EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
614259143
Author
Howitt S.H.; Grant S.W.; Riding D.M.; Malagon I.; McCollum C.N.
Institution
(Howitt, Grant, Riding, McCollum) Academic Surgery Unit, Institute of
Cardiovascular Sciences, University of Manchester, University Hospital of
South Manchester, Manchester, United Kingdom
(Howitt, Malagon) Department of Cardiothoracic Anaesthesia and Critical
Care, University Hospital of South Manchester, Manchester, United Kingdom
(Grant) National Institute for Cardiovascular Outcomes Research,
University College London, Institute of Cardiovascular Science, London,
United Kingdom
Title
Risk Models That Use Postoperative Patient Monitoring Data to Predict
Outcomes in Adult Cardiac Surgery: A Systematic Review.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (5) (pp 1865-1877),
2017. Date of Publication: October 2017.
Publisher
W.B. Saunders

<2>
Accession Number
615402298
Author
Maddali M.M.; Arora N.R.; Chatterjee N.
Institution
(Maddali, Arora) Department of Cardiac Anesthesia, National Heart Center
Royal Hospital, Muscat, Oman
(Chatterjee) Department of Anesthesia, Khoula Hospital, Muscat, Oman
Title
Ultrasound Guided Out-of-Plane Versus In-Plane Transpectoral Left Axillary
Vein Cannulation.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (5) (pp 1707-1712),
2017. Date of Publication: October 2017.
Publisher
W.B. Saunders
Abstract
Objective The primary objective was to compare the frequency of
first-attempt successful axillary vein cannulation by the Seldinger
technique using out-of-plane ultrasound guidance versus in-plane imaging.
Between the two ultrasound imaging planes, this study also compared the
number of attempts that were necessary for the cannulation of the left
axillary vein along with the number of needle redirections that had to be
done for final cannulation of the vein. Incidence of complications and the
number of times the procedure was abandoned also were compared between the
two imaging planes. Design Prospective, randomized, interventional study.
Setting Tertiary care cardiac center. Participants Cardiac surgical
patients. Interventions Left axillary vein cannulation under ultrasound
guidance by Seldinger technique. Measurements and Main Results The left
axillary vein was accessed under ultrasound guidance in 86 consecutive
adult cardiac surgical patients. They were randomized to out-of-plane
(Group I, n = 43) and in-plane (Group II, n = 43) groups. In group I, the
number of first-attempt cannulations was very high (p < 0.01). The number
of attempts to access the vein was significantly lower in this group (p <
0.05). The duration for completion of the procedure was also less in group
I with out-of-plane ultrasound guidance (p < 0.01). The number of needle
redirections and the incidence of complications (arterial puncture,
pneumothorax hematoma formation) were similar between the groups. There
was no difference in the number of times the procedure was abandoned
between the two groups. With an assumption that the first 10 patients in
each group would suffice for overcoming the learning curve, the above
aspects were analyzed further in each group. The first-attempt cannulation
success continued to be significantly higher in the out-of-plane group.
Conclusions Out-of-plane ultrasound imaging during axillary vein
cannulation increased the chance of first-attempt successful cannulation.
Axillary vein cannulation under out-of-plane ultrasound imaging also
appeared to be quicker and was preferable in terms of the fewer number of
attempts that were necessary for a successful vein
cannulation.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<3>
Accession Number
618015127
Author
El Tahan M.R.; Pasin L.; Marczin N.; Landoni G.
Institution
(El Tahan) Anesthesiology Department, University of Dammam, Al Khubar,
Saudi Arabia
(El Tahan) Cardiothoracic Anaesthesia and Surgical Intensive Care,
Mansoura University, Mansoura City, Egypt
(Pasin) Department of Anesthesia and Intensive Care, Sant'Antonio
Hospital, Padova, Italy
(Marczin) The Royal Brompton and Harefield NHS Foundation Trust, London,
United Kingdom
(Marczin) Section of Anaesthesia, Pain Medicine, and Intensive Care,
Imperial College London, London, United Kingdom
(Marczin) Semmelweis University, Budapest, Hungary
(Landoni) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Landoni) Vita-Salute San Raffaele University, Milano, Italy
Title
Impact of Low Tidal Volumes During One-Lung Ventilation. A Meta-Analysis
of Randomized Controlled Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (5) (pp 1767-1773),
2017. Date of Publication: October 2017.
Publisher
W.B. Saunders
Abstract
Objectives The link between ventilation strategies and perioperative
outcomes remains one of the fundamental paradigms of thoracic anaesthesia.
During one-lung ventilation (OLV), one lung is excluded from gas exchange
and ventilation is directed at the dependent lung. The authors
hypothesised that the use of low tidal volumes (V<inf>T</inf>) during OLV
provides adequate gas exchange and improves postoperative outcome. Design
Meta-analysis of randomized clinical trials. Setting Thoracic surgery.
Participants Patients undergoing OLV. Interventions None. Measurements and
Main Results The authors performed a meta-analysis of all randomized
trials on low versus high V<inf>T</inf> during OLV in patients undergoing
thoracic surgery. Outcomes of the study were gas exchange and airway
pressures during and after OLV, postoperative pulmonary complications
(PPCs), and hospital stay (HLOS). Fourteen randomized trials were
selected, but only a few of them contained one outcome of interest. Low
V<inf>T</inf> was associated with lower arterial oxygen tension, lower
airway pressures, and higher arterial carbon dioxide tension at specific
time points during OLV. Low V<inf>T</inf> was associated with preserved
gas exchange after OLV, lower incidence of pulmonary infiltrations, and
acute respiratory distress syndrome. Incidences of PPCs and HLOS were
similar. Conclusions The use of low V<inf>T</inf> reduces airway pressure
but worsens gas exchange during OLV. Preservation of postoperative
oxygenation and reduction in infiltrates suggest a lung-protective
modality with no demonstrable impact on PPCs and HLOS.<br/>Copyright
&#xa9; 2017 Elsevier Inc.

<4>
Accession Number
617216444
Author
Kang S.H.; Lee C.W.; Lee J.-B.; Lee P.H.; Ahn J.-M.; Park D.-W.; Kang
S.-J.; Lee S.-W.; Kim Y.-H.; Park S.-W.; Park S.-J.
Institution
(Kang) Department of Cardiology, CHA Bundang Medical Center, CHA
University, Seongnam, South Korea
(Lee, Lee, Ahn, Park, Kang, Lee, Kim, Park, Park) Division of Cardiology,
Heart Institute, Asan Medical Center, University of Ulsan, 88, Olympic-ro
43-gil, Songpa-gu, Seoul 138-736, South Korea
(Lee) Department of Clinical Epidemiology and Biostatistics, Asan Medical
Center, University of Ulsan College of Medicine, Seoul, South Korea
Title
Mortality of patients with previous stroke undergoing drug-eluting stent
implantation.
Source
Coronary Artery Disease. 28 (7) (pp 543-549), 2017. Date of Publication:
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective Patients with previous stroke are increasing among patients
receiving percutaneous coronary intervention (PCI) with drug-eluting
stents (DES); however, data about the influence of previous stroke on
patient outcomes are limited. We evaluated whether previous stroke is
associated with increased risk for mortality in coronary artery disease.
Patients and methods A total of 18 650 patients with coronary artery
disease undergoing PCI with DES were enrolled. Databases from three
real-world PCI registries were merged for a patient-level meta-analysis.
The primary outcome was death from any cause. The secondary outcomes were
death from a cardiac cause, myocardial infarction, stent thrombosis,
stroke, or repeat revascularization. Results Patients with previous stroke
(n=1361), compared with those without previous stroke (n=17 289), were
older and had a higher prevalence of risk factors or comorbidities. At a
median follow-up of 47.0 months, patients with previous stroke had a
higher risk for death from any cause [adjusted hazard ratio (HR)=1.623;
95% confidence interval (CI): 1.342-1.962; P<0.001], death from a cardiac
cause (adjusted HR=1.686; 95% CI: 1.339-2.124; P<0.001), and stroke
(adjusted HR=2.456; 95% CI: 1.853-3.255; P<0.001). There were no
significant differences in the risks for myocardial infarction, stent
thrombosis, or repeat revascularization. Conclusion Patients with previous
stroke showed higher risks for all-cause death and stroke after PCI with
DES than those without stroke. Previous stroke should be considered a risk
factor for all-cause death and stroke in this patient
population.<br/>Copyright &#xa9; 2017 Wolters Kluwer Health, Inc. All
rights reserved.

<5>
Accession Number
617070931
Author
Mahmoud K.; Ammar A.; Kasemy Z.
Institution
(Mahmoud, Ammar, Kasemy) Minoufiya Faculty of Medicine, Minoufiya
University, Shebin Elkoam, Egypt
Title
Comparison Between Pressure-Regulated Volume-Controlled and
Volume-Controlled Ventilation on Oxygenation Parameters, Airway Pressures,
and Immune Modulation During Thoracic Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (5) (pp 1760-1766),
2017. Date of Publication: October 2017.
Publisher
W.B. Saunders
Abstract
Objectives To compare 2 different ventilatory strategies:
pressure-regulated volume-controlled (PRVC) versus volume-controlled
ventilation during thoracotomy. Design Prospective randomized study.
Setting University hospital. Participants The study comprised 70 adult
patients undergoing thoracic surgery. Interventions Evaluation of
oxygenation parameters, airway pressures, and immune modulation.
Measurements and Main Results The primary outcome was arterial oxygen
tension/fraction of inspired oxygen
(PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf>) ratio, whereas secondary
outcomes included arterial and central venous blood gases, deadspace
volume/tidal volume ratio, peak inspiratory pressure, mean inspiratory
pressure, and plateau inspiratory pressure obtained at the following 4
time points: 20 minutes after total lung ventilation (T<inf>0</inf>), 20
minutes after 1-lung ventilation (T<inf>1</inf>), 20 minutes after return
to total lung ventilation (T<inf>2</inf>), and at the end of surgery
(T<inf>3</inf>). Furthermore, alveolar and plasma levels of interleukin-8
and tumor necrosis factor-alpha and changes in alveolar albumin levels and
cell numbers were measured at the same time points. Oxygenation parameters
(PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> and PaO<inf>2</inf>) were
significantly better in the PRVC group
(PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> ratio at T<inf>1</inf> was 176
v 146 in the PRVC and volume-controlled groups, respectively, with a p
value of 0.004). Deadspace volume/tidal volume ratio and inspiratory
airway pressures were significantly lower in the PRVC group. Furthermore,
all inflammatory parameters (alveolar and plasma interleukins, alveolar
albumin levels, and cell numbers) were significantly lower in the PRVC
group. Conclusions The PRVC mode during 1-lung ventilation in thoracic
surgery caused a favorable effect on oxygenation parameters, respiratory
mechanics, and immune modulation during thoracic surgery.<br/>Copyright
&#xa9; 2017 Elsevier Inc.

<6>
Accession Number
615119276
Author
Ryhammer P.K.; Tang M.; Hoffmann-Petersen J.; Leonaviciute D.; Greisen J.;
Storebjerg Gissel M.; Jakobsen C.-J.
Institution
(Ryhammer, Greisen, Storebjerg Gissel, Jakobsen) Department of
Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus,
Denmark, United Kingdom
(Tang) Department of Cardiothoracic Surgery, Aarhus University Hospital,
Aarhus, Denmark, United Kingdom
(Hoffmann-Petersen) Department of Anaesthesiology and Intensive Care,
Odense University Hospital, Odense, Denmark, United Kingdom
(Leonaviciute) Department of Thoracic Anaesthesiology and Intensive Care,
Aalborg University Hospital, Aalborg, Denmark, United Kingdom
Title
Colloids in Cardiac Surgery-Friend or Foe?.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (5) (pp 1639-1648),
2017. Date of Publication: October 2017.
Publisher
W.B. Saunders
Abstract
Objective The right choice of fluid replacement still is a matter of
debate. Recently, two large-scale studies on the use of hydroxyethyl
starches (HES) in the intensive care setting have been published, which
have caused a huge shift in the daily practice of volume therapy. These
results have been applied to patients outside intensive care. The aim of
this study was to evaluate the impact this change has had on the outcomes
in a large population of cardiac surgery patients, with a focus on the
type of colloid infusion. Design A prospective, registered, observational
study, using propensity score matching. Setting Cohort study from 3
university hospitals using a common registry. Participants The study
comprised 17,742 patients who were referred for cardiac surgery from 2007
to 2014. Interventions Patients were divided in groups according to
perioperative fluid replacement with either crystalloids or colloids. The
colloid group was further divided into HES or human albumin (HA). Analyses
were based on the following 3 subsections: HES versus crystalloids, HA
versus crystalloids, and HES versus HA, with use of propensity score
matching or direct matching of cases. Primary outcome parameters were
30-day and 6-month mortality, new postoperative renal replacement therapy,
and new cardiac ischemic events. Measurements and Main Results The groups
were fully comparable in individual analyses. The use of HES had no impact
on new dialysis and 30-day mortality. A Cox proportional regression
analysis showed that HES had no impact on 6-month mortality and new
postoperative ischemic events. When comparing HA with crystalloid use, a
significantly increased risk in crude analysis was demonstrated on all
outcome parameters; and when comparing HA with HES, a significantly higher
risk was observed in HA patients in mortality parameters and new
postoperative, but after adjustment, only the risk of new postoperative
dialysis persisted. Conclusion This study underlined the difficulties in
establishing hardcore outcome data, even in large cohort studies. The
findings seemed to diminish the magnitude of risk when using HES in
cardiac surgery patients and seriously questioned the choice of HA when a
plasma expander is needed.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<7>
Accession Number
612920673
Author
Wang P.-L.; Zhang L.; Wang S.-L.; Yang Q.-N.; Gao Z.-Y.; Du J.-P.; Zhang
D.-W.; Fu C.-G.; Gu F.; Xu H.; Li L.-Z.; Wang C.-L.; Shi D.-Z.
Institution
(Wang, Zhang, Yang, Gao, Du, Zhang, Fu, Gu, Xu, Li, Wang, Shi) Institute
of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese
Medical Sciences, Beijing 100091, China
(Wang) Department of Gastroenterology, Guang'anmen Hospital, China Academy
of Chinese Medical Sciences, Beijing 100053, China
Title
Long-term follow-up of Chinese herbal medicines combined with conventional
treatment in patients with acute coronary syndrome after percutaneous
coronary intervention: A multicenter randomized controlled trial.
Source
Chinese Journal of Integrative Medicine. 23 (10) (pp 740-746), 2017. Date
of Publication: 01 Oct 2017.
Publisher
Chinese Journal of Integrated Traditional and Western Medicine Press
(E-mail: cjim@jia.net)
Abstract
Objective: To evaluate the prognosis effect of Chinese herbal medicines
(CHMs) for benefiting qi and activating blood circulation adjunctive to
conventional treatment in patients with acute coronary syndrome (ACS)
after percutaneous coronary intervention (PCI). Methods: A total of 702
patients with ACS who underwent PCI were enrolled and randomly assigned to
receive conventional treatment plus CHMs for benefiting qi and activating
blood circulation (treatment group, 351 cases) or conventional treatment
alone (control group, 351 cases) for 6 months. Six months later, all
patients received conventional treatment alone. Follow-ups were scheduled
at 6th, 12th, 18th, 24th month after enrollment in April 2008, and the
final follow-up visit was during September 2011 and November 2011. The
primary endpoint was the composite of cardiac death, nonfatal myocardial
infarction or revascularization (PCI or coronary artery bypass grafting);
and the secondary endpoint was the composite of re-admission for ACS,
congestive heart failure, nonfatal stroke or other thrombus events.
Results: A total of 621 (88.59%) patients completed 35.4+/-3.8 months
follow-up, while 80 (11.41%) patients withdrew from the trial (41 in the
treatment group and 39 in the control group). The incidence of primary
endpoint was 5.7% (20 patients) in the treatment group versus 10.86% (38
patients) in the control group [relative risk (RR): 0.53; 95% confidence
interval (CI): 0.30, 0.88; P=0.013; absolute risk reduction (ARR):-0.052,
95% CI: -0.06, 0.01]. The incidence of secondary endpoint was 5.98% (21
patients) in the treatment group versus 10.28% (36 patients) in control
group (RR: 0.58, 95% CI: 0.33, 0.97, P=0.037; ARR: -0.043, 95% CI: 0.06,
0.01). Most of the primary and secondary endpoints were occurred in 18
months (84.50% in the treatment group versus 78.10% in the control group).
Conclusion: CHMs for benefiting qi and activating blood circulation
adjunctive to conventional treatment improved clinical outcomes for
patients with ACS after PCI in long-term follow-up.<br/>Copyright &#xa9;
2015, Chinese Association of the Integration of Traditional and Western
Medicine and Springer-Verlag Berlin Heidelberg.

<8>
Accession Number
617972770
Author
Fabbro M.; Winkler A.M.; Levy J.H.
Institution
(Fabbro) Miller School of Medicine, University of Miami, Miami, FL, United
States
(Winkler) Instrumentation Laboratory, Bedford, MA, United States
(Levy) Duke University Hospital, Duke University, Durham, NC, United
States
Title
Technology: Is There Sufficient Evidence to Change Practice in
Point-of-Care Management of Coagulopathy?.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (5) (pp 1849-1856),
2017. Date of Publication: October 2017.
Publisher
W.B. Saunders
Abstract
Currently, hemostasis is one of the most widely researched topics in
perioperative medicine. As investigators learn more about the complexity
of coagulation, developing tests with the ability to rapidly monitor
coagulation and guide targeted therapy is the key to optimizing hemostasis
management. There is mounting evidence that algorithmic transfusion using
point-of-care (POC) testing can reduce red cell and platelet transfusions
and major bleeding after cardiac surgery. Integrating these tests during
cardiac surgery and trauma management is especially important because
these groups use the most blood products within a health system and the
risks of transfusion are well documented. Currently, numerous POC tests
are available for evaluating hemostasis. The purpose of this review is to
provide a comprehensive evaluation of the current evidence surrounding the
most common POC testing devices in practice for managing
coagulation.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<9>
Accession Number
616204732
Author
Sanfilippo F.; Johnson C.; Bellavia D.; Morsolini M.; Romano G.;
Santonocito C.; Centineo L.; Pastore F.; Pilato M.; Arcadipane A.
Institution
(Sanfilippo, Santonocito, Centineo, Pastore, Arcadipane) Department of
Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i
Trapianti e Terapie ad alta specializzazione), Palermo, Italy
(Johnson) Department of Anesthesiology, University of Pittsburgh Medical
Center, Pittsburgh, PA, United States
(Bellavia, Romano) Cardiology Unit, Department for the Treatment and Study
of Cardiothoracic Diseases and Cardiothoracic Transplantation,
IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta
Specializzazione), Palermo, Italy
(Morsolini, Pilato) Cardiac Surgery and Heart Transplantation Unit,
Department for the Treatment and Study of Cardiothoracic Diseases and
Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i
Trapianti e Terapie ad alta Specializzazione), Palermo, Italy
Title
Mitral Regurgitation Grading in the Operating Room: A Systematic Review
and Meta-analysis Comparing Preoperative and Intraoperative Assessments
During Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (5) (pp 1681-1691),
2017. Date of Publication: October 2017.
Publisher
W.B. Saunders
Abstract
Objective To assess differences in mitral regurgitation (MR) grade between
the preoperative and the intraoperative evaluations. Design Systematic
review and meta-analysis of 6 observational studies found from MEDLINE and
EMBASE. Setting Cardiac surgery. Participants One hundred thirty-seven
patients. Intervention Comparison between the preoperative MR assessment
and the intraoperative evaluation conducted under general anesthesia (GA),
with or without "hemodynamic matching" (HM) (artificial increase of
afterload). Measurements and Main Results The primary outcome was the
difference between the preoperative and intraoperative MR grade under
"GA-only" or "after-HM." Secondary analyses addressed differences
according to effective regurgitant orifice area (EROA), regurgitant volume
(RVol), color-jet area, and vena contracta width. Risk of MR
underestimation was found under "GA-only" (SMD: 0.55; 95% confidence
interval [CI], 0.31-0.79, p < 0.00001), but not "after-HM" (SMD: -0.16;
95% CI, -0.46 to 0.13, p = 0.27). Under "GA-only", EROA had a trend toward
underestimation (p = 0.07), RVol was reliable (p = 0.17), while reliance
on color-jet area and vena contracta width incur risk of underestimation
(both p = 0.003). After HM, EROA accurately reflected preoperative MR (p =
0.68) while RVol had a trend toward overestimation (p = 0.05). The overall
reported incidence of misdiagnoses was slightly more common under
"GA-only" (mean 48%, 39% underestimation, 9% overestimation; range:
32%-57%) than "after-HM" (mean 41%, 12% underestimation, 29%
overestimation; range: 33%-50%). Only the minority of misdiagnoses were
clinically relevant: underestimation was around 10% (both approaches), but
18% had clinically significant overestimation "after-HM" as compared with
3% under GA-only. Conclusions Intraoperative assessment under "GA-only"
significantly underestimated MR. A more accurate intraoperative evaluation
can be obtained with afterload manipulation, although HM strategy carries
high risk of clinically significant overestimation.<br/>Copyright &#xa9;
2017 Elsevier Inc.

<10>
Accession Number
617848745
Author
Narendra Kumar K.; Singh N.G.; P.S. N.; Patil T.A.; Manjunath N.
Institution
(Narendra Kumar, Singh, P.S., Manjunath) Department of Cardiac
Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and
Research, Jayanagar, Bangalore, India
(Patil) Department of Cardiac Anaesthesiology, Fortis Hospital, Bangalore,
India
Title
Transesophageal Echocardiographic Assessment of Pulmonary
Artery-to-Ascending Aorta Ratio for the Detection of Pulmonary
Hypertension in Cardiac Surgical Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (5) (pp 1702-1706),
2017. Date of Publication: October 2017.
Publisher
W.B. Saunders
Abstract
Objective The objective of the study was to investigate if the main
pulmonary artery (mPA)-to-ascending aorta (AscAo), (mPA:AscAo) ratio could
serve as a screening tool in identifying pulmonary artery hypertension
(PAH). Design A prospective observational study. Setting Tertiary care
center, university hospital. Participants Fifty-four adult patients
undergoing off-pump coronary artery bypass grafting surgery (OPCAB).
Interventions mPA and AscAo transverse diameters were measured by
transesophageal echocardiography (TEE) and the mean pulmonary arterial
pressures (mPAP) were recorded simultaneously using a pulmonary artery
catheter. Measurements and Main Results mPA:AscAo ratio demonstrated
significant linear correlation with mPAP measured by pulmonary artery
catheterization (ie, r = 0.61, confidence interval [CI] = 0.5352-0.6736, p
< 0.0001). Receiver operating characteristic curves were performed to
evaluate sensitivity and specificity of mPA:AscAo ratio >=1 for diagnosing
PAH (mPAP >=25 mmHg). Area under the curve for mPA:AscAo ratio was 0.91
(95% CI, 0.869-0.936, p < 0.0001), with a sensitivity of 84.27%,
specificity of 83.92%, positive-predictive value of 87.6% and
negative-predictive value of 81.1% for a mPAP >=25 mmHg. Conclusions The
ratio of mPA:AscAo is a simple, reliable, and reproducible method that can
be obtained through TEE, which guides the clinician to screen patients
with PAH.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<11>
Accession Number
617592053
Author
Reddy S.K.; Bailey M.J.; Beasley R.W.; Bellomo R.; Mackle D.M.; Psirides
A.J.; Young P.J.
Institution
(Reddy, Beasley, Mackle, Young) Medical Research Institute of New Zealand,
Wellington, New Zealand
(Bailey, Bellomo) Australian and New Zealand Intensive Care Research
Centre, Monash University, Melbourne, VIC, Australia
(Bellomo) Intensive Care Unit, Austin Hospital, Melbourne, VIC, Australia
(Psirides, Young) Intensive Care Unit, Wellington Regional Hospital,
Wellington, New Zealand
Title
Effect of 0.9% Saline or Plasma-Lyte 148 as Crystalloid Fluid Therapy in
the Intensive Care Unit on Blood Product Use and Postoperative Bleeding
After Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (5) (pp 1630-1638),
2017. Date of Publication: October 2017.
Publisher
W.B. Saunders
Abstract
Objective To evaluate the effect of Plasma-Lyte 148 (PL-148) compared with
0.9% saline (saline) on blood product use and postoperative bleeding in
patients admitted to the intensive care unit (ICU) following cardiac
surgery. Design A post hoc subgroup analysis conducted within a
multicenter, double-blind, cluster-randomized, double-crossover study
(study 1) and a prospective, single-center nested-cohort study (study 2).
Setting Tertiary-care hospitals. Participants Adults admitted to the ICU
after cardiac surgery requiring crystalloid fluid therapy as part of the
0.9% saline vs. PL-148 for ICU fluid therapy (SPLIT) trial. Interventions
Blinded saline or PL-148 for 4 alternating 7-week blocks. Measurements and
Main Results 954 patients were included in study 1; 475 patients received
PL-148, and 479 received saline. 128 of 475 patients (26.9%) in the PL-148
group received blood or a blood product compared with 94 of 479 patients
(19.6%) in the saline group (OR [95% confidence interval], 1.51
[1.11-2.05]; p = 0.008). In study 2, 131 patients were allocated to PL-148
and 120 patients were allocated to saline. There were no differences
between groups in chest drain output from the time of arrival in the ICU
until 12 hours postoperatively (geometric mean, 566 mL for the PL-148
group v 547 mL in the saline group; p = 0.60). Conclusions The findings
did not support the hypothesis that using PL-148 for fluid therapy in ICU
following cardiac surgery reduces transfusion requirements compared to
saline. The significantly increased proportion of patients receiving blood
or blood product with allocation to PL-148 compared to saline was
unexpected and requires verification through further
research.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<12>
Accession Number
617594862
Author
Cavalca V.; Rocca B.; Veglia F.; Petrucci G.; Porro B.; Myasoedova V.; De
Cristofaro R.; Turnu L.; Bonomi A.; Songia P.; Cavallotti L.; Zanobini M.;
Camera M.; Alamanni F.; Parolari A.; Patrono C.; Tremoli E.
Institution
(Cavalca, Veglia, Porro, Myasoedova, Turnu, Bonomi, Songia, Cavallotti,
Zanobini, Camera, Alamanni, Tremoli) Monzino Cardiology Center, IRCCS,
Milan, Italy
(Cavalca, Turnu, Songia, Camera, Alamanni) University of Milan, Milan,
Italy
(Rocca, Petrucci, Patrono) Department of Pharmacology, Catholic
University, Rome, Italy
(De Cristofaro) Department of Hematology, Catholic University, Rome, Italy
(Parolari) Policlinico San Donato Hospital, IRCCS, San Donato Milanese,
Italy
Title
On-pump Cardiac Surgery Enhances Platelet Renewal and Impairs Aspirin
Pharmacodynamics: Effects of Improved Dosing Regimens.
Source
Clinical Pharmacology and Therapeutics. 102 (5) (pp 849-858), 2017. Date
of Publication: November 2017.
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
On-pump cardiac surgery may trigger inflammation and accelerate platelet
cyclooxygenase-1 renewal, thereby modifying low-dose aspirin
pharmacodynamics. Thirty-seven patients on standard aspirin 100 mg
once-daily were studied before surgery and randomized within 36 hours
postsurgery to 100 mg once-daily, 100 mg twice-daily, or 200 mg once-daily
for 90 days. On day 7 postsurgery, immature and mature platelets, platelet
mass, thrombopoietin, glycocalicin, leukocytes, C-reactive protein, and
interleukin-6 significantly increased. Interleukin-6 significantly
correlated with immature platelets. At day 7, patients randomized to 100
mg once-daily showed a significant increase in serum thromboxane
(TX)B<inf>2</inf> within the 24-hour dosing interval and urinary
TXA<inf>2</inf> metabolite (TXM) excretion. Aspirin 100 mg twice-daily
lowered serum TXB<inf>2</inf> and prevented postsurgery TXM increase (P <
0.01), without affecting prostacyclin metabolite excretion. After cardiac
surgery, shortening the dosing interval, but not doubling the once-daily
dose, rescues the impaired antiplatelet effect of low-dose aspirin and
prevents platelet activation associated with acute inflammation and
enhanced platelet turnover.<br/>Copyright &#xa9; 2017 American Society for
Clinical Pharmacology and Therapeutics

<13>
Accession Number
618265750
Author
Simon G.I.; Craswell A.; Thom O.; Fung Y.L.
Institution
(Simon, Fung) School of Health and Sports Sciences, University of the
Sunshine Coast, Sunshine Coast, QLD, Australia
(Craswell) School of Nursing, Midwifery, and Paramedicine, University of
the Sunshine Coast, Sunshine Coast, QLD, Australia
(Thom) Department of Emergency Medicine, Sunshine Coast Hospital and
Health Service, Sunshine Coast, QLD, Australia
Title
Outcomes of restrictive versus liberal transfusion strategies in older
adults from nine randomised controlled trials: a systematic review and
meta-analysis.
Source
The Lancet Haematology. 4 (10) (pp e465-e474), 2017. Date of Publication:
October 2017.
Publisher
Elsevier Ltd
Abstract
Background Guidelines for patient blood management recommend restrictive
transfusion practice for most adult patients. These guidelines are
supported by evidence from randomised controlled trials (RCTs); however,
one of the patient groups not explicitly examined in these studies is the
geriatric population. We examined RCTs relevant to transfusion outcomes in
older patients. Our aim was to determine whether special guidelines are
warranted for geriatric patients, recognising the different
pathophysiological characteristics of this group. Methods For this
systematic review and meta-analysis, we searched PubMed, Scopus, and the
Cochrane Library databases from their inception to May 5, 2017, for
evidence relating to transfusion outcomes in adults aged 65 years and
older. This criterion was widened to include RCTs where a substantial
proportion of the study population was older than 65 years. We also
included study populations of all clinical settings, and did not limit the
search by date, language, or study type. For articles not in English, only
available translations of the abstracts were reviewed. Studies were
excluded if they did not specify age. Observational studies and duplicate
patient and outcome data from studies that generated multiple publications
were also excluded. We screened bibliographies of retrieved articles for
additional publications. We analysed data extracted from published RCTs
comparing restrictive and liberal transfusion strategies in older adults.
We generated fixed effects risk ratios (RR) for pooled study data using
the Mantel-Haenszel method. Primary outcomes were 30-day and 90-day
mortality events for patients enrolled in restrictive and liberal
transfusion study groups. We included intention-to-treat outcome data in
the meta-analysis when available, otherwise we used per-protocol outcome
data. Findings 686 articles were identified by the search, and a further
37 by the snowball approach. Of these articles, 13 eligible papers
described findings from nine RCTs (five trials investigating orthopaedic
surgery, three cardiac surgery, and one oncology surgery; including 5780
patients). The risk of 30-day mortality was higher in older patients who
followed a restrictive transfusion strategy than in those who followed a
liberal transfusion strategy (risk ratio [RR] 1.36, 95% CI 1.05-1.74;
p=0.017). The risk of 90-day mortality was also higher in those who
followed a restrictive transfusion strategy than in those who followed a
liberal transfusion strategy (RR 1.45, 95% CI 1.05-1.98; p=0.022).
Interpretation Liberal transfusion strategies might produce better
outcomes in geriatric patients than restrictive transfusion strategies.
This outcome contradicts current restrictive transfusion approaches.
Population ageing will challenge resources globally, and this finding has
implications for blood supply and demand, and optimal care of older
adults. Further research is needed to formulate evidence-based transfusion
practice across clinical specialties specific to the geriatric population,
and to examine resource effects. Funding Australia's National Blood
Authority.<br/>Copyright &#xa9; 2017 Elsevier Ltd

<14>
Accession Number
617254818
Author
Filardo G.; Pollock B.D.; da Graca B.; Phan T.K.; Sass D.M.; Ailawadi G.;
Thourani V.; Damiano R.
Institution
(Filardo, Pollock, da Graca, Phan, Sass) Office of the Chief Quality
Officer, Baylor Scott & White Health, Dallas, Tex, United States
(Filardo) The Heart Hospital Baylor Plano, Plano, Tex, United States
(Ailawadi) Division of Thoracic and Cardiovascular Surgery, University of
Virginia, Charlottesville, Va, United States
(Thourani) Division of Cardiothoracic surgery, Emory University, Atlanta,
Ga, United States
(Damiano) Department of Cardiac Surgery, Washington University School of
Medicine and Barnes-Jewish Hospital, St Louis, Mo, United States
Title
Underestimation of the incidence of new-onset post-coronary artery bypass
grafting atrial fibrillation and its impact on 30-day mortality.
Source
Journal of Thoracic and Cardiovascular Surgery. 154 (4) (pp 1260-1266),
2017. Date of Publication: October 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective Inconsistent definitions of atrial fibrillation after coronary
artery bypass grafting have caused uncertainty about its incidence and
risk. We examined the extent to which limiting the definition to
post-coronary artery bypass grafting atrial fibrillation events requiring
treatment underestimates its incidence and impact on 30-day mortality.
Methods We assessed in-hospital atrial fibrillation and 30-day mortality
in 9268 consecutive patients without preoperative atrial fibrillation who
underwent isolated coronary artery bypass grafting at 5 US hospitals
(2004-2010). Patients who experienced 1 or more episode of post-coronary
artery bypass grafting atrial fibrillation detected via continuous
in-hospital electrocardiogram/telemetry monitoring were divided into those
for whom Society of Thoracic Surgeons data (applying the definition
"atrial fibrillation/flutter requiring treatment") also indicated atrial
fibrillation versus those for whom it did not. Risk-adjusted 30-day
mortality was compared between these 2 groups and with patients without
post-coronary artery bypass grafting atrial fibrillation. Results
Risk-adjusted incidence of post-coronary artery bypass grafting atrial
fibrillation incidence was 33.4% (27.0% recorded in Society of Thoracic
Surgeons data, 6.4% missed). Patients with post-coronary artery bypass
grafting atrial fibrillation missed by Society of Thoracic Surgeons data
had a significantly greater risk of 30-day mortality (odds ratio, 2.08,
95% confidence interval, 1.17-3.69) than those captured. By applying the
significant underestimation of post-coronary artery bypass grafting atrial
fibrillation incidence we observed (odds ratio [Society of Thoracic
Surgeons vs missed], 0.78; 95% confidence interval, 0.72-0.83) to the
approximately 150,000 patients undergoing isolated coronary artery bypass
grafting in the United States each year estimates this increased risk of
mortality is carried by 9600 patients (95% confidence interval, 9420-9780)
annually. Conclusions Defining post-coronary artery bypass grafting atrial
fibrillation as episodes requiring treatment significantly underestimates
incidence and misses patients at a significantly increased risk for
mortality. Further research is needed to determine whether this increased
risk carries over into long-term outcomes and whether it is mediated by
differences in treatment and management.<br/>Copyright &#xa9; 2017 The
American Association for Thoracic Surgery

<15>
Accession Number
618770546
Author
Karadeniz M.S.; Ciftci H.S.; Tefik T.; Erdem S.; Nane I.; Turkmen A.; Oguz
F.; Tugrul K.M.
Institution
(Karadeniz, Ciftci, Tefik, Erdem, Nane, Turkmen, Oguz, Tugrul) Istanbul
Medical Faculty, Istanbul University, Turkey
Title
Effects of different volatile anaesthetics on CXCL9 and CXCL10 in kidney
transplant surgeries.
Source
Transplant International. Conference: 18th Congress of the European
Society for Organ Transplantation. Spain. 30 (Supplement 2) (pp 529),
2017. Date of Publication: September 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Kidney transplant is the gold standard in terminal kidney
failure. Ischemia reperfusion damage is known to be affected by various
factors in the perioperative period. Ischemic hypoxic damage increases
local inflammation, which induces the secretion of proinflammatory
cytokines from proximal tubules. Chemokines (CXCL9, CXCL10) are small
proinflammatory mediators that have a significant role in leucocyte
migration into the graft. Decreasing the inflammation, the protective
effects of sevofluorane in ischemia reperfusion damage has been shown in
heart surgeries. In our study, we aimed to compare the effects of
sevofluorane and desfluorane on chemokines in transplant patients.
Methods/Materials: Seventy patients who underwent kidney transplant were
included in the study. The patients were randomized into two groups.
Anesthesia maintenance was provided using desfluorane in group D, and
sevofluorane in group S, following the induction of similar anethesia for
all patients. Demographic and immunologic data were recorded. CXCL9 and
CXCL10 levels were studied using ELISA taken from serum and urine samples
in the preoperative period, and postoperative day 1, 7, and month 1. serum
creatinine was recorded simultaneously and eGFR were calculated. Results:
No significant difference was detected between the groups regarding the
demographic data, preoperative and postoperative immunologic tests, and
immunosuppressive treatments (p > 0.05). Urine and serum CXCL 9 and CXCL
10 levels in the preoperative period, on day 1, 7, and month 1 were
similar between the groups (p > 0.05) No significant difference was
detected regarding kidney functions and rejection risk in the preoperative
period, day 1, 7, and month 1 (p > 0.05). Conclusion: In our study, we
found that two different inhalation agents desfluorane and sevofluorane
had similar effects on serum and urine chemokine levels in the early
postoperative period in kidney transplant patients.

<16>
Accession Number
618769225
Author
Masetti M.; Bellettini M.; Gaudenzi A.; Sabatino M.; Grigioni F.; Potena
L.
Institution
(Masetti, Bellettini, Gaudenzi, Sabatino, Grigioni, Potena) Bologna
University Hospital, Italy
Title
Does everolimus impact long term clinical events in heart
transplantation?.
Source
Transplant International. Conference: 18th Congress of the European
Society for Organ Transplantation. Spain. 30 (Supplement 2) (pp 226),
2017. Date of Publication: September 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Introduction: Prospective randomized trials (RTs) compare everolimus (EVE)
and mycophenolate (MMF) in de novo heart transplantation (HT); however,
long term data on clinical endpoints are lacking. Methods/Materials: We
reviewed 5 years post-transplant follow-up of all patients (pts) who had
been enrolled in RTs about EVE de novo in our Center. We analyzed
occurrence of fatal and non fatal major cardiovascular events (MACE),
all-cause mortality, cancers, and renal function. Given the frequent
cross-over during the follow-up, we performed both an intention-to-treat
(ITT) and an on-treatment (OT) analysis, defined post-hoc as the drug
taken for most of the time. Results: 93 pts (80% males, 53 +/- 11 years,
HT 2005-14, glomerular filtration rate (GFR) 70 +/- 32 ml/min) were
enrolled: 57 randomized to EVE, 36 to MMF, without statistically
significant differences at baseline. 32 (34%) pts had at least one cross
over, 11 (12%) for clinical reasons (cancers, renal failure, rejection),
21 (23%) for intolerance. Tolerability was lower in EVE arm (p = 0.03),
mostly due to pericardial effusions, but comparable to MMF after 3 months
from HT (p = 0.53). ITT analysis showed no differences on any study
endpoint between MMF and EVE (all p > 0.5). Among 19 fatal and non fatal
MACE, 5 occurred during EVE treatment. OT analysis showed in EVE group a
significantly lower incidence of fatal and non fatal MACE (7.6 +/- 4.2%
vs. 33.3 +/- 7.1%, p < 0.01) at 5 years, whereas mortality (9.6 +/- 4.5%
vs. 10.5 +/- 4.4%), cancer incidence and change in renal function were
similar (all p > 0.5). Conclusion: This is a post-hoc analysis of pts
randomized in trials with different endpoints. We found suggestive
evidence of potential benefits of EVE in reducing long-term MACE, without
affecting survival. These data are only hypothesis generating, but they
suggest a delayed introduction of EVE to favor tolerability, aiming to
take better advantage of its possible benefits.

<17>
Accession Number
618769033
Author
Ezzahouri I.; Sarmiento E.A.; Montanchez J.; Calahorra L.; Garcia S.;
Sousa-Casasnovas I.; Rodriguez-Ferrero M.L.; Valerio M.; Salcedo M.;
Navarro J.; Fernandez-Cruz E.; Carbone J.
Institution
(Ezzahouri, Sarmiento, Montanchez, Calahorra, Garcia, Sousa-Casasnovas,
Rodriguez-Ferrero, Valerio, Salcedo, Navarro, Fernandez-Cruz, Carbone)
Hospital General Universitario Gregorio Maranon, Madrid, Spain
Title
Intravenous immunoglobulin therapy increases serum anti clostridium
difficile toxin specific antibodies in heart transplant patients.
Source
Transplant International. Conference: 18th Congress of the European
Society for Organ Transplantation. Spain. 30 (Supplement 2) (pp 225),
2017. Date of Publication: September 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Background: New therapeutic approaches to improve survival in patients
with severe infections after solid organ transplantation (SOT) are needed.
We have previously addressed that intravenous immunoglobulin (IVIG) might
be an adjunctive therapy leading to an increase in specific anti
cytomegalovirus (CMV) antibodies. Clostridium difficile (CD) infection is
a common opportunistic infection in SOT. This is the first time that
passive transfer of anti CD toxins is addressed in serum of patients after
non specific IVIG therapy. Methods: 19 SOT patients (heart n = 13, kidney
n = 4, liver n = 2) presenting severe infections and hypogammaglobulinemia
(IgG<600 mg/dL) were included in an ongoing randomized multicenter
clinical trial. Patients received either IVIG (n = 9) additionally to
conventional antimicrobial treatment vs conventional therapy alone (n =
10). IVIG therapy included 5 doses of IVIG (2 doses of 15 grams (g) [7 to
15 days after infection diagnosis] followed by 3 doses of 20 g). We tested
serum IgG and specific antibodies (anti-CD antibodies against toxin A
[anti-CDTA] and toxin B [anti-CDTB], anti-CMV among other specific
antibodies, in a single center sub-study by commercial ELISA before visit
1 and at the last visit, 30 days after last dose. Results: No significant
differences between groups in the baseline levels were found. IVIG was
associated with significant higher levels in serum IgG anti-CDTA,
anti-CDTB and anti-CMV. Comparison by T test of values obtained after
treatment vs values at visit 1 showed significantly higher levels in the
IVIG group: Anti-CMV 44398 +/- 12564 vs 17518 +/- 9707 units, p < 0.001;
anti- CDTB 0.26 +/- 0.08 vs. 0.10 +/- 0.036 optical density units (OD), p
< 0.001; anti-CDTA 0.19 +/- 0.05 vs. 0.08 +/- 0.03 OD, p < 0.001.
Conclusion: We demonstrate utility of IVIG for the passive transfer of
anti CD toxins A and B and confirm previous observations for anti CMV
antibodies. Funds from FIS Project 1501472 and from EudraCT 2012-001327-12
with participation of FEDER funds.

<18>
Accession Number
618768952
Author
Mos F.A.; Peradejordi M.; Maria L.F.; Renedo F.; Guazzone A.L.; Barragan
P.M.; Gutierrez L.M.; Fortunato R.M.; Bertolotti A.M.; Favaloro R.;
Raffaele P.M.
Institution
(Mos, Peradejordi, Maria, Renedo, Guazzone, Barragan, Gutierrez,
Fortunato, Bertolotti, Favaloro, Raffaele) Hospital Universitario
Fundacion Favaloro, Argentina
Title
Efficacy and safety of different immunosuppression strategies (is) in
combined heart and kidney transplantation (CHKT).
Source
Transplant International. Conference: 18th Congress of the European
Society for Organ Transplantation. Spain. 30 (Supplement 2) (pp 224-225),
2017. Date of Publication: September 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Graft survival within 5 years after kidney transplantation
(KT) is now achieved in > 95% of recipients, but chronic graft
deterioration remains as a limiting factor of long term survival. Due to
heart transplant (HT) extended survival, post-transplant renal failure has
become a major factor impairing quality of life with significant
prognostic implications. One of the main reasons may be the toxicities
associated with calcineurin inhibitors (CNI). CNI minimization protocols
in trials that analyze isolated KT or HT are safe regarding rejection and
allograft dysfunction. There are no data about the maintenance IS in cHKT.
Methods: We analyzed 22 consecutives cHKT performed at the Hospital
Universitario Fundacion Favaloro, Buenos Aires, Argentina between 01/2006-
09/2016. 3 patients (p) were excluded because they died at early
posttransplantation. The initial IS was triple therapy consisting of
tacrolimus (CNI with serum levels around 10 ng/ml), mycophenolic acid (MA)
and corticosteroids (CS). During the follow up the cohort was divided per
IS into two groups: Group 1: standard group, including patients who
continued with initial IS; Group 2: CNI withdrawal/sparing group (serum
levels < 5 ng/ml). Causes for switch IS: nephrotoxicity, infection for BK
virus, tolerance, digestive intolerance, vascular allograft disease and
cancer. The subgroup minimized by nephrotoxicity or BK nephropathy showed
an increase in the Creatinine Clearance of 22 ml/min at 6 months of the
switch. Conclusion: This study suggests that conversion to mTOR-inhibitor
based IS with CNI minimization or elimination as a treatment strategy is
effective and safe in cHKT recipients. The standard group showed a clear
trend towards a higher infection rate and sepsis mortality, with no
difference in grafts rejection rate or grafts function. IS with low-dose
tacrolimus resulted in improved renal function without immunological risk.
(Table Presented).

<19>
Accession Number
618768932
Author
Garcia S.; Sarmiento E.; Calahorra L.; Gallego A.; Zatarain E.; Navas P.;
Sousa-Casasnovas I.; Lerma R.; Carbone J.
Institution
(Garcia, Sarmiento, Calahorra, Gallego, Zatarain, Navas, Sousa-Casasnovas,
Lerma) Hospital General Universitario Gregorio Maranon, Madrid, Spain
(Carbone) Hospital General Universitario Gregorio Maranon, Complutense
University, Madrid, Spain
Title
Immune monitoring of regulatory CD4 cells in heart recipients under
immunotherapeutic induction: One-single dose versus two-dose basiliximab.
Source
Transplant International. Conference: 18th Congress of the European
Society for Organ Transplantation. Spain. 30 (Supplement 2) (pp 224),
2017. Date of Publication: September 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Background: The impact and indication of induction immunosuppressive
therapy in heart transplantation (HT) is still unclear. Attempts to avoid
or reduce dose of induction therapy could be desirable in some cases. On
the other hand, reduction in anticalcineurin through levels or delay in
the initiation due to renal failure and other settings could be indicated
in selected cases. Immune monitoring of regulatory CD4 cells can provide
useful information in this regard. Methods: A comparative analysis between
the use of the recommended two doses of 20 mg (2D, n = 18) of
anti-IL2R-alpha monoclonal antibodies (Basiliximab) versus a single dose
(1D, n = 32) in selected patients of a single center was performed. We
analysed regulatory CD4 cell kinetics during the first 6 months after
transplantation. Assessment points: pre-HT, day [d] 7, d15, d30, d60, d90,
d180. Maintenance immunosuppression included steroids, tacrolimus and
mycophenolate mofetil. Percentages and total counts of distinct lymphocyte
subsets were studied by flow-cytometry. Results: In patients using 2 doses
of Basiliximab, a decrease of CD4 + CD25 + CD127low regulatory cells was
observed as compared with pre-transplant values between day 7 and 60;
while in patients that received a single dose the percentage remained
stable. Baseline (pre-transplant percentages were similar in both groups
(5.45 +/- 2.48 vs 5.36 +/- 3.31%, p = 0.93). Lower levels of regulatory
CD4 + cells were observed up to day 30 in patients using 2-doses: day 7
2.52 +/- 2.62 vs 4.76 +/- 3.90%, p = 0.046; day 14 2.75 +/- 2.55 vs 5.08
+/- 5.17%, p = 0.074 and day 30 2.96 +/- 2.69 vs 5.61 +/- 3.78%, p =
0.014. Conclusion: In a 6 month post transplant immune monitoring
follow-up study of a single cohort, one-dose of Basiliximab maintained
higher levels of regulatory CD4 + cells compared to a conventional 2-dose
regimen. This information is of interest since CD4 regulatory cells are
considered to have an important role in allograft rejection.

<20>
Accession Number
618768883
Author
Holmstrom E.; Tuuminen R.; Krebs R.; Syrjala S.; Nykanen A.; Lemstrom K.
Institution
(Holmstrom, Tuuminen, Krebs, Syrjala) Transplantation Laboratory,
University of Helsinki, Finland
(Nykanen, Lemstrom) Transplantation Laboratory, University of
Helsinki/Cardiac Surgery, Helsinki University Hospital, Finland
Title
Role of proinflammatory cytokines as predictive biomarkers for primary
graft dysfunction after heart transplantation.
Source
Transplant International. Conference: 18th Congress of the European
Society for Organ Transplantation. Spain. 30 (Supplement 2) (pp 143),
2017. Date of Publication: September 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Donor brain death, cold preservation, and subsequent ischemia-
reperfusion injury all participate in the pathology of primary graft
dysfunction (PGD) and trigger immune responses. Our experimental studies
suggest that this early immune response may initiate pro-inflammatory and
pro-fibrotic processes and develop into chronic rejection, limiting
long-term survival of HTx patients. In this clinical study, we
investigated the role of proinflammatory cytokines as biomarkers for PGD.
Methods: We analyzed 84 donor-recipient pairs collected in a prospective,
blinded single-center trial conducted 2010-2015. We collected donor and
recipient plasma samples and measured heart failure and myocardial injury
markers proBNP, TnT, and CK-MBm as well as a panel of 47 inflammatory
factors with a Multiplex immunoassay before transplantation and 1, 6, and
24 h after reperfusion. Results: According to ISHLT criteria, 7.1% of
patients had mild, 11.9% had moderate, and 9.5% had severe PGD.
Clinically, mild and moderate PGD differed little from normal graft
function. Mild PGD presented similar cytokine response as patients without
PGD. Moderate PGD associated with increased post-op levels of CX3CL1, and
IL-6 and -18 (p < 0.05). Severe PGD was linked to increased TnT and
lactate release (p < 0.001), longer hospital and ICU length of stays (p <
0.005), and increased 30-day mortality (p < 0.001) compared to patients
without PGD. In addition, severe PGD involved increased post-op levels of
CCL20, CX3CL1, CXCL1, IL-6, -10, and -18, PmuGF, and VEGF-A (p <
0.05-0.0001). Interestingly, severity of PGD did not correlate with early
rejections. Increased donor plasma levels of IP10, CXCL12, and CX3CL1 were
linked to moderate PGD (p < 0.05-0.01) with AUC for each 0.76-0.80.
Conclusions: Our results suggest that proinflammatory biomarkers may
predict moderate to severe PGD after HTx. We suggest that these biomarkers
may be used for risk evaluation and as a platform for therapeutic
interventions in PGD.

<21>
Accession Number
618768770
Author
Duplyakov D.; Suslina E.; Philippova I.; Vozhdaeva Z.; Sysuenkova E.
Institution
(Duplyakov, Suslina, Philippova) Samara Regional Cardiology Dispensary,
Samara, Russian Federation
(Vozhdaeva, Sysuenkova) VAZ Medical Center, Togliatti, Russian Federation
Title
2D and 3D-echo in LV intraventricular dyssynchrony assessement, and
factors related to its severity.
Source
Europace. Conference: European Heart Rhythm Association
EUROPACE-CARDIOSTIM 2017 Congress. Austria. 19 (Supplement 3) (pp iii212),
2017. Date of Publication: June 2017.
Publisher
Oxford University Press
Abstract
The role of mechanical dyssynchrony (MD) in the selection of patients
suitable for CRT is not well-estableshed and still a matter of debates in
current guidelines. Aim: To compare the value of 2D- and 3D-echo in the
diagnosis of intraventricular dyssynchrony (IVD) and to identify factors
related to its severity. Methods: 164 patients (110 men, 54.8+/-10.1 yrs)
with left bundle branch block (LBBB) on the ECG were enrolled into the
study. 52 of them (31,7%) had dilated, and 19 (11,6%) ischemic
cardiomyopathy; 43 patients (26,2%) had a history of previous myocardial
infarction and/or myocardial revascularization; 43 (26,2%) had
hypertension as a primary diagnosis, and the remaining 7 (4.2%) had no
clinical manifestations of any CVD (idiopathic LBBB). 53 patients had
EF<=30%; 70 patients had EF 31-49%; 41 patient had EF >= 50%. IVD was
examined by 2D-, and 3D-echo. The presence of IVD on 2D-echo was
demonstrated by the the septal to posterior wall motion delay (SPWMD),
obtained from Mmode in the parasternal long axis (SPWMD > 130 ms).
3D-echo: time to minimum systolic volume (Tmsv) and its dispersion (Diff.)
for each segment of LV were analyzed. Parameters of IVD were calculated
for 5 positions. Tmsv>12% was considered as a criterion of IVD. Results:
2D-echo allowed detecting IVD accurately in only 40% of patients with
LBBB, mainly due to the presence of severe wall motion abnormalities (a-,
hypo-, dyskinesia), and inability to obtained an adequate echo image.
3D-echo revealed IVD in 87% of the total cohort of patients with LBBB. The
incidence of IVD in patients with EF < 30% was 95.4%, but only 14.8% in
patients with EF>50%. Multiple linear regression analysis was used to
identify factors associated with the severity of IVD. Twenty six
parameters were analyzed altogether. The severity of TMSV Sel-SD (the
maximum value of dyssynchrony between randomly selected segments) was
related to the distance of 6-minute walk test (p = 0.006), and the points
score of the the Minnesota questionnaire (p = 0.05). LVEF was the only
predictor of TMSV 16-SD severity (all segments except the apex of LV, p =
0.006), TMSV 6-SD (dyssynchrony between the basal segments of LV, p =
0.001), and it showed a tendency for TMSV Sel-SD as well (p = 0.055)
Conclusions: 3D-echo reveals IVD in 87% of patients with LBBB, with the
incidence of 95.4% in patients having EF < 30%. EF value, and signs of CHF
determined the severity of IVD.

<22>
Accession Number
618768182
Author
Osca Asensi J.; Ferre M.J.; Perez-Dura M.J.; Vicente R.; Alonso P.; Cano
O.; Andres A.; Sancho Tello M.J.; Olague J.; Martinez-Dolz L.
Institution
(Osca Asensi, Ferre, Perez-Dura, Vicente, Alonso, Cano, Andres, Sancho
Tello, Olague, Martinez-Dolz) Hospital La Fe, Valencia, Spain
Title
A real-world comparison of vernakalant efficacy and safety for
pharmacological cardioversion in patients with recent-onset atrial
fibrillation in an emergency department and after cardiac surgery.
Source
Europace. Conference: European Heart Rhythm Association
EUROPACE-CARDIOSTIM 2017 Congress. Austria. 19 (Supplement 3) (pp iii48),
2017. Date of Publication: June 2017.
Publisher
Oxford University Press
Abstract
Background: Vernakalant is a novel antiarrhythmic agent with an
atrial-specific mechanism of action that has been shown to successfully
convert atrial fibrillation (AF) to normal sinus rhythm (SR) in patients
with paroxysmal AF. Its efficacy has been proved in emergency department
(ED) and in patients with new onset AF after cardiac surgery in Intensive
Cardiac Unit (ICU). Purpose: The aim of this study was to compare the
effectiveness and safety of Vernakalant in patients with paroxysmal AF in
2 scenarios: patients in an emergency department and patients with post
cardiac surgery AF. Methods: The study included 47 consecutive patients
who were admitted in our ED for paroxysmal AF and received Vernakalant
between May 2015 and December 2016. These patients were compared with a
group of 19 patients with new onset AF after cardiac surgery treated with
Vernakalant. Vernakalant was administered according to the manufacturer's
recommendations. Risk factors, the presence of structural heart disease,
duration of AF, time to convertion to synus rhythm and adverse effects
were collected. Results: The ED population had a mean age of 63+/-16 years
and the ICU patients had a mean age of 68+/-7 years (p=0.06). Most
patients were men in both groups (51% in ED vs. 68% in ICU, p 0.198).
Cardiac Surgery group included 10 valvular patients, 8 ischemic patients
and 1 patient after congenital heart disease surgery. Ejection fraction
was significantly lower in ICU patients (50%66% vs. 60%62%, p<0.0001). The
mean CHA2DS2VASC score was lower in ED patients (1,81 vs. 2,53, p 0.106).
Of the 47 ED patients given Vernakalant, 37 (79%) converted to sinus
rhythm, compared with 14 ICU patients (74%, p=0.75). The majority of
patients converted to SR with the first infusion. A second Vernakalant
infusion was needed in only 4 patients in ED (9%) versus 4 patients in the
ICU (21%) (p=0.192). The median time to conversion with Vernakalant was 16
minutes (range, 3-75) without differences in both groups. The most
frequent adverse event was hypotension that was significantly higher in
ICU patients (2% in ED vs. 21% in ICU, p 0.022). Hypotension was
conservatory managed in all patients. We observed a self-limiting atrial
flutter in 5 patients (11%) treated in ED versus none in the ICU patients
(p 0.139). Minor adverse events were common; dysgeusia was recorded in 9%
in ED patients vs. 5 % in ICU patients, p 0.574. Conclusions: The data
from this study confirm that vernakalant is an effective, rapid and safe
antiarrhythmic drug for pharmacological cardiovertion for paroxysmal AF.
Effectiveness was similar in patients with AF after cardiac surgery. In
this group, hypotension was more frequent after Vernakalant infusion.

<23>
Accession Number
618767864
Author
Van Stipdonk A.M.W.; Ter Horst I.A.H.; Kloosterman M.; Rienstra M.;
Prinzen F.W.; Meine M.; Maass A.H.; Vernooy K.
Institution
(Van Stipdonk, Vernooy) Maastricht University Medical Centre (MUMC),
Cardiology, Maastricht, Netherlands
(Ter Horst, Meine) University Medical Center Utrecht, Cardiology, Utrecht,
Netherlands
(Kloosterman, Rienstra, Maass) University Medical Center Groningen,
Cardiology, Groningen, Netherlands
(Prinzen) Cardiovascular Research Institute Maastricht (CARIM),
Physiology, Maastricht, Netherlands
Title
QRS area as superior electrocardiographic predictor of response to CRT.
Source
Europace. Conference: European Heart Rhythm Association
EUROPACE-CARDIOSTIM 2017 Congress. Austria. 19 (Supplement 3) (pp iii145),
2017. Date of Publication: June 2017.
Publisher
Oxford University Press
Abstract
Introduction: Patient selection in cardiac resynchronisation therapy (CRT)
currently relies on QRS duration and left bundle branch block (LBBB)
morphology. Significant non-response rates imply suboptimal patient
selection. Small studies have suggested that vectorcardiographically
determined QRSAREA improves identification of CRT responders. Purpose: To
compare the value of QRS area to that of QRS duration and morphology in
prediction of the occurrence of LV assist device (AD) implantation/cardiac
transplantation/all-cause mortality (primary endpoint), heart failure
hospitalisation within the first year after implantation and
echocardiographic response at 6 to 12 months after implantation (secondary
endpoints). Methods: In a multicentre cohort of patients implanted with a
CRT device between 2001 and 2015, patient electronic databases were
assessed for clinical and echocardiographical outcomes data. QRS area was
calculated by converting the digital 12-lead ECG and taking the root of
the sum of squared QRS area in X-, Y-, and Z-direction. Data on the
primary endpoint was available in 1.486 patients. Heart failure
hospitalisation data was available in 1.269 patients. Baseline and
follow-up echocardiograms (relative reduction in LV end-systolic volume)
were available for 928 patients. Results: In a mean follow-up time of
3.4+/-2.4 years, 474 patients (32%) experienced the primary endpoint.
Patients with LBBB (with QRS duration above and below 150ms) showed
significantly lower probability of experiencing the primary event than
patients with non-LBBB and a QRS below 150ms. This was the same for
patients within the two highest QRS area quartiles compared to patients
within the lowest QRS area quartiles (Figure 1.) 85 (6%) Patients were
hospitalised within the first year after CRT implantation. Patients above
the median of QRS area had significantly lower risk of heart failure
hospitalization, as did the patients above the median of QRS duration.
LBBB morphology however was not significantly associated with
hospitalization. Mean reduction of LVESV was 19+/-32%. Both LBBB patient
groups (QRS above and below 150ms) showed significantly higher reductions
than non-LBBB patient groups. Patients in the two upper QRS area quartiles
also experienced significantly more reduction. Multivariable cox
regression analyses proved higher QRS area to be the only independent
electrocardiographic predictor of lower incidence of the primary endpoint
(HR 0.52; 0.37-0.75) as well as for the risk of heart failure
hospitalisation (HR 0.56; 0.33-0.95) Conclusion: Baseline QRS area
correlates to clinical and echocardiographic outcomes in CRT patients.
Moreover its association seems stronger than that of traditional QRS
duration and morphology. (Figure presented).

<24>
Accession Number
618767805
Author
Carmo J.; Ferreira J.; Costa F.; Lopes N.; Carmo P.; Carvalho M.S.; Cavaco
D.; Morgado F.; Adragao P.
Institution
(Carmo, Ferreira, Costa, Lopes, Carmo, Carvalho, Cavaco, Morgado, Adragao)
Hospital De Santa Cruz, Lisbon, Portugal
Title
A trial fibrillation ablation is associated with lower risk of ischemic
stroke: A propensity matched analysis in 1692 patients.
Source
Europace. Conference: European Heart Rhythm Association
EUROPACE-CARDIOSTIM 2017 Congress. Austria. 19 (Supplement 3) (pp iii30),
2017. Date of Publication: June 2017.
Publisher
Oxford University Press
Abstract
Background: Ischemic stroke is one of the most devastating complications
of atrial fibrillation (AF). Ablation of AF reduces the arrhythmic burden,
but its impact on the reduction of ischemic stroke remains uncertain.
Purpose: To evaluate the relationship between AF ablation and ischemic
stroke risk. Methods: A total of 3168 patients diagnosed with AF who were
discharged between 2006 and 2015 from a tertiary hospital were identified.
During this period, 884 ablations were performed, and patients with atrial
flutter were excluded. We also excluded patients with mechanical
prosthetic valves, mitral stenosis and pacemaker or implanted
cardioverter- defibrillator. A 1:1 propensity matched analysis with
caliper 0.1 was performed between patients undergoing AF ablation versus
the remainder for demographic and clinical baseline characteristics. The
primary outcome was ischemic stroke at follow-up. Results: Patients
undergoing ablation were younger and had less comorbidities than other AF
patients. During a mean follow-up of 4 years, 10 ischemic strokes were
observed in the ablation group (N = 710) and 113 in the non-ablation group
(N = 982). After the adjustment for baseline characteristics, 197 patients
were selected for each group (Table). There were 3 ischemic strokes in the
ablation group (no event in the first 30 days) and 16 in the non-ablation
group. In multivariate analysis, AF ablation was associated with a lower
risk of ischemic stroke (HR 0.11, 0.03-0.41, P= 0.001). The benefit of
ablation was higher in patients with CHA2DS2-VASc >=2 (HR 0.11, 0.02-0.49,
P= 0.004 vs. HR 0.22, 0.04-11.29, P= 0.45 with CHA2DS2-VASc <2).
Conclusion: In patients with AF, ablation was associated with a lower risk
of ischemic stroke after correction for selection bias. (Table Presented).

<25>
Accession Number
618767656
Author
Tronconi A.; Galizio N.; Gonzalez J.; Robles F.; Palazzo A.; Carnero G.;
Mysuta M.; Amico C.D.; Lizarraga G.; Figueroa F.; Fraguas H.
Institution
(Tronconi, Galizio, Gonzalez, Robles, Palazzo, Carnero, Mysuta, Amico,
Lizarraga, Figueroa, Fraguas) Favaloro Foundation University Hospital,
Buenos Aires, Argentina
Title
Implantable cardioverter defibrillator in ischemic cardiomyopathy:
Appropriate therapies and mortality in real life.
Source
Europace. Conference: European Heart Rhythm Association
EUROPACE-CARDIOSTIM 2017 Congress. Austria. 19 (Supplement 3) (pp iii234),
2017. Date of Publication: June 2017.
Publisher
Oxford University Press
Abstract
Background: In previous trials implantable cardioverter defibrillator
(ICD) appropriate shocks (A-Sh) had been associated with higher mortality.
On the other hand, data about appropriate ATP (A-ATP) is inconsistent.
Purpose: To determine, in a long term follow up of patients (p) with ICD
for ischemic cardiomyopathy (IC), the association between appropriate
therapy (AT), A-Sh and AATP with mortality. Methods: From a prospective
registry, between January 2007 and August 2016, 356 p with IC were
implanted with an ICD for primary (PP) or secondary prevention (SP) of
sudden cardiac death (SCD). Baseline characteristics of p without AT (n:
273) and with AT (n: 83): male 246 (90%) vs 75p (90%) p=NS, age 65+/-11 vs
64+/-10years p=NS, PP 207 (76%) vs 39p (47%) p<0.001, SP 66 (24%) vs 44p
(53%) p<0.001, NYHA FC I 130 (48%) vs 42p (51%) p=NS, NYHA FC II 108 (40%)
vs 34p (41%) p=NS, NYHA FC III 33 (12%) vs 6p (7%) P=NS, AF 37 (14%) vs
11p (13%) P=NS, LBBB 56 (21%) vs 19p (23%) P=NS, QRS 112+/-34 vs
120+/-33ms p=NS, LVDD 64+/-9 vs 63+/-11mm p=NS, LVEF 28+/-8 vs 30+/-9%
p=NS, creatinine 1.25+/-0.5 vs 1.25+/-0.5mg% p=NS, beta-blockers 262 (96%)
vs 77p (93%) p=NS, ACEi/ARB 243 (89%) vs 72p (87%) p=NS, mineralocorticoid
receptor blockers 219 (80%) vs 67p (81%) p=NS and amiodarone 124 (45%) vs
45p (54%) p=0.01, respectively. Overall (OM), cardiovascular (CM) and
non-cardiovascular mortality (N-CM) was compared among p without vs with
AT, without AT vs with A-Sh and without AT vs with AATP. P who underwent
heart transplant or up-grade to CRT-D were excluded from mortality
analysis. Mean follow up: 44+/-38 months. Results: During the follow up,
83 p (23%) received AT, 63 (18%) A-Sh and 45 (13%) A-ATP. Conclusions: P
with AT had higher HF mortality than p without AT. P with A-Sh had higher
CM and HF mortality than p without AT. There was no difference in
mortality between p without AT and with A-ATP only. (Table Presented).

<26>
Accession Number
618767399
Author
Tronconi A.; Galizio N.; Gonzalez J.; Robles F.; Palazzo A.; Carnero G.;
Mysuta M.; Amico C.D.; Lizarraga G.; Figueroa F.; Fraguas H.
Institution
(Tronconi, Galizio, Gonzalez, Robles, Palazzo, Carnero, Mysuta, Amico,
Lizarraga, Figueroa, Fraguas) Favaloro Foundation University Hospital,
Buenos Aires, Argentina
Title
Which is the benefit of ICD in patients with ischemic cardiomyopathy
compare with those with idiopathic dilated cardiomyopathy, from DANISH
trial to real life.
Source
Europace. Conference: European Heart Rhythm Association
EUROPACE-CARDIOSTIM 2017 Congress. Austria. 19 (Supplement 3) (pp iii78),
2017. Date of Publication: June 2017.
Publisher
Oxford University Press
Abstract
Background: DANISH Trial has questioned the benefit of implantable
cardioverter defibrillator (ICD) for primary prevention (PP) in patients
(p) with non-ischemic systolic heart failure (NIC-HF). The trial could not
demonstrate a reduction in total mortality compared with "usual clinical
care". Purpose: To determine the incidence of appropriate therapy (AT) and
compare overall (OM), cardiovascular (CM) and non cardiovascular mortality
(N-CM) in p with ICD implanted for PP of sudden cardiac death (SCD) in
ischemic cardiomyopathy (IC) vs idiopathic dilated cardiomyopathy (IDC).
Methods: Between January 2007 and August 2016, 329p were implanted with an
ICD. Baseline characteristics, 256p (78%) had IC and 73p (22%) IDC: male
226 (78%) vs 73p (22%) p=0.005, age 64+/-2 vs 57+/-11years p=NS,
creatinine 1.2+/-0.5 vs 1.1+/-0.3mg% p=0.04, NYHA FC I 117 (46%) vs 22p
(30%) p=0.01, FC II 106 (41%) vs 33p (45%) p=NS, FC III 32 (12%) vs 16p
(22%) p=0.03, LVDD 64+/-9 vs 69+/-8mm p<0.001, LVEF 27+/-7 vs 23+/-6%
p<0.001, inappropriate shocks 25 (10%) vs 13p (18%) p=0.06, Beta-Blockers
247 (96%) vs 69p (95%) p=NS, ACEi/ARB 227 (89%) vs 64p (87%) p=NS,
Mineralcorticoid receptor blocker 204 (80%) vs 59p (81%) p=NS, amiodarone
92 (36%) vs 35p (48%) p=0.06, respectively. P who received heart
transplant or up-grade to CRT-D were excluded from mortality analysis.
Mean follow up 42+/-37 months (m). Results: During the follow up, 40p
(16%) with IC vs 9p (12%) with IDC had AT (p=NS), 27 (11%) vs 7(10%)
appropriate shocks and 21 (8%) vs 6 (8%) appropriate ATP (p=NS),
respectively. Table 1: Mortality outcomes. Conclusions: DANISH Trial
concluded that implantation of an ICD in p who had NICHF did not provide
an OM benefit. The probability of an ICD reducing OM depends on the ratio
of SCD/OM in the studied population. In our studied population, we do not
found significant differences between IC and IDC p on the incidence of AT,
OM, CM or N-CM. Although, IDC p died later than IC p. As p with IC, p with
IDC may benefit from ICD therapy. (Table Presented).

<27>
[Use Link to view the full text]
Accession Number
618768047
Author
Ye Y.; Yang M.; Zhang S.; Zeng Y.
Institution
(Ye, Yang, Zhang, Zeng) Department of Cardiology, Peking Union Medical
College Hospital, Peking Union Medical College, Chinese Academy of Medical
Sciences, Beijing 100730, China
Title
Percutaneous coronary intervention versus cardiac bypass surgery for left
main coronary artery disease.
Source
Medicine (United States). 96 (41) (no pagination), 2017. Article Number:
e8115. Date of Publication: 01 Oct 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Several updated meta-analyses comparing percutaneous coronary
intervention (PCI) with coronary artery bypass grafting (CABG) for left
main coronary artery disease (LM CAD) have been published recently.
However, the risk of false-positive results could be high in conventional
updated meta-analyses due to repetitive testing of accumulating data.
Therefore, we compared these treatment approaches via trial sequential
analysis (TSA). Methods: The MEDLINE, Embase, and Cochrane Central
Register of Controlled Trials databases were searched for published
randomized controlled trials (RCTs) or subgroups of RCTs comparing PCI and
CABG in patients with LM CAD. The primary outcome was major cardiac and
cerebrovascular adverse events (MACCE). TSA was used to confirm the
conclusions derived from conventional meta-analysis. Results: Six RCTs
with 4700 patients were included. PCI was associated with a greater risk
of MACCE compared with CABG (pooled relative risk [RR] 1.21, 95%
confidence interval [CI]: 1.05-1.40, P=.008). In addition, PCI resulted in
a significantly higher risk of revascularization than CABG (pooled RR
1.61, 95% CI: 1.33-1.95, P<.0001). TSA provided firm evidence for the
reduction of MACCE and revascularization with CABG compared with PCI
(cumulative z-curve crossed the monitoring boundary). In the subgroup
analysis, CABG was better than PCI in patients with SYNTAX score >32
(pooled RR 1.41, 95% CI: 1.12-1.76, P=.003), which was confirmed by the
TSA. There was no difference in patients with a SYNTAX score from 0 to 32.
Conclusions: In patients with LM CAD, CABG may be better than PCI for
reducing MACCE due to a reduced risk of revascularization. CABG remains
the first choice for LM CAD patients with high anatomic complexity, while
PCI could be an alternative for those with low-to-moderate anatomic
complexity.<br/>Copyright &#xa9; 2017 the Author(s). Published by Wolters
Kluwer Health, Inc.

<28>
Accession Number
618680984
Author
Lv W.; Li S.; Liao Y.; Zhao Z.; Che G.; Chen M.; Feng Y.
Institution
(Lv, Liao, Zhao, Chen, Feng) Department of Cardiology, West China
Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, China
(Li, Che) Department of Thoracic Surgery, West China Hospital, Sichuan
University, Chengdu, China
Title
The 'obesity paradox' does exist in patients undergoing transcatheter
aortic valve implantation for aortic stenosis: A systematic review and
meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 25 (4) (pp 633-642),
2017. Date of Publication: 01 Oct 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Most recent studies have proposed the paradoxical benefits of obesity in
surgical populations. For patients who underwent transcatheter aortic
valve implantation (TAVI) for aortic stenosis, the prognostic roles of
obesity and high body mass index remain controversial. Therefore, the
objective of this meta-analysis was to evaluate whether the 'obesity
paradox' exists in patients undergoing TAVI. We searched in PubMed and
EMBASE to identify the eligible articles. Odds ratios and hazard ratios
with the corresponding 95% confidence intervals (CI) were adopted for
synthesizing short-term and long-term survival outcomes, respectively. The
level of heterogeneity and the publication bias between studies were also
estimated. Finally, there were 16 studies with 12 330 patients who met the
eligibility criteria and who were thus included in this review. When body
mass index was analysed as a continuous variable, each increase of 1 kg/m
2 was significantly associated with the lower 30-day mortality rate (odds
ratio = 0.95; 95% CI = 0.93-0.97; P < 0.001) and better long-term overall
survival (hazard ratio = 0.96; 95% CI = 0.94-0.97; P < 0.001) for patients
undergoing TAVI. The obese patients had a significantly lower risk of
30-day mortality after TAVI than did normal patients (odds ratio = 0.69;
95% CI = 0.50-0.95; P = 0.024). Further analyses indicated that the
obesity could be predictive of more favourable long-term overall survival
of TAVI (hazard ratio = 0.84; 95% CI = 0.72-0.97; P = 0.021). However, we
found no difference in procedural complications between the obese and
normal patients. In conclusion, higher body mass index and obesity seem to
have protective benefits on both short-term and long-term survival of TAVI
patients. Current evidence suggests that the 'obesity paradox' may really
exist in TAVI.<br/>Copyright &#xa9; The Author 2017. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<29>
Accession Number
618680863
Author
Nwaejike N.; Son A.Y.; Milano C.A.; Daneshmand M.A.
Institution
(Nwaejike, Milano, Daneshmand) Division of Cardiothoracic Surgery,
Department of Surgery, Duke University Medical Center, Durham, NC 27705,
United States
(Son) New York University School of Medicine, New York, NY, United States
Title
Is there a role for upper-extremity intra-aortic balloon counterpulsation
as a bridge-to-recovery or a bridge-to-transplant in the treatment of
end-stage heart failure?.
Source
Interactive Cardiovascular and Thoracic Surgery. 25 (4) (pp 654-658),
2017. Date of Publication: 01 Oct 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: Is there a role for
upper-extremity intra-aortic balloon pump counterpulsation (UE-IABP) in
the treatment of end-stage heart failure? Altogether 230 papers were found
using the reported search, of which 6 papers represented the best evidence
to answer the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. Of the 163
bridge-to-transplantation (BTT) patients, 141 (86.5%) were successfully
transplanted and of the 9 bridge-to-recovery (BTR) patients, 6 (66.7%)
were successfully weaned from the device. Length of support ranged from 3
to 152 days, and the most frequent complications were device malfunction
or migration necessitating exchange or repositioning, occurring at a
collective rate of 37.3%. UE-IABP is a minimally invasive and
cost-effective strategy that provides haemodynamic support while
preserving both the mediastinum and the functional status in BTR and BTT
patients who may not tolerate more invasive modes of mechanical
circulatory support. We conclude that UE-IABP can be used as a
bridge-to-recovery (BTR) or transplant (BTT) in patients with end-stage
heart failure.<br/>Copyright &#xa9; The Author 2017. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<30>
Accession Number
618680739
Author
Elsayed H.H.; Gamal M.; Raslan S.; Hamid H.A.
Institution
(Elsayed) Department of Thoracic Surgery, Ain Shams University Hospital,
Abbasia Square, Cairo 31224, Egypt
(Gamal) Department of Cardiac Surgery, Nasser Institute for Research and
Treatment, Cairo, Egypt
(Raslan) Department of Cardiothoracic Surgery, Al Azhar University, Cairo,
Egypt
(Hamid) Department of Cardiothoracic Surgery, Ain Shams University
Hospital, Cairo, Egypt
Title
Video-assisted thoracoscopic thymectomy for non-thymomatous myasthenia
gravis: A right-sided or left-sided approach?.
Source
Interactive Cardiovascular and Thoracic Surgery. 25 (4) (pp 651-653),
2017. Date of Publication: 01 Oct 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was in [patients undergoing
video-assisted thoracoscopic thymectomy for myasthenia gravis (MG)] is a
[left-sided approach] superior to a [right-sided approach] in terms of
[clinical outcome]? Two hundred and fifty-nine papers were found using the
reported search. In looking at both procedures, we selected studies with a
sizeable number of patients performing or studying both procedures and
comparing their outcome. Hence, only 4 studies represented the best
evidence to answer the clinical question. The authors, journal, date,
country, study type, patient group, relevant outcomes and results of these
papers are tabulated. Two studies compared their clinical experience with
a right-sided versus a left-sided video assisted thoracoscopic surgery
thymectomy approach, while 1 study compared using a bilateral versus a
unilateral right-sided approach in patients with non-thymomatous MG. The
number of patients studied included 31, 107 and 103 patients,
respectively. All 3 studies demonstrated no difference regarding surgical
time, intraoperative blood loss, postoperative hospital stay,
postoperative complications and therapeutic effects (the last study
compared the 5-year complete stable remission rate). All 3 studies
concluded that both approaches are feasible, effective and comparable in
operative and long-term results for the treatment of non-thymomatous MG.
One anatomical study compared both approaches in 10 cadavers, 5 in each
group. They studied the size of the specimen resected and visualization of
different anatomic sites via each approach. Visualization was superior
using the left-sided approach, while a right-sided approach resulted in
slightly higher chances of an incomplete resection. The study concluded
that a left-sided approach achieves a better chance of radical
thoracoscopic thymectomy due to anatomic considerations. In conclusion,
despite 1 cadaveric study suggesting that a left-sided approach may
achieve more complete resection, possibly due to anatomical
considerations, there are no differences in outcomes with either
unilateral approach in terms of complications, hospital stay or long-term
symptom relief.<br/>Copyright &#xa9; The Author 2017. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<31>
[Use Link to view the full text]
Accession Number
618680162
Author
Glumac S.; Kardum G.; Sodic L.; Supe-Domic D.; Karanovic N.
Institution
(Glumac, Karanovic) Clinical Department of Anaesthesiology, Intensive
Care, University Hospital of Split, Spinciceva 1, Split 21000, Croatia
(Kardum) Department of Psychology, Faculty of Humanities and Social
Sciences, University of Split, Croatia
(Sodic) Clinical Department of Neurology, Croatia
(Supe-Domic) Department of Medical Laboratory Diagnostics, University
Hospital of Split, Croatia
(Karanovic) Department of Anaesthesiology and Intensive Medicine, School
of Medicine, University of Split, Split, Croatia
Title
Effects of dexamethasone on early cognitive decline after cardiac surgery;
A randomised controlled trial.
Source
European Journal of Anaesthesiology. 34 (11) (pp 776-784), 2017. Date of
Publication: 01 Nov 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND Postoperative cognitive decline (POCD), a very common
complication after cardiac surgery, is characterised by impairment of both
memory function and intellectual ability as well as being associated with
increased use of healthcare resources. The investigators focused on the
role of the inflammatory response to a surgical procedure as a potential
factor involved in the pathogenesis of POCD. OBJECTIVE The use of
prophylactic dexamethasone to attenuate the inflammatory response was
hypothesised to reduce the risk of POCD. DESIGN Randomised controlled
study. SETTING Single university teaching hospital, from March 2015 to
January 2016. PATIENTS A total of 169 patients scheduled for elective
cardiac surgery were enrolled, and 161 patients were included in the
analyses. INTERVENTION Patients were randomised to receive a single
intravenous bolus of 0.1mgkg -1 dexamethasone (n=85) or placebo (n=84) 10h
before the surgery. MAIN OUTCOME MEASURES The primary outcome measure in
both groups was the incidence of POCD on the 6th day after surgery. The
investigators also evaluated the effect of dexamethasone on the incidence
of systemic inflammatory response syndrome, postoperative C-reactive
protein levels and postoperative serum S100beta protein levels. RESULTS
Compared to the placebo group, the dexamethasone group showed
statistically significant reductions in the incidence of POCD (relative
risk, 0.43; 95% confidence interval, 0.21 to 0.89; P=0.02), the incidence
of systemic inflammatory response syndrome (30.0 versus 58.0%, P<0.001)
and postoperative C-reactive protein levels (P<0.001). Postoperative
S100beta levels were insignificantly lower (P=0.56) in the dexamethasone
group. CONCLUSION Preoperative administration of dexamethasone reduced the
inflammatory response and thereby decreased the risk of early POCD after
cardiac surgery. TRIAL REGISTRATION Clinicaltrials.gov identifier:
NCT02767713.<br/>&#xa9; Copyright2017 European Society of Anaesthesiology.
All rights reserved.

<32>
[Use Link to view the full text]
Accession Number
618680119
Author
Lee B.; Soh S.; Shim J.-K.; Kim H.Y.; Lee H.; Kwak Y.-L.
Institution
(Lee, Soh, Shim, Kim, Lee, Kwak) Department of Anaesthesiology and Pain
Medicine, Anaesthesia and Pain Research Institute, Yonsei Cardiovascular
Hospital, Yonsei University College of Medicine, 50 Yonsei-ro,
Seodaemun-Gu, Seoul 03722, South Korea
(Shim, Kwak) Yonsei Cardiovascular Hospital, Yonsei University College of
Medicine, Seoul, South Korea
Title
Evaluation of preoperative oral carbohydrate administration on insulin
resistance in off-pump coronary artery bypass patients: A randomised
trial.
Source
European Journal of Anaesthesiology. 34 (11) (pp 740-747), 2017. Date of
Publication: 01 Nov 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
BACKGROUND In fasting cardiac surgery patients, preoperative carbohydrate
(CHO) drink intake attenuated insulin resistance and improved cardiac
metabolism, although its beneficial effects were not evident after cardiac
surgery possibly due to cardiopulmonary bypass-related extreme systemic
inflammation. OBJECTIVE We aimed to evaluate whether preoperative CHO
intake affected insulin resistance and free-fatty acid (FFA)
concentrations in off-pump coronary revascularisation. DESIGN A randomised
controlled trial. SETTING Primary care in a university hospital in Korea
from January 2015 to July 2016. PATIENTS Sixty patients who underwent
elective multi-vessel off-pump coronary revascularisation were randomised
into two groups. Three patients were excluded from analysis and 57
patients completed study. INTERVENTION The CHO group received oral CHO
(400ml) the prior evening and 2 to 3h before surgery, and the control
group was fasted from food and water according to standard protocol. MAIN
OUTCOME MEASURES Insulin resistance was assessed twice, after anaesthetic
induction and after surgery via short insulin tolerance test. FFA,
C-reactive protein and creatine kinase-myocardial band concentrations were
determined serially for 48h after surgery. RESULTS Insulin sensitivity was
greater (P=0.002) and plasma FFA concentrations were lower (P=0.001) after
anaesthetic induction in the CHO group compared with the Control group,
although there were no intergroup differences after surgery. The
postoperative peak creatine kinase-myocardial band concentration was
significantly lower in the CHO group compared with the Control group [8.8
(5.4 to 18.2) vs. 6.4 (3.5 to 9.7)ngml -1, P=0.031]. CONCLUSION A
preoperative CHO supplement significantly reduced insulin resistance and
FFA concentrations compared with fasting at the beginning of the surgery,
but these benefits were lost after off-pump coronary revascularisation.
Despite their transient nature, these beneficial effects resulted in less
myocardial injury, mandating further studies focused on the impact of
preoperative CHO on myocardial ischaemia and cardiac function after
coronary revascularisation. TRIAL REGISTRATION Clinicaltrials.gov
identifier: NCT 02330263.<br/>&#xa9; Copyright2017 European Society of
Anaesthesiology. All rights reserved.

<33>
Accession Number
614570177
Author
Xiong B.; Nie D.; Cao Y.; Zou Y.; Yao Y.; Qian J.; Rong S.; Huang J.
Institution
(Xiong, Cao, Zou, Yao, Qian, Rong, Huang) Department of Cardiology, The
Second Affiliated Hospital of Chongqing Medical University, Chongqing
400010, China
(Nie) Department of Gastroenterology, The First Affiliated Hospital of
Chengdu Medical College, Chengdu, Sichuan 610500, China
Title
Preoperative Statin Treatment for the Prevention of Acute Kidney Injury in
Patients Undergoing Cardiac Surgery: A Meta-Analysis of Randomised
Controlled Trials.
Source
Heart Lung and Circulation. 26 (11) (pp 1200-1207), 2017. Date of
Publication: November 2017.
Publisher
Elsevier Ltd
Abstract
Background The effect of preoperative statin treatment (PST) on the risk
of postoperative acute kidney injury (AKI) after cardiac surgery remains
controversial. We performed a meta-analysis of randomised controlled
trials (RCT) to investigate whether PST could improve the renal outcomes
in patients undergoing cardiac surgery. Methods We conducted a
comprehensive search on PubMed, Embase and Cochrane Central Register of
Controlled Trials. Randomised controlled trials which reported incidence
of AKI and renal replacement treatment (RRT), mean change of serum
creatine (SCr) and C-reactive protein (CRP), length of stay in intensive
care unit (LOS-ICU) and hospital (LOS-HOS) were included. Results A total
of nine RCTs, covering 3,201 patients were included. Based on the results
of our meta-analysis, PST could not reduce the incidence of AKI (risk
ratio (RR) 1.12, 95% confidence interval (CI) 0.97 to 1.29, p = 0.37), and
RRT (RR 1.13, 95% CI 0.45 to 2.85, p = 0.80). Furthermore, SCr was not
likely to be improved by PST (weighted mean difference (WMD) 0.03, 95% CI
0.00 to 0.06, p = 0.055). However, the level of CRP (WMD -5.93, 95% CI
11.71 to 0.15, p = 0.044) in patients treated with PST was significantly
lower than that of patients administered with placebo. In addition, no
significant difference was observed in LOS-ICU and LOS-HOS between PST and
control groups. Conclusion Our meta-analysis suggests that PST cannot
provide any benefit for improving renal complications and clinical
outcomes, but may slightly reduce postoperative inflammation in patients
undergoing cardiac surgery. In the future, more powerful RCTs will be
needed to confirm these findings.<br/>Copyright &#xa9; 2017 Australian and
New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the
Cardiac Society of Australia and New Zealand (CSANZ)

<34>
Accession Number
614831487
Author
Mahmoud A.N.; Elgendy I.Y.; Mentias A.; Saad M.; Ibrahim W.; Mojadidi
M.K.; Nairooz R.; Eshtehardi P.; David Anderson R.; Samady H.
Institution
(Mahmoud, Elgendy, Mojadidi, David Anderson) Division of Cardiovascular
Medicine, University of Florida, Gainesville, FL, United States
(Mentias) Division of Cardiovascular Medicine, University of Iowa, Iowa
City, IA, United States
(Saad, Nairooz) Division of Cardiovascular Medicine, University of
Arkansas, Little Rock, AR, United States
(Ibrahim) Department of Medicine, Wayne State University, Detroit, MI,
United States
(Eshtehardi, Samady) Division of Cardiovascular Medicine, Emory University
School of Medicine, Atlanta, GA, United States
Title
Percutaneous coronary intervention or coronary artery bypass grafting for
unprotected left main coronary artery disease.
Source
Catheterization and Cardiovascular Interventions. 90 (4) (pp 541-552),
2017. Date of Publication: 01 Oct 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Recent trials comparing PCI with CABG for unprotected left
main disease yielded discrepant evidence. Objectives: To perform an
updated meta-analysis of randomized trials comparing percutaneous coronary
intervention (PCI) with coronary artery bypass grafting (CABG) in patients
with unprotected left main coronary artery disease. Methods: Randomized
trials comparing PCI versus CABG for patients with unprotected left main
coronary artery disease were included. Summary estimates risk ratios (RRs)
were performed with a DerSimonian and Laird model at short-term,
intermediate and long-term follow-up periods (i.e., 30-days, 1-year, and
>1-year). Outcomes evaluated were major adverse cardiac and
cerebrovascular events (MACCE), all-cause mortality, myocardial
infarction, stroke, revascularization and stent thrombosis or symptomatic
graft occlusion. Results: Six trials with 4,700 patients and a mean SYNTAX
score of 23 were included. At short-term follow-up, the risk of MACCE was
lower with PCI (RR 0.55, 95% confidence interval [CI] 0.39-0.76) driven by
the lower risk of myocardial infarction (RR 0.67, 95% CI 0.46-0.99), and
stroke (RR 0.38, 95% CI 0.16-0.90). The risk of MACCE was similar at the
intermediate follow-up (RR 1.21, 95% CI 0.97-1.51). At long-term
follow-up, PCI was associated with a higher risk of MACCE (RR 1.19, 95% CI
1.01-1.41), due to a higher risk of revascularization (RR 1.62, 95% CI
1.34-1.94), while the risk of all-cause mortality, myocardial infarction,
and stroke were similar. Conclusions: In patients with unprotected left
main coronary disease and low to intermediate SYNTAX score, PCI might be
an acceptable alternative to CABG. &#xa9; 2017 Wiley Periodicals,
Inc.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<35>
Accession Number
618715698
Author
Yaghoubi A.; Golfeshan E.; Azarfarin R.; Nazari A.; Alizadehasl A.; Ehasni
A.
Institution
(Yaghoubi) Rajaie Cardiovascular Medical and Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Golfeshan) Department of Critical Care Nursing, Qom University of Medical
Sciences, Qom, Iran, Islamic Republic of
(Azarfarin, Alizadehasl) Echocardiography Research Center, Rajaie
Cardiovascular Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Nazari) Department of Complementary Medicine, Vali-Asr Hospital, Qom,
Iran, Islamic Republic of
(Ehasni) Department of Medicine, Iran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
Title
Effects of acupressure on sleep quality after coronary artery bypass
surgery.
Source
Iranian Heart Journal. 18 (3) (pp 28-34), 2017. Date of Publication: 2017.
Publisher
Iranian Heart Association (E-mail: iha@iha.org.ir)
Abstract
Background: Sleep disturbances are common following coronary artery bypass
graft surgery (CABG). Nowadays, nonmedical therapies are considered along
with medical therapies for sleep disturbances. The aim of this study was
to evaluate the effects of acupressure on sleep quality in patients after
CABG. Methods: This randomized controlled trial assigned 60 patients
admitted to the intensive care unit after CABG to 2 groups. Each group
comprised 30 patients, with the experimental group receiving acupressure
on 5 different solar points for 5 to 15 minutes during 2 consecutive
postoperative days and the control group receiving only sedative drugs on
request. Sleep quality was measured the day before and after CABG using
the St Mary's Hospital Sleep Questionnaire (SMHSQ) in both groups. An
SMHSQ score 9 is normal and 36 is the worst sleep quality. Results:
According to the obtained data, before the intervention, the median
(interquartile range) score for sleep quality was 15 (13-17) in the
experimental group and 14 (13-14) in the control group; therefore, there
was no statistically significant difference between the 2 groups (P =
0.689). However, following acupressure, the scores changed significantly:
the SMHSQ score rose to 14 (13-14) in the experimental group, while it
remained at 23 (23-25) in the control group suggesting a reasonable
difference in sleep quality between the 2 groups after CABG (P = 0.001).
Also, the average difference in the control group's score (+9 points)
before and after the intervention period was more than that of the
acupressure group (-1 point). Conclusions: Our findings showed that
acupressure improved sleep quality in patients in the intensive care unit
after CABG surgery.<br/>Copyright &#xa9; 2017, Iranian Heart Association.
All rights reserved.

<36>
Accession Number
618572592
Author
Zheng J.; Cheng J.; Wang T.; Zhang Q.; Xiao X.
Institution
(Zheng, Wang, Zhang, Xiao) Department of Endocrinology, Key Laboratory of
Endocrinology, Ministry of Health, Peking Union Medical College Hospital,
Diabetes Research Center of Chinese Academy of Medical Sciences, Peking
Union Medical College, Beijing, China
(Cheng) Department of Cardiology, Key Laboratory of Cardiovascular
Remodeling and Function Research, Chinese Ministry of Education, Chinese
Ministry of Public Health, Qilu Hospital of Shandong University, Jinan,
China
Title
Does HbA1c Level Have Clinical Implications in Diabetic Patients
Undergoing Coronary Artery Bypass Grafting? A Systematic Review and
Meta-Analysis.
Source
International Journal of Endocrinology. 2017 (no pagination), 2017.
Article Number: 1537213. Date of Publication: 2017.
Publisher
Hindawi Limited (410 Park Avenue, 15th Floor, 287 pmb, New York NY 10022,
United States)
Abstract
Aims/Introduction. The aim of the present study was to investigate whether
HbA1c was related to clinical outcomes in diabetic patients undergoing
CABG surgery. Materials and Methods. A literature search was carried out
satisfying the predefined inclusion criteria from Pubmed, Embase, and
Cochrane Library. Differences were expressed as odds ratios (ORs) with 95%
confidence intervals (CIs) to assess the relationships of preoperative
HbA1c levels and clinical prognosis in diabetic patients. Results. 7895
diabetic patients undergoing CABG surgery from eight published studies
were finally involved in this meta-analysis. Combined analyses revealed
that the higher HbA1c level was significantly associated with increased
risks of all-cause mortality (OR 1.56, 95%CI 1.29-1.88), myocardial
infarction (OR 2.37, 95%CI 1.21-4.64), and stroke (OR 2.07, 95%CI
1.29-3.32) after CABG surgery. However, there was no significant
relationship between HbA1c levels and renal failure (OR 2.08, 95%CI
0.96-4.54) in diabetic patients undergoing CABG surgery. Conclusions. Our
meta-analysis demonstrated that the HbA1c level is potentially associated
with increased risks of all-cause mortality, myocardial infarction, and
stroke in diabetic subjects undergoing CABG surgery. However, further
clinical studies with larger sample sizes and longer follow-up period are
urgently warranted.<br/>Copyright &#xa9; 2017 Jia Zheng et al.

<37>
Accession Number
618688563
Author
Vidal-Petiot E.; Stebbins A.; Chiswell K.; Ardissino D.; Aylward P.E.;
Cannon C.P.; Ramos Corrales M.A.; Held C.; Lopez-Sendon J.L.; Stewart
R.A.H.; Wallentin L.; White H.D.; Steg P.G.
Institution
(Vidal-Petiot, Steg) Cardiology and Physiology Departments, Departement
Hospitalo-Universitaire FIRE, AP-HP, Hopital Bichat, 46 rue Henri Huchard,
Paris 75018, France
(Vidal-Petiot, Steg) Paris Diderot University, Sorbonne Paris Cite, Paris,
France
(Vidal-Petiot) INSERM U1149, Paris, France
(Stebbins, Chiswell) Duke Clinical Research Institute, Duke University
Medical Center, 2400 Pratt Street, Durham, NC 27705, United States
(Ardissino) Azienda Ospedaliero, Universitaria di Parma, Via Gramsci 14,
Parma 43126, Italy
(Aylward) South Australian Health and Medical Research Institute, Flinders
University and Medical Centre, Adelaide, Australia
(Cannon) Cardiovascular Division, Brigham and Women's Hospital, 70 Francis
street, Boston, MA 02115, United States
(Ramos Corrales) San Jose Satelite Hospital, Naucalpan, Circunvalacion
Poniente 53, Naucalpan de Juarez 53100, Mexico
(Held, Wallentin) Department of Medical Sciences, Cardiology and Uppsala
Clinical Research Center, Uppsala University, Dag Hammarskjolds vag 14B,
Uppsala SE-752 37, Sweden
(Lopez-Sendon) Hospital Universitario la Paz, IdiPaz, Paseo de la
Castellana 261, Madrid 28046, Spain
(Stewart, White) Green Lane Cardiovascular Service, Auckland City
Hospital, University of Auckland, Private Bag 92024, Auckland 1030, New
Zealand
(Steg) NHLI Imperial College, ICMS, Royal Brompton Hospital, London,
United Kingdom
Title
Visit-to-visit variability of blood pressure and cardiovascular outcomes
in patients with stable coronary heart disease. Insights from the
STABILITY trial.
Source
European Heart Journal. 38 (37) (pp 2813-2822), 2017. Date of Publication:
01 Oct 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims To study the relation between visit-to-visit variability of blood
pressure (BP) and cardiovascular risk in patients with stable coronary
heart disease. Methods and results In 15 828 patients from the STABILITY
trial (darapladib vs. placebo in patients with established coronary heart
disease), BP variability was assessed by the standard deviation (SD) of
systolic BP, the SD of diastolic BP, maximum BP, and minimum BP, from 5
measurements (baseline and months 1, 3, 6, and 12) during the first year
after randomisation. Mean (SD) average BP during the first year of study
was 131.0 (13.7) mmHg over 78.3 (8.3) mmHg. Mean (SD) of the
visit-to-visit SD was 9.8 (4.8) mmHg for systolic and 6.3 (3.0)mmHg for
diastolic BP. During the subsequent median follow-up of 2.6 years, 1010
patients met the primary endpoint, a composite of time to cardiovascular
death, myocardial infarction, or stroke. In Cox regression models adjusted
for average BP during first year of study, baseline vascular disease,
treatment, renal function and cardiovascular risk factors, the primary
endpoint was associated with SD of systolic BP (hazard ratio for highest
vs. lowest tertile, 1.30, 95% CI 1.10-1.53, P = 0.007), and with SD of
diastolic BP (hazard ratio for highest vs. lowest tertile, 1.38, 95% CI
1.18-1.62, P < 0.001). Peaks and troughs in BP were also independently
associated with adverse events. Conclusion In patients with stable
coronary heart disease, higher visit-to-visit variabilities of both
systolic and diastolic BP are strong predictors of increased risk of
cardiovascular events, independently of mean BP.

<38>
Accession Number
618551751
Author
Chatterjee A.; Bajaj N.S.; McMahon W.S.; Cribbs M.G.; White J.S.;
Mukherjee A.; Law M.A.
Institution
(Chatterjee, Bajaj, Cribbs) Division of Cardiovascular Diseases,
University of Alabama at Birmingham, AL, United States
(McMahon, Cribbs, Law) Department of Pediatric Cardiology, University of
Alabama at Birmingham, AL, United States
(White) Department of Internal Medicine, University of Alabama at
Birmingham, AL, United States
(Mukherjee) School of Public Health, University of Alabama at Birmingham,
AL, United States
Title
Transcatheter pulmonary valve implantation: A comprehensive systematic
review and meta-analyses of observational studies.
Source
Journal of the American Heart Association. 6 (8) (no pagination), 2017.
Article Number: e006432. Date of Publication: 01 Aug 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--Transcatheter pulmonary valve implantation is approved for the
treatment of dysfunctional right ventricle to pulmonary artery conduits.
However, the literature is limited because of a small patient population,
and it does not reflect changing procedural practice patterns over the
last decade. Methods and Results--A comprehensive search of Medline and
Scopus databases from inception through August 31, 2016 was conducted
using predefined criteria. We included studies reporting transcatheter
pulmonary valve implantation in at least 5 patients with a follow-up
duration of 6 months or more. In 19 eligible studies, 1044 patients
underwent transcatheter pulmonary valve implantation with a pooled
follow-up of 2271 person-years. Procedural success rate was 96.2% (95%
confidence intervals [CI], 94.6-97.4) with a conduit rupture rate of 4.1%
(95% CI, 2.5-6.8) and coronary complication rate of 1.3% (95% CI,
0.7-2.3). Incidence of reintervention was 4.4 per 100 person-years overall
(95% CI, 3.0-5.9) with a marked reduction in studies reporting >=75%
prestenting (2.9 per 100 person-years [95% CI, 1.5-4.3] versus 6.5/100
person-years [95% CI, 4.6-8.5]; P < 0.01). Pooled endocarditis rate was
1.4 per 100 person-years (95% CI, 0.9-2.0). Conclusions--Our study
provides favorable updated estimates of procedural and follow-up outcomes
after transcatheter pulmonary valve implantation. Widespread adoption of
prestenting has improved longer-term outcomes in these
patients.<br/>Copyright &#xa9; 2017 The Authors and Medtronic.

<39>
Accession Number
618551653
Author
Hahalis G.; Aznaouridis K.; Tsigkas G.; Davlouros P.; Xanthopoulou I.;
Koutsogiannis N.; Koniari I.; Leopoulou M.; Costerousse O.; Tousoulis D.;
Bertrand O.F.
Institution
(Hahalis, Tsigkas, Davlouros, Xanthopoulou, Koutsogiannis, Koniari,
Leopoulou) Patras University Hospital Rio, Rio, Patras, Greece
(Aznaouridis, Tousoulis) Hippokration Hospital, Athens Medical School,
Athens, Greece
(Aznaouridis) Castle Hill Hospital, Cottingham, United Kingdom
(Costerousse, Bertrand) Quebec Heart-Lung Institute, Quebec, Canada
Title
Radial artery and ulnar artery occlusions following coronary procedures
and the impact of anticoagulation: ARTEMIS (radial and ulnar artery
occlusion meta-analysis) systematic review and meta-analysis.
Source
Journal of the American Heart Association. 6 (8) (no pagination), 2017.
Article Number: e005430. Date of Publication: 01 Aug 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--Incidence of radial artery occclusions (RAO) and ulnar artery
occclusions (UAO) in coronary procedures, factors predisposing to forearm
arteries occlusion, and the benefit of anticoaggulation vary significantly
in existing literature. We sought to determine the incidence of RAO/UAO
and the impact of anticoagulation intensity. Methods and
Results--Meta-analysis of 112 studies assessing RAO and/or UAO (N=46 631)
were included. Overall, there was no difference between crude RAO and UAO
rates (5.2%; 95% confidence interval [CI], 4.4-6.0 versus 4.0%; 95% CI,
2.8-5.8; P=0.171). The early occlusion rate (in-hospital or within 7 days
after procedure) was higher than the late occlusion rate. The detection
rate of occlusion was higher with vascular ultrasonography compared with
clinical evaluation only. Low-dose heparin was associated with a
significantly higher RAO rate compared with high-dose heparin (7.2%; 95%
CI, 5.5-9.4 versus 4.3%; 95% CI, 3.5-5.3; Q=8.81; P=0.003). Early
occlusions in low-dose heparin cohorts mounted at 8.0% (95% CI, 6.1-10.6).
The RAO rate was higher after diagnostic angiographies compared with
coronary interventions, presumably attributed to the higher intensity of
anticoagulation in the latter group. Hemostatic techniques (patent versus
nonpatent hemostasis), geography (US versus non-US cohorts) and sheath
size did not impact on vessel patency. Conclusions--RAO and UAO occur with
similar frequency and in the order of 7% to 8% when evaluated early by
vascular ultrasonography following coronary procedures. More-intensive
anticoagulation is protective. Late recanalization occurs in a substantial
minority of patients.<br/>Copyright &#xa9; 2017 The Authors and Medtronic.

<40>
Accession Number
52344744
Author
Ebade A.A.; Khalil M.A.; Mohamed A.K.
Institution
(Ebade, Khalil, Mohamed) Department of Anesthesia, Faculty of Medicine,
Cairo University, Cairo, Egypt
(Khalil) Department of Anesthesia, Saad Specialist Hospital, Prince Faisal
Bin Fahad Street, Al-Khobar 31952, Saudi Arabia
Title
Levosimendan is superior to dobutamine as an inodilator in the treatment
of pulmonary hypertension for children undergoing cardiac surgery.
Source
Journal of Anesthesia. 27 (3) (pp 334-339), 2013. Date of Publication:
June 2013.
Publisher
Springer Japan (1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg., Tokyo
102-0073, Japan)
Abstract
Purpose: To compare the effectiveness of levosimendan and dobutamine in
reducing pulmonary artery pressure (PAP) and increasing cardiac output for
children undergoing cardiac surgery. Patients and methods: The study
included 50 patients with high systolic pulmonary artery pressure (PAP)
undergoing surgical repair of cardiac septal defects. Patients were
randomly allocated to two equal groups: group L received levosimendan and
group D received dobutamine. PAP was measured preoperatively, by use of
transthoracic echocardiography (baseline), intraoperatively, directly, by
use of a 22-gauge catheter inserted in the pulmonary artery, and
postoperatively, by use of transesophageal echocardiography (TEE). Cardiac
index (CI) was recorded by use of a transesophageal 4-MHz Doppler probe.
Results: Both drugs significantly reduced PAP compared with the level at
the time of induction of anesthesia. Mean PAP measurement before chest
closure, 1 and 20 h after ICU admission were significantly lower for
patients who received levosimendan (32.7 +/- 4.1, 25.8 +/- 2.8, 19.8 +/- 2
mmHg, respectively) than for those who received dobutamine (37.6 +/- 2.75,
32.8 +/- 2.36, 26.5 +/- 2.2 mmHg, respectively). Both drugs significantly
improved CI compared with its level at the time of induction of
anesthesia. Mean CI measurements 5 min after weaning from cardiopulmonary
bypass (CPB) until 20 h after ICU admission were significantly higher for
patients who received levosimendan than for those who received dobutamine
(3.55 +/- 0.35, 3.8 +/- 0.36, 3.81 +/- 0.34, respectively, in group L vs.
3.4 +/- 0.36, 3.6 +/- 0.33, 3.66 +/- 0.29, respectively, in group D).
Conclusion: Levosimendan is better than dobutamine for treatment of
pulmonary hypertension of children undergoing cardiac surgery. &#xa9; 2012
Japanese Society of Anesthesiologists.

<41>
Accession Number
617044344
Author
Kowalewski M.; Raffa G.M.; Szwed K.A.; Anisimowicz L.
Institution
(Kowalewski, Anisimowicz) Department of Cardiac Surgery, Dr Antoni Jurasz
Memorial University Hospital, Bydgoszcz, Poland
(Kowalewski) Department of Hygiene, Epidemiology and Ergonomics, Division
of Ergonomics and Physical Effort, Collegium Medicum UMK, Bydgoszcz,
Poland
(Szwed) Department of Clinical Neuropsychology, Collegium Medicum UMK,
Bydgoszcz, Poland
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo
per I Trapianti e Terapie ad alta specializzazione), Palermo, Italy
Title
Meta-analysis to assess the effectiveness of topically used vancomycin in
reducing sternal wound infections after cardiac surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 154 (4) (pp 1320-1323.e3),
2017. Date of Publication: October 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)

<42>
Accession Number
614798887
Author
Vezzani A.; Manca T.; Brusasco C.; Santori G.; Cantadori L.; Ramelli A.;
Gonzi G.; Nicolini F.; Gherli T.; Corradi F.
Institution
(Vezzani, Manca, Ramelli, Nicolini, Gherli) Department of Surgery,
University Hospital of Parma, Parma, Italy
(Brusasco, Corradi) Anaesthesia and Intensive Care Unit, E.O. Ospedali
Galliera, Mura Della Cappuccine 14, Genoa 16128, Italy
(Santori) Department of Surgical Sciences and Integrated Diagnostics,
University of Genoa, Genoa, Italy
(Cantadori) Department of Emergency Medicine, Fidenza Hospital, AUSL of
Parma, Parma, Italy
(Gonzi) Department of Cardiology, University Hospital of Parma, Parma,
Italy
Title
A randomized clinical trial of ultrasound-guided infra-clavicular
cannulation of the subclavian vein in cardiac surgical patients:
short-axis versus long-axis approach.
Source
Intensive Care Medicine. 43 (11) (pp 1594-1601), 2017. Date of
Publication: 01 Nov 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: The aim of this study was to compare the success rate and safety
of short-axis versus long-axis approaches to ultrasound-guided subclavian
vein cannulation. Methods: A total of 190 patients requiring central
venous cannulation following cardiac surgery were randomized to either
short-axis or long-axis ultrasound-guided cannulation of the subclavian
vein. Each cannulation was performed by anesthesiologists with at least 3
years' experience of ultrasound-guided central vein cannulation (>150
procedures/year, 50% short-axis and 50% long-axis). Success rate,
insertion time, number of needle redirections, number of separate skin or
vessel punctures, rate of mechanical complications, catheter
misplacements, and incidence of central line-associated bloodstream
infection were documented for each procedure. Results: The subclavian vein
was successfully cannulated in all 190 patients. The mean insertion time
was significantly shorter (p = 0.040) in the short-axis group (69 +/- 74
s) than in the long-axis group (98 +/- 103 s). The short-axis group was
also associated with a higher overall success rate (96 vs. 78%, p <
0.001), first-puncture success rate (86 vs. 67%, p = 0.003), and
first-puncture single-pass success rate (72 vs. 48%, p = 0.002), and with
fewer needle redirections (0.39 +/- 0.88 vs. 0.88 +/- 1.15, p = 0.001),
skin punctures (1.12 +/- 0.38 vs. 1.28 +/- 0.54, p = 0.019), and
complications (3 vs. 13%, p = 0.028). Conclusions: The short-axis
procedure for ultrasound-guided subclavian cannulation offers advantages
over the long-axis approach in cardiac surgery patients.<br/>Copyright
&#xa9; 2017, Springer-Verlag Berlin Heidelberg and ESICM.

<43>
Accession Number
618754954
Author
Miller K.; Greenwood J.
Institution
(Miller, Greenwood) Worcestershire Royal Hospital, United Kingdom
Title
Williams syndrome, hyponatraemia and an emergency laparotomy.
Source
Anaesthesia. Conference: Annual Congress of the Association of
Anaesthetists of Great Britain and Ireland, AAGBI 2017. United Kingdom. 72
(Supplement 4) (pp 28), 2017. Date of Publication: September 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Williams syndrome (WS) is a congenital condition affecting up to 1 in
20,000 live births due to a genetic deletion on the long arm of chromosome
7 [1,2]. Features of WS include an elfin face, hypercalcaemia, learning
difficulties and cardiac abnormalities (especially supra-valvular aortic
stenosis) and a documented association with malignant hyperpyrexia [1],
and sudden death under anaesthesia [2]. A Medline search with the combined
terms of Williams syndrome and anaesthesia yielded 18 papers with a
majority of paediatric cases. Description Our patient, a 45-year-old
female with a history of WS (including an elfin face and learning
difficulties but no cardiac abnormality), bladder calculi and hypertension
presented with an Escherichia coli urinary tract infection and
hyponatraemia (113). Her GP had started nitrofurantoin 6 days previously.
Despite stopping her bendroflumethiazide and a fluid restriction on day 1,
stopping citalopram and commencing rehydration on day 2, her hyponatraemia
did not fully resolve. On day 11 she developed diarrhoea with the
suspicion of melaena. A blood count on day 12 revealed a haemoglobin
concentration of 65 mg.l^-1 and subsequent endoscopy identified
a perforated duodenal ulcer. She then clinically decompensated with an
arterial blood gas showing: pH 6.8 and lactate 10. Resuscitation and rapid
transfer to theatre with induction of fentanyl 100 mug, propofol 20 mg and
rocuronium 40 mg prevented cardiovascular instability. Endotracheal
intubation was easily achieved and maintenance was oxygen/air/sevoflurane.
Central and arterial lines enabled cardiac output monitoring and the
metabolic acidosis improved with targeted fluid resuscitation.
Postoperative admission to the Intensive Care Unit on low dose
noradrenaline resulted in extubation 1 day later and discharge home on
postoperative day 8. Discussion There is limited literature for patients
with WS undergoing anaesthesia; especially for adult patients. Our case
shows that with a carefully planned induction, targeted fluids and
sevoflurane maintenance, an adult patient with WS can safely undergo
anaesthesia for emergency laparotomy. Planning for a difficult intubation
is essential, although here it was uneventful despite the elfin features
and small mandible. A previous echocardiogram showed no cardiac
abnormalities and this may have positively affected this patient's
outcome. Pre-operative assessment of cardiac and airway involvement is
essential to minimise complications intra-operatively.

<44>
Accession Number
618754844
Author
Blaudszun G.; Zochios V.; Butchart A.; Earwaker M.; Lawson-Brown W.; Jones
N.; Klein A.
Institution
(Blaudszun, Butchart, Earwaker, Lawson-Brown, Jones, Klein) Papworth
Hospital, NHS Foundation Trust, Cambridge, United Kingdom
(Zochios) University Hospitals Birmingham, NHS Foundation Trust, United
Kingdom
Title
A randomised controlled trial of highflow nasal oxygen (OptiflowTM) in
highrisk cardiac surgical patients.
Source
Anaesthesia. Conference: Annual Congress of the Association of
Anaesthetists of Great Britain and Ireland, AAGBI 2017. United Kingdom. 72
(Supplement 4) (pp 15), 2017. Date of Publication: September 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Cardiac surgical patients are at high risk of postoperative pulmonary
complications. Prophylactic continuous positive airway pressure therapy
(CPAP) reduces pulmonary complications and ICU readmission [1]. However,
it is costly, frequently requires admission to a higher dependency area of
the hospital and is associated with patient discomfort. High-flow nasal
oxygen therapy (HFNO) delivers low-level, flow-dependent positive airway
pressure and is better tolerated than CPAP. We have previously
demonstrated that HFNO after thoracic surgery reduces hospital
length-of-stay (LoS) and improves patient-reported functional recovery
[2]. Methods We conducted a randomised controlled blinded clinical trial.
Adult patients undergoing elective cardiac surgery were included if they
had one or more of the following risk factors for postoperative pulmonary
complications: chronic obstructive pulmonary disease; asthma; lower
respiratory tract infection; BMI >= 35 kg.m^-2; or current
smoker. Patients were randomly assigned to either postoperative HFNO
(OptiflowTMFisher and Paykel Healthcare, Auckland, New Zealand) or
standard oxygen (SO, soft face mask or nasal prongs) immediately after
extubation in the ICU. Oxygen therapy was discontinued after 24 h unless
clinically indicated. Our power calculation was based on an audit which
showed mean (SD) hospital LoS days to be 10 (3) in highrisk patients. We
expected HFNO to reduce this by 2 days, and using Wilcoxon's rank sum test
at a power of 90% and 5% significance, we calculated that at least 45
patients would be required in each group. Results One hundred patients
were enrolled, 1 had surgery cancelled and was not studied; 51 were
randomly allocated to HFNO and 48 to SO (Table 1). Analysis for the
primary outcome showed that HFNO led to a reduction in mean hospital LoS
by 4.7 days (95% CI 1.6-7.9) from 13.4 (9.9) to 8.6 (4.3) days, p = 0.004.
This equated to a 31% relative reduction in geometric mean LoS (RR 0.69,
95% CI 0.54-0.87; p = 0.002). HFNO was also associated with fewer ICU
readmissions (1/51 vs. 7/48; p = 0.028). Discussion When compared with
standard care, prophylactic postoperative use of HFNO in high-risk cardiac
surgical patients reduced hospital stay and readmission to ICU. We
recommend routine use of HFNO after extubation in this cohort of patients.

<45>
Accession Number
618755368
Author
Rivoisy C.; Vena A.; Schaeffer L.; Charlier C.; Delahaye F.; Fontanet A.;
Bouza E.; Lortholary O.; Munoz P.; Lefort A.
Institution
(Rivoisy) Universitary Hospital, Bordeaux, France
(Vena, Bouza, Munoz) Hospital General Universitario Gregorio Maranon,
Madrid, Spain
(Schaeffer, Fontanet) Institut Pasteur, Paris, France
(Charlier, Lortholary) Necker Hospital, Paris, France
(Delahaye) Universitary Hospital, Lyon, France
(Lefort) Beaujon Hospital, Clichy, France
Title
Prosthetic valve Candida spp. endocarditis: New insights into long term
prognosis-the ESCAPE study.
Source
Mycoses. Conference: 8th Congress on Trends in Medical Mycology, TIMM
2017. Serbia. 60 (Supplement 2) (pp 96), 2017. Date of Publication:
September 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Prosthetic valve endocarditis caused by Candida spp. (PVE-C)
is rare and devastating, with international guidelines based on expert
recommendations consisting in the combination of surgery and subsequent
azole treatment. Methods: PVE-C collected in Spain and France between 2001
and 2015 were retrospectively analyzed with a focus on management and
outcome. Results: Forty-six cases were followed up for a median of 9
months. Twenty-two cardiac valve surgeries were performed, 15 patients
received an echinocandin-based therapy and 21 an amphotericin B-based
therapy; 24 patients received a long-term azole treatment (maintenance
therapy). After multivariate analysis, older patients (aOR [95% IC]:0.14
[0.03-0.62]) and cardiac failure (aOR [95% IC]:0.09 [0.01-0.87]) were
associated with lower odds of being operated. Surgery did not protect
against 6 month mortality, suggesting that surgery is not mandatory for
patients with poor clinical status or with uncomplicated endocarditis.
Nine patients relapsed at least once. Overall, 5/10 (50%) of patients not
receiving maintenance treatment relapsed versus 4/21 (19%) of patients
receiving maintenance therapy; among operated patients, those receiving a
maintenance treatment had a 15% relapse rate, as compared to 50% in those
not receiving long-term azoles. A shorter duration of antifungal treatment
was associated with a higher mortality at 6 months (aOR [95% CI] 5.68
[1.18-27.46], P = .03), while the initial use of liposomal amphotericin B
was associated with lower mortality rates (aOR [95%CI] 0.08 [0.01-0.48], P
= .01). Conclusion: During PVE-C, cardiac surgery does appear to have a
positive impact for patients with uncomplicated endocarditis, while
maintenance azole treatment is effective and well tolerated among both
operated and non-operated patients.

<46>
Accession Number
618754999
Author
Kitchen C.; Alston P.; Just G.; McKenzie C.
Institution
(Kitchen, McKenzie) University of Edinburgh, United Kingdom
(Alston) NHS Lothian, United Kingdom
(Just) Queen's Medical Research Institute, United Kingdom
Title
Does the type of oxygenator influence arterial blood concentration of
isoflurane during cardiopulmonary bypass?.
Source
Anaesthesia. Conference: Annual Congress of the Association of
Anaesthetists of Great Britain and Ireland, AAGBI 2017. United Kingdom. 72
(Supplement 4) (pp 35), 2017. Date of Publication: September 2017.
Publisher
Blackwell Publishing Ltd
Abstract
During cardiopulmonary bypass (CPB), volatile anaesthetic agents may be
delivered via the oxygenator's sweep gas supply. However, differences in
oxygenator design may affect the quantity of agent reaching the blood, and
therefore anaesthetic depth. Previous research has shown significant
differences in arterial isoflurane concentration when comparing bubble or
polymethylpentene to polypropylene oxygenators. This study was novel in
comparing two polypropylene oxygenators. Anaesthetic depth reached by the
agent may be monitored using an electroencephalographic technique, the
bispectral index score (BIS), although this is controversial during CPB
[1]. It has been proposed that monitoring exhaust isoflurane concentration
may be an alternative method [2]. Methods This study was a single-centre
randomised control trial occurring over 3 months. Consenting adult
patients presenting for elective cardiac surgery using CPB, in whom
volatile anaesthesia was used throughout, were randomised into having the
Sorin Inspire (n = 2) or the Medtronic Affinity Fusion oxygenator (n = 13)
used during CPB. Arterial samples were taken at time points representing
cooling, stable hypothermia and rewarming. These were analysed using gas
chromatography and mass spectrometry. BIS, exhaust isoflurane
concentrations and other variables were also recorded. Results No
statistically significant difference was found in the mean arterial
isoflurane concentration between oxygenators; 5.5 mug.ml^-1
(7.99), p = 0.50. Exhaust isoflurane concentration is strongly correlated
with arterial isoflurane concentration (r = 0.810), although these two
variables did not act as predictors of BIS; r2 = 0.248, p = 0.320.
Discussion This study reassures anaesthetists that either oxygenator may
be used during CPB without affecting arterial isoflurane concentration,
and therefore anaesthetic depth. However, it is unclear whether this is
generalisable to other oxygenator models, particularly polymethylpentene
oxygenators. Additionally, it has added to the increasing evidence
suggesting that BIS may not accurately reflect anaesthetic depth during
CPB. Results suggest consideration of exhaust isoflurane concentration as
an alternate to BIS.

<47>
Accession Number
618754987
Author
Anonymous
Title
Abstracts of the AAGBI Annual Congress.
Source
Anaesthesia. Conference: Annual Congress of the Association of
Anaesthetists of Great Britain and Ireland, AAGBI 2017. United Kingdom. 72
(Supplement 4) (no pagination), 2017. Date of Publication: September 2017.
Publisher
Blackwell Publishing Ltd
Abstract
The proceedings contain 148 papers. The topics discussed include: use of
sugammadex for reversal of rocuronium after emergency laparotomy in a
patient with brittle myasthenia gravis; no 'one-size fits all': difficult
sizing of endotracheal tube in a south-east Asian woman with a narrow
transverse subglottic diameter; major haemorrhage from an epidural
insertion site; chlorhexidine: a hidden allergen; a rare cause of
worsening neurology in late pregnancy: the diagnostic conundrum;
intra-operative management of undiagnosed paraganglioma; extracorporeal
membrane oxygenation-CPR for refractory circulatory arrest during elective
hysteroscopy: the future of peri-operative resuscitation?; successful
cardiac arrest management and outcome following the cardiac advanced life
support approach; a prospective cohort study of extravascular lung water
in pulmonary endarterectomy: an in vivo example of reperfusion lung
injury; oxygenation in children during sevoflurane inhalational induction
with and without nitrous oxide; the effect of biliary aetiologies vs.
hepatocellular aetiologies vs. hepatocellular carcinoma on the ROTEM
profiles in patients undergoing elective liver transplant surgery: a
cohort study; analysis of registration rigour of randomised controlled
trials published in anaesthesia; primary care data and elective hip
surgery: mortality and the electronic frailty index; utilisation of jugaad
innovation techniques to develop a low-cost simulation manikin - PiBaby;
postoperative acute kidney injury prediction in orthopaedic surgery
patients by urinary peptide panel: a cohort study; and in elderly
patients, does a combined haemoglobin-ASA-timed up and go score better
predict postoperative mortality and morbidity than ASA grade alone?.

<48>
Accession Number
618754975
Author
Charlesworth M.; Venkateswaran R.; Barnard J.; Barker J.; Feddy L.
Institution
(Charlesworth) Health Education North West (Manchester), United Kingdom
(Venkateswaran, Barnard, Barker, Feddy) University Hospital South
Manchester, United Kingdom
Title
Extracorporeal life support for postcardiotomy cardiogenic shock: A
systematic review.
Source
Anaesthesia. Conference: Annual Congress of the Association of
Anaesthetists of Great Britain and Ireland, AAGBI 2017. United Kingdom. 72
(Supplement 4) (pp 32), 2017. Date of Publication: September 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Following a recent departmental audit of patients treated with
extracorporeal life support (ECLS) for refractory postcardiotomy
cardiogenic shock (PCCS), where 30-day and 2-year mortality was found to
be 50% [1], we wished to compare our data with other centres. We found one
review paper [2], with several studies possibly missing from the analysis.
We therefore decided to conduct our own systematic review of the topic.
Methods We systematically searched the electronic databases MEDLINE,
Embase and Google, from 1990 to 2017. The keywords were 'ECMO', 'ECLS',
'AMCS', 'extracorporeal', 'mechanical circulatory support',
'postcardiotomy', 'PCCS', 'cardiotomy', and 'cardiac surgery', among
others. (Full protocol available). Results From 11,005 initial citations,
27 papers were included for analysis. All were retrospective observational
case-series. No randomised controlled, casecontrolled, or propensity
matched studies were identified. Mixtures of outcomes were reported,
including the number weaned and discharged, and a range of mortalities.
The reported results were wide-ranging, and as it was not possible to
determine the heterogeneity of the data, we decided against the pooling of
outcomes. Where the mode of support was VA-ECMO, as in our study [1], we
were unable to find evidence of better results from other centres in terms
of 30-day and 2-year mortality. Discussion The use of ECLS for refractory
PCCS is an evolving science with a limited evidence base. The incidence of
its use in our centre is around 0.7% for each non-transplant cardiac case
undertaken. This niche patient population is therefore difficult to
prospectively study or randomise in a single-centre. There are several
problems with regards using a randomised controlled trial, as it may be
unethical to randomise patients to a poor outcome, and adequate power may
not be achieved. The reporting of outcomes for patients receiving ECLS in
this context is imprecise, with many different definitions and modes of
mechanical circulatory support. As such, we cannot be wholly confident
that all relevant studies have been included. Regardless, there is now a
need to move beyond the reporting of singlecentre observations, and look
towards other designs, such as a multicentred propensity matched study. An
investigation of the quality of life following discharge, and a cost
utility analysis of the intervention are also needed.

<49>
[Use Link to view the full text]
Accession Number
618737018
Author
Cho S.-M.; Deshpande A.; Pasupuleti V.; Hernandez A.V.; Uchino K.
Institution
(Cho, Deshpande, Pasupuleti, Hernandez, Uchino) From the Cerebrovascular
Center, Neurological Institute (S.-M.C., K.U.) and Medicine Institute
(A.D.), Cleveland Clinic, OH; ProEd Communications Inc, Cleveland, OH
(V.P.); School of Medicine, Universidad Peruana de Ciencias Aplicadas,
Lima, Peru (A.V.H.); School of Pharmacy, University of Connecticut, Storrs
(A.V.H.); and Hartford Hospital Evidence-Based Practice Center, CT
(A.V.H.)
Title
Radiographic and Clinical Brain Infarcts in Cardiac and Diagnostic
Procedures: A Systematic Review and Meta-Analysis.
Source
Stroke. 48 (10) (pp 2753-2759), 2017. Date of Publication: 01 Oct 2017.
Abstract
BACKGROUND AND PURPOSE: The incidence of periprocedural brain infarcts
varies among cardiovascular procedures. In a systematic review, we
compared the ratio of radiographic brain infarcts (RBI) to strokes and
transient ischemic attacks across cardiac and vascular procedures.
METHODS: We searched MEDLINE and 5 other databases for brain infarcts in
aortic valve replacement, coronary artery bypass grafting, cardiac
catheterization, and cerebral angiogram through September 2015. We
followed the PRISMA (preferred reporting items for systematic reviews and
meta-analyses) recommendations. We defined symptomatic rate ratio (RR) as
ratio of stroke plus transient ischemic attack rate to RBI rate.
RESULTS: Twenty-nine studies involving 2124 subjects met the inclusion
criteria. In meta-analysis of aortic valve replacements with 494 people,
69.4% (95% confidence interval (CI), 57.6%-81.4%) had RBIs, whereas 3.6%
(95% CI, 2.0%-5.2%) had clinical events (RR, 0.08; 95% CI, 0.05-0.12).
Coronary artery bypass grafting among 204 patients had 27.4% (95% CI,
6.0%-48.8%) RBIs and 2.4% (95% CI, 0.3%-4.5%) clinical events (RR, 0.11;
95% CI, 0.05-0.26). Cardiac catheterization among 833 people had 8.0% (95%
CI, 4.1%-12.0%) RBIs, and 0.6% (95% CI, 0.1%-1.1%) had clinical events
(RR, 0.16; 95% CI, 0.08-0.31). Cerebral angiogram among 593 people had
12.8% (95% CI, 6.6-19.0) RBIs and 0.6% (95% CI, 0%-13%) clinical events
(RR, 0.10; 95% CI, 0.04-0.27). The RR of all procedures was 0.10 (95% CI,
0.07-0.13) without differences in the RRs across procedures (P=0.29).
CONCLUSIONS: One of 10 people with periprocedural RBIs during cardiac
surgeries and invasive vascular diagnostic procedures resulted in strokes
or transient ischemic attacks, which may serve as a potential surrogate
marker of procedural proficiency and perhaps as a predictor of risk for
periprocedural strokes.<br/>Copyright &#xa9; 2017 American Heart
Association, Inc.

<50>
[Use Link to view the full text]
Accession Number
618737012
Author
Weimar C.; Bilbilis K.; Rekowski J.; Holst T.; Beyersdorf F.; Breuer M.;
Dahm M.; Diegeler A.; Kowalski A.; Martens S.; Mohr F.W.; Ondrasek J.;
Reiter B.; Roth P.; Seipelt R.; Siggelkow M.; Steinhoff G.; Moritz A.;
Wilhelmi M.; Wimmer-Greinecker G.; Diener H.-C.; Jakob H.; Ose C.; Scherag
A.; Knipp S.C.
Institution
(Weimar, Bilbilis, Rekowski, Holst, Beyersdorf, Breuer, Dahm, Diegeler,
Kowalski, Martens, Mohr, Ondrasek, Reiter, Roth, Seipelt, Siggelkow,
Steinhoff, Moritz, Wilhelmi, Wimmer-Greinecker, Diener, Jakob, Ose,
Scherag, Knipp) From the Universitatsklinikum Essen, Klinik fur
Neurologie, Germany (C.W., H.-C.D.); Universitatsklinikum Essen, Zentrum
fur Klinische Studien (ZKSE), Germany (K.B., C.O.); Universitatsklinikum
Essen, Institut fur Medizinische Informatik, Biometrie und Epidemiologie
(IMIBE), Germany (J.R.); Universitatsklinikum Essen, Klinik fur Thorax-
und Kardiovaskulare Chirurgie, Germany (T.H., H.J., S.C.K.);
Universitats-Herzzentrum Freiburg-Bad Krozingen, Klinik fur Herz- und
Gefaschirurgie, Germany (F.B.); Universitatsklinikum Jena, Klinik fur
Herz- und Thoraxchirurgie, Jena, Germany, now Zentralklinik Bad Berka,
Germany (M.B.); Westpfalz-Klinikum, Klinik fur Thorax-, Herz- und
Gefaschirurgie, Kaiserslautern, Germany (M.D.); Herz- und Gefasklinik Bad
Neustadt/Saale, Klinik fur Kardiochirurgie, Bad Neustadt an der Saale,
Germany (A.D.); Universitatsklinikum Schleswig-Holstein, Campus Kiel,
Klinik fur Herz- und Gefaschirurgie, Kiel, Germany (A.K., M.S.);
Universitatsklinikum Munster, Klinik fur Herzchirurgie, Germany (S.M.);
Herzzentrum Leipzig, Universitatsklinik, Klinik fur Herzchirurgie,
Leipzig, Germany (F.W.M.); Centrum Kardiovaskularni a Transplantacni
Chirurgie, Brno, Czech Republic (J.O.); Universitares Herzzentrum Hamburg,
Klinik und Poliklinik fur Herz- und Gefaschirurgie, Germany (B.R.);
Universitatsklinikum Giesen und Marburg, Herz-, Kinderherz- und
Gefaschirurgie, Giessen, Germany (P.R.); Universitatsmedizin Gottingen,
Abteilung fur Thorax-,Herz und Gefaschirurgie, Gottingen, Germany
Title
Safety of Simultaneous Coronary Artery Bypass Grafting and Carotid
Endarterectomy Versus Isolated Coronary Artery Bypass Grafting: A
Randomized Clinical Trial.
Source
Stroke. 48 (10) (pp 2769-2775), 2017. Date of Publication: 01 Oct 2017.
Abstract
BACKGROUND AND PURPOSE: The optimal operative strategy in patients with
severe carotid artery disease undergoing coronary artery bypass grafting
(CABG) is unknown. We sought to investigate the safety and efficacy of
synchronous combined carotid endarterectomy and CABG as compared with
isolated CABG.
METHODS: Patients with asymptomatic high-grade carotid artery stenosis
>=80% according to ECST (European Carotid Surgery Trial) ultrasound
criteria (corresponding to >=70% NASCET [North American Symptomatic
Carotid Endarterectomy Trial]) who required CABG surgery were randomly
assigned to synchronous carotid endarterectomy+CABG or isolated CABG. To
avoid unbalanced prognostic factor distributions, randomization was
stratified by center, age, sex, and modified Rankin Scale. The primary
composite end point was the rate of stroke or death at 30 days.
RESULTS: From 2010 to 2014, a total of 129 patients were enrolled at 17
centers in Germany and the Czech Republic. Because of withdrawal of
funding after insufficient recruitment, enrolment was terminated early. At
30 days, the rate of any stroke or death in the intention-to-treat
population was 12/65 (18.5%) in patients receiving synchronous carotid
endarterectomy+CABG as compared with 6/62 (9.7%) in patients receiving
isolated CABG (absolute risk reduction, 8.8%; 95% confidence interval,
-3.2% to 20.8%; PWALD=0.12). Also for all secondary end points at 30 days
and 1 year, there was no evidence for a significant treatment-group effect
although patients undergoing isolated CABG tended to have better outcomes.
CONCLUSIONS: Although our results cannot rule out a treatment-group effect
because of lack of power, a superiority of the synchronous combined
carotid endarterectomy+CABG approach seems unlikely. Five-year follow-up
of patients is still ongoing.
CLINICAL TRIAL REGISTRATION: URL: https://www.controlled-trials.com.
Unique identifier: ISRCTN13486906.<br/>Copyright &#xa9; 2017 The
Author(s).

<51>
Accession Number
618735857
Author
Kennon S.; Archbold A.
Institution
(Kennon, Archbold) Barts Heart Centre, St Bartholomew's Hospital, London,
United Kingdom
Title
Guidelines for the management of patients with aortic stenosis undergoing
non-cardiac surgery: Out of date and overly prescriptive.
Source
Interventional Cardiology Review. 12 (2) (pp 133-136), 2017. Date of
Publication: 2017.
Publisher
Radcliffe Publishing Ltd (E-mail: contact.us@radcliffemed.com)
Abstract
Patients with severe aortic stenosis who require non-cardiac surgery
present a difficult clinical problem. The most recent clinical practice
guidelines from the American College of Cardiology/American Heart
Association and the European Society of Cardiology for the perioperative
cardiovascular assessment and management of patients undergoing noncardiac
surgery were both published in 2014. These guidelines are reviewed in the
light of recently published randomised controlled trial data regarding the
efficacy of transcatheter aortic valve implantation to treat aortic
stenosis.<br/>Copyright &#xa9; Radcliffe Cardiology 2017.

<52>
Accession Number
618735847
Author
Sawaya F.J.; Sondergaard L.
Institution
(Sawaya, Sondergaard) The Heart Center, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark
Title
Will PARTNER 2 change my practice?.
Source
Interventional Cardiology Review. 12 (2) (pp 126-127), 2017. Date of
Publication: 2017.
Publisher
Radcliffe Publishing Ltd (E-mail: contact.us@radcliffemed.com)
Abstract
Transcatheter aortic valve implantation (TAVI) has become an established
and increasingly-used technique to treat patients with severe aortic valve
stenosis (AS) over the past decade. The clinical outcomes obtained with
TAVI have been found to be equivalent to surgical aortic valve replacement
(SAVR) in patients with a high-risk profile. Following the Placement of
Aortic Transcatheter Valves (PARTNER) 1 trial, which demonstrated the
utility of TAVI in inoperable and high-risk groups, the PARTNER 2 trial
was implemented. PARTNER 2 reflects the current TAVI practice in Europe,
confirms that transfemoral access is related to superior outcomes compared
to SAVR in a selected population and demonstrates improved results with
new-generation devices.<br/>Copyright &#xa9; Radcliffe Cardiology 2017.

<53>
Accession Number
618686712
Author
Nijs K.; Vandenbrande J.; Vaqueriza F.; Ory J.-P.; Yilmaz A.; Starinieri
P.; Dubois J.; Jamaer L.; Arijs I.; Stessel B.
Institution
(Nijs, Vandenbrande, Ory, Dubois, Jamaer, Stessel) Department of
Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
(Vandenbrande, Vaqueriza, Arijs, Stessel) Faculty of Medicine and Health
Sciences, Hasselt University, Hasselt, Belgium
(Yilmaz, Starinieri) Department of Cardiothoracic Surgery, Jessa Hospital,
Hasselt, Belgium
(Arijs) Limburg Clinical Research Program, Hasselt University and Jessa
Hospital, Hasselt, Belgium
(Stessel) Department of Anesthesiology, Maastricht University Medical
Center, Maastricht, Netherlands
Title
Neurological outcome after minimal invasive coronary artery surgery
(NOMICS): Protocol for an observational prospective cohort study.
Source
BMJ Open. 7 (10) (no pagination), 2017. Article Number: e017823. Date of
Publication: 01 Oct 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Adverse neurocognitive outcomes are still an important cause
of morbidity and mortality after cardiac surgery. The most common
neurocognitive disorders after conventional cardiac surgery are
postoperative cognitive dysfunction (POCD), stroke and delirium. Minimal
invasive cardiac procedures have recently been introduced into practice.
Endoscopic coronary artery bypass grafting (Endo-CABG) is a minimal
invasive cardiac procedure based on the conventional CABG procedure.
Neurocognitive outcome after minimal invasive cardiac surgery, including
Endo-CABG, has never been studied. Therefore, the main objective of this
study is to examine neurocognitive outcome after Endo-CABG. Methods and
analysis We will perform a prospective observational cohort study
including 150 patients. Patients are categorised into three groups: (1)
patients undergoing Endo-CABG, (2) patients undergoing a percutaneous
coronary intervention and (3) a healthy volunteer group. All patients in
the Endo-CABG group will be treated following a uniform, standardised
protocol. To assess neurocognitive outcome after surgery, a battery of six
neurocognitive tests will be administered at baseline and at 3-month
follow-up. In the Endo-CABG group, a neurological examination will be
performed at baseline and postoperatively and delirium will be scored at
the intensive care unit. Quality of life (QOL), anxiety and depression
will be assessed at baseline and at 3-month follow-up. Satisfaction with
Endo-CABG will be assessed at 3-month follow-up. Primary endpoints are the
incidence of POCD, stroke and delirium after Endo-CABG. Secondary
endpoints are QOL after Endo-CABG, patient satisfaction with Endo-CABG and
the incidence of anxiety and depression after Endo-CABG. Ethics and
dissemination The neurological outcome after minimal invasive coronary
artery surgery study has received approval of the Jessa Hospital ethics
board. It is estimated that the trial will be executed from December 2016
to January 2018, including enrolment and follow-up. Analysis of data,
followed by publication of the results, is expected in 2018. Trial
registration number NCT02979782.<br/>Copyright &#xa9; Article author(s)
2017.

<54>
Accession Number
618763459
Author
Dall'Ara G.; Marzocchi A.; Taglieri N.; Moretti C.; Rodino G.; Chiarabelli
M.; Bottoni P.; Marrozzini C.; Sabattini M.R.; Bacchi-Reggiani M.-L.;
Rapezzi C.; Saia F.
Institution
(Dall'Ara, Marzocchi, Taglieri, Moretti, Rodino, Chiarabelli, Bottoni,
Marrozzini, Sabattini, Bacchi-Reggiani, Rapezzi, Saia) Cardiology
UnitCardio-Thoraco-Vascular Department, University Hospital of Bologna,
Policlinico S. Orsola-MalpighiBolognaItaly
(Dall'Ara) Dottorato di ricerca XXXdegreeciclo, Scienze
Cardio-Nefro-ToracicheUniversity of BolognaBolognaItaly
Title
Randomized comparison of balloon aortic valvuloplasty performed with or
without rapid cardiac pacing: The pacing versus no pacing (PNP) study.
Source
Journal of Interventional Cardiology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: To compare the effectiveness and safety of balloon aortic
valvuloplasty (BAV) performed with or without rapid ventricular pacing
(RP). Background: BAV technique is poorly standardized. Methods: One
hundred consecutive patients were randomly assigned 1:1 between BAV
performed with or without RP. Exclusion criteria were an immediate
indication for surgical or transcatheter aortic valve replacement,
presentation in cardiogenic shock or pulmonary edema refractory to medical
stabilization. Results: There were 51 patients in the BAV group performed
with RP, 49 in the BAV group without RP (noRP). Procedural success (50%
hemodynamic gradient reduction) was achieved in 37.3% and 55.1%,
respectively (P=0.16). Fewer people in the noRP group complained of poor
tolerance to the procedure (16% vs 41%). The primary efficacy endpoint, a
50% reduction in the mean echocardiographic trans-aortic gradient, was met
in 21/49 patients in the noRP group compared to 20/51 in the RP (42.9% vs
39.2%; P=0.84). No significant difference between the groups was observed
in the primary safety endpoint, a 30-day composite of death, myocardial
infarction, stroke, acute aortic regurgitation, and BARC bleeding >=3
(8.2% noRP vs 13.7%; P=0.53). The noRP group required fewer bailout
temporary pacemakers (P=0.048) and had a lower incidence of
moderate/severe renal function worsening (4.1% vs 17.6%; P=0.052).
Conclusions: Rapid ventricular pacing did not influence BAV efficacy or
safety and tolerance was slightly worse.<br/>Copyright &#xa9; 2017, Wiley
Periodicals, Inc.

<55>
Accession Number
616750148
Author
Johnston L.E.; Downs E.A.; Hawkins R.B.; Quader M.A.; Speir A.M.; Rich
J.B.; Ghanta R.K.; Yarboro L.T.; Ailawadi G.
Institution
(Johnston, Downs, Hawkins, Ghanta, Yarboro, Ailawadi) Division of Thoracic
and Cardiovascular Surgery, Department of Surgery, University of Virginia,
Charlottesville, Virginia, United States
(Quader) Division of Cardiothoracic Surgery, Virginia Commonwealth
University, Richmond, Virginia, United States
(Speir) Inova Heart and Vascular Institute, Inova Fairfax Hospital,
Fairfax, Virginia, United States
(Rich) MidAtlantic Cardiothoracic Surgeons, Norfolk, Virginia, United
States
Title
Outcomes for Low-Risk Surgical Aortic Valve Replacement: A Benchmark for
Aortic Valve Technology.
Source
Annals of Thoracic Surgery. 104 (4) (pp 1282-1288), 2017. Date of
Publication: October 2017.
Publisher
Elsevier USA
Abstract
Background Two large, randomized trials are underway evaluating
transcatheter aortic valve replacement (AVR) against conventional surgical
AVR. We analyzed contemporary, real-world outcomes of surgical AVR in
low-risk patients to provide a practical benchmark of outcomes and cost
for evaluating current and future transapical AVR technology. Methods From
2010 to 2015, 2,505 isolated AVR operations were performed for severe
aortic stenosis at 18 statewide cardiac institutions. Of these, 2,138
patients had a Society of Thoracic Surgeons predicted risk of mortality of
less than 4%, and 1,119 met other clinical and hemodynamic criteria as
outlined in the PARTNER 3 (The Placement of Transcatheter Aortic Valves)
protocol. Patients with endocarditis, end-stage renal disease, ejection
fraction of less than 0.45, bicuspid valves, and previous valve
replacements were excluded. Outcomes of interest included operative death
and postoperative adverse events. Results The median Society of Thoracic
Surgeons predicted risk of mortality for the study-eligible patients was
1.44%, with a median age of 72 years (interquartile range [IQR], 65 to 78
years). Operative mortality was 1.3%, permanent stroke was 1.3%, and
pacemaker requirement was 4.2%. The most common adverse events were
transfusion of 2 or more units of red blood cells (18%) and atrial
fibrillation (28%). The median length of stay was 6 days (IQR, 5 to 8
days). Median total hospital cost was $37,999 (IQR, $30,671 to $46,138).
Examination of complications by age younger than 65 vs 65 or older
demonstrated a significantly lower need for transfusion (11.2%, p < 0.001)
and incidence of atrial fibrillation (17.1%, p < 0.001) but no difference
in operative mortality (2.2% vs 0.9%, p = 0.1), major morbidity (10.4% vs
12.6%, p = 0.3), or total hospital costs. Conclusions Low-risk patients
undergoing surgical AVR in the current era have excellent results. The
most common complications were atrial fibrillation and bleeding. These
real-world results should provide additional context for upcoming
transcatheter clinical trial data.<br/>Copyright &#xa9; 2017 The Society
of Thoracic Surgeons

<56>
Accession Number
618308563
Author
Tzani A.; Doulamis I.P.; Mylonas K.S.; Avgerinos D.V.; Nasioudis D.
Institution
(Tzani, Doulamis, Mylonas, Avgerinos, Nasioudis) Surgery Working Group,
Society of Junior Doctors, Athens, Greece
(Mylonas) Division of Pediatric Surgery, Department of Surgery,
Massachusetts General Hospital, Harvard Medical School, Boston, MA, United
States
(Avgerinos) Department of Cardiothoracic Surgery, New York Presbyterian
Medical Center, Weill Cornell College of Medicine, New York, NY, United
States
(Nasioudis) Department of Obstetrics and Gynecology, Hospital of the
University of Pennsylvania, Philadelphia, PA, United States
Title
Cardiac Tumors in Pediatric Patients: A Systematic Review.
Source
World Journal for Pediatric and Congenital Hearth Surgery. 8 (5) (pp
624-632), 2017. Date of Publication: 01 Sep 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
This systematic review sought to investigate the current evidence
regarding surgical management of primary cardiac tumors in children and
adolescents. Twenty-eight studies were deemed eligible, reporting on 745
pediatric patients. Rhabdomyoma was the most prevalent histologic type and
echocardiography was the most common diagnostic tool. Cumulative 30-day
mortality rate was 6.7%. Rhabdomyomas and teratomas had the highest 30-day
mortality. The higher percentage of tumor relapse was noted for myxoma and
teratoma. Although cardiac tumors are rare, their atypical clinical
presentation, potential for recurrence, and the poor prognosis associated
with recurrence elucidate the need for reliable diagnostic and therapeutic
management.<br/>Copyright &#xa9; 2017, &#xa9; The Author(s) 2017.

<57>
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, United States
(Sessler, Mascha, Zimmerman) Department of Outcomes Research,
Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, United States
(Mascha, Li, Zimmerman, Blackstone) Department of Quantitative Health
Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio,
United States
(Sabik, Blackstone) Department of Thoracic and Cardiovascular Surgery,
Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United
States
Title
A Randomized Clinical Trial of Red Blood Cell Transfusion Triggers in
Cardiac Surgery.
Source
Annals of Thoracic Surgery. 104 (4) (pp 1243-1250), 2017. Date of
Publication: October 2017.
Publisher
Elsevier USA
Abstract
Background Class I evidence supporting a threshold for transfusion in the
cardiac surgical setting is scarce. We randomly allocated patients to a
transfusion hematocrit trigger of 24% versus 28% to compare morbidity,
mortality, and resource use. Methods From March 2007 to August 2014, two
centers randomly assigned 722 adults undergoing coronary artery bypass
graft surgery or valve procedures to a 24% hematocrit trigger (n = 363,
low group) or 28% trigger (n = 354, high group). One unit of red blood
cells was transfused if the hematocrit fell below the designated
threshold. The primary endpoint was a composite of postoperative
morbidities and mortality. Treatment effect was primarily assessed using
an average relative effect generalized estimating equation model. Results
At the second planned interim analysis, the a priori futility boundary was
crossed, and the study was stopped. There was no detected treatment effect
on the composite outcome (average relative effect odds ratio, low versus
high, 0.86, 95% confidence interval: 0.29 to 2.54, p = 0.71). However, the
low group received fewer red blood cell transfusions than the high group
(54% versus 75%, p < 0.001), mostly administered in the operating room
(low group, 112 [31%]; high group, 208 [59%]), followed by intensive care
unit (low, 105 [31%]; high, 115 [34%]) and floor (low, 41 [12%]; high, 42
[13%]). The low group was exposed to lower hematocrits: median before
transfusion, 22% (Q1 = 21%, Q3 = 23%) versus 24% (Q1 = 22%, Q3 = 25%).
Conclusions Negative exposures differed between treatment groups, with
lower hematocrit in the 24% trigger group and more red blood cells used in
the 28% group, but adverse outcomes did not differ. Because red blood cell
use was less with a 24% trigger without adverse effects, our randomized
trial results support aggressive blood conservation efforts in cardiac
surgery.<br/>Copyright &#xa9; 2017 The Society of Thoracic Surgeons

<58>
Accession Number
618377678
Author
Mauermann E.; Bolliger D.; Fassl J.; Grapow M.; Seeberger E.E.; Seeberger
M.D.; Filipovic M.; Lurati Buse G.A.L.
Institution
(Mauermann, Bolliger, Fassl, Seeberger, Lurati Buse) Department for
Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and
Pain Therapy, University Hospital Basel, Basel, Switzerland
(Grapow) Division of Cardiac Surgery, University Hospital Basel, Basel,
Switzerland
(Seeberger, Filipovic) University of Basel Medical School, Basel,
Switzerland
Title
Association of Troponin Trends and Cardiac Morbidity and Mortality After
On-Pump Cardiac Surgery.
Source
Annals of Thoracic Surgery. 104 (4) (pp 1289-1297), 2017. Date of
Publication: October 2017.
Publisher
Elsevier USA
Abstract
Background Elevated, single-measure, postoperative troponin is associated
with adverse events after cardiac surgery. We hypothesized that increases
in troponin from the first to the second postoperative day are also
associated with all-cause, 12-month mortality and major adverse cardiac
events (MACE). Methods This observational study included consecutive
adults undergoing on-pump cardiac surgery with cardiac arrest. Troponin T
was measured on the first and second postoperative day and was classified
as "increasing" (>10%), "unchanged" (10% to -10%), or "decreasing"
(<-10%). The primary endpoint was all-cause, 12-month mortality. Secondary
endpoints were all-cause 12-month mortality or MACE and both outcomes at
30 days. The main analysis was by multivariable Cox regression. Results Of
1,417 included patients, 99 (7.0%) died and 162 (11.4%) died or suffered
MACE at 12 months. A significant interaction (p < 0.001) between first
postoperative day troponin and the troponin trend from the first to the
second postoperative day on 12-month, all-cause mortality precluded an
analysis independent of first postoperative day troponin. Consequently, we
stratified patients by their first postoperative day troponin (cutoff, 0.8
mug/L). Increasing troponin was associated with higher mortality in
patients with first postoperative day troponin T >= 0.8 mug/L (hazard
ratio, 1.98; 95% CI, 1.09 to 3.59; p = 0.025). Conclusions Troponin
changes from the first to the second postoperative day should not be
interpreted without consideration of the first postoperative day troponin
concentration. For patients with a first postoperative day troponin >= 0.8
mug/L, an increase by more than 10% from the first to the second
postoperative day was significantly associated with all-cause, 12-month
mortality and other adverse events.<br/>Copyright &#xa9; 2017 The Society
of Thoracic Surgeons

<59>
Accession Number
615615786
Author
Suominen P.K.; Keski-Nisula J.; Ojala T.; Rautiainen P.; Jahnukainen T.;
Hastbacka J.; Neuvonen P.J.; Pitkanen O.; Niemela J.; Kaskinen A.;
Salminen J.; Lapatto R.
Institution
(Suominen, Keski-Nisula, Rautiainen, Hastbacka) Department of Anesthesia
and Intensive Care, Children's Hospital, Helsinki University Hospital and
University of Helsinki, Helsinki, Finland
(Ojala, Jahnukainen, Pitkanen, Niemela, Kaskinen, Lapatto) Department of
Pediatrics, Children's Hospital, Helsinki University Hospital and
University of Helsinki, Helsinki, Finland
(Salminen) Department of Pediatric Surgery, Children's Hospital, Helsinki
University Hospital and University of Helsinki, Helsinki, Finland
(Neuvonen) Department of Clinical Pharmacology, University of Helsinki and
HUSLAB, Helsinki University Hospital, Helsinki, Finland
Title
Stress-Dose Corticosteroid Versus Placebo in Neonatal Cardiac Operations:
A Randomized Controlled Trial.
Source
Annals of Thoracic Surgery. 104 (4) (pp 1378-1385), 2017. Date of
Publication: October 2017.
Publisher
Elsevier USA
Abstract
Background Corticosteroids can improve the hemodynamic status of neonates
with postoperative low cardiac output syndrome after cardiac operations.
This study compared a prophylactically administered stress-dose
corticosteroid (SDC) regimen against placebo on inflammation,
adrenocortical function, and hemodynamic outcome. Methods Forty neonates
undergoing elective open heart operations were randomized into two groups.
The SDC group received perioperatively 2 mg/kg methylprednisolone, and 6
hours after the operation, a hydrocortisone infusion (0.2 mg/kg/h) was
started with tapering doses for 5 days. Placebo was administered in a
similar fashion. An adrenocorticotropic hormone stimulation test was
performed after the therapy. The primary endpoint of the study was plasma
concentration of interleukin (IL-6). Secondary clinical outcomes included
plasma cortisol, IL-10, C-reactive protein, echocardiographic systemic
ventricle contractility evaluated by the Velocity Vector Imaging program,
the inotropic score, and time of delayed sternal closure. Results The IL-6
values of the SDC group were significantly lower postoperatively than in
the placebo group. Significantly lower inotropic scores (p < 0.05),
earlier sternal closure (p = 0.03), and less deterioration in the systemic
ventricle mean delta strain values between the preoperative and the first
postoperative assessment (p = 0.01) were detected for the SDC group. The
SDC therapy did not suppress the hypothalamic-pituitary-adrenal axis more
than placebo. The mean plasma cortisol level did not decline in the
placebo group after the operation. Conclusions The SDC regimen for 5 days
postoperatively in neonates was safe and did not cause suppression of the
hypothalamic-pituitary-adrenal axis. Furthermore, the open heart operation
per se did not lead to adrenal insufficiency in neonates.<br/>Copyright
&#xa9; 2017 The Society of Thoracic Surgeons

<60>
Accession Number
616894755
Author
Pettersen O.; Haram P.M.; Winnerkvist A.; Karevold A.; Wahba A.; Stenvik
M.; Wiseth R.; Hegbom K.; Nordhaug D.O.
Institution
(Pettersen, Haram, Winnerkvist, Karevold, Wahba, Stenvik, Nordhaug)
Department of Cardiothoracic Surgery, St. Olav's University Hospital,
Trondheim, Norway
(Wiseth, Hegbom) Department of Cardiology, St. Olav's University Hospital,
Trondheim, Norway
(Pettersen, Wahba, Wiseth, Nordhaug) Department of Circulation and Medical
Imaging, Faculty of Medicine, Norwegian University of Science and
Technology, Trondheim, Norway
Title
Pedicled Vein Grafts in Coronary Surgery: Perioperative Data From a
Randomized Trial.
Source
Annals of Thoracic Surgery. 104 (4) (pp 1313-1317), 2017. Date of
Publication: October 2017.
Publisher
Elsevier USA
Abstract
Background Less-than-optimal long-term patency of the saphenous vein is
one of the main obstacles for the success of coronary artery bypass
grafting (CABG). Results from the IMPROVE-CABG trial has shown that
harvesting the saphenous vein with a pedicle of perivascular tissue less
than 5 mm while using manual distention provides comparable occlusion
rates but significantly less intimal hyperplasia at early follow-up. The
impact of pedicled veins on duration of operations, leg wound infections,
and postoperative bleeding is unknown. Methods One hundred patients
undergoing first-time elective CABG were randomly assigned to conventional
or pedicled vein harvesting. Perioperative and postoperative data were
collected prospectively during the hospital stay and at follow-up. Results
Duration of extracorporeal circulation was significantly longer in the
pedicled vein group (mean: 76 min versus 65 min, p = 0.006); however, no
significant difference was found in the cross-clamp time. No significant
difference was found in intraoperative vein graft flow, postoperative
bleeding, or leg wound infections (4% in each group). No reoperations were
due to vein graft bleeding. Conclusions Harvesting a pedicled vein
provides comparable postoperative bleeding and leg wound infection rates
in selected patients. The technique is associated with a slightly longer
duration of extracorporeal circulation than harvesting conventional veins.
Promising early results using the pedicled vein technique may contribute
to a change in standard vein harvesting technique for CABG in selected
patients.<br/>Copyright &#xa9; 2017 The Society of Thoracic Surgeons

<61>
Accession Number
618525524
Author
Bowman L.; Hopewell J.C.; Chen F.; Wallendszus K.; Stevens W.; Collins R.;
Wiviott S.D.; Cannon C.P.; Braunwald E.; Sammons E.; Landray M.J.
Institution
(Bowman, Hopewell, Chen, Wallendszus, Stevens, Collins) Clinical Trial
Service Unit, University of Oxford, Oxford, United Kingdom
(Wiviott, Cannon, Braunwald) Thrombolysis in Myocardial Infarction Study
Group, Brigham and Women's Hospital, Harvard Medical School, Boston,
United States
(Sammons, Landray) Clinical Trial Service Unit, Medical Research Council
Population Health Research Unit, University of Oxford, Oxford, United
Kingdom
Title
Effects of anacetrapib in patients with atherosclerotic vascular disease.
Source
New England Journal of Medicine. 377 (13) (pp 1217-1227), 2017. Date of
Publication: 28 Sep 2017.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: Patients with atherosclerotic vascular disease remain at high
risk for cardiovascular events despite effective statin-based treatment of
low-density lipoprotein (LDL) cholesterol levels. The inhibition of
cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL
cholesterol levels and increases high-density lipoprotein (HDL)
cholesterol levels. However, trials of other CETP inhibitors have shown
neutral or adverse effects on cardiovascular outcomes. METHODS: We
conducted a randomized, double-blind, placebo-controlled trial involving
30,449 adults with atherosclerotic vascular disease who were receiving
intensive atorvastatin therapy and who had a mean LDL cholesterol level of
61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol
level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL
cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The
patients were assigned to receive either 100 mg of anacetrapib once daily
(15,225 patients) or matching placebo (15,224 patients). The primary
outcome was the first major coronary event, a composite of coronary death,
myocardial infarction, or coronary revascularization. RESULTS: During the
median follow-up period of 4.1 years, the primary outcome occurred in
significantly fewer patients in the anacetrapib group than in the placebo
group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients
[11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97;
P=0.004). The relative difference in risk was similar across multiple
prespecified subgroups. At the trial midpoint, the mean level of HDL
cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the
anacetrapib group than in the placebo group (a relative difference of
104%), and the mean level of non-HDL cholesterol was lower by 17 mg per
deciliter (0.44 mmol per liter), a relative difference of -18%. There were
no significant between-group differences in the risk of death, cancer, or
other serious adverse events. CONCLUSIONS: Among patients with
atherosclerotic vascular disease who were receiving intensive statin
therapy, the use of anacetrapib resulted in a lower incidence of major
coronary events than the use of placebo.<br/>Copyright &#xa9; 2017
Massachusetts Medical Society.

<62>
Accession Number
611734667
Author
Park J.H.; Shim J.-K.; Song J.-W.; Soh S.; Kwak Y.-L.
Institution
(Park, Shim, Song, Soh, Kwak) Department of Anesthesiology and Pain
Medicine, Yonsei University College of Medicine, 50 Yonsei-ro,
Seodaemun-gu, Seoul 03722, South Korea
(Shim, Song, Kwak) Anesthesia and Pain Research Institute, Yonsei
Cardiovascular Research Institute, Yonsei University College of Medicine,
50 Yonsei-ro, Seodaemungu, Seoul 03722, South Korea
Title
Effect of atorvastatin on the incidence of acute kidney injury following
valvular heart surgery: a randomized, placebo-controlled trial.
Source
Intensive Care Medicine. 42 (9) (pp 1398-1407), 2016. Date of Publication:
01 Sep 2016.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Statins, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA)
reductase inhibitors have the potential to reduce acute kidney injury
(AKI) after cardiac surgery through their pleiotropic properties. Here we
studied the preventive effect of atorvastatin on AKI after valvular heart
surgery. Methods: Two-hundred statin-naive patients were randomly
allocated to receive either statin or placebo. Atorvastatin was
administered orally to the statin group according to a dosage schedule (80
mg single dose on the evening prior to surgery; 40 mg on the morning of
surgery; three further doses of 40 mg on the evenings of postoperative
days 0, 1, and 2). AKI incidence was assessed during the first 48
postoperative hours on the basis of Acute Kidney Injury Network criteria.
Results: The incidence of AKI was similar in the statin and control groups
(21 vs. 26 %, respectively, p = 0.404). Biomarkers of renal injury
including plasma neutrophil gelatinase-associated lipocalin and
interleukin-18 were also similar between the groups. The statin group
required significantly less norepinephrine and vasopressin during surgery,
and fewer patients in the statin group required vasopressin. There were no
significant differences in postoperative outcomes. Conclusions: Acute
perioperative statin treatment was not associated with a lower incidence
of AKI or improved clinical outcome in patients undergoing valvular heart
surgery. (ClinicalTrials.gov NCT01909739).<br/>Copyright &#xa9; 2016,
Springer-Verlag Berlin Heidelberg and ESICM.

<63>
Accession Number
612655119
Author
Sakurai R.; Burazor I.; Bonneau H.N.; Kaneda H.
Institution
(Sakurai) Department of Healthcare Information Management, The University
of Tokyo Hospital, Tokyo, Japan
(Burazor) Cardiac Rehabilitation Department, Institute for Rehabilitation,
Belgrade, Serbia
(Bonneau) Highlands Consulting, Inc., San Jose, CA, United States
(Kaneda) Okinaka Memorial Institute for Medical Research, Tokyo, Japan
Title
Long-term outcomes of biodegradable polymer biolimus-eluting stents versus
durable polymer everolimus-eluting stents: A meta-analysis of randomized
controlled trials.
Source
International Journal of Cardiology. 223 (pp 1066-1071), 2016. Date of
Publication: 15 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Both biodegradable polymer biolimus-eluting stents (BP-BES) and
biocompatible durable polymer everolimus-eluting stents (DP-EES) have been
developed to decrease the risk of late adverse events. However, their
efficacy and safety beyond 1 year after stent deployment still remain
controversial. Methods We conducted a meta-analysis on randomized
controlled trials (RCTs) comparing BP-BES with DP-EES in patients
undergoing percutaneous coronary intervention in long-term follow up
(beyond 1 year), and compared the pooled estimates with those in mid-term
follow up (within 1 year). Results Eight RCTs were included in this
meta-analysis. The risks in BP-BES versus DP-EES of death (odds ratio
(OR): 1.06, 95% confidence interval (CI): 0.86-1.31, p = 0.557 for
long-term; OR: 1.09, 95% CI: 0.76-1.56, p = 0.645 for mid-term),
myocardial infarction (OR: 1.06, 95% CI: 0.84-1.35, p = 0.628 for
long-term; OR: 1.04, 95% CI: 0.81-1.33, p = 0.778 for mid-term), and
definite or probable stent thrombosis (OR: 0.89, 95% CI: 0.51-1.57, p =
0.695 for long-term; OR: 1.36, 95% CI: 0.66-2.81, p = 0.400 for mid-term)
were comparable in each follow up, respectively. In contrast, the risk of
target vessel revascularization (TVR) tended to be higher in BP-BES as
compared to DP-EES in long-term follow up (OR: 1.15, 95% CI: 0.97-1.37, p
= 0.098 for long-term; OR: 1.09, 95% CI: 0.87-1.36, p = 0.447 for
mid-term). Conclusions Although the overall clinical outcomes were similar
between BP-BES and DP-EES, BP-BES may be associated with higher risk of
TVR up to 3 years after stent deployment compared with DP-EES. Further
studies are warranted in larger populations of patients during longer-term
follow up.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd

<64>
Accession Number
612919223
Author
Bonaca M.P.; Creager M.A.; Olin J.; Scirica B.M.; Gilchrist I.C.; Murphy
S.A.; Goodrich E.L.; Braunwald E.; Morrow D.A.
Institution
(Bonaca, Scirica, Gilchrist, Murphy, Goodrich, Braunwald, Morrow) TIMI
Study Group, Cardiovascular Division, Department of Medicine, Brigham and
Women's Hospital and Harvard Medical School, Boston, Massachusetts, United
States
(Creager) Dartmouth-Hitchcock Heart and Vascular Center, Geisel School of
Medicine at Dartmouth, Lebanon, New Hampshire, United States
(Olin) Wiener Cardiovascular Institute and Marie-Jose and Henry R. Kravis
Center for Cardiovascular Health, Mount Sinai School of Medicine, New
York, New York, United States
Title
Peripheral Revascularization in Patients With Peripheral Artery Disease
With Vorapaxar: Insights From the TRA 2degreeP-TIMI 50 Trial.
Source
JACC: Cardiovascular Interventions. 9 (20) (pp 2157-2164), 2016. Date of
Publication: 24 Oct 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to determine whether the reduction in
peripheral revascularization with vorapaxar in patients with peripheral
artery disease (PAD) is directionally consistent across indications,
including acute limb ischemia, progressively disabling symptoms, or both.
Background The protease-activated receptor-1 antagonist vorapaxar reduces
peripheral revascularization in patients with PAD. Methods The TRA
2degreeP-TIMI 50 (Thrombin Receptor Antagonist in Secondary Prevention of
Atherothrombotic Ischemic Events-Thrombolysis in Myocardial Infarction 50)
trial randomized 26,449 patients with histories of myocardial infarction,
stroke, or symptomatic PAD to vorapaxar or placebo on a background of
standard therapy. A total of 5,845 patients had a known history of PAD at
randomization. Peripheral revascularization procedures reported by the
site were a pre-specified outcome. We explored whether the benefit of
vorapaxar was consistent across indication and type of procedure. Results
Of the 5,845 patients with known PAD, a total of 934 (16%) underwent at
least 1 peripheral revascularization over 2.5 years (median). More than
one-half (55%) were for worsening claudication, followed by critical limb
ischemia (24%), acute limb ischemia (16%), and asymptomatic severe
stenosis (4%). Vorapaxar significantly reduced peripheral
revascularization (19.3% for placebo, 15.4% for vorapaxar; hazard ratio:
0.82; 95% confidence interval: 0.72 to 0.93; p = 0.003), with a consistent
pattern of efficacy across indication. Conclusions Vorapaxar reduces
peripheral revascularization in patients with PAD. This benefit of
vorapaxar is directionally consistent across type of procedure and
indication. (Trial to Assess the Effects of Vorapaxar [SCH 530348;
MK-5348] in Preventing Heart Attack and Stroke in Patients With
Atherosclerosis [TRA 2degreeP - TIMI 50] [P04737];
NCT00526474)<br/>Copyright &#xa9; 2016 American College of Cardiology
Foundation

<65>
Accession Number
611380635
Author
Koster G.; Bekema H.J.; Wetterslev J.; Gluud C.; Keus F.; van der Horst
I.C.C.
Institution
(Koster, Keus, van der Horst) Department of Critical Care, University of
Groningen, University Medical Centre Groningen, P.O. Box 30.001, Groningen
9700 RB, Netherlands
(Bekema) Department of Anaesthesiology, University of Groningen,
University Medical Centre Groningen, Groningen, Netherlands
(Wetterslev, Gluud) The Copenhagen Trial Unit, Centre for Clinical
Intervention Research, Department 7812, Rigshospitalet, Copenhagen
University Hospital, Copenhagen 2100, Denmark
Title
Milrinone for cardiac dysfunction in critically ill adult patients: a
systematic review of randomised clinical trials with meta-analysis and
trial sequential analysis.
Source
Intensive Care Medicine. 42 (9) (pp 1322-1335), 2016. Date of Publication:
01 Sep 2016.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Introduction: Milrinone is an inotrope widely used for treatment of
cardiac failure. Because previous meta-analyses had methodological flaws,
we decided to conduct a systematic review of the effect of milrinone in
critically ill adult patients with cardiac dysfunction. Methods: This
systematic review was performed according to The Cochrane Handbook for
Systematic Reviews of Interventions. Searches were conducted until
November 2015. Patients with cardiac dysfunction were included. The
primary outcome was serious adverse events (SAE) including mortality at
maximum follow-up. The risk of bias was evaluated and trial sequential
analyses were conducted. The quality of evidence was assessed by the
Grading of Recommendations Assessment, Development and Evaluation
criteria. Results: A total of 31 randomised clinical trials fulfilled the
inclusion criteria, of which 16 provided data for our analyses. All trials
were at high risk of bias, and none reported the primary composite outcome
SAE. Fourteen trials with 1611 randomised patients reported mortality data
at maximum follow-up (RR 0.96; 95% confidence interval 0.76-1.21).
Milrinone did not significantly affect other patient-centred outcomes. All
analyses displayed statistical and/or clinical heterogeneity of patients,
interventions, comparators, outcomes, and/or settings and all featured
missing data. Discussion: The current evidence on the use of milrinone in
critically ill adult patients with cardiac dysfunction suffers from
considerable risks of both bias and random error and demonstrates no
benefits. The use of milrinone for the treatment of critically ill
patients with cardiac dysfunction can be neither recommended nor refuted.
Future randomised clinical trials need to be sufficiently large and
designed to have low risk of bias.<br/>Copyright &#xa9; 2016, The
Author(s).

<66>
[Use Link to view the full text]
Accession Number
612540718
Author
Valkenburg A.J.; Calvier E.A.M.; Van Dijk M.; Krekels E.H.J.; O'Hare B.P.;
Casey W.F.; Mathot R.A.A.; Knibbe C.A.J.; Tibboel D.; Breatnach C.V.
Institution
(Valkenburg, Van Dijk, Tibboel) Intensive Care and Department of Pediatric
Surgery, Erasmus University Medical Center-Sophia Children's Hospital,
Rotterdam, Netherlands
(Calvier, Krekels, Knibbe) Division of Pharmacology, Leiden Academic
Centre for Drug Research, Leiden University, Leiden, Netherlands
(O'Hare, Casey, Breatnach) Department of Anesthesia and Critical Care
Medicine, Our Lady's Children's Hospital, Dublin, Ireland
(Mathot) Department of Pharmacy, Academic Medical Center, Amsterdam,
Netherlands
(Knibbe) Department of Clinical Pharmacy, St. Antonius Hospital,
Nieuwegein, Netherlands
Title
Pharmacodynamics and Pharmacokinetics of Morphine after Cardiac Surgery in
Children with and Without Down Syndrome.
Source
Pediatric Critical Care Medicine. 17 (10) (pp 930-938), 2016. Date of
Publication: 01 Oct 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: To compare the pharmacodynamics and pharmacokinetics of IV
morphine after cardiac surgery in two groups of children - those with and
without Down syndrome. Design: Prospective, single-center observational
trial. Setting: PICU in a university-affiliated pediatric teaching
hospital. Patients: Twenty-one children with Down syndrome and 17 without,
3-36 months old, scheduled for cardiac surgery with cardiopulmonary
bypass. Interventions: A loading dose of morphine (100 mug/kg) was
administered after coming off bypass; thereafter, morphine infusion was
commenced at 40 mug/kg/hr. During intensive care, nurses regularly
assessed pain and discomfort with validated observational instruments
(COMFORT-Behavior scale and Numeric Rating Scale - for pain). These scores
guided analgesic and sedative treatment. Plasma samples were obtained for
pharmacokinetic analysis. Measurements and Main Results: Median
COMFORT-Behavior and Numeric Rating Scale scores were not statistically
significantly different between the two groups. The median morphine
infusion rate during the first 24 hours after surgery was 31.3 mug/kg/hr
(interquartile range, 23.4-36.4) in the Down syndrome group versus 31.7
mug/kg/hr (interquartile range, 25.1-36.1) in the control group (p =
1.00). Population pharmacokinetic analysis revealed no statistically
significant differences in any of the pharmacokinetic variables of
morphine between the children with and without Down syndrome. Conclusions:
This prospective trial showed that there are no differences in
pharmacokinetics or pharmacodynamics between children with and without
Down syndrome if pain and distress management is titrated to effect based
on outcomes of validated assessment instruments. We have no evidence to
adjust morphine dosing after cardiac surgery in children with Down
syndrome.<br/>&#xa9; Copyright 2016 by the Society of Critical Care
Medicine and the World Federation of Pediatric Intensive and Critical Care
Societies.

<67>
Accession Number
613441012
Author
Franzone A.; Piccolo R.; Siontis G.C.M.; Lanz J.; Stortecky S.; Praz F.;
Roost E.; Vollenbroich R.; Windecker S.; Pilgrim T.
Institution
(Franzone, Piccolo, Siontis, Lanz, Stortecky, Praz, Vollenbroich,
Windecker, Pilgrim) Department of Cardiology, Swiss Cardiovascular Center,
University Hospital, Bern, Switzerland
(Roost) Department of Cardiovascular Surgery, University Hospital, Bern,
Switzerland
Title
Transcatheter Aortic Valve Replacement for the Treatment of Pure Native
Aortic Valve Regurgitation: A Systematic Review.
Source
JACC: Cardiovascular Interventions. 9 (22) (pp 2308-2317), 2016. Date of
Publication: 28 Nov 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study sought to summarize available evidence on
transcatheter aortic valve replacement (TAVR) for the treatment of native
pure aortic regurgitation (AR). Background Surgical aortic valve
replacement (SAVR) is the gold standard for the treatment of AR. However,
case series of high-risk patients undergoing TAVR for native pure AR were
reported. Methods We systematically searched Medline, Embase, and Scopus
for reports of at least 5 patients with native pure AR undergoing TAVR.
Patients' and procedural characteristics were summarized. The primary
outcome of interest was all-cause mortality. Pooled estimates were
calculated using a random-effects meta-analysis. The study protocol was
registered in PROSPERO (CRD42016038422). Results Thirteen reports
including 237 patients were included in the analysis. Self-expandable
prostheses were used in 79% of patients, whereas 21% of the patients were
treated with a balloon-expandable valve. Device success ranged between 74%
and 100%. Seventeen patients (7%) required the implantation of a second
valve. Conversion to SAVR was reported in 6 (2.5%) cases. The rate of
all-cause mortality at 30 days amounted to 7% (95% confidence interval
[CI]: 3% to 13%; I² = 37%). Cerebrovascular events were rare
(0%, 95% CI: 0% to 1%; I² = 0); major bleeding and vascular
complications occurred in 2% (95% CI: 0% to 7%; I² = 41%), and
3% (95% CI: 1% to 7%; I² = 0%), respectively. Permanent
pacemaker implantation was required in 11% of patients (95% CI: 5% to 19%;
I² = 50%). The rate of moderate or severe post-procedural AR
amounted to 9% (95% CI: 0% to 28%; I² = 90%). Conclusions Among
selected patients with native pure AR deemed at high risk for SAVR, TAVR
is technically feasible and associated with an acceptable risk of early
mortality.<br/>Copyright &#xa9; 2016 American College of Cardiology
Foundation

<68>
Accession Number
613441002
Author
Bonello L.; Laine M.; Puymirat E.; Lemesle G.; Thuny F.; Paganelli F.;
Michelet P.; Roch A.; Kerbaul F.; Boyer L.
Institution
(Bonello, Laine, Thuny, Paganelli) Service de Cardiologie, Centre
Hospitalier Universitaire de Marseille, Hopital Nord, Aix-Marseille
Universite, Marseille, France
(Bonello) Aix-Marseille Universite, INSERM UMR-S 1076, Vascular Research
Center of Marseille, Marseille, France
(Bonello, Laine, Thuny, Michelet, Roch, Kerbaul) MARS Cardio,
Mediterranean Association for Research and Studies in Cardiology, Hopital
Nord, Marseille, France
(Puymirat) Departement de Cardiologie, Hopital Europeen Georges Pompidou,
Assistance Publique des Hopitaux de Paris, Paris, France
(Puymirat) Universite Paris Descartes, INSERM U-970, Paris, France
(Lemesle) Service d'Accueil des Urgences, Hopital Timone, Marseille,
France
(Michelet) Departement de Cardiologie, CHU de Lille, Lille, France
(Roch) Service d'Accueil des Urgence, Hopital Nord, Marseille, France
(Kerbaul) Pole RUSH, Assistance-Publique Hopitaux de Marseille, Marseille,
France
(Boyer) EA 3279-Public Health, Chronic Diseases and Quality of
Life-Research Unit, Aix-Marseille University, Marseille, France
Title
Timing of Coronary Invasive Strategy in Non-ST-Segment Elevation Acute
Coronary Syndromes and Clinical Outcomes: An Updated Meta-Analysis.
Source
JACC: Cardiovascular Interventions. 9 (22) (pp 2267-2276), 2016. Date of
Publication: 28 Nov 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to compare an early versus a delayed
invasive strategy in non-ST-segment elevation acute coronary syndromes by
performing a meta-analysis of all available randomized controlled clinical
trials. Background An invasive approach is recommended to prevent death
and myocardial infarction in non-ST-segment elevation acute coronary
syndromes. However, the timing of angiography and the subsequent
intervention, when required, remains controversial. Methods A previous
meta-analysis of 7 randomized clinical trials comparing early and delayed
invasive strategies in non-ST-segment elevation acute coronary syndromes
with 3 new randomized clinical trials identified in a search of the
published research (n = 10 trials, n = 6,397 patients) was updated.
Results The median time between randomization and angiography ranged from
0.5 to 14.0 h in the early group and from 18.3 to 86.0 h in the delayed
group. There was no difference in the primary endpoint of mortality (4%
vs. 4.7%; random-effects odds ratio [OR]: 0.85; 95% confidence interval
[CI]: 0.67 to 1.09; p = 0.20; I² = 0%). The rate of myocardial
infarction was also similar (6.7% vs. 7.7%; random-effects OR: 0.88; 95%
CI: 0.53 to 1.45; p = 0.62; I² = 77.5%). An early strategy was
associated with a reduction in recurrent ischemia or refractory angina
(3.8% vs. 5.8%; random-effects OR: 0.54; 95% CI: 0.40 to 0.74; p < 0.01;
I² = 28%) and a shorter in-hospital stay (median 112 h
[interquartile range: 61 to 158 h] vs. 168 h [interquartile range: 90.3 to
192 h]; random-effects standardized mean difference -0.40; 95% CI: -0.59
to -0.21; p < 0.01; I² = 79%). Major bleeding was similar in
the 2 groups (3.9% vs. 4.2%; random-effects OR: 0.94; 95% CI: 0.73 to
1.22; p = 0.64; I² = 0%). Conclusions An early invasive
strategy does not reduce the risk for death or myocardial infarction
compared with a delayed strategy. Recurrent ischemia and length of stay
were significantly reduced with an early invasive strategy.<br/>Copyright
&#xa9; 2016 American College of Cardiology Foundation

<69>
Accession Number
611834716
Author
Dieberg G.; Smart N.A.; King N.
Institution
(Dieberg, Smart) School of Science and Technology, University of New
England, Armidale, NSW 2350, Australia
(King) School of Biomedical and Healthcare Sciences, Plymouth University
Peninsula Schools of Medicine and Dentistry, University of Plymouth,
Plymouth PL4 8AA, United Kingdom
Title
Minimally invasive cardiac surgery: A systematic review and meta-analysis.
Source
International Journal of Cardiology. 223 (pp 554-560), 2016. Date of
Publication: 15 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Minimally invasive (MI) cardiac surgery was introduced to
reduce problems associated with a full sternotomy. This meta-analysis
aimed to investigate the effects of minimally invasive cardiac surgery on
a range of clinical outcomes. Methods To identify potential studies
(randomised/prospective clinical trials) systematic searches were carried
out. The search strategy included the concepts of "minimally invasive" OR
"MIDCAB" AND "coronary artery bypass grafting" OR "cardiac surgery". This
was followed by a meta-analysis investigating cross-clamp time,
cardiopulmonary bypass (CPB) time, operation time, ventilation time,
intensive care unit (ICU) stay, hospital stay, incidence of myocardial
infarction and of stroke/neurologic complications. Results Eight studies
(9 intervention groups), totalling 596 participants were analysed. MI
cardiac surgery was associated with a shorter ICU stay mean difference
(MD) - 0.7 days (95% confidence interval (CI) - 1.23 to - 0.18, p = 0.009)
and longer cross-clamp MD 6.7 min (95% CI 1.24 to 12.17, p = 0.02), CPB MD
26.68 min (95% CI 10.31 to 43.05, p = 0.001), and operation times MD 55.03
min (95% CI 22.76 to 87.31, p = 0.0008). However no differences were found
in the ventilation time MD - 3.94 h (95% CI - 8.09 to 0.21, p = 0.06),
length of hospital stay MD - 1.14 days (95% CI - 3.11 to 0.83, p = 0.26)
and in the incidence of myocardial infarction odds ratio (OR) 1.97 (95% CI
0.49 to 7.9, p = 0.34) or stroke/neurologic complications OR 0.67 (95% CI
0.11 to 4.05, p = 0.66). Conclusions Minimally invasive cardiac surgery is
as safe as conventional surgery and could reduce costs due to a shorter
period spent in ICU.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd

<70>
Accession Number
613198250
Author
Shin D.-H.; Hong S.-J.; Mintz G.S.; Kim J.-S.; Kim B.-K.; Ko Y.-G.; Choi
D.; Jang Y.; Hong M.-K.
Institution
(Shin, Kim, Kim, Ko, Choi, Jang, Hong) Department of Internal Medicine,
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul,
South Korea
(Hong) Department of Internal Medicine, Sanggye Paik Hospital, Inje
University, Seoul, South Korea
(Mintz) Cardiovascular Research Foundation, New York, New York, United
States
(Kim, Kim, Ko, Choi, Jang, Hong) Cardiovascular Research Institute, Yonsei
University College of Medicine, Seoul, South Korea
(Jang, Hong) Severance Biomedical Science Institute, Yonsei University
College of Medicine, Seoul, South Korea
Title
Effects of Intravascular Ultrasound-Guided Versus Angiography-Guided
New-Generation Drug-Eluting Stent Implantation: Meta-Analysis With
Individual Patient-Level Data From 2,345 Randomized Patients.
Source
JACC: Cardiovascular Interventions. 9 (21) (pp 2232-2239), 2016. Date of
Publication: 14 Nov 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to evaluate the clinical usefulness
of intravascular ultrasound (IVUS)-guided new-generation drug-eluting
stent (DES) implantation using a meta-analysis of individual patient-level
data from randomized trials. Background Published randomized trials that
compare IVUS-guided versus angiography-guided new-generation DES
implantation are scarce. Methods Searches of the MEDLINE, Embase, and
Cochrane databases were performed to find randomized trials that compared
IVUS-guided versus angiography-guided new-generation DES implantation. A
total of 2,345 patients from 3 randomized trials were identified, and all
patients were treated for long lesions or chronic total occlusions.
Individual patient-level data were obtained. The primary endpoint was a
major adverse cardiac event, a composite of cardiac death, myocardial
infarction, or stent thrombosis. An intention-to-treat analysis and per
protocol analysis were performed. Results By 1 year post-procedure, major
adverse cardiac events had occurred in 0.4% of the patients who underwent
IVUS-guided DES implantation versus 1.2% of those who underwent
angiography-guided DES implantation (hazard ratio [HR]: 0.36; 95%
confidence interval [CI]: 0.13 to 0.99; p = 0.040). For the IVUS-guided
group, favorable clinical outcomes were observed for myocardial infarction
(0% vs. 0.4%; HR: 0.09; p = 0.026). In addition, the clinical benefit of
IVUS guidance was stronger in the per protocol analysis (HR: 0.32; 95% CI:
0.12 to 0.89; p = 0.021). Conclusions Compared with angiographic guidance,
IVUS-guided new-generation DES implantation was associated with favorable
outcomes in terms of major adverse cardiac events, the composite of
cardiac death, myocardial infarction, or stent thrombosis. These findings
must be interpreted only for complex lesions, because all identified
patients had long lesions or chronic total occlusions.<br/>Copyright
&#xa9; 2016 American College of Cardiology Foundation

<71>
Accession Number
611785112
Author
De Servi S.; Goedicke J.; Ferlini M.; Palmerini T.; Syvanne M.;
Montalescot G.
Institution
(De Servi, Ferlini) Division of Cardiology and Coronary Care Unit,
Fondazione Policlinico San Matteo, Pavia, Italy
(Goedicke) Scientific Consulting for Pharmaceutical Industry and CROs,
Hamburg, Germany
(Palmerini) Cardiovascular Department, Policlinico S. Orsola, Bologna,
Italy
(Syvanne) Finnish Heart Association, Helsinki, Finland
(Montalescot) UPMC Sorbonne Universites, ACTION Study Group, INSERM-UMRS
1166, Institut de Cardiologie, Pitie-Salpetriere Hospital (AP-HP), Paris,
France
Title
Prasugrel versus clopidogrel in acute coronary syndromes treated with PCI:
Effects on clinical outcome according to culprit artery location.
Source
International Journal of Cardiology. 223 (pp 632-638), 2016. Date of
Publication: 15 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Acute coronary syndrome (ACS) mortality increases when the
culprit lesion is in the left anterior descending (LAD) artery. We
investigated the effects of prasugrel versus clopidogrel according to site
of culprit lesion causing ACS treated with percutaneous coronary
intervention (PCI) in the TRITON-TIMI 38 study. Methods Patients were
divided into three groups based on the native coronary artery culprit
lesion location. The LAD artery group included also patients with the
culprit lesion in the left main (LM) artery. Results In the whole ACS
population, prasugrel recipients had lower rates of the primary endpoint
that included cardiovascular (CV) death, non-fatal myocardial infarction
(MI) or non-fatal stroke without significant differences across vessel
groups. CV death was significantly decreased with prasugrel in the whole
ACS population (p = 0.03) and in ST-elevation MI (STEMI) patients
undergoing primary PCI (p = 0.04), with pronounced differences in favour
of prasugrel versus clopidogrel when the LAD-LM was the culprit vessel
(relative risk reduction 50% in the whole ACS population, 57% in STEMI
treated with primary PCI, p for interaction 0.07 and 0.08 respectively).
Conclusions Prasugrel effects were particularly favourable when LAD-LM was
the culprit vessel, resulting in CV mortality reduction in the whole ACS
population and in STEMI patients when treated with primary
PCI.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd

<72>
Accession Number
611784500
Author
Musa T.A.; Uddin A.; Fairbairn T.A.; Dobson L.E.; Steadman C.D.; Kidambi
A.; Ripley D.P.; Swoboda P.P.; McDiarmid A.K.; Erhayiem B.; Garg P.;
Blackman D.J.; Plein S.; McCann G.P.; Greenwood J.P.
Institution
(Musa, Uddin, Fairbairn, Dobson, Kidambi, Ripley, Swoboda, McDiarmid,
Erhayiem, Garg, Plein, Greenwood) Multidisciplinary Cardiovascular
Research Centre & The Division of Cardiovascular and Diabetes Research,
Leeds Institute for Cardiovascular and Metabolic Medicine, University of
Leeds, Leeds, United Kingdom
(Steadman, McCann) Department of Cardiovascular Sciences, University of
Leicester, Cardiovascular Research Centre and the National Institute of
Health Research (NIHR), Cardiovascular Biomedical Research Unit, Glenfield
General Hospital, Leicester, United Kingdom
(Blackman) Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary,
Leeds, United Kingdom
Title
Right ventricular function following surgical aortic valve replacement and
transcatheter aortic valve implantation: A cardiovascular MR study.
Source
International Journal of Cardiology. 223 (pp 639-644), 2016. Date of
Publication: 15 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objective The response of the RV following treatment of aortic stenosis is
poorly defined, reflecting the challenge of accurate RV assessment.
Cardiovascular magnetic resonance (CMR) is the established reference for
imaging of RV volumes, mass and function. We sought to define the impact
of transcatheter aortic valve implantation (TAVI) and surgical aortic
valve replacement (SAVR) upon RV function in patients treated for severe
aortic stenosis using CMR. Methods A 1.5T CMR scan was performed
preoperatively and 6 months postoperatively in 112 (56 TAVI, 56 SAVR; 76
+/- 8 years) high-risk severe symptomatic aortic stenosis patients across
two UK cardiothoracic centres. Results TAVI patients were older (80.4 +/-
6.7 vs. 72.8 +/- 7.2 years, p < 0.05) with a higher STS score (2.13 +/-
0.73 vs. 5.54 +/- 3.41%, p < 0.001). At 6 months, SAVR was associated with
a significant increase in RV end systolic volume (33 +/- 10 vs. 37 +/- 10
ml/m², p = 0.008), and decrease in RV ejection fraction (58 +/-
8 vs. 53 +/- 8%, p = 0.005) and tricuspid annular plane systolic excursion
(22 +/- 5 vs. 14 +/- 3 mm, p < 0.001). Only 4 (7%) SAVR patients had new
RV late gadolinium hyper-enhancement with no new cases seen in the TAVI
patients at 6 months. Longer surgical cross-clamp time was the only
predictor of increased RV end systolic volume at 6 months. Post-TAVI,
there was no observed change in RV volumes or function. Over a maximum 6.3
year follow-up, 18(32%) of TAVI patients and 1(1.7%) of SAVR patients had
died (p = 0.001). On multivariable Cox analysis, the RV mass at 6 m
post-TAVI was independently associated with all-cause mortality (HR 1.359,
95% CI 1.108-1.666, p = 0.003). Conclusions SAVR results in a
deterioration in RV systolic volumes and function associated with longer
cross-clamp times and is not fully explained by suboptimal RV protection
during cardiopulmonary bypass. TAVI had no adverse impact upon RV volumes
or function.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd

<73>
Accession Number
612919221
Author
Giustino G.; Mehran R.; Veltkamp R.; Faggioni M.; Baber U.; Dangas G.D.
Institution
(Giustino, Mehran, Faggioni, Baber, Dangas) Interventional Cardiovascular
Research and Clinical Trials, The Zena and Michael A. Wiener
Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New
York, New York, United States
(Veltkamp) Department of Stroke Medicine, Division of Brain Sciences,
Imperial College, London, United Kingdom
Title
Neurological Outcomes With Embolic Protection Devices in Patients
Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and
Meta-Analysis of Randomized Controlled Trials.
Source
JACC: Cardiovascular Interventions. 9 (20) (pp 2124-2133), 2016. Date of
Publication: 24 Oct 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to investigate the efficacy and
safety of intraprocedural embolic protection (EP) during transcatheter
aortic valve replacement (TAVR). Background Randomized controlled trials
(RCTs) investigating the efficacy of EP devices during TAVR were
relatively underpowered. Methods A systematic review and study-level
meta-analysis was performed of randomized controlled trials that tested
the efficacy and safety of EP during TAVR. Trials using any type of EP and
TAVR vascular access were included. Primary imaging efficacy endpoints
were total lesion volume and number of new ischemic lesions. Primary
clinical efficacy endpoints were any deterioration in National Institutes
of Health Stroke Scale and Montreal Cognitive Assessment scores at
hospital discharge. Primary analyses were performed using the
intention-to-treat approach. Results Four randomized clinical trials
(total n = 252) were included. Use of EP was associated with lower total
lesion volume (standardized mean difference -0.65; 95% confidence interval
[CI]: -1.06 to -0.25; p = 0.002) and smaller number of new ischemic
lesions (standardized mean difference -1.27; 95% CI: -2.45 to -0.09; p =
0.03). EP was associated with a trend toward lower risk for deterioration
in National Institutes of Health Stroke Scale score at discharge (risk
ratio: 0.55; 95% CI: 0.27 to 1.09; p = 0.09) and higher Montreal Cognitive
Assessment score (standardized mean difference 0.40; 95% CI: 0.04 to 0.76;
p = 0.03). Risk for overt stroke and all-cause mortality were
nonsignificantly lower in the EP group. Conclusions Use of EP seems to be
associated with reductions in imaging markers of cerebral infarction and
early clinical neurological effectiveness in patients undergoing
TAVR.<br/>Copyright &#xa9; 2016 American College of Cardiology Foundation

<74>
Accession Number
611910471
Author
Castrodeza J.; Amat-Santos I.J.; Serra V.; Nombela-Franco L.; Brinster
D.R.; Gutierrez-Ibanes E.; Rojas P.; Tornos P.; Carnero M.; Cortes C.;
Tobar J.; Di Stefano S.; Gomez I.; San Roman J.A.
Institution
(Castrodeza, Amat-Santos, Rojas, Cortes, Tobar, Di Stefano, Gomez, San
Roman) Institute of Heart Sciences (ICICOR), Hospital Clinico
Universitario, Valladolid, Spain
(Serra, Tornos) Cardiology Department, Hospital Vall d'Hebron, Barcelona,
Spain
(Nombela-Franco) Cardiology Department, Hospital Clinico Universitario San
Carlos, Madrid, Spain
(Brinster) Cardiac Surgery Department, Lenox Hill Hospital Northwell
Health, NY, United States
(Gutierrez-Ibanes) Cardiology Department, Hospital General Universitario
Gregorio Maranon, Madrid, Spain
(Carnero) Cardiac Surgery Department, Hospital Clinico Universitario San
Carlos, Madrid, Spain
Title
Therapeutic alternatives after aborted sternotomy at the time of surgical
aortic valve replacement in the TAVI Era-Five centre experience and
systematic review.
Source
International Journal of Cardiology. 223 (pp 1019-1024), 2016. Date of
Publication: 15 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background We aimed to analyze causes, management, and outcomes of the
unexpected need to abort sternotomy in aortic stenosis (AS) patients
accepted for surgical aortic valve replacement (SAVR) in the transcatheter
aortic valve implantation (TAVI) era. Methods Cases of aborted sternotomy
(AbS) were gathered from 5 centers between 2009 and 2014. A systematic
review of all published cases in the same period was performed. Results A
total of 31 patients (71% males, 74 +/- 8 years, LogEuroSCORE 11.9 +/-
7.4%) suffered an AbS (0.19% of all sternotomies). Main reasons for Abs
included previously unknown porcelain aorta (PAo) in 83.9%, mediastinal
fibrosis due to radiotherapy in 12.9%, and chronic mediastinitis in 3.2%.
Median time between AbS and next intervention was 2.3 months (IQR:
0.7-5.8) with no mortality within this period. Only a case was managed
with open surgery. In 30 patients (96.8%) TAVI was performed with a rate
of success of 86.7%. Three patients (9.7%) presented in-hospital death and
17 (54.8%) had in-hospital complications including heart failure (9.6%),
major bleeding (6.9%), and acute kidney injury (9.6%). Older patients (76
+/- 8 vs. 70 +/- 8 years, p = 0.045), previous cardiac surgery (60% vs.
15.4%, p = 0.029), and shorter time from AbS to next intervention (5.1 +/-
5 vs. 1 +/- 0.7 months, p = 0.001) were related to higher six-month
mortality (22.6%). Conclusions The main reason for AbS was PAo. This
entity was associated to a higher rate of complications and mortality,
especially in older patients and with prior cardiac surgery. A preventive
strategy in these subgroups might be based on imaging evaluation. TAVI was
the most extended therapy.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd

<75>
Accession Number
607129139
Author
Patel N.N.; Avlonitis V.S.; Jones H.E.; Reeves B.C.; Sterne J.A.C.; Murphy
G.J.
Institution
(Patel) National Heart & Lung Institute, Imperial College London, London,
United Kingdom
(Avlonitis) Department of Cardiac Surgery, Guy's and St Thomas' NHS
Foundation Trust, London, United Kingdom
(Jones, Sterne) School of Social and Community Medicine, University of
Bristol, Bristol, United Kingdom
(Reeves) Clinical Trials and Evaluation Unit, School of Clinical Sciences,
University of Bristol, Bristol Royal Infirmary, Bristol, United Kingdom
(Murphy) Leicester Cardiovascular Biomedical Research Unit & Department of
Cardiovascular Sciences, University of Leicester, Glenfield General
Hospital, Leicester, United Kingdom
Title
Indications for red blood cell transfusion in cardiac surgery: a
systematic review and meta-analysis.
Source
The Lancet Haematology. 2 (12) (pp e543-e553), 2015. Date of Publication:
01 Dec 2015.
Publisher
Elsevier Ltd
Abstract
Background Good blood management is an important determinant of outcome in
cardiac surgery. Guidelines recommend restrictive red blood cell
transfusion. Our objective was to systematically review the evidence from
randomised controlled trials and observational studies that are used to
inform transfusion decisions in adult cardiac surgery. Methods We did a
systematic review by searching PubMed, Embase, Cochrane Library, and DARE,
from inception to May 1, 2015, databases from specialist societies, and
bibliographies of included studies and recent relevant review articles. We
included randomised controlled trials that assessed the effect of liberal
versus restrictive red blood cell transfusion in patients undergoing
cardiac and non-cardiac surgery, and observational studies that assessed
the effect of red blood cell transfusion compared with no transfusion on
outcomes in adult cardiac patients after surgery. We pooled adjusted odds
ratios using fixed-effects and random-effects meta-analyses. The primary
outcome was 30-day mortality. Findings We included data from six cardiac
surgical randomised controlled trials (3352 patients), 19 non-cardiac
surgical trials (8361 patients), and 39 observational studies (232 806
patients). The pooled fixed effects mortality odds ratios comparing
liberal versus restrictive transfusion thresholds was 0.70 (95% CI
0.49-1.02; p=0.060) for cardiac surgical trials and 1.10 (95% CI
0.96-1.27; p=0.16) for trials in settings other than cardiac surgery. By
contrast, observational cohort studies in cardiac surgery showed that red
blood cell transfusion compared with no transfusion was associated with
substantially higher mortality (random effects odds ratio 2.72, 95% CI
2.11-3.49; p<0.0001) and other morbidity, although with substantial
heterogeneity and small study effects. Interpretation Evidence from
randomised controlled trials in cardiac surgery refutes findings from
observational studies that liberal thresholds for red blood cell
transfusion are associated with a substantially increased risk of
mortality and morbidity. Observational studies and trials in non-cardiac
surgery should not be used to inform treatment decisions or guidelines for
patients having cardiac surgery. Funding None.<br/>Copyright &#xa9; 2015
Elsevier Ltd

<76>
Accession Number
614094611
Author
Morimoto T.; Aoyama Y.; Hyakuna E.; Kadota K.; Kimura K.; Hibi K.; Ishii
K.; Kataoka K.; Kimura T.; Shiomi H.; Shirotani M.; Miyazaki S.; Takeda
T.; Yasuda S.; Nakao K.; Akao M.; Ishii M.; Momona E.; Sumiyoshi T.;
Takamisawa I.; Daida H.; Miyauchi K.; Mimoto S.; Nakamura S.; Furukawa Y.;
Matsuda S.; Eizawa H.; Takizawa A.; Murata K.; Tanaka M.; Inada T.;
Noguchi Y.; Nakagawa Y.; Motooka M.; Ikari Y.; Awano K.; Haruna Y.;
Kitaguchi S.; Hirayama H.; Nanasato M.
Institution
(Shiomi, Kimura) Department of Cardiovascular Medicine, Graduate School of
Medicine, Kyoto University, Japan
(Morimoto) Department of Clinical Epidemiology, Hyogo College of Medicine,
Hyogo, Japan
(Kitaguchi, Haruna) Division of Cardiology, Hirakata Kohsai Hospital,
Hirakata, Japan
(Nakagawa) Division of Cardiology, Tenri Hospital, Nara, Japan
(Ishii) Division of Cardiology, Kansai Electric Power Hospital, Osaka,
Japan
(Takamisawa, Sumiyoshi) Department of Cardiology, Sakakibara Heart
Institute, Japan Research Promotion Society for Cardiovascular Diseases,
Tokyo, Japan
(Motooka) Division of Cardiology, Shizuoka General Hospital, Shizuoka,
Japan
(Nakao, Yasuda) Department of Cardiovascular Medicine, National Cerebral
and Cardiovascular Center, Osaka, Japan
(Matsuda, Eizawa) Division of Cardiology, Nishikobe Medical Center, Kobe,
Japan
(Mimoto, Nakamura) Department of Cardiology, New Tokyo Hospital, Tokyo,
Japan
(Aoyama, Hirayama) Department of Cardiology, Nagoya Second Red Cross
Hospital, Nagoya, Japan
(Takeda) Division of Cardiology, Koto Memorial Hospital, Higashioumi,
Japan
(Murata) Department of Cardiology, Shizuoka City Shizuoka Hospital,
Shizuoka, Japan
(Akao) Department of Cardiology, National Hospital Organization Kyoto
Medical Center, Kyoto, Japan
(Inada, Tanaka) Cardiovascular Center Osaka Red Cross Hospital, Osaka,
Japan
(Hyakuna) Department of Cardiology, Saiseikai Shimonoseki General
Hospital, Yamaguchi, Japan
(Awano) Department of Cardiology, Kitaharima Medical Center, Hyogo, Japan
(Shirotani) Department of Cardiology, Kindai University Nara Hospital,
Nara, Japan
(Furukawa) Department of Cardiovascular Medicine, Kobe City Medical Center
General Hospital, Kobe, Japan
(Kadota) Division of Cardiology, Kurashiki Central Hospital, Kurashiki,
Japan
(Miyauchi, Daida) Department of Cardiovascular Medicine, Juntendo
University, Graduate School of Medicine, Tokyo, Japan
(Noguchi) Department of Cardiology, Tsukuba Medical Center Hospital,
Tsukuba, Japan
(Miyazaki) Division of Cardiology, Kindai University, Osaka, Japan
(Kimura) Division of Cardiology, Yokohama City University Medical Center,
Yokohama, Japan
(Ikari) Department of Cardiology, Tokai University, Kanagawa, Japan
Title
The ReACT Trial: Randomized Evaluation of Routine Follow-up Coronary
Angiography After Percutaneous Coronary Intervention Trial.
Source
JACC: Cardiovascular Interventions. 10 (2) (pp 109-117), 2017. Date of
Publication: 23 Jan 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The purpose of this study was to evaluate long-term clinical
impact of routine follow-up coronary angiography (FUCAG) after
percutaneous coronary intervention (PCI) in daily clinical practice in
Japan. Background The long-term clinical impact of routine FUCAG after PCI
in real-world clinical practice has not been evaluated adequately. Methods
In this prospective, multicenter, open-label, randomized trial, patients
who underwent successful PCI were randomly assigned to routine
angiographic follow-up (AF) group, in which patients were to receive FUCAG
at 8 to 12 months after PCI, or clinical follow-up alone (CF) group. The
primary endpoint was defined as a composite of death, myocardial
infarction, stroke, emergency hospitalization for acute coronary syndrome,
or hospitalization for heart failure over a minimum of 1.5 years
follow-up. Results Between May 2010 and July 2014, 700 patients were
enrolled in the trial among 22 participating centers and were randomly
assigned to the AF group (n = 349) or the CF group (n = 351). During a
median of 4.6 years of follow-up (interquartile range [IQR]: 3.1 to 5.2
years), the cumulative 5-year incidence of the primary endpoint was 22.4%
in the AF group and 24.7% in the CF group (hazard ratio: 0.94; 95%
confidence interval: 0.67 to 1.31; p = 0.70). Any coronary
revascularization within the first year was more frequently performed in
AF group than in CF group (12.8% vs. 3.8%; log-rank p < 0.001), although
the difference between the 2 groups attenuated over time with a similar
cumulative 5-year incidence (19.6% vs. 18.1%; log-rank p = 0.92).
Conclusions No clinical benefits were observed for routine FUCAG after PCI
and early coronary revascularization rates were increased within routine
FUCAG strategy in the current trial. (Randomized Evaluation of Routine
Follow-up Coronary Angiography After Percutaneous Coronary Intervention
Trial [ReACT]; NCT01123291)<br/>Copyright &#xa9; 2017 American College of
Cardiology Foundation

<77>
Accession Number
614187156
Author
Teeuwen K.; van der Schaaf R.J.; Adriaenssens T.; Koolen J.J.; Smits P.C.;
Henriques J.P.S.; Vermeersch P.H.M.J.; Tjon Joe Gin R.M.; Scholzel B.E.;
Kelder J.C.; Tijssen J.G.P.; Agostoni P.; Suttorp M.J.
Institution
(Teeuwen, Agostoni, Suttorp) Department of Cardiology, St. Antonius
Hospital, Nieuwegein, Netherlands
(van der Schaaf) Department of Cardiology, Onze Lieve Vrouwe Gasthuis,
Amsterdam, Netherlands
(Adriaenssens) Department of Cardiology, University Hospital Leuven,
Belgium
(Koolen) Department of Cardiology, Catharina Hospital, Eindhoven,
Netherlands
(Smits) Department of Cardiology, Maasstad Hospital, Rotterdam,
Netherlands
(Henriques, Tijssen) Department of Cardiology, Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
(Vermeersch) Department of Cardiology, Middelheim Hospital, Antwerp,
Belgium
(Tjon Joe Gin) Department of Cardiology, Rijnstate Hospital, Arnhem,
Netherlands
(Scholzel) Department of Cardiology, Amphia Hospital, Breda, Netherlands
(Kelder) Department of Research and Statistics, St. Antonius Hospital,
Nieuwegein, Netherlands
Title
Randomized Multicenter Trial Investigating Angiographic Outcomes of Hybrid
Sirolimus-Eluting Stents With Biodegradable Polymer Compared With
Everolimus-Eluting Stents With Durable Polymer in Chronic Total
Occlusions: The PRISON IV Trial.
Source
JACC: Cardiovascular Interventions. 10 (2) (pp 133-143), 2017. Date of
Publication: 23 Jan 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to investigate the efficacy and
safety of the hybrid ultrathin-strut sirolimus-eluting stent (SES) with
biodegradable polymer compared with the thin-strut everolimus-eluting
stent (EES) with durable polymer in successfully recanalized chronic total
occlusions (CTOs). Background The introduction of drug-eluting stents
revolutionized the treatment of CTOs. However, limited data are available
on new-generation drug-eluting stents with biodegradable polymer in CTOs.
Methods In this multicenter trial, patients were randomized, after
successful CTO recanalization, to either SES or EES. The primary
noninferiority endpoint was in-segment late lumen loss (noninferiority
margin 0.2 mm). Secondary endpoints included in-stent late lumen loss and
clinical endpoints. Results Overall, 330 patients were included. At 9
months, angiography was available in 281 patients (85%). Duration of
occlusion >=3 months was 92.5%, with mean stent length of 52.4 +/- 28.1 mm
versus 52.3 +/- 26.5 mm in the SES and EES groups. The primary
noninferiority endpoint, in-segment late lumen loss, was not met for SES
versus EES (0.13 +/- 0.63 mm vs. 0.02 +/- 0.47 mm; p = 0.08, 2-sided;
difference 0.11 mm; 95% confidence interval: -0.01 to 0.25 mm;
p<inf>noninferiority</inf> = 0.11, 1-sided). In-stent late lumen loss was
comparable between SES and EES (0.12 +/- 0.59 mm vs. 0.07 +/- 0.46 mm; p =
0.52). The incidence of in-stent and in-segment binary restenosis was
significantly higher with SES compared with EES (8.0% vs. 2.1%; p =
0.028), with comparable rates of reocclusions (2.2% vs. 1.4%; p = 0.68).
Clinically indicated target lesion and target vessel revascularization
(9.2% vs. 4.0% [p = 0.08] and 9.2% vs. 6.0% [p = 0.33]), target vessel
failure (9.9% vs. 6.6%; p = 0.35), and definite or probable stent
thrombosis (0.7% vs. 0.7%; p = 1.00) were comparable between the SES and
EES groups. Conclusions This randomized trial failed to show
noninferiority of hybrid SES relative to EES in terms of in-segment late
lumen loss in successfully recanalized CTOs. Furthermore, a statistically
significantly higher rate of binary restenosis was found with
SES.<br/>Copyright &#xa9; 2017 American College of Cardiology Foundation

<78>
Accession Number
613945139
Author
Ramos dos Santos P.M.; Aquaroni Ricci N.; Aparecida Bordignon Suster E.;
de Moraes Paisani D.; Dias Chiavegato L.
Institution
(Ramos dos Santos, Aquaroni Ricci, Aparecida Bordignon Suster, Dias
Chiavegato) Masters and Doctoral Programmes in Physical Therapy,
Universidade Cidade de Sao Paulo, Sao Paulo, Brazil
(de Moraes Paisani) Research Institute, Hospital do Coracao, Sao Paulo,
Brazil
(Dias Chiavegato) Pulmonary Division, Universidade Federal de Sao Paulo,
Sao Paulo, Brazil
Title
Effects of early mobilisation in patients after cardiac surgery: a
systematic review.
Source
Physiotherapy (United Kingdom). 103 (1) (pp 1-12), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Ltd
Abstract
Background Early mobilisation is prescribed after cardiac surgery to
prevent postoperative complications, decrease length of hospital stay, and
augment return to daily activities. Objective To evaluate the evidence for
the effects of early mobilisation in patients after cardiac surgery on
length of hospital stay, functional capacity and postoperative
complications. Data sources The data sources used were Medline, Embase,
CINAHL, PEDro, Web of Science and Cochrane Central Register of Controlled
Trials. Study selection Randomised controlled trials of early mobilisation
after cardiac surgery. Study selection was not restricted by language or
publication time. Study appraisal and synthesis methods The methodological
quality of each article was appraised with the PEDro scale. All review
phases (selection, data extraction and appraisal) were conducted by two
investigators, and a third investigator provided consensus. Results Nine
trials were selected. The PEDro scale showed that the studies had a low
risk of bias (range 5 to 9 points). The trials revealed diversity in
techniques used for mobilisation, as well as periods considered early for
the start of the intervention. Early mobilisation groups had improved
outcomes compared with control groups without treatment. Generally, these
advantages did not differ when groups of interventions were compared.
Limitations It was not possible to perform a meta-analysis due to the
variability of the interventions proposed as early mobilisation.
Conclusions Regardless of the techniques used as mobilisation, the
essential point is to avoid bed rest. Early mobilisation seems to be
important to prevent postoperative complications, improve functional
capacity and reduce length of hospital stay in patients after cardiac
surgery.<br/>Copyright &#xa9; 2016 Chartered Society of Physiotherapy

<79>
Accession Number
614318092
Author
Li P.; Qu L.-P.; Qi D.; Shen B.; Wang Y.-M.; Xu J.-R.; Jiang W.-H.; Zhang
H.; Ding X.-Q.; Teng J.
Institution
(Li, Qi) Department of Nephrology, Yantai Yuhuangding Hospital, Yantai,
Shandong, China
(Qu) Department of Obstetrics, Yantai Yuhuangding Hospital, Yantai,
Shandong, China
(Shen, Wang, Xu, Jiang, Zhang, Ding, Teng) Department of Nephrology,
Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai,
China
(Shen, Wang, Xu, Jiang, Zhang, Ding, Teng) Kidney and Dialysis Institute
of Shanghai, Shanghai, China
(Ding, Teng) Shanghai Key Laboratory of Kidney and Blood Purification,
Shanghai, China
Title
Significance of perioperative goal-directed hemodynamic approach in
preventing postoperative complications in patients after cardiac surgery:
a meta-analysis and systematic review.
Source
Annals of Medicine. 49 (4) (pp 343-351), 2017. Date of Publication: 19 May
2017.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Purpose: Goal-directed hemodynamic therapy (GDT) is used to prevent
hypoperfusion resulting from surgery. The objective of this study was to
analyze the efficacy and importance of perioperative GDT. Methods: PUBMED,
MEDLINE, CENTRAL, and Google Scholar databases were searched until 17 June
2016 using the search terms: cardiac output, cardiac surgical procedures,
hemodynamics, goal-directed therapy, and intraoperative.
Randomized-controlled trials with pre-emptive hemodynamic intervention for
cardiac surgical population versus standard hemodynamic therapy were
included. Results: Nine studies were included with a total of 1148
patients. The overall analysis revealed no significant difference in the
all-cause mortality (pooled peto OR =0.58, 95%CI =0.27-1.525, p = 0.164),
duration of mechanical ventilation (pooled difference in mean= -1.48,
95%CI= -3.24 to 0.28, p = 0.099), or length of intensive care unit (ICU)
stay (pooled difference in mean= -9.10, 95%CI= -20.14 to 1.93, p = 0.106)
between patients in the GDT and control groups. Patients in the GDP group
were associated with shorter hospital stay than those in the control group
(pooled difference in mean= -1.52, 95%CI= -2.31 to -0.73, p < 0.001).
Conclusion: GDT reduces the length of hospital stay compared with the
standard of care. Further studies are necessary to continually assess the
benefit of GDT following major surgery.Key Messages The results of this
analysis revealed no significant difference between cardiac surgery
patients receiving goal-directed hemodynamic therapy (GDT) or conventional
fluid therapy in terms of the all-cause mortality, duration of mechanical
intervention, and length of ICU-stay. The length of hospital stay was
significantly reduced in patients treated with GDT compare to conventional
fluid therapy. GDT may have limited benefit in reducing mortality;
however, the association to shorter length of hospital stay may suggest
that better hemodynamic balance can facilitate postoperative
recovery.<br/>Copyright &#xa9; 2017 Informa UK Limited, trading as Taylor
& Francis Group.

<80>
Accession Number
616545369
Author
Stevens L.-M.; Noiseux N.; Avezum A.; Ayapati D.R.; Chen X.; Lucchesee
F.A.; Cacheda H.; Parvathaneni S.; Ou Y.; Lamy A.
Institution
(Stevens, Noiseux) Department of Surgery, Division of Cardiac Surgery,
Centre Hospitalier de l'Universite de Montreal and Research Center,
Montreal, QC, Canada
(Avezum) Research Division, Dante Pazzanese Institute of Cardiology, Sao
Paulo, Brazil
(Ayapati) Department of Cardiothoracic Surgery, India Global Hospitals,
Hyderabad, India
(Chen) Department of Cardiothoracic Surgery, Nanjing First Hospital,
Nanjing, China
(Lucchesee) Department of Cardiovascular Surgery, Sao Francisco Hospital,
Porto Alegre, Brazil
(Cacheda) Department of Cardiothoracic Surgery, Institute of Cardiology of
Corrientes, Corrientes, Argentina
(Parvathaneni) Department of Cardiothoracic Surgery, Mercy Medical
Research Institute, St-Louis, MO, United States
(Ou, Lamy) Department of Surgery, Division of Cardiac Surgery, McMaster
University and Population Health Research Institute, Hamilton, ON, Canada
Title
Conversion after off-pump coronary artery bypass grafting: The CORONARY
trial experience.
Source
European Journal of Cardio-thoracic Surgery. 51 (3) (pp 539-546), 2017.
Date of Publication: 01 Mar 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Emergent and late conversions form OFF-to-ON pump coronary
artery bypass grafting (CABG) have been associated with worse outcomes,
however, it remains unclear as to which risk factors are associated with
conversion and how to prevent them. METHODS: Among 4718 patients who
randomly underwent off- or on-pump CABG, the incidence of off-pump to
on-pump cross-over, or 'OFF-to-ON conversion', was 7.9% (186/2356). The
primary outcome was a composite of death, stroke, myocardial infarction,
or new renal failure requiring dialysis. We assessed the risk factors and
outcomes of converted patients. RESULTS: Emergent OFF-to-ON conversions,
defined as conversions for hypotension or ischaemia, were required for
3.2% of patients (n = 75), while most elective conversions were due to
small or intramuscular coronaries (n = 83). OFF-to-ON converted patients
required increased surgery time, blood transfusions, intensive care unit
stay, and presented a higher incidence at 1 year of the composite outcome
compared with non-converted off-pump patients (all P < 0.01), especially
if the conversion was emergent. Conversely, elective conversions outcomes
were no different compared with non-converted off-pump patients (P =
0.35). Independent predictors of emergent conversions included higher
heart rate or chronic atrial fibrillation, urgent surgery, more grafts
planned and surgeon experience with off-pump CABG. CONCLUSION: Emergent
OFF-to-ON conversion is associated with worse outcomes compared with
elective conversion or no conversion. In the presence of risk factors for
emergent conversion, an early and elective conversion approach is a
judicious strategy.<br/>Copyright &#xa9; The Author 2016. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<81>
Accession Number
614307143
Author
Ong M.E.H.; Hao Y.; Yap S.; Pek P.P.; Chua T.S.J.; Ng F.S.P.; Lim S.H.
Institution
(Ong, Yap, Pek, Lim) Department of Emergency Medicine, Singapore General
Hospital, Singapore
(Hao) Division of Research, Singapore General Hospital, Singapore
(Chua) National Heart Centre Singapore, Singapore General Hospital,
Singapore
(Ong) Health Services and Systems Research, Duke-NUS Graduate Medical
School, Singapore
(Chua) Singapore Health Services, Singapore
(Ng) Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
Title
Validation of the new vancouver chest pain rule in asian chest pain
patients presenting at the emergency department.
Source
Canadian Journal of Emergency Medicine. 19 (1) (pp 18-25), 2017. Date of
Publication: 01 Jan 2017.
Publisher
Cambridge University Press (E-mail: info@bcdecker.com)
Abstract
Objectives: The new Vancouver Chest Pain (VCP) Rule recommends early
discharge for chest pain patients who are at low risk of developing acute
coronary syndrome (ACS), and thus can be discharged within 2 hours of
arrival at the emergency department (ED). This study aimed to assess the
performance of the new VCP Rule for Asian patients presenting with chest
pain at the ED. Methods: This prospective cohort study involved patients
attended to at the ED of a large urban centre. Patients of at least 25
years old, presenting with stable chest pain and a non-diagnostic ECG, and
with no history of active coronary artery disease were included in the
study. The main outcome measures were cardiac events, angioplasty, or
coronary artery bypass within 30 days of enrolment. Results: The study
included 1690 patients from 27 August 2000 to 1 May 2002, with 661
patients fulfilling the VCP criteria. Of those for early discharge, 24 had
cardiac events and 13 had angioplasty or bypass at 30 days, compared to 91
and 41, respectively, for those unsuitable for discharge. This gave the
rule a sensitivity of 78.1% for cardiac events, including angioplasty and
bypass. Specificity was 41.0%, and negative predictive value (NPV) was
94.4%. Conclusion: We found the new VCP Rule to have moderate sensitivity
and poor specificity for adverse cardiac events in our population. With an
NPV of less than 100%, this means that a small proportion of patients sent
home with early discharge would still have adverse cardiac
events.<br/>Copyright &#xa9; Canadian Association of Emergency Physicians.

<82>
Accession Number
614470540
Author
Elbadawi A.; Saad M.; Nairooz R.
Institution
(Elbadawi) Department of Medicine, Rochester General Hospital, Rochester,
NY, United States
(Saad, Nairooz) Division of Cardiovascular Medicine, University of
Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR 72205,
United States
(Elbadawi) Department of Cardiovascular Medicine, Ain Shams University,
Cairo, Egypt
Title
Aspirin Use Prior to Coronary Artery Bypass Grafting Surgery: a Systematic
Review.
Source
Current Cardiology Reports. 19 (2) (no pagination), 2017. Article Number:
18. Date of Publication: 01 Feb 2017.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of Review: Aspirin use before coronary artery bypass graft (CABG)
surgery has been a puzzling question for years. Controversy existed
regarding the overall benefits vs. risk of pre-operative aspirin use and
was translated to conflicting guidelines from major societies. Recent
Findings: Observational studies have suggested a reduced mortality with
pre-operative aspirin use. A meta-analysis of randomized controlled trials
showed increased risk of post-operative bleeding with aspirin, with no
associated increased mortality risk. A recent large randomized controlled
trial did not find a significant difference in bleeding risk or
post-operative mortality with pre-CABG aspirin use. Summary: The results
of available studies showed a beneficial effect with pre-CABG aspirin use
by decreasing thrombotic complications and perioperative myocardial
infarction, with an associated adverse risk of bleeding that did not
affect mortality rates. Given overall benefit-risk assessment, we are in
favor of pre-operative aspirin use in CABG patients.<br/>Copyright &#xa9;
2017, Springer Science+Business Media New York.

<83>
Accession Number
618020316
Author
Alonso P.; Sanz J.; Garcia-Orts A.; Reina S.; Jimenez S.; Osca J.; Cano
O.; Andres A.; Sancho-Tello M.J.; Martinez L.
Institution
(Alonso, Garcia-Orts, Reina, Jimenez, Osca, Cano, Andres, Sancho-Tello)
Electrophysiology Section, Cardiology Department, La Fe University
Hospital, Valencia, Spain
(Sanz, Martinez) Cardiology Department, La Fe University Hospital,
Valencia, Spain
Title
Usefulness of Sodium Bicarbonate for the Prevention of Contrast-Induced
Nephropathy in Patients Undergoing Cardiac Resynchronization Therapy.
Source
American Journal of Cardiology. 120 (9) (pp 1584-1588), 2017. Date of
Publication: 01 Nov 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
The use of contrast media during cardiac resynchronization therapy (CRT)
devices implantation is associated with the risk of contrast-induced
nephropathy (CIN). The aim of this study was to evaluate the possible
beneficial role of periprocedural intravenous volume expansion with
isotonic saline and sodium bicarbonate solution in patients who undergo
CRT implantation. Eligible patients were randomly assigned in a 1:1 ratio
to receive hydration plus one-sixth molar sodium bicarbonate (study group)
or not (control group). Primary end point was CIN incidence. Secondary end
points were (1) a combined end point of death, heart transplantation, or
hospitalization for heart failure at 12 months, (2) incidence of death,
and (3) the need for renal replacement therapy at 12 months. Final
analysis was performed with 93 patients. In the hydration group CIN
incidence was significantly reduced related to control group (0% vs 11%, p
= 0.02). There was a trend to reduce the combined end point in hydration
group (12.5% vs 22%, p = 0.14). Finally, CIN incidence was related to a
higher 12 months mortality (25% vs 7%, p = 0.03). In conclusion, CIN
incidence was 11% in a nonselected population of patients receiving a CRT
device. CIN appearance could be reduced by using a hydration protocol
based on sodium bicarbonate and isotonic saline.<br/>Copyright &#xa9; 2017
Elsevier Inc.

<84>
Accession Number
618162249
Author
Khan M.R.; Kayani W.T.; Ahmad W.; Hira R.S.; Virani S.S.; Hamzeh I.; Jneid
H.; Lakkis N.; Alam M.
Institution
(Khan) Resident Internal Medicine, McLaren Flint/Michigan State
University, Flint, Michigan, United States
(Kayani, Virani, Hamzeh, Jneid, Lakkis, Alam) Department of Medicine,
Section of Cardiology, Baylor College of Medicine, Houston, Texas, United
States
(Ahmad) Nishtar Medical College, Multan, Pakistan
(Hira) University of Washington, Seattle, Washington, United States
(Virani, Jneid) Section of Cardiology, Michael E. DeBakey Veterans Affairs
Medical Center, Houston, Texas, United States
Title
Meta-Analysis of Comparison of 5-Year Outcomes of Percutaneous Coronary
Intervention Versus Coronary Artery Bypass Grafting in Patients With
Unprotected Left Main Coronary Artery in the Era of Drug-eluting Stents.
Source
American Journal of Cardiology. 120 (9) (pp 1514-1520), 2017. Date of
Publication: 01 Nov 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Patients with unprotected left main coronary artery (ULMCA) disease are
increasingly being treated with percutaneous coronary intervention (PCI)
using drug-eluting stents (DES), but long-term outcomes comparing PCI with
coronary artery bypass grafting (CABG) remain limited. We performed
aggregate data meta-analyses of clinical outcomes (all-cause death,
nonfatal myocardial infarction, stroke, repeat revascularization, cardiac
death, and major adverse cardiac and cerebrovascular events) in studies
comparing 5-year outcomes of PCI with DES versus CABG in patients with
ULMCA disease. A comprehensive literature search (January 1, 2003 to
December 10, 2016) identified 9 studies (6,637 patients). Effect size for
individual clinical outcomes was estimated using odds ratio (OR) with 95%
confidence intervals (CI) using a random effects model. At 5 years, PCI
with DES was associated with equivalent cardiac (OR 0.95, 95% CI 0.62 to
1.46) and all-cause mortality (OR 0.98, 95% CI 0.72 to 1.33), lower rates
of stroke (OR 0.50, 95% CI 0.30 to 0.84), and higher rates of repeat
revascularization (OR 2.52, 95% CI 1.63 to 3.91); compared with CABG,
major adverse cardiac and cerebrovascular events showed a trend favoring
CABG but did not reach statistical significance (OR 1.19, 95% CI 0.93 to
1.54). In conclusion, for ULMCA disease, PCI can be considered as a
comparably effective and yet less invasive alternative to CABG given the
comparable long-term mortality and lower incidences of
stroke.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<85>
Accession Number
612920724
Author
Nuhoglu F.; Gumus F.; Sinikoglu S.N.; Yektas A.; Erkalp K.; Alagol A.
Institution
(Nuhoglu) Department of Ophthalmology, Bezmialem Private University,
Istanbul, Turkey
(Gumus, Sinikoglu, Yektas, Erkalp, Alagol) Department of Anesthesiology
and Reanimation, Bagcilar Training and Research Hospital, Istanbul, Turkey
Title
Changes in intraocular pressure during cardiopulmonary bypass.
Source
International Ophthalmology. 37 (5) (pp 1155-1160), 2017. Date of
Publication: 01 Oct 2017.
Publisher
Springer Netherlands
Abstract
Purpose: The aim of the present study was to investigate the changes in
intraocular pressures (IOP) in patients who underwent pulsatile and
non-pulsatile cardiopulmonary bypass (CPB). Methods: A total of 42
patients operated for elective coronary bypass surgery (CABG) on CPB were
randomly allocated to pulsatile (Group P) and non-pulsatile (Group N)
groups. Pulsatile flow was applied to Group P patients during crops-clamp
period. The IOP measurements were made before and after the induction of
anesthesia, before the onset of CPB, on the 5th, 15th, 30th, 45th, and
60th min of CPB, after CPB and at the end of the operation. The results of
repetitive measurements were analyzed at different intervals and in two
groups. Results: The second IOP measurements of right and left eyes
displayed statistically significant decreases from the baseline level
[11.9 +/- 2.9 (p = 0.0001) and 12.5 +/- 3.2 (p = 0.0001), respectively].
The significant decrease in the IOP values persisted in the repeated
measurements except for the 5th min of CPB values [17.0 +/- 3.5 (p =
0.346) and 16.7 +/- 3.6 (p = 0.399)]. Comparison of two groups
demonstrated significant differences at pre-CPB (right 12.8 +/- 2.3 vs.
10.8 +/- 2.4; p = 0.013 and left 13.3 +/- 2.4 vs. 11.5 +/- 2.5; p =
0.023), and 5th min of CPB measurements (right 18.5 +/- 3.1 vs. 15.9 +/-
3.4; p = 0.015; left 18.2 +/- 3.0 vs. 15.7 +/- 3.6; p = 0.019).
Conclusion: We noted a steady decrease in repeated IOP measurements except
for the transient increase in CPB values on 5th min. The IOP values were
higher in pulsatile CPB group in pre-CPB and 5th min of CPB measurements;
however, the difference was not significant in the repeated
measurements.<br/>Copyright &#xa9; 2016, Springer Science+Business Media
Dordrecht.

<86>
Accession Number
614735343
Author
Jasseron C.; Legeai C.; Jacquelinet C.; Leprince P.; Cantrelle C.; Audry
B.; Porcher R.; Bastien O.; Dorent R.
Institution
(Jasseron) 1 Agence de la biomedecine, Direction Prelevement Greffe
Organes-Tissus, Saint-Denis La Plaine, France 2 Assistance Publique
Hopitaux de Paris, Service de chirurgie cardio-vasculaire, Hopital de la
Pitie Salpetriere, Paris, France 3 Assistance Publique Hopitaux de Paris,
Hotel-Dieu, Centre d'Epidemiologie Clinique, Universite Paris Descartes,
Inserm U1153, Paris, France
Title
Prediction of Waitlist Mortality in Adult Heart Transplant Candidates: The
Candidate Risk Score.
Source
Transplantation. (no pagination), 2017. Date of Publication: 08 Mar 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: The cardiac allocation system in France is currently based on
urgency and geography. Medical urgency is defined by therapies without
considering objective patient mortality risk factors. This study aimed to
develop a waitlist mortality risk score from commonly available candidate
variables. METHODS: The study included all patients, aged 16 years or
older, registered on the national registry CRISTAL for first single-organ
heart transplantation between January 2010 and December 2014. This
population was randomly divided in a 2:1 ratio into derivation and
validation cohorts. The association of variables at listing with 1-year
waitlist death or delisting for worsening medical condition was assessed
within the derivation cohort. The predictors were used to generate a
candidate risk score (CRS). Validation of the CRS was performed in the
validation cohort. Concordance probability estimation (CPE) was used to
evaluate the discriminative capacity of the models. RESULTS: During the
study period, 2333 patients were newly listed. The derivation (n=1 555)
and the validation cohorts (n=778) were similar. Short-term mechanical
circulatory support, natriuretic peptide decile, glomerular filtration
rate and total bilirubin level were included in a simplified model and
incorporated into the score. The CPE of the CRS was 0.73 in the derivation
cohort and 0.71 in the validation cohort. The correlation between observed
and expected 1-year waitlist mortality in the validation cohort was 0.87.
CONCLUSIONS: The candidate risk score provides an accurate objective
prediction of waitlist mortality. It is currently being used to develop a
modified cardiac allocation system in France.<br/>Copyright &#xa9; 2017
Wolters Kluwer Health, Inc. All rights reserved.

<87>
Accession Number
618000006
Author
Banerjee K.; Poddar K.; Mick S.; White J.; Krishnaswamy A.; Johnston D.;
Rodriguez L.; Tuzcu E.M.; Kapadia S.
Institution
(Banerjee, Poddar, Mick, White, Krishnaswamy, Johnston, Rodriguez, Tuzcu,
Kapadia) Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, Ohio, United States
Title
Meta-Analysis of Usefulness of Anticoagulation After Transcatheter Aortic
Valve Implantation.
Source
American Journal of Cardiology. 120 (9) (pp 1612-1617), 2017. Date of
Publication: 01 Nov 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Since the advent of bioprosthetic valves, the implications of long-term
anticoagulation after valve replacement are unclear. There are very little
data on outcomes of long-term anticoagulation after transcatheter aortic
valve implantation (TAVI). Our aim was to conduct a systematic review of
literature regarding anticoagulation after TAVI. The existing literature
on anticoagulation after bioprosthetic valve replacement was thoroughly
reviewed, including the most recent American College of
Cardiology/American Heart Association 2017 guidelines for management of
valvular disease, which is based on sparse, nonrandomized retrospective
data. A systematic review of MEDLINE, EMBASE, and Cochrane CENTRAL
databases was conducted to retrieve articles reporting outcomes on
anticoagulation after TAVI, and 5 articles were retrieved. Pooled analysis
revealed lower bleeding rates in the anticoagulated group (22% vs 35%, p =
0.006). Stroke and mortality were inconsistently reported by the studies.
The data regarding outcomes of patients on anticoagulation after TAVI are
sparse. Systematic collection of anticoagulation data in the existing
registries and future trials should be strongly considered in patients
undergoing TAVI.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<88>
Accession Number
618057288
Author
Casset C.; Jankowski A.; Bertrand B.; Saunier C.; Piliero N.; Rodiere M.;
Ferretti G.; Quesada J.-L.; Broisat A.; Riou L.; Fagret D.; Ghezzi C.;
Vanzetto G.; Barone-Rochette G.
Institution
(Casset, Bertrand, Saunier, Piliero, Vanzetto, Barone-Rochette) Department
of Cardiology, University Hospital, Grenoble Alpes, France
(Jankowski, Rodiere, Ferretti) Department of Radiology, University
Hospital, Grenoble Alpes, France
(Quesada) Clinical Investigation Center, Grenoble Alpes University
Hospital, France
(Broisat, Riou, Fagret, Ghezzi, Vanzetto, Barone-Rochette) INSERM, U1039,
Radiopharmaceutiques Biocliniques, Universite Grenoble Alpes, France
(Vanzetto, Barone-Rochette) French alliance clinical trial, French
Clinical Research Infrastructure Network, Paris, France
Title
Evaluation of Imaging Strategy to Optimize and Improve Outcome of
Transcatheter Aortic Valvular Implantation.
Source
American Journal of Cardiology. 120 (9) (pp 1633-1638), 2017. Date of
Publication: 01 Nov 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Cardiac computed tomography (CT) provides additional information with
ultrasound in the transcatheter heart valve (THV) size selection. However,
the influence of these incremental data on outcomes has not been evaluated
in a randomized study. A single-center prospective, randomized, and open
study was performed. Patients referred for transfemoral transcatheter
aortic valve implantation with a balloon-expandable endoprothesis were
included. THV size selection was performed using either transthoracic and
transesophageal echocardiography data (control group) or ultrasound and CT
results (CT group). The primary composite end point included the
occurrence of stroke, major vascular complications, and moderate or severe
paravalvular aortic regurgitation (PAR) at 1 year. Fifty patients (n = 25
in the control and CT groups) were enrolled. The primary composite end
point occurred in 40% and 8% of patients from the control and CT groups,
respectively (p = 0.008). The Kaplan-Meier analysis revealed a pejorative
association with not performing the CT (p = 0.007). A decrease in the
occurrence of PAR was observed in the CT group compared with the control
group (PAR 28% vs 4%, p = 0.04; major vascular complications 12% vs 4%, p
= 0.6; all-cause death 16% vs. 4%, p = 0.34; no stroke). In conclusion,
the use of cardiac CT in addition to ultrasound data in THV size selection
reduced the long-term occurrence of cardiovascular events.<br/>Copyright
&#xa9; 2017 Elsevier Inc.

<89>
Accession Number
618731093
Author
Lockwood G.G.; Cabreros L.; Banach D.; Punjabi P.P.
Institution
(Lockwood, Cabreros, Banach) Centre for Perioperative Medicine and
Critical Care Research, Imperial College Healthcare NHS Trust, Department
of Anaesthesia, Hammersmith Hospital, London W12 0HS, United Kingdom
(Punjabi) Department of Cardiothoracic Surgery, Imperial College
Healthcare NHS Trust, London, United Kingdom
Title
Continuous bilateral thoracic paravertebral blockade for analgesia after
cardiac surgery: A randomised, controlled trial.
Source
Perfusion (United Kingdom). 32 (7) (pp 591-597), 2017. Date of
Publication: 01 Oct 2017.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Background: Continuous bilateral thoracic paravertebral blockade has been
used for analgesia after cardiac surgery, but its efficacy has never been
formally tested. Method: Fifty adult patients were enrolled in a
double-blind, randomised, controlled study of continuous bilateral
thoracic paravertebral infusion of 0.5% lidocaine (1
mg.kg^-1.hr^-1) for analgesia after coronary surgery.
Control patients received a subcutaneous infusion of lidocaine at the same
rate through catheters inserted at the same locations as the study group.
The primary outcome was morphine consumption at 48 hours using
patient-controlled analgesia (PCA). Secondary outcomes included pain,
respiratory function, nausea and vomiting. Serum lidocaine concentrations
were measured on the first two post-operative days. Results: There was no
difference in morphine consumption or in any other outcome measure between
the groups. Serum lidocaine concentrations increased during the study,
with a maximum of 5.9 mg.l^-1. There were no adverse events as a
consequence of the study. Conclusion: Bilateral paravertebral infusion of
lidocaine confers no advantage over systemic lidocaine infusion after
cardiac surgery. Clinical trial registration: ISRCTN13424423
(https://www.isrctn.com)<br/>Copyright &#xa9; The Author(s) 2017.

<90>
Accession Number
618618189
Author
Shaybak E.; Abdollahimohammad A.; Rahnama M.; Masinaeinezhad N.;
Azadi-Ahmadabadi C.; Firouzkohi M.
Institution
(Shaybak) Nursing and Midwifery School, Zabol, Iran, Islamic Republic of
(Abdollahimohammad, Rahnama, Firouzkohi) Nusing and Midwifery School,
Zabol University of Medical Sciences, Zabol, Iran, Islamic Republic of
(Masinaeinezhad, Azadi-Ahmadabadi) Medical School, Zahedan University of
Medical Sciences, Zahedan, Iran, Islamic Republic of
Title
The effect of reiki energy healing on CABG postoperative chest pain caused
by coughing and deep breathing.
Source
Indian Journal of Public Health Research and Development. 8 (2) (pp
305-310), 2017. Date of Publication: April-June 2017.
Publisher
Indian Journal of Public Health Research and Development (Aster-06/603,
Supertech Emerald Court, Sector - 93 A, Expressway, NOIDA, UTTAR PRADESH
201 304, India)
Abstract
Introduction: Many heart patients need Coronary Artery Bypass Graft (CABG)
for their health and survival. CABG is known as the first and best choice
in the treatment of these patients.the aim m this study was to study the
effect of Reiki on chest pain of the patients undergoing CABG. Method and
materials: Forty patients after CABG were randomly assigned to Reiki and
Sham Reiki groups. CABG Postoperative Chest Pain Caused by Coughing and
Deep Breathing were measured before and after the interventions. The
patients underwent Reiki healing energy and sham Reiki for 9 minutes. The
short and modified version of the McGill pain questionnaire and the Visual
Analog Scale was used for pain measurement. Results: shows that 60% of the
patients were male in both groups. No significant difference was found
between two groups in terms of age, length of stay, and the outset of
energy healing (P>0.05). No significant difference was found in terms of
diabetes, high blood pressure, high cholesterol, and history of smoking
and drug addiction (P>0.05). Discussion: According to the findings, Reiki
energy healing is advised as a non-medical method, easy, inexpensive,
noninvasive, and effective method for pain relief of the CABG patients.
Conclusion: future studies recommended are recommended to study the
stability of Reiki on pain severity of patients at different times after
intervention and compare the Reiki with drug therapy and other methods of
complementary medicine for reducing the postoperative pain in order to
provide better services for patients.<br/>Copyright &#xa9; 2017, Indian
Journal of Public Health Research and Development. All rights reserved.

<91>
Accession Number
613672296
Author
Vallabhajosyula S.; Kanmanthareddy A.; Erwin P.J.; Esterbrooks D.J.;
Morrow L.E.
Institution
(Vallabhajosyula) Division of Pulmonary and Critical Care Medicine,
Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
(Vallabhajosyula) Multidisciplinary Epidemiology and Translational
Research in Intensive Care (METRIC) Laboratory, Mayo Clinic, Rochester,
MN, United States
(Kanmanthareddy, Esterbrooks) Division of Cardiovascular Diseases,
Department of Internal Medicine, Creighton University School of Medicine,
Omaha, NE, United States
(Erwin) Mayo Clinic Libraries, Mayo Clinic College of Medicine, Mayo
Clinic, Rochester, MN, United States
(Erwin) Evidence-Based Practice Research Program, Mayo Clinic, Rochester,
MN, United States
(Morrow) Division of Pulmonary, Critical Care and Sleep Medicine,
Department of Internal Medicine, Creighton University School of Medicine,
Omaha, NE, United States
(Morrow) Division of Pulmonary, Critical Care and Sleep Medicine,
Department of Internal Medicine, Veterans Affairs Nebraska-Western Iowa
Health Care System, Omaha, NE, United States
Title
Role of statins in delirium prevention in critical ill and cardiac surgery
patients: A systematic review and meta-analysis.
Source
Journal of Critical Care. 37 (pp 189-196), 2017. Date of Publication: 01
Feb 2017.
Publisher
W.B. Saunders
Abstract
Background The data evaluating the role of statins in delirium prevention
in the intensive care unit are conflicting and limited. Methods We
performed a systematic review and meta-analysis of literature from 1975 to
2015. All English-language adult studies evaluating delirium incidence in
statin and statin nonusers were included and studies without a control
group were excluded. Mantel-Haenszel model was used to calculate pooled
risk ratios (RRs) and 95% confidence intervals (CIs). Statistical
significance was defined as CI not including unity and P value less
than.05. Results Of a total 57 identified studies, 6 were included. The
studies showed high heterogeneity (I² = 73%) for all and
moderate for cardiac surgery studies (I² = 55%). Of 289 773
patients, statins were used in 22 292 (7.7%). Cardiac surgery was
performed in 4382 (1.5%) patients and 2321 (53.0%) used statins. Delirium
was noted in 710 (3.2%) and 3478 (1.3%) of the patients in the statin and
nonstatin groups, respectively, with no difference between groups in the
total cohort (RR, 1.05 [95% CI, 0.85-1.29]; P =.56) or in cardiac surgery
patients (RR, 1.03 [95% CI, 0.68-1.56]; P =.89). Conclusions In critically
ill and cardiac surgery patients, this meta-analysis did not show a
benefit with statin therapy in the prevention of delirium.<br/>Copyright
&#xa9; 2016 Elsevier Inc.

<92>
Accession Number
612111253
Author
Wassef A.; Butcher K.
Institution
(Wassef, Butcher) Division of Neurology, Department of Medicine,
University of Alberta, Edmonton, Canada
(Wassef) Division of General Internal Medicine, Department of Medicine,
University of Alberta, Edmonton, Canada
Title
Novel oral anticoagulant management issues for the stroke clinician.
Source
International Journal of Stroke. 11 (7) (pp 759-767), 2016. Date of
Publication: 01 Oct 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Four nonvitamin K antagonist oral anticoagulants (NOACs) are
approved for stroke prevention in patients with nonvalvular atrial
fibrillation (NVAF). Aims: In this review, we assemble available evidence
for the best management of ischemic and hemorrhagic stroke patients in the
context of NOAC use. Summary of review: NOACs provide predictable
anticoagulation with fixed dosages. The direct thrombin inhibitor
dabigatran and direct factor Xa inhibitors apixaban, edoxaban, and
rivaroxaban are all noninferior to warfarin for the prevention of ischemic
stroke and systemic embolism and are associated with reduced incidence of
intracranial hemorrhage. While these agents offer treatment options for
NVAF patients, they also present challenges specific to the clinician
managing cerebrovascular disease patients. Conclusions: We summarize
available evidence and current approaches to the initiation, dosing,
monitoring and potential reversal of NOACs in stroke
patients.<br/>Copyright &#xa9; 2016, &#xa9; 2016 World Stroke
Organization.

<93>
Accession Number
611448533
Author
Nishiyama N.; Komatsu T.; Kuroyanagi T.; Fujikake A.; Komatsu S.; Nakamura
H.; Yamada K.; Nakahara S.; Kobayashi S.; Taguchi I.
Institution
(Nishiyama, Komatsu, Kuroyanagi, Fujikake, Komatsu, Nakamura, Yamada,
Nakahara, Kobayashi, Taguchi) Department of Cardiology, Dokkyo Medical
University Koshigaya Hospital, Japan
Title
Clinical value of drug-coated balloon angioplasty for de novo lesions in
patients with coronary artery disease.
Source
International Journal of Cardiology. 222 (pp 113-118), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Despite the low restenosis rates of drug-eluting stents (DES),
several problems remain, including stent thrombosis, stent fracture, and
neo-atherosclerosis. 'Stent-less' (balloon alone) percutaneous coronary
intervention (PCI) is still being used, and several clinical trials have
supported the efficacy of DCB. The aim of this study was to investigate
the efficacy of a drug-coated balloon (DCB) in the treatment of de novo
coronary artery disease. Methods We enrolled 60 consecutive patients who
had been given elective PCI between May 2014 and June 2015. They were
randomly assigned to a 'stent-less' group (n = 30) and a 'stent' group (n
= 30). Twenty-seven patients were treated with DCB alone and 33 with DES,
and then evaluated for target lesion revascularization (TLR) rate and by
quantitative coronary angiography (QCA) eight months later. Results TLR
rates were similar in the two groups (DCB; 0.0%, DES; 6.1%, P = 0.169). In
the QCA analysis, minimal lumen diameter (MLD) and acute gain were
significantly smaller in the DCB group than in the DES group immediately
after PCI (2.36 +/- 0.46 vs 2.64 +/- 0.37, P = 0.011, and 1.63 +/- 0.41 vs
2.08 +/- 0.37, P < 0.0001, respectively). Eight months after PCI, however,
there was no significant difference in MLD or late lumen loss between the
two groups. Conclusions A 'stent-less' PCI using DCB could be useful even
in the DES era. After 'stent-less' PCI, antiplatelet agents might be
reduced or discontinued more safely than after DES
implantation.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd

<94>
Accession Number
617340530
Author
Li D.; Fan Q.; Iwase T.; Hirata Y.; An Q.
Institution
(Li, Fan, An) Department of Cardiovascular Surgery, West China Hospital,
Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan 610041, China
(Li, Iwase, Hirata) Department of Cardiac Surgery, The University of Tokyo
Hospital, Tokyo, Japan
Title
Modified Single-Patch Technique Versus Two-Patch Technique for the Repair
of Complete Atrioventricular Septal Defect: A Meta-Analysis.
Source
Pediatric Cardiology. 38 (7) (pp 1456-1464), 2017. Date of Publication: 01
Oct 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Technical selection for surgical repair of complete atrioventricular
septal defect (CAVSD) still remains controversial. This meta-analysis
aimed to compare the modified single-patch (MP) technique with the
two-patch (TP) technique for patients with CAVSD. Relevant studies
comparing the MP technique with the TP technique were identified through a
literature search using MEDLINE, EMBASE, Google Scholar, Cochrane Library,
and the China National Knowledge Infrastructure databases. The variables
were ventricular septal defect (VSD) size, cardiopulmonary bypass (CBP)
time, aortic cross-clamp (ACC) time, intensive care unit stay, hospital
stay, and other outcomes involving mortality, left ventricular outflow
tract obstruction, atrioventricular valve regurgitation, residual septal
shunt, atrioventricular block, and reoperation. A
random-effect/fixed-effect model was used to summarize the estimates of
mean difference/odds ratio with 95% confidence interval. Subgroup analysis
stratified by region was performed. Fifteen publications involving 1034
patients were included. This meta-analysis demonstrated that (1) VSD size
in the MP group was significantly smaller; (2) CBP time, ACC time, and
hospital stay in the MP group experienced improvement; (3) Other
postoperative outcomes showed no significant differences between two
groups; and (4) The trends in China and other countries were close. The MP
and TP techniques had comparable outcomes; however, the MP technique was
performed with significantly shorter CBP and ACC times in patients with
smaller VSDs. Given this limitation of data, the results of comparison of
the two techniques in patients with larger VSDs remain unknown. Further
studies are needed.<br/>Copyright &#xa9; 2017, Springer Science+Business
Media, LLC.

<95>
Accession Number
618637096
Author
Roy A.K.; Chevalier B.; Lefevre T.; Louvard Y.; Segurado R.; Sawaya F.;
Spaziano M.; Neylon A.; Serruys P.W.; Dawkins K.D.; Kappetein A.P.; Mohr
F.-W.; Colombo A.; Feldman T.; Morice M.-C.
Institution
(Roy, Chevalier, Lefevre, Louvard, Sawaya, Spaziano, Neylon, Morice)
Ramsay Generale de Sante, Institut Cardiovasculaire Paris Sud, Hopital
Prive Jacques Cartier, 6 Avenue du Noyer Lambert, Massy 91300, France
(Segurado) CSTAR Biostatistics, University College Dublin, Dublin, Ireland
(Serruys) Thoraxcenter, Rotterdam, Netherlands
(Dawkins) Boston Scientific Corporation, Marlborough, MA, United States
(Kappetein) Erasmus MC, Rotterdam, Netherlands
(Mohr) Heart Center Leipzig, University of Leipzig, Leipzig, Germany
(Colombo) EMO GVM Centro Cuore Columbus/San Raffaele Hospital, Milan,
Italy
(Feldman) Evanston Hospital, Evanston, IL, United States
Title
Does geographical variability influence five-year MACCE rates in the
multicentre SYNTAX revascularisation trial?.
Source
EuroIntervention. 13 (7) (pp 828-834), 2017. Date of Publication:
September 2017.
Publisher
EuroPCR
Abstract
Aims: The use of multiple geographical sites for randomised cardiovascular
trials may lead to important heterogeneity in treatment effects. This
study aimed to determine whether treatment effects from different
geographical recruitment regions impacted significantly on five-year MACCE
rates in the SYNTAX trial. Methods and results: Five-year SYNTAX results
(n=1,800) were analysed for geographical variability by site and country
for the effect of treatment (CABG vs. PCI) on MACCE rates. Fixed, random,
and linear mixed models were used to test clinical covariate effects, such
as diabetes, lesion characteristics, and procedural factors. Comparing
five-year MACCE rates, the pooled odds ratio (OR) between study sites was
0.58 (95% CI: 0.47-0.71), and countries 0.59 (95% CI: 0.45-0.73). By
homogeneity testing, no individual site (X2=93.8, p=0.051) or country
differences (X2=25.7, p=0.080) were observed. For random effects models,
the intraclass correlation was minimal (ICC site=5.1%, ICC country=1.5%,
p<0.001), indicating minimal geographical heterogeneity, with a hazard
ratio of 0.70 (95% CI: 0.59-0.83). Baseline risk (smoking, diabetes, PAD)
did not influence regional five-year MACCE outcomes (ICC 1.3%-5.2%), nor
did revascularisation of the left main vs. three-vessel disease (p=0.241),
across site or country subgroups. For CABG patients, the number of
arterial (p=0.49) or venous (p=0.38) conduits used also made no
difference. Conclusions: Geographic variability has no significant
treatment effect on MACCE rates at five years. These findings highlight
the generalisability of the five-year outcomes of the SYNTAX
study.<br/>Copyright &#xa9; Europa Digital & Publishing 2017. All rights
reserved.

<96>
Accession Number
616534323
Author
Talwar S.; Gupta A.; Nehra A.; Makhija N.; Kapoor P.M.; Sreenivas V.;
Choudhary S.K.; Airan B.
Institution
(Talwar, Gupta, Choudhary, Airan) Departments of Cardiothoracic and
Vascular Surgery, All India Institute of Medical Sciences, New Delhi,
India
(Nehra) Clinical Neuropsychology, Neurosciences Centre, All India
Institute of Medical Sciences, New Delhi, India
(Makhija, Kapoor) Departments of Cardiac Anaesthesiology, All India
Institute of Medical Sciences, New Delhi, India
(Sreenivas) Departments of Biostatistics, All India Institute of Medical
Sciences, New Delhi, India
Title
Bidirectional superior cavopulmonary anastomosis with or without
cardiopulmonary bypass: A randomized study.
Source
Journal of Cardiac Surgery. 32 (6) (pp 376-381), 2017. Date of
Publication: June 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Objectives: This study aims to compare the bidirectional superior
cavopulmonary anastomosis (BDG) with or without cardiopulmonary bypass
(CPB). Methods: 100 patients undergoing BDG were randomized into two
groups: Off-CPB or on-CPB groups. All patients underwent near-infrared
spectrophotometry (NIRS) and bispectral index (BIS) monitoring and pre-
and postoperative serum 100 beta protein measurements (Sbeta100) and
neuro-cognitive evaluation. Postoperative intensive care unit (ICU)
parameters were also studied. Results: The median age of patients in the
on-CPB and off-CPB group were 42 and 48 months, respectively (p = 0.11).
Median weights in the on-CPB group and off-CPB group were 13.5 (5-50) kg
and 15 (7-36) kg, respectively (p = 0.927). There was a significant rise
in superior vena cava (SVC) pressure on SVC clamping in the off-CPB group
(23.12 +/- 6.84 vs 2.98 +/- 2.22 mmHg) on-CPB group (p < 0.001). There was
a significant fall in NIRS and BIS values from baseline in the off-CPB
group during the anastomosis but there was no statistically significant
change in serum Sbeta100from pre-clamp to post-clamp in either group.
Inotropic support, duration of ventilation, ICU stay, and hospital stay
were significantly less in the off-CPB group (p < 0.001). Assessment of
Social Adaptive Functioning revealed no adverse sequelae. There were
significant cost savings if surgery was performed off-CPB (p < 0.001).
Conclusion: Off CPB-BDG is an economical and safe procedure. Duration of
inotropic and mechanical ventilatory support, ICU, and hospital stay is
significantly less. We did not observe any early adverse neurologic
sequelae in patients undergoing off-CPB BDG.<br/>Copyright &#xa9; 2017
Wiley Periodicals, Inc.

<97>
Accession Number
616402957
Author
Rahouma M.; Kamel M.; Benedetto U.; Ohmes L.B.; Di Franco A.; Lau C.;
Girardi L.N.; Tranbaugh R.F.; Barili F.; Gaudino M.
Institution
(Rahouma, Kamel, Ohmes, Di Franco, Lau, Girardi, Tranbaugh, Gaudino)
Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York,
NY, United States
(Benedetto) Bristol Heart Institute, School of Clinical Sciences,
University of Bristol, Bristol, United Kingdom
(Barili) Department of Cardiovascular Surgery, S. Croce e Carle Hospital,
Cuneo, Italy
Title
Endoscopic versus open radial artery harvesting: A meta-analysis of
randomized controlled and propensity matched studies.
Source
Journal of Cardiac Surgery. 32 (6) (pp 334-341), 2017. Date of
Publication: June 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: We sought to investigate the impact of radial artery
harvesting techniques on clinical outcomes using a meta-analytic approach
limited to randomized controlled trials and propensity-matched studies for
clinical outcomes, in which graft patency was analyzed. Methods: A
systematic literature review was conducted using PubMed and MEDLINE to
identify publications containing comparisons between endoscopic radial
artery harvesting (ERAH) and open harvesting (ORAH). Only randomized
controlled trials and propensity-matched series were included. Data were
extracted and analyzed with RevMan. The primary endpoint was wound
complication rate, while secondary endpoints were patency rate, early
mortality, and long-term cardiac mortality. Results: Six studies
comprising 743 patients were included in the meta-analysis. Of them 324
(43.6%) underwent ERAH and 419 (56.4%) ORAH. ERAH was associated with a
lower incidence of wound complications (odds ratio: 0.33, confidence
interval 0.14-0.77; p = 0.01). There were no differences in graft patency,
and early and long-term cardiac mortality between the two techniques.
Conclusion: ERAH reduces wound complications and does not affect graft
patency, or short- and long-term mortality compared to ORAH.<br/>Copyright
&#xa9; 2017 Wiley Periodicals, Inc.

<98>
Accession Number
614525461
Author
Dervan L.A.; Yaghmai B.; Watson R.S.; Wolf F.M.
Institution
(Dervan, Watson) Division of Pediatric Critical Care Medicine, Department
of Pediatrics, University of Washington School of Medicine, Seattle, WA,
United States
(Yaghmai) Department of Pediatrics, University of Kansas School of
Medicine-Wichita, Wichita, KS, United States
(Watson) Center for Child Health, Behavior, and Development, Seattle
Children's Research Institute, Seattle, WA, United States
(Wolf) Department of Biomedical Informatics and Medical Education,
University of Washington School of Medicine, Seattle, WA, United States
Title
The use of methadone to facilitate opioid weaning in pediatric critical
care patients: a systematic review of the literature and meta-analysis.
Source
Paediatric Anaesthesia. 27 (3) (pp 228-239), 2017. Date of Publication: 01
Mar 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background: Continuous opioid infusion therapy is commonly utilized in the
pediatric intensive care setting to treat pain and facilitate tolerance of
invasive therapies. Transitioning to methadone is one common strategy for
weaning from continuous opioid infusions, but in practice this transition
can be challenging, and many children still experience iatrogenic
withdrawal. Aim: We reviewed the literature to evaluate the best available
evidence to guide methadone therapy in this setting, and to summarize
associated adverse events. Methods: We included all studies of methadone
used to facilitate weaning from continuous opioid infusions in pediatric
critical care patients, including medical, cardiac, and surgical patients,
excluding case reports and studies treating neonatal abstinence syndrome,
or acute or chronic pain. Medline, Embase, and CINAHL databases from
inception to May 2015 were queried; references of included works and
conference proceedings were also reviewed. Two authors independently
extracted data from each study. Meta-analysis with fixed- and
random-effects models was used to pool results of studies when applicable.
Results: Twelve studies involving 459 patients met criteria for inclusion.
A wide variety of methadone dosing and taper strategies were reported.
Mean inpatient methadone taper times varied widely, from 4.3 to 26.2 days.
Excessive sedation was the most frequently reported adverse event,
occurring in up to 16% of patients. Withdrawal occurred in 27% of patients
among studies reporting this outcome. In three of three studies in which a
new methadone protocol was introduced, a decreased proportion of patients
experienced withdrawal (standardized mean difference, SMD = -0.60, 95% CI
= -0.998 to -0.195, P = 0.004). Conclusion: We did not identify sufficient
evidence to recommend any particular methadone weaning strategy, or to
recommend methadone over other medications or prescribed infusion weaning,
for successful weaning of continuous opioid infusions in the pediatric
intensive care setting.<br/>Copyright &#xa9; 2017 John Wiley & Sons Ltd

<99>
Accession Number
617170179
Author
Han Z.; Chen Z.; Lan R.; Di W.; Li X.; Yu H.; Ji W.; Zhang X.; Xu B.; Xu
W.
Institution
(Han, Chen, Lan, Di, Li, Yu, Ji, Zhang, Xu, Xu) Department of Cardiology,
Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital,
Nanjing, China
Title
Sex-specific mortality differences in heart failure patients with ischemia
receiving cardiac resynchronization therapy.
Source
PLoS ONE. 12 (7) (no pagination), 2017. Article Number: e0180513. Date of
Publication: July 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background Recent studies have reported prognosis differences between male
and female heart failure patients following cardiac resynchronization
therapy (CRT). However, the potential clinical factors that underpin these
differences remain to be elucidated. Methods A meta-analysis was performed
to investigate the factors that characterize sex-specific differences
following CRT. This analysis involved searching the Medline (Pubmed
source) and Embase databases in the period from January 1980 to September
2016. Results Fifty-eight studies involving 33445 patients (23.08% of whom
were women) were analyzed as part of this study. Only patients receiving
CRT with follow-up greater than six months were included in our analysis.
Compared with males, females exhibited a reduction of 33% (hazard ratio,
0.67; 95% confidence interval, 0.62-0.73; P < 0.0001) and 42% (hazard
ratio, 0.58; 95% confidence interval, 0.46-0.74; P = 0.003) in all-cause
mortality and heart failure hospitalization or heart failure,
respectively. Following a stratified analysis of all-cause mortality, we
observed that ischemic causes (p = 0.03) were likely to account for most
of the sex-specific differences in relation to CRT. Conclusion These data
suggest that women have a reduced risk of all-cause mortality and heart
failure hospitalization or heart failure following CRT. Based on the
results from the stratified analysis, we observed more optimal outcomes
for females with ischemic heart disease. Thus, ischemia are likely to play
a role in sex-related differences associated with CRT in heart failure
patients. Further studies are required to determine other indications and
the potential mechanisms that might be associated with sex-specific CRT
outcomes.<br/>Copyright &#xa9; 2017 Han 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.

<100>
Accession Number
615708562
Author
Muetterties C.; Menon R.; Moser W.; Carroll N.; Marulanda K.; Choi M.;
Wheatley G.H.
Institution
(Muetterties, Carroll, Marulanda) Lewis Katz School of Medicine at Temple
University, Philadelphia, PA, United States
(Menon) Howard University College of Medicine, Washington, DC, United
States
(Moser) Division of Cardiovascular Surgery, Lewis Katz School of Medicine
at Temple University, Philadelphia, PA, United States
(Choi) Arizona State University, Phoenix, AZ, United States
(Wheatley) Centennial Heart and Vascular Center, Nashville, TN, United
States
Title
Multispecialty involvement in the management of type B aortic dissections
in the endovascular era-Implications for training cardiothoracic
residents.
Source
Journal of Cardiac Surgery. 32 (5) (pp 296-300), 2017. Date of
Publication: May 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Purpose: Involvement of qualified specialists with proficiency in
endovascular therapies has created flux regarding the role of
cardiothoracic surgeons, vascular surgeons, and other catheter-skilled
specialists in the management of type B aortic dissections. We used
manuscript authorship trends and recent match data in order to study how
multi-specialty involvement in treating aortic dissections has changed in
the endovascular era. Methods: A PubMed review of published literature
between 1998 and 2015 was performed with "aortic dissection" in the title.
Case studies and entries with incomplete author or identifying information
were excluded. Author number, specialty affiliation, and treatment focus
were recorded. Available residency match data were obtained from the
National Resident Matching Program (NRMP). Results: Cardiothoracic
surgeons represented 38.5% (10/23) of the authors for papers with an
endovascular focus in 1998 compared with 27.7% (59/213) in 2015. Vascular
surgeons represented 19.2% (5/23) and 37.1% (79/213) of authors in 1998
and 2015, respectively. Radiologists accounted for 30.4% (7/23) of
authorship in 1998 and 8.9% (19/213) in 2015. NRMP match data revealed a
10.6% decrease in thoracic surgery matches from 2004 to 2015, while
vascular surgery and interventional radiology increased by 74.7% and
191.1%, respectively. Conclusions: Endovascular technologies have resulted
in significant changes as to which specialties manage complicated type B
aortic dissections. Vascular surgeons, with both open and extensive
endovascular training are optimally positioned to assume a major role in
the care of aortic dissection patients. Continued emphasis on endovascular
training and multispecialty collaboration is essential for cardiothoracic
surgeons in the endovascular era.<br/>Copyright &#xa9; 2017 Wiley
Periodicals, Inc.

<101>
Accession Number
614922115
Author
Guerra G.G.; Joffe A.R.; Seal R.; Phillipos E.; Wong M.; Moez E.K.; Dinu
I.A.; Duff J.P.; Ross D.; Rebeyka I.; Robertson C.M.T.
Institution
(Guerra, Joffe, Phillipos, Duff, Robertson) Department of Pediatrics,
University of Alberta, Edmonton, Canada
(Seal) Department of Anesthesia and Pain Medicine, University of Alberta,
Edmonton, Canada
(Wong) Stollery Children's Hospital, Edmonton, Canada
(Moez, Dinu) School of Public Health, University of Alberta, Edmonton,
Canada
(Ross, Rebeyka) Department of Surgery, University of Alberta, Edmonton,
Canada
Title
Pilot randomized controlled trial on early and late remote ischemic
preconditioning prior to complex cardiac surgery in young infants.
Source
Paediatric Anaesthesia. 27 (4) (pp 433-441), 2017. Date of Publication: 01
Apr 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background: Remote ischemic preconditioning involves providing a brief
ischemia-reperfusion event to a tissue to create subsequent protection
from a more severe ischemia-reperfusion event to a different tissue/organ.
The few pediatric remote ischemic preconditioning studies in the
literature show conflicting results. Aim: We conducted a pilot randomized
controlled trial to determine the feasibility of conducting a larger trial
and to gather provisional data on the effect of early and late remote
ischemic preconditioning on outcomes of infants after surgery for
congenital heart disease. Methods: This single-center, double-blind
randomized controlled trial of remote ischemic preconditioning vs control
(sham-remote ischemic preconditioning) in young infants going for surgery
for congenital heart disease at the Stollery Children's Hospital. Remote
ischemic preconditioning was performed at 24-48 h preoperatively and
immediately prior to cardiopulmonary bypass. Remote ischemic
preconditioning stimulus was performed with blood pressure cuffs around
the thighs. Primary outcomes were feasibility and peak blood lactate level
on day 1 postoperatively. Results: Fifty-two patients were randomized but
seven patients became ineligible after randomization leaving 45 patients
included in the study. In the included patients, 7 (15%) had protocol
deviations (five infants did not have the preoperative intervention and
two did not receive the intervention in the operating room). From a
comfort point of view, only one subject in the control group and two in
the Remote ischemic preconditioning group received sedation during the
preoperative intervention. There were no study-related adverse events and
no complications to the limbs subjected to preconditioning. There were no
significant differences between the Remote ischemic preconditioning group
and the control group in the highest blood lactate level on day 1
postoperatively (mean difference, 1.28; 95%CI, -0.22, 2.78; P-value =
0.093). Conclusion: In infants who underwent surgery for congenital heart
disease, our pilot randomized controlled trial on early and late remote
ischemic preconditioning proved to be feasible but did not find any
significant difference in acute outcomes. A larger trial may be
necessary.<br/>Copyright &#xa9; 2017 John Wiley & Sons Ltd

<102>
Accession Number
614408595
Author
Loomba R.S.; Buelow M.W.; Woods R.K.
Institution
(Loomba, Buelow, Woods) Division of Cardiology and Cardiothoracic Surgery,
Children's Hospital of Wisconsin/ Medical College of Wisconsin, 9000
Wisconsin Avenue, Milwaukee, WI 53226, United States
Title
Complete Repair of Tetralogy of Fallot in the Neonatal Versus Non-neonatal
Period: A Meta-analysis.
Source
Pediatric Cardiology. 38 (5) (pp 893-901), 2017. Date of Publication: 01
Jun 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
It is unclear if neonatal tetralogy of Fallot repair offers better
outcomes compared to repair later in infancy. We therefore conducted a
meta-analysis comparing outcomes of neonatal and non-neonatal repair.
Manuscripts were identified and reviewed for quality and bias with
favorably scored manuscripts being included in the final meta-analysis.
Several perioperative and postoperative variables were compared. A total
of 8 studies with 3858 patients were included in the analysis. Of these
patients, 19% underwent neonatal repair. Neonatal repair was associated
with increased mortality, longer intensive care unit stays, and longer
total hospital length of stay.<br/>Copyright &#xa9; 2017, Springer
Science+Business Media New York.

<103>
Accession Number
51697800
Author
Antolovic D.; Rakow A.; Contin P.; Ulrich A.; Rahbari N.N.; Buchler M.W.;
Weitz J.; Koch M.
Institution
(Antolovic, Rakow, Contin, Ulrich, Rahbari, Buchler, Weitz, Koch)
Department of General, Visceral and Transplantation Surgery, University of
Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
Title
A randomised controlled pilot trial to evaluate and optimize the use of
anti-platelet agents in the perioperative management in patients
undergoing general and abdominal surgery - The APAP trial
(ISRCTN45810007).
Source
Langenbeck's Archives of Surgery. 397 (2) (pp 297-306), 2012. Date of
Publication: February 2012.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Surgeons are increasingly confronted by patients on long-term
low-dose acetylsalicylic acid (ASA). However, owing to a lack of
evidence-based data, a widely accepted consensus on the perioperative
management of these patients in the setting of non-cardiac surgery has not
yet been reached. Primary objective was to evaluate the safety of
continuous versus discontinuous use of ASA in the perioperative period in
elective general or abdominal surgery. Methods: Fifty-two patients
undergoing elective cholecystectomy, inguinal hernia repair or
colonic/colorectal surgery were recruited to this pilot study. According
to cardiological evaluation, non-high-risk patients who were on longterm
treatment with low-dose ASA were eligible for inclusion. Patients were
allocated randomly to continuous use of ASA or discontinuation of ASA
intake for 5 days before until 5 days after surgery. The primary outcome
was the incidence of major haemorrhagic and thromboembolic complications
within 30 days after surgery. Results: A total of 26 patients were
allocated to each study group. One patient (3.8%) in the ASA continuation
group required re-operation due to post-operative haemorrhage. In neither
study group, further bleeding complications occurred. No clinically
apparent thromboembolic events were reported in the ASA continuation and
the ASA discontinuation group. Furthermore, there were no significant
differences between both study groups in the secondary endpoints.
Conclusions: Perioperative intake of ASA does not seem to influence the
incidence of severe bleeding in non-high-risk patients undergoing elective
general or abdominal surgery. Further, adequately powered trials are
required to confirm the findings of this study. &#xa9; Springer-Verlag
2011.

<104>
Accession Number
618690839
Author
Patel J.; Kittleson M.; Aintablian T.; Esmailian G.; Velleca A.; Hage A.;
Kransdorf E.; Geft D.; Chang D.H.; Czer L.; Kobashigawa J.A.
Institution
(Patel, Kittleson, Aintablian, Esmailian, Velleca, Hage, Kransdorf, Geft,
Chang, Czer, Kobashigawa) Cedars-Sinai Heart Institute, Los Angeles, CA,
United States
Title
Despite FDA black box warning, proliferation signal inhibitor (PSI) in the
first year with induction therapy appears safe in heart transplant
patients.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. United States. 36 (4 Supplement 1) (pp
S303-S304), 2017. Date of Publication: April 2017.
Publisher
Elsevier USA
Abstract
Purpose: According to the FDA black box warning, everolimus should not be
given in combination with anti-thymocyte globulin (ATG) induction therapy
(which is given immediately after transplant). The large randomized trials
with everolimus and cyclosporine (CsA) showed an increased incidence of
infection and infectious mortality when ATG induction was also given. It
is believed that the combination of proliferation signal inhibitor (PSI:
everolimus or sirolimus) and induction therapy along with calcineurin
inhibitor (CNI: CsA or tacrolimus) therapy creates an over
immunosuppressed state and a risk for infectious complication. It is not
known if PSI started later, between 2-12 months after heart transplant
(HTx), with ATG induction therapy is safe. Therefore, we sought to
evaluate our patients started on PSI between 2-12 months in the first year
to assess for safety. Methods: Between 2010 and 2014 we assessed 27 HTx
patients who were started on a PSI between 2-12 months after transplant
while being administered ATG induction at the time of transplant. 37.0%
(10/27) of patients received induction for renal sparing purposes, whereas
the remaining 63.0% (17/27) of patients received ATG due to their
sensitized state pre-HTx. These patients were compared to those started on
a PSI between 2-12 months but not given ATG induction therapy (n= 15).
Endpoints include subsequent 1-year survival, 1-year freedom from treated
infection, and 1-year freedom from any-treated rejection. Results:
Patients initiated on PSI in the first year post-HTx with induction
therapy had similar outcomes and infectious complications compared to
those patients maintained on PSI and CNI without induction therapy.
Subsequent survival and freedom from rejection episodes were comparable in
both groups. Conclusion: PSI in the first year (between 2-12 months) after
HTx in patients receiving ATG induction therapy appears to be safe and
effective without increased risk for infectious mortality (Table
presented).

<105>
Accession Number
618690817
Author
Lunze F.I.; Colan S.D.; Rifai N.; Gauvreau K.; Molloy M.A.; Veljkovic K.;
Kavsak P.; Adeli K.; Elizabeth E.D.; Blume D.; Singh T.P.
Institution
(Lunze, Colan, Gauvreau, Molloy, Elizabeth, Blume, Singh) Cardiology,
Boston Chilren's Hospital, Harvard Medical School, Boston, MA, United
States
(Rifai) Clinical Biochemistry, Boston Chilren's Hospital, Harvard Medical
School, Boston, MA, United States
(Veljkovic) Department of Pathology and Molecular Medicine, McMaster
University, Hamilton, ON, Canada
(Kavsak) Pathology and Molecular Medicine, McMaster University, Hamilton,
ON, Canada
(Adeli) Laboratory Medicine and Pathobiology, University of Toronto,
Toronto, ON, Canada
Title
Left atrial function during the first year after pediatric heart
transplantation.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. United States. 36 (4 Supplement 1) (pp
S104-S105), 2017. Date of Publication: April 2017.
Publisher
Elsevier USA
Abstract
Purpose: There is improvement in left ventricular function during the
first year after pediatric heart transplantation (HT) but less is known
about the left atrial (LA) function. We sought to assess serial changes in
LA size and function during the first year after HT in rejection free
children and relate them to their serum N-terminal pro B-type natriuretic
peptide (NT-proBNP) levels. Methods: We prospectively measured serial LA
size and function by 2D echocardiography and NT-proBNP levels in 36
patients during the first year after HT at the time of surveillance
biopsies. Children with a rejection episode during the year (n= 3, ISHLT
Grade >= 2R or antibody mediated rejection) were excluded from analysis.
LA size measures were expressed as z-scores based on laboratory data from
age-matched controls. LA global longitudinal strain (GLS) and pro-BNP data
were compared with age-matched controls. The Spearman correlation was used
to assess GLS and NT-proBNP association. Results: We analyzed 179 studies
(median 6 per patient, range 1-12) in 33 patients (median age at HT 10.3
yrs, range 0.3-18.5). Echocardiograms < 30 days after HT demonstrated
enlarged LA (area Z-score 2.3+/-0.7; length Z-score 3.4+/-1.3) with
impaired LA function compared to controls (GLS 14+/-6% vs. 58 +/-11%, P<
0.001). NT-proBNP levels <= 30 days after HT were elevated compared to
controls (median 3555 pg/ml; IQR: 1551-7422 vs. 67 pg/ml; IQR: 35.2-156.6,
P< 0.001). There was no significant change in LA size during the first
year after HT. However, there was a gradual increase in GLS and decline in
NT-proBNP from <= 30 days to 1 yr after HT (both P < 0.001, see Figure 1).
There was a strong inverse correlation between median NT-proBNP and GLS
over time (R=-0.94, p= 0.005). Conclusion: LA function is markedly
impaired early after HT but improves gradually during the first year
without recovering fully. The inverse temporal relationship of LA function
with NT-proBNP levels suggests that improvements in LA and biventricular
function in the transplanted allografts are closely related (Figure
presented).

<106>
Accession Number
618690758
Author
Morris K.L.; Lane K.A.; Lushin E.; Finet J.; Gradus-Pizlo I.; Hadi A.;
Caccamo M.
Institution
(Morris) Indiana University School of Medicine, Indianapolis, IN, United
States
(Lane) Department of Biostatistics, Indiana University School of Medicine,
Indianapolis, IN, United States
(Lushin) Pharmacy, Indiana University School of Medicine, Indianapolis,
IN, United States
(Finet, Gradus-Pizlo, Hadi, Caccamo) Cardiology, Indiana University School
of Medicine, Indianapolis, IN, United States
Title
Outcomes assessment based on a risk-stratified simple score after
orthotopic heart transplantation.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. United States. 36 (4 Supplement 1) (pp S301),
2017. Date of Publication: April 2017.
Publisher
Elsevier USA
Abstract
Purpose: Induction immunosuppression in cardiac transplantation is not a
one size fits all strategy and should be personalized to weigh a patient's
risk of rejection against their risk of infection. We performed a
retrospective outcome analysis in orthotopic cardiac transplant patients
after the implementation of a risk-stratified simple score to determine
induction immunosuppressive regimen. Methods: In 2014, our program
instituted an immunosuppression risk stratification tool for cardiac
transplant patients. This tool includes a 19-point score that considers a
patient's race, gender, age, panel reactive antibodies, presence of a LVAD
and degree of HLA mismatch. Based on this score, patients were placed in a
low, moderate or high risk category that determined their induction
immunosuppressive regimen at the time of transplant. Patients received
basiliximab if they were deemed low risk versus dose-adjusted
thymoglobulin for intermediate to high risk patients. We compared the
outcomes of pre-versus post-protocol patients, specifically the incidence
of rejection and number of infectious complications within the first year
post transplant. Our pre-protocol patients included cardiac transplant
patients between 2012 to 2014 prior to the initiation of the risk
stratification tool. Results: A trend toward a decrease in infectious
complications was seen in the post-protocol group without a change in
rejection. There was a lower amount of infectious complications in
comparison to the pre-protocol group (43.5% versus 51.3%). There was no
change in the incidence of rejection between the two groups. (Table
presented) Conclusion: We found that there was a decreasing trend towards
infectious complications without affecting the rate of rejection within
one year post transplant in those that received a patient tailored
induction immunosuppressive regimen. The results were not statistically
significant due to lack of power. Results will be prospectively tracked to
improve our outcome analysis over the next several years.

<107>
Accession Number
618690673
Author
Rabus M.B.; Cekmecelioglu D.; Ata P.; Salihi S.; Selcuk E.; Balkanay M.
Institution
(Rabus, Cekmecelioglu, Selcuk) Cardiovascular Surgery, Kartal Kosuyolu
Heart Research and Training Hospital, Istanbul, Turkey
(Ata) Medical Genetics, Marmara University Medical Faculty, Istanbul,
Turkey
(Salihi) Cardiovascular Surgery, Okan University Medical Faculty,
Istanbul, Turkey
(Balkanay) Cardiovascular Surgery, Katip Celebi University Medical
Faculty, Izmir, Turkey
Title
May intraoperative immunosuppressive therapy reduce the rejection episodes
at cardiac transplant recipients?.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. United States. 36 (4 Supplement 1) (pp S299),
2017. Date of Publication: April 2017.
Publisher
Elsevier USA
Abstract
Purpose: Our study was conducted to determine the effects of
intraoperative anti thymoglobulin (ATG) administration on donor hearts
obtained after cardiocirculatory death (DCD). We evaluate the impact of
ATG on the graft function and related parameters through applying it
during isothermic blood cardioplegia immediately the donor heart comes to
the table. Methods: The study designed as prospective and randomised
single center trial. Two groups defined as who receive retrograde ATG
infusion via coronary sinus starting before the implantation(Group I, N=
15) and who receive ATG infusion tradationally after the
implantation(Group II, N= 15). Between July 2011 and July 2014 we analyzed
30 patients with orthotopic cardiac transplantation. Blood samples have
taken from the aortic ostium at the beginning of the infusion, before the
anastomosis and after the anastomosis. Serum panel reactive antibody(PRA)
screening was performed and CD3 positive cell count was analyzed. Results:
Our patients had a mean age of 33.8(15-56). All patients had PRA less than
10% except 3 of them. The CD3 positive cell count decrease was more than
20%. The inotropic therapy dose need and the myocardial pressure
(stiffness) were less for the group I patients. These patients had less
acute rejection episodes than the group II(0% vs 13%; p< 0.05).
Conclusion: Our small sample size, favorable clinical outcomes were
observed in terms of less acute-rejection episodes and better graft
function at least at the early post-transplant period. Intra-operative ATG
treatment may have a preventive effect for acute cellular rejection in
cardiac transplant patients.(Table presented).

<108>
Accession Number
618690660
Author
Anderson M.; Morris L.; Tang D.; Batsides G.; Kirtane A.; Hanson I.; Meraj
P.; Kapur N.; O'Neill W.
Institution
(Anderson, Morris) Einstein Healthcare Network, Philadelphia, PA, United
States
(Tang) Virginia Commonwealth University, Richmond, VA, United States
(Batsides) Rutgers/Robert Wood Johnson, New Brunswick, NJ, United States
(Kirtane) Columbia Presbyterian University Hospital, New York, NY, United
States
(Hanson) William Beaumont, Royal Oak, MI, United States
(Meraj) Northwell Health, Manhasset, NY, United States
(Kapur) Tufts University, Boston, MA, United States
(O'Neill) Henry Ford, Detroit, MI, United States
Title
Impella RP post approval study: First multi-center, prospective post
market approval results for the impella RP in patients with right
ventricular failure.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. United States. 36 (4 Supplement 1) (pp
S64-S65), 2017. Date of Publication: April 2017.
Publisher
Elsevier USA
Abstract
Summary of Objectives: Right Ventricular (RV) failure increases morbidity
and mortality and contributes to prolonged hospital lengths of stay and
higher costs of care. The primary objective for this study is to assess
the outcomes of the post market approval use of the Impella RP , the first
percutaneous right ventricular support FDA approved device for patients
with RV failure that require hemodynamic support. Methods: The Impella RP
post approval study is a prospective, single arm multi-center study
planning to enroll 30 patients at 15 sites. Patients that develop acute RV
failure following LVAD implantation, post myocardial infarction or post
open heart surgery (including post heart transplant) and have BSA >= 1.5
m2 are included in the trial. Major exclusion criteria are presence of
mural thrombus into the right heart or the inferior vena cava, presence of
mechanical valves, or severe stenosis or regurgitation of the tricuspid or
pulmonic valves. Patient baseline and procedural characteristics,
hemodynamic parameters, hospital stay data and patient outcomes to 180
days are collected. Major adverse events are adjudicated by an independent
clinical events committee. Endpoints: The primary study endpoint is the
survival rate at 30 days post device explant or at hospital discharge
(whichever is longer). Secondary endpoints are major adverse events such
as death, major bleeding, pulmonary embolism, and hemolysis. Improvement
and hemodynamic parameters and use of inotropes are also evaluated. The
outcome trends in the post approval study will be benchmarked against the
original Recover Right study and the pooled data from all the Impella RP
clinical studies will be presented at the meeting.

<109>
Accession Number
618690648
Author
Arora S.; Gude E.; Karason K.; Andersson B.; Bartfay S.; Solbu D.;
Dellgren G.; Andreassen A.; Gullestad L.
Institution
(Arora, Gude, Andreassen, Gullestad) Cardiology, Oslo University Hospital,
Rikshospitalet, Oslo, Norway
(Karason, Andersson, Bartfay, Dellgren) Cardiology, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Solbu) Novartis Norge, Oslo, Norway
Title
The effect of everolimus initiation and early calcineurin inhibitor
withdrawal on exercise capacity in de-novo heart transplant recipients:
Results of the schedule trial after 36 months.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. United States. 36 (4 Supplement 1) (pp S299),
2017. Date of Publication: April 2017.
Publisher
Elsevier USA
Abstract
Purpose: Heart transplant (HTx) recipients have reduced exercise capacity
and peak oxygen consumption (VO2peak) is often found to be 50-70% of the
predicted value. Both reduced cardiac output and peripheral factors might
contribute to this reduction and there is little data on the potential
influence of different immunosuppressive regimes. Hence, the purpose of
the current sub-study of the SCHEDULE trial was to evaluate the effect of
everolimus initiation and total early cyclosporine elimination on exercise
capacity in de-novo HTx recipients. Methods: The SCHEDULE trial was a
multicenter Scandinavian trial where 115 de-novo HTx recipients were
randomized to everolimus with complete CNI withdrawal (EVE-group) or
standard cyclosporine therapy (CNI-group). In total, 60 patients (EVE= 30
and CNI = 30) were evaluated with a modified cardiopulmonary exercise test
(CPET) protocol at baseline, 12 and 36 months after randomization. CPET
included measurement of peak oxygen consumption (VO2peak) and RER > 1.1 or
recipient exhaustion was considered to be a satisfactory test. Results:
The EVE group demonstrated a progressive increase in peak oxygen
consumption (VO2peak) (17.5+/-4.1, 21.4+/-8.2, 22.8+/-5.9 ml/kg/min at
baseline, 12 and 36 months after randomization, respectively) but this was
not significantly different from the increase observed in the CNI group
(16.9+/-4.6, 21.1+/-6.6, 25.5+/-8.3 ml/kg/min at baseline, 12 and 36
months, respectively) (p> 0.05). When considering peak V02 as % of
expected the observed values in the EVE group were 59.7+/-17.2,
78.5+/-16.4, 87.8+/-18.8% as compared to 53.5+/-15.6, 79.0+/-20.0 and
94.5+/-27.6% in the CNI group at baseline, 12 and 36 months, respectively,
(p> 0.05). Maximum exercise capacity was noted to be 94.8+/-31.2,
123.9+/-38.8 and 121.1+/-37.2 Watts in the EVE group as compared to
103.1+/-38.3, 132.3+/-41.7 and 149.4+/-49.4 Watts in the CNI group at
baseline, 12 and 36 months, respectively, (p> 0.05). Conclusion:
Everolimus initiation and cyclosporine elimination in de-novo HTx
recipients does not have any significant effect on peak oxygen consumption
or maximal effort. Although exercise capacity was noted to increase
significantly during the study in both treatment arms the maximum exercise
capacity remained impaired at 12 and 36 months after HTx.

<110>
Accession Number
618690637
Author
Poglajen G.; Cerar A.; Zbacnik R.; Zemljic G.; Frljak S.; Ksela J.;
Knezevic I.; Berden P.; Vrtovec B.
Institution
(Poglajen, Cerar, Zemljic, Frljak, Vrtovec) Advanced Heart Failure and
Transplantation Programme, Dept. of Cardiology, University Medical Center
Ljubljana, Ljubljana, Slovenia
(Zbacnik, Berden) Institute of Radiology, University Medical Center
Ljubljana, Ljubljana, Slovenia
(Ksela, Knezevic) Dept. of Cardiovascular Surgery, University Medical
Center Ljubljana, Ljubljana, Slovenia
Title
Clinical usefulness of cardiac magnetic resonance imaging after heart
transplantation.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. United States. 36 (4 Supplement 1) (pp
S227-S228), 2017. Date of Publication: April 2017.
Publisher
Elsevier USA
Abstract
Purpose: Cardiac magnetic resonance imaging (cMRI) appears to have a high
negative predictive value when used as a screening tool for allograft
rejection after heart transplantation (HTX). We sought to compare
myocardial biopsy to cMRI screening to guide steroid withdrawal early
after HTX. Methods: In a prospective randomised single-center study we
enrolled 70 consecutive heart transplant recipients. At 12 months post-HTX
they were randomised (1:1) to be screened for rejection prior steroid
withdrawal using myocardial biopsy (Group A, N= 35) or cMRI (Group B, N=
35). Steroids were subsequently withdrawn if the screening test came back
negative for rejection. Recipients were followed for 6 months on montly
basis. At each visit clinical and biochemical data were collected and
echocardiography was done at baseline and at 6 months follow-up. All
recipients received standard immunoinduction (basiliximab) and maintenance
(CNI/MMF/steroids) immunosupression therapy. ISHLT grading system was used
for myocardial biopsy analysis. Renal dysfunction was defined as estimated
glomerular filtration rate (eGFR)< 90mL/min/1.73 m2. Results: The two
groups did not differ regarding age (50+/-10 years in Group A vs. 54+/-14
years in Group B; P= 0.29), gender (male: 83% vs. 79%; P= 0.67), presence
of renal dysfunction (25% vs. 21%; P= 0.67), arterial hypertension (63%
vs. 50%; P= 0.24), diabetes (22% vs. 26%; P= 0.68), donor age (42+/-11
years vs. 43+/-9 years; P= 0.71) or allograft ischemic time (175+/-76 min
vs. 191+/-73 min; P= 0.41). At baseline both groups had comparable left
ventricular ejection fraction (LVEF) (65+/-9% in Group A vs. 63+/-11%; P=
0.20) mean tacrolimus C0 (6.4+/-1.9 ng/mL in Group A vs. 7.1+/-1.5 ng/mL
in Group B, P= 0.22), dose of mycophenolate (2376+/-387 mg vs. 2527+/-487
mg, P= 0.32) and metylprednisolone (4 mg qd in both groups). 72% of
myocardial biopsies and 77% of cMRI scans were negative for signs of
rejection in Group A and Group B respectively (P= 0.68). All positive
myocardial biopsies were of grade 1R. At 6 months no clinical signs of
allograft rejection were seen in any of the study participants and graft
function remained stable (LVEF 64+/-8% in Group A vs. 66+/-12%; P= 0.38).
Conclusion: In patients after heart transplantation undergoing steroid
withdrawal, cMRI screening may represent a viable, less invasive
alternative to myocardial biopsy.

<111>
Accession Number
618690611
Author
Jeewa A.; Imamura M.; Canter C.; Niebler R.; VanderPluym C.; Rosenthal D.;
Kirklin J.K.; Tresler M.; McMullan M.; Morell V.; Turrentine M.; Ameduri
R.; Nguyen K.; Kanter K.; Conway J.; Gajarski R.; Fraser C.D.
Institution
(Jeewa) Hospital for Sick Children, Toronto, ON, Canada
(Imamura) Arkansas Children's Hospital, Little Rock, AR, United States
(Canter) St. Louis Children's Hospital, St. Louis, MO, United States
(Niebler) Children's Hospital of Wisconsin, Milwaukee, WI, United States
(VanderPluym) Boston Children's Hospital, Boston, MA, United States
(Rosenthal) Lucile Packard Children's Hospital at Stanford, Palo Alto, CA,
United States
(Kirklin, Tresler) University of Alabama at Birmingham, Birmingham, AL,
United States
(McMullan) Seattle Children's Hospital, Seattle, WA, United States
(Morell) Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
(Turrentine) Riley Hospital for Children, Indianapolis, IN, United States
(Ameduri) University of Minnesota, Minneapolis, MN, United States
(Nguyen) Mount Sinai Medical Center, New York, NY, United States
(Kanter) Children's Healthcare of Atlanta, Atlanta, GA, United States
(Conway) Stollery Children's Hospital, Edmonton, AB, Canada
(Gajarski) Nationwide Children's Hospital, Columbus, OH, United States
(Fraser) Texas Children's Hospital, Houston, TX, United States
Title
Post-transplant outcomes of patients supported with the berlin heart excor
as a bridge to transplantation: A multi-institutional study.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. United States. 36 (4 Supplement 1) (pp S163),
2017. Date of Publication: April 2017.
Publisher
Elsevier USA
Abstract
Purpose: There is increasing use of durable ventricular assist devices
(VAD) in children as a bridge to heart transplant (HTx). The Berlin Heart
IDE trial was the first pediatric VAD trial to demonstrate excellent
survival outcomes to HTx. Our aim was to compare the post-HTx outcomes for
children enrolled in the Berlin Heart IDE trial to a matched cohort that
did not require VAD support while waiting for HTx. Methods: The Pediatric
Heart Transplant Study Registry was linked to the Berlin Heart IDE study
database for all pediatric HTx recipients < 18 years, between 2007 to
2011. VAD supported patients were matched 2:1 to non-VAD supported
controls in the PHTS database based on age, diagnosis, listing status,
inotrope and ventilator requirement. Results: Eighty-three of the 109
patients enrolled in the Berlin Heart IDE study were identified in the
PHTS database and matched to 166 non-VAD supported controls. For both
groups, cardiomyopathy was the main diagnosis (71%) and 19% had congenital
heart disease. The main difference between groups was higher inotrope use
in the non-VAD supported patients (VAD 28% vs non-VAD 67%; p< 0.0001). The
post-HTx survival at 5 years was 81% for the VAD group compared to 88% for
the matched controls; however, this difference was not statistically
significant (p= 0.09). This also remained true when survival was compared
to the overall PHTS cohort (n= 1291) during the study period. In addition,
no statistical difference was noted between the matched groups with
regards to freedom from first rejection by 5 years [65% (VAD) vs 54%
(Controls); p= 0.1]( See Figure 1), and when compared to the overall PHTS
cohort. Conclusion: In the recent era, children supported with a Berlin
Heart EXCOR VAD do not appear to have different intermediate-term post-HTx
survival or incidence of first rejection compared to non-VAD supported
children. These promising post-HTx outcomes further support the importance
of this technology in the management of children with end-stage heart
failure.(Figure presented).

<112>
Accession Number
618690523
Author
Reich H.J.; Ramzy D.; Mirocha J.; De Robertis M.A.; Chung J.; Esmailian
F.; Chang D.; Moriguchi J.; Czer L.; Trento A.; Arabia F.
Institution
(Reich) Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United
States
(Ramzy, Mirocha, De Robertis, Chung, Esmailian, Trento, Arabia)
Cardiothoracic Surgery, Cedars-Sinai Heart Institute, Los Angeles, CA,
United States
(Chang, Moriguchi, Czer) Cardiology, Cedars-Sinai Heart Institute, Los
Angeles, CA, United States
Title
Not all intermacs level 1's are the same: Survival after total artificial
heart implantation with or without temporary circulatory support.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. United States. 36 (4 Supplement 1) (pp
S348-S349), 2017. Date of Publication: April 2017.
Publisher
Elsevier USA
Abstract
Purpose: Total artificial heart (TAH) implantation for Interagency
Registry for Mechanically Assisted Circulatory Support (INTERMACS) Level 1
patients was reported to have lower survival to transplant than Levels
2-4. We hypothesize that Level 1 "crash and burn" patients undergoing TAH
implantation with critical cardiogenic shock are clinically heterogeneous
and subsets have excellent clinical outcomes. Methods: Records of all
Level 1 TAH implants at Cedars-Sinai Medical Center from 2013-15 were
retrospectively reviewed. Patient characteristics and survival were
collected and compared between groups with no INTERMACS Level Modifier,
Modifier A (arrhythmia) or Modifier TCS (temporary circulatory support)
using Wilcoxon, log-rank and Fisher's exact tests. Results: Thirty-two
Level 1 patients underwent TAH implantation as bridge to heart
transplantation: 24 males (75%) with mean age 49.4+/-13.6 years.
Preoperative creatinine (1.8+/-1.0 vs. 1.6+/-0.6, p= 0.89) and total
bilirubin (3.3+/-2.9 vs. 2.1+/-1.8, p= 0.20) were similar for patients
with vs. without TCS. Survival at 6 and 12 months after implantation was
62.5% and 59.4%. Survival to transplant was 53.1%. Survival at 6 and 12
months post-transplant was 100% and 92.9%. Sample size for patients with
Modifier A was too small for comparison (n= 2). A trend toward
differential outcomes based on the presence or absence of TCS was
identified: 6-and 12-month survival after TAH, as well as survival to
transplant, was inferior for patients supported with TCS prior to TAH
implantation, while post-transplant survival at 6 and 12 months was
similar (Table). Conclusion: INTERMACS Level 1 TAH implantations without
prior TCS have satisfactory clinical outcomes, while those with prior TCS
may have reduced survival. A bridge-to-bridge strategy of TCS followed by
TAH may be associated with high mortality and new approaches may be
necessary to meet the needs of this cohort of patients.(Table presented).

<113>
Accession Number
618690473
Author
Chahal D.; Wright A.J.; Toma M.
Institution
(Chahal) University of British Columbia, Vancouver, BC, Canada
(Wright) Division of Infectious Diseases, University of British Columbia,
Vancouver, BC, Canada
(Toma) Division of Cardiology, University of British Columbia, Vancouver,
BC, Canada
Title
The impact of LVAD related infections on post cardiac transplant outcomes:
A systematic review.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. United States. 36 (4 Supplement 1) (pp S39),
2017. Date of Publication: April 2017.
Publisher
Elsevier USA
Abstract
Purpose: Left ventricular assist devices (LVADs) improve survival for
patients with end stage heart failure while they wait for transplantation.
LVADs may develop complications, such as infections. Development of an
infection decreases survival while on LVAD support. The impact of LVAD
related infections (LRIs) on outcomes after transplantation is less well
studied. We sought to determine if the presence of infection while on LVAD
support negatively influences clinical outcomes after cardiac
transplantation. Methods: We performed a systematic review by searching
Medline, Embase, and Cochrane Central Register of Controlled Trials for
eligible full text studies. We also hand searched study bibliographies.
Eligible studies included those that identified LRIs during support and
reported on outcomes after cardiac transplantation. Reviewers determined
study quality and collected baseline and outcomes data. Results:
Electronic search identified 1876 records; 16 were selected for analysis
(n= 5794, 64.7-92.1% male, mean age 34-55 years). 3173 continuous flow
LVADs and 2497 pulsatile LVADs were identified. 1749 developed LRIs. In
general, patients with LRIs seemed to have higher incidence of diabetes
(14.1-63.9% vs. 16.2-42.3%), and lower incidence of ischemia as etiology
of heart failure (33.0-44.2% vs 42.1-62.0%). Patients with LRIs had longer
LVAD support times (38.5-389.2 days vs. 25.0-220.0) and higher rates of
infection after cardiac transplantation (18.4-80.0% vs. 2.6-36.1%). 1443
out of 1749 (82.5%) patients with LRIs were transplanted. Post cardiac
transplant survival at 1, 3, and 5 years was similar for patients who had
LRIs vs. those who did not (60.0-96.0% vs. 72.7-95.0%, 37.5-100.0% vs.
48.6-100.0%, and 20.0-83.3% vs. 28.6-83.0%). Conclusion: Data regarding
the impact of LRIs on post cardiac transplantation outcomes is a
relatively understudied area. Most studies report on older, pulsatile
devices which may not be representative of newer, continuous flow devices.
Given the increasing use of LVADs, further studies are required that focus
on LVAD infections and their post-transplant impact.

<114>
Accession Number
618690385
Author
Pahl E.; Van'T Hof K.; Andrei A.; Shankel T.; Chinnock R.; Miyamoto S.;
Ambardekar A.; Addonizio L.; Latif F.; Lefkowitz D.; Goldberg L.;
Hollander S.; Pham M.; Grady K.
Institution
(Pahl, Van'T Hof) Cardiology, Ann and Robert H. Lurie Children's Hospital
of Chicago, Chicago, IL, United States
(Andrei) Northwestern University, Chicago, IL, United States
(Shankel, Chinnock) Loma Linda University Medical Center, Loma Linda, CA,
United States
(Miyamoto) Children's Hospital Colorado, Aurora, CO, United States
(Ambardekar) University of Colorado Hospital, Aurora, CO, United States
(Addonizio, Latif) Columbia University Medical Center, New York, NY,
United States
(Lefkowitz) Children's Hospital of Philadelphia, Philadelphia, PA, United
States
(Goldberg) University of Pennsylvania, Philadelphia, PA, United States
(Hollander, Pham) Stanford University, Palo Alto, CA, United States
(Grady) Northwestern Memorial Hospital, Chicago, IL, United States
Title
Pediatric heart transplantation: Transitioning to adult care.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. United States. 36 (4 Supplement 1) (pp
S265-S266), 2017. Date of Publication: April 2017.
Publisher
Elsevier USA
Abstract
Purpose: Medically complex patients who transition from pediatric to adult
care are at high risk for poor outcomes such as repeated hospitalizations
and death. Our randomized, controlled, multicenter pilot trial tests an
intervention focused on enhancing adherence to improve outcomes for heart
transplant (HT) patients (pts) who transfer to adult care. We report
baseline findings. Methods: We aim to enroll 100 pts-{50 intervention
(INT), 50 usual care (UC)} from six paired pediatric/adult U.S. sites over
3 years with 6 months post transfer follow-up. Our intervention uses
computer-based education modules followed by individualized discussion
with HT coordinators, and is delivered through 3 months post transfer.
Outcomes are: (1) immunosuppression levels, (2) adherence, (3) rejection
episodes, (4) use of healthcare resources (ER Visits/Admits). The
intervention focuses on enhancing HT knowledge, self-care, self-advocacy
and support. Assessments at baseline, 3 months and 6 months post
transition include: 1. HT knowledge questionnaire, 2. Transition readiness
assessment questionnaire, 3. Social support index and 4. Patient
assessment of problems with the HT regimen. Groups were compared via
t-tests and chi square. Results: To date, 77/126 screened pts (61%) are
enrolled and randomized (38= INT and 39= UC). Baseline demographics were
similar in both study arms: INT vs UC: mean age= 21.5+3.3 yrs vs, 21.8+3.5
yrs; female= 42% vs 46%; Caucasian= 82% vs 72%; > high school education=
55% vs 70%. Most pts in both groups were on tacrolimus based
immunosuppression (68 vs 64%). There were no differences between groups at
baseline: mean tacrolimus levels INT vs US (6.6+2.4 vs 5.9+3.1); overall
self-report of adherence (3.6 vs 3.5 [1= hardly ever to 4= all of the
time]); rejection episodes (1 vs 0); hospital re-admissions (7 vs 2; p=
11); and no differences regarding HT knowledge, self-care, self-advocacy,
and social support. Potential for improvement was similar in both groups.
Conclusion: Our pilot trial randomization scheme was effective. There were
no significant differences between INT and UC groups for demographics,
medical or psychosocial outcomes. Future analyses will inform whether our
intervention improves outcomes early after transfer to adult care.

<115>
Accession Number
618690338
Author
Casale J.P.; Logan A.T.; Doligalski C.T.
Institution
(Casale, Logan, Doligalski) Tampa General Hospital, Lutz, FL, United
States
Title
Still inferior? risks of azathioprine in tacrolimus based regimens for
heart transplant recipients.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. United States. 36 (4 Supplement 1) (pp S366),
2017. Date of Publication: April 2017.
Publisher
Elsevier USA
Abstract
Purpose: Mycophenolate (MPA) is the antimetabolite of choice in heart
transplant recipients (HTRs), based largely on data from cyclosporine
(CSA)-based regimens. Toxicities of MPA are common and the risks
associated with azathioprine (AZA) use in combination with tacrolimus is
not well described. Methods: An analysis of all HTRs at a single center
from 11/11-7/15 was conducted; re-transplant, multi-organ recipients and
HTRs on CSA were excluded. Rates of cellular and antibody mediated
rejection, CMV viremia, and skin cancers at 1 and 3 years were compared
between AZA and MPA cohorts. Results: 145 heart transplants were performed
during the study period; 22 (15.1%) required conversion to AZA, mostly due
to GI intolerance. HTRs requiring AZA conversion were older but otherwise
had similar baseline characteristics (Table 1). No differences in
mortality, BPAR, and CMV viremia were seen between AZA and MPA cohorts.
The AZA cohort had a higher rate of skin cancers (27.3 vs. 13.8%, p=
0.11), however the AZA group did have a longer post-transplant follow up.
Maintenance immunosuppression was different as well, with AZA HTRs more
likely to remain of corticosteroids as well as have mTORi added. Regarding
hematologic toxicities, mean WBC and platelet count were similar between
the AZA and MPA cohorts at 1 and 3 years with lower hemoglobin
concentrations in the AZA cohort at 1 year (11.6 vs. 12.7 p= 0.006) but
not 3 years (13.2 vs. 13.5 p= 0.69). Conclusion: In this limited cohort,
AZA appears to be a safe alternative to MPA when toxicities necessitate
conversion. Similar rejection rates were seen with no apparent increase in
toxicities, although the increased numerical rate of skin cancers warrants
judicious monitoring following AZA conversion.(Table presented).

<116>
Accession Number
618690270
Author
To L.; Jantz A.; Hencken L.; William C.; Nemeh H.
Institution
(To, Jantz, Hencken, William, Nemeh) Henry Ford Hospital, Sterling
Heights, MI, United States
Title
Safety and efficacy of four factor prothrombin complex concentrate for the
reversal of warfarin in LVAD patients prior to heart transplantation.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. United States. 36 (4 Supplement 1) (pp S365),
2017. Date of Publication: April 2017.
Publisher
Elsevier USA
Abstract
Purpose: Four factor prothrombin complex concentrate (4-factor PCC) is FDA
approved for reversal of anticoagulation with warfarin in acute major
bleeding. The purpose of this study is to evaluate the safety and efficacy
of using 4-factor PCC for reversal of LVAD patients on warfarin therapy in
preparation for heart transplantation. Methods: Retrospective case-control
study comparing anticoagulation reversal with 4-factor PCC versus
traditional therapy. Treatment group received 4-factor PCC with any
combination of vitamin K and FFP. Control group received standard therapy
with any combination of 3-factor PCC, Factor VIIa, vitamin K, and FFP.
Inclusion criteria: adult LVAD patients receiving warfarin prior to heart
transplant from Jan 2013 to Aug 2015 and followed for at least 3 months.
Primary endpoint is any acute thrombosis after 4-factor PCC
administration. Secondary endpoints: degree of INR reversal, volume
transfused in OR, time to extubation, length of ICU and hospital stay, and
post-operative thromboembolic events. Results: Thirty-five patients were
included in the study. There was no acute thrombosis after 4-factor PCC
administration. Intraoperative INR was lower with the treatment group
compared with control group, median INR 1.81 [1.40,1.97] vs 2.5
[1.74,3.07], p = 0.015. Overall volume received in OR was numerically less
than the control group, median 3685 [2467,5837] vs 5346 [3712,6691], p =
0.191. Subgroup analysis of fluids reveals that the treatment group
required less volume from FFP transfusion, median 851 mL [254,1000] vs
1380 mL [1250,1750], p = 0.001, and less patients required PRBC
transfusion, 46.4% vs 53.5%, p = 0.012. Of the patients that did receive
PRBC, the treatment group required numerically less volume, median 360 ml
[0,1620] vs 750 ml [360,1500], p = 0.214. The mean 4-factor PCC dose was
2065 units (25 units/kg). There were no differences in time to extubation,
ICU and hospital length of stay, and rate of post-operative DVT.
Conclusion: 4-factor PCC was safe and effective in reversing
anticoagulation in LVAD patients for heart transplantation. Patients who
received four factor PCC had lower INR intra-operatively and required less
transfusion with FFPs and less patients required PRBCs during the
operation. There were no differences in thromboembolic complications
post-operatively.

<117>
Accession Number
618690150
Author
Kim N.; Lee J.G.; Lee S.; Nam K.S.; Shu J.W.; Paik H.C.; Yoo Y.C.
Institution
(Kim, Yoo) Anesthesiology, Yonsei University, Seoul, South Korea
(Lee, Lee, Nam, Shu, Paik) Thoracic and Cardiovascular Surgery, Yonsei
University, Seoul, South Korea
Title
A comparison of propofol based total intravenous anesthesia and
sevoflurane based balanced anesthesia on renal protection during lung
transplantation under extracorporeal membrane oxygenation-a prospective,
randomized trial.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. United States. 36 (4 Supplement 1) (pp
S116-S117), 2017. Date of Publication: April 2017.
Publisher
Elsevier USA
Abstract
Purpose: Postoperative renal dysfunction is known to increase morbidity
and mortality after lung transplantation. Propofol has been shown to
provide protection against acute kidney injury (AKI) in patients
undergoing valvular heart surgery compared with sevoflurane. We aimed to
investigate the effect of propofol anesthesia on the occurrence of AKI
following lung transplantation surgery. Methods: Adult patients undergoing
lung transplantation with extracorporeal membrane oxygenation (ECMO)
support were randomized to receive either propofol (group P) or
sevoflurane anesthesia (group S) both with sufentanil. The primary
endpoint was incidence of postoperative 48 h AKI assessed by plasma levels
of creatinine and neutrophil gelatinase-associated lipocaline (NGAL).
Results: Sixty patients were included in analysis (n= 29 and 31 in group P
and group S, respectively). Baseline kidney function determined by serum
biomarkers was comparable between the groups. There was a trend toward
lower incidence of AKI in group P than group S (14 % vs.36, P= 0.053).
Plasma NGAL level was significantly lower in group P than group S
immediately after surgery (91.5 [69.5-145.2] vs. 128.8 [85.0-179.0] ng/ml,
P= 0.031) and postoperative 24 h (76.5 [57.0-107.2] vs. 131.8 [90.0-237.0]
ng/ml, P= 0.002). There was a trend toward a shorter length of hospital
stay and lower incidence of early mortality in group P compared to group
S. Conclusion: Propofol anesthesia could reduce perioperative renal injury
and might be helpful to facilitate recovery in patients undergoing lung
transplantation with ECMO support compared with sevoflurane (Table
presented).

<118>
Accession Number
618689992
Author
Jasseron C.; Legeai C.; Jacquelinet C.; Leprince P.; Cantrelle C.; Audry
B.; Lanoy E.; Porcher R.; Bastien O.; Dorent R.
Institution
(Jasseron, Legeai, Jacquelinet, Cantrelle, Audry, Bastien, Dorent)
Direction Prelevement Greffe Organes-Tissus, Agence de la Biomedecine,
Saint-Denis La Plaine, France
(Leprince) Service de Chirurgie Cardio-Vasculaire, Hopital de la Pitie
Salpetriere, Paris, France
(Lanoy) Unite de Biostatistiques et d'Epidemiologie, Institut
Gustave-Roussy, Villejuif, France
(Porcher) Centre d'Epidemiologie Clinique, Hopital Hotel-Dieu, Paris,
France
Title
Prediction of waitlist mortality in adult heart transplant candidates: The
candidate risk score.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. United States. 36 (4 Supplement 1) (pp S114),
2017. Date of Publication: April 2017.
Publisher
Elsevier USA
Abstract
Purpose: The cardiac allocation system in France is currently based on
urgency and geography. Medical urgency is defined by therapies without
considering objective patient mortality risk factors. This study aimed to
develop a waitlist mortality risk score from commonly available candidate
variables. Methods: The study included all patients, aged 16 years or
older, registered on the French national registry CRISTAL for first
single-organ heart transplant between January 2010 and December 2014. This
population was randomly divided in a 2:1 ratio into derivation and
validation cohorts. The association of variables at listing with 1-year
waitlist death or delisting for worsening medical condition was assessed
within the derivation cohort. The predictors were used to generate a
candidate risk score (CRS) by summing the products of the factors and
their beta estimations. Validation of the CRS was performed in the
validation cohort. Concordance probability estimation (CPE) was used to
evaluate the discriminative capacity of the models. Results: During the
study period, 2,333 patients were newly listed. The derivation (n= 1 555)
and the validation cohorts (n= 778) were similar. The factors associated
with 1-year waitlist death or delisting for worsening medical condition in
a simplified multivariate model were: short-term MCS (HR: 3.4; 95% CI:
2.2-5.0), total bilirubin level in logarithm (HR: 1.9; 95% CI: 1.5-2.4),
glomerular filtration rate in logarithm (HR: 0.6; 95% CI: 0.5-0.8), and NP
decile (HR: 1.2; 95% CI: 1.1-1.3). The CPE of the CRS was 0.74 in the
derivation cohort and 0.72 in the validation cohort. The correlation
between observed and expected 1-year waitlist mortality in the validation
cohort was 0.86. Conclusion: The candidate risk score provides an accurate
objective prediction of waitlist mortality. It is currently being used to
develop a modified cardiac allocation system in France.(Figure presented).

<119>
Accession Number
618689951
Author
Breslin N.; Salerno D.; Jandovitz N.; Tsapepas D.; Restaino S.; Latif F.;
Colombo P.; Farr M.; Jennings D.L.
Institution
(Breslin, Salerno, Jandovitz, Tsapepas, Restaino, Latif, Colombo, Farr,
Jennings) New York Presbyterian Columbia Irving Medical Center, New York,
NY, United States
Title
Tacrolimus dosing requirements are reduced in heart transplant recipients
with severe primary graft dysfunction on ecmo support.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. United States. 36 (4 Supplement 1) (pp
S151-S152), 2017. Date of Publication: April 2017.
Publisher
Elsevier USA
Abstract
Purpose: Severe primary graft dysfunction (PGD) following heart
transplantation (HTX) may require extracorporeal membrane oxygenation
(ECMO) support. ECMO is known to significantly alter the pharmacokinetic
parameters of many medications; however, no data exist regarding
weight-based tacrolimus dosing for patients with severe PGD on ECMO. We
hypothesize that severe PGD patients have different weight-based
tacrolimus dosing requirements. Methods: Single-center retrospective chart
review of patients who received HTX between January 1, 2014 through June
30, 2016. Multi-organ transplant recipients and re-transplants were
excluded. A therapeutic tacrolimus concentration was defined as a trough
level between 8-15 ng/mL for two consecutive days. The primary outcome was
the weight-based dosing requirements (mg/kg/day) for patients with PGD on
ECMO support after HTX as compared to those without severe PGD. Secondary
outcomes include the incidence of treatment-proven acute cellular
rejection (ACR) and infection during the index hospitalization, at
3-months and at 6-months post-transplant. Results: Of the 89 HTX patients
included, 22 (25%) developed PGD requiring ECMO support. Patient
characteristics were similar at the time of HTX, with the exception of
recipient age (median 60.5 years in PGD vs. 55 years in control, p =
0.041) and induction with basiliximab (50% in PGD vs. 26.5% in control, p
= 0.045). Median time to therapeutic concentration was 9 days (IQR: 7, 11)
in both groups. The median therapeutic dose was 0.08 (IQR: 0.07, 0.11) vs.
0.12 (IQR: 0.09, 0.16) in the PGD and control groups, respectively, (p =
0.004). Rates for ACR at 30 days were 4.55% in PGD vs. 29.85% in control
patients (p = 0.015). At 3-and 6-months, there were no significant
differences in the incidence of ACR. Incidence of infection during the
index hospitalization was 63.6% in PGD vs. 28.4% in control patients (p =
0.003). Conclusion: Patients with PGD on ECMO require lower weight-based
doses of tacrolimus, suggesting a potential pharmacokinetic alteration.
PGD was associated with a lower incidence of ACR and higher incidences of
infection, which may reflect higher use of induction immunosuppression.

<120>
Accession Number
618689873
Author
Yardley M.; Ueland T.; Aukrust P.; Michelsen A.; Bjorkelund E.; Gullestad
L.; Nytroen K.
Institution
(Yardley, Bjorkelund, Gullestad, Nytroen) Cardiology Department, OUS-HF
Rikshospitalet, Oslo, Norway
(Ueland, Michelsen) Research Institute of Internal Medicine, OUS-HF
Rikshospitalet, Oslo, Norway
(Aukrust) Research Institute of Internal Medicine, Section of Clinical
Immunology and Infectious Disease, OUS-HF Rikshospitalet, Oslo, Norway
Title
The immediate response in markers of inflammation and angiogenesis during
exercise in heart transplant recipients.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. United States. 36 (4 Supplement 1) (pp S395),
2017. Date of Publication: April 2017.
Publisher
Elsevier USA
Abstract
Purpose: The present study explored and compared the immediate responses
in markers of inflammation and angiogenesis in maintenance heart
transplant (HTx) recipients before, during and after sessions of
high-intensity interval training (HIT) versus moderate intensity
continuous training (MICT). The study aimed to explain some of the trigger
mechanisms behind HIT in HTx recipients. Methods: This cross-over study
included 14 HTx patients (mean+/-SD age: 53+/- 13 years; time since HTx;
3+/- 2 years). All participants underwent baseline blood samples and a
cardiopulmonary exercise-test during their first visit. The next two
visits included one HIT-session and one MICT-session, performed in a
randomized order (figure 1). Blood samples were taken during and after
each exercise session. Myokines and inflammatory markers related to
vascular inflammation, blood platelet activation and modulation of
angiogenesis were analyzed. Results: The main findings in this study were:
i) Exercise, regardless of intensity, induce a significant immediate
response in several vascular, angiogenetic and in particular platelet
derived inflammatory mediators in HTx recipients. ii) HIT induced an
increased response in vWF, VEGF-1 and Angiopoetin-2 (Ang-2), and a
decreased response in growth derived factor (GDF-15), compared to MICT
(figure 2). Conclusion: This pattern and in particular the increase in
angiogenetic mediators could contribute to the beneficial effects of HIT
in HTx recipients (Figure presented).

<121>
Accession Number
618689800
Author
Amin A.A.; Ariyamuthu V.K.; Urey M.A.; Araj F.G.; Drazner M.H.; Mammen
P.P.; Tanriover B.
Institution
(Amin, Urey, Araj, Drazner, Mammen) Cardiology, UT Southwestern, Dallas,
TX, United States
(Ariyamuthu, Tanriover) Nephrology, UT Southwestern, Dallas, TX, United
States
Title
Does induction therapy for heart transplant recipients on
tacrolimus/mycophenolate/prednisone improve survival in the current
allocation era?.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. United States. 36 (4 Supplement 1) (pp
S71-S72), 2017. Date of Publication: April 2017.
Publisher
Elsevier USA
Abstract
Purpose: The survival benefit of induction therapy (rabbit anti-thymocyte
globulin [r-ATG] and interleukin 2 receptor antagonists [IL-2RA]) over
noinduction in heart transplant recipients receiving contemporary
maintenance immunosuppression (tacrolimus/mycophenolate/prednisone
[TAC/MMF/P]) is not known. Methods: We compared survival in patients who
received r-ATG and IL2-RA to no-induction in a population maintained on
TAC/MMF/P using OPTN data between 2006 and 2015, reflecting the current
allocation era. To minimize selection bias for induction therapy, we
utilized inverse probability weighted propensity scoring (IPW-PS) in a
multivariable Cox analysis. Results: Baseline characteristics are
presented in the Table. The Figure shows KM-survival curves by induction
choice. In univariate analysis R-ATG and IL-2RA are associated with a
worse survival. In multivariable IPW-PS analysis, compared to no induction
therapy, r-ATG increased mortality (HR = 1.21 (95% CI 1.03-1.42)) and
there was a trend towards increased mortality for IL-2RA (HR= 1.11 (95% CI
0.99-1.24)). Conclusion: In a contemporary cohort of heart transplant
recipients receiving TAC/MMF/P, induction therapy with r-ATG is associated
with a higher mortality, while induction therapy with IL2-RA had a
non-significant trend towards higher mortality. Collectively, this data
suggests the need for a prospective clinical trial to assess the true
benefits of each of these therapies (Table presented).

<122>
Accession Number
618689777
Author
Peled Y.; Lavee J.; Raichlin E.; Katz M.; Arad M.; Shemesh Y.; Kassif Y.;
Asher E.; Elian D.; Har-Zahav Y.; Shlomo N.; Freimark D.; Goldenberg I.;
Klempfner R.
Institution
(Peled, Lavee, Katz, Arad, Shemesh, Kassif, Asher, Elian, Har-Zahav,
Shlomo, Freimark, Goldenberg, Klempfner) Sheba Medical Center and Tel Aviv
University, Tel Aviv, Israel
(Raichlin) University of Nebraska Medical Center, Omaha, NE, United States
Title
Metformin treatment after heart transplantation is associated with reduced
malignancy rate.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. United States. 36 (4 Supplement 1) (pp S71),
2017. Date of Publication: April 2017.
Publisher
Elsevier USA
Abstract
Purpose: Over the past decade survival and outcomes of heart
transplantation (HT) recipients have markedly improved. Malignancy is
causing significant morbidity and mortality after HT, with a rate of 2.6%
for survivors of first year and up to 27.7% in 10 years survivors (all
types combined). In addition, diabetes is a major cause for morbidity and
affects 36.8% of 5 years survivors. Metformin is one of the most commonly
used drugs worldwide, and has been suggested to confer anti-tumor
activity. Survival benefits of metformin have been demonstrated in a wide
range of malignancies among them breast cancer, prostate cancer,
pancreatic cancer, colorectal cancer and lung cancer. In the present study
we aimed to investigate the association between metformin therapy and
malignancy following HT. Methods: The study population comprised 275
patients who underwent HT between 1991-2016, and were prospectively
followed-up in a tertiary Heart Transplantation Clinic at Sheba Medical
Center. Clinical data were recorded on prospectively designed forms and
included comprehensive information during long-term follow-up. Results: A
total of 85 patients (31%) after HT had diabetes of whom 48 (56.5%) were
treated with metformin whereas 37 (43.5%) patients did not. Kaplan-Meier
survival analysis showed that at 15 years following HT the rate of
malignancy (all types combined) was 4% among diabetic patients who were
treated with metformin as compared with 62% among diabetic patients who
did not receive metformin (log rank p-value< 0.001 [Figure]). The
corresponding rates of the combined endpoint of cancer or death were 45%
vs. 83%, respectively (log-rank P< 0.001). Consistently multivariate
analysis showed that metformin therapy was independently associated with a
significant 74% reduction (HR 0.26;p< 0.001) in the risk for the
development of malignancy. Conclusion: Our findings suggest that among
diabetic patients who undergo HT metformin therapy is associated with
reduced risk for malignancy during long-term follow-up (Figure presented).

<123>
Accession Number
618689767
Author
Tchantchaleishvili V.; Luc J.G.; Phan K.; Dunlay S.M.; Maltais S.; Stulak
J.M.
Institution
(Tchantchaleishvili, Maltais, Stulak) Department of Cardiovascular
Surgery, Mayo Clinic, Rochester, MN, United States
(Luc) Faculty of Medicine and Dentistry, University of Alberta, Edmonton,
AB, Canada
(Phan) Faculty of Medicine, University of Sydney, Sydney, Australia
(Dunlay) Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN,
United States
Title
Management and outcomes of LVAD thrombosis: A systematic review and
meta-analysis.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. United States. 36 (4 Supplement 1) (pp
S109-S110), 2017. Date of Publication: April 2017.
Publisher
Elsevier USA
Abstract
Purpose: Pump thrombosis is a major adverse event in patients supported on
a left ventricular assist device (LVAD). Treatment approaches include
surgical (device exchange) or medical (lytic, anticoagulation, and
antiplatelet therapy). Few large studies have examined differing treatment
outcomes, and the optimal strategy has not been fully elucidated. Methods:
Large studies addressing pump thrombosis in the modern LVAD era were
systematically reviewed. A meta-analysis of proportions was performed and
subgroup analysis (surgical vs. medical therapy) followed by
random-effects meta-regression was conducted. Weighted Pearson's
coefficient was used to calculate correlation coefficients for
meta-regression analysis of temporal trend of thrombus rates based on
midpoint of study periods. Results: Total of 11 studies with 10750
patients were pooled for analysis, and 620 (4.0%, 95% CI 2.1-6.4%)
patients developed pump thrombus. Of those, 445 (72%) patients had
surgical pump exchange, 150 (24%) were treated medically, and 11 (2%)
underwent heart transplant, while the intervention for 14 (2%) patients
was not reported. Surgical therapy resulted in higher success (93.2%, 95%
CI 86.6-99.8) compared to medical management (43.3%, 95% CI 33.2-53.5) (p<
0.001), while medical therapy had a higher mortality rate (28.5%, 95% CI
14.7-42.3) compared to surgical therapy (4.6% 95% CI 2.6-6.6) (p= 0.001).
Recurrence of pump thrombosis after successful therapy was comparable
between surgical (10.5%, 95% CI 2.3-18.7) and medical therapy (17.7%, 95%
CI 0.6-34.8) (p= 0.434). Metaregression of the studies included in the
analysis was consistent with temporal increase of the thrombosis rate
(Figure, p= 0.047).(Figure presented). Conclusion: In properly selected
patients, surgical therapy offers higher success rate with lower
mortality. Recurrence rate does not differ between medically and
surgically treated patients. There appears to be a temporal increase in
the pump thrombosis rate.

<124>
Accession Number
618689754
Author
Milano C.A.; Rogers J.G.; Tatooles A.J.; Bhat G.; Slaughter M.S.; Birks
E.J.; Mokadam N.A.; Mahr C.; Miller J.S.; Jeevanandam V.; Leadley K.;
Aaronson K.D.; Pagani F.D.
Institution
(Milano, Rogers) Duke University Medical Center, Durham, NC, United States
(Tatooles) Advocate Christ Medical Center, Downers Grove, IL, United
States
(Bhat) Advocate Health Care, Oak Lawn, IL, United States
(Slaughter, Birks) University of Louisville, Louisville, KY, United States
(Mokadam, Mahr) University of Washington, Seattle, WA, United States
(Miller) Emory Healthcare, Atlanta, GA, United States
(Jeevanandam) University of Chicago, Chicago, IL, United States
(Leadley) HeartWare, Framingham, MA, United States
(Aaronson, Pagani) University of Michigan Medical Center, Ann Arbor, IL,
United States
Title
The treatment of patients with advanced heart failure ineligible for
cardiac transplantation with the heartware ventricular assist device:
Results of the endurance supplement trial.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. United States. 36 (4 Supplement 1) (pp S10),
2017. Date of Publication: April 2017.
Publisher
Elsevier USA
Abstract
Summary of Objectives: The ENDURANCE Trial previously demonstrated
non-inferiority of the HeartWare centrifugal flow ventricular assist
device system (HVAD) to the control HeartMate II (HMII) axial flow device
in 445 end-stage heart failure patients ineligible for heart
transplantation. However, the rate of strokes in the HVAD cohort was
higher than expected. Analysis of early clinical trial data found that
elevated mean arterial blood pressure (MAP) was a highly statistically
significant independent risk factor for stroke events. Therefore the
ENDURANCE Supplement was designed to enroll additional patients under the
ENDURANCE inclusion criteria in order to evaluate the impact of enhanced
blood pressure management on patient outcomes in a destination therapy
setting. Methods: The ENDURANCE Supplement was a prospective, multicenter
evaluation of 465 patients with chronic Stage D or NYHA Class IIIB-IV
symptoms randomized 2:1 to either HVAD (N= 308) or control (N= 157).
Patients were adults with a body surface area >= 1.2 m2 and an ejection
fraction <= 25% despite treatment with optimal medical therapy for >= 45
days or treatment with intravenous inotropes for >= 14 days or an
intra-aortic balloon pump for >= 7 days. Exclusion criteria included
significant end-organ dysfunction, recent myocardial infarction or stroke,
coagulopathy, or an anticipated need for a right ventricular assist
device. The 465th patient has recently completed the protocol-driven 12
month follow-up and the data are currently being locked and analyzed.
Endpoints: The primary endpoint was incidence at 12 months on the
originally implanted device of neurologic injury compared to control (MRS
> 0 at 24-weeks post-stroke). Treatment failure was defined as patient
death, stroke, or device malfunction or failure requiring exchange,
explantation, or urgent transplantation within the first year of support.

<125>
Accession Number
618689733
Author
Johl M.; Patel J.; Kittleson M.; Czer L.; Aintablian T.; Velleca A.;
Hamilton M.; Geft D.; Chang D.H.; Ramzy D.; Kobashigawa J.A.
Institution
(Johl, Patel, Kittleson, Czer, Aintablian, Velleca, Hamilton, Geft, Chang,
Ramzy, Kobashigawa) Cedars-Sinai Heart Institute, Los Angeles, CA, United
States
Title
ACE inhibitors or arbs-Do they improve outcome after heart
transplantation?.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. United States. 36 (4 Supplement 1) (pp
S234-S235), 2017. Date of Publication: April 2017.
Publisher
Elsevier USA
Abstract
Purpose: Angiotensin converting enzyme (ACE) inhibitor use in heart
transplantation (HTx) has been reported to decrease the development of
cardiac allograft vasculopathy (CAV). ACE inhibition is also used for
diabetics with potential renal insufficiency contributed by concomitant
use of calcineurin inhibitor's (CNI's). Similarly, angiotensin receptor
blockers (ARBs) provide comparable effects. However, differences in
clinical impact post-HTx have not been completely determined. We chose to
evaluate our heart transplant patients on ACE inhibitors or ARBs during
the first year post-HTx to assess subsequent development of CAV, first-yr
rejection, infections, and other complications. Methods: Between 2010 and
2012, we assessed 154 HTx patients (pts). We divided pts into three
groups: Group A= ACE inhibitor use within the first 3-months post-HTx with
a duration >= 1-yr, Group B= ARB use within 3-months post-HTX with a
duration >= 1-yr, Group C= No ACE inhibitor or ARB use post-HTx. 3-yr
outcomes were assessed for survival, CAV, Non-Fatal Major Adverse Cardiac
Events (NF-MACE: myocardial infarction, new congestive heart failure,
percutaneous coronary intervention, implantable cardioverter
defibrillator/pacemaker implant, stroke). 1-yr outcomes included freedom
from any-treated rejection (ATR), acute cellular rejection (ACR),
antibody-mediated rejection (AMR), biopsy negative rejection (BNR),
treated infection, and any incidence of infection and dialysis post-HTx.
Results: There was no significant difference between all three groups for
3-yr survival, CAV, or NF-MACE. There was also no difference amongst all
groups for 1-yr freedom from ATR, ACR, AMR, BNR and need for post-HTx
dialysis. However, there was significantly reduced 1-yr freedom from
treated infection in Group C compared to Group A. Conclusion: ACE
inhibitor or ARB usage does not appear to provide protection against the
development of CAV or NF-MACE. The protection against treated infection in
the ACE inhibitor cohort needs further evaluation.(Table presented).

<126>
Accession Number
618689714
Author
Fitzsimons S.; Parameshwar J.; Mills N.; Pettit S.
Institution
(Fitzsimons, Parameshwar, Pettit) Transplant Unit, Papworth Hospital,
Papworth, United Kingdom
(Mills) BHF Centre for Cardiovascular Sciences, Royal Infirmatory of
Edinburgh, Edinburgh, United Kingdom
Title
High sensitivity troponin assays can decrease the frequency of
endomyocardial biopsy after heart transplantation.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. United States. 36 (4 Supplement 1) (pp S70),
2017. Date of Publication: April 2017.
Publisher
Elsevier USA
Abstract
Purpose: Acute cellular rejection (ACR) occurs in up to a third of
patients in the first year post-heart transplantation (HT) and is often
asymptomatic. Currently endomyocardial biopsy (EMB) is used for routine
surveillance: an imperfect invasive test. Cardiac troponin (cTn) is a
specific marker of cardiomyocyte injury but measurement of cTn using
conventional assays (conv-Tn) is inadequate to diagnose ACR. The aim of
this meta-analysis is to determine whether high sensitivity Tn (hs-Tn)
assays have greater diagnostic accuracy and therefore could have a
non-invasive role in diagnosing ACR. Methods: We searched Pubmed, Medline,
Google Scholar and Journal of Heart and Lung Transplantation Archive for
relevant studies. The reference lists of included studies were also
searched. We identified 88 potential studies, reviewed 38 abstracts for
eligibility, 23 full text articles and identified 20 relevant studies.
Eleven studies had adequate data for inclusion in the statistical
analysis, of which 7 used conv-Tn assays and 4 used hs-Tn assays. Results:
In the 7 studies assessing conv-Tn there were 2849 paired EMB and Tn
assays. 339 (12%) of EMBs had clinically significant rejection (ISHLT >/=
2R/3a). Collectively conv-Tn assays had a sensitivity of 33%, specificity
72%, PPV 14% and NPV of 89% for diagnosing AR. In the 4 studies (see
table) assessing hs-Tn there were 881 paired EMB and Tn assays. 86 (10%)
of EMBs had >/= 2R/3a rejection. Collectively hs-Tn assays had a
sensitivity of 90%, specificity 51%, PPV 16% and NPV of 98% for diagnosing
AR. In total, 413 (47%) patients had a negative hs-Tn and could have
avoided EMB if hs-Tn-guided surveillance was used. Conclusion:
High-sensitivity cardiac troponin assays have superior diagnostic
performance than conventional assays in the identification of ACR . A high
NPV was found that rivals the Allomap gene test and suggest hsTn-guided
surveillance could be a cost-effective method of reducing the frequency of
EMB after heart transplantation (Table presented).

<127>
Accession Number
618689616
Author
Beauchamp S.; Borkon A.; Karl K.; Aggarwal S.; Kao A.; Magalski A.; Allen
K.; Austin B.; Khumari T.; Lawhorn S.; Long N.; Wang J.; Davis R.;
Thompson E.; Pak A.
Institution
(Beauchamp, Karl, Aggarwal, Kao, Allen, Long, Davis, Thompson, Pak)
Cardiovascular Surgery, Mid America Heart Institute of Saint Luke's
Hospital, Kansas City, MO, United States
(Borkon) Mid America Heart and Lung/St. Luke's, Kansas City, MO, United
States
(Magalski, Austin, Khumari, Lawhorn) Cardiology, Mid America Heart
Institute of Saint Luke's Hospital, Kansas City, MO, United States
(Wang) Biostatistics, Mid America Heart Institute of Saint Luke's
Hospital, Kansas City, MO, United States
Title
Cocaine use does not contribute to accelerated cad as determined by
angiography or IVUS.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. United States. 36 (4 Supplement 1) (pp
S295-S296), 2017. Date of Publication: April 2017.
Publisher
Elsevier USA
Abstract
Purpose: Many programs continue to exclude donors with a history of
cocaine use for fear of accelerated development of graft CAD after heart
transplant (HT). In conjunction with ISHLT-defined angiographic criteria
for CAD, intravascular coronary ultrasound (IVUS) may provide additional
information on the risk of developing CAD in donors with a history of
cocaine. Methods: 573 patients undergoing 581 HT between 6/15/1994 and
12/28/2015 were retrospectively studied from which 571 patients had at
least one post HT angiogram. Donor cocaine use was determined by history
or drug screen at the time of donation. A cohort of 222 patients with 2 or
more IVUS was identified and studied to evaluate the effectiveness of CAD
detection using IVUS. Overall 30-day mortality was 2.3%. IVUS and
angiography was carried out at 6-weeks, 1-year and annually, thereafter.
Maximum plaque thickness was determined at each interval and compared to
baseline (6-weeks). CAD was determined to be present if ISHLT guidelines
for CAD were met on angiography or maximum plaque thickness was found to
have increased by 0.5 mm or more on IVUS. Data was analyzed with
multivariable and Kaplan Meier analyses and Cox proportional hazard
modeling. Results: 60 out of 511 (10.5%) donors had a history of or were
drug screen positive for cocaine. Within this cohort there were users of
tobacco, 26 (44%), alcohol, 24 (41%), marijuana, 45 (75%) and
methamphetamine, 18 (31%). In the non-cocaine group (511) there were users
of tobacco, 140 (28%), alcohol, 81 (16%), marijuana, 177 (35%) and
methamphetamine, 35 (7%), all to a significantly lower degree than cocaine
cohort (P= 0.001). Other than substance use, donor and recipient patient
characteristics did not differ between groups. Overall survival at 4 years
was 86.7% and 82.6% (N.S.) for cocaine and non-cocaine donors,
respectively. Incidence of CAD as determined by angiography at 7 years was
identical (40.0%, N.S.) for both groups. At 4 years 18.8% of non-cocaine
and 21% of cocaine groups had evidence of CAD demonstrated by IVUS (N.S.)
Conclusion: A history of cocaine use in donors is a significant marker for
additional substance abuse. Even in the absence of cocaine use the
incidence of illicit drug use was found to be high in our population of
donors. Nevertheless, patients receiving donors hearts with a history of
cocaine use do not develop accelerated graft CAD as determined by
angiography or IVUS.

<128>
Accession Number
618689584
Author
Stulberg M.; Esbrook C.; Kagan V.; Juricek C.; Jeevanandam V.
Institution
(Stulberg, Esbrook) Therapy Services, University of Chicago Medicine,
Chicago, IL, United States
(Kagan, Juricek, Jeevanandam) Cardiac and Thoracic Surgery, University of
Chicago Medicine, Chicago, IL, United States
Title
Utilization of physical and occupational therapy services in patients
awaiting heart transplant with an ambulatory durable counterpulsation
system.
Source
Journal of Heart and Lung Transplantation. Conference: 37th Annual Meeting
and Scientific Sessions of the International Society for Heart and Lung
Transplantation, ISHLT 2017. United States. 36 (4 Supplement 1) (pp S431),
2017. Date of Publication: April 2017.
Publisher
Elsevier USA
Abstract
Purpose: Placement of a subclavian artery accessed intra-aortic balloon
pump (SC-IABP) has allowed for safe mobility in patients undergoing
management of end-stage heart failure. While participation in ambulation
and activities of daily living (ADL) is possible, the SC-IABP limits the
patient's ability to be independent without monitoring or assistance.
Nursing and physical/occupational therapy (PT/OT) resources are required
to progress these patients to a high level of functional independence. The
Nu-Pulse iVAS is a long-term, implanted counterpulsation system designed
to emulate the performance of an IABP. Compared to SC-IABP, the iVAS
console is reduced from 110 to 6 lbs; EKG electrodes are permanently
implanted; battery power is increased from 45 min to over 6 hours and
timing adjustments of counterpulsation are automated. We hypothesize that
these improvements in technology will reduce nursing and PT/OT resources.
Methods: Data was collected on 15 patients with a SC-IABP from January
2014 to December 2014 who received PT/OT prior to transplantation. To
date, data has been collected as part of a FDA IDE trial on 6 patients
with an iVAS from April 2016 to September 2016 who received PT/OT therapy
prior to transplantation. Results: Nursing ratio was reduced from 1:2 to
1:5 in iVAS patients and all patients could ambulate independently and
safely without nursing supervision. 15.9 was the average number of PT
sessions for patients with a SC-IABP prior to transplantation and 6
sessions for OT. For patients with an iVAS, the average number of PT and
OT sessions was 1.2 for patients prior to transplantation. Criteria for
discharge from therapy for patients with an iVAS was ability to ambulate
and complete ADL's independently. Conclusion: The use of iVAS devices in
patients vs. SC-IABP awaiting heart transplant decreases the utilization
of nursing and PT/OT resources, as patients are independent with
management of their devices. Larger cohorts of patients are needed to
better quantify resource allocation however, this approach may allow
therapists and nurses to see additional patients who require their skilled
services.

<129>
[Use Link to view the full text]
Accession Number
618687923
Author
Jahoor A.; Ghamande S.; Jones S.; Boethel C.; White H.D.
Institution
(Jahoor, Ghamande, Jones, Boethel, White) Department of Internal Medicine,
Division of Pulmonary, Critical Care and Sleep Medicine, Baylor Scott and
White Health, 2401S. 31st Street, Temple, TX 76508, United States
Title
Mediastinitis Following Endobronchial Ultrasound-guided Transbronchial
Needle Aspiration.
Source
Journal of Bronchology and Interventional Pulmonology. 24 (4) (pp
323-329), 2017. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Mediastinitis is a rare complication of endobronchial ultrasound-guided
transbronchial needle aspiration (EBUS-TBNA). Recent reports of infectious
complications following EBUS-TBNA involved oropharyngeal bacteria. Here,
we report 2 unusual cases of post-EBUS-TBNA mediastinitis involving
Streptococcus pneumoniae and Pseudomonas aeruginosa, which were likely the
result of direct inoculation of the organisms at the time of
transbronchial needle aspiration. The first case was successfully treated
with computed tomography-guided drainage and antibiotics, whereas the
second case had >50% distal tracheal obstruction and near total occlusion
of the left main stem bronchus, requiring rigid bronchoscopy, stent
placement, debulking, and antibiotics. Review of literature suggests that
the isolated pathogens are rare in this setting and are most likely not
related to oropharyngeal contamination during bronchoscope insertion.
Active bronchitis should be considered an additional risk factor for
EBUS-TBNA-induced mediastinitis. We suggest possible methods to decrease
the risk of this serious postprocedure complication. It is important to be
vigilant about the possibility of mediastinitis in patients that undergo
EBUS-TBNA. Fever and respiratory symptoms should lower the threshold for
ordering a computed tomography chest for early detection and management.
Our patients did not require thoracic surgery for the management of the
mediastinitis.<br/>&#xa9; Copyright 2017 Wolters Kluwer Health, Inc. All
rights reserved.

<130>
Accession Number
618697474
Author
van Zwol A.; Oosterloo N.B.C.; de Betue C.T.; Bogers A.; de Liefde I.I.;
Deutz N.E.P.; Joosten K.F.M.
Institution
(van Zwol, Oosterloo, de Betue, Joosten) Intensive Care and Department of
Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam,
Netherlands
(Bogers, de Liefde) Department of Cardiothoracic Surgery, Erasmus Medical
Centre, Rotterdam, Netherlands
(Deutz) Center of Translation Research in Aging and Longevity, Department
of Health and Kinesiology, Texas A and M University, College Station, TX,
United States
Title
Effects of glucocorticoids on serum amino acid levels during cardiac
surgery in children.
Source
Clinical Nutrition ESPEN. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier Ltd
Abstract
Background and aims: Children undergoing cardiac surgery with cardio
pulmonary bypass often receive glucocorticoids to reduce the systemic
inflammatory response. Glucocorticoids stimulate protein breakdown and
increase amino acid availability. We studied whether glucocorticoid
treatment influences the availability of amino acids, specifically those
involved in the nitric oxide pathway. Methods: We prospectively studied 49
children with congenital heart disease undergoing cardiac surgery. Serum
cortisol and amino acid levels were measured in arterial blood sampled
before surgery (t = -5 min), directly after surgery (t = 0 h) and at t =
12 h and t = 24 h after surgery. Serum cortisol and amino acid levels were
compared between children who had received glucocorticoids (G+) and
children who had not (G-). Results: Of 49 patients included ((49% male,
age 1.7 (0.5-8.7) y)), 33 (67%) received glucocorticoids. Baseline
characteristics were not different between groups, except a higher
weighted inotropic score in the G+ group. At t = 0 h, serum cortisol
levels in the G+ group were significantly higher than in the G- group
(7218 vs. 660 nmol/L; (p < 0.05)), but not different at the other time
points. The levels of plasma amino acids had dropped after surgery.
Compared to the G- group, in the G+ group the total amount of amino acids
was significantly higher at t = 12 and t = 24; citrulline levels were
higher at t = 12 and t = 24; and glutamine and arginine levels were higher
at t = 12. Conclusions: Glucocorticoid treatment during cardiac surgery in
children preserves serum amino acid levels post-surgery. The preservation
of glutamine, citrulline and arginine levels might have a beneficial
effect on the related NO metabolism.<br/>Copyright &#xa9; 2017 European
Society for Clinical Nutrition and Metabolism.

<131>
Accession Number
616541696
Author
Grocott H.P.; Lee Y.H.; Waszynski C.M.; Waberski W.; Apakama G.P.; Aquino
K.G.; Arya V.K.; Avidan M.S.; Abdallah A.B.; Dicks R.S.; Downey R.J.;
Emmert D.A.; Escallier K.E.; Fritz B.A.; Fardous H.; Funk D.J.; Gipson
K.E.; Girardi L.N.; Grocott H.; Gruber A.T.; Hudetz J.A.; Inouye S.K.;
Ivascu N.S.; Jacobsohn E.; Jayant A.; Kashani H.H.; Kavosh M.S.; Kunkler
B.S.; Lee Y.; Lenze E.J.; Mashour G.A.; Maybrier H.R.; McKinney A.S.;
McKinnon S.L.; Mickle A.M.; Monterola M.; Muench M.R.; Murphy M.R.; Noh
G.-J.; Pagel P.S.; Pryor K.O.; Rogers E.M.; Redko M.; Schmitt E.M.;
Sivanesan L.; Steinkamp M.L.; Tellor B.; Thomas S.; Upadhyayula R.T.;
Veselis R.A.; Vlisides P.E.; Waszynski C.; Yulico H.
Institution
(Avidan, Maybrier, Abdallah, Emmert, Muench, Fritz) Department of
Anesthesiology, Washington University School of Medicine, Saint Louis, MO,
United States
(Jacobsohn) Department of Anesthesiology and Department of Internal
Medicine, University of Manitoba, Winnipeg, MB, Canada
(Grocott) Department of Anesthesia and Perioperative Medicine, University
of Manitoba, Winnipeg, MB, Canada
(Vlisides, Mashour) Department of Anesthesiology, University of Michigan,
Ann Arbor, MI, United States
(Pryor, Rogers) Department of Anesthesiology, Weill Cornell Medicine, New
York City, NY, United States
(Veselis) Department of Neuroanesthesiology, Memorial Sloan Kettering
Cancer Center, New York City, NY, United States
(Downey) Department of Surgery, Memorial Sloan Kettering Cancer Center,
New York City, NY, United States
(Yulico) Department of Anesthesiology, Memorial Sloan Kettering Cancer
Center, New York City, NY, United States
(Noh, Lee) Department of Anesthesiology, Asan Medical Center, Seoul, South
Korea
(Waszynski) Department of Medicine, Hartford Hospital, Hartford, CT,
United States
(Arya) Department of Anaesthesiology and Intensive Care, Postgraduate
Institute of Medical Education and Research, Chandigarh, India
(Pagel, Hudetz) Department of Anesthesiology, Medical College of
Wisconsin, Milwaukee, WI, United States
(Waberski) Department of Anesthesiology, Hartford Hospital, Hartford,
Connecticut, United States
(Inouye) Department of Medicine, Beth Israel Deaconess Medical Center,
Harvard Medical School, Institute for Aging Research, Hebrew SeniorLife,
Boston, MA, United States
Title
Intraoperative ketamine for prevention of postoperative delirium or pain
after major surgery in older adults: an international, multicentre,
double-blind, randomised clinical trial.
Source
The Lancet. 390 (10091) (pp 267-275), 2017. Date of Publication: 15 - 21
July 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Delirium is a common and serious postoperative complication.
Subanaesthetic ketamine is often administered intraoperatively for
postoperative analgesia, and some evidence suggests that ketamine prevents
delirium. The primary purpose of this trial was to assess the
effectiveness of ketamine for prevention of postoperative delirium in
older adults. Methods The Prevention of Delirium and Complications
Associated with Surgical Treatments [PODCAST] study is a multicentre,
international randomised trial that enrolled adults older than 60 years
undergoing major cardiac and non-cardiac surgery under general
anaesthesia. Using a computer-generated randomisation sequence we randomly
assigned patients to one of three groups in blocks of 15 to receive
placebo (normal saline), low-dose ketamine (0.5 mg/kg), or high dose
ketamine (1.0 mg/kg) after induction of anaesthesia, before surgical
incision. Participants, clinicians, and investigators were blinded to
group assignment. Delirium was assessed twice daily in the first 3
postoperative days using the Confusion Assessment Method. We did analyses
by intention-to-treat and assessed adverse events. This trial is
registered with clinicaltrials.gov, number NCT01690988. Findings Between
Feb 6, 2014, and June 26, 2016, 1360 patients were assessed, and 672 were
randomly assigned, with 222 in the placebo group, 227 in the 0.5 mg/kg
ketamine group, and 223 in the 1.0 mg/kg ketamine group. There was no
difference in delirium incidence between patients in the combined ketamine
groups and the placebo group (19.45% vs 19.82%, respectively; absolute
difference 0.36%, 95% CI -6.07 to 7.38, p=0.92). There were more
postoperative hallucinations (p=0.01) and nightmares (p=0.03) with
increasing ketamine doses compared with placebo. Adverse events
(cardiovascular, renal, infectious, gastrointestinal, and bleeding),
whether viewed individually (p value for each >0.40) or collectively
(36.9% in placebo, 39.6% in 0.5 mg/kg ketamine, and 40.8% in 1.0 mg/kg
ketamine groups, p=0.69), did not differ significantly across groups.
Interpretation A single subanaesthetic dose of ketamine did not decrease
delirium in older adults after major surgery, and might cause harm by
inducing negative experiences. Funding National Institutes of Health and
Cancer Center Support.<br/>Copyright &#xa9; 2017 Elsevier Ltd

<132>
Accession Number
618501264
Author
Kwong J.S.W.; Li S.; Gu W.-J.; Chen H.; Zhang C.; Zeng X.-T.; Yu C.-M.
Institution
(Kwong) Department of Health Policy, National Center for Child Health and
Development, Tokyo, Japan
(Li) Department of Endocrinology and Metabolism, West China Hospital,
Sichuan University, Chengdu, China
(Gu) Department of Anesthesiology, Nanjing Drum Tower Hospital, Medical
College of Nanjing University, Nanjing, China
(Chen) Second Clinical College, Nanjing University of Chinese Medicine,
Nanjing, China
(Zhang) Center for Evidence-Based Medicine and Clinical Research, Taihe
Hospital, Hubei University of Medicine, Shiyan, China
(Zeng) Center for Evidence-Based and Translational Medicine, Zhongnan
Hospital of Wuhan University, Wuhan, China
(Zeng) Department of Urology, Zhongnan Hospital of Wuhan University,
Wuhan, China
(Yu) Chiu Hin Kwong Heart Centre, Hong Kong Baptist Hospital, Kowloon,
Hong Kong
Title
Efficacy and safety of instantaneous wave-free ratio in patients
undergoing coronary revascularisation: Protocol for a systematic review.
Source
BMJ Open. 7 (9) (no pagination), 2017. Article Number: e017868. Date of
Publication: 01 Sep 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Effective selection of coronary lesions for revascularisation
is pivotal in the management of symptoms and adverse outcomes in patients
with coronary artery disease. Recently, instantaneous a wave-free' ratio
(iFR) has been proposed as a new diagnostic index for assessing the
severity of coronary stenoses without the need of pharmacological
vasodilation. Evidence of the effectiveness of iFR-guided
revascularisation is emerging and a systematic review is warranted.
Methods and analysis This is a protocol for a systematic review of
randomised controlled trials and controlled observational studies.
Electronic sources including MEDLINE via Ovid, Embase, Cochrane databases
and ClinicalTrials.gov will be searched for potentially eligible studies
investigating the effects of iFR-guided strategy in patients undergoing
coronary revascularisation. Studies will be selected against transparent
eligibility criteria and data will be extracted using a prestandardised
data collection form by two independent authors. Risk of bias in included
studies and overall quality of evidence will be assessed using validated
methodological tools. Meta-analysis will be performed using the Review
Manager software. Our systematic review will be performed according to the
guidance from the Cochrane Handbook for Systematic Reviews of
Interventions and the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) statement. Ethics and dissemination Ethics approval
is not required. Results of the systematic review will be disseminated as
conference proceedings and peer-reviewed journal publication. Trial
registration number This protocol is registered in the International
Prospective Register of Systematic Reviews (PROSPERO), registration number
CRD42017065460.<br/>Copyright &#xa9; Article author(s) 2017. All rights
reserved.

<133>
Accession Number
618521129
Author
Zhang L.; Zheng X.; Long Y.; Wu M.; Chen Y.; Yang J.; Liu Z.; Zhang Z.
Institution
(Zhang, Chen, Yang, Liu, Zhang) Department of Clinical Laboratory and
Pathology, Wuhan Asia Heart Hospital, Wuhan University, Wuhan, China
(Zheng) Laboratory of Molecular Cardiology, Wuhan Asia Heart Hospital,
Wuhan University, Wuhan, China
(Long, Wu) Heart Center, Wuhan Asia Heart Hospital, Wuhan University,
Wuhan, China
Title
D-dimer to guide the intensity of anticoagulation in Chinese patients
after mechanical heart valve replacement: a randomized controlled trial.
Source
Journal of Thrombosis and Haemostasis. 15 (10) (pp 1934-1941), 2017. Date
of Publication: October 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Essentials Low anticoagulation intensity reduces bleeding but increases
thrombosis during warfarin therapy. Elevated D-dimer level is associated
with increased thrombosis events. D-dimer can be used to find potential
thrombosis in those receiving low intensity therapy. D-dimer-guided
therapy may be the optimal strategy for those with mechanical heart valve
replacement. Summary: Background Controversies remain regarding the
optimal anticoagulation intensity for Chinese patients after mechanical
heart valve replacement despite guidelines having recommended a standard
anticoagulation intensity. Objectives To investigate whether D-dimer could
be used to determine the optimal anticoagulation intensity in Chinese
patients after mechanical heart valve replacement. Patients/Methods This
was a prospective, randomized controlled clinical study. A total of 748
patients following mechanical heart valve replacement in Wuhan Asia Heart
Hospital were randomized to three groups at a ratio of 1 : 1 : 1. Patients
in two control groups received warfarin therapy based on constant standard
intensity (international normalized ratio [INR], 2.5-3.5; n = 250) and low
intensity (INR, 1.8-2.6; n = 248), respectively. In the experimental group
(n = 250), warfarin therapy was initiated at low intensity, then those
with elevated D-dimer levels were adjusted to standard intensity. All
patients were followed-up for 24 months until the occurrence of endpoints,
including bleeding events, thrombotic events and all-cause mortality.
Results A total of 718 patients were included in the analysis. Fifty-three
events occurred during follow-up. There was less hemorrhage (3/240 vs.
16/241; hazard ratio [HR], 0.18; 95% confidence interval [CI], 0.07-0.45)
and all-cause mortality (4/240 vs. 12/241; HR, 0.33; 95% CI, 0.12-0.87)
observed in the D-dimer-guided group than in the standard-intensity group.
A lower incidence of thrombotic events was also observed in the
D-dimer-guided group when compared with the low-intensity group (5/240 vs.
14/237; HR, 0.35; 95% CI, 0.14-0.85). Overall, the total events were less
in the D-dimer-guided group (9/240) when compared with the other two
control groups (24/241, 20/237; HR, 0.37, 0.44; 95% CI, 0.19-0.72,
0.21-0.90. Conclusions The D-dimer-guided adjustment of anticoagulation
intensity could reduce adverse events in Chinese patients after mechanical
heart valve replacement. Trial Registry: NCT01996657;
ClinicalTrials.gov.<br/>Copyright &#xa9; 2017 International Society on
Thrombosis and Haemostasis

<134>
Accession Number
618671284
Author
Rebello D.; Bakhit M.; McCarty T.R.; Sidhom P.; Machan J.T.; Quillin M.;
Moss S.F.
Title
Do the risks outweigh the benefits when a heparin bridge is used for
anticoagulated patients undergoing colonoscopy?.
Source
Gastroenterology. Conference: Digestive Disease Week 2017, DDW 2017.
United States. 152 (5 Supplement 1) (pp S224), 2017. Date of Publication:
April 2017.
Publisher
W.B. Saunders
Abstract
BACKGROUND AND AIM: Anticoagulation management for patients undergoing
colonoscopy includes the interruption of anticoagulation with or without
use of a heparin bridge. The primary aim of this study was to assess the
adverse events associated with heparin bridge (hep-bridge) therapy
compared to temporary cessation of anticoagulation without bridge
(no-bridge). METHODS: This single center, retrospective cohort study used
electronic medical records to identify all anticoagulated patients who
underwent colonoscopy between January 2015 and November 2016. In the
no-bridge cohort, NOACs (novel oral anticoagulation) were held two days
and warfarin was held 5 days pre-procedure and reinitiated immediately
following colonoscopy. In the hep-bridge cohort, warfarin or NOACs were
held and subcutaneous LMWH (enoxaparin 1 mg/kg BID) was started 5 days
prior to procedure. LMWH was held on the day of colonoscopy and warfarin
or NOACs was restarted post procedure. LMWH was reinitiated one-day post
procedure for 5 days. The primary outcome measure was post-polypectomy
bleeding, defined as a chief complaint of rectal bleeding upon
post-procedure emergency room (ER) or outpatient office visit within 30
days of the procedure. Secondary outcomes included cardiovascular events,
all cause complications, ER visits within 30 days, and predictive value of
the HASBLED and CHADS2 scores for 30 day ER visits. RESULTS: A total of
205 patients were included and 186 of those patients underwent polypectomy
(87.7%). The mean age was 68.4 years and 96.6% were male. There were 139
procedures performed with no-bridge and 66 procedures with hep-bridge.
Interventions and outcomes are summarized in Table I. Post-polypectomy
bleeding was seen in a total of 7.1% (n=15) of procedures. In the
no-bridge cohort a total of 5.5% had a post polypectomy bleed (n=7) and
13.6% in hep-bridge procedures (n=8; p<0.0747). Cardiovascular events
occurred in 1.9% of procedures (n=4); 2.1% in the no-bridge (n=3) and 1.4%
in the hep-bridge procedures (n=1; p<0.745). Thirty-day ER visits were
seen in 14.2% (n= 18) of the no-bridge procedures and 42.3% (n=25)
hep-bridge procedures (p<0.0001); this included urinary, musculoskeletal
and orthostatic chief complaints. Neither CHADS2 (p<0.86) nor HASBLED
(p<0.92) predicted post-polypectomy bleeding. CONCLUSION: In our cohort of
anticoagulated patients undergoing colonoscopy, the use of a heparin
bridge was not associated with increased gastrointestinal bleeding
compared to cessation of anticoagulation, but was associated with a
significant increase in ER visits within 30 days post-procedure. CHADS2
and HASBLED did not predict post-polypectomy bleeding. Table 1. Baseline
Characteristics of post-polypectomy bleeding in heparin bridge therapy
compared to interruption of anticoagulation. (Table Presented).

<135>
Accession Number
618669204
Author
Mahoney L.B.; Rosen R.
Title
The prevalence of Rome IV non-erosive esophageal phenotypes in children.
Source
Gastroenterology. Conference: Digestive Disease Week 2017, DDW 2017.
United States. 152 (5 Supplement 1) (pp S708), 2017. Date of Publication:
April 2017.
Publisher
W.B. Saunders
Abstract
Introduction: The majority of children with reflux symptoms do not have
erosive esophagitis at the time of endoscopy. The new Rome IV criteria
define a variety of non-erosive esophageal phenotypes based on the results
of 24-hour multichannel intraluminal impedance with pH (pH-MII) testing.
While these phenotypes are well-described in adults, there is little data
in children. The aim of this study was to characterize, in a large cohort
of children, the prevalence of Rome IV phenotypes, distribution of reflux
symptoms, rates of proton pump inhibitor (PPI) responsiveness and
frequency of microscopic esophagitis. Methods: Children < 2 years who
underwent upper endoscopy and pH-MII testing for evaluation of typical
reflux symptoms (pain, heartburn, chest pain, reflux, or regurgitation)
between 2004 and 2016 were included. All children underwent a minimum of
an 8-week PPI trial prior to diagnostic studies, though all studies were
performed off PPI therapy. Children with erosive reflux disease,
eosinophilic esophagitis, prior thoracic or abdominal surgery and those
who did not report symptoms during the pH-MII study were excluded.
Patients with abnormal esophageal acid exposure (pH <4 for >6% of the
study) were classified as having nonerosive reflux disease (NERD). Those
with normal acid exposure, but a positive symptom index (SI) to either
acid or nonacid reflux, were classified as acid or nonacid reflux
hypersensitivity. Those with normal acid exposure and negative SI were
classified as functional heartburn. Results: 50 children reported symptoms
during pH-MII monitoring (mean age 10.4+/-5.2 years, 52% female). Reported
symptoms included heartburn (36%), non-specific pain (50%), abdominal pain
(26%), chest pain (4%), reflux (14%) and regurgitation (20%). The
distribution of Rome IV non-erosive esophageal phenotypes was: 28% NERD,
32% reflux hypersensitivity (30% acid and 2% nonacid) and 40% functional
heartburn. 64% of NERD patients, 73% of acid reflux hypersensitivity
patients, 0% of nonacid reflux hypersensitivity patients and 50% of
functional heartburn patients had at least some symptomatic improvement
with PPI use, though there were no significant differences between groups
(p=0.32). 20% of all children had evidence of microscopic reflux
esophagitis on histology. Among subtypes, 14% of NERD patients, 27% of
patients with acid reflux hypersensitivity, 0% of those with nonacid
reflux hypersensitivity and 20% with functional heartburn had microscopic
esophagitis (p= 0.86). Conclusions: There is an even distribution of
non-erosive esophageal phenotypes in pediatric patients. The
characteristics of reflux symptoms, presence of microscopic esophagitis
and responsiveness to a PPI trial is not significantly different between
phenotypes. Correct diagnosis of patients requires the use of pH-MII
testing and is important to help guide future therapeutic options.

<136>
Accession Number
618664666
Author
Chen K.; Yang F.; Zhao H.; Wang T.; Wang L.T.; Wang J.
Institution
(Chen, Yang, Zhao, Wang) Peking University, People's Hospital, Beijing,
China
(Wang, Wang) Berry Genomics Corp, Beijing, China
Title
A prospective study of dynamic changes of circulating tumor DNA in
surgical lung cancer patients.
Source
Cancer Research. Conference: American Association for Cancer Research
Annual Meeting 2017. United States. 77 (13 Supplement 1) (no pagination),
2017. Date of Publication: July 2017.
Publisher
American Association for Cancer Research Inc.
Abstract
Objective: Most previous studies about circulating tumor DNA focused on
advanced stage cancer patients. We have completed a clinical prospective
study (NCT02645318) and showed the feasibility of ctDNA detection in early
stage (I-IIA) non-small cell lung cancer (NSCLC) patients, which have been
published (Sci. Rep.6,31985,2016). We also investigated its clinical
application on early diagnosis and showed our data by oral presentation in
American Association of Thoracic Surgery Annual meeting 2016 in Baltimore.
Based on our previous study, we further evaluated the clinical value of
ctDNA. Few study revealed dynamic changes of circulating tumor DNA in
surgical lung cancer patients that no criterion has been established of
how to use it for surveillance. The aim of this study is to investigate
the elimination rate of circulating tumor DNA level after surgery. This is
the first prospective study to evaluate the dynamic changes of ctDNA in
surgical lung cancer patients. Method: Consecutive patients with suspected
lung cancer who underwent curative-intent lung resection were enrolled
prospectively in this study from 11/2016. 10 mL blood samples were taken
by intravenous puncture. Plasma samples were obtained before surgery (time
A) and at a series of scheduled time-points (2 min to 72 hours, time B to
F) after tumor resection. DNA was prepared from 4mL of purified plasma. We
designed a multiplex assay based on circulating single-molecule
amplification and resequencing technology (cSMART) to simultaneously
detect and quantitate hot spot EGFR, KRAS, BRAF, ERBB2, PIK3CA, TP53, ALK,
RET and MET plasma DNA variants, with matched white blood cell DNA as
controls. Positive plasma mutations were validated in tumor tissue by
targeted sequencing. Study protocol (ClinicalTrials.gov identifier
NCT02965391) was approved by the Peking University People's Hospital
Medical Ethics Committee (2016PHB156-01). Results: A hundred and seven
patients were enrolled, in which 18(16.8%)patients showed detectable
driver mutations in the preoperative plasma sample (time A), 9 patients
were excluded due to non-radical surgery(3); no plasma of other
timepoints(2); non-somatic driver mutations (2); no surgery performed(2).
Therefore, 9 patients (4 stage I, 3 stage II and 2 stage III) with 11
mutations met the inclusion criteria, which included four EGFR, three
TP53, two PIK3CA, one KRAS and one ALK mutations. All of the patients had
a decrease of mutation ratio as time went on and dropped to 0 after 72
hours of tumor resection. The average mutation ratio was 2.99%, 1.64%,
0.82%, 0.03%, 0.015% and 0 at the time-points A to F, respectively. The
evaluated half-life of ctDNA was about 10 min. The total DNA template
appeared higher post-operation than preoperation (3082+/-2234
vs.1787+/-1181, p=0.12).One patient had concurrent driver mutations of
PIK3CA E545K and EGFR L858R. PIK3CA was detected in time A and decreased
gradually from time B to C. EGFR was not detected in time A but in plasma
time B and decreased in time C. Conclusion: The elimination of ctDNA in
lung cancer patients is very rapid after surgical resection. The
intraoperative manipulation may not only push forward releasing of cell
free DNA, but also lead heterogeneous tumor mutation discharging to
plasma. Detection of ctDNA 72h after surgery could be the reference value
for postoperative surveillance.

<137>
Accession Number
618661779
Author
Wu J.; Ly T.; Seco M.; Vallely M.; Wilson M.; Byrom M.; Bannon P.
Institution
(Wu, Ly, Seco, Vallely, Wilson, Byrom, Bannon) University of Sydney,
Sydney, NSW, Australia
Title
Meta-analysis of left ventricular assist device as bridge to heart
transplantation.
Source
Heart Lung and Circulation. Conference: Annual Scientific Meeting of the
Australian and New Zealand Society of Cardiac and Thoracic Surgeons,
ANZSCTS 2015. Australia. 25 (8) (pp e117), 2016. Date of Publication:
August 2016.
Publisher
Elsevier Ltd
Abstract
Purpose: Ventricular assist devices are employed as a bridge to
transplantation (BTT), allowing heart failure patients to survive longer
until a donor heart is available. Our aim was to perform a meta-analysis
of studies comparing post-transplant outcomes of patients with and without
left ventricular assist devices (LVADs) as BTT. Methodology: Electronic
searches were performed using six databases from their date of inception
to August 2015. Studies with no report on post-transplant survival, no
comparative data, or paediatric patient population were excluded. Data
were presented as odds ratios (ORs) and 95% confidence intervals (CIs).
Results: From 1715 publications, we identified 32 studies comparing 10,219
LVAD patients and 25,935 non-LVAD patients. Early post-transplant survival
was significantly lower in the LVAD group at 30 days (OR, 0.48; 95% CI,
0.33-0.69; P = .0001) and 6 months (OR, 0.79; 95% CI, 0.64- 0.97; P =
.02). No significant difference was observed for survival at 1 year (OR,
0.90; 95%CI, 0.73-1.10;P = .31), 5 years (OR, 0.93; 95%CI, 0.79-1.09; P =
.37), and 10 years (OR, 0.81; 95%CI, 0.35-1.91; P = .63). In addition,
there was no significant difference for post-transplant rejection (OR,
1.10; 95% CI, 0.75-1.62; P = .61), renal dysfunction (OR, 0.97; 95% CI,
0.47-2.01; P = .93), stroke (OR, 1.46; 95% CI, 0.95-2.52; P = .17), and
infection (OR, 1.22; 95% CI, 0.98-1.52; P = .08). Conclusion: LVADs do not
significantly influence longterm post-transplant survival, and provides
viable support as BTT for heart failure patients.

<138>
Accession Number
618661777
Author
Wu J.; Seco M.; Edelman J.; Eslick G.; Wilson M.; Vallely M.; Byrom M.;
Bannon P.
Institution
(Wu, Seco, Edelman, Eslick, Wilson, Vallely, Byrom, Bannon) University of
Sydney, Sydney, NSW, Australia
Title
Meta-analysis of mechanical versus biological aortic valve replacement in
patients aged 40 to 70 years.
Source
Heart Lung and Circulation. Conference: Annual Scientific Meeting of the
Australian and New Zealand Society of Cardiac and Thoracic Surgeons,
ANZSCTS 2015. Australia. 25 (8) (pp e117), 2016. Date of Publication:
August 2016.
Publisher
Elsevier Ltd
Abstract
Purpose: Selection of a mechanical valve (MV) or a biological valve (BV)
in aortic valve replacement (AVR) for middleaged adults remains
controversial, and rotates around different complications with different
time-related rates. In light of this evolving issue, our aim was to
perform a meta-analysis of studies comparing long-term clinical outcomes
between MVs and BVs in patients aged 40 to 70 years. Methodology:
Electronic searches were performed using six databases from their date of
inception to August 2015. Studies without comparative data, appropriate
patient age range, or isolated aortic valve replacement were excluded.
Data were presented as odds ratios (ORs) and 95% confidence intervals
(CIs). Results: From 893 publications, we identified 12 studies comparing
3,355 MV patients and 3,490 BV patients. No significant difference was
observed at 15 years for survival (OR, 1.03; 95% CI, 0.85-1.25; P = .75),
freedom from stroke (OR, 0.98; 0.70-1.36; P = .89), and freedom from
endocarditis (OR, 1.51; 95% CI, 0.63-3.63; P = .36). The freedom from
reoperation at 15 years was significantly lower in the BV group (OR, 1.67;
95% CI, 1.07-2.60; P = .02). Freedom from thromboembolism and freedom from
bleeding at 15 years was significantly lower in the MV group (OR, 0.61;
95% CI, 0.44-0.86; P = .004; and OR, 0.58; 95% CI, 0.37-0.90; P = .01,
respectively). Conclusion: Given the available evidence, the choice of
prosthetic valve type does not significantly influence survival for
middle-aged AVR patients. The present meta-analysis supports lowering the
currently recommended age threshold for implanting a BV.

<139>
Accession Number
618661771
Author
Parikh R.; Bannon P.; Dhurandhar V.; Virk S.; Saxena A.; Valelly M.
Institution
(Parikh, Bannon, Dhurandhar, Virk, Saxena, Valelly) Royal Prince Alfred
Hospital, Sydney, NSW, Australia
Title
The prognostic value of elevated troponin i for short-term mortality after
cardiac surgery.
Source
Heart Lung and Circulation. Conference: Annual Scientific Meeting of the
Australian and New Zealand Society of Cardiac and Thoracic Surgeons,
ANZSCTS 2015. Australia. 25 (8) (pp e97), 2016. Date of Publication:
August 2016.
Publisher
Elsevier Ltd
Abstract
Purpose: Current risk stratification models largely rely on preoperative
variables to predict mortality after cardiac surgery. However,
perioperative events also have a significant impact on mortality,
especially myocardial injury. Troponin I is a highly specific biomarker to
diagnose myocardial infarction. The present meta-analysis aimed to clarify
the prognostic value of elevated Troponin I for the prediction of
shortterm mortality after adult cardiac surgery. Methodology: Electronic
database searches of Medline, PubMed, Cochrane Central Register of
Controlled Trials and Cochrane Database of Systematic Reviews were
conducted to identify all relevant studies. Two reviewers independently
selected studies and extracted data. Measures of test accuracy were pooled
using random-effects modelling. Results: Six studies met the inclusion
criteria, involving a total of 2222 patients. The diagnostic odds ratio of
elevated Troponin I for short-term mortality was 12.00 (95% confidence
interval [CI], 6.31-22.84). Elevated Troponin I had pooled sensitivity of
0.62 (95% CI, 0.49-0.73) and specificity of 0.87 (95% CI, 0.85-0.88).
Pooled positive and negative likelihood ratios were 4.58 (95% CI,
2.65-7.90) and 0.51 (95% CI, 0.35-0.76), respectively. Conclusions: The
present meta-analysis provides evidence of an association between
perioperative Troponin I release and short-term mortality following adult
cardiac surgery. However, establishment of a singular Troponin I cut-off
value is hindered by differences in patient characteristics and testing
protocols across individual studies.

<140>
Accession Number
618661770
Author
Vo T.; Azari M.R.; Stuklis R.G.; Worthington M.
Institution
(Vo, Azari, Stuklis, Worthington) Royal Adelaide Hospital, Adelaide, SA,
Australia
Title
Recombinant factor VIIa use in cardiac surgical patients: A systematic
review.
Source
Heart Lung and Circulation. Conference: Annual Scientific Meeting of the
Australian and New Zealand Society of Cardiac and Thoracic Surgeons,
ANZSCTS 2015. Australia. 25 (8) (pp e116), 2016. Date of Publication:
August 2016.
Publisher
Elsevier Ltd
Abstract
Purpose: Recombinant activated factor VIIa (rFVIIa) is increasingly being
used off-label in the management of refractory haemorrhage post-cardiac
surgery. This review aimed to compare the safety, efficacy and the risk of
adverse events related to the use of rFVIIa in cardiac surgery. Methods:
Four electronic databases (Medline, Medline- Plus, The Cochrane Library
and PubMed) were used to identify studies involved in the use of rFVIIa in
cardiac surgery from January 2000 to June 2015. Search terms included
"recombinant activated factor VIIa" or "rFVIIa" and "cardiac surgery",
"thromboembolism", "stroke", "adverse events" or "blood transfusion".
Twenty-four studies were recovered and after applying inclusion and
exclusion criteria, 6 were selected for further analysis. Primary outcomes
were efficacy and adverse events (stroke, MI, DVT and PE). Results: Dosage
of rFVIIa varied across studies (between 18ug/kg to 90ug/kg). The
incidence of stroke was higher in the pooled rFVIIa group compared to the
control group (4.54% vs. 1.74%), as was DVT and PE (0.35% vs. 0%). MI was
higher in the control group (0.94% vs. 1.55%). The use of rFVIIa was
effective in lowering allogenic transfusion compared to placebo groups.
Overall, surgical re-exploration was less in the rFVIIa group, however
this did not reach statistical significance. Conclusion: The off-label use
of rFVIIa can be effective in controlling refractory bleeding post-cardiac
surgery. However, this is at increased risk of major thromboembolic
events. Currently, there are no clear guidelines on the indications and
dosing parameters for rFVIIa in cardiac surgery, thus its use should be
considered on a case-by-case basis.

<141>
Accession Number
618661767
Author
Phan K.; Tsai Y.-C.; Zhao D.F.; Zhou J.J.; Liao J.; Phan S.; Yan T.D.
Institution
(Phan, Tsai, Zhao, Zhou, Liao, Phan, Yan) Collaborative Research (CORE)
Group, Sydney, NSW, Australia
Title
Bioprosthetic versus mechanical prostheses for valve replacement in
end-stage renal disease patients: Systematic review and meta-analysis.
Source
Heart Lung and Circulation. Conference: Annual Scientific Meeting of the
Australian and New Zealand Society of Cardiac and Thoracic Surgeons,
ANZSCTS 2015. Australia. 25 (8) (pp e115), 2016. Date of Publication:
August 2016.
Publisher
Elsevier Ltd
Abstract
Objectives: Patients with end-stage renal disease (ESRD) indicated for
dialysis are increasingly requiring cardiac valve surgery. The choice of
bioprosthetic or mechanic valve prosthesis for such patients requires
careful risk assessment. A systematic review and meta-analysis was
performed to assess current evidence available. Methods: A comprehensive
search from six electronic databases was performed from their inception to
February 2015. Results from patients with ESRD undergoing cardiac surgery
for bioprosthetic or mechanical valve replacement were identified.
Results: 16 studies with 8483 patients with ESRD undergoing cardiac valve
replacement surgery were included. No evidence of publication bias was
detected. Prior angioplasty by percutaneous coronary intervention (PCI) or
coronary artery bypass graft (CABG) surgery was significantly higher in
the bioprosthetic group compared to the mechanical group (16.0% vs 12.0%,
P = 0.04); all other preoperative baseline patient characteristics were
similar. There was no significant difference in 30-day mortality or
all-cause mortality between the two comparisons. Compared with the
mechanical group, the frequency of bleeding (5.2% vs 6.4%, P = 0.04) and
risk of thromboembolism (2.7% vs 12.8%, P = 0.02) were significantly lower
in the bioprosthetic group. There were similar rates of reoperation and
valve endocarditis. Conclusion: The present study demonstrated that
patients with ESRD undergoing bioprosthetic or mechanical valve
replacement had similar mid- long-term survival. The bioprosthetic group
had lower rates of bleeding and thromboembolism. Further studies are
required to differentiate the impact of valve location. The presented
results may be applicable for ESRD patients requiring aortic valve
replacement.

<142>
Accession Number
618661762
Author
Meneguzzi J.; Hayward P.; Kilpin M.; Zhu Y.Y.; Doi A.; Reid C.; Tran L.;
Smith J.
Institution
(Meneguzzi, Hayward, Kilpin, Zhu, Doi, Reid, Tran, Smith) University of
Melbourne, Melbourne, VIC, Australia
Title
Impact of discontinuation of antiplatelet therapy prior to isolated valve
and combined coronary artery bypass graft and valve procedures on short
and intermediate term outcomes.
Source
Heart Lung and Circulation. Conference: Annual Scientific Meeting of the
Australian and New Zealand Society of Cardiac and Thoracic Surgeons,
ANZSCTS 2015. Australia. 25 (8) (pp e96), 2016. Date of Publication:
August 2016.
Publisher
Elsevier Ltd
Abstract
Purpose: This study aims to identify the optimal timing for administration
of aspirin in isolated valve or combined CABG and valve surgery to
minimise risk of perioperative morbidity and mortality. Methods: From a
prospectively compiled database collected by the Australian and New
Zealand Society of Cardiac and Thoracic Surgeons we identified 8,294
patients undertaking isolated valve or combined CABG and valve procedures
while discontinuing aspirin. Time points for cessation of antiplatelet
therapy were categorised as follows: <2 days, 3-7 days or >7 days
preoperatively. We evaluated the association of adverse in-hospital events
and intermediate term survival in each time category. Results:
Discontinuing aspirin 3-7 days from surgery decreased rates of returning
to theatre (HR=0.560, p=0.002) reduced ICC losses (HR=0.757, p=0.000) and
red blood cell and platelet transfusions (HR=0.719, p=0.000 and HR=0.604,
p=0.000 respectively) compared to patients continuing aspirin until <2
days from the procedure. Stopping aspirin <2 days from surgery increased
risk of reoperation for bleeding (HR=2.076, p=0.001), returning to theatre
(HR=1.781, p=0.000), ICC drain losses (HR=1.337, p=0.000) and transfusion
demands for red blood cells (HR=1.381, p=0.000) and platelets (HR=1.450,
p=0.000) when compared to those discontinuing aspirin >7 days from
surgery. Aspirin cessation <2 days from procedure does not confer a
survival benefit when compared to discontinuation >2 days from surgery.
Conclusion: Late discontinuation of aspirin before isolated valve or
combined coronary artery bypass graft and valve procedures results in
greater rates of bleeding and transfusion requirements without an
improvement in short- and intermediate-term survival.

<143>
Accession Number
618661730
Author
Dunne B.; Murphy M.; Skiba R.; Wang D.; Ho K.; Merry C.
Institution
(Dunne, Murphy, Skiba, Wang, Ho, Merry) Fiona Stanley Hospital, Perth, WA,
Australia
Title
Sternal cables are not superior to traditional sternal wiring. a
randomised controlled trial of sternal closure with sternal wires or
sternal cables.
Source
Heart Lung and Circulation. Conference: Annual Scientific Meeting of the
Australian and New Zealand Society of Cardiac and Thoracic Surgeons,
ANZSCTS 2015. Australia. 25 (8) (pp e90-e91), 2016. Date of Publication:
August 2016.
Publisher
Elsevier Ltd
Abstract
Purpose: Deep sternal wound infection is a devastating complication of
cardiac surgery. In the current era of increasing patient co-morbidity,
newer techniques must be evaluated in attempts to reduce the rates of deep
sternal wound infection. Methodology: A randomised controlled trial
comparing sternal closure with traditional sternal wires in figure-8
formation with the Pioneer cabling system from Medigroup after adult
cardiac surgery was performed. Results: 273 patients were enrolled with
137 and 135 patients randomised to sternal wires and cables group,
respectively. Baseline characteristics between the two groups were well
balanced. Deep sternal wound infection occurred in 0.7% of patients in the
wires group and 3.7% of patients in the cables group (absolute risk
difference = -3.0%, 95% confidence interval: -7.7% to 0.9%; p=0.12).
Patients in the cables group were extubated slightly earlier than the
patients in the sternal wires group postoperatively (9.7 vs. 12.8 hours;
p=0.03). There was, however, no significant difference in hospital and
follow-up pain scores or analgaesia requirements. Conclusion: The Pioneer
sternal cabling system appears to facilitate early extubation after adult
cardiac surgery, but it does not reduce the rate of deep sternal
infection.

<144>
Accession Number
618661727
Author
Nezafati P.; Shomali A.; Nezafati M.H.
Institution
(Nezafati, Shomali, Nezafati) Mashhad University of Medical Sciences,
Khorassan, Iran, Islamic Republic of
Title
Endoscopic vein harvesting versus open vein harvesting: Effect on
health-related quality of life in patients undergoing coronary artery
bypass grafting.
Source
Heart Lung and Circulation. Conference: Annual Scientific Meeting of the
Australian and New Zealand Society of Cardiac and Thoracic Surgeons,
ANZSCTS 2015. Australia. 25 (8) (pp e109), 2016. Date of Publication:
August 2016.
Publisher
Elsevier Ltd
Abstract
Introduction: The aim of this study was to compare the quality of life
(QOL) in Endoscopic Vein Harvesting (EVH) versus traditional Open Vein
Harvesting (OVH) for coronary artery bypass grafting (CABG) surgery.
Methods: From February 2014 to May 2014, 100 patients with relatively same
gender and similar age who were scheduled for CABG were selected, and were
prospectively randomised into two groups (50 EVH and 50 OVH). In addition,
demographic data including lipid profile, FBS, BMI, and cardiovascular
risk factors were collected. For QOL evaluation, 36-Item Short Form Health
Survey (SF-36), in eight dimensions as an interviewer-administered
questionnaire, was used 7 days, 1 month, and 6 months postoperatively.
Data analyses, including parametric and nonparametric tests were
undertaken using the SPSS 16 software. AP value < 0.05 was regarded as
statistically significant. Results: The mean age of EVH and OVH groups
were 63 +/-8.4 and 62 +/- 7.9, respectively (P=0.845). In addition,
smoking, DM, HTN, coronary artery disease (CAD), BMI, and FBS were not
significantly different between the two groups (P>0.05). At the seven-day
and one-month follow-ups, except for the SF-36 area of vitality, EVH group
had a significantly greater QOL in the other seven dimensions. Six months
after vein harvesting, EVH patients had significantly higher QOL indices
in the areas of physical functioning, social functioning, mental health,
general health perception, and pain (P<0.05). Conclusion: Besides
previously studied advantages of EVH, this technique brings greater
quality of life for patients undergoing coronary artery bypass grafting
surgery compared to OVH according to SF-36 questionnaire.

<145>
Accession Number
618661725
Author
Nezafati M.H.; Shomali A.; Tehrani S.O.; Nezafati P.
Institution
(Nezafati, Shomali, Tehrani, Nezafati) Mashhad University of Medical
Sciences, Khorassan, Iran, Islamic Republic of
Title
Zipfix versus conventional sternal closure: Oneyear follow-up.
Source
Heart Lung and Circulation. Conference: Annual Scientific Meeting of the
Australian and New Zealand Society of Cardiac and Thoracic Surgeons,
ANZSCTS 2015. Australia. 25 (8) (pp e108-e109), 2016. Date of Publication:
August 2016.
Publisher
Elsevier Ltd
Abstract
Purpose: The present study aimed to compare postoperative complications
commonly revealed after sternotomy closure by new sternal ZipFixTM and
conventional steel wire. Methodology: Our randomised double-blinded
controlled trial was performed on 326 patients who were candidates for
cardiac surgery from April 2014 to March 2015. After the surgery, the
sternal closure was randomly done with PEEKbased sternal ZipFix (ZF) on
the sternal body (n = 168) or with conventional wires (CWs) (n = 158). The
patients were followed postoperatively as well as 1, 3, 6, and 12 months
after discharge regarding postoperative complications such as pain
severity, dehiscence, and infection including incisional infections
(superficial or deep), and organ/space infection (mediastinitis or
osteomyelitis). Results: The mean age of the ZF and CW groups were 63
+/-14 and 62+/-12 years, respectively (P = 0.395). In addition, there was
no great difference between the two groups in BMI, DM, HTN, COPD, smoking
history, and osteoporosis (P>0.05). Our study showed higher mean pain
severity score in conventional closure group compared with ZipFix closure
group at all study time points (p<0.001). Infection was seen in 3.1% of
the overall participants with no significant difference of incisional and
organ infection between the two groups throughout the study. After
one-month follow-up, 8 patients in CW group had sternal dehiscence whereas
no patients in ZF had dehiscence at one-month follow-up (p=0.017) and at
other study time points. Conclusion: Our trial could demonstrate greater
clinical advantages in terms of pain and sternal dehiscence postsurgery by
using sternal ZipFix compared to conventional steel wire.

<146>
Accession Number
618648282
Author
Regan D.W.; Kashiwagi D.; Dougan B.; Sundsted K.; Mauck K.
Institution
(Regan, Dougan, Sundsted, Mauck) a General Internal Medicine , Mayo Clinic
, Rochester , MN , USA
(Kashiwagi) b Hospital Medicine , Mayo Clinic , Rochester , MN , USA
Title
Update in perioperative medicine: practice changing evidence published in
2016.
Source
Hospital practice (1995). 45 (4) (pp 158-164), 2017. Date of Publication:
01 Oct 2017.
Abstract
This summary reviews 18 key articles published in 2016 which have
significant practice implications for the perioperative medical care of
surgical patients. Due to the multi-disciplinary nature of the practice of
perioperative medicine, important new evidence is published in journals
representing a variety of medical and surgical specialties. Keeping
current with the evidence that drives best practice in perioperative
medicine is therefore challenging. We set out to identify, critically
review, and summarize key evidence which has the most potential for
practice change. We integrated the new evidence into the existing body of
medical knowledge and identified practical implications for real world
patient care. The articles address issues related to anticoagulation,
transfusion threshold, immunosuppressive medications, postoperative
delirium, myocardial injury after noncardiac surgery, postoperative pain
management, perioperative management of antihypertensives, perioperative
fasting, and perioperative diabetic control.

<147>
Accession Number
618683708
Author
Furukawa N.; Kuss O.; Preindl K.; Renner A.; Aboud A.; Hakim-Meibodi K.;
Benzinger M.; Puhler T.; Ensminger S.; Fujita B.; Becker T.; Gummert J.F.;
Borgermann J.
Institution
(Furukawa, Preindl, Renner, Aboud, Hakim-Meibodi, Benzinger, Puhler,
Ensminger, Fujita, Becker, Gummert, Borgermann) Clinic for Thoracic and
Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University
Bochum, Bad Oeynhausen, Germany
(Kuss) Institute for Biometrics and Epidemiology, German Diabetes Center,
Leibniz Institute for Diabetes Research at Heinrich Heine University
Dusseldorf, Dusseldorf, Germany
Title
Anaortic off-pump versus clampless off-pump using the PAS-Port device
versus conventional coronary artery bypass grafting: Mid-term results from
a matched propensity score analysis of 5422 unselected patients.
Source
European Journal of Cardio-thoracic Surgery. 52 (4) (pp 760-767), 2017.
Date of Publication: 01 Oct 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Meta-analyses from observational and randomized studies have
demonstrated benefits of off-pump surgery for hard and surrogate
endpoints. In some of them, increased re-revascularization was noted in
the off-pump groups, which could impact their longterm survival.
Therefore, we analyzed the course of all patients undergoing isolated
coronary surgery regarding the major cardiac and cerebrovascular event
(MACCE) criteria. METHODS: A prospective register was taken from a
high-volume off-pump center recording all anaortic off-pump (ANA),
clampless offpump (PAS-Port) and conventional (CONV) coronary artery
bypass operations between July 2009 and June 2015. Propensity Score
Matching was performed based on 28 preoperative risk variables. RESULTS:
We identified 935 triplets (N = 2805). Compared with CONV, in-hospital
mortality of both the ANA group (OR for ANA [95% CI] 0.25 [0.06; 0.83], P
= 0.021), and the PAS-Port group was lower (OR for PAS-Port [95% CI] 0.50
[0.17; 1.32], P = 0.17). In the mid-term followup there were no
significant differences between the groups regarding mortality (HR for ANA
[95%-CI] 0.83 [0.55-1.26], P = 0.38; HR for PAS-Port [95%-CI] 1.06
[0.70-1.59], P = 0.79), incidence of stroke (HR for ANA 0.81 [0.43-1.53],
P = 0.52; HR for PAS-Port 0.78 [0.41-1.50], P = 0.46), myocardial
infarction (HR for ANA 0.53 [0.22-1.31], P = 0.17; HR for PAS-Port 0.78
[0.37-1.66], P = 0.52) or re-revascularization rate (HR for ANA 0.99
[0.67-1.44], P = 0.94; HR for PAS-Port 0.95 [0.65-1.38], P = 0.77).
CONCLUSIONS: Both off-pump clampless techniques were associated with lower
in-hospital mortality compared with conventional CABG. The mid-term course
showed no difference with regard to the MACCE criteria between anaortic
off-pump, clampless off-pump using PAS-Port and conventional
CABG.<br/>Copyright &#xa9; 2017 The European Society of Cardiology.

<148>
Accession Number
618685470
Author
Wang H.; Han J.; Wang Z.; Yin Z.; Liu Z.; Jin Y.; Han H.
Institution
(Wang, Han, Wang, Yin, Jin, Han) Department of Cardiovascular Surgery,
General Hospital of Shenyang Military Area Command, Shenyang, China
(Liu) TEDA International Cardiovascular Hospital, Tianjin, China
Title
A prospective randomized trial of the cut-and-sew Maze procedure in
patients undergoing surgery for rheumatic mitral valve disease.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective: To evaluate the safety and efficacy of the addition of the
cut-and-sew Maze III procedure (CSM) for mitral valve replacement (MVR) in
patients with atrial fibrillation (AF) associated with rheumatic mitral
valve disease (RMVD). Methods: A total of 130 patients with persistent or
long-standing persistent AF associated with RMVD were assigned at random
to either the CSM plus MVR (Maze III) group or MVR alone (non-Maze) group.
The primary endpoint was a composite of freedom from stroke and death at 1
year. Results: There were no significant differences between the Maze III
and non-Maze groups in terms of major complications and in-hospital
mortality. One-year freedom from stroke or death was better in the Maze
III group compared with the non-Maze group (P = .0028; hazard ratio,
0.2653; 95% confidence interval, 0.1122 to 0.6270). The risk of AF
recurrence in the Maze III group was 0.002-fold that in non-Maze group (P
= .000). Conclusions: Addition of the CSM to an MVR procedure can decrease
the risk of stroke or death and high sinus rhythm at 1 year without
increasing the operative risk. CSM is a safe and effective approach to
treating AF associated with RMVD.<br/>Copyright &#xa9; 2017 The American
Association for Thoracic Surgery.

<149>
Accession Number
613925866
Author
Parra M.C.; Washburn K.; Brown J.R.; Beach M.L.; Yeager M.P.; Barr P.;
Bonham K.; Lamb K.; Loftus R.W.
Institution
(Parra, Loftus) Department of Anesthesiology, University of Iowa Hospitals
and Clinics, 200 Hawkins Rd, Iowa City, IA 52240, United States
(Washburn) Department of Anesthesiology, Providence Anesthesiology Assoc.,
P.A., Charlotte, NC, United States
(Brown) Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth, Hanover, NH, United States
(Beach, Yeager, Barr, Bonham, Lamb) Department of Anesthesiology,
Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
Title
Fluoroscopic guidance increases the incidence of thoracic epidural
catheter placement within the epidural space: A randomized trial.
Source
Regional Anesthesia and Pain Medicine. 42 (1) (pp 17-24), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background and Objectives: Thoracic epidural analgesia can reduce
postoperative pain and cardiopulmonarymorbidity, but it is associatedwith
a high rate of clinical failure. Up to 50% of clinical failure is thought
to be related to technical insertion. In this study, patients undergoing
thoracic surgery were randomized to one of two catheter insertion
techniques: fluoroscopically guided or conventional loss of resistance
with saline/air. Our primary aim was to examinewhether fluoroscopic
guidance could increase the incidence of correct catheter placement and
improve postoperative analgesia. Our secondary aim was to assess the
potential impact of correct epidural catheter positioning on length of
stay in the postanesthesia care unit and total hospital length of stay.
Methods: This randomized clinical trial was conducted at
Dartmouth-Hitchcock Medical Center over 25 months (January 2012 to
February 2014). Patients (N = 100) undergoing thoracic surgery were
randomized to fluoroscopic guidance (n = 47) or to loss of resistance with
saline/air (n = 53). Patients were followed for the primary outcomes of
24-hour morphine use, 24-hour numeric pain scores, and the incidence of
epidural catheter positioningwithin the epidural space. Postanesthesia
care unit and total hospital lengths of stay were evaluated as secondary
outcome measurements and compared for patients with correct epidural
catheter positioning and those without correct epidural catheter
positioning. Results: One hundred patients were included in an
intention-to-treat analysis. Numeric pain scores and 24-hour morphine
consumption were no different between groups. Fluoroscopic guidance was
associated with an increased incidence of epidural catheter placement
within the epidural space compared with loss of resistance with air/saline
[fluoroscopic guidance, epidural in 98% (46/47) versus loss of resistance
with saline/air, epidural in 74% (39/53)]. There was a significant
increase in correct catheter positioning with (odds ratio, 21.07; 95%
confidence interval, 2.07-214.38; P = 0.010) or without (odds ratio,
16.15; 95% confidence interval, 2.03-128.47; P = 0.009) adjustment for
potentially confounding variables. In an adjusted analysis, correctly
positioned thoracic epidural catheters were associated with shorter
postanesthesia care unit (5.87 +/- 5.39 hours vs 4.30 +/- 1.171 hours; P =
0.044) and total hospital length of stay (5.77 +/- 4.94 days vs 4.93 +/-
2.79 days; P = 0.031). Conclusions: Fluoroscopic guidance increases the
incidence of epidural catheter positioning within the epidural space and
may reduce postanesthesia care unit and hospital lengths of stay. Future
work should validate the effectiveness of this approach.<br/>Copyright
&#xa9; 2016 by American Society of Regional Anesthesia and Pain Medicine.

<150>
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.<br/>Copyright
&#xa9; 2017 Elsevier Inc.

<151>
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.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<152>
Accession Number
617760216
Author
Vaduganathan M.; Harrington R.A.; Stone G.W.; Steg P.G.; Gibson C.M.; Hamm
C.W.; Price M.J.; Deliargyris E.N.; Prats J.; Mahaffey K.W.; White H.D.;
Bhatt D.L.
Institution
(Vaduganathan, Bhatt) Brigham and Women's Hospital Heart & Vascular Center
and Harvard Medical School, Boston, Massachusetts, United States
(Harrington, Mahaffey) Stanford University Medical School, Stanford,
California, United States
(Stone) Columbia University Medical Center and the Cardiovascular Research
Foundation, New York City, New York, United States
(Steg) FACT (French Alliance for Cardiovascular clinical Trials), DHU
FIRE, INSERM Unite 1148, Universite Paris-Diderot, Paris, France
(Steg) Hopital Bichat, Assistance-Publique-Hopitaux de Paris, Paris,
France
(Steg) NHLI, Imperial College, Royal Brompton Hospital, London, United
Kingdom
(Gibson) Beth Israel Deaconess Medical Center, Division of Cardiology,
Boston, Massachusetts, United States
(Hamm) Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
(Price) Scripps Clinic and Scripps Translational Science Institute, La
Jolla, California, United States
(Deliargyris) Science and Strategy Consulting Group, Basking Ridge, New
Jersey, United States
(Prats) The Medicines Company, Parsippany, New Jersey, United States
(White) Green Lane Cardiovascular Service, Auckland, New Zealand
Title
Cangrelor Versus Clopidogrel on a Background of Unfractionated Heparin
(from CHAMPION PHOENIX).
Source
American Journal of Cardiology. 120 (7) (pp 1043-1048), 2017. Date of
Publication: 01 Oct 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Cangrelor is approved for use during percutaneous coronary intervention
(PCI) and is administered with different parenteral anticoagulants. We
examined the efficacy and safety of cangrelor in the subgroup of patients
who received unfractionated heparin (UFH) during PCI in the modified
intention-to-treat population of the randomized CHAMPION PHOENIX trial
(cangrelor vs clopidogrel; n = 10,939). The primary efficacy end point was
the composite of death, myocardial infarction, ischemia-driven
revascularization, or stent thrombosis (ST) at 48 hours. The key secondary
efficacy end point was ST. UFH was used in 69.2% (7,569/10,939) of
patients. In the UFH subgroup, cangrelor reduced the primary composite
efficacy end point at 48 hours compared with clopidogrel (4.8% vs 5.9%;
odds ratio [OR] 0.80 [0.65 to 0.98]; p = 0.03). Cangrelor consistently
reduced ST at 2 hours (0.7% vs 1.3%; OR 0.56 [0.35 to 0.90]; p = 0.01) and
48 hours (0.9% vs 1.4%; OR 0.70 [0.45 to 1.07]; p = 0.10). There was no
difference in GUSTO (Global Use of Strategies to Open Occluded Coronary
Arteries)-defined severe or life-threatening bleeding (0.1% vs 0.1%; OR
1.24 [0.33 to 4.61]; p = 0.75) or blood transfusion requirement at 48
hours (0.4% vs 0.2%; OR 1.87 [0.83 to 4.21]; p = 0.12). In conclusion,
cangrelor reduces early ischemic periprocedural complications without
increasing severe bleeding compared with clopidogrel in patients
undergoing PCI with UFH.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<153>
Accession Number
616775737
Author
Boitor M.; Gelinas C.; Richard-Lalonde M.; Thombs B.D.
Institution
(Boitor, Gelinas, Richard-Lalonde) Ingram School of Nursing, McGill
University, 3506 University Street, Montreal H3A 2A7, Canada
(Boitor, Gelinas) Centre for Nursing Research and Lady Davis Institute,
Jewish General Hospital, 3755 Cote Ste-Catherine Road, Montreal H3T 1E2,
Canada
(Thombs) Lady Davis Institute for Medical Research, Jewish General
Hospital, 3755 Cote Ste-Catherine Road, Montreal H3T 1E2, Canada
(Thombs) Department of Psychiatry, McGill University, 1033 Pine Avenue
West, Montreal H3A 1A1, Canada
(Thombs) Department of Epidemiology, Biostatistics, and Occupational
Health, McGill University, 1020 Pine Avenue West, Montreal H3A 1A2, Canada
(Thombs) Department of Medicine, McGill University, 1001 Decarie
Boulevard, Montreal H4A 3J1, Canada
(Thombs) Department of Educational and Counselling Psychology, McGill
University, 3700 McTavish Street, Montreal H3A 1Y2, Canada
(Thombs) Department of Psychology, McGill University, 1205 Dr Penfield
Avenue, Montreal H3A 1B1, Canada
Title
The Effect of Massage on Acute Postoperative Pain in Critically and
Acutely Ill Adults Post-thoracic Surgery: Systematic Review and
Meta-analysis of Randomized Controlled Trials.
Source
Heart and Lung: Journal of Acute and Critical Care. 46 (5) (pp 339-346),
2017. Date of Publication: September 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Critical care practice guidelines identify a lack of clear evidence on the
effectiveness of massage for pain control. To assess the effect of massage
on acute pain in critically and acutely ill adults post-thoracic surgery.
Medline, Embase, CINAHL, PsychInfo, Web of Science, Scopus and Cochrane
Library databases were searched. Eligible studies were randomized
controlled trials (RCTs) evaluating the effect of massage compared to
attention control/sham massage or standard care alone on acute pain
intensity post-thoracic surgery. Twelve RCTs were included. Of these, nine
evaluated massage in addition to standard analgesia, including 2 that
compared massage to attention control/sham massage in the intensive care
unit (ICU), 6 that compared massage to standard analgesia alone early
post-ICU discharge, and 1 that compared massage to both attention control
and standard care in the ICU. Patients receiving massage with analgesia
reported less pain (0-10 scale) compared to attention control/sham massage
(3 RCTs; N = 462; mean difference -0.80, 95% confidence interval [CI]
-1.25 to -0.35; p < 0.001; I² = 13%) and standard care (7 RCTs;
N = 1087; mean difference -0.85, 95% CI -1.28 to -0.42; p < 0.001;
I² = 70%). Massage, in addition to pharmacological analgesia,
reduces acute post-cardiac surgery pain intensity.<br/>Copyright &#xa9;
2017 Elsevier Inc.

<154>
Accession Number
611235346
Author
Zheng Z.; Xu B.; Zhang H.; Guan C.; Xian Y.; Zhao Y.; Fan H.; Yang Y.;
Wang W.; Gao R.; Hu S.
Institution
(Zheng, Xu, Zhang, Guan, Zhao, Fan, Yang, Wang, Gao, Hu) National Clinical
Research Center of Cardiovascular Diseases, State Key Laboratory of
Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing, China
(Zheng, Zhang, Fan, Wang, Hu) Department of Cardiovascular Surgery, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China
(Xu, Guan, Yang, Gao) Department of Cardiology, Fuwai Hospital, National
Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences
and Peking Union Medical College, Beijing, China
(Xian) Duke Clinical Research Institute, Durham, North Carolina, United
States
(Zhao) Medical Research & Biometrics Center, Fuwai Hospital, National
Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences
and Peking Union Medical College, Beijing, China
Title
Coronary Artery Bypass Graft Surgery and Percutaneous Coronary
Interventions in Patients With Unprotected Left Main Coronary Artery
Disease.
Source
JACC: Cardiovascular Interventions. 9 (11) (pp 1102-1111), 2016. Date of
Publication: 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study sought to investigate long-term clinical outcomes
following coronary artery bypass graft (CABG) and percutaneous coronary
intervention (PCI) in patients with unprotected left main disease (ULMD).
Background PCI has been increasingly used as an alternative mode of
revascularization for ULMD. However, there are limited data comparing
clinical outcomes between CABG surgery and PCI. Methods Between 2004 and
2010, 4,046 consecutive patients with ULMD were treated with either CABG
surgery (n = 2,604) or PCI (n = 1,442) with drug-eluting stents. The
primary outcome was 3-year all-cause mortality and the secondary outcome
was the composite of death, nonfatal myocardial infarction, or nonfatal
stroke. Results The unadjusted 3-year all-cause mortality was higher in
the PCI group as compared with the CABG group (3.8% vs. 2.5%; log-rank p =
0.03), although there was no significant difference in the composite
outcome (7.5% vs. 9.4%; log-rank p = 0.07). After adjustment for
differences in baseline risk factors, PCI was associated with
significantly higher risk of all-cause mortality (hazard ratio [HR]: 1.71;
95% confidence interval [CI]: 1.32 to 2.21; p < 0.001) but similar risk of
the composite outcome (HR: 0.94; 95% CI: 0.82 to 1.09; p = 0.43). These
differences were not statistically significant among patients with low or
intermediate SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery)
score (<=32) or diabetes; however, PCI was associated with an increased
risk among those with high SYNTAX score (>32), with HRs of 3.10 (95% CI:
1.84 to 5.22; p < 0.001) for all-cause mortality and 1.82 (95% CI: 1.36 to
2.45; p < 0.001) for the composite outcome. CABG was associated with lower
risk of repeat revascularization but higher risk of stroke in each
clinically relevant subgroup. Conclusions In this single-center
observational study among patients with ULMD, CABG was associated with
improved long-term outcomes, especially in patients with more complex
disease.<br/>Copyright &#xa9; 2016 American College of Cardiology
Foundation

<155>
Accession Number
610196600
Author
Punthakee Z.; Gerstein H.C.; Bosch J.; Tyrwhitt J.; Jung H.; Lee S.F.;
Lonn E.; Marsden T.; McKelvie R.; McQueen M.J.; Morillo C.A.; Yusuf S.;
Dagenais G.R.; Diaz R.; Maggioni A.P.; Probstfield J.; Ramachandran A.;
Riddle M.C.; Ryden L.E.; Badings E.A.; Birkeland K.I.; Cardona E.;
Commerford P.; Davies M.; Fodor J.G.; Gomis R.; Hanefeld M.; Hildebrandt
P.; Kacerovsky-Bielesz G.; Keltai M.; Lanas F.; Lewis B.S.;
Lopez-Jaramillo P.; Marin-Neto J.; Marre M.; Mendoza I.; Pan C.Y.; Pirags
V.; Rosenstock J.; Spinas G.A.; Sreenan S.; Syvanne M.; Yale J.-F.
Institution
(Punthakee, Gerstein, Bosch, Tyrwhitt, Jung, Lee, Lonn, Marsden, McKelvie,
McQueen, Morillo, Yusuf) Population Health Research Institute, McMaster
University, Hamilton, ON, Canada
(Dagenais) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec, Quebec City, QC, Canada
(Diaz) Estudios Clinicos Latino America, Rosario, Argentina
(Maggioni) Associazione Nazionale Medici Cardiologi Ospedalieri Research
Center, Florence, Italy
(Probstfield) University of Washington, Seattle, WA, United States
(Ramachandran) India Diabetes Research Foundation, Chennai, India
(Riddle) Oregon Health and Science University, Portland, OR, United States
(Ryden) Cardiology Unit, Department of Medicine K2, Karolinska Institute,
Stockholm, Sweden
(Badings) Department of Cardiology Research, Deventer Hospital, Deventer,
Netherlands
(Birkeland) Oslo University Hospital, University of Oslo, Oslo, Norway
(Cardona) Universidad de Guadalajara, Guadalajara, Mexico
(Commerford) University of Cape Town, Cape Town, South Africa
(Davies) University of Leicester, Diabetes Research Centre, Leicester,
United Kingdom
(Fodor) University of Ottawa, Heart Institute, Ottawa, ON, Canada
(Gomis) L'Institut d'Investigacions Biomediques August Pi i Sunyer,
Barcelona, Spain
(Hanefeld) GWT-TUD GmbH, Studycenter Prof. Hanefeld, Dresden, Germany
(Hildebrandt) Department of Cardiology and Endocrinology, Frederiksberg
Hospital, Frederiksberg, Denmark
(Kacerovsky-Bielesz) Hanusch-Krankenhaus Diabetesambulanz, Mauerbach,
Austria
(Keltai) Hungarian Institute of Cardiology, Semmelweis University,
Budapest, Hungary
(Lanas) Universidad de La Frontera, Temuco, Chile
(Lewis) Lady Davis Carmel Medical Center, Haifa, Israel
(Lopez-Jaramillo) Fundacion Oftalmologica de Santander (FOSCAL),
Universidad de Santander, Bucaramanga, Colombia
(Marin-Neto) Faculdade de Medicina de Riberirao Preto USP, Ribeirao Preto,
Brazil
(Marre) Groupe Hospitalier Bichat-Claude Bernard, Assistance Publique des
Hopitaux de Paris, Paris, France
(Mendoza) Urologico San Roman, Caracas, Venezuela
(Pan) Chinese PLA General Hospital, Beijing, China
(Pirags) Centre of Endocrinology, Pauls Stradins Clinical University
Hospital, Riga, Latvia
(Rosenstock) Dallas Diabetes and Endocrine Center at Medical City, Dallas,
TX, United States
(Spinas) University Hospital Zurich, Zurich, Switzerland
(Sreenan) 3U Diabetes, Connolly Hospital Blanchardstown, Dublin, Ireland
(Syvanne) Finnish Heart Association, Helsinki, Finland
(Yale) McGill University, Montreal, QC, Canada
Title
Cardiovascular and other outcomes postintervention with insulin glargine
and omega-3 fatty acids (ORIGINALE).
Source
Diabetes Care. 39 (5) (pp 709-716), 2016. Date of Publication: May 2016.
Publisher
American Diabetes Association Inc. (E-mail: membership@diabetes.org)
Abstract
OBJECTIVE: The Outcome Reduction With Initial Glargine Intervention
(ORIGIN) trial reported neutral effects of insulin glargine on
cardiovascular outcomes and cancers and reduced incident diabetes in
high-cardiovascular risk adults with dysglycemia after 6.2 years of active
treatment. Omega-3 fatty acids had neutral effects on cardiovascular
outcomes. The ORIGIN and Legacy Effects (ORIGINALE) study measured
posttrial effects of these interventions during an additional 2.7 years.
RESEARCH DESIGN AND METHODS: Surviving ORIGIN participants attended up to
two additional visits. The hazard of clinical outcomes during the entire
follow-up period from randomization was calculated. RESULTS: Of 12,537
participants randomized, posttrial data were analyzed for 4,718 originally
allocated to insulin glargine (2,351) versus standard care (2,367), and
4,771 originally allocatedto omega-3 fatty acid supplements (2,368) versus
placebo (2,403). Posttrial, small differences in median HbA1c persisted
(glargine 6.6% [49 mmol/mol], standard care 6.7% [50 mmol/mol], P =
0.025). From randomization to the end of posttrial follow-up, no
differences were found between the glargine and standard care groups in
myocardial infarction, stroke, or cardiovascular death (1,185 vs. 1,165
events; hazard ratio 1.01 [95%CI 0.94-1.10]; P = 0.72); myocardial
infarction, stroke, cardiovascular death, revascularization, or
hospitalization for heart failure (1,958 vs. 1,910 events; 1.03
[0.97-1.10]; P = 0.38); or any cancer (524 vs. 529 events; 0.99
[0.88-1.12]; P = 0.91) or between omega-3 and placebo groups in
cardiovascular death (688 vs. 700; 0.98 [0.88-1.09]; P = 0.68) or other
outcomes. CONCLUSIONS: During >6 years of treatment followed by >2.5 years
of observation, insulin glargine had neutral effects on health outcomes
and salutary effects on metabolic control, whereas omega-3 fatty acid
supplementation had no effect.<br/>Copyright &#xa9; 2016 by the American
Diabetes Association.

<156>
Accession Number
612026398
Author
Wolfrum M.; Fahrni G.; de Maria G.L.; Knapp G.; Curzen N.; Kharbanda R.K.;
Frohlich G.M.; Banning A.P.
Institution
(Wolfrum, Fahrni, de Maria, Kharbanda, Banning) Oxford University
Hospitals, Oxford Heart Centre, Headley Way, Oxford OX39DU, United Kingdom
(Knapp) TU University Dortmund, Department of Statistics, Dortmund,
Germany
(Curzen) University Hospital Southampton NHS Foundation Trust,
Southampton, United Kingdom
(Frohlich) Charite Universitatsmedizin Berlin (Campus Benjamin Franklin),
Department of Cardiology, Berlin, Germany
Title
Impact of impaired fractional flow reserve after coronary interventions on
outcomes: A systematic review and meta-analysis.
Source
BMC Cardiovascular Disorders. 16 (1) (no pagination), 2016. Article
Number: 177. Date of Publication: 08 Sep 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: FFR is routinely used to guide percutaneous coronary
interventions (PCI). Visual assessment of the angiographic result after
PCI has limited efficacy. Even when the angiographic result seems
satisfactory FFR after a PCI might be useful for identifying patients with
a suboptimal interventional result and higher risk for poor clinical
outcome who might benefit from additional procedures. The aim of this
meta-analysis was to investigate available data of studies that examined
clinical outcomes of patients with impaired vs. satisfactory fractional
flow reserve (FFR) after percutaneous coronary interventions (PCI).
Methods: This meta-analysis was carried out according to the Cochrane
Handbook for Systematic Reviews. The Mantel-Haenszel method using the
fixed-effect meta-analysis model was used for combining the results.
Studies were identified by searching the literature through mid-January,
2016, using the following search terms: fractional flow reserve, coronary
circulation, after, percutaneous coronary intervention, balloon
angioplasty, stent implantation, and stenting. Primary endpoint was the
rate of major adverse cardiac events (MACE). Secondary endpoints included
rates of death, myocardial infarction (MI), repeated revascularisation.
Results: Eight relevant studies were found including a total of 1337
patients. Of those, 492 (36.8 %) had an impaired FFR after PCI, and 853
(63.2 %) had a satisfactory FFR after PCI. Odds ratios indicated that a
low FFR following PCI was associated with an impaired outcome: major
adverse cardiac events (MACE, OR: 4.95, 95 % confidence interval [CI]:
3.39-7.22, p <0.001); death (OR: 3.23, 95 % CI: 1.19-8.76, p=0.022);
myocardial infarction (OR: 13.83, 95 % CI: 4.75-40.24, p <0.0001) and
repeated revascularisation (OR: 4.42, 95 % CI: 2.73-7.15, p <0.0001).
Conclusions: Compared to a satisfactory FFR, a persistently low FFR
following PCI is associated with a worse clinical outcome. Prospective
studies are needed to identify underlying causes, determine an optimal
threshold for post-PCI FFR, and clarify whether simple additional
procedures can influence the post-PCI FFR and clinical
outcome.<br/>Copyright &#xa9; 2016 The Author(s).

<157>
Accession Number
611595526
Author
Kowalewski M.; Suwalski P.; Pawliszak W.; Benetti F.; Raffa G.M.; Malvindi
P.G.; Carrel T.; Paparella D.; Anisimowicz L.
Institution
(Kowalewski, Pawliszak, Anisimowicz) Department of Cardiac Surgery, Dr
Antoni Jurasz Memorial University Hospital in Bydgoszcz, Poland
(Kowalewski) Department of Hygiene, Epidemiology and Ergonomics, Division
of Ergonomics and Physical Effort, Collegium Medicum UMK in Bydgoszcz,
Poland
(Suwalski) Clinical Department of Cardiac Surgery, Central Clinical
Hospital of the Ministry of Interior in Warsaw, Poland
(Suwalski) Pulaski University of Technology and Humanities, Radom, United
States
(Benetti) Division of Cardiothoracic Surgery, University of Pittsburgh,
Pittsburgh, PA, United States
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo
per I Trapianti e Terapie ad alta specializzazione), Palermo, Italy
(Malvindi) University Hospital Southampton NHS Foundation Trust, Wessex
Cardiothoracic Centre, Southampton, United Kingdom
(Carrel) Clinic for Cardiovascular Surgery, University Hospital and
University of Bern, Switzerland
(Paparella) Division of Cardiac Surgery, Department of Emergency and Organ
Transplant, University of Bari Aldo Moro, Bari, Italy
Title
Risk of stroke with "no-touch" - As compared to conventional off-pump
coronary artery bypass grafting. An updated meta-analysis of observational
studies.
Source
International Journal of Cardiology. 222 (pp 769-771), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Ireland Ltd

<158>
Accession Number
611549146
Author
Yang Y.; Lei J.; Huang W.; Lei H.
Institution
(Yang, Lei, Huang, Lei) Department of Cardiology, The First Affiliated
Hospital of Chongqing Medical University, Chongqing, China
Title
Efficacy and safety of biodegradable polymer sirolimus-eluting stents
versus durable polymer drug-eluting stents: A meta-analysis of randomized
trials.
Source
International Journal of Cardiology. 222 (pp 486-493), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background A meta-analysis was performed to investigate the safety and
efficacy of biodegradable polymer sirolimus-eluting stents (BP-SESs)
compared with durable polymer drug-eluting stents (DP-DESs). Methods
Online databases, including PubMed, EMBASE and the Cochrane Library, were
searched for randomized controlled trials that compared BP-SESs and
DP-DESs and reported rates of overall and cardiac mortality, myocardial
infarction (MI), stent thrombosis (ST), target lesion revascularization
(TLR), target vessel revascularization (TVR) and late lumen loss (LLL).
Results A total of 15 studies investigating 14,187 patients were included
in the meta-analysis. The BP-SESs significantly reduced the risk of late
ST (OR: 0.57; 95% CI: 0.33-0.98; p = 0.04), very late ST (OR: 0.53; 95%
CI: 0.29-0.97; p = 0.04) and in-stent LLL (MD: - 0.06, 95% CI: - 0.11 to -
0.01; p = 0.01) compared with the DP-DESs but did not improve mortality
(OR: 0.95; 95% CI: 0.81-1.11; p = 0.52), cardiac mortality (OR: 0.89; 95%
CI: 0.72-1.10; p = 0.27), MI (OR: 0.90; 95% CI: 0.76-1.08; p = 0.27), TLR
(OR: 0.95; 95% CI: 0.81-1.11; p = 0.51), TVR (OR: 0.96; 95% CI: 0.81-1.13;
p = 0.62) or in-segment LLL (MD: - 0.03, 95% CI: - 0.06-0.01; p = 0.10).
Conclusions In this meta-analysis of randomized controlled trials, the
BP-SESs were superior to the DP-DESs in terms of late ST, very late ST and
in-stent LLL. Further large randomized controlled trials with long-term
follow-up are required to validate the benefits of BP-SESs.<br/>Copyright
&#xa9; 2016 Elsevier Ireland Ltd

<159>
Accession Number
611549145
Author
Stenman M.; Holzmann M.J.; Sartipy U.
Institution
(Stenman, Sartipy) Department of Cardiothoracic Surgery and
Anesthesiology, Karolinska University Hospital, Stockholm, Sweden
(Stenman, Sartipy) Department of Molecular Medicine and Surgery,
Karolinska Institutet, Stockholm, Sweden
(Holzmann) Department of Emergency Medicine, Karolinska University
Hospital, Stockholm, Sweden
(Holzmann) Department of Internal Medicine, Karolinska Institutet,
Stockholm, Sweden
Title
Association between preoperative depression and long-term survival
following coronary artery bypass surgery - A systematic review and
meta-analysis.
Source
International Journal of Cardiology. 222 (pp 462-466), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Depression is common in patients with cardiovascular disease.
The importance of preoperative depression for long-term survival following
coronary artery bypass grafting (CABG) is not well known. The aim was to
provide a summary estimate of the association between preoperative
depression and long-term survival in adults who underwent CABG. Methods We
did a systematic search of MEDLINE, EMBASE, Cochrane Library, PsycINFO,
Web of Science, and PubMed from inception to November, 2015, including
cohort studies with at least one month of follow-up that reported hazard
ratios (HR) and 95% confidence intervals (CI) for long-term all-cause
mortality following CABG in patients with preoperative depression compared
to non-depressed patients. Two reviewers independently extracted data on
populations, exposure, outcome, risk of bias, and quality of evidence. We
calculated HR and 95% CIs for all-cause mortality using random-effects
meta-analyses and performed subgroup and sensitivity analyses. Results
Seven studies were included with a combined study population of 89,490
patients (4002 depressed/85,488 non-depressed). All studies observed a
positive association between preoperative depression and all-cause
mortality, and in 4 studies the association was statistically significant.
Patients with depression had a pooled hazard ratio of 1.46 (95% CI:
1.23-1.73, p < 0.0001) for all-cause mortality with moderate heterogeneity
(I² = 50.1%, p = 0.061). Conclusions This systematic review and
meta-analysis indicates that patients with preoperative depression are at
increased risk for long-term, all-cause mortality following CABG compared
with those without depression. Systematic screening for depression prior
to cardiac surgery could identify those at higher risk.<br/>Copyright
&#xa9; 2016 Elsevier Ireland Ltd

<160>
Accession Number
611546118
Author
Han R.; Yin X.; Zheng M.; Sun K.; Liu X.; Tian Y.; Yang X.
Institution
(Han, Liu, Yin, Zheng, Liu, Tian, Yang) Heart Center, Beijing Chao-Yang
Hospital, Capital Medical University, Beijing 100020, China
(Sun) Department of Radiology, Cardiovascular Institute and Fu Wai
Hospital, Chinese Academy of Medical Sciences, Peking Union Medical
College, Xi-Cheng District, Beijing 100037, China
Title
Effect of remote ischemic preconditioning on myocardial injury and
inflammatory response induced by ablation for atrial fibrillation: A
randomized controlled trial.
Source
International Journal of Cardiology. 222 (pp 396-400), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Remote ischemic preconditioning (RIPC) has been suggested to
reduce postoperative release of cardiac and inflammatory markers in
patients undergoing cardiac surgery. This study aimed to evaluate the
effect of RIPC on nonischemic myocardial damage and inflammatory response
in patients undergoing radiofrequency catheter ablation for paroxysmal
atrial fibrillation (AF). Methods Seventy-two patients with
drug-refractory paroxysmal AF undergoing radiofrequency catheter ablation
were randomized into RIPC or control groups. RIPC (intermittent arm
ischemia through four cycles of 5-min inflation and 5-min deflation of a
blood-pressure cuff) was performed once daily on 2 consecutive days before
the ablation and immediately before ablation. Cardiac troponin-I (cTnI),
high-sensitive C-reactive protein (hs-CRP), and interleukin (IL)-6 levels
were measured before RIPC/sham RIPC, after the ablation, and 24 and 72 h
later. The early recurrence of atrial fibrillation (ERAF) in the two
groups was observed over the subsequent 3 months. Results Radiofrequency
ablation resulted in a significant rise in cTnI, hs-CRP, and IL-6 in both
groups, which persisted for 72 h. The RIPC group showed a lower increase
in cTnI (P < 0.001), hs-CRP (P = 0.003), and IL-6 (P = 0.008) than the
control and tended to have a lower risk of ERAF (hazard ratio [HR] = 0.77,
95% confidence interval [CI]: 0.32-1.88). Conclusions These results show
that RIPC before ablation for paroxysmal AF significantly reduces the
increase in cTnI, hs-CRP, and IL-6 associated with the procedure and
results in a lower risk of ERAF. These findings suggest that RIPC could
provide cardioprotection against nonischemic myocardial
damage.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd

<161>
Accession Number
611535321
Author
Nudi F.; Lotrionte M.; Biasucci L.M.; Peruzzi M.; Marullo A.G.M.; Frati
G.; Valenti V.; Giordano A.; Biondi-Zoccai G.
Institution
(Nudi) Service of Nuclear Cardiology, Madonna della Fiducia Clinic, Rome,
Italy
(Nudi) Ostia Radiologica, Rome, Italy
(Nudi) ETISAN, Rome, Italy
(Lotrionte, Biasucci) Division of Cardiology, Catholic University, Rome,
Italy
(Peruzzi, Marullo, Frati, Biondi-Zoccai) Department of Medico-Surgical
Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
(Frati, Biondi-Zoccai) Department of AngioCardioNeurology, IRCCS Neuromed,
Pozzilli, Italy
(Valenti) Division of Radiology, University of Rome, Rome, Italy
(Giordano) Unita Operativa di Interventistica Cardiovascolare, Presidio
Ospedaliero Pineta Grande, Castel Volturno, Italy
(Giordano) Unita Operativa di Emodinamica, Casa di Salute Santa Lucia, San
Giuseppe Vesuviano, Italy
Title
Comparative safety and effectiveness of coronary computed tomography:
Systematic review and meta-analysis including 11 randomized controlled
trials and 19,957 patients.
Source
International Journal of Cardiology. 222 (pp 352-358), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background/objectives The clinical approach to suspected or established
coronary artery disease (CAD) has been revolutionized in the last few
decades by coronary computed tomography (coroCT). Yet, uncertainty
persists on its comparative diagnostic and clinical effectiveness. We
conducted a systematic review on randomized controlled trials (RCTs) of
coroCT. Methods We searched RCTs in PubMed and The Cochrane Library,
extracting as outcomes of interest long-term rates of death, myocardial
infarction, revascularization, and invasive coronary angiography. Effects
were estimated with risk ratios (RR) and 95% confidence intervals. Results
A total of 11 trials were included, with 19,957 patients followed for a
median of 6 months. One trial focused on screening, 3 on stable CAD, and 7
on acute CAD. Meta-analysis showed that coroCT was associated with a trend
toward fewer deaths or myocardial infarctions (RR = 0.84 [0.70-1.01])
whereas no significant difference was found for the risk of death (RR =
0.91 [0.71-1.18]). Conversely, the risk of myocardial infarction tended to
be lower with coroCT at the overall analysis (RR = 0.77 [0.59-1.02]), and
this effect reached statistical significance in studies focusing on
subjects with stable CAD (RR = 0.69 [0.49-0.99]). These potential benefits
were offset (or mediated) by a significant albeit modest increase in the
need for invasive angiography (RR = 1.36 [1.08-1.72]), and ensuing
coronary revascularization (RR = 1.76 [1.29-2.40]). Conclusions According
to the current evidence base, coroCT is associated with an increased usage
of invasive angiography and coronary revascularization when compared to
standard of care, with possible benefits on nonfatal myocardial
infarction, but without significant benefits on death or the composite of
death or myocardial infarction.<br/>Copyright &#xa9; 2016 Elsevier Ireland
Ltd

<162>
Accession Number
613449381
Author
Thongprayoon C.; Cheungpasitporn W.; Podboy A.J.; Gillaspie E.A.; Greason
K.L.; Kashani K.B.
Institution
(Thongprayoon, Cheungpasitporn, Kashani) Division of Nephrology and
Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN,
United States
(Podboy) Department of Hospital Internal Medicine, Department of Internal
Medicine, Mayo Clinic, Rochester, MN, United States
(Gillaspie, Greason) Division of Cardiovascular Surgery, Department of
Surgery, Mayo Clinic, Rochester, MN, United States
(Kashani) Division of Pulmonary and Critical Care Medicine, Department of
Internal Medicine, Mayo Clinic, Rochester, MN, United States
Title
The effects of contrast media volume on acute kidney injury after
transcatheter aortic valve replacement: a systematic review and
meta-analysis.
Source
Journal of Evidence-Based Medicine. 9 (4) (pp 188-193), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Blackwell Publishing (E-mail: info@asia.blackpublishing.com.au)
Abstract
Objective: The goal of this systematic review was to assess the effects of
contrast media volume on transcatheter aortic valve replacement-related
acute kidney injury. Methods: A literature search was performed using
Medline, EMbase, the Cochrane Database of Systematic Reviews, and
clinicaltrials.gov from the inception of these databases through December
2015. Studies that reported relative risk, odds ratio, or hazard ratio
comparing the risks of acute kidney injury following transcatheter aortic
valve replacement in patients who received high contrast media volume were
included. Pooled risk ratio (RR) and 95% confidence intervals (95% CI)
were calculated using a random-effect, generic inverse variance method.
Results: Four cohort studies composed of 891 patients were included in the
analyses to assess the risk of acute kidney injury after transcatheter
aortic valve replacement in patients who received high contrast media
volume. The pooled RR of acute kidney injury after transcatheter aortic
valve replacement in patients who received a large volume of contrast
media was 1.41 (95% CI, 0.87 to 2.28) compared with low contrast media
volume. The meta-analysis was limited to studies using standard acute
kidney injury definitions, and the pooled RR of acute kidney injury in
patients who received high contrast media volume is 1.12 (95% CI, 0.78 to
1.62). Conclusion: Our meta-analysis shows no significant association
between contrast media volume and risk of acute kidney injury after
transcatheter aortic valve replacement.<br/>Copyright &#xa9; 2016 Chinese
Cochrane Center, West China Hospital of Sichuan University and John Wiley
& Sons Australia, Ltd

<163>
Accession Number
611510987
Author
Mas J.-L.; Derumeaux G.; Amarenco P.; Arquizan C.; Aubry P.; Barthelet M.;
Bertrand B.; Brochet E.; Cabanes L.; Donal E.; Dubois-Rande J.-L.;
Durand-Zaleski I.; Ernande L.; Finet G.; Fraisse A.; Giroud M.; Guerin P.;
Habib G.; Juliard J.-M.; Leys D.; Lievre M.; Lusson J.-R.; Marcon F.;
Michel P.; Moulin T.; Mounier-Vehier F.; Pierard L.; Piot C.; Rey C.;
Rodier G.; Roudaut R.; Schleich J.-M.; Teiger E.; Turc G.; Vuillier F.;
Weimar C.; Woimant F.; Chatellier G.
Institution
(Mas, Turc) Department of Neurology, Sainte-Anne Hospital, Paris Descartes
University, Inserm 894, DHU NeuroVasc, Paris, France
(Derumeaux, Ernande, Teiger) Department of Physiology, Henri Mondor
Hospital, Paris Est Creteil University, Inserm 955, DHU ATVB, Creteil,
France
(Amarenco) APHP, Department of Neurology and Stroke Center, Bichat
Hospital, Paris-Diderot University, Inserm 1148, DHU FIRE, Paris, France
(Arquizan) Department of Neurology, Gui de Chauliac Hospital, Montpellier,
France
(Aubry, Brochet, Juliard) APHP, Department of Cardiology, Bichat Hospital,
Paris Diderot University, Inserm 1148, DHU FIRE, Paris, France
(Barthelet) Department of Cardiovascular Investigations, Louis Pradel
Hospital, Lyon University, Bron, France
(Bertrand) Department of Cardiology, CHU A. Michallon, Joseph Fourier
University, Grenoble, France
(Cabanes) AP-HP, Department of Cardiology, Cochin Hospital,
Paris-Descartes University, Paris, France
(Donal, Schleich) Department of Cardiology and Vascular Diseases,
Pontchaillou Hospital, Rennes University, Rennes, France
(Dubois-Rande) APHP, Department of Cardiology, Henri-Mondor Hospital,
Paris Est Creteil University, Inserm 955, DHU ATVB, Creteil, France
(Durand-Zaleski) AP-HP, Department of Public Health, Henri Mondor
Hospital, Paris Est Creteil University, Creteil, France
(Finet) Department of Cardiology, Cardiovascular Hospital, Claude Bernard
University, Inserm 1060, Lyon, France
(Fraisse) Department of Pediatric Cardiology, La Timone Hospital,
Aix-Marseille Universite, Marseille, France
(Giroud) Department of Neurology, CHU Dijon, Bourgogne University, Dijon
Stroke Registry, Dijon, France
(Guerin) Department of Cardiology, Institut du Thorax, CHU Nantes, Nantes,
France
(Habib) Department of Cardiology, La Timone Hospital, Aix-Marseille
Universite, Marseille, France
(Leys) Department of Neurology and Stroke Unit, Roger Salengro Hospital,
Lille 2 University, Inserm 1171, Lille, France
(Lievre) UMR CNRS 5558, Lyon 1 University, Lyon, France
(Lusson) Department of Cardiology and Vascular Diseases, Gabriel Montpied
Hospital, Auvergne University, UMR 6284, Clermont-Ferrand, France
(Marcon) Department of Cardiovascular Diseases, Pediatric Cardiology Unit,
Nancy University, Nancy, France
(Michel) Stroke Center, Department of Neurology, Centre Hospitalier
Universitaire Vaudois and Lausanne University, Lausanne, Switzerland
(Moulin, Vuillier) Department of Neurology, CHU Besancon, Franche-Comte
University, CIC 1431, Besancon, France
(Mounier-Vehier) Department of Neurology, Doctor Schaffner Hospital, Lens,
France
(Pierard) Department of Cardiology, Sart Tilman Hospital, Liege
University, Liege, Belgium
(Piot) Department of Interventional Cardiology, Clinique du Millenaire,
Montpellier University, UMR 5203, Montpellier, France
(Rey) Department of Pediatric Cardiology, Cardiology Hospital, Lille 2
University, Lille, France
(Rodier) Department of Neurology, Annecy-Genevois Hospital, Annecy, France
(Roudaut) Department of Cardiology and Vascular Diseases, Haut Leveque
Hospital, Bordeaux University, Bordeaux, France
(Weimar) Department of Neurology, University Hospital, University of
Duisburg-Essen, Essen, Germany
(Woimant) APHP, Department of Neurology, Lariboisiere Hospital, Agence
Regionale de Sante Ile-de-France, Paris, France
(Chatellier) APHP, Epidemiology and Clinical Research Unit, Georges
Pompidou European hospital, Paris Descartes University, Paris, France
Title
close: Closure of patent foramen ovale, oral anticoagulants or
antiplatelet therapy to prevent stroke recurrence: Study design.
Source
International Journal of Stroke. 11 (6) (pp 724-732), 2016. Date of
Publication: 01 Aug 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Rationale: Currently available data do not provide definitive evidence on
the comparative benefits of closure of patent foramen ovale, oral
anticoagulants and antiplatelet therapy in patients with patent foramen
ovale-associated cryptogenic stroke Aim: To assess whether transcatheter
patent foramen ovale closure plus antiplatelet therapy is superior to
antiplatelet therapy alone and whether oral anticoagulant therapy is
superior to antiplatelet therapy, for secondary stroke prevention in
patients aged 16 to 60 years with a large patent foramen ovale or a patent
foramen ovale associated with an atrial septal aneurysm, and an otherwise
unexplained ischaemic stroke or retinal ischaemia. Sample size: Six
hundred and sixty-four patients were included in the study. Methods and
design: CLOSE is an academic-driven, multicentre, randomized, open-label,
three-group, superiority trial with blinded adjudication of outcome
events. The trial has been registered with Clinical Trials Register
(Clinicaltrials.gov, NCT00562289). Patient recruitment started in December
2007. Patient follow-up will continue until December 2016. Expected mean
follow-up = 5.6 years. Study outcomes: The primary efficacy outcome is the
occurrence of fatal or nonfatal stroke. Safety outcomes include fatal,
life-threatening or major procedure- or device-related complications and
fatal, life-threatening or major haemorrhagic complications. Discussion:
CLOSE is the first specifically designed trial to assess the superiority
of patent foramen ovale closure over antiplatelet therapy alone and the
superiority of oral anticoagulants over antiplatelet therapy to prevent
stroke recurrence in patients with patent foramen ovale-associated
cryptogenic stroke.<br/>Copyright &#xa9; 2016, &#xa9; 2016 World Stroke
Organization.

<164>
Accession Number
611292353
Author
Liu Z.; Xu Y.; Hao H.; Yin C.; Xu J.; Li J.; Wang Y.; Xu D.
Institution
(Liu, Hao, Yin, Xu, Li, Wang, Xu) Division of Cardiology, Xuanwu Hospital
Capital Medical University, Beijing, China
(Xu) Division of Neurosurgery, Xuanwu Hospital Capital Medical University,
Beijing, China
Title
Efficacy of high intensity atorvastatin versus moderate intensity
atorvastatin for acute coronary syndrome patients with diabetes mellitus.
Source
International Journal of Cardiology. 222 (pp 22-26), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objective To investigate whether more benefits can be achieved through
high intensity atorvastatin compared with moderate intensity atorvastatin
in acute coronary syndrome (ACS) patients with diabetes mellitus (DM).
Methods This was a randomized controlled trail. Total 591 ACS patients
with DM who underwent percutaneous coronary intervention were enrolled,
297 in high intensity atorvastatin group (40 mg/day) and 294 in moderate
intensity atorvastatin group (20 mg/day). The primary end point was
one-year incidence of major adverse cardiovascular events (MACE, including
cardiovascular death, spontaneous myocardial infarction, unplanned
revascularization). Cox proportional hazard regression models were used to
analyze the association between clinical endpoints and atorvastatin
treatment. Results At the end of one-year, low-density lipoprotein
cholesterol level was lower in high intensity group than in moderate group
(1.6 +/- 0.6 vs 1.8 +/- 0.6, p = 0.041). MACE in high intensity group
decreased 44.5% than moderate group (8.4% vs. 14.6%, p = 0.018). The
adjusted hazard ratio (HR) for MACE in patients with atorvastatin 40 mg/d
was lower compared to patients with atorvastatin 20 mg/d (HR [95% CI] 0.61
[0.36 to 0.91], p = 0.026). The rates of adverse events were no
significantly different between the two groups. Conclusions For ACS
patients with DM, high intensity atorvastatin induced better long-term
outcomes compared with moderate intensity.<br/>Copyright &#xa9; 2016
Elsevier Ireland Ltd

<165>
Accession Number
612967110
Author
Charytan D.M.; Desai M.; Mathur M.; Stern N.M.; Brooks M.M.; Krzych L.J.;
Schuler G.C.; Kaehler J.; Rodriguez-Granillo A.M.; Hueb W.; Reeves B.C.;
Thiele H.; Rodriguez A.E.; Buszman P.P.; Buszman P.E.; Maurer R.;
Winkelmayer W.C.
Institution
(Charytan, Stern, Maurer) Departments of Medicine, Brigham & Women's
Hospital, Boston, Massachusetts, United States
(Desai, Mathur) Stanford University School of Medicine, Palo Alto,
California, United States
(Brooks) University of Pittsburgh, Graduate School of Public Health,
Pittsburgh, Pennsylvania, United States
(Krzych) Department of Cardiac Anesthesiology and Intensive Care Medicine,
Medical University of Silesia, Katowice, Poland
(Schuler) Heart Center, University of Leipzig, Leipzig, Germany
(Kaehler) Department of Cardiology, Klinikum Herford, Herford, Germany
(Rodriguez-Granillo) Research Department, Centro de Estudios en
Cardiologia Intervencionista, Buenos Aires, Argentina
(Hueb) Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil
(Reeves) Clinical Trials and Evaluation Unit, School of Clinical Sciences,
University of Bristol, Bristol, United Kingdom
(Thiele) University Heart Center Luebeck and German Heart Research Center
(DZHK), Luebeck, Germany
(Rodriguez) Cardiac Unit, Otamendi Hospital, Buenos Aires School of
Medicine, Buenos Aires, Argentina
(Buszman) Silesian Center for Heart Diseases, Zabrze, Poland
(Buszman, Buszman) American Heart of Poland, Katowice, Poland
(Winkelmayer) Department of Medicine, Baylor College of Medicine, Houston,
Texas, United States
Title
Reduced risk of myocardial infarct and revascularization following
coronary artery bypass grafting compared with percutaneous coronary
intervention in patients with chronic kidney disease.
Source
Kidney International. 90 (2) (pp 411-421), 2016. Date of Publication: 01
Aug 2016.
Publisher
Elsevier B.V.
Abstract
Coronary atherosclerotic disease is highly prevalent in chronic kidney
disease (CKD). Although revascularization improves outcomes, procedural
risks are increased in CKD, and unbiased data comparing coronary artery
bypass grafting (CABG) and percutaneous intervention (PCI) in CKD are
sparse. To compare outcomes of CABG and PCI in stage 3 to 5 CKD, we
identified randomized trials comparing these procedures. Investigators
were contacted to obtain individual, patient-level data. Ten of 27 trials
meeting inclusion criteria provided data. These trials enrolled 3993
patients encompassing 526 patients with stage 3 to 5 CKD of whom 137 were
stage 3b-5 CKD. Among individuals with stage 3 to 5 CKD, survival through
5 years was not different after CABG compared with PCI (hazard ratio [HR]
0.99, 95% confidence interval [CI] 0.67-1.46) or stage 3b-5 CKD (HR 1.29,
CI 0.68-2.46). However, CKD modified the impact on survival free of
myocardial infarction: it was not different between CABG and PCI for
individuals with preserved kidney function (HR 0.97, CI 0.80-1.17), but
was significantly lower after CABG in stage 3-5 CKD (HR 0.49, CI
0.29-0.82) and stage 3b-5 CKD (HR 0.23, CI 0.09-0.58). Repeat
revascularization was reduced after CABG compared with PCI regardless, of
baseline kidney function. Results were limited by unavailability of data
from several trials and paucity of enrolled patients with stage 4-5 CKD.
Thus, our patient-level meta-analysis of individuals with CKD randomized
to CABG versus PCI suggests that CABG significantly reduces the risk of
subsequent myocardial infarction and revascularization without affecting
survival in these patients.<br/>Copyright &#xa9; 2016 International
Society of Nephrology

<166>
Accession Number
611525576
Author
Zhou C.; Jeon Y.; Meybohm P.; Zarbock A.; Young P.J.; Li L.; Hausenloy
D.J.
Institution
(Zhou, Li) Department of Anesthesiology, State Key Laboratory of
Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing 100037, China
(Jeon) Department of Anesthesiology and Pain Medicine, Seoul National
University Hospital, Daehakro 101, Seoul 110-744, South Korea
(Meybohm) Department of Anesthesiology, Intensive Care Medicine, and Pain
Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt
60590, Germany
(Zarbock) Department of Anesthesiology, Critical Care Medicine and Pain
Therapy, University Hospital Munster, Albert- Schweitzer-Campus 1, Gebaude
A1, Munster 48149, Germany
(Young) Wellington Hospital, Capital and Coast District Health Board,
Private Bag 7902, Wellington 6242, New Zealand
(Hausenloy) The Hatter Cardiovascular Institute, University College
London, 67 Chenies Mews, London WC1E 6HX, United Kingdom
(Hausenloy) The National Institute of Health Research University College
London Hospitals Biomedical Research Centre, London, United Kingdom
(Hausenloy) National Heart Research Institute Singapore, National Heart
Centre Singapore, Singapore
(Hausenloy) Cardiovascular and Metabolic Disorders Program, Duke-National
University of Singapore, Singapore
Title
Renoprotection by remote ischemic conditioning during elective coronary
revascularization: A systematic review and meta-analysis of randomized
controlled trials.
Source
International Journal of Cardiology. 222 (pp 295-302), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Remote ischemic conditioning (RIC) has been recognized an
emerging non-invasive approach for preventing acute kidney injury (AKI) in
patients undergoing either elective coronary artery bypass graft (CABG)
surgery or percutaneous coronary intervention (PCI). On the other hand,
accumulating evidence has indicated the involving role of pre-CABG
contrast usage for coronary angiography in post-surgery AKI risk. Along
with the shortening time delay of CABG after coronary angiography, and the
prevalent hybrid coronary revascularization (HCR), the AKI prevention by
RIC has faced challenges following coronary revascuralization. Methods
Randomized controlled trials (RCTs) were searched from Pubmed, EMBase, and
Cochrane library (until May 2016). The primary outcome was postoperative
AKI. The second outcomes were included the requirement for renal
replacement therapy (RRT), and in-hospital or 30-day mortality. Results
Twenty eligible RCTs (CABG, 3357 patients; PCI, 1501 patients) were
selected. RIC significantly halved the incidence of AKI following PCI when
compared with controls [n = 1501; odds ratio (OR) = 0.51; 95% CI, 0.32 to
0.82; P = 0.006; I² = 29.6%]. However, RIC did not affect the
incidence of AKI following CABG (n = 1850; OR = 0.94; 95% CI, 0.73 to
1.19; P = 0.586; I² = 12.4%). The requirement for RRT and
in-hospital mortality was not affected by RIC in CABG (n = 2049, OR =
1.04, P = 0.87; n = 1920, OR = 0.89, P = 0.7; respectively). Conclusions
Our meta-analysis suggests that RIC for preventing AKI following CABG has
faced with challenges in terms of AKI, the requirement for RRT, and
mortality. However, RIC shows a renoprotective benefit for PCI. Hence, our
findings may infer the preserved renal effects of RIC in CABG with
preconditioning before the coronary angiography, or in HCR.<br/>Copyright
&#xa9; 2016

<167>
Accession Number
611509928
Author
Li M.; Zou H.; Xu G.
Institution
(Li) Jiangxi Medical College, Nanchang University, China
(Zou) Medical Center of the Graduate School, Nanchang University, China
(Xu) Department of Nephrology, Second Affiliated Hospital, Nanchang
University, Jiangxi 330006, China
Title
The prevention of statins against AKI and mortality following cardiac
surgery: A meta-analysis.
Source
International Journal of Cardiology. 222 (pp 260-266), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Objective It is universally acknowledged that acute kidney injury (AKI)
often comes following cardiac surgery with severe morbidity and mortality.
The impact of statins on the incidence of AKI and mortality after cardiac
surgery are controversial, therefore, it is urgent to explore the source
of heterogeneity via the subgroup analysis. Methods We searched PubMed,
ISI and Elsevier to May 31st 2016 for studies which investigated the
effects of statins relevant to this theme. Statistical analysis was using
RevMan5.2 and Stata12.0. The outcomes were the occurrence of AKI and the
mortality after cardiac surgery. For the first time, we discussed the
source of heterogeneity on the basis of the characters of patients in the
following subgroup analysis. Results A total of 17 studies with 18,684
statins and 24,033 non-statin users were included. The meta-analysis
suggested that statins not only reduced the occurrence of AKI [Odds Ratio
(OR) 0.72, 95% Confidence Interval (CI) 0.55-0.94)] in the subjects
without high risk factors, also decreased the mortality of the patients
suffering AKI (OR 0.40, 95% CI 0.22-0.72). Conclusion Patients undergoing
cardiac surgery might benefit from statins by reducing the occurrence of
AKI and the mortality of the patients suffering AKI.<br/>Copyright &#xa9;
2016 Elsevier Ireland Ltd

<168>
Accession Number
618536025
Author
Wu M.-J.; Yang M.-C.; Ran L.-Q.; Wei S.-M.; Zhou W.-L.; Gou Y.-S.; Yu H.
Institution
(Wu, Ran) Department of Anesthesiology, Chengdu Women and Children's
Central Hospital, Chongqing Medical University, Chengdu, Sichuan 610041,
China
(Yang) Department of Anesthesiology, Sichuan Provincial People's Hospital,
Chengdu, Sichuan 610041, China
(Wei) Department of Obstetrics, Chengdu Women and Children's Central
Hospital, Chongqing Medical University, Chengdu, Sichuan 610041, China
(Zhou) Department of Intensive Care Unit, Dazhou Central Hospital, Dazhou,
Sichuan 635000, China
(Gou) Department of Orthopedics, Shuangliu First People's Hospital,
Chengdu, Sichuan 610200, China
(Yu) Department of Anesthesiology, West China Hospital, Sichuan
University, Chengdu, Sichuan 610041, China
Title
Analgesic therapy improves arterial endothelial function following
non-cardiovascular surgery: A randomized, placebo-controlled trial.
Source
Experimental and Therapeutic Medicine. 14 (5) (pp 4767-4772), 2017. Date
of Publication: November 2017.
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece.
E-mail: subscriptions@spandidos-publications.com)
Abstract
Pain subsequent to non-cardiac surgery may affect the endothelial
function, which in turn contributes to myocardial injury (MI). The present
study examined whether effective pain control is able to improve the
postoperative endothelial function. Patients (n=160) undergoing
laparoscopic cholecystectomy were randomly assigned into two groups,
treated with tramadol analgesic or saline (placebo) following surgery. On
preoperative day 1 (baseline) and postoperatively at 2 h, 1 day and 5
days, pain was assessed on a visual analogue scale (VAS), and B-mode
ultrasound was used to measure brachial endothelium-dependent
flow-mediated dilation (FMD) and nitroglycerin-induced dilation. At 2 h
postoperatively, the FMD in the two groups was significantly lower
compared with that at the other three time points (P<=0.005), while VAS
was significantly higher (P<0.05). Patients in the tramadol group
presented significantly reduced VAS values in comparison with those in the
placebo group at 2 h and 1 day postoperatively (P=0.013 and 0.031,
respectively), as well as significantly higher FMD at 2 h (6.7+/-1.5 vs.
6.0+/-1.7%; P=0.001) and 1 day postoperatively (7.3+/-1.3 vs. 6.9+/-1.4%;
P=0.03). A VAS score of <5 was independently associated with postoperative
FMD of >=7 (odds ratio, 2.5; 95% confidence interval, 1.0-6.0; P=0.047).
Backward multivariate linear regression also demonstrated that FMD was
independently correlated with age and VAS score (B=-1.403, P=0.011;
B=-0.579, P=0.003). The response to nitroglycerin-induced dilation
remained stable in all patients at baseline and at all postoperative time
points. In conclusion, analgesic treatment may improve the arterial
endothelial function following non-cardiac surgery, which may help prevent
postoperative MI.<br/>Copyright &#xa9; 2017, Spandidos Publications. All
rights reserved.

<169>
Accession Number
614684165
Author
Cotogni P.; Barbero C.; Passera R.; Fossati L.; Olivero G.; Rinaldi M.
Institution
(Cotogni) University of Turin, Department of Anesthesia and Intensive
Care, S. Giovanni Battista Hospital, Via Giovanni Giolitti 9, Turin 10123,
Italy
(Barbero, Rinaldi) University of Turin, Department of Cardiovascular
Surgery, S. Giovanni Battista Hospital, Turin, Italy
(Passera) University of Turin, Nuclear Medicine Unit, S. Giovanni Battista
Hospital, Turin, Italy
(Fossati) University of Turin, Microbiology and Virology Laboratory, S.
Giovanni Battista Hospital, Turin, Italy
(Olivero) University of Turin, Department of Surgical Sciences, S.
Giovanni Battista Hospital, Turin, Italy
Title
Violation of prophylactic vancomycin administration timing is a potential
risk factor for rate of surgical site infections in cardiac surgery
patients: A prospective cohort study.
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 73. Date of Publication: 08 Mar 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Intensivists and cardiothoracic surgeons are commonly worried
about surgical site infections (SSIs) due to increasing length of stay
(LOS), costs and mortality. The antimicrobial prophylaxis is one of the
most important tools in the prevention of SSIs. The objective of this
study was to investigate the relationship between the timing of
antimicrobial prophylaxis administration and the rate of SSIs. Methods: A
prospective cohort study was carried out over 1-year period in all
consecutive adult patients undergoing elective cardiac surgery. The
population was stratified in patients whose antimicrobial prophylaxis
administration violated or not the vancomycin timing protocol (i.e., when
the first skin incision was performed before the end of vancomycin
infusion). To compare SSI rates, the cohort was further stratified in
patients at low and high risk of developing SSIs. Results: Over the study
period, 1020 consecutive adult patients underwent cardiac surgery and
according to study inclusion criteria, 741 patients were prospectively
enrolled. A total of 60 SSIs were identified for an overall infection rate
of 8.1%. Vancomycin prophylaxis timing protocol was violated in 305 (41%)
out of 741 enrolled patients. SSIs were observed in 3% of patients without
violation of the antimicrobial prophylaxis protocol (13/436) compared with
15.4% of patients with a violation of the timing protocol (47/305) (P <
0.0001). Patients at low risk with protocol violation had a higher
occurrence of SSIs (P = 0.004) and mortality (P = 0.03) versus patients at
low risk without protocol violation. Similarly, patients at high risk with
protocol violation had a higher occurrence of SSIs (P < 0.001) and
mortality (P < 0.001) versus patients at high risk without protocol
violation. The logistic regression analysis showed that internal mammary
artery use (P = 0.025), surgical time (P < 0.001), intensive care unit
(ICU) LOS (P = 0.002), high risk of developing SSIs (P < 0.001) and
protocol violation (P < 0.001) were risk factors for SSI occurrence as
well as age (P = 0.003), logistic EuroSCORE (P < 0.001), ICU LOS (P <
0.001), mechanical ventilation time (P < 0.001) and protocol violation (P
< 0.001) were risk factors for mortality. Conclusions: This study showed
that violation of the timing of prophylactic vancomycin administration
significantly increased the probability of SSIs and mortality from
infectious cause in cardiac surgery patients.<br/>Copyright &#xa9; 2017
The Author(s).

<170>
Accession Number
614538074
Author
Tong A.; Sautenet B.; Chapman J.R.; Harper C.; MacDonald P.; Shackel N.;
Crowe S.; Hanson C.; Hill S.; Synnot A.; Craig J.C.
Institution
(Tong, Sautenet, Harper, Hanson, Craig) Sydney School of Public Health,
The University of Sydney, Sydney, NSW, Australia
(Tong, Sautenet, Harper, Hanson, Craig) Centre for Kidney Research, The
Children's Hospital at Westmead, Sydney, NSW, Australia
(Chapman) Centre for Transplant and Renal Research, Westmead Hospital,
Sydney, NSW, Australia
(MacDonald) Heart Transplant Unit, St Vincent's Hospital, Sydney, NSW,
Australia
(MacDonald) Transplantation Research Laboratory, Victor Chang, Cardiac
Research Institute, Sydney, NSW, Australia
(Shackel) Department of Medicine, University of New South Wales, Sydney,
NSW, Australia
(Crowe) Crowe Associates Ltd, Oxon, United Kingdom
(Hill, Synnot) Centre for Health Communication and Participation, La Trobe
University, Melbourne, VIC, Australia
(Synnot) School of Preventive Medicine and Public Health, Monash
University, Melbourne, VIC, Australia
Title
Research priority setting in organ transplantation: a systematic review.
Source
Transplant International. 30 (4) (pp 327-343), 2017. Date of Publication:
01 Apr 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Barriers to access and long-term complications remain a challenge in
transplantation. Further advancements may be achieved through research
priority setting with patient engagement to strengthen its relevance. We
evaluated research priority setting in solid organ transplantation and
described stakeholder priorities. Databases were searched to October 2016.
We synthesized the findings descriptively. The 28 studies (n = 2071
participants) addressed kidney [9 (32%)], heart [7 (25%)], liver [3
(11%)], lung [1 (4%)], pancreas [1 (4%)], and nonspecified organ
transplantation [7 (25%)] using consensus conferences, expert panel
meetings, workshops, surveys, focus groups, interviews, and the Delphi
technique. Nine (32%) reported patient involvement. The 336 research
priorities addressed the following: organ donation [43 priorities (14
studies)]; waitlisting and allocation [43 (10 studies)];
histocompatibility and immunology [31 (8 studies)]; immunosuppression [21
(10 studies)]; graft-related complications [38 (13 studies)]; recipient
(non-graft-related) complications [86 (14 studies)]; reproduction [14 (1
study)], psychosocial and lifestyle [49 (7 studies)]; and disparities in
access and outcomes [10 (4 studies)]. The priorities identified were broad
but only one-third of initiatives engaged patients/caregivers, and details
of the process were lacking. Setting research priorities in an explicit
manner with patient involvement can guide investment toward the shared
priorities of patients and health professionals.<br/>Copyright &#xa9; 2017
Steunstichting ESOT

<171>
Accession Number
617524481
Author
Alsawas M.; Zaiem F.; Larrea-Mantilla L.; Almasri J.; Erwin P.J.; Upchurch
G.R.; Murad M.H.
Institution
(Alsawas, Zaiem, Larrea-Mantilla, Almasri, Murad) Evidence-based Practice
Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science
of Health Care Delivery, Mayo Clinic, Rochester, Minn, United States
(Erwin) Mayo Clinic Libraries, Mayo Clinic, Rochester, Minn, United States
(Upchurch) Division of Vascular and Endovascular Surgery, University of
Virginia, Charlottesville, Va, United States
Title
Effectiveness of surgical interventions for thoracic aortic aneurysms: A
systematic review and meta-analysis.
Source
Journal of Vascular Surgery. 66 (4) (pp 1258-1268.e8), 2017. Date of
Publication: October 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective A systematic review and meta-analysis was conducted to evaluate
the effectiveness of thoracic endovascular aortic repair (TEVAR) and open
repair in patients with descending thoracic aortic aneurysms (TAAs).
Methods PubMed, Ovid MEDLINE, Ovid Embase, EBSCO Cumulative Index to
Nursing and Allied Health Literature, and Scopus were searched from each
database's inception to January 29, 2016. We selected studies that
compared the two approaches in adults with TAAs and reported 30-day
mortality or procedure complications. Two reviewers independently
extracted data, and conflicts were resolved by consensus. Random-effects
meta-analysis was used to estimate odds ratios (ORs) and 95% confidence
intervals (CIs). The main outcomes and measures were all-cause 30-day
mortality, 30-day paraplegia or spinal cord ischemia, stroke, pulmonary
complications, and length of hospital and intensive care unit (ICU) stay.
Results Twenty-seven studies of moderate methodologic quality were
included. TEVAR was associated with lower 30-day mortality in ruptured
(OR, 0.58; 95% CI, 0.38-0.88) and intact (OR, 0.6; 95% CI, 0.36-0.99)
aneurysms. Paraplegia or spinal cord ischemia (OR, 0.35; 95% CI, 0.2-0.61)
and pulmonary complications (OR, 0.41; 95% CI, 0.37-0.46) were reduced in
patients undergoing TEVAR, whereas a reduction in stroke risk was not
statistically significant (OR, 0.89; 95% CI, 0.76-1.03). Pooled mean
difference in length of hospital and ICU stay was lower for TEVAR by -5.17
days (95% CI, -7.77 to -2.57) and -5.89 days (95% CI, -9.65 to -2.12),
respectively. Three studies showed that compared with open repair, a
hybrid approach reduced hospital stay (pooled mean difference, -8.83 days;
95% CI, -14.37 to -3.29) and ICU stay (pooled mean difference, -3.17 days
(95% CI, -5.54 to -0.97), with minimal evidence on other outcomes studied.
Conclusions Observational evidence at high risk of confounding suggests
that compared with open repair for TAA, TEVAR reduced risk of mortality,
paraplegia, spinal cord ischemia, and pulmonary complications within 30
days of intervention. Patients undergoing TEVAR also had shorter length of
hospital and ICU stay compared with patients undergoing open
repair.<br/>Copyright &#xa9; 2017 Society for Vascular Surgery

<172>
Accession Number
614241906
Author
Hemila H.; Suonsyrja T.
Institution
(Hemila) University of Helsinki, Department of Public Health, POB 20,
Tukholmankatu 8 B 2B, Helsinki FI-00014, Finland
(Suonsyrja) Helsinki University Central Hospital, Meilahti Hospital,
Emergency Clinic, Helsinki, Finland
Title
Vitamin C for preventing atrial fibrillation in high risk patients: A
systematic review and meta-analysis.
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 49. Date of Publication: 01 Feb 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Atrial fibrillation (AF), a common arrhythmia contributing
substantially to cardiac morbidity, is associated with oxidative stress
and, being an antioxidant, vitamin C might influence it. Methods: We
searched the Cochrane CENTRAL Register, MEDLINE, and Scopus databases for
randomised trials on vitamin C that measured AF as an outcome in high risk
patients. The two authors independently assessed the trials for inclusion,
assessed the risk of bias, and extracted data. We pooled selected trials
using the Mantel-Haenszel method for the risk ratio (RR) and the inverse
variance weighting for the effects on continuous outcomes. Results: We
identified 15 trials about preventing AF in high-risk patients, with 2050
subjects. Fourteen trials examined post-operative AF (POAF) in cardiac
surgery patients and one examined the recurrence of AF in cardioversion
patients. Five trials were carried out in the USA, five in Iran, three in
Greece, one in Slovenia and one in Russia. There was significant
heterogeneity in the effect of vitamin C in preventing AF. In 5 trials
carried out in the USA, vitamin C did not prevent POAF with RR=1.04 (95%
CI: 0.86-1.27). In nine POAF trials conducted outside of the USA, vitamin
C decreased its incidence with RR=0.56 (95% CI: 0.47-0.67). In the single
cardioversion trial carried out in Greece, vitamin C decreased the risk of
AF recurrence by RR=0.13 (95% CI: 0.02-0.92). In the non-US cardiac
surgery trials, vitamin C decreased the length of hospital stay by 12.6%
(95% CI 8.4-16.8%) and intensive care unit (ICU) stay by 8.0% (95% CI
3.0-13.0%). The US trials found no effect on hospital stay and ICU stay.
No adverse effects from vitamin C were reported in the 15 trials.
Conclusions: Our meta-analysis indicates that vitamin C may prevent
post-operative atrial fibrillation in some countries outside of the USA,
and it may also shorten the duration of hospital stay and ICU stay of
cardiac surgery patients. Vitamin C is an essential nutrient that is safe
and inexpensive. Further research is needed to determine the optimal
dosage protocol and to identify the patient groups that benefit the
most.<br/>Copyright &#xa9; 2017 The Author(s).

<173>
Accession Number
616986660
Author
Testa L.; Latib A.; Bollati M.; Montone R.A.; Colombo A.; Crea F.; Bedogni
F.
Institution
(Testa, Bollati, Montone, Bedogni) Dept. of Cardiology, IRCCS Pol S.
Donato, Milan, Italy
(Latib, Colombo) Interventional Cardiology Unit, San Raffaele Scientific
Institute, EMO GVM Centro Cuore Columbus, Milan, Italy
(Crea) Dept of Cardiology, Catholic Univ. of the Sacred Heart, Rome, Italy
Title
Unprotected left main revascularization: Percutaneous coronary
intervention versus coronary artery bypass. An updated systematic review
and meta-analysis of randomised controlled trials.
Source
PLoS ONE. 12 (6) (no pagination), 2017. Article Number: e0179060. Date of
Publication: June 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background The optimal treatment of unprotected left main (UPLM) with
either PCI or CABG remains uncertain. Aim The purpose of this study was to
determine the comparative safety and efficacy of PCI versus CABG in
patients with UPLM disease. Methods Search of BioMedCentral, CENTRAL,
mRCT, PubMed, major cardiological congresses proceedings and references
cross-check (updated November 2016). Outcomes were the rate of MACE [all
cause death, MI, stroke], the rates of the individual components of MACE
and the rate of target vessel revascularisation (TVR). Results We
identified 6 Randomised Controlled Trials totalling 4717 patients
allocated to PCI or CABG. At 1 year follow up, PCI and CABG were
substantially equivalent with respect to the rates of MACE [PCI 8.5% vs
CABG 8.9%, OR 1.02,(0.76-1.36), p = 0.9], death [PCI 5.4% vs CABG 6.6%, OR
0.81,(0.63-1.03),p = 0.08] and MI [PCI 3.4% vs CABG 4.3%, OR 0.80
(0.59-1.07), p = 0.14]. Notably, PCI was associated with a significantly
lower rate of stroke [PCI 0.6% vs CABG 1.8%, OR 0.36,(0.17-0.79), p =
0.01] and with a significantly higher rate of TVR [PCI 8.7% vs CABG 4.5%,
OR 2.00(1.46-2.75), p<0.01]. At a median follow up of 5years, the rates of
MACE were similar between the two strategies: PCI 14.6% vs CABG 13.8%, OR
1.02(0.76-1.38), p = 0.89. Likewise, the rates of death [PCI 8% and CABG
7.7%, OR 1(0.77-1.31), P = 0.9], MI [PCI 6.1% vs CABG 5%, OR
1.41(0.85-2.34), P = 0.19, I²59%], and stroke [PCI 2% vs CABG
2.2%, OR 0.85(0.42-1.81), p = 0.65,] were similar while PCI was associated
with a significantly higher rate of TVR [14.5% vs CABG 8.9%, OR
1.73(1.41-2.13), p<0.01]. Conclusion In patients with UPLM disease, PCI
and CABG are associated with similar rates of MACE and mortality at 1 year
as well as after 5 years. Differences can be detected for individual end
points at both short and long term FU.<br/>Copyright &#xa9; 2017 Testa 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.

<174>
Accession Number
617774794
Author
Kaushal S.; Wehman B.; Pietris N.; Naughton C.; Bentzen S.M.; Bigham G.;
Mishra R.; Sharma S.; Vricella L.; Everett A.D.; Deatrick K.B.; Huang S.;
Mehta H.; Ravekes W.A.; Hibino N.; Difede D.L.; Khan A.; Hare J.M.
Institution
(Kaushal, Wehman, Naughton, Bigham, Mishra, Sharma, Deatrick, Mehta)
Division of Cardiac Surgery, University of Maryland School of Medicine,
110 S Paca St, 7th Floor, Baltimore, MD, United States
(Pietris, Huang) Division of Pediatric Cardiology, University of Maryland
School of Medicine, 110 S Paca St, 7th Floor, Baltimore, MD, United States
(Bentzen) Department of Epidemiology and Public Health, University of
Maryland School of Medicine, 660 W Redwood St, Baltimore, MD, United
States
(Vricella, Everett, Ravekes, Hibino) Division of Pediatric Cardiac Surgery
and Cardiology, Johns Hopkins Hospital, Zayed Tower Suite 7107, 1800
Orleans St, Baltimore, MD, United States
(Difede, Khan, Hare) Interdisciplinary Stem Cell Institute, University of
Miami Miller School of Medicine, 1501 NW 10th Ave, 9th Floor, Miami,
Florida, United States
Title
Study design and rationale for ELPIS: A phase I/IIb randomized pilot study
of allogeneic human mesenchymal stem cell injection in patients with
hypoplastic left heart syndrome.
Source
American Heart Journal. 192 (pp 48-56), 2017. Date of Publication: October
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Despite advances in surgical technique and postoperative care, long-term
survival of children born with hypoplastic left heart syndrome (HLHS)
remains limited, with cardiac transplantation as the only alternative for
patients with failing single ventricle circulations. Maintenance of
systemic right ventricular function is crucial for long-term survival, and
interventions that improve ventricular function and avoid or defer
transplantation in patients with HLHS are urgently needed. We hypothesize
that the young myocardium of the HLHS patient is responsive to the
biological cues delivered by bone marrow-derived mesenchymal stem cells
(MSCs) to improve and preserve right ventricle function. The ELPIS trial
(Allogeneic Human MEsenchymal Stem Cell Injection in Patients with
Hypoplastic Left Heart Syndrome: An Open Label Pilot Study) is a phase
I/IIb trial designed to test whether MSC injection will be both safe and
feasible by monitoring the first 10 HLHS patients for new major adverse
cardiac events. If our toxicity stopping rule is not activated, we will
proceed to the phase IIb component of our study where we will test our
efficacy hypothesis that MSC injection improves cardiac function compared
with surgery alone. Twenty patients will be enrolled in a randomized phase
II trial with a uniform allocation to MSC injection versus standard
surgical care (no injection). The 2 trial arms will be compared with
respect to improvement of right ventricular function, tricuspid valve
annulus size, and regurgitation determined by cardiac magnetic resonance
and reduced mortality, morbidity, and need for transplantation. This study
will establish the safety and feasibility of allogeneic mesenchymal stem
cell injection in HLHS patients and provide important insights in the
emerging field of stem cell-based therapy for congenital heart disease
patients.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<175>
Accession Number
613757643
Author
Komocsi A.; Kehl D.; d'Ascenso F.; DiNicolantonio J.; Vorobcsuk A.
Institution
(Komocsi, Vorobcsuk) University of Pecs, Heart Institute, Department of
Interventional Cardiology, Pecs, Hungary
(Kehl) University of Pecs, Faculty of Business and Economics, Department
of Statistics and Econometrics, Pecs, Hungary
(d'Ascenso) Division of Cardiology, Department of Internal Medicine, Citta
della Salute e della Scienza, Turin, Italy
(DiNicolantonio) Saint Luke's Mid America Heart Institute, Kansas City,
MO, United States
Title
Pathfinding to an optimal strategy of revascularization in primary
coronary intervention in patients with multivessel disease: a network
meta-analysis of randomized trials.
Source
Current Medical Research and Opinion. 33 (3) (pp 421-429), 2017. Date of
Publication: 04 Mar 2017.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
Objectives: In ST-segment elevation myocardial infarction (STEMI), current
guidelines discourage treatment of the non-culprit lesions at the time of
the primary intervention. Latest trials have challenged this strategy
suggesting benefit of early complete revascularization. We performed a
Bayesian multiple treatment network meta-analysis of randomized clinical
trials (RCTs) in STEMI on culprit-only intervention (CO) versus different
timing multivessel revascularization, including immediate (IM), same
hospitalization (SH) or later staged (ST). Methods: Outcome parameters
were pooled with a random-effects model. For multiple-treatment
meta-analysis, a Bayesian Markov chain Monte Carlo method was used.
Results: Eight RCTs involving 2077 patients were identified. ST and IM
revascularization was associated with a decrease in major adverse cardiac
events (MACEs) compared to culprit-only approach (risk ratio [RR]: 0.43
credible interval [CrI]: 0.22-0.77 and RR: 0.36 CrI: 0.24-0.54,
respectively). IM was superior to SH (RR: 0.49 CrI: 0.29-0.80). With
regards to myocardial infarction IM was superior to SH (RR: 0.18 CrI:
0.02-0.99). The posterior probability of being the best choice of
treatment regarding the frequency of MACEs was 71.2% for IM, 28.5% for ST,
0.3% for SH and 0.05% for culprit-only approach. Conclusions: Results from
RCTs indicate that immediate or staged revascularization of non-culprit
lesions reduces major adverse events in patients after primary
percutaneous coronary intervention. Differences in MACEs suggest
superiority of the immediate or staged intervention; however, further
randomized trials are needed to determine the optimal timing of
revascularization of the non-culprit lesions.<br/>Copyright &#xa9; 2016
Informa UK Limited, trading as Taylor & Francis Group.

<176>
Accession Number
617808787
Author
Mojoli M.; Gersh B.J.; Barioli A.; Masiero G.; Tellaroli P.; D'Amico G.;
Tarantini G.
Institution
(Mojoli, Barioli, Masiero, D'Amico, Tarantini) Cardiology Unit, Department
of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical
School, Padua, Italy
(Gersh) Division of Cardiovascular Diseases, Mayo Clinic and Mayo Clinic
College of Medicine, Rochester, MN, United States
(Tellaroli) Epidemiology and Public Health Unit, Department of Cardiac,
Thoracic and Vascular Sciences, University of Padua Medical School, Padua,
Italy
Title
Impact of atrial fibrillation on outcomes of patients treated by
transcatheter aortic valve implantation: A systematic review and
meta-analysis.
Source
American Heart Journal. 192 (pp 64-75), 2017. Date of Publication: October
2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Conflicting data have been reported related to the impact of
atrial fibrillation (AF) on the outcomes after transcatheter aortic valve
implantation (TAVI). We aimed to assess the prognosis of TAVI-treated
patients according to the presence of pre-existing or new-onset AF.
Methods Studies published between April 2002 and November 2016 and
reporting outcomes of pre-existing AF, new-onset AF, or sinus rhythm in
patients undergoing TAVI were identified with an electronic search.
Pairwise and network meta-analysis were performed. Outcomes of interest
were short- and long-term mortality, stroke, and major bleeding. Results
Eleven studies (11,033 individuals) were eligible. Compared to sinus
rhythm, short-term and long-term mortality were significantly higher in
new-onset AF (short-term OR 2.9, P = .002; long-term OR 2.3, P < .0001)
and pre-existing AF groups (short-term OR 2.7, P = .004; long-term OR 2.8,
P < .0001). Compared to sinus rhythm, new-onset AF increased the risk of
stroke at early (OR 2.1, P < .0001) and late follow-up (OR 1.92, P <
.0001), and the risk of early bleedings (OR 1.65, P = .002), while
pre-existing AF increased the risk of late stroke (OR 1.3, P = 0.03), but
not the risk of bleeding. Compared to pre-existing AF, new-onset AF
correlated with higher risk of early stroke (OR 1.7, P = .002) and major
bleedings (OR 1.7, P = .002). Conclusions AF is associated with impaired
outcomes after TAVI, including mortality, stroke and (limited to new-onset
AF) major bleedings. Compared to pre-existing AF, new-onset AF correlates
with higher risk of early stroke and major bleedings. Improved management
of AF in the TAVI setting, including tailored antithrombotic treatment
strategies, remains a relevant need.<br/>Copyright &#xa9; 2017 Elsevier
Inc.

<177>
Accession Number
614518952
Author
Mitaka C.; Ohnuma T.; Murayama T.; Kunimoto F.; Nagashima M.; Takei T.;
Iguchi N.; Tomita M.
Institution
(Mitaka) Department of Anesthesiology, Tokyo Medical and Dental University
Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
(Mitaka) Department of Anesthesiology and Pain Medicine, Juntendo
University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
(Ohnuma, Murayama) Intensive Care Unit, Department of Anesthesiology,
Saitama Medical Center, Jichi Medical University, 1-847 Amanuma,
Ohmiya-ku, Saitama 330-8503, Japan
(Kunimoto) Intensive Care Unit, Gunma University Hospital, 3-39-15 Shouwa,
Maebashi, Gunma 371-8511, Japan
(Nagashima, Takei) Intensive Care Unit, Yokohama City Minato Red Cross
Hospital, 3-12-1 Shinyamashita, Naka-ku, Yokohama, Kanagawa 231-8682,
Japan
(Iguchi) Intensive Care Unit, Osaka University Hospital, 2-15 Yamadaoka,
Suita, Osaka 565-0871, Japan
(Tomita) Clinical Research Center, Tokyo Medical and Dental University
Hospital of Medicine 1-5-45 Yushima, Tokyo 113-8519, Japan
Title
Effects of low-dose atrial natriuretic peptide infusion on cardiac
surgery-associated acute kidney injury: A multicenter randomized
controlled trial.
Source
Journal of Critical Care. 38 (pp 253-258), 2017. Date of Publication: 01
Apr 2017.
Publisher
W.B. Saunders
Abstract
Purpose To evaluate the effects of atrial natriuretic peptide (ANP) on
renal function and medical costs in patients with acute kidney injury
(AKI) associated with cardiac surgery. Materials and methods The Japanese
trial for AKI in Post-cardiovascular surgery patients by ANP (JAPAN) was a
prospective, multicenter, randomized, double-blind, placebo-controlled
study conducted in 11 hospitals in Japan. Acute kidney injury was defined
as an increase in serum creatinine of at least 0.3 mg/dL within 48 hours.
The patients were randomly assigned to receive ANP (0.02 mug
kg^-1 min^-1) or placebo. The primary end point was a
change in renal function. The secondary end points were a need for renal
replacement therapy, the lengths of intensive care unit and hospital
stays, and medical costs incurred over the 90-day follow-up. Results Of
the 77 randomized patients, 37 were in the ANP group and 40 were in the
placebo group. Although ANP significantly (P =.018) increased urine
output, it did not significantly improve renal function compared with
placebo. There were no significant differences between the groups in the
renal replacement therapy rate, the lengths of the intensive care unit and
hospital stays, or medical costs. Conclusion Atrial natriuretic peptide
infusion did not show a renoprotective effect or cost-saving effect in the
treatment of cardiac surgery-associated AKI.<br/>Copyright &#xa9; 2016 The
Authors

<178>
Accession Number
618420751
Author
Karim M.N.; Reid C.M.; Cochrane A.; Tran L.; Alramadan M.; Hossain M.N.;
Billah B.
Institution
(Karim, Reid, Tran, Alramadan, Hossain, Billah) School of Public Health
and Preventive Medicine, Monash University, Alfred Centre, 99 Commercial
Road, Melbourne, VIC 3004, Australia
(Reid) School of Public Health, Curtin University, Perth, Australia
(Cochrane) Department of Cardiothoracic Surgery, Monash Medical Centre,
Clayton, Australia
Title
Mortality risk prediction models for coronary artery bypass graft surgery:
Current scenario and future direction.
Source
Journal of Cardiovascular Surgery. 58 (6) (pp 931-942), 2017. Date of
Publication: December 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
INTRODUCTION? Many risk prediction models are currently in use for
predicting short-Term mortality following coronary artery bypass graft
(CABG) surgery. This review critically appraised the methods that were
used for developing these models to assess their applicability in current
practice setting as well as for the necessity of up-gradation. EVIDENCE
ACQUISITION? Medline via Ovid was searched for articles published between
1946 and 2016 and EMBASE via Ovid between 1974 and 2016 to identify risk
prediction models for CABG. Article selection and data extraction was
conducted using the CHARMS checklist for review of prediction model
studies. Association between model development methods and model's
discrimination was assessed using Kruskal-Wallis one-way analysis of
variance and Mann-Whitney U-Test. EVIDENCE SYNTHESIS? A total of 53 risk
prediction models for short-Term mortality following CABG were identified.
The review found a wide variation in development methodology of risk
prediction models in the field. Ambiguous predictor and outcome
definition, sub-optimum sample size, inappropriate handling of missing
data and inefficient predictor selection technique are major issues
identified in the review. Quantitative synthesis in the review showed
"missing value imputation" and "adopting machine learning algorithms" may
result in better discrimination power of the models. CONCLUSIONS? There
are aspects in current risk modeling, where there is room for improvement
to reflect current clinical practice. Future risk modelling needs to adopt
a standardized approach to defining both outcome and predictor variables,
rational treatment of missing data and robust statistical techniques to
enhance performance of the mortality risk prediction.<br/>Copyright &#xa9;
2016 EDIZIONI MINERVA MEDICA.

<179>
Accession Number
614814597
Author
Bundhun P.K.; Yanamala C.M.; Huang W.-Q.
Institution
(Bundhun, Huang) The First Affiliated Hospital of Guangxi Medical
University, Institute of Cardiovascular Diseases, Nanning, Guangxi 530021,
China
(Yanamala) EALING Hospital, University of Buckingham, Department of
Internal Medicine, Uxbridge road, Southall, London UB1 3HW, United Kingdom
Title
Comparing Stent Thrombosis associated with Zotarolimus Eluting Stents
versus Everolimus Eluting Stents at 1 year follow up: A systematic review
and meta-analysis of 6 randomized controlled trials.
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 84. Date of Publication: 16 Mar 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Two thousand fifteen has been a winning year for Drug Eluting
Stents (DES). Increase in the number of patients with cardiovascular
diseases treated by Percutaneous Coronary Intervention (PCI) has resulted
to a high demand for second generation DES. This current analysis aimed to
compare the different types of Stent Thrombosis (ST) associated with
Zotarolimus Eluting Stents (ZES) versus Everolimus Eluting Stents (EES) at
1 year follow up. Methods: Electronic databases were searched for studies
comparing ZES with EES. Different types of ST reported at 1 year follow up
were considered as the primary endpoints in this analysis. Odds Ratios
(OR) with 95% Confidence Intervals (CIs) were used as the statistical
parameters and the pooled analyses were carried out by the RevMan 5 . 3
software. Results: A total number of 10,512 patients were included in this
analysis. No significant difference in any definite ST, acute definite ST,
subacute definite ST, and late definite ST were observed between ZES and
EES, at 1 year follow up with OR: 1.70, 95% CI: 0.92 - 3.16; P = 0.09, OR:
3.44, 95% CI: 0.82 - 14.43; P = 0.09, OR: 1.13, 95% CI: 0.43 - 2.95; P =
0.80 and OR: 2.39, 95% CI: 0.83 - 6.85; P = 0.11 respectively. Moreover,
any definite or probable ST and definite/probable/possible ST were also
not significantly different with OR: 1.39, 95% CI: 0.89 - 2.17; P = 0.15
and OR: 1.19, 95% CI: 0.84 - 1.70; P = 0.33 respectively. In addition, any
probable ST, acute probable ST, late probable ST and possible ST were also
not significantly different at 1 year follow up with OR: 1.11, 95% CI:
0.60 - 2.05; P = 0.75, OR: 0.53, 95% CI: 0.12 - 2.40; P = 0.41, OR: 1.67,
95% CI: 0.35 - 7.86; P = 0.52 and OR: 1.08, 95% CI: 0.64 - 1.82; P = 0.78
respectively. Conclusion: At 1 year follow up, ZES were not associated
with significantly lower or higher definite and probable ST compared to
EES. In addition, no significant difference was observed in acute,
subacute and late definite or probable ST. However, further trials are
recommended to assess the effects of these second-generation DES during
the long-term.<br/>Copyright &#xa9; 2017 The Author(s).

<180>
Accession Number
614107960
Author
Peng F.; Liu S.; Hu Y.; Yu M.; Chen J.; Liu C.
Institution
(Peng, Liu, Hu, Yu, Chen, Liu) Department of Anesthesiology, First
Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
(Peng) Department of Anesthesiology, Northern Jiangsu People's Hospital,
Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, China
Title
Influence of perioperative nonsteroidal anti-inflammatory drugs on
complications after gastrointestinal surgery: A meta-analysis.
Source
Acta Anaesthesiologica Taiwanica. 54 (4) (pp 121-128), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Elsevier Taiwan LLC (96 Chung Shan North Road, Section 2, Taipei, Taiwan
(Republic of China))
Abstract
Background Nonsteroidal anti-inflammatory drugs (NSAIDs) are a key part of
multimodal perioperative analgesia. This study aimed to evaluate the
influence of perioperative NSAIDs application on complications after
gastrointestinal surgery by using meta-analysis. Methods A systematic
review of published literature was conducted by searching computerized
databases including PubMed, CBM, Springer, Chinese Academic Journals, and
China Info since the databases were published until June 2015. The
articles and retrospective references regarding complications after
gastrointestinal surgery were collected to compare postoperative
complications associated with NSAIDs or other analgesics. After they were
assessed by randomized controlled trials and extracted by the standard of
the Jadad systematic review, the homogeneous studies were pooled using
RevMan 5.3 software. The meta-analysis was performed on five postoperative
complications: postoperative anastomotic leak, cardiovascular events,
surgical site infection, nausea and vomiting, and intestinal obstruction.
Results Twelve randomized controlled trials involving 3829 patients met
the inclusion criteria. The results of meta-analyses showed the following:
(1) postoperative anastomotic leak: NSAIDs (including selective and
nonselective NSAIDs) increased the incidence of anastomotic leak [odds
ratio (OR) = 3.02, 95% confidence interval (CI): 2.16-4.23, p = 0.00001].
Further results showed that nonselective NSAIDs significantly increased
the incidence of anastomotic leak (OR = 2.96, 95% CI: 1.99-4.42, p <
0.00001), and selective NSAIDs had no significant difference as compared
with the control group using other analgesics (OR = 2.27, 95% CI:
0.68-7.56, p = 0.18); (2) postoperative cardiovascular events: NSAIDs
(selective and nonselective NSAIDs) had no difference when compared with
other analgesics (OR = 0.50, 95% CI: 0.23-1.12, p = 0.09); (3)
postoperative surgical site infection: NSAIDs (selective and nonselective
NSAIDs) and other analgesics had no difference in surgical site infection
(OR = 0.77, 95% CI: 0.52-1.15, p = 0.20); (4) postoperative nausea and
vomiting: NSAIDs (selective and nonselective NSAIDs) decreased the
incidence of nausea and vomiting (OR = 0.53, 95% CI: 0.34-0.81, p =
0.003); (5) postoperative intestinal obstruction: NSAIDs (selective and
nonselective NSAIDs) decreased the incidence of intestinal obstruction (OR
= 0.35, 95% CI: 0.13-0.89, p = 0.03). Conclusions The meta-analysis
suggests that postoperative NSAIDs, especially nonselective NSAIDs, could
increase the incidence of anastomotic leak. NSAIDs could decrease
postoperative nausea and vomiting and intestinal obstruction, but showed
no difference in cardiovascular events and surgical site infection as
compared with other analgesics.<br/>Copyright &#xa9; 2016

<181>
Accession Number
618634556
Author
Do N.; Hill K.D.; Wallace A.S.; Vricella L.; Cameron D.; Quintessenza J.;
Goldenberg N.; Mavroudis C.; Karl T.; Pasquali S.K.; Jacobs J.P.; Jacobs
M.L.
Institution
(Do) Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
(Hill, Wallace) Duke Clinical Research Institute, Durham, North Carolina
(Vricella, Cameron, Jacobs) Division of Cardiac Surgery, Massachusetts
General Hospital, Boston, Massachusetts
(Quintessenza) Cincinnati Children's Hospital, Cincinnati, Ohio
(Goldenberg, Karl, Jacobs) Johns Hopkins All Children's Hospital, St.
Petersburg, Florida
(Mavroudis) Florida Hospital, Orlando, Florida
(Pasquali) C.S. Mott Children's Hospital, Ann Arbor, Michigan
Title
Shunt Failure-Risk Factors and Outcomes: An Analysis of The Society of
Thoracic Surgeons Congenital Heart Surgery Database.
Source
Annals of Thoracic Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier USA
Abstract
Background: Systemic-to-pulmonary shunt failure is a potentially
catastrophic complication. We analyzed a large multicenter clinical
registry to describe the prevalence and evaluate risk factors. Methods:
Infants (aged <=365 days) undergoing shunt operations (systemic
artery-to-pulmonary artery or systemic ventricle-to-pulmonary artery) in
The Society of Thoracic Surgeons Congenital Heart Surgery Database
(STS-CHSD) from 2010 to 2015 were included. Multivariable logistic
regression was used to evaluate risk factors for in-hospital shunt
failure. Model covariates included patient characteristics, preoperative
factors, procedural factors including shunt type, and center effects.
Centers with more than 15% missing data for key covariates were excluded.
Results: Shunt operations were performed in 9,172 infants (118 centers).
In-hospital shunt failure occurred in 674 (7.3%). In multivariable
analysis, risk factors for in-hospital shunt failure included lower weight
at operation (odds ratio [OR], 1.35; p = 0.001), preoperative
hypercoagulable state (OR, 2.47; p = 0.031), and the presence of any other
STS-CHSD preoperative risk factors (OR, 1.24; p = 0.038). Shunt failure
was less likely with a systemic ventricle-to-pulmonary artery shunt than a
systemic artery-to-pulmonary artery shunt (OR, 0.65; p = 0.020). Neither
cardiopulmonary bypass nor single-ventricle diagnosis was a risk factor
for shunt failure. Patients with in-hospital shunt failure had
significantly higher rates of operative mortality (31.9% vs 11.1%, p <
0.001) and major morbidity (84.4% vs 29.4%, p < 0.001), and longer median
postoperative length of stay among survivors (45 vs 22 days, p < 0.001).
Conclusions: In-hospital shunt failure is common, and associated mortality
risk is high. These data highlight at-risk patients and procedural cohorts
that warrant expectant surveillance and may benefit from enhanced
antithrombotic prophylaxis or other management strategies to reduce shunt
failure. These findings may inform planning of future clinical
trials.<br/>Copyright &#xa9; 2017 The Society of Thoracic Surgeons.

<182>
Accession Number
618634479
Author
Squiers J.J.; Potluri S.; Brinkman W.T.; DiMaio J.M.
Institution
(Squiers, DiMaio) Baylor Scott and White Research Institute, The Heart
Hospital Baylor Plano, Plano, Tex
(Potluri) Department of Cardiology, The Heart Hospital Baylor Plano,
Plano, Tex
(Brinkman, DiMaio) Department of Cardiothoracic Surgery, The Heart
Hospital Baylor Plano, Plano, Tex
(Squiers) Department of General Surgery, Baylor University Medical Center,
Dallas, Tex
Title
Systematic review of transcatheter aortic valve replacement after previous
mitral valve surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)

<183>
Accession Number
618619001
Author
Stone M.L.; Kelly J.; Mistry M.; Buck M.; Gangemi J.; Vergales J.
Institution
(Stone, Gangemi) Division of Thoracic and Cardiovascular Surgery, The
University of Virginia Health System, Charlottesville, Virginia
(Kelly, Mistry, Vergales) Division of Pediatric Cardiology, The University
of Virginia Health System, Charlottesville, Virginia
(Buck) Department of Pharmacology, The University of Virginia Health
System, Charlottesville, Virginia
Title
Use of Nicardipine After Cardiac Operations Is Safe in Children Regardless
of Age.
Source
Annals of Thoracic Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier USA
Abstract
Background: Control of postoperative hypertension is central to the care
of infants and children after cardiac operations. Continuous pharmacologic
delivery affords the advantage of rapid onset and ease of titration.
Although well established in older children and adults, calcium channel
blockers are routinely avoided in children aged younger than 1 year
secondary to concerns of safety and efficacy in the setting of
sarcoplasmic reticulum development. Thus, the purpose of this study was to
review a single-institution experience with nicardipine, a selective
calcium channel blocker, in pediatric patients after cardiac operations.
Methods: Children undergoing cardiac operations at the University of
Virginia from 2010 to 2015 were retrospectively reviewed after selection
based on receipt of nicardipine for blood pressure management in the
postoperative period. Demographic, operative, laboratory, and
postoperative data were collected for adverse effect analysis and outcomes
comparisons between infants aged younger than 6 months (group 1) and older
than 6 months (group 2). Results: During the study period, 68 children
(group 1: n = 33 [48%]; group 2: n = 35 [52%]) received nicardipine after
cardiac operations (0.5 to 1 mug . kg^-1 . min^-1).
Nicardipine was initiated at a mean of 6.6 +/- 13.1 hours postoperatively
in group 1 and 5.4 +/- 7.8 hours in group 2. Nine patients (13%)
demonstrated clinically significant hypotension necessitating dosing
titration with no statistically significant differences between groups. No
major adverse events occurred following nicardipine administration.
Conclusions: Nicardipine is well tolerated after cardiac operations in
children irrespective of age or underlying pathology. Thus, nicardipine
should be considered as safe and effective in children of all ages for
control of hypertension after cardiac operations.<br/>Copyright &#xa9;
2017 The Society of Thoracic Surgeons.

<184>
Accession Number
618528277
Author
Qian G.; Yang Y.-Q.; Dong W.; Cao F.; Chen Y.-D.
Institution
(Qian, Yang, Dong, Cao, Chen) Department of Cardiology, Chinese People's
Liberation Army General Hospital, Beijing, China
(Chen) Chinese People's Liberation Army General Hospital, 28# Fuxing
Street, Haidian District, Beijing 100853, China
Title
Comparison of Iodixanol and Iopromide in Patients with Renal Insufficiency
and Congestive Heart Failure Undergoing Coronary Angiography by
Hemodynamic Monitoring.
Source
Angiology. 68 (10) (pp 907-913), 2017. Date of Publication: 01 Nov 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
We investigated the impact of contrast media (CM) with different
osmolality on cardiac preload in patients with chronic kidney disease
(CKD) and congestive heart failure (CHF). Patients with CKD and CHF were
equally randomized to receive either iso-osmolar contrast media (IOCM)
iodixanol or low-osmolar contrast media iopromide. We measured cardiac
preload indexes by invasive hemodynamic monitoring before and after CM
injection. Major adverse cardiac events postprocedures were recorded.
Increase in extravascular lung water index was only seen in the iopromide
group (P <.001), while global end diastolic index and central venous
pressure were all significantly increased from baseline in the both groups
(P <.001, respectively), and the increase in cardiac preload indexes was
significantly greater in the iopromide group than in the iodixanol group
(P < 0.001). The overall incidence of acute heart failure was more
frequently observed in the iopromide group (P = 0.027). Low-osmolar
contrast media iopromide significantly increased cardiac preload in
patients with CKD and CHF undergoing cardiac catheterization procedures
compared with IOCM iodixanol.<br/>Copyright &#xa9; The Author(s) 2017.

<185>
Accession Number
618553662
Author
Bravo-Soto G.A.; Llovet-Gutierrez V.; Rada G.
Institution
(Bravo-Soto) Facultad de Medicina, Pontificia Universidad Catolica de
Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile;
radagabriel@gmail.com; Facultad de Medicina, Pontificia Universidad
Catolica de Chile, Lira 63, Santiago Centro, Chile
(Llovet-Gutierrez) Facultad de Medicina, Pontificia Universidad Catolica
de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile
(Rada) Proyecto Epistemonikos, Santiago, Chile; Departamento de Medicina
Interna, Facultad de Medicina, Pontificia Universidad Catolica de Chile;
Programa de Salud Basada en Evidencia, Facultad de Medicina, Pontificia
Universidad Catolica de Chile, Santiago, Chile; GRADE working group; The
Cochrane Collaboration
Title
Are perioperative statins beneficial for cardiac surgery?.
Source
Medwave. 17 (Supplement1) (pp e6834), 2017. Date of Publication: 16 Jan
2017.

<186>
Accession Number
612646533
Author
Koskinas K.C.; Shakir S.; Fankhauser M.; Nietlispach F.; Attinger-Toller
A.; Moschovitis A.; Wenaweser P.; Pilgrim T.; Stortecky S.; Praz F.; Raber
L.; Windecker S.; Meier B.; Gloekler S.
Institution
(Koskinas, Shakir, Fankhauser, Moschovitis, Wenaweser, Pilgrim, Stortecky,
Praz, Raber, Windecker, Meier, Gloekler) Cardiology, Cardiovascular
Department, University Hospital of Bern, Bern, Switzerland
(Nietlispach, Attinger-Toller) Cardiology, University Hospital of Zurich,
Zurich, Switzerland
Title
Predictors of Early (1-Week) Outcomes Following Left Atrial Appendage
Closure With Amplatzer Devices.
Source
JACC: Cardiovascular Interventions. 9 (13) (pp 1374-1383), 2016. Date of
Publication: 11 Jul 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to assess predictors of adverse
1-week outcomes and determine the effect of left atrial appendage (LAA)
morphology following LAA closure (LAAC) with Amplatzer devices. Background
Percutaneous LAAC is a valuable treatment option for stroke prevention in
patients with atrial fibrillation. Determinants of procedural safety
events with Amplatzer occluders are not well established, and the possibly
interrelating effect of LAA anatomy is unknown. Methods Between 2009 and
2014, 500 consecutive patients with atrial fibrillation ineligible or at
high risk for oral anticoagulation underwent LAAC using Amplatzer devices.
Procedure- and device-related major adverse events (MAEs) were defined as
the composite of death, stroke, major or life-threatening bleeding,
serious pericardial effusion, device embolization, major access-site
vascular complication, or need for cardiovascular surgery within 7 days
following the intervention. Results Patients (mean age 73.9 +/- 10.1
years) were treated with Amplatzer Cardiac Plug (n = 408 [82%]) or Amulet
(n = 92 [18%]) devices. Early procedural success was 97.8%, and MAEs
occurred in 29 patients (5.8%). Independent predictors of MAEs included
device repositioning (odds ratio: 9.13; 95% confidence interval: 2.85 to
33.54; p < 0.001) and left ventricular ejection fraction <30% (odds ratio:
4.08; 95% confidence interval: 1.49 to 11.20; p = 0.006), with no effect
of device type or size. Angiographic LAA morphology, characterized as
cauliflower (33%), cactus (32%), windsock (20%), or chicken wing (15%),
was not associated with procedural success (p = 0.51) or the occurrence of
MAEs (p = 0.78). Conclusions In this nonrandomized study, procedural
success of LAAC using Amplatzer devices was high. MAEs within 7 days were
predicted by patient- and procedure-related factors. Although LAA
morphology displayed substantial heterogeneity, outcomes were comparable
across the spectrum of LAA anatomies.<br/>Copyright &#xa9; 2016 American
College of Cardiology Foundation

<187>
Accession Number
608447919
Author
O'Gallagher K.; Dancy L.; Sinha A.; Sado D.
Institution
(O'Gallagher, Dancy, Sinha, Sado) Cardiology Department, King's College
Hospital, NHS Foundation Trust, London, United Kingdom
Title
Rosai-dorfman disease and the heart.
Source
Intractable and Rare Diseases Research. 5 (1) (pp 1-5), 2016. Date of
Publication: 2016.
Publisher
International Advancement Center for Medicine and Health Research (E-mail:
office@iacmhr.com)
Abstract
Rosai-Dorfman disease (RDD) is a non-malignant pathology of histiocyte
proliferation. The classical clinical presentation is with painless
cervical lymphadenopathy, but extranodal involvement is frequent,
occurring in approximately 40% of cases. The literature was systematically
reviewed to identify reported cases of RDD with cardiac involvement.
Eighteen cases were identified (3 pediatric and 15 adult). In adult
cardiac RDD (cRDD), three patterns of disease were noted: an intra-cardiac
mass, epicardial involvement, and pulmonary artery involvement. Reported
cases suggest that surgical excision of intra-cardiac masses confers a
good prognosis.

<188>
Accession Number
611281076
Author
Mukete B.N.; van der Heijden L.C.; Tandjung K.; Baydoun H.; Yadav K.;
Saleh Q.A.; Doggen C.J.M.; Rafeh N.A.; Le Jemtel T.H.; von Birgelen C.
Institution
(Mukete, Baydoun, Yadav, Saleh, Rafeh, Le Jemtel) Division of Cardiology,
Department of Medicine, Tulane University School of Medicine, Heart and
Vascular Institute, New Orleans, LA, United States
(van der Heijden, Tandjung, von Birgelen) Thoraxcentrum Twente, Medisch
Spectrum Twente, Enschede, Netherlands
(Doggen, von Birgelen) Health Technology and Services Research, MIRA
Institute for Biomedical Technology and Technical Medicine, University of
Twente, Enschede, Netherlands
Title
Safety and efficacy of everolimus-eluting bioresorbable vascular scaffolds
versus durable polymer everolimus-eluting metallic stents assessed at
1-year follow-up: A systematic review and meta-analysis of studies.
Source
International Journal of Cardiology. 221 (pp 1087-1094), 2016. Date of
Publication: 15 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background The Absorb bioresorbable vascular scaffold (BVS) was developed
to address long-term safety issues of metallic drug-eluting stents.
However, it may be associated with an increased event risk during the
first year. Methods A systematic literature search was performed (in
MEDLINE/PubMed, Cochrane CENTRAL, EMBASE, and scientific meeting
abstracts) to identify studies that compared BVS and cobalt-chromium
durable polymer everolimus-eluting stents (EES). For randomized clinical
trials and non-randomized propensity score matched studies that reported
1-year outcome data, fixed/random-effects models were used to generate
pooled estimates of outcomes, presented as odds ratios (OR) with
95%-confidence intervals (CI). Results The 1-year follow-up data of 6
trials with 5588 patients were analyzed. A device-oriented composite
endpoint (DOCE - cardiac death, target vessel myocardial infarction (MI),
or target lesion revascularization (TLR)) was reached by 308 BVS or EES
patients (195/3253 vs. 113/2315). Meta-analysis showed that patients who
received BVS had an increased risk of MI (4.3% vs. 2.3%; OR:1.63, 95%-CI:
1.18-2.25, p < 0.01) and definite-or-probable scaffold thrombosis (1.3%
vs. 0.6%; OR:2.10, 95%-CI: 1.13-3.87, p = 0.02). However, there was no
significant between-group difference in risk of DOCE (6.0% vs. 4.9%;
OR:1.19, 95%-CI: 0.94-1.52, p = 0.16), cardiac death (0.8% vs. 0.7%;
OR:1.14, 95%-CI: 0.54-2.39, p = 0.73), or TLR (2.5% vs. 2.5%; OR: 0.98,
95%-CI:0.69-1.40, p = 0.92). Conclusions During the first year of
follow-up, patients treated with BVS had a higher incidence of MI and
scaffold thrombosis. The risk of DOCE was not significantly different. As
BVS may pay off later, future robust data on long-term clinical outcome
will be of paramount importance.<br/>Copyright &#xa9; 2016 The Author(s)

<189>
Accession Number
613003291
Author
Alfonso F.; Perez-Vizcayno M.J.; Garcia del Blanco B.; Otaegui I.; Masotti
M.; Zueco J.; Velaquez M.; Sanchis J.; Garcia-Touchard A.; Lazaro-Garcia
R.; Moreu J.; Bethencourt A.; Cuesta J.; Rivero F.; Cardenas A.; Gonzalo
N.; Jimenez-Quevedo P.; Fernandez C.
Institution
(Alfonso, Cuesta, Rivero) Hospital Universitario de La Princesa, Madrid,
Spain
(Perez-Vizcayno) Fundacion Interhospitalaria Investigacion Cardiovascular,
Madrid, Spain
(Perez-Vizcayno, Cardenas, Gonzalo, Jimenez-Quevedo, Fernandez) Hospital
Universitario Clinico San Carlos, Madrid, Spain
(Garcia del Blanco, Otaegui) Hospital Universitario Vall d'Hebron,
Barcelona, Spain
(Masotti) Hospital Universitario Clinic de Barcelona, Barcelona, Spain
(Zueco) Hospital Universitario Marques de Valdecilla, Santander, Spain
(Velaquez) Hospital Universitario 12 de Octubre, Madrid, Spain
(Sanchis) Hospital Universitario Clinico de Valencia, Valencia, Spain
(Garcia-Touchard) Hospital Universitario Puerta de Hierro-Majadahonda,
Madrid, Spain
(Lazaro-Garcia) Hospital Universitario de Torrecardenas, Almeria, Spain
(Moreu) Hospital Universitario Virgen de la Salud, Toledo, Spain
(Bethencourt) Hospital Universitario Son Espases, Palma de Mallorca, Spain
Title
Long-Term Results of Everolimus-Eluting Stents Versus Drug-Eluting
Balloons in Patients With Bare-Metal In-Stent Restenosis: 3-Year Follow-Up
of the RIBS V Clinical Trial.
Source
JACC: Cardiovascular Interventions. 9 (12) (pp 1246-1255), 2016. Date of
Publication: 27 Jun 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to compare the long-term efficacy of
everolimus-eluting stents (EES) and drug-eluting balloons (DEB) in
patients with bare-metal stent in-stent restenosis (ISR). Background The
relative long-term clinical efficacy of current therapeutic modalities in
patients with ISR remains unknown. Methods The 3-year clinical follow-up
(pre-specified endpoint) of patients included in the RIBS V (Restenosis
Intra-Stent of Bare-Metal Stents: Drug-Eluting Balloon vs
Everolimus-Eluting Stent Implantation) randomized clinical trial was
analyzed. All patients were followed yearly using a pre-defined structured
questionnaire. Results A total of 189 patients with bare-metal stent ISR
were allocated to either EES (n = 94) or DEB (n = 95). Clinical follow-up
at 1, 2, and 3 years was obtained in all patients (100%). Compared with
patients treated with DEB, those treated with EES obtained better
angiographic results, including larger minimal luminal diameter at
follow-up (primary study endpoint; 2.36 +/- 0.6 mm vs. 2.01 +/- 0.6 mm; p
< 0.001). At 3 years, the rates of cardiac death (2% vs. 1%), myocardial
infarction (4% vs. 5%) and target vessel revascularization (9% vs. 5%)
were similar in the DEB and EES arms. Importantly, however, at 3 years,
the rate of target lesion revascularization was significantly lower in the
EES arm (2% vs. 8%; p = 0.04; hazard ratio: 0.23; 95% confidence interval:
0.06 to 0.93). The need for "late" (>1 year) target vessel (3 [3.2%] vs. 3
[3.2%]; p = 0.95) and target lesion (1 [1%] vs. 2 [2.1%]; p = 0.54)
revascularization was low and similar in the 2 arms. Rates of definite or
probable stent thrombosis (1% vs. 0%) were also similar in the 2 arms.
Conclusions The 3-year clinical follow-up of the RIBS V clinical trial
confirms the sustained safety and efficacy of EES and DEB in patients
treated for bare-metal stent ISR. In this setting, EES reduce the need for
target lesion revascularization at very long-term follow-up. (RIBS V
[Restenosis Intra-Stent of Bare Metal Stents: Paclitaxel-Eluting Balloon
vs Everolimus-Eluting Stent] [RIBS V]; NCT01239953)<br/>Copyright &#xa9;
2016 American College of Cardiology Foundation

<190>
Accession Number
611240772
Author
Dwaich K.H.; Al-Amran F.G.Y.; AL-Sheibani B.I.M.; Al-Aubaidy H.A.
Institution
(Dwaich) Ministry of Health & Environment, Karbala Health Directorate,
Iraq
(Al-Amran) Al-Najaf Center for Cardiothoracic surgery, Iraq
(AL-Sheibani) College of Pharmacy, University of Al-Qadisiyah, Iraq
(Al-Aubaidy) School of Medicine, University of Tasmania, Hobart, TAS,
Australia
Title
Melatonin effects on myocardial ischemia-reperfusion injury: Impact on the
outcome in patients undergoing coronary artery bypass grafting surgery.
Source
International Journal of Cardiology. 221 (pp 977-986), 2016. Date of
Publication: 15 Oct 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Myocardial ischemia/reperfusion injury represents a clinically
critical problem associated with coronary artery bypass graft surgery
(CABG). The degree of oxidative stress, inflammation and apoptosis are
increased during the reperfusion of the heart muscles following ischemia.
The present study aims to examine the protective role of melatonin in
ameliorating the degree of cardiac injury in patients undergoing bypass
surgery, and whether this effect is a dose related. Methods A total of
forty-five patients who were undergoing elective CABG in (Al-Najaf Cardiac
Center, Al-Najaf, Iraq) were included in this study for the period between
January, 2015 and November, 2015. Participants were randomly allocated
into 3 study groups: Placebo-controlled group (C), low dose melatonin
treatment group, 10 mg capsule once daily (M1) and high dose melatonin
treatment group 20 mg capsule once daily (M2). Results Compared to the
control group, there was a significant increase in the ejection fraction
(EF%) associated with a significant decline in heart rate (HR) among the
M1 and M2 groups compared to the C group (P < 0.05). In addition, there
was a significant reduction in plasma levels of cardiac Troponin-I (CTnI),
interleukin-1beta (IL-1beta), Inducible nitric oxide synthase (iNOS) and
caspase-3 enzymes in the melatonin groups (group M1 and M2) compared to
the control group, (P < 0.05) in Melatonin-treated groups. Comparing the
two melatonin study groups, the changes in the parameters mentioned above
were more significant in the M2 group compared to the M1 group (P < 0.05).
Conclusion These findings suggested that melatonin supplementation can
ameliorate the degree of myocardial ischemic-reperfusion injury, dose
dependent effects.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd

<191>
Accession Number
611037604
Author
Suwannasom P.; Sotomi Y.; Ishibashi Y.; Cavalcante R.; Albuquerque F.N.;
Macaya C.; Ormiston J.A.; Hill J.; Lang I.M.; Egred M.; Fajadet J.; Lesiak
M.; Tijssen J.G.; Wykrzykowska J.J.; de Winter R.J.; Chevalier B.; Serruys
P.W.; Onuma Y.
Institution
(Suwannasom, Ishibashi, Cavalcante, Onuma) ThoraxCenter, Erasmus
University Medical Center, Rotterdam, Netherlands
(Suwannasom, Sotomi, Tijssen, Wykrzykowska, de Winter) Academic Medical
Center, Amsterdam, Netherlands
(Suwannasom) Northern Region Heart Center, Maharaj Nakorn Chiang Mai
Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
(Albuquerque) Montefiore Medical Center, Albert Einstein College of
Medicine, New York, New York, United States
(Macaya) Hospital Universitario Clinico San Carlos, Madrid, Spain
(Ormiston) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Hill) King's College Hospital, London, United Kingdom
(Lang) Division of Cardiology, Department of Internal Medicine II, Medical
University of Vienna, Vienna, Austria
(Egred) Freeman Hospital, Newcastle upon Tyne, United Kingdom
(Fajadet) Department of Cardiology, Pasteur Hospital, Toulouse, France
(Lesiak) 1st Department of Cardiology, Medical University of Poznan,
Poland
(Chevalier) Institut Jacques Cartier, Massy, France
(Serruys) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
Title
The Impact of Post-Procedural Asymmetry, Expansion, and Eccentricity of
Bioresorbable Everolimus-Eluting Scaffold and Metallic Everolimus-Eluting
Stent on Clinical Outcomes in the ABSORB II Trial.
Source
JACC: Cardiovascular Interventions. 9 (12) (pp 1231-1242), 2016. Date of
Publication: 27 Jun 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The study sought to investigate the relationship between
post-procedural asymmetry, expansion, and eccentricity indices of metallic
everolimus-eluting stent (EES) and bioresorbable vascular scaffold (BVS)
and their respective impact on clinical events at 1-year follow-up.
Background Mechanical properties of a fully BVS are inherently different
from those of permanent metallic stent. Methods The ABSORB II (A
bioresorbable everolimus-eluting scaffold versus a metallic
everolimus-eluting stent for ischaemic heart disease caused by de-novo
native coronary artery lesions) trial compared the BVS and metallic EES in
the treatment of a de novo coronary artery stenosis. Protocol-mandated
intravascular ultrasound imaging was performed pre- and post-procedure in
470 patients (162 metallic EES and 308 BVS). Asymmetry index (AI) was
calculated per lesion as: (1 - minimum scaffold/stent diameter/maximum
scaffold/stent diameter). Expansion index and optimal scaffold/stent
expansion followed the definition of the MUSIC (Multicenter Ultrasound
Stenting in Coronaries) study. Eccentricity index (EI) was calculated as
the ratio of minimum and maximum scaffold/stent diameter per cross
section. The incidence of device-oriented composite endpoint (DoCE) was
collected. Results Post-procedure, the metallic EES group was more
symmetric and concentric than the BVS group. Only 8.0% of the BVS arm and
20.0% of the metallic EES arm achieved optimal scaffold/stent expansion (p
< 0.001). At 1 year, there was no difference in the DoCE between both
devices (BVS 5.2% vs. EES 3.1%; p = 0.29). Post-procedural devices
asymmetry and eccentricity were related to higher event rates while there
was no relevance to the expansion status. Subsequent multivariate analysis
identified that post-procedural AI >0.30 is an independent predictor of
DoCE (hazard ratio: 3.43; 95% confidence interval: 1.08 to 10.92; p =
0.037). Conclusions BVS implantation is more frequently associated with
post-procedural asymmetric and eccentric morphology compared to metallic
EES. Post-procedural devices asymmetry were independently associated with
DoCE following percutaneous coronary intervention. However, this approach
should be viewed as hypothesis generating due to low event rates. (ABSORB
II Randomized Controlled Trial [ABSORB II]; NCT01425281)<br/>Copyright
&#xa9; 2016 American College of Cardiology Foundation

<192>
Accession Number
612361292
Author
Pan M.; Ojeda S.; Villanueva E.; Chavarria J.; Romero M.; Mazuelos F.;
Segura J.; Carrasco F.; Hidalgo F.; Lopez Aguilera J.; Rodriguez S.;
Puente M.; Suarez de Lezo J.
Institution
(Pan, Ojeda, Villanueva, Chavarria, Romero, Suarez de Lezo, Mazuelos,
Segura, Carrasco, Hidalgo, Lopez Aguilera, Rodriguez, Puente, Suarez de
Lezo) Department of Cardiology, Reina Sofia Hospital, University of
Cordoba (IMIBIC), Cordoba, Spain
Title
Structural Damage of Jailed Guidewire During the Treatment of Coronary
Bifurcation Lesions: A Microscopic Randomized Trial.
Source
JACC: Cardiovascular Interventions. 9 (18) (pp 1917-1924), 2016. Date of
Publication: 26 Sep 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The study sought to compare the safety (resistance to damage)
and efficacy (ability to cross the side branch) of polymer-coated and
non-polymer-coated guidewires in the jailed wire technique used during the
percutaneous treatment of bifurcation lesions. Background The jailed wire
technique is a useful strategy in the treatment of bifurcation lesions by
provisional stenting. However, these wires can be damaged or even be
broken during their removal. Methods We performed a randomized study in
patients with bifurcation lesions treated by provisional stenting. The
jailed wire technique was mandatory, and the types of guidewires,
polymer-coated (n = 115) and non-polymer-coated (n = 120), were
randomized. After the procedures, the wires were evaluated by stereoscopic
microscopy. The induced damage in the wires was classified as follows: no
damage, mild, moderate, or severe. Results The clinical characteristics
were similar between patients treated with polymer-coated or
non-polymer-coated wires. Polymer-coated wires were significantly (p <
0.001) more resistant to retrieval damage (only 2 wires showed mild
damage) than were non-polymer-coated wires. However, 63 (55%) of the
non-polymer-coated wires were damaged; 37 (32%), 24 (21%), and 2 (2%) had
mild, moderate, and severe damage, respectively. Additionally, the jailed
length of the wire was a factor contributing to the degree of wire damage.
The time of side branch wiring was shorter in the polymer-coated wire
group (19 +/- 40 s vs. 42 +/- 72 s; p < 0.05). Conclusions Jailed wires
during interventional procedures of bifurcation lesions commonly showed
microscopic damage. Polymer-coated wires were more resistant to retrieval
damage and were more efficient in crossing the side branch ostium than
non-polymer-coated wires. (Jailed Wire Technique in the Treatment of
Coronary Bifurcations Lesions With Stent: Stereoscopic Microscopy Study;
NCT02516891)<br/>Copyright &#xa9; 2016 American College of Cardiology
Foundation

<193>
Accession Number
612361286
Author
Song P.S.; Song Y.B.; Lee J.M.; Hahn J.-Y.; Choi S.-H.; Choi J.-H.; Lee
S.H.; Park K.W.; Kim H.-S.; Jang Y.; Seung K.B.; Oh J.H.; Gwon H.-C.
Institution
(Song) Division of Cardiology, Department of Internal Medicine, Inje
University Haeundae Paik Hospital, Busan, South Korea
(Song, Lee, Hahn, Choi, Choi, Lee, Gwon) Division of Cardiology,
Department of Medicine, Samsung Medical Center, Sungkyunkwan University
School of Medicine, Seoul, South Korea
(Park, Kim) Seoul National University Hospital, Seoul, South Korea
(Jang) Yonsei University Severance Hospital, Seoul, South Korea
(Seung) Catholic University Kangnam St. Mary's Hospital, Seoul, South
Korea
(Oh) Samsung Changwon Hospital, Sungkyunkwan University School of
Medicine, Changwon, South Korea
Title
Major Predictors of Long-Term Clinical Outcomes After Percutaneous
Coronary Intervention for Coronary Bifurcation Lesions With 2-Stent
Strategy: Patient-Level Analysis of the Korean Bifurcation Pooled Cohorts.
Source
JACC: Cardiovascular Interventions. 9 (18) (pp 1879-1886), 2016. Date of
Publication: 26 Sep 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study investigated the long-term outcomes and predictors
of target vessel failure (a composite of cardiac death, myocardial
infarction, stent thrombosis, or target vessel revascularization) in
patients with bifurcation lesion treated by percutaneous coronary
intervention (PCI) utilizing the 2-stent strategy with a drug-eluting
stent (DES). Background There are limited data on outcomes of the 2-stent
strategy in bifurcation PCI. Methods Patient-level pooled analysis was
performed with patients undergoing PCI with 2-stent strategy from the
Korean Bifurcation Pooled Cohorts. Results A total of 951 patients (70.7%
men) with a median age of 64 years underwent bifurcation PCI with the
2-stent strategy. True bifurcation was observed in 73.2% of patients and
39.1% of patients had left main bifurcation lesions. The crush technique
was used most frequently (44.4%) and final kissing ballooning was
performed in 83.6%. The 3-year cumulative incidence of target vessel
failure, cardiac death, myocardial infarction, stent thrombosis, and
target vessel revascularization was 17.0%, 2.3%, 2.5%, 1.7%, and 14.3%,
respectively. The independent predictors of target vessel failure were
left main bifurcation (adjusted hazard ratio [HR]: 2.09; 95% confidence
interval [CI]: 1.43 to 3.03), high Synergy Between Percutaneous Coronary
Intervention With Taxus and Cardiac Surgery (SYNTAX) score (>32; adjusted
HR: 2.00; 95% CI: 1.28 to 3.14), diabetes mellitus (adjusted HR: 1.41; 95%
CI: 1.00 to 1.99), second-generation DES (adjusted HR: 0.26; 95% CI: 0.12
to 0.57), use of noncompliant balloon (adjusted HR: 0.53, 95% CI: 0.36 to
0.79), and final kissing ballooning (adjusted HR: 0.44; 95% CI: 0.29 to
0.68). Conclusions 2-stent strategy with DES is associated with feasible
procedural and acceptable long-term clinical outcomes in bifurcation PCI.
Several characteristics were identified as important periprocedural
predictors of long-term adverse outcomes.<br/>Copyright &#xa9; 2016
American College of Cardiology Foundation

<194>
Accession Number
612361290
Author
Abtan J.; Steg P.G.; Stone G.W.; Mahaffey K.W.; Gibson C.M.; Hamm C.W.;
Price M.J.; Abnousi F.; Prats J.; Deliargyris E.N.; White H.D.; Harrington
R.A.; Bhatt D.L.
Institution
(Abtan, Steg) DHU (Departement Hospitalo-Universitaire)-FIRE (Fibrosis,
Inflammation, REmodelling), Hopital Bichat, AP-HP (Assistance
Publique-Hopitaux de Paris), Universite Paris-Diderot, Sorbonne-Paris
Cite, FACT (French Alliance for Cardiovascular clinical Trials), An F-CRIN
network, INSERM U-1148, Paris, France
(Steg) NLHI, ICMS, Royal Brompton Hospital, Imperial College, London,
United Kingdom
(Stone) Columbia University Medical Center and the Cardiovascular Research
Foundation, New York, New York, United States
(Mahaffey, Harrington) Stanford Center for Clinical Research (SCCR);
Department of Medicine; Stanford School of Medicine, Stanford, California,
United States
(Gibson) Beth Israel Deaconess Medical Center, Division of Cardiology,
Harvard Medical School, Boston, Massachusetts, United States
(Hamm) Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
(Price, Abnousi) Scripps Clinic and Scripps Translational Science
Institute, La Jolla, California, United States
(Prats, Deliargyris) The Medicines Company, Parsippany, New Jersey, United
States
(White) University of Auckland, Auckland City Hospital, Auckland, New
Zealand
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center and Harvard
Medical School, Boston, Massachusetts, United States
Title
Efficacy and Safety of Cangrelor in Preventing Periprocedural
Complications in Patients With Stable Angina and Acute Coronary Syndromes
Undergoing Percutaneous Coronary Intervention: The CHAMPION PHOENIX Trial.
Source
JACC: Cardiovascular Interventions. 9 (18) (pp 1905-1913), 2016. Date of
Publication: 26 Sep 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The purpose of this study was to examine the safety and
efficacy of cangrelor in patients with stable angina (SA) or acute
coronary syndrome (ACS). Background The CHAMPION PHOENIX (A Clinical Trial
Comparing Cangrelor to Clopidogrel Standard Therapy in Subjects Who
Require Percutaneous Coronary Intervention) trial demonstrated that
cangrelor significantly reduced periprocedural ischemic events in
all-comer percutaneous coronary intervention with a modest increase in
mild and moderate bleeding. Whether this benefit is consistent across SA
and ACS has not been explored fully. Methods The CHAMPION PHOENIX trial
compared periprocedural administration of cangrelor or clopidogrel, with
either a 300- or 600-mg loading dose for the prevention of periprocedural
complications in patients undergoing percutaneous coronary intervention.
Among the 10,942 patients in the modified intention to treat population,
6,358 patients were classified as having SA, and 4,584 patients had ACS
(including unstable angina, non ST-segment elevation myocardial infarction
and ST-segment elevation myocardial infarction) at randomization. The
primary composite endpoint was death, myocardial infarction,
ischemia-driven revascularization, or stent thrombosis at 48 h. A key
secondary endpoint was stent thrombosis, and the primary safety endpoint
was GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen
Activator for Occluded Coronary Arteries) severe bleeding. Results
Cangrelor consistently reduced the primary endpoint in SA and ACS (odds
ratio [OR]: 0.83 [95% confidence interval (CI): 0.67 to 1.01] and OR: 0.71
[95% CI: 0.52 to 0.96], respectively; interaction p = 0.41). Cangrelor
also consistently reduced stent thrombosis in SA and ACS (OR: 0.55 [95%
CI: 0.30 to 1.01] and OR: 0.67 [95% CI: 0.42 to 1.06], respectively;
interaction p = 0.62). The impact of cangrelor on GUSTO severe/moderate
bleeding was also similar for SA and ACS (OR: 1.49 [95% CI: 0.67 to 3.33]
and OR: 1.79 [95% CI: 0.79 to 4.07], respectively; interaction p = 0.75).
Conclusions The benefits and risks of cangrelor were consistent in
patients with SA and ACS. (A Clinical Trial Comparing Cangrelor to
Clopidogrel Standard Therapy in Subjects Who Require Percutaneous Coronary
Intervention [PCI] [CHAMPION PHOENIX] [CHAMPION];
NCT01156571)<br/>Copyright &#xa9; 2016 American College of Cardiology
Foundation

<195>
Accession Number
612704050
Author
Chieffo A.; Petronio A.S.; Mehilli J.; Chandrasekhar J.; Sartori S.;
Lefevre T.; Presbitero P.; Capranzano P.; Tchetche D.; Iadanza A.;
Sardella G.; Van Mieghem N.M.; Meliga E.; Dumonteil N.; Fraccaro C.;
Trabattoni D.; Mikhail G.W.; Sharma S.; Ferrer M.C.; Naber C.; Kievit P.;
Faggioni M.; Snyder C.; Morice M.C.; Mehran R.
Institution
(Chieffo) Department of Cardiology, San Raffaele Scientific Institute,
Milan, Italy
(Petronio, Faggioni) Department of Cardiology, AOUP Cisanello, University
Hospital, Pisa, Italy
(Mehilli) Department of Cardiology, Ludwig-Maximilians-University of
Munich, Munich, Germany
(Chandrasekhar, Sartori, Faggioni, Snyder, Mehran) The Zena and Michael A.
Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai,
New York, New York, United States
(Lefevre, Morice) Department of Cardiology, Institut Hospitalier Jacques
Cartier, Ramsay Generale de Sante, Massy, France
(Presbitero) Department of Cardiology, Istituto Clinico Humanitas; Milan,
Italy
(Capranzano) Department of Cardiology, University of Catania, Catania,
Italy
(Tchetche) Department of Cardiology, Clinique Pasteur, Toulouse, France
(Iadanza) Department of Cardiology, Azienda Ospedaliera Universitaria
Senese, Policlinico Le Scotte, Siena, Italy
(Sardella) Department of Cardiology, Policlinico "Umberto I", "Sapienza"
University of Rome, Rome, Italy
(Van Mieghem) Department of Cardiology, Erasmus Medical Center,
Thoraxcenter, Rotterdam, Netherlands
(Meliga) Department of Cardiology, Mauriziano Hospital, Turin, Italy
(Dumonteil) Department of Cardiology, Rangueil University Hospital,
Toulouse, France
(Fraccaro) Department of Cardiology, University of Padova, Padova, Italy
(Trabattoni) Department of Cardiology, Centro Cardiologico Monzino, Milan,
Italy
(Mikhail) Department of Cardiology, Imperial College Healthcare NHS Trust,
Hammersmith Hospital, London, United Kingdom
(Sharma) Department of Cardiology, Mount Sinai Hospital, New York, New
York, United States
(Ferrer) Department of Cardiology, Hospital Universitario Miguel Servet,
Zaragoza, Spain
(Naber) Department of Cardiology, Contilia Heart and Vascular Centre,
Elisabeth Krankenhaus, Essen, Germany
(Kievit) Department of Cardiology, Radboud University Nijmegen Medical
Center, Nijmegen, Netherlands
Title
Acute and 30-Day Outcomes in Women After TAVR: Results From the WIN-TAVI
(Women's INternational Transcatheter Aortic Valve Implantation) Real-World
Registry.
Source
JACC: Cardiovascular Interventions. 9 (15) (pp 1589-1600), 2016. Date of
Publication: 08 Aug 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The study sought to examine the safety and performance of
transcatheter aortic valve replacement (TAVR) using an all-female registry
and to further explore the potential impact of female sex-specific
characteristics on clinical outcomes after TAVR. Background Although women
comprise 50% of patients with symptomatic severe aortic stenosis
undergoing TAVR, the optimal treatment strategy remains undetermined.
Methods The WIN-TAVI (Women's INternational Transcatheter Aortic Valve
Implantation) registry is a multinational, prospective, observational
registry of women undergoing TAVR for aortic stenosis, conducted without
any external funding. The primary endpoint was the Valve Academic Research
Consortium (VARC)-2 early safety endpoint at 30 days (composite of
mortality, stroke, major vascular complication, life-threatening bleeding,
stage 2 or 3 acute kidney injury, coronary artery obstruction, or repeat
procedure for valve-related dysfunction). Results Between January 2013 and
December 2015, 1,019 women were enrolled across 19 European and North
American centers. The mean patient age was 82.5 +/- 6.3 years, mean
EuroSCORE I was 17.8 +/- 11.7% and mean Society of Thoracic Surgeons score
was 8.3 +/- 7.4%. TAVR was performed via transfemoral access in 90.6% and
new-generation devices were used in 42.1%. In more than two-thirds of
cases, an Edwards SAPIEN 23 mm (Edwards Lifesciences, Irvine, California)
or Medtronic CoreValve <=26 mm (Medtronic Inc., Minneapolis, Minnesota)
device was implanted. The 30-day VARC-2 composite endpoint occurred in
14.0% with 3.4% all-cause mortality, 1.3% stroke, 7.7% major vascular
complications, and 4.4% VARC life-threatening bleeding. The independent
predictors of the primary endpoint were age (odds ratio [OR]: 1.04; 95%
confidence interval [CI]: 1.00 to 1.08), prior stroke (OR: 2.02; 95% CI:
1.07 to 3.80), left ventricular ejection fraction <30% (OR: 2.62; 95% CI:
1.07 to 6.40), new device generation (OR: 0.59; 95% CI: 0.38 to 0.91), and
history of pregnancy (OR: 0.57; 95% CI: 0.37 to 0.85). Conclusions Women
enrolled in this first ever all-female TAVR registry with collection of
female sex-specific baseline parameters, were at intermediate-high risk
and experienced a 30-day VARC-2 composite safety endpoint of 14.0% with a
low incidence of early mortality and stroke. Randomized assessment of TAVR
versus surgical aortic valve replacement in intermediate risk women is
warranted to determine the optimal strategy.<br/>Copyright &#xa9; 2016
American College of Cardiology Foundation

<196>
Accession Number
614646627
Author
Chen H.-L.; Shen W.-Q.; Liu P.; Liu K.
Institution
(Chen, Shen, Liu) School of Nursing, Nantong University, Nantong, China
(Liu) Department of Cardiothoracic Surgery, Affiliated Hospital of Nantong
University, Nantong, China
Title
Length of surgery and pressure ulcers risk in cardiovascular surgical
patients: a dose-response meta-analysis.
Source
International Wound Journal. 14 (5) (pp 864-869), 2017. Date of
Publication: October 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
The aim of this study was to assess the relationship between length of
surgery (LOS) and pressure ulcer (PU) risk in cardiovascular surgery
patients. PubMed and Web of Science were systematically searched. We
compared LOS difference between PU (+) group and PU (-) group. We also
examined the dose-response effect of this relationship. The mean LOS in
the PU(+) groups ranged from 252.5 to 335.7 minutes, compared with 233.0
to 298.3 minutes in PU(-) groups. The LOS was higher in PU(+) groups
compared with PU(-) groups [weighted mean difference (WMD) = 36.081
minutes; 95% CI: 21.640-50.522 minutes; Z = 4.90, P = 0.000]. The funnel
plot showed no publication bias. A significant dose-response association
was also found between the LOS and the risk of surgery-related pressure
ulcers (SRPU, model chi² = 9.29, P = 0.000). In the linear
model, the PU OR was 1.296 (95% CI 1.097-1.531) for a 60-minute increase
in the LOS intervals and 13.344 (95% CI 2.521-70.636) for a 600-minute
increase. In a spline model, the OR of PU increased almost linearly along
with the LOS. Our meta-analysis indicated that LOS was an important risk
factor for pressure ulcers in cardiovascular surgical
patients.<br/>Copyright &#xa9; 2017 Medicalhelplines.com Inc and John
Wiley & Sons Ltd

<197>
Accession Number
618053455
Author
Agarwal N.; Jain A.; Garg J.; Mojadidi M.K.; Mahmoud A.N.; Patel N.K.;
Agrawal S.; Gupta T.; Bhatia N.; Anderson R.D.
Institution
(Agarwal, Jain, Mojadidi, Mahmoud, Anderson) Department of Medicine,
University of Florida, Gainesville, FL, United States
(Garg) Department of Medicine, Lehigh Valley Health Network, Allentown,
PA, United States
(Patel) Department of Medicine, Virginia Commonwealth University Health
System, Richmond, VA, United States
(Agrawal) Department of Medicine, St. Lukes University Health Network,
Bethlehem, PA, United States
(Gupta) Department of Medicine, Montefiore Medical Centre, Albert Einstein
College of Medicine, Bronx, NY, United States
(Bhatia) Department of Medicine, Vanderbilt University Medical Center,
Nashville, TN, United States
Title
Staged versus index procedure complete revascularization in ST-elevation
myocardial infarction: A meta-analysis.
Source
Journal of Interventional Cardiology. 30 (5) (pp 397-404), 2017. Date of
Publication: October 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Complete revascularization of patients with ST-elevation
myocardial infarction and multivessel coronary artery disease reduces
adverse events compared to infarct-related artery only revascularization.
Whether complete revascularization should be done as multivessel
intervention during index procedure or as a staged procedure remains
controversial. Method: We performed a meta-analysis of randomized
controlled trials comparing outcomes of multivessel intervention in
patients with ST-elevation myocardial infarction and multivessel coronary
artery disease as staged procedure versus at the time of index procedure.
Composite of death or myocardial infarction was the primary outcome.
Mantel-Haenszel risk ratios were calculated using random effect model.
Results: Six randomized studies with a total of 1126 patients met our
selection criteria. At a mean follow-up of 13 months, composite of
myocardial infarction or death (7.2% vs 11.7%, RR: 1.66, 95%CI: 1.09-2.52,
P = 0.02), all cause mortality (RR: 2.55, 95%CI: 1.42-4.58, P < 0.01),
cardiovascular mortality (RR: 2.8, 95%CI: 1.33-5.86, P = 0.01), and
short-term (<30 days) mortality (RR: 3.54, 95%CI: 1.51-8.29, P < 0.01)
occurred less often in staged versus index procedure multivessel
revascularization. There was no difference in major adverse cardiac events
(RR: 1.14, 95%CI: 0.88-1.49, P = 0.33), repeat myocardial infarction (RR:
1.14, 95%CI: 0.68-1.92, P = 0.61), and repeat revascularization (RR: 0.92,
95%CI: 0.66-1.28, P = 0.62). Conclusion: In patients with ST-elevation
myocardial infarction and multivessel coronary artery disease, a strategy
of complete revascularization as a staged procedure compared to index
procedure revascularization results in reduced mortality without an
increase in repeat myocardial infarction or need for repeat
revascularization.<br/>Copyright &#xa9; 2017, Wiley Periodicals, Inc.

<198>
Accession Number
618510594
Author
Gao L.; Liu Y.; Sun Z.; Wang Y.; Cao F.; Chen Y.
Institution
(Gao, Liu, Sun, Wang, Cao, Chen) Department of Cardiology, PLA General
Hospital, Beijing 100853, China
Title
Percutaneous coronary intervention using drug-eluting stents versus
coronary artery bypass graft surgery in left main coronary artery disease
an updated meta-analysis of randomized clinical trials.
Source
Oncotarget. 8 (39) (pp 66449-66457), 2017. Date of Publication: 2017.
Publisher
Impact Journals LLC (E-mail: editors@impactaging.com)
Abstract
Objectives: To compare the safety and efficacy of percutaneous coronary
intervention (PCI) using drug-eluting stent (DES) and coronary artery
bypass graft (CABG) for the treatment of left main coronary artery (LMCA)
disease. Background: Several new randomized trials have recently examined
the clinical outcomes of PCI and CABG in LMCA disease. However, the
results of these studies were inconsistent. Materials and Methods: We
searched five online electronic databases to identify all the randomized
clinical trials assessing the outcomes of PCI using DES and CABG in
patients with LMCA. The clinical outcomes were the major adverse cardiac
and cerebrovascular event (MACCE), all-cause death, myocardial infarction
(MI), stroke, and repeat revascularization (RR). Results: A total of 5
randomized clinical trials with 4595 LMCA patients were included in this
meta-analysis. For one year follow-up, the results indicated that PCI were
associated with a lower risk of stroke (RR = 0.21, 95% CI = 0.07-0.65, P =
0.007), a higher risk of RR (RR = 1.72, 95% CI = 1.28-2.33, P < 0.001)
than CABG. Moreover, for long-term follow-up, there were significant
higher risks of MACCE and RR with PCI versus CABG (MACCE: HR = 1.26, 95%
CI = 1.11-1.44, P = 0.001; RR: HR = 1.70, 95% CI = 1.42-2.05, P < 0.001).
However, there were no significant differences between the two groups in
all-cause death and MI risks, regardless of follow-up duration.
Conclusions: PCI is noninferior to CABG in short term follow-up of
patients with LMCA disease, but CABG is more safety and efficacy than PCI
using DES in long-term follow-up.<br/>Copyright &#xa9; Gao et al.

<199>
Accession Number
618510156
Author
Gao S.; Zhang Z.; Aragon J.; Brunelli A.; Cassivi S.; Chai Y.; Chen C.;
Chen G.; Chen H.; Chen J.-S.; Cooke D.T.; Downs J.B.; Falcoz P.-E.; Fang
W.; Filosso P.L.; Fu X.; Force S.D.; Garutti M.I.; Gonzalez-Rivas D.;
Gossot D.; Hansen H.J.; He J.; Holbek B.L.; Hu J.; Huang Y.; Ibrahim M.;
Imperatori A.; Ismail M.; Jiang G.; Jiang H.; Jiang Z.; Kim H.K.; Li D.;
Li G.; Li H.; Li Q.; Li X.; Li Y.; Li Z.; Lim E.; Liu C.-C.; Liu D.; Liu
L.; Liu Y.; Lobdell K.W.; Ma H.; Mao W.; Mao Y.; Mou J.; Ng C.S.H.; Novoa
N.M.; Petersen R.H.; Oizumi H.; Papagiannopoulos K.; Pompili C.; Qiao G.;
Refai M.; Rocco G.; Ruffini E.; Salati M.; Seguin-Givelet A.; Sihoe
A.D.L.; Tan L.; Tan Q.; Tong T.; Tsakiridis K.; Venuta F.; Veronesi G.;
Villamizar N.; Wang H.; Wang Q.; Wang R.; Wang S.; Wright G.M.; Xie D.;
Xue Q.; Xue T.; Xu L.; Xu S.; Yan T.; Yu F.; Yu Z.; Zhang C.; Zhang L.;
Zhang T.; Zhang X.; Zhao X.; Zhi X.; Zhou Q.
Institution
(Gao, He, Mao, Mou, Xue) Department of Thoracic Surgical Oncology, Cancer
Institute and Hospital, Chinese Academy of Medical Sciences and Peking
Union Medical College, National Cancer Center, Beijing 100021, China
(Zhang) Department of Emergency Medicine, Sir Run-Run Shaw Hospital,
Zhejiang University School of Medicine, Hangzhou 310016, China
(Aragon) Calle/Luis Fernandez Castanon 2, Oviedo, Spain
(Brunelli, Papagiannopoulos, Pompili) Department of Thoracic Surgery, St.
James's University Hospital, Leeds, United Kingdom
(Cassivi) Mayo Clinic, Phoenix, AZ, United States
(Chai) Department of Thoracic Surgery, Second Affiliated Hospital, Medical
College of Zhejiang University, Hangzhou 310009, China
(Chen, Jiang) Department of Thoracic Surgery, Shanghai Pulmonary Hospital,
Shanghai 200433, China
(Chen) Department of Thoracic Surgery, Fujian Medical University Union
Hospital, Fujian 350001, China
(Chen) Department of Thoracic Surgery, Guangdong General Hospital,
Guangzhou 510080, China
(Chen, Fang) Department of Thoracic Surgery, Shanghai Chest Hospital,
Shanghai 200030, China
(Chen) Department of Anesthesiology, National Taiwan University Hospital,
National Taiwan University College of Medicine, Taipei 10002, Taiwan
(Republic of China)
(Cooke) Section of General Thoracic Surgery, University of California,
Davis Health System, Sacramento, CA, United States
(Downs) Department of Anesthesiology and Critical Care Medicine,
University of Florida, Gainesville, FL, United States
(Falcoz) Department of Thoracic Surgery, Strasbourg University Hospital,
Strasbourg, France
(Filosso, Ruffini) Department of Thoracic Surgery, University of Torino,
Torino, Italy
(Fu) Department of Thoracic Surgery, Tongji Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan 430030,
China
(Force) Cardiothoracic Surgery, Emory University, The Emory Clinic,
Atlanta, GA, United States
(Garutti) Department of Anaesthesia and Postoperative Care, Hospital
General Universitario Gregorio Maranon, Madrid, Spain
(Gonzalez-Rivas) Department of Thoracic Surgery, Coruna University
Hospital, Coruna, Spain
(Gossot, Seguin-Givelet) Department of Thoracic Surgery, Institut
Mutualiste Montsouris, Paris, France
(Hansen, Petersen) Department of Cardiothoracic Surgery, Rigshospitalet
(National University Hospital), Copenhagen, Denmark
(He) Department of Thoracic Surgery, The First Affiliated Hospital of
Guangzhou Medical University, Guangzhou 510000, China
(He) Guangzhou Institute of Respiratory Disease, China State Key
Laboratory of Respiratory Disease, National Clinical Research Center for
Respiratory Disease, Guangzhou 510000, China
(Holbek) Department of Cardiothoracic Surgery and Section for Surgical
Pathophysiology, Copenhagen University Hospital, Rigshospitalet,
Blegdamsvej 9, Copenhagen 2100, Denmark
(Hu) Department of Thoracic Surgery, First Affiliated Hospital, Medical
College of Zhejiang University, Hangzhou 310003, China
(Huang, Li) Department of Thoracic Surgery, Yunnan Cancer Hospital,
Kunming 650100, China
(Ibrahim) Division of Thoracic Surgery, Faculty of Medicine and
Psychology, Sant'Andrea Hospital, University of Rome 'Sapienza', Rome,
Italy
(Imperatori) Center for Thoracic Surgery, Department of Medicine and
Surgery, University of Insubria, Varese, Italy
(Ismail) Charite Kompetenzzentrum fur Thoraxchirurgie, Charite -
Universitatsmedizin Berlin, Chariteplatz 1, Berlin 10117, Germany
(Jiang, Yu) Department of Esophageal Oncology, Tianjin Medical University
Cancer Institute and Hospital, Tianjin 300060, China
(Jiang) Department of Thoracic Surgery, Shandong Qianfoshan Hospital,
Jinan 250014, China
(Kim) Department of Thoracic and Cardiovascular Surgery, College of
Medicine, Korea University Guro Hospital, Seoul, South Korea
(Li) Department of Thoracic Surgery, Peking Union Medical College
Hospital, Beijing 100032, China
(Li) Department of Thoracic Surgery, Beijing Chaoyang Hospital, Beijing
100049, China
(Li) Department of Thoracic Surgery, Sichuan Cancer Hospital and
Institute, Chengdu 610041, China
(Li) Department of Thoracic Surgery, Tangdu Hospital Fourth Military
Medical University, Xi'an 710038, China
(Li) Henan Cancer Hospital, Zhengzhou 450008, China
(Li) Department of Thoracic Surgery, Sir Run Run Shaw Hospital, Zhejiang
University School of Medicine, Hangzhou 310016, China
(Lim) Imperial College and The Academic Division of Thoracic Surgery,
Royal Brompton Hospital, Sydney Street, London, United Kingdom
(Liu) Division of Thoracic Surgery, Department of Surgery, Sun Yat-Sen
Cancer Center, Taipei, Taiwan (Republic of China)
(Liu) Department of Thoracic Surgery, China and Japan Friendship Hospital,
Beijing 100029, China
(Liu) Department of Cardiovascular and Thoracic Surgery, West China
Hospital, Sichuan University, Chengdu 610041, China
(Liu) Department of Thoracic Surgery, Liaoning Cancer Hospital and
Institute, Shengyang 110042, China
(Lobdell) Department of Thoracic and Cardiovascular Surgery, Sanger Heart
and Vascular Institute, Carolinas Medical Center, Charlotte, NC, United
States
(Ma) Department of Thoracic Surgery, The First Hospital Affiliated to
Soochow University, Suzhou 215000, China
(Mao) Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou
310000, China
(Ng) Department of Surgery, The Chinese University of Hong Kong, Prince of
Wales Hospital, Shatin, N.T., Hong Kong
(Novoa) Thoracic Surgery Service, University Hospital of Salamanca, Paseo
de San Vicente 58-182, Salamanca 37007, Spain
(Oizumi) Second Department of Surgery, Yamagata University Faculty of
Medicine, Yamagata, Japan
(Pompili) Leeds Institute of Cancer and Pathology, Leeds, United Kingdom
(Qiao) Department of Thoracic Surgery, Guangzhou General Hospital of
Guangzhou Military Area Command, Guangzhou 510000, China
(Refai) Thoracic Surgery Department, United Hospitals of Ancona, Via San
Vincenzo 5/f Polverigi, Ancona, Italy
(Rocco) Department of Thoracic Surgery and Oncology, National Cancer
Institute, Pascale Foundation, Naples, Italy
(Salati) Unit of Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy
(Sihoe) Department of Surgery, The University of Hong Kong, Queen Mary
Hospital, Hong Kong, China
(Tan, Wang, Xu) Department of Thoracic Surgery, Shanghai Zhongshan
Hospital of Fudan University, Shanghai 200032, China
(Tan, Wang) Department of Thoracic Surgery, Daping Hospital, Research
Institute of Surgery Third Military Medical University, Chongqing 400042,
China
(Tong) Department of Thoracic Surgery, Second Affiliated Hospital of Jilin
University, Changchun 130041, China
(Tsakiridis) Cardiac and Thoracic Department, Private Hospital 'St.
Lukes', Thessaloniki, Greece
(Venuta) Department of Surgery 'Paride Stefanini' - Thoracic Surgery Unit,
Policlinico Umberto I, University of Rome SAPIENZA, Rome, Italy
(Veronesi) Robotic Surgery, Division of Thoracic Surgery, Humanitas
Research Hospital, Via Manzoni 56, Rozzano, Italy
(Villamizar) University of Miami, Coral Gables, FL, United States
(Wang) Department of Thoracic Surgery, Southwest Hospital, Third Military
Medical University, Chongqing 400038, China
(Wang) Department of Thoracic Surgery, General Hospital of Shenyang
Military Area, Shenyang 110015, China
(Wright) Department of Surgical Oncology, St Vincent's Hospital,
Melbourne, Australia
(Wright) Department of Surgery, St Vincent's Hospital, University of
Melbourne, Melbourne, Australia
(Wright) Division of Surgical Oncology, Peter MacCallum Cancer Centre,
Melbourne, Australia
(Xie) Department of Cardiovascular and Thoracic Surgery, The First
Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
(Xue) Department of Thoracic Surgery, Zhongda Hospital Affiliated to
Southeast University, Nanjing 210009, China
(Xu) Department of Thoracic Surgery, Jiangsu Cancer Hospital, Nanjing
210008, China
(Xu) Department of Thoracic Surgery, Heilongjiang Cancer Hospital, Harbin
150049, China
(Yan) Department of Thoracic Surgery, Peking University Third Hospital,
Beijing 100083, China
(Yu) Department of Cardiovascular Surgery, Second Xiangya Hospital of
Central South University, Changsha 410011, China
(Zhang) Department of Thoracic Surgery, Xiangya Hospital, Central South
University, Changsha 410008, China
(Zhang) Cancer Center, San Yat-sen University, Guangzhou 510060, China
(Zhang) Department of Thoracic Surgery, The First Affiliated Hospital of
Xinjiang Medical Hospital, Urumqi 830011, China
(Zhang) Department of Thoracic Surgery, Tanjin Chest Hospital, Tianjin
300300, China
(Zhao) Department of Thoracic Surgery, Renji Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai 200003, China
(Zhao) Department of Thoracic Surgery, Shanghai Changzheng Hospital,
Shanghai 200000, China
(Zhi) Department of Thoracic Surgery, Xuanwu Hospital of Capital
University of Medical Sciences, Beijing 100053, China
(Zhou) Department of Thoracic Surgery, West China Hospital, Sichuan
University, Chengdu 610041, China
Title
The Society for Translational Medicine: Clinical practice guidelines for
the postoperative management of chest tube for patients undergoing
lobectomy.
Source
Journal of Thoracic Disease. 9 (9) (pp 3255-3264), 2017. Date of
Publication: 01 Sep 2017.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
The Society for Translational Medicine and The Chinese Society for
Thoracic and Cardiovascular Surgery conducted a systematic review of the
literature in an attempt to improve our understanding in the postoperative
management of chest tubes of patients undergoing pulmonary lobectomy.
Recommendations were produced and classified based on an internationally
accepted GRADE system. The following recommendations were extracted in the
present review: (I) chest tubes can be removed safely with daily pleural
fluid of up to 450 mL (non-chylous and non-sanguinous), which may reduce
chest tube duration and hospital length of stay (2B); (II) in rare
instances, e.g., persistent abundant fluid production, the use of
PrR<inf>P/B</inf> < 0.5 when evaluating fluid output to determine chest
tube removal might be beneficial (2B); (III) it is recommended that one
chest tube is adequate following pulmonary lobectomy, except for
hemorrhage and space problems (2A); (IV) chest tube clearance by milking
and stripping is not recommended after lung resection (2B); (V) chest tube
suction is not necessary for patients undergoing lobectomy after first
postoperative day (2A); (VI) regulated chest tube suction [-11 (-1.08 kPa)
to -20 (1.96 kPa) cmH<inf>2</inf>O depending upon the type of lobectomy]
is not superior to regulated seal [-2 (0.196 kPa) cmH2O] when electronic
drainage systems are used after lobectomy by thoracotomy (2B); (VII) chest
tube removal recommended at the end of expiration and may be slightly
superior to removal at the end of inspiration (2A); (VIII) electronic
drainage systems are recommended in the management of chest tube in
patients undergoing lobectomy (2B).<br/>Copyright &#xa9; Journal of
Thoracic Disease.

<200>
Accession Number
618509975
Author
Shang X.; Lu R.; Liu M.; Xiao S.; Dong N.
Institution
(Shang, Dong) Department of Cardiovascular Surgery, Union Hospital, Tongji
Medical College, Huazhong University of Science and Technology, Wuhan
430022, China
(Lu, Liu) Department of Intensive Care Unit, Wuhan No. 1 Hospital, Wuhan
430022, China
(Xiao) Pediatric Intensive Care Unit, Hubei Maternal and Child Health
Hospital, Wuhan 430022, China
Title
Mitral valve repair versus replacement in elderly patients: A systematic
review and meta-analysis.
Source
Journal of Thoracic Disease. 9 (9) (pp 3045-3051), 2017. Date of
Publication: 01 Sep 2017.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Although mitral valve repair (MVP) is generally accepted as
the standard treatment for mitral valve disease, in older patients, there
is increasing debate about whether MVP is superior to mitral valve
replacement (MVR). We, therefore, performed a meta-analysis to compare MVP
vs. MVR in the elderly population. Methods: We systematically searched
PubMed, the Cochrane Library, and Scopus up to February 2017 and
scrutinized the references of relevant literatures. Only studies of MVP
vs. MVR in the elderly patients (aged 70 years or older) that were
published after 2000 were included. Results: The retrieval process yielded
seven observational clinical studies with 1,809 patients. Compared with
MVR, MVP was associated with a significantly reduced 30-day mortality
[risk ratio (RR): 0.40, 95% confidence interval (CI): 0.25-0.64], with
shorter duration of postoperative hospital stay (days) (weighted mean
difference: -1.47, 95% CI: -2.47--0.48) and less postoperative
complications (RR: 0.69, 95% CI: 0.56-0.86). In addition, our study also
demonstrated improved 1-year (RR: 1.16, 95% CI: 1.08-1.24) and 5-year (RR:
1.26, 95% CI: 1.13-1.41) survival rates following MVP. There was no
difference in reoperations between these two surgery approaches.
Conclusions: The present meta-analysis indicates that elderly patients who
receive MVP have better early and late outcomes than those undergoing MVR.
MVP may be the preferred strategy for mitral valve surgery in the elderly
population.<br/>Copyright &#xa9; Journal of Thoracic Disease.

<201>
Accession Number
618509931
Author
Xu H.; Shu S.-H.; Wang D.; Chai X.-Q.; Xie Y.-H.; Zhou W.-D.
Institution
(Xu, Shu, Wang, Chai, Xie, Zhou) Department of Anesthesiology, Anhui
Provincial Hospital, Anhui Medical University, Hefei 230001, China
Title
Goal-directed fluid restriction using stroke volume variation and cardiac
index during one-lung ventilation: A randomized controlled trial.
Source
Journal of Thoracic Disease. 9 (9) (pp 2992-3004), 2017. Date of
Publication: 01 Sep 2017.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Goal-directed therapy confers a strong prognosis in patients
undergoing major cardiac or noncardiac surgery. The present study
investigated whether intraoperative goal-directed fluid restriction (GDFR)
using stroke volume variation (SVV) and cardiac index could improve
oxygenation and postoperative outcome in patients undergoing one-lung
ventilation (OLV). Methods: A Total of 168 patients scheduled for elective
thoracoscopic lobectomy under OLV were randomized into the GDFR protocol
(group G) or conventional fluid therapy groups (group C). Patients in
group C underwent conventional fluid therapy based on mean arterial
pressure (MAP), central venous pressure (CVP), and urine volume, whereas
those in group G received GDFR protocol associated with the SVV from
10-13% and the cardiac index was controlled at a minimum of 2.5
L/min/m². The primary outcome variable was
PaO<inf>2</inf>/FiO<inf>2</inf>. The secondary outcomes were other
pulmonary variables and lung mechanics, inflammatory response, the
incidence of postoperative pulmonary complications, and the length of
hospital stay. Results: During surgery, the
PaO<inf>2</inf>/FiO<inf>2</inf> ratio in group G was more than that of
group C at 30 and 60 min after OLV, 10 min after re-expansion, and the end
of the operation (259+/-29 vs. 314+/-34; 253+/-30 vs. 308+/-35; 341+/-34
vs. 394+/-39; 349+/-35 vs. 401+/-39, respectively, all P < 0.001).
Compared to conventional fluid therapy, GDFR protocol also significantly
improved the hemodynamic and lung mechanics with the initiation of OLV.
The incidence of postoperative pulmonary complications such as acute lung
injury and pneumonia, and the length of hospital stay were decreased by
GDFR protocol as compared to conventional fluid therapy (all P < 0.05).
However, there were no significant differences between groups with respect
to the concentration of serum tumor necrosis factor-alpha (TNF-alpha),
interleukin-6 (IL-6), and interleukin-10 (IL-10). Conclusions: The GDFR
protocol based on SVV and cardiac index applied in patients undergoing OLV
improves intraoperative pulmonary oxygenation. It can also reduce the
postoperative complications and length of hospital stay. However, the GDFR
strategy cannot reduce the local or systemic inflammation. Trial
registration: Chinese Clinical Trials Register ChiCTR-INR-16008288,
Registered 20 April, 2016.<br/>Copyright &#xa9; Journal of Thoracic
Disease.

<202>
Accession Number
617350858
Author
Lee J.; Jung C.-W.; Jeon Y.; Kim T.K.; Cho Y.J.; Koo C.-H.; Choi Y.H.; Kim
K.-B.; Hwang H.Y.; Kim H.-R.; Park J.-Y.
Institution
(Lee, Jung, Jeon, Kim, Cho, Koo, Choi) Department of Anesthesiology and
Pain Medicine, Seoul National University College of Medicine, Seoul
National University Hospital, Seoul, South Korea
(Kim, Hwang) Department of Thoracic and Cardiovascular Surgery, Seoul
National University College of Medicine, Seoul National University
Hospital, Seoul, South Korea
(Kim) Department of Anatomy and Cell Biology, Department of Biomedical
Sciences, BK21 Plus Biomedical Science Project, Seoul National University
College of Medicine, Seoul, South Korea
(Park) FACS Core Facility, Seoul National University College of Medicine,
Seoul, South Korea
(Lee) Department of Anesthesiology and Pain Medicine, Keimyung University
College of Medicine, Dongsan Medical Center, Daegu, South Korea
Title
Effects of preoperative aspirin on perioperative platelet activation and
dysfunction in patients undergoing off-pump coronary artery bypass graft
surgery: A prospective randomized study.
Source
PLoS ONE. 12 (7) (no pagination), 2017. Article Number: e0180466. Date of
Publication: July 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
The benefit of aspirin use after coronary artery bypass graft surgery has
been well proven. However, the effect of preoperative aspirin use in
patients undergoing off-pump coronary artery bypass graft surgery (OPCAB)
has not been evaluated sufficiently. To evaluate platelet function changes
during OPCAB due to preoperative aspirin use, we conducted a randomized
controlled trial using flow cytometry and the Multiplate
analyzer. Forty-eight patients scheduled for elective OPCAB were
randomized to the aspirin continuation (100 mg/day until operative day)
and discontinuation (4 days before the operative day) groups. Platelet
function was measured using the platelet activation markers CD62P, CD63,
and PAC-1 by flow cytometry, and platelet aggregation was measured using
the Multiplate analyzer, after the induction of anesthesia
(baseline), at the end of the operation, and 24 and 48 h postoperatively.
Findings of conventional coagulation assays, thromboelastography by
ROTEM assays, and postoperative bleeding-related clinical
outcomes were compared between groups. No significant change in CD62P,
CD63, or PAC-1 was observed at the end of the operation or 24 or 48 h
postoperatively compared with baseline in either group. The area under the
curve for arachidonic acid-stimulated platelet aggregation, measured by
the Multiplate analyzer, was significantly smaller in the
aspirin continuation group (P < 0.01). However, chest tube drainage and
intraoperative and postoperative transfusion requirements did not differ
between groups. Our study showed that preoperative use of aspirin for
OPCAB did not affect perioperative platelet activation, but it impaired
platelet aggregation, which did not affect postoperative bleeding, by
arachidonic acid.<br/>Copyright &#xa9; 2017 Lee 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.

<203>
Accession Number
614517188
Author
Elgendy I.Y.; Mahmoud A.N.; Kumbhani D.J.; Bhatt D.L.; Bavry A.A.
Institution
(Elgendy, Mahmoud, Bavry) Department of Medicine, University of Florida,
Gainesville, Florida, United States
(Kumbhani) Department of Medicine, University of Texas Southwestern
Medical Center, Dallas, Texas, United States
(Bhatt) Brigham and Women's Hospital Heart & Vascular Center, Harvard
Medical School, Boston, Massachusetts, United States
(Bavry) North Florida/South Georgia Veterans Health Systems, Gainesville,
Florida, United States
Title
Complete or Culprit-Only Revascularization for Patients With Multivessel
Coronary Artery Disease Undergoing Percutaneous Coronary Intervention: A
Pairwise and Network Meta-Analysis of Randomized Trials.
Source
JACC: Cardiovascular Interventions. 10 (4) (pp 315-324), 2017. Date of
Publication: 27 Feb 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The authors sought to compare the effectiveness of the
different revascularization strategies in ST-segment elevation myocardial
infarction (STEMI) patients with multivessel coronary artery disease
undergoing primary percutaneous coronary intervention (PCI). Background
Recent randomized trials have suggested that multivessel complete
revascularization at the time of primary percutaneous coronary
intervention (PCI) is associated with better outcomes, however; the
optimum timing for nonculprit PCI is unknown. Methods Trials that
randomized STEMI patients with multivessel disease to any combination of
the 4 different revascularization strategies (i.e., complete
revascularization at the index procedure, staged procedure during the
hospitalization, staged procedure after discharge or culprit-only
revascularization) were included. Random effect risk ratios (RRs) were
conducted. Network meta-analysis was constructed using mixed treatment
comparison models, and the 4 revascularization strategies were compared.
Results A total of 10 trials with 2,285 patients were included. In the
pairwise meta-analysis, complete revascularization (i.e., at the index
procedure or as a staged procedure) was associated with a lower risk of
major adverse cardiac events (MACE) (RR: 0.57; 95% confidence interval
[CI]: 0.42 to 0.77), due to lower risk of urgent revascularization (RR:
0.44; 95% CI: 0.30 to 0.66). The risk of all-cause mortality (RR: 0.76;
95% CI: 0.52 to 1.12), and spontaneous reinfarction (RR: 0.54; 95% CI:
0.23 to 1.27) was similar. The reduction in the risk of MACE was observed
irrespective of the timing of nonculprit artery revascularization in the
mixed treatment model. Conclusions Current evidence from randomized trials
suggests that the risk of all-cause mortality and spontaneous reinfarction
is not different among the various revascularization strategies for
multivessel disease. Complete revascularization at the index procedure or
as a staged procedure (either during the hospitalization or after
discharge) was associated with a reduction of MACE due to reduction in
urgent revascularization with no difference between these 3 strategies.
Future trials are needed to determine the impact of complete
revascularization on the risk of all-cause mortality and spontaneous
reinfarction.<br/>Copyright &#xa9; 2017 American College of Cardiology
Foundation

<204>
Accession Number
614517183
Author
Putzu A.; Boscolo Berto M.; Belletti A.; Pasotti E.; Cassina T.; Moccetti
T.; Pedrazzini G.
Institution
(Putzu, Cassina) Department of Cardiovascular Anesthesia and Intensive
Care, Cardiocentro Ticino, Lugano, Switzerland
(Boscolo Berto, Pasotti, Moccetti, Pedrazzini) Department of Cardiology,
Cardiocentro Ticino, Lugano, Switzerland
(Belletti) Department of Anesthesia and Intensive Care, Istituto di
Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific
Institute, Milan, Italy
Title
Prevention of Contrast-Induced Acute Kidney Injury by Furosemide With
Matched Hydration in Patients Undergoing Interventional Procedures: A
Systematic Review and Meta-Analysis of Randomized Trials.
Source
JACC: Cardiovascular Interventions. 10 (4) (pp 355-363), 2017. Date of
Publication: 27 Feb 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The objective of this meta-analysis of randomized trials was to
evaluate if the administration of furosemide with matched hydration using
the RenalGuard System reduces contrast-induced acute kidney injury
(CI-AKI) in patients undergoing interventional procedures. Background
CI-AKI is a serious complication following angiographic procedures and a
powerful predictor of unfavorable early and long-term outcomes. Methods
Online databases were searched up to October 1, 2016, for randomized
controlled trials. The primary outcome was the incidence of CI-AKI, and
the secondary outcomes were need for renal replacement therapy, mortality,
stroke, and adverse events. Results A total of four trials (n = 698)
published between 2011 and 2016 were included in the analysis and included
patients undergoing percutaneous coronary procedures and transcatheter
aortic valve replacement. RenalGuard therapy was associated with a lower
incidence of CI-AKI compared with control treatment (27 of 348 [7.76%]
patients vs. 75 of 350 [21.43%] patients; odds ratio [OR]: 0.31; 95%
confidence interval [CI]: 0.19 to 0.50; I² = 4%; p < 0.00001)
and with a lower need for renal replacement therapy (2 of 346 [0.58%]
patients vs. 12 of 348 [3.45%] patients; OR: 0.19; 95% CI: 0.05 to 0.76;
I² = 0%; p = 0.02). No major adverse events occurred in
patients undergoing RenalGuard therapy. Conclusions The main finding of
this meta-analysis is that furosemide with matched hydration by the
RenalGuard System may reduce the incidence of CI-AKI in high-risk patients
undergoing percutaneous coronary intervention or transcatheter aortic
valve replacement. However, further independent high-quality randomized
trials should elucidate the effectiveness and safety of this prophylactic
intervention in interventional cardiology.<br/>Copyright &#xa9; 2017
American College of Cardiology Foundation

<205>
Accession Number
618502170
Author
Krag A.E.; Hvas A.-M.
Institution
(Krag, Hvas) Department of Clinical Biochemistry, Center for Hemophilia
and Thrombosis, Aarhus University Hospital, Palle Juul-Jensens Boulevard
99, Aarhus N 8200, Denmark
Title
Ischemic Conditioning as a Hemostatic Intervention in Surgery and Cardiac
Procedures: A Systematic Review.
Source
Seminars in Thrombosis and Hemostasis. 43 (7) (pp 716-731), 2017. Date of
Publication: 01 Oct 2017.
Publisher
Thieme Medical Publishers, Inc. (E-mail: custserv@thieme.com)
Abstract
Ischemic conditioning induced by nonlethal cycles of tissue ischemia and
reperfusion attenuates ischemia-reperfusion injury. The objective of this
study is to systematically review the effects of local and remote ischemic
conditioning on laboratory parameters of hemostasis and the clinical
outcomes of thromboembolism or bleeding in patients undergoing surgery or
cardiac procedures. PubMed and Embase were searched for relevant human
trials published in English between January 1, 1986, and September 7,
2016, and additional studies were identified from reference lists. Data on
laboratory parameters of hemostasis, thromboembolism, and bleeding were
extracted for qualitative synthesis. In total, 69 studies were included;
of these, 53 were randomized controlled trials (RCTs) and 11 were
meta-analyses. Local and remote ischemic conditioning reduced platelet
activation in patients undergoing cardiac procedures. Local ischemic
conditioning did not reduce the thromboembolic risk in patients undergoing
surgery or cardiac procedures. Remote ischemic conditioning reduced the
incidence of arterial thromboembolism after surgery or cardiac procedures
in 3 out of 28 RCTs and 4 out of 5 meta-analyses. Local and remote
ischemic conditioning did not increase operative bleeding. In conclusion,
ischemic conditioning reduced platelet activity without increasing the
risk of bleeding in patients undergoing surgery or cardiac procedures.
Limited evidence supports the proposal that ischemic conditioning reduces
the incidence of arterial thromboembolism in patients undergoing surgery
or cardiac procedures.

<206>
Accession Number
614704403
Author
Jaguszewski M.; Aloysius R.; Wang W.; Bezerra H.G.; Hill J.; De Winter
R.J.; Karjalainen P.P.; Verheye S.; Wijns W.; Luscher T.F.; Joner M.;
Costa M.; Landmesser U.
Institution
(Jaguszewski, Landmesser) Department of Cardiology, Charite
Universitatsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
(Jaguszewski, Landmesser) Berlin Institute of Health (BIH), Berlin,
Germany
(Jaguszewski, Landmesser) Deutsches Zentrum fur Herz- und
Kreislaufforschung (DZHK), Berlin, Germany
(Jaguszewski) First Department of Cardiology, Medical University of
Gdansk, Gdansk, Poland, Poland
(Aloysius, Wang) Cardiovascular Imaging Core Laboratory, Harrington Heart
& Vascular Institute, Cleveland, Ohio, United States
(Bezerra, Costa) Cardiovascular Imaging Department, Case Western Reserve
University, Cleveland, Ohio, United States
(Hill) Cardiovascular Division, King's College London, London, United
Kingdom
(De Winter) Department of Cardiology, Academic Medical Center, Amsterdam,
Netherlands
(Karjalainen) Heart Center, Satakunta Central Hospital, Pori, Finland
(Verheye) Antwerp Cardiovascular Institute, Middelheim Hospital, Antwerp,
Belgium
(Wijns) Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium
(Luscher) Department of Cardiology, University Heart Center, University
Hospital Zurich, Zurich, Switzerland
(Joner) CVPath Institute Inc., Gaithersburg, Maryland, United States
Title
The REMEDEE-OCT Study: An Evaluation of the Bioengineered COMBO
Dual-Therapy CD34 Antibody-Covered Sirolimus-Eluting Coronary Stent
Compared With a Cobalt-Chromium Everolimus-Eluting Stent in Patients With
Acute Coronary Syndromes: Insights From Optical Coherence Tomography
Imaging Analysis.
Source
JACC: Cardiovascular Interventions. 10 (5) (pp 489-499), 2017. Date of
Publication: 13 Mar 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of the present study was to evaluate vascular healing
of the bioengineered COMBO Dual Therapy Stent compared with a
cobalt-chromium (CoCr) everolimus-eluting stent (EES) as assessed by
optical coherence tomography in patients with acute coronary syndromes.
Background CD34+ cells promote endothelial repair after vascular injury.
The bioengineered COMBO Dual Therapy Stent combines CD34+ cell-capturing
technology with abluminal sirolimus release, but more data from clinical
studies evaluating the vascular response are needed. Methods In a
prospective randomized multicenter clinical trial, 60 patients with acute
coronary syndromes were randomized 1:1 to COMBO or CoCr EES implantation.
The primary endpoint was the percentage of uncovered stent struts per
stent. Stent assessment by optical coherence tomography was performed at
baseline and at 60 days, followed by independent core laboratory analysis.
Results The percentage of uncovered struts per stent was higher with the
COMBO than the CoCr EES at 60 days (median 14.7% vs. 7.7%; p = 0.04).
However, no significant difference in uncovered stent struts was observed
in the strut level-based analysis at 60 days, which also accounted for
clustering (COMBO vs. CoCr EES; 13.6% vs. 6.9%; p = 0.09; generalized
linear mixed models-adjusted analysis). Neointimal thickness at 60 days
was lower with the COMBO compared with the CoCr EES (median 30.17 vs.
50.26 mum; p = 0.02; stent-level analysis). There were no significant
differences in the frequency of major adverse cardiac events and each
component of major adverse cardiac events within the study population
between the 2 groups at 30, 60, 180, 360, and 540 days post-procedure. No
target vessel stent thrombosis has been documented within 540 days.
Conclusions The present multicenter, prospective clinical study for the
first time compared the vascular response of the bioengineered COMBO Dual
Therapy Stent with a CoCr EES in patients early after acute coronary
syndrome by using intracoronary optical coherence tomographic analysis.
The percentage of uncovered stent struts per stent was somewhat higher
after COMBO versus CoCr EES implantation as detected by optical coherence
tomography, associated with reduced neointimal thickness.<br/>Copyright
&#xa9; 2017 American College of Cardiology Foundation

<207>
Accession Number
614137708
Author
Yeh R.W.; Silber S.; Chen L.; Chen S.; Hiremath S.; Neumann F.-J.; Qiao
S.; Saito S.; Xu B.; Yang Y.; Mauri L.
Institution
(Yeh) Smith Center for Outcomes Research in Cardiology, Beth Israel
Deaconess Medical Center, Boston, Massachusetts, United States
(Silber) Department of Cardiology, Heart Centre at the Isar, Munich,
Germany
(Chen) Union Hospital, Fujian Medical University, Fujian, China
(Chen) Nanjing First Hospital, Jiangshu, China
(Hiremath) Ruby Hall Clinic, Pune, India
(Neumann) University Heart Center Freiburg-Bad Krozingen, Bad Krozingen,
Germany
(Qiao, Xu, Yang) Fu Wai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences, Beijing, China
(Saito) Shonan Kamakura General Hospital, Kamakura, Japan
(Mauri) Division of Cardiovascular Medicine, Baim Institute for Clinical
Research, Brigham and Women's Hospital, Harvard Medical School, Boston,
Massachusetts, United States
Title
5-Year Safety and Efficacy of Resolute Zotarolimus-Eluting Stent: The
RESOLUTE Global Clinical Trial Program.
Source
JACC: Cardiovascular Interventions. 10 (3) (pp 247-254), 2017. Date of
Publication: 13 Feb 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The authors evaluated the 5-year cumulative incidence of
cardiovascular events following Resolute zotarolimus-eluting stent (R-ZES)
implantation. Background Individual trials are often underpowered to show
differences for low-frequency adverse events. The R-ZES was studied in 10
prospective clinical trials, designed with identical adverse event
definitions, ascertainment, and adjudication. Methods The RESOLUTE Global
Clinical Trial Program includes 7,618 patients treated with R-ZES:
RESOLUTE first-in-human study (N = 139), RESOLUTE All Comers (N = 1,140),
RESOLUTE International (N = 2,349), RESOLUTE US (N = 1,402), RESOLUTE US
38 mm (N = 114), RESOLUTE Japan (N = 100), RESOLUTE Japan Small Vessel
Study (N = 65), RESOLUTE Asia (N = 311), RESOLUTE China Randomized
Controlled Trial (N = 198), and RESOLUTE China Registry (N = 1,800). The
5-year cumulative incidence of events was calculated. Results The 5-year
cumulative incidence of cardiac events was 13.4% for target lesion failure
and included 5.0% cardiac death, 4.4% target vessel myocardial infarction,
and 6.3% clinically driven target lesion revascularization.
Dual-antiplatelet therapy at 1, 3, and 5 years was 91%, 37%, and 32%,
respectively. The 5-year cumulative incidence of definite or probable
stent thrombosis was 1.2%, which comprised 0.7% at 1 year and an
annualized rate of 0.1% thereafter. Five-year use of dual-antiplatelet
therapy varied geographically from 63% in Japan to 11% in Europe.
Conclusions In the largest group of R-ZES patients examined to date, the
majority of stent-related events, including target vessel myocardial
infarction and stent thrombosis, occurred within the first year of
implantation with much lower risks of these events out to 5
years.<br/>Copyright &#xa9; 2017 American College of Cardiology Foundation

<208>
Accession Number
606579913
Author
Amanda Dew M.; Rosenberger E.M.; Myaskovsky L.; DiMartini A.F.; DeVito
Dabbs A.J.; Posluszny D.M.; Steel J.; Switzer G.E.; Shellmer D.A.;
Greenhouse J.B.
Institution
(Amanda Dew, DiMartini) University of Pittsburgh School of Medicine and
Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213, United States
(Amanda Dew) Department of Psychology, University of Pittsburgh,
Pittsburgh, PA, United States
(Amanda Dew) Department of Epidemiology, University of Pittsburgh,
Pittsburgh, PA, United States
(Amanda Dew) Department of Biostatistics, University of Pittsburgh,
Pittsburgh, PA, United States
(Amanda Dew, Rosenberger) Clinical and Translational Science Institute,
University of Pittsburgh, Pittsburgh, PA, United States
(Rosenberger, Myaskovsky, Posluszny, Switzer) Department of Medicine,
University of Pittsburgh, Pittsburgh, PA, United States
(Myaskovsky, Switzer) Center for Health Equity Research and Promotion,
Veterans Administration Pittsburgh Healthcare System, Pittsburgh, PA,
United States
(DiMartini, Steel, Shellmer) Department of Surgery, University of
Pittsburgh, Pittsburgh, PA, United States
(DeVito Dabbs) Department of Acute and Tertiary Care, University of
Pittsburgh School of Nursing, Pittsburgh, PA, United States
(Greenhouse) Department of Statistics, Carnegie Mellon University,
Pittsburgh, PA, United States
Title
Depression and anxiety as risk factors for morbidity and mortality after
organ transplantation: A systematic review and meta-analysis.
Source
Transplantation. 100 (5) (pp 988-1003), 2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background. Depression and anxiety are common mental health problems in
transplant populations. There is mixed evidence concerning whether they
increase morbidity and mortality risks after transplantation. If such
associations exist, additional risk reduction strategiesmay be
needed.Methods. Four bibliographic databases were searched from1981
through September 2014 for studies prospectively examining whether
depression or anxiety (determined with diagnostic evaluations or
standardized symptomscales) affected risk for posttransplant mortality,
graft loss, acute graft rejection, chronic rejection, cancer, infection,
and rehospitalization. Results. Twenty-seven studies (10 heart, total n =
1738; 6 liver, n = 1063; 5 kidney, n = 49515; 4 lung, n = 584; 1 pancreas,
n = 80; 1 mixed recipient sample, n = 205) were identified. In each,
depression and/or anxiety were typically measured before or early after
transplantation. Follow-up for outcomes was a median of 5.8 years (range,
0.50-18.0). Depression increased the relative risk (RR) of mortality by
65% (RR, 1.65; 95% confidence interval [95% CI], 1.34-2.05; 20 studies).
Meta-regression indicated that risk was stronger in studies that did (vs
did not) control for potential confounders (P = .032). Risk was unaffected
by type of transplant or other study characteristics. Depression increased
death-censored graft loss risk (RR, 1.65; 95% CI, 1.21- 2.26, 3 studies).
Depression was not associated with other morbidities (each morbidity was
assessed in 1-4 studies). Anxiety did not significantly increase mortality
risk (RR, 1.39; 95% CI, 0.85-2.27, 6 studies) or morbidity risks (assessed
in single studies). Conclusions. Depression increases risk for
posttransplant mortality. Few studies considered morbidities; the
depression-graft loss association suggests that linkages with morbidities
deserve greater attention. Depression screening and treatment may be
warranted, although whether these activities would reduce posttransplant
mortality requires study.<br/>Copyright &#xa9; 2016 Wolters Kluwer Health,
Inc. All rights reserved.

<209>
Accession Number
618561064
Author
Rooke D.; Stumpf P.K.; Schefter T.; Goodman K.A.
Institution
(Rooke) University of Colorado, Aurora, CO, United States
(Stumpf, Schefter, Goodman) Department of Radiation Oncology, University
of Colorado School of Medicine, Aurora, CO, United States
Title
Evaluation of post-esophagectomy adverse events in patients who underwent
neoadjuvant concurrent chemoradiation.
Source
International Journal of Radiation Oncology Biology Physics. Conference:
59th Annual Meeting of the American Society for Radiation Oncology, ASTRO
2017. United States. 99 (2 Supplement 1) (pp E182-E183), 2017. Date of
Publication: 01 Oct 2017.
Publisher
Elsevier Inc.
Abstract
Purpose/Objective(s): Neoadjuvant chemoradiation is standard of care for
patients with Stage II-III esophageal and GE junction cancers. However,
this trimodality therapy carries significant risk of morbidity and
mortality, particularly in the post-operative setting with complication
rates of around 60%. In practice, different radiation modalities, doses,
and chemotherapy regimens are employed, however, the impact of these
factors on the incidence and severity of post-esophagectomy adverse events
is not well established. Recently, the CROSS study group reported the use
of the Comprehensive Complication Index (CCI) to assess adverse events for
those enrolled in the CROSS trial, finding 85% of patients experienced
post-operative complications. We retrospectively evaluated post-operative
complications and the correlation with treatment factors using the CCI.
Purpose/Objective(s): Eighty-three patients with mid to distal esophageal
cancer were treated with nCRT followed by resection between 2004 and 2016.
94% had adenocarcinoma. Almost all patients had a KPS >= 80 at onset of
treatment (99%). Total doses ranged from 39.6 to 52.5 Gy. Treatment was
planned using IMRT (41%), 3D-CRT (47%) and tomo-IMRT (12%). There were 29
patients who had VMAT. Concurrent chemotherapy regimens were
carboplatin/taxol (59%), cisplatin/5-FU (17%), or other (24%). Resection
was performed at a median of 9 weeks, generally by Ivor-Lewis (67%),
esophagogastrectomy (14%), or trans-hiatal (11%). Complications were
evaluated at 30, 60, and 90 day after surgery. Pulmonary, cardiac,
gastrointestinal, infectious, and nervous system complications were
retrospectively reviewed and graded using the Clavien-Dindo scale. CCI
scores were calculated with a web-based calculator at AssessSurgery.com
and means were evaluated using ANOVA. Results: Among the 83 patients, 47
experienced post-operative complications (57%). There were a total of 5
post-operative deaths (6%). There were 3 deaths in the cohort receiving up
to 45 Gy of total radiation (12%), 2 deaths between >45 and <50 Gy (10%),
and zero deaths in the group who received 50.4 Gy or more. The mean CCI
scores for all complications within 60 days were 25.1 (< or = to 45 Gy),
28.2 (>45 and <50.4 Gy), and 19.4 (> or = to 50.4), with the majority
initiating within 30 days. The mean CCI for IMRT and 3D-CRT was 27.4 and
21.8, respectively. Patients who received concurrent carboplatin/taxol had
a mean CCI of 26.2, and those who received concurrent cisplatin/5-FU had a
mean CCI of 28.3. No statistical significance was found when mean CCI
scores were compared for total radiation doses or when comparing
chemotherapy regimens. Conclusion: There did not appear to be a difference
in the severity of post-operative complications as measured by the CCI
when comparing total radiation dose or concurrent chemotherapy agents.
Additional studies are needed to further elucidate the optimal radiation
dose combined with systemic agents with the goal of improving disease
outcomes and minimizing toxicity.

<210>
Accession Number
618567714
Author
Dastan F.; Talasaz A.H.; Mojtahedzadeh M.; Karimi A.; Salehiomran A.; Bina
P.; Jalali A.
Institution
(Dastan) School of Pharmacy, ShahidBeheshti University of Medical
Sciences, Tehran, Iran
(Talasaz, Mojtahedzadeh) School of Pharmacy, Tehran University of Medical
Sciences, Tehran, Iran
(Karimi, Salehiomran, Bina, Jalali) Tehran Heart Center, Tehran University
of Medical Sciences, Tehran, Iran
Title
Randomized Trial of Carnitine for the Prevention of Perioperative Atrial
Fibrillation.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Atrial fibrillation (AF) is one of the most common complications in
patients who undergo coronary artery bypass graft surgery (CABG). The aim
of this study was to evaluate the effect of L-carnitine administration on
postoperative AF and the levels of C-reactive protein (CRP) following
CABG. The effects of L-carnitine on the incidence of acute kidney injury
after CABG were also assessed. One hundred thirty-four patients undergoing
elective CABG, without a history of AF or previous L-carnitine treatment,
were randomly assigned to an L-carnitine group (3000 mg/d L-carnitine) or
a control group. CRP levels, as a biomarker of inflammation, were assessed
in all the patients before surgery as baseline levels and 48 hours
postoperatively. Neutrophil gelatinase-associated lipocalin, as a kidney
biomarker, was also measured in the patients before surgery and 2 hours
thereafter. The incidence of AF was 13.4% in our population. The incidence
of AF was decreased in the L-carnitine group (7.5% in the L-carnitine
group vs 19.4% in the control group; P = 0.043) and the postoperative CRP
level (8.79 +/- 6.9 in the L-carnitine group, and 10.83 +/- 5.7 in the
control group; P = 0.021). The postoperative neutrophil
gelatinase-associated lipocalin concentration demonstrated no significant
rise after surgery compared with the preoperative concentration (72.54 +/-
20.30 in the L-carnitine group vs 67.68 +/- 22.71 in the placebo group; P
= 0.19). Our study showed that L-carnitine administration before CABG
might inhibit and reduce the incidence of AF after CABG. It seems that a
rise in the CRP level, as an inflammation marker, may be associated with
the incidence of AF. Inflammation as measured by CRP was also reduced in
the carnitine group, compared with the control group.<br/>Copyright &#xa9;
2017 Elsevier Inc.

<211>
Accession Number
618556258
Author
Reddy G.; Wang Z.; Nishimura R.A.; Greason K.L.; Yoon S.-H.; Makkar R.R.;
Holmes D.R.
Institution
(Reddy, Wang, Nishimura, Greason, Holmes) Department of Cardiovascular
DiseasesMayo ClinicRochester, Minnesota
(Yoon, Makkar) Department of Cardiovascular DiseasesCedars Sinai Medical
CenterLos Angeles, California
Title
Transcatheter aortic valve replacement for stenotic bicuspid aortic
valves: Systematic review and meta analyses of observational studies.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2017.
Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: The aim of this study was to perform a systematic review and
meta-analyses of observational studies of transcatheter aortic valve
replacement (TAVR) for bicuspid aortic valve stenosis (BcAV). Background:
TAVR for BcAV stenosis has been associated with an increased incidence of
paravalvular leaks, valve malposition, pacemaker placement and all-cause
mortality. The conclusions drawn have been limited by small sample sizes.
The use of TAVR for BcAV stenosis remains controversial. Methods: We
searched multiple databases from the inception of the databases through
September 30, 2016 for studies of TAVR for BcAV stenosis. We included all
observational studies with more than one patient and at least 1 month of
outcomes. Results: We analyzed 13 observational studies with 758 patients.
Meta analyses showed device success rate of 95% [95% confidence interval
(CI) 90.2% to 98.5%] and an early safety event in 16.9% [95% CI 12.2% to
22%]. At 30 days, moderate to severe paravalvular leak was seen in 12.2%
[95% CI 3.1% to 24.8%] and new pacemaker implantation in 17.9% [95% CI
14.2% to 22%]. All-cause mortality was 3.7% [95% CI 2.1% to 5.6%], which
should be viewed in the context of an STS PROM of 5.0%. Conclusions: This
analysis suggests that TAVR for BcAV is not associated with excess
mortality. The incidence of paravalvular leaks and pacemaker implant is
increased compared to tricuspid aortic valve cohorts undergoing TAVR, and
operators should weigh these potential complications against the clinical
benefit provided by TAVR for BcAV patients at high risk for surgical valve
replacement.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<212>
Accession Number
618550969
Author
Ando T.; Briasoulis A.; Telila T.; Afonso L.; Grines C.L.; Takagi H.
Institution
(Ando, Telila, Afonso) Division of CardiologyWayne State University,
Harper HospitalDetroit, Michigan
(Ando, Takagi) ALICE (All-Literature Investigation Cardiovascular
Evidence) group
(Briasoulis) Division of Heart FailureMayo ClinicRochester, Minnesota
(Grines) Division of CardiologyDetroit Medical CenterDetroit, Michigan
(Takagi) Department of Cardiovascular SurgeryShizuoka Medical Center
Shizuoka Japan
Title
Does mild paravalvular regurgitation post transcatheter aortic valve
implantation affect survival? A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2017.
Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: To assess the impact of post transcatheter aortic valve
implantation (TAVI) mild paravalvular regurgitation (PVR) on mortality.
More than moderate PVR after TAVI has decreased with the advent of
new-generation prosthetic valves. However, mild PVR remains common and its
clinical impact has been inconsistent. We aimed to assess the impact of
mild PVR through meta-analysis. Methods and Results: A systematic
literature search was conducted through PUBMED and EMBSE. Manuscripts that
reported hazard ratio (HR) with 95% confidence interval (CI) for clinical
outcome of interest (all-cause and cardiac mortality) has been included.
Random-effects model was used for calculation of HR. A total of 25
articles including total of 21,018 patients were finally included for
quantitative synthesis (meta-analysis). Our pooled analysis demonstrated
higher all-cause mortality in patients with mild PVR compared to
none/trivial PVR (HR 1.26, 95%CI 1.11-1.43, I²=45%, p<0.001)
(follow up duration range 6 months to 5 years). Significant heterogeneity
among studies was observed (p for heterogeneity=0.005). Egger's test
showed no evidence of publication bias. Cardiovascular mortality was
increased in patients with mild PVR compared with none/trivial PVR (HR
1.28, 95%CI 1.05-1.57, I²=8%, p=0.02) (follow up duration range
1-3 years). Conclusions: Mild PVR was associated with increased all-cause
and cardiovascular mortality after TAVI. Whether further interventions in
mild PVR is of benefit, has yet to be determined.<br/>Copyright &#xa9;
2017 Wiley Periodicals, Inc.

<213>
Accession Number
618504793
Author
Forrester J.D.; Cai L.Z.; Zeigler S.; Weiser T.G.
Institution
(Forrester, Weiser) Department of General Surgery, Stanford University,
300 Pasteur Drive, H3591, Stanford, CA 94305, United States
(Cai) School of Medicine, Stanford University, Stanford, CA, United States
(Zeigler) Department of Cardiothoracic Surgery, Stanford University,
Stanford, CA, United States
Title
Surgical Site Infection after Sternotomy in Low-and Middle-Human
Development Index Countries: A Systematic Review.
Source
Surgical Infections. 18 (7) (pp 774-779), 2017. Date of Publication:
October 2017.
Publisher
Mary Ann Liebert Inc. (E-mail: info@liebertpub.com)
Abstract
Background: The burden of cardiovascular disease is increasing in low-and
middle-human development index (LMHDI) countries, and cardiac operations
are an important component of a comprehensive cardiovascular care package.
Little is known about the baseline incidence of surgical site infections
(SSIs) among patients undergoing sternotomy in LMHDI countries. Methods: A
prospectively registered, systematic literature review of articles in the
PubMed, Ovid, and Web of Science databases describing the epidemiology and
management of SSIs among persons undergoing sternotomy in LMHDI countries
was performed. We performed a quantitative synthesis of patients
undergoing sternotomy for CABG to estimate published sternotomy SSI rates.
Results: Of the 423 abstracts identified after applying search criteria,
14 studies were reviewed in detail. The pooled SSI rate after sternotomy
among reviewed studies was 4.3 infections per 100 sternotomies (95%
confidence interval [CI] 1.3-6.0 infections per 100 sternotomies), which
is comparable to infection rates in high-human development index
countries. Conclusions: As the burden of cardiovascular disease in LMHDI
settings increases, the ability to provide safe cardiac surgical care is
paramount. Describing the baseline SSI rate after sternotomy in LMHDI
countries is an important first step in creating baseline expectations for
SSI rates in cardiac surgical programs in these settings.<br/>&#xa9;
Copyright 2017, Mary Ann Liebert, Inc. 2017.

<214>
Accession Number
616691743
Author
Ando T.; Takagi H.; Briasoulis A.; Umemoto T.
Institution
(Ando) Detroit Medical Center, Division of Cardiology, Detroit, MI, United
States
(Takagi, Umemoto) Shizuoka Medical Center, Division of Cardiovascular
Surgery, Shizuoka, Japan
(Briasoulis) Mayo Clinic, Division of Heart Failure, Rochester, MN, United
States
Title
Does diabetes mellitus impact prognosis after transcatheter aortic valve
implantation? Insights from a meta-analysis.
Source
Journal of Cardiology. 70 (5) (pp 484-490), 2017. Date of Publication:
November 2017.
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background Diabetes mellitus (DM) is well known to increase mortality in
several cardiovascular diseases. However, the prognostic impact of DM
following transcatheter aortic valve implantation (TAVI) remains
controversial. We sought to assess the impact of DM on perioperative
(in-hospital or 30-day) complications and mid-term (>=1 year) all-cause
mortality after TAVI through meta-analysis. Methods A comprehensive
literature search of PUBMED and EMBASE was conducted through January 1st
2002 to May 15th 2016. Articles that reported adjusted hazards ratio (HRs)
or unadjusted HR for mid-term all-cause mortality with 95% confidence
intervals (CIs) of DM or insulin dependent DM (IDDM) on mid-term all-cause
mortality post TAVI were included in the analysis. A meta-analysis was
performed with combination of both adjusted HR and un-adjusted HR.
Sensitivity analysis was performed with only the adjusted HR.
Random-effects model was used to calculate the pooled effect size. Results
A total of 22 observational cohort studies were identified with 28,440
(8998 DM and 19,442 non-DM) patients. The risk of perioperative
complications (myocardial infarction, bleeding, major vascular
complications, stroke, and new-onset atrial fibrillation) was similar
between DM and non-DM cohorts. A meta-analysis of all-cause mortality of
DM (19 studies after excluding 3 studies that only reported HR of IDDM on
mid-term all-cause mortality, 8808 DM and 17,829 non-DM patients) resulted
in significantly worse outcome (HR 1.21, 95%CI 1.10-1.34, p = 0.0002,
I² = 53%) in DM patients compared to non-DM patients post-TAVI.
Sensitivity analysis showed consistent results. Subgroup analysis (4
studies with 267 IDDM versus 2161 non-IDDM) demonstrated that IDDM was
associated with higher all-cause mortality (HR 2.05, 95%CI 1.54-2.73, p <
0.00001, I² = 0%) following TAVI. Conclusions DM was associated
with similar perioperative complications but was associated with increased
mid-term all-cause mortality after TAVI. Further study of the causes of
increased mortality during the follow-up may lead to improved
outcome.<br/>Copyright &#xa9; 2017 Japanese College of Cardiology

<215>
Accession Number
618502275
Author
Soga Y.; Shintani Y.; Hamasaki T.; Tomoi Y.; Takaoka J.; Suematsu N.;
Yokoi H.; Ando K.; Toyoda F.; Imoto Y.; Nakama T.; Taniguchi M.; Ishikwa
T.; Doi H.; Uehara Y.; Iwamoto K.
Institution
(Soga, Ando) Department of Cardiology, Kokura Memorial Hospital, 3-2-1
Asano, Kokurakita-ku, Kitakyushu 802-0001, Japan
(Shintani, Tomoi) Department of Cardiology, Shin-Koga Hospital, Kurume,
Japan
(Hamasaki) Department of Data Science, National Cerebral and
Cardiovascular Center, Suita, Japan
(Takaoka) Division of Cardiology, Tenyoukai Central Hospital, Kagoshima,
Japan
(Suematsu) Department of Cardiology, Saiseikai Fukuoka Hospital, Fukuoka,
Japan
(Yokoi) Cardiovascular Center, Fukuoka Sanno Hospital, Fukuoka, Japan
Title
Effectiveness of sarpogrelate after endovascular treatment for
femoropopliteal artery disease: ESPALIER study.
Source
Cardiovascular Intervention and Therapeutics. 32 (4) (pp 325-332), 2017.
Date of Publication: 01 Oct 2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Optimal medical therapy following endovascular therapy (EVT) for
femoropopliteal (FP) lesions remains unclear. Therefore, we investigated
whether sarpogrelate improves primary patency after EVT for FP lesions.
This study was performed as a multicenter, randomized, open-label clinical
trial. 186 patients (mean age 75 +/- 9 years, 78 % men) with Rutherford
class 2-5 due to an FP lesion were randomly assigned to receive or not
receive sarpogrelate in addition to aspirin. Primary endpoint was 1-year
primary patency and the secondary endpoints were target lesion
revascularization (TLR) and secondary patency. Primary patency was defined
as a treated vessel without restenosis or repeat revascularization.
Restenosis was defined as >2.5 of peak systolic velocity ratio. Patient,
lesion, and procedural characteristics did not differ significantly
between two groups (mean lesion length 156 +/- 94 mm, total occlusion 35
%). Stenting was performed in 133 patients (76 %). Eighty-four (94 %)
could ingest sarpogrelate during follow-up period. Primary patency was 66
% in sarpogrelate group and 56 % in non-sarpogrelate group, showing no
significant difference between the groups (p = 0.33). The incidence of TLR
did not differ in both groups (sarpogrelate 24 % vs non-sarpogrelate 32 %,
p = 0.12). Secondary patency also did not differ (sarpogrelate 90 % vs
non-sarpogrelate 92 %, p = 0.43). When the interaction of sarpogrelate
with the primary patency was analyzed in previously established subgroups,
no interactions were noted for any subset. Sarpogrelate did not improve
primary patency after EVT for FP disease in this study.<br/>Copyright
&#xa9; 2016, Japanese Association of Cardiovascular Intervention and
Therapeutics.

<216>
Accession Number
609918989
Author
Poyrazoglu H.H.; Duman Z.; Demir S.; Avsar M.K.; Atalay A.; Ciftci B.;
Bayraktar I.; Tor F.
Institution
(Poyrazoglu, Duman, Atalay, Ciftci, Bayraktar, Tor) Department of
Cardiovascular Surgery, Cukurova University School of Medicine, Adana,
Turkey
(Demir) Department of Cardiology, Adana State Hospital, Adana, Turkey
(Avsar) Department of Cardiovascular Surgery, Medicana International
Hospital, Istanbul, Turkey
Title
Investigating the impacts of preoperative steroid treatment on tumor
necrosis factor-alpha and duration of extubation time underwent
ventricular septal defect surgery.
Source
Balkan Medical Journal. 33 (2) (pp 158-163), 2016. Date of Publication:
March 2016.
Publisher
AVES Ibrahim Kara (E-mail: info@balkanmedicaljournal.org)
Abstract
Background: Cardiopulmonary bypass is known to cause inflammatory events.
Inflammation occurs due to many known important biological processes.
Numerous mechanisms are known to be responsible for the development of
inflammatory processes. Currently, there are many defined mediators as a
tumor necrosis factor-alpha (TNF-alpha) playing an active role in this
process. Aims: This research was to investigate the effects of
preoperative steroid use on inflammatory mediator TNF-alpha and on time to
extubation postoperatively in ventricular septal defect patients
undergoing cardiopulmonary bypass surgery. Study Design: Controlled
clinical study. Methods: This study included 30 patients. These patients
were assigned into two groups, each containing 15 patients. 5
micrograms/kg methylprednisolone was injected intravenously 2 hours before
the surgery to Group I, whereas there was no application to the patients
in Group II. TNF-alpha (pg/mL) level was measured in arterial blood
samples obtained at four periods including: the preoperative period (Pre
TNF); at the 5^th minute of cross-clamping (Per TNF); 2 hours
after termination of cardiopulmonary bypass (Post TNF); and at the
postoperative 24th hours in cardiovascular surgery intensive care unit
(Post 24 h TNF). Results: The mean cross-clamp time was 66+/-40 and
55+/-27 minutes in Group I and Group II respectively. No significant
difference was found between the groups in terms of cross-clamp time
(p>0.05). The mean time to extubation was 6.1+/-2.3 hours in Group I and
10.6+/-3.4 hours in Group II. Group I extubation time was significantly
shorter than Group II. Group I TNF-alpha levels at Post TNF and Post24h
TNF was lower than Group II. These differences are also statistically
significant (p<0.05). Conclusion: There is a strong indication that
preoperative steroid treatment reduced the TNF-alpha level together with
shortens duration of postoperative intubation and positively contributes
to extubation in ventricular septal defect patients operated in cardiac
surgery with cardiopulmonary bypass. (ClinicalTrials.gov Identifier:
TCTR20150930001).<br/>Copyright &#xa9; Trakya University Faculty of
Medicine.

<217>
Accession Number
372042617
Author
Guven O.; Sazak H.; Alagoz A.; Savkilioglu E.; Demirbas C.S.; Yildiz A.;
Karabulut E.
Institution
(Guven, Sazak, Alagoz, Savkilioglu, Demirbas) Department of Anesthesiology
and Reanimation, Ataturk Chest Diseases and Thoracic Surgery Education and
Research Hospital, Ankara, Turkey
(Yildiz) Department of Cardiology, Harran University, Sanliurfa, Turkey
(Karabulut) Department of Biostatistics, Hacettepe University, Ankara,
Turkey
Title
The effects of local anaesthetics on QT parameters during thoracic
epidural anaesthesia combined with general anaesthesia: Ropivacaine versus
bupivacaine.
Source
Balkan Medical Journal. 30 (4) (pp 410-414), 2013. Date of Publication:
2013.
Publisher
Galenos Publishing House
Abstract
Background: Many studies focusing on the effects of local anaesthetics on
QT intervals have been performed, but the articles evaluating the
relationship between thoracic epidural anaesthesia combined with general
anaesthesia and QT parameters are very limited. Aims: We aimed to compare
the effects of bupivacaine and ropivacaine on QT interval, corrected QT,
dispersion of QT, and corrected dispersion of QT in patients undergoing
lung resection under thoracic epidural anaesthesia combined with general
anaesthesia. Study Design: Prospective clinical study. Methods: Thirty ASA
physical status 1-3 patients requiring thoracic epidural anaesthesia
combined with general anaesthesia for thoracic surgery. Patients were
randomly assigned to two groups, which were allocated to receive either
bupivacaine (Group B) or ropivacaine (Group R) during thoracic epidural
anaesthesia. Following haemodynamic monitoring, a thoracic epidural
catheter was inserted. Local anaesthetic at an average dose of 1.5 mL/
segment was given through an epidural catheter. The same general
anaesthesia protocol was administered in both groups. Records and
measurements were performed on 10 phases that were between the thoracic
epidural catheter insertion to the 5^th min of endobronchial
intubation. In all phases, systolic arterial pressure, diastolic arterial
pressure, mean arterial pressure, heart rate, peripheral O2 saturation,
and electrocardiogram monitoring were performed in patients. All QT
parameters were recorded by 12-lead electrocardiogram and analysed
manually by a cardiologist. Results: QT intervals were similar between two
groups. In Group R, corrected QT values at the 20^th min of
local anaesthetic injection and the 5^th min of endobronchial
intubation were shorter than those in Group B (p<0.05). The basal
dispersion of QT and dispersion of QT values at the 1st min of propofol
injection were shorter than those in Group R (p<0.05). The corrected
dispersion of QT value at the 1st min of propofol injection was shorter in
Group R (p<0.05). In Group R, the decrease in mean arterial pressure at
the 1st min of fentanyl injection was significant compared with Group B
(p<0.05). There was no significant difference between the groups with
respect to heart rate and complications. Conclusion: The corrected QT,
dispersion of QT, and corrected dispersion of QT intervals were slightly
longer in the patients receiving bupivacaine compared with those receiving
ropivacaine in various phases of the present study. &#xa9; Trakya
University Faculty of Medicine.

<218>
Accession Number
362032446
Author
Hatemi A.C.; Ulusoy R.E.; Gursoy M.; Tongut A.; Canikoglu M.; Kaya A.; Ay
N.P.; Enar R.; Sozer F.F.; Karaoglu K.; Kansiz E.
Institution
(Hatemi, Gursoy, Tongut, Canikoglu, Kansiz) Department of Cardiovascular
Surgery, Institute of Cardiology, Istanbul University, Istanbul, Turkey
(Ulusoy) Department of Cardiology, Gulhane Military Medical Academy
Haydarpasa Training Hospital, Istanbul, Turkey
(Kaya) Department of Biochemistry Laboratory, Institute of Cardiology,
Istanbul University, Istanbul, Turkey
(Ay) Department of Public Health, Faculty of Medicine, Marmara University,
Istanbul, Turkey
(Enar) Department of Cardiology, Cerrahpasa Faculty of Medicine, Istanbul
University, Istanbul, Turkey
(Sozer, Karaoglu) Department of Anesthesiology and Reanimation, Institute
of Cardiology, Istanbul University, Istanbul, Turkey
Title
Myocardial protection with simultaneous antegrade/vein graft cardioplegia
compared to antegrade cardioplegia alone in elective coronary artery
bypass grafting patients.
Source
Balkan Medical Journal. 28 (1) (pp 75-79), 2011. Date of Publication:
2011.
Publisher
Galenos Publishing House
Abstract
Objective: Cardioplegia distribution beyond a stenotic coronary artery may
not be adequate. This problem can be overcome by direct delivery of
cardioplegia via the vein grafts anastomosed during the operation. The aim
of this study is to investigate the results of simultaneous antegrade/vein
graft cardioplegia versus antegrade cardioplegia alone in elective CABG
patients. Material and Methods: Forty consecutive patients were randomized
into the study group to whom antegrade/vein cardioplegia and to the
control group to whom only antegrade cardioplegia was given. Both groups
were similar with respect to demographic characteristics, postoperative
ECG changes and arrhythmia in the ICU, as well as in terms of operative
and postoperative variables (p>0.05). Results: All patients had excellent
operative and postoperative periods without any complications or death.
Release of total CK, CKMB, cTnI and lactate did not differ in the
preoperative and the frst 12^th hour (p>0.05) between the
groups, whereas in the study group a peak for total CK, CKMB, cTnI and
actate, consistent with myocardial injury (p<0.05), was found in the frst
24^th hour, which returned in the 48^th hour (p>0.05).
Conclusion: The primary fnding of this study is the inferiority of
myocardial protection with simultaneous antegrade/vein graft cardioplegia
compared with antegrade cardioplegia alone. &#xa9; Trakya University
Faculty of Medicine.

<219>
Accession Number
618504290
Author
Tang C.; Zhu Y.; Ye C.; Zhao Q.; Yu L.
Institution
(Tang, Yu) Department of Gastroenterology, China
(Zhu, Ye, Zhao) Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong
University School of Medicine, China
Title
Current status of concomitant use of proton pump inhibitors with different
antiplatelet therapies in Chinese patients after coronary artery bypass
grafting.
Source
Clinical Gastroenterology and Hepatology. Conference: 2016 International
Digestive Disease Forum, IDDF 2016. Hong Kong. 15 (1) (pp e39), 2017. Date
of Publication: January 2017.
Publisher
W.B. Saunders
Abstract
Background: Gastrointestinal complications of antiplatelet drugs are
common. Investigating the current status of concomitant use of proton pump
inhibitors (PPIs) is needed in antiplatelet drug users after coronary
artery bypass grafting (CABG). Methods: Two hundred and seventy patients
enrolled in Ruijin hospital, maximum proportion of those who were randomly
assigned into three groups after CABG including aspirin or ticagrelor
monotherapy group and ticagrelor plus aspirin group (DACAB trial, NCT
02201771), would undergo esophagogastroduodenoscopy (EGD) with their
consent at 12^th month. The grade of gastroduodenal mucosal
injury would be assessed according to the modified Lanza Endoscopic
Scoring System. Results: From August 2015 to February 2016, 109 of 124
patients finished the follow-up, of whom 92.7% (101/109) underwent EGD.
The prevalence of multiple gastroduodenal lesions, which should be treated
with PPIs, is higher in ticagrelor plus aspirin group (38.5%, 15/39),
compared with that in aspirin (33.3%, 10/30) or ticagrelor (31.3%, 10/32)
monotherapy group, respectively. All patients were prescribed with PPIs
for 1 month, 71.2% (72/101) of whom were treated with 3-month PPIs, only
7.0% (7/101) with more than 6-month. Among 17 patients with history of
peptic ulcers, 17.6% (3/17) were treated with 1-month PPIs, 64.7% (11/17)
with 3-month, only 17.7% (3/17) with more than 6-month. Conclusion: It
seems that Chinese patients are rarely under concomitant use of PPIs with
antiplatelet therapy for more than 6 months, even those with history of
peptic ulcer, demonstrating an unmet need for effective prophylactic
treatment with PPIs to decrease the risk of upper GI bleeding.

<220>
Accession Number
618505139
Author
Essex M.N.; Cheung R.; Li C.; Xie L.
Institution
(Essex, Cheung) Global Medical Affairs Pfizer Inc., 235 East 42nd St, New
York, NY 10017, United States
(Li) Biostatistics and Analysis Pfizer Inc., 1 Giralda Farms, Madison, NJ
07940, United States
(Xie) China Medical Affairs, Pfizer Investment Co. Ltd, 3-7 Chaoyangmen
North Avenue Dongcheng District, Beijing 100010, China
Title
Safety of parecoxib when used for more than 3 days for the management of
postoperative pain.
Source
Pain Management. 7 (5) (pp 383-389), 2017. Date of Publication: September
2017.
Publisher
Future Medicine Ltd. (E-mail: info@futuremedicine.com)
Abstract
Aim: To assess parecoxib safety when used for >3 days for postoperative
pain management. Methods: Treatment-emergent adverse event (TEAE)
occurrence after day 3 was examined in a pooled analysis of three
placebo-controlled trials of parecoxib following general or gynecologic
surgery, or total hip arthroplasty. A total of 358 patients received
parecoxib, and 318 placebo. Results: Mean treatment duration was similar
between treatment groups. The overall frequency of all TEAEs after day 3
was also similar between treatment groups. Most TEAEs occurred in <1% of
patients after day 3; frequencies were similar between treatment groups.
Most TEAEs were considered mild or moderate in severity. Conclusion: TEAE
occurrence in patients receiving parecoxib for >3 days was low and similar
to placebo after treatment day 3.<br/>Copyright &#xa9; 2017 Future
Medicine Ltd.

<221>
Accession Number
618478264
Author
Khan H.; Uzzaman M.; Benedetto U.; Butt S.; Raja S.G.
Institution
(Khan, Raja) Department of Cardiac Surgery, Harefield Hospital, London,
United Kingdom
(Uzzaman) Department of Cardiac Surgery, Queen Elizabeth Hospital,
Birmingham, United Kingdom
(Benedetto) Department of Cardiac Surgery, Bristol Heart Institute,
Bristol, United Kingdom
(Butt) Department of Cardiac Surgery, Kings College Hospital, London,
United Kingdom
Title
On- or off-pump coronary artery bypass grafting for octogenarians: A
meta-analysis of comparative studies involving 27,623 patients.
Source
International Journal of Surgery. 47 (pp 42-51), 2017. Date of
Publication: November 2017.
Publisher
Elsevier Ltd
Abstract
Objective Coronary artery bypass grafting (CABG) is being increasingly
offered to octogenarians. Both on- and off-pump CABG are reported as
effective surgical revascularization strategies for octogenarians by
single institution studies. However, the issue of superiority of one
strategy over the other for octogenarians remains unresolved due to
limited sample size of these studies. A meta-analysis of studies comparing
outcomes of on- and off-pump CABG in octogenarians was undertaken to
address the issue. Methods A literature search was conducted from 1966
through September 2016 using MEDLINE, EMBASE, Scopus and Web of Science to
identify relevant articles. Primary outcomes of interest included
in-hospital mortality and stroke. Secondary outcomes of interest were
atrial fibrillation, acute renal failure, reoperation for bleeding, deep
sternal wound infection, myocardial infarction, intensive therapy unit
(ITU) stay and hospital stay. The random effects model was used to
calculate the outcomes of both binary and continuous data to control any
heterogeneity between the studies. Heterogeneity amongst the trials was
determined by means of the Cochran Q value and quantified using the
I² inconsistency test. All p-values were 2-sided and a 5% level
was considered significant. Results Sixteen retrospective studies (18,685
on-pump patients and 8938 off-pump patients) were included in the
systematic review. In-hospital mortality (pooled OR = 0.64, 95% CI = 0.44
to 0.93; p = 0.02), stroke rate (pooled OR = 0.61, 95% CI = 0.48 to 0.76;
p < 0.001) and length of hospital stay (pooled WMD = +0.29, 95% CI = +0.02
to +0.56; p = 0.04) were significantly lower in the off-pump patients.
Atrial fibrillation (p = 0.36), acute renal failure (p = 0.47),
reoperation for bleeding (p = 0.99), deep sternal wound infection (p =
0.59), myocardial infarction (p = 0.93), and length of ITU stay (p = 0.27)
were comparable. Conclusion Off-pump compared to on-pump CABG offers
surgical myocardial revascularization to octogenarians with lower
in-hospital mortality, stroke rate and length of hospital stay with
similar incidence of other adverse outcomes. Preferentially offering
off-pump CABG to octogenarians could translate into reduced economic
burden on the healthcare providers.<br/>Copyright &#xa9; 2017 IJS
Publishing Group Ltd

<222>
Accession Number
618499671
Author
Body R.; Boachie C.; McConnachie A.; Carley S.; Van Den Berg P.; Lecky
F.E.
Institution
(Body) Cardiovascular Sciences, University of Manchester, Manchester,
United Kingdom
(Body, Carley) Emergency Department, Central Manchester University
Hospitals Foundation NHS Trust, Manchester, United Kingdom
(Boachie, McConnachie) Robertson Centre for Biostatistics, Institute of
Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
(Carley) Healthcare Sciences, Manchester Metropolitan University,
Manchester, United Kingdom
(Van Den Berg) School of Medicine, Maastricht University, Maastricht,
Netherlands
(Lecky) Emergency Department, Salford Royal Infirmary, Manchester, United
Kingdom
Title
Feasibility of the Manchester Acute Coronary Syndromes (MACS) decision
rule to safely reduce unnecessary hospital admissions: A pilot randomised
controlled trial.
Source
Emergency Medicine Journal. 34 (9) (pp 586-592), 2017. Date of
Publication: September 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background Observational studies suggest that the Manchester Acute
Coronary Syndromes (MACS) decision rule can effectively rule out' and rule
in' acute coronary syndromes (ACS) following a single blood test. In a
pilot randomised controlled trial, we aimed to determine whether a large
trial is feasible. Methods Patients presenting to two EDs with suspected
cardiac chest pain were randomised to receive care guided by the MACS
decision rule (intervention group) or standard care (controls). The
primary efficacy outcome was a successful discharge from the ED, defined
as a decision to discharge within 4 hours of arrival providing that the
patient did not have a missed acute myocardial infarction (AMI) or develop
a major adverse cardiac event (MACE: death, AMI or coronary
revascularisation) within 30 days. Feasibility outcomes included
recruitment and attrition rates. Results In total, 138 patients were
included between October 2013 and October 2014, of whom 131 (95%) were
randomised (66 to intervention and 65 controls). Nine (7%) patients had
prevalent AMI and six (5%) had incident MACE within 30 days. All 131
patients completed 30-day follow-up and were included in the final
analysis with no missing data for the primary analyses. Compared with
standard care, a significantly greater proportion of patients whose care
was guided by the MACS rule were successfully discharged within 4 hours
(26% vs 8%, adjusted OR 5.45, 95% CI 1.73 to 17.11, p=0.004). No patients
in either group who were discharged within 4 hours had a diagnosis of AMI
or incident MACE within 30 days (0.0%, 95% CI 0% to 20.0% in the
intervention group). Conclusions In this pilot trial, use of the MACS rule
led to a significant increase in safe discharges from the ED but a larger,
fully powered trial remains necessary. Our findings seem to support the
feasibility of that trial. Trial registration number ISRCTN 86818215.
Research Ethics Committee reference 13/NW/0081. UKCRN registration ID
14334.<br/>Copyright &#xa9; Article author(s) (or their employer(s) unless
otherwise stated in the text of the article) 2017. All rights reserved.

<223>
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).<br/>Copyright &#xa9; 2017 Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article) 2017. All rights reserved.

<224>
Accession Number
614767715
Author
Saad M.; Nairooz R.; Rashed A.; Abdelaziz H.K.; Mentias A.; Abbott J.D.
Institution
(Saad, Nairooz) Department of Medicine, Division of Cardiovascular
Medicine, University of Arkansas for Medical Sciences, Little Rock, AR,
United States
(Rashed) Department of Medicine, Division of Cardiovascular Medicine,
Wayne State University/Detroit Medical Center, Detroit, MI, United States
(Abdelaziz) Department of Cardiovascular Medicine, Blackpool Teaching
Hospital NHS Foundation Trust, Lancashire Cardiac Centre, Blackpool,
United Kingdom
(Mentias) Department of Medicine, Division of Cardiovascular Medicine,
University of Iowa Carver College of Medicine, Iowa City, IA, United
States
(Abbott) Division of Cardiovascular Medicine, Rhode Island Hospital, Brown
Medical School, Providence, RI, United States
Title
Bivalirudin versus heparin in women undergoing percutaneous coronary
intervention: A systematic review and meta-analysis of randomized clinical
trials.
Source
Cardiovascular Revascularization Medicine. 18 (6) (pp 418-424), 2017. Date
of Publication: September 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background The anticoagulant of choice during percutaneous coronary
intervention (PCI) in women is not well established. Methods An electronic
search was conducted for trials that randomized patients undergoing PCI to
bivalirudin versus heparin, and reported outcomes of interest in women.
Random effects DerSimonian-Laird risk ratios (RR) were calculated. Main
outcome was net adverse clinical events (NACE) at 30-days. Other outcomes
included major adverse cardiac events (MACE), all-cause mortality,
myocardial infarction (MI), target vessel revascularization (TVR), and
major bleeding at 30-days. 1-year all-cause mortality and MACE were also
examined. Results Nine trials that randomized women undergoing PCI to
bivalirudin (n = 3960) versus heparin (n = 4050) were included. At
30-days, bivalirudin was associated with reduced risk of NACE (RR = 0.85;
95% CI 0.73-0.98; p = 0.03), mainly driven by reduction in major bleeding
(RR = 0.59; 95% CI 0.49-0.71; p < 0.001) compared with heparin. No
difference in MACE (p = 0.92), all-cause mortality (p = 0.23), MI (p =
0.86); or TVR (p = 0.53) was demonstrated between both groups. At 1-year,
the risk of MACE and all-cause mortality was similar in both groups. On a
subgroup analysis, the benefit associated with bivalirudin appeared to be
less evident when Glycoprotein IIb/IIIa inhibitors (GPI) was used as
bailout therapy with heparin, however without significant interaction.
Furthermore, in STEMI population, no difference in NACE, MACE, or major
bleeding was observed between both groups. Conclusion In women undergoing
PCI, bivalirudin is associated with reduced risk of major bleeding and
NACE compared with heparin especially when GPI is routinely
used.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<225>
Accession Number
618444463
Author
Shoucri R.; Kerkhof P.L.M.; Kozman H.; Li J.K.J.
Institution
(Shoucri) Mathematics and Computer Science, Royal Military College of
Canada, Kingston, ON, Canada
(Kerkhof) Department of Physics and Medical Technology, Vrije Universiteit
Medical Center, Amsterdam, Netherlands
(Kozman) State University of New York Upstate Medical University,
Syracuse, NY, United States
(Li) Biomedical Engineering, Rutgers, The State University of New Jersey,
Piscataway, NJ, United States
Title
Heart Failure: An Exploration of Recent Advances in Research and
Treatment.
Source
Clinical Medicine Insights: Cardiology. 9s1 (pp 143-146), 2015. Date of
Publication: 01 Jan 2015.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)

<226>
Accession Number
618500434
Author
Filardo G.; Hamman B.L.; da Graca B.; Sass D.M.; Machala N.J.; Ismail S.;
Pollock B.D.; Collinsworth A.W.; Grayburn P.A.
Institution
(Filardo, Sass, Machala, Ismail, Pollock) Department of Epidemiology,
Baylor Scott and White Health, Dallas, Tex
(da Graca, Collinsworth) Center for Clinical Effectiveness, Baylor Scott
and White Health, Dallas, Tex
(Filardo, da Graca, Pollock, Collinsworth) Robbins Institute for Health
Policy and Research, Baylor University, Waco, Tex
(Filardo) Department of Statistics, Southern Methodist University, Dallas,
Tex
(Hamman) Department of Cardiothoracic Surgery, Baylor Heart and Vascular
Institute, Baylor University Medical Center, Dallas, Tex
(Grayburn) Department of Cardiology, Baylor Heart and Vascular Institute,
Baylor University Medical Center, Dallas, Tex
Title
Efficacy and effectiveness of on- versus off-pump coronary artery bypass
grafting: A meta-analysis of mortality and survival.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background: Despite many studies comparing on- versus off-pump coronary
artery bypass graft (CABG), there is no consensus as to whether one of
these techniques offers patients better outcomes. Methods: We searched
PubMed from inception to June 30, 2015, and identified additional studies
from bibliographies of meta-analyses and reviews. We identified 42
randomized controlled trials (RCTs) and 31 rigorously adjusted
observational studies (controlling for the Society of Thoracic
Surgeons-recognized risk factors for mortality) reporting mortality for
off-pump versus on-pump CABG at specified time points. Trial data were
extracted independently by 2 researchers using a standardized form.
Differences in probability of mortality (DPM) were estimated for the RCTs
and observational studies separately and combined, for time points ranging
from 30 days to 10 years. Results: RCT-only data showed no significant
differences at any time point, whereas observational-only data and the
combined analysis showed short-term mortality favored off-pump CABG (n =
1.2 million patients; 36 RCTs, 26 observational studies; DPM [95%
confidence interval (CI)], -44.8% [-45.4%, -43.8%]) but that at 5 years it
was associated with significantly greater mortality (n = 60,405 patients;
3 RCTs, 5 observational studies; DPM [95% CI], 10.0% [5.0%, 15.0%]). At 10
years, only observational data were available, and off-pump CABG showed
significantly greater mortality (DPM [95% CI], 14.0% [11.0%, 17.0%]).
Conclusions: Evidence from RCTs showed no differences between the
techniques, whereas rigorously adjusted observational studies (with >1.1
million patients) and the combined analysis indicated that off-pump CABG
offers lower short-term mortality but poorer long-term survival. These
results suggest that, in real-world settings, greater operative safety
with off-pump CABG comes at the expense of lasting survival
gains.<br/>Copyright &#xa9; 2017 The American Association for Thoracic
Surgery.