EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
618209938
Author
Yun-Dan D.; Wen-Jing D.; Xi-Jun X.
Institution
(Yun-Dan, Xi-Jun) Department of Cardiovascular Surgery, West China
Hospital, Sichuan University, No. 37 of Guoxuexiang, Wuhou District,
Chengdu, Sichuan 610041, China
(Wen-Jing) Department of Gynecology and Obstetrics, First Hospital,
Lanzhou University, Lanzhou, Gansu, China
Title
Comparison of Outcomes following Mitral Valve Repair versus Replacement
for Chronic Ischemic Mitral Regurgitation: A Meta-Analysis.
Source
Thoracic and Cardiovascular Surgeon. 65 (6) (pp 432-441), 2017. Date of
Publication: 01 Sep 2017.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Background The selection of mitral valve surgery, including mitral valve
repair and mitral valve replacement, is still an important dilemma for
patients with chronic ischemic mitral regurgitation. We carry out a
meta-analysis to evaluate the effectiveness and safety of mitral valve
repair versus replacement for ischemic mitral regurgitation. Methods We
searched PubMed, Embase, the Cochrane Library, and Web of Science to
identify studies from their inception to July 2015. A meta-analysis was
performed using RevMan 5.3 software (Cochrane Collaboration, Oxford,
United Kingdom). A random-effect model was used and sensitivity analysis
was performed on studies reporting on operation after 2000, high-quality
studies, and those studies reporting on more than 150 patients. Result A
total of 2,324 patients were identified from 10 retrospective studies.
Mitral valve repair was associated with a trend toward lower operative
mortality (odds ratio [OR] = 0.45; 95% confidence interval [CI]:
0.31-0.65; p < 0.0001) and higher recurrence of mitral regurgitation (OR =
5.89; 95% CI: 3.34-10.39; p < 0.00001). Five-year survival rate was
similar between the two groups (OR = 1.20; 95% CI: 0.88-1.65; p = 0.25).
No differences in reoperation, the incidence of acute renal failure and
acute respiratory failure, the length of ICU stay, and the length of
hospital stay were found. Conclusion Mitral valve repair was associated
with lower operative mortality but a higher recurrence of mitral
regurgitation compared with mitral valve replacement. Owing to the limited
quantity and quality of the included studies, this conclusion still needs
to be further confirmed by conducting more high-quality, multicenter
randomized controlled trials with large sample size.

<2>
Accession Number
615548519
Author
Sardar P.; Kundu A.; Chatterjee S.; Feldman D.N.; Owan T.; Kakouros N.;
Nairooz R.; Pape L.A.; Feldman T.; Dawn Abbott J.; Elmariah S.
Institution
(Sardar, Owan) Division of Cardiovascular Medicine, University of Utah,
Salt Lake City, UT, United States
(Kundu, Kakouros, Pape) Department of Medicine, University of
Massachusetts Medical School, Worcester, MA, United States
(Chatterjee) Division of Cardiology, Temple University School of Medicine,
Philadelphia, PA, United States
(Feldman) Division of Cardiology, Weill Cornell Medical College, New York
Presbyterian Hospital, New York, NY, United States
(Nairooz) University of Arkansas for Medical Sciences, Little Rock, AR,
United States
(Feldman) Department of Medicine, Division of Cardiology, Evanston
Hospital, Evanston, IL, United States
(Dawn Abbott) Division of Cardiology, Brown Medical School, Rhode Island
Hospital, Providence, RI, United States
(Elmariah) Cardiology Division, Department of Medicine, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, United States
Title
Transcatheter versus surgical aortic valve replacement in
intermediate-risk patients: Evidence from a meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 90 (3) (pp 504-515),
2017. Date of Publication: 01 Sep 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: We performed a meta-analysis to evaluate the efficacy and
safety of transcatheter aortic valve replacement (TAVR) in comparison to
surgical aortic valve replacement (SAVR) in intermediate-risk patients.
Background: TAVR is an established treatment option in high-risk patients
with severe aortic valve stenosis (AS). There are fewer data regarding
efficacy of TAVR in intermediate-risk patients. Methods: Databases were
searched through April 30, 2016 for studies that compared TAVR with SAVR
for the treatment of intermediate-risk patients with severe AS. We
calculated summary risk ratios (RRs) and 95% confidence intervals (CIs)
with the random-effects model. Results: The analysis included 4,601
patients from 7 studies (2 randomized and 5 observational). There was no
significant difference in all-cause mortality between the two groups after
mean follow-up of 1.15 years [14.7% with TAVR vs 15.4% with SAVR; RR 0.93;
95% CI 0.77-1.12]. TAVR resulted in lower rates of acute kidney injury
[number needed to treat (NNT) = 26], major bleeding (NNT = 4), and
atrial-fibrillation (NNT = 6), but higher rates of major vascular
complications [number needed to harm (NNH)= 18], and moderate/severe
aortic regurgitation (NNH = 13). The rate of permanent-pacemaker
implantation was significantly higher with TAVR in observational studies
(RR 2.31; 95% CI 1.22-2.81), but not in RCTs (RR 1.21; 95% CI 0.93-1.56).
No significant difference in the rate of stroke or myocardial infarction
was observed. Conclusions: Our analysis of mid-term results showed that
TAVR has similar clinical efficacy to SAVR in intermediate-risk patients
with severe AS, and can be a suitable alternative to surgical valve
replacement. &#xa9; 2017 Wiley Periodicals, Inc.<br/>Copyright &#xa9; 2017
Wiley Periodicals, Inc.

<3>
Accession Number
617683187
Author
Asakura M.; Kim J.; Asanuma H.; Hamasaki T.; Tsukahara K.; Higashino Y.;
Ishikawa T.; Nakama Y.; Koba S.; Maruyama Y.; Tsujimoto M.; Himeno H.;
Ohkusa T.; Fujino S.; Shimizu M.; Endo T.; Yoda S.; Muroya T.; Murohara
T.; Ohte N.; Suzuki H.; Kohno T.; Fukui K.; Shiono T.; Takase H.; Uzui H.;
Nagai Y.; Hashimoto Y.; Ikeda S.; Mizuno S.; Tamita K.; Fujita M.; Satake
K.; Kinoshita Y.; Nunohiro T.; Sakagami S.; Higaki J.; Morii I.; Sawada
R.; Hiasa Y.; Shigemasa T.; Nakahama M.; Sata M.; Doi O.; Ueda T.; Yamada
T.; Yamanouchi T.; Yamaguchi H.; Morita Y.; Hayashi H.; Kitakaze M.
Institution
(Asakura, Kim, Kitakaze) Department of Clinical Medicine and Development,
National Cerebral and Cardiovascular Center Suita, Osaka 565-8565, Japan
(Asakura, Kitakaze) Department of Cardiovascular Medicine, National
Cerebral and Cardiovascular Center, Osaka, Japan
(Asanuma) Department of Cell Biology, National Cerebral and Cardiovascular
Center, Osaka, Japan
(Asanuma) Cardiovascular Science and Technology, Kyoto Prefectural
University of Medicine, Kyoto, Japan
(Hamasaki) Department of Biomedical Statistics, Osaka University Graduate
School of Medicine, Suita, Japan
(Hamasaki) Department of Data Science, National Cerebral and
Cardiovascular Center, Osaka, Japan
(Tsukahara) Division of Cardiology, Yokohama City University Medical
Center, Kanagawa, Japan
(Higashino) Department of Cardiology, Higashi Takarazuka Satoh Hospital,
Hyogo, Japan
(Ishikawa) Department of Cardiology, Saitama Prefecture Cardiovascular and
Respiratory Center, Saitama, Japan
(Nakama) Department of Cardiology, Hiroshima City Hospital, Hiroshima,
Japan
(Koba) Division of Cardiology, Department of Medicine, Showa University
Hospital, Tokyo, Japan
(Maruyama) Department of Cardiology, Iwatsuki-minami Hospital, Saitama,
Japan
(Tsujimoto) Department of Cardiology, Cardiovascular Center, Veritas
Hospital, Hyogo, Japan
(Himeno) Division of Cardiology, Fujisawa City Hospital, Kanagawa, Japan
(Ohkusa) Department of Cardiology, Hokko Memorial Hospital, Hokkaido,
Japan
(Fujino) Department of Cardiology, Fukui Prefectural Hospital, Fukui,
Japan
(Shimizu) Department of Cardiology, International Goodwill Hospital,
Kanagawa, Japan
(Endo) Department of Cardiology, Saiseikai Yokohama City Southern
Hospital, Kanagawa, Japan
(Yoda) Division of Cardiology, Department of Internal Medicine, Nihon
University School of Medicine, Tokyo, Japan
(Muroya) Department of Cardiology, National Hospital Organization Ureshino
Medical Center, Saga, Japan
(Murohara) Department of Cardiology, Nagoya University Graduate School of
Medicine, Aichi, Japan
(Ohte) Department of Cardio-Renal Medicine and Hypertension, Nagoya City
University Graduate School of Medical Sciences, Aichi, Japan
(Suzuki) Division of Cardiology, Showa University Fujigaoka Hospital,
Kanagawa, Japan
(Kohno) Department of Cardiology, Tokyo Rinkai Hospital, Tokyo, Japan
(Kohno) Department of Cardiology, Kasukabe Municipal Hospital, Saitama,
Japan
(Fukui) Division of Cardiology, Kanagawa Cardiovascular Respiratory
Center, Kanagawa, Japan
(Shiono) Department of Cardiology, Kitasato University Medical Center,
Saitama, Japan
(Takase) Department of Internal Medicine, Enshu Hospital, Shizuoka, Japan
(Uzui) Department of Cardiology, Fukui University Hospital, Fukui, Japan
(Nagai) Department of Cardiology, Rinku General Medical Center, Osaka,
Japan
(Hashimoto) Department of Cardiology, Kameda Medical Center, Chiba, Japan
(Ikeda) Division of Cardiology, Uwajima City Hospital, Ehime, Japan
(Mizuno) Department of Cardiology, Fukui Cardiovascular Center, Fukui,
Japan
(Tamita) Department of Cardiology, Nishinomiya Watanabe Cardiovascular
Center, Hyogo, Japan
(Fujita) Department of Cardiovascular Division, Kansai Rosai Hospital,
Hyogo, Japan
(Satake) Department of Cardiology, Fukui General Clinic, Fukui, Japan
(Kinoshita) Kinoshita Clinic, Hiroshima, Japan
(Nunohiro) Department of Cardiology, Nagasaki Municipal Hospital,
Nagasaki, Japan
(Nunohiro) Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan
(Sakagami) Department of Cardiology, National Hospital Organization
Kanazawa Medical Center, Ishikawa, Japan
(Higaki) Department of Integrated Medicine and Informatics, Ehime
University Graduate School of Medicine, Ehime, Japan
(Morii) Department of Cardiology, Hokusetsu General Hospital, Osaka, Japan
(Sawada) Department of Cardiology, Hadano Red Cross Hospital, Kanagawa,
Japan
(Hiasa) Department of Cardiology, Tokushima Red Cross Hospital, Tokushima,
Japan
(Shigemasa) Department of Cardiovascular Medicine, International
University of Health and Welfare Atami Hospital, Shizuoka, Japan
(Nakahama) Department of Cardiology, Fukuyama City Hospital, Hiroshima,
Japan
(Sata) Department of Cardiovascular Medicine, University of Tokushima,
Tokushima, Japan
(Doi) Department of Cardiology, Shizuoka Prefectural General Hospital,
Shizuoka, Japan
(Ueda) Department of Cardiology, Tokyo Metropolitan Tama Medical Center,
Tokyo, Japan
(Yamada) Division of Cardiology, Osaka General Medical Center, Osaka,
Japan
(Yamanouchi) Department of Cardiology, Department of Internal Medicine,
Hitachi, Ltd. Hitachinaka General Hospital, Ibaraki, Japan
(Yamaguchi) Yamaguchi Clinic, Fukushima, Japan
(Morita) Department of Cardiology, National Hospital Organization
Sagamihara Hospital, Kanagawa, Japan
(Hayashi) Department of Internal Medicine, Hoetsu Hospital, Tokurshima,
Japan
Title
Does Treatment of Impaired Glucose Tolerance Improve Cardiovascular
Outcomes in Patients with Previous Myocardial Infarction?.
Source
Cardiovascular Drugs and Therapy. 31 (4) (pp 401-411), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: We evaluated the effects of an alpha-glucosidase inhibitor,
voglibose, on cardiovascular events in patients with a previous myocardial
infarction (MI) and impaired glucose tolerance (IGT). Methods: This
prospective, randomized, open, blinded-endpoint study was conducted in 112
hospitals and clinics in Japan in 3000 subjects with both previous MI and
IGT receiving voglibose (0.6 mg/day, n = 424) or no drugs (n = 435) for 2
years. The Data and Safety Monitoring Board (DSMB) recommended
discontinuation of the study in June 2012 after an interim analysis when
the outcomes of 859 subjects were obtained. The primary endpoint was
cardiovascular events including cardiovascular death, nonfatal MI,
nonfatal unstable angina, nonfatal stroke, and percutaneous coronary
intervention/coronary artery bypass graft. Secondary endpoints included
individual components of the primary endpoint in addition to all-cause
mortality and hospitalization due to heart failure. Results: The age,
ratio of males, and HbA<inf>1</inf>C were 65 vs. 65 years, 86 vs. 87%, and
5.6 vs. 5.5% in the groups with and without voglibose, respectively.
Voglibose improved IGT; however, Kaplan-Meier analysis showed no
significant between-group difference with respect to cardiovascular events
[12.5% with voglibose vs. 10.1% without voglibose for the primary endpoint
(95% confidence interval, 0.82-1.86)]; there were no significant
differences in secondary endpoints. Conclusion: Although voglibose
effectively treated IGT, no additional benefits for cardiovascular events
in patients with previous MI and IGT were observed. Voglibose may not be a
contributing therapy to the secondary prevention in patients with MI and
IGT. Trial Registration: Clinicaltrials.gov number:
NCT00212017.<br/>Copyright &#xa9; 2017, Springer Science+Business Media,
LLC.

<4>
Accession Number
614213565
Author
Anantha Narayanan M.; Aggarwal S.; Reddy Y.N.V.; Alla V.M.; Baskaran J.;
Kanmanthareddy A.; Suri R.M.
Institution
(Anantha Narayanan, Baskaran) Division of Cardiology, Department of
Medicine, University of Minnesota, School of Medicine, Minneapolis, MN,
United States
(Aggarwal, Alla, Kanmanthareddy) Division of Cardiology, CHI, Health
Creighton University Medical Center, Omaha, NE, United States
(Reddy) Division of Cardiovascular Sciences, Mayo Clinic, Rochester, MN,
United States
(Suri) Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic
Foundation, Cleveland, OH, United States
Title
Surgical Repair of Moderate Ischemic Mitral Regurgitation--A Systematic
Review and Meta-analysis.
Source
Thoracic and Cardiovascular Surgeon. 65 (6) (pp 447-456), 2017. Date of
Publication: 01 Sep 2017.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Introduction Moderate mitral regurgitation (MR) of ischemic etiology has
been associated with worse outcomes after coronary artery bypass grafting
(CABG). Studies comparing concomitant mitral valve replacement/repair
(MVR/Re) with CABG and standalone CABG have reported conflicting results.
We performed a systematic review and meta-analysis of the published
literature. Patients and Methods We searched using PubMed, Cochrane,
EMBASE, CINAHL, and Google scholar databases from January 1960 to June
2016 for clinical trials comparing CABG to CABG + MVR/Re for moderate MR.
Pooled risk ratio or mean difference (MD) with 95% confidence intervals
(CI) for individual outcomes were calculated using random effects model
and heterogeneity was assessed using Cochrane's Q-statistic. Results A
total of 11 studies were included. Mean follow-up was 35.3 months.
All-cause mortality (Mantel-Haenszel [MH] risk ratio [RR]: 0.96, 95% CI:
0.75-1.24, p = 0.775), early mortality (MH RR: 0.65, 95% CI: 0.39-1.07, p
= 0.092), and stroke rates (MH RR 0.65, 95% CI: 0.21-2.03, p = 0.464) were
similar between CABG and CABG + MVR/Re groups. Adverse event at follow-up
was lower with CABG (MH RR: 0.90, 95% CI: 0.61-1.32, p = 0.584). MD of
change from baseline in left ventricular (LV) end-systolic dimension (MD:
- 2.50, 95% CI: - 5.21 to - 0.21, p = 0.071) and LV ejection fraction (MD:
0.48, 95% CI: - 2.48 to 3.44, p = 0.750) were not significantly different
between the groups. Incidence of moderate MR (MH RR: 3.24, 95% CI:
1.79-5.89, p < 0.001) was higher in the CABG only group. Conclusion
Addition of MVR/Re to CABG in patients with moderate ischemic MR did not
result in improvement in early or overall mortality, stroke risk, or
intermediate markers of LV function when compared with CABG
alone.<br/>Copyright &#xa9; 2017 Georg Thieme Verlag KG Stuttgart.New
York.

<5>
Accession Number
618256232
Author
Parma R.; Zembala M.O.; Dabrowski M.; Jagielak D.; Witkowski A.; Suwalski
P.; Dudek D.; Olszowka P.; Wojakowski W.; Przybylski R.; Gil R.;
Kusmierczyk M.; Lesiak M.; Sadowski J.; Dobrzycki S.; Ochala A.; Hoffman
P.; Kapelak B.; Kazmierczak J.; Jasinski M.; Stepinska J.; Szymanski P.;
Hryniewiecki T.; Kochman J.; Grygier M.; Zembala M.; Legutko J.; Rozanski
J.
Institution
(Parma, Wojakowski, Ochala) Division of Cardiology and Structural Heart
Diseases, SMK in Katowice, Medical University of Silesia, Katowice, Poland
(Zembala, Przybylski, Zembala) Department of Cardiac, Vascular and
Endovascular Surgery and Transplantology, Silesian Centre for Heart
Diseases, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland
(Dabrowski, Witkowski) Department of Interventional Cardiology and
Angiology, Institute of Cardiology, Warsaw, Poland
(Jagielak) Department of Cardiovascular Surgery, Medical University of
Gdansk, Gdansk, Poland
(Suwalski) Department of Cardiac Surgery, Central Clinical Hospital of the
Ministry of the Interior and Administration, Warsaw, Poland
(Dudek) Institute of Cardiology, Jagiellonian University Medical College,
Krakow, Poland
(Olszowka) Department of Cardiac Surgery, District Hospital 2, Rzeszow,
Poland
(Gil) Department of Invasive Cardiology, Central Clinical Hospital of the
Ministry of Interior and Administration, Warsaw, Poland
(Kusmierczyk, Rozanski) Department of Cardiac Surgery and Transplantology,
Institute of Cardiology, Warsaw, Poland
(Lesiak, Grygier) Department of Cardiology, Poznan University of Medical
Science, Poznan, Poland
(Sadowski, Kapelak) Department of Cardiovascular Surgery and
Transplantology, Jagiellonian University Medical College, Krakow, Poland
(Dobrzycki) Department of Invasive Cardiology, Medical University of
Bialystok, Bialystok, Poland
(Hoffman) Department of Congenital Cardiac Defects, Institute of
Cardiology, Warsaw, Poland
(Kazmierczak) Department of Cardiology, Pomeranian Medical University in
Szczecin, Poland
(Jasinski) Department of Cardiac Surgery, Wroclaw Medical University,
Wroclaw, Poland
(Stepinska) Department of Intensive Cardiac Care Clinic, Institute of
Cardiology, Warsaw, Poland
(Szymanski, Hryniewiecki) Department of Acquired Cardiac Defects,
Institute of Cardiology, Warsaw, Poland
(Kochman) 1st Department of Cardiology, Medical University of Warsaw,
Warsaw, Poland
(Legutko) 2nd Department of Cardiology, Jagiellonian University Medical
College, ul. Kopernika 17, Krakow 31-501, Poland
Title
Transcatheter aortic valve implantation. Expert Consensus of the
Association of Cardiovascular Interventions of the Polish Cardiac Society
and the Polish Society of Cardio-Thoracic Surgeons, approved by the Board
of the Polish Cardiac Society and National Consultants in Cardiology and
Cardiac Surgery.
Source
Kardiologia Polska. 75 (9) (pp 937-964), 2017. Date of Publication: 08 Sep
2017.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland)
Abstract
Patients with severe symptomatic aortic stenosis have a poor prognosis
with medical management alone, and surgical aortic valve replacement can
improve symptoms and survival. In recent years, transcatheter aortic valve
implantation (TAVI) has been demonstrated to improve survival in
inoperable patients and to be an alternative treatment in patients in whom
the risk of surgical morbidity or mortality is high or intermediate. A
representative expert committee, summoned by the Association of
Cardiovascular Interventions of the Polish Cardiac Society (ACVI) and the
Polish Society of Cardio-Thoracic Surgeons, developed this Consensus
Statement in transcatheter aortic valve implantation. It endorses the
important role of a multi-disciplinary "TAVI team" in selecting patients
for TAVI and defines operator and institutional requirements fundamental
to the establishment of a successful TAVI programme. The article
summarises current evidence and provides specific recommendations on
organisation and conduct of transcatheter treatment of patients with
aortic valve disease in Poland.<br/>&#xa9; Copyright Polskie Towarzystwo
Kardiologiczne 2017.

<6>
Accession Number
618273266
Author
Zhang S.; Kolominsky-Rabas P.L.
Institution
(Zhang, Kolominsky-Rabas) Interdisciplinary Centre for Health Technology
Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander University
of Erlangen-Nurnberg, Erlangen, Bavaria, Germany
(Kolominsky-Rabas) National Leading-Edge Cluster Medical Technologies
"Medical Valley EMN", Erlangen, Bavaria, Germany
Title
How TAVI registries report clinical outcomes-A systematic review of
endpoints based on VARC-2 definitions.
Source
PLoS ONE. 12 (9) (no pagination), 2017. Article Number: e0180815. Date of
Publication: September 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Introduction Transcatheter aortic valve implantation (TAVI) has been
demonstrated to be an alternative treatment for severe aortic stenosis in
patients considered as high surgical risk. Since its first human
implantation by Cribier et al., TAVI has been shown to increase survival
rate and quality of life for high surgical risks patients. The objective
of this study is to provide an overview of TAVI registries and the
reporting clinical outcomes based on the VARC-2 definitions. In addition,
the comparability and adherence of VARC-2 reporting within the identified
TAVI registries was reviewed. Materials and methods A systematic review of
TAVI registries reporting VARC-2 definitions has been performed in line
with PRISMA guidelines in PubMed, ScienceDirect, Scopus databases and
EMBASE. Based on VARC-2, patients' characteristics and procedure
characteristics, 30-day clinical outcomes, 1-year mortality and composited
endpoints were extracted from each registry's publications. Results This
review identified 466 studies that were potentially relevant, and 20 TAVI
registries reported VARC-2 definitions involved in our present review. Of
all 20 registries, an overall sample size of 12,583 patients was involved.
The 30-day all-cause mortality ranged from 0 to 12.7%. From 20 registries,
14 registries reported the cardiovascular mortality at 30 days. 9
registries reported myocardial infarction (MI) rate based on VARC-2
definitions, and 7 registries reported peri-procedural MI rate (<72h). In
our review, most of registries presented MI rates ranging from 0.5% to 2%.
The majority of registries have reported complications such as bleeding,
vascular complications and new pacemaker implantation. Conclusion Since
the introduction of VARC definitions from 2011, VARC and VARC-2
definitions are still not systematically used by all TAVI studies. These
endpoint definitions warrant a concise and systemic analysis of outcome
measures. Reporting TAVI-outcome uniformly makes study result comparison
feasible. This definitely will increase patient safety, additionally to
provide sufficient evidence to support decision makers like regulatory
bodies, HTA agencies, payers.<br/>Copyright &#xa9; 2017 Zhang,
Kolominsky-Rabas. 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.

<7>
Accession Number
618308563
Author
Tzani A.; Doulamis I.P.; Mylonas K.S.; Avgerinos D.V.; Nasioudis D.
Institution
(Tzani, Doulamis, Mylonas, Avgerinos, Nasioudis) Surgery Working Group,
Society of Junior Doctors, Athens, Greece
(Mylonas) Division of Pediatric Surgery, Department of Surgery,
Massachusetts General Hospital, Harvard Medical School, Boston, MA, United
States
(Avgerinos) Department of Cardiothoracic Surgery, New York Presbyterian
Medical Center, Weill Cornell College of Medicine, New York, NY, United
States
(Nasioudis) Department of Obstetrics and Gynecology, Hospital of the
University of Pennsylvania, Philadelphia, PA, United States
Title
Cardiac Tumors in Pediatric Patients: A Systematic Review.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 8 (5) (pp
624-632), 2017. Date of Publication: 01 Sep 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
This systematic review sought to investigate the current evidence
regarding surgical management of primary cardiac tumors in children and
adolescents. Twenty-eight studies were deemed eligible, reporting on 745
pediatric patients. Rhabdomyoma was the most prevalent histologic type and
echocardiography was the most common diagnostic tool. Cumulative 30-day
mortality rate was 6.7%. Rhabdomyomas and teratomas had the highest 30-day
mortality. The higher percentage of tumor relapse was noted for myxoma and
teratoma. Although cardiac tumors are rare, their atypical clinical
presentation, potential for recurrence, and the poor prognosis associated
with recurrence elucidate the need for reliable diagnostic and therapeutic
management.<br/>Copyright &#xa9; 2017, &#xa9; The Author(s) 2017.

<8>
Accession Number
618314681
Author
Lennerz C.; Barman M.; Tantawy M.; Sopher M.; Whittaker P.
Institution
(Lennerz) Deutsches Herzzentrum Munchen, Klinik fur Herz- und
Kreislauferkrankungen, Abteilung fur Elektrophysiologie, Faculty of
Medicine, Technische Universitat Munchen, Munich, Germany
(Barman) Cardiology Department, Al Ahli Hospital, Doha, Qatar
(Tantawy) Memorial Souad Kafafi University Hospital, Cardiology
Department, Misr University for Science and Technology, 6 of October City,
Egypt
(Sopher) Royal Bournemouth Hospital, Bournemouth, United Kingdom
(Whittaker) Cardiovascular Research Institute, Department of Emergency
Medicine, Wayne State University School of Medicine, Detroit, USA
(Lennerz, Barman, Tantawy, Sopher, Whittaker) Department of Social Policy,
The London School of Economics and Political Science, London, United
Kingdom
Title
Colchicine for primary prevention of atrial fibrillation after open-heart
surgery: Systematic review and meta-analysis.
Source
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Atrial fibrillation occurs frequently after open-heart
surgery. It is associated with increased morbidity and mortality, longer
hospital stays, and increased healthcare costs. Prophylactic
administration of colchicine may mitigate post-operative atrial
fibrillation (POAF). Methods: We searched PubMed, ClinicalTrials.gov and
CENTRAL databases to identify randomized controlled trials (RCTs) that;
(1) compared prophylactic use of colchicine to placebo, or usual care, in
patients with sinus rhythm who underwent elective open-heart surgery and
(2) reported POAF-incidence. We excluded trials focused on incidence of
atrial fibrillation after percutaneous interventions or colchicine
treatment of diagnosed pericarditis or post-pericardiotomy-syndrome. A
random-effects model was used to pool data for POAF-incidence as the
primary outcome and for drug-related adverse effects, major adverse events
(death and stroke), and hospital length-of-stay as secondary outcomes.
Results: We included five RCTs (1412 patients). Colchicine treatment
reduced POAF-events by 30% versus placebo or usual care (18% vs. 27%, risk
ratio (RR) 0.69, 95% confidence interval (CI) 0.57 to 0.84, p = 0.0002).
Adverse drug-related effects, especially gastrointestinal intolerance,
increased with colchicine; (21% vs. 8.2%, RR 2.52, 95% CI 1.62 to 3.93, p.
<. 0.0001). However, major adverse events were unchanged (3.2% vs. 3.2%,
RR 0.96, 95% CI 0.48 to 1.95, p = 0.92). Length-of-stay decreased by 1.2.
days with colchicine (95% CI -1.89 to -0.44, p = 0.002). Conclusion:
Colchicine demonstrated superior efficacy versus usual care for prevention
of atrial fibrillation after cardiac surgery. Moreover, colchicine
treatment was associated with shorter hospital stays. These benefits
outweigh increased risk of adverse drug-related effects; although further
work is needed to minimize gastrointestinal effects.<br/>Copyright &#xa9;
2017 Elsevier Ireland Ltd.

<9>
Accession Number
618299532
Author
Ando T.; Takagi H.; Briasoulis A.; Afonso L.
Institution
(Ando, Afonso) Division of Cardiovascular Disease, Department of Internal
Medicine, Harper hospital, Wayne State University, Detroit, United States
(Takagi) Division of Cardiovascular Surgery, Department of Surgery,
Shizuoka Medical Center, Shizuoka, Japan
(Briasoulis) Division of Cardiovascular Disease, Department of Internal
Medicine, Mayo Clinic, Rochester, MN, United States
(Ando) Division of Cardiology, Detroit Medical Center, 3990, John R,
Detroit, MI 48201, United States
Title
Single versus dual anti-platelet therapy post transcatheter aortic valve
implantation: a meta-analysis of randomized controlled trials.
Source
Journal of Thrombosis and Thrombolysis. (pp 1-9), 2017. Date of
Publication: 13 Sep 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The purpose of this systematic review and meta-analysis was to assess the
30-days safety (bleeding and vascular events) and efficacy (reduction in
major stroke, myocardial infarction and mortality) of single anti-platelet
(SAPT) versus dual anti-platelet (DAPT) after transcatheter aortic valve
implantation (TAVI). We used a meta-analytic method with Mantel-Haenszel
methods to calculate the odds ratio (OR) and 95% confidence interval (CI).
Only randomized clinical trials that compared 30-days safety and efficacy
based on Valve Academic Research Consortium criteria were included.
Studies that included patients on anticoagulants were excluded. Our
analysis included three studies with a total of 421 patients (210 SAPT and
211 DAPT). Life-threatening and major bleeding as well as major vascular
complications was similar between SAPT and DAPT. Similarly, major stroke,
myocardial infarction and mortality was also comparable between the two
groups. The combined outcomes of 30-day mortality, life-threatening and
major bleeding showed tendency toward lower event rates in SAPT compared
to DAPT (9.5 vs. 15.6%, OR 0.57; 95% CI 0.31-1.03, p = 0.06). In
conclusion, SAPT provided similar safety without adding incremental
efficacy compared to DAPT but showed tendency of lower combined endpoints
of 30-day mortality, life-threatening and major bleeding.<br/>Copyright
&#xa9; 2017 Springer Science+Business Media, LLC

<10>
Accession Number
618222734
Author
Serraino G.F.; Murphy G.J.
Institution
(Serraino, Murphy) Department of Cardiovascular Sciences, NIHR Leicester
Biomedical Research Unit in Cardiovascular Medicine, University of
Leicester, Clinical Sciences Wing, Glenfield General Hospital, Leicester,
United Kingdom
Title
Effects of cerebral near-infrared spectroscopy on the outcome of patients
undergoing cardiac surgery: A systematic review of randomised trials.
Source
BMJ Open. 7 (9) (no pagination), 2017. Article Number: e016613. Date of
Publication: 01 Sep 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives Goal-directed optimisation of cerebral oxygenation using
near-infrared spectroscopy (NIRS) during cardiopulmonary bypass is widely
used. We tested the hypotheses that the use of NIRS cerebral oximetry
results in reductions in cerebral injury (neurocognitive function, serum
biomarkers), injury to other organs including the heart and brain,
transfusion rates, mortality and resource use. Design Systematic review
and meta-analysis. Setting Tertiary cardiac surgery centres in North
America, Europe and Asia. Participants A search of Cochrane Central
Register of Controlled Trials, ClinicalTrials.gov, Medline, Embase, and
the Cumulative Index to Nursing and Allied Health Literature Plus from
inception to November 2016 identified 10 randomised trials, enrolling a
total of 1466 patients, all in adult cardiac surgery. Interventions
NIRS-based algorithms designed to optimise cerebral oxygenation versus
standard care (non-NIRS-based) protocols in cardiac surgery patients
during cardiopulmonary bypass. Outcome measures Mortality, organ injury
affecting the brain, heart and kidneys, red cell transfusion and resource
use. Results Two of the 10 trials identified in the literature search were
considered at low risk of bias. Random-effects meta-analysis demonstrated
similar mortality (risk ratio (RR) 0.76, 95% CI 0.30 to 1.96), major
morbidity including stroke (RR 1. 08, 95% CI 0.40 to 2.91), red cell
transfusion and resource use in NIRS-treated patients and controls, with
little or no heterogeneity. Grades of Recommendation, Assessment,
Development and Evaluation of the quality of the evidence was low or very
low for all of the outcomes assessed. Conclusions The results of this
systematic review did not support the hypotheses that cerebral NIRS-based
algorithms have clinical benefits in cardiac surgery. Trial registration
number PROSPERO CRD42015027696.<br/>Copyright &#xa9; Article author(s) (or
their employer(s) unless otherwise stated in the text of the article)
2017. All rights reserved. No commercial use is permitted unless otherwise
expressly granted.

<11>
Accession Number
618295121
Author
Tariq M.I.; Khan A.A.; Khalid Z.; Farheen H.; Siddiqi F.A.; Amjad I.
Institution
(Tariq, Amjad) Riphah College of Rehabilitation Sciences, Islamabad,
Pakistan
(Khan) BARM Bahria Hospital, Rawalpindi, Pakistan
(Khalid, Farheen) Railway Hospital, Rawalpindi, Pakistan
(Siddiqi) Foundation University Institute of Rehabilitation Sciences,
Foundation University, Islamabad, Pakistan
Title
Effect of early <= 3 Mets (Metabolic Equivalent of Tasks) of physical
activity on patient's outcome after cardiac surgery.
Source
Journal of the College of Physicians and Surgeons Pakistan. 27 (8) (pp
490-494), 2017. Date of Publication: 2017.
Publisher
College of Physicians and Surgeons Pakistan (7th Central Street, Karachi
755000, Pakistan)
Abstract
Objective: To determine the effect of <= 3 Mets (Metabolic Equivalent of
Tasks) of physical activity on zero postoperative days for improving
hemodynamic and respiratory parameters of patients after cardiac
surgeries. Study Design: Randomized control trial. Place and Duration of
Study: BARMWT Hospital, Rawalpindi, from March to August 2015.
Methodology: A randomized controlled trial was conducted on 174 CABG and
valvular heart disease patients undergoing cardiac surgical procedures.
After selection of sample via non-probability purposive sampling, they
were randomly allocated into interventional group (n=87) and control group
(n=87). Treatment protocol for experimental group was <=3 Mets of physical
activity, i.e. chest physiotherapy, sitting over edge of bed, standing and
sitting on chair at bedside, on zero postoperative day but the control
group was treated with conventional treatment on first postoperative day.
Pre- and post-treatment assessment was done in control and interventional
groups on both zero and first postoperative days. Data was analyzed on
SPSS version 21. Results: The patients' mean age was 51.86 +/-13.76 years.
Male to female ratio was 132:42. Statistically significant differences in
respiratory rate and SpO<inf>2</inf> (p=0.000 and 0.000, respectively)
were found between both groups. Among ABG's, PCO<inf>2</inf> and pH showed
significant differences with p values of 0.039 and < 0.001, respectively.
No significant differences were observed between both groups regarding
electrolytes (Na+, K+, Cl-, p-values of 0.361, 0.575 and 0.120
respectively) and creatinine (p=0.783). Marked improvement in oxygen
saturation, dyspnea and a fall in systolic BP was seen in interventional
group. There was also observed to be a reduction in the length of ICU stay
among interventional group patients as frequency with percentage of total
stay was compared to control group. Conclusion: Early physical activity
(<=3 METS) post-cardiac surgeries prevent respiratory complications
through improvement in dyspnea, respiratory rate, and oxygen saturation.

<12>
Accession Number
618244631
Author
Wiysonge C.S.; Ntsekhe M.; Thabane L.; Volmink J.; Majombozi D.; Gumedze
F.; Pandie S.; Mayosi B.M.
Institution
(Wiysonge) South African Medical Research Council, Cochrane South Africa,
Francie van Zijl Drive, Parow Valley, Cape Town, Western Cape 7505, South
Africa
(Wiysonge, Volmink, Majombozi) Stellenbosch University, Centre for
Evidence-based Health Care, Faculty of Medicine and Health Sciences, Cape
Town, South Africa
(Ntsekhe) Groote Schuur Hospital, Division of Cardiology, Observatory
7925, Cape Town, South Africa
(Thabane) McMaster University, Department of Clinical Epidemiology and
Biostatistics, 50 Charlton Ave E, St. Joseph's Healthcare, Hamilton, ON
L8N 4A6, Canada
(Gumedze) University of Cape Town, Department of Statistical Sciences,
Cape Town, South Africa
(Pandie, Mayosi) University of Cape Town, Department of Medicine, Cape
Town, South Africa
Title
Interventions for treating tuberculous pericarditis.
Source
Cochrane Database of Systematic Reviews. 2017 (9) (no pagination), 2017.
Article Number: CD000526. Date of Publication: 13 Sep 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Tuberculous pericarditis can impair the heart's function and
cause death; long term, it can cause the membrane to fibrose and constrict
causing heart failure. In addition to antituberculous chemotherapy,
treatments include corticosteroids, drainage, and surgery. Objectives: To
assess the effects of treatments for tuberculous pericarditis. Search
methods: We searched the Cochrane Infectious Diseases Group Specialized
Register (27 March 2017); the Cochrane Central Register of Controlled
Trials (CENTRAL), published in the Cochrane Library (2017, Issue 2);
MEDLINE (1966 to 27 March 2017); Embase (1974 to 27 March 2017); and
LILACS (1982 to 27 March 2017). In addition we searched the metaRegister
of Controlled Trials (mRCT) and the World Health Organization (WHO)
International Clinical Trials Registry Platform (ICTRP) search portal
using 'tuberculosis' and 'pericard*' as search terms on 27 March 2017. We
searched ClinicalTrials.gov and contacted researchers in the field of
tuberculous pericarditis. This is a new version of the original 2002
review. Selection criteria: We included randomized controlled trials
(RCTs) and quasi-RCTs. Data collection and analysis: Two review authors
independently screened search outputs, evaluated study eligibility,
assessed risk of bias, and extracted data; and we resolved any
discrepancies by discussion and consensus. One trial assessed the effects
of both corticosteroid and Mycobacterium indicus pranii treatment in a
two-by-two factorial design; we excluded data from the group that received
both interventions. We conducted fixed-effect meta-analysis and assessed
the certainty of the evidence using the GRADE approach. Main results:
Seven trials met the inclusion criteria; all were from sub-Saharan Africa
and included 1959 participants, with 1051/1959 (54%) HIV-positive. All
trials evaluated corticosteroids and one each evaluated colchicine, M.
indicus pranii immunotherapy, and open surgical drainage. Four trials
(1841 participants) were at low risk of bias, and three trials (118
participants) were at high risk of bias. In people who are not infected
with HIV, corticosteroids may reduce deaths from all causes (risk ratio
(RR) 0.80, 95% confidence interval (CI) 0.59 to 1.09; 660 participants, 4
trials, low certainty evidence) and the need for repeat pericardiocentesis
(RR 0.85, 95% CI 0.70 to 1.04; 492 participants, 2 trials, low certainty
evidence). Corticosteroids probably reduce deaths from pericarditis (RR
0.39, 95% CI 0.19 to 0.80; 660 participants, 4 trials, moderate certainty
evidence). However, we do not know whether or not corticosteroids have an
effect on constriction or cancer among HIV-negative people (very low
certainty evidence). In people living with HIV, only 19.9% (203/1959) were
on antiretroviral drugs. Corticosteroids may reduce constriction (RR 0.55,
0.26 to 1.16; 575 participants, 3 trials, low certainty evidence). It is
uncertain whether corticosteroids have an effect on all-cause death or
cancer (very low certainty evidence); and may have little or no effect on
repeat pericardiocentesis (RR 1.02, 0.89 to 1.18; 517 participants, 2
trials, low certainty evidence). For colchicine among people living with
HIV, we found one small trial (33 participants) which had insufficient
data to make any conclusions about any effects on death or constrictive
pericarditis. Irrespective of HIV status, due to very low certainty
evidence from one trial, it is uncertain whether adding M. indicus pranii
immunotherapy to antituberculous drugs has an effect on any outcome. Open
surgical drainage for effusion may reduce repeat pericardiocentesis In
HIV-negative people (RR 0.23, 95% CI 0.07 to 0.76; 122 participants, 1
trial, low certainty evidence) but may make little or no difference to
other outcomes. We did not find an eligible trial that assessed the
effects of open surgical drainage in people living with HIV. The review
authors found no eligible trials that examined the length of
antituberculous treatment needed nor the effects of other adjunctive
treatments for tuberculous pericarditis. Authors' conclusions: For
HIV-negative patients, corticosteroids may reduce death. For HIV-positive
patients not on antiretroviral drugs, corticosteroids may reduce
constriction. For HIV-positive patients with good antiretroviral drug
viral suppression, clinicians may consider the results from HIV-negative
patients more relevant. Further research may help evaluate percutaneous
drainage of the pericardium under local anaesthesia, the timing of
pericardiectomy in tuberculous constrictive pericarditis, and new
antibiotic regimens.<br/>Copyright &#xa9; 2017 The Cochrane Collaboration.
Published by John Wiley & Sons, Ltd.

<13>
Accession Number
617716543
Author
Stojanovic Stipic S.; Carev M.; Bajic Z.; Supe Domic D.; Roje Z.; Jukic
A.; Stipic T.
Institution
(Stojanovic Stipic, Carev) Department of Anesthesiology and Intensive
Care, University Hospital Split, Spinciceva 1, Split 21000, Croatia
(Bajic) Biometrika Healthcare Research, Zagreb, Croatia
(Supe Domic) Department of Medical Laboratory Diagnostics, University
Hospital Split, Split, Croatia
(Roje) The Private ENT Practice, Split, Croatia
(Jukic) Department of Internal Medicine, University Hospital Split, Split,
Croatia
(Stipic) Department of Dermatology, University Hospital Split, Split,
Croatia
Title
Increase of plasma S100B and neuron-specific enolase in children following
adenotonsillectomy: a prospective clinical trial.
Source
European Archives of Oto-Rhino-Laryngology. 274 (10) (pp 3781-3788), 2017.
Date of Publication: 01 Oct 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
S100B protein and neuron-specific enolase (NSE) can be considered the
markers of cerebral injury. To our knowledge the association of general
anesthesia for elective non-cardiac surgery in children with these markers
has not been studied before. The goal of this study was to find out
whether these markers change after adenotonsillectomy with general
anesthesia. The secondary goal was to determine whether different types of
anesthesia, gender, age and body mass index are associated with the change
of S100B and NSE after adenotonsillectomy with general anesthesia. This
study was designed as a prospective clinical trial. We did a simple
pre-post experiment with no control group. In 59 children (aged 6-13, ASA
I-II) undergoing adenotonsillectomy and randomized to TIVA or inhalational
general anesthesia, plasma S100B and NSE were measured during anesthesia
before and after the surgery which lasted a median (interquartile range)
of 16.5 (13.0-20.0) min. S100B and NSE assays were performed using the
electrochemiluminescence immunoassay. Significance of the differences was
assessed by two-tailed asymptotic Wilcoxon signed rank test. Main outcome
measures were differences in the levels of S100B and NSE before and after
the general anesthesia and surgery. There were significant increases in
S100B and NSE levels after the surgery. S100B was increased by 38% (P <
0.001) and NSE was increased by 10% (P < 0.001). Increase of S100B was
significantly negatively associated with age (P = 0.023). We have not
found significant association of S100B and NSE with any other of the
monitored variables. The values of neurological biomarkers S100B and NSE
were significantly increased after general anesthesia for elective
adenotonsillectomy in children.<br/>Copyright &#xa9; 2017, Springer-Verlag
GmbH Germany.

<14>
Accession Number
610760824
Author
Biagini E.; Pazzi C.; Olivotto I.; Musumeci B.; Limongelli G.; Boriani G.;
Pacileo G.; Mastromarino V.; Bacchi Reggiani M.L.; Lorenzini M.; Lai F.;
Berardini A.; Mingardi F.; Rosmini S.; Resciniti E.; Borghi C.; Autore C.;
Cecchi F.; Rapezzi C.
Institution
(Biagini, Pazzi, Boriani, Bacchi Reggiani, Lorenzini, Lai, Berardini,
Mingardi, Rosmini, Resciniti, Borghi, Rapezzi) Cardiology, Department of
Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum,
University of Bologna, Bologna, Italy
(Olivotto, Cecchi) Cardiothoracovascular Department, Referral Center for
Myocardial Diseases, Azienda Ospedaliera Universitaria Careggi, Florence,
Italy
(Musumeci, Mastromarino, Autore) Department of Clinical and Molecular
Medicine, Sapienza University of Rome, Rome, Italy
(Limongelli, Pacileo) Department of Cardiology, Monaldi Hospital,
University of Naples, Naples, Italy
Title
Usefulness of Electrocardiographic Patterns at Presentation to Predict
Long-term Risk of Cardiac Death in Patients With Hypertrophic
Cardiomyopathy.
Source
American Journal of Cardiology. 118 (3) (pp 432-439), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The objective of this study was to investigate the prognostic significance
of 12-lead electrocardiogram (ECG) patterns in a large multicenter cohort
of patients with hypertrophic cardiomyopathy; 1,004 consecutive patients
with hypertrophic cardiomyopathy and a recorded standard ECG (64% men,
mean age 50 +/- 16 years) were evaluated at 4 Italian centers. The study
end points were sudden cardiac death (SCD) or surrogates, including
appropriate implanted cardiac defibrillator discharge and resuscitated
cardiac arrest and major cardiovascular events (including SCD or
surrogates and death due to heart failure, cardioembolic stroke, or heart
transplantation). Prevalence of baseline electrocardiographic
characteristics was: normal ECG 4%, ST-segment depression 56%,
pseudonecrosis waves 33%, "pseudo-ST-segment elevation myocardial
infarction (STEMI)" pattern 17%, QRS duration >=120 ms 17%, giant inverted
T waves 6%, and low QRS voltages 3%. During a mean follow-up of 7.4 +/-
6.8 years, 77 patients experienced SCD or surrogates and 154 patients
experienced major cardiovascular events. Independent predictors of SCD or
surrogates were unexplained syncope (hazard ratio [HR] 2.5, 95% confidence
interval [CI] 1.4 to 4.5, p = 0.003), left ventricular ejection fraction
<50% (HR 3.5, 95% CI 1.9 to 6.7, p = 0.0001), nonsustained ventricular
tachycardia (HR 1.7, 95% CI 1.1 to 2.6, p = 0.027), pseudo-STEMI pattern
(HR 2.3, 95% CI 1.4 to 3.8, p = 0.001), QRS duration >=120 ms (HR 1.8, 95%
CI 1.1 to 3.0, p = 0.033), and low QRS voltages (HR 2.3, 95% CI 1.01 to
5.1, p = 0.048). Independent predictors of major cardiovascular events
were age (HR 1.02, 95% CI 1.01 to 1.03, p = 0.0001), LV ejection fraction
<50% (HR 3.73, 95% CI 2.39 to 5.83, p = 0.0001), pseudo-STEMI pattern (HR
1.66, 95% CI 1.13 to 2.45, p = 0.010), QRS duration >=120 ms (HR 1.69, 95%
CI 1.16 to 2.47, p = 0.007), and prolonged QTc interval (HR 1.68, 95% CI
1.21 to 2.34, p = 0.002). In conclusion, a detailed qualitative and
quantitative electrocardiographic analyses provide independent predictors
of prognosis that could be integrated with the available score systems to
improve the power of the current model.<br/>Copyright &#xa9; 2016 Elsevier
Inc.

<15>
[Use Link to view the full text]
Accession Number
618233017
Author
Vandenbulcke L.; Lapage K.G.; Vanderstraeten K.V.; De Somer F.M.; De Hert
S.G.; Moerman A.T.
Institution
(Vandenbulcke, Lapage, De Hert, Moerman) Department of Anaesthesiology,
Ghent University Hospital, De Pintelaan 185, Gent 9000, Belgium
(De Somer) Department of Cardiac Surgery, Ghent University Hospital, Gent,
Belgium
(Vanderstraeten) Faculty of Medicine and Health Sciences, Ghent
University, Gent, Belgium
Title
Microvascular reactivity monitored with near-infrared spectroscopy is
impaired after induction of anaesthesia in cardiac surgery patients.
Source
European Journal of Anaesthesiology. 34 (10) (pp 688-694), 2017. Date of
Publication: 01 Oct 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND Induction of anaesthesia causes significant macrohaemodynamic
changes, but little is known about its effects on the microcirculation.
However, alterations in microvascular perfusion are known to be associated
with impaired tissue oxygenation and organ dysfunction. Microvascular
reactivity can be assessed with vascular occlusion testing, which
evaluates the response of tissue oxygen saturation to transient ischaemia
and reperfusion. OBJECTIVE The aim of the current study was to evaluate
the effects of an opioid-based anaesthesia induction on microvascular
reactivity. We hypothesised that despite minimal blood pressure changes,
microvascular function would be impaired. DESIGN Prospective,
observational study. SETTING Single-centre, tertiary university teaching
hospital, Belgium. PATIENTS Thirty-five adult patients scheduled for
elective coronary artery bypass grafting surgery. INTERVENTION
Microvascular reactivity was assessed before and 30 min after anaesthesia
induction by means of vascular occlusion testing and near-infrared
spectroscopy. MAIN OUTCOME MEASURES Tissue oxygen saturations,
desaturation rate, recovery time (time from release of cuff to the maximum
value) and rate of recovery were determined. RESULTS Data are expressed as
median (minimum to maximum). Tissue oxygen saturation was higher after
induction of anaesthesia [70 (54 to 78) vs. 73 (55 to 94)%, P = 0.015].
Oxygen consumption decreased after induction, appreciable by the higher
minimum tissue oxygen saturation [45 (29 to 69) vs. 53 (28 to 81)%, P <
0.001] and the slower desaturation rate [11 (4 to 18) vs. 9 (5 to 16)% min
-1, P < 0.001]. After induction of anaesthesia, recovery times were longer
[40 (20 to 120) vs. 48 (24 to 356) s, P = 0.004] and the rate of recovery
was lower [114 (12 to 497) vs. 80 (3 to 271)% min -1, P < 0.001].
CONCLUSION After induction of anaesthesia, oxygen consumption was
decreased. The longer recovery times and slower rates of recovery indicate
impaired microvascular reactivity after induction of anaesthesia. TRIAL
REGISTRATION The research project was registered at ClinicalTrials.gov
(NCT02034682).<br/>Copyright &#xa9; 2017 European Society of
Anaesthesiology. All rights reserved.

<16>
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).

<17>
Accession Number
617838285
Author
Stopyra J.P.; Miller C.D.; Hiestand B.C.; Lefebvre C.W.; Nicks B.A.; Cline
D.M.; Askew K.L.; Riley R.F.; Russell G.B.; Hoekstra J.W.; Mahler S.A.
Institution
(Stopyra, Miller, Hiestand, Lefebvre, Nicks, Cline, Askew, Hoekstra,
Mahler) Department of Emergency Medicine, Wake Forest School of Medicine,
Winston-Salem, NC, United States
(Russell) Department of Biostatistical Sciences, Wake Forest School of
Medicine, Winston-Salem, NC, United States
(Riley) Division of Cardiology, University of Washington, Seattle, WA,
United States
Title
Validation of the No Objective Testing Rule and Comparison to the HEART
Pathway.
Source
Academic Emergency Medicine. 24 (9) (pp 1165-1168), 2017. Date of
Publication: September 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: The no objective testing rule (NOTR) is a decision aid
designed to safely identify emergency department (ED) patients with chest
pain who do not require objective testing for coronary artery disease.
Objectives: The objective was to validate the NOTR in a cohort of U.S. ED
patients with acute chest pain and compare its performance to the HEART
Pathway. Methods: A secondary analysis of 282 participants enrolled in the
HEART Pathway randomized controlled trial was conducted. Each patient was
classified as low risk or at risk by the NOTR. Sensitivity for major
adverse cardiac events (MACE) at 30 days was calculated in the entire
study population. NOTR and HEART Pathways were compared among patients
randomized to the HEART Pathway in the parent trial using McNemar's test
and the net reclassification improvement (NRI). Results: Major adverse
cardiac events occurred in 22/282 (7.8%) participants, including no
deaths, 16/282 (5.6%) with myocardial infarction (MI), and 6/282 (2.1%)
with coronary revascularization without MI. NOTR was 100% (95% confidence
interval [CI] = 84.6%-100%) sensitive for MACE and identified 78/282
patients (27.7%, 95% = CI 22.5-33.3%) as low risk. In the HEART Pathway
arm (n = 141), both NOTR and HEART Pathway identified all patients with
MACE as at risk. Compared to NOTR, the HEART Pathway was able to correctly
reclassify 27 patients without MACE as low risk, yielding a NRI of 20.8%
(95% CI = 11.3%-30.2%). Conclusions: Within a U.S. cohort of ED patients
with chest pain, the NOTR and HEART Pathway were 100% sensitive for MACE
at 30 days. However, the HEART Pathway identified more patients suitable
for early discharge than the NOTR.<br/>Copyright &#xa9; 2017 by the
Society for Academic Emergency Medicine

<18>
Accession Number
618243389
Author
Cho Y.J.; Jo W.Y.; Oh H.; Koo C.-H.; Oh J.; Cho J.-Y.; Yu K.-S.; Jeon Y.;
Kim T.K.
Institution
(Cho, Jo, Oh, Jeon, Kim) Department of Anaesthesiology and Pain Medicine,
Seoul National University Hospital, Seoul, South Korea
(Koo) CHA Bundang Medical Centre, Department of Anaesthesiology and Pain
Medicine, Seongnam-si, South Korea
(Oh, Cho, Yu) Department of Clinical Pharmacology and Therapeutics, Seoul
National University College of Medicine and Hospital, Seoul, South Korea
Title
Performance of the Minto model for the target-controlled infusion of
remifentanil during cardiopulmonary bypass.
Source
Anaesthesia. 72 (10) (pp 1196-1205), 2017. Date of Publication: October
2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
We studied the predictive performance of the Minto pharmacokinetic model
during cardiopulmonary bypass in patients undergoing cardiac surgery.
Patients received remifentanil target-controlled infusion using the Minto
model during total intravenous anaesthesia with propofol. From 56
patients, 275 arterial blood samples were drawn before, during and after
bypass to determine the plasma concentration of remifentanil, and the
predicted concentrations were recorded at each time. For pooled data, the
median prediction error and median absolute prediction error were 21.3%
and 21.8%, respectively, and 22.1% and 22.3% during bypass. Both were
148.4% during hypothermic circulatory arrest and measured concentrations
were more than three times greater than predicted (26.9 (17.0) vs. 7.1
(1.6) ng.ml^-1). The Minto model showed considerable bias but
overall acceptable precision during bypass. The target concentration of
remifentanil should be reduced when using the Minto model during
hypothermic circulatory arrest.<br/>Copyright &#xa9; 2017 The Association
of Anaesthetists of Great Britain and Ireland

<19>
Accession Number
618222744
Author
Leonardi S.; Marino M.; Crimi G.; Maiorana F.; Rizzotti D.; Lettieri C.;
Bettari L.; Zuccari M.; Sganzerla P.; Tresoldi S.; Adamo M.; Ghiringhelli
S.; Sponzilli C.; Pasquetto G.; Pavei A.; Pedon L.; Bassan L.; Bollati M.;
Camisasca P.; Trabattoni D.; Brancati M.; Poli A.; Panciroli C.; Lettino
M.; Tarelli G.; Tarantini G.; De Luca L.; Varbella F.; Musumeci G.; De
Servi S.
Institution
(Leonardi, Crimi, Maiorana, Rizzotti) Coronary Care Unit, Fondazione IRCCS
Policlinico San Matteo, Pavia, Italy
(Marino) Cardiology, Ospedale Maggiore di Crema, Crema, Italy
(Lettieri) Cardiology, ASST Mantova-Ospedale Carlo Poma, Mantova, Italy
(Bettari) Cardiology, ASST Cremona-Ospedale di Cremona, Cremona, Italy
(Zuccari) Cardiology, Ospedale Fornaroli di Magenta, Magenta, Italy
(Sganzerla) Cardiology, ASST Bergamo Ovest-Ospedale di Treviglio,
Treviglio, Italy
(Tresoldi) Cardiology, Azienda Ospedaliera di Desio e Vimercate,
Vimercate, Italy
(Adamo) Cardiology, Spedali Civili di Brescia, Brescia, Italy
(Ghiringhelli) Cardiology, Ospedale di Circolo Fondazione Macchi, Varese,
Italy
(Sponzilli) Cardiology, Ospedale San Paolo, Milano, Italy
(Pasquetto) Cardiology, Ospedali Riuniti Padova Sud Madre Teresa di
Calcutta, Monselice, Italy
(Pavei) Cardiology, Presidio Ospedaliero di Conegliano, Conegliano, Italy
(Pedon) Cardiology, Presidio Ospedaliero di Cittadella, Cittadella, Italy
(Bassan) Cardiology, ULSS 4 Alto Vicentino, Thiene, Italy
(Bollati) Cardiology, IRCCS Policlinico San Donato, San Donato Milanese,
Italy
(Camisasca) Cardiology, Ospedale San Gerardo, Monza, Italy
(Trabattoni) Cardiology, Centro Cardiologico Monzino, Milano, Italy
(Brancati) Cardiology, Fondazione Poliambulanza, Milano, Italy
(Poli) Cardiology, ASST Ovest Milanese, Legnano, Italy
(Panciroli) Cardiology, ASST di Lodi, Lodi, Italy
(Lettino, Tarelli) Cardiology, Humanitas Research Hospital, Rozzano, Italy
(Tarantini) Cardiology, Ospedale di Padova, Padova, Italy
(De Luca) Cardiology, Ospedale San Giovanni Evangelista, Tivoli, Italy
(Varbella) Cardiology, Ospedale degli Infermi, Rivoli, Italy
(Musumeci) Cardiology, ASST-Papa Giovanni XXIII-Bergamo, Bergamo, Italy
(De Servi) Cardiology, IRCCS MultiMedica, Milano, Italy
Title
APpropriAteness of percutaneous Coronary interventions in patients with
ischaemic HEart disease in Italy: The APACHE pilot study.
Source
BMJ Open. 7 (9) (no pagination), 2017. Article Number: e016909. Date of
Publication: 01 Sep 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives To first explore in Italy appropriateness of indication,
adherence to guideline recommendations and mode of selection for coronary
revascularisation. Design Retrospective, pilot study. Setting 22
percutaneous coronary intervention (PCI)-performing hospitals (20 patients
per site), 13 (59%) with on-site cardiac surgery. Participants 440
patients who received PCI for stable coronary artery disease (CAD) or
non-ST elevation acute coronary syndrome were independently selected in a
4:1 ratio with half diabetics. Primary and secondary outcome measures
Proportion of patients who received appropriate PCI using validated
appropriate use scores (ie, AUS>=7). Also, in patients with stable CAD, we
examined adherence to the following European Society of Cardiology
recommendations: (A) per cent of patients with complex coronary anatomy
treated after heart team discussion; (B) per cent of fractional flow
reserve-guided PCI for borderline stenoses in patients without documented
ischaemia; (C) per cent of patients receiving guideline-directed medical
therapy at the time of PCI as well as use of provocative test of ischaemia
according to pretest probability (PTP) of CAD. Results Of the 401 mappable
PCIs (91%), 38.7% (95% CI 33.9 to 43.6) were classified as appropriate,
47.6% (95% CI 42.7 to 52.6) as uncertain and 13.7% (95% CI 10.5% to 17.5%)
as inappropriate. Median PTP in patients with stable CAD without known
coronary anatomy was 69% (78% intermediate PTP, 22% high PTP). Ischaemia
testing use was similar (p=0.71) in patients with intermediate (n=140,
63%) and with high PTP (n=40, 66%). In patients with stable CAD (n=352)
guideline adherence to the three recommendations explored was: (A) 11%;
(B) 25%; (C) 23%. AUS was higher in patients evaluated by the heart team
as compared with patients who were not (7 (6.8) vs 5 (4.7); p=0.001).
Conclusions Use of heart team approaches and adherence to guideline
recommendations on coronary revascularisation in a real-world setting is
limited. This pilot study documents the feasibility of measuring
appropriateness and guideline adherence in clinical practice and
identifies substantial opportunities for quality improvement. Trial
registration number NCT02748603.<br/>Copyright &#xa9; Article author(s)
(or their employer(s) unless otherwise stated in the text of the article)
2017. All rights reserved. No commercial use is permitted unless otherwise
expressly granted.

<20>
Accession Number
618266150
Author
Vaccaro O.; Masulli M.; Nicolucci A.; Bonora E.; Del Prato S.; Maggioni
A.P.; Rivellese A.A.; Squatrito S.; Giorda C.B.; Sesti G.; Mocarelli P.;
Lucisano G.; Sacco M.; Signorini S.; Cappellini F.; Perriello G.; Babini
A.C.; Lapolla A.; Gregori G.; Giordano C.; Corsi L.; Buzzetti R.; Clemente
G.; Di Cianni G.; Iannarelli R.; Cordera R.; La Macchia O.; Zamboni C.;
Scaranna C.; Boemi M.; Iovine C.; Lauro D.; Leotta S.; Dall'Aglio E.;
Cannarsa E.; Tonutti L.; Pugliese G.; Bossi A.C.; Anichini R.; Dotta F.;
Di Benedetto A.; Citro G.; Antenucci D.; Ricci L.; Giorgino F.; Santini
C.; Gnasso A.; De Cosmo S.; Zavaroni D.; Vedovato M.; Consoli A.;
Calabrese M.; di Bartolo P.; Fornengo P.; Riccardi G.
Institution
(Vaccaro, Masulli, Rivellese, Riccardi) Department of Clinical Medicine
and Surgery, University of Naples Federico II, Naples, Italy
(Iovine) Diabetes Unit, University of Naples Federico II, Naples, Italy
(Nicolucci, Lucisano, Sacco) Center for Outcomes Research and Clinical
Epidemiology (CORESEARCH), Pescara, Italy
(Bonora) Division of Endocrinology, Diabetes and Metabolism, University
and Hospital Trust of Verona, Verona, Italy
(Del Prato) Department of Clinical and Experimental Medicine, University
of Pisa, Pisa, Italy
(Maggioni) National Association of Hospital Cardiologists (ANMCO) Research
Center, Florence, Italy
(Squatrito) Diabetes Unit, University Hospital Garibaldi-Nesima of
Catania, Catania, Italy
(Giorda) Diabetes Unit, Azienda Sanitaria Locale (ASL) Torino 5, Torino,
Italy
(Sesti) Department of Medical and Surgical Sciences, Magna Graecia
University of Catanzaro, Italy
(Gnasso) Department of Clinical and Experimental Medicine, Magna Graecia
University of Catanzaro, Italy
(Mocarelli, Signorini, Cappellini) University Department Laboratory
Medicine, Hospital of Desio, Monza, Italy
(Perriello) Endocrinology and Metabolism, University of Perugia, Perugia,
Italy
(Babini) Medical Division, Rimini Hospital, Rimini, Italy
(Lapolla) Dipartimento di Medicina, Universita di Padova, Padova, Italy
(Gregori) Diabetes Unit, Massa Carrara, Azienda Unita Sanitarie Locali
(USL) Toscana Nord Ovest, Carrara, Italy
(Giordano) Section of Endocrinology, Diabetology and Metabolic Diseases,
University of Palermo, Palermo, Italy
(Corsi) Diabetes Unit, ASL 4 Chiavarese, Chiavari, Italy
(Buzzetti) Department of Experimental Medicine, Sapienza University, Rome,
Italy
(Pugliese) Department of Clinical and Molecular Medicine, Sapienza
University, Rome, Italy
(Clemente) Institute for Research on Population and Social
Policies-National Research Council, Penta di Fisciano, Italy
(Di Cianni) Diabetes and Metabolism, Livorno Hospital, Livorno, Italy
(Iannarelli) Diabetes Unit, Department of Medicine, San Salvatore
Hospital, L'Aquila, Italy
(Cordera) Diabetes Unit, School of Medicine, University of Genova,
Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Martino
Hospital, Genova, Italy
(La Macchia) Endocrinology, Azienda Ospedaliero Universitaria Ospedali
Riuniti, Foggia, Italy
(Zamboni) Diabetes Unit, University of Ferrara, Ferrara, Italy
(Scaranna) Endocrinology and Diabetology, Azienda Socio Sanitaria
Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
(Boemi) Diabetes and Metabolism Unit, IRCCS Istituto Nazionale Riposo e
Cura Anziani, Ancona, Italy
(Lauro) Department of Systems Medicine, University of Rome Tor Vergata,
Rome, Italy
(Leotta) UOC Diabetologia Ospedale Sandro Pertini, Rome, Italy
(Dall'Aglio) Clinical and Experimental Medicine, University of Parma,
Parma, Italy
(Cannarsa) Diabetes Unit, San Liberatore Hospital, Atri Teramo, Italy
(Tonutti) Endocrinology, Diabetes, Metabolism and Clinical Nutrition Unit,
Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
(Bossi) ASST Bergamo Ovest, Treviglio, Italy
(Anichini) Diabetes Unit, USL 3, Pistoia, Italy
(Dotta) Diabetes Unit, Department of Medicine, Surgery and Neurosciences,
University of Siena, Siena, Italy
(Di Benedetto) Department of Clinical and Experimental Medicine,
University of Messina, Messina, Italy
(Citro) Endocrinology and Diabetes Unit, Azienda Sanitaria Locale di
Potenza, Potenza, Italy
(Antenucci) Diabetes Unit, Renzetti Hospital, ASL 2 Abruzzo, Lanciano,
Italy
(Ricci) Diabetes Unit, USL Sud Est, Toscana, Italy
(Giorgino) Department of Emergency and Organ Transplantation,
Endocrinology and Metabolic Diseases, University of Bari Aldo Moro, Bari,
Apulia, Italy
(Santini) Department Endocrinology and Diabetology, Cesena Hospital,
Cesena, Italy
(De Cosmo) Unit of Internal Medicine, IRCCS Casa Sollievo della
Sofferenza, San Giovanni Rotondo, Italy
(Zavaroni) Diabetes Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
(Vedovato) Metabolism Unit, Azienda Ospedaliera di Padova, Padova, Italy
(Consoli) Department of Medicine and Aging Sciences, and Aging and
Translational Medicine Research Center (CeSI-Met), D'Annunzio University,
Chieti-Pescara, Italy
(Calabrese) Diabetes Unit, USL Toscana Centro, Prato, Italy
(di Bartolo) Diabetes Unit, Ravenna Internal Medicine Department, Romagna
Local Health Unit, Ravenna, Italy
(Fornengo) Department of Medical Sciences, University of Turin, Turin,
Italy
Title
Effects on the incidence of cardiovascular events of the addition of
pioglitazone versus sulfonylureas in patients with type 2 diabetes
inadequately controlled with metformin (TOSCA.IT): A randomised,
multicentre trial.
Source
The Lancet Diabetes and Endocrinology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: The best treatment option for patients with type 2 diabetes in
whom treatment with metformin alone fails to achieve adequate glycaemic
control is debated. We aimed to compare the long-term effects of
pioglitazone versus sulfonylureas, given in addition to metformin, on
cardiovascular events in patients with type 2 diabetes. Methods: TOSCA.IT
was a multicentre, randomised, pragmatic clinical trial, in which patients
aged 50-75 years with type 2 diabetes inadequately controlled with
metformin monotherapy (2-3 g per day) were recruited from 57 diabetes
clinics in Italy. Patients were randomly assigned (1:1), by permuted
blocks randomisation (block size 10), stratified by site and previous
cardiovascular events, to add-on pioglitazone (15-45 mg) or a sulfonylurea
(5-15 mg glibenclamide, 2-6 mg glimepiride, or 30-120 mg gliclazide, in
accordance with local practice). The trial was unblinded, but event
adjudicators were unaware of treatment assignment. The primary outcome,
assessed with a Cox proportional-hazards model, was a composite of first
occurrence of all-cause death, non-fatal myocardial infarction, non-fatal
stroke, or urgent coronary revascularisation, assessed in the modified
intention-to-treat population (all randomly assigned participants with
baseline data available and without any protocol violations in relation to
inclusion or exclusion criteria). This study is registered with
ClinicalTrials.gov, number NCT00700856. Findings: Between Sept 18, 2008,
and Jan 15, 2014, 3028 patients were randomly assigned and included in the
analyses. 1535 were assigned to pioglitazone and 1493 to sulfonylureas
(glibenclamide 24 [2%], glimepiride 723 [48%], gliclazide 745 [50%]). At
baseline, 335 (11%) participants had a previous cardiovascular event. The
study was stopped early on the basis of a futility analysis after a median
follow-up of 57.3 months. The primary outcome occurred in 105 patients
(1.5 per 100 person-years) who were given pioglitazone and 108 (1.5 per
100 person-years) who were given sulfonylureas (hazard ratio 0.96, 95% CI
0.74-1.26, p=0.79). Fewer patients had hypoglycaemias in the pioglitazone
group than in the sulfonylureas group (148 [10%] vs 508 [34%], p<0.0001).
Moderate weight gain (less than 2 kg, on average) occurred in both groups.
Rates of heart failure, bladder cancer, and fractures were not
significantly different between treatment groups. Interpretation: In this
long-term, pragmatic trial, incidence of cardiovascular events was similar
with sulfonylureas (mostly glimepiride and gliclazide) and pioglitazone as
add-on treatments to metformin. Both of these widely available and
affordable treatments are suitable options with respect to efficacy and
adverse events, although pioglitazone was associated with fewer
hypoglycaemia events. Funding: Italian Medicines Agency, Diabete Ricerca,
and Italian Diabetes Society.<br/>Copyright &#xa9; 2017 Elsevier Ltd.

<21>
Accession Number
618265935
Author
Bhavnani S.P.; Sola S.; Adams D.; Venkateshvaran A.; Dash P.K.; Sengupta
P.P.
Institution
(Bhavnani) Scripps Clinic and Research Foundation, San Diego, California
(Sola, Venkateshvaran, Dash) Sri Sathya Sai Institute of Higher Medical
Sciences, Whitefield, Bangalore, India
(Adams) Duke University School of Medicine, Durham, North Carolina
(Sengupta) West Virginia University Heart and Vascular Institute at West
Virginia University School of Medicine, Morgantown, West Virginia
Title
A Randomized Trial of Pocket-Echocardiography Integrated Mobile Health
Device Assessments in Modern Structural Heart Disease Clinics.
Source
JACC: Cardiovascular Imaging. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: This study sought to determine whether mobile health (mHealth)
device assessments used as clinical decision support tools at the
point-of-care can reduce the time to treatment and improve long-term
outcomes among patients with rheumatic and structural heart diseases
(SHD). Background: Newly developed smartphone-connected mHealth devices
represent promising methods to diagnose common diseases in
resource-limited areas; however, the impact of technology-based care on
long-term outcomes has not been rigorously evaluated. Methods: A total of
253 patients with SHD were randomized to an initial diagnostic assessment
with wireless devices in mHealth clinics (n = 139) or to standard-care (n
= 114) in India. mHealth clinics were equipped with point-of-care devices
including pocket-echocardiography, smartphone-connected-electrocardiogram
blood pressure and oxygen measurements, activity monitoring, and portable
brain natriuretic peptide laboratory testing. All individuals underwent
comprehensive transthoracic echocardiography to assess the severity of
SHD. The primary endpoint was the time to referral for therapy with
percutaneous valvuloplasty or surgical valve replacement. Secondary
endpoints included the probability of a cardiovascular hospitalization
and/or death over 1-year. Results: An initial mHealth assessment was
associated with a shorter time to referral for valvuloplasty and/or valve
replacement (83 +/- 79 days vs. 180 +/- 101 days, p <0.001) and was
associated with an increased probability for valvuloplasty/valve
replacement compared to standard-care (34% vs. 32%; adjusted hazard ratio:
1.54; 95% CI: 0.96 to 2.47, p = 0.07). Patients randomized to mHealth were
associated with a lower risk of a hospitalization and/or death on
follow-up (15% vs. 28%, adjusted hazard ratio: 0.41; 95% CI: 0.21 to 0.83;
p = 0.013). Conclusions: An initial mHealth diagnostic strategy was
associated with a shorter time to definitive therapy among patients with
SHD in a resource-limited area and was associated with improved outcomes.
(A Randomized Trial of Pocket-Echocardiography Integrated Mobile Health
Device Assessments in Modern Structural Heart Disease Clinics;
NCT02881398).<br/>Copyright &#xa9; 2017 American College of Cardiology
Foundation.

<22>
Accession Number
618265750
Author
Simon G.I.; Craswell A.; Thom O.; Fung Y.L.
Institution
(Simon, Fung) School of Health and Sports Sciences, University of the
Sunshine Coast, Sunshine Coast, QLD, Australia
(Craswell) School of Nursing, Midwifery, and Paramedicine, University of
the Sunshine Coast, Sunshine Coast, QLD, Australia
(Thom) Department of Emergency Medicine, Sunshine Coast Hospital and
Health Service, Sunshine Coast, QLD, Australia
Title
Outcomes of restrictive versus liberal transfusion strategies in older
adults from nine randomised controlled trials: A systematic review and
meta-analysis.
Source
The Lancet Haematology. (no pagination), 2017. Date of Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Background: Guidelines for patient blood management recommend restrictive
transfusion practice for most adult patients. These guidelines are
supported by evidence from randomised controlled trials (RCTs); however,
one of the patient groups not explicitly examined in these studies is the
geriatric population. We examined RCTs relevant to transfusion outcomes in
older patients. Our aim was to determine whether special guidelines are
warranted for geriatric patients, recognising the different
pathophysiological characteristics of this group. Methods: For this
systematic review and meta-analysis, we searched PubMed, Scopus, and the
Cochrane Library databases from their inception to May 5, 2017, for
evidence relating to transfusion outcomes in adults aged 65 years and
older. This criterion was widened to include RCTs where a substantial
proportion of the study population was older than 65 years. We also
included study populations of all clinical settings, and did not limit the
search by date, language, or study type. For articles not in English, only
available translations of the abstracts were reviewed. Studies were
excluded if they did not specify age. Observational studies and duplicate
patient and outcome data from studies that generated multiple publications
were also excluded. We screened bibliographies of retrieved articles for
additional publications. We analysed data extracted from published RCTs
comparing restrictive and liberal transfusion strategies in older adults.
We generated fixed effects risk ratios (RR) for pooled study data using
the Mantel-Haenszel method. Primary outcomes were 30-day and 90-day
mortality events for patients enrolled in restrictive and liberal
transfusion study groups. We included intention-to-treat outcome data in
the meta-analysis when available, otherwise we used per-protocol outcome
data. Findings: 686 articles were identified by the search, and a further
37 by the snowball approach. Of these articles, 13 eligible papers
described findings from nine RCTs (five trials investigating orthopaedic
surgery, three cardiac surgery, and one oncology surgery; including 5780
patients). The risk of 30-day mortality was higher in older patients who
followed a restrictive transfusion strategy than in those who followed a
liberal transfusion strategy (risk ratio [RR] 1.36, 95% CI 1.05-1.74;
p=0.017). The risk of 90-day mortality was also higher in those who
followed a restrictive transfusion strategy than in those who followed a
liberal transfusion strategy (RR 1.45, 95% CI 1.05-1.98; p=0.022).
Interpretation: Liberal transfusion strategies might produce better
outcomes in geriatric patients than restrictive transfusion strategies.
This outcome contradicts current restrictive transfusion approaches.
Population ageing will challenge resources globally, and this finding has
implications for blood supply and demand, and optimal care of older
adults. Further research is needed to formulate evidence-based transfusion
practice across clinical specialties specific to the geriatric population,
and to examine resource effects. Funding: Australia's National Blood
Authority.<br/>Copyright &#xa9; 2017 Elsevier Ltd.

<23>
Accession Number
617760216
Author
Vaduganathan M.; Harrington R.A.; Stone G.W.; Steg P.G.; Gibson C.M.; Hamm
C.W.; Price M.J.; Deliargyris E.N.; Prats J.; Mahaffey K.W.; White H.D.;
Bhatt D.L.
Institution
(Vaduganathan, Bhatt) Brigham and Women's Hospital Heart & Vascular Center
and Harvard Medical School, Boston, Massachusetts, United States
(Harrington, Mahaffey) Stanford University Medical School, Stanford,
California, United States
(Stone) Columbia University Medical Center and the Cardiovascular Research
Foundation, New York City, New York, United States
(Steg) FACT (French Alliance for Cardiovascular clinical Trials), DHU
FIRE, INSERM Unite 1148, Universite Paris-Diderot, Paris, France
(Steg) Hopital Bichat, Assistance-Publique-Hopitaux de Paris, Paris,
France
(Steg) NHLI, Imperial College, Royal Brompton Hospital, London, United
Kingdom
(Gibson) Beth Israel Deaconess Medical Center, Division of Cardiology,
Boston, Massachusetts, United States
(Hamm) Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
(Price) Scripps Clinic and Scripps Translational Science Institute, La
Jolla, California, United States
(Deliargyris) Science and Strategy Consulting Group, Basking Ridge, New
Jersey, United States
(Prats) The Medicines Company, Parsippany, New Jersey, United States
(White) Green Lane Cardiovascular Service, Auckland, New Zealand
Title
Cangrelor Versus Clopidogrel on a Background of Unfractionated Heparin
(from CHAMPION PHOENIX).
Source
American Journal of Cardiology. 120 (7) (pp 1043-1048), 2017. Date of
Publication: 01 Oct 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Cangrelor is approved for use during percutaneous coronary intervention
(PCI) and is administered with different parenteral anticoagulants. We
examined the efficacy and safety of cangrelor in the subgroup of patients
who received unfractionated heparin (UFH) during PCI in the modified
intention-to-treat population of the randomized CHAMPION PHOENIX trial
(cangrelor vs clopidogrel; n = 10,939). The primary efficacy end point was
the composite of death, myocardial infarction, ischemia-driven
revascularization, or stent thrombosis (ST) at 48 hours. The key secondary
efficacy end point was ST. UFH was used in 69.2% (7,569/10,939) of
patients. In the UFH subgroup, cangrelor reduced the primary composite
efficacy end point at 48 hours compared with clopidogrel (4.8% vs 5.9%;
odds ratio [OR] 0.80 [0.65 to 0.98]; p = 0.03). Cangrelor consistently
reduced ST at 2 hours (0.7% vs 1.3%; OR 0.56 [0.35 to 0.90]; p = 0.01) and
48 hours (0.9% vs 1.4%; OR 0.70 [0.45 to 1.07]; p = 0.10). There was no
difference in GUSTO (Global Use of Strategies to Open Occluded Coronary
Arteries)-defined severe or life-threatening bleeding (0.1% vs 0.1%; OR
1.24 [0.33 to 4.61]; p = 0.75) or blood transfusion requirement at 48
hours (0.4% vs 0.2%; OR 1.87 [0.83 to 4.21]; p = 0.12). In conclusion,
cangrelor reduces early ischemic periprocedural complications without
increasing severe bleeding compared with clopidogrel in patients
undergoing PCI with UFH.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<24>
Accession Number
618263742
Author
Wang L.; Wang H.; Hou X.
Institution
(Wang, Wang, Hou) Center for Cardiac Intensive Care, Capital Medical
University Affiliated Anzhen Hospital, Beijing, People's Republic of China
Title
Short-term effects of preoperative beta-blocker use for isolated coronary
artery bypass grafting: A systematic review and meta-analysis.
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 use of preoperative beta-blockers has been used as a
quality standard for patients undergoing coronary artery bypass grafting
(CABG). However, the benefits of beta-blockers use before CABG remain
controversial. We performed a systematic review and meta-analysis to
investigate the short-term effects of preoperative beta-blocker use for
patients undergoing isolated CABG. Methods: We searched PubMed, Embase,
and the Cochrane Library for English articles published from inception to
August 16, 2016. Observational studies comparing preoperative
beta-blockers therapy or non-beta-blockers therapy were considered
eligible for the current study. Results: Six observational studies with
1,231,850 patients were included. The pooled analyses of unadjusted
outcome (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.71-0.95; P
= .007) or risk-adjusted outcome (OR, 0.95; 95% CI, 0.92-0.97; P = .000)
showed slight reduction in operative mortality, whereas an insignificant
difference in mortality rate was observed in pooling postoperative data
from propensity score analysis (OR, 0.97; 95% CI, 0.94-1.00; P = .088).
Removing one study that used propensity-score covariate adjustment,
subgroup analysis of propensity-matched patients (313,417 in each group)
still generated a statistically nonsignificant benefit for preoperative
beta-blocker use (OR, 0.97; 95% CI, 0.94-1.00; P = .093). Furthermore, the
preoperative use of beta-blockers did not reduce the incidence of major
postoperative complications, such as postoperative myocardial infarction,
stroke, atrial fibrillation, reoperation, renal failure, prolonged
ventilation, and sternal wound infection. Conclusions: Our study suggests
that the use of preoperative beta-blockers did not reduce either operative
mortality or the incidence of postoperative complications in patients
undergoing CABG.<br/>Copyright &#xa9; 2017 The American Association for
Thoracic Surgery.

<25>
Accession Number
618249601
Author
Apelseth T.O.; Kvalheim V.; Berg R.S.; Lund K.B.; Mikkelsen K.E.;
Kristoffersen E.K.
Institution
(Apelseth, Kvalheim, Berg, Lund, Mikkelsen, Kristoffersen) Haukeland
University Hospital, Bergen, Norway
Title
Basophil activation test (BAT) as a measure of passive sensitization
following plasma transfusion.
Source
Allergy: European Journal of Allergy and Clinical Immunology. Conference:
36th Annual Congress of the European Academy of Allergy and Clinical
Immunology, EAACI 2017. Finland. 72 (pp 345-346), 2017. Date of
Publication: August 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Introduction: Passive transfer of IgE may occur in patients receiving
blood components from allergic blood donors. In solvent detergent treated
(SD) pooled plasma, specific IgE against common airborne allergens,
peanuts, wheat, and latex have been detected. During complex surgery,
patients may receive high volumes of plasma and other blood components.
Basophil activation test (BAT) measures basophil response to allergens
crosslinking membrane bound IgE. Basophil sensitivity may be used to
monitor effects of immunotherapy and levels of circulating IgE as seen in
anti-IgE treatment. Objectives: A pilot study was performed to investigate
whether passive transferred IgE are able to crosslink allergens and
thereby activate host basophils in patients receiving plasma transfusion
during complex cardiothoracic surgery Results: Following surgery, 15
patients were transfused with a range of 400-14200 mL SD treated pooled
plasma. The day after surgery, BAT and basophil sensitivity (maximal
reactivity, CDsens and Area Under the Curve (AUC)) were measured after
stimulation with house dust mite and timothy in 6 concentrations (100
000-0.1 squ/mL). Basophils were identified by use of CD193, and CD63
served as activation marker. Results were reported as (mean; median;
range). Significant increase in specific IgE (ImmunoCap, Thermo Fisher)
against house dust mite (1.11; 0.67; 0.03-4.57 kU/L) and timothy (0.80;
0.60; 0.14-1.84) were observed when comparing levels before with maximum
levels within the first day after surgery. 4 out of 15 (27%) patients had
a positive BAT result against house dust mite and timothy the day after
transfusion. Significant positive correlations (Spearman test) were
observed between maximum levels of IgE within day 1 against house dust
mite (1.61; 0.70; 0.16-7.54 kU/L) and basophil maximal reactivity (14.1;
6.7; 2.1-81.1%) and AUC (106; 40; 10- 7309103). Similar, positive
correlations were observed between maximum IgE against timothy (0.82;
0.61; 0.15-1.88) and the basophil maximal reactivity (10.8; 6.9;
2.0%-41.1%) and AUC (75; 43; 13-3209103). CDsens could be calculated for 3
positive samples only and showed no correlation to IgE level, maximal
reactivity or AUC. Conclusions: We conclude that passive sensitization of
basophils may follow plasma transfusion in patients undergoing
cardiothoracic surgery. Results must be interpreted with caution due to
low number, and further studies are recommended to determine the clinical
implication of these observations.

<26>
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.

<27>
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)

<28>
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.

<29>
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.

<30>
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.

<31>
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.

<32>
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.

<33>
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.

<34>
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.

<35>
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.

<36>
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.

<37>
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

<38>
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.

<39>
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.

<40>
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.

<41>
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.

<42>
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.

<43>
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.

<44>
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.

<45>
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.

<46>
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.

<47>
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.

<48>
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.

<49>
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.

<50>
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)

<51>
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.

<52>
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.

<53>
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.

<54>
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).

<55>
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).

<56>
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).

<57>
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).

<58>
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).

<59>
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.

<60>
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.

<61>
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.

<62>
[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.

<63>
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

<64>
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

<65>
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

<66>
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.

<67>
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.

<68>
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.

<69>
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?.

<70>
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.

<71>
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

<72>
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.

<73>
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.

<74>
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

<75>
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.

<76>
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

<77>
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.

<78>
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.

<79>
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.

<80>
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.