp 123-128), 2017. Date of Publication: 01
Apr 2017.
Publisher
W.B. Saunders
Abstract
Introduction The use of high-flow nasal cannula (HFNC) for the treatment
of many diseases has gained increasing popularity. In the present
meta-analysis, we aimed to assess the efficacy and safety of HFNCs
compared with conventional oxygen therapy (COT) in adult postextubation
cardiac surgical patients. Method We reviewed the Embase, PubMed, Cochrane
Central Register of Controlled Trials, Wanfang databases, and the China
National Knowledge Infrastructure. Two investigators independently
collected the data and assessed the quality of each study. RevMan 5.3 was
used for the present meta-analysis. Results We included 495 adult
postextubation cardiac surgical patients. There was no significant
heterogeneity among the studies. Compared with COT, HFNCs were associated
with a significant reduction in the escalation of respiratory support
(risk ratio, 0.61; 95% confidence interval [CI], 0.46-0.82; z = 3.32, P
<.001). There were no significant differences in the reintubation rate
(risk ratio, 0.96; 95% CI, 0.04-24.84; z = 0.02, P =.98) or length of
intensive care unit stay (weighted mean difference, 0.13; 95% CI, -0.88 to
7.92; z = 1.57, P =.12) between the 2 groups. No severe complications were
reported in either group. Conclusions The HFNC could reduce the need for
escalation of respiratory support compared with COT, and it could be
safely administered in adult postextubation cardiac surgical
patients.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<59>
Accession Number
614482803
Author
Li B.; Lang X.; Cao L.; Wang Y.; Lu Y.; Feng S.; Yang Y.; Chen J.; Jiang
H.
Institution
(Li, Lang, Cao, Wang, Lu, Feng, Yang, Chen, Jiang) Kidney Disease Center,
The First Affiliated Hospital, School of Medicine, Zhejiang University,
Qinchun Road 79#, Hangzhou 310003, China
(Li, Lang, Cao, Wang, Lu, Feng, Yang, Chen, Jiang) Kidney Disease
Immunology Laboratory, The Third Grade Laboratory, State Administration of
Traditional Chinese Medicine of P.R. China, Hangzhou, China
(Li, Lang, Cao, Wang, Lu, Feng, Yang, Chen, Jiang) Key Laboratory of
Multiple Organ Transplantation, Ministry of Health, Hangzhou, China
(Li, Lang, Cao, Wang, Lu, Feng, Yang, Chen, Jiang) Key Laboratory of
Nephropathy, Zhejiang Province, Hangzhou, Zhejiang, China
Title
Effect of remote ischemic preconditioning on postoperative acute kidney
injury among patients undergoing cardiac and vascular interventions: a
meta-analysis.
Source
Journal of Nephrology. 30 (1) (pp 19-33), 2017. Date of Publication: 01
Feb 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
It is currently controversial whether remote ischemic preconditioning
(RIPC) reduces the incidence of acute kidney injury (AKI) in patients
undergoing cardiovascular interventions. The main objective of this
meta-analysis was to investigate whether RIPC provides renal protection
for patients undergoing cardiac or vascular surgery. We searched the
PubMed database (1966-Oct 2015), Embase database (1966-Oct 2015), Google
Scholar, Cochrane Library, ClinicalTrials Database and Open Grey. Then we
conducted a meta-analysis of the randomized controlled trials that met the
inclusion criteria of our study. The interventions included use of an
inflatable tourniquet around the limbs or cross-clamping of the iliac
arteries before surgery (RIPC groups) and general cardiovascular
intervention (control groups). The main outcomes examined included the
incidence of AKI; changes in acute kidney injury biomarkers; and use of
renal replacement therapy. Other outcomes examined included in-hospital
mortality and the lengths of hospital stay and intensive care unit (ICU)
stay. Finally, we screened 26 eligible studies containing 6699 patients
who underwent cardiac or vascular interventions with RIPC (n = 3343) or
without RIPC (n = 3356). The AKI incidence was decreased in the RIPC group
as was the length of ICU stay. There were no differences in the changes in
AKI biomarkers, use of renal replacement therapy or in-hospital mortality
between the two groups. Remote ischemic preconditioning may decrease the
occurrence of AKI in cardiovascular surgery patients. Since studies
included have a significant heterogeneity, meta-analyses using a stricter
inclusion criteria are needed to clarify the renoprotection effect of
RIPC.<br/>Copyright &#xa9; 2016, The Author(s).

<60>
Accession Number
614482798
Author
Peeters M.J.; van den Brand J.A.; van Zuilen A.D.; Koster Y.; Bots M.L.;
Vervloet M.G.; Blankestijn P.J.; Wetzels J.F.
Institution
(Peeters, van den Brand, Wetzels) 464 Department of Nephrology, Radboud
University Medical Center, PO box 9101, Nijmegen 6500 HB, Netherlands
(van Zuilen, Koster, Blankestijn) Department of Nephrology, University
Medical Center Utrecht, Utrecht, Netherlands
(Bots) Julius Center for Health Sciences and Primary Care, University
Medical Center Utrecht, Utrecht, Netherlands
(Vervloet) Department of Nephrology, VU University Medical Center,
Amsterdam, Netherlands
Title
Abdominal aortic calcification in patients with CKD.
Source
Journal of Nephrology. 30 (1) (pp 109-118), 2017. Date of Publication: 01
Feb 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Abdominal aortic calcification (AAC) is independently
associated with cardiovascular events in dialysis patients and in the
general population. However, data in non-dialysis chronic kidney disease
(CKD) patients are limited. We analyzed determinants and prognostic value
of AAC in non-dialysis CKD patients. Methods: We included patients with
CKD not receiving renal replacement therapy from the MASTERPLAN study, a
randomized controlled trial that started in 2004. In the period 2008-2009,
an X-ray to evaluate AAC was performed in a subgroup of patients. We
studied AAC using a semi-quantitative scoring system by lateral lumbar
X-ray. We used baseline and 2-year data to find determinants of AAC. We
used a composite cardiovascular endpoint and propensity score matching to
evaluate the prognostic value of AAC. Results: In 280 patients an X-ray
was performed. In 79 patients (28 %) the X-ray showed no calcification, in
62 patients (22 %) calcification was minor (<4), while 139 patients (50 %)
had moderate or heavy calcification (>=4). Older age, prior cardiovascular
disease, higher triglyceride levels, and higher phosphate levels were
independent determinants of a calcification score >=4. AAC score >=4 was
independently associated with cardiovascular events, with a hazard ratio
of 5.5 (95 % confidence interval 1.2-24.8). Conclusions: Assessment of AAC
can identify CKD patients at higher cardiovascular risk, and may provide
important information for personalized treatment. Whether this approach
will ultimately translate into better outcomes remains to be
answered.<br/>Copyright &#xa9; 2016, The Author(s).

<61>
Accession Number
616552856
Author
Perrotta S.; Lentini S.
Institution
(Perrotta) Department of Cardiothoracic Surgery, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Lentini) Cardiovascular Department, Citta di Lecce Hospital, GVM Care and
Research, Lecce, Italy
Title
Surgical management of severe damage of the aortic annulus.
Source
Hellenic Journal of Cardiology. 57 (6) (pp 382-388), 2016. Date of
Publication: November 2016.
Publisher
Hellenic Cardiological Society
Abstract
Aortic annular erosion and abscess are serious complications of prosthetic
aortic valve endocarditis and can be treated with aortic valve
translocation and left ventricle outflow tract reconstruction. These two
surgical techniques seem to have similar early postoperative outcomes, and
their use can be considered an option after the failure of conventional
surgical methods.<br/>Copyright &#xa9; 2016 Hellenic Society of
Cardiology.

<62>
Accession Number
618442754
Author
Iwanski J.; Knapp S.M.; Avery R.; Oliva I.; Wong R.K.; Runyan R.B.;
Khalpey Z.
Institution
(Iwanski, Wong, Khalpey) Department of Medical Pharmacology, University of
Arizona College of Medicine, Tucson, AZ, USA
(Knapp) BIO5 Institute, Statistics Consulting Lab, University of Arizona,
Tucson, AZ, USA
(Avery, Oliva) Department of Nuclear Medicine, Banner University Medical
Center, Medical Imaging, Tucson, AZ, USA
(Runyan) Department of Cellular and Molecular Medicine, University of
Arizona College of Medicine, Tucson, AZ, USA
(Khalpey) Division of Cardiothoracic Surgery, Department of Surgery,
University of Arizona, Tucson, AZ, USA
(Khalpey) Division of Cardiothoracic Surgery, Regenerative Medicine,
Cellular & Molecular Medicine, University of Arizona College of Medicine,
1656 E. Mabel St, Rm 120, Medical Research Building, Tucson, AZ 85724, USA
Title
Clinical outcomes meta-analysis: measuring subendocardial perfusion and
efficacy of transmyocardial laser revascularization with nuclear imaging.
Source
Journal of cardiothoracic surgery. 12 (1) (pp 37), 2017. Date of
Publication: 19 May 2017.
Abstract
INTRODUCTION: Randomized and nonrandomized clinical trials have tried to
assess whether or not TMR patients experience an increase in myocardial
perfusion. However there have been inconsistencies reported in the
literature due to the use of different nuclear imaging modalities to test
this metric. The primary purpose of this meta-analysis was to determine
whether SPECT, MUGA and PET scans demonstrate changes in myocardial
perfusion between lased and non-lased subjects and whether laser type
affects myocardial perfusion. The secondary purpose was to examine the
overall effect of laser therapy on clinical outcomes including survival,
hospital re-admission and angina reduction.
METHODS: Sixteen studies were included in the primary endpoint analysis
after excluding all other non-imaging TMR papers. Standardized mean
difference was used as the effect size for all quantitative outcomes and
log odds ratio was used as the effect size for all binary outcomes.
RESULTS: Statistically significant improvements in myocardial perfusion
were observed between control and treatment groups in myocardial perfusion
at 6-month follow up using PET imaging with a porcine model. However
non-significant differences were observed in patients at 3 and 12 months
using SPECT, PET or MUGA scans. Both CO2 and Ho:YAG laser systems
demonstrated an increase in myocardial perfusion however this effect was
not statistically significant. In addition both laser types displayed
statistically significant decreases in patient angina at 3, 6 and 12
months but non-significant increases in survival rates and decreases in
hospital re-admissions.
CONCLUSION: In order to properly assess myocardial perfusion in TMR
subjects, subendocardial perfusion needs to be analyzed via nuclear
imaging. PET scans can provide this level of sensitivity and should be
utilized in future studies to monitor and detect perfusion changes in
lased and non-lased subjects.

<63>
Accession Number
618442554
Author
Satdhabudha O.; Noppawinyoowong N.
Institution
(Satdhabudha, Noppawinyoowong) Department of Surgery, Faculty of Medicine,
Thammasat University, 95 Phahonyothin Road, Khlong Nueng, Khlong Luang,
Pathum Thani, 12120, Thailand
Title
A randomized comparison of flow characteristics of semiskeletonized and
pedicled internal thoracic artery preparations in coronary artery bypass.
Source
Journal of cardiothoracic surgery. 12 (1) (pp 28), 2017. Date of
Publication: 16 May 2017.
Abstract
BACKGROUND: Harvesting the internal thoracic artery (ITA) with
semiskeletonization is an alternative technique between conventional wide
pedicle and skeletonization. It is almost as simple as pedicle harvesting;
however, it is supposed to provide the advantage of graft flow and length.
Since the heart is unique being the only organ which is perfused during
diastole, for comparing the intraoperative graft flow characteristics of
semiskeletonization and pedicle technique, we used diastolic filling (DF)
using transit-time flow measurement as a primary result. The objective of
this study is to compare if semiskeletonized ITA has a greater effect on
the intraoperative DF of graft flow versus conventional pedicled ITA in
coronary artery bypass.
METHODS: Between July 2015 and May 2016, a prospective evaluation of 60
consecutive patients undergoing coronary artery bypass grafting for left
anterior descending artery revascularization were randomized to having
semiskeletonized (n=30) or conventional pedicled (n=30) ITA graft
harvested by the same surgeon. Intraoperative transit-time flows were
obtained. The DF of the ITA graft at the end of operation was evaluated in
two groups.
RESULTS: The intraoperative DF was significantly greater in the
semiskeletonized grafts than in the pedicled grafts (70.50+/-14.15 versus
57.6+/-19.39%; p=0.005). No statistical difference was observed comparing
quantitative pulsatile flow and pulsatile index at the end of the
operation in the two groups. However, the free flow of the conduit during
the cardiopulmonary bypass before the anastomosis performed was greater in
semiskeletonized group than in pedicled group (94+/-48.37 versus
56.35+/-34.90 ml/min; p=0.003). The total operative time was comparable
between two groups (p=0.092).
CONCLUSIONS: Semiskeletonized ITA resulted in superior DF of left anterior
descending bypass graft flow as compared with pedicled ITA. It is also
provide a greater free flow and length of the graft without the
long-delayed operative time.
TRIAL REGISTRATION: Trial registration number (Study ID): TCTR20160913002
Date of registration: September 10, 2016.

<64>
Accession Number
618424535
Author
Giuliano S.; Guastalegname M.; Russo A.; Falcone M.; Ravasio V.; Rizzi M.;
Bassetti M.; Viale P.; Pasticci M.B.; Durante-Mangoni E.; Venditti M.
Institution
(Giuliano, Guastalegname, Russo, Falcone, Venditti) Department of Public
Health and Infectious Diseases, Policlinico Umberto I 'Sapienza'
University of Rome, Rome, Italy
(Ravasio, Rizzi) Infectious Diseases Unit, ASST Papa Giovanni XXIII,
Bergamo, Italy
(Bassetti) Infectious Diseases Division, Santa Maria Misericordia
University Hospital, Udine, Italy
(Viale) Infectious Diseases Unit, Department of Medical and Surgical
Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
(Pasticci) Infectious Disease Unit, University of Perugia, Perugia, Italy
(Durante-Mangoni) Department of Clinical and Experimental Medicine,
Universita della Campania 'Luigi Vanvitelli', AORN dei Colli-Ospedale
Monaldi, Naples, Italy
Title
Candida endocarditis: systematic literature review from 1997 to 2014 and
analysis of 29 cases from the Italian Study of Endocarditis.
Source
Expert Review of Anti-Infective Therapy. 15 (9) (pp 807-818), 2017. Date
of Publication: 02 Sep 2017.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Candida Endocarditis (CE) is a deadly disease. It is of
paramount importance to assess risk factors for acquisition of both
Candida native (NVE) and prosthetic (PVE) valve endocarditis and relate
clinical features and treatment strategies with the outcome of the
disease. Areas covered: We searched the literature using the Pubmed
database. Cases of CE from the Italian Study on Endocarditis (SEI) were
also included. Overall, 140 cases of CE were analyzed. Patients with a
history of abdominal surgery and antibiotic exposure had higher
probability of developing NVE than PVE. In the PVE group, time to onset of
CE was significantly lower for biological prosthesis compared to
mechanical prosthesis. In the whole population, greater age and longer
time to diagnosis were associated with increased likelihood of death.
Patients with effective anti-biofilm treatment, patients who underwent
cardiac surgery and patients who were administered chronic suppressive
antifungal treatment showed increased survival. For PVE, moderate active
anti-biofilm and highly active anti-biofilm treatment were associated with
lower mortality. Expert commentary: Both NVE and PVE could be considered
biofilm-related diseases, pathogenetically characterized by Candida
intestinal translocation and initial transient candidemia. Cardiac
surgery, EAB treatment and chronic suppressive therapy might be crucial in
increasing patient survival.<br/>Copyright &#xa9; 2017 Informa UK Limited,
trading as Taylor & Francis Group.

<65>
Accession Number
618419126
Author
Dong Z.; Zheng J.
Institution
(Dong, Zheng) Department of Cardiology, China-Japan Friendship Hospital,
No. 2 Yinghua Dongjie, Beijing 100029, China
Title
Anticoagulation after coronary stenting: A systemic review.
Source
British Medical Bulletin. 123 (1) (pp 79-89), 2017. Date of Publication:
2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Introduction or background: Anticoagulant therapy is mainly used to
prevent patients from suffering coronary and systemic thromboembolism
after stenting. Many studies have been done to formulate an optimized
regimen of a post-PCI or long-time anticoagulant therapy. Recent advances
in the selection and duration of anticoagulant agents will be conducive to
the management of patients who are considered to need anticoagulant
therapy after stenting. Sources of data: Key recent published literature,
including international guidelines and relevant reviews. Areas of
agreement: Anticoagulant therapy has been acknowledged to improve the
prognosis of patients after stenting by reducing the risk of coronary and
systemic thromboembolism. Areas of controversy: Firstly, the benefit-risk
ratio of post-PCI parenteral anticoagulation to prevent stent thrombosis
locally in the coronary artery is still unclear. Secondly, the efficacy
and safety of bivalirudin deserve to be discussed. Furthermore, the
recommendation to use long-time oral anticoagulant therapy to prevent
systemic thromboembolism after stenting should also be emphasized. Growing
points: Studies of anticoagulant therapy in patients after stenting add to
the understanding of an optimized anticoagulant regimen and contribute to
improving clinical outcomes. Areas for developing research (a) The safety
and efficacy of bivalirudin, a direct thrombin inhibitor, need to be
further investigated by more large-scale randomized clinical trials. (b)
Based on the widespread use of ticagrelor and prasugrel for patients who
need longtime oral anticoagulant therapy, further study is needed to find
an optimal strategy that balances the risk of bleeding and ischemic events
after coronary stenting.<br/>Copyright &#xa9; The Author 2017. Published
by Oxford University Press. All rights reserved.

<66>
Accession Number
618422321
Author
Gherli R.; Mariscalco G.; Dalen M.; Onorati F.; Perrotti A.; Chocron S.;
Verhoye J.P.; Gulbins H.; Reichart D.; Svenarud P.; Faggian G.; Santarpino
G.; Fischlein T.; Maselli D.; Dominici C.; Musumeci F.; Rubino A.S.;
Mignosa C.; De Feo M.; Bancone C.; Gatti G.; Maschietto L.; Santini F.;
Nicolini F.; Gherli T.; Zanobini M.; Kinnunen E.-M.; Ruggieri V.G.; Rosato
S.; Biancari F.
Institution
(Gherli, Musumeci) Department of Cardiovascular Sciences, Cardiac Surgery
Unit, San Camillo Forlanini Hospital, Rome, Italy
(Mariscalco) Department of Cardiovascular Sciences, Clinical Sciences
Wing, University of Leicester, Glenfield Hospital, Groby Rd, Leicester LE3
9QP, United Kingdom
(Dalen, Svenarud, Faggian) Department of Molecular Medicine and Surgery,
Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
(Dalen, Svenarud, Faggian) Department of Cardiothoracic Surgery and
Anesthesiology, Karolinska Institutet, Karolinska University Hospital,
Stockholm, Sweden
(Onorati) Division of Cardiovascular Surgery, Verona University Hospital,
Verona, Italy
(Perrotti, Chocron) Department of Thoracic and Cardiovascular Surgery,
University Hospital Jean Minjoz, Besancon, France
(Verhoye, Ruggieri) Division of Cardiothoracic and Vascular Surgery,
Pontchaillou University Hospital, Rennes, France
(Gulbins, Reichart) Hamburg University Heart Center, Hamburg, Germany
(Santarpino, Fischlein) Cardiovascular Center, Paracelsus Medical
University, Nuremberg, Germany
(Maselli, Dominici) Department of Cardiac Surgery, St Anna Hospital,
Catanzaro, Italy
(Rubino, Mignosa) Centro Cuore Morgagni, Pedara, Italy
(De Feo, Bancone) Division of Cardiac Surgery, Department of
Cardiothoracic Sciences, Second University of Naples, Naples, Italy
(Gatti, Maschietto) Division of Cardiac Surgery, Ospedali Riuniti,
Trieste, Italy
(Santini) Division of Cardiac Surgery, University of Genoa, Genoa, Italy
(Nicolini, Gherli) Division of Cardiac Surgery, University of Parma,
Parma, Italy
(Zanobini) Department of Cardiac Surgery, Centro Cardiologico-Fondazione
Monzino, Istituto di Ricovero e Cura A Carattere Scientifico, University
of Milan, Milan, Italy
(Kinnunen, Biancari) Department of Surgery, Oulu University Hospital,
Oulu, Finland
(Rosato) National Institute of Health, Rome, Italy
Title
Safety of preoperative use of ticagrelor with or without aspirin compared
with aspirin alone in patients with acute coronary syndromes undergoing
coronary artery bypass grafting.
Source
JAMA Cardiology. 1 (8) (pp E1-E8), 2016. Date of Publication: November
2016.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE The optimal timing of discontinuation of ticagrelor before
cardiac surgery is controversial. OBJECTIVE To evaluate the safety of
preoperative use of ticagrelor with or without aspirin in patients with
acute coronary syndromes (ACS) undergoing isolated coronary artery bypass
grafting (CABG) compared with aspirin alone. DESIGN, SETTING, AND
PARTICIPANTS This prospective, multicenter clinical trialwas performed at
15 European centers of cardiac surgery. Participants were patients with
ACS undergoing isolated CABG from the European Multicenter Study on
Coronary Artery Bypass Grafting (E-CABG) registry between January and
September 2015. EXPOSURES Before surgery, patients received ticagrelor
with or without aspirin or aspirin alone. MAIN OUTCOMES AND MEASURES
Severe bleeding as defined by the Universal Definition of Perioperative
Bleeding (UDPB) and E-CABG bleeding classification criteria. A propensity
score-matched analysis was performed to adjust for differences in baseline
and operative covariates. RESULTS Of 2482 patients from the E-CABG
registry, the study cohort included 786 (31.7%) consecutive patients with
ACS (mean [SD] age, 67.1 [9.3] years; range, 32-88 years), and 132 (16.8%)
were female. One-to-one propensity score matching provided 215 pairs,
whose baseline and operative covariates had a standardized difference of
less than 10%. Preoperative use of ticagrelor was associated with a
similar risk of bleeding according to the UDPB and E-CABG bleeding
classifications, but the incidence of platelet transfusion was higher in
the ticagrelor group (13.5%[29 of 215] vs 6.0% [13 of 215]. Compared with
those receiving aspirin alone, continuing ticagrelor up to the time of
surgery or discontinuing its use less than 2 days before surgery was
associated with a higher risk of platelet transfusion (22.7%[5 of 22] vs
6.4%[12 of 187]) and E-CABG bleeding grades 2 and 3 (18.2%[4 of 22] vs
5.9% [11 of 187]) and tended to have an increased risk of UDPB grades 3
and 4 (22.7%[5 of 22] vs 9.6%[18 of 187]). Among patients in whom
antiplatelet drug use was discontinued at least 2 days before surgery, the
incidence of platelet transfusion was 12.4%(24 of 193) in the ticagrelor
group and 3.6%(1 of 28) in the aspirin-alone group. CONCLUSIONS AND
RELEVANCE In propensity score-matched analyses among patients with ACS
undergoing CABG, the use of preoperative ticagrelor with or without
aspirin compared with aspirin alone was associated with more platelet
transfusion but similar degree of bleeding; in patients receiving
ticagrelor 1 day before or up until surgery, there was an increased rate
of severe bleeding.<br/>Copyright 2016 American Medical Association. All
rights reserved.

<67>
Accession Number
618426306
Author
Yousif A.; Addison D.; Lakkis N.; Rosengart T.; Virani S.S.; Birnbaum Y.;
Alam M.
Institution
(Yousif) Department of Medicine, Section of Cardiology, University of
Oklahoma School of Medicine, Oklahoma City, OK, United States
(Addison) Department of Medicine, Section of Cardiology, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, United States
(Addison) Department of Internal Medicine, Division of Cardiology,
Massachusetts General Hospital, 165 Cambridge Street, Suite 400, Boston,
MA 02114, United States
(Lakkis, Virani, Birnbaum, Alam) Department of Medicine, Section of
Cardiology, Baylor College of Medicine, Houston, TX, United States
(Rosengart) Department of Surgery, Section of Cardiothoracic Surgery,
Baylor College of Medicine, Houston, TX, United States
(Virani) Center Health Services Research and Development, Michael E.
DeBakey Veterans Affairs Medical Center, Houston, TX, United States
Title
Use of cardiopulmonary pump support during coronary artery bypass grafting
in the high-risk: a meta-analysis.
Source
Irish Journal of Medical Science. (pp 1-9), 2017. Date of Publication: 21
Sep 2017.
Publisher
Springer London
Abstract
Background: Data from randomized trials evaluating the efficacy of on-
versus off-pump coronary artery bypass grafting remain inconclusive,
particularly in high-risk populations. Aims: The aim of this study is to
compare the outcomes associated with on- versus off-pump coronary artery
bypass grafting among high-risk patients. Methods: We performed a
meta-analysis of randomized control trials comparing on- versus off-pump
coronary artery bypass grafting, focusing on high-risk populations.
Studies focusing on "high-risk" features: European System of Cardiac
Operative Risk Evaluation (EuroSCORE) >= 5, age > 70 years, preexisting
renal insufficiency, history of stroke(s), and the presence of left
ventricular dysfunction were included. MEDLINE, Scopus, and Embase were
searched for all publications between January 1, 2000 and August 1, 2016,
using the following terms: on-pump, off-pump, coronary artery bypass,
high-risk, left ventricular dysfunction, elderly, aged, and renal
insufficiency. Endpoints included cardiovascular and all-cause mortality,
non-fatal myocardial infarction, stroke, need for revascularization, renal
failure, and length of hospital stay. Results: Nine studies incorporating
11,374 patients with a mean age of 70 years were selected. There was no
statistical difference in cardiovascular mortality, all-cause mortality,
non-fatal myocardial infarction, and renal failure between the two groups.
There was a decrease in further revascularization at 1 year with on-pump
(OR 0.67 (0.50-0.89)). However, there was an increase in length of
hospital stay by 2.24 days (p = 0.03) among the on-pump group with no
difference in stroke (OR 1.34 (1.00-1.80)). Conclusions: On-pump is
associated with a decreased risk of additional revascularization by 1
year. However, this appears to be a cost of longer
hospitalization.<br/>Copyright &#xa9; 2017 Royal Academy of Medicine in
Ireland

<68>
Accession Number
618418792
Author
Takagi H.; Ando T.; Mitta S.
Institution
(Takagi, Mitta) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, Michigan
Title
Meta-Analysis Comparing >=10-Year Mortality of Off-Pump Versus On-Pump
Coronary Artery Bypass Grafting.
Source
American Journal of Cardiology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Off-pump coronary artery bypass grafting (CABG) is suggested to be
associated with an increase in long-term (>=5-year) all-cause mortality.
To determine whether off-pump CABG is associated with an increase in very
long-term (>=10-year) all-cause mortality, we performed a meta-analysis of
propensity-score matched observational comparative studies of off-pump
versus on-pump CABG. MEDLINE and EMBASE were searched through May 2017. A
hazard ratio of follow-up (including early) all-cause mortality for
off-pump versus on-pump CABG was extracted from each individual study.
Study-specific estimates were combined using inverse variance-weighted
averages of logarithmic hazard ratios in the random-effects model. Of 164
potentially relevant studies, our search identified 16 propensity-score
matched observational comparative studies of off-pump versus on-pump CABG
with >=10-year follow-up enrolling a total of 82,316 patients. A pooled
analysis of all the 16 studies demonstrated that off-pump CABG was
significantly associated with an increase in all-cause mortality (hazard
ratio 1.07, 95% confidence interval 1.03 to 1.12, p for effect = 0.0008; p
for heterogeneity = 0.30, I² = 12%). In a sensitivity analysis,
exclusion of any single hazard ratio from the analysis (leave-one-out
meta-analysis) did not substantively alter the overall result. There was
no evidence of a significant publication bias. In conclusion, off-pump
CABG is associated with an increase in very long-term (>=10 years)
all-cause mortality compared with on-pump CABG.<br/>Copyright &#xa9; 2017
Elsevier Inc.

<69>
Accession Number
616109010
Author
Wang M.; Furnary A.P.; Li H.-F.; Grunkemeier G.L.
Institution
(Wang, Li, Grunkemeier) Medical Data Research Center, Providence Health
and Services, Portland, Oregon, United States
(Furnary) Starr-Wood Cardiothoracic Group, Portland, Oregon, United States
Title
Bioprosthetic Aortic Valve Durability: A Meta-Regression of Published
Studies.
Source
Annals of Thoracic Surgery. 104 (3) (pp 1080-1087), 2017. Date of
Publication: September 2017.
Publisher
Elsevier USA
Abstract
To compare structural valve deterioration (SVD) among bioprosthetic aortic
valve types, a PubMed search found 54 papers containing SVD-free curves
extending to at least 10 years. The curves were digitized and fit to
Weibull distributions, and the mean times to valve failure (MTTF) were
calculated. Twelve valve models were collapsed into four valve types:
Medtronic (Medtronic, Minneapolis, MN) and Edwards (Edwards Lifesciences,
Irvine, CA) porcine; and Sorin (Sorin Group [now LivaNova], London, United
Kingdom) and Edwards pericardial. Meta-regression found MTTF was
associated with the patient's age, publication year, SVD definition, and
valve type. Sorin pericardial valves had significantly lower risk-adjusted
MTTF (higher SVD risk), and there were no significant differences in MTTF
among the other three valve types.<br/>Copyright &#xa9; 2017 The Society
of Thoracic Surgeons

<70>
Accession Number
615293874
Author
Wang Y.; Zhu S.; Gao P.; Zhang Q.
Institution
(Wang, Zhang) Department of Cardiology, West China Hospital, Sichuan
University, 37 Guoxue Street, Chengdu, Sichuan 610041, China
(Zhu) Department of Epidemiology and Biostatistics, School of Public
Health, Sichuan University, Chengdu, Sichuan, China
(Gao) Department of Nephrology, West China Hospital, Sichuan University,
Chengdu, Sichuan, China
Title
Comparison of coronary artery bypass grafting and drug-eluting stents in
patients with chronic kidney disease and multivessel disease: A
meta-analysis.
Source
European Journal of Internal Medicine. 43 (pp 28-35), 2017. Date of
Publication: September 2017.
Publisher
Elsevier B.V.
Abstract
Background The optimal revascularization strategy of coronary artery
bypass grafting (CABG) versus percutaneous coronary intervention with
drug-eluting stent (PCI-DES) in patients with chronic kidney disease (CKD)
and multivessel disease (MVD) remains unclear. Methods Pubmed, EMBASE and
Cochrane Library electronic databases were searched from inception until
June 2016. Studies that evaluate the comparative benefits of DES versus
CABG in CKD patients with multi-vessel disease were considered for
inclusion. We pooled the odds ratios from individual studies and conducted
heterogeneity, quality assessment and publication bias analyses. Results A
total of 11 studies with 29,246 patients were included (17,928 DES
patients; 11,318 CABG). Compared with CABG, pooled analysis of studies
showed DES had higher long-term all-cause mortality (OR, 1.22; p <
0.00001), cardiac mortality (OR, 1.29; p < 0.00001), myocardial infarction
(OR, 1.89; p = 0.02), repeat revascularization (OR, 3.47; p < 0.00001) and
major adverse cardiac and cerebrovascular events (MACCE) (OR, 2.00; p =
0.002), but lower short-term all-cause mortality (OR, 0.33; p < 0.00001)
and cerebrovascular accident (OR, 0.64; p = 0.0001). Subgroup analysis
restricted to patients with end-stage renal disease (ESRD) yielded similar
results, but no significant differences were found regarding CVA and
MACCE. Conclusions CABG for patients with CKD and MVD had advantages over
PCI-DES in long-term all-cause mortality, MI, repeat revascularization and
MACCE, but the substantial disadvantage in short-term mortality and CVA.
Future large randomized controlled trials are certainly needed to confirm
these findings.<br/>Copyright &#xa9; 2017 European Federation of Internal
Medicine

<71>
Accession Number
616740505
Author
Heiberg J.; Nyboe C.; Hjortdal V.E.
Institution
(Heiberg, Hjortdal) Department of Cardiothoracic & Vascular Surgery,
Aarhus University Hospital, Aarhus, Denmark
(Heiberg, Nyboe, Hjortdal) Department of Clinical Medicine, Aarhus
University Hospital, Aarhus, Denmark
(Nyboe) Department of Anesthesiology & Intensive Care, Aarhus University
Hospital, Aarhus, Denmark
Title
Permanent chronotropic impairment after closure of atrial or ventricular
septal defect.
Source
Scandinavian Cardiovascular Journal. 51 (5) (pp 271-276), 2017. Date of
Publication: 03 Sep 2017.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Objectives. Atrial and ventricular septal defects are commonly closed
surgically with low rates of post-operative morbidity, and the long-term
outcome has widely been described as benign. Nevertheless, there is an
increasing understanding of late morbidity, and the possibility of
postoperative chronotropic impairment is continuously questioned.
Furthermore, potentially abnormal chronotropic responses may be associated
with the recently demonstrated overrepresentation of late arrhythmias. We
conducted this review to methodically describe the potential effects of
surgical defect closure on the chronotropic response to exercise. Methods.
We performed a search protocol based on the 'Preferred Reporting Items for
Systematic Reviews and Meta- Analyses' (PRISMA) guidelines. A data
collection form was specifically developed and data were extracted from
the included studies by a primary reviewer and crosschecked by a secondary
reviewer. Results. A search of electronic databases revealed 16
publications, which consistently reported an abnormal heart rate responses
to exercise after surgical closure. In contrast, these and other studies
convincingly showed normal chronotropic response in un-operated patients
as well as after percutaneous closure. Potential mechanisms include
disturbances in the sinoatrial or atrioventricular conduction system and
denervation in the proximity of the aorta during the surgical procedure.
Discussion. ASD and VSD patients have abnormal heart rate responses to
exercise after surgical closure, which indicates a need of change in the
preoperative information given to these patients and their parents before
surgical defect closure. Although there may not be any alternatives to
surgery, patients should still be informed about potential long-term
consequences, including the risk of chronotropic incompetence. Moreover,
this review suggests that 'specialized', long-term follow up may be
indicated.<br/>Copyright &#xa9; 2017 Informa UK Limited, trading as Taylor
& Francis Group.

<72>
Accession Number
615708965
Author
Issitt R.W.; Harvey I.; Walsh B.; Voegeli D.
Institution
(Issitt) Perfusion Department, Great Ormond Street Hospital for Children,
London, United Kingdom
(Issitt, Walsh, Voegeli) Faculty of Health Sciences, University of
Southampton, Southampton, United Kingdom
(Harvey) Perfusion Department, John Radcliffe Hospital, Oxford, United
Kingdom
Title
Quantification of Lipid Filtration and the Effects on Cerebral Injury
During Cardiopulmonary Bypass.
Source
Annals of Thoracic Surgery. 104 (3) (pp 884-890), 2017. Date of
Publication: September 2017.
Publisher
Elsevier USA
Abstract
Background Lipid microemboli (LME) are formed in pericardial suction blood
which, when returned to the cardiopulmonary bypass (CPB) circuit, can pass
through filter materials and are returned to the arterial cannula. LME
have been observed to enter all major organs and have been associated with
small capillary arteriolar dilatations in the brains of patients who have
died after CPB. However, a causal relationship showing correlation between
LME and organ dysfunction has not been demonstrated, or whether removal of
LME results in improved organ function. Methods A prospective, single
center, randomized controlled trial examined 30 patients (15 per group)
undergoing coronary artery bypass grafting using CPB with or without a
lipid-depleting filter. The effects of LME filtration on neurocognitive
injury were assessed using neuron-specific enolase (NSE). Results The
study group showed a significant reduction in LME after filtration of the
pericardial suction blood (p < 0.001), whereas the control group exhibited
a significant rise in LME (p < 0.001). There was a significant reduction
in peak NSE release (p = 0.013) and significant attenuation throughout the
postoperative period (p = 0.002). Correlation and regression analyses
showed a significant relationship between the number of LME post-CPB and
peak NSE release (r = 0.42, p = 0.02). Conclusions Several methods of LME
filtration have been proposed, but none provided a suitable, efficacious
method for use within the clinical setting. The RemoweLL CPB system
removes significant numbers of LME from the cardiotomy suction.
Furthermore, LME correlate to the release of a known marker of neurologic
injury.<br/>Copyright &#xa9; 2017 The Society of Thoracic Surgeons

<73>
Accession Number
616977707
Author
Rezk M.E.
Institution
(Rezk) Cardiothoracic Surgery Department, Benha University, Benha, Egypt
Title
Role of ascorbic acid in reduction of the incidence of the atrial
fibrillation in patients under B-blocker and undergoing coronary artery
bypass graft operation in early post-operative period.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. 25 (3) (pp
198-203), 2017. Date of Publication: September 2017.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background The study was done to project the important role of the
anti-inflammatory and anti -oxidant properties of Ascorbic acid (vitamin
C) in reducing the incidence of atrial fibrillation (AF) in the early
post-operative period after coronary artery bypass graft operation (CABG).
Methods This prospective randomized study included 100 patients admitted
to cardio-thoracic surgery department, Benha University Hospital, Benha,
Egypt between 2011 and 2016. Those patients scheduled for CABG, were
randomized into two groups of patients: the first; group 1: A fifty CABG
patients were given beta -blocker (bisoprolol 5 mg o.d.) & ascorbic acid
(2 g daily in divided doses qds) for at least three days pre-operatively.
The second; group 2: A fifty CABG patients were given beta -blocker
(bisoprolol 5 mg o.d.) for at least three days pre-operatively. Patients
were followed up for AF after (CABG) for the short term of 3 weeks.
Results The incidence of AF after CABG in1st 48 h and after 1 month was
statistically significantly lower in Group 1 than Group 2 with p value
0.022 and 0.025 respectively. Intensive care unit stay, need for inotropic
support and ventilator stay were also significantly decreased in Group1
than Group 2 with p value 0.035, 0.045 and 0.048 respectively. Conclusions
The incidence of post CABG AF, intensive care unit stay, need for
inotropic support and ventilator stay were decreased by patients intake of
vitamin C in combination with beta -blockers
pre-operatively.<br/>Copyright &#xa9; 2017 The Egyptian Society of
Cardio-thoracic Surgery

<74>
Accession Number
609147989
Author
Zhou X.; Yu J.; Li L.; Gloy V.L.; Nordmann A.; Tiboni M.; Li Y.; Sun X.
Institution
(Zhou, Yu, Li, Li, Sun) Chinese Evidence-based Medicine Center, West China
Hospital, Sichuan University, Chengdu, China
(Li, Li, Sun) Clinical Research and Evaluation Unit, West China Hospital,
Sichuan University, Chengdu, China
(Gloy, Nordmann) Basel Institute of Clinical Epidemiology & Biostatistics,
University Hospital Basel, Hebelstrasse 10, Basel, Switzerland
(Tiboni) Saint Joseph's Hospital and McMaster University, Hamilton, ON,
Canada
(Sun) Center for Evidence-Based Medicine and Clinical Research, Taihe
Hospital, Hubei University of Medicine, Shiyan, Hubei 44200, China
Title
Effects of Bariatric Surgery on Mortality, Cardiovascular Events, and
Cancer Outcomes in Obese Patients: Systematic Review and Meta-analysis.
Source
Obesity Surgery. 26 (11) (pp 2590-2601), 2016. Date of Publication: 01 Nov
2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: The long-term effects of bariatric surgery have yet to be
established, and a number of important studies have recently emerged. This
systematic review aimed to assess the effects of bariatric surgery on
all-cause mortality, cardiovascular events, and cancer compared to
non-surgical treatment. Methods: We searched PubMed, EMBASE, and CENTRAL
up to July 13, 2015, and included randomized controlled trials (RCTs) and
non-randomized controlled studies comparing bariatric surgery versus
non-surgical treatment and reporting data on the three defined outcomes at
1 year or longer. We analyzed RCTs and non-randomized controlled studies,
respectively. Results: Eleven RCTs, 4 non-randomized controlled trials,
and 17 cohort studies were included. The randomized evidence suggested
substantial uncertainty regarding the effects on all-cause mortality
(0/382 vs. 1/287; 7 studies), cancer (OR 0.77, 95 % CI 0.22 to 2.71; 4
studies), and cardiovascular events (no data). The pooled adjusted
estimates from non-randomized studies suggested that, compared to the
control, the surgical group had lower risk of all-cause mortality (OR
0.55, 95 % CI 0.46 to 0.65; 10 studies), cancer (OR 0.74, 95 % CI 0.65 to
0.85; 2 studies), and cardiovascular events (MI: OR 0.71, 95 % CI 0.54 to
0.94; stroke: OR 0.66, 95 % CI 0.49 to 0.89; and their composite: OR 0.67,
95 % CI 0.54 to 0.83; 1 study). Conclusions: In conclusion, bariatric
surgery could reduce all-cause mortality and probably reduce the risk of
any type of cancer. The inference was, however, based on studies with
limited methodological rigor. Uncertainty remains regarding the effects on
cardiovascular events.<br/>Copyright &#xa9; 2016, Springer
Science+Business Media New York.

<75>
Accession Number
609105316
Author
Lakomkin N.; Sathiyakumar V.; Dodd A.C.; Jahangir A.A.; Whiting P.S.;
Obremskey W.T.; Sethi M.K.
Institution
(Lakomkin, Sathiyakumar, Dodd, Jahangir, Obremskey, Sethi) Vanderbilt
Orthopaedic Institute Center for Health Policy, Medical Center East, 1215
21st Avenue South, South Tower, Nashville, TN 37232, United States
(Whiting) University of Wisconsin Hospital and Clinics, 1685 Highland Ave,
Madison, WI 53704, United States
Title
Pre-operative labs: Wasted dollars or predictors of post-operative cardiac
and septic events in orthopaedic trauma patients?.
Source
Injury. 47 (6) (pp 1217-1221), 2016. Date of Publication: 01 Jun 2016.
Publisher
Elsevier Ltd
Abstract
Purpose As US healthcare expenditures continue to rise, there is
significant pressure to reduce the cost of inpatient medical services.
Studies have estimated that over 70% of routine labs may not yield
clinical benefits while adding over $300 in costs per day for every
inpatient. Although orthopaedic trauma patients tend to have longer
inpatient stays and hip fractures have been associated with significant
morbidity, there is a dearth of data examining pre-operative labs in
predicting post-operative adverse events in these populations. The purpose
of this study was to assess whether pre-operative labs significantly
predict post-operative cardiac and septic complications in orthopaedic
trauma and hip fracture patients. Methods Between 2006 and 2013, 56,336
(15.6%) orthopaedic trauma patients were identified and 27,441 patients
(7.6%) were diagnosed with hip fractures. Pre-operative labs included
sodium, BUN, creatinine, albumin, bilirubin, SGOT, alkaline phosphatase,
white count, hematocrit, platelet count, prothrombin time, INR, and
partial thromboplastin time. For each of these labs, patients were deemed
to have normal or abnormal values. Patients were noted to have developed
cardiac or septic complications if they sustained (1) myocardial
infarction (MI), (2) cardiac arrest, or (3) septic shock within 30 days
after surgery. Separate regressions incorporating over 40 patient
characteristics including age, gender, pre-operative comorbidities, and
labs were performed for orthopaedic trauma patients in order to determine
whether pre-operative labs predicted adverse cardiac or septic outcomes.
Results 749 (1.3%) orthopaedic trauma patients developed cardiac
complications and 311 (0.6%) developed septic shock. Multivariate
regression demonstrated that abnormal pre-operative platelet values were
significantly predictive of post-operative cardiac arrest (OR: 11.107, p =
0.036), and abnormal bilirubin levels were predictive (OR: 8.487, p =
0.008) of the development of septic shock in trauma patients. In the hip
fracture cohort, abnormal partial thromboplastin time was significantly
associated with post-operative myocardial infarction (OR: 15.083, p =
0.046), and abnormal bilirubin (OR: 58.674, p = 0.002) significantly
predicted the onset of septic shock. Conclusions This is the first study
to demonstrate the utility of pre-operative labs in predicting
perioperative cardiac and septic adverse events in orthopaedic trauma and
hip fracture patients. Particular attention should be paid to
haematologic/coagulation labs (platelets, PTT) and bilirubin values. Level
of evidence Prognostic Level II.<br/>Copyright &#xa9; 2016 Elsevier Ltd.
All rights reserved.

<76>
Accession Number
611114097
Author
Jujo K.; Saito K.; Ishida I.; Kim A.; Suzuki Y.; Furuki Y.; Ouchi T.;
Ishii Y.; Sekiguchi H.; Yamaguchi J.; Ogawa H.; Hagiwara N.
Institution
(Jujo, Sekiguchi, Yamaguchi, Ogawa, Hagiwara) Department of Cardiology,
Tokyo Women's Medical University, Tokyo, Japan
(Jujo, Saito, Ishida, Kim, Suzuki, Furuki, Ouchi) Department of
Cardiology, Nishiarai Heart Center Hospital, Tokyo, Japan
(Ishii) Department of Cardiology, Cardiovascular Center, Ogikubo Hospital,
Tokyo, Japan
Title
Intimal disruption affects drug-eluting cobalt-chromium stent expansion: A
randomized trial comparing scoring and conventional balloon predilation.
Source
International Journal of Cardiology. 221 (pp 23-31), 2016. Date of
Publication: 15 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Stent expansion remains one of the most important predictors of
restenosis and subacute thrombosis, even with the use of drug-eluting
stents. This study was designed to clarify the impact of lesion
preparation on final stent expansion. Methods Sixty-six consecutive
patients were included in this trial, and ultimately 52 enrolled
non-calcified de novo lesions were randomly assigned to undergo single
predilation with either a semi-compliant scoring balloon or a
semi-compliant conventional balloon. Lesions were treated with a single
2.5- to 3.0-mm cobalt-chromium everolimus-eluting stent under optical
coherence tomography (OCT) guidance without post-stenting dilation. Stent
expansion was defined as the ratio of OCT-measured minimum stent area to
the predicted stent area. Results Stent expansion was significantly higher
after predilation by a scoring balloon (68.0% vs. 62.1%, p = 0.017) with
similar stent lumen eccentricity (0.84 vs. 0.80, p = 0.18). Intimal
disruption was induced significantly more frequently (68.0% vs. 38.4%, p =
0.035) and was more extensive in the scoring group (122degree vs.
65degree, p = 0.038). Lesions with intimal disruption after predilation
achieved significantly higher stent expansion than that without it (67.7%
vs. 61.6%, p = 0.023). One case in the conventional group required target
lesion revascularization; however, any other adverse clinical events
including death, myocardial infarction, and stent thrombosis were not
observed up to 9 months after PCI in both groups. Conclusions In this
randomized study, pretreatment with a scoring balloon enhanced stent
expansion partly through induction of intimal disruption. Clinical trial
registration: URL: http://www.umin.ac.jp/ctr/index.htm. Unique identifier:
UMIN000014176.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd

<77>
Accession Number
611114110
Author
Pagnesi M.; Martino E.A.; Chiarito M.; Mangieri A.; Jabbour R.J.; Van
Mieghem N.M.; Kodali S.K.; Godino C.; Landoni G.; Colombo A.; Latib A.
Institution
(Pagnesi, Chiarito, Mangieri, Jabbour, Godino, Colombo, Latib)
Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan,
Italy
(Martino, Landoni) Department of Anesthesia and Intensive Care, IRCCS San
Raffaele Scientific Institute, Milan, Italy
(Jabbour, Colombo, Latib) Interventional Cardiology Unit, EMO-GVM Centro
Cuore Columbus, Milan, Italy
(Jabbour) Imperial College, London, United Kingdom
(Van Mieghem) Department of Interventional Cardiology, Thoraxcenter,
Erasmus Medical Center, Rotterdam, Netherlands
(Kodali) Department of Medicine, Columbia University Medical Center/New
York Presbyterian Hospital, New York, NY, United States
(Landoni, Colombo) Vita-Salute San Raffaele University, Milan, Italy
Title
Silent cerebral injury after transcatheter aortic valve implantation and
the preventive role of embolic protection devices: A systematic review and
meta-analysis.
Source
International Journal of Cardiology. 221 (pp 97-106), 2016. Date of
Publication: 15 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background The aims of this study were: 1) to evaluate silent cerebral
injury detected by cerebral diffusion weighted magnetic resonance imaging
(DW-MRI) after transcatheter aortic valve implantation (TAVI); and 2) to
assess the efficacy of embolic protection devices (EPDs) on DW-MRI
endpoints. Methods We included in a pooled analysis 25 prospective studies
reporting post-procedural cerebral DW-MRI data after TAVI (n = 1225).
Among these studies, we included in a meta-analysis 6 studies
investigating TAVI performed with versus without EPDs (n = 384). Primary
endpoints were the number of new lesions per patient and the total lesion
volume, while secondary endpoints were the number of patients with new
lesions and the single lesion volume. Results The main pooled DW-MRI
outcomes were: patients with new ischemic lesions, 77.5% (95% confidence
interval = 71.7-83.3%); total lesion volume, 437.5 mm³
(286.7-588.3 mm³); single lesion volume, 78.1 mm³
(56.7-99.5 mm³); and number of new lesions per patient, 4.2
(3.4-5.0). The use of EPDs was associated with a significant reduction in
total lesion volume (mean difference [95% confidence interval] = - 111.1
mm³ [- 203.6 to - 18.6 mm³]; p = 0.02) and single
lesion volume (- 12.1 mm³ [- 18.3 to - 6.0 mm³]; p =
0.0001) after TAVI. Conclusions Silent cerebral injury occurs in the
majority of patients undergoing TAVI and DW-MRI allows a precise
characterization of new ischemic brain lesions. EPDs reduce the total and
single volume of such lesions detected after the procedure, although the
number of new lesions per patient and the number of patients with new
lesions are not significantly reduced by such devices.<br/>Copyright
&#xa9; 2016 Elsevier Ireland Ltd

<78>
Accession Number
611114101
Author
Takagi H.; Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
Title
Impact of paravalvular aortic regurgitation after transcatheter aortic
valve implantation on survival.
Source
International Journal of Cardiology. 221 (pp 46-51), 2016. Date of
Publication: 15 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives To determine whether >= moderate paravalvular aortic
regurgitation (PAR) after transcatheter aortic valve implantation (TAVI)
independently impairs overall survival and how much the impact on survival
is, we performed an updated meta-analysis pooling not unadjusted but
adjusted hazard ratios (HRs). Methods Databases including MEDLINE and
EMBASE were searched through January 2016 using PubMed and OVID. Search
terms included paravalvular or perivalvular; regurgitation, leak, or
leakage; percutaneous, transcatheter, transluminal, transarterial,
transapical, transaortic, transcarotid, transaxillary, transsubclavian,
transiliac, transfemoral, or transiliofemoral; and aortic valve. Studies
considered for inclusion met the following criteria: the design was an
observational comparative study; the study population was patients
undergoing TAVI; patients were divided into >= moderate and <= mild
post-TAVI PAR; outcomes included >= 1-year all-cause mortality; and the
adjustment method was a multivariate Cox proportional hazards analysis. An
adjusted HR with its 95% confidence interval (CI) for >= moderate
post-TAVI PAR was abstracted from each individual study. Results Our
search identified 17 eligible studies including a total of 15,131
patients. A pooled analysis of all the 17 studies demonstrated a
statistically significant 2.12-fold increase in mortality with >= moderate
PAR (HR, 2.12; 95% CI, 1.79 to 2.51; p < 0.00001). Exclusion of any single
study from the meta-analysis did not substantively alter the overall
result disfavoring >= moderate PAR. Although the statistical tests
suggested funnel plot asymmetry, the corrected effect estimate from the
trim-and-fill method demonstrated still a statistically significant
1.83-fold risk of mortality with >= moderate PAR. Conclusions >= Moderate
post-TAVI PAR is associated with a 2.12-fold increase in overall (>=
1-year) all-cause mortality.<br/>Copyright &#xa9; 2016 Elsevier Ireland
Ltd

<79>
Accession Number
611104741
Author
Sardar P.; Chatterjee S.; Kundu A.; Samady H.; Owan T.; Giri J.; Nairooz
R.; Selzman C.H.; Heusch G.; Gersh B.J.; Abbott J.D.; Mukherjee D.; Fang
J.C.
Institution
(Sardar, Owan, Fang) Division of Cardiovascular Medicine, University of
Utah, Salt Lake City, UT, United States
(Chatterjee) St Luke's-Roosevelt Hospital of the Mount Sinai Health
System, New York, NY, United States
(Kundu) Department of Medicine, University of Massachusetts Medical
School, Worcester, MA, United States
(Samady) Division of Cardiology, Department of Medicine, Emory University
School of Medicine, Atlanta, GA, United States
(Giri) Cardiovascular Division, Hospital of the University of
Pennsylvania, Philadelphia, PA, United States
(Nairooz) University of Arkansas for Medical Sciences, Little Rock, AR,
United States
(Selzman) Division of Cardiothoracic Surgery, Department of Surgery,
University of Utah, Salt Lake City, UT, United States
(Heusch) Institute for Pathophysiology, West German Heart and Vascular
Center, University of Essen Medical School, Hufelandstr. 55, Essen 45122,
Germany
(Gersh) Division of Cardiovascular Diseases, Mayo Clinic and Mayo Clinic
College of Medicine, Rochester, MN, United States
(Abbott) Division of Cardiology, Brown Medical School, Rhode Island
Hospital, Providence, RI, United States
(Mukherjee) Texas Tech University Health Sciences Center, El Paso, TX,
United States
Title
Remote ischemic preconditioning in patients undergoing cardiovascular
surgery: Evidence from a meta-analysis of randomized controlled trials.
Source
International Journal of Cardiology. 221 (pp 34-41), 2016. Date of
Publication: 15 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Remote ischemic preconditioning (RIPC) has been associated with
reduced risk of myocardial injury in patients undergoing cardiovascular
surgery, but uncertainty about clinical outcomes remains, particularly in
the light of 2 recent large randomized clinical trials (RCTs) which were
neutral. We performed a meta-analysis to evaluate the efficacy of RIPC on
clinically relevant outcomes in patients undergoing cardiovascular
surgery. Methods We searched PubMed, Cochrane CENTRAL, EMBASE, EBSCO, Web
of Science and CINAHL databases from inception through November 30, 2015.
RCTs that compared the effects of RIPC vs. control in patients undergoing
cardiac and/or vascular surgery were selected. We calculated summary
random-effect odds ratios (ORs) and 95% confidence intervals (CI). Results
The analysis included 5652 patients from 27 RCTs. RIPC reduced the risk of
myocardial infarction (MI) (OR 0.72, 95% CI, 0.52 to 1.00; p = 0.05;
number needed to treat (NNT) = 42), acute renal failure (OR 0.73, 95% CI,
0.53 to 1.00; p = 0.05; NNT = 44) as well as the composite of all cause
mortality, MI, stroke or acute renal failure (OR 0.60, 95% CI, 0.39 to
0.90; p = 0.01; NNT = 25). No significant difference between RIPC and the
control groups was observed for the outcome of all-cause mortality (OR
1.10, 95% CI, 0.81 to 1.51). Randomization to RIPC group was also
associated with significantly shorter hospital stay (weighted mean
difference - 0.15 days; 95% CI - 0.27 to - 0.03 days). Conclusions RIPC
did not decrease overall mortality, but was associated with less MI and
acute renal failure and shorter hospitalizations in patients undergoing
cardiac or vascular surgery.<br/>Copyright &#xa9; 2016 Elsevier Ireland
Ltd

<80>
Accession Number
609203021
Author
Tam M.K.P.; Wong W.T.; Gomersall C.D.; Tian Q.; Ng S.K.; Leung C.C.H.;
Underwood M.J.
Institution
(Tam, Ng) Department of Anaesthesia and Intensive Care, Prince of Wales
Hospital, Shatin, Hong Kong
(Wong, Gomersall, Tian, Leung) Department of Anaesthesia and Intensive
Care, The Chinese University of Hong Kong, Shatin, Hong Kong
(Underwood) Division of Cardiothoracic Surgery, Department of Surgery, The
Chinese University of Hong Kong, Shatin, Hong Kong
Title
A randomized controlled trial of 2 protocols for weaning cardiac surgical
patients receiving adaptive support ventilation.
Source
Journal of Critical Care. 33 (pp 163-168), 2016. Date of Publication: 01
Jun 2016.
Publisher
W.B. Saunders
Abstract
Purpose: This study aims to compare the effectiveness of weaning with
adaptive support ventilation (ASV) incorporating progressively reduced or
constant target minute ventilation in the protocol in postoperative care
after cardiac surgery. Material and methods: A randomized controlled
unblinded study of 52 patients after elective coronary artery bypass
surgery was carried out to determine whether a protocol incorporating a
decremental target minute ventilation (DTMV) results in more rapid weaning
of patients ventilated in ASV mode compared to a protocol incorporating a
constant target minute ventilation. Results: Median duration of mechanical
ventilation (145 vs 309 minutes; P =.001) and intubation (225 vs 423
minutes; P =.005) were significantly shorter in the DTMV group. There was
no difference in adverse effects (42% vs 46%) or mortality (0% vs 0%)
between the 2 groups. Conclusions: Use of a DTMV protocol for
postoperative ventilation of cardiac surgical patients in ASV mode results
in a shorter duration of ventilation and intubation without evidence of
increased risk of adverse effects.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<81>
Accession Number
609947229
Author
Zhang L.; Diao Y.; Chen G.; Tanaka A.; Eastwood G.M.; Bellomo R.
Institution
(Zhang, Diao) Department of Nephrology, West China Hospital of Sichuan
University, Sichuan, Chengdu, China
(Chen) Department of Anesthesiology, Austin Hospital, 145 Studley Road,
Heidelberg, VIC 3084, Australia
(Zhang, Tanaka, Eastwood, Bellomo) Department of Intensive Care Unit,
Austin Hospital, 145 Studley Road, Heidelberg, VIC 3084, Australia
(Eastwood, Bellomo) Australian and New Zealand Intensive Care Research
Centre, Melbourne, VIC, Australia
Title
Remote ischemic conditioning for kidney protection: A meta-analysis.
Source
Journal of Critical Care. 33 (pp 224-232), 2016. Date of Publication: 01
Jun 2016.
Publisher
W.B. Saunders
Abstract
Background: Results from randomized controlled trials (RCTs) concerning
kidney effect of remote ischemic conditioning (RIC) are inconsistent.
Methods: We searched for relevant studies in Medline, Embase, the Cochrane
Library, Google Scholar and Chinese database (SinoMed), as well as
relevant references from their inception to November 2015. We performed a
systematic review and meta-analysis of all eligible RCTs of RIC with
kidney events. Results: We included 37 RCTs from 2007 to 2015 involving
8168 patients. Pooled analyses of all RCTs showed RIC significantly
reduced the incidence of investigator-defined acute kidney injury (AKI)
compared with control groups (RR 0.84, 95% CI 0.73-0.96, P =.009)
(I² = 25%). However, the difference was not significant when
only RIFLE (Risk, Injury, Failure, Loss, End Stage), AKIN (Acute Kidney
Injury Network), or KDIGO (Kidney Disease Improving Global Outcomes)
criteria were applied to the definition of AKI (RR 0.87, 95% CI 0.74-1.02,
P =.08) (I² = 22%). In subgroup analysis, RIC showed a
significant benefit on reducing investigator-defined AKI in patients
following percutaneous coronary intervention (RR 0.64, 95% CI 0.46-0.87),
but not after cardiac surgery (RR 0.93, 95% CI 0.82-1.06). There was no
difference for changes in the incidence of renal replacement therapy,
estimated glomerular filtration rate or serum creatinine. Conclusions: RIC
might be beneficial for the prevention of investigator-defined AKI;
however, the effect is likely small. Moreover, due to lack of an effect on
use of renal replacement therapy, estimated glomerular filtration rate,
RIFLE, AKIN, or KDIGO-defined AKI, and serum creatinine, the evidence for
RIC is not robust. Finally, recent large-scale RCTs of RIC focusing on
patient-centered outcomes do not support the wider application of
RIC.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<82>
Accession Number
611770769
Author
Van Mieghem N.M.; Van Gils L.; Ahmad H.; Van Kesteren F.; Van Der Werf
H.W.; Brueren G.; Storm M.; Lenzen M.; Daemen J.; Van Den Heuvel A.F.M.;
Tonino P.; Baan J.; Koudstaal P.J.; Schipper M.E.I.; Lugt A.V.D.; De
Jaegere P.P.T.
Institution
(Van Mieghem, Van Gils, Lenzen, Daemen, De Jaegere) Department of
Cardiology, Erasmus Medical Center, Gravendijkwal 230, Rotterdam 3015 CE,
Netherlands
(Ahmad, Lugt) Department of Radiology, Erasmus Medical Center, Rotterdam,
Netherlands
(Van Kesteren, Baan) Department of Cardiology, Academic Medical Center,
Amsterdam, Netherlands
(Van Der Werf, Van Den Heuvel) Department of Cardiology, University
Medical Center Groningen, Groningen, Netherlands
(Brueren, Tonino) Department of Cardiology, Catharina Ziekenhuis,
Eindhoven, Netherlands
(Storm, Koudstaal) Department of Neurology, Erasmus Medical Center,
Rotterdam, Netherlands
(Schipper) Department of Pathology, Erasmus Medical Center, Rotterdam,
Netherlands
Title
Filter-based cerebral embolic protection with transcatheter aortic valve
implantation: The randomised MISTRAL-C trial.
Source
EuroIntervention. 12 (4) (pp 499-507), 2016. Date of Publication: July
2016.
Publisher
EuroPCR
Abstract
Aims: Our aim was to determine whether use of the filter-based Sentinel
Cerebral Protection System (CPS) during transcatheter aortic valve
implantation (TAVI) can affect the early incidence of new brain lesions,
as assessed by diffusion-weighted magnetic resonance imaging (DW-MRI), and
neurocognitive performance. Methods and results: From January 2013 to July
2015, 65 patients were randomised 1:1 to transfemoral TAVI with or without
the Sentinel CPS. Patients underwent DW-MRI and extensive neurological
examination, including neurocognitive testing one day before and five to
seven days after TAVI. Follow-up DW-MRI and neurocognitive testing was
completed in 57% and 80%, respectively. New brain lesions were found in
78% of patients with follow-up MRI. Patients with the Sentinel CPS had
numerically fewer new lesions and a smaller total lesion volume (95 mm3
[IQR 10-257] vs. 197 mm3 [95-525]). Overall, 27% of Sentinel CPS patients
and 13% of control patients had no new lesions. Ten or more new brain
lesions were found only in the control cohort (in 20% vs. 0% in the
Sentinel CPS cohort, p=0.03). Neurocognitive deterioration was present in
4% of patients with Sentinel CPS vs. 27% of patients without (p=0.017).
The filters captured debris in all patients with Sentinel CPS protection.
Conclusions: Filter-based embolic protection captures debris en route to
the brain in all patients undergoing TAVI. This study suggests that its
use can lead to fewer and overall smaller new brain lesions, as assessed
by MRI, and preservation of neurocognitive performance early after
TAVI.<br/>Copyright &#xa9; Europa Digital & Publishing 2016. All rights
reserved.

<83>
Accession Number
613179298
Author
Rickard C.M.; Edwards M.; Spooner A.J.; Mihala G.; Marsh N.; Best J.;
Wendt T.; Rapchuk I.; Gabriel S.; Thomson B.; Corley A.; Fraser J.F.
Institution
(Rickard, Edwards, Spooner, Marsh, Best, Wendt, Corley, Fraser) AVATAR
Group, NHMRC Centre of Research Excellence in Nursing, Menzies Health
Institute Queensland, Griffith University, Nathan, Queensland 4111,
Australia
(Edwards, Spooner, Best, Wendt, Corley, Fraser) Critical Care Research
Group, The University of Queensland and The Prince Charles Hospital,
Chermside, Queensland 4032, Australia
(Mihala) Centre for Applied Health Economics, Menzies Health Institute
Queensland, School of Medicine, Griffith University, Meadowbrook,
Queensland 4131, Australia
(Marsh) Centre for Clinical Nursing, Royal Brisbane and Women's Hospital,
Herston, Queensland 4006, Australia
(Rapchuk) Department of Anaesthesia, The Prince Charles Hospital,
Chermside, Queensland 4032, Australia
(Gabriel) Cardiac Surgery Research Unit, The Prince Charles Hospital,
Chermside, Queensland 4032, Australia
(Thomson) Department of Cardiac Surgery, The Prince Charles Hospital,
Chermside, Queensland 4032, Australia
Title
A 4-arm randomized controlled pilot trial of innovative solutions for
jugular central venous access device securement in 221 cardiac surgical
patients.
Source
Journal of Critical Care. 36 (pp 35-42), 2016. Date of Publication: 01 Dec
2016.
Publisher
W.B. Saunders
Abstract
Purpose To improve jugular central venous access device (CVAD) securement,
prevent CVAD failure (composite: dislodgement, occlusion, breakage, local
or bloodstream infection), and assess subsequent trial feasibility.
Materials and Methods Study design was a 4-arm, parallel, randomized,
controlled, nonblinded, pilot trial. Patients received CVAD securement
with (i) suture + bordered polyurethane (suture + BPU; control), (ii)
suture + absorbent dressing (suture + AD), (iii) sutureless securement
device + simple polyurethane (SSD + SPU), or (iv) tissue adhesive + simple
polyurethane (TA + SPU). Midtrial, due to safety, the TA + SPU
intervention was replaced with a suture + TA + SPU group. Results A total
of 221 patients were randomized with 2 postrandomization exclusions.
Central venous access device failure was as follows: suture + BPU
controls, 2 (4%) of 55 (0.52/1000 hours); suture + AD, 1 (2%) of 56
(0.26/1000 hours, P = .560); SSD + SPU, 4 (7%) of 55 (1.04/1000 hours, P =
.417); TA + SPU, 4 (17%) of 23 (2.53/1000 hours, P = .049); and suture +
TA + SPU, 0 (0%) of 30 (P = .263; intention-to-treat, log-rank tests).
Central venous access device failure was predicted (P < .05) by baseline
poor/fair skin integrity (hazard ratio, 9.8; 95% confidence interval,
1.2-79.9) or impaired mental state at CVAD removal (hazard ratio, 14.2;
95% confidence interval, 3.0-68.4). Conclusions Jugular CVAD securement is
challenging in postcardiac surgical patients who are coagulopathic and
mobilized early. TA + SPU was ineffective for CVAD securement and is not
recommended. Suture + TA + SPU appeared promising, with zero CVAD failure
observed. Future trials should resolve uncertainty about the comparative
effect of suture + TA + SPU, suture + AD, and SSD + SPU vs suture +
BPU.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<84>
Accession Number
617171955
Author
O'Byrne M.L.; Kim S.; Hornik C.P.; Yerokun B.A.; Matsouaka R.A.; Jacobs
J.P.; Jacobs M.L.; Jonas R.A.
Institution
(O'Byrne) 1Division of Cardiology Children's National Health System,
Department of Pediatrics George Washington University of Health Sciences,
Washington DC; 2Duke Clinical Research Institute, Duke University School
of Medicine, Durham, NC; 3Department of Pediatrics, Duke University School
of Medicine, Durham, NC; 4Department of Biostatistics and Bioinformatics,
Duke University, Durham, NC; 5Division of Cardiovascular Surgery, Johns
Hopkins All Children's Heart Institute, Johns Hopkins University School of
Medicine, St. Petersburg, FL; 6Division of Cardiac Surgery, Johns Hopkins
University School of Medicine, Baltimore, MD; 7Division of Cardiothoracic
Surgery Children's National Health System, Department of Surgery George
Washington University of Health Sciences, Washington DC
Title
Effect of Obesity and Underweight Status on Perioperative Outcomes of
Congenital Heart Operations in Children, Adolescents, and Young Adults: An
Analysis of Data from the Society of Thoracic Surgeons Database.
Source
Circulation. (no pagination), 2017. Date of Publication: 30 Jun 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND-: Extreme BMI (either very high or very low) has been
associated with increased risk of adverse perioperative outcome in adults
undergoing cardiac surgery. The effect of body-mass index (BMI) on
perioperative outcomes in congenital heart disease patients has not been
evaluated. METHODS-: A multicenter retrospective cohort study was
performed studying patients 10-35 years undergoing a congenital heart
disease operation in the Society of Thoracic Surgeons Congenital Heart
Surgery Database between 1/1/2010-12/31/2015. The primary outcomes were
operative mortality and a composite outcome (one or more of operative
mortality, major adverse event, prolonged hospital length of stay, and
wound infection/dehiscence). The associations between age and sex-adjusted
BMI percentiles and these outcomes were assessed, adjusting for patient
level risk factors, using multivariate logistic regression. RESULTS-: Of
18,337 patients (118 centers), 16% were obese, 15% overweight, 53% normal
weight, 7% underweight and 9% were severely underweight. Observed risks of
operative mortality (p=0.04) and composite outcome (p<0.0001) were higher
in severely underweight and obese subjects. Severely underweight BMI was
associated with increased unplanned cardiac operation and reoperation for
bleeding. Obesity was associated with increased risk of wound infection.
In multivariable analysis, the association between BMI and operative
mortality was no longer significant. Obese (OR: 1.28 p=0.008), severely
underweight (OR: 1.29 p<0.0001) and underweight subjects (OR: 1.39
p=0.002) subjects were associated with increased risk of composite
outcome. CONCLUSIONS-: Obesity and underweight BMI were associated with
increased risk of composite adverse outcome independent of other risk
factors. Further research is necessary to determine whether BMI represents
a modifiable risk factor for perioperative outcome.<br/>Copyright &#xa9;
2017 by the American College of Cardiology Foundation and the American
Heart Association, Inc.

<85>
Accession Number
610371374
Author
Emmert A.; Franke R.; Brandes I.F.; Hinterthaner M.; Danner B.C.; Bauer
M.; Brauer A.
Institution
(Emmert, Franke, Hinterthaner, Danner) Department of Thoracic and
Cardiovascular Surgery, University Medical Center, Georg-August
University, Goettingen, Germany
(Brandes, Bauer, Brauer) Department of Anesthesiology, University Medical
Center, Georg-August University,Goettingen, Germany
Title
Comparison of Conductive and Convective Warming in Patients Undergoing
Video-Assisted Thoracic Surgery: A Prospective Randomized Clinical Trial.
Source
Thoracic and Cardiovascular Surgeon. (no pagination), 2016. Date of
Publication: 03 Apr 2016.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Background Perioperative hypothermia is frequent during thoracic surgery.
After approval by the local ethics committee and written informed consent
from patients, we examined the efficiency of prewarming and intraoperative
warming with a convective warming system and conductive warming system to
prevent perioperative hypothermia during video-assisted thoracic surgery
(VATS). Methods We randomized 60 patients with indication for VATS in two
groups (convective warming with an underbody blanket vs. conductive
warming with an underbody mattress and additional warming of the legs).
All patients were prewarmed before induction of anesthesia with the
corresponding system. Core temperature was measured sublingual and in the
nasopharynx. Results Both groups were not significantly different in
regard to clinical parameter, prewarming, and initial core temperature.
The patients in conduction group had lower intraoperative core
temperatures and a higher incidence of intraoperative (73.9 vs. 24%) and
postoperative hypothermia (56.5 vs. 8%) compared with convective warming.
Conclusions Pre- and intraoperative convective warming with an underbody
blanket prevents perioperative hypothermia during VATS better than
conductive warming. The inferior prevention in conductive warming group
may be caused by reduced body contact to the warming mattresses in lateral
position.<br/>Copyright &#xa9; 2016, Georg Thieme Verlag KG. All rights
reserved.

<86>
Accession Number
618369584
Author
Anonymous
Source
Anaesthesiology Intensive Therapy. Conference: 19. Miedzynarodowy Zjazd
Polskiego Towarzystwa Anestezjologii i Intensywnej Terapii. Poland. 49 (no
pagination), 2017. Date of Publication: 2017.
Publisher
Via Medica
Abstract
The proceedings contain 141 papers. The topics discussed include:
assessment of changes of regional ventilation distribution in the lung
tissue depending on the drive pressure applied during high frequency jet
ventilation; effects of balanced crystalloids and colloids on haemostasis:
in vitro assessment; effects of local anesthetics on cell cycle
distribution of ovarian cancer cell line (A2780) in vitro; effect of
ropivacaine on nitric oxide production in cord blood neutrophils regarding
the role of nitric oxide synthase; systemic concentrations of nitric oxide
metabolites during sevoflurane- vs propofol-based anesthesia for on-pump
coronary artery bypass grafting; continuous and single-shot paravertebral
block compared to epidural anesthesia for hydronephrosis surgery in
children; and an effect of one lung ventilation on oxygen reserve index
(ORI) in patients undergoing elective thoracic surgery.

<87>
Accession Number
618369545
Author
Samborska R.; Czerniak K.; Pacesz A.; Kulinska K.; Pielok J.; Plotek W.;
Billert H.
Institution
(Samborska, Pielok, Plotek) Oddzial Kardiochirurgii, Wielospecjalistyczny
Szpital Miejski, im. J. Strusia w Poznaniu, Poznan, Poland
(Czerniak, Pacesz, Kulinska, Billert) Zaklad Anestezjologii
Doswiadczalnej, Katedra Anestezjologii i Intensywnej Terapii, Uniwersytet
Medyczny, im. K. Marcinkowskiego w Poznaniu, Poznan, Poland
Title
Systemic concentrations of nitric oxide metabolites during sevoflurane-vs
propofol-based anesthesia for on-pump coronary artery bypass grafting.
Source
Anaesthesiology Intensive Therapy. Conference: 19. Miedzynarodowy Zjazd
Polskiego Towarzystwa Anestezjologii i Intensywnej Terapii. Poland. 49 (pp
6), 2017. Date of Publication: 2017.
Publisher
Via Medica
Abstract
Background: Optimization of anesthetic management of patients undergoing
cardiopulmonary bypass is under strong debate [1]. Impact of various
techniques on inflammatory reaction and its clinical signifcance has not
been sufciently cleared. Nitric oxide (NO) and its metabolites (NOx) play
a complex role in systemic inflammatory reaction during coronary artery
bypass grafting (CABG) and are critical for cardioprotection and optimal
graft function [2]. Whether sevoflurane-vs propofol-based anesthesia tech
nique would differentially influence perioperative systemic NOx levels in
this patient cohort is not known. We hypothesized that nitrite and nitrate
concentrations change during cardiopulmonary bypass depending on
anesthesia technique. Methods: Forty patients (EF > 40%), undergoing
planned procedure of conventional normothermic CABG were randomized into 2
groups depending on anesthesia method: sevoflurane-vs propofol-based
technique. Plasma nitrite and nitrate were estimated by chemiluminescent
method before induction, before extracorporeal circulation (ECC), 10 min
after aorta clamping, 10 min after clamp release, 30 min after weaning
from ECC, and after admission to postoperative unit. Results: No
differences in nitrite and nitrate concentrations between the studied
groups at particular time points could be observed. In propofol group,
lower nitrite levels starting after aorta clamping persisted till the end
of the study period, whereas in sevoflurane group this decrease appeared
signifcant only after ICU admission. Conclusions: Volatile
anesthestic-based regimens are currently recommended for cardiac surgery
procedures. We show that in CABG patients intraoperative NOx systemic
levels change irrespectively of anesthesia choice. This observation is in
line with previous report in general surgery patients [3].

<88>
Accession Number
617542596
Author
Estcourt L.J.; Malouf R.; Hopewell S.; Trivella M.; Doree C.; Stanworth
S.J.; Murphy M.F.
Institution
(Estcourt) NHS Blood and Transplant, Haematology/Transfusion Medicine,
Level 2, John Radcliffe Hospital, Headington, Oxford OX3 9BQ, United
Kingdom
(Malouf) University of Oxford, National Perinatal Epidemiology Unit
(NPEU), Old Road Campus, Oxford OX3 7LF, United Kingdom
(Hopewell) University of Oxford, Oxford Clinical Trials Research Unit,
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal
Sciences, Windmill Road, Oxford, Oxfordshire OX3 7LD, United Kingdom
(Trivella) University of Oxford, Centre for Statistics in Medicine, Botnar
Research Centre, Windmill Road, Oxford OX3 7LD, United Kingdom
(Doree) NHS Blood and Transplant, Systematic Review Initiative, John
Radcliffe Hospital, Oxford OX3 9BQ, United Kingdom
(Stanworth) Oxford University Hospitals NHS Foundation Trust and
University of Oxford, National Institute for Health Research (NIHR) Oxford
Biomedical Research Centre, John Radcliffe Hospital, Headley Way,
Headington, Oxford OX3 9BQ, United Kingdom
(Murphy) Oxford University Hospitals NHS Foundation Trust and University
of Oxford, NHS Blood and Transplant National Inst. for Health Research
(NIHR) Oxford Biomedical Research Centre, John Radcliffe Hospital,
Headington, Oxford, United Kingdom
Title
Pathogen-reduced platelets for the prevention of bleeding.
Source
Cochrane Database of Systematic Reviews. 2017 (7) (no pagination), 2017.
Article Number: CD009072. Date of Publication: 30 Jul 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Platelet transfusions are used to prevent and treat bleeding
in people who are thrombocytopenic. Despite improvements in donor
screening and laboratory testing, a small risk of viral, bacterial, or
protozoal contamination of platelets remains. There is also an ongoing
risk from newly emerging blood transfusion-transmitted infections for
which laboratory tests may not be available at the time of initial
outbreak. One solution to reduce the risk of blood transfusion-transmitted
infections from platelet transfusion is photochemical pathogen reduction,
in which pathogens are either inactivated or significantly depleted in
number, thereby reducing the chance of transmission. This process might
offer additional benefits, including platelet shelf-life extension, and
negate the requirement for gamma-irradiation of platelets. Although
current pathogen-reduction technologies have been proven to reduce
pathogen load in platelet concentrates, a number of published clinical
studies have raised concerns about the effectiveness of pathogen-reduced
platelets for post-transfusion platelet count recovery and the prevention
of bleeding when compared with standard platelets. This is an update of a
Cochrane review first published in 2013. Objectives: To assess the
effectiveness of pathogen-reduced platelets for the prevention of bleeding
in people of any age requiring platelet transfusions. Search methods: We
searched for randomised controlled trials (RCTs) in the Cochrane Central
Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue
9), MEDLINE (from 1946), Embase (from 1974), CINAHL (from 1937), the
Transfusion Evidence Library (from 1950), and ongoing trial databases to
24 October 2016. Selection criteria: We included RCTs comparing the
transfusion of pathogen-reduced platelets with standard platelets, or
comparing different types of pathogen-reduced platelets. Data collection
and analysis: We used the standard methodological procedures expected by
Cochrane. Main results: We identified five new trials in this update of
the review. A total of 15 trials were eligible for inclusion in this
review, 12 completed trials (2075 participants) and three ongoing trials.
Ten of the 12 completed trials were included in the original review. We
did not identify any RCTs comparing the transfusion of one type of
pathogen-reduced platelets with another. Nine trials compared Intercept
pathogen-reduced platelets to standard platelets, two trials compared
Mirasol pathogen-reduced platelets to standard platelets; and one trial
compared both pathogen-reduced platelets types to standard platelets.
Three RCTs were randomised cross-over trials, and nine were parallel-group
trials. Of the 2075 participants enrolled in the trials, 1981 participants
received at least one platelet transfusion (1662 participants in Intercept
platelet trials and 319 in Mirasol platelet trials). One trial included
children requiring cardiac surgery (16 participants) or adults requiring a
liver transplant (28 participants). All of the other participants were
thrombocytopenic individuals who had a haematological or oncological
diagnosis. Eight trials included only adults. Four of the included studies
were at low risk of bias in every domain, while the remaining eight
included studies had some threats to validity. Overall, the quality of the
evidence was low to high across different outcomes according to GRADE
methodology. We are very uncertain as to whether pathogen-reduced
platelets increase the risk of any bleeding (World Health Organization
(WHO) Grade 1 to 4) (5 trials, 1085 participants; fixed-effect risk ratio
(RR) 1.09, 95% confidence interval (CI) 1.02 to 1.15; I² = 59%,
random-effect RR 1.14, 95% CI 0.93 to 1.38; I² = 59%;
low-quality evidence). There was no evidence of a difference between
pathogen-reduced platelets and standard platelets in the incidence of
clinically significant bleeding complications (WHO Grade 2 or higher) (5
trials, 1392 participants; RR 1.10, 95% CI 0.97 to 1.25; I² =
0%; moderate-quality evidence), and there is probably no difference in the
risk of developing severe bleeding (WHO Grade 3 or higher) (6 trials, 1495
participants; RR 1.24, 95% CI 0.76 to 2.02; I² = 32%;
moderate-quality evidence). There is probably no difference between
pathogen-reduced platelets and standard platelets in the incidence of
all-cause mortality at 4 to 12 weeks (6 trials, 1509 participants; RR
0.81, 95% CI 0.50 to 1.29; I² = 26%; moderate-quality
evidence). There is probably no difference between pathogen-reduced
platelets and standard platelets in the incidence of serious adverse
events (7 trials, 1340 participants; RR 1.09, 95% CI 0.88 to 1.35;
I² = 0%; moderate-quality evidence). However, no bacterial
transfusion-transmitted infections occurred in the six trials that
reported this outcome. Participants who received pathogen-reduced platelet
transfusions had an increased risk of developing platelet refractoriness
(7 trials, 1525 participants; RR 2.94, 95% CI 2.08 to 4.16; I²
= 0%; high-quality evidence), though the definition of platelet
refractoriness differed between trials. Participants who received
pathogen-reduced platelet transfusions required more platelet transfusions
(6 trials, 1509 participants; mean difference (MD) 1.23, 95% CI 0.86 to
1.61; I² = 27%; high-quality evidence), and there was probably
a shorter time interval between transfusions (6 trials, 1489 participants;
MD -0.42, 95% CI -0.53 to -0.32; I² = 29%; moderate-quality
evidence). Participants who received pathogen-reduced platelet
transfusions had a lower 24-hour corrected-count increment (7 trials, 1681
participants; MD -3.02, 95% CI -3.57 to -2.48; I² = 15%;
high-quality evidence). None of the studies reported quality of life. We
did not evaluate any economic outcomes. There was evidence of subgroup
differences in multiple transfusion trials between the two
pathogen-reduced platelet technologies assessed in this review (Intercept
and Mirasol) for all-cause mortality and the interval between platelet
transfusions (favouring Intercept). Authors' conclusions: Findings from
this review were based on 12 trials, and of the 1981 participants who
received a platelet transfusion only 44 did not have a haematological or
oncological diagnosis. In people with haematological or oncological
disorders who are thrombocytopenic due to their disease or its treatment,
we found high-quality evidence that pathogen-reduced platelet transfusions
increase the risk of platelet refractoriness and the platelet transfusion
requirement. We found moderate-quality evidence that pathogen-reduced
platelet transfusions do not affect all-cause mortality, the risk of
clinically significant or severe bleeding, or the risk of a serious
adverse event. There was insufficient evidence for people with other
diagnoses. All three ongoing trials are in adults (planned recruitment
1375 participants) with a haematological or oncological
diagnosis.<br/>Copyright &#xa9; 2017 The Cochrane Collaboration.

<89>
Accession Number
614229287
Author
Guinot P.-G.; Abou-Arab O.; Guilbart M.; Bar S.; Zogheib E.; Daher M.;
Besserve P.; Nader J.; Caus T.; Kamel S.; Dupont H.; Lorne E.
Institution
(Guinot, Abou-Arab, Guilbart, Bar, Zogheib, Daher, Besserve, Dupont,
Lorne) Department of Anaesthesiology and Critical Care Medicine, Amiens
University Hospital, Place Victor Pauchet, Amiens 80054, France
(Guinot, Nader, Caus, Kamel, Dupont, Lorne) INSERM U1088, Jules Verne
University of Picardy, Amiens 80054, France
(Nader, Caus) Department of Cardiac Surgery, Amiens University Hospital,
Amiens 80054, France
Title
Monitoring dynamic arterial elastance as a means of decreasing the
duration of norepinephrine treatment in vasoplegic syndrome following
cardiac surgery: a prospective, randomized trial.
Source
Intensive Care Medicine. 43 (5) (pp 643-651), 2017. Date of Publication:
01 May 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: To evaluate the ability of an algorithm based on dynamic arterial
elastance to decrease the duration of norepinephrine treatment. Methods:
We performed a prospective, open-label, randomized study in patients
requiring norepinephrine for vasoplegic syndrome after cardiac surgery
with cardiopulmonary bypass. Patients were randomized to an
algorithm-based intervention group or a control group. The primary outcome
was the duration of norepinephrine treatment. The secondary outcomes
included the total dose of norepinephrine, the length of stay (LOS) in the
ICU, central venous oxygen saturation, arterial lactate levels, arrhythmia
and diuresis. Results: Of 130 included patients, 118 were analysed on an
intention-to-treat basis (intervention group: n = 59; control group: n =
59). On inclusion, the intervention and control groups did not differ
significantly in terms of demographic characteristics, surgical data or
the prior duration of norepinephrine treatment [5 h (4-10) vs. 5 h (5-7),
respectively; P = 0.543]. The cumulative duration of norepinephrine
treatment after inclusion was shorter in the intervention group than in
the control group [17 h (13-26)] vs. 39 h (19-58), respectively; (P <
0.001). The cumulative dose of norepinephrine and the LOS in the ICU were
also lower in the intervention group (P < 0.05). There were no intergroup
differences for other outcomes (the sepsis-related organ failure score,
central venous oxygen saturation, arrhythmia, and arterial lactate
levels). Conclusion: A haemodynamic algorithm based on dynamic arterial
elastance was associated with a shorter duration of norepinephrine
treatment and a shorter LOS in the ICU. Use of the algorithm did not alter
perfusion parameters or increase the volume of fluid infused.
ClinicalTrials.gov Identifier: NCT02479529.<br/>Copyright &#xa9; 2017,
Springer-Verlag Berlin Heidelberg and ESICM.

<90>
Accession Number
617562274
Author
Buttar S.N.; Yan T.D.; Taggart D.P.; Tian D.H.
Institution
(Buttar, Yan, Tian) Collaborative Research (CORE) Group, Macquarie
University, Sydney, Australia
(Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital,
University of Sydney, Sydney, Australia
(Taggart) Nuffield Department of Surgical Sciences, University of Oxford,
John Radcliffe Hospital, Oxford, United Kingdom
(Tian) Royal North Shore Hospital, Sydney, Australia
Title
Long-term and short-term outcomes of using bilateral internal mammary
artery grafting versus left internal mammary artery grafting: A
meta-analysis.
Source
Heart. 103 (18) (pp 1419-1426), 2017. Date of Publication: 01 Sep 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background A substantial body of evidence demonstrates that myocardial
revascularisation using bilateral internal mammary arteries (BIMA)
improves long-term survival compared with single/left internal mammary
artery (LIMA) grafting. To date, limited analyses have been made regarding
other short-term and long-term outcomes in BIMA strategy. Objectives The
primary aim of the present review is to update the difference in long-term
survival between BIMA and LIMA grafting and to thoroughly investigate
other secondary short-term and long-term clinical outcomes between these
two grafting procedures. Methods Electronic searches were performed using
three databases from their inception to November 2015. Relevant studies
comparing long-term survival between BIMA and LIMA grafting were
identified. Data were extracted by two independent reviewers and analysed
according to predefined clinical outcomes. Results Twenty-nine
observational studies were identified, with a total of 89 399 patients.
Overall, BIMA cohort had significantly improved long-term survival
compared with LIMA cohort (HR 0.78; p<0.00001). BIMA cohort also had
significantly reduced hospital mortality rates (1.2% vs 2.1%, p=0.04),
cerebrovascular accidents (1.3% vs 2.9%, p=0.0003) and need for
revascularisation (4.8% vs 10%, p=0.005), although the incidence of deep
sternal wound infection (DSWI) was increased (1.8% vs 1.4%, p=0.0008) in
this grafting strategy. Long-term cardiac-free, myocardial infarction-free
and angina-free survivals were also superior for the BIMA cohort.
Conclusions BIMA grafting is associated with enhanced overall long-term
outcomes compared with LIMA grafting. While the BIMA cohort demonstrates
an increased incidence of DSWI, the survival benefits and other morbidity
advantages outweigh this short-term risk.<br/>Copyright &#xa9; Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article) 2017. All rights reserved.

<91>
Accession Number
614524495
Author
Scholz-Kreisel P.; Spix C.; Blettner M.; Eckerle S.; Faber J.; Wild P.;
Merzenich H.; Hennewig U.
Institution
(Scholz-Kreisel, Blettner, Merzenich) Institute for Medical Biostatistics,
Epidemiology and Informatics, University Medicine of the Johannes
Gutenberg-University Mainz, Mainz, Germany
(Spix) German Childhood Cancer Registry at the Institute for Medical
Biostatistics, Epidemiology and Informatics, University Medicine of the
Johannes Gutenberg-University Mainz, Mainz, Germany
(Eckerle, Faber) Department of Pediatric Hematology/Oncology, University
Medicine of the Johannes Gutenberg-University Mainz, Mainz, Germany
(Wild) Preventive Cardiology and Preventive Medicine, Center for
Cardiology, University Medical Center of the Johannes Gutenberg-University
Mainz, Mainz, Germany
(Wild) Center for Thrombosis and Hemostasis, University Medical Center of
the Johannes Gutenberg-University Mainz, Mainz, Germany
(Wild) German Center for Cardiovascular Research (DZHK), Partner Site
RhineMain, Mainz, Germany
(Wild) Center for Translational Vascular Biology (CTVB), University
Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
(Hennewig) Department of Paediatric Haematology and Oncology, Center for
Paediatrics, University Hospital Giesen and Marburg, Giessen, Germany
Title
Prevalence of cardiovascular late sequelae in long-term survivors of
childhood cancer: A systematic review and meta-analysis.
Source
Pediatric Blood and Cancer. 64 (7) (no pagination), 2017. Article Number:
e26428. Date of Publication: July 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Cardiovascular diseases are well-known late effects of
childhood cancer and research on these late effects is a highly important
emerging field. We conducted a systematic review with a meta-analysis to
give an overview of the current evidence and the prevalence of late
cardiovascular events. Procedure: We included publications in which the
study populations were children and adolescents who survived cancer.
Outcome was defined as all cardiovascular clinical and subclinical
endpoints or diagnoses appearing at least one year after cancer diagnosis.
A systematic overview is presented for all included studies. A
quantitative meta-analysis was conducted for hypertension and stroke.
Results: Sixty-four papers were included in the review. The age range at
cancer diagnosis was 0-24 years; age at the end of follow-up ranged from 7
to 71 years. Prevalence of cardiovascular late effects varied from 0% for
stroke up to 70% for subclinical hypertension. Large heterogeneity was
found regarding study size, study design, definition of endpoints, and
investigation/examination method. The weighted average prevalence was
19.7% for hypertension and 2.3% for stroke. As no specific results for
gender, cancer therapy, or age at cancer diagnosis were present in most
papers, a detailed comparison and pooled analysis was difficult.
Conclusion: This review showed the vast range of cardiovascular late
effects after childhood or adolescent cancer therapy. The differences
between the papers prevented drawing a conclusive picture of the
prevalence of cardiovascular late effects. Large cohort studies and better
reporting are needed to improve the knowledge on this topic.<br/>Copyright
&#xa9; 2017 Wiley Periodicals, Inc.

<92>
Accession Number
614130504
Author
Racca V.; Bordoni B.; Castiglioni P.; Modica M.; Ferratini M.
Institution
(Racca, Bordoni, Modica, Ferratini) Cardiology Rehabilitation Center,
Santa Maria Nascente Institute-IRCCS, Don C. Gnocchi Foundation, Milan,
Italy
(Castiglioni) Biomedical Technology Department, Santa Maria Nascente
Institute-IRCCS, Don C. Gnocchi Foundation, Milan, Italy
Title
Osteopathic Manipulative Treatment Improves Heart Surgery Outcomes: A
Randomized Controlled Trial.
Source
Annals of Thoracic Surgery. 104 (1) (pp 145-152), 2017. Date of
Publication: July 2017.
Publisher
Elsevier USA
Abstract
Background Controlling sternal pain after heart surgery is important to
reduce the risk of postoperative complications, but pain is often
undertreated because of contraindications and side effects of analgesic
drugs. Recently, osteopathic manipulative treatment (OMT) was demonstrated
to reduce pain in different clinical contexts, suggesting its potential
utility after cardiac surgery. The aim of this open-label, controlled
study is to assess whether OMT contributes to sternal pain relief and
improves postoperative outcomes. Methods Eighty post-sternotomy adult
inpatients were randomly allocated one to one to receive a standardized
cardiorespiratory rehabilitation program alone (control group) or combined
with OMT. Pain intensity and respiratory functional capacity were
quantified by the Visual Analogue Scale score and by a standardized
breathing test, at the start and end of rehabilitation. Results At the
start of rehabilitation, the control group and the OMT group had similar
Visual Analogue Scale median scores (controls 4, interquartile range
[IQR]: 2 to 5; OMT 4, IQR: 3 to 5; p = not significant) and mean
inspiratory volumes (controls 825 +/- 381 mL; OMT 744 +/- 291 mL; p = not
significant). At the end of rehabilitation, the OMT group had a lower
Visual Analogue Scale median score (controls 3, IQR: 2 to 4; OMT 1, IQR: 1
to 2; p < 0.01) and higher mean inspiratory volume (controls 1,400 +/- 588
mL; OMT 1,781 +/- 633 mL; p < 0.01). The analgesic drug intake was similar
in the two groups. The hospitalization was shorter in the OMT group than
in the control group (19.1 +/- 4.8 versus 21.7 +/- 6.3 days; p < 0.05).
Conclusions The combination of standard care with OMT is effective in
inducing pain relief and functional recovery, and significantly improves
the management of patients after heart surgery with
sternotomy.<br/>Copyright &#xa9; 2017 The Society of Thoracic Surgeons

<93>
Accession Number
614429183
Author
Sanchez Munoz M.C.; De Kock M.; Forget P.
Institution
(Sanchez Munoz) Anesthesiology Department, Cliniques Universitaires
Saint-Luc, Institute of Neuroscience (Pole CEMO), Universite Catholique de
Louvain, Brussels, Belgium
(De Kock) Anesthesiology department, Centre hospitalier de Wallonie
Picarde (CHWAPI), Tournai, Belgium
(Forget) Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel
(UZ Brussel), department of Anesthesiology and Perioperative Medicine,
Brussels, Belgium
Title
What is the place of clonidine in anesthesia? Systematic review and
meta-analyses of randomized controlled trials.
Source
Journal of Clinical Anesthesia. 38 (pp 140-153), 2017. Date of
Publication: 01 May 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective A place for clonidine has been suggested for many
indications in perioperative medicine. The aim of this systematic review
and these meta-analyses is to systematically, and quantitatively, evaluate
these potential indications of clonidine. Design, setting, patients and
interventions We selected and analyzed (qualitatively and, when possible,
quantitatively) the available literature published on PubMed/Medline and
on the Cochrane database. Inclusion criteria included: human randomized
controlled trials involving adults who received perioperative systemic
(oral, intramuscular, transdermal and intravenous) clonidine for every
type of surgery. Measurements and main results We identified 775 trials
and thereafter excluded 718 and analyzed 57 trials concerning, in total,
14,790 patients of whom 7408 received clonidine and 6836 received placebo.
Most important results shows that, in qualitative and quantitative
analyses, clonidine vs placebo reduces analgesics consumption in,
respectively, (159 vs 154 patients: 24%, 95%CI[16%-32%]; p < 0.001),
reduces nausea and vomiting (risk ratio, in 180 vs 181 patients: 0.35,
95%CI[0.25-0.51]; p < 0.001), improves hemodynamic stability (reduction of
HR: 14.9 bpm, 95%CI[10.4-19.5]; p < 0.001; reduction of the MAP: 12.5 mm
Hg, 95%CI[7.14-17.86]; p < 0.001); 1 min after tracheal intubation, in 67
vs 68 patients), prevents postoperative shivering (risk ratio, in 140 vs
140 patients: 0.17, 95%CI[0.10-0.29]; p < 0.001). On the other hand,
clonidine does not have any influence on renal and cardiac outcomes
(adverse events rates, in 5873 vs 5533 patients: 0.00, 95%CI[- 0.10-0.11];
p = 0.96) and does not prolong awakening time. Conclusions In conclusion,
these systematic review and meta-analyses of 57 trials confirm that
clonidine improves pain control, reduces PONV, improves hemodynamic and
sympathetic stability, with no adverse consequences on renal function or
awakening time, but does not influence cardiac outcome in the general
population, after non-cardiac surgery. Nevertheless, given the high
heterogeneity between the studies, this does not exclude different results
in patient subgroups or specific procedures.<br/>Copyright &#xa9; 2017

<94>
[Use Link to view the full text]
Accession Number
611064365
Author
Di Giammarco G.; Marinelli D.; Foschi M.; Di Mauro M.
Institution
(Di Giammarco, Marinelli, Foschi, Di Mauro) Department of Cardiac Surgery,
University G. d'Annunzio, Chieti, Italy
Title
Intraoperative graft verification in coronary surgery.
Source
Journal of Cardiovascular Medicine. 18 (5) (pp 295-304), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Transit-time flow measurement (TTFM) is a reliable method to check the
graft function intraoperatively in coronary surgery. The given parameters
are: Mean Graft Flow (MGF); Pulsatility Index (PI) and Insufficiency Ratio
(%BF). Some cutoffs of these parameters have been identified as predictors
for unfair 1-y clinical outcome: mean graft flow (MGF) less than 20 ml/min
and high pulsatility index greater than 5. Other cutoffs have been found
as related to postoperative angiography: MGF 15 ml/min or less and
pulsatility index at least 3 (sensitivity 94%; specificity 61%); MGF less
than 15 ml/min and pulsatility index greater than 3 for left coronary
artery or pulsatility index greater than 5 for right coronary artery
(sensitivity 96%; specificity 77%); MGF 15 ml/min or less and pulsatility
index at least 5.1 left coronary artery (sensitivity 98%; specificity
26%). Hence, with the need to improve the diagnostic accuracy of TTFM, a
high-resolution epicardic coronary ultrasound module has been added to
graft flow evaluation providing 2D ultrasound imaging (either in
short-axis or long-axis) and color-flow mapping, allowing an accurate
morphological evaluation of body graft and anastomosis. An intraoperative
method aimed to verify coronary grafts should be easy to handle, not time
consuming, minimally invasive, easily meaningful and relatively cheap; in
addition, it should offer objective parameters more than qualitative
criteria. We herein report the results of our experience with
intraoperative graft verification with TTFM and high-resolution imaging
along with a systematic review of the literature in this field with the
aim to provide a road map to be followed.<br/>Copyright &#xa9; 2017
Italian Federation of Cardiology. All rights reserved.

<95>
Accession Number
615608566
Author
Heliczer N.; Gerber V.; Bruckmaier R.; Van Der Kolk J.H.; De Solis C.N.
Institution
(Heliczer, Gerber, Bruckmaier, Van Der Kolk) Swiss Institute of Equine
Medicine, Department of Veterinary Clinical Science and Veterinary
Physiology, Vetsuisse Faculty, University of Bern and Agroscope, Bern
CH-3012, Switzerland
(De Solis) Texas Veterinary Medical Center, Texas A&M University, College
Station, TX 77843, United States
Title
Cardiovascular findings in ponies with equine metabolic syndrome.
Source
Journal of the American Veterinary Medical Association. 250 (9) (pp
1027-1035), 2017. Date of Publication: 01 May 2017.
Publisher
American Veterinary Medical Association (E-mail: avmainfo@avma.org)
Abstract
OBJECTIVE To determine whether hypertension, high sympathetic tone,
resting and exercising arrhythmias, and echocardiographic changes
consistent with hypertensive cardiomyopathy were associated with equine
metabolic syndrome (EMS) in ponies. DESIGN Prospective case-control study.
ANIMALS 19 privately owned ponies with a diagnosis of EMS (history of
laminitis, body condition score >= 7/9, cresty neck score >= 3/5, and
abnormal oral sugar test result; cases) and 20 healthy control ponies.
PROCEDURES Heart rate (HR), noninvasively measured arterial blood pressure
(BP), markers of autonomic tone (splenic volume and HR variability),
24-hour and exercising ECGs, and echocardiograms were compared between
cases and controls. RESULTS Compared with controls, cases had a higher
mean +/- SD HR (44.5 +/- 7.5 beats/min vs 38.6 +/- 6.8 beats/min) and
median mean left ventricular wall thickness (2.0 cm vs 1.8 cm). No
differences were identified between groups in BP, splenic volume, HR
variability, and number of premature complexes in ECGs. Mean wall
thickness was correlated with BP (r = 0.54), high-frequency power (r =
-0.71), and ratio of low- to high-frequency power (rho = 0.66). Relative
wall thickness was correlated with serum insulin concentration (r = 0.71).
CONCLUSIONS AND CLINICAL RELEVANCE Ponies with EMS had myocardial
hypertrophy that was correlated with insulin response to an oral sugar
test, sympathetic and parasympathetic tone, and BP. The heterogeneity and
limited sample size of this preliminary study should be considered when
drawing conclusions. Cardiovascular changes associated with this syndrome
deserve further attention.<br/>Copyright &#xa9; 2017, American Veterinary
Medical Association. All rights reserved.

<96>
Accession Number
618278324
Author
Besen B.A.M.P.; Park M.; Nassar A.P.
Institution
(Besen, Park, Nassar) Hospital das Clinicas, University of Sao Paulo
Medical School, Medical Intensive Care Unit, Medical Emergencies
Discipline, Sao Paulo, Brazil
(Besen) Hospital da Luz, Intensive Care Unit, Sao Paulo, Brazil
(Nassar) A.C. Camargo Cancer Center, Intensive Care Unit, Sao Paulo,
Brazil
Title
Accounting for single center effects in systematic reviews cannot be
overlooked.
Source
Critical Care. 21 (1) (no pagination), 2017. Article Number: 241. Date of
Publication: 15 Sep 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)

<97>
Accession Number
618277671
Author
Lee P.H.; Lee J.-Y.; Lee C.W.; Han S.; Ahn J.-M.; Park D.-W.; Kang S.-J.;
Lee S.-W.; Kim Y.-H.; Park S.-W.; Park S.-J.
Institution
(Lee, Lee, Ahn, Park, Kang, Lee, Kim, Park, Park) Division of Cardiology,
Department of Internal Medicine, Asan Medical Center, University of Ulsan
College of Medicine, Asan Medical Center, Seoul, South Korea
(Lee) Division of Cardiology, Department of Internal Medicine, Kangbuk
Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South
Korea
(Han) Department of Applied Statistics, Gachon University, Seongnam, South
Korea
Title
Long-term outcomes of bypass grafting versus drug-eluting stenting for
left main coronary artery disease: Results from the IRIS-MAIN registry.
Source
American Heart Journal. 193 (pp 76-83), 2017. Date of Publication:
November 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
There are limited data on comparative outcomes and its determinants
following coronary artery bypass graft surgery (CABG) and percutaneous
coronary intervention (PCI) with drug-eluting stents (DES) for left main
coronary artery disease (LMCAD) in a real-world setting. Methods A total
of 3,504 consecutive patients with LMCAD treated with CABG (n = 1,301) or
PCI with DES (n = 2,203) from the IRIS-MAIN registry were analyzed. The
relative treatment effect of one strategy over another was assessed by
propensity-score matching method. The primary outcome was a composite of
death, myocardial infarction, or stroke. Results Median follow-up duration
was 4.7 years. In the matched cohort, both groups demonstrated a similar
risk for the primary outcome (adjusted hazard ratio [HR]: 0.94; 95% CI:
0.77-1.15; P =.54). Compared with CABG, PCI exhibited higher risks of
myocardial infarction (HR: 2.11; 95% CI: 1.16-3.83; P =.01) and repeated
revascularization (HR: 5.95; 95% CI: 3.94-8.98; P <.001). In the overall
population, age, presence of chronic kidney disease, and low ejection
fraction (<40%) were key clinical predictors of primary outcome regardless
of the treatment strategy. However, factors deemed to be associated with
perioperative morbidity were determinants of primary outcome in the CABG
group, whereas those generally associated with the severity of
atherosclerotic coronary artery disease were strong predictors in the PCI
group. Conclusions Among patients with significant LMCAD, the long-term
risk of the composite outcome of death, myocardial infarction, or stroke
was similar between CABG and PCI. Clinical variables that differentially
predict adverse outcomes might be useful in triaging appropriate
revascularization strategy<br/>Copyright &#xa9; 2017 Elsevier Inc.

<98>
Accession Number
617935400
Author
Swart L.M.; van der Zanden V.; Spies P.E.; de Rooij S.E.; van Munster B.C.
Institution
(Swart, van der Zanden, de Rooij) Department of Internal Medicine,
Geriatrics Section, Academic Medical Center, University of Amsterdam,
Meibergdreef 9, Amsterdam 1105 AZ, Netherlands
(Spies, van Munster) Gelre Hospitals, Department of Geriatric Medicine,
Albert Schweitzerlaan 31, Apeldoorn 7334 DZ, Netherlands
(de Rooij, van Munster) Department of Internal Medicine, University Center
of Geriatric Medicine, University Medical Center Groningen, Hanzeplein 1,
Groningen 9713 GZ, Netherlands
Title
The Comparative Risk of Delirium with Different Opioids: A Systematic
Review.
Source
Drugs and Aging. 34 (6) (pp 437-443), 2017. Date of Publication: 01 Jun
2017.
Publisher
Springer International Publishing
Abstract
Objective: There is substantial evidence that the use of opioids increases
the risk of adverse outcomes such as delirium, but whether this risk
differs between the various opioids remains controversial. In this
systematic review, we evaluate and discuss possible differences in the
risk of delirium from the use of various types of opioids in older
patients. Methods: We performed a search in MEDLINE by combining search
terms on delirium and opioids. A specific search filter for use in
geriatric medicine was used. Quality was scored according to the quality
assessment for cohort studies of the Dutch Cochrane Institute. Results:
Six studies were included, all performed in surgical departments and all
observational. No study was rated high quality, one was rated moderate
quality, and five were rated low quality. Information about dose, route,
and timing of administration of the opioid was frequently missing. Pain
and other important risk factors of delirium were often not taken into
account. Use of tramadol or meperidine was associated with an increased
risk of delirium, whereas the use of morphine, fentanyl, oxycodone, and
codeine were not, when compared with no opioid. Meperidine was also
associated with an increased risk of delirium compared with other opioids,
whereas tramadol was not. The risk of delirium appeared to be lower with
hydromorphone or fentanyl, compared with other opioids. Numbers used for
comparisons were small. Conclusion: Some data suggest that meperidine may
lead to a higher perioperative risk for delirium; however, high-quality
studies that compare different opioids are lacking. Further comparative
research is needed.<br/>Copyright &#xa9; 2017, The Author(s).

<99>
Accession Number
616266600
Author
Thongprayoon C.; Cheungpasitporn W.; Thamcharoen N.; Ungprasert P.;
Kittanamongkolchai W.; Mao M.A.; Sakhuja A.; Greason K.L.; Kashani K.
Institution
(Thongprayoon, Cheungpasitporn, Kittanamongkolchai, Mao, Kashani) Division
of Nephrology and Hypertension, Department of Internal Medicine, Mayo
Clinic, Rochester, MN, United States
(Thongprayoon, Thamcharoen) Department of Medicine, Bassett Medical
Center, Cooperstown, NY, United States
(Ungprasert) Division of Rheumatology, Department of Internal Medicine,
Mayo Clinic, Rochester, MN, United States
(Sakhuja, Kashani) Division of Pulmonary and Critical Care Medicine,
Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
(Greason) Division of Cardiovascular Surgery, Department of Surgery, Mayo
Clinic, Rochester, MN, United States
Title
Association of frailty status with acute kidney injury and mortality after
transcatheter aortic valve replacement: A systematic review and
meta-analysis.
Source
PLoS ONE. 12 (5) (no pagination), 2017. Article Number: e0177157. Date of
Publication: May 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Objective: Frailty is a common condition in patients with severe aortic
stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).
The aim of this systematic review was to assess the impact of frailty
status on acute kidney injury (AKI) and mortality after TAVR. Methods: A
systematic literature search was conducted using MEDLINE, EMBASE, and
Cochrane databases from the inception through November 2016. The protocol
for this study is registered with PROSPERO (International Prospective
Register of Systematic Reviews; no. CRD42016052350). Studies that reported
odds ratios, relative risks or hazard ratios comparing the risk of AKI
after TAVR in frail vs. non-frail patients were included. Mortality risk
was evaluated among the studies that reported AKI-related outcomes. Pooled
risk ratios (RR) and 95% confidence interval (CI) were calculated using a
random-effect, generic inverse variance method. Results: Eight cohort
studies with a total of 10,498 patients were identified and included in
the metaanalysis. The pooled RR of AKI after TAVR among the frail patients
was 1.19 (95% CI 0.97- 1.46, I² = 0), compared with non-frail
patients. When the meta-analysis was restricted only to studies with
standardized AKI diagnosis according to Valve Academic Research Consortium
(VARC)-2 criteria, the pooled RRs of AKI in frail patients was 1.16 (95%
CI 0.91-1.47, I² = 0). Within the selected studies, frailty
status was significantly associated with increased mortality (RR 2.01; 95%
CI 1.44-2.80, I² = 58). Conclusion: The findings from our study
suggest no significant association between frailty status and AKI after
TAVR. However, frailty status is associated with mortality after TAVR and
may aid appropriate patient selection for TAVR.<br/>Copyright &#xa9; 2017
Thongprayoon et al. This is an open access article distributed under the
terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.

<100>
Accession Number
618285115
Author
Lee S.; Kang D.-H.; Kim D.-H.; Song J.-M.; Song J.-K.; Park S.-W.; Park
S.-J.
Institution
(Lee, Kang, Kim, Song, Song, Park, Park) Divisions of Cardiology, Asan
Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro
43-gil, Songpa-gu, Seoul, South Korea
Title
Late outcome of percutaneous mitral commissurotomy: Randomized comparison
of Inoue versus double-balloon technique.
Source
American Heart Journal. 194 (pp 1-8), 2017. Date of Publication: December
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Late prognosis after successful percutaneous mitral
commissurotomy (PMC) is unclear. We compared late results of PMC using
Inoue versus double-balloon techniques up to 25 years in a randomized
trial. Methods Between 1989 and 1995, 302 patients (77 men, 41 +/- 11
years) with severe mitral stenosis were randomly assigned to undergo PMC
using Inoue (n = 152; group I) or double-balloon technique (n = 150; group
D). The end points were the composite events of death, mitral surgery,
repeat PMC, or deterioration of New York Heart Association (NYHA) class
>=3. Results During median follow-up of 20.7 years (maximum, 25.6),
clinical events occurred in 82 (53.9%) patients in group I (37 deaths, 44
mitral surgeries, 9 repeat PMCs, 3 NYHA class >=3) and in 79 (52.7%)
patients in group D (34 deaths, 51 mitral surgeries, 5 repeat PMCs, 4 NYHA
class >=3). Event-free survival rates at 24 years were not significantly
different between group I and group D (40.8% and 42.6%, respectively;
hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.65-1.20; P
=.423). On multivariate analysis, absence of post-PMC commissural mitral
regurgitation (MR) (HR, 1.84; 95% CI, 1.28-2.63; P =.001) and immediate
post-PMC mitral valve area (MVA) <1.8 cm² (HR, 1.53; 95% CI,
1.04-2.25; P =.031) were independently correlated with clinical events
after successful PMC. Conclusions The Inoue and double-balloon methods
showed similar good clinical outcomes up to 25 years, and the achievement
of effective commissurotomy to develop post-PMC commissural MR or
immediate post-PMC MVA >=1.8 cm² is important in optimizing the
late results of PMC.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<101>
Accession Number
617560028
Author
Clar C.; Al-Khudairy L.; Loveman E.; Kelly S.A.M.; Hartley L.; Flowers N.;
Germano R.; Frost G.; Rees K.
Institution
(Clar) Freelance, Hasenheide 67, Berlin 10967, Germany
(Al-Khudairy, Flowers, Rees) Warwick Medical School, University of
Warwick, Division of Health Sciences, Coventry CV4 7AL, United Kingdom
(Loveman) Effective Evidence LLP, 26 The Curve, Waterlooville, Hampshire
PO8 9SE, United Kingdom
(Kelly) University of Cambridge, Institute of Public Health, School of
Clinical Medicine, Forvie Site, Box 113 Cambridge Biomedical Campus,
Cambridge CB2 0SR, United Kingdom
(Hartley) RTI Health Solutions, Manchester M20 2LS, United Kingdom
(Germano) University of Naples Federico II, Division of Nutrition,
Department of Clinical Medicine and Surgery, Naples, Italy
(Frost) Hammersmith Hospital, Department of Nutrition and Dietetics,
Duncane Road, London W12 0HS, United Kingdom
Title
Low glycaemic index diets for the prevention of cardiovascular disease.
Source
Cochrane Database of Systematic Reviews. 2017 (7) (no pagination), 2017.
Article Number: CD004467. Date of Publication: 31 Jul 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: The glycaemic index (GI) is a physiological measure of the
ability of a carbohydrate to affect blood glucose. Interest is growing in
this area for the clinical management of people at risk of, or with,
established cardiovascular disease. There is a need to review the current
evidence from randomised controlled trials (RCTs) in this area. This is an
update of the original review published in 2008. Objectives: To assess the
effect of the dietary GI on total mortality, cardiovascular events, and
cardiovascular risk factors (blood lipids, blood pressure) in healthy
people or people who have established cardiovascular disease or related
risk factors, using all eligible randomised controlled trials. Search
methods: We searched CENTRAL, MEDLINE, Embase and CINAHL in July 2016. We
also checked reference lists of relevant articles. No language
restrictions were applied. Selection criteria: We selected RCTs that
assessed the effects of low GI diets compared to diets with a similar
composition but a higher GI on cardiovascular disease and related risk
factors. Minimum trial duration was 12 weeks. Participants included were
healthy adults or those at increased risk of cardiovascular disease, or
previously diagnosed with cardiovascular disease. Studies in people with
diabetes mellitus were excluded. Data collection and analysis: Two
reviewers independently screened and selected studies. Two review authors
independently assessed risk of bias, evaluated the overall quality of the
evidence using GRADE, and extracted data following the Cochrane Handbook
for Systematic Reviews of Interventions. We contacted trial authors for
additional information. Analyses were checked by a second reviewer.
Continuous outcomes were synthesized using mean differences and adverse
events were synthesized narratively. Main results: Twenty-one RCTs were
included, with a total of 2538 participants randomised to low GI
intervention (1288) or high GI (1250). All 21 included studies reported
the effect of low GI diets on risk factors for cardiovascular disease,
including blood lipids and blood pressure. Twenty RCTs (18 of which were
newly included in this version of the review) included primary prevention
populations (healthy individuals or those at high risk of CVD, with mean
age range from 19 to 69 years) and one RCT was in those diagnosed with
pre-existing CVD (a secondary prevention population, with mean age 26.9
years). Most of the studies did not have an intervention duration of
longer than six months. Difference in GI intake between comparison groups
varied widely from 0.6 to 42. None of the included studies reported the
effect of low GI dietary intake on cardiovascular mortality and
cardiovascular events such as fatal and nonfatal myocardial infarction,
unstable angina, coronary artery bypass graft surgery, percutaneous
transluminal coronary angioplasty, and stroke. The unclear risk of bias of
most of the included studies makes overall interpretation of the data
difficult. Only two of the included studies (38 participants) reported on
adverse effects and did not observe any harms (low-quality evidence).
Authors' conclusions: There is currently no evidence available regarding
the effect of low GI diets on cardiovascular disease events. Moreover,
there is currently no convincing evidence that low GI diets have a clear
beneficial effect on blood lipids or blood pressure
parameters.<br/>Copyright &#xa9; 2017 The Cochrane Collaboration.

<102>
Accession Number
614700724
Author
Fan Z.-G.; Gao X.-F.; Li X.-B.; Mao W.-X.; Chen L.-W.; Tian N.-L.
Institution
(Fan, Gao, Li, Mao, Chen, Tian) Department of Cardiology, Nanjing First
Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, Jiangsu
210006, China
(Gao, Li, Mao, Tian) Department of Cardiology, Nanjing Heart Center,
Nanjing, China
Title
The optimal strategy of percutaneous coronary intervention for
ST-elevation myocardial infarction patients with multivessel disease: An
updated meta-analysis of 9 randomized controlled trials.
Source
Minerva Cardioangiologica. 65 (2) (pp 148-156), 2017. Date of Publication:
April 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Introduction: The optimal strategy of percutaneous coronary intervention
(PCI) for patients with ST-elevation myocardial infarction (STEMI) and
multivessel disease (MVD) still remains controversial. This study sought
to explore the optimal PCIstrategy for those patients.
Evidenceacquisition: Medline, EMBASEand the Cochrane Controlled Trials
Registry were searched for relevant studies. We analyzed the comparison of
major adverse cardiac events (MACEs) as the primary end point between the
preventive PCIstrategy and the culprit only PCIstrategy (CV-PCI). The
further analysis of two subgroups described as the complete multivessel
PCIstrategy during primary procedure (CMV-PCI) and the staged PCIstrategy
(S-PCI) was also performed. Evidencesynthesis: Nine randomized trials were
identified. The risk of MACEs was reduced significantly regarding to
preventive PCIstrategy (OR=0.41, 95% CI: 0.31-0.53, P<0.001) compared to
CV-PCIstrategy. There were lower risks of long-term mortality,
reinfarction and repeat revascularization in the preventive PCI group
compared to the CV-PCIgroup (OR=0.41, 95% CI: 0.27-0.62, P<0.001; OR=0.54,
95% CI: 0.32-0.91, P=0.021; OR=0.37, 95% CI: 0.26-0.51, P<0.001). Subgroup
analysis showed that staged PCIstrategy reduced the incidence of long-term
mortality versus CMV-PCIstrategy. Conclusions: The preventive PCI is
associated with the lower risk of MACEs in STEMI patients with MVD
compared to the CV-PCIstrategy, and the S-PCIstrategy seems to be an
optimal choice for these patients rather than the CMV-PCI.<br/>Copyright
&#xa9; 2016 Edizioni Minerva Medica.

<103>
Accession Number
614689606
Author
Pancholy S.B.; Patel G.; Nanavaty S.P.; Pancholy M.S.
Institution
(Pancholy) Commonwealth Medical College, Scranton, PA, United States
(Pancholy, Patel, Nanavaty) Wright Center for Graduate Medical Education,
Scranton, PA, United States
(Pancholy) Sidney Kimmel Medical College, Thomas Jefferson University,
Philadelphia, PA, United States
Title
Cardiogenic shock and access site choice.
Source
Minerva Cardioangiologica. 65 (1) (pp 74-80), 2017. Date of Publication:
February 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
Transradial access (TRA) has increased in utilization, although operators
have been reluctant to use TRAin patients presenting with cardiogenic
shock (CS). Experienced TRAoperators have started using TRAin CS patients,
although the literature is scant. Several datasets have included CS
patients in their study population, while others have systematically
excluded CS patients when comparing outcomes with TRAto transfemoral
access (TFA). In this review, we have compiled the existing literature
describing outcomes of patients presenting with CS who underwent PCIusing
TRAversus TFA. Each dataset has been described in detail and its study
population, methodology and conclusions have been critically examined
after obtaining all published and most non-published details pertaining to
CS patients in these datasets. The contemporary literature consists of
observational data comparing access-site related outcomes in CS patients
undergoing PCI. Although the composite outcome appears to favor TRAover
TFA, the high likelihood of selection bias, with the sickest CS patients
getting triaged to TFA, makes an aggressive interpretation of the existing
results rather difficult. Despite the operating biases, a few high-quality
adjusted analyses clearly report better outcomes in CS patients undergoing
PCIvia TRA, highlighting an immediate necessity to perform an
appropriately powered randomized evaluation of this important
question.<br/>Copyright &#xa9; 2016 Edizioni Minerva Medica.

<104>
Accession Number
616540448
Author
Stavrakis S.; Humphrey M.B.; Scherlag B.; Iftikhar O.; Parwani P.; Abbas
M.; Filiberti A.; Fleming C.; Hu Y.; Garabelli P.; McUnu A.; Peyton M.; Po
S.S.
Institution
(Stavrakis, Humphrey, Scherlag, Iftikhar, Parwani, Abbas, Filiberti,
Fleming, Hu, Garabelli, McUnu, Peyton, Po) Heart Rhythm Institute,
University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma,
United States
Title
Low-Level Vagus Nerve Stimulation Suppresses Post-Operative Atrial
Fibrillation and Inflammation: A Randomized Study.
Source
JACC: Clinical Electrophysiology. 3 (9) (pp 929-938), 2017. Date of
Publication: September 2017.
Publisher
Elsevier Inc
Abstract
Objectives This study sought to examine the efficacy of low-level vagus
nerve stimulation (LLVNS) in suppressing post-operative atrial
fibrillation (POAF) and inflammatory cytokines in patients undergoing
cardiac surgery. Background POAF often complicates cardiac surgery.
Methods Patients undergoing cardiac surgery were randomized to active or
sham LLVNS. In all patients, a bipolar wire was sutured to the vagus nerve
pre-ganglionic fibers alongside the lateral aspect of the superior vena
cava. High-frequency (20 Hz) stimulation, 50% below the threshold for
slowing the heart rate, was delivered for 72 h in the LLVNS group. The
development of POAF was monitored continuously during the entire hospital
stay by use of telemetry. Blood was collected on arrival in the intensive
care unit and at 24 and 72 h for measurement of inflammatory cytokines.
Patients were followed up within 1 month after cardiac surgery. Results A
total of 54 patients were randomized to either active LLVNS (n = 26) or
sham control (n = 28). The baseline characteristics of the patients were
balanced in the 2 groups. POAF occurred in 3 patients (12%) in the LLVNS
group and 10 patients (36%) in the control group (hazard ratio: 0.28; 95%
confidence interval: 0.10 to 0.85; p = 0.027). None of the patients
developed any complications as a result of wire placement. At 72 h, serum
tumor necrosis factor-alpha and interleukin-6 levels were significantly
lower in the LLVNS group than in the control group. Conclusions These data
suggest that LLVNS suppresses POAF and attenuates inflammation in patients
undergoing cardiac surgery. Further studies are warranted.<br/>Copyright
&#xa9; 2017 American College of Cardiology Foundation

<105>
Accession Number
614345630
Author
Qiao P.-G.; Han C.; Qian T.; Li G.-J.; Yin H.
Institution
(Qiao, Yin) Department of Radiology, Xijing Hospital, The Fourth Military
Medical University, Xi'an, China
(Qiao, Li) Department of Radiology, Affiliated Hospital of Academy of
Military Medical Sciences, Beijing, China
(Han) Department of Neurosurgery, Affiliated Hospital of Academy of
Military Medical Sciences, Beijing, China
(Qian) Germany Siemens Healthcare, MR Collaborations NE Asia, Beijing,
China
Title
BOLD-fMRI with median nerve electrical stimulation predict hemodynamic
improvement after revascularization in patients with moyamoya disease.
Source
Journal of Magnetic Resonance Imaging. 46 (4) (pp 1159-1166), 2017. Date
of Publication: October 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Purpose: To assess the severity of cerebral hemodynamic impairment and
hemodynamic improvements, after revascularization in moyamoya disease
(MMD) by means of blood-oxygen-level dependent functional magnetic
resonance imaging (BOLD-fMRI). Materials and Methods: BOLD-fMRI with
median nerve electrical stimulation based on echo planar imaging was
performed in 73 volunteers with MMD and 15 healthy volunteers using a 3.0
Tesla MRI scanner. Twenty-four MMD patients were reexamined after
encephaloduroarteriosynangiosis. Time-signal intensity curves of the
activated area of the contralateral primary somatosensory cortex were
computed. Negative response time (Tnr) and peak (Pnr), positive response
time (Tpr) and peak (Ppr), and time to negative peak (TTPn) and positive
peak (TTPp) were measured. Results: Compared with nonparesthesia group and
the asymptomatic side of paresthesia group, the patients with paresthesia
showed extended Tnr (22.04 +/- 3.34 s versus 9.57 +/- 2.27 s and 12.67 +/-
2.69 s, P = 0.0096), decreased Pnr (-0.47 +/- 0.06 versus -0.30 +/- 0.09
and -0.33 +/- 0.09, P = 0.010), delayed TTPn (9.04 +/- 1.39 s versus 3.66
+/- 0.79 s and 4.88 +/- 1.10 s, P = 0.0064), shortened Tpr (22.75 +/- 2.30
s versus 36.85 +/- 2.68 s and 33 +/- 2.49 s, P = 0.0010), and decreased
Ppr (0.62 +/- 0.08 versus 0.99 +/- 0.15 and 0.97 +/- 0.11, P = 0.0149)
when subjected to median nerve electrical stimulation in the symptomatic
side. After surgery, the patients with paresthesia showed shorter Tnr
(1.53 +/- 1.66 s versus 17.88 +/- 22.61 s, P = 0.0002), increased Pnr
(-0.14 +/- 0.17 versus -0.44 +/- 0.53, P = 0.0178), advanced TTPn (1.29
+/- 1.21 s versus 7.29 +/- 8.21 s, P = 0.0005), extended Tpr (36.94 +/-
6.41 s versus 25.18 +/- 15.51 s, P = 0.0091), increased Ppr (1.21 +/- 0.87
versus 0.77 +/- 0.60, P = 0.0201), and advanced TTPp (11.18 +/- 4.70 s
versus 27.29 +/- 20.00 s, P = 0.0046). Conclusion: Bold-fMRI is useful to
assess disease severity and surgical efficacy in MMD. Level of Evidence:
1. Technical Efficacy: Stage 4. J. Magn. Reson. Imaging
2017;46:1159-1166.<br/>Copyright &#xa9; 2017 International Society for
Magnetic Resonance in Medicine

<106>
Accession Number
618326864
Author
Ganesan V.; Ponnusamy S.S.; Sundaramurthy R.
Institution
(Ganesan, Ponnusamy, Sundaramurthy) Velammal Medical College Hospital and
Research Institute, Microbiology and Interventional Cardiology, Velammal
Village, Tuticorin Ring Road, Anuppanadi, Madurai, TN, India
Title
Fungal endocarditis in paediatrics: A review of 192 cases (1971-2016).
Source
Cardiology in the Young. 27 (8) (pp 1481-1487), 2017. Date of Publication:
01 Oct 2017.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Background The aims of this article were to review the published
literature on fungal endocarditis in children and to discuss the aetiology
and diagnosis, with emphasis on non-invasive methods and various treatment
regimes. Methods We systematically reviewed published cases and case
series of fungal endocarditis in children. We searched the literature,
including PubMed and individual references for publications of original
articles, single cases, or case series of paediatric fungal endocarditis,
with the following keywords: fungal endocarditis, neonates, infants,
child, and cardiac vegetation. Results There have been 192 documented
cases of fungal endocarditis in paediatrics. The highest number of cases
was reported in infants (93/192, 48%) including 60 in neonates. Of the
neonatal cases, 57 were premature with a median gestational age of 27
weeks and median birth weight of 860 g. Overall, 120 yeast - fungus that
grows as a single cell - infections and 43 mould - fungus that grows in
multicellular filaments, hyphae - infections were reported. With
increasing age, there was an increased infection rate with moulds. All the
yeast infections were detected by blood culture. In cases with mould
infection, diagnosis was mainly established by culture or histology of
emboli or infected valves after invasive surgical procedures. There have
been a few recent cases of successful early diagnosis by non-invasive
methods such as blood polymerase chain reaction (PCR) for moulds. The
overall mortality for paediatric fungal endocarditis was 56.25%. The most
important cause of death was cardiac complications due to heart failure.
Among the various treatment regimens used, none of them was significantly
associated with better outcome. Conclusions Non-invasive methods such as
PCR tests can be used to improve the chances of detecting and identifying
the aetiological agent in a timely manner. Delays in the diagnosis of
these infections may result in high mortality and morbidity. No
significant difference was noted between combined surgical and medical
therapy over exclusively combined medical therapy.<br/>Copyright &#xa9;
Cambridge University Press 2017.

<107>
Accession Number
618412799
Author
Peyton P.J.; Wu C.; Jacobson T.; Hogg M.; Zia F.; Leslie K.
Institution
(Peyton) Associate Professor, Anaesthesia, Perioperative and Pain Medicine
Unit, Melbourne Medical School, University of Melbourne, Associate
Professor, Department of Surgery, Austin Health, University of Melbourne,
Head of Research, Dept of Anaesthesia, Austin Health, Melbourne, Victoria
(Wu) Anaesthetic Registrar, Department of Anaesthesia, Austin Health,
Melbourne, Victoria
(Jacobson) Medical student, University of Melbourne, Austin Health Medical
Education, Melbourne, Victoria
(Hogg) Head of Pain Services, Melbourne Health, Melbourne, Victoria
(Zia) Staff Anaesthetist, Ballarat Health Services, Department of
Anaesthesia, Ballarat, Victoria
(Leslie) Honorary Professorial Fellow, Anaesthesia, Perioperative and Pain
Medicine Unit, Melbourne Medical School, and Department of Pharmacology
and Therapeutics, University of Melbourne; Honorary Adjunct Professor,
Department of Epidemiology and Preventive Medicine, Monash University,
Melbourne, Victoria
Title
The effect of a perioperative ketamine infusion on the incidence of
chronic postsurgical pain-a pilot study.
Source
Anaesthesia and intensive care. 45 (4) (pp 459-465), 2017. Date of
Publication: 01 Jul 2017.
Abstract
Chronic postsurgical pain (CPSP) is a common and debilitating complication
of major surgery. We undertook a pilot study at three hospitals to assess
the feasibility of a proposed large multicentre placebo-controlled
randomised trial of intravenous perioperative ketamine to reduce the
incidence of CPSP. Ketamine, 0.5 mg/kg pre-incision, 0.25 mg/kg/hour
intraoperatively and 0.1 mg/kg/hour for 24 hours, or placebo, was
administered to 80 patients, recruited over a 15-month period, undergoing
abdominal or thoracic surgery under general anaesthesia. The primary
endpoint was CPSP in the area of the surgery reported at six-month
telephone follow-up using a structured questionnaire. Fourteen patients
(17.5%) reported CPSP (relative risk [95% confidence interval] if received
ketamine 1.18 [0.70 to 1.98], P=0.56). Four patients in the treatment
group and three in the control group reported ongoing analgesic use to
treat CPSP and two patients in each group reported their worst pain in the
previous 24 hours at >=3/10 at six months. There were no significant
differences in adverse event rates, quality of recovery scores, or
cumulative morphine equivalents consumption in the first 72 hours. Numeric
Rating Scale pain scores (median [interquartile range, IQR]) for average
pain in the previous 24 hours among those patients reporting CPSP were
17.5 [0 to 40] /100 with no difference between treatment groups. A large
(n=4,000 to 5,000) adequately powered multicentre trial is feasible using
this population and methodology.

<108>
Accession Number
618389896
Author
Bajaj N.S.; Patel N.; Kalra R.; Marogil P.; Bhardwaj A.; Arora G.; Arora
P.
Institution
(Bajaj) Division of Cardiovascular Medicine, Department of Radiology,
Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, United
States
(Bajaj, Patel, Bhardwaj, Arora, Arora) Division of Cardiovascular
Diseases, Department of Medicine, University of Alabama at Birmingham,
1900 University Boulevard Birmingham, AL 35233, United States
(Kalra) Cardiovascular Division, University of Minnesota, 420 Delaware St
SE, Minneapolis, MN 55455, United States
(Marogil) Department of Internal Medicine, Brookwood Baptist Health, 2010
Brookwood Medical Center Drive Birmingham, AL 35209, United States
(Arora) Section of Cardiology, Birmingham Veterans Affairs Medical Center,
700 19th St S, Birmingham, AL 35233, United States
Title
Percutaneous coronary intervention vs. coronary artery bypass grafting for
left main revascularization: An updated meta-analysis.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 3 (3) (pp
173-182), 2017. Date of Publication: 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims The optimal revascularization strategy for left main coronary artery
disease (LMD) remains controversial, especially with two recent randomized
controlled trials showing conflicting results. We sought to address this
controversy with our analysis. Methods and results Comprehensive
literature search was performed. We compared percutaneous coronary
intervention (PCI) and coronary artery bypass grafting (CABG) for LMD
revascularization using standard meta-analytic techniques. A 21% higher
risk of long-term major adverse cardiac and cerebrovascular event [MACCE;
composite of death, myocardial infarction (MI), stroke, and repeat
revascularization] was observed in patients undergoing PCI in comparison
with CABG [risk ratio (RR) 1.21, 95% confidence interval (CI) 1.05-1.40].
This risk was driven by higher rate of repeat revascularization in those
undergoing PCI (RR 1.61, 95% CI 1.34-1.95). On the contrary, MACCE rates
at 30 days were lower in PCI when compared with CABG (RR 0.55, 95% CI
0.39-0.76), which was driven by lower rates of stroke in the PCI arm (RR
0.41, 95% CI 0.17-0.98). At 1 year, lower stroke rates (RR 0.21, 95% CI
0.08-0.59) in the PCI arm were balanced by higher repeat revascularization
rates in those undergoing PCI (RR 1.78, 95% CI 1.33-2.37), resulting in a
clinical equipoise in MACCE rates between the two revascularization
strategies. There was no difference in death or MI between PCI when
compared with CABG at any time point. Conclusion Outcomes of CABG vs. PCI
for LMD revascularization vary over time. Therefore, individualized
decisions need to be made for LMD revascularization using the heart team
approach.<br/>Copyright &#xa9; 2017 The Author.

<109>
Accession Number
618389718
Author
Gupta P.; Chakraborty A.; Gossett J.M.; Rettiganti M.
Institution
(Gupta) Division of Pediatric Cardiology, Department of Pediatrics,
University of Arkansas for Medical Sciences, Arkansas Children's Hospital,
Little Rock, Ark
(Chakraborty) Department of Mathematical Sciences, University of Arkansas,
Fayetteville, Ark
(Gossett, Rettiganti) Biostatistics Program, Department of Pediatrics,
University of Arkansas for Medical Sciences, Arkansas Children's Hospital
Research Institute, Little Rock, Ark
Title
A prognostic tool to predict outcomes in children undergoing the Norwood
operation.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: To create and validate a prediction model to assess outcomes
associated with the Norwood operation. Methods: The public-use dataset
from a multicenter, prospective, randomized single-ventricle
reconstruction trial was used to create this novel prediction tool. A
Bayesian lasso logistic regression model was used for variable selection.
We used a hierarchical framework by representing discrete probability
models with continuous latent variables that depended on the risk factors
for a particular patient. Bayesian conditional probit regression and
Markov chain Monte Carlo simulations were then used to estimate the
effects of the predictors on the means of these latent variables to create
a score function for each of the study outcomes. We also devised a method
to calculate the risk of outcomes associated with the Norwood operation
before the actual heart operation. The 2 study outcomes evaluated were
in-hospital mortality and composite poor outcome. Results: The training
dataset used 520 patients to generate the prediction model. The model
included patient demographics, baseline characteristics, cardiac
diagnosis, operation details, site volume, and surgeon experience. An
online calculator for the tool can be accessed at
https://soipredictiontool.shinyapps.io/NorwoodScoreApp/. Model validation
was performed on 520 observations using an internal 10-fold
cross-validation approach. The prediction model had an area under the
curve of 0.77 for mortality and 0.72 for composite poor outcome on the
validation dataset. Conclusions: Our new prognostic tool is a promising
first step in creating real-time risk stratification in children
undergoing a Norwood operation; this tool will be beneficial for the
purposes of benchmarking, family counseling, and research.<br/>Copyright
&#xa9; 2017 The American Association for Thoracic Surgery.

<110>
Accession Number
618373762
Author
Maeno Y.; Abramowitz Y.; Yoon S.-H.; Israr S.; Jilaihawi H.; Watanabe Y.;
Sharma R.; Kawamori H.; Miyasaka M.; Kazuno Y.; Takahashi N.; Hariri B.;
Mangat G.; Kashif M.; Chakravarty T.; Nakamura M.; Cheng W.; Makkar R.R.
Institution
(Maeno, Abramowitz, Yoon, Israr, Sharma, Kawamori, Miyasaka, Kazuno,
Takahashi, Hariri, Mangat, Kashif, Chakravarty, Nakamura, Cheng, Makkar)
Cedars-Sinai Medical Center, Heart Institute, Los Angeles, California
(Jilaihawi) Medicine and Cardiothoracic Surgery, New York University
Langone Medical Center, New York, New York
(Watanabe) Department of Cardiology, Teikyo University Hospital, Itabashi,
Tokyo, Japan
Title
Relation Between Left Ventricular Outflow Tract Calcium and Mortality
Following Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Left ventricular outflow tract (LVOT) calcium is known to be associated
with adverse procedural outcomes after transcatheter aortic valve
implantation (TAVI), yet its effect on midterm outcomes has not been
previously investigated. The aim of this study was to determine the
influence of LVOT calcium on 2-year mortality after TAVI. A total of 537
consecutive patients underwent TAVI and 2 groups were established,
stratified based on the severity of the LVOT calcium. The primary outcome
was 2-year overall survival rate. The >=moderate LVOT calcium group
included 107 patients (19.9%) and the remaining 430 patients (80.1%) were
included in the <=mild LVOT calcium group. After a median follow-up of 717
days (interquartile range 484 to 828), the Kaplan-Meier analysis revealed
that the 2-year overall survival probability was significantly lower in
the >=moderate LVOT calcium group than in the <=mild LVOT calcium group
(log-rank p = 0.001). On a Cox hazard model, >=moderate LVOT calcium was
associated with increased all-cause mortality after TAVI (hazard ratio
1.74, p = 0.009). In the subgroup analysis, based on valve designs, SAPIEN
3-TAVI done in the setting of >=moderate LVOT calcium had a relatively
similar survival probability as those of <=mild LVOT calcium (log-rank p =
0.18), which is in contrast with older generation valves (log-rank p =
0.001). In conclusion, patients with >=moderate LVOT calcium were shown to
have a lower survival probability in the midterm follow-up after TAVI,
compared with those with <=mild LVOT calcium. Patients with high-grade
LVOT calcium should be monitored with longer-term follow-ups after
TAVI.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<111>
Accession Number
613253167
Author
Gaudin D.; Krafcik B.M.; Mansour T.R.; Alnemari A.
Institution
(Gaudin, Alnemari) Department of Surgery, Division of Neurological
Surgery, University of Toledo Medical Center, Toledo, Ohio, United States
(Krafcik, Mansour) University of Toledo College of Medicine, Toledo, Ohio,
United States
Title
Considerations in Spinal Fusion Surgery for Chronic Lumbar Pain:
Psychosocial Factors, Rating Scales, and Perioperative Patient Education-A
Review of the Literature.
Source
World Neurosurgery. 98 (pp 21-27), 2017. Date of Publication: 01 Feb 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective Despite widespread use of lumbar spinal fusion as a treatment
for back pain, outcomes remain variable. Optimizing patient selection can
help to reduce adverse outcomes. This literature review was conducted to
better understand factors associated with optimal postoperative results
after lumbar spinal fusion for chronic back pain and current tools used
for evaluation. Methods The PubMed database was searched for clinical
trials related to psychosocial determinants of outcome after lumbar spinal
fusion surgery; evaluation of commonly used patient subjective outcome
measures; and perioperative cognitive, behavioral, and educational
therapies. Reference lists of included studies were also searched by hand
for additional studies meeting inclusion and exclusion criteria. Results
Patients' perception of good health before surgery and low cardiovascular
comorbidity predict improved postoperative physical functional capacity
and greater patient satisfaction. Depression, tobacco use, and litigation
predict poorer outcomes after lumbar fusion. Incorporation of
cognitive-behavioral therapy perioperatively can address these
psychosocial risk factors and improve outcomes. The 36-Item Short Form
Health Survey, European Quality of Life five dimensions questionnaire,
visual analog pain scale, brief pain inventory, and Oswestry Disability
Index can provide specific feedback to track patient progress and are
important to understand when evaluating the current literature.
Conclusions This review summarizes current information and explains
commonly used assessment tools to guide clinicians in decision making when
caring for patients with lower back pain. When determining a treatment
algorithm, physicians must consider predictive psychosocial factors. Use
of perioperative cognitive-behavioral therapy and patient education can
improve outcomes after lumbar spinal fusion.<br/>Copyright &#xa9; 2016
Elsevier Inc.

<112>
Accession Number
618308563
Author
Tzani A.; Doulamis I.P.; Mylonas K.S.; Avgerinos D.V.; Nasioudis D.
Institution
(Tzani, Doulamis, Mylonas, Avgerinos, Nasioudis) Surgery Working Group,
Society of Junior Doctors, Athens, Greece
(Mylonas) Division of Pediatric Surgery, Department of Surgery,
Massachusetts General Hospital, Harvard Medical School, Boston, MA, United
States
(Avgerinos) Department of Cardiothoracic Surgery, New York Presbyterian
Medical Center, Weill Cornell College of Medicine, New York, NY, United
States
(Nasioudis) Department of Obstetrics and Gynecology, Hospital of the
University of Pennsylvania, Philadelphia, PA, United States
Title
Cardiac Tumors in Pediatric Patients: A Systematic Review.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 8 (5) (pp
624-632), 2017. Date of Publication: 01 Sep 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
This systematic review sought to investigate the current evidence
regarding surgical management of primary cardiac tumors in children and
adolescents. Twenty-eight studies were deemed eligible, reporting on 745
pediatric patients. Rhabdomyoma was the most prevalent histologic type and
echocardiography was the most common diagnostic tool. Cumulative 30-day
mortality rate was 6.7%. Rhabdomyomas and teratomas had the highest 30-day
mortality. The higher percentage of tumor relapse was noted for myxoma and
teratoma. Although cardiac tumors are rare, their atypical clinical
presentation, potential for recurrence, and the poor prognosis associated
with recurrence elucidate the need for reliable diagnostic and therapeutic
management.<br/>Copyright &#xa9; 2017, &#xa9; The Author(s) 2017.

<113>
Accession Number
617134974
Author
Anderson L.; Brown J.P.R.; Clark A.M.; Dalal H.; Rossau H.K.; Bridges C.;
Taylor R.S.
Institution
(Anderson, Taylor) University of Exeter Medical School, Institute of
Health Research, Veysey Building, Salmon Pool Lane, Exeter EX2 4SG, United
Kingdom
(Brown) BC Women's Hospital, Department of Anesthesia, 4500 Oak Street,
Vancouver, BC, BC V6H 3N1, Canada
(Clark) University of Alberta, Faculty of Nursing, Level 3 CSB, Edmonton,
AB T63 2G3, Canada
(Dalal) University of Exeter Medical School, Truro Campus, Knowledge Spa,
Royal Cornwall Hospitals Trust, Department of Primary Care, Truro TR1 3HD,
United Kingdom
(Rossau) University of Southern Denmark and Region of Southern Denmark,
Danish Knowledge Centre for Rehabilitation and Palliative Care,
Copenhagen, Denmark
(Bridges) University College London, Farr Institute of Health Informatics
Research, 222 Euston Road, London NW1 2DA, United Kingdom
Title
Patient education in the management of coronary heart disease.
Source
Cochrane Database of Systematic Reviews. 2017 (6) (no pagination), 2017.
Article Number: CD008895. Date of Publication: 28 Jun 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Coronary heart disease (CHD) is the single most common cause
of death globally. However, with falling CHD mortality rates, an
increasing number of people live with CHD and may need support to manage
their symptoms and improve prognosis. Cardiac rehabilitation is a complex
multifaceted intervention which aims to improve the health outcomes of
people with CHD. Cardiac rehabilitation consists of three core modalities:
education, exercise training and psychological support. This is an update
of a Cochrane systematic review previously published in 2011, which aims
to investigate the specific impact of the educational component of cardiac
rehabilitation. Objectives: 1. To assess the effects of patient education
delivered as part of cardiac rehabilitation, compared with usual care on
mortality, morbidity, health-related quality of life (HRQoL) and
healthcare costs in patients with CHD. 2. To explore the potential study
level predictors of the effects of patient education in patients with CHD
(e.g. individual versus group intervention, timing with respect to index
cardiac event). Search methods: We updated searches from the previous
Cochrane review, by searching the Cochrane Central Register of Controlled
Trials (CENTRAL) (Cochrane Library, Issue 6, 2016), MEDLINE (Ovid), Embase
(Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) in June 2016. Three trials
registries, previous systematic reviews and reference lists of included
studies were also searched. No language restrictions were applied.
Selection criteria: 1. Randomised controlled trials (RCTs) where the
primary interventional intent was education delivered as part of cardiac
rehabilitation. 2. Studies with a minimum of six-months follow-up and
published in 1990 or later. 3. Adults with a diagnosis of CHD. Data
collection and analysis: Two review authors independently screened all
identified references for inclusion based on the above inclusion criteria.
One author extracted study characteristics from the included trials and
assessed their risk of bias; a second review author checked data. Two
independent reviewers extracted outcome data onto a standardised
collection form. For dichotomous variables, risk ratios and 95% confidence
intervals (CI) were derived for each outcome. Heterogeneity amongst
included studies was explored qualitatively and quantitatively. Where
appropriate and possible, results from included studies were combined for
each outcome to give an overall estimate of treatment effect. Given the
degree of clinical heterogeneity seen in participant selection,
interventions and comparators across studies, we decided it was
appropriate to pool studies using random-effects modelling. We planned to
undertake subgroup analysis and stratified meta-analysis, sensitivity
analysis and meta-regression to examine potential treatment effect
modifiers. We used the Grading of Recommendations Assessment, Development
and Evaluation (GRADE) approach to evaluate the quality of the evidence
and the GRADE profiler (GRADEpro GDT) to create summary of findings
tables. Main results: This updated review included a total of 22 trials
which randomised 76,864 people with CHD to an education intervention or a
'no education' comparator. Nine new trials (8215 people) were included for
this update. We judged most included studies as low risk of bias across
most domains. Educational 'dose' ranged from one 40 minute face-to-face
session plus a 15 minute follow-up call, to a four-week residential stay
with 11 months of follow-up sessions. Control groups received usual
medical care, typically consisting of referral to an outpatient
cardiologist, primary care physician, or both. We found evidence of no
difference in effect of education-based interventions on total mortality
(13 studies, 10,075 participants; 189/5187 (3.6%) versus 222/4888 (4.6%);
random effects risk ratio (RR) 0.80, 95% CI 0.60 to 1.05; moderate quality
evidence). Individual causes of mortality were reported rarely, and we
were unable to report separate results for cardiovascular mortality or
non-cardiovascular mortality. There was evidence of no difference in
effect of education-based interventions on fatal and/or non fatal
myocardial infarction (MI) (2 studies, 209 participants; 7/107 (6.5%)
versus 12/102 (11.8%); random effects RR 0.63, 95% CI 0.26 to 1.48; very
low quality of evidence). However, there was some evidence of a reduction
with education in fatal and/or non-fatal cardiovascular events (2 studies,
310 studies; 21/152 (13.8%) versus 61/158 (38.6%); random effects RR 0.36,
95% CI 0.23 to 0.56; low quality evidence). There was evidence of no
difference in effect of education on the rate of total revascularisations
(3 studies, 456 participants; 5/228 (2.2%) versus 8/228 (3.5%); random
effects RR 0.58, 95% CI 0.19 to 1.71; very low quality evidence) or
hospitalisations (5 studies, 14,849 participants; 656/10048 (6.5%) versus
381/4801 (7.9%); random effects RR 0.93, 95% CI 0.71 to 1.21; very low
quality evidence). There was evidence of no difference between groups for
all cause withdrawal (17 studies, 10,972 participants; 525/5632 (9.3%)
versus 493/5340 (9.2%); random effects RR 1.04, 95% CI 0.88 to 1.22; low
quality evidence). Although some health-related quality of life (HRQoL)
domain scores were higher with education, there was no consistent evidence
of superiority across all domains. Authors' conclusions: We found no
reduction in total mortality, in people who received education delivered
as part of cardiac rehabilitation, compared to people in control groups
(moderate quality evidence). There were no improvements in fatal or non
fatal MI, total revascularisations or hospitalisations, with education.
There was some evidence of a reduction in fatal and/or non-fatal
cardiovascular events with education, but this was based on only two
studies. There was also some evidence to suggest that education-based
interventions may improve HRQoL. Our findings are supportive of current
national and international clinical guidelines that cardiac rehabilitation
for people with CHD should be comprehensive and include educational
interventions together with exercise and psychological therapy. Further
definitive research into education interventions for people with CHD is
needed.<br/>Copyright &#xa9; 2017 The Cochrane Collaboration. Published by
John Wiley & Sons, Ltd.

<114>
Accession Number
618244631
Author
Wiysonge C.S.; Ntsekhe M.; Thabane L.; Volmink J.; Majombozi D.; Gumedze
F.; Pandie S.; Mayosi B.M.
Institution
(Wiysonge) South African Medical Research Council, Cochrane South Africa,
Francie van Zijl Drive, Parow Valley, Cape Town, Western Cape 7505, South
Africa
(Wiysonge, Volmink, Majombozi) Stellenbosch University, Centre for
Evidence-based Health Care, Faculty of Medicine and Health Sciences, Cape
Town, South Africa
(Ntsekhe) Groote Schuur Hospital, Division of Cardiology, Observatory
7925, Cape Town, South Africa
(Thabane) McMaster University, Department of Clinical Epidemiology and
Biostatistics, 50 Charlton Ave E, St. Joseph's Healthcare, Hamilton, ON
L8N 4A6, Canada
(Gumedze) University of Cape Town, Department of Statistical Sciences,
Cape Town, South Africa
(Pandie, Mayosi) University of Cape Town, Department of Medicine, Cape
Town, South Africa
Title
Interventions for treating tuberculous pericarditis.
Source
Cochrane Database of Systematic Reviews. 2017 (9) (no pagination), 2017.
Article Number: CD000526. Date of Publication: 13 Sep 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Tuberculous pericarditis can impair the heart's function and
cause death; long term, it can cause the membrane to fibrose and constrict
causing heart failure. In addition to antituberculous chemotherapy,
treatments include corticosteroids, drainage, and surgery. Objectives: To
assess the effects of treatments for tuberculous pericarditis. Search
methods: We searched the Cochrane Infectious Diseases Group Specialized
Register (27 March 2017); the Cochrane Central Register of Controlled
Trials (CENTRAL), published in the Cochrane Library (2017, Issue 2);
MEDLINE (1966 to 27 March 2017); Embase (1974 to 27 March 2017); and
LILACS (1982 to 27 March 2017). In addition we searched the metaRegister
of Controlled Trials (mRCT) and the World Health Organization (WHO)
International Clinical Trials Registry Platform (ICTRP) search portal
using 'tuberculosis' and 'pericard*' as search terms on 27 March 2017. We
searched ClinicalTrials.gov and contacted researchers in the field of
tuberculous pericarditis. This is a new version of the original 2002
review. Selection criteria: We included randomized controlled trials
(RCTs) and quasi-RCTs. Data collection and analysis: Two review authors
independently screened search outputs, evaluated study eligibility,
assessed risk of bias, and extracted data; and we resolved any
discrepancies by discussion and consensus. One trial assessed the effects
of both corticosteroid and Mycobacterium indicus pranii treatment in a
two-by-two factorial design; we excluded data from the group that received
both interventions. We conducted fixed-effect meta-analysis and assessed
the certainty of the evidence using the GRADE approach. Main results:
Seven trials met the inclusion criteria; all were from sub-Saharan Africa
and included 1959 participants, with 1051/1959 (54%) HIV-positive. All
trials evaluated corticosteroids and one each evaluated colchicine, M.
indicus pranii immunotherapy, and open surgical drainage. Four trials
(1841 participants) were at low risk of bias, and three trials (118
participants) were at high risk of bias. In people who are not infected
with HIV, corticosteroids may reduce deaths from all causes (risk ratio
(RR) 0.80, 95% confidence interval (CI) 0.59 to 1.09; 660 participants, 4
trials, low certainty evidence) and the need for repeat pericardiocentesis
(RR 0.85, 95% CI 0.70 to 1.04; 492 participants, 2 trials, low certainty
evidence). Corticosteroids probably reduce deaths from pericarditis (RR
0.39, 95% CI 0.19 to 0.80; 660 participants, 4 trials, moderate certainty
evidence). However, we do not know whether or not corticosteroids have an
effect on constriction or cancer among HIV-negative people (very low
certainty evidence). In people living with HIV, only 19.9% (203/1959) were
on antiretroviral drugs. Corticosteroids may reduce constriction (RR 0.55,
0.26 to 1.16; 575 participants, 3 trials, low certainty evidence). It is
uncertain whether corticosteroids have an effect on all-cause death or
cancer (very low certainty evidence); and may have little or no effect on
repeat pericardiocentesis (RR 1.02, 0.89 to 1.18; 517 participants, 2
trials, low certainty evidence). For colchicine among people living with
HIV, we found one small trial (33 participants) which had insufficient
data to make any conclusions about any effects on death or constrictive
pericarditis. Irrespective of HIV status, due to very low certainty
evidence from one trial, it is uncertain whether adding M. indicus pranii
immunotherapy to antituberculous drugs has an effect on any outcome. Open
surgical drainage for effusion may reduce repeat pericardiocentesis In
HIV-negative people (RR 0.23, 95% CI 0.07 to 0.76; 122 participants, 1
trial, low certainty evidence) but may make little or no difference to
other outcomes. We did not find an eligible trial that assessed the
effects of open surgical drainage in people living with HIV. The review
authors found no eligible trials that examined the length of
antituberculous treatment needed nor the effects of other adjunctive
treatments for tuberculous pericarditis. Authors' conclusions: For
HIV-negative patients, corticosteroids may reduce death. For HIV-positive
patients not on antiretroviral drugs, corticosteroids may reduce
constriction. For HIV-positive patients with good antiretroviral drug
viral suppression, clinicians may consider the results from HIV-negative
patients more relevant. Further research may help evaluate percutaneous
drainage of the pericardium under local anaesthesia, the timing of
pericardiectomy in tuberculous constrictive pericarditis, and new
antibiotic regimens.<br/>Copyright &#xa9; 2017 The Cochrane Collaboration.
Published by John Wiley & Sons, Ltd.

<115>
Accession Number
616160579
Author
Sumner J.; Harrison A.; Doherty P.
Institution
(Sumner, Harrison, Doherty) University of York, Department of Health
Sciences, York, United Kingdom
Title
The effectiveness of modern cardiac rehabilitation: A systematic review of
recent observational studies in non-attenders versus attenders.
Source
PLoS ONE. 12 (5) (no pagination), 2017. Article Number: e0177658. Date of
Publication: May 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background The beneficial effects of cardiac rehabilitation (CR) have been
challenged in recent years and there is now a need to investigate whether
current CR programmes, delivered in the context of modern cardiology,
still benefit patients. Methods A systematic review of non-randomised
controlled studies was conducted. Electronic searches of Medline, Embase,
CINAHL, science citation index (web of science), CIRRIE and Open Grey were
undertaken. Non-randomised studies investigating the effects of CR were
included when recruitment occurred from the year 2000 onwards in
accordance with significant CR guidance changes from the late 1990's.
Adult patients diagnosed with acute myocardial infarction (AMI) were
included. Non-English articles were considered. Two reviewers
independently screened articles according to pre-defined selection
criteria as reported in the PROSPERO database (CRD42015024021). Results
Out of 2,656 articles, 8 studies involving 9,836 AMI patients were
included. Studies were conducted in 6 countries. CR was found to reduce
the risk of all-cause and cardiac-related mortality and improve
Health-Related Quality of Life (HRQOL) significantly in at least one
domain. The benefits of CR in terms of recurrent MI were inconsistent and
no significant effects were found regarding re-vascularisation or
re-hospitalisation following AMI. Conclusion Recent observational evidence
draws different conclusions to the most current reviews of trial data with
respect to total mortality and re-hospitalisation, questioning the
representativeness of historic data in the modern cardiological era.
Future work should seek to clarify which patient and service level factors
determine the likelihood of achieving improved allcause and cardiac
mortality and reduced hospital re-admissions.<br/>Copyright &#xa9; This is
an open access article, free of all copyright, and may be freely
reproduced, distributed, transmitted, modified, built upon, or otherwise
used by anyone for any lawful purpose. The work is made available under
the Creative Commons CC0 public domain dedication.

<116>
Accession Number
618295121
Author
Tariq M.I.; Khan A.A.; Khalid Z.; Farheen H.; Siddiqi F.A.; Amjad I.
Institution
(Tariq, Amjad) Riphah College of Rehabilitation Sciences, Islamabad,
Pakistan
(Khan) BARM Bahria Hospital, Rawalpindi, Pakistan
(Khalid, Farheen) Railway Hospital, Rawalpindi, Pakistan
(Siddiqi) Foundation University Institute of Rehabilitation Sciences,
Foundation University, Islamabad, Pakistan
Title
Effect of early <= 3 Mets (Metabolic Equivalent of Tasks) of physical
activity on patient's outcome after cardiac surgery.
Source
Journal of the College of Physicians and Surgeons Pakistan. 27 (8) (pp
490-494), 2017. Date of Publication: 2017.
Publisher
College of Physicians and Surgeons Pakistan (7th Central Street, Karachi
755000, Pakistan)
Abstract
Objective: To determine the effect of <= 3 Mets (Metabolic Equivalent of
Tasks) of physical activity on zero postoperative days for improving
hemodynamic and respiratory parameters of patients after cardiac
surgeries. Study Design: Randomized control trial. Place and Duration of
Study: BARMWT Hospital, Rawalpindi, from March to August 2015.
Methodology: A randomized controlled trial was conducted on 174 CABG and
valvular heart disease patients undergoing cardiac surgical procedures.
After selection of sample via non-probability purposive sampling, they
were randomly allocated into interventional group (n=87) and control group
(n=87). Treatment protocol for experimental group was <=3 Mets of physical
activity, i.e. chest physiotherapy, sitting over edge of bed, standing and
sitting on chair at bedside, on zero postoperative day but the control
group was treated with conventional treatment on first postoperative day.
Pre- and post-treatment assessment was done in control and interventional
groups on both zero and first postoperative days. Data was analyzed on
SPSS version 21. Results: The patients' mean age was 51.86 +/-13.76 years.
Male to female ratio was 132:42. Statistically significant differences in
respiratory rate and SpO<inf>2</inf> (p=0.000 and 0.000, respectively)
were found between both groups. Among ABG's, PCO<inf>2</inf> and pH showed
significant differences with p values of 0.039 and < 0.001, respectively.
No significant differences were observed between both groups regarding
electrolytes (Na+, K+, Cl-, p-values of 0.361, 0.575 and 0.120
respectively) and creatinine (p=0.783). Marked improvement in oxygen
saturation, dyspnea and a fall in systolic BP was seen in interventional
group. There was also observed to be a reduction in the length of ICU stay
among interventional group patients as frequency with percentage of total
stay was compared to control group. Conclusion: Early physical activity
(<=3 METS) post-cardiac surgeries prevent respiratory complications
through improvement in dyspnea, respiratory rate, and oxygen saturation.

<117>
Accession Number
369203050
Author
Metz D.; Stiller M.; Silber R.-E.; Kroll H.; Hofmann H.-S.; Diez C.
Institution
(Metz) Klinik fur Herz-, Thorax- und Gefaschirurgie, MediClin Herzzentrum
Coswig, Coswig, Germany
(Stiller, Silber) Klinik fur Herz- und Thoraxchirurgie,
Universitatsklinikum Halle (Saale), Halle, Germany
(Kroll) Klinik fur Anasthesiologie, Universitatsklinikum Halle (Saale),
Halle, Germany
(Hofmann) Abteilung fur Thoraxchirurgie, Universitatsklinikum Regensburg,
Regensburg, Germany
(Diez) Klinik fur Herz-, Thorax- und herznahe Gefaschirurgie,
Universitatsklinikum Regensburg, Franz-Josef-Straus-Allee 11, 93052
Regensburg, Germany
Title
Prophylactic intraaortic balloon pumping in high-risk cardiac surgery
patients.
Source
Medizinische Klinik - Intensivmedizin und Notfallmedizin. 106 (2) (pp
125-131), 2011. Date of Publication: 2011.
Publisher
Springer-Verlag (Germany)
Abstract
Background: We examined the impact of prophylactic IABP insertion in
EuroSCORE-stratified high-risk cardiac surgery patients with a score >=8.
Material and methods: A randomized trial with 104 patients either without
prophylactic IABP insertion (group A, n=52) or with IABP (group B, n=52)
was conducted. The primary endpoint was 30-day mortality. Results: The
median age of the patients was 74 years and 43% of participants were
females. The 30-day mortality did not differ between group A (17.3%) and
group B (13.4%; p=0.78). The median hospital stay was 14 days in both
groups. Intra- and postoperative IABP support was required by 13 patients
(21%) in group A. The median ventilation time (14 hours versus 13 hours),
median catecholamine dose, frequency of dialysis-dependent acute renal
failure (28% versus 18%), cardiac indices, and frequency of a low cardiac
output syndrome (26% versus 25%) did not significantly differ between
groups. Conclusion: Prophylactic preoperative IABP insertion in
EuroSCORE-stratified high-risk patients is not associated with decreased
30-day mortality. &#xa9; 2011 Urban & Vogel, Muenchen.

<118>
Accession Number
618335116
Author
Fredericks S.; Yau T.
Institution
(Fredericks) Daphne Cockwell, School of Nursing, Ryerson University, 350
Victoria St., Toronto, ON, M5B 2K3, Canada. Electronic address:
sfrederi@ryerson.ca
(Yau) University Health Network, Toronto General Hospital, 4N-470, 200
Elizabeth Street, Toronto, ON, M5G 2C4, Canada
Title
Clinical effectiveness of individual patient education in heart surgery
patients: A systematic review and meta-analysis.
Source
International journal of nursing studies. 65 (pp 44-53), 2017. Date of
Publication: 01 Jan 2017.
Abstract
The objective of this systematic review was to compare the effectiveness
of individualized patient education interventions to standardized patient
education interventions on the rate of readmission, performance of
specific health behaviours, depression, anxiety, and cognition during the
post-hospital discharge recovery period following cardiovascular surgery.
DESIGN AND DATA SOURCES: Randomized controlled trials that included study
participants who underwent their first bypass and/or valve replacement
surgery; were eighteen years of age or older; and were recovering in the
community.
REVIEW METHODS: For all data analyzed, data was entered based on the
principle of intention to treat. To be included in a given comparison,
outcome data had to have been available for at least 80% of those who were
randomized. Assessment of statistical heterogeneity was tested. Generic
inverse variance methods based on random effects models were used to pool
effect estimates across included studies.
RESULTS: Seventeen trials involving 2624 study participants where
individualized patient education was the primary interventional intent was
included in this review. Four studies that included 930 participants
reported on hospital readmissions. The sources of bias that remain unclear
or were judged as containing high risk of bias most frequently across
included trials were blinding of outcome assessment, incomplete outcome
data, and selective reporting. An effect of the individualized patient
education in reducing hospital readmission rates (Mean Difference: -1.28,
95% CI -1.87 to -0.68, p<0.00), depression (Mean Difference: -23.32, 95%
CI -23.70 to -22.95, p<0.00), and anxiety (Mean Difference: -19.34, 95% CI
-20.46 to -18.23, p<0.00) was noted. While an increase in the performance
of specific health behaviours (Mean Difference: 3.45, 95% CI 3.27-3.63,
p<0.00) and cognition (Mean Difference: 11.17, 95% CI 10.66-11.68, p<0.00)
was found. Most effect estimates were prone to statistical heterogeneity
among the trials.
CONCLUSION: The findings from this systematic review suggest favorable
effects on the readmission rates. However, a major limitation notes in the
current body of evidence relates to the small number of or even lacking
number of trials for clinically important outcomes. As well, the
individualized patient education intervention is effective in promoting
statistically significant changes in quality of life, performance of
health behaviours, depression, and anxiety.<br/>Copyright A&#xa9; 2016
Elsevier Ltd. All rights reserved.

<119>
Accession Number
618322323
Author
Sabatine M.S.; Leiter L.A.; Wiviott S.D.; Giugliano R.P.; Deedwania P.; De
Ferrari G.M.; Murphy S.A.; Kuder J.F.; Gouni-Berthold I.; Lewis B.S.;
Handelsman Y.; Pineda A.L.; Honarpour N.; Keech A.C.; Sever P.S.; Pedersen
T.R.
Institution
(Sabatine, Wiviott, Giugliano, Murphy, Kuder) TIMI Study Group, Division
of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard
Medical School, Boston, MA, USA
(Leiter) Li Ka Shing Knowledge Institute of St Michael's Hospital,
University of Toronto, Toronto, ON, Canada
(Deedwania) UCSF Fresno, Fresno, CA, USA
(De Ferrari) Department of Molecular Medicine, University of Pavia, and
Cardiac Intensive Care Unit and Laboratories for Experimental Cardiology,
IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
(Gouni-Berthold) Polyclinic for Endocrinology, Diabetes, and Preventive
Medicine, University of Cologne, Cologne, Germany
(Lewis) Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport
School of Medicine, Technion-IIT, Haifa, Israel
(Handelsman) Metabolic Institute of America, Tarzana, CA, USA
(Pineda, Honarpour) Amgen, Thousand Oaks, CA, USA
(Keech) Sydney Medical School, NHMRC Clinical Trials Centre, University of
Sydney, Sydney, NSW, Australia
(Sever) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, UK
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
University of Oslo, Oslo, Norway
Title
Cardiovascular safety and efficacy of the PCSK9 inhibitor evolocumab in
patients with and without diabetes and the effect of evolocumab on
glycaemia and risk of new-onset diabetes: A prespecified analysis of the
FOURIER randomised controlled trial.
Source
The Lancet Diabetes and Endocrinology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: The proprotein convertase subtilisin/kexin type 9 (PCSK9)
inhibitor evolocumab reduced LDL cholesterol and cardiovascular events in
the FOURIER trial. In this prespecified analysis of FOURIER, we
investigated the efficacy and safety of evolocumab by diabetes status and
the effect of evolocumab on glycaemia and risk of developing diabetes.
Methods: FOURIER was a randomised trial of evolocumab (140 mg every 2
weeks or 420 mg once per month) versus placebo in 27 564 patients with
atherosclerotic disease who were on statin therapy, followed up for a
median of 2.2 years. In this prespecified analysis, we investigated the
effect of evolocumab on cardiovascular events by diabetes status at
baseline, defined on the basis of patient history, clinical events
committee review of medical records, or baseline HbA<inf>1c</inf> of 6.5%
(48 mmol/mol) or greater or fasting plasma glucose (FPG) of 7.0 mmol/L or
greater. The primary endpoint was a composite of cardiovascular death,
myocardial infarction, stroke, hospital admission for unstable angina, or
coronary revascularisation. The key secondary endpoint was a composite of
cardiovascular death, myocardial infarction, or stroke. We also assessed
the effect of evolocumab on glycaemia, and on the risk of new-onset
diabetes among patients without diabetes at baseline. HbA<inf>1c</inf> was
measured at baseline then every 24 weeks and FPG was measured at baseline,
week 12, week 24, and every 24 weeks thereafter, and potential cases of
new-onset diabetes were adjudicated centrally. In a post-hoc analysis, we
also investigated the effects on glycaemia and diabetes risk in patients
with prediabetes (HbA<inf>1c</inf> 5.7-6.4% [39-46 mmol/mol] or FPG
5.6-6.9 mmol/L) at baseline. FOURIER is registered with
ClinicalTrials.gov, number NCT01764633. Findings: At study baseline, 11
031 patients (40%) had diabetes and 16 533 (60%) did not have diabetes (of
whom 10 344 had prediabetes and 6189 had normoglycaemia). Evolocumab
significantly reduced cardiovascular outcomes consistently in patients
with and without diabetes at baseline. For the primary composite endpoint,
the hazard ratios (HRs) were 0.83 (95% CI 0.75-0.93; p=0.0008) for
patients with diabetes and 0.87 (0.79-0.96; p=0.0052) for patients without
diabetes (p<inf>interaction</inf>=0.60). For the key secondary endpoint,
the HRs were 0.82 (0.72-0.93; p=0.0021) for those with diabetes and 0.78
(0.69-0.89; p=0.0002) for those without diabetes
(p<inf>interaction</inf>=0.65). Evolocumab did not increase the risk of
new-onset diabetes in patients without diabetes at baseline (HR 1.05,
0.94-1.17), including in those with prediabetes (HR 1.00, 0.89-1.13).
Levels of HbA<inf>1c</inf> and FPG were similar between the evolocumab and
placebo groups over time in patients with diabetes, prediabetes, or
normoglycaemia. Among patients with diabetes at baseline, the proportions
of patients with adverse events were 78.5% (4327 of 5513 patients) in the
evolocumab group and 78.3% (4307 of 5502 patients) in the placebo group;
among patients without diabetes at baseline, the proportions with adverse
events were 76.8% (6337 of 8256 patients) in the evolocumab group and
76.8% (6337 of 8254 patients) in the placebo group. Interpretation: PCSK9
inhibition with evolocumab significantly reduced cardiovascular risk in
patients with and without diabetes. Evolocumab did not increase the risk
of new-onset diabetes, nor did it worsen glycaemia. These data suggest
evolocumab use in patients with atherosclerotic disease is efficacious and
safe in patients with and without diabetes. Funding: Amgen.<br/>Copyright
&#xa9; 2017 Elsevier Ltd.

<120>
Accession Number
618319605
Author
Bungard T.J.; Mutch J.; Ritchie B.
Institution
(Bungard) EPICORE Centre, Division of Cardiology, 362 Heritage Medical
Research Centre, University of Alberta, Edmonton, AB T6G 2S2, Canada
(Mutch) Alberta Health Services, University of Alberta, 0G1.01, 8440 112
Street NW, Edmonton, AB T6G 2B7, Canada
(Ritchie) Division of Hematology, University of Alberta, 4-71 Medical
Sciences Building, Edmonton, AB T6G 2B6, Canada
Title
A randomized trial of restarting warfarin at maintenance versus loading
doses following an elective procedure.
Source
Journal of Thrombosis and Thrombolysis. (pp 1-9), 2017. Date of
Publication: 15 Sep 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Guidelines suggest restarting warfarin at known maintenance doses,
although this may result in a delay to achieving therapeutic
anticoagulation. As such, we compared the time to achieve an INR >= 2.0
between those restarting warfarin maintenance vs loading doses after
transient interruption, and the impact on protein C, S and factor II
levels. Patients requiring interruption of warfarin for elective
procedures without hospitalization were randomized 1:1 to receive warfarin
maintenance or loading doses (1.5 times the maintenance dose for 3 days
followed by pre-procedural warfarin maintenance dosing). Protein C, S and
Factor II were drawn at baseline (prior to warfarin interruption), 7 and
14 days after restarting warfarin. Among 19 patients randomized to
maintenance and 20 to loading doses, nearly half in each group had
mechanical heart valves with gastrointestinal endoscopic procedures most
commonly performed (41%). The median number of days to reach an INR >= 2.0
was 7.8 days in the loading and 9.0 in the maintenance group (difference
between medians 1.2 days, 95% CI -3.1 to 4.9; P = 0.19). Although levels
of protein C, S and factor II were lower in the loading vs maintenance
dose group, all remained above that of baseline. Warfarin resumption with
loading doses shortened the time to achieve a therapeutic INR by a median
of 1.2 days. Prompt warfarin dose escalation should be done in response to
the INR. Protein C and S remained above pre-warfarin interruption levels,
implying a lack of depletion with restarting warfarin.<br/>Copyright
&#xa9; 2017 Springer Science+Business Media, LLC

<121>
Accession Number
617328917
Author
Sabato L.A.; Salerno D.M.; Moretz J.D.; Jennings D.L.
Institution
(Sabato) Heart Failure and Cardiac Transplantation, Department of
Pharmacy, UC Health-University of Cincinnati Medical Center, Cincinnati,
OH, United States
(Salerno) Solid Organ Transplantation, Department of Pharmacy,
NewYork-Presbyterian Hospital - Weill Cornell Medical Center, New York,
NY, United States
(Moretz) Ventricular Assist Devices, Department of Pharmacy, Vanderbilt
University Medical Center, Nashville, TN, United States
(Jennings) Heart Transplant and Mechanical Circulatory Support, Department
of Pharmacy, New York-Presbyterian Hospital - Columbia University Medical
Center, New York, NY, United States
Title
Inhaled Pulmonary Vasodilator Therapy for Management of Right Ventricular
Dysfunction after Left Ventricular Assist Device Placement and Cardiac
Transplantation.
Source
Pharmacotherapy. 37 (8) (pp 944-955), 2017. Date of Publication: August
2017.
Publisher
Pharmacotherapy Publications Inc.
Abstract
Right ventricular failure (RVF) after cardiac transplant (CTX) or
implantation of a continuous-flow left ventricular assist device (CF-LVAD)
is associated with significant postoperative morbidity and mortality. A
variety of modalities have been used to treat postoperative RVF, including
management of volume status, intravenous inotropes and vasodilators, and
right-sided mechanical support. Inhaled vasodilator agents are a unique
treatment option aimed at minimizing systemic absorption by delivering
therapy directly to the pulmonary vasculature. Current LVAD and CTX
guidelines endorse inhaled vasodilators for managing postoperative RVF;
however, no guidance is offered regarding agent selection, dosing, or
administration. A review of the current literature confirms that inhaled
pulmonary vasodilator agents have been shown to decrease pulmonary artery
pressure when used in the perioperative period of CF-LVAD implant or CTX.
However, the literature regarding the potential impact on clinical
outcomes (e.g., survival or risk of developing RVF) is lacking with these
medications. Based on our assessment of the literature, we suggest that
when RVF occurs in the setting of a normal pulmonary vascular resistance
(PVR), traditional inotropic therapy (e.g., dobutamine) should be used.
Conversely, if the PVR is elevated (> 250 dynes/sec/cm⁵ or 3
Wood units), or the patient has other evidence of a high right ventricular
afterload (i.e., a transpulmonary gradient > 12 mm Hg), then an inhaled
pulmonary vasodilator would be the preferred initial pharmacologic agent.
Drug selection depends largely on the institution's capacity to safely
prepare and administer the medication, along with formulary
considerations, such as the high costs associated with inhaled iloprost
and inhaled nitric oxide.<br/>Copyright &#xa9; 2017 Pharmacotherapy
Publications, Inc.

<122>
Accession Number
615889001
Author
Frobert O.; Gotberg M.; Angeras O.; Jonasson L.; Erlinge D.; Engstrom T.;
Persson J.; Jensen S.E.; Omerovic E.; James S.K.; Lagerqvist B.; Nilsson
J.; Karegren A.; Moer R.; Yang C.; Agus D.B.; Erglis A.; Jensen L.O.;
Jakobsen L.; Christiansen E.H.; Pernow J.
Institution
(Frobert) Orebro University, Faculty of Health, Department of Cardiology,
Orebro, Sweden
(Gotberg, Erlinge) Department of Cardiology, University Hospital Lund,
Lund, Sweden
(Angeras, Omerovic) Department of Cardiology, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Jonasson) Department of Cardiology, University Hospital Linkoping,
Linkoping, Sweden
(Engstrom) Department of Cardiology, Rigshospitalet, University of
Copenhagen, Copenhagen, Denmark
(Persson) Karolinska Institutet, Department of Clinical Sciences, Danderyd
University Hospital, Stockholm, Sweden
(Jensen) Department of Cardiology, Aalborg University Hospital, Aalborg,
Denmark
(James, Lagerqvist) Department of Cardiology, University Hospital Uppsala,
Uppsala, Sweden
(Nilsson) Cardiology, Heart Centre, department of Public Health and
Clinical Medicine, Umea University, Umea, Sweden
(Karegren) Department of Cardiology, Vesteras County Hospital, Vasteras,
Sweden
(Moer) The Feiring Clinic, Feiring, Norway
(Yang) Clinical Epidemiology and Biostatistics, School of Medical
Sciences, Orebro University, Orebro and Unit of Biostatistics, Institute
of Evironmental Medicine, Karolinska Institutet, Stockholm, Sweden
(Agus) University of Southern California, Lawrence J. Ellison Institute
for Transformative Medicine, CA, United States
(Erglis) Latvian Centre of Cardiology, Pauls Stradins Clinical University
Hospital, Riga, Latvia
(Jensen) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Jakobsen, Christiansen) Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark
(Pernow) Karolinska Institutet, Cardiology Unit, Department of Medicine,
Karolinska University Hospital, Stockholm, Sweden
Title
Design and rationale for the Influenza vaccination After Myocardial
Infarction (IAMI) trial. A registry-based randomized clinical trial.
Source
American Heart Journal. 189 (pp 94-102), 2017. Date of Publication: 01 Jul
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Registry studies and case-control studies have demonstrated
that the risk of acute myocardial infarction (AMI) is increased following
influenza infection. Small randomized trials, underpowered for clinical
end points, indicate that future cardiovascular events can be reduced
following influenza vaccination in patients with established
cardiovascular disease. Influenza vaccination is recommended by
international guidelines for patients with cardiovascular disease, but
uptake is varying and vaccination is rarely prioritized during
hospitalization for AMI. Methods/design The Influenza vaccination After
Myocardial Infarction (IAMI) trial is a double-blind, multicenter,
prospective, registry-based, randomized, placebo-controlled, clinical
trial. A total of 4,400 patients with ST-segment elevation myocardial
infarction (STEMI) or non-STEMI undergoing coronary angiography will
randomly be assigned either to in-hospital influenza vaccination or to
placebo. Baseline information is collected from national heart disease
registries, and follow-up will be performed using both registries and a
structured telephone interview. The primary end point is a composite of
time to all-cause death, a new AMI, or stent thrombosis at 1 year.
Implications The IAMI trial is the largest randomized trial to date to
evaluate the effect of in-hospital influenza vaccination on death and
cardiovascular outcomes in patients with STEMI or non-STEMI. The trial is
expected to provide highly relevant clinical data on the efficacy of
influenza vaccine as secondary prevention after AMI.<br/>Copyright &#xa9;
2017 The Author(s)

<123>
Accession Number
616335288
Author
Arora S.; Ramm C.J.; Strassle P.D.; Vaidya S.R.; Caranasos T.G.; Vavalle
J.P.
Institution
(Arora, Ramm, Vavalle) Division of Cardiology, University of North
Carolina School of Medicine, Chapel Hill, North Carolina, United States
(Arora, Vaidya) Division of Internal Medicine, Cape Fear Valley Medical
Center, Fayetteville, North Carolina, United States
(Strassle) Department of Epidemiology, University of North Carolina at
Chapel Hill, Chapel Hill, North Carolina, United States
(Strassle, Caranasos) Department of Surgery, University of North Carolina
at Chapel Hill, Chapel Hill, North Carolina, United States
Title
Review of Major Registries and Clinical Trials of Late Outcomes After
Transcatheter Aortic Valve Replacement.
Source
American Journal of Cardiology. 120 (2) (pp 331-336), 2017. Date of
Publication: 15 Jul 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The results of the Placement of AoRtic TraNscathetER Valves (PARTNER) 2
trial established the feasibility of transcatheter aortic valve
replacement (TAVR) for intermediate surgical risk patients. The expansion
of TAVR into the low-risk patient population will largely depend on its
durability outcomes due to the high life expectancy in low-risk patients.
Long-term follow-up results from low-risk clinical trials will take
several years to be reported. Given this, we performed a systematic review
of current long-term data to provide further insights into TAVR durability
and long-term patient survival. We searched MEDLINE, Embase, Google
Scholar, BIOSIS, and major conference abstracts for TAVR studies with
follow-up of at least 4 years. Abstracts were retrieved and independently
reviewed for eligibility. Final studies were selected irrespective of the
type of TAVR valve, route of vascular access, or surgical risk profile. A
total of 12 studies met the inclusion criteria. We reviewed data from
these studies with emphasis on long-term survival and echocardiographic
findings.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<124>
Accession Number
617767693
Author
Jones J.D.; Chew P.G.; Dobson R.; Wootton A.; Ashrafi R.; Khand A.
Institution
(Jones, Chew, Dobson, Khand) University Hospital Aintree NHS Foundation
Trust, Liverpool, United Kingdom
(Jones, Ashrafi, Khand) University of Liverpool, Liverpool, United Kingdom
(Wootton) RMIT University, Melbourne, VIC, Australia
(Ashrafi) Bristol Heart Institute, Bristol, United Kingdom
(Khand) Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
Title
The prognostic value of heart type fatty acid binding protein in patients
with suspected acute coronary syndrome: A systematic review.
Source
Current Cardiology Reviews. 13 (3) (pp 189-198), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Heart type fatty acid protein (HFABP) is a cytosolic protein
released early after acute coronary syndrome (ACS) even in the absence of
myocardial necrosis. Objectives: The purpose of this systematic review was
to determine whether HFABP levels in patients with suspected, or confirmed
ACS, improve risk stratification when added to established means of risk
assessment. Methods: We searched Medline, Pubmed and Embase databases from
inception to July 2015 to identify prospective studies with suspected or
confirmed ACS, who had HFABP measured during the index admission with at
least 1 month follow up data. A prognostic event was defined as all-cause
mortality or acute myocardial infarction (AMI). Results: 7 trials
providing data on 6935 patients fulfilled inclusion criteria. There were
considerable differences between studies and this was manifest in
variation in prognostic impact of elevated HFABP(Odds ratio range 1.2-15.2
for death). All studies demonstrated that HFABP provide unad-justed
prognostic information and in only one study this was negated after
adjusting for covariates. A combination of both negative troponin and
normal HFABP conferred a very low event rate. No study evaluated the
incremental value of HFABP beyond that of standard risk scores. Only one
study used a high sensitive troponin assay. Conclusion: There was marked
heterogeneity in prognostic impact of HFABP in ACS between studies
reflecting differences in sampling times and population risk. Prospective
studies of suspected ACS with early sampling of HFABP in the era of high
sensitivity troponin are necessary to determine the clinical value of
HFABP. HFABP should not currently be used clinically as a prognostic
marker in patients with suspected ACS.<br/>Copyright &#xa9; 2017 Bentham
Science Publishers.

<125>
Accession Number
610189145
Author
Xu W.; Wang Y.; Song J.; Mo L.; Jiang T.
Institution
(Xu, Wang, Song, Jiang) Department of Respiratory Medicine, The First
Affiliated Hospital of Chongqing Medical University, Chongqing 400016,
China
(Mo) Department of Respiratory Medicine, Dazu District People's Hospital,
Chongqing 400016, China
Title
One-port video-assisted thoracic surgery versus three-port video-assisted
thoracic surgery for primary spontaneous pneumothorax: a meta-analysis.
Source
Surgical Endoscopy and Other Interventional Techniques. 31 (1) (pp 17-24),
2017. Date of Publication: 01 Jan 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Objective: To further understand the effects of video-assisted thoracic
surgery (VATS) with one-port versus three-port VATS for primary
spontaneous pneumothorax (PSP). Methods: In this study, we searched
information from the PubMed, Cochrane Library, Embase, ScienceDirect, Web
of Science, China National Knowledge Infrastructure (CNKI), and Wanfang
Data databases from inception to September 2015 to collect data of
randomized controlled trials (RCTs) and cohort studies about one-port VATS
versus three-port VATS for PSP. Two independent authors were committed to
screen literature, extract data, and assess the risk of bias of related
studies. Then, we used the RevMan 5.20 software for a meta-analysis of
one-port VATS versus three-port VATS for PSP. Results: Six cohort studies
involving 310 patients were finally selected in this meta-analysis. The
results of our study indicate that one-port VATS had a shorter hospital
stay (SMD = -0.39, 95 % CI -0.69 to 0.09, P = 0.01), lower VAS score of
24-h post-operative pain (SMD = -0.78, 95 % CI -1.40 to -0.52, P <
0.00001), shorter chest drainage time (SMD = -0.68, 95 % CI -1.15 to
-0.22, P = 0.004), and lower incidence of post-operative paraesthesia (OR
= 0.13, 95 % CI 0.06 to 0.29, P < 0.00001) compared with three-port VATS.
However, one-port VATS had a lower patient satisfaction score at 24 h (SMD
= -0.65, 95 % CI -0.95 to -0.35, P < 0.0001) and 48 h (SMD = -0.46, 95 %
CI -0.71 to -0.21, P = 0.0002). No differences in the recurrence of
pneumothorax (OR = 0.58, 95 % CI 0.20 to 1.67, P = 0.32), the operation
time (SMD = 1.01, 95 % CI -4.63 to 2.60, P = 0.58), and the satisfaction
score at 72 h (SMD = -0.11, 95 % CI -0.44 to 0.22, P < 0.00001) were noted
between the groups. Conclusion: Current evidence suggests that one-port
VATS may have certain advantages over three-port VATS for PSP. More
large-scale and high-quality studies are needed for
authentication.<br/>Copyright &#xa9; 2016, Springer Science+Business Media
New York.

<126>
Accession Number
617433800
Author
Kolodziejczak M.; Andreotti F.; Kowalewski M.; Buffon A.; Ciccone M.M.;
Parati G.; Scicchitano P.; Uminska J.M.; De Servi S.; Bliden K.P.; Kubica
J.; Bortone A.; Crea F.; Gurbel P.; Navarese E.P.
Institution
(Kolodziejczak) Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus
University, Sklodowskiej-Curie Street No. 9, Bydgoszcz 85-094, Poland
(Andreotti, Buffon, Crea) Institute of Cardiology, Catholic University
Medical School, Via Massimi 96, Rome 00136, Italy
(Kowalewski) Department of Cardiac Surgery, Dr Antoni Jurasz Memorial
University Hospital, Sklodowskiej-Curie Street No. 9, Bydgoszcz 85-094,
Poland
(Ciccone, Scicchitano, Bortone) Department of Emergency and Organ
Transplantation, Section of Cardiovascular Diseases, School of Medicine,
University of Bari, Piazza G. Cesare 11, Bari 70124, Italy
(Parati) Department of Cardiovascular, Neural and Metabolic Sciences, S.
Luca Hospital, IRCCS Istituto Auxologico Italiano, Piazzale Brescia, 20,
Milan 20149, Italy
(Uminska, Kubica) Department of Cardiology and Internal Medicine, Ludwik
Rydygier Collegium Medicum, Nicolaus Copernicus University,
Sklodowskiej-Curie Street No. 9, Bydgoszcz 85-094, Poland
(De Servi) Department of Cardiology, Multimedica IRCCS, Via Milanese, 300,
Milan 20141, Italy
(Bliden, Gurbel, Navarese) Inova Center for Thrombosis Research and Drug
Development, Inova Heart and Vascular Institute, 3300 Gallows Road, Falls
Church, VA 22042, United States
Title
Implantable cardioverter-defibrillators for primary prevention in patients
with ischemic or nonischemic cardiomyopathy: A systematic review and
meta-analysis.
Source
Annals of Internal Medicine. 167 (2) (pp 103-111), 2017. Date of
Publication: 18 Jul 2017.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)
Abstract
Background: Implantable cardioverter-defibrillators (ICDs) have a role in
preventing cardiac arrest in patients at risk for life-threatening
ventricular arrhythmias. Purpose: To compare ICD therapy with conventional
care for the primary prevention of death of various causes in adults with
ischemic or nonischemic cardiomyopathy. Data Sources: MEDLINE, Cochrane
Central Register of Controlled Trials, Google Scholar, and EMBASE
databases, as well as several Web sites, from 1 April 1976 through 31
March 2017. Study Selection: Randomized controlled trials, published in
any language, comparing ICD therapy with conventional care and reporting
mortality outcomes (all-cause, sudden, any cardiac, or noncardiac) in the
primary prevention setting. Data Extraction: 2 independent investigators
extracted study data and assessed risk of bias. Data Synthesis: Included
were 11 trials involving 8716 patients: 4 (1781 patients) addressed
nonischemic cardiomyopathy, 6 (4414 patients) ischemic cardiomyopathy, and
1 (2521 patients) both types of cardiomyopathy. Mean follow-up was 3.2
years. An overall reduction in all-cause mortality, from 28.26% with
conventional care to 21.37% with ICD therapy (hazard ratio [HR], 0.81 [95%
CI, 0.70 to 0.94]; P = 0.043), was found. The magnitude of reduction was
similar in the cohorts with nonischemic (HR, 0.81 [CI, 0.72 to 0.91]) and
ischemic (HR, 0.82 [CI, 0.63 to 1.06]) disease, although the latter
estimate did not reach statistical significance. The rate of sudden death
fell from 12.15% with conventional care to 4.39% with ICD therapy (HR,
0.41 [CI, 0.30 to 0.56]), with a similar magnitude of reduction in
patients with ischemic (HR, 0.39 [CI, 0.23 to 0.68]) and those with
nonischemic disease (HR, 0.44 [CI, 0.17 to 1.12]). Noncardiac and any
cardiac deaths did not differ significantly by treatment. Limitation:
Heterogeneous timing of ICD placement; heterogeneous pharmacologic and
resynchronization co-interventions; trials conducted in different eras;
adverse events and complications not reviewed. Conclusion: Overall,
primary prevention with ICD therapy versus conventional care reduced the
incidence of sudden and allcause death.<br/>Copyright &#xa9; 2017 American
College of Physicians. All Rights Reserved.

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

<128>
Accession Number
614015633
Author
Bundhun P.K.; Soogund M.Z.S.; Huang W.-Q.
Institution
(Bundhun, Huang) Institute of Cardiovascular Diseases, First Affiliated
Hospital of Guangxi Medical University, Nanning, Guangxi, China
(Soogund) Guangxi Medical University, Nanning, Guangxi, China
Title
Same day discharge versus overnight stay in the hospital following
percutaneous coronary intervention in patients with stable coronary artery
disease: A systematic review and meta-analysis of randomized controlled
trials.
Source
PLoS ONE. 12 (1) (no pagination), 2017. Article Number: e0169807. Date of
Publication: January 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: New research in interventional cardiology has shown the demand
for percutaneous coronary interventions (PCI) to have increased
tremendously. Effective treatment with a lower hospital cost has been the
aim of several PCI capable centers. This study aimed to compare the
adverse clinical outcomes associated with same day discharge versus
overnight stay in the hospital following PCI in a population of randomized
patients with stable coronary artery disease (CAD). Methods: The National
Library of Medicine (MEDLINE/PubMed), the Cochrane Registry of Randomized
Controlled Trials and EMBASE databases were searched (from March to June
2016) for randomized trials comparing same-day discharge versus overnight
stay in the hospital following PCI. Main endpoints in this analysis
included adverse cardiovascular outcomes observed during a 30-day period.
Statistical analysis was carried out by the RevMan 5.3 software whereby
odds ratios (OR) and 95% confidence intervals (CIs) were calculated with
respect to a fixed or a random effects model. Results: Eight randomized
trials with a total number of 3081 patients (1598 patients who were
discharged on the same day and 1483 patients who stayed overnight in the
hospital) were included. Results of this analysis showed that mortality,
myocardial infarction (MI) and major adverse cardiac events (MACEs) were
not significantly different between same day discharge versus overnight
stay following PCI with OR: 0.22, 95% CI: 0.04-1.35; P = 0.10, OR: 0.68,
95% CI: 0.33-1.41; P = 0.30 and OR: 0.45, 95% CI: 0.20-1.02; P = 0.06
respectively. Blood transfusion and re-hospitalization were also not
significantly different between these two groups with OR: 0.64, 95% CI:
0.13-3.21; P = 0.59 and OR: 1.53, 95% CI: 0.88- 2.65; P = 0.13
respectively. Similarly, any adverse event, major bleeding and repeated
revascularization were also not significantly different between these two
groups of patients with stable CAD, with OR: 0.42, 95% CI: 0.05-3.97; P =
0.45, OR: 0.73, 95% CI: 0.15-3.54; P = 0.69 and OR: 0.67, 95% CI:
0.14-3.15; P = 0.61 respectively. Conclusion: In terms of adverse
cardiovascular outcomes, same day discharge was neither superior nor
inferior to overnight hospital stay following PCI in those patients with
stable CAD. However, future research will have to emphasize on the
long-term consequences.<br/>Copyright &#xa9; 2017 Bundhun et al. This is
an open access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<129>
Accession Number
614169767
Author
Li Z.; Zhou Y.; Xu Q.; Chen X.
Institution
(Li, Chen) Department of Cardiology, Affiliated Hospital Ningbo No. 1
Hospital, Zhejiang University, Ningbo, China
(Zhou) Department of Cardiology, First Affiliated Hospital, School of
Medicine, Zhejiang University, Ningbo, China
(Xu) Department of Nephrology, Affiliated Hospital Ningbo No. 1 Hospital,
Zhejiang University, Ningbo, China
Title
Staged versus one-time complete revascularization with percutaneous
coronary intervention in STEMI patients with multivessel disease: A
systematic review and meta-analysis.
Source
PLoS ONE. 12 (1) (no pagination), 2017. Article Number: e0169406. Date of
Publication: January 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Introduction: In patients with acute ST-elevation myocardial infarction
(STEMI), the preferred intervention is percutaneous coronary intervention
(PCI). Whether staged PCI (S-PCI) or one-time complete PCI (MV-PCI) is
more beneficial and safer in terms of treating the non-culprit vessel
during the primary PCI procedure is unclear. We performed a meta-analysis
of all randomized and non-randomized controlled trials comparing S-PCI
with MV-PCI in patients with acute STEMI and MVD. Methods: Studies of
STEMI with multivessel disease receiving primary PCI were searched in
PUBMED, EMBASE and The Cochrane Register of Controlled Trials from January
2004 to December 2014. The primary end points were long-term rates of
major adverse cardiovascular events and their components - mortality,
reinfarction, and target-vessel revascularization. Data were combined
using a fixed-effects model. Results: Of 507 citations, 10 studies (4
randomized, 6 nonrandomized; 820 patients, 562 staged PCI and 347
one-time, complete multi-vessel PCI) were included. S-PCI compared to
MV-PCI significantly reduced mortality both long-term (OR 0.44, 95% CI
0.29-0.66, P<0.0001,I² = 0%) and short-term (OR 0.23, 95% CI
0.1-0.51, P = 0.0003,I² = 0%). There was a trend toward reduced
risk of MACE with s-PCI compared with MV-PCI (OR 0.83, 0.62-1.12, P =
0.22,I2 = 0%). No difference between S-PCI and MV-PCI was observed in
reinfarction (OR 0.97, 0.61-1.55, P = 0.91, I² = 0%), or target
vessel revascularization (OR1.17, 95% CI 0.81-1.69, P = 0.40,
I² = 8%). Conclusions: The staged strategy for non-culprit
lesions improved short- and long-term survival and should remain the
standard approach to primary PCI in patients with STEMI; one-time complete
multivessel PCI may be associated with greater mortality risk. However,
additional large, randomized trials are required to confirm the optimal
timing of a staged procedure on the non-culprit vessel in
STEMI.<br/>Copyright &#xa9; 2017 Li et al. This is an open access article
distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any
medium, provided the original author and source are credited.

<130>
Accession Number
613853744
Author
El-Mashad A.E.-R.; El-Mahdy H.; El Amrousy D.; Elgendy M.
Institution
(El-Mashad, El-Mahdy, El Amrousy, Elgendy) Pediatric Department, Tanta
University Hospital, Elgeish street, Tanta, Egypt
Title
Comparative study of the efficacy and safety of paracetamol, ibuprofen,
and indomethacin in closure of patent ductus arteriosus in preterm
neonates.
Source
European Journal of Pediatrics. 176 (2) (pp 233-240), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
In this prospective study, we compared the efficacy and side effects of
indomethacin, ibuprofen, and paracetamol in patent ductus arteriosus (PDA)
closure in preterm neonates. Three hundred preterm neonates with
hemodynamically significant PDA (hs-PDA) admitted at our neonatal
intensive care unit were enrolled in the study. They were randomized into
three groups. Group I (paracetamol group) received 15 mg/kg/6 h IV
paracetamol infusion for 3 days. Group II (ibuprofen group) received 10
mg/kg IV ibuprofen infusion followed by 5 mg/kg/day for 2 days. Group III
(indomethacin group) received 0.2 mg/kg/12 h indomethacin IV infusion for
three doses. Laboratory investigations such as renal function test, liver
function test, complete blood count, and blood gases were conducted in
addition to echocardiographic examinations. All investigations were done
before and 3 days after treatment. There was no significant difference
between all groups regarding efficacy of PDA closure (P = 0.868). There
was a significant increase in serum creatinine levels and serum blood urea
nitrogen (BUN) in the ibuprofen and indomethacin groups (P < 0.001). There
was a significant reduction in platelet count and urine output (UOP) in
both ibuprofen and indomethacin groups (P < 0.001). There was a
significant increase in bilirubin levels in only the ibuprofen group (P =
0.003). No significant difference of hemoglobin (HB) level or liver
enzymes in all groups (P > 0.05). Ventilatory settings improved
significantly in patients with successful closure of PDA than those with
failed PDA closure (P < 0.001). Conclusion: Paracetamol is as effective as
indomethacin and ibuprofen in closure of PDA in preterm neonates and has
less side effects mainly on renal function, platelet count, and GIT
bleeding.What is Known:* Hemodynamically significant patent ductus
arteriosus has many complications for preterm and low birth weight
neonates and better to be closed. Many drugs were used for medical closure
of PDA e.g. indomethacin, ibuprofen and recently paracetamol. Many studies
compare safety and efficacy of paracetamol with either indomethacin or
ibuprofen.What is New:* It is the first large study that compares the
efficacy and side effects of the three drugs in one study.<br/>Copyright
&#xa9; 2016, Springer-Verlag Berlin Heidelberg.

<131>
Accession Number
615893012
Author
Benstoem C.; Stoppe C.; Liakopoulos O.J.; Ney J.; Hasenclever D.; Meybohm
P.; Goetzenich A.
Institution
(Benstoem, Goetzenich) University Hospital Aachen, Department of
Cardiothoracic Surgery, Pauwelsstrasse 30, Aachen, North Rhine Westphalia
52074, Germany
(Stoppe) RWTH Aachen University, Department of Intensive Care Medicine,
Pauwelsstrasse 30, Aachen, North Rhine Westphalia 52074, Germany
(Liakopoulos) Heart Center, University of Cologne, Department of
Cardiothoracic Surgery, Kerpener Str. 62, Cologne 50937, Germany
(Ney) University Hospital RWTH Aachen, Department of Anaesthesiology,
Pauwelsstrasse 30, Aachen, Germany
(Hasenclever) University of Leipzig, Institute for Medical Informatics,
Statistics and Epidemiology (IMISE), Haertelstrasse 16-18, Leipzig,
Germany
(Meybohm) University Hospital Frankfurt, Department of Anaesthesiology,
Intensive Care and Pain Therapy, Theodor-Stern-Kai 7, Frankfurt am Main
60590, Germany
Title
Remote ischaemic preconditioning for coronary artery bypass grafting (with
or without valve surgery).
Source
Cochrane Database of Systematic Reviews. 2017 (5) (no pagination), 2017.
Article Number: CD011719. Date of Publication: 05 May 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom)
Abstract
Background: Despite substantial improvements in myocardial preservation
strategies, coronary artery bypass grafting (CABG) is still associated
with severe complications. It has been reported that remote ischaemic
preconditioning (RIPC) reduces reperfusion injury in people undergoing
cardiac surgery and improves clinical outcome. However, there is a lack of
synthesised information and a need to review the current evidence from
randomised controlled trials (RCTs). Objectives: To assess the benefits
and harms of remote ischaemic preconditioning in people undergoing
coronary artery bypass grafting, with or without valve surgery. Search
methods: In May 2016 we searched CENTRAL, MEDLINE, Embase and Web of
Science. We also conducted a search of ClinicalTrials.gov and the
International Clinical Trials Registry Platform (ICTRP). We also checked
reference lists of included studies. We did not apply any language
restrictions. Selection criteria: We included RCTs in which people
scheduled for CABG (with or without valve surgery) were randomly assigned
to receive RIPC or sham intervention before surgery. Data collection and
analysis: Two review authors independently assessed trials for inclusion,
extracted data and checked them for accuracy. We calculated mean
differences (MDs), standardised mean differences (SMDs) and risk ratios
(RR) using a random-effects model. We assessed quality of the trial
evidence for all primary outcomes using the GRADE methodology. We
completed a 'Risk of bias' assessment for all studies and performed
sensitivity analysis by excluding studies judged at high or unclear risk
of bias for sequence generation, allocation concealment and incomplete
outcome data. We contacted authors for missing data. Our primary endpoints
were 1) composite endpoint (including all-cause mortality, non-fatal
myocardial infarction or any new stroke, or both) assessed at 30 days
after surgery, 2) cardiac troponin T (cTnT, ng/L) at 48 hours and 72
hours, and as area under the curve (AUC) 72 hours (mug/L) after surgery,
and 3) cardiac troponin I (cTnI, ng/L) at 48 hours, 72 hours, and as area
under the curve (AUC) 72 hours (mug/L) after surgery. Main results: We
included 29 studies involving 5392 participants (mean age = 64 years, age
range 23 to 86 years, 82% male). However, few studies contributed data to
meta-analyses due to inconsistency in outcome definition and reporting. In
general, risk of bias varied from low to high risk of bias across included
studies, and insufficient detail was provided to inform judgement in
several cases. The quality of the evidence of key outcomes ranged from
moderate to low quality due to the presence of moderate or high
statistical heterogeneity, imprecision of results or due to limitations in
the design of individual studies. Compared with no RIPC, we found that
RIPC has no treatment effect on the rate of the composite endpoint with RR
0.99 (95% confidence interval (CI) 0.78 to 1.25); 2 studies; 2463
participants; moderate-quality evidence. Participants randomised to RIPC
showed an equivalent or better effect regarding the amount of cTnT release
measured at 72 hours after surgery with SMD -0.32 (95% CI -0.65 to 0.00);
3 studies; 1120 participants; moderate-quality evidence; and expressed as
AUC 72 hours with SMD -0.49 (95% CI -0.96 to -0.02); 3 studies; 830
participants; moderate-quality evidence. We found the same result in
favour of RIPC for the cTnI release measured at 48 hours with SMD -0.21
(95% CI -0.40 to -0.02); 5 studies; 745 participants; moderate-quality
evidence; and measured at 72 hours after surgery with SMD -0.37 (95% CI
-0.59 to -0.15); 2 studies; 459 participants; moderate-quality evidence.
All other primary outcomes showed no differences between groups (cTnT
release measured at 48 hours with SMD -0.14, 95% CI -0.33 to 0.06; 4
studies; 1792 participants; low-quality evidence and cTnI release measured
as AUC 72 hours with SMD -0.17, 95% CI -0.48 to 0.14; 2 studies; 159
participants; moderate-quality evidence). We also found no differences
between groups for all-cause mortality after 30 days, non-fatal myocardial
infarction after 30 days, any new stroke after 30 days, acute renal
failure after 30 days, length of stay on the intensive care unit (days),
any complications and adverse effects related to ischaemic
preconditioning. We did not assess many
patient-centred/salutogenic-focused outcomes. Authors' conclusions: We
found no evidence that RIPC has a treatment effect on clinical outcomes
(measured as a composite endpoint including all-cause mortality, non-fatal
myocardial infarction or any new stroke, or both, assessed at 30 days
after surgery). There is moderate-quality evidence that RIPC has no
treatment effect on the rate of the composite endpoint including all-cause
mortality, non-fatal myocardial infarction or any new stroke assessed at
30 days after surgery, or both. We found moderate-quality evidence that
RIPC reduces the cTnT release measured at 72 hours after surgery and
expressed as AUC (72 hours). There is moderate-quality evidence that RIPC
reduces the amount of cTnI release measured at 48 hours, and measured 72
hours after surgery. Adequately-designed studies, especially focusing on
influencing factors, e.g. with regard to anaesthetic management, are
encouraged and should systematically analyse the commonly used medications
of people with cardiovascular diseases.<br/>Copyright &#xa9; 2017 The
Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

<132>
Accession Number
608719832
Author
Frymoyer A.; Su F.; Grimm P.C.; Sutherland S.M.; Axelrod D.M.
Institution
(Frymoyer, Su, Grimm, Sutherland, Axelrod) Department of Pediatrics,
Stanford University, Stanford, CA, United States
Title
Theophylline Population Pharmacokinetics and Dosing in Children Following
Congenital Heart Surgery With Cardiopulmonary Bypass.
Source
Journal of Clinical Pharmacology. 56 (9) (pp 1084-1093), 2016. Date of
Publication: 2016.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Children undergoing cardiac surgery requiring cardiopulmonary bypass (CPB)
frequently develop acute kidney injury due to renal ischemia.
Theophylline, which improves renal perfusion via adenosine receptor
inhibition, is a potential targeted therapy. However, children undergoing
cardiac surgery and CPB commonly have alterations in drug
pharmacokinetics. To help understand optimal aminophylline (salt
formulation of theophylline) dosing strategies in this population, a
population-based pharmacokinetic model was developed using nonlinear
mixed-effects modeling (NONMEM) from 71 children (median age 5 months; 90%
range 1 week to 10 years) who underwent cardiac surgery requiring CPB and
received aminophylline as part of a previous randomized controlled trial.
A 1-compartment model with linear elimination adequately described the
pharmacokinetics of theophylline. Weight scaled via allometry was a
significant predictor of clearance and volume. In addition, allometric
scaled clearance increased with age implemented as a power maturation
function. Compared to prior reports in noncardiac children, theophylline
clearance was markedly reduced across age. In the final population
pharmacokinetic model, optimized empiric dosing regimens were developed
via Monte Carlo simulations. Doses 50% to 75% lower than those recommended
in noncardiac children were needed to achieve target serum concentrations
of 5 to 10 mg/L.<br/>Copyright &#xa9; 2016, The American College of
Clinical Pharmacology

<133>
Accession Number
610286491
Author
Li H.; Lin Y.-L.; Diao S.-L.; Ma B.-X.; Liu X.-L.
Institution
(Li, Lin, Diao, Ma) Department of Cardiology, Affiliated Hospital of
Binzhou Medical University, Binzhou, China
(Liu) Department of Cardiology, Qilu Hospital of Shandong University,
Jinan, Shandong Province, China
Title
Does short preoperative statin therapy prevent infectious complications in
adults undergoing cardiac or non-cardiac surgery?: A meta-analysis of 5
randomized placebo-controlled trials.
Source
Saudi Medical Journal. 37 (5) (pp 492-497), 2016. Date of Publication: May
2016.
Publisher
Saudi Arabian Armed Forces Hospital (E-mail: smjns.ksa@zajil.net)
Abstract
Objectives: To evaluate the effect of preoperative statin therapy on the
incidence of postoperative infection. Methods: This systematic review of
the literature was carried out in August 2015. Studies were retrieved via
PubMed, Embase, and the Cochrane Library (1980 to 2015), and the reference
files were limited to Englishlanguage articles. We used a standardized
protocol, and a meta-analysis was performed for data abstraction.
Systematic Review Results: Five studies comprising 1,362 patients
qualified for the analysis. The incidence of postoperative infections in
the statin group (1.1%) was not significantly lower than that in the
placebo group (2.4%), with a risk ratio (RR) of 0.56 (95% confidence
interval [CI] 0.24-1.33, p=0.19). Patients of 3 studies underwent cardiac
surgery. The aggregated results of these studies failed to show
significant differences in postoperative infection when a fixed effects
model was used (RR: 0.39; 95% CI: 0.08-1.97, p=0.26]. Conclusions: We
failed to find sufficient evidence to support the association between
statin use and postoperative infectious complications. The absence of any
evidence for a beneficial effect in available randomized trials reduces
the likelihood of a causal effect as reported in observational
studies.<br/>Copyright &#xa9; 2016, Saudi Arabian Armed Forces Hospital.
All rights reserved.

<134>
Accession Number
610114046
Author
Barbero U.; Iannaccone M.; D'Ascenzo F.; Barbero C.; Mohamed A.; Annone
U.; Benedetto S.; Celentani D.; Gagliardi M.; Moretti C.; Gaita F.
Institution
(Barbero, Iannaccone, D'Ascenzo, Mohamed, Annone, Benedetto, Celentani,
Gagliardi, Moretti, Gaita) Cardiology Department, Citta Della Salute,
Scienza Hospital, Turin, Italy
(Barbero) Cardiac Surgery Department, Citta Della Salute, Scienza
Hospital, Turin, Italy
Title
64 slice-coronary computed tomography sensitivity and specificity in the
evaluation of coronary artery bypass graft stenosis: A meta-analysis.
Source
International Journal of Cardiology. 216 (pp 52-57), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Elsevier Ireland Ltd
Abstract
A non-invasive approach to define grafts patency and stenosis in the
follow-up of coronary artery bypass graft (CABG) patients may be an
interesting alternative to coronary angiography. 64-slice-coronary
computed tomography is nowadays a diffused non-invasive method that
permits an accurate evaluation of coronary stenosis, due to a high
temporal and spatial resolution. However, its sensitivity and specificity
in CABG evaluation has to be clearly defined, since published studies used
different protocols and scanners. We collected all studies investigating
patients with stable symptoms and previous CABG and reporting the
comparison between diagnostic performances of invasive coronary
angiography and 64-slice-coronary computed tomography. As a result,
sensitivity and specificity of 64-slice-coronary computed tomography for
CABG occlusion were 0.99 (95% CI 0.97-1.00) and 0.99 (95% CI: 0.99-1.00)
with an area under the curve (AUC) of 0.99. 64-slice-coronary computed
tomography sensitivity and specificity for the presence of any CABG
stenosis > 50% were 0.98 (95% CI: 0.97-0.99) and 0.98 (95% CI: 0.96-0.98),
while AUC was 0.99. At meta-regression, neither the age nor the time from
graft implantation had effect on sensitivity and specificity of
64-slice-coronary computed tomography detection of significant CABG
stenosis or occlusion. In conclusion 64-slice-coronary computed tomography
confirmed its high sensitivity and specificity in CABG stenosis or
occlusion evaluation.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd. All
rights reserved.

<135>
Accession Number
610112476
Author
Anantha Narayanan M.; Sundaram V.; Reddy Y.N.V.; Baskaran J.; Agnihotri
K.; Badheka A.; Patel N.; Deshmukh A.
Institution
(Anantha Narayanan) Department of Internal Medicine, Creighton University,
School of Medicine, Omaha, NE, United States
(Reddy, Deshmukh) Division of Cardiovascular Diseases, Mayo Clinic,
Rochester, MN, United States
(Sundaram) Division of Cardiovascular Diseases, University Hospitals, Case
Medical Center, Cleveland, OH, United States
(Reddy) Department of Internal Medicine, Boston University, Medical
Center, Boston, MA, United States
(Baskaran) Sri Venkateshwaraa Medical College Hospital and Research
Center, Puducherry, India
(Agnihotri) Department of Internal Medicine, Saint Peters University
Hospital, New Brunswick, NJ, United States
(Badheka) Department of Cardiology, Everett Clinic, Everett, WA, United
States
(Patel) Department of Cardiology, University of Miami, Miller School of
Medicine, Miami, FL, United States
Title
What is the optimal approach to a non- culprit stenosis after ST-elevation
myocardial infarction - Conservative therapy or upfront revascularization?
An updated meta-analysis of randomized trials.
Source
International Journal of Cardiology. 216 (pp 18-24), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Non-culprit percutaneous coronary intervention (PCI) during a
ST-segment elevation myocardial infarction (STEMI) remains controversial.
We performed a meta-analysis of the published literature comparing a
strategy of complete revascularization (CR) with culprit or target vessel
revascularization (TVR)-only after STEMI in patients with multi-vessel
disease. Methods We searched PubMed/Medline, Cochrane, EMBASE, Web of
Science, CINAHL, Scopus and Google-scholar databases from inception to
March-2016 for clinical trials comparing CR with TVR during PCI for STEMI.
Mantel-Haenszel risk ratio (MH-RR) with 95% confidence intervals (CI) for
individual outcomes was calculated using random-effects model. Results A
total of 7 randomized trials with 2004 patients were included in the final
analysis. Mean follow-up was 25.4 months. Major adverse cardiac events
(MACE) (MH-RR: 0.58, 95% CI: 0.43-0.78, P < 0.001), cardiac deaths (MH-RR:
0.42, 95% CI: 0.24-0.74, P = 0.003) and repeat revascularization (MH-RR:
0.36, 95% CI: 0.27-0.48, P < 0.001) were much lower in the CR group when
compared to TVR. However, there was no significant difference in the risk
of all-cause mortality (0.84, 95% CI: 0.57-1.25, P = 0.394) or recurrent
MI (MH-RR: 0.66, 95% CI: 0.34-1.26, P = 0.205) between the two groups. CR
appeared to be safe with no significant increase in adverse events
including stroke rates (MH-RR: 2.19, 95% CI: 0.59-8.12, P = 0.241),
contrast induced nephropathy (MH-RR: 0.73, 95% CI: 0.34-1.57, P = 0.423)
or major bleeding episodes (MH-RR: 0.72, 95% CI: 0.34-1.54, P = 0.399).
Conclusions CR strategy in STEMI patients with multivessel coronary artery
disease is associated with reduction in MACE, cardiac mortality and need
for repeat revascularization but with no decrease in the risk of
subsequent MI or all-cause mortality. CR was safe however, with no
increase in adverse events including stroke, stent thrombosis or contrast
nephropathy when compared to TVR.<br/>Copyright &#xa9; 2016 Elsevier
Ireland Ltd. All rights reserved.

<136>
Accession Number
607428768
Author
Kosour C.; Dragosavac D.; Antunes N.; Almeida de Oliveira R.A.R.; Martins
Oliveira P.P.; Wilson Vieira R.
Institution
(Kosour) Department of Nursing, Federal University of Alfenas, Alfenas,
Brazil
(Kosour, Dragosavac, Antunes, Martins Oliveira, Wilson Vieira) Department
of Surgery, School of Medical Sciences, State University of Campinas
(Unicamp), Campinas, Barao Geraldo, Brazil
(Almeida de Oliveira) Pontifical University Catholic of Campinas
(PUC-Campinas), Campinas, Brazil
Title
Effect of Ultrafiltration on Pulmonary Function and Interleukins in
Patients Undergoing Cardiopulmonary Bypass.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (4) (pp 884-890),
2016. Date of Publication: 01 Aug 2016.
Publisher
W.B. Saunders
Abstract
Objective To evaluate the effect of ultrafiltration on interleukins,
TNF-alpha levels, and pulmonary function in patients undergoing coronary
artery bypass grafting (CABG). Design Prospective, randomized, controlled
trial. Setting University hospital. Participants Forty patients undergoing
CABG were randomized into a group assigned to receive ultrafiltration (UF)
during cardiopulmonary bypass (CPB) or into another group (control) that
underwent the same procedure but without ultrafiltration. Methods
Interleukins and TNF-alpha levels, pulmonary gas exchange, and ventilatory
mechanics were measured in the preoperative, intraoperative, and
postoperative periods. Interleukins and TNF-alpha also were analyzed in
the perfusate of the test group. Measurements and Main Results There were
increases in IL-6 and IL-8 at 30 minutes after CPB and 6, 12, 24, and 36
hours after surgery, along with an increase in TNF-alpha at 30 minutes
after CPB and 24, 36, and 48 hours after surgery in both groups. IL-1
increased at 30 minutes after CPB and 12 hours after surgery, while IL-6
increased 24 and 36 hours after surgery in the UF group. The analysis of
the ultrafiltrate showed the presence of TNF-alpha and traces of IL-1beta,
IL-6, and IL-8. There were alterations in the oxygen index,
alveolar-arterial oxygen difference, deadspace, pulmonary static
compliance and airway resistance after anesthesia and sternotomy, as well
as in airway resistance at 6 hours after surgery in both groups, with no
difference between them. Conclusions Ultrafiltration increased the serum
level of IL-1 and IL-6, while it did not interfere with gas exchange and
pulmonary mechanics in CABG.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<137>
Accession Number
617833310
Author
Li X.; Yang J.; Nie X.-L.; Zhang Y.; Li X.-Y.; Li L.-H.; Wang D.-X.; Ma D.
Institution
(Li, Zhang, Wang) Department of Anesthesiology and Critical Care Medicine,
Peking University First Hospital, Beijing, China
(Yang, Li) Department of Anesthesiology, Fuwai Hospital, National Center
for Cardiovascular Diseases, Chinese Academy of Medical Sciences and
Peking Union Medical College, Beijing, China
(Nie) Center for Clinical Epidemiology & Evidence-Based Medicine, Beijing
Children's Hospital, Capital Medical University, Beijing, China
(Li) Department of Biostatistics, Peking University First Hospital,
Beijing, China
(Ma) Section of Anaesthetics, Pain Management and Intensive Care,
Department of Surgery and Cancer, Imperial College London, Chelsea and
Westminster Hospital, London, United Kingdom
Title
Impact of dexmedetomidine on the incidence of delirium in elderly patients
after cardiac surgery: A randomized controlled trial.
Source
PloS one. 12 (2) (pp e0170757), 2017. Date of Publication: 2017.
Abstract
BACKGROUND: Delirium is a frequent complication after cardiac surgery and
its occurrence is associated with poor outcomes. The purpose of this study
was to investigate the impact of perioperative dexmedetomidine
administration on the incidence of delirium in elderly patients after
cardiac surgery.
METHODS: This randomized, double-blinded, and placebo-controlled trial was
conducted in two tertiary hospitals in Beijing between December 1, 2014
and July 19, 2015. Eligible patients were randomized into two groups.
Dexmedetomidine (DEX) was administered during anesthesia and early
postoperative period for patients in the DEX group, whereas normal saline
was administered in the same rate for the same duration for patients in
the control (CTRL) group. The primary endpoint was the incidence of
delirium during the first five days after surgery. Secondary endpoints
included the cognitive function assessed on postoperative days 6 and 30,
the overall incidence of non-delirium complications within 30 days after
surgery, and the all-cause 30-day mortality.
RESULTS: Two hundred eighty-five patients were enrolled and randomized.
Dexmedetomidine did not decrease the incidence of delirium (4.9% [7/142]
in the DEX group vs 7.7% [11/143] in the CTRL group; OR 0.62, 95% CI 0.23
to 1.65, p = 0.341). Secondary endpoints were similar between the two
groups; however, the incidence of pulmonary complications was slightly
decreased (OR 0.51, 95% CI 0.26 to 1.00, p = 0.050) and the percentage of
early extubation was significantly increased (OR 3.32, 95% CI 1.36 to
8.08, p = 0.008) in the DEX group. Dexmedetomidine decreased the required
treatment for intraoperative tachycardia (21.1% [30/142] in the DEX group
vs 33.6% [48/143] in the CTRL group, p = 0.019), but increased the
required treatment for postoperative hypotension (84.5% [120/142] in the
DEX group vs 69.9% [100/143] in the CTRL group, p = 0.003).
CONCLUSIONS: Dexmedetomidine administered during anesthesia and early
postoperative period did not decrease the incidence of postoperative
delirium in elderly patients undergoing elective cardiac surgery. However,
considering the low delirium incidence, the trial might have been
underpowered.
TRIAL REGISTRATION: ClinicalTrials.gov NCT02267538.

<138>
Accession Number
617835079
Author
Burton N.W.; Ademi Z.; Best S.; Fiatarone Singh M.A.; Jenkins J.S.; Lawson
K.D.; Leicht A.S.; Mavros Y.; Noble Y.; Norman P.; Norman R.; Parmenter
B.J.; Pinchbeck J.; Reid C.M.; Rowbotham S.E.; Yip L.; Golledge J.
Institution
(Burton) The University of Queensland School of Human Movement & Nutrition
Sciences, St Lucia, Brisbane, QLD, 4072, Australia
(Ademi) University of Basel Institute of Pharmaceutical Medicine, Basel,
Switzerland
(Ademi) University of Monash Department of Epidemiology and Preventive
Medicine, Melbourne, 3004, VIC, Australia
(Best, Pinchbeck, Yip, Golledge) Queensland Research Centre for Peripheral
Vascular Disease; College of Medicine and Dentistry, James Cook
University, Townsville, QLD, 4811, Australia
(Fiatarone Singh) Exercise, Health and Performance Faculty Research Group,
Faculty of Health Sciences, University of Sydney, Sydney, NSW, 2141,
Australia
(Jenkins) Vascular Surgery The Royal Brisbane and Women's Hospital,
Herston, QLD, 4059, Australia
(Lawson) Centre for Health Research, School of Medicine, Western Sydney
University, Sydney, NSW, 2753, Australia
(Lawson) Centre for Research Excellence in Chronic Disease Prevention,
Australian Institute for Public Health and Tropical Health and Medicine,
James Cook University, Townsville, QLD, 4811, Australia
(Leicht) Sport and Exercise Science, College of Healthcare Sciences, James
Cook University, Townsville, QLD, 4811, Australia
(Mavros, Noble) Exercise, Health and Performance Research Group, Faculty
of Health Sciences, University of Sydney, Sydney, NSW, 2141, Australia
(Norman) Surgery Fremantle Hospital, The University of Western Australia,
Crawley, WA, 6009, Australia
(Norman, Reid) School of Public Health, Curtin University, Perth, WA,
6845, Australia
(Parmenter) Department of Exercise Physiology, Faculty of Medicine,
University of New South Wales, Sydney, NSW, 2052, Australia
(Reid) School of Public Health and Preventive Medicine, Monash University,
Melbourne, VIC, 3004, Australia
(Rowbotham) The University of Queensland School of Medicine, Herston, QLD,
4006, Australia
(Rowbotham) The Royal Brisbane and Women's Hospital, Herston, QLD, 4029,
Australia
(Golledge) Department of Vascular and Endovascular Surgery, The Townsville
Hospital, Townsville, QLD, 4811, Australia
Title
Efficacy of brief behavioral counselling by allied health professionals to
promote physical activity in people with peripheral arterial disease
(BIPP): study protocol for a multi-center randomized controlled trial.
Source
BMC public health. 16 (1) (pp 1148), 2016. Date of Publication: 09 Nov
2016.
Abstract
BACKGROUND: Physical activity is recommended for people with peripheral
arterial disease (PAD), and can improve walking capacity and quality of
life; and reduce pain, requirement for surgery and cardiovascular events.
This trial will assess the efficacy of a brief behavioral counselling
intervention delivered by allied health professionals to improve physical
activity in people with PAD.
METHODS: This is a multi-center randomised controlled trial in four cities
across Australia. Participants (N=200) will be recruited from specialist
vascular clinics, general practitioners and research databases and
randomised to either the control or intervention group. Both groups will
receive usual medical care, a written PAD management information sheet
including advice to walk, and four individualised contacts from a
protocol-trained allied health professional over 3 months (weeks 1, 2, 6,
12). The control group will receive four 15-min telephone calls with
general discussion about PAD symptoms and health and wellbeing. The
intervention group will receive behavioral counselling via two 1-h
face-to-face sessions and two 15-min telephone calls. The counselling is
based on the 5A framework and will promote interval walking for 3x40
min/week. Assessments will be conducted at baseline, and 4, 12 and 24
months by staff blinded to participant allocation. Objectively assessed
outcomes include physical activity (primary), sedentary behavior, lower
limb body function, walking capacity, cardiorespiratory fitness,
event-based claudication index, vascular interventions, clinical events,
cardiovascular function, circulating markers, and anthropometric measures.
Self-reported outcomes include physical activity and sedentary behavior,
walking ability, pain severity, and health-related quality of life. Data
will be analysed using an intention-to-treat approach. An economic
evaluation will assess whether embedding the intervention into routine
care would likely be value for money. A cost-effectiveness analysis will
estimate change in cost per change in activity indicators due to the
intervention, and a cost-utility analysis will assess change in cost per
quality-adjusted life year. A full uncertainty analysis will be
undertaken, including a value of information analysis, to evaluate the
economic case for further research.
DISCUSSION: This trial will evaluate the efficacy and cost-effectiveness
of a brief behavioral counselling intervention for a common cardiovascular
disease with significant burden.
TRIAL REGISTRATION: ACTRN 12614000592640 Australian New Zealand Clinical
Trials Registry. Registration Date 4 June 2014.

<139>
Accession Number
617759020
Author
Kehler D.S.; Stammers A.N.; Tangri N.; Hiebert B.; Fransoo R.; Schultz
A.S.H.; Macdonald K.; Giacomontonio N.; Hassan A.; Legare J.-F.; Arora
R.C.; Duhamel T.A.
Institution
(Kehler, Stammers, Duhamel) Health, Leisure and Human Performance Research
Institute, Faculty of Kinesiology and Recreation Management, University of
Manitoba, Winnipeg, MB, Canada
(Kehler, Stammers, Duhamel) Institute of Cardiovascular Sciences, St.
Boniface Hospital Research Centre, Winnipeg, Canada
(Tangri) Seven Oaks Hospital Research Centre, Winnipeg, Canada
(Hiebert, Arora) Department of Surgery, University of Manitoba and Cardiac
Sciences Program, Winnipeg, Canada
(Fransoo) Department of Community Health Sciences and Manitoba Centre for
Health Policy, University of Manitoba, Winnipeg, Canada
(Schultz) College of Nursing, Faculty of Heath Sciences, University of
Manitoba, Winnipeg, Canada
(Macdonald) Seven Oaks Hospital Library, Winnipeg, Canada
(Giacomontonio) Division of Cardiology, Department of Medicine, Dalhousie
University, Halifax, Canada
(Hassan) Department of Cardiac Surgery, New Brunswick Heart Centre, Saint
John Regional Hospital, Saint John, MB, Canada
(Legare) Division of Cardiac Surgery, Department of Surgery, Dalhousie
University, Halifax, Canada
Title
Systematic review of preoperative physical activity and its impact on
postcardiac surgical outcomes.
Source
BMJ Open. 7 (8) (no pagination), 2017. Article Number: e015712. Date of
Publication: 01 Aug 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives The objective of this systematic review was to study the impact
of preoperative physical activity levels on adult cardiac surgical
patients' postoperative: (1) major adverse cardiac and cerebrovascular
events (MACCEs), (2) adverse events within 30 days, (3) hospital length of
stay (HLOS), (4) intensive care unit length of stay (ICU LOS), (5)
activities of daily living (ADLs), (6) quality of life, (7) cardiac
rehabilitation attendance and (8) physical activity behaviour. Methods A
systematic search of MEDLINE, Embase, AgeLine and Cochrane library for
cohort studies was conducted. Results Eleven studies (n=5733 patients) met
the inclusion criteria. Only self-reported physical activity tools were
used. Few studies used multivariate analyses to compare active versus
inactive patients prior to surgery. When comparing patients who were
active versus inactive preoperatively, there were mixed findings for
MACCE, 30 day adverse events, HLOS and ICU LOS. Of the studies that
adjusted for confounding variables, five studies found a protective,
independent association between physical activity and MACCE (n=1), 30-day
postoperative events (n=2), HLOS (n=1) and ICU LOS (n=1), but two studies
found no protective association for 30-day postoperative events (n=1) and
postoperative ADLs (n=1). No studies investigated if activity status
before surgery impacted quality of life or cardiac rehabilitation
attendance postoperatively. Three studies found that active patients prior
to surgery were more likely to be inactive postoperatively. Conclusion Due
to the mixed findings, the literature does not presently support that
self-reported preoperative physical activity behaviour is associated with
postoperative cardiac surgical outcomes. Future studies should objectively
measure physical activity, clearly define outcomes and adjust for
clinically relevant variables. Registration Trial registration number
NCT02219815. PROSPERO number CRD42015023606.<br/>Copyright &#xa9; Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article) 2017. All rights reserved.

<140>
Accession Number
617805238
Author
Hebra A.; Kelly R.E.; Ferro M.M.; Yuksel M.; Campos J.R.M.; Nuss D.
Institution
(Hebra) Nemours Children's Hospital, Orlando, FL, USA
(Kelly) Children's Hospital of the King's Daughters, Norfolk, VA, USA
(Ferro) Fundacion Hospitalaria Children's Hospital, Buenos Aires,
Argentina
(Yuksel) University of Sao Paulo, Sao Paulo, SP, Brazil
(Campos, Nuss) Marmara University, Istanbul, Turkey
Title
Life-threatening complications and mortality of minimally invasive pectus
surgery.
Source
Journal of Pediatric Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
W.B. Saunders
Abstract
The prevalence and type of life-threatening complications related to the
minimally invasive repair of pectus excavatum (MIRPE) and bar removal are
unknown and underreported. The purpose of this communication is to make
surgeons aware of the risk of these life threatening complications as well
as the modifications which have been developed to prevent them. Methods:
Data related to life-threatening complications of Pectus Excavatum (PE)
patients was obtained from four sources: 1. A survey of Chest Wall
International Group (CWIG) surgeons who specialize in repairing congenital
chest wall malformations, 2. Papers and case reports presented at CWIG
meetings, 3. Review of medico-legal cases from the USA and 4. A systematic
review of the literature related to major complications post MIRPE.
Results: From 1998 to 2016, we identified 27 published cases and 32
unreported life-threatening complications including: cardiac perforation,
hemothorax, major vessel injury, lung injury, liver injury,
gastrointestinal problems, and diaphragm injury. There were seven cases of
major complications with bar removal (reported and non-reported) with two
lethal outcomes. Mortality data with bar placement surgery: Four published
death cases and seven unpublished death cases. The overall incidence of
minor & major complications post MIRPE has been reported in the literature
to be 2-20%. The true incidence of life-threatening complications and
mortality is not known as we do not know the overall number of procedures
performed worldwide. However, based on data extrapolated from survey
information, the pectus bar manufacturer in the USA, literature reports,
and data presented at CWIG meetings as to the number of cases performed we
estimated that approximately fifty thousand cases have been performed and
that the incidence of life-threatening complications is less than 0.1%
with many occurring during the learning curve. Analysis of the cases
identified in our survey revealed that previous chest surgery, pectus
severity and inexperience were noted to be significant risk factors for
mortality. Conclusions: Published reports support the safety and efficacy
of MIRPE; however major adverse outcomes are underreported. Although major
complications with MIRPE and pectus bar removal surgery are very rare,
awareness of the risk and mortality of life-threatening complications is
essential to ensure optimal safety. Factors such as operative technique,
patient age, pectus severity and asymmetry, previous chest surgery, and
the surgeon's experience play a role in the overall incidence of such
events. These preventable events can be avoided with proper training,
mentoring, and the use of sternal elevation techniques. Type of study:
Treatment Study. Level of evidence: Level IV.<br/>Copyright &#xa9; 2017
Elsevier Inc.

<141>
Accession Number
614518916
Author
Cevallos P.C.; Armstrong A.K.; Glatz A.C.; Goldstein B.H.; Gudausky T.M.;
Leahy R.A.; Petit C.J.; Shahanavaz S.; Trucco S.M.; Bergersen L.J.
Institution
(Cevallos, Bergersen) Department of Cardiology, Boston Children's
Hospital, Boston, MA, United States
(Armstrong) Department of Cardiology, Nationwide Children's Hospital,
Columbus, OH, United States
(Glatz) Cardiac Center, The Children's Hospital of Philadelphia,
Philadelphia, PA, United States
(Goldstein) Department of Cardiology, Cincinnati Children's Hospital,
Cincinnati, OH, United States
(Gudausky) Division of Cardiology, Children's Hospital of Wisconsin,
Milwaukee, WI, United States
(Leahy) Department of Cardiology, Kosair Children's Hospital, Louisville,
KY, United States
(Petit) Department of Cardiology, Children's Healthcare of Atlanta Sibley
Heart Center, Atlanta, United States
(Shahanavaz) Division of Pediatric Cardiology, St. Louis Children's
Hospital, St. Louis, MO, United States
(Trucco) Division of Pediatric Cardiology, Children's Hospital of
Pittsburgh, Pittsburgh, PA, United States
Title
Radiation dose benchmarks in pediatric cardiac catheterization: A
prospective multi-center C3PO-QI study.
Source
Catheterization and Cardiovascular Interventions. 90 (2) (pp 269-280),
2017. Date of Publication: 01 Aug 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: This study sought to update benchmark values to use a quality
measure prospectively. Background: Congenital Cardiac Catheterization
Outcomes Project - Quality Improvement (C3PO-QI), a multi-center registry,
defined initial radiation dose benchmarks retrospectively across common
interventional procedures. These data facilitated a dose metric endorsed
by the American College of Cardiology in 2014. Methods: Data was collected
prospectively by 9 C3PO-QI institutions with complete case capture between
1/1/2014 and 6/30/2015. Radiation was measured in total air kerma (mGy),
dose area product (DAP) (micro&#32;Gy*M²), DAP per body weight,
and fluoroscopy time (min), and reported by age group as median,
75^th and 95^th%ile for the following six
interventional procedures: (1) atrial septal defect closure; (2) aortic
valvuloplasty; (3) treatment of coarctation of the aorta; (4) patent
ductus arteriosus closure; (5) pulmonary valvuloplasty; and (6)
transcatheter pulmonary valve implantation. Results: The study was
comprised of 1,680 unique cases meeting inclusion criteria. Radiation
doses were lowest for pulmonary valvuloplasty (age <1 yrs, median mGy: 59,
DAP: 249) and highest in transcatheter pulmonary valve implantation (age
>15 yrs, median mGy: 1835, DAP: 17990). DAP/kg standardized outcome
measures across weights within an age group and procedure type
significantly more than DAP alone. Radiation doses decreased for all
procedures compared to those reported previously by both median and median
weight-based percentile curves. These differences in radiation exposure
were observed without changes in median fluoroscopy time. Conclusions:
This study updates previously established benchmarks to reflect QI efforts
over time. These thresholds can be applied for quality measurement and
comparison. &#xa9; 2017 Wiley Periodicals, Inc.<br/>Copyright &#xa9; 2017
Wiley Periodicals, Inc.

<142>
Accession Number
616039960
Author
Gray R.G.; Menon S.C.; Johnson J.T.; Armstrong A.K.; Bingler M.A.;
Breinholt J.P.; Kenny D.; Lozier J.; Murphy J.J.; Sathanandam S.K.;
Taggart N.W.; Trucco S.M.; Goldstein B.H.; Gordon B.M.
Institution
(Gray, Menon) University of Utah, Salt Lake City, UT, United States
(Johnson) Division of Pediatric Cardiology, Ann & Robert H. Lurie
Children's Hospital of Chicago, IL, United States
(Armstrong) Division of Pediatric Cardiology, C.S. Mott Children's
Hospital, Ann Arbor, MI, United States
(Bingler) Division of Pediatric Cardiology, University of Missouri, Kansas
City, MO, United States
(Breinholt) Division of Pediatric Cardiology, University of Texas Health
Science Center, Houston, TX, United States
(Kenny) Rush University Medical Center, Chicago, IL, United States
(Lozier) Division of Pediatric Cardiology, Mercy Medical Center, Des
Moines, IA, United States
(Murphy) Division of Pediatric Cardiology, St Louis Children's Hospital,
St Louis, MO, United States
(Sathanandam) Division of Pediatric Cardiology, Le Bonheur Children's
Medical Center, TN, United States
(Taggart) Mayo Clinic, Rochester, MN, United States
(Trucco) Division of Pediatric Cardiology, Children's Hospital of UPMC,
Pittsburgh, PA, United States
(Goldstein) Division of Pediatric Cardiology, Cincinnati Children's
Hospital Medical Center, OH, United States
(Gordon) Division of Pediatric Cardiology, Loma Linda University
Children's Hospital, CA, United States
Title
Acute and midterm results following perventricular device closure of
muscular ventricular septal defects: A multicenter PICES investigation.
Source
Catheterization and Cardiovascular Interventions. 90 (2) (pp 281-289),
2017. Date of Publication: 01 Aug 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To describe acute and mid-term results of hybrid
perventricular device closure of muscular ventricular septal defects
(mVSDs). Background: Perventricular device closure of mVSDs can mitigate
technical limitations of percutaneous closure and need for cardiopulmonary
bypass or ventriculotomy with a surgical approach. Methods: This is a
multicenter retrospective cohort study of patients undergoing hybrid
perventricular mVSD device closure from 1/2004 to 1/2014. Procedural
details, adverse events, outcomes, and follow-up data were collected.
Patients were divided into two groups: (1) simple (mVSD closure alone) and
(2) complex (mVSD closure with concomitant cardiac surgery). Results:
Forty-seven patients (60% female) underwent perventricular mVSD device
closure at a median age of 5.2 months (IQR 1.8-8.9) and weight of 5.1 kg
(IQR 4.0-6.9). Procedural success was 91% [100% (n = 22) simple and 84% (n
= 21/25) complex]. Adverse events occurred in 19% (9/47) [9% (2/22) simple
and 28% (7/25) complex]. Hospital length of stay (LOS) was shorter in the
simple vs. complex group (4 vs. 14 days, P < 0.01). At mid-term follow-up
of 19.2 months (IQR 2.3-43) 90% of pts had complete mVSD closure; none
developed late heart block, increased atrioventricular (AV) valve
insufficiency or ventricular dysfunction. Conclusions: Perventricular
device closure of simple mVSD was associated with a high rate of
procedural success, few adverse events, and short hospital LOS. Procedural
adverse events were associated with the presence of concomitant complex
surgery. Residual mVSD, AV valve insufficiency, or ventricular dysfunction
were uncommon at mid-term follow-up. &#xa9; 2017 Wiley Periodicals,
Inc.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<143>
Accession Number
616133199
Author
Jahangirifard A.; Razavi M.R.; Ahmadi Z.H.; Forozeshfard M.
Institution
(Jahangirifard) Cardiac Anesthesiology, Tracheal Diseases Research Center,
NRITLD, Shaheed Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Razavi) Nursing Care Research Center, Semnan University of Medical
Sciences, Semnan, Iran, Islamic Republic of
(Ahmadi) Department of Surgery, Masih Daneshvari Hospital, Shaheed
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Forozeshfard) Cancer Research Center and Department of Anesthesiology,
Semnan University of Medical Sciences, Semnan, Iran, Islamic Republic of
Title
Effect of Desmopressin on the Amount of Bleeding and Transfusion
Requirements in Patients Undergoing Heart Transplant Surgery.
Source
Basic and Clinical Pharmacology and Toxicology. 121 (3) (pp 175-180),
2017. Date of Publication: September 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
One of the most common risks after a heart transplant is bleeding. In this
study, the effect of desmopressin administration on the amount of bleeding
and transfusion requirements after heart transplant surgery was
investigated. In a double-blind clinical trial, 48 patients who were
candidates for heart transplant surgery were randomly assigned to two
groups. In the intervention group, patients received desmopressin of 0.3
mug/kg, 30 min. before surgery. Patients in the control group received
normal saline at the same amount and time. Homeostasis was evaluated using
activated clotting time (ACT), PT, PTT and PLT before, 12 and 24 hr after
surgery, and also, chest tube drainage, blood products transfusion
requirements during the first day in both groups. No significant
differences were found between the groups in terms of ACT, PT, PTT and PLT
at all times. Transfusion of packed red blood cells and the mean drainages
of chest tube during the first 24 hr after surgery were significantly
lower in the desmopressin group compared to the saline group. Desmopressin
may reduce post-operative bleeding in patients undergoing heart transplant
surgery. Further studies are required to confirm the potential effect of
desmopressin on establishing haemostasis after heart
transplantation.<br/>Copyright &#xa9; 2017 Nordic Association for the
Publication of BCPT (former Nordic Pharmacological Society)

<144>
Accession Number
617786680
Author
Kremke M.; Gissel M.S.; Jakobsen C.-J.
Institution
(Kremke, Gissel, Jakobsen) Department of Anaesthesiology and Intensive
Care Medicine, Aarhus University Hospital, Aarhus, Denmark
Title
Coronary artery bypass grafting related bleeding risks due to
pre-operative treatment with ticagrelor.
Source
Acta Anaesthesiologica Scandinavica. Conference: 34th Congress of the
Scandinavian Society of Anesthesiology and Intensive Care Medicine, SSA
2017. Sweden. 61 (8) (pp 1045), 2017. Date of Publication: September 2017.
Publisher
Blackwell Munksgaard
Abstract
Background: Pre-operative treatment with adenosine diphosphate (ADP)
receptor antagonists can cause excessive bleeding after cardiac surgery.
The new ADP-receptor antagonist ticagrelor was introduced in Denmark in
2013. We have analyzed bleeding complications associated with the use of
ticagrelor before coronary artery bypass grafting (CABG) surgery. Methods:
This is a multicenter cohort analysis of 2 596 CABG patients operated upon
during the period January 2013 through March 2017. Using propensity
scores, study patients preoperatively exposed to dual antiplatelet therapy
(DAPT) with aspirin and ticagrelor (n = 118) were matched with control
patients exposed to aspirin only (n = 2 478), resulting in 95 pairs of
patients. Outcome measures were chest tube drainage volume, re-operations
due to bleeding, and patients transfused with red blood cells. Results:
Compared with patients treated with aspirin only, pre-operative DAPT with
ticagrelor was associated with more chest tube bleeding (550 vs. 425 ml, P
= 0.011), more re-operations due to bleeding (13% vs. 3%, P = 0.035), and
more frequent transfusion of red blood cells (38% vs. 18%, P < 0.0001).
Conclusions: Pre-operative DAPT with ticagrelor and aspirin is associated
with higher risks for bleeding complications after cardiac surgery.

<145>
Accession Number
617786549
Author
Sumitomo N.; Miyazaki A.; Sakaguchi H.; Iwamoto M.; Ueda H.; Tokunaga C.;
Takamuro M.; Takigiku K.; Yoshimoto J.; Ohashi N.; Takahashi K.; Anze T.
Institution
(Sumitomo) SaitamaJapan
(Miyazaki, Sakaguchi) SuitaJapan
(Iwamoto, Ueda) YokohamaJapan
(Tokunaga) TsukubaJapan
(Takamuro) SapporoJapan
(Takigiku) AzuminoJapan
(Yoshimoto) ShizuokaJapan
(Ohashi) NagoyaJapan
(Takahashi) OkinawaJapan
(Anze) OsakaJapan
Title
A prospective multicenter, open-label study of landiolol for
tachyarrhythmias in children: Control of the heart rate in infant and
child arrhythmias using landiolol (heartful) study.
Source
Europace. Conference: World Congress in Cardiac Electrophysiology and
Cardiac Techniques 2016. France. 18 (pp i147), 2016. Date of Publication:
June 2016.
Publisher
Oxford University Press
Abstract
Introduction: Persistent tachycardia in pediatric patients with heart
failure sometimes deteriorates their hemodynamic condition, which requires
immediate intervention to control their heart rate. Particularly,
tachyarrhythmias after congenital heart surgery may sometimes become
fatal. In Japan, there are only a few intravenous anti-arrhythmic agents
that have been approved to control pediatric arrhythmias. Although,
treatment of tachyarrhythmias in young patients with cardiac dysfunction
are mandatory, there are no approved medications to treat them in these
patients. Consequently, novel and effective medications for these patients
are required. Landiolol, an ultra-short-acting beta-blocker was approved
in 2013 for tachyarrhythmias in adult patients with cardiac dysfunction.
However, its efficacy and safety in pediatrics remain unknown. Methods:
This study is a phase IIb/phase III study to investigate the efficacy and
safety of landiolol in pediatric patients with tachyarrhythmias (atrial
fibrillation, atrial flutter, and supraventricular tachycardia) and heart
failure. This study was designed as a prospective multicenter open-label
study. Successful heart rate control was defined as a >=20% reduction in
the heart rate or conversion to normal sinus rhythm within 2hr after
starting the intravenous administration of landiolol. This study was
started in April 2015 and will end within a few years. Conclusion: The
data from the HEARTFUL study may establish the efficacy and safety of
landiolol for various tachyarrhythmias in pediatric patients, even if the
patients have cardiac dysfunction.

<146>
Accession Number
617786516
Author
Sholevar D.; Tung S.; Kuriachan V.; Leong-Sit P.; Roukoz H.; Engel G.;
Kutalek S.P.; Akula D.; Christie M.; Ostanniy M.; Thompson A.; Molin F.
Institution
(Sholevar, Akula) CamdenUnited States
(Tung) New WestminsterCanada
(Kuriachan) CalgaryCanada
(Leong-Sit) LondonCanada
(Roukoz) MinneapolisUnited States
(Engel) Redwood CityUnited States
(Kutalek) PhiladelphiaUnited States
(Christie, Ostanniy, Thompson) Mounds ViewUnited States
(Molin) Quebec CityCanada
Title
Feasibility of extravascular pacing with a novel substernal electrode
configuration: Results from the multi-center substernal pacing acute
clinical evaluation (space) trial.
Source
Europace. Conference: World Congress in Cardiac Electrophysiology and
Cardiac Techniques 2016. France. 18 (pp i25), 2016. Date of Publication:
June 2016.
Publisher
Oxford University Press
Abstract
Purpose: Subcutaneous defibrillators offer a viable alternative to
intravascular transvenous defibrillators. However, because of
extra-thoracic lead placement, this system is limited by high
defibrillation thresholds and an inability to deliver anti-tachycardia
pacing. The SPACE trial evaluated the feasibility of cardiac pacing from
an extra-vascular substernal space. Method: This prospective feasibility
study enrolled adult patients ( pts) undergoing midline sternotomy surgery
or S-ICD implant. The primary endpoint was to assess the feasibility of
pacing through a decapolar EP catheter (Marinr, 7F, Medtronic) temporarily
placed via percutaneous subxiphoid access into the mediastinal tissues
under the sternum at or adjacent to the midline. Using fluoroscopy and a
malleable tunneling tool and introducer, the middle pair of electrodes was
centered over the right ventricle. Pacing capture data in 7 vectors (3
bipolar and 4 unipolar) were collected with constant current pacing up to
20 mA and pulse-width (PW) up to 10 ms. Summary of Results: Twenty-six pts
(21 males, 5 females; age 64.4 + 10.0 years) were studied at 8 sites in
the US and Canada. Parent procedures included one S-ICD implantation and
25 cardiothoracic surgeries. Catheter placement was accomplished in all 26
pts (mean placement time = 11.7 + 10.1 minutes). Eighteen out of 26 pts
had successful, consistent ventricular pacing capture (PC) in >= 1 tested
vector. The mean pacing thresholds at PW 10 ms, 3 ms, 1 ms were 7.3 + 4.2
mA (18 pts), 9.0 + 4.7 mA (13 pts), 11.8 + 4.5 mA (7 pts), respectively.
Failed PC in 8 pts was mostly associated with sub-optimal implant or
atrial PC. Among the 18 pts with PC, 10 pts had the best PC in bipolar vs
7 pts in unipolar (no difference in 1 pt). Among the 16 pts with bipolar
PC, widely spaced bipolar electrode pairs were consistently associated
with the lowest threshold in all pts. For the 16 pts with bipolar PC with
electrode spacing 19 mm and 10 ms PW, the median pacing threshold was 3.0
V (IQR: 2.3-8.1 V) or 4.2 mA (IQR: 3.0-10.5 mA). Conclusion: Preliminary
data demonstrates that pacing is feasible from this novel extravascular
substernal location. A bipolar substernal electrode configuration with
wide electrode spacing has the potential to provide pacing in a future
extravascular defibrillator.

<147>
Accession Number
617786424
Author
Rodrigues I.; Abreu A.; Oliveira M.; Cunha P.S.; Lousinha A.; Portugal G.;
Almeida Morais L.; Rio P.; Moreira R.I.; Ferreira R.C.
Institution
(Rodrigues, Abreu, Oliveira, Cunha, Lousinha, Portugal, Almeida Morais,
Rio, Moreira, Ferreira) LisboaPortugal
Title
The impact of different CRT response criteria in outcomes.
Source
Europace. Conference: World Congress in Cardiac Electrophysiology and
Cardiac Techniques 2016. France. 18 (pp i49), 2016. Date of Publication:
June 2016.
Publisher
Oxford University Press
Abstract
Background: There is a lack of consensus on definition of responder to
resynchronization therapy (CRT). Numerous primary response criteria had
been utilized in the literature. It is not clear which response criteria
may have more influence on cardiac events. Purpose: The aim of the present
study was to identify the CRT response criteria that most influence the
occurrence of major events in heart failure. Methods: Retrospective
analyses of patients ( pts) undergoing CRT in one center, between 2011 and
2014. The evaluated parameters included left ventricular (LV) ejection
fraction (LVEF), LV end diastolic and end systolic volumes (LVEDV, LVESV,
respectively), peak oxygen consumption (VO2peak), New York Heart
Association (NHYA) functional class and quality of life (QoL), measured at
baseline and at 6 months after CRT, to define responders to CRT. The
response criteria analyzed, cited in literature, included
"echocardiographic response" [ LVEF 5 (units); LVEF 15% (relative); LVEDV
15%; LVESV 15%)], "clinical response" [ NYHA-1; VO2peak. 10; QoL .5;
clinical composite (2/3 of: NYHA 1, QoL 0.5, peak VO2 10%)] and "combined
response" ( LVEF 5 and NYHA 1 or QoL >= 0.5). The outcome analyzed was a
composite endpoint of all cause mortality, cardiac transplant or heart
failure hospitalization. Results: A total of 115 pts submitted to CRT were
followed for a period of 25 + 13 months. During the follow-up period, the
composite endpoint occurred in 25% of the pts. In univariate Cox
regression analyses, the only response criteria that had a significant
relationship with the composite endpoint were LVEF 5 [hazard ratio (HR)=
0.45 (0.21-0.94), p , 0.05], LVEF 15% [HR = 0.43 (0.20-0.90), p , 0.05],
NYHA 1 [HR = 0.39 (0.18-0.83), p , 0.05] and combined response [HR = 0.47
(0.22-1.00), p , 0.05). Conclusions: Our study demonstrated that pts who
improved NYHA functional class or LVEF were those with lowest incidence of
mortality, cardiac transplant or heart failure hospitalizations, which may
favor these criteria, compared to others, to define CRT responder (Figure
Presented).

<148>
Accession Number
617786410
Author
Di Leoni Ferrari A.; Monteiro C.; Caramori P.R.A.; Marino M.; Carvalho
L.A.; Siqueira D.; Sao T.L.; Perin M.; Lima V.; Guerios E.; Fabio S.D.B.J.
Institution
(Di Leoni Ferrari, Monteiro, Caramori) Porto AlegreBrazil
(Marino, Carvalho, Siqueira, Sao, Perin, Lima, Guerios, Fabio) Sao
PauloBrazil
Title
The multicenter tavi brazilian registry & the need for permanent pacemaker
following transcatheter aortic valve implantation. Incidence, predictors
and clinical outcomes.
Source
Europace. Conference: World Congress in Cardiac Electrophysiology and
Cardiac Techniques 2016. France. 18 (pp i23), 2016. Date of Publication:
June 2016.
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has
demonstrated favorable clinical outcomes, although development of
high-degree atrioventricular block requiring permanent pacemaker (PPM)
implantation is a frequent complication. The aim of this study was to
evaluate the incidence, contributing factors and clinical outcomes of PPM
implantation after TAVI procedures. Methods: Data from 819 patients with
severe aortic stenosis from 22 centers included in the Brazilian TAVI
registry between January 2008 and January 2015 were reviewed. After
excluding patients who died during the procedure, those with a previous
PPM and those that implanted InovareTM prosthesis, 670 patients were
analyzed. Multivariate regression was performed to identify predictors of
PPM implantation following TAVI. ROC curve analysis was used to measure
the ability of the risk factors as predictors. Results: At 30 days, 135
patients (20.1%) required PPM implantation. There was a decline in the
rate of PPM implantation, from 25.5% in 2012 to 15.8% in 2015 (p= 0.005).
Patients requiring PPM were more likely to be older (82.5 vs. 81.1 years,
p= 0.047), and male (59.3%; p= 0.003), but with similar surgical risk
scores between groups. The majority of PPMs were implanted during the
first 7 days following the TAVI. Those in the PPM group more frequently
received CoreValveTM devices (88.1% vs. 70.8%, p= ,0.001), and had
previous right bundle branch block (RBBB, 27.3% vs. 6.6%, p= ,0.001). On
multivariate analysis baseline RBBB (OR, 6.19; 95% CI, 3.56-10.75; p=
,0.001), CoreValveTM vs. Sapien XTTM (OR, 3.16; 95% CI, 1.74-5.72; p=
,0.001), and mean trans-aortic gradient .50mmHg (OR, 1.86; 95% CI,
1.08-3.2; p= 0.025) were independent predictors of PPM implantation. The
estimated risk for PPM insertion is 4% when none of the current risk
factors are present, reaching up to almost 63% when all of them are
present (Figs. 1 & 2). The current model of predictors showed a good
ability to predict PPM implantation: 0.69 (95% CI, 0.64-0.74) in the ROC
curve. Hospital lenght of stay was significantly prolonged for the PPM
group (mean= 15.7 +/-25.7 days for the PPM group vs. 11.8 +/-22.9 days for
the no PPM group; p ,0.001), but neither all-cause death (26.7% PPM group
vs. 25.6% PPM group; p= 0.80) or cardiovascular death (14.1% vs. 14.8% PPM
group and no PPM group respectively; p= 0.84) were affected by PPM
implantation. Sub-study of echocardiograms during follow-up denoted
worsened recovery of systolic function over time in the PPM group compared
against their counterparts without PPM (p= 0.001 at 1 year). Conclusion:
The present study identified pre-existing RBBB, mean aortic gradient that
exceeds 50mmHg and CoreValveTM device implantation as independent
predictors of the need for PPM implantation at 30-days after TAVI. PPM
implantation occurred in approximately one of every 5 TAVI cases and
prolonged hospital length of stay, but did not affect all-cause or
cardiovascular mortality. PPM implantation was unfavorably associated with
worsened recovery of left ventricular ejection fraction, which deserves
further investigation (Table Presented).

<149>
Accession Number
617786317
Author
Trucco M.E.; Jose T.M.; Hernandez Madrid A.; Toquero J.; Merino J.L.; Osca
J.; Quesada A.; Martinez-Ferrer J.; Villuendas R.; Rodon J.P.; Mont L.
Institution
(Trucco, Jose, Rodon, Mont) BarcelonaSpain
(Hernandez Madrid) Hospital Universitario Ramon y Cajal, Madrid, Spain
(Toquero) Madrid/MajadahondaSpain
(Merino) MadridSpain
(Osca, Quesada) ValenciaSpain
(Martinez-Ferrer) Vitoria-GasteizSpain
(Villuendas) BadalonaSpain
Title
Early AV node ablation versus pharmacological rate control in patients
with CRT and AF. results of spare III, a randomized multicenter study.
Source
Europace. Conference: World Congress in Cardiac Electrophysiology and
Cardiac Techniques 2016. France. 18 (pp i76), 2016. Date of Publication:
June 2016.
Publisher
Oxford University Press
Abstract
Introduction: Maximum ventricular pacing (VP) is necessary for good CRT
response. In AF AV node ablation is recommended. The aim of the study was
to analyze whether early AV node ablation (EAVNA) in patients with AF
submitted to CRT improved response to therapy. Methods: A multicenter
randomized trial analyzed a cohort of patients with AF treated with CRT.
Inclusion criteria were: AF, NYHA III-IV, QRS .120 ms and LVEV >=35%.
Patients with AF and fast, uncontrolled heart rate (HR) or patients with
AF and slow heart rate requiring ventricular pacing were excluded. After
successful CRT implant, patients were randomized to EAVNA or medical
therapy (MT) to slow HR. All patients underwent clinical and
echocardiographic evaluation prior to implantation and at 6-and 12-month
follow-up. Responders were defined as survivors at 12 months post-implant
with >=10% LVESV reduction without requiring heart transplant. Results: A
group of 60 patients was randomized to EAVNA (30) or MT (30). The
percentage of VP at 6 and 12 months was 99% and 99% respectively, in the
EAVNA group and 95% and in the MT group ( p: NS). During follow-up, 20% of
patients from the MT crossed over to AV node ablation. At 12 months, there
was no difference between groups in the percentage of responders: 12/30
(40%) EAVNA vs. 10/30 (33%) MT (RR 1.2, 95% CI [0.6-2.3], p = 0.79). LVEF
improvement was similar too (figure 1). In each group 2/30 patients died
(6.6% mortality); 1 patient from EAVNA required heart transplant. Hospital
admissions were also similar between study groups: 8/30 (26.6%) EAVNA and
8/30 (26.6%) MT. Conclusions: Compared to MT a strategy of EAVNA in
patients with CRT and AF did not improve CRT response or clinical
improvement (Figure Presented).

<150>
Accession Number
617786294
Author
Rodriguez R.D.C.R.; Antonia R.R.; Alfonso M.F.
Institution
(Rodriguez, Antonia, Alfonso) Las Palmas de Gran CanariaSpain
Title
Sex and cardiac resynchronization therapy.
Source
Europace. Conference: World Congress in Cardiac Electrophysiology and
Cardiac Techniques 2016. France. 18 (pp i20), 2016. Date of Publication:
June 2016.
Publisher
Oxford University Press
Abstract
Purpose: To study the differences between both sexes in patients who
underwent CRT and to evaluate changes in clinical and echocardiographic
data, as well as, to evaluate long-term mortality. Methods:We evaluated
302patients(p) who had received CRT between 2003 and 2015 at one center.
Baseline assessment was comprised of the collection of medical history,
clinical examination, 12-lead electrocardiogram, estimation of New York
Heart Association (NYHA) functional class and echocardiographic
evaluation. In hospital follow-up examinations were scheduled at 1 month
and every 6 months thereafter. The average duration of follow up was 7,51
+ 2,73years. We evaluated changes clinical and echocardiographic
parameters at 1 year, and assessed all cause mortality, cardiovascular
mortality a long term follow-up with respect to sex. Remodeler is defined
as the increase in the ejection fraction greater than or equal to 5%
and/or greater reduction of systolic diameter 10mm.Responder is defined as
the improvement of functional class, no hospital admissions or no need of
cardiac transplant. Summary: There were 220(72,8%)men and
82(27,2%)women.There were 61(77,2%) female responders and 173(79,4%) male
responders, p = 0,69. There were 69 (85,2%) female remodelers vs
183(83,9%) male remodelers, p = 0,79. Baseline characteristics:Men and
women were similar age (67,05 + 10,19years vs 68,26 + 10,39; p = 0,36).
Men had more defibrillator than women (104(47,3%) vs19(23,2%); p =
0,001)). The most frequent side left ventricular lead position was the
lateral position similar in both sexes. Men had more ischemic heart
disease and women more dilated cardiomyopathy. Men had more atrial
fibrillation and they needed more insulin than women. The hospital
attendance was similar in both sexes, but men had less heart failure
compared to women (40,2% vs 60%, p = 0,9). 97 (41,6%)men died vs 34(41,5%)
women, p = 0,196 and heart failure was the main cause of death especially
in women. Men used more antiarrythmics than women. Women survive longer
than men but it was not significatvie ( long rank p = 0,455). Conclusion:
There was significant improvement in clinical, electrocardiographic and
echocardiographic readings in both groups. Survival was worse in men than
in women without being significant (Table Presented).

<151>
Accession Number
617786281
Author
Rodriguez R.D.C.R.; Antonia R.R.; Alfonso M.F.
Institution
(Rodriguez, Antonia, Alfonso) Las Palmas de Gran CanariaSpain
Title
Cardiac resyncrhonization therapy and survival according to sex.
Source
Europace. Conference: World Congress in Cardiac Electrophysiology and
Cardiac Techniques 2016. France. 18 (pp i20), 2016. Date of Publication:
June 2016.
Publisher
Oxford University Press
Abstract
Purpose: To study the differences between both sexes in patients who
underwent CRT and to evaluate changes in clinical y echocardiographic
data, as well as, to evaluate long-term mortality. Methods: We evaluated
302patients( p) who had received CRT between 2003 and 2015 at one center.
Remodeler is defined as the increase in the ejection fraction greater than
or equal to 5% and/or greater reduction of systolic diameter
10mm.Responder is defined as the improvement of functional class, no
hospital admissions or no need of cardiac transplant. Summary: There were
220(72,8%)men and 82(27,2%)women.There were 61(77,2%) female responders
and 173(79,4%) male responders, p = 0,69. There were 69 (85,2%) female
remodelers vs 183(83,9%) male remodelers, p = 0,79. Baseline
characteristics:Men and women were similar age (67,05 + 10,19years vs
68,26 + 10,39; p = 0,36). Men had more defibrillator than women
(104(47,3%) vs19(23,2%); p = 0,001)). The most frequent side left
ventricular lead position was the lateral position similar in both sexes.
Men had more ischemic heart disease and women more dilated cardiomyopathy.
Men had more atrial fibrillation and they needed more insulin than women.
The hospital attendance was similar in both sexes, but men had less heart
failure compared to women (40,2% vs 60%, p = 0,9). 97 (41,6%)men died vs
34(41,5%) women, p = 0,196 and heart failure was the main cause of death
especially in women. Men used more antiarrythmics than women. Conclusion:
There was significant improvement in clinical, electrocardiographic and
echocardiographic readings in both groups. Survival was worse in men than
in women without being significant. Ilustracion AClinical,
electrocardiographic and echocardiographic changes according sex (Table
Presented).

<152>
Accession Number
617786233
Author
Mazzone P.; D'Angelo G.; Regazzoli D.; Molon G.; Senatore G.; Sacca S.;
Canali G.; Amellone C.; Turri R.; Bella P.D.
Institution
(Mazzone, D'Angelo, Regazzoli, Bella) San Raffaele Hospital, Milano, Italy
(Molon, Canali) Sacro Cuore Hospital, Negrar (VR), Italy
(Senatore, Amellone) P.O. Riunito-Ospedale Civile, Cirie (TO), Italy
(Sacca, Turri) Mirano Hospital, Mirano (VE), Italy
Title
Percutaneous left atrial appendage closure with watchman device: Results
from the traps registry.
Source
Europace. Conference: World Congress in Cardiac Electrophysiology and
Cardiac Techniques 2016. France. 18 (pp i7), 2016. Date of Publication:
June 2016.
Publisher
Oxford University Press
Abstract
Purpose of the study: The WATCHMAN device for Left Atrial Appendage
occlusion (LAAO) has been found effective and non-inferior to the oral
anticoagulation (OAC) in patients with atrial fibrillation, and is now
adopted in clinical practice. Method used: The TRAPS registry is an
observational, multicenter registry involving 4 Italian centers. Patients
who underwent LAAO with WATCHMAN device were enrolled, and clinical,
demographic and procedural data were collected. Summary of results: In
this analysis we included 148 patients. Mean age was 73 + 8 years, 57% of
patients were male, 22% had heart failure, 10% had a history of transient
ischemic attack, 23% a history of ischemic stroke and 72% a history of
bleeding. The baseline CHADS2 score was 2.4 + 1.3, the CHADsVASc score was
3.9 + 2.8 and the HAS-BLED score was 3.3 + 1.1. 57% of the patients were
on OAC at the time of implantation. The device was successfully positioned
in all patients with no or minimal (, 5mm) leakage, assessed by
peri-procedural transesophageal echo. Following intra-procedural
complications were reported: 2 pericardial effusions treated with
pericardiocentesis, 1 device-associated thrombus formation treated with
aspiration, and 1 vascular access dissection. Moreover, device
embolization was reported in 1 patient early after the implantation and
the device was successfully snared in the iliac bifurcation. The overall
rate of adverse events within 7 days was therefore (5/148 = 3.3%). In the
present experience, device size was chosen >=20% greater than the LAA
diameter in 68% of patients. Comparing the first half with the second half
of the study cohort, the procedure duration decreased from 89min to 64min
(p , 0.0001). Conclusion: The success rate in LAAO with WATCHMAN was high,
and the rate of adverse events was low.We reported an experience-related
improvement in procedural duration.

<153>
Accession Number
617786093
Author
Romanov A.; Goscinska-Bis K.; Bis J.; Cherniavsky A.; Prokhorova D.;
Syrtceva Y.; Shabanov V.; Ponomarev D.; Alsov S.; Karaskov A.; Deja M.;
Krejca M.; Pokushalov E.
Institution
(Romanov, Cherniavsky, Prokhorova, Syrtceva, Shabanov, Ponomarev, Alsov,
Karaskov, Pokushalov) NovosibirskRussian Federation
(Goscinska-Bis, Bis, Deja, Krejca) KatowicePoland
Title
Cardiac resynchronization therapy combined with coronary artery bypass
grafting in ischemic heart failure patients: Long-term results of the
rescue study.
Source
Europace. Conference: World Congress in Cardiac Electrophysiology and
Cardiac Techniques 2016. France. 18 (pp i165), 2016. Date of Publication:
June 2016.
Publisher
Oxford University Press
Abstract
Aims: Totally epicardial cardiac resynchronization therapy (CRT) is a
novel treatment modality for patients with heart failure and systolic
dyssynchrony undergoing coronary artery bypass grafting (CABG). In this
study we have prospectively evaluated the long-term outcomes of totally
epicardial CRT. Methods: Between September 2007 and June 2009, one hundred
seventy eight patients were randomly assigned to the CABG alone group (n =
87) and CABG with concomitant epicardial CRT implantation (n = 91). The
primary endpoint of the study was all-cause mortality in the two groups
between the day of surgery and August 13, 2013 (common closing date). The
secondary outcomes included mode of death, adverse cardiac events and lead
performance. Results: The mean follow-up was 55 + 10.7 months. According
to per-protocol analysis with treatment as a time-dependent variable to
account for conversion from CABG to CABG + CRT, there were 24 deaths
(35.8%) in the CABG group and 17 deaths (15.3 %) in the CABG + CRT group.
As compared to CABG alone, concomitant CRT was associated with reduced
risk of both all-cause mortality (hazard ratio (HR) 0.43, 95% confidence
interval (CI) 0.23 to 0.84, p = 0.012) and cardiac death (HR 0.39, 95% CI
0.21 to 0.72, p = 0.002). Eleven (12.6%) sudden deaths were observed in
the CABG group in comparison to 4 (4.4%) in the CABG + CRT group (p =
0.048). Hospital re-admission was required for 9 (9.9%) patients in CABG +
CRT group and for 25 (28.7%) patients in CABG group (r = 0.001). There
were 4 (1.5%) epicardial lead failures. Conclusion: The results of our
study suggest that the procedure of coronary artery bypass grafting and
totally epicardial CRT system implantation is safe and significantly
improves the survival of patients with heart failure and dyssynchrony
during long-term follow up.

<154>
Accession Number
617785903
Author
Mora G.; Olaya A.
Institution
(Mora, Olaya) BogotaColombia
Title
Incidence of adverse events at 7, 30 y 90 days in colombian patients with
syncope according to risk score egsys.
Source
Europace. Conference: World Congress in Cardiac Electrophysiology and
Cardiac Techniques 2016. France. 18 (pp i81), 2016. Date of Publication:
June 2016.
Publisher
Oxford University Press
Abstract
Objective: To describe the incidence of adverse events at 7, 30, 90 days
in patients with syncope who have applied the risk scale EGSYS. Materials
and method: A cohort study was conducted; the two comparison groups were
patients at high and low risk according to EGSYS scale who consulted the
emergency department of five hospitals in Colombia with diagnosis of
syncope. At the time of the consultation a complete history of which data
were obtained for a score and classification according to EGSYS scale;
then were followed up at 7, 30, and 90 days for assessment of adverse
events. Statistical analysis: qualitative variables were described by
absolute and relative frequencies and quantitative variables by means and
standard deviations. Once patients at high and low risk were classified,
the cumulative incidence of adverse events (death, re-hospitalization,
recurrence, invasive cardiac procedures and neurological events) was
calculated and compared between groups using relative risks and Multiple
Correspondence Analysis (MCA). Additionally, the frequency of adverse
events according to the score obtained on the scale was described.
Results:We included 173 patients with a median age of 69 years (IQR 50-80
years old); 57.8% were women. The clinical variable considered in the most
common were the absence scale EGSYS prodrome and abnormal ECG. The most
frequent scores were above 2; 60% of patients were classified at high
risk. The incidence at 90 days of follow-averse events was 42 % for
high-risk group and 21 % in the low risk group (RR 1.94, 95% CI 1.17 to
3.21); The main events were cardiologic interventions (26.9 % versus
10.1%) being higher in the high risk group (RR 2.6 IC 95% 1.22 to 5.73)
This association was also observed in the MCA. The nonparametric analysis
showed significant differences between the high and low risk curves at 90
days (p = 0.013); Cox regression showed increased risk for any adverse
events in the group of patients with greater than or equal to 3 score (HR
= 2.05, 95% CI 1.14 to 3.70). This association was also observed in the
ACM. Conclusions: The classification of risk score EGSYS applied to
patients with syncope is related to the incidence of adverse events at 90
days follow-up. The Egsys score can assist decision-making on inpatient or
outpatient management and the rational use of diagnostic aids.

<155>
[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.

<156>
Accession Number
617753898
Author
Sardella G.; Lucisano L.; Garbo R.; Pennacchi M.; Cavallo E.; Stio R.E.;
Calcagno S.; Ugo F.; Boccuzzi G.; Fedele F.; Mancone M.
Institution
(Sardella, Lucisano, Pennacchi, Cavallo, Stio, Calcagno, Fedele, Mancone)
Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology, and
Geriatric Sciences, "Sapienza" University of Rome, Rome, Italy
(Garbo, Ugo, Boccuzzi) Interventional Cardiology, San Giovanni Bosco
Hospital, Turin, Italy
Title
Single-Staged Compared With Multi-Staged PCI in Multivessel NSTEMI
Patients: The SMILE Trial.
Source
Journal of the American College of Cardiology. 67 (3) (pp 264-272), 2016.
Date of Publication: 26 January 2016.
Publisher
Elsevier USA
Abstract
Background A lack of clarity exists about the role of complete coronary
revascularization in patients presenting with non-ST-segment elevation
myocardial infarction. Objectives The aim of our study was to compare
long-term outcomes in terms of major adverse cardiovascular and
cerebrovascular events of 2 different complete coronary revascularization
strategies in patients with non-ST-segment elevation myocardial infarction
and multivessel coronary artery disease: 1-stage percutaneous coronary
intervention (1S-PCI) during the index procedure versus multistage
percutaneous coronary intervention (MS-PCI) complete coronary
revascularization during the index hospitalization. Methods In the SMILE
(Impact of Different Treatment in Multivessel Non ST Elevation Myocardial
Infarction Patients: One Stage Versus Multistaged Percutaneous Coronary
Intervention) trial, 584 patients were randomly assigned in a 1:1 manner
to 1S-PCI or MS-PCI. The primary study endpoint was the incidence of major
adverse cardiovascular and cerebrovascular events, which were defined as
cardiac death, death, reinfarction, rehospitalization for unstable angina,
repeat coronary revascularization (target vessel revascularization), and
stroke at 1 year. Results The occurrence of the primary endpoint was
significantly lower in the 1-stage group (1S-PCI: n = 36 [13.63%] vs.
MS-PCI: n = 61 [23.19%]; hazard ratio [HR]: 0.549 [95% confidence interval
(CI): 0.363 to 0.828]; p = 0.004). The 1-year rate of target vessel
revascularization was significantly higher in the MS-PCI group (1S-PCI: n
= 22 [8.33%] vs. MS-PCI: n = 40 [15.20%]; HR: 0.522 [95% CI: 0.310 to
0.878]; p = 0.01; p log-rank = 0.013). When the analyses were limited to
cardiac death (1S-PCI: n = 9 [3.41%] vs. MS-PCI: n = 14 [5.32%]; HR: 0.624
[95% CI: 0.270 to 1.441]; p = 0.27) and myocardial infarction (1S-PCI: n =
7 [2.65%] vs. MS-PCI: n = 10 [3.80%]; HR: 0.678 [95% CI: 0.156 to 2.657];
p = 0.46), no significant differences were observed between groups.
Conclusions In multivessel non-ST-segment elevation myocardial infarction
patients, complete 1-stage coronary revascularization is superior to
multistage PCI in terms of major adverse cardiovascular and
cerebrovascular events. (Impact of Different Treatment in Multivessel Non
ST Elevation Myocardial Infarction [NSTEMI] Patients: One Stage Versus
Multistaged Percutaneous Coronary Intervention [PCI] [SMILE]:
NCT01478984)<br/>Copyright &#xa9; 2016 American College of Cardiology
Foundation

<157>
Accession Number
617791007
Author
Yoon S.-H.; Whisenant B.K.; Bleiziffer S.; Delgado V.; Schofer N.;
Eschenbach L.; Fujita B.; Sharma R.; Ancona M.; Yzeiraj E.; Cannata S.;
Barker C.; Davies J.E.; Frangieh A.H.; Deuschl F.; Podlesnikar T.; Asami
M.; Dhoble A.; Chyou A.; Masson J.-B.; Wijeysundera H.C.; Blackman D.J.;
Rampat R.; Taramasso M.; Gutierrez-Ibanes E.; Chakravarty T.; Attizzani
G.F.; Kaneko T.; Wong S.C.; Sievert H.; Nietlispach F.; Hildick-Smith D.;
Nombela-Franco L.; Conradi L.; Hengstenberg C.; Reardon M.J.; Kasel A.M.;
Redwood S.; Colombo A.; Kar S.; Maisano F.; Windecker S.; Pilgrim T.;
Ensminger S.M.; Prendergast B.D.; Schofer J.; Schaefer U.; Bax J.J.; Latib
A.; Makkar R.R.
Institution
(Yoon, Sharma, Chakravarty, Kar, Makkar) Department of Interventional
Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, United
States
(Whisenant) Division of Cardiovascular Diseases, Intermountain Heart
Institute, Salt Lake City, Utah, United States
(Bleiziffer, Eschenbach) Clinic for Cardiovascular Surgery, German Heart
Center, Munich, Germany
(Delgado, Podlesnikar, Bax) Department of Cardiology, Leiden University
Medical Center, Leiden, Netherlands
(Schofer, Deuschl, Schaefer) Department of General and Interventional
Cardiology, University Heart Center, Hamburg, Germany
(Fujita, Ensminger) Department of Thoracic and Cardiovascular Surgery,
Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen,
Germany
(Ancona, Colombo, Latib) Interventional Cardiology Unit, EMO-GVM Centro
Cuore Columbus & San Raffaele Scientific Institute Milan, San Raffaele
Hospital, Milan, Italy
(Yzeiraj, Schofer) Hamburg University Cardiovascular Center, Hamburg,
Germany
(Cannata, Redwood, Prendergast) Department of Cardiology, St. Thomas'
Hospital, London, United Kingdom
(Barker, Reardon) Houston Methodist DeBakey Heart and Vascular Center,
Houston, Texas, United States
(Davies) Division of Cardiac and Thoracic Surgery, University of
Alabama-Birmingham, Birmingham, Alabama, United States
(Frangieh, Hengstenberg, Kasel) Deutsches Herzzentrum Munchen, Technische
Universitat Munchen, Munich, Germany
(Asami, Windecker, Pilgrim) Department of Cardiology, Bern University
Hospital, Bern, Switzerland
(Dhoble) Department of Cardiology, University of Texas Health Science
Center, Houston, Texas, United States
(Chyou, Wong) Greenberg Division of Cardiology, New York-Presbyterian
Hospital, Weil Cornell Medicine, New York, New York, United States
(Masson) Division of Cardiology, Centre Hospitalier de l'universite de
Montreal, Montreal, Quebec, Canada
(Wijeysundera) Division of Cardiology, Sunnybrook Health Science Centre,
Toronto, Ontario, Canada
(Blackman) Cardiology Department, Leeds Teaching Hospital, Leeds, United
Kingdom
(Rampat, Hildick-Smith) Sussex Cardiac Centre, Brighton and Sussex
University Hospitals NHS Trust, Brighton, United Kingdom
(Taramasso, Nietlispach, Maisano) University Heart Center, University
Hospital Zurich, Zurich, Switzerland
(Gutierrez-Ibanes) Department of Cardiology, Hospital General
Universitario Gregorio Maranon, Madrid, Spain
(Attizzani) The Valve and Structural Heart Interventional Center,
University Hospitals Case Medical Center, Cleveland, Ohio, United States
(Kaneko) Division of Cardiac Surgery, Brigham and Women's Hospital,
Boston, Massachusetts, United States
(Sievert) Department of Cardiology and Vascular Medicine, CardioVascular
Center, Frankfurt, Germany
(Nombela-Franco) Division of Cardiology, Hospital Clinicio San Carlos,
Madrid, Spain
(Conradi) Department of Cardiothoracic Surgery, University Heart Center
Hamburg, Hamburg, Germany
(Hengstenberg) German Center for Cardiovascular Research, Partner Site
Munich Heart Alliance, Munich, Germany
Title
Transcatheter Mitral Valve Replacement for Degenerated Bioprosthetic
Valves and Failed Annuloplasty Rings.
Source
Journal of the American College of Cardiology. 70 (9) (pp 1121-1131),
2017. Date of Publication: 29 August 2017.
Publisher
Elsevier USA
Abstract
Background Limited data exist regarding transcatheter mitral valve
replacement (TMVR) for patients with failed mitral valve replacement and
repair. Objectives This study sought to evaluate the outcomes of TMVR in
patients with failed mitral bioprosthetic valves (valve-in-valve [ViV])
and annuloplasty rings (valve-in-ring [ViR]). Methods From the TMVR
multicenter registry, procedural and clinical outcomes of mitral ViV and
ViR were compared according to Mitral Valve Academic Research Consortium
criteria. Results A total of 248 patients with mean Society of Thoracic
Surgeons score of 8.9 +/- 6.8% underwent TMVR. Transseptal access and the
balloon-expandable valve were used in 33.1% and 89.9%, respectively.
Compared with 176 patients undergoing ViV, 72 patients undergoing ViR had
lower left ventricular ejection fraction (45.6 +/- 17.4% vs. 55.3 +/-
11.1%; p < 0.001). Overall technical and device success rates were
acceptable, at 92.3% and 85.5%, respectively. However, compared with the
ViV group, the ViR group had lower technical success (83.3% vs. 96.0%; p =
0.001) due to more frequent second valve implantation (11.1% vs. 2.8%; p =
0.008), and lower device success (76.4% vs. 89.2%; p = 0.009) due to more
frequent reintervention (16.7% vs. 7.4%; p = 0.03). Mean mitral valve
gradients were similar between groups (6.4 +/- 2.3 mm Hg vs. 5.8 +/- 2.7
mm Hg; p = 0.17), whereas the ViR group had more frequent post-procedural
mitral regurgitation moderate or higher (19.4% vs. 6.8%; p = 0.003).
Furthermore, the ViR group had more frequent life-threatening bleeding
(8.3% vs. 2.3%; p = 0.03), acute kidney injury (11.1% vs. 4.0%; p = 0.03),
and subsequent lower procedural success (58.3% vs. 79.5%; p = 0.001). The
1-year all-cause mortality rate was significantly higher in the ViR group
compared with the ViV group (28.7% vs. 12.6%; log-rank test, p = 0.01). On
multivariable analysis, failed annuloplasty ring was independently
associated with all-cause mortality (hazard ratio: 2.70; 95% confidence
interval: 1.34 to 5.43; p = 0.005). Conclusions The TMVR procedure
provided acceptable outcomes in high-risk patients with degenerated
bioprostheses or failed annuloplasty rings, but mitral ViR was associated
with higher rates of procedural complications and mid-term mortality
compared with mitral ViV.<br/>Copyright &#xa9; 2017 American College of
Cardiology Foundation

<158>
Accession Number
617788567
Author
Chen P.T.; Ting C.K.; Lee M.Y.; Cheng H.W.; Chan K.H.; Chang W.K.
Institution
(Chen, Ting, Lee, Cheng, Chan, Chang) Department of Anesthesiology, Taipei
Veterans General Hospital, Taipei, Taiwan (Republic of China)
(Chen, Ting, Chan, Chang) Department of Anesthesiology, School of
Medicine, National Yang-Ming University, Taipei, Taiwan (Republic of
China)
(Chen) School of Nursing, Taipei Medical University, Taipei, Taiwan
(Republic of China)
(Chang) Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan (Republic of
China)
Title
A randomised trial comparing real-time double-lumen endobronchial tube
placement with the Disposcope with conventional blind
placement.
Source
Anaesthesia. 72 (9) (pp 1097-1106), 2017. Date of Publication: September
2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Double-lumen endobronchial tube placement is challenging. This study
compared double-lumen tube placement with the Disposcope, a
wireless videostylet allowing real-time visualisation, with conventional
blind placement. Patients undergoing elective thoracic surgery with normal
airways requiring one-lung ventilation were randomly allocated into two
groups (27 patients in each group). The Disposcope was used to assist
left-sided double-lumen tube placement in one group, and conventional
blind placement was performed in the control group. Placement in both
groups was checked with fibreoptic bronchoscopy. The Disposcope-assisted
group had a shorter total mean (SD) placement time (18.6 (2.5) s vs. 21.4
(2.9) s, p < 0.001), laryngoscopy to end of auscultation time (83.4 (3.0)
s vs. 93.9 (5.7) s, p < 0.001) and total operation time (130.7 (6.1) s vs.
154.5 (6.3) s, p < 0.001). In the Disposcope-assisted group, the
double-lumen tube was inserted in the correct side in all patients
(100.0%), whereas in the conventional group, the double-lumen tube was
placed in the correct side in 25 (92.6%) patients and in the wrong side in
2 (7.4%) patients; the difference was not significant (p = 0.150). In the
Disposcope-assisted group, the double-lumen tube was inserted to the
optimal depth in 24 (88.9%) patients, whereas in the conventional group it
was inserted to the optimal depth in one (4.0%) patient. The Disposcope
increased the success rate of double-lumen tube placement, and shortened
the total operation time when compared with standard placement with
confirmation using fibreoptic bronchoscopy, and may replace the
conventional method.<br/>Copyright &#xa9; 2017 The Association of
Anaesthetists of Great Britain and Ireland

<159>
Accession Number
617772603
Author
Bufarini C.; Leoni S.; Guglielmi S.; Caimmi S.; Bartolini G.; Ciaffi V.;
Sbaffo M.; Moriconi L.; Paolucci D.; Marinozzi A.
Institution
(Bufarini, Leoni, Guglielmi, Caimmi, Bartolini, Ciaffi, Marinozzi) AOU
Ospedali Riuniti Ancona, Clinical Pharmacy, Ancona, Italy
(Sbaffo, Moriconi, Paolucci) Loccioni Group, Department of Humancare, Moie
di Maiolati Spontini, Italy
Title
Centralised non-hazardous intravenous compounding: From theory to clinical
practice.
Source
European Journal of Hospital Pharmacy. Conference: 22nd Annual Congress of
the European Association of Hospital Pharmacists, EAHP 2017. France. 24
(pp A219-A220), 2017. Date of Publication: March 2017.
Publisher
BMJ Publishing Group
Abstract
Background After a preliminary study demonstrated its feasibility, a new
Central IntraVenous Additive Service (CIVAS) opened in April 2016
dedicated to the compounding of nontoxic injectable drugs (IV) in a new
class C cleanroom equipped with a robotic system. The following months
were dedicated to developing and improving the CIVAS pilot project,
increasing the number of hospital departments involved and enlarging the
IV productivity. Purpose This study presents the preliminary results of
the pilot CIVAS project in term of improvement in hospital workflow in the
pilot departments. Material and methods We examined 4 months of activity
involving 5 pilot hospital departments. All data were collected and
analysed through the APOTECAmanager software that manages the entire IV
production workflow of the hospital pharmacy. Results 7 drugs with
chemical stability >48 hours and prescribed in standard doses were
selected for the pilot study. The preparations identified in each unit
were: . Antibiotics: piperacillin-tazobactam (4.5 g and about 15
preparations/day) and ceftriaxone (1 g and 6 preparations/day); .
Haematology: palonosetron (250 mg and 14 preparations/day), ondansetron (8
mg, 6 preparations/day), zoledronic acid (4 mg, 5 preparations/week); .
Oncology: ondansetron (8 mg, 6 preparations/day), denosumab (120 mg, 5
preparations/week); . Cardiac surgery: cefazolin (1 g, 25
preparations/day); . Emergency medicine: piperacillin-tazobactam (4.5 g, 7
preparations/day). The automated compounding was performed in advance,
based on a daily consumption estimate for each unit. Therapies were stored
inside the refrigerator overnight. The day after, once the prescription
was confirmed, preparations were packed and delivered to the corresponding
unit. Average time per preparation was 2 min 30 s and dosage accuracy was
98.5%. Any preparation in excess remained in the refrigerator to be used
later as drug stability permitted. No wasted products were registered.
Conclusion The pilot results showed the desired outcomes of time saving
and drug waste reduction. The remaining challenge is not so much the
technology adoption as the organisational aspect in terms of production
planning and logistics. Future plans include continuing to enlarge the
number of drugs prepared and departments utilising this service,
demonstrating the benefits of this technology innovation more broadly
hospital-wide.

<160>
Accession Number
617772412
Author
Soler J.I.G.; De Vera A.P.R.; Casan V.A.; Molina O.M.G.; Comendador S.M.;
Lozano E.G.; Luz A.T.; Jimenez M.D.M.R.; Sanchez S.V.; De La Rubia Nieto
A.
Institution
(Soler, De Vera, Casan, Molina, Comendador, Lozano, Luz, Jimenez, Sanchez,
De La Rubia Nieto) Hospitalary Pharmacy, Murcia, Spain
Title
Descriptive analysis of active clinical trials in cardiology service.
Source
European Journal of Hospital Pharmacy. Conference: 22nd Annual Congress of
the European Association of Hospital Pharmacists, EAHP 2017. France. 24
(pp A78), 2017. Date of Publication: March 2017.
Publisher
BMJ Publishing Group
Abstract
Background Cardiovascular diseases are the leading cause of death in
Europe making it necessary to promote research projects. Purpose To
describe active cardiology clinical trials (CT) and the distribution of
included patients. To analyse investigational drugs (ID). Material and
methods This was a descriptive observational study in a tertiary hospital.
Active cardiology CT were considered from January 2015 to October 2016. ID
were classified into: New molecule, new indication and new scheme.
Collected data were: Number of CT and patients, medical conditions
included, ID and phase, trial design, location of study and promoter.
Results 26 CT with a total of 336 patients, and a mean of 13.4 patients
per CT (range 0-96) were studied. The number of CT/number of patients by
medical condition was: Chronic heart failure n=13/55 (50%/16.4%); acute
coronary syndrome n=4/110 (15.4%/32.7%); cardiomyopathy n=2/6 (7.7%/1.8%);
unstable angina n=1/32 (3.8%/9.5%); dyslipidaemia n=1/96 (3.8%/28.6%);
atrial fibrillation n=1/21 (3.8%/6.25%); pulmonary hypertension n=1/3
(3.8%/0.9%); platelet reactivity after transcatheter aortic valve
implantation n=1/11 (3.8%/3.3%); and patients with bicuspid aortic valve
and venous thromboembolism n=1/1 (3.8%/0.3%). Regarding the ID, the
distribution of CT/patient was: 12/211 new molecules (46.2%/68.8%), 12/90
new indications (46.2%/26.8%) and new schemes 2/35 (7.7%/10.4%). Depending
on the phase, the number of CT/number of patients was: 6/47 phase II
(23.1%/14%); 15/246 phase III (57.7%/73.2%); and 5/46 phase IV
(19.2%/13.7%). A total of 25 CT (96.1%) were multicentre and controlled;
20 (76.9%) double blind; 16 (64%) with placebo; and six (23.1%) were open
label. According to the study location, 21 (80.8%) were international. The
industry promoted 22 CT (84.6%). Conclusion There has been a predominance
of multicentre, randomised, phase III, double blind, placebo controlled
CT. Most were international and promoted by industry. There was a high
number of patients per cardiology CT, showing a predominance of those
included in phase III and acute coronary syndrome. However, the largest
number of trials was focused on chronic heart failure. No differences were
shown for the number of CT studying new drugs or new indications, although
more than two-thirds of patients were included in CT that were studying
new drugs.

<161>
Accession Number
617765110
Author
Sawhney V.; Domenichini G.; Baker V.; Gamble J.; Furniss G.; Panagopoulos
D.; Campbell N.; Lowe M.; Lambiase P.; Haywood G.; Rajappan K.; Sporton
S.; Earley M.; Dhinoja M.; Hunter R.; Betts T.; Schilling R.
Institution
(Sawhney, Domenichini, Baker, Lowe, Lambiase, Sporton, Earley, Dhinoja,
Hunter, Schilling) Barts Heart Centre, London, United Kingdom
(Gamble, Rajappan, Betts) John Radcliffe Hospital, Oxford, United Kingdom
(Furniss, Panagopoulos, Haywood) Plymouth Hospital NHS Trust, Plymouth,
United Kingdom
(Campbell) University Hospital of South Manchester NHS Foundation Trust,
Manchester, United Kingdom
Title
Thromboembolic events in left ventricular endocardial pacing: Long-term
outcomes from a multicentre UK Registry.
Source
Journal of Interventional Cardiac Electrophysiology. Conference: 13th
Annual Congress of the European Cardiac Arrhythmia Society, ECAS 2017.
Italy. 48 (pp S30-S31), 2017. Date of Publication: 2017.
Publisher
Springer New York LLC
Abstract
Background: Endocardial left ventricular (LV) pacing is an effective
alternative in patients with failed coronary sinus lead. However, the
major concern is the unknown long-term throm-boembolic risk, and much of
the data has come from a small number of centres. We examined the safety
and efficacy of endocardial LV pacing across four UK centres to determine
the long-term thromboembolic risk. Methods and results: Independent
prospective registries from four UK centres were combined to include 68
consecutive patients from 2010 to 2015. Medical records were reviewed and
patients were contacted for follow-up. Thromboembolic events were
con-firmed on imaging. Baseline patient demographics are shown in Table 1.
Of the patients, 65% were already anticoagulated (39 AF, 1 DVT, 2
prosthetic valve, 2 previous LV thrombus). The mean CHADS2VASC2 score for
the cohort was 3.5. Forty-four per cent of patients had trans-ventricular
LV lead. The mean procedure and fluoroscopy times were 200+/-120 and
32+/-28 min. Seventy-five per cent had a silicone-insulated pacing lead.
Post-procedure, three patients had haematomas and one had tamponade
requiring pericardial drain. Functional improvement was noted with a
decrease in mean NYHA from 3.5 +/-1 to 2.1+/-1.2 (p=0.001) and increase in
LVEF from 26.5 +/-12 to 34+/-18.1 (p=0.005) over a 20-month follow-up.
Redo procedure due to lead displacement was required in two patients. One
patient underwent system extraction and surgical epicardial lead after
device infection. The ischaemic stroke rate, defined as transient or
permanent loss of function associated with imaging confirmation of a
cerebral infarct in the appropriate territory, occurred in four patients
(6%), providing an annual event rate of 3.6%. In multivariate analyses,
the only significant correlation with the risk of CVA was sub-therapeutic
INRs (pBB =0.01, CI =0.02-0.68, HR = 0.12). There was no association
between lead material and mode of delivery (transatrial/ventricular) and
CVA. Fourteen patients died during follow-up, with mean time to death
post-procedure of 20 months. Cause of death was end-stage heart failure in
all patients, except three (pneumonia in two and knee sepsis in one).
Conclusion: Endocardial LV lead in heart failure patients has a good
success rate at 1.6 years follow-up. However, it is associated with a
modest thromboembolic risk largely due to sub-therapeutic anticoagulation.
These results have potential for improvement, and newer oral
anticoagulants might play a role in this setting.

<162>
Accession Number
617765280
Author
Anonymous
Title
13th Annual Congress of the European Cardiac Arrhythmia Society.
Source
Journal of Interventional Cardiac Electrophysiology. Conference: 13th
Annual Congress of the European Cardiac Arrhythmia Society, ECAS 2017.
Italy. 48 (no pagination), 2017. Date of Publication: 2017.
Publisher
Springer New York LLC
Abstract
The proceedings contain 165 papers. The topics discussed include: targeted
ablation of ectopy-triggering ganglionic plexi sites alone for paroxysmal
atrial fibrillation; the impact of obesity on atrial fibrillation
ablation: patient characteristics, long-term outcomes and complications;
incidence of classic atrial flutter in outpatients with paroxysmal atrial
fibrillation as identified with a new p-wave centric ECG monitor:
implications for the AF ablation procedure protocol; incidence of
pulmonary vein stenosis after radiofrequency catheter ablation of atrial
fibrillation; what do patients with incident atrial fibrillation and no
comorbidities at the time of diagnosis die of?; AV node ablation and
permanent his bundle pacing; his bundle pacing reduced mortality/morbidity
compared to right ventricular pacing in pacemaker population: long-term
follow-up; right ventricular high septal pacing vs. right ventricular
apical pacing following AV node ablation: 20 years follow-up;
thromboembolic events in left ventricular endocardial pacing: long-term
outcomes from a multicentre UK registry; predictors of long-term RV pacing
in patients post transcatheter aortic valve replacement with an Edwards
SAPIEN valve; and periprocedural management during left atrial ablation:
bridging, uninterrupted vitamin k antagonists or uninterrupted novel
anticoagulants?.

<163>
Accession Number
617764078
Author
Providencia R.; Barra S.; Papageorgiou N.; Falconer D.; Duehmke R.; Rehal
O.; Ahsan S.; Ezzat V.; Dhinoja M.; Ioannou A.; Segal O.; Sporton S.;
Rowland E.; Lowe M.; Lambiase P.; Agarwal S.; Chow A.W.
Institution
(Providencia, Papageorgiou, Ahsan, Ezzat, Dhinoja, Segal, Sporton,
Rowland, Lowe, Lambiase, Chow) Barts Health NHS Trust, London, United
Kingdom
(Barra, Duehmke) Papworth Hospital NHS Trust, Cambridge, United Kingdom
(Falconer) University College Hospital, London, United Kingdom
(Rehal) University College of Cardiology Hospital, NHS Trust, London,
United Kingdom
(Ioannou) Royal Free Hospital, London, United Kingdom
(Agarwal) Papworth Hospital NHS Trust, London, United Kingdom
Title
Bifocal right ventricular pacing in patients with failed coronary-sinus
lead implants: Long-term results from multicentre registry.
Source
Europace. Conference: Heart Rhythm Congress 2016. United Kingdom. 18 (pp
ii11), 2016. Date of Publication: October 2016.
Publisher
Oxford University Press
Abstract
Background: Bifocal right ventricular pacing (Bifocal-RV) has been
proposed as an alternative for patients with heart failure (HF) undergoing
cardiac resynchronization therapy (CRT) with a failure to deliver a
coronary sinus (CS) lead. Although short-term haemodynamic and
echocardiographic results of Bifocal-RV seem promising, no long-term
results on survival are currently available. Purpose: To assess the impact
of Bifocal-RV compared to CRT patients on all-cause mortality and/or heart
transplant in advanced HF patients undergoing CRT. Methods: Multicentre (3
centres) retrospective assessment of all bifocal-RV implants during a
13-year period. Patients with failed CS lead implant and treated with
Bifocal-RV were followed and assessed for the primary end point of
all-cause mortality and/or heart transplant. Secondary endpoints were:
freedom from sustained ventricular tachycardia/fibrillation, procedural
complications, infection, and lead-dislodgment. Comparisons were performed
with standard CRT implants matched controls. Results: 94 patients
implanted with bifocal-RV were compared with matched controls. The mean
age of these patients was 7045 +/- 9.6 years, 36.8% were women, mean LVEF
was 27 +/- 11%, NYHA was 2.7 +/- 0.7, and 63.2% were implanted with a
CRT-D (defibrillator). During a median of 1,719 days (IQR 753-2,408),
after adjustment for baseline differences, intention-to-treat analysis
showed that all-cause mortality and/or heart transplant was higher in the
Bifocal-RV group (adjusted HR = 1.78, 95%CI 1.27-2.50, P = 0.001). Three
patients in the Bifocal-RV group underwent transplant, and 13 crossed-over
to the CRT arm (2 transseptal LV lead, 8 successful CS lead implants, and
3 surgical-epicardial lead procedures) and 53.8% are currently still
alive. No significant differences were observed between the two groups in
all secondary endpoint comparisons. Conclusion: Our data suggest that
Bifocal-RV pacing leads to worse clinical outcomes and alternative CRT
options should be considered in patients with failed CS-lead implants.

<164>
Accession Number
613978918
Author
El-Tahan M.R.
Institution
(El-Tahan) Anesthesiology Department, King Fahd Hospital of the University
of Dammam, Dammam, Saudi Arabia
Title
Role of Thoracic Epidural Analgesia for Thoracic Surgery and Its
Perioperative Effects.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (4) (pp 1417-1426),
2017. Date of Publication: August 2017.
Publisher
W.B. Saunders

<165>
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.

<166>
Accession Number
609692152
Author
Uretsky S.; Argulian E.; Supariwala A.; Agarwal S.K.; El-Hayek G.; Chavez
P.; Awan H.; Jagarlamudi A.; Puppala S.P.; Cohen R.; Rozanski A.
Institution
(Uretsky) Department of Cardiovascular Medicine, Morristown Medical
Center, Gagnon Cardiovascular Institute, 100 Madison Ave, Morristown, NJ
07960, United States
(Argulian, El-Hayek, Chavez, Awan, Jagarlamudi, Puppala, Cohen, Rozanski)
Division of Cardiology, Department of Medicine, Mount Sinai St. Luke's
Hospital, New York, NY, United States
(Supariwala) Northshore LIJ Southside Hospital, Hofstra School of
Medicine, NSLIJHS, Bayshore, NY, United States
(Agarwal) Department of Cardiovascular Medicine, University of Arkansas
for Medical Sciences, Little Rock, AR, United States
Title
Comparative effectiveness of coronary CT angiography vs stress cardiac
imaging in patients following hospital admission for chest pain work-up:
The Prospective First Evaluation in Chest Pain (PERFECT) Trial.
Source
Journal of Nuclear Cardiology. 24 (4) (pp 1267-1278), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: Because the frequency of cardiac event rates is low among
chest pain patients following either performance of coronary CT
angiography (CCTA) or stress testing, there is a need to better assess how
these tests influence the central management decisions that follow from
cardiac testing. The present study was performed to assess the relative
impact of CCTA vs stress testing on medical therapies and downstream
resource utilization among patients admitted for the work-up of chest
pain. Methods: The admitted patients were randomized in a 1:1 ratio to
either cardiac imaging stress test or CCTA. Primary outcomes were time to
discharge, change in medication usage, and frequency of downstream
testing, cardiac interventions, and cardiovascular re-hospitalizations. We
randomized 411 patients, 205 to stress testing, and 206 to CCTA. Results:
There were no differences in time to discharge or initiation of new
cardiac medications at discharge. At 1 year follow-up, there was no
difference in the number of patients who underwent cardiovascular
downstream tests in the CCTA vs stress test patients (21% vs 15%, P = .1)
or cardiovascular hospitalizations (14% vs 16%, P = .5). However, there
was a higher frequency of invasive angiography in the CCTA group (11% vs
2%, P = .001) and percutaneous coronary interventions (6% vs 0%, P <
.001). Conclusions: Randomization of hospitalized patients admitted for
chest pain work-up to either CCTA or to stress testing resulted in similar
discharge times, change in medical therapies at discharge, frequency of
downstream noninvasive testing, and repeat hospitalizations. However, a
higher frequency of invasive coronary angiography and revascularization
procedures were performed in the CCTA arm. (ClinicalTrials.gov number,
NCT01604655.).<br/>Copyright &#xa9; 2016, American Society of Nuclear
Cardiology.

<167>
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

<168>
Accession Number
617753769
Author
Templeton T.W.; Morris B.N.; Goenaga-Diaz E.J.; Forest D.J.; Hadley R.;
Moore B.A.; Bryan Y.F.; Royster R.L.
Institution
(Templeton, Morris, Goenaga-Diaz, Forest, Hadley, Moore, Bryan, Royster)
Department of Anesthesiology, Wake Forest School of Medicine,
Winston-Salem, NC, United States
Title
A Prospective Comparison of Intraluminal and Extraluminal Placement of the
9-French Arndt Bronchial Blocker in Adult Thoracic Surgery Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (4) (pp 1335-1340),
2017. Date of Publication: August 2017.
Publisher
W.B. Saunders
Abstract
Objective To compare the standard intraluminal approach with the placement
of the 9-French Arndt endobronchial blocker with an extraluminal approach
by measuring the time to positioning and other relevant intraoperative and
postoperative parameters. Design A prospective, randomized, controlled
trial. Setting University hospital. Participants The study comprised 41
patients (20 intraluminal, 21 extraluminal) undergoing thoracic surgery.
Intervention: Placement of a 9-French Arndt bronchial blocker either
intraluminally or extraluminally. Comparisons between the 2 groups
included the following: (1) time for initial placement, (2) quality of
isolation at 1-hour intervals during one-lung ventilation, (3) number of
repositionings during one-lung ventilation, and (4) presence or absence of
a sore throat on postoperative days 1 and 2 and, if present, its severity.
Measurements and Main Results Median time to placement (min:sec) in the
extraluminal group was statistically faster at 2:42 compared with 6:24 in
the intraluminal group (p < 0.05). Overall quality of isolation was
similar between groups, even though a significant number of blockers in
both groups required repositioning (extraluminal 47%, intraluminal 40%, p
> 0.05), and 1 blocker ultimately had to be replaced intraoperatively. No
differences in the incidence or severity of sore throat postoperatively
were observed. Conclusions A statistically significant reduction in time
to placement using the extraluminal approach without any differences in
the rate of postoperative sore throat was observed. Whether placed
intraluminally or extraluminally, a significant percentage of Arndt
endobronchial blockers required at least one intraoperative
repositioning.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<169>
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

<170>
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.

<171>
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.

<172>
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.

<173>
Accession Number
617767777
Author
Jantarawan T.; Sriyoschati S.; Subtaweesin T.; Thongcharoen P.;
Laksanabunsong P.; Tantiwongkosri K.
Institution
(Jantarawan, Sriyoschati, Subtaweesin, Thongcharoen, Laksanabunsong,
Tantiwongkosri) Division of Cardiothoracic Surgery, Department of Surgery,
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok,
Thailand
Title
A pilot study of a sternal closure technique to prevent postoperative
pectus carinatum in congenital heart surgery pediatric patients.
Source
Journal of the Medical Association of Thailand. 100 (3 Supplement 2) (pp
S10-S15), 2017. Date of Publication: 2017.
Publisher
Medical Association of Thailand (E-mail: math@loxinfo.co.th)
Abstract
Background: Pectus carinatum has the psychological impact of the body
image and quality of life of patients. The authors have observed that
several pediatric patients with previously normal chest wall contour
undergoing open heart surgery developed acquired/iatrogenic postoperative
pectus carinatum. Objective: The aims of the study were (1) to determine
the incidence of postoperative pectus carinatum, and (2) to compare the
incidence of postoperative pectus carinatum in pediatric patients
undergoing open heart surgery using conventional parallel sternal closure
(PSC) versus convergent sternal closure (CSC) technique. Material and
Method: The authors prospectively enrolled 52 pediatric patients who
underwent open heart surgery. Twelve patients were excluded because of
secondary/delay sternal closure (n = 2), previous sternotomy (n = 6), and
prior chest wall deformity (n = 4). The 40 patients were randomized into
two groups: 20 in PSC and 20 in CSC group. All patients were followed-up
at 6 months postoperatively to determine the occurrence of postoperative
pectus carinatum. Results: Of 40 (1.6+/-1.2 years; 55% were female)
patients, post-operative pectus carinatum was present in 11 patients
(28%). At 6-month follow-up, post-operative pectus carinatum was more
prevalent in patients using PSC technique (n = 10) than those using CSC (n
= 1) technique (50% vs. 5%; RR = 10 [95% CI = 1.41-70.99], p<0.001.
Conclusion: (1) The incidence of postoperative pectus carinatum was about
one-fourth (28%) of pediatric patients undergoing open heart surgery. (2)
CSC technique reduced postoperative pectus carinatum compared with PSC
technique in those patients. (3) The authors suggest using convergent
sternal closure technique in pediatric cardiac surgery to prevent the
postoperative pectus carinatum.<br/>Copyright &#xa9; 2017, Medical
Association of Thailand. All rights reserved.