EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
617619316
Author
van Wijk S.W.H.; van der Stelt F.; ter Heide H.; Schoof P.H.; Doevendans
P.A.F.M.; Meijboom F.J.; Breur J.M.P.J.
Institution
(van Wijk, van der Stelt, ter Heide, Meijboom, Breur) Pediatric
Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
(Schoof) Pediatric Cardiothoracic Surgery, University Medical Center
Utrecht, Utrecht, Netherlands
(Doevendans) Cardiology, University Medical Center Utrecht, Utrecht,
Netherlands
Title
Sudden Death Due to Coronary Artery Lesions Long-term After the Arterial
Switch Operation: A Systematic Review.
Source
Canadian Journal of Cardiology. 33 (9) (pp 1180-1187), 2017. Date of
Publication: September 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background The arterial switch operation (ASO) is the preferred procedure
for children with dextrotransposition of the great arteries or
Taussig-Bing anomaly. Short- as well as long-term outcome of ASO are
excellent, but coronary artery stenoses are reported as a common long-term
complication. It has been hypothesized that these might result in sudden
cardiac death late after ASO. Methods A systematic search of PubMed and
EMBASE was conducted to evaluate sudden cardiac death because of coronary
complications late after ASO. Data on patients surviving >= 5 years
post-ASO were collected from selected studies, corrected for duplicate
data, and analyzed. Results After duplicate data correction 52 studies
remained for data analysis. Among the 8798 survivors with follow-up, 27
patients died >= 5 years post-ASO (0.3%). Of these patients, 10 were known
with relevant residual lesions. Five late deaths were sudden, possibly
from a cardiac cause. None of the late sudden deaths were confirmed to be
coronary-related. Conclusions Sudden cardiac death in asymptomatic
patients as a result of coronary artery stenosis or occlusion is extremely
rare, with 5 possible cases and no proven cases of coronary artery-related
sudden cardiac death in 8798 patients with 66,450 patient follow-up years.
Therefore, routine coronary imaging of asymptomatic, single-stage ASO
patients is not justified.<br/>Copyright &#xa9; 2017 Canadian
Cardiovascular Society

<2>
Accession Number
618018105
Author
Tam D.Y.; Vo T.X.; Wijeysundera H.C.; Ko D.T.; Rocha R.V.; Friedrich J.;
Fremes S.E.
Institution
(Tam, Rocha, Fremes) Division of Cardiac Surgery, Department of Surgery,
Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of
Toronto, Toronto, Ontario, Canada
(Tam, Wijeysundera, Ko, Fremes) Institute of Health Policy, Management and
Evaluation, University of Toronto, Toronto, Ontario, Canada
(Vo) School of Medicine, Queen's University, Kingston, Ontario, Canada
(Wijeysundera, Ko) Division of Cardiology, Department of Medicine,
Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of
Toronto, Toronto, Ontario, Canada
(Friedrich) Division of Critical Care Medicine, Department of Medicine, St
Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
Title
Transcatheter vs Surgical Aortic Valve Replacement for Aortic Stenosis in
Low-Intermediate Risk Patients: A Meta-analysis.
Source
Canadian Journal of Cardiology. 33 (9) (pp 1171-1179), 2017. Date of
Publication: September 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background Transcatheter aortic valve replacement (TAVR) has emerged as
the treatment of choice for patients with severe aortic stenosis at high
surgical risk; the role of TAVR compared with surgical aortic valve
replacement (SAVR) in the low-intermediate surgical risk population
remains uncertain. Our primary objective was to determine differences in
30-day and late mortality in patients treated with TAVR compared with SAVR
at low-intermediate risk (Society of Thoracic Surgeons Predicted Risk of
Mortality < 10%). Methods Medline and Embase were searched from 2010 to
March 2017 for studies that compared TAVR with SAVR in the
low-intermediate surgical risk population, restricted to randomized
clinical trials and matched observational studies. Two investigators
independently abstracted the data and a random effects meta-analysis was
performed. Results Four randomized clinical trials (n = 4042) and 9
propensity score-matched observational studies (n = 4192) were included in
the meta-analysis (n = 8234). There was no difference in 30-day mortality
between TAVR and SAVR (3.2% vs 3.1%, pooled risk ratio: 1.02; 95%
confidence interval, 0.80-1.30; P = 0.89; I² = 0%) or mortality
at a median of 1.5-year follow-up (incident rate ratio: 1.01; 95%
confidence interval, 0.90-1.15; P = 0.83; I² = 0%). There was a
higher risk of pacemaker implantation and greater than trace aortic
insufficiency in the TAVR group whereas the risk of early stroke, atrial
fibrillation, acute kidney injury, cardiogenic shock, and major bleeding
was higher in the SAVR group. Conclusions Although there was no difference
in 30-day and late mortality, the rate of complications differed between
TAVR and SAVR in the low-intermediate surgical risk
population.<br/>Copyright &#xa9; 2017 Canadian Cardiovascular Society

<3>
Accession Number
618018066
Author
Chamandi C.; Puri R.; Rodriguez-Gabella T.; Rodes-Cabau J.
Institution
(Chamandi, Puri, Rodriguez-Gabella, Rodes-Cabau) Quebec Heart and Lung
Institute, Laval University, Quebec City, Quebec, Canada
Title
Latest-Generation Transcatheter Aortic Valve Replacement Devices and
Procedures.
Source
Canadian Journal of Cardiology. 33 (9) (pp 1082-1090), 2017. Date of
Publication: September 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Transcatheter aortic valve replacement (TAVR) is a well-established
treatment for patients with severe symptomatic aortic stenosis who are at
high or prohibitive surgical risk. More recently, TAVR has emerged as a
valid alternative to surgical aortic valve replacement for treating
intermediate-risk patients, and several studies are currently evaluating
the role of TAVR in low-risk patients. Transcatheter heart valve (THV)
technologies have evolved considerably over time, and important iterations
have been implemented in many of the latest-generation devices to (1)
reduce the size and improve delivery system properties; (2) improve valve
deployment, repositioning, and retrievability; and (3) reduce paravalvular
leaks. This article reviews the main characteristics of, and clinical
results associated with, the newer-generation THVs while providing an
overview of novel TAVR indications.<br/>Copyright &#xa9; 2017 Canadian
Cardiovascular Society

<4>
Accession Number
612718129
Author
Likhvantsev V.V.; Landoni G.; Levikov D.I.; Grebenchikov O.A.; Skripkin
Y.V.; Cherpakov R.A.
Institution
(Likhvantsev, Grebenchikov, Skripkin) Anesthesiology and Intensive Care
Department, Moscow Regional Research and Clinical Institute, Moscow,
Russian Federation
(Landoni) Anesthesiology and Intensive Care, IRCCS San Raffaele Scientific
Institute, Vita-Salute San Raffaele University, Milan, Italy
(Levikov) Cardiology Intensive Care Unit, V.A. Negovsky Research Institute
of Reanimatology, Moscow, Russian Federation
(Cherpakov) Anesthesiology and Intensive Care Department, V.A. Negovsky
Research Institute of Reanimatology, Moscow, Russian Federation
Title
Sevoflurane Versus Total Intravenous Anesthesia for Isolated Coronary
Artery Bypass Surgery With Cardiopulmonary Bypass: A Randomized Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (5) (pp 1221-1227),
2016. Date of Publication: 01 Oct 2016.
Publisher
W.B. Saunders
Abstract
Objective Several studies have suggested that the cardioprotective effects
of halogenated anesthetics in cardiac surgery result in reduced cardiac
biomarker release compared with total intravenous anesthesia (TIVA). These
findings came from relatively small randomized clinical trials and
meta-analyses. The authors of this study hypothesized that the beneficial
effects of volatile anesthetics translate into a reduced length of
hospital stay after coronary artery bypass grafting surgery (CABG) with
cardiopulmonary bypass. Design A randomized controlled trial. Setting Two
university hospitals. Participants Adult patients undergoing elective CABG
surgery with cardiopulmonary bypass. Interventions Patients were assigned
randomly to 2 following groups: propofol-based TIVA group (n = 431) and
sevoflurane group (n = 437). Measurements and Main Results The primary
endpoint was hospital length of stay, and the secondary endpoint included
postoperative troponin T and N-terminal pro-brain natriuretic peptide
release and mortality. In the sevoflurane group, a reduced length of
hospital stay was observed compared with the propofol-based TIVA group (10
[9-11] days v 14 [10-16], p<0.001) as were reductions in cardiac troponin
T release (0.18 ng/mL v 0.57 ng/mL at 24 hours, p<0.001), in N-terminal
pro-brain natriuretic peptide release (633 pg/mL v 878 pg/mL at 24 hours,
p<0.001; 482 pg/mL v 1,036 pg/mL at 48 hours, p<0.001), and in mortality
at 1-year follow up (17.8% v 24.8%, p = 0.03). Conclusions Anesthesia with
sevoflurane reduced cardiac biomarker release and length of hospital stay
after CABG with cardiopulmonary bypass surgery compared with
propofol-based TIVA with a possible reduction in 1-year
mortality.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<5>
Accession Number
613367508
Author
Guan Z.; Lv Y.; Liu J.; Liu L.; Yuan H.; Shen X.
Institution
(Guan, Liu, Yuan, Shen) Departments of Anesthesiology and, China
(Lv) Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong
University, Xi'an, Shaanxi, China
(Liu) Department of Neurology, Second Affiliated Hospital of Xi'an
Jiaotong University, Xi'an, Shaanxi, China
Title
Smoking Cessation Can Reduce the Incidence of Postoperative Hypoxemia
After On-Pump Coronary Artery Bypass Grafting Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (6) (pp 1545-1549),
2016. Date of Publication: 01 Dec 2016.
Publisher
W.B. Saunders
Abstract
Objectives To determine whether smoking cessation can reduce the incidence
of postoperative hypoxemia (POH) after on-pump coronary artery bypass
grafting (CABG) surgery. Design Prospective, single-center, observational
study. Setting Single-center university teaching hospital. Participants
The study comprised 300 patients undergoing on-pump CABG surgery who met
the inclusion criteria. Patients were divided into the following 3 groups
according to smoking status: sustained quitters (n = 132)-smoking
cessation for more than 1 month and less than 1 year; quitters (n =
95)-smoking cessation for more than 1 week and less than 1 month; and
smokers (n = 73)-smoking at least 1 cigarette per day for at least 1 year.
Interventions None. Measurements and Main Results The primary outcome was
the incidence of POH after on-pump CABG surgery. Secondary outcomes
included length of postoperative mechanical ventilation and intensive care
unit stay between the POH group and non-POH group. There were significant
decreases of POH incidence in the sustained quitters and quitters compared
with the smokers both after intensive care unit (ICU) admission and 24
hours after surgery (18.2%, 18.9%, v 32.9%; p = 0.036 and 9.8%, 10.5%, v
26%; p = 0.003, respectively), and there was no significant difference in
POH incidence between the sustained quitters and quitters. The length of
postoperative mechanical ventilation was longer in smokers than in
sustained quitters and quitters (15.9+/-6.1 h v 11.9+/-5.3 h and
13.0+/-5.8 h, respectively; p<0.05), but there were no significant
differences in the length of ICU stay among the 3 groups (54.2+/-7.5 h v
55.1+/-7.5 h and 53.7+/-6.6 h, respectively; p = 0.333). Conclusions
Smoking cessation can reduce POH after on-pump CABG surgery, and it also
can shorten the length of postoperative mechanical
ventilation.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<6>
Accession Number
613366191
Author
Wang L.; Li B.; Liu C.; Rong T.; Yu Y.; Gu C.
Institution
(Wang, Li, Liu, Rong, Yu, Gu) Department of Cardiac Surgery, Beijing An
Zhen Hospital of Capital Medical University, Beijing, China
Title
Short- and Medium-Term Effects of Combined Mitral Valve Surgery and
Coronary Artery Bypass Grafting Versus Coronary Artery Bypass Grafting
Alone for Patients with Moderate Ischemic Mitral Regurgitation: A
Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (6) (pp 1578-1586),
2016. Date of Publication: 01 Dec 2016.
Publisher
W.B. Saunders
Abstract
Objective To investigate the short- and medium-term effects of combined
mitral valve surgery (MVS) and coronary artery bypass grafting (CABG)
versus CABG alone for patients with moderate ischemic mitral regurgitation
(IMR). Design Meta-analysis of 4 randomized controlled trials (RCTs) and 5
observational studies. Setting Hospitals that perform cardiac surgery.
Participants The study included 1,256 cardiac surgery patients from 4 RCTs
and 5 observational studies. Interventions None. Measurements and Main
Results Four RCTs and 5 observational studies were included in this
meta-analysis. Concomitant MVS significantly reduced the residual rate of
postoperative IMR (moderate or severe) (RCTs: OR -0.32, 95% confidence
interval [CI] -0.58 to -0.07, p = 0.01; observational studies: OR -0.23,
95% CI -0.34 to -0.12, p<0.0001) and the proportion of surviving patients
with New York Heart Association class III or IV (RCTs: OR 0.45, 95% CI
0.31-1.8, p = 0.008), but did not improve early mortality (RCTs: OR 0.91,
95% CI 0.30-2.74, p = 0.87; observational studies: OR 1.63, 95% CI
0.88-3.05, p = 0.12) or medium-term mortality (RCTs: OR 0.89, 95% CI
0.46-1.74, p = 0.73; observational studies: OR 0.94, 95% CI 0.65-1.37, p =
0.48) compared with CABG alone. Moreover, adding the mitral valve
procedure did not significantly increase the risk of stroke (RCTs: OR
2.27, 95% CI 0.73-7.08, p = 0.16; observational studies: OR 0.55, 95% CI
0.10-3.06, p = 0.50). Conclusions The potential benefits of combined MVS
and CABG could outweigh its risks for patients with moderate
IMR.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<7>
Accession Number
612824889
Author
Jelacic S.; Bollag L.; Bowdle A.; Rivat C.; Cain K.C.; Richebe P.
Institution
(Jelacic, Bollag, Bowdle, Rivat, Richebe) Department of Anesthesiology and
Pain Medicine, United States
(Cain) Biostatistics, University of Washington School of Public Health,
Seattle, WA, United States
Title
Intravenous Acetaminophen as an Adjunct Analgesic in Cardiac Surgery
Reduces Opioid Consumption But Not Opioid-Related Adverse Effects: A
Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 30 (4) (pp 997-1004),
2016. Date of Publication: 01 Aug 2016.
Publisher
W.B. Saunders
Abstract
Objectives The authors hypothesized that intravenous acetaminophen as an
adjunct analgesic would significantly decrease 24-hour postoperative
opioid consumption. Design Double-blind, randomized, placebo-controlled
trial. Setting A single academic medical center. Participants The study
was comprised of 68 adult patients undergoing cardiac surgery.
Interventions Patients were assigned randomly to receive either 1,000 mg
of intravenous acetaminophen or placebo immediately after anesthesia
induction, at the end of surgery, and then every 6 hours for the first 24
hours in the intensive care unit, for a total of 6-1,000 mg doses.
Measurements and Main Results The primary outcome was 24-hour
postoperative opioid consumption. The secondary outcomes included 48-hour
postoperative opioid consumption, incisional pain scores, opioid-related
adverse effects, length of mechanical ventilation, length of intensive
care unit stay, and the extent of wound hyperalgesia assessed at 24 and 48
hours postoperatively. The mean+/-standard deviation postoperative 24-hour
opioid consumption expressed in morphine equivalents was significantly
less in the acetaminophen group (45.6+/-29.5 mg) than in the placebo group
(62.3+/-29.5 mg), representing a 27% reduction in opioid consumption (95%
CI, 2.3-31.1 mg; p = 0.024). There were no differences in pain scores and
opioid-related adverse effects between the 2 groups. A significantly
greater number of patients in the acetaminophen group responded "very
much" and "extremely well" when asked how their overall pain experience
met their expectation (p = 0.038). Conclusions The administration of
intravenous acetaminophen during cardiac surgery and for the first 24
hours postoperatively reduced opioid consumption and improved patient
satisfaction with their overall pain experience but did not reduce opioid
side effects.<br/>Copyright &#xa9; 2016 Elsevier Inc.

<8>
Accession Number
617455309
Author
Relbo Authen A.; Grov I.; Karason K.; Gustafsson F.; Eiskjaer H.; Radegran
G.; Gude E.; Jansson K.; Dellgren G.; Solbu D.; Arora S.; Andreassen A.K.;
Gullestad L.
Institution
(Relbo Authen, Grov, Gude, Arora, Andreassen, Gullestad) Department of
Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
(Karason) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Gustafsson) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Eiskjaer) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(Radegran) The Section for Heart Failure and Valvular Disease, VO. Heart
and Lung medicine, Skane University Hospital and Department of Clinical
Sciences Lund, Cardiology, Lund University, Lund, Sweden
(Jansson) Department of Cardiology and Clinical Physiology, Institute of
Medicine and Health Sciences, Linkoping University, Linkoping, Sweden
(Dellgren) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Solbu) Novartis Norge AS, Oslo, Norway
(Arora, Andreassen, Gullestad) Center for Heart Failure Research, Faculty
of Medicine, University of Oslo, Oslo, Norway
Title
Effect of everolimus vs calcineurin inhibitors on quality of life in heart
transplant recipients during a 3-year follow-up: Results of a randomized
controlled trial (SCHEDULE).
Source
Clinical Transplantation. 31 (9) (no pagination), 2017. Article Number:
e13038. Date of Publication: September 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
The Scandinavian heart transplant everolimus de novo study with early
calcineurin inhibitors avoidance (SCHEDULE) trial was a 12 month,
randomized, open-label, parallel-group trial that compared everolimus
(EVR; n=56) to conventional CsA (n=59) immunosuppression. Previously, we
reported that EVR outperformed CsA in improving renal function and
coronary artery vasculopathy, despite a higher rejection rate with EVR.
This study aimed to compare the effects of these treatments on quality of
life (QoL). Within five post-operative days, patients (mean age 50+/-13
years, 27% women) were randomized to EVR or a standard CsA dosage (CsA
group). This study assessed quality of life (QoL), based on the Short
Form-36, EuroQol-5D, and Beck Depression Inventory (BDI). Assessments were
performed pre-HTx and 12 and 36 months post-HTx. At 12 and 36 months, the
groups showed similar improvements in Short Form-36 measures (at pre-HTx,
12 and 36 months the values were as follows: Physical component summary:
EVR: 31.5+/-110.9, 49.1+/-9.7, and 47.9+/-10.6; P<.01; CsA: 32.5+/-8.2,
48.4+/-8.5, and 46.5+/-11.5; P<.01; mental component summary: EVR:
46.0+/-12.0, 51.7+/-11.9, and 52.1+/-13.0; P<.01; CsA: 38.2+/-12.5,
53.4+/-7.1, and 54.3+/-13.0; P<.01); similar decrease in mean BDI (EVR:
10.9+/-10.2, 5.4+/-4.7, and 8.1+/-9.0; P<.01; CsA: 11.8+/-7.1, 6.3+/-5.4,
and 6.2+/-6.5; P<.01); and similar Euro Qol-improvements. Thus, in this
small-sized study, EVR-based and conventional CsA immunosuppressive
strategies produced similar QoL improvements.<br/>Copyright &#xa9; 2017
John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

<9>
Accession Number
617562274
Author
Buttar S.N.; Yan T.D.; Taggart D.P.; Tian D.H.
Institution
(Buttar, Yan, Tian) The Collaborative Research (CORE) Group, Macquarie
University, Sydney, Australia
(Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital,
University of Sydney, Sydney, Australia
(Taggart) Nuffield Department of Surgical Sciences, University of Oxford,
John Radcliffe Hospital, Oxford, UK
(Tian) Royal North Shore Hospital, Sydney, Australia
Title
Long-term and short-term outcomes of using bilateral internal mammary
artery grafting versus left internal mammary artery grafting: A
meta-analysis.
Source
Heart. (no pagination), 2017. Date of Publication: June 23, 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background: A substantial body of evidence demonstrates that myocardial
revascularisation using bilateral internal mammary arteries (BIMA)
improves long-term survival compared with single/left internal mammary
artery (LIMA) grafting. To date, limited analyses have been made regarding
other short-term and long-term outcomes in BIMA strategy.Objectives: The
primary aim of the present review is to update the difference in long-term
survival between BIMA and LIMA grafting and to thoroughly investigate
other secondary short-term and long-term clinical outcomes between these
two grafting procedures.Methods: Electronic searches were performed using
three databases from their inception to November 2015. Relevant studies
comparing long-term survival between BIMA and LIMA grafting were
identified. Data were extracted by two independent reviewers and analysed
according to predefined clinical outcomes.Results: Twenty-nine
observational studies were identified, with a total of 89 399 patients.
Overall, BIMA cohort had significantly improved long-term survival
compared with LIMA cohort (HR 0.78; p<0.00001). BIMA cohort also had
significantly reduced hospital mortality rates (1.2% vs 2.1%, p=0.04),
cerebrovascular accidents (1.3% vs 2.9%, p=0.0003) and need for
revascularisation (4.8% vs 10%, p=0.005), although the incidence of deep
sternal wound infection (DSWI) was increased (1.8% vs 1.4%, p=0.0008) in
this grafting strategy. Long-term cardiac-free, myocardial infarction-free
and angina-free survivals were also superior for the BIMA
cohort.Conclusions: BIMA grafting is associated with enhanced overall
long-term outcomes compared with LIMA grafting. While the BIMA cohort
demonstrates an increased incidence of DSWI, the survival benefits and
other morbidity advantages outweigh this short-term risk.<br/>Copyright
&#xa9; Article author(s) (or their employer(s) unless otherwise stated in
the text of the article) 2017.

<10>
Accession Number
616353321
Author
Lee A.J.; Sheppard C.E.; Kent W.D.T.; Mewhort H.; Sikdar K.C.; Fedak
P.W.M.
Institution
(Lee) Department of Surgery, Division of Cardiac Surgery, University of
British Columbia, Vancouver, BC, Canada
(Sheppard, Kent, Mewhort, Sikdar, Fedak) Department of Cardiac Sciences,
Libin Cardiovascular Institute of Alberta, University of Calgary, Division
of Cardiac Surgery, C880, 1403-29 Street NW, Calgary, AB T2N 2T9, Canada
Title
Safety and efficacy of prophylactic negative pressure wound therapy
following open saphenous vein harvest in cardiac surgery: A feasibility
study.
Source
Interactive Cardiovascular and Thoracic Surgery. 24 (3) (pp 324-328),
2017. Date of Publication: 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Objectives: Surgical site complications following great saphenous vein
(GSV) harvest presents a significant risk of morbidity. Negative pressure
wound therapy (NPWT) has shown promise in the treatment and prophylaxis of
open wounds and surgical incisions but has not been studied following GSV
harvest. We performed a feasibility study examining the use of NPWT
following GSV harvest for coronary bypass surgery. Methods: Sixty-four
patients were recruited in this single-centre, single-blind, randomized
controlled trial. The primary endpoint assessed feasibility by examining
rates of device complication and malfunction. Secondary endpoints included
rates of surgical site infection, lower leg complications, discharge date,
and quality of life at discharge and 6 weeks. NPWT was delivered using the
Prevena NPWT device. Results: There were no complications associated with
NPWT which required intervention aside from discontinuation. NPWT was
tolerated in 91% (30/33) of patients for the duration of treatment with an
average of 4.8 days (+/-1.45 days). Device malfunction which required
discontinuation was 6% (2/33) and involved a malfunctioning pressure
sensor and did not affect patient care or present safety concerns. One
patient had allergic contact dermatitis to the adhesive and had the device
removed. NPWT patients had an earlier date of discharge (6 vs 10 days, P =
0.008), increased ability for self-care (P = 0.0234) and quality of life
(P = 0.039) at initial assessment, and increased mobility at initial and
follow-up assessment (P = 0.0117 and 0.0123). Conclusions: The use of NPWT
following GSV harvest is safe, well tolerated and improves postoperative
recovery with prolonged impact on mobility at 6 weeks.<br/>Copyright
&#xa9; The Author 2016.

<11>
Accession Number
618049129
Author
Jeong H.S.; Hong S.J.; Cho S.-A.; Kim J.-H.; Cho J.Y.; Lee S.H.; Joo H.J.;
Park J.H.; Yu C.W.; Lim D.-S.
Institution
(Jeong, Hong, Cho, Kim, Cho, Lee, Joo, Park, Yu, Lim) Department of
Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul,
South Korea
Title
Comparison of Ticagrelor Versus Prasugrel for Inflammation, Vascular
Function, and Circulating Endothelial Progenitor Cells in Diabetic
Patients With Non-ST-Segment Elevation Acute Coronary Syndrome Requiring
Coronary Stenting: A Prospective, Randomized, Crossover Trial.
Source
JACC: Cardiovascular Interventions. 10 (16) (pp 1646-1658), 2017. Date of
Publication: 28 Aug 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study compared adenosine-associated pleiotropic effects of
the 2 P2Y<inf>12</inf> receptor antagonists on vascular function, systemic
inflammation, and circulating endothelial progenitor cells (EPCs).
Background Both ticagrelor and prasugrel have potent antiplatelet effects.
However, only ticagrelor inhibits cellular uptake of adenosine. Methods
Using a randomized, crossover design with 10-week follow-up ticagrelor or
prasugrel was administered to type 2 diabetic patients with non-ST-segment
elevation acute coronary syndrome requiring stent implantation. A total of
62 patients underwent randomization in a 1:1 ratio to receive ticagrelor
or prasugrel for 5 weeks followed by a direct cross over to the
alternative treatment for 5 additional weeks. Brachial artery
flow-mediated dilation, inflammatory markers, and number of circulating
EPCs were compared. Results Improvement in brachial artery flow-mediated
dilation was greater in the ticagrelor group (0.15 +/- 0.19 mm vs. -0.03
+/- 0.18 mm; p < 0.001). Moreover, ticagrelor compared with prasugrel
decreased interleukin 6 (-0.58 +/- 0.43 pg/ml vs. -0.05 +/- 0.24 pg/ml; p
< 0.001), tumor necrosis factor alpha (-5.62 +/- 4.40 pg/ml vs. -0.42 +/-
2.64 pg/ml; p < 0.001), and increased adiponectin (2.31 +/- 2.00 mug/ml
vs. 0.08 +/- 1.50 mug/ml; p < 0.001) during 10-week follow-up. Other
inflammatory cytokines like high-sensitivity C-reactive protein and
soluble vascular cell adhesion molecule-1 were decreased in both groups.
Ticagrelor compared with prasugrel significantly increased absolute
numbers of circulating EPCs CD34+/KDR+ (42.5 +/- 37.8 per mul vs. -28.2
+/- 23.7 per mul; p < 0.001), CD34+/CD117+ (51.9 +/- 77.2 per mul vs.
-66.3 +/- 45.2 per mul; p < 0.001), and CD34+/CD133+ (55.2 +/- 69.2 per
mul vs. -28.0 +/- 34.1 per mul; p < 0.001). Conclusions Compared with
prasugrel, ticagrelor significantly decreased inflammatory cytokines such
as interleukin 6 and tumor necrosis factor alpha and increased circulating
EPCs, contributing to improved arterial endothelial function in diabetic
non-ST-segment elevation acute coronary syndrome patients. Thus, data
support that pleiotropic effects of ticagrelor beyond its potent
antiplatelet effects could contribute to additional clinical benefits.
(Comparison of Ticagrelor vs. Prasugrel on Inflammation, Arterial
Stiffness, Endothelial Function, and Circulating Endothelial Progenitor
Cells in Diabetic Patients With Non-ST Elevation Acute Coronary Syndrome
[NSTE-ACS] Requiring Coronary Stenting; NCT02487732)<br/>Copyright &#xa9;
2017 American College of Cardiology Foundation

<12>
Accession Number
614686872
Author
Qi W.; Zhang N.; Korantzopoulos P.; Letsas K.P.; Cheng M.; Di F.; Tse G.;
Liu T.; Li G.
Institution
(Qi, Zhang, Liu, Li) Tianjin Key Laboratory of Ionic-Molecular Function of
Cardiovascular Disease, Department of Cardiology, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
(Qi) School of Public Health, Chinese Academy of Medical Sciences, Peking
Union Medical College, Beijing, China
(Korantzopoulos) First Department of Cardiology, University of Ioannina
Medical School, Ioannina, Greece
(Letsas) Second Department of Cardiology, Laboratory of Cardiac
Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
(Cheng) State Key Laboratory of Cardiovascular Disease, Fuwai Hospital,
National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences, Peking Union Medical College, Beijing, China
(Di) Department of Endocrinology and Metabolism, Third Central Hospital of
Tianjin, Tianjin, China
(Tse) Department of Medicine and Therapeutics, Chinese University of Hong
Kong, Hong Kong, Hong Kong
(Tse) Li Ka Shing Institute of Health Sciences, Chinese University of Hong
Kong, Hong Kong, Hong Kong
Title
Serum glycated hemoglobin level as a predictor of atrial fibrillation: A
systematic review with meta-analysis and metaregression.
Source
PLoS ONE. 12 (3) (no pagination), 2017. Article Number: e0170955. Date of
Publication: March 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background and Aim Glycated hemoglobin (HbA1c) is a long-term measure of
glucose control. Although recent studies demonstrated a potential
association between HbA1c levels and the risk of atrial fibrillation (AF),
the results have been inconsistent. The aim of this meta-analysis is to
evaluate the utility of HbA1c level in predicting AF. Methods PubMed and
the Cochrane Library databases were searched for relevant studies up to
March 2016. Prospective cohort studies and retrospective case-control
studies were included. Relative risk (RR) or odds ratio (OR) with 95%
confidence intervals (CIs) of AF development were determined for different
HbA1c levels. The random effect model was conducted according to the test
of heterogeneity among studies. Subgroup analyses and meta-regression
models were carried out to identify potential sources of heterogeneity.
Results Eight prospective cohort studies with 102, 006 participants and 6
retrospective case-control studies with 57, 669 patients were finally
included in the meta-analysis. In the primary metaanalysis, HbA1c levels
were not associated with an increased risk of AF whether as a continuous
(RR, 1.06; 95% CI, 0.96-1.18) or categorical variable (RR, 0.99; 95% CI,
0.83- 1.18). Nevertheless, prospective studies showed about 10% increased
risk of AF with elevated HbA1c levels both as a continuous (RR, 1.11; 95%
CI, 1.06-1.16) and as a categorical variable (RR, 1.09; 95% CI,
1.00-1.18). In subgroup analyses, pooled results from studies with longer
follow-up durations, published after 2012, aged < 63 years, with exclusion
of cardiac surgery patients demonstrated an increased risk of AF for every
1% increase in HbA1c levels, while studies conducted in the United States
with longer follow-up (more than 96 months), larger sample size and higher
quality score (<=6) showed an increased risk of AF for higher HbA1c level
as a categorical variable. Conclusions Elevated serum HbA1c levels may be
associated with an increased risk of AF, but further data are needed.
Serum HbA1c levels might be considered as a potential biomarker for
prediction of AF.<br/>Copyright &#xa9; 2017 Qi 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.

<13>
Accession Number
617987495
Author
Hou B.-J.; Du Y.; Yu J.; Ping F.-M.; Jin M.; Gu S.-X.; Wan L.; Wang H.-B.
Institution
(Hou, Yu, Ping, Jin, Gu, Wan, Wang) Department of Anesthesiology, Hebei
University of Engineering Affiliated Hospital, Handan, Hebei Province
056002, China
(Du) Department of Rehabilitation Therapy, Hebei University of Engineering
School of Medicine, Handan, Hebei Province 056002, China
Title
Influence of different anesthesia methods on the cognitive ability and
myocardial damage in cardiac surgery.
Source
International Journal of Clinical and Experimental Medicine. 10 (8) (pp
12856-12861), 2017. Article Number: IJCEM0054599. Date of Publication:
2017.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Objective: Cardiac surgery is associated with some degree of cognitive
dysfunction and myocardial injury. The aim of this study was to
investigate the effect of two anesthesia methods on cognitive ability and
myocardial damage in cardiac surgery patients. Methods: 90 patients
undergoing cardiac surgery were collected in the study and were randomly
divided into sevoflurane (S) and propofol (P) group. MMSE was performed to
measure the cognitive function of patients. Heart rate (HR), mean arterial
pressure (MAP), cardiac index (CI), and cardiac function index (CFI) were
monitored and cardiac troponin I (cTnI), myoglobin, and creatinine kinase
MB isoenzyme (CKMB) were determined using sandwich enzyme immunoassay
method. Results: Compared to T0 time, the MMSE score was significantly
decreased at T2 and T3 in both S and P groups, but no significant
difference was found between the two groups. Moreover, there were no
differences for any of the haemodynamic variables between the two groups,
except CI at T4 time. And the concentration of cTnI, myoglobin, and CKMB
increased significantly postoperatively with a peak at T2 time point in S
and P groups. The level of cTnI and CKMB was lower in S group than in P
group at T2. Conclusions: No significant difference was found on the
influence of two anesthesia method on post-operative cognitive function.
The implementation of seveflurane anesthesia in cardiac surgery may
exhibit a more favorable cardioprotective function and promote patients
recovery.<br/>Copyright &#xa9; 2017, E-Century Publishing Corporation. All
rights reserved.

<14>
Accession Number
617987354
Author
Tao S.; Qiu T.
Institution
(Tao) Department of Anatomy, Institute of Basic Medical Science, Zhejiang
Chinese Medical University, Hangzhou, Zhejiang, China
(Qiu) Department of Neurology, Zhejiang Provincial Hospital of Traditional
Chinese Medicine, Hangzhou, Zhejiang, China
Title
A comparative meta-analysis on curative effects of thymectomy and
sternotomy in treating the myasthenia gravis.
Source
International Journal of Clinical and Experimental Medicine. 10 (8) (pp
11703-11709), 2017. Date of Publication: 2017.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
Objective: To assess the therapeutic efficacy of thymectomy as a treatment
for myasthenia gravis (MG) by meta-analyses. Methods: Through the
retrieval of related literature in Chinese National Knowledge
Infrastructure database (CNKI), Wan Fang database, CiNii, NCBI, EBSCO, Web
of Science and so on, the data, which concerned with thymectomy for
myasthenia gravis and published from 2010 to 2016, were obtained. The
meta-analysis of operating time, drainage time, hemorrhage volume and
therapeutic efficacy were carried out by RevMan5.2 statistical software.
Results: Seventeen foreign literature, were included in this study, with
642 cases of the video-assisted thoracic surgery (VATS) group and 603
cases of the sternotomy group. The analysis revealed that the hemorrhage
volume of VATS thymectomy group was markedly less than conventional group
(RR=6.25, P=0.01), while the drainage time was longer than that of
conventional group (RR=1.26, P=0.12). No significant difference of MG
improvement rate was found between both groups (RR=1.00, P=0.16).
Conclusion: VATS thymectomy is a safe and reliable treatment for
myasthenia gravis and it shares the same prostecdtive efficacy with
conventional thymectomy. Combined with thoracoscopic surgery, the
hemorrhage volume can be decreased and the hospital stay can be shortened
in thymectomy.<br/>Copyright &#xa9; 2017, E-Century Publishing
Corporation. All rights reserved.

<15>
Accession Number
616557551
Author
Ad N.; Holmes S.D.; Rongione A.J.; Massimiano P.S.; Fornaresio L.M.
Institution
(Ad, Holmes, Fornaresio) Department of Cardiovascular and Thoracic
Surgery, West Virginia University, Morgantown, West Virginia, United
States
(Rongione, Massimiano) Section of Cardiac Surgery, Washington Adventist
Hospital, Takoma Park, Maryland, United States
Title
Does Surgical Ablation Energy Source Affect Long-Term Success of the
Concomitant Cox Maze Procedure?.
Source
Annals of Thoracic Surgery. 104 (1) (pp 29-35), 2017. Date of Publication:
July 2017.
Publisher
Elsevier USA
Abstract
Background The Cox maze (CM) procedure is routinely performed using
surgical ablation technology. Reports are scarce on long-term outcomes of
CM, especially for a large series of patients. This study examined the
potential impact of surgical ablation energy source on safety and
long-term efficacy of concomitant CM procedures. Methods The study sample
consisted of 709 concomitant CM-treated patients operated on with
cryothermal energy only (group 1; n = 386) or combination of cryothermal
and bipolar radiofrequency (group 2; n = 323). Data were collected
prospectively on perioperative outcomes, rhythm status, survival, and
clinical events. Propensity score matching conducted by energy source
resulted in 298 patients per group. Results Perioperative outcomes
included stroke (n = 4), reoperation for bleeding (n = 23), renal failure
requiring temporary dialysis (n = 18), readmissions before 30 days (n =
86), and operative death before 30 days (n = 16; ratio of observed to
expected mortality [O/E ratio], 0.50). Independent predictors for 1-year
and 5-year rhythm success were a shorter history of atrial fibrillation
(1-year odds ratio [OR], 0.93, p = 0.001; 5-year OR, 0.93, p = 0.042) and
cryothermia alone (1-year OR=1.77, p = 0.020; 5-year OR = 2.29, p =
0.009). After matching, group 1 had significantly higher sinus rhythm
without antiarrhythmic drugs at 6 months (79% vs 70%; p = 0.016), 36
months (81% vs 69%; p = 0.010), and 60 months (75% vs 57%; p = 0.008).
Stroke incidence was lower for group 1 (0.7% vs 3%; p = 0.033), with no
difference in major bleeding (10% vs 11%; p = 0.597). Groups had similar
survival rates (log rank, 0.6; p = 0.452). Conclusions Concomitant CM
procedures performed with cryothermal energy alone or combined with
bipolar radiofrequency ablation are safe and exceedingly effective. The
association of cryothermal energy alone with higher rates of sinus rhythm
and stroke reduction should be investigated further.<br/>Copyright &#xa9;
2017 The Society of Thoracic Surgeons

<16>
Accession Number
618000529
Author
Hummel J.; Rucker G.; Stiller B.
Institution
(Hummel, Stiller) Heart Center, University of Freiburg, Department of
Congenital Heart Defects and Pediatric Cardiology, Mathildenstr. 1,
Freiburg 79106, Germany
(Rucker) Faculty of Medicine and Medical Center - University of Freiburg,
Institute for Medical Biometry and Statistics, Stefan-Meier-Str. 26,
Freiburg 79104, Germany
Title
Prophylactic levosimendan for the prevention of low cardiac output
syndrome and mortality in paediatric patients undergoing surgery for
congenital heart disease.
Source
Cochrane Database of Systematic Reviews. 2017 (8) (no pagination), 2017.
Article Number: CD011312. Date of Publication: 02 Aug 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Low cardiac output syndrome remains a serious complication,
and accounts for substantial morbidity and mortality in the postoperative
course of paediatric patients undergoing surgery for congenital heart
disease. Standard prophylactic and therapeutic strategies for low cardiac
output syndrome are based mainly on catecholamines, which are effective
drugs, but have considerable side effects. Levosimendan, a calcium
sensitiser, enhances the myocardial function by generating more
energy-efficient myocardial contractility than achieved via adrenergic
stimulation with catecholamines. Thus potentially, levosimendan is a
beneficial alternative to standard medication for the prevention of low
cardiac output syndrome in paediatric patients after open heart surgery.
Objectives: To review the efficacy and safety of the postoperative
prophylactic use of levosimendan for the prevention of low cardiac output
syndrome and mortality in paediatric patients undergoing surgery for
congenital heart disease. Search methods: We identified trials via
systematic searches of CENTRAL, MEDLINE, Embase, and Web of Science, as
well as clinical trial registries, in June 2016. Reference lists from
primary studies and review articles were checked for additional
references. Selection criteria: We only included randomised controlled
trials (RCT) in our analysis that compared prophylactic levosimendan with
standard medication or placebo, in infants and children up to 18 years of
age, who were undergoing surgery for congenital heart disease. Data
collection and analysis: Two review authors independently extracted data
and assessed risk of bias according to a pre-defined protocol. We obtained
additional information from all but one of the study authors of the
included studies. We used the five GRADE considerations (study
limitations, consistency of effect, imprecision, indirectness, and
publication bias) to assess the quality of evidence from the studies that
contributed data to the meta-analyses for the prespecified outcomes. We
created a 'Summary of findings' table to summarise the results and the
quality of evidence for each outcome. Main results: We included five
randomised controlled trials with a total of 212 participants in the
analyses. All included participants were under five years of age. Using
GRADE, we assessed there was low-quality evidence for all analysed
outcomes. We assessed high risk of performance and detection bias for two
studies due to their unblinded setting. Levosimendan showed no clear
effect on risk of mortality (risk ratio (RR) 0.47, 95% confidence interval
(CI) 0.12 to 1.82; participants = 123; studies = 3) and no clear effect on
low cardiac output syndrome (RR 0.64, 95% CI 0.39 to 1.04; participants =
83; studies = 2) compared to standard treatments. Data on time-to-death
were not available from any of the included studies. There was no
conclusive evidence on the effect of levosimendan on the secondary
outcomes. The length of intensive care unit stays (mean difference (MD)
0.33 days, 95% CI -1.16 to 1.82; participants = 188; studies = 4), length
of hospital stays (MD 0.26 days, 95% CI -3.50 to 4.03; participants = 75;
studies = 2), duration of mechanical ventilation (MD -0.04 days, 95% CI
-0.08 to 0.00; participants = 208; studies = 5), and the risk of
mechanical circulatory support or cardiac transplantation (RR 1.49, 95% CI
0.19 to 11.37; participants = 60; studies = 2) did not clearly differ
between the groups. Published data about adverse effects of levosimendan
were limited. A meta-analysis of hypotension, one of the most feared side
effects of levosimendan, was not feasible because of the heterogeneous
expression of blood pressure values. Authors' conclusions: The current
level of evidence is insufficient to judge whether prophylactic
levosimendan prevents low cardiac output syndrome and mortality in
paediatric patients undergoing surgery for congenital heart disease. So
far, no significant differences have been detected between levosimendan
and standard inotrope treatments in this setting. The authors evaluated
the quality of evidence as low, using the GRADE approach. Reasons for
downgrading were serious risk of bias (performance and detection bias due
to unblinded setting of two RCTs), serious risk of inconsistency, and
serious to very serious risk of imprecision (small number of included
patients, low event rates).<br/>Copyright &#xa9; 2017 The Cochrane
Collaboration. Published by John Wiley & Sons, Ltd.

<17>
Accession Number
617558114
Author
Barbanti M.; Buccheri S.; Rodes-Cabau J.; Gulino S.; Genereux P.; Pilato
G.; Dvir D.; Picci A.; Costa G.; Tamburino C.; Leon M.B.; Webb J.G.
Institution
(Barbanti, Buccheri, Gulino, Pilato, Picci, Costa, Tamburino) Division of
Cardiology, Ferrarotto Hospital, University of Catania, Italy
(Rodes-Cabau) Division of Cardiology, Quebec Heart & Lung Institute,
Quebec City, Quebec, Canada
(Genereux) Division of Cardiology, Hopital du Sacre-Coeur de Montreal,
Universite de Montreal, Montreal, Quebec, Canada
(Dvir, Webb) Division of Cardiology, St. Paul's Hospital, University of
British Columbia, Vancouver, British Columbia, Canada
(Leon) Division of Cardiology, Columbia University Medical Center/New
York-Presbyterian Hospital, New York, United States
Title
Transcatheter aortic valve replacement with new-generation devices: A
systematic review and meta-analysis.
Source
International Journal of Cardiology. 245 (pp 83-89), 2017. Date of
Publication: 15 Oct 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Objective The aim of this study was to conduct a weighted meta-analysis to
determine the rates of acute (<= 30 days) major outcomes after (TAVR) with
second-generation devices. Methods A comprehensive search of multiple
electronic databases from January 2011 to May 2017 was conducted using
predefined criteria. New-generation TAVR devices were defined as any
device which received CE mark approval or is still under evaluation for CE
marking after CoreValve and SAPIEN XT prostheses. Results A total of 37
studies including 10,822 patients met inclusion criteria and were included
in the analysis. Devices investigated in the studies were the following:
SAPIEN 3 (n = 5423, 45.9%), Lotus Valve (n = 3007, %), Portico (n = 130,
1.1%), JenaValve (n = 345, 2.9%), Symetis Acurate (n = 1314, 11,1%), and
Evolut R (n = 1603, 13.6%). Thirty-day all-cause and cardiovascular 30-day
death were 2.2% (95% CI: 1.6% to 2.8%) and 1.6% (95% CI: 0.9% to 2.3%),
respectively; Any stroke and major/disabling stroke occurred at a pooled
estimate rate of 2.6% (95% CI: 2.0% to 3.3%) and 0.9% (95% CI: 0.2% to
1.6%), respectively; life-threatening bleeding, 3.9% (95% CI: 2.9% to
5.0%); major vascular complications, 4.5% (95% CI: 3.7% to 5.4%);
pacemaker implantation, 16.2% (95% CI: 12.7% to 19.6%); more than mild
aortic regurgitation, 1.6% (95% CI: 0.9 to 2.3). Conclusions
Second-generation TAVR devices are associated with very low mortality and
major complications rates at 30-day, and improved prosthesis performance
with < 2% of patients having more than mild post-procedural aortic
regurgitation. On the other hand, the need for pacemaker implantation
seems to remain an unresolved issue, and warrants further
investigation.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<18>
Accession Number
618112200
Author
Olmos C.; Vilacosta I.; Habib G.; Maroto L.; Fernandez C.; Lopez J.;
Sarria C.; Salaun E.; Di Stefano S.; Carnero M.; Hubert S.; Ferrera C.;
Tirado G.; Freitas-Ferraz A.; Saez C.; Cobiella J.; Bustamante-Munguira
J.; Sanchez-Enrique C.; Garcia-Granja P.E.; Lavoute C.; Obadia B.; Vivas
D.; Gutierrez A.; San Roman J.A.
Institution
(Olmos, Vilacosta, Maroto, Fernandez, Carnero, Ferrera, Tirado,
Freitas-Ferraz, Cobiella, Sanchez-Enrique, Vivas) Instituto
Cardiovascular. Hospital Universitario Clinico San Carlos, Madrid, Spain
(Habib, Salaun) Aix-Marseille Universite, Marseille, France
(Habib, Salaun, Hubert, Lavoute, Obadia) Department of Cardiology, APHM,
La Timone Hospital, Marseille, France
(Lopez, Di Stefano, Garcia-Granja, San Roman) Department of Cardiology,
Instituto de Ciencias del Corazon (ICICOR), CIBERCV, Hospital Clinico
Universitario de Valladolid, Valladolid, Spain
(Sarria, Saez, Bustamante-Munguira, Gutierrez) Servicio de Medicina
Interna-Infecciosas, Instituto de Investigacion Sanitaria, Hospital
Universitario de la Princesa, Madrid, Spain
Title
Risk score for cardiac surgery in active left-sided infective
endocarditis.
Source
Heart (British Cardiac Society). 103 (18) (pp 1435-1442), 2017. Date of
Publication: 01 Sep 2017.
Abstract
OBJECTIVE: To develop and validate a calculator to predict the risk of
in-hospital mortality in patients with active infective endocarditis (IE)
undergoing cardiac surgery.
METHODS: Thousand two hundred and ninety-nine consecutive patients with IE
were prospectively recruited (1996-2014) and retrospectively analysed.
Left-sided patients who underwent cardiac surgery (n=671) form our study
population and were randomised into development (n=424) and validation
(n=247) samples. Variables statistically significant to predict
in-mortality were integrated in a multivariable prediction model, the
Risk-Endocarditis Score (RISK-E). The predictive performance of the score
and four existing surgical scores (European System for Cardiac Operative
Risk Evaluation (EuroSCORE) I and II), Prosthesis, Age>=70, Large
Intracardiac Destruction, Staphylococcus, Urgent Surgery, Sex (Female)
(PALSUSE), EuroSCORE >=10) and Society of Thoracic Surgeons's Infective
endocarditis score (STS-IE)) were assessed and compared in our cohort.
Finally, an external validation of the RISK-E in a separate population was
done.
RESULTS: Variables included in the final model were age, prosthetic
infection, periannular complications, Staphylococcus aureus or fungi
infection, acute renal failure, septic shock, cardiogenic shock and
thrombocytopaenia. Area under the receiver operating characteristic curve
in the validation sample was 0.82 (95% CI 0.75 to 0.88). The accuracy of
the other surgical scores when compared with the RISK-E was inferior
(p=0.010). Our score also obtained a good predictive performance, area
under the curve 0.76 (95% CI 0.64 to 0.88), in the external validation.
CONCLUSIONS: IE-specific factors (microorganisms, periannular
complications and sepsis) beside classical variables in heart surgery
(age, haemodynamic condition and renal failure) independently predicted
perioperative mortality in IE. The RISK-E had better ability to predict
surgical mortality in patients with IE when compared with other surgical
scores.<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.

<19>
Accession Number
618103271
Author
Zhan Y.; Chen G.; Huang J.; Hou B.; Liu W.; Chen S.
Institution
(Zhan, Huang, Hou, Liu, Chen) Department of Anesthesia, The First
Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006
(Chen) Department of Reproductive Health, Jiangxi Province Maternal and
Child Health Care Hospital, Nanchang, Jiangxi 330046, China
Title
Effect of intercostal nerve block combined with general anesthesia on the
stress response in patients undergoing minimally invasive mitral valve
surgery.
Source
Experimental and Therapeutic Medicine. 14 (4) (pp 3259-3264), 2017. Date
of Publication: October 2017.
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece.
E-mail: subscriptions@spandidos-publications.com)
Abstract
The aim of the present study was to investigate the effect of intercostal
nerve block combined with general anesthesia on the stress response and
postoperative recovery in patients undergoing minimally invasive mitral
valve surgery (MIMVS). A total of 30 patients scheduled for MIMVS were
randomly divided into two groups (n=15 each): Group A, which received
intercostal nerve block combined with general anes-thesia and group B,
which received general anesthesia alone. Intercostal nerve block in group
A was performed with 0.5% ropivacaine from T3 to T7 prior to anesthesia
induction. In each group, general anesthesia was induced using midazolam,
sufentanil, propofol and vecuronium. Central venous blood samples were
collected to determine the concentrations of cortisol, glucose,
interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) at the
following time points: During central venous catheterization
(T<inf>1</inf>), 5 min prior to cardiopulmonary bypass (T<inf>2</inf>),
perioperative (T<inf>3</inf>) and 24 h following surgery (T<inf>4</inf>).
Clinical data, including parameters of opioid (sufent-anil) consumption,
time of mechanical ventilation, duration of intensive care unit (ICU)
stay, visual analog scale scores and any complications arising from
intercostal nerve block, were recorded. Levels of cortisol, glucose, IL-6
and TNF-alpha in group A were significantly lower than those in group B at
T<inf>2</inf>(all P<0.001; cortisol, P<0.05), T<inf>3</inf>(all P<0.001)
and T4(all P<0.001; glucose, P<0.05), suggesting that intercostal nerve
block combined with general anesthesia may inhibit the stress response to
MIMVS. Additionally, intercostal nerve block combined with general
anesthesia may significantly reduce sufentanil consumption (P<0.001),
promote early tracheal extubation (P<0.001), shorten the duration of ICU
stay (P<0.01) and attenuate postoperative pain (P<0.001), compared with
general anesthesia alone. Thus, these results suggest that inter-costal
nerve block combined with general anesthesia conforms to the concept of
rapid rehabilitation surgery and may besuitable for clinical
practice.<br/>Copyright &#xa9; 2017, Spandidos Publications. All rights
reserved.

<20>
Accession Number
618107572
Author
Mahajan V.; Samra T.; Puri G.D.
Institution
(Mahajan, Samra, Puri) Department of Anesthesia, Post Graduate Institute
of Medical Education and Research, Sector 12, Chandigarh 160012, India
Title
Anaesthetic depth control using closed loop anaesthesia delivery system
vs. target controlled infusion in patients with moderate to severe left
ventricular systolic dysfunction.
Source
Journal of Clinical Anesthesia. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives: To compare the efficacy of anaesthetic depth control using
Closed Loop Anaesthesia Delivery System (CLADS) and Target Controlled
Infusion (TCI) in patients with moderate to severe left ventricular
dysfunction (LVSD). Design: Randomized control trial. Patients: Forty ASA
III/IV adult patients with moderate to severe LVSD scheduled for open
heart surgery. Interventions: Propofol was administered using CLADS or TCI
for maintaining BIS of 50. Induction and maintenance doses were controlled
automatically in CLADS. Dixon's up and down method was used to estimate
the plasma concentration needed for induction in TCI. Measurement:
Percentage of total anaesthesia time ("valid CLADS time") for which BIS
remained within +/-. 10 of target (BIS = 50). Main results: BIS remained
within +/-10 of the target for a significantly longer duration of time in
CLADS group (p =0.001). Performance parameters like Median Performance
Error (MDPE), p =0.024; Median Absolute Performance Error (MDAPE), p
=0.0212; and global score p =0.017 were significantly better in CLADS
group. Total propofol consumption was significantly less in CLADS group (p
=0.014). Mean value (95% CI) of EC<inf>50</inf> and EC<inf>95</inf> for
target plasma propofol concentration for induction was 1.62 (1.45-1.79)
mugml^-1 and 1.87 (1.73-2.96) mugml^-1 respectively
using probit analysis. Conclusions: Closed loop delivery of propofol using
CLADS performed significantly better than TCI in this subset of patients.
Clinical trials registration no.:
www.ClinicalTrials.gov-NCT02645994<br/>Copyright &#xa9; 2017 Elsevier Inc.

<21>
Accession Number
618106868
Author
Ando T.; Takagi H.; Briasoulis A.; Telila T.; Slovut D.P.; Afonso L.;
Grines C.L.; Schreiber T.
Institution
(Ando, Telila, Grines, Schreiber) Division of CardiologyWayne State
University/Detroit Medical CenterDetroit, Michigan
(Takagi) Division of Cardiovascular SurgeryShizuoka Medical CenterShizuoka
Japan
(Briasoulis) Division of Heart FailureMayo ClinicRochester, Minnesota
(Slovut) Division of Cardiothoracic Surgery and CardiologyMontefiore
Medical CenterBronx, New York
(Afonso) Division of CardiologyWayne State UniversityDetroit, Michigan
Title
A systematic review of reported cases of combined transcatheter aortic and
mitral valve interventions.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2017.
Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To summarize the published data of combined transcatheter
aortic and mitral valve intervention (CTAMVI). Background: CTAMVI, a
combination of either transcatheter aortic valve replacement (TAVR) or
transcatheter aortic valve-in-valve (TAViV) and transcatheter mitral valve
replacement (TMVR), transcatheter mitral valve-in-valve/valve-in-ring
(TMViV/ViR), or percutaneous mitral valve repair (PMVR) is an attractive
alternative in high-surgical risk patients with combined aortic and mitral
valve disease. However, its procedural details and clinical outcomes have
not been well described. Methods: We performed a systematic review of all
the published articles from PUBMED and EMBASE. Results: A total of 37
studies with 60 patients were included. The indication for CTAMVI was high
or inoperable surgical risk and symptomatic severe aortic stenosis (92%)
or severe aortic regurgitation (8%) combined with moderate to
severe/severe mitral stenosis (30%) or moderate/severe mitral
regurgitation (65%) or both (5%). In majority of the cases, aortic valve
intervention was performed prior to the mitral valve. Mortality rate were
25% for TAVR+TMVR (range 42 days to 10 months), 17% for TAVR+TMViV/ViR
(range 13 days to 6 months), 0% for TAViV+TMViV/ViR (range 6-365 days),
and 15% for TAVR/ViV+PMVR (range 17 days to 419 days). Significant (more
than moderate) paravalvular regurgitation post-procedure was rare.
Conclusions: CTAMVI appears to confer reasonable clinical outcome. Further
large study is warranted to clarify the optimal strategy, procedural
details and clinical outcomes in the future.<br/>Copyright &#xa9; 2017
Wiley Periodicals, Inc.

<22>
Accession Number
617562276
Author
Wassef A.W.A.; Alnasser S.; Rodes-Cabau J.; Webb J.G.; Barbanti M.; Liu
Y.; Munoz-Garcia A.J.; Tamburino C.; Dager A.E.; Serra V.; Amat-Santos
I.J.; Al Lawati H.; Urena M.; Alonso Briales J.H.; Benitez L.M.; del
Blanco B.G.; Roman A.S.; Bagai A.; Buller C.E.; Peterson M.D.; Cheema A.N.
Institution
(Wassef, Alnasser, Liu, Al Lawati, Bagai, Buller, Peterson, Cheema) St.
Michael's Hospital, Toronto, Ontario, Canada
(Rodes-Cabau, Urena) Quebec Heart & Lung Institute, Laval University,
Quebec City, Quebec, Canada
(Webb) St-Paul's hospital, University of British Columbia, Vancouver,
British Columbia, Canada
(Barbanti, Tamburino) Ferrarotto Hospital, University of Catania, Italy
(Munoz-Garcia, Alonso Briales) Hospital Universitario Virgen de la
Victoria, Universidad de Malaga, Spain
(Dager, Benitez) Clinica de Occidente de Cali, Colombia
(Serra, del Blanco) Hospital Universitari Vall d'Hebron, Universitat
Autonoma de Barcelona, Barcelona, Spain
(Amat-Santos, Roman) Hospital Clinico Universitario de Valladolid,
Valladolid, Spain
Title
Institutional experience and outcomes of transcatheter aortic valve
replacement: Results from an international multicentre registry.
Source
International Journal of Cardiology. 245 (pp 222-227), 2017. Date of
Publication: 15 Oct 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Despite rapidly increasing use of TAVR across institutions,
limited data is available for the effect of procedural experience on TAVR
outcomes. We investigate the relationship between institutional experience
and TAVR outcomes. Methods 1953 patients undergoing TAVR at 8
international sites were grouped into chronological quantiles (Q) to
assess temporal changes on procedural and clinical outcomes and
multivariate logistic regression performed to determine predictors of
device success, early safety and all-cause mortality. Results The mean age
of patients was 81 +/- 7 years and 991 (51%) were female. The quantiles
comprised of first 62 cases for Q1, 63-133 for Q2, 134 to 242 for Q3 and
243 to 476 for Q4. Device success increased from Q1 to Q4 (78% vs 89%, p <
0.001) with significant improvement in the early safety endpoint (19% vs
10%, p < 0.001). All cause mortality reduced by half in Q4 compared to Q1
(8% vs 4%, p = 0.01) and rates of major vascular complications, major
bleeding and valve embolization decreased with increasing experience. The
multivariate analysis identified TAVR in Q3 and Q4 to be independently
associated with higher device success and lower risk of complications.
TAVR in Q4 was independently associated with lower mortality (OR 0.36 95%
CI 0.19-0.70, p = 0.002). Conclusions Greater institutional experience
with TAVR procedures improves device success and clinical outcomes. An
experience of > 242 cases is independently associated with lower
mortality. These findings have important implications for defining minimum
volume criteria for institutions and training standards for TAVR
procedure.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<23>
Accession Number
618086127
Author
Cleveland T.J.
Institution
(Cleveland) Sheffield Vascular Institute, Northern General Hospital,
Sheffield, United Kingdom
Title
Current evidence.
Source
CardioVascular and Interventional Radiology. Conference: Cardiovascular
and Interventional Radiological Society of Europe, CIRSE 2017. Denmark. 40
(2 Supplement 1) (pp S104-S106), 2017. Date of Publication: August 2017.
Publisher
Springer New York LLC
Abstract
Learning Objectives 1. To learn about the most recent publications in
regard to current evidence on CEA versus CAS 2. To learn how the recently
published long-term results of previous carotid stenting trials induce
resurgence of carotid stenting 3. To learn if there exists a clinical
equipoise in regard to CEA versus CAS or not Carotid artery stenting (CAS)
is no longer a new concept. Way back in the 1990's angioplasty was applied
to the carotid bifurcation, and the CAVATAS Trial was born and completed1.
This showed that angioplasty (and the majority was simple angioplasty with
no stents) could successfully be performed, with acceptable immediate
complications. Indeed within the confines of that randomised trial there
was no difference in the immediate significant neurological outcomes
between angioplasty and endarterectomy (CEA). However, the CAVATAS trial
came in for considerable criticism, in that the overall event rates for
both CEA and angioplasty was higher than would have been hoped. On
reflection, perhaps it was inevitable because the patients recruited to
this trial were both symptomatic (therefore at high risk of recurrent and
procedure related stroke) and at high risk of CEA (otherwise there was no
equipoise and uncertainty to allow randomisation). As a result of this,
and other trials (for example the Leicester Trial - which was stopped due
to the high event rate during stenting2), further investigation into the
procedure was undertaken. In addition, the environment was a challenging
one, as CEA was (and is) a procedure that has been very carefully
investigated and one that is beloved of the vascular surgical community.
Over the following years CAS has developed, continuously under scrutiny
and criticism from traditional vascular surgery3, into a much more mature
procedure, which continues to develop. It has been noticeable that the
level of industry enthusiasm for CAS waned for a while, as a direct result
of the relentless skepticism of the establishment. However, the march of
medicine away from large open operations towards the minimally invasive
and medical therapy/prevention is compelling. There remains considerable
variation in the rates of CAS throughout the world, with the proportion of
symptomatic patients being treated by CAS ranging from 0% (Denmark) to 19%
(USA)4. CAS has survived and is undergoing resurgence. One may ask why
this is so? It probably comes from a combination of drivers, firstly that
trials assessing modern CAS techniques have been completed, and long term
follow up data are now available. Secondly, acute stroke thrombectomy has
been shown to be effective (see later), and carotid bifurcation disease
(and its treatment) is integral to these therapies. CAS v CEA - Current
evidence In 2012 a Cochrane Library review of percutaneous transluminal
balloon angioplasty and stenting for carotid artery stenosis was
published5, and included data from trials published as early as 1998. Also
included in the analysis were results from the ICSS, SPACE and EVA3S (all
randomised trials of patients who were recently symptomatic). In all there
were 16 trials included which involved 7572 patients. In patients who had
symptomatic carotid artery disease and were considered at "standard"
surgical risk, endovascular treatment was associated with a higher risk of
having, within the first 30 days, death or any stroke, death or any stroke
or myocardial infarction, and any stroke. It was noted that the odds ratio
for the same outcomes were not different between CAS and CEA in patients
under 70 years of age (0R 1.16 range 0.80-1.67), but were higher in
patients of 70 years and over. This relationship between age and
peri-procedural strokes was confirmed in the CREST Trial6, with equal risk
at around the slightly lower age of 64 years. The treatment-by-age
interaction was not altered by symptomatic status (CREST included both
symptomatic and asymptomatic patients) or by sex. However when the data in
the systematic review were interrogated for the rate of death and major or
disabling stroke, they did not differ significantly between CAS and CEA.
In addition endovascular treatment was associated with lower risk of
myocardial infarction, cranial nerve palsy and haematoma. Considering more
long-term outcomes in the 2012 review, the rate of ipsilateral stroke
after the peri-operative period was not different, comparing CEA and CAS.
Restenosis of the treated segment was seen to be more common after
endovascular treatment, but it should be remembered that this group
included treatment with angioplasty as well as stents, and restenosis is
only relevant if this translates to clinical problems, such as recurrent
stroke (see later). It is interesting to note that in the trial data,
cranial nerve palsy is not regarded/recorded as a neurological event. Of
course it is not a cerebral event, but it is neurological one, which in
the ICSS Trial was 5.5% in the peri-procedural period7, in time the
majority recover. More recently the long-term results from two important
randomised trials have become available. The 10 year results of the CREST8
and the ICSS trials9. The CREST trial included 2502 patients who were
randomly assigned to stenting or endarterectomy at 117 centres. The
peri-procedural composite end point of stroke, death or myocardial
infarction did not differ significantly between the two groups. As in the
Cochrane review there were more peri-procedural strokes in the stenting
group, but fewer myocardial infarctions. The 10 year risk of the primary
composite end point (any stroke, myocardial infarction or death during the
peri-procedural period or ipsilateral stroke thereafter) did not differ
significantly between the two groups. There was also no difference at any
other year of follow up between 1 and 9 years. The CREST Trial included
both symptomatic and asymptomatic patients, and there were no treatment
differences according to the symptomatic status. As far as restenosis was
concerned, there was no significant difference between the groups in terms
of the percentage who had restenosis or underwent revascularization. The
ICSS trial included only patients who had recently been symptomatic from a
high-grade carotid artery stenosis. 1713 patients were included in the
study at 50 centres worldwide. They were followed up for a maximum of 10
years (median 4.2 years). The cumulative 5-year risk of fatal or disabling
strokes did not differ between the two treatment arms (6.4% CAS v 6.5%
CEA). Any stroke was more frequent in the stenting group (8.9% v 5.8%),
but the excess number were mainly non-disabling strokes. The distribution
of modified Rankin scale scores at 1 year, 5 years or final follow up did
not differ significantly between the groups. This demonstrated that in
symptomatic patients treated with either CAS or CEA there was an
equivalent ability of the two treatments in stroke prevention, up to 10
years after treatment. CAS was associated with a higher procedure-related
risk of non-disabling stroke than CEA (amounting to 1 extra stroke per 156
patient-years of follow up), but that functional ability did not differ
overall. Both treatments seemed to be equally preventive against
ipsilateral stroke and severe restenosis of the treated carotid artery. It
is also of interest to consider, not only the long-term consequences of
neurological events, but also the effect of peri-procedural myocardial
infarction. In the CREST Trial, peri-operative heart attack was associated
with a 3.5 fold increased risk of death at 4 years10. Thus, myocardial
events cannot just be considered as events that do not result in
subsequent risk, even if recovered from, at the time or considered a
simple biochemically discovered event. As the CAS procedure has developed
over time, it has become more complex and the equipment has become more
sophisticated. This includes the routine use of stents rather than simple
angioplasty balloons, low profile balloons and cerebral protection
devices. As data started to become available indicating that CAS was/is a
viable alternative to CEA (in patients suitable for both), one of the
arguments against the use of CAS was the equipment cost, and therefore the
overall cost. This additional up front cost for devices needed to be
considered on the background of a procedure that required local rather
than general anesthetic, was generally quicker to perform, and required
less hospital and high dependency care. A cost utility analysis was
performed from the ICSS trial11. Published in 2016, the mean costs per
patient were $10,477 for the stenting group and $9,669 in the
endarterectomy group. There were no differences in mean quality adjusted
life years per patient or in the adjusted costs between groups. CAS IN
ASSOCIATION WITH THROMBECTOMY A series of trials have demonstrated the
benefit of thrombectomy, for the early treatment of large vessel occlusion
embolic strokes12-16. Whilst tandem lesions of carotid artery stenosis
alongside an acute embolic event is not common (approximately 8% of
cases17), such a scenario is associated with a poor outcome. The exact
indications for, and techniques are yet to be defined, however there are a
number of case series showing the potential benefit of combined CAS and
thrombectomy which is sufficiently compelling to have CAS skills listed as
a requirement for training in stroke thrombectomy. CONCLUSIONS There
remains controversy surrounding the role of CAS in stroke prevention. The
published evidence would indicate that patients should expect a higher
risk of peri-procedural minor stroke if they have CAS compared with CEA.
However, it is to be expected that the effects of this will even out in
the 6-12 month period following the intervention, and that the individual
functional ability having had either treatment will be equivalent taken
out to a 10 year time period.

<24>
Accession Number
618045103
Author
Evers E.S.; Walavalkar V.; Pujar S.; Balasubramanian L.; Prinzen F.W.;
Delhaas T.; Vanagt W.Y.; Maiya S.
Institution
(Evers, Prinzen, Delhaas, Vanagt) Department of Physiology and Biomedical
Engineering, Cardiovascular Research Institute Maastricht, Maastricht
University, Universiteitssingel 50, Maastricht 6229ER, Netherlands
(Walavalkar, Pujar, Balasubramanian, Maiya) Department of Pedicatric
Cardiology, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka,
India
Title
Does heart-type fatty acid-binding protein predict clinical outcomes after
pediatric cardiac surgery?.
Source
Annals of Pediatric Cardiology. 10 (3) (pp 245-247), 2017. Date of
Publication: September-December 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Introduction: The early identification of vulnerable pediatric cardiac
surgery patients can help clinicians provide them with timely support.
Heart-type fatty acid-binding protein. (H-FABP) is an early biomarker of
myocardial injury in acute myocardial infarction in adults. In this study,
we evaluated the correlations between postoperative H-FABP, creatine
kinase-myocardial band (CK-MB), troponin-I, total bypass time, and
clinical outcomes. Methods: In 32 pediatric patients that underwent
ventricular septal defect. closure we measured H-FABP, troponin-I and
CK-MB preoperatively and 1, 3, and 6 h after aortic declamping. Spearman's
Rho correlations were calculated between laboratory and clinical
parameters including inotropic support duration, aortic cross-clamp time,
total bypass time, ventilation.weaning.time, and total Intensive Care Unit
stay. Results: H-FABP, CK-MB, troponin-I, and total bypass time have a
similarly weak to moderate correlation with clinical outcome measures.
Conclusions: The predictive value of H-FABP for clinical outcome is not
stronger than that of CK-MB, Troponin-I, or bypass times.<br/>Copyright
&#xa9; 2017 Annals of Pediatric Cardiology <br/> Published by Wolters
Kluwer - Medknow.

<25>
Accession Number
618043763
Author
van't Hof A.; Giannini F.; ten Berg J.; Tolsma R.; Clemmensen P.;
Bernstein D.; Coste P.; Goldstein P.; Zeymer U.; Hamm C.; Deliargyris E.;
Steg P.G.
Institution
(van't Hof, Giannini) Isala Hospital, Netherlands
(ten Berg) St Antonius Hospital, Netherlands
(Tolsma) EMS RAV IJsselland, Netherlands
(Clemmensen) The Heart Centre, Copenhagen University Hospital, Denmark
(Bernstein, Deliargyris) The Medicines Company, United States
(Coste) Centre Hospitalier Universitaire Bordeaux, Universite de Bordeaux,
France
(Goldstein) Centre Hospitalier Regional Universitaire de Lille, France
(Zeymer) Klinikum Ludwigshafen, Germany
(Hamm) Kerckhoff Heart and Thoraxcenter, Germany
(Steg) Universite Paris-Diderot, France
Title
ST-segment resolution with bivalirudin versus heparin and routine
glycoprotein IIb/IIIa inhibitors started in the ambulance in ST-segment
elevation myocardial infarction patients transported for primary
percutaneous coronary intervention: The EUROMAX ST-segment resolution
substudy.
Source
European Heart Journal: Acute Cardiovascular Care. 6 (5) (pp 404-411),
2017. Date of Publication: 01 Aug 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Myocardial reperfusion after primary percutaneous coronary
intervention (PCI) can be assessed by the extent of post-procedural
ST-segment resolution. The European Ambulance Acute Coronary Syndrome
Angiography (EUROMAX) trial compared pre-hospital bivalirudin and
pre-hospital heparin or enoxaparin with or without GPIIb/IIIa inhibitors
(GPIs) in primary PCI. This nested substudy was performed in centres
routinely using pre-hospital GPI in order to compare the impact of
randomized treatments on ST-resolution after primary PCI. Methods:
Residual cumulative ST-segment deviation on the single one hour
post-procedure electrocardiogram (ECG) was assessed by an independent core
laboratory and was the primary endpoint. It was calculated that 762
evaluable patients were needed to show non-inferiority (85% power, alpha
2.5%) between randomized treatments. Results: A total of 871 participated
with electrocardiographic data available in 824 patients (95%). Residual
ST-segment deviation one hour after PCI was 3.8+/-4.9 mm versus 3.9+/-5.2
mm for bivalirudin and heparin+GPI, respectively (p=0.0019 for
non-inferiority). Overall, there were no differences between randomized
treatments in any measures of ST-segment resolution either before or after
the index procedure. Conclusions: Pre-hospital treatment with bivalirudin
is non-inferior to pre-hospital heparin + GPI with regard to residual
ST-segment deviation or ST-segment resolution, reflecting comparable
myocardial reperfusion with the two strategies.<br/>Copyright &#xa9; The
European Society of Cardiology 2015.

<26>
Accession Number
615708965
Author
Issitt R.W.; Harvey I.; Walsh B.; Voegeli D.
Institution
(Issitt) Perfusion Department, Great Ormond Street Hospital for Children,
London, United Kingdom
(Issitt, Walsh, Voegeli) Faculty of Health Sciences, University of
Southampton, Southampton, United Kingdom
(Harvey) Perfusion Department, John Radcliffe Hospital, Oxford, United
Kingdom
Title
Quantification of Lipid Filtration and the Effects on Cerebral Injury
During Cardiopulmonary Bypass.
Source
Annals of Thoracic Surgery. 104 (3) (pp 884-890), 2017. Date of
Publication: September 2017.
Publisher
Elsevier USA
Abstract
Background Lipid microemboli (LME) are formed in pericardial suction blood
which, when returned to the cardiopulmonary bypass (CPB) circuit, can pass
through filter materials and are returned to the arterial cannula. LME
have been observed to enter all major organs and have been associated with
small capillary arteriolar dilatations in the brains of patients who have
died after CPB. However, a causal relationship showing correlation between
LME and organ dysfunction has not been demonstrated, or whether removal of
LME results in improved organ function. Methods A prospective, single
center, randomized controlled trial examined 30 patients (15 per group)
undergoing coronary artery bypass grafting using CPB with or without a
lipid-depleting filter. The effects of LME filtration on neurocognitive
injury were assessed using neuron-specific enolase (NSE). Results The
study group showed a significant reduction in LME after filtration of the
pericardial suction blood (p < 0.001), whereas the control group exhibited
a significant rise in LME (p < 0.001). There was a significant reduction
in peak NSE release (p = 0.013) and significant attenuation throughout the
postoperative period (p = 0.002). Correlation and regression analyses
showed a significant relationship between the number of LME post-CPB and
peak NSE release (r = 0.42, p = 0.02). Conclusions Several methods of LME
filtration have been proposed, but none provided a suitable, efficacious
method for use within the clinical setting. The RemoweLL CPB system
removes significant numbers of LME from the cardiotomy suction.
Furthermore, LME correlate to the release of a known marker of neurologic
injury.<br/>Copyright &#xa9; 2017 The Society of Thoracic Surgeons

<27>
Accession Number
616109010
Author
Wang M.; Furnary A.P.; Li H.-F.; Grunkemeier G.L.
Institution
(Wang, Li, Grunkemeier) Medical Data Research Center, Providence Health
and Services, Portland, Oregon, United States
(Furnary) Starr-Wood Cardiothoracic Group, Portland, Oregon, United States
Title
Bioprosthetic Aortic Valve Durability: A Meta-Regression of Published
Studies.
Source
Annals of Thoracic Surgery. 104 (3) (pp 1080-1087), 2017. Date of
Publication: September 2017.
Publisher
Elsevier USA
Abstract
To compare structural valve deterioration (SVD) among bioprosthetic aortic
valve types, a PubMed search found 54 papers containing SVD-free curves
extending to at least 10 years. The curves were digitized and fit to
Weibull distributions, and the mean times to valve failure (MTTF) were
calculated. Twelve valve models were collapsed into four valve types:
Medtronic (Medtronic, Minneapolis, MN) and Edwards (Edwards Lifesciences,
Irvine, CA) porcine; and Sorin (Sorin Group [now LivaNova], London, United
Kingdom) and Edwards pericardial. Meta-regression found MTTF was
associated with the patient's age, publication year, SVD definition, and
valve type. Sorin pericardial valves had significantly lower risk-adjusted
MTTF (higher SVD risk), and there were no significant differences in MTTF
among the other three valve types.<br/>Copyright &#xa9; 2017 The Society
of Thoracic Surgeons

<28>
Accession Number
618088580
Author
Nasiri M.; Naboureh A.; Fayazi S.
Institution
(Nasiri) Department of Operating Room Technology, Paramedical School, Qom
University of Medical Sciences, Qom, Iran, Islamic Republic of
(Nasiri) Spiritual Health Research Center, Qom University of Medical
Sciences, Qom, Iran, Islamic Republic of
(Naboureh) Department of Critical Care Nursing, Nursing and Midwifery
Faculty, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Fayazi) Department of Nursing, Nursing and Midwifery School, Ahvaz
Jundishapur University of Medical Sciences, Ahvaz, Iran, Islamic Republic
of
Title
The effect of an islamic praise (Zikr) on postoperative anxiety of
patients undergoing coronary artery bypasses graft surgery: A randomized
clinical trial on Iranian shia muslims.
Source
Research in Cardiovascular Medicine. 6 (3) (no pagination), 2017. Article
Number: e41388. Date of Publication: May 2017.
Publisher
KOWSAR Medical Publishing Company (E-mail: info@kowsarmed.com)
Abstract
Background: Patients undergoing heart surgery experience different levels
of anxiety that may affect their recovery. Objectives: As it is essential
to use low-cost and non-invasive methods for these patients, we decided to
assess the effect of an Islamic praise (Zikr) on patients' anxiety after
coronary artery bypass graft (CABG) surgery. Methods: In this trial, 80
hospitalized patients, who underwent CABG surgery at Busheher Bentolhoda
Hospital, Iran, were randomly allocated to intervention (n = 40) and
control (n = 40) groups. We asked patients in the intervention group to
recite Hazrate Zahra's praises while they received routine care, and in
the control group patients received only routine care. In both groups,
anxiety was assessed at three consecutive days before and immediately
after the intervention. Data was collected by demographic and clinical
checklist and hospital anxiety depression scale (HADS). Results: There was
no significant difference between patients' anxiety of both groups before
the intervention (P > 0.05), while after the intervention a significant
difference was seen in anxiety between patients, who had recited the
praise and those who had not, on all three days (P <= 0.001). Also, in the
intervention group, before and after the recitation, a significant
difference was seen during three days (for three days P <= 0.001), but no
significant difference was indicated before and after the intervention in
the control group (P = 0.423, P = 0.541 and P = 0.621, respectively).
Conclusions: Recitation of Hazrate Zahra's praises was effective on
patients' anxiety reduction after CABG surgery among Shia
Muslims.<br/>Copyright &#xa9; 2016, Rajaie Cardiovascular Medical and
Research Center, Iran University of Medical Sciences.

<29>
Accession Number
618042607
Author
Nemeth E.; Vig K.; Racz K.; Koritsanszky K.B.; Ronkay K.I.; Hamvas F.P.;
Borbely C.; Eory A.; Merkely B.; Gal J.
Institution
(Nemeth, Racz, Koritsanszky, Ronkay, Hamvas, Gal) Semmelweis University,
Department of Anaesthesia and Intensive Therapy, P.O.B. 2, Budapest
H-1428, Hungary
(Vig, Merkely) Semmelweis University, Heart and Vascular Centre, P.O.B. 2,
Budapest H-1428, Hungary
(Borbely) National Institute of Neuroscience, Amerikai Street 57, Budapest
H-1145, Hungary
(Eory) Semmelweis University, Department of Family Medicine, P.O.B. 2,
Budapest H-1428, Hungary
Title
Influence of the postoperative inflammatory response on cognitive decline
in elderly patients undergoing on-pump cardiac surgery: A controlled,
prospective observational study.
Source
BMC Anesthesiology. 17 (1) (no pagination), 2017. Article Number: 113.
Date of Publication: 29 Aug 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The role of non-infective inflammatory response (IR) in the
aetiology of postoperative cognitive dysfunction (POCD) is still
controversial. The aim of this controlled, prospective observational study
was to assess the possible relationship between the grade of IR, defined
by procalcitonin (PCT) changes, and development of POCD related to cardiac
surgery. Methods: Forty-two patients, who were >= 60 years of age and
scheduled for elective cardiac surgery, were separated into the low
inflammatory (LIR) and high inflammatory (HIR) response groups based on
their PCT levels measured on the first postoperative day. A matched
normative control group of 32 subjects was recruited from primary care
practice. The PCT and C-reactive protein (CRP) levels were monitored daily
during the first five postoperative days. The cognitive function and mood
state were preoperatively tested with a set of five neurocognitive tests
and two mood inventories and at the seventh postoperative day. The
Reliable Change Index modified for practice (RCIp) using data from
normative controls was applied to determine the significant decline in
test performance. Results: The LIR (n = 20) and HIR (n = 22) groups
differed significantly in the PCT (p < 0.001) but not in the CRP time
courses. The incidence of POCD at the first postoperative week was 35.7%
in the cohort. The LIR and HIR groups did not vary in the RCIp Z scores of
neurocognitive tests and frequencies of POCD (7 vs 8 cases, respectively,
p > 0.05). Additionally, there was no difference in the mood states,
anxiety levels and perioperative parameters known to influence the
development of POCD. Conclusions: In this study, the magnitude of the
non-infective inflammatory response generated by on-pump cardiac surgery
did not influence the development of POCD in the early postoperative
period in elderly patients.<br/>Copyright &#xa9; 2017 The Author(s).

<30>
[Use Link to view the full text]
Accession Number
618091637
Author
Lindman B.R.; Otto C.M.; Douglas P.S.; Hahn R.T.; Elmariah S.; Weissman
N.J.; Stewart W.J.; Ayele G.M.; Zhang F.; Zajarias A.; Maniar H.S.;
Jilaihawi H.; Blackstone E.; Chinnakondepalli K.M.; Tuzcu E.M.; Leon M.B.;
Pibarot P.
Institution
(Lindman) Cardiovascular Research, Structural Heart and Valve Center,
Vanderbilt University Medical Center, 2525 WestEnd, Nashville, TN 37203,
United States
(Lindman, Zajarias, Maniar) Washington University School of Medicine, St.
Louis, MO, United States
(Otto) University of Washington School of Medicine, Seattle, United States
(Douglas) Duke Clinical Research Institute, Duke University Medical
Center, Durham, NC, United States
(Hahn, Leon) Columbia University Medical Center, New York, NY, United
States
(Elmariah) Massachusetts General Hospital, Boston, United States
(Weissman) Medstar Health Research Institute, Georgetown University School
of Medicine, Washington, DC, United States
(Stewart, Blackstone, Tuzcu) Cleveland Clinic, OH, United States
(Ayele, Zhang, Leon) Cardiovascular Research Foundation, New York, NY,
United States
(Jilaihawi) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Chinnakondepalli) Saint Luke's Mid America Heart Institute, Kansas City,
MO, United States
(Pibarot) Department of Medicine, Laval University, Quebec City, QC,
Canada
Title
Blood Pressure and Arterial Load after Transcatheter Aortic Valve
Replacement for Aortic Stenosis.
Source
Circulation: Cardiovascular Imaging. 10 (7) (no pagination), 2017. Article
Number: e006308. Date of Publication: 01 Jul 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - After aortic valve replacement, left ventricular afterload is
often characterized by the residual valve obstruction. Our objective was
to determine whether higher systemic arterial afterload - as reflected in
blood pressure, pulsatile and resistive load - is associated with adverse
clinical outcomes after transcatheter aortic valve replacement (TAVR).
Methods and Results - Total, pulsatile, and resistive arterial load were
measured in 2141 patients with severe aortic stenosis treated with TAVR in
the PARTNER I trial (Placement of Aortic Transcatheter Valve) who had
systolic blood pressure (SBP) and an echocardiogram obtained 30 days after
TAVR. The primary end point was 30-day to 1-year all-cause mortality.
Lower SBP at 30 days after TAVR was associated with higher mortality
(20.0% for SBP 100-129 mm Hg versus 12.0% for SBP 130-170 mm Hg; P<0.001).
This association remained significant after adjustment, was consistent
across subgroups, and confirmed in sensitivity analyses. In adjusted
models that included SBP, higher total and pulsatile arterial load were
associated with increased mortality (P<0.001 for all), but resistive load
was not. Patients with low 30-day SBP and high pulsatile load had a 3-fold
higher mortality than those with high 30-day SBP and low pulsatile load
(26.1% versus 8.1%; hazard ratio, 3.62; 95% confidence interval,
2.36-5.55). Conclusions - Even after relief of valve obstruction in
patients with aortic stenosis, there is an independent association between
post-TAVR blood pressure, systemic arterial load, and mortality. Blood
pressure goals in patients with a history of aortic stenosis may need to
be redefined. Increased pulsatile arterial load, rather than blood
pressure, may be a target for adjunctive medical therapy to improve
outcomes after TAVR. Clinical Trial Registration - URL:
http://www.clinicaltrials.gov. Unique identifier:
NCT00530894.<br/>Copyright &#xa9; 2017 American Heart Association, Inc.

<31>
[Use Link to view the full text]
Accession Number
618093728
Author
Koehler D.; Marsh J.L.; Karam M.; Fruehling C.; Willey M.
Institution
(Koehler, Marsh, Karam, Fruehling, Willey) Department of Orthopaedic
Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa
City, IA, United States
Title
Efficacy of surgical-site, multimodal drug injection following operative
management of femoral fractures: A randomized controlled trial.
Source
Journal of Bone and Joint Surgery - American Volume. 99 (6) (pp 512-519),
2017. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Background: Multimodal analgesia inclusive of periarticular injection with
a local anesthetic agent has been rapidly assimilated, with demonstrated
safety and efficacy, into the care of patients undergoing elective
lower-extremity arthroplasty. The present study was performed to evaluate
the efficacy and safety of a surgical-site, multimodal drug injection for
postoperative pain control following operative management of femoral
fractures. Methods: There were 102 patients undergoing operative
intervention (plate fixation, intramedullary device, or arthroplasty) for
a broad range of femoral fracture patterns who were prospectively
randomized either to receive an intraoperative, surgical-site injection
into the superficial and deep tissues containing ropivacaine, epinephrine,
and morphine or to receive no injection. Visual analog scale (VAS) scores
were recorded at regular intervals as the primary outcome measure.
Narcotic consumption and medication-related side effects were also
monitored. Results: The injection group demonstrated significantly lower
VAS scores (p < 0.05) than the control cohort in the recovery room and at
the 4, 8, and 12-hour postoperative time points. The median score (and
interquartile range) was 1.6 (0 to 4.0) for the injection group and 3.2
(1.3 to 5.7) for the control group immediately postoperatively, 1.0 (0 to
3.0) for the injection group and 5.0 (2.0 to 7.0) for the control group at
4 hours, 2.0 (0 to 4.0) for the injection group and 5.0 (2.0 to 6.8) for
the control group at 8 hours, and 3.5 (0 to 5.0) for the injection group
and 5.0 (2.0 to 8.0) for the control group at 12 hours. Additionally,
narcotic consumption was significantly lower (p = 0.007) in the injection
group (5.0 mg [1.3 to 8.0 mg]) compared with the control group (9.7 mg
[3.9 to 15.6 mg]) over the first 8 hours following the surgical procedure.
No cardiac or central nervous system toxicity was observed secondary to
infiltration of the local anesthetic. Conclusions: Surgical-site injection
with a multimodal analgesic cocktail provides improved pain control and
reduces narcotic utilization over the first postoperative day, with no
observed adverse effects attributable to the local injection, across a
diverse orthopaedic trauma population undergoing operative intervention
for femoral fractures. Level of Evidence: Therapeutic Level I. See
Instructions for Authors for a complete description of levels of
evidence.<br/>Copyright &#xa9; 2017 by the Journal of bone and joint
surgery, incorporated.

<32>
Accession Number
618049564
Author
Phillips B.; Turco L.; Mirzaie M.; Fernandez C.
Institution
(Phillips, Mirzaie, Fernandez) Department of Surgery, Creighton University
School of Medicine, Omaha, NE, United States
(Phillips) Department of Clinical Science and Translational Research,
Creighton University School of Medicine, Omaha, NE, United States
(Turco) Department of Surgery, University of Kansas Medical Center, Kansas
City, KS, United States
Title
Trauma pneumonectomy: A narrative review.
Source
International Journal of Surgery. 46 (pp 71-74), 2017. Date of
Publication: October 2017.
Publisher
Elsevier Ltd
Abstract
Purpose Thoracic injuries are common in both blunt and penetrating trauma.
Most thoracic injuries are managed non-operatively, approximately 7-20%
undergo thoracotomy. Of the injuries requiring thoracotomy, 1-6%
ultimately require pulmonary resection. Wedge resection and lobectomies
are well-studied in the literature; however, there is a paucity regarding
reports on total pneumonectomy in the setting of trauma. Our objectives
were to summarize the evidence supporting the role of trauma pneumonectomy
(TP) in the current era and reiterate that despite the associated
morbidity and mortality TP is justified in selective cases. Methods A
review of the world's literature was conducted following standard
guidelines. Inclusion criteria included those studies reviewing blunt and
penetrating trauma to the lungs in adults (age greater than 15 year) that
reported mortality rates and outcome measures. Results The PubMed search
yielded 713 studies. Of these, 14 studies included pertinent information
on TP. Studies included in this review were published from 1985 to 2017
and involved patient data that was collected from 1972 to 2014. Mortality
ranged from 50% to 100% (median 63%; mean 68%). Conclusion In the setting
of severe thoracic trauma, pulmonary resection may be necessary. Less
aggressive techniques are options in a stable patient; however, in the
setting of ongoing hemorrhage, TP should be considered and expediently
conducted. The role of damage control thoracic surgery and related
techniques is vitally important in these patients to improve the
significant mortality of trauma pneumonectomy.<br/>Copyright &#xa9; 2017
IJS Publishing Group Ltd

<33>
Accession Number
618087532
Author
Lassaletta A.D.; Laham R.J.; Pinto D.S.; Pleskow D.K.; Sawhney M.S.;
Chuttani R.; Kent M.S.
Institution
(Lassaletta, Kent) Division of Thoracic Surgery and Interventional
Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School,
Boston, MA, United States
(Laham, Pinto) Division of Cardiovascular Medicine, Interventional
Section, Beth Israel Deaconess Medical Center, Harvard Medical School,
Boston, MA, United States
(Pleskow, Sawhney, Chuttani) Division of Gastroenterology, Beth Israel
Deaconess Medical Center, Harvard Medical School, Boston, MA, United
States
Title
Successful closure of an esophagopleural fistula with an Amplatzer
occluder sealed with liquid copolymer, with 3-year follow-up and review of
literature.
Source
PLEURA. 3 (no pagination), 2016. Date of Publication: 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Esophageal perforations may recur, and/or develop a mature fistulous tract
to the pleura, despite prompt surgical management. Treatment of a chronic
esophageal fistula is challenging and may require multiple reoperations.
We describe the closure of a controlled, chronic, benign esophagopleural
fistula using an Amplatzer occluder and sealed with a liquid copolymer
after failed open repair. At 3 years postprocedure, the patient has no
further recurrence or complication associated with the repair. Amplatzer
plugs and occluders, designed for endovascular and cardiac procedures, are
increasingly used off-label for the treatment of complex, recurrent, or
otherwise difficult to manage bronchopulmonary, pleural, and esophageal
fistulae.<br/>Copyright &#xa9; The Author(s) 2016.

<34>
Accession Number
362399416
Author
Montalescot G.; Zeymer U.; Silvain J.; Boulanger B.; Cohen M.; Goldstein
P.; Ecollan P.; Combes X.; Huber K.; Pollack Jr. C.; Benezet J.-F.; Stibbe
O.; Filippi E.; Teiger E.; Cayla G.; Elhadad S.; Adnet F.; Chouihed T.;
Gallula S.; Greffet A.; Aout M.; Collet J.-P.; Vicaut E.
Institution
(Montalescot, Silvain, Collet) Institut de Cardiologie, CHU
Pitie-Salpetrire (AP-HP), Universite Paris 6, Paris, France
(Ecollan) SMUR, CHU Pitie-Salpetrire (AP-HP), Universite Paris 6, Paris,
France
(Zeymer) Herzzentrum Klinikum Ludwigshafen, Medizinische Klinik B,
Ludwigshafen, Germany
(Boulanger) SAMU, CH Bretagne Atlantique, Vannes, France
(Filippi) Cardiology Department, CH Bretagne Atlantique, Vannes, France
(Cohen) Division of Cardiology, Newark Beth Israel Medical Center, Newark,
NJ, United States
(Goldstein) SAMU, CHU Lille, France
(Combes) SAMU, Henri Mondor Hospital, Creteil, France
(Teiger) Cardiology Department, Henri Mondor Hospital, Creteil, France
(Huber) Department of Internal Medicine, Cardiology and Emergency
Medicine, Wilhelminenhospital, Vienna, Austria
(Pollack Jr.) Pennsylvania Hospital, University of Pennsylvania,
Philadelphia, PA, United States
(Benezet) SAMU, CH Caremeau, Nimes, France
(Cayla) Cardiology Department, CH Caremeau, Nimes, France
(Stibbe) SAMU, CH de Lagny, Lagny-sur-Marne, France
(Elhadad) Cardiology Department, CH de Lagny, Lagny-sur-Marne, France
(Adnet) SAMU, Hopital Avicenne, Bobigny, France
(Chouihed) SAMU, Hopital Central, Nancy, France
(Gallula) SMUR, Hopital Lariboisire, Paris, France
(Greffet) SAMU, Hopital Necker, Paris, France
(Aout, Vicaut) Unite de Recherche Clinique, Lariboisire Hospital (AP-HP),
Universite Paris 7, Paris, France
Title
Intravenous enoxaparin or unfractionated heparin in primary percutaneous
coronary intervention for ST-elevation myocardial infarction: The
international randomised open-label ATOLL trial.
Source
The Lancet. 378 (9792) (pp 693-703), 2011. Date of Publication: August
20-26, 2011.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Primary percutaneous coronary intervention (PCI) for
ST-elevation myocardial infarction has traditionally been supported by
unfractionated heparin, which has never been directly compared with a new
anticoagulant using consistent anticoagulation and similar antiplatelet
strategies in both groups. We compared traditional heparin treatment with
intravenous enoxaparin in primary PCI. Methods In a randomised open-label
trial, patients presenting with ST-elevation myocardial infarction were
randomly assigned (1:1) to receive an intravenous bolus of 0.5 mg/kg of
enoxaparin or unfractionated heparin before primary PCI. Wherever
possible, medical teams travelling in mobile intensive care units
(ambulances) selected, randomly assigned (using an interactive voice
response system at the central randomisation centre), and treated
patients. Patients who had received any anticoagulant before randomisation
were excluded. Patients and caregivers were not masked to treatment
allocation. The primary endpoint was 30-day incidence of death,
complication of myocardial infarction, procedure failure, or major
bleeding. The main secondary endpoint was the composite of death,
recurrent acute coronary syndrome, or urgent revascularisation. Analysis
was by intention to treat. This trial is registered at ClinicalTrials.gov,
number NCT00718471. Findings 910 patients were assigned to treatment with
enoxaparin (n=450) or unfractionated heparin (n=460). The primary endpoint
occurred in 126 (28) patients after anticoagulation with enoxaparin versus
155 (34) patients on unfractionated heparin (relative risk [RR] 0.83, 95
CI 0.68-1.01, p=0.06). The incidence of death (enoxaparin, 17 [4] vs
heparin, 29 [6] patients; p=0.08), complication of myocardial infarction
(20 [4] vs 29 [6]; p=0.21), procedure failure (100 [26] vs 109 [28];
p=0.61), and major bleeding (20 [5] vs 22 [5]; p=0.79) did not differ
between groups. Enoxaparin resulted in a significantly reduced rate of the
main secondary endpoint (30 [7] vs 52 [11] patients; RR 0.59, 95 CI
0.38-0.91, p=0.015). Death, complication of myocardial infarction, or
major bleeding (46 [10] vs 69 [15] patients; p=0.03), death or
complication of myocardial infarction (35 [8] vs 57 [12]; p=0.02), and
death, recurrent myocardial infarction, or urgent revascularisation (23
[5] vs 39 [8]; p=0.04) were all reduced with enoxaparin. Interpretation
Intravenous enoxaparin compared with unfractionated heparin significantly
reduced clinical ischaemic outcomes without differences in bleeding and
procedural success. Therefore, enoxaparin provided an improvement in net
clinical benefit in patients undergoing primary PCI. Funding Direction de
la Recherche Clinique, Assistance Publique-Hopitaux de Paris;
Sanofi-Aventis. &#xa9; 2011 Elsevier Ltd.

<35>
Accession Number
618051842
Author
Nizamic T.; Murad M.H.; Allen L.A.; McIlvennan C.K.; Matlock D.D.;
Wordingham S.E.; Dunlay S.M.
Institution
(Nizamic, Allen, McIlvennan, Matlock) University of Colorado, Denver, CO,
United States
(Murad, Dunlay) Mayo Clinic Rochester, Rochester, MN, United States
(Wordingham) Mayo Clinic Scottsdale, Scottsdale, AZ, United States
Title
Ambulatory inotrope infusion in advanced heart failure: A systematic
review.
Source
Journal of Cardiac Failure. Conference: 21st Annual Scientific Meeting of
the Heart Failure Society of America, HFSA 2017. United States. 23 (8
Supplement 1) (pp S55), 2017. Date of Publication: August 2017.
Publisher
Churchill Livingstone Inc.
Abstract
Background: Ambulatory intravenous inotrope infusions are sometimes
offered to patients with advanced stage D heart failure (HF); however, a
contemporary evidence synthesis of the relative risks and benefits of
chronic outpatient inotropes infusions is lacking. Methods: We searched
SCOPUS, Web of Science, Ovid EMBASE, and Ovid MEDLINE for trials and
observational studies of long-term use of intravenous inotrope infusions
(milrinone, dobutamine, dopamine, levosimendan) in outpatients with
advanced HF. Meta-analysis was performed where appropriate using random
effects models. Results: A total of 66 studies including 3587 patients
(median 36 patients per study) met inclusion criteria, including 13
randomized controlled trials (RCTs), 4 nonrandomized trials, and 49
observational studies. The indication for inotropes was bridge to
transplant (BTT) in 11 studies, palliative in 8 studies, a combination of
BTT and palliative in 13 studies, and not specified in 34 studies.
Inotropes were administered intermittently (42 studies) and continuously
(30 studies). Most studies were at high risk for bias. The pooled rate of
death on inotropes was 4.4 per 100 person-months follow-up (95% CI
3.5-5.5; 46 studies). There was no difference in mortality in pa-tients
treated with inotropes compared with controls (pooled RR 0.68 CI
0.40-1.17, P =.16; 9 RCTs). On average, patients treated with inotropes
had an improvement of 1.2 New York Heart Association (NYHA) functional
classes (95% CI 1.0-1.4, P <.001; 24 studies), and the improvement was of
greater magnitude in patients treated with inotropes compared to controls
(mean difference 0.6 NYHA functional classes, 95% CI 0.2-1.0, P=.002; 5
RCTs). The pooled rates of all-cause hospitalizations (15 studies),
central line infection (15 studies), and ICD shocks (3 studies) on
inotropes were 22.2, 4.6, and 2.4 per 100 per-months follow-up,
respectively. Outpatient inotropes were cost-saving compared to ongoing
hospitalization while awaiting cardiac transplantation (5 studies) but no
studies compared costs of outpatient inotropes as palliation with other
strategies such as hospice. Studies comparing patients on inotropes with
controls were too limited to draw conclusions on outcomes including
quality of life, hospitalization, and ventricular arrhythmias. Conclusion:
High-quality evidence about the risks and benefits of ambulatory inotropes
infusions in patients with advanced HF is limited, particularly when used
for palliation. While available data suggest that outpatient inotrope
infusions are associated with improvement in NYHA functional class with no
impact on risk of death, there is insufficient evidence to determine how
inotropes impact other important outcomes such as hospitalization and
quality of life. RCTs or well-designed observational studies of inotrope
infusions for palliation compared with other strategies are needed.

<36>
Accession Number
618051801
Author
Blumer V.; Arcay L.; Mendirichaga R.; Chaparro S.
Institution
(Blumer, Mendirichaga, Chaparro) Univ. of Miami, Jackson Memorial
Hospital, Miami, FL, United States
(Arcay) University of Miami, Miami, FL, United States
Title
Mechanical circulatory support for peripartum cardiomyopathy: A systematic
review.
Source
Journal of Cardiac Failure. Conference: 21st Annual Scientific Meeting of
the Heart Failure Society of America, HFSA 2017. United States. 23 (8
Supplement 1) (pp S121), 2017. Date of Publication: August 2017.
Publisher
Churchill Livingstone Inc.
Abstract
Introduction: Peripartum cardiomyopathy (PPCM) is an uncommon form of
cardiomyopathy that occurs during the last month of pregnancy and up to
five months postpartum. PPCM can result in cardiogenic shock and patients
might require mechanical circulatory support (MCS). To date, there is
limited information regarding the use of MCS in women with PPCM. Methods:
We performed a comprehensive search of medical libraries through March
2017 for publications reporting use of MCS in PPCM. Results: Fourteen
studies (3 case series, 11 case reports) with 26 patients were included.
The median age was 33.5 years (IQR 26-36), 50% were multiparous and in 74%
there was a post-partum presentation. A prolactin inhibitor was used in
conjunction to MCS in 27% of cases. Most patients received support with
more than one device (42%). In the group that underwent implantation of
only one device, the most commonly used device was a ventricular assist
device (VAD) (31%), followed by intra-aortic balloon pump (12%), Impella
(7.6%) and ECMO (7.6%). Complications were described in 50% of the
patients analyzed. Bleeding was the most common complication, followed by
infection and thrombotic events, including stroke. Overall, 58% of
patients achieved recovery (n= 15), 23% underwent cardiac transplantation
(n = 6), 8% were listed for transplant (n = 2), and 11.5% died (n = 3).
Conclusions: MCS as bridge to recovery or bridge to transplant is feasible
in patients with PPCM. Despite the high incidence of complications,
mortality rate remained relatively low. Further studies are needed to
confirm these findings.

<37>
Accession Number
618051518
Author
Zhuo D.X.; Bilchick K.C.; Johnston L.E.; Kim M.M.; Mazimba S.
Institution
(Zhuo, Bilchick, Johnston, Mazimba) University of Virginia Health System,
Charlottesville, VA, United States
(Kim) University of Virginia, Charlottesville, VA, United States
Title
MAGGIC and STS risk scores are equivalent predictors of mortality
following valvular heart surgery.
Source
Journal of Cardiac Failure. Conference: 21st Annual Scientific Meeting of
the Heart Failure Society of America, HFSA 2017. United States. 23 (8
Supplement 1) (pp S133), 2017. Date of Publication: August 2017.
Publisher
Churchill Livingstone Inc.
Abstract
Introduction: The Meta-Analysis Global Group in Chronic Heart Failure
(MAGGIC) risk score is a well-validated prognostic model in patients with
both heart failure with reduced ejection fraction (HFrEF) and heart
failure with preserved ejection fraction (HEpEF). However, the MAGGIC risk
score has not been specifically studied in patients with valvular heart
disease, many of whom have clinical syndromes consistent with heart
failure requiring surgical intervention. Hypothesis: We sought to compare
the MAGGIC risk score with the established Society of Thoracic Surgeons
(STS) risk score, with respect to predicting mortality following valvular
heart surgery. Methods: A retrospective analysis was conducted involving
patients who underwent open aortic valve replacement (AVR), open mitral
valve repair/replacement (MVR), or transcatheter aortic valve replacement
(TAVR), at a single tertiary academic medical center from 2009-2014.
Patients with complete data to calculate MAGGIC and STS risk scores were
studied using bivariable logistic regression and receiver operating
characteristic (ROC) analysis, for the outcomes of 30-day and 1-year
mortality. Results: 268 patients were included in the analysis, with a
mean age of 70.9 +/- 12.3 years. 44% of the cohort was female. 204
patients underwent open AVR, 57 underwent open MVR, and 7 underwent TAVR.
For 30-day mortality, the area under the ROC curve (AUC) for the MAGGIC
risk score was 0.7080 (P <.05), compared to 0.7490 (P <.05) for the STS
risk score. The corresponding 1-year mortality AUC values for the MAGGIC
and STS risk scores were 0.6602 and 0.6750 (both with P <.05),
respectively. Conclusions: The MAGGIC and STS risk scores are equivalent
predictors of mortality in valvular heart surgery patients. This finding
has important implications in establishing the MAGGIC risk score as a
viable prognostic model in this population subset.

<38>
Accession Number
617958099
Author
Kelly S.A.M.; Hartley L.; Loveman E.; Colquitt J.L.; Jones H.M.;
Al-Khudairy L.; Clar C.; Germano R.; Lunn H.R.; Frost G.; Rees K.
Institution
(Kelly) University of Cambridge, Institute of Public Health, School of
Clinical Medicine, Forvie Site, Box 113 Cambridge Biomedical Campus,
Cambridge CB2 0SR, United Kingdom
(Hartley) RTI Health Solutions, Manchester M20 2LS, United Kingdom
(Loveman, Colquitt) Effective Evidence LLP, 26 The Curve, Waterlooville,
Hampshire PO8 9SE, United Kingdom
(Jones, Al-Khudairy, Lunn, Rees) Warwick Medical School, University of
Warwick, Division of Health Sciences, Coventry, United Kingdom
(Clar) Freelance, Hasenheide 67, Berlin 10967, Germany
(Germano) University of Naples Federico II, Division of Nutrition,
Department of Clinical Medicine and Surgery, Naples, Italy
(Frost) Hammersmith Hospital, Department of Nutrition and Dietetics,
Duncane Road, London W12 0HS, United Kingdom
Title
Whole grain cereals for the primary or secondary prevention of
cardiovascular disease.
Source
Cochrane Database of Systematic Reviews. 2017 (8) (no pagination), 2017.
Article Number: CD005051. Date of Publication: 24 Aug 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: There is evidence from observational studies that whole grains
can have a beneficial effect on risk for cardiovascular disease (CVD).
Earlier versions of this review found mainly short-term intervention
studies. There are now longer-term randomised controlled trials (RCTs)
available. This is an update and expansion of the original review
conducted in 2007. Objectives: The aim of this systematic review was to
assess the effect of whole grain foods or diets on total mortality,
cardiovascular events, and cardiovascular risk factors (blood lipids,
blood pressure) in healthy people or people who have established
cardiovascular disease or related risk factors, using all eligible RCTs.
Search methods: We searched CENTRAL (Issue 8, 2016) in the Cochrane
Library, MEDLINE (1946 to 31 August 2016), Embase (1980 to week 35 2016),
and CINAHL Plus (1937 to 31 August 2016) on 31 August 2016. We also
searched ClinicalTrials.gov on 5 July 2017 and the World Health
Organization International Clinical Trials Registry Platform (WHO ICTRP)
on 6 July 2017. We checked reference lists of relevant articles and
applied no language restrictions. Selection criteria: We selected RCTs
assessing the effects of whole grain foods or diets containing whole
grains compared to foods or diets with a similar composition, over a
minimum of 12 weeks, on cardiovascular disease and related risk factors.
Eligible for inclusion were healthy adults, those at increased risk of
CVD, or those previously diagnosed with CVD. Data collection and analysis:
Two review authors independently selected studies. Data were extracted and
quality-checked by one review author and checked by a second review
author. A second review author checked the analyses. We assessed treatment
effect using mean difference in a fixed-effect model and heterogeneity
using the I² statistic and the Chi² test of
heterogeneity. We assessed the overall quality of evidence using GRADE
with GRADEpro software. Main results: We included nine RCTs randomising a
total of 1414 participants (age range 24 to 70; mean age 45 to 59, where
reported) to whole grain versus lower whole grain or refined grain control
groups. We found no studies that reported the effect of whole grain diets
on total cardiovascular mortality or cardiovascular events (total
myocardial infarction, unstable angina, coronary artery bypass graft
surgery, percutaneous transluminal coronary angioplasty, total stroke).
All included studies reported the effect of whole grain diets on risk
factors for cardiovascular disease including blood lipids and blood
pressure. All studies were in primary prevention populations and had an
unclear or high risk of bias, and no studies had an intervention duration
greater than 16 weeks. Overall, we found no difference between whole grain
and control groups for total cholesterol (mean difference 0.07, 95%
confidence interval -0.07 to 0.21; 6 studies (7 comparisons); 722
participants; low-quality evidence). Using GRADE, we assessed the overall
quality of the available evidence on cholesterol as low. Four studies were
funded by independent national and government funding bodies, while the
remaining studies reported funding or partial funding by organisations
with commercial interests in cereals. Authors' conclusions: There is
insufficient evidence from RCTs of an effect of whole grain diets on
cardiovascular outcomes or on major CVD risk factors such as blood lipids
and blood pressure. Trials were at unclear or high risk of bias with small
sample sizes and relatively short-term interventions, and the overall
quality of the evidence was low. There is a need for well-designed,
adequately powered RCTs with longer durations assessing cardiovascular
events as well as cardiovascular risk factors.<br/>Copyright &#xa9; 2017
The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

<39>
Accession Number
614581999
Author
Mehrpooya M.; Larti F.; Nozari Y.; Sattarzadeh-Badkoobeh R.; Parsa A.F.Z.;
Zebardast J.; Tavoosi A.; Shahbazi F.
Institution
(Mehrpooya, Larti, Sattarzadeh-Badkoobeh, Parsa, Tavoosi) Department of
Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Nozari) Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Zebardast) Department of Electronic Learning in Medical Education, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Shahbazi) Department of Biology, Payame Noor University, Tehran, Iran,
Islamic Republic of
Title
Study of serum uric acid levels in myocardial infarction and its
association with killip class.
Source
Acta Medica Iranica. 55 (2) (pp 97-102), 2017. Date of Publication: 2017.
Publisher
Medical Sciences University of Teheran
Abstract
The present study aimed to compare the serum level of uric acid in
patients with and without heart failure and also to determine the
association between uric acid level and clinical status by Killip class in
patients with STEMI. This case-control study was conducted on 50
consecutives as control group and 50 patients with acute heart failure,
(20 patients had acute STEMI), who documented by both clinical conditions
and echocardiography assessment. The mean plasma level of uric acid in the
case group was 7.6+/-1.6 milligrams/deciliter (mg/dL) and in the control
group was 4.5+/-1.5 respectively (P<0.001). These values in patients with
STEMI was about 9.2+/-0.86, but in patients with acute heart failure in
absence of STEMI was 6.5+/-1.04 (P<0.001). Moreover, there was significant
difference among the level of uric acid and Killip classes (P<0.001). Also
there was significant difference for uric acid level between HFrEF (HF
with reduced EF) and severe LV systolic dysfunction (0.049). In STEMI
patients with culprit LAD, mean uric acid was significantly higher than
cases with culprit LCX [(9.7+/-0.98 versus 8.6+/-0.52 respectively)
P=0.012]. Regarding treatment plan in patients with STEMI, mean level of
uric acid in those considered for CABG was significantly higher than who
were considered for PCI, 9.9+/-0.82 versus 8.9+/-0.76 respectively,
P=0.029. In STEMI patients with higher killip class, higher level of uric
acid was seen. Also, the severity of LV systolic dysfunction was
associated with higher level of uric acid.<br/>Copyright &#xa9; 2017
Tehran University of Medical Sciences. All rights reserved.

<40>
Accession Number
618001156
Author
Japaridze L.; Sadunishvili M.
Institution
(Japaridze, Sadunishvili) Amtel Hospital First Clinical, Centre of
Vascular and Heart Diseases, Tbilisi State Medical University, Chapidze
Heart Centre, Chachava str.#1, Tbilisi 0159, Georgia
Title
The short-term effect of atorvastatin plus ezetimibe therapy versus
atorvastatin monotherapy on clinical outcome in acute coronary syndrome
patients by gender.
Source
Kardiologia Polska. 75 (8) (pp 770-778), 2017. Date of Publication: 18 Aug
2017.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland)
Abstract
Background: Atorvastatin reduces low-density lipoprotein cholesterol
(LDL-C) levels and the risk of cardiovascular events, but whether the
addition of ezetimibe (EZE), a non-statin drug that reduces intestinal
cholesterol absorption, can reduce the rate of cardiovascular events
further, and if there any sex differences, is not known. Aim: To evaluate
the effects of atorvastatin and EZE combination in acute coronary syndrome
(ACS) patients on the incidence of composite endpoint in short-term
follow-up and to assess differences according their gender. Methods: We
conducted a 16-week, single-centre, prospective, randomised, open-label
clinical trial involving 323 patients who had been hospitalised for an ACS
within the preceding 14 days. They received atorvastatin 20 mg for 28
days, and after that 292 patients who had LDL-C levels >= 1.81 mmol/L were
randomised to EZE 10 mg/day co-administered with atorvastatin therapy (EZE
+ statin) or double their current atorvastatin dose. The primary endpoint
was a composite of cardiovascular death, nonfatal myocardial infarction,
unstable angina requiring rehospitalisation, coronary revascularisation
(>= 30 days after randomisation), or nonfatal stroke. Results: The
Kaplan-Meier event-free survival rate at 16 weeks was 88.1% in the EZE +
statin group patients and 77.0% in the atorvastatin monotherapy group
(absolute risk reduction: 11.1 percentage points; hazard ratio: 2.099; 95%
confidence interval: 1.165-3.781; p = 0.014). The log rank test indicated
that there was not a statistically significant difference between male and
female survival rates in both treatment groups (p = 0.897). Conclusions:
The results of our study demonstrated that when added to statin therapy,
EZE resulted in improved cardiovascular outcomes, and the response to
atorvastatin and EZE combination was similar for both men and
women.<br/>Copyright &#xa9; Polskie Towarzystwo Kardiologiczne 2017.

<41>
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Accession Number
615438403
Author
Bagur R.; Solo K.; Alghofaili S.; Nombela-Franco L.; Kwok C.S.; Hayman S.;
Siemieniuk R.A.; Foroutan F.; Spencer F.A.; Vandvik P.O.; Schaufele T.G.;
Mamas M.A.
Institution
(Bagur, Alghofaili, Hayman) Division of Cardiology, Department of
Medicine, London Health Sciences Center, Western University, London, ON,
Canada
(Bagur, Solo) Department of Epidemiology and Biostatistics, Schulich
School of Medicine and Dentistry, Western University, 339 Windermere Rd,
London, ON N6A 5A5, Canada
(Bagur, Kwok, Mamas) Keele Cardiovascular Research Group, Institute of
Applied Clinical Science, Keele University and Royal Stoke Hospital,
Stoke-on-Trent, United Kingdom
(Nombela-Franco) Division of Cardiology, Hospital Clinico San Carlos,
Madrid, Spain
(Siemieniuk) Department of Medicine, University of Toronto, ON, Canada
(Foroutan) Department of Clinical Epidemiology and Biostatistics, McMaster
University, Hamilton, ON, Canada
(Spencer) Division of Cardiology, Department of Medicine, McMaster
University, Hamilton, ON, Canada
(Vandvik) Department of Medicine, Innlandet Hospital Trust, Gjovik, Norway
(Vandvik) Institute for Health and Society, Faculty of Medicine,
University of Oslo, Norway
(Schaufele) Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart,
Germany
Title
Cerebral Embolic Protection Devices during Transcatheter Aortic Valve
Implantation: Systematic Review and Meta-Analysis.
Source
Stroke. 48 (5) (pp 1306-1315), 2017. Date of Publication: 01 May 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background and Purpose - Silent ischemic embolic lesions are common after
transcatheter aortic valve implantation (TAVI). The use of embolic
protection devices (EPD) may reduce the occurrence of these embolic
lesions. Thus, a quantitative overview and credibility assessment of the
literature was necessary to draw a robust message about EPD. Therefore,
the aim of this meta-analysis was to study whether the use of EPD reduces
silent ischemic and clinically evident cerebrovascular events associated
with TAVI. Methods - We conducted a comprehensive search to identify
studies that evaluated patients undergoing TAVI with or without EPD.
Random-effects meta-analyses were performed to estimate the effect of EPD
compared with no-EPD during TAVI using aggregate data. Results - Sixteen
studies involving 1170 patients (865/305 with/without EPD) fulfilled the
inclusion criteria. The EPD delivery success rate was reported in all
studies and was achieved in 94.5% of patients. Meta-analyses evaluating
EPD versus without EPD strategies could not confirm or exclude any
differences in terms of clinically evident stroke (relative risk, 0.70;
95% confidence interval [CI], 0.38-1.29; P=0.26) or 30-day mortality
(relative risk, 0.58; 95% CI, 0.20-1.64; P=0.30). There were no
significant differences in new-single, multiple, or total number of
lesions. The use of EPD was associated with a significantly smaller
ischemic volume per lesion (standardized mean difference, -0.52; 95% CI,
-0.85 to -0.20; P=0.002) and smaller total volume of lesions (standardized
mean difference, -0.23; 95% CI, -0.42 to -0.03; P=0.02). Subgroup analysis
by type of valve showed an overall trend toward significant reduction in
new lesions per patient using EPD (standardized mean difference, -0.41;
95% CI, -0.82 to 0.00; P=0.05), driven by self-expanding devices.
Conclusions - The use of EPD during TAVI may be associated with smaller
volume of silent ischemic lesions and smaller total volume of silent
ischemic lesions. However, EPD may not reduce the number of new-single,
multiple, or total number of lesions. There was only very low quality of
evidence showing no significant differences between patients undergoing
TAVI with or without EPD with respect to clinically evident stroke and
mortality.<br/>Copyright &#xa9; 2017 American Heart Association, Inc.

<42>
Accession Number
614651175
Author
Wang Z.J.; Zhang L.L.; Elmariah S.; Han H.Y.; Zhou Y.J.
Institution
(Wang, Zhang, Han, Zhou) Beijing Anzhen Hospital, Capital Medical
University, Beijing Institute of Heart Lung and Blood Vessel Disease, The
Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of
Education, Beijing, China
(Elmariah) Cardiology Division, Department of Medicine, Massachusetts
General Hospital, Boston, United States
Title
Prevalence and Prognosis of Nonobstructive Coronary Artery Disease in
Patients Undergoing Coronary Angiography or Coronary Computed Tomography
Angiography: A Meta-Analysis.
Source
Mayo Clinic Proceedings. 92 (3) (pp 329-346), 2017. Date of Publication:
01 Mar 2017.
Publisher
Elsevier Ltd
Abstract
Objective To evaluate the prevalence, clinical characteristics, and risk
of cardiac events in patients with nonobstructive coronary artery disease
(CAD). Patients and Methods We searched PubMed, EMBASE, and the Cochrane
Library from January 1, 1990, to November 31, 2015. Studies were included
if they reported prevalence or prognosis of patients with nonobstructive
CAD (<=50% stenosis) among patients with known or suspected CAD. Patients
with nonobstructive CAD were further grouped as those with no angiographic
CAD (0% or <=20%) and those with mild CAD (>0% or >20% to <=50%). Data
were pooled using random effects modeling, and annualized event rates were
assessed. Results Fifty-four studies with 1,395,190 participants were
included. The prevalence of patients with nonobstructive CAD was 67% (95%
CI, 63%-71%) among patients with stable angina and 13% (95% CI, 11%-16%)
among patients with non-ST-segment elevation acute coronary syndrome. The
prevalence varied depending on sex, clinical setting, and risk profile of
the population investigated. The risk of hard cardiac events (cardiac
death or myocardial infarction) in patients with mild CAD was lower than
that in patients with obstructive CAD (risk ratio, 0.28; 95% CI,
0.20-0.38) but higher than that in those with no angiographic CAD (risk
ratio, 1.85; 95% CI, 1.52-2.26). The annualized event rates of hard
cardiac events in patients with no angiographic CAD, mild CAD, and
obstructive CAD were 0.3% (95% CI, 0.1%-0.4%), 0.7% (95% CI, 0.5%-1.0%),
and 2.7% (95% CI, 1.7%-3.7%), respectively, among patients with stable
angina and 1.2% (95% CI, 0.02%-2.3%), 4.1% (95% CI, 3.3%-4.9%), and 17.0%
(95% CI, 8.4%-25.7%) among patients with non-ST-segment elevation acute
coronary syndrome. The correlation between CAD severity and prognosis is
consistent regardless of clinical presentation of all-cause death,
myocardial infarction, total cardiovascular events, and revascularization.
Conclusion Nonobstructive CAD is associated with a favorable prognosis
compared with obstructive CAD, but it is not benign. The high prevalence
and impaired prognosis of this population warrants further efforts to
improve the risk stratification and management of patients with
nonobstructive CAD.<br/>Copyright &#xa9; 2016 Mayo Foundation for Medical
Education and Research

<43>
Accession Number
615731043
Author
Kuck K.-H.; Tilz R.R.; Deneke T.; Hoffmann B.A.; Ventura R.; Hansen P.S.;
Zarse M.; Hohnloser S.H.; Kautzner J.; Willems S.
Institution
(Kuck, Tilz) Department of Cardiology, Asklepios Klinik St. Georg,
Lohmuhlenstr. 5, Hamburg 20099, Germany
(Deneke) University Heart Center, University Hospital Bergmannsheil,
Bochum, Germany
(Hoffmann, Ventura, Willems) University Heart Center, Department of
Cardiology - Electrophysiology, Hamburg, Germany
(Hansen) Department of Cardiology, Aarhus University Hospital, Denmark
(Zarse) University of Witten-Herdecke, Germany
(Hohnloser) University Hospital Frankfurt, Germany
(Kautzner) Institute for Clinical and Experimental Medicine, Prague, Czech
Republic
(Tilz) Medical Clinic II, University Heart Center Lubeck, Germany
(Deneke) Klinik fur Kardiologie II, Herz- und Gefasklinik GmbH, Bad
Neustadt/Saale, Germany
(Hansen) Heart Center Varde, Denmark
Title
Impact of substrate modification by catheter ablation on implantable
cardioverter-defibrillator interventions in patients with unstable
ventricular arrhythmias and coronary artery disease: Results from the
multicenter randomized controlled SMS (Substrate Modification Study).
Source
Circulation: Arrhythmia and Electrophysiology. 10 (3) (no pagination),
2017. Article Number: e004422. Date of Publication: 01 Mar 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - The implantable cardioverter-defibrillator (ICD) is the
standard therapy to prevent sudden cardiac death in patients with coronary
artery disease and unstable ventricular tachyarrhythmias. The prospective
multinational SMS (Substrate Modification Study) was designed to assess
whether prophylactic ablation of the arrhythmogenic substrate reduces or
prevents the recurrence of ventricular tachycardia/ventricular
fibrillation in such patients. Methods and Results - Of 111 patients
included in an intention-to-treat analysis, 54 were randomly assigned
catheter ablation plus ICD implantation (ablation group: 68+/-8 years; 47
men), whereas 57 were assigned ICD implantation without catheter ablation
(ICD-only group: 66+/-8 years; 46 men). Primary study end point was the
time to first recurrence of ventricular tachycardia/ventricular
fibrillation. ICD episodes were assessed and verified by an independent
board. Patients were followed up for 2.3+/-1.1 years. The primary end
point was reached by 25 ablation patients and 26 ICD-only patients.
Two-year event-free survival was estimated at 49.0% (95% confidence
interval, 33.3%-62.9%) in the former and 52.4% (36.7%-65.9%) in the latter
groups. Comparison of episode incidence revealed no significant difference
in the primary end point (P=0.84). In an Andersen-Gill regression model
with multiple end point recurrences, the difference between the study arms
significantly favored catheter ablation for both the primary end point and
all but one of the predefined subgroups of detected arrhythmia events.
Conclusions - SMS failed to meet the primary end point of time to first
ventricular tachycardia/ventricular fibrillation recurrence. However,
catheter ablation did reduce the total number of ICD interventions during
the duration of follow-up. Clinical Trial Registration -
https://clinicaltrials.gov. Unique identifier: NCT00170287.<br/>Copyright
&#xa9; 2017 American Heart Association, Inc.

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Accession Number
615488589
Author
Murthy S.B.; Gupta A.; Merkler A.E.; Navi B.B.; Mandava P.; Iadecola C.;
Sheth K.N.; Hanley D.F.; Ziai W.C.; Kamel H.
Institution
(Murthy, Merkler, Navi, Iadecola, Kamel) Department of Neurology, 525 E
68th St, Room F610, New York, NY 10065, United States
(Murthy, Gupta, Merkler, Navi, Iadecola, Kamel) Clinical and Translational
Neuroscience Unit, Feil Family Brain and Mind Research Institute, United
States
(Gupta) Department of Radiology, Weill Cornell Medicine, New York, NY,
United States
(Mandava) Stroke Outcomes Laboratory, Department of Neurology, Baylor
College of Medicine and the Michael E. DeBakey VA Medical Center, Houston,
TX, United States
(Sheth) Division of Neurocritical Care and Emergency Neurology, Department
of Neurology, Yale University School of Medicine, New Haven, CT, United
States
(Hanley) Division of Brain Injury Outcomes, United States
(Ziai) Division of Neurosciences Critical Care, Johns Hopkins University
School of Medicine, Baltimore, MD, United States
Title
Restarting Anticoagulant Therapy after Intracranial Hemorrhage: A
Systematic Review and Meta-Analysis.
Source
Stroke. 48 (6) (pp 1594-1600), 2017. Date of Publication: 01 Jun 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background and Purpose-The safety and efficacy of restarting
anticoagulation therapy after intracranial hemorrhage (ICH) remain
unclear. We performed a systematic review and meta-Analysis to summarize
the associations of anticoagulation resumption with the subsequent risk of
ICH recurrence and thromboembolism. Methods-We searched published medical
literature to identify cohort studies involving adults with
anticoagulation-Associated ICH. Our predictor variable was resumption of
anticoagulation. Outcome measures were thromboembolic events (stroke and
myocardial infarction) and recurrence of ICH. After assessing study
heterogeneity and publication bias, we performed a meta-Analysis using
random-effects models to assess the strength of association between
anticoagulation resumption and our outcomes. Results-Eight studies were
eligible for inclusion in the meta-Analysis, with 5306 ICH patients.
Almost all studies evaluated anticoagulation with Vitamin K antagonists.
Reinitiation of anticoagulation was associated with a significantly lower
risk of thromboembolic complications (pooled relative risk, 0.34; 95%
confidence interval, 0.25-0.45; Q=5.12, P for heterogeneity=0.28). There
was no evidence of increased risk of recurrent ICH after reinstatement of
anticoagulation therapy, although there was significant heterogeneity
among included studies (pooled relative risk, 1.01; 95% confidence
interval, 0.58-1.77; Q=24.68, P for heterogeneity <0.001). No significant
publication bias was detected in our analyses. Conclusions-In
observational studies, reinstitution of anticoagulation after ICH was
associated with a lower risk of thromboembolic complications and a similar
risk of ICH recurrence. Randomized clinical trials are needed to determine
the true risk-benefit profile of anticoagulation resumption after
ICH.<br/>Copyright &#xa9; 2017 American Heart Association, Inc.

<45>
Accession Number
616369006
Author
Mehta R.H.; Leimberger J.D.; Van Diepen S.; Meza J.; Wang A.; Jankowich
R.; Harrison R.W.; Hay D.; Fremes S.; Duncan A.; Soltesz E.G.; Luber J.;
Park S.; Argenziano M.; Murphy E.; Marcel R.; Kalavrouziotis D.; Nagpal
D.; Bozinovski J.; Toller W.; Heringlake M.; Goodman S.G.; Levy J.H.;
Harrington R.A.; Anstrom K.J.; Alexander J.H.
Institution
(Mehta, Leimberger, Meza, Wang, Harrison, Levy, Anstrom, Alexander) Duke
Clinical Research Institute, Duke University School of Medicine, 2400
Pratt St., Durham, NC 27705, United States
(Jankowich, Hay) Tenax Therapeutics, Morrisville, NC, United States
(Van Diepen, Goodman) Canadian VIGOUR Centre, University of Alberta,
Edmonton, Canada
(Fremes) Sunnybrook Health Sciences Centre, Toronto, Canada
(Kalavrouziotis) Quebec Heart and Lung Institute, London, QC, Canada
(Nagpal) Health Sciences Centre, London, ON, Canada
(Bozinovski) Victoria Heart Institute Foundation, Victoria, BC, Canada
(Duncan, Soltesz) Cleveland Clinic Foundation, Cleveland, United States
(Park) University Hospitals Cleveland Medical Center, Cleveland, United
States
(Luber) Franciscan Health System, Tacoma, WA, United States
(Argenziano) Columbia University Medical Center, New York, United States
(Murphy) Spectrum Health, Grand Rapids, MI, United States
(Marcel) Heart Hospital Baylor Plano, Plano, TX, United States
(Toller) Medical University of Graz, Graz, Austria
(Heringlake) University of Luebeck, Luebeck, Germany
(Harrington) Department of Medicine, Stanford University, Stanford, United
States
Title
Levosimendan in patients with left ventricular dysfunction undergoing
cardiac surgery.
Source
New England Journal of Medicine. 376 (21) (pp 2032-2042), 2017. Date of
Publication: 25 May 2017.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Levosimendan is an inotropic agent that has been shown in small
studies to prevent or treat the low cardiac output syndrome after cardiac
surgery. METHODS In a multicenter, randomized, placebo-controlled, phase 3
trial, we evaluated the efficacy and safety of levosimendan in patients
with a left ventricular ejection fraction of 35% or less who were
undergoing cardiac surgery with the use of cardiopulmonary bypass.
Patients were randomly assigned to receive either intravenous levosimendan
(at a dose of 0.2 mug per kilogram of body weight per minute for 1 hour,
followed by a dose of 0.1 mug per kilogram per minute for 23 hours) or
placebo, with the infusion started before surgery. The two primary end
points were a four-component composite of death through day 30,
renal-replacement therapy through day 30, perioperative myocardial
infarction through day 5, or use of a mechanical cardiac assist device
through day 5; and a two-component composite of death through day 30 or
use of a mechanical cardiac assist device through day 5. RESULTS A total
of 882 patients underwent randomization, 849 of whom received levosimendan
or placebo and were included in the modified intention-to-treat
population. The four-component primary end point occurred in 105 of 428
patients (24.5%) assigned to receive levosimendan and in 103 of 421
(24.5%) assigned to receive placebo (adjusted odds ratio, 1.00; 99%
confidence interval [CI], 0.66 to 1.54; P = 0.98). The two-component
primary end point occurred in 56 patients (13.1%) assigned to receive
levosimendan and in 48 (11.4%) assigned to receive placebo (adjusted odds
ratio, 1.18; 96% CI, 0.76 to 1.82; P = 0.45). The rate of adverse events
did not differ significantly between the two groups. CONCLUSIONS
Prophylactic levosimendan did not result in a rate of the short-term
composite end point of death, renal-replacement therapy, perioperative
myocardial infarction, or use of a mechanical cardiac assist device that
was lower than the rate with placebo among patients with a reduced left
ventricular ejection fraction who were undergoing cardiac surgery with the
use of cardiopulmonary bypass. (Funded by Tenax Therapeutics; LEVO-CTS
ClinicalTrials.gov number, NCT02025621.)<br/>Copyright &#xa9; 2017
Massachusetts Medical Society. All rights reserved.

<46>
Accession Number
616369005
Author
Landoni G.; Lomivorotov V.V.; Alvaro G.; Lobreglio R.; Pisano A.;
Guarracino F.; Calabro M.G.; Grigoryev E.V.; Likhvantsev V.V.;
Salgado-Filho M.F.; Bianchi A.; Pasyuga V.V.; Baiocchi M.; Pappalardo F.;
Monaco F.; Boboshko V.A.; Abubakirov M.N.; Amantea B.; Lembo R.; Brazzi
L.; Verniero L.; Bertini P.; Scandroglio A.M.; Bove T.; Belletti A.;
Michienzi M.G.; Shukevich D.L.; Zabelina T.S.; Bellomo R.; Zangrillo A.
Institution
(Landoni, Calabro, Pappalardo, Monaco, Lembo, Scandroglio, Bove, Belletti,
Zangrillo) Department of Anesthesia and Intensive Care, San Raffaele
Scientific Institute, Milan, Italy
(Landoni, Zangrillo) Vita-Salute San Raffaele University, Milan, Italy
(Alvaro, Amantea, Michienzi) Department of Anesthesia and Intensive Care,
Azienda Ospedaliero, Universitaria Mater Domini Germaneto, Catanzaro,
Italy
(Lobreglio, Brazzi) Department of Anesthesia and Intensive Care, Azienda
Ospedaliero, Universitaria Citta della Salute e della Scienza, Turin,
Italy
(Bianchi) Department of Cardiovascular Anesthesia and Intensive Care,
Azienda Ospedaliera Ordine Mauriziano, Turin, Italy
(Brazzi) Department of Surgical Sciences, University of Turin, Turin,
Italy
(Pisano, Verniero) Division of Cardiac Anesthesia and Intensive Care Unit,
Azienda Ospedaliera di Rilievo Nazionale Dei Colli-Monaldi Hospital,
Naples, Italy
(Guarracino, Bertini) Division of Cardiothoracic and Vascular Anesthesia
and Intensive Care, Department of Anesthesia and Critical Care Medicine,
Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
(Baiocchi) Department of Cardiothoracic and Vascular Anesthesia and
Intensive Care, University Hospital Policlinico S. Orsola, Bologna, Italy
(Lomivorotov, Boboshko, Abubakirov) Department of Anesthesiology and
Intensive Care, State Research Institute of Circulation Pathology,
Novosibirsk, Russian Federation
(Grigoryev, Shukevich) Department of Anesthesiology and Intensive Care,
State Research Institute for Complex Issues of Cardiovascular Disease,
Kemerovo, Russian Federation
(Likhvantsev, Zabelina) Department of Anesthesiology and Intensive Care,
Moscow Regional Clinical and Research Institute, Moscow, Russian
Federation
(Pasyuga) Department of Anesthesiology and Intensive Care, Federal Center
for Cardiovascular Surgery Astrakhan, Astrakhan, Russian Federation
(Salgado-Filho) Federal University of Juiz de for A, Juiz de Fora, Brazil
(Bellomo) Department of Intensive Care, Austin Hospital, Heidelberg,
University of Melbourne, Melbourne, VIC 3084, Australia
Title
Levosimendan for Hemodynamic Support after Cardiac Surgery.
Source
New England Journal of Medicine. 376 (21) (pp 2021-2031), 2017. Date of
Publication: 25 May 2017.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Acute left ventricular dysfunction is a major complication of
cardiac surgery and is associated with increased mortality. Meta-analyses
of small trials suggest that levosimendan may result in a higher rate of
survival among patients undergoing cardiac surgery. METHODS We conducted a
multicenter, randomized, double-blind, placebo-controlled trial involving
patients in whom perioperative hemodynamic support was indicated after
cardiac surgery, according to prespecified criteria. Patients were
randomly assigned to receive levosimendan (in a continuous infusion at a
dose of 0.025 to 0.2 mug per kilogram of body weight per minute) or
placebo, for up to 48 hours or until discharge from the intensive care
unit (ICU), in addition to standard care. The primary outcome was 30-day
mortality. RESULTS The trial was stopped for futility after 506 patients
were enrolled. A total of 248 patients were assigned to receive
levosimendan and 258 to receive placebo. There was no significant
difference in 30-day mortality between the levosimendan group and the
placebo group (32 patients [12.9%] and 33 patients [12.8%], respectively;
absolute risk difference, 0.1 percentage points; 95% confidence interval
[CI], -5.7 to 5.9; P = 0.97). There were no significant differences
between the levosimendan group and the placebo group in the durations of
mechanical ventilation (median, 19 hours and 21 hours, respectively;
median difference, -2 hours; 95% CI, -5 to 1; P = 0.48), ICU stay (median,
72 hours and 84 hours, respectively; median difference, -12 hours; 95% CI,
-21 to 2; P = 0.09), and hospital stay (median, 14 days and 14 days,
respectively; median difference, 0 days; 95% CI, -1 to 2; P = 0.39). There
was no significant difference between the levosimendan group and the
placebo group in rates of hypotension or cardiac arrhythmias. CONCLUSIONS
In patients who required perioperative hemodynamic support after cardiac
surgery, low-dose levosimendan in addition to standard care did not result
in lower 30-day mortality than placebo. (Funded by the Italian Ministry of
Health; CHEETAH ClinicalTrials.gov number, NCT00994825.).<br/>&#xa9;
Copyright 2017 Massachusetts Medical Society. All rights reserved.

<47>
Accession Number
616041459
Author
Abdallah M.S.; Wang K.; Magnuson E.A.; Osnabrugge R.L.; Kappetein A.P.;
Morice M.-C.; Mohr F.A.; Serruys P.W.; Cohen D.J.
Institution
(Abdallah) Robert and Suzanne Tomsich Department of Cardiovascular
Medicine, Cleveland Clinic, Cleveland, Ohio, United States
(Wang, Magnuson, Cohen) Saint Luke's Mid America Heart Institute, Kansas
City, Missouri, United States
(Magnuson, Cohen) University of Missouri-Kansas City School of Medicine,
Kansas City, Missouri, United States
(Osnabrugge, Kappetein, Serruys) Erasmus University Medical Center,
Rotterdam, Netherlands
(Morice) Hopital Prive Jacques Cartier, Massy, France
(Mohr) Herzzentrum Universitat Leipzig, Leipzig, Germany
Title
Quality of Life After Surgery or DES in Patients With 3-Vessel or Left
Main Disease.
Source
Journal of the American College of Cardiology. 69 (16 Supplement) (pp
2039-2050), 2017. Date of Publication: 25 Apr 2017.
Publisher
Elsevier USA
Abstract
Background In the SYNTAX (Synergy Between Percutaneous Coronary
Intervention With Taxus and Cardiac Surgery) trial, patients with 3-vessel
or left main coronary artery disease (CAD) had improved long-term outcomes
with coronary artery bypass graft (CABG) surgery compared with
percutaneous coronary intervention (PCI) with drug-eluting stents (DES),
improvements driven mainly by differences in myocardial infarction and
repeat revascularization. Objectives This study compared the long-term
quality-of-life benefits of DES-PCI versus CABG for patients with 3-vessel
or left main CAD. Methods Between 2005 and 2007, the SYNTAX trial
randomized 1,800 patients with 3-vessel or left main CAD to either CABG or
DES-PCI. Health status was assessed at baseline and at 1, 6, 12, 36, and
60 months by using the Seattle Angina Questionnaire (SAQ) and the 36-Item
Short Form Health Survey. Results At 5-year follow-up, CABG was superior
to DES-PCI on several SAQ domains including angina frequency and physical
function, as well as the role physical and role emotional scales of the
36-Item Short Form Health Survey. Subgroup analysis demonstrated a
significant interaction between angiographic complexity (as assessed by
the SYNTAX score) and angina relief (mean difference in the SAQ angina
frequency score for CABG vs. PCI of -0.9, 3.3, and 3.9 points for low,
intermediate, and high SYNTAX score patients, respectively; p = 0.048 for
interaction). Conclusions Among patients with 3-vessel or left main CAD,
both CABG and DES-PCI were associated with substantial and sustained
quality-of-life benefits over 5 years of follow-up. In general, CABG
resulted in greater angina relief, although the absolute treatment benefit
was small. Angina relief at 5 years was enhanced with CABG among patients
with high SYNTAX scores, a finding reinforcing the recommendation that
CABG should be strongly preferred for such patients. (Synergy Between
Percutaneous Coronary Intervention With Taxus and Cardiac Surgery
[SYNTAX]; NCT00114972)<br/>Copyright &#xa9; 2017 American College of
Cardiology Foundation

<48>
Accession Number
616041411
Author
Palmerini T.; Bacchi Reggiani L.; Della Riva D.; Romanello M.; Feres F.;
Abizaid A.; Gilard M.; Morice M.-C.; Valgimigli M.; Hong M.-K.; Kim B.-K.;
Jang Y.; Kim H.-S.; Park K.W.; Colombo A.; Chieffo A.; Ahn J.-M.; Park
S.-J.; Schupke S.; Kastrati A.; Montalescot G.; Steg P.G.; Diallo A.;
Vicaut E.; Helft G.; Biondi-Zoccai G.; Xu B.; Han Y.; Genereux P.; Bhatt
D.L.; Stone G.W.
Institution
(Palmerini, Bacchi Reggiani, Della Riva, Romanello) Dipartimento
Cardio-Toraco-Vascolare, University of Bologna, Bologna, Italy
(Feres, Abizaid) Istituto Dante Pazzanese de Cardiologia, Sao Paulo,
Brazil
(Gilard) Department of Cardiology, Brest University, Brest, France
(Morice) Generale de Sante, Institut Cardiovasculaire Paris Sud, Massy,
France
(Valgimigli) Swiss Cardiovascular Center, Bern, Switzerland
(Hong, Kim, Jang) Severance Cardiovascular Hospital, Yonsei University
College of Medicine, Seoul, South Korea
(Kim, Park) Department of Internal Medicine, Seoul National University
Hospital, Seoul, South Korea
(Colombo, Chieffo) San Raffaele Scientific Institute, Milan, Italy
(Ahn, Park) The Heart Institute, University of Ulsan College of Medicine,
Asan Medical Center, Seoul, South Korea
(Schupke, Kastrati) ISAResearch Center, Deutsches Herzzentrum and
Deutsches Zentrum fur Herz-Kreislauf-Forschung, partner site Munich Heart
Alliance, Munich, Germany
(Montalescot) Sorbonne Universite-Paris 6, ACTION Study Group, Institut de
Cardiologie, Centre Hospitalier Universitaire Pitie-Salpetriere, Paris,
France
(Steg) Hopital Bichat, Assistance Publique-Hopitaux de Paris, Paris,
France
(Diallo, Vicaut) Unite de Recherche Clinique Lariboisiere Saint-Louis
Hopital Fernand Widal, Assistance Publique-Hopitaux de Paris, Paris,
France
(Helft) Institut de Cardiologie, Hopital Pitie-Salpetriere, Assistance
Publique-Hopitaux de Paris, Paris, France
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Latina, and Department of
AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
(Xu) Catheterization Laboratory, Fu Wai Hospital, National Center for
Cardiovascular Diseases, Beijing, China
(Han) Department of Cardiology, General Hospital of Shenyang Military
Region, Shenyang, China
(Genereux, Stone) Columbia University Medical Center/New York-Presbyterian
Hospital and the Cardiovascular Research Foundation, New York, New York,
United States
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center and Harvard
Medical School, Boston, Massachusetts, United States
Title
Bleeding-Related Deaths in Relation to the Duration of Dual-Antiplatelet
Therapy After Coronary Stenting.
Source
Journal of the American College of Cardiology. 69 (16 Supplement) (pp
2011-2022), 2017. Date of Publication: 25 Apr 2017.
Publisher
Elsevier USA
Abstract
Background Although some randomized controlled trials (RCTs) and
meta-analyses have suggested that prolonged dual-antiplatelet therapy
(DAPT) may be associated with increased mortality, the mechanistic
underpinnings of this association remain unclear. Objectives The aim of
this study was to analyze the associations among bleeding, mortality, and
DAPT duration after drug-eluting stent implantation in a meta-analysis of
RCTs. Methods RCTs comparing different DAPT durations after drug-eluting
stent placement were sought through the MEDLINE, Embase, and Cochrane
databases and the proceedings of international meetings. Deaths were
considered possibly bleeding related if occurring within 1 year of the
episodes of bleeding. Primary analysis was by intention-to-treat.
Secondary analysis was performed in a modified intention-to-treat
population in which events occurring when all patients were on DAPT were
excluded. Results Individual patient data were obtained for 6 RCTs, and
aggregate data were available for 12 RCTs. Patients with bleeding had
significantly higher rates of mortality compared with those without, and
in a time-adjusted multivariate analysis, bleeding was an independent
predictor of mortality occurring within 1 year of the bleeding episode
(hazard ratio: 6.93; 95% confidence interval: 4.53 to 10.60; p < 0.0001).
Shorter DAPT was associated with lower rates of all-cause death compared
with longer DAPT (hazard ratio: 0.85; 95% confidence interval: 0.73 to
1.00; p = 0.05), which was driven by lower rates of bleeding-related
deaths with shorter DAPT compared with prolonged DAPT (hazard ratio: 0.65;
95% confidence interval: 0.43 to 0.99; p = 0.04). Mortality unrelated to
bleeding was comparable between the 2 groups. Similar results were
apparent in the modified intention-to-treat population. Conclusions
Bleeding was strongly associated with the occurrence of mortality within 1
year after the bleeding event. Shorter compared with longer DAPT was
associated with lower risk for bleeding-related death, a finding that may
underlie the lower all-cause mortality with shorter DAPT in the RCTs of
different DAPT durations after DES.<br/>Copyright &#xa9; 2017 American
College of Cardiology Foundation

<49>
Accession Number
614701189
Author
Davar J.; Connolly H.M.; Caplin M.E.; Pavel M.; Zacks J.; Bhattacharyya
S.; Cuthbertson D.J.; Dobson R.; Grozinsky-Glasberg S.; Steeds R.P.;
Dreyfus G.; Pellikka P.A.; Toumpanakis C.
Institution
(Davar) Carcinoid Heart Disease Clinic, Department of Cardiology, Royal
Free Hospital, London, United Kingdom
(Connolly, Pellikka) Department of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minnesota, United States
(Caplin, Toumpanakis) Neuroendocrine Tumor Unit, ENETS Centre of
Excellence, Royal Free Hospital, London, United Kingdom
(Pavel) Internal Medicine with Gastroenterology and Nephrology,
Charite-Universitatsmedizin Berlin, Berlin, Germany
(Zacks) Center for Carcinoid and Neuroendocrine Tumors of the Icahn School
of Medicine at Mount Sinai, New York, New York, United States
(Bhattacharyya) Barts Heart Centre, St. Bartholomew's Hospital, London,
UCL Institute of Cardiovascular Science, University College London,
London, United Kingdom
(Cuthbertson) Obesity and Endocrinology Research Group, Institute of
Ageing and Chronic Diseases, University of Liverpool, Liverpool, United
Kingdom
(Dobson) Department of Cardiology, Liverpool Heart and Chest Hospital,
Liverpool, United Kingdom
(Grozinsky-Glasberg) Neuroendocrine Tumor Unit, Endocrinology and
Metabolism Service, Department of Medicine, Hadassah-Hebrew University
Medical Center, Jerusalem, Israel
(Steeds) University Hospital Birmingham, NHS Foundation Trust and
Institute of Cardiovascular Sciences, University of Birmingham,
Birmingham, United Kingdom
(Dreyfus) Cardiothoracic Center of Monaco, Monaco, France
Title
Diagnosing and Managing Carcinoid Heart Disease in Patients With
Neuroendocrine Tumors: An Expert Statement.
Source
Journal of the American College of Cardiology. 69 (10) (pp 1288-1304),
2017. Date of Publication: 14 Mar 2017.
Publisher
Elsevier USA
Abstract
Carcinoid heart disease is a frequent occurrence in patients with
carcinoid syndrome and is responsible for substantial morbidity and
mortality. The pathophysiology of carcinoid heart disease is poorly
understood; however, chronic exposure to excessive circulating serotonin
is considered one of the most important contributing factors. Despite
recognition, international consensus guidelines specifically addressing
the diagnosis and management of carcinoid heart disease are lacking.
Furthermore, there is considerable variation in multiple aspects of
screening and management of the disease. The aim of these guidelines was
to provide succinct, practical advice on the diagnosis and management of
carcinoid heart disease as well as its surveillance. Recommendations and
proposed algorithms for the investigation, screening, and management have
been developed based on an evidence-based review of the published data and
on the expert opinion of a multidisciplinary consensus panel consisting of
neuroendocrine tumor experts, including oncologists, gastroenterologists,
and endocrinologists, in conjunction with cardiologists and cardiothoracic
surgeons.<br/>Copyright &#xa9; 2017 American College of Cardiology
Foundation

<50>
Accession Number
617956058
Author
Elmaraezy A.; Ismail A.; Abushouk A.I.; Eltoomy M.; Saad S.; Negida A.;
Abdelaty O.M.; Abdallah A.R.; Aboelfotoh A.M.; Hassan H.M.; Elmaraezy
A.G.; Morsi M.; Althaher F.; Althaher M.; AlSafadi A.M.
Institution
(Elmaraezy, Ismail) Al-Azhar University, Faculty of Medicine, Cairo, Egypt
(Elmaraezy, Ismail, Abushouk) NovaMed Medical Research Association, Cairo,
Egypt
(Abushouk) Ain Shams University, Faculty of Medicine, Cairo, Egypt
(Eltoomy) University of Sadat City, Genetic Engineering and Biotechnology
Research Institute (GEBRI), Sadat City, Egypt
(Saad) Tanta University, Faculty of Medicine, Tanta, Egypt
(Negida) Zagazig University, Faculty of Medicine, Zagazig, Egypt
(Abdelaty) Ahmed Maher Teaching Hospital, Cairo, Egypt
(Abdallah, Aboelfotoh) Benha University, Faculty of Medicine, Benha, Egypt
(Hassan) Beni Suef University, Faculty of Medicine, Beni suef, Egypt
(Elmaraezy, Morsi) Minoufia University, Faculty of Medicine, Shebin
El-Kom, Egypt
(Althaher, Althaher) Misr University for science and technology (MUST),
6th of October City, Faculty of Medicine, Giza, Egypt
(AlSafadi) Damascus University, Faculty of Medicine, Damascus, Syrian Arab
Republic
Title
Efficacy and safety of transcatheter aortic valve replacement in aortic
stenosis patients at low to moderate surgical risk: A comprehensive
meta-analysis.
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 234. Date of Publication: 24 Aug 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Recently, transcatheter aortic valve replacement (TAVR) has
become the procedure of choice in high surgical risk patients with aortic
stenosis (AS). However, its value is still debated in operable AS cases.
We performed this meta-analysis to compare the safety and efficacy of TAVR
to surgical aortic valve replacement (SAVR) in low-to-moderate surgical
risk patients with AS. Methods: A systematic search of five authentic
databases retrieved 11 eligible studies (20,056 patients). Relevant Data
were pooled as risk ratios (RRs) or standardized mean differences (SMD),
with their 95% confidence interval, using Comprehensive Meta-Analysis and
RevMan software for windows. Results: At one-year of follow-up, the pooled
effect-estimates showed no significant difference between TAVR and SAVR
groups in terms of all-cause mortality (RR 1.02, 95% CI [0.83, 1.26],
stroke (RR 0.83, 95%CI [0.56, 1.21]), myocardial infarction (RR 0.82, 95%
CI [0.57, 1.19]), and length of hospital stay (SMD -0.04, 95% CI [-0.34,
0.26]). The incidence of major bleeding (RR 0.45, 95% CI [0.24, 0.86]) and
acute kidney injury (RR 0.52, 95% CI [0.30, 0.88]) was significantly lower
in the TAVR group, compared to the SAVR group. However, TAVR was
associated with a higher risk of permanent pacemaker implantation (RR
2.57, 95% CI [1.36, 4.86]), vascular-access complications at 1 year (RR
1.99, 95%CI [1.04, 3.80]), and paravalvular aortic regurgitation at 30
days (RR 3.90, 95% CI [1.25, 12.12]), compared to SAVR. Conclusions: Due
to the comparable mortality rates in SAVR and TAVR groups and the lower
risk of life-threatening complications in the TAVR group, TAVR can be an
acceptable alternative to SAVR in low-to-moderate risk patients with AS.
However, larger trials with longer follow-up periods are required to
compare the long-term outcomes of both techniques.<br/>Copyright &#xa9;
2017 The Author(s).

<51>
Accession Number
616609141
Author
Priti K.; Agrawal A.; Ranwa B.L.
Institution
(Priti, Agrawal, Ranwa) Dept of cardiology, JLN hospital, Ajmer, Rajasthan
305001, India
Title
High versus low dose statin therapy in Indian patients with acute
ST-segment elevation myocardial infarction undergoing thrombolysis.
Source
Indian Heart Journal. 69 (4) (pp 453-457), 2017. Date of Publication: July
2017.
Publisher
Elsevier B.V.
Abstract
Objectives This study sought to compare high dose versus low dose statin
therapy in Indian patients with ST-segment elevation myocardial infarction
(STEMI) undergoing thrombolysis. Background Randomized trials have
demonstrated that statin treatment reduced major adverse cardiac events
(MACEs) in patients with stable angina pectoris and acute coronary
syndrome. However, randomized studies of statin therapy in Indian patients
with STEMI are scarce. Methods Of 1859 patients with acute STEMI, 1027
eligible patients were randomized to 80-mg (n = 512) or 10-mg (n = 515)
atorvastatin. Primary end point was 30-day incidence of MACE (death from
any cause, myocardial infarction, NSTE-ACS requiring readmission, ischemia
driven revascularization, and stroke). Secondary end points included
individual components of primary end point and ST-segment resolution at 90
min after thrombolysis. Results Two groups did not differ in primary
endpoints of MACEs (8.79% in high dose vs 9.32% in low dose atorvastatin
group, OR = 0.938, 95% CI = 0.612-1.436, P = 0.764). With 80 mg
atorvastatin, there was insignificant reduction in rate of reinfarction,
revascularization and death. Stroke and readmission for NSTE-ACS increased
in 80 mg atrovastatin group, but was not statistically significant.
ST-segment resolution was significantly higher in 80-mg atorvastatin arm
(45.90% vs. 37.67%; p = 0.008). Myalgia was more in 80 mg statin group
(18.06% vs 7.57%, p = 0.0001). Conclusions High-dose atorvastatin did not
show significant difference of MACEs in STEMI patients undergoing
thrombolysis but showed significant improvement in immediate coronary flow
depicted by ST-segment resolution. This benefit of high dose statin is to
be weighed against greater myalgia, drug discontinuation and cost in
Indian patients.<br/>Copyright &#xa9; 2017

<52>
Accession Number
617935400
Author
Swart L.M.; van der Zanden V.; Spies P.E.; de Rooij S.E.; van Munster B.C.
Institution
(Swart, van der Zanden, de Rooij) Department of Internal Medicine,
Geriatrics Section, Academic Medical Center, University of Amsterdam,
Meibergdreef 9, Amsterdam 1105 AZ, Netherlands
(Spies, van Munster) Gelre Hospitals, Department of Geriatric Medicine,
Albert Schweitzerlaan 31, Apeldoorn 7334 DZ, Netherlands
(de Rooij, van Munster) Department of Internal Medicine, University Center
of Geriatric Medicine, University Medical Center Groningen, Hanzeplein 1,
Groningen 9713 GZ, Netherlands
Title
The Comparative Risk of Delirium with Different Opioids: A Systematic
Review.
Source
Drugs and Aging. 34 (6) (pp 437-443), 2017. Date of Publication: 01 Jun
2017.
Publisher
Springer International Publishing
Abstract
Objective: There is substantial evidence that the use of opioids increases
the risk of adverse outcomes such as delirium, but whether this risk
differs between the various opioids remains controversial. In this
systematic review, we evaluate and discuss possible differences in the
risk of delirium from the use of various types of opioids in older
patients. Methods: We performed a search in MEDLINE by combining search
terms on delirium and opioids. A specific search filter for use in
geriatric medicine was used. Quality was scored according to the quality
assessment for cohort studies of the Dutch Cochrane Institute. Results:
Six studies were included, all performed in surgical departments and all
observational. No study was rated high quality, one was rated moderate
quality, and five were rated low quality. Information about dose, route,
and timing of administration of the opioid was frequently missing. Pain
and other important risk factors of delirium were often not taken into
account. Use of tramadol or meperidine was associated with an increased
risk of delirium, whereas the use of morphine, fentanyl, oxycodone, and
codeine were not, when compared with no opioid. Meperidine was also
associated with an increased risk of delirium compared with other opioids,
whereas tramadol was not. The risk of delirium appeared to be lower with
hydromorphone or fentanyl, compared with other opioids. Numbers used for
comparisons were small. Conclusion: Some data suggest that meperidine may
lead to a higher perioperative risk for delirium; however, high-quality
studies that compare different opioids are lacking. Further comparative
research is needed.<br/>Copyright &#xa9; 2017, The Author(s).

<53>
Accession Number
617421439
Author
Ali Z.A.; Serruys P.W.; Kimura T.; Gao R.; Ellis S.G.; Kereiakes D.J.;
Onuma Y.; Simonton C.; Zhang Z.; Stone G.W.
Institution
(Ali, Stone) New York Presbyterian Hospital, Columbia University Medical
Center and the Cardiovascular Research Foundation, New York, NY, United
States
(Serruys) International Centre for Cardiovascular Health, Imperial
College, London, London, United Kingdom
(Kimura) Kyoto University Hospital, Kyoto, Japan
(Gao) Fu Wai Hospital, National Center for Cardiovascular Diseases,
Chinese Academy of Medical Sciences, Beijing, China
(Ellis) Cleveland Clinic, Cleveland, OH, United States
(Kereiakes) The Christ Hospital, Heart and Vascular Center, Lindner
Research Center, Cincinnati, OH, United States
(Onuma) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Simonton, Zhang) Abbott Vascular, Santa Clara, CA, United States
Title
2-year outcomes with the Absorb bioresorbable scaffold for treatment of
coronary artery disease: a systematic review and meta-analysis of seven
randomised trials with an individual patient data substudy.
Source
The Lancet. 390 (10096) (pp 760-772), 2017. Date of Publication: 19 - 25
August 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Bioresorbable vascular scaffolds (BVS) offer the potential to
improve long-term outcomes of percutaneous coronary intervention after
their complete bioresorption. Randomised trials have shown non-inferiority
between BVS and metallic drug-eluting stents at 1 year in composite safety
and effectiveness outcomes, although some increases in rates of target
vessel-related myocardial infarction and device thrombosis were
identified. Outcomes of BVS following the first year after implantation
are unknown. We sought to ascertain whether BVS are as safe and effective
as drug-eluting stents within 2 years after implantation and between 1 and
2 years. Methods We did a systematic review and meta-analysis of
randomised trials in which patients were randomly assigned to
everolimus-eluting Absorb BVS or metallic everolimus-eluting stents (EES)
and followed up for at least 2 years. We searched MEDLINE, the Cochrane
database, TCTMD, ClinicalTrials.gov, Clinical Trial Results, CardioSource,
and abstracts and presentations from major cardiovascular meetings up to
April 1, 2017, to identify relevant studies. The primary efficacy outcome
measure was the device-oriented composite endpoint (cardiac mortality,
target vessel-related myocardial infarction, or ischaemia-driven target
lesion revascularisation) and the primary safety outcome measure was
definite or probable device thrombosis. Individual patient data from the
four ABSORB trials were used for landmark and subgroup analysis and
multivariable modelling. Findings We identified seven randomised trials in
which 5583 patients were randomly assigned to Absorb BVS (n=3261) or
metallic EES (n=2322) and followed up for 2 years. BVS had higher 2-year
relative risks of the device-oriented composite endpoint than did EES
(9.4% [304 of 3217] vs 7.4% [169 of 2299]; relative risk [RR] 1.29 [95% CI
1.08-1.56], p=0.0059). These differences were driven by increased rates of
target vessel-related myocardial infarction (5.8% [187 of 3218] vs 3.2%
[74 of 2299]; RR 1.68 [95% CI 1.29-2.19], p=0.0003) and ischaemia-driven
target lesion revascularisation (5.3% [169 of 3217] vs 3.9% [90 of 2300];
1.40 [1.09-1.80], p=0.0090) with BVS, with non-significant differences in
cardiac mortality. The cumulative 2-year incidence of device thrombosis
was higher with BVS than with EES (2.3% [73 of 3187] vs 0.7% [16 of 2281];
RR 3.35 [95% CI 1.96-5.72], p<0.0001). Landmark analysis between 1 and 2
years also showed higher rates of the device-oriented composite endpoint
(3.3% [69 of 2100] vs 1.9% [23 of 1193]; RR 1.64 [95% CI 1.03-2.61],
p=0.0376) and device thrombosis (0.5% [11 of 2085] vs none [0 of 1183],
p<0.0001) in BVS-treated patients than in EES-treated patients.
Interpretation BVS was associated with increased rates of composite
device-oriented adverse events and device thrombosis cumulatively at 2
years and between 1 and 2 years of follow-up compared with EES. Funding
Abbott Vascular.<br/>Copyright &#xa9; 2017 Elsevier Ltd

<54>
Accession Number
617958901
Author
Cholley B.; Caruba T.; Grosjean S.; Amour J.; Ouattara A.; Villacorta J.;
Miguet B.; Guinet P.; Levy F.; Squara P.; Hamou N.A.; Carillon A.; Boyer
J.; Boughenou M.-F.; Rosier S.; Robin E.; Radutoiu M.; Durand M.; Guidon
C.; Desebbe O.; Charles-Nelson A.; Menasche P.; Rozec B.; Girard C.;
Fellahi J.-L.; Pirracchio R.; Chatellier G.
Institution
(Cholley, Boughenou, Pirracchio) Department of Anesthesiology and Critical
Care Medicine, Hopital Europeen Georges Pompidou, AP-HP, University Paris
Descartes-Sorbonne Paris Cite, Paris, France
(Caruba) Department of Pharmacy, Hopital Europeen Georges Pompidou, AP-HP,
University Paris Descartes-Sorbonne Paris Cite, Paris, France
(Grosjean, Boyer, Girard) Department of Anesthesiology and Critical Care
Medicine, Centre Hospitalo-Universitaire de Dijon-Bourgogne, France
(Amour, Hamou, Carillon) Department of Anesthesiology and Critical Care
Medicine, Hopital de La Pitie Salpetriere, AP-HP, University Pierre and
Marie Curie, Paris, France
(Ouattara) Department of Anaesthesiology and Critical Care II, Magellan
Medico-Surgical Center, University of Bordeaux, INSERM, UMR 1034, Biology
of Cardiovascular Diseases, Bordeaux, France
(Villacorta, Guidon) Department of Anesthesiology and Critical Care, CHU
La Timone, Marseille, France
(Miguet, Rozec) Department of Anesthesiology and Critical Care Medicine,
Hopital Laennec, Nantes, France
(Guinet, Rosier) Department of Anesthesiology and Critical Care Medicine,
Hopital Pontchaillou, Rennes, France
(Levy) Department of Anesthesiology and Critical Care, Nouvel Hopital
Civil, Strasbourg, France
(Squara) Department of Anesthesiology and Critical Care, Clinique Ambroise
Pare, Neuilly, France
(Robin) Department of Anesthesiology and Critical Care, Hopital Claude
Huriez, Lille, France
(Radutoiu) Department of Anesthesiology and Critical Care, CHU Cote de
Nacre, Caen, France
(Durand) Department of Anesthesiology and Critical Care, CHU Grenoble
Alpes, Grenoble, France
(Desebbe, Fellahi) Department of Anesthesiology and Critical Care, Hopital
Cardiologique Louis Pradel, INSERM U1060, University Claude Bernard, Lyon,
France
(Charles-Nelson, Chatellier) Department of Biostatistics, Hopital Europeen
Georges Pompidou, AP-HP, University Paris Descartes-Sorbonne Paris Cite,
Paris, France
(Menasche) Department of Cardiovascular Surgery, Hopital Europeen Georges
Pompidou, AP-HP, University Paris Descartes-Sorbonne Paris Cite, Paris,
France
Title
Effect of levosimendan on low cardiac output syndrome in patients with low
ejection fraction undergoing coronary artery bypass grafting with
cardiopulmonary bypass - The LICORN randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 318 (6) (pp 548-556),
2017. Date of Publication: 08 Aug 2017.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: Low cardiac output syndrome after cardiac surgery is
associated with high morbidity and mortality in patients with impaired
left ventricular function. OBJECTIVE: To assess the ability of
preoperative levosimendan to prevent postoperative low cardiac output
syndrome. DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind,
placebo-controlled trial conducted in 13 French cardiac surgical centers.
Patients with a left ventricular ejection fraction less than or equal to
40% and scheduled for isolated or combined coronary artery bypass grafting
with cardiopulmonary bypass were enrolled from June 2013 until May 2015
and followed during 6 months (last follow-up, November 30, 2015).
INTERVENTIONS: Patients were assigned to a 24-hour infusion of
levosimendan 0.1 mug/kg/min (n = 167) or placebo (n = 168) initiated after
anesthetic induction. MAIN OUTCOMES AND MEASURES: Composite end point
reflecting low cardiac output syndrome with need for a catecholamine
infusion 48 hours after study drug initiation, need for a left ventricular
mechanical assist device or failure to wean from it at 96 hours after
study drug initiation when the device was inserted preoperatively, or need
for renal replacement therapy at any time postoperatively. It was
hypothesized that levosimendan would reduce the incidence of this
composite end point by 15% in comparison with placebo. RESULTS: Among 336
randomized patients (mean age, 68 years; 16% women), 333 completed the
trial. The primary end point occurred in 87 patients (52%) in the
levosimendan group and 101 patients (61%) in the placebo group (absolute
risk difference taking into account center effect, -7% [95% CI, -17% to
3%]; P = .15). Predefined subgroup analyses found no interaction with
ejection fraction less than 30%, type of surgery, and preoperative use of
beta-blockers, intra-aortic balloon pump, or catecholamines. The
prevalence of hypotension (57% vs 48%), atrial fibrillation (50% vs 40%),
and other adverse events did not significantly differ between levosimendan
and placebo. CONCLUSIONS AND RELEVANCE: Among patients with low ejection
fraction who were undergoing coronary artery bypass grafting with
cardiopulmonary bypass, levosimendan compared with placebo did not result
in a significant difference in the composite end point of prolonged
catecholamine infusion, use of left ventricular mechanical assist device,
or renal replacement therapy. These findings do not support the use of
levosimendan for this indication. TRIAL REGISTRATION: EudraCT Number:
2012-000232-25; clinicaltrials.gov Identifier: NCT02184819.<br/>Copyright
&#xa9; 2017 American Medical Association. All rights reserved.

<55>
Accession Number
618025896
Author
Sayah D.M.; Bradfield J.S.; Moriarty J.M.; Belperio J.A.; Lynch J.P.
Institution
(Sayah, Belperio, Lynch) Division of Pulmonary and Critical Care Medicine,
Clinical Immunology, and Allergy, David Geffen School of Medicine, UCLA,
10833 Le Conte Ave, Los Angeles, CA 90095, United States
(Bradfield) Division of Cardiology, Department of Medicine, UCLA, Cardiac
Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles,
CA, United States
(Moriarty) Division of Interventional Radiology, Department of Radiology,
David Geffen School of Medicine, UCLA, Los Angeles, CA, United States
Title
Cardiac Involvement in Sarcoidosis: Evolving Concepts in Diagnosis and
Treatment.
Source
Seminars in Respiratory and Critical Care Medicine. 38 (4) (pp 477-498),
2017. Article Number: 01302. Date of Publication: 01 Aug 2017.
Publisher
Thieme Medical Publishers, Inc. (E-mail: custserv@thieme.com)
Abstract
Clinically evident sarcoidosis involving the heart has been noted in at
least 2 to 7% of patients with sarcoidosis, but occult involvement is much
higher (> 20%). Cardiac sarcoidosis is often not recognized antemortem, as
sudden death may be the presenting feature. Cardiac involvement may occur
at any point during the course of sarcoidosis and may occur in the absence
of pulmonary or systemic involvement. Sarcoidosis can involve any part of
the heart, with protean manifestations. Prognosis of cardiac sarcoidosis
is related to the extent and site(s) of involvement. Most deaths due to
cardiac sarcoidosis are due to arrhythmias or conduction defects, but
granulomatous infiltration of the myocardium may be lethal. The definitive
diagnosis of isolated cardiac sarcoidosis is difficult. The yield of
endomyocardial biopsies is low; treatment of cardiac sarcoidosis is often
warranted even in the absence of histologic proof. Radionuclide scans are
integral to the diagnosis. Currently, 18F-fluorodeoxyglucose-positron
emission tomography/computed tomography and gadolinium-enhanced magnetic
resonance imaging scans are the key imaging modalities to diagnose cardiac
sarcoidosis. The prognosis of cardiac sarcoidosis is variable, but
mortality rates of untreated cardiac sarcoidosis are high. Although
randomized therapeutic trials have not been done, corticosteroids (alone
or combined with additional immunosuppressive medications) remain the
mainstay of treatment. Because of the potential for sudden cardiac death,
implantable cardioverter defibrillators should be placed in any patient
with cardiac sarcoidosis and serious ventricular arrhythmias or heart
block, and should be considered for cardiomyopathy. Cardiac
transplantation is a viable option for patients with end-stage cardiac
sarcoidosis refractory to medical therapy.<br/>Copyright &#xa9; 2017 by
Thieme Medical Publishers, Inc.

<56>
Accession Number
618030509
Author
Doros G.; Massaro J.M.; Kandzari D.E.; Waksman R.; Koolen J.J.; Cutlip
D.E.; Mauri L.
Institution
(Doros) Department of Biostatistics, Boston University, Boston, MA, United
States
(Doros, Cutlip, Mauri) Baim Institute for Clinical Research, Boston, MA,
United States
(Massaro) Boston University School of Public Health, Boston, MA, United
States
(Kandzari) Piedmont Heart Institute, Atlanta, GA, United States
(Waksman) MedStar Washington Hospital Center, Washington, DC, United
States
(Waksman) Georgetown University, Washington, DC, United States
(Koolen) Catharina Hospital Eindhoven, Netherlands
(Cutlip) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Mauri) Brigham and Women's Hospital, Boston, MA, United States
(Cutlip, Mauri) Harvard Medical School, Boston, MA, United States
Title
Rationale of a novel study design for the BIOFLOW V study, a prospective,
randomized multicenter study to assess the safety and efficacy of the
Orsiro sirolimus-eluting coronary stent system using a Bayesian approach.
Source
American Heart Journal. 193 (pp 35-45), 2017. Date of Publication:
November 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Traditional study design submitted to the Food and Drug
Administration to test newer drug-eluting stents (DES) for marketing
approval is the prospective randomized controlled trial. However, several
DES have extensive clinical data from trials conducted outside the United
States that have led to utilization of a novel design using the Bayesian
approach. This design was proposed for testing DES with bioresorbable
polymer compared with DES most commonly in use today that use durable
polymers for drug elution. Study design and objectives This prospective,
multicenter, randomized, controlled trial is designed to assess the safety
and efficacy of the Orsiro bioresorbable polymer sirolimus-eluting stent
(BP SES). Up to 1,334 subjects with up to 3 de novo or restenotic coronary
artery lesions who qualify for percutaneous coronary intervention with
stenting will be randomized 2:1 to the BP SES versus the Xience durable
polymer everolimus-eluting stent (DP EES). Data from this trial will be
combined with data from 2 similarly designed trials that also randomize
subjects to BP SES and DP EES (BIOFLOW II, N = 452 and BIOFLOW IV, N =
579) by using a Bayesian approach. The primary end point is target lesion
failure at 12 months post index procedure, defined as cardiac death,
target vessel myocardial infarction, or clinically driven target lesion
revascularization, and the primary analysis is a test of noninferiority of
the BP SES versus DP EES on the primary end point according to a
noninferiority delta of 3.85%. Secondary end points include stent
thrombosis and the individual components of target lesion failure.
Subjects will be followed for 5 years after randomization. Conclusions The
BIOFLOW V trial offers an opportunity to assess clinical outcomes in
patients treated with coronary revascularization using the Orsiro BP SES
relative to a commonly used DP EES. The use of a Bayesian analysis
combines a large randomized cohort of patients 2 two smaller contributing
randomized trials to augment the efficiency of the
comparison.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<57>
Accession Number
618030508
Author
Shaddy R.; Canter C.; Halnon N.; Kochilas L.; Rossano J.; Bonnet D.; Bush
C.; Zhao Z.; Kantor P.; Burch M.; Chen F.
Institution
(Shaddy) Children's Hospital Los Angeles, Los Angeles, CA, United States
(Canter) Washington University, St Louis, MO, United States
(Halnon) University of California Los Angeles, Los Angeles, CA, United
States
(Kochilas) Children's Health Care of Atlanta, Atlanta, GA, United States
(Rossano) The Children's Hospital of Philadelphia, Philadelphia, PA,
United States
(Bonnet) Necker Hospital University, Paris, France
(Bush) Novartis Pharmaceuticals Corporation, East Hanover, NJ, United
States
(Zhao, Chen) Novartis Pharmaceuticals Corporation, Shanghai, China
(Kantor) University of Alberta, Edmonton, Canada
(Burch) Great Ormond Street Hospital for Children, London, United Kingdom
Title
Design for the sacubitril/valsartan (LCZ696) compared with enalapril study
of pediatric patients with heart failure due to systemic left ventricle
systolic dysfunction (PANORAMA-HF study).
Source
American Heart Journal. 193 (pp 23-34), 2017. Date of Publication:
November 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Sacubitril/valsartan (LCZ696) is an angiotensin receptor
neprilysin inhibitor approved for the treatment of adult heart failure
(HF); however, the benefit of sacubitril/valsartan in pediatric HF
patients is unknown. Study design This global multi-center study will use
an adaptive, seamless two-part design. Part 1 will assess the
pharmacokinetics/pharmacodynamics of single ascending doses of
sacubitril/valsartan in pediatric (1 month to <18 years) HF patients with
systemic left ventricle and reduced left ventricular systolic function
stratified into 3 age groups (Group 1: 6 to <18 years; Group 2: 1 to <6
years; Group 3: 1 month to <1 year). Part 2 is a 52-week, efficacy and
safety study where 360 eligible patients will be randomized to
sacubitril/valsartan or enalapril. A novel global rank primary endpoint
derived by ranking patients (worst-to-best outcome) based on clinical
events such as death, initiation of mechanical life support, listing for
urgent heart transplant, worsening HF, measures of functional capacity
(NYHA/Ross scores), and patient-reported HF symptoms will be used to
assess efficacy. Conclusion The PANORAMA-HF study, which will be the
largest prospective pediatric HF trial conducted to date and the first to
use a global rank primary endpoint, will determine whether
sacubitril/valsartan is superior to enalapril for treatment of pediatric
HF patients with reduced systemic left ventricular systolic
function.<br/>Copyright &#xa9; 2017 The Authors

<58>
Accession Number
618057972
Author
Chin A.; Ntsekhe M.; Viljoen C.; Rossouw J.; Pennel T.; Schwartz P.J.
Institution
(Chin, Ntsekhe, Viljoen, Schwartz) Division of Cardiology, Department of
Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town,
South Africa
(Rossouw, Pennel) Christiaan Barnard Division of Cardiothoracic Surgery,
Faculty of Health Sciences, University of Cape Town, 7925, Observatory,
Cape Town, South Africa
(Schwartz) IRCCS Istituto Auxologico Italiano, Center for Cardiac
Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics,
Milan, Italy
Title
Rationale and design of a prospective study to assess the effect of left
cardiac sympathetic denervation in chronic heart failure.
Source
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background: The main causes of mortality in patients with chronic heart
failure include sudden cardiac death (SCD) and progressive heart failure.
Autonomic dysfunction plays a detrimental role in the progression of
chronic heart failure. Left cardiac sympathetic denervation (LCSD) is an
inexpensive and safe procedure which modifies autonomic innervation of the
heart and is associated with a significant antifibrillatory effect.
Whether LCSD reduces the risk of SCD, delays progression of heart failure
and improves quality of life in patients with heart failure with reduced
ejection fraction (HFrEF) is not known. Methods and design: This is a
2-phased prospective, randomized trial to test the efficacy and safety of
LCSD as an adjunct to guideline recommended medical therapy for patients
with HFrEF. Once the safety and feasibility of conducting a large LCSD
study have been demonstrated in the pilot phase, a phase III efficacy
trial to assess the impact on ventricular arrhythmias, heart failure
outcomes, and mortality will be completed. Outcome data from the pilot
study will remain blinded and added to the results of phase III study for
analysis. Results: To date the study has received approval from local and
national ethics and regulatory bodies and recruitment has commenced, and 4
patients have been randomized so far. Conclusion: If LCSD is proven to be
safe, feasible and effective in this first ever study using this novel
approach in patients with HFrEF it may be a cost-effective alternative to
the implantable cardioverter defibrillator therapy especially in regions
where ICDs and cardiac transplantation are unavailable.<br/>Copyright
&#xa9; 2017.

<59>
Accession Number
618057288
Author
Casset C.; Jankowski A.; Bertrand B.; Saunier C.; Piliero N.; Rodiere M.;
Ferretti G.; Quesada J.-L.; Broisat A.; Riou L.; Fagret D.; Ghezzi C.;
Vanzetto G.; Barone-Rochette G.
Institution
(Casset, Bertrand, Saunier, Piliero, Vanzetto, Barone-Rochette) Department
of Cardiology, University Hospital, Grenoble Alpes, France
(Jankowski, Rodiere, Ferretti) Department of Radiology, University
Hospital, Grenoble Alpes, France
(Quesada) Clinical Investigation Center, Grenoble Alpes University
Hospital, France
(Broisat, Riou, Fagret, Ghezzi, Vanzetto, Barone-Rochette) INSERM, U1039,
Radiopharmaceutiques Biocliniques, Universite Grenoble Alpes, France
(Vanzetto, Barone-Rochette) French alliance clinical trial, French
Clinical Research Infrastructure Network, Paris, France
Title
Evaluation of Imaging Strategy to Optimize and Improve Outcome of
Transcatheter Aortic Valvular Implantation.
Source
American Journal of Cardiology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Cardiac computed tomography (CT) provides additional information with
ultrasound in the transcatheter heart valve (THV) size selection. However,
the influence of these incremental data on outcomes has not been evaluated
in a randomized study. A single-center prospective, randomized, and open
study was performed. Patients referred for transfemoral transcatheter
aortic valve implantation with a balloon-expandable endoprothesis were
included. THV size selection was performed using either transthoracic and
transesophageal echocardiography data (control group) or ultrasound and CT
results (CT group). The primary composite end point included the
occurrence of stroke, major vascular complications, and moderate or severe
paravalvular aortic regurgitation (PAR) at 1 year. Fifty patients (n = 25
in the control and CT groups) were enrolled. The primary composite end
point occurred in 40% and 8% of patients from the control and CT groups,
respectively (p = 0.008). The Kaplan-Meier analysis revealed a pejorative
association with not performing the CT (p = 0.007). A decrease in the
occurrence of PAR was observed in the CT group compared with the control
group (PAR 28% vs 4%, p = 0.04; major vascular complications 12% vs 4%, p
= 0.6; all-cause death 16% vs. 4%, p = 0.34; no stroke). In conclusion,
the use of cardiac CT in addition to ultrasound data in THV size selection
reduced the long-term occurrence of cardiovascular events.<br/>Copyright
&#xa9; 2017 Elsevier Inc.

<60>
Accession Number
618044514
Author
Lindholt J.S.; Sogaard R.
Institution
(Lindholt) Department of Cardiothoracic and Vascular Surgery, Odense
University Hospital, Odense, Denmark
(Lindholt) Vascular Research Unit, Viborg Hospital, Viborg, Denmark
(Sogaard) Department of Public Health and Department of Clinical Medicine,
Aarhus University, Aarhus, Denmark
Title
Population screening and intervention for vascular disease in Danish men
(VIVA): A randomised controlled trial.
Source
The Lancet. (no pagination), 2017. Date of Publication: 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Abdominal aortic aneurysm is the only cardiovascular disease
targeted by population screening. In this study, we test the effect of
screening and subsequent intervention for abdominal aortic aneurysm,
peripheral arterial disease, and hypertension combined. Methods: In this
randomised controlled trial, we randomly allocated (1:1) all men aged
65-74 years living in the Central Denmark Region to screening for
abdominal aortic aneurysm, peripheral arterial disease, and hypertension,
or to no screening. We based allocation on computer-generated random
numbers from 1 to 100 in blocks of 1067 to 4392, stratified by 19
municipalities. Only the non-screening group and the investigator
assessing outcomes were masked. We invited participants who were found to
have abdominal aortic aneurysm or peripheral arterial disease back for
confirmation and eventual initiation of relevant pharmacological therapy.
We further offered participants with abdominal aortic aneurysm annual
control or surgical repair. We referred participants with suspected
hypertension to their general practitioner. The primary outcome was
all-cause mortality, assessed 5 years after randomisation, analysed in all
randomly allocated participants except for those who had incorrect person
identification numbers. This trial is registered at ClinicalTrials.gov,
number NCT00662480. Findings: Between Oct 8, 2008, and Jan 11, 2011, we
randomly allocated 50 156 participants, with 25 078 (50%) each in the
screening and non-screening groups. Four (<1%) participants in the
screening group were lost to follow-up. After a median follow-up of 4.4
years (IQR 3.9-4.8), 2566 (10.2%) of 25 074 participants in the screening
group and 2715 (10.8%) of 25 078 in the non-screening group had died. This
finding resulted in a significant hazard ratio of 0.93 (95% CI 0.88-0.98;
p=0.01), an absolute risk reduction of 0.006 (0.001-0.011), and a number
needed to invite of 169 (89-1811). Incidences of diabetes (3995 per 100
000 person-years in the screening group vs 4129 per 100 000 person-years
in the non-screening group), intracerebral haemorrhage (146 vs 140), renal
failure (612 vs 649), cancer (3578 vs 3719), or 30 day mortality after
cardiovascular surgery (44.57 vs 39.33) did not differ between groups.
Interpretation: The observed reduction of mortality risk from abdominal
aortic aneurysm, peripheral arterial disease, and hypertension has never
been seen before in the population screening literature and can be linked
primarily to initiation of pharmacological therapy. Health policy makers
should consider implementing combined screening whether no screening or
isolated abdominal aortic aneurysm screening is currently offered.
Funding: The 7th European Framework Programme, Central Denmark Region,
Viborg Hospital, and the Danish Council for Independent
Research.<br/>Copyright &#xa9; 2017 Elsevier Ltd.

<61>
Accession Number
618044503
Author
Giugliano R.P.; Pedersen T.R.; Park J.-G.; De Ferrari G.M.; Gaciong Z.A.;
Ceska R.; Toth K.; Gouni-Berthold I.; Lopez-Miranda J.; Schiele F.; Mach
F.; Ott B.R.; Kanevsky E.; Pineda A.L.; Somaratne R.; Wasserman S.M.;
Keech A.C.; Sever P.S.; Sabatine M.S.
Institution
(Giugliano, Park, Kanevsky, Sabatine) TIMI Study Group, Division of
Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
University of Oslo, Oslo, Norway
(De Ferrari) Department of Molecular Medicine, University of Pavia and
Cardiac Intensive Care Unit and Laboratories for Experimental Cardiology,
IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
(Gaciong) Department of Internal Medicine, Hypertension and Vascular
Diseases, The Medical University of Warsaw, Warsaw, Poland
(Ceska) Center of Preventive Cardiology, 3rd Department Internal Medicine,
University General Hospital and 1st Medical Faculty, Prague, Czech
Republic
(Toth) 1st Department of Medicine, University of Pecs, Pecs, Hungary
(Gouni-Berthold) Polyclinic for Endocrinology, Diabetes, and Preventive
Medicine, University of Cologne, Cologne, Germany
(Lopez-Miranda) Lipids and Atherosclerosis Unit, Maimonides Biomedical
Research Institute of Cordoba, Reina Sofia University Hospital, University
of Cordoba, CIBEROBN, Cordoba, Spain
(Schiele) University Hospital Center Besancon, Besancon, France
(Mach) Hopital Cantonal, Hopitaux Universitaires de Geneva, Geneva,
Switzerland
(Ott) Rhode Island Hospital, Department of Neurology, Alpert Medical
School of Brown University, Providence, RI, USA
(Pineda, Somaratne, Wasserman) Amgen, Thousand Oaks, CA, USA
(Keech) Sydney Medical School, National Health and Medical Research
Council Clinical Trials Centre, University of Sydney, Sydney, NSW,
Australia
(Sever) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, UK
Title
Clinical efficacy and safety of achieving very low LDL-cholesterol
concentrations with the PCSK9 inhibitor evolocumab: A prespecified
secondary analysis of the FOURIER trial.
Source
The Lancet. (no pagination), 2017. Date of Publication: 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: LDL cholesterol is a well established risk factor for
atherosclerotic cardiovascular disease. How much one should or safely can
lower this risk factor remains debated. We aimed to explore the
relationship between progressively lower LDL-cholesterol concentrations
achieved at 4 weeks and clinical efficacy and safety in the FOURIER trial
of evolocumab, a monoclonal antibody to proprotein convertase
subtilisin-kexin type 9 (PCSK9). Methods: In this prespecified secondary
analysis of 25 982 patients from the randomised FOURIER trial, the
relationship between achieved LDL-cholesterol concentration at 4 weeks and
subsequent cardiovascular outcomes (primary endpoint was the composite of
cardiovascular death, myocardial infarction, stroke, coronary
revascularisation, or unstable angina; key secondary endpoint was the
composite of cardiovascular death, myocardial infarction, or stroke) and
ten prespecified safety events of interest was examined over a median of
2.2 years of follow-up. We used multivariable modelling to adjust for
baseline factors associated with achieved LDL cholesterol. This trial is
registered with ClinicalTrials.gov, number NCT01764633. Findings: Between
Feb 8, 2013, and June 5, 2015, 27 564 patients were randomly assigned a
treatment in the FOURIER study. 1025 (4%) patients did not have an LDL
cholesterol measured at 4 weeks and 557 (2%) had already had a primary
endpoint event or one of the ten prespecified safety events before the
week-4 visit. From the remaining 25 982 patients (94% of those randomly
assigned) 13 013 were assigned evolocumab and 12 969 were assigned
placebo. 2669 (10%) of 25 982 patients achieved LDL-cholesterol
concentrations of less than 0.5 mmol/L, 8003 (31%) patients achieved
concentrations between 0.5 and less than 1.3 mmol/L, 3444 (13%) patients
achieved concentrations between 1.3 and less than 1.8 mmol/L, 7471 (29%)
patients achieved concentrations between 1.8 to less than 2.6 mmol/L, and
4395 (17%) patients achieved concentrations of 2.6 mmol/L or higher. There
was a highly significant monotonic relationship between low
LDL-cholesterol concentrations and lower risk of the primary and secondary
efficacy composite endpoints extending to the bottom first percentile
(LDL-cholesterol concentrations of less than 0.2 mmol/L; p=0.0012 for the
primary endpoint, p=0.0001 for the secondary endpoint). Conversely, no
significant association was observed between achieved LDL cholesterol and
safety outcomes, either for all serious adverse events or any of the other
nine prespecified safety events. Interpretation: There was a monotonic
relationship between achieved LDL cholesterol and major cardiovascular
outcomes down to LDL-cholesterol concentrations of less than 0.2 mmol/L.
Conversely, there were no safety concerns with very low LDL-cholesterol
concentrations over a median of 2.2 years. These data support further
LDL-cholesterol lowering in patients with cardiovascular disease to well
below current recommendations. Funding: Amgen.<br/>Copyright &#xa9; 2017
Elsevier Ltd.

<62>
Accession Number
613705277
Author
Hedman K.F.; Mann C.L.; Spulecki C.; Castner J.
Institution
(Hedman, Mann) University at Buffalo, Buffalo, NY, United States
(Hedman, Mann) University of Rochester Medical Center, Rochester, NY,
United States
(Spulecki) University at Buffalo School of Nursing, Nurse Anesthesia
Program, Buffalo, NY, United States
(Castner) University at Buffalo School of Nursing, Buffalo, NY, United
States
Title
Low-dose vasopressin and analogues to treat intraoperative refractory
hypotension in patients prescribed angiotensin-converting enzyme
inhibitors undergoing general anesthesia: A systematic review.
Source
AANA Journal. 84 (6) (pp 413-419), 2016. Date of Publication: 2016.
Publisher
AANA Publishing Inc. (E-mail: llacey@aana.com )
Abstract
This review assessed the utility of vasopressin and vasopressin analogues
for the treatment of refractory hypotension associated with
angiotensin-converting enzyme (ACE) inhibitors in the perioperative
setting. A systematic review of the literature was conducted using
MEDLINE, Embase, and ProQuest. Six randomized controlled trials met
eligibility criteria. In the perioperative setting, continued use of ACE
inhibitors within 24 hours before surgery remains controversial. Authors
of the reviewed studies suggested that the morning dose of the ACE
inhibitor be held, and those patients experienced decreased catecholamine
use postoperatively and shorter duration of decreased mean arterial
pressure. No incidence of refractory hypertension from withholding the
morning dose of the ACE inhibitor was mentioned. All of the patients
receiving vasopressin demonstrated improved hemodynamic stability with
small, intermittent doses, without profound ischemic changes. For
management (prevention and treatment) of ACE inhibitor-associated
hypotension in the perioperative setting, all studies showed statistically
significant success with vasopressin or vasopressin analogues for
improvement of systemic blood pressures. Before vasopressin is widely
accepted as a standard of care, further studies are needed to confirm
these findings and assess the general utility of vasopressin in surgical
populations for management of ACE inhibitor-associated refractory
hypotension.

<63>
[Use Link to view the full text]
Accession Number
618027669
Author
Stoickov V.; Deljanin Ilic M.; Stoickov M.; Tasic I.; Saric S.; Andonov
S.; Mitic S.
Institution
(Stoickov, Deljanin Ilic, Tasic) University of Nis, Medical Faculty,
Institute of Cardiology Niska Banja, Nis, Serbia
(Stoickov, Saric, Andonov, Mitic) Institute of Cardiology, Niska Banja,
Nis, Serbia
Title
Impact of short-term exercise training and beta blockers on arterial blood
pressure and qt dispersion in patients after coronary artery bypass graft
surgery with hyperkinetic state.
Source
Journal of Hypertension. Conference: 27th European Meeting on Hypertension
and Cardiovascular Protection, ESH 2017. Italy. 35 (pp e126), 2017. Date
of Publication: September 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: The aim of this study was to establish the influence of
short-term exercise training and beta blockers (BB) on arterial blood
pressure (BP), double product (DP) and QT dispersion (QTd) in patients
after coronary artery bypass graft surgery (CABG) with hyperkinetic state.
Design and method: The study involved 135 patients after CABG with
hyperkinetic state, average age 56.7 years. Patients were randomly divided
into the physical training group (TG: 109 patients) and control group
(non-training group: 26 patients). In all subjects exercise test on
treadmill according to Bruce protocol were performed. TG patients
increased doses of beta blockers and are involved in rehabilitation
treatment for three weeks. TG patients were instructed to follow a
training program using the bicycle ergometer (10 min, 2 times a day) and
walking. From standard ECG corrected QT dispersion (QTdc) was calculated.
Results: After three days, we have found significant reduction of heart
rate from 87.1 +/- 5.8 to 75.9 +/- 5.5 beats/min (p < 0.001), of systolic
BP from 148.5 +/- 12.7 to 142.2 +/- 9.3 mmHg (p < 0.001), of diastolic BP
from 90.3 +/- 6.9 to 85.9 +/- 4.9 mmHg (p < 0.001) and of DP from 13102.3
+/- 797.8 to 12287.6 +/- 633.6 beat/ min x mmHg (p < 0.001) in the TG.
After three weeks, we have found significant reduction of QTdc from 54.5
+/- 16.5 to 47.8 +/- 14.7 ms (p < 0.005) in the TG. Also, in the TG, we
have found significant reduction of heart rate from 87.1 +/- 5.8 to 69.9
+/- 4.9 beats/min (p < 0.001), of systolic BP from 148.5 +/- 12.7 to 136.3
+/- 6.7 mmHg (p < 0.001), of diastolic BP from 90.3 +/- 6.9 to 82.7 +/-
3.8 mmHg (p < 0.001) and of DP from 13102.3 +/- 797.8 to 10912.2 +/- 602.4
beat/min x mmHg (p < 0.001). In contrast, the non-training group showed no
significant changes. Conclusions: The study showed that short-term
exercise training and BB have favourable effects on arterial BP, DP and
QTd in patients after CABG with hyperkinetic state. Beta blockers are
enabled to properly implement and improve the program of physical training
in study patients.

<64>
[Use Link to view the full text]
Accession Number
618026940
Author
De Leeuw P.W.; Bisognano J.; Bakris G.; Nadim M.; Haller H.; Kroon A.
Institution
(De Leeuw, Kroon) Department of Medicine, Maastricht University Medical
Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht,
Netherlands
(Bisognano) Department of Medicine, University of Rochester, Rochester,
NY, United States
(Bakris) Department of Medicine, University of Chicago Medicine, Chicago,
IL, United States
(Nadim) Department of Medicine, University of Southern California, Los
Angeles, CA, United States
(Haller) Department of Nephrology, Medizinische Hochschule Hannover,
Hannover, Germany
Title
Sustained reduction of blood pressure with baroreceptor activation
therapy: Results of six-year open follow-up.
Source
Journal of Hypertension. Conference: 27th European Meeting on Hypertension
and Cardiovascular Protection, ESH 2017. Italy. 35 (pp e63), 2017. Date of
Publication: September 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Baroreflex Activation Therapy (BAT) is a novel technique for
treating patients with resistant hypertension. Although short-term studies
have demonstrated that BAT lowers blood pressure, long-term results have
not yet been reported. The aim of the present study is to assess the
long-term efficacy and safety of BAT. Design and method: Long-term
follow-up data on blood pressure and heart rate were analyzed from all
patients who have been included in one of the three BAT trials that
focused on treatment-resistant hypertensive patients. These trials were
the US feasibility study, the DEBut-HT trial and the pivotal trial. The
first two were non-randomized, observational trials in the US and Europe
respectively. In the pivotal trial patients were randomized to either
immediate BAT or deferred BAT (six months after implantation). All
patients who have received an implant were followed with regular visits.
Results: Altogether, 383 patients were available for analysis: 143 of
these had completed five years of follow-up and 48 patients had completed
six years of follow-up. In the entire cohort, systolic blood pressure fell
from 179+24 mmHg to 144+28 mmHg (p < 0.0001) while diastolic pressure
dropped from 103+16 mmHg to 85+18 mmHg (p < 0.0001). The data further
demonstrate that the greatest fall in pressure already occurs within 6
months following device implant. The blood pressure lowering effect of BAT
is greater than average in patients with signs of heart failure, and less
than average in patients with isolated systolic hypertension. The
percentage of patients in whom systolic blood pressure at the end of
follow-up had fallen below 140 mmHg was greatest in those with unilateral
right-sided stimulation. In about 25% of patients it was possible to
reduce the number of medications from a median of 6 to a median of 3.
Temporary side effects, related to either the surgical procedure or to
cardiovascular instability, do occur, but they do not require specific
measures and resolve over time. Conclusions: After a follow-up of 5 years,
BAT is safe and maintains its efficacy for persistent reduction of blood
pressure in patients with resistant hypertension.

<65>
Accession Number
616527419
Author
Steinberg Z.L.; Dominguez-Islas C.P.; Otto C.M.; Stout K.K.; Krieger E.V.
Institution
(Steinberg, Otto, Stout, Krieger) Division of Cardiology, Department of
Medicine, University of Washington School of Medicine, Seattle,
Washington, United States
(Dominguez-Islas) Medical Research Council Biostatistics Unit, School of
Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
Title
Maternal and Fetal Outcomes of Anticoagulation in Pregnant Women With
Mechanical Heart Valves.
Source
Journal of the American College of Cardiology. 69 (22) (pp 2681-2691),
2017. Date of Publication: 06 Jun 2017.
Publisher
Elsevier USA
Abstract
Background Anticoagulation for mechanical heart valves during pregnancy is
essential to prevent thromboembolic events. Each regimen has drawbacks
with regard to maternal or fetal risk. Objectives This meta-analysis
sought to estimate and compare the risk of adverse maternal and fetal
outcomes in pregnant women with mechanical heart valves who received
different methods of anticoagulation. Methods Studies were identified
using a Medline search including all publications up to June 5, 2016.
Study inclusion required reporting of maternal death, thromboembolism, and
valve failure, and/or fetal spontaneous abortion, death, and congenital
defects in pregnant women treated with any of the following: 1) a vitamin
K antagonist (VKA) throughout pregnancy; 2) low-molecular-weight heparin
(LMWH) throughout pregnancy; 3) LMWH for the first trimester, followed by
a VKA (LMWH and VKA); or 4) unfractionated heparin for the first
trimester, followed by a VKA (UFH and VKA). Results A total of 800
pregnancies from 18 publications were included. Composite maternal risk
was lowest with VKA (5%), compared with LMWH (16%; ratio of averaged risk
[RAR]: 3.2; 95% confidence interval [CI]: 1.5 to 7.5), LMWH and VKA (16%;
RAR: 3.1; 95% CI: 1.2 to 7.5), or UFH and VKA (16%; RAR: 3.1; 95% CI: 1.5
to 7.1). Composite fetal risk was lowest with LMWH (13%; RAR: 0.3; 95% CI:
0.1 to 0.8), compared with VKA (39%), LMWH and VKA (23%), or UFH and VKA
(34%). No significant difference in fetal risk was observed between women
taking <=5 mg daily warfarin and those with an LMWH regimen (RAR: 0.9; 95%
CI: 0.3 to 2.4). Conclusions VKA treatment was associated with the lowest
risk of adverse maternal outcomes, whereas the use of LMWH throughout
pregnancy was associated with the lowest risk of adverse fetal outcomes.
Fetal risk was similar between women taking <=5 mg warfarin daily and
women treated with LMWH.<br/>Copyright &#xa9; 2017 The Authors

<66>
Accession Number
617924585
Author
Moscarelli M.; Athanasiou T.; Speziale G.; Punjabi P.P.; Malietzis G.;
Lancellotti P.; Fattouch K.
Institution
(Moscarelli) NHLI, Imperial College London, London, United Kingdom
(Moscarelli, Speziale) GVM Care and Research, Anthea Hospital, Via Camillo
Rosalba 35/37, Bari, Italy
(Athanasiou, Punjabi, Malietzis) Department of Surgery and Cancer,
Imperial College London, London, United Kingdom
(Lancellotti) Department of Cardiology, GIGA Cardiovascular Sciences,
University of Liege Hospital, Liege, Belgium
(Lancellotti, Fattouch) GVM Care and Research Group, Maria Eleonora,
Palermo, Italy
Title
The value of adding sub-valvular procedures for chronic ischemic mitral
regurgitation surgery: A meta-analysis.
Source
Perfusion (United Kingdom). 32 (6) (pp 436-445), 2017. Date of
Publication: 01 Sep 2017.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: The most performed repair technique for the treatment of
chronic ischemic mitral regurgitation in patients referred for bypass
grafting remains restricted annuloplasty. However, it is associated with a
high rate of failure, especially if severe tenting exists. Objectives: To
understand if adjunctive sub-valvular mitral procedures may provide better
repair performance. Methods: A systematic literature review identified six
studies of which five fulfilled the criteria for meta-analysis. Outcomes
for a total of 404 patients (214 had adjunctive sub-valvular procedures
and 190 restricted annuloplasty) were meta-analyzed using random effects
modeling. Heterogeneity and subgroup sensitivity analysis were assessed.
Primary endpoints were: late recurrence of moderate mitral regurgitation,
left ventricle remodeling and coaptation depth at follow-up. Secondary
endpoints were: early mortality, mid-term survival and operative outcomes.
Results: Sub-valvular procedure technique was associated with a
significantly lower late recurrence of mitral regurgitation (Odds ratio
(OR) 0.34, 95% Confidence Interval (CI) [0.18, 0.65], p=0.0009), smaller
left ventricle end-systolic diameter (Weighted Mean Difference (WMD)
-4.06, 95% CI [-6.10, -2.03], p=0.0001) and reduced coaptation depth (WMD
-2.36, 95% CI [-5.01, -0.71], p=0.009). These findings were consistent,
even in studies that included patients at high risk for repair failure
(coaptation depth >10 mm and tenting area >2.5 cm²). A low
degree of heterogeneity was observed. There was no difference in terms of
early mortality and mid-term survival; sub-valvular technique was
associated with prolonged cardiopulmonary and cross-clamp time.
Conclusions: Adding sub-valvular procedures when repairing ischemic
chronic mitral valve regurgitation may be associated with better
durability, even in the case of the presence of predictors for late
failure. Perspective: Surgical sub-valvular adjunctive procedures have to
be considered in the case of the presence of echocardiographic predictors
for late failure.<br/>Copyright &#xa9; The Author(s) 2017.

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

<68>
Accession Number
617923195
Author
Head S.J.; da Costa B.R.; Beumer B.; Stefanini G.G.; Alfonso F.;
Clemmensen P.; Collet J.-P.; Cremer J.; Falk V.; Filippatos G.; Hamm C.;
Kappetein A.P.; Kastrati A.; Knuuti J.; Kolh P.; Landmesser U.; Laufer G.;
Neumann F.-J.; Richter D.J.; Schauerte P.; Taggart D.P.; Torracca L.;
Valgimigli M.; Wijns W.; Witkowski A.; Windecker S.; Juni P.; Sousa-Uva M.
Institution
(Head, Beumer, Kappetein) Department of Cardiothoracic Surgery, Erasmus
University Medical Center, Rotterdam, Netherlands
(da Costa) Institute of Primary Health Care (BIHAM), University of Bern,
Bern, Switzerland
(Stefanini) Department of Biomedical Sciences, Humanitas University,
Rozzano-Milan, Italy
(Alfonso) Department of Cardiology, Hospital Universitario de La Princesa,
Madrid, Spain
(Clemmensen) Department of Medicine, Nykoebing F Hospital, University of
Southern Denmark, Odense, Denmark
(Collet) ACTION Study Group, Universite Pierre et Marie Curie (UPMC-Paris
06), Institut de Cardiologie, Pitie-Salpetriere Hospital (AP-HP), Paris,
France
(Cremer) Department of Cardiovascular Surgery, University Hospital
Schleswig-Holstein, Kiel, Germany
(Falk) Department of Cardiothoracic and Vascular Surgery, Klinik fur
Herz-Thorax-Gefasschirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany
(Filippatos) Heart Failure Unit, Department of Cardiology, Athens
University Hospital Attikon, Athens, Greece
(Hamm) Department of Cardiology, Kerckhoff Heart and Thoraxenter, Bad
Nauheim, Germany
(Kastrati) Department of Adult Cardiology, Deutsches Herzzentrum Munchen,
Technische Universitat, Munich, Germany
(Knuuti) Turku PET Centre, University of Turku, Turku University Hospital,
Turku, Finland
(Kolh) Department of Cardiovascular Surgery, University Hospital of Liege,
Liege, Belgium
(Landmesser) Department of Cardiology, Charite Berlin-University Medicine,
Campus Benjamin Franklin and Berlin Institute of Health (BIH), Berlin,
Germany
(Laufer) Department of Cardiac Surgery, Medical University of Vienna,
Vienna, Austria
(Neumann) Division of Cardiology and Angiology II, University Heart Center
Freiburg - Bad Krozingen, Bad Krozingen, Germany
(Richter) Second Cardiac Department, Euroclinic Hospital, Athens, Greece
(Schauerte) Department of Cardiology, University Hospital Aachen RWTH,
Aachen, Germany
(Taggart) Department of Cardiovascular Surgery, John Radcliffe Hospital,
University of Oxford, Oxford, United Kingdom
(Torracca) Cardio Center, Humanitas Research Hospital, Rozzano-Milan,
Italy
(Valgimigli, Windecker) Department of Cardiology, Bern University
Hospital, University of Bern, Bern, Switzerland
(Wijns) Cardiovascular Research Center, OLV Hospital Aalst, Aalst, Belgium
(Witkowski) Department of Interventional Cardiology and Angiology,
Institute of Cardiology, Warsaw, Poland
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute of
St Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Sousa-Uva) Department of Cardiac Surgery, Hospital Cruz Vermelha, Lisbon,
Portugal
Title
Adverse events while awaiting myocardial revascularization: A systematic
review and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 52 (2) (pp 206-217), 2017.
Article Number: ezx115. Date of Publication: 01 Aug 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The aim of the current study was to estimate adverse event
rates while awaiting myocardial revascularization and review criteria for
prioritizing patients. METHODS: A PubMed search was performed on 19
January 2015, to identify English-language, original, observational
studies reporting adverse events while awaiting coronary artery bypass
grafting (CABG) or percutaneous coronary intervention (PCI). Rates of
death, nonfatal myocardial infarction (MI) and emergency revascularization
were calculated as occurrence rates per 1000 patient-weeks and pooled
using random-effects models. RESULTS: The search yielded 1323 articles, of
which 22 were included with 66 410 patients and 607 675 patient-weeks on
the wait list. When awaiting CABG, rates per 1000 patient-weeks were 1.1
[95% confidence interval 0.9-1.3] for death, 1.0 [0.6-1.6] for non-fatal
MI and 1.8 [0.8-4.1] for emergency revascularization. Subgroup analyses
demonstrated consistent outcomes, and sensitivity analyses demonstrated
comparable event rates with low heterogeneity. Higher urgency of
revascularization was based primarily on angiographic complexity, angina
severity, left ventricular dysfunction and symptoms on stress testing, and
such patients with a semi-urgent status had a higher risk of death than
patients awaiting elective revascularization (risk ratio at least 2.8).
Individual studies identified angina severity and left ventricular
dysfunction as most important predictors of death when awaiting CABG.
Adverse rates per 1000 patient-weeks for patients awaiting PCI were 0.1
[95% confidence interval 0.0-0.4] for death, 0.4 [0.1-1.2] for non-fatal
MI and 0.7 [0.4-1.4] for emergency revascularization but were based on
only a few old studies. CONCLUSIONS: Rates of death, non-fatal MI and
emergency revascularization when awaiting myocardial revascularization are
infrequent but higher in specific patients. Countries that not yet have
treatment recommendations related to waiting times should consider
introducing a maximum to limit adverse events, particularly when awaiting
CABG.<br/>Copyright &#xa9; The Author 2017. Published by Oxford University
Press on behalf of the European Association for Cardio-Thoracic Surgery.
All rights reserved.

<69>
Accession Number
615318634
Author
Dalby A.J.; Gottlieb S.; Cyr D.D.; Magnus Ohman E.; McGuire D.K.; Ruzyllo
W.; Bhatt D.L.; Wiviott S.D.; Winters K.J.; Fox K.A.A.; Armstrong P.W.;
White H.D.; Prabhakaran D.; Roe M.T.
Institution
(Dalby) Milpark Hospital, Johannesburg, South Africa
(Gottlieb) Department of Cardiology, Shaare Zedek Medical Center,
Jerusalem, Israel
(Cyr, Magnus Ohman, Roe) Duke Clinical Research Institute, Durham, NC,
United States
(Magnus Ohman, Roe) Division of Cardiology, Department of Medicine, Duke
University School of Medicine, Durham, NC, United States
(McGuire) Division of Cardiology, University of Texas Southwestern Medical
Center, Dallas, TX, United States
(Ruzyllo) Department of Coronary Artery Disease, Institute of Cardiology,
Warsaw, Poland
(Bhatt, Wiviott) Brigham and Women's Hospital and Harvard Medical School,
Boston, MA, United States
(Winters) Eli Lilly and Company, Indianapolis, IN, United States
(Fox) Centre for Cardiovascular Science, University of Edinburgh,
Edinburgh, Scotland, United Kingdom
(Armstrong) Canadian VIGOUR Centre and Division of Cardiology, Department
of Medicine, University of Alberta, Edmonton, Alberta, Canada
(White) Green Lane Cardiovascular Service, City Hospital, Auckland,
Auckland, New Zealand
(Prabhakaran) Centre for Chronic Disease Control and Public Health
Foundation of India, New Delhi, India
Title
Dual antiplatelet therapy in patients with diabetes and acute coronary
syndromes managed without revascularization.
Source
American Heart Journal. 188 (pp 156-166), 2017. Date of Publication: 01
Jun 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective Patients with diabetes mellitus (DM) presenting with acute
coronary syndrome (ACS) and undergoing percutaneous coronary intervention
(PCI) derived enhanced benefit with dual antiplatelet therapy (DAPT) with
prasugrel vs. clopidogrel. The risk profile and treatment response to DAPT
for medically managed ACS patients with DM remains uncertain. Methods The
TRILOGY ACS trial compared aspirin + prasugrel vs. aspirin + clopidogrel
for up to 30 months in non-ST-segment elevation (NSTE) ACS patients
managed medically without revascularization. We compared treatment-related
outcomes among 3539 patients with DM vs. 5767 patients without DM. The
primary endpoint was a composite of cardiovascular death, myocardial
infarction, or stroke. Results Patients with vs. without DM were younger,
more commonly female, heavier, and more often had revascularization prior
to the index ACS event. The frequency of the primary endpoint through 30
months was higher among patients with vs. without DM (24.8% vs. 16.3%),
with a higher risk for those patients with DM treated with insulin vs.
those treated without insulin (35.3% vs. 19.9%). There was no significant
difference in the frequency of the primary endpoint by treatment with
prasugrel vs. clopiodgrel in those with or without DM (P<inf>int</inf> =
0.82) and with or without insulin treatment among those with DM
(P<inf>int</inf> = 0.304). Conclusions Among NSTE ACS patients managed
medically without revascularization, patients with DM had a higher risk of
ischemic events that was amplified among those treated with insulin. There
was no differential treatment effect with a more potent DAPT regimen of
aspirin + prasugrel vs. aspirin + clopidogrel.<br/>Copyright &#xa9; 2017
Elsevier Inc.

<70>
Accession Number
611367901
Author
Bhattacharjee H.K.; Jalaludeen A.; Bansal V.; Krishna A.; Kumar S.;
Subramanium R.; Ramachandran R.; Misra M.
Institution
(Bhattacharjee, Jalaludeen, Bansal, Krishna, Kumar, Misra) Department of
Surgical Disciplines, All India Institute of Medical Sciences, New Delhi,
India
(Subramanium, Ramachandran) Department of Anaesthesiology, All India
Institute of Medical Sciences, New Delhi, India
Title
Impact of standard-pressure and low-pressure pneumoperitoneum on shoulder
pain following laparoscopic cholecystectomy: a randomised controlled
trial.
Source
Surgical Endoscopy and Other Interventional Techniques. 31 (3) (pp
1287-1295), 2017. Date of Publication: 01 Mar 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: The incidence of shoulder pain (SP) following laparoscopic
cholecystectomy (LC) varies between 21 and 80 %. A few randomised
controlled trials and meta-analysis have shown lesser SP in LC performed
under low-pressure carbon dioxide pneumoperitoneum (LPCP) than under
standard-pressure carbon dioxide pneumoperitoneum (SPCP). However, the
possible compromise in adequate exposure and effective working space
during LPCP has negatively influenced its uniform adoption for LC.
Materials and methods: All consecutive patients undergoing elective LC for
gallstone disease who met the inclusion and exclusion criteria were
enroled. Fourty patients were randomised to SPCP group (pressure of 14
mmHg) and 40 to LPCP group (pressure of 9-10 mmHg). Primary outcome
measured was incidence of SP and its severity on visual analogue scale
(VAS) at 4, 8, 24 h and 7 days after LC. Secondary outcomes measured were
procedural time, technical difficulty, surgeons' satisfaction score on
exposure and working space, intra-operative changes in heart rate and
blood pressure, abdominal pain and analgesic requirement. Analyses were
performed using Stata software. Results: There was no conversion to open
surgery, bile duct injury or need to increase intra-abdominal pressure on
either group. Twenty-three patients (57.5 %) in SPCP group and nine
patients (22.5 %) in LPCP group had SP (p = 0.001). The severity of SP was
significantly more in SPCP group at 8 and 24 h (p = 0.009 and 0.005,
respectively). Both the groups had similar procedural time, surgeons'
satisfaction score, intra-operative changes in heart rate and blood
pressure. Conclusion: The incidence and severity of SP following LC
performed at LPCP are significantly less compared to that in SPCP. The
safety, efficacy and surgeons' satisfaction appear to be comparable in
both the groups. Hence, a routine practice of low-pressure carbon dioxide
pneumoperitoneum may be recommended in selected group of patients
undergoing laparoscopic cholecystectomy. Clinical trial registration
number: CTRI/2016/02/006590.<br/>Copyright &#xa9; 2016, Springer
Science+Business Media New York.

<71>
Accession Number
614881081
Author
Kedhi E.; Fabris E.; van der Ent M.; Kennedy M.W.; Buszman P.; von
Birgelen C.; Cook S.; Wedel H.; Zijlstra F.
Institution
(Kedhi, Fabris, Kennedy) Isala Hartcentrum, Zwolle, Netherlands
(Fabris) Cardiovascular Department, University of Trieste, Trieste, Italy
(van der Ent) Maasstad Ziekenhuis, Rotterdam, Netherlands
(Buszman) American Heart of Poland, Ustron, Poland
(von Birgelen) University of Twente, Enschede, Netherlands
(Cook) Department of Cardiology, University & Hospital, Fribourg,
Switzerland
(Wedel) Sahlgrenska Academy, University of Gothenburg, Nordic School of
Public Health, Gothenburg, Sweden
(Zijlstra) Erasmus Medisch Centrum, Rotterdam, Netherlands
Title
A prospective, randomized, open-label trial of 6-month versus 12-month
dual antiplatelet therapy after drug-eluting stent implantation in
ST-elevation myocardial infarction: Rationale and design of the
"DAPT-STEMI trial".
Source
American Heart Journal. 188 (pp 11-17), 2017. Date of Publication: 01 Jun
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background The optimal duration of dual antiplatelet therapy (DAPT) after
percutaneous coronary intervention with second-generation drug eluting
stents (DESs) is unclear. Because prolonged DAPT is associated with higher
bleeding risk and health care costs, establishing optimal DAPT duration is
of paramount importance. No other randomized controlled trials have
evaluated the safety of shorter DAPT duration in ST-elevation myocardial
infarction (STEMI) patients treated with second-generation DESs and latest
P2Y12 platelet receptor inhibitors. Hypothesis Six months of DAPT after
Resolute Integrity stent implantation in STEMI patients is not inferior to
12 months of DAPT in clinical outcomes. Study design The Dual Antiplatelet
Therapy After Drug-Eluting Stent Implantation In ST-elevation Myocardial
Infarction (DAPT-STEMI) trial is a randomized, multicenter, international,
open-label trial designed to examine the safety (noninferiority) of
6-month DAPT after Resolute Integrity stent implantation in STEMI patients
compared with 12-month DAPT. Event-free patients on DAPT at 6month will be
randomized (1:1 fashion) between single (aspirin only) versus DAPT for an
additional 6 months and followed until 2 years after primary percutaneous
coronary intervention. The primary end point is a patient-oriented
composite endpoint of all-cause mortality, any myocardial infarction, any
revascularization, stroke, and major bleeding (net adverse clinical events
[NACE]) at 18 months after randomization. To achieve a power of 85% for a
noninferiority limit of 1.66, a total of 1100 enrolled patients are
required. Summary The DAPT-STEMI trial aims to assess in STEMI patients
treated with second-generation DESs whether discontinuation of DAPT after
6 months of event-free survival is noninferior to routine 12-month
DAPT.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<72>
Accession Number
618030176
Author
Kandzari D.E.; Mauri L.; Koolen J.J.; Massaro J.M.; Doros G.;
Garcia-Garcia H.M.; Bennett J.; Roguin A.; Gharib E.G.; Cutlip D.E.;
Waksman R.
Institution
(Kandzari) Piedmont Heart Institute, Atlanta, GA, USA
(Mauri) Divison of Cardiovascular Medicine, Brigham and Women's Hospital,
Boston, MA, USA
(Koolen) Catharina Hospital, Eindhoven, Netherlands
(Massaro, Doros) Department of Biostatistics and Epidemiology, Boston
University School of Public Health, Boston, MA, USA
(Doros) Baim Institute for Clinical Research, Boston, MA, USA
(Garcia-Garcia, Waksman) Division of Interventional Cardiology, MedStar
Cardiovascular Research Network, MedStar Washington Hospital Center,
Washington, DC, USA
(Bennett) Department of Cardiovascular Medicine, University Hospitals
Leuven, Leuven, Belgium
(Roguin) Department of Cardiology, Rambam Medical Center, Haifa, Israel
(Gharib) Charleston Area Medical Center, Charleston, WV, USA
(Cutlip) Beth Israel Deaconess Medical Center, Baim Institute for Clinical
Research, Boston, MA, USA
Title
Ultrathin, bioresorbable polymer sirolimus-eluting stents versus thin,
durable polymer everolimus-eluting stents in patients undergoing coronary
revascularisation (BIOFLOW V): A randomised trial.
Source
The Lancet. (no pagination), 2017. Date of Publication: 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: The development of coronary drug-eluting stents has included
use of new metal alloys, changes in stent architecture, and use of
bioresorbable polymers. Whether these advancements improve clinical safety
and efficacy has not been shown in previous randomised trials. We aimed to
examine the clinical outcomes of a bioresorbable polymer sirolimus-eluting
stent compared with a durable polymer everolimus-eluting stent in a broad
patient population undergoing percutaneous coronary intervention. Methods:
BIOFLOW V was an international, randomised trial done in patients
undergoing elective and urgent percutaneous coronary intervention in 90
hospitals in 13 countries (Australia, Belgium, Canada, Denmark, Germany,
Hungary, Israel, the Netherlands, New Zealand, South Korea, Spain,
Switzerland, and the USA). Eligible patients were those aged 18 years or
older with ischaemic heart disease undergoing planned stent implantation
in de-novo, native coronary lesions. Patients were randomly assigned (2:1)
to either an ultrathin strut (60 mum) bioresorbable polymer
sirolimus-eluting stent or to a durable polymer everolimus-eluting stent.
Randomisation was via a central web-based data capture system (mixed
blocks of 3 and 6), and stratified by study site. The primary endpoint was
12-month target lesion failure. The primary non-inferiority comparison
combined these data from two additional randomised trials of bioresorbable
polymer sirolimus-eluting stent and durable polymer everolimus-eluting
stent with Bayesian methods. Analysis was by intention to treat. The trial
is registered with ClinicalTrials.gov, number NCT02389946. Findings:
Between May 8, 2015, and March 31, 2016, 4772 patients were recruited into
the study. 1334 patients met inclusion criteria and were randomly assigned
to treatment with bioresorbable polymer sirolimus-eluting stents (n=884)
or durable polymer everolimus-eluting stents (n=450). 52 (6%) of 883
patients in the bioresorbable polymer sirolimus-eluting stent group and 41
(10%) of 427 patients in the durable polymer everolimus-eluting stent
group met the 12-month primary endpoint of target lesion failure (95% CI
-6.84 to -0.29, p=0.0399), with differences in target vessel myocardial
infarction (39 [5%] of 831 patients vs 35 [8%] of 424 patients, p=0.0155).
The posterior probability that the bioresorbable polymer sirolimus-eluting
stent is non-inferior to the durable polymer everolimus-eluting stent was
100% (Bayesian analysis, difference in target lesion failure frequency
-2.6% [95% credible interval -5.5 to 0.1], non-inferiority margin 3.85%,
n=2208). Interpretation: The outperformance of the ultrathin,
bioresorbable polymer sirolimus-eluting stent over the durable polymer
everolimus-eluting stent in a complex patient population undergoing
percutaneous coronary intervention suggests a new direction in improving
next generation drug-eluting stent technology. Funding:
BIOTRONIK.<br/>Copyright &#xa9; 2017 Elsevier Ltd.

<73>
Accession Number
618029522
Author
Ring W.S.; Edgerton J.R.; Herbert M.; Prince S.; Knoff C.; Jenkins K.M.;
Jessen M.E.; Hamman B.L.
Institution
(Ring, Jessen) Department of Cardiovascular and Thoracic Surgery,
University of Texas Southwestern Medical Center, Dallas, Texas
(Ring, Edgerton, Knoff, Jenkins, Jessen, Hamman) Texas Quality Initiative,
Dallas-Fort Worth Hospital Council Foundation, Irving, Texas
(Edgerton) Center for Advanced Cardiovascular Care, The Heart Hospital
Baylor Plano, Plano, Texas
(Herbert) Department of Clinical Research, Medical City Dallas Hospital,
Dallas, Texas
(Prince) Department of Cardiovascular Outcomes, Medical City Healthcare,
Dallas, Texas
(Hamman) Cardiovascular and Thoracic Surgery, Texas Health Resources,
Arlington, Texas
Title
Impact of Accurate 30-Day Status on Operative Mortality: Wanted Dead or
Alive, Not Unknown.
Source
Annals of Thoracic Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier USA
Abstract
Background: Risk-adjusted operative mortality is the most important
quality metric in cardiac surgery for determining The Society of Thoracic
Surgeons (STS) Composite Score for star ratings. Accurate 30-day status is
required to determine STS operative mortality. The goal of this study was
to determine the effect of unknown or missing 30-day status on
risk-adjusted operative mortality in a regional STS Adult Cardiac Surgery
Database cooperative and demonstrate the ability to correct these
deficiencies by matching with an administrative database. Methods: STS
Adult Cardiac Surgery Database data were submitted by 27 hospitals from
five hospital systems to the Texas Quality Initiative (TQI), a regional
quality collaborative. TQI data were matched with a regional hospital
claims database to resolve unknown 30-day status. The risk-adjusted
operative mortality observed-to-expected (O/E) ratio was determined before
and after matching to determine the effect of unknown status on the
operative mortality O/E. Results: TQI found an excessive (22%) unknown
30-day status for STS isolated coronary artery bypass grafting cases.
Matching the TQI data to the administrative claims database reduced the
unknowns to 7%. The STS process of imputing unknown 30-day status as alive
underestimates the true operative mortality O/E (1.27 before vs 1.30 after
match), while excluding unknowns overestimates the operative mortality O/E
(1.57 before vs 1.37 after match) for isolated coronary artery bypass
grafting. Conclusions: The current STS algorithm of imputing unknown
30-day status as alive and a strategy of excluding cases with unknown
30-day status both result in erroneous calculation of operative mortality
and operative mortality O/E. However, external validation by matching with
an administrative database can improve the accuracy of clinical databases
such as the STS Adult Cardiac Surgery Database.<br/>Copyright &#xa9; 2017
The Society of Thoracic Surgeons.

<74>
Accession Number
618025581
Author
Zhao B.-C.; Shen P.; Liu K.-X.
Institution
(Zhao, Liu) Department of Anesthesiology, Nanfang Hospital, Southern
Medical University, Guangzhou, China
(Shen) Department of Anesthesiology, the First Affiliated Hospital, Sun
Yat-Sen University, Guangzhou, China
Title
Perioperative Statins Do Not Prevent Acute Kidney Injury After Cardiac
Surgery: A Meta-analysis of Randomized Controlled Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objectives: To evaluate whether perioperative statins reduce the risk of
acute kidney injury (AKI) after cardiac surgery. Design: Systematic review
and meta-analysis of randomized trials. Setting: Perioperative management
in hospitals that perform cardiac surgery. Participants: Adult patients
undergoing cardiac surgery. Interventions: PubMed, EMBASE, and the
Cochrane Library databases were searched for randomized trials.
Random-effects meta-analyses were performed to compare the effects of
statins versus placebo/control. Trial sequential analysis was conducted to
confirm the results. Measurements and Main Results: The primary outcome
was incidence of postoperative AKI. Eight trials enrolling 3,204 patients
were included. The statin arms and the control arms were comparable in
incidence of postoperative AKI (risk ratio [RR] = 1.02, 95% confidence
interval [CI] = 0.82-1.28), need for renal replacement therapy (RR = 1.09,
95% CI = 0.45-2.66), mechanical ventilation duration (mean difference [MD]
= 24.84 min, 95% CI = -55.53-105.20), intensive care unit length of stay
(MD = 0.04 days, 95% CI = -3.13-3.20), hospital length of stay (MD = -0.08
days, 95% CI = -0.31-0.15), and in-hospital mortality (RR = 3.76, 95% CI =
0.93-15.14). Trial sequential analysis confirmed that it is unlikely that
perioperative statin therapy could achieve a 20% or more relative risk
reduction in AKI incidence. Conclusions: Among patients undergoing cardiac
surgery, perioperative statin treatment did not reduce the risk of AKI.
Statin therapy should not be initiated to prevent AKI following cardiac
surgery.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<75>
Accession Number
618020316
Author
Alonso P.; Sanz J.; Garcia-Orts A.; Reina S.; Jimenez S.; Osca J.; Cano
O.; Andres A.; Sancho-Tello M.J.; Martinez L.
Institution
(Alonso, Sanz, Garcia-Orts, Reina, Jimenez, Osca, Cano, Andres,
Sancho-Tello, Martinez) Electrophysiology Section, Cardiology Department,
La Fe University Hospital, Valencia, Spain
Title
Usefulness of Sodium Bicarbonate for the Prevention of Contrast-Induced
Nephropathy in Patients Undergoing Cardiac Resynchronization Therapy.
Source
American Journal of Cardiology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The use of contrast media during cardiac resynchronization therapy (CRT)
devices implantation is associated with the risk of contrast-induced
nephropathy (CIN). The aim of this study was to evaluate the possible
beneficial role of periprocedural intravenous volume expansion with
isotonic saline and sodium bicarbonate solution in patients who undergo
CRT implantation. Eligible patients were randomly assigned in a 1:1 ratio
to receive hydration plus one-sixth molar sodium bicarbonate (study group)
or not (control group). Primary end point was CIN incidence. Secondary end
points were (1) a combined end point of death, heart transplantation, or
hospitalization for heart failure at 12 months, (2) incidence of death,
and (3) the need for renal replacement therapy at 12 months. Final
analysis was performed with 93 patients. In the hydration group CIN
incidence was significantly reduced related to control group (0% vs 11%, p
= 0.02). There was a trend to reduce the combined end point in hydration
group (12.5% vs 22%, p = 0.14). Finally, CIN incidence was related to a
higher 12 months mortality (25% vs 7%, p = 0.03). In conclusion, CIN
incidence was 11% in a nonselected population of patients receiving a CRT
device. CIN appearance could be reduced by using a hydration protocol
based on sodium bicarbonate and isotonic saline.<br/>Copyright &#xa9; 2017
Elsevier Inc.

<76>
Accession Number
618019417
Author
Upadhyay S.; Walsh E.P.; Cecchin F.; Triedman J.K.; Villafane J.; Saul
J.P.
Institution
(Upadhyay) Department of Pediatrics Connecticut Children's Medical Center
University of Connecticut School of Medicine Hartford, CT USA
(Walsh, Triedman) Department of Pediatrics Boston Children's Hospital
Harvard University Boston, MA USA
(Cecchin) Department of Pediatrics New York University School of Medicine
New York, NY USA
(Villafane) Department of Pediatrics University of Kentucky Louisville, KY
USA
(Saul) Department of Pediatrics University of West Virginia School of
Medicine Morgantown, WV USA
Title
Epicardial ablation of tachyarrhythmia in children: Experience at two
academic centers.
Source
PACE - Pacing and Clinical Electrophysiology. (no pagination), 2017. Date
of Publication: 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Experience with percutaneous epicardial ablation of
tachyarrhythmia in pediatrics is limited. This case series addresses the
feasibility, safety, and complications of the procedure in children.
Methods: A total of nine patients underwent 10 epicardial ablation
procedures from 2002 to 2013 at two academic centers. Activation mapping
was performed in all cases, and electroanatomic map was utilized in nine
of the 10 procedures. Patients had undergone one to three failed
endocardial catheter ablations in addition to medical management, and all
had symptoms, a high-risk accessory pathway (AP), aborted cardiac arrest
with Wolff-Parkinson-White syndrome (WPW), or ventricular dysfunction. A
standard epicardial approach was used for access in all cases, using a 7-
or 8- Fr sheath. Epicardial ablation modality was radiofrequency (RF) in
seven, cryoablation (CRYO) in one, and CRYO plus RF in one. Results:
Median age was 14 (range 8-19) years. Indications: drug refractory ectopic
atrial tachycardia (one), ventricular tachycardia (VT) (five), high-risk
AP (two), and aborted cardiac arrest from WPW - (one). Epicardial ablation
was not performed in one case despite access due to an inability to
maneuver the catheter around a former pericardial scar. VT foci included
the right ventricular outflow tract septum, high posterior left ventricle
(LV), LV outflow tract, postero-basal LV, and scar from previous
rhabdomyoma surgery. WPW foci were in the area of the posterior septum and
coronary sinus in all three cases. Overall procedural success was 70%
(7/10), with epicardial ablation success in five and endocardial ablation
success after epicardial mapping in two. The VT focus was close to the
left anterior descending coronary artery in one of the unsuccessful cases
in which both RF and CRYO were used. There was one recurrence after a
successful epicardial VT ablation, which was managed with a second
successful epicardial procedure. There were no other recurrences at more
than 1 year of follow-up. Complications were minimal, with one case of
inadvertent pleural access requiring no specific therapy. No pericarditis
or effusion was seen in any of the patients who underwent epicardial
ablation. Conclusion: Epicardial ablation in pediatric patients can be
performed with low complications and acceptable success. It can be
considered for a spectrum of tachycardia mechanisms after failed
endocardial ablation attempts and suspected epicardial foci. Success and
recurrence may be related to foci in proximity to the epicardial
coronaries, pericardial scar, or a distant location from the closest
epicardial location. Repeat procedures may be necessary.<br/>Copyright
&#xa9; 2017 Wiley Periodicals, Inc.

<77>
Accession Number
618015127
Author
El Tahan M.R.; Pasin L.; Marczin N.; Landoni G.
Institution
(El Tahan) Anesthesiology Department, University of Dammam, Al Khubar,
Saudi Arabia
(El Tahan) Cardiothoracic Anaesthesia and Surgical Intensive Care,
Mansoura University, Mansoura City, Egypt
(Pasin) Department of Anesthesia and Intensive Care, Sant'Antonio
Hospital, Padova, Italy
(Marczin) The Royal Brompton and Harefield NHS Foundation Trust, London,
UK
(Marczin) Section of Anaesthesia, Pain Medicine, and Intensive Care,
Imperial College London, London, UK
(Marczin) Semmelweis University, Budapest, Hungary
(Landoni) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Landoni) Vita-Salute San Raffaele University, Milano, Italy
Title
Impact of Low Tidal Volumes During One-Lung Ventilation. A Meta-Analysis
of Randomized Controlled Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objectives: The link between ventilation strategies and perioperative
outcomes remains one of the fundamental paradigms of thoracic anaesthesia.
During one-lung ventilation (OLV), one lung is excluded from gas exchange
and ventilation is directed at the dependent lung. The authors
hypothesised that the use of low tidal volumes (V<inf>T</inf>) during OLV
provides adequate gas exchange and improves postoperative outcome. Design:
Meta-analysis of randomized clinical trials. Setting: Thoracic surgery.
Participants: Patients undergoing OLV. Interventions: None. Measurements
and Main Results: The authors performed a meta-analysis of all randomized
trials on low versus high V<inf>T</inf> during OLV in patients undergoing
thoracic surgery. Outcomes of the study were gas exchange and airway
pressures during and after OLV, postoperative pulmonary complications
(PPCs), and hospital stay (HLOS). Fourteen randomized trials were
selected, but only a few of them contained one outcome of interest. Low
V<inf>T</inf> was associated with lower arterial oxygen tension, lower
airway pressures, and higher arterial carbon dioxide tension at specific
time points during OLV. Low V<inf>T</inf> was associated with preserved
gas exchange after OLV, lower incidence of pulmonary infiltrations, and
acute respiratory distress syndrome. Incidences of PPCs and HLOS were
similar. Conclusions: The use of low V<inf>T</inf> reduces airway pressure
but worsens gas exchange during OLV. Preservation of postoperative
oxygenation and reduction in infiltrates suggest a lung-protective
modality with no demonstrable impact on PPCs and HLOS.<br/>Copyright
&#xa9; 2017 Elsevier Inc.

<78>
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.

<79>
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)

<80>
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.

<81>
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.

<82>
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.

<83>
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.

<84>
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.

<85>
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.

<86>
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.

<87>
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.

<88>
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.

<89>
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

<90>
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.

<91>
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.

<92>
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.

<93>
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.

<94>
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.

<95>
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.

<96>
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.

<97>
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.

<98>
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.

<99>
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.

<100>
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.

<101>
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.

<102>
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)

<103>
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.

<104>
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.

<105>
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.

<106>
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).

<107>
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).

<108>
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).

<109>
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).

<110>
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).

<111>
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.

<112>
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.

<113>
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.

<114>
[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.

<115>
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

<116>
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

<117>
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.

<118>
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.

<119>
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.

<120>
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?.

<121>
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.

<122>
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

<123>
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.

<124>
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.

<125>
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

<126>
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.

<127>
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

<128>
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.

<129>
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.

<130>
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.

<131>
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.