EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 120

Results Generated From:
Embase <1980 to 2017 Week 38>
Embase <2017> (updates since 2017-09-08)

<1>
Accession Number
618235797
Author
Megens M.; Churilov L.; Thijs V.
Institution
(Megens, Churilov, Thijs) University of Melbourne, Australia
(Megens, Thijs) Austin Health, Australia
(Megens, Churilov, Thijs) Florey Institute of Neuroscience, Australia
Title
New-onset atrial fibrillation after CAGS and long-term risk of stroke.
Source
International Journal of Stroke. Conference: 27th Annual Scientific
Meeting of the Stroke Society of Australasia. New Zealand. 12 (3
Supplement 1) (pp 6-7), 2017. Date of Publication: August 2017.
Publisher
SAGE Publications Inc.
Abstract
Introduction: New-onset atrial fibrillation (NOAF) after coronary artery
graft surgery (CAGS) is related to an increased short-term risk of stroke,
increased incidence of atrial fibrillation, and increased
short-and-long-term mortality risk. We investigated if NOAF increased the
long-term risk of stroke after CAGS. Methods: This review was registered
in PROSPERO (CRD42017059482). A systematic search was undertaken in the
MEDLINE, EMBASE and CENTRAL databases using the terms "stroke", "cardiac
surgery" and "atrial fibrillation." Appropriate prospective or
retrospective studies included patients that developed NOAF post-CAGS,
without previous AF. The primary outcome was stroke incidence at six
months or more. Data were pooled using a random-effects model. Results: 16
out of 4744 identified citations fulfilled entry criteria, including
108,711 total patients. An increased long-term risk of stroke in patients
with NOAF was observed in studies not adjusted for common stroke risk
factors (effect size 1.36, 95% CI 1.12-1.65, p=0.001); and in studies that
did (effect size 1.25, 95% CI 1.09-1.42, p=0.001). There was evidence for
moderate heterogeneity in trials reporting unadjusted (p=0.021, I2=49.8%)
and adjusted data (p=0.081, I2=49.1%). Statistical evidence for
publication bias was not detected in unadjusted studies (intercept 0.821,
p=0.087); but was in adjusted studies (intercept 1.80, p=0.031).
Sensitivity analysis by study design, study quality and surgical
sub-population did not alter the direction of effect. Conclusion: There is
increased long-term risk of stroke in patients post-CAGS with NOAF.
Further studies are needed to show whether the increased risk is mediated
by atrial fibrillation and whether anticoagulation reduces risk.

<2>
Accession Number
618227365
Author
Araujo A.I.R.; Allegro B.B.; Pacheco F.T.; Branco H.R.A.C.; Nunes R.H.;
Junior A.C.M.M.; Da Rocha A.J.
Institution
(Araujo, Allegro, Pacheco, Branco, Nunes, Junior) Servico de Diagnostico
Por Imagem, Santa Casa de Misericordia de Sao Paulo, Division of
Neuroradiology, Sao Paulo, Brazil
(Da Rocha) Ervico de Diagnostico Por Imagem, Santa Casa de Misericordia de
Sao Paulo, Division of Neuroradiology, Sao Paulo, Brazil
Title
Acute cerebral artery occlusion how important is the identification of
calcified emboli to predict outcome.
Source
Neuroradiology. Conference: 40th European Society of Neuroradiology
Diagnostic and Interventional Annual Meeting, ESNR 2017. Sweden. 59 (1
Supplement 1) (pp S70), 2017. Date of Publication: 2017.
Publisher
Springer Verlag
Abstract
Recent studies have been demonstrating the relevant relationship between
thrombus constitution and its density on non-contrast-enhanced computed
tomography (NCCT) to predict outcome of different subtypes of acute
ischemic stroke (AIS). It is assumed that calcified cerebral embolus (CCE)
is prone to lead a worse clinical course and a substantial risk for
recurrent stroke. Despite that, proper identification of CCE in the
setting of AIS might support an appropriated approach in hyperacute stroke
setting, also to prevent future embolic events, neurologic impairment and
death. However, it was not confirmed in current guidelines yet and only
pictorial reports have been supporting clinical decisions. CCE was firstly
described in 1981 as a consequence of either cardiac surgery or cervical
procedures. Currently, it is assumed that CCE is very rare, but mainly
occur spontaneously, and it's mostly located in the middle cerebral artery
(up to 83%). We reviewed our institution's database to identify all
patients that have been included in our stroke protocol since Dec-2010
until Dec-2016. 126 NCCT scans were scrutinized by 2 board-certified
neu-roradiologists and 2 patients with CCE were found. A systematic review
in PUBMED's database was conducted, and 13 articles were selected and had
their demographic, clinical data, as well as thrombus features (including
location and presumed source) were compared to the results of our series.

<3>
Accession Number
618227224
Author
Granata F.; Mirra M.; Iacovelli F.; Salemme L.; Verdoliva S.; Pucciarelli
A.; Popusoi G.; Cioppa A.; Vigorito F.; Coccia M.; Di Domenico R.; Tesorio
T.; Attisano T.
Institution
(Granata, Iacovelli, Salemme, Verdoliva, Pucciarelli, Popusoi, Cioppa,
Tesorio) Division of Interventional Cardiology, Montervergine Clinic,
Mercogliano, Italy
(Mirra, Vigorito, Coccia, Di Domenico, Attisano) Interventional Cardiology
Unit, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno,
Italy
Title
Antithrombotic therapy post-tavr: Two center experience.
Source
Giornale Italiano di Cardiologia. Conference: 37 Congresso Nazionale della
Societa Italiana di Cardiologia Interventistica - GISE. Italy. 17 (10
Supplement 2) (pp e13), 2016. Date of Publication: October 2016.
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
On behalf of Campania SICI-GISE Community Transcatheter aortic-valve
replacement (TAVR) is established therapy for patients with severe aortic
stenosis (AS) who are not candidate for surgery or who are at high risk
for complication due to surgery. Despite improving experience and
techniques, ischemic and bleeding complication remains prevalent in
periprocedural period and months after transcatheter aorticvalve
replacement (TAVR). Dual antiplatelet therapy (DAPT) is currently
recommended with considerable differences about duration and association
with oral anticoagulant (OAC). Moreover, restricted data about TAVR and
new anticoagulant oral (NAO). The aim of our retrospective registry was to
assess prevalence, timing and prognosis of different
antithrombotic/anticoagulant strategies employed in TAVR patients. A total
of 121 consecutive patients, undergoing TAVR at Montevergine Clinic and
San Giovanni di Dio e Ruggi d'Aragona Hospital, have been enrolled in our
study, from January 2015 to June 2016. Fifty-three (64.13%) patients were
in aspirin, of which thirty-two (38.72%) were in DAPT (most for recent
coronary stent). Clopidogrel alone was administered in thirty-four
(41.14%) patients for peripheral artery disease or aspirin intolerance.
Twenty-four (29.04%) patients, with atrial fibrillation (AF) and CHADS2
score >1, had an indication to OAC pre-TAVR, of which 22 (26.62%) on
vitamin K antagonist (VKA) and 2 (2.42%) on new oral anticoagulant (NAO).
Ten (12.10%) patients were naive for antithrombotic/anticoagulant therapy
at the procedure. At discharge, sixty-three (76.23%) had indication to
DAPT at least for 3 months. Of 24 patients with indication to OAC, 22
(26.62%) were discharged on OAC and clopidogrel, of which 20 (24.20%) on
VKA and clopidogrel and 2 (2.42%) on NAO and clopidogrel. Patients with
PAD or aspirin intolerance were confirmed on clopidogrel. In the total
cohort there were 7 (8.47%) deaths, 6 ischemic stroke and 4 major bleeding
event at follow up of 18 months. Of 6 patients with ischemic stroke, 3
were not on baseline OAC. In conclusion, post-procedural
antithrombotic/anticoagulant therapy post-TAVR is highly variable.
Particularly in patients with high risk of adverse event as like those
with AF, should be evaluated prospectively in future randomized trials.

<4>
Accession Number
618227184
Author
Lettieri C.; Iorio A.; Collaku E.; Savonitto S.; Musumeci G.; Lettino M.;
Trabattoni D.; Calchera I.; Molfese M.; Ferlini M.; De Servi S.; Visconti
L.O.; Piccaluga E.; Piatti L.; Caporale R.; Serino F.; Senni M.; Valsecchi
O.; Rossini R.
Institution
(Lettieri) Ospedale Carlo Poma, Mantova, Italy
(Iorio, Collaku, Musumeci, Serino, Senni, Valsecchi, Rossini) ASST Papa
Giovanni XXIII, Bergamo, Italy
(Savonitto, Piatti) Ospedale Alessandro Manzoni, Lecco, Italy
(Lettino) Istituto Clinico Humanitas, Milano, Italy
(Trabattoni) Centro Cardiologico Monzino IRCCS, Milano, Italy
(Calchera) Ospedale San Gerardo, Monza, Italy
(Molfese) Ospedale Galliera, Genova, Italy
(Ferlini, De Servi, Visconti) Policlinico San Matteo Fondazione IRCCS,
Pavia, Italy
(Piccaluga) Ospedale Niguarda Ca' Granda, Milano, Italy
(Caporale) Ospedale Civile Dell'Annunziata, Cosenza, Italy
Title
Impact of ace-inhibitors and statins in heart failure patients with
coronary artery disease undergoing cardiac surgery.
Source
Giornale Italiano di Cardiologia. Conference: 37 Congresso Nazionale della
Societa Italiana di Cardiologia Interventistica - GISE. Italy. 17 (10
Supplement 2) (pp e42), 2016. Date of Publication: October 2016.
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Background. Heart failure (HF) is an established risk factor for poor
outcomes in patients undergoing surgery, yet the effectiveness of HF
related treatment in patients with HF and coronary artery disease is
widely unknown. Aim. The effectiveness of optimal HF related medical
treatment, including ACE-inhibitors (ACEi), angiotensin receptor blockers
(ARB), and betablockers, in HF patients with coronary artery disease
undergoing cardiac and noncardiac surgery. Methods and Results. The
Surgery After Stenting (SAS) Registry is a prospective registry of
consecutive patients with prior coronary stenting undergoing any type of
surgery at 19 hospitals in Italy, who were followed-up for 30 days. In the
present study, 30-day risk of MACE (all-cause death, myocardial
infarction, probable/definite stent thrombosis) was assessed in patients
with HF who were exposed to betablockers in the perioperative phase,
compared with patients who were not, using multivariable logistic
regression models (NNH). Out of 113 patients (13%) presenting with HF at
time of surgical procedure (mean age 72 +/- 9; male 73%; LVEF 42+/-12),
41% had diabetes mellitus, 86% history of hypertension, 42% chronic kidney
disease, 62% history of previous myocardial infarction. Of all HF
patients, 50% underwent cardiac surgery, 11% vascular surgery, 11% urology
surgery. At the time of surgical procedure, 71% were exposed to
betablockers, 50% to ACEi, 78% to statins, 15% to ARBs, 15% to dual
antiplatelet therapy. At 30-day follow-up, MACE occurred in 6% of HF
population, with a significant protective role of ACEi (OR-2.2; p=0.02)
and statins (OR-1.7; p=0.004). The trend of a protective role of ACEi and
statins remained unchanged in the different types of surgical procedures.
Conclusion. Preliminary data showed that in HF patients with coronary
artery disease predominantly undergoing cardiac surgery, perioperative
exposure to ACEi and statins may have a protective effect at 30-day
follow-up. This may suggest major effort to optimize perioperative medical
therapy in this subset of patients.

<5>
Accession Number
618227111
Author
Anonymous
Source
Giornale Italiano di Cardiologia. Conference: 37 Congresso Nazionale della
Societa Italiana di Cardiologia Interventistica - GISE. Italy. 17 (10
Supplement 2) (no pagination), 2016. Date of Publication: October 2016.
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
The proceedings contain 211 papers. The topics discussed include: coronary
sinus reducer implantation for the treatment of chronic refractory angina:
a single center experience; vascular complications after balloon aortic
valvuloplasty in recent years: incidence and comparison of two haemostatic
devices; a randomized comparison of balloon aortic valvuloplasty performed
with or without rapid cardiac pacing - the pacing vs no pacing (PNP)
study; TAVR with mechanically expanded prostheses: is balloon
valvuloplasty really necessary?; impact of mitral annular calcification on
peri-procedural and midterm outcome after transcatheter aortic valve
implantation; patent foramen ovale: red flag in radiologically isolated
syndrome; and intracoronary vs intravenous adenosine for fractional flow
reserve measurement: a meta-analysis.

<6>
Accession Number
618227062
Author
Yzeiraj E.; Bijuklic K.; Haselbach T.; Witt J.; Krause K.; Hansen L.;
Riess F.-C.; Schofer J.
Institution
(Yzeiraj, Bijuklic, Schofer) Medical Care Center Prof. Mathey, Prof.
Schofer, Hamburg, Germany
(Haselbach, Witt, Krause, Hansen, Riess) Albertinen Heart Center, Hamburg,
Germany
Title
DW-MRI results in patients with compared to patients without cerebral
embolic protection during Tavi.
Source
Giornale Italiano di Cardiologia. Conference: 37 Congresso Nazionale della
Societa Italiana di Cardiologia Interventistica - GISE. Italy. 17 (10
Supplement 2) (pp e60), 2016. Date of Publication: October 2016.
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Background. The TriGuard (Keystone Heart, Israel) embolic protection
system is positioned in the aortic arch to protect the brain by deflecting
emboli. A small controlled study has shown a beneficial effect, however,
there is a lack of data in a real world setting. The aim of the study was
to compare cerebral infarcts (CI) after transcatheter aortic valve
implantation (TAVI) in patients without cerebral embolic protection
compared to patients who underwent TAVI using the TriGuard device.
Methods. A group of 10 patients received TAVI under cerebral embolic
protection with the TriGuard device. In the control group there were 150
patients who underwent TAVI without cerebral embolic protection. All
patients were treated with a balloon expandable valve and underwent DW-MRI
3-5 days after the procedure. Cerebral DW-MRI were analysed by a blinded
physician to assess incidence, number and volume of new CI. Results.
Compared to the control group, TriGuard use was associated with a
significant lower incidence of new CI (20% versus 68%, p=0.04), number of
lesions per-patient (p=0.062) and total lesion volume (TLV) per-patient
(p=0.077). Stroke rate was 0% in both groups. Conclusions. The use of the
TriGuard cerebral protection device is feasible in a real world setting
and shows promising results, which have to be confirmed by a larger
randomized trial.

<7>
Accession Number
618227016
Author
Castriota F.; Nerla R.; Micari A.; Cavazza C.; Squeri A.; Montorfano M.;
Testa L.; Bedogni F.; Cremonesi A.
Institution
(Castriota, Nerla, Micari, Cavazza, Squeri, Cremonesi) Cardiovascular Unit
GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
(Montorfano) Ospedale San Raffaele, Milano, Italy
(Testa, Bedogni) Policlinico San Donato, San Donato Milanese, Italy
Title
Transcatheter aortic valve-in-valve implantation using lotus valve system
for failed surgical bioprostheses: The early italian experience.
Source
Giornale Italiano di Cardiologia. Conference: 37 Congresso Nazionale della
Societa Italiana di Cardiologia Interventistica - GISE. Italy. 17 (10
Supplement 2) (pp e58), 2016. Date of Publication: October 2016.
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Background. Patients with failed bioprostheses are an increasing
population at high risk for redo surgery. Valve-in valve (VIV)
transcatheter aortic valve implantation (TAVI) is a promising alternative
but a limited number of devices has proven efficacy in all cases.
Objectives. To evaluate the performance of the new generation LotusTM
Valve System (LVS) in patients with degenerated aortic bioprostheses.
Methods. Patients with degenerated bioprostheses were included in the
Registry after being addressed to VIV intervention for being judged at too
high risk for surgery by a local Heart Team. Main basal and follow-up
(1-month and 6-month) clinical and procedural data of patients undergoing
VIV-TAVI with LVS implantation in 3 high-volume Italian centres were
entered in the Registry. Results. Twelve patients (age 71.1+/-14.1 years,
66% males, logistic Euroscore 28.8+/-22.9%, NYHA III-IV in 100%) were
included in the registry. Implantation success rate was 92%, since in 1
patient the valve was completely and safely retrieved due to the presence
of not satisfactory transvalvular gradients after LVS positioning. All
procedures were done through femoral access and all but one required only
local anaesthesia. In patients with stenosis as pure or mixed mechanism
for degeneration (n=7), mean ventriculo-aortic gradient decreased from
46.7+/-7.0 mmHg to 16.6+/-5.7 mmHg (p<0.001). No patients had more than
mild aortic regurgitation both at the end of TAVI procedure and at
hospital discharge. LVS results were confirmed at 1-month and at 6-month
follow-up, with a dramatic improvement of NYHA functional status in all
patients (NYHA I-II in 100% patients). Conclusions. VIV procedure using
the new generation LVS is a safe and effective alternative to repeat
cardiac surgery in high-risk patients with degenerated surgical
bioprostheses. Using LVS in this challenging and increasingly frequent
scenario could offer a safe and highly effective strategy to be explored
in larger randomized clinical trials.

<8>
Accession Number
618226979
Author
Dall'Ara G.; Saia F.; Taglieri N.; Marrozzini C.; Moretti C.; Ciuca C.;
Ghetti G.; Chiarabelli M.; Bottoni P.; Rodino G.; Sabattini M.R.; Rapezzi
C.; Marzocchi A.
Institution
(Dall'Ara, Saia, Taglieri, Marrozzini, Moretti, Ciuca, Ghetti,
Chiarabelli, Bottoni, Rodino, Sabattini, Rapezzi, Marzocchi) Cardiology
Unit, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna,
Italy
Title
A randomized comparison of balloon aortic valvuloplasty performed with or
without rapid cardiac pacing-the pacing VS no pacing (PNP) study.
Source
Giornale Italiano di Cardiologia. Conference: 37 Congresso Nazionale della
Societa Italiana di Cardiologia Interventistica - GISE. Italy. 17 (10
Supplement 2) (pp e24), 2016. Date of Publication: October 2016.
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Objectives. To compare the effectiveness and safety of balloon aortic
valvuloplasty (BAV) performed with or without rapid ventricular pacing
(RP). Background. Controversies exist about the usefulness to perform the
procedure under RP to improve efficacy and safety. Methods. A 1:1
randomized, pilot study enrolling 100 consecutive patients. Exclusion
criteria were an immediate indication to AVR or TAVI and presentation in
cardiogenic shock. The primary efficacy endpoint was a 50% reduction in
the mean echocardiographic trans-aortic gradient. The primary safety
endpoint was the 30-day composite of death, myocardial infarction, stroke,
acute aortic regurgitation and BARC bleeding =3. Results. From April to
October 2015, 51 patients entered the Pacing Group (PG), 49 the No Pacing
Group (NPG). Baseline characteristics did not differ. A 50% hemodynamic
gradient reduction was met in 37.3% and 55.1% respectively (p=0.16). Fewer
people in the latter group complained poor tolerance to the procedure (16%
vs 41%, p<0.05). The primary endpoint was met in 21/49 patients in the NP
group compared to 20/51 in the PG (42.9% vs 39.2%; p=0.84). In the NPG, we
found a lower need of bailout use of a temporary pacemaker (0% vs 7.8%,
p=0.048) and a lower incidence of moderate/severe renal function worsening
(4.1% vs 17.6%; p=0.052). The primary safety composite endpoint did not
differ between groups (8.2% for NPG vs 13.7%; p=0.53). Conclusions. RP did
not influenced BAV efficacy and 30-day safety. However BAV without RP
seemed to confer a slight advantage in term of patient comfort and lower
complications rate.

<9>
Accession Number
618226926
Author
Barioli A.; Fovino L.N.; D'Amico G.; Purita P.; Schiavo A.; Figliozzi S.;
Ferri L.; Masiero G.; Mojoli M.; Mamary A.A.; Fraccaro C.; Napodano M.;
Tarantini G.
Institution
(Barioli, Fovino, D'Amico, Purita, Schiavo, Figliozzi, Ferri, Masiero,
Mojoli, Mamary, Fraccaro, Napodano, Tarantini) Dipartimento di Scienze
Cardiache, Toraciche e Vascolari, Universita di Padova, Padova, Italy
Title
Coronary artery bypass grafting VS percutaneous coronary intervention for
unprotected left main coronary artery disease: An updated meta-analysis of
randomized trials.
Source
Giornale Italiano di Cardiologia. Conference: 37 Congresso Nazionale della
Societa Italiana di Cardiologia Interventistica - GISE. Italy. 17 (10
Supplement 2) (pp e48-e49), 2016. Date of Publication: October 2016.
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Background. Available evidences suggest that unprotected left main
coronary artery (ULMCA) disease treatment with percutaneous coronary
intervention (PCI) is safe and provides comparable results to coronary
artery bypass grafting (CABG), in presence of isolated or associated
lower-severity left main (LM) lesions. Recent metanalyses comparing the
long-term outcomes of PCI with drug eluting stents (DESs) or bare metal
stents (BMSs) versus CABG for ULMCA stenosis have shown that CABG was
associated with a small increased risk of stroke but reduced risk of
repeat revascularization at all time points. Methods. A search of
randomized controlled trials (RCTs) comparing the outcomes of PCI versus
CABG in the setting of ULMCA disease was conducted using MEDLINE (PubMed).
We analyzed the incidence of the composite endpoint of major adverse
cardiac and cerebrovascular events (MACCEs). Subgroup analysis was used to
investigate the effects of SYNTAX (SYNergy between PCI with TAXUS and
Cardiac Surgery) score (SS) on clinical outcomes. Results. Four RCTs,
involving 1,611 patients, met our inclusion criteria. First generation DES
were used in 3 studies; in one study both first generation DES and BMS
were used. Overall, we found no statistically significant differences in
MACCEs rate between PCI or CABG (OR 1.26, 95%CI 0.99-1.60, p=0.0587).
After stratification for lesion complexity by the use of SS, PCI and CABG
showed similar outcomes in patients with low to intermediate SS (OR 1.13,
95%CI 0.81-1.58, p=0.458), whereas PCI was associated with significant
worse outcome (OR 1.88, 95%CI 1.23-2.87, p=0.0037) in patients with SS=33.
Conclusions. In the setting of ULMCA disease, CABG only trended to be
superior in term of event free survival compared to PCI. Subgroup analysis
for MACCEs rate according to SS showed that stenting was significantly
inferior to CABG for patients with SS >= 33.

<10>
Accession Number
618227329
Author
Mangieri A.; Ancona M.; Regazzoli D.; Bertoldi L.F.; Ancona F.; Montorfano
M.; Chieffo A.; Jabbour R.; Colombo A.; Latib A.
Institution
(Mangieri, Ancona, Regazzoli, Bertoldi, Ancona, Montorfano, Chieffo,
Jabbour, Colombo, Latib) Ospedale San Raffaele, Milano, Italy
Title
Single antiplatelet therapy in patients with contraindication to dual
antiplatelet therapy after Tavi: A safe alternative?.
Source
Giornale Italiano di Cardiologia. Conference: 37 Congresso Nazionale della
Societa Italiana di Cardiologia Interventistica - GISE. Italy. 17 (10
Supplement 2) (pp e19), 2016. Date of Publication: October 2016.
Publisher
Il Pensiero Scientifico Editore s.r.l.
Abstract
Aims. There is limited evidence to support decision making regarding
discharge antiplatelet therapy following transcatheter aortic valve
implantation (TAVI). Our aim was to assess the outcome of patients
discharged on single antiplatelet (SAPT) or dual antiplatelet therapy
(DAPT) following TAVI. Methods. Consecutive patients were identified by
retrospective review of a dedicated TAVI database of a single high volume
center in Milan, Italy between January 2009 and December 2014. Our primary
endpoint was the rate of net adverse clinical events (NACE) defined as a
composite of all-cause mortality, major bleeding requiring
hospitalization, cerebrovascular accidents, redo-TAVI or surgical aortic
valve replacement and valve thrombosis. Results. A total of 458 patients
were included in the final analysis; 118 patients were discharged on
SAPTand 340 on DAPT. Reasons for discharge SAPT included: high risk of
bleeding (n= 34; 29%), post procedural bleeding (n=37; 31%),
thrombocytopenia (n=23; 19%), vascular complications (n=16; 14%) and
high-risk vascular access (n=8; 7%). The mean length of DAPT therapy was
5.1+/-2.4 months. Patients discharged on DAPT had a higher burden of
coronary artery disease (48.4% vs. SAPT 38.9%; p=0.015). At follow-up, no
differences were observed in the incidence of NACE, all-cause or
cardiovascular mortality and cerebrovascular events. NYHA class III-IV was
an independent predictor of NACE. Conclusions. Prescribing only SAPT after
TAVI in selected patients was not associated with an increased risk of
events and may be an acceptable alternative to DAPT in elderly patients at
high-risk of bleeding. However, the results of randomized controlled
trials are awaited to understand the impact of different anti-thrombotic
strategies on long-term outcomes.

<11>
Accession Number
616775737
Author
Boitor M.; Gelinas C.; Richard-Lalonde M.; Thombs B.D.
Institution
(Boitor, Gelinas, Richard-Lalonde) Ingram School of Nursing, McGill
University, 3506 University Street, Montreal H3A 2A7, Canada
(Boitor, Gelinas) Centre for Nursing Research and Lady Davis Institute,
Jewish General Hospital, 3755 Cote Ste-Catherine Road, Montreal H3T 1E2,
Canada
(Thombs) Lady Davis Institute for Medical Research, Jewish General
Hospital, 3755 Cote Ste-Catherine Road, Montreal H3T 1E2, Canada
(Thombs) Department of Psychiatry, McGill University, 1033 Pine Avenue
West, Montreal H3A 1A1, Canada
(Thombs) Department of Epidemiology, Biostatistics, and Occupational
Health, McGill University, 1020 Pine Avenue West, Montreal H3A 1A2, Canada
(Thombs) Department of Medicine, McGill University, 1001 Decarie
Boulevard, Montreal H4A 3J1, Canada
(Thombs) Department of Educational and Counselling Psychology, McGill
University, 3700 McTavish Street, Montreal H3A 1Y2, Canada
(Thombs) Department of Psychology, McGill University, 1205 Dr Penfield
Avenue, Montreal H3A 1B1, Canada
Title
The Effect of Massage on Acute Postoperative Pain in Critically and
Acutely Ill Adults Post-thoracic Surgery: Systematic Review and
Meta-analysis of Randomized Controlled Trials.
Source
Heart and Lung: Journal of Acute and Critical Care. 46 (5) (pp 339-346),
2017. Date of Publication: September 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Critical care practice guidelines identify a lack of clear evidence on the
effectiveness of massage for pain control. To assess the effect of massage
on acute pain in critically and acutely ill adults post-thoracic surgery.
Medline, Embase, CINAHL, PsychInfo, Web of Science, Scopus and Cochrane
Library databases were searched. Eligible studies were randomized
controlled trials (RCTs) evaluating the effect of massage compared to
attention control/sham massage or standard care alone on acute pain
intensity post-thoracic surgery. Twelve RCTs were included. Of these, nine
evaluated massage in addition to standard analgesia, including 2 that
compared massage to attention control/sham massage in the intensive care
unit (ICU), 6 that compared massage to standard analgesia alone early
post-ICU discharge, and 1 that compared massage to both attention control
and standard care in the ICU. Patients receiving massage with analgesia
reported less pain (0-10 scale) compared to attention control/sham massage
(3 RCTs; N = 462; mean difference -0.80, 95% confidence interval [CI]
-1.25 to -0.35; p < 0.001; I² = 13%) and standard care (7 RCTs;
N = 1087; mean difference -0.85, 95% CI -1.28 to -0.42; p < 0.001;
I² = 70%). Massage, in addition to pharmacological analgesia,
reduces acute post-cardiac surgery pain intensity.<br/>Copyright &#xa9;
2017 Elsevier Inc.

<12>
Accession Number
618233200
Author
Senturk J.C.; Kristo G.; Gold J.; Bleday R.; Whang E.
Institution
(Senturk, Gold, Bleday, Whang) Department of Surgery, Brigham and Women's
Hospital, Harvard Medical School, Surgery Education Office, 75 Francis
Street, CA034, Boston, MA 02115, United States
(Kristo, Gold, Whang) Department of Surgery, VA Boston Healthcare System,
West Roxbury, MA, United States
Title
The Development of Enhanced Recovery after Surgery Across Surgical
Specialties.
Source
Journal of Laparoendoscopic and Advanced Surgical Techniques. 27 (9) (pp
863-870), 2017. Date of Publication: September 2017.
Publisher
Mary Ann Liebert Inc. (E-mail: info@liebertpub.com)
Abstract
Background: Enhanced recovery after surgery (ERAS) principles
have gained traction in variety of surgical disciplines. The promise of a
reduced length of stay without compromising patient safety or increasing
readmission rates has produced a body of literature examining the
implementation of ERAS in the care of general, thoracic, urologic, and
gynecologic surgery patients. Methods: We performed a review of the
literature pertaining to studies of ERAS implementation across colorectal
surgery, general surgery, thoracic surgery, urology, and gynecology. The
extent of ERAS implementation and reported outcomes across key studies as
well as systematic reviews and meta-analyses in each field were
summarized. Results: The implementation of ERAS protocols has not been
uniform across surgical specialties. Despite this, ERAS has produced
improvements in patient outcomes. The most commonly described benefit of
ERAS application has been reduced length of stay; complication and
readmission rates are most consistently decreased in the colorectal
literature. Studies have started to measure more nuanced measures of
postoperative patient well-being. Efforts are growing to standardize ERAS
protocols across diverse fields and call attention to the need for quality
control. Conclusions: Challenges remain in the study and execution of
ERAS. Controlling for adherence to ERAS components and implementing
uniform ERAS protocols across studies are burgeoning topics that have
significant implications for study design. The practice of ERAS and its
benefits to patients are expected to evolve. Assessing improvements in
postdischarge quality of life, timing of return to work and independent
living, and adherence to scheduled delivery of adjuvant treatments will
strengthen future ERAS investigations.<br/>&#xa9; Copyright 2017, Mary Ann
Liebert, Inc. 2017.

<13>
Accession Number
618195293
Author
Field T.
Institution
(Field) Touch Research Institute, University of Miami/Miller School of
Medicine, United States
(Field) Fielding Graduate University, United States
Title
Preterm newborn pain research review.
Source
Infant Behavior and Development. 49 (pp 141-150), 2017. Date of
Publication: November 2017.
Publisher
Elsevier Ltd
Abstract
This narrative review is based on a literature search of PubMed and
PsycINFO for research on preterm newborn pain published during the last
ten years. The high prevalence of painful procedures being performed with
preterm newborns without analgesia (79%), with a median of 75 painful
procedures being received during hospitalization and as many as 51 painful
procedures per day highlights the importance of this problem. This review
covers the pain assessments that have been developed, the short-term
effects of the painful procedures, the longer-term developmental outcomes
and the pharmacological and alternative therapies that have been
researched. The most immediate effects reported for repeated painful
procedures include increased heart rate, oxidative stress and cortisol as
well as decreased vagal activity. Lower body weight and head circumference
have been noted at 32 weeks gestation. Blunted cortisol reactivity to
stressors has been reported for three-month-olds and thinner gray matter
in 21 of 66 cerebral regions and motor and cognitive developmental delays
have been noted as early as eight months. Longer-term outcomes have been
reported at school age including less cortical thickness, lower vagal
activity, delayed visual- perceptual development, lower IQs and
internalizing behavior. Pharmacological interventions and their side
effects and non-pharmacological therapies are also reviewed including
sucrose, milk and nonnutritive sucking which have been effective but
thought to negatively affect breast-feeding. Full-body interventions have
included tucking, swaddling, kangaroo care and massage therapy. Although
these have been effective for alleviating immediate pain during invasive
procedures, research is lacking on the routine use of these therapies for
reducing long-term pain effects. Further, additional randomized controlled
replication studies are needed.<br/>Copyright &#xa9; 2017

<14>
Accession Number
618234251
Author
Al Jawad M.A.; Ali I.; Shokri H.; Shorbagy M.S.
Institution
(Al Jawad, Ali) Department of Cardio-Thoracic Surgery, Ain Shams
University, Cairo, Egypt
(Shokri, Shorbagy) Department of Anesthesiology, Ain Shams University,
Abbasya Square, Cairo, Egypt
Title
Systemic versus local analgesia for chest drain removal in post cardiac
surgery patients: The taming of a beast.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. (no
pagination), 2017. Date of Publication: 2017.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: Among the most emotionally distressing experiences in cardiac
surgery is the removal of mediastinal drains. The study compared between
two commonly used methods for pain control during the procedure of chest
drain removal. We either used systemic administration of IV morphine or
local infiltration of Bupivacaine as a mode of analgesia. Our goal was to
provide effective analgesia and patient comfort, while keeping high
standards of patient safety. Methods: A prospective, randomized, single
blinded observational study conducted in a single institution;
Cardio-thoracic surgery Academy, Ain -Shams University, Cairo, Egypt. 70
Patients, with valvular heart lesions needing elective surgical
intervention in the form of valve replacement/repair were enrolled in the
study. On the day after surgery, when the mediastinal drains were no
longer surgically needed, patients were randomized to one of two groups.
In the first group (Morphine group, n = 35), patients received an IV bolus
of 0.1 mg/kg morphine over a period of 2 min. The second group
(Bupivacaine group, n = 35), received 0.5% bupivacaine as subcutaneous
infiltration around the sites of drain insertion, using a standardized
technique. Drains were removed 20 min later. All the patients had their
blood pressure, heart rate and the pain score on a Visual Analog Scale
(VAS) assessed 20 min before starting the procedure (baseline values), and
were assessed one more time, 5 min after completion of the procedure
(drain removal values). Results: The median difference within the
bupivacaine group between baseline and drain removal VAS scores was 19.94
+/- 2.36 mm and 9.52 +/- 2.41 mm respectively (this showed to be highly
significant, P < 0.001).Median VAS scores difference between the
bupivacaine and morphine groups on drain removal were 9.52 +/- 2.41 mm and
18.93 +/- 2.96 mm respectively (this showed to be highly significant, P <
0.001). Conclusions: There was a significant difference with regards to
patients' pain control between both groups. Concerning pain scores (VAS)
reduction at post procedural point, a local subcutaneous infiltration of
0.5% bupivacaine is a superior analgesic modality.<br/>Copyright &#xa9;
2017 The Egyptian Society of Cardio-thoracic Surgery.

<15>
Accession Number
618231986
Author
Meneguzzi J.; Kilpin M.; Zhu Y.Y.; Doi A.; Reid C.; Tran L.; Hayward P.;
Smith J.
Institution
(Meneguzzi, Kilpin, Doi) The Alfred Hospital, Melbourne, Vic, Australia
(Zhu, Hayward) The Austin Hospital, Melbourne, Vic, Australia
(Reid, Tran) The Alfred Centre, Melbourne, Vic, Australia
(Smith) Monash University, Melbourne, Vic, Australia
Title
Impact of Discontinuation of Antiplatelet Therapy Prior to Isolated Valve
and Combined Coronary Artery Bypass Graft and Valve Procedures on Short
and Intermediate Term Outcomes.
Source
Heart Lung and Circulation. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier Ltd
Abstract
Background: A change in cardiac surgery practice over the past decade has
seen an increase in urgent or inpatient referrals for surgery, with
antiplatelet therapy often continued up until surgery. This study aims to
identify the optimal timing for administration of aspirin to minimise risk
of perioperative morbidity and mortality. Methods: From a prospectively
compiled database collected by the Australian and New Zealand Society of
Cardiac and Thoracic Surgeons, we identified 8,294 patients undertaking
combined CABG and valve or isolated valve procedures while discontinuing
aspirin. Time points for cessation of antiplatelet therapy were
categorised as follows: <2 days, 3-7 days or >7 days preoperatively. We
evaluated the association of adverse in-hospital events and intermediate
term survival in each time category. Results: Discontinuing aspirin three
to seven days from surgery decreased rates of perioperative MI (HR =
0.300, p = 0.027), return to theatre (HR = 0.560, p = 0.002) reduced drain
output (HR = 0.757, p = 0.000) and red blood cell and platelet
transfusions (HR = 0.719, p = 0.000 and HR = 0.604, p = 0.000
respectively) compared to patients continuing aspirin until <2 days from
the procedure.Stopping aspirin <2 days from the date of surgery increased
risk of perioperative MI (HR = 5.919, p = 0.000), reoperation for bleeding
(HR = 2.076, p = 0.001), returning to theatre (HR = 1.781, p = 0.000), ICC
drain losses (HR = 1.337, p = 0.000) and transfusion demands for red blood
cells (HR = 1.381, p = 0.000) and platelets (HR = 1.450, p = 0.000) when
compared to those discontinuing aspirin >7 days from surgery. Conclusion:
Late discontinuation of aspirin before combined coronary artery bypass
graft and valve procedures results in greater rates of bleeding and
transfusion requirements. Earlier discontinuation of aspirin results in no
benefit in intermediate term survival.<br/>Copyright &#xa9; 2017.

<16>
Accession Number
618224992
Author
Lee C.-T.; Lin Y.-C.; Yeh Y.-C.; Chen T.-L.; Chen C.-Y.
Institution
(Lee, Yeh) Department of Anesthesiology, National Taiwan University
Hospital, Taipei, Taiwan (Republic of China)
(Lin, Chen, Chen) Department of Anesthesiology, Taipei Medical University
Hospital, 252 Wuxing St, Taipei 10031, Taiwan (Republic of China)
(Lin) School of Nursing, College of Nursing, Taipei Medical University,
Taipei, Taiwan (Republic of China)
(Chen, Chen) Department of Anesthesiology, School of Medicine, College of
Medicine, Taipei Medical University, Taipei, Taiwan (Republic of China)
Title
Effects of levosimendan for perioperative cardiovascular dysfunction in
patients receiving cardiac surgery: a meta-analysis with trial sequential
analysis.
Source
Intensive Care Medicine. (pp 1-2), 2017. Date of Publication: 07 Sep 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)

<17>
Accession Number
618224017
Author
Amiet V.; Perez M.-H.; Longchamp D.; Boulos Ksontini T.; Natterer J.;
Plaza Wuthrich S.; Cotting J.; Di Bernardo S.
Institution
(Amiet, Perez, Longchamp, Natterer, Cotting) Pediatric Intensive Care
Unit, University Hospital and Medicine and Biology Faculty of Lausanne,
Lausanne, Switzerland
(Boulos Ksontini, Plaza Wuthrich, Di Bernardo) Pediatric cardiology Unit,
University Hospital and Medicine and Biology Faculty of Lausanne, CHUV,
rue du Bugnon 46, Lausanne 1011, Switzerland
Title
Use of Levosimendan in Postoperative Setting After Surgical Repair of
Congenital Heart Disease in Children.
Source
Pediatric Cardiology. (pp 1-7), 2017. Date of Publication: 07 Sep 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Low cardiac output is one of the most common complications after cardiac
surgery. Levosimendan, a new inotrope agent, has been demonstrated in
adult patient to be an effective treatment for this purpose when classical
therapy is not effective. The aim of this study was to evaluate the effect
of Levosimendan on cardiac output parameters in cardiac children with low
cardiac output syndrome (LCOS.). We carried out a retrospective analysis
on 62 children hospitalized in our pediatric intensive care unit (PICU)
after cardiac surgery, which demonstrated LCOS not responding to classical
catecholamine therapy and who received levosimendan as rescue therapy.
LCOS parameters like diuresis, central venous oxygen saturation
(SvO<inf>2</inf>), venous-to-arterial CO<inf>2</inf> difference
(avCO<inf>2</inf>), and plasmatic lactate were compared before therapy and
at 3, 6, 12, and 24 h after the beginning of the levosimendan infusion. We
also analyzed the effect on the Vasoactive-inotropic score (VIS), adverse
events, and mortality. After the beginning of levosimendan infusion,
diuresis (1.1 vs. 3.5 ml/kg/h, p = 0.001) and SvO<inf>2</inf> (59.5 vs.
63.3%, p = 0.026) increased significantly during the 24 h of infusion, and
at the same time, plasmatic lactate (2.3 vs. 1.3 mmol/l, p < 0.001)
decreased. avCO<inf>2</inf> (10.8 vs. 9.4 mmHg, p = 0.21) and the VIS
(44.5 vs. 22.5, p = 0.143) also decreased, but not significantly. No side
effects were noted. The mortality in this patient group was 16%.
Levosimendan is an effective treatment in children presenting LCOS after
congenital heart surgery. Our study confirms the improvement of cardiac
output already shown in other pediatric studies, with no undesirable side
effects.<br/>Copyright &#xa9; 2017 Springer Science+Business Media, LLC

<18>
Accession Number
617848569
Author
Ambardekar A.V.; Thibodeau J.T.; DeVore A.D.; Kittleson M.M.; Forde-McLean
R.C.; Palardy M.; Mountis M.M.; Cadaret L.; Teuteberg J.J.; Pamboukian
S.V.; Xie R.; Stevenson L.W.; Stewart G.C.
Institution
(Ambardekar) Division of Cardiology, University of Colorado, Aurora,
Colorado, United States
(Thibodeau) Department of Internal Medicine and Cardiology, University of
Texas Southwestern, Dallas, Texas, United States
(DeVore) Division of Cardiology, Duke University Medical School, Durham,
North Carolina, United States
(Kittleson) Division of Cardiology, Cedars-Sinai Heart Institute, Los
Angeles, California, United States
(Forde-McLean) Department of Medicine, University of Pennsylvania,
Philadelphia, Pennsylvania, United States
(Palardy) Department of Internal Medicine and Cardiovascular Medicine,
University of Michigan, Ann Arbor, Michigan, United States
(Mountis) Division of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, Ohio, United States
(Cadaret) Division of Cardiology, University of Iowa, Iowa City, Iowa,
United States
(Teuteberg) Heart and Vascular Institute, University of Pittsburgh Medical
Center, Pittsburgh, Pennsylvania, United States
(Pamboukian, Xie) Division of Cardiovascular Diseases, University of
Alabama at Birmingham, Birmingham, Alabama, United States
(Stevenson, Stewart) Division of Cardiovascular Medicine, Brigham and
Women's Hospital, Boston, Massachusetts, United States
Title
Discordant Perceptions of Prognosis and Treatment Options Between
Physicians and Patients With Advanced Heart Failure.
Source
JACC: Heart Failure. 5 (9) (pp 663-671), 2017. Date of Publication:
September 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study assessed patient and physician perceptions of heart
failure (HF) disease severity and treatment options. Background The
prognosis for ambulatory patients with advanced HF on medical therapy is
uncertain, yet has important implications for decision making regarding
transplantation and left ventricular assist device (LVAD) placement.
Methods Ambulatory patients with advanced HF (New York Heart Association
functional class III to IV, Interagency Registry for Mechanically Assisted
Circulatory Support profiles 4 to 7) on optimized medical therapy were
enrolled across 11 centers. At baseline, treating cardiologists rated
patients for perceived risk for transplant, LVAD, or death in the upcoming
year. Patients were also surveyed about their own perceptions of life
expectancy and willingness to undergo various interventions. Results At
enrollment, physicians regarded 111 of 161 patients (69%) of the total
cohort to be at high risk for transplant, LVAD, or death, whereas only 23
patients (14%) felt they were at high risk. After a mean follow-up of 13
months, 61 patients (38%) experienced an endpoint of 33 deaths (21%), 13
transplants (8%), and 15 LVAD implants (9%). There was poor discrimination
between risk prediction among both patients and physicians. Among
physician-identified high-risk patients, 77% described willingness to
consider LVAD, but 63% indicated that they would decline 1 or more other
simpler forms of life-sustaining therapy such as ventilation, dialysis, or
a feeding tube. Conclusions Among patients with advanced HF, physicians
identified most to be at high risk for transplantation, LVAD, or death,
whereas few patients recognized themselves to be at high risk. Patients
expressed inconsistent attitudes toward lifesaving treatments, possibly
indicating poor understanding of these therapies. Educational
interventions regarding disease severity and treatment options should be
introduced prior to the need for advanced therapies such as intravenous
inotropic therapy, transplantation, or LVAD.<br/>Copyright &#xa9; 2017
American College of Cardiology Foundation

<19>
Accession Number
617838244
Author
Cabalka A.K.; Hellenbrand W.E.; Eicken A.; Kreutzer J.; Gray R.G.;
Bergersen L.; Berger F.; Armstrong A.K.; Cheatham J.P.; Zahn E.M.;
McElhinney D.B.
Institution
(Cabalka) Division of Pediatric Cardiology, Mayo Clinic, Rochester,
Minnesota, United States
(Hellenbrand) Division of Pediatric Cardiology, Yale University School of
Medicine, New Haven, Connecticut, United States
(Eicken) Deutsches Herzzentrum Munchen, Klinik fur Kinderkardiologie und
angeborene Herzfehler, Technische Universitat Munchen, Munich, Germany
(Kreutzer) Division of Pediatric Cardiology, University of Pittsburgh
School of Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh,
Pennsylvania, United States
(Gray) Department of Pediatric Cardiology, University of Utah, Salt Lake
City, Utah, United States
(Bergersen) Department of Cardiology, Boston Children's Hospital, Boston,
Massachusetts, United States
(Berger) Department of Congenital Heart Disease/Pediatric Cardiology,
Deutsches Herzzentrum Berlin, Berlin, Germany
(Berger) German Center of Cardiovascular Research, Berlin, Germany
(Armstrong, Cheatham) The Heart Center, Nationwide Children's Hospital,
Columbus, Ohio, United States
(Zahn) The Guerin Family Congenital Heart Program, The Heart Institute and
Department of Pediatrics, Cedars-Sinai Heart Institute, Los Angeles,
California, United States
(McElhinney) Department of Cardiothoracic Surgery, Lucille Packard
Children's Hospital Stanford, Palo Alto, California, United States
Title
Relationships Among Conduit Type, Pre-Stenting, and Outcomes in Patients
Undergoing Transcatheter Pulmonary Valve Replacement in the Prospective
North American and European Melody Valve Trials.
Source
JACC: Cardiovascular Interventions. 10 (17) (pp 1746-1759), 2017. Date of
Publication: 11 Sep 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study sought to evaluate the incidence of and risk factors
for conduit and stent-related outcomes following transcatheter pulmonary
valve replacement (TPVR). Background Stent fracture (SF) and right
ventricular outflow tract (RVOT) reintervention are among the most
important adverse outcomes after TPVR using the Melody valve (Medtronic,
Minneapolis, Minnesota). The conduit environment and conduit preparation
practices vary among patients who undergo TPVR. Methods Data from 3
prospective Melody valve multicenter studies were pooled and analyzed. All
patients who had successful implant of a Melody valve that was present at
hospital discharge comprised the study cohort; patients who had TPVR into
a stentless conduit comprised the analysis cohort. SF was diagnosed using
protocol-specified or clinical fluoroscopy or radiography, and classified
as major or minor. Results Of 358 patients who underwent catheterization
with intent to perform TPVR, 309 were discharged with the Melody valve in
place (study cohort) of which 251 patients had TPVR into a stentless
conduit (analysis cohort). Median follow-up was 5 years. New pre-stents
were placed in 68% of patients with a stentless conduit, and 22% received
multiple pre-stents. At 3 years, freedom from any SF and major SF was 74
+/- 3% and 85 +/- 2%, respectively, and freedom from RVOT reintervention
was 85 +/- 2%. New pre-stents were associated with longer freedom from SF
and RVOT reintervention than was no pre-stent. Conclusions Risks of SF and
reintervention after TPVR with a Melody valve were reduced by implantation
of pre-stents, which has become standard practice. This study supports
pre-stenting as an important component of TPVR therapy.<br/>Copyright
&#xa9; 2017

<20>
Accession Number
618210620
Author
Keller M.; Meierhenrich R.
Institution
(Keller, Meierhenrich) Klinik fur Anasthesie und Intensivmedizin,
Diakonie-Klinikum Stuttgart, Germany
Title
The septic patient with new-onset atrial fibrillation-how to treat?.
Source
Infection. Conference: 8th International Congress "Sepsis and Multiorgan
Dysfunction". Germany. 45 (1 Supplement 1) (pp S43), 2017. Date of
Publication: September 2017.
Publisher
Urban und Vogel GmbH
Abstract
Introduction: Atrial fibrillation (AF) is the most common arrhythmia which
occurs during sepsis or septic shock and is promoted by systemic
inflammation and atrial remodeling. Especially the occurrence of new-onset
AF with no history of preexisting "typical" AF is associated with
increased morbidity and mortality. It can further lead to hemodynamic
failure and secondary thromboembolic complications such as stroke. Yet,
there are no specific guidelines on treatment of septic patients with
new-onset AF and its ideal management currently remains unclear.
Objectives: To investigate the state-of-the-art on anti-arrhythmic and
stroke-preventive therapeutic strategies specifically for patients with
new-onset AF during sepsis. Methods: A systematic review of the literature
was conducted on MEDLINE using various search terms. Abstracts of the
listed publications were systematically analyzed and included if relevance
and quality matched our inclusion criteria. We manually added current
versions of major guidelines focusing on AF management to investigate
their current treatment approaches for new-onset AF, AF during sepsis or
AF due to other inflammatory causes. Results: 1 meta-analysis, 3 reviews
and 11 studies were included. AF management guidelines of the European
Society of Cardiology, the American Heart Association and the American
Association for Thoracic Surgery were investigated. The Surviving Sepsis
Campaign guidelines for clinical sepsis management were also included. The
current standards determine that the necessity of immediate electric
cardioversion is dependent on hemodynamic stability. Electrical
cardioversion alone seems to be ineffective and should most likely be
combined with amiodarone. Evidence on a pReference of rhythm or rate
control in hemodynamically stable patients is poor. Systemic
anticoagulation for stroke prevention is crucial but it seems that typical
scoring systems such as CHA2DS2-VASc score fail to identify septic
patients at risk. According to studies and guidelines, anticoagulation in
new-onset AF - especially during and after cardioversion - should only be
administered to patients at high risk for stroke. Conclusions: While
adequate antibiotic therapy and if necessary surgical intervention as a
causal approach to eliminate the inflammatory mechanisms responsible for
new-onset AF during sepsis form the basis of the treatment strategy, exact
knowledge on specific treatment options of new-onset AF in the septic
patient is lacking and further prospective treatment studies are required.
Stroke-preventive anticoagulation should only be performed in patients at
high thromboembolic risk, while the exact risk factors associated with
stroke during sepsis are currently unknown. Even though there is no
definite data on follow-up of patients with new-onset AF during sepsis,
routine long-term cardiology examinations after such an episode are
recommended.

<21>
[Use Link to view the full text]
Accession Number
618128930
Author
Cerrato E.; Barbero U.; D'Ascenzo F.; Taha S.; Biondi-Zoccai G.; Omede P.;
Bianco M.; Echavarria-Pinto M.; Escaned J.; Gaita F.; Varbella F.
Institution
(Cerrato, Varbella) Interventional Cardiology, San Luigi Gonzaga
University Hospital, Orbassano and Rivoli Infermi Hospital, Italy
(Barbero, D'Ascenzo, Taha, Omede, Gaita) Division of Cardiology, Citta
della Salute e della Scienza, University of Turin, Turin, Italy
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina and Department of
AngioCardioNeurology, IRCCS, Neuromed, Pozzilli, Italy
(Bianco) Division of Cardiology, San Luigi Gonzaga University Hospital,
Orbassano, Turin, Italy
(Echavarria-Pinto) Department of Cardiology, Hospital General ISSSTE,
Queretaro, Mexico
(Escaned) Hospital Clinico San Carlos, Madrid, Spain
Title
What is the optimal treatment for symptomatic patients with isolated
coronary myocardial bridge? A systematic review and pooled analysis.
Source
Journal of Cardiovascular Medicine. 18 (10) (pp 758-770), 2017. Date of
Publication: 01 Oct 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background Myocardial bridging is a common coronary anomaly, with few
severe adverse events but a relevant symptom burden. Myocardial bridging
treatment, however, remains uncertain because of the lack of randomized
trials. Material MEDLINE/PubMed was systematically screened for studies
reporting on isolated myocardial bridging diagnosed at coronary
angiography or with coronary computed tomography in patients admitted for
suspected angina or with an acute coronary syndrome. Baseline, treatment
and outcome data were appraised and pooled according to treatment (medical
therapy, bypass surgery/myotomy or stenting). Results A total of 899
patients in 18 studies were included with a low prevalence of traditional
risk factors, especially diabetes (15.6%, interquartile range 2.5-21.5).
After a median of 31.0 months (interquartile range 12.4-37.1), major
cardiovascular events (composite of death, myocardial infarction or target
vessel revascularization) occurred in only 3.4% of the study patients and
78.7% [70.5-86.9; 95% confidence intervals (CI)] were managed
conservatively and free of symptoms. When an invasive strategy was
planned, freedom from angina was higher in patients treated with surgery
[84.5% (78.4-90.7; 95% CI)] than in those treated with stenting [54.7%
(38.9-70.6; 95% CI)]. Patients in the stenting group experienced a high
incidence of major cardiovascular events related to target vessel
revascularization [40.07% (19.83-60.32; 95% CI)]. Meta-regression showed
that patients treated with beta-blockers or with a history of hypertension
were more likely to remain free from angina (B -0.6, P=0.013; B -0.66,
P=0.006). Conclusion Patients with symptomatic isolated myocardial
bridging generally have a good long-term prognosis. Pharmacological
treatment alone, especially with beta-blockers, is able to improve angina
in most cases. Surgical treatment appears to be more effective than
stenting in nonresponders.<br/>Copyright &#xa9; 2017 Italian Federation of
Cardiology. All rights reserved.

<22>
Accession Number
618156033
Author
Gargiulo G.; Valgimigli M.; Capodanno D.; Bittl J.A.
Institution
(Gargiulo, Valgimigli) Department of Cardiology, Bern University Hospital,
University of Bern, Bern, Switzerland
(Gargiulo) Department of Advanced Biomedical Sciences, Federico II
University of Naples, Naples, Italy
(Capodanno) Cardiac-Thoracic-Vascular Department, Ferrarotto Hospital,
University of Catania, Catania, Italy
(Bittl) Munroe Regional Medical Center, 1500 SE 1st Avenue, Ocala, FL
34471, United States
Title
State of the art: Duration of dual antiplatelet therapy after percutaneous
coronary intervention and coronary stent implantation - Past, present and
future perspectives.
Source
EuroIntervention. 13 (6) (pp 717-733), 2017. Date of Publication: August
2017.
Publisher
EuroPCR
Abstract
Evidence from studies published more than 10 years ago suggested that
patients receiving first-generation drug-eluting stents (DES) needed dual
antiplatelet therapy (DAPT) for at least 12 months. Current evidence from
randomised controlled trials (RCT) reported within the past five years
suggests that patients with stable ischaemic heart disease who receive
newer-generation DES need DAPT for a minimum of three to six months.
Patients who undergo stenting for an acute coronary syndrome benefit from
DAPT for at least 12 months, but a Bayesian network meta-analysis confirms
that extending DAPT beyond 12 months confers a trade-off between reduced
ischaemic events and increased bleeding. However, the network
meta-analysis finds no credible increase in all-cause mortality if DAPT is
lengthened from three to six months to 12 months (posterior median odds
ratio [OR] 0.98; 95% Bayesian credible interval [BCI]: 0.73-1.43), from 12
months to 18-48 months (OR 0.87; 95% BCI: 0.64-1.17), or from three to six
months to 18-48 months (OR 0.86; 95% BCI: 0.63-1.21). Future investigation
should focus on identifying scoring systems that have excellent
discrimination and calibration. Although predictive models should be
incorporated into systems of care, most decisions about DAPT duration will
be based on clinical judgement and patient preference.<br/>Copyright
&#xa9; Europa Digital & Publishing 2017. All rights reserved.

<23>
Accession Number
618173858
Author
Roosen L.J.; Karamermer Y.; Vos J.A.; De Jong G.M.; Bos W.J.; Elgersma
O.E.
Institution
(Roosen, Elgersma) Department of Radiology, Albert Schweitzer Hospital,
Albert Schweitzerplaast 25, Dordecht 3318 AT, Netherlands
(Karamermer) Department of Radiology, Jeroen Bosch Hospital, Den Bosch,
Netherlands
(Vos) Department of Radiology, Antonius Hospital, Nieuwegein, Netherlands
(De Jong) Department of Nephrology, Albert Schweitzer Hospital, Dordrecht,
Netherlands
(Bos) Department of Nephrology, Antonius Hospital, Nieuwegein, Netherlands
Title
Paclitaxel-coated balloons do not prevent recurrent stenosis in
hemodialysis access fistulae: Results of a randomized clinical trial.
Source
Italian Journal of Vascular and Endovascular Surgery. 24 (2) (pp 35-40),
2017. Date of Publication: June 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
BACKGROUND: Fistula failure is frequently caused by stenosis. Percutaneous
transluminal angioplasty (PTA) has a poor patency, as it induces intima
hyperplasia and hence recurrent stenosis. Paclitaxel-coated balloons (PCB)
have shown good results in treating stenosis in coronary and lower
extremity arteries compared to conventional balloon angioplasty (CBA).
This study compares secondary patency rates of PCB to CBA in recurrent
stenosis in haemodialysis fistula. METHODS: In this multicenter trial 34
patients with recurrent stenosis in their fistula were randomized for
either CBA (N.=18) or PCB (N.=16). Follow-up interval was set 3, 6, 9 and
12 months with duplex ultrasonography. Primary endpoints were occlusion,
re-stenosis grade >50% or blood flow measurements <600 mL/min.
Reintervention was planned within two to seven days. RESULTS: One patient
was lost in follow up. One patient in the PCB group had an early
complication with thrombosis of the fistula due to an allergic reaction to
the contrast agent. Another patient had a subtotal occlusion a few hours
after intervention. The cause was not entirely clear. 5 patients reached
their endpoint prematurely by the cause of death. In this total group of
34 patients no beneficial effects were seen in the PCB group. The primary
patency defined as the target lesion revascularization (TLR) free interval
in this group was 130 days compared to the mean TLR free interval for CBA
of 189 days (P=0.197). CONCLUSIONS: Our study does not support the use of
paclitaxel coated balloons to prevent recurrent stenosis in hemodialysis
fistulae.<br/>Copyright &#xa9; 2017 EDIZIONI MINERVA MEDICA.

<24>
Accession Number
618049564
Author
Phillips B.; Turco L.; Mirzaie M.; Fernandez C.
Institution
(Phillips, Mirzaie, Fernandez) Department of Surgery, Creighton University
School of Medicine, Omaha, NE, United States
(Phillips) Department of Clinical Science and Translational Research,
Creighton University School of Medicine, Omaha, NE, United States
(Turco) Department of Surgery, University of Kansas Medical Center, Kansas
City, KS, United States
Title
Trauma pneumonectomy: A narrative review.
Source
International Journal of Surgery. 46 (pp 71-74), 2017. Date of
Publication: October 2017.
Publisher
Elsevier Ltd
Abstract
Purpose Thoracic injuries are common in both blunt and penetrating trauma.
Most thoracic injuries are managed non-operatively, approximately 7-20%
undergo thoracotomy. Of the injuries requiring thoracotomy, 1-6%
ultimately require pulmonary resection. Wedge resection and lobectomies
are well-studied in the literature; however, there is a paucity regarding
reports on total pneumonectomy in the setting of trauma. Our objectives
were to summarize the evidence supporting the role of trauma pneumonectomy
(TP) in the current era and reiterate that despite the associated
morbidity and mortality TP is justified in selective cases. Methods A
review of the world's literature was conducted following standard
guidelines. Inclusion criteria included those studies reviewing blunt and
penetrating trauma to the lungs in adults (age greater than 15 year) that
reported mortality rates and outcome measures. Results The PubMed search
yielded 713 studies. Of these, 14 studies included pertinent information
on TP. Studies included in this review were published from 1985 to 2017
and involved patient data that was collected from 1972 to 2014. Mortality
ranged from 50% to 100% (median 63%; mean 68%). Conclusion In the setting
of severe thoracic trauma, pulmonary resection may be necessary. Less
aggressive techniques are options in a stable patient; however, in the
setting of ongoing hemorrhage, TP should be considered and expediently
conducted. The role of damage control thoracic surgery and related
techniques is vitally important in these patients to improve the
significant mortality of trauma pneumonectomy.<br/>Copyright &#xa9; 2017
IJS Publishing Group Ltd

<25>
[Use Link to view the full text]
Accession Number
618093728
Author
Koehler D.; Marsh J.L.; Karam M.; Fruehling C.; Willey M.
Institution
(Koehler, Marsh, Karam, Fruehling, Willey) Department of Orthopaedic
Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa
City, IA, United States
Title
Efficacy of surgical-site, multimodal drug injection following operative
management of femoral fractures: A randomized controlled trial.
Source
Journal of Bone and Joint Surgery - American Volume. 99 (6) (pp 512-519),
2017. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background: Multimodal analgesia inclusive of periarticular injection with
a local anesthetic agent has been rapidly assimilated, with demonstrated
safety and efficacy, into the care of patients undergoing elective
lower-extremity arthroplasty. The present study was performed to evaluate
the efficacy and safety of a surgical-site, multimodal drug injection for
postoperative pain control following operative management of femoral
fractures. Methods: There were 102 patients undergoing operative
intervention (plate fixation, intramedullary device, or arthroplasty) for
a broad range of femoral fracture patterns who were prospectively
randomized either to receive an intraoperative, surgical-site injection
into the superficial and deep tissues containing ropivacaine, epinephrine,
and morphine or to receive no injection. Visual analog scale (VAS) scores
were recorded at regular intervals as the primary outcome measure.
Narcotic consumption and medication-related side effects were also
monitored. Results: The injection group demonstrated significantly lower
VAS scores (p < 0.05) than the control cohort in the recovery room and at
the 4, 8, and 12-hour postoperative time points. The median score (and
interquartile range) was 1.6 (0 to 4.0) for the injection group and 3.2
(1.3 to 5.7) for the control group immediately postoperatively, 1.0 (0 to
3.0) for the injection group and 5.0 (2.0 to 7.0) for the control group at
4 hours, 2.0 (0 to 4.0) for the injection group and 5.0 (2.0 to 6.8) for
the control group at 8 hours, and 3.5 (0 to 5.0) for the injection group
and 5.0 (2.0 to 8.0) for the control group at 12 hours. Additionally,
narcotic consumption was significantly lower (p = 0.007) in the injection
group (5.0 mg [1.3 to 8.0 mg]) compared with the control group (9.7 mg
[3.9 to 15.6 mg]) over the first 8 hours following the surgical procedure.
No cardiac or central nervous system toxicity was observed secondary to
infiltration of the local anesthetic. Conclusions: Surgical-site injection
with a multimodal analgesic cocktail provides improved pain control and
reduces narcotic utilization over the first postoperative day, with no
observed adverse effects attributable to the local injection, across a
diverse orthopaedic trauma population undergoing operative intervention
for femoral fractures. Level of Evidence: Therapeutic Level I. See
Instructions for Authors for a complete description of levels of
evidence.<br/>Copyright &#xa9; 2017 by the Journal of bone and joint
surgery, incorporated.

<26>
Accession Number
616740505
Author
Heiberg J.; Nyboe C.; Hjortdal V.E.
Institution
(Heiberg, Hjortdal) Department of Cardiothoracic & Vascular Surgery,
Aarhus University Hospital, Aarhus, Denmark
(Heiberg, Nyboe, Hjortdal) Department of Clinical Medicine, Aarhus
University Hospital, Aarhus, Denmark
(Nyboe) Department of Anesthesiology & Intensive Care, Aarhus University
Hospital, Aarhus, Denmark
Title
Permanent chronotropic impairment after closure of atrial or ventricular
septal defect.
Source
Scandinavian Cardiovascular Journal. 51 (5) (pp 271-276), 2017. Date of
Publication: 03 Sep 2017.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Objectives. Atrial and ventricular septal defects are commonly closed
surgically with low rates of post-operative morbidity, and the long-term
outcome has widely been described as benign. Nevertheless, there is an
increasing understanding of late morbidity, and the possibility of
postoperative chronotropic impairment is continuously questioned.
Furthermore, potentially abnormal chronotropic responses may be associated
with the recently demonstrated overrepresentation of late arrhythmias. We
conducted this review to methodically describe the potential effects of
surgical defect closure on the chronotropic response to exercise. Methods.
We performed a search protocol based on the 'Preferred Reporting Items for
Systematic Reviews and Meta- Analyses' (PRISMA) guidelines. A data
collection form was specifically developed and data were extracted from
the included studies by a primary reviewer and crosschecked by a secondary
reviewer. Results. A search of electronic databases revealed 16
publications, which consistently reported an abnormal heart rate responses
to exercise after surgical closure. In contrast, these and other studies
convincingly showed normal chronotropic response in un-operated patients
as well as after percutaneous closure. Potential mechanisms include
disturbances in the sinoatrial or atrioventricular conduction system and
denervation in the proximity of the aorta during the surgical procedure.
Discussion. ASD and VSD patients have abnormal heart rate responses to
exercise after surgical closure, which indicates a need of change in the
preoperative information given to these patients and their parents before
surgical defect closure. Although there may not be any alternatives to
surgery, patients should still be informed about potential long-term
consequences, including the risk of chronotropic incompetence. Moreover,
this review suggests that 'specialized', long-term follow up may be
indicated.<br/>Copyright &#xa9; 2017 Informa UK Limited, trading as Taylor
& Francis Group.

<27>
Accession Number
617455309
Author
Relbo Authen A.; Grov I.; Karason K.; Gustafsson F.; Eiskjaer H.; Radegran
G.; Gude E.; Jansson K.; Dellgren G.; Solbu D.; Arora S.; Andreassen A.K.;
Gullestad L.
Institution
(Relbo Authen, Grov, Gude, Arora, Andreassen, Gullestad) Department of
Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
(Karason) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Gustafsson) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Eiskjaer) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(Radegran) The Section for Heart Failure and Valvular Disease, VO. Heart
and Lung medicine, Skane University Hospital and Department of Clinical
Sciences Lund, Cardiology, Lund University, Lund, Sweden
(Jansson) Department of Cardiology and Clinical Physiology, Institute of
Medicine and Health Sciences, Linkoping University, Linkoping, Sweden
(Dellgren) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Solbu) Novartis Norge AS, Oslo, Norway
(Arora, Andreassen, Gullestad) Center for Heart Failure Research, Faculty
of Medicine, University of Oslo, Oslo, Norway
Title
Effect of everolimus vs calcineurin inhibitors on quality of life in heart
transplant recipients during a 3-year follow-up: Results of a randomized
controlled trial (SCHEDULE).
Source
Clinical Transplantation. 31 (9) (no pagination), 2017. Article Number:
e13038. Date of Publication: September 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
The Scandinavian heart transplant everolimus de novo study with early
calcineurin inhibitors avoidance (SCHEDULE) trial was a 12 month,
randomized, open-label, parallel-group trial that compared everolimus
(EVR; n=56) to conventional CsA (n=59) immunosuppression. Previously, we
reported that EVR outperformed CsA in improving renal function and
coronary artery vasculopathy, despite a higher rejection rate with EVR.
This study aimed to compare the effects of these treatments on quality of
life (QoL). Within five post-operative days, patients (mean age 50+/-13
years, 27% women) were randomized to EVR or a standard CsA dosage (CsA
group). This study assessed quality of life (QoL), based on the Short
Form-36, EuroQol-5D, and Beck Depression Inventory (BDI). Assessments were
performed pre-HTx and 12 and 36 months post-HTx. At 12 and 36 months, the
groups showed similar improvements in Short Form-36 measures (at pre-HTx,
12 and 36 months the values were as follows: Physical component summary:
EVR: 31.5+/-110.9, 49.1+/-9.7, and 47.9+/-10.6; P<.01; CsA: 32.5+/-8.2,
48.4+/-8.5, and 46.5+/-11.5; P<.01; mental component summary: EVR:
46.0+/-12.0, 51.7+/-11.9, and 52.1+/-13.0; P<.01; CsA: 38.2+/-12.5,
53.4+/-7.1, and 54.3+/-13.0; P<.01); similar decrease in mean BDI (EVR:
10.9+/-10.2, 5.4+/-4.7, and 8.1+/-9.0; P<.01; CsA: 11.8+/-7.1, 6.3+/-5.4,
and 6.2+/-6.5; P<.01); and similar Euro Qol-improvements. Thus, in this
small-sized study, EVR-based and conventional CsA immunosuppressive
strategies produced similar QoL improvements.<br/>Copyright &#xa9; 2017
John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

<28>
Accession Number
618116819
Author
Peigh G.; Kumar J.; Unai S.; Diehl J.T.; Hirose H.
Institution
(Peigh, Kumar, Unai, Diehl, Hirose) Division of Cardiothoracic Surgery,
Thomas Jefferson University Hospital, Philadelphia, PA, United States
(Hirose) Division of Cardiothoracic Surgery, Thomas Jefferson University,
1025 Walnut Street, Room 605, Philadelphia, PA 19107, United States
Title
Randomized trial of sternal closure for low risk patients: Rigid fixation
versus wire closure.
Source
Heart Surgery Forum. 20 (4) (pp E164-E169), 2017. Date of Publication:
August 2017.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Background: A previous retrospective analysis of our cardiac surgery
patients showed shortened ventilation time and hospital stay among
patients receiving rigid sternal fixation compared to sternal wire
fixation. We performed a prospective randomized study to further
investigate these outcomes and determine if rigid closure can provide
reduced pain after cardiac surgery. Methods: Patients undergoing cardiac
surgery between July 2011 and May 2014 were prospectively randomized into
wire closure (Group C) or rigid fixation using sternal plates (Group R)
groups. Age above 80, emergency surgery, redo sternotomy, and
immunosuppression were among major exclusion criteria precluding
randomization. Intubation time was recorded for all patients. Pain scores
were determined daily from postoperative day 1 until day 5 at 6 a.m. using
a numeric rating scale. Narcotic pain medication requirements from day 1
to 5 were collected and converted into intravenous morphine equivalents.
Results: Of 80 patients, 39 patients were in Group R (average age 65 +/-
8; 31 male and 8 female) and 41 patients were in Group C (average age 66
+/- 9; 34 male and 7 female). Group R patients had a higher body mass
index than patients in Group C (Group R: 31 +/- 5; Group C: 29 +/- 5; P =
.04). No significant differences in the end points of intubation time and
postoperative pain were observed. Conclusion: This randomized study of
cardiac surgery patients showed no significant benefits of rigid fixation
over conventional sternal wire closure with regard to intubation time,
postoperative pain, or length of hospital stay.<br/>Copyright &#xa9; 2017
Forum Multimedia Publishing, LLC

<29>
Accession Number
618057916
Author
Faerber G.; Zacher M.; Reents W.; Boergermann J.; Kappert U.; Boening A.;
Diegeler A.; Doenst T.
Institution
(Faerber, Doenst) Department of Cardiothoracic Surgery, Jena University
Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
(Zacher, Reents, Diegeler) Cardiovascular Clinic Bad Neustadt, Bad
Neustadt, Germany
(Boergermann) Clinic for Heart, Thoracic and Cardiovascular Surgery, Heart
and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
(Kappert) Department of Cardiac Surgery, Cardiovascular Institute,
University of Dresden, Dresden, Germany
(Boening) Department of Cardiovascular Surgery, University of Giesen,
Giesen, Germany
Title
Female sex is not a risk factor for post procedural mortality in coronary
bypass surgery in the elderly: A secondary analysis of the GOPCABE trial.
Source
PLoS ONE. 12 (8) (no pagination), 2017. Article Number: e0184038. Date of
Publication: August 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Objective: Female sex is considered a significant risk in cardiac surgery
and is included in the majority of scores for risk assessment. However,
the evidence is controversial and older women undergoing cardiac surgery
have not specifically been investigated. We assessed the influence of
female sex on surgical risk (30-day mortality) in a secondary analysis of
the GOPCABE trial (German Off-Pump Coronary Artery Bypass grafting in the
Elderly (GOPCABE) trial, comparing on- to off-pump) and also evaluated its
impact on risk prediction from commonly used risk scores. Methods: We
performed logistic regression analyses on the GOPCABE trial population,
where patients were randomized to either on- or off-pump CABG. The study
was performed in 12 cardiac surgery centers in Germany and analyzed 2394
patients having undergone CABG at age >=75 years (1187 on-pump, 1207
off-pump). Of the 2394 patients, 755 (32%) were women. The logistic
EuroSCORE and the German KCH score were calculated as expected (E)
mortality and values were compared to observed (O) 30-day mortality (O/E
ratio). Results: There was no difference in mortality or major
cardiovascular adverse events after 30 days between men and women for both
on- and off-pump CABG (men: on- vs. off-pump OR = 0.90, 95%-CI:
[0.63;1.27]; women: on- vs. off-pump OR = 1.07, 95%-CI: [0.62;1.87]).
Therefore, groups were combined for further analyses. Both men and women
had considerable and similar comorbidities. Expected mortality was
significantly higher for women than for men (logistic EuroSCORE:
8.88+/-6.71% vs. 7.99+/-6.69%, p = 0.003; KCH score: 4.42 +/-3.97% vs.
3.57+/-3.65%, p = 0.001). However, observed mortality rates (O) tended to
be even lower in women (2.1% vs. 3.0%). The O/E ratio was closer to 1 in
men than in women (0.84 vs. 0.47). Excluding female sex from the risk
models increased O/E ratio to 0.69. Conclusions: Female sex is not a risk
factor in coronary bypass surgery in the GOPCABE population. The result is
the same for on- and off-pump surgery. Since female sex is a component of
most risk scores, the findings may identify a potential inaccuracy in
current surgical risk assessment, specifically for elderly women. Trial
registration: Clinicaltrials.gov GOPCABE trial No.
NCT00719667.<br/>Copyright &#xa9; 2017 Faerber et al. This is an open
access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<30>
Accession Number
618046831
Author
Huang S.-C.; Wong M.-K.; Lin P.-J.; Tsai F.-C.; Chu J.-J.; Wu M.-Y.; Fu
T.-C.; Wang J.-S.
Institution
(Huang, Wong) Department of Physical Medicine and Rehabilitation, Chang
Gung Memorial Hospital, Linkuo, Taiwan (Republic of China)
(Lin, Tsai, Chu, Wu) Division of Thoracic and Cardiovascular Surgery,
Chang Gung Memorial Hospital, Linkuo, Taiwan (Republic of China)
(Fu) Department of Physical Medicine and Rehabilitation, Chang Gung
Memorial Hospital, Keelung, Taiwan (Republic of China)
(Wang) Healthy Aging Research Center, Graduate Institute of Rehabilitation
Science, Medical College, Chang Gung University, Tao-Yuan, Taiwan
(Republic of China)
(Wang) Heart Failure Center, Department of Physical Medicine and
Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan (Republic of
China)
Title
Short-term intensive training attenuates the exercise-induced interaction
of mono-1/2 cells and platelets after coronary bypass in cardiac patients.
Source
Thrombosis and Haemostasis. 117 (9) (pp 1761-1771), 2017. Date of
Publication: 2017.
Publisher
Schattauer GmbH (E-mail: info@schattauer.de)
Abstract
The interaction between platelets and monocytes plays a critical role in
the pathogenesis and progression of cardiovascular diseases. This study
investigated how short-term intensive training (SIT) influences monocyte
subset characteristics and exercise-induced monocyte and platelet
aggregates (MPAs) following elective coronary bypass (CABG) in cardiac
patients. Forty-nine patients hospitalised for CABG were randomised into
SIT (N=26) and conventional training (CT, N=23) groups. The SIT subjects
underwent supervised aerobic training at 80~120 % of the ventilatory
anaerobic threshold based on sub-maxi-mal exercise tests performed 7 days
post-CABG for 20 sessions with two sessions/day and 30 min/session, which
were completed within four weeks after surgery. The CT subjects performed
light-intensity conditioning exercise for <=4 sessions. Resting and
maximal exercise-mediated monocyte characteristics and MPA were determined
before and following intervention. The SIT group had a larger improvement
in ventilation efficiency and anaerobic threshold than the CT group; the
SIT group exhibited larger reductions in blood monocyte subtypes 1 and 2
(Mono1 and 2) counts at rest than the CT group; the SIT group but not the
CT group exhibited attenuated formation of Mono1/pla-telet
hetero-aggregation (MPA1) and CD42b expression on Mono1/2 caused by
strenuous exercise; and plasma levels of macrophage inflammatory
protein-1beta and soluble P-selectin showed similar trends as Mono1/2 and
MPA1, respectively. In conclusion, SIT modestly improved aerobic capacity
in patients following CABG. Moreover, SIT simultaneously ameliorated the
CD42b expression of Mono1/2 cells and maximal exercise-induced MPA1, which
may reduce the risk of inflammatory thrombosis.<br/>Copyright &#xa9;
Schattauer 2017.

<31>
Accession Number
618159359
Author
De Rosa S.; Polimeni A.; Sabatino J.; Indolfi C.
Institution
(De Rosa, Polimeni, Sabatino, Indolfi) Magna Graecia University, Division
of Cardiology, Department of Medical and Surgical Sciences, Catanzaro
88100, Italy
(Indolfi) Consiglio Nazionale delle Ricerche (CNR), URT-CNR, Department of
Medicine, Catanzaro 88100, Italy
Title
Long-term outcomes of coronary artery bypass grafting versus stent-PCI for
unprotected left main disease: A meta-analysis.
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 240. Date of Publication: 06 Sep 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Coronary artery bypass graft (CABG) surgery has traditionally
represented the standard of care for left main coronary artery (LMCA)
disease. However, percutaneous coronary intervention with stent
implantation (PCI) has more recently emerged as a valuable alternative.
The long-time awaited results of the largest randomized trials on the
long-term impact of PCI versus CABG in LMCA disease, the newly published
NOBLE and EXCEL studies, revealed contrasting results. Thus, aim of the
present meta-analysis was to review the most robust evidence from
randomized comparisons of CABG versus PCI for revascularization of LMCA.
Methods: Randomized studies comparing long-term clinical outcomes of CABG
or Stent-PCI for the treatment of LMCA disease were searched for in
PubMed, the Chochrane Library and Scopus electronic databases. A total of
5 randomized studies were selected, including 4499 patients. Results: No
significant difference between CABG and PCI was found in the primary
analysis on the composite endpoint of death, stroke and myocardial
infarction (OR=106 95% CI 080-140; p=070). Similarly, no differences were
observed between CABG and PCI for all-cause death (OR=103 95% CI 081-132;
p=081). Although not statistically significant, a lower rate of stroke was
registered in the PCI arm (OR=086; p=067), while a lower rate of
myocardial infarction was found in the CABG arm (OR=143; p=017). On the
contrary, a significantly higher rate of repeat revascularization was
registered in the PCI arm (OR=176 95% CI 145-213; p<0001). Conclusions:
The present meta-analysis, the most comprehensive and updated to date,
including 5 randomized studies and 4499 patients, demonstrates no
difference between Stent-PCI and CABG for the treatment of LMCA disease in
the composite endpoint of death, stroke and myocardial infarction. Hence,
a large part of patients with unprotected left main coronary artery
disease can be managed equally well by means of both these
revascularization strategies.<br/>Copyright &#xa9; 2017 The Author(s).

<32>
Accession Number
618215632
Author
Russo A.; Carriero G.; Farcomeni A.; Ceccarelli G.; Tritapepe L.; Venditti
M.
Institution
(Russo, Farcomeni, Ceccarelli, Venditti) Department of Public Health and
Infectious Diseases Sapienza University of Rome Rome Italy
(Carriero, Tritapepe) Department of Cardiovascular, Respiratory,
Nephrologic, Anesthesiologic and Geriatric Sciences Sapienza University of
Rome Rome Italy
Title
Role of oral nystatin prophylaxis in cardiac surgery with
prolongedextracorporeal circulation.
Source
Mycoses. (no pagination), 2017. Date of Publication: 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Duration >120 minutes of extracorporeal circulation (ECC) during
cardiopulmonary bypass procedure was associated to an increased risk of
candidemia in the intensive care unit (ICU). To evaluate oral nystatin
prophylaxis in cardiac surgery considering its exclusive effect on
Candida, in the absence of systemic effects and selection of resistant
strains to polyene. We conducted an observational study in the postcardiac
surgery ICU of Policlinico "Umberto I" of Rome. From January 2014, all
patients with a prolonged ECC >120 minutes were systematically treated
with oral nystatin (Prophylaxis group). This group was compared with all
patients hospitalised in the same ICU, who have not received oral nystatin
after ECC >120 minutes (No prophylaxis group). Overall, 672 consecutive
patients were analyzed: 318 (47.3%) patients belonged to the no
prophylaxis group, and 354 (52.7%) patients to the prophylaxis group.
Diagnosis of candidemia was confirmed in 7 (2.2%) patients, all belonged
to the no prophylaxis group. At multivariate analysis, oral nystatin
prophylaxis showed a protective effect for development of candidemia after
cardiac surgery. Oral nystatin prophylaxis, in patients who underwent a
ECC >120 minutes, seems to reduce development of candidemia; however, the
real efficacy of such prophylaxis approach requires further
investigation.<br/>Copyright &#xa9; 2017 Blackwell Verlag GmbH.

<33>
Accession Number
618215074
Author
Song Y.; Song J.W.; Lee S.; Jun J.-H.; Kwak Y.-L.; Shim J.-K.
Institution
(Song, Song, Kwak, Shim) Department of Anesthesiology and Pain Medicine,
Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul,
Republic of Korea
(Song, Song, Jun, Kwak, Shim) Anesthesia and Pain Research Institute,
Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul,
Republic of Korea
(Lee) Department of Thoracic and Cardiovascular Surgery, Yonsei University
College of Medicine, Seoul, Republic of Korea
Title
Effects of remote ischemic preconditioning in patients with concentric
myocardial hypertrophy: A randomized, controlled trial with molecular
insights.
Source
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Efficacy of remote ischemic preconditioning (RIPC) for
cardioprotection in cardiac surgery is controversial. We aimed to evaluate
the clinical and molecular effects of RIPC on the concentrically
hypertrophied myocardium. Methods: Seventy-two aortic stenosis patients
receiving aortic valve replacement (AVR) under sevoflurane anesthesia were
randomly allocated to RIPC (3. cycles of 5-min inflation [300. mm. Hg] and
deflation on the left arm) or control (deflated cuff placement) group. The
primary endpoints were 24-h area under the curve (AUC) for serum creatine
kinase (CK)-MB and troponin (Tn)-T levels. The secondary endpoints were
myocardial activation of cell signaling pathways, including reperfusion
injury salvage kinases (RISK), signal transducer and activator of
transcription (STAT), nitric oxide synthase (NOS), and apoptosis related
molecules, obtained from right atrial tissue before and after
cardiopulmonary bypass (CPB). Results: There were no intergroup
differences in 24-h AUCs of CK-MB and Tn-T. Phosphorylations of RISK
pathway molecules were not enhanced by RIPC before and after CPB.
Phosphorylation of STAT5 was significantly lower in the RIPC group before
and after CPB. Phosphorylations of STAT3 and endothelial NOS were not
enhanced by RIPC before and after CPB. Expression level of cleaved
caspases-3/caspase-3 was significantly higher in the RIPC group before
CPB. Conclusions: RIPC did not provide clinical benefits or activate
protective signaling in patients with concentric left ventricular
hypertrophy undergoing AVR.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<34>
Accession Number
618215053
Author
Heo S.-H.; Yoon K.-W.; Woo S.-Y.; Park Y.-J.; Kim Y.-W.; Kim K.-H.; Chung
C.-S.; Bang O.-Y.; Kim D.-I.
Institution
(Heo, Yoon, Woo, Park, Kim, Kim) Division of Vascular Surgery, Samsung
Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South
Korea
(Kim) Department of Radiology Samsung Medical Centre, Sungkyunkwan
University School of Medicine, Seoul, South Korea
(Chung, Bang) Department of Neurology, Samsung Medical Centre,
Sungkyunkwan University School of Medicine, Seoul, South Korea
Title
Comparison of Early Outcomes and Restenosis Rate Between Carotid
Endarterectomy and Carotid Artery Stenting Using Propensity Score Matching
Analysis.
Source
European Journal of Vascular and Endovascular Surgery. (no pagination),
2017. Date of Publication: 2017.
Publisher
W.B. Saunders Ltd
Abstract
Objective/Background: Despite randomised evidence, the debate continues
about the preferred treatment strategy for carotid stenosis in routine
clinical practice. The aim of this study was to compare early outcomes and
restenosis rates after carotid endarterectomy (CEA) and carotid stenting
(CAS) in unselected patients using propensity score matching (PSM).
Methods: The 30 day incidence of major adverse clinical events (MACE;
defined as stroke, transient ischaemic attack, myocardial infarction, or
death) and procedure related complications, as well as restenosis rates
during follow-up were compared between unselected patients undergoing CEA
or CAS between January 2002 and December 2015 at a single institution. PSM
was used to balance the following factors between the CEA and CAS cohorts:
age, sex, hypertension, diabetes, dyslipidaemia, smoking, atrial
fibrillation, previous percutaneous coronary intervention or coronary
artery bypass grafting, valvular heart disease, contralateral carotid
occlusion, degree of carotid stenosis, and symptomatic status. Statistical
comparisons of outcomes were based on logistic regression analysis and log
rank test. Results: Of 1184 patients (654 CEA and 530 CAS), 452 PSM pairs
of CEA and CAS patients were created. The CAS group showed a relatively
higher 30 day incidence of MACE (7.5% vs. 2.4%; odds ratio [OR] 3.261, 95%
confidence interval [CI] 1.634-6.509; p = .001) but a lower incidence of
procedure related complications (1.5% vs. 5.3%; OR 0.199, 95% CI
0.075-0.528; p = .001). During a mean follow-up of 49.1 months (range
1-180 months), restenosis rates were higher after CAS than after CEA (1.5%
vs. 1.0% at 12 months and 5.4% vs. 1.2% at 24 months, respectively; p =
.008). Conclusion: This PSM based observation reconfirmed previous trial
results in both asymptomatic and symptomatic patients with carotid artery
stenosis in routine clinical practice: CEA showed lower 30 day MACE and
mid-term restenosis rates than CAS.<br/>Copyright &#xa9; 2017 European
Society for Vascular Surgery.

<35>
Accession Number
618192967
Author
Kimura T.; Nagata Y.
Institution
(Kimura, Nagata) Hiroshima University, Department of Radiation Oncology,
Hiroshima, Japan
Title
SBRT for oligometastases.
Source
Radiotherapy and Oncology. Conference: 2017 Annual Conference of the
European Society for Radiotherapy and Oncology, ESTRO 36. Austria. 123 (pp
S72), 2017. Date of Publication: May 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Stereotactic body radiotherapy (SBRT) is commonly used to treat patients
with extracranial oligometastases in clinical settings. In addition, the
"abscopal effect", which is radiotherapy-induced immune-mediated tumor
regression at sites distant to the irradiated field, and treatment with a
combination of SBRT and immune checkpoint inhibitors have attracted
attentions of researchers. According to an international survey of more
than 1000 radiation oncologists reported by Lewis SL et al.[1], 61% of
responders have been using SBRT for extracranial oligometastases, and the
most commonly treated organs were the lung (90%), liver (75%) and spine
(70%). Many authors have suggested that surgery for extracranial
oligometastases might improve local control and overall survival. With the
recent technical developments in SBRT, SBRT is also a promising modality
for achieving a high rate of local control with minimal invasiveness. In
this lecture, we would like to review the treatment results of SBRT for
extracranial oligometastases, such as those located in the lung, liver and
spine and discuss comparisons between surgery and SBRT, and
cost-effectiveness. 1) SBRT for extracranial oligometastases, such as
those located in the lung, liver and spine. 1. Lung Colorectal cancer
(CRC) often presents with oligometastases, commonly in the lung and liver,
and CRC has a high risk of local failure [2]. The accepted selection
criteria include a good performance status (PS), absence of
extra-pulmonary disease, control of the primary tumor, 1-5 synchronous or
metachronous metastases and adequate respiratory function [3, 4]. Several
authors have reported that the 2-year local control rate ranges 49- 96%.
The optimal dose is recommended at least 48 Gy in three fractions to
achieve greater than 90% 2-year control. 2. Liver The best candidates are
patients with a good PS, controlled or absent extra-hepatic disease, <=3
hepatic lesions, size lesions <=3 cm, lesion distance from organs at risk
>8 mm, good liver function (Childs A) and a healthy liver [5]. Several
authors have reported that the 2-year local control rate ranged from 79-
92%. The optimal dose is recommended 48- 60 Gy in three fractions for
lesions with a diameter <=3 cm, while for lesions with a diameter >3 cm a
higher prescription dose, such as 60- 75 Gy is necessary to obtain similar
local control [5]. 3. Spine The goal of spinal SBRT is local control and
pain control. Several authors have reported that the 1-year local control
rate ranges 80- 98% and provides pain relief. Therefore, several
dose/fractionation schedules, such as 24 Gy in 1 fraction or 27 or 30 Gy
in 3 fractions have been used and the optimal dose/fraction schedule is
still unclear. 2) Comparison between surgery and SBRT for extracranial
oligometastases According to several guidelines, surgery for extracranial
oligometastases is still standard practice because of lack of evidence
that SBRT has clinical advantages. A retrospective analysis comparing
surgery with SBRT for 110 patients with pulmonary oligometastases
demonstrated that 3-years overall survival rates were 62% for surgery and
60% for SBRT (p = 0.43) [6]. The authors concluded survival after surgery
was not better than after SBRT although SBRT should be the second choice
after surgery. However, no randomized trials have been conducted, and
prospective randomized studies are required to define the effectiveness of
each modality. 3) Cost-effectiveness Extracranial oligometastases have
been usually managed with systemic therapy with or without surgery.
However, systemic therapy, including molecular targeted drugs, is
expensive. A cost-effectiveness analysis using a Markov modelling approach
demonstrated that video-assisted thoracic surgery wedge resection or SBRT
could be costeffective in selected patients with pulmonary oligometastases
[7]. Increases in medical expenses are a social problem worldwide, but it
can be said that SBRT is a promising modality in this aspect.

<36>
Accession Number
618192094
Author
Kim D.-J.; Kim H.-S.; Oh M.K.; Kim E.-Y.; Shin J.-G.
Institution
(Kim, Kim, Oh, Kim, Shin) Inje University College of Medicine, Busan,
South Korea
(Kim, Kim, Shin) Inje University Busan Paik Hospital, Busan, South Korea
Title
Cost-effectiveness of genotype-guided warfarin dosing in the patients with
mechanical heart valve replacement under fee-for-service system.
Source
Clinical Therapeutics. Conference: 13th Congress of the European
Association for Clinical Pharmacology and Therapeutics, EACPT 2017. Czech
Republic. 39 (8 Supplement 1) (pp e9), 2017. Date of Publication: August
2017.
Publisher
Excerpta Medica Inc.
Abstract
Background: Although studies assessing the cost-effectiveness of
genotype-guided warfarin dosing for the management of atrial fbril-lation
and venous thromboembolism have been reported, no publications have
addressed genotype-guided warfarin therapy in mechanical heart valve
replacement (MHVR) patients or genotype-guided warfarin therapy under the
fee-for-service insurance system. The aim of this study was to evaluate
the cost-effectiveness of genotype-guided warfarin dosing in patients with
MHVR under the fee-for-service system from the Korea healthcare sector
perspective. Methods: A decision-analytic Markov model was developed to
evaluate the cost-effectiveness of genotype-guided warfarin dosing
compared to standard dosing. Estimates of clinical adverse event rates and
health state utilities were derived from the published literature. The
outcome measure was the incremental cost-effectiveness ratio (ICER) per
quality-adjusted life-year (QALY). One-way and probabilistic sensitivity
analyses were performed to explore the range of plausible results.
Results: In a base-case analysis, genotype-guided warfarin dosing was
associated with marginally higher QALYs compared to standard warfarin
dosing (6.088 vs. 6.083, respectively), at a slightly higher cost
(US$6.8). The ICER was US$1,356.2 per QALY gained. In probabilistic
sensitivity analysis, there was an 82.7% probability that genotype-guided
dosing was dominant over standard dosing, and a 99.8% probability that it
was cost-effective at a willingness-to-pay threshold of US$50,000 per QALY
gained. Conclusions: Compared with only standard warfarin therapy,
gen-otype-guided warfarin dosing was cost-effective in MHVR patients under
the fee-for-service insurance system.

<37>
Accession Number
618198316
Author
Akintoye E.; Sellke F.; Marchioli R.; Tavazzi L.; Mozaffarian D.
Institution
(Akintoye) Department of Internal Medicine, Wayne State University School
of Medicine, Detroit, Mich
(Sellke) Department of Cardiothoracic Surgery, Alpert Medical School,
Brown University, Providence, RI
(Marchioli) Department of Hematology and Oncology, Therapeutic Science and
Strategy Unit, Quintiles, Milan, Italy
(Tavazzi) Department of Cardiology and LTTA Centre, University of Ferrara,
Ferrara, Italy; Maria Cecilia Hospital- GVM Care and Research, and E.S.
Health Science Foundation, Cotignola, Italy
(Mozaffarian) Friedman School of Nutrition Science and Policy, Tufts
University, Boston, Mass
Title
Factors associated with postoperative atrial fibrillation and other
adverse events after cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: The study objective was to evaluate the impact of various
surgical characteristics and practices on the risk of postoperative atrial
fibrillation and other adverse outcomes after cardiac surgery. Methods: By
using the prospectively collected data of patients who underwent cardiac
surgery in 28 centers across the United States, Italy, and Argentina, the
details of surgery characteristics were collected for each patient and the
outcomes, including postoperative atrial fibrillation, major adverse
cardiovascular events, and mortality. These were evaluated via
multivariable-adjusted models. Results: In 1462 patients, a total of 460
cases of postoperative atrial fibrillation, 33 major adverse
cardiovascular events, 23 cases of 30-day mortality, and 46 cases of
1-year mortality occurred. We found that type of surgery and
cardiopulmonary bypass use predicted the occurrence of postoperative
atrial fibrillation. Compared with coronary artery bypass grafting alone,
there was a higher risk of postoperative atrial fibrillation with valvular
surgery alone (odds ratio, 1.4; 95% confidence interval, 1.1-1.9), and the
risk was even higher with concomitant valvular and coronary artery bypass
grafting surgery (odds ratio, 1.8; 95% confidence interval, 1.2-2.7).
Compared with no bypass, use of cardiopulmonary bypass was associated with
higher risk of postoperative atrial fibrillation (odds ratio, 2.4; 95%
confidence interval, 1.7-3.5), but there were significant age and sex
differences of the impact of bypass use among patients undergoing coronary
artery bypass grafting (P for interaction = .04). In addition, compared
with spontaneous return of rhythm, ventricular pacing was associated with
a higher risk of major adverse cardiovascular events (odds ratio, 5.0; 95%
confidence interval, 1.4-18), whereas concomitant coronary artery bypass
grafting and valvular surgery was associated with a higher risk of 30-day
mortality (hazard ratio, 4.3; 95% confidence interval, 1.2-14) compared
with coronary artery bypass grafting alone. Occurrence of postoperative
atrial fibrillation was associated with greater length of stay and 1-year
mortality (hazard ratio, 2.2; 95% confidence interval, 1.2-3.9).
Conclusions: In this multicenter trial, we identified specific adverse
outcomes that are associated with concomitant valvular and coronary artery
bypass graft surgery, cardiopulmonary bypass, ventricular pacing, and
occurrence of postoperative atrial fibrillation.<br/>Copyright &#xa9; 2017
The American Association for Thoracic Surgery.

<38>
Accession Number
618198288
Author
Khan S.U.; Rahman H.; Arshad A.; Khan M.U.; Lekkala M.; Yang T.; Mishra
A.; Kaluski E.
Institution
(Khan, Rahman, Lekkala, Yang, Mishra, Kaluski) Guthrie Health
System/Robert Packer Hospital, Sayre, PA, USA
(Arshad) Unity Hospital/Rochester Regional Health System, Rochester, NY,
USA
(Khan) West Virginia University School of Medicine, Morgantown, WV, USA
(Kaluski) Rutgers Medical School, Newark, NJ
(Kaluski) Geisinger Commonwealth School of Medicine, Scranton, PA
Title
Percutaneous Coronary Intervention Versus Surgery in Left Main Stenosis-A
Meta-Analysis and Systematic Review of Randomised Controlled Trials.
Source
Heart Lung and Circulation. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier Ltd
Abstract
Objective: To investigate the safety and efficacy of percutaneous coronary
interventions (PCI) versus coronary artery bypass graft (CABG) surgery for
left main coronary artery (LMCA) disease. Methods: Six randomised
controlled trials (RCTs) were reviewed by searching PubMed/Medline, Embase
and the Cochrane Library. Estimates were pooled according to random
effects model. Binary outcomes were reported as risk ratio (RR) and
continuous outcomes were reported as mean difference (MD) with 95%
confidence interval (CI). Results: 3794 patients were randomised into PCI
and CABG arms. Mean age of the total population was 64.7 years, 74.4% were
male and mean Logistic EURO score (LES) was 2.9. When compared with CABG,
patients treated with PCI had reduced risk of major adverse cardiovascular
events (MACE) at 30 days: (RR: 0.55; 95% CI, 0.41-0.75; p<0.001;
I² =0) but similar risk at 1year (RR: 1.15; 95% CI, 0.92-1.45;
p=0.22; I² =0). Five years MACE rates favoured CABG (RR: 1.32;
95% CI, 1.13-1.53; p<0.001; I² =0) driven by a higher rate of
target vessel revascularisation (TVR) (RR: 1.71; 95%CI, 1.38-2.12;
p<0.001; I² =0) and myocardial infarction (MI) (RR: 1.97;
95%CI, 1.28-3.04; p<0.001; I² =22). Percutaneous coronary
intervention was comparatively a safer procedure with lower rates of
periprocedural adverse events including MI, stroke, bleeding events and
need for blood transfusions. Conclusion: Percutaneous coronary
intervention reduced MACE at 30. days with comparable MACE at 1. year.
However, CABG was a more effective modality when considering mid- to
long-term outcomes. PCI is a safer procedure with regards to
periprocedural adverse events.<br/>Copyright &#xa9; 2017 Australian and
New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the
Cardiac Society of Australia and New Zealand (CSANZ).

<39>
Accession Number
618173018
Author
Perrotti A.; Chenevier-Gobeaux C.; Ecarnot F.; Barrucand B.; Lassalle P.;
Dorigo E.; Chocron S.
Institution
(Perrotti, Chenevier-Gobeaux, Ecarnot, Barrucand, Lassalle, Dorigo,
Chocron) Departments of aThoracic and Cardiovascular Surgery and
bCardiology, EA3920, University Hospital Jean Minjoz, Besancon,
cDepartment of Automated Biological Diagnosis, Hopitaux Universitaires
Paris Centre (HUPC), Assistance Publique des Hopitaux de Paris (AP-HP),
Paris, and dInstitut Pasteur de Lille, Center for Infection and Immunity
of Lille, Lille, France
Title
Relevance of Endothelial Cell-Specific Molecule 1 (Endocan) Plasma Levels
for Predicting Pulmonary Infection after Cardiac Surgery in Chronic Kidney
Disease Patients: The Endolung Pilot Study.
Source
CardioRenal Medicine. (pp 1-8), 2017. Date of Publication: 31 Aug 2017.
Publisher
S. Karger AG
Abstract
Objectives: This pilot study aimed to evaluate the relevance of endocan
plasma levels for predicting pulmonary infection after cardiac surgery in
patients with chronic kidney disease (CKD). Methods: Serum collected in a
previous prospective cohort study (from 166 patients with preoperative CKD
who underwent cardiac surgery) was used. Five patients with postoperative
pulmonary infection were compared with 15 randomly selected CKD patients
with an uneventful outcome. Blood samples were tested at 4 time points
(preoperatively and 6, 12, and 24 h after the end of surgery). Endocan,
procalcitonin, and C-reactive protein plasma levels were compared between
the two groups. Results: At 6 h, the patients with pulmonary infection had
significantly higher levels of endocan than the patients without pulmonary
infection (24.2 +/- 15.6 vs. 6.4 +/- 3.2 ng/mL; p = 0.03). A receiver
operating characteristic curve analysis showed 80% sensitivity and 100%
specificity for endocan to predict pulmonary infection (area under the
curve 0.84), with a cutoff value of 15.9 ng/mL. The time saved by
assessment of the endocan dosage compared to a clinical diagnosis of
pulmonary infection was 47 h. Conclusion: This pilot study showed that a
specific study to assess the link between endocan plasma levels and
pulmonary infection after cardiac surgery in CKD patients is of potential
utility.<br/>Copyright &#xa9; 2017 S. Karger AG, Basel

<40>
Accession Number
618030509
Author
Doros G.; Massaro J.M.; Kandzari D.E.; Waksman R.; Koolen J.J.; Cutlip
D.E.; Mauri L.
Institution
(Doros) Department of Biostatistics, Boston University, Boston, MA, United
States
(Doros, Cutlip, Mauri) Baim Institute for Clinical Research, Boston, MA,
United States
(Massaro) Boston University School of Public Health, Boston, MA, United
States
(Kandzari) Piedmont Heart Institute, Atlanta, GA, United States
(Waksman) MedStar Washington Hospital Center, Washington, DC, United
States
(Waksman) Georgetown University, Washington, DC, United States
(Koolen) Catharina Hospital Eindhoven, Netherlands
(Cutlip) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Mauri) Brigham and Women's Hospital, Boston, MA, United States
(Cutlip, Mauri) Harvard Medical School, Boston, MA, United States
Title
Rationale of a novel study design for the BIOFLOW V study, a prospective,
randomized multicenter study to assess the safety and efficacy of the
Orsiro sirolimus-eluting coronary stent system using a Bayesian approach.
Source
American Heart Journal. 193 (pp 35-45), 2017. Date of Publication:
November 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Traditional study design submitted to the Food and Drug
Administration to test newer drug-eluting stents (DES) for marketing
approval is the prospective randomized controlled trial. However, several
DES have extensive clinical data from trials conducted outside the United
States that have led to utilization of a novel design using the Bayesian
approach. This design was proposed for testing DES with bioresorbable
polymer compared with DES most commonly in use today that use durable
polymers for drug elution. Study design and objectives This prospective,
multicenter, randomized, controlled trial is designed to assess the safety
and efficacy of the Orsiro bioresorbable polymer sirolimus-eluting stent
(BP SES). Up to 1,334 subjects with up to 3 de novo or restenotic coronary
artery lesions who qualify for percutaneous coronary intervention with
stenting will be randomized 2:1 to the BP SES versus the Xience durable
polymer everolimus-eluting stent (DP EES). Data from this trial will be
combined with data from 2 similarly designed trials that also randomize
subjects to BP SES and DP EES (BIOFLOW II, N = 452 and BIOFLOW IV, N =
579) by using a Bayesian approach. The primary end point is target lesion
failure at 12 months post index procedure, defined as cardiac death,
target vessel myocardial infarction, or clinically driven target lesion
revascularization, and the primary analysis is a test of noninferiority of
the BP SES versus DP EES on the primary end point according to a
noninferiority delta of 3.85%. Secondary end points include stent
thrombosis and the individual components of target lesion failure.
Subjects will be followed for 5 years after randomization. Conclusions The
BIOFLOW V trial offers an opportunity to assess clinical outcomes in
patients treated with coronary revascularization using the Orsiro BP SES
relative to a commonly used DP EES. The use of a Bayesian analysis
combines a large randomized cohort of patients 2 two smaller contributing
randomized trials to augment the efficiency of the
comparison.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<41>
Accession Number
613729061
Author
Bryskin R.B.; Robie D.K.; Mansfield F.M.; Freid E.B.; Sukumvanich S.
Institution
(Bryskin, Freid) Department of Anesthesiology, Nemours Children's Clinic,
FL, Jacksonville, United States
(Robie) Department of Surgery, Nemours Children's Clinic, Jacksonville,
FL, United States
(Mansfield, Sukumvanich) Mayo School of Graduate Medical Education, United
States
(Mansfield) JLR Medical Group, Orlando, FL, United States
Title
Introduction of a novel ultrasound-guided extrathoracic sub-paraspinal
block for control of perioperative pain in Nuss procedure patients.
Source
Journal of Pediatric Surgery. 52 (3) (pp 484-491), 2017. Date of
Publication: 01 Mar 2017.
Publisher
W.B. Saunders
Abstract
Background A safe and effective method of multilevel thoracic pain control
remains an elusive goal in patients undergoing the Nuss procedure. The aim
of our study was to develop a nonopioid centered approach using a novel
regional technique as part of a quality improvement initiative. Methods
The proposed ultrasound-guided technique positions multi-perforated soaker
catheter deep to the paraspinal muscles from T2 to T11. The project was
conducted in two phases. First, a cadaveric dissection was performed to
establish the pathway of spread of local anesthetic in vivo. Second, a
pilot double blind randomized control project was conducted to evaluate
effectiveness of the technique in ten patients and to derive parameters
necessary for the definitive future study. Outcomes were evaluated based
on the narcotic requirement, pain scores and functional measures. Results
Placement of the catheters in two cadavers demonstrated reliable
positioning in the subparaspinal tissue plane, and multilevel dye spread
along the intercostal nerve path. In addition, a potential route of spread
toward the paravertebral space along the canal accommodating dorsal ramus
of the thoracic nerve was demonstrated. The pilot trial demonstrated a
trend in decreased cumulative hydromorphone requirement in comparison to
the control group at both 24 h (0.19 +/- 0.09 mg/kg vs. 0.13 +/- 0.08
mg/kg p = 0.72) and 48 h (0.37 +/- 0.2 mg/kg vs. 0.3 +/- 0.12 mg/kg p =
0.37). Functional performance ability was higher in the treatment group on
both POD#1 (6.7 +/- 1.8 vs. 4.8 +/- 1 p = 0.0495) and POD#2 (8.9 +/- 0.8
vs. 6.5 +/- 1.2 p = 0.04). Pain scores were similar among the two groups
(p = 0.96). Conclusions We describe a new technique to treat multilevel
thoracic pain following the Nuss procedure that is reproducible, safe,
allows diminished opioid use and enhances functional
recovery.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<42>
Accession Number
613571932
Author
Macdonald A.L.; Sevdalis N.
Institution
(Macdonald) Department of Paediatric Surgery, Chelsea and Westminster
Hospital NHS Foundation Trust, London, United Kingdom
(Sevdalis) Health Service and Population Research Department, King's
College, London, United Kingdom
Title
Patient safety improvement interventions in children's surgery: A
systematic review.
Source
Journal of Pediatric Surgery. 52 (3) (pp 504-511), 2017. Date of
Publication: 01 Mar 2017.
Publisher
W.B. Saunders
Abstract
Background Adult surgical patient safety literature is plentiful; however,
there is a disproportionate paucity of published safety work in the
children's surgical literature. We sought to systematically evaluate the
nature and quality of patient safety evidence pertaining to pediatric
surgical practice. Methods Systematic search of MEDLINE and EMBASE
databases and gray literature identified 1399 articles. Data pertaining to
demographics, methodology, interventions, and outcomes were extracted.
Study quality was assessed utilizing formal criteria. Results 20 studies
were included. 14 (70%) comprised peer-reviewed articles. 18 (90%) were
published in the last 4 years. 13 (65%) described a novel intervention,
and 7 (35%) described a modification of an existing intervention. Median
patient sample size was 79 (29-1210). A large number (n = 55) and variety
(n = 35) of measures were employed to evaluate the effect of interventions
on patient safety. 15 (75%) studies utilized a checklist tool as a
component of their intervention. 9 (45%) studies [comprising handoff tools
(n = 7); checklists (n = 1); and multidimensional quality improvement
initiatives (n = 1)] reported a positive effect on patient safety. Quality
assessment was undertaken on 14 studies. Quantitative studies had
significantly higher quality scores than qualitative studies (61 [0-89] vs
44 [11-78], p = 0.03). Conclusions Pediatric surgical patient safety
evidence is in its early stages. Successful interventions that we
identified were typically handoff tools. There now ought to be an onus on
pediatric surgeons to develop and apply bespoke pediatric surgical safety
interventions and generate an evidence base to parallel the adult
literature. Level of Evidence Level IV, Case series with no comparison
group.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<43>
Accession Number
618162249
Author
Khan M.R.; Kayani W.T.; Ahmad W.; Hira R.S.; Virani S.S.; Hamzeh I.; Jneid
H.; Lakkis N.; Alam M.
Institution
(Khan) Resident Internal Medicine, McLaren Flint/Michigan State
University, Flint, Michigan
(Kayani, Virani, Hamzeh, Jneid, Lakkis, Alam) Department of Medicine,
Section of Cardiology, Baylor College of Medicine, Houston, Texas
(Ahmad) Nishtar Medical College, Multan, Pakistan
(Hira) University of Washington, Seattle, Washington
(Virani, Jneid) Section of Cardiology, Michael E. DeBakey Veterans Affairs
Medical Center, Houston, Texas
Title
Meta-Analysis of Comparison of 5-Year Outcomes of Percutaneous Coronary
Intervention Versus Coronary Artery Bypass Grafting in Patients With
Unprotected Left Main Coronary Artery in the Era of Drug-eluting Stents.
Source
American Journal of Cardiology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Patients with unprotected left main coronary artery (ULMCA) disease are
increasingly being treated with percutaneous coronary intervention (PCI)
using drug-eluting stents (DES), but long-term outcomes comparing PCI with
coronary artery bypass grafting (CABG) remain limited. We performed
aggregate data meta-analyses of clinical outcomes (all-cause death,
nonfatal myocardial infarction, stroke, repeat revascularization, cardiac
death, and major adverse cardiac and cerebrovascular events) in studies
comparing 5-year outcomes of PCI with DES versus CABG in patients with
ULMCA disease. A comprehensive literature search (January 1, 2003 to
December 10, 2016) identified 9 studies (6,637 patients). Effect size for
individual clinical outcomes was estimated using odds ratio (OR) with 95%
confidence intervals (CI) using a random effects model. At 5 years, PCI
with DES was associated with equivalent cardiac (OR 0.95, 95% CI 0.62 to
1.46) and all-cause mortality (OR 0.98, 95% CI 0.72 to 1.33), lower rates
of stroke (OR 0.50, 95% CI 0.30 to 0.84), and higher rates of repeat
revascularization (OR 2.52, 95% CI 1.63 to 3.91); compared with CABG,
major adverse cardiac and cerebrovascular events showed a trend favoring
CABG but did not reach statistical significance (OR 1.19, 95% CI 0.93 to
1.54). In conclusion, for ULMCA disease, PCI can be considered as a
comparably effective and yet less invasive alternative to CABG given the
comparable long-term mortality and lower incidences of
stroke.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<44>
Accession Number
612450117
Author
James C.; Millar J.; Horton S.; Brizard C.; Molesworth C.; Butt W.
Institution
(James, Millar, Butt) Department of Intensive Care, Royal Children's
Hospital, 50 Flemington Road, Parkville, Melbourne, VIC 3052, Australia
(James, Millar, Horton, Molesworth, Butt) Murdoch Children's Research
Institute, Melbourne, Australia
(Horton) Perfusion Department, Royal Children's Hospital, Melbourne,
Australia
(Brizard) Department of Cardiac Surgery, Royal Children's Hospital,
Melbourne, Australia
(Butt) Department of Paediatrics, University of Melbourne, Melbourne,
Australia
Title
Nitric oxide administration during paediatric cardiopulmonary bypass: a
randomised controlled trial.
Source
Intensive Care Medicine. 42 (11) (pp 1744-1752), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Cardiopulmonary bypass induces an ischaemia-reperfusion injury
and systemic inflammatory response, which contributes to low cardiac
output syndrome following cardiac surgery. Exogenous nitric oxide during
cardiopulmonary bypass has shown potential to ameliorate such injury. We
undertook a large randomised controlled trial to investigate the clinical
effects of administering nitric oxide to the cardiopulmonary bypass
circuit in children. Methods: After written informed consent, children
were randomised to receive 20 ppm nitric oxide to the gas inflow of the
cardiopulmonary bypass oxygenator, or standard conduct of bypass. Results:
101 children received nitric oxide and developed low cardiac output
syndrome less frequently (15 vs. 31 %, p = 0.007) than the 97 children who
did not receive nitric oxide. This effect was most marked in children aged
less than 6 weeks of age (20 vs. 52 %, p = 0.012) and in those aged 6
weeks to 2 years (6 vs. 24 %, p = 0.026), who also had significantly
reduced ICU length of stay (43 vs. 84 h, p = 0.031). Low cardiac output
syndrome was less frequent following more complex surgeries if nitric
oxide was administered (17 vs. 48 %, p = 0.018). ECMO was used less often
in the nitric oxide group (1 vs. 8 %, p = 0.014). Conclusions: Delivery of
nitric oxide to the oxygenator gas flow during paediatric cardiopulmonary
bypass reduced the incidence of low cardiac output syndrome by varying
degrees, according to age group and surgery complexity. Clinical Trial
Registration: ACTRN12615001376538.<br/>Copyright &#xa9; 2016,
Springer-Verlag Berlin Heidelberg and ESICM.

<45>
Accession Number
611617170
Author
Park K.; Lai D.; Handberg E.M.; Moye L.; Perin E.C.; Pepine C.J.; David
Anderson R.
Institution
(Park, Handberg, Pepine, David Anderson) Division of Cardiovascular
Medicine, Houston, TX 77030, United States
(Lai, Moye) Department of Medicine, University of Florida College of
Medicine, Gainesville, FL 32610, United States
(Moye) Coordinating Center for Clinical Trials, Houston, TX 77030, United
States
(Perin) School of Public Health, University of Texas Health Science Center
at Houston, United States
(Perin) Stem Cell Center, Houston, TX 77030, United States
(Lai, Handberg, Moye, Perin, Pepine, David Anderson) Texas Heart
Institute, Houston, TX 77030, United States
Title
Association between high endocardial unipolar voltage and improved left
ventricular function: In patients with ischemic cardiomyopathy.
Source
Texas Heart Institute Journal. 43 (4) (pp 291-296), 2016. Date of
Publication: August 2016.
Publisher
Texas Heart Institute (E-mail: thijeditor@heart.thi.tmc.edu)
Abstract
We know that endocardial mapping reports left ventricular electrical
activity (voltage) and that these data can predict outcomes in patients
undergoing traditional revascularization. Because the mapping data from
experimental models have also been linked with myocardial viability, we
hypothesized an association between increased unipolar voltage in patients
undergoing intramyocardial injections and their subsequent improvement in
left ventricular performance. For this exploratory analysis, we evaluated
86 patients with left ventricular dysfunction, heart-failure symptoms,
possible angina, and no revascularization options, who were undergoing
endocardial mapping. Fifty-seven patients received bone marrow mononuclear
cell (BMC) injections and 29 patients received cell-free injections of a
placebo. The average mapping site voltage was 9.7 +/- 2 mV, and sites with
voltage of >=6.9 mV were engaged by needle and injected (with BMC or
placebo). For all patients, at 6 months, left ventricular ejection
fraction (LVEF) improved, and after covariate adjustment this improvement
was best predicted by injection-site voltage. For every 2-mV increase in
baseline voltage, we detected a 1.3 increase in absolute LVEF units for
all patients (P=0.038). Multiple linear regression analyses confirmed that
voltage and the CD34+ count present in bone marrow (but not treatment
assignment) were associated with improved LVEF (P=0.03 and P=0.014,
respectively). In an exploratory analysis, higher endocardial voltage and
bone marrow CD34⁺levels were associated with improved left
ventricular function among ischemic cardiomyopathy patients.
Intramyocardial needle injections, possibly through stimulation of
angiogenesis, might serve as a future therapy in patients with reduced
left ventricular function and warrants investigation.<br/>Copyright &#xa9;
2016 by the Texas Heart Institute, Houston.

<46>
Accession Number
611054326
Author
Villablanca P.A.; Briceno D.F.; Massera D.; Hlinomaz O.; Lombardo M.;
Bortnick A.E.; Menegus M.A.; Pyo R.T.; Garcia M.J.; Mookadam F.;
Ramakrishna H.; Wiley J.; Faggioni M.; Dangas G.D.
Institution
(Villablanca, Briceno, Massera, Bortnick, Menegus, Pyo, Garcia, Wiley)
Division of Cardiovascular Diseases, Montefiore Medical Center/Albert
Einstein College of Medicine, New York, United States
(Hlinomaz) International Clinical Research Center, St. Anne University
Hospital, Brno, Czech Republic
(Lombardo) Department of Internal Medicine, New York-Presbyterian
Hospital/Weill Cornell Medical College, New York, NY, United States
(Mookadam) Cardiovascular Division, Mayo Clinic College of Medicine,
Scottsdale, AZ, United States
(Ramakrishna) Division of Cardiovascular and Thoracic Anesthesiology, Mayo
Clinic College of Medicine, Scottsdale, AZ, United States
(Faggioni, Dangas) The Zena and Michael A. Wiener Cardiovascular
Institute, Icahn School of Medicine at Mount Sinai, New York, United
States
Title
Culprit-lesion only versus complete multivessel percutaneous intervention
in ST-elevation myocardial infarction: A systematic review and
meta-analysis of randomized trials.
Source
International Journal of Cardiology. 220 (pp 251-259), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background ST-segment elevation myocardial infarction (STEMI) in patients
with concomitant multivessel (MV) coronary artery disease (CAD) is
associated with poor outcomes. Percutaneous coronary intervention (PCI) of
the culprit-lesion only (CLO) as compared with a MV PCI approach to
revascularization remains uncertain. Our objective is to gain a better
understanding of the efficacy and safety of CLO as compared with MV PCI in
patients with STEMI by conducting an updated meta-analysis. Methods A
comprehensive search of PubMed, CENTRAL, EMBASE, The Cochrane Central
Register, the ClinicalTrials.gov Website, and Google Scholar databases of
randomized controlled trials (RCTs) was performed. Results Seven RCTs were
included, enrolling a total of 2006 patients. We found that there was a
significant reduction in major adverse cardiovascular events (MACE) (OR,
0.62; 95% CI, 0.43-0.90), cardiovascular mortality (OR, 0.46; 95% CI,
0.27-0.80), and repeat revascularization (RRV) (OR, 0.39; 95% CI,
0.30-0.51) favoring MV over the CLO approach for patients undergoing
primary PCI. The number needed to treat in order to prevent one CV
mortality, RRV, or MACE event is 47, 11, and 16 patients, respectively. No
differences were observed between MV vs. CLO PCI for subsequent myocardial
infarction (OR, 0.74; 95% CI, 0.40-1.39), all-cause mortality (OR, 0.78;
95% CI, 0.53-1.15), non-cardiovascular mortality (OR, 1.35; 95% CI,
0.74-2.48), all-bleeding events (OR, 0.82; 95% CI, 0.40-1.65),
contrast-induced nephropathy (OR, 0.72; 95% CI, 0.33-1.54), and stroke
(OR, 1.28; 95% CI, 0.47-3.46). Conclusions MV PCI significantly reduces
the rate of MACE, CV mortality, and RRV without significant harm as
compared to CLO PCI.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd

<47>
Accession Number
611054321
Author
Takagi H.; Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
Title
Worse survival after transcatheter aortic valve implantation than surgical
aortic valve replacement: A meta-analysis of observational studies with a
propensity-score analysis.
Source
International Journal of Cardiology. 220 (pp 320-327), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives To determine whether transcatheter aortic valve implantation
(TAVI) improves (or impairs) follow-up overall survival compared with
surgical aortic valve replacement (SAVR), we performed a meta-analysis of
observational studies with a propensity-score analysis and another
meta-analysis of randomized controlled trials (RCTs). Methods Databases
including MEDLINE and EMBASE were searched through October 2015 using
PubMed and OVID. Eligible studies were observational studies with a
propensity-score analysis or RCTs of TAVI versus SAVR enrolling patients
with severe aortic stenosis and reporting follow-up overall survival or
all-cause mortality as an outcome. A hazard ratio (HR) with its 95%
confidence interval (CI) of follow-up (including early) all-cause
mortality for TAVI versus SAVR was abstracted from each individual study.
Results Our search identified 19 observational studies with a
propensity-score analysis enrolling a total of 6234 patients. The
arithmetic means of 1-year and 3-year survival rates were 82.7% and 71.3%
after TAVI and 84.8% and 77.9% after SAVR, respectively. A pooled analysis
demonstrated a statistically significant 21% increase in the hazard of
mortality with TAVI relative to SAVR (HR, 1.21; 95% CI, 1.05 to 1.39; p =
0.010). Another pooled analysis of 4 RCTs (enrolling a total of 1795
patients) demonstrated no statistically significant difference in
mortality between TAVI and SAVR (HR, 0.92; 95% CI, 0.62 to 1.37; p =
0.69). Conclusions The arithmetic mean of 3-year survival rates was 71.3%
after TAVI and 77.9% after SAVR. Compared with SAVR, TAVI appears to be
associated with a significant increase in follow-up all-cause
mortality.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd

<48>
Accession Number
611113665
Author
Fei Y.; Tsoi M.F.; Cheung T.T.; Cheung B.M.Y.
Institution
(Fei, Tsoi, Cheung, Cheung) Division of Clinical Pharmacology and
Therapeutics, Department of Medicine, The University of Hong Kong,
Pokfulam, China
(Cheung, Cheung) Partner State Key Laboratory of Pharmaceutical
Biotechnology, The University of Hong Kong, Pokfulam, China
(Cheung) Research Centre of Heart, Brain, Hormone and Healthy Aging, The
University of Hong Kong, Pokfulam, China
(Cheung) Institute of Cardiovascular Science and Medicine, The University
of Hong Kong, Pokfulam, China
Title
Optimal duration of dual antiplatelet therapy after drug-eluting stent
implantation: Meta-analysis of randomized controlled trials.
Source
International Journal of Cardiology. 220 (pp 895-900), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objective After implantation of drug-eluting stents (DES), patients
usually receive 6-12 months of dual antiplatelet therapy (DAPT). However,
the optimal duration of DAPT is controversial. Therefore, we performed a
meta-analysis of randomized controlled trials to assess the risks and
benefits of different DAPT durations. Methods We searched the literature
using MEDLINE, Scopus, EMBASE, ISI Web of Science, Cochrane Library,
ClinicalTrials.gov and recent conference proceedings, and included those
trials randomizing patients to receive different durations of DAPT after
DES implantation and reporting frequencies of cardiovascular and bleeding
events. Data from eleven trials were analyzed using RevMan. Results
Compared to 12-month DAPT treatment, extended DAPT significantly reduced
the frequencies of myocardial infarction (OR 0.54 95% CI: 0.43-0.66; p <
0.00001) and stent thrombosis (OR 0.36 95% CI: 0.24-0.55; p < 0.00001),
but the risks of major bleeding (OR 1.54 95% CI 1.22-1.96) and all-cause
mortality (OR 1.43 95% CI 1.14-1.81) were substantially increased. There
was no significant difference in stroke, cardiovascular mortality or
repeat revascularization. Compared to short-term DAPT, 12-month DAPT or
longer was associated with increased major bleeds (OR 1.98 95% CI:
1.26-3.11). No significant differences were found in the risk of other
primary outcomes. Conclusion 12-month DAPT appears to be a pragmatic
compromise between preventing stent thrombosis and increasing bleeding
risk. Patients at high bleeding risk should have shorter duration DAPT
while those with low bleeding risk can be considered for DAPT beyond 12
months.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd

<49>
Accession Number
611054261
Author
Amber K.I.; Hadi N.R.; Muhammad-Baqir B.M.; Jamil D.A.; Al-Aubaidy H.A.
Institution
(Amber) Al-Najaf Center for Cardiac Surgery and Trans Catheter Therapy,
Iraq
(Hadi) Department of Pharmacology and Therapeutics, Faculty of Medicine,
University of Kufa, Iraq
(Muhammad-Baqir) Department of Pharmacology and Toxicology, Faculty of
Pharmacy, University of Kufa, Iraq
(Jamil, Al-Aubaidy) School of Medicine, University of Tasmania, TAS 7001,
Australia
Title
Trimetazidine attenuates the acute inflammatory response induced by
Novolimus eluting bioresorbable coronary scaffold implantation.
Source
International Journal of Cardiology. 220 (pp 514-519), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background This study aims to investigate the inflammatory response in
Novolimus bioresorbable coronary scaffold implantation after a course
treatment with trimetazidine (35 mg tablet/twice daily for 4 days).
Methods This was a randomized single blind study. Forty diabetic patients
with critical coronary stenosis were subjected to elective coronary
scaffold implantation in Al-Najaf Center for Cardiac Surgery and
Trans-Catheter Therapy, Najaf, Iraq, between January and July 2015. All
patients were informed about the nature of the study and they signed the
consent form before they included in the study. Patients were randomly
allocated into the two study groups: Group 1 included 20 patients who did
the elective coronary scaffold implementation without trimetazidine
medication. Group 2 included 20 patients who did the elective coronary
scaffold implementation with a course of the trimetazidine (35 mg
tablet/twice daily for 4 days). Results There were significant reduction
in the levels of the interleukin-6 and cardiac troponin-I in the
trimetazidine-treated group (group 2) compared to the control group (group
1) (P < 0.001), after 12 h and 24 h post-operative. This was associated
with a significant rise in the levels of interleukin 10 in group 2
compared to group 1 (P < 0.001). Pentraxin-3 was significantly reduced in
group 2 but only 24 h post-operative (P < 0.006). Conclusion Our study
concluded that trimetazidine minimizes the acute inflammatory response
occurred due to systemic release of inflammatory markers into blood in
diabetic patients undergoing elective Novolimus bioresorbable coronary
scaffold implementation.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd

<50>
Accession Number
611018798
Author
Matsuyama K.; Koizumi N.; Nishibe T.; Iwasaki T.; Iwahasi T.; Toguchi K.;
Takahashi S.; Iwahori A.; Maruno K.; Ogino H.
Institution
(Matsuyama, Koizumi, Nishibe, Iwasaki, Iwahasi, Toguchi, Takahashi,
Iwahori, Maruno, Ogino) Department of Cardiovascular Surgery, Tokyo
Medical University Hospital, 6-7-1 Nishshinjuku Shinjyuku-ku Tokyo
160-0023, Japan
Title
Effects of short-term administration of tolvaptan after open heart
surgery.
Source
International Journal of Cardiology. 220 (pp 192-195), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Postoperative fluid overload following cardiac surgery is
associated with increased morbidity and mortality. Unlike loop diuretics,
tolvaptan (TLV) promotes aquaretic effect. Relatively little has been
documented regarding the efficacy of TLV after cardiac surgery. The aim of
the study was to investigate the effectiveness and safety of tolvaptan for
the management of immediately postoperative fluid retention following
cardiac surgery. Methods Between January to May 2014, patients undergoing
cardiac surgery were randomly assigned to control or TLV group immediately
after cardiac surgery. In control group, patients received 20 mg of
furosemide and 25 mg of spironolactone as conventional diuretics. In the
TLV group, 7.5 mg of TLV was administered in combination with conventional
diuretics. Results TLV use was associated with increased urine output from
postoperative day 1 to 3.Body weight reduction in the TLV group was
significantly greater than the control group from postoperative day 2 to
4, and serum creatinine levels decreased to below preoperative values in
the TLV group. Conclusions The combination of tolvaptan with conventional
diuretics increases urine output without renal dysfunction and can be
effective for postoperative fluid management and appropriate body weight
reduction.<br/>Copyright &#xa9; 2016

<51>
Accession Number
611070450
Author
Ando T.; Briasoulis A.; Holmes A.A.; Taub C.C.; Takagi H.; Afonso L.
Institution
(Ando) Department of Internal Medicine, Mount Sinai Beth Israel, Icahn
School of Medicine at Mount Sinai, New York, NY 10003, United States
(Briasoulis, Afonso) Wayne State University/Detroit Medical Center,
Division of Cardiology, Detroit, MI 48226, United States
(Holmes, Taub) Division of Cardiology, Montefiore Medical Center; Albert
Einstein College of Medicine, Bronx, NY 10467, United States
(Takagi) Shizuoka Medical Center, Department of Cardiovascular Surgery,
Shizuoka, Japan
Title
Sapien 3 versus Sapien XT prosthetic valves in transcatheter aortic valve
implantation: A meta-analysis.
Source
International Journal of Cardiology. 220 (pp 472-478), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives The S3 prosthetic valve was introduced to overcome several
issues with its predecessor, the SXT, in transcatheter aortic valve
implantation (TAVI), however, the clinical outcomes of this new model are
not clearly defined. We performed a meta-analysis to compare the outcomes
in Sapien 3 (S3) and Sapien XT (SXT) recipients. Methods A literature
search through PUBMED and EMBASE was conducted. Articles that included at
least one of the clinical outcomes of interest were included in the
meta-analysis: moderate to severe paravalvular regurgitation (PVR),
permanent pacemaker implantation (PPI), major vascular complications
(MVC), cerebrovascular events (stroke and transient ischemic attack)
(CVE), failure rate of device implantation, life-threatening, disabling or
major bleeding, need for post-dilation and early all-cause-mortality.
Results A total of 9 observational cohort studies were included. S3 was
implanted in 945 and SXT in 1553 patients. S3 was associated with a lower
incidence of moderate to severe PVR (1.6% vs 6.9%, p < 0.0001), lower MVC
(5.1% vs 8.9%, p = 0.01) and less serious bleeding (8.1% vs 15.2%, p =
0.003) compared to the SXT. Device deployment failure rate was lower in
the S3 (1.2% vs 5.9%, p = 0.004) and the S3 required less post-dilation
(16.9% vs 26.9%, p = 0.05). Rates of CVE, perioperative mortality and PPI
were similar between the two valves. Conclusions Implantation of the S3
prosthetic valve results in lower rates of moderate to severe PVR, MVC,
post-dilation and serious bleeding however it does not improve on the SXT
in terms of CVE, PPI and early mortality.<br/>Copyright &#xa9; 2016
Elsevier Ireland Ltd

<52>
Accession Number
613864946
Author
De Oliveira A.P.A.; De Souza E.N.; Pellanda L.C.
Institution
(De Oliveira, De Souza, Pellanda) Universidade Federal de Ciencias da
Saude de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
(Pellanda) Instituto de Cardiologia do Rio Grande do Sul / Fundacao
Universitaria de Cardiologia (IC/FUC), Porto Alegre, RS, Brazil
Title
Effectiveness of video resources in nursing orientation before cardiac
heart surgery.
Source
Revista da Associacao Medica Brasileira. 62 (8) (pp 762-767), 2016. Date
of Publication: November 2016.
Publisher
Associacao Medica Brasileira
Abstract
Objective: To evaluate the effectiveness of video resources in increasing
patient knowledge during preoperative orientation for cardiac surgery
compared to standard orientation. Method: Randomized clinical trial.
Patients in the intervention group (IG) received bedside orientation with
the aid of a short video and a slide presentation on the day prior to
surgery. Patients in the control group (CG) received standard orientation.
Allocation and analysis of knowledge were blinded. Analysis was performed
according to the intention to treat principle. Results: We included 90
patients, 45 in each group; 27.8% had incomplete primary education. There
were no differences between groups in the baseline. After orientation, IG
scored 7.20 (+/-1.56) and scored CG 2.71 (+/-1.96, p<0,001). The topic
"surgical room" had the lowest proportion of correct answers in CG (6.7%),
compared to IG (68.9%). The question about "postoperative unit" was the
one with the highest proportion of correct answers in IG (93.3%), while in
CG the proportion was 22.2%. "Ventilatory support" had a low proportion of
correct answers in IG (60%), but still much higher than the correct
answers in CG (17.8%). Conclusion: Orientation performed with the aid of
video resources is more effective for knowledge retention in preoperative
patients, compared to verbal orientation alone.<br/>Copyright &#xa9; 2016,
Associacao Medica Brasileira. All rights reserved.

<53>
Accession Number
613171903
Author
Gao H.; Zhang N.; Lu F.; Yu X.; Zhu L.; Mo X.; Wang W.
Institution
(Gao, Zhang, Lu, Yu, Zhu, Wang) Department of Cardiothoracic Surgery,
Shanghai Children's Medical Center, Shanghai Jiaotong University, School
of Medicine, 1678 Dongfang Road, Pudong, Shanghai 200127, China
(Mo) Institute for Pediatric Translational Medicine, Shanghai Children's
Medical Center, Shanghai Jiaotong University, School of Medicine,
Shanghai, China
Title
Circulating histones for predicting prognosis after cardiac surgery: A
prospective study.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (5) (pp 681-687),
2016. Date of Publication: 01 Nov 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES The objective of this study was to assess the perioperative
changes in circulating histones and their relationships with other
biomarkers and clinical outcomes after cardiac surgery with
cardiopulmonary bypass (CPB) in patients. METHODS Forty-eight patients
with congenital cardiac diseases undergoing corrective procedure with CPB
were prospectively enrolled in this study. Circulating histones,
N-terminal pro-brain natriuretic peptide (NT-proBNP), procalcitonin (PCT)
and C-reactive protein (CRP) were measured preoperatively (T0) and at 0
(T1), 24 (T2), 48 (T3) and 72 (T4) h postoperatively. The relationships
between biomarkers and clinical outcomes were analysed. RESULTS
Circulating histones, NT-proBNP, PCT and CRP increased significantly
postoperatively, with histones reaching the peak value earliest at T1.
Circulating histone levels were higher in patients with adverse events.
Receiver operating characteristic curve analysis showed that peak histone
levels had a better predictive value for adverse events postoperatively.
Peak histone levels correlated with the peak level of NT-proBNP (r =
0.563, P < 0.01), PCT (r = 0.551, P < 0.01), CRP (r = 0.606, P < 0.01) and
clinical parameters such as ventilation time (r = 0.601, P < 0.01) and
intensive care unit time (r = 0.623, P < 0.01). CONCLUSIONS Circulating
histones reached peak levels faster than NT-proBNP, PCT and CRP.
Furthermore, peak histone levels correlated with biomarkers and
postoperative clinical outcomes. Circulating histones may be used as a
prognostic indicator for patients after cardiac surgery with CPB. CLINICAL
TRIALS ClinicalTrials.gov (ID: NCT02325765).<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.

<54>
Accession Number
617934320
Author
Van Hillegersberg R.; Valkenet K.; Trappenburg J.; Backx F.
Institution
(Van Hillegersberg, Valkenet, Trappenburg, Backx) University Medical
Center Utrecht, Utrecht, Netherlands
Title
Preoperative inspiratory muscle training to prevent postoperative
pneumonia in esophagectomy patients (prepare trial): A multicenter rct.
Source
Diseases of the Esophagus. Conference: 15th World Congress of the
International Society for Diseases of the Esophagus, ISDE 2016. Singapore.
29 (pp 16A), 2016. Date of Publication: September 2016.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Esophagectomy is the cornerstone of esophageal cancer
treatment. Although the incidence is decreasing due to less invase surgery
tehcniques and fast track recovery programs, still 10 to 40% of patients
suffer a pneumonia after esophagectomy. Since mortality rates in patients
treated for postoperative pneumonia are 3 times higher, additional efforts
are needed to further reduce the incidence of this severe complication.
Improving preoperative pulmonary condition by exercise training
(prehabilitation) may put a patient in a more favorable position to
withstand the surgical stress. Preoperative inspiratory muscle training
has shown to prevent postoperative pneumonia and reduce length of hospital
stay in cardiac surgery. Pilot studies in esophagectomy patients on this
subject however are contradictory. Therefore, we conducted a robust trial
to investigate the impact of inspiratory muscle training on postoperative
pneumonia rates after esophageal resection. Methods: An international
single blind multicenter randomized controlled trial was conducted in 9
hospitals in the Netherlands, Belgium, Ireland and Finland (the PREPARE
study). In total 248 patients (age >18yrs ) undergoing esophagectomy for
esophageal cancer will be included in this study. Patients in the
intervention group receive an inspiratory muscle training program
additional to usual care.A high-intensity training protocol is performed
before surgery. The main study endpoint is the incidence of postoperative
pneumonia. Secondary objectives are to evaluate the effect of preoperative
inspiratory muscle training on length of hospital stay, duration of
mechanical ventilation, incidence of other postoperative complications,
quality of life and on postoperative respiratorymuscle function and lung
function. Results: Recruitment started in September 2013 and is expected
to be finished in March 2016. Preliminary analyses of 134 patients show
that inspiratory muscle endurance is significantly increased in the
intervention group (P50.000) while the control group did not increase
(p50.1). Maximal inspiratory muscle strength is significantly increased in
both groups (p50.000), but the intervention group showed a higher
increase. Analyses on postoperative outcomeswill be performed at the end
of the trial. Discussion: During the convention in Singapore in September
2016 we will be able to present all final results of this robust trial on
improving preoperative pulmonary condition of patients undergoing
esophagectomy.

<55>
Accession Number
617934096
Author
Furukawa H.; Makino T.; Yamasaki M.; Miyazaki Y.; Takahashi T.; Kurokawa
Y.; Nakajima K.; Takiguchi S.; Mori M.; Doki Y.
Institution
(Furukawa, Makino, Yamasaki, Miyazaki, Takahashi, Kurokawa, Nakajima,
Takiguchi, Mori, Doki) Graduate School of Medicine, Osaka University,
Suita, Osaka, Japan
Title
A comparison of safetyand short-term outcome between video-assisted
thoracoscopic surgery versus open esophagectomy for esophageal cancer.
Source
Diseases of the Esophagus. Conference: 15th World Congress of the
International Society for Diseases of the Esophagus, ISDE 2016. Singapore.
29 (pp 96A), 2016. Date of Publication: September 2016.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Transthoracic subtotal esophagectomy for esophageal cancer is
a highly invasive procedure and has been associated with high mortality
and morbidity rate. In recent years, video-assisted thoracoscopic surgery
(VATS) as a minimally invasive operation have been developed for treating
esophageal cancer. However, feasibility and advantage of VATS
esophagectomy still remains to be controversial. Methods: Between January
2011 and December 2014, 86 patients who underwent conventional open
esophagectomy (OS group) and 103 patients who underwent VATS (VATS group)
in our hospital were included in the present study. To evaluate safety and
benefit of VATS esophagectomy, the surgical outcomes, postoperative course
including systemic inflammatory response syndrome (SIRS) and the number of
dissected lymph nodeswere retrospectively compared between the two groups.
Results: There was no significant difference in patient background
including age, gender, BMI, ASA-PS and preoperative pulmonary functions
between the two groups except for clinical stage(OS versus VATS;
cStageI/II/III/IV55/ 26/39/16 vs 45/25/24/9, p<0.001). More number of
patients received neoadjuvant chemotherapy in the OS group as compared to
the VATS group (89.5% vs 81.0%, p50.006). Intraoperative blood loss were
similar between the two groups while operation time during thoracic
procedure was significantly longer in the VATS group than that the OS
group (208 vs 262min, p<0.001). Regarding short-term outcome, no
significant difference was identified in postoperative complications,
postoperative hospital stay, and time to restart oral intake between the
two groups. The postoperative maximum WBC and C-reactive protein levels
were also similar between the two groups. Compare with the OP group,
intensive care unit stay tends to be shorter in VATS group (4[0-16] vs
3[0-18] days, p50.100) and, notably, SIRS duration was significantly
shorter in the VATS group (3[0-16] vs 2[0-10] days, p 50.004). The average
number of dissected thoracic lymph nodes was similar between the two
groups (26.5 vs 23, p50.152). Discussion: In the present retrospective
study, VATS esophagectomy was proven to be a safe procedure that
attenuated postoperative SIRS, implying it is a potentially minimally
invasive procedure for esophageal cancer patients. However a larger-scale
randomized clinical trial is necessary to validate the clinical
significance of our findings.

<56>
Accession Number
617933969
Author
Tangoku A.; Yoshida T.; Inoue S.
Institution
(Tangoku, Yoshida, Inoue) Tokushima University Graduate School, Tokushima,
Japan
Title
Efficacy of prophylactic landiolol for atrial fibrillation in
transthoracic esophagectomy.
Source
Diseases of the Esophagus. Conference: 15th World Congress of the
International Society for Diseases of the Esophagus, ISDE 2016. Singapore.
29 (pp 93A), 2016. Date of Publication: September 2016.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Atrial fibrillation (Af) is one of the most common
cardiovascular complications after esophagectomy. Once Af occurs, it is
sometimes difficult to treat Af successfully. This randomized study was
conducted to evaluate the preventive effects and safety of landiolol, a
b1-selective blocker, on tachycardia or Af in the perioperative period.
Methods: Eighty consecutive patients scheduled for esophagectomy at our
institute between July 2009 and March 2014 agreed to participate in the
clinical trial. Patients were randomly assigned to a landiolol group or
control group. Landiolol was started at 5 g/kg/min after induction of
anesthesia and continued for 24 hours. Tachycardia as a perioperative
cardiovascular event was defined as 120 or more beats per minute.
Electrocardiography was monitored continuously for 2 days after surgery,
after which heart rates and electrocardiography was monitored
intermittently. Results: There were no significant differences in patient
background between the control group (n540) and landiolol group (n539)
except for one patient with preoperative Af. Af was identified in only one
patient in the control group, and the onset was on the second
postoperative day. Overall incidence of Af after esophagectomy was 1.3 %
(1/79). Incidences of tachycardia were 12.5 % and 12.8 % in the control
group and the landiolol group, respectively. No adverse event causing a
discontinuation of landiolol was identified in this study. Discussion: The
rate of postoperative Af was only 1.3%in this study.No significant
preventive effect of landiolol on tachycardia or Af after esophagectomy
could be identified in this study.

<57>
Accession Number
617902308
Author
Ou L.; Chen J.; Hillman K.; Flabouris A.
Institution
(Ou, Chen, Hillman) University of New South Wales, Sydney, Australia
(Flabouris) University of Adelaide, Adelaide, Australia
Title
Hospital variations in postoperative sepsis and related outcomes after
coronary artery bypass grafting surgery.
Source
International Journal for Quality in Health Care. Conference: 33rd
International Conference of the International Society for Quality in
Health Care, ISQua. Japan. 28 (pp 7-8), 2016. Date of Publication: October
2016.
Publisher
Oxford University Press
Abstract
Objectives: To assess hospital variations in the incidence rates of sepsis
and sepsis related deaths, sepsis case fatality, overall in-hospital
mortality and 30-day post-discharge mortality, as well as readmission
within 28 days after discharge among elective surgical patients who
underwent coronary artery bypass grafting (CABG) in New South Wales (NSW),
Australia. Methods: We selected elective surgical patients who underwent
CABG surgery performed in 9 public acute hospitals (all principal referral
hospitals) and in 12 private hospitals (7 major, 2 district and 3
community) in NSW from 2007 to 2013 using the state-wide Admitted Patient
Data Collection records linked with the NSW Registry of Births, Deaths,
and Marriages. Following the inclusion criteria and the definition of
"postoperative sepsis" developed by the Agency for Healthcare Research and
Quality, we derived the outcome using 54 non-principal diagnostic fields
in patient medical records. We targeted elective surgical patients aged
>=18 years and stayed in the hospital more than 3 days, and excluded those
who were principally diagnosed with sepsis or infection on admission,
cases with any-listed ICD-10-AM diagnosis codes for cancer, or cases with
any-listed ICD-10-AM diagnosis codes or any-listed ICD-10-AM procedure
codes for immunocompromised state. We used Poisson mixed models to derive
rate ratios (RR) for each outcome adjusted for patient and hospital
characteristics (age, gender, country of birth, marital status,
comorbidity and socio-economic status, hospital district (metropolitan and
rural)). The comparisons were performed between the public and private
hospital groups, and between the bottom 20% (worst) and top 20% (best)
within the two hospital groups. Results: Between 2007 and 2013, 10,868
(53.9%) elective CABG surgery were admitted to public hospitals, and 9,312
(46.1%) to private hospitals. Patients in the public hospitals were
younger than patients in private hospitals (65 yrs vs 67 yrs, P<0.001),
and had less proportion male patients. Between the two hospital groups,
both of the incidence rates of sepsis and sepsis related deaths in the
public hospitals were twice times the incidence rates in the private
hospitals (sepsis: 24.9 vs 12.8 per 1,000 admissions; adjusted RR=1.73,
95%CI: 1.23-2.42; sepsis related deaths: 5.0 vs 2.5 per 1,000 admissions;
adjusted RR=1.81, 95%CI: 1.06-3.08). There was no significant difference
in sepsis cases fatality between the two hospital groups. The higher rate
of overall in-hospital mortality was observed in public hospitals compared
with private hospitals (14.7 vs 6.4 per 1,000 admissions, adjusted
RR=1.74, 95%CI: 1.00-3.03), but similar rates showed in 30-day
post-discharge mortality. Within the public hospital group, between the
worst and the best quintiles, there were significant differences in the
sepsis incidence rate (42.4 vs 15.5 per 1,000 admissions; adjusted
RR=1.18, 95%CI: 1.07-1.30), the incidence rate of sepsis related deaths
(7.8 vs 1.2 per 1,000 admissions; adjusted RR=1.34, 95%CI: 1.06-1.69), and
overall in-hospital mortality rate (21.2 vs 6.6 per 1,000 admissions;
adjusted RR=1.15 (1.00-1.31). Within the private hospital group, there was
only significant difference in the incidence rate of sepsis related deaths
between the worst and the best quintiles (5.6 vs 1.0 per 1,000 admissions,
adjusted RR=1.49, 95%CI: 1.07-2.07). Conclusion: Significant hospital
variation exists in the incidence of sepsis and sepsis related death,
overall in-hospital mortality and 28-day readmission after elective CABG
surgery. The public hospital group showed greater variations compared with
the private hospital group. Further research is needed to investigate the
causes of such variations and to develop necessary policy interventions.

<58>
Accession Number
617932665
Author
Lemoine M.; Samama C.M.; Smadja D.; Bavoux F.; Conort O.; Lillo-Le Louet
A.
Institution
(Lemoine, Lillo-Le Louet) Centre De Pharmacovigilance, Paris-HEGP, France
(Samama) Anesthesie-Reanimation, Cochin, France
(Smadja) Hematologie, HEGP, Cochin, France
(Bavoux) CRPV, Cochin, France
(Conort) Pharmacie, Cochin, France
Title
Safety profile of idarucizumab, a reversal agent for dabigatran:
Setting-up a regional observatory.
Source
Drug Safety. Conference: 16th ISoP Annual Meeting "Pharmacovigilance for
Safer Tomorrow". India. 39 (10) (pp 1024), 2016. Date of Publication:
October 2016.
Publisher
Springer International Publishing
Abstract
Introduction: Idarucizumab is a monoclonal antibody developed to
antagonize the direct oral antithrombin inhibitor, dabigatran (Pradaxa).
It has been authorized at the end of 2015, by the EMA and the FDA for the
management of uncontrolled or life-threatening bleeding or for emergency
surgery in dabigatran treated patients. Preliminary results, on the first
90 patients of the clinical trial (CT) REVERSE-AD [1], have shown an
immediate reversal anticoagulation with normalization of coagulation
parameters. As the primary end point was purely biological, the
transposition of these results in clinical routine practice is
interesting. Moreover, in the CT, five cases of thrombosis, a mortality
rate of 17.6 %, and a rebound in dabigatran concentrations after
idarucizumab administration in 22 patients is questioning. Aim: To collect
clinical and biological information about idarucizumab use, indication,
efficacy and safety. Method: All hospitals corresponding to two
Pharmacovigilance centers (CRPV) and likely to use idarucizumab were
identified. We focus on hospitals having healthcare facilities with
emergency, intensive care, surgery, digestive and vascular neurology
units. For each hospital, we contacted pharmacists, emergency physicians,
anesthetists and hematologists. After their consent, a meeting was
organized to explain the inclusion and follow-up of patients, using a A
specific data collection sheet. Results: A total of 10 hospitals were
contacted and all agreed for participating. From February 1st to May 1st,
five patients (3 men, median age 79) were included, treated with
dabigatran for atrial fibrillation. Four patients received one
idarucizumab administration: two for digestive hemorrhage, one for
subdural hematoma and one for emergency cardiac surgery. The other patient
received the first dose of idarucizumab for ischemic colitis surgery and a
second dose, 2 days later, for new surgery. After idarucizumab
administration, for the four patients tested, the dabigatran concentration
was below 30 ng/ml in less than 1 h. However, a rebound of dabigatran
concentration was observed in all four patients. Dabigatran was not
reintroduced in any patient. Conclusions: Idarucizumab is the first
specific antidote of a direct oral anticoagulant available. This study
emphasizes the importance of a biological and clinical monitoring as some
questions are still pending. Moreover, in some circumstances (massive
overdoses or acute renal failure) a fixed dose may not be adapted and
there is insufficient data on the risk of hypersensitivity, in particular
for patient requiring two doses. To date, all hospitals contacted agree
for participating and in the next weeks, this observatory will be extended
to the overall 4 CRPV of Paris area.

<59>
Accession Number
615026821
Author
Tan M.K.H.; Jarral O.A.; Thong E.H.E.; Kidher E.; Uppal R.; Punjabi P.P.;
Athanasiou T.
Institution
(Tan, Jarral, Thong, Kidher, Athanasiou) Department of Surgery and Cancer,
Imperial College London, London W2 1NY, United Kingdom
(Uppal) Department of Cardiothoracic Surgery, St. Bartholomew's Hospital,
London, United Kingdom
(Punjabi) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
Title
Quality of life after mitral valve intervention.
Source
Interactive Cardiovascular and Thoracic Surgery. 24 (2) (pp 265-272),
2017. Date of Publication: 01 Feb 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Advancements in surgical technique and understanding of the
pathophysiology of mitral valve (MV) dysfunction have led to improved
outcomes. Seen as a development beyond measures of morbidity and
mortality, health-related quality-of-life (HRQOL) outcome measures are
becoming increasingly popular. These measures are important because
complications following routine (i.e. low-risk) operations on the MV are
uncommon and further markers of outcome are needed. Surgeons are
increasingly operating earlier on asymptomatic patients and will need to
prove that HRQOL is not impacted. Novel minimally invasive and
transcatheter technologies will also need to demonstrate satisfactory
HRQOL outcomes prior to widespread use. This systematic review provides an
overview of all available literature detailing HRQOL in patients receiving
MV interventions. In the 43 studies included, 6865 patients underwent
procedures ranging from open replacement to percutaneous repair using
devices such as the Mitraclip Clip Delivery System (MitraClip) (Abbott
Vascular, Santa Clara, CA, USA). Most studies performed baseline HRQOL
assessment, allowing postinterventional comparison. While the underlying
literature had deficiencies, most studies report acceptable
postintervention HRQOL that was comparable to that of matched general
populations. Patient-specific (e.g. female gender, renal dysfunction) and
surgical-specific factors (e.g. replacement instead of repair, elevated
transmitral gradient) were identified that predispose patients to poorer
long-term HRQOL outcomes. These factors are important for clinicians
developing strategies to maximize their HRQOL outcomes. Future randomized
studies would benefit from HRQOL measurements at specific time points to
allow large-scale comparisons. Establishing a common HRQOL instrument for
use in MV intervention studies may support detailed comparisons between
specific techniques. Physical activity monitors, physiological biomarkers
and radiological markers could also be used as innovative indicators of
functional outcome.<br/>Copyright &#xa9; The Author 2016. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<60>
Accession Number
615026805
Author
Gronlykke L.; Ihlemann N.; Ngo A.T.; Thyregod H.G.H.; Kjaergaard J.;
Korshin A.; Gustafsson F.; Hassager C.; Nilsson J.C.; Sondergaard L.; Ravn
H.B.
Institution
(Gronlykke, Korshin, Nilsson, Ravn) Department of Cardiothoracic
Anaesthesiology, Rigshospitalet, Copenhagen University Hospital,
Thoraxanaestesiologisk Afdeling. 4141, Copenhagen 2100, Denmark
(Ihlemann, Ngo, Kjaergaard, Gustafsson, Hassager, Sondergaard) Department
of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
(Thyregod) Department of Cardiothoracic Surgery, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Denmark
Title
Measures of right ventricular function after transcatheter versus surgical
aortic valve replacement.
Source
Interactive Cardiovascular and Thoracic Surgery. 24 (2) (pp 181-187),
2017. Date of Publication: 01 Feb 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES: Describe changes in measures of right ventricular (RV)
function in patients treated for aortic stenosis using open-chest surgery
(SAVR) or transcatheter treatment (TAVR). METHODS: Patients in the Nordic
Aortic Valve Intervention (NOTION) trial were randomized 1:1 to TAVR (n =
114) or SAVR (n = 106). Echocardiography was performed at baseline and 3
and 12 months post-procedure. Tricuspid annular plane systolic excursion
(TAPSE) and right ventricular fractional area change (RVFAC) were used as
measures of longitudinal and transverse RV contraction. Left ventricular
ejection fraction (LVEF) and LV atrioventricular plane displacement (AVPD)
were recorded as measures of LV function. Association to NYHA class was
examined. RESULTS: There were no differences in echocardiographic
measurements between TAVR and SAVR at baseline. In the SAVR group, TAPSE
was reduced after 3 months (2.4 +/- 0.5 cm vs 1.6 +/- 0.4 cm; P < 0.001),
and 12 months (2.4 +/- 0.5 cm vs 1.7 +/- 0.4 cm; P < 0.001). RVFAC was
reduced after 3 months (44% +/- 11% vs 39% +/- 10%; P = 0.001), but
recovered at 12 months (43% +/- 10%; P = 0.39). AVPD lateral increased
during follow-up (1.4 +/- 0.3 cm vs 1.6 +/- 0.4 cm (P = 0.001) and 1.7 +/-
0.4 cm, respectively; P < 0.001), whereas AVPD medial remained stable
(baseline vs 3 months: P = 0.06 and baseline vs 12 months: P = 0.59). In
the TAVR group, all echocardiographic measures remained unchanged from
baseline to 12 months postoperatively. We found no association between
echocardiographic changes and NYHA class. CONCLUSIONS: TAPSE and AVPD
lateral differed between TAVR and SAVR at 3 and 12 months follow-up, but
these findings were not related to any changes in NYHA class. These
observations indicate that following SAVR, echocardiographic changes may
not reflect right ventricular function, but merely a change in the
physiological conditions. CLINICALTRIALS.GOV IDENTIFIER:
NCT01057173.<br/>Copyright &#xa9; The Author 2016. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<61>
Accession Number
615547777
Author
Zhang X.-L.; Zhu Q.-Q.; Yang J.-J.; Chen Y.-H.; Li Y.; Zhu S.-H.; Xie J.;
Wang L.; Kang L.-N.; Xu B.
Institution
(Zhang, Chen, Li, Zhu, Xie, Wang, Kang, Xu) Affiliated Drum Tower
Hospital, Nanjing University School of Medicine, Department of Cardiology,
321 Zhongshan Road, Nanjing, Jiangsu Province 210008, China
(Zhu) Jinling Hospital, Nanjing University School of Medicine, Department
of Respiratory Medicine, Nanjing, China
(Yang) Nanjing Drum Tower Hospital, Clinical College of Traditional
Chinese and Western Medicine, Nanjing University of Chinese Medicine,
Department of Traditional Chinese Medicine, Nanjing, China
Title
Percutaneous intervention versus coronary artery bypass graft surgery in
left main coronary artery stenosis: A systematic review and meta-analysis.
Source
BMC Medicine. 15 (1) (no pagination), 2017. Article Number: 84. Date of
Publication: 21 Apr 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The optimal revascularization technique in patients with left
main coronary artery disease (CAD) remains controversial. We aimed to
compare the long-term performance of percutaneous coronary intervention
(PCI) versus coronary artery bypass graft (CABG) surgery in treatment of
left main CAD. Methods: PubMed, EMBASE, and the Cochrane Library were
searched until November 16, 2016. Results: Six randomized controlled
trials and 22 matched observational studies including 22,487 patients and
90,167 patient-years of follow-up were included. PCI was associated with
an overall higher risk for the major adverse cardiac and cerebrovascular
events (hazard ratio (HR), 1.42; 95% confidence interval (CI), 1.14-1.77),
mainly driven by higher rates of myocardial infarction (HR, 1.69; 95% CI,
1.22-2.34) and revascularization (HR, 2.80; 95% CI, 1.86-4.22). The
overall risks for all-cause death (HR, 1.05; 95% CI, 0.93-1.20), cardiac
death (HR, 1.05; 95% CI, 0.69-1.59), stroke (HR, 0.64; 95% CI, 0.33-1.24),
and the composite safety endpoint of death, myocardial infarction, or
stroke (HR, 1.06; 95% CI, 0.97-1.16) were similar between PCI and CABG.
Stratified analysis based on stent types showed that the increased risk
for myocardial infarction associated with PCI was only evident in patients
with bare-metal stents or early-generation drug-eluting stents (DES), but
not newer-generation DES. Stratified analyses based on study designs
showed largely similar findings with the overall analyses, except for a
significantly higher incidence of myocardial infarction in adjusted
studies (HR, 2.01; 95% CI, 1.64-2.45) but a trend toward higher incidence
in randomized trials (HR, 1.39; 95% CI, 0.85-2.27) associated with PCI.
Conclusions: Compared with CABG, PCI with newer-generation DES might be a
safe alternative revascularization strategy for treatment of left main
CAD, but is associated with more repeat revascularization.<br/>Copyright
&#xa9; 2017 The Author(s).

<62>
Accession Number
614440707
Author
Dous G.V.; Grigos A.C.; Grodman R.
Institution
(Dous) SUNY Downstate, Department of Cardiology, Brooklyn, New York,
United States
(Grigos) Richmond University Medical Center, Department of Medicine,
Staten Island, New York, United States
(Grodman) Richmond University Medical Center, Department of Cardiology,
Staten Island, New York, United States
Title
Elevated troponin in patients with acute stroke - Is it a true heart
attack?.
Source
Egyptian Heart Journal. 69 (3) (pp 165-170), 2017. Date of Publication:
September 2017.
Publisher
Egyptian Society of Cardiology (E-mail: secretary@cardioegypt.com)
Abstract
Although the prognostic value of a positive troponin in an acute stroke
patient is still uncertain, it is a commonly encountered clinical
situation given that Ischemic Heart Disease (IHD) and cerebrovascular
disease (CVD) frequently co-exist in the same patient and share similar
risk factors. Our objectives in this review are to (1) identify the
biologic relationship between acute cerebrovascular stroke and elevated
troponin levels, (2) determine the pathophysiologic differences between
positive troponin in the setting of acute stroke versus acute myocardial
infarction (AMI), and (3) examine whether positive troponin in the setting
of acute stroke has prognostic significance. We also will provide an
insight analysis of some of the available studies and will provide
guidance for a management approach based on the available data according
to the current guidelines.<br/>Copyright &#xa9; 2017 Egyptian Society of
Cardiology

<63>
Accession Number
614678286
Author
Shi J.; Bai Z.-X.; Zhang B.-G.; Ren W.-J.; Guo Y.-Q.
Institution
(Shi, Bai, Zhang, Ren, Guo) Department of Cardiovascular Surgery, West
China Hospital, Sichuan University, Chengdu, Sichuan, China
Title
A modified Cox maze IV procedure: A simpler technique for the surgical
treatment of atrial fibrillation.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (6) (pp 856-860),
2016. Date of Publication: 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES: To determine the effectiveness of a simplified surgical
treatment method for atrial fibrillation (AF). METHODS: Between September
2012 and October 2013, 120 patients (mean age, 52.3 +/- 8.8 years)
underwent valve surgery and concomitant bipolar radiofrequency ablation
for the treatment of AF. Patients were randomized to a Cox maze IV
procedure (CMP-IV) group (n = 60) or a modified CMP-IV (MCMP-IV) group (n
= 60). Freedom from AF was defined as freedom from any left atrial
arrhythmia lasting <30 s and no requirement of antiarrhythmic drugs after
6 months. Data were recorded at postoperative follow-up examinations,
which were scheduled at 1, 3, 6 and 12 months, and annually thereafter.
RESULTS: No ablation-related complications occurred in either group. The
mean ablation time was longer in the CMP-IV group than in the MCMP-IV
group (18.5 +/- 1.7 vs 16.6 +/- 1.6 min, P < 0.001). The mean follow-up
time was 32.4 +/- 3.6 months (range, 26-39 months). Freedom from AF tended
to be higher, but not significantly so, among the MCMP-IV group than among
the CMP-IV group over the entire follow-up period. CONCLUSIONS: The
MCMP-IV is an effective surgical procedure for the treatment of AF. In
certain patients, such as those with anatomic variations of the pulmonary
veins, the MCMP-IV is simpler than the CMP-IV. CLINICAL TRIALS
REGISTRATION ID: ChiCTR-TRC-12002742.<br/>Copyright &#xa9; The Author
2016. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<64>
Accession Number
618140647
Author
Ramani J.; Malhotra A.; Wadhwa V.; Sharma P.; Garg P.; Tarsaria M.; Pandya
H.
Institution
(Ramani, Malhotra, Wadhwa, Sharma, Garg, Tarsaria, Pandya) Department of
Cardiovascular and Thoracic Surgery of U.N. Mehta Institute of Cardiology
and Research Center (Affiliated to B.J. Medical College), Civil hospital
Campus, Asarwa, Ahmedabad, India
Title
Single-Dose Lignocaine-Based Blood Cardioplegia in Single Valve
Replacement Patients.
Source
Brazilian journal of cardiovascular surgery. 32 (2) (pp 90-95), 2017. Date
of Publication: 01 Mar 2017.
Abstract
RESULTS:: We did not find any statistically significant difference in
preoperative baseline parameters. Cardiopulmonary bypass time were
73.8+/-16.5 and 76.4+/-16.9 minutes (P=0.43) and cross clamp time were
58.9+/-10.3 and 66.3+/-11.2 minutes (P=0.23) in group 1 and group 2,
respectively. Mean of maximum inotrope score was 6.3+/-2.52 and 6.1+/-2.13
(P=0.65) in group 1 and group 2, respectively. We also did not find any
statistically significant difference in creatine-phosphokinase-MB
(CPK-MB), Troponin-I levels, lactate level and cardiac functions
postoperatively.
CONCLUSION:: This study proves the safety and efficacy of long-acting
lignocaine-based single-dose blood cardioplegia compared to the standard
short-acting multi-dose blood cardioplegia in patients requiring the
single valve replacement. Further studies need to be undertaken to
establish this non-inferiority in situations of complex cardiac procedures
especially in compromised patients.
OBJECTIVE:: Myocardial protection is the most important in cardiac
surgery. We compared our modified single-dose long-acting lignocaine-based
blood cardioplegia with short-acting St Thomas 1 blood cardioplegia in
patients undergoing single valve replacement.
METHODS:: A total of 110 patients who underwent single (aortic or mitral)
valve replacement surgery were enrolled. Patients were divided in two
groups based on the cardioplegia solution used. In group 1 (56 patients),
long-acting lignocaine based-blood cardioplegia solution was administered
as a single dose while in group 2 (54 patients), standard St Thomas IB
(short-acting blood-based cardioplegia solution) was administered and
repeated every 20 minutes. All the patients were compared for preoperative
baseline parameters, intraoperative and all the postoperative parameters.

<65>
Accession Number
618116414
Author
Ahmed M.; Mostafa E.A.; Ibrahim A.A.E.A.; Ammar A.M.; Khorshid R.M.R.;
Rezk M.E.
Institution
(Ahmed) Cardiothoracic Surgery Department, Nasser Institute Hospital,
Cairo, Egypt
(Mostafa, Ibrahim, Ammar, Khorshid) Cardiovascular and Thoracic Surgery,
Faculty of Medicine, Ain Shams University, Cairo, Egypt
(Rezk) Cardiothoracic Surgery Department, Benha University, Benha, Egypt
Title
Comparative study between CardiaMed valves (freely floating valve
leaflets) versus St. Jude Medical (fixed valve leaflets) in mitral valve
replacement surgery.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. (no
pagination), 2017. Date of Publication: 2017.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: With the availability of a wide variety of valve prostheses,
surgeons are still searching for the ideal valve, striving for improved
hemodynamics, durability and thrombogenicity.The purpose of this
prospective, randomized, comparative study was to evaluate the early
post-operative hemodynamic function and major clinical events in patients
receiving CardiaMedTM prosthetic valves in comparison to St. Jude
MedicalTM (SJM) valves in the mitral valve position. Methods: Between Sept
2013 and Sept 2015, 60 elective mitral valve replacement (MVR) patients in
Ain Shams Hospital, Cairo, Egypt were divided into two groups of 30. Group
I received the CardiaMed valve and Group II received the SJM valve. All
patients were followed up at discharge from hospital, and at three and six
months post-operatively. Results: There were no statistical differences
between groups regarding the demographic data, preoperative clinical and
functional NYHA class, cardiac assessment or mitral valve pathology. By
the end of the follow up, there was no valve-related co-morbidity. Early
post-operative complications were seen in 4 patients (13.3%) in Group I
and in 5 patients in Group II (16.7%), namely; re-exploration for
bleeding, rhythm disturbance, or wound infection. The PPG and MPG were
slightly higher in Group I (10.9 +/- 1.2 and 5.3 +/- 0.9) than in Group II
(10.2 +/- 2.3 and 5.2 +/- 1.3); p = 0.798 and 0.107 respectively. There
was no significant statistical difference between the groups regarding the
post-operative echo follow-up data. Conclusions: CardiaMed freely floating
leaflet prostheses showed good hemodynamic characteristics. The prosthesis
adequately corrects hemodynamics and is safe and no worse than the St.
Jude Medical valve in the mitral valve position.<br/>Copyright &#xa9; 2017
The Egyptian Society of Cardio-thoracic Surgery.

<66>
Accession Number
617328917
Author
Sabato L.A.; Salerno D.M.; Moretz J.D.; Jennings D.L.
Institution
(Sabato) Heart Failure and Cardiac Transplantation, Department of
Pharmacy, UC Health-University of Cincinnati Medical Center, Cincinnati,
OH, United States
(Salerno) Solid Organ Transplantation, Department of Pharmacy,
NewYork-Presbyterian Hospital - Weill Cornell Medical Center, New York,
NY, United States
(Moretz) Ventricular Assist Devices, Department of Pharmacy, Vanderbilt
University Medical Center, Nashville, TN, United States
(Jennings) Heart Transplant and Mechanical Circulatory Support, Department
of Pharmacy, New York-Presbyterian Hospital - Columbia University Medical
Center, New York, NY, United States
Title
Inhaled Pulmonary Vasodilator Therapy for Management of Right Ventricular
Dysfunction after Left Ventricular Assist Device Placement and Cardiac
Transplantation.
Source
Pharmacotherapy. 37 (8) (pp 944-955), 2017. Date of Publication: August
2017.
Publisher
Pharmacotherapy Publications Inc.
Abstract
Right ventricular failure (RVF) after cardiac transplant (CTX) or
implantation of a continuous-flow left ventricular assist device (CF-LVAD)
is associated with significant postoperative morbidity and mortality. A
variety of modalities have been used to treat postoperative RVF, including
management of volume status, intravenous inotropes and vasodilators, and
right-sided mechanical support. Inhaled vasodilator agents are a unique
treatment option aimed at minimizing systemic absorption by delivering
therapy directly to the pulmonary vasculature. Current LVAD and CTX
guidelines endorse inhaled vasodilators for managing postoperative RVF;
however, no guidance is offered regarding agent selection, dosing, or
administration. A review of the current literature confirms that inhaled
pulmonary vasodilator agents have been shown to decrease pulmonary artery
pressure when used in the perioperative period of CF-LVAD implant or CTX.
However, the literature regarding the potential impact on clinical
outcomes (e.g., survival or risk of developing RVF) is lacking with these
medications. Based on our assessment of the literature, we suggest that
when RVF occurs in the setting of a normal pulmonary vascular resistance
(PVR), traditional inotropic therapy (e.g., dobutamine) should be used.
Conversely, if the PVR is elevated (> 250 dynes/sec/cm⁵ or 3
Wood units), or the patient has other evidence of a high right ventricular
afterload (i.e., a transpulmonary gradient > 12 mm Hg), then an inhaled
pulmonary vasodilator would be the preferred initial pharmacologic agent.
Drug selection depends largely on the institution's capacity to safely
prepare and administer the medication, along with formulary
considerations, such as the high costs associated with inhaled iloprost
and inhaled nitric oxide.<br/>Copyright &#xa9; 2017 Pharmacotherapy
Publications, Inc.

<67>
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)

<68>
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.

<69>
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.

<70>
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.

<71>
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.

<72>
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.

<73>
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.

<74>
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.

<75>
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.

<76>
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.

<77>
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

<78>
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.

<79>
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.

<80>
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.

<81>
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.

<82>
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.

<83>
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.

<84>
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.

<85>
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.

<86>
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.

<87>
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.

<88>
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.

<89>
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.

<90>
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)

<91>
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.

<92>
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.

<93>
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.

<94>
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).

<95>
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).

<96>
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).

<97>
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).

<98>
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).

<99>
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.

<100>
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.

<101>
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.

<102>
[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.

<103>
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

<104>
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

<105>
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

<106>
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.

<107>
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.

<108>
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.

<109>
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?.

<110>
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.

<111>
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

<112>
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.

<113>
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.

<114>
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

<115>
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.

<116>
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

<117>
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.

<118>
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.

<119>
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.

<120>
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.