EPICORE Embase Updates: EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
615172811
Author
Rubboli A.; Saia F.; Sciahbasi A.; Leone A.M.; Palmieri C.;
Bacchi-Reggiani M.L.; Calabro P.; Bordoni B.; Piccalo G.; Franco N.;
Nicolino A.; Magnavacchi P.; Vignali L.; Mameli S.; Dallago M.; Maggiolini
S.; Steffanon L.; Piovaccari G.; Di Pasquale G.
Institution
(Rubboli, Di Pasquale) Division of Cardiology - Laboratory of
Interventional Cardiology, Ospedale Maggiore, Bologna, Italy
(Saia, Bacchi-Reggiani, Bordoni) Cardio-Thoraco-Vascular Department,
University Hospital S. Orsola-Malpighi, Bologna, Italy
(Sciahbasi) Unit of Interventional Cardiology, Ospedale Sandro Pertini,
Roma, Italy
(Leone) Department of Cardiovascular Sciences, Universita Cattolica del
Sacro Cuore, Roma, Italy
(Palmieri) Division of Interventional Cardiology, Ospedale del Cuore G.
Pasquinucci, Massa, Italy
(Calabro) Division of Cardiology, Seconda Universita, Ospedale Monaldi,
Napoli, Italy
(Piccalo) Division of Cardiology 1, Ospedale Niguarda, Milano, Italy
(Franco, Piovaccari) Division of Cardiology, Ospedale degli Infermi,
Rimini, Italy
(Nicolino) Division of Cardiology, Ospedale S. Corona, Pietra Ligure,
Italy
(Magnavacchi) Division of Cardiology, Ospedale Civile S. Agostino Estense,
Modena, Italy
(Vignali) Division of Cardiology, Azienda Ospedaliera-Universitaria,
Parma, Italy
(Mameli) Division of Cardiology, Ospedale S. Francesco, Nuoro, Italy
(Dallago) Division of Cardiology, Ospedale S. Chiara, Trento, Italy
(Maggiolini) Division of Cardiology, Ospedale S. Leopoldo Mandic, Merate,
Italy
(Steffanon) Unit of Cardiac and Vascular interventions, Hesperia Hospital,
Modena, Italy
Title
Twelve-month outcome of patients with an established indication for oral
anticoagulation undergoing coronary artery stenting and stratified by the
baseline risk of bleeding: Insights from the Warfarin and Coronary
Stenting (War-Stent) Registry.
Source
Cardiovascular Revascularization Medicine. 18 (6) (pp 425-430), 2017. Date
of Publication: September 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Purpose To evaluate the outcome of patients with an established indication
for oral anticoagulation (OAC) undergoing coronary stent implantation
(PCI-S) and stratified by the baseline risk of bleeding. Material and
methods The database of the prospective, multicentre, observational
WAR-STENT registry (ClinicalTrials.gov identifier NCT00722319) was
analyzed and patients with atrial fibrillation and
CHA<inf>2</inf>DS<inf>2</inf>-VASc score >=2, mechanical heart valve,
prior cardiac embolism, intra-cardiac thrombus and recent venous
thromboembolism who were treated with either triple (warfarin, aspirin and
clopidogrel) or dual (warfarin and clopidogrel) or dual antiplatelet
(aspirin and clopidogrel) therapy, identified. Patients were then sorted
into two groups at non-low and low risk of bleeding, as defined by an
ATRIA score >3 and <=3 respectively, and compared regarding major adverse
cardiac and vascular events (MACVE) and bleeding. Results At 12-month
follow up, MACVE were comparable in the two groups, whereas total, major
and minor bleeding, as well as combined MACVE and total bleeding, were
significantly more frequent in the non-low bleeding risk group. Upon Cox
univariate and multivariable analysis, non-low bleeding risk category
confirmed as an independent predictor of major bleeding. The choice of
antithrombotic therapy however, appeared not to be influenced by the
bleeding risk category at baseline. Conclusions In patients with an
established indication for OAC undergoing PCI-S, non-low bleeding risk
category is the most potent independent predictor of major bleeding.
Stratification of the bleeding risk at baseline should therefore be
regarded as an indispensable process to be carried out before selection of
the antithrombotic therapy. Copyright © 2017 Elsevier Inc.

<2>
Accession Number
618467553
Author
Giannitsis E.; Wallentin L.; James S.K.; Bertilsson M.; Siegbahn A.;
Storey R.F.; Husted S.; Cannon C.P.; Armstrong P.W.; Steg P.G.; Katus H.A.
Institution
(Giannitsis, Katus) Medizinische Klinik, Universitatsklinikum Heidelberg,
Germany
(Wallentin, James, Siegbahn) Department of Medical Sciences, Uppsala
University, Sweden
(Wallentin, James, Bertilsson, Siegbahn) Uppsala Clinical Research Center,
Uppsala University, Sweden
(Storey) Department of Cardiovascular Science, University of Sheffield,
United Kingdom
(Husted) Medical Department, Hospital Unit West, Herning/Holstebro,
Denmark
(Cannon) Cardiovascular Division, Brigham and Women's Hospital, United
States
(Cannon) Harvard Clinical Research Institute, United States
(Armstrong) Canadian VIGOUR Centre, University of Alberta, Canada
(Steg) INSERM-Unite 1148, France
(Steg) Hopital Bichat, France
(Steg) Universite Paris-Diderot, Sorbonne-Paris Cite, France
(Steg) National Heart and Lung Institute, Imperial College London, United
Kingdom
(Steg) Institute of Cardiovascular Medicine and Science, Royal Brompton
Hospital, United Kingdom
Title
Outcomes after planned invasive or conservative treatment strategy in
patients with non-ST-elevation acute coronary syndrome and a normal value
of high sensitivity troponin at randomisation: A Platelet Inhibition and
Patient Outcomes (PLATO) trial biomarker substudy.
Source
European Heart Journal: Acute Cardiovascular Care. 6 (6) (pp 500-510),
2017. Date of Publication: 01 Sep 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Aims: Current guidelines for patients with non-ST-elevation acute coronary
syndrome (NSTE-ACS) recommend early invasive treatment in
intermediate-to-high risk patients based on medical history,
electrocardiogram (ECG) and elevated troponin. Patients with normal levels
of cardiac troponin measured with a high-sensitivity method (cTnT-hs)
might not benefit from early invasive procedures. Methods and results: In
this Prospective Randomized Platelet Inhibition and Patient Outcomes
(PLATO) blood-core substudy, 1232 patients presented with NSTE-ACS had a
high sensitivity cardiac troponin T (cTnT-hs) level <99th
percentile (<14 ng/l) at randomisation. The outcomes in relation to a
planned invasive (n=473) vs planned conservative treatment (n=759), were
evaluated by adjusted Cox proportional hazard analyses. In patients with a
normal cTnT-hs at randomisation, regardless of randomised treatment, a
planned invasive vs conservative treatment was associated with a 2.3-fold
higher risk (7.3% vs 3.4%, p=0.0028) for cardiovascular (CV) death or
myocardial infarction (MI), driven by higher rates of procedure-related MI
(3.4% vs 0.1%), while there were no differences in rates of CV death (1.3%
vs 1.3%, p=0.72) or spontaneous MI (3.0% vs 2.1%, p=0.28). There were
significantly more major bleeds (hazard ratio (HR) 2.98, p<0.0001), mainly
due to coronary artery bypass graft (CABG)-related (HR 4.05, p<0.0001) and
non-CABG procedural-related major bleeding events (HR 5.31, p=0.0175),
however there were no differences in non-procedure-related major bleeding
(1.5% vs 1.9%, p=0.45). Findings were consistent for patients with a
normal cTnI-hs at randomisation. Conclusions: In patients with NSTE-ACS
and normal cTnT-hs, a planned early invasive treatment strategy was
associated with increased rates of procedure-related MI and bleeding but
no differences in long-term spontaneous MI, non-procedure-related bleeding
or mortality. Copyright © 2016, © The European Society of
Cardiology 2016.

<3>
Accession Number
618464567
Author
Rogers C.A.; Stoica S.; Ellis L.; Stokes E.A.; Wordsworth S.; Dabner L.;
Clayton G.; Downes R.; Nicholson E.; Bennett S.; Angelini G.D.; Reeves
B.C.; Murphy G.J.
Institution
(Rogers, Ellis, Dabner, Clayton, Reeves) Clinical Trials and Evaluation
Unit, School of Clinical Sciences, University of Bristol, Bristol Royal
Infirmary, Bristol BS2 8HW, United Kingdom
(Stoica, Downes, Nicholson, Angelini) Bristol Heart Institute, National
Institute for Health Research Bristol Biomedical Research Unit in
Cardiovascular Medicine, University Hospitals Bristol NHS Foundation
Trust, Bristol Royal Infirmary, Bristol BS2 8HW, United Kingdom
(Stokes, Wordsworth) Health Economics Research Centre, Nuffield Department
of Population Health, University of Oxford, Old Road Campus, Old Road,
Headington, Oxford OX3 7LF, United Kingdom
(Bennett) Cardiac Anaesthesia and Intensive Care, King Faisal Cardiac
Center, NGHA, Jeddah, Saudi Arabia
(Murphy) Department of Cardiovascular Sciences, National Institute for
Health Research Leicester Biomedical Research Unit in Cardiovascular
Medicine, University of Leicester, Clinical Sciences Wing, Glenfield
General Hospital, Leicester LE3 9QP, United Kingdom
Title
Randomized trial of near-infrared spectroscopy for personalized
optimization of cerebral tissue oxygenation during cardiac surgery.
Source
British Journal of Anaesthesia. 119 (3) (pp 384-393), 2017. Date of
Publication: 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Background. We assessed whether a near-infrared spectroscopy (NIRS)-based
algorithm for the personalized optimization of cerebral oxygenation during
cardiopulmonary bypass combined with a restrictive red cell transfusion
threshold would reduce perioperative injury to the brain, heart, and
kidneys. Methods. In a randomized controlled trial, participants in three
UK centres were randomized with concealed allocation to a NIRS (INVOS
5100; Medtronic Inc., Minneapolis, MN, USA)-based patient-specific'
algorithm that included a restrictive red cell transfusion threshold
(haematocrit 18%) or to a generic' non-NIRS-based algorithm (standard
care). The NIRS algorithm aimed to maintain cerebral oxygenation at an
absolute value of > 50% or at > 70% of baseline values. The primary
outcome for the trial was cognitive function measured up to 3 months
postsurgery. Results. The analysis population comprised eligible
randomized patients who underwent valve or combined valve surgery and
coronary artery bypass grafts using cardiopulmonary bypass between
December 2009 and January 2014 (n=98 patient-specific algorithm; n=106
generic algorithm). There was no difference between the groups for the
three core cognitive domains (attention, verbal memory, and motor
coordination) or for the non-core domains psychomotor speed and
visuo-spatial skills. The NIRS group had higher scores for verbal fluency;
mean difference 3.73 (95% confidence interval 1.50, 5.96). Red cell
transfusions, biomarkers of brain, kidney, and myocardial injury, adverse
events, and health-care costs were similar between the groups.
Conclusions. These results do not support the use of NIRS-based algorithms
for the personalized optimization of cerebral oxygenation in adult cardiac
surgery. Clinical trial registration.http://www.controlled-trials.com,
ISRCTN 23557269. Copyright © 2017 The Author.

<4>
Accession Number
618433429
Author
Zorrilla-Vaca A.; Nunez-Patino R.A.; Torres V.; Salazar-Gomez Y.
Institution
(Zorrilla-Vaca) Faculty of Health, Universidad Del Valle, School of
Medicine, Hospital Universitario Del Valle, Cali, Colombia
(Zorrilla-Vaca) Department of Anesthesiology and Critical Care Medicine,
Johns Hopkins Hospital, Baltimore, MD, United States
(Nunez-Patino) Faculty of Health Sciences, Pontificia Universidad
Javeriana, Cali, Colombia
(Torres, Salazar-Gomez) Faculty of Health, Universidad Libre, Cali,
Colombia
Title
The Impact of Volatile Anesthetic Choice on Postoperative Outcomes of
Cardiac Surgery: A Meta-Analysis.
Source
BioMed Research International. 2017 (no pagination), 2017. Article Number:
7073401. Date of Publication: 2017.
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Objectives. To evaluate the impact of volatile anesthetic choice on
clinically relevant outcomes of patients undergoing cardiac surgery.
Methods. Major databases were systematically searched for randomized
controlled trials (RCTs) comparing volatile anesthetics (isoflurane versus
sevoflurane) in cardiac surgery. Study-level characteristics,
intraoperative events, and postoperative outcomes were extracted from the
articles. Results. Sixteen RCTs involving 961 patients were included in
this meta-analysis. There were no significant differences between both
anesthetics in terms of intensive care unit length of stay (SMD -0.07, 95%
CI -0.38 to 0.24, P=0.66), hospital length of stay (SMD 0.06, 95% CI -0.33
to 0.45, P=0.76), time to extubation (SMD 0.29, 95% CI -0.08 to 0.65,
P=0.12), S100beta (at the end of surgery: SMD 0.08, 95% CI -0.33 to 0.49,
P=0.71; 24 hours after surgery: SMD 0.21, 95% CI -0.23 to 0.65, P=0.34),
or troponin (at the end of surgery: SMD -1.13, 95% CI -2.39 to 0.13,
P=0.08; 24 hours after surgery: SMD 0.74, 95% CI -0.15 to 1.62, P=0.10).
CK-MB was shown to be significantly increased when using isoflurane
instead of sevoflurane (SMD 2.16, 95% CI 0.57 to 3.74, P=0.008).
Conclusions. The volatile anesthetic choice has no significant impact on
postoperative outcomes of patients undergoing cardiac
surgery. Copyright © 2017 Andres Zorrilla-Vaca et al.

<5>
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. 42 (pp 106-113), 2017. Date of
Publication: November 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)
mug ml- 1 and 1.87 (1.73-2.96) mug ml- 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 Copyright © 2017 Elsevier Inc.

<6>
Accession Number
618452031
Author
Schwarz K.; Singh S.; Parasuraman S.K.; Rudd A.; Shepstone L.; Feelisch
M.; Minnion M.; Ahmad S.; Madhani M.; Horowitz J.; Dawson D.K.; Frenneaux
M.P.
Institution
(Schwarz, Singh, Parasuraman, Rudd, Dawson) School of Medicine and
Dentistry, University of Aberdeen, Aberdeen, United Kingdom
(Schwarz) Royal Wolverhampton Hospital, Wolverhampton, United Kingdom
(Parasuraman, Shepstone, Frenneaux) Norwich Medical School, University of
East Anglia, Norwich, United Kingdom
(Feelisch, Minnion) University of Southampton, Southampton, United Kingdom
(Ahmad) Aston Medical Research Institute, Aston University, Birmingham,
United Kingdom
(Horowitz) Basil Hetzel Institute, University of Adelaide, Adelaide,
Australia
(Madhani) Institute of Cardiovascular Sciences, University of Birmingham,
Birmingham, United Kingdom
Title
Inorganic nitrate in angina study: A randomized double-blind
placebo-controlled trial.
Source
Journal of the American Heart Association. 6 (9) (no pagination), 2017.
Article Number: e006478. Date of Publication: 01 Sep 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--In this double-blind randomized placebo-controlled crossover
trial, we investigated whether oral sodium nitrate, when added to existing
background medication, reduces exertional ischemia in patients with
angina. Methods and Results--Seventy patients with stable angina, positive
electrocardiogram treadmill test, and either angiographic or functional
test evidence of significant ischemic heart disease were randomized to
receive oral treatment with either placebo or sodium nitrate (600 mg; 7
mmol) for 7 to 10 days, followed by a 2-week washout period before
crossing over to the other treatment (n=34 placebo-nitrate, n=36
nitrate-placebo). At baseline and at the end of each treatment, patients
underwent modified Bruce electrocardiogram treadmill test, modified
Seattle Questionnaire, and subgroups were investigated with dobutamine
stress, echocardiogram, and blood tests. The primary outcome was time to 1
mm ST depression on electrocardiogram treadmill test. Compared with
placebo, inorganic nitrate treatment tended to increase the primary
outcome exercise time to 1 mm ST segment depression (645.6 [603.1, 688.0]
seconds versus 661.2 [6183, 704.0] seconds, P=0.10) and significantly
increased total exercise time (744.4 [702.4, 786.4] seconds versus 760.9
[719.5, 802.2] seconds, P=0.04; mean [95% confidence interval]). Nitrate
treatment robustly increased plasma nitrate (18.3 [15.2, 21.5] versus
297.6 [218.4, 376.8] mumol/L, P < 0.0001) and almost doubled circulating
nitrite concentrations (346 [285, 405] versus 552 [398, 706] nmol/L,
P=0.003; placebo versus nitrate treatment). Other secondary outcomes were
not significantly altered by the intervention. Patients on antacid
medication appeared to benefit less from nitrate supplementation.
Conclusions--Sodium nitrate treatment may confer a modest exercise
capacity benefit in patients with chronic angina who are taking other
background medication. Copyright © 2017 The Authors.

<7>
Accession Number
618451983
Author
Khan A.A.; Chung M.J.; Novak E.; Brown D.L.
Institution
(Khan) Department of Internal Medicine, Washington University School of
Medicine, St. Louis, MO, United States
(Chung, Novak, Brown) Cardiovascular Division, Washington University
School of Medicine, St. Louis, MO, United States
Title
Increased hazard of myocardial infarction with insulin-provision therapy
in actively smoking patients with diabetes mellitus and stable ischemic
heart disease: The BARI 2D (Bypass Angioplasty Revascularization
Investigation 2 Diabetes) trial.
Source
Journal of the American Heart Association. 6 (9) (no pagination), 2017.
Article Number: e005946. Date of Publication: 01 Sep 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--In the BARI 2D (Bypass Angioplasty Revascularization
Investigation 2 Diabetes) trial, randomization of diabetic patients with
stable ischemic heart disease to insulin provision (IP) therapy, as
opposed to insulin sensitization (IS) therapy, resulted in biochemical
evidence of impaired fibrinolysis but no increase in adverse clinical
outcomes. We hypothesized that the prothrombotic effect of IP therapy in
combination with the hypercoagulable state induced by active smoking would
result in an increased risk of myocardial infarction (MI). Methods and
Results--We analyzed BARI 2D patients who were active smokers randomized
to IP or IS therapy. The primary end point was fatal or nonfatal MI. PAI-1
(plasminogen activator inhibitor 1) activity was analyzed at 1, 3, and 5
years. Of 295 active smokers, MI occurred in 15.4% randomized to IP and in
6.8% randomized to IS over the 5.3 years (P=0.023). IP therapy was
associated with a 3.2-fold increase in the hazard of MI compared with IS
therapy (hazard ratio: 3.23; 95% confidence interval, 1.43- 7.28;
P=0.005). Baseline PAI-1 activity (19.0 versus 17.5 Au/mL, P=0.70) was
similar in actively smoking patients randomized to IP or IS therapy.
However, IP therapy resulted in significantly increased PAI-1 activity at
1 year (23.0 versus 16.0 Au/mL, P=0.001), 3 years (24.0 versus 18.0 Au/mL,
P=0.049), and 5 years (29.0 versus 15.0 Au/mL, P=0.004) compared with IS
therapy. Conclusions--Among diabetic patients with stable ischemic heart
disease who were actively smoking, IP therapy was independently associated
with a significantly increased hazard of MI. This finding may be explained
by higher PAI-1 activity in active smokers treated with IP
therapy. Copyright © 2017 The Authors.

<8>
Accession Number
618451939
Author
Guimaraes P.O.; Granger C.B.; Stebbins A.; Chiswell K.; Held C.; Hochman
J.S.; Krug-Gourley S.; Lonn E.; Lopes R.D.; Stewart R.A.H.; Vinereanu D.;
Wallentin L.; White H.D.; Hagstrom E.; Danchin N.
Institution
(Guimaraes, Granger, Stebbins, Chiswell, Lopes) Duke Clinical Research
Institute, Durham, NC, United States
(Granger, Lopes) Duke University Medical Center, Durham, NC, United States
(Held, Wallentin, Hagstrom) Department of Medical Sciences, Cardiology and
Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
(Hochman) Department of Medicine, NYU Langone Medical Center, New York,
NY, United States
(Krug-Gourley) Metabolic Pathways and Cardiovascular Therapeutic Area,
GlaxoSmithKline, Collegeville, PA, United States
(Lonn) Department of Medicine and Population Health Research Institute,
McMaster University, Hamilton, ON, Canada
(Stewart, White) Green Lane Cardiovascular Service, Auckland City Hospital
and University of Auckland, Auckland, New Zealand
(Vinereanu) University of Medicine and Pharmacy Carol Davila, Bucharest,
Romania
(Danchin) Hopital Europeen Georges Pompidou, Assistance Publique Hopitaux
de Paris, INSERM U-970 and Universite Paris Descartes, Paris, France
Title
Sex differences in clinical characteristics, psychosocial factors, and
outcomes among patients with stable coronary heart disease: Insights from
the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of
Darapladib Therapy) trial.
Source
Journal of the American Heart Association. 6 (9) (no pagination), 2017.
Article Number: e006695. Date of Publication: 01 Sep 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Greater understanding of differences between men and women with
coronary heart disease is needed. Methods and Results-In this post hoc
analysis of the STABILITY (Stabilization of Atherosclerotic Plaque by
Initiation of Darapladib Therapy) trial, we described psychosocial
factors, treatments, and outcomes of men versus women with stable coronary
heart disease and explored the association of sex with psychosocial
characteristics and cardiovascular risk. Cox proportional hazards models
were used to assess the relationship between sex and outcomes.
Interactions among sex, psychosocial factors, and the composite of
cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke
were tested. Of 15 828 patients, 2967 (19%) were women. Among women, 21.2%
felt often or always stressed at home (versus 9.8% of men), and 19.2% felt
often or always sad or depressed (versus 10.1% of men; all P < 0.0001).
The median duration of follow-up was 3.7 years (25th-75th percentiles:
3.5-3.8 years). Use of evidence-based medications for coronary heart
disease at baseline and 24 months was similar between sexes, as were event
rates for all outcomes analyzed. In the multivariable model including
psychosocial measures, female sex was associated with lower cardiovascular
risk. There was a statistically significant interaction (P=0.03) such that
the lower risk in women varied by depressive symptom frequency, whereby
women who were more depressed had a risk similar to men.
Conclusions-Female sex was independently associated with better long-term
clinical outcomes, although this was modified by frequency of depressive
symptoms. This suggests that emotional state may be an important target
for improving outcomes in patients with coronary heart disease,
specifically in women. Copyright © 2017 The Authors.

<9>
Accession Number
618458099
Author
Young M.N.; Inglessis I.
Institution
(Young, Inglessis) Cardiology Division, Massachusetts General Hospital,
Harvard Medical School, 55 Fruit Street, GRB8-852E, Boston, MA 02114,
United States
Title
Transcatheter Aortic Valve Replacement: Outcomes, Indications,
Complications, and Innovations.
Source
Current Treatment Options in Cardiovascular Medicine. 19 (10) (no
pagination), 2017. Article Number: 81. Date of Publication: 01 Oct 2017.
Publisher
Springer Healthcare
Abstract
Transcatheter aortic valve replacement (TAVR) has become the standard of
care for the treatment of severe aortic stenosis in individuals who are at
prohibitive surgical risk and presents a viable alternative to surgery in
selected patients who are at high operative risk. To date, outcomes from
the PARTNER (Placement of AoRtic TraNscathetER Valve) and Medtronic
CoreValve US Pivotal trials continue to show the benefits of TAVR in these
high-risk subgroups out to 5 and 3 years, respectively (as reported by
Mack et al. Lancet. 85:2477-2484 2015; Kapadia et al. Lancet.
385:2485-2491 2015; Deeb et al. J Am Coll Cardiol. 67:2565-2574 2016).
Furthermore, the recent release of the PARTNER-2 and SURTAVI trial results
among other international data suggest that clinical outcomes for
intermediate risk patients may be promising for TAVR compared to surgical
aortic valve replacement (SAVR) (as reported by Leon et al. N Engl J Med.
374:1609-1620 2016; Reardon et al. N Engl J Med. 376:1321-1331 2017).
However, several questions persist regarding TAVR-specific complications
as well as long-term durability. Paravalvular regurgitation, permanent
pacemaker implantation, stroke, vascular access injury, and renal failure
in post-TAVR patients remain adversaries in the quest to perfect this
groundbreaking, game-changing technology (as reported by Khatri et al. Ann
Intern Med. 158:35-46 2013). In this review, we provide an up-to-date
synopsis of results from landmark clinical trials that cumulatively attest
to the comparability of TAVR to best medical therapy and SAVR in
extreme-risk, high-risk, and intermediate-risk patient populations. We
continue with a review of studies that seek to compare transcatheter vs.
surgical valve implantation in lower-risk subgroups. We also introduce
ongoing efforts to optimize the peri-procedural management of TAVR and
conclude with a presentation of management strategies and new generation
valve platforms that seek to address some of the current limitations of
transcatheter valve implantation. Copyright © 2017, Springer
Science+Business Media, LLC.

<10>
Accession Number
618496802
Author
Choudhury M.
Institution
(Choudhury) Department of Cardiac Anesthesia, Cardiothoracic Sciences
Centre, AIIMS, New Delhi, India
Title
Post-cardiac transplant recipient: Implications for anaesthesia.
Source
Indian Journal of Anaesthesia. 61 (9) (pp 768-774), 2017. Date of
Publication: September 2017.
Publisher
Indian Society of Anaesthetists (Flat No 12/1A K Point, 68-BAPC Roy Road,
Kolkata 700009, India)
Abstract
The annual heart transplant rate is gradually increasing worldwide. A
proportion of this patient population present for an elective or emergency
surgery which may or may not be related to the transplanted heart. A
MEDLINE search for heart transplant, anaesthesia, adult, paediatric and
surgery was conducted to review anaesthetic management for heart
transplant recipients. Anaesthesia and perioperative management are
different in these cases. A thorough understanding of the physiology of
denervated heart, post-transplant morbidities and pharmacology of
immunosuppressants is essential for best perioperative management and
improved post-operative outcome. Copyright © 2017 Indian Journal
of Anaesthesia.

<11>
Accession Number
618496786
Author
Junghare S.W.; Desurkar V.
Institution
(Junghare) Dr. D. Y. Patil Medical College Hospital and Research Centre,
Pimpri, India
(Desurkar) Department of Anaesthesia, Deenanath Mangeshkar Hospital and
Research Centre, Pune, Maharashtra, India
Title
Congenital heart diseases and anaesthesia.
Source
Indian Journal of Anaesthesia. 61 (9) (pp 744-752), 2017. Date of
Publication: September 2017.
Publisher
Indian Society of Anaesthetists (Flat No 12/1A K Point, 68-BAPC Roy Road,
Kolkata 700009, India)
Abstract
Patients with congenital heart diseases (CHDs) are at increased risk of
developing complications during anaesthesia. Improvements in medical and
surgical management in recent decades have resulted in significantly more
children with CHD surviving to adulthood. The aim of this article is to
focus on broad classification of CHD and to provide an updated review on
the current perioperative anaesthetic management of CHD patients in
different settings such as (a) interventional cardiac procedures that have
dominated the field, (b) uncorrected patients for non-cardiac surgery and
(c) corrected patients for non-cardiac surgery. The complexity of the
defects along with a variety of non-cardiac surgery makes it impossible to
have one single-anaesthesia technique. Search on Ovid, PubMed, Google
Scholar and Medline were done with MeSH terms such as 'congenital heart
disease', 'cardiac catheterisation', 'anaesthetic management' and
'non-cardiac surgery' mainly focusing on review articles and controlled
studies for preparing the article. Copyright © 2017 Indian
Journal of Anaesthesia.

<12>
Accession Number
618496781
Author
Paul A.; Das S.
Institution
(Paul, Das) Department of Cardiac Anaesthesiology, Narayana Institute of
Cardiac Sciences, Bengaluru, Karnataka, India
Title
Valvular heart disease and anaesthesia.
Source
Indian Journal of Anaesthesia. 61 (9) (pp 721-727), 2017. Date of
Publication: September 2017.
Publisher
Indian Society of Anaesthetists (Flat No 12/1A K Point, 68-BAPC Roy Road,
Kolkata 700009, India)
Abstract
Valvular heart disease presents as mixed spectrum lesion in healthcare
settings in the third-world and developing countries. Rheumatic heart
disease still forms the bulk of the aetiopathology of valve lesions.
Mitral and aortic valve lesions top the list of valvular pathology. A
thorough understanding of the pathophysiology of valvular heart disease is
essential while planning anaesthesia and perioperative care for such
patients. Meticulous use of optimal fluids, close monitoring of the
changing haemodynamics and avoidance of situations that can cause major
reduction of cardiac output and fluid shifts are mandatory to achieve good
clinical outcome. We searched MEDLINE using combinations of the following:
anaesthesia, aortic, mitral, regurgitation, stenosis and valvular heart
disease. We also hand searched textbooks and articles on valvular heart
disease and anaesthesia. This article mainly focuses on the understanding
the pathophysiology of valvular heart disease in patients presenting for
non-cardiac surgeries in secondary and tertiary care
setting. Copyright © 2017 Indian Journal of Anaesthesia.

<13>
Accession Number
618496774
Author
Hedge J.; Balajibabu P.R.; Sivaraman T.
Institution
(Hedge, Balajibabu, Sivaraman) Department of Anaesthesiology, Sparsh Super
Speciality Hospital, Sri Jayadeva Institute Cardiovascular Sciences and
Research, Bengaluru, Karnataka, India
Title
The patient with ischaemic heart disease undergoing non cardiac surgery.
Source
Indian Journal of Anaesthesia. 61 (9) (pp 705-711), 2017. Date of
Publication: September 2017.
Publisher
Indian Society of Anaesthetists (Flat No 12/1A K Point, 68-BAPC Roy Road,
Kolkata 700009, India)
Abstract
The incidence of ischaemic heart disease (IHD) is increasing. The patients
with IHD with or without interventions coming for non-cardiac surgical
procedures are also increasing. These patients have increased risk of
myocardial ischaemia, myocardial infarction (MI), conduction disturbances,
morbidity and mortality during the peri-operative period. The risks of
these events are even higher in patients with recent MI. An
anaesthesiologist should be aware of the pathophysiology and the need to
thoroughly evaluate the patient for peri-operative management. We searched
Pubmed using combinations of terms like "ischemic heart disease" and
"anaesthesia", "perioperative", and "anaesthetic implications". We
reviewed the current practices and guidelines regarding evaluation, risk
stratification and management. Copyright © 2017 Indian Journal of
Anaesthesia.

<14>
Accession Number
618473534
Author
Ehret C.; Rossaint R.; Foldenauer A.C.; Stoppe C.; Stevanovic A.; Dohms
K.; Hein M.; Schalte G.
Institution
(Ehret, Rossaint, Stoppe, Stevanovic, Dohms, Hein, Schalte) Department of
Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany
(Foldenauer) Department of Medical Statistics, University Hospital RWTH
Aachen, Aachen, Germany
Title
Is local anaesthesia a favourable approach for transcatheter aortic valve
implantation? A systematic review and meta-analysis comparing local and
general anaesthesia.
Source
BMJ Open. 7 (9) (no pagination), 2017. Article Number: e016321. Date of
Publication: 01 Sep 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives We conducted a systematic review and meta-analysis to identify
the potential favourable effects of local anaesthesia plus sedation (LAS)
compared with general anaesthesia (GA) in transcatheter aortic valve
implantation (TAVI). Methods Electronic databases (PubMed/Medline, Embase,
Cochrane Central Register of Controlled Trials) and the reference lists of
eligible publications were screened for randomised controlled trials
(RCTs) and observational studies published between 1 January 2006 and 26
June 2016 that compare LAS to GA in an adult study population undergoing
TAVI. We conducted study quality assessments using the Cochrane risk of
bias tool and structured the review according to PRISMA. A meta-analysis
calculating the pooled risk ratios (RRs) and mean differences (MDs) with
95% confidence intervals (CIs) under the assumption of a random-effects
model was performed. Statistical heterogeneity was evaluated using the I
statistic and Cochran's Q-test. Results After database screening, one RCT
and 19 observational studies were included in the review. We found no
differences between LAS and GA in terms of 30-day mortality, in-hospital
mortality and other endpoints that addressed safety and complication
rates. LAS was associated with a shorter ICU and hospital stay and with
lower rates of catecholamine administration and red blood cell
transfusion. New pacemaker implantations occurred more frequently under
LAS. The overall conversion rate from LAS to GA was 6.2%. Conclusion For
TAVI, both LAS and GA are feasible and safe. LAS may have some benefits
such as increased haemodynamic stability and shorter hospital and ICU
stays, but it does not impact 30-day mortality. Since there is a paucity
of randomised trial data and the findings are mainly based on
observational study data, this review should be considered as a
hypothesis-generating article for subsequent RCTs that are required to
confirm the potential favourable effects we detected for LAS. Registration
number CRD42016048398 (PROSPERO). Copyright © 2017 Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article) 2017. All rights reserved.

<15>
Accession Number
616237485
Author
Mina G.S.; Gill P.; Soliman D.; Reddy P.; Dominic P.
Institution
(Mina, Gill, Soliman, Reddy, Dominic) Department of Cardiology, Louisiana
State University Health Sciences Center-Shreveport, Shreveport, LA, United
States
Title
Diabetes mellitus is associated with increased acute kidney injury and
1-year mortality after transcatheter aortic valve replacement: A
meta-analysis.
Source
Clinical Cardiology. 40 (9) (pp 726-731), 2017. Date of Publication:
September 2017.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: Diabetes mellitus (DM) is associated with adverse outcomes
after surgical aortic valve replacement. However, there are conflicting
data on the impact of DM on outcomes of transcatheter aortic valve
replacement (TAVR). Hypothesis: DM is associated with poor outcomes after
different cardiac procedures. Therefore, DM can also be associated with
poor outcomes after TAVR. Methods: We searched PubMed and Cochrane Central
Register of Controlled Trials for studies that evaluated outcomes after
TAVR and stratified at least 1 of the studied endpoints by DM status. The
primary endpoint was all-cause mortality at 1 year. Secondary endpoints
were early (up to 30 days) mortality, acute kidney injury (AKI),
cerebrovascular accident (CVA), major bleeding, and major vascular
complications. Pooled odds ratio (OR) and 95% confidence interval (CI)
were calculated using random effects models. Results: We included 64
studies with a total of 38 686 patients. DM was associated with
significantly higher 1-year mortality (OR: 1.14, 95% CI: 1.04-1.26, P =
0.008) and periprocedural AKI (OR: 1.28, 95% CI: 1.08-1.52, P = 0.004). On
the other hand, there were no significant differences between diabetics
and nondiabetics in early mortality, CVAs, major bleeding, or major
vascular complications. Conclusions: DM is associated with increased
1-year mortality and periprocedural AKI in patients undergoing TAVR. The
results of this study suggest that DM is a predictor of adverse outcomes
in patients undergoing TAVR. Copyright © 2017 Wiley Periodicals,
Inc.

<16>
Accession Number
618450149
Author
Eljezi V.; Biboulet C.; Boby H.; Schoeffler P.; Pereira B.; Duale C.
Institution
(Eljezi, Biboulet, Boby, Schoeffler, Pereira, Duale) CHU Clermont-Ferrand,
Clermont-Ferrand, France
Title
The dose-dependent effects of ketoprofen on dynamic pain after open heart
surgery.
Source
Pain Physician. 20 (6) (pp 509-520), 2017. Date of Publication:
September-October 2017.
Publisher
American Society of Interventional Pain Physicians (E-mail:
editor@painphysicianjournal.com)
Abstract
Background: Non-steroidal anti-inflammatory drugs (NSAIDs) can reduce
postoperative pain, in both static (i.e., at rest) and dynamic contexts
(e.g., during coughing or mobilization), and reduced doses could improve
their efficacy/tolerance balance. Objectives: To test this hypothesis of
efficacy after open heart surgery, in which NSAIDs are poorly used,
particularly for safety concerns. Study Design: Randomized, double-blind
trial. Setting: Single-center, French university hospital. Methods:
Patients. One hundred patients at low risk of postoperative complications
undergoing scheduled open heart surgery (97 analyzed). Intervention. We
tested intravenous ketoprofen, at a dose of 0.5 mg/kg-1 every 6 hours
during the 48 hours following the end of sedation, after surgery. This
standard protocol was compared to a similar one in which half doses were
administered, to one with quarter doses, as well as to a placebo group.
Analgesia was supplemented by acetaminophen plus self- and
nurse-administered intravenous morphine. Measurement. The primary outcome
was the intensity of dynamic pain, assessed over 48 hours on an 11-point
numerical rating scale (NRS). Results: Only the full-dose ketoprofen group
showed reduced dynamic and static postoperative pain vs. placebo (P <
0.00001 for both). The evolution of dynamic pain suggested a delayed and
therefore non-significant effect with the low doses. Ketoprofen did not
affect either the postoperative morphine consumption or the tolerance
outcomes, such as the volumes of chest tube drainage and the renal
function. Limitations: This pilot trial was undersized to test major
tolerance outcomes. Conclusions: Although we failed to demonstrate any
analgesic effects with low doses of ketoprofen, we confirmed the good
efficacy/tolerance balance with this propionic NSAID of intermediate
COX<inf>2</inf>-selectivity. Lower doses of NSAIDs, potentiated by a
loading dose, should be tested in the future. Copyright © 2017,
American Society of Interventional Pain Physicians. All rights reserved.

<17>
Accession Number
618393216
Author
Vinereanu D.; Al-Khalidi H.R.; Rao M.P.; He W.; Lopes R.D.; Bahit C.M.;
Ciobanu A.O.; Fox K.A.; Pokorney S.D.; Xian Y.; Jiang J.; Kamath D.Y.;
Berwanger O.; Tajer C.; Huo Y.; Xavier D.; Granger C.B.
Institution
(Vinereanu, Ciobanu) University of Medicine and Pharmacy Carol Davila,
University and Emergency Hospital, Bucharest, Romania
(Al-Khalidi, Rao, He, Lopes, Fox, Pokorney, Xian, Granger) Duke Clinical
Research Institute, Duke University Medical Center, Durham, NC, United
States
(Lopes, Berwanger) Federal University of Sao Paulo, Sao Paulo, Brazil
(Lopes, Berwanger) Brazilian Clinical Research Institute (BCRI), Sao
Paulo, Brazil
(Bahit) INECO Neurociencias Rosario, Buenos Aires, Argentina
(Xian) Department of Neurology, Duke University Medical Center, Durham,
NC, United States
(Jiang, Huo) Peking University First Hospital, Beijing, China
(Kamath, Xavier) St John's Medical College and Research Institute,
Bangalore, India
(Tajer) Hospital El Cruce, Buenos Aires, Argentina
Title
Regional differences in presentation and antithrombotic treatment of
patients with atrial fibrillation: Baseline characteristics from a
clustered randomized trial to IMProve treatment with AntiCoagulanTs in
patients with atrial fibrillation (IMPACT-AF).
Source
American Heart Journal. 192 (pp 38-47), 2017. Date of Publication: October
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia
worldwide. However, there are few contemporary comparative data on AF from
middle-income countries. Methods Baseline characteristics of the IMPACT-AF
trial were analyzed to assess regional differences in presentation and
antithrombotic treatment of AF from 5 middle-income countries (Argentina,
Brazil, China, India, and Romania) and factors associated with
antithrombotic treatment prescription. Results IMPACT-AF enrolled 2281
patients (69 +/- 11 years, 47% women) at 48 sites. Overall, 66% of
patients were on anticoagulation at baseline, ranging from 38% in China to
91% in Brazil. The top 3 reasons for not prescribing an anticoagulant were
patient preference/refusal (26%); concomitant antiplatelet therapy (15%);
and risks outweighing the benefits, as assessed by the physician (13%). In
a multivariable model, the most significant factors associated with
prescription of oral anticoagulants were no prior major bleeding (odds
ratio [OR] = 4.34; 95% CI = 2.22-8.33), no alcohol abuse (OR = 2.27; 95%
CI = 1.12-4.55), and history of rheumatic valvular heart disease (OR =
2.10; 95% CI = 1.36-3.26), with a strong predictive accuracy (c statistic
= 0.85), whereas the most significant factors associated with prescription
of a combination of oral anticoagulants and antiplatelet drugs were prior
coronary revascularization (OR = 5.10; 95% CI = 2.88-9.05), prior
myocardial infarction (OR = 2.24; 95% CI = 1.38-3.63), and no alcohol
abuse (OR = 2.22; 95% CI = 1.11-4.55), with a good predictive accuracy (c
statistic = 0.76). Conclusions IMPACT-AF provides contemporary data from 5
middle-income countries regarding antithrombotic treatment of AF. Lack of
prior major bleeding and coronary revascularization were the most
important factors associated with prescription of oral anticoagulants and
their combination with antiplatelet drugs, respectively. Copyright
© 2017 Elsevier Inc.

<18>
Accession Number
618393212
Author
Albert M.A.; Durazo E.M.; Slopen N.; Zaslavsky A.M.; Buring J.E.; Silva
T.; Chasman D.; Williams D.R.
Institution
(Albert, Durazo) University of California San Francisco, CeNter for the
StUdy of AdveRsiTy and CardiovascUlaR DiseasE (NURTURE Center) Division of
Cardiology, Department of Medicine, 505 Parnassus Avenue, San Francisco,
CA, United States
(Slopen) Department of Epidemiology and Biostatistics, University of
Maryland College Park, School of Public Health, College Park, MD, United
States
(Buring, Silva, Chasman) Division of Preventive Medicine, Department of
Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston,
MA, United States
(Buring) Department of Epidemiology, Harvard T.H. Chan School of Public
Health, Boston, MA, United States
(Zaslavsky, Williams) Department of Social and Behavioral Sciences,
Harvard T.H. Chan School of Public Health, Boston, MA, United States
(Zaslavsky) School of Health Policy, Harvard University, Boston, MA,
United States
(Williams) Department of African and African American Studies, Harvard
University, Cambridge, MA, United States
Title
Cumulative psychological stress and cardiovascular disease risk in middle
aged and older women: Rationale, design, and baseline characteristics.
Source
American Heart Journal. 192 (pp 1-12), 2017. Date of Publication: October
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Although a growing body of evidence indicates strong links between
psychological stress (stress) and untoward cardiovascular disease (CVD)
outcomes, comprehensive examination of these effects remains lacking. The
"Cumulative Psychological Stress and Cardiovascular Disease Risk in Middle
Aged and Older Women" study is embedded within the landmark Women's Health
Study (WHS) follow-up cohort and seeks to evaluate the individual and
joint effects of stressors (cumulative stress) on incident CVD risk,
including myocardial infarction, stroke, coronary revascularization and
CVD death. GWAS data will be used for exploratory analyses to identify any
genes associated with stress and CVD. This study prospectively follows
25,335 women (mean age 72.2 +/- 6.04 years) without CVD who returned a
short mailed stress questionnaire at baseline and 3 years of follow-up
inquiring about their experiences with stress including perceived stress,
work stress, work-family spillover, financial stress, traumatic and major
life events, discrimination and neighborhood environment/stressors. Other
domains ascertained were sleep, anger, cynical hostility, depression,
anxiety, social support, intimate partner relations, and volunteer and
social activities. Higher levels of cumulative stress were associated with
younger age and black race/ethnicity, divorced or separated marital
status, increased prevalence of obesity, smoking, diabetes, depression and
anxiety (p<0.001 for each). Findings from this study will provide
clinically important, new information about associations of cumulative
stress, environmental, lifestyle and genetic factors with incident CVD
risk in aging women. Copyright © 2017 Elsevier Inc.

<19>
Accession Number
617323653
Author
Esteves W.A.M.; Lodi-Junqueira L.; Soares J.R.; Sant'Anna Athayde G.R.;
Goebel G.A.; Carvalho L.A.; Zeng X.; Hung J.; Tan T.C.; Nunes M.C.P.
Institution
(Esteves, Soares, Sant'Anna Athayde, Nunes) Post-Graduate Program in
Infectious Diseases and Tropical Medicine, School of Medicine,
Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
(Esteves, Lodi-Junqueira, Soares, Sant'Anna Athayde, Goebel, Carvalho,
Nunes) School of Medicine and Hospital das Clinicas, Universidade Federal
de Minas Gerais, Belo Horizonte, MG, Brazil
(Zeng, Hung, Tan) Cardiac Ultrasound Lab, Massachusetts General Hospital,
Harvard Medical School, Boston, MA, United States
Title
Impact of percutaneous mitral valvuloplasty on left ventricular function
in patients with mitral stenosis assessed by 3D echocardiography.
Source
International Journal of Cardiology. 248 (pp 280-285), 2017. Date of
Publication: 01 Dec 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background The status of intrinsic left ventricular (LV) contractility in
patients with isolated rheumatic mitral stenosis (MS) has been debated.
The acute changes in loading conditions after percutaneous mitral
valvuloplasty (PMV) may affect LV performance. We aimed to examine the
acute effects of PMV on LV function and identify factors associated with
LV ejection fraction (LVEF) changes, and determinants of long-term events
following the procedure. Methods One hundred and forty-two patients who
underwent PMV for symptomatic rheumatic MS (valve area of 0.99 +/- 0.3
cm2) were prospectively enrolled. LV volumes and LVEF were
measured by three-dimensional (3D) echocardiography. Long-term outcome was
a composite endpoint of death, mitral valve (MV) replacement, repeat PMV,
new onset of atrial fibrillation, and stroke. Results The mean age was
42.3 +/- 12.1 years, and 125 patients were women (88%). After PMV, LVEF
increased significantly (51.4 vs 56.5%, p < 0.001), primary due to a
significant increase in LV end-diastolic volume (65.8 mL vs 67.9 mL, p =
0.002), and resultant increase in the stroke volume (33.9 mL vs 39.6 mL, p
< 0.001). Changes in cardiac index and systolic pulmonary artery pressure
were associated with LVEF changes after PMV. During a mean follow-up
period of 30.8 months, 28 adverse clinical events were observed.
Postprocedural mitral regurgitation, MV area, and mean gradient were
independent predictors of composite endpoints. Conclusions In patients
with rheumatic MS, PMV resulted in a significant improvement in LV
end-diastolic volume, stroke volume and consequently increased in LVEF.
Changes in cardiac index and systolic pulmonary artery pressure were
associated with LVEF changes after PMV. The predictors of long-term
adverse events following PMV were post-procedural variables, including
mitral regurgitation, valve area, and mean gradient. Copyright ©
2017 Elsevier B.V.

<20>
Accession Number
616544711
Author
Shigematsu H.; Kawaguchi M.; Hayashi H.; Takatani T.; Iwata E.; Tanaka M.;
Okuda A.; Morimoto Y.; Masuda K.; Tanaka Y.
Institution
(Shigematsu, Iwata, Tanaka, Okuda, Morimoto, Masuda, Tanaka) Department of
Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara
City, Nara 6348522, Japan
(Kawaguchi, Hayashi, Tanaka) Department of Anesthesiology, Nara Medical
University, 840 Shijo-cho, Kashihara City, Nara 6348522, Japan
(Takatani) Division of Central Clinical Laboratory, Nara Medical
University, 840 Shijo-cho, Kashihara City, Nara 6348522, Japan
Title
Higher success rate with transcranial electrical stimulation of
motor-evoked potentials using constant-voltage stimulation compared with
constant-current stimulation in patients undergoing spinal surgery.
Source
Spine Journal. 17 (10) (pp 1472-1479), 2017. Date of Publication: October
2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background Context During spine surgery, the spinal cord is
electrophysiologically monitored via transcranial electrical stimulation
of motor-evoked potentials (TES-MEPs) to prevent injury. Transcranial
electrical stimulation of motor-evoked potential involves the use of
either constant-current or constant-voltage stimulation; however, there
are few comparative data available regarding their ability to adequately
elicit compound motor action potentials. We hypothesized that the success
rates of TES-MEP recordings would be similar between constant-current and
constant-voltage stimulations in patients undergoing spine surgery.
Purpose The objective of this study was to compare the success rates of
TES-MEP recordings between constant-current and constant-voltage
stimulation. Study Design This is a prospective, within-subject study.
Patient Sample Data from 100 patients undergoing spinal surgery at the
cervical, thoracic, or lumbar level were analyzed. Outcome Measures The
success rates of the TES-MEP recordings from each muscle were examined.
Materials and Methods Transcranial electrical stimulation with
constant-current and constant-voltage stimulations at the C3 and C4
electrode positions (international "10-20" system) was applied to each
patient. Compound muscle action potentials were bilaterally recorded from
the abductor pollicis brevis (APB), deltoid (Del), abductor hallucis (AH),
tibialis anterior (TA), gastrocnemius (GC), and quadriceps (Quad) muscles.
Results The success rates of the TES-MEP recordings from the right Del,
right APB, bilateral Quad, right TA, right GC, and bilateral AH muscles
were significantly higher using constant-voltage stimulation than those
using constant-current stimulation. The overall success rates with
constant-voltage and constant-current stimulations were 86.3% and 68.8%,
respectively (risk ratio 1.25 [95% confidence interval: 1.20-1.31]).
Conclusions The success rates of TES-MEP recordings were higher using
constant-voltage stimulation compared with constant-current stimulation in
patients undergoing spinal surgery. Copyright © 2017 Elsevier
Inc.

<21>
Accession Number
618424535
Author
Giuliano S.; Guastalegname M.; Russo A.; Falcone M.; Ravasio V.; Rizzi M.;
Bassetti M.; Viale P.; Pasticci M.B.; Durante-Mangoni E.; Venditti M.
Institution
(Giuliano, Guastalegname, Russo, Falcone, Venditti) Department of Public
Health and Infectious Diseases, Policlinico Umberto I 'Sapienza'
University of Rome, Rome, Italy
(Ravasio, Rizzi) Infectious Diseases Unit, ASST Papa Giovanni XXIII,
Bergamo, Italy
(Bassetti) Infectious Diseases Division, Santa Maria Misericordia
University Hospital, Udine, Italy
(Viale) Infectious Diseases Unit, Department of Medical and Surgical
Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
(Pasticci) Infectious Disease Unit, University of Perugia, Perugia, Italy
(Durante-Mangoni) Department of Clinical and Experimental Medicine,
Universita della Campania 'Luigi Vanvitelli', AORN dei Colli-Ospedale
Monaldi, Naples, Italy
Title
Candida endocarditis: systematic literature review from 1997 to 2014 and
analysis of 29 cases from the Italian Study of Endocarditis.
Source
Expert Review of Anti-Infective Therapy. 15 (9) (pp 807-818), 2017. Date
of Publication: 02 Sep 2017.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Candida Endocarditis (CE) is a deadly disease. It is of
paramount importance to assess risk factors for acquisition of both
Candida native (NVE) and prosthetic (PVE) valve endocarditis and relate
clinical features and treatment strategies with the outcome of the
disease. Areas covered: We searched the literature using the Pubmed
database. Cases of CE from the Italian Study on Endocarditis (SEI) were
also included. Overall, 140 cases of CE were analyzed. Patients with a
history of abdominal surgery and antibiotic exposure had higher
probability of developing NVE than PVE. In the PVE group, time to onset of
CE was significantly lower for biological prosthesis compared to
mechanical prosthesis. In the whole population, greater age and longer
time to diagnosis were associated with increased likelihood of death.
Patients with effective anti-biofilm treatment, patients who underwent
cardiac surgery and patients who were administered chronic suppressive
antifungal treatment showed increased survival. For PVE, moderate active
anti-biofilm and highly active anti-biofilm treatment were associated with
lower mortality. Expert commentary: Both NVE and PVE could be considered
biofilm-related diseases, pathogenetically characterized by Candida
intestinal translocation and initial transient candidemia. Cardiac
surgery, EAB treatment and chronic suppressive therapy might be crucial in
increasing patient survival. Copyright © 2017 Informa UK Limited,
trading as Taylor & Francis Group.

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

<23>
Accession Number
618484830
Author
Lemoine S.; Zhu L.; Gerard J.-L.; Hanouz J.-L.
Institution
(Lemoine, Zhu, Gerard, Hanouz) Department of Anaesthesiology and Intensive
Care, Universite Caen-Normandie, Centre Hospitalier Universitaire de Caen,
14033 Caen, France
(Hanouz) EA 4650, Universite Caen-Normandie, Centre Hospitalier
Universitaire de Caen, 14033 Caen, France
Title
Sevoflurane-induced cardioprotection in coronary artery bypass graft
surgery: Randomised trial with clinical and ex-vivo endpoints.
Source
Anaesthesia Critical Care and Pain Medicine. (no pagination), 2017. Date
of Publication: 2017.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Background: Myocardial ischaemia reperfusion injury following cardiac
surgery with cardiopulmonary bypass (CPB) increases postoperative
mortality. Setting techniques to protect the heart during this critical
period therefore represents a considerable challenge. Method: A randomised
controlled study in Caen University Hospital Centre, investigated whether
the clinical cardio protective effects of administration sevoflurane
before cardiopulmonary bypass during coronary artery bypass graft surgery
(CABG) could translate into protected atrial trabeculae contractility
against hypoxia-reoxygenation in vitro. Patients undergoing elective
on-pump CABG surgery were allocated to receive either sevoflurane (n = 24)
or no halogenated volatile anaesthetic (n = 21). Main outcome measures:
the relationship between sevoflurane exposure before CPB and the incidence
of major adverse cardiac events, with primary endpoint: the postoperative
troponin I peak level, and secondary endpoints: the inotropic support, and
the duration of stay in intensive unit and in-hospital stay were chosen as
study endpoints. The right atrial was collected at the beginning of bypass
surgery for the in vitro experimentation. Isometrically contracting
isolated human right atrial trabeculae obtained from the two groups were
exposed to 30-min hypoxia followed by 60-min reoxygenation. Results: The
patients receiving sevoflurane prior to aortic clamping significantly
exhibited less cardiac Troponin I (1.39 [0.34-2.97] vs. 2.80 [2.54-3.64]
ng.mL-1 in Control; P =0.03) and required a reduced inotropic
drug support (P <0.001). Isolated trabeculae from patients receiving
sevoflurane enhanced the recovery of force after reoxygenation compared to
the Control group (79+/-5% vs. 53+/-8% of baseline in Control; P <0.001).
Conclusions: Administration of sevoflurane before CPB induced
cardioprotection in patients undergoing CABG and preconditioned human
myocardium against hypoxia-reoxygenation in vitro. Copyright ©
2017 Societe francaise d'anesthesie et de reanimation (Sfar).

<24>
Accession Number
618483110
Author
Mazine A.; Friedrich J.O.; Nedadur R.; Verma S.; Ouzounian M.; Juni P.;
Puskas J.D.; Yanagawa B.
Institution
(Mazine, Nedadur, Verma, Yanagawa) Department of Surgery, St Michael's
Hospital, University of Toronto, Toronto, Ontario, Canada
(Friedrich) Department of Critical Care Medicine, St Michael's Hospital,
University of Toronto, Toronto, Ontario, Canada
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute, St
Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
(Ouzounian) Division of Cardiac Surgery, Department of Surgery, Peter Munk
Cardiac Centre, Toronto General Hospital and University of Toronto,
Toronto, Ontario, Canada
(Puskas) Department of Cardiothoracic Surgery, Mount Sinai Saint Luke's,
New York, NY
Title
Systematic review and meta-analysis of chordal replacement versus leaflet
resection for posterior mitral leaflet prolapse.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: To compare outcomes of chordal replacement versus leaflet
resection techniques for repair of isolated posterior mitral leaflet
prolapse. Methods: We searched MEDLINE and EMBASE databases for studies
that compared chordal replacement ("neo-chord" group) versus leaflet
resection ("resection" group) techniques for the treatment of posterior
mitral leaflet prolapse. Data were extracted by 2 independent
investigators and subjected to a meta-analysis using a random-effects
model. Results: One randomized controlled trial (RCT), 1
propensity-matched study, and 6 unadjusted observational studies, with a
total of 1926 patients, met our inclusion criteria. Two studies reported
only perioperative outcomes; mean follow-up ranged from 1.0 to 5.9 years
in the remaining studies. In pooled data from unadjusted observational
studies, annuloplasty ring diameter was higher in the neo-chord group
(+1.5 mm; P = .0003), but with high heterogeneity (I 2 =
91%). Based on limited data, postprocedural left ventricular ejection
fraction may be greater in the neo-chord group, but this difference
reached statistical significance only in the RCT (+3.4%; P = .03), and not
in 2 observational studies that reported this outcome (+2.7%; P = .10).
There was no difference in recurrent mitral regurgitation at follow-up
between the resection and neo-chord groups; however, patients in the
neo-chord group had a lower rate of mitral valve reoperation at follow-up
in the unadjusted observational studies (incidence rate ratio, 0.22; P =
.0008 [I 2 = 0%; 4 studies, 1331 patients]). Conclusions:
Chordal replacement may be associated with greater freedom from
reoperation and may lead to improved postoperative left ventricular
function compared with leaflet resection. However, these conclusions are
supported primarily by data from unadjusted observational studies, and
high-quality RCTs of chordal replacement versus leaflet resection are
needed. Copyright © 2017 The American Association for Thoracic
Surgery.

<25>
Accession Number
617401376
Author
Aya H.D.
Institution
(Aya) St George's University Hospitals, St George's University of London,
United Kingdom
Title
The fluid challenge technique: Standardization of fluid administration and
assessment of fluid responsiveness in critically ill patients.
Source
Journal of the Intensive Care Society. Conference: Intensive Care Society
State-of-the-Art Meeting, ICSSOA 2016. United Kingdom. 17 (4 Supplement 1)
(pp 196-198), 2016. Date of Publication: November 2016.
Publisher
SAGE Publications Inc.
Abstract
Background: The administration of intravenous fluids is one of the most
common interventions in intensive care. Given the increasing evidence of
poor outcomes associated with an excessive administration of fluids,1,2
the fluid challenge (FC) is recommended for treatment of patients in
shock3 and sepsis.4 An FC is the administration of a small volume of IV
fluids in order to test the cardiovascular response to an increase in
intravascular volume. However, the response to this test may not be only
related to the patient's physiopathology but also to the technique
particularities. The overall hypothesis of this project is that an FC
performed in different ways will lead to different results and different
clinical decisions. If this were true, standardization of the technique
would be desirable. Systematic reviews: I undertook a systematic review of
the literature that reported an FC. This revealed an enormous
heterogeneity in the technique5: the range of volume given was from 100 ml
to 3 L, although the most frequent were 500 ml (36%); the infusion
duration varies from 1 min of infusion to 1000 ml/h. Cardiac index (CI)
equal or greater than 15% is the most frequent used parameter for
assessment of fluid responsiveness but only with a 28% and only 52% of
authors assessed the effect of the FC immediately after the fluid
infusion, 21% did it between 1 and 10 min and the rest of the authors
after that. The variety of techniques may have an impact on clinical
practice. The FC is frequently used in the process of early goal-directed
therapy (EGDT) of high-risk surgical patients and septic patients. In
high-risk surgical patients, EGDT reduces post-surgical complications and
mortality. 6 However, most haemodynamic studies in critically ill patients
are performed in post-cardiac surgical patients, where this process is
seen as controversial. Therefore, I performed a systematic review and
metaanalysis 7 of clinical trials of EGDT in cardiac surgery. Although
mortality is not affected by this intervention, EGDT reduce morbidity and
hospital length of stay in patients after cardiac surgery. Observational
studies: In order to observe the effect of an FC in the cardiovascular
system independently from the cardiac function, it is necessary to observe
the mean systemic filling pressure (Pmsf). Pmsf is the pressure in the
cardiovascular system when the heart stops and there is no blood motion.
This pressure depends solely on the intravascular volume and the mean
systemic compliance. Measuring Pmsf in humans with intact circulation is
technically and ethically challenging; therefore, I measured surrogates of
the Pmsf. Initially, I observed the changes of the Pmsf-analogue (Pmsa),
which is calculated mathematically on the basis of cardiac output (CO),
mean arterial pressure (MAP) and central venous pressure (CVP).8 Pmsa
increased similarly in both responders (R) and non-responders (NR) after
infusion of 250 ml of crystalloids in 10 min, but the gradient of venous
return (Pmsa-CVP) increased significantly in R from 5.7 +/- 1.1 to 6.9 +/-
1.2 (p < 0.001) but not in NR. Then, in order to understand the duration
of the impact of a FC in the circulation, I observed the duration of the
haemodynamic effect of 50 FC in 26 patients over 10 min, describing the
overall impact as the area under the curve of the change of haemodynamics
(i.e. MAP) vs. time. I used a multilevel level analysis to take into
account the intra-subject and inter-subject variability. Also a Bayesian
framework was used in order to calculate real probabilities.9 I observed
that the maximum change in CO is happens 1 min after the end of the fluid
infusion, the overall impact on CVP seems to be greater in NR (Bayesian
probability=0.12), similar changes in terms of Pmsa in R and NR and no
differences in terms of MAP or changes after 10 min in both groups for any
haemodynamic variable. Experimental studies: The next question was whether
I was using enough volume to actually test the circulation. Pmsf would be
the key variable, but Pmsa would not allow me to obtain valid conclusions,
as it is mathematically linked to other haemodynamics. I used the
stop-flow arterial-venous equilibrium method (Pmsf-arm). This technique
was described and validated in patients after cardiac surgery in
comparison with other methods such as the Pmsa and the intra-thoracic hold
pressure method.10 As I was interested in the changes of Pmsf-arm over
time in response to a FC, I studied the precision of this technique. I
observed Pmsfarm in 20 patients after cardiac surgery who were in a steady
cardiovascular state. Pmsf-arm was measured four times in 20 min. Then, I
calculated the coefficient of variation and, more importantly, the least
significant change, which was 14% for a single measurement. This is the
magnitude of change that we need to observe to believe, with 95 % of
confidence that a real change have happened.11 I then hypothesised that
different doses of fluids may have different impact on Pmsf, and possibly
different impact in venous return, CO and proportion of R and NR. I
conducted a quasi-randomised clinical trial where 80 post-cardiac surgical
patients were allocated to four groups: 1, 2, 3 and 4 ml/kg of
crystalloids as FC infused in 5 min. I measured haemodynamics before and
after the FC, including Pmsf-arm. I found that the minimal dose of
crystalloids required to increase the Pmsf-arm by 14% was 4 ml/kg of total
body weight. Importantly, the proportion of R increased along with the
dose of fluids used, confirming my initial hypothesis (Figure 1).
Similarly, a randomised clinical trial was also conducted in 80 septic
patients using 2 to 5 ml/kg. No dose increased Pmsf-arm by more than 14%
in these patients, and the estimation based on these data point out that
about 9 ml/kg would be necessary to achieve a DELTAPmsfarm of 26.02% (95%
CI: 14.07 to 39.96). Finally, I was interested to observe the
pharmacodynamics of an FC using 4 ml/kg, and also investigate the effect
on the microcirculation and its relationship with the Pmsf. Thus, a study
in 24 post-cardiac surgeries was conducted observing the effect on
haemodynamics including Pmsf-arm and on sublingual microcirculatory
variables using an incident dark-field camera. Data were recorded at
baseline, immediately after the FC, 5 and 10 min after the fluid infusion.
I observed that baseline values of microcirculatory parameters are
inversely related to the overall effect of the FC on microcirculation
(Figure 2). These changes in the microcirculation cannot be explained by
the haemodynamic classification between R and NR. The FC with 4 ml/kg is
able to increase arterial pressure in R (p=0.01) and those changes are
still present 10 min after the fluid infusion for CO (p=0.01) and SV
(p=0.01). And finally, no relationship was found between the Pmsf-arm at
baseline and the changes on Pmsf, with the overall changes of
microcirculation in this sample. Conclusion: In conclusion, the
haemodynamic response to an FC depends on the technique used. Thus, full
standardisation of this technique is necessary to avoid misleading
interpretations. The minimal dose required for an effective FC is 4 ml/kg
in post-operative patients, and more than 5 ml/kg in septic patients. The
haemodynamic effect of IV fluids is transitory and reveals the ventricular
response when assess immediately, and the vascular response when observe
10 min after end of fluid infusion. Assessment of tissue perfusion seems
to be more important than the haemodynamic variables to predict the
response of microcirculation to the FC. (Figure Presented).

<26>
Accession Number
617302828
Author
Kanmanthareddy A.; Reddy M.; Anugula D.; Alla V.; Hunter C.; Mooss A.;
Lavu M.; Bommana S.; Atkins D.; Natale A.; Lakkireddy D.
Institution
(Kanmanthareddy, Reddy, Anugula, Alla, Hunter, Mooss, Lavu, Bommana,
Atkins, Natale, Lakkireddy) Creighton University School of Medicine,
Omaha, NE, United States
Title
Sotalol versus other anti-arrhythmic agents for prevention of
post-operative supraventricular arrhythmias after cardiac surgery:
Meta-analysis of randomized controlled studies.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 546), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Supraventricular arrhythmias such as atrial fbrillation(AF)
and atrial futter are common after cardiac surgery. Wecompared the effcacy
of Sotalol compared to other agents for the prevention of these
arrhythmias after cardiac surgery. Methods: We searched PubMed, Google
Scholar and EBSCO databases to identify studies comparing sotalol with
other antiarrhythmicmedications for the prevention of supraventricular
arrhythmias after cardiac surgery. We then synthesized the data using
STATA 13 software to estimate the risk ratio (RR) and 95% CI for
occurrence of these arrhythmias. Results: A total of 6 randomized
controlled studies with 1,328 patients were included. Sotalol versus
beta-blockers were compared in 5 studies and sotalol with amiodarone was
compared in 2 studies. Supraventricular arrhythmias occurred in 14% and
23% of the sotalol andbeta-blocker groups, respectively. Sotalol group had
a lower incidence of these arrhythmias compared to beta-blockers (RR
0.69,95% CI 0.53 - 0.91). The incidence of these arrhythmias was 28% and
23% in the sotalol and amiodarone groups, respectively. There was no
difference between sotalol and amiodarone groups (RR 1.18, 95% CI 0.78 -
1.78). Conclusions: Sotalol appears to be superior to beta-blockers but
similar in effcacy to amiodarone in preventing supra ventricular
tachyarrhythmias after cardiac surgery.

<27>
Accession Number
617291278
Author
Montero N.; Rovira A.; Hueso M.; Rama I.; Sbraga F.; Boza E.;
Vazquez-Reveron J.M.; Cruzado J.
Institution
(Boza) Anesthesiology, Hospital Universitari De Bellvitge, L'Hospitalet de
Llobregat, Spain
(Sbraga) Cardiac Surgery, Hospital Universitari De Bellvitge, L'Hospitalet
de Llobregat, Spain
(Vazquez-Reveron) Intensive Care, Hospital Universitari De Bellvitge,
L'Hospitalet de Llobregat, Spain
(Montero, Rovira, Hueso, Rama, Cruzado) Nephrology, Hospital Universitari
De Bellvitge, L'Hospitalet de Llobregat, Spain
Title
Nephrology intervention in patients awaiting cardiac surgery: A randomised
controlled trial.
Source
Nephrology Dialysis Transplantation. Conference: 54th Annual Congress of
the European Renal Association-European Dialysis and Transplant
Association, ERA-EDTA 2017. Spain. 32 (Supplement 3) (pp iii186-iii187),
2017. Date of Publication: May 2017.
Publisher
Oxford University Press
Abstract
INTRODUCTION AND AIMS: Acute kidney injury(AKI) is a frequent complication
after cardiac surgery. Its incidence ranges from 19 to 44% depending on
the study and which definition is used. There are some well-known risk
factors associated with AKI, including baseline patient characteristics
(age and comorbidities), need of perioperative blood transfusion or
presence of previous chronic kidney disease. We wanted to evaluate if a
nephrologist management and control of potential risk factors of renal
disease can be used to prevent AKI, thereby minimizing the risk of need
RRT, reducing costs and improving survival in these patients. It will be
the first study focused on this intervention. The aim of this study is to
assess if a nephrology intervention before cardiac surgery can reduce the
postoperative incidence of AKI. METHODS: Unicentric prospective randomized
controlled trial of 108 participants. The inclusion criteria was patients
undergoing scheduled cardiac surgery of >18 years old. The exclusion
criteria was current outpatient management by a nephrologist or CKD stage
>3B (eGFR<45mL/min/1.73m2 estimated by CKD-EPI equation) or a
requirement for renal replacement therapy before surgery. Clinical
Research Ethics Committee of Bellvitge have approved the study before
initiation. All patients have given written informed consent. We have done
an intention-to-treat analysis, continuous variables have been compared
between groups using Student's t test and categorical variables have been
compared using X2. RESULTS: Nephrology intervention before surgery,
included a preoperative study done minimum 1 month before the surgery to
optimise the patient' s overall condition by optimization of hydratation
state, remove or minimize dose of drugs that potentially deteriorate
kidney function and correct metabolic disorders. The characteristics of
the patients is shown at Table 1. The number of patients with AKI KDIGO
stage 1 was a total of 7 of which 3 were from the intervention arm and 4
were from the control arm (p=0.642), only one patients of the control
group reached a stage 2 and none of them required renal replacement
therapy. We found 0.019% of mortality (1 participant in the intervention
group and one in control group). We have not been able to make a
stratified analysis because the low incidence of AKI. Data at 1 year
follow-up (n= 21) showed no indicidence of kidney disease (creatinine in
intervention arm 90.6+/-41.5mumol/L and in control arm 72+/-20, p=0.1997)
without differences in albuminuria. CONCLUSIONS: In summary, we did not
find any difference in acute kidney injury and death when a nephrology
intervention is done to cardiac surgery patients, probably it would be
necessary to increase the sample size to make conclusions. The results at
1 year follow-up showed no kidney disease in these patients. We will
maintain the recruitment until a larger sample size is obtained. (Table
Presented).

<28>
Accession Number
617290109
Author
Wu V.-C.; Wang J.-J.; Wu K.-D.
Institution
(Wang) Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan (Republic
of China)
(Wu, Wu) Internal Medicine, National Taiwan University Hospital, Taipei,
Taiwan (Republic of China)
Title
Urinary biomarkers predicts advanced acute kidney injury after
cardiovascular surgery.
Source
Nephrology Dialysis Transplantation. Conference: 54th Annual Congress of
the European Renal Association-European Dialysis and Transplant
Association, ERA-EDTA 2017. Spain. 32 (Supplement 3) (pp iii173), 2017.
Date of Publication: May 2017.
Publisher
Oxford University Press
Abstract
INTRODUCTION AND AIMS: Acute kidney injury (AKI) after cardiovascular
surgeries were a serious complication. Less is known about whether novel
biomarkers adding to clinical risk scores could predict advanced AKI. We
validate clinical models adding on to the urinary biomarkers, devoted to
finding the best prediction model for advanced AKI or mortality after
cardiovascular surgery. METHODS: In this prospectively conducted
multicenter study, urine samples were collected from 149 adults at hours
3, 6, 12 and 24 after receiving cardiovascular surgery. Novel urine
protein,alpha-Glutathione S-transferases; urinary pi-Glutathione
Stransferases; Hemojuvelin; Kidney injury molecule-1 and Neutrophil
gelatinase associated lipocalin were illustrated as panel markers. Primary
outcome was advanced AKI, in term of AKIN stage 2, 3 and composite
outcomes were AKIN stage 2, 3 or mortality. RESULTS: Patients who had
advanced AKI had significant higher uHJV and uKIM1 at hours 3, 6 and 12
after operation. Normalized by the urine creatinine level, uKIM1 adding to
uHJV at hour 3 has the best prediction ability for advanced AKI and
composite outcomes (AUC was 0.898 and 0.905, respectively). Panel of
normalized uKIM1, uHJV at hour 3 after operation and Liano's score
performing the best to predict advanced AKI(AUC was 0.931 for advanced
AKI, category-free net reclassification improvement of 1.149, and P <
0.001). CONCLUSIONS: We showed that a panel of urine biomarkers, with
normalized uKIM1, uHJV at hour 3 after cardiovascular surgery adding to
clinical risk score improve risk stratification and identify patients at
higher risk for progression of advanced AKI and composite outcomes.

<29>
Accession Number
617289691
Author
Sanders P.; Anand R.; Kowal R.; Piorkowski C.; Rizwan Sohail M.; Kragten
H.; Moya A.; Stromberg K.; Rogers J.D.
Institution
(Sanders, Anand, Kowal, Piorkowski, Rizwan Sohail, Kragten, Moya,
Stromberg, Rogers) South Australian Health and Medical Research Institute,
University of Adelaide, Adelaide, Australia
Title
Insertion of a miniaturized insertable cardiac monitor outside the
traditional hospital setting: Results from the rio 2 international study.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 354), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: The vast majority of current insertable cardiac monitor (ICM)
procedures are performed in a cardiac catheterization (cath)/EP lab.
Miniaturization of ICMs may allow device insertion to be moved from these
traditional hospital setting to other "out-of-lab" less resource intensive
locations within the hospital, such as holding areas or procedure rooms.
Methods: The Reveal LINQTM in-Offce 2 (RIO 2) International
study is a single arm, multicenter, prospective study designed to assess
the safety of Reveal LINQTM ICM insertion procedures performed
outside the traditional hospital setting within the hospital. Patients
indicated for an ICM and willing to undergo device insertion outside the
cath/EP lab or operating room were eligible. The protocol required
maintaining an appropriate sterile technique during the days after
insertion, with visits 30 and 90 days post-procedure. The primary
objective was to estimate the rate of untoward events (a composite of
unsuccessful ICM insertion and complication related to ICM procedure)
associated with out-of-lab procedures. A complication was a adverse even
requiring invasive intervention such as system revision or intravenous
drug administration. Results: A total of 191 patients (45.5% female aged
63.8 + 26.9 years) underwent an ICM insertion attempt between September
2015 and May 2016, at 17 centers in Europe, Canada and Australia. All
procedures took place within the hospital but in out-of-lab settings and
were successful. The median visit duration was 106 min. Among the 191
patients, the rate of untoward events was 0.0% (95% CI: 0.0% - 2.1%). Four
patients presented with procedure related adverse events that did not
require invasive intervention (1 patient had insertion site pain, 2 had an
incision site hemorrhage, and 1 had vasovagal syncope following the
procedure). Non of the patients developed infections despite the fact that
56% of procedures were conducted without antibiotic prophylaxis.
Conclusions: The Reveal LINQTM ICM insertion procedure can be
safely performed outside of the traditional hospital settings.

<30>
Accession Number
617289628
Author
Cardoso R.; Rivera M.; Rivner H.; Mendirichaga R.; D'Avila A.
Institution
(Cardoso, Rivera, Rivner, Mendirichaga, D'Avila) University of Miami,
Jackson Memorial Hospital, Miami, FL, USA, Instituto de Pesquisa em
Arritmia Cardiaca, Hospital Cardiologico, Florianopolis, Brazil
Title
Percutaneous epicardial mapping and ablation of ventricular tachycardia: A
systematic review of safety outcomes.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 346), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Safety outcomes of percutaneous epicardial ventricular
tachycardia (VT) ablations vary widely in the literature. This is likely
related to small sample sizes and heterogeneous patient and substrate
characteristics between different studies. We aimed to perform a
systematic review of safety outcomes following percutaneous epicardial VT
procedures. Methods: PubMed, EMBASE, and Cochrane Central were searched
for studies that reported procedural complications of percutaneous
epicardial access and mapping or ablation for VT. There were no
restrictions with regards to the arrhythmogenic substrate. The overall
complication rates were calculated among all included studies. Results:
The search yielded 465 results. A total of 32 studies, 1,972 patients, and
2,047 procedures were included. Approximately 1/3 of substrates were
ischemic and 2/3 of patients were men. Successful percutaneous epicardial
access was achieved in 92.6% of cases. Table 1 reports the pooled
incidence of adverse events. Pericarditis was not reported due to its
ordinary occurrence after epicardial procedures. The most common
complication was right ventricular puncture (8.7%). Procedure-related
mortality was rare (0.7%). Conclusions: We report the pooled literature
rate of complications following percutaneous epicardial VT mapping or
ablation. These results can be used in a shared decision making process by
physicians for a discussion with patients about the overall risks of
percutaneous epicardial VT procedures.

<31>
Accession Number
617289627
Author
Scudeler T.; Hueb W.; De Soarez P.C.; Campolina A.G.; Rezende P.; Lima E.;
Garzillo C.L.; Freitas D.F.C.; Costa L.; Oikawa F.T.; Ramires J.; Filho
R.K.
Institution
(Scudeler, Hueb, De Soarez, Campolina, Rezende, Lima, Garzillo, Freitas,
Costa, Oikawa, Ramires, Filho) Heart Institute (InCor - HCFMUSP), Sao
Paulo, Brazil
Title
Cost-effectiveness analysis and quality of life of on-pump and off-pump
stable multivessel coronary artery bypass grafting: Mass III trial 5-year
follow-up.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 100), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Long-term costs and quality of life for patients who underwent
on-pump and off-pump coronary artery bypass graft surgery (CABG) are
unknown. Methods: Between 2001 and 2006, 308 patients with stable
multivessel coronary artery disease and preserved ventricular function
were randomized to on-pump CABG (n=153) or off-pump CABG (n=155). The 2
groups were well matched for baseline characteristics. Costs for
hospitalizations, physician services, outpatient care, and medications
were assigned using 2016 US dollars. Health state utilities were assessed
using the SF-6D questionnaire. Results: On-pump CABG patients received a
greater number of grafts per patient (2.97 versus 2.49; P<0.001) and had
less incomplete revascularization (42.5% versus 52.9%; P=0.052). QoL
improved similarly in both groups from baseline (0.781 vs 0.768, p=0.381)
to 6 months (0.817 vs 0.809, p=0.175), 12 months (0.832 vs 0.831,
p=0.696), 24 months (0.837 vs 0.827, p=0.349) and 60 months (0.829 vs
0.820, p=0.300). The cumulative QALY adjusted by baseline over 5-year
follow-up was higher in on-pump group (3.707; IC 95% 3.678-3.736 and
3.556; IC 95% 3.528-3.585), but not statistically signifcant. Total costs
for the index hospitalization per patient was higher in the off-pump CABG
group ($2966.72+/-381.45 vs $3046.39+/-890.81, p=0.293). Over the 5-year
follow-up, costs were similar between the two treatment groups.
Nonetheless, 5-year cumulative cost remained only $180.64 higher per
patient with on-pump CABG. Conclusions: Despite incomplete
revascularization following off-pump CABG, there was no difference in QoL
and cost-analysis between off-pump and on-pump procedures. QoL markedly
improved in both treatment groups over 5-year follow-up.

<32>
Accession Number
617289594
Author
Salam A.; Al Habib K.; Singh R.; Asaad N.; Suwaidi J.
Institution
(Salam, Al Habib, Singh, Asaad, Suwaidi) Second Gulf Registry of Acute
Coronary Events (Gulf RACE-2) Investigators, Hamad Medical Corporation,
Doha, Qatar
Title
Do women benefit from early coronary artery bypass graft and percutaneous
coronary interventions in acute coronary syndromes: Answers from the
second gulf registry of acute coronary events.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 98), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Objectives: Data is scarce about the benefts of coronary artery bypass
graft (CABG) in women when performed early during an acute coronary
syndrome (ACS) event and its impact on prognosis as compared to
percutaneous coronary interventions (PCI) and conservative management.
Accordingly, we examined that in a multicenter multinational ACS registry
from the Middle East. Methods: For a period of 9 months in 2008 to 2009,
1686 consecutive women with ACS were enrolled from 65 hospitals in 6
Middle East countries. Those undergoing early CABG during hospitalization
were compared to PCI and conservative medical management. Clinical
feature, coronary anatomy, in-hospital, and one-year mortality were
examined. Results: During the study period, 40 women (2.4%) underwent CABG
during the index hospitalization (group A), and 177 women (10.5%) were
submitted to PCI (group B) and 1469 women (87.1%) were not submitted to
mechanical revascularization (group C). Patients from group A more
frequently had diabetes mellitus, hypertension, and dyslipidemia (all P<
0.001) compared to groups B and C. They had signifcantly more severe
coronary anatomy: 3 vessel disease (72.5% vs. 22% vs. 5.3%, P<0.001) and
the culprit lesion was more frequently on the left main (30% versus 2.8%
versus 1.1%, P<0.001). There were no signifcant difference between the 3
groups in inhospital and one year mortality. Conclusions: the observed low
rates of early interventions in women with ACS in our region warrants
further study.

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

<34>
Accession Number
617289580
Author
Bockeriya O.; Kudzoeva Z.; Khugaev S.
Institution
(Bockeriya, Kudzoeva, Khugaev) Bakulev Center for Cardiovascular Surgery,
Moscow, Russian Federation
Title
Time-to-event meta-analysis for bypass grafting versus stenting in
multivessel disease in contemporary era.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 97), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Previous meta-analysis of coronary artery bypass grafting
(CABG) versus percutaneous coronary interventions (PCI) have shown higher
incidence of stroke for CABG during different follow-up periods and
similar results or prevalence of CABG for late outcomes. New data on
long-term results from numerous randomized trials appears in literature
over time. "Time-to-event" analysis was not previously used to avoid
potential data bias in long-term (5 years and more) follow-up. Aim: To
perform "time-to-event" meta-analysis for CABG versus PCI with drug
eluting stents (DES) during 5-year follow-up in multivessel disease
patient group. Materials and Methods: We included 8 randomized trials
(5499 patients in total) comparing CABG versus PCI with DES. End-points
were: repeat revascularization, death, MI and stroke. We performed
time-to-event analysis for the end-points results between two follow-up
periods: 12 and 13-60 months. Statistical analysis was performed using
Comprehensive Meta-Analysis V.2.0. For dichotomous outcomes odds ratio
(OR) and 95% confdence interval (CI) were calculated. Results: At 12
months follow-up MI and death rates were similar (OR 1.012, CI
0.692-1.483, p =0.951 and OR 1.060, CI 0.731-1.538, p =0.758); CABG had
lower repeat revascularization rate (OR = 0.745; 95% CI 0.647-0.858, p =
0.000) and higher stroke (OR = 1.040; 95% CI 0.646-1.675, p = 0.870). In
13-60 month follow-up - CABG had better survival, MI and repeat
revascularization rate (OR 0.736, CI 0.460-1.179, p = 0.202; OR 0.312, CI
0.115-0.849, p =0.022; OR = 0.491; 95% CI: [0.365-0.659]; p = 0.000) and
no differences in stroke (OR 1.055, CI 0.776-2.368, p=0.022) comparing to
PCI. Conclusions: Time-to-event analysis is a new tool for detailed
evaluation of the events in long-term follow-up. It provides more accurate
results and strengthens the evidence base. In this meta-analysis we found
the CABG prevalence in all end-points after the 1st year in
multivessel disease. Stroke risk was similar at this time of follow-up.

<35>
Accession Number
617289486
Author
McHugh K.E.; Pasquali S.; Scheurer M.; Hall M.A.; Nathan M.
Institution
(McHugh, Pasquali, Scheurer, Hall, Nathan) Medical University of South
Carolina, Charleston, SC, USA, Children's Hospital Boston, Boston, MA, USA
Title
The association of technical performance with postoperative complications
and hospital costs for the norwood operation.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 596), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Technical performance scores (TPS) have been associated with
both clinical outcomes and hospital costs in the congenital heart surgery
population. However, the impact of TPS on costs in important subgroups,
such as single ventricle patients (who account for the highest costs
overall in this population) remains unclear. We evaluated the TPS-cost
relationship in a multicenter Norwood cohort. Methods: Clinical data from
the Single Ventricle Reconstruction (SVR) trial were linked with cost data
from Children's Hospital Association's CaseMix Database. TPS (optimal,
adequate, inadequate) was assigned based on pre-defned criteria using the
SVR dataset. The relationship of TPS with hospital costs was modeled,
adjusting for baseline patient characteristics. Postoperative
complications were also examined. Results: A total of 266/555 (48%) SVR
patients across 9 centers had both TPS and cost data available. Overall,
73% were classifed as optimal TPS, 13% adequate, and 14% inadequate. In
adjusted analysis, both total costs and the number of complications were
more than 2 times higher in those with inadequate vs. optimal TPS (ratio
between groups 2.3, 95% CI 1.6-3.3, p<.001, and 2.2, 95% CI 1.4-3.2,
p<.001, respectively). Adjusted costs across TPS groups are shown in
Figure 1. Conclusions: Patients with inadequate Norwood TPS had more
complications and higher hospital costs. These data suggest efforts geared
toward improving TPS may have the potential to improve outcomes and reduce
costs of care.

<36>
Accession Number
617289449
Author
Khand A.; Chew P.; Frost F.; Fisher M.; Ruth G.; Albouaini K.; Zadeh H.;
Dodd J.; Patel B.; Liam M.
Institution
(Khand, Chew, Frost, Fisher, Ruth, Albouaini, Zadeh, Dodd, Patel, Liam)
University Hospital Aintree NHS Trust, Liverpool, United Kingdom,
University of Liverpool, Liverpool, United Kingdom
Title
A direct comparison of accelerated discharge strategies utilising a single
high sensitivity troponin T in suspected acute coronary syndromes:
Prospective cohort study of undetectable troponin T versus low risk timi,
grace and heart scores (The macros study- mersey acute coronary syndrome
rule-out study).
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 237), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: A single undetectable high sensitivity troponin T (hstnT)
versus low risk scores as the optimum discharge tool for suspected acute
coronary syndromes (ACS) presentations remains untested. Methods:
Consecutive patients with a primary symptom of chest pain (CP) presenting
to the emergency room in a large English hospital were prospectively
defned. TIMI, GRACE and HEART scores were computed from presentation
details alone. Blinded, independent 2 consultant cardiologist adjudication
of type 1 myocardial infarction (MI) was undertaken for all biomarker
positive CP index and readmissions to any national hospital up to 1 year
post discharge. The primary outcome was MACE (type 1 MI, all cause death
and unplanned coronary revascularisation) at 42 days Results: Of 3054
presentations 1642 individual patients had both hstnT and an ECG
undertaken (suspected ACS cohort; median age 59, male 52%, previous MI
20%). 211 (12.9%) and 279 (17%) suspected ACS patients were adjudicated to
suffer MACE at 6 weeks and 1 year respectively. Only HEART<=3 (NPV MACE
99.3% type 1 MI 99.7%) and undetectable hstnT strategy (NPV MACE 99.7%
type 1 MI 99.7%) achieved pre-specifed negative predictive value (NPV)
>99% at 42 days with discharge potential of 54.4% and 40.7% respectively.
At 1 year NPV for both HEART<=3 ( MACE 97% type 1 MI 99.4%) and
undetectable hstnT (MACE 98.1% type 1 MI 99.4%) was acceptable Conclusion:
Heart <=3 and undetectable hstnT are optimum early discharge strategies
for suspected ACS population using a single hstnT.

<37>
Accession Number
617289386
Author
Kosiv K.; Gossett J.; Bai S.; Collins R.
Institution
(Kosiv, Gossett, Bai, Collins) University of Arkansas for the Medical
Sciences, Little Rock, AR, USA, Arkansas Children's Hospital, Little Rock,
AR, USA
Title
Congenital heart surgery in patients with trisomy 13 associated with lower
inhospital mortality.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 589), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Congenital heart disease (CHD) occurs in about 80% of patients
with Trisomy 13 (T13), but surgical repair has not been offered to these
patients in most centers because of low median survival. Data on
congenital heart surgery (CHS) for T13 are lacking. Methods: Nationally
distributed data from 44 pediatric hospitals in the 2004 to 2015 Pediatric
Health Information System (PHIS) database were used to identify patients
with hospital admissions with an International Classifcation of
Diseases-9th Revision code for T13 and CHD. Data were
restricted to newborns admitted < 14 days of age. In-hospital mortality,
length of stay (LOS) and adjusted total costs were compared between
infants undergoing CHS and those treated medically. Results: Of 644
infants with T13 identifed, 471 had CHD (73%). Median age at admission was
<1 day (IQR: 0, 1). CHS was performed in 39/471 (8% with CHD). Median LOS
for the CHS group was 30 days (19, 68) versus 8 days (4, 19) in the
non-surgical group (p<0.001). Mortality was 49% lower in the CHS group
(28% versus 55%, p<0.001). Median hospital cost was 302% higher in the CHS
group ($133,858 versus $33,299, p<0.001). Conclusions: In-hospital
mortality occurs in greater than half of neonates with T13 by less than
one week of age. CHS in these patients is associated with decreased
in-hospital mortality. Hospital costs are signifcantly increased in those
who underwent CHS largely due to increased hospital LOS.

<38>
Accession Number
617289344
Author
Witberg G.; Regev E.; Chen S.; Assali A.; Barbash I.; Planer D.; Assa
H.V.; Guetta V.; Zeniou V.; Orvin K.; Danenberg H.; Segev A.; Kornowski R.
Institution
(Witberg, Regev, Chen, Assali, Barbash, Planer, Assa, Guetta, Zeniou,
Orvin, Danenberg, Segev, Kornowski) Rabin Medical Center, Petach-Tikva,
Israel
Title
The association of coronary artery disease severity and pre procedural
completeness of revasclarization on mortality in patients undergoing
transcatheter aortic valve replacement.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 983), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Coronary artery disease (CAD) is very common in patients
referred for Transcatheter Aortic Vavle Replacement (TAVR), however, data
regarding the prognostic signifcance of CAD in this population is
conficting. A few single center studies have suggested that only severe
CAD is associated with worse prognosis. Methods: We analyzed data on 1270
consecutive patients with severe Aortic Stenosis (AS) undergoing TAVR from
3 referral centers during 2008-2014. Patients were classifed as having 1)
no CAD 2) CAD with low SYNTAX Score (SS) - <22 3) CAD with medium/high SS
- >22. We examined the association of CAD severity with all cause
mortality following TAVR. In addition, we examined whether the
completeness of pre-procedural revascularization, as determined by the
residual SS (rSS) - >/< 8 is associated with post TAVR mortality using a
Cox proportional hazards ratio model adjusted for multiple prognostic
variables. Results: Of the 1270 patients 847 (67%) had no CAD, 366 (28%)
were in the low SS group and 57 (5%) were in the medium/high SS group.
Overall, CAD severity was associated with a higher burden of
comorbidities. The average SS and rSS were 7 vs. 29 and 5 vs.20 in the low
and medium/high SS strata, respectively. Over a median follow up of 1.9
years 426 (33.5%) patients had died, 253 (29.9%) in the no CAD, 141
(38.6%) in the low SS and 32 (55.4%) in the medium/high SS groups,
respectively (log rank p<0.001). the corresponding fgures according to rSS
strata were 104 (33.2%) and 59 (53.7%) for the more vs less complete
revascularization groups (log rank p<0.001).After multivariate adjustment,
both medium/high SS (HR=2.4,p<0.001) and high rSS (HR=1.9,p<0.001) were
associated with increased mortality whereas patients in the low SS or rSS
had similar mortality rates to patients without CAD (p=0.356 and p=0.244,
respectively). Conclusions: Our results show that severe CAD is associated
with increased mortality post TAVR whereas lower severity CAD is not. In
addition the data suggests that more complete revascularization pre TAVR
may attenuate the association of severe CAD and mortality and thereby may
be used to improve the outcomes of patients with severe CAD referred for
TAVR.

<39>
Accession Number
617289328
Author
O'Byrne M.L.; Kennedy K.; Kanter J.; Berger J.; Glatz A.
Institution
(O'Byrne, Kennedy, Kanter, Berger, Glatz) Children's National Medical
Center, Washington, DC, USA, The Children's Hospital of Philadelphia,
Philadelphia, PA, USA
Title
Risk of catastrophic outcome following cardiac catheterization for
pulmonary hypertension: An analysis of data from the impact registry.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 585), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Cardiac catheterization is the gold standard test for
hemodynamic assessment of patients with pulmonary hypertension (PH). The
risk of this procedure in children with PH is uncertain. PH registries
report mortality risks of 0-0.06%, while an estimate of the risk of
catastrophic adverse events <=1 day from catheterization using
administrative data from a broader range of pediatric hospitals was 3.5%.
We sought to utilize a national clinical registry to measure the risk of
catastrophic adverse outcome and identify risk factors for those events.
Methods: A multicenter retrospective cohort study was performed using data
from the IMPACT registry of subjects up to 21 years with PH undergoing
catheterization from 1/2011 to 12/2015. Subjects were identifed using a
combination of diagnostic codes and hemodynamic parameters. Using
multivariable logistic regression, the association between pre-specifed
covariates and the risk of a composite outcome (death within 1 day of
catheterization, cardiac arrest, or initiation of mechanical circulatory
support following cardiac catheterization) was assessed. Results: 9,010
procedures performed in 6,669 subjects with PH at 74 centers were studied.
Median age was 3 years (IQR: 0-11). The etiology of PH was primary
pulmonary hypertension in 23%, congenital heart disease 53%, status post
heart transplantation 16%, cardiomyopathy 6%, and pulmonary vein stenosis
6%. Median pulmonary vascular resistance was 4.1 WU m2 (IQR:
2.6-6.5). 2% had undergone a cardiac operation in the prior 30 days, 14%
received mechanical ventilation, and 13% received inotropes. In terms of
procedural risk, 49% of procedures were in the lowest risk IMPACT risk
category. The observed risk of composite outcome was 1.2%, and death
before discharge was 4.7%. Younger age, lower systemic arterial oxygen
saturation, and receipt of inotropic agents were associated with increased
risk of adverse outcome. Conclusions: The risk of catastrophic adverse
outcome following cardiac catheterization in PH patients in IMPACT was
signifcantly higher than that reported from PH-specifc registries. Further
research is necessary to determine to degree to which this risk is
modifable.

<40>
Accession Number
617289286
Author
Stone G.W.; Cavalcante R.; Kappetein A.P.; Sabik J.; Banning A.; Taggart
D.; Sabate M.; Polmar J.; Boonstra P.; Lembo N.; Simonton C.; Onuma Y.;
Serruys P.W.
Institution
(Stone, Cavalcante, Kappetein, Sabik, Banning, Taggart, Sabate, Polmar,
Boonstra, Lembo, Simonton, Onuma, Serruys) Cardiovascular Research
Foundation, New York, NY, United States
Title
Sex differences in outcomes after stenting or bypass surgery for
unprotected left main disease.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 980), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: The impact of sex on outcomes of patients with unprotected
left-main disease (UPLMD) treated with up-to-date percutaneous coronary
intervention (PCI) and coronary bypass graft (CABG) techniques is still
unknown, and the existing literature harbors conficting data. In the
SYNTAX trial, female sex was an independent correlate of 4-year mortality
in the PCI arm, but not in the CABG arm. A signifcant interaction effect
was present between sex and CABG vs. PCI for that outcome. This fnding
lead to the inclusion of sex in the SYNTAX II score mortality prediction
model that provides guidance for the selection of the revascularization
strategy in patients with multivessel disease and/or UPLMD. Conversely,
this worse prognosis for women treated with PCI was not observed in the
BEST and PRECOMBAT trials. Methods: The Evaluation of XIENCE versus
Coronary Artery Bypass Surgery for Effectiveness of Left Main
Revascularization (EXCEL) trial randomized 1905 patients with UPLMD to
undergo CABG or PCI. The primary endpoint was the composite of all-cause
death, myocardial infarction or stroke at a median follow-up of 3 years.
The present study reports the pre-specifed sex subgroup analysis of the
trial. Results: Of the total population, 441 (23%) were female and 1464
(77%) were male patients. Compared to men, women were older and had a
worse baseline risk profle with a higher prevalences of hyperlipidemia,
hypertension, medically treated diabetes, and chronic kidney disease.
Regarding coronary anatomy, women had more ostial and less distal
bifurcation left main lesions, as well as lower anatomic SYNTAX scores and
fewer non left main diseased vessels, as compared to men. At the moment of
the submission of this abstract, outcomes data of the trial are still
under embargo. Conclusions: In the EXCEL trial, women had a worse baseline
risk profle but less complex coronary anatomy than men. At ACC 2017 we
intend to present all outcomes data of the trial according to sex and
treatment arm.

<41>
Accession Number
617289272
Author
Singh S.; Dhillon A.S.; Mirza M.; Arora R.
Institution
(Singh, Dhillon, Mirza, Arora) Chicago Medical School, North Chicago, IL,
United States
Title
Minimally invasive cabg reduces target vessel revascularizations in
comparison to pci without increased major adverse events: A meta-analysis
of randomized trials.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 28), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: The trials comparing Minimally Invasive Direct Coronary Artery
Bypass Graft (MIDCABG) with Percutaneous Coronary Intervention (PCI) for
proximal Left Anterior Descending Artery (LAD) stenosis show conficting
results. Methods: The PubMed, EMBASE, and Cochrane Central Register of
Controlled Trials were searched for randomized controlled trials reporting
clinical outcomes of MIDCABG vs PCI in patients with single vessel
proximal LAD coronary artery disease. The effect estimates were pooled
using Der-Simonian and Laird random-effects meta-analysis models. Results:
Eight randomized trials comprising of 1, 161 patients met inclusion
criteria. Median follow up was 18 months (range 6 months to 10 years).
Over 6 to 12 month follow up, need for any coronary intervention was
signifcantly lower in MIDCABG compared to PCI [ Risk Ratio (RR): 0.28; 95%
confdence intervals (CI): 0.16-0.49]. All-cause mortality, myocardial
infarction and recurrence of angina were not signifcantly different among
two groups over near or long term [Fig. 1]. Upon follow up of more than a
year, Target Vessel Revascularization (RR: 0.30; CI: 0.20-0.46) and need
for any coronary intervention (RR: 0.28; CI: 0.15-0.50) were signifcantly
lower in MIDCABG group. Conclusions: The MIDCABG reduces target vessel
revascularizations and need for any coronary intervention in comparison to
PCI for single vessel proximal LAD stenosis without increased all-cause
mortality, myocardial infarction and recurrence of angina.

<42>
Accession Number
617289266
Author
Abigail Simmons M.; Book W.; Shioda K.; Mori M.; Elder R.
Institution
(Abigail Simmons, Book, Shioda, Mori, Elder) Yale University School of
Medicine, New Haven, CT, USA, Emory University School of Medicine,
Atlanta, GA, USA
Title
Towards a better predictive model of adverse events in adult fontan
patients.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 633), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: The Fontan palliation causes chronic hepatic congestion and
carries a risk of late-adverse cardiac events. VAST and Model for
End-stage Liver Disease eXcluding INR (MELD-XI) scores are validated
risk-assessment tools in this group. This study investigates whether a
combination of these clinical (VAST) and lab-based models (MELD-XI) would
improve prediction of adverse cardiac events in Fontan patients. Methods:
Retrospective, two-center study of adult Fontan patients between 2001-16.
Adverse events were defned as cardiac death/heart transplantation. VAST
score (1 point each Varices, Ascites, Splenomegaly and Thrombocytopenia,
range 0-4), MELD-XI score [11.76 (loge creatinine) + 5.112 (loge total
bilirubin) + 9.44] and combined M-VAST score (range 0-5), for which a
MELD-XI >=13 was counted as a +1 to VAST score, were compared as
predictors of adverse events using receiver operating characteristics
(ROC) analysis. Optimal cut-off points were identifed using Yoden index.
Scores were calculated at a period of outpatient stability. Non-event
cohort was censored at last clinical evaluation. Results: VAST and MELD-XI
scores were available in 160 adult patients. After a mean follow-up of 22
yrs, 23 (14%) experienced an adverse event. The event cohort was older
(38.7 +/-10.3 vs. 31.6 +/-8.0 years, p=0.0049), had higher VAST scores
(2.2 +/-1.2 vs. 0.8 +/-1.0, p<0.0001) and higher MELD-XI scores (12.5
+/-3.3 vs. 11.1 +/-2.3, p=0.049) compared to non-event cohort. ROC curve
for VAST alone as a predictor of adverse events yielded an AUC of 0.80
with the optimal cutoff of >=2. ROC curve for MELD-XI score yielded an AUC
of 0.66 with the optimal cutoff of >=13. ROC curve for the M-VAST score
yielded an improved AUC of 0.82 with the optimal cutoff of M-VAST >=2.
Compared to VAST alone, M-VAST improved sensitivity from 0.70 to 0.78 but
decreased specifcity from 0.79 to 0.72. Kaplan-Meier analysis with strata
divided at M-VAST >=2 demonstrated improved event free survival of the
lower score strata (log rank =0.0002). Conclusions: Incorporating a
MELD-XI into the VAST score, thus combining laboratory and clinical
variables, improves the ability to predict death and cardiac transplant in
adult Fontan patients.

<43>
Accession Number
617289244
Author
Goldstone A.B.; Chiu P.; Baiocchi M.; Ligala B.; Boyd J.; Joseph Woo Y.
Institution
(Goldstone, Chiu, Baiocchi, Ligala, Boyd, Joseph Woo) Stanford University,
Stanford, CA, United States
Title
Effectiveness of a second arterial conduit for multi vessel coronary
bypass: A state-wide analysis of 60,897 patients.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 26), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Whether a second arterial conduit improves outcomes after
multi vessel coronary artery bypass grafting (CABG) remains unclear, and
some believe equipoise exists. Consequently, arterial conduits other than
the left internal mammary artery are seldom used in the United States.
Methods: We compared propensity score matched cohorts who underwent
primary, isolated multi vessel CABG at 127 hospitals in California between
2006 and 2011 with an internal mammary artery (IMA), and who either: A)
received an additional IMA or radial artery as a second conduit (N=5,988);
or B) received veins for remaining conduits (N=54,909). The primary
outcome was all-cause mortality; secondary outcomes included the competing
risks of repeat revascularization, myocardial infarction, and stroke.
Follow-up ended December 31, 2013. We also compared outcomes of recipients
of a second IMA (N=1,607) with matched recipients of a radial artery
(N=4,381) as a second conduit. Results: Second arterial conduit use
decreased from 10.9% in 2006 to 9.1% in 2011 (P<0.001). However, receipt
of a second arterial conduit signifcantly improved survival (HR 0.81, 95%
CI 0.74-0.89, P<0.001) and freedom from major adverse cardiovascular
events (HR 0.81, 95% CI 0.76-0.85, P<0.001) over the 8-year study period.
A second arterial conduit reduced the cumulative incidence of the
competing risks of repeat revascularization (HR 0.81, 95% CI 0.75-0.87,
P<0.001) and myocardial infarction (HR 0.80, 95% CI 0.72-0.89, P<0.001),
but not stroke. The age above which patients no longer beneftted from a
second arterial conduit was 73 years. In a comparison of arterial
conduits, overall survival (P=0.83) and freedom from major adverse
cardiovascular events (P=0.43) were equivalent between recipients of a
second IMA or a radial artery. Conclusions: The use of a second arterial
conduit in patients undergoing multi vessel CABG at a mix of community and
academic practices was associated with improved survival and lower risks
of repeat revascularization and myocardial infarction. This beneft may
extend to those >70 years old. The equipoise between venous and arterial
conduits as secondary grafts for CABG should be reconsidered.

<44>
Accession Number
617289176
Author
Erickson L.; Reid K.; Ricketts A.; Beaven B.; Goudar S.; Lay A.; Stroup
R.; O'Brien J.; Shirali G.
Institution
(Erickson, Reid, Ricketts, Beaven, Goudar, Lay, Stroup, O'Brien, Shirali)
Children's Mercy Kansas City, Kansas City, MO, United States
Title
Interstage resource utilization of infants with single ventricle: Results
of a crossover study.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 628), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Since 2014, we have monitored interstage infants with single
ventricle (SV) at home with CHAMP, a tablet PC with cloud-based instant
analytic algorithms. This study identifes predictors of high resource
utilization (HRU) readmissions. Methods: From 5/14 to 6/15, SV infants
were enrolled in a crossover study comparing traditional binder to CHAMP.
All were discharged with the binder; they were randomized to receive CHAMP
instead of binder 1 or 2 months after discharge. One month after
randomization, caregivers chose either binder or CHAMP for the remainder
of the interstage. Charts were reviewed for neonatal characteristics,
readmission data including events prior to readmission, length of stay
(LOS), ICU LOS and charges. High resource utilization (HRU) were defned as
the 25% of readmissions that were associated with the greatest ICU LOS,
and were compared to all others (Low resource utilization (LRU)). Results:
31 infants were monitored for 4911 interstage days. There were no
interstage deaths and 73 readmissions. HRU did not differ from LRU in
neonatal characteristics (Table). HRU were signifcantly more likely to be
unplanned, at a younger age, and associated with a longer delay from
clinical change to readmission. HRU had higher charges, LOS, and more
cardiac and general surgeries. Conclusions: Interstage SV infants are at
high risk for readmissions. Delays in care are associated with HRU; CHAMP
may help decrease delays. This study may provide the basis for predictive
analytic algorithms.

<45>
Accession Number
617289132
Author
Genereux P.; Serruys P.; Kappetein A.; Van Boven A.; Hickey M.; Kandzari
D.; Schampaert E.; Horkay F.; Ungi I.; Mansour S.; Pocock S.; Banning A.;
Taggart D.; Sabate M.; Gershlick A.; Boonstra P.; Lembo N.; Puskas J.;
Kosmidou I.; Morris Brown W.; Mehran R.; Ben-Yehuda O.; Simonton C.; Sabik
J.; Stone G.
Institution
(Genereux, Serruys, Kappetein, Van Boven, Hickey, Kandzari, Schampaert,
Horkay, Ungi, Mansour, Pocock, Banning, Taggart, Sabate, Gershlick,
Boonstra, Lembo, Puskas, Kosmidou, Morris Brown, Mehran, Ben-Yehuda,
Simonton, Sabik, Stone) Cardiovascular Research Foundation, New York, NY,
USA, Columbia University Medical Center, New York, N Y, USA
Title
Outcomes of pci versus cabg in left main disease according to syntax score
by site versus angiographic core laboratory assessment: Insights from the
excel trial.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 972), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Outcomes of revascularization with PCI vs. CABG in patients
with coronary artery disease (CAD) are dependent on the anatomic SYNTAX
score, a measure of CAD complexity. PCI is currently only recommended for
patients with a low or intermediate SYNTAX score (<=32), data generated
from angiographic core laboratory (ACL) assessment. However, sites tend to
under-estimate the SYNTAX score compared to ACL measures; the implications
of this on patient outcomes are unknown. Methods: In the Evaluation of
XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left
Main Revascularization (EXCEL) trial, 1905 patients with left main
coronary artery disease (LMCAD) and SYNTAX score <=32 based on site
assessment were randomized to CABG (n=957) vs. PCI with fuoropolymer-based
cobalt-chromium everolimus-eluting stents (n=948). The primary endpoint
was the 3-year composite rate of death, stroke or myocardial infarction
(MI), powered for noninferiority testing. Major secondary outcomes
included this endpoint at 30 days, and the composite rate of death,
stroke, MI or ischemia-driven revascularization at 3 years. The local
Heart Team consisting of an interventional cardiologist and cardiac
surgeon computed study eligibility SYNTAX scores. Qualifying baseline
angiograms were also analyzed at an independent ACL. Results: The median
SYNTAX score was higher by ACL read than by site assessment (mean 26.5 +/-
9.3 vs. 20.6 +/- 6.2, P<0.0001). By site assessment the SYNTAX score was
low (<=22) in 60.5% of patients and intermediate (23-32) in 39.5% of
patients. By ACL analysis the SYNTAX score was low, intermediate and high
(>=33) in 35.8%, 40.0% and 24.2% of patients respectively. Conclusions:
The EXCEL trial intended to enroll patients with LMCAD and low to
intermediate SYNTAX scores. However, by ACL analysis, ~25% of patients had
a high SYNTAX score. At ACC 2017 the reasons for this discrepancy will be
described, and the primary and secondary outcome measures in patients
randomized to PCI vs. CABG will be reported stratifed by site SYNTAX
score, ACL SYNTAX score using original tertiles, and by true EXCEL
population tertiles (results currently under embargo).

<46>
Accession Number
617289104
Author
O'Byrne M.L.; Kim S.; Hornik C.; Yerokun B.; Matsouaka R.; Jacobs J.;
Jacobs M.; Jonas R.
Institution
(O'Byrne, Kim, Hornik, Yerokun, Matsouaka, Jacobs, Jacobs, Jonas)
Children's National Medical Center, Washington, DC, USA, Duke University
School of Medicine, Durham, NC, USA
Title
Effect of obesity and underweight status on perioperative outcomes in
patients with congenital heart disease: An analysis of data from the
society of thoracic surgeons congenital heart surgery database.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 574), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Obesity is increasingly prevalent in the congenital heart
disease population. The effect of obesity and body-mass index (BMI) on
perioperative outcomes has not been evaluated. We sought to study the
association between BMI and perioperative outcomes following congenital
heart operations in children and young adults. Methods: A multicenter
retrospective cohort study was performed using data from the Society of
Thoracic Surgeons Congenital Heart Surgery Database of children and young
adults between 10-35 years undergoing any cardiac operation from 1/2010 to
12/2015. The primary exposure was BMI percentile, adjusted for age and
sex. The primary outcomes were operative mortality and composite outcome
(operative mortality, major complications, post-operative hospital length
of stay >14 days, and wound infection/dehiscence). The association between
BMI percentile and primary outcomes was assessed using multivariate mixed
effects models adjusting for demographic, preoperative and operative
factors including STS-EACTS Mortality Category. Results: Of 18,337
subjects undergoing index operations at 118 centers, 16% were obese (BMI
percentile>95%), 15% overweight (85-95%), 53% normal weight (15-85%), 7%
underweight (5-15%), and 9% were severely underweight (5th
percentile). The observed risks of operative mortality (p=0.04) and
composite outcome (p<0.0001) were higher in severely underweight and obese
subjects than in normal weight subjects. Risk of unplanned cardiac
operation and reoperation for bleeding was higher with severely
underweight BMI. Risk of wound infection/dehiscence was higher in obese
subjects. In multivariate analysis, the association between BMI and
operative mortality was not signifcant. Obese (OR: 1.21, 95% CI:
1.05-1.39), underweight (OR: 1.33, 95% CI: 1.11-1.60), and severely
underweight subjects (OR: 1.53, 95% CI: 1.31-1.79) were at increased risk
of the composite outcome. Conclusions: Obese and underweight BMI were
associated with increased risk of composite adverse outcome independent of
other risk factors. Further research is necessary to determine whether BMI
represents a modifable risk factor for perioperative outcome.

<47>
Accession Number
617289008
Author
Pieter Kappetein A.; Milojevic M.; Serruys P.; Sabik J.; Head S.; Kandzari
D.; Schampaert E.; Taggart D.; Horkay F.; Laszlo K.I.; Mansour S.; Banning
A.; Sabate M.; Bochenek A.; Pomar J.; Lembo N.; Noiseux N.; Puskas J.;
Kosmidou I.; Mehran R.; Ben-Yehuda O.; Genereux P.; Simonton C.; Pocock
S.; Stone G.
Institution
(Pieter Kappetein, Milojevic, Serruys, Sabik, Head, Kandzari, Schampaert,
Taggart, Horkay, Laszlo, Mansour, Banning, Sabate, Bochenek, Pomar, Lembo,
Noiseux, Puskas, Kosmidou, Mehran, Ben-Yehuda, Genereux, Simonton, Pocock,
Stone) Erasmus MC, Rotterdam, Netherlands
Title
Treatment of left main coronary artery disease in patients with diabetes:
3-Year outcomes comparing cabg and PCI with everolimus-eluting stents from
the excel study.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 967), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: The optimal revascularization strategy in diabetic pts and
left main coronary artery disease (LMCAD) is unclear. We therefore
examined the effect of diabetes in pts with LMCAD randomized to
percutaneous coronary intervention (PCI) or coronary artery bypass surgery
(CABG) in the large-scale, international EXCEL trial. Methods: Pts
(N=1905) with LMCAD with SYNTAX score <=32 were randomized to receive
either PCI with everolimus-eluting stents or CABG. Randomization was
stratifed by diabetes, SYNTAX score, and center. The primary endpoint was
the 3-year composite rate of death, stroke or myocardial infarction (MI),
powered for noninferiority testing (margin 4.2%). Major secondary outcomes
included this endpoint at 30 days, and the composite rate of death,
stroke, MI or ischemia-driven revascularization at 3 years. Outcomes were
examined in subgroups with (N=554; 29.1%) and without (N=1351; 70.9%)
diabetes Results: Among the 554 diabetic pts, 286 (30.2%) were randomized
to PCI and 268 (28.0%) were randomized to CABG; 73 (7.7%) and 74 (7.7%) in
the PCI and CABG groups respectively were insulin-treated. The PCI and
CABG groups in the diabetes and non-diabetes cohorts were well-matched for
baseline characteristics. Three-year outcomes of pts with diabetes will be
available at the time of the presentation and will be compared to those
without diabetes, in all pts and per insulin-treatment and baseline SYNTAX
score. Conclusions: PCI is a potential treatment option for selected pts
with LMCAD, although diabetic pts often have more diffuse disease, smaller
vessels and other comorbidities that increase revascularization risk. This
pre-specifed analysis from the EXCEL trial will provide a treatment
algorithm for physicians to gauge clinical outcomes in this high-risk
cohort based on baseline characteristics, diabetes severity, and anatomic
complexity, enabling selection of the safest and most effective
revascularization option for each pt.

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

<49>
Accession Number
617288922
Author
Bytyci I.; Bajraktari G.; Bhatt D.L.; Morgan C.J.; Ahmed A.; Aronow W.S.;
Banach M.
Institution
(Bytyci, Bajraktari, Bhatt, Morgan, Ahmed, Aronow, Banach) Clinic of
Cardiology, Prishtina, Albania, Medical University of Lodz, Lodz, Poland
Title
Hydrophilic versus lipophilic statins in coronary artery disease
undergoing percutaneous coronary intervention: A meta-analysis of
randomized controlled trials.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 161), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Hydrophilic statins may be more benefcial than lipophilic
statins in patients with acute ischemia undergoing percutaneous coronary
intervention (PCI). In the current meta-analysis we examined the effect of
lipophilic in comparison with hydrophilic statins in patients with acute
coronary syndrome (ACS) and undergoing PCI. Methods: We systematically
searched selected electronic databases up to July 2016 in order to
identify randomized controlled trials (RCTs) which compared clinical
outcomes of hydrophilic vs. lipophilic statins in ACS patients. Primary
outcomes were major adverse cardiac events (MACE), myocardial infarction
(MI), cardiac revascularization, stroke, cardiovascular (CV)
hospitalization, cardiovascular (CV) and all-cause of mortality. Results:
A total of 8708 patients from 8 RCTs had been randomized to receive
lipophilic (n=4277) or hydrophilic statins (n=4431), with mean follow-up
12.4 months, and were included to the meta-analysis. In comparison to
hydrophilic statins, the lipophilic statins showed comparable risk
reduction of MACE (relative risk [RR]=1.05, 95% CI, 0.88 to 1.25, p=0.591;
Figure). Similar effects were observed on MI and CV death (Figure) and
other outcomes. Conclusions: We found no evidence of differential effect
on MACE or other outcomes between lipophilic and hydrophilic statins in
patients with ACS undergoing PCI.

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

<51>
Accession Number
617288877
Author
Parikh V.; Lavu M.; Vuddanda V.L.K.; Jazayeri M.; Reddy V.; Yarlagadda B.;
Korra H.; Venkata R.; Bommana S.; Atkins D.; Reddy M.; Lakkireddy D.
Institution
(Parikh, Lavu, Vuddanda, Jazayeri, Reddy, Yarlagadda, Korra, Venkata,
Bommana, Atkins, Reddy, Lakkireddy) University of Kansas Hospital, Kansas
City, KS, United States
Title
Peri-procedural use of novel oral anticoagulation agents during cardiac
device implantation: Are they safe?.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 309), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Safety of peri-procedural use of novel oral anticoagulation
agents (NOACs) during cardiac device implantation has been suggested in
small observational studies. Larger data affrming its safety is lacking.
Methods: We performed a multicenter evaluation of safety of uninterrupted
anticoagulation with NOACs during cardiac device implantation procedures.
965 consecutive patients from 3 centers were included in the study.
Baseline demographics and complication rates were collected. Results: 553
(57%) patients were on warfarin and 412 (43%) patients were on NOACs. Out
of these, 511 (53%) had new device implantation, 285 (29.5%) had generator
change and 169 (17.6%) had device upgrade. Mean INR in warfarin group was
2.07 +/- 0.76. NOAC group included 93 (22.6 %) patients on dabigatran, 198
(48.2 %) patients on rivaroxaban, 119 (28.9%) patients on apixaban and 1
(0.2%) patient was on edoxaban. NOACs were continued un-interrupted in
majority and resumed within 24 hours of the procedure. There were no
signifcant differences in the total bleeding (5.1 % vs 6.6%; p=0..33) or
non-minor bleeding (2.3% vs 2.4%; p=0.79) rates between both the groups.
Results were consistent after adjusting for other variables using
multivariate logistic regression analysis. There were no thromboembolic
events or deaths in any of the groups. Conclusions: Peri-procedural use of
novel oral anticoagulation agents during cardiac device implantation
appears to be safe.

<52>
Accession Number
617288835
Author
Pepe M.; Masi F.; Signore N.; Bortone A.S.; Cecere A.; Tito A.; Zanna D.;
Quagliara D.; Favale S.
Institution
(Pepe, Masi, Signore, Bortone, Cecere, Tito, Zanna, Quagliara, Favale)
Cardiovascular Diseases Section, Department of Emergency & Organ
Transplantation, University of Bari, Bari, Italy, Institute of Cardiac
Surgery, University of Bari, Bari, Italy
Title
Time related benefit of antiplatelet therapy on coronary reperfusion in
ST-Elevation Myocardial Infarction (STEMI) patients.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 257), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: The goal of STEMI treatment is early reperfusion. The new oral
P2Y<inf>12</inf> inhibitors (P2Y<inf>12</inf>-I) prasugrel and ticagrelor
demonstrated to improve angiographic results of primary percutaneous
coronary intervention (pPCI) and clinical prognosis, but their onset of
action is signifcantly impaired in STEMI patients. Aim of our
observational study was to establish if the beneft of the
P2Y<inf>12</inf>-I loading dose (LD) administration is time related.
Methods: A total of 250 consecutive patients with STEMI (81.3% males,
65.5+/-12.5 years old, 33.5% diabetics) addressed to pPCI were enrolled.
Cardiogenic shock was an exclusion criterion. We divided our population
into three groups depending of the time interval from "P2Y<inf>12</inf>-I
LD administration to balloon": the frst group included patients receiving
P2Y<inf>12</inf>-I LD at least 60 minutes before pPCI, the second group
within the 60 minutes before pPCI, the third group at the moment of pPCI
after angiography. Two skilled interventional cardiologists evaluated the
TIMI fow grade (TFG) of the culprit artery in the frst angiogram
immediately prior to PCI and post pPCI in a double blinded fashion.
Results: Pre-pPCI TFG decreased throughout the groups proportionally to
the increasing "P2Y<inf>12</inf>-I LD administration to balloon" time; we
found the following rates of pre-pPCI TFG 0/1: 51.3% in the frst group,
62.1% in the second group, 83.2% in the third group (p< 0.001). Moreover
post-pPCI TFG was signifcantly different in the three groups (p<0.001): it
improved throughout the groups proportionally to the increasing "
P2Y<inf>12</inf>-I LD administration to balloon" time with the following
rates: 97.4% in the frst group, 88.4% in the second group, 82.2% in the
third Group. Conclusions: Despite rapid initiation is recommended,
absorption and effectiveness of P2Y<inf>12</inf>-I is known to be impaired
in STEMI patients. Our observational study is the frst evidence of a
progressive time-related angiographic beneft of P2Y<inf>12</inf>-I LD
administration: a longer time window between P2Y<inf>12</inf>-I
administration and pPCI signifcantly improves coronary reperfusion in
terms of both pre and post pPCI TFG; this fnding supports the relevance of
P2Y<inf>12</inf>-I LD administration as soon as possible at frst medical
contact.

<53>
Accession Number
617288818
Author
Ogunbayo G.; Olorunfemi O.; Elbadawi A.; Saheed D.; Guglin M.
Institution
(Ogunbayo, Olorunfemi, Elbadawi, Saheed, Guglin) University of Kentucky,
Lexington, KY, USA, Rochester General Hospital, Rochester, NY, USA
Title
Outcomes of intra-aortic balloon pump use in myocarditis complicated by
cardiogenic shock.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 860), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Temporary mechanical support may be necessary in patients with
myocarditis. Our study describes the outcomes of intra-aortic balloon pump
(IABP) use in patients with myocarditis complicated with cardiogenic
shock. Methods: We identifed patients with cardiogenic shock and a primary
diagnosis of myocarditis using ICD-9 codes in the National Inpatient
Sample Database. We compared outcomes in the patients who received IABP
and in those who did not. We also compared the effects of early (within 24
hours of admission) versus late (after 24 hours) IABP use on mortality,
length of stay and treatment cost. We performed logistic regression
analysis with mortality as the primary outcome. Results: We identifed
7,972 patients with primary diagnosis of myocarditis, 427 (5.4%) of whom
developed cardiogenic shock. Of these, 187 (42.8%) received an IABP. Both
groups (IABP and no IABP) were not different in terms of common
comorbidities (old myocardial infarction, chronic Ischemic heart disease,
congestive heart failure, diabetes mellitus and hypertension]. There was
signifcantly less incidence of stroke (1.1% vs. 5.0% p=.028), use of other
ventricular assist devices (11.2 vs. 20.8 p=.008) and occurrence of heart
transplant (0.5% vs. 4.2% p=.027) in the IABP group. Patients that died in
the IABP arm had more ventricular tachycardia (p= .047) and ventricular
fbrillation (p= .043). Overall, mortality did not signifcantly differ in
patients on IABP support versus no IABP (25.5 vs. 21.5; p=.334). However
there was signifcantly less mortality in this cohort when the IABP was
deployed within 24 hours of admission than after 24 hours (23.8% vs. 35.2%
p=.032). After adjusting for age, sex, race and comorbidities, this beneft
of early IABP use remained signifcant (OR= .57; 95%CI .34-.98; p value=
.041). Conclusions: The use of IABP in patients with cardiogenic shock is
fairly common. The early use of this device (within the frst 24 hours of
presentation) appears to offer a mortality beneft. This fnding needs to be
confrmed in randomized clinical trials.

<54>
Accession Number
617288801
Author
Kirolos I.; Derbal O.; Gadde R.; Yakoub D.; Alfonso C.; Chaparro S.;
Salerno T.; Cohen M.
Institution
(Kirolos, Derbal, Gadde, Yakoub, Alfonso, Chaparro, Salerno, Cohen)
University of Miami, Miami, FL, United States
Title
Perioperative administration of amiodarone or beta blockers in cardiac
surgery: Which is more effective in reducing postoperative atrial
fibrillation?.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 459), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Optimum prophylaxis for post-operative atrial fbrillation (AF)
in cardiac surgery patients is controversial. We aimed to compare the
utility of amiodarone (A) versus beta blockers (BB) in decreasing the
postoperative incidence of AF. Methods: Online search of PubMed, MEDLINE,
EMBASE, SCOPUS, COCHRANE, and GOOGLE SCHOLAR databases was performed (1988
- Present); key bibliographies were reviewed. Studies comparing use of
perioperative A to BB in cardiac surgery patients were included. Relative
risks with the corresponding 95% confdence intervals (CI) by random and
fxed effects models of pooled data were calculated. Study quality was
assessed using STROBE criteria. The primary outcome was postoperative
incidence of AF. Secondary outcomes included onset, duration of AF and
ventricular response rate (VRR). Results: Search strategy yielded 136
studies, 8 randomized controlled trials met our selection criteria. A
total of 1457 patients underwent either coronary artery bypass graft (n=
1397), valvular surgery (n=24) or both (n=36). There was no signifcant
difference between the two groups in age, sex, smoking status, number of
cardiac vessels involved or co-morbities. Median age was 62 yrs. M/F ratio
was 2.6/1. 722 patients received peri-operative A and 735 patients
received BB mostly metoprolol. Metaanalysis of included data showed
signifcantly less incidence of AF in the A group (RR 0.75; 95%
CI:0.58-0.97, p=0.029). The onset of AF was delayed in the BB group (SMD
0.43; CI:0.08-0.76, p=0.014). There was no signifcant difference between
the groups in duration of AF (SMD -0.28; 95% CI:-1.01 to 0.46, p=0.45) or
VRR (SMD 0.58; 95% CI:-0.51-1.68, p=0.29). Conclusions: Peri-operative use
of amiodarone in cardiac surgery patients is associated with lower yet
earlier incidence of AF compared to BB. Randomized clinical trials are
needed to validate this fnding and further investigate independent risk
factors associated with postoperative AF.

<55>
Accession Number
617288783
Author
Martin M.H.; Meadows J.; Goldstein B.; Bergersen L.; Qureshi A.;
Shahanavaz S.; Aboulhosn J.; Berman D.; Peng L.; Gillespie M.; Armstrong
A.; Weng C.; Gray R.
Institution
(Martin, Meadows, Goldstein, Bergersen, Qureshi, Shahanavaz, Aboulhosn,
Berman, Peng, Gillespie, Armstrong, Weng, Gray) University of Utah, Salt
Lake City, UT, USA, Primary Children's Hospital, Salt Lake City, UT, USA
Title
Safety and feasibility of melody transcatheter pulmonary valve replacement
in the native right ventricular outflow tract: A multicenter study.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 558), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Melody Transcatheter Pulmonary Valve Replacement (TPVR) is FDA
approved within right ventricular to pulmonary artery (RV-PA) conduits;
however, >80% of patients needing pulmonary valve replacement do not have
a conduit. Therefore, Melody TPVR has been adopted clinically to treat
native (non-conduit) right ventricular outfow tracts (nRVOT). Safety,
feasibility and factors associated with successful nRVOT TPVR have not
been studied. Methods: This is a multicenter, retrospective review of all
patients presenting for nRVOT TPVR. Pre-procedural imaging (MRI and echo)
and cath data were collected. Results: Of 229 patients (mean age 21 years,
range 4-67) from 11 centers, 132 (58%) had successful TPVR. The remaining
97 (42%) did not receive TPVR due to large nRVOT (n=67), aortic root or
coronary compression (n=18) and not clinically indicated (n=12). There
were no deaths and 5 (2%) serious complications: stent embolization
requiring surgery (4) and arrhythmia requiring cardioversion (1). Factors
associated with successful TPVR included higher TPVR volume center,
pre-cath pulmonary stenosis, and no prior transannular patch. Pre-cath MRI
measurements were signifcantly different in the implanted vs.
not-implanted groups (Table). Conclusions: TPVR in the nRVOT is safe,
however, nearly half the patients are found not to be candidates, mainly
due to large RVOT size. Improved understanding and use of MRI data as well
as availability of larger devices may improve success rates for nRVOT
TPVR.

<56>
Accession Number
617288738
Author
Brunetti M.; Retzloff L.B.; Lehrich J.L.; William Gaynor J.; Pasquali S.;
Bailly D.; Davis S.; Klugman D.; Koch J.; Lasa J.; Gaies M.
Institution
(Brunetti, Retzloff, Lehrich, William Gaynor, Pasquali, Bailly, Davis,
Klugman, Koch, Lasa, Gaies) Children's Hospital of Philadelphia,
Philadelphia, PA, USA, University of Michigan, Ann Arbor, MI, USA
Title
Characteristics, risk factors & outcomes of extracorporeal membrane
oxygenation use in the pediatric cardiac intensive care unit.
Source
Journal of the American College of Cardiology. Conference: 66th Annual
Scientific Session of the American College of Cardiology and i2 Summit:
Innovation in Intervention, ACC.17. United States. 69 (11 Supplement 1)
(pp 556), 2017. Date of Publication: 21 Mar 2017.
Publisher
Elsevier USA
Abstract
Background: Extracorporeal Membrane Oxygenation (ECMO) is used to support
pediatric patients with medical and surgical cardiac disease. We aimed to
characterize ECMO use across a multicenter cohort. Methods: Retrospective
analysis of the Pediatric Cardiac Critical Care Consortium
(PC4) clinical registry was performed to describe ECMO
frequency and outcomes. Within strata of medical and surgical
hospitalizations, we identifed risk factors associated with ECMO use
through multivariate logistic regression. Results: Across 23 hospitals,
there were 14,526 eligible hospitalizations from 8/1/14-6/30/16, of which
449 (3.1%) included at least 1 ECMO course. ECMO was used in 120 (2.4%)
medical and 329 (3.5%) surgical hospitalizations. Low cardiac output was
the most common ECMO indication in both groups. Extracorporeal
cardiopulmonary resuscitation (E-CPR) was used in 42% of medical and 32%
of surgical ECMO courses. Risk factors associated with ECMO use in the
medical group included acute heart failure and higher vasoactive inotropic
score at admission (both p<0.0001). Stroke (15%) and renal failure (15%)
were the most common ECMO complications in the medical group. Risk factors
associated with post-operative ECMO use in the surgical group included
younger age, extra-cardiac anomalies, pre-operative morbidity, higher STAT
category, bypass time, and early post-operative mechanical ventilation and
arrhythmias (within 2 hours) (all p<0.05). Bleeding requiring re-operation
(25%) was the most common ECMO complication in the surgical group.
Hospital mortality was 63% in the medical group and 50% in the surgical
group with E-CPR mortality rates of 83% and 50%, respectively.
Conclusions: This is the frst multicenter study describing contemporary
ECMO use and outcomes in pediatric CICU patients with all forms of cardiac
disease. ECMO is a rare therapy, yet mortality remains high, highlighting
the importance of identifying levers to improve care. We identifed unique
high-risk subgroups to target for quality initiatives within medical and
surgical patients.

<57>
Accession Number
618389896
Author
Bajaj N.S.; Patel N.; Kalra R.; Marogil P.; Bhardwaj A.; Arora G.; Arora
P.
Institution
(Bajaj) Division of Cardiovascular Medicine, Department of Radiology,
Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, United
States
(Bajaj, Patel, Bhardwaj, Arora, Arora) Division of Cardiovascular
Diseases, Department of Medicine, University of Alabama at Birmingham,
1900 University Boulevard Birmingham, AL 35233, United States
(Kalra) Cardiovascular Division, University of Minnesota, 420 Delaware St
SE, Minneapolis, MN 55455, United States
(Marogil) Department of Internal Medicine, Brookwood Baptist Health, 2010
Brookwood Medical Center Drive Birmingham, AL 35209, United States
(Arora) Section of Cardiology, Birmingham Veterans Affairs Medical Center,
700 19th St S, Birmingham, AL 35233, United States
Title
Percutaneous coronary intervention vs. coronary artery bypass grafting for
left main revascularization: An updated meta-analysis.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 3 (3) (pp
173-182), 2017. Date of Publication: 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims The optimal revascularization strategy for left main coronary artery
disease (LMD) remains controversial, especially with two recent randomized
controlled trials showing conflicting results. We sought to address this
controversy with our analysis. Methods and results Comprehensive
literature search was performed. We compared percutaneous coronary
intervention (PCI) and coronary artery bypass grafting (CABG) for LMD
revascularization using standard meta-analytic techniques. A 21% higher
risk of long-term major adverse cardiac and cerebrovascular event [MACCE;
composite of death, myocardial infarction (MI), stroke, and repeat
revascularization] was observed in patients undergoing PCI in comparison
with CABG [risk ratio (RR) 1.21, 95% confidence interval (CI) 1.05-1.40].
This risk was driven by higher rate of repeat revascularization in those
undergoing PCI (RR 1.61, 95% CI 1.34-1.95). On the contrary, MACCE rates
at 30 days were lower in PCI when compared with CABG (RR 0.55, 95% CI
0.39-0.76), which was driven by lower rates of stroke in the PCI arm (RR
0.41, 95% CI 0.17-0.98). At 1 year, lower stroke rates (RR 0.21, 95% CI
0.08-0.59) in the PCI arm were balanced by higher repeat revascularization
rates in those undergoing PCI (RR 1.78, 95% CI 1.33-2.37), resulting in a
clinical equipoise in MACCE rates between the two revascularization
strategies. There was no difference in death or MI between PCI when
compared with CABG at any time point. Conclusion Outcomes of CABG vs. PCI
for LMD revascularization vary over time. Therefore, individualized
decisions need to be made for LMD revascularization using the heart team
approach. Copyright © 2017 The Author.

<58>
Accession Number
618470395
Author
Mylonas K.S.; Tzani A.; Metaxas P.; Schizas D.; Boikou V.; Economopoulos
K.P.
Institution
(Mylonas) Division of Pediatric Surgery, Massachusetts General Hospital,
Harvard Medical School, Warren 11, 55 Fruit Street, Boston, MA 02114,
United States
(Mylonas, Tzani, Metaxas, Schizas, Economopoulos) Surgery Working Group,
Society of Junior Doctors, Athens, Greece
(Schizas) First Department of Surgery, Laiko General Hospital, National
and Kapodistrian University of Athens, Athens, Greece
(Boikou) Athens University of Economics and Business, Athens, Greece
(Economopoulos) Department of Surgery, Massachusetts General Hospital,
Harvard Medical School, Boston, MA, United States
Title
Blood Versus Crystalloid Cardioplegia in Pediatric Cardiac Surgery: A
Systematic Review and Meta-analysis.
Source
Pediatric Cardiology. (pp 1-13), 2017. Date of Publication: 25 Sep 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The benefit of blood cardioplegia (BCP) compared to crystalloid
cardioplegia (CCP) is still debatable. Our aim was to systematically
review and synthesize all available evidence on the use of BCP and CCP to
assess if any modality provides superior outcomes in pediatric cardiac
surgery. A systematic literature search of the PubMed and Cochrane
databases was performed with respect to the PRISMA statement
(end-of-search date: January 30th, 2017). We extracted data on study
design, demographics, cardioplegia regimens, and perioperative outcomes as
well as relevant biochemical markers, namely cardiac troponin I (cTnI),
lactate, and ATP levels at baseline, after reperfusion and postoperatively
at 1, 4, 12, and 24 h as applicable. Data were appropriately pooled using
random and mixed effects models. Our systematic review includes 56 studies
reporting on a total of 7711 pediatric patients. A meta-analysis of the 10
eligible studies directly comparing BCP (n = 416) to CCP (n = 281) was
also performed. There was no significant difference between the two groups
with regard to cTnI and Lac at any measured time point, ATP levels after
reperfusion, length of intensive care unit stay (WMD: -0.08, 95% CI -1.52
to 1.36), length of hospital stay (WMD: 0.13, 95% CI -0.85 to 1.12), and
30-day mortality (OR 1.11, 95% CI 0.43-2.88). Only cTnI levels at 4 h
postoperatively were significantly lower with BCP (WMD: -1.62, 95% CI
-2.07 to -1.18). Based on the available data, neither cardioplegia
modality seems to be superior in terms of clinical outcomes, ischemia
severity, and overall functional recovery. Copyright © 2017
Springer Science+Business Media, LLC

<59>
Accession Number
618469322
Author
Spinthakis N.; Farag M.; Gorog D.A.; Prasad A.; Mahmood H.; Gue Y.;
Wellsted D.; Nabhan A.; Srinivasan M.
Institution
(Spinthakis, Farag, Gorog, Mahmood, Gue, Srinivasan) Department of
Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK
(Spinthakis, Farag, Gorog, Wellsted) Postgraduate Medical School,
University of Hertfordshire, UK
(Gorog) National Heart and Lung Institute, Imperial College, London, UK
(Prasad) Department of Cardiovascular Diseases, Mayo Clinic, Rochester,
MN, United States
(Nabhan) Cochrane Advisory Group, Postgraduate Medical School, Ain Shams
University, Cairo, Egypt
Title
Percutaneous coronary intervention with drug-eluting stent versus coronary
artery bypass grafting: A meta-analysis of patients with left main
coronary artery disease.
Source
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background: The relative efficacy and safety of percutaneous coronary
intervention (PCI) with drug-eluting stents (DES), in comparison to
coronary artery bypass grafting (CABG) for left main coronary artery
disease (LMCAD) remains controversial. Methods: We performed a
meta-analysis of randomised studies comparing patients with LMCAD treated
with PCI with DES versus those treated with CABG, with respect to clinical
outcomes at 1, 3 and 5. years. A secondary meta-analysis was performed
according to low (<. 32), or high (>=. 33) SYNTAX score. Results: Five
studies comprising 4595 patients were included. There was no significant
difference in all-cause death at all time points or when stratified with
respect to SYNTAX score. The need for repeat revascularization was
significantly higher with PCI at all time-points, and regardless of SYNTAX
score. There was significant association between need for repeat
revascularization with PCI and diabetics (p = 0.04). At 5. years,
non-fatal MI was higher with PCI owing to increased non-procedural events
(OR 3.00; CI 1.45-6.21; p = 0.003). CABG showed higher rate of stroke at
1. year (OR 0.21; CI 0.07-0.63; p = 0.005). There was no difference in
non-fatal MI or stroke at other time points, nor according to SYNTAX
score. Conclusions: PCI with DES or CABG are equivalent strategies for
LMCAD up to 5. years with respect to death, regardless of SYNTAX score.
PCI increases the rate of non-procedural MI at 5. years. CABG avoids the
need for repeat revascularization, especially in diabetics, but this
benefit is offset by higher rate of stroke in the first year of follow
up. Copyright © 2017.

<60>
Accession Number
618469265
Author
Omran A.M.
Institution
(Omran) National Heart Institute, Cairo, 11411, Egypt
Title
Role of intra-aortic morphine in post conditioning during valvular surgery
with low ejection fraction.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. (no
pagination), 2017. Date of Publication: 2017.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background: The application of cardioplegia does not completely eradicate
myocardial ischemia in cardiac/reperfusion injury due to cardiac arrest.
Post conditioning is novel strategy of attaining cardioprotection.
Pharmacological post conditioning using a drug as morphine administered
before reperfusion would protect the heart against ischemia-reperfusion
injury. We investigated whether intra-aortic morphine administration has a
post conditioning effect on patients with low ejection fraction (EF)
undergoing valve surgery. Methods: This prospective randomized controlled
trial in a single center involved one hundred patients scheduled for
elective valve surgery were divided into two groups: the Post conditioning
group and the Control group. The Post conditioning group (n = 50) received
a dose of morphine (0.1 mg/kg) diluted in 20 ml normal saline, injected
via a cardioplegia needle into the aortic root with warm hotshot before
aortic cross-clamp removal while the control group (n = 50) received the
same volume of saline without morphine. Both groups received antegrade
warm blood cardioplegia. To assess results EF, fractional shortening (FS),
troponin level, ABG, inotropes, postoperative ventilation time, and length
of ICU stay were assessed. Results: Postoperative EF and FS revealed a
statistically significant higher readings in the Post conditioning group.
A significant reduction in the troponin levels was recorded in the study
group than the control group. Duration of postoperative ventilation and
length of ICU stay were statistically lesser in the Post conditioning
group. Conclusions: Morphine administration immediately with warm hotshot
was related to improvement in the cardiopulmonary function, less inotropic
drug use, and higher left ventricular EF. Copyright © 2017 The
Egyptian Society of Cardio-thoracic Surgery.

<61>
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. Copyright © 2017 Pharmacotherapy
Publications, Inc.

<62>
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. Copyright ©
2017 The Author(s)

<63>
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. Copyright © 2017 Elsevier Inc.

<64>
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. Copyright © 2017 Bentham
Science Publishers.

<65>
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. Copyright © 2016, Springer Science+Business Media
New York.

<66>
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. Copyright © 2017 American
College of Physicians. All Rights Reserved.

<67>
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. Copyright © 2016 The American Laryngological, Rhinological
and Otological Society, Inc.

<68>
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. Copyright © 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.

<69>
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. Copyright © 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.

<70>
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. Copyright
© 2016, Springer-Verlag Berlin Heidelberg.

<71>
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. Copyright © 2017 The
Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

<72>
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. Copyright © 2016, The American College of
Clinical Pharmacology

<73>
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. Copyright © 2016, Saudi Arabian Armed Forces Hospital.
All rights reserved.

<74>
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. Copyright © 2016 Elsevier Ireland Ltd. All
rights reserved.

<75>
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. Copyright © 2016 Elsevier
Ireland Ltd. All rights reserved.

<76>
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. Copyright © 2016 Elsevier Inc.

<77>
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.

<78>
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.

<79>
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. Copyright © Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article) 2017. All rights reserved.

<80>
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. Copyright © 2017 The Society of Thoracic Surgeons.

<81>
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. Copyright © 2017
Elsevier Inc.

<82>
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. Copyright © 2017 The Society of Thoracic Surgeons.

<83>
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 Gy*M2), DAP per body weight,
and fluoroscopy time (min), and reported by age group as median,
75th and 95th%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. © 2017 Wiley Periodicals, Inc. Copyright © 2017
Wiley Periodicals, Inc.

<84>
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. © 2017 Wiley Periodicals,
Inc. Copyright © 2017 Wiley Periodicals, Inc.

<85>
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. Copyright © 2017 Nordic Association for the
Publication of BCPT (former Nordic Pharmacological Society)

<86>
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.

<87>
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.

<88>
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.

<89>
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).

<90>
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).

<91>
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).

<92>
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).

<93>
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).

<94>
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.

<95>
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.

<96>
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.

<97>
[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. Copyright © 2017 European Society of
Anaesthesiology. All rights reserved.

<98>
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) Copyright © 2016 American College of Cardiology
Foundation

<99>
Accession Number
617791007
Author
Yoon S.-H.; Whisenant B.K.; Bleiziffer S.; Delgado V.; Schofer N.;
Eschenbach L.; Fujita B.; Sharma R.; Ancona M.; Yzeiraj E.; Cannata S.;
Barker C.; Davies J.E.; Frangieh A.H.; Deuschl F.; Podlesnikar T.; Asami
M.; Dhoble A.; Chyou A.; Masson J.-B.; Wijeysundera H.C.; Blackman D.J.;
Rampat R.; Taramasso M.; Gutierrez-Ibanes E.; Chakravarty T.; Attizzani
G.F.; Kaneko T.; Wong S.C.; Sievert H.; Nietlispach F.; Hildick-Smith D.;
Nombela-Franco L.; Conradi L.; Hengstenberg C.; Reardon M.J.; Kasel A.M.;
Redwood S.; Colombo A.; Kar S.; Maisano F.; Windecker S.; Pilgrim T.;
Ensminger S.M.; Prendergast B.D.; Schofer J.; Schaefer U.; Bax J.J.; Latib
A.; Makkar R.R.
Institution
(Yoon, Sharma, Chakravarty, Kar, Makkar) Department of Interventional
Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, United
States
(Whisenant) Division of Cardiovascular Diseases, Intermountain Heart
Institute, Salt Lake City, Utah, United States
(Bleiziffer, Eschenbach) Clinic for Cardiovascular Surgery, German Heart
Center, Munich, Germany
(Delgado, Podlesnikar, Bax) Department of Cardiology, Leiden University
Medical Center, Leiden, Netherlands
(Schofer, Deuschl, Schaefer) Department of General and Interventional
Cardiology, University Heart Center, Hamburg, Germany
(Fujita, Ensminger) Department of Thoracic and Cardiovascular Surgery,
Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen,
Germany
(Ancona, Colombo, Latib) Interventional Cardiology Unit, EMO-GVM Centro
Cuore Columbus & San Raffaele Scientific Institute Milan, San Raffaele
Hospital, Milan, Italy
(Yzeiraj, Schofer) Hamburg University Cardiovascular Center, Hamburg,
Germany
(Cannata, Redwood, Prendergast) Department of Cardiology, St. Thomas'
Hospital, London, United Kingdom
(Barker, Reardon) Houston Methodist DeBakey Heart and Vascular Center,
Houston, Texas, United States
(Davies) Division of Cardiac and Thoracic Surgery, University of
Alabama-Birmingham, Birmingham, Alabama, United States
(Frangieh, Hengstenberg, Kasel) Deutsches Herzzentrum Munchen, Technische
Universitat Munchen, Munich, Germany
(Asami, Windecker, Pilgrim) Department of Cardiology, Bern University
Hospital, Bern, Switzerland
(Dhoble) Department of Cardiology, University of Texas Health Science
Center, Houston, Texas, United States
(Chyou, Wong) Greenberg Division of Cardiology, New York-Presbyterian
Hospital, Weil Cornell Medicine, New York, New York, United States
(Masson) Division of Cardiology, Centre Hospitalier de l'universite de
Montreal, Montreal, Quebec, Canada
(Wijeysundera) Division of Cardiology, Sunnybrook Health Science Centre,
Toronto, Ontario, Canada
(Blackman) Cardiology Department, Leeds Teaching Hospital, Leeds, United
Kingdom
(Rampat, Hildick-Smith) Sussex Cardiac Centre, Brighton and Sussex
University Hospitals NHS Trust, Brighton, United Kingdom
(Taramasso, Nietlispach, Maisano) University Heart Center, University
Hospital Zurich, Zurich, Switzerland
(Gutierrez-Ibanes) Department of Cardiology, Hospital General
Universitario Gregorio Maranon, Madrid, Spain
(Attizzani) The Valve and Structural Heart Interventional Center,
University Hospitals Case Medical Center, Cleveland, Ohio, United States
(Kaneko) Division of Cardiac Surgery, Brigham and Women's Hospital,
Boston, Massachusetts, United States
(Sievert) Department of Cardiology and Vascular Medicine, CardioVascular
Center, Frankfurt, Germany
(Nombela-Franco) Division of Cardiology, Hospital Clinicio San Carlos,
Madrid, Spain
(Conradi) Department of Cardiothoracic Surgery, University Heart Center
Hamburg, Hamburg, Germany
(Hengstenberg) German Center for Cardiovascular Research, Partner Site
Munich Heart Alliance, Munich, Germany
Title
Transcatheter Mitral Valve Replacement for Degenerated Bioprosthetic
Valves and Failed Annuloplasty Rings.
Source
Journal of the American College of Cardiology. 70 (9) (pp 1121-1131),
2017. Date of Publication: 29 August 2017.
Publisher
Elsevier USA
Abstract
Background Limited data exist regarding transcatheter mitral valve
replacement (TMVR) for patients with failed mitral valve replacement and
repair. Objectives This study sought to evaluate the outcomes of TMVR in
patients with failed mitral bioprosthetic valves (valve-in-valve [ViV])
and annuloplasty rings (valve-in-ring [ViR]). Methods From the TMVR
multicenter registry, procedural and clinical outcomes of mitral ViV and
ViR were compared according to Mitral Valve Academic Research Consortium
criteria. Results A total of 248 patients with mean Society of Thoracic
Surgeons score of 8.9 +/- 6.8% underwent TMVR. Transseptal access and the
balloon-expandable valve were used in 33.1% and 89.9%, respectively.
Compared with 176 patients undergoing ViV, 72 patients undergoing ViR had
lower left ventricular ejection fraction (45.6 +/- 17.4% vs. 55.3 +/-
11.1%; p < 0.001). Overall technical and device success rates were
acceptable, at 92.3% and 85.5%, respectively. However, compared with the
ViV group, the ViR group had lower technical success (83.3% vs. 96.0%; p =
0.001) due to more frequent second valve implantation (11.1% vs. 2.8%; p =
0.008), and lower device success (76.4% vs. 89.2%; p = 0.009) due to more
frequent reintervention (16.7% vs. 7.4%; p = 0.03). Mean mitral valve
gradients were similar between groups (6.4 +/- 2.3 mm Hg vs. 5.8 +/- 2.7
mm Hg; p = 0.17), whereas the ViR group had more frequent post-procedural
mitral regurgitation moderate or higher (19.4% vs. 6.8%; p = 0.003).
Furthermore, the ViR group had more frequent life-threatening bleeding
(8.3% vs. 2.3%; p = 0.03), acute kidney injury (11.1% vs. 4.0%; p = 0.03),
and subsequent lower procedural success (58.3% vs. 79.5%; p = 0.001). The
1-year all-cause mortality rate was significantly higher in the ViR group
compared with the ViV group (28.7% vs. 12.6%; log-rank test, p = 0.01). On
multivariable analysis, failed annuloplasty ring was independently
associated with all-cause mortality (hazard ratio: 2.70; 95% confidence
interval: 1.34 to 5.43; p = 0.005). Conclusions The TMVR procedure
provided acceptable outcomes in high-risk patients with degenerated
bioprostheses or failed annuloplasty rings, but mitral ViR was associated
with higher rates of procedural complications and mid-term mortality
compared with mitral ViV. Copyright © 2017 American College of
Cardiology Foundation

<100>
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. Copyright © 2017 The Association of
Anaesthetists of Great Britain and Ireland

<101>
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.

<102>
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.

<103>
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.

<104>
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?.

<105>
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.

<106>
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

<107>
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. Copyright © 2017 Elsevier
Inc.

<108>
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.). Copyright © 2016, American Society of Nuclear
Cardiology.

<109>
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

<110>
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. Copyright © 2017 Elsevier Inc.

<111>
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. Copyright © 2017

<112>
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. Copyright © 2017 Elsevier Inc.

<113>
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. Copyright © 2017
The Author.

<114>
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. Copyright © 2017 The Author.

<115>
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. Copyright © 2017, Medical
Association of Thailand. All rights reserved.

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