EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
618319605
Author
Bungard T.J.; Mutch J.; Ritchie B.
Institution
(Bungard) EPICORE Centre, Division of Cardiology, 362 Heritage Medical
Research Centre, University of Alberta, Edmonton, AB T6G 2S2, Canada
(Mutch) Alberta Health Services, University of Alberta, 0G1.01, 8440 112
Street NW, Edmonton, AB T6G 2B7, Canada
(Ritchie) Division of Hematology, University of Alberta, 4-71 Medical
Sciences Building, Edmonton, AB T6G 2B6, Canada
Title
A randomized trial of restarting warfarin at maintenance versus loading
doses following an elective procedure.
Source
Journal of Thrombosis and Thrombolysis. 44 (4) (pp 507-515), 2017. Date of
Publication: 01 Nov 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Guidelines suggest restarting warfarin at known maintenance doses,
although this may result in a delay to achieving therapeutic
anticoagulation. As such, we compared the time to achieve an INR >= 2.0
between those restarting warfarin maintenance vs loading doses after
transient interruption, and the impact on protein C, S and factor II
levels. Patients requiring interruption of warfarin for elective
procedures without hospitalization were randomized 1:1 to receive warfarin
maintenance or loading doses (1.5 times the maintenance dose for 3 days
followed by pre-procedural warfarin maintenance dosing). Protein C, S and
Factor II were drawn at baseline (prior to warfarin interruption), 7 and
14 days after restarting warfarin. Among 19 patients randomized to
maintenance and 20 to loading doses, nearly half in each group had
mechanical heart valves with gastrointestinal endoscopic procedures most
commonly performed (41%). The median number of days to reach an INR >= 2.0
was 7.8 days in the loading and 9.0 in the maintenance group (difference
between medians 1.2 days, 95% CI -3.1 to 4.9; P = 0.19). Although levels
of protein C, S and factor II were lower in the loading vs maintenance
dose group, all remained above that of baseline. Warfarin resumption with
loading doses shortened the time to achieve a therapeutic INR by a median
of 1.2 days. Prompt warfarin dose escalation should be done in response to
the INR. Protein C and S remained above pre-warfarin interruption levels,
implying a lack of depletion with restarting warfarin.<br/>Copyright
&#xa9; 2017, Springer Science+Business Media, LLC.

<2>
[Use Link to view the full text]
Accession Number
614735959
Author
Andersen L.W.
Institution
(Andersen) Research Center for Emergency Medicine, Aarhus University
Hospital, Norrebrogade 44, Bygning 30, 1. sal, Aarhus C 8000, Denmark
(Andersen) Center for Resuscitation Science, Department of Emergency
Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
(Andersen) Department of Anesthesiology, Aarhus University Hospital,
Aarhus, Denmark
(Andersen) Department of Medicine, Regional Hospital Holstebro, Aarhus
University, Holstebro, Denmark
Title
Lactate Elevation during and after Major Cardiac Surgery in Adults: A
Review of Etiology, Prognostic Value, and Management.
Source
Anesthesia and Analgesia. 125 (3) (pp 743-752), 2017. Date of Publication:
01 Sep 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Elevated lactate is a common occurrence after cardiac surgery. This review
summarizes the literature on the complex etiology of lactate elevation
during and after cardiac surgery, including considerations of oxygen
delivery, oxygen utilization, increased metabolism, lactate clearance,
medications and fluids, and postoperative complications. Second, the
association between lactate and a variety of outcomes are described, and
the prognostic role of lactate is critically assessed. Despite the fact
that elevated lactate is strongly associated with many important outcomes,
including postoperative complications, length of stay, and mortality,
little is known about the optimal management of postoperative patients
with lactate elevations. This review ends with an assessment of the
limited literature on this subject.<br/>Copyright &#xa9; 2017
International Anesthesia Research Society.

<3>
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.

<4>
Accession Number
616575738
Author
Sabri M.R.; Bigdelian H.; Hosseinzadeh M.; Ahmadi A.; Ghaderian M.; Shoja
M.
Institution
(Sabri, Hosseinzadeh, Ahmadi, Ghaderian, Shoja) Pediatric Department,
Isfahan University of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Bigdelian) Pediatric Cardiac Surgery Department, Isfahan University of
Medical Sciences, Isfahan, Iran, Islamic Republic of
(Sabri, Bigdelian, Hosseinzadeh, Ahmadi, Ghaderian) Pediatric Cardiology
Research Center, Isfahan Cardiovascular Research Institute, Isfahan, Iran,
Islamic Republic of
Title
Comparison of the therapeutic effects and side effects of tadalafil and
sildenafil after surgery in young infants with pulmonary arterial
hypertension due to systemic-to-pulmonary shunts.
Source
Cardiology in the Young. 27 (9) (pp 1686-1693), 2017. Date of Publication:
01 Nov 2017.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Young children with CHD and large systemic-to-pulmonary shunts eventually
develop pulmonary hypertension. At present, phosphodiesterase type-5
inhibitors such as sildenafil have been used to control pulmonary pressure
before and after cardiac surgery. Recently, tadalafil has been utilised in
older children with similar efficacy, but it has been used to a lesser
extent in young infants. From April, 2015 to June, 2016, 42 patients aged
3-24 months with a large septal defect and pulmonary arterial hypertension
were randomly divided into two equal groups: one group received oral
sildenafil (1-3 mg/kg/day every 8 hours), whereas the other group received
oral tadalafil (1 mg/kg once a day) from 7-10 days before surgery to 3-4
weeks after surgery. During the first 48 hours after surgery, pulmonary
artery-to-aortic pressure ratio and recorded systolic pulmonary artery
pressures were not significantly different between the two groups
(p>0.05); moreover, there were no differences in paediatric ICU length of
stay, mechanical ventilation time, clinical findings of low cardiac output
state, and echocardiographic data between the two groups (p>0.05). Most of
the patients had no side effects, and only five patients had a minor with
no significant difference in both groups (p=0.371). Tadalafil can be
considered as an effective oral therapy for preoperative and postoperative
pulmonary hypertension in young infants. It can be administered at a
once-daily dose with an appropriate efficacy and safety profile as
sildenafil, and therefore it can be considered as an alternative to
sildenafil in young children.<br/>Copyright &#xa9; Cambridge University
Press 2017.

<5>
[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.

<6>
Accession Number
619032645
Author
Sannino A.; Smith R.L.; Schiattarella G.G.; Trimarco B.; Esposito G.;
Grayburn P.A.
Institution
(Sannino, Grayburn) Division of Cardiology, Department of Medicine, Baylor
University Medical Center, Baylor Heart and Vascular Hospital, Dallas, TX,
United States
(Sannino, Schiattarella) Division of Cardiology, Department of Medicine,
Universita Degli Studi di Napoli Federico II, Naples, Italy
(Smith) Department of Cardiothoracic Surgery, Heart Hospital Baylor Plano,
Plano, TX, United States
(Schiattarella) Division of Cardiology, Department of Medicine, University
of Texas Southwestern Medical Center, Dallas, United States
(Trimarco, Esposito) Division of Cardiology, Department of Medicine,
Universita Degli Studi di Napoli Federico II, Naples, Italy
Title
Survival and cardiovascular outcomes of patients with secondary mitral
regurgitation: A systematic review and meta-analysis.
Source
JAMA Cardiology. 2 (10) (pp 1130-1139), 2017. Date of Publication: October
2017.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: The outcomes of patients with left ventricular (LV)
dysfunction and secondary mitral regurgitation (SMR) are still
controversial. OBJECTIVE: To clarify the role of SMR in the outcomes of
patients with ischemic or idiopathic cardiomyopathies. DATA SOURCES:
MEDLINE, ISI Web of Science, and Scopus databases were searched for
studies published up to March 2017. STUDY SELECTION: Studies reporting
data on outcomes in patients with SMR were included. Duplicate publication
data, studies lacking data on SMR grade and its correlation with outcomes,
mixed data on SMR and primary mitral regurgitation, studies not clearly
reporting the outcome of interest, and studies with fewer than 100
patients were excluded. Of the initial 3820 articles identified, 1.4% were
finally included. DATA EXTRACTION AND SYNTHESIS: The study met PRISMA
requirements. Two of us independently screened articles for fulfillment of
inclusion criteria. MAIN OUTCOMES AND MEASURES: The primary outcome, set
after data collection, was the incidence of all-cause mortality in
patients with and without SMR. Secondary outcomes included hospitalization
for heart failure (HF), cardiac mortality, and a composite end point of
death, HF hospitalization, and cardiac transplant. RESULTS: Fifty-three
studies and 45 900 patients were included in the meta-analysis. The mean
(SD) length of follow-up was 40.8 (22.2) months. In 26 of 36 studies
reporting LV function by SMR grade, increasing SMR severity was associated
with worse LV function. When SMR was categorized as present or absent,
all-cause mortality was significantly higher in the patients with SMR (17
studies, 26 359 patients; risk ratio [RR],1.79; 95% CI, 1.47-2.18; P <
.001, I² = 85%); when SMR was qualitatively graded, the
incidence of all-cause mortality was significantly increased in patients
having any degree of SMR compared with patients not having SMR (21
studies, 21 081 patients; RR, 1.96; 95% CI, 1.67-2.31; P < .001,
I² = 74%). Finally, when SMR was quantitatively graded, it
remained associated with an increased all-cause mortality rate (9 studies,
3649 patients; RR, 1.97; 95% CI, 1.71-2.27; P < .001, I² = 0%).
Moreover, SMR was associated with an increased risk of hospitalization for
HF (16 studies, 10 171 patients; RR, 2.26; 95% CI, 1.92-2.67; P < .001,
I² = 41%), cardiac mortality (12 studies, 11 896 patients; RR,
2.62; 95% CI, 1.87-3.69; P < .001, I² = 74%), and death, HF,
and transplant (11 studies, 8256 patients; RR, 1.63; 95% CI, 1.33-1.99; P
< .001, I² = 78%). CONCLUSIONS AND RELEVANCE: To our knowledge,
this study is the first meta-analysis to date to demonstrate that SMR,
even when mild, correlates with adverse outcomes in patients with ischemic
or idiopathic cardiomyopathies. Because SMR is an intrinsic consequence of
LV dysfunction, causality between SMR and mortality should not be
implied.<br/>Copyright &#xa9; 2017 American Medical Association. All
rights reserved.

<7>
Accession Number
619032639
Author
Giacoppo D.; Colleran R.; Cassese S.; Frangieh A.H.; Wiebe J.; Joner M.;
Schunkert H.; Kastrati A.; Byrne R.A.
Institution
(Giacoppo, Colleran, Cassese, Frangieh, Wiebe, Joner, Schunkert, Kastrati,
Byrne) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
Munich, Germany
(Joner, Schunkert, Kastrati, Byrne) German Centre for Cardiovascular
Research, Partner Site Munich Heart Alliance, Munich, Germany
Title
Percutaneous coronary intervention vs coronary artery bypass grafting in
patients with left main coronary artery stenosis: A systematic review and
meta-analysis.
Source
JAMA Cardiology. 2 (10) (pp 1079-1088), 2017. Date of Publication: October
2017.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: In patients with left main coronary artery (LMCA) stenosis,
coronary artery bypass grafting (CABG) has been the standard therapy for
several decades. However, some studies suggest that percutaneous coronary
intervention (PCI) with drug-eluting stents may be an acceptable
alternative. OBJECTIVE: To compare the long-term safety of PCI with
drug-eluting stent vs CABG in patients with LMCA stenosis. DATA SOURCES:
PubMed, Scopus, EMBASE, Web of Knowledge, and ScienceDirect databases were
searched from December 18, 2001, to February 1, 2017. Inclusion criteria
were randomized clinical trial, patients with LMCA stenosis, PCI vs CABG,
exclusive use of drug-eluting stents, and clinical follow-up of 3 or more
years. DATA EXTRACTION AND SYNTHESIS: Trial-level hazard ratios (HRs) and
95% CIs were pooled by fixed-effect and random-effects models with inverse
variance weighting. Time-to-event individual patient data for the primary
end point were reconstructed. Sensitivity analyses according to
drug-eluting stent generation and coronary artery disease complexity were
performed. MAIN OUTCOMES AND MEASURES: The primary end point was a
composite of all-cause death, myocardial infarction, or stroke at
long-term follow-up. Secondary end points included repeat
revascularization and a composite of all-cause death, myocardial
infarction, stroke, or repeat revascularization at long-term follow-up.
RESULTS: A total of 4 randomized clinical trials were pooled; 4394
patients were included in the analysis. Of these, 3371 (76.7%) were men;
pooled mean age was 65.4 years. According to Grading of Recommendations,
Assessment, Development and Evaluation, evidence quality with respect to
the primary composite end point was high. Percutaneous coronary
intervention and CABG were associated with a comparable risk of all-cause
death, myocardial infarction, or stroke both by fixed-effect (HR, 1.06;
95% CI, 0.90-1.24; P = .48) and random-effects (HR, 1.06; 95% CI,
0.85-1.32; P = .60) analysis. Sensitivity analyses according to low to
intermediate Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX)
score (random-effects: HR, 1.02; 95% CI, 0.74-1.41; P = .89) and
drug-eluting stent generation (first generation: HR, 0.90; 95% CI,
0.68-1.20; P = .49; second generation: HR, 1.19; 95% CI, 0.82-1.73; P =
.36) were consistent. Kaplan-Meier curve reconstruction did not show
significant variations over time between the techniques, with a 5-year
incidence of all-cause death, myocardial infarction, or stroke of 18.3%
(319 events) in patients treated with PCI and 16.9% (292 events) in
patients treated with CABG. However, repeat revascularization after PCI
was increased (HR, 1.70; 95% CI, 1.42-2.05; P < .001). Other individual
secondary end points did not differ significantly between groups. Finally,
pooled estimates of trials with LMCA stenosis tended overall to differ
significantly from those of trials with multivessel coronary artery
disease without left main LMCA stenosis. CONCLUSIONS AND RELEVANCE:
Percutaneous coronary intervention and CABG show comparable safety in
patients with LMCA stenosis and low to intermediate-complexity coronary
artery disease. However, repeat revascularization is more common after
PCI.<br/>Copyright &#xa9; 2017 American Medical Association. All rights
reserved.

<8>
Accession Number
618314681
Author
Lennerz C.; Barman M.; Tantawy M.; Sopher M.; Whittaker P.
Institution
(Lennerz) Deutsches Herzzentrum Munchen, Klinik fur Herz- und
Kreislauferkrankungen, Abteilung fur Elektrophysiologie, Faculty of
Medicine, Technische Universitat Munchen, Munich, Germany
(Barman) Cardiology Department, Al Ahli Hospital, Doha, Qatar
(Tantawy) Memorial Souad Kafafi University Hospital, Cardiology
Department, Misr University for Science and Technology of October City 6,
Egypt
(Sopher) Royal Bournemouth Hospital, Bournemouth, United Kingdom
(Whittaker) Cardiovascular Research Institute, Department of Emergency
Medicine, Wayne State University School of Medicine, Detroit, United
States
(Lennerz, Barman, Tantawy, Sopher, Whittaker) Department of Social Policy,
The London School of Economics and Political Science, London, United
Kingdom
Title
Colchicine for primary prevention of atrial fibrillation after open-heart
surgery: Systematic review and meta-analysis.
Source
International Journal of Cardiology. 249 (pp 127-137), 2017. Date of
Publication: 15 Dec 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Atrial fibrillation occurs frequently after open-heart surgery.
It is associated with increased morbidity and mortality, longer hospital
stays, and increased healthcare costs. Prophylactic administration of
colchicine may mitigate post-operative atrial fibrillation (POAF). Methods
We searched PubMed, ClinicalTrials.gov and CENTRAL databases to identify
randomized controlled trials (RCTs) that; (1) compared prophylactic use of
colchicine to placebo, or usual care, in patients with sinus rhythm who
underwent elective open-heart surgery and (2) reported POAF-incidence. We
excluded trials focused on incidence of atrial fibrillation after
percutaneous interventions or colchicine treatment of diagnosed
pericarditis or post-pericardiotomy-syndrome. A random-effects model was
used to pool data for POAF-incidence as the primary outcome and for
drug-related adverse effects, major adverse events (death and stroke), and
hospital length-of-stay as secondary outcomes. Results We included five
RCTs (1412 patients). Colchicine treatment reduced POAF-events by 30%
versus placebo or usual care (18% vs. 27%, risk ratio (RR) 0.69, 95%
confidence interval (CI) 0.57 to 0.84, p = 0.0002). Adverse drug-related
effects, especially gastrointestinal intolerance, increased with
colchicine; (21% vs. 8.2%, RR 2.52, 95% CI 1.62 to 3.93, p < 0.0001).
However, major adverse events were unchanged (3.2% vs. 3.2%, RR 0.96, 95%
CI 0.48 to 1.95, p = 0.92). Length-of-stay decreased by 1.2 days with
colchicine (95% CI -1.89 to - 0.44, p = 0.002). Conclusion Colchicine
demonstrated superior efficacy versus usual care for prevention of atrial
fibrillation after cardiac surgery. Moreover, colchicine treatment was
associated with shorter hospital stays. These benefits outweigh increased
risk of adverse drug-related effects; although further work is needed to
minimize gastrointestinal effects.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<9>
Accession Number
617305902
Author
Takagi H.; Ando T.; Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Title
Perioperative depression or anxiety and postoperative mortality in cardiac
surgery: a systematic review and meta-analysis.
Source
Heart and Vessels. 32 (12) (pp 1458-1468), 2017. Date of Publication: 01
Dec 2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
We performed a systematic review and meta-analysis to determine whether
perioperative depression and anxiety are associated with increased
postoperative mortality in patients undergoing cardiac surgery. MEDLINE
and EMBASE were searched through January 2017 using PubMed and OVID, to
identify observational studies enrolling patients undergoing cardiac
surgery and reporting relative risk estimates (RREs) (including odds,
hazard, or mortality ratios) of short term (30 days or in-hospital) and/or
late all-cause mortality for patients with versus without perioperative
depression or anxiety. Study-specific estimates were combined using
inverse variance-weighted averages of logarithmic RREs in the
random-effects models. Our search identified 16 eligible studies. In
total, the present meta-analysis included data on 236,595 patients
undergoing cardiac surgery. Pooled analysis demonstrated that
perioperative depression was significantly associated with increased both
postoperative early (RRE, 1.44; 95% confidence interval [CI] 1.01-2.05; p
= 0.05) and late mortality (RRE, 1.44; 95% CI 1.24-1.67; p < 0.0001), and
that perioperative anxiety significantly correlated with increased
postoperative late mortality (RRE, 1.81; 95% CI 1.20-2.72; p = 0.004). The
relation between anxiety and early mortality was reported in only one
study and not statistically significant. In the association of depression
with late mortality, there was no evidence of significant publication bias
and meta-regression indicated that the effects of depression are not
modulated by the duration of follow-up. In conclusion, perioperative
depression and anxiety may be associated with increased postoperative
mortality in patients undergoing cardiac surgery.<br/>Copyright &#xa9;
2017, Springer Japan KK.

<10>
Accession Number
618469322
Author
Spinthakis N.; Farag M.; Gorog D.A.; Prasad A.; Mahmood H.; Gue Y.;
Wellsted D.; Nabhan A.; Srinivasan M.
Institution
(Spinthakis, Farag, Gorog, Mahmood, Gue, Srinivasan) Department of
Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, United
Kingdom
(Spinthakis, Farag, Gorog, Wellsted) Postgraduate Medical School,
University of Hertfordshire, United Kingdom
(Gorog) National Heart & Lung Institute, Imperial College, London, United
Kingdom
(Prasad) Department of Cardiovascular Diseases, Mayo Clinic, Rochester,
MN, United States
(Nabhan) Cochrane Advisory Group, Postgraduate Medical School, Ain Shams
University, Cairo, Egypt
Title
Percutaneous coronary intervention with drug-eluting stent versus coronary
artery bypass grafting: A meta-analysis of patients with left main
coronary artery disease.
Source
International Journal of Cardiology. 249 (pp 101-106), 2017. Date of
Publication: 15 Dec 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background The relative efficacy and safety of percutaneous coronary
intervention (PCI) with drug-eluting stents (DES), in comparison to
coronary artery bypass grafting (CABG) for left main coronary artery
disease (LMCAD) remains controversial. Methods We performed a
meta-analysis of randomised studies comparing patients with LMCAD treated
with PCI with DES versus those treated with CABG, with respect to clinical
outcomes at 1, 3 and 5 years. A secondary meta-analysis was performed
according to low (< 32), or high (>= 33) SYNTAX score. Results Five
studies comprising 4595 patients were included. There was no significant
difference in all-cause death at all time points or when stratified with
respect to SYNTAX score. The need for repeat revascularization was
significantly higher with PCI at all time-points, and regardless of SYNTAX
score. There was significant association between need for repeat
revascularization with PCI and diabetics (p = 0.04). At 5 years, non-fatal
MI was higher with PCI owing to increased non-procedural events (OR 3.00;
CI 1.45-6.21; p = 0.003). CABG showed higher rate of stroke at 1 year (OR
0.21; CI 0.07-0.63; p = 0.005). There was no difference in non-fatal MI or
stroke at other time points, nor according to SYNTAX score. Conclusions
PCI with DES or CABG are equivalent strategies for LMCAD up to 5 years
with respect to death, regardless of SYNTAX score. PCI increases the rate
of non-procedural MI at 5 years. CABG avoids the need for repeat
revascularization, especially in diabetics, but this benefit is offset by
higher rate of stroke in the first year of follow up.<br/>Copyright &#xa9;
2017

<11>
Accession Number
619082432
Author
Benck U.; Mundt H.; Schmitt W.H.; Kramer B.K.; Schnuelle P.
Institution
(Benck, Mundt, Schmitt, Kramer, Schnuelle) Universitatsmedizin Mannheim,
V. Medizinische Klinik, Mannheim, Germany
(Schmitt, Schnuelle) Nierenzentrum Weinheim, Weinheim, Germany
Title
Impact of spontaneous donor hypothermia on graft outcomes in solid organ
transplantation.
Source
Transplant International. Conference: 26th Annual Meeting of the German
Transplantation Society. Germany. 30 (Supplement 4) (pp 30), 2017. Date of
Publication: October 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Introduction and Background: A previous controlled donor intervention
trial found that therapeutic hypothermia reduced delayed graft function
(DGF) after kidney transplantation. This study investigates the effects of
spontaneous donor hypothermia on initial kidney graft function, and
evaluates graft survival including heart and liver transplants in the
cohort of the randomized dopamine trial (ClinicalTrials.gov identifier:
NCT000115115). Methods: This retrospective cohort study is nested in the
randomized dopamine trial, which included 264 hemodynamically stable
brain-dead donors between March 2004 and August 2007. Results and
Conclusions: Hypothermia (core body temperature <36degreeC) was associated
with less DGF after kidney transplantation (OR 0.56, 95%CI 0.34-0.91). The
benefit was greater when need for more than a single post-transplant
dialysis session was analyzed (OR 0.48, 95%CI 0.28-0.82). Donor dopamine
ameliorated dialysis requirement independently from hypothermia in a
time-relationship with exposure (OR 0.93; 95%CI 0.87-0.98, per hour).
Hypothermia did not alter kidney graft survival (HR 0.83, 95%CI
0.54-1.27), while dopamine treatment was associated with improved
long-term outcome (HR 0.95, 95%CI 0.91-0.99 per hour). Stratified analyses
of non-renal organs in tertiles of the donor's core body temperature
disclosed negative effects on heart allograft survival (HR 1.89, 95%CI
1.09-3.27). Spontaneous donor hypothermia is associated with less DGF but
does not appear to affect long-term outcome of the kidney graft. Our data
raise safety concerns against therapeutic hypothermia in multi-organ
donors when a thoracic transplantation is considered.

<12>
Accession Number
619051548
Author
Zhang R.; Gupta D.; Albert S.G.
Institution
(Zhang) Department of Internal Medicine, Saint Louis University School of
Medicine, United States
(Gupta, Albert) Division of Endocrinology, Saint Louis University School
of Medicine, United States
Title
Pheochromocytoma as a reversible cause of cardiomyopathy: Analysis and
review of the literature.
Source
International Journal of Cardiology. 249 (pp 319-323), 2017. Date of
Publication: 15 Dec 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Context Pheochromocytoma and paraganglioma are rare neuroendocrine tumors
which overproduce catecholamines and arise from the adrenal gland or
extra-adrenal chromaffin cells of the sympathetic and parasympathetic
ganglia (1). Excessive catecholamine-induced stimulation of cardiac
myocytes leads to damage which manifests in several forms ranging from
Takotsubo to dilated cardiomyopathy. Diagnosis of pheochromocytoma-related
cardiomyopathies is often delayed due to the atypical presentation
associated with many cases. Objective Limited data exists on the
presentation and outcomes of the various forms of pheochromocytoma-induced
cardiomyopathies. We performed a literature review to assess the
association of pheochromocytoma and cardiomyopathy to aide in further
understanding this clinical entity. Design 163 cases from 150 articles
published between 1991 and November 2016 were included from a PubMed
search. Results There were 163 occurrences of pheochromocytoma and
cardiomyopathy (63 dilated cardiomyopathy, 38 Takotsubo cardiomyopathy, 30
inverted Takotsubo cardiomyopathy, 10 HOCM, 8 myocarditis, and 14
unspecified cardiomyopathy). Many patients lacked classic signs or
symptoms of pheochromocytoma with hypertension as a presenting symptom in
65% and the triad of headache, palpitations, and diaphoresis only in 4%.
Resection of the pheochromocytoma led to improvement of the cardiomyopathy
in 96% while lack of resection was associated with death or cardiac
transplantation in 44%. Conclusion Pheochromocytoma should be considered
in the evaluation of non-ischemic, non-valvular cardiomyopathy even in the
absence of symptoms of catecholamine excess. Our study highlights the
importance of early suspicion and diagnosis of pheochromocytoma in cases
of idiopathic heart failure as early resection may prevent progression to
irreversible myocardial remodeling and death.<br/>Copyright &#xa9; 2017
Elsevier Ireland Ltd

<13>
Accession Number
619086068
Author
Tarighatnia A.; Mohammadalian A.; Ghojazade M.; Pourafkari L.; Farajollahi
A.
Institution
(Tarighatnia) Immunology Research Center, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Tarighatnia) Department of Medical Physics, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Ghojazade) Liver and Gastrointestinal Disease Research Center, Tabriz
University of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Pourafkari) Cardiovascular Research Center, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Farajollahi) Medical Education Research Center, Tabriz University of
Medical Sciences, Tabriz, Iran, Islamic Republic of
(Tarighatnia, Mohammadalian) Interventional Cardiology Unit, Aalinasab
Hospital, Tabriz, Iran, Islamic Republic of
Title
Beam projections and radiation exposure in transradial and transfemoral
approaches during coronary angiography.
Source
Anatolian Journal of Cardiology. 18 (4) (pp 298-303), 2017. Date of
Publication: October 2017.
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: We aimed to compare the operator and patient radiation exposure
in standard projections during elective diagnostic coronary angiography
procedures via transradial (TRA) versus transfemoral (TFA) approaches.
Methods: In this analytical cross-sectional study, a total of 202
consecutive patients who were candidates for diagnostic coronary
angiography were randomized to undergo the procedure via TFA or TRA
approaches (101 in each group). Patients with abnormal Allen test and
history of coronary artery bypass surgery, valvular heart disease, and
unsuccessful coronary angiography were excluded from the study. A single
operator performed all of the procedures using a single angiography
system. Patient and operator radiation exposure were measured using
diamentor and an electronic personal dosimeter, respectively. Each
procedure comprised a standardized sequence of projections including four
standard views for the left coronary system and two standard views for the
right coronary system. Results: Left anterior oblique (LAO) caudal
(50degree/30degree) and right anterior oblique RAO (30degree) projections
were associated with the highest and lowest patient radiation exposure,
respectively. The operator received a significantly higher radiation
exposure in the TRA approach for LAO cranial (for both left and right
coronary systems) and LAO caudal (for left coronary system) projections
during coronary angiography compared with the TFA approach. Conclusion:
Though a similar amount of patient radiation exposure in each projection
was observed among TFA and TRA groups; LAO cranial and LAO caudal
projections were associated with a significantly higher operator radiation
exposure in the TRA group. These findings need to be considered when
choosing the optimal arterial approach for patients scheduled for coronary
angiography.<br/>Copyright &#xa9; 2017 by Turkish Society of Cardiology.

<14>
Accession Number
619046901
Author
Luc J.G.Y.; Graham M.M.; Norris C.M.; Al Shouli S.; Nijjar Y.S.; Meyer
S.R.
Institution
(Luc, Norris, Al Shouli, Nijjar, Meyer) University of Alberta, Division of
Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry,
Edmonton, Canada
(Graham, Norris, Al Shouli, Meyer) Mazankowski Alberta Heart Institute,
Edmonton, Canada
(Graham, Norris) University of Alberta, Division of Cardiology, Department
of Medicine, Faculty of Medicine and Dentistry, Edmonton, Canada
Title
Predicting operative mortality in octogenarians for isolated coronary
artery bypass grafting surgery: A retrospective study.
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 275. Date of Publication: 02 Nov 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Available cardiac surgery risk scores have not been validated
in octogenarians. Our objective was to compare the predictive ability of
the Society of Thoracic Surgeons (STS) score, EuroSCORE I, and EuroSCORE
II in elderly patients undergoing isolated coronary artery bypass grafting
surgery (CABG). Methods: All patients who underwent isolated CABG (2002 -
2008) were identified from the Alberta Provincial Project for Outcomes
Assessment in Coronary Heart Disease (APPROACH) registry. All patients
aged 80 and older (n = 304) were then matched 1:2 with a randomly selected
control group of patients under age 80 (n = 608 of 4732). Risk scores were
calculated. Discriminatory accuracy of the risk models was assessed by
plotting the areas under the receiver operator characteristic (AUC) and
comparing the observed to predicted operative mortality. Results:
Octogenarians had a significantly higher predicted mortality by STS Score
(3 +/- 2% vs. 1 +/- 1%; p < 0.001), additive EuroSCORE (8 +/- 3% vs. 4 +/-
3%; p < 0.001), logistic EuroSCORE (15 +/- 14% vs. 5 +/- 6%; p < 0.001),
and EuroSCORE II (4 +/- 3% vs. 2 +/- 2%; p < 0.001) compared to patients
under age 80 years. Observed mortality was 2% and 1% for patients age 80
and older and under age 80, respectively (p = 0.323). AUC revealed areas
for STS, additive and logistic EuroSCORE I and EuroSCORE II, respectively,
for patients age 80 and older (0.671, 0.709, 0.694, 0.794) and under age
80 (0.829, 0.750, 0.785, 0.845). Conclusion: All risk prediction models
assessed overestimated surgical risk, particularly in octogenarians.
EuroSCORE II demonstrated better discriminatory accuracy in this
population. Inclusion of new variables into these risk models, such as
frailty, may allow for more accurate prediction of true operative
risk.<br/>Copyright &#xa9; 2017 The Author(s).

<15>
Accession Number
619087008
Author
Podlesnikar T.; Prihadi E.A.; van Rosendael P.J.; Vollema E.M.; van der
Kley F.; de Weger A.; Ajmone Marsan N.; Naji F.; Fras Z.; Bax J.J.;
Delgado V.
Institution
(Podlesnikar, Prihadi, van Rosendael, Vollema, van der Kley, Ajmone
Marsan, Bax, Delgado) Department of Cardiology, Heart and Lung Center,
Leiden University Medical Center, Leiden, The Netherlands
(de Weger) Department of Cardio-Thoracic Surgery, Heart and Lung Center,
Leiden University Medical Center, Leiden, The Netherlands
(Naji) Department of Cardiology and Angiology, University Medical Centre
Maribor, Maribor, Slovenia
(Fras) Internal Medicine Clinic, University Medical Centre Ljubljana,
Ljubljana, Slovenia
Title
Influence of the Quantity of Aortic Valve Calcium on the Agreement Between
Automated 3-Dimensional Transesophageal Echocardiography and Multidetector
Row Computed Tomography for Aortic Annulus Sizing.
Source
American Journal of Cardiology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Accurate aortic annulus sizing is key for selection of appropriate
transcatheter aortic valve implantation (TAVI) prosthesis size. The
present study compared novel automated 3-dimensional (3D) transesophageal
echocardiography (TEE) software and multidetector row computed tomography
(MDCT) for aortic annulus sizing and investigated the influence of the
quantity of aortic valve calcium (AVC) on the selection of TAVI prosthesis
size. A total of 83 patients with severe aortic stenosis undergoing TAVI
were evaluated. Maximal and minimal aortic annulus diameter, perimeter,
and area were measured. AVC was assessed with computed tomography. The low
and high AVC burden groups were defined according to the median AVC score.
Overall, 3D TEE measurements slightly underestimated the aortic annulus
dimensions as compared with MDCT (mean differences between maximum,
minimum diameter, perimeter, and area: -1.7 mm, 0.5 mm, -2.7 mm, and -13
mm², respectively). The agreement between 3D TEE and MDCT on
aortic annulus dimensions was superior among patients with low AVC burden
(<3,025 arbitrary units) compared with patients with high AVC burden
(>=3,025 arbitrary units). The interobserver variability was excellent for
both methods. 3D TEE and MDCT led to the same prosthesis size selection in
88%, 95%, and 81% of patients in the total population, the low, and the
high AVC burden group, respectively. In conclusion, the novel automated 3D
TEE imaging software allows accurate and highly reproducible measurements
of the aortic annulus dimensions and shows excellent agreement with MDCT
to determine the TAVI prosthesis size, particularly in patients with low
AVC burden.<br/>Copyright &#xa9; 2017 The Author(s).

<16>
Accession Number
613337422
Author
Cao Y.; Tian X.-Y.; Zhang R.; Zhao J.-Q.; Zhang M.; Cheng Y.-T.; Li C.-F.;
Liu G.-L.; An Y.
Institution
(Cao, An) Department of Cardiology, Affiliated Hospital, Qingdao
University, No. 59, Haier Road, Laoshan District, Qingdao, Shandong, China
(Cao, Zhang, Zhao, Zhang, Cheng, Li, Liu) Department of Cardiology,
Affiliated Hospital of Jining Medical University, Jining, Shandong, China
(Tian) Department of Health Management, Community Service Center,
Affiliated Hospital of Jining Medical University, Jining, Shandong, China
Title
Short- and long-term efficacy and safety of triple vs. dual antithrombotic
therapy in patients with drug-eluting stent implantation and an indication
for oral anticoagulation: A meta-analysis.
Source
International Journal of Clinical Pharmacology and Therapeutics. 54 (12)
(pp 950-965), 2016. Date of Publication: 2016.
Publisher
Dustri-Verlag Dr. Karl Feistle (Bajuwarenring 4, Oberhaching 82041,
Germany. E-mail: marina.rottner@dustri.de)
Abstract
Background: The optimal antithrombotic regimen after coronary stenting in
patients taking oral anticoagulants (OACs) is still unclear. Therefore,
this meta-analysis focused on the short- and long-term efficacy and safety
of triple therapy (TT: OAC, aspirin, and thienopyridine) and dual therapy
(DT: OAC plus single antiplatelet drug or aspirin plus thienopyridine).
Methods: We searched PubMed, Embase, the Cochrane Library, Wangfang
database, and Google Scholar up to December 1, 2015 (January 1, 2000 -
December 2015), from randomized and nonrandomized studies comparing TT and
DT in patients with OACs undergoing drug-eluting stent (DES) implantation.
Major adverse cardiac and cerebrovascular events (MACCE) were the main
outcome. Safety outcome was major bleeding (MB). Results: Of 964
publications identifi ed, 1 randomized study and 27 nonrandomized studies
of 31,346 patients were included. Overall, TT and OAC plus clopidogrel
were associated with a lower risk of MACCE, stroke, MI, and allcause
mortality compared with dual antiplatelet therapy or OAC plus aspirin.
Additionally, short-term use of triple antithrombotic regimen with OAC,
aspirin, and clopidogrel is associated with equivalent risk of major
bleeding and decreased rate of MACCE. Long-term use of OAC plus
clopidogrel after TT was associated with equal or better benefit and
safety outcomes. Conclusion: For patients on OAC after coronary stenting,
triple therapy (OAC, aspirin, clopidogrel) should be considered in the
short term, followed by more long-term therapy with OAC plus clopidogrel.
More randomized studies are needed to confirm these
findings.<br/>Copyright &#xa9; 2016 Dustri-Verlag Dr. K. Feistle.

<17>
[Use Link to view the full text]
Accession Number
617261932
Author
Kim E.-H.; Lee J.-H.; Song I.-K.; Kim J.-T.; Lee W.-J.; Kim H.-S.
Institution
(Kim, Lee, Song, Kim, Lee, Kim) Department of Anesthesiology and Pain
Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu,
Seoul 110-744, South Korea
Title
Posterior Tibial Artery as an Alternative to the Radial Artery for
Arterial Cannulation Site in Small Children: A Randomized Controlled
Study.
Source
Anesthesiology. 127 (3) (pp 423-431), 2017. Date of Publication: 01 Sep
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: We evaluated the posterior tibial artery as an alternative
arterial cannulation site to the radial artery in small children. Methods:
A two-stage study was conducted. First, we evaluated the anatomical
characteristics of the posterior tibial artery compared with the radial
and dorsalis pedis arteries. Next, a parallel-arm single-blind randomized
controlled study compared the initial success rate of ultrasound-guided
arterial cannulation among three arteries as a primary outcome. Results:
Sixty patients were analyzed in the observational study. The diameter of
the posterior tibial artery (1.5 +/- 0.2 mm) was similar to that of the
radial artery (1.5 +/- 0.2 mm) and larger than that of the dorsalis pedis
artery (1.2 +/- 0.2 mm; P < 0.001). The posterior tibial artery has a
larger cross-sectional area (2.8 +/- 1.1 mm²) compared with the
radial (2.3 +/- 0.8 mm²; P = 0.013) and dorsalis pedis arteries
(1.9 +/- 0.6 mm²; P = 0.001). In total, 234 patients were
analyzed in the randomized study. The first-attempt success rate of the
posterior tibial artery (75%) was similar to that of the radial (83%; P =
0.129; odds ratio, 1.53; 95% CI, 0.69 to 3.37) and higher than that of the
dorsalis pedis artery (45%; P < 0.001; odds ratio, 3.95; 95% CI, 1.99 to
7.87). Median cannulation time of the posterior tibial artery (21 s;
interquartile range, 14 to 30) was similar to that of the radial artery
(27 s; interquartile range, 17 to 37) and shorter than that of the
dorsalis pedis artery (34 s; interquartile range, 21 to 50). Conclusions:
The posterior tibial artery is a reasonable alternative to the radial
artery for ultrasound-guided arterial cannulation in small
children.<br/>&#xa9; Copyright 2017, the American Society of
Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved.

<18>
Accession Number
613201906
Author
Cao Z.; Shen R.; Zhang X.; Cheng G.; Yan Z.
Institution
(Cao, Shen, Zhang, Cheng, Yan) Department of Cardiac Surgery, Affiliated
Province Hospital of Anhui Medical University, Hefei 230001, China
Title
Effects of remote ischemic preconditioning on acute myocardial injury in
patients undergoing valve replacement.
Source
Irish Journal of Medical Science. 186 (4) (pp 889-893), 2017. Date of
Publication: 01 Nov 2017.
Publisher
Springer London
Abstract
Background: This study investigated the effects of remote ischemic
preconditioning (RIPC) on acute myocardial injury and clinical outcome in
adult patients undergoing valve replacement surgery. Methods: Sixty-three
adult patients scheduled for elective valve replacement undergoing
cardiopulmonary bypass (CPB) were randomly assigned to control or remote
ischemic preconditioning treatment. RIPC was applied beginning with the
first surgical incision by three times of inflating the cuff to 200 mmHg
for 5 min, followed by 5 min of deflation. The plasma creatine kinase-MB
(CK-MB) and cardiac troponin I (cTnI) were determined. The preoperative,
intraoperative, and postoperative characteristics, and hemodynamics values
were recorded during the study. Results: There were no significant
differences in patient preoperative, intraoperative, and postoperative
characteristics and hemodynamics values between groups. The activity of
CK-MB and cTnI was significantly lower in RIPC group than CON group at 4
and 48 h after aortic unclamping. Conclusions: The present study
demonstrated that remote ischemic preconditioning might reduce release of
CK-MB and cTnI in patients undergoing valve replacement. However, RIPC
does not improve the clinical outcome of these patients.<br/>Copyright
&#xa9; 2016, Royal Academy of Medicine in Ireland.

<19>
[Use Link to view the full text]
Accession Number
619007127
Author
Salzmann S.; Euteneuer F.; Laferton J.A.C.; Auer C.J.; Shedden-Mora M.C.;
Schedlowski M.; Moosdorf R.; Rief W.
Institution
(Salzmann, Euteneuer, Laferton, Auer, Rief) Department of Clinical
Psychology and Psychotherapy, Philipps University of Marburg,
Gutenbergstrase 18, Marburg 35032, Germany
(Laferton) Philipps University of Marburg, Germany
(Shedden-Mora) Department of Clinical Psychology and Psychotherapy,
Psychologische Hochschule Berlin, Germany
(Schedlowski) Department of Psychosomatic Medicine and Psychotherapy,
University Medical Center Hamburg-Eppendorf, Germany
(Moosdorf) Institute of Medical Psychology and Behavioral Immunobiology,
University Clinic Essen, Essen, Germany
(Moosdorf) Clinic for Cardiac and Thoracic Vessel Surgery, Heart Center,
Philipps University of Marburg, Germany
Title
Effects of Preoperative Psychological Interventions on Catecholamine and
Cortisol Levels after Surgery in Coronary Artery Bypass Graft Patients:
The Randomized Controlled PSY-HEART Trial.
Source
Psychosomatic Medicine. 79 (7) (pp 806-814), 2017. Date of Publication: 01
Sep 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective The aim of the study was to examine whether preoperative
psychological interventions targeting patients' expectations are capable
of influencing the biological stress response after coronary artery bypass
graft (CABG) surgery and could thus improve recovery after heart surgery.
Methods Randomized controlled trial with assessments 10 days before
surgery, after psychological intervention (day of hospital admission, but
before surgery), postoperative (6-8 days later), and at follow-up (6
months after surgery). Eligible patients (N = 124) scheduled for elective
on-pump CABG or CABG with valve replacement surgery were approached before
hospital admission. Standard medical care (SMC) was compared with two
additional preoperative psychological interventions: (a) an expectation
manipulation intervention to optimize patients' expectations about course
and outcomes or (b) supportive therapy, containing the same amount of
therapeutic attention, but without specifically focusing on expectations.
Postoperative plasma adrenaline, noradrenaline, and cortisol levels were a
secondary outcome of our study (primary outcome patients' disability 6
months after surgery and other secondary patient-reported or clinical
outcomes were reported elsewhere). Results Expectation manipulation
intervention (3.68 ln pg/mL, 95% confidence interval = 3.38-3.98, p =.015)
and supportive therapy (3.70 ln pg/mL, 95% confidence interval =
3.38-4.01, p =.026) led to significantly lower postoperative adrenaline
levels compared with SMC (4.26 ln pg/mL, 95% confidence interval =
3.99-4.53) only. There were no treatment effects of the preoperative
intervention for noradrenaline (p =.90) or cortisol (p =.30). Higher
postoperative adrenaline levels predicted disability 6 months after
surgery (r =.258, p =.018). Conclusions In addition to SMC, preoperative
psychological interventions seem to buffer psychobiological stress
responses and could thus facilitate recovery from CABG surgery. Patients'
postoperative stress responses could be an important factor for explaining
trajectories of long-term outcomes. Clinical Trial Registration
www.clinicaltrials.gov (NCT01407055).<br/>Copyright &#xa9; Lippincott
Williams & Wilkins.

<20>
Accession Number
619027754
Author
Charloux A.; Quoix E.
Institution
(Charloux) Physiology and Functional Explorations Dept, University
Hospital, Strasbourg, France
(Charloux) EA 3072, Federation of Translational Medicine, Strasbourg
University, Strasbourg, France
(Quoix) Pulmonology Dept, University Hospital, Strasbourg, France
Title
Lung segmentectomy: Does it offer a real functional benefit over
lobectomy?.
Source
European Respiratory Review. 26 (146) (no pagination), 2017. Article
Number: 170079. Date of Publication: 31 Dec 2017.
Publisher
European Respiratory Society (E-mail: info@ersnet.org)
Abstract
Anatomical segmentectomy has been developed to offer better pulmonary
function preservation than lobectomy, in stage IA lung cancer. Despite the
retrospective nature of most of the studies and the lack of randomised
studies, a substantial body of literature today allows us to evaluate to
what extent lung function decreases after segmentectomy and whether
segmentectomy offers a real functional benefit over lobectomy. From the
available series, it emerges that the mean decrease in forced expiratory
volume in 1 s (FEV<inf>1</inf>) is low, ranging from -9% to -24% of the
initial value within 2 months and -3 to-13% 12 months after segmentectomy.
This reduction in lung function is significantly lower than that induced
by lobectomy, but saves only a few per cent of pre-operative
FEV<inf>1</inf>. Moreover, the published results do not firmly establish
the functional benefit of segmentectomy over lobectomy in patients with
poor lung function. Some issues remain to be addressed, including whether
video-assisted thoracic surgery (VATS) segmentectomy may preserve lung
function better than VATS lobectomy in patients with poor lung function,
especially within the early days after surgery, and whether this may
translate to lowering the functional limit for surgery. Eventually, trials
comparing stereotactic ablative body radiotherapy, radiofrequency ablation
and segmentectomy functional consequences are warranted.<br/>Copyright
&#xa9; ERS 2017.

<21>
Accession Number
618215074
Author
Song Y.; Song J.W.; Lee S.; Jun J.-H.; Kwak Y.-L.; Shim J.-K.
Institution
(Song, Song, Kwak, Shim) Department of Anesthesiology and Pain Medicine,
Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul,
South Korea
(Song, Song, Jun, Kwak, Shim) Anesthesia and Pain Research Institute,
Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul,
South Korea
(Lee) Department of Thoracic and Cardiovascular Surgery, Yonsei University
College of Medicine, Seoul, South Korea
Title
Effects of remote ischemic preconditioning in patients with concentric
myocardial hypertrophy: A randomized, controlled trial with molecular
insights.
Source
International Journal of Cardiology. 249 (pp 36-41), 2017. Date of
Publication: 15 Dec 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Efficacy of remote ischemic preconditioning (RIPC) for
cardioprotection in cardiac surgery is controversial. We aimed to evaluate
the clinical and molecular effects of RIPC on the concentrically
hypertrophied myocardium. Methods Seventy-two aortic stenosis patients
receiving aortic valve replacement (AVR) under sevoflurane anesthesia were
randomly allocated to RIPC (3 cycles of 5-min inflation [300 mm Hg] and
deflation on the left arm) or control (deflated cuff placement) group. The
primary endpoints were 24-h area under the curve (AUC) for serum creatine
kinase (CK)-MB and troponin (Tn)-T levels. The secondary endpoints were
myocardial activation of cell signaling pathways, including reperfusion
injury salvage kinases (RISK), signal transducer and activator of
transcription (STAT), nitric oxide synthase (NOS), and apoptosis related
molecules, obtained from right atrial tissue before and after
cardiopulmonary bypass (CPB). Results There were no intergroup differences
in 24-h AUCs of CK-MB and Tn-T. Phosphorylations of RISK pathway molecules
were not enhanced by RIPC before and after CPB. Phosphorylation of STAT5
was significantly lower in the RIPC group before and after CPB.
Phosphorylations of STAT3 and endothelial NOS were not enhanced by RIPC
before and after CPB. Expression level of cleaved caspases-3/caspase-3 was
significantly higher in the RIPC group before CPB. Conclusions RIPC did
not provide clinical benefits or activate protective signaling in patients
with concentric left ventricular hypertrophy undergoing AVR.<br/>Copyright
&#xa9; 2017 Elsevier B.V.

<22>
Accession Number
618803310
Author
Lange U.; Classen K.; Muller-Ladner U.; Richter M.
Institution
(Lange, Muller-Ladner) Department of Rheumatology and Clinical Immunology,
Kerckhoff Clinic, Bad Nauheim, Germany
(Classen, Richter) Department of Cardiac Surgery, Kerckhoff-Clinic, Bad
Nauheim, Germany
(Muller-Ladner) Department of Internal Medicine and Rheumatology,
Justus-Liebig University Giessen, Giessen, Germany
(Lange) Department of Internal Rheumatology, Osteology and Physical
Medicine, Justus-Liebig University Giessen, Giessen, Germany
Title
Weekly oral bisphosphonates over 2 years prevent bone loss in cardiac
transplant patients.
Source
Clinical Transplantation. 31 (11) (no pagination), 2017. Article Number:
e13122. Date of Publication: November 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background: Heart transplantation (HTX) is an established therapy for
end-stage heart disease. The aim of this study was to determine whether
application of oral bisphosphonates is effective in preventing osseous
complications after HTX. Methods: Thirty-three cardiac transplant
recipients were treated with alendronate 70 mg/wk or risedronate 35 mg/wk
in combination with 1000 mg calcium and 800 IU vitamin D. Markers of bone
metabolism and dual-energy X-ray absorptiometry (DXA) were determined
directly after HTX and 2 years later. Primary endpoints were changes in
bone mineral density (BMD), markers of bone metabolism (osteocalcin,
crosslaps), serum levels of the cytokines osteoprotegerin (OPG), receptor
activator of NF kappa-B ligand (RANKL), and incidence of fractures.
Results: Eight patients presented with osteoporosis, and 16 patients with
osteopenia by DXA without prevalent fractures. Over 2 years, the BMD
improved in 2 patients from osteoporosis to osteopenia, and overall BMD
remained stable, and fractures did not occur. In addition, the serum
levels of OPG increased (P <.0005), and the RANKL levels (P <.001) as well
as the RANKL/OPG-ratio decreased significantly (P <.0005). The serum
crosslaps showed no significant changes. The BMD showed a significant
association with the increased 25-vitamin D levels only in females (P
<.001). Conclusions: In heart transplanted patients, weekly oral
bisphosphonates in combination with calcium and vitamin D supplementation
preserved bone mass, prevented uncoupling of bone resorption/formation and
fractures. Bone density should be measured and adequately treated, that
is, with regular bisphosphonates.<br/>Copyright &#xa9; 2017 John Wiley &
Sons A/S. Published by John Wiley & Sons Ltd

<23>
Accession Number
619067875
Author
Jones B.M.; Krishnaswamy A.; Tuzcu E.M.; Mick S.; Jaber W.A.; Svensson
L.G.; Kapadia S.R.
Institution
(Jones, Krishnaswamy, Jaber, Kapadia) Robert and Suzanne Tomsich
Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid
Avenue, Cleveland, OH 44195, United States
(Tuzcu) Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Al
Maryah Island, Abu Dhabi, United Arab Emirates
(Mick, Svensson) Department of Cardiovascular Surgery, Cleveland Clinic,
9500 Euclid Avenue, Cleveland, OH 44195, United States
Title
Matching patients with the ever-expanding range of TAVI devices.
Source
Nature Reviews Cardiology. 14 (10) (pp 615-626), 2017. Date of
Publication: 01 Oct 2017.
Publisher
Nature Publishing Group (Houndmills, Basingstoke, Hampshire RG21 6XS,
United Kingdom)
Abstract
Transcatheter aortic valve implantation (TAVI) has become a widely
accepted strategy for the treatment of aortic stenosis in patients at
intermediate, high, or prohibitive surgical risk. After >1 decade of
innovation and clinical trial experience, the available technology for
TAVI has grown enormously, and now includes a myriad of vascular access
approaches and innovative valve designs. As a result, the range of
patients who can benefit from these advances continues to grow rapidly.
Furthermore, given the improved safety profile and clinical success of
current-generation devices in randomized trials, the use of TAVI among
even low-risk populations is justified in current trials. With the rapid
dissemination and expansion of this technology, operators need to have a
comprehensive understanding of how to select the appropriate procedural
approach for each individual patient. In this Review, we detail the
current evidence for TAVI among different patient populations, discuss the
different vascular access approaches currently in use, and explore
differences in design features among currently available and
investigational valve systems. Furthermore, we provide an overview of
important considerations for special patient populations, such as those
with existing mitral prostheses, bicuspid aortic stenosis, isolated aortic
regurgitation, or severe left ventricular outflow tract
calcification.<br/>Copyright &#xa9; 2017 Macmillan Publishers Limited,
part of Springer Nature. All rights reserved.

<24>
Accession Number
619003623
Author
Rivinius R.; Helmschrott M.; Ruhparwar A.; Rahm A.-K.; Darche F.F.; Thomas
D.; Bruckner T.; Ehlermann P.; Katus H.A.; Doesch A.O.
Institution
(Rivinius, Helmschrott, Rahm, Darche, Thomas, Ehlermann, Katus, Doesch)
Department of Cardiology, Angiology and Pneumology, Heidelberg University
Hospital, Heidelberg, India
(Ruhparwar) Department of Cardiac Surgery, Heidelberg University Hospital,
Heidelberg, India
(Rahm) Faculty of Medicine, University of Heidelberg, Heidelberg, India
(Bruckner) Institute for Medical Biometry and Informatics, University of
Heidelberg, Heidelberg, India
(Doesch) Asklepios Klinik Bad Salzungen GmbH, Department of Pneumology and
Oncology, Bad Salzungen, Germany
Title
Chronic digitalis therapy in patients before heart transplantation is an
independent risk factor for increased posttransplant mortality.
Source
Therapeutics and Clinical Risk Management. 13 (pp 1399-1407), 2017. Date
of Publication: 13 Oct 2017.
Publisher
Dove Medical Press Ltd. (PO Box 300-008, Albany, Auckland, New Zealand)
Abstract
Objectives: Digitalis therapy (digoxin or digitoxin) in patients with
heart failure is subject to an ongoing debate. Recent data suggest an
increased mortality in patients receiving digitalis. This study
investigated the effects of chronic digitalis therapy prior to heart
transplantation (HTX) on posttransplant outcomes. Patients and methods:
This was a retrospective, observational, single-center study. It comprised
530 adult patients who were heart-transplanted at Heidelberg University
Hospital between 1989 and 2012. Patients with digitalis prior to HTX (>=3
months) were compared to those without (no or <3 months of digitalis).
Patients with digitalis were further subdivided into patients receiving
digoxin or digitoxin. Primary outcomes were early posttransplant atrial
fibrillation and mortality. Results: A total of 347 patients (65.5%) had
digitalis before HTX. Of these, 180 received digoxin (51.9%) and 167
received digitoxin (48.1%). Patients with digitalis before HTX had a
significantly lower 30-day (P=0.0148) and 2-year (P=0.0473) survival.
There was no significant difference between digoxin and digitoxin in
30-day (P=0.9466) or 2-year (P=0.0723) survival. Multivariate analysis for
posttransplant 30-day mortality showed pretransplant digitalis therapy as
an independent risk factor (hazard ratio =2.097, CI: 1.036-4.248,
P=0.0397). Regarding atrial fibrillation in the early posttransplant
period, there was neither a statistically significant difference between
patients with and without digitalis (P=0.1327) nor between patients with
digoxin or digitoxin (P=0.5867). Conclusion: Digitalis in patients before
HTX is an independent risk factor for increased posttransplant
mortality.<br/>Copyright &#xa9; 2017 Rivinius et al.

<25>
Accession Number
613488204
Author
Yuan X.; Du J.; Liu Q.; Zhang L.
Institution
(Yuan, Zhang) Department of Nephrology, the Second Affiliated Hospital of
Chongqing Medical University, Chongqing, China
(Du) Department of Cardiology, the Second Affiliated Hospital of Chongqing
Medical University, Chongqing, China
(Liu) Institute for Viral Hepatitis, Key Laboratory of Molecular Biology
for Infectious Diseases, the Second Affiliated Hospital of Chongqing
Medical University, Chongqing, China
Title
Defining the role of perioperative statin treatment in patients after
cardiac surgery: A meta-analysis and systematic review of 20 randomized
controlled trials.
Source
International Journal of Cardiology. 228 (pp 958-966), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Although statin use has been indicated to prevent atrial
fibrillation in previous observational and experimental trials, the issue
remains inadequately and insufficiently explored. We therefore performed
this meta-analysis to evaluate the effects of perioperative statin therapy
on complications and short-term prognosis following cardiac surgery.
Methods A search of the PubMed, EMBASE and the Cochrane database of
controlled trials was performed from inception to June 2016 to identify
relevant randomized controlled trials (RCTs). The primary endpoints
included postoperative atrial fibrillation, acute kidney injury and
all-cause mortality. Results Twenty studies involving 4338 patients were
included in the meta-analysis. Among the patients who underwent cardiac
surgery, perioperative statin therapy was significantly associated with a
decreased risk of postoperative atrial fibrillation (OR: 0.50; P =
0.0004), particularly in the subgroup of patients who used atorvastatin
and those who underwent isolated coronary artery bypass grafting (CABG)
surgery. Moreover, perioperative statin use significantly decreased the
length of hospital stay (weighted mean difference (WMD): - 0.43; P =
0.002). However, no reductions were observed in acute kidney injury,
myocardial infarction, postoperative serum creatinine concentration or the
length of intensive care unit (ICU) stay. Conclusions Perioperative statin
therapy might be promising for the prevention of postoperative atrial
fibrillation following cardiac surgery, especially for patients undergoing
isolated CABG surgery or atorvastatin administration. Additionally, statin
use can decrease the length of the hospital stay.<br/>Copyright &#xa9;
2016

<26>
Accession Number
613696421
Author
Takagi H.; Ando T.; Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Title
A review of comparative studies of MitraClip versus surgical repair for
mitral regurgitation.
Source
International Journal of Cardiology. 228 (pp 289-294), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives We summarized comparative studies of MitraClip versus surgical
repair for mitral regurgitation (MR) with a systematic literature search
and meta-analytic estimates. Methods MEDLINE, EMBASE, and the Cochrane
Central Register of Controlled Trials were searched through June 2016.
Eligible studies were randomized controlled or observational comparative
studies of MitraClip versus surgical repair enrolling patients with MR and
reporting early (30-day or in-hospital) or late (>= 6-month including
early) all-cause mortality. For each study, data regarding all-cause
mortality and incidence of recurrent > 2 + MR in both groups were used to
generate odds ratios (ORs). Alternatively, ORs or hazard ratios (HRs) for
mortality and recurrent MR themselves were directly abstracted from each
study. Results Eight reports of 7 studies comparing MitraClip with
surgical repair enrolling a total of 1015 patients with MR were identified
and included. Pooled analyses demonstrated significantly higher age and
logistic European System of Cardiac Operative Risk Evaluation and
significantly lower ejection fraction in the MitraClip than surgical
repair group, no significant difference in rate of women and patients with
New York Heart Association functional class of > II, no statistically
significant difference in early- (OR, 0.54; p = 0.08) and late-mortality
(HR/OR, 1.17; p = 0.46), and significantly higher incidence of recurrent
MR in the MitraClip than surgical repair group (HR/OR, 4.80; p < 0.00001).
Conclusions In patients with MR, the MitraClip procedure achieves similar
survival to surgical MV repair despite higher risk profiles. Recurrent MR,
however, occurs more frequently (4.8-fold) after the MitraClip than
surgical repair.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd

<27>
Accession Number
613873001
Author
Nairooz R.; Valgimigli M.; Rochlani Y.; Pothineni N.V.; Raina S.; Sardar
P.; Mukherjee D.; Naidu S.S.; Shavelle D.M.
Institution
(Nairooz, Pothineni, Raina) Division of Cardiology, University of Arkansas
for Medical Sciences, Little Rock, AR, United States
(Valgimigli) Division of Cardiology, Thoraxcenter, Erasmus Medical Center,
Rotterdam, Netherlands
(Rochlani) Department of Medicine, University of Arkansas for Medical
Sciences, Little Rock, AR, United States
(Sardar) Division of Cardiovascular Medicine, University of Utah, Salt
Lake City, UT, United States
(Mukherjee) Department of Cardiology, Texas Tech University Health
Sciences Center, El Paso, TX, United States
(Naidu) Division of Cardiology, Winthrop University Hospital, Mineola, NY,
United States
(Shavelle) Division of Cardiovascular Medicine, University of Southern
California, Los Angeles, CA, United States
Title
Meta-analysis of clopidogrel pretreatment in acute coronary syndrome
patients undergoing invasive strategy.
Source
International Journal of Cardiology. 229 (pp 82-89), 2017. Date of
Publication: 15 Feb 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background It is unknown whether pretreatment with clopidogrel in acute
coronary syndrome (ACS) managed invasively, is superior to a strategy of
administering clopidogrel in the cardiac catheterization laboratory at the
time of percutaneous coronary intervention (PCI). Current practice
guidelines do not endorse one strategy over the other. Methods A
comprehensive literature search was done to identify all relevant studies
comparing pretreatment with clopidogrel to administration in the cardiac
catheterization laboratory at the time of PCI (no pretreatment). A
meta-analysis using a random effects model was used to calculate outcomes
of interest. Results Our search identified 16 studies including 61,517 ACS
patients undergoing cardiac catheterization. At 30 days, clopidogrel
pretreatment was associated with lower MACE 7.67% vs 9.46% (odds ratio
(OR) 0.77, 95% confidence interval (CI) [0.68, 0.86]; P < 0.0001) and
all-cause mortality 2.8% vs 4.1% (OR 0.70, 95% CI [0.58, 0.85]; P =
0.0003). Mortality according to the longest follow up available was also
significantly lower with pretreatment. No difference in major bleeding
events was observed. These results were not significantly different
between randomized vs observational studies or STEMI vs NSTEACS patients.
Sensitivity analysis showed significantly lower MACE 7.98% vs 9.6% (OR
0.83, 95% CI [0.71, 0.96]; P = 0.01) without increased major bleeding in
NSTEACS patients undergoing PCI within 48 h from pretreatment. Conclusion
In ACS patients undergoing PCI, clopidogrel pretreatment was associated
with significantly lower 30 day all-cause mortality and major adverse
cardiovascular events without increased major bleeding
events.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd

<28>
Accession Number
613630461
Author
Kim T.K.; Min J.J.; Cho Y.J.; Hausenloy D.J.; Ahn H.; Kim K.-H.; Hwang
H.Y.; Hong D.M.; Jeon Y.
Institution
(Kim, Cho, Hong, Jeon) Department of Anesthesiology and Pain Medicine,
Seoul National University Hospital, Seoul, South Korea
(Min) Department of Anesthesiology and Pain Medicine, Samsung Medical
Center, Seoul, South Korea
(Hausenloy) The Hatter Cardiovascular Institute, University College
London, London, United Kingdom
(Hausenloy) The National Institute of Health Research, University College
London Hospitals Biomedical Research Center, London, United Kingdom
(Hausenloy) National Heart Research Institute Singapore, National Heart
Center Singapore, Singapore, Singapore
(Hausenloy) Cardiovascular and Metabolic Disorders Program, Duke-National
University of Singapore, Singapore, Singapore
(Ahn, Kim, Hwang) Department of Thoracic and Cardiovascular Surgery, Seoul
National University Hospital, Seoul, South Korea
Title
Effects of delayed remote ischemic preconditioning on peri-operative
myocardial injury in patients undergoing cardiac surgery - A randomized
controlled trial.
Source
International Journal of Cardiology. 227 (pp 511-515), 2017. Date of
Publication: 15 Jan 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Remote ischemic preconditioning (RIPC) has two time windows for
organ protection: acute and delayed. Previous studies have mainly focused
on the acute time window to evaluate organ protection by RIPC. We
evaluated myocardial protection by delayed RIPC in adult patients
undergoing cardiac surgery. Methods A total of 160 adult patients
undergoing cardiac surgery with cardiopulmonary bypass were randomized to
receive either delayed RIPC (four cycles of 5 min of ischemia followed by
5 min of reperfusion by inflation to 200 mm Hg and deflation of a blood
pressure cuff on the upper arm) or the control treatment 24-48 h before
surgery. The primary endpoint was post-operative troponin I levels
serially measured for 72 h. Secondary endpoints included post-operative
serum creatinine levels, acute kidney injury, and composite complications.
Results There were no significant differences in post-operative troponin I
values. The incidence of acute kidney injury, defined by the Acute Kidney
Injury Network staging system, was lower in the delayed RIPC group
compared to the control group (30.0% vs. 47.5%; relative risk, 0.768; 95%
confidence interval, 0.599-0.985; p = 0.023). Moreover, the occurrence of
composite complications was lower in the delayed RIPC group compared with
the control group (65.0% vs. 81.3%; relative risk, 0.536; 95% confidence
interval, 0.311-0.924; p = 0.020). Conclusions While RIPC did not provide
cardioprotective effects in patients undergoing cardiac surgery, it
appeared to reduce acute kidney injury, as well as the rate of composite
complications.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd

<29>
Accession Number
613227014
Author
Takagi H.; Ando T.; Umemoto T.
Institution
(Takagi, Umemoto) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI,
United States
Title
Direct and adjusted indirect comparisons of perioperative mortality after
sutureless or rapid-deployment aortic valve replacement versus
transcatheter aortic valve implantation.
Source
International Journal of Cardiology. 228 (pp 327-334), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives To determine which procedure, aortic valve replacement (AVR)
with a sutureless or rapid-deployment prosthesis (SL-AVR) or transcatheter
aortic valve implantation (TAVI), achieves better perioperative survival
for severe aortic stenosis (AS), we conducted direct-comparison
meta-analyses (DC-MAs) and an adjusted indirect-comparison meta-analysis
(IDC-MA). Methods We searched MEDLINE, EMBASE, and the Cochrane Central
Register of Controlled Trials through April 2016. Eligible studies were
randomized controlled trials (RCTs) and propensity-score matched (PSM)
studies. We performed a DC-MA-[A] of SL-AVR versus TAVI, a DC-MA-[B] of
SL-AVR versus conventional AVR (C-AVR), and a DC-MA-[C] TAVI versus C-AVR.
Then, we computed a IDC-MA-[A'] of TAVI versus SL-AVR from the results of
the DC-MA-[B] and the DC-MA-[C]. Results We identified 6 RCTs and 30 PSM
studies enrolling a total of 15,887 patients. The 3 DC-MAs demonstrated
significantly lower perioperative (30-day or in-hospital) all-cause
mortality after SL-AVR than after TAVI (odds ratio [OR], 0.48; 95%
confidence interval [CI], 0.28 to 0.80; p = 0.005) and no significant
differences between SL-AVR and C-AVR (OR, 1.07; 95% CI, 0.60 to 1.94; p =
0.81) and between TAVI and C-AVR (1.07; 95% CI, 0.90 to 1.27; p = 0.45).
The computed IDC-MA-[A'] indicated no significant difference in mortality
between SL-AVR and TAVI (1.01; 95% CI, 0.54 to 1.86). Combining the
results of the DC-MA-[A] and IDC-MA [A'] showed significantly lower
mortality after SL-AVR than after TAVI (OR, 0.65; 95% CI, 0.44 to 0.97; p
= 0.03). Conclusions For patients with severe AS, SL-AVR may achieve
better perioperative survival than TAVI.<br/>Copyright &#xa9; 2016
Elsevier Ireland Ltd

<30>
Accession Number
611358196
Author
Ruotsalainen H.; Bellsham-Revell H.; Bell A.; Pihkala J.; Ojala T.;
Simpson J.
Institution
(Ruotsalainen, Pihkala, Ojala) Department of Pediatric Cardiology,
Children's Hospital, University Hospital of Helsinki and University of
Helsinki, Stenbackinkatu 11, Helsinki 00029 HUS, Finland
(Ruotsalainen) Department of Pediatrics, Kuopio University Hospital,
Kuopio, Finland
(Bellsham-Revell, Bell, Simpson) Department of Congenital Heart Disease,
Evelina London Children's Hospital, London, United Kingdom
Title
Right ventricular systolic function in hypoplastic left heart syndrome: A
comparison of velocity vector imaging and magnetic resonance imaging.
Source
European Heart Journal Cardiovascular Imaging. 17 (6) (pp 687-692), 2016.
Date of Publication: 01 Jun 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims Velocity vector imaging (VVI) is an echocardiographic technique based
on speckle tracking, which has been validated for the left ventricle (LV).
It has not been validated to assess the systemic right ventricle (RV) in
patients with hypoplastic left heart syndrome (HLHS). The aim of this
study was to evaluate whether VVI measurements reliably reflect RV
systolic function in patients with HLHS when compared with RV ejection
fraction (EF) calculated using magnetic resonance imaging (MRI). Methods
and results In this prospective study, 49 children with HLHS underwent
transthoracic echocardiography and cardiac MRI under the same general
anaesthetic as a part of routine assessment between the different stages
of palliative surgery. Global RV fractional area change (FAC-VVI), strain
(S), strain rate (SR), and peak systolic velocity (V) were analysed from
the apical four-chamber view using the VVI technique. MRI-derived EF was
calculated from a short-Axis cine stack of images. Intraand interobserver
reproducibility was excellent for all VVI parameters (intraclass
correlation coefficient .0.9). All VVI-derived parameters, except
myocardial velocity, correlated with MRI-derived EF (FAC-VVI: R = 0.7, P <
0.001; S: R = 20.5, P < 0.001; SR: R = 0.5, P = 0.001, and V: R = 0.1, P =
0.4). Conclusions All VVI-derived parameters, except V, correlate with
MRI-derived EF, with FAC being the best predictor of it. Reproducibility
of all VVI parameters is excellent. VVI provides a useful tool for the
follow-up of RV function during the staged treatment protocol for
HLHS.<br/>Copyright &#xa9; 2016 The Author.

<31>
Accession Number
611124677
Author
Bagur R.; Kwok C.S.; Nombela-Franco L.; Ludman P.F.; de Belder M.A.;
Sponga S.; Gunning M.; Nolan J.; Diamantouros P.; Teefy P.J.; Kiaii B.;
Chu M.W.A.; Mamas M.A.
Institution
(Bagur, Diamantouros, Teefy) Division of Cardiology, Department of
Medicine, London Health Sciences Centre, London, ON, Canada
(Bagur) Department of Epidemiology and Biostatistics, London, ON, Canada
(Chu) Department of Surgery, London, ON, Canada
(Gunning, Nolan, Chu, Mamas) Department of Western University, London, ON,
Canada
(Kwok, Mamas) Department of Royal Stoke University Hospital,
Stoke-on-Trent, Staffordshire, United Kingdom
(Kwok) Department of Keele Cardiovascular Research Group, Institute of
Science and Technology in Medicine and Primary Care, Keele University,
Stoke-on-Trent, Staffordshire, United Kingdom
(Nombela-Franco) Division of Cardiology, Hospital Clinico San Carlos,
Madrid, Spain
(Ludman) Queen Elizabeth Hospital, Birmingham, United Kingdom
(de Belder) James Cook University Hospital, Middlesbrough, North
Yorkshire, United Kingdom
(Sponga) Cardiothoracic Department, University Hospital of Udine, Italy
(Kiaii) Division of Cardiac Surgery, London Health Sciences Centre,
University Hospital, London, ON, Canada
Title
Transcatheter aortic valve implantation with or without preimplantation
balloon aortic valvuloplasty: A systematic review and meta-analysis.
Source
Journal of the American Heart Association. 5 (6) (no pagination), 2016.
Article Number: e003191. Date of Publication: 01 Jun 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--Preimplantation balloon aortic valvuloplasty (BAV) is
considered a routine procedure during transcatheter aortic valve
implantation (TAVI) to facilitate prosthesis implantation and expansion;
however, it has been speculated that fewer embolic events and/or less
hemodynamic instability may occur if TAVI is performed without
preimplantation BAV. The aim of this study was to systematically review
the clinical outcomes associated with TAVI undertaken without
preimplantation BAV. Methods and Results--We conducted a search of Medline
and Embase to identify studies that evaluated patients who underwent TAVI
with or without preimplantation BAV for predilation. Pooled analysis and
random-effects meta-analyses were used to estimate the rate and risk of
adverse outcomes. Sixteen studies involving 1395 patients (674 with and
721 without preimplantation BAV) fulfilled the inclusion criteria. Crude
device success was achieved in 94% (1311 of 1395), and 30-day all-cause
mortality occurred in 6% (72 of 1282) of patients. Meta-analyses
evaluating outcomes of strategies with and without preimplantation BAV
showed no statistically significant differences in terms of mortality
(relative risk [RR] 0.61, 95% CI 0.32-1.14, P=0.12), safety composite end
point (RR 0.85, 95% CI 0.62-1.18, P=0.34), moderate to severe paravalvular
leaks (RR 0.68, 95% CI 0.23-1.99, P=0.48), need for postdilation (RR 0.86,
95% CI 0.66-1.13, P=0.58), stroke and/or transient ischemic attack (RR
0.72, 95% CI 0.30-1.71, P=0.45), and permanent pacemaker implantation (RR
0.80, 95% CI 0.49-1.30, P=0.37). Conclusions--Our analysis suggests that
TAVI procedures with or without preimplantation BAV were associated with
similar outcomes for a number of clinically relevant end points. Further
studies including a large number of patients are needed to ascertain the
impact of TAVI without preimplantation BAV as a standard
practice.<br/>Copyright &#xa9; 2016 The Authors.

<32>
[Use Link to view the full text]
Accession Number
611984143
Author
Firat A.C.; Zeyneloglu P.; Ozkan M.; Pirat A.
Institution
(Firat, Zeyneloglu, Pirat) Department of Anesthesiology, Baskent
University Faculty of Medicine, Ankara, Turkey
(Ozkan) Department of Cardiovascular Surgery, Baskent University Faculty
of Medicine, Ankara, Turkey
Title
A Randomized Controlled Comparison of the Internal Jugular Vein and the
Subclavian Vein as Access Sites for Central Venous Catheterization in
Pediatric Cardiac Surgery.
Source
Pediatric Critical Care Medicine. 17 (9) (pp e413-e419), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: To compare internal jugular vein and subclavian vein access
for central venous catheterization in terms of success rate and
complications. Design: A 1:1 randomized controlled trial. Setting: Baskent
University Medical Center. Patients: Pediatric patients scheduled for
cardiac surgery. Interventions: Two hundred and eighty children undergoing
central venous catheterization were randomly allocated to the internal
jugular vein or subclavian vein group during a period of 18 months.
Measurements and Main Results: The primary outcome was the first-attempt
success rate of central venous catheterization through either approach.
The secondary outcomes were the rates of infectious and mechanical
complications. The central venous catheterization success rate at the
first attempt was not significantly different between the subclavian vein
(69%) and internal jugular vein (64%) groups (p = 0.448). However, the
overall success rate was significantly higher through the subclavian vein
(91%) than the internal jugular vein (82%) (p = 0.037). The overall
frequency of mechanical complications was not significantly different
between the internal jugular vein (25%) and subclavian vein (31%) (p =
0.456). However, the rate of arterial puncture was significantly higher
with internal jugular vein (8% vs 2%; p = 0.03) and that of catheter
malposition was significantly higher with subclavian vein (17% vs 1%; p <
0.001). The rates per 1,000 catheter days for both positive catheter-tip
cultures (26.1% vs 3.6%; p < 0.001) and central-line bloodstream infection
(6.9 vs 0; p < 0.001) were significantly higher with internal jugular
vein. There were no significant differences between the groups in the
length of ICU and hospital stays or in-hospital mortality rates (p > 0.05
for all). Conclusions: Central venous catheterization through the internal
jugular vein and subclavian vein was not significantly different in terms
of success at the first attempt. Although the types of mechanical
complications were different, the overall rate was similar between
internal jugular vein and subclavian vein access. The risk of infectious
complications was significantly higher with internal jugular vein
access.<br/>Copyright &#xa9; 2016 by the Society of Critical Care Medicine
and the World Federation of Pediatric Intensive and Critical Care
Societies.

<33>
[Use Link to view the full text]
Accession Number
611984092
Author
Klee P.; Arni D.; Saudan S.; Schwitzgebel V.M.; Sharma R.; Karam O.;
Rimensberger P.C.
Institution
(Klee, Schwitzgebel) Paediatric Endocrine and Diabetes Unit, Service of
Development and Growth, Department of Pediatrics, University Hospital of
Geneva, 6, rue Willy-Donze, Geneva 1211, Switzerland
(Arni, Karam, Rimensberger) Service of Neonatology and Pediatric Intensive
Care, Department of Pediatrics, University Hospital of Geneva, Geneva,
Switzerland
(Saudan, Sharma) Pediatric Anesthesia Unit, Department of Anesthesiology,
University Hospital of Geneva, Geneva, Switzerland
Title
Ketosis after Cardiopulmonary Bypass in Children Is Associated with an
Inadequate Balance between Oxygen Transport and Consumption.
Source
Pediatric Critical Care Medicine. 17 (9) (pp 852-859), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: Hyperglycemia after cardiac surgery and cardiopulmonary bypass
in children has been associated with worse outcome; however, causality has
never been proven. Furthermore, the benefit of tight glycemic control is
inconsistent. The purpose of this study was to describe the metabolic
constellation of children before, during, and after cardiopulmonary
bypass, in order to identify a subset of patients that might benefit from
insulin treatment. Design: Prospective observational study, in which
insulin treatment was initiated when postoperative blood glucose levels
were more than 12 mmol/L (216 mg/dL). Setting: Tertiary PICU. Patients:
Ninety-six patients 6 months to 16 years old undergoing cardiac surgery
with cardiopulmonary bypass. Interventions: None. Measurements and Main
Results: Metabolic tests were performed before anesthesia, at the end of
cardiopulmonary bypass, at PICU admission, and 4 and 12 hours after PICU
admission, as well as 4 hours after initiation of insulin treatment.
Ketosis was present in 17.9% patients at the end of cardiopulmonary bypass
and in 31.2% at PICU admission. Young age was an independent risk factor
for this condition. Ketosis at PICU admission was an independent risk
factor for an increased difference between arterial and venous oxygen
saturation. Four hours after admission (p = 0.05). Insulin corrected
ketosis within 4 hours. Conclusions: In this study, we found a high
prevalence of ketosis at PICU admission, especially in young children.
This was independently associated with an imbalance between oxygen
transport and consumption and was corrected by insulin. These results set
the basis for future randomized controlled trials, to test whether this
subgroup of patients might benefit from increased glucose intake and
insulin during surgery to avoid ketosis, as improving oxygen transport and
consumption might improve patient outcome.<br/>Copyright &#xa9; 2016 by
the Society of Critical Care Medicine and the World Federation of
Pediatric Intensive and Critical Care Societies.

<34>
Accession Number
618266150
Author
La Macchia O.; Vaccaro O.; Masulli M.; Nicolucci A.; Maggioni A.P.; Sesti
G.; Mocarelli P.; Lucisano G.; Sacco M.; Signorini S.; Cappellini F.;
Riccardi G.; Boemi M.; D'Angelo F.; Giansanti R.; Tanase L.; Lanari L.;
Testa I.; Ricci L.; Pancani F.; Ranchelli A.; Vagheggi P.; Scatona A.;
Giorgino F.; Laviola L.; Tarantino L.; Ippolito C.; Gigantelli V.;
Manicone M.; Conte E.; Trevisan R.; Scaranna C.; Rota R.; Corsi A.;
Dodesini A.R.; Reggiani G.M.; Montesi L.; Mazzella N.; Forlani G.; Di
Luzio R.; Aiello A.; Barrea A.; Musto A.; D'Amico F.; Squatrito S.;
Sinagra T.; Longhitano S.; Trowpea V.; Sparti M.; Italia S.; Lisi E.;
Grasso G.; Pezzino V.; Insalaco F.; Gnasso A.; Carallo C.; Scicchitano C.;
De Franceschi M.S.; Santini C.; Mazzotti A.; Calbucci G.; Corsi L.; Cuneo
G.; Corsi S.; Giorda C.B.; Romeo F.; Lesina A.; Comoglio M.; Bonetto C.;
Robusto A.; Nada E.; Asprino V.; Cetraro R.; Impieri M.; Lucchese G.;
Donnarumma G.; Tizio B.; Clemente G.; Lenza L.; Paraggio P.; Tomasi F.;
Zamboni C.; Dozio N.; Scalambra E.; Mannucci E.; Lamanna C.; Cignarelli
M.; Macchia O.L.; Fariello S.; Sorrentino M.R.; Franzetti I.; Radin R.;
Cordera R.; Annunziata F.; Bonabello L.A.; Durante A.; Dolcino M.; Gallo
F.; Mazzucchelli C.; Aleo A.; Melga P.; Briatore L.; Maggi D.; Storace D.;
Cecoli F.; Antenucci D.; D'Ugo E.; Pupillo M.; Baldassarre M.P.A.; Salvati
F.; Minnucci A.; De Luca A.; Zugaro A.; Santarelli L.; Bosco A.; Petrella
V.; La Verghetta G.G.; Iannarelli R.; De Gregorio A.; D'Andrea S.;
Giuliani A.E.; Polidoro W.L.; Sperandio A.; Sciarretta F.; Pezzella A.;
Buzzetti R.; Carlone A.; Venditti C.; Foffi C.; Carbone S.; Cipolloni L.;
Moretti C.; Leto G.; Serra R.; Petrachi F.; Romano I.; Di Cianni G.;
Lacaria E.; Russo L.; Goretti C.; Sannino C.; Gregori G.; Dolci M.;
Bruselli L.; Mori M.L.; Baccetti F.; Del Freo M.; Fontana L.; Di Benedetto
A.; Cucinotta D.; Giunta L.; Ruffo M.C.; Cannizzaro D.; Pintaudi B.;
Perrone G.; Pata P.; Ragonese F.; Lettina G.; Mancuso T.; Coppolino A.;
Piatti P.M.; Monti L.; Stuccillo M.; Lucotti P.; Setola M.; Crippa G.V.;
Loi C.; Oldani M.; Bottalico M.L.; Pellegata B.; Bonomo M.; Resi V.;
Bertuzzi F.; Disoteo E.O.; Pizzi G.; Rivellese A.A.; Annuzzi G.; Capaldo
B.; Nappo R.; Auciello S.M.; Turco A.A.; Costagliola L.; Iovine C.; Corte
G.D.; Vallefuoco P.; Nappi F.; Cocozza S.; Ciano O.; Massimino E.;
Garofalo N.; Avogaro A.; Vedovato M.; Guarneri G.; Lapolla A.; Fedele D.;
Sartore G.; Chilelli N.C.; Burlina S.; Bonsembiante B.; Giordano C.;
Galluzzo A.; Torregrossa V.; Dall'Aglio E.; Mancastroppa G.; Arsenio L.;
Cioni F.; Caronna S.; Papi M.; Babini M.; Perriello G.; Santeusanio F.;
Calagreti G.; Timi A.; Tantucci A.; Marino C.; Consoli A.; Ginestra F.; Di
Biagio R.; Taraborelli M.; Del Prato S.; Miccoli R.; Bianchi C.; Garofolo
M.; Politi K.S.; Penno G.; Zavaroni D.; Livraga S.; Calzoni F.;
Mancastroppa G.L.F.; Anichini R.; Corsini E.; Tedeschi A.; Gagliano M.S.;
Ippolito G.; Salutini E.; Citro G.; Cervellino F.; Natale M.; Salvatore
V.; Zampino A.; Sinisi R.; Calabrese M.; Arcangeli A.; Zogheri A.;
Guizzotti S.; Longo R.; Di Bartolo P.; Caselli C.; Pellicano F.; Scolozzi
P.; Termine S.; Luberto A.; Ballardini G.; Babini A.C.; Ripani R.; Trojani
C.; Mazzuca P.; Bruglia M.; Ciamei M.; Genghini S.; Zannoni C.; Pugliese
G.; Vitale M.; Rangel G.; Salvi L.; Zappaterreno A.; Cordone S.; Simonelli
P.; Meggiorini M.; Frasheri A.; Di Pippo C.; Maglio C.; Mazzitelli G.;
Lauro D.; Rinaldi M.E.; Galli A.; Romano M.; D'Angelo P.; Leotta S.;
Suraci C.; De Cosmo S.; Bacci S.; Palena A.P.; Genovese S.; Mancino M.;
Rondinelli M.; Capone F.; Calabretto E.; Bulgheroni M.; Bucciarelli L.;
Dotta F.; Ceccarelli E.; Fondelli C.; Santacroce C.; Guarino E.; Nigi L.;
Lalli C.; Di Vizia G.; Scarponi M.; Montani V.; Di Bernardino P.; Romagni
P.; Dolcetti K.; Cannarsa E.; Forte E.; Potenziani S.; Tamburo L.;
Fornengo P.; Perin P.C.; Prinzis T.; Gruden G.; Bruno G.; Zucco C.;
Perotta M.; Marena S.; Monsignore S.; Panero F.; Ponzi F.; Bossi A.C.;
Carpinteri R.; Coletti M.F.; Menicatti L.S.M.; Balini A.; Filopanti M.;
Madaschi S.; Pulcina A.; Grimaldi F.; Tonutti L.; Venturini G.; Agus S.;
Pagnutti S.; Guidotti F.; Cavarape A.; Casagrande M.L.; Bonora E.;
Cigolini M.; Pichiri I.; Brangani C.; Fainelli G.; Tomasetto E.; Zoppini
G.; Galletti A.; Perrone D.; Capra C.; Bianchini F.; Ceseri M.; Di Nardo
B.; Sasso E.; Bartolomei B.; Suliman I.; Fabbri G.; Romano G.; Maturo N.;
Nunziata G.; Capobianco G.; De Simone G.; Villa V.; Rota G.; Pentangelo
C.; Carbonara O.; Caiazzo G.; Cutolo M.; Sorrentino T.; Mastrilli V.;
Amelia U.; Masi S.; Corigliano G.; Gaeta I.; Armentano V.; Calatola P.;
Capuano G.; Angiulli B.; Auletta P.; Petraroli E.; Iodice C.E.; Agrusta M.
Institution
(Vaccaro, Masulli, Rivellese, Riccardi) Department of Clinical Medicine
and Surgery, University of Naples Federico II, Naples, Italy
(Iovine) Diabetes Unit, University of Naples Federico II, Naples, Italy
(Nicolucci, Lucisano, Sacco) Center for Outcomes Research and Clinical
Epidemiology (CORESEARCH), Pescara, Italy
(Bonora) Division of Endocrinology, Diabetes and Metabolism, University
and Hospital Trust of Verona, Verona, Italy
(Del Prato) Department of Clinical & Experimental Medicine, University of
Pisa, Pisa, Italy
(Maggioni) National Association of Hospital Cardiologists (ANMCO) Research
Center, Florence, Italy
(Squatrito) Diabetes Unit, University Hospital Garibaldi-Nesima of
Catania, Catania, Italy
(Giorda) Diabetes Unit, Azienda Sanitaria Locale (ASL) Torino 5, Torino,
Italy
(Sesti) Department of Medical and Surgical Sciences, Magna Graecia
University of Catanzaro, Italy
(Gnasso) Department of Clinical and Experimental Medicine, Magna Graecia
University of Catanzaro, Italy
(Mocarelli, Signorini, Cappellini) University Department Laboratory
Medicine, Hospital of Desio, Monza, Italy
(Perriello) Endocrinology and Metabolism, University of Perugia, Perugia,
Italy
(Babini) Medical Division, Rimini Hospital, Rimini, Italy
(Lapolla) Dipartimento di Medicina, Universita di Padova, Padova, Italy
(Gregori) Diabetes Unit, Massa Carrara, Azienda Unita Sanitarie Locali
(USL) Toscana Nord Ovest, Carrara, Italy
(Giordano) Section of Endocrinology, Diabetology and Metabolic Diseases,
University of Palermo, Palermo, Italy
(Corsi) Diabetes Unit, ASL 4 Chiavarese, Chiavari, Italy
(Buzzetti) Department of Experimental Medicine, Sapienza University, Rome,
Italy
(Pugliese) Department of Clinical and Molecular Medicine, Sapienza
University, Rome, Italy
(Clemente) Institute for Research on Population and Social
Policies-National Research Council, Penta di Fisciano, Italy
(Di Cianni) Diabetes and Metabolism, Livorno Hospital, Livorno, Italy
(Iannarelli) Diabetes Unit, Department of Medicine, San Salvatore
Hospital, L'Aquila, Italy
(Cordera) Diabetes Unit, School of Medicine, University of Genova,
Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Martino
Hospital, Genova, Italy
(La Macchia) Endocrinology, Azienda Ospedaliero Universitaria Ospedali
Riuniti, Foggia, Italy
(Zamboni) Diabetes Unit, University of Ferrara, Ferrara, Italy
(Scaranna) Endocrinology and Diabetology, Azienda Socio Sanitaria
Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
(Boemi) Diabetes and Metabolism Unit, IRCCS Istituto Nazionale Riposo e
Cura Anziani, Ancona, Italy
(Lauro) Department of Systems Medicine, University of Rome Tor Vergata,
Rome, Italy
(Leotta) UOC Diabetologia Ospedale Sandro Pertini, Rome, Italy
(Dall'Aglio) Clinical and Experimental Medicine, University of Parma,
Parma, Italy
(Cannarsa) Diabetes Unit, San Liberatore Hospital, Atri Teramo, Italy
(Tonutti) Endocrinology, Diabetes, Metabolism and Clinical Nutrition Unit,
Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
(Bossi) ASST Bergamo Ovest, Treviglio, Italy
(Anichini) Diabetes Unit, USL 3, Pistoia, Italy
(Dotta) Diabetes Unit, Department of Medicine, Surgery and Neurosciences,
University of Siena, Siena, Italy
(Di Benedetto) Department of Clinical and Experimental Medicine,
University of Messina, Messina, Italy
(Citro) Endocrinology and Diabetes Unit, Azienda Sanitaria Locale di
Potenza, Potenza, Italy
(Antenucci) Diabetes Unit, Renzetti Hospital, ASL 2 Abruzzo, Lanciano,
Italy
(Ricci) Diabetes Unit, USL Sud Est, Toscana, Italy
(Giorgino) Department of Emergency and Organ Transplantation,
Endocrinology and Metabolic Diseases, University of Bari Aldo Moro, Bari,
Apulia, Italy
(Santini) Department Endocrinology and Diabetology, Cesena Hospital,
Cesena, Italy
(De Cosmo) Unit of Internal Medicine, IRCCS Casa Sollievo della
Sofferenza, San Giovanni Rotondo, Italy
(Zavaroni) Diabetes Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
(Vedovato) Metabolism Unit, Azienda Ospedaliera di Padova, Padova, Italy
(Consoli) Department of Medicine and Aging Sciences, Aging and
Translational Medicine Research Center (CeSI-Met), D'Annunzio University,
Chieti-Pescara, Italy
(Calabrese) Diabetes Unit, USL Toscana Centro, Prato, Italy
(di Bartolo) Diabetes Unit, Ravenna Internal Medicine Department, Romagna
Local Health Unit, Ravenna, Italy
(Fornengo) Department of Medical Sciences, University of Turin, Turin,
Italy
Title
Effects on the incidence of cardiovascular events of the addition of
pioglitazone versus sulfonylureas in patients with type 2 diabetes
inadequately controlled with metformin (TOSCA.IT): a randomised,
multicentre trial.
Source
The Lancet Diabetes and Endocrinology. 5 (11) (pp 887-897), 2017. Date of
Publication: November 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background The best treatment option for patients with type 2 diabetes in
whom treatment with metformin alone fails to achieve adequate glycaemic
control is debated. We aimed to compare the long-term effects of
pioglitazone versus sulfonylureas, given in addition to metformin, on
cardiovascular events in patients with type 2 diabetes. Methods TOSCA.IT
was a multicentre, randomised, pragmatic clinical trial, in which patients
aged 50-75 years with type 2 diabetes inadequately controlled with
metformin monotherapy (2-3 g per day) were recruited from 57 diabetes
clinics in Italy. Patients were randomly assigned (1:1), by permuted
blocks randomisation (block size 10), stratified by site and previous
cardiovascular events, to add-on pioglitazone (15-45 mg) or a sulfonylurea
(5-15 mg glibenclamide, 2-6 mg glimepiride, or 30-120 mg gliclazide, in
accordance with local practice). The trial was unblinded, but event
adjudicators were unaware of treatment assignment. The primary outcome,
assessed with a Cox proportional-hazards model, was a composite of first
occurrence of all-cause death, non-fatal myocardial infarction, non-fatal
stroke, or urgent coronary revascularisation, assessed in the modified
intention-to-treat population (all randomly assigned participants with
baseline data available and without any protocol violations in relation to
inclusion or exclusion criteria). This study is registered with
ClinicalTrials.gov, number NCT00700856. Findings Between Sept 18, 2008,
and Jan 15, 2014, 3028 patients were randomly assigned and included in the
analyses. 1535 were assigned to pioglitazone and 1493 to sulfonylureas
(glibenclamide 24 [2%], glimepiride 723 [48%], gliclazide 745 [50%]). At
baseline, 335 (11%) participants had a previous cardiovascular event. The
study was stopped early on the basis of a futility analysis after a median
follow-up of 57.3 months. The primary outcome occurred in 105 patients
(1.5 per 100 person-years) who were given pioglitazone and 108 (1.5 per
100 person-years) who were given sulfonylureas (hazard ratio 0.96, 95% CI
0.74-1.26, p=0.79). Fewer patients had hypoglycaemias in the pioglitazone
group than in the sulfonylureas group (148 [10%] vs 508 [34%], p<0.0001).
Moderate weight gain (less than 2 kg, on average) occurred in both groups.
Rates of heart failure, bladder cancer, and fractures were not
significantly different between treatment groups. Interpretation In this
long-term, pragmatic trial, incidence of cardiovascular events was similar
with sulfonylureas (mostly glimepiride and gliclazide) and pioglitazone as
add-on treatments to metformin. Both of these widely available and
affordable treatments are suitable options with respect to efficacy and
adverse events, although pioglitazone was associated with fewer
hypoglycaemia events. Funding Italian Medicines Agency, Diabete Ricerca,
and Italian Diabetes Society.<br/>Copyright &#xa9; 2017 Elsevier Ltd

<35>
Accession Number
618987811
Author
Shahin M.; Obeid S.; Hamed L.; Templin C.; Gamperli O.; Nietlispach F.;
Maiera W.; Yousif N.; Mach F.; Roffi M.; Windecker S.; Raber L.; Matter
C.M.; Luscher T.F.
Institution
(Shahin, Obeid, Templin, Gamperli, Nietlispach, Maiera, Yousif, Matter,
Luscher) Department of Cardiology, University Heart Center, Zurich,
Switzerland
(Hamed) Department of Internal Medicine, University Hospital Sohag, Egypt
(Mach, Roffi) Cardiovascular Center, Department of Cardiology, University
Hospital Geneva, Switzerland
(Windecker, Raber) Cardiovascular Center, Department of Cardiology,
University Hospital Bern, Switzerland
Title
Occurrence and impact of time delay to primary percutaneous coronary
intervention in patients with ST-segment elevation myocardial infarction.
Source
Cardiology Research. 8 (5) (pp 190-198), 2017. Date of Publication: 2017.
Publisher
Elmer Press (E-mail: production@elmerpress.com)
Abstract
Background: The aim of the study was to evaluate the occurrence, duration
and impact of time delays to primary percutaneous coronary intervention
(pPCI) in ST-segment elevation myocardial infarction (STEMI). Methods: A
total of 357 consecutive STEMI patients enrolled in the prospective
Special Program University Medicine ACS (SPUMACS) cohort were included. In
order to identify the causes behind a possible treatment delay, we
constructed four different time points which included: 1) symptom onset to
hospital arrival, 2) hospital arrival to arrival in the catheterization
laboratory, 3) hospital arrival to first balloon inflation, and 4) time
from arrival in the catheterization laboratory to first balloon inflation
in addition to total ischemic time. Patients were stratified according to
a delay > 3 h, > 30 min, > 90 min and > 1 h, respectively and major
adverse events at 0, 30 and 365 days were analyzed. Results: Resuscitated
STEMI patients (23 patients) and STEMI patients presenting at weekends
(101 patients) and to lesser extent at night hours (100 patients)
experienced more time delays than stable patients and those presenting at
office hours. Median door-to-balloon time averaged 93 min in resuscitated,
but 65 min in stable patients. Median door-to-balloon time at weekends and
public holidays was 89 min, but 68 min at office hours. Median time from
hospital arrival to cathlab arrival at weekends and public holidays was 30
min, but 15 min during office hours. Corresponding times for resuscitated
patients was 45 and 15 min in stable patients. Of note, resuscitated
patients were late presenters as regards time from symptoms onset to
hospital arrival with a median time of 180 min compared to 155 min in
stable patients. Median total ischemic time was 225 min for all patients,
223 min at day hours, 239 at night hours, 244 min at weekends, 233 min at
office days, 220 min in stable patients and 273 min in resuscitated
patients. Patients with STEMI who arrived > 3 h after symptom onset had a
higher rate of myocardial infarction (MI) at 1 year (1.6% vs. 9% in < 3 h;
P = 0.008). Furthermore, STEMI patients who had a delay of > 1 h from
cathlab arrival to first balloon inflation had a higher rate of in
hospital reinfarction at 0 day (0.6% vs. 0% in < 1 h; P = 0.007), MI at 30
days (0.8% vs. 0% in < 1 h; P = 0.001) and MI at 1 year (1.4% vs. 1.1% in
< 1 h; P = 0.012). Similarly, in these patients, cardiac deaths at 0 day
(0.8% vs. 0.6% in < 1 h; P = 0.035) and at 30 days (0.8% vs. 0.6% in < 1
h; P = 0.035) were higher as were major adverse cardiovascular events
(MACCE) at 0 day (1.4% vs. 0.8% in < 1 h; P = 0.004). Conclusion:
Resuscitated STEMI patients and those presenting at weekends and to lesser
extent at night hours experienced more time delays and longer ischemic
time than stable patients and those presenting at office hours. In STEMI
patients, any delay in treatment increased their risk of MACCE. Efforts
should focus on improving patient's awareness along with minimizing
in-hospital transfer to the catheterization laboratory especially at
weekends and in resuscitated patients.<br/>Copyright &#xa9; The authors.

<36>
Accession Number
619009666
Author
Ghods K.; Davari H.; Ebrahimian A.
Institution
(Ghods, Ebrahimian) Cardiac Intensive Care Unit, Kowsar Educational and
Research Center, Semnan University of Medical Sciences, School of Nursing
and Midwifery, Km 5 Damghan Road, Semnan, Iran, Islamic Republic of
(Davari) Nursing Care Research Center, Semnan University of Medical
Sciences, Semnan, Iran, Islamic Republic of
Title
Evaluation of the effect of metformin and insulin in hyperglycemia
treatment after coronary artery bypass surgery in nondiabetic patients.
Source
Annals of Cardiac Anaesthesia. 20 (4) (pp 427-431), 2017. Date of
Publication: October-December 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Introduction: Insulin therapy is the most commonly used treatment for
controlling hyperglycemia after coronary artery bypass surgery in both
diabetic and nondiabetic patients. Metformin has been indicated for
critically ill patients as an alternate for the treatment of
hyperglycemia. This study evaluated the effect of metformin and insulin in
hyperglycemia treatment after coronary artery bypass surgery in
nondiabetic patients. Settings and Design: This study was a clinical trial
comprising nondiabetic patients who had undergone coronary artery bypass
surgery. Patients were randomly divided into the insulin group and the
metformin group. Methods: Patients in the insulin group received
continuous infusion of insulin while those in the metformin group received
500 mg metformin tablets twice daily. All the patients were followed up
for 3 days after stabilization of blood glucose levels. Statistical
Analysis: Data were analyzed using Chi-square test and Mann-Whitney
U-test. Results: This study included a total of 56 patients. During the
study period, the mean blood glucose levels decreased from 225.24 to
112.36 mg/dl (112.88 mg/dl) in the insulin group and from 221.80 to 121.92
mg/dl in the metformin group (99.88 mg/dl). There was no significant
difference in the blood glucose levels of the patients between the two
groups at any measurement times (P > 0.05). Conclusion: Using 500 mg
metformin twice daily is similar to using insulin in nondiabetic patients
undergoing coronary artery bypass graft. Therefore, the use of metformin
can be considered as a treatment strategy for controlling hyperglycemia in
this group of patients.<br/>Copyright &#xa9; 2017 Annals of Cardiac
Anaesthesia <br/> Published by Wolters Kluwer - Medknow.

<37>
Accession Number
619009639
Author
Joshi V.S.; Kollu S.S.; Sharma R.M.
Institution
(Joshi) Department of Cardiac Anaesthesia, Military Hospital CTC, Pune,
Maharashtra, India
(Kollu) Department of Anaesthesiology and Critical Care, AFMC, Pune,
Maharashtra, India
(Sharma) Department of Anaesthesiology and Critical Care, Command Hospital
Air Force, Bengaluru, Karnataka, India
Title
Comparison of dexmedetomidine and ketamine versus propofol and ketamine
for procedural sedation in children undergoing minor cardiac procedures in
cardiac catheterization laboratory.
Source
Annals of Cardiac Anaesthesia. 20 (4) (pp 422-426), 2017. Date of
Publication: October-December 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: The ideal anaesthetic technique for management of paediatric
patients scheduled to undergo cardiac catheterisation is still not
standardised. Aim: To compare the effects of ketamine-propofol and
ketamine-dexmedetomidine combinations on hemodynamic parameters and
recovery time in paediatric patients undergoing minor procedures and
cardiac catheterisation under sedation for various congenital heart
diseases. Material and Methods: 60 children of either sex undergoing
cardiac catheterisation were randomly assigned into two groups
Dexmedetomidine-ketamine group (DK) and Propofol-ketamine (PK) of 30
patients each. All patients were premedicated with glycopyrrolate and
midazolam (0.05mg/kg) intravenously 5-10 min before anaesthetic induction.
Group 'DK'received dexmedetomidineiv infusion 1 mug/kg over 10 min +
ketamine1mg/kg bolus, followed by iv infusion of dexmedetomidine
0.5mug/kg/hr and of ketamine1 mg/kg/hr. Group 'PK' received propofol
1mg/kg and ketamine 1mg/kg/hr for induction followed by iv infusion of
propofol 100 mug/kg/hr and ketamine 1 mg/kg/hr for maintenance.
Haemodynamic parameters and recovery time was recorded postoperatively.
Statistical Analysis: Independent sample t test was used to compare the
statistical significance of continuous variables of both the groups.Chi
square test was used for numerical data like gender.Fischer exact test was
applied for non parametric data like ketamine consumption. Results: We
observed that heart rate in dexmedetomidine (DK) group was significantly
lower during the initial 25 mins after induction compared to the propofol
(PK) group. Recovery was prolonged in the DK group compared to the PK
group (40.88 vs. 22.28 min). Even ketamine boluses consumption was higher
in DK group. Conclusion: Use of dexmedetomidine-ketamine combination is a
safe alternative, without any hemodynamic orrespiratory effects during the
cardiac catheterization procedure but with some delayed
recovery.<br/>Copyright &#xa9; 2017 Annals of Cardiac Anaesthesia <br/>
Published by Wolters Kluwer - Medknow.

<38>
Accession Number
619009615
Author
Elgebaly A.S.
Institution
(Elgebaly) Department of Anesthesia and PSICUD, Faculty of Medicine, Tanta
University, 19 Elfaloga St, Elgharbia, Tanta, Egypt
Title
Does bilevel positive airway pressure improve outcome of acute respiratory
failure after open-heart surgery?.
Source
Annals of Cardiac Anaesthesia. 20 (4) (pp 416-421), 2017. Date of
Publication: October-December 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Background: Respiratory failure is of concern in the postoperative period
after cardiac surgeries. Invasive ventilation (intermittent positive
pressure ventilation [IPPV]) carries the risks and complications of
intubation and mechanical ventilation (MV). Aims: Noninvasive positive
pressure ventilation (NIPPV) is an alternative method and as effective as
IPPV in treating insufficiency of respiration with less complications and
minimal effects on respiratory and hemodynamic parameters next to
open-heart surgery. Design: This is a prospective, randomized and
controlled study. Materials and Methods: Forty-four patients scheduled for
cardiac surgery were divided into two equal groups: Group I (IPPV) and
Group II (NIPPV). Heart rate (HR), mean arterial pressure (MAP),
respiratory rate (RR), oxygen saturation (SpO<inf>2</inf>), arterial blood
gas, weaning time, reintubation, tracheotomy rate, MV time, postoperative
hospital stay, and ventilator-associated pneumonia during the period of
hospital stay were recorded. Results: There was statistically significant
difference in HR between groups with higher in Group I at 30 and 60 min
and at 12 and 24 h. According to MAP, it started to increase significantly
at hypoxemia, 15 min, 30 min, 4 h, 12 h, and at 24 h which was higher in
Group I also. RR, PaO<inf>2</inf>, and PaCO<inf>2</inf>showed significant
higher in Group II at 15, 30, and 60 min and 4 h. According to pH, there
was a significant difference between groups at 15, 30, and 60 min and at
4, 12, and 24 h postoperatively. SpO<inf>2</inf>showed higher significant
values in Group I at 15 and 30 min and at 12 h postoperatively. Duration
of postoperative supportive ventilation was higher in Group I than that of
Group II with statistically significant difference. Complications were
statistically insignificant between Group I and Group II. Conclusion: Our
study showed superiority of invasive over noninvasive mode of ventilator
support. However, NIPPV (bilevel positive airway pressure) was proved to
be a safe method.<br/>Copyright &#xa9; 2017 Annals of Cardiac Anaesthesia
<br/> Published by Wolters Kluwer - Medknow.

<39>
Accession Number
619009547
Author
Soliman R.; Hussien M.
Institution
(Soliman) Departments of Cardiac Anesthesia, Madinah Cardiac Center,
Almadinah Almonwarah, Saudi Arabia
(Soliman) Department of Anesthesia, Cairo University, Giza, Egypt
(Hussien) Cardiac Surgery, Madinah Cardiac Center, Almadinah Almonwarah,
Saudi Arabia
Title
Comparison of the renoprotective effect of dexmedetomidine and dopamine in
high-risk renal patients undergoing cardiac surgery: A double-blind
randomized study.
Source
Annals of Cardiac Anaesthesia. 20 (4) (pp 408-415), 2017. Date of
Publication: October-December 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objective: The purpose of the current study was to compare the
renoprotective effects of continuous infusion of dexmedetomidine and
dopamine in high-risk renal patients undergoing cardiac surgery. Design: A
double-blind randomized study. Setting: Cardiac Centers. Patients: One
hundred and fifty patients with baseline serum creatinine level >=1.4
mg/dl were scheduled for cardiac surgery with cardiopulmonary bypass.
Intervention: The patients were classified into two groups (each = 75):
Group Dex - the patients received a continuous infusion of dexmedetomidine
0.4 mug/kg/h without loading dose during the procedure and the first 24
postoperative hours and Group Dopa - the patients received a continuous
infusion of dopamine 3 mug/kg/min during the procedure and the first 24
postoperative hours. Measurements: The monitors included serum creatinine,
creatinine clearance, blood urea nitrogen, and urine output. Main Results:
The creatinine levels and blood urea nitrogen decreased at days 1, 2, 3,
4, and 5 in Dex group and increased in patients of Dopa group (P < 0.05).
The creatinine clearance increased at days 1, 2, 3, 4, and 5 in Dex group
and decreased in patients of Dopa group (P < 0.05). The amount of urine
output was too much higher in the Dex group than the Dopa group (P <
0.05). Conclusions: The continuous infusion of dexmedetomidine during
cardiac surgery has a renoprotective effect and decreased the
deterioration in the renal function in high-risk renal patients compared
to the continuous infusion of dopamine.<br/>Copyright &#xa9; 2017 Annals
of Cardiac Anaesthesia <br/> Published by Wolters Kluwer - Medknow.

<40>
Accession Number
615635715
Author
Kandasamy A.; Simon H.A.; Murthy P.; Annadurai M.; Ali M.M.; Ramanathan G.
Institution
(Kandasamy, Simon, Murthy, Annadurai, Ali, Ramanathan) Department of
Cardiothoracic Anesthesia, SRM Medical College Hospital and Research
Centre, SRM University, Kattankulathur, Chennai, Tamil Nadu, India
Title
Comparison of Levosimendan versus Dobutamine in Patients with Moderate to
Severe Left Ventricular Dysfunction Undergoing Off-pump Coronary Artery
Bypass Grafting: A Randomized Prospective Study.
Source
Annals of Cardiac Anaesthesia. 20 (2) (pp 200-206), 2017. Date of
Publication: April-June 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Context: Recent upsurge in referral of patients with compromised left
ventricular (LV) function for cardiac surgery has led to an increasing use
inotropes to achieve improvement of tissue perfusion in the perioperative
period. Aims and Objectives: To compare the hemodynamic effects and
immediate postoperative outcomes with levosimendan and dobutamine in
patients with moderate to severe LV dysfunction undergoing off-pump
coronary artery bypass grafting (OPCAB). Settings and Design: University
teaching hospital, randomized control study. Materials and Methods: Eighty
patients were randomly divided into two groups of 40 each. Group I
received levosimendan at 0.1 mug/kg/min and Group II received dobutamine
at 5 mug/kg/min. Hemodynamic data were noted at 30 min, during obtuse
marginal grafting, 1, 6, 12, and 24 h after surgery. Heart rate (HR), mean
arterial pressure (MAP), pulmonary capillary wedge pressure (PCWP),
cardiac index (CI), systemic vascular resistance index (SVRI) and
pulmonary vascular resistance index (PVRI), left ventricular stroke work
index (LVSWI) and right ventricular stroke work index (RVSWI), mixed
venous oximetry (SvO<inf>2</inf>), and lactate were measured. Statistical
Analysis Used: Chi-square and Student's t-test. Results: The HR, MAP,
PCWP, SVRI, and PVRI were lower in Group I when compared to Group II.
Group I patients showed a statistically significant increase in LVSWI,
RVSWI, and CI, when compared to Group II. Comparatively, Group I patients
maintained higher SvO<inf>2</inf>and lower lactate levels. Duration of
ventilation, Intensive Care Unit (ICU), and hospital stay were lower in
Group I. Conclusions: Levosimendan was associated with statistically
significant increase in indices of contractility (CI, LVSWI, and RVSWI)
and decrease in PCWP during and after OPCAB. Levosimendan group had lower
incidence of atrial fibrillation, shorter length of ICU, and hospital
stay.<br/>Copyright &#xa9; 2017 Annals of Cardiac Anaesthesia <br/>
Published by Wolters Kluwer - Medknow.

<41>
Accession Number
615635700
Author
Modak S.D.; Kane D.G.
Institution
(Modak) Department of Anaesthesiology, Lokmanya Tilak Municipal Medical
and General Hospital, Sion, Switzerland
(Kane) Department of Anaesthesiology, Seth G. S. Medical College, KEM
Hospital, Parel, Mumbai, Maharashtra, India
Title
Conscious sedation for balloon mitral valvotomy: A comparison of fentanyl
versus sufentanil.
Source
Annals of Cardiac Anaesthesia. 20 (2) (pp 163-168), 2017. Date of
Publication: April-June 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Context: Analgesia and sedation are required for the comfort of patient
and the cardiologist during balloon mitral valvotomy. Aims: In this study,
efficacy of analgesia, sedation, and patient satisfaction with sufentanil
was compared with fentanyl. Settings and Design: Single-centered,
prospective single-blind study of sixty patients. Materials and Methods:
Patients between 15 and 45 years of rheumatic mitral stenosis with valve
area of 0.8-1 cm² undergoing elective balloon mitral valvotomy,
randomly divided to receive bolus injection fentanyl 1 mcg/kg (Group 1, n
= 30) followed by infusion at 1 mcg/kg/h or bolus of injection sufentanil
0.1 mcg/kg (Group 2, n = 30) followed by continuous infusion at 0.1 mcg/h.
Both the groups received injection midazolam bolus 0.02 mg/kg followed by
infusion at 15 mcg/kg/h. Pain intensity (by visual analog score [VAS]),
level of sedation (by Ramsay sedation scale), overall patient and
operator's satisfaction, effect on cardiorespiratory parameters, and
discharge score (by modified Aldrete score) were assessed. Statistical
Analysis Used: Statistical analysis used Student's unpaired t-test and
Chi-square test. P < 0.05 was considered statistically significant.
Results: Mean number of bolus doses in fentanyl group was 0.9 versus 0.13
in sufentanil group (P < 0.01). The mean value of mean blood pressure in
fentanyl group was 83.52 mmHg versus 88 mmHg in sufentanil group (P <
0.05), but the value was within normal range in both the groups. The mean
VAS - patient's opinion in fentanyl group was 8.97 versus 9.53 in
sufentanil group (P < 0.05). Mean discharge score in fentanyl group was
17.87 versus 18.23 in sufentanil group (P < 0.05). No statistically
significant difference was found with respect to heart rate, respiratory
rate, oxygen saturation, PaCO<inf>2</inf>values, and anxiety scores.
Conclusion: Sufentanil was found to be better with respect to analgesia,
patient satisfaction, and recovery however not cost-effective for
continuous infusion technique.<br/>Copyright &#xa9; 2017 Annals of Cardiac
Anaesthesia <br/> Published by Wolters Kluwer - Medknow.

<42>
Accession Number
615635697
Author
Kiran U.; Ladha S.; Makhija N.; Kapoor P.M.; Choudhury M.; Das S.; Gharde
P.; Malik V.; Airan B.
Institution
(Kiran, Ladha, Makhija, Kapoor, Choudhury, Das, Gharde, Malik, Airan)
Department of Cardiac Anaesthesia, Cardiothoracic Centre, All India
Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India
Title
The role of Rajyoga meditation for modulation of anxiety and serum
cortisol in patients undergoing coronary artery bypass surgery: A
prospective randomized control study.
Source
Annals of Cardiac Anaesthesia. 20 (2) (pp 158-162), 2017. Date of
Publication: April-June 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Introduction: Rajyoga meditation is a form of mind body intervention that
is promoted by the Brahma Kumaris World Spiritual University. This form of
meditation can be easily performed without rituals or mantras and can be
practiced anywhere at any time. The practice of Rajyoga meditation can
have beneficial effects on modulating anxiety and cortisol level in
patients undergoing major cardiac surgery. Materials and Methods: A
prospective randomized control study was carried out in a single tertiary
care center. One hundred and fifty patients undergoing elective coronary
artery bypass surgery were enrolled in the study. The patients were
randomized in two groups namely, Group 1 (Rajyoga group) and Group 2
(Control Group). Anxiety was measured on a visual analog scale 1-10 before
the start of Rajyoga training or patient counseling (T1), on the morning
of the day of surgery (T2), on the 2^nd postoperative day (T3),
and on the 5^th postoperative day (T4). The serum cortisol level
was measured in the morning of the day of surgery (T1), on the
2^nd postoperative day (T2) and on the 5^th
postoperative day (T3), respectively. Results: In the study, it was seen
that the anxiety level of the patients before the surgery (T<inf>1</inf>)
and on the day of surgery (T<inf>2</inf>) were comparable between the two
groups. However on the 2^nd postoperative day (T<inf>3</inf>),
the patients who underwent Rajyoga training had lower anxiety level in
comparison to the control group (3.12 +/- 1.45 vs. 6.12 +/- 0.14, P <
0.05) and on the 5^th postoperative day (T<inf>4</inf>) it was
seen that Rajyoga practice had resulted in significant decline in anxiety
level (0.69 +/- 1.1 vs. 5.6 +/- 1.38, P < 0.05). The serum cortisol level
was also favorably modulated by the practice of Rajyoga meditation.
Conclusion: Mindbody intervention is found to effective in reducing the
anxiety of the patients and modulating the cortisol level in patients
undergoing wellknown stressful surgery like coronary artery bypass
surgery.<br/>Copyright &#xa9; 2017 Annals of Cardiac Anaesthesia <br/>
Published by Wolters Kluwer - Medknow.

<43>
Accession Number
615635694
Author
Hashemian M.; Ahmadinejad M.; Mohajerani S.A.; Mirkheshti A.
Institution
(Hashemian, Ahmadinejad) Department of Anesthesiology and Pain Medicine,
Kerman University of Medical Sciences, Kerman, Iran, Islamic Republic of
(Mohajerani, Mirkheshti) Department of Anesthesiology, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Impact of dexmedetomidine on hemodynamic changes during and after coronary
artery bypass grafting.
Source
Annals of Cardiac Anaesthesia. 20 (2) (pp 152-157), 2017. Date of
Publication: April-June 2017.
Publisher
Medknow Publications (B9, Kanara Business Centre, off Link Road, Ghatkopar
(E), Mumbai 400 075, India)
Abstract
Objective: To determine the effect of dexmedetomidine (Dex) on hemodynamic
changes during cardiopulmonary pump and postoperative period in coronary
artery bypass grafting (CABG). Methods and Design: This study is designed
as a double-blinded, randomized clinical trial. Setting: University
hospital and single center. Participants: patients candidate for elective
CABG. Intervention: Dex 0.5 mug/kg/h or placebo was infused from the
initiation of anesthesia up to extubation in Intensive Care Unit (ICU).
Measurements: Heart rate (HR) and blood pressure (BP), pain score, and
total morphine dose requirement were monitored and compared during cardiac
pump up to 12 h postoperative in ICU. Results: Mean arterial pressure was
significantly higher in Dex group in postoperation period at 1 (P = 0.010)
and 2 h (P = 0.002) compared to control group. HR was significantly lower
in Dex group in postcardiopulmonary bypass (CPB) time at 0 h (P = 0.001),
1 h (P = 0.0016), and 2 h (P = 0.001), and then in postoperative period in
ICU at 1 h (P = 0.025), 2 h (P = 0.0012), and 4 h (P = 0.0025) compared to
control group. Postoperative pain score was significantly lower during 12
h after surgery. Conclusion: Dex could effectively blunt hemodynamic
response to surgical stress, particularly during CPB pump and afterward.
Infusion of Dex maintains BP at higher range and HR at lower range
compared to placebo.<br/>Copyright &#xa9; 2017 Annals of Cardiac
Anaesthesia <br/> Published by Wolters Kluwer - Medknow.

<44>
Accession Number
617215622
Author
Krishnamoorthy B.; Critchley W.R.; Thompson A.J.; Payne K.; Morris J.;
Venkateswaran R.V.; Caress A.L.; Fildes J.E.; Yonan N.
Institution
(Krishnamoorthy) 1Department of Cardiothoracic Surgery, University
Hospital of South Manchester NHS Foundation Trust, Manchester, United
Kingdom; 2Manchester Centre for Collaborative Research, School of
Translational Medicine, University of Manchester, Manchester, United
Kingdom; 3Manchester Centre for Health Economics, The University of
Manchester, Manchester, United Kingdom; 4Department of Medical Statistics,
University Hospital of South Manchester NHS Foundation Trust, Manchester,
United Kingdom; 5School of Nursing and Midwifery, The University of
Manchester, Manchester, United Kingdom; 6Faculty of Health and Social
Care, Edge Hill University, Ormskirk, Lancashire, United Kingdom
Title
A Study Comparing Vein Integrity and Clinical Outcomes (VICO) in Open Vein
Harvesting and Two Types of Endoscopic Vein Harvesting for Coronary Artery
Bypass Grafting: The VICO Randomised Clinical Trial.
Source
Circulation. (no pagination), 2017. Date of Publication: 01 Jul 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND-: Current consensus statements maintain that endoscopic vein
harvesting (EVH) should be standard care in coronary artery bypass surgery
(CABG) but vein quality and clinical outcomes have been questioned. The
Vein Integrity and Clinical Outcome (VICO) trial was designed to assess
the impact of different vein harvesting methods on vessel damage and if
this contributes to clinical outcomes following CABG. METHODS-: A single
centre, randomised clinical trial of patients undergoing CABG with an
internal mammary artery, and with one to four vein grafts were recruited.
All the veins were harvested by a single experienced practitioner. We
randomly allocated n=300 patients into: closed tunnel CO2 EVH (CT-EVH)
(n=100), open tunnel CO2 EVH (OT-EVH) (n=100) and traditional open vein
harvesting (OVH) (n=100) groups. The primary end-point was endothelial
integrity and muscular damages of the harvested vein. Secondary end-points
included clinical outcomes (major adverse cardiac events, MACE), use of
healthcare resources and impact on health status (quality-adjusted life
years, QALYs). RESULTS-: The OVH group demonstrated marginally better
endothelial integrity in random samples (85% vs. 88% vs. 93% for CT-EVH,
OT-EVH and OVH, p<0.001). CT-EVH displayed the lowest longitudinal
hypertrophy (1% vs. 13.5% vs. 3%, p=0.001). However, no differences in
endothelial stretching were observed between groups (37% vs. 37% vs. 31%,
p=0.62). Secondary clinical outcomes demonstrated no significant
differences in composite MACE scores at each time point up to 48 months.
The QALY gain per patient was: 0.11 (p<0.001) for closed tunnel CO2 EVH
and 0.07 (p=0.003) for open tunnel CO2 EVH compared with open vein
harvesting. The likelihood of being cost-effective, at a pre-defined
threshold of 20,000 per QALY gained was: 75% for closed tunnel, 19% for
open tunnel and 6% for open vein harvesting. CONCLUSIONS-: Our study
demonstrates that harvesting techniques do impact upon integrity of
different vein layers, albeit with only a small effect. Secondary outcomes
suggest that histological findings do not directly contribute to MACE
outcomes. Gains in health status were observed and cost-effectiveness was
better with CT-EVH. High level experience with endoscopic harvesting
performed by a dedicated specialist practitioner gives optimal results
which is comparable to open vein harvesting. CLINICAL TRIAL REGISTRATION-:
URL: https://www.isrctn.com Unique Identifier: ISRCTN:
91485426<br/>Copyright &#xa9; 2017 by the American College of Cardiology
Foundation and the American Heart Association, Inc.

<45>
Accession Number
1354164983
Author
Lie I.; Arnesen H.; Sandvik L.; Hamilton G.; Bunch E.H.
Institution
(Lie) Department of Nursing Research, Ulleval University Hospital, 0407,
Oslo, Norway
Title
Health-related quality of life after coronary artery bypass grafting. The
impact of a randomised controlled home-based intervention program.
Source
Quality of life research : an international journal of quality of life
aspects of treatment, care and rehabilitation. 18 (2) (pp 201-207), 2009.
Date of Publication: 01 Mar 2009.
Abstract
OBJECTIVE: The aim of this study was to evaluate the impact of a home
based intervention program (HBIP) on health related quality of life
(HRQoL) after coronary artery bypass grafting (CABG). To strengthen the
clinical interpretation, HRQoL data were compared to the general
population.
METHODS: In a randomised controlled trial (RCT), a total of 185 CABG
patients (93 vs 92) completed the study. The intervention group received a
HBIP 2 and 4 weeks after surgery. HRQoL was measured by the Seattle Angina
Questionnaire (SAQ) and the Short Form 36 (SF-36) in both patient groups
before surgery, at 6 weeks and 6 months after surgery.
RESULTS: Significant improvements were found in both groups for the
majority of subscales of HRQoL at 6-week and 6-month follow-up. However,
these improvements did not differ significantly between the groups.
Compared to the general population, significant differences (P < 0.05)
were found for the SF-36 subscales: role physical, role emotional and
bodily pain.
CONCLUSIONS: HRQoL after CABG improved markedly over time, but no
significant or clinically important differences were found when compared
with controls. Thus, work to further develop and test the effect of a HBIP
on HRQoL in patients undergoing rehabilitation following CABG is
warranted.

<46>
Accession Number
619044542
Author
Beng Leong L.; Ming N.W.; Feng L.W.
Institution
(Beng Leong, Ming, Feng) Ng Teng Fong Hospital, Emergency, Singapore,
Singapore
Title
High flow nasal cannula oxygen versus non-invasive ventilation in acute
respiratory failure? A systematic analysis of available literature.
Source
Intensive Care Medicine Experimental. Conference: 30th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2017. Austria. 5 (2
Supplement 1) (no pagination), 2017. Date of Publication: September 2017.
Publisher
SpringerOpen
Abstract
INTRODUCTION. Non-invasive ventilation (NIV) and high flow nasal cannula
(HFNC) are used in acute respiratory failure (ARF). OBJECTIVE. We
conducted this systematic review to examine their use. METHODS. We
searched several databases; including randomized trials comparing at least
NIV with HFNC or NIV + HFNC with NIV. Primary outcome was mainly
intubation rates. Secondary outcomes included ICU mortality and
morbidities. We reported medians (IQRs), p values, odds ratios (ORs) [95%
CIs]. RESULTS. Five trials were included; three compared HFNC to NIV. One
compared HFNC, NIV and oxygen therapy (OT) while one compared HFNC + NIV
with NIV. They recruited patients with acute hypoxaemic RF largely defined
as PaO<inf>2</inf>/FiO<inf>2</inf> <= 300 mmHg. Heterogeneity occurred in
patient populations, primary outcomes and study design; preventing result
pooling. Patient populations ranged from post cardiothoracic surgery to
pneumonia. Two trials were done post extubation, two pre-intubation and
one during intubation. Three trials reported patient-centred primary
outcomes (PCPOs) [re-intubation and Day 28 intubation rates]. The other
two trials reported lowest SpaO<inf>2</inf> during flexible bronchoscopy
(FB) and intubation. Three and two studies had superior and non-inferior
design respectively. Of the trials with PCPOs, the ORs for intubation or
reintubation for the NIV vs HFNC group ranged from 0.80 (95% CIs: 0.54 -
1.19) to 1.65 (95% CIs: 0.96 - 2.84). For the trials with surrogate
primary outcome, only one reported higher lowest SpaO<inf>2</inf> during
intubation in the NIV + HFNC vs NIV group [100 (IQR: 95-100)% vs 96 (IQR:
92-99)%; p = 0.029]. Important secondary outcomes were lower ICU mortality
rate in HFNC vs NIV or OT group and better patient tolerability favouring
HFNC over NIV. CONCLUSIONS. Results were conflicting but highlighted
important future research directions. These include selection of patients
with acute hypercapnic RF, more severe hypoxaemia
(PaO<inf>2</inf>/FiO<inf>2</inf> <= 200 mmHg); inclusion of an OT arm,
superior trial design and PCPOs.

<47>
Accession Number
619044501
Author
Miret M.; Danel A.; Olariu E.; Pooley N.; Preiser J.-C.
Institution
(Miret, Danel) Nestle Health Science, Vevey, Switzerland
(Olariu, Pooley) PHMR Ltd, London, United Kingdom
(Preiser) Erasme University Hospital, Universite Libre De Bruxelles,
Department of Intensive Care, Brussels, Belgium
Title
A systematic scoping review on the incidence and risk factors of
hyperglycaemia in ICU adult patients.
Source
Intensive Care Medicine Experimental. Conference: 30th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2017. Austria. 5 (2
Supplement 1) (no pagination), 2017. Date of Publication: September 2017.
Publisher
SpringerOpen
Abstract
INTRODUCTION. Stress hyperglycaemia(SHG) is common in critically ill
patients and is strongly associated with poor outcomes in intensive care
unit(ICU) patients. Many studies have been conducted to gain an insight
into the epidemiology of SHG, but a general overview of the data is
lacking. OBJECTIVE. To map the literature describing the epidemiology of
SHG in ICU patients to identify the prevalence, the incidence of SHG and
the risk factors(RF) for developing SHG. METHODS. We followed the Joanna
Briggs methodology on systematic scoping reviews to identify relevant
publications in Medline, Embase, and The Cochrane Library from January
2000 to December 2015. Two reviewers assessed studies for eligibility.
Studies were included if they reported on either the prevalence or
incidence of hyperglycaemia or risk factors for hyperglycaemia in adult
ICU patients. No definition for hyperglycaemia or RF was set apriori. Data
extraction was performed by one reviewer and checked by another. The
results presented here are for incidence and RF(if RF were reported in
more than one study). RESULTS. We identified 3062 relevant records: 385
full-text articles were screened and 92 studies(8,082,774 patients) were
included in the review. Of these, 10(13,773 patients) reported on the
incidence of SHG in the ICU. The included studies were conducted in
general ICU patients (606 patients), stroke patients (1,385 patients),
trauma patients (1,350 patients), cardiac surgical patients (1,565
patients), a mix of medical and surgical ICU patients (8,307 patients),
and surgical ICU patients (560 patients). Incidence was defined in most of
the studies (seven) as new cases of hyperglycaemia that developed during
the ICU stay without mentioning a specific time period. Studies were
mainly conducted in samples with mixed diabetic status (five studies;3,026
patients) and very few in non-diabetic patients (two studies;1,606
patients). Incidence levels varied widely, most probably due to variations
in hyperglycaemia definitions (109 mg/dl to 240 mg/dl). SHG incidence
ranged from 9.6% (blood glucose level [BGL] > 180 mg/dl) to 99% (BGL > 109
mg/dl). Studies reporting on the incidence of SHG in ICU patients are
highly heterogeneous limiting the comparability of results across studies.
RF for SHG were reported in five studies, with diabetes being the most
frequently reported RF (two studies;3,257 patients). CONCLUSIONS. Stress
hyperglycaemia is frequent in critical care patients irrespective of their
underlying condition. Assessing the risk factors at admission may help
controlling the incidence of stress hyperglycaemia and setting up
appropriate therapeutic and nutritional measures. Homogeneity in blood
glucose cut off points as well as time of measurement is determinant to
compare study results.

<48>
Accession Number
619044275
Author
Heines S.; Strauch U.; Van De Poll M.C.; Roekaerts P.M.; Bergmans D.C.
Institution
(Heines, Strauch, Van De Poll, Roekaerts, Bergmans) Maastricht University
Medical Centre+, Intensive Care, Maastricht, Netherlands
Title
Alveolar collapse and overdistension in patients with ARDS versus post
cardiac thoracic surgery patients assessed by electrical impedance
tomography.
Source
Intensive Care Medicine Experimental. Conference: 30th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2017. Austria. 5 (2
Supplement 1) (no pagination), 2017. Date of Publication: September 2017.
Publisher
SpringerOpen
Abstract
INTRODUCTION. Lung recruitment decreases alveolar collapse (CL) but may
induce regional overdistension (OD). "Optimal PEEP" can be defined as a
PEEP level where CL and OD are balanced. However, the effect of
incremental or decremental PEEP steps on OD and CL between patients post
cardiac thoracic surgery (CTS) and with ARDS is different. Electrical
impedance tomography (EIT) enables visualization of CL and OD1.
OBJECTIVES. To compare the effect of PEEP on CL and OD in ARDS and
post-CTS. METHODS. Twenty-nine ARDS patients (mean
PaO<inf>2</inf>/FiO<inf>2</inf>-ratio 141, SD 55) and 17 CTS patients
(mean PaO<inf>2</inf>/FiO<inf>2</inf>-ratio 339, SD 73) were
retrospectively analysed. Overdistension and CL were measured by EIT
during an incremental and decremental PEEP trial of 4 steps, each with a
delta pressure of 2 cmH<inf>2</inf>O. The balance between overdistended
and collapsed alveoli is calculated by adding CL to OD (ODCL). An ODCL of
0% indicates an optimal balance between CL and OD. Data are expressed as
mean (SEM). Changes in ODCL between ARDS and CTC were tested using 2-way
ANOVA. RESULTS. At baseline ODCL in CTS patients was 22% (1,5) and 14%
(1,2) in patients with ARDS. During the increment in PEEP, ODCL
significantly increased to 30% (1,7) in CTS and 32% (1,3) in ARDS (p <
0.001). The increase and decrease was significantly different in both
groups (p < 0.0001, Fig. 111). The changes in ODCL are more gradual in the
CTS group. CONCLUSIONS. Alveolar OD and CL occur simultaneously and add up
to the ODCL. The ODCL can be influenced by increasing PEEP, making the OD
more pronounced than CL. During the incremental PEEP trial the increase of
OD is larger in ARDS patients than in post- CTS patients, which is
probably due to a lower respiratory system compliance. At the beginning of
the decremental PEEP trial the ODCL is more optimal in the post-CTC
patients, which could be explained by a better alveolar recruitability.
When determining optimal PEEP settings, variations in the balance between
OD and CL should be taken into account. To this end visualization of local
ventilation by EIT appears to be a useful tool.

<49>
Accession Number
619044262
Author
Gocze I.; Jauch D.; Gotz M.; Kennedy P.; Graf B.M.; Banas B.; Bein T.;
Schlitt H.J.; Bergler T.
Institution
(Gocze, Gotz, Kennedy, Graf, Banas, Bein, Schlitt, Bergler)
Universitatsklinikum Regensburg, Regensburg, Germany
(Jauch) Universitatsklinikum Freiburg, Freiburg, Germany
Title
Biomarker-guided intervention to prevent acute kidney injury after major
surgery: The prospective randomized BigpAK study.
Source
Intensive Care Medicine Experimental. Conference: 30th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2017. Austria. 5 (2
Supplement 1) (no pagination), 2017. Date of Publication: September 2017.
Publisher
SpringerOpen
Abstract
INTRODUCTION. Early optimization of volume status, maintenance of adequate
perfusion pressure and discontinuation of nephrotoxic medication before
the occurrence of AKI may be the crucial step to reduce preventable AKI.
OBJECTIVES. To determine the impact of renal biomarker guided
implementation of the Kidney Disease Improving Global Outcomes (KDIGO)
guidelines on incidence of acute kidney injury (AKI) after major
non-cardiac surgery in randomized clinical trial. METHODS. Early
administration of KDIGO bundle was compared to standard ICU care in 121
patients with increased AKI-Risk determined by elevated urinary [TIMP2 *
IGFBP7] biomarkers. Incidence of overall AKI, severity of AKI; incidence
of creatinine increase of >25%, length of stay, major kidney events (MAKE)
at discharge and cost effectiveness between both groups were evaluated.
RESULTS. The incidence of overall AKI was not statistically different
between both groups, but incidence of moderate and severe AKI (6.7% versus
19.7%; odds ratio [95%CI] 3.43 [1.0, 11.3], p = 0.04) and incidence of
creatinine increase >25% of baseline value (40.0% versus 62.3%, OR 2.48
(1.19, 5.15), p = 0.01) were significantly reduced in the intervention
group. Additionally, length of ICU and hospital stay decreased in the
intervention group (p = 0.04) and the intervention significantly
attenuated release of cellular stress biomarker (p = 0.03). There were no
significant differences in the need for renal replacement therapy,
in-hospital mortality or in MAKE by hospital discharge. CONCLUSIONS. Among
patients after major non-cardiac surgery early biomarker- based detection
of AKI- risk followed by implementation of KDIGO bundle reduced AKI
severity, postoperative creatinine increase, length of ICU and hospital
stay.

<50>
Accession Number
619044214
Author
Ederoth P.; Dardashti A.; Grins E.; Bronden B.; Metzsch C.; Erdling A.;
Nozohoor S.; Mokhtari A.; Hansson M.J.; Elmer E.; Algotsson L.; Jovinge
S.; Bjursten H.
Institution
(Ederoth, Dardashti, Grins, Bronden, Metzsch, Erdling, Algotsson) Lund
University, Department of Anesthesiology and Intensive Care, Clinical
Sciences, Lund, Sweden
(Nozohoor, Mokhtari) Lund University, Department of Cardiothoracic
Surgery, Clinical Sciences, Lund, Sweden
(Hansson, Elmer) Lund University, Department of Mitochondrial Medicine,
Clinical Sciences, Lund, Sweden
(Jovinge) Van Andel Institute, Fredrik Meijer Heart and Vascular Institute
Spectrum Health, Grand Rapids, United States
(Jovinge) Stanford University, School of Medicine, Cardiovascular
Institute, Stanford, United States
(Bjursten) Lund University, Department of of Cardiothoracic Surgery,
Clinical Sciences, Lund, Sweden
Title
Ciclosporin to protect renal function in cardiac surgery (CiPRICS). A
double blind, randomized, placebo controlled, proof of concept study.
Source
Intensive Care Medicine Experimental. Conference: 30th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2017. Austria. 5 (2
Supplement 1) (no pagination), 2017. Date of Publication: September 2017.
Publisher
SpringerOpen
Abstract
INTRODUCTION. A possible mechanism for acute kidney injury (AKI) after
cardiac surgery is ischemia-reperfusion injury caused by the
Extracorporeal Circulation (ECC) [1], resulting in opening of the
mitochondrial Permeability Transition Pore (mPTP) [2] in the kidneys,
which in turn can led to cell injury or death [3]. Cyclophilin-D is a key
regulator of the mPTP [4]. Animal studies have shown that ciclosporin may
block the opening of mPTP by inhibition of cyclophilin-D [5] in the
kidneys and decrease the renal injury [6] if administered before the
ischemia-reperfusion event. OBJECTIVES. We hypothesised that ciclosporin
given as a single dose before start of ECC in coronary artery bypass
grafting (CABG) surgery will decrease the degree of AKI. METHODS. The
CiPRICS study is an investigator-initiated, doubleblind, randomized,
placebo-controlled, single-centre study performed at Skane University
Hospital (Lund, Sweden). The study was approved by the Regional Ethical
Review Board and registered under NCT02397213 and EudraCT: 2014-004610-29.
Before enrolment, oral and written informed consent was obtained. Between
April 2015 and June 2016, 154 patients with estimated glomerular
filtration rate of 15-90 mL/min/1.73m² planned for elective
CABG with ECC were enrolled. Study patients were randomized in a 1:1 ratio
to receive 2.5 mg/kg ciclosporin or placebo intravenously after
anaesthesia induction but before surgery. Primary endpoint was relative
plasma cystatin C changes from the preoperative day to postoperative day
3, tested with a linear mixed model in the mITT population. Secondary
endpoints included biomarkers of kidney, heart, and brain injury. Safety
data was collected from administration of study drug. An independent Data
Safety Monitoring Board evaluated the study after 50 and 100 patients had
received study drug and recommended the study to continue without changes
in protocol. RESULTS. The ciclosporin group showed a more pronounced
relative increase from baseline plasma cystatin C to day 3 compared to
placebo (1.36 +/- 0.35 vs 1.16 +/- 0.31, p < 0.001). The same pattern was
observed for the other renal markers. There were no differences in
clinical outcome or AE/SAE distribution between the groups. CONCLUSIONS.
Administration of ciclosporin 2.5 mg/kg before surgery did not protect
CABG patients from AKI. Instead, ciclosporin caused a transient decrease
in renal function compared to placebo.

<51>
Accession Number
619044196
Author
Kotani T.; Bito K.; Kimura S.; Shono A.
Institution
(Kotani, Bito, Kimura) Showa University, Anesthesiology and Critical Care
Medicine, Tokyo, Japan
(Shono) Shimane University, Anesthesiology, Izumo, Japan
Title
Positive end expiratory pressure levels evaluated by two different methods
using electrical impedance tomography had different effects on oxygenation
after cardiac surgery.
Source
Intensive Care Medicine Experimental. Conference: 30th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2017. Austria. 5 (2
Supplement 1) (no pagination), 2017. Date of Publication: September 2017.
Publisher
SpringerOpen
Abstract
INTRODUCTION. Positive end expiratory pressure (PEEP) is one of the
important factors to provide better global and regional ventilation
distribution that leads to better oxygenation and to prevent
ventilator-induced lung injury. However, the method to set PEEP safely and
effectively is still not established. It is reported that electrical
impedance tomography (EIT) can provide valuable information to determine
PEEP level in an independent patient. OBJECTIVES. In this study we
assessed PEEP to obtain even distribution of global and regional
ventilation using two different methods of EIT in patients after elective
cardiac surgery, and investigated the clinical efficacy of each
EIT-evaluated PEEP. METHODS. A decremental PEEP trial (from 20 to 4
cmH<inf>2</inf>O of PEEP, 8 steps of every 2 cmH<inf>2</inf>O) was
performed in 22 consecutive postcardiac surgery patients in the intensive
care unit. At each PEEP step, EIT measurements were performed and
recorded. Using EIT machine at bedside (online PEEP) and software later
(offline PEEP), the lowest PEEP at which dorsal ventilation was preserved
was determined in each way. The surgeon who had no knowledge of the
experiment could change the PEEP one hour after determining PEEP. Time
course of oxygenation and ventilation distribution were investigated and
compared between the patients ventilated with EIT-evaluated PEEP until
weaning and the patients ventilated with reduced PEEP. Wilcoxon rank sum
test and chi-square test were used for statistical analysis as
appropriate. RESULTS. Online and offline PEEP were 10 (6-15) and 10 (8-14)
cmH<inf>2</inf>O, respectively (median (interquartile range), p = 0.96).
After 1 hour PEEP was decreased in 9 cases and in 6 of them dorsal
ventilation decreased later. In contrast, PEEP was maintained at
EIT-evaluated level in 13 cases and dorsal ventilation decreased in 3 of
them (p = 0.04). In 8 cases EIT-evaluated PEEP was maintained until
weaning process was started and their oxygenation was preserved by
standard oxygen therapy, whereas in 6 of 14 cases PEEP was decreased from
EIT-evaluated level and the patients required non-invasive positive
pressure ventilation or high flow nasal cannula oxygen therapy (p = 0.03).
CONCLUSIONS. Offline EIT-evaluated PEEP provided better dorsal ventilation
distribution and might have an impact on oxygenation and oxygen therapy
after extubation.

<52>
Accession Number
619044026
Author
Pilarczyk K.; Lubarksi J.; Demircioglu E.; Huschens B.; Jakob H.; Dusse F.
Institution
(Pilarczyk) Imland Klinik Rendsburg (managed by Sana AG), Department of
Intensive Care Medicine, Rendsburg, Germany
(Lubarksi, Demircioglu, Huschens, Jakob) West German Heart and Vascular
Center, University Hospital Essen, Department for Thoracic and
Cardiovascular Surgery, Essen, Germany
(Dusse) University Witten/Herdecke, Medical Centre Cologne-Merheim,
Department of Anaesthesiology and Intensive Care Medicine, Koln, Germany
Title
Veno-arterial carbon dioxide difference/arterial-venous oxygen difference
ratio but not central venous oxygen saturation or lactate predict increase
in oxygen consumption in fluid responders after cardiac surgery.
Source
Intensive Care Medicine Experimental. Conference: 30th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2017. Austria. 5 (2
Supplement 1) (no pagination), 2017. Date of Publication: September 2017.
Publisher
SpringerOpen
Abstract
INTRODUCTION. Fluid responsiveness is defined as an increase of stroke
volume after a fluid challenge. However, primary goal of volume
resuscitation in critically ill patients is an increase in oxygen
consumption (VO2). OBJECTIVE. To evaluate the ability of mixed venous
oxygen saturation (SvO<inf>2</inf>), lactate and markers of anaerobic
metabolism (mixed venous-to-arterial carbon dioxide tension difference
(DELTAPCO<inf>2</inf>) and DELTAPCO<inf>2</inf>/arteriovenous oxygen
content difference ratio (DELTAContO<inf>2</inf> ratio) to predict whether
a fluid-induced increase in oxygen delivery (DO<inf>2</inf>) results in an
increase in oxygen consumption (VO<inf>2</inf>). METHODS. 45 consecutive
hemodynamically stable patients after cardiac surgery were enrolled in
this study. Hemodynamic variables, Lactate and SvO<inf>2</inf> were
assessed with pulmonary artery catheter (PAC) before and after a
crystalloid fluid challenge of 6ml/kgBW. Fluid and VO<inf>2</inf>
responsiveness was defined as increase of stroke volume and VO<inf>2</inf>
> 15%, respectively, after fluid challenge. RESULTS. 28 out of 45 patients
were fluid-responders (62.2%). In these patients, DO2 increased
significantly (DELTADO<inf>2</inf> 98. +/- 107.3 ml/min) whereas
DO<inf>2</inf> decreased in fluid-non-responders due to a
hemodilution-induced decrease in hematocrit (DELTADO<inf>2</inf> -9.3. +/-
81.4 ml/ min). An increase in oxygen consumption >=15% (VO2-responders)
was observed in 29% of these 28 volume-responders. Compared with
VO2-non-responders, VO<inf>2</inf>-responders were characterized by higher
DELTAPCO<inf>2</inf> (4.7 +/- 1.8 vs. 3.5 +/- 1.1, p = 0.04) and
DELTAPCO<inf>2</inf>/DELTAContO<inf>2</inf> ratio (4.7 +/- 1.9 vs. 0.9 +/-
0.3, p > 0.001) whereas lactate (2.2 +/- 1.3 vs. 1.8 +/- 0.8) and
SvO<inf>2</inf> (66.9 +/- 7.1 vs. 65.3 +/- 6.7) did not show any group
difference. A fluid-induced increase in oxygen consumption greater > 15%
was not predicted by baseline SvO<inf>2</inf>, Lactate and
DELTAPCO<inf>2</inf> but DELTAPCO<inf>2</inf>/DELTAContO<inf>2</inf> ratio
(AUC 0.731 +/- 0.091, p = 0.03). CONCLUSION. Whereas SvO<inf>2</inf> and
lactate failed to predict VO<inf>2</inf> responsiveness,
DELTAPCO<inf>2</inf>/DELTAContO<inf>2</inf> ratio might help to identify
patients that will increase oxygen consumption after fluid administration.
This suggests that after assessing hemodynamic fluid-responsiveness,
indicators of anaerobic metabolism e.g.
DELTAPCO<inf>2</inf>/DELTAContO<inf>2</inf> ratio should be considered to
identify patients that will benefit from fluid expansion in terms of an
increase in VO<inf>2</inf>.

<53>
Accession Number
619043855
Author
Kirov M.; Putanov M.; Sokolova M.; Lenkin P.; Slastilin V.; Baskakova I.;
Kiriluk A.; Chetskaja K.; Isakova T.; Rumjantseva M.
Institution
(Kirov, Sokolova, Lenkin, Kiriluk, Chetskaja, Isakova, Rumjantseva)
Northern State Medical University, Arkhangelsk, Russian Federation
(Putanov, Slastilin, Baskakova, Rumjantseva) City Hospital 1 of
Arkhangelsk, Arkhangelsk, Russian Federation
Title
Use of brain protein "Cellex" for prevention of postoperative cognitive
dysfunction after cardiac surgery.
Source
Intensive Care Medicine Experimental. Conference: 30th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2017. Austria. 5 (2
Supplement 1) (no pagination), 2017. Date of Publication: September 2017.
Publisher
SpringerOpen
Abstract
INTRODUCTION. Cardiac surgery can be accompanied by cognitive dysfunction
and complicated postoperative period. Recently, a novel brain protein
"Cellex" has been introduced into clinical practice. However, despite
several promising pilot studies after stroke, its' role for attenuation of
postoperative cognitive dysfunction is still unsettled. OBJECTIVES. The
aim of our study was to evaluate the efficacy of brain protein "Cellex"
for prevention of postoperative cognitive dysfunction after cardiac
surgery. METHODS. Our study included 60 patients undergoing elective
cardiosurgical operations who were randomized into two groups. In the
"Cellex" group, the patients received 1,0 ml of "Cellex" subcutaneously
daily during 8 days, beginning from the preoperative day; the control
group received a saline treatment as a placebo. The cognitive function was
assessed using Montreal cognitive assessment (MoCA) test. The plasma
concentration of S 100b protein was measured before the surgery, at Days 3
and 7. The patients received monitoring of gas exchange, hemodynamics and
cerebral oxygenation. In addition, the efficacy of "Cellex" and the
severity of cognitive dysfunction were evaluated in operations with
cardiopulmonary bypass (CPB). RESULTS. There was no difference between
groups in age and preoperative MoCA score. The duration of surgery and
mechanical ventilation, as well as hemodynamics and cerebral oxymetry data
also did not differ significantly. There was a transient decrease of
cognitive functions at Day 3 after surgery in both groups (p < 0.01). At
Day 7, the MoCA score was still decreased in the control group (p < 0.003)
but returned to baseline in the "Cellex" group; these effects were more
evident after surgery with CPB. The plasma concentrations of S100b protein
at Day 7 after surgery correlated with baseline MoCA score and PaCO2
during early postoperative period; intraoperative PaCO2 was also
associated with cerebral oxygenation. CONCLUSIONS. The perioperative use
of "Cellex" can attenuate cognitive dysfunction after cardiac surgery,
especially after interventions with CPB.

<54>
Accession Number
619043673
Author
Faivre G.; Burtin P.; Leclercq C.; Berthezene R.; Roussiaux A.; Halchini
C.
Institution
(Faivre, Burtin, Leclercq, Berthezene, Roussiaux, Halchini) Clinique
Millenaire, Montpellier, France
Title
Is left ventricular global longitudinal strain (AvgGLS) impairment after
cardiopulmonary bypass related to anesthesia technique? A single center
pilot study.
Source
Intensive Care Medicine Experimental. Conference: 30th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2017. Austria. 5 (2
Supplement 1) (no pagination), 2017. Date of Publication: September 2017.
Publisher
SpringerOpen
Abstract
INTRODUCTION. Strain Analysis by 2D T<inf>EE</inf> is a new technology
allowing a semiobjective and quantitative measure of regional myocardial
function (1) which is less preload dependant than left ventricular
ejection fraction (LVEF). Applications of Speckle-tracking Strain imaging
in the perioperative period of cardiac surgery are still being evaluated
(2). The only study available with a before/after CPB design demonstrated
a LV improvement and a RV impairment after aortic valve replacement (3).
OBJECTIVES. We conducted a pilot observational study to assess LV strain
modification before/after CPB and investigate the role of anesthesia
technique. METHODS. All scheduled cardiac surgery patients with a complete
perioperative T<inf>EE</inf> examination (10/01/2016 to 01/31/2017) were
included. T<inf>EE</inf> was performed with a GE Vivid S70 device, before
sternal incision and after sternal closure. Speckle-tracking Strain
imaging calculations were made on site using the vendor software (AFI)
using 3 incidences (APLAX, 4C, 2C). Patients were divided in two groups
depending on the anesthesia technique with volatile anesthetics (HALOG) or
with total intravenous anesthesia (TIVA). Normothermic blood cardioplegia
is used in all patients. Groups were compared using Student t and Chi2
tests as indicated (p < 0.05 significant). RESULTS. 63 patients were
included : 25 AVR, 36 CABG, 1 MVR, 1 AVR + CABG. 25 patients are in group
TIVA, 38 in group HALOG. Some characteristics are shown in Table 145.
Overall, a significant decrease is observed for AvgGLS before and after
CPB (-13,60% +/- 4,44 (IC95% : [- 12,48%;-14,72%]) vs -10,60% +/- 5,70
(IC95% : [-9,17%:-12,02%]), p < 0,05). There is no difference between TIVA
and HALOG groups for the characteristics studied (Table 146). This is the
first study investigating the role of anesthesia technique on LV strain
modification in cardiac surgery. We observed an overall impairment of LV
strain in our study, and this result is not consistent with the only study
available to date (3). While mean decrease of AvgGLS was larger in the
HALOG group, there is no statistically significant role of volatile
anesthetics on LV strain variation. These findings should be investigated
through a randomized controlled trial in order to assess the factors
accounting for LV strain impairment in the perioperative period of cardiac
surgery. Further studies are also needed to assess the role of GLS
impairment on patients outcome. Speckle-tracking Strain imaging could be
used as a unique clinical tool to investigate the pharmacologic effect on
the myocardium of anesthesia and cardioplegia techniques. CONCLUSIONS.
T<inf>EE</inf> measurement of the global longitudinal strain didn't reveal
any significant difference on the alteration of LV function and patient's
outcome according to the type of anesthesia in cardiac surgery with CPB.
(Figure Presented).

<55>
Accession Number
619043654
Author
Alnajjar M.M.; Abokhudair W.A.; Rajab M.F.; Albuti H.M.; Shennawy M.M.;
Badawy A.A.
Institution
(Alnajjar, Rajab, Badawy) King Fahd Armed Forces Hospital, Jeddah,Cardiac
Care Unit, Cardiac Services Department, Jeddah, Saudi Arabia
(Abokhudair) King Fahd Armed Forces Hospital, Jeddah,Head of Adult Cardiac
Surgery Department, Jeddah, Saudi Arabia
(Albuti) King Fahd Armed Forces Hospital, Jeddah,Clinical Pharmacy
Department, Jeddah, Saudi Arabia
(Shennawy) King Fahd Armed Forces Hospital, Jeddah,Cardiac Anaesthesia
Unit, Cardiac Services Department, Jeddah, Saudi Arabia
Title
Effect of levosimendan on the short-term clinical course of
cardiomyopathic patients after cardiopulmonary bypass surgery.
Source
Intensive Care Medicine Experimental. Conference: 30th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2017. Austria. 5 (2
Supplement 1) (no pagination), 2017. Date of Publication: September 2017.
Publisher
SpringerOpen
Abstract
INTRODUCTION. Levosimendan is an inodilator indicated for the short-term
treatment of acutely decompensated severe chronic heart failure, and in
situations where conventional therapy is not considered adequate.
Levosimendan improves cardiac function by a novel mechanism of action
compared to currently available drugs. We hypothesized that, in patients
with severely compromised ventricular function, the use of levosimendan
would be associated with better postoperative cardiac function than with
inotropic drugs that increase myocardial oxygen consumption. OBJECTIVES.
To evaluate the efficacy and safety of levosimendan, given intravenously
to cardiomyopathic patients during and after cardiopulmonary bypass
surgery METHODS. 250 patients with a preoperative ejection fraction <=30%
scheduled for elective cardiac surgery with cardiopulmonary bypass were
subjected to two different inotropic protocols: group A (levosemindan
goup) levosimendan started immediately after the release of the aortic
cross clamp by loading dose 6 mug / kg administered in 10 minutes then 0.1
mg /kg/ min continuous intravenous infusion in addition to our standard
protocol started immediately after finishing the loading dose and
maintained for 48 hours infusion. And group B (usual protocol group)
received our standard protocol for these cases milrinone +/- dobutamine
and noradrenalin, adrenalin and dopamine according to blood pressure. The
treatment was masked to the observers. We assessed Haemodynamics of
patients using Flotrac, Invasive arterial pressure monitoring, blood
lactate level in ABG samples. RESULTS. Cardiac Index was similar between
groups initially after surgery, but it declined 12 h after surgery in the
usual inotropic group but not in the levosemindan group (P < 0.05 between
groups) despite similar filling pressures. Total dose, duration of
inotropic drug administration and norepinephrine dose were lower in the
levosimendan group than in the usual inotropic group (P < 0.05). The
duration of tracheal intubation and Intensive care length of stay were
shorter in the Levosemindan group compared with the group B (P < 005).
Three patients in the group B died within 30 days of surgery but only one
in levosemindan group. CONCLUSIONS. In cardiac surgery patients with a low
preoperative ejection fraction, Cardiac index and stroke volume was better
maintained when adding levosimendan to our inotropic protocol. Also, ICU
LOS was decreased with no increased risk of adverse Cardiovascular events.

<56>
Accession Number
619043616
Author
Santonocito C.; De Loecker I.; Chiarenza F.; Cucuzza G.; Sanfilippo F.;
George S.; Astuto M.; Vincent J.L.
Institution
(Santonocito) Oxford University Hospitals NHS Trust, Anesthesia and
Intensive Care, Oxford, United Kingdom
(De Loecker, Vincent) Erasme Hospital, Universite Libre De Bruxelles,
Department of Intensive Care, Brussels, Belgium
(Chiarenza, Cucuzza, Sanfilippo, George) Oxford University Hospitals NHS
Trust, Oxford, United Kingdom
(Astuto) Policlinico University Hospital Catania, Catania, Italy
Title
Biomarkers and sepsis after cardiac surgery: C-reactive protein kinetics,
is it reliable?.
Source
Intensive Care Medicine Experimental. Conference: 30th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2017. Austria. 5 (2
Supplement 1) (no pagination), 2017. Date of Publication: September 2017.
Publisher
SpringerOpen
Abstract
INTRODUCTION.Sepsis is a leading cause of morbidity and mortality in
acutely ill patients, and after major surgery the early diagnosis of
sepsis is challenging [1].OBJECTIVES.To analyze CRP and WBC kinetics
during the first postoperative (PO) week after cardiac surgery and between
groups of patients with and without postoperative infection
(POI).METHODS.This is a multicenter retrospective observational study
conducted from Nov 2013 to Aug 2014.We screened all post cardiac surgery
patients admitted to the Cardithoracic Critical Care Unit at JR Hospital
in Oxford and to the Intensive Care Unit at Erasme University Hospital in
Bruxelles.We included all adult (>18 yrs) patients post cardiac surgery
(elective/emergency), ON/OFF CPB.We excluded: ongoing preoperative
infections (including endocarditis), thoracic interventions, trauma,
pregnancy, immunocompromised, cirrhotic patients.Four groups were
identified: CABG (ON/OFF CPB), valve replacement (R), valve repair (r),
CABG + valve r/R.For all subgroups, we separated patients who developed a
PO infection from the others.EUROSCORE, SOFA score, clinical,
microbiological data, CRP, WBC values, antibiotic therapies were daily
recorded up to 7 POD in ICU and in the ward.Intraoperatively, as routine
practice, at Erasme Hospital, a bolus of steroid was administered before
starting on CPB.RESULTS.A total of 511 patients were screened, and 429
included.Baseline patients characteristics are presented in (Table
184).When compared ON-CPB vs OFF-CPB CABG, considering patients without
POI, no difference was found on CRP kinetics at JRH, while data from
Erasme showed CRP significant rising during POD1, 2 and 3 in the group
OFF-CPB CABG (Fig.244).No difference was observed for WBC count.In the
ON-CPB CABG group, infected patients had higher CRP values than patients
with no infection from POD3 to POD7 (Fig.245), with cut off values ranging
from 131 to 153 mg/dl (Table 184); and from 8 to 18.5 mg/dl when steroids
were administered preCPB (Table 186).Moreover, when no steroids were
given, we got higher WBC values in the patients group with POI from POD0
to POD3.In the OFF-CPB CABG and post valve surgery groups, no difference
was found for CRP and WBC kinetics between patients with and without
POI.CONCLUSIONS.Interestingly, the ON-CPB group did not show higher CRP
and WBC values than the OFF-CPB group despite the use of CPB, probably due
to the high biocompatibility of the new pump circuits.After ON-CPB CABG,
higher CRP values after POD3 could help in detecting PO infections.CRP got
higher sensitivity and specificity from POD3 to POD7, while WBC count from
POD0 to POD3.Post valve and valve + CABG surgery no WBC count difference
was found between infected and not infected.

<57>
Accession Number
619043554
Author
Amezcua-Gutierez M.A.; Zamora-Gomez S.E.; Gorordo-Delsol L.A.;
Montoya-Rojo J.O.; Lima-Lucero I.M.; Montesinos-Cruz E.S.; Garduno-Lopez
J.; Hernandez-Romero M.; Toledo-Rivera M.A.; Carrasco-Flores M.A.;
Hernandez-Lopez G.D.; Castanon-Gonzalez J.A.
Institution
(Amezcua-Gutierez, Zamora-Gomez, Gorordo-Delsol, Montoya-Rojo,
Lima-Lucero, Montesinos-Cruz, Garduno-Lopez, Hernandez-Romero,
Toledo-Rivera, Carrasco-Flores, Hernandez-Lopez, Castanon-Gonzalez)
Hospital Juarez De Mexico, Intensive Care Unit, Mexico City, Mexico
Title
Comparison of four ventilation modes for weaning mechanical ventilation.
Source
Intensive Care Medicine Experimental. Conference: 30th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2017. Austria. 5 (2
Supplement 1) (no pagination), 2017. Date of Publication: September 2017.
Publisher
SpringerOpen
Abstract
INTRODUCTION.The weaning is a key element of mechanical ventilation (MV),
occupying up to 50% of its duration.It's crucial to identify the right
time to extubate, since re-intubation is associated with an increased risk
infections, prolonged ICU-LOS, death and substantially increased
costs.Innovative modes of MV, mainly based on complex closed loop, have
been developed and are available for clinical use, therefore, it is
necessary to compare them with conventional modes for
weaning.OBJECTIVES.Determine the relationship between success in weaning
and the ventilatory modes used at the ICU of a thertiary hospital Mexico
City.METHODS.A retrospective analysis, during last 5 months of 2016,
collected patients who received MV and were ready for weaning, randomly
assigned to one MV mode for weaning: Pressure Support (PSV), Mandatory
Minute Volume (MMV), Proportional Assist Ventilation (PAV) and Adaptive
Support Ventilation (ASV).Standardized protocols were followed for each MV
mode.RESULTS.We collected 51 patients (28 males).The causes of MV were:
acute respiratory failure (ARF) 27%, neurocritical care 24%, abdominal
surgery 16%, thoracic surgery 10%, acute heart failure 10%, and other
14%.The distribution by mode of MV was PSV = 28, ASV = 10, PAV = 7 and MMV
= 6.The average time of MV was 4.72, 3.1, 5.77 and 2.73 days respectively,
with an overall average time of 4,05 days.Total patients per group,
successful weaning, mean and variance in Table 193.The analysis of
variance show the sum of the squares = 4.5098, 3 degrees of freedom
intergroups and 47 intragroups, through F-test we obtain F = 0.2616 and a
ciritical value for F = 2.8023, and p = 0.8526, so there is no variation
in the 4 ventilatory modes used in for weaning.CONCLUSIONS.The PSV mode
was the most used, similar to international literature.There is no
significant difference between the 4 modes used.Nevertheless, the study
regarding modes to facilitate weaning remains of interest, large sample
are needed to elucidate the role of ventilatory modes, as well as to
analyze other variables that may contribute to the success or failure of
the weaning protocol.

<58>
Accession Number
619043507
Author
Flechet M.; Guiza F.; Vlasselaers D.; Desmet L.; Lamote S.; Delrue H.;
Beckers M.; Casaer M.P.; Wouters P.; Van den Berghe G.; Meyfroidt G.
Institution
(Flechet, Guiza, Vlasselaers, Desmet, Lamote, Delrue, Beckers, Casaer,
Wouters, Van den Berghe, Meyfroidt) KU Leuven, Laboratory of Intensive
Care Medicine, Leuven, Belgium
Title
Predictive value of cerebral oximetry for acute outcomes after pediatric
cardiac surgery: A prospective observational study.
Source
Intensive Care Medicine Experimental. Conference: 30th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2017. Austria. 5 (2
Supplement 1) (no pagination), 2017. Date of Publication: September 2017.
Publisher
SpringerOpen
Abstract
INTRODUCTION.Near-infrared spectroscopy (NIRS) has been proposed as a
technique to monitor cerebral tissue oxygen saturation (SctO<inf>2</inf>)
non-invasively and continuously.NIRS-based monitors are increasingly used
in perioperative monitoring of children undergoing surgery for congenital
heart disease (1).However, the usefulness of postoperative NIRS-based
monitoring remains unclear.OBJECTIVES.To assess whether SctO<inf>2</inf>
is predictive for prolonged intensive care unit (ICU) stay and for
prolonged duration of invasive mechanical ventilation in critically ill
children after pediatric cardiac surgery.METHODS.Single-center
prospective, observational study (Clinical Trials.gov, NCT01706497) of 177
critically ill children and infants with congenital heart disease, younger
than 12 years old, admitted to the pediatric ICU between October 2012 and
November 2015.Children were monitored with the FORESIGHT cerebral oximeter
from ICU admission until they were weaned off mechanical ventilation.Using
the first 24 hours of SctO<inf>2</inf>, we defined a SctO<inf>2</inf>
desaturation score, using the percentage of area below 50%, and a low
frequency variability, using the standard deviation of a smoothed signal
created by taking the median of a rolling 20-sample window of the initial
SctO<inf>2</inf> signal.RESULTS.Outcome was predictive value of
postoperative SctO<inf>2</inf> for duration of ICU stay (Table 251, median
(95% confidence interval), 4 days (3-8)) and duration of mechanical
ventilation (median (95% confidence interval), 111.3 hours
(69.3-190.4)).In a multivariable bootstrap analysis adjusted for age,
weight, gender, PIM2, cyanogenic cardiopathy and time prior to
SctO<inf>2</inf> monitoring, risk factors associated with worse outcomes
included increased SctO<inf>2</inf> variability and elevated
SctO<inf>2</inf> desaturation score below 50%.Patients with cyanogenic
cardiopathy had lower SctO<inf>2</inf> (P < 0.001), stayed longer in the
ICU (P = 0.002) and were longer mechanically ventilated (Table 251, P =
0.002).In these patients, only the SctO<inf>2</inf> low frequency
variability was a significant predictor of adverse outcomes.On the
contrary, in patients without cyanogenic cardiopathy, the variability was
not predictive for adverse outcome but the mean SctO<inf>2</inf> and the
desaturation score below 50% were predictive.CONCLUSIONS.Increased
SctO<inf>2</inf> variability and elevated SctO<inf>2</inf> desaturation
score are associated with longer ICU stay and with longer duration of
mechanical ventilation after pediatric cardiac surgery.Further research is
required to investigate how these measures can be used to drive
therapeutic interventions and to investigate additional possible clinical
applications.

<59>
Accession Number
619043493
Author
Kossivas P.; Dimopoulos S.; Doubou D.; Nanas S.; Marathias K.; Karabinis
A.; Routsi C.
Institution
(Kossivas, Dimopoulos, Doubou, Marathias, Karabinis) Onassis Cardiac
Surgery Center, Surgical Intensive Care Unit, Athens, Greece
(Nanas, Routsi) National and Kapodistrian University of Athens,
Evangelismos Hospital, Department of Intensive Care, Athens, Greece
Title
Factors associated with delayed weaning from mechanical ventilation in
patients after cardiac surgery.
Source
Intensive Care Medicine Experimental. Conference: 30th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2017. Austria. 5 (2
Supplement 1) (no pagination), 2017. Date of Publication: September 2017.
Publisher
SpringerOpen
Abstract
INTRODUCTION.Patients undergoing cardiac surgery are generally able to
wean from mechanical ventilation within the first postoperative hours.Some
patients however, require mechanical ventilation for a longer period and
this is associated with morbidity and costs.OBJECTIVES.The aim of this
study was to identify factors associated with delayed weaning from
mechanical ventilation, following cardiac surgery.METHODS.A prospective
study was performed including consecutive, adult patients who had
undergone an elective cardiac surgery and were admitted to ICU.Demographic
and clinical characteristics, preand intraoperative parameters and type of
surgical procedure were recorded.The patients underwent a weaning trial
under low-level pressure support.They were divided into 2 groups: Group A
included patients who weaned from mechanical ventilation within 12 hours
after surgery and Group B those who were mechanically ventilated for more
than 12 hours following ICU admission.RESULTS.Ninety patients (mean age 67
+/- 10 years, 62 males) who have undergone a cardiac surgical procedure
(coronary artery bypass grafting, valve replacement, ascending aortic
aneurysm repair or combined surgery) were studied.Group A included 70
patients (mean duration of mechanical ventilation 8.5 +/- 1.6 hours) and
Group B the remaining 20 patients (mean duration of mechanical ventilation
55.6 +/- 35 hours).Compared to patients in Group A, the Group B patients
were older (mean age of 72 +/- 9 vs.65 +/- 11 years, p = 0.004); they had
increased duration of cardiopulmonary bypass and aortic cross-clamping
(171 +/- 28 vs.93 +/- 30 min and 123.8 +/- 21.3 vs.70.6 +/- 27.6 min,
respectively, p < 0.001) and more red blood cells (RBCs) transfusion (4.5
vs.1.6, p = 0.027).On ICU admission, central venous oxygen content
(ScvO<inf>2</inf>) was significantly lower in Group B patients compared to
Group A (64 +/- 7 vs.67 +/- 5, p < 0.001), and serum troponin I was
significantly higher (13.7 +/- 2.7 ng/ml vs.4.2 +/- 2.8 ng/ml, p <
0.05).During the weaning trials the respiratory frequency / tidal volume
was lower in Group A patients compared to Group B (32.6 +/- 7.8 vs.42.3
+/- 17.9 respectively, p = 0.038).Also, combined surgery as compared to a
single surgical procedure was associated with delayed discontinuation from
the ventilator (p = 0.043).CONCLUSIONS.Increased age, increased duration
of extracorporeal circulation and aortic clamping, RBCs transfusion
number, low ScvO<inf>2</inf> and high troponin I values following surgery,
and combined surgery should be considered as factors that delay the
weaning from mechanical ventilation in patients after cardiac surgery.

<60>
Accession Number
619043380
Author
Kobayashi T.; Onodera Y.; Suzuki H.; Nakane M.; Kawamae K.
Institution
(Kobayashi, Nakane) Yamagata University, Faculty of Medicine, Emergency
and Critical Care Medicine, Yamagata, Japan
(Kobayashi, Onodera, Suzuki, Kawamae) Yamagata University, Faculty of
Medicine, Anaesthesiology, Yamagata, Japan
Title
Manual ASV vs INTELLiVENT-ASV for the patients after cardiac surgery-are
automated ventilators better for the patients?.
Source
Intensive Care Medicine Experimental. Conference: 30th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2017. Austria. 5 (2
Supplement 1) (no pagination), 2017. Date of Publication: September 2017.
Publisher
SpringerOpen
Abstract
INTRODUCTION.Automated ventilators (INTELLiVENT-ASV:I-ASV), with which
physicians only need to set target PETCO<inf>2</inf> and SpO<inf>2</inf>
levels, were developed to provide more appropriate ventilation to patients
and reduce medical staff workloads.However, I-ASV has not been thoroughly
investigated for the patients after cardiac surgery.Thus, we compared
ventilator settings adjusted by I-ASV and manual ASV (M-ASV) after cardiac
surgery in our ICU.OBJECTIVES.To assess feasibility of I-ASV for the
patients after cardiac surgery.METHODS.We enrolled patients who underwent
cardiac surgery from July 2013 to April 2014.After ICU admission, patients
were randomized into two groups: I-ASV and M-ASV.With I-ASV,
SpO<inf>2</inf> target shift was fixed to +3 and PETCO<inf>2</inf> target
shift was adjusted for PaCO<inf>2</inf> of 35-45 mmHg.Ventilator settings
were automatically adjusted until spontaneous breathing test.With M-ASV,
PEEP, FIO<inf>2</inf> and %minute volume (%MV) were initially decided by
ICU physicians.PEEP and %MV were adjusted by physicians and
FIO<inf>2</inf> was adjusted by nursing staff based on arterial blood gas
analysis.Ventilator settings (PEEP, FIO<inf>2</inf>, %MV), P/F ratio,
PaO<inf>2</inf>, respiratory rate (RR) and PaCO<inf>2</inf> were recorded
each hour after ICU admission for 24 hours.Statistical analysis was made
by Wilcoxon rank sum test, and pvalues of < 0.05 were considered
significant.RESULTS.Data from 48 patients were analysed (I-ASV: 28, M-ASV:
20).No safety issues occurred.All of the parameters (PEEP,
FIO<inf>2</inf>, %MV, P/ F ratio, PaO<inf>2</inf>,RR and PaCO<inf>2</inf>)
were not detected significant difference as a trend, except for
FIO<inf>2</inf> from one to six hours after the operation.The
FIO<inf>2</inf> of I-ASV group is much lower than that of M-ASV group
(IASV versus M-ASV: FIO<inf>2</inf>-1h 0.3(0.3 to 0.34) versus 0.4 (0.35
to 0.49), FIO<inf>2</inf>-2h 0.3 (0.3 to 0.33) versus 0.4 (0.3 to 0.4),
FIO<inf>2</inf>-3h 0.3 (0.3 to 0.32) versus 0.4 (0.3 to 0.4),
FIO<inf>2</inf>-4h 0.3 (0.3 to 0.33) versus 0.38 (0.3 to 0.4), and
FIO<inf>2</inf>-6h 0.3 (0.3 to 0.32) versus 0.35 (0.3 to 0.4),
respectively; P < 0.05).CONCLUSIONS.I-ASV ventilator adjustments were not
much different compared with M-ASV settings.FIO<inf>2</inf> during early
phase was set lower by I-ASV, although oxygenation was not different.Thus,
INTELLiVENTASV use may be feasible for patients after cardiac surgery.

<61>
Accession Number
619043345
Author
Pilarczyk K.; Wiens F.; Jakob H.; Huschens B.; Demircioglu E.; Dusse F.
Institution
(Pilarczyk, Wiens) Imland Klinik Rendsburg (managed by Sana AG),
Department of Intensive Care Medicine, Rendsburg, Germany
(Jakob, Huschens, Demircioglu) West German Heart and Vascular Center,
University Hospital Essen, Department for Thoracic and Cardiovascular
Surgery, Essen, Germany
(Dusse) University Witten/Herdecke, Medical Centre Cologne-Merheim,
Department of Anaesthesiology and Intensive Care Medicine, Koln, Germany
Title
Effect of lormetazepam administration for prolonged sedation on incidence
of delirium in critically ill patients.
Source
Intensive Care Medicine Experimental. Conference: 30th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2017. Austria. 5 (2
Supplement 1) (no pagination), 2017. Date of Publication: September 2017.
Publisher
SpringerOpen
Abstract
INTRODUCTION. Long-term sedation with commonly used agents, e.g. midazolam
or propofol in intensive care units (ICUs) has serious adverse effects.
The intravenous benzodiazepine lormetazepam is approved for anxiolysis and
sedation in critically ill patients in Germany and might offer some
advantages over other sedatives. However, the literature lacks reports
about the safety and efficacy of lormetazepam as well as its effect on
delirium in critically ill patients. OBJECTIVE. It was the aim of the
present study to evaluate the effect of intravenous lormetazepam
administration for prolonged sedation after cardiac surgery on incidence
and severity of delirium. METHODS. 50 adult patients on the cardiothoracic
ICU with the need for sedation for more than 24 hours were included in
this prospective observational study. Intravenous lormetazepam was
administered with an initial bolus followed by a continuous infusion as
clinically indicated for a maximum of five days. Sedation level and
delirium were assessed using the Richmond Agitation-Sedation Scale (RASS)
and Intensive Care Delirium Screening Checklist (ICDSC) every 8 hours.
Primary endpoint was the ICDSC score 72 h after initiation of lormetazepam
sedation. RESULTS. 50 patients with a mean age of 60.8 +/- 18.0 years (18
female) were included in this study. Mean duration of lormetazepam
administration was 77.7 +/- 43.8 h with a mean dosage of 14.6 +/- 11.9 mg
per day. Total ICDSC scores significantly improved after lormetazepam
administration (2.68 +/- 2.32 vs. 3.8 +/- 2.23, p = 0.045) as well as
several subscores e.g. inappropriate speech or mood (0.05 +/- 0.19 vs.
0.34 +/- 0.43, p = 0.01) or altered level of consciousness (0.38 +/- 0.47
vs. 0.69 +/- 0.50 vs. p = 0.03) accompanied by a significant reduction of
other sedatives. A mild bradypnoe was observed in one patient possibly
related to the administration of lormetazepam in combination with opioids
without need for further intervention. CONCLUSION. Our data suggest that
lormetazepam represents a safe and efficient agent for prolonged sedation
in cardiothoracic patients with beneficial effects on incidence and
severity of delirium. However, randomized controlled trials are needed to
investigate whether administration of lormetazepam compared to other
sedatives might be favorable for the ICU patient.

<62>
Accession Number
619043237
Author
Aisa Alvarez A.; Soto M.E.; Camarena Alejo G.; Torres Aguilar O.; Aguirre
Sanchez J.; Franco Granillo J.
Institution
(Aisa Alvarez, Camarena Alejo, Torres Aguilar, Aguirre Sanchez, Franco
Granillo) American British Cowdray Medical Center, Intensive Care Unit,
Mexico City, Mexico
(Soto) American British Cowdray Medical Center, Department of
Investigation, Mexico City, Mexico
Title
The use of functional and structural biomarkers as predictors in the
prognosis of acute kidney injury (AKI): Preliminary report.
Source
Intensive Care Medicine Experimental. Conference: 30th Annual Congress of
the European Society of Intensive Care Medicine, ESICM 2017. Austria. 5 (2
Supplement 1) (no pagination), 2017. Date of Publication: September 2017.
Publisher
SpringerOpen
Abstract
INTRODUCTION. The 10th Consensus Conference of the Acute Dialysis Quality
Initiative suggested that combining AKI biomarkers could have better
precision when determining AKI outcome1. OBJECTIVES. To evaluate the
prognostic utility of combining novel biomarkers of functional and
structural renal injury in patients undergoing cardiac surgery. METHODS.
Prospective, observational and comparative cohort study. We included
adults >18 years undergoing cardiac surgery without Chronic Kidney Disease
who had not received contrast medium. We took baseline creatinine at the
admission. After surgery, we took structural (urinary NGAL and cystatin,
serum creatinine, albuminuria, and urinary sediment) and functional
biomarkers (serum cystatin), and monitored patients with serum creatinine,
urinary volume and fluid balance until their hospital discharge. RESULTS.
31 patients were analyzed. Patients with AKI had higher levels of serum
creatinine (1.12 +/- 0.34 vs 0.81 +/- 0.09; p = 0.002), serum cystatin
[0.82 (0.56-1.65) vs 0.69 (0.40-1.12); p = 0.04] and urinary NGAL [48.3
(1.1- 3103) vs 7.1 (1.2-71.3; p = 0.04]. Patients with persistent AKI had
higher levels of serum cystatin [1.19 (0.78-1.65) VS 0.74 (0.56-1); p =
0.01] and albuminuria [123 (55-997) vs 25 (6.6-310); p = 0.01]. Patients
with severe AKI (stages II and III) had higher levels of serum creatinine
[1.6 (0.9-1.70) vs 0.95 (0.70 -1.5); p = 0.05] and serum cystatin [1.2
(1-1.65) vs 0.75 (0.56- 0.97); p = 0.002]. The combination of a functional
and structural biomarker was present in 20% of the AKI group, in 80% of
the persistent group, and in 100% of the severe group. We found a low
sensitivity (20%) and good specificity (100%) in the AKI group due to the
low percentage of the biomarkers combination. In the persistent and severe
form of AKI, this combination improves the sensibility (100% and 80%),
specificity (80% and 80%), negative predictive value (100% and 92%) and
accuracy (84% and 80%) when performing diagnostic test analysis.
CONCLUSIONS. In the persistent and severe form of AKI there is a higher
frequency of functional and structural biomarker combinations with
statistically significant difference. The presence of the combination
improves the sensitivity, specificity, positive predictive value, negative
predictive value and accuracy of the test for severe and persistent AKI.

<63>
Accession Number
619062560
Author
Khorsandi M.; Dougherty S.; Bouamra O.; Pai V.; Curry P.; Tsui S.; Clark
S.; Westaby S.; Al-Attar N.; Zamvar V.
Institution
(Khorsandi, Curry, Al-Attar) Department of Cardiac Surgery and
Transplantation, Golden Jubilee National Hospital, Glasgow, UK
(Dougherty) Department of Cardiology, Ninewells hospital, Dundee, UK
(Bouamra) Medical Statistics, Trauma, Audit & Research Network, University
of Manchester, Salford Royal NHS foundation trust, Manchester, UK
(Pai) Department of Cardiovascular and Thoracic Surgery, Kasturba Medical
College, Manipal University, Manipal, India
(Tsui) Department of Cardiac Surgery and Transplantation, Papworth
hospital, Cambridge, UK
(Clark) Department of Cardiac surgery and Transplantation, Freeman
hospital, Newcastle, UK
(Westaby) Department of Cardiac Surgery, Oxford Heart Center, John
Radcliffe Hospital, Oxford, UK
(Zamvar) Department of Cardiothoracic Surgery, Royal Infirmary of
Edinburgh, Edinburgh, UK
Title
Extra-corporeal membrane oxygenation for refractory cardiogenic shock
after adult cardiac surgery: a systematic review and meta-analysis.
Source
Journal of cardiothoracic surgery. 12 (1) (pp 55), 2017. Date of
Publication: 17 Jul 2017.
Abstract
BACKGROUND: Postcardiotomy cardiogenic shock (PCCS) refractory to
inotropic support and intra-aortic balloon pump (IABP) occurs rarely but
is almost universally fatal without mechanical circulatory support. In
this systematic review and meta-analysis we looked at the evidence behind
the use of veno-arterial extra-corporeal membrane oxygenation (VA ECMO) in
refractory PCCS from a patient survival rate and determinants of outcome
viewpoint.
METHODS: A systematic review was performed in January 2017 using PubMed
(with no defined time period) using the keywords "postcardiotomy",
"cardiogenic shock", "extracorporeal membrane oxygenation" and "cardiac
surgery". We excluded papers pertaining to ECMO following paediatric
cardiac surgery, medical causes of cardiogenic shock, as well as case
reports, review articles, expert opinions, and letters to the editor. Once
the studies were collated, a meta-analysis was performed on the proportion
of survivors in those papers that met the inclusion criteria.
Meta-regression was performed for the most commonly reported adverse
prognostic indicators (API).
RESULTS: We identified 24 studies and a cumulative pool of 1926 patients
from 1992 to 2016. We tabulated the demographic data, including the
strengths and weaknesses for each of the studies, outcomes of VA ECMO for
refractory PCCS, complications, and APIs. All the studies were
retrospective cohort studies. Meta-analysis of the moderately
heterogeneous data (95% CI 0.29 to 0.34, p < 0.01, I 2 = 60%) revealed
overall survival rate to hospital discharge of 30.8%. Some of the commonly
reported APIs were advanced age (>70 years, 95% CI -0.057 to 0.001, P =
0.058), and long ECMO support (95% CI -0.068 to 0.166, P = 0.412).
Postoperative renal failure, high EuroSCORE (>20%), diabetes mellitus,
obesity, rising lactate whilst on ECMO, gastrointestinal complications had
also been reported.
CONCLUSION: Haemodynamic support with VA ECMO provides a survival benefit
with reasonable intermediate and long-term outcomes. Many studies had
reported advanced age, renal failure and prolonged VA ECMO support as the
most likely APIs for VA ECMO in PCCS. EuroSCORE can be utilized to
anticipate the need for prophylactic perioperative VA ECMO in the
high-risk category. APIs can be used to aid decision-making regarding both
the institution and weaning of ECMO for refractory PCCS.

<64>
Accession Number
619058117
Author
Webb C.M.; Orion E.; Taggart D.P.; Channon K.M.; Di Mario C.
Institution
(Webb, Di Mario) Department of Cardiology, National Institute of Health
Research Cardiovascular BRU, Royal Brompton Hospital, and the National
Heart & Lung Institute, Imperial College London, London, UK
(Orion) Vascular Graft Solutions, Tel Aviv, Israel
(Taggart) Nuffield Department of Surgery, University of Oxford, John
Radcliffe Hospital, Oxford, UK
(Channon) Department of Cardiovascular Medicine, University of Oxford,
John Radcliffe Hospital, Oxford, UK
Title
OCT imaging of aorto-coronary vein graft pathology modified by external
stenting: 1-year post-surgery.
Source
European heart journal cardiovascular Imaging. 17 (11) (pp 1290-1295),
2016. Date of Publication: 01 Nov 2016.
Abstract
AIMS: The Venous External Support Trial (VEST) evaluated whether a novel
external stent attenuated saphenous vein graft (SVG) disease assessed with
intravascular ultrasound 1 year following coronary artery bypass graft
(CABG) surgery. This sub-study assessed SVGs with and without external
stenting using optical coherence tomography (OCT). The aim of this study
was to accurately compare quantitative and qualitative features of SVGs
with and without a novel external stent using OCT.
METHODS AND RESULTS: Twenty-four of 30 patients (65 +/- 8 years) enrolled
in VEST underwent coronary angiography with OCT imaging using a
non-occlusive technique. Quantitative analysis of lumen area was performed
in one frame every 10 mm along the length of the graft, from distal to
proximal anastomosis, and pathological features within the lumen were
noted. Mean cross-sectional area was greater in unstented vs. stented
grafts (8.4 +/- 3 vs. 7.6 +/- 2.7 mm; P = 0.005). The lumen of the stented
grafts was more homogeneous (difference between maximum and minimum lumen
diameter was significantly smaller in stented compared with unstented
grafts, 0.28 +/- 0.19 vs. 0.33 +/- 0.23 mm, respectively, P = 0.006), and
more circular (mean eccentricity index 0.08 +/- 0.06 vs. 0.10 +/- 0.06,
stented vs. unstented; P = 0.019). Adherent thrombus was identified in
three grafts (all unstented).
CONCLUSION: Our findings highlight the early changes occurring in SVGs
after implantation of aorto-coronary bypass conduits, changes that may
accelerate vein graft failure. External stenting resulted in a more
homogeneous and less eccentric lumen with no thrombus
formation.<br/>Copyright Published on behalf of the European Society of
Cardiology. All rights reserved. &#xa9; The Author 2015. For permissions
please email: journals.permissions@oup.com.

<65>
Accession Number
618986695
Author
Bottle A.; Mariscalco G.; Shaw M.A.; Benedetto U.; Saratzis A.; Mariani
S.; Bashir M.; Aylin P.; Jenkins D.; Oo A.Y.; Murphy G.J.; Bryan A.J.;
Cooper G.; Duncan A.; Harrington D.; Kuduvalli M.; Mascaro J.; Rosendahl
U.; Tsang G.; Unsworth-White J.
Institution
(Bottle, Saratzis, Aylin) Dr Foster Unit, Department of Primary Care and
Public Health, School of Public Health, Imperial College, London, United
Kingdom
(Mariscalco, Shaw, Mariani, Murphy) Leicester Cardiovascular Biomedical
Research Unit, Department of Cardiovascular Sciences, Glenfield Hospital,
University of Leicester, United Kingdom
(Shaw) Information Department, Liverpool Heart and Chest Hospital,
Liverpool, United Kingdom
(Oo) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Benedetto) School of Clinical Sciences, Bristol Heart Institute,
University of Bristol, United Kingdom
(Bashir) Department of Health Economics, University of Liverpool, United
Kingdom
(Jenkins) Department of Cardiothoracic Surgery, Papworth Hospital,
Cambridge, United Kingdom
(Bryan) Bristol Heart Institute, University Hospital Bristol NHS Trust,
United Kingdom
(Cooper) Sheffield Teaching Hospitals, United Kingdom
(Duncan) Biomedical Research Unit, The Royal Brompton Hospital, United
Kingdom
(Harrington, Kuduvalli) Liverpool Heart and Chest Hospital, United Kingdom
(Mascaro) Queen Elizabeth Hospital, University Hospitals Birmingham,
United Kingdom
(Rosendahl) Aortic Centre, Royal Brompton and Harefield NHS Trust, United
Kingdom
(Tsang) University Hospital Southampton NHS Foundation Trust, United
Kingdom
(Unsworth-White) Southwest Cardiothoracic Centre, Derriford Hospital,
Plymouth, United Kingdom
Title
Unwarranted Variation in the Quality of Care for Patients With Diseases of
the Thoracic Aorta.
Source
Journal of the American Heart Association. 6 (3) (no pagination), 2017.
Article Number: e004913. Date of Publication: March 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background-Thoracic aortic disease has a high mortality. We sought to
establish the contribution of unwarranted variation in care to regional
differences in outcomes observed in patients with thoracic aortic disease
in England. Methods and Results-Data from the Hospital Episode Statistics
(HES) and the National Adult Cardiac Surgery Audit (NACSA) were extracted.
A parallel systematic review/meta-analysis through December 2015, and
structure and process questionnaire of English cardiac surgery units were
also accomplished. Treatment and mortality rates were investigated. A
total of 24 548 adult patients in the HES study, 8058 in the NACSA study,
and 103 543 from a total of 33 studies in the systematic review were
obtained. Treatment rates for thoracic aortic disease within 6 months of
index admission ranged from 7.6% to 31.5% between English counties.
Risk-adjusted 6-month mortality in untreated patients ranged from 19.4% to
36.3%. Regional variation persisted after adjustment for disease or
patient factors. Regional cardiac units with higher case volumes treated
more-complex patients and had significantly lower risk-adjusted mortality
relative to low-volume units. The results of the systematic review
indicated that the delivery of care by multidisciplinary teams in
high-volume units resulted in better outcomes. The observational analyses
and the online survey indicated that this is not how services are
configured in most units in England. Conclusions-Changes in the
organization of services that address unwarranted variation in the
provision of care for patients with thoracic aortic disease in England may
result in more-equitable access to treatment and improved
outcomes.<br/>Copyright &#xa9; 2017 The Authors.

<66>
Accession Number
619046142
Author
Wang Z.; Chen Q.; Guo H.; Li Z.; Zhang J.; Lv L.; Guo Y.
Institution
(Wang, Chen, Guo, Li, Zhang, Lv, Guo) Department of Anesthesiology, Shanxi
Provincial People's Hospital, Taiyuan, Shanxi 030000, China
Title
Effects of dexmedetomidine on H-FABP, CK-MB, cTnI levels, neurological
function and near-term prognosis in patients undergoing heart valve
replacement.
Source
Experimental and Therapeutic Medicine. 14 (6) (pp 5851-5856), 2017. Date
of Publication: December 2017.
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece.
E-mail: subscriptions@spandidos-publications.com)
Abstract
This study investigated the effects of dexmedetomidine on heart-type fatty
acid binding protein (H-FABP), creatine kinase isoenzymes (CK-MB), and
troponin I (cTnI) levels, neurological function and near-term prognosis in
patients undergoing heart valve replacement. Patients undergoing heart
valve replacement were randomly allocated to remifentanil anesthesia
(control group, n=48) or dexmedetomidine anesthesia (observation group,
n=48). Hemodynamic parameters were measured before anesthesia induction
(T1), 1 min after intubation (T2), 10 min after start of surgery (T3), and
on completion of surgery (T4). Levels of plasma H-FABP, CK-MB and cTnI
were measured 10 min before anesthesia induction (C1), 10 min after start
of surgery (C2), on completion of surgery (C3), 6 h after surgery (C4),
and 24 h after surgery (C5). S100beta protein and serum neuron-specific
enolase (NSE) were detected 10 min before anesthesia induction (C1), and
24 h after surgery (C5). Neurological and cardiac function was evaluated
24 h after surgery. Incidence of cardiovascular adverse events was
recorded for 1 year of follow-up. There were no significant differences in
the average heart rate between the two groups during the periop-erative
period. The mean arterial pressure in the observation group was
significantly lower than control group (P<0.05). Levels of H-FABP, CK-MB
and cTnI at C2, C3, C4 and C5, were significantly higher than C1, but
significantly lower in the observation versus control group (P<0.05).
Twenty-four hours after surgery, levels of S100beta and NSE in both groups
were higher than those before induction (P<0.05), but significantly lower
in the observation versus control group (P<0.05). Twenty-four hours after
surgery, neurological function scores were better, and myocardial
contractility and arrhythmia scores significantly lower in the observation
versus control group (P<0.05 for all). After follow-up for 1 year,
incidence of cardiovascular adverse events was significantly lower in the
observation versus control group (P<0.05). Dexmedetomidine anesthesia can
effectively maintain hemodynamic stability, reduce myocardial injury and
the occurrence of cognitive dysfunction, and improve prognosis in patients
undergoing heart valve replacement.<br/>Copyright &#xa9; 2017, Spandidos
Publications. All rights reserved.

<67>
Accession Number
618984231
Author
Cornel J.H.; Ohman E.M.; Neely B.; Jakubowski J.A.; Bhatt D.L.; White
H.D.; Ardissino D.; Fox K.A.A.; Prabhakaran D.; Armstrong P.W.; Erlinge
D.; Tantry U.S.; Gurbel P.A.; Roe M.T.
Institution
(Cornel) Medisch Centrum Alkmaar, Alkmaar, Netherlands
(Ohman, Neely, Roe) Duke Clinical Research Institute, Durham, NC, United
States
(Ohman, Roe) Division of Cardiology, Department of Medicine, Duke
University Medical Center, Durham, NC, United States
(Jakubowski) Eli Lilly and Company, Indianapolis, IN, United States
(Bhatt) Brigham and Women's Hospital Heart, Vascular Center and Harvard
Medical School, Boston, MA, United States
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Ardissino) Division of Cardiology, Azienda Ospedaliero-Universitaria di
Parma, Italy
(Fox) Centre for Cardiovascular Science, University of Edinburgh,
Scotland, United Kingdom
(Prabhakaran) Centre for Chronic Disease Control, Public Health Foundation
of India, New Delhi, India
(Armstrong) Canadian VIGOUR Centre and Division of Cardiology, University
of Alberta, Edmonton, AL, Canada
(Erlinge) Department of Cardiology, Lund University, Lund, Sweden
(Tantry, Gurbel) Sinai Center for Thrombosis Research, Baltimore, MD,
United States
Title
Relationship of Platelet Reactivity With Bleeding Outcomes During
Long-Term Treatment With Dual Antiplatelet Therapy For Medically Managed
Patients With Non-St-Segment Elevation Acute Coronary Syndromes.
Source
Journal of the American Heart Association. 5 (11) (no pagination), 2016.
Article Number: e003977. Date of Publication: November 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--The relationship between "on-treatment" low platelet
reactivity and longitudinal risks of major bleeding dual antiplatelet
therapy following acute coronary syndromes remains uncertain, especially
for patients who do not undergo percutaneous coronary intervention.
Methods and Results--We analyzed 2428medicallymanaged acute coronary
syndromes patients fromthe Targeted Platelet Inhibition to Clarify the
Optimal Strategy to Medically Manage Acute Coronary Syndromes (TRILOGY
ACS) trial who had serial platelet reactivity measurements
(P2Y<inf>12</inf> reaction units; PRUs) and were randomized to
aspirin+prasugrel versus aspirin+clopidogrel for up to 30 months. Contal's
method was used to determine whether a cut point for steady-state PRU
values could distinguish high versus low bleeding risk using 2-level
composites: Global Use of Strategies to Open Occluded Coronary Arteries
(GUSTO) severe/life-threatening or moderate bleeding unrelated to coronary
artery bypass grafting (CABG) and non-CABG Thrombolysis In Myocardial
Infarction (TIMI) major orminor bleeding. Exploratory analyses used
3-level composites that incorporatedmild andminimalGUSTOand TIMI
events.Continuousmeasures of PRUs (per 10-unit decrease)were not
independently associatedwith the 2-levelGUSTO (adjusted hazard ratio [HR],
1.01; 95% CI, 0.96-1.06) or TIMI composites (1.02; 0.98-1.07).
Furthermore, no PRU cut point could significantly distinguish bleeding
risk using the 2-level composites.However, the PRUcut point of 75
differentiated bleeding riskwith the 3-level composites ofGUSTO(26.5% vs
12.6%; adjusted HR, 2.28; 95% CI, 1.77-2.94; P<0.001) and TIMI bleeding
events (25.9% vs 12.2%; adjusted HR, 2.30; 95% CI, 1.78-2.97; P<0.001).
Conclusions--Among medically managed non-ST-segment elevation acute
coronary syndromes patients receiving prolonged dual antiplatelet therapy,
PRU values were not significantly associated with the long-term risk of
major bleeding events, suggesting that low on-treatment platelet
reactivity does not independently predict serious bleeding
risk.<br/>Copyright &#xa9; 2016 The Authors.

<68>
[Use Link to view the full text]
Accession Number
611371485
Author
Noelck N.; Papak J.; Freeman M.; Paynter R.; Low A.; Motu'apuaka M.; Kondo
K.; Kansagara D.
Institution
(Noelck, Papak, Kansagara) Department of Medicine, VA Portland Healthcare
System, Portland, OR, United States
(Noelck, Papak, Kansagara) Department of Medicine, Oregon Health and
Science University, Portland, OR, United States
(Freeman, Paynter, Low, Motu'apuaka, Kondo, Kansagara) VA Evidence-based
Synthesis Program, VA Portland Healthcare System, Portland, OR, United
States
Title
Effectiveness of left atrial appendage exclusion procedures to reduce the
risk of stroke: A systematic review of the evidence.
Source
Circulation: Cardiovascular Quality and Outcomes. 9 (4) (pp 395-405),
2016. Date of Publication: 01 Jul 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Atrial fibrillation is an important cause of cardioembolic
stroke. Oral anticoagulants (OAC) reduce stroke risk but increase the risk
of serious bleeding. Left atrial appendage (LAA) procedures have been
developed to isolate the LAA from circulating blood flow, as an
alternative to OAC. We conducted a systematic review of the benefits and
harms of surgical and percutaneous LAA exclusion procedures. Methods and
Results - We searched multiple data sources, including Ovid MEDLINE,
Cochrane, and Embase, through January 7, 2015. Of 2567 citations, 20
primary studies met prespecified inclusion criteria. We abstracted data on
patient characteristics, stroke, mortality, and adverse effects. We
assessed study quality and graded the strength of evidence using published
criteria. Trials found low-strength evidence that percutaneous LAA
exclusion confers similar risks of stroke and mortality as continued OAC,
but this evidence was limited to the Watchman device in patients eligible
for long-term OAC. Observational studies found moderate-strength evidence
of serious harms with a variety of percutaneous LAA procedures. There is
low-strength evidence that surgical LAA exclusion does not add significant
harm during heart surgery for another indication, but evidence on stroke
reduction is insufficient. Conclusions - There is limited evidence that
the Watchman device may be noninferior to long-term OAC in selected
patients. Data on effectiveness of LAA exclusion devices is lacking in
patients ineligible for long-term OAC. Percutaneous LAA devices are
associated with high rates of procedure-related harms. Although surgical
LAA exclusion during heart surgery does not seem to add incremental harm,
there is insufficient evidence of benefit.<br/>Copyright &#xa9; 2016
American Heart Association, Inc.

<69>
Accession Number
604034832
Author
Horn P.; Stern D.; Veulemans V.; Heiss C.; Zeus T.; Merx M.W.; Kelm M.;
Westenfeld R.
Institution
(Horn, Stern, Veulemans, Heiss, Zeus, Merx, Kelm, Westenfeld) Division of
Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty,
University Duesseldorf, Moorenstr. 5, Dusseldorf D-40225, Germany
(Kelm) Cardiovascular Research Institute Duesseldorf (CARID), University
Duesseldorf, Duesseldorf, Germany
Title
Improved endothelial function and decreased levels of endothelium-derived
microparticles after transcatheter aortic valve implantation.
Source
EuroIntervention. 10 (12) (pp 1456-1463), 2015. Date of Publication: 01
Apr 2015.
Publisher
EuroPCR
Abstract
Aims: Degenerative aortic valve stenosis (AVS) is independently associated
with endothelial dysfunction and increased levels of circulating
endothelium-derived microparticles (EMPs) as a marker of compromised
endothelial integrity. The aim of this study was to investigate whether
therapy for severe AVS by transcatheter aortic valve implantation (TAVI)
improves endothelial function and decreases EMPs. Methods and results:
Fifty-six patients with indication for TAVI due to symptomatic severe AVS
were prospectively enrolled. Brachial wall shear stress (WSS), endothelial
function and circulating microparticles (MPs) were measured before and
three months following TAVI. Endothelial function was assessed as
flow-mediated dilation (FMD) using ultrasound. MP subpopulations were
discriminated by flow cytometry according to the expression of established
surface antigens: CD31⁺/CD41^-, CD144⁺ and
CD62E⁺ as EMPs and CD41⁺ as platelet-derived MPs
(PMPs). In patients with severe AVS, decreased brachial WSS was an
independent predictor of low FMD. At three-month follow-up after TAVI, WSS
and FMD increased along with decreased levels of EMPs as compared to pre
TAVI. Decrease of CD31⁺/CD41^-, CD144⁺ and
CD62E⁺ EMP levels correlated with the increase of FMD.
Conclusions: Therapy for AVS by TAVI was associated with improved
endothelial function and integrity indicating beneficial effects of TAVI
on systemic arterial function.<br/>Copyright &#xa9; Europa Digital &
Publishing 2015. All rights reserved.

<70>
Accession Number
604034745
Author
Watkins S.; Oldroyd K.G.; Preda I.; Holmes D.R.; Colombo A.; Morice M.-C.;
Leadley K.; Dawkins K.D.; Mohr F.W.; Serruys P.W.; Feldman T.E.; Kornowski
R.
Institution
(Watkins, Oldroyd) Golden Jubilee National Hospital, Department of
Cardiology, Agamemnon Street, Clydebank, Glasgow G81 4DY, United Kingdom
(Preda) National Health Service Centre, Budapest, Hungary
(Holmes) Mayo Clinic, Rochester, MN, United States
(Colombo) San Rafffaele Scientific Institute, Milan, Italy
(Morice) Institut Cardiovasculaire Paris Sud, Massy, France
(Leadley, Dawkins) Boston Scientific, Marlborough, MA, United States
(Mohr) Herzzentrum Universitat Leipzig, Leipzig, Germany
(Serruys) Erasmus University Medical Centre, Rotterdam, Netherlands
(Feldman) Evanston Hospital, Evanston, IL, United States
(Kornowski) Department of Cardiology, Rabin Medical Center, Petach Tikva,
Israel
Title
Five-year outcomes of staged percutaneous coronary intervention in the
SYNTAX study.
Source
EuroIntervention. 10 (12) (pp 1402-1408), 2015. Date of Publication: 01
Apr 2015.
Publisher
EuroPCR
Abstract
Aims: The SYNTAX study compared PCI with TAXUS Express stents to CABG for
the treatment of de novo 3-vessel and/or left main coronary disease. This
study aimed to determine patient characteristics and five-year outcomes
after a staged PCI strategy compared to single-session PCI. Methods and
results: In the SYNTAX trial, staged procedures were discouraged but were
allowed within 72 hours or, if renal insufficiency or contrast-induced
nephropathy occurred, within 14 days (mean 9.8+/-18.1 days post initial
procedure). A total of 125 (14%) patients underwent staged PCI. These
patients had greater disease severity and/or required a more complex
procedure. MACCE was significantly increased in staged patients (48.1% vs.
35.5%, p=0.004), as was the composite of death/stroke/MI (32.2% vs. 19%,
p=0.0007). Individually, cardiac death and stroke occurred more frequently
in the staged PCI group (p=0.03). Repeat revascularisation was
significantly higher in staged patients (32.8% vs 24.8%, p=0.035), as was
stent thrombosis (10.9% vs. 4.7%, p=0.005). Conclusions: There is a higher
incidence of MACCE in patients undergoing staged compared to
single-session PCI for 3-vessel and/or left main disease over the first
five years of follow-up. However, these patients had more comorbidities
and more diffuse disease.<br/>Copyright &#xa9; Europa Digital & Publishing
2015. All rights reserved.

<71>
Accession Number
607056522
Author
Kaier K.; Gutmann A.; Vach W.; Sorg S.; Siepe M.; Von Zur Muhlen C.; Moser
M.; Blanke P.; Beyersdorf F.; Zehender M.; Bode C.; Reinohl J.
Institution
(Kaier, Vach) Clinical Epidemiology, Center for Medical Biometry and
Medical Informatics, Medical Center, University of Freiburg,
Stefan-Meier-Str. 26, Freiburg D-79104, Germany
(Kaier, Gutmann, Von Zur Muhlen, Moser, Zehender, Bode, Reinohl)
Department of Cardiology, Heart Center Freiburg University, Freiburg,
Germany
(Sorg, Siepe, Beyersdorf) Department of Cardiovascular Surgery, Heart
Center Freiburg University, Freiburg, Germany
(Blanke) Department of Diagnostic Radiology, Medical Center, University of
Freiburg, Freiburg, Germany
Title
"Heart Team" decision making in elderly patients with symptomatic aortic
valve stenosis who underwent AVR or TAVI - A look behind the curtain.
Results of the prospective TAVI Calculation of Costs Trial (TCCT).
Source
EuroIntervention. 11 (7) (pp 793-798), 2015. Date of Publication: November
2015.
Publisher
EuroPCR
Abstract
Aims: Little is known about how "Heart Team" treatment decisions among
patients suitable for either surgical aortic valve replacement (AVR) or
transcatheter aortic valve implantation (TAVI) are made under routine
conditions. Methods and results: The "Heart Team" decision-making process
was analysed with respect to 124 patients of a non-randomised prospective
clinical trial that included patients aged >=75 years: 41 patients
underwent AVR and 83 underwent TAVI. By use of the non-parametric
classification and regression tree (CART) methodology, 21 baseline
parameters were tested to reconstruct the decision process
retrospectively. Next, multivariate logistic and Cox regression models
were fitted to evaluate the decision and outcome relevance (two-year
survival) of the parameters as identified in the CART procedure. For
patients with a baseline EuroSCORE I >=13.48%, no further cut-off points
were identified and the majority of these patients underwent TAVI. Among
patients with a baseline EuroSCORE I <13.48%, age and left ventricular
ejection fraction (LVEF) were identified as further relevant decision
parameters. The decision relevance of EuroSCORE I (p=0.003), age (p=0.024)
and LVEF (p=0.047) were confirmed by multivariate analysis; however,
outcome relevance can be confirmed for EuroSCORE I (p=0.015) only, while
treatment decision (TAVI or AVR) was not a significant predictor of
mortality (p=0.655). Conclusions: Despite or even because of the
systematic risk selection according to EuroSCORE I values, we observed
two-year survival rates of about 75% regardless of whether the patient
received TAVI or AVR, suggesting that the decisions made by the "Heart
Team" were appropriate.<br/>Copyright &#xa9; Europa Digital & Publishing
2014. All rights reserved.

<72>
Accession Number
607056282
Author
Kelbaek H.; Holmvang L.; Richardt G.; Eberli F.R.; Stella P.; Buszman
P.E.; Neumann F.-J.; Serruys P.W.; Windecker S.; Widimsky P.; Belardi
J.A.; Silber S.
Institution
(Kelbaek, Holmvang) Cardiac Catheterization Laboratory, Department of
Cardiology, Heart Center, Rigshospitalet, University of Copenhagen,
Blegdamsvej 9, Copenhagen 2100, Denmark
(Richardt) Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
(Eberli) Department of Cardiology, University Hospital, Zurich,
Switzerland
(Stella) Department of Cardiology, University Medical Center, Utrecht,
Netherlands
(Buszman) Department of Cardiology, Medical University of Silesia,
Katowice, Poland
(Neumann) Heart Center Bad Krozingen, Bad Krozingen, Germany
(Serruys) Erasmus Medical Center, Rotterdam, Netherlands
(Windecker) Department of Interventional Cardiology, Bern University
Hospital, Bern, Switzerland
(Widimsky) Cardiocenter Kralovske Vinohrady, Charles University, Prague,
Czech Republic
(Belardi) Instituto Cardiovascular de Buenos Aires, Buenos Aires,
Argentina
(Silber) Heart Center of the Isar, Munich, Germany
Title
Clinical results with the Resolute zotarolimus-eluting stent in total
coronary occlusions.
Source
EuroIntervention. 11 (6) (pp 650-657), 2015. Date of Publication: October
2015.
Publisher
EuroPCR
Abstract
Aims: We conducted a pooled post hoc analysis (RESOLUTE All Comers and
RESOLUTE International) of patients who had the Resolute
zotarolimus-eluting stent (R-ZES) implanted in revascularised total
occlusions (TO) compared with patients treated with R-ZES for non-occluded
lesions. Methods and results: Patients were divided into three groups:
chronic TO (CTO; n=256), non-chronic TO (n=292), and no occlusion
(n=2,941). Clinical and safety outcomes assessed through two years
included target lesion failure (TLF: cardiac death, target vessel
myocardial infarction, and clinically driven target lesion
revascularisation) and Academic Research Consortium definite or probable
stent thrombosis. The rate of TLF at two years was not significantly
different among patients in the CTO (9.1%), TO (9.8%), and no occlusion
(10.4%) groups (log-rank p=0.800); neither were the components of TLF.
Definite or probable stent thrombosis occurred more frequently in the TO
group (2.8% vs. 1.2% in the CTO and 1.1% in the group with no occlusion,
p=0.027). There were 10 late and six very late stent thrombosis events.
Conclusions: Apart from a higher rate of stent thrombosis in patients with
TO, patients with totally occluded coronary arteries who receive
revascularisation with an R-ZES have clinical outcomes comparable to those
who receive a similar stent in non-occluded lesions.<br/>Copyright &#xa9;
Europa Digital & Publishing 2015. All rights reserved.

<73>
Accession Number
607056258
Author
Genereux P.; Campos C.M.; Yadav M.; Palmerini T.; Caixeta A.; Xu K.;
Francese D.P.; Dangas G.D.; Mehran R.; Leon M.B.; Serruys P.W.; Stone G.W.
Institution
(Genereux, Yadav, Leon, Stone) New York-Presbyterian Hospital, Columbia
University, Medical Center, New York, NY, United States
(Genereux, Xu, Francese, Dangas, Mehran, Leon, Stone) Columbia University,
Medical Center, Cardiovascular Research Foundation, 111 E. 59th St., New
York, NY 10022, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Universite de Montreal,
Montreal, QC, Canada
(Campos, Serruys) Department of Interventional Cardiology, Erasmus
University, Medical Center, Thoraxcenter, Rotterdam, Netherlands
(Campos) Department of Interventional Cardiology, Heart Institute (InCor),
University of Sao Paulo, Medical School, Sao Paulo, Brazil
(Palmerini) Istituto di Cardiologia, Policlinico S. Orsola, University of
Bologna, Bologna, Italy
(Caixeta) Hospital Israelita Albert Einstein, Escola Paulista de Medicina,
Universidade Federal de Sao Paulo, Sao Paulo, Brazil
(Dangas, Mehran) Icahn School of Medicine at Mount Sinai, New York, NY,
United States
Title
Reasonable incomplete revascularisation after percutaneous coronary
intervention: The SYNTAX Revascularisation Index.
Source
EuroIntervention. 11 (6) (pp 634-642), 2015. Date of Publication: October
2015.
Publisher
EuroPCR
Abstract
Aims: Incomplete revascularisation is common after percutaneous coronary
intervention (PCI). While the absolute amount of residual coronary artery
disease (CAD) after PCI has been shown to be associated with worse
outcomes, whether the proportion of treated CAD is prognostically
important remains to be determined. We sought to quantify the proportion
of CAD burden treated by PCI and to evaluate its impact on outcomes using
a new prognostic instrument - the SYNTAX Revascularisation Index (SRI).
Methods and results: The baseline SYNTAX score (bSS) and residual SYNTAX
score (rSS) were determined from 2,618 angiograms of patients enrolled in
the prospective ACUITY trial. The SRI was then calculated for each patient
using the following formula: SRI=(1-[rSS/bSS])x100. Outcomes were examined
according to three SRI groups (SRI=100% [complete revascularisation],
50-99%, and <50%). The median bSS was nine (IQR 5, 16), and after PCI the
median rSS was one (IQR 0, 6). The median SRI was 85% (IQR 50, 100), and
was 100% in 1,079 patients (41.2%), 50-99% in 907 patients (34.6%), and
<50% in 632 patients (24.1%). One-year adverse outcomes, including death,
were inversely proportional to the SRI. An SRI cut-off of <80% (present in
1,189 [45.4%] patients after PCI) had the best prognostic accuracy for
prediction of death (area under the curve 0.60, 95% confidence interval
[CI]: 0.53-0.67, p<0.0001). By multivariable analysis, SRI was an
independent predictor of one-year mortality (hazard ratio [HR] 2.17, 95%
CI: 1.05-4.35, p=0.03). However, when compared to other scores, the rSS
showed superior accuracy and predictive capability for one-year mortality.
Conclusions: The SRI is a newly described method for quantifying the
proportion of CAD burden treated by PCI. Given its correlation with
mortality, and pending external validation, the SRI may be useful in
assessing the degree of revascularisation after PCI, with SRI >=80%
representing a reasonable goal. However, the rSS showed superior
predictive capability for one-year mortality.<br/>Copyright &#xa9; Europa
Digital & Publishing 2015. All rights reserved.

<74>
Accession Number
605986012
Author
Genereux P.; Bernard S.; Palmerini T.; Caixeta A.; Rosner G.; Reiss G.R.;
Xu K.; Mehran R.; Stone G.W.
Institution
(Genereux, Bernard, Rosner, Reiss, Xu, Stone) Columbia University Medical
Center, Cardiovascular Research Foundation, 111 E 59th St, 11th Floor, New
York, NY 10022, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Universite de Montreal,
Montreal, QC, Canada
(Palmerini) Istituto di Cardiologia, University of Bologna, Bologna, Italy
(Caixeta) Escola Paulista de Medicina, Universidade Federal de Sao Paulo,
Hospital Israelita Albert Einstein, Sao Paulo, Brazil
(Mehran) Mount Sinai Medical Center, New York, NY, United States
Title
Incidence, predictors, and impact of neurological events in non-ST-segment
elevation acute coronary syndromes: The ACUITY trial.
Source
EuroIntervention. 11 (4) (pp 399-406), 2015. Date of Publication: 01 Aug
2015.
Publisher
EuroPCR
Abstract
Aims: We sought to describe the incidence, predictors, and impact of
adverse neurological events (NE) in a non-ST-segment elevation acute
coronary syndromes (NSTEACS) population undergoing percutaneous coronary
intervention (PCI), coronary artery bypass grafting (CABG), or medical
therapy (MT). Methods and results: 13,819 patients with moderate and
high-risk NSTEACS were enrolled in the prospective ACUITY trial.
Angiography was performed within 72 hours of presentation, after which
7,789 patients (56.4%) underwent PCI, 1,539 (11.1%) underwent CABG, and
4,491 (32.5%) received MT. The rate of NE (stroke or transient ischaemic
attack) at 30 days and one year and its relationship to adverse ischaemic
events, including death, were assessed. Thirty-day rates of NE were 1.1%
with CABG, 0.3% with PCI, and 0.5% with MT (p<0.001). One-year rates of NE
were 1.1% with CABG, 0.3% with PCI, and 0.6% with MT (p<0.001).
Independent predictors of NE at 30 days and one year included age, renal
insufficiency, baseline troponin elevation, and initial treatment with
CABG. The occurrence of NE was a strong independent predictor of death at
30 days and one year (HR 4.07, 95% CI [1.49, 11.11], p=0.006, and HR 4.25,
95% CI [2.37, 7.62], p<0.001, respectively). Conclusions: In the
large-scale ACUITY trial, CABG was associated with a higher risk of NE at
30 days and one year compared to PCI and MT. The occurrence of NE in
patients with NSTEACS was strongly associated with increased early and
late mortality. Clinical Trials.gov Identifier NCT00093158.<br/>Copyright
&#xa9; Europa Digital & Publishing 2015. All rights reserved.

<75>
Accession Number
603774489
Author
Lowik M.M.; Lam M.K.; Sen H.; Tandjung K.; Houwelingen K.G.; De Man
F.H.A.F.; Stoel M.G.; Louwerenburg J.W.; Linssen G.C.M.; Doggen C.J.M.;
Von Birgelen C.
Institution
(Lowik, Lam, Sen, Tandjung, Houwelingen, De Man, Stoel, Louwerenburg, Von
Birgelen) Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum
Twente, Haaksbergerstraat 55, Enschede 7513 ER, Netherlands
(Linssen) Department of Cardiology, Ziekenhuisgroep Twente, Almelo,
Netherlands
(Linssen) Department of Cardiology, Ziekenhuisgroep Twente, Hengelo,
Netherlands
(Doggen, Von Birgelen) Health Technology and Services Research,
MIRA-Institute for Biomedical Technology and Technical Medicine,
University of Twente, Enschede, Netherlands
Title
Safety of second-generation drug-eluting stents three years after
randomised use in the TWENTE trial.
Source
EuroIntervention. 10 (11) (pp 1276-1279), 2015. Date of Publication: 01
Mar 2015.
Publisher
EuroPCR
Abstract
Aims: To assess three-year clinical outcome following randomised use of
the second-generation Resolute zotarolimus-eluting stent (ZES) and the
XIENCE V everolimus-eluting stent (EES). For Resolute ZES and randomised
use, outcome data >=3 years are relatively scarce. Methods and results:
The TWENTE trial examined 1,391 patients with stable angina or
non-ST-elevation acute coronary syndromes, of whom 21.6% were diabetics,
70.1% had complex B2 or C lesions and 77.4% had "off-label" indications
for DES use. Three-year follow-up data were obtained in 1,381 patients
(99.3%; 10 withdrawals). Adverse clinical events were independently
adjudicated. The primary endpoint target vessel failure (TVF), a composite
of cardiac death, target vessel-related myocardial infarction and
clinically indicated target vessel revascularisation, was 12.1% for
Resolute ZES and 13.4% for XIENCE V EES (p=0.50). Cardiac death rates were
1.9% vs. 3.5% (p=0.06); the other individual components of TVF also showed
no significant between-group differences. The rates of
definite-or-probable stent thrombosis (1.4% vs. 1.6%, p=0.82) and very
late stent thrombosis (0.6% vs. 0.4%, p=1.0) did not differ between the
groups. Conclusions: Three-year follow-up data of patients included in the
randomised TWENTE trial demonstrated similar and sustained safety and
efficacy of Resolute ZES and XIENCE V EES.<br/>Copyright &#xa9; Europa
Digital & Publishing 2015. All rights reserved.

<76>
Accession Number
603774483
Author
Teeuwen K.; Van Den Branden B.J.L.; Koolen J.J.; Van Der Schaaf R.J.;
Henriques J.P.S.; Tijssen J.G.P.; Kelder J.C.; Vermeersch P.H.M.J.;
Rensing B.J.W.M.; Suttorp M.J.
Institution
(Teeuwen, Rensing, Suttorp) Department of Interventional Cardiology, St.
Antonius Hospital, Koekoekslaan 1, Nieuwegein 3435 CM, Netherlands
(Van Den Branden) Department of Interventional Cardiology, Amphia
Hospital, Breda, Netherlands
(Koolen) Department of Interventional Cardiology, Catharina Hospital,
Eindhoven, Netherlands
(Van Der Schaaf) Department of Interventional Cardiology, Onze Lieve
Vrouwe Gasthuis, Amsterdam, Netherlands
(Henriques) Department of Interventional Cardiology, Academic Medical
Center, Amsterdam, Netherlands
(Tijssen) Research and Statistics, Academic Medical Center, Amsterdam,
Netherlands
(Kelder) Department of Research and Statistics, St. Antonius Hospital,
Nieuwegein, Netherlands
(Vermeersch) Department of Interventional Cardiology, Middelheim Hospital,
Antwerp, Belgium
Title
Three-year clinical outcome in the primary stenting of totally occluded
native coronary arteries III (PRISON III) trial: A randomised comparison
between sirolimus-eluting stent implantation and zotarolimus-eluting stent
implantation for the treatment of total coronary occlusions.
Source
EuroIntervention. 10 (11) (pp 1272-1275), 2015. Date of Publication: 01
Mar 2015.
Publisher
EuroPCR
Abstract
Aims: Sirolimus-eluting stents (SES) have been shown to be superior to
Endeavor zotarolimus-eluting stents (ZES) and comparable to Resolute ZES
at eight-month angiography in patients treated for total coronary
occlusions (TCO). This study investigated clinical outcome at three-year
follow-up. Methods and results: The PRISON III trial investigated the
efficacy and safety of SES against ZES (Endeavor and Resolute) in two
study phases. In the first phase, 51 patients were randomised to receive
SES and 46 to Endeavor ZES. In the second phase, 103 and 104 patients were
randomised to SES or Resolute ZES, respectively. Between one and three
years there were only a few additional clinical events in all groups. As a
result, the rates of target lesion revascularisation 12.2% vs. 19.6%,
p=0.49, target vessel failure 14.3% vs. 19.6%, p=0.68, and definite or
probable stent thrombosis 4.1% vs. 2.2% were comparable between SES and
Endeavor ZES at three years. In the second study phase, the rates of
target lesion revascularisation 10% vs. 5.9%, p=0.42, target vessel
failure 10% vs. 7.9%, p=0.79 and definite or probable stent thrombosis
1.0% vs. 0% were similar between SES and Resolute ZES. Conclusions: The
present study demonstrated a low incidence of clinical events between
one-and threeyear follow-up with either SES compared to Endeavor ZES or
SES versus Resolute ZES in patients treated for total coronary
occlusions.<br/>Copyright &#xa9; Europa Digital & Publishing 2015. All
rights reserved.

<77>
Accession Number
605047774
Author
Cassese S.; Byrne R.A.; Laugwitz K.-L.; Schunkert H.; Berger P.B.;
Kastrati A.
Institution
(Cassese, Byrne, Schunkert, Kastrati) Deutsches Herzzentrum, Technische
Universitat Munchen, Lazarettstrasse 36, Munich D-80636, Germany
(Laugwitz, Kastrati) Medizinische Klinik, Klinikum Rechts der Isar,
Technische Universitat Munchen, Munich, Germany
(Laugwitz, Schunkert, Kastrati) DZHK (German Centre for Cardiovascular
Research), Partner Site Munich Heart Alliance, Munich, Germany
(Berger) Geisinger Medical Center, Danville, PA, United States
Title
Bivalirudin versus heparin in patients treated with percutaneous coronary
intervention: A meta-analysis of randomised trials.
Source
EuroIntervention. 11 (2) (pp 196-203), 2015. Date of Publication: 01 Jun
2015.
Publisher
EuroPCR
Abstract
Aims: Current recommendations on the use of bivalirudin in patients
treated with percutaneous coronary intervention (PCI) are mostly based on
trials comparing bivalirudin versus heparin plus planned glycoprotein
IIb/IIIa inhibitor (GPI). Whether bivalirudin is also superior to heparin
alone is still not well established. This meta-analysis investigates the
efficacy and safety of bivalirudin versus heparin in patients treated with
PCI without planned use of GPI. Methods and results: Scientific databases
and websites were searched for randomised controlled trials. The primary
efficacy and safety outcomes were the 30-day incidence of death and major
bleeding, respectively. The secondary outcomes were the 30-day incidence
of myocardial infarction (MI), definite stent thrombo-sis (ST), urgent
target vessel revascularisation (TVR), and overall death at the longest
available follow-up. Odds ratio (OR) and 95% confidence interval (95% CI)
served as summary statistics. Ten trials were identi-fied including a
total of 18,065 PCI patients randomised to bivalirudin (n=9,033) versus
heparin (n=9,032). At 30 days, bivalirudin versus heparin showed a
comparable risk of death (1.09 [0.83-1.41], p=0.54), and MI (1.10
[0.83-1.46], p=0.50) with a trend towards a higher risk of urgent TVR
(1.37 [0.96-1.96], p=0.08). The risk of major bleeding was lower with
bivalirudin (0.57 [0.40-0.80], p=0.001) and the bleeding reduction was
more evident when high doses of heparin were used as comparator (p for
interaction <0.001). The risk of definite ST (2.09 [1.26-3.47], p=0.005)
and, in particular, the risk of acute ST (3.48 [1.66-7.28], p<0.001) was
increased by bivalirudin. Conclusions: Patients undergoing PCI randomised
to therapy with either bivalirudin or heparin display a similar mortality.
Bivalirudin as compared to heparin appears to reduce the risk of major
bleeding at the expense of a higher risk of acute ST.<br/>Copyright &#xa9;
Europa Digital & Publishing 2015. All rights reserved.

<78>
Accession Number
606401649
Author
Chevalier B.; Wijns W.; Silber S.; Garcia E.; Serra A.; Paunovic D.;
Serruys P.
Institution
(Chevalier) Institut Cardiovasculaire Paris-Sud, Hopital Prive Jacques
Cartier, Massy 91300, France
(Wijns) Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
(Silber) Kardiologische Gemeinschaftspraxis und HKL, Munich, Germany
(Garcia) Hospital Monteprincipe, Madrid, Spain
(Serra) Hospital Sant Pau, Barcelona, Spain
(Paunovic) Terumo Europe, Leuven, Belgium
(Serruys) Erasmus MC, Rotterdam, Netherlands
Title
Five-year clinical outcome of the Nobori drug-eluting coronary stent
system in the treatment of patients with coronary artery disease: Final
results of the NOBORI 1 trial.
Source
EuroIntervention. 11 (5) (pp 549-554), 2015. Date of Publication: 01 Sep
2015.
Publisher
EuroPCR
Abstract
Aims: To assess the safety and performance of the Nobori drug-eluting
stent with biodegradable polymer versus the TAXUS drug-eluting stent with
permanent polymer, in the treatment of patients with de novo coronary
artery lesions. Methods and results: NOBORI 1 was a multicentre,
randomised (2:1), prospective, controlled, clinical trial which enrolled
363 patients (238 Nobori and 125 TAXUS) with up to two de novo lesions in
two epicardial vessels. The primary endpoint was in-stent late loss at
nine months, while secondary endpoints included safety and efficacy up to
five years. At five years, clinical data were available for 350 patients
(96%). There were no differences in the composite of death and myocardial
infarction (10.9% vs. 11.2%) and target lesion failure (9.2% and 10.4%),
while ischaemia- and non-ischaemia-driven target lesion revascularisations
were less frequent in the Nobori (6.3%) than in the TAXUS arm (16.0%). The
rates of stent thrombosis (definite and probable according to the ARC
definitions) were 0.0% and 3.2%, in the Nobori and TAXUS stents,
respectively (p=0.014). Conclusions: Five years after implantation, the
Nobori DES resulted in durable treatment effects with very low TLR and no
stent thrombosis. The study was not powered to assess the differences in
clinical endpoints. These data are hypothesis-generating.<br/>Copyright
&#xa9; Europa Digital & Publishing 2015. All rights reserved.

<79>
Accession Number
600294691
Author
Carrie D.; Delarche N.; Piot C.; Berland J.; Menneveau N.; Bonello L.; Py
A.; Teiger E.; Leborgne L.; Bayet G.; Wittenberg O.; Schiele F.
Institution
(Carrie) Cardiology B, Cardiovascular and Metabolic Pole, Rangueil
Hospital, Toulouse, France
(Delarche) Cardiology Department, Hospital Centre, Pau, France
(Piot) Cardiology Department, Arnaud de Villeneuve Hospital, Montpellier,
France
(Berland) Cardiology Department, St. Hilaire Clinic, Rouen, France
(Menneveau, Schiele) Cardiology Department, Jean Minjoz Hospital,
Besancon, France
(Bonello) Cardiology Department, North Hospital, Marseille, France
(Py) Cardiology Department, Alexandre Dumas Medical Centre, Amiens, France
(Teiger) Cardiology Department, Henri Mondor Hospital, Creteil, France
(Leborgne) Cardiology Department, North Hospital, Amiens, France
(Bayet) Cardiology Department, Rhone Durance Clinic, Avignon, France
(Wittenberg) Cardiology Department, Beauregard Polyclinic, Marseille,
France
Title
Everolimus-eluting stent for the treatment of bare metal in-stent
restenosis: Clinical and angiographic outcomes at nine-month follow-up of
XERES (Xience Evaluation in bare metal stent REStenosis) trial.
Source
EuroIntervention. 10 (6) (no pagination), 2014. Date of Publication: 01
Oct 2014.
Publisher
EuroPCR
Abstract
Aims: Restenosis is a frequent complication of coronary stent
implantation, especially bare metal stent (BMS) implantation. The
everolimus-eluting stent (EES) has previously been shown to be efficacious
in the treatment of de novo lesions. We performed this study to evaluate
clinical, angiographic and IVUS results after EES implantation for the
treatment of BMS ISR.
Methods and results: XERES was a prospective, multicentre, nationwide
study, enrolling 97 consecutive patients with in-stent restenosis (ISR)
after BMS implantation across 20 centres in France. Suitable lesions had a
reference vessel diameter between 2.5 mm and 4 mm, a length <=22 mm and a
diameter stenosis between 50 and 100-. The primary endpoint was
angiographic in-stent late loss (LL) as determined by quantitative
coronary angiography (QCA) at nine-month follow-up. QCA was required to be
performed in each included patient and IVUS was performed in a subgroup of
27 patients. At nine-month follow-up, the in-stent late loss was
0.35+/-0.63 mm. The rate of in-stent binary restenosis was 12.22-,
including two complete occlusions. The average volume of neointimal
hyperplasia was 15.6+/-9.9 mm3. The in-stent percent volume obstruction
was 8.5+/-5.2-. The in-segment percent area and diameter obstruction were
32+/-17- and 27+/-11-, respectively. Two initial malappositions were
persistent and two other patients had late acquired stent malapposition.
The cumulative incidence of major adverse cardiac events (MACE) was 10.1-.
Conclusions: EES for the treatment of bare metal in-stent restenosis
seemed safe and efficacious.

<80>
[Use Link to view the full text]
Accession Number
619000848
Author
Fok M.; Bashir M.; Harky A.; Sladden D.; Dimartino M.; Elsyed H.; Howard
C.; Knipe M.; Shackcloth M.J.
Institution
(Fok, Elsyed, Howard, Knipe) Thoracic Aortic Aneurysm Service, Liverpool
Heart and Chest Hospital, Liverpool, United Kingdom
(Bashir, Harky, Sladden, Dimartino) Cardiothoracic Surgery, Barts Heart
Centre, St. Bartholomew's Hospital, London EC1A 7BE, United Kingdom
(Shackcloth) General Thoracic and Oesophageal Surgery, Liverpool Heart and
Chest Hospital, Liverpool, United Kingdom
Title
Video-Assisted Thoracoscopic Versus Robotic-Assisted Thoracoscopic
Thymectomy.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 12 (4) (pp 259-264), 2017. Date of Publication: 01 Jul 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective Minimally invasive thoracic surgical procedures, performed with
or without the assistance of a robot, have gained popularity over the last
decade. They have increasingly become the choice of intervention for a
number of thoracic surgical operations. Minimally invasive surgery
decreases postoperative pain, hospital stay and leads to a faster recovery
in comparison with conventional open methods. Minimally invasive
techniques to perform a thymectomy include video-assisted thoracoscopic
surgery (VATS) or robotic-assisted thoracoscopic surgery (RATS). In this
study, we aim to systematically review and interrogate the literature on
minimally invasive thymectomy and draw a meta-analysis on the outcomes
between the two approaches. Methods An extensive electronic health
database search was performed on all articles published from inception to
May 2015 for studies describing outcomes in VATS and RATS thymectomy.
Results A total of 350 patients were included in this study, for which 182
and 168 patients underwent RATS and VATS thymectomy, respectively. There
were no recorded in-hospital deaths for either procedure. There was no
statistical difference in conversion to open, length of hospital stay, or
postoperative pneumonia. Operational times for RATS thymectomy were
longer. Conclusions The VATS and RATS thymectomy offer good and safe
operative and perioperative outcomes. There is little difference between
the two groups. However, there is poor evidence basis for the long-term
outcomes in minimally invasive procedures for thymectomy. It is imperative
that future studies evaluate oncological outcomes both short and long term
as well as those related to safety.<br/>Copyright &#xa9; 2017 by the
International Society for Minimally Invasive Cardiothoracic Surgery.

<81>
[Use Link to view the full text]
Accession Number
619000838
Author
Kiaii B.B.; Swinamer S.A.; Fox S.A.; Stitt L.; Quantz M.A.; Novick R.J.
Institution
(Kiaii, Swinamer, Fox, Stitt, Quantz) Departments of Surgery, Western
University, 339 Windermere Rd, London, ON N0M 1C0, Canada
(Novick) Department of Surgery, University of Calgary, Calgary, AL, Canada
Title
A Prospective Randomized Study of Endoscopic Versus Conventional
Harvesting of the Radial Artery.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 12 (4) (pp 231-238), 2017. Date of Publication: 01 Jul 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Objective The aims of the study were to determine whether endoscopic
harvesting of the radial artery (RA) reduces morbidity due to pain,
infection, and disability with improvement in satisfaction and cosmesis
compared to the conventional technique and (2) to compare the 6-month
angiographic patency of the RA harvested conventionally and
endoscopically. Methods In a prospective randomized study, 119 patients
undergoing coronary artery bypass grafting using the RA were randomized to
have RA harvested either conventionally (n = 59) or endoscopically (n =
60). Results Radial artery harvest time (open wound time) was
significantly reduced in the endoscopic group (36.5 +/- 9.4 vs 57.7 +/-
9.4 minutes, P < 0.001). Only one patient developed wound infection (1.6%)
in the endoscopic group compared with six patients (10.2%), P = 0.061, in
the conventional group. Although this was not statistically significant,
clinically this was relevant in terms of reduction in postoperative
morbidity. Postoperative pain in the arm incision was significantly lower
in the endoscopic group at postoperative day 2 (P < 0.001) and at
discharge (P < 0.001) and similar to the conventional open group at 6
weeks' follow-up (P = 0.103). Overall patient satisfaction and cosmesis
were significantly better in the endoscopic group at postoperative day 2
(P < 0.001), at discharge (P < 0.001), and at 6 weeks' follow-up (P <
0.001). There was no difference in the arm disability postoperatively (P =
0.505) between the two groups. Six-month angiographic assessment of 23
patients (12 endoscopic and 11 open) revealed no difference in the patency
rate (10/12 in endoscopic and 9/11 in open group). Conclusions Endoscopic
RA harvesting reduced the incidence of postoperative wound infection and
wound pain and improved patient satisfaction and cosmesis compared with
conventional harvesting technique. There was no difference in the 6-month
angiographic patency of the RA harvested conventionally and
endoscopically.<br/>Copyright &#xa9; 2017 by the International Society for
Minimally Invasive Cardiothoracic Surgery.

<82>
Accession Number
618931628
Author
Cervi A.; Kelly D.; Alexopoulou I.; Khalidi N.
Institution
(Cervi, Kelly) McMaster University, Hamilton, ON, Canada
(Alexopoulou) Department of Pathology and Molecular Medicine, McMaster
University, Hamilton, ON, Canada
(Khalidi) Department of Rheumatology, McMaster University, Hamilton, ON,
Canada
Title
ANCA-associated pauci-immune glomerulonephritis in a patient with
bacterial endocarditis: A challenging clinical dilemma.
Source
Clinical Nephrology - Case Studies. 5 (1) (pp 32-37), 2017. Date of
Publication: 2017.
Publisher
Dustri-Verlag Dr. Karl Feistle (Bajuwarenring 4, Oberhaching 82041,
Germany. E-mail: marina.rottner@dustri.de)
Abstract
Purpose: We report the case of a 59-year-old man with chronic hepatitis B
and C infection presenting with acute kidney injury and enterococcus
faecalis-infective endocarditis (IE). An elevated proteinase-3 (PR3)-ANCA
and pauci-immune glomerulonephritis (GN) on renal biopsy were discovered,
corresponding to ANCA-mediated GN. We conducted a literature review to
assess the role of ANCA in IE and treatment implications. Methods: On
systematic review of the literature, we found five previous cases whereby
IE caused by streptococcus and bartonella species were related to ANCA
vasculitis- associated GN. Results: Most reports of IE-related GN are
mediated by immune complex deposition and resolve following microbial
clearance. Of the 5 cases of ANCA GN in the setting of IE, all had
markedly elevated levels of PR3-ANCA with either a subacute or chronic
course of infection. Patients were treated with a combination of steroids
and cyclophosphamide (2/5), steroids and antibiotics alone (1/5), or with
valvular replacement (2/5). Renal function was recovered in 4/5 patients.
Conclusion: Infection is a major etiologic player in the formation of
ANCA; however, the role of PR3-ANCA in IE remains unclear. Kidney biopsy
is essential in differentiating IE-related GN due to infection and immune
complex deposition versus ANCA-associated vasculitis. A paucity of reports
on the development of GN in IE-associated ANCA vasculitis exists,
highlighting the rarity of our case and lack of clear therapeutic
strategies in a patient with active infection requiring immunosuppression.
In this case, the patient's chronic hepatitis B and C coinfection
presented a unique challenge.<br/>Copyright &#xa9; 2017 Dustri-Verlag Dr.
K. Feistle.

<83>
Accession Number
614721435
Author
Korteland N.M.; Ahmed Y.; Koolbergen D.R.; Brouwer M.; De Heer F.; Kluin
J.; Bruggemans E.F.; Klautz R.J.M.; Stiggelbout A.M.; Bucx J.J.J.;
Roos-Hesselink J.W.; Polak P.; Markou T.; Van Den Broek I.; Ligthart R.;
Bogers A.J.J.C.; Takkenberg J.J.M.
Institution
(Korteland, Bogers, Takkenberg) Department of Cardio-Thoracic Surgery,
Erasmus MC, PO Box 2040, Rotterdam 3000 CA, Netherlands
(Roos-Hesselink) Department of Cardiology, Erasmus MC, Rotterdam,
Netherlands
(Ahmed, Koolbergen, De Heer, Kluin) Department of Cardio-Thoracic Surgery,
Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
(Brouwer) Department of Cardio-Thoracic Surgery, University Medical Center
Utrecht, Utrecht, Netherlands
(Bruggemans, Klautz) Department of Cardio-Thoracic Surgery, Leiden
University Medical Center, Netherlands
(Stiggelbout) Department of Medical Decision Making, Leiden University
Medical Center, Netherlands
(Bucx) Department of Cardiology, Diakonessenhuis, Utrecht, Netherlands
(Polak) Department of Cardiology, St. Anna Hospital, Geldrop, Netherlands
(Markou) Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle,
Netherlands
(Van Den Broek, Ligthart) Patient Organisation De HartandVaatgroep, The
Hague, Netherlands
Title
Does the use of a decision aid improve decision making in prosthetic heart
valve selection?.
Source
Circulation: Cardiovascular Quality and Outcomes. 10 (2) (no pagination),
2017. Article Number: e003178. Date of Publication: 01 Feb 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - A Dutch online patient decision aid to support prosthetic
heart valve selection was recently developed. A multicenter randomized
controlled trial was conducted to assess whether use of the patient
decision aid results in optimization of shared decision making in
prosthetic heart valve selection. Methods and Results - In a 5-center
randomized controlled trial, patients were allocated to receive either
standard preoperative care (control group) or additional access to the
patient decision aid (intervention group). Legally capable adult patients
accepted for elective isolated or combined aortic and mitral valve
replacement were included. Primary outcome was preoperative decisional
conflict (Decisional Conflict Scale); secondary outcomes included patient
knowledge, involvement in valve selection, anxiety and depression,
(valve-specific) quality of life, and regret. Out of 306 eligible
patients, 155 were randomized (78 control and 77 intervention).
Preoperative decisional conflict did not differ between the groups (34%
versus 33%; P=0.834). Intervention patients felt better informed (median
Decisional Conflict Scale informed subscore: 8 versus 17; P=0.046) and had
a better knowledge of prosthetic valves (85% versus 68%; P=0.004).
Intervention patients experienced less anxiety and depression (median
Hospital Anxiety and Depression Scale score: 6 versus 9; P=0.015) and
better mental well-being (mean Short Form Health Survey score: 54 versus
50; P=0.032). Three months postoperatively, valve-specific quality of life
and regret did not differ between the groups. Conclusions - A patient
decision aid to support shared decision making in prosthetic heart valve
selection does not lower decisional conflict. It does result in more
knowledgeable, better informed, and less anxious and depressed patients,
with a better mental well-being.<br/>Copyright &#xa9; 2017 American Heart
Association, Inc.

<84>
Accession Number
618878399
Author
Reindl M.; Reinstadler S.J.; Feistritzer H.-J.; Theurl M.; Basic D.;
Eigler C.; Holzknecht M.; Mair J.; Mayr A.; Klug G.; Metzler B.
Institution
(Reindl, Reinstadler, Feistritzer, Theurl, Basic, Eigler, Holzknecht,
Mair, Klug, Metzler) University Clinic of Internal Medicine III,
Cardiology and Angiology, Medical University of Innsbruck, Austria
(Mayr) University Clinic of Radiology, Medical University of Innsbruck,
Austria
Title
Relation of low-density lipoprotein cholesterol with microvascular injury
and clinical outcome in revascularized ST-elevation myocardial infarction.
Source
Journal of the American Heart Association. 6 (10) (no pagination), 2017.
Article Number: e006957. Date of Publication: 01 Oct 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--Microvascular injury (MVI) after primary percutaneous coronary
intervention for ST-elevation myocardial infarction (STEMI) is a major
determinant of adverse clinical outcome. Experimental data indicate an
impact of hypercholesterolemia on MVI; however, there is a lack of
clinical studies confirming this relation. We aimed to investigate the
association of cholesterol concentrations on admission with MVI visualized
by cardiac magnetic resonance imaging and clinical outcome in STEMI
patients treated by primary percutaneous coronary intervention. Methods
and Results--In this prospective, observational study, we included 235
consecutive revascularized STEMI patients. Cholesterol (total cholesterol,
low-density lipoprotein [LDL], and high-density lipoprotein cholesterol)
and triglyceride concentrations were determined at presentation. Cardiac
magnetic resonance scans were performed 2 (2-4) days after infarction to
assess infarct characteristics, including MVI. Clinical end point was the
occurrence of major adverse cardiac events (MACE) comprising allcause
mortality, nonfatal reinfarction, and new congestive heart failure.
Patients with MVI (n=129; 55%) showed higher levels of total cholesterol
(204 [172-226] versus 185 [168-212] mg/dL; P=0.01) and LDL cholesterol
(142 [113-166] versus 118 [103-149] mg/dL; P=0.001), whereas high-density
lipoprotein cholesterol and triglycerides did not differ significantly. In
multivariable analysis, including all significant clinical and cardiac
magnetic resonance determinants of MVI, LDL concentration emerged as an
independent predictor of MVI (odds ratio, 1.02 [95% confidence interval,
1.01-1.02]; P=0.002). Furthermore, increased LDL cholesterol (>150 mg/dL)
significantly predicted the occurrence of major adverse cardiac events
(hazard ratio, 3.09 [95% confidence interval, 1.22-7.87]; P=0.01).
Conclusions--In STEMI patients undergoing primary percutaneous coronary
intervention, baseline LDL cholesterol concentrations were independently
associated with MVI, revealing a clinically relevant link between LDL
metabolism and MVI in acute STEMI.<br/>Copyright &#xa9; 2017 The Authors.

<85>
Accession Number
615953753
Author
Wei S.; Chen M.; Chen N.; Liu L.
Institution
(Wei, Chen, Liu) Sichuan University, Department of Thoracic surgery, West
China Hospital, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China
(Chen) Guangdong Women and Children Hospital, Center for Reproductive
Medicine, Guangzhou 510010, China
(Wei, Chen, Liu) Sichuan University, Western China Collaborative
Innovation Center for Early Diagnosis, Multidisciplinary Therapy of Lung
Cancer, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China
Title
Feasibility and safety of robot-assisted thoracic surgery for lung
lobectomy in patients with non-small cell lung cancer: A systematic review
and meta-analysis.
Source
World Journal of Surgical Oncology. 15 (1) (no pagination), 2017. Article
Number: 98. Date of Publication: 08 May 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The aim of this study is to evaluate the feasibility and
safety of robot-assisted thoracic surgery (RATS) lobectomy versus
video-assisted thoracic surgery (VATS) for lobectomy in patients with
non-small cell lung cancer (NSCLC). Methods: An electronic search of six
electronic databases was performed to identify relevant comparative
studies. Meta-analysis was performed by pooling the results of reported
incidence of overall morbidity, mortality, prolonged air leak, arrhythmia,
and pneumonia between RATS and VATS lobectomy. Subgroup analysis was also
conducted based on matched and unmatched cohort studies, if possible.
Relative risks (RR) with their 95% confidence intervals (CI) were
calculated by means of Revman version 5.3. Results: Twelve retrospective
cohort studies were included, with a total of 60,959 patients. RATS
lobectomy significantly reduced the mortality rate when compared with VATS
lobectomy (RR = 0.54, 95% CI 0.38-0.77; P=0.0006), but this was not
consistent with the pooled result of six matched studies (RR = 0.12, 95%
CI 0.01-1.07; P=0.06). There was no significant difference in morbidity
between the two approaches (RR = 0.97, 95% CI 0.85-1.12; P=0.70).
Conclusions: RATS lobectomy is a feasible and safe technique and can
achieve an equivalent short-term surgical efficacy when compared with
VATS, but its cost effectiveness also should be taken into
consideration.<br/>Copyright &#xa9; 2017 The Author(s).

<86>
Accession Number
615229923
Author
Morris N.; Howard L.
Institution
(Morris, Howard) Institution Central Manchester University Hospitals NHS
Foundation Trust, Manchester, United Kingdom
(Morris) University of Manchester, Manchester, United Kingdom
(Howard) Manchester Metropolitan University, Manchester, United Kingdom
Title
Bet 1: In patients with suspected acute coronary syndrome, does Wellens'
sign on the electrocardiograph identify critical left anterior descending
artery stenosis?.
Source
Emergency Medicine Journal. 34 (4) (pp 264-266), 2017. Date of
Publication: April 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Wellens' syndrome consists of a history suggestive of an acute coronary
syndrome and biphasic or deeply inverted T waves in ECG leads V2-V3. A
shortcut review was carried out to establish whether this ECG pattern
identifies patients with a critical left anterior descending artery
stenosis. Six relevant papers were found. The clinical bottom line is that
biphasic T-wave inversion in lead V2-V3 should alert the clinician to a
probable critical stenosis of the left anterior descending
artery.<br/>Copyright &#xa9; 2017, BMJ Publishing Group. All rights
reserved.

<87>
[Use Link to view the full text]
Accession Number
610427275
Author
Riaz H.; Alansari S.A.R.; Khan M.S.; Riaz T.; Raza S.; Luni F.K.; Khan
A.R.; Riaz I.B.; Krasuski R.A.
Institution
(Riaz, Alansari) Department of Internal Medicine, Cleveland Clinic, 9500
Euclid Ave, Cleveland, OH 44195, United States
(Alansari, Raza) Department of Cardiothoracic Surgery, Heart and Vascular
Institute, Cleveland Clinic, Cleveland, OH, United States
(Khan) Department of Internal Medicine, Dow University of Health Sciences,
Karachi, Pakistan
(Riaz) Department of Internal Medicine, Bronx Lebanon Hospital, New York,
NY, United States
(Luni) Department of Cardiovascular Medicine, Mercy Saint Vincent Medical
Center, Toledo, OH, United States
(Khan) Department of Cardiovascular Medicine, University of Louisville,
Louisville, KY, United States
(Riaz) Department of Internal Medicine, University of Arizona, Tucson, AZ,
United States
(Krasuski) Department of Cardiovascular Medicine, Duke University, Durham,
NC, United States
Title
Safety and use of anticoagulation after aortic valve replacement with
bioprostheses.
Source
Circulation: Cardiovascular Quality and Outcomes. 9 (3) (pp 294-302),
2016. Date of Publication: 01 May 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - The American College of Cardiology guidelines recommend 3
months of anticoagulation after replacement of the aortic valve with a
bioprosthesis. However, there remains great variability in the current
clinical practice and conflicting results from clinical studies. To assist
clinical decision making, we pooled the existing evidence to assess
whether anticoagulation in the setting of a new bioprosthesis was
associated with improved outcomes or greater risk of bleeding. Methods and
Results - We searched the PubMed database from the inception of these
databases until April 2015 to identify original studies (observational
studies or clinical trials) that assessed anticoagulation with warfarin in
comparison with either aspirin or no antiplatelet or anticoagulant
therapy. We included the studies if their outcomes included
thromboembolism or stroke/transient ischemic attacks and bleeding events.
Quality assessment was performed in accordance with the Newland Ottawa
Scale, and random effects analysis was used to pool the data from the
available studies. I 2 testing was done to assess the heterogeneity of the
included studies. After screening through 170 articles, a total of 13
studies (cases=6431; controls=18210) were included in the final analyses.
The use of warfarin was associated with a significantly increased risk of
overall bleeding (odds ratio, 1.96; 95% confidence interval, 1.25-3.08;
P<0.0001) or bleeding risk at 3 months (odds ratio, 1.92; 95% confidence
interval, 1.10-3.34; P<0.0001) compared with aspirin or placebo. With
regard to composite primary outcome variables (risk of venous
thromboembolism, stroke, or transient ischemic attack) at 3 months, no
significant difference was seen with warfarin (odds ratio, 1.13; 95%
confidence interval, 0.82-1.56; P=0.67). Moreover, anticoagulation was
also not shown to improve outcomes at time interval >3 months (odds ratio,
1.12; 95% confidence interval, 0.80-1.58; P=0.79). Conclusions - Contrary
to the current guidelines, a meta-analysis of previous studies suggests
that anticoagulation in the setting of an aortic bioprosthesis
significantly increases bleeding risk without a favorable effect on
thromboembolic events. Larger, randomized controlled studies should be
performed to further guide this clinical practice.<br/>Copyright &#xa9;
2016 American Heart Association, Inc.

<88>
Accession Number
369155273
Author
Fisher S.A.; Doree C.; Brunskill S.J.; Mathur A.; Martin-Rendon E.
Institution
(Fisher, Doree, Brunskill) Systematic Review Initiatives, NHS Blood and
Transplants, John Radcliffe Hospital, Oxford, United Kingdom
(Fisher, Doree, Brunskill, Martin-Rendon) Nuffield Division of Clinical
Laboratory Sciencess, Radcliffe Department of Medicines, University of
Oxford, Oxford, United Kingdom
(Mathur) Queen Mary University of London CV Biomedical Research Units,
Barts and The London School of Medicine and Dentistry, London, United
Kingdom
(Martin-Rendon) Stem Cell Research Laboratorys, NHS Blood and Transplants,
John Radcliffe Hospital, Oxford, United Kingdom
Title
Bone Marrow Stem Cell Treatment for Ischemic Heart Disease in Patients
with No Option of Revascularization: A Systematic Review and
Meta-Analysis.
Source
PLoS ONE. 8 (6) (no pagination), 2013. Article Number: e64669. Date of
Publication: 19 Jun 2013.
Publisher
Public Library of Science (185 Berry Street, Suite 1300, San Francisco CA
94107, United States)
Abstract
Objective:To evaluate bone marrow stem cell treatment (BMSC) in patients
with ischemic heart disease (IHD) and no option of
revascularization.Background:Autologous BMSC therapy has emerged as a
novel approach to treat patients with acute myocardial infarction or
chronic ischemia and heart failure following percutaneous or surgical
revascularization, respectively. However, the effect of the treatment has
not been systematic evaluated in patients who are not eligible for
revascularization.Methods:MEDLINE (1950-2012), EMBASE (1980-2012), CENTRAL
(The Cochrane Library 2012, Issue 8) and ongoing trial databases were
searched for relevant randomized controlled trials. Trials where
participants were diagnosed with IHD, with no option for revascularization
and who received any dose of stem cells by any delivery route were
selected for inclusion. Study and participant characteristics, details of
the intervention and comparator, and outcomes measured were recorded by
two reviewers independently. Primary outcome measures were defined as
mortality and measures of angina; secondary outcomes were heart failure,
quality of life measures, exercise/performance and left ventricular
ejection fraction (LVEF).Results:Nine trials were eligible for inclusion.
BMSC treatment significantly reduced the risk of mortality (Relative Risk
0.33; 95% Confidence Interval 0.17 to 0.65; P = 0.001). Patients who
received BMSC showed a significantly greater improvement in CCS angina
class (Mean Difference -0.55; 95% Confidence Interval -1.00 to -0.10; P =
0.02) and significantly fewer angina episodes per week at the end of the
trial (Mean Difference -5.21; 95% Confidence Interval -7.35 to -3.07;
P<0.00001) than those who received no BMSC. In addition, the treatment
significantly improved quality of life, exercise/performance and LVEF in
these patients.Conclusions:BMSC treatment has significant clinical benefit
as stand-alone treatment in patients with IHD and no other treatment
option. These results require confirmation in large well-powered trials
with long-term follow-up to fully evaluate the clinical efficacy of this
treatment. &#xa9; 2013 Fisher et al.

<89>
Accession Number
618299532
Author
Ando T.; Takagi H.; Briasoulis A.; Afonso L.
Institution
(Ando, Afonso) Division of Cardiovascular Disease, Department of Internal
Medicine, Harper hospital, Wayne State University, Detroit, United States
(Takagi) Division of Cardiovascular Surgery, Department of Surgery,
Shizuoka Medical Center, Shizuoka, Japan
(Briasoulis) Division of Cardiovascular Disease, Department of Internal
Medicine, Mayo Clinic, Rochester, MN, United States
(Ando) Division of Cardiology, Detroit Medical Center, 3990, John R,
Detroit, MI 48201, United States
Title
Single versus dual anti-platelet therapy post transcatheter aortic valve
implantation: a meta-analysis of randomized controlled trials.
Source
Journal of Thrombosis and Thrombolysis. 44 (4) (pp 448-456), 2017. Date of
Publication: 01 Nov 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The purpose of this systematic review and meta-analysis was to assess the
30-days safety (bleeding and vascular events) and efficacy (reduction in
major stroke, myocardial infarction and mortality) of single anti-platelet
(SAPT) versus dual anti-platelet (DAPT) after transcatheter aortic valve
implantation (TAVI). We used a meta-analytic method with Mantel-Haenszel
methods to calculate the odds ratio (OR) and 95% confidence interval (CI).
Only randomized clinical trials that compared 30-days safety and efficacy
based on Valve Academic Research Consortium criteria were included.
Studies that included patients on anticoagulants were excluded. Our
analysis included three studies with a total of 421 patients (210 SAPT and
211 DAPT). Life-threatening and major bleeding as well as major vascular
complications was similar between SAPT and DAPT. Similarly, major stroke,
myocardial infarction and mortality was also comparable between the two
groups. The combined outcomes of 30-day mortality, life-threatening and
major bleeding showed tendency toward lower event rates in SAPT compared
to DAPT (9.5 vs. 15.6%, OR 0.57; 95% CI 0.31-1.03, p = 0.06). In
conclusion, SAPT provided similar safety without adding incremental
efficacy compared to DAPT but showed tendency of lower combined endpoints
of 30-day mortality, life-threatening and major bleeding.<br/>Copyright
&#xa9; 2017, Springer Science+Business Media, LLC.

<90>
Accession Number
619026232
Author
Ikeme S.; Bothma G.; Cianciulli D.; Pay N.; Epstein J.; Kuntze E.
Institution
(Ikeme) Baxter Healthcare Corporation, Deerfield, IL, United States
(Bothma, Kuntze) Baxter Healthcare Corporation, Zurich, Switzerland
(Cianciulli) Baxter Healthcare Corporation, Rome, Italy
(Pay, Epstein) Stratevi, Santa Monica, CA, United States
Title
Cost effectiveness analysis of hemostatic matrix pads vs standard of care
in cardiac surgery (Italian Hospital Perspective).
Source
Value in Health. Conference: ISPOR 20th Annual European Congress. United
Kingdom. 20 (9) (pp A609), 2017. Date of Publication:
October&#xFFFD;November 2017.
Publisher
Elsevier Ltd
Abstract
Objectives: To compare costs and effectiveness of using two different
hemostatic matrices (Hemopatch vs. dry or wet gauze compression or similar
standard of care (SOC)) in cardiac surgery from the Italian hospital
perspective. Methods: Using clinical outcomes from a published randomized
control trial (Weltert 2016), a costing framework was utilized to model
the economic impact of using Hemopatch in 170 cardiac surgeries. In this
trial, patients treated with Hemopatch had a 97.6% hemostasis success rate
(defined as reaching hemostasis in three minutes) which was statistically
significantly better than 65.8% with SOC (p< 0.001). Additional clinically
significant endpoints studied in the trial (blood transfusions and
surgical revisions) were also analyzed. It was assumed that each surgery
utilized 2 units of Hemopatch (dimensions of 4.5 x 9 cm) and 2 units of
SOC. The Italian product acquisition costs for Hemopatch and SOC were
included along with outcome-related costs derived from the literature and
adjusted to 2017 EUR using standard inflation estimates. One-way
sensitivity analysis (OWSA) and probabilistic sensitivity analyses (PSA)
were performed by varying all variables within the 95% confidence interval
(CI) of the point estimate or +/-20% when CI was not available. Results:
Considering only product acquisition cost, Hemopatch had an incremental
cost effectiveness ratio (ICER) of 619.81 per hemostasis success when
compared to SOC. However, when considering the cost and potential
difference in the frequency of transfusions and revisions compared to SOC,
the ICER reduced to 474.27 and Hemopatch was associated with a reduction
of 1.87 revisions and 17.85 transfusions, saving 3,901.74 and 3,966.27,
respectively. Sensitivity analysis demonstrated model robustness.
Conclusions: This analysis supports the use of Hemopatch over standard of
care in cardiac surgery in Italian hospitals, as it offers a statistically
significant higher hemostasis success rate and may lead to sizable cost
savings from reduced transfusions and surgical revisions.

<91>
Accession Number
619026140
Author
Yagudina R.; Kulikov A.; Skripnik A.
Institution
(Yagudina, Kulikov) I.M. Sechenov First Moscow State Medical University,
Moscow, Russian Federation
(Skripnik) Financial University, Government of the Russian Federation,
Moscow, Russian Federation
Title
Cost-effectiveness analysis of standard therapy with phosphocreatine vs
standard therapy in perioperative management of cardiac surgery patients
with extracorporeal circulation, with ischemic heart disease or with
chronic heart insufficiency.
Source
Value in Health. Conference: ISPOR 20th Annual European Congress. United
Kingdom. 20 (9) (pp A616), 2017. Date of Publication:
October&#xFFFD;November 2017.
Publisher
Elsevier Ltd
Abstract
Objectives: To determine the preferential scheme of medical therapy in
perioperative management of cardiac surgery patients with extracorporeal
circulation, with ischemic heart disease or with chronic heart
insufficiency from the point of view of pharmacoeconomic analysis with the
use of standard therapy in comparison with standard therapy +
phosphocreatine. Methods: The developed pharmacoeconomic model was based
on the results of meta-analysis of Landoni G. and co-authors, and an
open-label non-interventional comparative study by FSBI A.N. Bakoulev
Scientific Center of the MOH of Russia. Final result of the cost analysis
included the direct expenses associated with complications due to the
surgery. The time horizon was 1 year. Results: Use of phosphocreatine in
perioperative management of cardiac surgery patients has led to the higher
values of LYG in comparison with the use of standard therapy and is more
efficient as a result of improvement of such parameters as: frequency of
myocardial infarction cases, frequency of arrhythmia cases, the need in
inotropic therapy, the need to stay in emergency department and the number
of inpatient days. In case of the standard therapy + phosphocratine, the
values of LYG constituted 0.96 years, and in case of the standard therapy
- 0.88 years. The cost of a 12-months treatment with standard therapy and
with standard therapy + phosphocreatine constituted 83,566 rubles and
75,337 rubles respectively. Cost-effectiveness analysis reveals that the
cost-effectiveness ratio in the group of standard therapy +
phosphocreatine constitutes 78,444 rubles, whereas in the group of
standard therapy - 95,176 rubles. Conclusions: Insignificant increase of
the standard therapy cost by adding phosphocreatine makes it possible to
prevent perioperative complications and mortality of cardiac surgery
patients, is cost saving and make expenses efficient. Standard therapy +
phosphocreatine is a dominant treatment method in comparison with the
standard therapy.

<92>
Accession Number
619026047
Author
Walter E.; Schalle K.
Institution
(Walter, Schalle) Institute for Pharmaeconomic Research, Vienna, Austria
Title
Cost-effectiveness of landiolol, an ultra-short-acting beta-blocker, for
prevention of postoperative atrial fibrillation in Germany.
Source
Value in Health. Conference: ISPOR 20th Annual European Congress. United
Kingdom. 20 (9) (pp A615), 2017. Date of Publication:
October&#xFFFD;November 2017.
Publisher
Elsevier Ltd
Abstract
Objectives: Postoperative atrial-fibrillation (POAF) is common among
surgical patients and associated with a worse outcome.
Arterial-fibrillation (AF) is the most frequent complication arising after
coronary-artery-bypass-grafting (CABG) surgery, occurring in 30% of cases.
The incidence of this complication is even higher after valve-replacement
surgery (30-40%) and after compound operative procedures (40-60%).
Beta-blockers reduce POAF and supraventricular tachycardia and have direct
antiarrhythmic activity. Landiolol hydrochloride, is an ultra-short-acting
betablocker half-life of approximately 4 min. The selectivity ratio of
landiolol is higher than other beta-blockers. Methods: A decision-model
was developed to reflect the cost-effectiveness of landiolol vs.
no-prevention, standard-of-care (SoC) and esmolol for the patient group
with different cardiac surgeries and a subgroup of CABG. The model benefit
is expressed in a reduction in POAF episodes and reduced complications.
Clinical data were derived mainly from the meta-analysis of Li et al.
(2015) involving 807 patients (9 RCTs). The model calculates total
inpatient costs (incl. surgery, ICU, complication and re-hospitalisation)
over the hospital-length-of-stay (LOS). Costs from published sources were
used (2016 Euro) from the German hospital perspective. A one-way
deterministic sensitivity-analysis accounts for uncertainty. Results:
Patients with POAF had a higher incidence of mortality, morbidity and LOS
including ICU and more frequent readmissions and finally higher costs. Per
patient costs with landiolol are estimated between 24,234.21 -25,910.02
and AF occurred in 12.4%-19.1% of cases. Against no-prevention landiolol
is able to reduce hospital cost by 1,636.10 and decreases POAF by 24.9%.
Compared with SoC landiolol lower hospital costs by 1,840.63 and reduce
POAF events by 20.1%. Analysing the CABG subgroup, per patient costs with
landiolol are estimated between 23,960.86 -24,216.84 . AF cases occurred
in 8.8%-12.1% of patients. Compared to comparators landiolol is able to
reduce costs between 1,536.92 (no-prevention) and 1,448.23 (esmolol).
Conclusions: The economic-analysis shows that the use of landiolol is
highly cost-effective and associated with cost-savings.

<93>
Accession Number
619025546
Author
Okumura L.M.; Riveros B.S.; Lucchetta R.C.; Rosim M.P.; Nita M.E.;
Ferreira C.N.
Institution
(Okumura) Pontificia Universidade Catolica (PUC-RS), Porto Alegre, Brazil
(Riveros, Lucchetta) Universidade Federal Do Parana, Curitiba, Brazil
(Rosim) Universidade de Sao Paulo, Sao Paulo, Brazil
(Nita) Market Access and Patient Engagement Solutions-MAPES, Sao Paulo,
Brazil
(Ferreira) Edwards Lifesciences Latam, Sao Paulo, Brazil
Title
Cost associated with self-expandable valves in patients undergoing
transcatheter aortic valve replacement in Latin America.
Source
Value in Health. Conference: ISPOR 20th Annual European Congress. United
Kingdom. 20 (9) (pp A867), 2017. Date of Publication:
October&#xFFFD;November 2017.
Publisher
Elsevier Ltd
Abstract
Objectives: To estimate the economic impact of Transcatheter aortic valve
replace-ment in Latin America. Methods: To determine the costs and
efficacy of each technology Balloon-expandable valve (BEV) and
self-expandable valves (SEV), a literature review was performed, aiming to
find acquisition costs and probabilities of cardiovascular mortality,
myocardial infarction, renal failure, stroke, major vascular
complications, and other relevant cardiovascular outcomes. Costs were
expressed as USD and five Latin American countries were selected for the
base case (Brazil, Mexico, Argentina, Porto Rico and Chile). Time horizon
was set at 30 days, based on mortality outcomes reported at clinical
trials on valve replacement and other post-commercialization studies.
Results: BEV and SEV were associated with lower rates of mortality (1-4%).
Overall, myocardial infarction, renal failure, stroke, major vascular
complications and other outcomes were improved with BEV (Sapien 3). On
average, by considering all countries, the overall cost difference between
BEV and other technologies was-5,800 USD/patient. Argentina was the most
expensive setting, where the average cost between BEV and other medical
devices was USD 9,447 vs 23,319; while the lowest cost was observed in
Brazil (USD 2,060 vs 6,767). ConClusions: It is recognizable that there
are a low number of randomized controlled trials and other primary
comparative evidences to estimate comparative value of medical devices,
when compared to medications. Therefore, we identified studies comprising
patients requiring aortic valve replacement and various TAVI technologies
to infer the costs related to each technology. In the aforementioned
countries, Sapien 3 might be an efficient technology for aortic valve
replacement, in comparison to other technologies.

<94>
Accession Number
619024300
Author
Oberhoffer M.; Huelskoetter M.; Bayer N.; Geidel S.; Schmoeckel M.;
Canobbio M.
Institution
(Oberhoffer, Huelskoetter, Bayer, Geidel, Schmoeckel) Asklepios Hospital
St. Georg, Hamburg, Germany
(Canobbio) Becton Dickinson Italia SpA, Milano, Italy
Title
Infection prevention in heart surgery in germany: An economic analysis.
Source
Value in Health. Conference: ISPOR 20th Annual European Congress. United
Kingdom. 20 (9) (pp A782), 2017. Date of Publication:
October&#xFFFD;November 2017.
Publisher
Elsevier Ltd
Abstract
Objectives: Patients undergoing coronary artery bypass grafting (CABG)
using bilateral mammarian arteries (BIMA) are at high risk for surgical
site infections (SSI). In these patients, the use of 2% chlorhexidine
gluconate (w/v) in 70% isopropyl alcohol (CHG-IPA) in a single use
applicator has been found to reduce by 36% the rate of SSI compared with
isopropyl alcohol (IPA) alone. An economic analysis has been developed to
assess the economic impact of CHG-IPA for CABG-BIMA surgery in the
perspective of a German hospital. MethOds: An economic model with a
decision tree structure was developed to compare CHG-IPA and IPA alone in
a cohort of 100 patients undergoing CABG-BIMA surgery. Costs and rate of
surgical site infec-tions were retrieved from German clinical and economic
evidence. A univariate sensitivity analysis was performed to test the
robustness of the results. Results: Compared with IPA alone, CHG-IPA with
single use applicator was associated with 3 fewer SSIs every 100 patients
undergoing CABG-BIMA, leading to a total saving of 55'961 for the
hospital ( 560 per patient undergoing surgery). The sensitivity analysis
demonstrates that results are driven by SSI rates: a minimum relative
reduction in the SSI rate (< 1%) makes CHG-IPA economically advantageous
compared with IPA alone. cOnclusiOns: The choice of the antiseptic may
play an important role both clinically and economically for German
hospitals, especially in high-risk and high-cost procedures as CABG-BIMA
surgeries.

<95>
Accession Number
619024023
Author
Kolominsky-Rabas P.L.; Zhang S.
Institution
(Kolominsky-Rabas, Zhang) Friedrich-Alexander-University of
Erlangen-Nurnberg, Erlangen, Germany
Title
Reporting clinical outcomes in TAVI registries.
Source
Value in Health. Conference: ISPOR 20th Annual European Congress. United
Kingdom. 20 (9) (pp A594-A595), 2017. Date of Publication:
October&#xFFFD;November 2017.
Publisher
Elsevier Ltd
Abstract
Objectives: Transcatheter aortic valve implantation (TAVI) has been
demonstrated to be an alternative treatment for high surgical risk
patients with severe aortic stenosis. However, the fast growth of TAVI has
created difficulties in cross-study result comparison. In 2011 and 2013,
Valve Academic Research Consortium (VARC) published standardized
definitions on reporting endpoints in TAVI studies. The objective of this
study is to provide an overview of TAVI registries and the reporting of
clinical outcomes based on VARC-2 definitions. Methods: A systematic
review of TAVI registries reporting VARC-2 definitions has been performed
in line with PRISMA guidelines in PubMed, ScienceDirect, Scopus databases
and EMBASE. Based on VARC-2, patients' characteristics and procedure
characteristics, 30-day clinica outcomes, 1-year mortality and composited
endpoints were extracted from each registry's publications. No publication
time restriction was used. Results: 20 TAVI registries were identified in
our review with an overall sample size of 12,583 patients. 20 TAVI
registries used either EuroScore or Society of Thoracic Surgery Risk Score
(STS) or both to record patients' baseline characteristics and case
selection. The 30-day all-cause mortality ranged from 0 to 12.7%. 14
registries reported 30-day cardiovascular mortality, and only 11
registries reported 1-year mortality. Myocardial infarction (MI) should be
differentiating into periprocedural MI and spontaneous MI, the author only
can identify 11 registries who reported periprocedural MI. The majority of
registries have reported complications such as bleeding, vascular
complications and new pacemaker implantation. Of all 20 TAVI registries,
30% reported 9 of 9 complications, and 55% missed 1-2 complications.
Conclusions: VARC and VARC-2 definitions are more and more widely used by
TAVI registries. Reporting VARC-2 definitions makes cross-registry
comparisons more feasible. Since the introduction of VARC, the number of
systematic-review and meta-analysis is dramatically increasing. This
transparence will provide better evidence to patients and decision makers
such as regulatory bodies, payers and HTA agencies.

<96>
Accession Number
619023974
Author
Angleitner P.; Kaider A.; Gokler J.; Moayedifar R.; Osorio E.; Zuckermann
A.; Laufer G.; Aliabadi-Zuckermann A.
Institution
(Angleitner, Gokler, Moayedifar, Osorio, Zuckermann, Laufer,
Aliabadi-Zuckermann) Division of Cardiac Surgery, Austria
(Kaider) Center for Medical Statistics, Informatics and Intelligent
Systems (CeMSIIS), Austria
Title
Higher dose norepinephrine donor support is not associated with outcomes
following heart transplantation.
Source
Transplant International. Conference: 31st Annual Meeting of the Austrian
Society of Transplantation, Transfusion and Genetics - Austrotransplant
2017. Austria. 30 (Supplement 3) (pp 15), 2017. Date of Publication:
October 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Background: Higher dose norepinephrine donor support is a frequent reason
for donor heart decline although its associations with outcomes following
heart transplantation are unclear. Methods: We retrospectively analysed
patients transplanted between 1992 and 2015 at the Heart Transplant
Program Vienna. Recipients (n = 965) were stratified depending on
respective donor norepinephrine doses administered before organ
procurement (group 0: 0 mug/kg/min; group 1: 0.01-0.1 mug/kg/min; group 2:
>0.1 mug/kg/min). Associations between groups and outcome variables were
investigated using a multivariable Cox proportional hazards model and
logistic regression analyses. Results: Donor norepinephrine dose groups
were not associated with overall mortality (group 1 vs. 0: Hazard Ratio
(HR) 1.12, 95% Confidence Interval (CI): 0.87-1.43; group 2 vs. 0: HR
1.07, 95% CI: 0.82-1.39; p = 0.669). No significant group differences were
found for rates of 30-day mortality (group 0: 10.5%; group 1: 8.3%; group
2: 7.4%; p = 0.35), 1-year mortality (15.8% vs. 16.3% vs. 14.9%, p =
0.897), primary graft dysfunction (17.4% vs. 16.2% vs. 16.4%, p = 0.898),
prolonged ventilation (> 7 days) (18.9% vs. 24.5% vs. 24.2%, p = 0.133),
and renal replacement therapy (20.0% vs. 22.4% vs. 24.9%, p = 0.324).
Groups 1 and 2 showed higher rates of prolonged intensive care unit stay
(> 14 days) (18.9% vs. 28.5% vs. 27.5%, p = 0.005). Conclusions:
Acceptance of selected donor hearts supported by higher doses of
norepinephrine may be a safe option to increase the donor organ pool.

<97>
Accession Number
619023818
Author
Baron D.; Stefaniak-Baron J.; Leitner G.; Ullrich R.
Institution
(Baron, Stefaniak-Baron, Leitner, Ullrich) Medizinische Universitat Wien,
Vienna, Austria
Title
Transfusion of stored blood induces pulmonary vasoconstriction in
critically ill patients after cardiac surgery.
Source
Transplant International. Conference: 31st Annual Meeting of the Austrian
Society of Transplantation, Transfusion and Genetics - Austrotransplant
2017. Austria. 30 (Supplement 3) (pp 6), 2017. Date of Publication:
October 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Introduction: Experimental studies have shown that transfusion of packed
red blood cells (PRBCs) stored for 40 days increases pulmonary arterial
pressure (PAP) and pulmonary vascular resistance (PVR). We hypothesized
that transfusion of stored blood would induce pulmonary vasoconstriction
in critically ill patients after cardiac surgery. Methods: This study was
performed as a double-blind, parallel-group, randomized clinical trial at
the Medical University of Vienna after ethics committee approval and
registration (NCT02050230). Critically ill patients requiring one unit of
PRBCs were randomized to receive PRBCs stored for <=14 days (fresh PRBCs)
or standard-issue PRBCs (the oldest compatible unit available from the
blood bank) over 15 min. The increase of PAP during transfusion (DPAP) was
defined as primary outcome parameter. PAP, mean arterial pressure (MAP),
and cardiac output (CO) were measured at baseline and after transfusion.
PVR and systemic vascular resistance (SVR) were calculated. Concentrations
of macrophage migration inhibitory factor (MIF) and syndecan-1 (SDC1) in
serum and in supernatant of PRBCs were measured with ELISA. Statistical
analysis was performed with Welch's test. Results: Six patients received
fresh PRBCs and five patients received standard-issue PRBCs. DPAP was
greater after transfusion of standard-issue PRBCs than fresh PRBCs (7 +/-
3 vs. 2 +/- 2 mmHg, p = 0.012). Similarly, PVR (81 +/- 50 vs -1 +/- 37 dyn
s/cm⁵, p = 0.018) and SVR (166 +/- 61 vs. 9 +/- 72 dyn
s/cm⁵, p = 0.004) increased to a greater extent after
transfusion of standard-issue PRBCs than fresh PRBCs. Standard-issue PRBCs
increased systemic MIF concentrations by 56 +/- 70% (p = 0.02), while
transfusion of fresh PRBCs did not (p = 0.54). Systemic SDC1
concentrations increased after transfusion of fresh and standard-issue
PRBCs (p < 0.05), but did not differ among groups (p = 0.99). Conclusion:
Transfusion of standard-issue PRBCs induces pulmonary vasoconstriction in
critically ill patients after cardiac surgery.

<98>
Accession Number
619039870
Author
Hamester L.; Souza E.N.; Cielo C.; Moraes M.A.; Pellanda L.C.
Institution
(Hamester) Student of the Primary Health Care Residency Program - Public
Health, Escola de Saude Publica do Rio Grande do Sul, Porto Alegre, RS,
Brazil
(Souza) PhD, Professor, Departamento de Enfermagem, Universidade Federal
de Ciencias da Saude de Porto Alegre, Porto Alegre, RS, Brazil
(Cielo) Student of the Multidisciplinary Integrated Health Residency
Program - Nursing in Cardiology, Instituto de Cardiologia, Fundacao
Universitaria de Cardiologia, Porto Alegre, RS, Brazil
(Moraes) PhD, Professor, Instituto de Cardiologia, Fundacao Universitaria
de Cardiologia, Porto Alegre, RS, Brazil
(Pellanda) PhD, Professor, Departamento de Saude Coletiva, Universidade
Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, RS, Brazil
Title
Effectiveness of a nursing intervention in decreasing the anxiety levels
of family members of patients undergoing cardiac surgery: a randomized
clinical trial.
Source
Revista latino-americana de enfermagem. 24 (pp e2729), 2016. Date of
Publication: 15 Aug 2016.
Abstract
RESULTADOS: foram incluidos 210 sujeitos, 105 em cada grupo, com idade
media de 46,4+/-14,5 anos, sendo 69% do sexo feminino e 41% filhos dos
pacientes. Na avaliacao da ansiedade, o escore medio para o grupo
intervencao foi de 41,3+/-8,6 pontos e, para o grupo controle, 50,6+/-9,4
pontos (p<0,001).
CONCLUSAO: a intervencao de enfermagem voltada a orientacao de familiares,
no momento que antecede a primeira visita no pos-operatorio imediato de
cirurgia cardiaca, contribui para possivel reducao da ansiedade dos
acompanhantes, contribuindo para que se sintam mais preparados para esse
momento. Registro Brasileiro de Ensaios Clinicos (ReBEC) e The Universal
Trial Number (UTN), sob o numero U1111-1145-6172.
OBJETIVO: verificar la efectividad de las orientaciones de enfermeria -
dadas a familiares de pacientes en el posoperatorio inmediato de cirugia
cardiaca, antes de la primera visita, en la sala de recuperacion
postanestesica - en los niveles de ansiedad, comparados con la orientacion
de rutina de la unidad.
METODOS: ensayo clinico aleatorio, realizado con familiares abordados en
la sala de espera, antes de la primera visita en el posoperatorio
inmediato. Familiares designados para el grupo intervencion recibieron
orientaciones audiovisuales sobre las condiciones en que el paciente se
encontraba en aquel momento, y el grupo control recibio las orientaciones
de rutina de la unidad. El resultado ansiedad fue evaluado por el
inventario IDATE.
RESULTADOS: fueron incluidos 210 sujetos, 105 en cada grupo, con edad
promedio de 46,4+/-14,5 anos, siendo 69% del sexo femenino y 41% eran
hijos de los pacientes. En la evaluacion de la ansiedad, el puntaje
promedio para el grupo intervencion fue de 41,3+/-8,6 puntos y, para el
grupo control, 50,6+/-9,4 puntos (p<0,001).
CONCLUSION: la intervencion de enfermeria dirigida a orientar a
familiares, en el momento que antecede a la primera visita en el
posoperatorio inmediato de cirugia cardiaca, induce una posible reduccion
de la ansiedad de los acompanantes, contribuyendo para que se sientan mas
preparados para ese momento. Registro Brasileno de Ensayos Clinicos
(ReBEC) y The Universal Trial Number (UTN), bajo el no U1111-1145-6172.
OBJECTIVE: to verify the effectiveness of nursing orientation provided to
families of patients in the immediate post-operative following cardiac
surgery before the first visit to the post-anesthesia care unit, in
decreasing anxiety levels, compared to the unit's routine orientation.
METHOD: open randomized clinical trial addressing family members in the
waiting room before the first visit in the immediate post-operative
period. The family members assigned to the intervention group received
audiovisual orientation concerning the patients' conditions at the time
and the control group received the unit's routine orientation. Outcome
anxiety was assessed using the STAI-State.
RESULTS: 210 individuals were included, 105 in each group, aged 46.4 years
old on average (+/-14.5); 69% were female and 41% were the patients'
children. The mean score obtained on the anxiety assessment in the
intervention group was 41.3+/-8.6, while the control group scored
50.6+/-9.4 (p<0.001).
CONCLUSION: a nursing intervention focused on providing guidance to
families before their first visit to patients in the immediate
post-operative period of cardiac surgery helps to decrease the levels of
anxiety of companions, making them feel better prepared for the moment.
ReBEC (Brazilian Clinical Trials Registry) and The Universal Trial Number
(UTN), No. U1111-1145-6172.
OBJETIVO: verificar a efetividade das orientacoes de enfermagem a
familiares de pacientes em pos-operatorio imediato de cirurgia cardiaca,
antes da primeira visita na sala de recuperacao pos-anestesica, nos niveis
de ansiedade, comparados com a orientacao de rotina da unidade.
METODOS: ensaio clinico randomizado, realizado com familiares abordados na
sala de espera, antes da primeira visita no pos-operatorio imediato.
Familiares alocados no grupo intervencao receberam orientacoes
audiovisuais sobre as condicoes em que o paciente se encontrava naquele
momento, e o grupo controle recebeu as orientacoes de rotina da unidade. O
desfecho ansiedade foi avaliado pelo inventario IDATE.

<99>
Accession Number
614213565
Author
Anantha Narayanan M.; Aggarwal S.; Reddy Y.N.V.; Alla V.M.; Baskaran J.;
Kanmanthareddy A.; Suri R.M.
Institution
(Anantha Narayanan, Baskaran) Division of Cardiology, Department of
Medicine, University of Minnesota, School of Medicine, Minneapolis, MN,
United States
(Aggarwal, Alla, Kanmanthareddy) Division of Cardiology, CHI, Health
Creighton University Medical Center, Omaha, NE, United States
(Reddy) Division of Cardiovascular Sciences, Mayo Clinic, Rochester, MN,
United States
(Suri) Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic
Foundation, Cleveland, OH, United States
Title
Surgical Repair of Moderate Ischemic Mitral Regurgitation--A Systematic
Review and Meta-analysis.
Source
Thoracic and Cardiovascular Surgeon. 65 (6) (pp 447-456), 2017. Date of
Publication: 01 Sep 2017.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Introduction Moderate mitral regurgitation (MR) of ischemic etiology has
been associated with worse outcomes after coronary artery bypass grafting
(CABG). Studies comparing concomitant mitral valve replacement/repair
(MVR/Re) with CABG and standalone CABG have reported conflicting results.
We performed a systematic review and meta-analysis of the published
literature. Patients and Methods We searched using PubMed, Cochrane,
EMBASE, CINAHL, and Google scholar databases from January 1960 to June
2016 for clinical trials comparing CABG to CABG + MVR/Re for moderate MR.
Pooled risk ratio or mean difference (MD) with 95% confidence intervals
(CI) for individual outcomes were calculated using random effects model
and heterogeneity was assessed using Cochrane's Q-statistic. Results A
total of 11 studies were included. Mean follow-up was 35.3 months.
All-cause mortality (Mantel-Haenszel [MH] risk ratio [RR]: 0.96, 95% CI:
0.75-1.24, p = 0.775), early mortality (MH RR: 0.65, 95% CI: 0.39-1.07, p
= 0.092), and stroke rates (MH RR 0.65, 95% CI: 0.21-2.03, p = 0.464) were
similar between CABG and CABG + MVR/Re groups. Adverse event at follow-up
was lower with CABG (MH RR: 0.90, 95% CI: 0.61-1.32, p = 0.584). MD of
change from baseline in left ventricular (LV) end-systolic dimension (MD:
- 2.50, 95% CI: - 5.21 to - 0.21, p = 0.071) and LV ejection fraction (MD:
0.48, 95% CI: - 2.48 to 3.44, p = 0.750) were not significantly different
between the groups. Incidence of moderate MR (MH RR: 3.24, 95% CI:
1.79-5.89, p < 0.001) was higher in the CABG only group. Conclusion
Addition of MVR/Re to CABG in patients with moderate ischemic MR did not
result in improvement in early or overall mortality, stroke risk, or
intermediate markers of LV function when compared with CABG
alone.<br/>Copyright &#xa9; 2017 Georg Thieme Verlag KG Stuttgart.New
York.

<100>
Accession Number
618209938
Author
Yun-Dan D.; Wen-Jing D.; Xi-Jun X.
Institution
(Yun-Dan, Xi-Jun) Department of Cardiovascular Surgery, West China
Hospital, Sichuan University, No. 37 of Guoxuexiang, Wuhou District,
Chengdu, Sichuan 610041, China
(Wen-Jing) Department of Gynecology and Obstetrics, First Hospital,
Lanzhou University, Lanzhou, Gansu, China
Title
Comparison of Outcomes following Mitral Valve Repair versus Replacement
for Chronic Ischemic Mitral Regurgitation: A Meta-Analysis.
Source
Thoracic and Cardiovascular Surgeon. 65 (6) (pp 432-441), 2017. Date of
Publication: 01 Sep 2017.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Background The selection of mitral valve surgery, including mitral valve
repair and mitral valve replacement, is still an important dilemma for
patients with chronic ischemic mitral regurgitation. We carry out a
meta-analysis to evaluate the effectiveness and safety of mitral valve
repair versus replacement for ischemic mitral regurgitation. Methods We
searched PubMed, Embase, the Cochrane Library, and Web of Science to
identify studies from their inception to July 2015. A meta-analysis was
performed using RevMan 5.3 software (Cochrane Collaboration, Oxford,
United Kingdom). A random-effect model was used and sensitivity analysis
was performed on studies reporting on operation after 2000, high-quality
studies, and those studies reporting on more than 150 patients. Result A
total of 2,324 patients were identified from 10 retrospective studies.
Mitral valve repair was associated with a trend toward lower operative
mortality (odds ratio [OR] = 0.45; 95% confidence interval [CI]:
0.31-0.65; p < 0.0001) and higher recurrence of mitral regurgitation (OR =
5.89; 95% CI: 3.34-10.39; p < 0.00001). Five-year survival rate was
similar between the two groups (OR = 1.20; 95% CI: 0.88-1.65; p = 0.25).
No differences in reoperation, the incidence of acute renal failure and
acute respiratory failure, the length of ICU stay, and the length of
hospital stay were found. Conclusion Mitral valve repair was associated
with lower operative mortality but a higher recurrence of mitral
regurgitation compared with mitral valve replacement. Owing to the limited
quantity and quality of the included studies, this conclusion still needs
to be further confirmed by conducting more high-quality, multicenter
randomized controlled trials with large sample size.

<101>
Accession Number
617922869
Author
Baikoussis N.G.; Antonopoulos C.N.; Papakonstantinou N.A.; Argiriou M.;
Geroulakos G.
Institution
(Baikoussis, Antonopoulos, Papakonstantinou, Argiriou) Cardiovascular and
Thoracic Surgery Department, General Hospital of Athens "Evangelismos",
Athens, Greece
(Antonopoulos) Department of Vascular Surgery, King's College Hospital,
London, United Kingdom
(Geroulakos) Department of Vascular Surgery, "Attikon" Hospital, Medical
School, National and Kapodistrian University of Athens, Athens, Greece
Title
Endovascular stent grafting for ascending aorta diseases.
Source
Journal of Vascular Surgery. 66 (5) (pp 1587-1601), 2017. Date of
Publication: November 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective Conventional open surgery encompassing cardiopulmonary bypass
has been traditionally used for the treatment of ascending aorta diseases.
However, more than one in five of these patients will be finally
considered unfit for open repair. We conducted a systematic review and
meta-analysis to investigate the role of thoracic endovascular aortic
repair (TEVAR) for aortic diseases limited to the ascending aorta. Methods
The current meta-analysis was conducted using the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses guidelines. We investigated
patients' baseline characteristics along with early (30 days/in-hospital
stay) and late (beyond 30 days/in-hospital stay) outcomes after TEVAR
limited to the ascending aorta and not involving the arch vessels.
Separate analyses for case reports and case series were conducted, and
pooled proportions with 95% confidence intervals (CIs) of outcome rates
were calculated. Results Approximately 67% of the patients had a prior
cardiac operation. TEVAR was performed mainly for acute or chronic
Stanford type A dissection (49%) or pseudoaneurysm (28%). The device was
usually delivered through the femoral artery (67%), and rapid ventricular
pacing was used in nearly half of the patients. Technical success of the
method was 95.5% (95% CI, 87.8-99.8). Among the early outcomes, conversion
to open repair was 0.7% (95% CI, 0.1-4.8), whereas mortality was 2.9% (95%
CI, 0.02-8.6). We estimated a pooled rate of 1.8% (95% CI, 0.1-7.0) for
neurologic events (stroke or transient ischemic attack) and 0.8% (95% CI,
0.1-5.6) for myocardial infarction. Late endoleak was recorded in 16.4%
(95% CI, 8.2-26.0), and 4.4% (95% CI, 0.1-12.4) of the population died in
the postoperative period. Finally, reoperation was recorded in 8.9% (95%
CI, 3.1-16.4) of the study sample. Conclusions TEVAR in the ascending
aorta seems to be safe and feasible for selected patients with various
aortic diseases, although larger studies are required.<br/>Copyright
&#xa9; 2017 Society for Vascular Surgery

<102>
Accession Number
612375354
Author
Kalogianni A.; Almpani P.; Vastardis L.; Baltopoulos G.; Charitos C.;
Brokalaki H.
Institution
(Kalogianni, Almpani) Faculty of Nursing, Technological Educational
Institute of Athens, Ag. Spiridona Str, Aigaleo, Athens 122 10, Greece
(Vastardis) Intensive Care Unit of Department of Cardiac Surgery,
Evangelismos General Hospital, Athens, Greece
(Baltopoulos, Brokalaki) Faculty of Nursing, National and Kapodistrian
University of Athens, Greece
(Charitos) Cardiothoracic Surgery Department, Evangelismos, General
Hospital of Athens, Greece
Title
Can nurse-led preoperative education reduce anxiety and postoperative
complications of patients undergoing cardiac surgery?.
Source
European Journal of Cardiovascular Nursing. 15 (6) (pp 447-458), 2016.
Date of Publication: 01 Oct 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: The effect of preoperative education on anxiety and
postoperative outcomes of cardiac surgery patients remains unclear. Aim:
The aim of the study was to estimate the effectiveness of a nurse-led
preoperative education on anxiety and postoperative outcomes. Methods: A
randomised controlled study was designed. All the patients who were
admitted for elective cardiac surgery in a general hospital in Athens with
knowledge of the Greek language were eligible to take part in the study.
Patients in the intervention group received preoperative education by
specially trained nurses. The control group received the standard
information by the ward personnel. Measurements of anxiety were conducted
on admission-A, before surgery-B and before discharge-C by the state-trait
anxiety inventory. Results: The sample consisted of 395 patients
(intervention group: 205, control group: 190). The state anxiety on the
day before surgery decreased only in the intervention group (34.0 (8.4)
versus 36.9 (10.7); P=0.001). The mean decrease in state score during the
follow-up period was greater in the intervention group (P=0.001). No
significant difference was found in the length of stay or readmission.
Lower proportions of chest infection were found in the intervention group
(10 (5.3) versus 1 (0.5); P=0.004). Multivariate linear regression
revealed that education and score in trait anxiety scale on admission are
independent predictors of a reduction in state anxiety. Conclusion:
Preoperative education delivered by nurses reduced anxiety and
postoperative complications of patients undergoing cardiac surgery, but it
was not effective in reducing readmissions or length of
stay.<br/>Copyright &#xa9; European Society of Cardiology.

<103>
Accession Number
612375319
Author
Doering L.V.; McGuire A.; Eastwood J.-A.; Chen B.; Bodan R.C.; Czer L.S.;
Irwin M.R.
Institution
(Doering, Eastwood, Chen) School of Nursing, University of California,
Factor Building 4-266, 700 Tiverton Ave, Los Angeles, CA 90095, United
States
(McGuire) School of Nursing, California State University, Long Beach,
United States
(Bodan) School of Nursing, California State University, Fullerton, United
States
(Czer) Cedars-Sinai Heart Institute, United States
(Irwin) Cousins Center for Psychoneuroimmunology, University of
California, United States
Title
Cognitive behavioral therapy for depression improves pain and perceived
control in cardiac surgery patients.
Source
European Journal of Cardiovascular Nursing. 15 (6) (pp 417-424), 2016.
Date of Publication: 01 Oct 2016.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Depression after cardiac surgery (CS) is associated with
increased pain and decreased sleep quality. While cognitive behavioral
therapy (CBT) aimed at depression is effective in relieving depressive
symptoms after cardiac surgery, little is known about its ability to
ameliorate other common postoperative problems that affect recovery and
quality of life. Aims: The purpose of this study was to evaluate the
effects of CBT for depression on pain severity, pain interference, sleep,
and perceived control in patients recovering from CS. Methods: Depressed
patients recovering from CS were randomized to receive either eight weeks
of CBT or usual care. At baseline and post-intervention, patients
completed questionnaires for depressive symptoms, pain, sleep, and
perceived control. Group comparisons were conducted using t-tests or chi
square analysis. Repeated measures analysis was used to assess the effect
of the intervention in changes over time. Results: The sample (n=53)
included 16.9% women and had a mean age of 67.8+/-9.2 years. CBT for
depression increased perceived control (p<0.001) and decreased pain
interference (p=0.02) and pain severity (p=0.03). Group effects remained
significant (p<0.05) for perceived control and pain interference and a
trend was observed for pain severity (p<0.10) after controlling for
variables that differed at baseline. There were no group differences in
sleep disturbance over time. Conclusions: A depression-focused CBT
intervention yields benefits in other common postoperative problems,
specifically improved perceived control and decreased pain in depressed
cardiac surgery patients.<br/>Copyright &#xa9; European Society of
Cardiology.

<104>
Accession Number
613791534
Author
Bjornnes A.K.; Parry M.; Lie I.; Fagerland M.W.; Watt-Watson J.; Rustoen
T.; Stubhaug A.; Leegaard M.
Institution
(Bjornnes, Rustoen) Department of Research and Development, Division of
Emergencies and Critical Care, Oslo University Hospital, Norway and
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo,
Norway
(Parry, Watt-Watson) Lawrence S. Bloomberg Faculty of Nursing, University
of Toronto, Canada
(Lie) Department of Cardiothoracic Surgery, Oslo University Hospital,
Ulleval/Center for Patient Centered Heart and Lung Research, Division of
Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Norway
(Fagerland) Oslo Centre for Biostatistics and Epidemiology, Research
Support Services, Oslo University Hospital, Norway
(Stubhaug) Department of Pain Management and Research, Oslo University
Hospital, Institute of Clinical Medicine, Faculty of Medicine, University
of Oslo, Norway
(Leegaard) Oslo and Akershus University, College of Applied Sciences,
Faculty of Health Sciences, Institute of Nursing, Norway
Title
The impact of an educational pain management booklet intervention on
postoperative pain control after cardiac surgery.
Source
European Journal of Cardiovascular Nursing. 16 (1) (no pagination), 2017.
Date of Publication: 01 Jan 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Relevant discharge information about the use of analgesic
medication and other strategies may help patients to manage their pain
more effectively and prevent postoperative persistent pain. Aims: To
examine patients' pain characteristics, analgesic intake and the impact of
an educational pain management booklet intervention on postoperative pain
control after cardiac surgery. Concerns about pain and pain medication
prior to surgery will also be described. Methods: From March 2012 to
September 2013, 416 participants (23% women) were consecutively enrolled
in a randomized controlled trial. The intervention group received usual
care plus an educational booklet at discharge with supportive telephone
follow-up on postoperative day 10, and the control group received only
usual care. The primary outcome was worst pain intensity (The Brief Pain
Inventory - Short Form). Data about pain characteristics and analgesic use
were collected at 2 weeks and at 1, 3, 6 and 12 months post-surgery.
General linear mixed models were used to determine between-group
differences over time. Results: Twenty-nine percent of participants
reported surgically related pain at rest and 9% reported moderate to
severe pain at 12 months post-surgery. Many participants had concerns
about pain and pain medication, and analgesic intake was insufficient
post-discharge. No statistically significant differences between the
groups were observed in terms of the outcome measures following surgery.
Conclusion: Postoperative pain and inadequate analgesic use were problems
for many participants regardless of group allocation, and the current
intervention did not reduce worst pain intensity compared with control.
Further examination of supportive follow-up monitoring and/or
self-management strategies post-discharge is required.<br/>Copyright
&#xa9; European Society of Cardiology.

<105>
Accession Number
617408818
Author
Halkos M.E.; Anderson A.; Binongo J.N.G.; Stringer A.; Lasanajak Y.;
Thourani V.H.; Lattouf O.M.; Guyton R.A.; Baio K.T.; Sarin E.; Keeling
W.B.; Cook N.R.; Carssow K.; Neill A.; Glas K.E.; Puskas J.D.
Institution
(Halkos, Thourani, Lattouf, Guyton, Baio, Keeling, Cook, Carssow, Neill)
Division of Cardiothoracic Surgery, Emory University School of Medicine,
Atlanta, Ga, United States
(Anderson) Department of Neurology, Emory University School of Medicine,
Atlanta, Ga, United States
(Stringer) Department of Rehabilitation Medicine, Emory University School
of Medicine, Atlanta, Ga, United States
(Glas) Department of Anesthesiology, Emory University School of Medicine,
Atlanta, Ga, United States
(Binongo, Lasanajak) Rollins School of Public Health, Emory University
School of Medicine, Atlanta, Ga, United States
(Sarin) Department of Cardiothoracic Surgery, Inova Fairfax Healthcare
System, Falls Church, Va, United States
(Puskas) Department of Cardiothoracic Surgery, Mount Sinai University
School of Medicine, New York, NY, United States
Title
Operative strategies to reduce cerebral embolic events during on- and
off-pump coronary artery bypass surgery: A stratified, prospective
randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 154 (4) (pp 1278-1285.e1),
2017. Date of Publication: October 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective To determine the impact of different aortic clamping strategies
on the incidence of cerebral embolic events during coronary artery bypass
grafting (CABG). Methods Between 2012 and 2015, 142 patients with
low-grade aortic disease (epiaortic ultrasound grade I/II) undergoing
primary isolated CABG were studied. Those undergoing off-pump CABG were
randomized to a partial clamp (n = 36) or clampless facilitating device
(CFD; n = 36) strategy. Those undergoing on-pump CABG were randomized to a
single-clamp (n = 34) or double-clamp (n = 36) strategy. Transcranial
Doppler ultrasonography (TCD) was performed to identify high-intensity
transient signals (HITS) in the middle cerebral arteries during periods of
aortic manipulation. Neurocognitive testing was performed at baseline and
30-days postoperatively. The primary endpoint was total number of HITS
detected by TCD. Groups were compared using the Mann-Whitney U test.
Results In the off-pump group, the median number of total HITS were higher
in the CFD subgroup (30.0; interquartile range [IQR], 22-43) compared with
the partial clamp subgroup (7.0; IQR, 0-16; P <.0001). In the CFD
subgroup, the median number of total HITS was significantly lower for
patients with 1 CFD compared with patients with >1 CFD (12.5 [IQR, 4-19]
vs 36.0 [IQR, 25-47]; P =.001). In the on-pump group, the median number of
total HITS was 10.0 (IQR, 3-17) in the single-clamp group, compared with
16.0 (IQR, 4-49) in the double-clamp group (P =.10). There were no
differences in neurocognitive outcomes across the groups. Conclusions For
patients with low-grade aortic disease, the use of CFDs was associated
with an increased rate of cerebral embolic events compared with partial
clamping during off-pump CABG. A single-clamp strategy during on-pump CABG
did not significantly reduce embolic events compared with a double-clamp
strategy.<br/>Copyright &#xa9; 2017 The American Association for Thoracic
Surgery

<106>
Accession Number
619005857
Author
Gibson C.M.; Davis S.; Bradford D.
Institution
(Gibson) Department of Pharmacotherapy, University of North, Texas System
College of Pharmacy, 3500 Camp Bowie Blvd., Fort Worth, TX 76107, United
States
(Davis, Bradford) Medical City Arlington, Arlington, TX, United States
Title
Examining the use of sodium nitroprusside in coronary artery bypass
grafting: Is the benefit worth the cost?.
Source
Hospital Pharmacy. 52 (7) (pp 502-507), 2017. Date of Publication:
July-August 2017.
Publisher
SAGE Publications Ltd (E-mail: info@sagepub.co.uk)
Abstract
Purpose: Sodium nitroprusside is a vasodilator frequently used in the
coronary artery bypass grafting (CABG) setting. However, the price of a
50-mg vial of sodium nitroprusside increased from $5.00 in 2003 to up to
$900 in 2016. The purpose of this review is to help health systems balance
high-quality patient care with economic responsibility. Methods: A MEDLINE
literature search was performed using the search terms "nitroprusside" and
"coronary artery bypass." All English-language trials in human subjects
assessing the use of sodium nitroprusside in the setting of CABG were
evaluated. The references of these studies were also reviewed. Results: In
the setting of CABG, sodium nitroprusside attenuates conduit vasospasm and
reduces the incidence of inflammation, atrial fibrillation, and acute
kidney injury after surgery. However, other vasodilators are more
effective at maintaining postoperative blood pressure at goal.
Conclusions: Despite its cost, sodium nitroprusside may be an appropriate
agent to use during CABG operations, but other agents should be considered
for treatment of postoperative hypertension.<br/>Copyright &#xa9; The
Author(s) 2017.

<107>
Accession Number
619004332
Author
Jonokuchi A.J.; Knopman J.; Radwanski R.E.; Martinez M.A.; Taylor B.E.S.;
Rothbaum M.; Sullivan S.; Robison T.R.; Lo E.; Christophe B.R.; Bruce
E.M.; Khan S.; Kellner C.P.; Sigounas D.; Youngerman B.; Bagiella E.;
Angevine P.D.; Lowy F.D.; Sander Connolly E.
Institution
(Jonokuchi, Radwanski, Martinez, Taylor, Robison, Lo, Christophe, Bruce,
Kellner, Youngerman, Angevine, Sander Connolly) Department of Neurological
Surgery, Columbia University College of Physicians and Surgeons, 710 W
168th Street, New York, NY 10032, United States
(Knopman, Rothbaum, Sigounas) Department of Neurological Surgery, Weill
Cornell Medical Center, 525 East 68th Street, Box 99, New York, NY 10065,
United States
(Sullivan, Khan, Lowy) Department of Pathology and Cell Biology, Columbia
University College of Physicians and Surgeons, 630 W 168th Street, New
York, NY 10032, United States
(Bagiella) Center for Biostatistics, Department of Population Health
Science and Policy, Mount Sinai School of Medicine, 1 Gustave L. Levy
Place, New York, NY 10029, United States
Title
Topical vancomycin to reduce surgical-site infections in neurosurgery:
Study protocol for a multi-center, randomized controlled trial.
Source
Contemporary Clinical Trials. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Surgical-site infections (SSIs) account for 20% of all
healthcare-associated infections, are the most common nosocomial infection
among surgical patients, and are a focus of quality improvement
initiatives. Despite implementation of many quality care measures (e.g.
prophylactic antibiotics), SSIs remain a significant cause of morbidity,
mortality, and economic burden, particularly in the field of neurosurgery.
Topical vancomycin is increasingly utilized in instrumented spinal and
cardiothoracic procedures, where it has been shown to reduce the risk of
SSIs. However, a randomized controlled trial assessing its efficacy in the
general neurosurgical population has yet to be done.The principle aim of
"Topical Vancomycin for Neurosurgery Wound Prophylaxis" (NCT02284126) is
to determine whether prophylactic, topical vancomycin reduces the risk of
SSIs in the adult neurosurgical population. This prospective, multicenter,
patient-blinded, randomized controlled trial will enroll patients to
receive the standard of care plus topical vancomycin, or the standard of
care alone. The primary endpoint of this study is a SSI by postoperative
day (POD) 30. Patients must be over 18. years of age. Patients are
excluded for renal insufficiency, vancomycin allergy, and some ineligible
procedures. Univariate analysis and logistic regression will determine the
effect of topical vancomycin on SSIs at 30. days.A randomized controlled
trial is needed to determine the efficacy of this treatment. Results of
this trial are expected to directly influence the standard of care and
prevention of SSIs in neurosurgical patients.<br/>Copyright &#xa9; 2017
Elsevier Inc.

<108>
Accession Number
619002488
Author
Burri H.; Muller H.; Kobza R.; Sticherling C.; Ammann P.; Zerlik H.;
Stettler C.; Klersy C.; Prinzen F.; Auricchio A.
Institution
(Burri, Muller, Stettler) University Hospital of Geneva, Switzerland
(Kobza) Luzerner Kantonsspital, Switzerland
(Sticherling) University Hospital of Basel, Switzerland
(Ammann) Kantonsspital St-Gallen, Switzerland
(Zerlik) Abbott, Switzerland
(Klersy) Service of Biometry and Clinical Epidemiology, Research
Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
(Prinzen) Department of Physiology, Cardiovascular Research Institute,
University of Maastricht, The Netherlands
(Auricchio) Fondazione Cardiocentro Ticino, Lugano, Switzerland
Title
RIght VErsus Left Apical transvenous pacing for bradycardia: Results of
the RIVELA randomized study.
Source
Indian Pacing and Electrophysiology Journal. (no pagination), 2017. Date
of Publication: 2017.
Publisher
Indian Pacing and Electrophysiology Group (Pulikkottil Thondayad, Calicut
Kerala 673017, India)
Abstract
Aims: To compare cardiac function when pacing from the right or left
ventricular apex in patients with preserved left ventricular systolic
function, at 1-year follow-up. Methods: Prospective, multicentre centre
randomizing conventional right ventricular apical (RVA) versus left
ventricular apical (LVA) pacing using a coronary sinus lead in patients
requiring ventricular pacing for bradycardia. Follow-up was performed
using 3D-echocardiography at 6 and 12 months. Results: A total of 36
patients (age 75.4 +/- 8.7 years, 21 males) were enrolled (17 patients in
the RVA group and 19 patients in the LVA group). A right ventricular lead
was implanted in 8 patients in the LVA group, mainly because of high
capture thresholds. There were no differences in the primary endpoint of
LVEF at 1 year (60.4 +/- 7.1% vs 62.1 +/- 7.2% for the RVA and LVA groups
respectively, P = 0.26) nor in any of the secondary endpoints (left
ventricular dimensions, left ventricular diastolic function, right
ventricular systolic function and tricuspid/mitral insufficiency). LVEF
did not change significantly over follow-up in either group. Capture
thresholds were significantly higher in the LVA group, and two patients
had unexpected loss of capture of the coronary sinus lead during
follow-up. Conclusions: Left univentricular pacing seems to be comparable
to conventional RVA pacing in terms of ventricular function at up to 1
year follow-up, and is an option to consider in selected patients (e.g.
those with a tricuspid valve prosthesis).<br/>Copyright &#xa9; 2017 Indian
Heart Rhythm Society.

<109>
Accession Number
618215053
Author
Heo S.-H.; Yoon K.-W.; Woo S.-Y.; Park Y.-J.; Kim Y.-W.; Kim K.-H.; Chung
C.-S.; Bang O.-Y.; Kim D.-I.
Institution
(Heo, Yoon, Woo, Park, Kim, Kim) Division of Vascular Surgery, Samsung
Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South
Korea
(Kim) Department of Radiology Samsung Medical Centre, Sungkyunkwan
University School of Medicine, Seoul, South Korea
(Chung, Bang) Department of Neurology, Samsung Medical Centre,
Sungkyunkwan University School of Medicine, Seoul, South Korea
Title
Editor's Choice - Comparison of Early Outcomes and Restenosis Rate Between
Carotid Endarterectomy and Carotid Artery Stenting Using Propensity Score
Matching Analysis.
Source
European Journal of Vascular and Endovascular Surgery. 54 (5) (pp
573-578), 2017. Date of Publication: November 2017.
Publisher
W.B. Saunders Ltd
Abstract
Objective/Background Despite randomised evidence, the debate continues
about the preferred treatment strategy for carotid stenosis in routine
clinical practice. The aim of this study was to compare early outcomes and
restenosis rates after carotid endarterectomy (CEA) and carotid stenting
(CAS) in unselected patients using propensity score matching (PSM).
Methods The 30 day incidence of major adverse clinical events (MACE;
defined as stroke, transient ischaemic attack, myocardial infarction, or
death) and procedure related complications, as well as restenosis rates
during follow-up were compared between unselected patients undergoing CEA
or CAS between January 2002 and December 2015 at a single institution. PSM
was used to balance the following factors between the CEA and CAS cohorts:
age, sex, hypertension, diabetes, dyslipidaemia, smoking, atrial
fibrillation, previous percutaneous coronary intervention or coronary
artery bypass grafting, valvular heart disease, contralateral carotid
occlusion, degree of carotid stenosis, and symptomatic status. Statistical
comparisons of outcomes were based on logistic regression analysis and log
rank test. Results Of 1184 patients (654 CEA and 530 CAS), 452 PSM pairs
of CEA and CAS patients were created. The CAS group showed a relatively
higher 30 day incidence of MACE (7.5% vs. 2.4%; odds ratio [OR] 3.261, 95%
confidence interval [CI] 1.634-6.509; p =.001) but a lower incidence of
procedure related complications (1.5% vs. 5.3%; OR 0.199, 95% CI
0.075-0.528; p =.001). During a mean follow-up of 49.1 months (range 1-180
months), restenosis rates were higher after CAS than after CEA (1.5% vs.
1.0% at 12 months and 5.4% vs. 1.2% at 24 months, respectively; p =.008).
Conclusion This PSM based observation reconfirmed previous trial results
in both asymptomatic and symptomatic patients with carotid artery stenosis
in routine clinical practice: CEA showed lower 30 day MACE and mid-term
restenosis rates than CAS.<br/>Copyright &#xa9; 2017 European Society for
Vascular Surgery

<110>
[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.

<111>
Accession Number
618786431
Author
Tousek P.; Kocka V.; Petr R.; Ulman J.; Hlavicka J.; Kolesar M.
Institution
(Tousek, Kocka, Petr, Ulman, Hlavicka, Kolesar) Cardiocenter, University
Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles
University, Prague, Czech Republic
Title
Use of Amplatzer occluders for treatment of aorto-pulmonary fistulas-case
and review of the literature.
Source
Expert Review of Medical Devices. 14 (11) (pp 845-847), 2017. Date of
Publication: 02 Nov 2017.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: the use of amplatzer occluder family in daily clinical
practice has already overcome on-label indications, with growing clinical
experience and the technological evolution of devices. Areas covered: We
present the case of a patient with a very rare complication following
proximal aortic surgery treated using a unique strategy. A huge
pseudoaneurysm around an ascending aortic prosthesis ruptured into the
right pulmonary artery. A hybrid treatment strategy consisting of
percutaneous closure of the fistula followed by cardiosurgery was chosen
due to the patient's poor haemodynamic condition. We also review current
clinical experience of endovascular treatment of aortopulmonary fistulas
by searching case reports in PubMed. Expert commentary: Closure of the APF
using an Amplatzer occluder via the antegrade venous approach is feasible,
and may improve the haemodynamic conditions and decrease the risk of
subsequent cardiac surgery.<br/>Copyright &#xa9; 2017 Informa UK Limited,
trading as Taylor & Francis Group.

<112>
Accession Number
618981393
Author
Wilczynski M.; Wybraniec M.T.; Sanak M.; Goral J.; Mizia-Stec K.
Institution
(Wilczynski) Department of Cardiac Surgery, Medical University of Lodz,
Lodz, Poland
(Wybraniec, Mizia-Stec) First Department of Cardiology, School of Medicine
in Katowice, Medical University of Silesia, Katowice, Poland; Public
Hospital No 7 in Katowice, Upper Silesia Medical Center
(Sanak) II Department of Internal Medicine, Division of Molecular Biology
and Clinical Genetics, Jagiellonian University Medical College, Krakow,
Poland
(Goral) Department of Laboratory Medicine, Public Hospital No 7 in
Katowice, Upper Silesia Medical Center, Katowice, Poland
Title
Metamizole and Platelet Inhibition by Aspirin Following On-Pump Coronary
Artery Bypass Grafting.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objective: The purpose of the study was to evaluate the impact of
intravenous metamizole on platelet inhibition by aspirin in patients with
coronary artery disease early after on-pump coronary artery bypass
grafting (CABG). Design: Prospective, single-blind, randomized trial.
Setting: Tertiary referal hospital. Participants: The study comprised 43
patients with multivessel coronary artery disease undergoing CABG.
Interventions: Patients were randomized to postoperative intravenous
metamizole +/- opioids (study group; n = 23) or opioids alone (control
group; n = 20). Aspirin was withheld at least 7 days before the surgery
and reinitiated (300 mg) immediately after the procedure prior to
metamizole use, and continued daily thereafter (150 mg). Platelet function
was evaluated using multielectrode impedance aggregometry (acid-induced
platelet activation [ASPI] and collagen-induced platelet activation [COL]
test), P-selectin expression and urinary 11-dehydro-thromboxane
B<inf>2</inf> (11-DTXB<inf>2</inf>) level at baseline, postoperative day
(POD) 0, POD 1, POD 2, and POD 6. Residual platelet reactivity (RPR) was
defined as ASPI test >400 AU*min. Measurements and Main Results: In all
study participants, postoperative ASPI test value moderately decreased
(1058.2 v 966.6 AU*min, p = 0.047), urinary 11-DTXB<inf>2</inf> level
increased (923.4 v 4367.3 pg/mg, p < 0.001), and P-selectin expression and
COL test value remained stable postprocedure. The decreases of ASPI (p =
0.146) and COL test (p = 0.642), and P-selectin expression (p = 0.318) did
not differ between both groups. Patients in the control group had higher
postoperative increase of urinary 11-DTXB<inf>2</inf> level (p = 0.001).
The prevalence of RPR was high and comparable between study and control
groups (day 1, 95.6% v 100%, p = 0.535; day 6, 100% v 90%, p = 0.21).
Multivariate analysis revealed that metamizole use did not predict the
fluctuations of ASPI and COL test values and P-selectin expression, yet it
independently predicted postoperative change of 11-DTXB<inf>2</inf> level
(b = -0.518, p = 0.001). Conclusions: Intravenous metamizole preceded by a
loading dose of aspirin did not modify platelet response to aspirin in the
postoperative period after CABG.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<113>
Accession Number
618504793
Author
Forrester J.D.; Cai L.Z.; Zeigler S.; Weiser T.G.
Institution
(Forrester, Weiser) Department of General Surgery, Stanford University,
300 Pasteur Drive, H3591, Stanford, CA 94305, United States
(Cai) School of Medicine, Stanford University, Stanford, CA, United States
(Zeigler) Department of Cardiothoracic Surgery, Stanford University,
Stanford, CA, United States
Title
Surgical Site Infection after Sternotomy in Low-and Middle-Human
Development Index Countries: A Systematic Review.
Source
Surgical Infections. 18 (7) (pp 774-779), 2017. Date of Publication:
October 2017.
Publisher
Mary Ann Liebert Inc. (E-mail: info@liebertpub.com)
Abstract
Background: The burden of cardiovascular disease is increasing in low-and
middle-human development index (LMHDI) countries, and cardiac operations
are an important component of a comprehensive cardiovascular care package.
Little is known about the baseline incidence of surgical site infections
(SSIs) among patients undergoing sternotomy in LMHDI countries. Methods: A
prospectively registered, systematic literature review of articles in the
PubMed, Ovid, and Web of Science databases describing the epidemiology and
management of SSIs among persons undergoing sternotomy in LMHDI countries
was performed. We performed a quantitative synthesis of patients
undergoing sternotomy for CABG to estimate published sternotomy SSI rates.
Results: Of the 423 abstracts identified after applying search criteria,
14 studies were reviewed in detail. The pooled SSI rate after sternotomy
among reviewed studies was 4.3 infections per 100 sternotomies (95%
confidence interval [CI] 1.3-6.0 infections per 100 sternotomies), which
is comparable to infection rates in high-human development index
countries. Conclusions: As the burden of cardiovascular disease in LMHDI
settings increases, the ability to provide safe cardiac surgical care is
paramount. Describing the baseline SSI rate after sternotomy in LMHDI
countries is an important first step in creating baseline expectations for
SSI rates in cardiac surgical programs in these settings.<br/>&#xa9;
Copyright 2017, Mary Ann Liebert, Inc. 2017.

<114>
Accession Number
613244267
Author
Villablanca P.A.; Mathew V.; Thourani V.H.; Rodes-Cabau J.; Bangalore S.;
Makkiya M.; Vlismas P.; Briceno D.F.; Slovut D.P.; Taub C.C.; McCarthy
P.M.; Augoustides J.G.; Ramakrishna H.
Institution
(Villablanca, Briceno, Slovut, Taub) Division of Cardiovascular Diseases,
Montefiore Medical Center/Albert Einstein College of Medicine, New York,
NY, United States
(Mathew) Division of Cardiology, Loyola University Stritch School of
Medicine, Maywood, IL, United States
(Thourani) Emory University School of Medicine, Division of Cardiothoracic
Surgery, Atlanta, GA, United States
(Rodes-Cabau) Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
(Bangalore) New York University School of Medicine, New York, NY, United
States
(Makkiya, Vlismas) Department of Internal Medicine, Montefiore Medical
Center/Albert Einstein College of Medicine, New York, NY, United States
(Slovut) Department of Cardiothoracic and Vascular Surgery, Montefiore
Medical Center, Albert Einstein College of Medicine, New York, NY, United
States
(McCarthy) Division of Cardiac Surgery, Bluhm Cardiovascular Institute,
Northwestern University Feinberg School of Medicine, Chicago, Ill, United
States
(Augoustides) Department of Anesthesiology and Critical Care, Perelman
School of Medicine, University of Pennsylvania, Philadelphia, PA, United
States
(Ramakrishna) Division of Cardiovascular and Thoracic Anesthesiology, Mayo
Clinic College of Medicine, Scottsdale, AZ, United States
Title
A meta-analysis and meta-regression of long-term outcomes of transcatheter
versus surgical aortic valve replacement for severe aortic stenosis.
Source
International Journal of Cardiology. 225 (pp 234-243), 2016. Date of
Publication: 15 Dec 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Transcatheter aortic valve replacement (TAVR) has emerged as an
alternative to surgical aortic-valve replacement (SAVR) for patients with
severe symptomatic aortic stenosis (AS) who are at high operative risk. We
sought to determine the long-term (>= 1 year follow-up) safety and
efficacy TAVR compared with SAVR in patients with severe AS. Methods A
comprehensive search of PubMed, EMBASE, Cochrane Central Register of
Controlled Trials, conference proceedings, and relevant Web sites from
inception through 10 April 2016. Results Fifty studies enrolling 44,247
patients met the inclusion criteria. The mean duration follow-up was 21.4
months. No difference was found in long-term all-cause mortality (risk
ratios (RR), 1.06; 95% confidence interval (CI) 0.91-1.22). There was a
significant difference favoring TAVR in the incidence of stroke (RR, 0.82;
95% CI 0.71-0.94), atrial fibrillation (RR, 0.43; 95% CI 0.33-0.54), acute
kidney injury (RR, 0.70; 95% CI 0.53-0.92), and major bleeding (RR, 0.57;
95% CI 0.40-0.81). TAVR had significant higher incidence of vascular
complications (RR, 2.90; 95% CI 1.87-4.49), aortic regurgitation (RR,
7.00; 95% CI 5.27-9.30), and pacemaker implantation (PPM) (RR, 2.02; 95%
CI 1.51-2.68). TAVR demonstrated significantly lower stroke risk compared
to SAVR in high-risk patients (RR, 1.49; 95% CI 1.06-2.10); no differences
in PPM implantation were observed in intermediate-risk patients (RR, 1.68;
95% CI 0.94-3.00). In a meta-regression analysis, the effect of TAVR
baseline clinical features did not affect the long-term all-cause
mortality outcome. Conclusion TAVR and SAVR showed similar long-term
survival in patients with severe AS; with important differences in
treatment-associated morbidity.<br/>Copyright &#xa9; 2016 Elsevier Ireland
Ltd

<115>
Accession Number
610611051
Author
Kanamori H.; Weber D.J.; Rutala W.A.
Institution
(Kanamori, Weber, Rutala) Division of Infectious Diseases, University of
North Carolina, School of Medicine, 101 Manning Drive, Chapel Hill, NC
27514, United States
(Kanamori, Weber, Rutala) Hospital Epidemiology, University of North
Carolina Health Care, Chapel Hill, NC, United States
Title
Healthcare outbreaks associated with a water reservoir and infection
prevention strategies.
Source
Clinical Infectious Diseases. 62 (11) (pp 1423-1435), 2016. Date of
Publication: 01 Jun 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Hospital water may serve as a reservoir of healthcare-associated
pathogens, and contaminated water can lead to outbreaks and severe
infections. The clinical features of waterborne outbreaks and infections
as well as prevention strategies and control measures are reviewed. The
common waterborne pathogens were bacteria, including Legionella and other
gram-negative bacteria, and nontuberculous mycobacteria, although fungi
and viruses were occasionally described. These pathogens caused a variety
of infections, including bacteremia and invasive and disseminated
diseases, particularly among immunocompromised hosts and critically ill
adults as well as neonates. Waterborne outbreaks occurred in healthcare
settings with emergence of new reported reservoirs, including electronic
faucets (Pseudomonas aeruginosa and Legionella), decorative water wall
fountains (Legionella), and heater-cooler devices used in cardiac surgery
(Mycobacterium chimaera). Advanced molecular techniques are useful for
achieving a better understanding of reservoirs and transmission pathways
of waterborne pathogens. Developing prevention strategies based on water
reservoirs provides a practical approach for healthcare
personnel.<br/>Copyright &#xa9; 2016 The Author 2016. Published by Oxford
University Press for the Infectious Diseases Society of America.

<116>
Accession Number
613790758
Author
Lee C.W.; Ahn J.-M.; Cavalcante R.; Sotomi Y.; Onuma Y.; Suwannasom P.;
Tenekecioglu E.; Yun S.-C.; Park D.-W.; Kang S.-J.; Lee S.-W.; Kim Y.-H.;
Park S.-W.; Serruys P.W.; Park S.-J.
Institution
(Lee, Ahn, Park, Kang, Lee, Kim, Park, Park) Heart Institute, University
of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
(Cavalcante, Onuma, Suwannasom, Tenekecioglu, Serruys) Erasmus University
Medical Center, Amsterdam, Netherlands
(Sotomi) Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
(Yun) Division of Biostatistics, Center for Medical Research and
Information, University of Ulsan College of Medicine, Asan Medical Center,
Seoul, South Korea
(Serruys) International Center for Circulatory Health, Imperial College
London, London, United Kingdom
Title
Coronary Artery Bypass Surgery Versus Drug-Eluting Stent Implantation for
Left Main or Multivessel Coronary Artery Disease: A Meta-Analysis of
Individual Patient Data.
Source
JACC: Cardiovascular Interventions. 9 (24) (pp 2481-2489), 2016. Date of
Publication: 26 Dec 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The authors undertook a patient-level meta-analysis to compare
long-term outcomes after coronary artery bypass grafting (CABG) versus
percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in
3,280 patients with left main or multivessel coronary artery disease
(CAD). Background The relative efficacy and safety of CABG versus PCI with
DES for left main or multivessel CAD remain controversial. Methods Data
were pooled from the BEST (Randomized Comparison of Coronary Artery Bypass
Surgery and Everolimus Eluting Stent Implantation in the Treatment of
Patients With Multivessel Coronary Artery Disease), PRECOMBAT (Premier of
Randomized Comparison of Bypass Surgery vs. Angioplasty Using
Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery
Disease), and SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery)
trials. The primary outcome was a composite of all-cause death, myocardial
infarction, or stroke. Results The median follow-up was 60 months, and
follow-up was completed for 96.2% of patients. The rate of primary outcome
was significantly lower with CABG than with PCI (13.0% vs. 16.0%; hazard
ratio [HR]: 0.83; 95% confidence interval [CI]: 0.69 to 1.00; p = 0.046).
The difference was mainly driven by reduction in myocardial infarction
(HR: 0.46; 95% CI: 0.33 to 0.64; p < 0.001). There was significant
interaction between treatment effect and types of CAD, showing CABG to be
superior compared with PCI with DES in patients with multivessel CAD (p =
0.001), but no between-group difference in those with left main CAD (p =
0.427). The rates for all-cause death and stroke were similar between the
2 groups. By contrast, the need for repeat revascularization was
significantly lower in the CABG group compared with the PCI group.
Conclusions CABG, as compared with PCI with DES, reduced long-term rates
of the composite of all-cause death, myocardial infarction, or stroke in
patients with left main or multivessel CAD. The advantage of CABG over PCI
with DES was particularly pronounced in those with multivessel
CAD.<br/>Copyright &#xa9; 2016 American College of Cardiology Foundation

<117>
Accession Number
613790708
Author
Rojas P.; Amat-Santos I.J.; Cortes C.; Castrodeza J.; Tobar J.; Puri R.;
Sevilla T.; Vera S.; Varela-Falcon L.H.; Zunzunegui J.L.; Gomez I.;
Rodes-Cabau J.; San Roman J.A.
Institution
(Rojas, Amat-Santos, Cortes, Castrodeza, Tobar, Sevilla, Vera,
Varela-Falcon, Gomez, San Roman) Institute of Heart Sciences, Hospital
Clinico Universitario, Valladolid, Spain
(Puri, Rodes-Cabau) Quebec Heart & Lung Institute, Quebec, Quebec, Canada
(Zunzunegui) Hospital General Universitario Gregorio Maranon, Madrid,
Spain
Title
Acquired Aseptic Intracardiac Shunts Following Transcatheter Aortic Valve
Replacement: A Systematic Review.
Source
JACC: Cardiovascular Interventions. 9 (24) (pp 2527-2538), 2016. Date of
Publication: 26 Dec 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aim of this study was to describe the incidence,
mechanisms, features, and management of aseptic intracardiac shunts
(AICS). Background AICS following transcatheter aortic valve replacement
(TAVR) are an uncommon and barely described complication. Methods A
systematic review was performed of all published cases of AICS following
TAVR, and the incidence, predictors, main features, management, and
related outcomes were analyzed. Results A total of 31 post-TAVR AICS were
gathered. After excluding transapical fistulas, the 28 remaining cases
corresponded with an incidence of about 0.5%. Mean age and mean logistic
European System for Cardiac Operative Risk Evaluation score were 80 +/- 11
years and 19.2 +/- 8.3%, respectively. Prior radiation therapy for cancer
was present in 14.3%, and 42.8% had severe calcification of the aortic
valve. TAVR was undertaken using balloon-expandable prostheses in the
majority of cases (85.7%), via the transapical approach in one-third.
Median time from TAVR to diagnosis was 21 days (interquartile range: 7 to
30 days), with intraprocedural suspicion in 12 cases (42.9%) and a mean
Q<inf>p</inf>/Q<inf>s</inf> ratio of 1.8 +/- 0.6. The most common location
for AICS was the interventricular septum (60.7%). Heart failure was
frequent (46.4%), but 14 patients (50%) remained asymptomatic. Medical
treatment (71.4%) was associated with poor outcomes (30-day mortality rate
25%), especially in symptomatic patients (35% vs. 0%; p = 0.020) and in
those with higher Q<inf>p</inf>/Q<inf>s</inf> ratios (1.9 +/- 0.6 vs. 1.4
+/- 0.1), while cardiac surgery (3.6%), and percutaneous closure (25%) led
to good outcomes after a median follow-up period of 3 months
(interquartile range: 1 to 9 months). Conclusions Post-TAVR AICS are
uncommon but have high 30-day mortality if left untreated, especially in
symptomatic patients. Percutaneous closure was feasible and safe in
symptomatic patients but remains controversial in asymptomatic
subjects.<br/>Copyright &#xa9; 2016 American College of Cardiology
Foundation

<118>
Accession Number
611219037
Author
Wyatt C.M.; Shineski M.; Chertow G.M.; Bangalore S.
Institution
(Wyatt) Department of Medicine, Division of Nephrology, Icahn School of
Medicine at Mount Sinai, New York, New York, United States
(Shineski) ISCHEMIA Clinical Coordinating Center, New York University
School of Medicine, New York, New York, United States
(Chertow) Department of Medicine, Division of Nephrology, Stanford School
of Medicine, Stanford, California, United States
(Bangalore) Department of Medicine, Division of Cardiology, New York
University School of Medicine, New York, New York, United States
Title
ISCHEMIA in chronic kidney disease: improving the representation of
patients with chronic kidney disease in cardiovascular trials.
Source
Kidney International. 89 (6) (pp 1178-1179), 2016. Date of Publication:
2016.
Publisher
Elsevier B.V.
Abstract
Despite the high cardiovascular risk associated with chronic kidney
disease, a recent systematic review confirmed that patients with kidney
disease remain underrepresented in cardiovascular trials. Two ongoing
trials are assessing the risk:benefit of aggressive evaluation and
intervention for ischemic heart disease in patients with advanced chronic
kidney disease.<br/>Copyright &#xa9; 2016 International Society of
Nephrology

<119>
Accession Number
609871359
Author
Tarantini G.; Mojoli M.; Windecker S.; Wendler O.; Lefevre T.; Saia F.;
Walther T.; Rubino P.; Bartorelli A.L.; Napodano M.; D'Onofrio A.; Gerosa
G.; Iliceto S.; Vahanian A.
Institution
(Tarantini, Mojoli, Napodano, D'Onofrio, Gerosa, Iliceto) Department of
Cardiac, Thoracic and Vascular Sciences, University Hospital of Padova,
Via Giustiniani 2, Padua 35128, Italy
(Windecker) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
(Wendler) King's College Hospital, London, United Kingdom
(Lefevre) Cardiovascular Institute Paris-Sud, Massy, France
(Saia) University Hospital Policlinic S. Orsola-Malpighi, Institute of
Cardiology, Bologna, Italy
(Walther) Kerckhoff Clinic, Bad Nauheim, Germany
(Rubino) Cardiology Division, Clinica Montevergine, Mercogliano, Italy
(Bartorelli) Centro Cardiologico Monzino, IRCCS, University of Milan,
Milan, Italy
(Vahanian) Cardiology Department, Hospital Bichat-Claude Bernard, Paris,
France
Title
Prevalence and Impact of Atrial Fibrillation in Patients with Severe
Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement An
Analysis from the SOURCE XT Prospective Multicenter Registry.
Source
JACC: Cardiovascular Interventions. 9 (9) (pp 937-946), 2016. Date of
Publication: 09 May 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The aims of this study were to assess the epidemiology of
atrial fibrillation (AF) in patients treated with transcatheter aortic
valve replacement (TAVR) and included in the large prospective SOURCE XT
(SAPIEN XT Aortic Bioprosthesis Multi-Region Outcome Registry) study and
to evaluate their outcomes according to the presence of pre-existing or
new-onset AF (NOAF) (defined as AF occurring within 30 days after TAVR).
Background Data on the epidemiology and clinical impact of AF in patients
undergoing TAVR are scant and limited to small retrospective studies.
Methods The SOURCE XT study is a multicenter, prospective registry of
consecutive patients treated with the SAPIEN XT valve at 99 sites in 17
countries. Follow-up was scheduled at discharge, 1 month, 1 year, and
yearly thereafter. Patients (n = 2,706) were categorized according to the
presence of pre-existing or NOAF. Results The prevalence of pre-existing
AF was 35.6%, whereas NOAF occurred in 7.2% of patients. Both pre-existing
AF and NOAF correlated with worse clinical outcomes compared with patients
in sinus rhythm, including all-cause death, cardiac death, and bleeding
events. NOAF was associated with higher rates of stroke at 2 years
compared with sinus rhythm. Independent predictors of NOAF were age
(hazard ratio: 1.1), New York Heart Association class III or IV (hazard
ratio: 1.9), nontransfemoral access route (hazard ratio: 3), and balloon
post-dilation (odds ratio: 1.6). No interaction was observed between any
degree of post-implantation paravalvular leak and NOAF. Conclusions In the
large dataset of the SOURCE XT registry, the presence of either
pre-existing or NOAF increased all-cause and cardiac mortality and
bleeding events. NOAF was associated with increased stroke rates at
long-term follow-up.<br/>Copyright &#xa9; 2016 American College of
Cardiology Foundation.

<120>
Accession Number
612290572
Author
Indraratna P.; Tian D.H.; Yan T.D.; Doyle M.P.; Cao C.
Institution
(Indraratna, Tian, Yan, Cao) The Collaborative Research (CORE) Group,
Macquarie University, Sydney, Australia
(Indraratna) Department of Cardiology, St George Hospital, Sydney,
Australia
(Tian) Royal North Shore Hospital, Sydney, Australia
(Yan) Department of Cardiothoracic, Royal Prince Alfred Hospital, Sydney,
Australia
(Doyle, Cao) Department of Cardiothoracic Surgery, St George Hospital,
Sydney, Australia
Title
Transcatheter aortic valve implantation versus surgical aortic valve
replacement: A meta-analysis of randomized controlled trials.
Source
International Journal of Cardiology. 224 (pp 382-387), 2016. Date of
Publication: 01 Dec 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Transcatheter aortic valve implantation (TAVI) has become a
widely utilized method of treatment of severe aortic valve stenosis. The
present meta-analysis included all published relevant randomized
controlled trials (RCTs) and aimed to compare the safety and efficacy of
TAVI compared to surgical aortic valve replacement (AVR). Method Nine
electronic databases were comprehensively searched. Eligible studies were
required to be randomized controlled trials which reported comparative
endpoints on both TAVI and AVR. Results Five published RCTs were included
in the meta-analysis. A total of 3828 patients were studied. The overall
mortality and stroke rates at 30 days and 1 year were not significantly
different between TAVI and AVR. Patients undergoing TAVI were more likely
to experience vascular complications, aortic regurgitation and permanent
pacemaker insertion, however, they were less likely to encounter acute
renal failure and major haemorrhage. Conclusions The data suggest that
TAVI is a safe and efficacious alternative to surgical aortic valve
replacement in judiciously selected patients.<br/>Copyright &#xa9; 2016
Elsevier Ireland Ltd

<121>
Accession Number
618889473
Author
Hassan M.E.; Mahran E.
Institution
(Hassan, Mahran) Department of Anaesthesia, ICU, National Cancer
Institute, Cairo University, Giza, Egypt
Title
Evaluation of the role of dexmedetomidine in improvement of the analgesic
profile of thoracic paravertebral block in thoracic surgeries: A
randomised prospective clinical trial.
Source
Indian Journal of Anaesthesia. 61 (10) (pp 826-831), 2017. Date of
Publication: October 2017.
Publisher
Indian Society of Anaesthetists (Flat No 12/1A K Point, 68-BAPC Roy Road,
Kolkata 700009, India)
Abstract
Background and Aims: Thoracic paravertebral block (TPB) is one of the
effective methods for management of post-operative pain in thoracic
surgeries. The aim of the study was to evaluate effectiveness of addition
of dexmedetomidine to paravertebral block with bupivacaine in improving
the postoperative pain relief and pulmonary functions in patients
undergoing thoracic surgeries. Methods: A prospective randomized
double-blinded study was performed on forty patients scheduled for
thoracic surgery. A paravertebral catheter was secured under ultrasound
guidance preoperatively for all patients. Group B (n = 20) received a
bolus dose of 0.25% bupivacaine at 0.3 mL/kg followed by continuous
infusion of 0.125% bupivacaine 0.1 mL/kg/h. Group (BD) received a bolus
dose of 0.25% bupivacaine + dexmedetomidine 1 mug/kg at 0.3 mL/kg followed
by continuous infusion of dexmedetomidine 0.2 mug/kg/h + 0.125%
bupivacaine 0.1 mL/kg/h. Anaesthesia technique was standardized for all
patients. Postoperatively, all patients were assessed during first 24
hours for intraoperative fentanyl and post-operative morphine
requirements, Visual Analogue Scores (VAS) scores at rest and during
cough, and postoperative pulmonary functions. Results: Post-operative
morphine consumption in the first 24 hours and intraoperative fentanyl
requirement were significantly less in group BD (2.95 +/- 1.986 mg, 80.75
+/- 31.551mug respectively) compared to group B (9.85 +/- 3.468 mg, 186
+/- 39.683 mug respectively). Group BD showed less VAS scores during cough
and better postoperative pulmonary functions (P < 0.05). Conclusion:
Addition of dexmedetomidine to paravertebral bupivacaine in patients
undergoing thoracic surgeries provides more effective analgesia with
improvement in post-operative pulmonary functions.<br/>Copyright &#xa9;
2017 Indian Journal of Anaesthesia.

<122>
Accession Number
614458769
Author
Cousino M.K.; Rea K.E.; Schumacher K.R.; Magee J.C.; Fredericks E.M.
Institution
(Cousino, Schumacher, Fredericks) Department of Pediatrics, University of
Michigan Health System, Ann Arbor, MI, United States
(Cousino, Rea, Schumacher, Magee, Fredericks) University of Michigan
Transplant Center, Ann Arbor, MI, United States
(Magee) Department of Surgery, University of Michigan Health System, Ann
Arbor, MI, United States
(Fredericks) Child Health Evaluation and Research Center, University of
Michigan, Ann Arbor, MI, United States
Title
A systematic review of parent and family functioning in pediatric solid
organ transplant populations.
Source
Pediatric Transplantation. 21 (3) (no pagination), 2017. Article Number:
e12900. Date of Publication: 01 May 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
The process of pediatric solid organ transplantation (SOT) places new and
increased stressors on patients and family members. Measures of family
functioning may predict psychological and health outcomes for pediatric
patients and their families, and provide opportunity for targeted
intervention. This systematic review investigated parent and family
functioning and factors associated with poorer functioning in the
pediatric SOT population. Thirty-seven studies were identified and
reviewed. Studies featured a range of organ populations (eg, heart, liver,
kidney, lung, intestine) at various stages in the transplant process.
Findings highlighted that parents of pediatric SOT populations commonly
report increased stress and mental health symptoms, including
posttraumatic stress disorder. Pediatric SOT is also associated with
increased family stress and burden throughout the transplant process.
Measures of parent and family functioning were associated with several
important health-related factors, such as medication adherence, readiness
for discharge, and number of hospitalizations. Overall, findings suggest
that family stress and burden persists post-transplant, and parent and
family functioning is associated with health-related factors in SOT,
highlighting family-level functioning as an important target for future
intervention.<br/>Copyright &#xa9; 2017 John Wiley & Sons A/S. Published
by John Wiley & Sons Ltd

<123>
Accession Number
618863964
Author
Kassimis G.; Bourantas C.V.; Tushar R.; de Maria G.L.; Davlouros P.;
Hahalis G.; Alexopoulos D.; Banning A.P.
Institution
(Kassimis, Tushar) Cardiology Department, Gloucestershire Hospitals NHS
Foundation Trust, Cheltenham General Hospital, Cheltenham, United Kingdom
(Bourantas) Institute of Cardiovascular Sciences, University College of
London, London, United Kingdom
(Bourantas) Department of Cardiology, Barts Health NHS Trust, London,
United Kingdom
(de Maria, Banning) Oxford Heart Center, John Radcliffe Hospital, Oxford,
United Kingdom
(Davlouros, Hahalis) Cardiology Department, University Hospital of Patras,
Rion, Greece
(Alexopoulos) Cardiology Department, Attikon University Hospital, Athens,
Greece
Title
Percutaneous coronary intervention vs. cardiac surgery in diabetic
patients. Where are we now and where should we be going?.
Source
Hellenic Journal of Cardiology. 58 (3) (pp 178-189), 2017. Date of
Publication: May 2017.
Publisher
Hellenic Cardiological Society
Abstract
Patients with diabetes mellitus are at increased risk of developing
coronary artery disease (CAD) and have an increased incidence of recurrent
events following revascularization. Choosing the most appropriate strategy
to revascularize these high-risk patients is crucial for improving the
clinical outcomes. Several studies, randomized trials and meta-analyses
have compared short- and long-term outcomes following coronary artery
bypass grafting (CABG) and percutaneous coronary intervention (PCI) in
diabetic patients suffering from CAD. The aim of this article is to review
the currently available evidence on the role of PCI and CABG in the
management of diabetic patients with CAD.<br/>Copyright &#xa9; 2017
Hellenic Society of Cardiology

<124>
Accession Number
618872541
Author
Alfonso F.; Trillo R.; Moris C.
Institution
(Alfonso) Department of Cardiology, Hospital Universitario de la Princesa,
Instituto de Investigacion Sanitaria Princesa, Universidad Autonoma de
Madrid, IIS-IP, Diego de Leon 62, Madrid 28006, Spain
(Trillo) Department of Cardiology, Hospital Universitario de Santiago de
Compostela, La Coruna, Spain
(Moris) Department of Cardiology, Hospital Universitario Central de
Asturias, Oviedo, Spain
Title
Shifting transcatheter aortic valve implantation to low-risk patients: A
pilgrimage with no shortcuts.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 3 (4) (pp
258-261), 2017. Date of Publication: 01 Oct 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)

<125>
Accession Number
618872391
Author
Singh K.; Bhalla A.S.; Qutub M.A.; Carson K.; Labinaz M.
Institution
(Singh) Department of Cardiology, Gold Coast University Hospital, 1
Hospital Blvd, Southport, QLD 4215, Australia
(Singh) Griffith University, 58 Parklands Drive, Gold Coast, QLD 4215,
Australia
(Singh, Carson) University of Adelaide, North Terrace, Adelaide, SA 5000,
Australia
(Bhalla) University of Sydney, Sydney, NSW 2006, Australia
(Qutub) Department of Medicine, King Abdulaziz University, Jeddah, Saudi
Arabia
(Labinaz) University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON
K1Y 4W7, Canada
Title
Systematic review and meta-analysis to compare outcomes between
intermediate- and high-risk patients undergoing transcatheter aortic valve
implantation.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 3 (4) (pp
289-295), 2017. Date of Publication: 01 Oct 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims Recent studies have reported non-inferior outcomes for transcatheter
aortic valve implantation (TAVI) compared with surgical aortic valve
replacement (SAVR) in intermediate-risk patients. However, a comparison of
outcomes among TAVI patients depending upon the surgical risk score has
not been performed in a large study. Our aim was to compare the outcomes
of TAVI in low-, intermediate-, and high-risk patients, to ascertain if
the morbidity and mortality is related to the patient's risk profile or
the procedure itself. Methods and results A thorough computer-based search
was performed using Ovid MEDLINE, EMBASE, Google Scholar, and PubMed
databases. We included original research studies reporting data on TAVI in
the low-, intermediate-, and high-risk groups. Patients in
intermediate-risk group were compared to the high-risk cohort for device
success, mortality, and complications. A total of 2414 patients in the
intermediate-risk group were compared with 1597 high-risk patients. On
meta-analysis, intermediate-risk group demonstrated similar device success
[odds ratio (OR) 1.29, 95% confidence interval (CI) 0.87-1.90, I 2 = 0%, P
= 0.2) but a lower 30-day mortality OR 0.54, 95% CI 0.34-0.86, I 2 = 49%,
P = 0.009). There was no difference in the incidence of stroke (OR 1.17,
95% CI 0.80-1.71, I 2 = 36%, P = 0.42) or permanent pacemaker implantation
between the two groups (OR 1.04, 95% CI 0.82-1.32, I 2 = 41%, P = 0.74).
Conclusion Transcatheter aortic valve implantation in intermediate-risk
patients carries a low mortality and high success. Incidence of pacemaker
and stroke remains high in the lower risk group. Published on behalf of
the European Society of Cardiology. All rights reserved.<br/>Copyright
&#xa9; The Author 2017.

<126>
Accession Number
610371374
Author
Emmert A.; Franke R.; Brandes I.F.; Hinterthaner M.; Danner B.C.; Bauer
M.; Brauer A.
Institution
(Emmert, Franke, Hinterthaner, Danner) Department of Thoracic and
Cardiovascular Surgery, University Medical Center, Georg-August
University, Goettingen, Germany
(Brandes, Bauer, Brauer) Department of Anesthesiology, University Medical
Center, Georg-August University, Goettingen, Germany
Title
Comparison of Conductive and Convective Warming in Patients Undergoing
Video-Assisted Thoracic Surgery: A Prospective Randomized Clinical Trial.
Source
Thoracic and Cardiovascular Surgeon. 65 (5) (pp 362-366), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Georg Thieme Verlag (E-mail: kunden.service@thieme.de)
Abstract
Background Perioperative hypothermia is frequent during thoracic surgery.
After approval by the local ethics committee and written informed consent
from patients, we examined the efficiency of prewarming and intraoperative
warming with a convective warming system and conductive warming system to
prevent perioperative hypothermia during video-assisted thoracic surgery
(VATS). Methods We randomized 60 patients with indication for VATS in two
groups (convective warming with an underbody blanket vs. conductive
warming with an underbody mattress and additional warming of the legs).
All patients were prewarmed before induction of anesthesia with the
corresponding system. Core temperature was measured sublingual and in the
nasopharynx. Results Both groups were not significantly different in
regard to clinical parameter, prewarming, and initial core temperature.
The patients in conduction group had lower intraoperative core
temperatures and a higher incidence of intraoperative (73.9 vs. 24%) and
postoperative hypothermia (56.5 vs. 8%) compared with convective warming.
Conclusions Pre- and intraoperative convective warming with an underbody
blanket prevents perioperative hypothermia during VATS better than
conductive warming. The inferior prevention in conductive warming group
may be caused by reduced body contact to the warming mattresses in lateral
position.<br/>Copyright &#xa9; Georg Thieme Verlag Stuttgart New York.

<127>
Accession Number
615121632
Author
Kober L.
Institution
(Kober) Department of Cardiology, Rigshospitalet, University of
Copenhagen, Copenhagen, Denmark
Title
Complete revascularization in ST-elevation myocardial infarction?.
Source
New England Journal of Medicine. 376 (13) (pp 1282-1284), 2017. Date of
Publication: 30 Mar 2017.
Publisher
Massachussetts Medical Society

<128>
Accession Number
618936931
Author
Chahal D.; Yau A.; Marquez V.
Institution
(Chahal) Medicine, University of British Columbia, Quesnel, BC, Canada
(Yau, Marquez) Gastroenterology, University of British Columbia,
Vancouver, BC, Canada
Title
Bnp to predict post-liver transplant mortality: Systematic review and
meta-analysis.
Source
Hepatology. Conference: 68th Annual Meeting of the American Association
for the Study of Liver Diseases, AASLD 2017. United States. 66 (Supplement
1) (pp 912A), 2017. Date of Publication: October 2017.
Publisher
John Wiley and Sons Inc.
Abstract
Background: Cardiac events are a major cause of mortality after liver
transplantation. Brain Natriuretic Peptide (BNP) is elevated in cirrhotic
patients and is used to predict cardiac events after non-cardiac surgery.
It's utility to predict mortality after liver transplantation is unknown.
Methods: We searched Medline, Embase, Cochrane Register of Controlled
Trials and bibliographies. Eligible studies included those with
peri-operative BNP data, those which stratified patient cohorts by BNP
level or presence of post-transplant heart failure, and those with
post-transplant outcomes data. Two reviewers independently determined
study quality and extracted data. Meta-analyses were performed using
random effects modeling. Results: Electronic search yielded 192 records; 7
were eligible for analysis (total patients = 2010, age 52.5 +/-9.3, 51.5%
to 81.3% male, MELD 21.4 +/-9). Hepatitis C was the most prevalent
etiology (38%), followed by alcohol (23%). 335 patients were identified as
having high BNP levels or heart failure post-transplant. These patients
were older (56.1 vs. 54), had lower BMIs (25.2 vs. 27.1), higher MELD
scores (24.5 vs. 19.1) and lower LVEFs (55.9% vs. 61.7%). Post-transplant
mortality was higher in patients with high BNP (25% vs. 7%) or
post-transplant heart failure (39% vs. 25%). Meta-analysis of three
studies examining post-transplant mortality based on elevated BNP revealed
a risk ratio of 3.1 (95% CI 1.9-5.0). Meta-analysis of two studies
examining post-transplant mortality based on post-transplant heart failure
revealed a risk ratio of 1.6 (95% CI 1.3-2.1). One study examining
post-transplant cardiac events based on elevated BNP revealed a risk ratio
of 7.9 (95% CI 1.8-34.7). Conclusions: Increase BNP could be useful to
predict post-liver transplant mortality, however the optimal cut-off value
is unknown. Future studies should focus on further establishing the
sensitivity and specificity of BNP levels for detecting patients at higher
risk for post-transplant mortality (Figure presented).

<129>
[Use Link to view the full text]
Accession Number
618967604
Author
Besch G.; Perrotti A.; Mauny F.; Puyraveau M.; Baltres M.; Flicoteaux G.;
Salomon du Mont L.; Barrucand B.; Samain E.; Chocron S.; Pili-Floury S.
Institution
(Besch) From the Department of Anesthesiology and Intensive Care Medicine
(G.B., M.B., G.F., B.B., E.S., S.P.-F.), EA 3920 (G.B., A.P., L.S., E.S.,
S.C., S.P.-F.), Department of Cardiothoracic Surgery (A.P., S.C.),
Clinical Methodology Center (F.M., M.P.), and Department of Vascular
Surgery (L.S.), University Hospital of Besancon, Chrono-environement
Laboratory, UMR6249 CNRS (F.M.), and SFR-FED 4234 INSERM (E.S., S.P.-F.),
University of Franche-Comte, Besancon, France
Title
Clinical Effectiveness of Intravenous Exenatide Infusion in Perioperative
Glycemic Control after Coronary Artery Bypass Graft Surgery: A Phase
II/III Randomized Trial.
Source
Anesthesiology. 127 (5) (pp 775-787), 2017. Date of Publication: 01 Nov
2017.
Abstract
BACKGROUND: We aimed to assess the clinical effectiveness of intravenous
exenatide compared to insulin in perioperative blood glucose control in
coronary artery bypass grafting surgery patients.
METHODS: Patients more than 18 yr old admitted for elective coronary
artery bypass grafting were included in a phase II/III nonblinded
randomized superiority trial. Current insulin use and creatinine clearance
of less than 60ml/min were exclusion criteria. Two groups were compared:
the exenatide group, receiving exenatide (1-h bolus of 0.05
micro&#32;g/min followed by a constant infusion of 0.025 micro&#32;g/min),
and the control group, receiving insulin therapy. The blood glucose target
range was 100 to 139mg/dl. The primary outcome was the proportion of
patients who spent at least 50% of the study period within the target
range. The consumption of insulin (Cinsulin) and the time to start insulin
(Tinsulin) were compared between the two groups.
RESULTS: In total, 53 and 51 patients were included and analyzed in the
exenatide and control groups, respectively (age: 70+/-9 vs. 68+/-11 yr;
diabetes mellitus: 12 [23%] vs. 10 [20%]). The primary outcome was
observed in 38 (72%) patients in the exenatide group and in 41 (80%)
patients in the control group (odds ratio [95% CI] = 0.85 [0.34 to 2.11];
P = 0.30). Cinsulin was significantly lower (60 [40 to 80] vs. 92 [63 to
121] U, P < 0.001), and Tinsulin was significantly longer (12 [7 to 16]
vs. 7 [5 to 10] h, P = 0.02) in the exenatide group.
CONCLUSIONS: Exenatide alone at the dose used was not enough to achieve
adequate blood glucose control in coronary artery bypass grafting
patients, but it reduces overall consumption of insulin and increases the
time to initiation of insulin.

<130>
Accession Number
618953137
Author
Tummala R.; Banerjee K.; Sankaramangalam K.; Mick S.; Krishnaswamy A.;
White J.; Fares M.; Mehta A.; Popovic Z.; Svensson L.G.; Kapadia S.R.
Institution
(Tummala) Department of Internal MedicineSt. Vincent Charity Medical
Center, An Affiliate of Case Western Reserve UniversityCleveland, Ohio
(Banerjee, Sankaramangalam, Mick, Krishnaswamy, White, Fares, Mehta,
Popovic, Svensson, Kapadia) Heart and Vascular Institute, Cleveland
ClinicCleveland, Ohio
Title
Clinical and procedural outcomes with the SAPIEN 3 versus the SAPIEN XT
prosthetic valves in transcatheter aortic valve replacement: A systematic
review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2017.
Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: The SAPIEN 3 valve (S3V) was designed to overcome the
shortcomings of its predecessor, the SAPIEN XT (SXT) valve. We conducted a
meta-analysis to compare their clinical outcomes and procedural
characteristics. Methods: PUBMED, EMBASE, and Cochrane CENTRAL were
searched by two independent reviewers. The clinical outcomes of interest
were paravalvular leakage (PVL), major vascular complications (MVC),
bleeding, acute kidney injury (AKI), device success, need for post
dilation all-cause mortality and procedural details. Results: Fifteen
observational cohort studies were included in the analysis involving a
total of 4,496 patients. Of these, 1,700 were S3V recipients and 2,796
were SXT recipients. The S3V group showed fewer complications compared to
the SXT group with respect to PVL (5.58% vs. 19.35%, OR: 0.27, P: 0.000),
MVC (4.07% vs. 9.13%, OR: 0.44, P: 0.002), bleeding (6.40% vs. 12.03%, OR:
0.50, P: 0.003), 30-day mortality (3.29% vs. 5.68%, OR: 0.51, P: 0.000),
and stroke (1.48% vs. 2.86%, OR: 0.49, P: 0.014). Device success was
higher in the S3V (98.18% vs. 93.76%, OR: 3.14, P: 0.000). Cardiovascular
mortality, myocardial infarction, AKI and post-dilatation were not
significantly different. Permanent pacemaker implantation (PPI) was higher
in S3V recipients (13.29% vs. 9.23%, OR: 1.58, P: 0.000). Procedure time
was shorter for the S3V (71.94 vs. 86.85, P: 0.016) and used less contrast
volume (129.36 vs. 161.18, P: 0.049). Conclusions: Patients receiving the
S3V had lower risk of PVL, MVC, bleeding, mortality, and stroke. PPI was
somewhat higher in the S3V group. S3V implantation was faster and used
less contrast.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<131>
Accession Number
618947562
Author
Faraji R.; Behjati-Ardakani M.; Moshtaghioun S.M.; Kalantar S.M.;
Namayandeh S.M.; Soltani M.; Emami M.; Zandi H.; Firoozabadi A.D.;
Kazeminasab M.; Ahmadi N.; Sarebanhassanabadi M.
Institution
(Faraji, Behjati-Ardakani, Namayandeh, Soltani, Emami, Firoozabadi,
Ahmadi, Sarebanhassanabadi) Yazd Cardiovascular Research Center, Shahid
Sadoughi University of Medical Sciences, Yazd, Iran
(Moshtaghioun) Department of Biology, Faculty of Science, Yazd University,
Yazd, Iran
(Kalantar) Medical Genetic Research and Clinical Centre for Infertility,
Shahid Sadoughi University of Medical Sciences, Yazd, Iran
(Zandi) Department of Microbiology, Faculty of Medicine, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran
(Kazeminasab) Student Research Committee, Shahid Sadoughi University of
Medical Sciences, Yazd, Iran
Title
The diagnosis of microorganism involved in infective endocarditis (IE) by
polymerase chain reaction (PCR) and real-time PCR: A systematic review.
Source
Kaohsiung Journal of Medical Sciences. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier (Singapore) Pte Ltd (3 Killiney Road, 08-01, Winsland House I,
Singapore 239519, Singapore)
Abstract
Broad-range bacterial rDNA polymerase chain reaction (PCR) followed by
sequencing may be identified as the etiology of infective endocarditis
(IE) from surgically removed valve tissue; therefore, we reviewed the
value of molecular testing in identifying organisms' DNA in the studies
conducted until 2016. We searched Google Scholar, Scopus, ScienceDirect,
Cochrane, PubMed, and Medline electronic databases without any time
limitations up to December 2016 for English studies reporting
microorganisms involved in infective endocarditis microbiology using PCR
and real-time PCR. Most studies were prospective. Eleven out of 12 studies
used valve tissue samples and blood cultures while only 1 study used whole
blood. Also, 10 studies used the molecular method of PCR while 2 studies
used real-time PCR. Most studies used 16S rDNA gene as the target gene.
The bacteria were identified as the most common microorganisms involved in
infective endocarditis. Streptococcus spp. and Staphylococcus spp. were,
by far, the most predominant bacteria detected. In all studies, PCR and
real-time PCR identified more pathogens than blood and tissue cultures;
moreover, the sensitivity and specificity of PCR and real-time PCR were
more than cultures in most of the studies. The highest sensitivity and
specificity were 96% and 100%, respectively. The gram positive bacteria
were the most frequent cause of infective endocarditis. The molecular
methods enjoy a greater sensitivity compared to the conventional blood
culture methods; yet, they are applicable only to the valve tissue of the
patients undergoing cardiac valve surgery.<br/>Copyright &#xa9; 2017.

<132>
Accession Number
618945432
Author
Heir J.S.; Guo S.-L.; Purugganan R.; Jackson T.A.; Sekhon A.K.; Mirza K.;
Lasala J.; Feng L.; Cata J.P.
Institution
(Heir, Purugganan, Jackson, Sekhon, Mirza, Lasala, Cata) Department of
Anesthesiology and Perioperative Medicine, The University of Texas MD
Anderson Cancer Center, Houston, TX
(Guo) Department of Anesthesiology, Cathay General Hospital, Taipei,
Taiwan
(Guo) Department of Anesthesiology, Tri-Service General Hospital and
National Defense Medical Center, Taipei, Taiwan
(Feng) Department of Biostatistics, The University of Texas MD Anderson
Cancer Center, Houston, TX
Title
A Randomized Controlled Study of the Use of Video Double-Lumen
Endobronchial Tubes Versus Double-Lumen Endobronchial Tubes in Thoracic
Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objective: To compare the incidence of fiberoptic bronchoscope (FOB) use
(1) during verification of initial placement and (2) for reconfirmation of
correct placement following repositioning, when either a double-lumen tube
(DLT) or video double-lumen tube (VDLT) was used for lung isolation during
thoracic surgery. Design: A randomized controlled study. Setting:
Single-center university teaching hospital. Participants: The study
comprised 80 patients who were 18 years or older requiring lung isolation
for surgery. Interventions: After institutional review board approval,
patients were randomized prior to surgery to either DLT or VDLT usage.
Attending anesthesiologists placed the Mallinckrodt DLT or Vivasight (ET
View Ltd, Misgav, Israel) VDLT with conventional laryngoscopy or video
laryngoscopy then verified correct tube position through the view provided
with either VDLT external monitor or FOB. Measurements and Main Results:
Data collected included: sex, body mass index, successful intubation and
endobronchial placement, intubation time, confirmation time of tube
position, FOB use, quality of view, dislodgement of tube, and ability to
forewarn dislodgement of endobronchial cuff and complications. FOB use for
verification of final position of the tube (VDLT 13.2% [5/38] v DLT 100%
[42/42], p < 0.0001), need for FOB to correct the dislodgement (VDLT 7.7%
[1/13] v DLT 100% [14/14], p < 0.0001), dislodgement during positioning
(VDLT 61.5% [8/13] v DLT 64.3% [9/14], p = ns), dislodgement during
surgery (VDLT 38.5% [5/13] v DLT 21.4% [3/14], p = ns), and ability to
forewarn dislodgement of endobronchial cuff (VDLT 18.4% [7/38] v DLT 4.8%
[2/42], p = 0.078). Conclusion: This study demonstrated a reduction of
86.8% in FOB use, which was a similar reduction found in other published
studies.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<133>
Accession Number
618945390
Author
Vaporciyan A.A.; Fikfak V.; Lineberry M.C.; Park Y.S.; Tekian A.
Institution
(Vaporciyan) Department of Thoracic and Cardiovascular Surgery, Division
of Surgery, MD Anderson Cancer Center, University of Texas, Houston, Texas
(Fikfak) Department of General Surgery, Houston Methodist Hospital,
Houston, Texas
(Lineberry) Department of Health Policy and Management, Zamierowksi
Institute for Experiential Learning, University of Kansas Medical Center,
Kansas City, Kansas
(Park) Department of Medical Education, College of Medicine, University of
Chicago, Chicago, Illinois
(Tekian) Department of Medical Education, College of Medicine, University
of Illinois at Chicago, Chicago, Illinois
Title
Consensus-Derived Coronary Anastomotic Checklist Reveals Significant
Variability Among Experts.
Source
Annals of Thoracic Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier USA
Abstract
Background: Surgical skill assessment tools frequently reflect the
opinions of small groups of surgeons. That raises concerns over their
generalizability as well as their utilization when applied broadly. A
Delphi approach could engage a broad group of experts to identify key
elements for a checklist assessing coronary anastomotic skill, improving
generalizability. Methods: Expert surgeons in North America (10 or more
years in practice, actively teaching coronary artery surgery) were
contacted randomly to participate. Consenting surgeons first provided
items they believed were mandatory when performing a coronary artery
bypass. These were then entered into a three-round Delphi. Positive
consensus was reached when 75% or more of participants ranked an item
mandatory. Results: Sixteen faculty consented to participate. Each
participant provided 25 +/- 10 items. The 407 items provided were
condensed, resulting in 146 items in the final list, divided into six
sections based on the conduct of the operation. Twenty-three items reached
consensus in the first round, 14 in the second, and 3 in the third. These
40 items represented only 27% of the initial 146 items. Agreement within
sections varied widely, from 0% for "management of assistants" to 47% for
"testing and final steps.". Conclusions: A randomly selected group of
experts using a Delphi approach can generate a checklist to assess
construction of a coronary artery bypass. Considerable disagreement among
experts regarding what steps are mandatory calls into question the
generalizability of any locally developed checklist.<br/>Copyright &#xa9;
2017 The Society of Thoracic Surgeons.

<134>
Accession Number
618734014
Author
Gray A.M.; Murphy J.; Altman D.G.; Benedetto U.; Campbell H.; Flather M.;
Gerry S.; Lees B.; Taggart D.P.
Institution
(Gray, Murphy, Campbell) Nuffield Department of Population Health, Health
Economics Research Centre, University of Oxford, Old Road Campus,
Headington, Oxford OX3 7LF, United Kingdom
(Altman, Gerry) Nuffield Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, Centre for Statistics in Medicine, Botnar
Research Centre, University of Oxford, Oxford, United Kingdom
(Benedetto) School of Clinical Sciences, University of Bristol and Bristol
Royal Infirmary, Bristol, United Kingdom
(Flather) Norwich Medical School, University of East Anglia, Norfolk and
Norwich University Hospital, Norwich, United Kingdom
(Lees, Taggart) Nuffield Department of Surgical Sciences, University of
Oxford, John Radcliffe Hospital, Oxford, United Kingdom
Title
One-year costs of bilateral or single internal mammary grafts in the
Arterial Revascularisation Trial.
Source
Heart. 103 (21) (pp 1719-1726), 2017. Date of Publication: 01 Nov 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: Coronary artery bypass grafting (CABG) using bilateral internal
mammary arteries (BIMA) may improve survival over CABG using single
internal mammary arteries (SIMA), but may be surgically more complex (and
therefore costly) and associated with impaired sternal wound healing. We
report, for the first time, a detailed comparison of healthcare resource
use and costs over 12 months, as part of the Arterial Revascularisation
(ART) Trial. Methods: 3102 patients in 28 hospitals in seven countries
were randomised to CABG surgery using BIMA (n=1548) or SIMA (n=1554).
Detailed resource use data were collected covering surgery, the initial
hospital episode, and for 12 months post randomisation. Using UK unit
costs, total costs were calculated and compared between trial arms and for
subgroups. Results: Patients randomised to BIMA spent 20 min longer in
theatre (95% CI 15 to 25, p<0.001) and also required more treatment for
sternal wound problems. Mean (SD) total costs per patient at 12 months
were 13 839 (10 534) for BIMA and 12 717 (9719) for SIMA (mean cost
difference 1122, 95% CI 407 to 1838, p=0.002). No tests for interaction
between subgroups and treatment allocation were significant. Conclusions:
At 12 months from randomisation, mean costs were approximately 9% higher
in BIMA than SIMA patients, primarily due to longer time in theatre and
in-hospital stay, and slightly higher costs related to sternal wound
problems during follow-up. Follow-up to the primary trial endpoint of 10
years will reveal whether longer-term differences emerge in graft patency
or in overall survival.<br/>Copyright &#xa9; 2017 Article author(s).

<135>
Accession Number
613198627
Author
Bavishi C.; Balasundaram K.; Argulian E.
Institution
(Bavishi, Balasundaram, Argulian) Mount Sinai St. Luke's and Mount Sinai
West Hospitals, New York, New York, United States
Title
Integration of Flow-Gradient Patterns Into Clinical Decision Making for
Patients With Suspected Severe Aortic Stenosis and Preserved LVEF: A
Systematic Review of Evidence and Meta-Analysis.
Source
JACC: Cardiovascular Imaging. 9 (11) (pp 1255-1263), 2016. Date of
Publication: 01 Nov 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study was designed to evaluate the evidence base for the
2014 American Heart Association/American College of Cardiology (AHA/ACC)
guidelines for severe aortic stenosis (SAS) and preserved left ventricular
ejection fraction by comparing the natural history of the disease in
subgroups of low-gradient (LG) aortic stenosis patients with high-gradient
(HG) patients. Background The 2014 AHA/ACC valvular disease guidelines
recommend estimation of stroke volume index by echocardiography in
patients with suspected LG SAS and preserved left ventricular ejection
fraction. Methods PubMed, Embase, and Scopus databases were searched for
all studies that have compared the natural history of SAS with preserved
ejection fraction in flow-gradient patterns. We studied the following 3
subgroups: HG, low-flow low-gradient (LFLG), and normal-flow low-gradient
(NFLG). The random effects model was used to pool individual study
results. The end-point was long-term all-cause mortality. Results A total
of 9 studies with 3,065 patients fulfilled the criteria. Compared to HG
SAS, both LFLG and NFLG patients had a higher burden of comorbidities such
as coronary artery disease and hypertension. Atrial fibrillation was more
prevalent in LFLG patients. Moreover, end-diastolic volume index was
smaller for LFLG patients and indexed aortic valve area was larger for
NFLG patients. All-cause mortality was similar between HG and LFLG
subgroups (relative risk: 1.07; 95% confidence interval: 0.83 to 1.38; p =
0.60), whereas patients with NFLG had a significantly lower all-cause
mortality compared to the HG subgroup (relative risk: 0.64; 95% confidence
interval: 0.47 to 0.86; p = 0.004). Conclusions Patients with LFLG SAS
have similar outcomes compared to HG SAS but worse compared to NFLG SAS.
These findings support estimating stroke volume index in patients with
suspected LG SAS. All analyses revealed high heterogeneity and further
high-quality studies are necessary.<br/>Copyright &#xa9; 2016 American
College of Cardiology Foundation

<136>
Accession Number
608521296
Author
Budoff M.J.; Nakazato R.; Mancini G.B.J.; Gransar H.; Leipsic J.; Berman
D.S.; Min J.K.
Institution
(Budoff) Department of Medicine, Los Angeles Biomedical Research Center,
Harbor-UCLA Medical Center, 1124 W. Carson Street, Torrance, CA 90502,
United States
(Nakazato, Gransar, Berman) Cedars-Sinai Heart Institute, Department of
Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Mancini, Leipsic) Department of Medicine and Radiology, University of
British Columbia, Vancouver, BC, Canada
(Min) Department of Radiology, New York-Presbyterian Hospital, Weill
Cornell Medical College, New York, NY, United States
Title
CT Angiography for the Prediction of Hemodynamic Significance in
Intermediate and Severe Lesions Head-to-Head Comparison with Quantitative
Coronary Angiography Using Fractional Flow Reserve as the Reference
Standard.
Source
JACC: Cardiovascular Imaging. 9 (5) (pp 559-564), 2016. Date of
Publication: 01 May 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The goal of this study was to compare the diagnostic
performance of coronary computed tomography angiography (CTA) versus
quantitative coronary angiography (QCA) for the detection of
lesion-specific ischemia using fractional flow reserve (FFR) as the gold
standard. Background Coronary CTA has emerged as a noninvasive method for
accurate detection and exclusion of high-grade coronary stenoses. FFR is
the gold standard for determining lesion-specific ischemia and has been
shown to improve clinical outcomes when guiding revascularization. Methods
A total of 252 patients from 5 countries were prospectively enrolled (mean
age 63 years; 71% male). Patients underwent coronary CTA and invasive
coronary angiography (ICA) with FFR in 407 lesions. Coronary CTA, QCA, and
FFR were interpreted by independent core laboratories. Stenosis severity
according to coronary CTA and QCA were graded as 0% to 29%, 30% to 49%,
50% to 69%, and 70% to 100%; stenosis >=50% was considered anatomically
obstructive. Lesion-specific ischemia was defined according to FFR <=0.8,
whereas QCA and coronary CTA stenosis >=50% were considered obstructive.
Diagnostic accuracy and areas under the receiver-operating characteristics
curve (AUC) for lesion-specific ischemia was assessed. Results According
to FFR, ischemia was present in 151 (37%) of 407 lesions. Diagnostic
accuracy, sensitivity, specificity, positive predictive value, and
negative predictive value were 69%, 79%, 63%, 55%, and 83% for coronary
CTA; and 71%, 74%, 70%, 59%, and 82% for QCA. AUC for identification of
ischemia-causing lesions was similar: 0.75 for coronary CTA and 0.77 for
QCA (p = 0.6). No differences between CTA and QCA existed for
discrimination of ischemia within the left anterior descending artery (AUC
0.71 vs. 0.73; p = 0.6), left circumflex artery (AUC 0.78 vs. 0.85; p =
0.4), and right coronary artery (AUC 0.80 vs. 0.83; p = 0.6). Conclusions
CTA and ICA exhibited similar diagnostic performance for the detection and
exclusion of lesion-specific ischemia. Using a true reference standard to
determine appropriate revascularization targets, 3-dimensional coronary
CTA performed as well as 2-dimensional ICA.<br/>Copyright &#xa9; 2016
American College of Cardiology Foundation.

<137>
Accession Number
611652835
Author
Wang L.; Bi Y.; Cao M.; Ma R.; Wu X.; Ding W.; Liu Y.; Yu Q.; Zhang Y.;
Jiang H.; Sun Y.; Tong D.; Guo L.; Dong Z.; Tian Y.; Kou J.; Shi J.
Institution
(Wang, Bi, Yu, Dong, Tian) Department of Cardiology, Harbin Medical
University, Harbin, China
(Cao, Ma, Wu, Zhang, Liu, Tong, Guo, Shi) Department of Hematology, The
First Hospital, Harbin Medical University, Harbin, China
(Ding, Zhang, Jiang, Kou) Department of Cardiology, The Second Hospital,
Harbin Medical University, Harbin, China
(Sun) Department of Nephropathy, The First Hospital, Harbin Medical
University, Harbin, China
(Shi) Cardiothoracic Surgery Division, Brigham and Women's Hospital, VA
Boston Healthcare System, Harvard Medical School, Boston, MA, United
States
Title
Microparticles and blood cells induce procoagulant activity via
phosphatidylserine exposure in NSTEMI patients following stent
implantation.
Source
International Journal of Cardiology. 223 (pp 121-128), 2016. Date of
Publication: 15 Nov 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background Relatively little is known about the role of phosphatidylserine
(PS) in procoagulant activity (PCA) in patients with non-ST-elevated
myocardial infarction (NSTEMI) after stent implantation. This study was
designed to evaluate whether exposed PS on microparticles (MPs) and blood
cells were involved in the hypercoagulable state in NSTEMI patients with
stent implantation. Methods NSTEMI patients (n= 90) and healthy controls
(n = 20) were included in our study. PS exposure on MPs and blood cells
was analyzed with flow cytometer and confocal microscope. PCA was
evaluated by clotting time, purified coagulation complex assays and fibrin
production assays. Results Baseline levels of MPs and PS⁺ blood
cells were significantly higher (P < 0.001) in the patients than in
controls. After stent implantation, a remarkable increase was observed in
both MPs and PS⁺ blood cells. Specifically, PS⁺ MPs,
PS⁺ platelets and erythrocytes peaked at 18 h following stent
implantation, while PS⁺ leukocytes peaked on day 2. In
addition, circulating MPs (mostly derived from platelets, leukocytes,
erythrocytes and endothelial cells) cooperating with PS⁺ blood
cells, contributed to markedly shortened coagulation time and markedly
increased FXa/thrombin/fibrin (all P < 0.01) generation in patient group.
Moreover, blockade of exposed PS on MPs and cells with lactadherin
inhibited PCA by approximately 70%. Conclusions Our results suggest that
PS⁺ MPs and blood cells play a procoagulant role in NSTEMI
patients following stent implantation. Blockade of PS prior to stenting
could become a novel therapeutic modality for the prevention of thrombosis
in these patients.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd

<138>
Accession Number
613234060
Author
Opolski M.P.; Staruch A.D.; Jakubczyk M.; Min J.K.; Gransar H.; Staruch
M.; Witkowski A.; Kepka C.; Kim W.-K.; Hamm C.W.; Mollmann H.; Achenbach
S.
Institution
(Opolski, Staruch, Witkowski) Department of Interventional Cardiology and
Angiology, Institute of Cardiology, Warsaw, Poland
(Jakubczyk) Institute of Econometrics, Warsaw School of Economics, Warsaw,
Poland
(Min) Department of Radiology, The New York-Presbyterian Hospital and
Weill Cornell Medical College, New York, New York, United States
(Gransar) Department of Imaging and Division of Cardiology, Department of
Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, California, United States
(Staruch) Medical University of Warsaw, Warsaw, Poland
(Kepka) Department of Coronary and Structural Heart Diseases, Institute of
Cardiology, Warsaw, Poland
(Kim, Hamm, Mollmann) Department of Cardiology, Kerckhoff Heart Center,
Bad Nauheim, Germany
(Hamm) Department of Cardiology and Angiology, Justus-Liebig University of
Giessen, Giessen, Germany
(Achenbach) Department of Internal Medicine 2 (Cardiology), University of
Erlangen, Erlangen, Germany
Title
CT Angiography for the Detection of Coronary Artery Stenoses in Patients
Referred for Cardiac Valve Surgery: Systematic Review and Meta-Analysis.
Source
JACC: Cardiovascular Imaging. 9 (9) (pp 1059-1070), 2016. Date of
Publication: 01 Sep 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study aimed to evaluate the diagnostic accuracy of
coronary computed tomography angiography (CTA) for detecting coronary
artery stenoses in patients with valvular heart disease undergoing valve
surgery. Background Coronary CTA is currently not routinely recommended
for detecting coronary artery stenoses before cardiac valve surgery.
However, recent improvements in computed tomography technology may enable
the identification of the most appropriate candidates for coronary CTA
before valve surgery. Methods A systematic review was performed of PubMed,
EMBASE, and the Cochrane databases for all studies that used >=16-detector
row computed tomography scanning to perform coronary CTA in patients with
valvular heart disease scheduled for valve surgery and validated the
results against invasive angiography. Summary diagnostic accuracies were
calculated by using a bivariate random effects model, and a generalized
linear mixed model was applied for heterogeneity analysis. Results
Seventeen studies analyzing 1,107 patients and 12,851 coronary segments
were included. Patient-based analysis revealed a pooled sensitivity of 93%
(95% confidence interval [CI]: 86 to 97), specificity of 89% (95% CI: 86
to 91), a negative likelihood ratio (LR) of 0.07 (95% CI: 0.04 to 0.16),
and a positive LR of 8.44 (95% CI: 6.49 to 10.99) for coronary CTA to
identify individuals with stenosis >=50%. Specificity and positive LR were
higher in patients without aortic stenosis (AS) versus those with AS (96%
vs. 87% and 21.2 vs. 7.4, respectively), as well as with >=64 detectors
versus <64 detectors (90% vs. 86% and 9.5 vs. 6.9). Heterogeneity analysis
revealed a significant impact of AS and the number of detectors on
specificity of CTA. Conclusions Coronary CTA using currently available
technology is a reliable imaging alternative to invasive angiography with
excellent sensitivity and negative LR for the detection of significant
coronary stenoses in patients undergoing cardiac valve surgery. The
specificity of coronary CTA may be decreased against the background of AS
(Computed Tomography Angiography for the Detection of Coronary Artery
Disease in Patients Referred for Cardiac Valve Surgery: A Meta-Analysis;
CRD42015016213)<br/>Copyright &#xa9; 2016 American College of Cardiology
Foundation

<139>
Accession Number
607405273
Author
Weinsaft J.W.; Kim J.; Medicherla C.B.; Ma C.L.; Codella N.C.F.; Kukar N.;
Alaref S.; Kim R.J.; Devereux R.B.
Institution
(Weinsaft, Kim, Medicherla, Ma, Alaref, Devereux) Greenberg Cardiology
Division, Department of Medicine, Weill Cornell Medical College, New York,
NY, United States
(Weinsaft, Kim) Department of Radiology, Weill Cornell Medical College,
New York, NY, United States
(Codella) IBM T.J. Watson Research Center, Yorktown Heights, NY, United
States
(Kukar) Memorial Sloan Kettering Cancer Center, New York, NY, United
States
(Kim) Duke Cardiovascular Magnetic Resonance Center, Durham, NC, United
States
(Weinsaft) Cardiac Magnetic Resonance Imaging Program, Weill Medical
College of Cornell University, 525 East 68th Street, Starr-4, New York, NY
10021, United States
Title
Echocardiographic Algorithm for Post-Myocardial Infarction LV Thrombus A
Gatekeeper for Thrombus Evaluation by Delayed Enhancement CMR.
Source
JACC: Cardiovascular Imaging. 9 (5) (pp 505-515), 2016. Date of
Publication: 01 May 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The goal of this study was to determine the prevalence of
post-myocardial infarction (MI) left ventricular (LV) thrombus in the
current era and to develop an effective algorithm (predicated on
echocardiography [echo]) to discern patients warranting further testing
for thrombus via delayed enhancement (DE) cardiac magnetic resonance
(CMR). Background LV thrombus affects post-MI management. DE-CMR provides
thrombus tissue characterization and is a well-validated but an
impractical screening modality for all patients after an MI. Methods A
same-day echo and CMR were performed according to a tailored protocol,
which entailed uniform echo contrast (irrespective of image quality) and
dedicated DE-CMR for thrombus tissue characterization. Results A total of
201 patients were studied; 8% had thrombus according to DE-CMR. All
thrombi were apically located; 94% of thrombi occurred in the context of a
left anterior descending (LAD) infarct-related artery. Although patients
with thrombus had more prolonged chest pain and larger MI (p <= 0.01),
only 18% had aneurysm on echo (cine-CMR 24%). Noncontrast (35%) and
contrast (64%) echo yielded limited sensitivity for thrombus on DE-CMR.
Thrombus was associated with stepwise increments in basal -> apical
contractile dysfunction on echo and quantitative cine-CMR; the
echo-measured apical wall motion score was higher among patients with
thrombus (p < 0.001) and paralleled cine-CMR decrements in apical ejection
fraction and peak ejection rates (both p < 0.005). Thrombus-associated
decrements in apical contractile dysfunction were significant even among
patients with LAD infarction (p < 0.05). The echo-based apical wall motion
score improved overall performance (area under the curve 0.89 +/- 0.44)
for thrombus compared with ejection fraction (area under the curve 0.80
+/- 0.61; p = 0.01). Apical wall motion partitions would have enabled all
patients with LV thrombus to be appropriately referred for DE-CMR testing
(100% sensitivity and negative predictive value), while avoiding further
testing in more than one-half (56% to 63%) of patients. Conclusions LV
thrombus remains common, especially after LAD MI, and can occur even in
the absence of aneurysm. Although DE-CMR yielded improved overall thrombus
detection, apical wall motion on a noncontrast echocardiogram can be an
effective stratification tool to identify patients in whom DE-CMR thrombus
assessment is most warranted. (Diagnostic Utility of Contrast
Echocardiography for Detection of LV Thrombi Post ST Elevation Myocardial
Infarction; NCT00539045).<br/>Copyright &#xa9; 2016 American College of
Cardiology Foundation.

<140>
Accession Number
618792253
Author
Sanfilippo F.; Knight J.B.; Scolletta S.; Santonocito C.; Pastore F.;
Lorini F.L.; Tritapepe L.; Morelli A.; Arcadipane A.
Institution
(Sanfilippo, Knight, Santonocito, Pastore, Arcadipane) Department of
Anesthesia and Intensive Care, Istituto Mediterraneo per i Trapianti e
Terapie ad alta specializzazione (IRCCS-ISMETT), Via Tricomi 5, Palermo
90127, Italy
(Knight) University of Pittsburgh Medical Center, Department of
Anesthesiology, Pittsburgh, PA, United States
(Scolletta) Azienda Ospedaliera Universitaria Senese, Unit of Anesthesia
and Critical Care Medicine, Department of Medical Biotechnologies, Siena,
Italy
(Lorini) Department of Anaesthesia and Intensive Care, Papa Giovanni XXIII
Hospital, Bergamo, Italy
(Tritapepe) Sapienza University of Rome, Department of Cardiovascular,
Respiratory, Nephrological, Anaesthetic and Geriatric Sciences, Rome,
Italy
(Morelli) Policlinico Umberto 1, Sapienza University of Rome, Department
of Anesthesiology and Intensive Care, Rome, Italy
Title
Levosimendan for patients with severely reduced left ventricular systolic
function and/or low cardiac output syndrome undergoing cardiac surgery: A
systematic review and meta-analysis.
Source
Critical Care. 21 (1) (no pagination), 2017. Date of Publication: 19 Oct
2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Previous studies have shown beneficial effects of levosimendan
in high-risk patients undergoing cardiac surgery. Two large randomized
controlled trials (RCTs), however, showed no advantages of levosimendan.
Methods: We performed a systematic review and meta-analysis (MEDLINE and
Embase from inception until March 30, 2017), investigating whether
levosimendan offers advantages compared with placebo in high-risk cardiac
surgery patients, as defined by preoperative left ventricular ejection
fraction (LVEF) <= 35% and/or low cardiac output syndrome (LCOS). The
primary outcomes were mortality at longest follow-up and need for
postoperative renal replacement therapy (RRT). Secondary postoperative
outcomes investigated included myocardial injury, supraventricular
arrhythmias, development of LCOS, acute kidney injury (AKI), duration of
mechanical ventilation, intensive care unit and hospital lengths of stay,
and incidence of hypotension during drug infusion. Results: Six RCTs were
included in the meta-analysis, five of which investigated only patients
with LVEF <= 35% and one of which included predominantly patients with
LCOS. Mortality was similar overall (OR 0.64 [0.37, 1.11], p = 0.11) but
lower in the subgroup with LVEF < 35% (OR 0.51 [0.32, 0.82], p = 0.005).
Need for RRT was reduced by levosimendan both overall (OR 0.63 [0.42,
0.94], p = 0.02) and in patients with LVEF < 35% (OR 0.55 [0.31, 0.97], p
= 0.04). Among secondary outcomes, we found lower postoperative LCOS in
patients with LVEF < 35% receiving levosimendan (OR 0.49 [0.27, 0.89], p =
0.02), lower overall AKI (OR 0.62 [0.42, 0.92], p = 0.02), and a trend
toward lower mechanical support, both overall (p = 0.07) and in patients
with LVEF < 35% (p = 0.05). Conclusions: Levosimendan reduces mortality in
patients with preoperative severely reduced LVEF but does not affect
overall mortality. Levosimendan reduces the need for RRT after high-risk
cardiac surgery.<br/>Copyright &#xa9; 2017 The Author(s).

<141>
Accession Number
618780251
Author
Chen Q.-H.; Zheng R.-Q.; Lin H.; Shao J.; Yu J.-Q.; Wang H.-L.
Institution
(Chen, Zheng, Lin, Shao, Yu, Wang) Yangzhou University, Department of
Critical Care Medicine, Subei People's Hospital, School of Medicine, 98
Nantong West Road, Yangzhou, Jiangsu 225001, China
(Wang) Yangzhou University, Department of Cardiology, Subei People's
Hospital, School of Medicine, 98 Nantong West Road, Yangzhou 225001, China
Title
Effect of levosimendan on prognosis in adult patients undergoing cardiac
surgery: A meta-analysis of randomized controlled trials.
Source
Critical Care. 21 (1) (no pagination), 2017. Date of Publication: 17 Oct
2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Small trials suggest that levosimendan is associated with a
favorable outcome in patients undergoing cardiac surgery. However,
recently published larger-scale trials did not provide evidence for a
similar benefit from levosimendan. We performed a meta-analysis to assess
the survival benefits of levosimendan in patients undergoing cardiac
surgery and to investigate its effects in subgroups of patients with
preoperative low-ejection fraction (EF). Methods: We identified randomized
clinical trials through 20 April 2017 that investigated levosimendan
therapy versus control in patients undergoing cardiac surgery. Individual
patient data from each study were compiled. Meta-analyses were performed
for primary outcomes, secondary outcomes and serious adverse events, and
subgroup analyses according to the preoperative EF of enrolled patients
were also conducted. The risk of bias was assessed using the Cochrane
risk-of-bias tool. Results: Seventeen studies involving a total of 2756
patients were included. Levosimendan therapy was associated with a
significant reduction in 30-day mortality (RR 0.67; 95% CI, 0.49 to 0.93;
p = 0.02) and reduced the risk of death in single-center trials (RR 0.49;
95% CI, 0.30 to 0.79; p = 0.004) and in subgroup trials of inferior
quality (RR 0.39; 95% CI, 0.17 to 0.92; p = 0.02); however, in multicenter
and in high-quality subgroup-analysis trials, no significant difference in
mortality was observed between patients who received levosimendan therapy
and controls (p > 0.05). However, in high-quality subgroup trials,
levosimendan therapy was associated with reduced mortality in patients in
a preoperative low-EF subgroup (RR 0.58; 95% CI, 0.38 to 0.88; p = 0.01).
Similarly, only patients in the preoperative low-EF subgroup benefited in
terms of reduced risk of renal replacement therapy (RR 0.54; 95% CI, 0.34
to 0.85; p = 0.007). Furthermore, levosimendan therapy was associated with
a significant reduction in intensive care unit (ICU) length of stay (MDR
-17.19; 95% CI, -34.43 to -2.94; p = 0.02). Conclusions: In patients
undergoing cardiac surgery, the benefit of levosimendan in terms of
survival was not shown in multicenter or in high-quality trials; however,
levosimendan therapy was associated with reduced mortality in patients
with preoperative ventricular systolic dysfunction.<br/>Copyright &#xa9;
2017 The Author(s).

<142>
Accession Number
617326918
Author
Nehus E.; Kaddourah A.; Bennett M.; Pyles O.; Devarajan P.
Institution
(Nehus, Bennett, Pyles, Devarajan) Division of Nephrology and
Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati,
OH, United States
(Kaddourah) Sidra Medical Research Center, Doha, Qatar
Title
Subclinical Kidney Injury in Children Receiving Nonsteroidal
Anti-Inflammatory Drugs After Cardiac Surgery.
Source
Journal of Pediatrics. 189 (pp 175-180), 2017. Date of Publication:
October 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective To investigate the association of nonsteroidal anti-inflammatory
drug (NSAID) administration with urinary neutrophil gelatinase-associated
lipocalin (NGAL) levels in children following cardiopulmonary bypass (CPB)
who did not develop acute kidney injury (AKI). Study design In this
prospective observational study, urinary NGAL levels were investigated in
210 children who underwent cardiothoracic surgery requiring CPB. Children
with clinical AKI (defined as an increase in serum creatinine >=50% from
baseline within 72 hours of CPB) were excluded from the analysis. NSAIDs
were administered no sooner than 24 hours after CPB. NGAL levels were
compared between children who received NSAIDs (n = 146) and those who did
not receive NSAIDs (n = 64). Results The median age was 3.2 years in the
children who received NSAIDs and 2.5 years in those who did not receive
NSAIDs (P =.05). Before NSAID administration at 24 hours following CPB,
the median NGAL level was 15 ng/mL in both groups (P =.92). Following
NSAID administration, the median urinary NGAL level increased to 83 ng/mL
(IQR, 45-95 ng/mL) at 72 hours after CPB in those receiving NSAIDs (P
<.001). In contrast, the median NGAL level decreased to 10 ng/mL (IQR,
5.4-15.9 ng/mL) at 72 hours after CPB in those who did not receive NSAIDs
(P =.01). In multivariable analysis, children receiving NSAIDs
demonstrated a 5-fold elevation of urinary NGAL levels at 60-72 hours
following CPB compared with those who did not receive NSAIDs (P <.001).
Conclusion NSAID administration was associated with a significant increase
in urinary NGAL in children who did not develop clinical AKI following
CPB. This indicates that NGAL can detect NSAID-induced subclinical kidney
injury in this population.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<143>
Accession Number
618909246
Author
Van Gageldonk B.J.H.G.; Fiolet A.T.L.; Bank I.E.M.; Mosterd A.; Verberne
H.J.; De Klerk J.M.H.; Scholtens A.M.
Institution
(Van Gageldonk, Fiolet, Mosterd, De Klerk, Scholtens) Meander Medical
Center, Amersfoort, Netherlands
(Bank) University Medical Center, Utrecht, Netherlands
(Verberne) Academic Medical Center, Amsterdam, Netherlands
Title
Value of Rubidium-82 flow measurements in patients with CABG.
Source
European Journal of Nuclear Medicine and Molecular Imaging. Conference:
30th Annual Congress of the European Association of Nuclear Medicine, EANM
2017. Austria. 44 (2 Supplement 1) (pp S354-S355), 2017. Date of
Publication: 2017.
Publisher
Springer Berlin Heidelberg
Abstract
Purpose: Rubidium-82 Positron Emission Tomography (Rb-82 PET) is a
reliable technique to detect ischemia. Global myocardial stress flow in
native coronary arteries (cut-off 2.0mL/g/min) is strongly related to
clinical outcome. However, grafted coronary arteries may have different
myocardial stress flow, due to differences in blood-to-vessel wall
interactions and differences in diameter between arterial and venous
grafts compared to native coronary arteries. Rb-82 PET myocardial stress
flow values have not been validated for grafted coronaries specifically.
Therefore we investigated Rb-82 PET global myocardial stress flow in
patients who had undergone coronary artery bypass grafting (CABG).
Methods: A retrospective analysis of all Rb- 82 PET scans (n=2819)
performed in our institution between February 2014 and May 2016 identified
295 scans in post- CABG patients. These patients were divided based on
global myocardial stress flow ((<1.8mL/g/min; low (group 1, n=106),
1.8-2.0mL/g/min; borderline-low (group 2, n=39), >;2.0mL/g/ min; normal
(group 3, n=150)). Left ventricular ejection frac- tion (LVEF), myocardial
blood flow and summed difference scores (SDS, indicating extent of
ischemia) were compared across groups. During follow-up coronary
revascularizations and acute coronary syndromes (ACS) were recorded.
Results: Group 1 was minimally older than groups 2 and 3 (74.6+/-7.9 vs
71.6+/-10 vs 71.4+/-9.1 years, p<0.05) and had a higher percentage of
males (86.8% vs 76.9% vs 64.7%, p<0.05). Grafts in group 1 were implanted
longer ago than in the other groups (Graft age 13.1+/-7.9 vs 9.2+/-6.3 vs
9.7+/-7.2 years, p<0.05). Rb-82 PET measurements in the 'borderline-low'
and 'low' group were comparable in terms of SDS (6.1+/-5.4 vs 4.2+/-4.4,
p=0.100) and both resting LVEF (50.8+/-15.5% vs 55.3+/-13.6%, p=0.203) and
stress LVEF (51.2+/-15.5% vs 57.3+/-14.0%, p=0.067). The 'normal' group
had lower SDS (2.4+/-3.5) and higher LVEF in rest and at stress
(62.1+/-11.5% and 64.5+/-11.6%, respectively). There was a significant
difference across groups in patients free of ACS and/ or revascularization
during follow-up (71.4% vs 79.5% vs 88.1%, p=0.003; mean follow-up 644
days). Conclusion: Established Rb-82 PET myocardial blood flow velocity
cut-off values provide useful (prognostic) information in CABG patients,
comparable to the evaluation of native coronary arteries.

<144>
Accession Number
612286255
Author
Wang S.; Mamuti W.; Wang Y.; Zuo W.; Dong L.
Institution
(Wang, Mamuti) Kashgar Prefecture Second People's Hospital, Department of
Cardiology, Kashi, China
(Wang, Zuo, Dong) Zhongshan Hospital, Fudan University, Shanghai, China
Title
Transcatheter aortic valve implantation in high-risk patients with
severely stenotic bicuspid versus tricuspid aortic valves.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1399-1400), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has shown
promise for the treatment of symptomatic aortic stenosis in patients at
high risk for conventional surgery. However, the presence of a bicuspid
aortic valve (BAV) continues to be considered as a relative
contraindication to TAVI. Objective: This study was to evaluate the
outcomes of transcatheter aortic valve implantation (TAVI) in high-risk
patients with severely stenotic BAV versus tricuspid aortic valves (TAV).
Methods: The published literature was scanned by formal searches of
electronic databases from January 2000 to December 2014. All comparative
studies were eligible for inclusion if they directly compared the TAVI
outcomes in BAV patients wersus TAV patients. Results: Prespecified
criteria were met by 4 trials involving 2204 patients. There was no
significant difference in device success (odds ratios [OR] 0.81, 95%
confidence intervals [CI] 0.29-2.29, P=0.70) or conversion to open-heart
surgery (OR 2.50, 95% CI 0.65-9.63, P=0.18) in BAV patients compared with
TAV patients undergoing TAVI. Similar mean pressure gradient was achieved
in both groups (standardized mean difference [SMD] 0.03, 95% CI
-0.17-0.23, P=0.76), but there was a tendency toward a higher incidence of
postprocedural aortic regurgitation grade >=2 in the BAV group as compared
with the TAV group (OR 1.5, 95% CI 0.94-2.4, P=0.09). There was no
significant difference in 30-day mortality (OR 1.23, 95% CI 0.43-3.50,
P=0.70) and 1 year mortality (OR 1.24, 95% CI 0.48- 3.20, P=0.66) between
the two groups. Conclusion: TAVI in selected high-risk patients with
severely stenotic BAV appears to be feasible with a low complication rate
and acceptable outcomes similar to that for TAV patients. However, a
relatively higher risk of aortic regurgitation post TAVI for BAV patients
requires further improvements.

<145>
Accession Number
612286253
Author
Noutsias M.; Ak A.; Porokhovnikov I.; Kuethe F.; Schlattmann P.
Institution
(Noutsias) University Hospital Jena, Department of Cardiology, KIM I,
Jena, Germany
(Ak, Porokhovnikov, Schlattmann) Institute of Medical Statistics,
Friedrich-Schiller University Jena, Jena, Germany
(Kuethe) HELIOS Klinik Herzberg/Osterode, Department of Cardiology,
Herzberg am Harz, Germany
Title
Comparison of transcatheter aortic valve implantation versus surgical
aortic valve replacement and medical treatment: A systematic review and
meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1399), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Introduction: Transcatheter aortic valve replacement (TAVI) is a promising
therapy option for patients with severe aortic stenosis, multiple
comorbidities and high risk for surgical aortic valve replacement (SAVR).
Purpose: To compare TAVI with SAVR and with medical therapy (MT) by
metaanalysis. Methods: A systematic review was conducted by two
independent investigators. We carried out literature search using Medline
(via PubMed), the Cochrane Library and Embase, and reference lists of
identified primary studies. We included articles written in English,
German, or Turkish that compared TAVI with other treatment options based
on all cause-mortality, and which contained baseline characteristics of
Gender, Age and EuroSCORE. Patients without aortic stenosis, healthy
subjects and data with less than 30-days follow-up time were excluded.
Relative Risk (RR) was calculated and graphically displayed in forest
plots. We used I² for heterogeneity and determined the source
of it by metaregression. Funnel plots were investigated by Egger's
regression test of asymmetry. Results: 22 studies, existing of 19
observational studies and three randomized controlled trials, with a total
of 6.539 patients were included. Compared with MT, TAVI showed a
statistically significant benefit for all-cause mortality at 12 months
(RR=0.68, 95% CI 0.49-0.95) and at 24 months (RR=0.75, 95% CI 0.44-1.27).
TAVI versus SAVR, overall result on 12 months showed significant advantage
for SAVR (RR=1.23, 95% CI 0.95-1.60). To be in contrast with that our
subgroup analysis with two randomized controlled trials militated here a
minimal better result for TAVI (RR=0.91, 95% CI 0.91-1.14). Long-term
outcome between SAVR and TAVI at 2 years presented no significant
difference (RR=1.09, 95% CI 1.01- 1.17). Mean age showed a substantial
influence on long-term survival (OR=7.375, 95% CI 0.78-69.43).
Conclusions: Based on the data available for this meta-analysis, survival
after TAVI is significantly better compared to MT. Survival after SAVR and
TAVI are similar at 2 years. Patients' age has a substantial impact on
long-term survival. Further future analyses are warranted to elucidate the
long-term comparison of TAVR versus SAVR beyond a 2-year follow-up time.

<146>
Accession Number
612286246
Author
Conrotto F.; Andreis A.; Salizzoni S.; D'Onofrio A.; Agrifoglio M.;
Chieffo A.; Regesta T.; Gabbieri D.; Saia F.; D'Ascenzo F.; D'Amico M.;
Moretti C.; Rinaldi M.; Gaita F.
Institution
(Conrotto, D'Amico) Hospital Citta Della Salute E Della Scienza Di Torino,
Cardiology, Turin, Italy
(Andreis, D'Ascenzo, Moretti, Gaita) University of Turin, Division of
Cardiology, Citta Della Salute E Della Scienza Di Torino Hospital, Turin,
Italy
(Salizzoni, Rinaldi) University of Turin, Department of Surgical Sciences,
Turin, Italy
(D'Onofrio) University of Padova, Department of Cardiac, Thoracic and
Vascular Sciences, Padua, Italy
(Agrifoglio) University of Milan, Centro Cardiologico Monzino, Department
of Clinical Sciences and Community, Milan, Italy
(Chieffo) San Raffaele Hospital of Milan (IRCCS), Milan, Italy
(Regesta) San Martino Hospital, Divisione Di Cardiochirurgia, Genoa, Italy
(Gabbieri) Modena Hospital, Hesperia Hospital, Modena, Italy
(Saia) University Hospital Policlinic S. Orsola-Malpighi, AOU Di Bologna,
Bologna, Italy
Title
Transcatheter aortic valve implantation in patients with advanced chronic
kidney disease: Futility or reliability?.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1398-1399), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Introduction: Chronic kidney disease is a strong risk factor for
cardiovascular disease and deeply affects prognosis of patients (pts)
undergoing cardiac interventions. Transcatheter aortic valve implantation
(TAVI) is a therapeutic alternative to traditional surgical aortic valve
replacement (SAVR) in pts with severe symptomatic aortic stenosis
ineligible for SAVR. Advanced chronic kidney disease (ACKD) is associated
with poor outcomes in SAVR, while its prognostic role in TAVI has not been
adequatly appraised. Purpose: To investigate outcomes/prognostic markers
in ACKD pts undergoing TAVI, enrolled in the ITER (Italian Transcatheter
Balloon-Expandable Valve Implantation Registry) registry. Methods: 1904
consecutive pts undergoing balloon-expandable TAVI in 33 italian centers
between 2007 and 2012 were enrolled in the ITER registry. ACKD was defined
depending on baseline glomerular filtration rate (GFR) as stage 4 (S4):
15-29 mL/min/1.73 m² or stage 5 (S5): <15 mL/min/1.73
m² or dialysis. Ed wards Sapien and Sapien XT prosthesis were
implanted during TAVI procedures. Primary end point was all-cause
mortality during follow-up (FU). Secondary end points were 30-days and FU
major adverse cardiac events (MACE), defined with VARC-2 criteria.
Results: Among 421 ACKD pts, 74 pts were classified as S5 and 347 as S4.
S5 pts were younger, with a higher prevalence of porcelain aorta and a
lower incidence of previous stroke. Procedural complications rates and
30-days outcomes were not different between S5 and S4 group. During a mean
FU of 670 (+/-466) days, S5 pts compared to S4 had higher rates of
all-cause mortality (69% vs 39%, p<0.01) and cardiac death (19% vs. 9%,
p=0.02). No differences were found in the others FU outcome rates among S5
and S4 groups. At multivariable analysis male sex (HR 1.6, 95% CI:
1.2-2.2), LVEF<30% (HR 2.3, 95% CI: 1.3-4), atrial fibrillation (AF) (HR
1.4, 95% CI: 1.0-1.9) and S5 (HR 1.5, 95% CI: 1.0-2.1) were found to be
predictors of death. Conclusions: TAVI in pre-dialytic or dialytic
patients (i.e. S5) is independently associated with unacceptable poor
outcome. Conversely, in severe CKD patients (i.e. S4) a rigorous risk
stratification is required to avoid the futility risk.

<147>
Accession Number
612286172
Author
Bokma J.P.; De Wilde K.C.; Vliegen H.W.; Van Dijk A.P.; Van Melle J.P.;
Meijboom F.J.; Zwinderman A.H.; Groenink M.; Mulder B.J.; Bouma B.J.
Institution
(Bokma, De Wilde, Zwinderman, Groenink, Mulder, Bouma) Academic Medical
Center of Amsterdam, Cardiology, Amsterdam, Netherlands
(Vliegen) Leiden University Medical Center, Leiden, Netherlands
(Van Dijk) University Hospital Nijmegen, Nijmegen, Netherlands
(Van Melle) University Medical Center Groningen, Groningen, Netherlands
(Meijboom) University Medical Center Utrecht, Utrecht, Netherlands
Title
Biventricular dysfunction predicts major adverse outcomes in tetralogy of
Fallot.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1242), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Despite major advancements in the early management of
Tetralogy of Fallot (TOF), morbidity in adulthood remains substantial.
Cardiovascular magnetic resonance (CMR) imaging is recommended to quantify
right ventricular (RV) and left ventricular (LV) function but accurate
thresholds to identify patients at high risk for ventricular arrhythmias
and death are lacking in current risk models. Purpose: We sought to
improve risk stratification by determining thresholds for biventricular
function to predict major adverse clinical outcomes. Methods: All adult
patients with repaired TOF from a prospective, multicenter cohort in whom
baseline CMR examination was performed were included. Multivariable Cox
hazards regression analysis was performed to determine variables
independently predictive for the primary composite outcome, consisting of
allcause death or major ventricular arrhythmias. Figure 1 Results: A total
of 575 patients were included (57% male, mean age 31+/-11 years). During
follow-up of 7.1+/-3.5 years, 35 patients experienced the primary outcome
(including all-cause death in 13 patients). In multivariable analysis,
optimal ventricular dysfunction thresholds: RV EF <30% (HR 4.32, 95% CI
2.05- 9.13, p<0.001), LV EF <45% (HR 3.49, 95% CI 1.72-7.08, p=0.001) and
history of supraventricular tachyarrhythmia (HR 3.50, 95% CI 1.56-7.84,
p=0.002) were independently predictive for the primary outcome. In
patients (n=21) with both RV EF <30% and LV EF <45%, 10-year freedom from
the primary outcome was only 32% (figure 1). Previous pulmonary valve
replacement (PVR) showed no interaction with the established function
thresholds. Conclusions: In repaired TOF patients, optimal CMR derived
ventricular dysfunction thresholds to predict major adverse clinical
outcomes were RV EF <30% and LV EF <45%. These independent thresholds were
applicable in patients with or without previous PVR and may be implemented
in risk stratification.

<148>
Accession Number
612286103
Author
Timoteo A.T.; Rosa S.A.; Nogueira M.A.; Ferreira R.C.
Institution
(Timoteo, Rosa, Nogueira, Ferreira) Hospital Santa Marta, CHLC, Lisbon,
Portugal
Title
Impact of triglycerides/HDL-cholesterol ratio on coronary artery disease
severity and in short-term outcome of patients with acute coronary
syndromes.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1390), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Introduction: Lipid fractions with demonstrated impact in outcome are
total and LDL-cholesterol. However, other fractions, such as small and
dense LDL, have also an important role, but technical difficulties are a
barrier for its clinical use in a routine basis. This fraction is
correlated with the triglycerides/HDL-cholesterol (TG/HDL) ratio, an
important atherogenic index and a risk marker in the general population.
Objectives: To evaluate the impact of TG/HDL ratio in patients with
established coronary disease (CAD) (acute coronary syndrome-ACS) in CAD
severity and in hospital death/re-infarction. Methods: Analysis of
patients included in a national multicenter registry of ACS between June
2011 and November 2015. Patients with a previous infarction or myocardial
revascularization were excluded. A cut-off for multivessel (MV) CAD
(>=2vessels with stenosis >50%) was obtained by ROC curve analysis
including only patients submitted to coronary angiography and another
cut-off was identified for hospital mortality in the entire population of
patients studied. We also analyzed the impact of TG/HDL ratio for the
presence of MV CAD and for the occurrence of hospital death and
re-infarction by uni and multivariate logistic regression analysis.
Results: From 9345 patients with lipid profile analyzed on admission, 2163
were excluded because of previous CAD. From the 5859 submitted to coronary
angiography, 45.5% presented MV CAD, and the ideal cut-off is >=1.76.
Patients with TG/HDL >=1.76 were younger, had higher body mass index and
are more frequently males, smokers, diabetics and have more
hyperlipidemia. They presented less frequently with ST elevation
myocardial infarction. There are no differences in previous use of
statins. They have more MV CAD (47.5% vs. 37.6%, p<0.001), and this ratio
is an independent predictor for MV CAD, even after adjustment for other
predictors (OR 1.59, 95% CI 1.38-1.83, p<0.001). In the complete study
population (7182 patients), the cut-off for hospital mortality is <=3.56.
However, although it is associated with higher mortality (2.8% vs. 1.7%,
OR 1.68, 95% CI 1.20-2.35, p=0.002), it is not an independent predictor of
hospital death (OR 1.03, 95% CI 0.66-1.62). There is also an association
with hospital death/re-infarction (4.0% vs. 2.4%, OR 1.71, 95% CI
1.27-2.29, p<0.001) but it is not an independent predictor (OR 1.17, 95%
CI 0.81-1.68). Conclusions: A TG/HDL ratio >=1,.76 is an independent
predictor for MV CAD in patients with ACS. There is however a paradoxical
relationship for hospital death or death/re-infarction that is not
independent from other prognostic variables.

<149>
Accession Number
612286008
Author
Wang T.K.M.; Wang M.T.M.; Pemberton J.
Institution
(Wang, Pemberton) Green Lane Cardiovascular Service, Auckland City
Hospital, Auckland, New Zealand
(Wang) University of Auckland, Department of Medicine, Auckland, New
Zealand
Title
Surgery for mitral valve endocarditis: Meta-analysis of repair or
replacement.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1238), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Mitral valve repair has superior results to replacement for
severe degenerative mitral valve disease, however in the infective
endocarditis setting, mixed results have been reported. Objectives: We
compared the outcomes of mitral valve repair and replacement for infective
endocarditis in this meta-analysis. Methods: MEDLINE, Embase and Cochrane
databases from 1 January 1980 to 31 December 2015 were searched for
original studies. Two authors evaluated these studies for inclusion
independently, then data were extracted and pooled. Results: A total of
3,976 papers was obtained from the search, 99 full-texts were reviewed,
and 13 studies which included both mitral valve repair and replacement
patients involving 8,130 patients were included for analyses. Pooled rates
and odds ratio (95% confidence interval) for operative mortality of repair
versus replacement were 3.7% vs 10.9%, 0.33 (0.26-0.41). Odds ratio for
long term mortality at 1-year (n=4) was 0.31 (0.14-0.72), and at 5 years
(n=8) was 0.42 (0.25-0.69). Peri-operative stroke rates and odds ratio
(n=4) were 2.8% vs 3.8%, 0.75 (0.55-1.00). Five year recurrent
endocarditis and redo-operations (n=6 for both) odds ratios were 0.39
(0.10-1.58) and 0.49 (0.12-2.02) respectively. Similar results were
observed when one large study making up 85% of the meta-analysis cohort
population was removed. Conclusion: Mitral valve repair is associated with
reduction in mortality and stroke, and similar recurrent endocarditis and
redo-operation rates compared to mitral valve replacement in mitral valve
endocarditis. It is therefore preferred when feasible, similar to surgery
for degenerative mitral valve disease.

<150>
Accession Number
612285954
Author
Bueno H.; Rossello X.; Pocock S.J.; Van De Werf F.; Chin C.T.; Danchin N.;
Lee S.W.-L.; Medina J.; Vega A.; Huo Y.
Institution
(Bueno) Centro Nacional De Investigaciones Cardiovasculares, Hospital 12
De Octubre, Madrid, Spain
(Rossello, Pocock) London School of Hygiene and Tropical Medicine, London,
United Kingdom
(Van De Werf) University Hospitals (UZ) Leuven, Leuven, Belgium
(Chin) National Heart Centre, Singapore, Singapore
(Danchin) Hopital Europeen Georges Pompidou, Rene Descartes University,
Paris, France
(Lee) Queen Mary Hospital, Hong Kong, Hong Kong
(Medina, Vega) AstraZeneca, Medical Evidence and Observational Research,
Global Medical Affairs, Madrid, Spain
(Huo) Peking University First Hospital, Beijing, China
Title
Regional variations in patients, management and 2-year mortality of
non-ST-segment elevation acute coronary syndromes in Europe, Latin America
and Asia. The EPICOR and EPICOR-Asia studies.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1386), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: There is a lack of evidence on regional variations in
non-STsegment elevation acute coronary syndromes (NSTEACS) management and
prognosis. Purpose: This study aimed to compare patient profiles, hospital
treatment and post-discharge mortality in several world regions. Methods:
Patients enrolled in two prospective registries of ACS survivors: EPICOR
(10 568 patients from 555 hospitals in 20 countries in Europe and Latin
America recruited between September 2010 and March 2011; NCT01171404) and
EPICOR Asia (12 922 patients from 218 hospitals in eight Asian countries
recruited between June 2011 and May 2012; NCT01361386) were studied.
Baseline characteristics, in-hospital management and 2-year outcome were
compared by pre-defined regions within Europe (E): (Northern E [NE],
Southern E [SE] and Eastern E [EE]; Latin America (LA); and Asia: (China
[CN], India [IN], South East Asia [SA] and South Korea-Hong Kong-Singapore
[KS]) in 11 931 NSTEACS patients (5625 EPICOR, 6306 EPICOR-Asia). Two-year
mortality risk was adjusted for 16 other variables identified as
independent predictors. Results: Patient characteristics differed widely
between regions: mean age (59 years IN, 65.9 years SE*), diabetes (21.4%
NE, 35.5% IN*) and smoking (32% NE, 62% IN*). Management was also
different: dual antiplatelet therapy at discharge (lowest 79.0%, NE,
highest 90.1%, SA*), coronary angiography (53.9% IN, 90.6% KS*),
percutaneous coronary intervention (35.1% LA, 78.6% KS*) and coronary
artery bypass graft (0.7% KS, 5.7% NE*). Unadjusted 2-year mortality
ranged between 3.8% in KS and 11.7% in SE.* Using CN as the reference,
differences in 2-year adjusted mortality risk were found among regions
(Figure), with the lowest in KS (hazard ratio [HR], 0.77; 95% confidence
interval [CI], 0.49- 1.21)* and the highest in LA (HR, 1.59; 95% CI,
1.22-2.06).* Conclusion: There is a wide variation in patient
characteristics, in-hospital management and risk-adjusted mortality
between continents and regions. Substantial room for improvement in
management and prognosis remains worldwide. *p<0.001 for all comparisons.
(Figure Presented).

<151>
Accession Number
612285888
Author
Cai C.; Xu X.; Zhang Z.
Institution
(Cai, Xu, Zhang) Shanghai Children's Medical Center, Cardiac Intensive,
China
Title
Intravenous treprostinil was used in pediatric patients during the early
postoperative period of fontan operation.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1370), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Care Unit of Cardiothoracic Surgery, Shanghai, China People's Republic of
Purpose: Treprostinil is a stable, long-acting prostacyclin analogue.
Subcutaneous treprostinil has been shown in a large multicenter randomized
controlled trial in patients with pulmonary arterial hypertention (PAH).
Intravenous treprostinil can also be used in postoperatinve PAH for
children with heart disease, but it's seldom used for selective reduction
of pulmonary vascular resistance after Fontan procedrure. Our purpose was
seek the effect of treprostinil for for Fontan patients in early
postoperative period. Methods: This was retrospective study of 86
pediatric patients during the early postoperative period of Fontan
operation receiving continuous intravenous treprostinil from September
2014 to Decenber 2015 in our center. Medication was started when the
patients were transferred to CICU. The starting dose is 5 ng/kg/min, then
gradually increase by 2.5 ng/kg/min per 30 min to 30 ng/kg/min. The
effective standards is descend range of Pp/Ps >=20% and the hemodynamic
parameters is stable. Results: Mean age was 3.7+/-1.2 years. Mean weight
was 15.5+/-3.0 kg. Mean Central Venous Pressure (CVP) at baseline was
22.0+/-8.0. Mean pulmonary-tosystemic blood pressure ratio (Pp/Ps) at
baseline was 0.36+/-0.2. Before awakening, 68 (79.1%) cases achieved the
above standards, and mean descend range of Pp/Ps was 23.6+/-15.3%, and the
minimum effective dose (MED) of treprostinil was 20.4+/-4.5 ng/kg/min.
After awakening, 43 (57.8%) cases achieved the above standards, and mean
descend range of Pp/Ps was 18.7+/-8.2%, and the MED of treprostinil was
23.6+/-3.8 ng/kg/min. All patients was extubation successfully. Mean time
of mechanical ventalation was 18.0+/-9.6 hours (6.5-21.5 hours).
Conclusion: Intravenous treprostinil is an effective and safe treatment
for selective reduction of pulmonary vascular resistance for Fontan
patients in early postoperative period.

<152>
Accession Number
612285877
Author
Bongiovanni D.; Kuehl C.; Schymik G.; Frank D.; Frey N.; Mehilli J.;
Massberg S.; Laugwitz K.L.; Kupatt C.
Institution
(Bongiovanni, Laugwitz, Kupatt) Hospital Rechts Der Isar, I. Medizinische
Klinik und Poliklinik, Munich, Germany
(Kuehl, Frank, Frey) University Medical Center of Schleswig-Holstein,
Klinik fur Innere Medizin III, Kiel, Germany
(Schymik) Hospital Municipal Karlsruhe, Medizinische Klinik IV, Karlsruhe,
Germany
(Mehilli, Massberg) Ludwig-Maximilians University, Medizinische Klinik und
Poliklinik I, Klinikum Groshadern, Munich, Germany
Title
The BAVTAV registry: Emergency TAVI versus emergency balloon valvuloplasty
followed by elective TAVI in patients with decompensated aortic stenosis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1355), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Aims: Despite the recent improvements of support therapies and of
transcatheter devices, the optimal treatment of severely decompensated
patients due to aortic stenosis remain to be determined. Our aim was to
assess the early outcome of emergency TAVI (eTAVI) and of emergency
Balloon Aortic Valvuloplasty (eBAV) followed by TAVI in elective
circumstances. Methods and results: Emergency condition was defined as:
cardiogenic shock with requirement of catecholamine therapy, severe acute
dyspnea (NYHA 4), cardiac resuscitation or artificial respiration support.
The data were collected according to the VARC-2 criteria. In 4 German
centers 14 patients (Log.EuroScore I 37.49+/-18.3) underwent eTAVI and 114
patients (Log.EuroScore I 35.85+/-21.1) underwent eBAV. In the eTAVI
group, immediate procedural mortality was 14.3%, compared to 21.1% for the
eBAV group (p=0.55). At 30 days, cardiovascular mortality for the eTAVI
group was 25% and for the eBAV group 29.6% (p=0.73). The logistic
regression, adjusting for potential confounding factor, did not provide
evidence of a difference. Of note, the elective TAVI performed after eBAV
(N=29, Log. EuroScore I 26.3+/-14.5) displayed an immediate procedural of
10.3% and a cardiovascular mortality at 30 days of 17.2%. Among the VARC-2
criteria, reached the significant difference between groups (p<0.05) the
rate of major vascular complication (3.6% for eBAV vs 21.4% for eTAVI
p=0.01) and of acute kidney injury (2.4% for eBAV vs 14.3% for eTAVI
p=0.04) Conclusion: In this multicentric cohort of patients, the immediate
procedural and 30 days mortality of emergency TAVI and BAV was similarly
high, whereas in elective circumstances after emergency BAV the immediate
mortality of TAVI was lower. These results did not suggest a clear
superior strategy. A randomized multicentric study is needed to finally
indicate a superior approach to acute decompensated valvular aortic
stenosis.

<153>
Accession Number
612285820
Author
Landes U.; Barsheshet A.; Finkelstein A.; Guetta V.; Assali A.; Halkin A.;
Vaknin-Assa H.; Segev A.; Bental T.; Ben-Shoshan J.; Barbash I.M.;
Kornowski R.
Institution
(Landes, Barsheshet, Assali, Vaknin-Assa, Bental, Kornowski) Rabin Medical
Center, Cardiology, Petah Tikva, Israel
(Finkelstein, Halkin, Ben-Shoshan) Tel Aviv Sourasky Medical Center,
Cardiology, Tel Aviv, Israel
(Guetta, Segev, Barbash) Sheba Medical Center, Cardiology, Ramat Gan,
Israel
Title
Temporal trends in transcatheter aortic valve implantation in Israel
2008-2014: Patient characteristics, procedural issues and outcome.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1354), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: About a decade past the first Transcatheter Aortic Valve
Implantation (TAVI), there is limited data about the temporal trends
accompanying its' evolution from novel technology to mainstream therapy.
Purpose: To evaluated these trends in a large multicenter TAVI registry.
Methods: Patients who underwent TAVI between Jan-2008 to Dec-2014 at 3
high volume Israeli centers were divided into 5 time quintiles according
to procedural date (Q1: 2008-10, n=260; Q2: 2011, n=251; Q3: 2012, n=266;
Q4: 2013, n=261; Q5: 2014, n=248). Outcomes were analyzed and reported
according to the Valve Academic Research Consortium 2. Results: A total of
1,285 patients were studied: 43% males, age 83+/-3 years, STS-score
5.5+/-3.6. Throughout the years there was a shift to treat patients at
lower STS-score, escalated practice of conscious sedation and transfemoral
approach and less balloon pre-dilatation convention. The
balloon-expandable to self-expandable valve utilization ratio decreased,
the valve in valve experience sprout from 4% to 17% of all TAVI volume,
and hospital admission time was halved (p=0.006). Kaplan-Meier survival
curves showed a gradual decrease in mortality risk over the years
(p=0.031), but there was no significant 1-year mortality decrease by
multivariable analysis. Each year increment was associated with an
adjusted 20%, 15%, and 12% decrease in new pacemaker obligation (p=0.004),
new pacemaker obligation or left bundle brunch block (p=0.008) and
in-hospital infections (p=0.082), respectively. Conclusions: Temporal
trends accompanying TAVI evolution include utilization in lower risk
patients, procedural simplification, decreased new pacemaker obligation,
shorter hospital stay and improved survival. (Table Presented).

<154>
Accession Number
612285728
Author
De Sensi F.; Cresti A.; Miracapillo G.; Addonisio L.; Breschi M.; Paneni
F.; Limbruno U.
Institution
(De Sensi, Cresti, Miracapillo, Addonisio, Breschi, Limbruno) Misericordia
Hospital, Cardiology, Grosseto, Italy
(Paneni) Karolinska Institute, Cardiology, Stockholm, Sweden
Title
Epidemiological and clinical features of cardiac device-related
endocarditis in a single electrophysiology center: A 17-year follow-up
study.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1292), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Prevalence of cardiac device-related endocarditis (CDE) is
alarmingly increasing and their diagnosis and management represent a
growing challenge. However, available evidence on CDE-related features
mostly comes from extraction reference centers or multicenter studies with
a short follow-up. Informations on CDE long-term outcomes are lacking.
Purpose: To investigate clinical features of CDE in a single
electrophysiology lab over a 17-year follow-up. Methods: Patients with a
definite diagnosis of CDE following a cardiac device procedure were
consecutively recruited from January 1998 to December 2014. Results: 4414
cardiac device procedures (3070 new PMK implants, 378 new ICD implants,
849 PMK replacements, 117 ICD replacements) were performed during the
study period. CDE occurred in 6 patients [F/M (0/6), 3/6 PMK recipients
(50%), 2/6 ICD recipients (33%), 1/6 CRT-D recipient (17%)] with an
estimated overall incidence of 0,13%. Five out of 6 patients (83%)
developed endocarditis after device replacement. Average time from index
procedure to diagnosis was 9 months (range 2-24). Moreover, 5/6 pts (83%)
developed a pocket infection preceding endocarditis. S. Epidermidis was
isolated in 3/6 pts (50%), S. coagulasenegative in 2/6 pts (33%), E.
Cloacae in 1/6 pt (17%). Lead vegetations were visible at transesophageal
echocardiogram (ETE) in any patient and average diameter recorded was 8 mm
(range 5-12mm). Two cases (33%) of pulmonary embolism were recorded, in
both cases dimensions of lead vegetations (>=10 mm) as well as embolic
risk estimated as "high" at transesophageal echocardiogram, correlated
well with the thromboembolic event. Among CDE patients, five underwent
extraction at a reference center with a good long-term outcome. Only one
patient received conservative treatment, he died 2 months after diagnosis.
Conclusions: In this 17-year follow-up study, we describe clinical and
epidemiological features of CDE observed in a single electrophysiology
lab, reporting an overall incidence of 0.13%. Cardiac device extraction
remains the gold standard approach in these patients.

<155>
Accession Number
612285727
Author
Kayvanpour E.; Amr A.; Sedaghat-Hamedani F.; Lai A.; Haas J.; Holzer D.;
Frese K.; Keller A.; Jensen K.; Katus H.; Meder B.
Institution
(Kayvanpour, Amr, Sedaghat-Hamedani, Lai, Haas, Holzer, Frese, Keller,
Jensen, Katus, Meder) University Hospital of Heidelberg, Department of
Medicine III, Heidelberg, Germany
Title
Does it matter which gene? A meta-analysis on genotype-phenotype
association in dilated cardiomyopathy.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1115), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Risk stratification in patients with dilated cardiomyopathy
(DCM) is currently to the most extent independent of their genotype. This
is due to lack of sufficient data, as most studies investigating
genotype-phenotype correlation in DCM have been in small cohorts or
restricted to a few genes. Purpose: The present study provides to the best
of our knowledge the first systematic meta-analysis on genotype-phenotype
associations in DCM. Methods: We searched PubMed/Medline literature on
genotype-phenotype associations in DCM patients with mutations in LMNA,
PLN, RBM20, MYBPC3, MYH7, TNNT2 and TNNI3. Titin (TTN) was not included as
the pathogenicity of some of its known variants is still controversial. We
summarized and extensively reviewed all studies that passed selection
criteria and performed a meta-analysis on key phenotypic features.
Results: Al together, 8097 individuals from 48 studies were included. The
highest frequency of mutations was in LMNA (5%), followed by MYBPC3 (4%),
and MYH7 (3%). Regardless of the mutated gene, carriers presented the
disease on average in the beginning of their fifth decade. The phenotype
was the most aggressive in LMNA mutation carriers. These patients
presented with conduction disease (73%), ventricular arrhythmia (50%), and
end stage heart failure with the need for cardiac transplantation (27%).
The frequency of ventricular arrhythmia was also considerably high in PLN
mutation carriers (43%). Although patients with RBM20 mutations did not
differ significantly in gender, age of disease onset, left ventricular
ejection fraction, or ventricular arrhythmia, these patients were
transplanted in a significantly younger age (28.5 years versus >40 years
in other gene mutation carriers). The frequency and clinical relevance of
TNNI3 mutations in DCM were negligibly low. Conclusion: This meta-analysis
showed interesting and considerable genotypephenotype correlations in DCM.
Knowing which gene is mutated in the patient or his healthy first degree
relative may support physicians to better estimate course of disease and
individualize monitoring and therapy.

<156>
Accession Number
612285653
Author
Moayyeri A.; Patel R.; Pujades Rodriguez M.; Denaxas S.; Banerjee A.;
Allan V.; Direk K.; Prieto-Merino D.; Asselbergs F.W.; Hingorani A.D.;
Casas J.P.; Hemingway H.
Institution
(Moayyeri, Patel, Pujades Rodriguez, Denaxas, Banerjee, Allan, Direk,
Prieto-Merino, Hingorani, Casas, Hemingway) University College London,
Institute of Health Informatics, London, United Kingdom
(Asselbergs) University Medical Center Utrecht, Department of Cardiology,
Division of Heart and Lungs, Utrecht, Netherlands
Title
Low levels of LDL-cholesterol and incidence of a wide range of
cardiovascular diseases: A linked electronic health records cohort of
550,000 people.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1190-1191), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: New prevention strategies and use of aggressive lipid-lowering
therapies will be informed by a better understanding of the impact of
low-density lipoprotein-cholesterol (LDL-C) at very low levels on a wide
spectrum of pathologically diverse cardiovascular diseases (CVDs). In
statin trials common cardiovascular diseases such as heart failure and
atrial fibrillation have only been studied as non-primary endpoints and
meta-analyses do not show a clear protective effect. In this study, we
investigated the association of LDL-C with initial presentations of
multiple CVDs in a large contemporary population-based cohort. Methods: We
analysed linked national electronic health records from the CALIBER
programme (4 sources of primary and secondary care data and disease and
mortality registries in England, 1997 to 2010). A cohort of 563,299
participants, aged 18 years or more and initially free from any diagnosed
CVD, was identified and followed for the first occurrence of 15 CVDs
(coronary events, sub-types of stroke, cardiac and vascular diseases) for
up to 13 years. Of these, 169,443 participants (30%) had LDL-C <110 mg/dL
at baseline. We examined multivariableadjusted associations of LDL-C with
these endpoints using Cox proportional hazards models. Results: Lower
LDL-C levels were associated with decreased risk of coronary events
(myocardial infarction (MI), stable and unstable angina, coronary
revascularisation and death) and abdominal aortic aneurysm, and increased
risk of haemorrhagic stroke, heart failure (HF) and atrial fibrillation
(AF). No association was observed with ischaemic stroke and peripheral
arterial disease. Compared to people with baseline LDL-C of 110-130 mg/dL,
those with LDL-C <70 mg/dL had lower risk of MI (hazard ratio 0.61 [95% CI
0.50-0.74]) but higher risk of HF (1.44 [1.27-1.63]), AF (1.38
[1.20-1.59]) and intracerebral haemorrhage (1.84 [1.26-2.68]), while those
with LDL-C >160 mg/dL had higher risk of myocardial infarction (1.46
[1.33-1.59]) but lower risk of heart failure (0.78 [0.72-0.86]) and atrial
fibrillation (0.69 [0.63-0.76]). The inverse associations with HF and AF
were linear throughout the range of values, with no evidence of threshold,
were robust to adjustment for competing risk of mortality, and consistent
in those with or without diabetes, other co-morbidities, or receiving
statins at baseline. Conclusions: Very low levels of LDL-C (i.e. <70
mg/dL) are associated with the lowest risk of myocardial infarction but
increased risk of other common but less-studied CVDs. The possibility that
there are trade-offs across different CVDs should guide further research
into the wider impact of intensive LDL-C lowering therapies for primary
prevention of atherosclerotic CVD. (Figure Presented).

<157>
Accession Number
612285586
Author
Czerwinska K.; Zembala M.; Dabrowski M.; Witkowski A.; Ochala A.; Kochman
J.; Dudek D.; Kubler P.; Jagielak D.; Stepinska J.
Institution
(Czerwinska, Stepinska) Institute of Cardiology, Intensive Cardiac Therapy
Department, Warsaw, Poland
(Zembala) Silesian Center for Heart Diseases (SCHD), Department of Cardiac
Surgery and Transplantology., Zabrze, Poland
(Dabrowski, Witkowski) Institute of Cardiology, Department of
Interventional Cardiology and Angiology, Warsaw, Poland
(Ochala) 7th Public Hospital, Silesian Medical University, Katowice,
Poland
(Kochman) Medical University of Warsaw, 1st Department of Cardiology,
Warsaw, Poland
(Dudek) Jagiellonian University Medical College, Krakow, Poland
(Kubler) Wroclaw Medical University, Wroclaw, Poland
(Jagielak) Medical University of Gdansk, Department of Cardiac and
Vascular Surgery, Gdansk, Poland
Title
Can TAVI patients receive aspirin monotherapy as patients after surgical
aortic bioprosthesis implantation? Data from the Polish Registry POL-TAVI.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1207), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Introduction: The currently recommended antithrombotic prophylaxis after
Transcatheter Aortic Valve Implantation (TAVI) is based on the expert
consensus and optimal periprocedural care in this field is unknown.
Purpose: This observational analysis was aimed to investigate in-hospital
safety and efficacy of periprocedural antithrombotic/antiplatelet therapy
used in TAVI patients included into the Polish Nationwide Cardiac Surgical
and Cardiology Registry of Transcatheter Aortic Valve Implantation
(POL-TAVI). Methods: All patients who underwent TAVI in 21 participating
centers between 2013-2014 were included. Adopted endpoints: severe
bleeding (SB), vascular complications (VC), thromboembolic events,
myocardial infarction, all-cause mortality within 30-days after TAVI
defined according to Valve Academic Research Consortium 2. SB composed of
major and life-threatening/disabling bleeding, VC composed of major and
minor events. Thromboembolic events composed of stroke/TIA, valve
thrombosis and peripheral embolism. Statistical methods: logistic
regression with propensity score analysis, Cox regression analysis,
absolute/ relative risk reduction (ARR/RRR), number needed to treat
(NNT)/number need to harm (NNH) to measure effectiveness and the risk
associated with antithrombotic/ antiplatelet therapies. Results: 827
patients were included; 35-93 yr (79.31+/-7.53); 457 (55.29%) women.
Endpoints noted: SB - 130 (15.72%)pts, VC - 135 (16.32%) pts,
thromboembolic events - 26 (3.14%)pts, myocardial infarction - 24 (2.90%)
pts, allcause mortality - 58 (7.01%) pts. Aspirin premedication, resulted
in the least number of early VC (OR 0.56 95% CI [0.345-0.938]; p=0.027),
while dual antiplatelet therapy (DAPT)/triple anticoagulation (TAT)
predicted VC (OR 2.195 95% CI [1.200-4.014]; p=0.01/OR 1.952 95% CI
[1.01-3.776]; p=0.047). ARR for VC with aspirin in comparison to DAPT and
TAT premedication was 13.95% and 16.12%, respectively. RRR for VC with
aspirin vs. DAPT was 58.34%, and aspirin vs. TAT was 61.81%. NNT for VC
with aspirin premedication was 9.54. NNH for VC with DAPT/TAT
premedication was 10.28 and 12.2, respectively. Postprocedural aspirin
prophylaxis reduced independently the risk of VC (OR 0.089 95% CI
[0.0217-0.372]; p=0.001) and SB (OR 0.138 95% CI [0.043-0.447]; p=0.001)
(Fig.1), with no adverse impact on efficacy endpoints. ARR for VC and SB
with aspirin vs. DAPT was 14.64% and 13.74%, respectively, RRR for both
safety endpoints with aspirin vs. DAPT was 89.56% and 90.15%,
respectively. NNT for VC and SB with postporcedural aspirin was 5.5 and
6.42, respectively. The beneficial safety profile of postprocedural
aspirin remained significant in comparison to all other types of
prophylaxis, in propensity score: for VC (OR 0.068 95% CI [0.009-0.529];
p=0.01), for SB (OR 0.176 95% CI [0.049-0.627]; p=0.007). Conclusions:
Aspirin monotherapy after TAVI appears to be safer than currently
recommended DAPT; therefore it should be considered as TAVI antithrombotic
prophylaxis. (Figure Presented).

<158>
Accession Number
612285463
Author
Thomet C.; Schwerzmann M.; Oechslin E.; Kovacs A.
Institution
(Thomet, Schwerzmann) Bern University Hospital, Center for Congenital
Heart Disease, Bern, Switzerland
(Oechslin, Kovacs) Toronto Congenital Cardiac Centre for Adults, Peter
Munk Cardiac Centre, University of Toronto, Toronto, Canada
Title
Patient characteristics and perceived self-efficacy in adult patients with
congenital heart disease.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1127), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Introduction: Congenital heart disease (CHD) is a chronic disorder. During
their lifetimes, most adults with repaired CHD will face long-term
complications such as heart failure, arrhythmias, and re-operations.
Perceived self-efficacy has been recognized as an important and positive
element for people living with chronic diseases. It describes a person's
belief in one's own competence to tackle difficult life situations and
cope with hardships. Thus far, no study investigated the level of
self-efficacy in adults with CHD. We aimed to assess perceived
self-efficacy in adult CHD patients in relation to patients'
characteristics. Methods: As a sub-study of the cross-sectional,
multicentre study of patientreported outcomes in CHD
(APPROACH-International Study), data from 454 adults with CHD from
Switzerland and Canada were included. The 10-item General Self-Efficacy
(GSE) questionnaire was used to assess patients' self-efficacy. We
investigated whether GSE scores differed as a function of
socio-demographic variables (sex, age, marital status, children,
graduation, religion), mood disorders and/or CHD variables (severity of
CHD, number of cardiac surgeries, cardiac devices, history of congestive
heart failure or arrhythmias). Results: Of the total sample, 45% of the
patients were female and the mean age was 35+/-13.5 years; 50% were highly
educated. Twenty percent of the patients had mild, 49% moderate, and 31%
severe CHD. The mean GSE score was 30.1+/-3.3, which is close to GSE
scores observed in the general population (mean = 29.4). There was a
statistical difference in self-efficacy between males and females (GSE
score 30.6+/-4.9 vs. 29.5+/-5.4, p<.02). No associations were found
between GSE score and the other socio-demographic, mood disorders or CHD
variables. Conclusion: In CHD patients, the GSE score is not affected by
disease severity and comparable to the GSE score in the general
population. As explanation, we hypothesize that adults living with a
pediatric-onset medical condition have grown up accustomed to the
heart-related disease burden and have developed sufficient coping
abilities. Although the mean score for males was higher than the mean
score for females, the literature suggests that this is unlikely to be
clinically meaningful.

<159>
Accession Number
612285441
Author
Giustino G.; Chieffo A.; Palmerini T.; Valgimigli M.; Feres F.; Abizaid
A.; Hong M.K.; Kim H.S.; Gilard M.; Morice M.C.; Leon M.B.; Bhatt D.L.;
Genereux P.; Stone G.W.; Colombo A.
Institution
(Giustino, Chieffo) University Vita-Salute San Raffaele, Cardiothoracic
Department, Interventional Cardiology Unit, Milan, Italy
(Palmerini) University of Bologna, Bologna, Italy
(Valgimigli) Bern University Hospital, Bern, Switzerland
(Feres, Abizaid) Institute Dante Pazzanese of Cardiology, Sao Paulo,
Brazil
(Hong, Kim) Yonsei University, College of Medicine, Seoul, South Korea
(Gilard) University Hospital of Brest, Brest, France
(Morice) Cardiovascular Institute Paris-Sud (ICPS), Massy, France
(Leon, Genereux, Stone, Colombo) Columbia University Medical Center, New
York, United States
(Bhatt) Brigham and Women's Hospital, Boston, United States
Title
Safety and efficacy of prolonged dual antiplatelet therapy following
complex percutaneous coronary artery revascularization with drug-eluting
stents.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 839), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: After percutaneous coronary intervention (PCI) with
drug-eluting stents, dual antiplatelet therapy (DAPT) potency and duration
should be tailored according to the individual ischemic and bleeding risk.
Whether PCI complexity modulates the clinical effectiveness of prolonged
platelet inhibition with DAPT is unknown. Objectives: We sought to
investigate the efficacy and safety of prolonged DAPT with aspirin and
clopidogrel in patients undergoing complex PCI. Methods: We pooled
patient-level data from six randomized controlled trials investigating
DAPT durations. Complex PCI was defined as the presence of at least one of
the following: >=3 stents implanted, >=3 lesions treated, bifurcation
lesion with 2 stents implanted, total stent length >=60 mm and chronic
total occlusion as target lesion. Short-DAPT was defined as a DAPT
duration <=6 months, while long-DAPT was defined as a DAPT duration >=12
months. Primary efficacy endpoint was adverse cardiac events (MACE)
defined as the composite of cardiac death, myocardial infarction or
definite or probable stent thrombosis at follow-up. Primary safety
endpoint was major TIMI bleeding at follow-up. Results: Out of 11,473
patients included in the pooled dataset, 1,896 were excluded due to
missing variables. Among 9,577 patients, 1,708 (17.8%) underwent complex
PCI. Of them, 867 were randomized to long-DAPT (50.8%) and 841 (49.2%) to
short-DAPT. Study groups were well-balanced. At a median followup time of
392 days (interquartile range 366 to 710 days), patients who underwent
complex PCI had higher crude rates of MACE (8.1% versus 4.1%; log-rank
p<0.0001). Overall, long-DAPT had no significant effect on MACE (adjusted
hazard ratio [HR]: 0.85; 95% confidence interval [CI]: 0.66-1.08; p=0.18).
However, long-DAPT was associated with significantly greater reductions in
MACE in the complex PCI group (adjusted HR: 0.56; 95% CI: 0.35-0.89)
compared with noncomplex PCI (adjusted HR: 1.01; 95% CI: 0.75-1.35;
pinteraction = 0.01). The benefit of long-DAPT on MACE was proportional to
the number of high-risk procedural features (Figure). Long-DAPT was
overall associated with increased risk of major bleeding (adjusted HR:
2.15; 95% CI: 1.21-3.82), which was uniform in magnitude between complex
and non-complex PCI groups (pinteraction = 0.15). Conclusions: Patients
undergoing complex PCI remain at higher risk for MACE. After complex PCI,
long-DAPT significantly reduced the risk of ischemic events, in a fashion
that was proportional to the degree of procedural complexity. PCI
complexity seems to be an important parameter to take into account in
tailoring DAPT duration. (Figure Presented).

<160>
Accession Number
612285432
Author
Balagny P.; Guedeney P.; Lebreton G.; Laali M.; Rousseau H.; Vicaut E.;
Mohammedi S.; Barthelemy O.; Montalescot G.; Leprince P.; Collet J.P.
Institution
(Balagny, Guedeney, Lebreton, Laali, Rousseau, Vicaut, Mohammedi,
Barthelemy, Montalescot, Leprince, Collet) Hospital Pitie-Salpetriere,
Universite Pierre et Marie Curie (UPMC Paris 6), ACTION Study Group
(www.action-coeur.org), INSERM U, Paris, France
Title
30 days and one year impact of the antithrombotic treatment following
TAVI.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 942), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Optimal antithrombotic regimen after transcatheter-aortic
valve implantation (TAVI) is not evidence-based and its impact on outcome
is debated. Purpose: To evaluate clinical outcome after successful TAVI
according to antithrombotic treatment at discharge. Methods: This
single-center study was conducted between 2010 and 2014 and compare
patients previously or discharged on oral anticoagulation (OAC) with
patient discharged on single or dual antiplatelet therapy (SAPT, DAPT)
alone. The primary and secondary endpoints were defined according to
VARC-2 as the composite of death, myocardial infarction, stroke, any
device-related events including thrombosis and major bleeding at one month
and one year, respectively. Results: Among the 424 patients who were
considered, 97 were discharged on OAC. They had more frequently AF and
less frequently coronary artery disease but overall baseline and
procedural characteristics were balanced between the two groups. SAPT was
used in combinaison with OAC in 43% of patients. The primary outcome
occurred in 17.6% versus 21,8% in OAC and non-OAC group, respectively (OR
=0.81, 95% CI [0.49-1.34]). There was no difference after multiple
adjustment (OR adj = 0.79, 95% CI [0.43-1.46]). There was no difference at
one year follow-up (OR adj =1.15; 95% CI [0.72-1.84]) between OAC and non-
OAC groups. The rate of major bleeding did not differ although there was a
trend for more bleeds in the OAC group (4% versus 2% in OAC and non-OAC
groups, p=0.99). Coronary artery disease was the only independent
correlate associated with the primary endpoint (OR=2.07, 95% CI
[1.31-3.27]) Conclusion: Antithrombotic regimen after TAVI deserves a
randomized evaluation in this high-risk frail population.

<161>
Accession Number
612285381
Author
Trenkwalder T.; Pellegrini C.; Holzamer A.; Philipp A.; Schunkert H.;
Kastrati A.; Hilker M.; Hengstenberg C.; Husser O.
Institution
(Trenkwalder, Pellegrini, Schunkert, Kastrati, Hengstenberg, Husser)
Deutsches Herzzentrum Technische Universitat, Klinik fur Herz- und
Kreislauferkrankungen, Munich, Germany
(Holzamer, Philipp, Hilker) University Hospital Regensburg, Klinik und
Poliklinik fur Herz-, Thorax- und herznahe Gefaschirurgie, Regensburg,
Germany
Title
Emergency venoarterial extracorporeal hemodynamic support for
life-threatening complications in transcatheter aortic valve implantation:
Incidence, outcome and temporal trends.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1141), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Purpose: Life-threatening complications during transcatheter aortic valve
implantation (TAVI) are decreasing due to advancing device technology,
low-profile delivery systems, and growing operator experience. However,
unpredictable complications occur and emergency venoarterial
extracorporeal membrane oxygenation (eECMO) has been used for circulatory
stabilization in these cases. Data on frequency of use, outcome, and
temporal trends of this strategy in the rapidly evolving field of TAVI are
lacking. We report our two-center experience of eECMO as a rescue strategy
during life-threatening complications in TAVI. Methods: Between February
2010 and October 2015, 1741 consecutive patients underwent TAVI at two
centers (transfemoral n=1362 and transapical n=363). In selected cases
(n=16), an alternative subclavian, transaortic, or transcaval access was
chosen. In total, eECMO was required in 33 patients using venoarterial
femoral cannulation in all cases. Clinical data, type of complication, and
outcome were analyzed. In addition, frequency of eECMO required over time
was evaluated. Results: Of the 33 patients requiring eECMO, 22 underwent
transfemoral (67%) and 11 transapical (33%) TAVI. Indications for eECMO
implantation were hemodynamic instability (n=17, 52%), ventricular rupture
(n=10, 30%), coronary artery impairment (n=3, 9%), aortic annulus rupture
(n=2, 6%), and aortic dissection (n=1, 3%). Mean age of eECMO patients was
81+/-5 years, mean logistic EuroScore I was 21.5+/-14.3%, and mean left
ventricular ejection fraction was 53+/-14%. Conversion to open heart
surgery was necessary in 14 patients (42%). Percutaneous coronary
intervention was performed in all cases with coronary artery impairment
(3/33, 9%). All other patients received conservative treatment (16/33,
48%). Median duration of eECMO support was 114 [61-445] minutes.
In-hospital mortality was 46% (15/33). Survival of patients according to
eECMO indication did not differ between the groups. In-hospital survivors
spent a median of 17 [13-23] days in clinic and 7 [3-14] days on intensive
care unit (ICU). eECMO related vascular complications occurred in 5
patients (15%). 30-day mortality of in-hospital survivors was 0%. The
frequency of eECMO requirement decreased from 2010 (10%) to 2015 (1%),
whilst the number of TAVI procedures increased from n=41 in 2010 until
n=486 in 2015 (Fig.1). Conclusion: eECMO represents a feasible rescue
strategy for hemodynamic support in life-threatening complications during
TAVI. However, mortality in these patients remains high even with optimal
circulatory support. Nevertheless, with increasing TAVI experience
requirement of eECMO decreases and remains necessary in about 1% of TAVI
cases. (Figure Presented).

<162>
Accession Number
612285376
Author
Nagao K.; Morimoto T.; Taniguchi T.; Sakata R.; Kimura T.
Institution
(Nagao) Osaka Red Cross Hospital, Osaka, Japan
(Morimoto) Hyogo College of Medicine, Clinical Eidemiology, Hyogo, Japan
(Taniguchi, Sakata, Kimura) Kyoto University, Graduate School of Medicine,
Kyoto, Japan
Title
Clinical profile and prognosis of acute heart failure complicating severe
aortic stenosis: Insights from the CURRENT AS Registry.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 941), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Patients with severe aortic stenosis (AS) often present with
acute heart failure (AHF), which is a critical point in the natural
history of AS. Purpose: The present study sought to clarify the clinical
profile and prognosis of AHF complicating severe AS. Methods: CURRENT AS
Registry is a retrospective multicenter registry enrolling consecutive
patients with severe AS defined by echocardiographic criteria. Entire
patients were categorized into the 3 groups; no heart failure (HF),
chronic HF (CHF) and AHF according to the symptom of HF and necessity for
in-hospital management at the time of index echocardiography. Clinical
outcomes at 5-year were compared among the 3 groups. Results: Of 3815
patients, 2212 (58%), 813 (21%) and 790 (21%) patients were categorized
into no HF, CHF and AHF groups, respectively. Median follow-up was 1361
days with 90% follow-up rate at 2 years. The cumulative 5-year incidence
of all-cause death, aortic valve-related death and HF hospitalization in
No HF, CHF and AHF groups were 37.1%, 41.8% and 61.8%, p<0.001; 9%, 13%
and 30.7%, p<0.001; 13.7%, 23.4% and 38.8%, p<0.001, respectively. The
cumulative 5-year incidence of surgical aortic valve replacement (AVR) or
transcatheter aortic valve implantation in No HF, CHF and AHF groups were
55.4%, 69.6% and 48.2%, p<0.001, respectively. By multivariable cox
proportional hazard model, AHF was an independent predictor of all-cause
mortality (adjusted hazard ratio, 1.67 vs. no HF; p<0.001), while CHF was
not (adjusted hazard ratio, 1.10 vs. no HF; p=0.21). Of note, even among
the patients for whom AVR was initially planned, AHF was associated with
high 5-year mortality rate (No HF; 17.3%, CHF; 25.2%, AHF; 33%, p<0.0001,
respectively). Conclusions: In this observational registry of severe AS
patients, AHF was associated with a dismal prognosis with extremely high
mortality rate, which could not be fully reversed by AVR after AHF. Early
AVR strategy before emergence of AHF should be warranted to improve the
clinical outcomes of patients with severe AS.

<163>
Accession Number
612285261
Author
Leao S.; Araujo C.; Laszczynska O.; Fontes P.; Dias P.; Maciel M.J.;
Moreira I.; Azevedo A.
Institution
(Leao, Araujo, Fontes, Moreira) Hospital Center of Tras-os-Montes and Alto
Douro, Cardiology, Vila Real, Portugal
(Laszczynska) University of Porto, EPIUnit - Institute of Public Health,
Porto, Portugal
(Dias, Maciel) Sao Joao Hospital, Cardiology, Porto, Portugal
(Azevedo) Faculty of Medicine University of Porto, Department of Clinical
Epidemiology, Predictive Medicine and Public Health, Porto, Portugal
Title
Age-related differences in the management of acute coronary syndromes.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 941), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Introduction: The risk of acute coronary syndrome (ACS) increases with
age. Several studies show that the elderly are less likely to receive
invasive management and evidence-based therapies, although the associated
benefits are maintained at older ages. The aim of this study was to assess
the relation between age and management with an invasive approach and with
secondary-prevention therapies, taking into account the functional status
of the patients. Methods: Within a prospective cohort study of consecutive
patients admitted to two tertiary hospitals with acute ACS, between August
2013 and December 2014, we evaluated 868 patients whose functional status,
assessed through the Barthel index scale (BIS), was available at baseline.
Data were obtained through face-to-face interviews and medical records
review. Age was categorized as: <65 years, 65 to 79 years and >=80 years.
Invasive management was defined as performance of coronary angiography,
angioplasty or coronary artery bypass graft during the index
hospitalization. All medications at baseline and discharge were recorded.
Logistic regression models were used to evaluate differences in the
invasive approach and pharmacological treatment by age and functional
status. Results: About half of patients were younger than 65 years, with
13% aged 80 or more years. Eleven percent had moderate or severe
functional limitation according to BIS, with a significantly higher
proportion among those 80 years or older (30.2%, p<0.001). Less than 4% of
patients were treated with a conservative approach. The proportion of
patients discharged with aspirin was 95%, adenosine diphosphate receptor
inhibitors 97%, dual anti-platelet agents 92%, statins 97%, beta-blockers
80%, and ACE-inhibitor/ARB 80%. Older patients were significantly less
likely to undergo invasive management [OR=0.10, 95% confidence interval
(95% CI)=0.04-0.24], even after adjustment for BIS (OR=0.12, 95% CI:
0.05-0.30), and independently of the ACS type. At discharge, older
patients, independently of BIS, were much less likely to receive
evidence-based therapies, namely aspirin (OR=0.39, 95% CI: 0.15-0.99),
statins (OR=0.08, 95% CI: 0.02-0.25) or beta blockers (OR=0.33, 95% CI:
0.20- 0.54). Prescription of dual antiplatelet therapy or
ACE-inhibitors/ARB was not different between age groups. Conclusion:
Although the vast majority of ACS patients were managed invasively and
discharged on evidence-based secondary preventive medications, elderly
patients were still less likely to be treated with these recommended
therapies. Other factors bot not functional status might explain this
inequality.

<164>
Accession Number
612285234
Author
Iida Y.; Inomata T.; Kaida T.; Fujita T.; Ikeda Y.; Nabeta T.; Ishii S.;
Koitabashi T.; Ako J.
Institution
(Iida, Inomata, Kaida, Fujita, Ikeda, Nabeta, Ishii, Koitabashi, Ako)
Kitasato University, Department of Cardiovascular Medicine, Sagamihara,
Japan
Title
Clinical impact of segmental wall motion abnormalities in cardiac
sarcoidosis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 955-956), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Although there are some reports indicating that idiopathic
dilated cardiomyopathy (IDCM) patients with the segmental left ventricular
(LV) wall motion abnormalities (SWMA) have poor prognosis, characteristic
feature and clinical impact of SWMA in cardiac sarcoidosis (CS) have not
been well elucidated. Methods: After excluding patients with complete left
bundle branch block or cardiac pacemakers, we retrospectively evaluated
left ventriculogram (LVG) in consecutive patients with new-onset CS (n=34)
and IDCM (n=323). The LV wall motions were conventionally estimated using
the scoring into 4 degrees (0: normokinesis, 1: hypokinesis, 2: akinesis,
3: dyskinesis) on the 7 segments according to the American Heart
Association classification. SWMA was defined as the score dispersion by
more than 1 degree among segments. All images on regional wall motion were
evaluated by 3 blinded, experienced observers without knowledge of the
results of other diagnostic modalities. The LV basal area was defined as
segment 1 and 5 in LVG. Regarding the correlation between SWMA and
prognosis, primary endpoints included cardiovascular event; an arrhythmic
composite of sudden cardiac death (SCD) or aborted SCD (appropriate ICD
shock, sustained ventricular tachycardia); and a composite of HF death, HF
hospitalization, or cardiac transplantation. Results: There were 22 (65%)
and 54 (17%) patients with SWMA in CS and IDCM, respectively. Concerning
the prevalent location, SWMA including aneurysm was observed in LV basal
area significantly more frequent in CS than in IDCM (65% vs. 16% P<0.0001)
(Figure1). Limited in CS patients, Kaplan-Meier survival curves
demonstrated that the CS with SWMA had a lower event-free rate of the
primary endpoints than those without (p=0.018, log-rank test) (Figure2).
Cox proportional hazards analysis demonstrated that the SWMA (Hazard ratio
= 5.85, 95% confidence interval, 0.95-114.2; p=0.05) together with NYHA
functional class, III to IV was an independent predictors for the primary
endpoints. Conclusion: SWMA is located frequently in LV basal area, and is
a significant predictor associated with a poor prognosis In CS patients.
(Figure Presented).

<165>
Accession Number
612285218
Author
Yamamoto S.; Yamaga T.; Sakai Y.; Ishida T.; Nakasone S.; Ohira M.; Yajima
F.; Yamazaki S.; Higuchi S.; Ota E.; Mori R.; Ikeda U.
Institution
(Yamamoto, Yamaga, Sakai, Ishida, Nakasone) Shinshu University Hospital,
Department of Rehabilitation, Matsumoto, Japan
(Ohira) Shinshu University, Department of Physical Therapy, School of
Health Sciences, Matsumoto, Japan
(Yajima) Shinshu University Hospital, Department of Nursing, Matsumoto,
Japan
(Yamazaki, Higuchi, Ikeda) Shinshu University Hospital, Department of
Cardiovascular Medicine, Matsumoto, Japan
(Ota, Mori) National Center for Child Health and Development, Department
of Health Policy, Tokyo, Japan
Title
Association between 6 minutes walking distance and mortality in patients
with coronary artery disease and heart failure: A meta-analysis of cohort
studies.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1125), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Six-minute walk distance (6MD) of patients with heart disease
including heart failure (HF) is lower than that of people who do not a
have heart disease, and is related to mortality and re-admission rates.
However, the relationship between 6MD and mortality varies in different
papers. Purpose: The aim of this study was to clarify the relationship
between 6MD and mortality in patients with coronary artery disease (CAD)
and HF using metaanalysis. Methods: This meta-analysis included all-aged
participants in community settings who had a history of the following
conditions or procedures: myocardial infarction, or coronary
revascularization (coronary artery bypass grafting, percutaneous
transluminal coronary angioplasty or coronary artery stent), angina
pectoris or heart failure. They were divided into two groups; CAD group
and HF group. We searched EMBASE and MEDLINE, PubMed, and the Cochrane
Library with no limitations on date, language, document type, or
publication status. Identified studies were prospective and retrospective
cohort studies. We pooled hazard ratios of Cox proportional hazard models
after logarithmic transformation and performed meta-analysis by using the
inverse-variance method. Results: Fourteen cohort studies reported in 15
papers, involving 7309 participants, were included in the meta-analysis.
The pooled hazard ratios of the highest 6MD category compared with the
lowest category were 2.55 (95% confidence interval (CI): 1.60 to 4.06) in
the CAD group and 2.09 (95% CI: 1.59 to 2.75, P<0.001) in the HF group for
all-cause mortality (Figure). Furthermore, the pooled hazard ratios for
each 1-meter increase were 1.00 (95% CI: 0.99-1.00) in the CAD group and
1.00 (95% CI: 0.99 to 1.00, P<0.001) in the HF group. The p-values for the
overall effect of both hazard ratios in the CAD groups were not calculated
because they were reported in only one paper. Conclusion: Meta-analysis of
cohort studies showed a strong association of 6MD and mortality in people
with heart failure. However, an association of 6MD and mortality in CAD
patients is unclear. Therefore, more cohort studies are needed for CAD
patients. (Figure Presented).

<166>
Accession Number
612285204
Author
Anselmino M.; Garberoglio L.; Gili S.; Bertaglia E.; Stabile G.; Marazzi
R.; Themistoclakis S.; Solimene F.; Frea S.; Grosso Marra W.; Morello M.;
Scaglione M.; De Ponti R.; Gaita F.
Institution
(Anselmino, Garberoglio, Gili, Frea, Grosso Marra, Morello, Gaita)
University of Turin, Division of Cardiology, Department of Medical
Sciences, Turin, Italy
(Bertaglia) University of Padova, Department of Cardiac, Thoracic and
Vascular Sciences, Padua, Italy
(Stabile) Clinica Mediterranea, Naples, Italy
(Marazzi, De Ponti) University of Insubria, Department of Heart and
Vessels, Ospedale Di Circolo E Fondazone Macchi, Varese, Italy
(Themistoclakis) Hospital Dell'Angelo, Department of Cardiothoracic and
Vascular Medicine, Mestre-Venice, Italy
(Solimene) Montevergine Cardiology Clinic, Mercogliano, Italy
(Scaglione) Cardinal Massaia Hospital, Division of Cardiology, Department
of Internal Medicine, Asti, Italy
Title
Left atrial appendage thrombi relate to easily accessible clinical
parameters in patients undergoing atrial fibrillation transcatheter
ablation: A multicenter retrospective study.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1081), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Transesophageal echocardiography (TEE) is routinely performed
before atrial fibrillation (AF) transcatheter ablation to exclude the
presence of left atrial (LA) or LA appendage (LAA) thrombi. Purpose: Aim
of the study is to evaluate if easily accessible clinical parameters may
relate to the presence of LA or LAA thrombi to identify patients who could
potentially avoid TEE. Methods: Between January 2012 and September 2014
data from 1,539 consecutive patients undergoing TEE, as a work-up before
AF transcatheter ablation, in six large volume centers were collected.
Baseline clinical features, CHA2DS2-VASc score, transthoracic
echocardiography and presence of thrombi at TEE were recorded. Exclusion
criteria were valvular, hypertrophic or dilated cardiomiopathy, previous
heart surgery or an ejection fraction <=35%. Results: Mean age was
59.6+/-10.4 years, 1,215 (78.9%) were males; 951 (62.9%) presented in
sinus rhythm (SR) on admission, 324 (21.1%) had undergone at least one
previous ablation and 900 (58.5%) had CHA2DS2-VASc score 0-1. Thrombi were
encountered in 12 patients (0.8%). At univariate analysis SR on admission
(p=0.024) and first ablation procedure (p=0.001) related to the absence of
thrombi. No patient with CHA2DS2-VASc score 0-1 and SR on admission
presented thrombi at TEE (p=0.011, positive predictive value 100%). Figure
1 shows the prevalence of LAA thrombi stratified according to heart rhythm
at admission and CHA2DS2-VASc score. Conclusions: In a selected population
of patients referred for AF ablation, LAA thrombi prevalence is low. No
patients in SR with CHA2DS2-VASc score 0-1 presented LAA thrombi at TEE,
identifying a significant subset of patients who could potentially safely
be spared from pre-procedural TEE. (Figure Presented).

<167>
Accession Number
612285201
Author
Chopard R.; Genet B.; Chatot M.; Napporn G.; Hyvert A.; Didier-Petit K.;
Schiele F.; Meneveau N.
Institution
(Chopard, Genet, Chatot, Schiele, Meneveau) University Hospital of
Besancon, Hospital Jean Minjoz, Besancon, France
(Napporn) Centre Hospitalier Louis Pasteur, Cardiology, Dole, France
(Hyvert) Centre Hospitalier, Cardiology, Pontarlier, France
(Didier-Petit) Centre Hospitalier, Cardiology, Remiremont, France
Title
Long-term clinical implications of residual pulmonary vascular obstruction
after pulmonary embolism: A ventilation-perfusion lung scan follow-up
study at two timepoints.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 406), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: The long-term impact of persistent pulmonary vascular
obstruction after pulmonary embolism (PE) remains unknown. Objectives:
Based on ventilation-perfusion (V-Q) lung scan performed at discharge and
3 months after a first pulmonary embolism (PE), we aimed to investigate
the prognostic value on 5-year adverse events of (1) residual pulmonary
vascular obstruction (RPVO) at discharge (DIS-RPVO), (2) RPVO at 3 months
(3M-RPVO), and (3) relative change in RPVO between the two scans (RC-RPVO)
Methods: Prospective, multicenter cohort study from January 2007 to
December 2009 including patients who survived at least 3 months after aPE.
RC-RPVO was defined as (DIS-RPVO - 3M-RPVO)/DIS-RPVO. The primary endpoint
was a combined endpoint at 5 years, composed of all-cause death, recurrent
venous thromboembolism, chronic thromboembolic pulmonary hypertension,
heart failure (HF) and rehospitalization for cardiac causes.
Receiver-operating characteristic curves were computed to define
thresholds of DIS-RPVO, 3M-RPVO and RC-RPVO predictive of the primary
combined end-point at 5 years. Factors associated with the occurrence of
the 5-year combined endpoint were identified using multivariate Cox
models. Results: Overall, 241 patients were included (high-risk PE:11.2%,
intermediaterisk PE:51.8%, low-risk PE:37%). Mean DIS-RPVO was
27.9+/-15.1%, mean 3MRPVO was 10.3+/-10.8% and mean RC-RPVO was
61.7+/-33.4%. At 5 years, 112 patients (46.5%) experienced the combined
end-point. Both 3M-RPVO>=15% and RC-RPVO<=37.5% were independently related
to the occurrence of the combined end-point at 5 years (Hazard Ratio (HR):
1.71, 95% CI: 1.17-2.51, p=0.01 and HR: 1.64, 95% CI: 1.08-2.49, p=0.02,
respectively). DIS-RPVO did not predict long-term adverse events (HR:
1.32; 95% CI: 0.91-1.93; p=0.14). Conclusion: RC-RPVO<=37.5% and
3M-RPVO>=15% were independently related to the occurrence of adverse
events at 5 years after a first PE. Follow-up V-Q scan at 3 months could
be useful after PE to identify patients at risk of long-term adverse
events.

<168>
Accession Number
612285189
Author
Unal S.; Acar B.; Balci M.M.; Yayla C.; Ertem A.; Kara M.; Maden M.;
Temizhan A.; Tola M.; Balbay Y.
Institution
(Unal, Acar, Balci, Yayla, Ertem, Kara, Maden, Temizhan, Balbay) Turkiye
Yuksek Ihtisas Hospital, Cardiology, Ankara, Turkey
(Tola) Turkiye Yuksek Ihtisas Hospital, Radiology, Ankara, Turkey
Title
Manual heating of radial artery to facilitate radial puncture prior to
transradial coronary catheterization: A randomized, double-blind clinical
trial: The balbay maneuver study.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1068), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background/Objectives: Transradial access (TRA) is increasingly being used
for both diagnostic and interventional cardiac procedures. The use of TRA
offers many advantages: decreased bleeding, vascular complications,
reduced length of hospital stay, and reduced cost. However, the small size
of the radial artery limits the size of the equipment that can be used via
this approach. In this study we sought to investigate whether
pre-procedural manual heating of radial artery facilitates radial artery
puncture or not. Methods: Patients undergoing transradial cardiac
catheterization were randomized in a double-blind fashion to a
subcutaneous combination of nitroglycerin+ diltiazem or manual heating
(Balbay Maneuver). The study endpoint was puncture score (score 1: easiest
puncture-first try, score 2: puncture at second try, score 3:puncture at
third try, score 4: puncture at forth or more try, score 5: radial
puncture failed). Results: 90 patients were enrolled (45 allocated to
treatment group and 45 to heating group). Patients underwent ultrasound of
the radial artery before the catheterization. Complications were rare: one
hematoma (treatment group) and one radial artery occlusion (heating
group). Baseline demographic and clinical characteristics were similar.
The baseline radial artery diameter was similar in both groups.
(2.41+/-0.46 mm in heating group and 2.30+/-0.48 mm in treatment group.
However, puncture score was 1.47+/-0.9 in heating group and 2.22+/-1.2 in
treatment group (p=0.002), respectively. Conclusions: Pre-procedural
manual heating of radial artery by Balbay maneuver facilitates radial
artery puncture in patients undergoing transradial cardiac
catheterization. (Table Presented).

<169>
Accession Number
612285146
Author
Miyake M.; Izumi C.; Taniguchi T.; Morimoto T.; Amano M.; Takahashi Y.;
Yoshikawa Y.; Nishimura S.; Kuroda M.; Tamura T.; Kondo H.; Kaitani K.;
Nakagawa Y.; Sakata R.; Kimura T.
Institution
(Miyake, Izumi, Amano, Takahashi, Yoshikawa, Nishimura, Kuroda, Tamura,
Kondo, Kaitani, Nakagawa) Tenri Hospital, Tenri, Japan
(Taniguchi, Kimura) Kyoto University, Graduate School of Medicine,
Department of Cardiovascular Medicine, Kyoto, Japan
(Morimoto) Hyogo College of Medicine, Department of Clinical Epidemiology,
Nishinomiya, Japan
(Sakata) Kyoto University, Graduate School of Medicine, Department of
Cardiovascular Surgery, Kyoto, Japan
Title
Long-term outcomes and its predictors of aortic valve replacement for
asymptomatic severe aortic stenosis; comparison between initial surgical
strategy and conservative strategy.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1218-1219), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: There are few reports from large-scale data regarding
comparison of long-term outcomes after aortic valve replacement (AVR) for
asymptomatic severe aortic stenosis (AS) between patients initially
treated with AVR and those initially managed conservatively. Purpose: The
purpose of the study is to assess long-term outcomes after AVR for
asymptomatic severe AS and its predictors, and to clarify whether there is
difference in long-term outcomes after AVR between the initial AVR group
and the conservative group. Methods: We analyzed data from a large
multicenter registry (the CURRENT AS Registry) enrolling 3,815 consecutive
patients with severe AS (peak aortic jet velocity >4.0 m/s, or mean aortic
pressure gradient >40 mm Hg, or aortic valve area <1.0 cm²).
Among 1,808 asymptomatic patients, 286 patients underwent AVR shortly
after initial diagnosis and remaining 377 patients were initially managed
conservatively and consequently underwent AVR. The primary end points were
all-cause death and cardiovascular death. Clinical characteristics and
echocardiographic findings at initial diagnosis were assessed. Median
follow-up was 1,452 days. Results: The 5-year survival and cardiovascular
death-free survival after AVR in all 663 patents were 84.9% and 91.0%,
respectively. Independent predictors impacting the 5-year survival after
AVR in asymptomatic severe AS patients were age (hazard ratio [HR], 1.04;
confidence interval [CI],1.00-1.07; p=0.03), history of atrial
fibrillation (HR,2.97; CI,1.71-5.16; p<0.001), prior coronary artery
bypass grafting (HR,5.24; CI,2.15-12.78; p<0.001), left ventricular mass
index (HR, 1.01; CI,1.00-101; p=0.01), anemia (HR, 1.84; CI, 1.03-3.28,
p=0.04) and creatinine level of more than 2mg/dl or hemodialysis (HR,
4.56; CI,2.48-8.38; p<0.001). There is no difference in the 5-year
survival and cardiovascular deathfree survival after AVR between the
initial AVR group and the conservative group (86.0% versus 84.1%, p=0.33;
91.3% versus 91.1%, p=0.61, respectively). However, in 260 patients with a
peak aortic jet velocity of 4.5m/s or more, the 5-year survival and
cardiovascular death-free survival after AVR in the initial AVR group
(n=180) is better than in the conservative group (n=80) (88.5% versus
70.6%, p=0.003; 91.9% versus 81.7%, p=0.023, respectively). Conclusions:
Early AVR is recommended especially for asymptomatic severe AS patients
with a peak aortic velocity of 4.5m/s or more at initial diagnosis.

<170>
Accession Number
612285065
Author
Stratz C.; Boemicke T.; Amann M.; Valina C.; Trenk D.; Neumann F.J.;
Hochholzer W.
Institution
(Stratz, Boemicke, Amann, Valina, Valina, Trenk, Neumann, Hochholzer)
University Heart Center Freiburg-Bad Krozingen, Cardiology and Angiology
II, Bad Krozingen, Germany
Title
Evaluation of immature platelet parameters as compared to established
predictors of platelet reactivity after thienopyridine loading.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1018), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Previous data suggest that reticulated platelets impact
significantly on antiplatelet response to thienopyridines. So far it is
unknown whether parameters describing reticulated platelets can predict
antiplatelet response to thienopyridines. Objective: This studies examines
to which extend parameters describing reticulated platelets can predict
antiplatelet response to thienopyridine loading when compared to
established predictors. Methods: This study randomized elective patients
undergoing coronary stenting to loading with clopidogrel 600mg, prasugrel
30mg, or prasugrel 60mg (n=300). ADP-induced platelet reactivity was
assessed by impedance aggregometry before loading (=intrinsic platelet
reactivity) and on day 1 after loading. Multiple parameters of reticulated
platelets were assessed by automated whole blood flow cytometry: immature
platelet fraction, highly-fluorescent immature platelet fraction, and
absolute immature platelet count. Results: Each parameter of reticulated
platelets correlated significantly with ADP-induced platelet reactivity
(p<0.01 for all three parameters). In a multivariable model including all
three parameters, only immature platelet count remained as significant
predictor of platelet reactivity (p<0.001). In models adjusting each of
the three parameters for known predictors of on-treatment platelet
reactivity including cytochrome P450 2C19 polymorphisms, age, body mass
index, diabetes, and intrinsic platelet reactivity, only immature platelet
count prevailed as independent predictor (p=0.001; Figure). In this model,
immature platelet count was the strongest predictor of on-treatment
platelet reactivity followed by intrinsic platelet reactivity. Conclusion:
Immature platelet count is the strongest independent platelet count
derived predictor of antiplatelet response to thienopyridine treatment.
Given its easy availability together with its even stronger association
with on-treatment platelet reactivity when compared to known predictors
including the CYP2C19*2 polymorphism, immature platelet count might become
the preferable predictor of antiplatelet response to thienopyridine
Treatment. (Figure Presented).

<171>
Accession Number
612284990
Author
Duplyakov D.; Vozhdaeva Z.; Sysuenkova E.; Suslina E.; Phillipova I.;
Khokhlunov S.
Institution
(Duplyakov, Suslina, Phillipova, Khokhlunov) Samara Regional Cardiology
Dispensary, Samara, Russian Federation
(Vozhdaeva, Sysuenkova) VAZ Medical Center, Togliatti, Russian Federation
Title
LV dyssynchrony and factors related to its severity.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 854-855), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
The role of mechanical dyssynchrony (MD) in the selection of patients
suitable for CRT is not well-estableshed and still a matter of debates in
current guidelines. Aim: To compare the value of 2D- and 3D-echo in the
diagnosis of intraventricular dyssynchrony (IVD) and to identify factors
related to its severity. Methods: 164 patients (110 men, 54.8+/-10.1 yrs)
with left bundle branch block (LBBB) on the ECG were enrolled into the
study. 52 of them (31,7%) had dilated, and 19 (11,6%) ischemic
cardiomyopathy; 43 patients (26,2%) had a history of previous myocardial
infarction and/or myocardial revascularization; 43 (26,2%) had
hypertension as a primary diagnosis, and the remaining 7 (4.2%) had no
clinical manifestations of any CVD (idiopathic LBBB). 53 patients had
EF<=30%; 70 patients had EF 31-49%; 41 patient had EF >=50%. IVD was
examined by 2D-, and 3D-echo. The presence of IVD on 2D-echo was
demonstrated by the the septal to posterior wall motion delay (SPWMD),
obtained from M-mode in the parasternal long axis (SPWMD >130 ms).
3D-echo: time to minimum systolic volume (Tmsv) and its dispersion (Diff.)
for each segment of LV were analyzed. Parameters of IVD were calculated
for 5 positions. Tmsv>12% was considered as a criterion of IVD. Results:
2D-echo allowed detecting IVD accurately in only 40% of patients with
LBBB, mainly due to the presence of severe wall motion abnormalities (a-,
hypo-, dyskinesia), and inability to obtained an adequate echo image.
3D-echo revealed IVD in 87% of the total cohort of patients with LBBB. The
incidence of IVD in patients with EF <30% was 95.4%, but only 14.8% in
patients with EF>50%. Multiple linear regression analysis was used to
identify factors associated with the severity of IVD. Twenty six
parameters were analyzed altogether. The severity of TMSV Sel-SD (the
maximum value of dyssynchrony between randomly selected segments) was
related to the distance of 6-minute walk test (p=0.006), and the points
score of the the Minnesota questionnaire (p=0.05). LVEF was the only
predictor of TMSV 16-SD severity (all segments except the apex of LV,
p=0.006), TMSV 6-SD (dyssynchrony between the basal segments of LV,
p=0.001), and it showed a tendency for TMSV Sel-SD as well (p=0.055)
Conclusions: 3D-echo reveals IVD in 87% of patients with LBBB, with the
incidence of 95.4% in patients having EF <30%. EF value, and signs of CHF
determined the severity of IVD.

<172>
Accession Number
612284830
Author
Wang T.K.M.; Wang M.T.M.; Pemberton J.
Institution
(Wang, Pemberton) Green Lane Cardiovascular Service, Auckland City
Hospital, Auckland, New Zealand
(Wang) University of Auckland, Department of Medicine, Auckland, New
Zealand
Title
Performance of risk models in surgery for infective endocarditis: A
meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1016), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Surgery is indicated in infective endocarditis patients with
heart failure, uncontrolled infection and prevention of systemic embolism.
Risk scores play an important role in stratification for cardiac surgery,
but have been rarely utilised in the endocarditis setting. Objectives: We
meta-analysed the performance of surgical risk models in endocarditis
surgery. Methods: MEDLINE, Embase, Cochrane and Web of Science databases
from 1 January 1980 to 31 December 2015 were searched. Two authors
independently assessed studies for inclusion, and then extracted data for
pooled analyses. Results: Amongst 480 articles searched, 20 full-text
articles were screened and 8 studies (1,743 cases) included for analyses.
Mean EuroSCORE was 20.2% with overall operative mortality 16.3% (O/E ratio
0.80) and EuroSCORE II 12.3% with overall operative mortality 14.9% (O/E
ratio 1.21); other scores (STS, De Feo, Pulsuse and Costa) were excluded
as their performance were reported in no more than one external validation
study. Areas under curve (95% confidence interval) of operative mortality
were 0.76 (0.72-0.81) for EuroSCORE in seven studies and 0.79 (0.72-0.85)
for EuroSCORE II in three studies. Peto's odds ratios (95% confidence
interval) were 0.76 (0.57-1.01) for EuroSCORE and 1.25 (0.84-1.86) for
EuroSCORE II. Conclusion: The general EuroSCORE and EuroSCORE II had good
discrimination of operative mortality for endocarditis surgery, however
EuroSCORE had a trend to over-estimating operative mortality. There is a
need for further studies of general and endocarditis-specific risk scores
for endocarditis surgery, and as well as development of logistic risk
models.

<173>
Accession Number
612284826
Author
Aldalati O.; Silaschi M.; Byrne J.; Eskandari M.; Ludman P.; Dworakowski
R.; Wendler O.; Alcock E.; Doshi S.; Heneghan M.; Monaghan M.; MacCarthy
P.
Institution
(Aldalati, Silaschi, Byrne, Eskandari, Dworakowski, Wendler, Alcock,
Heneghan, Monaghan, MacCarthy) King's College Hospital, Cardiology,
London, United Kingdom
(Ludman, Doshi) Queen Elizabeth Hospital Birmingham, Birmingham, United
Kingdom
Title
Aortic valve intervention in patients with liver cirrhosis; TAVI is a
viable option.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 355-356), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Introduction: Aortic valve intervention in patients with liver cirrhosis
(LC) is associated with high mortality. However, data on outcomes in the
era of transcatheter aortic valve implantation (TAVI) is limited. Purpose:
We sought to assess outcomes of TAVI and aortic valve replacement (AVR) in
patients with established LC. Methods: We retrospectively analysed data on
TAVI patients with established LC from two tertiary cardiac centers and
patients who underwent aortic valve intervention (single center) from 2003
to 2015. Patients with endocarditis were excluded. Endpoints were
adjudicated according to the valve academic research consortium (VARC-2)
criteria. Results: 31 patients were identified treated either with TAVI
(n=13) or AVR (n=18, simultaneous orthotopic liver transplant in 3) 74%
male, mean age (TAVI 70+/-8.1years, AVR 63.1+/-9.4years, p=0.037), mean
logistic EuroSCORE (TAVI 10.3+/-8%, AVR 5.6+/-4.5%, p=0.038) and mean
Charlson Co-morbidity Index (TAVI 7+/-1.3, AVR 5+/-1.9, p=0.001). The mean
MELD score (TAVI 11.2+/-2.7, AVR 10+/-3.3, p=0.26) and Child Pugh A (8
TAVI, 10 AVR), B (5 TAVI, 7 AVR) and C (1 AVR). Device success was
achieved in 100% of TAVI patients and 94.4% (17/18) of AVR patients
(p=0.5). Thirty day mortality was 0% with TAVI and 5.6% (1/18) with AVR
(p=0.5) and 1 year mortality was 30% (4/13) with TAVI and 11% (2/18) with
AVR (p=0.2). Early safety was observed in 92.3% (12/13) after TAVI and
72.2% (13/18) after AVR (p=0.1). At 180 days, clinical efficacy was
observed in 85% (11/13) after TAVI and 72.2% (13/18) after AVR (p=0.4)
whilst time related valve safety was observed in 85% (11/13) after TAVI
and 83.3% (15/18) after AVR (p=0.5). The mean number of red blood cell
(RBC) units (TAVI 0.38+/-0.7 vs AVR 1.56+/-2.8, p=0.1), and platelet units
(TAVI 0.46+/-0.8, AVR 0.78+/-1.2, p=0.4) transfused peri-procedurally did
not reach statistical significance between the two groups. Patients with
LC undergoing TAVI required more platelets transfusion periprocedurally
comparing to randomly selected 300 TAVI cases performed in our center
without LC (TAVI with LC 0.46+/-0.8, TAVI without LC 0.01+/-0.07, p<0.001,
Mann-Whitney U test) but RBC transfusion requirement was similar (TAVI
with LC 0.38+/-0.7, TAVI without LC 0.26+/-0.4, p=0.9, Mann-Whitney U
test). Conclusion: Concurrent aortic valve intervention in patients with
LC (Child-Pugh A and B class) yields good outcomes. TAVI compares
favorably with AVR despite constituting a higher risk population. Such
patients demand multidisciplinary management across both the Heart and
Liver Teams.

<174>
Accession Number
612284821
Author
Taniguchi T.; Morimoto T.; Shiomi H.; Ando K.; Kanamori N.; Murata K.;
Naritatsu S.; Sakata R.; Kimura T.
Institution
(Taniguchi, Shiomi, Naritatsu, Kimura) Kyoto University, Department of
Cardiovascular Medicine, Kyoto, Japan
(Morimoto) Hyogo College of Medicine, Department of Clinical Epidemiology,
Hyogo, Japan
(Ando) Kokura Memorial Hospital, Department of Cardiology, Kokura, Japan
(Kanamori) Shimada Municipal Hospital, Shimada, Japan
(Murata) Shizuoka City Hospital, Shizuoka, Japan
(Sakata) Kyoto University, Graduate School of Medicine, Department of
Cardiovascular Surgery, Kyoto, Japan
Title
The long-term clinical outcome of patients with low gradient severe aortic
stenosis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 745), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Although current guidelines recommend the watchful waiting for
aortic valve replacement (AVR) until symptom emerge in patients with low
gradient (LG: peak aortic jet velocity [Vmax] <4 m/s and mean aortic
pressure gradient [PG] <40mmHg and aortic valve area [AVA]
<1cm²) severe aortic stenosis (AS) except for patients who are
undergoing other cardiac surgery, the management of patients with LG
severe AS remains controversial. Purpose: The aim of study was to evaluate
the impact of initial AVR strategy on long-term clinical outcome of
patients with LG severe AS. Methods: The CURRENT AS registry is a
multicenter retrospective registry enrolling 3,815 consecutive patients
with severe AS (Vmax >4.0 m/s, or mean aortic PG >40 mm Hg, or AVA <1.0
cm²) between January 2003 and December 2011. Primary outcome
measures in the present study were all-cause death and heart failure (HF)
hospitalization. Median follow-up period was 1334 days. Results: Among the
entire cohort, LG severe AS was seen in 1718 patients (45%). Patients with
LG severe AS were older (79.0+/-9.3 versus 76.8+/-10.0 years old) and more
often had left ventricular dysfunction (ejection fraction <50%) and
comorbidities such as prior stroke or coronary artery disease than those
with HG severe AS. Surgical AVR was more frequently performed in patients
with HG than in those with LG during the follow-up (60.0% versus 28.2%,
P<0.001). The cumulative 5-year incidences of all-cause death and HF
hospitalization were higher in patients with LG severe AS than in those
with HG (47.0% versus 39.8%, P<0.001; 35.2% versus 25.3%, P<0.001).
Initial AVR strategy was chosen in 220 of patients with LG, and in 977 of
patients with HG severe AS. The cumulative 5-year incidence of all-cause
death was lower in the initial AVR than in the conservative strategy both
in patients with LG severe AS (28.9% versus 49.5%, P<0.001) and in those
with HG (21.7% versus 54.9%, P<0.001). After adjusting for confounders,
initial AVR strategy was independently associated with lower risk for
all-cause death in patients with LG (adjusted hazard ratio: 0.59, 95%
confidence interval 0.44-0.78, P<0.001), and in those with HG (adjusted
hazard ratio: 0.44, 95% confidence interval 0.36-0.52, P<0.001). The lower
risk of initial AVR strategy for all-cause death in patients with LG and
HG was consistently seen across subgroups stratified with left ventricular
function (EF <50%) and symptomatic status. Conclusions: Despite less
severe gradient, the long-term clinical outcome of patients with low
gradient severe AS was dismal, which might be improved by initial AVR
strategy.

<175>
Accession Number
612284815
Author
Wang T.K.M.; Wang M.T.M.; Pemberton J.
Institution
(Wang, Pemberton) Green Lane Cardiovascular Service, Auckland City
Hospital, Auckland, New Zealand
(Wang) University of Auckland, Department of Medicine, Auckland, New
Zealand
Title
Infective endocarditis with cerebral embolism: Early or late surgery
meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1201), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Surgery is recommended for infective endocarditis patients who
develop ischaemic stroke, however the optimal timing of surgery remains
controversial. Objectives: In this meta-analysis, we compared the outcomes
of early and delayed cardiac surgery for infective endocarditis in this
setting. Methods: PubMed, MEDLINE, Embase, Cochrane and Scopus databases
from 1 January 1980 to 30 June 2015 were searched for original studies.
Two authors evaluated these studies for inclusion independently, then
extracted and pooled data for analyses. Results: Amongst 2,423 papers
obtained from the search, 23 full-texts were reviewed, and 6 studies
involving 701 patients were included for analyses. Early surgery was
defined as less than 7 days from diagnosis in 2 studies and less than 14
days in 4 studies. Rates and pooled odds ratio (95% confidence interval)
for operative mortality of early or late surgery set at 7 days were 13.5%
vs 10.8%, 1.40 (0.61-3.02); 14 days were 20.7% vs 13.0%, 1.95 (0.95-4.01);
and all "early or late surgery" 14.5% vs 10.2%, 1.58 (1.01-2.47). Pooled
odds ratio of early versus late surgery for long-term mortality was 2.95
(0.35-25.0), and for neurological events during follow-up, pooled odds
ratio for embolic events was 1.22 (0.33-4.56) and for intracranial
bleeding 1.55 (0.16-15.32). Conclusion: Early surgery within 1-2 weeks of
diagnosis of infective endocarditis with cerebral embolism can be safely
performed, and is not associated with statistically higher long-term
mortality or neurological events. Data is however limited and larger and
randomised studies would help to determine the optimal timing.

<176>
Accession Number
612284811
Author
Amat Santos I.J.; Castrodeza J.; Serra V.; Nombela-Franco L.; Brinster
D.R.; Gutierrez-Ibanes E.; Tornos P.; Carnero M.; Ruiz C.E.; Di Stefano
S.; Tobar J.; Cortes C.; Morquecho I.; San Roman J.A.
Institution
(Amat Santos, Castrodeza, Di Stefano, Tobar, Cortes, Morquecho, San Roman)
University Hospital of Vallodolid, ICICOR, Valladolid, Spain
(Serra, Tornos) University Hospital Vall D'Hebron, Cardiology, Barcelona,
Spain
(Nombela-Franco, Carnero) Hospital Clinic San Carlos, Cardiology, Madrid,
Spain
(Brinster, Ruiz) Lenox Hill Heart and Vascular Institute, Cardiac Surgery,
New York, United States
(Gutierrez-Ibanes) University Hospital Gregorio Maranon, Cardiology,
Madrid, Spain
Title
Bailout transcatheter aortic valve implantation after aborted sternotomy
at the time of surgical aortic valve replacement: A multicenter study.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 561), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Introduction: As transcatheter aortic valve implantation (TAVI) is
increasingly permormed in patients with aortic stenosis (AS), also
surgical aortic valve replacement (SAVR) is being performed in older and
sicker patients. One potential consequence is the need to abort the
intervention once sternotomy has been performed. We aimed to analyse the
causes, incidence, management, and outcomes of aborted sternotomy (AbS) in
aortic stenosis patients. Methods: Cases of AS accepted for SAVR who
underwent sternotomy but whose aorta could not be clamped due to different
reasons were gathered from 5 centers between 2009 and 2014. Results: A
total of 31 pacientes (71% males, 74+/-8 years, LogEuroSCORE: 11.9+/-7.4%)
underwent AbS. Peak and mean gradients were 73.9+/-26.8 and 43.7+/-16.1
mmHg, respectively, and left ventricular function 55+/-10%. Main reasons
for the aborted procedure included previously unknown porcelain aorta in
83.9%, mediastinal fibrosis due to radiotherapy in 12.9%, and chronic
mediastinitis in 3.2%. Five patients (16.1%) presented in-hospital death
and 13 (41.9%) had in-hospital complications after AbS including atrial
fibrillation (12.9%), heart failure (9.7%), major bleeding (9.7%), and
acute kidney injury (6.4%). In 29 patients (93.5%) TAVI was performed (one
of them eventually required SAVR due to severe paravalvular leak) and in
only one new surgical approach was decided, requiring valved conduit
implantation and complicating with in-hospital death. Also, 3 of them
(10.3%) underwent off-pump coronary bypass and 12 (41.4%) percutaneous
revascularization. Median time between AbS and next intervention was 2.3
(IQR: 0.7-5.8) months with no mortality within this period. TAVI procedure
was considered successfull (VARC-2) in 76% of the patients with no
differences according to valve type (50% after self-expandable and 81%
after balloon-expandable valve, p=0.116), or the approach (trasfemoral: 21
pts, 76.2% of success vs. transapical: 8 pts, 62.5% of success, p=0.382).
The combination of transfemoral approach and balloon-expandable valve
presented rate of success of 100%. Older patients (76+/-8 vs. 70+/-8 anos,
p=0.045) and those with previous cardiac surgery (60 s. 15.4%, p=0.029)
presented a higher six-month follow up mortality (22.6%). Also, shorter
time from AbS to next intervention was related to higher mortality
(5.1+/-5 vs. 1+/-0.7 months, p=0.001). Conclusions: The main reason of AbS
was porcelain aorta. This entity was associated to high rate of
complications and mortality, specially in those aged >=76 years old or
with previous cardiac surgery suggesting that a preventive strategy based
on pre-intervention imaging evaluation could be useful in this subgroups.
Most patients were successfully treated with TAVI, specially with
balloonexpandable transfemoral devices.

<177>
Accession Number
612284806
Author
Iliuta L.
Institution
(Iliuta) Institute of Cardiovascular Diseases "Prof. Dr. CC Iliescu",
Bucharest, Romania
Title
Tissue Doppler Imaging predicts unsuccessfull cardiac rehabilitation after
coronary artery bypass grafting and surgical ventricular reconstruction.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1123), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Aims: 1. To evaluate the ability of TDI measurements to predict
unsuccessfull postoperative cardiac rehabilitation (CR) in patients
undergoing coronary artery bypass grafting (CABG) and surgical ventricular
reconstruction (SVR). 2. To determine the relation between left
ventricular (LV) function assessed by TDI and exercise capacity and
whether the diastolic and/or systolic dysfunction participate in
unsuccessfull CR. 3. To define the independent predictors for
unsuccessfull CR and for medium term prognosis/evolution in these pts.
Material and method: Prospective randomized study on 157 patients with LV
systolic dysfunction (LVEF <30%) who underwent CABG and SVR included in
postoperative CR program (12 weeks of supervised exercise training 3
times/ week). A complete echocardiography (including TDI) was performed
before the CR and weekly till 3 months postoperatively. The primary
endpoints were the composites of changes in peak oxygen uptake and in
physical capacity. Stastistical analysis used SYSTAT and SPSS for
regression analysis and for the relative risks and correlation coefficient
calculations. Results: 1. The percent of the pts with a favourable effect
of CR was higher in those with normal LV diastolic filling pattern (LVDFP)
(94,90%) compared with pts with restrictive LV filling (75.16%, p<0.0001).
The presence of a restrictive LVDFP increased the risk for unsuccessfull
CR by 8.4 fold. 2. Before and during the CR, the E/E' ratio was higher in
the failed group than in the successfull group. The cut-off value to
predict CR failure (obtained from ROC), gave an E/E' ratio before CR of
14.5 with a sensitivity of 79% and a specificity of 96.2% (p<0.01). The
LVEF did not differ significantly between the two groups, whereas left and
right ventricular TDI velocities were highier in successfull group. E' was
lower in the failed group and increased during CR in the successfull group
while no change occurred in the failed group. 3. Regression analysis has
identified as independent predictors for unsuccessfull CR: E/E' >14.5,
late systolic myocardial motion (Sm) <5.5 cm/sec, restrictive LVDFP,
age>75 years, LVEF <20% and LV endsystolic diameter (LVESD) >56 mm.
Conclusions: 1. The presence of a restrictive LVDFP in CABG pts is an
independent predictor for unsuccessfull CR, the LV diastolic function
being a more reliable parameter for prognosis appreciation than LV
systolic function. 2. Sm and E/E' ratio were the only TDI variables
independently predicting exercise capacity and related to success of CR
program (p<0.05). 3. The independent predictors for unsuccessfull CR were:
E/E'>14.5, Sm <5.5 cm/sec, restrictive LVDFP, age >75 years, LVEF <20% and
LVESD >56 mm.

<178>
Accession Number
612284677
Author
Marwan M.; Achenbach S.; Goeller M.; Loders S.; Schuhbaeck A.; Hell M.;
Arnold M.
Institution
(Marwan, Achenbach, Goeller, Loders, Schuhbaeck, Hell, Arnold) University
of Erlangen-Nuremberg (Friedrich-Alexander-University), Erlangen, Germany
Title
Leaflet thrombosis following transcatheter aortic valve implantation:
Insights from a single center experience.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1048), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Recently, reports from multi-center data have been published
showing subclinical leaflet thrombosis following bioprosthestic aortic
valve replacement. We report the incidence and clinical presentation of
leaflet thrombosis in patients referred for follow-up contrast enhanced CT
angiography following TAVI. Methods: 59 consecutive patients referred for
follow-up CT angiography following TAVI were screened for inclusion in
this analysis. In all patients, retrospectively ECG-gated spiral
acquisition with tube modulation were performed to allow for assessment of
leaflet motion. All prostheses were analyzed for presence of leaflet
thrombosis defined as hypo-attenuated leaflet thickening with or without
leaflet restriction. Post procedural antithrombotic regimen as well as
symptom status was documented in all patients. Results: 37 consecutive
patients (21 males, 84+/-4 years) were analyzed. TAVI has been performed
in all patients with either balloon-expandable prostheses or
self-expandable prostheses. The interval between the index procedure and
CT angiography was 2-8 months in 89% of the patients (in 4 patients after
10 days, 4 years, 12 and 20 months). Leaflet thrombosis was detected in 10
patients (27%, 7 Sapien 3, 2 Sapien XT, 1 SJM Portico, CT performed after
3-5 months in 8 patients and after 8 and 20 months in 2 patients). Out of
10 patients with CT-documented leaflet thrombosis, 9 patients had received
post-procedural dual antiplatelet therapy for 3-6 months no patient was on
effective oral anticoagulation at the time of CT examination. On the other
hand, 11 out of 21 patients (52%) with no leaflet thrombosis were on
continuous oral anticoagulation following TAVI. In patients with leaflet
thrombosis, 3 leaflets were affected in 5 patients, 2 leaflets in 4
patients and in 1 patient only 1 leaflet was affected. Clinical symptoms
(angina, dyspnea or both) were reported in 3/10 patients with leaflet
thrombosis (40%) and in all 10 patients a significant increase of the mean
echocardiographic gradient over the prosthesis was documented (mean: 7+/-2
mmHg directly after the index procedure versus 19+/-12 mmHg at the time of
CT angiography, p=0.016). The percentage increase in mean gradient was
significantly higher in symptomatic versus asymptomatic patients (83%+/-4
versus 34%+/-23, respectively, p=0.01) with improvement of symptoms
following oral anticoagulation. Follow-up CT was available for 4 patients
with complete resolution of the hypo-attenuated leaflet thickening
following treatment. Conclusion: Leaflet thrombosis following TAVI is a
relatively frequent finding in patients referred for contrast enhanced CT
angiography following TAVI and follows a subclinical course in the
majority of patients. It is substantially more frequent in individuals who
are not on oral anticoagulation. However, in patients with relevant
increase in prosthetic gradients, symptomatic presentations are possible
with improvement on oral anticoagulation.

<179>
Accession Number
612284593
Author
Amat Santos I.J.; Castrodeza J.; Nombela-Franco L.; Munoz-Garcia A.J.;
Gutierrez-Ibanes E.; De La Torre J.M.; Cordoba-Soriano J.G.;
Hernandez-Garcia J.M.; Gonzalez-Mansilla A.; Cortes C.; Morquecho I.;
Islas F.; Revilla A.; Puerto A.; San Roman J.A.
Institution
(Amat Santos, Castrodeza, Cortes, Morquecho, Revilla, Puerto, San Roman)
University Hospital of Vallodolid, ICICOR, Valladolid, Spain
(Nombela-Franco, Islas) Hospital Clinic San Carlos, Cardiology, Madrid,
Spain
(Munoz-Garcia, Hernandez-Garcia) University Hospital Virgen De La
Victoria, Cardiology, Malaga, Spain
(Gutierrez-Ibanes, Gonzalez-Mansilla) University Hospital Gregorio
Maranon, Cardiology, Madrid, Spain
(De La Torre) University Hospital Marques De Valdecilla, Cardiology,
Santander, Spain
(Cordoba-Soriano) Albacete University Hospital, Cardiology, Albacete,
Spain
Title
Potential candidates to percutaneous therapies on the mitral valve after
transcatheter aortic valve implantation: A computed tomography-based
multicentre study.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 249), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Introduction: The most frequent valvular diseases, often concomitant, are
aortic stenosis (AS) and mitral regurgitation (MR). The MR degree may
persist after transcatheter aortic implantation (TAVR). Purpose: We aimed
to evaluate how many patients could benefit from subsequent percutaneous
intervention on the mitral valve after TAVI. Methods: Off-line central
analysis of echocardiographic and multidetector computed tomography (MDCT)
images in TAVI patients was performed for patients with persistent MR>=III
one month after TAVI. The presence of criteria for edgeto- edge mitral
repair or balloon-expandable valve implantation within a severely
calcified mitral annulus were investigated. Results: A total of 1110
patients were included and 15.9% (177 patients) presented MR>=III at
baseline. In 74 patients (41.8%) it persisted 1-month after TAVI. In 33
patients (3.5%) with MR<=II at baseline it progressed to III or IV MR
after TAVI leading to a total of 107 patients with MR>=III 1-month after
TAVI. Up to 14 patients (1.3% of all TAVI patients, 13.1% of patients with
persistent MR) might have undergone some of the percutaneous mitral
therapies currently available. Specifically, 4 patients (3.8%) with
organic MR could potentially benefit from balloonexpandable valve
implantation within a mitral annulus with circumferential calcification
and area as measured by MDCT below pre-specified limits (720
mm²) while 10 patients (9.3%) presented criteria for Mitraclip
implantation. Within this last group, 8 patients presented functional MR
(80%) and 2 presented isolated prolapsed leaflet segment (20% of organic
MR). Remarkably, none of these patients were in NYHA class I at 1-month
follow up and 12 of them (85.7%) had died 6 months after TAVI. (Figure
presented) Conclusions: More than half of the patients with MR>=III at
baseline improved the MR degree after TAVI. From those who did not, at
least 13% could benefit from percutaneous mitral valve therapies. When
untreated they presented a dreadful prognosis.

<180>
Accession Number
612284554
Author
Dedic A.; Lubbers M.M.; Schaap J.; Lamfers E.J.; Rensing B.J.; Braam R.L.;
Lammers J.; Moelker A.; Nathoe H.M.; Van Dalen B.M.; Post J.C.; Schultz
C.J.; Boersma E.; De Feyter P.J.; Nieman K.
Institution
(Dedic, Lubbers, Van Dalen, Boersma, De Feyter, Nieman) Erasmus Medical
Center, Department of Cardiology, Rotterdam, Netherlands
(Schaap) Amphia Hospital, Breda, Netherlands
(Lamfers) Canisius Wilhelmina Ziekenhuis, Nijmegen, Netherlands
(Rensing) St Antonius Hospital, Nieuwegein, Netherlands
(Braam) Gelre Hospital of Apeldoorn, Apeldoorn, Netherlands
(Lammers, Post) Catharina Hospital, Eindhoven, Netherlands
(Moelker) Erasmus Medical Center, Department of Radiology, Rotterdam,
Netherlands
(Nathoe) University Medical Center Utrecht, Utrecht, Netherlands
(Schultz) Royal Perth Hospital, Perth, Australia
Title
Coronary CT angiography for suspected acute coronary syndrome in the era
of hs-troponins: Sex-associated differences.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 981), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: It is assumed that women suffer from a different
pathophysiological pattern of atherosclerosis with a different clinical
presentation compared to men, which might require a different diagnostic
work-up. Purpose: In this pre-specified sub-analaysis of the Better
Evaluation of Acute Chest Pain with Coronary Computed Tomography
Angiography (BEACON) trial, we assess whether sex affects clinical
effectiveness of early CCTA in the work-up of suspected acute coronary
syndrome (ACS) patients in the era of hs-troponins. Methods: In the
BEACON-trial, we randomized 500 patients (47% women) at the emergency
departments of 7 hospitals to either a diagnostic strategy supplemented by
early CCTA or standard optimal care. Results: Median age of women was
higher, 56+/-10 years versus 53+/-10 years (p<0.01). Atypical chest pain
was most frequent in both groups (52% of women and 51% of men), followed
by typical (33% versus 32%, p=0.62 for trend). Obstructive CAD as detected
by CCTA was less frequent in women (14% versus 33 29%, p<0.01), while no
difference was observed in exercise test results (p=0.42 for trend). Women
were admitted less often (33% versus 43%, p=0.02) and at discharge, ACS
was diagnosed less often in women (5% versus 10%, p=0.03). Coronary
angiography followed by revascularisation was less frequent in women than
in men, although not reaching statistical significance (6% versus 9%,
p=0.25). No difference was found between coronary revascularisations,
hospital admissions, length of stay or direct medical costs between sexes
and diagnostic strategies. Conclusions: In this trial, women had less
severe CAD as detected by CCTA and were less often diagnosed with ACS
requiring less admissions. However, type of chest pain at presentation was
not different between sexes. These results do not show a difference in
clinical effectiveness of early CCTA for suspected ACS between women and
men in the era of hs-troponins.

<181>
Accession Number
612284550
Author
Feuchtner G.M.; Plank F.; Schachner T.; Bonaros N.; Mueller S.; Burghard
P.; Plass A.; El Alhassan D.; Leipsic J.; De Cecco C.N.
Institution
(Feuchtner, Plank, Schachner, Bonaros, Mueller, Burghard) Innsbruck
Medical University, Innsbruck, Austria
(Plass) University Hospital Zurich, Clinic of Cardiothoracic Surgery,
Zurich, Switzerland
(El Alhassan, Leipsic) University of British Columbia, Radiology,
Vancouver, Canada
(De Cecco) Medical University of South Carolina, Department of Radiology
and Radiological Science, Charleston, United States
Title
Cardiac computed tomography for evaluation of prosthetic valve
dysfunction. The ProHEARTVD registry.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 999), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Imaging of prosthetic valve dysfunction (PVD) is challenging.
The purpose of our multicenter study was to evaluate the accuracy of
cardiac computed tomography angiography (CCTA) for diagnosis of PVD in
comparison with surgical findings and transesophageal echocardiography
(TEE). Methods: 84 patients (66.6y, 30.9% females) (n=90 devices: 38
mechanical, 45 bioprosthesis, 7 mitral annuloplasty-rings) were included
into our multicenter registry (4 centers; The ProHEARTVD-registry) and
examined with retrospective- ECG-gated CCTA. Receiver operating curve
(ROC) analysis was performed to detect differences in the diagnostic
performance of CCTA vs surgery and TEE vs surgery, respectively. Results:
The accuracy of CCTA for diagnosis of PVD as compared to surgery was
c=0.978 (95% CI: 0.89-99) (p<0.0001) per-patient and per-lesion,
sensitivity and specificity were 94.0% and 98.5%, resp. (c=0.925; 95% CI:
0.86-0.96; p<0.0001). Agreement for n=92 lesions between CCTA and surgery
was k=0.93 (95% CI: 0.83-1.03; p<0.0001). CCTA detected 12/13 (92.3%)
paravalvular leaks and 10 abscesses (4 false positives; 2/4 excluded by
18FDG/PET). For pseudoaneurysm (n=10), accuracy for CT was c=1.0 (95% CI:
0.93-1) while for TEE vs surgery, c-value was 0.80 (95% CI: 0.66-0.90)
(p=0.014). 22/25 (88%) masses (13 thrombi/pannus; 8 vegetations; 1 other)
were correctly identified by CCTA (c=0.935; 95% CI: 0.81-0.98) while for
TEE, accuracy vs surgery was c=0.761 (95% CI: 0.6-0.88) (p=0.001). 16/17
(94.1%) structural bioprosthetic valve degeneration (SVD) and 12 (100%)
dehiscences (c=1.0; 95% CI: 0.91-1) were diagnosed by CCTA while for TEE,
accuracy vs surgery was c=0.66 (95% CI: 0.5-0.8) (p=0.002). For CCTA vs
TEE (per-lesion), sens. was 95.6%, spec. 96.3% and PPV 85.7%, resp.
(k=0.88; 95% CI: 0.79-0.97 for morphological findings). Conclusions: CCTA
is an accurate imaging modality for PVD detection, in particular for
paravalvular pathologies and thombus/pannus detection. (Figure Presented).

<182>
Accession Number
612284533
Author
Abe M.; Akao M.; Morimoto T.; Kimura T.
Institution
(Abe, Akao) Kyoto Medical Center, National Hospital Organization, Kyoto,
Japan
(Morimoto) Hyogo College of Medicine, Department of Clinical Epidemiology,
Hyogo, Japan
(Kimura) Graduate School of Medicine, Kyoto University, Department of
Cardiovascular Medicine, Kyoto, Japan
Title
Impact of transient or persistent contrast-induced nephropathy on
long-term mortality after percutaneous coronary intervention.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1063), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: It is well known that contrast-induced nephropathy (CIN) after
percutaneous coronary intervention (PCI) is associated with increased
long-term mortality, although CIN ranges from a transient elevation of the
serum creatinine (SCr) concentration to permanent renal failure
necessitating dialysis. Although an association between CIN and death was
previously suggested, it has not been fully evaluated whether the impact
of transient or persistent CIN on long-term mortality is different or not.
Purpose: The aim of this study was to clarify the incidence of transient
or persistent CIN after PCI and the effect of that on all-cause death.
Methods: We used CREDO-Kyoto cohort-2 multicenter registry enrolling
consecutive patients undergoing first PCI or coronary artery bypass
grafting among 26 centers. CIN was defined as an elevation in the peak SCr
of >=0.5 mg/dl within 5 days after PCI from the baseline SCr, and
follow-up SCr data were collected from 180 to 550 days after PCI. Among
CIN patients, we defined transient CIN as an elevation in the SCr <0.5
mg/dl at the time of follow-up, and persistent CIN as follow-up SCr
elevation >=0.5 mg/dl from the baseline SCr. Results: Of 13058 patients
enrolled in the PCI arm of the registry, we excluded patients who were
emergent situation (n=5137), on dialysis before PCI (n=385), without
baseline laboratory data (n=2020), died within 12 months after PCI
(n=250), and who did not have follow-up SCr data (n=1280). Among 3986
patients eligible for the 12-month landmark analysis, 90 patients (2.3%)
suffered from transient CIN, 50 patients (1.3%) had persistent CIN, and
3846 patients (96.5%) were free from CIN. These three groups have
significantly different baseline clinical and procedural characteristics,
and 524 patients (13.1%) died during a median follow-up of 1886 days
(interquartile range, 1624 to 2171 days). The SCr values before PCI, after
PCI, and at follow-up in each group were 1.36+/-0.87, 2.21+/-1.22, and
1.45+/-0.71 mg/dL with transient CIN, 2.15+/-1.44, 3.23+/-1.87, and
3.53+/-2.17 mg/dL with persistent CIN, and 0.93+/-0.45, 0.97+/-0.42, and
1.00+/-0.62 mg/dL in patients without CIN, respectively. Compared with
patients not suffered from CIN, both transient CIN (HR, 2.08; 95% CI,
1.32-3.10) and persistent CIN (HR, 4.10; 95% CI, 2.54-6.24) were
significantly associated with death by univariate analysis. After
adjustment for the pre-specified 38 confounders including age >=75 years,
diabetes with insulin, heart failure, multivessel disease, estimated
glomerular filtration rate <30, and anemia, patients with persistent CIN
were significantly correlated with long-term mortality (HR, 1.83; 95% CI,
1.08- 2.94; p=0.03) but patients with transient CIN were not associated
with that (HR, 1.11; 95% CI, 0.68-1.71; p=0.7). Conclusion: The incidence
of transient or persistent CIN was 2.3% or 1.3%, respectively. Persistent
CIN after PCI was shown to be an independent risk factor for long-term
mortality, but transient CIN was not.

<183>
Accession Number
612284505
Author
Hansen T.B.; Zwisler A.D.; Berg S.K.; Sibilitz K.L.; Thygesen L.C.;
Kjellberg J.; Doherty P.; Oldridge N.; Soegaard R.
Institution
(Hansen) Roskilde Hospital, Department of Cardiology, Roskilde, Denmark
(Zwisler) University of Southern Denmark, Danish Centre for Rehabilitation
and Palliative care, Odense, Denmark
(Berg, Sibilitz) Rigshospitalet, Copenhagen University Hospital, Heart
Centre, Copenhagen, Denmark
(Thygesen) National Institute of Public Health, University of Southern
Denmark, Copenhagen, Denmark
(Kjellberg) National Institute for Regional and Local Government Research,
Copenhagen, Denmark
(Doherty) University of York, Department of Health Sciences, York, United
Kingdom
(Oldridge) University of Wisconsin-Milwaukee, College of Health Sciences,
Milwaukee, United States
(Soegaard) Aarhus University, Department of Public Health, Aarhus, Denmark
Title
Cost-utility analysis of cardiac rehabilitation after heart valve surgery
versus usual care (the CopenHeartVR trial).
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1121), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: While cardiac rehabilitation after myocardial infarction and
in patients with heart failure is considered cost-effective, evidence may
not be transferable to heart valve surgery patients. No studies have
investigated the costeffectiveness of cardiac rehabilitation to patients
following heart valve surgery. Purpose: The aim of this study was to
investigate the cost-effectiveness of cardiac rehabilitation following
heart valve surgery. Methods: We conducted a cost-utility analysis, which
takes into account both costs and health-related quality of life, based on
a randomised controlled trial of 147 patients who had undergone heart
valve surgery and were followed for 6 months. Patients were randomised to
cardiac rehabilitation consisting of 12 weeks of physical exercise
training and monthly psycho-educational consultations or to usual care.
Costs were measured from a societal perspective and quality-adjusted life
years were based on the EQ-5D. Estimates were presented as means and 95%
confidence intervals based on bootstrapping. Costs and effect differences
were presented in a scatter plot and were transformed into net benefit and
presented in cost-effectiveness acceptability curves. Results: No
statistically significant differences were found in total societal costs
-1,609 (95% CI -6162; 2942) or in quality-adjusted life years -0.000 (95%
CI - 0.021; 0.020) between groups. However, approximately 70% of the cost-
and effect differences were located south of the x-axis in the scatter
plot and the cost-effectiveness acceptability curves showed that the
probability for cost- effectiveness of cardiac rehabilitation compared to
usual care is at minimum 75% driven by a tendency of costs savings.
Conclusions: Cardiac rehabilitation after heart valve surgery does not
seem to improve health-related quality of life but is most likely cost
saving to society outweighing the extra costs of cardiac rehabilitation.

<184>
Accession Number
612284480
Author
Zhao D.F.; Edelman J.J.B.; Phan K.; Seco M.; Bannon P.G.; Wilson M.K.;
Byrom M.J.; Taggart D.P.; Puskas J.D.; Vallely M.P.
Institution
(Zhao, Phan) University of Sydney, Sydney Medical School, Sydney,
Australia
(Edelman, Seco, Bannon, Wilson, Byrom, Vallely) Royal Prince Alfred
Hospital, Cardiothoracic Surgery Unit, Sydney, Australia
(Taggart) University of Oxford, Department of Cardiovascular Surgery,
Oxford, United Kingdom
(Puskas) Mount Sinai School of Medicine, Department of Cardiac Surgery,
New York, United States
Title
Perioperative stroke after coronary artery bypass grafting with
manipulation of the aorta: A systematic review and meta-analysis with
37384 cases.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1199), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Increasingly elderly and high-risk patients are requiring
surgical revascularisation for coronary artery disease. Coronary artery
bypass grafting (CABG) remains the standard of treatment for three-vessel
and left main disease but is associated with an increased risk of stroke
compared to percutaneous coronary intervention. Aortic no-touch/anaortic
off-pump CABG (anOPCAB) eliminates manipulation of the aorta and
cardiopulmonary bypass (CPB). Purpose: To determine whether avoiding
aortic manipulation decreases postoperative stroke, mortality, myocardial
infarction, renal failure, atrial fibrillation, bleeding, and length of
stay in intensive care unit, a systematic review and metaanalysis was
performed. Methods: A comprehensive search from six electronic databases
was performed from their inception to September 2015. Results from
patients undergoing anOPCAB, CABG, OPCAB with side-clamp, and OPCAB with a
proximal anastomotic device were included. Analysis was limited to
available 30-day or in-hospital outcomes. Results: There were 12 studies
with 37384 patients. The anaortic group had significantly higher previous
stroke than the aortic group (7.1% vs 5.6%, P=0.02). All other baseline
characteristics were similar. Comparing anOPCAB with CABG, there was a
significant reduction in postoperative stroke (0.4% vs 1.8%, P<0.00001),
mortality (1.0% vs 2.2%, P<0.0001), renal failure (1.3% vs 1.8%,
P<0.0001), atrial fibrillation (14.3% vs 20%, P<0.00001), bleeding (1.6%
vs 2.4%, P=0.03), and length of stay in intensive care unit (56.7+/-82.9
vs 71+/-137.4 hours, P<0.0001). Comparing anOPCAB to OPCAB using an aortic
side-clamp, there was a significant reduction in postoperative stroke
(0.4% vs 1.3%, P<0.0001) and atrial fibrillation (15.5% vs 19.1%, P=0.02).
Postoperative stroke was significantly decreased in OPCAB with a proximal
anastomotic device compared to CABG (1.0% vs 2.2%, P=0.009). Conclusion:
This meta-analysis suggests that compared to CABG, the avoidance of aortic
manipulation in anOPCAB may decrease the risk of postoperative stroke,
especially in patients with higher stroke risk. In addition, the
elimination of CPB may reduce the risk of short-term mortality, renal
failure, atrial fibrillation, bleeding, and length of stay in intensive
care unit. (Table Presented).

<185>
Accession Number
612284457
Author
Panoulas V.; Thyregod H.G.; Nihoyannopoulos P.; Sen S.; Ariff B.; Gopalan
D.; Sutaria N.; Bicknell C.; Malik I.; Francis D.; Mikhail G.W.
Institution
(Panoulas, Nihoyannopoulos, Francis) Imperial College London, National
Heart and Lung Institute, London, United Kingdom
(Thyregod) Heart Centre, RIgshospitalet, Cardiothoracic Surgery,
Copenhagen, Denmark
(Sen, Ariff, Gopalan, Sutaria, Malik, Mikhail) Hammersmith Hospital,
London, United Kingdom
(Bicknell) Imperial College London, Surgery and Cancer, London, United
Kingdom
Title
Increased survival of females with severe aortic stenosis after
transcatheter aortic valve implantation compared to surgical aortic valve
replacement; a meta-analysis of randomised controlled studies.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 72), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Despite signals in several studies suggesting prolonged
survival of females versus males undergoing transcatheter aortic valve
implantation (TAVI) for severe aortic stenosis, to date no study has
examined whether TAVI offers improved survival compared to surgical aortic
valve replacement in females with aortic stenosis. Purpose: The aim of the
current meta-analysis was to evaluate the mid-term (up to 2-year) survival
in females with aortic stenosis undergoing TAVI versus surgical aortic
valve replacement. Methods: Randomised controlled trials reporting
mid-term survival of female patients with severe aortic stenosis treated
with TAVI versus surgical aortic valve replacement were searched through
MEDLINE, EMBASE and COCHRANE databases and proceedings of international
meetings. The results of all studies were combined using a random-effects
model to minimize heterogeneity between groups. A 2-tailed alpha of 5% was
used for hypothesis testing. Results: Four randomised controlled trials
(reported by different authors at different time points) including a total
of N=1844 patients were analysed (PARTNER 1, NOTION, CoreValve US Pivotal
Trial, STACCATO). In these studies a total of 831 females were treated
with either TAVI (N=422) or surgical aortic valve replacement (N=409). An
increased survival was demonstrated in female patients treated with TAVI
versus surgical aortic valve replacement, both at 1-year (hazard ratio
0.60, 95% confidence interval: 0.37 to 0.97) and 2-years (hazard ratio
0.65, 95% confidence interval: 0.47 to 0.91) (Figure 1). A similar trend
was not observed in the male subgroup., neither in 1 (hazard ratio 1.09,
95% confidence interval 0.78 to 1.51)], nor in the 2-year (hazard ratio
1.02, 95% confidence interval 0.74 to 1.41) follow-up. This beneficial
effect could be attributed to the reduced peri-procedural mortality and
bleeding complications in the TAVI group alongside the increased
post-procedural aortic valve area, which could expedite favourable left
ventricular remodelling. Conclusions: The current meta-analysis suggests
an increased mid-term survival in female patients undergoing TAVI versus
surgical aortic valve implantation for severe AS. (Figure Presented).

<186>
Accession Number
612284433
Author
Maniotis C.; Andreou C.; Oikonomidis D.; Misailidou S.; Kiokas S.; Fatsiou
A.; Aggelaki M.; Kouvelas K.; Kyriakides Z.S.; Koutouzis M.
Institution
(Maniotis, Andreou, Oikonomidis, Misailidou, Kiokas, Fatsiou, Aggelaki,
Kouvelas, Kyriakides, Koutouzis) Red Cross Hospital, Department of
Cardiology, Athens, Greece
Title
Is percutaneous coronary intervention associated with lower risk of acute
kidney injury compared to coronary artery bypass grafting?.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1062-1063), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background/Introduction: Acute Kidney Injury (AKI) is a well-known
complication of both percutaneous coronary intervention (PCI) and coronary
artery bypass grafting (CABG). However, a limited number of studies have
compared their impact on kidney function in similar clinical settings.
Purpose: We performed a meta-analysis aiming to investigate the rates of
AKI in the relationship with the method of revascularization used.
Methods: We searched PubMed, Scopus, Elsevier Science, Science Direct and
Embase databases for all randmized and observational published studies
that evaluated the complication of the AKI in patients who underwent PCI
versus CABG. Relative Risk was calculated by and random-effects model.
Heterogeneity was defined as I2 values >25%. Review Manager 5.1 was used
for statistical analysis. Results: In our meta-analysis a total number of
9981 patients were included. Of these, 6485 were underwent PCI and 3496
CABG. Analysis of data from randomized and observational studies,
demonstrated that PCI is associated with a lower risk of AKI compared to
CABG (Relative Risk of 0.40 (CI 95% 0.19-0.82), p=0.01). When data were
pooled only from randomized trials, the relative risk was 0.67 (CI 95%
0.22-1.36) but this result was not statistically significant different
(p=0.52). In the sub-analysis of only the observational studies the
Relative Risk was 0.26 (CI 95% 0.08-0.85), p=0.03. Conclusions: This is
the first meta-analysis demonstrating that PCI compared to CABG may causes
less frequently a deterioration of kidney function in patients at the same
clinical setting. Further studies are needed, in order to evaluate these
findings. (Table Presented).

<187>
Accession Number
612284384
Author
Roginski Mendes Dos Santos A.; Marinho Florentino T.; Pessoa Correa A.;
Vianna Cedro A.; Costa Souza A.; Costa Bignoto T.; Costa De Souza Le Bihan
D.; De Alvim Siqueira D.A.; Arrais Dos Santos M.; Isabel De Oliveira Ramos
A.; Massamitsu Kambara A.; Bellio De Mattos Barretto R.; Assef J.E.; Cunha
Abizaid A.A.; Moraes Rego Sousa J.E.
Institution
(Roginski Mendes Dos Santos, Marinho Florentino, Pessoa Correa, Vianna
Cedro, Costa Souza, Costa Bignoto, Costa De Souza Le Bihan, De Alvim
Siqueira, Arrais Dos Santos, Isabel De Oliveira Ramos, Massamitsu Kambara,
Bellio De Mattos Barretto, Assef, Cunha Abizaid, Moraes Rego Sousa)
Institute Dante Pazzanese, Cardiology, Sao Paulo, Brazil
Title
Modifications on mitral regurgitation in patients with severe aortic
stenosis undergoing transcatheter aortic valve implantation.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 71-72), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Introduction: Mitral regurgitation (MR) can be found in 74% of patients
with severe aortic stenosis (AS) and represents a negative prognostic
factor when it is moderate or severe. However, the evolution of MR after
transcatheter aortic valve implantation (TAVI) is not well established.
Purpose: This study aims to assess modifications on MR in patients
undergoing TAVI, and to identify factors associated with these
modifications. Methods: We conducted an observational study with all
patients with symptomatic severe AS who underwent TAVI between January
2009 to April 2015, in two centers of expertise. In addition to severity
of MR, we evaluated clinical and echocardiographic data before and one
year after intervention, in order to identify whether the regurgitation
regressed or worsened, and factors related to these modifications.
Patients were divided into two groups according to the severity of the MR
before the procedure: Group I consisted of patients with trace or mild MR
and group II corresponded to patients with moderate or severe MR. Patients
who did not complete one year of follow-up or who had died in the first 30
days of procedure were excluded. Results: From a total of 270 patients who
underwent TAVI, 91 patients met the inclusion criteria. Considering the
whole group of patients, there was a significant change in the degree of
MR after TAVI (p=0.013). In Group I (67 patients, 82.7%), 92.5% of
patients remained with the same MR grade, while 7.5% showed a worsening
after TAVI (p<0.001). In group II (24 patients, 17.3%), there was a
regression in the degree of MR in 66.7% of patients, while in the other
33.3% regurgitation remained moderate or severe (p=0.076). Comparisons
among patients in group II have shown no differences regarding age
(85.12+/-5.84 vs. 84 25+/-7.94, p=0.559), presence of coronary artery
disease (50% vs. 37.5%, p=0.673), left ventricular function (56.68+/-13.06
vs. 48.87+/-16.63, p=0.358) and severity of pulmonary arterial
hypertension (57.62+/-12.10 vs. 52.37+/-15.28, p=0.391) in patients with
regression or maintenance of MR degree respectively. Patients whose MR
regressed had less illnesses according to EuroEscore II (5.68+/-3.32 vs.
11.03+/-5.30, p=0.023) and STS morbidity (25,87+/-7,91 vs. 34,88+/-11,93,
p=0,027). Conclusions: There was significant change in the degree of MR
after TAVI, with maintenance in those with mild MR and a trend towards
improvement in those with moderate or severe MR. In patients with moderate
or severe MR, improvement was correlated with lower preoperative risk
scores.

<188>
Accession Number
612284212
Author
Gkouziouta A.; Lazaros G.; Karavolias G.; Miliopoulos D.; Pantou M.;
Hatzianastasiou S.; Karavidas A.; Cokkinos P.H.; Voudris V.; Adamopoulos
S.
Institution
(Gkouziouta, Karavolias, Miliopoulos, Pantou, Hatzianastasiou, Cokkinos,
Voudris, Adamopoulos) Onassis Cardiac Surgery Center, Athens, Greece
(Lazaros) Hippokration General Hospital, First Cardiology Department,
Athens, Greece
(Karavidas) General Hospital of Athens G. Gennimatas, Department of
Cardiology, Athens, Greece
Title
Pathogen-driven treatment strategy in new-onset dilated cardiomyopathy.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 526), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Purpose: Clinical management of new-onset dilated cardiomyopathy (NODC)
has been an object of intensive research in recent years. Apart from
established conventional heart failure therapy, there are additional -
"second line" - treatment options that include, among others,
immunomodulatory therapies. One such option is the administration of
pathogen-driven treatment (PDT) given the isolation of infectious agents.
In the present investigation we assessed the efficacy of PDT in patients
with NODC. Methods: We administered PDT in patients with NODC whose EMB
unveiled one or more pathogens susceptible to specific treatment. The
patients were divided into two groups depending on whether they complied
with the treatment. They were followed-up for 3 years. The primary
endpoint was to assess the effect of PDT on LVEF after adjustment for
baseline characteristics. A secondary objective was to compare the
incidence of non-fatal complications [left ventricular assist device
(LVAD) or BiVAD implantation and heart transplantation] in terms of
survival analysis. Results: Overall, 93 consecutive patients (aged
38.9+/-13.1 years, 72% men) were enrolled and assessed prospectively.
Optimal conventional heart failure treatment was administered to all
patients. Group A included 41 patients to whom PDT was administered
against the isolated pathogens (58,5% Chlamydiae, 41,5% HHV). Group B
included the remaining 52 patients (19,2% Chlamydiae, 42,3% Parvo- B19,
23,1% Coxsackie, 15,4% HHV). Baseline LVEF was 25% (IQR 20-45%) and 25%
(IQR 20-33%) in groups A and B respectively. LVEF at the end of follow-up
was 48,3% (IQR 30-55,8%) and 25% (IQR 20-50%) respectively. As a result
there was a tendency of an increase in LVEF by 4,86% (p=0,047) in patients
to whom PDT was administered. In regards to the secondary objectives, no
statistically significant changes were found (p>0,05 for all).
Conclusions: This investigation highlights for the first time the
beneficial impact of PDT in terms of LV function in the setting of NODC
and evidence of infection in the EMB. A randomized administration of PDT
in patients with susceptible pathogens should be performed to confirm this
study results.

<189>
Accession Number
612284190
Author
Kanamori N.; Taniguchi T.; Morimoto T.; Ando K.; Murata K.; Kitai T.;
Kawase Y.; Izumi C.; Mitsuoka H.; Kato M.; Hirano Y.; Nagao K.; Sakata R.;
Aoyama T.; Kimura T.
Institution
(Kanamori, Aoyama) Shimada Municipal Hospital, Division of Cardiology,
Shimada, Japan
(Taniguchi, Kimura) Kyoto University, Graduate School of Medicine,
Department of Cardiovascular Medicine, Kyoto, Japan
(Morimoto) Hyogo College of Medicine, Department of Clinical Epidemiology,
Nishinomiya, Japan
(Ando) Kokura Memorial Hospital, Department of Cardiology, Kokura, Japan
(Murata) Shizuoka City Shizuoka Hospital, Department of Cardiology,
Shizuoka, Japan
(Kitai) Kobe City Medical Center General Hospital, Department of
Cardiovascular Medicine, Kobe, Japan
(Kawase) Kurashiki Central Hospital, Department of Cardiovascular
Medicine, Kurashiki, Japan
(Izumi) Tenri Hospital, Department of Cardiology, Tenri, Japan
(Mitsuoka) Nara Hospital, Kinki University, Division of Cardiology, Ikoma,
Japan
(Kato) Mitsubishi Kyoto Hospital, Department of Cardiology, Kyoto, Japan
(Hirano) Kinki University Hospital, Department of Cardiology, Osakasayama,
Japan
(Nagao) Osaka Red Cross Hospital, Department of Cardiovascular Center,
Osaka, Japan
(Sakata) Kyoto University, Graduate School of Medicine, Department of
Cardiovascular Surgery, Kyoto, Japan
Title
Prognosis of asymptomatic versus symptomatic patients with severe aortic
stenosis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 556-557), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Current guidelines recommend the watchful waiting for aortic
valve replacement (AVR) until symptoms emerge in patients with
asymptomatic severe aortic stenosis (AS), and the prompt AVR for
symptomatic AS patients, based on the good prognosis of AS patients while
they are asymptomatic. However, the prognosis of patients with
asymptomatic severe AS in comparison with that of symptomatic patients has
not been adequately evaluated yet in real clinical practice. Objectives:
We compared the long-term clinical outcomes of asymptomatic severe AS
patients with those of symptomatic severe AS patients in a large
observational database of patients with severe AS. Methods: The CURRENT AS
registry is a retrospective multicenter registry enrolling 3,813
consecutive patients (77.8+/-9.8 years of age, and female: 62.2%) with
severe AS (peak aortic jet velocity (Vmax) >4.0 m/s, or mean aortic
pressure gradient >40 mm Hg, or aortic valve area <1.0 cm²)
from 27 Japanese centers between January 2003 and December 2011. Outcome
measures evaluated in the present study included all-cause death, heart
failure (HF) hospitalization, and surgical AVR or transcatheter aortic
valve implantation (TAVI) during follow up. Results: There were 2005
symptomatic (HF with NYHA >=2: N=1603, syncope: N=136, angina: N=266)
patients (78.6+/-9.9 years of age, female: 64.4%, and Vmax: 4.3+/-1.0m/s)
and 1808 asymptomatic patients (76.8+/-9.6 years of age, female: 59.6%,
and Vmax: 3.9+/-0.8m/s). Initial AVR strategy was selected in 1196
patients (symptomatic: N=905, asymptomatic: N=291). During median
follow-up of 37 months, the cumulative 5-year incidences of all-cause
death, HF hospitalization and surgical AVR or TAVI were significantly
higher in the symptomatic group than in the asymptomatic group (48.1% and
37.5%, p<0.001; 36.8% and 21.5%, p<0.001, and 63.9% and 50.7%, p<0.001,
respectively). After exclusion of 790 hospitalized patients due to acute
HF at index echocardiography, who were deemed to have extremely high
mortality risk, the cumulative 5-year incidence of all-cause death was not
different between symptomatic and asymptomatic patients (39.4% and 37.5%,
p=0.09). Although new symptoms emerged in 501 (27.7%) out of 1808 patients
with asymptomatic group, only 247 (49.3%) of these 501 patients had AVR or
TAVI. Conclusions: Although the prognosis of asymptomatic patients with
severe AS is better than that of symptomatic patients, the 5-year
mortality rate of asymptomatic patients was very high. After exclusion of
hospitalized patients with acute HF, the 5-year rate of all-cause death
was not different between symptomatic and asymptomatic patients with
severe AS.

<190>
Accession Number
612284144
Author
Providencia R.; Barra S.; Papageorgiou N.; Falconer D.; Duehmke R.; Rehal
O.; Ahsan S.; Ezzat V.; Ioannou A.; Segal O.; Rowland E.; Lowe M.;
Lambiase P.; Agarwal S.; Chow A.
Institution
(Providencia, Papageorgiou, Ahsan, Ezzat, Segal, Rowland, Lowe, Lambiase,
Chow) Barts Health NHS Trust, London, United Kingdom
(Barra, Duehmke, Agarwal) Papworth Hospital NHS Trust, Cambridge, United
Kingdom
(Falconer, Rehal) University College Hospital, London, United Kingdom
(Ioannou) Royal Free Hospital, London, United Kingdom
Title
Should dual-site right ventricular pacing be used in failed coronary-sinus
lead implants? Long term results from multicentre registry.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 447), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Dual-site right ventricular pacing (Dual-RV) has been proposed
as an alternative for patients with heart failure (HF) undergoing cardiac
resynchronization therapy (CRT) with a failure to deliver a coronary sinus
(CS) lead. Although short-term haemodynamic and echocardiographic results
of Dual-RV seem promising, no long-term results on survival are currently
available. Purpose: To assess the impact of Dual-RV compared to CRT
patients on allcause mortality and/or heart transplant in advanced HF
patients undergoing CRT. Methods: Multicentre retrospective assessment of
all CRT implants during an 8- year period. Patients with failed CS lead
implant and treated with Dual-RV were followed and assessed for the
primary end point of all-cause mortality and/or heart transplant.
Secondary endpoints were: freedom from sustained ventricular
tachycardia/fibrillation, procedural complications, infection, and
lead-dislodgment. Comparisons were performed with standard CRT implants
matched controls. Results: Among 1,246 patients undergoing CRT, 62 (4.98%)
were implanted with Dual-Site. The mean age of these patients was
68.5+/-10.0 years, 35.5% were women, mean LVEF was 27+/-11%, NYHA was
2.8+/-0.7, and 64.5% were implanted with a CRT-D (defibrillator). During a
median of 1,719 days (IQR 731-2,698), after adjustment for baseline
differences, intention-to-treat analysis showed that all-cause mortality
and/or heart transplant was higher in the Dual-RV group (adjusted HR=2.02,
95% CI 1.28-3.17, P=0.002) (Figure 1). Two patients in the Dual-RV group
underwent transplant, and 7 crossed-over to the CRT arm (1 transseptal LV
lead, 3 successful CS lead implants, and 3 surgical-epicardial lead
procedures) and are currently still alive. No significant differences were
observed between the two groups in all secondary endpoint comparisons.
Conclusion: Our data suggest that Dual-RV pacing leads to worse clinical
outcomes and alternative CRT options should be considered in patients with
failed CS-lead implants. (Figure Presented).

<191>
Accession Number
612284137
Author
Dimitroulis D.; Wolff G.; Kolodziejczak M.; Brockmeyer M.; Kereiakes D.D.;
Navarese E.P.
Institution
(Dimitroulis, Wolff, Brockmeyer, Navarese) University Hospital Dusseldorf,
Dusseldorf, Germany
(Kolodziejczak) Nicolaus Copernicus University (NCU), Bydgoszcz, Poland
(Kereiakes) Christ Hospital, Cincinnati, United States
Title
Mortality after revascularization in patients with reduced ejection
fraction: A comprehensive meta analysis of 13,286 patients comparing CABG
vs PCI vs OMT.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 246), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Heart failure with reduced ejection fraction caused by
ischemic coronary artery disease is associated with increased for
morbidity and mortality. It remains unclear whether revascularization by
either coronary artery bypass grafting (CABG) or percutaneous coronary
intervention (PCI) may carry benefits and risks compared to optimal
medical treatment (OMT). Methods: We performed the first comprehensive
meta analysis of available studies comparing percutaneous and surgical
coronary revascularization strategies or OMT in patients with ejection
fraction <40%. Results: Twenty studies with a total of 13,286 patients
were included. Compared to OMT there was a significant reduction in
mortality with CABG (odds ratio (OR) 0.53, CI 0.47-0.61) and PCI (OR 0.5,
CI 0.38-0.66). When compared to PCI, CABG showed a superior efficacy in
reducing mortality (OR 0.78, CI 0.69-0.88). Sensitivity analyses performed
in studies including only randomized or propensity-score-matched patients,
confirmed the significantly improved survival with CABG vs. OMT (OR 0.74,
CI 0.61-0.91) and CABG vs. PCI (OR 0.81, CI 0.67-0.97). Conclusions:
Revascularization strategies are superior to OMT in improving survival.
The findings show a significant improved survival with the invasive
procedures. However, CABG compared to PCI is the more favourable
revascularization treatment strategy in patients with reduced ejection
fraction. These findings if confirmed in a large RCT might have a profound
impact on public health.

<192>
Accession Number
612284098
Author
Shiino K.; Yamada A.; Walters D.; Hamilton-Craig C.; Platts D.G.; Burstow
D.; Scalia G.M.; Chan J.
Institution
(Shiino, Chan) Griffith University, School of Medicine, Menzies Health
Institute Queensland, Gold Coast, Australia
(Yamada) Fujita Health University, Toyoake, Japan
(Walters, Hamilton-Craig, Platts, Burstow, Scalia) Prince Charles
Hospital, Cardiology, Brisbane, Australia
Title
Short-term effects of transcatheter aortic valve implantation (TAVI) on
left ventricular transmural mechanics using multi-layer speckle tracking
echocardiography.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 462), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has emerged as
an alternative treatment in surgically high risk inoperable patients with
severe aortic stenosis (AS). Purpose: We aim to evaluate the short-term
effects of TAVI on transmural myocardial mechanics using multi-layer
speckle tracking echocardiography. Methods: Fifteen normal controls and 16
severe AS patients with normal LV systolic function underwent 2D speckle
tracking echocardiography before and after TAVI. Multi-layer global
longitudinal strain (GLS) was measured from the endocardial (endo), mid,
and epicardial (epi) layers by blinded independent observers. Results:
Severe AS patients had significantly reduced GLS in all 3 layers of the
myocardium compared to controls (endo: -17.5+/-4.4 vs. -25.1+/-2.1%,
p<0.0001; mid: -15.2+/-4.0 vs. -22.3+/-1.9%, p<0.0001; epi: -13.2+/-3.6
vs. - 19.8+/-1.9%, p<0.0001). Post TAVI, there was a significant increase
in aortic valve area (0.80+/-0.20 cm² vs. 1.94+/-0.53
cm², p<0.0001) and significant reduction in mean aortic valve
pressure gradient (48+/-10 mmHg vs. 12+/-4 mmHg, p<0.0001). There was no
significant change in EF (60+/-12% vs. 63+/-11%, p = ns) and mean arterial
pressure (89+/-13 mmHg vs. 87+/-14 mmHg, p = ns), but GLS increased
significantly in all 3 layers (endo: -17.5+/-4.4% vs. -19.6+/-4.3%,
p=0.02; mid: - 15.2+/-4.0% vs. -17.1+/-3.9%, p=0.02; epi: -13.2+/-3.6% vs.
-14.9+/-3.5%, p=0.02). Conclusions: GLS was significantly reduced in all 3
layers of the myocardium in severe AS despite normal LV function. There
was a significant improvement in GLS in all 3 layers at short-term
follow-up post TAVI.

<193>
Accession Number
612283946
Author
Caliskan I.E.; Sahin A.; Yilmaz M.; Seifert B.; Hinzpeter R.; Alkadhi H.;
Falk V.; Maisano F.; Salzberg S.P.; Emmert M.Y.
Institution
(Caliskan, Sahin, Yilmaz, Maisano, Salzberg, Emmert) University Hospital
Zurich, Division of Cardiac and Vascular Surgery, Zurich, Switzerland
(Seifert) University of Zurich, Department of Biostatistics, Epidemiology,
Biostatistics and Prevention Institute, Zurich, Switzerland
(Hinzpeter, Alkadhi) University Hospital Zurich, Institute of Diagnostic
and Interventional Radiology, Zurich, Switzerland
(Falk) Deutsches Herzzentrum Berlin, Berlin, Germany
Title
Epicardial left atrial appendage occlusion provides first evidence on
stroke reduction in patients with atrial fibrillation undergoing cardiac
surgery.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 890), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Atrial fibrillation (AF) is an independent risk-factor for
stroke due to thromboembolic events often originating from the left atrial
appendage (LAA). Therefore, LAA-occlusion has emerged as an alternative to
oral anticoagulants for stroke prevention in patients with AF. The aim of
this study was to demonstrate the safety, durability and efficacy of
concomitant device-enabled LAA-occlusion during elective open heart
surgery in regard to stroke reduction. Methods: A total of 291 AtriClip
devices were deployed epicardially on 291 consecutive patients comprising
of forty patients from a first-in-man device trial and 251 patients from a
consecutive institutional registry. The primary efficacy endpoint for
stroke reduction was defined as the occurrence of ischemic or hemorrhagic
neurological events during FU (Stroke). The primary safety endpoint was
any device related event (perioperatively, in-hospital, FU). Secondary
endpoints included overall mortality and durability as assessed by CT. A
composite endpoint including death for cardiac reason or of unknown cause,
systemic embolism and hemorrhagic or ischemic stroke was created. To
assess the efficacy after epicardial LAA occlusion, time intervals for
each patient on or off oral anticoagulation or antiplatelet treatment were
determined. Individual risks for stroke (imputed/calculated stroke risk)
according to the obtained time interval and the CHA2DS2-VASc-Score were
calculated Results: The AtriClip device was successfully implanted in all
patients and overall mean follow-up (FU) was 36.1+/-23.1months (median FU
31months; range: 0.7- 97.1months). Early and late mortality was 5.5% and
was 17.9% with none for device related issues and no device-related
complications were detected throughout the entire study indicating a
favorable safety-profile. Long-term computed-tomography in selected
patients (5.1-8.1 years post implant) displayed complete LAA-occlusion
without any signs of residual reperfusion or substantial LAA-stump
indicating an excellent durability profile. In regards to stroke
reduction, the subgroup analysis of patients without oral anticoagulation
during FU (n=166) revealed a relative risk reduction of 87.5% with an
observed ischemic stroke rate of 0.5/100 patient years (mean CHA2DS2-VASc
score 3.1, expected rate of 4.0/100 patient years). No strokes occurred in
the subgroup with OAC. Conclusions: The long-term results of epicardial
LAA occlusion with the AtriClip in patients with AF undergoing cardiac
surgery provide excellent evidence for the safety and durability and
indicate first signs of efficacy in regard to stroke reduction. When
validated in large randomized trials, routine closure of LAA during
cardiac surgery or in a stand-alone minimally invasive fashion may play a
crucial role in stroke prevention in then selected patients.

<194>
Accession Number
612283929
Author
Almeida J.; Dias T.; Guerreiro C.; Pereira E.; Caeiro D.; Oliveira M.;
Goncalves H.; Rodrigues A.; Ribeiro J.; Primo J.; Braga P.; Gama V.
Institution
(Almeida, Dias, Guerreiro, Pereira, Caeiro, Oliveira, Goncalves,
Rodrigues, Ribeiro, Primo, Braga, Gama) Hospital Center Vila Nova Gaia,
Cardiology, Porto, Portugal
Title
Prognostic impact of intraventricular conduction disturbances after
transcatheter aortic valve implantation.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1074), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) often leads
to intraventricular conduction abnormalities (ICA), especially left bundle
branch block (LBBB) and advanced atrioventricular block requiring
permanent pacemaker (PM). Ventricular pacing has mechanical/hemodynamic
disadvantages similar to LBBB and both long term deleterious effect have
already been demonstrated. Purpose: To evaluate the prognostic impact of
ICA in patients undergoing TAVI. Methods: This retrospective study
included all patients who underwent TAVI between August/2007 and
November/2015 in one centre. Patients with previous LBBB or PM and
intra-procedure deaths were excluded. ICA included new LBBB and/or new PM
and we performed a comparative analysis of two groups: with and without
ICA. We conducted a logistic regression analysis to determine predictors
of ICA and a survival analysis with Kaplan-Meier curves and Cox
regression. Results: We included 200 patients (mean age 78.7 years-old;
female gender 53%). A transfemoral approach was used in 86.4% and a
self-expandable prosthesis was deployed in 59.6%. PM was implanted in
29.5% and 31% developed new-LBBB. Overall, ICA occurred in 46% and there
were no statistical differences between groups in previous New York Heart
Association (NYHA) class (III or IV: 69.9 vs 68.3%, p=0.820) or
transthoracic echocardiographic (TTE) ejection fraction (52.1 vs 51.7%,
p=0.960). Independent predictors of ICA: chronic obstructive pulmonary
disease (OR 2.3; 95% CI 1.0-5.4, p=0.047), prosthesis size (OR 1.4; 95% CI
1.1-1.9, p=0.007) and balloon pre-dilation (OR 3.7, 95% CI 1.2-10.7,
p=0.018). After TAVI, only respiratory infections were more frequent in
ICA group (20 vs 6.6%, p=0.005). In follow-up, ICA group showed less
peak-VO2 in one-month cardiopulmonary exercise testing (11,5 vs
14,5ml/kg/min, p=0.012), statistical tendency for more readmissions (22.2
vs 9.9%, p=0.067) and fewer patients in NYHA class I (20.8 vs 44.1%,
p=0.066). The 6-month TTE showed inferior ejection fraction (53 vs 56%,
p=0.045), without statistical differences in end-systolic volume variation
(+2.5 vs -2.2ml, p=0.543). All-cause mortality was significantly superior
in patients with ICA (log-rank test: p=0.005) and ICA were an independent
predictor of all-cause mortality (adjusted- HR 2.2, 95% CI 1.3-3.8,
p=0.006). Conclusions: Conduction disturbances occurred in almost half of
the patients. In follow-up, ICA were associated with less functional
capacity, inferior ejection fraction and they were an independent
predictor of all-cause mortality. (Figure Presented).

<195>
Accession Number
612283832
Author
Yoneyama K.; Ishibashi Y.; Akashi Y.; Itoh T.; Morino Y.; Mizutani T.; Ako
J.; Nakano M.; Yoshioka K.; Inami S.; Komatsu T.; Sugimura H.; Nomura T.;
Sugi K.; Yoshino H.
Institution
(Yoneyama, Ishibashi, Akashi) St. Marianna University, Shool of Medicine,
Kawasaki, Japan
(Itoh, Morino) Iwate Medical University, Cardiology, Morioka, Japan
(Mizutani, Ako) Kitasato University, Cardiovascular Medicine, Sagamihara,
Japan
(Nakano, Yoshioka) Tokai University (Tokyo), Cardiology, Isehara, Japan
(Inami) Dokkyo Medical University, Cardiology, Mibu, Japan
(Komatsu) Dokkyo Koshigaya University of Medicine, Cardiology, Koshigaya
City, Japan
(Sugimura) Dokkyo Medical University, Nikko Medical Center, Cardiology,
Tochigi, Japan
(Nomura, Yoshino) Teikyo University, Cardiology, Tokyo, Japan
(Sugi) Saitama International Medical Center, Cardiology, Hidaka, Japan
Title
Subacute cardiac rupture as a predictor of in-hospital mortality in
patients with cardiac rupture after acute myocardial infarction in Japan;
a retrospective analysis of multicenter registry data.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 768), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Despite the known association of cardiac rupture after acute
myocardial infarction (AMI), which substantially increases the risk of
death, it is not clear whether clinical characteristics are associated
with increased risk of in-hospital deaths among patients with AMI
complicated by cardiac rupture. Methods: The multicenter mechanical
complications registry is a retrospective registry, and is being conducted
at eight medical universities in Eastern Japan. Among a total of 10,305
consecutive AMI patients, we included 183 patients with cardiac rupture
after AMI and examined incident in-hospital deaths during a median
duration follow-up of 26 days. Patients were stratified into three groups
according to AMI-to-cardiac rupture time, and into a less-than-24-hour
group (n=111), a 24-48-hour-group (n=20), and a greater-than-48-hour group
(n=52). Cox proportional hazards regression was used to estimate hazard
ratio (HR) and confidence interval (CI) for hospital mortality. Results:
Eighty-seven (48%) patients experienced in-hospital death and 126 (67%)
had cardiac surgery. In multivariable Cox regression, a nonlinear
association was observed across three groups for mortality (HR [CI]: <24h:
1.0; reference, 24-48h: 0.73 [0.27-1.86], >48h: 2.25 [1.22-4.15] after
adjustments for age, sex, Killip classification, percutaneous coronary
intervention, blood pressure, creatinine, peak creatine kinase MB
fraction, left ventricular ejection fraction, and type of rupture. Cardiac
surgery was independently associated with a reduction in the HR of
mortality (HR [CI]: 0.27 [0.12-0.61]), and attenuated the association of
the time category with mortality (statistically nonsignificant) in the Cox
model. Conclusions: These data suggest that AMI-to-cardiac rupture time
contributes to a significant risk of in-hospital mortality; however,
making a quick diagnosis and initiating prompt surgical interventions are
crucial to improve outcome in patients with cardiac rupture after AMI.
(Figure Presented).

<196>
Accession Number
612283741
Author
Ruivo C.; Sa F.; Correia J.; Pernencar S.; Antunes A.; Saraiva F.;
Carvalho N.; Morais J.
Institution
(Ruivo, Sa, Correia, Pernencar, Antunes, Saraiva, Carvalho, Morais)
Hospital Santo Andre, Department of Cardiology, Leiria, Portugal
Title
Very high and very low risk patients: Predictors of death-an exploratory
analysis considering the baseline thrombotic and hemorrhagic risk.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 172), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: The GRACE and CRUSADE risk scores are useful risk
stratification tools to identifie high-risk patients (pts) with Acute
Coronary Syndrome (ACS) for whom more aggressive treatment is warranted.
Purpose: To search for independent predictors of death in pts with ACS
categorized according to the thrombotic and bleeding risk at baseline.
Methods: From October 2010 to November 2014, 4445 consecutive pts with ACS
(66+/-13 years; 73% male) included in a multicenter national registry were
enrolled. Based on ROC curves, optimal cut-off points were created. Then,
4 groups were defined and compared: A) GRACE<160 and CRUSADE<33; B)
GRACE>=160 and CRUSADE<33; C) GRACE<160 and CRUSADE>=33); D) GRACE>=160
and CRUSADE>=33. In order to determine predictors of risk of death at 12
months a Cox regression analysis was performed in the very high risk
population (group D). Results: Comparative analyses between A (n=2365;
53.2%), B (n=575; 12.9%), C (n=529; 11.9%) and D (n=976; 22.0%) groups
revealed, respectively, progressive increasing age (58+/-11 vs 71+/-9 vs
71+/-11 vs 77+/-9, p<0.001), higher rates of previous cardiovascular
diseases [stroke/TIA (4.9% vs 7.1% vs 12.3% vs 13.6%, p<0.001)], lower
left ventricular ejection fraction (57+/-12 vs 53+/-12 vs 54+/-14 vs
49+/-14, p<0.001), more angina equivalents as clinical presentation (3.1%
vs 5.4% vs 8.7% vs 21.8%, p<0.001) and higher Killip class (KK>1: 2.2% vs
12.0% vs 10.4% vs 46.6%, p<0.001). The myocardial revascularization was
accomplished progressively in lower rates (87.6% vs 84.0% vs 83.1% vs
73.4%, p<0.001). In group D, 178 (18.2%) pts died during follow-up; ROC
curves with optimal cutoff points were created and Cox regression
identified independent predictors of endpoint death (Table). Conclusions:
Age, atherosclerotic burden, and heart failure with inotropic drugs use
all mark worse prognosis in pts with high GRACE and high CRUSADE scores.
In spite of a clear benefit, an invasive revascularization strategy is
paradoxically less frequently used in this higher risk population. (Table
Presented).

<197>
Accession Number
612283729
Author
Cha K.S.; Park J.S.; Kim B.W.; Lee H.W.; Oh J.H.; Choi J.H.; Lee H.C.;
Hong T.J.
Institution
(Choi, Cha, Park, Kim, Lee, Oh, Choi, Lee, Hong) Pusan National University
Hospital, Busan, South Korea
Title
Comparison of frequency of major adverse cardiac events following final
kissing balloon dilatation versus no final kissing balloon dilatation
during crossover stenting at the left main bifurcation dis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1058), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Purpose: There are limited data regarding the effect of final kissing
balloon (FKB) dilatation during crossover stenting at the left main tract
(LMT) bifurcation lesions. Therefore, we evaluated the clinical outcomes
of performing FKB dilatation during crossover stenting at the LMT
bifurcation lesions. Methods: Of 234 patients who underwent coronary
stenting at the LMT from March 2006 through December 2014, 118 patients
with crossover stenting from the LMT to the LAD were selected and divided
into the two groups; FKB group (n=31) and non-FKB group (n=87) based on
the FKB dilatation. Primary outcome was the composite of major adverse
cardiac events (MACE), defined as all-cause death, non-fatal myocardial
infarction (MI) and target lesion revascularization (TLR). Results: Twenty
patients (16.9%) had more than one clinical event during the median
follow-up of 2.54 years (25th-75th interquartile; 0.95-5.53 years).
In-hospital death occurred in 0 (0%) and 5 (5.7%) patients in the FKB and
no-FKB groups, respectively. The rate of MACE did not differ between the
two groups (9.7% vs. 11.5%, hazard ratio[HR] 0.8, 95% confidence
interval[CI] 0.224-2.967, p=0.76). The rates of all-cause death (HR 0.4,
95% CI 0.045-3.001, p=0.35), non-fatal MI (HR 1.0, 95% CI 0.008-124.103,
p=0.70), and TLR (HR 1.9, 95% CI 0.313- 11.324, p=0.49) did not differ
between the two groups. In multivariate cox regression analysis, no FKB
dilatation during crossover stenting was not an independent predictor of
MACE (HR 6.8, 95% CI 0.239-194.081, p=0.26). Conclusions: This study
showed that the frequency of clinical events did not differ significantly
between FKB dilatation and no FKB dilatation during crossover stenting at
the LMT bifurcation disease. This result and the effect of FKB dilatation
during crossover stenting of LMT bifurcation lesions need to be validated
in large randomized studies. (Table Presented).

<198>
Accession Number
612283586
Author
Cortes C.; Amat Santos I.J.; Nombela-Franco L.; Munoz-Garcia A.J.;
Gutierrez-Ibanes E.; De La Torre J.M.; Cordoba-Soriano J.G.;
Gonzalez-Mansilla A.; Ruano J.G.; Tobar J.; Islas F.; Revilla A.; Puerto
A.; Gomez I.; San Roman J.A.
Institution
(Cortes, Amat Santos, Tobar, Revilla, Puerto, Gomez, San Roman) University
Hospital of Vallodolid, ICICOR, Valladolid, Spain
(Nombela-Franco, Islas) Hospital Clinic San Carlos, Cardiology, Madrid,
Spain
(Munoz-Garcia) University Hospital Virgen De La Victoria, Cardiology,
Malaga, Spain
(Gutierrez-Ibanes, Gonzalez-Mansilla) University Hospital Gregorio
Maranon, Cardiology, Madrid, Spain
(De La Torre, Ruano) University Hospital Marques De Valdecilla,
Cardiology, Santander, Spain
(Cordoba-Soriano) Albacete University Hospital, Cardiology, Albacete,
Spain
Title
Multidetector computed tomography parameters as predictors of improvement
of mitral regurgitation after transcatheter aortic valve replacement. A
multicentre study.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 1145-1146), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Introduction: The management of concomitant aortic stenosis (AS) and
mitral regurgitation (MR) is challenging. MR degree may improve after
Transcatheter aortic valve implantation (TAVI). Purpose: We aimed to
evaluate the potential use of multidetector computed tomography (MDCT) as
predictor of MR changes after TAVI. Methods: Consecutive patients
diagnosed of severe AS who underwent TAVI in six centres were included.
MDCT analysis was performed before TAVI procedure and off-line analysis of
the mitral apparatus was carried out for those patients with MR>=III.
Calcification of the mitral annulus and leaflets (from 0=none to 4=severe)
and annular dimensions were also determined. Results: Of 1110 patients
included (age: 80.5+/-6.9 years, males: 41.9%), 177 patients presented
MR>=III at baseline, 103 of them (58.2%) presented improvement of the MR
degree. Uni- and multi-variable analysis of imaging predictors of MR
persistence are summarized in the table. ROC analysis of mitral annulus
diameter determined that 35.5 mm was the best cut-off value to predict MR
persistence. Conclusion: The severity of calcification of the mitral
apparatus determined by MDCT was the most important independent predictor
of MR persistence, more accurate than the mere classification as
organic/functional by TTE. The extended use of MDCT to plan the TAVI
procedures can offer important information for the treatment of patients
with concomitant MR.

<199>
Accession Number
612283525
Author
Tolosana J.M.; Trucco M.E.; Hernandez Madrid A.; Toquero J.; Merino J.L.;
Osca J.; Quesada A.; Martinez Ferrer J.; Villuendas R.; Perez J.; Mont
L.L.
Institution
(Tolosana, Trucco, Mont) Hospital Clinic, Arrhythmia Section, Cardiology
Dept., Barcelona, Spain
(Hernandez Madrid) University Hospital Ramon y Cajal De Madrid, Arrhythmia
Section, Cardiology Dept., Madrid, Spain
(Toquero) University Hospital Puerta De Hierro Majadahonda, Arrhythmia
Section, Cardiology Dept., Madrid, Spain
(Merino) University Hospital La Paz, Arrhythmia Section, Cardiology Dept.,
Madrid, Spain
(Osca) Hospital Universitario y Politecnico La Fe, Arrhythmia Section,
Cardiology Dept., Valencia, Spain
(Quesada) University General Hospital of Valencia, Arrhythmia Section,
Cardiology Dept., Valencia, Spain
(Martinez Ferrer) Hospital Universitario Txagorritxu Victoria., Arrhythmia
Section, Cardiology Dept., Pais Vasco, Spain
(Villuendas) University Hospital Trias i Pujol, Arrhythmia Section,
Cardiology Dept., Barcelona, Spain
(Perez) University Hospital Vall d'Hebron, Arrhythmia Section, Cardiology
Dept., Barcelona, Spain
Title
Early AV node ablation versus pharmacological rate control in patients
with CRT and AF. Results of SPARE III, a randomized multicenter study.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 445), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Introduction: Maximum ventricular pacing (VP) is necessary for good CRT
response. In AF AV node ablation is recommended. The aim of the study was
to analyze whether early AV node ablation (EAVNA) in patients with AF
submitted to CRT improved response to therapy. Methods: A multicenter
randomized trial analyzed a cohort of patients with AF treated with CRT.
Inclusion criteria were: AF, NYHA III-IV, QRS >120 ms and LVEV <=35%.
Patients with AF and fast, uncontrolled heart rate (HR) or patients with
AF and slow heart rate requiring ventricular pacing were excluded. After
successful CRT implant, patients were randomized to EAVNA or medical
therapy (MT) to slow HR. All patients underwent clinical and
echocardiographic evaluation prior to implantation and at 6- and 12-month
follow-up. Responders were defined as survivors at 12 months post-implant
with >=10% LVESV reduction without requiring heart transplant. Results: A
group of 60 patients was randomized to EAVNA (30) or MT (30). The
percentage of VP at 6 and 12 months was 99% and 99% respectively, in the
EAVNA group and 95% and in the MT group (p: NS). During follow-up, 20% of
patients from the MT crossed over to AV node ablation. At 12 months, there
was no difference between groups in the percentage of responders: 12/30
(40%) EAVNA vs. 10/30 (33%) MT (RR 1.2, 95% CI [0.6-2.3], p=0.79). LVEF
improvement was similar too (figure1). In each group 2/30 patients died
(6.6% mortality);1 patient from EAVNA required heart transplant. Hospital
admissions were also similar between study groups: 8/30 (26.6%) EAVNA and
8/30 (26.6%) MT. Conclusions: Compared to MT a strategy of EAVNA in
patients with CRT and AF did not improve CRT response or clinical
improvement. (Figure Presented).

<200>
Accession Number
612283486
Author
Wang T.K.M.; Wang M.T.M.; Ruygrok P.
Institution
(Wang, Ruygrok) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Wang) University of Auckland, Department of Medicine, Auckland, New
Zealand
Title
Comparison of surgical risk scores to predict mortality after
transcatheter aortic valve implantation: A meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 458), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is considered
in patients with severe aortic valve disease at high risk for surgical
aortic valve replacement. Risk stratification plays a critical role in
selecting the appropriate treatment modality. We compared the prognostic
utility of surgical risk scores at predicting mortality after TAVI in this
meta-analysis. Methods: MEDLINE, Embase, Cochrane and Web of Science
databases from 1 January 1980 to 31 December 2015 were searched. Studies
were systematically reviewed for inclusion, then data extracted for pooled
analyses. Results: Amongst 1688 articles searched, 47 full-text articles
were screened and 23 studies (11,936 TAVI cases) included for analyses.
Areas under curve (95% confidence interval) for operative mortality were
EuroSCORE 0.61 (0.56- 0.66) in 20 studies, EuroSCORE II 0.62 (0.59-0.66)
in 15 studies, STS Score 0.62 (0.59-0.65) in 20 studies, Ambler Score 0.54
(0.49-0.58) in 4 studies and Parsonnet Score 0.51 (0.44-0.58) in 2
studies. Respective Peto's odds ratios (95% confidence interval) were
EuroSCORE 0.32 (0.30-0.35), EuroSCORE II 1.31 (1.14-1.50), STS 0.84
(0.76-0.94), Ambler Score 1.46 (1.09-1.96) and Parsonnet Score 0.38
(0.29-0.50). Areas under curve (95% confidence interval) for 1-year
mortality were EuroSCORE 0.62 (0.57-0.67), EuroSCORE II 0.66 (0.61- 0.71)
and STS Score 0.58 (0.53-0.64). Conclusion: Only the widely used
EuroSCORE, EuroSCORE II and STS Scores moderately discriminated operative
and 1-year mortality. EuroSCORE and Parsonnet score grossly over-estimated
operative mortality, while EuroSCORE II/Ambler Score and STS Score
marginally under-estimated and over-estimated operative mortality
respectively, but this varied by the level of estimated surgical risk.

<201>
Accession Number
612283399
Author
Jafri H.; Offerhaus J.; Schulman S.P.; Cingolani H.
Institution
(Jafri, Offerhaus, Schulman, Cingolani) Johns Hopkins University of
Baltimore, Medicine/Cardiology, Baltimore, United States
Title
Cardioprotective effects of Melatonin in patients undergoing cardiac
surgery.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 886), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Cardiac surgery and cardiopulmonary bypass (CPB) play a key role in the in
the development of post op arrhythmias and hemodynamic instability.
Increased oxidative stress (ROS) are associated with CPB. Animal studies
have demonstrated that ROS may lead to electroanatomical remodeling and
increase the vulnerability to cardiac arrhythmias. A few randomized
controlled trials have demonstrated a small beneficial effect pre-treating
patients undergoing cardiac surgery with statins, which are known to have
anti-ROS properties. Other trials have also explored compounds with
similar mechanistic effects. The problem is that most antioxidants used to
date, fail to reach optimal concentrations inside the cells, making them
inefficient. Melatonin (N-acetyl-5-methoyxtryptamine) has been shown to be
a powerful scavenger of ROS and is regarded as the most potent endogenous
antioxidant. In fact, melatonin (M) is more effective than other
antioxidants in removing free radicals and activating the antioxidant
transcription factor NRF-2, and has both lipophilic and hydrophilic
properties contributing to its more consistent penetration through
cellular membranes. We have previously shown that M prevents pressure
overload hypertrophy and pressure in animals. This time we decided to test
the hypothesis that Melatonin will prevent cardiac arrhythmias in patients
undergoing cardiac surgery. Methods: In this randomized, double blind,
placebo controlled pilot study, (DREAM study) 20 patients were randomized
to receive high dose M, 40 mg at night or placebo (P) starting 2 days
before the surgery through post-op day 3. Left atrial appendage (LAA) was
removed at the end of surgery before decanulation and rapidly stored in
liquid nitrogen for ROS determination by TBARS (ELISA), and the
antioxidant transcription factor NRF-2 (qPCR). The primary endpoint was
incidence of post op atrial fibrillation (AF). The secondary endpoint was
post op complications specified as ventricular arrhythmias (VF/VT),
hypotension requiring pressor drugs, coagulopathy, renal failure or death.
Patients were followed from pre-op day until discharged from hospital.
Results: 10 patients received Melatonin and 10 placebo. There was no
difference in the incidence of AF (3 in each group). Among patients
receiving P, 4 had post op complications (3 with VF /VT, 2 with
hypotension, one with coagulopathy), whereas none in the M group did
(p<0.001). Patients receiving M were also discharged earlier from the
hospital, and had better post op renal function (p<0.05). The antioxidant
transcription factor NRF-2 (mRNA) was also higher in LAA from patients
receiving M (P<0.005; M versus P). Lipid peroxidation (TBARS) levels were
also lower in LAA from the M group (p=0.02, M vs P). Conclusion: Melatonin
seems to be cardioprotective in patients undergoing cardiac surgery, lat
least in part through a ROS scavenging mechanism and also by an effect
mediated by the antioxidant transcription factor NRF-2.

<202>
Accession Number
612283390
Author
Weber M.; Weigert A.; Klein U.; Momcilovic D.; Schueler R.; Oeztuerk C.;
Pingel S.; Stundl A.; Sinning J.-M.; Hammerstingl C.; Werner N.; Grube E.;
Nickenig G.; Ghanem A.
Institution
(Weber, Weigert, Klein, Momcilovic, Schueler, Pingel, Stundl, Sinning,
Hammerstingl, Werner, Grube, Nickenig) University of Bonn, Medical Clinic
II - Cardiology, Bonn, Germany
(Oeztuerk, Ghanem) Asklepios Clinic St. Georg, Department of Cardiology,
Hamburg, Germany
Title
Benefit of pre-and intensified post-procedural physiotherapy in patients
with symptomatic aortic stenosis undergoing transcatheter aortic valve
implantation (4P-TAVI) study.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 943), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Percutaneous transcatheter techniques emerge in the treatment
of high risk patients with aortic stenosis. The objective of this study is
to demonstrate that pre-procedural and intensified post-procedural
physiotherapy is associated with a better functional and clinical outcome.
Methods: This is a prospective study of 51 patients randomized in two
groups. While patients in group A (control group: 24 patients, age:
83,0+/-6,6 years, 46% male) did not receive physiotherapy prior
transcatheter aortic valve implantation (TAVI), group B (intervention
group: 27 patients, age 82,5+/-6,2 years, 44% male) participated in
intensive physiotherapy which comprises inspiratory muscle training (IMT,
4x5minutes/day) and a minimum of 30 minutes of walking below the threshold
of subjective exhaustion. After TAVI, the participants of both groups A
and B get individual therapy with supervision of a physiotherapist (group
B: 2x30 minutes/day, group A: 1x30 minutes/day). After TAVI 30 and 90 days
Follow-up (FU) included clinical examination and standardized functional
and psychological tests. Results: Patients in the interventional group had
a 5 days shorter mean hospital stay (p<0.05), a lower rate of
postoperative pulmonary complications score 3 months after TAVI
(PPC-Score: 0,07+/-0,26 vs. 0,8+/-1,3, p<0.05) and a lower NYHA value 3
months after TAVI (NYHA: 1,4+/-0,4 vs. 2,2+/-0,7, p<0.05). Mortality,
rehospitalisation rate and psychological status was not different between
groups. Conclusion: Intensified periinterventional physiotherapy seems to
have positive effects on clinical outcome 90 days after TAVI. These
preliminary results of the 4P TAVI study should be regarded as hypothesis
generating. Longer follow up and higher numbers of subjects are needed to
confirm these interim results.

<203>
Accession Number
612283201
Author
Cordoba Soriano J.G.; Jimenez Mazuecos J.; Gutierrez Diez A.; Diaz
Fernandez J.F.; Sanchez Burguillos F.J.; Botas Rodriguez J.; Lazaro Garcia
R.; Herrero Garibi J.; Gallego Sanchez G.; Roa Garrido J.; Perez Santigosa
P.; Hernando Marrupe L.; Valencia Serrano F.; Robles J.; Gallardo Lopez A.
Institution
(Cordoba Soriano, Jimenez Mazuecos, Gutierrez Diez, Gallego Sanchez,
Gallardo Lopez) Complejo Hospitalario, Universitario De Albacete,
Albacete, Spain
(Diaz Fernandez, Roa Garrido) Hospital Juan Ramon Jimenez, Huelva, Spain
(Sanchez Burguillos, Perez Santigosa) Hospital Universitario Virgen De
Valme, Sevilla, Spain
(Botas Rodriguez, Hernando Marrupe) Fundacion Hospital Alcorcon, Alcorcon,
Spain
(Lazaro Garcia, Valencia Serrano) Hospital Torrecardenas, Almeria, Spain
(Herrero Garibi, Robles) University Hospital of Burgos, Burgos, Spain
Title
TAVR procedures with self-expandable valves can be safely performed in
centres without on site cardiac surgery.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 749), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Current guidelines restrict TAVR procedures for centres with
on site cardiac surgery due to the possibility of the need for emergent
open-surgery conversion. Today the evidence available to recommend the
opposite is scarce. Purpose and methods: Multicentre prospective registry
to analyse patients and procedure characteristics as well as outcomes of
patients undergoing TAVR in six centres without on site cardiac surgery.
All centres have the possibility for transfer to a reference centre for
urgent (non-emergent) cardiac surgery as well as all procedures were
accepted by each heart-team. VARC-2 definitions were used. Results: We
included 206 patients (81.6+/-5 years; 49% male; mean STS score 5+/-3%;
mean EUROSCORE 18+/-10%; NYHA III-IV 72%; LVEF 54+/-11%; Mean aortic valve
area 0.67+/-0.2 cm²). The mean distance from the cardiac
surgery centre of reference was 66 Km (0.2-154 Km). The 28% of the
procedures were performed under general anaesthesia with fully
percutaneous intervention in 90%. Pre-dilatation was performed in 74% of
the patients and 20% of valves were postdilated. The success of the device
was achieved in 97%. Regarding the outcomes, in-hospital mortality and at
30 days was 4.9% and 4.4% respectively (2.45% cardiovascular and 2.45%
non-cardiovascular death). No annular ruptures or aortic dissections were
described. There were 4 cardiac perforations and 3 coronary occlusions
which were managed percutaneously. No transfers to urgent or elective
surgery occurred. The incidence of major bleeding and major vascular
complications was 8% and 3.9% respectively and 26% required a definitive
pacemaker insertion. Conclusions: In this multicentre registry survival at
discharge and 30-day are similar to those published in centres with on
site cardiac surgery. The few complications recorded were all managed
percutaneously. Nowadays with the improvements of self-expandable devices
and the higher experience on the selection of patients the restriction of
TAVR interventions for centres without on site cardiac surgery does not
seem reasonable.

<204>
Accession Number
612283169
Author
Carmo J.; Ferreira J.; Costa F.M.; Vale N.; Castro M.; Rodrigues G.;
Mendes M.
Institution
(Carmo, Ferreira, Costa, Vale, Castro, Rodrigues, Mendes) Hospital De
Santa Cruz, Lisbon, Portugal
Title
Coronary artery bypass surgery or percutaneous coronary intervention in
multivessel disease: A systematic review and meta-analysis of randomized
trials.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 392), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: The best approach for patients with multivessel coronary
disease remains uncertain. Randomized trials on coronary artery bypass
graft (CABG) surgery versus percutaneous coronary intervention (PCI) in
multivessel disease were not designed to detect differences in mortality.
Purpose: To compare mortality and long-term morbidity for the two
strategies in multivessel coronary disease through a review and
meta-analysis of randomized trials. Methods: We searched PubMed, Embase
and Scopus databases until December 2015, without language restrictions.
We selected studies according to the following criteria: follow-up of at
least one year, at least one arterial graft in >=90% of CABG patients, at
least one stent in >=70% of PCI patients and reported mortality and
clinical events. Results: A total of seven studies involving 7640 patients
were selected (3815 underwent CABG and 3825 underwent PCI). Mean follow-up
was 4 years. The risk of mortality was significantly lower in patients
treated with CABG (risk ratio RR 0.76, 95% CI 0.66-0.88, p<0.001) compared
to those treated with PCI. There was also a significant reduction in the
risk of myocardial infarction (RR 0.62, 0.46- 0.86, p=0.004) and in the
need for coronary revascularization (RR 0.34, 0.24 to 0.50, p<0.001) in
patients treated with CABG when compared to those treated with PCI.
However, there was an increased risk of ischaemic stroke in patients
treated with CABG (RR 1.45, 1.10-1.91, p=0.008) when compared to patients
treated with PCI. Conclusion: In multivessel coronary artery disease, CABG
was associated with a lower risk of mortality, myocardial infarction and
coronary revascularization, but with an increased risk of stroke when
compared with PCI.

<205>
Accession Number
612283139
Author
Pontes M.R.N.; Sales M.C.; Furini F.; Oliveira A.; Rosler A.M.; Fraportti
J.; Lima V.C.; Brito F.S.; Lucchese F.A.
Institution
(Pontes) Federal University of Health Sciences of Porto Alegre, Porto
Alegre, Brazil
(Sales, Furini, Oliveira, Rosler, Fraportti, Lima, Lucchese) Hospital Sao
Francisco, Cardiovascular Surgery, Porto Alegre, Brazil
(Brito) Hospital Israelita Albert Einstein, Interventional Cardiology, Sao
Paulo, Brazil
Title
Atrial fibrillation increases short-term outcomes and 1-year mortality
after transcatheter aortic valve implantation: An analysis of the
brazilian multicenter TAVI registry (RIBAC).
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 748), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Introduction: Risk evaluation and patient selection for transcateter
aortic valve implantation (TAVI) are evolving and the impact of atrial
fibrillation (AF) still unknown. The goal was to evaluate the impact of
previous AF (PREAF) and new onset perioperative AF (NOPAF) in the short
and long-term outcomes in patients who underwent TAVI. Methods: The RIBAC
enrolled 819 TAVI patients (Jan2008-Dec2014). Outcomes defined according
to VARC-II included immediate mortality (72h), 30-day and 1- year
complications and mortality. Groups: No-AF, PREAF and NOPAF. Univariate
analysis was performed to detect variables associated with short and
long-term complications and all-cause and cardiovascular mortality.
Survival analysis with Kaplan-Meyer and Cox Regression. Results: 49% male;
82+/-7years. No-AF 684 patients (83,5%); PREAF 109 patients (13,3%); NOPAF
26 patients (3,2%). 96% of transfemoral access. PREAF group showed higher
prevalence of pulmonary hypertension and NYHA Class III-IV. 30-day
mortality 8,9%, immediate mortality 5% and procedural mortality 11,7%.
NOPAF showed increases in hospital stay (No-AF 12+/-18, PREAF 14+/-23,
NOPAF 24+/-70, p=0,024), and a nonsignificant trend to increased 30- day
incidence of stroke, vascular complications and death. PREAF increase 1-
year incidence of all-cause death (No-AF 19,6%; PREAF 35,7%;NOPAF 16,1%;
p<0,001). In a fully adjusted Cox regression model, previous FA was an
independent preditor of 1-year all-cause death (HR1,92; 95CI:1,31-2,81;
p=0,001). Other independent predictors include age, severe HF and mitral
regurgitation. Conclusion: In TAVI patients, New Onset AF is associated
with short-term morbidity and longer hospital stay. Previous AF is an
independent predictor of 1-year all-cause death after TAVI. The presence
of AF should be included in the preoperative risk evaluation of patients
for TAVI. (Figure Presented).

<206>
Accession Number
612283014
Author
Drozd M.; Joy E.R.; Giurula J.; Paton M.F.; Jamil H.A.; Cubbon R.M.;
Kearney M.T.; Witte K.K.
Institution
(Drozd, Joy, Giurula, Paton, Jamil, Cubbon, Kearney, Witte) University of
Leeds, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds,
United Kingdom
Title
Cardiac resynchronization therapy outcomes in patients with chronic heart
failure: CRT-P vs. CRT-D.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 200-201), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Introduction: Cardiac resynchronization therapy (CRT) for chronic heart
failure (CHF) with left ventricular systolic dysfunction (LVSD) has
consistently been shown to improve survival against optimal medical
therapy. Limited data exist comparing the outcomes between CRT with
pacemaker (CRT-P) and defibrillator (CRT-D). We aimed to investigate the
long-term prognosis of patients who received CRT-P or CRT-D. Methods: Data
were prospectively collected from all consecutive patients with CHF
(LVEF<35%) and standard indication for CRT who were implanted with a CRT
device at a single tertiary centre between 2008 and 2012. All-cause
mortality and total hospitalisation were compared between those patients
who received either CRT-P or CRT-D. Analyses were also stratified by
aetiology of heart failure comparing ischaemic and non-ischaemic CHF.
Results: We analysed data on 795 patients receiving CRT devices: 544
(68.4%) CRT-P and 251 (31.6%) CRT-D. During a mean follow-up of 1072 days,
there were a total of 272 (34.2%) patient deaths, 189 patients (35%) with
CRT-P and 83 patients (33%) with CRT-D. In the total cohort, there was no
survival benefit in those patients implanted with a CRT-D compared to
CRT-P (HR 1.09, 95% CI 0.84-1.41, p=0.51). In patients with non-ischaemic
CHF (n=265 (33.3%)), there was no survival benefit (HR 0.98 95% CI
0.42-2.27, p=0.96) nor difference in hospitalisation associated with CRT-D
compared to CRT-P (HR 1.05, 95% CI 0.53-2.08, p=0.89). In patients with
ischaemic CHF (n=530 (66.7%)), there was a trend for improved survival
with CRT-D however this was not significant after adjustment for age and
sex (HR 0.85, 95% CI 0.61-1.17, p=0.31). There was a lower risk of
hospitalisation in those receiving CRT-D compared to CRT-P (HR 0.52, 95%
CI 0.39-0.69, p<0.001) in patients with ischaemic CHF that persisted
despite correction for age, sex, and other clinical variables of relevance
including but not limited to NYHA class, atrial fibrillation, creatinine,
coronary artery bypass graft, percutaneous coronary intervention,
medication use including ACE inhibitors/angiotensin receptor blockers,
beta-blockers, amiodarone and digoxin suggesting unmeasured confounders of
general health may be relevant. Conclusions: We did not find a survival
benefit of CRT-D compared with CRT-P in our unselected consecutive
population. A randomised placebo-controlled trial would be required to
eliminate the effect of unmeasured confounders.

<207>
Accession Number
612282938
Author
Romanov A.; Goscinska-Bis K.; Bis J.; Cherniavsky A.; Prokhorova D.;
Syrtceva Y.; Shabanov V.; Ponomarev D.; Alsov S.; Karaskov A.; Deja M.;
Krejca M.; Pokushalov E.
Institution
(Romanov, Cherniavsky, Prokhorova, Syrtceva, Shabanov, Ponomarev, Alsov,
Karaskov, Pokushalov) State Research Institute of Circulation Pathology,
Novosibirsk, Russian Federation
(Goscinska-Bis, Bis, Deja, Krejca) Medical University of Silesia,
Katowice, Poland
Title
Cardiac resynchronization therapy combined with coronary artery bypass
grafting in ischemic heart failure patients: Long-term results of the
rescue study.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 422), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Aims: Totally epicardial cardiac resynchronization therapy (CRT) is a
novel treatment modality for patients with heart failure and systolic
dyssynchrony undergoing coronary artery bypass grafting (CABG). In this
study we have prospectively evaluated the long-term outcomes of totally
epicardial CRT Methods: Between September 2007 and June 2009, one hundred
seventy eight patients were randomly assigned to the CABG alone group
(n=87) and CABG with concomitant epicardial CRT implantation (n=91). The
primary endpoint of the study was all-cause mortality in the two groups
between the day of surgery and August 13, 2013 (common closing date). The
secondary outcomes included mode of death, adverse cardiac events and lead
performance Results: The mean follow-up was 55+/-10.7 months. According to
per-protocol analysis with treatment as a time-dependent variable to
account for conversion from CABG to CABG+CRT, there were 24 deaths (35.8%)
in the CABG group and 17 deaths (15.3%) in the CABG+CRT group. As compared
to CABG alone concomitant CRT was associated with reduced risk of both
all-cause mortality (hazard ratio (HR) 0.43, 95% confidence interval (CI)
0.23 to 0.84, p=0.012) and cardiac death (HR 0.39, 95% CI 0.21 to 0.72,
p=0.002). Eleven (12.6%) sudden deaths were observed in the CABG group in
comparison to 4 (4.4%) in the CABG+CRT group (p=0.048). Hospital
re-admission was required for 9 (9.9%) patients in CABG + CRT group and
for 25 (28.7%) patients in CABG group (p=0.001). There were 4 (1.5%)
epicardial lead failures Conclusion: The results of our study suggest that
the procedure of coronary artery bypass grafting and totally epicardial
CRT system implantation is safe and significantly improves the survival of
patients with heart failure and dyssynchrony during long-term follow up.

<208>
Accession Number
612282869
Author
Medina-Inojosa J.R.; Allison T.A.; Somers V.; Thomas R.J.; Gomez Ibarra
M.A.; Leth S.; Barr L.; Jean N.; Lopez-Jimenez F.
Institution
(Medina-Inojosa, Allison, Somers, Thomas, Gomez Ibarra, Leth, Barr, Jean,
Lopez-Jimenez) Mayo Clinic, Rochester, United States
Title
Peak oxygen uptake during exercise testing and long-term cardiovascular
events in patients with coronary artery disease undergoing cardiac
rehabilitation: A population-based study.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 623), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Measurement of percentage of predicted peak oxygen consumption
(%VO2) during cardiopulmonary exercise testing has been shown to predict
mortality in patients with coronary artery disease (CAD). Its association
with major adverse cardiovascular events (MACE) has not been determined.
Purpose: To test the hypothesis that decreased exercise capacity
(represented by %VO2) is associated with long-term MACE in patients with
CAD in the community. Methods: We performed a community-based
retrospective longitudinal study on stable CAD patients entering Phase II
cardiac rehabilitation between the years 2002 through 2012 and who
completed a symptom-limited graded VO2 treadmill exercise test. VO2 was
computed using a Medical Graphics CPX/D metabolic cart after collecting
expired gases. %VO2 was estimated using the Astrand equation for men and
the Jones equation for women. The composite outcome of MACE included acute
coronary syndromes (myocardial infarction or unstable angina), coronary
artery bypass graft, percutaneous coronary revascularization, ventricular
arrhythmias requiring hospitalization, stroke or death from any cause, and
was ascertained using a record linkage system. Cox proportional hazard
models were adjusted for age, gender, and factors known to affect both
exercise capacity and MACE (See table). Results: Our cohort included 887
patients, 77% males, mean age 63+/-12 years. After a mean follow-up of 5
years, 172 patients had a MACE (#): MI (50), unstable angina (33), CABG
(14), PCI (93), ventricular arrhythmia (5), stroke (17) and death (25).
Normal or increased exercise capacity was related to lower rate of MACE
(HR 0.43, 95% CI 0.21-0.79, p=0.04) comparing those with %VO2 >=100% to
those with %VO2 <100%. The lower the %VO2 the higher the rate of MACE (See
table). Per each 1 mL/kg/min decrease in % VO2 the risk for MACE increased
1% (HR 1.01, p=0.02). Conclusion: Patients with normal or increased
exercise capacity had reduced rates of MACE events. The lower the %VO2 the
higher the rate of MACE, suggesting that exercise capacity at time of
cardiac rehabilitation predicts cardiovascular outcomes. (Table
Presented).

<209>
Accession Number
612282860
Author
Hioki H.; Watanabe Y.; Kozuma K.; Nara Y.; Kawashima H.; Kataoka A.;
Yamamoto M.; Takagi K.; Araki M.; Tada N.; Shirai S.; Nakayama F.;
Hayashida K.
Institution
(Hioki, Watanabe, Kozuma, Nara, Kawashima, Kataoka) Teikyo University
Hospital, Division of Cardiology, Department of Internal Medicine, Tokyo,
Japan
(Yamamoto) Toyohashi Heart Center, Division of Cardiovascular Medicine,
Aichi, Japan
(Takagi) New Tokyo Hospital, Interventional Cardiology Unit, Chiba, Japan
(Araki) Yokohama City Easter Hospital, Department of Cardiovascular
Medicine, Kanagawa, Japan
(Tada) Sendai Kosei Hospital, Department of Cardiovascular Center, Sendai,
Japan
(Shirai) Kokura Memorial Hospital, Department of Cardiology, Kokura, Japan
(Nakayama) Shonan Kamakura General Hospital, Department of Cardiovascular
Center, Kamakura, Japan
(Hayashida) Keio University, School of Medicine, Department of Cardiology,
Tokyo, Japan
Title
Do we need antiplatelet therapy before transcatheter aortic valve
implantation?.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 151), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: The clinical benefit of pre-procedural antiplatelet therapy
before transcatheter aortic valve implantation (TAVI) has not been
established. Objective: The aim of this study is to evaluate the incidence
of adverse events in patients undergoing transfemoral TAVI with and
without pre-procedural antiplatelet therapy using multicenter cohort data.
Methods: OCEAN-TAVI registry is a prospective, multicenter, observational
cohort registry, enrolling 749 patients who underwent TAVI from October,
2013 to August, 2015 in Japan. Of 749 patients, we identified 540 patients
(median age 85 years, 68.1% female) undergoing transfemoral TAVI without
pre-procedural antiplatelet therapy (n=80) and with antiplatelet therapy
(n=460). The clinical endpoints were any bleeding (life-threatening,
major, and minor bleeding) and thrombotic event (stroke, myocardial
infarction and valve thrombosis) during hospitalization. Results: The
prevalence of heart failure on admission, diabetes mellitus, and previous
percutaneous coronary intervention were higher in antiplatelet therapy
than in no antiplatelet therapy (86.1% vs. 58.8%, p<0.001; 26.7% vs.
11.3%, p=0.001; 31.1% vs. 1.3%, p<0.001). The puncture approach and median
Logistic EuroSCORE II were lower in antiplatelet therapy (47.4% vs. 80.0%,
p<0.001; 3.25 vs. 4.17, p=0.004). The patients with antiplatelet therapy
had significantly higher incidence of any bleeding than those without
antiplatelet therapy (p=0.024). No antiplatelet therapy before TAVI did
not increase the risk of thrombotic event. In multivariate logistic
regression analysis, dual antiplatelet therapy (DAPT) before TAVI
significantly increased the risk of any bleeding than no antiplatelet
therapy (Odd ratio, 2.35; 95% confidence interval, 1.15-4.80). The risk of
bleeding was not different between single and no antiplatelet therapy
before TAVI. Conclusion: In current study, DAPT before TAVI increased the
risk of bleeding. In modern TAVI era, it might be acceptable to perform
TAVI on pre-procedural single or no antiplatelet therapy without the
increase of adverse events.

<210>
Accession Number
612282838
Author
Sobczak M.; Qawoq H.; Krawczyk M.; Kasprzak J.D.
Institution
(Sobczak, Qawoq, Krawczyk, Kasprzak) Medical University in Lodz, Dep. of
II Chair and Cardiology, Lodz, Poland
Title
Effects of cognitive behavioral therapy in cardiac electrotherapy device
recipients.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 684), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Purpose: Modern cardiac electrotherapy (CE) improves health-related
quality of life (QoL), but up to one-third of CE recipients experience
psychological distress after implantation, including anxiety or
depression. The purpose of this study was to evaluate the effects of
custom-designed cognitive-behavioral therapy (CBT) programme in patients
undergoing CE. Methods: Patients qualified for CE device implantation were
randomized in order to receive either four weeks of CBT or standard
medical care. CBT consisted of four one-hour sessions conducted over 30
(+/-3) days with a psychologist (practice nurse may also perform the
therapy), who had received standardized training. Demographic, clinical
and psychological factors were assessed. Beck Depression Inventory (BDI),
State-Trait Anxiety Inventory (STAI), Acceptance of Illness Scale (AIS),
and EuroQol-5D (EQ-5D) health questionnaires were used twice [at baseline
(0), and 6 months after the implantation (6)]. Repeated measures analysis
was used in order to assess the changes in effects of the intervention
over time. Results: We studied 128 patients (36,7% women, mean age
64,5+/-8,9). There were no statistically significant differences in
psychological parameters between groups at baseline. The proposed cycle of
four structured CBT meetings was well accepted by the patients, which is
confirmed by their high turnout for these meetings. After six months,
psychological/QoL indices were significantly improved in CE recipients
assigned to CBT, including: Visual Analogue Scale EQ-5D [80.2+/-11.8 vs
64.9+/-14.3 (p<0.0001)], weaker occurrence of depression symptoms (BDI:
8.4+/-4.2 vs 11.0+/-5.2 (p=0.0003), lower anxiety level [STAI-trait:
31.4+/-5,9 vs 38.1+/-9.6 (p<0,0001) and STAI-state: 32.2+/-5.5 vs
38.5+/-8.9 (p=0,0001)], and better acceptance of illness [AIS: 35.6+/-4.3
vs 28.7+/-6.1 (p<0.0001)]. Interestingly, these benefits were accompanied
by better exercise tolerance [6-minute walk test: 392.5+/-128.2 vs
349.3+/-106.7 (p=0,02), which equates 144%+/-28% vs 129%+/-18% (p=0,0001)]
as compared to the patients subject to standard care following their
electrotherapy. Conclusions: Our study has important clinical implications
for nursing and medical management, caring for the group of patients in
question. Custom-designed protocol of four cognitive-behavioral therapy
sessions significantly improved indices of quality of life, depression,
anxiety, and acceptance of illness, as well as exercise tolerance (6MWT)
six months after cardiac electrotherapy procedure. CBT has multiple
benefits in this population, as well as ensured the fulfillment of its
expected therapeutical effect, while the short duration of the therapy did
not prolong hospitalization itself.

<211>
Accession Number
612282809
Author
Halliday B.P.; Gulati A.; Ali A.; Guha K.; Arzanauskaite M.; Newsome S.;
Lota A.; Tayal U.; Vassiliou V.; Auger D.; Khalique Z.; Pareek N.; Pennell
D.J.; Cook S.; Prasad S.K.
Institution
(Halliday, Gulati, Ali, Guha, Arzanauskaite, Lota, Tayal, Vassiliou,
Auger, Khalique, Pareek, Pennell, Cook, Prasad) Royal Brompton Hospital,
Department of Cardiovascular Magnetic Resonance, London, United Kingdom
(Newsome) London School of Hygiene and Tropical Medicine, London, United
Kingdom
Title
Risk stratification of mild-to-moderate phenotypes of dilated
cardiomyopathy-the role of mid-wall fibrosis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 198-199), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Current stratification for prophylactic implantable
cardioverter defibrillator (ICD) therapy in non-ischaemic dilated
cardiomyopathy (DCM) is based on left ventricular ejection fraction
(LVEF<=35%). However, this approach lacks sensitivity and specificity for
the prediction of sudden cardiac death (SCD). Between 60-70% of SCD cases
occur in individuals with LVEF>35%. Improved SCD risk stratification of
DCM patients with mild and moderately reduced LVEF is an unmet need.
Purpose: To investigate whether myocardial mid-wall fibrosis, detected by
late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR),
predicts SCD risk in DCM patients with mild and moderately reduced LVEF.
Methods: We prospectively studied consecutive patients with DCM referred
for CMR between 2000 and 2011. The diagnosis of DCM with an LVEF between
40 and 60% was made using clinical, CMR and coronary angiographic
findings. The presence of mid-wall fibrosis was determined by a specialist
blinded to all clinical data. The primary end-point was a composite of SCD
and aborted SCD. Secondary end-points were all-cause mortality, and
composites of cardiovascular (CV) mortality and cardiac transplantation
and CV mortality, CV hospitalisation and cardiac transplantation. An
independent panel, blinded to the CMR results, adjudicated outcome events.
Results: 408 patients (259 male, mean age 50 yrs, mean LVEF 49.5%) were
followed up for a median duration of 4.5 years. In total, 22 of the 117
(19.0%) patients with mid-wall fibrosis reached the SCD composite
end-point, compared with 13 of the 291 patients (4.5%) without mid-wall
fibrosis (HR 5.9, 95% CI 2.8-12.29, p<0.0001; figure 1). On multivariable
analysis, after adjustment for LVEF and other conventional prognostic
factors, fibrosis remained an independent predictor of the primary
endpoint (HR 5.80, 95% CI 2.7-12.4, p<0.001). When analysed individually
in multivariable analysis, fibrosis was predictive of sudden cardiac
(Figure Presented) death (HR 3.1, 95% CI 1.1-8.4, p=0.03) and aborted
sudden cardiac death (HR 10.9, 95% CI 3.4-35.5 p<0.0001). Fibrosis also
independently predicted composites of CV mortality and transplantation (HR
3.4, 95% CI 1.4-8.2, p=0.006) and CV mortality, CV hospitalization and
transplantation (HR 2.6, 95% CI 1.6- 4.1, p<0.0001) but was not
significantly associated with all-cause mortality (HR 1.4, 95% CI 0.7-2.9,
p=0.34). Conclusion: Mid-wall fibrosis on LGE-CMR is a significant
independent predictor of SCD risk in DCM patients with mild and moderately
reduced LVEF. Our findings support the potential utility of LGE-CMR in
identifying patients with mild and moderate phenotypes of DCM at high risk
of SCD who may benefit from primary prevention ICD therapy but do not meet
current LVEF criteria.

<212>
Accession Number
612282794
Author
Nunes Filho A.C.B.; Katz M.; Campos C.M.; Carvalho L.A.; Siqueira D.;
Tumelero R.T.; Portella A.L.F.; Esteves V.; Perin M.A.; Lemos P.A.;
Mangione J.A.; Sarmento-Leite R.; Tarasoutchi F.; Brito F.S.
Institution
(Nunes Filho, Katz, Campos, Perin, Tarasoutchi, Brito) Hospital Israelita
Albert Einstein, Sao Paulo, Brazil
(Carvalho, Siqueira, Tumelero, Portella, Esteves, Lemos, Mangione,
Sarmento-Leite) Sociedade Brasileira De Hemodinamica E Cardiologia
Intervencionista, Sao Paulo, Brazil
Title
Acute kidney injury following transcatheter aortic valve implantation:
Does it affect long-term outcomes?.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 420), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Acute kidney injury (AKI) is frequently observed after
transcatheter aortic valve implantation (TAVI) and is associated with
mortality. However, there is conflicting evidence regarding the impact of
AKI on the long-term. Additionally previous studies used heterogeneous
definitions of AKI including the VARC-1 definitions and consider only
short- and mid-term follow-up periods Purpose: Therefore, in this study we
aimed to evaluate the clinical impact of AKI on long-term (up to 4 years)
all-cause and cardiovascular mortality after TAVI using the updated VARC-2
criteria Methods: From January 2008 to January 2015, 819 consecutive
patients with symptomatic severe aortic stenosis underwent TAVI and were
included in a multicenter Brazilian registry. Four-year outcomes were
determined as Kaplan-Meier survival curves and compared using a log-rank
test. An exploratory landmark analysis was used to test the impact of AKI
considering only survivors at 12 months and follow-up starting after one
year. Cox proportional hazards models were used to test the impact of AKI
on all-cause and cardiovascular mortality. A stepwise logistic regression
analysis was used to identify the predictors of AKI The criterion for
statistical significance was P<0.05 Results: The incidence of AKI
following TAVI was 18%. Independent predictors of AKI were: age, diabetes
mellitus, major or life threatening bleeding and valve malpositioning, the
latter being the strongest predictor of AKI (OR 4.9; 95% CI 2.4-9.9;
p<0.001). AKI was associated with higher all-cause HR 3.06 (95% CI
2.06-4.55; p<0.001) and cardiovascular mortality HR 4.24 (95% CI
2.52-7.12; p<0.001) over the entire follow-up period. However, when
considering only survivors at 12 months, there was no difference in
all-cause HR 1.20 (95% CI 0.60- 2.39; p=0.58) and cardiovascular mortality
HR 1.35 (95% CI 0.46-3.95; p=0.4). Conclusions: Acute kidney injury is a
frequent complication after TAVI, with older age, diabetes, major or
life-threatening bleeding and valve malpositioning being independent
predictors of AKI. The impact of AKI on mortality was limited mostly to
the first year after TAVI, questioning the real impact of AKI on the
long-term. (Figure Presented).

<213>
Accession Number
612282793
Author
Sinning J.M.; Van Mieghem N.M.; Zucchelli G.; Nickenig G.; Bekeredjian R.;
Bosmans J.; Bedogni F.; Branny M.; Stangl K.; Kovac J.; Schiltgen M.;
Nordell A.; De Jaegere P.; Petronio A.S.
Institution
(Sinning, Nickenig) II. Medizinische Klinik, Universitatsklinikum Bonn,
Bonn, Germany
(Van Mieghem, De Jaegere) Erasmus Medical Center, Rotterdam, Netherlands
(Zucchelli, Petronio) Azienda Ospedaliero-Universitaria Pisana, Pisa,
Italy
(Bekeredjian) University Hospital of Heidelberg, Heidelberg, Germany
(Bosmans) University of Antwerp Hospital (Edegem), Antwerp, Belgium
(Bedogni) Sant'Ambrogio Clinical Institute, Milan, Italy
(Branny) Hospital Podlesi, Trinec, Czech Republic
(Stangl) Charite - Campus Mitte (CCM), Berlin, Germany
(Kovac) University Hospitals of Leicester, Glenfield Hospital, Leicester,
United Kingdom
(Schiltgen) Department of Structural Heart Clinical Operations, Medtronic,
Minneapolis, United States
(Nordell) Department of Biostatistics, North American Sciences Associates,
Inc., Minneapolis, United States
Title
Transcatheter aortic valve replacement with the self-expanding CoreValve
prosthesis performed using clinical best practices: Impact on clinical
outcomes to six months. The ADVANCE II study.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 150), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Best clinical practice recommendations include control of
implant depth to 6 mm or less relative to the aortic annulus, valve size
selection based on MSCT images, and management of post-transcatheter
aortic valve replacement (TAVR) conduction disturbances according to
international guidelines. Objective: To assess outcomes in TAVR patients
treated in accordance with best clinical practices for CoreValve
implantation. Methods: Patients with severe aortic stenosis at high risk
for surgery were enrolled in the multicenter, prospective, observational
ADVANCE II study and followed for 6 months. All imaging and ECG data were
analyzed by an independentcore laboratory. Safety-related adverse events
were adjudicated to valvular academic research consortium-2 (VARC-2)
definitions by an independent clinical events committee. Results: From
October 2011 to April 2013, 200 patients were enrolled, and 194 were
implanted. The mean age was 80.2+/-6.7 years, 47.5% were male, and the
mean STS-PROM was 7.2+/-6.8%. At 6 months, all-cause mortality was 9.2%,
stroke was 2.6%, and permanent pacemaker implantation (PPI) was 19.2% for
class I and II indications. In patients with implant depth <=6 mm, both
mortality and PPI were lower than in patients with depth >6 mm (2.5% vs.
14.5%, p<0.01 and 18.1% vs. 31.7%, p=0.03, respectively). The rate of
moderate and severe paravalvular leak (PVL) decreased over time from was
9.8% at 7 days post-TAVR, to 4.3% at 6 months (p=0.02). Conclusions:
Findings from the ADVANCE II study reinforce that adherence to best
clinical practices has a strong positive impact on patient outcomes.
(Figure presented).

<214>
Accession Number
612282763
Author
Gonzalez Ferreiro R.; Pascual I.; Munoz-Garcia A.J.; Lopez Otero D.;
Avanzas P.; Alonso-Briales J.H.; Trillo Nouche R.; Moris C.;
Hernandez-Garcia J.M.
Institution
(Gonzalez Ferreiro) University of Santiago De Compostela, Cardiology,
Santiago de Compostela, Spain
(Pascual, Avanzas, Moris) University Hospital Central De Asturias, Oviedo,
Spain
(Munoz-Garcia, Alonso-Briales, Hernandez-Garcia) University Hospital
Virgen De La Victoria, Malaga, Spain
(Lopez Otero, Trillo Nouche) University Hospital of Santiago De
Compostela, Santiago de Compostela, Spain
Title
Effect of body mass index on mortality after transcatheter aortic valve
implantation: J-shaped curve.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 419-420), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Objectives: The aim of our study is to determine if the body mass index
(BMI) is a prognostic factor in patients undergoing transcatheter aortic
valve implantation (TAVI), in terms of long-term mortality from any cause
Background: In the context of established cardiovascular disease, obesity
is a good prognostic indicator, being protective factor. This is known as
"obesity paradox" In the group of patients undergoing TAVI, the prognostic
significance of BMI is a matter currently under discussion, because the
number of studies is scarce and wiht controversial results Methods: A
retrospective study was carried out in three centers. 770 patients
undergoing TAVI between 2008 and 2014. Patients were distributed according
to their BMI in three groups: normal weight (18,5-24,9 kg/m²),
overweight (25,0- 29,9 kg/m²) and obesity (30
kg/m²). The study endpoint was to assess, using Cox regression,
the value of BMI to predict all-cause mortality during follow-up Results:
A total of 155 patients died during follow-up (2,7+/-1,8 years). The
overweight group (n=302, 38,97%) has a lower mortality rate compared with
normal weight and obese groups (15,9% vs 25,7% y 21,0%; log-rank p-value
0,036) After adjusting for logistic EuroScore and other confounding
variables in the multivariate Cox regression analysis, overweight was
independent protective factor for mortality (HR: 0.63 [95% CI: 0.42 to
0.94], p=0.024), not obesity (HR: 0.92 [95% CI: 0.63 to 1.35], p=0.664).
In our study we describe for the first time a "J"- shaped regression, that
relates the BMI with long-term mortality (figure 1). Thus patients at the
extremes of the curve (underweight and extreme obesity) has the worst
prognosis, whereas patients who are overweight have the most favorable
prognosis. Conclusions: BMI has prognostic value in patients with severe
aortic stenosis undergoing TAVI, with a "J"-shaped curve. Overweight was
associated with lower long-term motality rate. (Figure Presented).

<215>
Accession Number
612282750
Author
Farkouh M.; Fuster V.
Institution
(Farkouh) Peter Munk Cardiac Centre, Toronto, Canada
(Fuster) Mount Sinai Medical Center, New York, United States
Title
Adjudicated cause of death in diabetic patients undegoing coronary
revascularization.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 42), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: The cause of death may provide insights into the beneficial
effects of coronary artery bypass grafting (CABG) over percutaneous
coronary intervention with drug-eluting stents (PCI) in diabetic patients
with multivessel coronary artery disease (MV-CAD). To date meta-analyses
have only reported all-cause mortality statistics. Purpose: To evaluate
the proportion of adjudicated deaths in the FREEDOM trial attributed to
cardiovascular (CV) causes and characterize the proportion of CV deaths
caused by fatal myocardial infarction (MI) or sudden death in diabetic
patients with MV-CAD undergoing either CABG or PCI. Methods: The FREEDOM
trial randomized 1900 diabetic patients with MV-CAD and demonstrated a
significant benefit for CABG over PCI in reducing the 5-year rates of
all-cause death, MI and stroke (18.7% versus 26.6%, p=0.005). The cause of
death was adjudicated by an independent Clinical Events Committee
comprised of cardiovascular and neurology experts. Deaths were classified
first as CV versus non-CV and then sub-classified for MI-related and
sudden cardiac deaths. Using an intention-to-treat approach, the
association of revascularization group and incidence of death within these
categories was evaluated. Results: There were 197 deaths during the 5 year
follow-up time, 114 in the PCI group and 83 in the CABG group. There was
no difference in the proportion of deaths from a CV cause in the 2 groups
(73 deaths (64.0%) in the PCI arm compared to 52 deaths (62.7%) in the
CABG group, p=0.88). There were trends for a greater proportion of deaths
from both fatal MI (12.3% versus 7.2%, p=0.34) and sudden cardiac death
(29.8% versus 18.1%, p=0.07) in the PCI arm. For the combination of fatal
MI and sudden cardiac death there was a greater proportion observed in the
PCI arm (42.1% versus 25.3%, p=0.02). Conclusions: PCI patients
experienced a greater likelihood of mortality from MI and sudden cardiac
death over 5 years of follow-up. The potential role of stent thrombosis
and progression of non-target lesions should be studied in diabetic
patients after PCI for MV-CAD to fully develop strategies to reduce these
types of events. More intensive medical therapy on the horizon may alter
the rates of ischemia-related CV deaths.

<216>
Accession Number
612282736
Author
Desai S.; Vijayashree N.; Merina A.; Benjamin N.; Rajan R.
Institution
(Desai, Vijayashree, Merina, Benjamin, Rajan) Madras Medical Mission,
Cardiac Anaesthesia, Chennai, India
Title
Effect of preoperative L-glutamine supplementation on primary outcomes in
elective cardiac surgery.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 729), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Introduction: Nutritional support is recognized as an essential component
of all medical care. Patients undergoing major cardiac surgeries are
usually characterized by enhanced oxidative stress, depressed immune
defense mechanism are at the risk of sepsis, have prolonged hospital stay
and high mortality rates. In addition to cardiac complications, the lack
of optimal nutrition can induce nutrient deficiencies of the immune
system. Objectives: To study the effect of preoperative oral L-glutamine
supplementation on biochemical parameters, ICU and hospital stay, rate of
infection and mortality of patients undergoing elective cardiac surgery.
Methods and materials: 80 Patients undergoing major cardiac surgery were
randomly selected for the study. 40 patients supplemented 20 gm of oral
LGlutamine preoperatively for five days (study group), 40 patients were
observed as control group. Total Leukocyte Count (TLC), C-reactive
protein, Lymphocyte, Platelets, Total protein, Serum Albumin, Hemoglobin,
Renal Function Test (RFT), Liver Function Test (LFT) and Electrolytes (Pre
and post operative), infection rate, length of ICU and hospital stay
(LOS), and mortality were used as markers of better surgical outcome.
Results: Results showed increase in TLC in less in study group +36% (SD-
2287.44) when compare to control group =62% (SD- 4328) post operatively.
Similar results were found in C-reactive protein +35% in study group and
+53% in Control group. Increase in Lymphocyte increase in study group was
+28% in supplement group and 42% in control group. The platelet count
drops in both the group but it was high in the experimental group - 42%
compare to the supplement group - 16%. Total protein decrease is less in
supplementary group (study group SD = +0.77, control group SD = +0.88) and
Sr. Albumin levels dropped by 53% in control group and 28% in supplement
group. Average decrease in Hb in study group is 0.9 and experiment group
is 1.2 g/dl. 6% of the study group and 20% of the control group suffered
with pneumonia in the post operative stage, similarly 13% of the study
group and 33% of the control group had wound infection. 20% of the control
group patients had fever postoperatively when compare to 6% in study
group. The average LOS at ICU (3.87+/-0.516) and LOS at hospital stay
(8.27+/-0.884) of the study group is less compare to the control group
(LOS of ICU 5.13+/-0.827, LOS of Hospital - 11.67+/-2.690). There were no
significant differences in the mortality rate of both the groups.
Conclusion: Preoperative L-Glutamine supplement decreases the risk of
infection and reduces the ICU and Hospital stay in electric cardiac
surgery.

<217>
Accession Number
612282688
Author
Pluchinotta F.R.; Caimi A.; Sturla F.; Giugno L.; Secchi F.; Giusti G.;
Redaelli A.; Lombardi M.; Carminati M.
Institution
(Pluchinotta, Giugno, Secchi, Giusti, Lombardi, Carminati) IRCCS
Policlinico San Donato, Milano, Italy
(Caimi, Sturla, Redaelli) Milan Polytechnic, Milan, Italy
Title
Towards a more accurate planning of invasive procedures: Finite element
simulation of percutaneous pulmonary valve implantation.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 61), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Introduction: Percutaneous Pulmonary Valve Implantation (PPVI) is a
minimally invasive procedure to treat severe right ventricular outflow
tract dysfunction in selected patients. Such innovative procedure
represents an optimal field for conducting investigations through
patient-specific finite element (FE) simulations to predict stent behavior
during the intervention and unravel problems of cardiovascular mechanics.
Here we present a virtual cardiac laboratory we recently created to plan
interventional procedures. Methods: Based on CT images, performed in a
selected cohort of patients with complex congenital heart disease, the
cardiac anatomy was segmented using the a software and subsequently
extracted, obtaining an STL-file that in some cases was printed as a 3D
plaster model. Also, geometrical models were used to reproduce structural
patient-specific PPVI simulations exploiting FE methods: the real FE model
of the stent was replicated, discretized into hexahedral elements, and
complemented by the description of its mechanical properties [Bosi et al.
2015]; the mesh of the pulmonary trunk was refined and reliable mechanical
properties adopted. All simulations were run on a commercial solver.
Results: Models of a cohort of patients with right ventricular outflow
tract dysfunction candidated to PPVI were created. Data were sheared with
our team of engineers to set up a computer simulation of PPVI release and
implantation. We simulated both stent crimping and deployment through
balloon inflation. The developed procedure enabled us to simulate the
virtual implantation of prosthetic valve selected for each
patient-specific right ventricle outflow tract (figure 1a); hence, it
allows to assess the impact of stent deployment on the pulmonary trunk
wall (figure 1b and 1c) as well as to predict possible distortion of the
cardiac anatomy and identify local concentrations of high mechanical
stress (figure 1d). Analysis of risk of coronaries compression during the
procedure is under investigation. Conclusions: The clinical use of 3D
models allows to assess, plan, and simulate interventions necessary in
case of complex congenital malformations. These skills are especially
important for young doctors and surgeons in training. In our experience,
the simulation program for PPVI had been a useful tool to improve
patients' selection and to avoid any potential surprise during the
procedure in vivo. Multi-center studies should be set up to evaluate the
impact of cardiac 3D models on medical decisions, the quality of care, and
the patients' outcome. (Figure Presented).

<218>
Accession Number
612282674
Author
Belley-Cote E.P.; Connolly S.J.; Brady K.; Singal R.K.; Healey J.; Lamy
A.; Devereaux P.J.; Ramakrishna K.; Whitlock R.P.
Institution
(Belley-Cote, Connolly, Healey, Lamy, Devereaux, Whitlock) McMaster
University, Hamilton, Canada
(Brady, Ramakrishna) Population Health Research Institute, Hamilton,
Canada
(Singal) University of Manitoba, Winnipeg, Canada
Title
Surgical ablation of atrial fibrillation ablation in 11 countries: The
LAAOS III trial.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 280), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Atrial fibrillation (AF) ablation can be performed at the time
of cardiac surgery. However, uncertainty persists regarding its efficacy,
optimal patient selection, and the choice of lesion set. Methods: LAAOS
III is an ongoing international randomized controlled trial of surgical
left atrial appendage occlusion versus no occlusion in patients with a
history of AF undergoing cardiac surgery. In this trial, the conduct of AF
ablation is at the discretion of the local surgeon.We compared the
characteristics of enrolled patients with at least 6 months of follow-up,
including the conduct of surgical AF ablation and specific lesion sets,
energy used, and outcomes. Results: Of the 1541 randomized patients, 880
had completed 6 months of follow-up. In the 36 centres in 11 countries AF
ablation rates varied from 0% to 100%. Sixty-one of 127 surgeons (48%)
performed AF ablation in 293 (33%) patients. Patients who underwent AF
ablation were significantly younger (70+/-9 years vs. 73+/-9 years;
p<0.01) and more likely to require isolated valve surgery (relative risk
[RR] 1.4; 95% confidence interval [CI] 1.1, 1.8; p<0.01). Patients with
paroxysmal AF were more like to be ablated (paroxysmal 169/453 (37%) vs.
non-paroxysmal 123/420 (29%), p=0.01). AF was present on the baseline ECG
in 56% (164/293) of ablation patients and in 57% (331/583) of non-ablation
patients (p=0.82). In patients with concomitant AF ablation, surgeons
performed bi-atrial ablation in 125 (43%) patients, complete left atrial
ablation in 98 patients (33%) and pulmonary vein isolation in 70 patients
(24%). Radiofrequency was the most frequently used energy (69%) followed
by cryotherapy (19%), cut and sew (11%), and laser and microwave (1%).
Exit block confirmation was performed in 98 patients (33%). At the latest
follow-up, significantly more patients who had undergone AF ablation were
taking anti-arrhythmic drugs (31% vs 13%, p<0.001). Sinus rhythm was more
common in the ablated patients at hospital discharge (57% vs. 43%; RR 1.3;
95% CI [1.2, 1.5]; p<0.01)), 30 days of follow-up (41% vs. 28% RR 1.4; 95%
CI [1.2, 1.7]; p<0.01), and 6 months (30% vs. 21% RR 1.4; 95% CI [1.1,
1.8]; p<0.01). Conclusion: The use of surgical AF ablation ranges from 0%
to 100% across 36 sites in 11 countries in an international cardiac
surgery trial recruiting AF patients, 33% undergo concomitant AF ablation.
Most surgeons perform bi-atrial lesions and use radiofrequency ablation.
AF ablation modestly reduces AF recurrence.

<219>
Accession Number
612282666
Author
Taha S.; Moretti C.; Mennuni M.; Barbanti M.; Giacoppo D.; Quadri G.;
Luciano Rossi M.; Dascenzo F.; Rettegno S.; Zavalloni D.; Agostoni P.;
Gita F.; Tamburino C.; Presbitero P.
Institution
(Taha) Assuit Faculty of Medicine, Assuit, Egypt
(Moretti, Quadri, Dascenzo, Rettegno, Zavalloni, Gita) Hospital Citta
Della Salute E Della Scienza Di Torino, Cardiologia 1, Turin, Italy
(Mennuni, Luciano Rossi, Presbitero) Sant'Ambrogio Clinical Institute,
Milan, Italy
(Barbanti, Giacoppo, Tamburino) Ferrarotto Hospital, Catania, Italy
(Agostoni) UtrectNetherlands
Title
Impact of residual coronary artery disease on patients undergoing TAVI: A
multicenter study.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 419), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Management of coronary artery disease (CAD) remains a matter
of debate in patients undergoing Transcatheter aortic valve implantation
(TAVI) Our aim was to assess the impact of residual coronary artery
disease, evaluated by Syntax Score (Sx), in TAVI patients Methods and
results: In this retrospective study, a total of 1032 patients with severe
aortic stenosis (AS) underwent TAVI between January 2007 and July 2014 in
our Centers. Patients were first stratified according to absence or
presence of CAD, and then were divided in 3 groups according to tertiles
of their basal syntax (Sx) or of residual syntax score (rSx) in case of
PCI related to TAVI procedure Primary endpoint was long-term all-cause
death. Secondary endpoints were 30- day death, vascular complications,
stroke, and acute kidney injury. Three hundred and eighty one (45.1%)
patients did not present with significant coronary stenosis while 239
(28.3%) presented with Sx =0 (group 1), 160 (18.9%) and 64 (7.5%) with Sx
>0-<=10 (group 2) and Sx >10 (group 3) respectively. At 30 days, more
deaths were observed in the third group, with no significant differences
between the groups (no CAD:6.8%, Sx =0: 7.1%, Sx>0-<=10:6.3%, Sx >10:
14.1%; pvalue= 0.21), with high rates of cardiovascular mortality in the
same group (3.7% vs. 3.8% vs. 4.4% vs. 7.8%; p=0.04). After a mean follow
up 575+/-488 days, there were no differences in all-cause and
cardiovascular mortality (32.0% vs. 31.8% vs. 25.6% vs. 26.6%, p=0.28 and
6.6% vs. 7.5% vs. 13.8% vs. 12.5%; p=0.14) At multivariate analysis,
pre-procedural Sx >10 independently predicted both all cause and CV
mortality (HR:1.7, 95% CI: 1.32-2.21, p:<0.0001; HR:1.5,95% CI:1.04-2.29,
p: 0.03 respectively) Conclusions: Number of patients undergoing TAVI with
residual high levels of Syntax appears to be low in this large multicenter
registry. Residual Sx values increase risk of all cause and cardiovascular
death at follow up, while those with Sx <=10 could undergo TAVI without
increased risk of cardiovascular death.

<220>
Accession Number
612282598
Author
Voller H.; Eichler S.; Harnath A.; Nothroff J.; Butter C.; Schikora M.;
Wegscheider K.; Salzwedel A.
Institution
(Voller) Klinik am See, Ruedersdorf, Germany
(Eichler, Salzwedel) University of Potsdam, Center of Rehabilitation
Research, Potsdam, Germany
(Harnath) Sana Heart Center Cottbus, Cottbus, Germany
(Nothroff) MediClin Reha-Zentrum Spreewald, Burg, Germany
(Butter) Brandenburg Heart Center, Bernau bei Berlin, Germany
(Schikora) Brandenburg Klinik, Bernau bei Berlin, Germany
(Wegscheider) University Medical Center Hamburg Eppendorf, Hamburg,
Germany
Title
Multicomponent cardiac rehabilitation in patients after transcatheter
aortic valve implantation (TAVI)-course of functioning and quality of
life.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 542), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Purpose: For more than a decade, transcatheter aortic valve implantation
(TAVI) has become a promising treatment modality for patients with severe
aortic stenosis and a high surgical risk. It is well known that the
intervention itself reduces mortality, but there is still a lack of data
concerning the course as well as influencing factors of functioning and
quality of life during multicomponent cardiac rehabilitation (CR).
Methods: From 10/2013 to 07/2015, patients with an elective TAVI and a
subsequent three-week inpatient CR were enrolled in the prospective
multicentre registry. Frailty-Index (Activities of Daily Living,
Instrumental Activities of Daily Living, Mini Mental State Exam [MMSE],
Mini Nutritional Assessment, Timed Up and Go [TUG], and a subjective
pre-clinical mobility disability), Quality of Life (SF12), maximum
6-minute walk distance (6MWD) and max. work load in cycle ergometry were
performed at admission and discharge of CR. The association between
patient characteristics before or at CR admission and improvements in
6MWD, maximum work load or SF12 components were studied univariately and
multivariately using regression models. Results: 136 patients (80.6+/-5.0
years, 47.8% male) with LVEF 56.1+/-9.7%, NYHA III/IV in 37.5% and a
EuroScore of 15.5+/-11.6% were enrolled. 6MWD and max. work load increased
by 56.3+/-65.3 m (p<0.001) and 8.0+/-14.9 Watt (p<0.001), respectively.
TUG decreased by 1.1+/-4.6 sec (p<0.001) as well as the amount of patients
with a pathologic Frailty-Index by 9% (p=0.003). Additionally, an
improvement in quality of life (physical sum score 2.5+/-8.7, p=0.002,
psychological sum score 3.4+/-10.2, p<0.001) could be observed. In
multivariate analysis, enhancement of 6MWD and max. work load was
positively influenced by MMSE and bundle branch block. An inverse
association was observed for baseline values and age. The same effect
occurred in changes of physical and psychological sum score in SF12.
Furthermore, the latter improved in patients with NYHA III/IV.
Conclusions: CR can improve functioning and quality of life in patients
after TAVI. In particular, patients with poor health status at baseline
should receive intensive medical care during CR.

<221>
Accession Number
612282564
Author
Muneretto C.; Alfieri O.; Bisleri G.; De Bonis M.; Di Bartolomeo R.;
Savini C.; Folesani G.; Di Bacco L.; Maureira J.P.; Laborde F.; Tespili
M.; Repossini A.; Folliguet T.
Institution
(Muneretto, Bisleri, Di Bacco, Repossini) University of Brescia, Division
of Cardiac Surgery, Spedali Civili, Brescia, Italy
(Alfieri, De Bonis) San Raffaele Hospital of Milan (IRCCS), Division of
Cardiac Surgery, Milan, Italy
(Di Bartolomeo, Savini, Folesani) University Hospital Policlinic S.
Orsola-Malpighi, Department of Cardiac Surgery, Bologna, Italy
(Maureira, Folliguet) University Hospital of Nancy, Division of Cardiac
Surgery, Nancy, France
(Laborde) Institut Mutualiste Montsouris, Division of Cardiac Surgery,
Paris, France
(Tespili) Bolognini Hospital, Division of Cardiology, Seriate, Italy
Title
Treatment options in intermediate-high risk patients with aortic stenosis
and renal disfunction: The European multicenter propensity match study
comparing tavr versus conventional avr surgery.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 147), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Surgical Aortic Valve Replacement (sAVR) still represents the
gold standard therapy for patients with severe aortic stenosis.
Transcatheter Aortic Valve Replacement (TAVR) is becoming an attractive
strategy in inoperable or extremely-high patients, albeit a its use is
expanding also in those patients patients with intermediate-high risk
profile with one or more organ disfunction. Purpose: Renal dysfunction has
been identified as an independent predictor of perioperative morbidity and
mortality in patients undergoing TAVR. We therefore sought to investigate
the impact of pre-operative renal dysfunction (GFR<60ml/min) in patients
with intermediate-high risk profile undergoing either surgical AVR or
TAVR. Methods: From 2007 to 2014, 700 patients with isolated severe aortic
stenosis and an intermediate-high risk profile (STS Score >4 and logistic
EuroSCORE I>10) were collected from 7 European centers. Among the study
population, 433 patients had preoperative renal dysfunction: 197 underwent
surgical AVR (G1), and 236 TAVR (G2). A propensity score analysis was
performed in order to obtain two homogeneous groups of 126 patients the
most common pre-operative risk factors (STS score and others continuous
and discrete variables). Primary end points were 30-day mortality and
overall survival at 36-month follow-up; the secondary end point was
survival freedom from a composite end point of major adverse cardiac
events (MACCE) defined as cardiac-related mortality, myocardial
infarction, CVA, major hemorrhagic events and periprosthetic regurgitation
> grade II. Results: There were no significant differences in 30-day
mortality between the groups (sAVR = 3.2% vs TAVR = 6.1%; p=0.092). The
incidence of postprocedural PM implantation was 3.6% in sAVR group vs
16.6% in TAVR group (p=0.004), peripheral vascular complications 0% in
sAVR group vs 9.5% of TAVR patients (p<0.001). There were no differences
in terms of post-operative acute renal failure (sAVR = 11.9% vs TAVR
=13.5%; p=0.767) and need of dialysis (sAVR = 3.7% vs TAVR =5.3%;
p=0.332). At 36-months follow-up, overall survival (sAVR= 86.0% +/- 2.4%
vs TAVR = 65.9% +/- 4.3%; p<0.001) and survival freedom from MACCE (sAVR =
74.7%+/-3.7% vs TAVR = 52.5%+/-7.5%; p<0.001) were significantly better in
patients undergoing surgical aortic valve replacement than in TAVR
patients (Figure 1). Multivariate Cox regression analysis depicts TAVR as
an independent risk factor for all-cause of death hazard ratio (HR: 3.4;
confidence interval, 1.7-6.6; p<0.001) and MACCEs (HR: 5.1; confidence
interval, 2.6-9.6; p<0.001). (Figure presented) Conclusion: Surgical AVR
yields excellent outcomes at short and mid-term follow-up even in patients
with renal dysfunction. In this multicenter propensity matched study the
use of TAVR apparently worsened outcome in this subset population
indicating that further Randomized Controlled Trials are mandatory before
extending the use of TAVR in intermediate-high risk patients.

<222>
Accession Number
612282547
Author
Gaisin I.R.; Gazimzyanova A.S.; Abseeva V.M.; Galimova A.A.; Maksimov
N.I.; Voronova M.A.; Sabirzyanova E.R.; Chernikch E.A.; Richkova L.V.
Institution
(Gaisin, Maksimov) State Medical Academy, Izhevsk, Russian Federation
(Gazimzyanova, Abseeva, Galimova, Voronova, Sabirzyanova, Chernikch,
Richkova) Clinical Diagnostic Centre of the Udmurt Republic, Izhevsk,
Russian Federation
Title
Magnesium orotate improves symptoms, exercise capacity and quality of life
in patients with valve prosthesis: Results from a randomized, open-label,
case-control 2-year study.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 620), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Successful surgery for valvular heart disease prolongs life
and generally improves symptoms and cardiac function. Nevertheless,
myocardial dysfunction and health-related quality of life (QoL) impairment
may persist and worsen postoperatively. We aimed to assess safety and
efficacy of nonsteroidal anabolic magnesium orotate (MO) in a long-term
treatment of heart failure in operated valvular heart disease. Methods:
200 patients [aged 58.3+/-4.2 years; 64% males; 65% NYHA class III, 35%
NYHA FC II; 38% concomitant SCAD, 22% CABG; median (IQR) 6-min walk
distance (6-MWD) 351 (156-448) m; mean (SE) left ventricular ejection
fraction (LVEF) 53.5 (2.1)%] 2-4 weeks after conventional aortic (n=113)
or mitral (n=87) valve replacement by mechanical (94%) or biological (6%)
prostheses (39% due to degenerative, 30% rheumatic, 15% myxomatous, 11%
congenital valve diseases and 5% infective endocarditis) were randomized
1:1 to receive either optimal standard therapy (vitamin K antagonists,
ACEIs/ARBs, beta-blockers, diuretics, MRAs, statins and digoxin) or
magnesium orotate 500 mg t.i.d. added to conventional treatment. Efficacy
endpoints included changes from preoperative baseline in 6-MWD, NYHA FC,
echo-parameters, heart failure hospitalizations and all-cause mortality.
QoL was assessed by the Short Form (SF-36 v.1) Health Survey. Results:
There were no significant differences between MO and control groups at
baseline. Patients reported poor postoperative QoL. At month 24, patients
receiving MO (n=100) had a mean increase in 6-MWD of 245 m (p<0.0001);
control patients (n=100) had a mean 6-MWD increase of 192 m (p<0.001),
with a control-adjusted difference of +53 m (p=0.009). NYHA status
improved by two classes in 64% of MO vs. 55% of controls (p=0.022), by one
class in 36% vs. 45% (p=0.022). MO delayed the time to clinical worsening
(p=0.0056) and reduced the heart failure admissions (p=0.0038).
Improvements were noted in control-adjusted changes in supraventricular
(p=0.0018) and ventricular arrhythmias (p=0.027) and in postoperative
heart remodeling, e.g. in mean LVEF (+3.5%; p=0.0087), left ventricular
end-diastolic diameter (-5.8 mm; p=0.0015) and endsystolic diameter (-3.5
mm; p=0.0056). Combination therapy with MO was well tolerated. In both
groups, SF-36 scores substantially rose after follow-up. MO patients had
significantly higher improvements in QoL over time compared to controls.
One patient died in the control group (p=0.83). Conclusions: Long-term
magnesium orotate therapy for patients with aortic/ mitral valve
prostheses improves symptom status, cardiac function, exercise capacity
and QoL. Magnesium orotate is a new promising therapy of heart failure in
operated valvular heart disease.

<223>
Accession Number
612282535
Author
Kuck K.-H.; Nickenig G.; Hammerstingl C.; Vahanian A.; Messika-Zeitoun D.;
Frerker C.; Alfieri O.; Colombo A.; Latib A.; Baldus S.; Rudolph V.;
Topilsky Y.; Grayburn P.; Maisano F.
Institution
(Kuck, Frerker) Asklepios Klinik St. Georg, Cardiology, Hamburg, Germany
(Nickenig, Hammerstingl) University Hospital Bonn, Cardiology, Bonn,
Germany
(Vahanian, Messika-Zeitoun) Hospital Bichat-Claude Bernard, Cardiology,
Paris, France
(Alfieri, Colombo, Latib) San Raffaele Hospital of Milan (IRCCS), Milan,
Italy
(Baldus, Rudolph) Cologne University Hospital - Heart Center, Cologne,
Germany
(Topilsky) Sourasky Medical Center, Tel Aviv, Israel
(Grayburn) Baylor University Medical Center, Dallas, United States
(Maisano) University Hospital Zurich, Zurich, Switzerland
Title
Up to 1-year follow-up results from a multi-centre trial of a novel
percutaneous mitral annuloplasty system.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 229), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Aims: The Cardioband system enables percutaneous transseptal implantation
of an adjustable "surgical-like" device for mitral annuloplasty to reduce
mitral regurgitation (MR). The aim of this multi-centre study was to
evaluate the feasibility, safety, and up to 12-month outcomes of
Cardioband implantation in patients with secondary MR. Methods and
results: Between February 2013 and October 2015, 49 highrisk patients with
significant secondary MR were enrolled at 7 sites in Europe. All patients
were screened by echocardiography and cardiac computed tomography to
assess feasibility. Mean patient age was 71 (range 48-81) years, 38
patients (78%) were men. Mean EuroSCORE II was 7.3+/-6.5%. At baseline,
82% of patients were in NYHA functional class III-IV, with a mean left
ventricular ejection fraction of 33+/-12% (15-69%). Device implantation
was feasible in all patients. Procedural success (device successfully
implanted with reduction of MR grade to <=2+ at discharge) was achieved in
87% of patients (41/47). After device cinching, a reduction in the
septo-lateral annular diameter by about 30% was observed (from 37+/-4 mm
to 26+/-4 mm; p<0.01). Thirty-day mortality was 4.2% (adjudicated as
unrelated to the device). At 12-month follow-up (n=22), 89% of patients
had MR <=2+, 68% presented in NYHA functional class I-II, with a
significant improvement in quality of life (Minnesota Living with Heart
Failure questionnaire score) from 39 to 19 (p<0.001) and exercise
tolerance (6-minute walk distance) from 279 to 351 m (p<0.001).
Conclusions: Transseptal mitral valve repair with the Cardioband device
resulted in MR reduction by reconstruction of the mitral annulus. The
safety profile is comparable to other transcatheter mitral procedures. MR
severity reduction and clinical benefit are stable up to 12 months.

<224>
Accession Number
612282484
Author
Tajstra M.; Gasior M.; Zembala M.O.; Filipiak K.; Gierlotka M.; Hrapkowicz
T.; Hawranek M.; Polonski L.; Zembala M.
Institution
(Tajstra, Gasior, Zembala, Filipiak, Gierlotka, Hrapkowicz, Hawranek,
Polonski, Zembala) Slaskie Centrum Chorob Serca, Zabrze, Poland
Title
Comparison of long-term mortality of hybrid coronary revascularization vs.
coronary artery bypass grafting. Three-years mortality of Hybrid
Revascularization for Multivessel Coronary Artery Disease (H.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 680), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Conventional coronary artery bypass grafting (CABG) is still
treatment of choice in patients with multivessel coronary disease (MVD).
However, limitations of standard CABG and unsatisfactory long-term patency
of saphenous grafts are commonly known. Hybrid coronary revascularization
(HCR) is promising option however, there is still no data evaluating the
effect on long-term prognosis of HCR in comparison with standard
open-chest CABG. Objectives: To compare three-years all-cause mortality
according to treatment fashion: hybrid coronary revascularization vs.
standard CABG in patients with MVD (HYBRID study population of patients).
Methods: 200 patients with MVD involving left anterior descending artery
(LAD) and a critical (>70%) lesion in at least one major epicardial vessel
(except LAD) amenable to both PCI and CABG, and referred for conventional
surgical revascularization, were randomly assigned to undergo HCR or CABG
(in a 1:1 ratio). The occurrence of major adverse cardiac events such as
death, myocardial infarction, stroke, repeated revascularization and major
bleeding within the 12 - month period after randomization and three-years
all-cause mortality were assessed. Results: Most of the pre-procedural
characteristics were similar in the two groups. 93.9% patients in hybrid
group had complete HCR and 6.1% patients were converted to standard CABG.
At 12 months, the rates of death (2.0% vs. 2.9%, p=NS), myocardial
infarction (6.1% vs. 3.9%, p=NS), major bleeding (2% vs. 2%, p=NS), repeat
revascularization (2% vs. 0%, p=NS) were similar in the two groups. In
both groups no cerebrovascular incidents were observed. Three years
mortality was without significance difference in studied groups (3.1% vs.
4.9%, p=NS). Conclusion: Three-years mortality in patients with MVD
treated with conventional CABG vs. with HCR was similar.

<225>
Accession Number
612282465
Author
Witberg G.; Barbash I.; Finkelstein A.; Assali A.; Segev A.; Halkin A.;
Fefer P.; Ben-Shoshan J.; Konigstein M.; Guetta V.; Kornowski R.;
Barsheshet A.
Institution
(Witberg, Assali, Kornowski, Barsheshet) Rabin Medical Center, Department
of Cardiology, Petach Tikva, Israel
(Barbash, Segev, Fefer, Guetta) Sheba Medical Center, Leviev Heart Center,
Tel Hashomer, Israel
(Finkelstein, Halkin, Ben-Shoshan, Konigstein) Tel Aviv Sourasky Medical
Center, Cardiology, Tel Aviv, Israel
Title
Aortic valve gradient and mortality in patients undergoing transcatheter
aortic valve implantation for severe aortic stenosis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 146), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Mortality of patients undergoing Transcatheter Aortic Valve
Implantation (TAVI) remains high, making optimal patient selection for
this costly procedure extremely important. We aimed to evaluate the
relationship between baseline aortic valve gradients (AVGs) and mortality
post TAVI and assess the role of AVG in risk stratification for TAVI
candidates. Methods: We analyzed data on 1,186 consecutive patients with
severe Aortic Stenosis (AS), who underwent TAVI at 3 tertiary centers from
2008 through 2014. The relation between AVG and mortality was evaluated
among all patients and in subgroup of patients with high AVGs using the
Cox proportional hazard model adjusting for multiple prognostic variables.
Peak AVG was categorized as: <60mmHg, 60-100mmHg, >100mmHg and assessed as
a continuous measure. Results: Patients had a peak AVG of (mean+SD) 75+24
mmHg, mean AVG of 47 +17 mmHg, and aortic valve area of 0.7+0.2
cm². During a mean follow up of 1.8 years, baseline AVG was
inversely associated with mortality (Figure). By multivariable analysis,
patients with AVG 60-100 mmHg and >100 mmHg had a respective 30% (p=0.02)
and 70% (p<0.001) reduction in mortality compared to patients with
AVG<60%. Every 10 mmHg increase in peak AVG was associated with 9%
reduction in mortality (HR 0.914, p=0.003). Subgroup analyses among
patients with left ventricular ejection fraction (LVEF) >40%, or peak
AVG>=60 mmHg yielded similar results (HR 0.910, p=0.003 and HR 0.905,
p=0.025, per 10 mmHg increase in peak AVG respectively). Analyses using
mean AVGs yielded consistent results to those of peak AVG. (Figure
presented) Conclusions: Baseline AVGs are directly associated with
improved survival post TAVI. These results were consistent also in
patients with high gradient AS, suggesting that AVG can be used to select
patients most likely to benefit from TAVI.

<226>
Accession Number
612282458
Author
Maleva O.; Trubnikova O.; Barbarash O.
Institution
(Maleva, Trubnikova, Barbarash) Research Institute for Complex Issues of
Cardiovascular Diseases, Kemerovo, Russian Federation
Title
Statins for the prevention of early postoperative cognitive dysfunction in
patients undergoing coronary artery bypass grafting.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 386), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Purpose: To evaluate the effect of perioperative statin therapy on the
incidence of early postoperative cognitive dysfunction (POCD) in patients
undergoing coronary artery bypass grafting (CABG). Methods: Cognitive
performance was analyzed in 110 male patients (the mean age 56.3+/-5.5
years) who underwent CABG between 2009 and 2011. All patients were
randomized to two groups: the study group (n=70) received rosuvastatin, 20
mg daily, and the control group (n=40) didn't receive any statins. Both
groups were comparable by all clinical and demographic data. All patients
underwent on-pump CABG. The duration of cardiopulmonary bypass was
95.5+/-18.2 minutes. Attention was assessed in all patients with the
Bourdon's test. Visual short-term memory was assessed with 10 words
memorizing test, and 10 numbers memorizing test. Moreover, all patients
underwent neuropsychological testing using the automated complex software
(Status PF). Complex visual-motor reaction (CVMR), level of functional
mobility of nervous processes (FMNP) and nervous processing capability
(NPC) were measured. Cognitive functioning was assessed prior to
randomization, then at day 2 prior to CABG, and at days 7-10 after CABG.
The statistical analysis was conducted using "Statistica 8.0". The
presence of POCD was estimated on the basis of criteria defined as a 20%
decline on 20% of the tests. Results: Neurodynamic parameters before
randomization did not differ between the groups. Rosuvastatin-treated
patients at days 7-10 after CABG demonstrated an increase of reaction time
for CVMR tests (p=0.005), missed fewer signals for FMNP tests (p=0.03),
processed more symbols over 4 minutes of the Bourdon's test (p=0.005) and
recalled more words (p=0.008) compared to patients without rosuvastatin
treatment. The individual analysis of neurodynamic parameters reported the
development of POCD in 81% of patients in the control group, and in 55% in
the study group. Conclusion: Preoperative rosuvastatin treatment (20 mg
daily) reduces the incidence of early POCD in patients undergoing on-pump
CABG, suggesting its positive neuroprotective effect.

<227>
Accession Number
612282423
Author
Yamada S.; Yamamoto Y.; Ishizuka M.; Yamamoto K.; Takizawa M.; Uozumi H.;
Ikenouchi H.
Institution
(Yamada, Yamamoto, Ishizuka, Yamamoto, Takizawa, Uozumi, Ikenouchi)
Japanese Red Cross Medical Center, Cardiology, Tokyo, Japan
Title
Electrocardiographic screening of cardiac amyloidosis in patients with
primary AL amyloidosis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 725-726), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Introduction: The presence of cardiac amyloidosis is one of the most
important prognostic factors in patients with primary amyloidosis.
Electrocardiogram (ECG) could be the easiest screening procedure for
possible cardiac amyloidosis. Purpose: This study analyzed the
relationship between the findings of ECG and LV wall thickness of
echocardiography in primary AL amyloidosis as a surrogate marker of
cardiac amyloidosis. Methods: We performed an analysis of 141 primary AL
amyloidosis patients in one center from 2010 to 2015. We divided AL
amyloidosis patients into the two groups with LV wall thickness (>=13mm,
"Thick group"; <12mm, "Thin group") by echocardiography. A Chi-square test
was applied to verify an association between the variables. Results: 98
out of 141 patients were in thin group and the other 43 were in thick
group. Poor R wave progression (PRWP) or QS patterns in V1-3 are shown in
13 (13.3%) in thin group and 30 (69.8%) in thick group (p<0.001). Left
anterior hemiblock (LAHB) are shown in 11 (11.2%) in thin group and 20
(46.5%) in thick group (p<0.001). Low voltage is also significantly more
often shown in thick group (17 (17.3%) vs 18 (41.9%), p=0.003). The
sensitivity of PRWP or QS patterns in V1-3, or LAHB is 81.4%. The
specificity of PRWP or QS patterns in V1-3, and LAHB is 92.6%. Conclusion:
Combination of these findings, PRWP or QS pattern in V1-3, and LAHB in ECG
could predict possible cardiac amyloidosis in high predictive value in
primary AL amyloidosis patients. (Table Presented).

<228>
Accession Number
612282358
Author
Mendoza I.; Morr I.; Gonzalez K.; Torres J.; Meza Y.; Villalobos I.;
Marques J.; Vazquez R.; Chazzim G.; Morr C.; Mendoza I.J.
Institution
(Mendoza) Jackson Memorial Hospital, Cardiology, Miami, United States
(Morr, Gonzalez, Torres, Meza, Chazzim, Villalobos, Marques, Vazquez,
Chazzim, Morr, Morr, Mendoza) Central University of Venezuela (UCV),
Tropical Cardiology Department, Caracas, Venezuela
Title
Acute atrial tachyarrhythmias due to tropical viral disease. A new world
wide threat.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 603), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Zika, Chikungunya and Dengue fever virus are arthropod-borne
diseases that have caused millions of infections globally. There are very
few published reports concerning the cardiac complications in general and
arrhythmias in particular, due to Tropical virus disease. Purpose: To
investigate the occurrence of acute atrial tachyarrhythmia's in tropical
virus disease. Methods: Prospective multi-center observational study of
277 patients with a Zika, Chikungunya and dengue infection from a
Venezuelan outbreak. Clinical evaluation, chest X-Ray, ECG,
echocardiogram, Holter, including virological evaluation, cardiac
biomarkers, and cardiac MRI procedures were performed. Results: Of the 277
patients examined, 117 were males with a mean age of 59+/-8, 91 developed
palpitations. Acute atrial tachyarrhythmia's (34%) including atrial
fibrillation (8 patients)and atrial tachycardia (11). New onset
symptomatic atrial fibrillation was observed in 19 cases (71), after the
acute episodes 12 were classified as paroxysmal, 4 persistent and 3
permanent. Myocarditis was present in all of them. Conclusion: New onset
atrial tachyarrhythmias occurred in approximately 7% of patients with
Chikungunya, Zika and Dengue. Myocarditis was detected in all of them and
in 45% of a with Chikungunya.

<229>
Accession Number
612282319
Author
Halbach M.; Abraham W.T.; Butter C.; Ducharme A.; Klug D.; Little W.C.;
Lovett E.; Schafer J.E.; Senni E.; Swarup V.; Wachter R.; Weaver F.A.;
Zile M.R.; Muller-Ehmsen J.
Institution
(Halbach) Cologne University Hospital, Heart Center, Dept. of Internal
Medicine III, Cologne, Germany
(Abraham) Ohio State University, Division of Cardiovascular Medicine,
Columbus, United States
(Butter) Immanuel Heart Center Bernau, Medical School Brandenburg, Dept.
of Cardiology, Bernau, Germany
(Ducharme) University of Montreal, Montreal Heart Institute, Montreal,
Canada
(Klug) Lille University Hospital, Dept. of Cardiology A, Lille, France
(Little) University of Mississippi Medical Center, Division of Cardiology,
Jackson, United States
(Lovett) CVRx Inc., Minneapolis, United States
(Schafer) NAMSA Inc., Dept. of Statistics, Minneapolis, United States
(Senni) Ospedale Papa Giovanni XXIII, Cardiovascular Dept., Bergamo, Italy
(Swarup) Arizona Heart Hospital, Department of Electrophysiology, Phoenix,
United States
(Wachter) University Medicine, Gottingen and German Cardiovascular
Research Center, Clinic for Cardiology and Pneumology, Gottingen, Germany
(Weaver) University of Southern California, Division of Vascular Surgery
and Endovascular Therapy, Keck School of Medicine, Los Angeles, United
States
(Zile) Medical University of South Carolina, Ralph H. Johnson Dept. of
Veterans Affairs Medical Center, Charleston, United States
(Muller-Ehmsen) Asklepios Clinic Altona, Dept. of Medicine, Hamburg,
Germany
Title
Baroreflex activation therapy for the treatment of heart failure with
reduced ejection fraction in patients with and without coronary artery
disease.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 724-725), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Progression of heart failure with reduced ejection fraction (HFrEF) is
promoted by autonomic imbalance. Baroreflex activation therapy (BAT) by
electrical stimulation of baroreceptors at the carotid sinus improved
exercise capacity, quality of life and NT-proBNP levels in a randomized
trial of guideline-directed medical and device-based therapy (GDMDT) alone
or plus BAT in patients with HFrEF. In view of different mechanisms
underlying HFrEF, especially ischemic versus nonischemic dilated
cardiomyopathy, we sought to analyze efficacy and safety of BAT in
patients with and without coronary artery disease (CAD). Methods: Patients
with left ventricular ejection fraction (LVEF) <35% and New York Heart
Association (NYHA) class III were randomized 1:1 to GDMDT alone or plus
BAT. System or procedure related major adverse neurological or
cardiovascular events (MANCE) were evaluated as safety endpoint, efficacy
endpoints included Minnesota Living with Heart Failure (MLWHF) quality of
life, 6-min walk distance (6MWD), NT-proBNP and LVEF. Patients with a
history of CAD, prior myocardial infarction or coronary artery bypass
graft were assigned to the CAD group, all others were in the no CAD group.
Results: Of 71 BAT treated patients, 52 (73%) had CAD and 19 (27%) had no
CAD. In the control group, 49 of 69 (71%) patients had CAD and 20 (29%)
had no CAD. System or procedure related MANCE rate was 3.8% in the CAD
group vs. 0% in the no CAD group (p=1.0). In the whole cohort, NYHA class,
MLWHF score, 6MWD and NTproBNP were improved in BAT treated patients
compared to controls. Statistical analyses revealed no interaction between
presence of CAD and effect of BAT (all p>0.05; see table for detailed NYHA
class and MLWHF data). Conclusion: We found no difference in efficacy and
safety of BAT between patients with and without CAD. This subgroup
analysis indicates that BAT improves exercise capacity, quality of life
and NTproBNP in patients with ischemic and nonischemic cardiomyopathy,
despite differences in the pathophysiology underlying HFrEF. (Table
Presented).

<230>
Accession Number
612282210
Author
Fernandes F.; Moreira C.H.; Oliveira L.C.; Ianni B.M.; Lorenzo C.D.;
Ramires F.J.A.; Nastari L.; Ribeiro A.L.P.; Cunha Neto E.; Sabino E.C.;
Mady C.
Institution
(Fernandes, Ianni, Ramires, Nastari, Cunha Neto) University of Sao Paulo,
Faculty of Medicine, Clinics Hospital, Sao Paulo, Brazil
(Moreira, Oliveira, Lorenzo, Sabino, Mady) Clinical Hospital, University
of Sao Paulo, Department of Infectious Disease/Institute of tropical
Medicine, Sao Paulo, Brazil
(Ribeiro) Federal University of Minas Gerais, Belo Horizonte, Brazil
Title
The predictive value of plasma Galectin-3 for cardiac impairment and
mortality in patients with Chagas disease.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 430-431), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: The main histopathological characteristics of Chagas' disease
(ChD) is the presence of myocarditis with diffuse lymphocytic
infiltration, destruction of fibres, severe myocardial fibrosis, and few
parasite nests. Galectin (Gal-3) reflect two pathophysiological
mechanisms: fibrosis and inflammation. It also has been linked to heart
failure development and has shown association with mortality Purpose: The
objective of this study was to evaluate if Gal-3 level is associate with
the development of the severe forms of Chagas cardiomyopathy (CC) and
mortality Methods: We studied a cohort including T cruzi seropositive
blood donors (BD) This cohort was supplemented with CC patients from a
tertiary hospital. All subjects underwent a clinical evaluation,
electrocardiogram (ECG), and echocardiogram (Echo), both were reviewed
blindly by centralized reading center. The subjects were classified as
with or without signs of CC by a blinded panel of three cardiologists.
Gal-3 (VIDAS Gal-3 France - bioMerieux Inc.) was available to test samples
Results: We considered three groups of patients: NonCC-BD (187
blood-donors subjects with positive T.cruzi serology and no
cardiomyopathy), CC-nonD (45 blood-donors with positive T.cruzi serology
and ECG abnormalities, but normal systolic function at rest)and CC-D (111
positive T.cruzi serology and CC with left ventricular dysfunction)
(table). Ejection fraction <50 was associated with higher levels of Gal3
(p=0.0001). Gal 3 was significantly correlated with IL6, TNFalpha, IFgama
IL8, and NT-proBNP (p values <0,01). Follow up date on mortality was
available for the CC-D patients. In this group, we could detect an
association of Gal-3 level and subsequent death or heart transplantation
in follow up of 5 years (HR 3.87; 95% confidence interval 1.53-9.79;
p=0.004). In conclusion, high levels of plasma Gal-3 is independently
associated with cardiac impairment and severe forms in patients with ChD
and may be useful to identify high risk patients to death and heart
transplantation.

<231>
Accession Number
612282179
Author
Ayesta Lopez A.; Urrutia G.; Madrid E.; Vernooij R.W.M.; Fernandez Aviles
F.; Martinez-Selles M.
Institution
(Ayesta Lopez, Fernandez Aviles, Martinez-Selles) University Hospital
Gregorio Maranon, Madrid, Spain
(Urrutia, Vernooij) Hospital De La Santa Creu I Sant Pau, Cochrane Centre
Iberoamericano, Barcelona, Spain
(Madrid) Universidad De Valparaiso, Escuela De Medicina, Valparaiso, Chile
Title
Sex-mismatch interaction and prognosis after heart transplantation. A
clarifying meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 114), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Orthotopic heart transplantation is the treatment of choice in
selected patients with terminal heart disease. Optimal donor allocation is
essential due to the current shortness of grafts. When allocating a graft,
donor and recipient relation is essential and includes several factors
like blood group, size, serological and immunological factors. The
possible role of donor and recipient sex has been discussed for years.
Despite some contradictory results, it has been reported that survival
after heart transplantation seems to be worse when donor-recipient gender
is mismatched. There may be an interaction between sex mismatch and gender
of the recipient. Purpose: This systematic review and meta-analyses aimed
to appraise the current evidence on the effect of gender mismatching after
heart transplantation depending on sex of the recipient. Methods: We
searched PUBMED and EMBASE until February 2015. Comparative cohort and
registry studies regarding survival after heart transplantation on both
genders were included. Articles published were identified systematically
and meta-analyses were performed. Primary endpoint was one-year mortality
in both genders. 10-years mortality was appraised but meta-analyses were
not possible as 10 years follow-up was not completed. Results: After
retrieving 510 articles, 10 studies (53.199 patients) were included. When
analyzing recipients of both genders, significant differences were found
for one-year survival between gender matched and mismatched recipients
[odds ratio (OR) = 1.30, 95% confidence interval (CI) = 1.25-1.35]. In
male recipients, we found that gender mismatch was a risk factor for
one-year mortality (OR= 1.38, 95% CI = 1.31-1.44), but this was not valid
for female recipients (OR= 0.92, 95% CI = 0.85-1.00). In this latter
group, better survival was suggested (Figure 1). Conclusions: Sex mismatch
increases one-year mortality after heart transplantation only in male
recipients, while better survival is suggested in female recipients. Due
to the current shortness of grafts, clinical protocols should be taken
into account when allocating a graft. (Table Presented).

<232>
Accession Number
612282136
Author
Mazzone P.; Angelo G.D.; Regazzoli D.; Molon G.; Senatore G.; Sacca S.;
Canali G.; Amellone C.; Turri R.; Della Bella P.
Institution
(Mazzone, Angelo, Regazzoli, Della Bella) San Raffaele Hospital (IRCCS),
Arrhythmology,Electrophysiology and Cardiac Pacing Unit, Milan, Italy
(Molon, Canali) Sacred Heart Hospital of Negrar, Negrar-Verona, Italy
(Senatore, Amellone) Civic Hospital of Cirie, Cirie (Turin), Italy
(Sacca, Turri) Mirano Hospital, Mirano, Italy
Title
Percutaneous left atrial appendage closure with Watchman device: Results
from the TRAPS registry.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 273-274), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Introduction: The WATCHMAN device for Left Atrial Appendage occlusion
(LAAO) has been found effective and non-inferior to the oral
anticoagulation (OAC) in patients with atrial fibrillation, and is now
adopted in clinical practice. Purpose: Aim of the study was to evaluate
the rate of successfully implantation and peri-procedural complications.
Methods: The TRAPS registry is an observational, multicenter registry
involving 4 Italian centers. Patients who underwent LAAO with WATCHMAN
device were enrolled, and clinical, demographic and procedural data were
collected. Results: In this analysis we included 148 patients. Mean age
was 73+/-8 years, 57% of patients were male, 22% had heart failure, 10%
had a history of transient ischemic attack, 23% a history of ischemic
stroke and 72% a history of bleeding. The baseline CHADS2 score was
2.4+/-1.3, the CHADsVASc score was 3.9+/-2.8 and the HAS-BLED score was
3.3+/-1.1. 57% of the patients were on OAC at the time of implantation.
The device was successfully positioned in all patients with no or minimal
(<5mm) leakage, assessed by peri-procedural transesophageal echo.
Following intra-procedural complications were reported: 2 pericardial
effusions treated with pericardiocentesis, 1 device-associated thrombus
formation treated with aspiration, and 1 vascular access dissection.
Moreover, device embolization was reported in 1 patient early after the
implantation and the device was successfully snared in the iliac
bifurcation. The overall rate of adverse events within 7 days was
therefore (5/148=3.3%). In the present experience, device size was chosen
>=20% greater than the LAA diameter in 68% of patients. Comparing the
first half with the second half of the study cohort, the procedure
duration decreased from 89min to 64min (p<0.0001). Conclusion: The success
rate in LAAO with WATCHMAN was high, and the rate of adverse events was
low. We reported an experience-related improvement in procedural duration.

<233>
Accession Number
612282097
Author
Pierce B.; Bole I.; Patel V.; Brown D.
Institution
(Pierce, Bole, Patel, Brown) Washington University, School of Medicine,
Cardiology, St. Louis, United States
Title
Clinical outcomes of remote ischemic preconditioning prior to cardiac
surgery: An updated meta-analysis of randomized controlled trials.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 476), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Remote ischemic preconditioning (RIPC) is an intervention
that, by inducing ischemia in one location, confers protection against
ischemia in distant tissues. In animal and human studies, RIPC has led to
reductions in biomarkers of injury. Randomized controlled trials of RIPC
prior to cardiac surgery, however, have yielded conflicting results.
Methods: PubMed, Cochrane Library Central Register of Controlled Trials,
EMBASE, and Web of Science databases from 1970 to December 13, 2015 were
searched. Randomized controlled trials comparing RIPC to a sham procedure
prior to cardiac surgery requiring cardiopulmonary bypass were included.
Summary risk ratios (RR) and 95% confidence intervals (CI) were calculated
using a random-effects model. Results: All-cause mortality, acute kidney
injury (AKI), and myocardial infarction (MI) were the primary outcomes of
interest. In 20 trials, 5,265 patients were randomized to receive RIPC or
a sham procedure. All-cause mortality was not reduced by RIPC (RR, 0.981;
95% CI, 0.630-1.528; P=0.93). AKI and MI were not favorably impacted by
RIPC (RR, 0.846; 95% CI, 0.69-1.032; P=0.10) and (RR, 0.798; 95% CI,
0.613-1.038; P=0.093). In cardiac surgeries performed without propofol
anesthesia, RIPC reduced the risk of AKI (RR, 0.70; 95% CI, 0.513- 0.955;
P=0.024). Conclusion: Remote ischemic preconditioning does not confer
protection against perioperative morbidity and mortality in patients
undergoing cardiac surgery requiring cardiopulmonary bypass. Propofol
anesthesia may mitigate the benefits of ischemic preconditioning. Further
investigation is warranted to assess the utility of RIPC in the absence of
propofol anesthesia.

<234>
Accession Number
612282012
Author
Angeloni E.; Melina G.; Refice S.; Roscitano A.; Capuano F.; Comito C.;
Sinatra R.
Institution
(Angeloni, Melina, Refice, Roscitano, Capuano, Comito, Sinatra) Sapienza
University of Rome, Sant'Andrea Hospital, Rome, Italy
Title
Preoperative SYNTAX score is correlated with intraoperative graft failure
during coronary artery bypass grafting.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 476), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Transit-Time Flow Measurement (TTFM) is currently recommended,
but underused, to intraoperatively assess graft patency after coronary
artery bypass grafting (CABG). The SYNTAX score (SS) reliably quantifies
complexity of coronary artery disease (CAD), and has been shown to be
correlated with postoperative mortality and morbidity. Purpose: To
investigate the relationship between preoperative SS and intraoperative
coronary flow resulting after CABG. Methods: A total of 622 patients who
underwent first time, elective CABG at one Institution between 2004 and
2015, and for whom TTFM data were available were studied. Off-pump and
multi-arterial revascularizations were excluded. Mean graft flow (MGF),
and pulsatility index (PI) were measured after cardiopulmonary bypass
weaning. Graft failure was defined as MGF<=15ml/min, and PI>=3.
Preoperative angiograms were reviewed by 2 experienced interventional
cardiologists to retrospectively calculate the SS of every patients
included. A multivariable logistic regression model was built to identify
factors independently correlated with intraoperative graft failure.
Receiver Operating Characteristic (ROC) curve and Hosmer-Lemeshow analyses
were used to assess predictive power of SS with respect to graft failure.
Results: Overall, mean SS was 29.4+/-16.1, MGF was 28.4 ml/min (95% CI
18.6- 39.3 ml/min), and mean pulsatility index (PI) was 1.7 (95% CI
1.3-2.4). Referring to the original SYNTAX stratification, patients with
low CAD complexity (SS<=22) showed the lowest rate of graft failure (4/177
or 2.3%), with respect to patients with intermediate (23-32), and high
(>=33) SS, (7/206 or 3.4%, and 12/239 or 5%) respectively (ANOVA p=0.004).
Furthermore, patients with low SS also showed higher MGF (32.1 ml/min)
with respect to those with intermediate and high SS, with 28.9, and 24.1
ml/min, respectively (ANOVA p=0.0002). Logistic regression analysis
revealed age (OR 1.4 per year increase, p=0.0003), diabetes (OR 3.2,
p=0.001), and SS (OR 1.1 per point increase, p=0.02) to be independently
correlated with graft failure. In addition, SS showed excellent predictive
power with respect to intraoperative graft failure (AUC 0.78, p<0.0001,
H-L p=0.45), with highest accuracy point being a SS>=31.6 (Sensitivity
73%, Specificity 82%). Conclusion: Higher CAD complexity, as expressed by
the SYNTAX score, is independently correlated with poorer coronary flow
after CABG, as detected by TTFM. Further randomized studies are warranted
to confirm this finding.

<235>
Accession Number
612281939
Author
Davos C.H.; Doherty P.; Voller H.; Salzwedel A.; Saure D.; Metzendorf
M.I.; Jensen K.; Schmid J.P.; Rauch B.
Institution
(Davos) Biomedical Research Foundation, Athens, Greece
(Doherty) University of York, Department of Health Sciences, York, United
Kingdom
(Voller, Salzwedel) University of Potsdam, Human Sciences Faculty,
Potsdam, Germany
(Saure, Jensen) University of Heidelberg, Institute of Medical Biometry
and Informatics, Heidelberg, Germany
(Metzendorf) Heinrich Heine University, Metabolic and Endocrine Disorders
Group, Institute of General Practice, Dusseldorf, Germany
(Schmid) Spital Tiefenau, Department of Cardiology, Bern, Switzerland
(Rauch) Institut fur Herzinfarktforschung Ludwigshafen, Ludwigshafen am
Rhein, Germany
Title
The prognostic effect of cardiac rehabilitation in the era of acute
revascularization and statin therapy: The cardiac rehabilitation outcome
study (CROS).
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 645), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Despite having over sixty clinical trials and numerous
metaanalyses the prognostic effect of multi-component cardiac
rehabilitation (CR), in the modern era, remains a matter of debate. The
purpose of this systematic review and meta-analysis was to evaluate the
effect of strictly defined CR on total mortality specifically in patients
with coronary artery disease (CAD) in the era of statins and acute
coronary revascularization. Methods: Randomized controlled trials (RCT)
and controlled retrospective and prospective cohort studies (rCCS; pCCS)
evaluating CR in patients either after an acute coronary syndrome (ACS),
coronary artery bypass grafting (CABG) or in a mixed population with the
index event >=1995 and a follow-up of at least 6 months were included.
Databases used were PubMed, Embase, Cochrane Central, CINAHL, LILACS,
CIRRIE, and ICTRP without language restriction, and searches were
performed from >=1995 until December 22th, 2015. CR was defined as a
structured, exercise based multi-component programme including supervised
exercise training at least twice a week plus components like education,
motivation and psychosocial support. Statistical analyses were done
separately with regard to study designs and predefined populations.
Results: 25 studies were identified (RCT n=1; pCCS n=7; rCCS n=17)
including 219,702 participants (ACS: n=46,338 CABG: n=14,583, mixed
population: n=158,781; male: 74.9%; mean age: 60.8 years, mean follow up:
40.35 months), and total mortality was evaluated in 23 studies. Apart from
different designs the studies showed heterogeneity in biometrical
assessment of results and potential confounders. CCS evaluating ACS
patients showed a significantly reduced mortality for CR-participants
[pCCS (HR 0.37; 95% CI 0.20-0.69), rCCS (HR 0.64; 95% CI 0.49-0.84 and OR
0.16; 95% CI 0.05-0.54)]. The only RCT included showed a neutral result
[HR 1.01; 95% CI 0.85-1.21]. Participation in CR was also associated with
a reduced mortality in the CABG [pCCS (OR 0.13; 95% CI 0.03-0.72); rCCTs
(HR 0.63; 95% CI 0.55-0.73)], and the mixed CAD population [pCCS (HR 0.67;
95% CI 0.55-0.82), rCCS (HR 0.57; 95% CI 0.44-0.75 and OR 0.57; 95% CI
0.28-1.18). Conclusions: Using data from the modern era of CAD treatment
and applying quality methods to study inclusion we conclude that exercise
based multicomponent CR is strongly associated with reduced total
mortality. The lack of RCTs in the CROS study, compared to previous
meta-analyses, is a consequence of our CAD-ACS focus and strict criteria
about the timing and content of CR. Heterogeneity of the evaluated studies
highlight the need of further investigations and minimal standards in
performing and presenting CR outcome studies in future.

<236>
Accession Number
612281925
Author
Gagliardi J.; Mariani J.; De Abreu M.; Stutzbach P.G.; Fuentes Suarez
R.O.; Alzugaray P.D.; Haefeli M.; Kyle D.; Riga N.; Cestari G.; Doval
H.C.; Tajer C.D.
Institution
(Gagliardi) Hospital Argerich, Cardiology, Buenos Aires, Argentina
(Mariani, De Abreu, Kyle, Riga, Tajer) Hospital El Cruce, Florencio
Varela, Buenos Aires, Argentina
(Stutzbach) Sanatorio Las Lomas, San Isidro, Argentina
(Fuentes Suarez) Hospital Espanol De Buenos Aires, Buenos Aires, Argentina
(Alzugaray) Hospital Espanol De La Plata, La Plata, Argentina
(Haefeli) IMC, Ituzaingo, Argentina
(Cestari) Sanatorio Guemes, Buenos Aires, Argentina
(Doval) Hospital Italiano De Buenos Aires, Buenos Aires, Argentina
Title
Electronic discharge record form (Epi-cardio) as a tool for a multicenter
prospective registry of clinical practice in coronary care units. results
on 106705 patients.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 597), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
There are few large registries of cardiovascular clinical practice in
Latin America due to a lack of centralized medical records. Purpose: To
evaluate the feasibility of an electronic discharge record form shared by
a network of CCU, as an inexpensive tool to generate prospective
registries. Methods: Since 2006, a network of 48 CCU began a prospective
registry, Epi- Cardio, sharing a discharge record form created for
administrative and academic purposes. The design includes formularies for
common problems, and generates a report for patients (pts) and a database
for analysis. Results: From 01/2006 to 12/2014, 106705 patients were
admitted. Mean age was 64.5 years, and 64.2% were men. Main discharge
diagnoses were: acute coronary syndrome 27532 pts (25.8%), after
percutaneous interventional procedures 11468 pts (10.7%), heart failure
13593 pts (12.7%), arrhythmias 15763 pts (14.8%), post cardiovascular
surgery 6144 pts (5.8%), syncope 3687 pts (3.5%), post electronic devices
implants 4605 pts (4.3%), others 23779 pts (22.3%). Global mortality was
of 2.5% (2698 pts). Patients with non-ST segment elevation acute coronary
syndrome (16321 pts -15.3%) underwent coronary angiography in 43.7% of
cases and 21.3% underwent percutaneous coronary intervention. At discharge
aspirin was indicated in 93.8% of cases, beta-blockers in 88.8%, statins
in 92.5% and clopidogrel in 67.5%. Mortality rate was 0.7% (110 pts). In
patients with ST-segment elevation acute coronary syndrome (11211 pts
-10.5%), a reperfusion strategy was indicated in 64.7% of cases. Discharge
treatment included aspirin in 98.4% of cases, beta-blockers in 91.2%,
statins in 94.3% and enalapril in 72.5%. Mortality rate was 3.0% (331
pts). Conclusions: Based on the shared use of a discharge record form as a
inexpensive tool for routine care, the Epi-Cardio prospective registry has
generated data of the in-hospital evolution of more than 100,000 patients,
with results in concordance with international registries.

<237>
Accession Number
612281919
Author
Roncalli J.; Godin M.; Boughalem K.; Shayne J.; Piot C.; Huret B.; Belle
L.; Cayla G.; Faurie B.; Amor M.; Karsenty B.; Le Feuvre C.; Leclercq F.
Institution
(Roncalli) Toulouse Rangueil University Hospital (CHU), Cardiovascular and
Metabolic Pole, Toulouse, France
(Godin) University Hospital of Rouen, Department of Cardiology, Rouen,
France
(Boughalem) Clinique Labrouste, Department of Cardiology, Paris, France
(Shayne) Clinique Du Diaconat Fonderie, Departement of Cardiology,
Mulhouse, France
(Piot) Clinique Du Millenaire, Department of Cardiology, Montpellier,
France
(Huret) Private Hospital Saint Martin, Department of Cardiology, Caen,
France
(Belle) Hospital of Annecy, Department of Cardiology, Annecy, France
(Cayla) University Hospital of Nimes, Department of Cardiology, Nimes,
France
(Faurie) Groupe Hospitalier Mutualiste, Department of Cardiology,
Grenoble, France
(Amor) Clinique Louis Pasteur, Department of Cardiology, Essey-les-Nancy,
France
(Karsenty) Private Hospital Saint Martin, Department of Cardiology,
Pessac, France
(Le Feuvre) Hospital Pitie-Salpetriere, Department of Cardiology, Paris,
France
(Leclercq) Hospital Regional, University of Montpellier, Montpellier,
France
Title
Alternative treatment to patients for whom drug eluting stent implantation
is not indicated, thanks to drug eluting balloon:1 year clinical results
of panelux study.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 675), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Background: Prolonged double antiplatelet therapy (DAPT) indicated for
percutaneous coronary angioplasty with Drug Eluting Stent (DES) is
challenging in high bleeding risk patients, either referred for
extra-cardiac semi-urgent surgery, or with curative oral anticoagulation.
Purpose: The Panelux multicenter, interventional study examined the safety
of a novel alternative of DES with the use of a combination of a Bare
Metal Stent (BMS) plus deliberated Drug Eluting Balloon (DEB) and limited
1 month DAPT. Methods: The study included patients with at least one de
novo lesion located in a native coronary artery and requiring semi-urgent
non-coronary intervention or on long term anticoagulant therapy. BMS
(PRO-Kinetic Energy) implantation was followed by balloon angioplasty with
the Pantera Lux DEB. The primary endpoint was the rate of patients with
Target Lesion failure (TLF) at 12 months followup. Secondary endpoints
included hemorrhagic events defined by Bleeding Academic Research
Consortium (BARC) at 1, 6 and 12 months, as well ischemic events as
Myocardial Infarction, and Target Lesion Revascularization (TLR). Results:
Between October 2013 and April 2015, 501 patients, including 75% men, with
mean age of 74.0+/-9.2 years were enrolled in 37 French centers. A total
of 345 patients included (68.9%) were previously treated with an oral
anticoagulant and 145 (28.9%) were waiting for a semi-urgent non-cardiac
surgery which contraindicate them for prolonged DAPT and DES implantation.
Risk factors were: hypertension 366 (73.1%), dyslipidemia 274 (54.7%),
current or previous smoker 256 (51.1%), diabetes 188 (37.5%). 128 (25.5%)
already had a PCI with stent implantation. For the intermediate analysis
including 150 patients of the cohort followed up to 6 months, the average
of DAPT interruption was 52.2+/-54.9 days after angioplasty and the median
was 32 days (Q1-Q3 30.0-41.0). The TLF was 2.9% (CI 95% [0.8-7.4]) and
bleeding (BARC 3 to 5) had occurred in 11 (8.0%) patients. Results for the
entire cohort at 12 months follow up will be available and presented
during the congress. Conclusion: The new combination of BMS + DEB
angioplasty is safe even with a short DAPT and seems to be an interesting
alternative to DES in high bleeding risk patients.

<238>
Accession Number
612281851
Author
Yokoi H.
Institution
(Yokoi) Fukuoka Sanno Hospital, Cardiovascular Medicine, Fukuoka, Japan
Title
Impact of pioglitazone on cardiovascular events in patients with type-II
diabetes mellitus after drug-eluting stent implantation.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 2), 2016. Date of Publication:
August 2016.
Publisher
Oxford University Press
Abstract
Background: It is known that outcome of patients after drug-eluting stent
(DES) implantation with diabetes mellitus (DM) is worse than that of
patients without DM. It was reported that Pioglitazone decreased cardio
vascular events via antiatherosclerotic effect as well as blood glucose
lowering effect in patients with DM. Objective: The aim of this study is
to evaluate the effect of Pioglitazone on cardiovascular events in
patients with DM after DES implantation from 3-year followup results of
the Japan-Drug Eluting Stents Evaluation; a Randomized Trial (JDESsERT).
Methods: In the J-DESsERT trail, a prospective multicenter randomized
controlled trial, 3533 patients were randomized 1:1 to coronary stenting
with either sirolimus-eluting stent or paclitaxel-eluting stent and
followed for 3 years. The criteria of lesion length was <46mm with vessel
diameters from >=2.5mm to <3.75 mm. Definitions for DM of this trial were
1. previous DM diagnosis; 2. currently on diabetic medication (oral
hypoglycemic drugs or injection of insulin preparation); 3. HbA1c >=6.9%
within 30 days before the procedure. Results: The number of patients with
DM was 1705 (48%) in this trail. Among them, 357 patients had been
medicated Pioglitazone before PCI. The rate of cardiovascular events
(death/ myocardial infarction/stroke/target vessel revascularization)
3-year after DES implantation in Pioglitazone treated group significantly
decreased (11.5%) compared to that in other therapy group without
Pioglitazone (17.7%) (P=0.003). There were no significant between group
differences in the rates of myocardial infarction (1.6% and 2.2% in the
other therapy group), but in the Pioglitazone group there were
significantly lower rates of death from any causes (2.4%, vs. 5.6% in the
other therapy group; 57% relative risk reduction), stroke (1.9% and 3.8%,
respectively; 59% relative risk reduction), and target vessel
revascularization (7.9% and 14.2%, respectively; 45% relative risk
reduction). Conclusion: Pioglitazone significantly decreased
cardiovascular events of patients with Type-II DM after DES implantation
according to the 3-year follow-up results.

<239>
Accession Number
612281846
Author
Efendi Z.; Armein Hanafy D.; Raharjo S.; Yuniadi Y.; Tobing D.
Institution
(Efendi, Armein Hanafy, Raharjo, Yuniadi, Tobing) National Cardiovascular
Center Harapan Kita, Dept of Cardiology and Vascular Medicine, FKUI,
Jakarta, Indonesia
Title
Perioperative allopurinol reduces atrial fibrillation following coronary
artery bypass graft surgery.
Source
European Heart Journal. Conference: European Society of Cardiology, ESC
Congress 2016. Italy. 37 (Supplement 1) (pp 285), 2016. Date of
Publication: August 2016.
Publisher
Oxford University Press
Abstract
Introduction: Atrial fibrillation (AF) is the most common arrhythmias
following coronary artery bypass graft (CABG) surgery. Increased oxidative
stress, inflammation, neurohormonal activity has a role on AF following
CABG surgery. Various pharmacological strategies such as antiarrhythmias,
antiinflammatory, and antioxidant have been studied to decrease insidence
of AF following CABG surgery, but the incidence of AF is still high.
Allopurinol has antioxidant effects, but there was no clinical trials that
studied the effect of allopurinol on insidence of AF. Purpose: The aim of
this study was to assess allopurinol effect on the incidence of AF
following CABG surgery. Methods: A double-blind randomized clinical trial
conducted at our national cardiovascular center from April to May 2015.
The subject were the elective on-pump CABG surgery patients who selected
by consecutive sampling then divided into two groups: allopurinol and
placebo groups with block randomization. Subjects given Allopurinol 600 mg
or placebo single dose since 1 day before surgery until the 5th day after
surgery. The incidence of atrial fibrillation was observed postoperatively
during hospital care. Results: A total of 90 subjects were included in
this study, 45 subjects in each group. Mean post-operative length of stay
was 7,68+/-3,87 days. Insidence of AF was significantly lower in the
allopurinol group (12 (26.7%) vs 22 (48.9%) p 0,030). Absolute risk
reduction was 22,2% and number needed to treat was 5 at 7,68+/-3,87 days
follow up. Conclusion: Perioperative allopurinol reduces the incidence of
atrial fibrillation following coronary artery bypass graft surgery.

<240>
Accession Number
610503682
Author
Dayan V.; Vignolo G.; Soca G.; Paganini J.J.; Brusich D.; Pibarot P.
Institution
(Dayan, Vignolo, Soca, Paganini, Brusich) Centro Cardiovascular, Hospital
de Clinicas, Universidad de la Republica, Montevideo, Uruguay
(Pibarot) Insitut Universitaire de Cardiologie et de Peneumologie/Quebec
Heart and Lung Institute, Department of Cardiology, Quebec, Canada
Title
Predictors and Outcomes of Prosthesis-Patient Mismatch After Aortic Valve
Replacement.
Source
JACC: Cardiovascular Imaging. 9 (8) (pp 924-933), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study sought to evaluate predictors of prosthesis-patient
mismatch (PPM) and its association with the risk of perioperative and
overall mortality. Background PPM is associated with increased mid- and
long-term mortality after surgical aortic valve replacement. Conflicting
results have been reported with regard to its association with
perioperative mortality. Methods Databases were searched for studies
published between 1965 and 2014. Main outcomes of interest were
perioperative mortality and overall mortality. Results The search yielded
382 studies for inclusion. Of these, 58 articles were analyzed and their
data extracted. The total number of patients included was 40,381 (39,568
surgical aortic valve replacement and 813 transcatheter aortic valve
replacement). Perioperative (odds ratio: 1.54; 95% confidence interval:
1.25 to 1.91) and overall (i.e., perioperative and post-operative)
mortality (hazard ratio: 1.26; 95% confidence interval: 1.16 to 1.36) was
increased in patients with PPM. The impact of PPM on mortality was higher
in those studies in which the mean age of the patients was <70 years of
age (and/or AVR with associated coronary artery bypass graft was
included). Severe PPM was associated with increased risk of both
perioperative and overall mortality, whereas moderate PPM was associated
with increased risk of perioperative mortality but not of overall
mortality. The impact of PPM was less pronounced in patients with larger
body mass index (>28 kg/m²) compared with those with lower
index. Predictors of PPM were older age, female sex, hypertension,
diabetes, renal failure, larger body surface area, larger body mass index,
and the utilization of a bioprosthesis. Conclusions PPM increases
perioperative and overall mortality proportionally to its severity. The
identification of predictors for PPM may be useful to identify patients
who are at higher risk for PPM. The findings of this study support the
implementation of strategies to prevent PPM especially in patients <70
years of age and/or with concomitant coronary artery bypass
graft.<br/>Copyright &#xa9; 2016 American College of Cardiology Foundation

<241>
Accession Number
615147071
Author
Layland J.; Rauhalammi S.; Lee M.M.Y.; Ahmed N.; Carberry J.; May V.T.Y.;
Watkins S.; McComb C.; Mangion K.; McClure J.D.; Carrick D.; O'Donnell A.;
Sood A.; McEntegart M.; Oldroyd K.G.; Radjenovic A.; Berry C.
Institution
(Layland, Lee, Ahmed, Watkins, Mangion, Carrick, O'Donnell, McEntegart,
Oldroyd, Berry) West of Scotland Heart and Lung Centre, Golden Jubilee
National Hospital, Glasgow, United Kingdom
(Layland, Rauhalammi, Lee, Ahmed, Carberry, May, McComb, Mangion, McClure,
Carrick, Radjenovic, Berry) BHF Glasgow Cardiovascular Research Centre,
Institute of Cardiovascular and Medical Sciences, University of Glasgow,
United Kingdom
(Sood) Hairmyres Hospital, East Kilbride, United Kingdom
Title
Diagnostic accuracy of 3.0-T magnetic resonance T1 and T2 mapping and
T2-weighted dark-blood imaging for the infarct-related coronary artery in
Non-ST-segment elevation myocardial infarction.
Source
Journal of the American Heart Association. 6 (4) (no pagination), 2017.
Article Number: e004759. Date of Publication: 01 Apr 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--Patients with recent non-ST-segment elevation myocardial
infarction commonly have heterogeneous characteristics that may be
challenging to assess clinically. Methods and Results--We prospectively
studied the diagnostic accuracy of 2 novel (T1, T2 mapping) and 1
established (T2-weighted short tau inversion recovery [T2W-STIR]) magnetic
resonance imaging methods for imaging the ischemic area at risk and
myocardial salvage in 73 patients with non-ST-segment elevation myocardial
infarction (mean age 57+/-10 years, 78% male) at 3.0-T magnetic resonance
imaging within 6.5+/-3.5 days of invasive management. The infarct-related
territory was identified independently using a combination of
angiographic, ECG, and clinical findings. The presence and extent of
infarction was assessed with late gadolinium enhancement imaging
(gadobutrol, 0.1 mmol/kg). The extent of acutely injured myocardium was
independently assessed with native T1, T2, and T2W-STIR methods. The mean
infarct size was 5.9+/-8.0% of left ventricular mass. The infarct zone T1
and T2 times were 1323+/-68 and 575 ms, respectively. The diagnostic
accuracies of T1 and T2 mapping for identification of the infarct-related
artery were similar (P=0.125), and both were superior to T2W-STIR (P <
0.001). The extent of myocardial injury (percentage of left ventricular
volume) estimated with T1 (15.8+/-10.6%) and T2 maps (16.0+/-11.8%) was
similar (P=0.838) and moderately well correlated (r=0.82, P < 0.001). Mean
extent of acute injury estimated with T2W-STIR (7.8+/-11.6%) was lower
than that estimated with T1 (P < 0.001) or T2 maps (P < 0.001).
Conclusions--In patients with non-ST-segment elevation myocardial
infarction, T1 and T2 magnetic resonance imaging mapping have higher
diagnostic performance than T2W-STIR for identifying the infarct-related
artery. Compared with conventional STIR, T1 and T2 maps have superior
value to inform diagnosis and revascularization planning in non-ST-segment
elevation myocardial infarction.<br/>Copyright &#xa9; 2017 The Authors.

<242>
Accession Number
615775379
Author
Samanta A.; Kaja A.K.; Afzal M.R.; Zuba-Surma E.K.; Dawn B.
Institution
(Samanta) Department of Medicine, University of Missouri-Kansas City,
Kansas City, MO, United States
(Kaja, Dawn) Division of Cardiovascular Diseases, Cardiovascular Research
Institute, Midwest Stem Cell Therapy Center, University of Kansas Medical
Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, United States
(Afzal) Division of Cardiology, Ohio State University Wexner Medical
Center, Columbus, OH, United States
(Zuba-Surma) Department of Cell Biology, Faculty of Biochemistry,
Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
Title
Bone marrow cells for heart repair: Clinical evidence and perspectives.
Source
Minerva Cardioangiologica. 65 (3) (pp 299-313), 2017. Date of Publication:
June 2017.
Publisher
Edizioni Minerva Medica (E-mail: subscriptions.dept@minervamedica.it)
Abstract
More than 15 years ago, bone marrow cell (BMC) therapy for cardiac repair
was hailed as a highly promising and revolutionary treatment approach that
was poised to benefit countless patients with ischemic heart disease (IHD)
and heart failure. The ensuing years have unfortunately witnessed endless
controversy not only about the mechanisms of action of cardiac repair with
cell therapy, but also regarding the efficacy of such approach. Somewhat
discordant results from smaller clinical trials with diverse study
designs, BMC types, routes of injection, timing after myocardial
infarction (MI), and other key study variables have been less than
conclusive. Because of this uncertainty regarding outcomes of BMC therapy,
a large number of meta-analyses have been performed, also with dissimilar
findings. Although the field continues to evolve with emergence of data
from newer and larger clinical trials with more stringent design, the
overall evidence does support efficacy of BMC injection in patients with
IHD with regard to improvement in cardiac parameters as well as patient
outcomes. Given the limitless potential of adult stem cell therapy in
general, at this juncture, a careful appraisal of the cumulative evidence
is critically necessary to appreciate the true impact of BMC therapy on
injured heart. This review will discuss the clinical evidence and
perspectives from trials and meta-analyses of BMC therapy in patients with
IHD that have accumulated in published literature.<br/>Copyright &#xa9;
2016 EDIZIONI MINERVA MEDICA.

<243>
Accession Number
616474436
Author
Palmisano P.; Aspromonte V.; Ammendola E.; Dell'era G.; Ziacchi M.; Guerra
F.; Aquilani S.; Maglia G.; Del Giorno G.; Giubertoni A.; Boriani G.;
Capucci A.; Ricci R.P.; Accogli M.
Institution
(Palmisano, Accogli) Cardiology Unit, 'Card. G. Panico' Hospital, Via S.
Pio X, 4, Tricase 73039, Italy
(Aspromonte, Maglia) Cardiology - Coronary Care Unit, Pugliese-Ciaccio
Hospital, Catanzaro, Italy
(Ammendola, Del Giorno) Department of Cardiology, Monaldi Hospital, Second
University of Naples, Naples, Italy
(Dell'era, Giubertoni) Division of Cardiology, University of Eastern
Piedmont, Maggiore della Carita Hospital, Novara, Italy
(Ziacchi, Boriani) Institute of Cardiology, University of Bologna, S.
Orsola-Malpighi University Hospital, Bologna, Italy
(Guerra, Capucci) Cardiology and Arrhythmology Clinic, Marche Polytechnic
University, University Hospital 'Umberto I - Lancisi - Salesi', Ancona,
Italy
(Aquilani, Ricci) Department of Cardiology, San Filippo Neri Hospital,
Rome, Italy
(Boriani) Cardiology Department, University of Modena and Reggio Emilia,
Policlinico di Modena, Modena, Italy
Title
Effect of fixed-rate vs. Rate-RESPONSIve pacing on exercise capacity in
patients with permanent, refractory atrial fibrillation and left
ventricular dysfunction treated with atrioventricular junction aBLation
and bivEntricular pacing (RESPONSIBLE): A prospective, multicentre,
randomized, single-blind study.
Source
Europace. 19 (3) (pp 414-420), 2017. Date of Publication: 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims: Atrioventricular junction (AVJ) ablation followed by biventricular
pacing is an established strategy for improving symptoms and morbidity in
patients with permanent atrial fibrillation (AF), reduced left ventricular
ejection fraction (LVEF), and uncontrolled ventricular rate. There is no
clear evidence that such patients benefit from rate-responsive (RR)
pacing. Methods and results: This prospective, randomized, single-blind,
multicentre study was designed as an intra-patient comparison and enrolled
60 patients (age 69.5 +/- 11.8 years, males 63.3%, NYHA 3.0 +/-0.6) with
refractory AF and reduced LVEF (mean 32.4+/-8.3%) treated with AVJ
ablation and biventricular pacing. Two 6-minute walking tests (6MWT) were
performed 1 week apart: one during VVI 70/min biventricular pacing and the
other during VVIR 70-130/min biventricular pacing; patients were randomly
and blindly assigned to Group A (n = 29, first 6MWT in VVIR mode) or B (n
= 31, first 6MWT in VVI mode). Rate-responsive activation determined an
increase of 18.8+/-24.4 m in the distance walked during the 6MWT (P <
0.001). The increase was similar in both groups (P = 0.571). A >5%
increase in the distance walked was observed in 76.7% of patients. The
increase in the distance walked was linearly correlated with the increase
in heart rate recorded during the 6MWT in the VVIR mode (r = 0.54; P <
0.001). Conclusion: In permanent AF patients with uncontrolled rate and
reduced LVEF who had undergone AVJ ablation and biventricular pacing, RR
pacing yields a significant gain in exercise capacity, which seems to be
related to the RR-induced frequency during effort.<br/>Copyright &#xa9;
The Author 2016.

<244>
Accession Number
618838114
Author
Cowper P.A.; Sheng S.; Lopes R.D.; Anstrom K.J.; Stafford J.A.;
Davidson-Ray L.; Al-Khatib S.M.; Ansell J.; Dorian P.; Husted S.; McMurray
J.J.V.; Steg P.G.; Alexander J.H.; Wallentin L.; Granger C.B.; Mark D.B.
Institution
(Cowper, Sheng, Lopes, Anstrom, Stafford, Davidson-Ray, Al-Khatib,
Alexander, Granger, Mark) Duke Clinical Research Institute, Duke
University Medical Center, PO Box 17969, Durham, NC 27715, United States
(Ansell) Department of Medicine, Hofstra Northwell School of Medicine,
Hemstead, NY, United States
(Dorian) Division of Cardiology, University of Toronto, Toronto, ON,
Canada
(Husted) Aarhus University, Aarhus, Denmark
(McMurray) British Heart Foundation, Cardiovascular Research Centre,
University of Glasgow, Glasgow, United Kingdom
(Steg) Universite Paris-Diderot, Sorbonne Paris Cite, French Alliance for
Cardiovascular Clinical Trials, Departement Hospitalo-Universitaire
Fibrosis, Inflammation, Remodeling, Assistance-Publique-Hopitaux de Paris,
Institut National de la Sante et de la Recherche Medicale U-1148, Paris,
France
(Steg) National Heart and Lung Institute, Royal Brompton Hospital,
Imperial College, London, United Kingdom
(Wallentin) Uppsala Clinical Research Center, Uppsala University, Uppsala,
Sweden
Title
Economic analysis of Apixaban therapy for patients with Atrial
Fibrillation from a us perspective: Results from the Aristotle randomized
clinical trial.
Source
JAMA Cardiology. 2 (5) (pp 525-534), 2017. Date of Publication: May 2017.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: The Apixaban for Reduction in Stroke and Other Thromboembolic
Events in Atrial Fibrillation (ARISTOTLE) trial reported that apixaban
therapy was superior to warfarin therapy in preventing stroke and
all-cause death while causing significantly fewer major bleeds. To
establish the value proposition of substituting apixiban therapy for
warfarin therapy in patients with atrial fibrillation, we performed a
cost-effectiveness analysis using patient-level data from the ARISTOTLE
trial. Objective: To assess the cost and cost-effectiveness of apixaban
therapy compared with warfarin therapy in patients with atrial
fibrillation from the perspective of the US health care system. Design,
Setting, and Participants: This economic analysis uses patient-level
resource use and clinical data collected in the ARISTOTLE trial, a
multinational randomized clinical trial that observed 18 201 patients
(3417 US patients) for a median of 1.8 years between 2006 and 2011.
Interventions: Apixaban therapy vs warfarin therapy. Main Outcomes and
Measures: Within-trial resource use and costwere compared between
treatments, using externally derived US cost weights. Life expectancies
for US patients were estimated according to their baseline risk and
treatment using time-based and age-based survival models developed using
the overall ARISTOTLE population. Quality-of-life adjustment factors were
obtained from external sources. Cost-effectiveness (incremental cost per
quality-adjusted life-year gained) was evaluated from a US perspective,
and extensive sensitivity analyses were performed. Results: Of the 3417 US
patients enrolled in ARISTOTLE, the mean (SD) age was 71 (10) years; 2329
(68.2%) were male and 3264 (95.5%) were white. After 2 years of
anticoagulation therapy, health care costs (excluding the study drug) of
patients treated with apixaban therapy and warfarin therapy were not
statistically different (difference, -$60; 95%CI, -$2728 to $2608). Life
expectancy, modeled from ARISTOTLE outcomes, was significantly longer with
apixaban therapy vs warfarin therapy (7.94 vs 7.54 quality-adjusted life
years). The incremental cost, including cost of anticoagulant and
monitoring, of achieving these benefits was within accepted US norms ($53
925 per quality-adjusted life year, with 98% likelihood of meeting a $100
000 willingness-to-pay threshold). Results were generally consistent when
model assumptions were varied, with lifetime cost-effectiveness most
affected by the price of apixaban and the time horizon. Conclusions and
Relevance: Apixaban therapy for ARISTOTLE-eligible patients with atrial
fibrillation provides clinical benefits at an incremental cost that
represents reasonable value for money judged using US benchmarks for
cost-effectiveness.<br/>Copyright &#xa9; 2017 American Medical
Association. All rights reserved.

<245>
Accession Number
618838054
Author
Engstrom T.; Kelbaek H.; Helqvist S.; Hofsten D.E.; Klovgaard L.;
Clemmensen P.; Holmvang L.; Jorgensen E.; Pedersen F.; Saunamaki K.;
Ravkilde J.; Tilsted H.-H.; Villadsen A.; Aaroe J.; Jensen S.E.; Raungaard
B.; Botker H.E.; Terkelsen C.J.; Maeng M.; Kaltoft A.; Krusell L.R.;
Jensen L.O.; Veien K.T.; Kofoed K.F.; Torp-Pedersen C.; Kyhl K.;
Nepper-Christensen L.; Treiman M.; Vejlstrup N.; Ahtarovski K.; Lonborg
J.; Kober L.; Thygesen K.; Jeppesen J.; Galloe A.; Jensen G.B.; Gislasson
G.; Erlinge D.
Institution
(Engstrom, Helqvist, Hofsten, Klovgaard, Clemmensen, Holmvang, Jorgensen,
Pedersen, Saunamaki, Tilsted, Kofoed, Kyhl, Nepper-Christensen, Vejlstrup,
Ahtarovski, Lonborg, Kober) Department of Cardiology, Rigshospitalet,
University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
(Kelbaek, Galloe) Department of Cardiology, Roskilde Hospital, Roskilde,
Denmark
(Ravkilde, Villadsen, Aaroe, Jensen, Raungaard) Department of Cardiology,
Aalborg University Hospital, Aalborg, Denmark
(Botker, Terkelsen, Maeng, Kaltoft, Krusell) Department of Cardiology,
Skejby University Hospital, Skejby, Denmark
(Jensen, Veien) Department of Cardiology, Odense University Hospital,
Odense, Denmark
(Torp-Pedersen) Department of Clinical Epidemiology, Aalborg University
Hospital, Aalborg, Denmark
(Treiman) Department of Biomedical Sciences, Faculty of Health Sciences,
University of Copenhagen, Copenhagen, Denmark
(Thygesen) Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
(Jeppesen) Department of Medicine, Copenhagen University Hospital
Glostrup, Copenhagen, Denmark
(Jensen) Department of Cardiology, Hvidovre Hospital, Hvidovre, Denmark
(Gislasson) Department of Cardiology, Gentofte Hospital, Cohenhagen,
Denmark
(Erlinge) Department of Cardiology, Lund University, Lund, Sweden
Title
Effect of ischemic postconditioning during primary percutaneous coronary
intervention for patients with ST-segment elevation myocardial infarction:
A randomized clinical trial.
Source
JAMA Cardiology. 2 (5) (pp 490-497), 2017. Date of Publication: May 2017.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Ischemic postconditioning of the heart during primary
percutaneous coronary intervention (PCI) induced by repetitive
interruptions of blood flow to the ischemic myocardial region immediately
after reopening of the infarct-related arterymay limit myocardial damage.
Objective: To determine whether ischemic postconditioning can improve the
clinical outcomes in patients with ST-segment elevationmyocardial
infarction (STEMI). Design, Setting, and Participants: In this
multicenter, randomized clinical trial, patients with onset of symptoms
within 12 hours, STEMI, and thrombolysis inmyocardial infarction (TIMI)
grade 0-1 flow in the infarct-related artery at arrival were randomized to
conventional PCI or postconditioning. Inclusion began on March 21, 2011,
through February 2, 2014, and follow-up was completed on February 2, 2016.
Analysis was based on intention to treat. Interventions: Patients were
randomly allocated 1:1 to conventional primary PCI, including stent
implantation, or postconditioning performed as 4 repeated 30-second
balloon occlusions followed by 30 seconds of reperfusion immediately after
opening of the infarct-related artery and before stent implantation. Main
Outcome and Measures: A combination of all-cause death and hospitalization
for heart failure. Results: During the inclusion period, 1234 patients
(975 men [79.0%] and 259 women [21.0%]; mean [SD] age, 62 [11] years)
underwent randomization in the trial. Median follow-up was 38 months
(interquartile range, 24-58 months). The primary outcome occurred in 69
patients (11.2%) who underwent conventional primary PCI and in 65 (10.5%)
who underwent postconditioning (hazard ratio, 0.93; 95%CI, 0.66-1.30; P =
.66). The hazard ratios were 0.75 (95%CI, 0.49-1.14; P = .18) for
all-cause death and 0.99 (95%CI, 0.60-1.64; P = .96) for heart failure.
Conclusions and Relevance: Routine ischemic postconditioning during
primary PCI failed to reduce the composite outcome of death from any cause
and hospitalization for heart failure in patients with STEMI and TIMI
grade 0-1 flow at arrival.<br/>Copyright &#xa9; 2017 American Medical
Association. All rights reserved.

<246>
Accession Number
618837823
Author
Secemsky E.A.; Yeh R.W.; Kereiakes D.J.; Cutlip D.E.; Cohen D.J.; Steg
P.G.; Cannon C.P.; Apruzzese P.K.; D'Agostino R.B.; Massaro J.M.; Mauri
L.; Kaplan A.; Ahmed A.; Ahmed A.-H.; Albirini A.; Moreyra A.; Rabinowitz
A.; Shroff A.; Moak A.; Jacobs A.; Kabour A.; Gupta A.; Irimpen A.;
Rosenthal A.; Taussig A.; Ferraro A.; Chhabra A.; Pucillo A.; Spaedy A.;
White A.; Pratsos A.; Shakir A.; Ghitis A.; Agarwal A.; Chawla A.; Tang
A.; Barker B.; Bertolet B.; Uretsky B.; Erickson B.; Rama B.; McLaurin B.;
Dearing B.; Negus B.; Price B.; Brott B.; Bhambi B.; Bowers B.; Watt B.;
Donohue B.; Hassel C.D.; Croft C.; Lambert C.; O'Shaughnessy C.; Shoultz
C.; Kim C.; Caputo C.; Nielson C.; Scott C.; Wolfe C.; McKenzie C.;
Brachfeld C.; Thieling C.; Fisher D.; Simon D.; Churchill D.; Dobies D.;
Eich D.; Goldberg D.; Griffin D.; Henderson D.; Kandzari D.; Lee D.; Lewis
D.; Mego D.; Paniagua D.; Rizik D.; Roberts D.; Safley D.; Abbott D.; Shaw
D.; Temizer D.; Canaday D.; Myears D.; Westerhausen D.; Ebersole D.; Netz
D.; Baldwin D.; Letts D.; Harlamert E.; Kosinski E.; Portnay E.; Mahmud
E.; Korban E.; Hockstad E.; Rivera E.; Shawl F.; Shamoon F.; Kiernan F.;
Aycock G.R.; Schaer G.; Kunz G.; Kichura G.; Myers G.; Pilcher G.; Tadros
G.; Kaddissi G.I.; Ramadurai G.; Eaton G.; Elsner G.; Mishkel G.; Simonian
G.; Piegari G.; Chen H.; Liberman H.; Aronow H.; Tamboli H.P.; Dotani I.;
Marin J.; Fleischhauer J.F.; Hopkins J.; Leggett J.; Mills J.; Phillips
J.; Revenaugh J.; Mann J.T.; Wilson J.; Pattanayak J.; Aji J.; Strain J.;
Patel J.; Carr J.; Moses J.; Chen J.-C.; Williams J.; Greenberg J.; Cohn
J.; Douglas J.; Gordon J.; Griffin J.; Hawkins J.; Katopodis J.; Lopez J.;
Marshall J.; Wang J.; Waltman J.; Saucedo J.; Galichia J.; McClure M.;
Kozina J.; Stella J.; Tuma J.; Kieval J.; Giri K.; Ramanathan K.; Allen
K.; Atassi K.; Baran K.; Khaw K.; Clayton K.; Croce K.; Skelding K.; Patel
K.; Garratt K.; Harjai K.; Chandrasekhar K.; Kalapatapu K.; Lin L.; Dean
L.; Barr L.; MacDonald L.; Cannon L.; Satler L.; Gruberg L.; Tami L.;
Bikkina M.; Shah M.; Atieh M.; Chauhan M.; Litt M.; Unterman M.; Lechin
M.; Zughaib M.; Fisch M.; Grabarczyk M.; Greenberg M.; Lurie M.;
Rothenberg M.; Stewart M.; Purvis M.; Hook M.; Leesar M.; Buchbinder M.;
Weiss M.; Guerrero M.; Abu-Fadel M.; Ball M.; Chang M.; Cunningham M.; Del
Core M.; Jones M.; Kelberman M.; Lim M.; Ragosta M.; Rinaldi M.; Rosenberg
M.; Savage M.; Tamberella M.; Kellett M.; Vidovich M.; Effat M.; Mirza
M.A.; Khan M.; Dib N.; Laufer N.; Kleiman N.; Farhat N.; Amjadi N.;
Schechtmann N.; Bladuell N.; Quintana O.; Gigliotti O.; Best P.; Flaherty
P.; Hall P.; Gordon P.; Gurbel P.; Ho P.; Luetmer P.; Mahoney P.; Mullen
P.; Teirstein P.; Tolerico P.; Ramanathan P.; Kerwin P.; Lee P.V.; Kraft
P.; Wyman R.M.; Gonzalez R.; Kamineni R.; Dave R.; Sharma R.; Prashad R.;
Aycock R.; Quesada R.; Goodroe R.; Magorien R.; Randolph R.; Bach R.;
Kettelkamp R.; Paulus R.; Waters R.; Zelman R.; Ganim R.; Bashir R.;
Applegate R.; Feldman R.; Frankel R.; Hibbard R.; Jobe R.; Jumper R.;
Maholic R.; Siegel R.; Smith R.; Stoler R.; Watson R.; Wheatley R.; Gammon
R.; Hill R.; Sundrani R.; Caputo R.; Jenkins R.; Stella R.; Germanwala S.;
Hadeed S.; Ledford S.; Dube S.; Gupta S.; Davis S.; Martin S.; Waxman S.;
Dixon S.; Naidu S.; Potluri S.; Cook S.; Crowley S.; Kirkland S.; McIntyre
S.; Thew S.; Lin S.; Marshalko S.; Guidera S.; Hearne S.; Karas S.;
Manoukian S.; Rowe S.; Yakubov S.; Pollock S.; Banerjee S.; Allaqaband S.;
Choi S.; Mulukutla S.; Papadakos S.; Bajwa T.; Addo T.; Schreiber T.;
Haldis T.; Mathew T.; McGarry T.; Nygaard T.; Pow T.; Larkin T.; Caulfield
T.; Stys T.; Lee T.; Mansouri V.; Srinivas V.; Gupta V.; Marquardt W.;
Ballard W.; Bachinsky W.; Colyer W.; Dillon W.; Felten W.; French W.;
Kuehl W.; Nicholas W.; Nicholson W.; Phillips W.; Khatib Y.; Al-Saghir Y.;
Hawa Z.; Masud Z.; Jafar Z.; Muller D.; Meredith I.; Rankin J.; Worthley
M.; Jepson N.; Thompson P.; Hendriks R.; Whitbourn R.; Duffy S.; Stasek
J.; Novobilsky K.; Naplava R.; Coufal Z.; Vaquette B.; Bressollette E.;
Teiger E.; Coste P.; Rihani R.; Darius H.; Bergmann M.W.; Radke P.;
Sebastian P.; Strasser R.; Hoffmann S.; Behrens S.; Moebius-Winkler S.;
Rutsch W.; Lupkovics G.; Horvath I.; Kancz S.; Forster T.; Koszegi Z.;
Devlin G.; Hart H.; Elliott J.; Ormiston J.; Abernathy M.; Fisher N.; Kay
P.; Harding S.; Jaffe W.; Hoffmann A.; Sosnowski C.; Trebacz J.; Buszman
P.; Dobrzycki S.; Kornacewicz-Jach Z.; Iancu A.C.; Ginghina C.D.; Matei
C.; Dobreanu D.; Bolohan F.R.; Dorobantu M.; Jacques A.; Jain A.; Bakhai
A.; Gershlick A.; Adamson D.; Newby D.; Felmeden D.; Purcell I.; Edmond
J.; Irving J.; De Belder M.; Pitt M.; Kelly P.; O'Kane P.; Clifford P.;
Suresh V.
Institution
(Secemsky) Division of Cardiology, Massachusetts General Hospital, Boston,
MA, United States
(Secemsky, Yeh, Cutlip, Cannon, Mauri) Harvard Medical School, Boston, MA,
United States
(Secemsky, Mauri) Center for Clinical Biometrics, Department of Medicine,
Brigham and Women's Hospital, Boston, MA, United States
(Secemsky, Yeh) Smith Center for Outcomes Research in Cardiology, Beth
Israel Deaconess Medical Center, Boston, MA, United States
(Secemsky, Yeh, Cutlip, Cannon, Apruzzese, D'Agostino, Massaro, Mauri)
Baim Institute for Clinical Research, Boston, MA, United States
(Yeh, Cutlip) Division of Cardiology, Beth Israel Deaconess Medical
Center, Boston, MA, United States
(Kereiakes) Christ Hospital Heart and Vascular Center, Cincinnati, OH,
United States
(Kereiakes) Lindner Center for Research and Education, Cincinnati, OH,
United States
(Cohen) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Cohen) University of Missouri-Kansas City, School of Medicine, Kansas
City, MO, United States
(Steg) Universite Paris-Diderot, Institut National de la Sante et de la
Recherche Medicale U-1148, Hopital Bichat, Paris, France
(Steg) Departement Hospitalo-Universitaire Fibrosis, Inflammation, and
Remodeling, Assistance Publique, Hopitaux de Paris, Paris, France
(Steg) National Heart and Lung Institute, Institute of Cardiovascular
Medicine and Science, Royal Brompton Hospital, Imperial College, London,
United Kingdom
(Cannon, Mauri) Division of Cardiology, Brigham and Women's Hospital, 75
Francis St, Boston, MA 02115, United States
(D'Agostino, Massaro) Boston University School of Public Health, Boston,
MA, United States
(Kaplan) Dartmouth Hitchcock Medical Center, United States
(Ahmed, Ahmed) Altru Health System, United States
(Albirini) Genesis HealthCare System, United States
(Moreyra) University of Medicine and Dentistry of New Jersey, United
States
(Rabinowitz) South Texas Cardiovascular, United States
(Shroff) Jesse Brown VA Medical Center, United States
(Moak) Penn Presbyterian Medical Center, United States
(Jacobs) Boston Medical Center, United States
(Kabour) Mercy St Vincent's Medical Center, United States
(Gupta) North Mississippi Medical Center, United States
(Irimpen) Tulane Medical Center, United States
(Rosenthal) Bayfront Medical Center, United States
(Taussig, Kim) Florida Hospital, United States
(Ferraro) Sacred Heart Medical Center, United States
(Chhabra) Cardiovascular Research, United States
(Pucillo, Kalapatapu) Westchester Medical Center, United States
(Spaedy) Missouri Heart Center, United States
(White) NEA Baptist Clinic, United States
(Pratsos) Bryn Mawr Hospital, United States
(Shakir) Midwest Regional Medical Center, United States
(Ghitis) Diagnostic Cardiology Associates, United States
(Agarwal, Strain) Valley Hospital, United States
(Jain) California Cardiovascular Consultants Medical Associates, United
States
(Chawla) Iowa Heart Center, United States
(Tang) Chambersburg Hospital, United States
(Barker, Siegel) Arizona Regional Medical Center, United States
(Bertolet) Cardiology Associates Research, United States
(Uretsky) Arkansas VA Medical Center, United States
(Erickson) Central Minnesota Heart Center, St Cloud Hospital, United
States
(Rama) Frederick C. Smith Clinic, United States
(McLaurin) AnMed Health, United States
(Dearing) Thomas Hospital, United States
(Negus, Ledford) Chattanooga Heart Institute, United States
(Price, Paulus) King's Daughters Medical Center, United States
(Brott) University of Alabama at Birmingham, United States
(Bhambi) Bakersfield Heart, United States
(Bowers) Cardiopulmonary Research Science and Technology Institute, United
States
(Watt) North Central Heart Institute, United States
(Donohue) University of Pittsburgh Medical Center, Shadyside Hospital,
United States
(Hassel, Litt) Jacksonville Heart Center, United States
(Croft) Holmes Regional Medical Center, United States
(Lambert) Pepin Heart Hospital, United States
(O'Shaughnessy, Farhat) North Ohio Heart Center, United States
(Shoultz) Providence Health Center, United States
(Suresh) Derriford Hospital, United States
(Caputo) North Florida Regional Medical Center, United States
(Nielson) Medical University of South Carolina Hospital, United States
(Scott) University of Tennessee Medical Center, United States
(Wolfe) Providence St Peter Hospital, United States
(McKenzie) St John's Mercy Cardio Research, United States
(Brachfeld) Promise Regional Medical Center, United States
(Thieling) Hattiesburg Clinic PA, United States
(Fisher) UMASS Memorial Medical Center, United States
(Lee) Bay Regional Medical Center, United States
(Simon, Cunningham) University Hospitals Case Medical Center, United
States
(Churchill) Washington Regional Medical Center, United States
(Dobies) Genesys Regional Medical Center, United States
(Eich, Mahoney) Sentara Norfolk General Hospital, United States
(Goldberg) New England Heart Institute, United States
(Griffin, Temizer) Good Samaritan Hospital, United States
(Henderson) Cardiology Research Associates, United States
(Kandzari, Ballard) Piedmont Heart Institute, United States
(Lee) Bakersfield Memorial Hospital, United States
(Lewis) South Central Wisconsin Heart, United States
(Mego, Flaherty) Little Rock Cardiology Clinic, United States
(Paniagua) Michael E. DeBakey VA Medical Center, United States
(Rizik) Scottsdale Health Care, United States
(Roberts) Sacramento Heart and Vascular Institute, United States
(Safley) St Luke's Hospital, United States
(Abbott) Rhode Island Hospital, United States
(Shaw) Christus St Frances Cabrini Hospital, United States
(Clifford) Wycombe General Hospital, United States
(Canaday) Inland Cardiology Associates, United States
(Myears, Hawkins) St John's Medical Research Institute, United States
(Westerhausen) Midwest Cardiovascular Research and Education Foundation,
United States
(Ebersole) Watson Clinic Center for Research, United States
(Netz) Nebraska Heart Institute, United States
(Baldwin) Tulane University Medical School, United States
(Letts, Tamberella) Carolina Heart Specialists, United States
(Harlamert, Fisch) Clarian North Medical Center, United States
(Kosinski) Connecticut Clinical Research, United States
(Portnay, Jumper) Cardiology Associates of Fairfield County, United States
(Mahmud) UCSD Medical Center, United States
(Korban) Jackson-Madison County General Hospital, United States
(Hockstad) Kansas City Heart Foundation, United States
(Rivera) Amarillo Heart Group, United States
(Shawl) Washington Adventist Hospital, United States
(Shamoon) St Michael's Medical Center, United States
(Kiernan) Hartford Hospital, United States
(Aycock, Fleischhauer, Stewart, Aycock) Cardiology Consultants, United
States
(Schaer) Rush University Medical Center, United States
(Kunz) New Mexico Heart Institute PA, United States
(Kichura) St John's Mercy Cardiovascular Research, United States
(Myers) Redmond Regional Medical Center, United States
(Pilcher) St Vincent's Healthcare, United States
(Tadros) North Memorial Medical Center, United States
(Kaddissi, Khaw) Our Lady of Lourdes Medical Center, United States
(Ramadurai) Heartland Cardiovascular Center, United States
(Eaton) Medcentral Health System, United States
(Elsner, McClure, Ball) Care Group, United States
(Mishkel) St John's Hospital, United States
(Simonian) Hackensack University Medical Center, United States
(Piegari) Berks Cardiologists, United States
(Chen) Heart Center PC, United States
(Liberman) Emory University Hospital Midtown, United States
(Aronow) Michigan Heart and Vascular Institute, United States
(Tamboli) Bay Area Cardiology Associates, United States
(Dotani) McFarland Clinic PC, United States
(Marin) St Joseph's Hospital, United States
(O'Kane) Bournemouth Hospital, United States
(Hopkins) Christiana Hospital, United States
(Leggett) Over Lake Hospital Medical Center, United States
(Mills) Duke Raleigh Hospital, United States
(Phillips) Palmetto Richland Memorial Hospital, United States
(Revenaugh) J. L. Sorenson Heart and Lung, United States
(Mann, Hook, Jobe) Wake Heart Research Institute, United States
(Wilson) Texas Heart Institute, United States
(Pattanayak, Kuehl) Asheville Cardiology Associates, United States
(Aji) Cooper University Hospital, United States
(Kelly) Basildon University Hospital, United States
(Patel) Hamilton Cardiology Associates, United States
(Carr) East Texas Medical Center, United States
(Moses) Columbia Presbyterian Hospital, United States
(Chen) Straub Clinic and Hospital, United States
(Williams) Mid Carolina Cardiology, United States
(Greenberg, Crowley) Aurora Denver Cardiology Associates, United States
(Cohn) Ingham Regional Medical Center, United States
(Douglas) Emory University Hospital, United States
(Gordon) Sharp Memorial Hospital, United States
(Griffin) Alegent Health Research Center, United States
(Griffin) Cardiovascular Associates, United States
(Pitt) Heartland Hospital, United States
(Katopodis) Tallahassee Research Institute, United States
(Lopez) Loyola University Medical Center, United States
(Marshall) Northeast Georgia Medical Center, United States
(Wang) Union Memorial Hospital, United States
(Waltman, Caputo, Lin) St Joseph Hospital, United States
(Saucedo, Abu-Fadel) University of Oklahoma Health Science Center, United
States
(Galichia) Galichia Heart Hospital, United States
(McClure) Mid-Michigan Heart and Vascular Center, United States
(Kozina, Chang, Marquardt) Mercy General Hospital, United States
(Stella, Stella) Heart Care Research Foundation, United States
(Tuma) Black Hills Cardiovascular Research, United States
(Kieval, Rothenberg) Palm Beach Heart Research Institute, United States
(Giri) Cardiovascular Associates of Delaware Valley, United States
(Ramanathan, Ramanathan) Northwest Ohio Cardiology Consultants, United
States
(Allen) Presbyterian Heart Group, United States
(Atassi) Northwest Indiana Cardiovascular Physicians PC, United States
(Baran) St Paul Heart Clinic, United States
(De Belder) James Cook Hospital, United States
(Clayton) Munson Medical Center, United States
(Croce) Brigham and Women's Hospital, United States
(Skelding) Geisinger Medical Center, United States
(Patel) St Joseph Mercy Oakland, United States
(Garratt, Papadakos) Lenox Hill Hospital, United States
(Harjai) Donald Guthrie Foundation, United States
(Chandrasekhar) Winter Haven Hospital, United States
(Irving) Ninewells Hospital and MS, United States
(Lin) Morton Plant Hospital, United States
(Dean) University of Washington, United States
(Barr, Kerwin) Midwest Heart Foundation, United States
(MacDonald) Swedish Medical Center, United States
(Cannon) Cardiac and Vascular Research Center of North Michigan, United
States
(Satler) Washington Hospital Center, United States
(Gruberg) Stony Brook University Medical Center, United States
(Tami) Memorial Regional Hospital, United States
(Bikkina) St Joseph's Regional Medical Center, United States
(Shah) Shah Associates, United States
(Atieh) Pinehurst Medical Clinic, United States
(Chauhan) Cardiovascular Specialists of Texas, United States
(Edmond) Weston General Hospital, United States
(Unterman) St Joseph's Hospital Atlanta, United States
(Lechin) College Station Medical Center, United States
(Zughaib, Hall) Providence Hospital, United States
(Purcell) Freeman Hospital, United States
(Grabarczyk) Greenville Memorial Hospital, United States
(Greenberg) Moses Hospital, United States
(Lurie, Wyman) Torrance Memorial Medical Center, United States
(Felmeden) Torbay Hospital, United States
(Newby) Royal Infirmary of Edinburgh, United States
(Purvis) Medical Center of the Rockies, United States
(Adamson) Coventry and Warwickshire UH, United States
(Leesar, Effat) University of Cincinnati, United States
(Buchbinder) Foundation for Cardiovascular Medicine, United States
(Weiss) Jersey Shore University Medical Center, United States
(Guerrero) Henry Ford Hospital, United States
(Gershlick) Glenfield Hospital, United States
(Bakhai) Barnet Hospital, United States
(Jain) London Chest Hospital, United States
(Jacques) St Peter's Hospital, United Kingdom
(Del Core) Cardiac Center of Creighton University Medical Center, United
States
(Jones) Central Baptist Hospital, United States
(Kelberman) St Elizabeth Medical Center, United States
(Lim) St Louis University, United States
(Ragosta) University of Virginia, United States
(Rinaldi) Carolinas Medical Center, United States
(Rosenberg) Advocate Good Shepherd Hospital, United States
(Savage) Thomas Jefferson University Hospital, United States
(Dorobantu) Spitalul Clinic de Urgenta Bucuresti, Romania
(Bolohan) Centrul Clinic de Urgenta de Boli Cardi, Romania
(Kellett) Maine Medical Center, United States
(Vidovich) University of Illinois Hospital, United States
(Dobreanu) Institutul de Boli Cardiovasculare si, Romania
(Mirza) Carilion Medical Center, United States
(Khan) North Dallas Research Associates, United States
(Dib) Mercy Gilbert Medical Center, United States
(Laufer) Heart and Vascular Center of Arizona, United States
(Kleiman) Methodist Hospital, United States
(Matei) Institutul de Urgentapentru Boli Cardiovas, Romania
(Amjadi) Texas Heart and Vascular, United States
(Schechtmann, Karas) MIMA Century Research Associates, United States
(Bladuell) WellStar Kennestone Hospital, United States
(Quintana) Hospital at Renaissance, United States
(Gigliotti) Seton Heart Institute, United States
(Best) Mayo Clinic, United States
(Ginghina) Inst. Urgenta Boli Cardiovasculare, Romania
(Iancu) Institutul Inimii Niculae Stancioiu Cluj-Napoca, Romania
(Gordon) Miriam Hospital, United States
(Gurbel) Sinai Center for Thrombosis Research, United States
(Ho) Kaiser Foundation Hospitals, United States
(Luetmer) Aspirus Heart and Vascular Institute, United States
(Kornacewicz-Jach) SPSK nr 2 Pomor. AM Szczecin, Poland
(Mullen) Memorial Hospital at Gulfport, United States
(Teirstein) Scripps Green Hospital, United States
(Tolerico, Nicholson) York Hospital, United Kingdom
(Dobrzycki) Uniwer. Szpital Klin. Bialystok, Poland
(Buszman) Polsko-Amerykanskie Kliniki Serca, Poland
(Lee) Northeast Cardiology Associates, United States
(Kraft) Beaumont Hospital Troy, United States
(Trebacz) NZOZ Centr. Med. Beluga-Med, Poland
(Gonzalez) Scott and White Health Care Round Rock, United States
(Kamineni) Salem Hospital, United States
(Dave) Spirit Physician Services, United States
(Sharma) St Anthony Central Hospital, United States
(Prashad) Ocala Research Institute, United States
(Sosnowski) Instytut Kardiologii Kardynala Wyszynskiego, Poland
(Quesada) Baptist Hospital, India
(Goodroe) Grand Strand Regional Medical Center, United States
(Magorien) Ohio State University Medical Center, United States
(Randolph) Winchester Medical Center, United States
(Bach) Washington University School of Medicine, St Louis, MO, United
States
(Kettelkamp) Cardiologists LC, United States
(Hoffmann) Wielospecj. Szpital Miejskiim, Poland
(Waters) St Joseph's Medical Center, United States
(Zelman) Cape Cod Research Institute, United States
(Ganim) Kingwood Medical Center, United States
(Bashir) Temple University, United States
(Applegate) Wake Forest University, United States
(Feldman) MediQuest Munroe Regional Medical Center, United States
(Frankel) Maimonides Medical Center, United States
(Hibbard) Bryan LGH Medical Center, United States
(Jaffe) Ascot Integrated Hospital, United States
(Harding) Wellington Hospital, United Kingdom
(Maholic) Hamot Medical Center, United States
(Kay) Middlemore Hospital, United States
(Smith) Tyler Cardiovascular Consultants, United States
(Stoler) Baylor Heart and Vascular Hospital, United States
(Watson) Abington Medical Specialist, United States
(Wheatley) Centennial Heart, United States
(Gammon) Austin Heart Research, United States
(Hill) St Bernard's Medical Center, United States
(Sundrani) Cardiovascular Consultants, United States
(Fisher) Nelson Hospital, United States
(Jenkins) Kootenai Medical Center, United States
(Abernathy) Wakefield Hospital, United States
(Germanwala) Longview Regional Medical Center, United States
(Hadeed) Conemaugh Valley Memorial Hospital, United States
(Ormiston) Mercy Angiography, United States
(Dube) Indiana Heart Hospital, United States
(Gupta) Oregon Health and Science University, United States
(Davis) Baptist Health Medical Center, United States
(Martin) Covenant Medical Center, United States
(Waxman) Lahey Clinic Medical Center, United States
(Dixon) William Beaumont Hospital, United States
(Naidu) Winthrop University Hospital, United States
(Potluri) Heart Hospital Baylor Plano, United States
(Cook) Novant Clinical Research Institute, United States
(Cook) Sacred Heart General Hospital, United States
(Elliott) Christchurch Hospital, United States
(Kirkland) Forsyth Medical Center, United States
(McIntyre) Martin Memorial Health Systems, United States
(Thew) Heart Clinics Northwest PS, United States
(Hart) North Shore Hospital, United States
(Marshalko) Bridgeport Hospital, United States
(Guidera) Doylestown Hospital, United States
(Hearne) Delmarva Heart Research Foundation, United States
(Devlin) Waikato Hospital, New Zealand
(Manoukian) Sarah Cannon Research Institute, United States
(Rowe) Cox Medical Centers, United States
(Yakubov) Ohio Health Research Institute, United States
(Pollock) Rockingham Memorial Hospital, United States
(Banerjee) VA North Texas Health Care Center, United States
(Allaqaband, Bajwa) Sinai Medical Center, United States
(Choi) California Pacific Medical Center Research, United States
(Mulukutla) University of Pittsburgh Medical Center, United States
(Koszegi) Josa Andras Oktato Korhaz Nonprofit Kft, Hungary
(Forster) Szegedi Tudomanyegyetem SZ-GY, Hungary
(Addo) University of Texas Southwestern Medical Center, United States
(Schreiber) DMC Harper University Hospital, United States
(Haldis) MeritCare Hospital Pharmacy, United States
(Mathew) Slocum Dickson Medical Group, United States
(McGarry) Oklahoma Foundation for Cardiovascular Research, United States
(Nygaard) Cardiovascular Group, United States
(Pow) Great Lakes Heart and Vascular Institute, United States
(Larkin) Midwest Heart Specialists, United States
(Caulfield) Providence St Vincent Medical Center, United States
(Stys) Sanford Research, United States
(Lee) Stanford Medical Center, United States
(Mansouri) St Thomas Hospital, United States
(Srinivas) Weiler Hospital, United States
(Gupta) Borgess Research Institute, United States
(Kancz) Gottsegen Gyorgy Orszagos Kardiologiai Intezet, Hungary
(Horvath) Pecsi Tudomanyegyetem Klinikai Kozpont, Hungary
(Bachinsky) Pinnacle Health, United States
(Colyer) University of Toledo Medical Center, United States
(Dillon) Louisville Cardiology Medical, United States
(Felten) Mid-Michigan Medical Center, United States
(French) LA Biomed Research Institute, United States
(Lupkovics) Zala Megyei Korhaz, Hungary
(Nicholas) Freeman West Hospital, United States
(Rutsch) Helios Klinikum Emil von Behring, Germany
(Phillips) Central Maine Medical Center, United States
(Khatib, Al-Saghir) 1st Coast Cardiovascular Institute, United States
(Moebius-Winkler) Herzzentrum Leipzig GmbH, Germany
(Hawa) North Kansas City Hospital, United States
(Masud) Kaleida Health, United States
(Jafar) Hudson Valley Heart Center, United States
(Muller) St Vincent's Hospital Sydney, Australia
(Meredith) Monash Heart Southern Health, Australia
(Rankin) Royal Perth Hospital, Australia
(Worthley) Royal Adelaide Hospital, Australia
(Jepson) Prince of Wales Eastern Heart, Australia
(Thompson) Sir Charles Gardiner Hospital, Australia
(Hendriks) Fremantle Hospital, Australia
(Whitbourn) St Vincent's Hospital Melbourne, Australia
(Duffy) Alfred Hospital, Australia
(Stasek) FN Hradec Kralove, Czech Republic
(Novobilsky) Mestska nemocnice Ostrava, Czech Republic
(Naplava) Centrum pro choroby srdce, Czech Republic
(Coufal) KNTB a.s., Czech Republic
(Vaquette) Hopital Saint Louis, France
(Bressollette) Nouvelle Clinique Nantaise, France
(Teiger) CHU Henri Mondor, France
(Coste) Groupe Hospitalier Sud, France
(Rihani) Hopital Saint Philibert, France
(Darius) Vivantes-Klinikum Neukoelln, Germany
(Bergmann) Asklepios Klinik St Georg, Germany
(Radke) UK-SH, Germany
(Sebastian) Elbe-Kliniken Stade GmbH, Germany
(Strasser) Universitaetsklinikum Dresden, Germany
(Hoffmann) Vivantes Klin. Friedrichshain, Germany
(Behrens) VivantesHumboldt Klinikum, Germany
Title
Mortality following cardiovascular and bleeding events occurring beyond 1
year after coronary stenting: A secondary analysis of the Dual
Antiplatelet Therapy (DAPT) Study.
Source
JAMA Cardiology. 2 (5) (pp 478-487), 2017. Date of Publication: May 2017.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
Importance: Early cardiovascular and bleeding events after coronary
stenting are associated with high risk of morbidity and mortality.
Objective: To assess the prognosis of cardiovascular and bleeding events
occurring beyond 1 year after coronary stenting. Design, Setting, and
Participants: This secondary analysis is derived from data from the Dual
Antiplatelet Therapy (DAPT) Study, a multi center trial involving 220 US
and in ternational clinical sites from 11 countries. The study dateswere
August 2009 to May 2014. Individuals who underwent coronary stenting and
completed 12 months of thienopyridine plus aspirin therapy without
ischemic or bleeding events remained on an aspirin regimen and were
randomized to continued thienopyridine therapy vs placebo for 18
additional months. Individuals were then followed up for 3 additional
months while receiving aspirin therapy alone. The analysis began in August
2015. Exposures: Ischemic events (myocardial infarction not related to
stent thrombosis, stent thrombosis, and ischemic stroke) and bleeding
events (Global Utilization of Streptokinase and Tissue Plasminogen
Activator for Occluded Arteries [GUSTO] classification moderate or severe
bleeding). Main Outcomes and Measures: Ischemic events (myocardial
infarction not related to stent thrombosis, stent thrombosis, and ischemic
stroke) and bleeding events (GUSTO classification moderate or severe
bleeding). Death at 21 months after randomization (33 months after
coronary stenting). Results: Intotal, 25 682 individuals older than 18
years with an indication for coronarystentingwere enrolled, and 11
648(meanage,61.3 years; 25.1%female)were randomized. After randomization,
478 individuals (4.1%) had 502 ischemic events (306 with myocardial
infarction, 113 with stent thrombosis, and 83 with ischemic stroke), and
232 individuals (2.0%) had 235 bleeding events (155 with moderate and 80
with severe bleeding). Among individuals with ischemic events, 52(10.9%)
died. The annualized mortality rate after an ischemic event was 27.2
(95%CI, 20.3-35.7) per 100 person-years. The cumulative incidence of death
after an ischemic event among the total randomized study population was
0.5%(0.3% with myocardial infarction,0.1% with stent thrombosis, and 0.1%
with ischemic stroke). Among individuals with bleeding events, 41 (17.7%)
died. The annualized mortality rate after a bleeding event was 21.5
(95%CI, 15.4-29.1) per 100 person-years. The cumulative incidence of death
after a bleeding event among the total randomized study population was
0.3%(0.1% with moderate and 0.2% with severe bleeding). Conclusions and
Relevance: In patients treated with dual antiplatelet therapy for at least
1 year after coronary stenting, ischemic events were more frequent than
bleeding events, and both events were associated with high risk of
mortality.<br/>Copyright &#xa9; 2017 American Medical Association. All
rights reserved.

<247>
Accession Number
618870648
Author
Zeymer U.; Werdan K.; Schuler G.; Zahn R.; Neumann F.-J.; Furnau G.; de
Waha S.; Schneider S.; Thiele H.
Institution
(Zeymer, Zahn) Klinikum Ludwigshafen, Medizinische Klinik B, Germany
(Zeymer, Schneider) Institut fur Herzinfarktforschung Ludwigshafen,
Germany
(Werdan) Universitatsklinikum Halle, Klinik fur Kardiologie, Germany
(Schuler, Furnau, Thiele) Universitat Leipzig, Herzzentrum, Kardiologie,
Germany
(Neumann) Herzzentrum Bad Krozingen, Germany
(de Waha) Herzzentrum Bad Segeberg, Germany
(Thiele) Medical Clinic II, Universitares Herzzentrum Lubeck University
Hospital Schleswig-Holstein, Germany
Title
Editor's Choice- Impact of immediate multivessel percutaneous coronary
intervention versus culprit lesion intervention on 1-year outcome in
patients with acute myocardial infarction complicated by cardiogenic
shock: Results of the randomised IABP-SHOCK II trial.
Source
European Heart Journal: Acute Cardiovascular Care. 6 (7) (pp 601-609),
2017. Date of Publication: 01 Oct 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Current guidelines recommend immediate multivessel
percutaneous coronary intervention (PCI) in patients with cardiogenic
shock, despite the lack of randomised trials. We sought to investigate the
use and impact on outcome of multivessel PCI in comparison to culprit
lesion only PCI in a retrospective analysis in patients with cardiogenic
shock complicating acute myocardial infarction. Methods and results: In
the randomised IABP-SHOCK II trial, investigating the effect of
intra-aortic balloon pump on outcome, 451 (75%) of the total of 600
patients had multivessel coronary artery disease and underwent PCI.
Immediate multivessel PCI was performed in 167 (37%) patients. TIMI 3
patency after PCI in all treated vessels was observed in 83.2% versus
79.0% of patients after multivessel versus culprit lesion PCI,
respectively. The 30-day (44.9% vs. 42.3%) and 12-month (54.8% vs. 52.7%)
mortality rates did not significantly differ between the two groups. In
the multivariate analysis multivessel PCI was not associated with an
improved mortality after 12 months (odds ratio 0.92, 95% confidence
intervals 0.69-1.21). Conclusion: In this retrospective analysis of the
largest randomised study in cardiogenic shock immediate multivessel PCI
was used in approximately one third of patients with cardiogenic shock.
There was no benefit with immediate multivessel PCI in comparison to
culprit lesion only PCI. Therefore a randomised trial is needed to
determine the definitive role of multivessel PCI in cardiogenic shock.
Clinical Trial Registration: ClinicalTrials.gov,
NCT00491036.<br/>Copyright &#xa9; 2016, &#xa9; The European Society of
Cardiology 2016.

<248>
Accession Number
615341291
Author
Miyahara S.; Miyata H.; Motomura N.; Takamoto S.; Okita Y.
Institution
(Miyahara, Okita) Department of Surgery, Division of Cardiovascular
Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
(Miyata) Health Care Quality Assessment, University of Tokyo, Tokyo, Japan
(Motomura) Department of Cardiovascular Surgery, Toho University Medical
Center Sakura Hospital, Chiba, Japan
(Takamoto) Mitsui Memorial Hospital, Tokyo, Japan
Title
Clinical significance of chronic obstructive pulmonary disease in patients
undergoing elective total arch replacement: Analysis based on the Japan
adult cardiovascular surgery database.
Source
European Journal of Cardio-thoracic Surgery. 51 (4) (pp 761-766), 2017.
Article Number: ezw371. Date of Publication: 01 Apr 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVE: We investigated the impact of chronic obstructive pulmonary
disease (COPD) on in-hospital outcomes of patients undergoing conventional
total aortic arch replacement (TAR), based on the Japan Adult
Cardiovascular Surgery Database. METHODS: A total of 12 590 patients who
underwent elective TAR between 2008 and 2013 were retrospectively
reviewed. Patients were divided into 4 categories: normal respiratory
function (control), with ratio of forced expiratory volume of air in 1 s
(FEV<inf>1</inf>) to forced vital capacity (FVC) of 76% or greater (TAR, n
= 10 040); mild COPD, with FEV<inf>1</inf>/FVC ratio 60-75% and/or use of
bronchodilator (TAR, n = 1890); moderate COPD, FEV<inf>1</inf>/FVC ratio
50 to 59% and/or use of steroids (TAR, n = 504); and severe COPD,
FEV<inf>1</inf>/FVC ratio less than 50% and/or presence of respiratory
failure (TAR, n = 156). RESULTS: In-hospital mortality was 5.7% (5.2% in
controls, 7.0% in mild COPD, 9.3% in moderate COPD and 9.0% in severe
COPD). A significant trend towards the severity of COPD was noted (P <
0.0001). A higher incidence of postoperative pneumonia (6.0% in control,
11.0% in mild COPD, 12.3% in moderate COPD and 15.4% in severe COPD; P <
0.0001) and a greater need for prolonged ventilation (17.5% in control,
22.0% in mild COPD, 26.6% in moderate COPD and 29.5% in severe COPD; P <
0.0001) were observed in cases of more severe COPD. The odds ratio of
moderate/severe COPD for in-hospital mortality was 1.44 with confidence
interval of 1.08-1.91 (P = 0.012). CONCLUSIONS: There was a significant
increase in in-hospital mortality and morbidity with increasing severity
of COPD in patients who underwent TAR.<br/>Copyright &#xa9; The Author
2017. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<249>
Accession Number
615341281
Author
Andresen B.; Mishra V.; Lewandowska M.; Andersen J.G.; Andersen M.H.;
Lindbergb H.; Dohlen G.; Fosse E.
Institution
(Andresen, Lewandowska, Fosse) The Intervention Centre, Oslo University
Hospital, Oslo, Norway
(Andresen) The Department of Cardiothoracic Surgery, Oslo University
Hospital, Rikshospitalet, Oslo, Norway
(Mishra) Department of Finance and Resource Management Unit, Oslo
University Hospital, Rikshospitalet, Oslo, Norway
(Andersen) Division of Radiology and Nuclear Medicine, Oslo University
Hospital, Ulleva l, Oslo, Norway
(Andersen) Division of Surgery, Inflammation Medicine and Transplantation,
Oslo University Hospital, Rikshospitalet, Oslo, Norway
(Lindbergb) Institute for Clinical Medicine, Faculty of Medicine,
University of Oslo, Oslo, Norway
(Dohlen, Fosse) The Department of Pediatric Cardiology, Oslo University
Hospital, Rikshospitalet, Oslo, Norway
Title
In-hospital cost comparison between percutaneous pulmonary valve
implantation and surgery.
Source
European Journal of Cardio-thoracic Surgery. 51 (4) (pp 747-753), 2017.
Article Number: ezw371. Date of Publication: 01 Apr 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: Today, both surgical and percutaneous techniques are available
for pulmonary valve implantation in patients with right ventricle outflow
tract obstruction or insufficiency. In this controlled, non-randomized
study the hospital costs per patient of the two treatment options were
identified and compared. METHODS: During the period of June 2011 until
October 2014 cost data in 20 patients treated with the percutaneous
technique and 14 patients treated with open surgery were consecutively
included. Two methods for cost analysis were used, a retrospective average
cost estimate (overhead costs) and a direct prospective detailed cost
acquisition related to each individual patient (patient-specific costs).
RESULTS: The equipment cost, particularly the stents and valve itself was
by far the main cost-driving factor in the percutaneous pulmonary valve
group, representing 96% of the direct costs, whereas in the open surgery
group the main costs derived from the postoperative care and particularly
the stay in the intensive care department. The device-related cost in this
group represented 13.5% of the direct costs. Length-of-stay-related costs
in the percutaneous group were mean $3885 (1618) and mean $17 848 (5060)
in the open surgery group. The difference in postoperative stay between
the groups was statistically significant (P <= 0.001). CONCLUSIONS: Given
the high postoperative cost in open surgery, the percutaneous procedure
could be cost saving even with a device cost of more than five times the
cost of the surgical device.<br/>Copyright &#xa9; The Author 2016.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery.

<250>
Accession Number
615341253
Author
Carnero-Alcazar M.; Maroto L.C.; Cobiella-Carnicer J.; Vilacosta I.;
Nombela-Franco L.; Alswies A.; Villagran-Medinilla E.; Macaya C.
Institution
(Carnero-Alcazar, Maroto, Cobiella-Carnicer, Alswies, Villagran-Medinilla)
Department of Cardiac Surgery, Hospital Clinico San Carlos, Madrid, Spain
(Vilacosta, Nombela-Franco, Macaya) Department of Cardiology, Hospital
Clinico San Carlos, Madrid, Spain
Title
Transcatheter versus surgical aortic valve replacement in moderate and
high-risk patients: A meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 51 (4) (pp 644-652), 2017.
Article Number: ezw373. Date of Publication: 01 Apr 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The evidence of the benefits of transcatheter aortic valve
replacement (TAVR) or surgical aortic valve replacement (SAVR) for
patients of high or intermediate surgical risk is not consistent. We
performed a meta-analysis to compare major adverse outcomes after TAVR or
SAVR. METHODS: We searched propensity score matched studies or randomized
clinical trials comparing the risks of mortality, stroke, major bleeding,
acute renal injury, pacemaker implantation, vascular complications and
prostheses haemodynamic performance between TAVR and SAVR in patients with
moderate or high risk. Combined odds ratios (ORs), relative risk or mean
differences with corresponding 95% confidence intervals (CIs) were
calculated using a random effects model. Analyses of sensitivity and
publication bias were also conducted. RESULTS: We included 5 clinical
trials and 37 observational studies, enrolling 20 224 patients (TAVR, n =
9099 and SAVR, n = 11 125). The pooled analysis suggested no differences
in early (OR = 1.11, 95% CI 0.9-1.39, P = 0.355) or late mortality
(relative risk = 0.91, 95% CI 0.78- 1.05, P = 0.194). TAVR was associated
with a lower risk of major bleeding (OR = 0.42, 95% CI 0.25-0.69, P <
0.001) and acute kidney injury (OR = 0.51, 95% CI 0.34-0.71) but with an
increase in the incidence of pacemaker implantation (OR = 2.31, 95% CI
1.73-3.08) and vascular complications (OR = 4.88, 95% CI 2.84-8.39).
Residual aortic regurgitation was more frequent after TAVR (OR= 6.83, 95%
CI 4.87-9.6). SAVR prostheses were associated with poor trans-prosthetic
gradients (mean difference: -2.4 mmHg, 95% CI - 3.27 to - 1.53).
CONCLUSIONS: TAVR and SAVR have similar short and long-term all-cause
mortality and risk of stroke among patients of moderate or high surgical
risk. TAVR decreases the risk of major bleeding, acute kidney injury and
improves haemodynamic performance compared with SAVR but increases the
risk of vascular complications, the need for a pacemaker and residual
aortic regurgitation.<br/>Copyright &#xa9; The Author 2016.

<251>
Accession Number
615341249
Author
Yi B.; Chen X.; Shi H.; Lin T.; Lin H.; Xu Y.; Rong J.
Institution
(Yi) Department of Cardiothoracic Surgery, Heart Center, The First
Affiliated Hospital, Ministry of Health, Sun Yat-Sen University, and Key
Laboratory on Assisted Circulation, Guangzhou, China
(Yi, Shi, Rong) Department of Extracorporeal Circulation, Heart Center,
The First Affiliated Hospital, Sun Yat-Sen Department of General Surgery,
The Second Xiangya Hospital, Central South University, Changsha, China
(Chen) Musculoskeletal Oncology Center, The First Affiliated Hospital, Sun
Yat-Sen University, Guangzhou, China
(Lin) Scientific Research Section, The First Affiliated Hospital, Sun
Yat-Sen University, Guangzhou, China
(Lin) Department of Oncology, The First Affiliated Hospital, Sun Yat-Sen
University, Guangzhou, China
Title
Remote ischaemic preconditioning reduces acute kidney injury in adult
patients undergoing cardiac surgery with cardiopulmonary bypass: A
meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 51 (4) (pp 616-623), 2017.
Article Number: ezw372. Date of Publication: 01 Apr 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
This article represents the first attempt to perform a pooled analysis
about remote ischaemic preconditioning (RIPC) in reduction of acute kidney
injury (AKI) of adult patients undergoing cardiac surgery with
cardiopulmonary bypass (CPB). A systematic search was performed using
PubMed (1966-5 January 2016), the Cochrane Library (1996-5 January 2016),
the Web of Science (1986-5 January 2016) and Chinese database (SinoMed)
(1978-5 January 2016) to identify studies that have described the effect
of RIPC on AKI in adult patients undergoing cardiac surgery with CPB. The
outcomes used for this analysis included the incidence of AKI and the need
for renal replacement therapy (RRT). Thirteen randomized controlled trials
(4370 participants) were included in this analysis. RIPC significantly
reduced the risk of AKI (risk ratio, 0.81; 95% confidence interval, [0.66,
0.99]; P = 0.04; I²=46%) for adult patients compared with
control group. However, there was no significant difference with respect
to the incidence of RRT between the two groups. The present meta-analysis
found that RIPC may reduce the incidence of AKI among adult patients
following cardiac surgery with CPB. Adequately powered trials are
warranted to provide further corroboration of our findings in the
future.<br/>Copyright &#xa9; The Author 2016.

<252>
Accession Number
618784017
Author
Choi P.T.; Beattie W.S.; Bryson G.L.; Paul J.E.; Yang H.
Institution
(Choi) Department of Anesthesiology, Pharmacology and Therapeutics,
University of British Columbia, Vancouver, BC, Canada
(Beattie) Department of Anaesthesia, University Health Network, Toronto,
ON, Canada
(Bryson, Yang) Department of Anesthesiology, University of Ottawa, Ottawa,
ON, Canada
(Paul) Department of Anesthesia, McMaster University, Hamilton, ON, Canada
Title
Effects of Neuraxial Blockade May Be Difficult to Study Using Large
Randomized Controlled Trials: The PeriOperative Epidural Trial (POET)
Pilot Study.
Source
PLoS ONE. 4 (2) (no pagination), 2009. Article Number: e4644. Date of
Publication: 2009.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: Early randomized controlled trials have suggested that
neuraxial blockade may reduce cardiorespiratory complications after
non-cardiothoracic surgery, but recent larger trials have been
inconclusive. We conducted a pilot study to assess the feasibility of
conducting a large multicentre randomized controlled trial in Canada.
Methodology/Principal Findings: After Research Ethics Board approvals from
the participating institutions, subjects were recruited if they were >=45
years old, had an expected hospital stay >=48 hours, were undergoing a
noncardiothoracic procedure amenable to epidural analgesia, met one of six
risk criteria, and did not have contraindications to neuraxial blockade.
After informed consent, subjects were randomly allocated to combined
epidural analgesia (epidural group) and neuraxial anesthesia, with or
without general anesthesia, or intravenous opioid analgesia (IV group) and
general anesthesia. The primary outcomes were the rate of recruitment and
the percents of eligible patients recruited, crossed over, and followed
completely. Feasibility targets were defined a priori. A blinded,
independent committee adjudicated the secondary clinical outcomes.
Subjects were followed daily while in hospital and then at 30 days after
surgery. Analysis was intentionto- treat. Over a 15-month period, the
recruitment rate was 0.5+/-0.3 (mean+/-SEM) subjects per week per centre;
112/494 (22.7%) eligible subjects were recruited at four tertiary-care
teaching hospitals in Canada. Thirteen (26.5%) of 49 subjects in the
epidural group crossed over to the IV group; seven (14.3%) were due to
failed or inadequate analgesia or complications from epidural analgesia.
Five (9.8%) of 51 subjects in the IV group crossed over to the epidural
group but none were due to inadequate analgesia or complications.
Ninety-eight (97.0%) of 101 subjects were successfully followed up until
30 days after their surgery. Conclusion/Significance: Of the criteria we
defined for the feasibility of a full-scale trial, only the follow-up
target was met. The other feasibility outcomes did not meet our preset
criteria for success. The results suggest that a large multicentre trial
may not be a feasible design to study the perioperative effects of
neuraxial blockade.<br/>Copyright &#xa9; 2009 Choi et al. This is an open
access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<253>
Accession Number
618886414
Author
Lammers A.; Golden S.; Thomas C.R.; Mitin T.; Moghanaki D.; Timmerman
R.D.; Slatore C.
Institution
(Lammers, Thomas, Mitin, Slatore) Oregon Health and Science University,
Portland, OR, United States
(Golden) VA Portland Health Care System, Portland, OR, United States
(Moghanaki) Hunter Holmes McGuire Veterans Affairs Medical Center,
Richmond, VA, United States
(Timmerman) University of Texas Southwestern Medical Center, Dallas, TX,
United States
Title
Lung cancer specialists' opinions on treatments for stage I lung cancer: A
multidisciplinary survey.
Source
International Journal of Radiation Oncology. Conference: 58th Annual
Meeting of the American Society for Radiation Oncology, ASTRO 2016. United
States. 96 (2 Supplement 1) (pp S172-S173), 2016. Date of Publication:
October 2016.
Publisher
Elsevier Inc.
Abstract
Purpose/Objective(s): Several trials comparing surgical resection to
stereotactic body radiation therapy (SBRT) for surgically-eligible
patients with stage I non-small cell lung cancer (NSCLC) were halted
because of inability to accrue participants. This lack of accrual was
likely related to differing viewpoints on the effectiveness of each
therapy. We sought to understand specialists' opinions about evidence
regarding treatment of Stage I NSCLC, how clinicians translate evidence
into practice, and how specialists weigh oncologic outcomes vs quality of
life (QOL) in order to guide the conduct of future trials and
implementation strategies. Materials/Methods: We conducted a 28-item,
web-based survey. We invited all participating providers listed in the
following medical society directories: American Society for Radiation
Oncology (ASTRO), American Thoracic Society (ATS), Thoracic Oncology
Assembly, and the International Association for the Study of Lung Cancer
(IASLC). We received IRB approval. Descriptive statistics are reported.
Results: We collected data from 1018 respondents with the following
response rates: ATS 60 (6.6%), IASLC 399 (7.2%), and ASTRO 559 (6.4%).
Most respondents were radiation oncologists (RO) (64.0%). Most ROs,
(65.6%), felt that for surgically-eligible patients with stage I NSCLC,
current evidence for the efficacy of SBRT is "the same" as surgery in
terms of oncologic outcomes while most non-radiation oncologists (NRO)
(pulmonary, medical oncology, thoracic surgery) felt SBRT is "a little
worse," (63.5%). Both groups believed this was based on "neither strong
nor weak" evidence, (42.0% vs 38.6%). When asked to consider a randomized
trial of SBRT vs. surgery for surgically-eligible patients with stage I
NSCLC, 94.4% of ROs agreed or strongly agreed that they would permit their
patients to enroll while only 61.9% of NROs responded similarly. When
asked about the lowest level of efficacy that would convince clinicians to
recommend SBRT over surgery, the majority of both groups favored allowing
SBRT with equal (within 5%) 5-year mortality rates: 71.0% of ROs and 55.8%
of NROs. We then asked "if the trial showed that SBRT decreased QOL less
than surgery, how would you change your answers?" Most ROs (46.7%) would
accept "a little larger mortality" difference, while 55.4% of NROs
responded it "wouldn't change my decision." Assuming a trial showed equal
5 year mortality and a higher QOL in those receiving SBRT, many clinicians
believed that changing practice in thoracic surgery would be "somewhat
difficult"; 47.1% for both ROs and NROs. Conclusion: Most
surgically-eligible patients with NSCLC do not routinely see a radiation
oncologist prior to treatment. Our results suggest it may be difficult to
enroll these patients into treatment trials. Furthermore, changing
practice patterns may be problematic even if such a trial showed SBRT had
equivalent mortality but improved QOL.

<254>
Accession Number
618885602
Author
Sapir E.; Tao Y.; Lin J.; Kollar L.; Schipper M.; Chugh R.; Schuetze S.M.;
Biermann J.S.; Lawrence T.S.; Feng M.
Institution
(Sapir, Chugh, Biermann) University of Michigan Health System, Ann Arbor,
MI, United States
(Tao, Lin, Feng) University of Michigan, Ann Arbor, MI, United States
(Kollar) University of Washington Medical Center, Seattle, WA, United
States
(Schipper) Department of Biostatistics, University of Michigan, Ann Arbor,
MI, United States
(Schuetze) Department of Internal Medicine, Division of
Hematology/Oncology, University of Michigan, Ann Arbor, MI, United States
(Lawrence) Department of Radiation Oncology, University of Michigan, Ann
Arbor, MI, United States
Title
Surgical resection or stereotactic body radiation therapy for sarcoma
patients with pulmonary metastases.
Source
International Journal of Radiation Oncology. Conference: 58th Annual
Meeting of the American Society for Radiation Oncology, ASTRO 2016. United
States. 96 (2 Supplement 1) (pp S26), 2016. Date of Publication: October
2016.
Publisher
Elsevier Inc.
Abstract
Purpose/Objective(s): Aggressive management of oligometastases from
sarcoma can result in long-term survival and a chemotherapy-free holiday.
Surgical resection is considered to be the treatment of choice, with
stereotactic body radiotherapy (SBRT) generally offered to patients who
are not candidates for surgical resection due to co-morbidities or concern
about residual lung function. We examined outcomes of resection and SBRT
for patients with sarcoma oligometastases at our institution and
identified predictive factors for local control, with the hypothesis that
overall local control would be similar. Materials/Methods: After
IRB-approval, we queried our institutional thoracic surgery and radiation
oncology databases, supplemented with an institutional query using
diagnosis and billing codes for sarcoma, lung metastases, lung resections,
and SBRT. We applied inverse probability of treatment weighting to adjust
for imbalances in treatment assignment. Freedom from local progression
(FFLP) for surgical resection was defined as absence of recurrence at the
resection line, while FFLP for SBRT was defined as the absence of
progression within or at the PTV margin. Results: Between 1997 and 2014,
78 patients (pts) with 127 lung lesions were treated with surgical
resection and 26 pts with 47 pulmonary metastases were ablated with SBRT.
Median tumor size was 1.5 cm (0.1-12.8) and 1.4 cm (0.4-4.8),
respectively, for surgically and SBRT-managed pulmonary metastases. Median
follow-up was 20.9 months (1 to 224) and 15.3 months (2 to 57) for
patients treated with surgical resection and SBRT, respectively (P =
0.01). On average, pts in the SBRT group were older (age 60 v 52, P =
0.03), had received more prior systemic therapies (1.98 vs. 1.29, PZ 0.01)
and had a higher presence of active extrathoracic disease at treatment
start (59.6% vs. 29.9%, P < 0.001). Local control was not different
between groups when adjusted for size, other sites of active disease, age,
and performance status (HR = 1.47, 95% CI 0.20 e 10.9, P Z0.71). 1-and
2-yr FFLP rates for all resected lung lesions vs SBRT were 96.8% and 96.8%
vs 97.4% and 97.4%. 1 and 2-year overall survival (OS) were 92.6% and
62.2% for surgery pts and 88.1% and 57.9% for SBRT pts, with no difference
between groups (HRZ0.71, 95% CI Z0.39 e 1.29, P = 0.27). 1 and 2-year
progression free survival (PFS) were 33.4% and 15.7% for surgery pts and
42.3% and 21.6% for SBRT pts, with no significant difference between
groups (HR = 1.21, 95% CI Z0.87 e 1.68, P = 0.25). Grade 3+ adverse events
were observed in five pts treated with surgery vs. none in pts with SBRT.
Conclusion: In this series SBRT provides similar LC, PFS, and OS compared
with surgical resection of lung metastases from sarcoma, and thus may
serve as a safe alternative to surgical resection. A randomized,
prospective study is required to determine if there is comparable
long-term survival with SBRT vs. surgery for treatment of sarcoma lung
metastases.

<255>
Accession Number
618898163
Author
Cordeiro A.L.L.; Gruska C.A.; Ysla P.; Queiroz A.; Nogueira S.C.O.; Leite
M.C.; Freitas B.; Guimaraes A.R.
Institution
(Cordeiro) Escola Bahiana de Medicina e Saude Publica (EBMSP), Salvador,
BA, Brazil
(Cordeiro, Gruska, Ysla, Queiroz) Faculdade Nobre (FAN), Feira de Santana,
BA, Brazil
(Nogueira, Leite, Freitas, Guimaraes) Instituto Nobre de Cardiologia
(INCARDIO), Feira de Santana, BA, Brazil
(Guimaraes) Santa Casa de Misericordia de Feira de Santana, Feira de
Santana, BA, Brazil
Title
Effect of Different Levels of Peep on Oxygenation during Non-Invasive
Ventilation in Patients Submitted to CABG Surgery: Randomized Clinical
Trial.
Source
Brazilian journal of cardiovascular surgery. 32 (4) (pp 295-300), 2017.
Date of Publication: 01 Jul 2017.
Abstract
INTRODUCTION: During and after coronary artery bypass grafting, a decline
in multifactor lung function is observed. Due to this fact, some patients
may benefit from non-invasive ventilation after extubation targeting lung
expansion and consequently improved oxygenation.
OBJECTIVE: To test the hypothesis that higher levels of positive end
expiration pressure during non-invasive ventilation improves oxygenation
in patients undergoing coronary artery bypass grafting.
METHODS: A randomized clinical trial was conducted at Instituto Nobre de
Cardiologia in Feira de Santana. On the first day after surgery, the
patients were randomized: Group PEEP 10, Group PEEP 12 and Group PEEP 15
who underwent non-invasive ventilation with positive end expiration
pressure level. All patients were submitted to analysis blood pressure
oxygen (PaO2), arterial oxygen saturation (SaO2) and oxygenation index
(PaO2/FiO2).
RESULTS: Thirty patients were analyzed, 10 in each group, with 63.3% men
with a mean age of 61.1+/-12.2 years. Mean pulmonary expansion pre-therapy
PaO2 was generally 121.9+/-21.6 to 136.1+/-17.6 without statistical
significance in the evaluation among the groups. This was also present in
PaO2/FiO2 and SaO2. Statistical significance was only present in pre and
post PEEP 15 when assessing the PaO2 and SaO2 (P=0.02).
CONCLUSION: Based on the findings of this study, non-invasive ventilation
with PEEP 15 represented an improvement in oxygenation levels of patients
undergoing coronary artery bypass grafting.

<256>
Accession Number
618897270
Author
Pieczkoski S.M.; Margarites A.G.F.; Sbruzzi G.
Institution
(Pieczkoski, Sbruzzi) Multi-Professional Integrated Residency in Health
and Cardiovascular Care of the Hospital de Clinicas of Porto Alegre
(HCPA), Porto Alegre, RS, Brazil
(Margarites) Hospital de Clinicas of Porto Alegre (HCPA), Porto Alegre,
RS, Brazil
(Sbruzzi) Universidade Federal do Rio Grande do Sul (UFGRS), Porto Alegre,
RS, Brazil
Title
Noninvasive Ventilation During Immediate Postoperative Period in Cardiac
Surgery Patients: Systematic Review and Meta-Analysis.
Source
Brazilian journal of cardiovascular surgery. 32 (4) (pp 301-311), 2017.
Date of Publication: 01 Jul 2017.
Abstract
METHODS: Systematic review and meta-analysis recorded in the International
Prospective Register of Ongoing Systematic Reviews (number
CRD42016036441). The research included the following databases: MEDLINE,
Cochrane Central, PEDro, LILACS and manual search of the references of
studies published until March 2016. The review included randomized
controlled trials with patients during the immediate postoperative period
of cardiac surgery, which compared the use of noninvasive ventilation,
BiLevel modes, continuous positive airway pressure, intermittent positive
pressure breathing and positive pressure ventilation with conventional
physiotherapy or oxygen therapy, and assessed the mortality rate,
occurrence of pulmonary complications (atelectasis, pneumonia, acute
respiratory failure, hypoxemia), reintubation rate, ventilation time, time
spent in the intensive care unit (ICU), length of hospital stay and
partial pressure of oxygen.
OBJECTIVE: To verify the effectiveness of noninvasive ventilation compared
to conventional physiotherapy or oxygen therapy in the mortality rate and
prevention of pulmonary complications in patients during the immediate
postoperative period of cardiac surgery.
RESULTS: Among the 479 selected articles, ten were included in the
systematic review (n=1050 patients) and six in the meta-analysis. The use
of noninvasive ventilation did not significantly reduce the risk for
atelectasis (RR: 0.60; CI95% 0.28-1.28); pneumonia (RR: 0.20; CI95%
0.04-1.16), reintubation rate (RR: 0.51; CI95%: 0.15-1.66), and time spent
in the ICU (-0.04 days; CI95%: -0.13; 0.05).
CONCLUSION: Prophylactic noninvasive ventilation did not significantly
reduce the occurrence of pulmonary complications such as atelectasis,
pneumonia, reintubation rate and time spent in the ICU. The use is still
unproven and new randomized controlled trials should be carried out.