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<1>
Accession Number
615238224
Author
Gist K.M.; Goldstein S.L.; Wrona J.; Alten J.A.; Basu R.K.; Cooper D.S.;
Soranno D.E.; Duplantis J.; Altmann C.; Gao Z.; Faubel S.
Institution
(Gist, Soranno, Duplantis) Children's Hospital Colorado-The University of
Colorado, 13123 E 16th Ave, Aurora, CO 80045, United States
(Gist, Wrona) The Heart Institute, Children's Hospital Colorado, 13123 E
16th Ave, B100, Aurora, CO 80045, United States
(Goldstein) Center for Acute Care Nephrology, Cincinnati Children's
Hospital Medical Center, 3333 Burnet Ave, MLC 7022, Cincinnati, OH 45229,
United States
(Alten) Pediatric Critical Care Medicine, Children's of Alabama-University
of Alabama, WIC 1799 6th Ave S, Suite 9100 176 F, Birmingham, AL 35233,
United States
(Basu) Pediatric Critical Care Medicine, Center for Acute Care Nephrology,
Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2005,
Cincinnati, OH 45229, United States
(Cooper) The Heart Institute, Cincinnati Children's Hospital Medical
Center, 3333 Burnet Ave, MLC 2003, Cincinnati, OH 45229, United States
(Soranno, Duplantis) The Kidney Center, Children's Hospital Colorado-The
University of Colorado, 13123 E 16th Ave, Aurora, CO 80045, United States
(Altmann, Faubel) Department of Internal Medicine, Division of Renal
Disease and Hypertension, University of Colorado Anschutz Medical Campus,
12700 E 19th Ave, Box C281, Aurora, CO 80045, United States
(Gao) Heart Institute Research Core, Cincinnati Children's Hospital
Medical Center, 3333 Burnet Ave, MLC, Cincinnati, OH 45229, United States
Title
Kinetics of the cell cycle arrest biomarkers (TIMP-2*IGFBP-7) for
prediction of acute kidney injury in infants after cardiac surgery.
Source
Pediatric Nephrology. 32 (9) (pp 1611-1619), 2017. Date of Publication: 01
Sep 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Background: Tissue inhibitor metalloproteinase-2 (TIMP-2) and insulin-like
growth factor binding protein-7 (IGFBP-7) are cell-cycle arrest biomarkers
that have been shown to be predictive of acute kidney injury (AKI) in
critically ill adults. AKI affects a large proportion (40%) of children
following cardiac surgery. The aim of this study was to describe the
kinetics of TIMP-2*IGFBP-7 and test its ability to predict AKI in infants
following cardiac surgery. Methods: A multicenter prospective study was
performed in infants undergoing cardiac surgery with cardiopulmonary
bypass (CPB) from October 2013 to January 2015. Urine samples were
obtained at baseline and at 2, 6, 12, 24, 48 and 72 h after CPB
initiation. TIMP-2*IGFBP-7 concentration was measured in urine samples
using the Astute 140 meter to determine a risk score for AKI. This risk
score is the product of TIMP-2 (ng/mL) and IGFBP-7 (ng/mL) divided by
1000. Results: A total of 94 infants with a mean age of 154.2 +/- 85.7
days were enrolled in the study, of whom 31 (33%) subsequently developed
AKI. The mean time to AKI diagnosis was 25 +/- 7 h after CPB initiation.
The concentration of TIMP-2*IGFBP-7 was significantly higher in patients
with AKI at 12 h after CPB initiation relative to baseline (p = 0.006). At
12 h after CPB initiation patients with a TIMP-2*IGFBP-7 concentration of
>=0.78 had a threefold higher odds of developing AKI than those with a
TIMP-2*IGFBP-7 concentration of < 0.78 (95% confidence interval 1.47-6.11,
p = 0.001). Conclusion: These results demonstration that TIMP-2*IGFBP-7
concentration can be used in infants to predict subsequent serum
creatinine-defined AKI following CPB.<br/>Copyright &#xa9; 2017, IPNA.

<2>
Accession Number
618007959
Author
Bonvicini D.; Labate D.; Benacchio L.; Olivieri A.; Pizzirani E.
Institution
(Bonvicini, Labate, Pizzirani) Ulss 15 Alta Padovana, Anesthesia and
Intensive Care Unit, Camposampiero, Italy
(Benacchio, Olivieri) Ulss 15 Alta Padovana, Epidemiology Unit,
Camposampiero, Italy
Title
Type of stress-ulcer prophylaxis and incidence of ventilator-associated
pneumonia.
Source
Intensive Care Medicine Experimental. Conference: 29th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2016. Italy. 4 (no
pagination), 2016. Date of Publication: September 2016.
Publisher
SpringerOpen
Abstract
Introduction: Ventilator-Associated Pneumonia (VAP) is a leading
nosocomial infection in intensive care unit (ICU) patients undergoing
mechanical ventilation (MV). Giving that such patients show an increasing
risk of important gastrointestinal (GI) bleeding, stress-ulcer prophylaxis
(SUP) has been recommended for the prevention of upper GI hemorrhage. SUP
strategy rely on drugs that block the secretion of gastric acid and
increase the gastric pH (histamine-2-receptor antagonists-H2RA, and proton
pump inhibitor-PPI) and those that does not alter gastric pH (sucralfate).
The increase of gastric pH leads to bacterial overgrowth and potential
colonization of trachea determining a higher risk of VAP. Objectives: In
the setting of a study designated to assess VAP outcomes, we collected
data on known VAP risk factors (SUP strategy). Our objective was to
evaluate the risk of VAP accounting for exposure to H2RA, PPI and
sucralfate. Methods: We recruited 772 patients in a multicenter
prospective observational study, conducted in 21 Italian ICUs. Patients
admitted to the ICU for at least 48 hours, received MV from the admission,
and were followed until discharge, the day of withholding MV, the day of
transfer in other hospital ward, or death.We recorded demographic data,
admission category, and severity scores on admission. Each day of ICU
staying SUP approach (H2RA, PPI or sucralfate) was recorded. VAP was
defined as pneumonia occurring after a MV period of at least 48 hours
during the ICU stay.Independent relationships between VAP incidence and
the specific SUP approach was assessed by using a logistic regression
analysis. Results: Among 772 patients experiencing on average 11.3 days of
MV, 116 (15 %) developed VAP. Sucralfate was less frequently used (8 %),
while 28 % has been receiving H2RA and 77 % PPI. The risk of VAP was
higher for patients treated mainly with PPI (OR 4.27, 95%CI 2.57-7.09)
than those who received H2RA (OR 2.30, 95%CI 1.08-5.07). Conclusions: Our
study show that the use of ranitidine is associated with a lower risk of
VAP, compared with PPI. Sucralfate was less frequently used in the
participating ICUs. Although some meta-analysis indicate a lower risk of
VAP associated with sucralfate, an important study have not established a
superiority of this medication compared with ranitidine [1]. Miano et al.
compared the use of pantoprazole vs ranitidine in Cardiothoracic Surgery
patients showing that pantoprazole was associated with a higher rate of
VAP [2]. Such VAP rate associated with PPI would seem to be linked to a
greater antacid power than ranitidine. This can lead to a more extensive
gastric bacterial colonization in patients treated with these drugs.
Randomized-Controlled Trial of Stress-ulcer prophylaxis are needed to
assess which drug show the highest risk of VAP and the relationship with
the incidence of major GI bleeding.

<3>
Accession Number
618007927
Author
Barbanti C.; Amour J.; Gaudard P.; Rozec B.; Mauriat P.; M'Rini M.; Leger
P.L.; Cambonie G.; Liet J.M.; Girard C.; Laroche S.; Damas P.; Assaf Z.;
Loron G.; Lecourt L.; Pouard P.
Institution
(Barbanti) Hopital Universitaire Necker Enfants Malades, Pediatric Cardiac
Intensice Care Unit, Paris, France
(Amour) Pitie-Salpetriere Hospital, Pierre and Marie Curie University,
Reanimation Chirurgicale Cardio Vasculaire et Thoracique, Paris, France
(Gaudard) Arnaud de Villeneuve, Anesthesie Reanimation, Montpellier,
France
(Rozec) Hopital Laennec CHU de Nantes, Anesthesie Reanimation, Nantes,
France
(Mauriat) Maison du Haut Leveque CHU Bordeaux, Congenital Cardiac Surgery
Unit, Bordeaux, France
(M'Rini) Clinic Pasteur, Service Anesthesie Reanimation, Toulouse, France
(Leger) Hopital Trousseau, Reanimation Neonatale et Polyvalente, Paris,
France
(Cambonie) Hopital Arnaud de Villeneuve, Reanimation Pediatrique et
Neonatale, Montpellier, France
(Liet) CHU de Nantes, Pediatric Intensive Care Unit, Nantes, France
(Girard) CHU Bocage, Reanimation Cardio Vasculaire et Polyvalente, Dijon,
France
(Laroche) Air Liquide Sante International, Reserach Center Paris Saclay,
Paris, France
(Damas) Hopital Start-Tilman, Services de Soins Intensifs Generaux, Liege,
Belgium
(Assaf) Hopital Necker, Reanimation Neonatale, Paris, France
(Loron) American Memorial Hospital, Reanilmation Neonatale et Polyvalente,
Reims, France
(Lecourt) Air Liquide Sante International, Gentilly, France
(Pouard) Hopital Necker Enfants Malades, Pediatric Cardiac Intensive Care,
Paris, France
Title
The use of inhaled nitric oxide (INO) in neonatal, pediatric and adult
intensive care units, a franco belgian multicenter prospective survey from
the positive study group.
Source
Intensive Care Medicine Experimental. Conference: 29th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2016. Italy. 4 (no
pagination), 2016. Date of Publication: September 2016.
Publisher
SpringerOpen
Abstract
Introduction: Inhaled NO is a well-known selective pulmonary vasodilator
in Europe since 20 years nevertheless few study really described the daily
ICU practice. The objective of this study was to determine the gap between
guidelines and real life. Methods: This is a multicenter, prospective,
observational study on iNO administered through an integrated delivery and
monitoring device (EZ-Kinox) in 12 French and 1 Belgian centers for
pulmonary arterial hypertension after cardiac surgery (PAH CS) and for
persistent pulmonary hypertension of the newborn (PPHN). The following
parameters were observed: Dose, treatment duration, ventilation modes,
monitoring procedures, weaning procedures and occurrence of a rebound
effect. Concomitant pulmonary vasodilators treatments and safety data were
also collected. Results: 236 patients were studied among 238 patients
enrolled within one year period: 81 children and 117 adults with PAHCC and
38 neonates with PPHN. Echocardiography or pulmonary artery
catheterization were performed to diagnose PAH respectively in 86 % and 31
% of the cardiac patients. In the neonatal group 97.4 % had an
echocardiographic diagnosis. Inhaled NO was initiated before ICU admission
in adult population (57 %) but rarely in cardiac pediatric patients (12.7
%), p < 0.01 and 38.9 % in neonates. The median initial dosage of iNO set
was 20 ppm [18-20] in the cardiac pediatric group and 10 ppm [10-15] for
adults and 16.7 ppm [11.2-20] for neonates with a median duration
respectively 3.9 days [1.9-6.1], 3.8 days [1.8-6.8] and 3.07 days
[1.04-5.74]. The NO therapy classically was delivered during controlled
ventilation mode including high frequency oscillation and more and more
via non invasive ventilation as high flow nasal cannula. The clinical
effect of iNO was considered sufficient in 89 % of the cases and the dose
was gradually decreased before definitive withdrawal in 86 % of the cases.
Adverse effects (AE) occurred 75 times (80 % of the patients without AE)
including rebound effect in 1.2 % of children, 3.4 % of adults and 2.6 %
of neonates, methaemoglobinemia was observed on 7.9 % of neonates and 1.7
% of adults. The NO<inf>2</inf> generated by contact between NO and O2 was
above 0.5 ppm value in 17 % of the pediatric cases, 1 % of the adult cases
and never observed on neonates population. All these AE related to iNO
recovered without sequelae. Pulmonary vasodilators (levosimendan,
sildenafil, milrinone) were associated in 95 % of the cases in pediatrics,
23 % in adults (p < 0.01) and 23.7 % in neonates. ICU stay was 8 days
[6-15] for children, 10 days [6-16] for adults and 3.7 days [1-5.7] for
neonates. Discussion. This survey confirms the good efficacy and safety of
NO therapy in the three populations. Occurrence of rebound effect is
particularly rare with a large application of a gradually withdrawal of
iNO and pulmonary vasodilators use. The usage of last generation of NO
devices subject to prior training allows good compliance with
recommendations.

<4>
Accession Number
618007669
Author
Iwasaka H.; Tahara S.; Nagamine M.; Ichigatani A.
Institution
(Iwasaka) Oita Almeida Hospital, Intensive Care Unit, Oita, Japan
(Tahara, Nagamine, Ichigatani) Oita Almeida Hospital, Department of
Anesthesiology, Oita, Japan
Title
The effects of computer regulated continuous blood glucose management in
diabetic patients underwent cardiac surgery.
Source
Intensive Care Medicine Experimental. Conference: 29th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2016. Italy. 4 (no
pagination), 2016. Date of Publication: September 2016.
Publisher
SpringerOpen
Abstract
Introduction: It is well known that poor preoperative blood glucose
control is associated with poor postoperative blood glucose control and
postoperative complications. Postoperative hyperglycemia is common in
patients underwent cardiac surgery, especially in those with a
preoperative elevated HbA1c. The STG-55 (Nikkiso CO., Ltd., Tokyo, Japan)
is a newly developed and commercialized computer regulated continuous
blood glucose management apparatus. Objectives: To compare the usefulness
and the workload of ICU nurses of the STG-55 with the conventional sliding
scale method in diabetic patients underwent cardiac surgery. Methods: The
study was approved by the Institutional Review Board, and written,
informed consent was obtained from all participants. This study included
28 patients underwent elective cardiac surgery with preoperative HbA1c >
6.0 %. The management of blood glucose was performed from immediately
after admission to the ICU for two research days. The patients were
randomly assigned to control blood glucose levels with the STG-55 group (n
= 16) or sliding scale method, SS group (n = 12). The usefulness of blood
glucose management defined the incidence of hyperglycemia (blood glucose >
180 mg/dL), hypoglycemia (<80 mg/dL), and the maximum glycemic variability
(maximum blood glucose level minus minimum blood glucose level). The
workload of ICU nurses defined the number of blood samplings for the
management of blood glucose and the number of calls made to the physician.
Results: The two groups were comparable with respect to age, gender,
height, weight, duration of surgery, the amount of blood loss during
surgery and the preoperative HbA1c. The blood glucose levels determined
STG-55 and ABL3 acid-base laboratory analyzer were strongly correlated (R2
= 0.936), with nearly identical values. The incidence of hyperglycemia and
hypoglycemia was significantly lower in the STG-55 group (1.9 +/- 1.3 vs
6.7 +/- 4.9 times/day, p < 0.001; 0.2 +/- 0.1 vs 5.8 +/- 6.0 times/day, p
< 0.001) than SS group. The maximum gly-cemic variability was also
significantly lower in the STG-55 group (46 +/- 32 vs 283 +/- 165 mg/dL, p
< 0.01). The frequency of blood samplings (4.2 +/- 3.7 vs 21.5 +/- 14.1
times/day, p < 0.01), and the number of calls made to physician (2.1 +/-
2.2 vs 6.9 +/- 5.4 times/day, p < 0.05) were significantly lower in the
STG-55 group than SS group. Conclusions: Use of the STG-55 in the ICU
contributed to improved blood glucose management and reduced workload of
ICU nurses compared to using the sliding scale method.

<5>
Accession Number
618007570
Author
Ampatzidou F.; Vlachou A.; Kehagioglou G.; Karaiskos T.; Madesis A.;
Mauromanolis C.; Michail N.; Drossos G.
Institution
(Ampatzidou) G. Papanikolaou Hospital, Department of Cardiac Surgery ICU,
Thessaloniki, Greece
(Vlachou, Kehagioglou, Karaiskos, Madesis, Mauromanolis, Michail, Drossos)
G. Papanikolaou Hospital, Department of Cardiac Surgery, Thessaloniki,
Greece
Title
Postoperative morbidity and mortality in cardiac surgery patients with a
history of malignancy.
Source
Intensive Care Medicine Experimental. Conference: 29th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2016. Italy. 4 (no
pagination), 2016. Date of Publication: September 2016.
Publisher
SpringerOpen
Abstract
Introduction: Cancer survival rates are improving over time. Coexistence
of cardiac disease requiring cardiac surgery and a history of malignancy
is not unusual. Whether malignancy history impairs short-term outcomes
after cardiac surgery has not been well studied. Objectives: Aim of this
study is to describe the characteristics and outcomes of patients with a
history of solid tumor or hematological malignancy who underwent cardiac
surgery procedure under the use of cardiopulmonary bypass. Methods: A
total of 1618 consecutive patients underwent cardiac surgery from May 2012
to March 2016. Our clinic's electronic database was searched for patients
with a history of solid tumor or hematological malignancies (Group A) The
following factors were compared between group A and group B (control):
Age, Euroscore II, total red blood transfusions > 3units, post-op low
cardiac output syndrome (LCOS), prolonged mechanical ventilation (>24
hours), post-op non-invasive ventilation(NIV) because of respiratory
failure, acute kidney injury(AKI-RIFLE criteria), post-op atrial
fibrillation and mortality. Statistical analysis was based on x square
test. Results: History of malignancy was found in 47 (9 females) patients
(2,9 %, group A): 9 prostate, 8 breast, 5 colon/rectum,5 lung,4 stom-ach,3
laryngeal,2 bladder, 1 kidney,1 skin,1 salivary gland cancer, 7 lymphomas
(2 Hodgin) and 1 sarcoma. In all patients, cancer was in remission.
Performed procedures were (6 emergency):41 CABG +/- valve, 5 thoracic
aorta surgery and 1 resection of heart sarcoma. Cancer patients were
older-mean age 68,6 +/- 7,6 vs 65,1 +/- 10,6-and had slightly higher
Euroscore II:2,4 +/- 2,4 vs 2,1 +/- 3,3. Median ICU days were 2 for both
groups. Median mechanical ventilation time was 8 hours for group A vs 7
hours for group B. No re-intubations, no strokes, no sternal wound
infections were recorded for group A while mortality was 0 %. Comparing
the 2 groups for transfusions with > 3RBCs (9/47, p = 0,43), post-op
atrial fibrillation (19/47, p = 0,39), AKI(7/47, p = 0,85), NIV(5/47, p =
0,94), prolonged ventilation (3/47, p = 0,8) and LCOS (1/47, p = 0,58) no
statistical difference was found. Conclusions: History of cancer has no
impact on postoperative mortality and morbidity in patients after cardiac
surgery under the use of cardiopulmonary bypass.

<6>
Accession Number
618007502
Author
PerezVela J.L.; MarinMateos H.; Rivera J.J.J.; Llorente M.A.A.; De Marcos
B.G.; Fernandez F.J.G.; Laborda C.G.; Zamora D.F.
Institution
(PerezVela, MarinMateos) Hospital 12 de Octubre, Madrid, Spain
(Rivera) Complejo Universitario Canarias, Tenerife, Spain
(Llorente) Fundacion Jimenez Diaz, Madrid, Spain
(De Marcos) Hospital 12 de la Princesa, Madrid, Spain
(Fernandez) Hospital Virgen Macarena, Sevilla, Spain
(Laborda) Hospital Miguel Servet, Zaragoza, Spain
(Zamora) Hospital Carlos Haya, Malaga, Spain
Title
Low cardiac output syndrome and renal failure in postoperative cardiac
surgery patients. Esbaga study.
Source
Intensive Care Medicine Experimental. Conference: 29th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2016. Italy. 4 (no
pagination), 2016. Date of Publication: September 2016.
Publisher
SpringerOpen
Abstract
Introduction: Low cardiac output syndrome (LCOS) is a potential
complication in patients undergoing cardiac surgery. This clinical
situation can be associated with increased morbidity (including acute
deterioration of renal function) and mortality. Objetive: Descriptive
analysis of patients undergoing cardiac surgery and has a low cardiac
output syndrome (LCOS), its relationship with renal failure and
association with mortality. Methods: Observational, prospective,
multicenter study of patients admitted to the ICU during the post-surgical
period and develops a LCOS (2012 Consensus definition). Preoperative data
(type of intervention, cardiac function, risk scores), intraoperative
variables (type of surgery, CEC, use of inotropic) and postoperative data
to hospital discharge (including complications/postoperative mortality)
are recorded. Descriptive statistics, ANOVA and Chi2 analysis, from June
2014 to June 2015. Data analyzed using SPSS-windows. Results: 14 centers
have provided 138 patients with LCOS (age 68.3 +/- 9.3 years; 65 % male)
operated mostly scheduled basis (59.4 %, 33.3 % urgency and 6.5 %
emergency) with an Euroscore of 9.99 +/- 13. Isolated myocardial
revascularization (16.8 %) or accompanied by valve surgery (24.8 %) and
aortic valve replacement (11.7 %) were the most frequent procedures. Most
relevant antecedents: AMI (31.9 %; 22 cases in the pre-intervention 90
days), severe pulmonary hypertension (21.7 %), critical preoperative state
(18.8 %), previous cardiac surgery (18.1 %), PTCA/stent (16.7 %), LVEF <
35 % (33.6 %), and NYHA III-IV (52.9 %). Prior to surgery, 21 patients
(15.4 %) requiring vasoactive drugs. 70.1 % needed two (or more)
vasoactive drugs for exit of the CPB (mean 147.4 +/- 60 min).
Postoperatively, 46.7 % of patients with LCOS (n = 63) develops acute
deterioration of renal function (39 % AKI1, 23 % AKI2 and 37.7 % AKI3).
The time to worst creatinine value was 41 +/- 46 hours. 20 % required
renal replacement technique; there is significant difference in the
cardiogenic shock (CS) group (11.4 % LCOS, 14.6 % clinical group and 36.6
% CS, p = 0.007). Analyzing by subgroup of AKI (worst recorded value in
the evolution), the AKI3 stage was associated with multiorgan failure
(MOF) (17.4 % AKI1, 28.6 % AKI2, 68.2 % AKI3, p = 0.001), total days
income (p = 0.03) and ICU mortality (16.7 % AKI1, 28.6 % AKI2 and 69.6 %
AKI3, p = 0.001). Conclusions: LCOS patients have a high incidence of
acute deterioration of renal function and need for renal replacement
technique. The AKI stadium is associated with increased development of MOF
and mortality.

<7>
Accession Number
618007461
Author
Besch G.; Perrotti A.; Puyraveau M.; Carteron L.; Baltres M.; Samain E.;
Chocron S.; Pili-Floury S.
Institution
(Besch, Carteron, Baltres, Samain, Pili-Floury) University Hospital of
Besancon, Anesthesiology and Critical Care Medicine, Besancon, France
(Besch, Perrotti, Carteron, Samain, Chocron, Pili-Floury) University of
Franche-Comte, Besancon, France
(Perrotti, Chocron) University Hospital of Besancon, Thoracic and
Cardiovascular Surgery, Besancon, France
(Puyraveau) University Hospital of Besancon, Clinical Methodology Center,
Besancon, France
Title
Safety and efficacy of intravenous exenatide in the management of stress
hyperglycemia after coronary artery graft bypass surgery: The ExSTRESS
phase II trial.
Source
Intensive Care Medicine Experimental. Conference: 29th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2016. Italy. 4 (no
pagination), 2016. Date of Publication: September 2016.
Publisher
SpringerOpen
Abstract
Introduction: Intravenous infusion of short-acting insulin remains the
gold standard treatment of stress hyperglycemia after coronary artery
graft bypass (CABG) surgery despite the risk of insulin-related
hypoglycemia. Exenatide is an agonist of the glucagon-like peptide-1
receptor that stimulates pancreatic insulin secretion and inhibits
pancreatic glucagon production. The risk of exenatide-related hypoglycemia
is theoretically null as the effect of exenatide depends on the blood
glucose level. Objectives: The aim of the ExSTRESS study was to assess the
efficacy and the safety of intravenous exenatide in the management of
stress hyperglycemia after CABG surgery. Methods: The ExSTRESS study
(NCT01969149) was a one-center randomized phase II trial. Patients
scheduled for CABG surgery between January and December, 2015 were
eligible. Non-inclusion criteria were: Insulin-requiring diabetes
mellitus, creatin-ine clearance < 60 ml/min, and a medical history of
pancreatec-tomy, acute or chronic pancreatitis. Intravenous exenatide (EXE
group) or intravenous insulin (INS group) was randomly allocated to
achieve a blood glucose target between 5.5 and 7.7 mmol/l. A validated
insulin therapy protocol was used in the INS group [1]. The primary
outcome was the percentage of patients achieving the blood glucose target
during at least half of the first 48 postoperative hours. The secondary
outcomes were: Incidence of moderate (<3.3 mmol/l) and severe (<2.2
mmol/l) hypoglycemia during the first 48 postoperative hours, and the
incidence of adverse events at Day 30. According to the study protocol
(O'Brien and Fleming plan for analysis), no statistical test was used for
in-tergroup comparison. Data are presented as mean (standard deviation) or
number of patients (percentage). Results: 54 and 52 patients were included
respectively in the EXE and in the INS groups (age: 70 (9) vs 68 (11)
years; male: 49 (91) vs 42 (81); diabetes mellitus: 12 (27) vs 11 (26);
HbA1c: 6.1 (0.7) vs 5.8 (0.6) %; Euroscore: 6.4 (2.3) vs 6.1 (2.7) %;
respectively in the EXE and in the INS groups). 39 (72) and 39 (75)
achieved the blood glucose target during at least half of the first 48
postoperative hours respectively in the EXE and in the INS groups. The
mean blood glucose value was 6.9 (0.5) mmol/l vs 6.9 (0.4) mmol/l
respectively in the EXE and in the INS groups. 0 (0) and 0 (0) patient has
presented at least one episode of severe hypoglycemia and 2 (4) vs 1 (2)
patients suffered from at least one moderate hypoglycemia respectively in
the EXE and in the INS groups. 6 (11) vs 3 (6) patients did not require
intravenous insulin respectively in the EXE and in the INS groups. No
exenatide-related adverse event has been reported at Day 30. Conclusions:
Intravenous exenatide allows a safe management of stress hyperglycemia
after CABG surgery but requires intravenous insulin rescue therapy in most
patients.

<8>
Accession Number
618008657
Author
Smith L.E.; Smith D.K.; Linton M.F.; Billings F.T.
Institution
(Smith, Billings) Dept of Anesthesiology, Vanderbilt Univ Med Cntr,
Nashville, TN, United States
(Smith) Dept of Biostatistics, Vanderbilt Univ Med Cntr, Nashville, TN,
United States
(Linton) Depts of Medicine and Pharmacology, Div of Cardiovascular
Medicine, Vanderbilt Univ Med Cntr, Nashville, TN, United States
Title
A novel association between high density lipoprotein levels and the risk
of postoperative acute kidney injury.
Source
Arteriosclerosis, Thrombosis, and Vascular Biology. Conference: American
Heart Association's Arteriosclerosis, Thrombosis and Vascular
Biology/Peripheral Vascular Disease 2016 Scientific Sessions. United
States. 36 (no pagination), 2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Acute kidney injury (AKI) after cardiac surgery occurs in up to 30% of
patients and is an independent predictor of death. HDL may attenuate
mechanisms of AKI. We hypothesized that a high preoperative HDL
cholesterol concentration is protective against postoperative AKI. We
analyzed data from a prospective, 393-subject trial of perioperative
atorvastatin to prevent post-cardiac surgery AKI. Statin-using patients
were randomized to placebo or 80mg atorvastatin the morning of surgery and
40mg on postoperative day 1. Stain-naive patients were randomized to
placebo or 80mg the day prior to surgery and 40mg daily thereafter during
hospitalization. The association between HDL level and maximum serum
creatinine change from baseline in the first 48 postoperative hours was
assessed using a two-component latent variable mixture model and AKI risk
factors. Regression analyses assessed interactions of chronic statin use,
perioperative atorvastatin treatment, and HDL level on AKI risk.
Postoperative AKI occurred in 99 patients (25.2%). Median (10, 90
percentile) preoperative HDL was 37.6 (25.0, 54.0) mg/dL and postoperative
creatinine change 0.09 (-0.11, 0.59) mg/dL. Lower HDL levels were
independently associated with increased creatinine rise (p=0.02) (Figure
1A). Regression analysis showed this association was present in
statin-using but not statin-naive patients (p=0.008) (1B). The protective
effect of high HDL in chronic statin users was enhanced with perioperative
atorvastatin treatment (p=0.004) (1C) and with increasing chronic statin
dose (p=0.003) (1D). Similar analyses using LDL found no association with
AKI risk (p=0.51). Conclusions: Higher preoperative HDL was associated
with less risk of AKI. Statin exposure modified this association.
Specifically, subjects with higher HDL levels on chronic statin therapy
had less creatinine rise and appeared to further benefit from higher
chronic statin dose and perioperative atorvastatin therapy.

<9>
Accession Number
618008512
Author
Atchison C.; Amankwah E.; Wilhelm J.; Arkilar S.; Stock A.; Branchford B.;
Takemoto C.; Streiff M.; Ayala I.; Everett A.; Stapleton G.; Jacobs M.;
Jacobs J.; Goldenberg N.
Institution
(Atchison) Pediatrics, Univ of South Florida Morsani College of Medicine,
Tampa, FL, United States
(Amankwah, Wilhelm, Arkilar, Stock, Ayala, Stapleton, Jacobs, Jacobs,
Goldenberg) Pediatrics, All Children's Hosp Johns Hopkins Medicine, St
Petersburg, FL, United States
(Branchford) Pediatrics, Univ of Colorado Children's Hosp, Aurora, CO,
United States
(Takemoto, Streiff, Everett) Pediatrics, Johns Hopkins Univ, Baltimore,
MD, United States
Title
Risk factors for hospitalassociated venous thromboembolism in
critically-ill children with cardiac disease undergoing cardiothoracic
surgery or cardiac catheter-based therapeutic intervention.
Source
Arteriosclerosis, Thrombosis, and Vascular Biology. Conference: American
Heart Association's Arteriosclerosis, Thrombosis and Vascular
Biology/Peripheral Vascular Disease 2016 Scientific Sessions. United
States. 36 (no pagination), 2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Pediatric hospital-acquired venous thromboembolism (HA-VTE)
has dramatically risen in recent years. Children with congenital or
acquired heart disease are at particular risk and have not been addressed
by recent, novel retrospectivelyderived risk scores. Aims: We sought to
develop a risk model for HA-VTE in critically-ill children with cardiac
disease. Methods: We conducted a retrospective, case-control study of
children admitted to the CVICU at All Children's Hospital Johns Hopkins
Medicine (St. Petersburg, FL, USA) from January 2006-April 2013. We
identified cases via ICD-9 codes, and employed case validation via review
of radiologic records. Two controls were randomly selected for each case.
Associations between putative risk factors and HA-VTE were estimated using
odds ratios (ORs) and ninety-five percent confidence intervals (95%CIs)
from univariate and multivariate logistic regression analyses. Variables
with P-values < 0.1 in univariate analyses were included in the
multivariate model. A HA-VTE risk score was developed with weighting based
on the relative magnitudes of the individual ORs from the multivariate
model. Results: After adjustment in a multiple logistic regression, length
of stay (LOS) >30 days, cardiac catheterization, and major infection were
found to be statisticallysignificant independent risk factors for HA-VTE
in these children. An 8-point risk score was developed in which scores of
0-1, 2-6, and 7-8 yielded HA-VTE risks of < 1%, 1-< 2%, and =2%,
corresponding to conventional thresholds for instituting no prophylaxis,
mechanical prophylaxis, and pharmacological prophylaxis (respectively) in
hospitalized adults. Conclusions: LOS >30 days, cardiac catheterization,
and major infection are significant independent risk factors for HA-VTE in
critically-ill children with cardiac disease leading to the development of
a novel HA-VTE risk score in this population. If prospectively validated,
this risk score will inform the design of risk-stratified clinical trials
of HA-VTE prevention.

<10>
Accession Number
618011889
Author
Wang B.; Hao N.; Zhang X.
Institution
(Wang, Hao) Department of Thoracic Surgery, Tianjin 4th Centre Hospital,
China
(Zhang) Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin,
China
Title
Factors influencing the psychology and quality of life in lung cancer
patients.
Source
Saudi Medical Journal. 38 (9) (pp 948-951), 2017. Date of Publication:
2017.
Publisher
Saudi Arabian Armed Forces Hospital (E-mail: smjns.ksa@zajil.net)
Abstract
Objectives: To determine the factors closely correlated with the unhealthy
psychological status of patients with lung cancer and to ascertain whether
the unhealthy psychology adversely affects their quality-of-life (QOL).
Methods: The patients newly diagnosed with lung cancer between May 2013
and December 2015 in the Department of Thoracic Surgery, Tianjin 4th
Centre Hospital, Tianjin, China were enrolled in this cross-sectional
study. The patients were asked to complete the Symptom Checklist 90
(SCL-90) and Quality of Life Questionnaire (QLQ-C30) survey. From the
responses, the correlation between the patient's psychological status and
QOL were analyzed with respect to several variables. Results: From the
total of 258 patients subjected to the test, 168 belonged to the unhealthy
psychology group and 90 to the healthy psychology group. Multiple
regression analysis revealed that significant factors related to poor QOL
among the 2 groups are gender (p=0.02), younger age (p=0.001), surgical
history (p=0.04), employment status (p=0.03), and medical insurance
(p=0.01) significantly predicted the severity of unhealthy psychology in
lung cancer patients. A significantly negative correlation was noted
between the points of SCL-90 and the general QOL in all included patients
(p=0.03). Conclusion: Gender, younger age, surgical history, employment
status, and medical insurance significantly predicted the severity of
unhealthy psychology in lung cancer patients.<br/>Copyright &#xa9; 2017
Saudi Arabian Armed Forces Hospital. All rights reserved.

<11>
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.

<12>
Accession Number
618003838
Author
Sedaghat-Hamedani F.; Kayvanpour E.; Tugrul O.F.; Lai A.; Amr A.; Haas J.;
Proctor T.; Ehlermann P.; Jensen K.; Katus H.A.; Meder B.
Institution
(Sedaghat-Hamedani, Kayvanpour, Tugrul, Lai, Amr, Haas, Ehlermann, Katus,
Meder) Institute for Cardiomyopathy, Department of Medicine III,
University of Heidelberg, INF 410, Heidelberg 69120, Germany
(Sedaghat-Hamedani, Kayvanpour, Tugrul, Amr, Haas, Katus, Meder) DZHK
(German Centre for Cardiovascular Research), Berlin, Germany
(Proctor, Jensen) Institute of Medical Biometry and Informatics,
University of Heidelberg, Heidelberg, Germany
Title
Clinical outcomes associated with sarcomere mutations in hypertrophic
cardiomyopathy: a meta-analysis on 7675 individuals.
Source
Clinical Research in Cardiology. (pp 1-12), 2017. Date of Publication: 24
Aug 2017.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: Hypertrophic cardiomyopathy (HCM) is the most common genetic
cardiovascular disease, which goes along with increased risk for sudden
cardiac death (SCD). Despite the knowledge about the different causal
genes, the relationship between individual genotypes and phenotypes is
incomplete. Methods and results: We retrieved PubMed/Medline literatures
on genotype-phenotype associations in patients with HCM and mutations in
MYBPC3, MYH7, TNNT2, and TNNI3. Altogether, 51 studies with 7675 HCM
patients were included in our meta-analysis. The average frequency of
mutations in MYBPC3 (20%) and MYH7 (14%) was higher than TNNT2 and TNNI3
(2% each). The mean age of HCM onset for MYH7 mutation positive patients
was the beginning of the fourth decade, significantly earlier than
patients without sarcomeric mutations. A high male proportion was observed
in TNNT2 (69%), MYBPC3 (62%) and mutation negative group (64%). Cardiac
conduction disease, ventricular arrhythmia and heart transplantation (HTx)
rate were higher in HCM patients with MYH7 mutations in comparison to
MYBPC3 (p < 0.05). Furthermore, SCD was significantly higher in patients
with sarcomeric mutations (p < 0.01). Conclusion: A pooled dataset and a
comprehensive genotype-phenotype analysis show that the age at disease
onset of HCM patients with MYH7 is earlier and leads to a more severe
phenotype than in patient without such mutations. Furthermore, patients
with sarcomeric mutations are more susceptible to SCD. The present study
further supports the clinical interpretation of sarcomeric mutations in
HCM patients.<br/>Copyright &#xa9; 2017 Springer-Verlag GmbH Germany

<13>
Accession Number
617992683
Author
Parlevliet K.L.; Touw H.R.W.; Beerepoot M.; Boer C.; Elbers P.W.G.;
Tuinman P.R.
Institution
(Parlevliet, Beerepoot, Elbers, Tuinman) VU University Medical Center,
Intensive Care Medicine, Amsterdam, Netherlands
(Touw, Boer) VU University Medical Center Amsterdam, Anaesthesiology,
Amsterdam, Netherlands
Title
Lung ultrasound detects pulmonary complications earlier than chest x-ray
in patients after cardiac surgery: A prospective single centre
observational study.
Source
Intensive Care Medicine Experimental. Conference: 29th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2016. Italy. 4 (no
pagination), 2016. Date of Publication: September 2016.
Publisher
SpringerOpen
Abstract
Introduction: Postoperative pulmonary complications (PPCs) are common
after cardiac surgery and especially clinically relevant PPCs (cr-PPCs)
are associated with adverse outcomes. Early detection is important as it
may lead to improved outcome (1). The accuracy of chest X-rays (CXRs) in
the detection of PPCs is limited. Lung ultrasound (LUS) is emerging as an
accurate diagnostic tool for pulmonary pathology within the intensive care
unit (ICU) (2, 3). In literature little is known about the value of LUS
for the detection of PPCs in patients after cardiac surgery. Objectives:
The primary aim of this study was to assess whether routine LUS can detect
cr-PPCs earlier than routine CXR in patients after cardiac surgery.
Methods: This is a prospective observational single centre study performed
in a tertiary ICU. 40 cardiac surgical patients were included. LUS was
performed on the same days as routine CXR; at ICU admission (day 0), day 2
and day 3 post-operative. CXR and LUS findings on day 0, 2 and 3 were
compared to cr-PPCs. Cr-PPCs were defined as PPCs requiring an
intervention by the attending ICU-physician and considered the composite
reference standard. Physicians were blinded for LUS findings. To analyse
earlier detection of cr-PPCs the Wilcoxon Signed-Rank test was used.
Detection of a cr-PPC was ranked per day and rankings between methods were
compared per patient. Results: Overall PPC (>=1) incidence was 37 (92.5 %)
for CXR and 40 (100 %) for LUS. Fifteen cr-PPCs were identified in 14
patients (35 %). Patients with a cr-PPC had a prolonged ICU stay (82 +/-
45 vs. 53 +/- 24 hours; p=0.004) and a lower
PaO<inf>2</inf>/FiO<inf>2</inf> ratio (199 +/- 56 vs. 277 +/- 97 mmHg; p =
0.010) compared to patients without cr-PPCs. CXR detected 5 (33.3 %) and
LUS detected 11 (78.6 %) cr-PPCs. These cr-PPCs were detected earlier with
LUS than CXR as presented in Table 19 (p=0.024). Conclusions: LUS detects
the more PPCs and cr-PPCs than CXR and in an earlier stage. Further
research needs to determine which specific LUS findings are associated
with the development of clinically relevant pulmonary complications.
(Table presented).

<14>
Accession Number
617992088
Author
Gordillo-Brenes A.; Fernandez-Zamora M.D.; Perez-Borrero L.; Arias-Verdu
M.D.; Aguilar-Alonso E.; Herruzo-Aviles A.; Garcia-Delgado M.;
Hinojosa-Perez R.; Curiel-Balsera E.; Rivera-Fernandez R.
Institution
(Gordillo-Brenes) Hospital Puerta Del Mar, Cadiz, Spain
(Fernandez-Zamora, Curiel-Balsera) Hospital Regional, Intensive Care,
Malaga, Spain
(Perez-Borrero, Rivera-Fernandez) Hospital Serrania, Ronda, Spain
(Arias-Verdu) Hospital Regional, Intensive Care, Malaga, Spain
(Aguilar-Alonso) Hospital Infanta Margarita, Intensive Care, Cabra, Spain
(Herruzo-Aviles, Hinojosa-Perez) Hospital Virgen Del Rocio, Intensive
Care, Sevilla, Spain
(Garcia-Delgado) Hospital Virgen De Las Nieves, Intensive Care, Granada,
Spain
Title
Preoperative use of statin and event of atrial fibrillation in cardiac
surgery. Analysis with propensity score.
Source
Intensive Care Medicine Experimental. Conference: 29th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2016. Italy. 4 (no
pagination), 2016. Date of Publication: September 2016.
Publisher
SpringerOpen
Abstract
Introduction: Statin therapy has shown conflicting data in the prevention
of the postoperative atrial fibrilation (AF) in cardiac surgery.
Objective: To analyze the relationship between preoperative use of statin
and development of AF in postoperative cardiac surgery patients according
to the type of surgery performed. Methods: A prospective multicenter study
in 11 hospitals, between 2008 to 2012, included in Spanish ARIAM database.
The patients with previous use of statins were paired with those who do
not, according to a propensity score that quantify the probability of
being treated with statins preoperatively based on demographics dates,
comorbidities, medication and preoperative diagnosis according surgery
type (valvular or coronary bypass). We analyze differences in the
postoperative incidence of AF in both groups. Results: Cohort of 7276
patients, Mean age 63.91 +/- 12.45 years. 85.9 % was elective surgery.
EuroSCORE 5.86 +/- 3.14 points. ICU mortality was 7.6 %. Prior to surgery,
51.5 % and 25.8 % taking statins present a history of AF. 21.9 %
postoperative AF episode presented. The patients treated before surgery
with statins had AF 19.8 % vs 22.5 % (P =0.006). We pair a group of 1528
patients with statins with other similar group that do not take, based on
an propensity score . The frequency of AF was 20.4 % in treated and 24.9 %
in untreated (p = 0.003), OR: 0.772 (0.652-0.916). In coronary bypass
surgery (n = 1649), AF occurs in 17.2 % of 331 patients that not taking
statins and 14 % of 1318 patients with previous statins treatment (p
=0.141). We calculated a specific propensity score and matching was
performed; 276 patients without statins occurred AF in 17.4 % and other
276 patients with statins in 13.8 % (p = 0.241), OR: 0.76 (0.48-1.21). In
valvular surgery (n = 6245), AF occurs in 24.4 % of 2475 patients with
statins and 22.9 % of 1790 without statins (p = 0.256). After propensity
score calculation, matching is performed; in 842 patients with statins ,
the AF appears in 27.7 % and in 842 patients without statins 22.8 % (p =
0.021), OR: 0.772 (0.62 -0.96). Conclusions: Preoperative statin use was
associated with a lower risk of atrial fibrillation after cardiac surgery,
observed in valve surgery (significant differences) and bypass (although
significant differences by possible under sample number).

<15>
Accession Number
617991595
Author
Zwaag J.; Beunders R.; Pickkers P.; Kox M.
Institution
(Zwaag, Beunders, Pickkers, Kox) Radboud University Medical Center,
Intensive Care Research, Nijmegen, Netherlands
Title
Remote ischemic preconditioning does not influence the innate immune
response during human endotoxemia.
Source
Intensive Care Medicine Experimental. Conference: 29th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2016. Italy. 4 (no
pagination), 2016. Date of Publication: September 2016.
Publisher
SpringerOpen
Abstract
Introduction: Using a tourniquet to temporary cut off blood supply to the
arm (Remote Ischemic Preconditioning - RIPC) has been shown to result in
myocardial protection and reduced incidence of AKI in patients undergoing
cardiac surgery. However, a recently performed large multi-center trial in
CABG patients showed no beneficial effects on clinically relevant
endpoints [1]. Animal studies have shown an 'early window of protection'
in the 1-2 hours after RIPC as well as a 'late window of protection' 12-24
hours after RIPC. Several mechanisms have been suggested to mediate the
protective effects of RIPC, of which attenuation of the immune response is
an important candidate, although this has hitherto also only been shown in
animal studies [2]. Objectives: To determine the effect of single and
repeated RIPC, thereby investigating both the early and late windows of
protection, on the inflammatory response during endotoxemia, a
standardized, controlled model of systemic inflammation in humans in vivo.
Methods: We performed a randomized controlled study in 30 healthy
non-smoking male volunteers. Subjects were assigned to either the
single-dose RIPC group, multiple-dose RIPC group, or the control group (n
= 10 per group). The single-dose RIPC group received 1 dose of RIPC,
consisting of 4 cycles of 5-minute ischemia of the arm followed by 5
minutes of reperfusion just before administration of 2 ng/kg
lipopolysaccharide (LPS). The multiple-dose RIPC group received one dose
of RIPC per day on the 6 days before the endotoxemia experiment day, and 1
dose just before LPS administration. Results: LPS administration resulted
in a typical increase in body temperature, flu-like symptoms, and
hemodynamic changes, with no differences between groups. Administration of
LPS resulted in a sharp increase in plasma levels of the proinflammatory
cytokines TNF-alpha, IL-6, and IL-8 as well as the antiinflammatory
cytokine IL-10. No differences in plasma levels of these cytokines were
observed between the different groups (Figure 39). Conclusions: In the
present study, we demonstrate that RIPC does not affect the in vivo
inflammatory response induced by administration of endotoxin in humans.
These results implicate that RIPC does not exert direct anti-inflammatory
effects and that the previously observed protective effects are mediated
through other mechanisms. Furthermore, the absence of immunomodulatory
effects of RIPC in the present study tempers expectations of using RIPC as
an immunomodulatory treatment strategy in patients. (Figure presented).

<16>
Accession Number
617991196
Author
Delgado-Amaya M.; Curiel-Balsera E.; Rivera-Romero L.; Castillo-Lorente
E.; Carrero-Gomez F.; Aguayo-DeHoyos E.
Institution
(Delgado-Amaya, Curiel-Balsera, Rivera-Romero) Hospital Regional Malaga,
Malaga, Spain
(Castillo-Lorente) Complejo Hospitalario De Jaen, Jaen, Spain
(Carrero-Gomez) Hospital Puerta Del Mar, Cadiz, Spain
(Aguayo-DeHoyos) Hospital Virgen De Las Nieves, Granada, Spain
Title
Effects of preoperative conditions on health-related quality of life after
cardiac surgery.
Source
Intensive Care Medicine Experimental. Conference: 29th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2016. Italy. 4 (no
pagination), 2016. Date of Publication: September 2016.
Publisher
SpringerOpen
Abstract
Introduction: Factors influencing the postoperative health-related quality
of life (HRQOL) after cardiac surgery have not been well described yet,
mainly in the older people. Objectives: To study the relationship between
preoperative conditions, type of surgery and the HRQOL in a cohort of 4430
patients, recluted at 11andalusian hospitals. Methods: Observational,
prospective and multicenter study of patients included in the ARIAM
registry of adult cardiac surgery. We analized clinical variables, surgery
data, outcomes and scores (SAPS3 and EuroSCORE). We have interviewed 1382
patients with the SF-36 questionnaire during the follow up (medium 1291+/-
166 days). Results: Medium age was 63,73 years (SD 12,69), 61,2 % were
male. Medium weight was 76,6 kg (SD 14,21). BMI was 28,4 (SD 4,7). 20.4 %
were over 75 years old at the moment of the surgery. Figure 86 shows
previous cardiac clinical history Figure 87 shows other relevant
comorbidities. It was first surgery in 90.5 % of the patients. 68,7 % of
the cases were valvular surgery (with or without CABG); 21,4 % were
isolated CABG; 5,1 % thoracic aortic surgery; 5,4 % were other surgeries
(congenital disease surgery, post AMI complications, pericardiectomy).
Tables 61 and 62 summarizes the results of the application of SF-36
questionnaire in the 1382 patients interviewed in the follow up In the
comparative analysis we found worse QOL in women than men (p = 0,0001),
and a negative correlation between age and QOL (p = 0,0001). Women in our
study were significantly older than men (p = 0,0001). We found no
differences between the type of surgery and the postoperative QOL, or
between surgery or extracorporeal circulation duration and QOL. There was
a relationship between NYHA degree during the follow up and the SF 36
Health score Prognostic scores showed an inverse relationship with QOL,
but with a low correlation; Pearson coefficient -0,22 (Euroscore), -0,28
(SAPS 3). Conclusions: In our study, involving 11 hospitals in Andalusia
(South Spain), 71,5 % of cardiac surgery patients didn't show any activity
limitation or only a slight limitation before 3 years of follow up.
Perceived quality of life decreases as age increases or worsens the
functional status of the patients. (Table Presented).

<17>
Accession Number
617991120
Author
Chernyshuk S.; Yemets H.; Zhovnir V.
Institution
(Chernyshuk, Yemets, Zhovnir) UCCC, ICU, Kyiv, Ukraine
Title
Comparison of postoperative sedation and analgesia of neonates in cardiac
surgery: Dexmedetomidine vs standard regimen.
Source
Intensive Care Medicine Experimental. Conference: 29th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2016. Italy. 4 (no
pagination), 2016. Date of Publication: September 2016.
Publisher
SpringerOpen
Abstract
Introduction: Sedation and analgesia are important components of
postoperative management of neonates who underwent cardiac surgery.
Excessive or inadequate sedation may have a significant adverse effect on
patient outcome. Objectives. We aimed to determine which drug regimen
would be most effective with less side-effect and better outcome. Methods:
From March 2012 till March 2014 we conducted a randomized controlled
prospective study in 60 neonates with congenital heart disease who
underwent Arterial Switch Operation in our clinic. Inclusion criteria: 1)
gestational age more than 36 weeks, 2) birth weight over 2500 g, 3) age -
up to 28 days, 4) absence of concomitant diseases and surgical
complications. Patients were randomized into 2 cohorts: 30 patients (50 %)
were given infusion of dexmedetomidine with morphine boluses (study group)
and 30 patients (50 %) were randomized to the standard regimen - infusion
of morphine with diazepam boluses (control group). Results: In both groups
there were no differences in pre- and intraoperative indexes, duration of
mechanical ventilation, sympathomimetic support, and time of infusion of
dexmedetomidine/ morphine. In study group time of ICU stay - 93.5 h - was
significantly shorter than in control group -120 h (p-0.02). Onset of
peristalsis and start of feeding in study group was earlier than in
control group - 1- st vs 2-d day (p- 0.007) and 2-d vs 2.5-day (p-0.035),
respectively. In the control group there were more patients who had
complicated feeding (start after 3-d day, bloating or vomiting) - 11(37 %)
vs 3(10 %) in the study group. We did not observe any decrease of mean
blood pressure and heart rate in the study group as it could be expected.
Conclusion: Use of dexmedetomidine with morphine hydrochloride boluses for
postoperative sedation and analgesia is effective and facilitates feeding
process in neonates, leads to earlier onset of peristalsis and start of
feeding, decreasing ICU stay.

<18>
Accession Number
617068216
Author
Udesh R.; Natarajan P.; Jeevanantham V.; Gleason T.G.; Badhwar V.;
Thirumala P.D.
Institution
(Udesh, Natarajan, Thirumala) Department of Neurological Surgery,
University of Pittsburgh School of Medicine, Center for Clinical
Neurophysiology, Presbyterian-Suite B-400 200 Lothrop Street, Pittsburgh,
PA 15213, United States
(Gleason) Department of Cardiothoracic Surgery, University of Pittsburgh
Medical Center, Pittsburgh, PA, United States
(Jeevanantham) Saint Anthony Hospital, Oklahoma City, OK, United States
(Badhwar) Division of Cardiothoracic Surgery, West Virginia University,
Morgantown, WV, United States
Title
Perioperative strokes following surgical correction of mitral valves: A
systematic review and meta-analysis.
Source
European Neurology. 78 (1-2) (pp 63-70), 2017. Date of Publication: 01 Aug
2017.
Publisher
S. Karger AG
Abstract
Objective: The primary aim of this meta-analysis was to quantify the
impact of perioperative strokes on stroke-related mortality after open
mitral valve (MV) procedures were performed. Methods: An electronic search
of the PubMed, Embase, and the Web of Science databases was performed to
retrieve articles published up to December 2015, relevant to patients
undergoing MV procedures. Data were extracted from the final list of 25
studies to calculate a summary OR for 30-day stroke-related mortality.
Results: The stroke rate in the total sample population was 1.62%
(73/4,498). The 30-day all-cause mortality rate was 3.51% (158/4,498). The
percentage of total deaths caused by stroke was 6.87%. The summary OR of
stroke-related mortality following MV procedures was estimated to be 7.22
(95% CI 4.13-12.63, p < 0.0001). A subgroup analysis was done for studies
involving concomitant MV surgery and coronary artery bypass grafting. The
summary estimate of the subgroup showed an OR of 8.508 (95% CI
1.552-46.622, p = 0.0136). Conclusion: Perioperative strokes following
open MV procedures may be associated with more than 7 times greater odds
of 30-day stroke-related mortality. They appear to be more commonly
occurring than what is reported by current literature, making further
studies investigating possible mechanisms and preventive measures a
priority.<br/>Copyright &#xa9; 2017 S. Karger AG, Basel.

<19>
Accession Number
617956058
Author
Elmaraezy A.; Ismail A.; Abushouk A.I.; Eltoomy M.; Saad S.; Negida A.;
Abdelaty O.M.; Abdallah A.R.; Aboelfotoh A.M.; Hassan H.M.; Elmaraezy
A.G.; Morsi M.; Althaher F.; Althaher M.; AlSafadi A.M.
Institution
(Elmaraezy, Ismail) Al-Azhar University, Faculty of Medicine, Cairo, Egypt
(Elmaraezy, Ismail, Abushouk) NovaMed Medical Research Association, Cairo,
Egypt
(Abushouk) Ain Shams University, Faculty of Medicine, Cairo, Egypt
(Eltoomy) University of Sadat City, Genetic Engineering and Biotechnology
Research Institute (GEBRI), Sadat City, Egypt
(Saad) Tanta University, Faculty of Medicine, Tanta, Egypt
(Negida) Zagazig University, Faculty of Medicine, Zagazig, Egypt
(Abdelaty) Ahmed Maher Teaching Hospital, Cairo, Egypt
(Abdallah, Aboelfotoh) Benha University, Faculty of Medicine, Benha, Egypt
(Hassan) Beni Suef University, Faculty of Medicine, Beni suef, Egypt
(Elmaraezy, Morsi) Minoufia University, Faculty of Medicine, Shebin
El-Kom, Egypt
(Althaher, Althaher) Misr University for science and technology (MUST),
6th of October City, Faculty of Medicine, Giza, Egypt
(AlSafadi) Damascus University, Faculty of Medicine, Damascus, Syrian Arab
Republic
Title
Efficacy and safety of transcatheter aortic valve replacement in aortic
stenosis patients at low to moderate surgical risk: A comprehensive
meta-analysis.
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 234. Date of Publication: 24 Aug 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Recently, transcatheter aortic valve replacement (TAVR) has
become the procedure of choice in high surgical risk patients with aortic
stenosis (AS). However, its value is still debated in operable AS cases.
We performed this meta-analysis to compare the safety and efficacy of TAVR
to surgical aortic valve replacement (SAVR) in low-to-moderate surgical
risk patients with AS. Methods: A systematic search of five authentic
databases retrieved 11 eligible studies (20,056 patients). Relevant Data
were pooled as risk ratios (RRs) or standardized mean differences (SMD),
with their 95% confidence interval, using Comprehensive Meta-Analysis and
RevMan software for windows. Results: At one-year of follow-up, the pooled
effect-estimates showed no significant difference between TAVR and SAVR
groups in terms of all-cause mortality (RR 1.02, 95% CI [0.83, 1.26],
stroke (RR 0.83, 95%CI [0.56, 1.21]), myocardial infarction (RR 0.82, 95%
CI [0.57, 1.19]), and length of hospital stay (SMD -0.04, 95% CI [-0.34,
0.26]). The incidence of major bleeding (RR 0.45, 95% CI [0.24, 0.86]) and
acute kidney injury (RR 0.52, 95% CI [0.30, 0.88]) was significantly lower
in the TAVR group, compared to the SAVR group. However, TAVR was
associated with a higher risk of permanent pacemaker implantation (RR
2.57, 95% CI [1.36, 4.86]), vascular-access complications at 1 year (RR
1.99, 95%CI [1.04, 3.80]), and paravalvular aortic regurgitation at 30
days (RR 3.90, 95% CI [1.25, 12.12]), compared to SAVR. Conclusions: Due
to the comparable mortality rates in SAVR and TAVR groups and the lower
risk of life-threatening complications in the TAVR group, TAVR can be an
acceptable alternative to SAVR in low-to-moderate risk patients with AS.
However, larger trials with longer follow-up periods are required to
compare the long-term outcomes of both techniques.<br/>Copyright &#xa9;
2017 The Author(s).

<20>
Accession Number
618001156
Author
Japaridze L.; Sadunishvili M.
Institution
(Japaridze, Sadunishvili) Amtel Hospital First Clinical, Centre of
Vascular and Heart Diseases, Tbilisi State Medical University, Chapidze
Heart Centre, Chachava str.#1, Tbilisi 0159, Georgia
Title
The short-term effect of atorvastatin plus ezetimibe therapy versus
atorvastatin monotherapy on clinical outcome in acute coronary syndrome
patients by gender.
Source
Kardiologia Polska. 75 (8) (pp 770-778), 2017. Date of Publication: 18 Aug
2017.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland)
Abstract
Background: Atorvastatin reduces low-density lipoprotein cholesterol
(LDL-C) levels and the risk of cardiovascular events, but whether the
addition of ezetimibe (EZE), a non-statin drug that reduces intestinal
cholesterol absorption, can reduce the rate of cardiovascular events
further, and if there any sex differences, is not known. Aim: To evaluate
the effects of atorvastatin and EZE combination in acute coronary syndrome
(ACS) patients on the incidence of composite endpoint in short-term
follow-up and to assess differences according their gender. Methods: We
conducted a 16-week, single-centre, prospective, randomised, open-label
clinical trial involving 323 patients who had been hospitalised for an ACS
within the preceding 14 days. They received atorvastatin 20 mg for 28
days, and after that 292 patients who had LDL-C levels >= 1.81 mmol/L were
randomised to EZE 10 mg/day co-administered with atorvastatin therapy (EZE
+ statin) or double their current atorvastatin dose. The primary endpoint
was a composite of cardiovascular death, nonfatal myocardial infarction,
unstable angina requiring rehospitalisation, coronary revascularisation
(>= 30 days after randomisation), or nonfatal stroke. Results: The
Kaplan-Meier event-free survival rate at 16 weeks was 88.1% in the EZE +
statin group patients and 77.0% in the atorvastatin monotherapy group
(absolute risk reduction: 11.1 percentage points; hazard ratio: 2.099; 95%
confidence interval: 1.165-3.781; p = 0.014). The log rank test indicated
that there was not a statistically significant difference between male and
female survival rates in both treatment groups (p = 0.897). Conclusions:
The results of our study demonstrated that when added to statin therapy,
EZE resulted in improved cardiovascular outcomes, and the response to
atorvastatin and EZE combination was similar for both men and
women.<br/>Copyright &#xa9; Polskie Towarzystwo Kardiologiczne 2017.

<21>
Accession Number
618000006
Author
Banerjee K.; Poddar K.; Mick S.; White J.; Krishnaswamy A.; Johnston D.;
Rodriguez L.; Tuzcu E.M.; Kapadia S.
Institution
(Banerjee, Poddar, Mick, White, Krishnaswamy, Johnston, Rodriguez, Tuzcu,
Kapadia) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, Ohio
Title
Meta-Analysis of Usefulness of Anticoagulation After 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
Since the advent of bioprosthetic valves, the implications of long-term
anticoagulation after valve replacement are unclear. There are very little
data on outcomes of long-term anticoagulation after transcatheter aortic
valve implantation (TAVI). Our aim was to conduct a systematic review of
literature regarding anticoagulation after TAVI. The existing literature
on anticoagulation after bioprosthetic valve replacement was thoroughly
reviewed, including the most recent American College of
Cardiology/American Heart Association 2017 guidelines for management of
valvular disease, which is based on sparse, nonrandomized retrospective
data. A systematic review of MEDLINE, EMBASE, and Cochrane CENTRAL
databases was conducted to retrieve articles reporting outcomes on
anticoagulation after TAVI, and 5 articles were retrieved. Pooled analysis
revealed lower bleeding rates in the anticoagulated group (22% vs 35%, p =
0.006). Stroke and mortality were inconsistently reported by the studies.
The data regarding outcomes of patients on anticoagulation after TAVI are
sparse. Systematic collection of anticoagulation data in the existing
registries and future trials should be strongly considered in patients
undergoing TAVI.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<22>
Accession Number
617996659
Author
Leal R.T.; Monteiro G.C.; da Silva Menezes Junior A.
Institution
(Leal, Monteiro, da Silva Menezes Junior) Pontificia Universidade Catolica
de Goias, Escola de Ciencias Medicas, Farmaceuticas e Biomedicas, Avenida
Universitaria 1440, Goiania, Goias, Brazil
Title
Catheter ablation in the treatment of electrical storm: Integrative
review.
Source
Indian Pacing and Electrophysiology Journal. (no pagination), 2017. Date
of Publication: 2017.
Publisher
Indian Pacing and Electrophysiology Group (Pulikkottil Thondayad, Calicut
Kerala 673017, India)
Abstract
Background: The incidence of electrical storm (ES) has been increasing
with the rise of the indicated uses of implantable cardioverter
defibrillators (ICDs). It is estimated that 20% of patients will evolve to
have this complication. Ablative therapy stands out as the treatment for
this condition when it is refractory to antiarrhythmic treatment. The
objective was to define the current role of catheter ablation in the
treatment of electrical storm. Methods: An integrative literature review
was performed using the PubMed and BVS databases. All identified articles
were screened and verified for eligibility by the authors. Results:
Twenty-five out of the initial 951 articles were used in the final
analysis. The categories listed for analysis included indication for
ablation in ES, modality of the approach, therapeutic success,
complications related to the procedure, mortality and cardiovascular
follow-up and alternative therapeutic modalities by frequency of these
categories in the articles researched. Conclusion: Catheter ablation is
the initial therapy for patients with ischemic cardiomyopathy (ICM) and
ES. The endocardial approach presents more relevant success rates than the
other therapeutic methods presented.<br/>Copyright &#xa9; 2017 Indian
Heart Rhythm Society.

<23>
Accession Number
614488845
Author
Friedland-Little J.M.; Uzark K.; Yu S.; Lowery R.; Aiyagari R.;
Hirsch-Romano J.C.
Institution
(Friedland-Little) Division of Pediatric Cardiology, University of
Washington School of Medicine, Seattle Children's Hospital, Seattle,
Washington, United States
(Uzark, Yu, Lowery, Aiyagari, Hirsch-Romano) Division of Pediatric
Cardiology, Department of Pediatrics and Communicable Disease, University
of Michigan, Ann Arbor, Michigan, United States
(Hirsch-Romano) Section of Pediatric Cardiac Surgery, Department of
Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, United
States
Title
Functional Status and Quality of Life in Survivors of Extracorporeal
Membrane Oxygenation After the Norwood Operation.
Source
Annals of Thoracic Surgery. 103 (6) (pp 1950-1955), 2017. Date of
Publication: June 2017.
Publisher
Elsevier USA
Abstract
Background Infants who require extracorporeal membrane oxygenation (ECMO)
support after a Norwood operation are at increased risk for early and late
death compared with patients who do not require ECMO post-Norwood. Little
is known about the effect that ECMO post-Norwood has on functional status
and quality of life among long-term survivors. Methods We prospectively
evaluated functional status and health-related quality of life in 12
surviving patients (cases) and 19 corresponding patients (controls) from a
previous retrospective case-control assessment of long-term survival in
patients requiring ECMO post-Norwood. Functional status was assessed with
the Vineland Adaptive Behavior Scale-II, and health-related quality of
life was assessed with the Pediatric Quality of Life Inventory (PedsQL)
core and cardiac modules. Results There were no differences in
demographics, extracardiac or genetic anomalies, or age at follow-up
assessment between ECMO cases and non-ECMO controls. The Vineland Adaptive
Behavior Scale-II scores were comparable between groups, with both groups
demonstrating function in the normal range in all four domains tested. The
only difference in PedsQL scores between cases and controls was perceived
physical appearance, which was lower among ECMO survivors by both patient
and proxy report. PedsQL scores of both groups were comparable to
published scores for patients with single-ventricle congenital heart
disease but generally lower than scores for the healthy population.
Conclusions The requirement for ECMO support after a Norwood operation
does not appear to significantly affect functional status or quality of
life among the subset of patients who achieve long-term
survival.<br/>Copyright &#xa9; 2017 The Society of Thoracic Surgeons

<24>
Accession Number
611320802
Author
Deng H.-Y.; Zhu Z.-J.; Wang Y.-C.; Wang W.-P.; Ni P.-Z.; Chen L.-Q.
Institution
(Deng, Wang, Wang, Ni, Chen) Department of Thoracic Surgery, West China
Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan
610041, China
(Zhu) Department of Thoracic Surgery, Gansu Provincial Hospital, Gansu,
China
Title
Non-intubated video-assisted thoracoscopic surgery under loco-regional
anaesthesia for thoracic surgery: A meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (1) (pp 31-40), 2016.
Date of Publication: 01 Jul 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES The short-term feasibility and safety of non-intubated
video-assisted thoracoscopic surgery under loco-regional anaesthesia for
thoracic surgery remains unknown. Therefore, we conducted a meta-analysis
to provide evidence for the short-term efficacy and safety profile of
non-intubated video-assisted thoracoscopic surgery under loco-regional
anaesthesia for thoracic surgery. METHODS We performed a systematic
literature search in PubMed, Embase, Cochrane Library databases and Google
Scholar, as well as American Society of Clinical Oncology to identify
relevant studies comparing non-intubated video-assisted thoracoscopic
surgery under loco-regional anaesthesia with conventionally intubated
video-assisted thoracoscopic surgery under general anaesthesia, dated up
to 31 August 2015. Data concerning global in-operating room time, hospital
stays, rate of postoperative complications and perioperative mortality
were extracted and analysed. We conducted a meta-analysis of the overall
results and two subgroup analyses based on study design (a meta-analysis
of randomized controlled trials and a second meta-analysis of
observational studies). RESULTS Four randomized controlled trials and six
observational studies with a total of 1283 patients were included. We
found that in the overall analysis, patients treated with non-intubated
video-assisted thoracoscopic surgery under loco-regional anaesthesia
achieved significantly shorter global in-operating room time [weighted
mean difference = -41.96; 95% confidence interval (CI) = (-57.26, -26.67);
P < 0.001] and hospital stays [weighted mean difference = -1.24; 95% CI =
(-1.46, -1.02); P < 0.001] as well as a lower rate of postoperative
complications [relative risk = 0.55; 95% CI = (0.40, 0.74); P < 0.001]
than patients treated with intubated video-assisted thoracoscopic surgery
under general anaesthesia. Subgroup meta-analyses based on study design
achieved the same outcomes as overall analysis. In our meta-analysis, no
perioperative mortality was observed in patients treated with
non-intubated video-assisted thoracoscopic surgery under loco-regional
anaesthesia. CONCLUSIONS Non-intubated video-assisted thoracoscopic
surgery under loco-regional anaesthesia for thoracic surgery proved to be
feasible and safe. Future multicentre and well-designed randomized
controlled trials with longer follow-up are needed to confirm and update
the findings of our study, as well as the long-term efficacy of
non-intubated video-assisted thoracoscopic surgery under loco-regional
anaesthesia.<br/>Copyright &#xa9; 2016 The Author 2016. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<25>
Accession Number
613014869
Author
Thyregod H.G.H.; Steinbruchel D.A.; Ihlemann N.; Ngo T.A.; Nissen H.;
Kjeldsen B.J.; Chang Y.; Hansen P.B.; Olsen P.S.; Sondergaard L.
Institution
(Thyregod, Steinbruchel, Olsen) Department of Cardiothoracic Surgery, The
Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
(Ihlemann, Ngo, Sondergaard) Department of Cardiology, The Heart Centre,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Nissen) Department of Cardiology, Odense University Hospital, Odense,
Denmark
(Kjeldsen) Department of Cardiothoracic and Vascular Surgery, Odense
University Hospital, Odense, Denmark
(Chang) Medtronic Inc., Mounds View, MN, United States
(Hansen) Department of Cardiac Anesthesia, The Heart Centre,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
Title
No clinical effect of prosthesis-patient mismatch after transcatheter
versus surgical aortic valve replacement in intermediate- and low-risk
patients with severe aortic valve stenosis at mid-term follow-up: An
analysis from the NOTION trial.
Source
European Journal of Cardio-thoracic Surgery. 50 (4) (pp 721-728), 2016.
Date of Publication: 01 Oct 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Prosthesis-patient mismatch (PPM) after surgical aortic valve
replacement (SAVR) for severe aortic valve stenosis (AVS) is common, but
less common after transcatheter aortic valve replacement (TAVR) in
patients considered at high risk for death after surgery. The objectives
of this study were to determine incidence and clinical effect of PPM after
SAVR and TAVR in a primarily low-risk patient group. METHODS: Patients 70
years or older with severe isolated AVS, regardless of predicted operative
mortality risk, were consecutively randomized 1:1 to TAVR using a
self-expandable bioprosthesis (n = 145) or SAVR (n = 135). Post-procedure
PPM was graded after 3 months as follows: Not present-mild, if indexed
effective orifice area (iEOA) >0.85 cm²/m²,
moderate, if 0.65 cm²/m² < iEOA >= 0.85
cm²/m² and severe, if iEOA >=0.65
cm²/m². Outcomes were major adverse cardiac and
cerebrovascular events (MACCE, e.g. composite rate of all-cause death,
stroke, myocardial infarction or valve reintervention), cardiac-related
hospitalizations and New York Heart Association (NYHA) functional class
after 2 years. RESULTS: The incidence and the severity of PPM were
significantly lower after TAVR compared with SAVR (severe, moderate,
none-mild 14.0, 35.5, 50.4 vs 33.9, 36.7, 29.4%; P<0.001). PPM resulted in
similar higher mean valve gradients at 3 months for both groups. Baseline
characteristics related to severe PPM were younger age, absence of
diabetes mellitus, lower mortality-risk score for TAVR, and younger age
and higher body mass index for SAVR. At 2 years, there were numerical but
no statistically significant differences between both TAVR and SAVR
patients with severe and no severe PPM for MACCE (0.0 vs 12.8% for TAVR; P
= 0.13, and 13.5 vs 7.0% for SAVR; P = 0.27), number of cardiac-related
hospitalizations (mean +/- standard deviation 0.4 +/- 0.6 vs 0.6 +/- 0.8;
P = 0.23, and 0.4 +/- 0.8 vs 0.5 +/- 0.9; P = 0.70) and NYHA functional
class (Class I/II/III/IV: 64.7/29.4/5.9/0.0 vs 62.1/34.7/3.2/0.0%,
respectively; P = 0.91, and 71.4/25.7/2.9/0.0 vs 72.9/22.9/4.3/0.0%,
respectively; P = 0.92). CONCLUSIONS: The incidence of PPM was lower and
less severe after TAVR compared with SAVR in intermediate- and low-risk
patients with severe AVS. There were no significant differences in MACCE,
cardiac-related hospitalizations or NYHA class after 2 years for patients
with versus those without severe PPM.<br/>Copyright &#xa9; The Author
2016. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<26>
Accession Number
613014868
Author
Borger M.A.; Dohmen P.M.; Knosalla C.; Hammerschmidt R.; Merk D.R.;
Richter M.; Doenst T.; Conradi L.; Treede H.; Moustafine V.; Holzhey D.M.;
Duhay F.; Strauch J.
Institution
(Borger) Columbia University Medical Center, New York, NY, United States
(Dohmen, Merk, Holzhey) Leipzig Heart Center, Leipzig, Germany
(Knosalla, Hammerschmidt) German Heart Institute Berlin, Berlin, Germany
(Richter, Doenst) Jena University Hospital, Jena, Germany
(Conradi, Treede) University Medical Center Hamburg-Eppendorf, Hamburg,
Germany
(Moustafine, Strauch) University Hospitals of the Ruhr University of
Bochum, Bochum, Germany
(Duhay) Edwards Lifesciences LLC, Irvine, CA, United States
Title
Haemodynamic benefits of rapid deployment aortic valve replacement via a
minimally invasive approach: 1-year results of a prospective multicentre
randomized controlled trial.
Source
European Journal of Cardio-thoracic Surgery. 50 (4) (pp 713-720), 2016.
Date of Publication: 01 Oct 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Aortic valve replacement (AVR) via minimally invasive surgery
(MIS) may provide clinical benefits in patients with aortic valve disease.
A new class of bioprosthetic valves that enable rapid deployment AVR
(RDAVR) may facilitate MIS. We here report the 1-year results of a
randomized, multicentre trial comparing the outcomes for MIS-RDAVR with
those for conventional AVR via full sternotomy (FS) with a commercially
available stented aortic bioprosthesis. METHODS: A total of 100 patients
with aortic stenosis were enrolled in a prospective, multicentre,
randomized comparison trial (CADENCE-MIS). Key exclusion criteria included
AVR requiring concomitant procedures, ejection fraction of <25% and recent
myocardial infarction or stroke. Patients were randomized to undergo
MIS-RDAVR via upper hemisternotomy (EDWARDS INTUITY) or AVR via FS with a
commercially available stented valve. Procedural, early and late clinical
outcomes were assessed for both groups. Haemodynamic performance was
evaluated by an echocardiography CoreLaboratory. RESULTS: Technical
success was achieved in 94% of MIS-RDAVR patients. MIS-RDAVR was
associated with significantly reduced cross-clamp times compared with FS
(41.3 +/- 20.3 vs 54.0 +/- 20.3 min, P < 0.001). Clinical and functional
outcomes were similar at 30 days and 1 year postoperatively for both
groups. While both groups received a similarly sized implanted valve (22.9
+/- 2.1 mm MIS-RDAVR vs 23.0 +/- 2.1 mm FS-AVR; P = 0.91), MIS-RDAVR
patients had significantly lower peak gradients 1 year postoperatively
(16.9 +/- 5.3 vs 21.9 +/- 8.6 mmHg; P = 0.033) and a trend towards lower
mean gradients (9.1 +/- 2.9 vs 11.5 +/- 4.3 mmHg; P = 0.082). In addition,
MIS-RDAVR patients had a significantly larger effective orifice area 1
year postoperatively (1.9 +/- 0.5 vs 1.7 +/- 0.4 cm2; P = 0.047).
Paravalvular leaks, however, were significantly more common in the
MIS-RDAVR group (P = 0.027). CONCLUSIONS: MIS-RDAVR is associated with a
significantly reduced cross-clamp time and better valvular haemodynamic
function than FS-AVR. However, paravalvular leak rates are higher with
MIS-RDAVR.<br/>Copyright &#xa9; The Author 2016. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<27>
Accession Number
613014857
Author
Umminger J.; Krueger H.; Beckmann E.; Kaufeld T.; Fleissner F.; Haverich
A.; Shrestha M.; Martens A.
Institution
(Umminger, Krueger, Beckmann, Kaufeld, Fleissner, Haverich, Shrestha,
Martens) Clinic for Cardiothoracic, Transplantation and Vascular Surgery,
Hannover Medical School, Hannover, Germany
Title
Management of early graft infections in the ascending aorta and aortic
arch: A comparison between graft replacement and graft preservation
techniques.
Source
European Journal of Cardio-thoracic Surgery. 50 (4) (pp 660-667), 2016.
Date of Publication: 01 Oct 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Treatment of infected thoracic aortic grafts is associated
with considerable morbidity and mortality. The replacement of an infected
graft is an effective strategy, yet a complex surgical endeavour,
especially if the aortic root or aortic arch is involved. In situ
graft-sparing surgical therapy with continuous mediastinal irrigation
after surgical debridement might offer an alternative in the management of
early graft infections in the thoracic aorta. METHODS: Between 1996 and
August 2015, 25 patients were treated in our institution for early graft
infection after thoracic aortic surgery via sternotomy. In 11 patients,
the infected prosthesis was replaced by a cryopreserved homograft or a
biological valved pericardial xenograft. In 14 patients, an attempt to
salvage the graft was made by resternotomy, aggressive debridement and
subsequent continuous mediastinal antibiotic irrigation over a course of 2
weeks, accompanied by systemic antibiotic therapy. RESULTS: In-hospital
mortality was comparable (replacement group: 2/11 = 18%, graft-sparing
group: 2/14 = 14%, P = ns). The time interval from the initial surgery was
significantly shorter in the graft-sparing group (replacement group: 165
days [range 95-300 days] and graft-sparing group: 24 days [range 15-93
days], P = 0.004]. Two patients (14%), who were treated with the
graft-sparing approach >100 days after the initial surgery, were retreated
for infection, and 1 due to an intra-aortic infection of an aortic arch
hybrid stent graft was not amenable to external irrigation (median
follow-up: 1.5 years [range 1.1-2.1 years]). One patient in the
replacement group (9%) was reoperated on due to homograft degeneration
(median follow-up: 6.0 years [3.0-8.9 years]). CONCLUSIONS: In situ
graft-sparing surgical therapy is safe and effective if diagnosis and
treatment of aortic graft infection is initiated promptly and aggressively
(ideally <1 month post-surgery). Our method produces good midterm results
(3 years). For aortic graft infections that become clinically apparent
>3-6 months after surgery, replacement of grafts with biological conduits
(homografts or pericardial xenografts) most likely remains the best
treatment option.<br/>Copyright &#xa9; The Author 2016. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<28>
Accession Number
613014842
Author
Huygens S.A.; Mokhles M.M.; Hanif M.; Bekkers J.A.; Bogers A.J.J.C.;
Rutten-van Molken M.P.M.H.; Takkenberg J.J.M.
Institution
(Huygens, Mokhles, Hanif, Bekkers, Bogers, Takkenberg) Department of
Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam,
Netherlands
(Huygens, Rutten-van Molken) Institute for Medical Technology Assessment,
Erasmus University, Rotterdam, Netherlands
(Huygens, Rutten-van Molken) Department of Health Policy and Management,
Erasmus University, Rotterdam, Netherlands
Title
Contemporary outcomes after surgical aortic valve replacement with
bioprostheses and allografts: sA systematic review and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 50 (4) (pp 605-616), 2016.
Date of Publication: 01 Oct 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
Many observational studies have reported outcomes after surgical aortic
valve replacement (AVR), but there are no recent systematic reviews and
meta-analyses including all available bioprostheses and allografts. The
objective of this study is to provide a comprehensive and up-to-date
overview of the outcomes after AVR with bioprostheses and allografts
reported in the last 15 years. We conducted a systematic literature review
(PROSPERO register: CRD42015017041) of studies published between 2000-15.
Inclusion criteria were observational studies or randomized controlled
trials reporting on outcomes of AVR with bioprostheses (stented or
stentless) or allografts, with or without coronary artery bypass grafting
(CABG) or valve repair procedure, with study population size n >= 30 and
mean follow-up length >=5 years. Fifty-four bioprosthesis studies and 14
allograft studies were included, encompassing 55 712 and 3872 patients and
349 840 and 32 419 patient-years, respectively. We pooled early mortality
risk and linearized occurrence rates of valve-related events,
reintervention and late mortality in a random-effects model. Sensitivity,
meta-regression and subgroup analyses were performed to investigate the
influence of outliers on the pooled estimates and to explore sources of
heterogeneity. Funnel plots were used to investigate publication bias.
Pooled early mortality risks for bioprostheses and allografts were 4.99%
(95% confidence interval [CI], 4.44-5.62) and 5.03% (95% CI, 3.61-7.01),
respectively. The late mortality rate was 5.70%/patient-year (95% CI,
4.99-5.62) for bioprostheses and 1.68%/patient-year (95% CI, 1.23-2.28)
for allografts. Pooled reintervention rates for bioprostheses and
allografts were 0.75%/patient-year (95% CI, 0.61-0.91) and
1.87%/patient-year (95% CI, 1.52-2.31), respectively. There was
substantial heterogeneity in most outcomes. Meta-regression analyses
identified covariates that could explain the heterogeneity: implantation
period, valve type, patient age, gender, pre-intervention New York Heart
Association class III/IV, concomitant CABG, study design and follow-up
length. There is possible publication bias in all outcomes. This
comprehensive systematic review and meta-analysis provides an overview of
the outcomes after AVR with bioprostheses and allografts reported during
the last 15 years. The results of this study can support patients and
doctors in the prosthetic valve choice and can be used in microsimulation
models to predict patient outcomes and estimate the cost-effectiveness of
AVR with bioprostheses or allografts compared with current and future
heart valve prostheses.<br/>Copyright &#xa9; The Author 2016. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery.

<29>
Accession Number
617524806
Author
Sokoloff A.; Eltchaninoff H.
Institution
(Sokoloff) Rouen University Hospital, Department of Cardiology, FHU
REMOD-VHF, Rouen 76000, France
(Eltchaninoff) Normandie university, UNIROUEN, Rouen University Hospital,
FHU REMOD-VHF, Department of Cardiology, Inserm U1096, Rouen 76000, France
Title
TAVI: History and perspectives.
Source
46 (7-8P1) (pp 772-776), 2017. Date of Publication: July - August 2017.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Nearly 20 years have passed from the concept to clinical development of
percutaneous aortic valve replacement, starting from an idea considered
"stupid" of Professor Alain Cribier in Rouen. After a first phase of
compassionate implantation, large randomized trials PARTNER and COREVALVE
US have allowed TAVI to impose itself in the European and American
recommendations in patients inoperable or considered with high surgical
risk. Next European recommendations on the management of valvular heart
diseases expected in 2017 should take into account the positive results
observed in intermediate risk patients in the PARTNER 2 and SURTAVI
studies, recently adopted in the US recommendations. Randomized trials in
"all coming" patients are already on their way, and the future of TAVI is
to be the reference treatment for a vast majority of patients with aortic
stenosis.<br/>Copyright &#xa9; 2017

<30>
Accession Number
617954797
Author
Heimer J.; Ruder T.; Ampanozi G.; Thali M.; Schweitzer W.
Institution
(Heimer, Ruder, Ampanozi, Thali, Schweitzer) Institute of Forensic
Medicine, University of Zurich, Forensic Medicine and Imaging, Zurich,
Switzerland
Title
Forensic imaging: High prevalence of pneumopericardium in falls from great
height as identified in post mortem computed tomography.
Source
Rechtsmedizin. Conference: 10th International Symposium Advances in Legal
Medicine combined with the 96th Annual Conference German Society of Legal
Medicine. Germany. 27 (4) (pp 314-315), 2017. Date of Publication: August
2017.
Publisher
Springer Verlag
Abstract
Background. Pneumopericardium describes the presence of gas in the
pericardial cavity and is considered a rare phenomenon. Main causes of
pneumopericardium are penetrating and blunt trauma to the chest and
complications of thoracic surgery. Other possible etiologies include
positive pressure ventilation, infectious pericarditis or fistula between
the pericardium and adjacent air-containing organs. Historically,
pneumopericardium is explained with the "Macklin Effect", an alveolar
rupture due to an increased pressure gradient that leads to an escape of
air into the mediastinum via peribronchial and pulmonary perivascular
sheaths. In this research we conducted a systematic review of all cases
with severe chest traumata in our institution from 2014 to 2017 in order
to explore occurrence and surrounding circumstances of pneumopericardium.
As pneumopericardium is challenging to find in classical autopsy, we
evaluated postmortem computed tomography (PMCT). Material and methods. All
cases that presented severe blunt chest injury (documented by CT and/or
autopsy reports) and deceased within 24 hours post-trauma in the period of
March 2014 to March 2017 (preliminary N = 100) were included in the study.
Cases underwent routine CT-Scans (Philips ICT SP, Philips Healthcare,
Best, Netherlands) as well as autopsy. Cases that were treated surgically
were excluded from the study. CT scans of the included cases were searched
for signs of severe blunt chest trauma in addition to case history and
trauma causality. Results were documented and statistically evaluated.
Results. Preliminary results showed a relatively high prevalence of
pneumopericardium in falls from heights (16/38). In falls above 20 meters
of height, the occurrence of pneumopericardium was very high (12/14). In
other trauma mechanisms with severe chest trauma, the pneumopericardium
was less frequently observed (8/62). In cases with pneumopericar dium in
non-fall cases, high velocity traffic accidents were the most prevalent
(6/8). Pneumopericardium was far more uncommon than skeletal fractures,
pneumo- or hemothorax. There was no case of pneumopericardium without at
least one concurrently observed pneumothorax. Hemopericardium and
pneumopericardium were not observed in conjunction. Tears or defects in
what appeared be freely identifiable parts of the pericardium could be
visualized in 11 of 24 cases, and in all of these cases, the defect was
located on the side of a pneumothorax. Discussion and conclusions.
Pneumopericardium appears to be frequent in cases of falls from more than
20 meters of height and prominent in high velocity motor vehicle
accidents. Thus, pneumopericardium seems to be a result of significant
thoracic deceleration trauma. As all cases of pneumopericardium also
present pneumothorax, pneumothorax seems to be a precondition for a
pneumopericardium with traumatic etiology. As etiology of pneumothorax is
linked to rupture of the visceral pleura, a similar mechanism must be
proposed for traumatic pneumopericardium. A pericardial rupture due to
massive deceleration causes gas to be trapped in the pericardial cavity,
as long as there is a concurrent pneumothorax at the site of the leakage.
As pneumopericardium is only found in cases of most severe deceleration
trauma, its presence should be considered an indicator for high velocity
incidents.

<31>
Accession Number
617955607
Author
Fernandez Zamora M.D.; Munoz-Bono J.; Curiel-Balsera E.; Aguilar-Alonso
E.; Hinojosa R.; Gordillo-Brenes A.; Arboleda-Sanchez J.A.
Institution
(Fernandez Zamora, Munoz-Bono, Curiel-Balsera) Hospital Regional Malaga,
Intensive Care, Malaga, Spain
(Aguilar-Alonso) Hospital Infanta Margarita, Intensive Care, Cabra, Spain
(Hinojosa) Hospital Virgen Del Rocio, Intensive Care, Sevilla, Spain
(Gordillo-Brenes) Hospital Puerta Del Mar, Intensive Care, Cadiz, Spain
(Arboleda-Sanchez) Hospital Regional Malaga, Malaga, Spain
Title
Resolving dudes:IABP before CABG or levosimendan after?.
Source
Intensive Care Medicine Experimental. Conference: 29th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2016. Italy. 4 (no
pagination), 2016. Date of Publication: September 2016.
Publisher
SpringerOpen
Abstract
Introduction: Meta-analyses suggest that levosimendan is superior to
traditional inotropes, with decreased postoperative morbidity, improved
hemodynamic function and decreased myocardial injury but at no time has
been compared to the balloon counterpulsation. Methods: Observational
prospective admitted patients in ARIAM registry from February2010 to
September 2012 in 13 public and private hospitals with CCV. We
retrospectively compared the patients who underwent CABG who were treated
with IABP before surgery and those who received levosimendan during
surgery or immediately after surgery. We analysed clinical and
epidemiological data of both groups as well as complications, hospital
stays and mortality. We used the Mann Whitney U test and Fischer's exact
test with an alpha maximum of 5 % for the comparison of variables
according to necessity. Results: 949 patients were involved CABG in the
time period studied. Of these, 17 patients were treated with BCIAO before
surgery and 96 received levosimendan. No differences in age or
comorbidities between the two groups analysed or extracorporeal
circulation time (p > 0.05). However, functional status at the time of
surgery was worse in the group BCIAo (NYHA III or IV 43.8 % from 22.2 %) p
= 0.011, and the risk score used (EuroSCORE p = 0, 0001), 30 % of patients
had no postoperative complications, similar in both groups. There were no
differences in hospital stay or mortality in both groups. The group of
patients treated with levosimendan developed lower rate of heart failure,
renal failure (Creat > 2 mg / dl) and prolonged mechanical ventilation
than the group that received BCIAO (p < 0.05). However, the levosimendan
group required in 4.2 % of patients while it was not necessary in the
other group. Conclusions: levosimendan in heart coronary artery bypass
surgery decreases postoperative morbidity (heart failure, renal failure or
prolonged mechanical ventilation)with an increase in the need for CRRT. No
differences were found in mortality or hospital stay.

<32>
Accession Number
617955601
Author
Beerepoot M.; Touw H.R.; Parlevliet K.; Boer C.; Elbers P.W.; Tuinman P.R.
Institution
(Beerepoot) VU University Medical Center Amsterdam, Intensive Care,
Amsterdam, Netherlands
(Touw, Parlevliet, Boer, Elbers, Tuinman) VU University Medical Center
Amsterdam, Amsterdam, Netherlands
Title
Lung ultrasound detects more pulmonary complications than chest X-ray in
patients after cardiac-surgery: A prospective observational study.
Source
Intensive Care Medicine Experimental. Conference: 29th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2016. Italy. 4 (no
pagination), 2016. Date of Publication: September 2016.
Publisher
SpringerOpen
Abstract
Introduction Patients after cardiac surgery are prone to develop
postoperative pulmonary complication (PPCs), which are currently diagnosed
by chest Xray (CXR). LUS may provide accurate diagnostic information in
patients with acute respiratory distress [1]. The role of LUS in detecting
PPCs in patients after cardiac surgery has yet to be determined.
Objectives To compare the rates of PPCs detected by LUS-and CXR in
patients after cardiac surgery admitted to ICU. Additionally, we assessed
the inter-observer agreement for LUS and compared the time it takes to
perform LUS and CXR. Method This is a prospective observational single
centre study. The study was approved by the institutional review board. On
admission to the ICU, rates of PPCs detected by LUS according to the
BLUE-protocol [2] and by CXR were compared. In addition, accuracy of LUS
and CXR for detecting clinical relevant (cr-PPCs), PPCs for which the
attending physician, blinded for the LUS data, initiated therapy was
evaluated. Cr-PPCs were considered the composite reference standard. 70
blue points were assessed to determine inter-observer agreement. In 15
patients time to perform both techniques was compared. Results 70 % Of the
134 enrolled patients was male with a mean age of 68 +/- 9,5. LUS
identified 62 PPCs (46 %), compared to 29 (22 %) by CXR (P = 0,011). PPCs
identified were: positive Postero-Lateral Alveolar and/or Pleural Syndrome
(PLAPS) 40 % vs 13 %, pulmonary edema (5 % vs 9 %) and pneumothorax (1 %
vs 0 %). Incidence of cr-PPCs was 16 (12 %). Table 88 summarizes the
diagnostic accuracy of LUS and CXR for the cr-PPCs identified. LUS can be
performed within 15 +/- 5 minutes compared to 42 +/- 16 minutes for CXR,(p
< 0.01). Overall inter-observer agreement for LUS showed a near to perfect
agreement (k = 0.907, p <= 0.000). Conclusions LUS detects more PPCs than
CXR in patients after cardiac surgery and with good inter-observer
agreement. In addition, time to perform LUS is significantly shorter.
However, most PPCs detected by LUS come with little clinical consequence.
Therefore, we suggest in further studies to quantify the extent of the PPC
detected by LUS to improve its value in clinical decision making.

<33>
Accession Number
617955290
Author
Silversides J.A.; Major E.; Mann E.E.; Ferguson A.J.; McAuley D.F.;
Marshall J.C.; Blackwood B.; Fan E.
Institution
(Silversides, Major, Mann, McAuley) Belfast Health and Social Care Trust,
Critical Care, Belfast, United Kingdom
(Silversides, McAuley, Blackwood) Queen's University of Belfast, Centre
for Experimental Medicine, Belfast, United Kingdom
(Ferguson) Southern Health and Social Care Trust, Anaesthetics and
Intensive Care, Craigavon, United Kingdom
(Marshall, Fan) University of Toronto, Critical Care Medicine, Toronto,
Canada
Title
Conservative fluid management or deresuscitation for patients with sepsis
or acute respiratory distress syndrome: A systematic review and
meta-analysis.
Source
Intensive Care Medicine Experimental. Conference: 29th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2016. Italy. 4 (no
pagination), 2016. Date of Publication: September 2016.
Publisher
SpringerOpen
Abstract
Introduction A positive fluid balance is associated with worse outcomes in
the critically ill [1,2], and it has been suggested that conservative
fluid administration or deresuscitation (active removal of fluid using
diuretics or renal replacement therapy (RRT)) may be beneficial following
haemodynamic stabilisation [3]. Objectives We performed a systematic
review and meta-analysis to evaluate the efficacy and safety of
conservative or deresuscitative fluid strategies in adults and children
with acute respiratory distress syndrome (ARDS), sepsis, or systemic
inflammatory response syndrome (SIRS) following initial resuscitation [4].
Methods We searched Medline, Embase, and the Cochrane central register of
controlled trials without restrictions, and manually searched conference
proceedings for the last 5 years. Two reviewers independently assessed
publications. We included randomised controlled trials comparing two or
more fluid regimens in which fluid balance differed, and observational
studies investigating the relationship between fluid volume administered
or fluid balance achieved and patient outcomes. We excluded studies
published before 1980, studies of neonatal, post-cardiac surgical, or
heart failure patients, and observational studies with fewer than 50
participants. Results In a meta-analysis of the 7 included randomised
trials (n = 1390), we found a non-significant reduction in mortality with
a conservative or deresuscitative fluid strategy (pooled odds ratio 0.86,
95 % confidence interval (CI) 0.68-1.09) compared to a liberal strategy or
usual care (Fig. 72). We found a non-significant reduction in RRT use with
a conservative or deresuscitative fluid strategy (2 studies, pooled odds
ratio 0.73, 95 % CI 0.51-1.05). Four trials reported shorter length of ICU
stay or increased number of ICU-free days, and 2 studies reported shorter
duration of mechanical ventilation or increased ventilator-free days with
a conservative or deresuscitative fluid strategy compared to a liberal
strategy or usual care. Marked clinical heterogeneity was present.
Conclusions A conservative or deresuscitative approach to fluid management
may improve patient outcomes, and does not appear to increase the
incidence of acute kidney injury or RRT use. Large randomised trials
comparing alternative fluid regimens are needed to determine the optimal
approach to fluid management in critically ill patients.

<34>
Accession Number
617808787
Author
Mojoli M.; Gersh B.J.; Barioli A.; Masiero G.; Tellaroli P.; D'Amico G.;
Tarantini G.
Institution
(Mojoli, Barioli, Masiero, D'Amico, Tarantini) Cardiology Unit, Department
of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical
School, Padua, Italy
(Gersh) Division of Cardiovascular Diseases, Mayo Clinic and Mayo Clinic
College of Medicine, Rochester, MN, United States
(Tellaroli) Epidemiology and Public Health Unit, Department of Cardiac,
Thoracic and Vascular Sciences, University of Padua Medical School, Padua,
Italy
Title
Impact of atrial fibrillation on outcomes of patients treated by
transcatheter aortic valve implantation: A systematic review and
meta-analysis.
Source
American Heart Journal. 192 (pp 64-75), 2017. Date of Publication: October
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Conflicting data have been reported related to the impact of
atrial fibrillation (AF) on the outcomes after transcatheter aortic valve
implantation (TAVI). We aimed to assess the prognosis of TAVI-treated
patients according to the presence of pre-existing or new-onset AF.
Methods Studies published between April 2002 and November 2016 and
reporting outcomes of pre-existing AF, new-onset AF, or sinus rhythm in
patients undergoing TAVI were identified with an electronic search.
Pairwise and network meta-analysis were performed. Outcomes of interest
were short- and long-term mortality, stroke, and major bleeding. Results
Eleven studies (11,033 individuals) were eligible. Compared to sinus
rhythm, short-term and long-term mortality were significantly higher in
new-onset AF (short-term OR 2.9, P = .002; long-term OR 2.3, P < .0001)
and pre-existing AF groups (short-term OR 2.7, P = .004; long-term OR 2.8,
P < .0001). Compared to sinus rhythm, new-onset AF increased the risk of
stroke at early (OR 2.1, P < .0001) and late follow-up (OR 1.92, P <
.0001), and the risk of early bleedings (OR 1.65, P = .002), while
pre-existing AF increased the risk of late stroke (OR 1.3, P = 0.03), but
not the risk of bleeding. Compared to pre-existing AF, new-onset AF
correlated with higher risk of early stroke (OR 1.7, P = .002) and major
bleedings (OR 1.7, P = .002). Conclusions AF is associated with impaired
outcomes after TAVI, including mortality, stroke and (limited to new-onset
AF) major bleedings. Compared to pre-existing AF, new-onset AF correlates
with higher risk of early stroke and major bleedings. Improved management
of AF in the TAVI setting, including tailored antithrombotic treatment
strategies, remains a relevant need.<br/>Copyright &#xa9; 2017 Elsevier
Inc.

<35>
Accession Number
607899783
Author
Ihmsen H.; Rohde D.; Schuttler J.; Jeleazcov C.
Institution
(Ihmsen, Rohde, Schuttler, Jeleazcov) Anasthesiologische Klinik,
Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat
Erlangen-Nurnberg, Krankenhausstrasse 12, Erlangen 91054, Germany
Title
External Validation of a Recently Developed Population Pharmacokinetic
Model for Hydromorphone During Postoperative Pain Therapy.
Source
European Journal of Drug Metabolism and Pharmacokinetics. 42 (1) (pp
17-28), 2017. Date of Publication: 01 Feb 2017.
Publisher
Springer-Verlag France (22, Rue de Palestro, Paris 75002, France. E-mail:
york@springer-paris.fr)
Abstract
Background and Objective: We recently developed a new population
pharmacokinetic model for hydromorphone in patients including age and
bodyweight as covariates. The aim of the present study was to evaluate
prospectively the predictive performance of this new model during
postoperative pain therapy. Methods: This was a prospective,
single-blinded, randomized, single-center study with two parallel arms.
Fifty patients aged 40-85 years undergoing cardiac surgery involving
thoracotomy were enrolled. Hydromorphone was administered postoperatively
on the intensive care unit as target controlled infusion (TCI) for patient
controlled analgesia (TCI-PCA) using the new pharmacokinetic model, or as
conventional patient controlled analgesia (PCA). Arterial blood samples
were taken for measurement of the hydromorphone plasma concentration. The
predictive performance of the pharmacokinetic model was assessed by the
median performance error (MDPE), the median absolute performance error
(MDAPE), wobble and divergence. For comparison, the performance indices
were also determined for three older models from the literature. Results:
903 plasma concentrations of 41 patients were analyzed. The mean values
(95 % CI) of MDPE, MDAPE, wobble and divergence for the new
pharmacokinetic model were 11.2 % (3.9 to 18.7 %), 28.5 % (23.9 to 33.0
%), 21.4 % (18.0 to 24.9 %) and -1.6 %/h (-2.3 to -0.8 %/h). When compared
with older models from the literature, performance was better with less
overshoot after bolus doses. Conclusion: The new pharmacokinetic model of
hydromorphone showed a good precision and a better performance than older
models. It is therefore suitable for TCI with hydromorphone during
postoperative pain therapy. Trial Registration: EudraCT 2013-002875-16,
Clinical Trials NCT02035709.<br/>Copyright &#xa9; 2016, Springer
International Publishing Switzerland.

<36>
Accession Number
617795506
Author
Zhou Y.; Wang Y.; Wu Y.; Huang C.; Yan H.; Zhu W.; Xu W.; Zhang L.; Zhu J.
Institution
(Zhou, Wu, Huang, Yan, Zhu, Zhang, Zhu) Department of Cardiology, The
First Affiliated Hospital, Zhejiang University, School of Medicine, 79
Qingchun Road, Zhejiang, Hangzhou 310003, China
(Wang) Department of Cardiology, Ningbo Medical Treatment Center Lihuili
Hospital, Ningbo 315000, China
(Xu) Department of Endocrinology, The First Affiliated Hospital, Zhejiang
University, School of Medicine, 79 Qingchun Road, Hangzhou 310003, China
Title
Individualized dual antiplatelet therapy based on platelet function
testing in patients undergoing percutaneous coronary intervention: A
meta-analysis of randomized controlled trials.
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 157. Date of Publication: 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: High on-treatment platelet reactivity (HPR) represents a
strong risk factor for thrombotic events after PCI. We aim to evaluate the
efficacy and safety of individualizing intensified dual antiplatelet
therapy (DAPT) in PCI-treated patients with HPR based on platelet function
testing (PFT). Methods: Electronic databases were searched for randomized
control trials that reported the clinical outcomes of using an intensified
antiplatelet protocol with P2Y12 receptor inhibitor comparing with
standard maintenance dose of clopidogrel on the basis of platelet function
testing. Clinical endpoints were assessed. Results: From 2005 to 2016,
thirteen clinical studies comprising 7290 patients were included for
analysis. Compared with standard antiplatelet therapy with clopidogrel,
the intensified protocol based on platelet function testing was associated
with a significant reduction in major adverse cardiovascular events
(RR:0.55, 95% CI: 0.36-0.84, p = 0.005), cardiovascular death (RR:0.60,
95% CI: 0.38-0.96, p = 0.03), stent thrombosis (RR:0.58, 95% CI:
0.36-0.93, p = 0.02) and target vessel revascularization (RR:0.33, 95% CI:
0.14-0.76, p = 0.009). No significant difference was found in the rate of
bleeding events between intensified and standard protocol. Conclusions:
Compared with standard clopidogrel therapy, individualized intensified
antiplatelet therapy on the basis of platelet reactivity testing reduces
the incidence of cardiovascular events in patient undergoing PCI, without
increasing the risk of bleeding.<br/>Copyright &#xa9; The Author(s). 2017.

<37>
Accession Number
617850803
Author
Wrzosek A.; Jakowicka-Wordliczek J.; Zajaczkowska R.; Serednicki W.T.;
Jankowski M.; Bala M.M.; Polak M.; Wordliczek J.
Institution
(Wrzosek, Zajaczkowska, Serednicki, Wordliczek) Jagiellonian University,
Medical College, Department of Interdisciplinary Intensive Care, Krakow,
Poland
(Jakowicka-Wordliczek, Jankowski) University Hospital, Department of
Anaesthesiology and Intensive Care, Krakow, Poland
(Bala) Jagiellonian University Medical College, Department of Hygiene and
Dietetics, Systematic Reviews Unit - Polish Cochrane Branch, Kopernika 7,
Krakow 31-034, Poland
(Polak) Jagiellonian University, Medical College Krakow, Department of
Epidemiology and Population Studies in the Institute of Public Health,
Krakow, Poland
Title
Perioperative restrictive versus goal-directed fluid therapy for adults
undergoing major non-cardiac surgery.
Source
Cochrane Database of Systematic Reviews. 2017 (8) (no pagination), 2017.
Article Number: CD012767. Date of Publication: 21 Aug 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives
are as follows: To find out whether perioperative restrictive fluid
therapy (RFT) may be beneficial to adults undergoing major non-cardiac
surgery, compared with goal-directed fluid therapy (GDFT).<br/>Copyright
&#xa9; 2017 The Cochrane Collaboration. Published by John Wiley & Sons,
Ltd.

<38>
Accession Number
611530288
Author
Kim T.K.; Cho Y.J.; Lim C.-W.; Min J.J.; Choi E.-K.; Hong D.M.; Jeon Y.
Institution
(Kim, Cho, Hong, Jeon) Seoul National University Hospital, Department of
Anaesthesiology and Pain medicine, Daehakro 101, Jongno-gu, Seoul 110-744,
South Korea
(Lim) Cheorwon Gil Hospital, Department of Anaesthesiology and Pain
Medicine, Gangwon-Do, South Korea
(Min) Samsung Medical Centre, Department of Anaesthesiology and Pain
Medicine, Seoul, South Korea
(Choi) Seoul National University Hospital, Department of Internal
Medicine, Seoul, South Korea
Title
Effect of ramosetron on QTc interval: A randomised controlled trial in
patients undergoing off-pump coronary artery bypass surgery.
Source
BMC Anesthesiology. 16 (1) (no pagination), 2016. Article Number: 56. Date
of Publication: 03 Aug 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Ramosetron is a relatively new 5-hydroxytryptamine three
receptor antagonist with higher binding affinity and more prolonged
duration of action compared to ondansetron. The present study was
performed to evaluate the effects of ramosetron on QTc interval and
possible cardiovascular adverse effects in patients undergoing cardiac
surgery. Method: A total of 114 patients who underwent off-pump coronary
artery bypass surgery were enrolled in this randomised placebo-controlled
trial. Patients were allocated into two groups that received intravenous
injection of 0.3 mg ramosetron or normal saline during induction of
anaesthesia. QTc intervals were measured before the operation,
intraoperatively (0, 1, 2, 3, 5, 10, 15, 30, 45, 60, 90, 120, and 240 min
after injection of ramosetron or normal saline), at the end of the
operation, and on postoperative day 1. Results: There were no differences
in mean QTc interval between groups at every time point. However, maximal
change in QTc interval during surgery was higher in the ramosetron group
than the placebo group (25.1 +/- 22.0 vs. 17.5 +/- 14.5 ms, 95 % CI
0.34-14.78, P = 0.040). Also, there were more patients with a QTc interval
increase of > 60 ms in the ramosetron group (5 vs. 0, 95 % CI 1.6-18.0, P
= 0.021). There were no significant differences in cardiovascular
complications. Conclusions: Ramosetron administered during induction of
anaesthesia may affect maximal change in QTc interval during off-pump
coronary artery bypass surgery. Ramosetron should be used with caution in
high risk patients for developing Torsades de Pointes. Trial registration:
ClinicalTrials.gov NCT02139241. Registered November 12, 2013<br/>Copyright
&#xa9; 2016 The Author(s).

<39>
Accession Number
614667158
Author
Crucitti P.; Mangiameli G.; Petitti T.; Condoluci A.; Rocco R.; Gallo
I.F.; Longo F.; Rocco G.
Institution
(Crucitti, Mangiameli, Condoluci, Rocco, Gallo, Longo) Section of Thoracic
Surgery, Department of Vascular Surgery, Campus Bio-Medico University of
Rome, Rome, Italy
(Petitti) Department of Public Health, Hygiene and Statistics, Campus
Bio-Medico University of Rome, Rome, Italy
(Rocco) Department of Thoracic Surgery and Oncology, Division of Thoracic
Surgery, Istituto Nazionale Tumori, IRCCS, Fondazione Pascale, Napoli,
Italy
Title
Does prophylactic ligation of the thoracic duct reduce chylothorax rates
in patients undergoing oesophagectomy? A systematic review and
meta-Analysis.
Source
European Journal of Cardio-thoracic Surgery. 50 (6) (pp 1-6), 2016. Date
of Publication: 2016.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
A systematic review of English and non-English articles using OVID MEDLINE
(1980-2014) was performed to evaluate the potential value of prophylactic
ligation of the thoracic duct in preventing chylous leakage after
oesophagectomy for cancer. Search terms included [Oesophagectomy OR
esophagectomy] AND [chylothorax] AND [thoracic duct ligation]. Only those
papers that directly compared the incidence of chylothorax in patients who
underwent prophylactic ligation [ligation group (LG)] with that in those
who had conservative treatment were selected [preservation group (PG)];
all the articles presenting original data and supplying sufficient
information on the chylothorax rate after oesophagectomy were included.
Independent extraction of articles was performed by two authors using
predefined data fields, including study quality indicators. The PRISMA
guidelines were carefully adhered to. A total of 5254 subjects were
included in the 7 clinical studies examined into the current
meta-analysis. Of these, 2179 patients underwent prophylactic ligature of
the thoracic duct (LG group) and 3075 had preservation of the thoracic
duct (PG group). A significant difference in terms of chylothorax rate
[odd ratios (ORs) 0.47 in favour of LG, 95% confidence interval (CI)
0.27-0.80] was noted between the LG group and the PG group. According to
our meta-analysis and taking into account-specific caveats, prophylactic
ligation of the thoracic duct could be considered as an effective
preventative measure to reduce the incidence of postoperative
chylothorax.<br/>Copyright &#xa9; The Author 2016.

<40>
Accession Number
613792715
Author
Rosendahl J.; Koranyi S.; Jacob D.; Zech N.; Hansen E.
Institution
(Rosendahl, Jacob) Jena University Hospital, Friedrich-Schiller
University, Institute of Psychosocial Medicine and Psychotherapy, Stoystr.
3, Jena 07743, Germany
(Koranyi) University Hospital Leipzig, Department of Medical Psychology
and Medical Sociology, Philipp-Rosenthal-Str. 55, Leipzig 04103, Germany
(Zech, Hansen) University Hospital Regensburg, Department of
Anaesthesiology, Franz-Josef-Strauss-Allee 11, Regensburg 93053, Germany
Title
Efficacy of therapeutic suggestions under general anesthesia: A systematic
review and meta-analysis of randomized controlled trials.
Source
BMC Anesthesiology. 16 (1) (no pagination), 2016. Article Number: 125.
Date of Publication: 22 Dec 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: General anesthesia does not block central nervous processing
of auditive information. Therefore, positive suggestions even given during
surgery might have the potential to encourage well-being and recovery of
patients. Aim of this review was to summarize the evidence on the efficacy
of therapeutic suggestions under general anesthesia in adults undergoing
surgery compared to an attention control (i.e. white noise). Methods: We
included randomized controlled trials that investigated therapeutic
suggestions presented during general anesthesia to adult patients
undergoing surgery or medical procedures. Outcomes on pain intensity,
mental distress, recovery, use of medication, measured postoperatively
within hospitalization were considered. Electronic searches were carried
out in the following databases (last search February 23, 2015): MEDLINE,
CENTRAL, Web of Science, PsycINFO, ProQuest Dissertations and Theses.
Results: Thirty-two eligible randomized controlled trials were included,
comprising a total of 2102 patients. All studies used taped suggestions.
Random effects meta-analyses revealed no effects on pain intensity
(Hedges' g = 0.04, CI 95% [0.04; 0.12], number needed to treat [NNT] =
44.3) and mental distress (g = 0.03, CI 95% [0.11; 0.16], NNT = 68.2). In
contrast, we found small but significant positive effects on use of
medication (g = 0.19, CI 95% [0.09; 0.29], NNT = 9.2) and on recovery (g =
0.14, CI 95% [0.03; 0.25], NNT = 13.0). All effects were homogeneous and
robust. Conclusions: Even though effects were small, our results provide
indications that intraoperative suggestions can have the potential to
reduce the need for medication and enhance recovery. Further high quality
trials are needed to strengthen the promising evidence on the efficacy of
therapeutic suggestions under general anesthesia for patients undergoing
surgery.<br/>Copyright &#xa9; 2017 The Author(s).

<41>
Accession Number
617985616
Author
Kimenai D.M.; Gerritse B.M.; Lucas C.; Rosseel P.M.; Bentala M.; van
Hattum P.; van der Meer N.J.; Scohy T.V.
Institution
(Kimenai) Department of Extracorporeal Circulation, Amphia Hospital,
Breda, Netherlands
(Gerritse, Rosseel, van der Meer, Scohy) Department of Anesthesiology,
Amphia Hospital, Breda, Netherlands
(Lucas) Department of Clinical Epidemiology, Biostatistics and
Bioinformatics, Academic Medical University Centre of Amsterdam,
Amsterdam, Netherlands
(Bentala) Department of Cardiothoracic Surgery, Amphia Hospital, Breda,
Netherlands
(van Hattum) Department of Clinical Pharmacology, Amphia Hospital, Breda,
Netherlands
Title
Effectiveness of pericardial lavage with or without tranexamic acid in
cardiac surgery patients receiving intravenous tranexamic acid: a
randomized controlled trial.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 50 (6) (pp 1124-1131),
2016. Date of Publication: 01 Dec 2016.
Abstract
OBJECTIVES: Pericardial lavage with saline, with or without tranexamic
acid (TA), is still not evidence-based within current clinical practice as
a part of a blood conservation strategy in cardiac surgery patients
receiving intravenous TA administration. The objective was to determine
whether intravenous TA combined with pericardial lavage with saline, with
or without TA, reduces blood loss by 25% after cardiac surgery measured in
the first 12 h postoperatively.
METHODS: In this single-centre, randomized controlled, multiple-armed,
parallel study, individual patients were randomly assigned to receive
either topical administration of 2 g TA diluted in 200 ml of saline (TA
group), 200 ml of saline (placebo group) or no topical administration at
all (control group). Eligible participants were all adults aged 18 or
older and scheduled for elective cardiac surgery on cardiopulmonary
bypass. All patients received 2 g TA intravenously before sternal incision
and 2 g TA after cardiopulmonary bypass. The main outcome measure was the
12-h postoperative blood loss.
RESULTS: In total, 739 individuals were analysed according to
intention-to-treat analyses (TA group, n = 245 patients; placebo group, n
= 249 patients; control group, n = 245 patients). There was no difference
in the median 12-h postoperative blood loss between the three groups [TA
group, 290 (IQR 190-430) ml; placebo group, 290 (IQR 210-440) ml; control
group, 300 (IQR 190-450) ml, P= 0.759].
CONCLUSIONS: Pericardial lavage, with or without TA, does not result in a
statistically significant difference in the 12-h postoperative blood loss
in cardiac surgery patients receiving intravenous TA administration.
Pericardial lavage with saline, with or without TA, should not be a part
of a blood conservation strategy.<br/>Copyright &#xa9; The Author 2016.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<42>
Accession Number
617985574
Author
Anastasiadis K.; Antonitsis P.; Kostarellou G.; Kleontas A.; Deliopoulos
A.; Grosomanidis V.; Argiriadou H.
Institution
(Anastasiadis, Kostarellou, Kleontas, Deliopoulos, Grosomanidis,
Argiriadou) Cardiothoracic Department, AHEPA University Hospital,
Thessaloniki, Greece
(Antonitsis) Cardiothoracic Department, AHEPA University Hospital,
Thessaloniki, Greece antonits@auth.gr antonits@otenet.gr
Title
Minimally invasive extracorporeal circulation improves quality of life
after coronary artery bypass grafting.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 50 (6) (pp 1196-1203),
2016. Date of Publication: 01 Dec 2016.
Abstract
OBJECTIVES: The effect on postoperative health-related quality of life
(HRQoL) after coronary artery bypass grafting (CABG) surgery with
conventional cardiopulmonary bypass (cCPB) and off-pump surgery has been
investigated extensively; however, there are no studies focusing on HRQoL
after surgery with minimally invasive extracorporeal circulation (MiECC).
Therefore, we sought to prospectively investigate the effect of MiECC on
postoperative HRQoL when compared with cCPB in patients undergoing CABG
over a short-term (3-month) follow-up period.
METHODS: Sixty patients scheduled for elective CABG surgery were randomly
assigned into two groups: those who had surgery on MiECC system (n = 30)
and those who underwent CABG using cCPB (n = 30). Quality-of-life
assessment was performed preoperatively (baseline-T0), at first
postoperative month (T1) and at 3-month follow-up (T3). The RAND SF-36
scale was used for data collection, which included both sociodemographic
and clinical characteristics of patients. The primary outcome of the study
was quantitative measurement of postoperative HRQoL at 3-month follow-up.
RESULTS: Both groups were balanced in terms of demographic, socio-economic
and operative characteristics. At 3-month follow-up, mean SF-36 component
and summary scores in each group were higher in absolute values than the
respective mean baseline scores, apart from role-physical score in
patients operated with cCPB. Patients operated on MiECC showed uniformly
significantly higher values in all individual and summary domains, whereas
patients operated on cCPB showed significant improvement in 6/8 individual
domains. Patients operated on MiECC showed a more pronounced increase in
SF-36 individual domain scores from the first to the third postoperative
month when compared with cCPB, which was statistically significant
regarding physical functioning (P = 0.001), role-physical (P < 0.001),
vitality (P = 0.01) and role-emotional (P = 0.004). This resulted in a
significant improvement in physical (P = 0.002) and mental (P = 0.01)
summary scores.
CONCLUSIONS: The current study proves that MiECC significantly improves
HRQoL after coronary surgery compared with cCPB. This finding, combined
with results from large-scale studies showing superior clinical outcomes
from its use, enhances the role of MiECC as a dominant technique in
coronary revascularization surgery.<br/>Copyright &#xa9; The Author 2016.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<43>
Accession Number
617982382
Author
Scarfe A.J.; Schuhmann-Hingel S.; Duncan J.K.; Ma N.; Atukorale Y.N.;
Cameron A.L.
Institution
(Scarfe) Australian Safety and Efficacy Register of New Interventional
Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons,
Adelaide, SA, Australia college.asernip@surgeons.org
anje.scarfe@surgeons.org
(Schuhmann-Hingel) KAGes - Styrian Hospitals Holding, Graz, Austria
(Duncan, Ma, Atukorale, Cameron) Australian Safety and Efficacy Register
of New Interventional Procedures - Surgical (ASERNIP-S), Royal
Australasian College of Surgeons, Adelaide, SA, Australia
Title
Continuous paravertebral block for post-cardiothoracic surgery analgesia:
a systematic review and meta-analysis.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 50 (6) (pp 1010-1018),
2016. Date of Publication: 01 Dec 2016.
Abstract
A continuous paravertebral block is used when pain relief is required
beyond the duration of a single-injection paravertebral block. Surgical
procedures requiring an incision into the pleural cavity are some of the
most painful procedures postoperatively and, if not managed appropriately,
can lead to chronic pain. The current gold standard for
post-cardiothoracic surgery pain management is epidural analgesia, which
has contraindications, a failure rate of up to 12% and risk of
complications such as epidural abscess and spinal haematoma. This
systematic review and meta-analysis aimed to investigate the use of a
continuous paravertebral block for post-cardiothoracic surgery analgesia.
Randomized controlled trials evaluating the continuous paravertebral block
against epidural analgesia, wound infiltration, placebo or standard care
(intravenous opioids) for post-cardiothoracic surgery analgesia were
considered for inclusion in the systematic review. PubMed, EMBASE, The
Cochrane Library and the University of York Centre for Reviews and
Dissemination databases were searched from inception to 15 September 2014.
Risk of bias and generalizability were assessed using a modified Downs and
Black checklist. A meta-analysis was conducted on suitable studies
comparing the continuous paravertebral nerve block with epidural
anaesthesia, with fixed-effects models being used to pool the effects.
Twenty-three randomized controlled trials with 1120 participants were
included. The continuous paravertebral block was associated with a
significant improvement in incidence of nausea and vomiting (odds ratio =
0.29, 95% confidence interval = [0.16, 0.56]), hypotension (odds ratio =
0.16, 95% confidence interval = [0.06, 0.41]) and urinary retention (odds
ratio = 0.22, 95% confidence interval = [0.09, 0.52]) compared with the
epidural block. No statistically significant difference in pain relief was
reported. The continuous paravertebral block has equivalent analgesic
effects to epidural analgesia, wound infiltration and standard care, but
is associated with a lower incidence of nausea and vomiting, hypotension
and urinary retention than epidural analgesia.<br/>Copyright &#xa9; The
Author 2016. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<44>
Accession Number
617958901
Author
Cholley B.; Caruba T.; Grosjean S.; Amour J.; Ouattara A.; Villacorta J.;
Miguet B.; Guinet P.; Levy F.; Squara P.; Hamou N.A.; Carillon A.; Boyer
J.; Boughenou M.-F.; Rosier S.; Robin E.; Radutoiu M.; Durand M.; Guidon
C.; Desebbe O.; Charles-Nelson A.; Menasche P.; Rozec B.; Girard C.;
Fellahi J.-L.; Pirracchio R.; Chatellier G.
Institution
(Cholley, Boughenou, Pirracchio) Department of Anesthesiology and Critical
Care Medicine, Hopital Europeen Georges Pompidou, AP-HP, University Paris
Descartes-Sorbonne Paris Cite, Paris, France
(Caruba) Department of Pharmacy, Hopital Europeen Georges Pompidou, AP-HP,
University Paris Descartes-Sorbonne Paris Cite, Paris, France
(Grosjean, Boyer, Girard) Department of Anesthesiology and Critical Care
Medicine, Centre Hospitalo-Universitaire de Dijon-Bourgogne, France
(Amour, Hamou, Carillon) Department of Anesthesiology and Critical Care
Medicine, Hopital de La Pitie Salpetriere, AP-HP, University Pierre and
Marie Curie, Paris, France
(Ouattara) Department of Anaesthesiology and Critical Care II, Magellan
Medico-Surgical Center, University of Bordeaux, INSERM, UMR 1034, Biology
of Cardiovascular Diseases, Bordeaux, France
(Villacorta, Guidon) Department of Anesthesiology and Critical Care, CHU
La Timone, Marseille, France
(Miguet, Rozec) Department of Anesthesiology and Critical Care Medicine,
Hopital Laennec, Nantes, France
(Guinet, Rosier) Department of Anesthesiology and Critical Care Medicine,
Hopital Pontchaillou, Rennes, France
(Levy) Department of Anesthesiology and Critical Care, Nouvel Hopital
Civil, Strasbourg, France
(Squara) Department of Anesthesiology and Critical Care, Clinique Ambroise
Pare, Neuilly, France
(Robin) Department of Anesthesiology and Critical Care, Hopital Claude
Huriez, Lille, France
(Radutoiu) Department of Anesthesiology and Critical Care, CHU Cote de
Nacre, Caen, France
(Durand) Department of Anesthesiology and Critical Care, CHU Grenoble
Alpes, Grenoble, France
(Desebbe, Fellahi) Department of Anesthesiology and Critical Care, Hopital
Cardiologique Louis Pradel, INSERM U1060, University Claude Bernard, Lyon,
France
(Charles-Nelson, Chatellier) Department of Biostatistics, Hopital Europeen
Georges Pompidou, AP-HP, University Paris Descartes-Sorbonne Paris Cite,
Paris, France
(Menasche) Department of Cardiovascular Surgery, Hopital Europeen Georges
Pompidou, AP-HP, University Paris Descartes-Sorbonne Paris Cite, Paris,
France
Title
Effect of levosimendan on low cardiac output syndrome in patients with low
ejection fraction undergoing coronary artery bypass grafting with
cardiopulmonary bypass - The LICORN randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 318 (6) (pp 548-556),
2017. Date of Publication: 08 Aug 2017.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: Low cardiac output syndrome after cardiac surgery is
associated with high morbidity and mortality in patients with impaired
left ventricular function. OBJECTIVE: To assess the ability of
preoperative levosimendan to prevent postoperative low cardiac output
syndrome. DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind,
placebo-controlled trial conducted in 13 French cardiac surgical centers.
Patients with a left ventricular ejection fraction less than or equal to
40% and scheduled for isolated or combined coronary artery bypass grafting
with cardiopulmonary bypass were enrolled from June 2013 until May 2015
and followed during 6 months (last follow-up, November 30, 2015).
INTERVENTIONS: Patients were assigned to a 24-hour infusion of
levosimendan 0.1 mug/kg/min (n = 167) or placebo (n = 168) initiated after
anesthetic induction. MAIN OUTCOMES AND MEASURES: Composite end point
reflecting low cardiac output syndrome with need for a catecholamine
infusion 48 hours after study drug initiation, need for a left ventricular
mechanical assist device or failure to wean from it at 96 hours after
study drug initiation when the device was inserted preoperatively, or need
for renal replacement therapy at any time postoperatively. It was
hypothesized that levosimendan would reduce the incidence of this
composite end point by 15% in comparison with placebo. RESULTS: Among 336
randomized patients (mean age, 68 years; 16% women), 333 completed the
trial. The primary end point occurred in 87 patients (52%) in the
levosimendan group and 101 patients (61%) in the placebo group (absolute
risk difference taking into account center effect, -7% [95% CI, -17% to
3%]; P = .15). Predefined subgroup analyses found no interaction with
ejection fraction less than 30%, type of surgery, and preoperative use of
beta-blockers, intra-aortic balloon pump, or catecholamines. The
prevalence of hypotension (57% vs 48%), atrial fibrillation (50% vs 40%),
and other adverse events did not significantly differ between levosimendan
and placebo. CONCLUSIONS AND RELEVANCE: Among patients with low ejection
fraction who were undergoing coronary artery bypass grafting with
cardiopulmonary bypass, levosimendan compared with placebo did not result
in a significant difference in the composite end point of prolonged
catecholamine infusion, use of left ventricular mechanical assist device,
or renal replacement therapy. These findings do not support the use of
levosimendan for this indication. TRIAL REGISTRATION: EudraCT Number:
2012-000232-25; clinicaltrials.gov Identifier: NCT02184819.<br/>Copyright
&#xa9; 2017 American Medical Association. All rights reserved.

<45>
Accession Number
617795495
Author
Li Q.; Zhang X.; Wu J.; Xu M.
Institution
(Li, Zhang, Wu, Xu) Department of Anesthesiology of Shanghai Chest
Hospital, Shanghai Jiaotong University, Shanghai 200030, China
Title
Two-minute disconnection technique with a double-lumen tube to speed the
collapse of the non-ventilated lung for one-lung ventilation in
thoracoscopic surgery.
Source
BMC Anesthesiology. 17 (1) (no pagination), 2017. Article Number: 80. Date
of Publication: 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Thoracic surgery requires the effective collapse of the
non-ventilated lung. In the majority of cases, we accomplished,
accelerated lung collapse using a double-lumen tube (DLT). We hypothesized
that using the twominute disconnection technique with a DLT would improve
lung collapse during subsequent one-lung ventilation. Methods: Fifty
patients undergoing thoracoscopic surgery with physical classification I
or II according to the American Society of Anesthesiologists were randomly
divided into two groups for respiratory management of one-lung ventilation
(OLV). In group N, OLV was initiated after the DLT was disconnected for 2
min; the initiation time began when the surgeon made the skin incision. In
group C, OLV was initiated when the surgeon commenced the skin incision
and scored the quality of lung collapse (using a four-point ordinal
scale). The surgeon's satisfaction or comfort with the surgical conditions
was assessed using a visual analogue scale. rSO<inf>2</inf> level, mean
arterial pressure, pulse oxygen saturation, arterial blood gas analysis,
intraoperative hypoxaemia, intraoperative use of CPAP during OLV, and
awakening time were determined in patients at the following time points:
while inhaling air (T<inf>0</inf>), after anaesthesia induction
andinhaling 100% oxygen in the supine position under double lung
ventilation for five mins (T<inf>1</inf>), at two mins after skin incision
(T<inf>2</inf>), at ten mins after skin incision (T<inf>3</inf>), and
after the lung recruitment manoeuvres and inhaling 50% oxygen for five
mins (T<inf>4</inf>). Results: The two-minute disconnection technique was
associated with a significantly shorter time to total lung collapse
compared to that of the conventional OLV ventilation method (15 mins vs 22
mins, respectively; P < 0.001), and the overall surgeon's satisfaction was
higher (9 vs 7, respectively; P < 0.001). At T<inf>2</inf>, the
PaCO<inf>2</inf>, left rSO<inf>2</inf> and right rSO<inf>2</inf> were
higher in group N than in group C. There were no statistically significant
differences between the incidence of intraoperative hypoxaemia and
intraoperative use of CPAP during OLV (10% vs 5%, respectively; P =
1.000), duration of awakening (18 mins vs 19 mins, respectively; P =
0.616). Conclusions: A two-minute disconnection technique using a
double-lumen tube was used to speed the collapse of the non-ventilated
lung during one-lung ventilation for thoracoscopic surgery. The surgeon
was satisfied with the surgical conditions.<br/>Copyright &#xa9; The
Author(s). 2017.

<46>
Accession Number
617792696
Author
Zou H.; Hong Q.; Xu G.
Institution
(Zou) Medical Center of the Graduate School, Nanchang University,
Nanchang, China
(Hong) Science and Technology College, Jiangxi University of Traditional
Chinese Medicine, Nanchang, China
(Zou, Xu) Department of Nephrology, The Second Affiliated Hospital of
Nanchang University, No. 1, Minde Road, Donghu District, Nanchang 330006,
China
Title
Early versus late initiation of renal replacement therapy impacts
mortality in patients with acute kidney injury post cardiac surgery: A
meta-analysis.
Source
Critical Care. 21 (1) (no pagination), 2017. Article Number: 150. Date of
Publication: 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Acute kidney injury (AKI) is a common clinical complication of
cardiac surgery and increases mortality and hospitalization. We aimed to
explore and perform an updated meta-analysis of qualitative and
quantitative evaluations of the relationship between early renal
replacement therapy (RRT) and mortality. Methods: We searched the Chinese
Biomedical Database, the Cochrane Library, EMBASE, Global Health, MEDLINE
and PubMed. Results: Fifteen studies (five randomized controlled trials
(RCTs), one prospective cohort and nine retrospective cohorts) including
1479 patients were identified for detailed evaluation. The meta-analysis
suggested that early RRT initiation reduced 28-day mortality (odds ratio
(OR) 0.36; 95% confidence interval (CI) 0.23 to 0.57; I² 60%),
and shortened intensive care unit (ICU) length of stay (LOS) (mean
difference (MD) -2.50; 95% CI -3.53 to -1.47; I2 88%) and hospital LOS (MD
-0.69; 95% CI -1.13 to -0.25; I² 88%), and also reduced the
duration of RRT (MD -1.18; 95% CI -2.26 to -0.11; I² 69%),
especially when RRT was initiated early within 12 hours (OR 0.23; 95% CI
0.08 to 0.63; I² 73%) and within 24 hours (OR 0.52; 95% CI 0.28
to 0.95; I² 58%) in patients with AKI after cardiac surgery.
Conclusions: Early RRT initiation decreased 28-day mortality, especially
when it was started within 24 hours after cardiac surgery in patients with
AKI.<br/>Copyright &#xa9; The Author(s). 2017.

<47>
Accession Number
615346947
Author
Enezate T.H.; Kumar A.; Fadel M.A.; Patel M.; Al Dadah A.; Omran J.
Institution
(Enezate, Kumar, Omran) University of Missouri-Columbia School of
Medicine, Columbia, MO, United States
(Fadel) University of Oklahoma Health Science Center, Oklahoma City, OK,
United States
(Patel) University of California-San Diego Health Systems, San Diego, CA,
United States
(Al Dadah) Prairie Heart Institute, SpringField, IL, United States
Title
Transcatheter versus surgical aortic valve replacement in patients with
non-high surgical risk severe aortic stenosis: A systematic review.
Source
Cardiovascular Revascularization Medicine. 18 (5 Supplement 1) (pp
S40-S48), 2017. Date of Publication: July 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective Transcatether aortic valve replacement (TAVR) has emerged as an
acceptable alternative to surgical aortic valve replacement (SAVR) in
patients with high-risk surgical profile. In this analysis, we compare
both approaches in non-high surgical risk severe aortic stenosis. Methods
Only studies comparing SAVR and TAVR and enrolling patients with
low-intermediate risk were included from January 2000 through May 2016.
Primary endpoints were assessed at 1 and 12 months including: mortality,
cerebrovascular accident (CVA) and myocardial infarction (MI). Secondary
endpoints at 1 month included: bleeding, acute kidney injury, new
permanent pacemaker implantation and vascular access site complications.
Results A total of 5223 patients from 8 studies were included (4
prospective and 4 retrospective). There were no significant differences
between TAVR and SAVR at one month in terms of mortality (risk ratio RR
0.91, 95% CI: 0.68 to 1.20), or CVA (RR 0.91, 95% CI 0.68 to 1.21).
However, MI was lower in the TAVR group (RR 0.58, 95% CI 0.34 to 0.99). At
12 months, there was no significant difference between strategies in terms
of mortality (RR 0.98, 95% CI 0.84-1.13), CVA (RR1.07, 95% CI 0.85-1.33)
or MI (RR 0.78, 95% CI 0.53-1.15). With regard to secondary outcomes, TAVR
was associated with lower rates of bleeding (RR 0.44, 95% CI 0.22-0.88)
and acute kidney injury (RR 0.54, 95% CI 0.31-0.93) but higher need for
new permanent pacemaker implantation (RR 2.99, 95% CI 1.51-5.94) and high
rate of vascular access site complications (RR 9.08, 95% CI 2.03-40.66).
Conclusion In severe AS patients with non-high surgical risk, TAVR has
lower risk of MI at one month, but both TAVR and SAVR yielded similar
outcomes at one month in terms of mortality and CVA and at 12 months in
terms of mortality, CVA and MI. In regard to secondary outcomes at one
month, TAVR has lower rates of bleeding and acute kidney injury, and
higher rates of need for new permanent pacemakers and high rate of
vascular access site complications.<br/>Copyright &#xa9; 2017 Elsevier
Inc.

<48>
Accession Number
616842262
Author
Millot S.; Lesclous P.; Colombier M.-L.; Radoi L.; Messeca C.; Ballanger
M.; Charrier J.-L.; Tramba P.; Simon S.; Berrebi A.; Doguet F.; Lansac E.;
Tribouilloy C.; Habib G.; Duval X.; Iung B.
Institution
(Millot) Department of oral surgery, Montpellier university hospital,
Montpellier 34295, France
(Millot) Inserm 1149, Paris 75018, France
(Lesclous) Department of oral surgery, Nantes hospital, university of
Nantes, Inserm U791, LIOAD, Nantes 44093, France
(Colombier) Department of periodontology, Louis-Mourier hospital, AP-HP,
university of Paris Descartes, Colombes 92700, France
(Radoi) Department of oral surgery, Louis-Mourier hospital, AP-HP,
university of Paris Descartes, Inserm U1018, Colombes 92700, France
(Messeca) Odontology department, Bichat hospital, AP-HP, Paris 75018,
France
(Ballanger) Department of oral surgery, Pitie-Salpetriere hospital, AP-HP,
university of Paris Descartes, Paris 75013, France
(Charrier) Department of oral surgery, Bretonneau hospital, AP-HP,
university of Paris Descartes, Paris 75018, France
(Tramba) Department of implantology and prosthetics, Pitie Salpetriere
hospital, AP-HP, university of Paris Descartes, Paris 75013, France
(Simon) Endodontics department, Pitie-Salpetriere hospital, AP-HP,
Paris-Diderot university, Paris 75013, France
(Berrebi) Department of cardiology, Georges Pompidou european hospital,
AP-HP, institut mutualiste Montsouris, Paris 75014, France
(Doguet) Department of thoracic and cardiovascular surgery, Rouen
university hospital, Inserm U1096, Rouen 76000, France
(Lansac) Department of cardiac surgery, institut mutualiste Montsouris,
Paris 75014, France
(Tribouilloy) Department of cardiology, university hospital of Amiens,
Inserm U1088, Jules-Verne university of Picardie, Amiens 80480, France
(Habib) Department of cardiology, La Timone hospital, Aix-Marseille
university, Marseille 13385, France
(Duval) Centre of clinical investigations, Inserm 1425, Bichat hospital,
AP-HP, Paris-Diderot university, Inserm U1137, AEPEI, Paris 75018, France
(Iung) Department of cardiology, Bichat hospital, AP-HP, DHU FIRE,
Paris-Diderot university, 46, rue Henri-Huchard, Paris 75018, France
Title
Position paper for the evaluation and management of oral status in
patients with valvular disease: Groupe de Travail Valvulopathies de la
Societe Francaise de Cardiologie, Societe Francaise de Chirurgie Orale,
Societe Francaise de Parodontologie et d'Implantologie Orale, Societe
Francaise d'Endodontie et Societe de Pathologie Infectieuse de Langue
Francaise.
Source
Archives of Cardiovascular Diseases. 110 (8-9) (pp 482-494), 2017. Date of
Publication: August 2017.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Oral health is of particular importance in patients with heart valve
diseases because of the risk of infective endocarditis. Recommendations
for antibiotic prophylaxis before dental procedures have been restricted,
but the modalities of oral evaluation and dental care are not detailed in
guidelines. Therefore, a multidisciplinary working group reviewed the
literature to propose detailed approaches for the evaluation and
management of buccodental status in patients with valvular disease. Simple
questions asked by a non-dental specialist may draw attention to
buccodental diseases. Besides clinical examination, recent imaging
techniques are highly sensitive for the detection of inflammatory bone
destruction directly related to oral or dental infection foci. The
management of buccodental disease before cardiac valvular surgery should
be adapted to the timing of the intervention. Simple therapeutic
principles can be applied even before urgent intervention. Restorative
dentistry and endodontic and periodontal therapy can be performed before
elective valvular intervention and during the follow-up of patients at
high risk of endocarditis. The detection and treatment of buccodental foci
of infection should follow specific rules in patients who present with
acute endocarditis. Implant placement is no longer contraindicated in
patients at intermediate risk of endocarditis, and can also be performed
in selected high-risk patients. The decision for implant placement should
follow an analysis of general and local factors increasing the risk of
implant failure. The surgical and prosthetic procedures should be
performed in optimal safety conditions. It is therefore now possible to
safely decrease the number of contraindicated dental procedures in
patients at risk of endocarditis.<br/>Copyright &#xa9; 2017 Elsevier
Masson SAS

<49>
Accession Number
617936119
Author
Chen X.; Huang T.; Cao X.; Xu G.
Institution
(Chen, Cao) Grade 2013, The Second Clinical Medical College of Nanchang
University, Nanchang, Jiangxi, China
(Huang, Xu) Department of Nephrology, The Second Affiliated Hospital of
Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, Jiangxi
330006, China
Title
Comparative Efficacy of Drugs for Preventing Acute Kidney Injury after
Cardiac Surgery: A Network Meta-Analysis.
Source
American Journal of Cardiovascular Drugs. (pp 1-10), 2017. Date of
Publication: 17 Aug 2017.
Publisher
Springer International Publishing
Abstract
Background: Acute kidney injury (AKI) occurs frequently after cardiac
surgery and has been associated with increased hospital length of stay,
mortality, and costs. Objective: We aimed to evaluate the efficacy of
pharmacologic strategies for preventing AKI after cardiac surgery.
Methods: We searched PubMed, Embase, the Cochrane Central Register of
Controlled Trials (CENTRAL) up to 6 May 2017 and the reference lists of
relevant articles about trials. The outcome was the occurrence of AKI.
This is the first network meta-analysis of the different prevention
strategies using Bayesian methodology. Results: The study included 63
articles with 19,520 participants and evaluated the effect of ten
pharmacologic strategies to prevent AKI in patients undergoing cardiac
surgery. Compared with placebo, the odds ratio (OR) for the occurrence of
AKI was 0.24 [95% confidence interval (CI) 0.16-0.34] with natriuretic
peptide, 0.33 (95% CI 0.14-0.70) with fenoldopam, 0.54 (95% CI 0.31-0.84)
with dexmedetomidine, 0.56 (95% CI 0.29-0.95) with low-dose
erythropoietin, 0.63 (95% CI 0.43-0.88) with levosimendan, 0.76 (95% CI
0.52-1.10) with steroids, 0.83 (95% CI 0.48-1.40) with high-dose
erythropoietin, 0.85 (95% CI 0.64-1.14) with N-acetylcysteine, 0.96 (95%
CI 0.69-1.29) with sodium bicarbonate, and 1.05 (95% CI 0.70-1.41) with
statins. The surface under the cumulative ranking curve probabilities
indicated that natriuretic peptide was the best treatment therapy and that
fenoldopam ranked second. Conclusions: Natriuretic peptide is probably the
preferred pharmacologic strategy to prevent AKI in adult patients
undergoing cardiac surgery, especially in those at high risk of
AKI.<br/>Copyright &#xa9; 2017 Springer International Publishing AG

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

<51>
Accession Number
617599171
Author
Ikeme S.; Rock M.; Bin Sawad A.; Kuntze E.; Martin M.
Institution
(Ikeme, Rock) Baxter Healthcare Corporation, Deerfield, IL, United States
(Bin Sawad, Kuntze) Baxter Healthcare, Deerfield, IL, United States
(Martin) InVentiv Health, London, United Kingdom
Title
Clinical and economic burden of transfusion in cardiac surgery: A
systematic review.
Source
Value in Health. Conference: ISPOR 22nd Annual International Meeting.
United States. 20 (5) (pp A279), 2017. Date of Publication: May 2017.
Publisher
Elsevier Ltd
Abstract
OBJECTIVES: We conducted a systematic review to identify published
evidence from observational studies on the clinical and economic burden of
transfusion in cardiac surgery. METHODS: We searched Embase, Pubmed and
the Centre for Reviews and Dissemination (CRD) suite of databases for
English language articles and analyzed these qualitatively. The search was
limited to evidence published in the last 10 years (2006-2016). RESULTS:
The review identified 16 publications and 15 were observational study
design. Majority of the studies examined patients undergoing coronary
artery bypass graft (CABG) and aortic valve replacement (AVR). The rate of
transfusion ranged from 15% to 84% in those patients who experienced
excessive bleeding after cardiac surgery. A significant reduction in
transfusion rates and red blood cell (RBC) usage was observed with
patients who did not experience bleeding, use blood conversation
strategies and less invasive surgical techniques (n=6). Platelet use
ranged from 9.8% to 84% and was significantly higher in patients who
experienced bleeding or underwent re-exploration (n=5). Fresh Frozen
Plasma (FFP) use ranged from 2.4% to 63% (n=5) and there was a significant
difference in units of FFP transfused in patients with post-operative
bleeding and re-exploration (n=2). Transfused cardiac surgery patients had
significantly longer hospital stays, were more frequently hospitalized and
utilized more ICU services. Total costs of blood and transfusions were
highest in the United States and correlated significantly with transfusion
rate. Mortality data (n=5) showed that patients who received transfusion
had higher in-hospital (1.7%-3.07%) and long-term (5.8%-6.4%) mortality
and a dose-dependent relationship between unit of packed RBC and higher
odds for post-operative mortality. CONCLUSIONS: Transfusion of blood
products and the resultant higher resource utilization in cardiac surgery
patients pose substantial clinical burden to the patient and economic
consequences to the hospital/health system. Reducing both factors has the
potential to reduce patient morbidity and healthcare cost.

<52>
Accession Number
617598674
Author
Avdeyev A.; Mendykulov S.; Mussayev S.; Albayev R.; Kaptagayeva A.; Sharip
B.; Tabarov A.; Zhanabekova L.; Gizatullina A.; Makalkina L.
Institution
(Avdeyev, Mendykulov, Mussayev, Albayev, Sharip, Tabarov, Zhanabekova,
Gizatullina) Hospital of the Medical Center, President's Affairs
Administration of the Republic of Kazakhstan, Astana, Kazakhstan
(Kaptagayeva) Ministry of Healthcare, Social Development of the Republic
of Kazakhstan, Astana, Kazakhstan
(Makalkina) Medical University Astana, Astana, Kazakhstan
Title
Simultaneous endovascular aneurysm repair and coronary artery bypass
grafting.
Source
Value in Health. Conference: ISPOR 22nd Annual International Meeting.
United States. 20 (5) (pp A276), 2017. Date of Publication: May 2017.
Publisher
Elsevier Ltd
Abstract
OBJECTIVES: Simultaneous endovascular aneurysm repair (EVAR) and coronary
artery bypass grafting (CABG) includes two different surgical operations
doing by two teams of operating surgeons during one anaesthetic support.
Patients with concomitant aortic aneurismal disease and coronary artery
disease stay in group of high risk of perioperative aortic aneurism
rupture and myocardial infarction. Therefore, simultaneous EVAR/CABG can
reduce the incidence of late aortic aneurism rupture and myocardial
infarction and can improve survival in the short and long-term period.
This research aim is to evaluate clinical effectiveness, safety and
economic effectiveness of simultaneous EVAR/CABG compared with conducting
these surgical operations separately. METHODS: For opportunity to evaluate
clinical effectiveness, safety and economic effectiveness of simultaneous
EVAR/CABG the systematic literature search was conducted in databases of
evidence-based medicine named MEDLINE, EMBASE, Tripdatabase, Clinical
Trials. Publication date: nolaterthan 10 years (since 2007). RESULTS: As a
result of systematic search we found 12 articles; all of these articles
confirmed clinical effectiveness and safety of simultaneous EVAR/ CABG in
patients with large and/or symptomatic aortic aneurism and severe coronary
artery disease. Simultaneous EVAR/CABG can be viable procedure with low
operative mortality and acceptable rate of perioperative complications.
From the side of economic effectiveness conducting simultaneous EVAR/CABG
can reduce costs for 1
patienttreatmentbyameanof7.5%(1120USD)dueto1)reducing duration of hospital
stay and postoperative rehabilitation; 2) no need for additional
anaesthetic support; 3) decreasing in incidence of post-operative aortic
aneurism ruptures and myocardial infarctions in patients with concomitant
aortic aneurismal and coronary artery diseases. CONCLUSIONS: Simultaneous
endovascular aneurysm repair and coronary artery bypass grafting can be
viable procedure for patients with concomitant large and/or symptomatic
aortic aneurism and severe coronary artery disease with low operative
mortality, acceptable rate of perioperative complications and has some
economic advantages over conducting these surgical operations separately.

<53>
Accession Number
616790188
Author
Cerfolio R.; Louie B.E.; Farivar A.S.; Onaitis M.; Park B.J.
Institution
(Cerfolio) Division of Thoracic Surgery, New York University, New York,
NY, United States
(Louie, Farivar) Division of Thoracic Surgery, Swedish Cancer Institute,
Seattle, Wash, United States
(Onaitis) Division of Thoracic Surgery, Duke University, Durham, NC,
United States
(Park) Thoracic Service, Department of Surgery, Memorial Sloan Kettering
Cancer Center, New York, NY, United States
Title
Consensus statement on definitions and nomenclature for robotic thoracic
surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 154 (3) (pp 1065-1069),
2017. Date of Publication: September 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives Robotic thoracic operations are increasing, and new robotic
systems are imminent. A definition of what constitutes a robotic thoracic
operation and a nomenclature to detail the technique used is needed to
accurately compare outcomes. Methods The American Association of Thoracic
Surgeons Guideline Committee appointed an expert consensus writing
committee to construct definitions and nomenclature for robotic thoracic
surgery. A PubMed search was generated and after vetting and review of the
literature a consensus statement was reached. Results The proposed
definition is: "A robotic thoracic operation is a minimally invasive
surgical procedure that does not spread, lift or remove any part of the
chest or abdominal wall and is characterized by: the surgeon and the
assistant's vision of the operative field is via a monitor only and the
patient's tissue is manipulated by robotic instruments that follow a slave
like mimic of human hands or thoughts via a computerized system." In
addition, a flexible nomenclature is proposed that should be applicable to
current and future robotic systems that details the number of robotic arms
used, the types of ports and/or incisions made, the use of insufflation,
and the operation performed. Conclusions The American Association of
Thoracic Surgeons writing committee proposes a definition and nomenclature
for robotic thoracic surgery. Definitions are needed to ensure that future
studies accurately compare results and outcomes and nomenclatures allow
surgeons and scientists from diverse countries and cultures to use the
same language to allow accurate communication.<br/>Copyright &#xa9; 2017
The American Association for Thoracic Surgery

<54>
Accession Number
617774794
Author
Kaushal S.; Wehman B.; Pietris N.; Naughton C.; Bentzen S.M.; Bigham G.;
Mishra R.; Sharma S.; Vricella L.; Everett A.D.; Deatrick K.B.; Huang S.;
Mehta H.; Ravekes W.A.; Hibino N.; Difede D.L.; Khan A.; Hare J.M.
Institution
(Kaushal, Wehman, Naughton, Bigham, Mishra, Sharma, Deatrick, Mehta)
Division of Cardiac Surgery, University of Maryland School of Medicine,
110 S Paca St, 7th Floor, Baltimore, MD, United States
(Pietris, Huang) Division of Pediatric Cardiology, University of Maryland
School of Medicine, 110 S Paca St, 7th Floor, Baltimore, MD, United States
(Bentzen) Department of Epidemiology and Public Health, University of
Maryland School of Medicine, 660 W Redwood St, Baltimore, MD, United
States
(Vricella, Everett, Ravekes, Hibino) Division of Pediatric Cardiac Surgery
and Cardiology, Johns Hopkins Hospital, Zayed Tower Suite 7107, 1800
Orleans St, Baltimore, MD, United States
(Difede, Khan, Hare) Interdisciplinary Stem Cell Institute, University of
Miami Miller School of Medicine, 1501 NW 10th Ave, 9th Floor, Miami,
Florida, United States
Title
Study design and rationale for ELPIS: A phase I/IIb randomized pilot study
of allogeneic human mesenchymal stem cell injection in patients with
hypoplastic left heart syndrome.
Source
American Heart Journal. 192 (pp 48-56), 2017. Date of Publication: October
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Despite advances in surgical technique and postoperative care, long-term
survival of children born with hypoplastic left heart syndrome (HLHS)
remains limited, with cardiac transplantation as the only alternative for
patients with failing single ventricle circulations. Maintenance of
systemic right ventricular function is crucial for long-term survival, and
interventions that improve ventricular function and avoid or defer
transplantation in patients with HLHS are urgently needed. We hypothesize
that the young myocardium of the HLHS patient is responsive to the
biological cues delivered by bone marrow-derived mesenchymal stem cells
(MSCs) to improve and preserve right ventricle function. The ELPIS trial
(Allogeneic Human MEsenchymal Stem Cell Injection in Patients with
Hypoplastic Left Heart Syndrome: An Open Label Pilot Study) is a phase
I/IIb trial designed to test whether MSC injection will be both safe and
feasible by monitoring the first 10 HLHS patients for new major adverse
cardiac events. If our toxicity stopping rule is not activated, we will
proceed to the phase IIb component of our study where we will test our
efficacy hypothesis that MSC injection improves cardiac function compared
with surgery alone. Twenty patients will be enrolled in a randomized phase
II trial with a uniform allocation to MSC injection versus standard
surgical care (no injection). The 2 trial arms will be compared with
respect to improvement of right ventricular function, tricuspid valve
annulus size, and regurgitation determined by cardiac magnetic resonance
and reduced mortality, morbidity, and need for transplantation. This study
will establish the safety and feasibility of allogeneic mesenchymal stem
cell injection in HLHS patients and provide important insights in the
emerging field of stem cell-based therapy for congenital heart disease
patients.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<55>
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.

<56>
Accession Number
617839605
Author
Sauer A.C.; Veldhuijzen D.S.; Ottens T.H.; Slooter A.J.C.; Kalkman C.J.;
Van Dijk D.
Institution
(Sauer, Veldhuijzen, Ottens, Kalkman) Department of Anesthesiology,
University Medical Center Utrecht, PO Box 85500, GA Utrecht 3508,
Netherlands
(Veldhuijzen) Institute of Psychology, Health, Medical, and
Neuropsychology Unit, Faculty of Social Sciences, Leiden University, PO
Box 9555, RB, Leiden 2300, Netherlands
(Slooter, Van Dijk) Department of Intensive Care Medicine, University
Medical Center Utrecht, PO Box 85500, Utrecht 3508 GA, Netherlands
Title
Association between delirium and cognitive change after cardiac surgery.
Source
British Journal of Anaesthesia. 119 (2) (pp 308-315), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Previous studies provide inconsistent data on whether postoperative
delirium (POD) is a risk factor for postoperative cognitive decline
(POCD). We thus investigated the relationship between POD and cognitive
change after cardiac surgery and assessed the relationship between
preoperative cognitive domain scores and POD. Methods. Postoperative
deliriumwas assessed with the Confusion Assessment Method (CAM) adapted
for the intensive care unit and the conventional CAM accompanied by chart
review. Cognitive function was assessed with a neuropsychological test
battery before elective cardiac surgery and 1 month and 1 yr afterwards.
Cognitive change was calculated using the Reliable Change Index (RCI).
Multiple linear regression was used to adjust for confounding. Results. Of
the 184 patients who completed baseline assessment, 23 (12.5%) developed
POD. At 1 month, the decline in cognitive performance was worse in
patients with POD [median composite RCI 1.00, interquartile range (IQR)
1.67 to 0.28] than in patients without POD (RCI 0.04, IQR 0.70 to 0.63,
P0.02). At 1 yr, both groups showed cognitive improvement on average
compared with baseline (POD patients median composite RCI 0.25, IQR 0.42
to 1.31, vs non-POD patients RCI 0.92, IQR 0.18-1.53; P0.08). Correction
for differences in age and level of education did not change the results.
Patients with POD performed less well than patients without POD on the
preoperative Trailmaking test part A (P0.03). Conclusions. Postoperative
delirium is independently associated with cognitive decline 1 month after
surgery, but cognitive performance generally recovers in 1 yr. Patients
with a predisposition to POD can be identified before surgery by worse
performance in an attention task.<br/>Copyright &#xa9; The Author 2017.
Published by Oxford University Press.

<57>
Accession Number
614748523
Author
Nagaraja V.; Mamas M.; Mahmoudi M.; Rogers C.; Curzen N.
Institution
(Nagaraja) Department of Cardiology, Prince of Wales Hospital, Sydney,
NSW, Australia
(Mamas) Keele Cardiovascular Research Group, University of Keele, Royal
Stoke University Hospital, University Hospitals of North Midlands,
Stoke-on-Trent, United Kingdom
(Mahmoudi, Curzen) Faculty of Medicine, University of Southampton, United
Kingdom
(Rogers) HeartFlow, Redwood City, CA, United States
(Curzen) University Hospital Southampton NHS Foundation Trust, United
Kingdom
Title
Change in angiogram-derived management strategy of patients with chest
pain when some FFR data are available: How consistent is the effect?.
Source
Cardiovascular Revascularization Medicine. 18 (5) (pp 320-327), 2017. Date
of Publication: July 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background The assessment of patients presenting with angina using
invasive angiography alone is imperfect. By contrast, fractional flow
reserve (FFR) allows for assessment of lesion-specific ischemia, which is
predictive of clinical outcome. A series of studies has demonstrated that
the availability of FFR data at the time of diagnostic angiography leads
to significant differences in the management of those patients.
Hypothesis: The objective of this paper is to assess the consistency in
the difference in management resulting from an FFR-directed versus and
angiogram-directed strategy in appropriate observational and randomized
trials. Methods A methodical search was made using MEDLINE, Current
Contents Connect, Google Scholar, EMBASE, Cochrane library, PubMed,
Science Direct, and Web of Science. Results Eight studies were identified
using the eligibility criteria. A total of 2468 patients were recommended
to have optimal medical therapy (OMT) alone after initial angiographic
assessment but, after FFR results were available, a total of 716 (29.0%)
were referred for revascularization (PCI 626 patients [25.36%]; CABG 90
patients [3.64%]). Similarly, 3766 patients were originally committed to
PCI after initial angiography: of these 1454 patients (38.61%) were
reconsidered to be suitable for OMT alone and 71 individuals (1.8%) were
deemed suitable for CABG after FFR data were available. Further, of 366
patients referred for CABG based on angiographic data, the availability of
FFR data changed the final decision to OMT alone in 65 patients (17.76%)
and PCI in 51 patients (13.9%). Overall, the angiogram-derived management
was changed in 22%-48% of these study populations when FFR data were
available. Conclusions Some use of FFR during coronary angiography alters
the angiogram-directed management in a remarkably consistent manner. These
data suggest that routine use of FFR at the diagnostic angiogram would
improve patient care.<br/>Copyright &#xa9; 2017

<58>
Accession Number
617924585
Author
Moscarelli M.; Athanasiou T.; Speziale G.; Punjabi P.P.; Malietzis G.;
Lancellotti P.; Fattouch K.
Institution
(Moscarelli) NHLI, Imperial College London, London, United Kingdom
(Moscarelli, Speziale) GVM Care and Research, Anthea Hospital, Via Camillo
Rosalba 35/37, Bari, Italy
(Athanasiou, Punjabi, Malietzis) Department of Surgery and Cancer,
Imperial College London, London, United Kingdom
(Lancellotti) Department of Cardiology, GIGA Cardiovascular Sciences,
University of Liege Hospital, Liege, Belgium
(Lancellotti, Fattouch) GVM Care and Research Group, Maria Eleonora,
Palermo, Italy
Title
The value of adding sub-valvular procedures for chronic ischemic mitral
regurgitation surgery: A meta-analysis.
Source
Perfusion (United Kingdom). 32 (6) (pp 436-445), 2017. Date of
Publication: 01 Sep 2017.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: The most performed repair technique for the treatment of
chronic ischemic mitral regurgitation in patients referred for bypass
grafting remains restricted annuloplasty. However, it is associated with a
high rate of failure, especially if severe tenting exists. Objectives: To
understand if adjunctive sub-valvular mitral procedures may provide better
repair performance. Methods: A systematic literature review identified six
studies of which five fulfilled the criteria for meta-analysis. Outcomes
for a total of 404 patients (214 had adjunctive sub-valvular procedures
and 190 restricted annuloplasty) were meta-analyzed using random effects
modeling. Heterogeneity and subgroup sensitivity analysis were assessed.
Primary endpoints were: late recurrence of moderate mitral regurgitation,
left ventricle remodeling and coaptation depth at follow-up. Secondary
endpoints were: early mortality, mid-term survival and operative outcomes.
Results: Sub-valvular procedure technique was associated with a
significantly lower late recurrence of mitral regurgitation (Odds ratio
(OR) 0.34, 95% Confidence Interval (CI) [0.18, 0.65], p=0.0009), smaller
left ventricle end-systolic diameter (Weighted Mean Difference (WMD)
-4.06, 95% CI [-6.10, -2.03], p=0.0001) and reduced coaptation depth (WMD
-2.36, 95% CI [-5.01, -0.71], p=0.009). These findings were consistent,
even in studies that included patients at high risk for repair failure
(coaptation depth >10 mm and tenting area >2.5 cm²). A low
degree of heterogeneity was observed. There was no difference in terms of
early mortality and mid-term survival; sub-valvular technique was
associated with prolonged cardiopulmonary and cross-clamp time.
Conclusions: Adding sub-valvular procedures when repairing ischemic
chronic mitral valve regurgitation may be associated with better
durability, even in the case of the presence of predictors for late
failure. Perspective: Surgical sub-valvular adjunctive procedures have to
be considered in the case of the presence of echocardiographic predictors
for late failure.<br/>Copyright &#xa9; The Author(s) 2017.

<59>
Accession Number
617923267
Author
Rogers C.A.; Capoun R.; Scott L.J.; Taylor J.; Jain A.; Angelini G.D.;
Narayan P.; Suleiman M.-S.; Sarkar K.; Ascione R.
Institution
(Rogers, Scott, Taylor) Clinical Trials and Evaluation Unit, School of
Clinical Sciences, University of Bristol, Bristol, United Kingdom
(Capoun, Angelini, Suleiman, Ascione) Bristol Heart Institute, School of
Clinical Sciences, University of Bristol, Bristol, United Kingdom
(Jain) SAL Hospital and Medical Institute, Ahmedabad, India
(Narayan, Sarkar) Rabindranath Tagore International Institute of Cardiac
Sciences (RTIICS), Kolkata, India
Title
Shortening cardioplegic arrest time in patients undergoing combined
coronary and valve surgery: Results from a multicentre randomized
controlled trial: The SCAT trial.
Source
European Journal of Cardio-thoracic Surgery. 52 (2) (pp 288-296), 2017.
Article Number: ezx087. Date of Publication: 01 Aug 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Combined coronary artery bypass grafting and valve surgery
requires a prolonged period of cardioplegic arrest (CA) predisposing to
myocardial injury and postoperative cardiac-specific complications. The
aim of this trial was to reduce the CA time in patients undergoing
combined coronary artery bypass grafting and valve surgery and assess if
this was associated with less myocardial injury and related
complications.METHODS: Participants were randomized to (i) coronary artery
bypass grafting performed on the beating heart with cardiopulmonary bypass
support followed by CA for the valve procedure (hybrid) or (ii) both
procedures under CA (conventional). To assess complications related to
myocardial injury, we used the composite of death, myocardial infarction,
arrhythmia, need for pacing or inotropes for >12 h. To assess myocardial
injury, we used serial plasma troponin T and markers of metabolic stress
in myocardial biopsies.RESULTS: Hundred and sixty patients (80 hybrid and
80 conventional) were randomized. Mean age was 66.5 years and 74% were
male. Valve procedures included aortic (61.8%) and mitral (33.1%) alone or
in combination (5.1%). CA time was 16% lower in the hybrid group [median
98 vs 89 min, geometric mean ratio (GMR) 0.84, 95% confidence interval
(CI) 0.77-0.93, P = 0.0004]. Complications related to myocardial injury
occurred in 131/160 patients (64/80 conventional, 67/80 hybrid), odds
ratio 1.24, 95% CI 0.54-2.86, P = 0.61. Release of troponin T was similar
between groups (GMR 1.04, 95% CI 0.87-1.24, P = 0.68). Adenosine
monophosphate was 28% lower in the hybrid group (GMR 0.72, 95% CI
0.51-1.02, P = 0.056).CONCLUSIONS: The hybrid procedure reduced the CA
time but myocardial injury outcomes were not superior to conventional
approach.TRIAL REGISTRATION: ISRCTN65770930.<br/>Copyright &#xa9; The
Author 2017. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<60>
Accession Number
617923195
Author
Head S.J.; da Costa B.R.; Beumer B.; Stefanini G.G.; Alfonso F.;
Clemmensen P.; Collet J.-P.; Cremer J.; Falk V.; Filippatos G.; Hamm C.;
Kappetein A.P.; Kastrati A.; Knuuti J.; Kolh P.; Landmesser U.; Laufer G.;
Neumann F.-J.; Richter D.J.; Schauerte P.; Taggart D.P.; Torracca L.;
Valgimigli M.; Wijns W.; Witkowski A.; Windecker S.; Juni P.; Sousa-Uva M.
Institution
(Head, Beumer, Kappetein) Department of Cardiothoracic Surgery, Erasmus
University Medical Center, Rotterdam, Netherlands
(da Costa) Institute of Primary Health Care (BIHAM), University of Bern,
Bern, Switzerland
(Stefanini) Department of Biomedical Sciences, Humanitas University,
Rozzano-Milan, Italy
(Alfonso) Department of Cardiology, Hospital Universitario de La Princesa,
Madrid, Spain
(Clemmensen) Department of Medicine, Nykoebing F Hospital, University of
Southern Denmark, Odense, Denmark
(Collet) ACTION Study Group, Universite Pierre et Marie Curie (UPMC-Paris
06), Institut de Cardiologie, Pitie-Salpetriere Hospital (AP-HP), Paris,
France
(Cremer) Department of Cardiovascular Surgery, University Hospital
Schleswig-Holstein, Kiel, Germany
(Falk) Department of Cardiothoracic and Vascular Surgery, Klinik fur
Herz-Thorax-Gefasschirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany
(Filippatos) Heart Failure Unit, Department of Cardiology, Athens
University Hospital Attikon, Athens, Greece
(Hamm) Department of Cardiology, Kerckhoff Heart and Thoraxenter, Bad
Nauheim, Germany
(Kastrati) Department of Adult Cardiology, Deutsches Herzzentrum Munchen,
Technische Universitat, Munich, Germany
(Knuuti) Turku PET Centre, University of Turku, Turku University Hospital,
Turku, Finland
(Kolh) Department of Cardiovascular Surgery, University Hospital of Liege,
Liege, Belgium
(Landmesser) Department of Cardiology, Charite Berlin-University Medicine,
Campus Benjamin Franklin and Berlin Institute of Health (BIH), Berlin,
Germany
(Laufer) Department of Cardiac Surgery, Medical University of Vienna,
Vienna, Austria
(Neumann) Division of Cardiology and Angiology II, University Heart Center
Freiburg - Bad Krozingen, Bad Krozingen, Germany
(Richter) Second Cardiac Department, Euroclinic Hospital, Athens, Greece
(Schauerte) Department of Cardiology, University Hospital Aachen RWTH,
Aachen, Germany
(Taggart) Department of Cardiovascular Surgery, John Radcliffe Hospital,
University of Oxford, Oxford, United Kingdom
(Torracca) Cardio Center, Humanitas Research Hospital, Rozzano-Milan,
Italy
(Valgimigli, Windecker) Department of Cardiology, Bern University
Hospital, University of Bern, Bern, Switzerland
(Wijns) Cardiovascular Research Center, OLV Hospital Aalst, Aalst, Belgium
(Witkowski) Department of Interventional Cardiology and Angiology,
Institute of Cardiology, Warsaw, Poland
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute of
St Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Sousa-Uva) Department of Cardiac Surgery, Hospital Cruz Vermelha, Lisbon,
Portugal
Title
Adverse events while awaiting myocardial revascularization: A systematic
review and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 52 (2) (pp 206-217), 2017.
Article Number: ezx115. Date of Publication: 01 Aug 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The aim of the current study was to estimate adverse event
rates while awaiting myocardial revascularization and review criteria for
prioritizing patients. METHODS: A PubMed search was performed on 19
January 2015, to identify English-language, original, observational
studies reporting adverse events while awaiting coronary artery bypass
grafting (CABG) or percutaneous coronary intervention (PCI). Rates of
death, nonfatal myocardial infarction (MI) and emergency revascularization
were calculated as occurrence rates per 1000 patient-weeks and pooled
using random-effects models. RESULTS: The search yielded 1323 articles, of
which 22 were included with 66 410 patients and 607 675 patient-weeks on
the wait list. When awaiting CABG, rates per 1000 patient-weeks were 1.1
[95% confidence interval 0.9-1.3] for death, 1.0 [0.6-1.6] for non-fatal
MI and 1.8 [0.8-4.1] for emergency revascularization. Subgroup analyses
demonstrated consistent outcomes, and sensitivity analyses demonstrated
comparable event rates with low heterogeneity. Higher urgency of
revascularization was based primarily on angiographic complexity, angina
severity, left ventricular dysfunction and symptoms on stress testing, and
such patients with a semi-urgent status had a higher risk of death than
patients awaiting elective revascularization (risk ratio at least 2.8).
Individual studies identified angina severity and left ventricular
dysfunction as most important predictors of death when awaiting CABG.
Adverse rates per 1000 patient-weeks for patients awaiting PCI were 0.1
[95% confidence interval 0.0-0.4] for death, 0.4 [0.1-1.2] for non-fatal
MI and 0.7 [0.4-1.4] for emergency revascularization but were based on
only a few old studies. CONCLUSIONS: Rates of death, non-fatal MI and
emergency revascularization when awaiting myocardial revascularization are
infrequent but higher in specific patients. Countries that not yet have
treatment recommendations related to waiting times should consider
introducing a maximum to limit adverse events, particularly when awaiting
CABG.<br/>Copyright &#xa9; The Author 2017. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.

<61>
Accession Number
617931165
Author
Villablanca P.A.; Al-Bawardy R.; Mohananey D.; Maraboto C.; Weinreich M.;
Gupta T.; Briceno D.F.; Ramakrishna H.
Institution
(Villablanca) New York University Langone Medical CenterNew York, New York
(Al-Bawardy) Division of CardiologyMassachusetts General Hospital/Harvard
Medical SchoolBoston, Massachusetts
(Mohananey) Department of Internal MedicineCleveland ClinicCleveland, Ohio
(Maraboto) Department of MedicineJacobi Medical Center/Albert Einstein
College of MedicineNew York, New York
(Weinreich, Gupta, Briceno) Division of Cardiovascular DiseasesMontefiore
Medical Center/Albert Einstein College of MedicineNew York, New York
(Ramakrishna) Division of Cardiovascular and Thoracic AnesthesiologyMayo
Clinic College of MedicineScottsdale, Arizona
Title
Bivalirudin versus heparin in patients undergoing percutaneous
transcatheter aortic valve interventions: A systematic review and
meta-analysis.
Source
Journal of Interventional Cardiology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Bivalirudin may be an effective anticoagulation alternative to
heparin as anticoagulant agent in percutaneous transcatheter aortic valve
interventions (PAVI). We aimed to compare safety and efficacy of
bivalirudin versus heparin as the procedural anticoagulant agent in
patients undergoing PAVI. Methods: We conducted an electronic database
search of all published data. The primary efficacy endpoints were
all-cause mortality, cardiovascular mortality, myocardial infarction, and
stroke. Safety endpoints include major and life-threatening bleed
according to VARC and BARC bleeding, blood transfusion, vascular
complications, and acute kidney injury. Odds ratios (OR) and 95%
confidence intervals (CI) computed using the Mantel-Haenszel method.
Results: Three studies (n=1690 patients) were included, one randomized
trial and two observational studies. There was a significant difference
favoring bivalirudin over heparin for myocardial infarction (OR 0.41,
95%CI 0.20-0.87). There was no significant difference in all-cause
mortality at 30 days (OR 0.97, 95%CI 0.62-1.52), cardiovascular mortality
(OR 1.03, 95%CI 0.52-2.05), stroke (OR 1.23, 95%CI 0.62-2.46), vascular
complications (OR 0.96, 95%CI 0.70-1.32), acute kidney injury (OR 1.03,
95%CI 0.53-2.00), blood transfusion (OR 0.67, 95% CI 0.45-1.01), major and
life-threatening bleed (OR 0.74, 95%CI 0.37-1.49), and BARC bleeding (OR
0.52, 95%CI 0.23-1.18). Conclusions: In patient undergoing aortic valve
interventions, no difference was seen between the use of bivalirudin and
heparin as the procedural anticoagulant agent, except for a significant
lower myocardial infarction events when bivalirudin was used. Further
large randomized trials are needed to confirm current
results.<br/>Copyright &#xa9; 2017, Wiley Periodicals, Inc.

<62>
Accession Number
617922869
Author
Baikoussis N.G.; Antonopoulos C.N.; Papakonstantinou N.A.; Argiriou M.;
Geroulakos G.
Institution
(Baikoussis, Antonopoulos, Papakonstantinou, Argiriou) Cardiovascular and
Thoracic Surgery Department, General Hospital of Athens Evangelismos,
Athens, Greece
(Antonopoulos) Department of Vascular Surgery, King's College Hospital,
London, United Kingdom
(Geroulakos) Department of Vascular Surgery, Attikon Hospital, Medical
School, National and Kapodistrian University of Athens, Athens, Greece
Title
Endovascular stent grafting for ascending aorta diseases.
Source
Journal of Vascular Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: Conventional open surgery encompassing cardiopulmonary bypass
has been traditionally used for the treatment of ascending aorta diseases.
However, more than one in five of these patients will be finally
considered unfit for open repair. We conducted a systematic review and
meta-analysis to investigate the role of thoracic endovascular aortic
repair (TEVAR) for aortic diseases limited to the ascending aorta.
Methods: The current meta-analysis was conducted using the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We
investigated patients' baseline characteristics along with early (30
days/in-hospital stay) and late (beyond 30 days/in-hospital stay) outcomes
after TEVAR limited to the ascending aorta and not involving the arch
vessels. Separate analyses for case reports and case series were
conducted, and pooled proportions with 95% confidence intervals (CIs) of
outcome rates were calculated. Results: Approximately 67% of the patients
had a prior cardiac operation. TEVAR was performed mainly for acute or
chronic Stanford type A dissection (49%) or pseudoaneurysm (28%). The
device was usually delivered through the femoral artery (67%), and rapid
ventricular pacing was used in nearly half of the patients. Technical
success of the method was 95.5% (95% CI, 87.8-99.8). Among the early
outcomes, conversion to open repair was 0.7% (95% CI, 0.1-4.8), whereas
mortality was 2.9% (95% CI, 0.02-8.6). We estimated a pooled rate of 1.8%
(95% CI, 0.1-7.0) for neurologic events (stroke or transient ischemic
attack) and 0.8% (95% CI, 0.1-5.6) for myocardial infarction. Late
endoleak was recorded in 16.4% (95% CI, 8.2-26.0), and 4.4% (95% CI,
0.1-12.4) of the population died in the postoperative period. Finally,
reoperation was recorded in 8.9% (95% CI, 3.1-16.4) of the study sample.
Conclusions: TEVAR in the ascending aorta seems to be safe and feasible
for selected patients with various aortic diseases, although larger
studies are required.<br/>Copyright &#xa9; 2017 Society for Vascular
Surgery.

<63>
Accession Number
617920749
Author
Ando T.; Takagi H.; Telila T.; Afonso L.
Institution
(Ando, Telila, Afonso) Detroit Medical Center/Wayne State University,
Division of Cardiology, Detroit, United States
(Takagi) Shizuoka Medical Center, Division of Cardiovascular Surgery,
Shizuoka, Japan
Title
Comparison of outcomes in new-generation versus early-generation heart
valve in transcatheter aortic valve implantation: A systematic review and
meta-analysis.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: New-generation (NG) valves for transcatheter aortic valve
implantation (TAVI) has recently been widely used in real-world practice,
yet its comparative outcomes with early-generation (EG) valves remain
under-explored. Methods: An electronic literature search using PUBMED and
EMBASE was conducted from inception to April 2017 for matched-cohort
studies. Articles that compared the outcomes of NG vs. EG valves post TAVI
with at least one of the following clinical outcome reported were
included: all-cause mortality, major or life-threatening bleeding, major
vascular complications (MVC), significant (more than moderate)
paravalvular regurgitation (PVR), cerebrovascular events, significant
(stage 2 or 3) acute kidney injury (AKI) and new permanent pacemaker
implantation (PPI) that occurred either in-hospital or within 30-days.
Results: A total of 6 observational matched-cohort studies with 585 and
647 patients included in NG and EG valves, respectively, were included. EG
valves were associated with a lower incidence of major or life-threatening
bleeding (5.7% vs. 15.7%, p <. 0.00001), significant paravalvular
regurgitation (5.3% vs. 14.4%, p = 0.001), and significant AKI (4.4% vs.
7.5, p = 0.03). All-cause mortality (3.5% vs. 5.0, p = 0.43),
cerebrovascular events (3.4% vs. 2.3%, p = 0.34) and new PPI (11.0% vs.
14.6%, p = 0.52) were similar between the two groups. NG demonstrated
lower tendency of MVC (2.5% vs. 7.2, p = 0.09) compared to EG valves.
Conclusions: NG demonstrated lower rates of significant AKI, significant
PVR and major or life-threatening bleeding while all-cause mortality, new
PPI, and cerebrovascular events remained similar compared to EG
valves.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<64>
Accession Number
617911914
Author
Patel N.N.; Murphy G.J.
Institution
(Patel) National Heart and Lung Institute, Imperial College London,
Hammersmith Campus, London, UK
(Murphy) Department of Cardiovascular Sciences, University of Leicester,
Glenfield Hospital, Leicester, UK
Title
Evidence-Based Red Blood Cell Transfusion Practices in Cardiac Surgery.
Source
Transfusion Medicine Reviews. (no pagination), 2017. Date of Publication:
2017.
Publisher
W.B. Saunders
Abstract
Cardiac surgical patients are among the highest consumers of allogeneic
red blood cells (RBCs) due to the prevalence of anemia and bleeding. Up
until recently, there was a paucity of high-quality evidence informing
transfusion decisions in this patient group which led to wide variability
in transfusion decision making. The article reviews and critically
analyzes the available evidence for RBC transfusion in cardiac surgery,
focusing on trials of transfusion triggers and age of blood, and provides
suggestions for future research. Observational studies analyzing outcomes
in patients transfused vs those not transfused have consistently shown RBC
transfusion to be associated with adverse outcomes. However, multiple
sources of bias in these studies invalidate their conclusions. The best
available evidence comes from randomized controlled trials which compare
liberal vs restrictive transfusion thresholds. To date, 6 randomized
controlled trials have been reported in cardiac surgical patients, and
pooled analyses have shown no differences in clinical outcomes between the
2 strategies. Similarly, research into age of RBCs and adverse outcomes
has failed to demonstrate a pathological effect attributable to the
storage lesion; the recent multicenter Red Cell Storage Duration Study
(RECESS) trial has demonstrated no difference in outcomes between patients
receiving fresh or old RBCs. Future research needs to identify what a safe
transfusion threshold may be, and how this differs for different patient
groups and different stages of the perioperative journey. There is also a
need to evaluate other physiological parameters which, coupled with
hemoglobin concentration, can better inform those patients who need an RBC
transfusion.<br/>Copyright &#xa9; 2017.

<65>
Accession Number
617911808
Author
Danek B.A.; Karatasakis A.; Tajti P.; Sandoval Y.; Karmpaliotis D.;
Alaswad K.; Jaffer F.; Yeh R.W.; Kandzari D.E.; Lembo N.J.; Patel M.P.;
Mahmud E.; Choi J.W.; Doing A.H.; Lombardi W.L.; Wyman R.M.; Toma C.;
Garcia S.; Moses J.W.; Kirtane A.J.; Hatem R.; Ali Z.A.; Parikh M.;
Karacsonyi J.; Rangan B.V.; Khalili H.; Burke M.N.; Banerjee S.; Brilakis
E.S.
Institution
(Danek, Karatasakis, Karacsonyi, Rangan, Khalili, Banerjee, Brilakis) VA
North Texas Healthcare System/UT Southwestern Medical Center, Dallas,
Texas
(Tajti, Sandoval, Burke, Brilakis) Minneapolis Heart Institute,
Minneapolis, Minnesota
(Karmpaliotis, Moses, Kirtane, Hatem, Ali, Parikh) Columbia University,
New York, New York
(Alaswad) Henry Ford Hospital, Detroit, Michigan
(Jaffer) Massachusetts General Hospital and Harvard Medical School,
Boston, Massachusetts
(Yeh) Beth Israel Deaconess Medical Center and Harvard Medical School,
Boston, Massachusetts
(Kandzari, Lembo) Piedmont Heart Institute, Atlanta, Georgia
(Patel, Mahmud) VA San Diego Healthcare System/University of California
San Diego, San Diego, California
(Choi) Baylor Heart and Vascular Hospital, Dallas, Texas
(Doing) Medical Center of the Rockies, Loveland, Colorado
(Lombardi) PeaceHealth St. Joseph Medical Center, Bellingham, Washington
(Wyman) Torrance Memorial Medical Center, Torrance, California
(Toma) University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
(Garcia) Minneapolis VA Medical Center, Minneapolis, Minnesota
Title
Incidence, Treatment, and Outcomes of Coronary Perforation During Chronic
Total Occlusion Percutaneous Coronary Intervention.
Source
American Journal of Cardiology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Coronary perforation is a potential complication of chronic total
occlusion (CTO) percutaneous coronary intervention (PCI). We analyzed
2,097 CTO PCIs performed in 2,049 patients from 2012 to 2017. Patient age
was 65 +/- 10 years, 85% were men, and 36% had prior coronary artery
bypass graft surgery. Technical and procedural success were 88% and 87%,
respectively. A major periprocedural adverse cardiovascular event occurred
in 2.6%. Coronary perforation occurred in 85 patients (4.1%); The
frequency of Ellis class 1, 2, and 3 perforations was 21%, 26%, and 52%,
respectively. Perforation occurred more frequently in older patients and
those with previous coronary artery bypass graft surgery (61% vs 35%, p <
0.001). Cases with perforation were angiographically more complex
(Multicenter CTO Registry in Japan score 3.0 +/- 1.2 vs 2.5 +/- 1.3, p <
0.001). Twelve patients (14%) with perforation experienced tamponade
requiring pericardiocentesis. Patient age, previous PCI, right coronary
artery target CTO, blunt or no stump, use of antegrade dissection
re-entry, and the retrograde approach were associated with perforation.
Adjusted odds ratio for periprocedural major periprocedural adverse
cardiovascular events among patients with perforation was 15.04 (95%
confidence interval 7.35 to 30.18). In conclusion, perforation occurs
relatively infrequently in contemporary CTO PCI performed by experienced
operators and is associated with baseline patient characteristics and
angiographic complexity necessitating use of advanced crossing techniques.
In most cases, perforations do not result in tamponade requiring
pericardiocentesis, but they are associated with reduced technical and
procedural success, higher periprocedural major adverse events, and
reduced procedural efficiency.<br/>Copyright &#xa9; 2017.

<66>
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)

<67>
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.

<68>
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.

<69>
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.

<70>
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.

<71>
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.

<72>
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.

<73>
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.

<74>
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.

<75>
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.

<76>
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

<77>
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.

<78>
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.

<79>
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.

<80>
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.

<81>
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.

<82>
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.

<83>
Accession Number
617811393
Author
Cattoni M.; Vallieres E.; Brown L.M.; Sarkeshik A.A.; Margaritora S.;
Siciliani A.; Imperatori A.; Rotolo N.; Farjah F.; Wandell G.; Costas K.;
Mann C.; Hubka M.; Kaplan S.; Farivar A.S.; Aye R.W.; Louie B.E.
Institution
(Cattoni, Vallieres, Mann, Farivar, Aye, Louie) Division of Thoracic
Surgery, Swedish Cancer Institute, Seattle, Washington
(Brown, Sarkeshik) Section of General Thoracic Surgery, Department of
Surgery, UC Davis Medical Center, Sacramento, California
(Margaritora, Siciliani) Unit of Thoracic Surgery, Catholic University
Sacred Heart, Rome, Italy
(Imperatori, Rotolo) Center of Thoracic Surgery, University of Insubria,
Ospedale di Circolo, Varese, Italy
(Farjah, Wandell) Division of Cardiothoracic Surgery, University of
Washington Medical Center, Seattle, Washington
(Costas) Division of Thoracic Surgery, Providence Regional Medical Center,
Everett, Washington
(Hubka, Kaplan) Division of Thoracic Surgery, Virginia Mason Hospital and
Seattle Medical Center, Seattle, Washington
Title
External Validation of a Prognostic Model of Survival for Resected Typical
Bronchial Carcinoids.
Source
Annals of Thoracic Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier USA
Abstract
Background: This study aimed to assess the reliability and the validity of
a prognostic model of survival recently developed by the European Society
of Thoracic Surgery Neuroendocrine Tumor Working Group to predict 5-year
overall survival after surgical resection of pulmonary typical carcinoid.
Methods: We retrospectively collected data on 240 consecutive patients
(164 men, 76 women; median age, 58 years [interquartile range, 47 to 68])
who underwent curative lung resection for pulmonary typical carcinoid in
seven centers between 2000 and 2015. For each patient, we calculated the
corresponding risk class (A, B, C, D) using the following variables: male,
age, previous malignancy, Eastern Cooperative Oncology Group performance
status, peripheral tumor, TNM stage. Kaplan-Meier method, and Cox
proportional hazards model were used for the statistical analysis.
Results: During a median follow-up of 42 months (interquartile range, 11
to 84), the 5-year overall survival was 94.2% (95% confidence interval
[CI]: 90.2% to 98.2%); 15 of 240 patients died. A significantly decreasing
rate of survival was observed from class A to class D (p = 0.004) with
rates of 100% (95% CI: 100% to 100%), 96.3% (95% CI: 88.6% to 98.8%),
86.7% (95% CI: 63.0% to 95.7%), and 33.3% (95% CI: 0.9% to 77.4%),
respectively, for class A, B, C, and D. This difference persisted also
using clinical stage as a variable in the risk class calculation (p =
0.006). No differences were observed in term of overall survival among TNM
stage I, II, and III patients (p = 0.94). Conclusions: This prognostic
model of survival is easily applicable, it is validated by our independent
cohort, and it appears to stratify better than the traditional TNM
staging. Therefore, it may be useful in counseling patients about their
outcomes from surgical treatment and in tailoring treatment for high-risk
patients.<br/>Copyright &#xa9; 2017 The Society of Thoracic Surgeons.

<84>
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.

<85>
Accession Number
617803497
Author
Koch C.G.; Sessler D.I.; Mascha E.J.; Sabik J.F.; Li L.; Duncan A.I.;
Zimmerman N.M.; Blackstone E.H.
Institution
(Koch, Duncan) Department of Cardiothoracic Anesthesiology, Anesthesiology
Institute, Cleveland Clinic, Cleveland, Ohio
(Sessler, Mascha, Zimmerman) Department of Outcomes Research,
Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
(Mascha, Li, Zimmerman, Blackstone) Department of Quantitative Health
Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
(Sabik, Blackstone) Department of Thoracic and Cardiovascular Surgery,
Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
Title
A Randomized Clinical Trial of Red Blood Cell Transfusion Triggers in
Cardiac Surgery.
Source
Annals of Thoracic Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier USA
Abstract
Background: Class I evidence supporting a threshold for transfusion in the
cardiac surgical setting is scarce. We randomly allocated patients to a
transfusion hematocrit trigger of 24% versus 28% to compare morbidity,
mortality, and resource use. Methods: From March 2007 to August 2014, two
centers randomly assigned 722 adults undergoing coronary artery bypass
graft surgery or valve procedures to a 24% hematocrit trigger (n = 363,
low group) or 28% trigger (n = 354, high group). One unit of red blood
cells was transfused if the hematocrit fell below the designated
threshold. The primary endpoint was a composite of postoperative
morbidities and mortality. Treatment effect was primarily assessed using
an average relative effect generalized estimating equation model. Results:
At the second planned interim analysis, the a priori futility boundary was
crossed, and the study was stopped. There was no detected treatment effect
on the composite outcome (average relative effect odds ratio, low versus
high, 0.86, 95% confidence interval: 0.29 to 2.54, p = 0.71). However, the
low group received fewer red blood cell transfusions than the high group
(54% versus 75%, p < 0.001), mostly administered in the operating room
(low group, 112 [31%]; high group, 208 [59%]), followed by intensive care
unit (low, 105 [31%]; high, 115 [34%]) and floor (low, 41 [12%]; high, 42
[13%]). The low group was exposed to lower hematocrits: median before
transfusion, 22% (Q1 = 21%, Q3 = 23%) versus 24% (Q1 = 22%, Q3 = 25%).
Conclusions: Negative exposures differed between treatment groups, with
lower hematocrit in the 24% trigger group and more red blood cells used in
the 28% group, but adverse outcomes did not differ. Because red blood cell
use was less with a 24% trigger without adverse effects, our randomized
trial results support aggressive blood conservation efforts in cardiac
surgery.<br/>Copyright &#xa9; 2017 The Society of Thoracic Surgeons.

<86>
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.

<87>
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.

<88>
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)

<89>
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.

<90>
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.

<91>
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.

<92>
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).

<93>
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).

<94>
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).

<95>
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).

<96>
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).

<97>
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.

<98>
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.

<99>
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.

<100>
[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.

<101>
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

<102>
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

<103>
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

<104>
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.

<105>
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.

<106>
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.

<107>
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?.

<108>
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.

<109>
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

<110>
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.

<111>
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.

<112>
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

<113>
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.

<114>
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

<115>
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.

<116>
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.

<117>
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.

<118>
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.