EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
619074939
Author
Dai Z.; Chu H.; Wang S.; Liang Y.
Institution
(Dai, Chu, Wang, Liang) Department of Anesthesiology, The Affiliated
Hospital of Qingdao University, 16 Jiangsu Road, Qingdao 276000, China
Title
The effect of tranexamic acid to reduce blood loss and transfusion on
off-pump coronary artery bypass surgery: A systematic review and
cumulative meta-analysis.
Source
Journal of Clinical Anesthesia. 44 (pp 23-31), 2018. Date of Publication:
January 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study Objective To assess the safety and efficacy of tranexamic acid (TA)
on off-pump coronary artery bypass (OPCAB) surgery. Design Meta-analysis.
Setting Operating room, OPCAB surgery, all surgeries were elective
measurements. Searching the following data sources respectively:
PubMed/MEDLINE, the Cochrane Library, EMBASE and reference lists of
identified articles, we performed a meta-analysis of postoperative 24 h
blood loss, postoperative allogeneic transfusion, re-operation for massive
bleeding, postoperative mortality, and postoperative thrombotic
complications. Main results Using electronic databases, we selected 15
randomized control trials (RCTs), carried out between 2003 and 2016, with
a total of 1250 patients for our review. TA significantly reduced the
postoperative 24 h blood loss (mean difference - 213.32 ml, 95% confidence
intervals, - 247.20 ml to - 179.43 ml; P < 0.0001). And, TA also
significantly reduced the risk of packed red blood cell (PRBCs)
transfusion (risk ratio 0.62; 95% confidence intervals 0.51 to 0.76; P <
0.0001) and fresh frozen plasma (FFP) transfusion (0.65; 0.52 to 0.81; P <
0.001). There were no statistical significance on platelet transfusion
(risk difference - 0.00, 95% confidence interval - 0.02 to 0.02; P = 0.73)
and re-operation (0.00, - 0.02 to 0.02; P = 1.00). No association was
found between TA and morbility (risk difference - 0.00, 95% confidence
interval - 0.02 to 0.02; P = 0.99) and thrombotic complications (- 0.01, -
0.01 to 0.02; P = 0.70). Conclusions TA reduced the probability of
receiving a PRBCs and FFP transfusion during OPCAB surgery. And no
association with postoperative death and thrombotic events was found.
However, further trials with an appropriate sample size are required to
confirm TA safety in OPCAB surgery.<br/>Copyright &#xa9; 2017 Elsevier
Inc.

<2>
Accession Number
619085266
Author
Ding M.; Gao Y.-D.; Zeng X.-T.; Guo Y.; Yang J.
Institution
(Ding, Gao, Yang) Zhongnan Hospital of Wuhan University, Department of
Respiratory Medicine, Donghu Road 169, Wuhan 430071, China
(Zeng, Guo) Center for Evidence-based and Translational Medicine, Zhongnan
Hospital of Wuhan University, Donghu Road 169, Wuhan 430071, China
Title
Endobronchial one-way valves for treatment of persistent air leaks: A
systematic review.
Source
Respiratory Research. 18 (1) (no pagination), 2017. Article Number: 186.
Date of Publication: 06 Nov 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Persistent air leak (PAL) is associated with significant morbidity and
mortality, prolonged hospitalization and increased health-care costs. It
can arise from a number of conditions, including pneumothorax, necrotizing
infection, trauma, malignancies, procedural interventions and
complications after thoracic surgery. Numerous therapeutic options,
including noninvasive and invasive techniques, are available to treat
PALs. Recently, endobronchial one-way valves have been used to treat PAL.
We conducted a systematic review based on studies retrieved from PubMed,
EMbase and Cochrane library. We also did a hand-search in the
bibliographies of relevant articles for additional studies. 34 case
reports and 10 case series comprising 208 patients were included in our
review. Only 4 patients were children, most of the patients were males.
The most common underlying disease was COPD, emphysema and cancer. The
most remarkable cause was pneumothorax. The upper lobes were the most
frequent locations of air leaks. Complete resolution was gained within
less than 24 h in majority of patients. Complications were migration or
expectoration of valves, moderate oxygen desaturation and infection of
related lung. No death related to endobronchial one-way valves
implantation has been found. The use of endobronchial one-way valve adds
to the armamentarium for non-invasive treatments of challenging PAL,
especially those with difficulties of anesthesia, poor condition and high
morbidity. Nevertheless, prospective randomized control trials with large
sample should be needed to further evaluate the effects and safety of
endobronchial one-way valve implantation in the treatment of
PAL.<br/>Copyright &#xa9; 2017 The Author(s).

<3>
Accession Number
617604749
Author
Lips M.; Mraz M.; Klouckova J.; Kopecky P.; Dobias M.; Krizova J.; Lindner
J.; Diamant M.; Haluzik M.
Institution
(Lips, Kopecky, Dobias) Department of Anaesthesiology, Resuscitation and
Intensive Care, First Faculty of Medicine, Charles University and General
University Hospital, Prague, Czech Republic
(Mraz, Haluzik) Department of Diabetes, Diabetes Centre, Institute for
Clinical and Experimental Medicine, Prague, Czech Republic
(Mraz, Klouckova, Haluzik) Institute of Medical Biochemistry and
Laboratory Diagnostics, First Faculty of Medicine, Charles University and
General University Hospital, Prague, Czech Republic
(Klouckova, Haluzik) Department of Experimental Diabetology, Centre for
Experimental Medicine, Institute for Clinical and Experimental Medicine,
Prague, Czech Republic
(Krizova) 3rd Department of Medicine - Department of Endocrinology and
Metabolism, First Faculty of Medicine, Charles University and General
University Hospital, Prague, Czech Republic
(Lindner) 2nd Department of Surgery - Department of Cardiovascular
Surgery, First Faculty of Medicine, Charles University and General
University Hospital, Prague, Czech Republic
(Diamant) VU University Medical Centre, Amsterdam, Netherlands
(Haluzik) Department of Obesitology, Institute of Endocrinology, Prague,
Czech Republic
Title
Effect of continuous exenatide infusion on cardiac function and
peri-operative glucose control in patients undergoing cardiac surgery: A
single-blind, randomized controlled trial.
Source
Diabetes, Obesity and Metabolism. 19 (12) (pp 1818-1822), 2017. Date of
Publication: December 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
We performed a randomized controlled trial with the glucagon-like
peptide-1 (GLP-1) receptor agonist exenatide as add-on to standard
peri-operative insulin therapy in patients undergoing elective cardiac
surgery. The aims of the study were to intensify peri-operative glucose
control while minimizing the risk of hypoglycaemia and to evaluate the
suggested cardioprotective effects of GLP-1-based treatments. A total of
38 patients with decreased left ventricular systolic function (ejection
fraction <=50%) scheduled for elective coronary artery bypass grafting
(CABG) were randomized to receive either exenatide or placebo in a
continuous 72-hour intravenous (i.v.) infusion on top of standard
peri-operative insulin therapy. While no significant difference in
postoperative echocardiographic variables was found between the groups,
participants receiving exenatide showed improved peri-operative glucose
control as compared with the placebo group (average glycaemia 6.4 +/- 0.5
vs 7.3 +/- 0.8 mmol/L; P <.001; percentage of time in target range of
4.5-6.5 mmol/L 54.8% +/- 14.5% vs 38.6% +/- 14.4%; P =.001; percentage of
time above target range 39.7% +/- 13.9% vs 52.8% +/- 15.2%; P =.009)
without an increased risk of hypoglycaemia (glycaemia <3.3 mmol/L: 0.10
+/- 0.32 vs 0.21 +/- 0.42 episodes per participant; P =.586). Continuous
administration of i.v. exenatide in patients undergoing elective CABG
could provide a safe option for intensifying the peri-operative glucose
management of such patients.<br/>Copyright &#xa9; 2017 John Wiley & Sons
Ltd

<4>
Accession Number
619106355
Author
Gong Z.; Ma L.I.; Zhong Y.-L.; Li J.; Lv J.; Xie Y.-B.
Institution
(Gong, Lv, Xie) Department of Anesthesiology, The First Affiliated
Hospital of Guangxi Medical University, China
(Ma, Zhong, Li) Department of Anesthesiology, The People's Hospital of
Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, China
Title
Myocardial protective effects of dexmedetomidine in patients undergoing
cardiac surgery: A meta-analysis and systematic review.
Source
Experimental and Therapeutic Medicine. 13 (5) (pp 2355-2361), 2017. Date
of Publication: May 2017.
Publisher
Spandidos Publications (10 Vriaxidos Street, Athens 116 10, Greece.
E-mail: subscriptions@spandidos-publications.com)
Abstract
Arrhythmias are the common complications following cardiac surgery and
contribute to hemodynamic instability, cognitive impairment,
thromboembolic events, and congestive heart failure. Prevention of atrial
fibrillation following cardiac surgery reduces morbidity and among the
many available preventive approaches dexmedetomidine shows many positive
effects on cardiovascular stability. Even though many studies indicated
the beneficial effects of dexmedetomidine, the power of the analysis and
conclusion of these studies is rather weak due to relatively smaller
number of patients in these studies. In the present meta-analysis, we
included a large number of patients, both children and adults, undergoing
cardiac surgery, to address the efficacy of dexmedetomidine. Several
databases were searched to identify clinical studies comparing the
efficacy of dexmedetomidine in myocardial protection in patients
undergoing cardiac surgery. Cardiac function related parameters including
heart rate, blood pressure, tachycardia, arrhthmias, and bradycardia were
measured. In accordance with the selection criteria, a total of 18 studies
published between 2003 and 2016, with a total of 19,225 patients were
included in the present meta-analysis. Dosage of dexmedetomidine was in
the range of 0.5-1 micro&#32;g/kg body weight loading followed by
continuous infusion at a rate of 0.2-0.7 micro&#32;g/kg/h. Dexmedetomidine
treatment was found to lower heart rate, systolic blood pressure,
incidence of tachycardia and arrhythmias in both adult and pediatric
patients, but elevated the risk of bradycardia. In conclusion, results of
this meta-analysis indicate that dexmedetomidine is an efficacious
cardioprotective drug in adults and children undergoing cardiac
surgery.<br/>Copyright &#xa9; 2017, Spandidos Publications. All rights
reserved.

<5>
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Accession Number
614559816
Author
Nelson L.M.; Andreassen A.K.; Andersson B.; Gude E.; Eiskjaer H.; Radegran
G.; Dellgren G.; Gullestad L.; Gustafsson F.
Institution
(Nelson, Gustafsson) Department of Cardiology, Heart Center, Copenhagen
University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen DK-2100,
Denmark
(Andreassen, Gude, Gullestad) Department of Cardiology, Oslo University
Hospital, Rikshospitalet, Oslo, Norway
(Andreassen, Gude, Gullestad) Faculty of Medicine, University of Oslo,
Oslo, Norway
(Andersson) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Eiskjaer) Department of Cardiology, Aarhus University Hospital, Skejby,
Aarhus, Denmark
(Radegran) Section for Heart Failure and Valvular Disease, Skane
University Hospital, Lund, Sweden
(Radegran) Department of Clinical Sciences, Cardiology, Lund University,
Lund, Sweden
(Dellgren) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
Title
Effect of Calcineurin Inhibitor-Free, Everolimus-Based Immunosuppressive
Regimen on Albuminuria and Glomerular Filtration Rate After Heart
Transplantation.
Source
Transplantation. 101 (11) (pp 2793-2800), 2017. Date of Publication: 01
Nov 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Albuminuria in maintenance heart transplantation (HTx) is
associated with poor renal response when switching to a calcineurin
inhibitor (CNI)-lowered or CNI-free immunosuppressive regimen using
everolimus (EVR), but the significance of albuminuria associated with EVR
treatment after early CNI withdrawal in de novo HTx is unknown. Methods:
We tested if measured glomerular filtration rate (mGFR, by
chrome-ethylenediaminetetraacetic acid clearance) was associated with
urine albumin/creatinine ratio (UACR) post-HTx in a subgroup of patients
included in the Scandinavian Heart Transplant Everolimus De Novo Study
With Early Calcineurin Inhibitor Avoidance trial, where de novo HTx
patients (n = 115) were randomized to EVR with complete CNI elimination 7
to 11 weeks post-HTx or standard CNI immunosuppression. Results: In 66
patients, UACR measures were available at 1 year. In 7 patients in the EVR
group, a CNI was reintroduced within 12 months. Median mGFR was
significantly higher in the EVR group both 1 and 3 years post-HTx (P =
0.0004 and P = 0.03, respectively). Median UACR at 1 year was
significantly higher in the EVR group (P = 0.002). There was no
correlation between log(UACR) at 1 year and mGFR at 1 or 3 years (r =
-0.01, P = 0.9 and r = 0.15, P = 0.26, respectively) and in the EVR group
between log(UACR) at 1 year and change in mGFR (DELTA1-3 years) (r = 0.27,
P = 0.14). Excluding patients in the EVR group in whom a CNI was
reintroduced did not significantly change the results. Conclusions: The
effects of EVR with early CNI withdrawal after HTx on albuminuria and
renal function seem dissociated; hence, the clinical significance of
albuminuria in this setting is uncertain and should not necessarily rule
out EVR-based immunosuppression.<br/>Copyright &#xa9; 2017 Wolters Kluwer
Health, Inc. All rights reserved.

<6>
Accession Number
619209723
Author
Lei L.; Katznelson R.; Fedorko L.; Carroll J.; Poonawala H.; Machina M.;
Styra R.; Rao V.; Djaiani G.
Institution
(Lei, Katznelson, Fedorko, Carroll, Poonawala, Machina, Djaiani)
Departments of Anesthesia and Pain Management, Toronto General Hospital,
University Health Network, University of Toronto, Toronto, ON, Canada
(Styra) Department of Psychiatry, Toronto General Hospital, University
Health Network, University of Toronto, Toronto, ON, Canada
(Rao) Division of Cardiovascular Surgery, Toronto General Hospital,
University Health Network, University of Toronto, Toronto, ON, Canada
Title
Cerebral oximetry and postoperative delirium after cardiac surgery: a
randomised, controlled trial.
Source
Anaesthesia. 72 (12) (pp 1456-1466), 2017. Date of Publication: December
2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Postoperative delirium is associated with increased morbidity and
mortality. We hypothesised that restoration of regional cerebral oxygen
desaturation would reduce the incidence of postoperative delirium in
elderly patients after cardiac surgery. After institutional ethics review
board approval and informed consent, a double-blinded, prospective,
randomised, controlled trial was conducted in patients >= 60 years of age
undergoing cardiac surgery with cardiopulmonary bypass. In the
intervention group, an algorithm was commenced if regional cerebral oxygen
saturation decreased below 75% of baseline value for 1 min or longer. In
the control group, the cerebral oximetry monitor screen was electronically
blinded. Assessment of delirium was performed with confusion assessment
method for intensive care unit or confusion assessment method after
discharge from intensive care unit at 12-h intervals for seven
postoperative days. Postoperative delirium was present in 30 out of 123
(24.4%) and 31 out of 126 (24.6%) patients in the intervention and control
groups, respectively, odds ratio 0.98 (95%CI 0.55-1.76), p = 0.97.
Postoperative delirium was present in 20 (71%) out of 28 and in 41 (18%)
out of 221 patients with baseline regional cerebral oxygen saturation <=
50, or > 50%, respectively, p = 0.0001. Higher baseline regional cerebral
oxygen saturation and body mass index were protective against
postoperative delirium. Restoration of regional cerebral oxygen
desaturation did not result in lower postoperative delirium after cardiac
surgery. Pre-operative regional cerebral oxygen saturation <= 50% was
associated with increased postoperative delirium rates in elderly patients
following cardiac surgery.<br/>Copyright &#xa9; 2017 The Association of
Anaesthetists of Great Britain and Ireland

<7>
Accession Number
619208648
Author
Wang J.; Li K.; Li H.; Zhu W.; Sun H.; Lu C.
Institution
(Wang, Li, Li, Zhu, Sun, Lu) Qindao University Medical College Affiliated
Yantai Yuhuangding Hospital, Yantai, Shandong, China
Title
Comparison of anticoagulation regimens for pregnant women with prosthetic
heart valves: A meta-analysis of prospective studies.
Source
Cardiovascular Therapeutics. 35 (6) (no pagination), 2017. Article Number:
e12292. Date of Publication: December 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Introduction: Pregnancy is associated with a hypercoagulable state, which
makes pregnant women with prosthetic heart valves at high risk of
thromboembolism. The proper anticoagulation regimen should take both the
maternal protection and the fetal outcomes into consideration. However, no
consensus on the present anticoagulation regimen for those women has been
reached yet, especially in the first trimester of pregnancy. Aims: The
present meta-analysis is conducted to compare anticoagulation efficiency
and feto-maternal complications of heparin and warfarin in the first
trimester. Results: Databases of MEDLINE, EMBASE, and the Cochrane Library
were systematically searched (all from their inception to October 2016)
for cohort studies reporting the outcome of anticoagulation in pregnant
women with mechanical heart valves. Seven relevant prospective studies
were identified for inclusion in the present meta-analysis. The forest
plots indicated that warfarin was more effective in prevention valve
thrombosis in the first trimester than heparin (OR: 14.58; 95% confidence
interval [CI]: 3.94-53.94; P <.0001; I² = 0%). The spontaneous
abortion between the two regimens was not statistically different (OR:
1.42; 95% CI: 0.80-2.49; P =.23; I² = 20%), which indicated
that heparin could not provide better protection to the fetus in the early
stage of pregnancy than warfarin. The incidence of warfarin embryopathy
was low, and it only occurred in a twin among all the included cases.
Conclusions: The present meta-analysis indicated that warfarin can provide
better protection for the mother and the teratogenic effects may be
overestimated. Heparin does not ensure better fetal outcomes as it is
associated with severe adverse maternal outcomes, including
mortality.<br/>Copyright &#xa9; 2017 John Wiley & Sons Ltd

<8>
Accession Number
619190675
Author
Sherwood M.W.; Kiefer T.L.
Institution
(Sherwood) Inova Heart and Vascular Institute, 3300 Gallows Rd. 1st floor
Suite 1225, Falls Church, VA 22042, United States
(Sherwood) Duke Clinical Research Institute, 2400 Pratt Street, P.O. Box
17969, Durham, NC 27715, United States
(Kiefer) Division of Cardiology, Duke University Medical Center, 2301
Erwin Road, Durham, NC 27710, United States
Title
Challenges in Aortic Valve Stenosis: Low-Flow States Diagnosis,
Management, and a Review of the Current Literature.
Source
Current Cardiology Reports. 19 (12) (no pagination), 2017. Article Number:
130. Date of Publication: 01 Dec 2017.
Publisher
Current Medicine Group LLC 1 (E-mail: info@phl.cursci.com)
Abstract
Purpose of Review: We will describe and define the current diagnosis,
management, and potential therapy for low-flow aortic stenosis (AS)
states, as well as summarize the available evidence underlying these
recommendations. Recent Findings: Low-flow aortic stenosis syndromes have
worse prognoses than traditionally defined normal flow severe aortic
stenosis. In this setting, aortic valve replacement is the only therapy
that improves outcomes. Transcatheter aortic valve replacement has an
ever-expanding role in the treatment of aortic stenosis, and there is
growing evidence that TAVR may be a preferred therapy for low-flow AS
states. Summary: Aortic stenosis remains one of the most common valvular
diseases requiring therapy. Low-flow AS represents up to 40% of all
patients with AS and is associated with significant mortality. This
condition requires further testing for appropriate diagnosis and
treatment. Low-flow AS states have poor prognoses, thus AVR and especially
TAVR have a growing role in treatment of this challenging subset of AS
patients.<br/>Copyright &#xa9; 2017, Springer Science+Business Media, LLC.

<9>
Accession Number
619209390
Author
Teng Y.; Ou M.; Yu H.
Institution
(Teng, Ou, Yu) Department of Anaesthesiology, West China Hospital, Sichuan
University, Chengdu, Sichuan, China
Title
Feasibility of the Use of Transesophageal Echocardiography as a Surface
Probe for Puncturing and Catheterization of the Internal Jugular Vein: A
Randomized Controlled Pilot Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objective: To compare the transesophageal echocardiography (TEE) probe as
a surface probe with the vascular probe for guiding internal jugular vein
(IJV) catheterization. Design: Prospective, randomized, controlled pilot
study. Setting: University hospital. Participants: One hundred cardiac
surgery patients, including 50 adult and 50 pediatric patients.
Interventions: Patients in the TEE probe group received right IJV
catheterization using the TEE probe, while the vascular probe group used
the vascular probe for catheterization. Measurements and Main Results: The
puncture time, first-attempt success rate, quality of the imaging with
needle tip positioning, wire positioning, and catheter positioning were
recorded. The incidence of complication or any adverse event also was
observed. Adult patients: In the vascular probe group, the success rate
for first attempt IJV catheterization was 24/25 (96%), while in the TEE
probe group, the success rate for first attempt IJV catheterization was
25/25 (100%). There was no statistical difference in the puncture time,
image quality, needle tip positioning, wire positioning, and catheter
positioning between groups (p > 0.05). Pediatric patients: The success
rate for first-attempt IJV catheterization was 100% in both groups, and
there were no statistical differences in the puncture time, image quality,
and positioning between the 2 groups (p > 0.05). No complications or
adverse events were observed in either group. Conclusion: The TEE probe,
used as a surface probe, can be used to guide IJV puncturing and
catheterization in cardiac surgery patients with favorable feasibility and
safety.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<10>
Accession Number
619197730
Author
Moore P.; Burrage M.; Garrahy P.; Lim R.; McCann A.; Camuglia A.
Institution
(Moore, Burrage, Garrahy, Lim, McCann, Camuglia) Department of Cardiology,
Princess Alexandra Hospital, Brisbane, Qld, Australia
(Moore, Burrage, Garrahy, Lim, McCann, Camuglia) School of Medicine,
University of Queensland, Brisbane, Qld, Australia
Title
Drug-Eluting Stents Versus Coronary Artery Bypass Grafts for Left Main
Coronary Disease: A Meta-Analysis and Review Of Randomised Controlled
Trials.
Source
Heart Lung and Circulation. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier Ltd
Abstract
Background: Revascularisation of left main coronary artery (LMCA) disease
can be potentially managed with percutaneous coronary intervention (PCI)
or coronary artery bypass graft surgery (CABG). Recent randomised
controlled trial (RCT) data have added to the literature on this subject
and this meta-analysis aims to assess the state of the data to assist in
guiding patient treatment decisions. Methods: A systematic literature
search of Cochrane Library, Embase, OVID, and PubMed MEDLINE was
performed. Randomised controlled trials of patients with LMCA disease
undergoing PCI with drug eluting stents or CABG were included. Clinical
outcomes and adverse events were assessed and analysed. Results: Four
suitable RCTs of adequate quality and follow-up were identified. The
incidence of major adverse cardiac and cerebrovascular events (MACCE) at 3
to 5 years of follow-up was significantly increased with PCI compared to
CABG (23.3% vs 18.2%, OR 1.37; 95% CI: 1.18-1.58; p=<0.0001; I²
=0%) and was largely driven by more repeat revascularisation procedures
among patients treated with PCI. There was no statistically significant
difference in rates of mortality, myocardial infarction or stroke (either
individually or when these outcomes were combined as a composite
endpoint). Conclusions: Coronary artery bypass grafting and PCI both
represent reasonable treatment modalities for LMCA disease in
appropriately selected patients. However, where CABG is feasible it offers
superior long-term freedom from repeat revascularisation. Longer-term
follow-up is required to further clarify the durability of mortality
outcomes, especially in patients treated with PCI.<br/>Copyright &#xa9;
2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).

<11>
Accession Number
619197728
Author
Akinseye O.A.; Jha S.K.; Ibebuogu U.N.
Institution
(Akinseye, Jha, Ibebuogu) Division of Cardiovascular Diseases, Department
of Medicine, University of Tennessee Health Science Center, Memphis, TN,
United States
Title
Clinical outcomes of coronary occlusion following transcatheter aortic
valve replacement: A systematic review.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Coronary occlusion (CO) is a rare but serious complication
following transcatheter aortic valve replacement (TAVR) with limited
published data. We sought to evaluate the immediate and short-term
outcomes of CO complicating TAVR. Methods: Studies, including case
reports, case series and original articles published from 2002 to 2016
describing CO following TAVR were identified with a systematic electronic
search using the PRISMA Statement. Only studies reporting data on
demographic and procedural characteristics, management and follow up
outcomes were analyzed. Results: A total of 40 publications describing 96
patients (86 native, 10 bioprosthetic) were identified. Mean age was 83.
+/-. 7. years and most (81%) were females. The mean logistic EuroSCORE and
STS score was 23.5. +/-. 14.6% and 9.1. +/-. 3.2% respectively. TAVR
access site was transfemoral in 73% and a balloon expandable valve was
used in 78%. Among those with LCA occlusion, the mean LCA ostium height
was 10.1. +/-. 1.8. mm while the mean RCA ostium height was 10.4. +/-.
2.0. mm among those with RCA occlusion. CO frequently involved the left
main coronary artery (80%) and the most common mechanism was displacement
of native valve leaflet (60%), and most cases occurred within 1-hour
post-implantation (88%). Percutaneous coronary intervention was attempted
in 82 patients and successful in 89%. Procedural death was 10.4%. CO
following TAVR in native aortic valve stenosis was associated with a
30-day mortality rate of 35.3%. Conclusions: CO following TAVR is
associated with a high procedural and 30-day mortality rate despite
aggressive resuscitative measures including percutaneous coronary
intervention.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<12>
Accession Number
619197476
Author
Ueki K.; Sasako T.; Okazaki Y.; Kato M.; Okahata S.; Katsuyama H.;
Haraguchi M.; Morita A.; Ohashi K.; Hara K.; Morise A.; Izumi K.; Ishizuka
N.; Ohashi Y.; Noda M.; Kadowaki T.
Institution
(Ueki) Department of Molecular Diabetic Medicine, Diabetes Research
Center, National Center for Global Health and Medicine, Tokyo, Japan
(Izumi) Department of Clinical Research Strategic Planning, Center for
Clinical Sciences, National Center for Global Health and Medicine, Tokyo,
Japan
(Ueki, Sasako, Okazaki, Haraguchi, Morita, Kadowaki) Department of
Diabetes and Metabolic Diseases, Graduate School of Medicine, The
University of Tokyo, Tokyo, Japan
(Sasako, Kadowaki) Translational Systems Biology and Medicine Initiative,
The University of Tokyo, Tokyo, Japan
(Kato) Health Management Center and Diagnostic Imaging Center, Toranomon
Hospital, Tokyo, Japan
(Okahata) Division of Diabetes and Metabolism, Toho University Ohashi
Medical Center, Tokyo, Japan
(Katsuyama) Department of Internal Medicine, National Center for Global
Health and Medicine, Kohnodai Hospital, Chiba, Japan
(Ohashi) Department of General Internal Medicine, National Cancer Center
Hospital, Tokyo, Japan
(Hara) Department of Endocrinology and Metabolism, Saitama Medical Center,
Jichi Medical University, Saitama, Japan
(Morise) Department of Internal Medicine, Tokyo Takanawa Hospital, Tokyo,
Japan
(Ishizuka) Clinical Research Center, The Cancer Institute Hospital,
Japanese Foundation for Cancer Research, Tokyo, Japan
(Ohashi) Department of Integrated Science and Engineering for Sustainable
Society, Chuo University, Tokyo, Japan
(Noda) Department of Endocrinology and Diabetes, Saitama Medical
University, Saitama, Japan
Title
Effect of an intensified multifactorial intervention on cardiovascular
outcomes and mortality in type 2 diabetes (J-DOIT3): An open-label,
randomised controlled trial.
Source
The Lancet Diabetes and Endocrinology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Limited evidence suggests that multifactorial interventions
for control of glucose, blood pressure, and lipids reduce macrovascular
complications and mortality in patients with type 2 diabetes. However,
safe and effective treatment targets for these risk factors have not been
determined for such interventions. Methods: In this multicentre,
open-label, randomised, parallel-group trial, undertaken at 81 clinical
sites in Japan, we randomly assigned (1:1) patients with type 2 diabetes
aged 45-69 years with hypertension, dyslipidaemia, or both, and an
HbA<inf>1c</inf> of 6.9% (52.0 mmol/mol) or higher, to receive
conventional therapy for glucose, blood pressure, and lipid control
(targets: HbA<inf>1c</inf> <6.9% [52.0 mmol/mol], blood pressure <130/80
mm Hg, LDL cholesterol <120 mg/dL [or 100 mg/dL in patients with a history
of coronary artery disease]) or intensive therapy (HbA<inf>1c</inf> <6.2%
[44.3 mmol/mol], blood pressure <120/75 mm Hg, LDL cholesterol <80 mg/dL
[or 70 mg/dL in patients with a history of coronary artery disease]).
Randomisation was done using a computer-generated, dynamic balancing
method, stratified by sex, age, HbA<inf>1c</inf>, and history of
cardiovascular disease. Neither patients nor investigators were masked to
group assignment. The primary outcome was occurrence of any of a composite
of myocardial infarction, stroke, revascularisation (coronary artery
bypass surgery, percutaneous transluminal coronary angioplasty, carotid
endarterectomy, percutaneous transluminal cerebral angioplasty, and
carotid artery stenting), and all-cause mortality. The primary analysis
was done in the intention-to-treat population. This study is registered
with ClinicalTrials.gov, number NCT00300976. Findings: Between June 16,
2006, and March 31, 2009, 2542 eligible patients were randomly assigned to
intensive therapy or conventional therapy (1271 in each group) and
followed up for a median of 8.5 years (IQR 7.3-9.0). Two patients in the
intensive therapy group were found to be ineligible after randomisation
and were excluded from the analyses. During the intervention period, mean
HbA<inf>1c</inf>, systolic blood pressure, diastolic blood pressure, and
LDL cholesterol concentrations were significantly lower in the intensive
therapy group than in the conventional therapy group (6.8% [51.0 mmol/mol]
vs 7.2% [55.2 mmol/mol]; 123 mm Hg vs 129 mm Hg; 71 mm Hg vs 74 mm Hg; and
85 mg/dL vs 104 mg/dL, respectively; all p<0.0001). The primary outcome
occurred in 109 patients in the intensive therapy group and in 133
patients in the conventional therapy group (hazard ratio [HR] 0.81, 95% CI
0.63-1.04; p=0.094). In a post-hoc breakdown of the composite outcome,
frequencies of all-cause mortality (HR 1.01, 95% CI 0.68-1.51; p=0.95) and
coronary events (myocardial infarction, coronary artery bypass surgery,
and percutaneous transluminal coronary angioplasty; HR 0.86, 0.58-1.27;
p=0.44) did not differ between groups, but cerebrovascular events (stroke,
carotid endarterectomy, percutaneous transluminal cerebral angioplasty,
and carotid artery stenting) were significantly less frequent in the
intensive therapy group (HR 0.42, 0.24-0.74; p=0.002). Apart from
non-severe hypoglycaemia (521 [41%] patients in the intensive therapy
group vs 283 [22%] in the conventional therapy group, p<0.0001) and oedema
(193 [15%] vs 129 [10%], p=0.0001), the frequencies of major adverse
events did not differ between groups. Interpretation: Our results do not
fully support the efficacy of further intensified multifactorial
intervention compared with current standard care for the prevention of a
composite of coronary events, cerebrovascular events, and all-cause
mortality. Nevertheless, our findings suggest a potential benefit of an
intensified intervention for the prevention of cerebrovascular events in
patients with type 2 diabetes. Funding: Ministry of Health, Labour and
Welfare of Japan, Asahi Kasei Pharma, Astellas Pharma, AstraZeneca, Bayer,
Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Eli Lilly,
GlaxoSmithKline, Kissei Pharmaceutical, Kowa Pharmaceutical, Mitsubishi
Tanabe Pharma, Mochida Pharmaceutical, MSD, Novartis Pharma, Novo Nordisk,
Ono Pharmaceutical, Pfizer, Sanwa Kagaku Kenkyusho, Shionogi, Sumitomo
Dainippon Pharma, Taisho Toyama Pharmaceutical, and Takeda.<br/>Copyright
&#xa9; 2017 Elsevier Ltd.

<13>
Accession Number
619197294
Author
Kirkwood K.A.; Gulack B.C.; Iribarne A.; Bowdish M.E.; Greco G.; Mayer
M.L.; O'Sullivan K.; Gelijns A.C.; Fumakia N.; Ghanta R.K.; Raiten J.M.;
Lala A.; Ladowski J.S.; Blackstone E.H.; Parides M.K.; Moskowitz A.J.;
Horvath K.A.
Institution
(Kirkwood, Parides) International Center for Health Outcomes and
Innovation Research (InCHOIR) and Center for Biostatistics in the
Department of Population Health Science and Policy, Icahn School of
Medicine at Mount Sinai, New York, NY
(Greco, O'Sullivan, Gelijns, Moskowitz) International Center for Health
Outcomes and Innovation Research, Department of Population Health Science
and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
(Lala) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine, New York, NY
(Gulack) Division of Cardiovascular and Thoracic Surgery, Department of
Surgery, Duke Health, Durham, NC
(Iribarne) Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon,
NH
(Bowdish) Department of Surgery, Keck School of Medicine of USC,
University of Southern California, Los Angeles, Calif
(Mayer) Division of Cardiovascular Surgery, Department of Surgery,
University of Pennsylvania School of Medicine, Philadelphia, Pa
(Raiten) Department of Anesthesiology and Critical Care, University of
Pennsylvania School of Medicine, Philadelphia, Pa
(Fumakia) Division of Cardiovascular Surgery, Toronto General Hospital,
Toronto, Ontario, Canada
(Ghanta) Michael E. DeBakey Department of Surgery, Baylor College of
Medicine, Houston, Tex
(Ladowski) Indiana Ohio Heart, Fort Wayne, Ind
(Blackstone) Cardiothoracic Research, Cleveland Clinic, Cleveland, Ohio
(Horvath) Clinical Transformation, Association of American Medical
Colleges, Washington, DC
Title
A multi-institutional cohort study confirming the risks of Clostridium
difficile infection associated with prolonged antibiotic prophylaxis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: The incidence and severity of Clostridium difficile infection
(CDI) have increased rapidly over the past 2 decades, particularly in
elderly patients with multiple comorbidities. This study sought to
characterize the incidence and risks of these infections in cardiac
surgery patients. Methods: A total of 5158 patients at 10 Cardiothoracic
Surgical Trials Network sites in the US and Canada participated in a
prospective study of major infections after cardiac surgery. Patients were
followed for infection, readmission, reoperation, or death up to 65 days
after surgery. We compared clinical and demographic characteristics,
surgical data, management practices, and outcomes for patients with CDI
and without CDI. Results: C difficile was the third most common infection
observed (0.97%) and was more common in patients with preoperative
comorbidities and complex operations. Antibiotic prophylaxis for >2 days,
intensive care unit stay >2 days, and postoperative hyperglycemia were
associated with increased risk of CDI. The median time to onset was 17
days; 48% of infections occurred after discharge. The additional length of
stay due to infection was 12 days. The readmission and mortality rates
were 3-fold and 5-fold higher, respectively, in patients with CDI compared
with uninfected patients. Conclusions: In this large multicenter
prospective study of major infections following cardiac surgery, CDI was
encountered in nearly 1% of patients, was frequently diagnosed
postdischarge, and was associated with extended length of stay and
substantially increased mortality. Patients with comorbidities, longer
surgery time, extended antibiotic exposure, and/or hyperglycemic episodes
were at increased risk for CDI.<br/>Copyright &#xa9; 2017 The American
Association for Thoracic Surgery.

<14>
Accession Number
613630502
Author
Wang S.; Li H.; He N.; Sun Y.; Guo S.; Liao W.; Liao Y.; Chen Y.; Bin J.
Institution
(Wang, Li, He, Sun, Guo, Liao, Chen, Bin) State Key Laboratory of Organ
Failure Research, Department of Cardiology, Nanfang Hospital, Southern
Medical University, Guangzhou, China
(Liao) Department of Oncology, Nanfang Hospital, Southern Medical
University, Guangzhou, China
Title
Impact of remote ischaemic preconditioning on major clinical outcomes in
patients undergoing cardiovascular surgery: A meta-analysis with trial
sequential analysis of 32 randomised controlled trials.
Source
International Journal of Cardiology. 227 (pp 882-891), 2017. Date of
Publication: 15 Jan 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background The impact of remote ischaemic preconditioning (RIPC) on major
clinical outcomes in patients undergoing cardiovascular surgery remains
controversial. We systematically reviewed the available evidence to
evaluate the potential benefits of RIPC in such patients. Methods PubMed,
Embase, and Cochrane Library databases were searched for relevant
randomised controlled trials (RCTs) conducted between January 2006 and
March 2016. The pooled population of patients who underwent cardiovascular
surgery was divided into the RIPC and control groups. Trial sequential
analysis was applied to judge data reliability. The pooled relative risks
(RRs) with 95% confidence intervals (CIs) between the groups were
calculated for all-cause mortality, major adverse cardiovascular and
cerebral events (MACCEs), myocardial infarction (MI), and renal failure.
Results RIPC was not associated with improvement in all-cause mortality
(RR, 1.04; 95%CI, 0.82-1.31; I² = 26%; P > 0.05) or MACCE
incidence (RR, 0.90; 95%CI, 0.71-1.14; I² = 40%; P > 0.05)
after cardiovascular surgery, and both results were assessed by trial
sequential analysis as sufficient and conclusive. Nevertheless, RIPC was
associated with a significantly lower incidence of MI (RR, 0.87; 95%CI,
0.76-1.00; I² = 13%; P <= 0.05). However, after excluding a
study that had a high contribution to heterogeneity, RIPC was associated
with increased rates of renal failure (RR, 1.53; 95%CI, 1.12-2.10;
I² = 5%; P <= 0.05). Conclusions In patients undergoing
cardiovascular surgery, RIPC reduced the risk for postoperative MI, but
not that for MACCEs or all-cause mortality, a discrepancy likely related
to the higher rate of renal failure associated with RIPC.<br/>Copyright
&#xa9; 2016 Elsevier Ireland Ltd

<15>
Accession Number
613630413
Author
Varho V.; Nammas W.; Kiviniemi T.O.; Sia J.; Romppanen H.; Pietila M.;
Airaksinen J.K.; Karjalainen P.P.
Institution
(Varho, Kiviniemi, Pietila, Airaksinen) Heart Center, Turku University
Hospital, University of Turku, Turku, Finland
(Nammas, Kiviniemi, Karjalainen) Heart Centre, Satakunta Central Hospital,
Pori, Finland
(Sia) Department of Cardiology, Central Ostrobothnia Central Hospital,
Kokkola, Finland
(Romppanen) Cardiology Unit, Kuopio University Hospital, Kuopio, Finland
Title
Comparison of two different sampling intervals for optical coherence
tomography evaluation of neointimal healing response after coronary stent
implantation.
Source
International Journal of Cardiology. 227 (pp 194-200), 2017. Date of
Publication: 15 Jan 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background/objectives Optical coherence tomography (OCT) is widely used
for evaluation of healing response to stent implantation. We sought to
test the agreement between the 1-mm and 0.6-mm sampling intervals for
assessment of the percentage of uncovered and malapposed struts by OCT.
Methods Thirty-eight patients presenting with acute coronary syndrome were
randomized to receive either a titanium-nitride-oxide-coated stent (n =
19) or an everolimus-eluting stent (n = 19). Neointimal strut coverage and
strut apposition were evaluated by OCT at 2-month follow-up. Two
independent investigators performed offline OCT image analysis at 1-mm
intervals. One investigator repeated the measurements at 0.6-mm intervals
and measurements were compared between the two sampling intervals. Results
At a median follow-up of 60 [8] days, 694 cross-sections (7603 struts) and
1138 cross-sections (12,331 struts) were analysed at 1-mm and at 0.6-mm
intervals, respectively. The median [IQR] percentage of uncovered struts
was 3.27% [11.1] versus 3.38% [9.76] (p = 0.001), and the mean (+/- SD)
percentage was 7.69 +/- 9.99% versus 6.27 +/- 8.14% (p = 0.004), for the
1-mm sampling interval versus the 0.6-mm sampling interval analysis,
respectively; the median percentage of malapposed struts was 0.42% [2.04]
versus 0.12% [1.63], respectively, (p = 0.003). The intraclass correlation
coefficient between the two observers for the percentage of uncovered
struts was 0.95. Conclusions The OCT-evaluated strut-level measurements of
neointimal healing after stent implantation differ significantly between
the 1-mm and the 0.6-mm sampling intervals.<br/>Copyright &#xa9; 2016
Elsevier Ireland Ltd

<16>
Accession Number
619051493
Author
Yang X.; Chen C.; Teng S.; Fu X.; Zha Y.; Liu H.; Wang L.; Tian J.; Zhang
X.; Liu Y.; Nie J.; Hou F.F.
Institution
(Yang, Teng, Fu, Tian, Liu, Nie, Hou) National Clinical Research Center
for Kidney Disease, Southern Medical University, Nanfang Hospital, 1838
North Guangzhou Avenue, Guangzhou 510515, China
(Chen) Department of Critical Care Medicine, Guangdong Cardiovascular
Institute, Guangdong Academy of Medical Sciences, Guangdong General
Hospital, Guangzhou, China
(Zha, Zhang) Department of Nephrology, Guiyang Medical University, Guizhou
Provincial People's Hospital, Guiyang, China
(Liu) Division of Nephrology, Institute of Nephrology, Guangdong Medical
College, Zhanjiang, China
(Wang) Division of Nephrology, Sichuan Provincial People's Hospital,
Chengdu, China
Title
Urinary matrix metalloproteinase-7 predicts severe AKI and poor outcomes
after cardiac surgery.
Source
Journal of the American Society of Nephrology. 28 (11) (pp 3373-3382),
2017. Date of Publication: November 2017.
Publisher
American Society of Nephrology (E-mail: email@asn-online.org)
Abstract
Urinary matrix metalloproteinase-7 (uMMP-7) levels consistently reflect
the activity of intrarenal Wnt/b-catenin, which is activated in AKImodels.
To test the hypothesis that uMMP-7 is a predictor for severe AKI in
patients after cardiac surgery, we performed a prospective, multicenter,
two-stage cohort study in 721 patients undergoing cardiac surgery. In
stage 1,we enrolled 323 children from three academic medical centers. In
stage 2, we enrolled 398 adults at six centers. We analyzed levels of
uMMP-7 and other injury biomarkers during the perioperative period.
SevereAKI was defined asKidneyDisease ImprovingGlobalOutcomesstage2or3.
uMMP-7 levelpeaked within 6 hours after surgery in patients who
subsequently developed severe AKI. After multivariate adjustment, the
highest quintile of postoperative uMMP-7 level, compared with the lowest
quintile, associated with 17-fold (in adults) and 36-fold (in children)
higher odds of severe AKI. ElevateduMMP-7 level associatedwith increased
risk of composite events (severe AKI, acute dialysis, and in-hospital
death) and longer stay in the intensive care unit and hospital. For
predicting severe AKI, uMMP-7 had an area under the receiver operating
characteristic curve of 0.81 (in children) and 0.76 (in adults),
outperforming urinary IL-18, angiotensinogen, neutrophil
gelatinase-associated lipocalin, albumin-to-creatinine ratio, and tissue
inhibitor of metalloproteinase-2zIGF-binding protein-7 and the clinical
model. uMMP-7 significantly improved risk reclassification over the
clinicalmodel alone, as measured by net reclassification improvement and
integrated discrimination improvement. In conclusion, uMMP-7 is a
promising predictor for severe AKI and poor in-hospital outcomes in
patients after cardiac surgery.<br/>Copyright &#xa9; 2017 by the American
Society of Nephrology.

<17>
Accession Number
607801732
Author
Patel A.J.; Daniel G.; Naidu B.; Bishay E.
Institution
(Patel, Daniel, Naidu, Bishay) Department of Thoracic Surgery, Birmingham
Heartlands Hospital, Heart of England NHS Trust, Bordesley Green East,
Birmingham, West Midlands B9 5SS, United Kingdom
Title
The significance of microvascular invasion after complete resection of
early-stage non-small-cell lung cancer.
Source
Interactive Cardiovascular and Thoracic Surgery. 22 (1) (pp 101-105),
2016. Date of Publication: 01 Jan 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was 'in patients with
non-small-cell lung cancer who have undergone complete resection, does the
presence of microvascular invasion (MVI) significantly impact long-term
survival or prognosis?' Altogether, more than 250 papers were found using
the reported search, of which 12 represented the best evidence to answer
the clinical question. Outcome parameters that were used in the assessment
include 5-year overall survival, event-free or recurrence-free survival
(RFS) and incidence of metastatic relapse. The authors, journal, date and
country of publication, patient group studied, study type, relevant
outcomes, results and study weaknesses were tabulated. The majority of the
data collected were retrospective. Meta-analysis of data of over 16 000
patients showed that when considering RFS, MVI positivity was associated
with a significantly reduced period of RFS; pooled hazard ratio estimates
by univariate and multivariate analyses were 3.28 (95% CI 2.14-5.05; P <
0.0001) and 3.98 (95% CI 2.24-7.06; P < 0.0001), respectively. Eight of
the studies showed a significantly worse 5-year survival in the presence
of MVI, whereas a further study found a reduced median survival with MVI.
One study showed no difference, but concurred with five other studies that
MVI was associated with a significantly shorter event-free or RFS.
Multivariate analyses have furthermore demonstrated that MVI positivity
correlates with larger tumour size, an increased risk of distant
metastases, visceral pleural involvement, lymphovascular invasion, higher
tumour grade and nodal status. We conclude that the presence of
microvascular invasion in resected early-stage non-small-cell lung cancer
is a negative prognostic factor.<br/>Copyright &#xa9; 2015 The Author
2015. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<18>
Accession Number
607801725
Author
Sepehripour A.H.; Chaudhry U.A.; Suliman A.; Kidher E.; Sayani N.;
Ashrafian H.; Harling L.; Athanasiou T.
Institution
(Sepehripour, Chaudhry, Suliman, Kidher, Sayani, Ashrafian, Harling,
Athanasiou) Department of Surgery and Cancer, Imperial College London,
QEQM Building, St Mary's Hospital, London W2 1NY, United Kingdom
Title
How revascularization on the beating heart with cardiopulmonary bypass
compares to off-pump? A meta-analysis of observational studies.
Source
Interactive Cardiovascular and Thoracic Surgery. 22 (1) (pp 63-71), 2016.
Date of Publication: 01 Jan 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Off-pump coronary artery bypass surgery has been a controversial area of
debate and the outcome profile of the technique has been thoroughly
investigated. Scepticism regarding the reported outcomes and the conduct
of the randomized trials comparing this technique with conventional
on-pump coronary artery bypass surgery has been widely voiced, and the
technique of off-pump surgery remains as an infrequently adopted approach
to myocardial revascularization worldwide. Criticisms of the technique are
related to lower rates of complete revascularization and its unknown
long-term consequences, the significant detrimental effects on mortality
and major adverse events when emergency conversion is required, and the
significant lack of long-term survival and morbidity data. The hybrid
technique of myocardial revascularization on the beating heart with the
use of cardiopulmonary bypass may theoretically provide the beneficial
effects of off-pump surgery in terms of myocardial protection and organ
protection, while providing the safety and stability of on-pump surgery to
allow complete revascularization. Large randomized comparison to support
evidence-based choices is currently lacking. In this article, we have
meta-analysed the outcomes of on-pump beating heart surgery in comparison
with off-pump surgery focusing on major adverse cardiovascular and
cerebrovascular adverse events (MACCE) including mortality, stroke and
myocardial infarction and the degree of revascularization and number of
bypass grafts performed. It was demonstrated that the beating heart
on-pump technique allows a significantly higher number of bypass grafts to
be performed, resulting in significantly higher degree of
revascularization. We have also demonstrated a slightly higher rate of
30-day mortality and MACCE with the technique although not at a
statistically significant level. These results should be considered
alongside the population risk profile, where a significantly higher risk
cohort had undergone the beating heart on-pump technique. Long-term
survival and morbidity figures are required to assess the impact of these
findings in the coronary surgery patient population.<br/>Copyright &#xa9;
2015 The Author 2015. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.

<19>
Accession Number
607801649
Author
Hosseinpour A.-R.; Adsuar-Gomez A.; Gonzalez-Calle A.; Pedrote A.;
Arana-Rueda E.; Garcia-Riesco L.; Arce-Leon A.; Jimenez-Velasco A.;
Borrego-Dominguez J.M.; Ordonez-Fernandez A.
Institution
(Hosseinpour, Adsuar-Gomez, Gonzalez-Calle, Pedrote, Arana-Rueda,
Garcia-Riesco, Arce-Leon, Jimenez-Velasco, Borrego-Dominguez,
Ordonez-Fernandez) Heart Unit, University Hospitals Virgen Del Rocio,
Department of Cardiac Surgery, Avenida Manuel Siurot s/n, Seville 41013,
Spain
Title
A simple surgical technique to prevent atrial reentrant tachycardia in
surgery for congenital heart disease.
Source
Interactive Cardiovascular and Thoracic Surgery. 22 (1) (pp 47-52), 2016.
Date of Publication: 01 Jan 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES To present and test a simple surgical technique that may
prevent atrial reentrant tachycardia following surgery for congenital
heart disease. This arrhythmia is one of the commonest long-term
complications of such a surgery. It may occur many years (even decades)
after the operation. It is usually explained as a late consequence of
right atriotomy, which is an inherent component of many operations for
congenital heart disease. Right atriotomy results in a long scar on the
right atrial myocardium. This scar, as any scar, is a barrier to
electrical conduction, and macro-reentrant circuits may form around it,
causing reentrant tachycardia. However, this mechanism may be
counterchecked and neutralized by our proposed method, which prevents
reentrant circuits around right atriotomy scars. METHODS The proposed
method is implemented after termination of cardiopulmonary bypass and
tying the venous purse-strings. It consists of constructing a
full-thickness suture line on the intact right atrial wall from the
inferior vena cava (IVC) (a natural conduction barrier) to the atriotomy
incision. This suture line is made to cross the venous cannulation sites
if these are on the atrial myocardium (rather than being directly on the
venae cavae). Thus, the IVC, atriotomy and cannulation sites are connected
to each other in series by a full-thickness suture line on the atrial
wall. If this suture line becomes a conduction barrier, it would prevent
reentrant circuits around right atrial scars. This was tested in 13 adults
by electroanatomical mapping. All 13 patients had previously undergone
right atriotomy for atrial septal defect closure: 8 of them with the
addition of the proposed preventive suture line (treatment group) and 5
without (control group). RESULTS In all 13 cases, the atriotomy scar was
identified as a barrier to electrical conduction with electrophysiological
evidence of fibrosis (scarring). In the 8 patients with the proposed
suture line, this had also become a scar and a complete conduction
barrier. In the 5 patients without this suture line, there was free
electrical conduction between the IVC and atriotomy scar. CONCLUSIONS The
proposed suture line becomes a scar and conduction barrier. Therefore, it
would prevent reentrant circuits around atrial scars and their consequent
arrhythmias.<br/>Copyright &#xa9; 2015 The Author 2015. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<20>
Accession Number
614004741
Author
Bavishi C.; Baber U.; Panwar S.; Pirrotta S.; Dangas G.D.; Moreno P.;
Tamis-Holland J.; Kini A.S.; Sharma S.K.
Institution
(Bavishi, Pirrotta, Moreno, Tamis-Holland) Department of Cardiology, Mount
Sinai St. Luke's and Mount Sinai West Hospitals, New York, United States
(Baber, Panwar, Dangas, Moreno, Kini, Sharma) Zena and Michael A. Wiener
Cardiovascular Institute, Mount Sinai Hospital, New York, United States
Title
Efficacy and safety of everolimus and zotarolimus-eluting stents versus
first-generation drug-eluting stents in patients with diabetes: A
meta-analysis of randomized trials.
Source
International Journal of Cardiology. 230 (pp 310-318), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Introduction Patients with diabetes and coronary artery disease remain at
high risk for adverse cardiovascular events after percutaneous coronary
intervention. The efficacy and safety of the various drug-eluting stents
(DES) in patients with diabetes is unclear. Methods Randomized controlled
trials comparing first-generation DES [paclitaxel-eluting stents (PES) and
sirolimus-eluting stents (SES)] with everolimus-eluting stents (EES) and
zotarolimus-eluting stents (ZES) in diabetic patients were systematically
searched. Efficacy [target vessel revascularization (TVR) and target
lesion revascularization (TLR)] and safety [major adverse cardiac events
(MACE), all-cause and cardiac mortality, myocardial infarction, stent
thrombosis] outcomes were evaluated. Results Eighteen randomized
controlled trials comprising of 8095 patients (17,000 patient-years of
follow-up) were included. Compared to first-generation DES, EES
significantly decreased MACE by 18% (relative risk [RR]: 0.82, 95%
confidence interval [CI]: 0.70-0.96), myocardial infarction by 43% (RR:
0.57, 95% CI: 0.39-0.84) and stent thrombosis by 46% (RR: 0.54, 95% CI:
0.35-0.82) in patients with diabetes. Moreover EES showed a trend towards
reduction in rates of TLR and TVR (p = 0.05). ZES was associated with 89%
increased risk for TLR (RR: 1.89, 95% CI: 1.10-3.22) compared to
first-generation DES. Furthermore, meta-regression analysis showed a
greater magnitude of benefit of EES over first-generation DES for MACE (p
= 0.037) and stent thrombosis (p = 0.036) in diabetic patients requiring
Insulin. Conclusions In patients with diabetes and coronary artery disease
undergoing stenting, EES is the most efficacious and safe DES. The
outcomes data for ZES in diabetes patients were limited and further trials
are needed.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd

<21>
Accession Number
614303172
Author
Redfors B.; He C.-H.; Palmerini T.; Caixeta A.; Giustino G.; Ayele G.M.;
Kirtane A.J.; Mehran R.; Stone G.W.; Genereux P.
Institution
(Redfors, He, Ayele, Kirtane, Mehran, Stone, Genereux) Cardiovascular
Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, United
States
(He) First Affiliated Hospital of Xinjiang Medical University, Urumqi,
Xinjiang, China
(Palmerini) Dipartimento Cardiovascolare, Policlinico S. Orsola, Bologna,
Italy
(Caixeta) Hospital Israelita Albert Einstein, Sao Paulo, Brazil
(Giustino, Mehran) Icahn School of Medicine at Mount Sinai, New York, NY,
United States
(Kirtane, Stone) NewYork-Presbyterian Hospital, Columbia University
Medical Center, New York, NY, United States
(Genereux) Hopital du Sacre-Coeur de Montreal, Montreal, QC, Canada
(Genereux) Morristown Medical Center, Morristown, NJ, United States
Title
The SYNTAX score does not predict risk of adverse events in patients with
non-ST elevation acute coronary syndrome who undergo coronary artery
bypass graft surgery.
Source
Journal of Invasive Cardiology. 29 (2) (pp 42-49), 2017. Date of
Publication: February 2017.
Publisher
HMP Communications
Abstract
Objectives. We tested the ability of the SYNTAX score (SS) to predict
1-year adverse outcomes for patients with non-ST segment elevation acute
coronary syndromes (NSTE-ACS) who undergo coronary artery bypass graft
(CABG) surgery. Background. The SS effectively risk stratifies patients
who undergo percutaneous coronary intervention, but not patients with
stable coronary disease who undergo CABG. Methods. We calculated the SS
for 457 patients with NSTE-ACS in the angiographic substudy of the ACUITY
(Acute Catheterization and Urgent Intervention Triage StrategY) trial who
underwent CABG. We stratified and compared patients according to SS
tertiles. We tested the ability of the SS, as a linear covariate, to
predict adverse events by univariate analyses and by univariate and
multivariable Cox proportional hazards model. We also tested the
predictive abilities of the Age, Creatinine Clearance, and Ejection
Fraction (ACEF) score, the clinical SS, and the logistic clinical SS.
Results. The median SS was 23 (interquartile range, 15-30). Baseline
clinical characteristics were similar among the groups. One-year mortality
and major adverse cardiovascular events (all-cause death, myocardial
infarction, any stroke, or urgent revascularization) were similar between
the groups (P=.13 and P=.62, respectively). Receiver operating
characteristic curves, net reclassification indices, and integrated
discrimination indices did not improve with SS, clinical SS, or logistic
clinical SS compared with the ACEF score. Conclusions. The anatomical SS
does not appear to be useful in risk stratifying patients with NSTE-ACS
who undergo CABG. Clinical variables may better risk stratify patients
with complex coronary artery disease considered for CABG.

<22>
Accession Number
619096217
Author
Zittermann A.; Ernst J.B.; Prokop S.; Fuchs U.; Dreier J.; Kuhn J.; Knabbe
C.; Birschmann I.; Schulz U.; Berthold H.K.; Pilz S.; Gouni-Berthold I.;
Gummert J.F.; Dittrich M.; Borgermann J.
Institution
(Zittermann, Ernst, Prokop, Fuchs, Schulz, Gummert, Borgermann) Clinic for
Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr
University Bochum, Georgstrase 11, Bad Oeynhausen 32545, Germany
(Dreier, Kuhn, Knabbe, Birschmann) Institute for Laboratory and
Transfusion Medicine, Heart and Diabetes Center NRW, Ruhr University
Bochum, Georgstrase 11, Bad Oeynhausen 32545, Germany
(Berthold) Department of Internal Medicine and Geriatrics, Evangelical
Hospital of the Bethel Foundation, Schildescher Strase 99, Bielefeld
33611, Germany
(Pilz) Division of Endocrinology and Diabetology, Department of Internal
Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz 8036,
Austria
(Gouni-Berthold) Center of Endocrinology, Diabetes and Preventive
Medicine, University of Cologne, Kerpener Strase 62, Cologne 50937,
Germany
(Dittrich) Department of Bioinformatics, Institute of Human Genetics,
Biocenter, University of Wuerzburg, Am Hubland/Biozentrum, Wuerzburg
97074, Germany
Title
Effect of Vitamin D on all-causemortality in heart failure (EVITA): A
3-year randomized clinical trial with 4000 IU Vitamin D daily.
Source
European Heart Journal. 38 (29) (pp 2279-2286), 2017. Date of Publication:
01 Aug 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims Circulating 25-hydroxyVitamin D (25OHD) levels <75 nmol/L are
associated with a nonlinear increase in mortality risk. Such 25OHD levels
are common in heart failure (HF). We therefore examined whether oral
Vitamin D supplementation reduces mortality in patients with advanced HF.
Methods and results Four hundred HF patients with 25OHD levels <75 nmol/L
were randomized to receive 4000 IU Vitamin D daily or matching placebo for
3 years. Primary endpoint was all-cause mortality. Key secondary outcome
measures included hospitalization, resuscitation, mechanical circulatory
support (MCS) implant, high urgent listing for heart transplantation,
heart transplantation, and hypercalcaemia. Initial 25OHD levels were on
average <40 nmol/L, remained around 40 nmol/L in patients assigned to
placebo and plateaued around 100 nmol/L in patients assigned to Vitamin D.
Mortality was not different in patients receiving Vitamin D (19.6%; n =
39) or placebo (17.9%; n = 36) with a hazard ratio (HR) of 1.09 [95%
confidence interval (CI): 0.69-1.71; P = 0.726]. The need for MCS implant
was however greater in patients assigned to Vitamin D (15.4%, n = 28) vs.
placebo [9.0%, n = 15; HR: 1.96 (95% CI: 1.04-3.66); P = 0.031]. Other
secondary clinical endpoints were similar between groups. The incidence of
hypercalcaemia was 6.2% (n = 10) and 3.1% (n = 5) in patients receiving
Vitamin D or placebo (P = 0.192). Conclusion A daily Vitamin D dose of
4000 IU did not reduce mortality in patients with advanced HF but was
associated with a greater need for MCS implants. Data indicate caution
regarding long-term supplementation with moderately high Vitamin D doses.
Trial Registration Information clinicaltrials.gov Idenitfier:
NCT01326650.<br/>Copyright &#xa9; The Author 2016.

<23>
Accession Number
619096188
Author
Hagiwara N.; Kawada-Watanabe E.; Koyanagi R.; Arashi H.; Yamaguchi J.;
Nakao K.; Tobaru T.; Tanaka H.; Oka T.; Endoh Y.; Saito K.; Uchida T.;
Matsui K.; Ogawa H.
Institution
(Hagiwara, Kawada-Watanabe, Koyanagi, Arashi, Yamaguchi, Ogawa) Department
of Cardiology, Heart Institute of Japan, Tokyo Women's Medical University,
8-1, Kawada-cho, Shinjuku, Tokyo 162-8666, Japan
(Nakao) Division of Cardiology, Cardiovascular Center, Saisei-Kai Kumamoto
Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto-shi, Kumamoto 861-4193, Japan
(Tobaru) Department of Cardiology, Sakakibara Heart Institute, 3-16-1
Asahi-cho, Fuchu-shi, Tokyo 183-0003, Japan
(Tanaka) Division of Cardiology, Tokyo Metropolitan Tama Medical Center,
2-8-29 Musashidai, Fuchu-shi, Tokyo 183-8524, Japan
(Oka) Department of Cardiology, Seirei Hamamatsu General Hospital, 2-12-12
Sumiyoshi, Naka-ku, Hamamatsu-shi, Shizuoka 430-8558, Japan
(Endoh) Department of Cardiology, Saisei-Kai Kurihashi Hospital, 714-6
Kouemon, Kuki-shi, Saitama 349-1105, Japan
(Saito) Department of Cardiology, Nishiarai Heart Center, 1-12-8,
Nishiarai-honcho, Adachi-Ku, Tokyo 123-0845, Japan
(Uchida) Department of Cardiology, Cardiovascular Center of Sendai, 1-6-12
Izumichuo, Izumi-ku, Sendai-shi, Miyagi 981-3133, Japan
(Matsui) Department of General and Community Medicine, Kumamoto University
Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
Title
Low-density lipoprotein cholesterol targeting with pitavastatin 1
ezetimibe for patients with acute coronary syndrome and dyslipidaemia: The
HIJ-PROPER study, a prospective, open-label, randomized trial.
Source
European Heart Journal. 38 (29) (pp 2264-2275), 2017. Date of Publication:
01 Aug 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims To elucidate the effects of intensive LDL-C lowering treatment with a
standard dose of statin and ezetimibe in patients with dyslipidaemia and
high risk of coronary events, targeting LDL-C less than 70 mg/dL (1.8
mmol/L), compared with standard LDL-C lowering lipid monotherapy targeting
less than 100 mg/dL (2.6 mmol/L). Methods and results The HIJ-PROPER study
is a prospective, randomized, open-label trial to assess whether intensive
LDL-C lowering with standard-dose pitavastatin plus ezetimibe reduces
cardiovascular events more than standard LDL-C lowering with pitavastatin
monotherapy in patients with acute coronary syndrome (ACS) and
dyslipidaemia. Patients were randomized to intensive lowering (target
LDL-C < 70 mg/dL [1.8mmol/L]; pitavastatin plus ezetimibe) or standard
lowering (target LDL-C 90 mg/dL to 100 mg/dL [2.3-2.6mmol/L]; pitavastatin
monotherapy). The primary endpoint was a composite of all-cause death,
non-fatal myocardial infarction, non-fatal stroke, unstable angina, and
ischaemiadriven revascularization. Between January 2010 and April 2013,
1734 patients were enroled at 19 hospitals in Japan. Patients were
followed for at least 36months. Median follow-up was 3.86 years. Mean
follow-up LDL-C was 65.1 mg/dL (1.68mmol/L) for pitavastatin plus
ezetimibe and 84.6 mg/dL (2.19mmol/L) for pitavastatin monotherapy. LDL-C
lowering with statin plus ezetimibe did not reduce primary endpoint
occurrence in comparison with standard statin monotherapy (283/864, 32.8%
vs. 316/857, 36.9%; HR 0.89, 95% CI 0.76-1.04, P = 0.152). In, ACS
patients with higher cholesterol absorption, represented by elevated
pre-treatment sitosterol, was associated with significantly lower
incidence of the primary endpoint in the statin plus ezetimibe group (HR
0.71, 95% CI 0.56-0.91).<br/>Copyright &#xa9; The Author 2016.

<24>
Accession Number
616233070
Author
Mahboobi S.K.
Institution
(Mahboobi) Department of Anesthesiology, Lahey Hospital and Medical
Center, Burlington, MA, United States
Title
Dexmedetomidine and Renal Protection after Cardiac Surgery.
Source
Journal of Clinical Anesthesia. 40 (pp 121-122), 2017. Date of
Publication: August 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)

<25>
[Use Link to view the full text]
Accession Number
614665368
Author
Hoechter D.J.; Shen Y.-M.; Kammerer T.; Gunther S.; Weig T.; Schramm R.;
Hagl C.; Born F.; Meiser B.; Preissler G.; Winter H.; Czerner S.; Zwissler
B.; Mansmann U.U.; Von Dossow V.
Institution
(Hoechter, Kammerer, Weig, Czerner, Zwissler, Von Dossow) Department of
Anesthesiology, University Hospital, Ludwig-Maximilians-University (LMU),
Marchioninistr. 15, Munich D-81377, Germany
(Shen, Mansmann) Institute of Medical Biometry and Epidemiology,
Ludwig-Maximilians-University (LMU), Munich, Germany
(Gunther, Schramm, Hagl, Born) Clinic of Cardiac Surgery, University
Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
(Schramm, Meiser) Transplantation Center, University Hospital,
Ludwig-Maximilians-University (LMU), Munich, Germany
(Preissler, Winter) Department of General, Visceral, Transplant, Vascular
and Thoracic Surgery, University Hospital, Ludwig-Maximilians-University
(LMU), Munich, Germany
Title
Extracorporeal Circulation during Lung Transplantation Procedures: A
Meta-Analysis.
Source
ASAIO Journal. 63 (5) (pp 551-561), 2017. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Extracorporeal circulation (ECC) is an invaluable tool in lung
transplantation (lutx). More than the past years, an increasing number of
centers changed their standard for intraoperative ECC from cardiopulmonary
bypass (CPB) to extracorporeal membrane oxygenation (ECMO) - with
differing results. This meta-analysis reviews the existing evidence. An
online literature research on Medline, Embase, and PubMed has been
performed. Two persons independently judged the papers using the
ACROBAT-NRSI tool of the Cochrane collaboration. Meta-analyses and
meta-regressions were used to determine whether veno-arterial ECMO
(VA-ECMO) resulted in better outcomes compared with CPB. Six papers - all
observational studies without randomization - were included in the
analysis. All were considered to have serious bias caused by
heparinization as co-intervention. Forest plots showed a beneficial trend
of ECMO regarding blood transfusions (packed red blood cells (RBCs) with
an average mean difference of -0.46 units [95% CI = -3.72, 2.80],
fresh-frozen plasma with an average mean difference of -0.65 units [95% CI
= -1.56, 0.25], platelets with an average mean difference of -1.72 units
[95% CI = -3.67, 0.23]). Duration of ventilator support with an average
mean difference of -2.86 days [95% CI = -11.43, 5.71] and intensive care
unit (ICU) length of stay with an average mean difference of -4.79 days
[95% CI = -8.17, -1.41] were shorter in ECMO patients. Extracorporeal
membrane oxygenation treatment tended to be superior regarding 3 month
mortality (odds ratio = 0.46, 95% CI = 0.21-1.02) and 1 year mortality
(odds ratio = 0.65, 95% CI = 0.37-1.13). However, only the ICU length of
stay reached statistical significance. Meta-regression analyses showed
that heterogeneity across studies (sex, year of ECMO implementation, and
underlying disease) influenced differences. These data indicate a benefit
of the intraoperative use of ECMO as compared with CPB during lung
transplant procedures regarding short-term outcome (ICU stay). There was
no statistically significant effect regarding blood transfusion needs or
long-term outcome. The superiority of ECMO in lutx patients remains to be
determined in larger multi-center randomized trials.<br/>Copyright &#xa9;
2017 by the ASAIO.

<26>
Accession Number
366426156
Author
Zarani F.; Besharat M.A.; Sarami G.; Sadeghian S.
Institution
(Zarani) Department of Psychology, University of Tehran, Iran
Title
An information-motivation-behavioral skills (IMB) model-based intervention
for CABG patients.
Source
International journal of behavioral medicine. 19 (4) (pp 543-549), 2012.
Date of Publication: 01 Dec 2012.
Abstract
BACKGROUND: In order to benefit from a coronary artery bypass graft (CABG)
surgery, patients must adhere to medical recommendations and health
advices. Despite the importance of adherence in CABG patients, adherence
rates are disappointingly low. Despite the low adherence rates, very few
articles regarding adherence-enhancing intervention among heart patients
have been published.
PURPOSE: The goal of this study was to assess the effects of the
Information-Motivation-Behavioral Skills (IMB) model-based intervention on
the IMB model constructs among patients undergoing CABG and to evaluate
the relationship of information, motivation, and behavioral skills with
adherence.
METHOD: A total of 152 CABG patients were randomly assigned to either an
intervention group or to a standard care control group. Participants
completed pretest measures and were reassessed 1 month later.
RESULTS: Findings showed mixed support for the effectiveness of the
intervention. There was a significant effect of IMB intervention on
information and motivation of patients, but no significant effect on
behavioral skills. Furthermore, the results revealed that intervention
constructs (information, motivation, and behavioral skills) were
significantly related to patients' adherence.
CONCLUSIONS: Findings provided initial evidence for the effectiveness of
IMB-based interventions on the IMB constructs and supported the importance
of these constructs to improve adherence; however, there are additional
factors that need to be identified in order to improve behavioral skills
more effectively.

<27>
Accession Number
619091635
Author
Benstoem C.; Moza A.; Meybohm P.; Stoppe C.; Autschbach R.; Devane D.;
Goetzenich A.
Institution
(Benstoem, Moza, Autschbach, Goetzenich) Department of Thoracic and
Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
(Meybohm) Department of Anaesthesiology, Intensive Care and Pain Medicine,
University Hospital Frankfurt, Frankfurt am Main, Germany
(Stoppe) Department of Intensive Care Medicine, University Hospital RWTH
Aachen, Aachen, Germany
(Devane) Department of Nursing and Midwifery, National University of
Ireland Galway, School of Nursing and Midwifery, Galway, Ireland
Title
A core outcome set for adult cardiac surgery trials: A consensus study.
Source
PLoS ONE. 12 (11) (no pagination), 2017. Article Number: e0186772. Date of
Publication: November 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: Invasive off- or on-pump cardiac surgery (elective and
emergency procedures, excluding transplants are routinely performed to
treat complications of ischaemic heart disease. Randomised controlled
trials (RCT) evaluate the effectiveness of treatments in the setting of
cardiac surgery. However, the impact of RCTs is weakened by heterogeneity
in outcome measuring and reporting, which hinders comparison across
trials. Core outcome sets (COS, a set of outcomes that should be measured
and reported, as a minimum, in clinical trials for a specific clinical
field) help reduce this problem. In light of the above, we developed a COS
for cardiac surgery effectiveness trials. Methods: Potential core outcomes
were identified a priori by analysing data on 371 RCTs of 58,253 patients.
We reached consensus on core outcomes in an international three-round
eDelphi exercise. Outcomes for which at least 60% of the participants
chose the response option "no" and less than 20% chose the response option
"yes" were excluded. Results: Eighty-six participants from 23 different
countries involving adult cardiac patients, cardiac surgeons,
anaesthesiologists, nursing staff and researchers contributed to this
eDelphi. The panel reached consensus on four core outcomes: 1) Measure of
mortality, 2) Measure of quality of life, 3) Measure of hospitalisation
and 4) Measure of cerebrovascular complication to be included in adult
cardiac surgery trials. Conclusion: This study used robust research
methodology to develop a minimum core outcome set for clinical trials
evaluating the effectiveness of treatments in the setting of cardiac
surgery. As a next step, appropriate outcome measurement instruments have
to be selected.<br/>Copyright &#xa9; 2017 Benstoem 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.

<28>
Accession Number
619110208
Author
De Von H.A.; Vuckovic K.; Ryan C.J.; Barnason S.; Zerwic J.J.; Pozehl B.;
Schulz P.; Seo Y.; Zimmerman L.
Institution
(De Von, Vuckovic, Ryan, Zerwic) University of Illinois at Chicago,
College of Nursing, Chicago, IL, United States
(Barnason, Pozehl, Schulz, Seo, Zimmerman) University of Nebraska, College
of Nursing, Lincoln, NE, United States
Title
Systematic review of symptom clusters in cardiovascular disease.
Source
European Journal of Cardiovascular Nursing. 16 (1) (pp 6-17), 2017. Date
of Publication: 01 Jan 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Although individual symptoms and symptom trajectories for
various cardiovascular conditions have been reported, there is limited
research identifying the symptom clusters that may provide a better
understanding of patients' experiences with heart disease. Aims: To
summarize the state of the science in symptom cluster research for
patients with acute coronary syndrome, myocardial infarction, coronary
artery bypass surgery, and heart failure through systematic review and to
provide direction for the translation of symptom cluster research into the
clinical setting. Methods: Databases were searched for articles from
January 2000 through to May 2015 using MESH terms "symptoms, symptom
clusters, acute coronary syndrome (ACS), myocardial infarction (MI),
coronary heart disease (CHD), ischemic heart disease (IHD), heart failure
(HF), coronary artery bypass surgery (CABS), cluster analyses, and latent
classes." The search was limited to human studies, English language
articles, and original articles investigating symptom clusters in
individuals with heart disease. Fifteen studies meeting the criteria were
included. Results: For patients with ACS and MI, younger persons were more
likely to experience clusters with the most symptoms. Older adults were
more likely to experience clusters with the lowest number of symptoms and
more diffuse and milder symptom clusters that are less reflective of
classic ACS presentations. For HF patients, symptom clusters frequently
included physical and emotional/cognitive components; edema clustered in
only three studies. Symptom expression was congruent across geographical
regions and cultures. Conclusions: The findings demonstrated similarities
in symptom clusters during ACS, MI, and HF, despite multiple methods and
analyses. These results may help clinicians to prepare at-risk patients
for proper treatment-seeking and symptom self-management
behaviors.<br/>Copyright &#xa9; The European Society of Cardiology 2016.

<29>
Accession Number
619188996
Author
Tse G.; Gong M.; Wong S.H.; Wu W.K.K.; Bazoukis G.; Lampropoulos K.; Wong
W.T.; Xia Y.; Wong M.C.S.; Liu T.; Woo J.
Institution
(Tse, Wong, Woo) Department of Medicine and Therapeutics, Faculty of
Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's
Republic of China
(Tse, Wong, Wu) Li Ka Shing Institute of Health Sciences, Faculty of
Medicine, Chinese University of Hong Kong, Hong Kong, SAR, People's
Republic of China
(Gong, Liu) Tianjin Key Laboratory of Ionic-Molecular Function of
Cardiovascular disease, Department of Cardiology, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin,
People's Republic of China
(Wu) Department of Anaesthesia and Intensive Care, State Key Laboratory of
Digestive Disease, The Chinese University of Hong Kong, Hong Kong,
People's Republic of China
(Bazoukis, Lampropoulos) Second Department of Cardiology, Laboratory of
Cardiac Electrophysiology, Evangelismos General Hospital of Athens,
Athens, Greece
(Wong) School of Life Sciences, The Chinese University of Hong Kong, Hong
Kong, People's Republic of China
(Xia) Department of Cardiology, First Affiliated Hospital of Dalian
Medical University, Dalian, People's Republic of China
(Wong) JC School of Public Health and Primary Care, The Chinese University
of Hong Kong, Hong Kong, People's Republic of China
(Wong) State Key Laboratory of Digestive Disease, Chinese University of
Hong Kong
Title
Frailty and Clinical Outcomes in Advanced Heart Failure Patients
Undergoing Left Ventricular Assist Device Implantation: A Systematic
Review and Meta-analysis.
Source
Journal of the American Medical Directors Association. (no pagination),
2017. Date of Publication: 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: Frailty has been identified as a risk factor for adverse
clinical outcomes after cardiac intervention or surgery. However, whether
it increases the risk of adverse outcomes in patients undergoing left
ventricular assist device (LVAD) therapy has been controversial.
Therefore, we conducted a systematic review and meta-analysis of the
frailty measures and clinical outcomes of length of stay and mortality in
this setting. Methods: PubMed and Embase were searched until September 11,
2017, for studies evaluating the association between frailty and clinical
outcomes in advanced heart failure patients undergoing LVAD implantation.
Results: A total of 46 and 79 entries were retrieved from our search
strategy. A total of 13 studies involving 3435 patients were included in
the final meta-analysis (mean age: 57.7 +/- 15.3 years; 79% male,
follow-up duration was 13 +/- 14 months). Compared to nonfrail patients (n
= 2721), frail patients (n = 579) had significantly longer
time-to-extubation (n = 3; mean difference: 45 +/- 6 hours; I
²: 0%) and hospital length of stay (n = 4; mean difference: 2.9
+/- 1.2 days; P = .001; I ²: 21%). Frailty was not a predictor
of inpatient or short-term mortality [n = 3; hazard ratio (HR): 1.22, 95%
confidence interval (CI): 0.66-2.26; P > .05; I ²: 0%] but
predicted long-term mortality (n = 7; HR: 1.44, 95% CI: 1.15-1.80; P =
.001; I ²: 0%). Conclusions: Frailty leads to significantly
longer time to extubation, hospital length of stay, and long-term
mortality in advanced heart failure patients who have undergone LVAD
implantation. Older patients being considered for LVAD implantation should
therefore be assessed for frailty status. The risk and benefit of the
procedure should be explained to the patient, emphasizing that frailty
increases the likelihood of adverse clinical outcomes.<br/>Copyright
&#xa9; 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

<30>
Accession Number
619185339
Author
Bhavsar R.; Ryhammer P.K.; Greisen J.; Jakobsen C.-J.
Institution
(Bhavsar, Ryhammer, Greisen, Jakobsen) Department of Anaesthesiology and
Intensive Care, Aarhus University Hospital, Aarhus, Denmark
Title
Lower Dose of Sufentanil Does Not Enhance Fast Track Significantly-A
Randomized Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objective: Adjustment in the doses of opioids has been a focus of interest
for achieving better fast-track conditions in cardiac anesthesia, but
relatively sparse information exists on the potential effect of
psychologic and behavioral factors, such as stress, anxiety, and type of
personality, on anesthesia requirements and patient turnover in the
cardiac recovery unit (CRU); to the authors' knowledge, this particular
focus has not been systematically investigated. In this randomized study,
the authors tested the hypothesis that low-dose sufentanil, compared with
a standard dose, can improve fast-track parameters and the overall quality
of recovery. Opioid requirements related to personality type, pain
sensitivity, and preoperative stress and anxiety also were assessed.
Design: A randomized, prospective study. Participants: The study comprised
60 patients scheduled for elective coronary artery bypass grafting with or
without aortic valve replacement. Setting: A university hospital.
Interventions: Patients were randomly assigned to receive either a
standard dose (bolus 0.5 mug/kg) or low dose (bolus 0.25 mug/kg) of
sufentanil combined with propofol. Measurements and Main Results: The
primary outcome variables were ventilation time and eligible time to
discharge from the CRU. The secondary objective was to evaluate the
relationship between opioid requirements and personality type, pain
sensitivity, and preoperative stress and anxiety. The groups were
comparable in selected demographics and perioperative parameters. There
was no difference between groups in ventilation time (low dose: 191
[163-257] v standard dose: 205 [139-279] min; p = 0.405); eligible CRU
discharge time (10.3 +/- 5.0 v 10.3 +/- 4.2 h; p = 0.978); or
administration of postoperative morphine (25 [11-34) v 27 [10-39] g; p =
0.790). There was no difference between groups in total sufentanil
administration and various preoperative psychologic and behavioral test
levels nor in the time to reach bispectral index <50 during induction,
except that personality type A demonstrated a longer induction time of 10
(8-12) minutes versus 6 (4-8) minutes in low-score patients. Conclusion: A
lower dose of sufentanil, compared with a standard dose, does not enhance
fast-track conditions significantly.<br/>Copyright &#xa9; 2017 Elsevier
Inc.

<31>
Accession Number
619169404
Author
Thein P.M.; White K.; Banker K.; Lunny C.; Mirzaee S.; Nasis A.
Institution
(Thein) Department of Medicine, Monash Medical Centre, Monash Health,
Melbourne, Vic, Australia
(Thein, White, Banker) Monash University, School of Public Health and
Preventive Medicine, Melbourne, Vic, Australia
(Lunny) Department of Epidemiology and Preventive Medicine, School of
Public Health and Preventive Medicine, Cochrane Australia, Melbourne, Vic,
Australia
(Mirzaee, Nasis) MonashHeart, Monash Cardiovascular Research Centre,
Monash Health and Department of Medicine (MMC), Monash University,
Melbourne, Vic, Australia
Title
Preoperative Use of Oral Beta-Adrenergic Blocking Agents and the Incidence
of New-Onset Atrial Fibrillation After Cardiac Surgery. A Systematic
Review and Meta-Analysis.
Source
Heart Lung and Circulation. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier Ltd
Abstract
Background: Current epidemiological data suggests that postoperative
atrial fibrillation or atrial flutter (POAF) causes significant morbidity
and mortality after cardiac surgery. The literature for prophylactic
management of POAF is limited, resulting in the lack of clear guidelines
on management recommendations. Aim: To examine the efficacy of
prophylactic rate control agents in reducing the incidence of new-onset
POAF in patients undergoing elective cardiac surgery. Methods: Cochrane
Central Register of Controlled Trials (CENTRAL), Embase, and Medline were
systematically searched for blinded randomised controlled studies (RCT)
evaluating adults with no history of atrial fibrillation randomised to a
pharmacological agent (either beta blocker, calcium channel blocker or
digoxin), compared to placebo. Utilising Cochrane guidance, three
reviewers screened, extracted and the quality of the evidence was
assessed. We used a random effects meta-analysis to compare a rate-control
agent with placebo. Results: Five RCTs (688 subjects, mean age 61+/-8.9,
69% male) were included. Beta blocker administration prior to elective
cardiac surgery significantly reduced the incidence of POAF (OR 0.43,
95%Cl [0.30-0.61], I² =0%) without significant impact on
ischaemic stroke (OR 0.49, 95%Cl [0.10-2.44], I² =0%),
non-fatal myocardial infarction (OR 0.76, 95%Cl [0.08-7.44], I²
=0%), overall mortality (OR 0.83, 95%Cl [0.19-3.66], I² =0%),
or length of stay (mean -0.96days 95%Cl [-1.49 to -0.42], I²
=0%). An increased rate of bradycardic episodes was observed (OR 3.53,
95%Cl [1.22-10.23], I² =0%). Conclusions: This review suggests
that selective administration of prophylactic oral beta blockers prior to
elective cardiac surgery is safe and may reduce the incidence of
POAF.<br/>Copyright &#xa9; 2017 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ).

<32>
Accession Number
619048579
Author
Jones T.L.; McCabe J.M.
Title
Cardiovascular highlights from non-cardiology journals.
Source
Heart. 103 (19) (pp 1553), 2017. Date of Publication: October 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)

<33>
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.

<34>
Accession Number
619086026
Author
Gajulapalli R.D.; Dias S.; Pattanshetty D.J.; Athappan G.
Institution
(Gajulapalli) Department of Medicine, Cleveland Clinic, Cleveland, OH,
United States
(Dias) School of Social and Community Medicine, University of Bristol,
Bristol, United Kingdom
(Pattanshetty) Case Western University, Metro Health, Cleveland, OH,
United States
(Athappan) Department of Interventional Cardiology, Temple University
Hospital, Philadelphia-PA, United States
Title
Optimal duration of dual antiplatelet therapy after drug eluting stent
implantation: A network meta-analysis.
Source
Anatolian Journal of Cardiology. 18 (4) (pp 251-260), 2017. Date of
Publication: October 2017.
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: There has been much debate regarding the optimal duration of
dual antiplatelet therapy (DAPT) cover after drug eluting stent (DES)
implantation. We aimed to assess the relative benefits of shorter and
longer durations of DAPT coverage. Methods: We performed a network
meta-analysis (NMA) of all the randomized clinical trials (RCT) comparing
different time durations of DAPT cover. Results: We included 11 unique
trials with a total of 33,458 patients; the longest duration of follow-up
was 48 months and the shortest was 3 months. NMA results demonstrated that
compared with 12 months, longer DAPT of 30 months reduced the hazard ratio
(HR) of stent thrombosis (HR, 0.29; 95% CrI, 0.17-0.49). There was no
difference in mortality between shorter and longer durations of DAPT
except for 30 vs. 48 months (HR, 0.48; 95% CrI, 0.23-0.98). Compared with
12 months, longer DAPT of 30 months reduced the risk of myocardial
infarction (HR, 0.47; 95% CrI, 0.37-0.61). Results also demonstrated that
compared with 12 months, a shorter-term DAPT reduced the risk of major
bleeding (6 months: HR, 0.53; 95% CrI, 0.29-0.98), whereas longer-term
DAPT increased the risk of major bleeding (30 months: HR, 1.61; 95% CrI,
1.21-2.15). Conclusion: As expected, bleeding was less in the shorter
duration regimens, whereas the ischemic outcomes were better in the longer
duration ones.<br/>Copyright &#xa9; 2017 by Turkish Society of Cardiology.

<35>
Accession Number
619083017
Author
Castano A.; Narotsky D.L.; Hamid N.; Khalique O.K.; Morgenstern R.; DeLuca
A.; Rubin J.; Chiuzan C.; Nazif T.; Vahl T.; George I.; Kodali S.; Leon
M.B.; Hahn R.; Bokhari S.; Maurer M.S.
Institution
(Castano, Narotsky, Rubin, Maurer) Division of Cardiology, Center for
Advanced Cardiac Care, Columbia University Medical Center, 622 W 168 St,
New York, NY 10032, United States
(Castano, Morgenstern, DeLuca, Bokhari) Division of Cardiology, Department
of Internal Medicine, Columbia University Medical Center, 622 W 168th St,
New York, NY 10032, United States
(Hamid, Khalique, Nazif, Vahl, George, Kodali, Leon, Hahn) Division of
Cardiology, Department of Internal Medicine, Columbia University Medical
Center, 173 Fort Washington Ave, New York, NY 10032, United States
(Chiuzan) Department of Biostatistics, Columbia University, Mailman School
of Public Health, 722 West 168th Street, New York, NY 10032, United States
Title
Unveiling transthyretin cardiac amyloidosis and its predictors among
elderly patients with severe aortic stenosis undergoing transcatheter
aortic valve replacement.
Source
European Heart Journal. 38 (38) (pp 2879-2887), 2017. Date of Publication:
07 Oct 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims Transthyretin cardiac amyloidosis (ATTR-CA) has been reported in
patients with aortic stenosis (AS) but its prevalence and phenotype are
not known. We examine elderly patients with severe symptomatic AS
undergoing transcatheter aortic valve replacement (TAVR) and determine the
prevalence and phenotype of ATTR-CA non-invasively. Methods and results We
performed technetium-99m pyrophosphate (^99mTc-PYP) cardiac
scintigraphy prospectively on patients who underwent TAVR, to screen for
ATTR-CA. Transthoracic echocardiography and speckle-strain imaging were
performed. We assessed the association of several parameters with ATTR-CA
using multivariable logistic regression and constructed receiver operating
curves to evaluate the best predictors of ATTR-CA. Among 151 patients
(mean age 84 +/- 6 years, 68% men), 16% (n = 24) screened positive for
ATTR-CA with ^99mTc-PYP scintigraphy. Compared with patients
without ATTR-CA, ATTR-CA patients had a thicker interventricular septum
(1.3 vs. 1.1 cm, P = 0.007), higher left ventricular (LV) mass index (130
vs. 98 g/m², P = 0.002), and lower stroke volume index (30 vs.
36 mL/m², P = 0.009). ATTR-CA patients had advanced diastolic
dysfunction with higher E/A ratio (2.3 vs. 0.9, P = 0.001) and lower
deceleration time (176 vs. 257 ms, P < 0.0001); impairment in systolic
function with lower ejection fraction (48% vs. 56%, P = 0.011), myocardial
contraction fraction (26 vs. 41, P < 0.0001), and average of lateral and
septal mitral annular tissue Doppler S' (4.0 vs. 6.6 cm/s, P < 0.0001).
While ATTR-CA patients had more impaired global longitudinal strain (-12
vs. -16%, P = 0.007), relative apical longitudinal strain was the same
regardless of ATTR-CA diagnosis (0.98 vs. 0.98, P = 0.991). Average S'
best predicted ATTR-CA in multivariable logistic regression (odds ratio
16.67 per 1 cm/s decrease with AUC 0.96, 95% confidence interval
0.90-0.99, P = 0.002) with a value <=6 conferring 100% sensitivity for
predicting a positive ^99mTc-PYP amyloid scan. Conclusions
Transthyretin cardiac amyloidosis is prevalent in 16% of patients with
severe calcific AS undergoing TAVR and is associated with a severe AS
phenotype of low-flow low-gradient with mildly reduced ejection fraction.
Average tissue Doppler mitral annular S' of < 6 cm/s may be a sensitive
measure that should prompt a confirmatory ^99mTc-PYP scan and
subsequent testing for ATTR-CA. Prospective assessment of outcomes after
TAVR is needed in patients with and without ATTR-CA.<br/>Copyright &#xa9;
The Author 2016.

<36>
Accession Number
619081466
Author
Davidson J.A.; Urban T.T.; Baird C.; Tong S.; Woodruff A.; Twite M.;
Jaggers J.; Simoes E.A.F.; Wischmeyer P.
Institution
(Davidson, Baird, Simoes) Department of Pediatrics, Children's Hospital
Colorado/University of Colorado, Denver, Aurora CO, United States
(Urban) Research Institute, Children's Hospital Colorado, Aurora, CO,
United States
(Tong) Department of Biostatistics, University of Colorado, Denver,
Aurora, CO, United States
(Woodruff) Division of Pediatric Critical Care Medicine, Boston Children's
Hospital, Department of Anesthesia, Boston, MA, United States
(Woodruff) Harvard Medical School, Boston, MA, United States
(Twite) Department of Anesthesiology, Children's Hospital
Colorado/University of Colorado, Denver, Aurora CO, United States
(Jaggers) Department of Surgery, Children's Hospital Colorado/University
of Colorado, Denver, Aurora CO, United States
(Wischmeyer) Department of Anesthesiology, Duke University, Durham, NC,
United States
Title
Alkaline Phosphatase in Infant Cardiopulmonary Bypass: Kinetics and
Relationship to Organ Injury and Major Cardiovascular Events.
Source
Journal of Pediatrics. 190 (pp 49-55.e2), 2017. Date of Publication:
November 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives To determine the kinetics of alkaline phosphatase (AP) activity
and concentration after infant cardiopulmonary bypass, including
isoform-specific changes, and to measure the association between
postoperative AP activity and major postoperative cardiovascular events,
organ injury/dysfunction, and postoperative support requirements Study
design Prospective cohort study of 120 infants <=120 days of age
undergoing cardiopulmonary bypass. AP total and isoform-specific activity
was assessed at 6 time points (preoperation, rewarming, 6, 24, 48, and 72
hours postoperation). Low AP activity was defined as <=80 U/L. AP
concentrations and biomarkers of organ injury/dysfunction were collected
through 24 hours postoperation. Major cardiovascular events were defined
as cardiac arrest, mechanical circulatory support, or death. Results AP
activity loss occurred primarily during the operation (median decrease 89
U/L; P <.0001) secondary to decreased bone and liver 2 isoforms. Activity
declined through 24 hours in 27% of patients. AP activity strongly
correlated with serum concentration (r = 0.87-0.91; P <.0001). Persistent
low AP activity at 72 hours was associated independently with occurrence
of a major cardiac event (OR 5.6; P <.05). Early AP activity was
associated independently with subsequent vasoactive-inotropic score (P
<.001), peak lactate (P <.0001), peak creatinine (P <.0005), N-terminal
pro-brain natriuretic peptide (P <.05), and intestinal fatty acid binding
protein (P <.005). Conclusions AP activity decreases during infant
cardiopulmonary bypass and may continue to decrease for 24 hours. Activity
loss is secondary to decreased bone and liver 2 isoform concentrations.
Early low AP activity is associated independently with subsequent
postoperative support and organ injury/dysfunction, and persistence of AP
activity <=80 U/L at 72 hours is associated independently with increased
odds of major cardiovascular events.<br/>Copyright &#xa9; 2017 Elsevier
Inc.

<37>
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

<38>
Accession Number
619051523
Author
Hansen R.; Frydland M.; Moller-Helgestad O.K.; Lindholm M.G.; Jensen L.O.;
Holmvang L.; Ravn H.B.; Kjaergaard J.; Hassager C.; Moller J.E.
Institution
(Hansen, Moller-Helgestad, Jensen, Holmvang, Moller) Department of
Cardiology, Odense University Hospital, Sdr Boulevard 29, Odense C
DK-5000, Denmark
(Frydland, Lindholm, Ravn, Kjaergaard, Hassager) The Heart Center,
Copenhagen University Hospital Rigshospitalet, Blegdamsvej, Copenhagen
DK-2100, Denmark
Title
Association between QRS duration on prehospital ECG and mortality in
patients with suspected STEMI.
Source
International Journal of Cardiology. 249 (pp 55-60), 2017. Date of
Publication: 15 Dec 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background QRS duration has previously shown association with mortality in
patients with acute myocardial infarction treated with thrombolytics, less
is known in patients with suspected ST segment elevation myocardial
infarction (STEMI) when assessing QRS duration on prehospital ECG. Thus,
the objective was to investigate the prognostic effect of QRS duration on
prehospital ECG and presence of classic left and right bundle branch block
(LBBB/RBBB) for all-cause mortality in patients with suspected STEMI.
Method In total 2105 consecutive patients (mean age 64 +/- 13 years, 72%
men) with suspected STEMI were prospectively included. QRS duration was
registered from automated QRS measurement on prehospital ECG and patients
were divided according to quartiles of QRS duration (< 89 ms, 89-98 ms,
99-111 ms and > 111 ms). Primary endpoint was all-cause 30-day mortality.
Predictors of all-cause mortality were assessed using Cox proportional
hazards analysis. Results Among all patients median QRS duration was 98 ms
(IQR 88-112 ms). RBBB-morphology was seen in 126 patients (6.0%) and LBBB
in 88 patients (4.2%), 80% were treated with percutaneous coronary
intervention and the final diagnosis was STEMI in 1777 patients (84%).
Thirty-day mortality was 7.6% in patients with suspected STEMI. In
multivariable analysis, QRS duration > 111 ms (hazard ratio (HR) 3.08; 95%
confidence interval (CI): 1.71-5.57, p = 0.0002), LBBB - morphology (HR
3.0; 95% CI: 1.38-6.53, p = 0.006) and RBBB (HR 3.68; 95% CI: 1.95-6.95, p
< 0.0001) were associated with 30 day all-cause mortality. Conclusion In
patients with suspected STEMI, QRS prolongation, LBBB, and RBBB on
prehospital ECG are associated with increased risk of death.<br/>Copyright
&#xa9; 2017 Elsevier B.V.

<39>
Accession Number
619075443
Author
Chang H.-M.; Okwuosa T.M.; Scarabelli T.; Moudgil R.; Yeh E.T.H.
Institution
(Chang, Yeh) Center for Precision Medicine, Department of Medicine,
University of Missouri, Columbia, Missouri, United States
(Okwuosa) Division of Cardiology, Rush University Medical Center, Chicago,
Illinois, United States
(Scarabelli) Division of Cardiology, Virginia Common Wealth University,
Richmond, Virginia, United States
(Moudgil) Department of Cardiology, University of Texas, MD Anderson
Cancer Center, Houston, Texas, United States
Title
Cardiovascular Complications of Cancer Therapy: Best Practices in
Diagnosis, Prevention, and Management: Part 2.
Source
Journal of the American College of Cardiology. 70 (20) (pp 2552-2565),
2017. Date of Publication: 14 - 21 November 2017.
Publisher
Elsevier USA
Abstract
In this second part of a 2-part review, we will review cancer or cancer
therapy-associated systemic and pulmonary hypertension, QT prolongation,
arrhythmias, pericardial disease, and radiation-induced cardiotoxicity.
This review is based on a MEDLINE search of published data, published
clinical guidelines, and best practices in major cancer centers. Newly
developed targeted therapy can exert off-target effects causing
hypertension, thromboembolism, QT prolongation, and atrial fibrillation.
Radiation therapy often accelerates atherosclerosis. Furthermore,
radiation can damage the heart valves, the conduction system, and
pericardium, which may take years to manifest clinically. Management of
pericardial disease in cancer patients also posed clinical challenges.
This review highlights the unique opportunity of caring for cancer
patients with heart problems caused by cancer or cancer therapy. It is an
invitation to action for cardiologists to become familiar with this
emerging subspecialty.<br/>Copyright &#xa9; 2017 American College of
Cardiology Foundation

<40>
Accession Number
619071570
Author
Socha M.; Wronecki K.; Sobiech K.A.
Institution
(Socha, Sobiech) Department of Human Biology, Faculty of Physiotherapy,
University School of Physical Education, Wroclaw, Poland
(Wronecki) Faculty of Physical Education and Physiotherapy, University of
Technology, Opole, Poland
Title
Gender and age-dependent differences in body composition changes in
response to cardiac rehabilitation exercise training in patients after
coronary artery bypass grafting.
Source
Annals of Agricultural and Environmental Medicine. 24 (3) (pp 517-521),
2017. Date of Publication: 2017.
Publisher
Institute of Agricultural Medicine (E-mail: aaem@galen.imw.lublin.pl)
Abstract
Cardiac rehabilitation (CR) is the standard procedure in persons after
coronary artery bypass grafting (CABG). Its basic aim is to combat
coronary heart disease (CHD) risk factors through physical activity and
normalization of body mass. Many authors highlight the differences in
response to training in CR as dependent on gender, age and occurrence of
accompanying disease. The aim of this study is to assess the effectiveness
of a three-week early CR in reference to changing body composition
parameters in patients over 50 years of age. The study involved a random
group of 65 patients (44 men and 21 women) between the ages of 50-76
(average: 62.6 +/- 7.2) years with CHD following CABG. Anthropometric and
body composition (bioelectrical impedance method) measurements were taken
at the commencement of CR and after the training programme. After CR, body
mass and body mass index were reduced in men < 65 and >= 65 years, and in
women < 65 years. A reduction % body fat and increase % fat free mass and
% total body water was observed only in patients < 65. years. Furthermore,
in men < 65 years, an increase in % body cell mass was observed. In women
>= 65 years, no statistically significant changes were observed in body
fat indices and body composition features between initial and final study.
Patients >= 65 years of age following surgery over a period of hospital
cardiac rehabilitation do not experience the same significant improvement
in body composition parameters associated with risk of CHD as middle-aged
adults. Older women post-cardiac surgery are characterized by a higher
disability index in relation to tolerance to physical stress in comparison
with men of the same age and persons < 65 years of age.<br/>Copyright
&#xa9; 2017, Institute of Agricultural Medicine. All rights reserved.

<41>
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.

<42>
[Use Link to view the full text]
Accession Number
614538458
Author
Chen S.-L.; Santoso T.; Zhang J.-J.; Ye F.; Xu Y.-W.; Fu Q.; Kan J.; Zhang
F.-F.; Zhou Y.; Xie D.-J.; Kwan T.W.
Institution
(Chen, Zhang, Ye, Kan, Zhang) Division of Cardiology, Nanjing First
Hospital, Nanjing Medical University, 68 Changle Rd, Nanjing 210006, China
(Santoso) Division of Cardiology, Medistra Hospital, University of
Indonesia Medical School, Jakarta, Indonesia
(Xu) Division of Cardiology, Shanghai 10th People's Hospital, China
(Fu) Division of Cardiology, Xuzhou Central Hospital, China
(Zhou) Division of Cardiology, Zhangjiagang People's Hospital, China
(Xie) Division of Cardiology, Huainan Xinhua Hospital, China
(Kwan) Division of Cardiology, Beth Israel Hospital, New York, NY, United
States
Title
Clinical Outcome of Double Kissing Crush Versus Provisional Stenting of
Coronary Artery Bifurcation Lesions.
Source
Circulation: Cardiovascular Interventions. 10 (2) (no pagination), 2017.
Article Number: e004497. Date of Publication: 01 Feb 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Provisional stenting is effective for anatomic simple
bifurcation lesions. Double kissing crush stenting reduces the 1-year rate
of target lesion revascularization. This study aimed to investigate the
5-year clinical results of the DKCRUSH-II study (Randomized Study on
Double Kissing Crush Technique Versus Provisional Stenting Technique for
Coronary Artery Bifurcation Lesions). Methods and Results - A total of 370
patients with coronary bifurcation lesions who were randomly assigned to
either the double kissing crush or provisional stenting group in the
DKCRUSH-II study were followed for 5 years. The primary end point was the
occurrence of a major adverse cardiac event at 5 years. Patients were
classified by simple and complex bifurcation lesions according to the
DEFINITION criteria (Definitions and Impact of Complex Bifurcation Lesions
on Clinical Outcomes After Percutaneous Coronary Intervention Using
Drug-Eluting Stents). At 5 years, the major adverse cardiac event rate
(23.8%) in the provisional stenting group was insignificantly different to
that of the double kissing group (15.7%; P=0.051). However, the difference
in the target lesion revascularization rate between 2 groups was sustained
through the 5-year follow-up (16.2% versus 8.6%; P=0.027). The definite
and probable stent thrombosis rate was 2.7% in each group (P=1.0). Complex
bifurcation was associated with a higher rate of target lesion
revascularization (21.6%) at 5 years compared with 11.1% in patients with
a simple bifurcation (P=0.037), with an extremely high rate in the
provisional stenting group (36.8% versus 12.5%, P=0.005) mainly because of
final kissing balloon inflation (19.4% versus 5.2%; P=0.036). Conclusions
- The double kissing crush stenting technique for coronary bifurcation
lesions is associated with a lower rate of target lesion
revascularization. The optimal stenting approach based on the lesions'
complexity may improve the revascularization for patients with complex
bifurcations. Clinical Trial Registration - URL: http://www.chictr.org.
Unique identifier: ChiCTR-TRC-0000015.<br/>Copyright &#xa9; 2017 The
Authors.

<43>
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.

<44>
Accession Number
615299064
Author
Doenst T.; Essa Y.; Jacoub K.; Moschovas A.; Gonzalez-Lopez D.; Kirov H.;
Diab M.; Bargenda S.; Faerber G.
Institution
(Doenst, Essa, Jacoub, Moschovas, Gonzalez-Lopez, Kirov, Diab, Bargenda,
Faerber) Department of Cardiothoracic Surgery,
Friedrich-Schiller-University of Jena, Am Klinikum 1, Jena 07747, Germany
Title
Cardiac surgery 2016 reviewed.
Source
Clinical Research in Cardiology. 106 (11) (pp 851-867), 2017. Date of
Publication: 01 Nov 2017.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
For the year 2016, more than 20,000 published references can be found in
Pubmed when entering the search term "cardiac surgery". Publications last
year have helped to more clearly delineate the fields where classic
surgery and modern interventional techniques overlap. The field of
coronary bypass surgery (partially compared to percutaneous coronary
intervention) was enriched by five large prospective randomized trials.
The value of CABG for complex coronary disease was reconfirmed and for
less complex main stem lesions, PCI was found potentially equal. For
aortic valve treatment, more evidence was presented for the superiority of
transcatheter aortic valve implantation for patients with intermediate
risk. However, the 2016 evidence argued against the liberal expansion to
the low-risk field, where conventional aortic valve replacement still
appears superior. For the mitral valve, many publications emphasized the
significant impact of mitral valve reconstruction on survival in
structural mitral regurgitation. In addition, there were many relevant and
other interesting contributions from the purely operative arena in the
fields of coronary revascularization, surgical treatment of valve disease,
terminal heart failure (i.e., transplantation and ventricular assist
devices), and aortic surgery. While this article attempts to summarize the
most pertinent publications it does not have the expectation of being
complete and cannot be free of individual interpretation. As in recent
years, it provides a condensed summary that is intended to give the reader
"solid ground" for up-to-date decision-making in cardiac
surgery.<br/>Copyright &#xa9; 2017, Springer-Verlag Berlin Heidelberg.

<45>
Accession Number
614533311
Author
Rafiq S.; Johansson P.I.; Kofoed K.F.; Lund J.T.; Olsen P.S.; Bentsen S.;
Steinbruchel D.A.
Institution
(Rafiq, Lund, Olsen, Bentsen, Steinbruchel) Department of Cardiothoracic
Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital,
Copenhagen, Denmark
(Johansson) Capital Region Blood Bank, Section for Transfusion Medicine,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Kofoed) Department of Cardiology, The Heart Centre, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Denmark
Title
Thrombelastographic hypercoagulability and antiplatelet therapy after
coronary artery bypass surgery (TEG-CABG trial): a randomized controlled
trial.
Source
Platelets. 28 (8) (pp 786-793), 2017. Date of Publication: 17 Nov 2017.
Publisher
Taylor and Francis Ltd (E-mail: healthcare.enquiries@informa.com)
Abstract
A hypercoagulable state has, in observational studies, been associated
with increased risk of thromboembolic events. The aim of this trial was to
study whether dual antiplatelet therapy (DAPT) with clopidogrel in
addition to aspirin could reduce the rate of graft occlusions,
thromboembolic events, and death compared to aspirin monotherapy in
hypercoagulable patients undergoing coronary artery bypass surgery. A
total of 1683 patients were screened for eligibility, among which 165
patients were randomized and 133 patients underwent multislice computed
tomography scan to evaluate their grafts. Thrombelastography (TEG) and
multiplate aggregometry were performed before and after surgery, and again
at three months follow up. TEG hypercoagulability was defined as the
maximum amplitude above 69 mm. At three months follow up, 17 out of 66
(25.7%) DAPT patients and 15 of 67 (22.4%) aspirin patients had
significant graft stenosis or occlusions (p = 0.839). Saphenous vein
grafts (SVGs) were stenosed or occluded in 15 (22.7%) patients in the DAPT
group and 7 (10.4%) in the aspirin group (p = 0.167). Thromboembolic
events and death after the second postoperative day (when clopidogrel was
started) were numerically, but not statistically, lower in the DAPT group,
3 (3.8%) vs. 8 (9.9%), p = 0.211. In univariate logistic regression
analysis, only postoperative day 4 platelet response to aspirin measured
with multiplate was correlated with graft occlusion, OR 1.020
[1.002-1.039], p = 0.033. This is the first trial to test the hypothesis
of intensified antiplatelet therapy in hypercoagulable patients. Due to
the low enrollment and high loss to follow up, our results can only be
viewed as hypothesis generating. We found a high rate of graft occlusions
in this patient population. Our results were not suggestive of that DAPT
improved saphenous vein graft patency. A trend was observed in patients on
DAPT toward fewer MI and deaths. Postoperative response to aspirin therapy
was found to be associated with early SVG occlusion.<br/>Copyright &#xa9;
2017 Taylor & Francis.

<46>
Accession Number
619089770
Author
Koo H.-K.; Lawrence K.A.; Musini V.M.
Institution
(Koo) University of British Columbia, 217-2176 Health Sciences Mall,
Vancouver, BC V6T 1Z3, Canada
(Lawrence) University of Utah, Population Health Sciences, Salt Lake City,
UT, United States
(Musini) University of British Columbia, Department of Anesthesiology,
Pharmacology and Therapeutics, 2176 Health Science Mall, Vancouver, BC V6T
1Z3, Canada
Title
Beta-blockers for preventing aortic dissection in Marfan syndrome.
Source
Cochrane Database of Systematic Reviews. 2017 (11) (no pagination), 2017.
Article Number: CD011103. Date of Publication: 07 Nov 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Marfan syndrome is a hereditary disorder affecting the
connective tissue and is caused by a mutation of the fibrillin-1 (FBN1)
gene. It affects multiple systems of the body, most notably the
cardiovascular, ocular, skeletal, dural and pulmonary systems. Aortic root
dilatation is the most frequent cardiovascular manifestation and its
complications, including aortic regurgitation, dissection and rupture are
the main cause of morbidity and mortality. Objectives: To assess the
long-term efficacy and safety of beta-blocker therapy as compared to
placebo, no treatment or surveillance only in people with Marfan syndrome.
Search methods: We searched the following databases on 28 June 2017;
CENTRAL, MEDLINE, Embase, Science Citation Index Expanded and the
Conference Proceeding Citation Index - Science in the Web of Science Core
Collection. We also searched the Online Metabolic and Molecular Bases of
Inherited Disease (OMMBID), ClinicalTrials.gov and the World Health
Organization (WHO) International Clinical Trials Registry Platform (ICTRP)
on 30 June 2017. We did not impose any restriction on language of
publication. Selection criteria: All randomised controlled trials (RCTs)
of at least one year in duration assessing the effects of beta-blocker
monotherapy compared with placebo, no treatment or surveillance only, in
people of all ages with a confirmed diagnosis of Marfan syndrome were
eligible for inclusion. Data collection and analysis: Two review authors
independently screened titles and abstracts for inclusion, extracted data
and assessed trial quality. Trial authors were contacted to obtain missing
data. Dichotomous outcomes will be reported as relative risk and
continuous outcomes as mean differences with 95% confidence intervals. We
assessed the quality of evidence using the Grading of Recommendations
Assessment, Development and Evaluation (GRADE) approach. Main results: One
open-label, randomised, single-centre trial including 70 participants with
Marfan syndrome (aged 12 to 50 years old) met the inclusion criteria.
Participants were randomly assigned to propranolol (N = 32) or no
treatment (N = 38) for an average duration of 9.3 years in the control
group and 10.7 years in the treatment group. The initial dose of
propranolol was 10 mg four times daily and the optimal dose was reached
when the heart rate remained below 100 beats per minute during exercise or
the systolic time interval increased by 30%. The mean (+/- standard error
(SE)) optimal dose of propranolol was 212 +/- 68 mg given in four divided
doses daily. Beta-blocker therapy did not reduce the incidence of
all-cause mortality (RR 0.24, 95% CI 0.01 to 4.75; participants = 70;
low-quality evidence). Mortality attributed to Marfan syndrome was not
reported. Non-fatal serious adverse events were also not reported.
However, study authors report on pre-defined, non-fatal clinical
endpoints, which include aortic dissection, aortic regurgitation,
cardiovascular surgery and congestive heart failure. Their analysis showed
no difference between the treatment and control groups in these outcomes
(RR 0.79, 95% CI 0.37 to 1.69; participants = 70; low-quality evidence).
Beta-blocker therapy did not reduce the incidence of aortic dissection (RR
0.59, 95% CI 0.12 to 3.03), aortic regurgitation (RR 1.19, 95% CI 0.18 to
7.96), congestive heart failure (RR 1.19, 95% CI 0.18 to 7.96) or
cardiovascular surgery, (RR 0.59, 95% CI 0.12 to 3.03); participants = 70;
low-quality evidence. The study reports a reduced rate of aortic
dilatation measured by M-mode echocardiography in the treatment group
(aortic ratio mean slope: 0.084 (control) vs 0.023 (treatment), P <
0.001). The change in systolic and diastolic blood pressure, total adverse
events and withdrawal due to adverse events were not reported in the
treatment or control group at study end point. We judged this study to be
at high risk of selection (allocation concealment) bias, performance bias,
detection bias, attrition bias and selective reporting bias. The overall
quality of evidence was low. We do not know whether a statistically
significant reduced rate of aortic dilatation translates into clinical
benefit in terms of aortic dissection or mortality. Authors' conclusions:
Based on only one, low-quality RCT comparing long-term propranolol to no
treatment in people with Marfan syndrome, we could draw no definitive
conclusions for clinical practice. High-quality, randomised trials are
needed to evaluate the long-term efficacy of beta-blocker treatment in
people with Marfan syndrome. Future trials should report on all clinically
relevant end points and adverse events to evaluate benefit versus harm of
therapy.<br/>Copyright &#xa9; 2017 The Cochrane Collaboration. Published
by John Wiley & Sons, Ltd.

<47>
Accession Number
619152530
Author
Antonic M.
Institution
(Antonic) Department of Cardiac Surgery, University Medical Centre
Maribor, Ljubljanska ulica 5, Maribor SI-2000, Slovenia
Title
Effect of ascorbic acid on postoperative acute kidney injury in coronary
artery bypass graft patients: A pilot study.
Source
Heart Surgery Forum. 20 (5) (pp E214-E218), 2017. Date of Publication:
October 2017.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Background: Even minor postoperative reductions in renal function
influence the outcome of cardiac surgery. The mechanisms of postoperative
renal injury in cardiac surgery are multifactorial and include
ischemia-reperfusion injury. The study investigates the effect of the
antioxidant ascorbic acid on the postoperative acute kidney injury after
elective CABG surgery. Methods: A prospective randomized single-center
trial was conducted in on-pump coronary artery bypass patients. The
patients in the ascorbic acid group received 2 grams of ascorbic acid 24
hours and 2 hours preoperatively and 1 gram twice daily five days after
the surgery. Postoperatively, the subjects were monitored for renal
dysfunction and other complications. Results: 100 patients were included,
with 50 patients in each study group. The groups were well matched for
baseline demographics, preoperative medications, comorbidities, and had
similar intraoperative characteristics. The incidence of postoperative
acute kidney injury in the ascorbic acid group was 16% and 14% in the
control group (P = .779). The groups also did not differ in peak
postoperative serum creatinine (83 [33] mumol/L versus 83 [39] mumol/L; P
= .434), the lowest postoperative creatinine clearance (96.40 +/- 35.78
mL/min versus 90.89 +/- 36.18 mL/min; P = .766), and time from surgery to
the onset of peak postoperative serum creatinine (1.64 +/- 1.34 days
versus 1.92 +/- 1.54 days; P = .393). There was no dialysis required in
any patient. Conclusion: The results of this study did not demonstrate a
significant protective effect of ascorbic acid on the incidence of
postoperative acute renal injury in elective onpump CABG
patients.<br/>Copyright &#xa9; 2017 Forum Multimedia Publishing, LLC.

<48>
Accession Number
619142116
Author
Patel S.V.; Sonani R.; Singh V.; Patel P.; Badheka A.
Institution
(Patel) Department of Medicine, Sparks Health Systems, Fort Smith, AR,
United States
(Sonani) Department of Medicine, Brandon Regional Hospital, Brandon, FL,
United States
(Singh) Massachusetts General Hospital, Harvard School of Medicine, MA,
United States
(Patel) Department of Health Sciences, Massachusetts College of Pharmacy
and Health sciences, MA, United States
(Badheka) Department of Cardiology, Everett Clinic, WA, United States
Title
Outcomes of transcatheter aortic valve replacement for bicuspid aortic
stenosis-a systematic review of existing literature.
Source
Expert Review of Pharmacoeconomics and Outcomes Research. 17 (6) (pp
579-585), 2017. Date of Publication: 02 Nov 2017.
Publisher
Taylor and Francis Ltd (E-mail: info@expert-reviews.com)
Abstract
Introduction: Patients with bicuspid aortic valve (BAV) have traditionally
been excluded from large randomized clinical trials involving
transcatheter aortic valve replacements (TAVR). Technical enhancements,
availability of new generation devices and improved outcomes have led to a
marked increase in TAVR volume across the world including off label use in
patients with BAV stenosis. Areas covered: In this manuscript, we have
reviewed the currently available data regarding safety, efficacy, and
outcomes of TAVR in patients with BAV stenosis. 11 large observational
studies with near 1300 patients with BAV stenosis were included to
summarizes outcomes of TAVR. Expert Commentary: The present review
suggested that TAVR may be a safe and feasible treatment modality in BAV
stenosis patients. New generation devices were associated with high device
success rate whereas higher adverse procedural events were observed in
early generation devices. There are no differences in post procedural
outcomes with new generation TAVR devices for BAV when compared to
tricuspid aortic anatomy. Larger studies are needed to evaluate the
long-term outcome and durability of TAVR in patients with
BAV.<br/>Copyright &#xa9; 2017 Informa UK Limited, trading as Taylor &
Francis Group.

<49>
Accession Number
619160295
Author
Anonymous
Title
Erratum: Induction chemoradiation in stage IIIA/N2 non-small-cell lung
cancer: a phase 3 randomised trial (The Lancet (2015) 386(9998)
(1049-1056) (S014067361560294X) (10.1016/S0140-6736(15)60294-X)).
Source
The Lancet. 386 (9998) (pp 1040), 2015. Date of Publication: 12 - 18
September 2015.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Pless M, Stupp R, Ris H-B, et al. Induction chemoradiation in stage
IIIA/N2 non-small-cell lung cancer: a phase 3 randomised trial. Lancet
2015; 386: 1049-56-In the affiliations, Urs R Meier should have been at
the Department of Radiation Oncology, Kantonsspital Winterthur, and
Han-Beat Ris should have been at the Department of Thoracic Surgery,
Centre Hospitalier Universitaire Vaudois,. These corrections have been
made to the online version as of Sept 11, 2015, and the printed Article is
correct.<br/>Copyright &#xa9; 2015 Elsevier Ltd

<50>
Accession Number
619159136
Author
Landoni G.; Lomivorotov V.; Silvietti S.; Nigro Neto C.; Pisano A.; Alvaro
G.; Hajjar L.A.; Paternoster G.; Riha H.; Monaco F.; Szekely A.; Lembo R.;
Aslan N.A.; Affronti G.; Likhvantsev V.; Amarelli C.; Fominskiy E.;
Baiardo Redaelli M.; Putzu A.; Baiocchi M.; Ma J.; Bono G.; Camarda V.;
Covello R.D.; Di Tomasso N.; Labonia M.; Leggieri C.; Lobreglio R.; Monti
G.; Mura P.; Scandroglio A.M.; Pasero D.; Turi S.; Roasio A.; Votta C.D.;
Saporito E.; Riefolo C.; Sartini C.; Brazzi L.; Bellomo R.; Zangrillo A.
Institution
(Landoni, Silvietti, Monaco, Lembo, Affronti, Baiardo Redaelli, Bono,
Camarda, Di Tomasso, Leggieri, Monti, Scandroglio, Turi, Votta, Saporito,
Riefolo, Sartini, Zangrillo) Department of Anesthesia and Intensive Care,
IRCCS San Raffaele Scientific Institute, Milan, Italy
(Landoni, Zangrillo) Vita-Salute San Raffaele University, Milan, Italy
(Lomivorotov, Fominskiy) Department of Anaesthesiology and Intensive Care,
Siberian Biomedical Research Center of the Ministry of Health,
Novosibirsk, Russia
(Nigro Neto) Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
(Pisano) Division of Cardiac Anesthesia and Intensive Care, Azienda
Ospedaliera Dei Colli, Monaldi Hospital, Naples, Italy
(Alvaro, Labonia) Department of Anesthesia and Intensive Care, Policlinico
Universitario Mater Domini, Catanzaro, Italy
(Hajjar) Surgical Intensive Care, Department of Cardiopneumology, InCor,
University of Sao Paulo. Sao Paulo, Brazil
(Paternoster) Department of Cardiovascular Anaesthesia and Intensive Care,
Ospedale San Carlo, Potenza, Italy
(Riha) Cardiothoracic Anaesthesiology and Intensive Care, Department of
Anaesthesiology and Intensive Care Medicine, Institute for Clinical and
Experimental Medicine, Prague, Czech Republic
(Szekely) Department of Anesthesia and Intensive Care, Semmelweis Egyetem,
Budapest, Hungary
(Aslan) Medipol Mega University Hospital, Department of Anesthesiology and
Intensive Care, Istanbul, Turkey
(Likhvantsev) Department of Anesthesia and Intensive Care, Moscow Regional
Clinical and Research Institute, Moscow, Russia
(Amarelli) Department of Cardiovascular Surgery and Transplants, Monaldi
Hospital, Azienda dei Colli, Naples, Italy
(Putzu) Department of Cardiovascular Anesthesia and Intensive Care,
Cardiocentro Ticino, Lugano, Switzerland
(Baiocchi) Department of Anesthesia and Intensive Care, S. Orsola-Malpighi
University Hospital, Bologna, Italy
(Ma) Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing, People's Republic of China
(Covello) Anesthesia and Intensive Care Unit, Busto Arsizio Hospital, ASST
Valle Olona, Varese, Italy
(Lobreglio, Pasero, Brazzi) Department of Anesthesia and Intensive Care,
A.O.U. Citta della Salute e della Scienza, Turin, Italy
(Mura) Department of Anesthesia and Intensive Care Unit, Policlinico
Duilio Casula AOU Cagliari, Department of Medical Sciences M. Aresu,
Cagliari, Italy
(Roasio) Department of Anaesthesia and Intensive Care, Ospedale Cardinal
Massaia di Asti, Asti, Italy
(Bellomo) School of Medicine, The University of Melbourne, Parkville,
Melbourne, Australia
(Brazzi) Department of Surgical Sciences, University of Turin, Italy
Title
Nonsurgical Strategies to Reduce Mortality in Patients Undergoing Cardiac
Surgery: An Updated Consensus Process.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objective: A careful choice of perioperative care strategies is pivotal to
improve survival in cardiac surgery. However, there is no general
agreement or particular attention to which nonsurgical interventions can
reduce mortality in this setting. The authors sought to address this issue
with a consensus-based approach. Design: A systematic review of the
literature followed by a consensus-based voting process. Setting: A
web-based international consensus conference. Participants: More than 400
physicians from 52 countries participated in this web-based consensus
conference. Interventions: The authors identified all studies published in
peer-reviewed journals that reported on interventions with a statistically
significant effect on mortality in the setting of cardiac surgery through
a systematic Medline/PubMed search and contacts with experts. These
studies were discussed during a consensus meeting and those considered
eligible for inclusion in this study were voted on by clinicians
worldwide. Measurements and Main Results: Eleven interventions finally
were selected: 10 were shown to reduce mortality (aspirin, glycemic
control, high-volume surgeons, prophylactic intra-aortic balloon pump,
levosimendan, leuko-depleted red blood cells transfusion, noninvasive
ventilation, tranexamic acid, vacuum-assisted closure, and volatile
agents), whereas 1 (aprotinin) increased mortality. A significant
difference in the percentages of agreement among different countries and a
variable gap between agreement and clinical practice were found for most
of the interventions. Conclusions: This updated consensus process
identified 11 nonsurgical interventions with possible survival
implications for patients undergoing cardiac surgery. This list of
interventions may help cardiac anesthesiologists and intensivists
worldwide in their daily clinical practice and can contribute to direct
future research in the field.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<51>
Accession Number
619158324
Author
Slavich M.; Pizzetti G.; Vella A.M.; Carlucci C.; Margonato D.; Spoladore
R.; Fragasso G.; Margonato A.
Institution
(Slavich, Pizzetti, Vella, Margonato, Spoladore, Fragasso, Margonato)
Division of Cardiology, IRCCS Ospedale San Raffaele, Milano, Italy
(Carlucci) Hematology Project Foundation, Vicenza, Italy
Title
Extracorporeal myocardial shockwave therapy; a precious blast for
refractory angina patients.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Introduction: Refractory Angina Pectoris (RAP) dramatically affects
patients' life quality and medical costs. External Shockwave Myocardial
Revascularization (ESMR) improves the cardiac blood flow thanks to its
pro-angiogenetic action on ischaemic tissues. We hereby describe our
experience of ESMR in RAP patients. Materials and methods: This is a
retrospective study encompassing all patients referred to OSR for RAP
treatment. Efficacy of ESMR was assessed considering the difference
between pre and post therapy data in SAQ score and CCS, stress test
performance, 24. h ECG monitoring, NT-proBNP and echocardiographic
measures. Results: From a total of 97 patients with RAP, 19 patients
underwent ESMR, whereas 4 were considered as control group. After the end
of the treatment, ESWT group showed a significant improvement in CCS class
(-1.32. +/-. 0.58; p. <. 0.001) and in each of the five variables of the
SAQ score (p. <. 0.05). Patients also improved their exercise duration
(50,74. +/-. 29.40 seconds; p. <. 0,001) and double product (1340,53. +/-.
1321,77; p. <. 0,001) and reduced the number of daily ST segment
depression (-1,16. +/-. 1,01; p. <. 0,01). Ejection Fraction (2,05. +/-.
1,84%; p. <. 0,01) and Cardiac Output (0,20. +/-. 0,28. L, p. <. 0,01)
improved too. No changes were documented in the control group. Conclusion:
ESMR is an efficient therapy for refractory angina capable to improve both
symptoms and instrumental tests.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<52>
Accession Number
619147414
Author
Putzu A.; Clivio S.; Belletti A.; Cassina T.
Institution
(Putzu, Clivio, Cassina) Department of Cardiovascular Anesthesia and
Intensive Care, Cardiocentro Ticino, Lugano, Switzerland
(Belletti) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Milan, Italy
Title
Perioperative levosimendan in cardiac surgery: A systematic review with
meta-analysis and trial sequential analysis.
Source
International Journal of Cardiology. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background: Several studies suggested beneficial effects of perioperative
levosimendan on postoperative outcome after cardiac surgery. However,
three large randomized controlled trials (RCTs) have been recently
published and presented neutral results. We performed a systematic review
with meta-analysis and trial sequential analysis (TSA) to assess benefits
and harms of perioperative levosimendan therapy in cardiac surgery.
Methods: Electronic databases were searched up to September 2017 for RCTs
on preoperative levosimendan versus any type of control. The Cochrane
methodology was employed. We calculated odds ratio (OR) or Risk Ratio (OR)
and 95% confidence interval (CI) using fixed-effects meta-analyses and we
further performed TSA. Results: We included data from 40 RCTs and 4246
patients. Pooled analysis of 5 low risk of bias trials (1910 patients)
showed no association between levosimendan and mortality (OR 0.86 [95% CI,
0.62, 1.18], p = 0.34, TSA inconclusive), acute kidney injury, need of
renal replacement therapy, myocardial infarction, ventricular arrhythmias,
and serious adverse events, but an association with higher incidence of
supraventricular arrhythmias (RR 1.11 [95% CI, 1.00, 1.24], p = 0.05, TSA
inconclusive) and hypotension (RR 1.15 [95% CI, 1.01, 1.30], p = 0.04, TSA
inconclusive). Analysis including all 40 trials found that levosimendan
was associated with lower postoperative mortality (OR 0.56 [95% CI, 0.44,
0.71], p <. 0.00001, TSA conclusive), acute kidney injury, and renal
replacement therapy, and higher incidence of hypotension. Conclusions:
There is not enough high-quality evidence to neither support nor
discourage the systematic use of levosimendan in cardiac
surgery.<br/>Copyright &#xa9; 2017 Elsevier Ireland Ltd.

<53>
Accession Number
619147403
Author
Meesters M.I.; Burtman D.; van de Ven P.M.; Boer C.
Institution
(Meesters, Burtman, Boer) Department of Anaesthesiology, VU University
Medical Centre, Amsterdam, The Netherlands
(van de Ven) Department of Epidemiology and Biostatistics, VU University
Medical Centre, Amsterdam, The Netherlands
Title
Prediction of Postoperative Blood Loss Using Thromboelastometry in Adult
Cardiac Surgery: Cohort Study and Systematic Review.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objective: The aim was to evaluate the predictive value of
thromboelastometry for postoperative blood loss in adult cardiac surgery
with cardiopulmonary bypass. Design: Retrospective cohort study and
systematic review of the literature. Setting: A tertiary university
hospital. Participants: 202 patients undergoing elective cardiac surgery.
Interventions: Thromboelastometry was performed before cardiopulmonary
bypass and 3 minutes after protamine administration. Measurements and Main
Results: The cohort study showed that the preoperative and postoperative
thromboelastometric positive predicting value was poor (0%-22%); however,
the negative predicting value was high (89%-94%). The systematic review of
the literature to evaluate the predictive value of thromboelastometry for
major postoperative bleeding in cardiac surgery resulted in 1,311
articles, 11 of which were eligible (n = 1,765; PubMed and Embase, until
June 2016). Two studies found a good predictive value, whereas the other 9
studies showed a poor predictability for major postoperative bleeding
after cardiac surgery. The overall negative predicting value was high.
Conclusions: Thromboelastometry does not predict which patients are at
risk for major postoperative bleeding.<br/>Copyright &#xa9; 2017 Elsevier
Inc.

<54>
Accession Number
619146700
Author
Laine A.; Niemi T.; Schramko A.
Institution
(Laine, Niemi, Schramko) Division of Anesthesiology, Department of
Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki,
Helsinki University Hospital, Helsinki, Finland
Title
Transfusion Threshold of Hemoglobin 80 g/L Is Comparable to 100 g/L in
Terms of Bleeding in Cardiac Surgery: A Prospective Randomized Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objective: Anemia is common after cardiac surgery and, according to some
suggestive evidence, may be associated with increased bleeding, other
morbidity, and mortality. However, transfusion of red blood cells (RBC)
may cause adverse effects and increase cost. The authors hypothesized that
the restrictive hemoglobin threshold (Hb of 80 g/L) may aggravate bleeding
more than the higher Hb threshold (Hb 100 g/L). Design: Prospective
randomized trial. Type of Hospital: University Hospital of Helsinki,
Finland. Participants: Eighty patients with written informed consent,
scheduled for elective open-heart surgery were randomized in 2 groups.
Interventions: Two study groups had RBC transfusion threshold of either Hb
80 g/L or 100 g/L. These triggers were followed for a 24-hour period
postoperatively. A medical follow-up was carried out for 7 days after
surgery. Measurements and Main Results: Rotational thromboelastometry
(ROTEM) and conventional laboratory tests were performed to evaluate
coagulation. There was no significant difference in bleeding or ROTEM
parameters between the groups. Complication rate and Hb concentration
after 7-day follow-up were not different between the groups, but Group 100
g/L had received twice the amount of RBC transfusions. Conclusion: Hb
threshold of 80 g/L for RBC transfusion in cardiac surgery is comparable
to 100 g/L in terms of bleeding and possibly short-term
complications.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<55>
Accession Number
619144063
Author
Varenne O.; Cook S.; Sideris G.; Kedev S.; Cuisset T.; Carrie D.; Hovasse
T.; Garot P.; El Mahmoud R.; Spaulding C.; Helft G.; Diaz Fernandez J.F.;
Brugaletta S.; Pinar-Bermudez E.; Mauri Ferre J.; Commeau P.; Teiger E.;
Bogaerts K.; Sabate M.; Morice M.-C.; Sinnaeve P.R.
Institution
(Varenne) Hopital Cochin, Assistance Publique-Hopitaux de Paris, Paris,
France
(Varenne) Cardiology Department, Universite' Paris Descartes, Sorbonne
Paris-Cite', Paris, France
(Cook) Cardiology Department, University and Hospital Fribourg, Fribourg,
Switzerland
(Sideris) Service de Cardiologie-Institut national de la sante' et de la
recherche me'dicale U942, Hopital Lariboisiere, Assistance Publique -
Hopitaux de Paris, Universite' Paris Diderot, Paris, France
(Kedev) Cardiology Department, University St Cyril and Methodius, Skopje,
Macedonia
(Cuisset) De'partement de Cardiologie, Centre hospitalier universitaire
Timone, Marseille, France
(Carrie') Service de Cardiologie, Centre hospitalier universitaire
Toulouse Rangueil, Universite' Paul Sabatier, Toulouse, France
(Hovasse, Garot) Institut Cardiovasculaire Paris-Sud, Ramsay Ge'ne'rale de
Sante', Massy and Quincy, France
(El Mahmoud) Hopital Ambroise Pare' Assistance Publique-Hopitaux de Paris,
Universite' Versailles-Saint Quentin en Yvelines, Versailles, France
(Spaulding) Service de Cardiologie, Hopital Europe'en Georges Pompidou,
Assistance Publique-Hopitaux de Paris, Paris Descartes University and
Sudden Death Expert Center, Institut national de la sante' et de la
recherche me'dicale U990, Paris, France
(Helft) Institut de Cardiologie, Hopital Pitie'-Salpe'triere, Assistance
Publique-Hopitaux de Paris, Universite' Pierre et Marie Curie et Institut
hospitalo-universitaire, Institute of Cardiometabolism and Nutrition,
Hopital Pitie'-Salpe'triere, Paris, France
(Diaz Fernandez) Juan Ramo'n Jime'nez University Hospital, Huelva, Spain
(Brugaletta) Cardiovascular Institute, Hospital Clinic, Institut
d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
(Pinar-Bermudez) Hospital Universitario Virgen de la Arrixaca, Murcia,
Spain
(Mauri Ferre) Hospital Universitari Germans Trias i Pujol, Badalona, Spain
(Commeau) De'partement de Cardiologie Interventionnelle, Polyclinique Les
Fleurs, Ollioules, France
(Teiger) Service de Cardiologie, Hopital Henri Mondor Assistance
Publique-Hopitaux de Paris, Universite' Paris Est Cre'teil, Cre'teil,
France
(Bogaerts) Interuniversity Institute for Biostatistics and Statistical
Bioinformatics (I-BioStat), Department of Public Health and Primary Care,
Katholieke Universiteit Leuven, Leuven, Belgium
(Bogaerts) Interuniversity Institute for Biostatistics and Statistical
Bioinformatics (I-BioStat), University Hasselt, Hasselt, Belgium
(Sabate) Interventional Cardiology Unit, Cardiovascular Institute,
Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer,
Barcelona, Spain
(Morice) Cardiovascular European Research Center, Massy, France
(Sinnaeve) Department of Cardiovascular Medicine, University Hospitals
Leuven, Leuven, Belgium
Title
Drug-eluting stents in elderly patients with coronary artery disease
(SENIOR): A randomised single-blind trial.
Source
The Lancet. (no pagination), 2017. Date of Publication: 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background: Elderly patients regularly receive bare-metal stents (BMS)
instead of drug-eluting stents (DES) to shorten the duration of double
antiplatelet therapy (DAPT). The aim of this study was to compare outcomes
between these two types of stents with a short duration of DAPT in such
patients. Methods: In this randomised single-blind trial, we recruited
patients from 44 centres in nine countries. Patients were eligible if they
were aged 75 years or older; had stable angina, silent ischaemia, or an
acute coronary syndrome; and had at least one coronary artery with a
stenosis of at least 70% (>=50% for the left main stem) deemed eligible
for percutaneous coronary intervention (PCI). Exclusion criteria were
indication for myocardial revascularisation by coronary artery bypass
grafting; inability to tolerate, obtain, or comply with DAPT; requirement
for additional surgery; non-cardiac comorbidities with a life expectancy
of less than 1 year; previous haemorrhagic stroke; allergy to aspirin or
P2Y<inf>12</inf> inhibitors; contraindication to P2Y<inf>12</inf>
inhibitors; and silent ischaemia of less than 10% of the left myocardium
with a fractional flow reserve of 0.80 or higher. After the intended
duration of DAPT was recorded (1 month for patients with stable
presentation and 6 months for those with unstable presentation), patients
were randomly allocated (1:1) by a central computer system (blocking used
with randomly selected block sizes [two, four, eight, or 16]; stratified
by site and antiplatelet agent) to either a DES or similar BMS in a
single-blind fashion (ie, patients were masked), but those assessing
outcomes were masked. The primary outcome was to compare major adverse
cardiac and cerebrovascular events (ie, a composite of all-cause
mortality, myocardial infarction, stroke, or ischaemia-driven target
lesion revascularisation) between groups at 1 year in the
intention-to-treat population, assessed at 30 days, 180 days, and 1 year.
This trial is registered with ClinicalTrials.gov, number NCT02099617.
Findings: Between May 21, 2014, and April 16, 2016, we randomly assigned
1200 patients (596 [50%] to the DES group and 604 [50%] to the BMS group).
The primary endpoint occurred in 68 (12%) patients in the DES group and 98
(16%) in the BMS group (relative risk [RR] 0.71 [95% CI 0.52-0.94];
p=0.02). Bleeding complications (26 [5%] in the DES group vs 29 [5%] in
the BMS group; RR 0.90 [0.51-1.54]; p=0.68) and stent thrombosis (three
[1%] vs eight [1%]; RR 0.38 [0.00-1.48]; p=0.13) at 1 year were infrequent
in both groups. Interpretation: Among elderly patients who have PCI, a DES
and a short duration of DAPT are better than BMS and a similar duration of
DAPT with respect to the occurrence of all-cause mortality, myocardial
infarction, stroke, and ischaemia-driven target lesion revascularisation.
A strategy of combination of a DES to reduce the risk of subsequent repeat
revascularisations with a short BMS-like DAPT regimen to reduce the risk
of bleeding event is an attractive option for elderly patients who have
PCI. Funding: Boston Scientific.<br/>Copyright &#xa9; 2017 Elsevier Ltd.

<56>
Accession Number
619144060
Author
Amedro P.; Bajolle F.; Bertet H.; Cheurfi R.; Lasne D.; Nogue E.; Auquier
P.; Picot M.-C.; Bonnet D.
Institution
(Amedro) Pediatric and Congenital Cardiology Department, M3C Regional
Reference Center, University Hospital, Physiology and Experimental Biology
of Heart and Muscles Laboratory, PHYMEDEXP, UMR CNRS 9214-Inserm U1046,
University of Montpellier, Montpellier, France
(Amedro, Auquier) Self-perceived Health Assessment Research Unit, EA3279,
Public Health Department, Aix-Marseille University, Marseille, France
(Bajolle, Cheurfi, Bonnet) Pediatric Cardiology Department, AP-HP,
Necker-Enfants malades, M3C National Reference Center, Paris Descartes
University, Sorbonne Paris Cite', Paris, France
(Bertet, Picot) Epidemiology Department, University Hospital, Clinical
Investigation Center, Inserm-CIC 1411, Montpellier, France
(Lasne, Nogue) Hematology Laboratory, AP-HP, Necker-Enfants malades,
Paris, France
Title
Quality of life in children participating in a non-selective INR
self-monitoring VKA-education programme.
Source
Archives of Cardiovascular Diseases. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Background: The quality of life (QoL) of children receiving vitamin K
antagonist (VKA) treatment has been scarcely studied. Aim: To assess QoL
of children, and its evolution, throughout our non-selective international
normalized ratio (INR) self-monitoring education programme. Methods:
Children and parents completed QoL questionnaires (Qualin, PedsQL) during
education sessions. Scores were compared with those from controls.
Results: A total of 111 children (mean. +/-. standard deviation age 8.7.
+/-. 5.4 years) were included over a 3-year period. Indications for VKA
treatment were congenital heart diseases (valve replacement [42.3%], total
cavopulmonary connection [29.7%]), myocardiopathy (11.7%), coronary
aneurysm (7.2%), venous/intracardiac thrombosis (4.5%), pulmonary artery
hypertension (1.8%), arrhythmia (0.9%) and extra-cardiac disease (1.8%).
Eighty children, 105 mothers and 74 fathers completed the QoL
questionnaires. QoL was good among children aged 1. -4 years and
moderately impaired in those aged between 5 and 18 years. There was no
significant relationship between self-reported QoL and patient's sex, type
of VKA, number of group sessions attended, disease duration or time of
diagnosis (prenatal or postnatal). QoL scores were significantly lower
among children with congenital heart diseases compared with other
diseases. There were few differences in QoL between children under
transient VKA treatment and those treated for life. Parental proxy QoL
scoring correlated well with but was significantly lower than child
self-assessments. QoL reported by mothers increased throughout the
education programme, independently of any improvement of the health
condition. Conclusions: This QoL study provides original data from a large
cohort of children and their parents participating in a formalized INR
self-monitoring education programme for VKA treatment.<br/>Copyright
&#xa9; 2017 Elsevier Masson SAS.

<57>
Accession Number
619144039
Author
Gleason T.G.; Schindler J.T.; Hagberg R.C.; Deeb G.M.; Adams D.H.; Conte
J.V.; Zorn G.L.; Hughes G.C.; Guo J.; Popma J.J.; Reardon M.J.
Institution
(Gleason) Department of Cardiothoracic Surgery, University of Pittsburgh
Medical Center Heart and Vascular Institute, University of Pittsburgh
School of Medicine, Pittsburgh, Pennsylvania
(Schindler) Department of Medicine, University of Pittsburgh Medical
Center Heart and Vascular Institute, University of Pittsburgh School of
Medicine, Pittsburgh, Pennsylvania
(Hagberg) Department of Cardiac Surgery, University of Michigan Hospitals,
Ann Arbor, Michigan
(Deeb) Department of Cardiovascular Surgery, Mount Sinai Health System,
New York, New York
(Adams) Division of Cardiac Surgery, The Johns Hopkins University,
Baltimore, Maryland
(Conte) Department of Cardiothoracic Surgery, University of Kansas,
Lawrence, Kansas
(Zorn) Department of Thoracic and Cardiac Surgery, Duke University Medical
Center, Durham, North Carolina
(Hughes) Statistical Services, Medtronic, Mounds View, Minnesota
(Guo) Cardiovascular Division, Department of Internal Medicine and
Cardiovascular Surgery, and Department of Surgery, Beth Israel Deaconess
Medical Center, Boston Massachusetts
(Popma, Reardon) Department of Cardiovascular Surgery, The Methodist
DeBakey Heart and Vascular Center, Houston, Texas
Title
Subclavian/Axillary Access for Self-Expanding Transcatheter Aortic Valve
Replacement Renders Equivalent Outcomes as Transfemoral.
Source
Annals of Thoracic Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier USA
Abstract
Background: Iliofemoral arterial disease can preclude transfemoral (TF)
transcatheter aortic valve replacement (TF-TAVR). Transthoracic access by
direct aortic or a transapical approach imparts a greater risk of
complications and death than TF access. We hypothesized that
subclavian/axillary arterial (SCA) access offers equivalent risks and
outcomes as TF access. Methods: The outcomes of 202 patients from the
CoreValve (Medtronic, Minneapolis, MN) United States Pivotal Trial Program
treated with SCA access were propensity matched with patients treated with
TF access and analyzed. Results: Matching was successful, with no
significant baseline differences in the SCA group and the TF group, except
the SCA group had more past or present smokers (79.2% vs 61.4%, p < 0.001)
and fewer patients with anemia requiring transfusion (18.5% vs 27.5%, p =
0.04). SCA patients experienced a significantly longer time from
enrollment to procedure (8.6 +/- 19.1 vs 5.3 +/- 6.3 days; p = 0.02),
likely the result of case planning. Significant differences in procedural
outcomes include less post-TAVR balloon dilation (17.9% vs 26.7%, p =
0.03) and more general anesthesia (99.0% vs 89.6%, p < 0.001) for the SCA
accesses. There were no differences in procedure time (57.8 +/- 45.3 vs
57.5 +/- 32.1 min, p = 0.94) or Valve Academic Research Consortium
I-defined procedure success between groups (p = 0.89). Event rates at 30
days or 1 year were similar, with a trend toward fewer pacemakers with SCA
accesses. Conclusions: Major morbidity and mortality rates SCA-TAVR are
equivalent to TF-TAVR. The SCA should be the preferred secondary access
site for TAVR because it offers procedural and clinical outcomes
comparable to TF-TAVR and applies to most patients who are not TF
candidates.<br/>Copyright &#xa9; 2017 The Society of Thoracic Surgeons.

<58>
Accession Number
619140888
Author
Crawford T.C.; Magruder J.T.; Grimm J.C.; Suarez-Pierre A.; Patel N.;
Sciortino C.M.; Zehr K.J.; Mandal K.; Tedford R.J.; Russell S.D.; Conte
J.V.; Higgins R.S.; Cameron D.E.; Whitman G.J.
Institution
(Crawford, Magruder, Grimm, Suarez-Pierre, Patel, Sciortino, Zehr, Mandal,
Conte, Higgins, Cameron, Whitman) Division of Cardiac Surgery, Johns
Hopkins University School of Medicine, Baltimore, Maryland
(Tedford, Russell) Division of Cardiology, Johns Hopkins University School
of Medicine, Baltimore, Maryland
Title
A Comprehensive Risk Score to Predict Prolonged Hospital Length of Stay
After Heart Transplantation.
Source
Annals of Thoracic Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier USA
Abstract
Background: Prolonged hospital length of stay (PLOS) after heart
transplantation increases cost and morbidity. To better inform care, we
developed a risk score to identify patients at risk for PLOS after heart
transplantation. Methods: We queried the United Network for Organ Sharing
Scientific Registry of Transplant Recipients database for adult patients
who underwent isolated heart transplantation from 2003 to 2012. The
population was randomly divided into a derivation cohort (80%) and a
validation cohort (20%). The outcome of interest was PLOS, defined as a
posttransplant hospital length of stay of more than 30 days. Associated
univariables (p < 0.20) in the derivation cohort were included in a
multivariable model, and a risk index was derived from the adjusted odds
ratios of significant covariates. Results: During the study period, 16,723
patients underwent heart transplantation with an average PLOS of 19 +/- 21
days, and 2,020 orthotopic heart transplant recipients (12%) had PLOS.
Baseline characteristics were similar between the derivation and
validation cohorts. Twenty-four recipient and nine donor variables, cold
ischemic time, and center volume were tested as univariables. Seventeen
covariates significantly affected PLOS and comprised the prolonged
hospitalization after heart transplant risk score, which was stratified
into three risk groups. The risk model was subsequently validated, and
predicted rates of PLOS correlated well with observed rates (R = 0.79).
Rates of PLOS in the validation cohort were 8.3%, 11%, and 22% for low,
moderate, and high risk groups, respectively. Conclusions: The risk of
PLOS after heart transplantation can be determined at the time of
transplant. The prolonged hospitalization after heart transplant score may
lead to individualized postoperative management strategies to reduce
duration of hospitalization for patients at high risk.<br/>Copyright
&#xa9; 2017 The Society of Thoracic Surgeons.

<59>
Accession Number
619137474
Author
Grady K.L.; Hof K.V.; Andrei A.-C.; Shankel T.; Chinnock R.; Miyamoto S.;
Ambardekar A.V.; Anderson A.; Addonizio L.; Latif F.; Lefkowitz D.;
Goldberg L.; Hollander S.A.; Pham M.; Weissberg-Benchell J.; Cool N.;
Yancy C.; Pahl E.
Institution
(Grady, Andrei, Anderson, Yancy) Division of Cardiac Surgery, Northwestern
University Feinberg School of Medicine, 201 East Huron Street, Galter
Pavilion 11-140 Chicago, Chicago, IL 60611-3056, United States
(Hof, Weissberg-Benchell, Pahl) Ann & Robert H. Lurie Children's Hospital
of Chicago, Chicago, IL, United States
(Shankel, Chinnock) Loma Linda University Children's Hospital, Loma Linda,
CA, United States
(Miyamoto) Children's Hospital Colorado, Aurora, CO, United States
(Ambardekar) University of Colorado, Aurora, CO, United States
(Addonizio, Latif) Columbia University Medical Center, New York, NY,
United States
(Lefkowitz) The Children's Hospital of Philadelphia, Philadelphia, PA,
United States
(Goldberg) University of Pennsylvania, Philadelphia, PA, United States
(Hollander, Pham) Stanford University, Palo Alto, CA, United States
(Cool) Northwestern Memorial Hospital, Chicago, IL, United States
(Pahl) Department of Medicine, Northwestern University Feinberg School of
Medicine, Chicago, IL, United States
Title
Pediatric Heart Transplantation: Transitioning to Adult Care (TRANSIT):
Baseline Findings.
Source
Pediatric Cardiology. (pp 1-11), 2017. Date of Publication: 03 Nov 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Young adult solid organ transplant recipients who transfer from pediatric
to adult care experience poor outcomes related to decreased adherence to
the medical regimen. Our pilot trial for young adults who had heart
transplant (HT) who transfer to adult care tests an intervention focused
on increasing HT knowledge, self-management and self-advocacy skills, and
enhancing support, as compared to usual care. We report baseline findings
between groups regarding (1) patient-level outcomes and (2) components of
the intervention. From 3/14 to 9/16, 88 subjects enrolled and randomized
to intervention (n = 43) or usual care (n = 45) at six pediatric HT
centers. Patient self-report questionnaires and medical records data were
collected at baseline, and 3 and 6 months after transfer. For this report,
baseline findings (at enrollment and prior to transfer to adult care) were
analyzed using Chi-square and t-tests. Level of significance was p < 0.05.
Baseline demographics were similar in the intervention and usual care
arms: age 21.3 +/- 3.2 vs 21.5 +/- 3.3 years and female 44% vs 49%,
respectively. At baseline, there were no differences between intervention
and usual care for use of tacrolimus (70 vs 62%); tacrolimus level (mean
+/- SD = 6.5 +/- 2.3 ng/ml vs 5.6 +/- 2.3 ng/ml); average of the within
patient standard deviation of the baseline mean tacrolimus levels (1.6 vs
1.3); and adherence to the medical regimen [3.6 +/- 0.4 vs 3.5 +/- 0.5 (1
= hardly ever to 4 = all of the time)], respectively. At baseline, both
groups had a modest amount of HT knowledge, were learning self-management
and self-advocacy, and perceived they were adequately supported. Baseline
findings indicate that transitioning HT recipients lack essential
knowledge about HT and have incomplete self-management and self-advocacy
skills.<br/>Copyright &#xa9; 2017 Springer Science+Business Media, LLC

<60>
Accession Number
619136992
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, Im Neuenheimer Feld 410, Heidelberg 69120, Germany
(Ruhparwar) Department of Cardiac Surgery, Heidelberg University Hospital,
Heidelberg, Germany
(Rahm) Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
(Bruckner) Institute for Medical Biometry and Informatics, University of
Heidelberg, Heidelberg, Germany
Title
Control of cardiac chronotropic function in patients after heart
transplantation: effects of ivabradine and metoprolol succinate on resting
heart rate in the denervated heart.
Source
Clinical Research in Cardiology. (pp 1-10), 2017. Date of Publication: 02
Nov 2017.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: Patients after heart transplantation (HTX) present with sinus
tachycardia due to graft denervation. As elevated heart rates negatively
affect survival, the aim of this study was to analyze the effects of
ivabradine vs metoprolol succinate on heart rate, left ventricular (LV)
mass and survival following HTX. Methods: This observational retrospective
single-center study assessed 84 patients continuously receiving either
ivabradine (n = 40) or metoprolol succinate (n = 44) within 2 years after
HTX. Patients with dual therapy (ivabradine and metoprolol succinate),
other beta blockers, amiodarone, or digitalis were excluded. Patient
characteristics, post-transplant medication, heart rates, LV mass, and
survival were investigated. Results: Analysis of patient characteristics,
immunosuppressive drug regimen, and post-transplant medication showed no
significant differences between groups except for ivabradine and
metoprolol succinate. Baseline heart rates differed not significantly
between patients treated with ivabradine [87.0 beats per minute (bpm)] and
metoprolol succinate (86.2 bpm; P = 0.6395). At 2-year follow-up, patients
with ivabradine (76.7 bpm) had a significantly lower heart rate compared
to baseline (P < 0.0001) and to metoprolol succinate (82.0 bpm; P =
0.0283). LV mass in patients receiving ivabradine was lower at 2-year
follow-up compared to baseline (P = 0.0067) and patients receiving
metoprolol succinate (P = 0.0179). Patients with ivabradine had a superior
2-year survival after HTX (P = 0.0049). Conclusion: Treatment with
ivabradine in patients within 2 years after HTX significantly reduced
post-transplant heart rate and LV mass and was associated with a superior
survival in comparison with patients receiving metoprolol
succinate.<br/>Copyright &#xa9; 2017 Springer-Verlag GmbH Germany

<61>
Accession Number
610652829
Author
Spadaccio C.; Nappi F.; Al-Attar N.; Sutherland F.W.; Acar C.; Nenna A.;
Trombetta M.; Chello M.; Rainer A.
Institution
(Spadaccio, Al-Attar, Sutherland) Department of Cardiothoracic Surgery,
Golden Jubilee National Hospital, Agamemnon Street Clydebank, Glasgow G81
4DY, United Kingdom
(Spadaccio, Al-Attar) College of Medical, Veterinary and Life Sciences,
Institute of Cardiovascular and Medical Sciences, University of Glasgow,
Glasgow, United Kingdom
(Nappi) Cardiac Surgery Centre Cardiologique du Nord de Saint-Denis,
Paris, France
(Acar) Department of Cardiothoracic Surgery, Hopital Pitie-Salpetriere,
Paris, France
(Nenna, Chello) Department of Cardiovascular Sciences
, University Campus Bio-Medico of Rome, Roma, Italy
(Trombetta, Rainer) CIR-Laboratory of Tissue Engineering, Universita
Campus Bio-Medico di Roma, Roma, Italy
Title
Old Myths, New Concerns: the Long-Term Effects of Ascending Aorta
Replacement with Dacron Grafts. Not All That Glitters Is Gold.
Source
Journal of Cardiovascular Translational Research. 9 (4) (pp 334-342),
2016. Date of Publication: 01 Aug 2016.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Synthetic grafts are widely used in cardiac and vascular surgery since the
mid-1970s. Despite their general good performance, inability of mimicking
the elastomechanical characteristics of the native arterial tissue, and
the consequent lack of adequate compliance, leads to a cascade of
hemodynamic and biological alterations deeply affecting cardiovascular
homeostasis. Those concerns have been reconsidered in more contemporaneous
surgical and experimental reports which also triggered some research
efforts in the tissue engineering field towards the realization of
biomimetic arterial surrogates. The present review focuses on the
significance of the "compliance mismatch" phenomenon occurring after
aortic root or ascending aorta replacement with prosthetic grafts and
discusses the clinical reflexes of this state of tissue incompatibility,
as the loss of the native elastomechanical properties of the aorta can
translate into detrimental effects on the normal efficiency of the aortic
root complex with impact in the long-term results of patients undergoing
aortic replacement.<br/>Copyright &#xa9; 2016, The Author(s).

<62>
Accession Number
614616356
Author
Dong C.-S.; Zhang J.; Lu Q.; Sun P.; Yu J.-M.; Wu C.; Sun H.
Institution
(Dong, Zhang, Lu, Sun, Yu, Wu, Sun) Third affiliation hospital of Anhui
Medical University, Department of Anesthesiology, Hefei huaihe road No.
390, Hefei 230061, China
Title
Effect of Dexmedetomidine combined with sufentanil for post- thoracotomy
intravenous analgesia: A randomized, controlled clinical study.
Source
BMC Anesthesiology. 17 (1) (no pagination), 2017. Article Number: 33. Date
of Publication: 01 Mar 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Few studies have investigated the use of dexmedetomidine in
patient-controlled intravenous analgesia (PCIA) after thoracic surgery.
This study to evaluate the effect of dexmedetomidine combined with
sufentanil for PCIA after thoracotomy under general anaesthesia. Methods:
Ninety-seven adults patients scheduled for thoracotomy surgery. All two
groups received PCIA with either sufentanil alone (control group) or
combining dexmedetomidine with sufentanil (dexmedetomidine group).
Hemodynamic measurements, visual analog scale (VAS) scores at rest and at
coughing, Ramsay sedation score (RSS), analgesic consumption, and
postoperative nausea and vomiting (PONV) as well as drug-related adverse
effects were compared at 2, 6, 12, 24, 36 and 48 h postoperatively.
Results: In the patients of the dexmedetomidine group, compared to the
control group, the pain scores at rest or at coughing during 48 h
postoperatively were lower (P < 0.001), the sedation scores were lower,
the consumption of sufentanil and rescue meperidine were lower, and the
number of episode of moderate PONV was three times lower. No signs of
toxicity or local complications were observed. There was a non-significant
trend for a lower HR and BP in the dexmedetomidine group vs. Control.
Conclusion: The combining dexmedetomidine with sufentanil for
post-thoracotomy PCIA can improve pain control together with the decrease
in sufentanil requirements, and improve postoperative patient's
satisfaction compared with sufentanil alone in PCIA. Trial Registration:
This trial was retrospectively registered on 27 April 2016 at the Chinese
Clinical Trial Register (number: ChiCTR-ONC-16008376 ).<br/>Copyright
&#xa9; 2017 The Author(s).

<63>
Accession Number
615590952
Author
Hasanin A.; Aiyad A.; Elsakka A.; Kamel A.; Fouad R.; Osman M.; Mokhtar
A.; Refaat S.; Hassabelnaby Y.
Institution
(Hasanin, Aiyad, Elsakka, Kamel, Osman, Mokhtar, Refaat, Hassabelnaby)
Cairo University, Department of Anesthesia and Critical Care Medicine,
Cairo, Egypt
(Fouad) Cairo University, Department of Obstetrics and Gynecology, Cairo,
Egypt
Title
Leg elevation decreases the incidence of post-spinal hypotension in
cesarean section: A randomized controlled trial.
Source
BMC Anesthesiology. 17 (1) (no pagination), 2017. Article Number: 60. Date
of Publication: 24 Apr 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Maternal hypotension is a common complication after spinal
anesthesia for cesarean section (CS). In this study we investigated the
role of leg elevation (LE) as a method for prevention of post-spinal
hypotension (PSH) for cesarean section. Methods: One hundred and fifty
full term parturients scheduled for CS were included in the study.
Patients were randomized into two groups: Group LE (leg elevation group,
n=75) and group C (Control group, n=75). Spinal block was performed in
sitting position after administration of 10mL/Kg Ringer's lactate as fluid
preload. After successful intrathecal injection of local anesthetic,
Patients were positioned in the supine position. Leg elevation was
performed for LE group directly after spinal anesthesia and maintained
till skin incision. Intraoperative hemodynamic parameters (Arterial blood
pressure and heart rate), intra-operative ephedrine consumption, incidence
of PSH, and incidence of nausea and vomiting were reported. Results: LE
group showed lower incidence of PSH (34.7% Vs 58.7%, P=0.005) compared to
the control group. Arterial blood pressure was higher in the LE group
compared to the control group in the first two readings after spinal
block. Other readings showed comparable arterial blood pressure and heart
rate values between both study groups; however, LE showed less ephedrine
consumption (4.9+/-7.8mg Vs 10+/-11mg, P=0.001). Conclusion: LE performed
immediately after spinal block reduced the incidence of PSH in parturients
undergoing CS. Trial registration: The study was registered at Pan African
Clinical Trials Registry system on 5/10/2015 with trial number
PACTR201510001295348.<br/>Copyright &#xa9; 2017 The Author(s).

<64>
Accession Number
616876443
Author
Fabritius M.L.; Geisler A.; Petersen P.L.; Wetterslev J.; Mathiesen O.;
Dahl J.B.
Institution
(Fabritius, Dahl) Bispebjerg and Frederiksberg Hospitals, Department of
Anaesthesiology and Intensive Care, Bispebjerg bakke 23, Copenhagen, NV
2400, Denmark
(Geisler, Mathiesen) Zealand University Hospital, Department of
Anaesthesiology, Lykkebaekvej 1, Koge 4600, Denmark
(Petersen) Copenhagen University Hospital, Department of Anaesthesiology,
Centre of Head and Orthopaedics, Rigshospitalet, Blegdamsvej 9, Copenhagen
2100, Denmark
(Wetterslev) Copenhagen University Hospital, Copenhagen Trial Unit, Centre
for Clinical Intervention Research, Rigshospitalet, Blegdamsvej 9,
Copenhagen 2100, Denmark
Title
Gabapentin in procedure-specific postoperative pain management -
preplanned subgroup analyses from a systematic review with meta-analyses
and trial sequential analyses.
Source
BMC Anesthesiology. 17 (1) (no pagination), 2017. Article Number: 85. Date
of Publication: 21 Jun 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: It has been argued that postoperative pain treatment should be
"procedure-specific", since different analgesics may have specific effects
dependent on the surgical procedure. The aim of the present subgroup
analysis was to compare the beneficial and harmful effects of
perioperative gabapentin treatment in different surgical procedures.
Methods: Relevant databases were searched for randomized clinical trials
(RCTs) comparing gabapentin versus placebo. Two authors independently
screened titles and abstracts, extracted data and assessed risk of bias.
The primary outcomes were differences in 24-h morphine consumption, and
serious adverse events (SAE) between surgical procedures. These subgroup
analyses were predefined in a PRISMA compliant systematic review
registered at PROSPERO (ID: CRD42013006538). It was predefined that
conclusions should primarily be based on trials classified as overall low
risk of bias. Results: Seventy-four RCTs with 5645 patients were included,
assessing benefit and harm in cholecystectomy, hysterectomy, mastectomy,
and arthroplasty surgery, spinal surgery, and thoracic surgery. Only eight
of 74 trials were classified as overall low risk of bias limiting our
ability to conclude on the estimates in most meta-analyses. The
differences between surgical procedures in these trials were not
statistically significant when tested for subgroup differences. Fifteen
trials with 1377 patients reported a total of 59 SAEs, most of which were
observed in the thoracic surgery group. Conclusion: Both beneficial and
harmful effects in these subgroup analyses were influenced by bias and
insufficient data, limiting conclusions. With these limitations, we could
not adequately test for differences in beneficial or harmful outcomes
between six surgical subgroups undergoing perioperative gabapentin
treatment.<br/>Copyright &#xa9; 2017 The Author(s).

<65>
Accession Number
617795495
Author
Li Q.; Zhang X.; Wu J.; Xu M.
Institution
(Li, Zhang, Wu, Xu) Department of Anesthesiology of Shanghai Chest
Hospital, Shanghai Jiaotong University, Shanghai 200030, China
Title
Two-minute disconnection technique with a double-lumen tube to speed the
collapse of the non-ventilated lung for one-lung ventilation in
thoracoscopic surgery.
Source
BMC Anesthesiology. 17 (1) (no pagination), 2017. Article Number: 80. Date
of Publication: 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Thoracic surgery requires the effective collapse of the
non-ventilated lung. In the majority of cases, we accomplished,
accelerated lung collapse using a double-lumen tube (DLT). We hypothesized
that using the twominute disconnection technique with a DLT would improve
lung collapse during subsequent one-lung ventilation. Methods: Fifty
patients undergoing thoracoscopic surgery with physical classification I
or II according to the American Society of Anesthesiologists were randomly
divided into two groups for respiratory management of one-lung ventilation
(OLV). In group N, OLV was initiated after the DLT was disconnected for 2
min; the initiation time began when the surgeon made the skin incision. In
group C, OLV was initiated when the surgeon commenced the skin incision
and scored the quality of lung collapse (using a four-point ordinal
scale). The surgeon's satisfaction or comfort with the surgical conditions
was assessed using a visual analogue scale. rSO<inf>2</inf> level, mean
arterial pressure, pulse oxygen saturation, arterial blood gas analysis,
intraoperative hypoxaemia, intraoperative use of CPAP during OLV, and
awakening time were determined in patients at the following time points:
while inhaling air (T<inf>0</inf>), after anaesthesia induction
andinhaling 100% oxygen in the supine position under double lung
ventilation for five mins (T<inf>1</inf>), at two mins after skin incision
(T<inf>2</inf>), at ten mins after skin incision (T<inf>3</inf>), and
after the lung recruitment manoeuvres and inhaling 50% oxygen for five
mins (T<inf>4</inf>). Results: The two-minute disconnection technique was
associated with a significantly shorter time to total lung collapse
compared to that of the conventional OLV ventilation method (15 mins vs 22
mins, respectively; P < 0.001), and the overall surgeon's satisfaction was
higher (9 vs 7, respectively; P < 0.001). At T<inf>2</inf>, the
PaCO<inf>2</inf>, left rSO<inf>2</inf> and right rSO<inf>2</inf> were
higher in group N than in group C. There were no statistically significant
differences between the incidence of intraoperative hypoxaemia and
intraoperative use of CPAP during OLV (10% vs 5%, respectively; P =
1.000), duration of awakening (18 mins vs 19 mins, respectively; P =
0.616). Conclusions: A two-minute disconnection technique using a
double-lumen tube was used to speed the collapse of the non-ventilated
lung during one-lung ventilation for thoracoscopic surgery. The surgeon
was satisfied with the surgical conditions.<br/>Copyright &#xa9; The
Author(s). 2017.

<66>
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.

<67>
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.

<68>
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

<69>
Accession Number
618216921
Author
Fors A.; Swedberg K.; Ulin K.; Wolf A.; Ekman I.
Institution
(Fors, Ulin, Wolf, Ekman) Institute of Health and Care Sciences,
Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden, Box 457,
Gothenburg 405 30, Sweden
(Fors, Swedberg, Ulin, Wolf, Ekman) Centre for Person-Centred Care (GPCC),
University of Gothenburg, Gothenburg, Sweden
(Fors) Narhalsan Research and Development Primary Health Care, Region
Vastra Gotaland, Sweden
(Swedberg) Department of Molecular and Clinical Medicine, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden
(Swedberg) National Heart and Lung Institute, Imperial College, London,
United Kingdom
Title
Effects of person-centred care after an event of acute coronary syndrome:
Two-year follow-up of a randomised controlled trial.
Source
International Journal of Cardiology. 249 (pp 42-47), 2017. Date of
Publication: 15 Dec 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Aim To assess the long-term effect of person-centred care (PCC) in
patients with acute coronary syndrome (ACS). Method Patients with ACS were
randomly assigned to treatment as usual (control group) or an added PCC
intervention for six months. The primary endpoint was a composite score of
changes in general self-efficacy >= five units, return to work or to a
prior activity level and re-hospitalisation or death. Results The
composite score improved in the PCC intervention group (n = 94) at a
two-year follow-up compared with the control group (n = 105) (18.1%, n =
17 vs. 10.5%, n = 11; P = 0.127). In the per-protocol analysis (n = 183)
the improvement was significant in favour of the PCC intervention (n = 78)
compared with usual care (n = 105) (21.8%, n = 17 vs. 10.5%, n = 11; P =
0.039). This effect was driven by the finding that more patients in the
PCC group improved their general self-efficacy score >= 5 units (32.2%, n
= 19 vs. 17.3%, n = 14; P = 0.046). The composite score improvement was
significantly higher in the PCC intervention group without post-secondary
education (n = 33) in comparison with corresponding patients in the
control group (n = 50) (30.3%, n = 10 vs. 10.0%, n = 5; P = 0.024).
Conclusion Implementation of PCC results in sustained improvements in
health outcome in patients with ACS. PCC can be incorporated into
conventional cardiac prevention programmes to improve equity in uptake and
patient health outcomes. Trial registration Swedish registry,
Researchweb.org, ID NR 65791.<br/>Copyright &#xa9; 2017 The Authors

<70>
[Use Link to view the full text]
Accession Number
613879067
Author
Nerlekar N.; Ha F.J.; Verma K.P.; Bennett M.R.; Cameron J.D.; Meredith
I.T.; Brown A.J.
Institution
(Nerlekar, Ha, Verma, Cameron, Meredith, Brown) Monash Cardiovascular
Research Centre, Monash University, Clayton, VIC, Australia
(Nerlekar, Ha, Verma, Cameron, Meredith, Brown) MonashHeart, Clayton, VIC,
Australia
(Nerlekar, Ha, Verma, Cameron, Meredith, Brown) Monash Health, Clayton,
VIC, Australia
(Bennett, Brown) Division of Cardiovascular Medicine, University of
Cambridge, Cambridge, United Kingdom
Title
Percutaneous coronary intervention using drug-eluting stents versus
coronary artery bypass grafting for unprotected left main coronary artery
stenosis.
Source
Circulation: Cardiovascular Interventions. 9 (12) (no pagination), 2016.
Date of Publication: 01 Dec 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Current guidelines suggest that coronary artery bypass
grafting (CABG) should be the preferred revascularization method for
unprotected left main coronary artery stenosis. In light of evidence from
recent randomized trials, we assessed whether percutaneous coronary
intervention (PCI) using drug-eluting stents is as safe and effective as
CABG for the treatment of unprotected left main coronary artery disease.
Methods and Results - Digital databases and manual searches were performed
for randomized trials comparing PCI and CABG for unprotected left main
coronary artery stenosis. Among 3887 potentially relevant studies, 5 met
inclusion criteria. The primary safety end point was defined as the
composite of all-cause death, myocardial infarction, or stroke. Secondary
end points included a clinical effectiveness composite, which was defined
as all-cause death, myocardial infarction, stroke, or repeat
revascularization. Summary estimates were obtained using random-effects
modeling. In total, 4594 patients were included in the analysis. There was
no significant difference in the primary safety end point between the
revascularization strategies (odds ratio [OR], 0.97; 95% confidence
interval [CI], 0.79-1.17; P=0.73). However, when compared with CABG, PCI
was less effective (OR, 1.36; 95% CI, 1.18-1.58; P<0.001) because of
significantly higher rates of repeat revascularization (OR, 1.85; 95% CI,
1.53-2.23; P<0.001). The incidence of all-cause death (OR, 1.03; 95% CI,
0.78-1.35; P=0.61), myocardial infarction (OR, 1.46; 95% CI, 0.88-2.45;
P=0.08), and stroke (OR, 0.88; 95% CI, 0.39-1.97; P=0.53) did not differ
between PCI and CABG. Conclusions - PCI using drug-eluting stents and CABG
are equally safe methods of revascularization for patients at low surgical
risk with significant unprotected left main coronary artery stenosis.
However, CABG is associated with significantly lower rates of repeat
revascularization.<br/>Copyright &#xa9; 2016 American Heart Association,
Inc.

<71>
[Use Link to view the full text]
Accession Number
613333633
Author
Rodes-Cabau J.; Jolly S.S.; Cairns J.; Mansour S.; L'Allier P.L.; Teefy
P.J.; Graham J.J.; Le May M.R.; Cantor W.J.; Wood D.; Balasubramanian K.;
Delarochelliere R.; Dzavik V.
Institution
(Rodes-Cabau, Delarochelliere) Department of Cardiology, Quebec Heart and
Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Quebec City
G1V4G5, Canada
(Jolly) Population Health Research Institute, Hamilton General Hospital,
McMaster University, Ontario, Canada
(Cairns, Wood) Department of Medicine, Vancouver General Hospital, British
Columbia, Canada
(Mansour) Cardiology Department, Centre Hospitalier Universitaire,
Montreal, QC, Canada
(L'Allier) Department of Medicine, Montreal Heart Institute, Quebec,
Canada
(Teefy) Department of Medicine, University Hospital, London Health
Sciences Centre, Ontario, Canada
(Graham) Division of Cardiology, St. Michael's Hospital, Toronto, ON,
Canada
(Le May) Department of Cardiology, Ottawa Heart Institute, Ontario, Canada
(Cantor) York PCI Group, Division of Cardiology, Southlake Regional
Hospital, Newmarket, ON, Canada
(Balasubramanian) Statistics Department, Population Health Research
Centre, Hamilton, ON, Canada
(Dzavik) Department of Medicine, Toronto General Hospital, Ontario, Canada
Title
Sealing Intermediate Nonobstructive Coronary Saphenous Vein Graft Lesions
with Drug-Eluting Stents as a New Approach to Reducing Cardiac Events: A
Randomized Controlled Trial.
Source
Circulation: Cardiovascular Interventions. 9 (11) (no pagination), 2016.
Article Number: e004336. Date of Publication: 01 Nov 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background-The objective of this study was to assess the efficacy of
sealing intermediate nonobstructive coronary saphenous vein graft (SVG)
lesions with drug-eluting stents (DES; paclitaxel-or everolimus-eluting
stents) for reducing major adverse cardiac events (MACE). Methods and
Results-This was a randomized controlled multicenter clinical trial that
enrolled patients with a previous coronary artery bypass graft who had
developed at least 1 intermediate nonobstructive SVG lesion (30%-60%
diameter stenosis by visual estimation). Patients were randomized (1:1) to
DES implantation (SVG-DES) or medical treatment (SVG-MT) of the target SVG
lesion. The primary efficacy outcome was the first occurrence of MACE
defined as the composite of cardiac death, myocardial infarction, or
coronary revascularization related to the target SVG during the duration
of follow-up (minimum of 2 years). Secondary efficacy outcomes included
MACE related to the target SVG lesion and overall MACE. A total of 125
patients (mean age 70+/-9 years, 87% men) were included, with a mean time
from coronary artery bypass graft of 12+/-5 years. Sixty and 65 patients
were allocated to the SVG-DES and SVG-MT groups, respectively. There were
no events related to the target SVG at 30 days. After a median follow-up
of 3.4 (interquartile range: 2.8-3.9) years, the MACE rate related to the
target SVG was not significantly different in the 2 groups (SVG-DES:
15.0%, SVG-MT: 20.0%; hazard ratio, 0.65; 95% confidence interval,
0.23-1.53; P=0.33). There were no significant differences between groups
in MACE related to the target SVG lesion (SVG-DES: 10.0%, SVG-MT: 16.9%;
hazard ratio, 0.53; 95% confidence interval, 0.20-1.43; P=0.21) or global
MACE (SVG-DES: 36.7%, SVG-MT: 44.6%; hazard ratio, 0.73; 95% confidence
interval, 0.42-1.27; P=0.26). Conclusions-Sealing intermediate
nonobstructive SVG lesions with DES was safe but was not associated with a
significant reduction of cardiac events at 3-year follow-up.<br/>Copyright
&#xa9; 2016 American Heart Association, Inc.

<72>
Accession Number
619127987
Author
Bigdelian H.; Sedighi M.
Institution
(Bigdelian) Department of Cardiovascular Surgery, School of Medicine,
Isfahan University of Medical Science, Isfahan, Iran, Islamic Republic of
(Sedighi) Department of Cardiovascular Surgery, Chamran Heart Center,
Isfahan University of Medical Science, Isfahan, Iran, Islamic Republic of
(Sedighi) Department of Neuroscience, Faculty of Advanced Technologies in
Medicine, Iran University of Medical Science, Tehran, Iran, Islamic
Republic of
Title
The role of preoperative sildenafil therapy in controlling of
postoperative pulmonary hypertension in children with ventricular septal
defects.
Source
Journal of Cardiovascular and Thoracic Research. 9 (3) (pp 179-182), 2017.
Date of Publication: 2017.
Publisher
Tabriz University of Medical Sciences (E-mail: tmj@taibahu.edu.sa)
Abstract
Introduction: Most of the ventricular septal defects (VSD) are complicated
with pulmonary arterial hypertension (PAH) which is the major cause of
pulmonary hypertensive crisis and right ventricular failure. Methods: We
reviewed clinical outcomes of 63 infants who underwent cardiac surgery and
were divided into three groups. Control group (n=20) did not received
sildenafil while group A (n = 22) received drug (0.3 mg/kg) before and
after surgery. Group B (n=21) received drug at the initiation of surgery.
Demographic data, preoperative and postoperative variables were compared
among the patients. Results: Patients in the group A had lower
preoperative pulmonary arterial pressure (PAP) compared to other groups (P
<0.001). Also, patients in control group had longer cardiopulmonary bypass
time (P <0.05). Postoperative PAP in patients of group A and B decreased
significantly compared to control group (P <0.001). Also, pre- and
postoperative PVR (pulmonary vascular resistance) showed a significant
decrease in group A compared with control and group B (P <0.001). The
intubation time in patients of the control group was significantly more
prolonged compared with patients of group A and B (P <0.001). Moreover,
the length of ICU stay was significantly longer in patients of control
group compared with group A and B (P <0.001). Conclusion: Preoperative
sildenafil therapy seems to be effective and safe to prevent postoperative
PAH and pulmonary hypertensive crisis in children with ventricular septal
defects and has a positive impact on postoperative care.<br/>Copyright
&#xa9; 2017 The Author (s).

<73>
Accession Number
619122345
Author
Levy J.H.; Rossaint R.; Zacharowski K.; Spahn D.R.
Institution
(Levy) Department of Anesthesiology, Duke University School of Medicine,
Durham, NC, United States
(Rossaint) Department of Anaesthesiology, RWTH Aachen University Hospital,
Aachen, Germany
(Zacharowski) Department of Anaesthesiology, Intensive Care Medicine &
Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
(Spahn) Institute of Anesthesiology, University and University Hospital of
Zurich, Zurich, Switzerland
Title
What is the evidence for platelet transfusion in perioperative settings?.
Source
Vox Sanguinis. 112 (8) (pp 704-712), 2017. Date of Publication: November
2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Background and Objectives: Platelet transfusions are widely administered
to restore perioperative haemostasis in haemorrhagic patients; however,
the role of platelet transfusion is not well understood and administration
is often based on empiric data. This review aims to explore consensus
regarding platelet transfusion trigger, dose and how the haemostatic
efficacy of platelet transfusion was assessed for the treatment of
perioperative bleeding. Materials and Methods: A literature search was
carried out using MEDLINE (PubMed) on 28 February 2017, to identify
publications reporting the effect of platelet transfusion in relation to
triggers, dose and assessment of haemostatic efficacy in bleeding patients
in a perioperative setting. Results: Eight publications were identified
across a variety of settings, covering both prophylactic and therapeutic
platelet transfusion in adult patients; the majority of the reports were
in cardiac surgery. A high degree of variability was observed in the
published studies, with only 50% of articles specifying a trigger for
platelet transfusion. The most commonly used trigger was platelet count
(25% of publications), with no consensus identified regarding the platelet
count values used as triggers. Doses reported per transfusion varied from
1 to 12 units, and outcome measures were mixed, although the majority of
publications (63%) assessed the requirement for transfusion with other
blood products. Conclusion: The lack of consensus in published studies
hinders our ability to draw conclusions regarding platelet transfusion and
highlights the need for further studies to assess the appropriate dose and
triggers for use in perioperative patients.<br/>Copyright &#xa9; 2017
International Society of Blood Transfusion

<74>
Accession Number
613630429
Author
Wiebe J.; Detten G.; Scheckel C.; Gearhart D.; Wheeler D.; Sanders D.;
Vassar M.
Institution
(Wiebe, Detten, Scheckel, Gearhart, Wheeler, Sanders, Vassar) Oklahoma
State University Center for Health Sciences, United States
Title
The heart of the matter: Outcome reporting bias and registration status in
cardio-thoracic surgery.
Source
International Journal of Cardiology. 227 (pp 299-304), 2017. Date of
Publication: 15 Jan 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Our objective is to compare registered outcomes to published
reports; to evaluate for discrepancies favoring statistically significant
outcomes; to examine funding source and likelihood of outcome reporting
bias; and to evaluate for any temporal trends in outcome reporting bias.
Methods PubMed was searched for randomized controlled trials published
between 2008 and 2015 from 4 high impact cardio-thoracic journals:
European Journal of Cardio-thoracic Surgery (EJCS), The Journal of
Cardiothoracic Surgery (JCS), The Journal of Thoracic and Cardiovascular
Surgery (JTCS), and Annals of Cardiothoracic Surgery (ACS). Data was
collected using a standardized extraction form. Results We reviewed 287
articles, of which 214 (74.6%) did not meet registration criteria. Of
those 214, 94 (43.9%) were published in the EJCS, 34 (15.9%) in JCS, 86
(40.2%) in JTCS, and 0 (0%) in the ACS. Of the remaining 73 articles, 34
(46.6%) had a discrepancy between the primary outcome registered and the
published outcome, and 11 of the 34 reported p-values favoring the change.
We also found that 12 of the 73 registrations had updated primary outcomes
from the initial report to the final report. The timing of registration
was an incidental finding showing 14 (19.1%) articles retrospectively
registered, 29 (39.7%) registered during patient enrollment, and 30
(41.1%) registered prospectively. Conclusion The results indicated that
selective outcome reporting is prevalent in cardio-thoracic surgery
journals. The more concerning issue, however, is the lack of registration
or provision of registration number for randomized controlled trials
within these journals.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd

<75>
[Use Link to view the full text]
Accession Number
608698034
Author
Stehouwer M.C.; De Vroege R.; Kelder J.C.; Hofman F.N.; De Mol B.A.;
Bruins P.
Institution
(Stehouwer) Department of Extracorporeal Circulation, St Antonius
Hospital, Koekoekslaan 1, Nieuwegein 3430 EM, Netherlands
(De Vroege) Department of Extracorporeal Circulation, HAGA Hospital, The
Hague, Netherlands
(Kelder) Department of Cardiology, St Antonius Hospital, Nieuwegein,
Netherlands
(Hofman) Department of Cardiothoracic Surgery, St Antonius Hospital,
Nieuwegein, Netherlands
(De Mol) Section Cardiovascular Biomechanics, Faculty of Biomedical
Technology, Technical University Eindhoven, Eindhoven, Netherlands
(Bruins) Department of Anaesthesiology, Intensive Care and Pain
Management, St Antonius Hospital, Nieuwegein, Netherlands
Title
Effect of oxygenator size on air removal characteristics: A clinical
evaluation.
Source
ASAIO Journal. 62 (4) (pp 421-426), 2016. Date of Publication: 01 Aug
2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
During cardiopulmonary bypass (CPB), gaseous microemboli (GME) are
released into the patients' arterial bloodstream. Gaseous microemboli may
contribute to the adverse outcome after cardiac surgery. Recently, two
oxygenator models with or without integrated arterial filter (IAF) were
designed and only differ in size, leading to a change of 20% in surface
area of the hollow fibers and 25% in blood velocities. The aim of this
study was to assess the air removal characteristics of the inspire
oxygenators with or without IAF. Sixty-eight patients were randomly
assigned to four different groups: optimized adult and full adult and an
additional IAF. Gaseous microemboli reduction rates were measured with a
bubble counter. The number of GME reduction rates showed no differences.
However, both models reduced significantly less volume of GME (optimized
adult: 40.6% and full adult: 50.3%) compared with both models with IAF
(88.7% and 88.5%, respectively). No significant differences of reduction
rates were found between both devices without IAF and also not between
both models with IAF. In conclusion, the larger inspire oxygenator tends
to remove more GME. No effect from size of oxygenator device with
integrated screen filter on GME reduction was observed. The inspire
oxygenators with IAF may be considered as an adequate GME
filter.<br/>Copyright &#xa9; 2016 by the American Society for Artificial
Internal Organs.

<76>
Accession Number
612224674
Author
Ibrahim M.; Menna C.; Andreetti C.; Puyo C.; Maurizi G.; D'andrilli A.;
Ciccone A.M.; Massullo D.; Vanni C.; Berardi G.; Baldini R.; Rendina E.A.
Institution
(Ibrahim, Andreetti, Maurizi, D'andrilli, Ciccone, Vanni, Rendina)
Division of Thoracic Surgery, Sapienza University of Rome, Sant'Andrea
Hospital, Via di Grottarossa, Rome 1035-00189, Italy
(Menna) Division of Thoracic Surgery, University of L'Aquila, G. Mazzini
Hospital of Teramo, Teramo, Italy
(Puyo) Department of Anesthesiology, Washington University in St. Louis,
St. Louis, MO, United States
(Massullo) Division of Anesthesiology, Sapienza University of Rome,
Sant'Andrea Hospital, Rome, Italy
(Berardi) Division of General Surgery, Sapienza University of Rome,
Sant'Andrea Hospital, Rome, Italy
(Baldini) Department of Statistics, Faculty of Medicine and Psychology,
Sapienza University of Rome, Rome, Italy
Title
Does a multimodal No-Compression suture technique of the intercostal space
reduce chronic postthoracotomy pain? A prospective randomized study.
Source
Journal of Thoracic Oncology. 11 (9) (pp 1460-1468), 2016. Date of
Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: agents@lww.com)
Abstract
Introduction: Chronic postthoracotomy pain is a significant adverse
outcome of thoracic surgery. We evaluated with a prospective randomized
trial the effect of a multimodal no-compression suture technique of the
intercostal space on postoperative pain occurrence in patients undergoing
minithoracotomy. Methods: Patients undergoing a muscle-sparing lateral
minithoracotomy for different thoracic diseases were randomly divided into
two groups: 146 patients received intercostal muscle flap harvesting and
pericostal nocompression "edge" suture (the IMF group), and 151 patients
received a standard suture technique associated with an intrapleural
intercostal nerve block (the IINB group). Pain scores and interference of
pain with daily activities were assessed by using the Italian version of
the Brief Pain Inventory on day 1, and at 1 to 6 months postoperatively.
The results of pulmonary function tests (spirometry and the 6-minute
walking test ) were evaluated preoperatively and at 1 and 6 months
postoperatively. Results: Postthoracotomy pain scores throughout the first
postoperative day were significantly lower in the IMF group. After 1 and 6
months, patients in the IMF group had a significantly lower average pain
score (p = 0.001). There were no significant differences in pain
interference scores at each evaluation time point in either group.
However, differences were shown in lung function test results at 1 and 6
months postoperatively (the forced expiratory volume in 1 second in the
IINB group averaged 68.8 +/- 17.4% of predicted value and 72.8 +/- 10.5%,
respectively, and in the IMF group it averaged 83.1 +/- 7.4% and 86.4 +/-
12.8%, respectively [p = 0.023 and 0.013, respectively]; the 6-minute
walking test results in the IINB group averaged 311.1 +/- 51.0 and 329.9
+/- 54.8 m, respectively, and those in the IMF group averaged 371.2 +/-
54.8 and 395.7 +/- 56.4 m, respectively [p = 0.0001]). Conclusions: The
multimodal no-compression suture technique is a rapid and feasible
procedure that reduces the intensity of early and chronic postthoracotomy
pain.<br/>Copyright &#xa9; 2016 International Association for the Study of
Lung Cancer. Published by Elsevier Inc. All rights reserved.

<77>
[Use Link to view the full text]
Accession Number
616784257
Author
Al Tmimi L.; Devroe S.; Dewinter G.; Van De Velde M.; Poortmans G.; Meyns
B.; Meuris B.; Coburn M.; Rex S.
Institution
(Al Tmimi, Devroe, Dewinter, Van De Velde, Poortmans, Rex) Department of
Anesthesiology, University Hospitals Leuven, Herestraat 49, Leuven 3000,
Belgium
(Van De Velde, Meyns, Meuris, Rex) Departments of Cardiovascular Sciences,
University Hospitals Leuven, Leuven, Belgium
(Meyns, Meuris) Cardiac Surgery, KU Leuven, University of Leuven,
University Hospitals Leuven, Leuven, Belgium
(Coburn) Department of Anesthesiology, University Hospital of the RWTH
Aachen, Aachen, Germany
Title
Xenon as an Adjuvant to Propofol Anesthesia in Patients Undergoing
Off-Pump Coronary Artery Bypass Graft Surgery: A Pragmatic Randomized
Controlled Clinical Trial.
Source
Anesthesia and Analgesia. 125 (4) (pp 1118-1128), 2017. Date of
Publication: 01 Oct 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
BACKGROUND: Xenon was shown to cause less hemodynamic instability and
reduce vasopressor needs during off-pump coronary artery bypass (OPCAB)
surgery when compared with conventionally used anesthetics. As xenon
exerts its organ protective properties even in subanesthetic
concentrations, we hypothesized that in patients undergoing OPCAB surgery,
30% xenon added to general anesthesia with propofol results in superior
hemodynamic stability when compared to anesthesia with propofol alone.
METHODS: Fifty patients undergoing elective OPCAB surgery were randomized
to receive general anesthesia with 30% xenon adjuvant to a
target-controlled infusion of propofol or with propofol alone. The primary
end point was the total intraoperative dose of norepinephrine required to
maintain an intraoperative mean arterial pressure >70 mm Hg. Secondary
outcomes included the perioperative cardiorespiratory profile and the
incidence of adverse and serious adverse events. RESULTS: Adding xenon to
propofol anesthesia resulted in a significant reduction of norepinephrine
required to attain the predefined hemodynamic goals (cumulative
intraoperative dose: median [interquartile range]: 370 [116-570] vs 840
[335-1710] mug, P =.001). In the xenon-propofol group, significantly less
propofol was required to obtain a similar depth of anesthesia as judged by
clinical signs and the bispectral index (propofol effect site
concentration [mean +/- SD]: 1.8 +/- 0.5 vs 2.8 +/- 0.3 mg, P<=.0001).
Moreover, the xenon-propofol group required significantly less
norepinephrine during the first 24 hours on the intensive care unit
(median [interquartile range]: 1.5 [0.1-7] vs 5 [2-8] mg, P =.048). Other
outcomes and safety parameters were similar in both groups. CONCLUSIONS:
Thirty percent xenon added to propofol anesthesia improves hemodynamic
stability by decreasing norepinephrine requirements in patients undergoing
OPCAB surgery.<br/>Copyright &#xa9; 2017 International Anesthesia Research
Society.

<78>
Accession Number
619070096
Author
Ishii A.; Chihara H.; Kikuchi T.; Arai D.; Ikeda H.; Miyamoto S.
Institution
(Ishii, Chihara, Kikuchi, Arai, Ikeda, Miyamoto) Department of
Neurosurgery, Kyoto University, Graduate School of Medicine, 54
Kawahara-cho, Syogo-in, Sakyo-ku, Kyoto 606-8507, Japan
Title
Contribution of the straightening effect of the parent artery to decreased
recanalization in stent-assisted coiling of large aneurysms.
Source
Journal of Neurosurgery. 127 (5) (pp 1063-1069), 2017. Date of
Publication: November 2017.
Publisher
American Association of Neurological Surgeons (E-mail:
jnevro@virginia.edu)
Abstract
OBJECTIVE The durability of embolization of large aneurysms is enhanced by
use of the neck-bridging stent. However, it remains unclear what factors
contribute to decreased recanalization. The purpose of this study was to
demonstrate the contribution of the straightening effect of the parent
artery to the durability of stent-assisted coiling for large aneurysms.
METHODS Of the 182 aneurysms treated by embolization since the
introduction of the neurovascular stent, 82 consecutive unruptured
aneurysms with a diameter greater than 7 mm were selected. There were 52
aneurysms treated with a stent (Group S) and 30 treated without a stent
(Group NS). Occlusion status was evaluated 12 months after embolization
with digital subtraction angiography. The vascular angle of the parent
artery was measured before, immediately after, and 12 months after
embolization. The rates of recanalization were compared between Group S
and Group NS. In Group S, the rates of recanalization were further
compared between those aneurysms with and without a significant angle
change. RESULTS The rate of major recanalization was 9.6% in Group S and
26.7% in Group NS. The volume embolization ratio was 32.6% in Group S and
31.6% in Group NS, with no statistically significant difference. However,
the angulation change before and after coiling was significantly higher in
Group S (10.6degree) than in Group NS (0.9degree). The difference in the
angulation was more evident 12 months after coiling (19.1degree in Group S
and 1.5degree in Group NS). In Group S, recanalization was found in 14.3%
of 35 stented aneurysms without a significant angular change when a
significant angular change was defined as more than 20degree. In contrast,
all 17 aneurysms with >=20degree of angular change remained occluded.
CONCLUSIONS Significant angular change of >=20degree most likely leads to
decreased recanalization following stentassisted embolization of large
aneurysms.<br/>Copyright &#xa9; AANS, 2017.

<79>
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.

<80>
Accession Number
619107212
Author
Anonymous
Title
21st International Congress of the Polish Cardiac Society.
Source
Kardiologia Polska. Conference: 21st International Congress of the Polish
Cardiac Society. Poland. 75 (Supplement 4) (no pagination), 2017. Date of
Publication: September 2017.
Publisher
Via Medica
Abstract
The proceedings contain 126 papers. The topics discussed include: effect
of antiplatelet P2Y12 receptor blockers on angiogenic properties of
vascular endothelial cells in vitro conditions; the effect of
maltose-modified 4th generation of poly(propylene imine) dendrimers on
barrier functions and inflammatory activation of human vascular
endothelium; none of fibrosis-linked microRNA (miR-21, miR-26, miR-29,
miR-30 and miR-133a) is associated with cardiovascular events in dilated
cardiomyopathy; beneficial effect of intravenous iron, ferric
carboxymaltose, in heart failure; elevated levels of circulating miRNA-499
in early phase of non-ST elevation acute coronary syndromes predict a risk
of major adverse cardiac events in long-term monitoring; do beta-blockers
improve one-year survival in heart failure patients with atrial
fibrillation? - results from the ESC-HF registry; the prevalence of
cardiotropic viruses in patients with clinical suspicion of viral heart
disease; heart failure with mid-range ejection fraction - clinical
characteristics and in-hospital outcomes. insights into novel enigma based
on the results from the ESC-HF registries; quantification of mitral
regurgitation in patients with hypertrophic cardiomyopathy with the use of
aortic and pulmonary flow data: impact of left ventricular outflow tract
obstruction and different left ventricular segmentation methods;
comparison of outcomes in patients with severe aortic stenosis undergoing
concomitant balloon aortic valvuloplasty and percutaneous coronary
intervention versus balloon aortic valvuloplasty alone; epidemiology and
chronobiology of out-of-hospital cardiac arrest in Opole district - a
2-year observation; and influence of energy drinks on hemodynamic
parameters in young healthy adults - randomized double-blind placebo
controlled cross-over study.