EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

Total documents retrieved: 89

Results Generated From:
Embase <1980 to 2017 Week 48>
Embase (updates since 2017-11-17)

<1>
Accession Number
614075888
Author
Hongisto M.; Tarvasmaki T.; Tolppanen H.; Parissis J.; Masip J.; Harjola
V.-P.; Harjola V.; Banaszewski M.; Kober L.; Lassus J.; Mebazaa A.;
Silva-Cardoso J.; Sionis A.; Di Somma S.; Spinar J.; Koniari K.;
Voumvourakis A.; Karavidas A.; Sans-Rosello J.; Vila M.; Duran-Cambra A.;
Metra M.; Carubelli V.; Bulgari B.; Lazzarini V.; Parenica J.; Stipal R.;
Ludka O.; Palsuva M.; Ganovska E.; Kubena P.; Lindholm M.G.; Hassager C.;
Backlund T.; Jurkko R.; Jarvinen K.; Nieminen T.; Pulkki K.; Soininen L.;
Sund R.; Tierala I.; Tolonen J.; Varpula M.; Korva T.; Pietila M.; Pitkala
A.; Marino R.; Sousa A.; Sousa C.; Paiva M.; Rangel I.; Almeida R.; Pinho
T.; Julia Maciel M.; Stepinska J.; Skrobisz A.; Goral P.
Institution
(Hongisto, Tarvasmaki, Harjola) Emergency Medicine, University of
Helsinki, Department of Emergency Care, Helsinki University Hospital,
Helsinki, Finland
(Lassus, Tolppanen) Helsinki University Hospital, Heart and Lung Center,
Division of Cardiology, Helsinki, Finland
(Sionis) Intensive Cardiac Care Unit, Cardiology Department, Hospital de
la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant
Pau) Barcelona, Spain
(Lindholm) Rigshospitalet, Copenhagen University Hospital, Intensive
Cardiac Care Unit, Copenhagen, Denmark
(Banaszewski) Institute of Cardiology, Intensive Cardiac Therapy Clinic,
Warsaw, Poland
(Parissis) Attikon University Hospital, Heart Failure Clinic and Secondary
Cardiology Department, Athens, Greece
(Spinar) University Hospital Brno, Department of Internal Medicine and
Cardiology, Brno, Czech Republic
(Silva-Cardoso) University of Porto, CINTESIS, Department of Cardiology,
Porto Medical School, Sao Joao Hospital Center, Porto, Portugal
(Carubelli) Division of Cardiology, Department of Medical and Surgical
Specialties, Radiological Sciences, and Public Health, University and
Civil Hospital of Brescia, Italy
(Di Somma) Department of Medical Sciences and Translational Medicine,
University of Rome Sapienza, Emergency Medicine Sant'Andrea Hospital,
Rome, Italy
(Masip) University of Barcelona, Hospital Sant Joan Despi Moises Broggi,
Critical Care Department, Consorci Sanitari Integral, Barcelona, Spain
Title
Use of noninvasive and invasive mechanical ventilation in cardiogenic
shock: A prospective multicenter study.
Source
International Journal of Cardiology. 230 (pp 191-197), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Despite scarce data, invasive mechanical ventilation (MV) is
widely recommended over non-invasive ventilation (NIV) for ventilatory
support in cardiogenic shock (CS). We assessed the real-life use of
different ventilation strategies in CS and their influence on outcome
focusing on the use of NIV and MV. Methods 219 CS patients were
categorized by the maximum intensity of ventilatory support they needed
during the first 24 h into MV (n = 137; 63%), NIV (n = 26; 12%), and
supplementary oxygen (n = 56; 26%) groups. We compared the clinical
characteristics and 90-day outcome between the MV and the NIV groups.
Results Mean age was 67 years, 74% were men. The MV and NIV groups did not
differ in age, medical history, etiology of CS,
PaO<inf>2</inf>/FiO<inf>2</inf> ratio, baseline hemodynamics or LVEF. MV
patients predominantly presented with hypoperfusion, with more severe
metabolic acidosis, higher lactate levels and greater need for vasoactive
drugs, whereas NIV patients tended to be more often congestive. 90-day
outcome was significantly worse in the MV group (50% vs. 27%), but after
propensity score adjustment, mortality was equal in both groups.
Confusion, prior CABG, ACS etiology, higher lactate level, and lower
baseline PaO<inf>2</inf> were independent predictors of mortality, whereas
ventilation strategy did not have any influence on outcome. Conclusions
Although MV is generally recommended mode of ventilatory support in CS, a
fair number of patients were successfully treated with NIV. Moreover,
ventilation strategy was not associated with outcome. Thus, NIV seems a
safe option for properly chosen CS patients.<br/>Copyright &#xa9; 2016
Elsevier Ireland Ltd

<2>
Accession Number
616823653
Author
Bikmoradi A.; Masmouei B.; Ghomeisi M.; Roshanaei G.; Masiello I.
Institution
(Bikmoradi) Department of health economics and management, School of
public health, Hamadan University of Medical Sciences, Hamadan, Iran,
Islamic Republic of
(Masmouei) Department of Medical Surgical Nursing, School of Nursing and
Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran, Islamic
Republic of
(Ghomeisi) Department of Surgery, School of Medicine, Kermanshah
University of Medical Sciences, Kermanshah, Iran, Islamic Republic of
(Roshanaei) Department of Epidemiology &amp; Biostatistics, School of
Public Health, Hamadan University of Medical Sciences, Hamadan, Iran,
Islamic Republic of
(Masiello) Department of Clinical Science and Education, Karolinska
Institutet, Sodersjukhuset, Stockholm, Sweden
Title
Impact of telephone counseling on the quality of life of patients
discharged after coronary artery bypass grafts.
Source
Patient Education and Counseling. 100 (12) (pp 2290-2296), 2017. Date of
Publication: December 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background This study aimed to assess the impact of telephone counseling
on quality of life in patients with coronary artery bypass graft. Methods
A quasi-experimental study was conducted with 71 discharged patients after
coronary artery bypass graft surgery at Ekbatan Edcuational hospital in
Hamadan, Iran, in 2014. The patients were randomly allocated into
intervention (n = 36) and control group (n = 35). The intervention group
received education and counseling about therapeutic plan via telephone
after discharge. Patients in the control group received only routines. All
patients completed the quality of life questionnaire before and after the
intervention period of five weeks. Results There was no significant
difference between intervention and control group about quality of life
before intervention (p = 0.696). However, there was significant and
positive deference between the two groups in favor of the telephone
counseling after the intervention (P = 0.01) and control group (P = 0.04).
Quality of life in the intervention group was significantly better
compared to control group (P = 0.01). Conclusions Telephone counseling
could be a cost-effective patient counseling plan for therapeutic
adherence after coronary artery bypass surgery in order to improve the
patients' quality of life. Practice implications Telephone counseling is
feasible to implement and well accepted for patient counseling for many
diseases.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<3>
Accession Number
619243556
Author
Amouzegar S.M.; Lak M.
Institution
(Amouzegar, Lak) Department of Anesthesiology, School of Medical Sciences,
Baqiyatallah University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Title
An assessment of renal function with pulsatile perfusion during proximal
graft using cardiac contraction in coronary artery bypass graft surgery.
Source
Nephro-Urology Monthly. 9 (5) (no pagination), 2017. Article Number:
e14324. Date of Publication: September 2017.
Publisher
Kowsar Corp (E-mail: info@anesthpain.com)
Abstract
Background: Short-term pulsatile perfusion during cardio pulmonary bypass
has shown higher protection for renal physiology, following standard
preservation of glomerular filtration and reduction of renal tissue
damage. Methods: In this randomized clinical trial study, 70 patients, who
had undergone CABG surgery were divided to 2 groups; pulsatile and
non-pulsatile groups. The researchers transferred continuous blood flow to
pulsatile blood flow during proximal graft using cardiac contraction.
Patients' laboratory tests, such as blood urea nitrogen (BUN) and
creatinine were checked preoperatively, at the arrival of the open heart
intensive care unit (ICU-OH), and 24 and 48 hours after admission.
Results: Both case and control groups had significantly increased BUN and
creatinine. Increased creatinine on the first and second postoperative day
was significantly higher in the control group. Furthermore,BUNincreased on
the second day in the control group and was significantly higher than the
case group Conclusions: Despite the rise inBUNand creatinine in the 2
groups, there werenocases of renal failure in the patients. However, the
results of this study regarding creatinine and BUN criteria were supported
by the pulsatile perfusion method during the proximal graft by using a
cardiac contraction in CABG surgery.<br/>Copyright &#xa9; 2017,
Nephro-Urology Monthly.

<4>
Accession Number
619209723
Author
Lei L.; Katznelson R.; Fedorko L.; Carroll J.; Poonawala H.; Machina M.;
Styra R.; Rao V.; Djaiani G.
Institution
(Lei, Katznelson, Fedorko, Carroll, Poonawala, Machina, Djaiani)
Departments of Anesthesia and Pain Management, Toronto General Hospital,
University Health Network, University of Toronto, Toronto, ON, Canada
(Styra) Department of Psychiatry, Toronto General Hospital, University
Health Network, University of Toronto, Toronto, ON, Canada
(Rao) Division of Cardiovascular Surgery, Toronto General Hospital,
University Health Network, University of Toronto, Toronto, ON, Canada
Title
Cerebral oximetry and postoperative delirium after cardiac surgery: a
randomised, controlled trial.
Source
Anaesthesia. 72 (12) (pp 1456-1466), 2017. Date of Publication: December
2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Postoperative delirium is associated with increased morbidity and
mortality. We hypothesised that restoration of regional cerebral oxygen
desaturation would reduce the incidence of postoperative delirium in
elderly patients after cardiac surgery. After institutional ethics review
board approval and informed consent, a double-blinded, prospective,
randomised, controlled trial was conducted in patients >= 60 years of age
undergoing cardiac surgery with cardiopulmonary bypass. In the
intervention group, an algorithm was commenced if regional cerebral oxygen
saturation decreased below 75% of baseline value for 1 min or longer. In
the control group, the cerebral oximetry monitor screen was electronically
blinded. Assessment of delirium was performed with confusion assessment
method for intensive care unit or confusion assessment method after
discharge from intensive care unit at 12-h intervals for seven
postoperative days. Postoperative delirium was present in 30 out of 123
(24.4%) and 31 out of 126 (24.6%) patients in the intervention and control
groups, respectively, odds ratio 0.98 (95%CI 0.55-1.76), p = 0.97.
Postoperative delirium was present in 20 (71%) out of 28 and in 41 (18%)
out of 221 patients with baseline regional cerebral oxygen saturation <=
50, or > 50%, respectively, p = 0.0001. Higher baseline regional cerebral
oxygen saturation and body mass index were protective against
postoperative delirium. Restoration of regional cerebral oxygen
desaturation did not result in lower postoperative delirium after cardiac
surgery. Pre-operative regional cerebral oxygen saturation <= 50% was
associated with increased postoperative delirium rates in elderly patients
following cardiac surgery.<br/>Copyright &#xa9; 2017 The Association of
Anaesthetists of Great Britain and Ireland

<5>
Accession Number
619295929
Author
Lesiawan E.; Stewart R.; Webster M.
Institution
(Lesiawan, Stewart) University of Auckland, Auckland, New Zealand
(Lesiawan, Stewart, Webster) Green Lane Cardiovascular Services Auckland
City Hospital, New Zealand
Title
A meta-analysis of current era randomised clinical trials comparing
revascularisation with optimal medical therapy for coronary artery
disease.
Source
Heart Lung and Circulation. Conference: Cardiac Society of Australia and
New Zealand Annual Scientific Meeting, CSANZ 2017. New Zealand. 26
(Supplement 1) (pp S18), 2017. Date of Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Background: An invasive strategy is recommended in patients presenting
with an acute coronary syndrome, but the benefits of coronary
revascularisation in patients with stable coronary heart disease (CHD)
have been more controversial. To evaluate current evidence, we undertook a
metaanalysis of relevant, more recent randomised clinical trials. Method:
Medline, PubMed, and Central were searched for randomised trials comparing
revascularisation procedures (coronary artery bypass surgery and/or
percutaneous coronary interventions (PCI)) to optimal medical therapy
published from 2000 to 2016. Studies were included with >=100 patients
randomised and clinical outcomes reported for >=12 months. Results: 17
trials allocated 8,448 patients to a revascularisation procedure and 8,259
patients to medical therapy. Revascularisation was associated with lower
mortality [Odds Ratio (OR) 0.88 (95%CI 0.81s,0.96)], cardiac mortality [OR
0.79 (95%CI 0.71,0.88)] and revascularisation [OR 0.61 (95%CI 0.57,0.66)]
at latest follow-up. The reduction in myocardial infarction with
revascularisation was less marked [OR 0.91 (95%CI 0.82,1.00)]. Results
were similar when restricted to studies of patients with stable CHD. When
comparing PCI with optimal medical therapy in a non-acute setting, PCI
reduced cardiac mortality [OR 0.76 (95%CI 0.60,0.97)] and
revascularisation [OR 0.64 (95%CI 0.57,0.71)], but not allcause mortality
[OR 0.90 (95%CI 0.77,1.05)] or myocardial infarction [OR 1.08 (95%CI
0.90,1.29)]. Conclusion: A meta-analysis of clinical trials published
between 2000 and 2016 suggests that coronary revascularisation is
associated with reduced major adverse cardiac events, compared to medical
therapy in all patients and in those with stable coronary heart disease.

<6>
Accession Number
619295732
Author
Thein P.; White K.; Banker K.; Lunny C.; Mirzaee S.; Nasis A.
Institution
(Thein) Monash Medical Centre, Monash Health, Clayton, Australia
(White, Banker) Monash University, Melbourne, Australia
(Mirzaee, Nasis) Monash Heart, Monash Medical Centre, Monash Health,
Melbourne, Australia
(Lunny) Cochrane Australia, Department of Epidemiology, Preventive
Medicine School of Public Health, Melbourne, Australia
Title
Prophylactic role of beta blockers in new-onset atrial fibrillation after
cardiac surgery. a systematic review and meta-analysis.
Source
Heart Lung and Circulation. Conference: Cardiac Society of Australia and
New Zealand Annual Scientific Meeting, CSANZ 2017. New Zealand. 26
(Supplement 1) (pp S27), 2017. Date of Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Background: Current epidemiological data suggests that postoperative
atrial fibrillation or atrial flutter (POAF) causes significant morbidity
and mortality after cardiac surgery. The literature for prophylactic
management of POAF is limited, resulting in lack of clear guideline
management recommendations. Aim: To examine the efficacy of prophylactic
rate control agents in reducing the incidence of new-onset POAF in
patients undergoing elective cardiac surgery. Methods: Cochrane Central
Register of Controlled Trials (CENTRAL), EMBASE, and MEDLINE were
systematically searched for blinded randomised controlled studies (RCT)
evaluating adults with no history of atrial fibrillation randomised to a
pharmacological agent (either beta blocker, calcium channel blocker or
digoxin), compared to placebo. Utilising Cochrane guidance, three
reviewers screened, extracted and assessed the quality of the evidence. We
used a random effects meta-analysis to compare a rate-control agent with
placebo. Results: Five RCTs (688 subjects, mean age 61 +/- 8.9, 69% male)
were included. Beta blocker administration prior to elective cardiac
surgery significantly reduced the incidence of POAF (OR 0.43,95%Cl [0.30,
0.61], I2 = 0%) without significant impact on ischaemic stroke (OR 0.49,
95%Cl [0.10, 2.44], I2 = 0%), non-fatal myocardial infarction (OR 0.76,
95%Cl [0.08-7.44]), overall mortality (OR 0.83, 95%Cl [0.19-3.66], I2 =
0%), or length of stay-0.96 days (95%Cl-1.49 to-0.42, I2 = 0%). An
increased rate of bradycardic episodes was observed (OR 3.53, 95%Cl
[1.22-10.23], I2 = 0%). Conclusion: This review suggests that selective
administration of prophylactic oral beta blockers prior to elective
cardiac surgery is safe and may reduce the incidence of POAF.

<7>
Accession Number
619295658
Author
Wang T.K.M.; Wang M.T.M.; Glenie T.; El-Jack S.; Khan A.
Institution
(Wang) Auckland City Hospital, Auckland, New Zealand
(Wang, Glenie, El-Jack, Khan) North Shore Hospital, Auckland, New Zealand
(Wang, Wang) University of Auckland, Auckland, New Zealand
Title
Percutaneous coronary intervention versus coronary artery bypass grafting
for severe left main disease: A meta-analysis.
Source
Heart Lung and Circulation. Conference: Cardiac Society of Australia and
New Zealand Annual Scientific Meeting, CSANZ 2017. New Zealand. 26
(Supplement 1) (pp S23), 2017. Date of Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Background: Coronary artery bypass (CABG) grafting is traditionally the
gold standard treatment for severe unprotected left main (LMS) coronary
artery disease, however percutaneous coronary intervention (PCI) for LMS
disease has gained popularity in recent years. This meta-analysis pooled
the outcomes of randomised trials comparing PCI and CABG for severe LMS
disease. Methods: We searched Medline, Embase and Cochrane from 1980 to 31
October 2016 for randomised trials of PCI versus CABG for severe LMS
disease for data extraction and subsequent pooled analyses using random
effects models. Results: Amongst 2,275 articles searched, 53 full-texts
were reviewed and 6 randomised trials totalling 4,706 patients were
included. Composite of death, myocardial infarction (MI) and stroke was
similar between PCI and CABG odds ratio 0.98 (95% confidence interval
0.81-1.20, p = 0.86), with no difference in all-cause mortality (p =
0.91), myocardial infarction (p = 0.17) or stroke (p = 0.65). PCI did have
higher rates of repeat revascularisation 1.76 (1.02-1.53) and if this is
included also higher MACE 1.33 (1.15-1.54, p < 0.001). There were no
differences in all of the above individual endpoints at 30 days. Subgroup
analyses found no differences in MACE rates between the two treatment
modalities for elderlies >65 years of age, either sex, diabetics or all
tertiles of syntax scores. Conclusions: PCI had similar rates of death,
myocardial infarction, stroke and their composite during follow-up
compared to CABG, except for more repeat revascularisation required. PCI
therefore provides a viable alternative intervention for severe LMS
traditionally treated by CABG.

<8>
Accession Number
619295644
Author
Liao Y.-W.B.; Wang T.K.M.; Wang M.T.M.; Wheeler M.
Institution
(Liao, Wang, Wheeler) Auckland City Hospital, Auckland, New Zealand
(Wang, Wang) University of Auckland, Auckland, New Zealand
Title
Meta-analysis of surgical repair or replacement for rheumatic mitral valve
disease.
Source
Heart Lung and Circulation. Conference: Cardiac Society of Australia and
New Zealand Annual Scientific Meeting, CSANZ 2017. New Zealand. 26
(Supplement 1) (pp S34-S35), 2017. Date of Publication: 2017.
Publisher
Elsevier Ltd
Abstract
Background: Rheumatic heart disease remains one of the leading causes of
valvular heart disease worldwide despite being a preventable condition.
Valve repair is superior to replacement in degenerative mitral valve
disease, however their relative efficacies is controversial in rheumatic
heart disease, in part because of differing and mixed lesions and
pathologies, technical challenges, and recurrent events. This
meta-analysis compared mitral valve repair and replacement surgery for
rheumatic mitral valve disease. Methods: We searched Medline, EMBASE,
Cochrane and Scopus databases from January 1980 to June 2016 for original
studies reporting outcomes of both mitral valve repair and replacement in
rheumatic heart disease. Two authors independently assessed studies for
inclusion, followed by data extraction and analysis. Results: The search
yielded 933 articles, with 100 full-texts reviewed after initial screening
and 17 studies were included for analysis, totalling 1982 mitral valve
repairs and 3426 replacements. Pooled rates and odds ratio (95% confidence
interval) for operative mortality of repair versus replacement was 3.2% vs
4.3%, 0.68 (0.50-0.92; p = 0.01). Pooled odds ratios (95% confidence
interval) were for long-term mortality 0.41 (0.30-0.56; p < 0.001); valve
related mortality 0.23 (0.14-0.37; p < 0.001); re-operation 3.02
(1.72-5.31; p < 0.001); and bleeding 0.26 (0.11-0.63; p = 0.003). There
was a trend towards lower thromboembolism 0.42 (0.17-1.03; p = 0.06) and
no significant difference in endocarditis (p = 0.76) rates during
follow-up. Conclusion: Mitral valve repair is associated with reduction in
operative and long-term mortality and bleeding, so is recommended to be
performed in rheumatic mitral valve disease where feasible, although it
does have higher rates of re-operations during follow-up.

<9>
Accession Number
619297396
Author
Callahan S.; Yarmus L.; Silvestri G.; Pastis N.
Institution
(Callahan, Yarmus, Silvestri, Pastis) Medical University of South
Carolina, Charleston, SC, United States
Title
Correlation between vital signs and depth of sedation determined by
modified observer's assessment of alertness and sedation score.
Source
Chest. Conference: CHEST 2017 Annual Meeting. Canada. 152 (4 Supplement 1)
(pp A886), 2017. Date of Publication: October 2017.
Publisher
Elsevier Inc.
Abstract
PURPOSE: American Society of Anesthesiologist (ASA) guidelines recommend
recording level of consciousness, hemodynamics and respiratory function at
regular intervals before and during a procedure, at recovery, and prior to
discharge. The Modified Observer's Assessment of Alertness and Sedation
(MOAA/S) score is frequently used, but its methods are subjective in
determining level of sedation. The scale ranges from group 5 (responds
readily to name) to group 0 (does not respond to painful stimuli). The
primary aim of this study was to evaluate the correlation between MOAA/S
level of sedation and changes in vital signs. METHODS: Data was taken from
two large multicenter three arm phase III studies evaluating the efficacy
and safety of Remimazolam compared to Midazolam and to placebo in patients
undergoing colonoscopy (n=461) and bronchoscopy (n=446). The complete
colonoscopy data and early bronchoscopy data were available. MOAA/S scores
were recorded pre-dose, then at 1, 1.5, 2, 2.5, and 3 minutes after
medication injection and then at 1 minute intervals until the patient was
fully alert. After fully alert, the MOAA/S score was recorded every 5
minutes until ready for discharge and thereafter every 10 minutes. Vital
signs were recorded at 5 hours, 30, 15 and 1 minute(s) pre-dose, then 2
and 5 minutes post dose and then every 5 minutes thereafter until fully
alert. Descriptive summaries (n, mean, Standard Deviation (SD), median,
minimum and maximum) and ANOVA models were used for comparison. RESULTS:
The number of MOAA/S data points in MOAA/S groups 0-2 during bronchoscopic
and endoscopic procedures were 10% and 6.8%, respectively. Combined MOAA/S
data points in group 0-2 were 8.0%. 92% of the combined MOAA/S data points
were in groups 3-5. Using analysis of variance, pulse oximetry
(SpO<inf>2</inf>) of patients was almost equal in MOAA/S group 0 (98.4%,
SD 2.3) and group 5 (98.5%, SD 2.07). Heart rate, systolic and diastolic
blood pressure of group 0 were near baseline value. There was only a
correlation between respiratory rate and MOAA/S score showing decrease in
respiratory rate as level sedation increased. This decrease in respiratory
rate, however, did not affect SpO<inf>2</inf>. Adverse event data
available from the colonoscopy study suggests that hypotension appeared to
be more pronounced in the Midazolam group compared to Remimazolam or
placebo groups, but there was no clinically significant difference across
MOAA/S scores in each treatment group. CONCLUSIONS: In patients undergoing
bronchoscopic or endoscopic procedures, heart rate and blood pressure
remained at baseline despite deep sedation (MOAA/S groups 0-2).
SpO<inf>2</inf> at MOAA/S group 0 was the same as group 5. While
respiratory rate declines as patients become more sedated based on MOAA/S,
other vital signs remain stable, including SpO<inf>2</inf>. Vital signs do
not consistently change along with level of sedation, but further studies
are warranted to confirm this.

<10>
Accession Number
619296224
Author
Dickfos M.
Institution
(Dickfos) Prince Charles Hospital, Brisbane, QLD, Australia
Title
Surgical management of amiodarone-induced thyroiditis.
Source
International Journal of Surgery. Conference: 40th Anniversary Conference
of the Association of Surgeons in Training, ASiT 2016. United Kingdom. 36
(Supplement 1) (pp S45), 2016. Date of Publication: November 2016.
Publisher
Elsevier Ltd
Abstract
Introduction: Amiodarone can be a life-saving medication; however it also
has multiple side effects, for example; amiodarone-induced thyroiditis
(AIT). AIT is rare, (incidence of 3-5%[1]), complex and life-threatening.
AIT can cause significant cardiac dysfunction and cardiac failure. Medical
management in Australia consists of cessation of amiodarone, prescription
of thionamides, percholates and steroids.[2] However, a small sub-group
don't respond and are referred for a semi-elective total thyroidectomy.
These are complex surgical patients with hyperthyroidism, the potential
for thyrotoxic crisis, and end-stage cardiac failure. However without
surgical removal of their thyroid gland they will continue to deteriorate,
with a mortality rate of 30-50%.[3]. Method: Due to the rarity of this
condition, a case series was used to evaluate the role of surgical
management of AIT in those who have failed medical treatment. Results:
Patients were analysed with respect to; duration of trial of medical
treatment, pre-medical treatment cardiac function, pre- and postoperative
cardiac function, surgical complications and survival. Their results were
compared to those of non-AIT patients undergoing total thyroidectomy.
Conclusions: Total thyroidectomy in patients with AIT shows comparable
clinical outcomes to total thyroidectomies for other indications. It also
restores euthyroidism and reduces mortality risk in patients with AIT.

<11>
Accession Number
619296161
Author
Karsan R.; Rajakaruna C.
Institution
(Karsan, Rajakaruna) University of Bristol, Bristol, United Kingdom
Title
Aprotinin for reduction of post-operative blood loss and incidences of
cerebrovascular events following endocarditis surgery. A pilot study.
Source
International Journal of Surgery. Conference: 40th Anniversary Conference
of the Association of Surgeons in Training, ASiT 2016. United Kingdom. 36
(Supplement 1) (pp S55), 2016. Date of Publication: November 2016.
Publisher
Elsevier Ltd
Abstract
Aprotinin has shown to be efficacious in cardiac surgeries involving high
blood loss. There is strong evidence indicating it effectively reduces
postoperative blood loss and the need for blood transfusion following
surgery. Evidence is however, limited in relation to the potential
benefits/risks of aprotinin in open-heart endocarditis surgery. Aim: To
determine whether aprotinin reduces post-operative bleeding following
endocarditis surgery, compared to conventional techniques. Method: In this
retrospective study, data from 50 patients who underwent endocarditis
surgery from 2011-15, was analysed comparing 24-hour postoperative blood
loss, kidney function and cerebrovascular events. Comparisons of aprotinin
vs. control (tranexamic acid) were undertaken with; paired t-test,
Mann-Whitney U test, Kruskal-Wallis test and Chi-squared analysis. Result:
Blood loss over 24 hours was found to be lower in the group given
aprotinin, with a significant difference seen at 6 and 12 hours
postoperatively (p=0.03). The need for blood transfusion was also seen to
be lower in the aprotinin arm (RR = 0.875, 95% CI = 0.55-1.38 p = 0.09).
Conclusion: This pilot study highlights potential benefits of aprotinin to
reduce post-operative blood loss and transfusion requirement in
endocarditis surgery, This is only a snapshot but suggests that the study
methodology employed is viable to a much larger study with increased
power.

<12>
Accession Number
619305011
Author
Schiller W.; Barnewold L.; Kazmaier T.; Beckmann A.; Masseli F.; Welz A.;
Szecsenyi J.; Heller G.
Institution
(Schiller, Masseli, Welz) Department of Cardiac Surgery, University of
Bonn, Bonn, Germany
(Barnewold, Kazmaier, Szecsenyi) AQUA-Institut fur angewandte
Qualitatsforderung, Forschung im Gesundheitswesen GmbH, Gottingen, Germany
(Beckmann) Department of Cardiac and Vascular Surgery, Heart Center
Duisburg, Duisburg, Germany
(Heller) IQTIG-Institut fur Qualitatssicherung, Transparenz im
Gesundheitswesen, Berlin, Germany
Title
The German aortic valve score II.
Source
European Journal of Cardio-thoracic Surgery. 52 (5) (pp 881-887), 2017.
Date of Publication: 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The German Aortic Valve Score (GAVS) was developed for
national quality assurance regarding the in-hospital mortality rate of
patients following isolated aortic valve replacement. The goal of this
work was the recalibration of the GAVS in the context of increased numbers
of transcatheter aortic valve implantations. METHODS: In 2011 and 2012, 36
183 cases were documented who had either surgical aortic valve replacement
or transcatheter aortic valve implantation (45%). All cases were randomly
assigned to the study or to the validation group. All items of the data
set were checked for significance by developing a multiregression risk
model using iterative backward elimination. Calibration was ascertained
using the Hosmer-Lemeshow method. To define the quality of discrimination,
the area under the receiver operating characteristic curve (C-statistic)
was calculated. RESULTS: The randomized study cohort comprised 18 054
patients. After modelling with multiple regression algorithms, 18 of the
initial 28 risk factors entered the risk model. When applied to the
validation group, the newly developed GAVS II showed good calibration with
a P-value of 0.411 in the Hosmer-Lemeshow test and good discrimination
with a C-statistic of 0.741. CONCLUSIONS: The GAVS II is a new risk model
that is applicable to cohorts having surgical aortic valve replacement or
transcatheter aortic valve implantation procedures.<br/>Copyright &#xa9;
The Author 2017. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<13>
Accession Number
619304993
Author
Sa M.P.B.O.; Soares A.F.; Miranda R.G.A.; Araujo M.L.; Menezes A.M.;
Vasconcelos Silva F.P.; Lima R.C.
Institution
(Sa, Soares, Miranda, Araujo, Menezes, Vasconcelos Silva, Lima) Division
of Cardiovascular Surgery, Pronto Socorro Cardiologico de Pernambuco
(PROCAPE), Recife, Brazil
(Sa, Soares, Miranda, Araujo, Menezes, Vasconcelos Silva, Lima) University
of Pernambuco (UPE), Recife, Brazil
(Sa, Lima) Nucleus of Postgraduate and Research in Health Sciences of
Faculty of Medical Sciences, Biological Sciences Instituite (FCM/ICB),
Recife, Brazil
Title
Stopping versus continuing acetylsalicylic acid before coronary artery
bypass surgery: A systematic review and meta-analysis of 14 randomized
controlled trials with 4499 patients.
Source
European Journal of Cardio-thoracic Surgery. 52 (5) (pp 838-847), 2017.
Date of Publication: 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
This study aimed to evaluate the efficacy and safety of continuing versus
stopping aspirin [acetylsalicylic acid (ASA)] preoperatively in patients
undergoing coronary artery bypass graft surgery. MEDLINE, EMBASE,
CENTRAL/Cochrane Controlled Trials Register (CCTR), ClinicalTrials.gov,
Scientific Electronic Library Online (SciELO), Literatura Latino Americana
em Ciencias da Saude (LILACS), Google Scholar and reference lists of
relevant articles were searched for randomized controlled trials that
reported efficacy outcomes ofmyocardial infarction and mortality, and
safety outcomes of blood loss, packed red blood cell transfusion and
surgical re-exploration were compared between groups. Fourteen studies
fulfilled our eligibility criteria and included a total of 4499 patients
(2329 for 'continuing ASA' and 2170 for 'stopping ASA'). In the pooled
analysis, continuing aspirin therapy did not reduce the risk of myocardial
infarction [risk ratio 0.834, 95% confidence interval (CI) 0.688-1.010; P
= 0.063] or operative mortality (risk ratio 1.384, 95% CI 0.727-2.636; P =
0.323). Preoperative ASA increased postoperative chest tube drainage (mean
difference 143 ml, 95% CI 39-248 ml; P = 0.007) and packed red blood cell
transfusion (mean difference 142ml, 95% CI 55-228; P = 0.001) but did not
increase the risk of surgical re-exploration (risk ratio 1.316, 95% CI
0.910-1.905; P = 0.145). This meta-analysis found no statistically
significant difference regarding the risk of operative mortality and
myocardial infarction between the 'continuing ASA' and 'stopping ASA'
strategies. On the other hand, the mean volume of blood loss and packed
red blood cell transfusion was higher in the 'continuing ASA' group, but
this finding did not translate into higher risk of reoperation for
bleeding.<br/>Copyright &#xa9; The Author 2017. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<14>
Accession Number
619304670
Author
Barker C.M.; Reardon M.J.
Institution
(Barker, Reardon) Houston Methodist DeBakey Heart and Vascular Center,
Houston Methodist Hospital, Houston, TX, United States
Title
Clinical practice update: Who should be referred for transcatheter aortic
valve replacement in 2017?.
Source
US Cardiology Review. 11 (2) (pp 67-71), 2017. Date of Publication: 2017.
Publisher
Radcliffe Publishing Ltd (E-mail: jonathan.mckenna@touchbriefings.com)
Abstract
Transcatheter aortic valve replacement (TAVR) was initially envisioned as
a less invasive option for patients with severe symptomatic aortic
stenosis (AS) either not candidates or very high-risk candidates for
surgical aortic valve replacement (SAVR). Based on data from the original
Placement of Aortic Transcatheter Valves (PARTNER) trial and CoreValve US
Pivotal trials, TAVR is now approved and accepted in the treatment for
severe symptomatic AS in extreme-, high-, and intermediate-risk patients.
Thus far, the randomized controlled trial data for TAVR have been
non-inferior or even superior to both medical therapy and SAVR. Given all
the data, the logical next step is to study low-risk patient groups.
Anecdotal and non-randomized data have been conflicting when comparing
TAVR with SAVR in low-risk patients. Two low-risk randomized trials have
started in the US, and ultimately, these trials will determine the
feasibility of TAVR as an acceptable alternative to SAVR in low-risk
patients with severe AS. Thus, in 2017, any patient with AS should be
referred to a multidisciplinary valve team to be evaluated for TAVR, SAVR,
or nothing, depending on risk and availability of ongoing clinical
trials.<br/>Copyright &#xa9; Radcliffe Cardiology 2017.

<15>
Accession Number
619304658
Author
Cutlip D.E.
Institution
(Cutlip) Division of Cardiology and Department of Medicine, Beth Israel
Deaconess Medical Center, Harvard Medical School, Boston, MA, United
States
Title
Clinical trial perspective: Optimizing crossover from ticagrelor to
clopidogrel in patients with acute coronary syndrome (CAPITAL OPTICROSS).
Source
US Cardiology Review. 11 (2) (pp 59-61), 2017. Date of Publication: 2017.
Publisher
Radcliffe Publishing Ltd (E-mail: jonathan.mckenna@touchbriefings.com)
Abstract
Guideline-recommended treatment in patients with acute coronary syndrome
is dual anti-platelet therapy (DAPT) with aspirin and a P2Y12 inhibitor,
with clopidogrel or ticagrelor the preferred options for initial therapy.
Ticagrelor has been demonstrated to have improved efficacy, and is
preferred over clopidogrel in the absence of contraindications or the need
for oral anticoagulation. However, it is not uncommon that patients are
switched to clopidogrel after starting on ticagrelor. Reasons for this may
be related to recognition of the increased risk of bleeding, the higher
costs of ticagrelor, or adverse effects such as adenosine-mediated
dyspnea. It is therefore important to understand the optimal dosing
strategy in patients undergoing a switch from ticagrelor to clopidogrel. A
loading dose of clopidogrel is standard when initiating therapy for acute
coronary syndrome or before coronary stenting. However, whether this is
required in patients who have already achieved adequate platelet
inhibition with ticagrelor is unknown. Owing to the short half-life of the
unbound active metabolite of clopidogrel at standard doses, there are
concerns of high on-treatment platelet activity for a period of time
following switching. However, this must be balanced against concerns of an
increased risk of bleeding if a loading dose is used. To investigate this,
the Optimizing Crossover From Ticagrelor To Clopidogrel In Patients With
Acute Coronary Syndrome (CAPITAL OPTICROSS) clinical trial was conducted
to compare a clopidogrel bolus dose with no bolus among patients currently
treated with ticagrelor and whose treating physician had decided to switch
therapy to clopidogrel. This review summarizes the CAPITAL OPTICROSS trial
and its findings, and discusses the implications for clinical
practice.<br/>Copyright &#xa9; Radcliffe Cardiology 2017.

<16>
Accession Number
619254736
Author
Pilgrim T.; Raber L.; Limacher A.; Wenaweser P.; Cook S.; Stauffer J.-C.;
Garachemani A.; Moschovitis A.; Meier B.; Juni P.; Windecker S.
Institution
(Pilgrim, Raber, Wenaweser, Moschovitis, Meier, Windecker) Department of
Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern
3010, Switzerland
(Limacher, Juni, Windecker) Clinical Trials Unit Bern, Department of
Clinical Research, University of Bern, Bern, Switzerland
(Cook, Stauffer) Cardiology, University of Fribourg, Fribourg, Switzerland
(Garachemani) Lindenhof Hospital, Bern, Switzerland
(Juni) Institute of Social and Preventive Medicine, University of Bern,
Bern, Switzerland
Title
Five-year results of a randomised comparison of
titanium-nitride-oxide-coated stents with zotarolimus-eluting stents for
coronary revascularisation.
Source
EuroIntervention. 10 (11) (pp 1284-1287), 2015. Date of Publication: 01
Mar 2015.
Publisher
EuroPCR
Abstract
Aims: Stents with a passive coating of titanium-nitride-oxide (TiNO) have
been compared with Endeavor zotarolimus-eluting stents (E-ZES) with regard
to the primary endpoint of in-stent late lumen loss at six to eight
months. The objective of the present analysis was to compare the long-term
outcomes of TiNO stents with E-ZES up to five years of clinical follow-up.
Methods and results: A total of 302 patients had been randomly allocated
to treatment with TiNO or E-ZES. Up to five years of follow-up, major
adverse cardiac events (MACE), the composite of cardiac death, myocardial
infarction, or clinically indicated target vessel revascularisation (TLR),
were observed in 27.6% of patients treated with TiNO stents and 25.3% of
patients treated with E-ZES (RR 1.13, 95% CI: 0.72-1.75, p=0.60), with the
majority of events related to clinically indicated TVR (TiNO 21.7% versus
E-ZES 20.7%, RR 1.10, 95% CI: 0.67-1.81). There were no differences with
respect to individual events including cardiac death, myocardial
infarction or stent thrombosis between the two treatment arms up to five
years of followup. A majority of patients remained free from angina
throughout the entire study duration (TiNO 77.3% versus E-ZES 76.1%,
p=0.92). Conclusions: Final five-year outcomes of the TIDE trial comparing
TiNO stents with E-ZES revealed increased rates of MACE driven primarily
by clinically indicated TVR. The TIDE trial is registered at
ClinicalTrials.gov: NCT00492908.<br/>Copyright &#xa9; Europa Digital &
Publishing 2015. All rights reserved.

<17>
Accession Number
619292065
Author
Collet J.-P.; Montalescot G.
Institution
(Collet, Montalescot) Institut de Cardiologie-INSERM U 937-Groupe
A.C.T.I.O.N., Groupe Hospitalier Pitie-Salpetriere, Universite Pierre et
Marie Curie (UPMC-Paris 6), 47-83, boulevard de l'Hopital, Paris 75013,
France
Title
Antithrombotic and antiplatelet therapy in TAVI patients: A fallow field?.
Source
EuroIntervention. 9 (SupplementS) (pp S43-S47), 2013. Date of Publication:
2013.
Publisher
EuroPCR
Abstract
Guidelines on antithrombotic therapy after TAVI are scarce and no
randomised evaluation has been performed to demonstrate what the best
strategy is. Extrapolation from what we know on surgical heart valve
replacement is also hazardous as the level of evidence is not very high
and the situation, the valves and the patients are different. Patients
undergoing TAVI are fragile and at high risk for both bleeding and stroke
complications. In addition, the procedure itself may contribute to the
occurrence of these complications rendering risk stratification a key
step. Improvement in both periprocedural and post-procedural outcome is a
major challenge of antithrombotic therapy. The recent release of more
potent but also safer antithrombotic therapies is a unique opportunity to
sort out what is the best combination for which patient. Our goal is to
review the evidence and analyse what are the perspectives in this
challenging area.<br/>Copyright &#xa9; Europa Digital & Publishing 2013.
All rights reserved.

<18>
Accession Number
619254756
Author
Hoendermis E.S.; Douglas Y.L.; Van Den Heuvel A.F.M.
Institution
(Hoendermis) Center of Congenital Heart Disease, University Medical Center
Groningen, P.O. Box 30001, Groningen NL-9700 RB, Netherlands
(Douglas) Department of Thoracic Surgery, University Medical Center
Groningen, Groningen, Netherlands
(Van Den Heuvel) Department of Cardiology, University Medical Center
Groningen, Groningen, Netherlands
Title
Percutaneous edwards sapien valve implantation in the tricuspid position:
Case report and review of literature.
Source
EuroIntervention. 8 (5) (pp 628-633), 2012. Date of Publication: 2012.
Publisher
EuroPCR
Abstract
Aims: Experience with transcatheter valve-in-valve implantation in a
failing bioprosthetic tricuspid valve is very limited. Fewer than 30 cases
have been reported, and in most of them the Melody valve (Medtronic, Inc.,
Minneapolis, MN, USA) was used. With this case report and review of
literature we sought to evaluate the safety and feasibility of the Edwards
SAPIEN transcatheter valve (Edwards Lifesciences, Irvine, CA, USA) in
valve implantation in the tricuspid position and to compare this
intervention with the more established Melody valve implantation. Methods
and results: We describe one of the rarely reported Edwards SAPIEN valve
implantations in a bioprosthetic tricuspid valve which is also the first
in a patient with Ebstein's anomaly. A review is presented of all eight
case reports on Edwards SAPIEN valve implantations in tricuspid position.
The procedure was successful in all cases. Valve performance after
implantation was good and no complications were described. In only one
procedure pre-stenting was performed. Transatrial, transjugular and
transfemoral approaches have been used. The results are comparable to
those of the series about Melody valve-in-valve implantation in the
tricuspid valve. Mid-term follow-up data are not yet available for both
valves. Conclusions: Edwards SAPIEN valve implantation in tricuspid
bioprosthetic valves is feasible and safe. Considering the available sizes
of the Edwards SAPIEN valve, it may become the preferred prosthesis for
valve-in-valve implantation in the tricuspid position in the
future.<br/>Copyright &#xa9; Europa Digital & Publishing 2012.

<19>
Accession Number
619290615
Author
Biancari F.; Perrotti A.; Dalen M.; Guerrieri M.; Fiore A.; Reichart D.;
Dell'Aquila A.M.; Gatti G.; Ala-Kokko T.; Kinnunen E.-M.; Tauriainen T.;
Chocron S.; Airaksinen J.K.E.; Ruggieri V.G.; Brascia D.
Institution
(Biancari, Kinnunen, Tauriainen, Airaksinen, Brascia) Heart Center, Turku
University Hospital and Department of Surgery, University of Turku, Turku,
Finland
(Biancari, Guerrieri) Department of Surgery, University of Oulu, Oulu,
Finland
(Perrotti, Chocron) Department of Thoracic and Cardio-Vascular Surgery,
University Hospital Jean Minjoz, Besancon, France
(Dalen) Department of Molecular Medicine and Surgery, Department of
Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet,
Karolinska University Hospital, Stockholm, Sweden
(Fiore) Department of Cardiothoracic Surgery, Henri Mondor University
Hospital, AP-HP, Paris-Est University, Creteil, France
(Reichart) Hamburg University Heart Center, Hamburg, Germany
(Dell'Aquila) Department of Cardiothoracic Surgery, University Hospital
Muenster, Muenster, Germany
(Gatti) Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
(Ala-Kokko) Department of Anesthesiology, Division of Intensive Care
Medicine, Oulu University Hospital, Medical Research Center Oulu, Oulu
University, Oulu, Finland
(Ruggieri) Division of Cardiothoracic and Vascular Surgery, Pontchaillou
University Hospital, Rennes, France
Title
Meta-Analysis of the Outcome After Postcardiotomy Venoarterial
Extracorporeal Membrane Oxygenation in Adult Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objective: This study was planned to pool existing data on outcome and to
evaluate the efficacy of postcardiotomy venoarterial extracorporeal
membrane oxygenation (VA-ECMO) in adult patients. Design: Systematic
review of the literature and meta-analysis. Setting: Multi-institutional
study. Participants: Adult patients with acute heart failure immediately
after cardiac surgery. Interventions: VA-ECMO after cardiac surgery.
Studies evaluating only heart transplant patients were excluded from this
analysis. Measurements and Main Results: A literature search was performed
to identify studies published since 2000. Thirty-one studies reported on
2,986 patients (mean age, 58.1 years) who required postcardiotomy VA-ECMO.
The weaning rate from VA-ECMO was 59.5% and hospital survival was 36.1%
(95% CI 31.5-40.8). The pooled rate of reoperation for bleeding was 42.9%,
major neurological event 11.3%, lower limb ischemia 10.8%, deep sternal
wound infection/mediastinitis 14.7%, and renal replacement therapy 47.1%.
The pooled mean number of transfused red blood cell units was 17.7 (95% CI
13.3-22.1). The mean stay in the intensive care unit was 13.3 days (95% CI
10.2-16.4). Survivors were significantly younger (mean, 55.7 v 63.6 years,
p = 0.015) and their blood lactate level before starting VA-ECMO was lower
(mean, 7.7 v 10.7 mmol/L, p = 0.028) than patients who died. One-year
survival rate was 30.9% (95% CI 24.3-37.5). Conclusions: Pooled data
showed that VA-ECMO may salvage one-third of patients unresponsive to any
other resuscitative treatment after adult cardiac surgery.<br/>Copyright
&#xa9; 2017 Elsevier Inc.

<20>
[Use Link to view the full text]
Accession Number
619034900
Author
Jeong D.M.; Ahn H.J.; Park H.W.; Yang M.; Kim J.A.; Park J.
Institution
(Jeong, Ahn, Yang, Kim, Park) Department of Anesthesiology and Pain
Medicine, Samsung Medical Center, Sungkyunkwan University, School of
Medicine, 50, Irwon-dong, Gangnam-gu, Seoul 06351, South Korea
(Park) Department of Anesthesiology and Pain Medicine, Seoul Medical
Center, Seoul, South Korea
Title
Stroke Volume Variation and Pulse Pressure Variation Are Not Useful for
Predicting Fluid Responsiveness in Thoracic Surgery.
Source
Anesthesia and Analgesia. 125 (4) (pp 1158-1165), 2017. Date of
Publication: 01 Oct 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Stroke volume variation (SVV) and pulse pressure variation
(PPV) are used as indicators of fluid responsiveness, but little is known
about the usefulness of these dynamic preload indicators in thoracic
surgery, which involves an open thoracic cavity and 1-lung ventilation
(OLV). Therefore, we investigated whether SVV and PPV could predict fluid
responsiveness, and whether the thresholds of these parameters should be
adjusted for thoracic surgery. METHODS: This was a prospective, controlled
study conducted in a tertiary care center. Eighty patients scheduled for
an elective lobectomy requiring OLV were included (n = 40, video-assisted
thoracoscopic surgery (VATS); n = 40, open thoracotomy). Twenty minutes
after opening the thoracic cavity, 7 mL/kg hydroxyethyl starch was
administered for 30 minutes. Various hemodynamic parameters were measured
before and after fluid challenge. RESULTS: Among the 80 patients enrolled
in this study, 37% were fluid responders (increase in stroke volume index
>=10%). SVV before fluid challenge was not different between nonresponders
and responders (mean +/- SD: 7.1 +/- 2.7% vs 7.4 +/- 2.6%, P =.68). This
finding was true regardless of whether the surgery involved open
thoracotomy or VATS. PPV before fluid challenge showed the difference
between nonresponders and responders (mean +/- SD: 6.9 +/- 3.0% vs 8.4 +/-
3.2%; P =.045); however, the sensitivity and specificity of the threshold
value (PPV = 7%) were low (58% and 62%, respectively) and the area under
the receiver operating characteristics curve was only 0.63 (95% confidence
interval, 0.52-0.74; P =.041). CONCLUSIONS: Dynamic preload indicators are
not useful for predicting fluid responsiveness in VATS or open thoracic
surgery.<br/>Copyright &#xa9; 2017 International Anesthesia Research
Society.

<21>
Accession Number
619012736
Author
Ezhov M.V.; Afanasieva O.I.; Il'ina L.N.; Safarova M.S.; Adamova I.Y.;
Matchin Y.G.; Konovalov G.A.; Akchurin R.S.; Pokrovsky S.N.
Institution
(Ezhov, Afanasieva, Il'ina, Safarova, Adamova, Matchin, Akchurin,
Pokrovsky) Cardiology Research Center, 3rd Cherepkovskaya Street, 15a,
Moscow 121552, Russian Federation
(Konovalov) MEDSI Clinic, Georgian Lane, 3a, Moscow 123056, Russian
Federation
Title
Association of lipoprotein(a) level with short- and long-term outcomes
after CABG: The role of lipoprotein apheresis.
Source
Atherosclerosis Supplements. 30 (pp 187-192), 2017. Date of Publication:
November 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Objective To evaluate the association of lipoprotein(a) [Lp(a)] level with
short- and long-term outcomes after coronary artery bypass grafting (CABG)
and to assess the effect of a 12 month course of weekly lipoprotein
apheresis on vein graft patency and coronary atherosclerosis course in
post-CABG patients with hyperlipidemia. Methods This study was performed
in patients after successful CABG and consisted of three parts: a) a
retrospective part with computed tomography assessment of vein graft
patency in patients with first-year recurrence of chest pain after CABG (n
= 102); b) a prospective trial with evaluation of cardiovascular outcomes
during follow up time up to 15 years in relation to baseline Lp(a) levels
(n = 356); c) an 12-months interventional controlled study in 50 patients
with low-density lipoprotein cholesterol (LDL-C) levels >2.6 mmol/L prior
to the operation despite statin treatment that allocated into 2 groups:
active (n = 25, weekly apheresis by cascade plasma filtration (CPF) plus
atorvastatin), and control (n = 25, atorvastatin alone). Results Patients
subjected to computed tomography were divided in two groups: 66 (65%) with
at least one vein graft occlusion and 36 (35%) without occlusions. Lp(a)
levels were significantly higher in patients with occluded grafts with a
median (95% confidence intervals (CI)) of 24 (17-42) mg/dL vs. 12 (6-24)
mg/dL in patients with patent grafts, p < 0.01. Over a mean of 8.5 +/- 3.5
years (range 0.9-15.0 years), the primary and secondary endpoints were
registered in 46 (13%) and 107 (30%) patients, respectively. Patients with
Lp(a) >=30 mg/dL were at significantly greater risk for the primary
endpoint (hazard ratio (HR) 2.98, 95% confidence interval (CI) 1.76-5.03,
p < 0.001) and secondary endpoint (HR 3.47, 95%CI 2.48-4.85, p < 0.001)
than patients with Lp(a) values <30 mg/dL. During the CPF procedure LDL-C
levels decreased by 59 +/- 14%, Lp(a) levels by 49 +/- 15. The frequency
of vein graft occlusions at study end was 14.3% (11 of 77) in the
apheresis group and 27.4% (23 of 84) in the control group, p < 0.05.
Progression of atherosclerosis was obtained in 26 (14.2%) segments of
native coronary arteries in the apheresis group and in 50 (25.0%) segments
of the control group. Regression signs were found in 30 (16.4%) and 19
(9.5%) segments, stabilization in 127 (69.4%) and 131 (65.5%) segments,
respectively (chi² = 9.37, p < 0.01). A Lp(a) level higher than
30 mg/dL was associated with a three-fold increased risk of vein grafts
occlusion during first year after CABG, p < 0.001. Conclusion Our data
suggest that elevated Lp(a) is associated with a significantly increasing
rate of one-year vein graft occlusions and adverse long-term
cardiovascular outcomes whereas the use of lipoprotein apheresis improves
vein graft patency during the first year after CABG.<br/>Copyright &#xa9;
2017 Elsevier B.V.

<22>
Accession Number
618891751
Author
Issa O.M.; Roberts R.; Mark D.B.; Boineau R.; Goertz C.; Rosenberg Y.;
Lewis E.F.; Guarneri E.; Drisko J.; Magaziner A.; Lee K.L.; Lamas G.A.
Institution
(Issa, Lamas) Columbia University Division of Cardiology at Mount Sinai
Medical Center, Miami Beach, FL, United States
(Roberts, Mark, Lee) Duke University Clinical Research Institute, Durham,
NC, United States
(Boineau) National Center of Complementary and Integrative Health (NCCIH),
Bethesda, MD, United States
(Goertz) Palmer Center for Chiropractic Research, Davenport, IA, United
States
(Rosenberg) National Heart, Blood and Lung Institute (NHLBI), Bethesda,
MD, United States
(Lewis) Brigham and Women's Hospital, Boston, MA, United States
(Guarneri) Pacific Pearl La Jolla, La Jolla, CA, United States
(Drisko) University of Kansas Medical Center, Kansas City, KS, United
States
(Magaziner) Magaziner Center for Wellness, Cherry Hill, NJ, United States
Title
Effect of high-dose oral multivitamins and minerals in participants not
treated with statins in the randomized Trial to Assess Chelation Therapy
(TACT).
Source
American Heart Journal. 195 (pp 70-77), 2018. Date of Publication: January
2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Importance In a prespecified subgroup analysis of participants not on
statin therapy at baseline in the TACT, a high-dose complex oral
multivitamins and multimineral regimen was found to have a large
unexpected benefit compared with placebo. The regimen tested was
substantially different from any vitamin regimen tested in prior clinical
trials. Objective To explore these results, we performed detailed
additional analyses of participants not on statins at enrollment in TACT.
Design TACT was a factorial trial testing chelation treatments and a
28-component high-dose oral multivitamins and multiminerals regimen versus
placebo in post-myocardial infarction (MI) patients 50 years or older.
Participants There were 460 (27%) of 1,708 TACT participants not taking
statins at baseline, 224 (49%) were in the active vitamin group and 236
(51%) were in the placebo group. Setting Patients were enrolled at 134
sites around the United States and Canada. Intervention Daily high-dose
oral multivitamins and multiminerals (6 tablets, active or placebo). Main
outcome The primary end point of TACT was time to the first occurrence of
any component of the composite end point: all-cause mortality, MI, stroke,
coronary revascularization, or hospitalization for angina. Results The
primary end point occurred in 137 nonstatin participants (30%), of which
51 (23%) of 224 were in the active group and 86 (36%) of 236 were taking
placebo (hazard ratio, 0.62; 95% confidence interval, 0.44-0.87; P =.006).
Results in the key TACT secondary end point, a combination of
cardiovascular mortality, stroke, or recurrent MI, was consistent in
favoring the active vitamin group (hazard ratio, 0.46; 95% confidence
interval, 0.28-0.75; P =.002). Multiple end point analyses were consistent
with these results. Conclusion and relevance High-dose oral multivitamin
and multimineral supplementation seem to decrease combined cardiac events
in a stable, post-MI population not taking statin therapy at baseline.
These unexpected findings are being retested in the ongoing
TACT2.<br/>Copyright &#xa9; 2017 The Authors

<23>
[Use Link to view the full text]
Accession Number
616669989
Author
Noiseux N.; Stevens L.-M.; Chartrand-Lefebvre C.; Soulez G.; Prieto I.;
Basile F.; Mansour S.; Dyub A.M.; Kieser T.M.; Lamy A.
Institution
(Noiseux, Stevens, Chartrand-Lefebvre, Soulez, Mansour) Research Center,
Centre Hospitalier, Universite de Montreal (CRCHUM), Montreal, QC, Canada
(Noiseux, Stevens, Prieto, Basile) Division of Cardiac Surgery, Centre
Hospitalier, Universite de Montreal, 3840 Saint-Urbain Street, Montreal,
QC H2W1T8, Canada
(Chartrand-Lefebvre, Soulez) Department of Radiology, Centre Hospitalier,
Universite de Montreal, Montreal, QC, Canada
(Mansour) Division of Cardiology, Centre Hospitalier, Universite de
Montreal, Montreal, QC, Canada
(Dyub, Lamy) Division of Cardiac Surgery, McMaster University, Hamilton,
ON, United States
(Lamy) Population Health Research Institute (PHRI), Hamilton Health
Sciences, Hamilton, ON, United States
(Kieser) University of Calgary, Calgary, AB, Canada
Title
Off-pump Versus On-pump Coronary Artery Bypass Surgery: Graft Patency
Assessment with Coronary Computed Tomographic Angiography.
Source
Journal of Thoracic Imaging. 32 (6) (pp 370-377), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose: A large multicenter randomized trial (RCT) is needed to assess
off-pump coronary artery bypass graft (CABG) patency when performed by
skilled surgeons. This prospective multicenter randomized pilot study
compares graft patency after on-pump and off-pump techniques and addresses
the feasibility of such an RCT. Materials and Methods: Consecutive
patients were prospectively recruited for >=64-slice computed tomography
angiography graft patency assessment 1 year after randomization to
off-pump or on-pump CABG. Blinded assessment of graft patency was
performed, and the results were categorized as normal, >=50% stenosis, or
occlusion. A multilevel model with random effects on the patient was used
to account for correlation of results in patients with multiple grafts.
Results: A total of 157 patients (3 centers, 84 off-pump and 73 on-pump
patients, 512 grafts, assessability rate 98.4%) were included. Patency
index (% nonoccluded grafts) was 89% for the off-pump technique and 95%
for the on-pump technique (P=0.09). Patency was similar for arterial and
vein grafts (both 92%; P=0.88), as well as between target territories (89%
to 94%; P=0.53). Conclusions: In this pilot study, 1-year graft patency
results after off-pump and on-pump surgery were similar. This feasibility
trial demonstrates that a large multicenter RCT to compare CABG patency
after on-pump with that after off-pump techniques is feasible and can be
reliably undertaken using computed tomography angiography.<br/>Copyright
&#xa9; 2017 Wolters Kluwer Health, Inc. All rights reserved.

<24>
Accession Number
619208648
Author
Wang J.; Li K.; Li H.; Zhu W.; Sun H.; Lu C.
Institution
(Wang, Li, Li, Zhu, Sun, Lu) Qindao University Medical College Affiliated
Yantai Yuhuangding Hospital, Yantai, Shandong, China
Title
Comparison of anticoagulation regimens for pregnant women with prosthetic
heart valves: A meta-analysis of prospective studies.
Source
Cardiovascular Therapeutics. 35 (6) (no pagination), 2017. Article Number:
e12292. Date of Publication: December 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Introduction: Pregnancy is associated with a hypercoagulable state, which
makes pregnant women with prosthetic heart valves at high risk of
thromboembolism. The proper anticoagulation regimen should take both the
maternal protection and the fetal outcomes into consideration. However, no
consensus on the present anticoagulation regimen for those women has been
reached yet, especially in the first trimester of pregnancy. Aims: The
present meta-analysis is conducted to compare anticoagulation efficiency
and feto-maternal complications of heparin and warfarin in the first
trimester. Results: Databases of MEDLINE, EMBASE, and the Cochrane Library
were systematically searched (all from their inception to October 2016)
for cohort studies reporting the outcome of anticoagulation in pregnant
women with mechanical heart valves. Seven relevant prospective studies
were identified for inclusion in the present meta-analysis. The forest
plots indicated that warfarin was more effective in prevention valve
thrombosis in the first trimester than heparin (OR: 14.58; 95% confidence
interval [CI]: 3.94-53.94; P <.0001; I² = 0%). The spontaneous
abortion between the two regimens was not statistically different (OR:
1.42; 95% CI: 0.80-2.49; P =.23; I² = 20%), which indicated
that heparin could not provide better protection to the fetus in the early
stage of pregnancy than warfarin. The incidence of warfarin embryopathy
was low, and it only occurred in a twin among all the included cases.
Conclusions: The present meta-analysis indicated that warfarin can provide
better protection for the mother and the teratogenic effects may be
overestimated. Heparin does not ensure better fetal outcomes as it is
associated with severe adverse maternal outcomes, including
mortality.<br/>Copyright &#xa9; 2017 John Wiley & Sons Ltd

<25>
Accession Number
614031385
Author
Olper L.; Bignami E.; Di Prima A.L.; Albini S.; Nascimbene S.; Cabrini L.;
Landoni G.; Alfieri O.
Institution
(Olper, Bignami, Di Prima, Albini, Nascimbene, Cabrini, Landoni, Alfieri)
Cardiothoracic and Vascular Department, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Landoni, Alfieri) Vita-Salute San Raffaele University, Milan, Italy
Title
Continuous Positive Airway Pressure Versus Oxygen Therapy in the Cardiac
Surgical Ward: A Randomized Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 31 (1) (pp 115-121),
2017. Date of Publication: 01 Feb 2017.
Publisher
W.B. Saunders
Abstract
Background Noninvasive ventilation (NIV) is a common technique to manage
patients with acute respiratory failure in the intensive care unit.
However, use of NIV in general wards is less well described. The authors'
aim was to demonstrate efficacy of NIV, applied in a cardiac surgery ward,
in improving oxygenation in patients who developed hypoxemic acute
respiratory failure after being discharged from the intensive care unit.
Design Randomized, open-label trial. Setting University hospital.
Participants Sixty-four patients with hypoxemia
(PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> ratio between 100 and 250)
admitted to the main ward after cardiac surgery. Interventions Patients
were randomized to receive standard treatment (oxygen, early mobilization,
a program of breathing exercises and diuretics) or continuous positive
airway pressure in addition to standard treatment. Continuous positive
airway pressure was administered 3 times a day for 2 consecutive days.
Every cycle lasted 1 to 3 hours. All patients completed their 1-year
follow-up. Data were analyzed according to the intention-to-treat
principle. Measurements and Main Results The primary endpoint was the
number of patients with PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf><200 48
hours after randomization. Continuous positive airway pressure use was
associated with a statistically significant reduction in the number of
patients with PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf><200 (4/33 [12%] v
14/31 [45%], p = 0.003). One patient in the control group died at the
30-day follow-up. Conclusions Among patients with acute respiratory
failure following cardiac surgery, administration of continuous positive
airway pressure in the main ward was associated with improved respiratory
outcome. This was the first study that was performed in the main ward of
post-surgical patients with acute respiratory failure.<br/>Copyright
&#xa9; 2017 Elsevier Inc.

<26>
Accession Number
618418792
Author
Takagi H.; Ando T.; Mitta S.
Institution
(Takagi, Mitta) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit,
Michigan, United States
Title
Meta-Analysis Comparing >=10-Year Mortality of Off-Pump Versus On-Pump
Coronary Artery Bypass Grafting.
Source
American Journal of Cardiology. 120 (11) (pp 1933-1938), 2017. Date of
Publication: 01 Dec 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Off-pump coronary artery bypass grafting (CABG) is suggested to be
associated with an increase in long-term (>=5-year) all-cause mortality.
To determine whether off-pump CABG is associated with an increase in very
long-term (>=10-year) all-cause mortality, we performed a meta-analysis of
propensity-score matched observational comparative studies of off-pump
versus on-pump CABG. MEDLINE and EMBASE were searched through May 2017. A
hazard ratio of follow-up (including early) all-cause mortality for
off-pump versus on-pump CABG was extracted from each individual study.
Study-specific estimates were combined using inverse variance-weighted
averages of logarithmic hazard ratios in the random-effects model. Of 164
potentially relevant studies, our search identified 16 propensity-score
matched observational comparative studies of off-pump versus on-pump CABG
with >=10-year follow-up enrolling a total of 82,316 patients. A pooled
analysis of all the 16 studies demonstrated that off-pump CABG was
significantly associated with an increase in all-cause mortality (hazard
ratio 1.07, 95% confidence interval 1.03 to 1.12, p for effect = 0.0008; p
for heterogeneity = 0.30, I² = 12%). In a sensitivity analysis,
exclusion of any single hazard ratio from the analysis (leave-one-out
meta-analysis) did not substantively alter the overall result. There was
no evidence of a significant publication bias. In conclusion, off-pump
CABG is associated with an increase in very long-term (>=10 years)
all-cause mortality compared with on-pump CABG.<br/>Copyright &#xa9; 2017
Elsevier Inc.

<27>
Accession Number
618373762
Author
Maeno Y.; Abramowitz Y.; Yoon S.-H.; Israr S.; Jilaihawi H.; Watanabe Y.;
Sharma R.; Kawamori H.; Miyasaka M.; Kazuno Y.; Takahashi N.; Hariri B.;
Mangat G.; Kashif M.; Chakravarty T.; Nakamura M.; Cheng W.; Makkar R.R.
Institution
(Maeno, Abramowitz, Yoon, Israr, Sharma, Kawamori, Miyasaka, Kazuno,
Takahashi, Hariri, Mangat, Kashif, Chakravarty, Nakamura, Cheng, Makkar)
Cedars-Sinai Medical Center, Heart Institute, Los Angeles, California,
United States
(Jilaihawi) Medicine and Cardiothoracic Surgery, New York University
Langone Medical Center, New York, New York, United States
(Watanabe) Department of Cardiology, Teikyo University Hospital, Itabashi,
Tokyo, Japan
Title
Relation Between Left Ventricular Outflow Tract Calcium and Mortality
Following Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 120 (11) (pp 2017-2024), 2017. Date of
Publication: 01 Dec 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Left ventricular outflow tract (LVOT) calcium is known to be associated
with adverse procedural outcomes after transcatheter aortic valve
implantation (TAVI), yet its effect on midterm outcomes has not been
previously investigated. The aim of this study was to determine the
influence of LVOT calcium on 2-year mortality after TAVI. A total of 537
consecutive patients underwent TAVI and 2 groups were established,
stratified based on the severity of the LVOT calcium. The primary outcome
was 2-year overall survival rate. The >=moderate LVOT calcium group
included 107 patients (19.9%) and the remaining 430 patients (80.1%) were
included in the <=mild LVOT calcium group. After a median follow-up of 717
days (interquartile range 484 to 828), the Kaplan-Meier analysis revealed
that the 2-year overall survival probability was significantly lower in
the >=moderate LVOT calcium group than in the <=mild LVOT calcium group
(log-rank p = 0.001). On a Cox hazard model, >=moderate LVOT calcium was
associated with increased all-cause mortality after TAVI (hazard ratio
1.74, p = 0.009). In the subgroup analysis, based on valve designs, SAPIEN
3-TAVI done in the setting of >=moderate LVOT calcium had a relatively
similar survival probability as those of <=mild LVOT calcium (log-rank p =
0.18), which is in contrast with older generation valves (log-rank p =
0.001). In conclusion, patients with >=moderate LVOT calcium were shown to
have a lower survival probability in the midterm follow-up after TAVI,
compared with those with <=mild LVOT calcium. Patients with high-grade
LVOT calcium should be monitored with longer-term follow-ups after
TAVI.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<28>
Accession Number
619285374
Author
Criss C.N.; Dimick J.B.; Gadepalli S.K.
Institution
(Criss, Dimick, Gadepalli) University of Michigan, Ann Arbor, MI, United
States
Title
Sponsoring surgeons: Influence of robot industry on patient care.
Source
Journal of the American College of Surgeons. Conference: 2017 Clinical
Congress of the 3rd Owen H Wangesteen Scientific Forum. United States. 225
(4 Supplement 1) (pp S91), 2017. Date of Publication: October 2017.
Publisher
Elsevier Inc.
Abstract
INTRODUCTION: The integrity of the medical literature about robotic
surgery remains unclear despite wide-spread adoption. We sought to
determine the influence on medical literature by the robot industry,
specifically, top-earning surgeons from Intuitive Surgical Incorporated
(ISI). METHODS: Publicly available financial data were gathered from the
Centers for Medicare and Medicaid (CMS) website regarding the top-20
earners from ISI for 2015. Studies conducted by these surgeons were
identified using PubMed. Inclusion criteria consisted of publications
involving robotic surgery and patient care, excluding those outside the
United States. Primary outcome was whether a study conclusion was
positive/equivocal/negative toward the robot. Secondary outcomes included
authorship, sponsorship, study controls, and disclosure. RESULTS: The top
earners received $3, 296, 844 in 2015, with a mean of $106, 176.
Sub-specialties included general surgery (60%), colorectal (20%), thoracic
surgery (15%), and obstetrics/gynecology (5%). Of 40 studies, there was 1
randomized controlled trial and 1 case report, with observational studies
comprising the rest. The majority of the studies (n = 22, 55%) had no
control population, and only 7 (3%) compared to same institution/sur-geon;
however, 33 (83%) studies had positive conclusions for robot use, 6 (15%)
equivocal, and 1 (3%) negative. Overall, 16 earners had lead authorship
and 14 senior. ISI sponsored 9 studies, all positive. CONCLUSIONS: This
pilot study highlights a potential bias, as current literature published
by benefactors demonstrates a lopsided approval of the robot.

<29>
Accession Number
619285038
Author
Tam D.Y.; Nedadur R.; Yu M.; Fremes S.E.
Institution
(Tam, Nedadur, Yu, Fremes) University of Toronto, Toronto, ON, Canada
Title
Rigid plate fixation vs conventional wire cerclage closure for sternotomy
after cardiac surgery: A systematic review and meta-analysis.
Source
Journal of the American College of Surgeons. Conference: 2017 Clinical
Congress of the 3rd Owen H Wangesteen Scientific Forum. United States. 225
(4 Supplement 1) (pp S34), 2017. Date of Publication: October 2017.
Publisher
Elsevier Inc.
Abstract
INTRODUCTION: Traditionally, the sternum is reapproximated with wire
cerclage (WC) after sternotomy in cardiac surgery. Recent evidence
suggested that sternal closure with rigid plate fixation (RPF) reduced the
incidence of sternal complications. This meta-analysis sought to determine
the benefits of RPF vs WC in patients undergoing sternotomy for cardiac
surgery. METHODS: MEDLINE and EMBASE databases were searched from
inception to 2017 for studies that compared RPF with WC in patients
undergoing sternotomy. Data were abstracted independently by 2
investigators. A random-effects meta-analysis was undertaken to compare
rates of sternal complication (defined as deep sternal wound infection
[SWI], superficial SWI or sternal instability), mortality, and length of
stay (LOS). RESULTS: Three randomized controlled trials (RCTs, n = 427),
and 5 unadjusted observational studies (n = 1, 025) met inclusion
criteria. There was a decrease in sternal complications during a mean
follow-up period of 3.2 months (incidence rate ratio 0.45, 95% CI 0.21,
1.00, p = 0.05) and a significant decrease in perioperative mortality
(relative risk 0.52, 95% CI 0.28, 0.97, p = 0.04) favoring RFP. Although
no difference was observed for all pooled studies in LOS between the 2
groups (mean difference-0.84 days, 95% CI-1.86, 0.18, p = 0.11), there was
a significant decrease in LOS for RPF restricted to the observational
studies (mean difference-1.69 days, 95% CI-2.87,-0.51, p = 0.005).
CONCLUSIONS: This meta-analysis suggests that RPF may lead to a decreased
incidence of sternal complications, improved perioperative survival, and
decreased hospital LOS compared with WC. Further RCTs will be critical in
defining the role of RPF in sternal closure after sternotomy.

<30>
Accession Number
619266041
Author
Lopez F.J.G.; Ruiz-Tovar M.; Almazan-Isla J.; Alcalde-Cabero E.; Calero
M.; de Pedro-Cuesta J.
Institution
(Lopez, Ruiz-Tovar, Almazan-Isla, Alcalde-Cabero, de Pedro-Cuesta)
National Epidemiology Centre, Carlos III Institute of Health, Madrid,
Spain
(Lopez, Ruiz-Tovar, Almazan-Isla, Alcalde-Cabero, Calero, de Pedro-Cuesta)
Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED),
Madrid, Spain
(Calero) Carlos III Institute of Health, Madrid, Spain
(Calero) Alzheimer Disease Research Unit, CIEN Foundation, Queen Sofia
Foundation Alzheimer Centre, Madrid, Spain
Title
Risk of transmission of sporadic Creutzfeldt-Jakob disease by surgical
procedures: Systematic reviews and quality of evidence.
Source
Eurosurveillance. 22 (43) (no pagination), 2017. Date of Publication: 26
Oct 2017.
Publisher
European Centre for Disease Prevention and Control (ECDC) (ECDC, Stockholm
171 83, Sweden. E-mail: eurosutveiliance@eecdc.europa.eu)
Abstract
Background: Sporadic Creutzfeldt-Jakob disease (sCJD) is potentially
transmissible to humans. Objective: This study aimed to summarise and rate
the quality of the evidence of the association between surgery and sCJD.
Design and methods: Firstly, we conducted systematic reviews and
meta-analyses of case-control studies with major surgical procedures as
exposures under study. To assess quality of evidence, we used the Grading
of Recommendations, Assessment, Development and Evaluations (GRADE)
approach. Secondly, we conducted a systematic review of sCJD case reports
after sharing neurosurgical instruments. Results: Thirteen case-control
studies met the inclusion criteria for the systematic review of
case-control studies. sCJD was positively associated with heart surgery,
heart and vascular surgery and eye surgery, negatively associated with
tonsillectomy and appendectomy, and not associated with neurosurgery or
unspecified major surgery. The overall quality of evidence was rated as
very low. A single case-control study with a low risk of bias found a
strong association between surgery conducted more than 20 years before
disease onset and sCJD. Seven cases were described as potentially
transmitted by reused neurosurgical instruments. Conclusion: The
association between surgery and sCJD remains uncertain. Measures currently
recommended for preventing sCJD transmission should be strongly
maintained. Future studies should focus on the potential association
between sCJD and surgery undergone a long time previously.<br/>Copyright
&#xa9; The Authors, 2017.

<31>
[Use Link to view the full text]
Accession Number
619264448
Author
Nenna A.; Lusini M.; Spadaccio C.; Nappi F.; Prestipino F.; Barbato R.;
Casacalenda A.; Pugliese G.; Barberi F.; Giacinto O.; Petitti T.; Covino
E.; Chello M.
Institution
(Nenna, Lusini, Prestipino, Barbato, Casacalenda, Pugliese, Barberi,
Giacinto, Covino, Chello) Department of Cardiovascular Surgery, Universita
Campus Bio-Medico di Roma, Rome, Italy
(Spadaccio) Department of Cardiothoracic Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord de
Saint-Denis, Paris, France
(Petitti) Department of Public Health and Statistics, Universita Campus
Bio-Medico di Roma, Rome, Italy
Title
Preoperative atorvastatin reduces bleeding and blood products use in
patients undergoing on-pump coronary artery bypass grafting.
Source
Journal of Cardiovascular Medicine. 18 (12) (pp 976-982), 2017. Date of
Publication: 01 Dec 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Aims Statins are a widely recognized weapon in the primary and secondary
prevention of coronary artery disease for their pleiotropic effects.
However, recent reports from the cerebrovascular and pharmacological
literature are insinuating concerns about a potential increase in the
haemorrhagic risk among statin users. The effect of statins in
postoperative bleeding should be carefully investigated in major cardiac
surgery that exposes per se to risk of bleeding. Methods In this
retrospective cohort study, we evaluated 441 patients who received
atorvastatin until surgery and 213 patients who had never been treated
with statins, undergoing elective primary isolated on-pump coronary artery
bypass grafting. Postoperative bleedings, blood products use and
complications were monitored during hospitalization. Results Preoperative
and intraoperative variables were similar between groups. Early and
overall postoperative bleedings were reduced among statin users, who had
lower C-reactive protein values in the first postoperative day.
Atorvastatin carries a strong protective effect against major bleedings,
with a propensity score-adjusted odds ratio of 0.28 (P < 0.01). Also,
blood products use for statin-treated patients was lower compared with
controls, with fewer transfused patients and fewer red-packed cells units
per transfused patient. Conclusion Preoperative atorvastatin use is
associated with reduced risk of bleeding and blood products use after
coronary artery bypass grafting, likely due to a reduction in the
postoperative inflammatory response. Statin continuation at the highest
tolerable dose should be encouraged before cardiac surgery. The
preoperative use of statins in cardiac surgery as 'bleeding-preventers'
might have profound clinical implications.<br/>Copyright &#xa9; 2017
Italian Federation of Cardiology. All rights reserved.

<32>
Accession Number
619223870
Author
Mead G.E.; Elder A.; Flapan A.D.; Cordina J.
Institution
(Mead) University of Edinburgh, Centre for Clinical Brain Sciences, Royal
Infirmary, Little France Crescent, Edinburgh EH16 4SA, United Kingdom
(Elder) Royal Victoria Hospital, 13 Craigleth Road, Edinburgh, United
Kingdom
(Flapan) Royal Infirmary of Edinburgh, Department of Cardiology,
Department of Cardiology, New Royal Infirmary, Little France Crescent,
Edinburgh EH16 4SB, United Kingdom
(Cordina) Victoria Hospital, Ward 11, Hayfield Road, Kirkcaldy KY2 5AH,
United Kingdom
Title
Electrical cardioversion for atrial fibrillation and flutter.
Source
Cochrane Database of Systematic Reviews. 2017 (11) (no pagination), 2017.
Article Number: CD002903. Date of Publication: 15 Nov 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Atrial fibrillation increases stroke risk and adversely
affects cardiovascular haemodynamics. Electrical cardioversion may, by
restoring sinus rhythm, improve cardiovascular haemodynamics, reduce the
risk of stroke, and obviate the need for long-term anticoagulation.
Objectives: To assess the effects of electrical cardioversion of atrial
fibrillation or flutter on the risk of thromboembolic events, strokes and
mortality (primary outcomes), the rate of cognitive decline, quality of
life, the use of anticoagulants and the risk of re-hospitalisation
(secondary outcomes) in adults (>18 years). Search methods: We searched
the Cochrane CENTRAL Register of Controlled Trials (1967 to May 2004),
MEDLINE (1966 to May 2004), Embase (1980 to May 2004), CINAHL (1982 to May
2004), proceedings of the American College of Cardiology (published in
Journal of the American College of Cardiology 1983 to 2003),
www.trialscentral.org, www.controlled-trials.com and reference lists of
articles. We hand-searched the indexes of the Proceedings of the British
Cardiac Society published in British Heart Journal (1980 to 1995) and in
Heart (1995 to 2002); proceedings of the European Congress of Cardiology
and meetings of the Joint Working Groups of the European Society of
Cardiology (published in European Heart Journal 1983-2003); scientific
sessions of the American Heart Association (published in Circulation
1990-2003). Personal contact was made with experts. Selection criteria:
Randomised controlled trial or controlled clinical trials of electrical
cardioversion plus 'usual care' versus 'usual care' only, where 'usual
care' included any combination of anticoagulants, antiplatelet drugs and
drugs for 'rate control'. We excluded trials which used pharmacological
cardioversion as the first intervention, and trials of new onset atrial
fibrillation after cardiac surgery. There were no language restrictions.
Data collection and analysis: For dichotomous data, odds ratios were
calculated; and for continuous data, the weighted mean difference was
calculated. Main results: We found three completed trials of electrical
cardioversion (rhythm control) versus rate control, recruiting a total of
927 participants (Hot Cafe; RACE; STAF) and one ongoing trial (J-RHYTHM).
There was no difference in mortality between the two strategies (OR 0.83;
CI 0.48 to 1.43). There was a trend towards more strokes in the rhythm
control group (OR 1.9; 95% CI 0.99 to 3.64). At follow up, three domains
of quality of life (physical functioning, physical role function and
vitality) were significantly better in the rhythm control group (RACE
2002; STAF 2003). Authors' conclusions: Electrical cardioversion (rhythm
control) led to a non-significant increase in stroke risk but improved
three domains of quality of life.<br/>Copyright &#xa9; 2017 The Cochrane
Collaboration. Published by John Wiley & Sons, Ltd.

<33>
Accession Number
619163586
Author
Wu H.-L.; Xu Y.-H.; Shi J.-H.
Institution
(Wu, Xu) Nursing Department of Cardiothoracic-Surgery, Affiliated Hospital
of Nantong University, Nantong City, Jiangsu Province, China
(Shi) Department of Cardiothoracic-Surgery, Affiliated Hospital of Nantong
University, Nantong City, Jiangsu Province, China
Title
5% NaHCO<inf>3</inf> Is Appropriate for Skin Cleaning With Central Venous
Catheters.
Source
American Journal of the Medical Sciences. 353 (1) (pp 12-16), 2017. Date
of Publication: 01 Jan 2017.
Publisher
Elsevier B.V. (E-mail: kathiest.clai@apta.org)
Abstract
Objectives The purpose of this study was to compare the effects of skin
cleaning with 5% NaHCO<inf>3</inf> to 75% alcohol on the removal of skin
grease and pain of patients with central venous catheters (CVC). Materials
and Methods This was a randomized, controlled, single-blinded and
prospective study. From January-September 2015, 143 consecutive patients
who met the inclusion and exclusion criteria and who underwent elective
cardiovascular surgery with placement of a CVC were selected. Patients
were randomly divided into 2 groups according to the disinfection
preparation procedure: experimental group (n = 60), in which 5%
NaHCO<inf>3</inf> and distilled water solution at 40-45degreeC were used,
and the control group (n = 66), in which 75% alcohol was used. Main
outcome measures were verbal rating scale pain score, satisfaction and
bacterial count after 2 minutes of iodine disinfection. Results The verbal
rating scale pain scores were lower in the experimental group than in the
control group (P < 0.001). In the control group, 4.5% of patients and 43%
of nurses were satisfied with 75% alcohol cleaning before disinfection
procedure, compared to 74% and 78%, respectively, in the experimental
group. The bacterial count did not show any difference between these 2
groups after iodine disinfection (P = 0.455). Conclusions Cleaning of the
CVC before disinfection with 5% NaHCO<inf>3</inf> and distilled water at
40-45degreeC alleviated pain and improved patient and nurse satisfaction
compared with using 75% alcohol.<br/>Copyright &#xa9; 2017 Southern
Society for Clinical Investigation

<34>
Accession Number
619282869
Author
Tobis J.M.; Charles A.; Silberstein S.D.; Sorensen S.; Maini B.; Horwitz
P.A.; Gurley J.C.
Institution
(Tobis, Charles) David Geffen School of Medicine, University of
California, Los Angeles, California, United States
(Silberstein) Jefferson Headache Center, Sidney Kimmel Medical College,
Thomas Jefferson University, Philadelphia, Pennsylvania, United States
(Sorensen) Intermountain Medical Center, Salt Lake City, Utah, United
States
(Maini) Tenet Healthcare Corporation, Boca Raton, Florida, United States
(Horwitz) University of Iowa Carver College of Medicine, Iowa City, Iowa,
United States
(Gurley) University of Kentucky College of Medicine, Lexington, Kentucky,
United States
Title
Percutaneous Closure of Patent Foramen Ovale in Patients With Migraine:
The PREMIUM Trial.
Source
Journal of the American College of Cardiology. 70 (22) (pp 2766-2774),
2017. Date of Publication: 5 December 2017.
Publisher
Elsevier USA
Abstract
Background Migraine is a prevalent and disabling disorder. Patent foramen
ovale (PFO) has been associated with migraine, but its role in the
disorder remains poorly understood. Objectives This study examined the
efficacy of percutaneous PFO closure as a therapy for migraine with or
without aura. Methods The PREMIUM (Prospective, Randomized Investigation
to Evaluate Incidence of Headache Reduction in Subjects With Migraine and
PFO Using the AMPLATZER PFO Occluder to Medical Management) was a
double-blind study investigating migraine characteristics over 1 year in
subjects randomized to medical therapy with a sham procedure (right heart
catheterization) versus medical therapy and PFO closure with the Amplatzer
PFO Occluder device (St. Jude Medical, St. Paul, Minnesota). Subjects had
6 to 14 days of migraine per month, had failed at least 3 migraine
preventive medications, and had significant right-to-left shunt defined by
transcranial Doppler. Primary endpoints were responder rate defined as 50%
reduction in migraine attacks and adverse events. Secondary endpoints
included reduction in migraine days and efficacy in patients with versus
without aura. Results Of 1,653 subjects consented, 230 were enrolled.
There was no difference in responder rate in the PFO closure (45 of 117)
versus control (33 of 103) groups. One serious adverse event (transient
atrial fibrillation) occurred in 205 subjects who underwent PFO closure.
Subjects in the PFO closure group had a significantly greater reduction in
headache days (-3.4 vs. -2.0 days/month, p = 0.025). Complete migraine
remission for 1 year occurred in 10 patients (8.5%) in the treatment group
versus 1 (1%) in the control group (p = 0.01). Conclusions PFO closure did
not meet the primary endpoint of reduction in responder rate in patients
with frequent migraine. (Prospective, Randomized Investigation to Evaluate
Incidence of Headache Reduction in Subjects With Migraine and PFO Using
the AMPLATZER PFO Occluder to Medical Management [PREMIUM];
NCT00355056)<br/>Copyright &#xa9; 2017 American College of Cardiology
Foundation

<35>
Accession Number
619282830
Author
Flaherty L.B.; Wood T.; Cheng A.; Khan A.R.
Institution
(Flaherty) Department of Psychological and Brain Sciences, University of
Louisville School of Arts and Sciences, Louisville, Ky, United States
(Wood, Khan) Division of Cardiovascular Medicine, University of Louisville
School of Medicine, Louisville, Ky, United States
(Cheng) Division of Cardiothoracic Surgery, Washington University School
of Medicine, St Louis, Mo, United States
Title
Pre-existing psychological depression confers increased risk of adverse
cardiovascular outcomes following cardiac surgery: A systematic review and
meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 154 (5) (pp 1578-1586.e1),
2017. Date of Publication: November 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)

<36>
Accession Number
619110208
Author
De Von H.A.; Vuckovic K.; Ryan C.J.; Barnason S.; Zerwic J.J.; Pozehl B.;
Schulz P.; Seo Y.; Zimmerman L.
Institution
(De Von, Vuckovic, Ryan, Zerwic) University of Illinois at Chicago,
College of Nursing, Chicago, IL, United States
(Barnason, Pozehl, Schulz, Seo, Zimmerman) University of Nebraska, College
of Nursing, Lincoln, NE, United States
Title
Systematic review of symptom clusters in cardiovascular disease.
Source
European Journal of Cardiovascular Nursing. 16 (1) (pp 6-17), 2017. Date
of Publication: 01 Jan 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Although individual symptoms and symptom trajectories for
various cardiovascular conditions have been reported, there is limited
research identifying the symptom clusters that may provide a better
understanding of patients' experiences with heart disease. Aims: To
summarize the state of the science in symptom cluster research for
patients with acute coronary syndrome, myocardial infarction, coronary
artery bypass surgery, and heart failure through systematic review and to
provide direction for the translation of symptom cluster research into the
clinical setting. Methods: Databases were searched for articles from
January 2000 through to May 2015 using MESH terms "symptoms, symptom
clusters, acute coronary syndrome (ACS), myocardial infarction (MI),
coronary heart disease (CHD), ischemic heart disease (IHD), heart failure
(HF), coronary artery bypass surgery (CABS), cluster analyses, and latent
classes." The search was limited to human studies, English language
articles, and original articles investigating symptom clusters in
individuals with heart disease. Fifteen studies meeting the criteria were
included. Results: For patients with ACS and MI, younger persons were more
likely to experience clusters with the most symptoms. Older adults were
more likely to experience clusters with the lowest number of symptoms and
more diffuse and milder symptom clusters that are less reflective of
classic ACS presentations. For HF patients, symptom clusters frequently
included physical and emotional/cognitive components; edema clustered in
only three studies. Symptom expression was congruent across geographical
regions and cultures. Conclusions: The findings demonstrated similarities
in symptom clusters during ACS, MI, and HF, despite multiple methods and
analyses. These results may help clinicians to prepare at-risk patients
for proper treatment-seeking and symptom self-management
behaviors.<br/>Copyright &#xa9; The European Society of Cardiology 2016.

<37>
Accession Number
619127987
Author
Bigdelian H.; Sedighi M.
Institution
(Bigdelian) Department of Cardiovascular Surgery, School of Medicine,
Isfahan University of Medical Science, Isfahan, Iran, Islamic Republic of
(Sedighi) Department of Cardiovascular Surgery, Chamran Heart Center,
Isfahan University of Medical Science, Isfahan, Iran, Islamic Republic of
(Sedighi) Department of Neuroscience, Faculty of Advanced Technologies in
Medicine, Iran University of Medical Science, Tehran, Iran, Islamic
Republic of
Title
The role of preoperative sildenafil therapy in controlling of
postoperative pulmonary hypertension in children with ventricular septal
defects.
Source
Journal of Cardiovascular and Thoracic Research. 9 (3) (pp 179-182), 2017.
Date of Publication: 2017.
Publisher
Tabriz University of Medical Sciences (E-mail: tmj@taibahu.edu.sa)
Abstract
Introduction: Most of the ventricular septal defects (VSD) are complicated
with pulmonary arterial hypertension (PAH) which is the major cause of
pulmonary hypertensive crisis and right ventricular failure. Methods: We
reviewed clinical outcomes of 63 infants who underwent cardiac surgery and
were divided into three groups. Control group (n=20) did not received
sildenafil while group A (n = 22) received drug (0.3 mg/kg) before and
after surgery. Group B (n=21) received drug at the initiation of surgery.
Demographic data, preoperative and postoperative variables were compared
among the patients. Results: Patients in the group A had lower
preoperative pulmonary arterial pressure (PAP) compared to other groups (P
<0.001). Also, patients in control group had longer cardiopulmonary bypass
time (P <0.05). Postoperative PAP in patients of group A and B decreased
significantly compared to control group (P <0.001). Also, pre- and
postoperative PVR (pulmonary vascular resistance) showed a significant
decrease in group A compared with control and group B (P <0.001). The
intubation time in patients of the control group was significantly more
prolonged compared with patients of group A and B (P <0.001). Moreover,
the length of ICU stay was significantly longer in patients of control
group compared with group A and B (P <0.001). Conclusion: Preoperative
sildenafil therapy seems to be effective and safe to prevent postoperative
PAH and pulmonary hypertensive crisis in children with ventricular septal
defects and has a positive impact on postoperative care.<br/>Copyright
&#xa9; 2017 The Author (s).

<38>
Accession Number
614533311
Author
Rafiq S.; Johansson P.I.; Kofoed K.F.; Lund J.T.; Olsen P.S.; Bentsen S.;
Steinbruchel D.A.
Institution
(Rafiq, Lund, Olsen, Bentsen, Steinbruchel) Department of Cardiothoracic
Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital,
Copenhagen, Denmark
(Johansson) Capital Region Blood Bank, Section for Transfusion Medicine,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Kofoed) Department of Cardiology, The Heart Centre, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Denmark
Title
Thrombelastographic hypercoagulability and antiplatelet therapy after
coronary artery bypass surgery (TEG-CABG trial): a randomized controlled
trial.
Source
Platelets. 28 (8) (pp 786-793), 2017. Date of Publication: 17 Nov 2017.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
A hypercoagulable state has, in observational studies, been associated
with increased risk of thromboembolic events. The aim of this trial was to
study whether dual antiplatelet therapy (DAPT) with clopidogrel in
addition to aspirin could reduce the rate of graft occlusions,
thromboembolic events, and death compared to aspirin monotherapy in
hypercoagulable patients undergoing coronary artery bypass surgery. A
total of 1683 patients were screened for eligibility, among which 165
patients were randomized and 133 patients underwent multislice computed
tomography scan to evaluate their grafts. Thrombelastography (TEG) and
multiplate aggregometry were performed before and after surgery, and again
at three months follow up. TEG hypercoagulability was defined as the
maximum amplitude above 69 mm. At three months follow up, 17 out of 66
(25.7%) DAPT patients and 15 of 67 (22.4%) aspirin patients had
significant graft stenosis or occlusions (p = 0.839). Saphenous vein
grafts (SVGs) were stenosed or occluded in 15 (22.7%) patients in the DAPT
group and 7 (10.4%) in the aspirin group (p = 0.167). Thromboembolic
events and death after the second postoperative day (when clopidogrel was
started) were numerically, but not statistically, lower in the DAPT group,
3 (3.8%) vs. 8 (9.9%), p = 0.211. In univariate logistic regression
analysis, only postoperative day 4 platelet response to aspirin measured
with multiplate was correlated with graft occlusion, OR 1.020
[1.002-1.039], p = 0.033. This is the first trial to test the hypothesis
of intensified antiplatelet therapy in hypercoagulable patients. Due to
the low enrollment and high loss to follow up, our results can only be
viewed as hypothesis generating. We found a high rate of graft occlusions
in this patient population. Our results were not suggestive of that DAPT
improved saphenous vein graft patency. A trend was observed in patients on
DAPT toward fewer MI and deaths. Postoperative response to aspirin therapy
was found to be associated with early SVG occlusion.<br/>Copyright &#xa9;
2017 Taylor & Francis.

<39>
Accession Number
619152530
Author
Antonic M.
Institution
(Antonic) Department of Cardiac Surgery, University Medical Centre
Maribor, Ljubljanska ulica 5, Maribor SI-2000, Slovenia
Title
Effect of ascorbic acid on postoperative acute kidney injury in coronary
artery bypass graft patients: A pilot study.
Source
Heart Surgery Forum. 20 (5) (pp E214-E218), 2017. Date of Publication:
October 2017.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Background: Even minor postoperative reductions in renal function
influence the outcome of cardiac surgery. The mechanisms of postoperative
renal injury in cardiac surgery are multifactorial and include
ischemia-reperfusion injury. The study investigates the effect of the
antioxidant ascorbic acid on the postoperative acute kidney injury after
elective CABG surgery. Methods: A prospective randomized single-center
trial was conducted in on-pump coronary artery bypass patients. The
patients in the ascorbic acid group received 2 grams of ascorbic acid 24
hours and 2 hours preoperatively and 1 gram twice daily five days after
the surgery. Postoperatively, the subjects were monitored for renal
dysfunction and other complications. Results: 100 patients were included,
with 50 patients in each study group. The groups were well matched for
baseline demographics, preoperative medications, comorbidities, and had
similar intraoperative characteristics. The incidence of postoperative
acute kidney injury in the ascorbic acid group was 16% and 14% in the
control group (P = .779). The groups also did not differ in peak
postoperative serum creatinine (83 [33] mumol/L versus 83 [39] mumol/L; P
= .434), the lowest postoperative creatinine clearance (96.40 +/- 35.78
mL/min versus 90.89 +/- 36.18 mL/min; P = .766), and time from surgery to
the onset of peak postoperative serum creatinine (1.64 +/- 1.34 days
versus 1.92 +/- 1.54 days; P = .393). There was no dialysis required in
any patient. Conclusion: The results of this study did not demonstrate a
significant protective effect of ascorbic acid on the incidence of
postoperative acute renal injury in elective onpump CABG
patients.<br/>Copyright &#xa9; 2017 Forum Multimedia Publishing, LLC.

<40>
Accession Number
614326645
Author
Marwali E.M.; Boom C.E.; Budiwardhana N.; Fakhri D.; Roebiono P.S.;
Santoso A.; Sastroasmoro S.; Slee A.; Portman M.A.
Institution
(Marwali, Boom, Budiwardhana) Pediatric Cardiac Intensive Care and
Anesthesiology Division, National Cardiovascular Center Harapan Kita,
Jakarta, Indonesia
(Fakhri) Pediatric Cardiac Surgery Division, National Cardiovascular
Center Harapan Kita, Jakarta, Indonesia
(Roebiono, Santoso) Pediatric Cardiology and Congenital Heart Disease
Division, National Cardiovascular Center Harapan Kita and Department of
Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Indonesia, Jakarta, Indonesia
(Sastroasmoro) Center for Clinical Epidemiology and Evidence Based
Medicine, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas
Indonesia, Jakarta, Indonesia
(Slee) Axio Research, Seattle, Washington, United States
(Portman) Seattle Children's Hospital and Research Institute, University
of Washington, Seattle, Washington, United States
Title
Oral Triiodothyronine for Infants and Children Undergoing Cardiopulmonary
Bypass.
Source
Annals of Thoracic Surgery. 104 (2) (pp 688-695), 2017. Date of
Publication: August 2017.
Publisher
Elsevier USA
Abstract
Background This study evaluated the efficacy and safety of oral
triiodothyronine (T3; Tetronine, Dalim BioTech, Korea) for infants and
children undergoing cardiopulmonary bypass in an Indonesian population.
Methods We performed a single-center, randomized, double-blind, and
placebo-controlled trial in children aged 3 years and younger undergoing
congenital heart disease operations with cardiopulmonary bypass. We
administered oral T3 (1 mug/kg per body weight/dose) or placebo (saccharum
lactis) by nasogastric tube every 6 hours for 60 hours after induction of
anesthesia. The primary end point, time to extubation, was compared with
Cox regression. Results The modified intention-to-treat group included 101
placebo and 104 treated patients. The stratified log-rank test did not
show a significant treatment difference (p = 0.061) for time to
extubation, but after adjustment for age, the nutritional Z score, and
Aristotle surgical complexity, the hazard ratio was 1.33 (95% confidence
interval, 1.00 to 1.76; p = 0.049). The effect of T3 was stronger in the
strata aged 5 months and younger (hazard ratio, 1.86; 95% confidence
interval 1.02 to 3.39; p = 0.043). Median intubation time was 47.3 hours
for the placebo and 32.1 hours for the T3 group in aged 5 months and
younger. Adverse events rates, including arrhythmia, were similar between
groups, although sepsis was more frequent with placebo. Conclusions Oral
T3 supplementation may shorten time to extubation in children undergoing
congenital heart disease operations, particularly infants aged 5 months or
younger. Administration is relatively safe, simple and
inexpensive.<br/>Copyright &#xa9; 2017 The Society of Thoracic Surgeons

<41>
Accession Number
618389718
Author
Gupta P.; Chakraborty A.; Gossett J.M.; Rettiganti M.
Institution
(Gupta) Division of Pediatric Cardiology, Department of Pediatrics,
University of Arkansas for Medical Sciences, Arkansas Children's Hospital,
Little Rock, Ark, United States
(Chakraborty) Department of Mathematical Sciences, University of Arkansas,
Fayetteville, Ark, United States
(Gossett, Rettiganti) Biostatistics Program, Department of Pediatrics,
University of Arkansas for Medical Sciences, Arkansas Children's Hospital
Research Institute, Little Rock, Ark, United States
Title
A prognostic tool to predict outcomes in children undergoing the Norwood
operation.
Source
Journal of Thoracic and Cardiovascular Surgery. 154 (6) (pp 2030-2037.e2),
2017. Date of Publication: December 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives To create and validate a prediction model to assess outcomes
associated with the Norwood operation. Methods The public-use dataset from
a multicenter, prospective, randomized single-ventricle reconstruction
trial was used to create this novel prediction tool. A Bayesian lasso
logistic regression model was used for variable selection. We used a
hierarchical framework by representing discrete probability models with
continuous latent variables that depended on the risk factors for a
particular patient. Bayesian conditional probit regression and Markov
chain Monte Carlo simulations were then used to estimate the effects of
the predictors on the means of these latent variables to create a score
function for each of the study outcomes. We also devised a method to
calculate the risk of outcomes associated with the Norwood operation
before the actual heart operation. The 2 study outcomes evaluated were
in-hospital mortality and composite poor outcome. Results The training
dataset used 520 patients to generate the prediction model. The model
included patient demographics, baseline characteristics, cardiac
diagnosis, operation details, site volume, and surgeon experience. An
online calculator for the tool can be accessed at
https://soipredictiontool.shinyapps.io/NorwoodScoreApp/. Model validation
was performed on 520 observations using an internal 10-fold
cross-validation approach. The prediction model had an area under the
curve of 0.77 for mortality and 0.72 for composite poor outcome on the
validation dataset. Conclusions Our new prognostic tool is a promising
first step in creating real-time risk stratification in children
undergoing a Norwood operation; this tool will be beneficial for the
purposes of benchmarking, family counseling, and research.<br/>Copyright
&#xa9; 2017 The American Association for Thoracic Surgery

<42>
Accession Number
618030176
Author
Kandzari D.E.; Mauri L.; Koolen J.J.; Massaro J.M.; Doros G.;
Garcia-Garcia H.M.; Bennett J.; Roguin A.; Gharib E.G.; Cutlip D.E.;
Waksman R.
Institution
(Kandzari) Piedmont Heart Institute, Atlanta, GA, USA
(Mauri) Divison of Cardiovascular Medicine, Brigham and Women's Hospital,
Boston, MA, USA
(Koolen) Catharina Hospital, Eindhoven, Netherlands
(Massaro, Doros) Department of Biostatistics and Epidemiology, Boston
University School of Public Health, Boston, MA, USA
(Doros) Baim Institute for Clinical Research, Boston, MA, USA
(Garcia-Garcia, Waksman) Division of Interventional Cardiology, MedStar
Cardiovascular Research Network, MedStar Washington Hospital Center,
Washington, DC, USA
(Bennett) Department of Cardiovascular Medicine, University Hospitals
Leuven, Leuven, Belgium
(Roguin) Department of Cardiology, Rambam Medical Center, Haifa, Israel
(Gharib) Charleston Area Medical Center, Charleston, WV, USA
(Cutlip) Beth Israel Deaconess Medical Center, Baim Institute for Clinical
Research, Boston, MA, USA
Title
Ultrathin, bioresorbable polymer sirolimus-eluting stents versus thin,
durable polymer everolimus-eluting stents in patients undergoing coronary
revascularisation (BIOFLOW V): A randomised trial.
Source
The Lancet. (no pagination), 2017. Date of Publication: 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: The development of coronary drug-eluting stents has included
use of new metal alloys, changes in stent architecture, and use of
bioresorbable polymers. Whether these advancements improve clinical safety
and efficacy has not been shown in previous randomised trials. We aimed to
examine the clinical outcomes of a bioresorbable polymer sirolimus-eluting
stent compared with a durable polymer everolimus-eluting stent in a broad
patient population undergoing percutaneous coronary intervention. Methods:
BIOFLOW V was an international, randomised trial done in patients
undergoing elective and urgent percutaneous coronary intervention in 90
hospitals in 13 countries (Australia, Belgium, Canada, Denmark, Germany,
Hungary, Israel, the Netherlands, New Zealand, South Korea, Spain,
Switzerland, and the USA). Eligible patients were those aged 18 years or
older with ischaemic heart disease undergoing planned stent implantation
in de-novo, native coronary lesions. Patients were randomly assigned (2:1)
to either an ultrathin strut (60 mum) bioresorbable polymer
sirolimus-eluting stent or to a durable polymer everolimus-eluting stent.
Randomisation was via a central web-based data capture system (mixed
blocks of 3 and 6), and stratified by study site. The primary endpoint was
12-month target lesion failure. The primary non-inferiority comparison
combined these data from two additional randomised trials of bioresorbable
polymer sirolimus-eluting stent and durable polymer everolimus-eluting
stent with Bayesian methods. Analysis was by intention to treat. The trial
is registered with ClinicalTrials.gov, number NCT02389946. Findings:
Between May 8, 2015, and March 31, 2016, 4772 patients were recruited into
the study. 1334 patients met inclusion criteria and were randomly assigned
to treatment with bioresorbable polymer sirolimus-eluting stents (n=884)
or durable polymer everolimus-eluting stents (n=450). 52 (6%) of 883
patients in the bioresorbable polymer sirolimus-eluting stent group and 41
(10%) of 427 patients in the durable polymer everolimus-eluting stent
group met the 12-month primary endpoint of target lesion failure (95% CI
-6.84 to -0.29, p=0.0399), with differences in target vessel myocardial
infarction (39 [5%] of 831 patients vs 35 [8%] of 424 patients, p=0.0155).
The posterior probability that the bioresorbable polymer sirolimus-eluting
stent is non-inferior to the durable polymer everolimus-eluting stent was
100% (Bayesian analysis, difference in target lesion failure frequency
-2.6% [95% credible interval -5.5 to 0.1], non-inferiority margin 3.85%,
n=2208). Interpretation: The outperformance of the ultrathin,
bioresorbable polymer sirolimus-eluting stent over the durable polymer
everolimus-eluting stent in a complex patient population undergoing
percutaneous coronary intervention suggests a new direction in improving
next generation drug-eluting stent technology. Funding:
BIOTRONIK.<br/>Copyright &#xa9; 2017 Elsevier Ltd.

<43>
[Use Link to view the full text]
Accession Number
608297014
Author
Wozniczka J.K.; Ledonio C.G.T.; Polly D.W.; Rosenstein B.E.; Nuckley D.J.
Institution
(Wozniczka, Ledonio, Polly) Musculoskeletal Biomechanics Research
Laboratory, Department of Orthopaedic Surgery, University of Minnesota,
2450 Riverside Avenue South, Suite R 200, Minneapolis, MN 55454, United
States
(Rosenstein) Department of Biomedical Engineering, University of
Minnesota, Minneapolis, MN, United States
(Nuckley) Zimmer Spine, Minneapolis, MN, United States
Title
Adolescent Idiopathic Scoliosis Thoracic Volume Modeling: The Effect of
Surgical Correction.
Source
Journal of Pediatric Orthopaedics. 37 (8) (pp e512-e518), 2017. Date of
Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Scoliosis has been shown to have detrimental effects on
pulmonary function, traditionally measured by pulmonary function tests,
which is theorized to be correlated to the distortion of the spine and
thorax. The changes in thoracic volume with surgical correction have not
been well quantified. This study seeks to define the effect of surgical
correction on thoracic volume in patients with adolescent idiopathic
scoliosis. Methods: Images were obtained from adolescents with idiopathic
scoliosis enrolled in a multicenter database (Prospective Pediatric
Scoliosis Study). A convenience sample of patients with Lenke type 1
curves with a complete data set meeting specific parameters was used.
Blender v2.63a software was used to construct a 3-dimensional (3D)
computational model of the spine from 2-dimensional calibrated
radiographs. To accomplish this, the 3D thorax model was deformed to match
the calibrated radiographs. The thorax volume was then calculated in cubic
centimeters using Mimics v15 software. Results: The results using this
computational modeling technique demonstrated that surgical correction
resulted in decreased curve measurement as determined by Cobb method, and
increased postoperative thoracic volume as expected. Thoracic volume
significantly increased by a mean of 567 mm 3 (P<0.001). The percent
change in thoracic volume after surgical correction averaged 40% (range,
3% to 87%). The smaller the baseline volume, the greater the change in
volume postoperatively (r=-0.86). Evaluation of postoperative data
demonstrated that spinal curve measurement as determined by Cobb method
was significantly reduced from a mean of 69 degrees (range, 50 to 96
degrees) preoperatively to 27 degrees (range, 13 to 33 degrees)
postoperatively (P<0.001). Conclusions: This pilot study demonstrates
methodologic plausibility for measuring 3D changes in thoracic volumes
using 2-dimensional imaging. This is an assessment of the novel modeling
technique, to be used in larger future studies to assess clinical
significance. Level of Evidence: Level 3 - retrospective comparison of
prospectively collected data.<br/>Copyright &#xa9; 2016 Wolters Kluwer
Health, Inc. All rights reserved.

<44>
Accession Number
619249011
Author
Hoffmann T.; Albert A.; Roussel E.; Besser V.; Balasubramaniam K.;
Lichtenberg A.; Sixt S.
Institution
(Hoffmann, Roussel, Balasubramaniam) Heinrich Heine University, Medical
Faculty, Transfusion Medicine and Clinical Haemostaseology, Dusseldorf,
Germany
(Albert, Besser, Lichtenberg) Heinrich Heine University, Medical Faculty,
Department of Cardiovascular Surgery, Dusseldorf, Germany
(Sixt) Heinrich Heine University, Medical Faculty, Department of
Anaesthesiology, Dusseldorf, Germany
Title
D-Dimer testing for the assessment of intra-operative fibrinolytic
activity with tranexamic acid prophylaxis.
Source
Transfusion Medicine and Hemotherapy. Conference: 50. Jahrestagung der
Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie, DGTI
2017. Germany. 44 (Supplement 1) (pp 68-69), 2017. Date of Publication:
October 2017.
Publisher
S. Karger AG
Abstract
Introduction: Antifibrinolytic therapy with tranexamic acid is an
established anti-haemorrhagic strategy in situations such as trauma,
peripartal bleeding or major surgery. D-dimer testing is a diagnostic
standard for exclusion of venous thromboembolism. More recently increased
D-dimers have been shown to predict not only thromboembolism but also
bleeding in patients with atrial fibrillation (Siegbahn et al, 2016). We
assessed the course of D-dimer levels during cardiac surgery. The
incidence of increasing D-dimers was put into relation with surgery types,
and transfusion needs were calculated for patient groups with and without
increasing D-dimers. Patients and Methods: We prospectively collected data
from 3.214 cardio surgery patients. D-dimer measurement was performed with
a turbidimetric standard assay. D-dimer results from 1st testing at
incision as well as 2nd testing shortly before administration of protamine
were included in the present analysis. During this period, tranexamic acid
(TA; Cyklokapron) was administered. A subgroup comparison was performed
according to surgery types: bypass-, single valve-, combined bypass and
valve-, multiple valve-, aorta surgery, heart transplant (HTX), left
ventricular assist device implantation (LVAD). Transfusion rates (mean
number of units per patient) were calculated for red blood cell
concentrates (RBC), fresh frozen plasma (FFP) and platelet concentrates
(PC). Results: Overall 11% of patients showed increasing D-dimers from
incision to the pre-protamine testing despite TA treatment. Differences
with respect to surgery types are given in the table: In patients with
increasing D-dimers the intraoperative need for RBC and PC was
significantly higher as compared to patients with stable or decreasing
D-dimers (RBC: 3.5 vs. 1.9; p < 0.0001; PC: 1.6 vs 0.9; p < 0.0001).
Likewise, within transfusion needs 24hrs postoperatively remained
significantly higher (mean RBC: 1.8 vs 1.0; p = 0.001; mean PC 0.7 vs 0.4;
p = 0.0006; FFP 2.1 vs 1.1; p < 0.0001) in patients with increasing
D-dimers. Conclusion: Even within the short intra-operative period,
sequential D-dimer testing allows the identification of patients with
increasing fibrinolytic activity despite tranexamic acid prophylaxis. The
probability of 'break-through' fibrinolysis depends on the type of cardiac
disease or cardiac surgery. Increasing fibrinolysis is associated with
increased bleeding as objectified by higher transfusion needs. According
to these data, intra-operative D-dimer monitoring allows for
identification of the fibrinolysis-related bleeding risk and potentially,
for risk adjusted dosing of antifibrinolytic therapy. Further analyses
have to clarify if intra-operatively increasing D dimers are associated
also with thromboembolic risks.

<45>
Accession Number
619248839
Author
Hess J.R.
Institution
(Hess) University of Washington, Laboratory Medicine and Hematology,
Seattle, United States
Title
Optimal use of plasma.
Source
Transfusion Medicine and Hemotherapy. Conference: 50. Jahrestagung der
Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie, DGTI
2017. Germany. 44 (Supplement 1) (pp 25), 2017. Date of Publication:
October 2017.
Publisher
S. Karger AG
Abstract
Plasma, the acellular portion of blood, is made into multiple blood
components and fractions. For the basic transfused blood components,
plasma and cryoprecipitate, indications continue to evolve. In 2010,
Roback and colleagues published a systematic review of the indications for
plasma and found few. Plasma is indicated for the replacement of factors
for which specific factor concentrates do not exist and for large volume
plasma replacement as in plasma exchange for thrombotic thrombocytopenia
purpura. The utility of plasma in trauma resuscitation was strongly
suggested, but the evidence was felt weak. Since that time, wider
understanding of cell-based coagulation and broad experience with
hemorrhage control resuscitation suggests that plasma, used in a 1:1 unit
ratio with red blood cells, is the ideal resuscitation fluid for massive
uncontrolled hemorrhage. We have level 1 evidence that such use is safe,
and strong level 3 evidence that it is effective. Beyond trauma
resuscitation, plasma is important in other massive hemorrhage situations.
The volume of bleeding and mortality in cardiac surgery and liver
transplantation is greater when 5 units of red cells are given without
equivalent amounts of plasma. Cryoprecipitate is largely used for
fibrinogen replacement, but at least in vitro, the blood component is more
effective for treating hyperfibrinolysis than purified fibrinogen
concentrate alone. Retrospective data suggest excess mortality in trauma
and obstetric hemorrhage when the fibrinogen concentration is less than
2g/L. Miminum plasma concentrations for coagulation factors in
non-hemorrhage situations are not rigorously defined, but experience with
hemophilias suggests that they are low.

<46>
Accession Number
619236053
Author
Gur O.; Gurkan S.; Yumun G.; Turker P.
Institution
(Gur, Gurkan, Yumun) Department of Cardiovascular Surgery, Namik Kemal
University, Tekirdag, Turkey
(Turker) Department of Urology, Namik Kemal University, Tekirdag, Turkey
Title
The Comparison of the Effects of Nebivolol and Metoprolol on Erectile
Dysfunction in the Cases with Coronary Artery Bypass Surgery.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. 23 (2) (pp
91-95), 2017. Date of Publication: 20 Apr 2017.
Abstract
PURPOSE: Beta-blocker use is common in the cases with coronary artery
bypass surgery. According to the literature, beta-blockers have positive
effects but may cause erectile dysfunction (ED). The most commonly used
beta-blockers in ischemic cardiac disease are nebivolol and metoprolol. In
our clinic, we aimed to compare the effects of nebivolol and metoprolol
succinate on ED in the sexually active cases with coronary artery bypass
surgery.
METHODS: In our clinic, a total of 119 patients with coronary artery
bypass surgery were included in the study. International Index of Erectile
Function (IIEF-5) Test was used to evaluate whether the patients had ED
and to grade the cases.
RESULTS: No significant difference was found in terms of anti-ischemic
efficacy between metoprolol succinate and nebivolol in the postoperative
period; however, the incidence of any grade ED was %85.96 in Group 1,
%83.87 in Group 2. This difference was considered as statistically
significant (p = 0.036).
CONCLUSION: Beta-blocker use increases the risk of ED in cases with
ischemic cardiac disease. We suggest that the complaints of ED could be
less frequent with nebivolol use in sexually active cases with ischemic
cardiac disease.

<47>
Accession Number
619230288
Author
Connolly S.J.; Eikelboom J.W.; Bosch J.; Dagenais G.; Dyal L.; Lanas F.;
Metsarinne K.; O'Donnell M.; Dans A.L.; Ha J.-W.; Parkhomenko A.N.; Avezum
A.A.; Lonn E.; Lisheng L.; Torp-Pedersen C.; Widimsky P.; Maggioni A.P.;
Felix C.; Keltai K.; Hori M.; Yusoff K.; Guzik T.J.; Bhatt D.L.; Branch
K.R.H.; Cook Bruns N.; Berkowitz S.D.; Anand S.S.; Varigos J.D.; Fox
K.A.A.; Yusuf S.
Institution
(Connolly, Eikelboom, Dyal, Lonn, Anand, Yusuf) Population Health Research
Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON,
Canada
(Bosch) School of Rehabilitation Science, McMaster University, Hamilton,
ON, Canada
(Dagenais) Institut Universitaire de Cardiologie et Pneumologie de Quebec,
Quebec, QC, Canada
(Lanas) Universidad de la Frontera, Temuco, Chile
(Metsarinne) Department of Medicine, Turku University Central Hospital and
Turku University, Turku, Finland
(O'Donnell) Department of Medicine, National University of Ireland,
Galway, Ireland
(Dans) Department of Medicine, University of Philippines, Manila,
Philippines
(Ha) Yonsei University College of Medicine, Seoul, Korea
(Parkhomenko) Institute of Cardiology, Kiev, Ukraine
(Avezum) Instituto Dante Pazzanese de Cardiologia and University Santo
Amaro, Sao Paulo, Brazil
(Lisheng) FuWai Hospital, CAMS, Beijing, China
(Torp-Pedersen) University of Aalborg, Aalborg, Denmark
(Widimsky) Charles University, Prague, Czech Republic
(Maggioni) ANMCO Research Center, Florence, Italy
(Felix) Universidad Tecnologica Equinoccial, Facultad de Ciencias de la
Salud Eugenio, Espejo, Quito, Ecuador
(Keltai) Department of Medicine, Semmelweis University, Budapest, Hungary
(Hori) Osaka International Cancer Institute, Osaka, Japan
(Yusoff) Universiti Teknologi Mara, Selangor, Malaysia
(Guzik) Collegium Medicum Jagiellonian University, Krakow, Poland
(Guzik) University of Glasgow, Glasgow, UK
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center and Harvard
Medical School, Boston, MA, USA
(Branch) Department of Medicine, University of Washington Medical Centre,
Seattle, WA, USA
(Cook Bruns) Bayer AG, Wuppertal, Germany
(Berkowitz) Bayer AG, Parsippany, NJ, USA
(Varigos) Monash University, Melbourne, VIC, Australia
(Fox) Department of Medicine, University of Edinburgh, Edinburgh, UK
Title
Rivaroxaban with or without aspirin in patients with stable coronary
artery disease: An international, randomised, double-blind,
placebo-controlled trial.
Source
The Lancet. (no pagination), 2017. Date of Publication: 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Coronary artery disease is a major cause of morbidity and
mortality worldwide, and is a consequence of acute thrombotic events
involving activation of platelets and coagulation proteins. Factor Xa
inhibitors and aspirin each reduce thrombotic events but have not yet been
tested in combination or against each other in patients with stable
coronary artery disease. Methods: In this multicentre, double-blind,
randomised, placebo-controlled, outpatient trial, patients with stable
coronary artery disease or peripheral artery disease were recruited at 602
hospitals, clinics, or community centres in 33 countries. This paper
reports on patients with coronary artery disease. Eligible patients with
coronary artery disease had to have had a myocardial infarction in the
past 20 years, multi-vessel coronary artery disease, history of stable or
unstable angina, previous multi-vessel percutaneous coronary intervention,
or previous multi-vessel coronary artery bypass graft surgery. After a
30-day run in period, patients were randomly assigned (1:1:1) to receive
rivaroxaban (2.5 mg orally twice a day) plus aspirin (100 mg once a day),
rivaroxaban alone (5 mg orally twice a day), or aspirin alone (100 mg
orally once a day). Randomisation was computer generated. Each treatment
group was double dummy, and the patients, investigators, and central study
staff were masked to treatment allocation. The primary outcome of the
COMPASS trial was the occurrence of myocardial infarction, stroke, or
cardiovascular death. This trial is registered with ClinicalTrials.gov,
number NCT01776424, and is closed to new participants. Findings: Between
March 12, 2013, and May 10, 2016, 27395 patients were enrolled to the
COMPASS trial, of whom 24824 patients had stable coronary artery disease
from 558 centres. The combination of rivaroxaban plus aspirin reduced the
primary outcome more than aspirin alone (347 [4%] of 8313 vs 460 [6%] of
8261; hazard ratio [HR] 0.74, 95% CI 0.65-0.86, p<0.0001). By comparison,
treatment with rivaroxaban alone did not significantly improve the primary
outcome when compared with treatment with aspirin alone (411 [5%] of 8250
vs 460 [6%] of 8261; HR 0.89, 95% CI 0.78-1.02, p=0.094). Combined
rivaroxaban plus aspirin treatment resulted in more major bleeds than
treatment with aspirin alone (263 [3%] of 8313 vs 158 [2%] of 8261; HR
1.66, 95% CI 1.37-2.03, p<0.0001), and similarly, more bleeds were seen in
the rivaroxaban alone group than in the aspirin alone group (236 [3%] of
8250 vs 158 [2%] of 8261; HR 1.51, 95% CI 1.23-1.84, p<0.0001). The most
common site of major bleeding was gastrointestinal, occurring in 130 [2%]
patients who received combined rivaroxaban plus aspirin, in 84 [1%]
patients who received rivaroxaban alone, and in 61 [1%] patients who
received aspirin alone. Rivaroxaban plus aspirin reduced mortality when
compared with aspirin alone (262 [3%] of 8313 vs 339 [4%] of 8261; HR
0.77, 95% CI 0.65-0.90, p=0.0012). Interpretation: In patients with stable
coronary artery disease, addition of rivaroxaban to aspirin lowered major
vascular events, but increased major bleeding. There was no significant
increase in intracranial bleeding or other critical organ bleeding. There
was also a significant net benefit in favour of rivaroxaban plus aspirin
and deaths were reduced by 23%. Thus, addition of rivaroxaban to aspirin
has the potential to substantially reduce morbidity and mortality from
coronary artery disease worldwide. Funding: Bayer AG.<br/>Copyright &#xa9;
2017 Elsevier Ltd.

<48>
Accession Number
619216352
Author
Chang J.-E.; Kim H.; Min S.-W.; Lee J.-M.; Ryu J.-H.; Yoon S.; Hwang J.-Y.
Institution
(Chang, Kim, Min, Lee, Hwang) Department of Anesthesiology and Pain
Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
(Ryu) Department of Anesthesiology and Pain Medicine, Seoul National
University Bundang Hospital, Gyeonggi-go, Republic of Korea
(Yoon) Department of Anesthesiology and Pain Medicine, Seoul National
University Hospital, Seoul, Republic of Korea
Title
A Randomized Controlled Trial Comparing the Utility of Lighted Stylet and
GlideScope for Double-Lumen Endobronchial Intubation.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objective: To compare GlideScope and lighted stylet for double-lumen
endobronchial tube (DLT) intubation in terms of intubation time, success
rate of first attempt at intubation, difficulty in DLT advancement toward
the glottis, and postoperative sore throat and hoarseness. Design: A
prospective, randomized study. Setting: Medical center governed by a
university hostpial. Participants: Sixty-two adult patients undergoing
thoracic surgery using DLT intubation. Intervention: After the induction
of anesthesia, DLT intubation was performed using GlideScope (n = 32) or
lighted stylet (n = 32). Measurements and Main Results: Number of
intubation attempts, difficulty of DLT advancement toward the glottis,
time taken for DLT intubation, and the incidence and severity of
postoperative sore throat and hoarseness at 1 and 24 hours after surgery
were evaluated. Time taken for DLT intubation was shorter in the lighted
stylet group compared with the GlideScope group (30 [28-32] s v 45 [38-53]
s, median [interquartile range], respectively; p < 0.001). DLT advancement
toward the glottis was easier in the lighted stylet group than in the
GlideScope group (p = 0.016). The success rate of DLT intubation in the
first attempt (96.9% v 90.6% for lighted stylet and GlideScope,
respectively), and the incidence and severity of postoperative sore throat
and hoarseness were not different between the two groups. Conclusions: The
use of lighted stylet allowed easier advancement of the DLT toward the
glottis in the oropharyngeal space and reduced time for achieving DLT
intubation compared with GlideScope.<br/>Copyright &#xa9; 2017 Elsevier
Inc.

<49>
Accession Number
619122345
Author
Levy J.H.; Rossaint R.; Zacharowski K.; Spahn D.R.
Institution
(Levy) Department of Anesthesiology, Duke University School of Medicine,
Durham, NC, United States
(Rossaint) Department of Anaesthesiology, RWTH Aachen University Hospital,
Aachen, Germany
(Zacharowski) Department of Anaesthesiology, Intensive Care Medicine &
Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
(Spahn) Institute of Anesthesiology, University and University Hospital of
Zurich, Zurich, Switzerland
Title
What is the evidence for platelet transfusion in perioperative settings?.
Source
Vox Sanguinis. 112 (8) (pp 704-712), 2017. Date of Publication: November
2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background and Objectives: Platelet transfusions are widely administered
to restore perioperative haemostasis in haemorrhagic patients; however,
the role of platelet transfusion is not well understood and administration
is often based on empiric data. This review aims to explore consensus
regarding platelet transfusion trigger, dose and how the haemostatic
efficacy of platelet transfusion was assessed for the treatment of
perioperative bleeding. Materials and Methods: A literature search was
carried out using MEDLINE (PubMed) on 28 February 2017, to identify
publications reporting the effect of platelet transfusion in relation to
triggers, dose and assessment of haemostatic efficacy in bleeding patients
in a perioperative setting. Results: Eight publications were identified
across a variety of settings, covering both prophylactic and therapeutic
platelet transfusion in adult patients; the majority of the reports were
in cardiac surgery. A high degree of variability was observed in the
published studies, with only 50% of articles specifying a trigger for
platelet transfusion. The most commonly used trigger was platelet count
(25% of publications), with no consensus identified regarding the platelet
count values used as triggers. Doses reported per transfusion varied from
1 to 12 units, and outcome measures were mixed, although the majority of
publications (63%) assessed the requirement for transfusion with other
blood products. Conclusion: The lack of consensus in published studies
hinders our ability to draw conclusions regarding platelet transfusion and
highlights the need for further studies to assess the appropriate dose and
triggers for use in perioperative patients.<br/>Copyright &#xa9; 2017
International Society of Blood Transfusion

<50>
Accession Number
614659366
Author
Zhu Z.G.; Xiong W.; Ding J.L.; Chen J.; Li Y.; Zhou J.L.; Xu J.J.
Institution
(Zhu, Chen, Li, Zhou, Xu) Department of Cardiothoracic Surgery, Second
Affiliated Hospital of Nanchang University, Nanchang, China
(Xiong) Guangxi University of Chinese Medicine, Nanning, China
(Ding) Department of Gastroenterology, Second Affiliated Hospital of
Nanchang University, Nanchang, China
Title
Comparison of outcomes between off-pump versus on-pump coronary artery
bypass surgery in elderly patients: A meta-analysis.
Source
Brazilian Journal of Medical and Biological Research. 50 (3) (no
pagination), 2017. Article Number: e5711. Date of Publication: 2017.
Publisher
Associacao Brasileira de Divulgacao Cientifica (E-mail:
bjournal@fmrp.usp.br)
Abstract
The aim of this study was to analyze if off-pump coronary artery bypass
surgery (CABG) is associated with better treatment outcomes in elderly
patients (>70 years of age) than on-pump CABG, using meta-analysis.
Medline, PubMed, Cochrane and Google Scholar databases were searched until
September 13, 2016. Sensitivity and quality assessment were performed.
Twenty-two studies, three randomized control trials (RCTs) and 20 non-RCTs
were included with 24,127 patients. The risk of death associated with
on-pump or off-pump CABG in the RCTs were similar (pooled OR=0.945,
95%CI=0.652 to 1.371, P=0.766). However, in the non-RCTs, mortality risk
was lower in patients treated with off-pump CABG than on-pump CABG (pooled
OR=0.631, 95%CI=0.587 to 0.944, P=0.003). No differences were observed
between the two treatment groups in terms of the occurrence of 30-day
post-operative stroke or myocardial infarction (P>=0.147). In the
non-RCTs, off-pump CABG treatment was associated with a shorter length of
hospital stay (pooled standardized difference in means=-0.401,
95%CI=-0.621 to -0.181, P<=0.001). The meta-analysis with pooled data from
non-RCTs, but not RCTs, found that mortality was lower with off-pump
compared with on-pump CABG, and suggested that there may be some benefit
of off-pump CABG compared with on-pump CABG in the risk of mortality and
length of hospital stay.<br/>Copyright &#xa9; 2017, Associacao Brasileira
de Divulgacao Cientifica. All rights reserved.

<51>
[Use Link to view the full text]
Accession Number
619222265
Author
Maor E.; Sara J.D.; Lerman L.O.; Lerman A.
Institution
(Maor, Sara, Lerman, Lerman) Div of Cardiovascular Diseases, Mayo Clinic
Rochester, Rochester, MN, United States
Title
The sound of atherosclerosis: Voice signal characteristics are
independently associated with coronary artery disease.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: There is a clinical need for remote, non-invasive, and
objective tests for the presence of coronary artery disease (CAD). Voice
signal analysis is an emerging non-invasive diagnostic tool that has been
assessed and associated with several disease states. The current study
tested the hypothesis that patient voice signal characteristics are
associated with the presence of CAD. Methods: The study population
included 121 consecutive patients referred for elective coronary
angiography, as well as 25 control patients referred for non-cardiac
elective procedures. All subjects had their voice signal recorded using an
application downloaded to their personal smartphone device prior to the
coronary angiography. Voice was recorded, stored and analyzed for multiple
features of voice intensity and frequency using "Beyond Verbal
Communications" clinical trial application. Analysis was blinded with
respect to patient data. CAD was defined as at least one angiographic
stenosis > 70%. Results: Mean age of the study population was 58+/-12
years and 51% were men. 42 (34%) patients had significant CAD. Compared
with subjects with no coronary disease, patients with CAD were older
(62+/-10 vs. 56+/-13 years, p=0.002). Univariate binary logistic
regression analysis identified 11 voice features that were associated with
CAD (p<0.05 for all). Stepwise binary logistic regression with adjustment
for age and gender showed the every one unit increase in the average cycle
time of fluctuations in the frequency band around 1622hz was associated
with 2.4 increased likelihood of CAD (95% CI 1.18-4.79, p=0.015).
Conclusions: We identified abnormal voice characteristics that are
independently associated with CAD. This study suggests a potential
relationship between voice characteristics and CAD.

<52>
[Use Link to view the full text]
Accession Number
619222193
Author
Giustino G.; Mehran R.; Veltkamp R.; Faggioni M.; Danias G.; Baber U.;
Dangas G.
Institution
(Giustino, Mehran, Faggioni, Danias, Baber, Dangas) Zena and Michael A.
Wiener Cardiovascular Institute, Icahn Sch of Medicine at Mount Sinai, New
York, NY, United States
(Veltkamp) Dept of Stroke Medicine, Div of Brain Sciences, Imperial
College, London, United Kingdom
Title
Neurologic outcomes with embolic protection devices in patients undergoing
transcatheter aortic valve replacement: A systematic review and
meta-analysis of randomized controlled trials.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Clinical or subclinical cerebral embolization is a relatively
frequent complication of transcatheter aortic valve replacement (TAVR).
Randomized controlled trials (RCTs) investigating the efficacy of embolic
protection devices during TAVR were relatively underpowered to detect
meaningful differences in imaging and clinical endpoints. Methods: We
performed a systematic review and study-level meta-analysis of RCTs that
tested the efficacy and safety of EP during TAVR. RCTs using any type of
EP and TAVR vascular access were included. Primary imaging efficacy
endpoints were total lesion volume (TLV; in mm ) and number of new
ischemic lesions. Primary clinical efficacy endpoints were any
deterioration in National Institute of Health Stroke Scale (NIHSS) and
Montreal Cognitive Assessment (MoCA) score at hospital discharge. Primary
analyses were performed with the intention-to-treat approach. Results: A
total of 4 RCTs (total n=252) have been included. Use of EP was associated
with lower TLV (Figure; standardized mean difference [SMD]: -0.65; 95%
confidence interval [CI]: -1.06 to -0.25; p=0.002) and lower number of new
ischemic lesions (Figure; SMD: -1.27; 95% CI: -2.45 to -0.09; p = 0.03).
EP was associated with a trend to lower risk of deterioration in NIHSS at
discharge (RR: 0.55; 95% CI: 0.27 to 1.09; p=0.09) and higher MoCA score
(SMD: +0.40; 95% CI: +0.04 to +0.76; p = 0.03). Risk of overt stroke and
all-cause mortality were non-significantly lower in the EP group.
Conclusions: Use of EP seems to be associated with a reduction of imaging
markers of cerebral infarction and early clinical neurologic effectiveness
in patients undergoing TAVR. (Figure Presented).

<53>
[Use Link to view the full text]
Accession Number
619222192
Author
Chaikriangkrai K.; Shanta G.P.S.; Abdulhak A.B.; Jhun H.Y.; Bhama J.K.;
Sigurdsson G.
Institution
(Chaikriangkrai, Shanta, Abdulhak, Sigurdsson) Medicine, Univ of Iowa
Heart and Vascular Cntr, Iowa City, IA, United States
(Jhun) Medicine, Univ of Kansas, Kansas City, KS, United States
(Bhama) Surgery, Univ of Iowa Heart and Vascular Cntr, Iowa City, IA,
United States
Title
Diagnostic accuracy of coronary computed tomography angiography in
patients undergoing cardiac valve surgery: Systematic review and
meta-analysis.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The objective of this study is to investigate the diagnostic
accuracy of coronary computed tomography angiography (CCTA) in patients
undergoing cardiac valve surgery using invasive coronary angiography (ICA)
as gold standard. Hypothesis: CCTA is accurate for identification of
significant coronary stenosis in cardiac valve surgery patients Methods:
We search databases for all diagnostic studies of CCTA in patients
undergoing cardiac valve surgery which reported diagnostic testing
characteristics required to pool summary sensitivity, specificity,
positive likelihood ratio and negative likelihood ratio. Significant
stenosis in both CCTA and ICA is defined by >50% stenosis in any coronary
artery, in-stent stenosis or bypass graft. Results: Nine studies evaluated
659 patients (mean age = 66 years, 52% men). The pooled prevalence of
significant stenosis determined by ICA is 25% (range 18%-56%). Summary
receiver operating characteristic (sROC) analysis demonstrates a summary
area under curve (sAUC) of 0.97. The pooled sensitivity and negative
likelihood ratio of CCTA in identifying significant stenosis determined by
ICA are 96% and 0.07 without significant inter-study heterogeneity. The
pooled specificity and positive likelihood ratio are 89% and 7.36 with
mild-moderate inter-study heterogeneity. Conclusions: In patients
undergoing cardiac valve surgery, CCTA has excellent sensitivity and
negative likelihood ratio to exclude significant coronary stenosis. Our
meta-analysis supports the role of preoperative computed tomography as a
rule-out test in this population. (Figure presented).

<54>
[Use Link to view the full text]
Accession Number
619222178
Author
Marume K.; Tateishi E.; Kamakura T.; Goto Y.; Morita Y.; Kusano K.F.;
Yasuda S.; Noguchi T.
Institution
(Marume, Tateishi, Kamakura, Goto, Morita, Kusano, Yasuda, Noguchi) Dept
of Cardiovascular Medicine, National Cerebral and Cardiovascular Cntr,
Suita Osaka, Japan
Title
Prognostic impact of combination of widened QRS plus gadlinium enhancement
on mortality in dilated cardiomyopathy.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Late gadolinium enhancement (LGE) has been established as a
prognostic indicator in non-ischemic cardiomyopathy. However, it is not
necessarily ideal for detecting diffuse myocardial fibrosis in idiopathic
dilated cardiomyopathy (DCM). Widened QRS (wQRS) on electrocardiogram
(ECG) has been recognized as a simple index for predicting outcomes in
patients with DCM. To avoid missing patients at high risk for cardiac
events by assessing LGE-positive status alone, we wished to determine
whether LGE plus wQRS is a better prognostic factor in patients with DCM.
Method: LGE and ECG results in consecutive 415 patients with DCM were
examined. Any QRS morphology with QRS duration>=120ms were defined as
wQRS. Patients were divided into four groups according to the presence or
absence of LGE and wQRS: LGE-positive + wQRS-positive (n=83), LGE-positive
+ wQRS-negative (n=125), LGE-negative + wQRS-positive (n=50) and
LGE-negative + wQRS-negative (n=157). The composite end point was cardiac
death, cardiac transplantation, or LV assist device implantation. Results:
During median follow up of 57 months, 36 (8.7%) patients developed the
composite end point. Kaplan-Meier curves analysis showed that the cardiac
event free survival rate was lowest in the LGE-positive + wQRS-positive
group and highest in the LGE-negative + wQRS-negative group (P<0.001)
(Figure). Of note, there was no significant difference in the cardiac
eventfree survival rate between the LGE-positive + wQRS-negative and
LGE-negative + wQRS-positive groups (P=NS) (Figure). Multivariable Cox
regression analysis identified that the combination of the presence of LGE
and wQRS was significantly associated with cardiac events (Hazard ratio
2.72, 95% CI 1.28 to 5.75, p<0.001) Conclusion: The combination of LGE and
wQRS provides more clinically relevant information for assessing the risk
of cardiac events in patients with DCM than LGE status alone.

<55>
Accession Number
619222164
Author
Amin A.; Keshishian A.; Vo L.; Mardekian J.; Singhal S.; Patel C.; Odell
K.; Trocio J.
Institution
(Amin) Medicine, Univ of California, Irvine, CA, United States
(Keshishian) Health Economics and Outcomes Rsch, STATinMED Rsch, Ann
Arbor, MI, United States
(Vo, Singhal, Patel) Health Economics and Outcomes Rsch, Bristol-Myers
Squibb Company, New York, NY, United States
(Mardekian, Odell, Trocio) Health Economics and Outcomes Rsch, Pfizer Inc,
New York, NY, United States
Title
Real-world comparisons of major bleeding risk for commercially insured
non-valvular atrial fibrillation patients initiating apixaban, dabigatran,
rivaroxaban, or warfarin.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Clinical trials have demonstrated that non-VKA oral
anticoagulants (NOACs) are at least as effective as warfarin for risk
reduction of stroke or systemic embolism and are associated with similar
or lower bleeding rates. This study compared the risk of major bleeding
among non-valvular atrial fibrillation (NVAF) patients initiating oral
anticoagulants. Methods: Commercially-insured adult patients in the Optum
database prescribed apixaban, rivaroxaban, dabigatran, or warfarin were
selected from 01JAN2013-30SEP2015. Patients were required to have an AF
diagnosis (ICD-9-CM code: 427.31), continuous health plan enrollment for
>=12 months, and no OAC use in the 12 months before the index date (first
OAC claim date). Patients with claims suggestive of valvular heart
disease, cardiac surgery, venous thromboembolism, reversible AF, or
evidence of pregnancy were excluded. Major bleeding, defined as bleeding
requiring hospitalization, was compared using a Cox proportional hazards
model adjusted for age, sex, and baseline comorbidities. Patient data were
assessed until health plan disenrollment, inpatient death, 1 year
post-index date, or end of the study period, whichever occurred first.
Results: The study included 13,103 patients: 2,656 apixaban, 1,376
dabigatran, 5,348 rivaroxaban, and 3,723 warfarin patients. Apixaban,
dabigatran, and rivaroxaban patients were younger and had lower
CHA<inf>2</inf>DS<inf>2</inf>-VASc scores compared to warfarin patients.
After adjusting for baseline characteristics, apixaban patients had a
significantly lower risk of major bleeding than warfarin patients
(HR=0.62; 95% CI=0.39-0.99). Dabigatran (HR=0.81; 95% CI=0.45-1.45)
patients had a non-significant numerically lower risk of major bleeding
and rivaroxaban (HR=1.05; 95% CI=0.75-1.48) patients had a similar risk of
major bleeding compared to warfarin patients. Conclusions: In a large
national commercially-insured population, treatment-naive NVAF patients
prescribed apixaban had a significantly lower risk of major bleeding
compared to those prescribed warfarin. Patients prescribed dabigatran or
rivaroxaban had similar risks of major bleeding compared to those
prescribed warfarin.

<56>
Accession Number
619221761
Author
Moneghetti K.J.; Giraldeau G.; Kobayashi Y.; Ariyama M.; Boulate D.;
Kouznestsova T.; Schnittger I.; Wheeler M.; Wu J.C.; Ashley E.; Myers J.;
Haddad F.
Institution
(Moneghetti, Kobayashi, Ariyama, Boulate, Kouznestsova, Wheeler, Wu,
Haddad) Clinical Biomarker and Phenotype Core Laboratory (BPCL), Stanford
Cardiovascular Institute, Stanford, CA, United States
(Giraldeau, Schnittger, Ashley) Div of Cardiovascular Medicine, Stanford
Univ, Sch of Medicine, Stanford, CA, United States
(Myers) Div of Cardiology, Veterans Affairs Palo Alto Healthcare System,
Palo Alto, CA, United States
Title
Complementary role of exercise performance and right heart metrics to the
validated maggic score: Insights from a network analysis.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Risk stratification in heart failure can be completed with
established risk scores. However, right heart metrics, deformation imaging
and the cardiopulmonary response to exercise have not been routinely
incorporated. We investigated the interaction and incremental prognostic
value of novel echocardiographic metrics and exercise performance in a
consecutive cohort of patients with dilated cardiomyopathy (DCM). Methods:
The Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) score was
applied to 208 ambulatory patients with DCM (age 47 +/- 13 years) who had
undergone echocardiography in conjunction with cardiopulmonary exercise
testing. Patients were followed for the composite end point of death,
heart transplant, left ventricular device implantation and hospitalization
for acute heart failure. Partial correlation network analysis was used to
assess interaction between variables. Cox proportional hazard models
identified independent predictors of outcome. Results: Mean LVEF and LV
GLS were 33 +/- 13 % and -10.6 +/- 4.4 % respectively. Among
echocardiographic variables, LVEF and LV GLS and LV strain rate were
strongly related (r = -0.89, and -0.86, respectively, p < 0.01). Age, sex,
BMI, LV GLS and RV GLS explained 56% of the variance in peak
VO<inf>2</inf>dian follow up of 5.3 years, 60 events occurred including 16
deaths. MAGGIC scores were normally distributed (Figure 1, left) and log
rank testing showed significant differences in survival. Cox proportional
hazards identified MAGGIC score (1.78 [1.27-2.50], p <0.01), peak
VO<inf>2</inf> (HR 0.40 [0.24-0.84], p<0.01) and right atrial volume
indexed (RAVI) (HR 1.10 [1.02-1.19], p = 0.01) as independently associated
with outcome. In combination these variables were incremental in
prognostic value compared to MAGGIC score alone (x = 65 vs 42, p <0.01,
Figure 1, right). Conclusion: In patients with DCM exercise performance
and RAVI provide incremental prognostic value when combined with the
validated MAGGIC score. (Figure Presented).

<57>
[Use Link to view the full text]
Accession Number
619221449
Author
Bagai A.; Lu D.; Lucas J.; Goyal A.; Garvey J.L.; Wang T.Y.; Goodman S.G.;
Roe M.T.
Institution
(Bagai, Goodman) Medicine, St. Michael's Hosp, Toronto, Canada
(Lu, Lucas) Statistics, Duke Clinical Rsch Institute, Durham, NC, United
States
(Goyal) Epidemiology, Emory Rollins Sch of Public Health, Atlanta, GA,
United States
(Garvey) Emergency Medicine, Carolinas Med Cntr, Charlotte, NC, United
States
(Wang, Roe) Medicine, Duke Clinical Rsch Institute, Durham, NC, United
States
Title
Differences in utilization of anti-thrombotic therapies and invasive
cardiac procedures for myocardial infarction by degree of chronic kidney
disease: A report from the action registry-GWTG.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Worse clinical outcomes after myocardial infarction (MI) in
patients with chronic kidney (CKD) may be in part attributable to lower
use of guideline recommended therapies. Methods: MI patients from the
ACTION registry-GWTG between 01/2007 and 12/2014 were stratified by STEMI
and NSTEMI, and categorized into 3 groups based on the degree of CKD
[end-stage renal disease (ESRD) on dialysis, CKD (GFR<60ml/min/1.73m ) not
on dialysis, and no CKD (GFR>=60ml/min/1.73m )]. Treatment with
anti-thrombotic therapies and coronary revascularization were compared
between groups using chi-square test. Results: We included 690,514
patients [39.1% STEMI, 60.9% NSTEMI) from 804 US hospitals. STEMI patients
with CKD were treated less frequently with aspirin or a P2Y receptor
inhibitor within 24 hours and anticoagulation in-hospital compared with
patients without CKD, with lowest use in ESRD patients on dialysis
(Table). STEMI patients with CKD were also less likely to undergo coronary
angiography; however, among those who underwent angiography, percentage of
primary PCI and CABG was similar regardless of the presence or degree of
CKD. Lower use of aspirin, P2Y1 receptor inhibitor, anticoagulation and
coronary angiography, both among ESRD patients on dialysis and those with
CKD not requiring dialysis, was also observed among NSTEMI patients.
However, unlike STEMI, among patients with NSTEMI undergoing angiography,
both PCI and CABG were performed less frequently in patients with ESRD on
dialysis and CKD not requiring dialysis compared with patients without
CKD. Conclusions: CKD patients, particularly ESRD patients on dialysis are
less likely than non-CKD patients to be treated with guideline-recommended
therapies during a MI hospitalization. Underutilization of coronary
revascularization in patients with CKD is more prevalent in NSTEMI
compared with STEMI. These findings demonstrate an opportunity to improve
care in this high-risk population.

<58>
[Use Link to view the full text]
Accession Number
619221268
Author
Cutlip D.E.; Kereiakes D.J.; Yeh R.W.; Stefanescu Schmidt A.C.; Steg P.G.;
Massaro J.M.; Hsieh W.-H.; Mauri L.
Institution
(Cutlip) Cardiology, Beth Israel Deaconess Med Cntr, Boston, MA, United
States
(Kereiakes) Cardiology, Christ Hosp Heart and Vascular Cntr, Lindner Cntr
for Rsch and Education, Cincinnati, OH, United States
(Yeh) Richard and Susan Smith Cntr for Outcomes Rsch in Cardiology, Beth
Israel Deaconess Med Cntr, Boston, MA, United States
(Stefanescu Schmidt) Cardiology, Massachusetts General Hosp, Boston, MA,
United States
(Steg) Cardiologie, Assistance Publique - Hopitaux De Paris, Paris, France
(Massaro) Biostatistics, Boston Univ, Sch of Public Health, Boston, MA,
United States
(Hsieh) Biostatistics, Harvard Clinical Rsch Institute, Boston, MA, United
States
(Mauri) Medicine, Div of Cardiology, Brigham Womens Hosp, Boston, MA,
United States
Title
Baseline risk score and interruption of dual antiplatelet therapy within
one year after coronary stents: The dual antiplatelet therapy study
results.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The Dual Antiplatelet Therapy (DAPT) Score, derived from
baseline risk factors for ischemic or bleeding events, was developed as a
decision tool to determine benefit or harm from dual antiplatelet therapy
given beyond 12 months after coronary stenting. The relationship of the
DAPT Score to incident ischemic and bleeding events and the relationship
to therapy interruptions within the first 12 months after stenting is
unknown. Methods: The DAPT Study enrolled 25,682 patients eligible for at
least 12 months of treatment with a thienopyridine and aspirin following
coronary stenting. Endpoints included ischemic events- a composite of
myocardial infarction (MI) or stent thrombosis, bleeding - GUSTO moderate
or severe, and major adverse cardiovascular and cerebrovascular events
(MACCE). Patients were separated into 2 groups according to median DAPT
score. Any interruption of antiplatelet therapy was ascertained over the
first 6 months. Unadjusted outcomes were compared according to DAPT Score
group and interruption status. Results: Among enrolled patients, the
median DAPT score was 2. From enrollment through 12 months, ischemia was
higher (3.7% vs. 2.0%, p<0.001) and bleeding lower (2.0% vs. 3.5%,
p=0.014) for DAPT Score >=2 vs. <2. Therapy interruption within 6 months
occurred in 4% of subjects and did not differ by DAPT Score category.
Compared with patients without interruption, patients who interrupted
therapy had increased risk for ischemia and MACCE within both DAPT score
groups (Figure). Conclusions: Higher DAPT scores were associated with
higher ischemic and lower bleeding rates within 1 year after coronary
stenting in patients prescribed 12 months of dual antiplatelet therapy.
Patients who interrupted therapy within 6 months had increased risk for
ischemia and MACCE regardless of DAPT score status. Rates of ischemia were
highest among high DAPT Score patients who interrupted therapy. (Figure
Presented).

<59>
[Use Link to view the full text]
Accession Number
619221218
Author
Wenner J.B.; Bami K.; Samardhi H.; Nery P.; Birnie D.; Nair G.; Redpath
C.J.
Institution
(Wenner) Cardiology, Univ of British Columbia, Vancouver, Canada
(Bami) Internal Medicine, Univ of Ottawa, Ottawa, Canada
(Samardhi, Nery, Birnie, Nair, Redpath) Electrophysiology, Univ of Ottawa
Heart Institute, Ottawa, Canada
Title
Atrial fibrillation complicating non-cardiothoracic surgery (POAF) is
associated with increased mortality and stroke: A systematic review.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: More than 37 million non-cardiothoracic operations are
performed per year in the USA alone. Single studies have reported that
POAF complicates non-cardiothoracic surgery in up to 12% of patients and
may be associated with adverse outcomes. Purpose: We performed a
systematic review to determine the frequency and implications of POAF
complicating noncardiothoracic surgery. Methods: We searched the MEDLINE,
Embase, HTA, Cochrane, and Pubmed databases for primary data describing
POAF frequency and outcomes on February 2, 2015. Reference lists of
included manuscripts were mined for relevant publications. A second Pubmed
search was conducted on February 8, 2016. We defined POAF as AF or atrial
flutter documented within 30 days of non-cardiothoracic surgery. We
included publications describing POAF frequency and/or outcomes. We
excluded case reports, publications that were non-English, described
cardiothoracic surgical patients, were missing AF frequency data or
included patients aged <18 years. Results: Our searches produced 5602
titles; 714 publications were identified for review and we analyzed 254
publications. POAF occurred in 29798/ 776932 patients (3.8%, n=186; median
[IQR] 2.3% [1.0-5.9]). Preoperative AF was identified in 148402/ 4265675
patients (3.5%, n=80; 7.6% [4.3-13.3]) and de novo postoperative AF was
identified in 15589/ 1781960 patients (0.9%, n=54; 6.7% [3.5-12.2]).
One-year postoperative mortality occurred in 2446/74314 (3.3%) POAF
patients, versus 13748/799694 (1.7%) non-AF patients (OR [95% CI] 2.9
[2.3-3.7], p<0.001). One-year postoperative stroke occurred in 1539/100930
(1.5%) POAF patients, versus 14243/2557767 (0.6%) non-AF patients (OR 2.5
[1.4-4.3], p=0.001) [Fig. 1]. Conclusion: POAF complicates
non-cardiothoracic surgery in approximately 4% of patients and is
associated with significantly increased 1-year mortality and stroke.
Prospective research is needed to confirm these findings. (Figure
Presented).

<60>
Accession Number
619221076
Author
Wong K.L.; Masa M.J.V.; Taner T.; Daly R.C.; Kushwaha S.S.; Pereira N.
Institution
(Wong, Masa, Kushwaha, Pereira) Cardiovascular Disease, Mayo Clinic,
Rochester, MN, United States
(Taner) Transplantation Surgery, Mayo Clinic, Rochester, MN, United States
(Daly) Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States
Title
The development of de novo donor specific antibodies is associated with
higher rejection risk after heart transplantation.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: There is controversy regarding monitoring patients after
heart transplantation (HTX) for development of de novo donor specific
anti-human leucocyte antibodies (dnDSA) measured by solid phase arrays due
to limited data on its impact on clinical outcomes. Hypothesis: The
objective of this study was to examine the association between dnDSA that
were detected on routine surveillance testing and clinical outcomes after
HTX. Methods: Adult patients undergoing HTX from January 2009 to December
2013 had anti-HLA measured at regular intervals post HTX by LABScreen
Single Antigen Beads and read on a Luminex platform. DSA levels with mean
fluorescence intensity >= 2000 were considered positive. Subjects were
sub-classified based on the development of class I or II dnDSA. All
endomyocardial biopsy results were retrieved and rejection-free survivals
from transplant to first episode of rejection were analyzed with Log-rank
test as well as Cox-proportional hazard model in multivariate analyses.
Standard definition for antibody mediated rejection (AMR) was used and
acute cellular rejection (ACR) grade 2R or more was considered severe.
Results: Amongst 86 HTX recipients, 29 (33.7%) developed dnDSA. Patients
with class I dnDSA as compared to patients without class I dnDSA had
significantly worse rejection-free survival for AMR (28.6% vs 85.7% at 5
years, p<0.001). Patients with class II dnDSA as compared to those without
class II dnDSA had worse severe ACR-free survival (52% vs 75.8% at 5
years, p=0.015). Multivariate analysis revealed class I dnDSA to be
independently associated with an increased risk for AMR (HR=5.520,
p=0.008) while class II dnDSA was independently associated with increased
risk of severe ACR (HR=3.140, p=0.013). Conclusions: This study highlights
the importance of measuring anti-HLA after HTX. The development of class I
and class II dnDSAs were independently associated with AMR and severe ACR
respectively. Strategies to treat HTx recipients with dnDSA need to be
developed to improve clinical outcomes.

<61>
[Use Link to view the full text]
Accession Number
619220833
Author
Burkholder G.; Muntner P.; Zhao H.; Mugavero M.; Overton E.T.; Kilgore M.;
Drozd D.; Crane H.; Moore R.; Mathews C.; Geng E.; Boswell S.;
Floris-Moore M.; Taylor B.; Monda K.; Rosenson R.S.
Institution
(Burkholder, Mugavero, Overton) Medicine, Univ of Alabama at Birmingham,
Birmingham, AL, United States
(Muntner, Zhao) Epidemiology, Univ of Alabama at Birmingham, Birmingham,
AL, United States
(Kilgore) Health Care Organization and Policy, Univ of Alabama at
Birmingham, Birmingham, AL, United States
(Drozd, Crane) Medicine, Univ of Washington, Seattle, WA, United States
(Moore) Medicine, Johns Hopkins Univ, Baltimore, MD, United States
(Mathews) Medicine, Univ of California, San Diego, CA, United States
(Geng) Medicine, Univ of California, San Francisco, San Francisco, CA,
United States
(Boswell) Medicine, Fenway Community Health Cntr, Boston, MA, United
States
(Floris-Moore) Medicine, Univ of North Carolina, Chapel Hill, NC, United
States
(Taylor, Monda) Cntr for Observational Rsch, Amgen, Inc, Thousand Oaks,
CA, United States
(Rosenson) Medicine, Icahn Sch of Medicine at Mount Sinai, New York, NY,
United States
Title
Low density lipoprotein cholesterol response after statin initiation among
HIV-positive persons with high risk for cardiovascular disease events.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The 2013 ACC/AHA cholesterol guideline recommends use of
moderate- or high-intensity statins to reduce LDL-C and the risk of CVD
events in high-risk groups. Meta-analyses of general population studies
report median LDL-C reduction of 30% with moderate-intensity and 50% with
high-intensity statins. We evaluated LDL-C response after first statin
initiation among high risk HIV+ patients in the Center for AIDS Research
Network of Integrated Clinical Systems (CNICS). Methods: We conducted a
retrospective cohort study including CNICS patients for 2009-2013 without
prior statin use. High risk groups included patients with history of MI or
coronary artery revascularization, diabetes mellitus, pre-statin LDL-C
>=190 mg/dL, and 10-year risk for first CVD event >=7.5%. Results: Among
14,116 patients without prior statin use, 1,229 (9%) initiated statins
(mean age 50 years, 82% male, 37% African-American, 9% Hispanic). Statins
were initiated at low intensity for 21% of patients and at moderate and
high intensity for 63% and 9%, respectively. Mean (SD) pre-statin LDL-C
was 136 (41) mg/dL and post-statin LDL-C 107 (36) mg/dL among 933 patients
with available laboratory measures. Overall, 34% had a >=30% reduction in
LDL-C (Table 1). Among high risk groups, a higher proportion of patients
with pre-statin LDL-C >=190 mg/dL had a >=30% reduction (59%). There were
no statistically significant differences in the proportion of patients
achieving a >=30% LDL-C reduction between the other high risk groups
(p=0.127). In a sensitivity analysis including 707 (76%) patients still
taking a statin at the time of post-statin LDL-C measurement, 35% had a
>=30% reduction in LDL-C and 7% had a >=50% reduction. Conclusions: The
majority of HIV+ patients with high CVD risk did not achieve a >=30% LDL-C
reduction following initiation of a statin. More widespread use of
high-intensity statins among HIV+ persons in whom it is not
contraindicated by antiretroviral drug interactions may be beneficial.
(Table Presented).

<62>
[Use Link to view the full text]
Accession Number
619220786
Author
Carnicelli A.; De Caterina R.; Halperin J.; Renda G.; Ruff C.; Trevisan
M.; Nordio F.; Mercuri M.; Antman E.; Giugliano R.
Institution
(Carnicelli) Internal Medicine, Brigham and Women's Hosp, Boston, MA,
United States
(De Caterina, Renda) Dept of Cardiology, Institute of Cardiology and Cntr
of Excellence on Aging, G. D'Annunzio Univ, Chieti, Italy
(Halperin) Cardiovascular Medicine, Mt Sinai Med Cntr, New York, NY,
United States
(Ruff) Cardiovascular Medicine, Brigham and Women's Hosp, Boston, MA,
United States
(Trevisan, Nordio) Cardiovascular Div, TIMI Study Group, Boston, MA,
United States
(Mercuri) Pharmaceutical Development,Daiichi Sankyo,Inc., Parsippany, NJ,
United States
(Antman, Giugliano) Cardiovascular Div, Brigham and Women's Hosp, Boston,
MA, United States
Title
Edoxaban for the prevention of thromboembolism in patients with
bioprosthetic valves in engage AF-TIMI 48.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Randomized data with NOACs in patients (pts) with atrial
fibrillation (AF) and bioprosthetic valves (BPV) are scarce. We compared
outcomes in pts with BPV and in pts with valvular heart disease (VHD) but
no BPV in ENGAGE AF-TIMI 48, which randomized pts to edoxaban (E) vs
warfarin (W). Methods: Pts with mechanical valves or mod-severe mitral
stenosis were excluded from the trial. VHD was defined as aortic or mitral
valve surgery, mod-severe aortic stenosis/regurgitation, or mod-severe
mitral regurgitation. Outcomes included stroke or systemic embolism (SSE),
ischemic stroke or systemic embolism (ISSE), major bleeding (MB), and a
net clinical outcome (NCO = SSE, MB, CV death). Hazard ratios (HRs)
comparing BPV vs no BPV were adjusted for baseline differences. HRs
comparing higher-dose E (HDE) vs W stratified by BPV status were derived
using Cox proportional hazards modeling. An interaction term was used to
test for effect modification. Results: Of 191 pts with BPV (31% aortic,
69% mitral), the mean age was 73.3 +/- 8.6 yrs, 63.4% were male, and
median CHA<inf>2</inf>DS<inf>2</inf>-VASc score was 5. Pts with BPV had
higher adjusted risks of SSE (HR<inf>adj</inf> 1.84, p=0.027) and ISSE
(HR<inf>adj</inf> 1.88, p=0.033), but not of MB or the NCO compared to
other pts with VHD (n=2633). No effect modification (p-int >0.05) by BPV
presence or absence was evident for SSE, ISSE, or MB with HDE vs W
(Figure). Among pts with BPV, the risk of SSE (HR 0.37; [0.10-1.40]) and
ISSE (HR 0.48; [0.12-1.96]) was no different between HDE (n=63) and W
(n=70). For the NCO, the benefit of HDE vs W in pts with BPV (HR 0.45;
[0.23-0.90]) was greater than in other pts with VHD (HR 1.01;
[0.84-1.22]); p-int=0.03. Conclusions: Although pts with BPV are at higher
adjusted risk of SSE and ISSE than other pts with VHD, pts with BPV had no
greater risk of SSE or ISSE when treated with HDE compared to W. Patients
with BPV had better net outcomes with HDE than with W and the relative
benefit may be even greater in pts with BPV than in those without BPV.

<63>
[Use Link to view the full text]
Accession Number
619220745
Author
Hawkins R.B.; Mehaffey J.H.; Guo A.; Fonner C.; Speir A.; Rich J.; Yarboro
L.; Ghanta R.; Ailawadi G.
Institution
(Hawkins, Mehaffey, Guo, Yarboro, Ghanta, Ailawadi) Surgery, Univ of
Virginia, Charlottesville, VA, United States
(Fonner) Virginia Cardiac Surgery Quality Initiative, Falls Church, VA,
United States
(Speir) Cardiothoracic Surgery, INO VA Heart and Vascular Institute, Falls
Church, VA, United States
(Rich) VCSQI Board of Directors, Virginia Cardiac Surgery Quality
Initiative, Falls Church, VA, United States
Title
Impact of preoperative statin use on ascending aortic aneurysm repair
outcomes.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: Statins have potent pleiotropic effects that have been
correlated with improved perioperative cardiovascular surgery outcomes.
Additionally, statins are protective in murine aortic aneurysm models.
Hypothesis: We hypothesize that statins may improve short-term morbidity
and mortality after ascending aortic surgery. Methods: A total of 2,781
patients who underwent ascending aortic aneurysm repair in a
multi-institution database (2004-2015) were stratified by preoperative
statin administration. Patients with endocarditis or aortic dissection
were excluded. To account for baseline differences, patients were
propensity matched (1:1) across 41 preoperative and procedural
characteristics, resulting in a well matched cohort of 1682 patients.
Patient characteristics and outcomes were analyzed by univariate analysis
and logistic regression. Results: In the total cohort, patients taking
statins were older with more comorbid disease, yet had less extensive
surgery performed. Composite major morbidity and mortality was
significantly lower in patients taking statins (30.2% vs 33.9%, p=0.045).
However, in the propensity-matched analysis, patients taking statins had
similar outcomes compared to patients not receiving statins including
operative mortality (5.6% vs 6.7%, p=0.32) and major morbidity (47.2% vs
46.3%, p=0.72). Postoperative atrial fibrillation (28.3% vs 27.5%, p=0.71)
and acute kidney injury (4.8% vs 5.9%, p=0.29) were similar. Furthermore,
statin use was not associated with risk-adjusted mortality or major
morbidity by logistic regression (all p>0.05). This study has 93% to >99%
power to detect a risk reduction in mortality similar to that seen after
coronary bypass. Conclusion: Perioperative statin administration has no
apparent clinically significant impact on short-term outcomes after aortic
repair. There is insufficient evidence to recommend preoperative statin
therapy before ascending aortic repair.

<64>
Accession Number
619220688
Author
Al Turki A.; Marafi M.; Cardinale D.; Blackwell R.; Bessissow A.; Essebag
V.; Healey J.S.; Huynh T.
Institution
(Al Turki, Bessissow) Internal Medicine, McGill Univ Health Cntr,
Montreal, Canada
(Marafi) Neurology, McGill Univ Health Cntr, Montreal, Canada
(Cardinale) Cardioncology Unit, European Institute of Oncology, Milan,
Italy
(Blackwell) Urology, Loyola Univ Med Cntr, Maywood, IL, United States
(Essebag, Huynh) Cardiology, McGill Univ Health Cntr, Montreal, Canada
(Healey) Cardiology, Hamilton Health Sciences, McMaster Univ, Hamilton,
Canada
Title
Risk of stroke associated with atrial fibrillation after non-cardiac
surgery: Insights from a meta-analysis of randomized controlled studies
and observational studies.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Post-operative atrial fibrillation (POAF) is a frequent
occurrence after non-cardiac surgery. Due to its generally short duration,
it remains uncertain whether POAF is associated with increased risk of
stroke. We aim to elucidate the risk of stroke associated with POAF
following non-cardiac surgery by a meta-analysis of randomized controlled
studies and observational studies. Methods: We searched MEDLINE, EMBASE,
Web of Science, Scopus and clinicaltrials.gov from inception to April 6
2016, for all studies that reported strokes in patients who developed POAF
after non-cardiac surgery. Two reviewers independently performed the
search and extraction. We used a random-effects model to summarize the
studies. Results: From a total of 4364 abstracts screened, we retained 13
studies enrolling 1,694,663 patients for final analyses. 16,061 patients
had POAF, in whom mean ages ranged from 60-72 years and females ranged
from 21%-41%. In addition, 30%-72% were hypertensive, 11%-33% were
diabetic and 15%-50% had coronary artery disease. In comparison, 1,678,602
patients did not have POAF. Their mean ages ranged from 56-72 years and
females ranged from 22%-60%. Moreover, 22%-70% were hypertensive, 7%-31%
were diabetic and 10%-40% had coronary artery disease. At one month
follow-up, POAF was associated with approximately three times increase in
risk of short-term stroke [odds ratio (OR): 3.09 (95% Confidence intervals
(CI): 2.14-4.46); n=9 studies]. POAF was associated with approximately
four times increase in long-term risk of stroke with OR: 3.97(95% CI:
3.46-4.57) in four studies with >=12-month follow-up. Combining all 13
studies, the overall increase in risk of stroke associated with POAF was
3.84 (95% CI: 3.38-4.38) (Figure 1). Conclusions: POAF was associated with
increased short and long-term risk of stroke after non-cardiac surgery.
Future studies are needed to evaluate the impact of anticoagulation in
decreasing the risk of stroke in these patients. (Figure Presented).

<65>
[Use Link to view the full text]
Accession Number
619220590
Author
Zheng Q.; Cyrille N.; She L.; Szwed H.; Lang I.M.; Farsky P.S.;
Castelvecchio S.; Biernat J.; Paraforos A.; Kosevic D.; Favaloro L.E.;
Nicolau J.C.; Varadaragan P.; Velazquez E.; Pai R.G.; Lee K.;
Desvigne-Nickens P.; Piha I.L.
Institution
(Zheng, Cyrille, Piha) Cardiology, Montefiore Med Cntr, Bronx, NY, United
States
(She, Lee) Duke Clinical Rsch Institute, Duke Clinical Rsch Institute,
Durham, NC, United States
(Szwed) Institute of Cardiology, Institute of Cardiology, Warsaw, Poland
(Lang) Cardiology, Med Univ of Vienna, Vienna, Austria
(Farsky) Cardiology, Dante Pazzanese Institute of Cardiology of Sao Paulo,
Sao Paulo, Brazil
(Castelvecchio) Cardiology, IRCCS Policlinico San Donato, Milan, Italy
(Biernat) Med Univ of Silesia, Med Univ of Silesia, Katowice, Poland
(Paraforos) Dept of Cardiac Surgery, Hosp of the Brothers of Charity,
Trier, Germany
(Kosevic) Dedinje Cardiovascular Institute, Belgrade, Serbia
(Favaloro) Hosp Universitario Fundacion Favaloro, Buenos Aires, Argentina
(Nicolau) Univ of Sao Paulo Med Sch, Sao Paulo, Brazil
(Varadaragan, Pai) Cardiology, Loma Linda Univ Med Cntr, Loma Linda, CA,
United States
(Velazquez) Cardiology, Duke Univ Med Cntr, Durham, NC, United States
(Desvigne-Nickens) National Heart,Lung,and Blood Institute, Montefiore Med
Cntr, Bethesda, MD, United States
Title
Does sex influence the effect of surgical revascularization in patients in
ischemic left ventricular dysfunction? Results from the STICH Trial.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Studies have shown sex-specific differences regarding CAD
and heart failure with left ventricular (LV) dysfunction. Whether these
differences impact the benefit of CABG in patients with ischemic LV
dysfunction has not been studied prospectively. Female sex is
conventionally considered a risk factor for open-heart surgery, and has
been included as a poor prognostic factor in multiple cardiac operative
risk evaluation scores. We investigated the impact of sex on the long-term
benefit of CABG in patients enrolled in the prospective Surgical Treatment
for Ischemic Heart Failure Study (STICH) trial. Method: The STICH trial
randomized 1212 patients [148 (12%) women and 1064 (88%) men] with CAD and
EF< 35% to medical therapy alone (MED) versus MED plus CABG. Long-term
(10-year) outcomes with each treatment were compared according to sex.
Results: At baseline, women were older with higher BMI and more CAD risk
factors (e.g. diabetes) except for smoking, and had lower rates of prior
CABG than men (all p<0.05). Moreover, women had higher NYHA class, lower
6-min walk capacity and lower Kansas City Cardiomyopathy Questionnaire
scores (all p<0.05). At 10-year follow up, the all-cause mortality rate
(HR 0.70, CI 0.55-0.89, adjusted p=0.002) and CV mortality rate (HR 0.64,
CI 0.48-0.86, adjusted p=0.006) were significantly lower in women than
men. Furthermore, with randomization to CABG vs. MED treatment, there was
no significant interaction between sex and treatment group in all-cause
mortality, CV mortality, mortality or CV hospitalization (all p>0.05,
Figure 1). In addition, surgical deaths were similar for both sexes among
patients randomized to CABG. Conclusion: Sex does not impact the effect of
CABG on all-cause mortality, CV mortality, CV hospitalization or surgical
deaths in patients with ischemic LV dysfunction. Thus, sex should not
influence treatment decisions regarding CABG in these patients.

<66>
Accession Number
619220524
Author
Chauvette V.; Voisine E.; Moisan A.-S.; Mohammadi S.; Dagenais F.; Voisine
P.
Institution
(Chauvette, Voisine, Moisan, Mohammadi, Dagenais, Voisine) Cardiac
Surgery, Institut Universitaire De Cardiologie Et De Pneumologie De
Quebec, Quebec, Canada
Title
Ticagrelor : Similar rates of perioperative hemorrhagic complications and
mid-term survival compared with clopidogrel.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The PLATO trial suggested that ticagrelor is associated with
better survival at 1 year for patients with acute coronary syndrome (ACS)
undergoing coronary artery bypass grafting (CABG). The aim of this study
was to compare perioperative bleeding complications and mid-term outcomes
of patients receiving ticagrelor or clopidogrel perioperatively over a 2
years period in our institution. Hypothesis: We assessed the hypothesis
that perioperative use of ticagrelor would result in better clinical
outcomes without increasing bleeding risks in ACS patients undergoing
CABG. Methods: Data were recorded from 467 patient's file who underwent
CABG following an ACS between 2013 and 2015. The Bleeding Academic
Research Consortium (BARC) and Thrombolysis in Myocardial Infarction
(TIMI) criteria were used to assess major bleedings. Results: Ticagrelor
was stopped 4.5+/-0.50 days prior to surgery (5.8+/-0.29 days for
clopidogrel ; p=0.06). BARC (6.2% vs 8.5% ; p=0.46) and TIMI (5.2% vs 7.3%
; p=0.43) major bleedings were similar. Among major bleedings, 24 occurred
when discontinuation time was <3 days prior to surgery (17 vs 7 ; p=0.43)
and 6 at >3 days (6 vs 0 ; p=0.34), for clopidogrel and ticagrelor
respectively. Multivariate analyses showed that independent predictors of
perioperative bleeding were immediate preoperative aPTT; shorter delay
between antiplatelet discontinuation and surgery, preoperative haemoglobin
and CPB duration. The type of antiplatelet agent used was not a
significant factor. One year follow up showed no difference in survival
(99.1%, vs 95.5% ; p=0.25), death from cardiovascular causes (1.6% vs 1.2%
; p=1.0), angina stability (50.5+/-6.2 vs 51.1+/-7.3 ; p=0.58) and
frequency (97.8+/-8.4 vs 98.1+/-7.4 ; p=0.84) according to the Seattle
Angina score for clopidogrel and ticagrelor, respectively. Conclusion: The
use of ticagrelor is not associated with a higher risk of perioperative
hemorrhagic complications when compared with clopidogrel. Mortality rates
from cardiovascular causes were lower than expected from the PLATO study.
Prospective studies are needed to assess ideal discontinuation time for
ticagrelor and determine the long term clinical outcomes of CABG patients
receiving ticagrelor perioperatively.

<67>
Accession Number
619220400
Author
Shiryaev A.; Lepilin M.; Galyautdinov D.; Vasilyev V.; Cherkashin D.;
Akchurin R.
Institution
(Shiryaev, Lepilin, Galyautdinov, Vasilyev, Cherkashin, Akchurin)
Cardiovascular Surgery, Russian Cardiology Rsch Cntr, Moscow, Russian
Federation
Title
Microsurgical technique in coronary surgery improves long-term outcomes.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The operating microscope is widely used in surgical
practice, but there is no common opinion on the benefits of its use in
coronary surgery. Objectives: The aim of this study was to compare the
long-term outcomes of coronary artery bypass grafting with microsurgical
technique and conventional technique. Methods: We have studied 270
patients operated on for coronary artery disease by the same surgical team
in 2004. We included observations of 3-vessel disease in which at least 1
bypassed vessel was type C according to Coronary Artery Surgery Study
protocol or had the diameter at the anastomotic site of less than 1.5 mm.
Patients were randomly assigned to 2 groups: microsurgical group (n=128);
patients were operated on using a microsurgical technique (8-12x
magnification, 8-0 polypropylene sutures with a 3/8, 6.5 mm needle for
distal anastomoses) and nonmicrosurgical group (n=142); patients were
operated on with a magnifying loupes (3.5x magnification, 8-0
polypropylene sutures with a 3/8, 8.0 mm needle). The mean number of
distal anastomoses in microsurgical group was 4.1+/-0.8 vs 3.9+/-0.9
(p=ns) in nonmicrosurgical group, the number of anastomoses to arteries of
less than 1.5 mm - 254 vs 121 (p=<0.001) and patients with
endarterectomies - 3 vs 44 (p=<0.001), respectively. In all cases the left
internal thoracic artery was anastomosed to the left anterior descending
coronary artery. Follow-up was complete in 95% (258 patients). Survival
curves were constructed using the Kaplan-Meier method and compared by the
log-rank test. Results: Ten-year survival rates in groups of patients
operated on with and without the use of microsurgical technique were 82.7%
vs 72.0% (p=0.03), incidence of non-fatal myocardial infarction - 9.8% vs
16.1 % (p=0.14), recurrence of angina - 14.7% vs 22.7% (p=0.11), repeat
interventions - 8.1% vs 17.6% (p=0.02), all cardiac events - 34.4% vs
58.8% (p=0.0001), respectively. Conclusions: The use of the microsurgery
compared with the conventional technique yields superior clinical results
in coronary surgery during a 10-year follow-up.

<68>
Accession Number
619220358
Author
Villablanca P.A.; Nikolic K.; Vucicevic D.; Maldonato Y.; Augoustides
J.G.; Ramakrishna H.
Institution
(Villablanca) Div of Cardiovascular Disease, Albert Einstein College, New
York, NY, United States
(Nikolic, Ramakrishna) Anesthesiology Dept, Mayo Clinic, Phoenix, AZ,
United States
(Vucicevic) Cardiovascular Department, Mayo Clinic, Phoenix, AZ, United
States
(Maldonato) Anesthesiology Dept, Western Campus of Temple Univ, Sch of
Medicine, Pittsburgh, PA, United States
(Augoustides) Div of Anesthesiology, Univ of Pennsylvania Med Cntr,
Philadelphia, PA, United States
Title
Comparison of general versus local anesthesia in patients undergoing
transcatheter aortic valve replacement (TAVR): A meta-analysis.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Transcatheter Aortic Valve Replacement (TAVR) is typically
performed under general anesthesia with endotracheal intubation (GA).
There is growing data in the literature however, that this procedure can
be safely performed under local anesthesia (LA). Hypothesis: To gain a
better understanding of the efficacy and safety of GA as compared to LA in
patients undergoing TAVR by conducting an updated meta-analysis. Methods:
We performed a comprehensive search of EMBASE, PUBMED, and Web of Science
databases. Odds ratios (OR), difference of the mean (DM) and 95%
confidence intervals (CI) were computed using the Mantel-Haenszel method.
Fixed-effect model was used; if heterogeneity (I )>40, effects were
obtained using a random model. Sensitivity and cumulative analysis was
performed for each outcome. Results: A total of 18 studies and 19 255
patients were included in meta-analysis. The use of GA for TAVR was
associated with an increased overall 30- day mortality (RR 1.35, Cl
1.07-1.70), length of stay (DM 2.33, CI 1.28-3.38), ICU stay (DM 8.98, CI
1.47-16.50), procedural time (DM 24.46, CI 16.52-32.41), use of
vasopressors/inotropes (RR 1.95, CI 1.58-2.40), vascular complications (RR
1.41, CI 1.05-1.89) and post procedural intubation (RR 32.71, CI
18.18-58.88). TAVR with GA showed a lower incidence of paravalvular leak
(RR 0.8, CI 0.66-0.80). No difference was observed between GA and LA for
stroke (RR 1.15, Cl 0.91-1.45), cardiovascular mortality (RR 1.32, Cl
0.83-2.10), permanent pacemaker implantation (RR 1.32, Cl 0.83-
2.10),vascular complications (RR 1.11, Cl 0.84-1.46),major bleeding (RR
1.09, Cl 0.70-1.68), acute kidney injury (RR1.07, CL 0.69-1.65),
myocardial infarction (RR 0.72, Cl 0.39-1.33), procedural success (RR
1.01, CL 0.96-1.06),conduction abnormalities (RR 0.83,Cl
0.64-1.07),annular rupture (RR 0.73, Cl 0.27-1.99) and fluoroscopy time
(DM 1.77, Cl - 0.06-3.61). Conclusion: Our meta- analysis suggests that
the use of LA in patients undergoing TAVR is associated with decreased
mortality, shorter hospital stay, reduced vascular complications and
procedural time. Further large randomized trials are needed to confirm our
findings.

<69>
Accession Number
619220311
Author
Gianos E.; Schoenthaler A.; Guo Y.; Weintraub H.S.; Schwartzbard A.Z.;
Underberg J.A.; Newman J.D.; Fisher E.A.; Berger J.S.
Institution
(Gianos, Guo, Weintraub, Schwartzbard, Underberg, Newman, Fisher, Berger)
Medicine-Cardiology, NYU Langone Med Cntr, New York, NY, United States
(Schoenthaler) Medicine-Cardiology, NYU Langone Med Cntr, Ctr for
Healthful Behavior Change, New York, NY, United States
Title
Investigation of motivational interviewing and prevention consults to
achieve cardiovascular targets trial.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Patients undergoing cardiovascular (CV) procedures often have
suboptimal risk factor control and would benefit from strategies targeting
healthy lifestyle behaviors and education. Implementation of prevention
strategies may be timely at this point of heightened motivation. Methods:
A prospective randomized, controlled clinical trial was conducted in
patients undergoing a non-urgent CV procedure to evaluate the impact of
different prevention strategies on CV risk factors 6 months
post-procedure. 400 patients were recruited at the time of a CV procedure
between 5/12 and 8/15. Patients were randomized in a 1:1:1 fashion to
usual care (Group A), in-hospital prevention consult (Group B), or
in-hospital prevention consult plus behavioral intervention program
[telephone-based motivational interviewing and tailored text messages]
(Group C). The primary endpoint was non-HDL-cholesterol (non-HDL-C).
Secondary endpoints included LDL-C, HDL-C, triglycerides, blood pressure
(BP), HbA1c, body mass index, guideline-directed medical therapy, and
validated measures of lifestyle and quality of life. Results: The mean age
was 64.6 +/- 10.8 years, 23.7% were female and 31.5% were non-white.
Overall, the absolute reduction in non-HDL was-20.7 mg/dl [95% CI
(24.9,-16.5) p<0.001]. There were no between-group differences in the
intervention and control arms (B and C vs A) with an absolute difference
of-4.42 mg/dl, [95% CI (-12.7, 6.2) (p=0.29)]. However, patients in the
intervention groups were more likely to be on high intensity statins at 6
months, (52.9% vs 38.1%, p=0.01). In contrast to men, women had a
significant reduction in non-HDL with a prevention consult alone (group B
vs A); absolute difference-22.73 mg/dl, [(95% CI (-43.95,-1.52), p=0.04])
and systolic BP reduction was greater in group C vs. A,-3.5 mmHg [95% CI
(-9.63,-0.44) (p=0.03)]. Conclusions: At 6 months following a CV
procedure, there was no between-group difference in the primary endpoint,
other than in the subgroup of women. However, the greater use of high
potency statins following a prevention consult could still translate into
improved long-term health outcomes. Results of this trial will illustrate
areas to target secondary prevention and areas where deficiencies remain.

<70>
Accession Number
619220283
Author
Heo S.; McSweeney J.; Tsai P.-F.; Ounpraseuth S.
Institution
(Heo, McSweeney, Tsai, Ounpraseuth) College of Nursing, Univ of Arkansas
for Med Sciences, Little Rock, AR, United States
Title
The synergistic effects of fatigue and depression on use of medical
services in patients with heart failure.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Heart failure (HF) is an expensive clinical condition, which
imparts a considerable burden on patients and society. Fatigue and
depression are the most common physical and psychological symptoms, and
together may have more impact on use of medical services than one symptom
alone. Hypothesis: We hypothesized that fatigue and depression would have
the synergistic effects on use of different medical services controlling
for common covariates. Methods: We conducted a secondary data analysis of
a university medical center electronic database (N = 582, mean age 63 +/-
14 years, 54% males). Data were collected on fatigue, depression,
covariates (i.e., sociodemographic and clinical characteristics, vital
signs, laboratory tests [serum troponin, albumin, triglycerides,
creatinine, sodium, hemoglobin, monocytes, and neutrophils], and
medication [beta-blockers, antidepressants, and angiotensin converting
enzyme inhibitors]), and frequency of medical service use based on CPT
codes. Patients were categorized into one of four symptom groups based on
ICD-9 codes: no symptom, fatigue only, depression only, and fatigue and
depression. General linear regression was used to analyze the data.
Results: The mean number of total medical service use was 96.5 +/- 84.3
over 3 years. The mean number in the fatigue and depression group (152.6
+/- 103.4) was greater than the fatigue only (122.9 +/- 97.9, p =.016),
depression only (84.3 +/- 62.0, p <.001), and no symptom groups (61.7 +/-
46.7, p <.001) controlling for covariates. In further analyses, the
numbers of medical service use in the fatigue and depression group
compared with the other groups were greater in evaluation and management
services (e.g., inpatient and outpatient services, p <.001), radiology
services (e.g., diagnostic imaging and ultrasound, p <.001), and medicine
services (e.g., medical services and procedures such as cardiovascular, p
<.05). Conclusion: Fatigue and depression showed synergistic impact on the
number of total medical service use. Clinicians should assess and manage
fatigue and depression together and provide interventions to manage them
effectively to assist in reducing medical service use.

<71>
Accession Number
619220020
Author
Hedman K.; Borg S.; Nylander E.; Tamas E.
Institution
(Hedman, Nylander, Tamas) Dept of Cardiovascular Medicine, Dept of Med and
Health Sciences, Linkoping, Sweden
(Borg) Div of Physiotherapy, Dept of Med and Health Sciences, Linkoping,
Sweden
Title
Improved aerobic capacity up to a year following an exercise intervention
in patients undergoing aortic valve replacement for aortic stenosis.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: In the RASP (Rehabilitation in Aortic Stenosis Patients)
study, we investigate effects of supervised exercise compared to physical
activity recommendations on aerobic capacity (peakVO<inf>2</inf>) and
physical activity level (PAL) in patients following open heart surgery for
aortic stenosis. We hereby present preliminary results from a first
interim analysis. Methods: So far, 12 patients (median age 63 years, 9
males) have been randomized equally to either 12 weeks of exercise on a
bicycle ergometer 45 minutes 3 times/week (SupEX) or to receive
recommendations regarding physical activity following cardiac surgery
(HomeEX). Patients performed a maximal cardiopulmonary exercise test
(CPET) PRE, POST and 1-YEAR after the intervention which started 6 weeks
after the surgery. Physical activity level (PAL) was inquired at the same
occasions with the IPAQ questionnaire. Results: Data from CPETs are
presented in figure 1 (table). At 1-YEAR, median (range) improvement from
PRE in peakVO<inf>2</inf> (mL/kg/min) was 17% (15-20%, p=0.043) in SupEX
and 11% (0-33%, p=0.116) in HomeEX. A trend toward increased PAL in both
groups at POST and 1-YEAR was seen, together with a trend toward higher
total PAL in the SupEX than in the HomeEX group following intervention,
although not statistically significant (figure 2). Conclusions: This
interim analysis in the RASP study shows that both patients performing
supervised exercise training and patients receiving physical activity
recommendations improve in peakVO<inf>2</inf>. Non-statistically
significant trends toward larger improvement in peakVO<inf>2</inf> and PAL
at 1 year after supervised exercise training than after physical activity
recommendations were seen.

<72>
Accession Number
619219836
Author
Shibata M.; Kurita J.; Miyagi Y.; Nitta T.
Institution
(Shibata, Kurita, Miyagi, Nitta) Dept. of Cardiovascular Surgery, Nippon
Med Sch, Bunkyo-ku, Japan
Title
Enhanced sternal healing via effect of controlled release and spatial
retention of platelet-rich plasma impregnated in biodegradable gelatin
hydrogel.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Platelet-rich plasma (PRP) contains numerous growth factors
and accelerates bone fracture healing. However, it is limited by the short
half-life period during which it can promote regeneration. Hypothesis: A
controlled release of PRP will be more effective than conventional usage
of PRP on the sternal healing. Methods: A biodegradable gelatin hydrogel
was used to control the release of PRP prepared from whole blood of
Japanese white rabbits. After median sternotomy, 16 rabbits were
randomized into four groups (n=4): control (Ctrl), 30 mg of gelatin
hydrogel incorporating 300 muL of phosphate-buffered saline (gel), as well
as that incorporating 300 muL of PRP (PRP+gel), and 300 muL of PRP
solution (PRP). Before the sternum was closed, these solutions were
implanted between sternum incisions. We compared sternal healing among the
groups 7 days after surgical intervention with micro-computed tomography
and histology. Results: The resultant number of platelets (p<0.01) and
concentrations of platelet-derived growth factor-BB, vascular endothelial
growth factor, and transforming growth factor-beta1 (p<0.05) were
significantly higher in the PRP than in the whole blood. There were no
significant differences (p>0.05) in the mineral density of cortical bones
(656.9+/-46.2, 641.6+/-23.2, 629.3+/-100.8, and 691.1+/-60.6 mg/cm3 for
Ctrl, gel, PRP, and PRP + gel, respectively). However, the controlled
release of PRP increased the bone mineral density of sponge bones (382.7
mg/cm3) compared with those of the Ctrl, gel, and PRP groups
(265.4+/-18.9, 325.6+/-41.4, and 285.4+/-31.5 mg/cm3, respectively,
p<0.01). Histological analysis of the PRP+gel group indicated possible
invasion of fibrous tissue into the separated sternal space and no change
in the vascular density around the sternum. Apparent sternal dehiscence
was observed in the Ctrl, gel, and PRP groups by radiography. Conclusions:
Controlled release of PRP is markedly effective in promoting sternal
healing at an early phase. It is possible that this novel therapy prevents
complications, such as deep sternal wound infection, and causes early
postoperative ambulation after thoracic surgery. Further studies are
needed to elucidate the mechanism for clinical use.

<73>
[Use Link to view the full text]
Accession Number
619219776
Author
Masaki N.; Takase B.; Adachi T.
Institution
(Masaki, Takase) Intensive Care Medicine, National Defense Med College,
Tokorozawa, Japan
(Adachi) Dept. of Cardiology, National Defense Med College, Tokorozawa,
Japan
Title
Effectiveness of combination of intracellular and extracellular
aminothiols for prediction of cardiovascular events.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Backgrounds: disulfide bonds are formed from the oxidation of sulfhydryl
(-sh) groups such as glutathione disulfide (gssh) from glutathione (gsh),
cystine from cysteine. the aminothiols indicate oxidative stress. but, the
difference has not been fully investigated. hypothesis: combination of
gssg in red blood cells (rbc) and serum total cysteine (tcys) comprising
mainly cystine may predict cardiovascular events. methods: 255 patients
with cardiovascular disease (65+/-13 y/o) were prospectively followed up
for 2.68+/-1.47 years. an oxidative stress test of d-roms was also
performed. results: in the follow-up, there were 8 (3%) of cardiovascular
deaths, 12 (5%) of maces, 47 (18%) of cardiovascular events (maces plus
hospitalization for heart failure, cardiovascular surgery,
revascularization). there was a weak correlation between gssg and tcys
(r=0.167), but neither of them was associated with d-roms. tcys was
negatively correlated to egfr (r=-0.350). we classified the patients into
four groups with combining the medians as cut-off points (tcys: 165.20
mum, gssg: 34.61 mum); group i (number of pts.=72): low tcys and low gssg,
group II (57): high tcys and low gssg, group iii (57): low tcys and high
gssg, group iv (69): high tcys and high gssg. kaplan-meier curves showed
that group ii, iv had significantly higher rates of cardiovascular events
and group iii tended to increase cardiovascular events (log-rank; p=0.050)
(figure). in univariate cox analysis, hazard ratios (hr) with setting
group i as reference were group II 3.094 (ci 1.089-8.792, p=0.034), group
iii 3.025 (ci 1.012-9.040, p=0.047), group iv 5.210 (ci 1.962-13.830,
p=0.001). after adjustment for age, sex, coronary risk factors, crp, egfr,
d-roms, group iii, iv remained in high risk; group iii 3.598 (ci
1.183-10.945, p=0.024), group iv 3.646 (ci 1.294-10.277, p=0.014).
conclusions: tcys partially depended on renal function, but gssg did not.
the combination was useful to stratify further cardiovascular risks.

<74>
[Use Link to view the full text]
Accession Number
619219554
Author
Akintoye E.; Sellke F.; Marchioli R.; Tavazzi L.; Mozaffarian D.
Institution
(Akintoye) Internal Medicine, Wayne State Univ, Sch of Medicine, Detroit,
MI, United States
(Sellke) Cardiothoracic surgery, Alpert Med Sch, Brown Univ, Providence,
RI, United States
(Marchioli) Hematology and Oncology, Therapeutic Science and Strategy
Unit, Quintiles, Italy
(Tavazzi) Dept of Cardiology and LTTA Center, Univ of Ferrara Maria
Cecilia Hosp- GVM Care and Rsch and E.S. Health Science Foundation,
Ferrara and Cotignola, Italy
(Mozaffarian) Friedman Sch of Nutrition Science and Policy, Tufts Univ,
Boston, MA, United States
Title
Surgery characteristic and incidence of postoperative atrial fibrillation,
in-hospital major adverse cardiovascular event (MACE), and mortality in
the operatrial.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Postoperative atrial fibrillation (PoAF) complicates about 1/3
of the cases of cardiac surgery and it has been associated with major
adverse consequences. However, there is very scant data on how the various
surgery characteristics contribute to the risk of PoAF and other clinical
outcomes. We therefore set out to address this important gap in knowledge.
Methods: This study was conducted using the prospectively-collected data
of the OPERA trial involving 1516 patients undergoing cardiac surgery
across 28 centers in the US, Italy and Argentina. Surgery characteristics
evaluated include type of surgery, mini thoracotomy, cardiopulmonary
bypass, pump use, cardioplegia use, and method of rhythm return. Endpoints
included the occurrence of PoAF, MACE, and mortality. Association between
surgery characteristics and each endpoint was evaluated via multivariate
logistic regression. In addition, we evaluated the impact of PoAF on
resource utilization (including ICU and total hospital stay) and
mortality. Result: Mean (SD) age was 64 (13) years. There was significant
trend (OR [95% CI]) across categories of surgery type (1.3 [1.0-1.4]),
cardiopulmonary bypass use (2.4 [1.7-3.5]), off-pump vs on-pump (0.65
[0.44-0.96]), and cardioplegia use (2.3 [1.6- 3.3]) with regards to the
incidence of PoAF (Figure 1). However, only surgery type significantly
predicts 30-day mortality (1.5 [1.0-2.2]) while spontaneous return of
rhythm was associated with lower risk of MACE (0.47 [0.24-0.92]). PoAF was
associated with increase resource utilization (p<0.001) and 1-year
mortality (OR: 2.8 [95% CI, 1.4-5.4]). Conclusion: In this multi-center
clinical trial, we identified surgery characteristics that are associated
with adverse clinical outcomes, especially PoAF. We believe this
relatively novel information will facilitate adequate patient
education/counseling, inform guideline for surgical practices, and
identify procedures that will require PoAF prophylaxis.

<75>
Accession Number
619219462
Author
Ou J.; Zhou L.; Liu X.; Wang Z.-Q.; Ou Z.-J.; Xu Y.-Q.; Wang Z.-P.
Institution
(Ou, Zhou, Liu, Wang, Xu, Wang) Div of Cardiac Surgery, First Affiliated
Hosp, Sun Yat-sen Univ, Guangzhou, China
(Ou) Div of Hypertension and Vascular Diseases, First Affiliated Hosp, Sun
Yat-sen Univ, Guangzhou, China
Title
Simvastatin inhibited myocardial apoptosis undergoing noncoronary artery
cardiac surgery.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: We previously demonstrated that simvastatin was
cardioprotective in patients undergoing noncoronary artery cardiac
surgery. However, the mechanisms by which simvastatin protected myocardium
were not fully understood. Hypothesis: Simvastatin protects myocardium is
related to the inhibition of apoptosis Methods: 35 patients undergoing
noncoronary cardiac surgery such as valvular surgery, congenital heart
diseases surgery, 19 from simvastatin group and 16 from untreated control
group, were selected from a previous clinical trial. Simvastatin (20mg)
was administered preoperatively for 5-7 days. Myocardial tissues biopsies
were taken in the right atrial appendage before crossclamping the aorta
and heart beating 10 minutes after removing the aorta cross-clamp. The
apoptosis in myocardium was detected by transmission electron microscope
and TUNEL staining. The expression of Bcl-2 and Bak were detected by
Western blot. Results: In the untreated controls, electron microscopic
analyses revealed evidence for ischemic injury in cardiomyocytes
characterized by swollen mitochondria with vacuoles, and shortened and
disrupted cristae. Simvastatin significantly reduced these changes
compared to the control group. TUNEL staining showed that myocardial
apoptosis in simvastatin group was much less than that in the control
group. Simvastatin significantly upregulated the expression of Bcl-2 and
downregulated the expression of Bak after surgery. Conclusions: The
mechanisms by which simvastatin protected myocardium undergoing
noncoronary cardiac surgery is, at least in part, related to the
inhibition of apoptosis, which may be related to the preservation of
mitochondrial structure and function.

<76>
[Use Link to view the full text]
Accession Number
619219457
Author
Oesterle A.; Weber B.; Choudhry N.; Singh J.; Upadhyay G.
Institution
(Oesterle, Weber, Upadhyay) Cardiology, Univ of Chicago, Chicago, IL,
United States
(Choudhry) Medicine, Brigham and Women's Hosp, Boston, MA, United States
(Singh) Cardiology, Massachusetts General Hosp, Boston, MA, United States
Title
Prophylaxis of atrial fibrillation after non-cardiac surgery: A
meta-analysis.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Although postoperative atrial fibrillation (AF) is common
after non-cardiac surgery, there is a relative paucity of data regarding
effective pharmacologic prophylaxis. Methods: This was a meta-analysis of
randomized controlled trials and prospective cohort studies investigating
pharmacologic therapy to prevent postoperative AF after non-cardiac
surgery. The primary endpoint was incidence of postoperative AF and
secondary endpoint was incidence of adverse events due to medical therapy.
Results: Of 14,225 studies reviewed, 18 were selected for analysis,
representing 11,111 patients. Types of surgery performed included vascular
surgery (3,465 patients, 31%), thoracic surgery (2,260 patients, 20%),
general surgery (2,292 patients, 20%), orthopedic surgery (1,756 patients,
16%), and other surgery (1,338 patients, 12%). The overall incidence of
postoperative AF was 5.9%; 17.1% after thoracic surgery, and 3.1% after
non-thoracic surgery. Pharmacologic prophylaxis reduced the incidence of
AF compared to control overall (OR 0.56, 95% confidence interval [CI]
0.39-0.79) driven by calcium channel blockers (OR 0.47, 95% CI 0.23-0.95)
and amiodarone (OR 0.36, 95% CI 0.19-0.68) (see Figure). Magnesium (OR
0.69, 95% CI 0.18-2.64) showed no efficacy at prophylaxis. There was a
trend towards benefit in patients receiving beta-blockers (OR 0.36, 95% CI
0.11-1.24), and to increased risk in those receiving digoxin (OR 1.86, 95%
CI 0.99-3.52). Incidence of adverse events was comparable across agents,
except for a signal for increased risk for hypotension, bradycardia, and
stroke in patients receiving beta-blockers. The I is 69%, indicating
significant heterogeneity amongst the studies. Conclusion: Pharmacologic
prophylaxis-particularly with calcium channel blockers or
amiodarone-reduces incidence of postoperative AF after non-cardiac
surgery, while digoxin may increase risk. (Figure Presented).

<77>
Accession Number
619219406
Author
McClure G.R.; Belley-Cote E.P.; Singal R.K.; Jaffer I.; Dvirnik N.; An
K.R.; Fortin G.; Spence J.; Whitlock R.P.
Institution
(McClure, An) Undergraduate Medicine, McMaster Univ, Hamilton, Canada
(Belley-Cote, Spence) Clinical Epidemiology and Biostatistics, McMaster
Univ, Hamilton, Canada
(Singal) Surgery Univ of Manitoba, Winnipeg, Canada
(Jaffer, Dvirnik, Whitlock) Surgery McMaster Univ, Hamilton, Canada
(Fortin) Medicine, Universite do Sherbrooke, Hamilton, Canada
Title
Surgical atrial fibrillation ablation: A systematic review and
meta-analysis of randomized controlled trials.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Surgical ablation for atrial fibrillation (AF) significantly
improves maintenance of sinus rhythm and is recommended as a concomitant
procedure in patients undergoing cardiac surgery. Current trials lack
power to assess for patient-important outcomes such as mortality, stroke
and pacemaker requirement. We performed a systematic review and
metaanalysis to evaluate the efficacy and safety of surgical AF ablation.
Methods: We searched Cochrane CENTRAL, MEDLINE and EMBASE from inception
to May 2016 for RCTs evaluating surgical AF ablation using any lesion set
versus no surgical AF ablation in adults with AF undergoing cardiac
surgery. We performed screening, full-text eligibility assessment, risk of
bias evaluation and data collection independently and in duplicate. We
evaluated the risk of bias for individual studies with the modified
Cochrane tool, overall quality of evidence with the GRADE framework and
pooled data using a random effects model in Revman 5.3. Results: We
identified 22 studies (n=1839) meeting eligibility criteria. Surgical AF
ablation was associated with more freedom from AF at 12 months (RR 2.35,
95% CI [1.92 to 2.88], p<0.001, I2 = 46%, low quality). However, no
significant difference was seen in mortality (RR 1.02, 95% CI [0.72 to
1.47], I2= 0%, moderate quality), stroke (RR 1.19, 95% CI [0.59 to 2.39],
p=, 0.63, I2=0% moderate quality) and pacemaker implantation (RR 1.27, 95%
CI [0.82 to 1.98], p=0.28, I2= 3%, high quality). Comparing biatrial and
left sided lesion sets, no significant difference was seen in freedom from
AF at 12 months (p=0.12), mortality (p =0.39) or stroke (p=0.15). Biatrial
procedures conferred an increased risk of pacemaker requirement (RR 2.72,
95%CI[1.37 to 5.37], p=0.004, I2=0%) while left sided lesion sets did not
(RR 1.08, 95%CI[0.66 to 1.78], p=0.75, I2=6%). This difference was
significant (p for interaction=0.03). Conclusion: Surgical AF ablation
during cardiac surgery improved freedom from AF on follow-up. However
patient-important outcomes including mortality and stroke did not differ.
Biatrial when compared to left sided lesion sets showed no difference in
freedom from AF, mortality or stroke but was associated with a
significantly increased risk of pacemaker requirement.

<78>
[Use Link to view the full text]
Accession Number
619219043
Author
Ando M.; Funamoto M.; Sundt T.M.
Institution
(Ando, Funamoto, Sundt) Cardiac Surgery, Massachusetts General Hosp,
Boston, MA, United States
Title
Should we close left atrial appendage in cardiac surgery ? : Meta-analysis
of 7466 Patients who underwent open-heart surgery.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: While percutaneous closure of left atrial appendage (LAA)
can be a potential alternative to life-long anticoagulation in patients
with atrial fibrillation (AF), comprehensive evidence on surgical LAA
closure (LAAC) is scant. Hypothesis: Surgical LAAC is associated with
reduced risk of mortality and stroke. Methods: We conducted a
meta-analysis on the studies comparing the patients who underwent
open-heart surgery with or without LAAC. Literature search was performed
on PubMed, Embase, and Cochrane Trials databases. Outcomes of interest
were 30-day/in-hospital mortality and morbidity, and late mortality and
stroke. I-square statistics were used to evaluate heterogeneity and
publication bias was evaluated by Begg's and Egger's tests. Results: We
reviewed 821 articles and 12 articles including 7466 patients (3039 in
LAAC group and 4427 in Non-LAAC group) were selected for the analysis.
Among 12 studies, 3 were randomized-controlled, 2 were propensity-matched,
and others were cohort study. There was no significant heterogeneity or
publication bias. At 30-day/in-hospital follow-up, LAAC was not associated
with risk of mortality or stroke (Risk ratio (RR) 0.67, 95% confidence
interval (CI) 0.42-1.06 for mortality, and RR 0.83, 95%CI 0.54-1.26 for
stroke). LAAC was not associated with risk of postoperative AF or
re-exploration for bleeding. At the latest follow-up, LAAC was
significantly associated with decreased risk of mortality (Risk ratio (RR)
0.64, 95%CI 0.44-0.94, p-value 0.024). This association showed similar
tendency in stratified meta-analysis by age, sex, study design, type of
surgery, and preoperative AF status. Arrhythmias, treatment of Atrial
fibrillation Cardiac surgery Conclusions: LAAC was associated with
decreased risk of late mortality, but not late stroke. Better survival in
LAAC group would be based on baseline differences or postoperative
anticoagulation management. Further prospective investigation is needed to
clarify these findings.

<79>
[Use Link to view the full text]
Accession Number
619219016
Author
Oikonomou E.K.; Odutayo A.; Akoumianakis I.; Antonopoulos A.; Thomas S.;
Herdman L.; Trivella M.; Collins G.; Petrou M.; Channon K.
Institution
(Oikonomou, Akoumianakis, Antonopoulos, Thomas, Herdman, Channon) Div of
Cardiovascular Medicine, Univ of Oxford, Oxford, United Kingdom
(Odutayo, Trivella, Collins) Cntr for Statistics in Medicine, Univ of
Oxford, Oxford, United Kingdom
(Petrou) Dept of Cardiothoracic Surgery, Oxford Univ Hosps, Oxford, United
Kingdom
Title
Identifying biological predictors of early saphenous vein graft failure: A
meta-analysis of 5134 patients with angiographic follow up in
safinous-cabg collaborative group.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Early failure of saphenous vein grafts (SVG) used in
coronary artery bypass grafting (CABG) is often attributed to technical
factors. We explore the contribution of biological factors relevant to
either the quality of the SVG or the patient's risk profile, in predicting
early SVG failure. Methods: In study 1, 176 patients undergoing CABG with
>1 SVG in Oxford University Hospitals were recruited. Intact SVG segments
were obtained before distension to study endothelial nitric oxide (NO)
bioavailability ex vivo (vasorelaxation to acetylcholine (ACh
3x10-8<br/>j, n=57) and quantify superoxide (O<inf>2-</inf>) generation
(n=121). The contribution of uncoupled nitric oxide synthase (NOS) and
NADPH oxidases in SVG redox balance was determined using NOS inhibitor
LNAME and NADPH oxidases inhibitor Vas2870 respectively. SVG patency was
determined using CT angiography 6 weeks post CABG. In study 2, data from 8
studies in SAFINOUS-CABG (n=5134 CABG cases with angiographic follow up
<1y post-CABG) were used in a meta-analysis, searching for
patient-specific biological predictors of early SVG failure. Results:
There were 20 patients with >1 failed SVG (11.36%) in Study 1. Failed SVGs
had impaired vasorelaxation to ACh (A) but similar resting O<inf>2-</inf>
(B) and similar NADPH-stimulated or Vas2870-inhibitable O<inf>2-</inf>,
compared to non-failed SVGs (data not shown). In SAFINOUS-CABG study,
average SVG failure was 9.17% within the first year, and gender was the
strongest predictor (C). Conclusions: This is the first study
demonstrating that biological factors like NO bioavailability of the
intact SVG (before surgical preparation) predict early graft failure in
CABG. Further to the biology of the SVGs and a variety of technical
factors, patient characteristics (e.g. gender) are also driving early SVG
failure. We propose a predictive model of early SVG failure based on both
patient-specific and technical factors, that will guide therapeutic
strategies following CABG.

<80>
Accession Number
619218993
Author
Patrono C.; Cavalca V.; Rocca B.; Veglia F.; De Cristofaro R.; Parolari
A.; Tremoli E.
Institution
(Patrono, Rocca) Pharmacology, Catholic Univ, Sch of Medicine, Rome, Italy
(Cavalca, Veglia, Tremoli) Cntr Cardiologico Monzino, IRCCS, Milan, Italy
(De Cristofaro) Medicine, Catholic Univ, Sch of Medicine, Rome, Italy
(Parolari) Dept of 'Scienze Biomediche per la Salute', Universita degli
Studi di Milano, Milan, Italy
Title
Twice daily dosing normalyzes the impaired antiplatelet effect of low-dose
aspirin due to enhanced platelet turnover in patients undergoing on-pump
cardiac surgery.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Previous studies reported reduced platelet cyclooxygenase (COX)-1
inhibition by once-daily (od) low-dose aspirin early after cardiac
surgery. We hypothesized that on-pump cardiac surgery enhances platelet
turnover, leading to faster platelet COX-1 renewal. We measured: serum
thromboxane (TX)E>2 (sTXE>2) and its urinary metabolite (TXM) to assess
aspirin pharmacodynamics; thrombopoietin (TPO), interleukin (IL)-6,
glycocalycin, immature platelet fraction (IPF), C-reactive protein to
investigate the kinetics of platelet turnover. We also assessed whether a
regimen of 100 mg twice-daily (bid) or 200 mg od aspirin could restore
sTXE2 inhibition 7 days and 3 months post-surgery, and tested the vascular
safety of these regimens, as reflected by prostacyclin (PGy metabolite
(PGIM) excretion. Thirty-seven patients (aged 67+/-6 years, 83% M) on
aspirin 100 mg od were studied the day before surgery, randomized 24-36
hrs post-surgery to 100 mg od, 100 mg bid or 200 mg od for 3 months, and
sampled at 8 am and 8 pm before and on day 7 post-surgery and at 3 months.
IPF, mature platelets, platelet mass, TPO, IL-6, glycocalycin, leukocytes,
and C-reactive protein significantly (P<0.001) increased at day 7 post-
vs. pre-surgery, with IL-6 showing a 50-fold increase. A significant
(P<0.01) inverse correlation between IPF and total platelets was observed
on day 7 post-surgery, consistent with enhanced thrombopoiesis. In
patients randomized to 100 mg od, the 24-h peak value of sTXE2 increased
post- (3.4 [1.9-10.9] ng/mL; median [IQR]) vs. pre-surgery (2.2 [1-4.2]
ng/mL, p<0.05), and evening urinary TXM almost doubled (130 [75-210] vs
244 [120-345] pg/mg creatinine, p<0.01). Patients randomized to 200 mg od
had similar 24-h sTXE2 peak values pre- and 7 days post-surgery, with
significantly increased TXM. Aspirin 100 mg bid lowered by ~30% sTXE2 24-h
peak value post-surgery (P<0.01) and prevented TXM increase. Urinary PGIM
significantly (P<0.01) increased at day 7 post-surgery independently of
the aspirin regimen. In conclusion, a standard low-dose aspirin regimen
inadequately inhibits platelet TXA^ after cardiac surgery in association
with increased platelet turnover. A bid regimen restores the antiplatelet
pharmacodynamics without affecting endothelial safety.

<81>
Accession Number
619218985
Author
Oellgaard J.; Gaede P.; Rossing P.; Lund-Andersen H.; Parving H.H.;
Pedersen O.
Institution
(Oellgaard, Gaede) Cardiology and Endocrinology, Slagelse Hosp, Slagelse,
Denmark
(Rossing) 520, Steno Diabetes Cntr, Gentofte, Denmark
(Lund-Andersen) Eye Clinic, Capital Region, Kbh O, Denmark
(Parving) Dept. of Medical Endocrinology, Rigshospitalet, Kbh O, Denmark
(Pedersen) Section of Metabolic Genetics, Novo Nordisk Foundation Cntr for
Basic Metabolic Rsch, Kbh O, Denmark
Title
Long-term reduction in coronary artery disease and stroke with 7,8 years
of intensified, multifactorial intervention in patients with type 2
diabetes and microalbuminuria in the steno-2 study.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Intensified multifactorial intervention for 7.8 years in
patients with type 2 diabetes mellitus and microalbuminuria increased life
length and reduces complication rates. The present analysis is a sub-study
examining the long-term effects specifically on coronary artery disease
(CAD) and cerebrovascular disease. Methods: The original intervention
(mean treatment duration 7.8 years) involved 160 patients with type 2
diabetes mellitus and microalbuminuria that were randomly assigned to
either conventional therapy or intensified, multifactorial treatment
including both behavioral and pharmacological approaches. After 7.8 years
the study continued as an observational follow-up with all patients
offered treatment as for the original intensive-therapy group. The primary
end-point of this sub-analysis of the follow-up, ²¹.2 years
after intervention start was the relative risk reduction in CAD (defined
as non-fatal acute myocardial infarction or cardiac revascularization) and
cerebrovascular disease (defined as non-fatal ischemic or hemorrhagic
stroke) and the secondary end-point was a composite of CAD stroke and
death from cardiovascular disease. Results: Hazard rates of CAD, stroke
and the composite end-point were all significantly decreased in the
intensive-therapy group with HR of 0.43 [95 % CI 0.23-0.77; p = 0.005],
0.26 [95 % CI 0.12-0.55; p < 0.001] and 0.36 [95 % CI 0.23-0.57; p <
0.001], respectively in Cox-regressions adjusted for age and sex. In
addition, the risk of recurrent primary events was significantly decreased
in the intensive-therapy group (p = 0.049 for CAD and p = 0.003 for
stroke). Conclusions: At 21.2 years of follow up of 7.8 years of
intensified, multifactorial, target driven treatment of type 2 diabetes
mellitus with microalbuminuria, we demonstrate significant risk reductions
in coronary and cerebral artery disease.

<82>
Accession Number
619218974
Author
Kishimoto Y.; Nakamura Y.; Fujiwara Y.; Harada S.; Ohnohara T.; Kishimoto
S.; Kurashiki T.; Nishimura M.
Institution
(Kishimoto, Nakamura, Fujiwara, Harada, Ohnohara, Kishimoto, Kurashiki,
Nishimura) Dept of Cardiovascular Surgery, Tottori Univ Hosp, Yonago,
Tottori, Japan
Title
Could tolvaptan prevent the new onset of atrial fibrillation after cardiac
surgery?.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Atrial fibrillation (Af) occurs frequently after cardiac
surgery and not only prolongs hospitalization but also influences the
prognosis. Tolvaptan (TV) has a strong diuretic effect, which is
beneficial for body fluid management in patients with acute heart failure.
We hypothesized that concomitant administration of TV with conventional
diuretic treatment is beneficial for perioperative body fluid management
in patients who have undergone cardiac surgery, which may reduce
postoperative Af. In this study, we prospectively randomized the patients
into the TV group, in which TV was administered, and the control group, in
which the patients received conventional diuretics only. Our primary
endpoint was occurrence of Af. Logistic regression analysis was performed
to investigate risk factors for Af. Methods: 165 patients who underwent
cardiac surgery between July 2013 and February 2016 were included in the
study and divided into 2 groups, which were the TV group (TV, TV +
furosemide, 92 patients) and conventional diuretic treatment group
(Control [C], furosemide, 73 patients). We compared urine output for 3
days after surgery, the time required to restore the preoperative body
weight, and the occurrence of postoperative Af between the 2 groups. In
the TV group, patients received TV 7.5mg/day orally starting on
postoperative day (POD) 1 and continued to take TV up to POD 5 or until
the body weight returned to the preoperative value. Results: The mean ages
of the TV and C groups were 70.0 +/- 12.3 and 69.3 +/- 13.5 years old,
respectively. The mean daily urine output from POD1 to POD 3 of the TV
group (2672 +/- 769 mL/day) was higher than that of the C group (2240 +/-
529 mL/day) (p = 0.001). The time required to restore preoperative body
weight was shorter in the TV group (3.8 +/- 1.4 days) than in the C group
(4.8 +/- 2.0 days) (p=0.003). Af occurred 21 patients (22.8 %) in the TV
group versus 27 patients (37.0 %) in the C group (p < 0.05). Multivariate
analysis revealed that significant risk factors for Af was a non-use of
TV. Conclusion: Administration of TV with conventional diuretics in the
early postoperative period after cardiac surgery could be beneficial not
only in maintaining urine output, but also in reducing the occurrence of
postoperative Af.

<83>
[Use Link to view the full text]
Accession Number
619218972
Author
Secemsky E.; Yeh R.; Kereiakes D.; Cutlip D.E.; Steg P.G.; Massaro J.M.;
Apruzzese P.K.; Mauri L.
Institution
(Secemsky) Dept of Medicine, Div of Cardiology, Massachusetts General
Hosp, Boston, MA, United States
(Yeh, Cutlip) Dept of Medicine, Div of Cardiology, Beth Israel Deaconess
Med Cntr, Boston, MA, United States
(Kereiakes) Dept of Medicine, Div of Cardiology, Christ Hosp, Cincinnati,
OH, United States
(Steg) Departement de Cardiologie, Hopital Bichat, Assistance
Publique-Hopitaux de Paris, Paris, France
(Massaro) Sch of Public Health, Boston Univ, Boston, MA, United States
(Apruzzese) Dept. of Biostatistics, Harvard Clinical Rsch Institute,
Boston, MA, United States
(Mauri) Dept of Medicine, Div of Cardiology, Brigham and Women's Hosp,
Boston, MA, United States
Title
Extended duration dual antiplatelet therapy after percutaneous coronary
intervention among patients with peripheral arterial disease: A
sub-analysis of the dual antiplatelet therapy study.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Peripheral arterial disease (PAD) is prevalent among
patients undergoing percutaneous coronary intervention (PCI). Hypotheses:
PAD patients have increased coronary ischemic risk after PCI and may
experience different ischemic event reduction and bleeding risk with
extended dual antiplatelet therapy versus those without PAD. Methods: The
DAPT Study enrolled 25,682 patients following PCI with coronary stenting.
After 12 months of thienopyridine plus aspirin, 11,648 were randomized to
thienopyridine plus aspirin versus placebo plus aspirin for 18 months.
Endpoints included ischemic events (myocardial infarction or
definite/probable stent thrombosis) and bleeding (GUSTO moderate or
severe). Results: Of enrolled patients, 1,745 (6.8%) had PAD. PAD patients
were older, had more cardiac risk factors including diabetes, hypertension
and prior MI, and presented less often with MI at index PCI. Compared with
patients without PAD, PAD patients had higher rates of ischemic events
(6.2% v 2.7%, p<0.01) and bleeding (5.7% vs 2.5%, p<0.01) within the first
12 months (Figure). Among randomized patients, 649 (5.6%) had PAD. Between
12 and 30 months, PAD patients had greater rates of ischemic events (6.0%
vs 2.9%, p<0.01) and bleeding (4.9% vs 1.7%, p<0.01) compared with those
without PAD. Of patients with and without PAD, continued thienopyridine
versus placebo was associated with consistent reductions in ischemic
events (PAD: 4.7% vs 7.3%, HR 0.63, 95%CI 0.32-1.22, p=0.16; no PAD: 2.0%
vs 3.8%, HR 0.53, 95%CI 0.42-0.66, p<0.01; interaction p=0.70) and
increases in rates of bleeding (PAD: 6.3% vs 3.5%, HR 1.82, 95%CI
0.87-3.83, p=0.11; no PAD: 2.2% vs 1.3%, HR 1.66, 95%CI 1.23-2.24, p<0.01;
interaction p=0.28). Conclusions: PAD patients had more early and late
ischemic and bleeding events after PCI than did those without PAD.
Extended dual antiplatelet therapy provides consistent ischemic benefit
and bleeding risk among patients with and without PAD.

<84>
Accession Number
619218812
Author
Franklin M.; Wailoo A.; Dayer M.J.; Jones S.; Prendergast B.; Baddour
L.M.; Lockhart P.B.; Thornhill M.H.
Title
The use of antibiotic prophylaxis to prevent infective endocarditis is
cost effective.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: In March 2008, the National Institute for Health and Care
Excellence (NICE) recommended stopping antibiotic prophylaxis (AP) for
those at risk of infective endocarditis (IE) undergoing dental procedures
in the UK, citing a lack of efficacy and cost-effectiveness. We performed
a new health economic evaluation comparing 'AP' to 'No AP' using
present-day estimates of efficacy, adverse events and resource-use.
Methods: A decision analytic cost-effectiveness model was used. Health
service costs and benefits were measured as Quality Adjusted Life Years
(QALYs). Rates of IE before and after the NICE guidelines were used to
estimate AP efficacy. AP adverse event rates (congestive heart failure,
valve replacement, AP side effects and mortality) were derived from recent
UK data and resource implications (hospitalisation, outpatient and primary
care, and medications) were based on national Hospital Episode Statistics.
Results: AP was less costly and more effective than no AP for all patients
at risk of IE. The results are sensitive to AP efficacy, but efficacy
would have to be substantially lower for AP not to be cost-effective. AP
was even more cost-effective in patients at high-risk of IE. Only a
marginal reduction in annual IE rates (1.56 cases, high-risk; 35 cases,
all-at-risk) would be required for AP to be considered cost-effective at
20,000 ($28,381/25,166) per QALY. Annual cost savings of 5.3-7.9m
($7.5-11.2m/6.7-9.9m) and health gains >2,500 QALYs could be gained from
reinstating AP in England. A conservative expected value of perfect
information (EVPI) estimate was 25.9m ($36.8m/32.6m) when uncertainty
around AP efficacy was increased. This indicates that any randomised
controlled trial costing <25.9m ($36.8m/32.6m) would be cost-effective
because of the value of the reduced uncertainty about the benefits of AP
that would result. Conclusions: AP is cost-effective for preventing IE,
particularly in those at high-risk of IE. These findings support the
cost-effectiveness of guidelines recommending AP use in high-risk
individuals, such as recommended in current American Heart Association and
European Society of Cardiology guidelines.

<85>
Accession Number
619218764
Author
Heianza Y.; Ma W.; Qi L.
Institution
(Heianza, Qi) Dept of Epidemiology, Tulane Univ Sch of Public Health and
Tropical Medicine, New Orleans, LA, United States
(Ma) Dept of Epidemiology, Harvard T.H. Chan Sch of Public Health, Boston,
MA, United States
Title
Gut-microbiota-derived trimethylamine-n-oxide levels and risk of major
adverse cardiovascular events: A systematic review and meta-analysis of
prospective cohort studies.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Gut microbial metabolite trimethylamine-N-oxide (TMAO) has
been implicated as a novel risk factor for cardiovascular events. The
strength and consistency of the association between blood levels of the
gut microbiota-related risk factor and cardiovascular events or deaths
remain unclear. Hypothesis: We performed a systematic review and
meta-analysis of prospective cohort studies to quantify the association of
blood levels of TMAO and the risk of major adverse cardiovascular events
(MACE). Methods: PubMed and Embase databases were searched up to 3 May
2016 and prospective studies with either quantitative estimates of the
association of blood TMAO levels with incident MACE were included. MACE
was indicated by myocardial infarction, stroke, heart transplant, heart
failure, other ischemic cardiovascular events or death (either
cardiovascular or all-cause). Two reviewers independently extracted data
and assessed study quality. Generalized least-squares trend estimation was
used to assess dose-response relationships. Summary relative risk (RR) for
higher TMAO levels as compared to lower levels was calculated using only
prospective cohort studies. Results: A total of 12 cohorts were included
in the meta-analysis. High circulating TMAO levels were associated with an
increased risk of MACE with a pooled RR of 1.76 (95% confidence interval:
1.50, 2.07; heterogeneity p = 0.22; I-squared = 22.8%) compared with low
TMAO levels. Elevated TMAO levels were consistently associated with an
increased risk of MACE regardless of older ages, high prevalence of
diabetes, histories of cardiovascular diseases or renal failure at the
baseline across studies. Pooled adjusted RR (95% confidence interval) of
MACE was 1.02 (1.01, 1.04) per 1 muM (n=6 cohorts) or 1.22 (1.12, 1.32)
per log-transformed 1 SD (n=4) increment in TMAO levels. Conclusions:
Higher blood TMAO levels were consistently and dose-dependently associated
with the development of MACE across diverse populations, independently of
traditional risk factors.

<86>
Accession Number
619218720
Author
Lima E.G.; Hueb W.; Garzillo C.L.; Favarato D.; Hueb A.C.; Rezende P.C.;
Silva E.E.; Garcia R.M.; Scudeler T.L.; Ramires J.A.; Filho R.K.
Institution
(Lima, Hueb, Garzillo, Favarato, Hueb, Rezende, Silva, Garcia, Scudeler,
Ramires, Filho) Clinical Div, Heart Institute (InCor) Univ of Sao Paulo,
Sao Paulo, Brazil
Title
Impact of chronic kidney dysfunction among patients with stable coronary
artery disease: Ten-year follow-up of mass ii trial.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Chronic kidney disease (CKD) has poor prognosis among
patients with stable coronary artery disease (CAD), but there is a lack of
evidence regarding long term follow-up. Our objective was to evaluate the
CKD in patients with multivesselCAD preserved ventricular function, and
the interaction betweenreceived treatment and mortality in a 10-year
follow-up. Hypothesis: CKD level would interact with treatment options
regarding mortality. Methods: The glomerular filtration rate was
determined at baseline on 611 patients who were randomized intothree
treatment groups: medical treatment (MT), percutaneous coronary
intervention (PCI), and coronary artery bypass surgery (CABG). Endpoint
considered was overall death.Survival was estimated by the Kaplan-Meier
method and hazard ratio (HR) using Cox proportional hazard. Results: Of
611 patients, 112 (18%) had normal renal function, 349 (57%) mild
dysfunction, and 150 (25%) moderate dysfunction. Treatment assigned and
baseline characteristicswere similar among renal function (RF) groups,
except by age,smoking, body mass index, number of diseased vessels,
triglycerides, and HDL cholesterollevels. There were
significantdifferences among cumulative overall mortality curves among the
three renal function groups. Survival rates were 81.3%, 76,2% and 60,7%
for normal renal function, mild CKD, and moderate CKD respectively
(log-rank=0.001; HR:0.43: 0.260.70 for normal RF versus moderate CKD; and
HR:0.64; 0.46-0.90 for mild versus moderate CKD). Comparing treatment
strategies in RF groups we observed a higher survival in CABG group (81%)
compared to those in PCI (75.9%) and MT (71.4%) groups among mild CKD
subjects (log-rank:0.015; HR: 0.44; 0.25-0.77 for CABG versus MT; HR:
0.59; 0.33-1.03 for CABG versus PCI) Conclusions: CAD associated to
chronic kidney dysfunction has a worse prognosis, regardless of the
therapeutic strategy option. Additionally, our data suggest that CABG is
related to higher survival when compared to MT among mild CKD subjects.

<87>
Accession Number
619218636
Author
Perrault L.
Institution
(Perrault) Surgery, Montreal Heart Institute, Montreal, Canada
Title
SOMVC001(duragraft) vascular graft treatment in patients undergoing
coronary arterybypass grafting.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The principal mechanism thought to limit the benefits of CABG
is saphenous vein graft disease leading to vein graft failure (VGF).
Injury to the saphenous vein graft (SVG) endothelium during harvesting and
implantation promotes inflammation and neointimal hyperplasia that can
lead to subsequent graft atherosclerosis and occlusion. We investigated
the impact of a novel intraoperative vein graft treatment SOMVC001
(DuraGraft) on angiographic early graft wall thickness and late lumen loss
in patients undergoing CABG. Methods: This is a prospective randomized,
double-blinded study designed to compare within patient the impact of
DuraGraft vs. the standard of care by evaluating the magnitude of change
in the mean wall thickness of paired grafts within patients from 4-6 weeks
to 3 months and the change from 4-6 weeks to 12 months in mean lumen
diameter over each graft plus the lumen diameter at maximal stenosis
within-person following CABG surgery using 64-slice or better
multi-detector computed tomography (MDCT) angiography. Results: Enrollment
of 134 patients from seven investigational sites was completed. Patient
baseline and procedural characteristics is representative of a
contemporary population of individuals undergoing initial CABG with at
least two SVG. MDCT angiographic follow-up is ongoing and scheduled to be
completed in October 2016. Conclusions: The study data will establish
whether SVGs pretreated with DuraGraft can prevent early (1 to 3 months)
graft wall thickness as an expression of intima hyperplasia and late (12
months) graft lumen loss as an expression of VGF in patients undergoing
CABG surgery.

<88>
[Use Link to view the full text]
Accession Number
619218579
Author
Ferket B.S.; Ailawadi G.; Gelijns A.; Acker M.A.; Hohmann S.F.; Chang H.;
Bouchard D.; Meltzer D.; Michler R.E.; Moquete E.; Voisine P.; Mullen
J.C.; Mack M.; Gillinov A.M.; Thourani V.; Miller M.A.; Gammie J.; Parides
M.; Bagiella E.; Smith R.L.; Smith P.K.; Hung J.W.; Gupta L.; Rose E.A.;
O'Gara P.; Moskowitz A.
Institution
(Ferket, Gelijns, Chang, Moquete, Parides, Bagiella, Gupta, Moskowitz)
Population Health Science and Policy, Icahn Sch of Medicine at Mount
Sinai, New York, NY, United States
(Ailawadi) Population Health Science and Policy, Univ of Virginia,
Charlottesville, VA, United States
(Acker) Population Health Science and Policy, Hosp of the Univ of
Pennsylvania, Philadelphia, PA, United States
(Hohmann) Population Health Science and Policy, Vizient, Chicago, IL,
United States
(Bouchard) Population Health Science and Policy, Montreal Heart Inst,
Montreal, Canada
(Meltzer) Population Health Science and Policy, Univ of Chicago, Chicago,
IL, United States
(Michler) Population Health Science and Policy, Montefiore Med Ctr, Albert
Einstein Coll of Med., Bronx, NY, United States
(Voisine) Population Health Science and Policy, Inst Univire De
Cardiologie et De Pneumologie De Quebec, Quebec, Canada
(Mullen) Population Health Science and Policy, Univ of Alberta, Edmonton,
AB, Canada
(Mack) Population Health Science and Policy, Baylor Health Care System,
Plano, TX, United States
(Gillinov) Population Health Science and Policy, Cleveland Clinic,
Cleveland, OH, United States
(Thourani) Population Health Science and Policy, Emory Univ Hosp Midtown,
Atlanta, GA, United States
(Miller) Population Health Science and Policy, Natl Heart, Lung, and Blood
Inst, Bethesda, MD, United States
(Gammie) Population Health Science and Policy, Univ of Maryland Baltimore,
Baltimore, MD, United States
(Smith) Population Health Science and Policy, Baylor Res Inst, Plano, TX,
United States
(Smith) Population Health Science and Policy, Duke Univ Med Ctr, Durham,
NC, United States
(Hung) Population Health Science and Policy, Massachusetts General Hosp,
Boston, MA, United States
(Rose) Population Health Science and Policy, Mount Sinai Health System,
New York, NY, United States
(O'Gara) Population Health Science and Policy, Brigham and Women's Hosp,
Boston, MA, United States
Title
Cost-effectiveness of repair versus replacement for severe ischemic mitral
regurgitation: A randomized clinical trial from the cardiothoracic
surgical trials network.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: We recently reported no difference in left ventricular end
systolic volume index (LVESVI) or survival at 2 years post surgery between
patients with severe ischemic MR randomized to mitral valve (MV) repair
(n=126) or replacement (n=125). However, MV replacement provided more
durable correction of MR, as well as fewer heart failure events and
cardiovascular readmissions over time. These events have important
clinical and economic implications, requiring a cost-effectiveness
analysis to elucidate. Methods: We conducted a cost-effectiveness analysis
using patient-level cost and clinical data from the trial, and developed a
microsimulation model for projecting readmission rates and mortality
events over a 10-year period. Andersen-Gill modelling was used for these
projections, accounting for competing risks. We performed bootstrap
resampling to assess parameter uncertainty and threshold analyses to test
model assumptions. Results: The mean age of the trial cohort was 68+/-10
years, mean baseline LVESVI was 63.4+/-26.8, and 2-year mortality was
19.0% for MV repair and 23.2% for MV replacement patients (HR 0.79, 95% CI
0.46-1.35; p=0.39). The clinical outcomes of the model will be expressed
in quality-adjusted life years using longitudinally measured SF-6D scores.
Cost outcomes will be derived from claims data using cost-to-charge
ratios, and include the index hospitalization and all readmissions.
Predictive validity was established by developing the microsimulation
model in 1-year data and comparing predicted with observed outcomes at 2
years (Figure). Conclusions: The benefits of these procedures, which have
upfront risks and costs, extend beyond 2 years. Our costeffectiveness
analysis will delineate the long-term cost-benefit trade-offs between MV
repair versus replacement that should inform surgical decision making, and
examine how differences in life expectancy and risk profiles of different
patient groups affect cost-effectiveness. (Figure presented).

<89>
Accession Number
619218492
Author
Winterhalter M.; Rex S.; Stoppe C.; Kienbaum P.; Muller H.-H.; Kaufmann
I.; Dongas A.; Kuppe H.; Zwissler B.
Institution
(Winterhalter) Dept of Anesthesiology, Klinikum Bremen-Mitte GmbH, Bremen,
Germany
(Rex) Dept of Cardiovascular Sciences, Univ Hosps Leuven, Leuven, Belgium
(Stoppe) Dept of Anesthesiology, RWTH Aachen Univ, Aachen, Germany
(Kienbaum) Dept of Anesthesiology, Dusseldorf Univ, Dusseldorf, Germany
(Muller) Institute of Biometrics, Marburg Univ, Marburg, Germany
(Kaufmann) Dept of Anesthesiology, Klinikum Neuperlach, Berlin, Germany
(Dongas) Dept of Anesthesiology, Franziskus Hosp Bielefeld, Aachen,
Germany
(Kuppe) Dept of Anesthesiology, Charite berlin, Berlin, Germany
(Zwissler) Dept of Anesthesiology, LMU Munich, Munich, Germany
Title
The clinical significance of intraoperative iloprost inhalation on outcome
of high risk cardiac surgical patients: A multicenter randomized
controlled trial.
Source
Circulation. Conference: American Heart Association's 2016 Scientific
Sessions and Resuscitation Science Symposium. United States. 134
(Supplement 1) (no pagination), 2016. Date of Publication: November 2016.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Perioperative right ventricular (RV) failure due to pressure
overload resulting from pulmonary hypertension (PH) worsens postoperative
outcomes in cardiac surgery. Inhaled iloprost is a potent pulmonary
vasodilator improving biventricular performance, ameliorating myocardial
and pulmonary ischemia-reperfusion injury and attenuating inflammation. We
hypothesized that the prophylactic inhalation of iloprost improves
postoperative outcome in patients undergoing elective open heart surgery
being at an increased risk for perioperative RV failure. Methods and
Results: In this phase 3, multicenter, randomized, double-blind,
placebo-controlled trial, we randomly assigned 253 cardiac surgical
patients at high risk for perioperative RV failure to the prophylactic
inhalation of 20mug iloprost or placebo before and during weaning from
extracorporeal circulation (ECC). The primary endpoint was the duration of
postoperative ventilation. Secondary endpoints included perioperative
hemodynamics, intensive care unit and hospital length of stay, and 90-
days mortality. Safety was assessed by the incidences of adverse events.
Iloprost had no significant effect on the time until extubation (iloprost:
median: 720min [first quartile, third quartile][540min; 1218min]; placebo:
780min [468min; 1170min]; p=0.37). While the nebulization of iloprost
decreased RV afterload and improved cardiac index, major secondary
endpoints were not significantly affected. Treatment with iloprost was
safe with the incidences of adverse events not differing between groups.
Conclusions: The prophylactic inhalation of iloprost does not result in
any meaningful improvement of perioperative morbidity and outcome in
high-risk cardiac surgical patients.