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<1>
Accession Number
618044514
Author
Lindholt J.S.; Sogaard R.
Institution
(Lindholt) Department of Cardiothoracic and Vascular Surgery, Odense
University Hospital, Odense, Denmark
(Lindholt) Vascular Research Unit, Viborg Hospital, Viborg, Denmark
(Sogaard) Department of Public Health and Department of Clinical Medicine,
Aarhus University, Aarhus, Denmark
Title
Population screening and intervention for vascular disease in Danish men
(VIVA): a randomised controlled trial.
Source
The Lancet. 390 (10109) (pp 2256-2265), 2017. Date of Publication: 18 - 24
November 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Abdominal aortic aneurysm is the only cardiovascular disease
targeted by population screening. In this study, we test the effect of
screening and subsequent intervention for abdominal aortic aneurysm,
peripheral arterial disease, and hypertension combined. Methods In this
randomised controlled trial, we randomly allocated (1:1) all men aged
65-74 years living in the Central Denmark Region to screening for
abdominal aortic aneurysm, peripheral arterial disease, and hypertension,
or to no screening. We based allocation on computer-generated random
numbers from 1 to 100 in blocks of 1067 to 4392, stratified by 19
municipalities. Only the non-screening group and the investigator
assessing outcomes were masked. We invited participants who were found to
have abdominal aortic aneurysm or peripheral arterial disease back for
confirmation and eventual initiation of relevant pharmacological therapy.
We further offered participants with abdominal aortic aneurysm annual
control or surgical repair. We referred participants with suspected
hypertension to their general practitioner. The primary outcome was
all-cause mortality, assessed 5 years after randomisation, analysed in all
randomly allocated participants except for those who had incorrect person
identification numbers. This trial is registered at ClinicalTrials.gov,
number NCT00662480. Findings Between Oct 8, 2008, and Jan 11, 2011, we
randomly allocated 50 156 participants, with 25 078 (50%) each in the
screening and non-screening groups. Four (<1%) participants in the
screening group were lost to follow-up. After a median follow-up of 4.4
years (IQR 3.9-4.8), 2566 (10.2%) of 25 074 participants in the screening
group and 2715 (10.8%) of 25 078 in the non-screening group had died. This
finding resulted in a significant hazard ratio of 0.93 (95% CI 0.88-0.98;
p=0.01), an absolute risk reduction of 0.006 (0.001-0.011), and a number
needed to invite of 169 (89-1811). Incidences of diabetes (3995 per 100
000 person-years in the screening group vs 4129 per 100 000 person-years
in the non-screening group), intracerebral haemorrhage (146 vs 140), renal
failure (612 vs 649), cancer (3578 vs 3719), or 30 day mortality after
cardiovascular surgery (44.57 vs 39.33) did not differ between groups.
Interpretation The observed reduction of mortality risk from abdominal
aortic aneurysm, peripheral arterial disease, and hypertension has never
been seen before in the population screening literature and can be linked
primarily to initiation of pharmacological therapy. Health policy makers
should consider implementing combined screening whether no screening or
isolated abdominal aortic aneurysm screening is currently offered. Funding
The 7th European Framework Programme, Central Denmark Region, Viborg
Hospital, and the Danish Council for Independent Research.<br/>Copyright
&#xa9; 2017 Elsevier Ltd

<2>
Accession Number
618215632
Author
Russo A.; Carriero G.; Farcomeni A.; Ceccarelli G.; Tritapepe L.; Venditti
M.
Institution
(Russo, Farcomeni, Ceccarelli, Venditti) Department of Public Health and
Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
(Carriero, Tritapepe) Department of Cardiovascular, Respiratory,
Nephrologic, Anesthesiologic and Geriatric Sciences, "Sapienza" University
of Rome, Rome, Italy
Title
Role of oral nystatin prophylaxis in cardiac surgery with
prolongedextracorporeal circulation.
Source
Mycoses. 60 (12) (pp 826-829), 2017. Date of Publication: December 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Duration >120 minutes of extracorporeal circulation (ECC) during
cardiopulmonary bypass procedure was associated to an increased risk of
candidemia in the intensive care unit (ICU). To evaluate oral nystatin
prophylaxis in cardiac surgery considering its exclusive effect on
Candida, in the absence of systemic effects and selection of resistant
strains to polyene. We conducted an observational study in the postcardiac
surgery ICU of Policlinico "Umberto I" of Rome. From January 2014, all
patients with a prolonged ECC >120 minutes were systematically treated
with oral nystatin (Prophylaxis group). This group was compared with all
patients hospitalised in the same ICU, who have not received oral nystatin
after ECC >120 minutes (No prophylaxis group). Overall, 672 consecutive
patients were analyzed: 318 (47.3%) patients belonged to the no
prophylaxis group, and 354 (52.7%) patients to the prophylaxis group.
Diagnosis of candidemia was confirmed in 7 (2.2%) patients, all belonged
to the no prophylaxis group. At multivariate analysis, oral nystatin
prophylaxis showed a protective effect for development of candidemia after
cardiac surgery. Oral nystatin prophylaxis, in patients who underwent a
ECC >120 minutes, seems to reduce development of candidemia; however, the
real efficacy of such prophylaxis approach requires further
investigation.<br/>Copyright &#xa9; 2017 Blackwell Verlag GmbH

<3>
Accession Number
616841676
Author
Gatti G.; Perrotti A.; Fiore A.; Bergoend E.; Chocron S.; Couetil J.-P.;
Sinagra G.; Pappalardo A.
Institution
(Gatti, Sinagra, Pappalardo) Cardiovascular department, Ospedali Riuniti
and university of Trieste, Trieste, Italy
(Perrotti, Chocron) Department of thoracic and cardiovascular surgery,
university hospital Jean-Minjoz, Besancon 25000, France
(Fiore, Bergoend, Couetil) Department of cardiac and thoracic surgery,
university hospital Henri-Mondor, Assistance publique-Hopitaux de Paris,
Creteil 94000, France
Title
Is bilateral internal thoracic artery grafting a safe option for chronic
dialysis patients?.
Source
Archives of Cardiovascular Diseases. 110 (12) (pp 646-658), 2017. Date of
Publication: December 2017.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Background The use of bilateral internal thoracic artery (BITA) grafting
has been proposed for dialysis patients with multivessel coronary artery
disease, primarily because of hypothetical long-term survival benefits.
Aims To investigate the outcome of BITA grafting in dialysis patients.
Methods This was a retrospective analysis of the use of BITA grafting in
105 consecutive patients with end-stage renal failure on chronic dialysis
in three European centres with extensive experience in BITA. Baseline
patient characteristics, operative data, early postoperative complications
and late survival were reviewed. Outcomes of patients from one of the
three centres who underwent either BITA (n = 40) or single internal
thoracic artery (SITA) grafting (n = 19) were also analysed; a one-to-one
propensity score (PS)-matched analysis was performed. Results There were
19 (18.1%) hospital deaths. Despite differences in preoperative patient
characteristics and surgical features, in each centre, hospital mortality
was greater than the 75th percentile of expected operative risk (EuroSCORE
II). Diseased ascending aorta and extracardiac arteriopathy were found to
be predictors of hospital death (odds ratio 9.7; P = 0.006) and
complicated hospital course (odds ratio 2.54; P = 0.035), respectively.
The 7-year non-parametric estimates of freedom from all-cause death and
cardiac or cerebrovascular death were 59% (95% confidence interval:
52.3-65.7%) and 75.6% (95% confidence interval: 71.2-80%), respectively.
There were no significant differences in early and late outcomes between
BITA and SITA PS-matched groups. Conclusions BITA grafting remains a risky
operation for chronic dialysis patients, even when performed routinely. No
long-term survival benefits for the use of BITA versus SITA were
proven.<br/>Copyright &#xa9; 2017 Elsevier Masson SAS

<4>
Accession Number
619416813
Author
Anonymous
Title
Late Breaking Clinical Trial - 21st Annual Scientific Meeting, Heart
Failure Society of America.
Source
Journal of Cardiac Failure. Conference: 21st Annual Scientific Meeting of
the Heart Failure Society of America, HFSA 2017. United States. 23 (11)
(no pagination), 2017. Date of Publication: November 2017.
Publisher
Churchill Livingstone Inc.
Abstract
The proceedings contain 5 papers. The topics discussed include:
transcatheter mitral valve repair in patients with functional mitral
regurgitation - one-year outcomes from the multicenter CE trial; geriatric
out-of-hospital randomized meal trial in heart failure (GOURMET-HF) pilot
randomized trial: primary results; effect of natriuretic peptide-guided
therapy on outcomes in high-risk patients with heart failure and reduced
ejection fraction: a randomized clinical trial; randomized evaluation of
heart failure with preserved ejection fraction patients with acute heart
failure and dopamine (Ropa-Dop) trial; and the HeartLogic multi-sensor
algorithm significantly augments the prognosis of a baseline NT-proBNP
assessment for heart failure events.

<5>
Accession Number
619430986
Author
Park C.H.; Lee S.H.
Institution
(Park, Lee) Spine Health Wooridul Hospital, Daegu, South Korea
Title
Endoscopic epidural laser decompression versus transforaminal
epiduroscopic laser annuloplasty for lumbar disc herniation: A
prospective, randomized trial.
Source
Pain Physician. 20 (7) (pp 663-670), 2017. Date of Publication:
November-December 2017.
Publisher
American Society of Interventional Pain Physicians (E-mail:
editor@painphysicianjournal.com)
Abstract
Background: Lumbar radicular pain often results from lumbar disc
herniation, spinal stenosis, or degenerative spondylolisthesis. Minimally
invasive disc decompression procedures, such as nucleoannuloplasty or
epiduroscopic neural decompression by laser, have been devised to treat
such pain. Objective: The short-term outcomes of disc decompression by
endoscopic epidural laser decompression (EELD) or transforaminal
epiduroscopic laser annuloplasty (TELA) were compared in patients with
lumbar radicular pain due to disc herniation. Study Design: A randomized,
prospective trial. Setting: The Department of Anesthesiology and Pain
Medicine at Spine Health Wooridul Hospital in Daegu, Korea. Methods: A
total of 97 patients were enrolled in this study; 48 patients underwent
EELD and 49 underwent TELA. The pain relief was evaluated at baseline and
at 1, 3, and 6 months post-procedure via the numeric rating scale (NRS).
The Oswestry Disability Index (ODI) was recorded at baseline and at the
final follow-up. Postoperative wound pain was assessed over a 24-hour
period. Complications and side effects were also recorded, as were
operative times (from local anesthetic infiltration at entry sites to
suturing of skin). Results: At post-treatment months 1, 3, and 6 the mean
pain scores of patients were significantly lower (relative to
pre-treatment baseline) regardless of the procedure used. However, the
mean pain scores did not differ significantly by procedure (EELD vs TELA).
As well, the number of patients who obtained relief from their pain and
needed analgesics was not statistically significant. The irrigation volume
was significantly higher in the TELA group. Two patients undergoing TELA
procedures experienced headache during the procedures; however, no serious
complications such as bleeding, dural/neural injuries, or infection were
recorded for either group. Limitation: The observed significant reductions
in pain (from baseline) lacked secondary outcome substantiation and given
the mid follow-up period, no long-term follow-up results were monitored.
Conclusion: Both EELD and TELA provide similar outcomes and are reasonable
treatment options for carefully selected patients with lower back or
radicular pain.<br/>Copyright &#xa9; 2017, American Society of
Interventional Pain Physicians. All rights reserved.

<6>
Accession Number
619430118
Author
Mariathas M.; Rawlins J.; Curzen N.
Institution
(Mariathas, Rawlins, Curzen) Coronary Research Group, University Hospital
Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
(Mariathas, Curzen) Faculty of Medicine, University of Southampton,
Southampton SO16 6YD, United Kingdom
Title
Transcatheter aortic valve implantation: Where are we now?.
Source
Future Cardiology. 13 (6) (pp 551-566), 2017. Date of Publication:
November 2017.
Publisher
Future Medicine Ltd. (E-mail: info@futuremedicine.com)
Abstract
Transcatheter aortic valve implantation (TAVI) was first used in clinical
practice in 2002. Since 2002, there has been a rapid increase in TAVI
activity in patients with symptomatic severe aortic stenosis. This has
been supported by systematic randomized data comparing TAVI against the
gold standard treatment for the last 50 years' surgical aortic valve
replacement. TAVI is now currently a recommended therapeutic intervention
in the treatment of severe aortic stenosis patients who are deemed either
high risk or inoperable. The indications for TAVI continue to expand.
Within this review we will focus on the current guidelines for TAVI, the
evidence for it, the complications of TAVI, postprocedure care, the
technology available to clinicians now and finally the future perspectives
for TAVI.<br/>Copyright &#xa9; 2017 Future Medicine Ltd.

<7>
Accession Number
616940430
Author
Hengstenberg C.; Chandrasekhar J.; Sartori S.; Lefevre T.; Mikhail G.;
Meneveau N.; Tron C.; Jeger R.; Kupatt C.; Vogel B.; Farhan S.; Sorrentino
S.; Sharma M.; Snyder C.; Husser O.; Boekstegers P.; Hambrecht R.; Widder
J.; Hildick-Smith D.; De Carlo M.; Wijngaard P.; Deliargyris E.; Bernstein
D.; Baber U.; Mehran R.; Anthopoulos P.; Dangas G.
Institution
(Hengstenberg) Division of Cardiology, DZHK (German Centre for
Cardiovascular Research), Partner Site Munich Heart Alliance, Munich,
Germany
(Hengstenberg) Division of Cardiology, Deutsches Herzzentrum Munchen,
Technische Universitat Munchen, Munich, Germany
(Chandrasekhar, Sartori, Vogel, Farhan, Sorrentino, Sharma, Snyder, Baber,
Mehran, Dangas) Division of Cardiology, The Zena and Michael A. Wiener
Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New
York, United States
(Lefevre) Division of Cardiology, Institut Hospitalier Jacques Cartier,
Ramsay Generale de Sante, Massy, France
(Mikhail) Division of Cardiology, Imperial College Healthcare NHS Trust,
Hammersmith Hospital, London, United Kingdom
(Meneveau) Division of Cardiology, CHU Jean Minjoz, Besancon, France
(Tron) Division of Cardiology, CHU de Rouen, Rouen, France
(Jeger) Department of Cardiology, University Hospital Basel, Switzerland
(Kupatt) Division of Cardiology, LMU Munich, Germany
(Husser) Division of Cardiology, Deutsches Herzzentrum Munchen, Germany
(Boekstegers) Division of Cardiology, Helios Heart Center, Siegburg,
Germany
(Hambrecht) Department of Cardiology and Angiology, Klinikum Links der
Weser, Bremen, Germany
(Widder) Department of Cardiology and Angiology, Hannover Medical School,
Hannover, Germany
(Hildick-Smith) Division of Cardiology, Sussex Cardiac Centre-Brighton &
Sussex University Hospitals NHS Trust, Brighton, East Sussex, United
Kingdom
(De Carlo) Division of Cardiology, Azienda Ospedaliero-Universitaria
Pisana, Pisa, Italy
(Wijngaard, Anthopoulos) Division of Cardiology, The Medicines Company,
Zurich, Switzerland
(Deliargyris, Bernstein) Division of Cardiology, The Medicines Company,
Parsippany, NJ, United States
Title
Impact of pre-existing or new-onset atrial fibrillation on 30-day clinical
outcomes following transcatheter aortic valve replacement: Results from
the BRAVO 3 randomized trial.
Source
Catheterization and Cardiovascular Interventions. 90 (6) (pp 1027-1037),
2017. Date of Publication: 15 Nov 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Prior studies have suggested that patients with atrial
fibrillation (AF) undergoing transcatheter aortic valve replacement (TAVR)
are at higher risk for adverse cardiovascular events. Whether procedural
bivalirudin compared with unfractionated heparin (UFH) has a beneficial
effect on early outcomes in these patients is unknown. We examined for the
effect of baseline or new-onset AF within 30 days of TAVR and explored for
the effect of bivalirudin versus UFH by AF status, on 30-day outcomes from
the BRAVO 3 trial. Methods: The BRAVO-3 trial multicenter randomized trial
included 802 patients undergoing transfemoral TAVR randomized to
bivalirudin or UFH. We compared AF and no-AF groups and examined for
30-day Bleeding Academic Research Consortium type >=3b bleeding, major
vascular complications and all ischemic endpoints. Adjusted outcomes were
analyzed using logistic regression methods. Results: Of the study
population, 41.4% (n = 332) patients had baseline or new-onset AF within
30 days of TAVR, whereas 58.6% (n = 470) had no AF. Patients with AF had
greater prevalence of renal dysfunction, lower left ventricular ejection
fraction, and higher euroSCORE I compared with their counterparts without
AF. Among AF and no-AF patients, there were no significant baseline
differences between bivalirudin and UFH groups. At 30 days the incidence
of death (6.0 vs. 4.5%, P = 0.324) and stroke (3.9 vs. 2.6%, P = 0.274)
was similar in AF vs. no-AF patients. However, new-onset AF (n = 38) was
associated with significantly greater crude risk of 30-day stroke compared
with no AF (HR 4.49, 95% CI 1.37-14.67). Regardless of AF status, there
were no differences in 30-day death (P-int = 0.652) or stroke (P-int =
0.066) by anticoagulation type. Conclusions: Prior or new-onset AF is
noted in more than one-third of patients undergoing transfemoral TAVR.
Despite greater baseline comorbidities than non-AF patients, AF was not
associated with significantly higher risk of adjusted 30-day outcomes. In
the BRAVO 3 trial, early outcomes were similar regardless of anticoagulant
strategy in each group.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<8>
Accession Number
617455253
Author
Linke A.; Chandrasekhar J.; Sartori S.; Lefevre T.; van Belle E.; Schaefer
U.; Tchetche D.; Sardella G.; Webb J.; Colombo A.; Windecker S.; Vogel B.;
Farhan S.; Sorrentino S.; Sharma M.; Snyder C.; Asgar A.; Dumonteil N.;
Tamburino C.; Hink U.; Violini R.; Stella P.; Bernstein D.; Deliargyris
E.; Hengstenberg C.; Baber U.; Mehran R.; Anthopoulos P.; Dangas G.
Institution
(Linke) Department of Internal Medicine/Cardiology, University of Leipzig,
Heart Centre, Germany
(Chandrasekhar, Sartori, Vogel, Farhan, Sorrentino, Sharma, Snyder, Baber,
Mehran, Dangas) Division of Cardiology, The Zena and Michael A. Wiener
Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY,
United States
(Lefevre) Division of Cardiology, Institut Hospitalier Jacques Cartier,
Ramsay Generale de Sante, Massy, France
(van Belle) Department of Cardiology and INSERM UMR 1011, University
Hospital, and CHRU Lille, Lille, France
(Schaefer) Division of Cardiologyy, University Heart Center, Hamburg,
Germany
(Schaefer) Division of Cardiologyy, Asklepios Clinics St. Georg, Hamburg,
Germany
(Tchetche, Dumonteil) Division of Cardiologyy, Clinique Pasteur Toulouse,
France
(Sardella) Division of Cardiologyy, Policlinico Umberto I, Rome, Italy
(Webb) Division of Cardiologyy, St. Paul's Hospital, Vancouver, BC, Canada
(Colombo) Division of Cardiologyy, San Raffaele Hospital, Milan, Italy
(Windecker) Department of Cardiology, Bern University Hospital,
Switzerland
(Asgar) Division of Cardiology, Montreal Heart Institute, Montreal, Canada
(Tamburino) Division of Cardiology, University of Catania, Italy
(Hink) Cardiology Department, Johannes Gutenberg University Hospital,
Mainz, Germany
(Violini) Division of Cardiology, Azienda Ospedaliera San
Camillo-Forlanini di Roma, Italy
(Stella) Division of Cardiology, University Medical Center Utrecht,
Netherlands
(Bernstein, Deliargyris) Division of Cardiology, The Medicines Company,
Parsippany, NJ, United States
(Hengstenberg) Division of Cardiology, DZHK (German Centre for
Cardiovascular Research), partner site Munich Heart Alliance, Munich,
Germany
(Hengstenberg) Division of Cardiologyy, Deutsches Herzzentrum Munchen,
Technische Universitat Munchen, Munich, Germany
(Anthopoulos) Division of Cardiology, The Medicines Company, Zurich,
Switzerland
Title
Effect of valve design and anticoagulation strategy on 30-day clinical
outcomes in transcatheter aortic valve replacement: Results from the BRAVO
3 randomized trial.
Source
Catheterization and Cardiovascular Interventions. 90 (6) (pp 1016-1026),
2017. Date of Publication: 15 Nov 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background: Selection of valve type and procedural anticoagulant may
impact bleeding and vascular complications in transfemoral transcatheter
aortic valve replacement (TAVR). We sought to compare outcomes by valve
[balloon expandable (BE) or non-BE] and anticoagulant [bivalirudin vs.
unfractionated heparin (UFH)] type from the BRAVO-3 trial. Methods:
BRAVO-3 was a randomized multicenter trial including 500 BE-TAVR and 282
non-BE TAVR patients, randomized to bivalirudin versus UFH. Selection of
valve type was at the discretion of the operator but randomization was
stratified according to valve type. Total follow up was to 30 days. We
examined the incidence of Bleeding Academic Research Consortium type >=3b
bleeding, major vascular complications and all ischemic outcomes at
30-days. Outcomes were adjusted using logistic regression analysis.
Results: Of the trial cohort, 63.9% were treated with BE valves (n = 251
bivalirudin vs. n = 249 UFH) and 36.1% with non-BE valves (n = 140
bivalirudin vs. n = 142 UFH). Patients treated with non-BE valves were
older, with higher euroSCORE I. At 30 days, there were nonsignificant
differences between the two valve types for adjusted risk of all-cause
death (HR 2.07, 95% CI 0.91-4.70, P = 0.084) and major vascular
complications (HR 1.78, 95% CI 0.97-3.26, P = 0.062) with non-BE compared
with BE valves, but all other outcomes were similar. A significant
interaction was observed between valve and anticoagulant type, with lower
risk of major vascular complications with bivalirudin compared with UFH in
non-BE TAVR (P-interaction = 0.039). Conclusions: Majority of patients in
the BRAVO 3 trial received BE valves. At 30-days, adjusted risk of
clinical outcomes was similar with non-BE vs. BE valves. A significant
interaction was observed between valve type and procedural anticoagulant
for lower risk of major vascular complications with bivalirudin versus UFH
in non-BE TAVR.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<9>
Accession Number
616719956
Author
Zaman S.; Zaman S.S.; Scholtes T.; Shun-Shin M.J.; Plymen C.M.; Francis
D.P.; Cole G.D.
Institution
(Zaman, Zaman, Scholtes, Shun-Shin, Plymen, Francis, Cole) International
Centre for Circulatory Health, National Heart and Lung Institute, Imperial
College London, London, United Kingdom
Title
The mortality risk of deferring optimal medical therapy in heart failure:
a systematic comparison against norms for surgical consent and patient
information leaflets.
Source
European Journal of Heart Failure. 19 (11) (pp 1401-1409), 2017. Date of
Publication: November 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Aims: The prescription of optimal medical therapy for heart failure is
often delayed despite compelling evidence of a reduction in mortality. We
calculated the absolute risk resulting from delayed prescription of
therapy. For comparison, we established the threshold applied by
clinicians when discussing the risk for death associated with an
intervention, and the threshold used in official patient information
leaflets. Methods and results: We undertook a meta-analysis of randomized
controlled trials to calculate the excess mortality caused by deferral of
medical therapy for 1 year. Risk ratios for angiotensin-converting enzyme
inhibitors, beta-blockers and aldosterone antagonists were 0.80, 0.73 and
0.77, respectively. In patients who might achieve a 1-year survival rate
of 90% if treated, a 1-year deferral of treatment reduced survival to 78%
(i.e. an annual absolute increase in mortality of 12 in 100 patients).
This corresponds to an additional absolute mortality risk per month of 1%.
A survey of clinicians carried out to establish the risk threshold at
which they would obtain written consent showed the majority (85%) sought
written consent for interventions associated with a 12-fold lower
mortality risk: one in 100 patients. A systematic review of UK patient
information leaflets to establish the magnitude of risk considered
sufficient to be stated explicitly showed that leaflets begin to mention
death at a ~18 000-fold lower mortality risk of just 0.0007 in 100
patients. Conclusions: Deferring heart failure treatment for 1 year
carries far greater risk than the level at which most doctors seek written
consent, and 18 000 times more risk than the level at which patient
information leaflets begin to mention death.<br/>Copyright &#xa9; 2017 The
Authors. European Journal of Heart Failure published by John Wiley & Sons
Ltd on behalf of European Society of Cardiology.

<10>
Accession Number
617557334
Author
Stehouwer M.C.; de Vroege R.; Hoohenkerk G.J.F.; Hofman F.N.; Kelder J.C.;
Buchner B.; de Mol B.A.; Bruins P.
Institution
(Stehouwer) Department of Extracorporeal Circulation, St Antonius
Hospital, Nieuwegein, Netherlands
(de Vroege, Buchner) Department of Extracorporeal Circulation, HAGA
Hospital, The Hague, Netherlands
(Hoohenkerk) Department of Cardiothoracic Surgery, HAGA Hospital, The
Hague, Netherlands
(Hofman) Department of Cardiothoracic Surgery, St Antonius Hospital,
Nieuwegein, Netherlands
(Kelder) Department of Cardiology, St Antonius Hospital, Nieuwegein,
Netherlands
(de Mol) Section Cardiovascular Biomechanics, Faculty of Biomedical
Technology, University of Technology, Eindhoven, Netherlands
(Bruins) Department of Anaesthesiology, Intensive Care and Pain
Management, St Antonius Hospital, Nieuwegein, Netherlands
Title
Carbon Dioxide Flush of an Integrated Minimized Perfusion Circuit Prior to
Priming Prevents Spontaneous Air Release Into the Arterial Line During
Clinical Use.
Source
Artificial Organs. 41 (11) (pp 997-1003), 2017. Date of Publication:
November 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Recently, an oxygenator with an integrated centrifugal blood pump (IP) was
designed to minimize priming volume and to reduce blood foreign surface
contact even further. The use of this oxygenator with or without
integrated arterial filter was compared with a conventional oxygenator and
nonintegrated centrifugal pump. To compare the air removal characteristics
60 patients undergoing coronary artery bypass grafting were alternately
assigned into one of three groups to be perfused with a minimized
extracorporeal circuit either with the conventional oxygenator, the
oxygenator with IP, or the oxygenator with IP plus integrated arterial
filter (IAF). Air entering and leaving the three devices was measured
accurately with a bubble counter during cardiopulmonary bypass. No
significant differences between all groups were detected, considering air
entering the devices. Our major finding was that in both integrated
devices groups incidental spontaneous release of air into the arterial
line in approximately 40% of the patients was observed. Here, detectable
bolus air (>500 micro&#32;m) was shown in the arterial line, whereas in
the minimal extracorporeal circulation circuit (MECC) group this
phenomenon was not present. We decided to conduct an amendment of the
initial design with METC-approval. Ten patients were assigned to be
perfused with an oxygenator with IP and IAF. Importantly, the integrated
perfusion systems used in these patients were flushed with carbon dioxide
(CO<inf>2</inf>) prior to priming of the systems. In the group with
CO<inf>2</inf> flush no spontaneous air release was observed in all cases
and this was significantly different from the initial study with the group
with the integrated device and IAF. This suggests that air spilling may be
caused by residual air in the integrated device. In conclusion,
integration of a blood pump may cause spontaneous release of large air
bubbles (>500 micro&#32;m) into the arterial line, despite the presence of
an integrated arterial filter. CO<inf>2</inf> flushing of an integrated
cardiopulmonary bypass system prior to priming may prevent spontaneous air
release and is strongly recommended to secure patient
safety.<br/>Copyright &#xa9; 2017 International Center for Artificial
Organs and Transplantation and Wiley Periodicals, Inc.

<11>
Accession Number
619255484
Author
Tian N.-L.; Gami S.-K.; Ye F.; Zhang J.-J.; Liu Z.-Z.; Lin S.; Ge Z.; Shan
S.-J.; You W.; Chen L.; Zhang Y.-J.; Mintz G.; Chen S.-L.
Institution
(Tian, Gami, Liu, Ge, Chen, Zhang, Chen) Department of Cardiology, Nanjing
First Hospital, Nanjing Medical University, No. 68 Changle Road, Qinhuai
District, Nanjing 210006, China
(Ye, Zhang, Lin, Shan, You) Department of Cardiology, Nanjing Heart
Centre, Nanjing, China
(Mintz) Cardiovascular Research Foundation, New York, NY, United States
Title
Angiographic and clinical comparisons of intravascular ultrasound- versus
angiography-guided drug-eluting stent implantation for patients with
chronic total occlusion lesions: Two-year results from a randomised
AIR-CTO study.
Source
EuroIntervention. 10 (12) (pp 1409-1417), 2015. Date of Publication: 01
Apr 2015.
Publisher
EuroPCR
Abstract
Aims: This study sought to compare angiographic endpoints at one-year
follow-up after a drug-eluting stent implantation guided by either
intravascular ultrasound (IVUS) or angiography in patients with chronic
total occlusion (CTO) lesions. Methods and results: Patients with at least
one CTO lesion recanalised successfully were randomly assigned to the
IVUS-guided or the angiography-guided group. The use of IVUS for
penetration of the true lumen and optimisation of stent expansion was only
done in the IVUS-guided group. The primary endpoint was in-stent late
lumen loss (LLL) at one-year follow-up. A total of 230 patients with CTO
lesions after successful recanalisation were enrolled and followed with
office visits or telephone contact up to 24 months. In-stent LLL in the
IVUS-guided group was significantly lower compared to the
angiography-guided group at one-year follow-up (0.28+/-0.48 mm vs.
0.46+/-0.68 mm, p=0.025), with a significant difference in restenosis of
the "in-true-lumen" stent between the two groups (3.9% vs.13.7%, p=0.021).
The minimal lumen diameter and minimal stent cross-section area
significantly and negatively correlated with LLL (all p<0.001). The rates
of adverse clinical events were comparable between the IVUS- and
angiography-guided groups at two-year follow-up (21.7% vs. 25.2%,
p=0.641). Conclusions: The IVUS-guided stenting of the CTO lesion was
associated with less LLL and a lower incidence of "in-true-lumen" stent
restenosis. Additional study is required to identify the clinical benefit
of the IVUS-guided procedure for CTO lesions.
[ChiCTR-TRC-10000996]<br/>Copyright &#xa9; Europa Digital & Publishing
2015. All rights reserved.

<12>
Accession Number
619246984
Author
Sheiban I.; La Spina C.; Cavallero E.; Biondi-Zoccai G.; Colombo F.;
Palmerini T.; Marzocchi A.; Tamburino C.; Margheri M.; Vecchi G.;
Sangiorgi G.; Santarelli A.; Bartorelli A.L.; Briguori C.; Vignali L.; Di
Pede F.; Ramondo A.; Fantoni C.; De Carlo M.; Falsini G.; Benassi A.;
Palmieri C.; Filippone V.; Sangiorgi D.; De Servi S.
Institution
(Sheiban, La Spina, Cavallero, Biondi-Zoccai, Colombo) Divisione di
Cardiologia, Universita di Torino, S. Giovanni Battista Molinette
Hospital, Corso Bramante 88-90, Turin 10126, Italy
(Palmerini, Marzocchi, Sangiorgi) Istituto di Cardiologia, Policlinico S.
Orsola, Universita di Bologna, Bologna, Italy
(Tamburino) Dipartimento di Cardiologia, Ospedale Ferrarotto, Universita
di Catania, Catania, Italy
(Margheri) Dipartimento Cardiovascolare, Ospedale Careggi, Universita di
Firenze, Florence, Italy
(Vecchi) Dipartimento di Cardiologia, Ospedale S. Maria Delle Croci,
Ravenna, Italy
(Sangiorgi) Centro Cuore Columbus, Milan, Italy
(Santarelli) Dipartimento di Cardiologia, Ospedale degli Infermi, Rimini,
Italy
(Bartorelli) Centro Centro Cardiologico Monzino, Dipartimento di Scienze
Cardiovascolari, Universita di Milano, Milan, Italy
(Briguori) Dipartimento di Cardiologia, Clinica Mediterranea, Naples,
Italy
(Vignali) Unita Operativa di Cardiologia, Azienda
Ospedaliero-Universitaria, Parma, Italy
(Di Pede) Dipartimento di Cardiologia, Azienda Ospedaliera, Mestre, Italy
(Ramondo) Dipartimento di Scienze Cardiovascolari, Universita di Padova,
Padua, Italy
(Fantoni) Cardiovascular Interventional Radiology Department, IRCCS
Policlinico S. Donato, S. Donato Milanese, Milan, Italy
(De Carlo) Dipartimento Cardio-Toracico, Ospedale Cisanello, Pisa, Italy
(Falsini) Dipartimento Cardiovascolare, Ospedale S. Donato, Arezzo, Italy
(Benassi) Dipartimento di Cardiologia (A.B.), Hesperia Hospital, Modena,
Italy
(Palmieri) Istituto Fisiologia Clinica, CNR, Massa, Italy
(Filippone) Dipartimento Cardiovascolar, Ospedale Cervello, Palermo, Italy
(De Servi) Dipartimento di Malattie Cardiovascolari, Ospedale Civile,
Legnano, Italy
Title
Sex-related differences in patients undergoing percutaneous unprotected
left main stenting.
Source
EuroIntervention. 5 (7) (pp 795-800), 2010. Date of Publication: 2010.
Publisher
EuroPCR
Abstract
Aims: Percutaneous coronary intervention (PCI) is increasingly being used
for unprotected left main (Ulm) disease. Limited data are available on
sex-related differences in this setting. We investigated genderassociated
differences in patients undergoing stent-based PCI for Ulm. Methods and
results: We analysed baseline, procedural and long-term data of patients
with Ulm undergoing stent-based PCI at participating centres. The primary
end-point was the long-term rate of major cardiovascular events rate
(MACE, i.e., the composite of death, myocardial infarction, or target
lesion revascularisation). The study population included 1,452 cases, with
27.8% females and 72.2% males. Women were older, more frequently diabetic,
hypertensive or presenting with an acute coronary syndrome, and thus with
a higher EuroSCORE, but were less commonly treated with drug-eluting
stents (DES), in comparison to men (all p<0.01). After a median follow-up
of 18 months, women showed an unadjusted higher risk of death (p=0.040),
cardiac death (p=0.033), and the death/myocardial infarction (p=0.012).
However, after multivariable adjustment, gender was no longer an
independent predictor of death (hazard ratio=1.119 [0.804-1.558]), cardiac
death (hazard ratio=1.045 [0.697-1.567]), or death/myocardial infarction
(hazard ratio=0.531 [0.192-1.465]), given the predominant role of age,
diabetes and EuroSCORE as independent predictors and confounders of the
gender-based comparison. Conclusions: Women undergoing PCI for Ulm present
more often with an acute coronary syndrome, are treated less frequently
with DES, and have more adverse events, but these gender biases are not
confirmed after adjusting for confounders. Thus, stent-based PCI for Ulm
offers similarly favourable clinical results in women as well as in
men.<br/>Copyright &#xa9; Europa Edition. All rights reserved.

<13>
Accession Number
615407118
Author
Ray Mohapatra C.K.; Mishra P.; Saxena P.; Raut C.; Khandekar J.; Ammannaya
G.K.; Seth H.S.; Shah V.; Singh J.
Institution
(Ray Mohapatra, Mishra, Raut, Khandekar, Ammannaya, Seth, Shah, Singh)
Department of Cardiovascular & Thoracic Surgery, Lokmanya Tilak Municipal
Medical College & Sion Hospital, Mumbai, India
(Saxena) Department of Cardiothoracic Surgery, The Townsville Hospital,
James Cook University, Australia
Title
Use of nitroglycerin and verapamil solution by organ bath technique in
preparation of left internal thoracic artery for coronary artery bypass
surgery.
Source
Indian Heart Journal. 69 (6) (pp 772-776), 2017. Date of Publication:
November 2017.
Publisher
Elsevier B.V.
Abstract
Background The aim of this prospective study was to compare the effect of
application of nitroglycerin and verapamil solution (GV) by organ bath
technique with other methods of applications and solutions on the free
blood flow of LITA. The technique was not described for in situ graft
before. Method The patients were randomly assigned to four groups: group I
(n_32, GV solution by organ bath technique), group II (n_30, papaverine
solution by organ bath technique), group III (n_29, topical GV solution)
or group IV (n_29, topical papaverine solution). In each patient, pedicled
LITA was harvested; thereafter applied with the randomized different
methods and solutions. The free flow from the distal end of the divided
LITA was measured for 15 s under controlled hemodynamic conditions after
harvesting (Flow 1). The flow of LITA was measured again just prior to
anastomosing the conduit (Flow 2). Result The mean blood flow in LITA was
56.2 +/- 5.0 ml/min before application of solutions. After application,
the mean blood flow in group I:102.3 +/- 7.0 ml/min, in group II: 92.7 +/-
3.4 ml/min, and in group III: 88.6 +/- 2.2 ml/min and in group IV: 81.4
+/- 2.1. Proportional increases in blood flow observed in group I (82.6%)
> group II (65.1%)?> group III (57.6) > group IV (44.8%) (p < 0.05).
Conclusions GV solution by organ bath technique is effective and superior
in comparison to use of papaverine using organ bath technique or topical
spray of GV or papaverine solution.<br/>Copyright &#xa9; 2017
Cardiological Society of India

<14>
Accession Number
618470395
Author
Mylonas K.S.; Tzani A.; Metaxas P.; Schizas D.; Boikou V.; Economopoulos
K.P.
Institution
(Mylonas) Division of Pediatric Surgery, Massachusetts General Hospital,
Harvard Medical School, Warren 11, 55 Fruit Street, Boston, MA 02114,
United States
(Mylonas, Tzani, Metaxas, Schizas, Economopoulos) Surgery Working Group,
Society of Junior Doctors, Athens, Greece
(Schizas) First Department of Surgery, Laiko General Hospital, National
and Kapodistrian University of Athens, Athens, Greece
(Boikou) Athens University of Economics and Business, Athens, Greece
(Economopoulos) Department of Surgery, Massachusetts General Hospital,
Harvard Medical School, Boston, MA, United States
Title
Blood Versus Crystalloid Cardioplegia in Pediatric Cardiac Surgery: A
Systematic Review and Meta-analysis.
Source
Pediatric Cardiology. 38 (8) (pp 1527-1539), 2017. Date of Publication: 01
Dec 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
The benefit of blood cardioplegia (BCP) compared to crystalloid
cardioplegia (CCP) is still debatable. Our aim was to systematically
review and synthesize all available evidence on the use of BCP and CCP to
assess if any modality provides superior outcomes in pediatric cardiac
surgery. A systematic literature search of the PubMed and Cochrane
databases was performed with respect to the PRISMA statement
(end-of-search date: January 30th, 2017). We extracted data on study
design, demographics, cardioplegia regimens, and perioperative outcomes as
well as relevant biochemical markers, namely cardiac troponin I (cTnI),
lactate, and ATP levels at baseline, after reperfusion and postoperatively
at 1, 4, 12, and 24 h as applicable. Data were appropriately pooled using
random and mixed effects models. Our systematic review includes 56 studies
reporting on a total of 7711 pediatric patients. A meta-analysis of the 10
eligible studies directly comparing BCP (n = 416) to CCP (n = 281) was
also performed. There was no significant difference between the two groups
with regard to cTnI and Lac at any measured time point, ATP levels after
reperfusion, length of intensive care unit stay (WMD: -0.08, 95% CI -1.52
to 1.36), length of hospital stay (WMD: 0.13, 95% CI -0.85 to 1.12), and
30-day mortality (OR 1.11, 95% CI 0.43-2.88). Only cTnI levels at 4 h
postoperatively were significantly lower with BCP (WMD: -1.62, 95% CI
-2.07 to -1.18). Based on the available data, neither cardioplegia
modality seems to be superior in terms of clinical outcomes, ischemia
severity, and overall functional recovery.<br/>Copyright &#xa9; 2017,
Springer Science+Business Media, LLC.

<15>
Accession Number
618322323
Author
Sabatine M.S.; Leiter L.A.; Wiviott S.D.; Giugliano R.P.; Deedwania P.; De
Ferrari G.M.; Murphy S.A.; Kuder J.F.; Gouni-Berthold I.; Lewis B.S.;
Handelsman Y.; Pineda A.L.; Honarpour N.; Keech A.C.; Sever P.S.; Pedersen
T.R.
Institution
(Sabatine, Wiviott, Giugliano, Murphy, Kuder) TIMI Study Group, Division
of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard
Medical School, Boston, MA, United States
(Leiter) Li Ka Shing Knowledge Institute of St Michael's Hospital,
University of Toronto, Toronto, ON, Canada
(Deedwania) UCSF Fresno, Fresno, CA, United States
(De Ferrari) Department of Molecular Medicine, University of Pavia, and
Cardiac Intensive Care Unit and Laboratories for Experimental Cardiology,
IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
(Gouni-Berthold) Polyclinic for Endocrinology, Diabetes, and Preventive
Medicine, University of Cologne, Cologne, Germany
(Lewis) Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport
School of Medicine, Technion-IIT, Haifa, Israel
(Handelsman) Metabolic Institute of America, Tarzana, CA, United States
(Pineda, Honarpour) Amgen, Thousand Oaks, CA, United States
(Keech) Sydney Medical School, NHMRC Clinical Trials Centre, University of
Sydney, Sydney, NSW, Australia
(Sever) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
University of Oslo, Oslo, Norway
Title
Cardiovascular safety and efficacy of the PCSK9 inhibitor evolocumab in
patients with and without diabetes and the effect of evolocumab on
glycaemia and risk of new-onset diabetes: a prespecified analysis of the
FOURIER randomised controlled trial.
Source
The Lancet Diabetes and Endocrinology. 5 (12) (pp 941-950), 2017. Date of
Publication: December 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background The proprotein convertase subtilisin/kexin type 9 (PCSK9)
inhibitor evolocumab reduced LDL cholesterol and cardiovascular events in
the FOURIER trial. In this prespecified analysis of FOURIER, we
investigated the efficacy and safety of evolocumab by diabetes status and
the effect of evolocumab on glycaemia and risk of developing diabetes.
Methods FOURIER was a randomised trial of evolocumab (140 mg every 2 weeks
or 420 mg once per month) versus placebo in 27 564 patients with
atherosclerotic disease who were on statin therapy, followed up for a
median of 2.2 years. In this prespecified analysis, we investigated the
effect of evolocumab on cardiovascular events by diabetes status at
baseline, defined on the basis of patient history, clinical events
committee review of medical records, or baseline HbA<inf>1c</inf> of 6.5%
(48 mmol/mol) or greater or fasting plasma glucose (FPG) of 7.0 mmol/L or
greater. The primary endpoint was a composite of cardiovascular death,
myocardial infarction, stroke, hospital admission for unstable angina, or
coronary revascularisation. The key secondary endpoint was a composite of
cardiovascular death, myocardial infarction, or stroke. We also assessed
the effect of evolocumab on glycaemia, and on the risk of new-onset
diabetes among patients without diabetes at baseline. HbA<inf>1c</inf> was
measured at baseline then every 24 weeks and FPG was measured at baseline,
week 12, week 24, and every 24 weeks thereafter, and potential cases of
new-onset diabetes were adjudicated centrally. In a post-hoc analysis, we
also investigated the effects on glycaemia and diabetes risk in patients
with prediabetes (HbA<inf>1c</inf> 5.7-6.4% [39-46 mmol/mol] or FPG
5.6-6.9 mmol/L) at baseline. FOURIER is registered with
ClinicalTrials.gov, number NCT01764633. Findings At study baseline, 11 031
patients (40%) had diabetes and 16 533 (60%) did not have diabetes (of
whom 10 344 had prediabetes and 6189 had normoglycaemia). Evolocumab
significantly reduced cardiovascular outcomes consistently in patients
with and without diabetes at baseline. For the primary composite endpoint,
the hazard ratios (HRs) were 0.83 (95% CI 0.75-0.93; p=0.0008) for
patients with diabetes and 0.87 (0.79-0.96; p=0.0052) for patients without
diabetes (p<inf>interaction</inf>=0.60). For the key secondary endpoint,
the HRs were 0.82 (0.72-0.93; p=0.0021) for those with diabetes and 0.78
(0.69-0.89; p=0.0002) for those without diabetes
(p<inf>interaction</inf>=0.65). Evolocumab did not increase the risk of
new-onset diabetes in patients without diabetes at baseline (HR 1.05,
0.94-1.17), including in those with prediabetes (HR 1.00, 0.89-1.13).
Levels of HbA<inf>1c</inf> and FPG were similar between the evolocumab and
placebo groups over time in patients with diabetes, prediabetes, or
normoglycaemia. Among patients with diabetes at baseline, the proportions
of patients with adverse events were 78.5% (4327 of 5513 patients) in the
evolocumab group and 78.3% (4307 of 5502 patients) in the placebo group;
among patients without diabetes at baseline, the proportions with adverse
events were 76.8% (6337 of 8256 patients) in the evolocumab group and
76.8% (6337 of 8254 patients) in the placebo group. Interpretation PCSK9
inhibition with evolocumab significantly reduced cardiovascular risk in
patients with and without diabetes. Evolocumab did not increase the risk
of new-onset diabetes, nor did it worsen glycaemia. These data suggest
evolocumab use in patients with atherosclerotic disease is efficacious and
safe in patients with and without diabetes. Funding Amgen.<br/>Copyright
&#xa9; 2017 Elsevier Ltd

<16>
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.; Haneda M.; Iwashima Y.; Suda T.;
Tamasawa N.; Daimon M.; Satoh J.; Takebe N.; Ishigaki Y.; Watanabe T.;
Satoh H.; Kasai K.; Aso Y.; Ishibashi S.; Katayama S.; Ishikawa S.-E.;
Kakei M.; Namai K.; Hashimoto N.; Suzuki Y.; Onishi S.; Yokote K.; Matsuda
M.; Masuzawa M.; Hayashi Y.; Saito S.; Ogihara N.; Ishihara H.; Tajima N.;
Utsunomiya K.; Itoh H.; Kawamori R.; Watada H.; Mori Y.; Shiba T.; Isogawa
A.; Sakura H.; Odawara M.; Tobe K.; Tsukamoto K.; Yamauchi T.; Teramoto
T.; Hirata Y.; Uchimura I.; Ogawa Y.; Yoshino G.; Hirose T.; Kajio H.;
Atsumi Y.; Shimada A.; Oikawa Y.; Araki A.; Ueki A.; Ohno A.; Kitaoka M.;
Fujita Y.; Moriya T.; Tojo T.; Shichiri M.; Suzuki D.; Toyoda M.; Hamano
K.; Komi R.; Terauchi Y.; Kuzuya N.; Yamada M.; Takamura T.; Imura M.;
Tanaka H.; Hayashi M.; Kato Y.; Itoh M.; Suzuki A.; Nakayama M.; Sano T.;
Nakashima E.; Sumida Y.; Yano Y.; Tanaka T.; Murata K.; Kashiwagi A.;
Maegawa H.; Kono S.; Inagaki N.; Kosugi K.; Yasuda T.; Yoshimasa Y.;
Kishimoto I.; Sato T.; Hosoi M.; Yamasaki T.; Matsuhisa M.; Shimomura I.;
Taniguchi A.; Kuroe A.; Kurose T.; Ohara T.; Sakaguchi K.; Namba M.; Kaku
K.; Fujiwara M.; Shimizu I.; Ono K.; Ebisui O.; Tanizawa Y.; Okada Y.;
Kodera T.; Sato N.; Ide M.; Yamada K.; Umeda F.; Natori S.; Eto T.; Mimura
K.; Hiramatsu S.; Inoue T.; Takei R.; Ogo A.; Eguchi K.; Kawasaki E.;
Koide Y.; Araki E.; Jinnouchi H.; Yamamoto H.; Motoyoshi M.; Hiyoshi T.;
Tanaka Y.; Momoki T.; Sato K.; Yoneyama A.; Ito K.; Sobajima H.; Ikegami
H.; Ikeda M.; Ikeda H.; Takahashi K.; Makino H.; Ueda Y.; Nakazato M.
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. 5 (12) (pp 951-964), 2017. Date of
Publication: December 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

<17>
Accession Number
619376948
Author
Rezaei-Nodehi M.; Shorofi S.A.; Bagheri-Nesami M.; Ghafari R.;
Yazdani-Charati J.; Darbeheshti M.
Institution
(Rezaei-Nodehi) Student Research Committee, School of Nursing and
Midwifery, Addiction Institute, Mazandaran University of Medical Sciences,
Sari, Iran, Islamic Republic of
(Shorofi) Traditional and Complementary Medicine Research Center,
Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of
(Shorofi) Adjunct Research Fellow, Flinders University, Adelaide,
Australia
(Bagheri-Nesami) Traditional and Complementary Medicine Research Center,
Addiction Institute, Mazandaran University of Medical Sciences, Sari,
Iran, Islamic Republic of
(Ghafari) Department of Cardiac Surgery, School of Medicine, Mazandaran
University of Medical Sciences, Sari, Iran, Islamic Republic of
(Yazdani-Charati) Health Sciences Research Center, Mazandaran University
of Medical Science, Sari, Iran, Islamic Republic of
(Darbeheshti) Department of Radiology, Mazandaran Cardiac Surgery Center,
Sari, Iran, Islamic Republic of
Title
The effect of pleasant olfactory mental imagery on the incidence and
extent of atelectasis in patients after open heart surgery.
Source
Complementary Therapies in Medicine. 36 (pp 33-37), 2018. Date of
Publication: February 2018.
Publisher
Churchill Livingstone
Abstract
Background and purpose Atelectasis is the most common pulmonary
complication after open heart surgery. This study was intended to examine
the effects of pleasant olfactory mental imagery on postoperative
atelectasis in patients undergoing open heart surgery. Materials and
methods This is a randomized controlled clinical trial. The sample
consisted of 80 patients who were randomly assigned to either practice
olfactory mental imagery (test group) or receive routine care (control
group). A card with the image of roses was given to patients and they were
asked to look at the image, visualize the scent of roses in the mind, and
then sniff as much as possible, hold their breath for 2 s and eventually
exhale slowly through the nose. This procedure was consecutively repeated
five times. After a fifteen-minute break, patients proceeded to practice
olfactory mental imagery with other fruit images (banana, apple, and
lemon). The test group executed the olfactory mental imagery for two hours
in the morning and two hours in the afternoon on postoperative days 1 and
2. The control group received the routine ICU care. A questionnaire
collected information on sociodemographic characteristics and clinical
parameters. Chest radiographs were used to diagnose atelectasis, which
were evaluated by the hospital radiologist. Results No statistically
significant differences were observed between the two groups regarding
sociodemographic, medical and surgical information. The incidence of
atelectasis in the test group (40%, n = 16) was significantly lower than
in the control group (67.5%, n = 27) on postoperative day 2 (p = 0.02).
Conclusion Our findings suggest that olfactory mental imagery can improve
respiratory function and reduce the risk of atelectasis in patients with
cardiac surgery.<br/>Copyright &#xa9; 2017

<18>
Accession Number
619398361
Author
Fiorentino M.; Castellano G.; Kellum J.A.
Institution
(Fiorentino, Kellum) Department of Critical Care Medicine, Center for
Critical Care Nephrology, CRISMA (Clinical Research, Investigation, and
Systems Modeling of Acute Illness) Center, University of Pittsburgh School
of Medicine, Pittsburgh, United States
(Fiorentino, Castellano) Department of Emergency and Organ
Transplantation, Nephrology, Dialysis and Transplantation Unit, University
of Bari, Bari, Italy
Title
Differences in acute kidney injury ascertainment for clinical and
preclinical studies.
Source
Nephrology Dialysis Transplantation. 32 (11) (pp 1789-1805), 2017. Date of
Publication: 01 Nov 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Background Acute kidney injury (AKI) is a common clinical condition
directly associated with adverse outcomes. Several AKI biomarkers have
been discovered, but their use in clinical and preclinical studies has not
been well examined. This study aims to investigate the differences between
clinical and preclinical studies on AKI biomarkers. Methods We performed a
systematic review of clinical and preclinical interventional studies that
considered AKI biomarkers in enrollment criteria and/or outcome assessment
and described the main differences according to their setting, the
inclusion of biomarkers in the definition of AKI and the use of biomarkers
as primary or secondary end points. Results In the 151 included studies
(76 clinical, 75 preclinical), clinical studies have prevalently focused
on cardiac surgery (38.1%) and contrast-associated AKI (17.1%), while the
majority of preclinical studies have focused on ether ischemia-reperfusion
injury or drug-induced AKI (42.6% each). A total of 57.8% of clinical
studies defined AKI using the standard criteria and only 19.7% of these
studies used AKI biomarkers in the definition of renal injury. Conversely,
the majority of preclinical studies defined AKI according to the increase
in serum creatinine and blood urea nitrogen, and 32% included biomarkers
in that definition. The percentage of both clinical and preclinical
studies with biomarkers as a primary end point has not significantly
increased in the last 10 years; however, preclinical studies are more
likely to use AKI biomarkers as a primary end point compared with clinical
studies [odds ratio 2.31 (95% confidence interval 1.17-4.59); P=0.016].
Conclusion Differences between clinical and preclinical studies are
evident and may affect the translation of preclinical findings in the
clinical setting.<br/>Copyright &#xa9; The Author 2017. Published by
Oxford University Press on behalf of ERA-EDTA. All rights reserved.

<19>
Accession Number
619329733
Author
Li S.; Zhou K.; Che G.; Yang M.; Su J.; Shen C.; Yu P.
Institution
(Li, Zhou, Che, Yang, Shen) Department of Thoracic Surgery, Rehabilitation
Medicine Center, West China Hospital, Sichuan University, Chengdu, China
(Su, Yu) Department of Rehabilitation, Rehabilitation Medicine Center,
West China Hospital, Sichuan University, Chengdu, China
Title
Enhanced recovery programs in lung cancer surgery: Systematic review and
meta-analysis of randomized controlled trials.
Source
Cancer Management and Research. 9 (pp 657-670), 2017. Date of Publication:
16 Nov 2017.
Publisher
Dove Medical Press Ltd (PO Box 300-008, Albany, 44 Corinthian Drive,
Albany,Auckland 0752, New Zealand. E-mail: angela@dovepress.com)
Abstract
Background: Enhanced recovery after surgery (ERAS) program is an effective
evidence-based multidisciplinary protocol of perioperative care, but its
roles in thoracic surgery remain unclear. This systematic review of
randomized controlled trials (RCTs) aims to investigate the efficacy and
safety of the ERAS programs for lung cancer surgery. Materials and
methods: We searched the PubMed and EMBASE databases to identify the RCTs
that implemented an ERAS program encompassing more than four care elements
within at least two phases of perioperative care in lung cancer surgery.
The heterogeneity levels between studies were estimated by the Cochrane
Collaborations. A qualitative review was performed if considerable
heterogeneity was revealed. Relative risk (RR) and weighted mean
difference served as the summarized statistics for the meta-analyses.
Additional analyses were also performed to perceive potential bias risks.
Results: A total of seven RCTs enrolling 486 patients were included. The
meta-analysis indicated that the ERAS group patients had significantly
lower morbidity rates (RR=0.64; p<0.001), especially the rates of
pulmonary (RR=0.43; p<0.001) and surgical complications (RR=0.46;
p=0.010), than those of control group patients. No significant reduction
was found in the inhospital mortality (RR=0.70; p=0.58) or cardiovascular
complications (RR=1.46; p=0.25). In the qualitative review, most of the
evidence reported significantly shortened length of hospital and intensive
care unit stay and decreased hospitalization costs in the ERAS-treated
patients. No significant publication bias was detected in the
meta-analyses. Conclusion: Our review demonstrates that the implementation
of an ERAS program for lung cancer surgery can effectively accelerate
postoperative recovery and save hospitalization costs without compromising
patients' safety. A worldwide consensus guideline is urgently required to
standardize the ERAS protocols for elective lung resections in the
future.<br/>Copyright &#xa9; 2017 Li et al.

<20>
Accession Number
619411584
Author
O'Hair D.P.; Bajwa T.K.; Popma J.J.; Watson D.R.; Yakubov S.J.; Adams
D.H.; Sharma S.; Robinson N.; Petrossian G.; Caskey M.; Byrne T.; Kleiman
N.S.; Zhang A.; Reardon M.J.
Institution
(O'Hair) Department of Cardiothoracic Surgery, Aurora St. Luke's Medical
Center, Milwaukee, Wisconsin
(Bajwa) Department of Cardiology, Aurora St. Luke's Medical Center,
Milwaukee, Wisconsin
(Popma) Department of Internal Medicine, Cardiovascular Division, Beth
Israel Deaconess Medical Center, Boston, Massachusetts
(Watson) Department of Cardiothoracic Surgery, OhioHealth, Riverside
Methodist Hospital, Columbus, Ohio
(Yakubov) Department of Cardiology, OhioHealth, Riverside Methodist
Hospital, Columbus, Ohio
(Adams) Department of Cardiothoracic Surgery, Mount Sinai Health System,
New York, New York
(Sharma) Department of Cardiology, Mount Sinai Health System, New York,
New York
(Robinson) Department of Cardiothoracic Surgery, St. Francis Hospital,
Roslyn, New York
(Petrossian) Department of Cardiology, St. Francis Hospital, Roslyn, New
York
(Caskey) Department of Cardiothoracic Surgery, Banner Good Samaritan
Regional Medical Center, Phoenix, Arizona
(Byrne) Department of Cardiology, Banner Good Samaritan Regional Medical
Center, Phoenix, Arizona
(Kleiman) Department of Cardiology, Houston Methodist DeBakey Heart and
Vascular Center, Houston, Texas
(Zhang) Coronary and Structural Heart, Medtronic, Mounds View, Minnesota
(Reardon) Department of Cardiovascular Surgery, Houston Methodist DeBakey
Heart and Vascular Center, Houston, Texas
Title
Direct Aortic Access for Transcatheter Aortic Valve Replacement Using a
Self-Expanding Device.
Source
Annals of Thoracic Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
Elsevier USA
Abstract
Background: Transcatheter aortic valve replacement (TAVR) using a
self-expanding valve has been shown to be superior to an open operation in
high-risk patients. Extensive iliofemoral peripheral vascular disease can
prohibit femoral access. In these cases, direct aortic (DA) implantation
may be a suitable option. Methods: The current analysis compared outcomes
in patients undergoing TAVR with the self-expanding CoreValve prosthesis
(Medtronic, Minneapolis, MN) by direct aortic (DA) access vs iliofemoral
(IF) access. Patients treated in the CoreValve US High Risk and Extreme
Risk Pivotal Trials and Continued Access Study were included. Propensity
score matching was used to account for differences in baseline
characteristics between groups. Clinical outcomes were compared at 30 days
and 1 year. Results: We identified 394 matched pairs of IF and DA
patients. The all-cause mortality rate was significantly higher in the DA
group than in the IF group at 30 days (10.9% vs 4.1%, p < 0.001), but this
difference was reduced at 1 year (28.1% vs 23.2%, p = 0.063). All-cause
mortality or major stroke was significantly higher for DA vs IF access at
30 days (13.5% vs 5.3%, p < 0.001) and at 1 year (30.4% vs 24.2%, p =
0.025). Major/life-threatening bleeding and acute kidney injury were
significantly greater in the DA group at 30 days (66.7% vs 35.4% and 19.7%
vs 10.0%, respectively, both p < 0.001). Conclusions: When femoral access
is not feasible, DA access allows effective delivery of the valve but
incurs an increased risk of death and adverse events, potentially the
result of procedural differences.<br/>Copyright &#xa9; 2017 The Society of
Thoracic Surgeons.

<21>
Accession Number
619406774
Author
Khan S.U.; Lone A.N.; Saleem M.A.; Kaluski E.
Institution
(Khan, Lone, Kaluski) Department of Internal Medicine Guthrie
Clinic/Robert Packer Hospital Sayre, Pennsylvania
(Saleem) Department of Family Medicine Mercy Health Janesville, Wisconsin
(Kaluski) Department of Cardiology Rutgers Medical School, Newark, New
Jersey, and The Commonwealth Medical College Scranton, Pennsylvania
(Kaluski) Department of Cardiology Guthrie Clinic/Robert Packer Hospital
Sayre, Pennsylvania
Title
Transcatheter vs surgical aortic-valve replacement in low- to
intermediate-surgical-risk candidates: A meta-analysis and systematic
review.
Source
Clinical Cardiology. (no pagination), 2017. Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
The American and European expert documents recommend transcatheter aortic
valve replacement (TAVR) for inoperable or high-surgical-risk patients
with severe aortic stenosis. In comparison, efficacy of TAVR is relatively
less studied in low- to intermediate-surgical-risk patients. We sought to
discover whether TAVR can be as effective as surgical aortic valve
replacement (SAVR) in low- to intermediate-surgical-risk candidates. Four
randomized clinical trials (RCTs) and 8 prospective matched studies were
selected using PubMed/MEDLINE, Embase, and Cochrane Library (inception:
March 2017). Results were reported as random-effects odds ratio (OR) with
95% confidence interval (CI). Among 9851 patients, analyses of RCTs showed
that all-cause mortality was comparable between TAVR and SAVR (short term,
OR: 1.19, 95% CI: 0.86-1.64, P=0.30; mid-term, OR: 0.97, 95% CI:
0.75-1.26, P=0.84; and long term, OR: 0.97, 95% CI: 0.81-1.16, P=0.76).
The analysis restricted to matched studies showed similar outcomes. In the
analysis stratified by study design, no significant differences were noted
in the RCTs for stroke, whereas TAVR was better than SAVR in matched
studies at short term only (OR: 0.46, 95% CI: 0.33-0.65, P<0.001). TAVR is
associated with reduced risk of acute kidney injury and new-onset atrial
fibrillation (P<0.05). However, increased incidence of permanent pacemaker
implantation and paravalvular leaks was observed with TAVR. TAVR can
provide similar mortality outcome compared with SAVR in low- to
intermediate-surgical-risk patients with critical aortic stenosis.
However, both procedures are associated with their own array of adverse
events.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<22>
Accession Number
617902108
Author
Hong S.S.; Alison J.A.; Milross M.A.; Robledo K.; Dignan R.
Institution
(Hong) Physiotherapy Department, Liverpool Hospital, Elizabeth Street,
Liverpool, Sydney, NSW 2170, Australia
(Alison, Milross) Discipline of Physiotherapy, University of Sydney,
Sydney, Australia
(Alison) Department of Physiotherapy, Royal Prince Alfred Hospital,
Australia
(Dignan) Department of Cardiothoracic Surgery, Liverpool Hospital and
University of New South Wales, Sydney, Australia
(Robledo) NHMRC Clinical Trials Centre, University of Sydney, Sydney,
Australia
(Alison) Discipline of Physiotherapy, Faculty of Health Sciences, The
University of Sydney, 75 East Street, Lidcombe NSW 2141, Australia
(Dignan) Cardiothoracic Surgery Department, Liverpool Hospital, Elizabeth
Street, Liverpool NSW 2170, Australia
Title
Does continuous infusion of local anaesthesia improve pain control and
walking distance after coronary artery bypass graft surgery? A randomised
controlled trial.
Source
Physiotherapy (United Kingdom). 103 (4) (pp 407-413), 2017. Date of
Publication: December 2017.
Publisher
Elsevier Ltd
Abstract
Objectives To evaluate the effects of continuous infusion of ropivacaine
compared to sham infusion or usual care on pain scores before and after
physiotherapy treatment, distance walked and time to discharge from
physiotherapy, after coronary artery bypass graft (CABG) surgery. Design
Prospective, randomised, double blind controlled trial. Setting and
participants Seventy-five participants who underwent CABG surgery with
left internal mammary artery grafts were allocated, to the ropivacaine
group (n = 26), the sham group (n = 25), or usual care group (n = 24).
Participants in the ropivacaine group received 0.5% ropivacaine and
participants in the sham group received normal saline, both as continuous
infusions via two parasternally tunnelled catheters for 96 hours
continuously. The usual care group did not receive a device. All groups
had patient-controlled analgesia and/or oral analgesia. Results
Seventy-two participants completed the study. There was no significant
between-group differences in pain scores, distance walked on any post
operative day (POD) or number of participants discharged from
physiotherapy by POD 4. For the group as a whole there was a significant
linear decrease in pain score from mean (SD) 42 (24) mm on POD1 to 15 (16)
mm on POD4 (p < 0.001), (MD 27 mm, 95% CI 22 to 32) and walking distance
increased from 1 (5) m on POD1 to 183 (239) m on POD4 (p < 0.001) MD 181
m, 95% CI 126 to 236). Conclusion Infusion of ropivacaine post CABG
surgery was unable to reduce pain, increase distance walked or reduce time
to physiotherapy discharge compared to sham or usual care. Trial
registration number ACTRN12612001243808.<br/>Copyright &#xa9; 2017
Chartered Society of Physiotherapy

<23>
Accession Number
617340620
Author
Bergmeijer T.O.; Janssen P.W.A.; Van Oevelen M.; Van Rooijen D.; Godschalk
T.C.; Kelder J.C.; Deneer V.H.M.; Serebruany V.L.; Ten Berg J.M.
Institution
(Bergmeijer, Janssen, Van Oevelen, Van Rooijen, Godschalk, Kelder, Ten
Berg) Department of Cardiology, St. Antonius Hospital, Nieuwegein,
Netherlands
(Deneer) Department of Clinical Pharmacy, St. Antonius Hospital,
Nieuwegein, Netherlands
(Serebruany) Johns Hopkins University, Baltimore, MD, United States
(Ten Berg) St. Antonius Hospital Nieuwegein, PO Box 2500, EM Nieuwegein
NL-3432, Netherlands
Title
Incidence and Causes for Early Ticagrelor Discontinuation: A "real-World"
Dutch Registry Experience.
Source
Cardiology (Switzerland). 138 (3) (pp 164-168), 2017. Date of Publication:
01 Nov 2017.
Publisher
S. Karger AG
Abstract
Objectives: The PLATO trial revealed superiority of ticagrelor over
clopidogrel for the prevention of atherothrombotic events in patients with
acute coronary syndrome. However, adverse events such as bleeding,
dyspnea, and bradycardia were frequently reported, potentially leading to
excess early ticagrelor discontinuation (ETD), later confirmed in the
PEGASUS trial. We here evaluated the incidence and causes for ETD in a
real-world patient cohort in a high-volume nonacademic percutaneous
coronary intervention center in the Netherlands. Methods: In a
retrospective single-center registry, all patients discharged from the
hospital with a new ticagrelor prescription were screened for ETD.
Follow-up data were obtained using the hospital electronic patient file
records and confirmed by telephone contact with the patient and/or general
practitioner, if necessary, to complement the data. Results: Ticagrelor
was prescribed in 354 patients between December 2011 and December 2012.
The follow-up data were available in 301 patients with a mean follow-up
duration of 330 days. ETD or switching to another antiplatelet agent
occurred in 73 patients (24.3%), mostly due to dyspnea (11.6%), bleeding
(3.7%), or planned major surgery (2.7%). Conclusions: Almost one quarter
of ticagrelor patients were discontinued prematurely or switched to
another antiplatelet agent within 1 year, mostly due to dyspnea or
bleeding.<br/>Copyright &#xa9; 2017 S. Karger AG, Basel.

<24>
Accession Number
617974658
Author
Lamore K.; Montalescot L.; Untas A.
Institution
(Lamore, Montalescot, Untas) Laboratory of Psychopathology and Health
Processes (EA 4057), University of Paris Descartes, Sorbonne Paris Cite,
71, Avenue Edouard-Vaillant, Boulogne-Billancourt 92100, France
Title
Treatment decision-making in chronic diseases: What are the family
members' roles, needs and attitudes? A systematic review.
Source
Patient Education and Counseling. 100 (12) (pp 2172-2181), 2017. Date of
Publication: December 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Objective This systematic review aims to examine the roles of family
members (FMs) in treatment decision-making for adult patients without
cognitive or psychiatric disorders affecting their ability to participate
in decision-making. Methodology A comprehensive, systematic search of the
Cochrane Library, PsycINFO, PubMed and ScienceDirect databases, with
relevant keywords, was conducted. Two authors evaluated the eligibility of
the studies independently, then cross-checked for accuracy. The quality of
included studies were assessed using standardized criteria. Results Out of
the 12.137 studies identified, 40 were included. Results highlighted the
different roles and influences FMs have in the decision-making process.
Moreover, several factors ranging from personal to cultural and
family-related factors influence their level of involvement. Regardless of
the illness, some similarities in family influence exist (e.g., social
support). However, the type of family involvement varies according to the
illness, the treatment choice and the patients' culture. Conclusion FMs
have an important role in the decision-making process. In fact, the final
decision is often made by the patients after consulting their families.
FMs can support both patients and medical teams, and thus facilitate the
process. Practice implications Physicians should include FMs in treatment
decision-making when the patients and their FMs wish to be
included.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<25>
Accession Number
619305019
Author
Della Corte A.; Bancone C.; Spadafora A.; Borrelli M.; Galdieri N.;
Quintiliano S.N.; Bifulco O.; de Feo M.
Institution
(Della Corte, Bancone, Spadafora, Borrelli, Galdieri, Quintiliano,
Bifulco, de Feo) Department of Cardiothoracic Sciences, Second University
of Naples, Unit of Cardiac Surgery of the Monaldi Hospital, Naples, Italy
Title
Postoperative bleeding in coronary artery bypass patients on double
antiplatelet therapy: Predictive value of preoperative aggregometry.
Source
European Journal of Cardio-thoracic Surgery. 52 (5) (pp 901-908), 2017.
Date of Publication: 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: We tested the possible value of routine aggregometry testing
for bleeding prediction following coronary artery bypass grafting in
patients who received preoperative double antiplatelet therapy. METHODS:
In 226 patients undergoing on-pump isolated coronary artery bypass
grafting, aggregometry [adenosine diphosphate (ADP) test and ASPI test]
was always prospectively performed by Multiplate analyser immediately
before surgery. We assessed the differences in postoperative bleeding
according to the type of double antiplatelet therapy [acetylsalicylic acid
plus clopidogrel (ASA+C), or plus ticagrelor (ASA+T)], duration of
clopidogrel/ticagrelor withdrawal (0-3 days or >= 4 days) and results of
aggregometry tests. Multivariable predictors of blood losses were sought
by linear regressions (drainage amount at 6, 12 and 24 postoperative
hours) and logistic regression (increased bleeding: 75th percentile of
blood losses at 6 h, i.e. >450 ml). RESULTS: Overall, postoperative blood
losses did not significantly differ between treatment groups (median at 6
h: ASA + C = 335 ml, ASA + T = 300 ml, P = 0.21). With longer withdrawal
interval, higher rates of patients with normal ADP-related platelet
function were observed in both groups (ASA + C: P = 0.04; ASA + T: P =
0.006) but only in the ASA + T group were blood losses significantly
smaller at all 3 time points. Bleeders (>450 ml at 6 h) were significantly
less frequent among patients with ADP test showing recovered platelet
function (ASA + T: P = 0.002; ASA + C: P = 0.053). The correlation between
ADP test result and blood losses amount was stronger in the ASA + T group
(e.g. at 6 h: r = -0.6; P < 0.001). In multivariable analyses, the ADP
test result independently predicted postoperative bleeding in the ASA + T
group and the ASPI test in the ASA + C group. CONCLUSIONS: Aggregometry
can help in predicting postoperative bleeding in double antiplatelet
therapy patients undergoing coronary artery bypass grafting.<br/>Copyright
&#xa9; The Author 2017. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.

<26>
Accession Number
619305011
Author
Schiller W.; Barnewold L.; Kazmaier T.; Beckmann A.; Masseli F.; Welz A.;
Szecsenyi J.; Heller G.
Institution
(Schiller, Masseli, Welz) Department of Cardiac Surgery, University of
Bonn, Bonn, Germany
(Barnewold, Kazmaier, Szecsenyi) AQUA-Institut fur angewandte
Qualitatsforderung, Forschung im Gesundheitswesen GmbH, Gottingen, Germany
(Beckmann) Department of Cardiac and Vascular Surgery, Heart Center
Duisburg, Duisburg, Germany
(Heller) IQTIG-Institut fur Qualitatssicherung, Transparenz im
Gesundheitswesen, Berlin, Germany
Title
The German aortic valve score II.
Source
European Journal of Cardio-thoracic Surgery. 52 (5) (pp 881-887), 2017.
Date of Publication: 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
OBJECTIVES: The German Aortic Valve Score (GAVS) was developed for
national quality assurance regarding the in-hospital mortality rate of
patients following isolated aortic valve replacement. The goal of this
work was the recalibration of the GAVS in the context of increased numbers
of transcatheter aortic valve implantations. METHODS: In 2011 and 2012, 36
183 cases were documented who had either surgical aortic valve replacement
or transcatheter aortic valve implantation (45%). All cases were randomly
assigned to the study or to the validation group. All items of the data
set were checked for significance by developing a multiregression risk
model using iterative backward elimination. Calibration was ascertained
using the Hosmer-Lemeshow method. To define the quality of discrimination,
the area under the receiver operating characteristic curve (C-statistic)
was calculated. RESULTS: The randomized study cohort comprised 18 054
patients. After modelling with multiple regression algorithms, 18 of the
initial 28 risk factors entered the risk model. When applied to the
validation group, the newly developed GAVS II showed good calibration with
a P-value of 0.411 in the Hosmer-Lemeshow test and good discrimination
with a C-statistic of 0.741. CONCLUSIONS: The GAVS II is a new risk model
that is applicable to cohorts having surgical aortic valve replacement or
transcatheter aortic valve implantation procedures.<br/>Copyright &#xa9;
The Author 2017. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<27>
Accession Number
619304993
Author
Sa M.P.B.O.; Soares A.F.; Miranda R.G.A.; Araujo M.L.; Menezes A.M.;
Vasconcelos Silva F.P.; Lima R.C.
Institution
(Sa, Soares, Miranda, Araujo, Menezes, Vasconcelos Silva, Lima) Division
of Cardiovascular Surgery, Pronto Socorro Cardiologico de Pernambuco
(PROCAPE), Recife, Brazil
(Sa, Soares, Miranda, Araujo, Menezes, Vasconcelos Silva, Lima) University
of Pernambuco (UPE), Recife, Brazil
(Sa, Lima) Nucleus of Postgraduate and Research in Health Sciences of
Faculty of Medical Sciences, Biological Sciences Instituite (FCM/ICB),
Recife, Brazil
Title
Stopping versus continuing acetylsalicylic acid before coronary artery
bypass surgery: A systematic review and meta-analysis of 14 randomized
controlled trials with 4499 patients.
Source
European Journal of Cardio-thoracic Surgery. 52 (5) (pp 838-847), 2017.
Date of Publication: 2017.
Publisher
European Association for Cardio-Thoracic Surgery (E-mail:
info@eacts.co.uk)
Abstract
This study aimed to evaluate the efficacy and safety of continuing versus
stopping aspirin [acetylsalicylic acid (ASA)] preoperatively in patients
undergoing coronary artery bypass graft surgery. MEDLINE, EMBASE,
CENTRAL/Cochrane Controlled Trials Register (CCTR), ClinicalTrials.gov,
Scientific Electronic Library Online (SciELO), Literatura Latino Americana
em Ciencias da Saude (LILACS), Google Scholar and reference lists of
relevant articles were searched for randomized controlled trials that
reported efficacy outcomes ofmyocardial infarction and mortality, and
safety outcomes of blood loss, packed red blood cell transfusion and
surgical re-exploration were compared between groups. Fourteen studies
fulfilled our eligibility criteria and included a total of 4499 patients
(2329 for 'continuing ASA' and 2170 for 'stopping ASA'). In the pooled
analysis, continuing aspirin therapy did not reduce the risk of myocardial
infarction [risk ratio 0.834, 95% confidence interval (CI) 0.688-1.010; P
= 0.063] or operative mortality (risk ratio 1.384, 95% CI 0.727-2.636; P =
0.323). Preoperative ASA increased postoperative chest tube drainage (mean
difference 143 ml, 95% CI 39-248 ml; P = 0.007) and packed red blood cell
transfusion (mean difference 142ml, 95% CI 55-228; P = 0.001) but did not
increase the risk of surgical re-exploration (risk ratio 1.316, 95% CI
0.910-1.905; P = 0.145). This meta-analysis found no statistically
significant difference regarding the risk of operative mortality and
myocardial infarction between the 'continuing ASA' and 'stopping ASA'
strategies. On the other hand, the mean volume of blood loss and packed
red blood cell transfusion was higher in the 'continuing ASA' group, but
this finding did not translate into higher risk of reoperation for
bleeding.<br/>Copyright &#xa9; The Author 2017. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<28>
Accession Number
616965919
Author
Veen E.V.; Bovendeert J.F.M.; Backx F.J.G.; Huisstede B.M.A.
Institution
(Veen, Bovendeert, Backx, Huisstede) University Medical Center Utrecht,
Rudolf Magnus Institute of Neurosciences, Department of Rehabilitation,
Nursing Science & Sports, Utrecht, Netherlands
Title
E-coaching: New future for cardiac rehabilitation? A systematic review.
Source
Patient Education and Counseling. 100 (12) (pp 2218-2230), 2017. Date of
Publication: December 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Objective To provide an evidence-based overview of the effectiveness of
e-coaching as a cardiac rehabilitation program (CRP). Methods Pubmed,
Embase, PEDro and CINAHL were searched to identify relevant RCTs. The
e-coaching programs were divided into basic or complex depending on their
content. Two reviewers independently assessed the methodological quality
and extracted the data. A best-evidence synthesis was used to summarize
the results. Results 19 RCTs were included. Detailed descriptions of the
e-coaching programs were lacking. Complex e-coaching was more effective
than usual-care for physical capacity (moderate evidence for short-, and
mid-term; strong evidence for long-term), for clinical status (limited
evidence for short- and mid-term; moderate evidence for the long-term),
and for psychosocial health (moderate evidence for short-term; strong
evidence for mid-, and long-term). For basic e-coaching only limited or no
evidence for effectiveness was found. Conclusion Promising results were
found for the effectiveness of complex e-coaching as a CRP to improve a
patients' physical capacity, clinical status and psychosocial health.
Practice implications The content of the e-coaching programs were not
clearly described. This makes it difficult to identify which components of
e-coaching are most effective and should be further developed to deliver
the most optimal care for cardiac rehabilitation patients.<br/>Copyright
&#xa9; 2017 Elsevier B.V.

<29>
Accession Number
619282830
Author
Flaherty L.B.; Wood T.; Cheng A.; Khan A.R.
Institution
(Flaherty) Department of Psychological and Brain Sciences, University of
Louisville School of Arts and Sciences, Louisville, Ky, United States
(Wood, Khan) Division of Cardiovascular Medicine, University of Louisville
School of Medicine, Louisville, Ky, United States
(Cheng) Division of Cardiothoracic Surgery, Washington University School
of Medicine, St Louis, Mo, United States
Title
Pre-existing psychological depression confers increased risk of adverse
cardiovascular outcomes following cardiac surgery: A systematic review and
meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 154 (5) (pp 1578-1586.e1),
2017. Date of Publication: November 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)

<30>
Accession Number
619254736
Author
Pilgrim T.; Raber L.; Limacher A.; Wenaweser P.; Cook S.; Stauffer J.-C.;
Garachemani A.; Moschovitis A.; Meier B.; Juni P.; Windecker S.
Institution
(Pilgrim, Raber, Wenaweser, Moschovitis, Meier, Windecker) Department of
Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern
3010, Switzerland
(Limacher, Juni, Windecker) Clinical Trials Unit Bern, Department of
Clinical Research, University of Bern, Bern, Switzerland
(Cook, Stauffer) Cardiology, University of Fribourg, Fribourg, Switzerland
(Garachemani) Lindenhof Hospital, Bern, Switzerland
(Juni) Institute of Social and Preventive Medicine, University of Bern,
Bern, Switzerland
Title
Five-year results of a randomised comparison of
titanium-nitride-oxide-coated stents with zotarolimus-eluting stents for
coronary revascularisation.
Source
EuroIntervention. 10 (11) (pp 1284-1287), 2015. Date of Publication: 01
Mar 2015.
Publisher
EuroPCR
Abstract
Aims: Stents with a passive coating of titanium-nitride-oxide (TiNO) have
been compared with Endeavor zotarolimus-eluting stents (E-ZES) with regard
to the primary endpoint of in-stent late lumen loss at six to eight
months. The objective of the present analysis was to compare the long-term
outcomes of TiNO stents with E-ZES up to five years of clinical follow-up.
Methods and results: A total of 302 patients had been randomly allocated
to treatment with TiNO or E-ZES. Up to five years of follow-up, major
adverse cardiac events (MACE), the composite of cardiac death, myocardial
infarction, or clinically indicated target vessel revascularisation (TLR),
were observed in 27.6% of patients treated with TiNO stents and 25.3% of
patients treated with E-ZES (RR 1.13, 95% CI: 0.72-1.75, p=0.60), with the
majority of events related to clinically indicated TVR (TiNO 21.7% versus
E-ZES 20.7%, RR 1.10, 95% CI: 0.67-1.81). There were no differences with
respect to individual events including cardiac death, myocardial
infarction or stent thrombosis between the two treatment arms up to five
years of followup. A majority of patients remained free from angina
throughout the entire study duration (TiNO 77.3% versus E-ZES 76.1%,
p=0.92). Conclusions: Final five-year outcomes of the TIDE trial comparing
TiNO stents with E-ZES revealed increased rates of MACE driven primarily
by clinically indicated TVR. The TIDE trial is registered at
ClinicalTrials.gov: NCT00492908.<br/>Copyright &#xa9; Europa Digital &
Publishing 2015. All rights reserved.

<31>
Accession Number
616403730
Author
Sidell D.R.; Koth A.M.; Bauser-Heaton H.; McElhinney D.B.; Wise-Faberowski
L.; Tracy M.C.; Hanley F.L.; Asija R.
Institution
(Sidell, Koth, McElhinney, Tracy, Asija) Department of Pediatrics,
Stanford University, Palo Alto, CA, United States
(Sidell) Department of Otolaryngology, Head and Neck Surgery and the LPCH
Stanford Pediatric Aerodigestive Program, Stanford University, Palo Alto,
CA, United States
(Bauser-Heaton) Department of Pediatrics, Children's Healthcare of
Atlanta, Stanford University, Palo Alto, CA, United States
(McElhinney, Hanley) Department of Cardiothoracic Surgery, Stanford
University, Palo Alto, CA, United States
(Wise-Faberowski) Department of Anesthesia, Stanford University, Palo
Alto, CA, United States
Title
Bronchoscopy in children with tetralogy of fallot, pulmonary atresia, and
major aortopulmonary collaterals.
Source
Pediatric Pulmonology. 52 (12) (pp 1599-1604), 2017. Date of Publication:
December 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: Children with Tetralogy of Fallot, Pulmonary Atresia, and Major
Aortopulmonary Collaterals (TOF/PA/MAPCAs) undergoing unifocalization
surgery are at risk for developing more postoperative respiratory
complications than children undergoing other types of congenital heart
surgery. Bronchoscopy is used in the perioperative period for diagnostic
and therapeutic purposes. In this study, we describe bronchoscopic
findings and identify factors associated with selection for bronchoscopy.
Design: Retrospective case-control. Patients and Methods: All patients
with TOF/PA/MAPCAs who underwent unifocalization surgery from September
2005 through March 2016 were included. Patients who underwent bronchoscopy
in the perioperative period were compared to a randomly selected cohort of
172 control patients who underwent unifocalization without bronchoscopy
during the study period. Results: Forty-three children underwent
perioperative bronchoscopy at a median of 9 days postoperatively. Baseline
demographics were similar in bronchoscopy patients and controls. Patients
who underwent bronchoscopy were more likely to have a chromosome 22q11
deletion and were more likely have undergone unifocalization surgery
without intracardiac repair. These patients had a longer duration of
mechanical ventilation, ICU duration, and length of hospitalization.
Abnormalities were detected on bronchoscopy in 35 patients (81%), and 20
(35%) of bronchoscopy patients underwent a postoperative intervention
related to abnormalities identified on bronchoscopy. Conclusion:
Bronchoscopy is a useful therapeutic and diagnostic instrument for
children undergoing unifocalization surgery, capable of identifying
abnormalities leading to an additional intervention in over one third of
patients. Special attention should be given to children with a 22q11
deletion to expedite diagnosis and intervention for possible airway
complications.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<32>
Accession Number
619390689
Author
Seco M.; Cao C.; Modi P.; Bannon P.G.; Wilson M.K.; Vallely M.P.; Misfeld
M.; Mohr F.; Yan T.D.
Institution
(Seco, Cao, Modi, Bannon, Wilson, Vallely, Misfeld, Mohr, Yan) Sydney
Medical School, University of Sydney; The Baird Institute of Applied Heart
and Lung Surgical Research; Royal Prince Alfred Hospital, Sydney; Heart
Centre Leipzig, University of Leipzig, Leipzig, Germany
Title
Systematic review of robotic mitral valve surgery.
Source
Heart Lung and Circulation. Conference: 2014 Australia and New Zealand
Society of Cardio-thoracic Surgeons Annual Scientific Meeting, ANZSCTS
2014. Australia. 24 (Supplement 1) (pp e42-e43), 2015. Date of
Publication: 2015.
Publisher
Elsevier Ltd
Abstract
Introduction: We provide a synopsis of the published literature on robotic
mitral valve surgery (MVS), focusing on clinical outcomes and
cost-effectiveness. Methods: Structured searches of online databases were
performed in August 2013. All studies of robotic MVS were included. Data
regarding intraoperative, short termand long term end points, cost
effectiveness, and quality of life were extracted. Results: Twenty-seven
studies were included in qualitative review, 16 ofwhich had <=50 patients
andwere presented quantitatively. All studies were observational in
nature. Patients generally had good left ventricular performance, and mean
patient age ranged form 52.6-58.4 years. Rates of intraoperative outcomes
ranged from: 0.0-9.1% for conversion to non-robotic surgery, 106 +/-
22-188.5 +/- 53.8 min for cardiopulmonary bypass time, and 79 +/--140 +/-
40 min for cross-clamp time. Rates of short-termpostoperative outcomes
ranged from: 0.0-3.0%for mortality, 0.0-3.2% for myocardial infarction,
0.0-3.0% for permanent stroke, 1.6-15% for pleural effusion, 0.0-5.0% for
reoperations for bleeding, 0.0-0.3% for infection, and 1.1-6% for
prolonged ventilation (>48 hours), 1.5-5.4% for early repair failure, 12.3
+/- 6.7-36.6 +/- 24.7 hours for intensive care length of stay, 3.1 +/-
0.3-6.3 +/- 3.9 days for hospital length of stay, and 81.7-97.6% had none
or trivial mitral regurgitation before discharge. One Australian study
assessed cost-effectiveness, which found that compared to sternotomy MVS,
robotic MVS resulted in higher intraoperative costs (AU$12, 328 vs. AU $9,
755), but these were offset by lower postoperative costs (AU$6, 174
vs.AU$8, 124, P<0.001), such that total hospital cost was not
significantly different (AU$18, 503.49 vs. AU $17, 879.80, average
difference AU$623, 95% CI: -$282 to $1, 529, P=0.176). International
studies of cost-effectiveness found similar results. Two studies assessed
quality of life and postoperative pain. In the 0-12months postoperative
period, roboticMVS resulted in better quality of life survey scores, less
chest pain, and faster return to work (33 vs. 54 days, p=0.001). In the
12-24 month postoperative period quality of life and pain scores were
similar. Discussion: All subtypes of mitral valve prolapse are repairable
with robotic techniques. Cardiopulmonary bypass and cross-clamp times are
long, though novel techniques such as the Cor-Knot, Nitinol clips or
running sutures may reduce the time required. The overall rates of early
postoperative mortality and morbidity are low. Improvements in
postoperative quality of life and expeditious return to work offset the
increase in equipment and intraoperative cost. Evidence for long-term
outcomes are as yet limited.

<33>
Accession Number
619390682
Author
Zahoor B.A.; Scalea T.M.; Noorbakhsh M.R.; Bruns B.R.
Institution
(Zahoor, Scalea, Noorbakhsh, Bruns) Division of Trauma, University of
Maryland Medical Center, Shock Trauma Center, Baltimore, MD 21201, United
States
Title
Penetrating cardiac injury as the result of pre-hospital needle
decompression.
Source
Heart Lung and Circulation. Conference: 2014 Australia and New Zealand
Society of Cardio-thoracic Surgeons Annual Scientific Meeting, ANZSCTS
2014. Australia. 24 (Supplement 1) (pp e69-e72), 2015. Date of
Publication: 2015.
Publisher
Elsevier Ltd
Abstract
The widespread use of pre-hospital needle decompression, in the absence of
rigid criteria, extensive training, and effective equipment, runs the risk
of potentially devastating complications. A trauma patient suspected of
tension pneumothorax underwent bilateral needle decompression, in the
field, that resulted in penetrating cardiac injury requiring immediate
repair. We review current literature regarding the utility of needle
decompression as an adjuvant in the field and caution its use.
Introduction: Tension pneumothorax is a life threatening injury and unless
rapidly decompressed, can lead to death. Definitive decompression involves
placing a tube thoracostomy, but a tension pneumothorax can be temporized
by decompression using a needle. A standard 14 gauge angiocath,
approximately 4.5 cm is perhaps the most commonly used implement
[1,2,10,11]. It is generally placed in the second intercostal space in the
midclavicular line, or in the fifth intercostal space in themid-axillary
line [12]. Needle decompression is a skill that is commonly used in the
field prior to hospital presentation. This is unequivocally a temporizing
measure, which when faced with prolonged transport times and a critically
ill patient, saves lives [2]. A rush of air via the catheter confirms the
diagnosis of a large tension pneumothorax. Generally, if there are no
other causes for patient instability, the patients stabilize quickly.
Needle decompression in the field, however, remains a controversial
procedure. While it can be lifesaving, if performed incorrectly, the
complications can be disastrous [2,6]. We present a patient who had a
penetrating cardiac injury from an attempt at needle decompression in the
field. Methods/Clinical Record: A twenty-seven-year-old male was struck by
a vehicle at high speed. In the field, he was minimally responsive with
clenched teeth, moaning and with-drawing to pain (GCS=7; E=1, V=2, M=4).
On auscultation, decreased breath sounds were elicited bilaterally. An
endotracheal intubation was completed and bilateral needle decompression
attempted prior to being airlifted to our institution. On arrival in the
ED, again breath sounds were noted to be diminished bilaterally. Bilateral
thoracostomy tubes were placed without any return of blood or air. The
patient was noted to be hypertensive (/mmHg), tachypneic (32RR) and
tachycardic (HR). Physical exam revealed obvious external injury to his
head, multiple torso abrasions, and an obvious lower extremity fracture.
FAST exam showed minimal fluid in the LUQ and a technically difficult view
of the pericardium with no obvious large pericardial effusion. Secondary
survey revealed a puncture site, consistent with the attempted needle
decompression attempted in the field, in the fourth intercostal space
adjacent to the sternum (Fig. 1). Resuscitation continued until the
patient was deemed a candidate for further evaluation using a CT scan of
the head, cervical spine, chest, abdomen, and pelvis to delineate
injuries. The patient was found to have a high grade splenic injury and
pneumopericardium with a small pericardial effusion (Fig. 2). The injuries
noted on CT scan are listed in Table 1. Laboratory evaluation was
pertinent for an elevated cardiac component (0.5 ng/ml). In the setting of
traumatic brain injury (TBI), the decision was made to proceed with
operative exploration. The patient underwent a laparotomy, during which a
trans-diaphragmatic pericardial window was created. This revealed 10 cc's
of blood. The patient's midline laparotomy incision was extended to his
chest, and a median sternotomy was completed with the pericardium
reflected. This revealed a pinpoint puncture wound (Fig. 3) on the
anterior surface of his heart adjacent to the left anterior descending
coronary artery. Of note, the site of the small perforation was just under
the site of his needle decompression. This was repaired using a 3-0
prolene U stitch with pledgets that successfully achieved complete
hemostasis (Fig. 4). A splenectomy was then completed, after which, the
operation concluded uneventfully. The patient was stable postoperatively
and made a slow recovery from his TBI. He had no thoracic or abdominal
complications and was ultimately discharged to a TBI rehabilitation
facility for continued recuperation. Discussion: Several studies describe
multiple groups' experience with pre-hospital needle decompression, with
some suggestion of improved outcomes and a relatively low complication
rate [2-5,9]. However, Netto and colleagues demonstrated, in that even in
the setting of rigid criteria for the performance of needle decompression
by trained personnel, a high proportion of decompressions were performed
in dangerous anatomic locations. Of fore-most concern, were decompressions
performed in the cardiac "box"(Fig. 1) placing the patient at greatest
risk for cardiac and great vessel injury [11]. Needle decompression can be
a lifesaving procedure, particularly in the case of a tension pneumothorax
with hemodynamic instability. Definitive therapy involves placing a tube
thoracostomy. However, this is not possible in the field. Even, in some
Emergency Departments, the skill to place a tube thoracostomy may not be
immediately available [2]. Thus, there is clear rationale for needle
decompression [1,6,11]. However, needle decompression has come under
controversy recently, and may have failure rates as high as 50% [10].
Inaba et al, studied needle decompression in human cadavers and
demonstrated that anterior placement of a standard 1gauge angiocatheter
was only effective with decompressing a simulated tension pneumothorax in
58% of subjects studied [7]. In contrast, decompression was % successful
when the mid axillary line was used [3]. However, a military study then
demonstrated a high failure rate associated with use of the mid-axillary
line in patients who were transported by stretcher, which is obviously the
case in virtually every patient that presents to the Emergency Department
after injury [3,12]. Martin et al, has demonstrated poor efficacy in
accomplishing chest decompression. Finally, Alwyin et al, reported that 9%
of needle decompression in the field had complications referable to the
procedure. In addition, they demonstrated that over 24% of the needle
decompressions done in the field were retrospectively unnecessary [10].
Certainly one of the potential problems with needle decompression in the
field is both assuring adequate training, and then maintaining proficiency
[14]. While the best training regimen is unclear, in a large EMS system,
EMS providers may only perform this procedure several times per year.
Other common procedures performed in the pre-hospital setting such as
endotracheal intubation, may suffer from similar problems, adequate
training and maintenance of competence. In our case, this almost certainly
seems to have been a problem, as the puncture site was located well
inferior to the second intercostal space, directly over the heart. Studer
et al. have demonstrated that the only independent predictor in
proficiency or confidence is additional training [14]. Finally, it is very
likely that the catheters used are simply inadequate. The standard
14-guage, 4.5 cm angiocatheter, is simply not long enough to access the
chest in many patients and often renders the procedure unnecessarily
difficult [2,12,13]. A longer catheter would likely solve this. However,
longer catheters may come with increased risk to the viscera around the
chest, such as the mediastinal great vessels, the lung and the heart.
Lubin et al have developed a modified Veress needle that has proved
successful in animal studies, though there is no human data available [8].
Conclusion:We present a casewhere the heartwas injured when a well-meaning
prehospital provider attempted to decompress the chest. The procedure does
carry significant risk, and the minimization of this risk by avoiding
unnecessary decompression should be a priority. In this case, the
indication, decreased breath sounds without hypotension, seems marginal at
best. The complication, injury to the heart, required sternotomy and
cardiac repair. This should raise concerns about wide spread use of needle
decompression technique, especially in light of its high failure rate
[13,15]. In conclusion, further consideration is warranted regarding the
use of needle decompression. Recent use of laparoscopic trocars has shown
to be both, rapid and effective with no record of visceral injury [16];
this should be fully explored as an alternative.

<34>
Accession Number
619390677
Author
Seco M.; James J.; Edelman B.; Van Boxtel B.; Forrest P.; Byrom M.J.;
Wilson M.K.; Fraser J.; Bannon P.G.; Vallely M.P.
Institution
(Seco, James, Edelman, Van Boxtel, Forrest, Byrom, Wilson, Fraser, Bannon,
Vallely) Columbia University Medical Center, University of Sydney, Royal
Prince Alfred Hospital, Sydney, NY, United States
Title
Neurological injury and protection in adult cardiac and aortic surgery.
Source
Heart Lung and Circulation. Conference: 2014 Australia and New Zealand
Society of Cardio-thoracic Surgeons Annual Scientific Meeting, ANZSCTS
2014. Australia. 24 (Supplement 1) (pp e41-e42), 2015. Date of
Publication: 2015.
Publisher
Elsevier Ltd
Abstract
Introduction: Neurological injury is a serious peri-operative complication
of adult cardiac and aortic surgery, which can produce short-term coma or
confusion or permanent cognitive decline. Methods: A thorough review of
published literature was performed and an assessment of the level of
evidence for each technique was made using the Oxford Centre for Evidence
Based Medicine Levels of Evidence (2009). Results:Mechanisms of
neurological injury include macro and micro-embolisation of air, clot or
atheromatous plaque, hypoperfusion, hyperperfusion, and inflammatory
reactions. Current neurological assessment techniques all have limited
sensitivity and/or specificity for subtle, subclinical injury. Assessment
of the aorta for atherosclerotic burden using transoesophageal and/or
epiaortic ultrasound prior to cannulation for cardiopulmonary bypass (CPB)
is an important step in preventing plaque rupture and embolisation, and
indicates the use of alternate cannulation sites. In coronary artery
bypass grafting an anaortic off-pump technique, which avoids all
manipulation of the aorta, has been shown to significantly reduce
neurological injury compared to an on-pump technique (level 2a) and also
an offpump technique with side-clamp (level 2a). During aortic arch
surgery, the addition of antegrade cerebral perfusion (level 2a) or
retrograde cerebral perfusion (level 3b) to deep hypothermic circulatory
arrest (14.1-20 8C) is beneficial. Current evidence suggests that moderate
hypothermic circulatory (20.1-28 8C) arrest may also be used with
antegrade cerebral perfusion (level 2a). Other beneficial techniques
include slow rewarming to avoid hyperthermia (level 2b) and alpha-stat pH
management in adults to optimise cerebral blood flow (level 2b). During
open repair of extensive thoracoabdominal aneurysms, in addition to
reconstruction of the Artery of Adamkiewicz, spinal cord protection may be
provided by reimplantation of segmental arteries (level 2b),
neurophysiological monitoring with motor or sensory evoked potentials
(level 2b), possibly staging repair to allow adaption of the collateral
blood supply (level 2b), distal aortic perfusion (level 2b), cerebral
spinal fluid drainage (level 2a) alone or with an intrathecal vasodilator
(level 2c) or regional spinal cord hypothermia (level 2c) Increased
understanding of molecular pathways involved in neurological injury and
recovery will lead to novel pharmacological agents and techniques that may
have future applications, such as the free radical scavenger edaravone or
remote ischaemic preconditioning.

<35>
Accession Number
619390671
Author
Fricke T.A.; D'Udekem Y.; Brizard C.P.; Konstantinov I.E.
Institution
(Fricke, D'Udekem, Brizard, Konstantinov) Department of Cardiothoracic
Surgery, Royal Children's Hospital, Melbourne, Australia
Title
Early mentoring of medical students and junior doctors on a path to
academic cardiothoracic surgery.
Source
Heart Lung and Circulation. Conference: 2014 Australia and New Zealand
Society of Cardio-thoracic Surgeons Annual Scientific Meeting, ANZSCTS
2014. Australia. 24 (Supplement 1) (pp e41), 2015. Date of Publication:
2015.
Publisher
Elsevier Ltd
Abstract
Introduction: In 2005 the Cardiothoracic Surgery department at The Royal
Children's Hospital started an early academic mentoring program for
medical students and junior doctors with the aim of fostering an interest
in academic surgery. The aim of this study was to assess the outcomes of
this early academic mentoring program. Methods: Between 2005 and 2013, 28
medical students and junior doctors participated in research in the
Cardiothoracic Surgery department at The Royal Children's Hospital. Each
was given an initial project on which to obtain ethics approval, perform a
literature review, data collection, statistical analysis and prepare a
manuscript for publication. A search of the names of these former students
and doctors was conducted on PubMed to identify publications. Results: A
total of 86 journal articles were published in peer-reviewed journals with
an average impact factor of 2.8 (range 0.5-15.2). Twenty three (23/28,
82%) published at least article. A student or junior doctorwas first
author in 53 (53/, 62%) of the journal articles. Forty six (46/86, 53%)
journal articles hadmore than 1 student or junior doctor as an author.
There was a mean 3.9 journal articles published per student or junior
doctor (range 0-33). Nine (9/28, 32%) received scholarships for their
research. Seven (7/28, 25%) have completed or are enrolled in higher
research degrees with a cardiothoracic surgical focus. One (1/28, 4%)
completed a Masters of Surgery degree. Six (6/28, 21%) have enrolled in
PhD programs. Of these 6, two have completed PhD degrees while in
cardiothoracic surgical training. Four are currently enrolled in PhD,
including 2 current cardiothoracic surgical trainees. Four (4/28, 14%)
entered cardiothoracic surgical training. Of these 4, three former
students have been accepted into cardiothoracic training and 1 has
obtained FRACS. Discussion and Conclusion: Our results demonstrate the
feasibility of an early academic mentoring program in a busy
cardiothoracic surgery unit.Mentoring ofmotivated individuals in academic
surgery does not only benefit their medical career, but also helps
maintain high academic output of the unit.

<36>
Accession Number
619390669
Author
Jenkinson C.; Holmes K.; Andrews D.
Institution
(Jenkinson, Holmes, Andrews) Children's Cardiac Centre, Princess Margaret
Hospital, Perth, Australia
Title
A brief history of cardiac surgery - A pictorial overview.
Source
Heart Lung and Circulation. Conference: 2014 Australia and New Zealand
Society of Cardio-thoracic Surgeons Annual Scientific Meeting, ANZSCTS
2014. Australia. 24 (Supplement 1) (pp e68-e69), 2015. Date of
Publication: 2015.
Publisher
Elsevier Ltd
Abstract
Introduction: The history of cardiac surgery is a story that involves a
combination of technological breakthroughs, persistent researchers, and
brave pioneering surgeons. We recount nearly two centuries of progress,
including daring surgeries, marvels of medical science, strange
situations, and personal conflicts, involving the pioneers of this
once-new speciality of medicine. Methods: A search of peer-reviewed
journals viaMedline, PubMed, Google Scholar, and Science Directwas
undertaken to find publications associated with the history of cardiac
surgery. References were examined to follow further back in time. Results:
The first paper we identified as relating to cardiac surgery was published
in by Francisco Romero, where a pericardiostomy was described. This was
followed by the cardiorrhaphy in (Ludwig Rehn), and the closed aortic
valvotomy in (Theodore Tuffier). Robbert Gross (working for William Ladd)
performed the first ligation of Patent Ductus Arteriosus in 8, however was
dismissed from his post at Boston Children's Hospital, forcing him to
return to his family's chicken farm for a period. The Blalock-Taussig
Shunt (4) is next examined, including the involvement of the
African-American, Dr Vivien Thomas (who was only awarded an honorary
doctorate many years later). This paved the way for Clarence Craaford's
repair of aortic coarctation, and the closed mitral valvotomy by Dwight
Harken and Charles Bailey. (Dr Bailey claimed his medical student job of
selling womens' girdles assisted in his understanding of the mitral
valve.) John Lewis used systemic hypothermia to repair secundum atrial
septal defect in 2, causing Walton Lillehei to search for a "better way" -
leading to the use of parental cross-circulation. John Gibbon's use of the
heart-lung machine in enabled John Kirklin, Michael DeBakey, and Denton
Cooley to further increase the scope of the cardiac surgeon, once
resulting in a famous rivalry that lasted nearly forty years. Discussion:
The history of cardiac surgery is a fascinating story, where the
circumstances and characters often are as interesting as the scientific
advancement and improvement in surgical techniques. We examine the key
persons, with many original publications and period photographs that still
inspire us today.

<37>
Accession Number
619390661
Author
Cao C.; Gupta S.; Chandrakumar D.; Indraratna P.; Yan T.D.
Institution
(Cao, Gupta, Chandrakumar, Indraratna, Yan) Collaborative Research (CORE)
Group, Sydney, Australia
(Cao) Department of Cardiothoracic Surgery, Prince of Wales Hospital,
Sydney, Australia
(Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital,
Sydney University, Sydney, Australia
Title
A meta-analysis of robotic versus conventional mitral valve surgery.
Source
Heart Lung and Circulation. Conference: 2014 Australia and New Zealand
Society of Cardio-thoracic Surgeons Annual Scientific Meeting, ANZSCTS
2014. Australia. 24 (Supplement 1) (pp e68), 2015. Date of Publication:
2015.
Publisher
Elsevier Ltd
Abstract
Introduction: The present study is the first meta-analysis to compare the
surgical outcomes of robotic versus conventional mitral valve surgery in
patients with degenerative mitral valve disease. Methods: A systematic
review of the literature was conducted to identify all relevant studies
with comparative data on robotic versus conventional mitral valve surgery.
Predefined primary endpoints included mortality, stroke and reoperation
for bleeding. Secondary endpoints included cross-clamp time,
cardiopulmonary bypass time, length of hospitalization and duration of
intensive care unit stay. Echocardiographic outcomes were assessed when
possible. Results: Six relevant retrospective studies with comparative
data for robotic versus conventionalmitral valve surgery were identified
from the existing literature. Meta-analysis demonstrated a superior
perioperative survival outcome for patients who underwent robotic surgery.
Incidences of stroke and reoperation were not statistically different
between the two treatment arms. Patients who underwent robotic surgery
required a significantly longer period of cardiopulmonary bypass time and
cross-clamp time. However, the lengths of hospitalization and intensive
care unit staywere not significantly different. Both surgical techniques
appeared to achieve satisfactory echocardiographic out- comes in the
majority of patients. Discussion: Current evidence on comparative outcomes
of robotic versus conventional mitral surgery is limited, and results of
the present meta-analysis should be interpreted with caution due to
differing patient characteristics. However, it has been demonstrated that
robotic mitral valve surgery can be safely performed by expert surgeons
for selected patients. A successful robotic program is dependent on a
specially trained team and a sufficient volume of referrals to attain and
retain safety.

<38>
Accession Number
619390642
Author
Cao C.; Virk S.; Tian D.; Akhunji Z.; Yan T.D.
Institution
(Cao, Virk, Tian, Yan) Collaborative Research (CORE) Group, Macquarie
University, Sydney, Australia
(Cao, Akhunji) Department of Cardiothoracic Surgery, Prince of Wales
Hospital, Australia
(Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital,
University of Sydney, Sydney, Australia
Title
Systematic review of percutaneous coronary intervention and transcatheter
aortic valve implantation for concomitant aortic stenosis and coronary
artery disease.
Source
Heart Lung and Circulation. Conference: 2014 Australia and New Zealand
Society of Cardio-thoracic Surgeons Annual Scientific Meeting, ANZSCTS
2014. Australia. 24 (Supplement 1) (pp e67), 2015. Date of Publication:
2015.
Publisher
Elsevier Ltd
Abstract
Introduction: Co-existing coronary artery disease (CAD) is common in
patientswith severe aortic stenosis (AS).Although transcatheter aortic
valve implantation (TAVI) has emerged as a feasible alternative to
surgical aortic valve replacement (SAVR) for high-risk patients with AS,
the optimal treatment of CAD in patients undergoing TAVI remains unclear.
Combined PCI and TAVI have been performed in selected institutions, but
clinical outcomes remain uncertain. The present systematic review aimed to
assess the safety and efficacy of combined PCI and TAVI for patientswith
severeAS andCAD. Methods: An electronic search was conducted on six
data-bases to identify all relevant studies and the outcomes were
statistically summarized. The primary endpoints included 30-day mortality
and 12-month survival. Secondary end-points were measured according to the
Valve Academic Research Consortium criteria. Results: From seven studies
involving patients, periprocedural mortality was 8.8%. At 30-days, pooled
incidences of stroke, vascular complications and major bleeding were 2.9%,
5.4% and 16.3%, respectively. Acute renal failure developed in 3.8% of
patients, 2.7% had myocardial infarction and 19.9% required a permanent
pacemaker. Overall survival at 1- and 2-years was 81.2% and 73.8%,
respectively. Discussion: PCI and TAVI can be performed for high-risk
patients with severe AS and CAD. However, their perioperative mortality
may be higher than those with isolated AS who require TAVI alone. Mid-term
outcomes are more encouraging, but longer follow-up is needed in future
studies. Results of this study serves as an important benchmark to compare
with surgical outcomes of patients who undergo SAVR and coronary artery
bypass graft surgery.

<39>
Accession Number
619390640
Author
Jenkinson C.; Holmes K.; Andrews D.
Institution
(Jenkinson, Holmes, Andrews) Children's Cardiac Centre, Princess Margaret
Hospital, Perth, Australia
Title
Twenty-five years of arterial switch operations-A metaanalysis.
Source
Heart Lung and Circulation. Conference: 2014 Australia and New Zealand
Society of Cardio-thoracic Surgeons Annual Scientific Meeting, ANZSCTS
2014. Australia. 24 (Supplement 1) (pp e9), 2015. Date of Publication:
2015.
Publisher
Elsevier Ltd
Abstract
Introduction: Transposition of the Great Arteries is a complex congenital
cardiac disorder that "baffled" a generation of great surgeons, including
Blalock, Rashkind, Bailey, Senning, and Mustard. It was not until the
Jatene Repair in 1975, followed by modifications by Lecompte in 1982, that
long term survival with excellent outcomes was made possible. Many centres
and databases contain results of the Arterial Switch Operation, however
this is the first time to our knowledge that a systematic review has been
undertaken of world-wide published results. Methods: A systematic review
of the literature was undertaken, using Medline, ubMed, Google Scholar,
and Science Direct. By searching for "arterial switch" and "transposition
of great arteries", and combining these results with "outcomes", 706
articles were found. Results were limited to peer reviewed journal
articles published between 1 January 19 and 20 May 2014. Of these, 101
were reviewed more closely, and 29 articles subsequently formed our
meta-analysis. Results: Following the above methodology, a total of 6906
consecutive patients were included. There were 455 mortalities reported in
these studies, for a total mortality rate of .59%. In many cases, data
pertaining to underlying pathology (intact ventricular septum versus
ventricular septal defect, and coronary abnormalities) were able to be
collected. We also collected morbidity data, including seizure,
re-exploration, open chest, dialysis, and use of extracorporeal membranous
oxygenation. Discussion: The Arterial Switch Operation presents many
unique challenges to the Paediatric Cardiac Surgeon. The results of our
meta-analysis demonstrate the past 15 years of worldwide experience.
Incidences of morbidity and mortality are similar to established
international databases, such as the European Association for
Cardio-Thoracic Surgery Congenital Database. There is also a trend towards
improving outcomes over time, especially in Transposition of the Great
Arteries with Intact Ventricular Septum. Thismay represent a combination
of improving surgical technique, improvements in perioperative and
post-operative care, and greater experience with this challenging
condition.

<40>
Accession Number
619390636
Author
Jenkinson C.; Holmes K.; Andrews D.
Institution
(Jenkinson, Holmes, Andrews) Children's Cardiac Centre, Princess Margaret
Hospital, Perth, Australia
Title
Results of a small centre arterial switch programme - The Perth
experience.
Source
Heart Lung and Circulation. Conference: 2014 Australia and New Zealand
Society of Cardio-thoracic Surgeons Annual Scientific Meeting, ANZSCTS
2014. Australia. 24 (Supplement 1) (pp e67), 2015. Date of Publication:
2015.
Publisher
Elsevier Ltd
Abstract
Introduction: Transposition of the Great Arteries is a complex congenital
cardiac disorder that "baffled" a generation of great surgeons, including
Blalock, Rashkind, Bailey, Senning, and Mustard. It was not until the
Jatene Repair in 5, followed by modifications by Lecompte in 2, that long
term survival with excellent outcomes was made possible. ! We present the
results of the Arterial Switch Operation undertaken in a small paediatric
cardiac surgical unit, with all cases operated by a single surgeon.
Results are then compared against international databases, as well as the
metaanalysis we have conducted of international peerreviewed literature
(see presentation titled Twenty-Five Years Of Arterial Switch Operations -
A meta-analysis). Methods: A prospectively collected database of all
paediatric cardiac surgical cases was used to identify all patients
undergoing Arterial Switch Operation at Princess Margaret Hospital from 20
February to 3 June 8. Data were collected on pathology, morbidity, and
mortality. Results: There were 44 cases of Transposition of the Great
Arteries treated with Arterial Switch Operation in the history of our
unit, all undertaken in the above-mentioned time frame. In 32 cases
(72.7%), the ventricular septum was intact. Coronary abnormalities were
present in 9 cases (20.5%). There were three deaths in the series
(mortality rate of 6.8%), of which only one was in the intact ventricular
septum group. In this patient, there was a concomitant coronary artery
abnormality. There were six cases (13.6%) of re-exploration for bleeding,
two runs of extracorporeal membranous oxygenation (4.5%), five
neurological events (11.3%), and seven patients required haemofiltration
(15.9%). Discussion: The Arterial Switch Operation presents many
challenges to the cardiac surgical team. Our results show statistical
comparability to both the European Assocation for Cardio-Thoracic Surgery
Congenital Database, as well as our meta-analysis. Achieving good results
in the Arterial Switch Operation requires excellent teamwork between a
multi-skilled group of people, however good results are possible in
centres such as ours, and should be strived for.

<41>
Accession Number
619390604
Author
Iyengar A.J.; Winlaw D.S.; Grigg L.E.; Celermajer D.S.; D'Udekem Y.
Institution
(Iyengar, D'Udekem) Department of Cardiac Surgery, Royal Children's
Hospital, Melbourne, Australia
(Winlaw) Heart Centre for Children, Children's Hospital at Westmead,
Sydney, Australia
(Grigg) Department of Cardiology, Royal Melbourne Hospital, Melbourne,
Australia
(Celermajer) Department of Cardiology, Royal Prince Alfred Hospital,
Sydney, Australia
Title
No benefit of warfarin over aspirin after the extracardiac fontan in a
propensity score analysis of patients.
Source
Heart Lung and Circulation. Conference: 2014 Australia and New Zealand
Society of Cardio-thoracic Surgeons Annual Scientific Meeting, ANZSCTS
2014. Australia. 24 (Supplement 1) (pp e65), 2015. Date of Publication:
2015.
Publisher
Elsevier Ltd
Abstract
Introduction: The most effective method of long-term thromboprophylaxis
after the Fontan procedure is not clear. We compared the rates of
thromboembolic events between patients receiving aspirin and warfarin
after an extracardiac conduit Fontan procedure in a bi-national registry.
Methods: All patients who underwent an extracardiac conduit Fontan
procedure from to in Australia and New Zealand were identified. Medication
status and routine follow-up and echocardiographic datawere obtained in
all patients. Survival analysiswith propensity scorematching and
adjustment was performed to determine the treatment effect of warfarin
compared to aspirin beyond the first year of follow-up, after which time
patients had settled on their long-term thromboprophylaxis strategy.
Results: Out of eligible patients, the data of patients who were alive and
regularly followed-up without transplant, Fontan takedown or mechanical
valve replacement were available for analysis. Long-term
thromboprophylaxis consisted of warfarin in patients (62%), aspirin in
(34%) and none in 16 (3%). The 12-year freedom from thromboembolic events
was 91% (95%CI 88-94%) at 12 years. Unadjusted rates of events occurring
after the 1st year were 0.65 (0.29-1.5) per patient-years for aspirin and
0.70 (0.40 - 1.2) for warfarin. After [i] propensity score adjustment and
[ii] matching yielding pairs, rates of thromboembolic events beyond the 1
st year were similar for the aspirin and warfarin groups ([i] HR 1.8,
95%CI 0.5-7.1, p=0.4 and [ii] HR 1.9, 0.6-6.4, p=0.3 respectively).
Discussion: Similar rates of late thromboembolic events were observed
between aspirin and warfarin after the extracardiac conduit Fontan
procedure. Routine administration of warfarin may not justified after
Fontan surgery.

<42>
Accession Number
619390600
Author
Royse A.; Royse C.; Scott D.; Shehata N.; Mazer D.
Institution
(Royse, Royse, Scott) University of Melbourne, Australia
(Royse, Royse) Royal Melbourne Hospital, Australia
(Scott) St Vincents Hospital, Australia
(Shehata) Mt Sinai Hospital, Toronto, Canada
(Shehata, Mazer) St Michaels Hospital, Toronto, Canada
(Mazer) Canadian Institutes of Health Research, Canada
Title
Trics-III prospective randomised controlled trial of a restrictive or
liberal blood transfusion protocol.
Source
Heart Lung and Circulation. Conference: 2014 Australia and New Zealand
Society of Cardio-thoracic Surgeons Annual Scientific Meeting, ANZSCTS
2014. Australia. 24 (Supplement 1) (pp e5-e6), 2015. Date of Publication:
2015.
Publisher
Elsevier Ltd
Abstract
Introduction: Hypothesis: That a "restrictive" transfusion protocol is not
inferior to a "liberal" transfusion protocol in high risk cardiac surgery
patients as measured by a composite outcome of mortality and serious
morbidity in high risk cardiac surgery patients. Methods: The primary
endpoint is a composite endpoint of in-hospital mortality and major
morbidity (myocardial infarction, new renal failure, new focal
neurological deficit). The restrictive group will have a transfusion
threshold of < g/L throughout their hospital admission whereas the liberal
group will have a transfusion threshold of < 95 g/L in the operating room
(OR) and Intensive Care Unit (ICU) followed by a threshold of < 85 g/L in
the ward. Secondary endpoints are to assess the impact of transfusion
threshold on the incidence of adverse clinical events, blood utilisation
and 6-month mortality. Adverse event outcomes include length of stay in
the ICU and hospital, prolonged low cardiac output state, use of
intra-aortic balloon pump ventricular assist device postoperatively,
duration of mechanical ventilation, infection, acute kidney injury, and
gut infarction. Results: This study is awaiting final ethics and
governance clearance in Australia and will commence in 2014. Discussion:
The restrictive protocol would save costs by decreasing the utilization of
RBCs - however, if the outcome favours the liberal protocol, then we will
have collected adequate information to conduct an economic analysis.

<43>
Accession Number
619390581
Author
Sanders L.H.A.
Institution
(Sanders) Sir Charles Gairdner Hospital, Nedlands, Perth, Australia
(Sanders) Hollywood Private Hospital, Lung Health Clinic, Nedlands, Perth,
Australia
(Sanders) University of Western Australia, Crawley, Perth, Australia
(Sanders) Lung Institute of Western Australia, Nedlands, Perth, Australia
Title
The current status of lone left atrial appendage management: Is there hope
for the cardiothoracic surgical involvement ?.
Source
Heart Lung and Circulation. Conference: 2014 Australia and New Zealand
Society of Cardio-thoracic Surgeons Annual Scientific Meeting, ANZSCTS
2014. Australia. 24 (Supplement 1) (pp e64-e65), 2015. Date of
Publication: 2015.
Publisher
Elsevier Ltd
Abstract
Introduction: Traditionally Left Atrial Appendage (LAA) closure during
concomitant cardiac surgery has had poor and inconsistent results. Boston
Scientific is seeking FDA approval for the third time for their
percutaneousWatchman Left atrial appendage closure device. If approved,
LAA closure might become the method of choice for treatment of patient
with Atrial Fibrillation (AF). With the function of cardiologist as
gatekeeper questioned in other areas is there hope of Cardiothoracic
Surgical involvement in LAA appendage management? Methods: The medical
literature was reviewed for methods and results of LAA open surgical and
percutaneous closure. Discussion: The annual stroke risk in patients with
Atrial Fibrillation is 5%. Left atrial clot, a potential source of emboli,
is situated in the LAA in over 90% in patients with nonrheumatic AF. In
addition to anticoagulation, LAA occlusion has been recommended for
patients in AF during heart surgery. In the PROTECT AF and PREVAIL trial
the Watchman device has demonstrated non-inferiority to anticoagulation
with warfarin in patients with lone AF. LAA closure might become the main
focus of therapy for AF. Traditionally various surgical methods exist for
exclusion or excision of the LAA. Some surgical exclusion methods have a
success rate of only 23%. Recently it has become clear that surgical
excision by scissors or stapling can have a success rate of over 70% and
close to % if the definition of failure is limited to color Doppler flow
traversing the LAA to LA body separation. Surgical exclusion with the
AtriClip device has shown similar results. Both the AtriClip and stapling
devices can be applied thoracoscopically for lone AF. In the literature
the gatekeeper function of the cardiologist has been questioned in respect
of referrals for triple vessel disease, myomectomy, aortic valve
replacement. Although the European Society of Cardiology guidelines advise
multidisciplinary team assessment before intervention, these guidelines
are not uni-versally applied. A randomized trial comparing surgical versus
percutaneous LAA occlusion and control group is called for.

<44>
Accession Number
619390562
Author
Dunne B.; Tan D.; Chu D.; Yau V.; Larbalestier R.
Institution
(Dunne, Tan, Chu, Yau, Larbalestier) Department of Cardiothoracic Surgery,
Royal Perth Hospital, Perth, Australia
Title
Systematic review and meta-analysis of direct aortic versus Trans-apical
TAVI.
Source
Heart Lung and Circulation. Conference: 2014 Australia and New Zealand
Society of Cardio-thoracic Surgeons Annual Scientific Meeting, ANZSCTS
2014. Australia. 24 (Supplement 1) (pp e74), 2015. Date of Publication:
2015.
Publisher
Elsevier Ltd
Abstract
Introduction: Transcatheter Aortic Valve Implantation (TAVI) continues to
evolve and is becoming a well-established technique for high-risk patients
with severe aortic stenosis. The Transapical approach is the most popular
alternative for those unsuitable for Trans-femoral TAVI, however,
morbidity and mortality with this approach remains significant when
compared with the Transfemoral approach. The newer Direct Aortic offers an
alternative approach for these patients which avoids thoracotomy and
puncture of the left ventricular apex and may provide a lower-risk
alternative for these patients. Methods: An electronic search was
conducted using five online databases from their dates of inception to
July 2014. Studies were selected according to predefined inclusion
criteria and meta-analyzed. Results: A total of 70 suitable papers were
included, yielding data on 10,390 patients, including 9977 Transapicaland
Direct Aortic patients. There were no series available providing direct
comparison between Transapical and Direct Aortic TAVI. Procedural success
(as defined by the Valve Academic Research Consortium) was significantly
better in the Direct Aortic group 99.7% (95%CI 98.3-99.7) compared to
96.0%(95% CI 94.7-97.3) in the Transapical group. Other outcomes analyses
showed a trend toward lower mortality (5.1% compared to 9.3%), lower
stroke rate (0.2% compared to 1.9%) and lower rates of major bleeding
(4.2% compared to 8.5%) in the Direct Aortic group. However, these
outcomes were not statistically significant. Discussion: Direct Aortic
TAVI is an emerging technique that offers an attractive alternative to
Transapical TAVI. Using the currently available data, our analysis has
shown that Direct Aortic TAVI has a significantly higher rate of
procedural success. Our analysis of morbidity and mortality has shown a
trend toward better outcomes with the Direct Aortic approach that may
become clearer with studies directly comparing the two techniques. 4165.

<45>
Accession Number
619390426
Author
Royse A.; Reade M.C.; Johnson L.; Marks D.C.
Institution
(Royse, Reade) Australian Defence Force, Australia
(Royse) Royal Melbourne Hospital, Australia
(Reade) University of Queensland, Brisbane, Australia
(Johnson, Marks) Australian Red Cross Blood Service (ARCBS), Sydney,
Australia
Title
Clip (cryopreserved vs. liquid platelets for surgical bleeding): Protocol
for a randomised controlled trial.
Source
Heart Lung and Circulation. Conference: 2014 Australia and New Zealand
Society of Cardio-thoracic Surgeons Annual Scientific Meeting, ANZSCTS
2014. Australia. 24 (Supplement 1) (pp e57-e58), 2015. Date of
Publication: 2015.
Publisher
Elsevier Ltd
Abstract
Introduction: Platelets have a short shelf life (5 days).
SmallerAustralian hospitals often cannot justify keepingmany (or even any)
platelet units on-site. Paradoxically, up to 30% of platelet units are
discarded. The provision of platelets in military field hospitals is
similarly challenging. In response, the Netherlands Military Blood Bank
modified US protocols to freeze, store and reconstitute platelets. First
employed in Bosnia in 1, thawed frozen platelets were used from 6-10 to
treat Australian soldiers in the Dutch-led NATO hospital in Afghanistan.
Platelets are reconstituted in thawed plasma within seven minutes,
requiring minimal equipment and skill. The single controlled clinical
trial of this technology randomised 73 cardiac surgery patients to
cryopreserved or liquidstored platelets for treatment of bleeding [1].
Cryopreserved platelets were associated with less bleeding and fewer red
cell transfusions. No adverse effects were observed. However, this study
was almost certainly underpowered to ensure safety. Before cryopreserved
platelets can be approved by the Australian TGA, more information about
their comparative effectiveness, cost-effectiveness, and safety is
required. Methods: CLIP is a 90-patient, 4-hospital pilot blinded
randomised controlled effectiveness trial of cryopreserved platelets in
comparison to apheresis platelets. Outcomes that will be assessed for
possible use in a subsequent definitive trial include 28 day mortality,
blood loss, transfusion requirement, and incidence of venous
thromboembolism. Cardiac surgery patients at high risk of bleeding in the
perioperative period will be identified using a validated score. Consented
patients will be randomised to receive either cryopreserved or
conventional platelets if the treating clinician decides a platelet
transfusion is indicated. Patients will receive up to three units of study
platelets. Should more be required, these will be conventional open-label
platelets. The ARCBS has optimised a method for manufacturing
cryopreserved apheresis platelets [2] and compared various in vitro
characteristics to conventional liquid platelets. Results: Cryopreserved
and conventional platelet units contain similar platelet numbers
(approximately x /unit). GPIba and GPIIb receptor expression is reduced by
cryopreservation, compared to conventional platelets, but activation
markers CD62P and CD63 are similar. Cryopreserved platelet units contained
significantly more phosphatidylserine- and tissue factor-positive
microparticles, which were associated with a reduction in the time to clot
formation and increased thrombin generation. Discussion: Cryopreserved
platelets prepared using this method are of sufficient quality for
clinical trials. The CLIP pilot study, planned to commence in November 4,
is a prelude to a definitive multicentre trial in Australian cardiac
surgery patients aimed at providing sufficient evidence to inform
regulatory evaluation and potential widespread use in Australian civilian
and military practice.

<46>
Accession Number
619390813
Author
Thakur S.; Viana Ff.; Stuklis Rg.; Worthington Mg.; Edwards J.R.M.
Institution
(Thakur, Viana, Stuklis, Worthington, Edwards) D'Arcy Sutherland
Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA,
Australia
Title
Tricuspid valve replacement: 25-year-experience at the royal Adelaide
Hospital.
Source
Heart Lung and Circulation. Conference: 2014 Australia and New Zealand
Society of Cardio-thoracic Surgeons Annual Scientific Meeting, ANZSCTS
2014. Australia. 24 (Supplement 1) (pp e24), 2015. Date of Publication:
2015.
Publisher
Elsevier Ltd
Abstract
Background: Patients requiring tricuspid valve replacement (TVR) often
present with advanced symptoms and cardiac dysfunction. TVR is still an
uncommon procedure but is associated with high morbidity and mortality.
The aim of this study was to review our 25-year-experience with TVR and
compare the pre-operative and early post-operative results with the
available literature. Methods: A retrospective chart review was undertaken
of all patients undergoing TVR between 1988 and 2013 at the D'Arcy
Sutherland Cardiothoracic Surgical Unit, Royal AdelaideHospital. Patient
demographics, pre-operative clinical status, operative details,
post-operative morbidity and -day mortality were analysed. A literature
review was conducted using PubMed. Search terms included "tricuspid valve
replacement" and "tricuspid valve surgery", alone and in combination. Full
text English publications regarding isolated TVR as well as TVR combined
with other procedures were included. Reports describing tricuspid valve
repair were not included in this review. Results: Between 1988 and 2013,
25 patients underwent tricuspid valve replacement at the D'Arcy Sutherland
Cardiothoracic Surgical Unit, Royal Adelaide Hospital. The mean age was
55.9 +/- 18 years, and 64% were female. Preoperative New York Heart
Association functional class were II (n=2, 8%), III (n=14, 56%) and IV
(n=9, 36%). Aetiology for tricuspid dysfunction was rheumatic (44%),
infective endocarditis (24%), carcinoid (8%), iatrogenic (8%), trauma
(4%), dilated cardiomyopathy (4%) and pulmonary hypertension (4%).
Pre-operative echocardiogramshowed severe tricuspid stenosis in 16% (n=4)
and severe tricuspid regurgitation in the remainder (n=21, 84%). Tricuspid
leafletmorphologywas deemed primary (n=11, 44%) or functional (n=14, 56%).
Preoperative right ventricular systolic function was normal (36%), mild
impairment (20%), moderate impairment (24%), or severe impairment (16%).
Left ventricular systolic function was normal in 23 cases, andmoderately
impaired in cases (mean LVEF 60.8%). Pre-operative right heart dilatation
was mild (24%), moderate (20%) or severe (48%). Mean pre-operative
systolic pulmonary artery pressure was 46.3- 16.2 mmHg and mean
pre-operative pulmonary capillary wedge pressure was 19.25- 7.4 mmHg.
Seven patients (28%) had previous cardiac surgery. Three patients
underwent isolatedminimally invasive TVR viamini-thoracotomy, while the
remaining 22 patients underwent TVR via median sternotomy, 7 patients as
an isolated procedure and 15 patients combined with another procedure.
Five patients underwent surgery as an emergency operation. Mean aortic
cross clamp time was 78.3 minutes. Three cases were done with no aortic
cross clamp. Mean cardiopulmonary bypass time was 122 min. A tissue
prosthesis was used in 22 cases, and a mechanical prosthesis was used in 3
cases. Post-operative morbidity included pacemaker insertion (28%),
pneumonia (40%), acute kidney injury requiring dialysis (48%), bleeding
requiring return to theatre (8%), and stroke (8%). Thirty-day mortality
was 32% (n= 8). Conclusion: Tricuspid valve replacement is rare but the
procedure is associated with significant morbidity and mortality. The
decision to operate can be challenging. Careful pre-operative assessment
is crucial. Etiology, clinical presentation and right heart and pulmonary
vascular haemodynamics are major determinants of the outcome. 651.

<47>
Accession Number
619390782
Author
Anonymous
Title
Long-term follow-up of off-pump total arterial revascularisation without
aortic manipulation has not been published.
Source
Heart Lung and Circulation. Conference: 2014 Australia and New Zealand
Society of Cardio-thoracic Surgeons Annual Scientific Meeting, ANZSCTS
2014. Australia. 24 (Supplement 1) (pp e21), 2015. Date of Publication:
2015.
Publisher
Elsevier Ltd
Abstract
It has been shown and confirmed (Misfeld et al., 2011) that the risk of
stroke associated with coronary bypass surgery can be minimized by
avoiding aortic manipulation, and this is now published in American Heart
Association Guideline for coronary surgery (Hillis et al., 2011).
Long-term benefits of usage of the right internal mammary artery for
grafting the circumflex system are becoming obvious (Raza et al., 2014;
Hillis et al., 2011). A pilot study to determine the feasibility of a
routine operation achieving total arterial revascularisation without
cardiopulmonary bypass nor any aortic manipulation and with optimal use of
internal mammary arterial conduits and dual mammary inflows was commenced
in August 2001 at Royal North Shore Hospital and presented at the Annual
Scientific Meeting, Noosa, in 2002. Long-term follow-up of the first 20
patients is complete (100%) at 13 years +/- 3 months. Hypothesis: The
underlying but untested premise is that routine use of the right mammary
grafted to the circumflex will benefit long term survival, avoidance of
aortic manipulation will benefit short term survival through avoidance of
atheroembolic stroke, and a composite radial graft based on right mammary
inflow will provide higher flow to the remote territory of the heart and
be less subject to competitive flow; at least the first two of these may
provide a survival benefit beyond left mammary to left anterior descending
grafting. The hypothesis of the pilot study is that off-pump surgery with
total arterial revascularisation can be performed routinely and safely
without compromising short or long-term results. Methods: The first 20
consecutive patients from inception of the technique are re-evaluated at
13 years +/- 3 months. The technique was defined by the performance of a
coronary grafting operation for triple vessel disease, without
cardiopulmonary bypass, and using the graft geometry described by Butchart
(Pitsis et al., 1999). Ancillary techniques of exposure, stabilisation,
shunt deployment, anaesthetic management were largely established before
inception but evolved through the period of the pilot study. Surviving
patients underwent further consultation in September 2014, and for all
patients general practice records, cardiology records, hospital records
and post mortem reports if applicable were reviewed. Progressive NYHA and
CCVS status, stress test ecg, echocardiographic estimation of ejection
fraction and valvular functionwere determined for all patients.
Angiography was performed when clinically indicated. All angiograms were
reviewed by at least three parties. Results: Graft patency was 100% Grade
AI(FitzGibbon et al., 1996) on angiography. 5 patients underwent symptom
directed angiography on 6 occasions and one patient underwent post-mortem
evaluation of grafts. 3 angiograms were performed at less than three
years, and three at more than ten years post operatively. All inflows, all
conduits, all distal anastomoses and all distal coronaries were widely
patent, being 18 conduits and 21 distals in 6 patients. No patient
suffered myocardial infarction, or required further coronary surgical
intervention, nor required percutaneous coronary intervention at less than
ten years. There was no clinical suspicion of any graft occlusion not
negated by angiography or post mortem. One patient underwent percutaneous
intervention on native circulation not served by a graft due to
progression of native disease at twelve years. One patient suffered a
cerebral event associatedwith cerebral metastatic melanoma at three years.
Survival was 100% at one year, 90% at five years, and 65% at ten years.
One death at three years was due to alcoholic cardiomyopathy and
arrhythmia with confirmed graft patency, no acute coronary thrombosis, and
worsened cardiomegaly at post mortem. Remaining deaths were largely due to
metastatic malignancy. Discussion: The pilot study suggests off-pump
surgery with total arterial revascularisation can be performed routinely
with safety, without compromise of long term results. Those patients who
survive beyond the first decade without fatal malignancy may then benefit
from the extended survival related to right mammary patency. Graft patency
does not appear to be impaired with off-pump arterial anaortic
revascularisation, and may be enhanced above conventional surgery because
of suitable use of the right mammary artery, and improved surgical
technique including but not limited to, wide pericardial division, transit
time Doppler, and use of soft silastic intracoronary shunts. FitzGibbon,
G.M. et al., 1996. Coronary bypass graft fate and patient outcome:
angiographic follow-up of 5,065 grafts related to survival and reoperation
in 1,388 patients during years. Journal of the American College of
Cardiology, 28(3), pp.616-626. Q1 Hillis, L.D. et al., 2011. 2011 ACCF/AHA
Guideline for Coronary Artery Bypass Graft Surgery. A Report of the
American College of Cardiology Foundation/ American Heart Association Task
Force on Practice Guidelines. Journal of the American College of
Cardiology, 58(24)e123-210. Misfeld, M. et al., 2011. Neurologic
complications after off- pump coronary artery bypass grafting with and
without aortic manipulation: meta-analysis of 11,398 cases from 8 studies.
The Journal of thoracic and cardiovascular surgery, (2), pp.e11-7. Pitsis,
A.A. et al., 1999. A new strategy of total arterial revascularization.
ATS, 67(4), pp.1186-1187. Raza, S. et al., 2014. Surgical
revascularization techniques that minimize surgical risk and maximize late
survival after coronary artery bypass grafting in patients with diabetes
mellitus. The Journal of thoracic and cardiovascular surgery, (4),
pp.1257-1266.e9.

<48>
Accession Number
619390755
Author
Aldemirr M.
Title
Nebivolol compared with metoprolol for erectile function in males
undergoing coronary artery bypass graft.
Source
Heart Lung and Circulation. Conference: 2014 Australia and New Zealand
Society of Cardio-thoracic Surgeons Annual Scientific Meeting, ANZSCTS
2014. Australia. 24 (Supplement 1) (pp e48-e49), 2015. Date of
Publication: 2015.
Publisher
Elsevier Ltd
Abstract
Objective: The aim of this study was to evaluate the effects of two widely
used adrenoceptor beta-blockers, namely nebivolol and metoprolol on
erectile function in males undergoing coronary artery bypass grafting.
Methods: Sixty patients scheduled for coronary artery bypass grafting
surgery were randomly assigned into two groups: the N group, which
received 5 mg of nebivolol orally for 2 weeks before surgery plus 12 weeks
after surgery or the M group, which received 50 mg of metoprolol orally
for the same period. All patients were evaluated by the erectile function
domain of the International Index of Erectile Function (IIEF) at time of
admission (before starting beta blocker) and three months after surgery.
Results: In the metoprolol group, the mean IIEF-5 score decreased
significantly from a baseline of 15.2+/-5.8 to 12.9 +/-5.8 (p<0.), but in
the nebivolol group this difference was not statistically significant
(from baseline 12.9+/-5.5 to 12.4 +/-5.5 and p=0.). For all patients the
mean IIEF-5 score decreased significantly from a baseline of 14.0+/-5.7 to
12.6 +/-5.6 (p<0.). Conclusion: While the selective b1-blocker metoprolol
significantly affects erectile function, the vasodilating selective
b1-blocker nebivolol exerts protective effects on erectile function
against the disruptive effects of CPB in patients 3 undergoing CABG.(Table
Presented) Data were expressed as mean +/-standard deviation or n 0 (%).
BMI: bodymass index, EF: ejection fraction, ACE:
angiotensin-converting-enzyme, Ca: Calcium, LDL: Low Density 2
Lipoprotein, CPB: cardiopulmonary bypass, ICU: intensive 3 care
unit,MI:myocardial infarction; IIEF: International Index 4 of Erectile
Function. 5 Table II Comparison of preoperative and postoperative 6 IIEF-5
scores in all patients and groups. Data were expressed as mean +/-standard
deviation. IIEF: 0 International Index of Erectile Function. Data were
expressed as n (%). (Table Presented) ED: erectile dysfunction. Mild ED
score: 17-21. Mild-Moderate ED score: 12-16. Moderate ED score: 8-11.
Severe ED score: 5-7.

<49>
Accession Number
619390754
Author
Fanning J.P.; Clarke A.J.; Platts D.G.; O'Sullivan C.; Walters D.L.;
Fraser J.F.
Institution
(Fanning, Platts, Fraser) Critical Care Research Group, Prince Charles
Hospital, Brisbane, QLD, Australia
(Fanning, Clarke, Platts, O'Sullivan, Walters) Heart Lung Institute,
Prince Charles Hospital, Brisbane, QLD, Australia
Title
Comparison of new brain infarction associated with isolated aortic valve
surgeries.
Source
Heart Lung and Circulation. Conference: 2014 Australia and New Zealand
Society of Cardio-thoracic Surgeons Annual Scientific Meeting, ANZSCTS
2014. Australia. 24 (Supplement 1) (pp e17-e18), 2015. Date of
Publication: 2015.
Publisher
Elsevier Ltd
Abstract
Introduction: TAVI is gaining widespread acceptance for the management of
high-risk and inoperable patients with severe AS. However, the benefits
associated with the procedure are mitigated by the occurrence of
neurological injury. Although their clinical significance is not always
apparent, brain infarction detected by diffusionweightedMRI (DWI) is
gaining widespread acceptance as a marker for the cerebrovascular burden
of cardiovascular surgeries/procedures. The purpose of this study is to
characterise the incidence of these DWI-detected brain lesions in patients
with severe aortic stenosis undergoing management with conventional aortic
valve replacement (AVR) compared with transcatheter aortic valve
implantation (TAVI). Methods: Systematic searches of the Medline and
EMBASE databases for full text articles published from 1946 to April 2014
were performed to identify original, prospective, longitudinal, studies
derived from isolated surgical AVR or TAVI cohorts that reported the
incidence of brain infarction determined by diffusion weighted MRI (DWI).
12 studies were deemed eligible and a total of 469 patients included.
Statistical analysis was performed using a two-sample Z-test. Differences
in continuous parametric data between groups was summarised using the
t-test statistic. For both a two-sided statistical significance of 5% was
applied. (Table Presented) Discussion: The incidence of new DWI lesions is
significantly less with AVR as compared with TAVI in the data published to
date. However, these results are confounded by significant differences in
baseline characteristics of the two cohorts. This highlights the
requirement for clinical studies in risk-matched cohorts undergoing AVR
and TAVI to elucidate any true difference in the burden of neurological
injury associated with each strategy. Additionally, inconsistencies in MRI
configurations, methodologies for detecting neurological impairment and
reporting of variables limit interpretation of summary effects and
suggesting a requirement for standardisation.

<50>
Accession Number
619390748
Author
Phan K.; Xie A.; Tsai Y.-C.; Kumar N.; La Meir M.; Yan T.D.
Institution
(Phan, Xie, Yan) Collaborative Research (CORE) Group, Macquarie
University, Sydney, Australia
(Phan) Sydney Medical School, University of Sydney, Sydney, Australia
(Tsai) Prince Charles Hospital, Chermside, Australia
(Kumar, La Meir) Department of Cardiothoracic Surgery and Cardiology,
Academic Hospital Maastricht, Cardiovascular Research Institute
Maastricht, Maastricht, Netherlands
(La Meir) University Hospital Brussels, Brussels, Belgium
(Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital,
University of Sydney, Sydney, Australia
Title
Biatrial ablation versus left atrial concomintant surgical ablation for
treatment of atrial fibrillation: A meta-analysis.
Source
Heart Lung and Circulation. Conference: 2014 Australia and New Zealand
Society of Cardio-thoracic Surgeons Annual Scientific Meeting, ANZSCTS
2014. Australia. 24 (Supplement 1) (pp e47-e48), 2015. Date of
Publication: 2015.
Publisher
Elsevier Ltd
Abstract
Introduction: Surgical ablation performed concomitantly 4 with cardiac
surgery has emerged as an effective treatment 5 strategy for atrial
fibrillation (AF) [1,2]. Left atrial (LA) lesion 6 sets for ablation have
been suggested to reduce procedural 7 times and post-surgical bradycardia
compared to biatrial 8 (BA) lesions. Given the inconclusive literature
regarding 9 BA versus LA ablation, the present meta-analysis sought 0 to
assess the current evidence. 1 Methods: Electronic searches were performed
using 6 2 databases fromtheir inception to December 3, identifying 3 all
relevant randomized trials and observational studies comparing BA versus
LA surgical ablation AF patients under taking cardiac surgery. 6 Results:
In 10 included studies, patient results were 7 available for analysis to
compare BA (n=) versus LA 8 (n=7) ablation. Sinus rhythm prevalence was
higher in the BA cohort compared to LA cohort at 6 month and 12 month
follow-up, but similar beyond 1 year. Permanent pacemaker implantations
were higher in the BA cohort, but 30-day and late mortality, neurological
events and reoperation for bleeding was similar between BA and LA groups.
Discussion: BA and LA ablations produced comparable 30-day and late
mortality but LA was associated with significantly reduced permanent
pacemaker implantation rates. BA ablation appeared to be more efficacious
than LA ablation in achieving SR at 1 year, but this difference was not
maintained beyond 1 year. Trends appear to be driven by the preferential
selection of long-standing and persistent AF patients for the BA approach.
Future randomized studies of adequate follow-up are required to validate
risks and benefits of BA versus LA surgical ablation.

<51>
Accession Number
619390741
Author
Phan K.; Zhou J.J.; Niranjan N.; Tsai Y.-C.; Di Eusanio M.; Yan T.D.
Institution
(Phan, Zhou, Niranjan, Di Eusanio, Yan) Collaborative Research (CORE)
Group, Macquarie University, Sydney, Australia
(Tsai) Department of Cardiothoracic Surgery, PrinceCharles Hospital,
Chermside, Australia
(Di Eusanio) Cardiovascular Surgery Department, Sant'Orsola-Malpighi
Hospital, Bologna University, Bologna, Italy
(Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital,
University of Sydney, Sydney, Australia
Title
Minimally invasive reoperative aortic valve eplacement - A systematic
review and meta-analysis.
Source
Heart Lung and Circulation. Conference: 2014 Australia and New Zealand
Society of Cardio-thoracic Surgeons Annual Scientific Meeting, ANZSCTS
2014. Australia. 24 (Supplement 1) (pp e47), 2015. Date of Publication:
2015.
Publisher
Elsevier Ltd
Abstract
Introduction: Minimally invasive cardiac surgery has been shown to be a
safe and efficacious alternative to median sternotomy for aortic valve
replacement, and may reduce surgical trauma and hospitalization [1,2].
With prolonged life expectancy and more frequent use of biological
prostheses, an increasingly higher proportion of patients are undergoing
aortic valve replacement (AVR) after previous sternotomy. We critically
appraised the evidence on minimally invasive (MIrAVR) versus conventional
(CrAVR) approaches for reoperative AVR. Methods: Electronic searches were
performed using six databases from their inception to April 2014. Relevant
studies utilizing a minimally invasive approach for reoperative AVR were
identified. Data were extracted and analyzed according to predefined
clinical endpoints. Results: Four single-arm and seven comparative
observational studies including a total of MIrAVR patients were included
for quality assessment, data extraction and analysis. 3 In-hospital
mortality ranged from 0-9.5%, and was similar between the MIrAVR and CrAVR
groups (RR, 0.77; 95% CI, 5 0.39-1.54; P=0.46). Stroke rates ranged from
2.6-8% and were also similar between the two cohorts. The rates of
pacemaker implantation, renal failure and reoperation for bleeding were 8
not significantly different between the two groups. There were no reports
of myocardial infarctions in the included studies. No significant
difference in hospital stay was observed for the MIrAVR versus CrAVR
group. Discussion: The current literature suggests that MIrAVR has similar
efficacy and mortality outcomes compared to CrAVR without compromise to
myocardial protection or hospitalization duration. It appears to be a
valid alternative option for patients requiring reoperative AVR.

<52>
Accession Number
619390722
Author
Seco M.; Forrest P.; Jackson S.A.; Martinez G.; Andvik S.; Bannon P.G.; Ng
M.; Fraser J.; Wilson M.K.; Vallely M.P.
Institution
(Seco, Forrest, Jackson, Martinez, Andvik, Bannon, Ng, Fraser, Wilson,
Vallely) Baird Institute of Applied Heart and Lung Surgical Research,
University of Sydney, Royal Prince Alfred Hospital, Sydney, Australia
Title
Extracorporeal membrane oxygenation for very high-risk transcatheter
aortic valve implantation.
Source
Heart Lung and Circulation. Conference: 2014 Australia and New Zealand
Society of Cardio-thoracic Surgeons Annual Scientific Meeting, ANZSCTS
2014. Australia. 24 (Supplement 1) (pp e14), 2015. Date of Publication:
2015.
Publisher
Elsevier Ltd
Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) can cause
profound haemodynamic perturbation in the peri-operative period.
Veno-arterial extracorporeal membrane oxygenation (ECMO) can be used to
provide cardiorespiratory support during this time, either
prophylactically or emergently. Methods: 100 TAVI procedures were
performed between 2009 and 2013 in our institution. ECMO was used in
patients, including 8 prophylactic and 3 rescue cases. Rescue ECMO was
required for ventricular fibrillation after valvuloplasty, and aortic
annulus rupture. The criteria for prophylactic ECMO included heart failure
requiring stabilisation pre-TAVI, haemodynamic instability with balloon
aortic valvuloplasty performed to improve heart function pre-TAVI,
moderate or severe left and/or right ventricular failure, or borderline
haemodynamics at procedure. Differences in preoperative characteristics
and postoperative outcomes between ECMO and non-ECMO TAVI patients were
compared, and significant results were further assessed controlling for
EuroSCORE. Results: Compared to TAVI patients who did not require ECMO,
ECMO patients had significantly higher mean Euro-SCORE (51 vs. 30%,
p<.05). All-cause mortality occurred in nil prophylactic ECMO patients,
one rescue ECMO patient, and two non-ECMO patients. The difference in
mortality between ECMO and non-ECMO patients was not significantly
different (9 vs. 2%; p>.05). Other non-significant out-comes (p<.05)
included peri-procedural and spontaneous myocardial infarction (0 vs. 2%
and 0 vs. 0%, respectively); disabling and non-disabling stroke (0 vs. 0%
and 0 vs. 2%, respectively); transient ischaemic attack (0 vs. 0%); life-
threatening, major and minor bleeding (12 vs. 3%, 0 vs. % and 38 vs. 13%,
respectively); and major and minor vascular complications (12 vs. 5% and 0
vs. 13%, respectively). ECMO patients were more likely to develop acute
renal failure than non-ECMO patients (36 vs. 8%, p<.05), which was most
likely due to haemodynamic collapse and end-organ dysfunction in patients
that required emergent ECMO rescue. Discussion: ECMO, in both prophylactic
and rescue settings, is effective at providing cardiorespiratory support
in very-high risk TAVI patients, and may have contributed to the low
mortality in this series. Instituting prophylactic ECMO in an elective,
controlled setting may help avoid consequences of intraoperative
complications such as systemic hypoperfusion and acute renal failure,
compared to emergent ECMO with rapid setup and cannulation. Limitations of
this study include small patient sample size and observational nature.
Future studies performed in a prospective, randomised fashion are required
to evaluate the use of prophylactic ECMO, and to determine the ideal
selection criteria.

<53>
Accession Number
619390714
Author
Phan K.; Ha H.; Thomas S.; Medi C.; Yan T.D.
Institution
(Phan, Yan) Collaborative Research (CORE) Group, Macquarie University,
Sydney, Australia
(Phan, Ha, Thomas) Department of Cardiology, Westmead Hospital, Sydney,
Australia
(Phan) St Vincent's Clinical School, University of New South Wales,
Sydney, Australia
(Medi, Yan) Department of Cardiothoracic Surgery and Cardiology, Royal
Prince Alfred Hospital, University of Sydney, Sydney, Australia
Title
New-onset atrial fibrillation following coronary bypass surgery predicts
long-term mortality.
Source
Heart Lung and Circulation. Conference: 2014 Australia and New Zealand
Society of Cardio-thoracic Surgeons Annual Scientific Meeting, ANZSCTS
2014. Australia. 24 (Supplement 1) (pp e13-e14), 2015. Date of
Publication: 2015.
Publisher
Elsevier Ltd
Abstract
Introduction: Atrial fibrillation is one of the most common postoperative
complications following cardiac surgery. Recent evidence suggests that
postoperative atrial fibrillation (POAF) may be more "malignant" than
previously thought, associated with follow-up mortality and morbidity. In
order to evaluate the long-term survival of POAF versus No-POAF cohorts
following coronary bypass surgery, the current-meta-analysis with
reconstructed individual patient data was performed. Methods: Electronic
searches were performed using six databases from their inception to August
2014. Relevant studies with long-term survival data presented for POAF vs
No-POAF were identified. Data were extracted by two independent reviewers
and analyzed according to predefined clinical endpoints. Results: Pooled
hazard ratio significantly favored higher survival in No-POAF over POAF
(HR 1.28; 95% CI, 1.19-1.37; I 192 2=96%; P<0.00001). Individual patient
data of 69,518 patients were available for inverted Kaplan-Meier survival
curve analysis. Analysis of aggregate data using Kaplan-Meier curve
methods for POAF vs No-POAF groups determined survival rates at 1-year
(95.7% vs 98%), 2-year (92.3% vs 95.4%), 3-year (88.7% vs 93.9%), 5-year
(82.6% vs 89.4%), 10-year (65.5% vs 75.3%) and 15-year (49.6% vs 60.7%)
follow-up. Other complications including 30-day mortality, strokes,
respiratory failure, pneumonia, and hospitalization were significantly
higher in the POAF group. Discussion: New-onset atrial fibrillation
following coronary bypass surgery is associated with significantly higher
risk of mortality in short and long-term follow-up. This difference in
survival rate remains even up to 15 years postoperative follow-up. Current
evidence suggests the need for more strict surveillance and monitoring of
POAF following coronary bypass surgery.

<54>
Accession Number
619390704
Author
Nadal J.M.; Varzaly J.; Jennings S.; Vadivelu A.; Chan J.; Xu R.; Thakur
S.; Yoshimoto A.; Viana F.F.
Institution
(Nadal, Varzaly, Jennings, Vadivelu, Chan, Xu, Thakur, Yoshimoto, Viana)
D'Arcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital,
Adelaide, SA, Australia
Title
Mediastinal abscess following acupuncture: Case report and review of
literature.
Source
Heart Lung and Circulation. Conference: 2014 Australia and New Zealand
Society of Cardio-thoracic Surgeons Annual Scientific Meeting, ANZSCTS
2014. Australia. 24 (Supplement 1) (pp e73), 2015. Date of Publication:
2015.
Publisher
Elsevier Ltd
Abstract
Introduction: Acupuncture is a widely used form of ancient Chinese
treatment which has been used primarily for pain relief. Although benefits
derived from this form of therapy have been described, thoracic surgeons
are involved in the infrequent but not rare complications following
acupuncture. We describe the first documented case of anterior mediastinal
abscess following acupuncture for pain due to a suspected torn pectoralis
muscle. Methods: Retrospective analysis of case data including
pre-operative, intra-operative and post-operative, including laboratory
and radiological investigations was performed. A systematic review of the
literature was also conducted through PubMed, Embase and Cochrane library,
focusing on infectious complications following acupuncture. Search of
combined terms "mediastinal abscess after acupuncture" in all fields
yielded no results. A more broad search was carried out of
"acupunctureANDabscess" yielded 53 results. Of these, 26 articles were
relevant to the topic and included in our systematic review. Results: A 78
year old Caucasian male presented to the Emergency Department with
erythema and swelling over the left sternoclavicular joint and purulent
discharge from his left upper chest just below his left clavicle. He had
received physiotherapy and acupuncture therapy to the affected area two
weeks prior to presentation after sustaining a suspected left pectoral
tear. Subsequent cultures grew Methicillin-Resistant Staphylococcus Aureus
(MRSA). An incision and drainage was performed. There was still note of
swelling postoperatively, and imaging revealed extension of the abscess
into the anteriormediastinum.He underwent a left anterior mediastinotomy
and drainage of the anterior mediastinal abscess and pectoral muscle
abscess, with VAC dressings and Yates drains applied to the wounds. The
patient was later discharged on his 17th hospital day on a six week course
of intravenous antibiotics followed by a four week course of oral
antibiotics. Follow up to two months demonstrated an almost complete
recovery pending completion of antibiotic therapy. Literature review
revealed a total of 26 acupuncture related abscess formations. Psoas
abscesses were the most frequent occurences with 38% followed by epidural
abscesses at 19%. Only one case of a pericardial abscess was found in the
literature. Fifty eight percent of cases were noted to have survived, with
38% not specifying outcome. Therewas onemortality, that being the
documented case of a pericardial abscess. Discussion: This is the first
report of an anterior mediastinal abscess following acupuncture therapy.
This report high-lights the importance of anatomy knowledge and sterile
precautions that therapists must be aware of when performing such
procedures. Thoracic surgeons will continue to be challenged with
complications arising from invasive procedures performed outside the
hospital environment.

<55>
Accession Number
619390699
Author
Bevan P.
Institution
(Bevan) Dunedin Public Hospital, New Zealand
Title
Near-infrared spectroscopy in adult cardiac surgery: An ongoing debate.
Source
Heart Lung and Circulation. Conference: 2014 Australia and New Zealand
Society of Cardio-thoracic Surgeons Annual Scientific Meeting, ANZSCTS
2014. Australia. 24 (Supplement 1) (pp e43), 2015. Date of Publication:
2015.
Publisher
Elsevier Ltd
Abstract
Introduction: In the context of adult cardiac surgery, an effective and
user-friendly method of cerebral monitoring stands to offer a significant
advance in patient care. Nearinfrared spectroscopy (NIRS) is non-invasive,
easy to use, and offers real-time monitoring of the oxygen content of
cerebral tissue. The use of NIRS to monitor brain protection during
cardiac surgery is gaining in popularity, despite arguments that the
evidence has failed to show definitive neurological benefits. This review
will summarise the need for neuromonitoring and the principles of NIRS. It
will examine the thresholds used to define desaturation, the evidence for
clinical benefit from NIRS, and the criticisms and limitations of NIRS. It
will also discuss the uses of NIRS beyond improving neurological outcomes
alone. Methods: A literature search was carried out using the terms
"near-infrared spectroscopy", "cerebral oximetry", combined with "cardiac
surgery", limited to studies in English and in adult patients. Secondary
references were reviewed to gather further relevant papers. Results:
Neurological complications are a key issue in cardiac surgery, and
hypoperfusion appears to be central to their pathogenesis. While all NIRS
monitors operate from the same basic principles, devices differ in the
methods they use to generate data and in the algorithms they use to
process it, making comparison between devices difficult. The evidence
assessing the clinical efficacy of NIRS in adult cardiac surgery is
hindered by the use of multiple devices, and by a wide range of thresholds
to define desaturation. Studies have thus far failed to definitively show
that interventions to correct cerebral desaturations improve neurological
outcomes. Discussion: The field of adult cardiac surgery currently a lacks
a well-accepted method of neuromonitoring.While the literature does not
provide strong evidence of improvement in neurological outcomes, it can be
argued that the overall risk to benefit ratio falls on the side of NIRS.
NIRS gives valuable information not only about cerebral oxygenation, but
also about the oxygenation of systemic tissues. It may be that, in surgery
that does not involve the aortic arch, the value of NIRS will be in
increased individualization of patient management and improved systemic
perfusion, impacting general outcomes asmuch as neurological outcomes.

<56>
Accession Number
619390856
Author
Kashani A.; Manganas C.
Institution
(Kashani, Manganas) St. George Hospital, Sydney, NSW, Australia
Title
Extracorporeal membrane oxygenation (ECMO) in post-cardiotomy cardiogenic
shock (PCCS) in adults: A systematic review.
Source
Heart Lung and Circulation. Conference: 2014 Australia and New Zealand
Society of Cardio-thoracic Surgeons Annual Scientific Meeting, ANZSCTS
2014. Australia. 24 (Supplement 1) (pp e56), 2015. Date of Publication:
2015.
Publisher
Elsevier Ltd
Abstract
Background: Post-Cardiotomy Cardiogenic Shock (PCCS) is a rare but a
significant cause of death in patients undergoing cardiac surgery.
Venous-Arterial ECMO (VA-ECMO) is potentially life-saving. However, there
are no clear selection criteria or prognostic predictors to direct patient
selection and conduct of VA-ECMO in this specific subset of patients.
Method: A systematic search was conducted in OvidMed line, Cochrane
Register of Systematic Reviews, and Embase for articles from Jan to July
using the keywords "Cardiogenic Shock", "Cardiotomy" or "Cardiac Surgery",
and "Extracorporeal Membrane Oxygenation" or "ECMOr" or "Mechanical
Circulatory Support". Additional papers were identified by manual search
of the references from the key articles. Those covering pediatric cases,
case reports, or containing mixed data with other causes of refractory
cardiogenic shock were excluded. Results: Indications, demographic data,
statistically significant prognostic markers, and outcomes of VA-ECMO in
PCCS were analyzed. There were no randomized controlled trials. 11 case
series were identified, in which patients received VA-ECMO for PCCS.
56.12% (31.27%-67.74%) of the patients could be weaned off. However, the
overall survival to hospital discharge was 31.48% (15.69%- 58.06%). Age
was the commonest prognostic factor, followed by serum lactate levels 48
hours after initiation of ECMO, and dialysis. Conclusion: Due to
continuing improvements in VA-ECMO over the last decade, increased numbers
of patients supported can be successfully weaned off ECMO. However, this
may not translate to successful discharge from the hospital and overall
survival rate post cardiotomy shock has remained unchanged. This prompts
our literature review of important selection criteria and prognostic
predictors in this patient subset.

<57>
Accession Number
619299961
Author
Panoulas V.F.; Francis D.P.; Ruparelia N.; Malik I.S.; Chukwuemeka A.; Sen
S.; Anderson J.; Nihoyannopoulos P.; Sutaria N.; Hannan E.L.; Samadashvili
Z.; D'Errigo P.; Schymik G.; Mehran R.; Chieffo A.; Latib A.; Presbitero
P.; Mehilli J.; Petronio A.S.; Morice M.-C.; Tamburino C.; Thyregod
H.G.H.; Leon M.; Colombo A.; Mikhail G.W.
Institution
(Panoulas, Francis, Malik, Sen, Nihoyannopoulos, Sutaria, Mikhail)
Cardiovascular Sciences, National Heart and Lung Institute, Imperial
College London, London, United Kingdom
(Panoulas, Ruparelia, Malik, Sen, Nihoyannopoulos, Mikhail) Cardiology
Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust,
London, United Kingdom
(Chukwuemeka, Anderson) Cardiothoracic Department, Hammersmith Hospital,
Imperial College Healthcare NHS Trust, United States
(Hannan, Samadashvili) School of Public Health, University at Albany,
State University of New York, Albany, NY, United States
(D'Errigo) National Centre for Epidemiology, Surveillance and Health
Promotion, Istituto Superiore di Sanita, Rome, Italy
(Schymik) Medical Clinic IV, Department of Cardiology, Municipal Hospital
Karlsruhe, Academic Teaching Hospital of the University of Freiburg,
Freiburg, Germany
(Mehran) Interventional Cardiovascular Research and Clinical Trials, The
Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of
Medicine at Mount Sinai, New York, NY, United States
(Chieffo, Latib, Colombo) Cardiology department, San Raffaele Scientific
Institute, Milan, Italy
(Presbitero) Hemodynamic and Invasive Cardiology Unit, IRCCS Istituto
Clinico Humanitas, Milan, Italy
(Mehilli) Munich University Clinic, Ludwig-Maximilians University, Munich,
Germany
(Mehilli) Munich Heart Alliance at Deutsches Zentrum fur
Herz-Kreislauf-Forschung, Munich, Germany
(Petronio) Cardiothoracic and Vascular Department, University of Pisa,
Italy
(Morice) RAMSAY, Generale de Sante, ICPS, Institut Cardiovasculaire Paris
Sud, Massy, France
(Tamburino) Division of Cardiology, Ferrarotto Hospital, University of
Catania, Italy
(Thyregod) Department of Cardiothoracic Surgery, The Heart Centre,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Leon) Columbia University Medical Center, New York, United States
(Tamburino) ETNA Foundation, Catania, Italy
Title
Female-specific survival advantage from transcatheter aortic valve
implantation over surgical aortic valve replacement: Meta-analysis of the
gender subgroups of randomised controlled trials including 3758 patients.
Source
International Journal of Cardiology. 250 (pp 66-72), 2018. Date of
Publication: 01 Jan 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Transcatheter aortic valve implantation (TAVI) for severe aortic stenosis
(AS) is the first area of interventional cardiology where women are
treated as often as men. In this analysis of the gender specific results
of randomised controlled trials (RCTs) comparing TAVI with surgical aortic
valve replacement (SAVR) we aimed to determine whether gender affects the
survival comparison between TAVI and SAVR. We identified all RCTs
comparing TAVI versus SAVR for severe AS and reporting 1 and/or 2 year
survival. Summary odds ratios (ORs) were obtained using a random-effects
model. Heterogeneity was assessed using the Q statistic and I².
Four RCTs met the criteria, totalling 3758 patients, 1706 women and 2052
men. Amongst females, TAVI recipients had a significantly lower mortality
than SAVR recipients, at 1 year (OR 0.68; 95%CI 0.50 to 0.94) and at 2
years (OR 0.74; 95%CI 0.58 to 0.95). Amongst males there was no difference
in mortality between TAVI and SAVR, at 1 year (OR 1.09; 95%CI 0.86 to
1.39) or 2 years (OR 1.05; 95%CI 0.85 to 1.3). The difference in treatment
effect between genders was significant at both 1 year
(p<inf>interaction</inf> = 0.02) and 2 years (p<inf>interaction</inf> =
0.04). In women TAVI has a 26 to 31% lower mortality odds than SAVR. In
men, there is no difference in mortality between TAVI and
SAVR.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<58>
Accession Number
619329442
Author
Hu A.; Qiu Y.; Zhang P.; Hu B.; Yang Y.; Li S.; Zhao R.; Zhang Z.; Zhang
Y.; Zheng Z.; Qiu C.; Li F.; Gong X.
Institution
(Hu, Zhang, Zhang, Zheng) Shenzhen People's Hospital, Department of
Anesthesiology, Shenzhen 518001, China
(Hu, Zhang, Zhang, Zheng) Shenzhen Anesthesiology Engineering Center,
Shenzhen 518001, China
(Hu, Zhang, Zhang, Zheng) Jinan University, The Second Clinical Medical
College, Shenzhen 518001, China
(Qiu) West China Hospital, Sichuan University, Department of
Anesthesiology and Translational Neuroscience Center, Chengdu 610000,
China
(Zhang) Sichuan Academy of Medical Sciences and Sichuan Provincial
People's Hospital, Department of Anesthesiology, Chengdu 610072, China
(Hu) Affiliated Hospital of Guizhou Medical University, Department of
Anesthesiology, Guiyang 550004, China
(Yang) Henan Provincial People's Hospital of Zhengzhou University,
Department of Anesthesiology, Zhengzhou 450000, China
(Li) Taihe Hospital of Hubei University of Medicine, Department of
Anesthesiology, Shiyan, Hubei 442000, China
(Zhao) The Third Affiliated Hospital of Kunming Medical University,
Department of Anesthesiology, Kunming 650106, China
(Qiu, Li, Gong) The Second Clinical Medicine College, Jinan University,
Clinical Medical Research Center, Shenzhen 518001, China
Title
Comparison of the effect of high versus low mean arterial pressure levels
on clinical outcomes and complications in elderly patients during
non-cardiothoracic surgery under general anesthesia: Study protocol for a
randomized controlled trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 554. Date of
Publication: 21 Nov 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Intraoperative blood pressure (BP) is a concern in daily
clinic anesthesia and contributes to the differences in clinical outcome.
We conducted a randomized controlled trial (RCT) to compare the effect of
high vs. low mean arterial pressure (MAP) levels on clinical outcomes and
complications in elderly patients under general anesthesia (GA). Methods:
In this multicenter, randomized, parallel-controlled, open-label,
assessor-blinded clinical trial, 322 patients aged more than 65years will
be randomized for a low-level MAP (60-70mmHg) or high-level MAP
(90-100mmHg) during non-cardiothoracic surgery under GA. The primary
outcome will be the incidence of postoperative delirium. The secondary
outcomes will include the delirium duration days, intraoperative urine
volume, intraoperative blood loss, specific postoperative complications,
and all-cause 28-day mortality. Discussion: Results of this trial will
help clarify whether BP management is beneficial for elderly patients
under GA and will make clear whether the effect of high-level MAP can
reduce the postoperative complication compared to low-level MAP. Trial
registration: ClinicalTrials.gov, NCT02857153. Registered on 15 July
2016.<br/>Copyright &#xa9; 2017 The Author(s).

<59>
Accession Number
619378692
Author
Pibarot P.; Hahn R.T.; Weissman N.J.; Arsenault M.; Beaudoin J.; Bernier
M.; Dahou A.; Khalique O.K.; Asch F.M.; Toubal O.; Leipsic J.; Blanke P.;
Zhang F.; Parvataneni R.; Alu M.; Herrmann H.; Makkar R.; Mack M.;
Smalling R.; Leon M.; Thourani V.H.; Kodali S.
Institution
(Pibarot, Arsenault, Beaudoin, Bernier, Dahou, Toubal) Institut
Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec Heart and
Lung Institute, Department of Medicine, Laval University, Quebec, QC,
Canada
(Hahn, Khalique, Leon, Kodali) Columbia University Medical Center, New
York Presbyterian Hospital, New York, NY, United States
(Weissman, Asch) MedStar Health Research Institute, Georgetown University,
Washington, DC, United States
(Leipsic, Blanke) St. Paul Hospital, Vancouver, Vancouver, BC, Canada
(Zhang, Parvataneni, Alu) Cardiovascular Research Foundation, New York,
NY, United States
(Herrmann) University of Pennsylvania, Philadelphia, PA, United States
(Makkar) Cedars-Sinai Medical center, Los Angeles, CA, United States
(Mack) Department of Cardiovascular Surgery, Baylor Scott and White
Health, Plano, TX, United States
(Smalling) Memorial Hermann Health System, Houston, TX, United States
(Thourani) Emory University School of Medicine, Atlanta, GA, United States
Title
Association of paravalvular regurgitation with 1-year outcomes after
transcatheter aortic valve replacement with the SAPIEN 3 valve.
Source
JAMA Cardiology. 2 (11) (pp 1208-1216), 2017. Date of Publication:
November 2017.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: Moderate/severe and even mild paravalvular regurgitation (PVR)
are associated with increased mortality following transcatheter aortic
valve replacement (TAVR) with first and second generations of
transcatheter valves. OBJECTIVE: To examine the incidence, evolution, and
effect on 1-year outcomes of PVR following TAVR with a third-generation
balloon-expandable transcatheter heart valve. DESIGN, SETTING, AND
PARTICIPANTS: Prespecified analysis of PVR in the Placement of Aortic
Transcatheter Valves (PARTNER) II SAPIEN 3 trial, conducted between
October 1, 2013, and September 3, 2014. Multicenter, nonrandomized
registry of 1661 patients at intermediate or high surgical risk undergoing
TAVR with the SAPIEN 3. Patients with severe, symptomatic aortic stenosis
and high/intermediate surgical risk were enrolled in the registry at 51
sites in the United States and Canada. INTERVENTIONS: Transcatheter aortic
valve replacement with the SAPIEN 3 valve. MAIN OUTCOMES AND MEASURES:
Paravalvular regurgitation was assessed in a core laboratory at 30 days
and 1 year according to a 5-class scheme: 0, none or trace; 1, mild; 2,
mild to moderate; 3, moderate; 4, moderate to severe; and 5, severe. We
assessed the effect of PVR on 1-year mortality and heart failure
rehospitalization. RESULTS: Among the 1661 included in the registry, 1592
received a SAPIEN 3 valve and had assessment of PVR. Of these patients,
55.7% had none-trace PVR, 32.6% had mild, 8.2% had mild to moderate, and
3.5% had at least moderate PVR at 30 days. At 1 year, 9.3% of patients had
died and 14.2% had been rehospitalized. Only patients with at least
moderate PVR had higher 1-year mortality (hazard ratio [HR], 2.40; 95% CI,
1.30-4.43; P = .005) and composite of mortality/rehospitalization (HR,
2.35; 95% CI, 1.52-3.62; P < .001). In a paired comparison including 1213
patients, 73% of the patients with at least moderate PVR at 30 days showed
a reduction in PVR severity of at least 1 PVR class at 1 year. CONCLUSIONS
AND RELEVANCE: In this series of patients undergoing TAVR with the SAPIEN
3 valve, at least moderate PVR was rare but associated with increased risk
of death and heart failure rehospitalization at 1 year. Even the upper
range of the mild class in the 3-class grading scheme (ie, mild to
moderate in the 5-class scheme) had no significant effect on short-term
mortality or rehospitalization. Most patients with at least moderate PVR
at 30 days showed a decrease of PVR severity grade at 1 year. TRIAL
REGISTRATION: clinicaltrials.gov Identifier: NCT01314313.<br/>Copyright
&#xa9; 2017 American Medical Association. All rights reserved.

<60>
Accession Number
619378690
Author
Douglas P.S.; Leon M.B.; Mack M.J.; Svensson L.G.; Webb J.G.; Hahn R.T.;
Pibarot P.; Weissman N.J.; Miller D.C.; Kapadia S.; Herrmann H.C.; Kodali
S.K.; Makkar R.R.; Thourani V.H.; Lerakis S.; Lowry A.M.; Rajeswaran J.;
Finn M.T.; Alu M.C.; Smith C.R.; Blackstone E.H.
Institution
(Douglas, Leon, Hahn) Duke University Medical Center, Durham, NC, United
States
(Leon, Hahn, Kodali, Finn, Alu, Smith) New York Presbyterian Hospital,
Columbia University Medical Center, New York, NY, United States
(Mack) Baylor Scott and White Health, Plano, TX, United States
(Svensson, Kapadia, Lowry, Rajeswaran, Blackstone) Cleveland Clinic,
Cleveland, OH, United States
(Webb) St Paul's Hospital, University of British Columbia, Vancouver, BC,
Canada
(Pibarot) Quebec Heart and Lung Institute, Laval University, Quebec City,
QC, Canada
(Weissman, Miller) MedStar Washington Hospital Center, Washington, DC,
United States
(Miller) Stanford University, Stanford, CA, United States
(Herrmann) University of Pennsylvania Health System, Philadelphia, PA,
United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Thourani, Lerakis) Emory University, Atlanta, GA, United States
Title
Longitudinal hemodynamics of transcatheter and surgical aortic valves in
the PARTNER Trial.
Source
JAMA Cardiology. 2 (11) (pp 1197-1206), 2017. Date of Publication:
November 2017.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: Use of transcatheter aortic valve replacement (TAVR) for
severe aortic stenosis is growing rapidly. However, to our knowledge, the
durability of these prostheses is incompletely defined. OBJECTIVE: To
determine the midterm hemodynamic performance of balloon-expandable
transcatheter heart valves. DESIGN, SETTING, AND PARTICIPANTS: In this
study, we analyzed core laboratory-generated data from echocardiograms of
all patients enrolled in the Placement of Aortic Transcatheter Valves
(PARTNER) 1 Trial with successful TAVR or surgical AVR (SAVR) obtained
preimplantation and at 7 days, 1 and 6 months, and 1, 2, 3, 4, and 5 years
postimplantation. Patients from continued access observational studies
were included for comparison. INTERVENTIONS: Successful implantation after
randomization to TAVR vs SAVR (PARTNER 1A; TAVR, n = 321; SAVR, n = 313),
TAVR vs medical treatment (PARTNER 1B; TAVR, n = 165), and continued
access (TAVR, n = 1996). Five-year echocardiogram data were available for
424 patients after TAVR and 49 after SAVR. MAIN OUTCOMES AND MEASURES:
Death or reintervention for aortic valve structural indications, measured
using aortic valve mean gradient, effective orifice area, Doppler velocity
index, and evidence of hemodynamic deterioration by reintervention,
adverse hemodynamics, or transvalvular regurgitation. RESULTS: Of 2795
included patients, the mean (SD) age was 84.5 (7.1) years, and 1313
(47.0%) were female. Population hemodynamic trends derived from nonlinear
mixed-effects models showed small early favorable changes in the first few
months post-TAVR, with a decrease of -2.9 mm Hg in aortic valve mean
gradient, an increase of 0.028 in Doppler velocity index, and an increase
of 0.09 cm² in effective orifice area. There was relative
stability at a median follow-up of 3.1 (maximum, 5) years. Moderate/severe
transvalvular regurgitation was noted in 89 patients (3.7%) after TAVR and
increased over time. Patients with SAVR showed no significant changes. In
TAVR, death/reintervention was associated with lower ejection fraction,
stroke volume index, and aortic valve mean gradient up to 3 years, with no
association with Doppler velocity index or valve area. Reintervention
occurred in 20 patients (0.8%) after TAVR and in 1 (0.3%) after SAVR and
became less frequent over time. Reintervention was caused by structural
deterioration of transcatheter heart valves in only 5 patients. Severely
abnormal hemodynamics on echocardiograms were also infrequent and not
associated with excess death or reintervention for either TAVR or SAVR.
CONCLUSIONS AND RELEVANCE: This large, core laboratory-based study of
transcatheter heart valves revealed excellent durability of the
transcatheter heart valves and SAVR. Abnormal findings in individual
patients, suggestive of valve thrombosis or structural deterioration, were
rare in this protocol-driven database and require further investigation.
TRIAL REGISTRATION: clinicaltrials.gov Identifier:
NCT00530894.<br/>Copyright &#xa9; 2017 American Medical Association. All
rights reserved.

<61>
Accession Number
619343342
Author
Liu B.; Edwards N.C.; Neal D.A.H.; Weston C.; Nash G.; Nikolaidis N.;
Barker T.; Patel R.; Bhabra M.; Steeds R.P.
Institution
(Liu, Edwards, Neal, Bhabra, Steeds) University Hospital Birmingham NHS
Foundation Trust, Birmingham, United Kingdom
(Liu, Edwards, Weston, Nash, Steeds) Institute of Cardiovascular Sciences,
University of Birmingham, Birmingham, United Kingdom
(Barker, Patel) University Hospitals Coventry and Warwickshire NHS Trust,
Coventry, United Kingdom
(Nikolaidis) The Royal Wolverhampton NHS Trust, Wolverhampton, United
Kingdom
Title
A prospective study examining the role of myocardial Fibrosis in outcome
following mitral valve repair IN DEgenerative mitral Regurgitation:
Rationale and design of the mitral FINDER study.
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 282. Date of Publication: 22 Nov 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The optimal management of chronic severe primary degenerative
mitral regurgitation (MR) is to repair the valve but identification of the
optimal timing of surgery remains challenging. Current guidelines suggest
'watchful waiting' until the onset of symptoms or left ventricular (LV)
dysfunction but these have been challenged as promoting 'rescue surgery'.
Better predictors are required to inform decision-making in relation to
the necessity and timing of surgery. Chronic volume overload is a stimulus
for adverse adaptive LV remodelling. Subclinical reduction in LV strain
before mitral repair predicts a fall in LV ejection fraction following
surgery and is thought to reflect the development of myocardial fibrosis
in response to chronic volume overload. Myocardial fibrosis can be
detected non-invasively using cardiac magnetic resonance (CMR) imaging
techniques as an expansion of the extracellular volume (ECV).
Methods/design: This study investigates whether: 1) patients with above
median ECV will have smaller reduction in end-systolic volume index (as a
measure of the degree of reverse LV remodelling) on CMR following mitral
valve repair, compared to those with below median ECV; and 2) higher ECV
on CMR, validated through histology, adversely impacts upon post-operative
complications and symptomatic improvement following surgery. This is a
multi-centre, prospective, cross-sectional comparison of patients prior to
and 9 months following surgery for chronic severe primary degenerative MR.
To establish the natural history of ECV in MR, an additional cohort of
patients with asymptomatic MR who do not wish to consider early repair
will be followed. Investigations include CMR, cardiopulmonary exercise
test, stress echocardiography, signal-averaged electrocardiogram, 24-h
electrocardiogram monitoring, laboratory tests and patient-reported
outcome measures. Patients undergoing surgery will have cardiac biopsies
performed at the time of mitral valve repair for histological
quantification of fibrosis. Discussion: This study will advance our
understanding of ventricular remodelling in MR, its impact on patient
symptoms and ventricular response following surgery. Establishing the link
between myocardial fibrosis (measured on CMR and validated through
histology), with early ventricular dysfunction, will offer physicians a
novel non-invasive biomarker that can further inform the timing of
surgery. Trial registration: This trial was registered at
ClinicalTrials.gov ( NCT02355418 ) on 30th November 2015.<br/>Copyright
&#xa9; 2017 The Author(s).

<62>
Accession Number
619394099
Author
Naser N.; Tandir S.; Begic E.
Institution
(Naser) Polyclinic 'Dr Nabil', Sarajevo, Sarajevo, Bosnia and Herzegovina
(Tandir) Faculty of Medicine, University of Zenica, Zenica, Bosnia and
Herzegovina
(Begic) Faculty of Medicine, Sarajevo School of Science and Technology,
Sarajevo, Bosnia and Herzegovina
Title
Telemedicine in cardiology - Perspectives in Bosnia and Herzegovina.
Source
Acta Informatica Medica. 25 (4) (pp 263-266), 2017. Date of Publication:
2017.
Publisher
Avicena Publishing (E-mail: avicena@lol.ba)
Abstract
Introduction: Aim of article was to present perspectives of telemedicine
in the field of cardiology in Bosnia and Herzegovina. Material and
methods: Article has descriptive character and present review of
literature. Results: Information technology can have the application in
the education of students, starting from basic medical sciences up to
clinical subjects. Information technologies are used for ECG analysis, 24h
ECG Holter monitoring, which detects different rhythm disorders. By
developing software packages for electrocardiogram analysis, which can be
divided and interpreted by mobile phones, and complete the whole of the
patient in the ambulance, specialist, experienced specialists, or even
consultations in various illnesses and cities. Image segmentation
algorithms have significance in the quantization and diagnostics of
anatomic and pathological structures, and 3D representation has an
important role in education, topography and clinical anatomy, radiology,
pathology, as well as in clinical cardiology itself, especially in the
sphere of coronary arteries identification in the multislice computerized
angiography of coronary arteries. Interactive video consultations with
subspecialists from the state and the region in adult cardiology, adult
interventional cardiology, cardiovascular surgery, pediatric invasive and
non-invasive cardiology enable better access to heart specialists and
subspecialist, accurate diagnosis, better treatment, reduction of
mortality, and a significant reduction in costs. Conclusion: Telemedicine
by slow steps in entering the soil of Bosnia and Herzegovina, but the
potential exists. It is necessary to educate the medical staff, as well as
to provide a tempting environment for software engineers. Investing in
infrastructure and equipment is imperative, as well as a positive climate
for the its implementation.<br/>Copyright &#xa9; 2017 Nabil Naser, Salih
Tandir, Edin Begic.

<63>
Accession Number
619392908
Author
Sharma A.; Sekaran N.K.; Coles A.; Pagidipati N.J.; Hoffmann U.; Mark
D.B.; Lee K.L.; Al-Khalidi H.R.; Lu M.T.; Pellikka P.A.; Trong Q.A.;
Douglas P.S.
Institution
(Sharma, Sekaran, Coles, Pagidipati, Mark, Lee, Al-Khalidi, Douglas) Duke
Clinical Research Institute, Duke University School of Medicine, Durham,
NC, United States
(Sharma) Mazankowski Alberta Heart Institute, University of Alberta,
Edmonton, AB, Canada
(Hoffmann, Lu) Massachusetts General Hospital, Harvard Medical School,
Boston, MA, United States
(Pellikka) Mayo Clinic, Rochester, MN, United States
(Trong) New York-Presbyterian Hospital, Weill Cornell Medicine, New York,
NY, United States
Title
Impact of diabetes mellitus on the evaluation of stable chest pain
patients: Insights from the promise (prospective multicenter imaging study
for evaluation of chest pain) trial.
Source
Journal of the American Heart Association. 6 (11) (no pagination), 2017.
Article Number: e007019. Date of Publication: 01 Nov 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--The impact of diabetes mellitus on the clinical presentation
and noninvasive test (NIT) results among stable outpatients presenting
with symptoms suggestive of coronary artery disease (CAD) has not been
well described. Methods and Results--The PROMISE (Prospective Multicenter
Imaging Study for Evaluation of Chest Pain) trial enrolled 10 003 patients
with known diabetic status, of whom 8966 were tested as randomized and had
interpretable NIT results (1908 with diabetes mellitus, 21%). Differences
in symptoms and NIT results were evaluated using logistic regression.
Patients with diabetes mellitus (versus without) were similar in age
(median 61 versus 60 years) and sex (female 54% versus 52%), had a greater
burden of cardiovascular comorbidities, and had a similar likelihood of
nonchest pain symptoms (29% versus 27%). The Diamond-Forrester/ Coronary
Artery Surgery Study score predicted that patients with diabetes mellitus
(versus without) had similar likelihood of obstructive CAD (low 1.8%
versus 2.7%; intermediate 92.3% versus 92.6%; high 5.9% versus 4.7%).
Physicians estimated patients with diabetes mellitus to have a higher
likelihood of obstructive CAD (low to very low: 28.3% versus 40.1%;
intermediate 63.9% versus 55.9%; high to very high 7.8% versus 4.0%).
Patients with diabetes mellitus (versus without) were more likely to have
a positive NIT result (15% versus 11%; adjusted odds ratio, 1.23; P=0.01).
Conclusions--Stable chest pain patients with and without diabetes mellitus
have similar presentation and pretest likelihood of obstructive CAD;
however, physicians perceive that patients with diabetes mellitus have a
higher pretest likelihood of obstructive CAD, an assessment supported by
increased risk of a positive NIT. Further evaluation of diabetes
mellitus's influence on CAD assessment is required.<br/>Copyright &#xa9;
2017 The Authors.

<64>
Accession Number
619321567
Author
Ghaffary S.; Ghaeli P.; Talasaz A.H.; Karimi A.; Noroozian M.; Salehiomran
A.; Jalali A.
Institution
(Ghaffary) Hematology and Oncology Research Center, Tabriz University of
Medical Sciences, Tabriz, Iran, Islamic Republic of
(Ghaeli, Talasaz) Departments of Pharmacotherapy, Faculty of Pharmacy,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Talasaz, Karimi, Salehiomran, Jalali) Tehran Heart Center, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Noroozian) Memory and Behavioral Neurology Department, Roozbeh Hospital,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
Title
Effect of memantine on post-operative cognitive dysfunction after cardiac
surgeries: A randomized clinical trial.
Source
DARU, Journal of Pharmaceutical Sciences. 25 (1) (no pagination), 2017.
Article Number: 24. Date of Publication: 21 Nov 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Post-operative cognitive dysfunction (POCD) is an important
complication of cardiac surgeries. Glutamate plays a critical role in
physiologic and pathologic conditions in the brain. Due to the role of
glutamate in ischemia, this study is designed to identify the effect of
memantine in prevention of POCD early and late after cardiac surgeries.
Methods: In this randomized clinical trial, 172 patients with ages 45-75
years old who underwent elective cardiac surgery were enrolled. For
patients in memantine group, 5 mg of memantine per day administered at
least 48 h before surgery and increased to 10 mg per day during the first
24 h after surgery and continued for 3 months. A brief Wechsler memory
test (WMT) was administered before, three to 5 days after, and 3 months
after surgery for both groups. Results: Both groups demonstrate standard
pattern of cognitive dysfunction after surgery and in follow up. Pre- and
post-operative WMT score showed significant improvement in memantine
compared to control group (P < 0.001) both in unadjusted and adjusted with
confounding factor analysis. Unadjusted pre-, post-operative, and follow
up WMT score improved significantly after 3 months in memantine group (P =
0.006). Conclusion: Pre-operative administration of memantine protects
patients from POCD following cardiac surgeries. In addition, it improves
cognitive function 3 months after surgery. Trial registration: The trial
was registered in the Iranian Registry of Clinical Trials (registration
number: IRCT201303168698N12). Graphical abstract: Memantin effect on
POCD.<br/>Copyright &#xa9; 2017 The Author(s).

<65>
Accession Number
619384508
Author
Van Den Berg J.P.; Eleveld D.J.; De Smet T.; Van Den Heerik A.V.M.; Van
Amsterdam K.; Lichtenbelt B.J.; Scheeren T.W.L.; Absalom A.R.; Struys
M.M.R.F.
Institution
(Van Den Berg, Eleveld, Van Den Heerik, Van Amsterdam, Lichtenbelt,
Scheeren, Absalom, Struys) Department of Anesthesiology, University of
Groningen, University Medical Center Groningen, Groningen, Netherlands
(De Smet) Demed Medical, Temse, Belgium
(Struys) Department of Anaesthesia and Peri-Operative Medicine, Ghent
University, Ghent, Belgium
Title
Influence of Bayesian optimization on the performance of propofol
target-controlled infusion.
Source
British Journal of Anaesthesia. 119 (5) (pp 918-927), 2017. Date of
Publication: 01 Nov 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Background Target controlled infusion (TCI) systems use population-based
pharmacokinetic (PK) models that do not take into account inter-individual
residual variation. This study compares the bias and inaccuracy of a
population-based vs a personalized TCI propofol titration using Bayesian
adaptation. Haemodynamic and hypnotic stability, and the prediction
probability of alternative PK models, was studied. Methods. A
double-blinded, prospective randomized controlled trial of 120 subjects
undergoing cardiac surgery was conducted. Blood samples were obtained at
10, 35, 50, 65, 75 and 120 min and analysed using a point-of-care propofol
blood analyser. Bayesian adaptation of the PK model was applied at 60 min
in the intervention group. Median (Absolute) Performance Error (Md(A)PE)
was used to evaluate the difference between bias and inaccuracy of the
models. Haemodynamic (mean arterial pressure [MAP], heart rate) and
hypnotic (bispectral index [BIS]) stability was studied. The predictive
performance of four alternative propofol PK models was studied. Results.
MdPE and MdAPE did not differ between groups during the pre-Adjustment
period (control group: 6.3% and 16%; intervention group: 5.4% and 18%).
MdPE differed in the post-Adjustment period (12% vs.-0.3%), but MdAPE did
not (18% vs. 15%). No difference in heart rate, MAP or BIS was found.
Compared with the other models, the Eleveld propofol PK model (patients)
showed the best prediction performance. Conclusions. When an accurate
population-based PK model was used for propofol TCI, Bayesian adaption of
the model improved bias but not precision. Clinical trial registration
Dutch Trial Registry NTR4518.<br/>Copyright &#xa9; The Author 2017.
Published by Oxford University Press on behalf of the British Journal of
Anaesthesia.All rights reserved.

<66>
Accession Number
619365801
Author
Aykut G.; Kilercik M.; Ariturk C.; Ulugol H.; Aksu U.; Kudsioglu T.;
Atalan N.; Yapici N.; Karabulut H.; Toraman F.
Institution
(Aykut) Department of Anesthesiology, Heidelberg University Hospital,
Heidelberg, Germany
(Kilercik) Department of Biochemistry, School of Medicine, Acibadem
University, Istanbul, Turkey
(Ariturk, Karabulut) Department of Cardiovascular Surgery, School of
Medicine, Acibadem University, Istanbul, Turkey
(Ulugol, Toraman) Department of Anesthesiology and Reanimation, School of
Medicine, Acibadem Kadikoy Hospital, Acibadem University, Tekin sok. No:
8, 34713 Kadikoy, Istanbul, Turkey
(Aksu) Department of Biology, Faculty of Science, Istanbul University,
Istanbul, Turkey
(Kudsioglu, Atalan, Yapici) Department of Anesthesiology and Reanimation,
Dr Siyami Ersek Thoracic and Cardiovascular Training and Research
Hospital, Istanbul, Turkey
Title
Correction of dilutional anemia induces renal dysfunction in diabetic
patients undergoing coronary artery bypass grafting: a consequence of
microcirculatory alterations?.
Source
Journal of Nephrology. (pp 1-6), 2017. Date of Publication: 22 Mar 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Background: In this study we aimed to evaluate the effects of dilutional
anemia resulting from cardiopulmonary bypass (CPB) and its correction with
red blood cell (RBC) transfusion on tissue oxygenation and renal function
in diabetic patients undergoing coronary artery bypass grafting (CABG).
Method: 70 diabetic patients who underwent elective CABG and whose
hematocrit values had been between 24-28% at any time during CBP were
prospectively randomized and equally allocated to two groups: patients who
received RBC during CPB (group I, n = 35) vs. did not receive RBC during
CPB (group II, n = 35). Besides routine hemodynamic and biochemical
parameters, biomarkers of ischemia and renal injury such as ischemia
modified albumin (IMA), protein oxidation parameters [advanced oxidative
protein products (AOPP), total thiol (T-SH)], neutrophil
gelatinase-associated lipocalin (NGAL) and estimated glomerular filtration
rate (eGFR) were measured in both groups. Results: In group I, T-SH, NGAL
and urea levels were found to be significantly increased postoperatively
compared to preoperative measurements (p < 0.05). Also, postoperatively,
NGAL, creatinine, aspartate aminotransferase and AOPP levels were higher
in group I than group II (p < 0.05). Conclusion: The correction of anemia
with RBC transfusion in diabetic patients undergoing CABG could increase
the risk of renal injury. Further studies verifying the effects of blood
transfusions at the microcirculatory level are needed to optimize the
efficacy of transfusions.<br/>Copyright &#xa9; 2017 Italian Society of
Nephrology

<67>
Accession Number
619361263
Author
D'Ercole F.; Arora H.; Kumar P.A.
Institution
(D'Ercole, Arora, Kumar) Department of Anesthesiology, University of North
Carolina School of Medicine, Chapel Hill, NC
(Arora, Kumar) Outcomes Research Consortium, Cleveland, OH
Title
Paravertebral Block for Thoracic Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Local anesthetic injected into a wedge-shaped space lateral to the spinal
nerves as they emerge from the intervertebral foramina produces
somatosensory and sympathetic nerve blockade effective for anesthesia and
for managing pain of unilateral origin from the chest and abdomen.
Paravertebral blockade (PVB) is versatile and may be applied unilaterally
or bilaterally. Unlike thoracic epidural, the PVB technique may be used to
avoid contralateral sympathectomy, thereby minimizing hypotension and
leading to better preservation of blood pressure. There are no reports on
systemic toxicity associated with bilateral PVB despite the need for
relatively large doses of local anesthetics. This review includes an
important historic background and captures the resurgence of PVB-an almost
lost technique. Thoracic PVB provides post-thoracotomy pain relief
comparable with thoracic epidural analgesia (TEA) with lower side effects
supported by moderate-quality evidence. The feasibility and potential of
bilateral thoracic PVB for bilateral thoracic surgery appear practical.
However, there is existing controversy in the assumption that thoracic PVB
is a satisfactory, safer alternative when anticoagulation status is a
contraindication to thoracic epidural placement. During the last 2 decades
of systematic reviews and meta-analyses, both TEA and PVB have been deemed
appropriate in the management of thoracic surgery. A multimodal approach
to analgesia includes regional techniques for thoracic surgery that may
reduce the likelihood of the development of postoperative complications
and chronic pain. Purpose of This Review: The authors evaluated current
opinion, clinical practice, new multimodal adjuvants, regional anesthesia,
and innovation and technology related PVB in the thoracic surgery patient
population. The review focuses on history, techniques, application, ease
of placement, and relative safety of this regional technique. For this
review, studies and reference lists were retrieved from the Cochrane
library, Embase, and Medline from January 1995 through January 2017.
Summary: Existing evidence demonstrates noninferiority of thoracic PVB
compared with TEA for postoperative analgesia, with fewer side effects for
unilateral and bilateral thoracic surgery, including video-assisted
thoracoscopy. The determining factors in selecting the regional technique
of choice include the following: (1) tolerance of side effects associated
with TEA, (2) consensus on best practice or technique, and (3) operator
experience. There is no consensus on the optimal approach for thoracic PVB
technique or any standardization when comparing the landmark,
ultrasound-guided, or stimulation-based PVB approaches. Moreover, the
efficacy of TEA compared with PVB in preventing post-thoracotomy chronic
pain syndrome has not been investigated thoroughly and requires future
clinical trials.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<68>
Accession Number
619347036
Author
Atchison C.M.; Amankwah E.; Wilhelm J.; Arlikar S.; Branchford B.R.; Stock
A.; Streiff M.; Takemoto C.; Ayala I.; Everett A.; Stapleton G.; Jacobs
M.L.; Jacobs J.P.; Goldenberg N.A.
Institution
(Atchison, Jacobs, Jacobs) Undergraduate Medical Education, Department of
Pediatrics, University of South Florida Morsani College of Medicine,
Tampa, Florida, United States of America
(Amankwah) Department of Oncology, Johns Hopkins University School of
Medicine and Sidney Kimmel Cancer Center, Baltimore, Maryland, United
States of America
(Amankwah, Arlikar, Ayala, Goldenberg) Johns Hopkins All Children's Cancer
and Blood Disorders Institute, St. Petersburg, Florida, United States of
America
(Wilhelm, Everett, Stapleton, Jacobs, Jacobs, Goldenberg) Johns Hopkins
All Children's Heart Institute, St. Petersburg, Florida, United States of
America
(Branchford) Section of Hematology/Oncology/Bone Marrow Transplantation,
Department of Pediatrics, University of Colorado School of Medicine
Anschutz Medical Campus and Children's Hospital Colorado, Aurora,
Colorado, United States of America
(Stock) Division of Critical Care Medicine, Rush University Medical
Center, Chicago, Illinois, United States of America
(Streiff, Takemoto, Goldenberg) Divisions of Hematology, Departments of
Pediatrics and/or Medicine, Johns Hopkins University School of Medicine,
Baltimore, Maryland, United States of America
(Takemoto, Ayala, Goldenberg) Johns Hopkins Medicine Pediatric Thrombosis
Program, Johns Hopkins All Children's Hospital and Johns Hopkins
Children's Center, St. Petersburg, Florida, United States of America
(Everett) Division of Cardiology, Department of Pediatrics, Johns Hopkins
University School of Medicine, Baltimore, Maryland, United States of
America
(Jacobs, Jacobs) Department of Surgery, Division of Cardiothoracic
Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland,
United States of America
Title
Risk factors for hospital-associated venous thromboembolism in critically
ill children following cardiothoracic surgery or therapeutic cardiac
catheterisation.
Source
Cardiology in the Young. (pp 1-9), 2017. Date of Publication: 08 Nov 2017.
Publisher
Cambridge University Press (E-mail: Journals_subscriptions@cup.cam.ac.uk)
Abstract
Background: Paediatric hospital-associated venous thromboembolism is a
leading quality and safety concern at children's hospitals. Objective: The
aim of this study was to determine risk factors for hospital-associated
venous thromboembolism in critically ill children following cardiothoracic
surgery or therapeutic cardiac catheterisation. Methods: We conducted a
retrospective, case-control study of children admitted to the
cardiovascular intensive care unit at Johns Hopkins All Children's
Hospital (St. Petersburg, Florida, United States of America) from 2006 to
2013. Hospital-associated venous thromboembolism cases were identified
based on ICD-9 discharge codes and validated using radiological record
review. We randomly selected two contemporaneous cardiovascular intensive
care unit controls without hospital-associated venous thromboembolism for
each hospital-associated venous thromboembolism case, and limited the
study population to patients who had undergone cardiothoracic surgery or
therapeutic cardiac catheterisation. Odds ratios and 95% confidence
intervals for associations between putative risk factors and
hospital-associated venous thromboembolism were determined using
univariate and multivariate logistic regression. Results: Among 2718
admissions to the cardiovascular intensive care unit during the study
period, 65 met the criteria for hospital-associated venous thromboembolism
(occurrence rate, 2%). Restriction to cases and controls having undergone
the procedures of interest yielded a final study population of 57
hospital-associated venous thromboembolism cases and 76 controls. In a
multiple logistic regression model, major infection (odds ratio=5.77, 95%
confidence interval=1.06-31.4), age 1 year (odds ratio=6.75, 95%
confidence interval=1.13-160), and central venous catheterisation (odds
ratio=7.36, 95% confidence interval=1.13-47.8) were found to be
statistically significant independent risk factors for hospital-associated
venous thromboembolism in these children. Patients with all three factors
had a markedly increased post-test probability of having
hospital-associated venous thromboembolism. Conclusion: Major infection,
infancy, and central venous catheterisation are independent risk factors
for hospital-associated venous thromboembolism in critically ill children
following cardiothoracic surgery or cardiac catheter-based intervention,
which, in combination, define a high-risk group for hospital-associated
venous thromboembolism.<br/>Copyright &#xa9; Cambridge University Press
2017

<69>
Accession Number
619266041
Author
Lopez F.J.G.; Ruiz-Tovar M.; Almazan-Isla J.; Alcalde-Cabero E.; Calero
M.; de Pedro-Cuesta J.
Institution
(Lopez, Ruiz-Tovar, Almazan-Isla, Alcalde-Cabero, de Pedro-Cuesta)
National Epidemiology Centre, Carlos III Institute of Health, Madrid,
Spain
(Lopez, Ruiz-Tovar, Almazan-Isla, Alcalde-Cabero, Calero, de Pedro-Cuesta)
Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED),
Madrid, Spain
(Calero) Carlos III Institute of Health, Madrid, Spain
(Calero) Alzheimer Disease Research Unit, CIEN Foundation, Queen Sofia
Foundation Alzheimer Centre, Madrid, Spain
Title
Risk of transmission of sporadic Creutzfeldt-Jakob disease by surgical
procedures: Systematic reviews and quality of evidence.
Source
Eurosurveillance. 22 (43) (no pagination), 2017. Date of Publication: 26
Oct 2017.
Publisher
European Centre for Disease Prevention and Control (ECDC) (ECDC, Stockholm
171 83, Sweden. E-mail: eurosutveiliance@eecdc.europa.eu)
Abstract
Background: Sporadic Creutzfeldt-Jakob disease (sCJD) is potentially
transmissible to humans. Objective: This study aimed to summarise and rate
the quality of the evidence of the association between surgery and sCJD.
Design and methods: Firstly, we conducted systematic reviews and
meta-analyses of case-control studies with major surgical procedures as
exposures under study. To assess quality of evidence, we used the Grading
of Recommendations, Assessment, Development and Evaluations (GRADE)
approach. Secondly, we conducted a systematic review of sCJD case reports
after sharing neurosurgical instruments. Results: Thirteen case-control
studies met the inclusion criteria for the systematic review of
case-control studies. sCJD was positively associated with heart surgery,
heart and vascular surgery and eye surgery, negatively associated with
tonsillectomy and appendectomy, and not associated with neurosurgery or
unspecified major surgery. The overall quality of evidence was rated as
very low. A single case-control study with a low risk of bias found a
strong association between surgery conducted more than 20 years before
disease onset and sCJD. Seven cases were described as potentially
transmitted by reused neurosurgical instruments. Conclusion: The
association between surgery and sCJD remains uncertain. Measures currently
recommended for preventing sCJD transmission should be strongly
maintained. Future studies should focus on the potential association
between sCJD and surgery undergone a long time previously.<br/>Copyright
&#xa9; The Authors, 2017.

<70>
Accession Number
618418792
Author
Takagi H.; Ando T.; Mitta S.
Institution
(Takagi, Mitta) Department of Cardiovascular Surgery, Shizuoka Medical
Center, Shizuoka, Japan
(Ando) Department of Cardiology, Detroit Medical Center, Detroit,
Michigan, United States
Title
Meta-Analysis Comparing >=10-Year Mortality of Off-Pump Versus On-Pump
Coronary Artery Bypass Grafting.
Source
American Journal of Cardiology. 120 (11) (pp 1933-1938), 2017. Date of
Publication: 01 Dec 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Off-pump coronary artery bypass grafting (CABG) is suggested to be
associated with an increase in long-term (>=5-year) all-cause mortality.
To determine whether off-pump CABG is associated with an increase in very
long-term (>=10-year) all-cause mortality, we performed a meta-analysis of
propensity-score matched observational comparative studies of off-pump
versus on-pump CABG. MEDLINE and EMBASE were searched through May 2017. A
hazard ratio of follow-up (including early) all-cause mortality for
off-pump versus on-pump CABG was extracted from each individual study.
Study-specific estimates were combined using inverse variance-weighted
averages of logarithmic hazard ratios in the random-effects model. Of 164
potentially relevant studies, our search identified 16 propensity-score
matched observational comparative studies of off-pump versus on-pump CABG
with >=10-year follow-up enrolling a total of 82,316 patients. A pooled
analysis of all the 16 studies demonstrated that off-pump CABG was
significantly associated with an increase in all-cause mortality (hazard
ratio 1.07, 95% confidence interval 1.03 to 1.12, p for effect = 0.0008; p
for heterogeneity = 0.30, I² = 12%). In a sensitivity analysis,
exclusion of any single hazard ratio from the analysis (leave-one-out
meta-analysis) did not substantively alter the overall result. There was
no evidence of a significant publication bias. In conclusion, off-pump
CABG is associated with an increase in very long-term (>=10 years)
all-cause mortality compared with on-pump CABG.<br/>Copyright &#xa9; 2017
Elsevier Inc.

<71>
Accession Number
619163586
Author
Wu H.-L.; Xu Y.-H.; Shi J.-H.
Institution
(Wu, Xu) Nursing Department of Cardiothoracic-Surgery, Affiliated Hospital
of Nantong University, Nantong City, Jiangsu Province, China
(Shi) Department of Cardiothoracic-Surgery, Affiliated Hospital of Nantong
University, Nantong City, Jiangsu Province, China
Title
5% NaHCO<inf>3</inf> Is Appropriate for Skin Cleaning With Central Venous
Catheters.
Source
American Journal of the Medical Sciences. 353 (1) (pp 12-16), 2017. Date
of Publication: 01 Jan 2017.
Publisher
Elsevier B.V. (E-mail: kathiest.clai@apta.org)
Abstract
Objectives The purpose of this study was to compare the effects of skin
cleaning with 5% NaHCO<inf>3</inf> to 75% alcohol on the removal of skin
grease and pain of patients with central venous catheters (CVC). Materials
and Methods This was a randomized, controlled, single-blinded and
prospective study. From January-September 2015, 143 consecutive patients
who met the inclusion and exclusion criteria and who underwent elective
cardiovascular surgery with placement of a CVC were selected. Patients
were randomly divided into 2 groups according to the disinfection
preparation procedure: experimental group (n = 60), in which 5%
NaHCO<inf>3</inf> and distilled water solution at 40-45degreeC were used,
and the control group (n = 66), in which 75% alcohol was used. Main
outcome measures were verbal rating scale pain score, satisfaction and
bacterial count after 2 minutes of iodine disinfection. Results The verbal
rating scale pain scores were lower in the experimental group than in the
control group (P < 0.001). In the control group, 4.5% of patients and 43%
of nurses were satisfied with 75% alcohol cleaning before disinfection
procedure, compared to 74% and 78%, respectively, in the experimental
group. The bacterial count did not show any difference between these 2
groups after iodine disinfection (P = 0.455). Conclusions Cleaning of the
CVC before disinfection with 5% NaHCO<inf>3</inf> and distilled water at
40-45degreeC alleviated pain and improved patient and nurse satisfaction
compared with using 75% alcohol.<br/>Copyright &#xa9; 2017 Southern
Society for Clinical Investigation

<72>
Accession Number
618389718
Author
Gupta P.; Chakraborty A.; Gossett J.M.; Rettiganti M.
Institution
(Gupta) Division of Pediatric Cardiology, Department of Pediatrics,
University of Arkansas for Medical Sciences, Arkansas Children's Hospital,
Little Rock, Ark, United States
(Chakraborty) Department of Mathematical Sciences, University of Arkansas,
Fayetteville, Ark, United States
(Gossett, Rettiganti) Biostatistics Program, Department of Pediatrics,
University of Arkansas for Medical Sciences, Arkansas Children's Hospital
Research Institute, Little Rock, Ark, United States
Title
A prognostic tool to predict outcomes in children undergoing the Norwood
operation.
Source
Journal of Thoracic and Cardiovascular Surgery. 154 (6) (pp 2030-2037.e2),
2017. Date of Publication: December 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives To create and validate a prediction model to assess outcomes
associated with the Norwood operation. Methods The public-use dataset from
a multicenter, prospective, randomized single-ventricle reconstruction
trial was used to create this novel prediction tool. A Bayesian lasso
logistic regression model was used for variable selection. We used a
hierarchical framework by representing discrete probability models with
continuous latent variables that depended on the risk factors for a
particular patient. Bayesian conditional probit regression and Markov
chain Monte Carlo simulations were then used to estimate the effects of
the predictors on the means of these latent variables to create a score
function for each of the study outcomes. We also devised a method to
calculate the risk of outcomes associated with the Norwood operation
before the actual heart operation. The 2 study outcomes evaluated were
in-hospital mortality and composite poor outcome. Results The training
dataset used 520 patients to generate the prediction model. The model
included patient demographics, baseline characteristics, cardiac
diagnosis, operation details, site volume, and surgeon experience. An
online calculator for the tool can be accessed at
https://soipredictiontool.shinyapps.io/NorwoodScoreApp/. Model validation
was performed on 520 observations using an internal 10-fold
cross-validation approach. The prediction model had an area under the
curve of 0.77 for mortality and 0.72 for composite poor outcome on the
validation dataset. Conclusions Our new prognostic tool is a promising
first step in creating real-time risk stratification in children
undergoing a Norwood operation; this tool will be beneficial for the
purposes of benchmarking, family counseling, and research.<br/>Copyright
&#xa9; 2017 The American Association for Thoracic Surgery

<73>
Accession Number
617317261
Author
Yu Y.; Shi E.; Gu T.; Tang R.; Gao S.; Wang Y.; Liu H.
Institution
(Yu, Shi, Gu, Tang, Gao, Wang) Department of Cardiac Surgery, First
Affiliated Hospital, Shenyang, China
(Liu) Department of Health Statistics, School of Public Health, China
Medical University, Shenyang, China
Title
Overexpression of microRNA-30a contributes to the development of aortic
dissection by targeting lysyl oxidase.
Source
Journal of Thoracic and Cardiovascular Surgery. 154 (6) (pp 1862-1869),
2017. Date of Publication: December 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective To explore the role of microRNA (miR)-30a in the development of
aortic dissection. Methods Human aortic specimens of aortic dissections
and aneurysms were harvested. Aortic specimens from donors for heart
transplantation served as controls. Rat aortic vascular smooth muscle
cells (VSMCs) were transfected with agomiR-30a or antagomiR-30a, and
control cells were incubated with empty vectors. Rats were pretreated with
agomiR-30a or antagomiR-30a (5 x 10⁷ transfection units every 3
days for 4 weeks), and empty vectors were infused to controls. Acute
aortic dissection was induced by subcutaneous infusion of angiotensin II
(1 mug . kg^-1 . min^-1 for 24 hours). Protein
expressions of lysyl oxidase (LOX) and elastin and gene expression of
miR-30a were measured in VSMCs and human and rat aortic specimens by
Western blot analysis and quantitative real-time polymerase chain
reaction. Results Gene expression of miR-30a was much higher, and protein
abundance of LOX and elastin was significantly lower, in the aortic
dissection specimens (P <.05 vs controls). Transfection of agomiR-30a
markedly decreased the luciferase activity of LOX in VSMCs of wild type,
but not of LOX 3'-UTR mutant (P =.002). In cultured VSMCs, transfection of
agomiR-30a dramatically enhanced the gene expression of miR-30a and
down-regulated the protein abundance of LOX and elastin (P <.05 vs
controls). Pretreatment with agomiR-30a in vivo enhanced miR-30a
expression and down-regulated the protein abundance of LOX and elastin in
rat aortas (P <.05 vs controls). The rate of dissection was significantly
higher in rats pretreated with agomiR-30a (P =.003 vs controls).
Conclusions Overexpression of miR-30a contributes to the development of
aortic dissection, possibly by targeting LOX.<br/>Copyright &#xa9; 2017
The American Association for Thoracic Surgery

<74>
Accession Number
619350173
Author
Marks D.C.; Johnson L.; Reade M.C.
Institution
(Marks, Johnson) Research and Development, Australian Red Cross Blood
Service, Sydney, Australia
(Marks) Sydney Medical School, University of Sydney, Sydney, Australia
(Reade) University of Queensland, Brisbane, Australia
(Reade) Australian Defence Force, Australia
Title
A clinical trial of frozen platelets.
Source
Vox Sanguinis. Conference: 28th Regional Congress of the International
Society of Blood Transfusion. China. 112 (Supplement 2) (pp 25), 2017.
Date of Publication: November 2017.
Publisher
Blackwell Publishing Ltd
Abstract
Introduction: Platelets have a short shelf life (5 days) and up to 20% of
platelet units may be discarded due to expiry. Smaller Australian
hospitals often cannot justify keeping many (or even any) platelet units
on-site, and cryopreserved platelets may alleviate this problem. A single
controlled clinical trial of cryopreserved platelets in cardiac surgery
patients has previously shown that transfusion of cryopre-served platelets
was associated with less bleeding and fewer red cell transfusions, with no
adverse effects. Before cryopreserved platelets can be approved for
civilian use, more information regarding their efficacy,
cost-effectiveness, and safety is required. Therefore a pilot clinical
trial is being conducted to demonstrate the effectiveness and feasibility
of using cryopreserved platelets for the management of postsurgical
bleeding, to inform a future definitive trial. Methods: Cryopreserved vs
liquid platelets for surgical bleeding (CLIP) is a multi-site, blinded
randomised controlled effectiveness trial comparing cryopreserved
pla-telets to liquid-stored platelets. Cardiac surgery patients at high
risk of perioperative bleeding are identified using a validated scoring
method. Consented patients are ran-domised to receive either cryopreserved
or conventional platelets. Platelets are cryopreserved at the Australian
Red Cross Blood Service and shipped to hospital sites. When required, the
platelets are thawed and reconstituted in thawed FFP immediately prior to
transfusion. Outcomes include acceptability to clinicians, a sufficient
trend towards greater efficacy in reducing blood loss and transfusion
requirements, the rate of adverse effects, incidence of venous
thromboembolism, cost per patient, length of ICU stay and 28-day
mortality. Results: To date 107 patients in four metropolitan tertiary
hospitals have been randomised. Of these, 40 patients have been
transfused. No adverse events have been reported to date, and no reported
transfusion delays. One of the challenges has been the low overall
conversion rate from randomisation to transfusion (37%). Access to
monitored -80degreeC freezer storage has also been challenging. As thawing
platelets is not a routine blood banking activity, training large numbers
of hospital blood bank staff in this process and maintaining their
competency over the duration of the trial was also demanding. Conclusions:
There have been many challenges associated with introduction of a novel
blood component in a clinical trial, all of which have been overcome. Upon
completion data will be analysed, and together with other learnings from
the trial, will be used to inform the design and sample size calculations
for a larger definitive trial.

<75>
Accession Number
619331514
Author
Phan K.; Abi-Hanna D.; Kerferd J.; Lu V.M.; Dmytriw A.A.; Ho Y.-T.;
Fairhall J.; Reddy R.; Wilson P.
Institution
(Phan, Abi-Hanna, Kerferd) NeuroSpine Surgery Research Group, Prince of
Wales Private Hospital, Sydney, Australia
(Phan, Lu, Ho) Sydney Medical School, University of Sydney, Sydney,
Australia
(Dmytriw) Department of Medical Imaging, University of Toronto, Toronto,
Canada
(Fairhall, Reddy, Wilson) Department of Neurosurgery, Prince of Wales
Hospital, Randwick, Sydney, Australia
Title
Resumption of Antithrombotic Agents in Chronic Subdural Hematoma: A
Systematic Review and Meta-analysis.
Source
World Neurosurgery. (no pagination), 2017. Date of Publication: 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background: The clinical decision whether and when to resume
antithrombotics in patients with chronic subdural hematomas (CSDH)
postoperatively is limited by a lack of quality evidence exploring this
topic. Our study aims to assess the available evidence of patient
complication outcomes, specifically hemorrhagic and thromboembolic events,
following the resumption or non-resumption of antithrombotic agents
postoperatively in CSDH patients already on these agents before CSDH.
Methods: We followed recommended PRISMA guidelines for systematic reviews.
Electronic database searches were performed to identify included studies.
Data were extracted and analyzed using meta-analysis. Results: Eight
studies were included for analysis. The most common indication for
antithrombotic treatment before onset of CSDH was atrial fibrillation
(29.6%), followed by prosthetic heart valve (16.6%), recent myocardial
infarction (14.1%), prior stroke or transient ischemic attack (11.6%), and
finally venous thromboembolism (8.3%). The overall hemorrhagic
complication rate was 14.8% in the resumption group versus 18.6% in the no
resumption group (P = 0.591). This did not differ between early (<2 weeks)
versus late (>1 month) resumption (15% vs. 18.6%, P = 0.97). The rate of
thromboembolism however was statistically lower in those who resumed
antithrombotics (2.9% vs. 6.8%, P<0.001). There was a non-significant
trend towards higher thromboembolic rates with early resumption (5.3% vs.
2.1%, P = 0.23). Conclusions: The decision to resume antithrombotics
postoperatively in the clinical management of CSDH patients is a complex
one and should therefore be a highly individualized process. Our
meta-analysis demonstrates that in selected cases, it is feasible to
resume early antithrombotic treatment without additional hemorrhagic or
thromboembolic risk.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<76>
Accession Number
619247495
Author
Chen S.-L.; Zhang J.-J.; Han Y.; Kan J.; Chen L.; Qiu C.; Jiang T.; Tao
L.; Zeng H.; Li L.; Xia Y.; Gao C.; Santoso T.; Paiboon C.; Wang Y.; Kwan
T.W.; Ye F.; Tian N.; Liu Z.; Lin S.; Lu C.; Wen S.; Hong L.; Zhang Q.;
Sheiban I.; Xu Y.; Wang L.; Rab T.S.; Li Z.; Cheng G.; Cui L.; Leon M.B.;
Stone G.W.
Institution
(Chen, Zhang, Kan, Liu) Division of Cardiology, Nanjing First Hospital and
Key Laboratory of Targeted Intervention of Cardiovascular Disease,
Collaboratory Innovation Center for Cardiovascular Disease Translational
Medicine, Nanjing Medical University, Nanjing, China
(Han) Division of Cardiology, Shenyang Northern Hospital, Shenyang, China
(Chen) Division of Cardiology, United Hospital, Fujian Medical University,
Fuzhou, China
(Qiu) Division of Cardiology, Zhengzhou University First Hospital,
Zhengzhou, China
(Jiang) Division of Cardiology, Armed Police Medical University, Tianjin,
China
(Tao) Division of Cardiology, Xijin Hospital, 4th Military Medical
University, Xi'an, China
(Zeng) Division of Cardiology, Wuhan Tongji Hospital, United Medical
University, Wuhan, China
(Li) Division of Cardiology, Guangzhou Red Cross Hospital, Guangzhou,
Guangdong, China
(Xia) Division of Cardiology, Xuzhou Medical University Affiliated
Hospital, Xuzhou, China
(Gao) Division of Cardiology, Henan Provincial People's Hospital,
Zhengzhou, China
(Santoso) Division of Cardiology, Medistra Hospital, University of
Indonesia Medical School, Jakarda, Indonesia
(Paiboon) Division of Cardiology, Bankok General Hospital, Bankok,
Thailand
(Wang) Division of Cardiology, Zhongshan Hospital, Xiamen University,
Xiamen, China
(Kwan) Division of Cardiology, Beth Israel Hospital, New York, New York,
United States
(Ye, Tian, Lin) Division of Cardiology, Nanjing Heart Center, Nanjing,
China
(Lu) Division of Cardiology, Tianjin 1^st Central Hospital,
Tianjin, China
(Wen) Division of Cardiology, Daqin Oil General Hospital, Daqin, China
(Hong) Division of Cardiology, Jiangxi Provincial People's Hospital,
Nanchang, China
(Zhang) Division of Cardiology, Shanghai East Hospital, Shanghai, China
(Sheiban) Division of Cardiology, Pederzoli Hospital-Peschiera del Garda,
Verona, Italy
(Xu) Division of Cardiology, Shanghai 10th People's Hospital, Shanghai,
China
(Wang) Division of Cardiology, Beijing Chaoyang Hospital, Beijing, China
(Rab) Division of Cardiology, Emory University Hospital, Atlanta, Georgia
(Li) Division of Cardiology, Liaoning Provincial People's Hospital,
Shenyang, China
(Cheng) Division of Cardiology, Huaihe Hospital, Henan University,
Kaifeng, China
(Cui) Division of Cardiology, Shandong Provincial Hospital, Shandong
University, Jinan, China
(Leon, Stone) Division of Cardiology, Columbia University Medical Center
and the Cardiovascular Research Foundation, New York, New York, United
States
Title
Double Kissing Crush Versus Provisional Stenting for Left Main Distal
Bifurcation Lesions: DKCRUSH-V Randomized Trial.
Source
Journal of the American College of Cardiology. 70 (21) (pp 2605-2617),
2017. Date of Publication: 28 November 2017.
Publisher
Elsevier USA
Abstract
Background Provisional stenting (PS) is the most common technique used to
treat distal left main (LM) bifurcation lesions in patients with
unprotected LM coronary artery disease undergoing percutaneous coronary
intervention. The double kissing (DK) crush planned 2-stent technique has
been shown to improve clinical outcomes in non-LM bifurcations compared
with PS, and in LM bifurcations compared with culotte stenting, but has
never been compared with PS in LM bifurcation lesions. Objectives The
authors sought to determine whether a planned DK crush 2-stent technique
is superior to PS for patients with true distal LM bifurcation lesions.
Methods The authors randomized 482 patients from 26 centers in 5 countries
with true distal LM bifurcation lesions (Medina 1,1,1 or 0,1,1) to PS (n =
242) or DK crush stenting (n = 240). The primary endpoint was the 1-year
composite rate of target lesion failure (TLF): cardiac death, target
vessel myocardial infarction, or clinically driven target lesion
revascularization. Routine 13-month angiographic follow-up was scheduled
after ascertainment of the primary endpoint. Results TLF within 1 year
occurred in 26 patients (10.7%) assigned to PS, and in 12 patients (5.0%)
assigned to DK crush (hazard ratio: 0.42; 95% confidence interval: 0.21 to
0.85; p = 0.02). Compared with PS, DK crush also resulted in lower rates
of target vessel myocardial infarction I (2.9% vs. 0.4%; p = 0.03) and
definite or probable stent thrombosis (3.3% vs. 0.4%; p = 0.02).
Clinically driven target lesion revascularization (7.9% vs. 3.8%; p =
0.06) and angiographic restenosis within the LM complex (14.6% vs. 7.1%; p
= 0.10) also tended to be less frequent with DK crush compared with PS.
There was no significant difference in cardiac death between the groups.
Conclusions In the present multicenter randomized trial, percutaneous
coronary intervention of true distal LM bifurcation lesions using a
planned DK crush 2-stent strategy resulted in a lower rate of TLF at 1
year than a PS strategy. (Double Kissing and Double Crush Versus
Provisional T Stenting Technique for the Treatment of Unprotected Distal
Left Main True Bifurcation Lesions: A Randomized, International,
Multi-Center Clinical Trial [DKCRUSH-V];
ChiCTR-TRC-11001213)<br/>Copyright &#xa9; 2017 American College of
Cardiology Foundation

<77>
Accession Number
619265543
Author
Rajapakse S.; Weeratunga P.; Rodrigo C.; de Silva N.L.; Fernando S.D.
Institution
(Rajapakse, Weeratunga, de Silva) University Medical Unit, National
Hospital Colombo, Colombo, Sri Lanka
(Rajapakse, Weeratunga, Rodrigo) Faculty of Medicine, Department of
Clinical Medicine, University of Colombo, Colombo, Sri Lanka
(Rodrigo) Department of Pathology, School of Medical Sciences, University
of New South Wales, Sydney, Australia
(de Silva) Faculty of Medicine, Department of Medicine, General Sir John
Kotelawala Defence University, Rathmalana, Sri Lanka
(Fernando) Faculty of Medicine, Department of Parasitology, University of
Colombo, Colombo, Sri Lanka
Title
Prophylaxis of human toxoplasmosis: a systematic review.
Source
Pathogens and Global Health. 111 (7) (pp 333-342), 2017. Date of
Publication: 03 Oct 2017.
Publisher
Taylor and Francis Ltd. (E-mail: maney@maney.co.uk)
Abstract
Toxoplasmosis is an infection caused by the intracellular protozoan
parasite Toxoplasma gondii, and is associated with clinically significant
infection in immunocompromised individuals. Vertical transmission during
pregnancy can manifest as congenital toxoplasmosis in the neonate, and can
have serious consequences. This review aims to describe the modalities for
prophylaxis of toxoplasmosis in susceptible populations, and focuses on
the following: (1) prophylaxis of congenital toxoplasmosis; (2)
prophylaxis of toxoplasmosis in patients with HIV/AIDS; and (3)
prophylaxis of toxoplasmosis in transplant recipients.<br/>Copyright
&#xa9; 2017 Informa UK Limited, trading as Taylor & Francis Group.

<78>
Accession Number
619232730
Author
Foy A.J.; Dhruva S.S.; Peterson B.; Mandrola J.M.; Morgan D.J.; Redberg
R.F.
Institution
(Foy, Peterson) Department of Medicine, Penn State College of Medicine,
Hershey, PA, United States
(Foy) Department of Public Health Sciences, Penn State College of
Medicine, Hershey, PA, United States
(Dhruva) Robert Wood Johnson Foundation Clinical Scholars Program,
Department of Internal Medicine, Yale School of Medicine, New Haven, CT,
United States
(Mandrola) Louisville Cardiology Group, Baptist Health, Louisville, KY,
United States
(Morgan) Department of Medicine, University of Maryland School of
Medicine, Baltimore, United States
(Redberg) Philip R. Lee Institute for Health Policy Studies, University of
California, San Francisco, United States
Title
Coronary computed tomography angiography vs functional stress testing for
patients with suspected coronary artery disease: A systematic review and
meta-analysis.
Source
JAMA Internal Medicine. 177 (11) (pp 1623-1631), 2017. Date of
Publication: November 2017.
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: Coronary computed tomography angiography (CCTA) is a new
approach for the diagnosis of anatomical coronary artery disease (CAD),
but it is unclear how CCTA performs compared with the standard approach of
functional stress testing. OBJECTIVE: To compare the clinical
effectiveness of CCTA with that of functional stress testing for patients
with suspected CAD. DATA SOURCES: A systematic literature search was
conducted in PubMed and MEDLINE for English-language randomized clinical
trials of CCTA published from January 1, 2000, to July 10, 2016. STUDY
SELECTION: Researchers selected randomized clinical trials that compared a
primary strategy of CCTA with that of functional stress testing for
patients with suspected CAD and reported data on patient clinical events
and changes in therapy. DATA EXTRACTION AND SYNTHESIS: Two reviewers
independently extracted data from and assessed the quality of the trials.
This analysis followed the PRISMA statement for reporting systematic
reviews and meta-analyses and used the Cochrane Collaboration's tool for
assessing risk of bias in randomized trials. The Mantel-Haenszel method
was used to conduct the primary analysis. Summary relative risks were
calculated with a random-effects model. MAIN OUTCOMES AND MEASURES: The
outcomes of interest were all-cause mortality, cardiac hospitalization,
myocardial infarction, invasive coronary angiography, coronary
revascularization, new CAD diagnoses, and change in prescription for
aspirin and statins. RESULTS: Thirteen trials were included, with 10 315
patients in the CCTA arm and 9777 patients in the functional stress
testing arm who were followed up for a mean duration of 18 months. There
were no statistically significant differences between CCTA and functional
stress testing in death (1.0% vs 1.1%; risk ratio [RR], 0.93; 95% CI,
0.71-1.21) or cardiac hospitalization (2.7% vs 2.7%; RR, 0.98; 95% CI,
0.79-1.21), but CCTA was associated with a reduction in the incidence of
myocardial infarction (0.7% vs 1.1%; RR, 0.71; 95% CI, 0.53-0.96).
Patients undergoing CCTA were significantly more likely to undergo
invasive coronary angiography (11.7% vs 9.1%; RR, 1.33; 95% CI, 1.12-1.59)
and revascularization (7.2% vs 4.5%; RR, 1.86; 95% CI, 1.43-2.43). They
were also more likely to receive a diagnosis of new CAD and to have
initiated aspirin or statin therapy. CONCLUSIONS AND RELEVANCE: Compared
with functional stress testing, CCTA is associated with a reduced
incidence of myocardial infarction but an increased incidence of invasive
coronary angiography, revascularization, CAD diagnoses, and new
prescriptions for aspirin and statins. Despite these differences, CCTA is
not associated with a reduction in mortality or cardiac
hospitalizations.<br/>Copyright &#xa9; 2017 American Medical Association.
All rights reserved.

<79>
Accession Number
619260417
Author
Wee H.E.; Sin K.Y.K.; Chiang P.; Guo K.W.Q.
Institution
(Wee) Department of Surgical Oncology, National Cancer Centre Singapore,
Singapore
(Sin) Department of Cardiothoracic Surgery, National Heart Centre
Singapore, Singapore
(Chiang, Guo) Department of Cardiology, National Heart Centre Singapore,
Singapore
Title
Validation of the use of a point-of-care device in monitoring the
international normalised ratio in postoperative cardiac patients.
Source
Annals of the Academy of Medicine Singapore. 45 (9) (pp 424-426), 2016.
Date of Publication: September 2016.
Publisher
Academy of Medicine Singapore

<80>
Accession Number
619317687
Author
Abouarab A.A.; Rahouma M.; Kamel M.
Institution
(Abouarab) Cardiothoracic Surgery, University of Alabama at Birmingham,
Birmingham, AL, United States
(Rahouma, Kamel) Surgical Oncology Department, National Cancer Institute,
Cairo University, Cairo, Egypt
Title
Uni-versus conventional multi-portal VATS; a meta-analysis.
Source
Journal of Thoracic Oncology. Conference: 2017 Chicago Multidisciplinary
Symposium in Thoracic Oncology. United States. 12 (11 Supplement 1) (pp
S1562), 2017. Date of Publication: November 2017.
Publisher
Elsevier Inc.
Abstract
Background: Video assisted thoracic surgery (VATS) has been successful in
treating different thoracic diseases and with many benefits for patients
over open surgery. Conventionally, VATS was performed via multiple small
incisions (C-VATS). Recent studies reported encouraging results with the
single port VATS (S-VATS) over the conventional technique. However, these
studies were either; small in size, unfocused, nonuniform, retrospective,
lacking follow up information or focused on pain. We aim to validate
previously reported results in a single large metaanalysis including only
the best evidence studies available. Methods: Systematic review was
performed through the literature available in PubMed. We included only
full English articles with Newcastle Ottawa Scale (NOS) score >= 7. The
primary outcome was the complication rate while secondary outcomes were
operative time, resected LN, chest tube duration, estimated blood loss
(EBL), length of postoperative stay (LOS) and postoperative pain (POD 1).
Odds ratio and standard mean difference (OR and SMD) were used as effect
estimates. Random model and leave one out analysis were used. Results: A
total of 39 were included with 4635 patients (1686 S-VATS vs. 2949
C-VATS). No differences between both groups regarding mortality or
morbidity rates. SVATS has resulted in significantly less postoperative
pain (P<0.0001), blood loss (P=0.006), LOS (P<0.00001) and chest tube
duration (P=0.00001). Table 1 shows the results of the different variables
examined. In lung cancer patients the number of retrieved lymph nodes was
similar to that of C-VATS (P>0.05). Subgroup comparison of the rate of
complications between lung resections vs. other intrathoracic procedures,
lung cancer vs. pneumothorax, and lung cancer vs. other lung only lesions
did not show any significant differences between S-VATS and C-VATS
regarding perioperative outcomes. (Table Presanted) Conclusion: Uniportal
VATS technique, when appropriately indicated and performed, has shown
superior postoperative outcomes to the conventional multi-portal VATS in
the treatment of both minor and major lung disorders.

<81>
Accession Number
619231001
Author
Shah S.I.; Bui H.; Velasco N.; Rungta S.
Institution
(Shah, Bui, Velasco, Rungta) Department of Pathology, University of
Cincinnati Medical Center, Cincinnati, OH, United States
(Shah, Bui, Rungta) Department of Pathology, Cincinnati VA Medical Center,
Cincinnati, OH, United States
(Velasco) Department of Primary Care, Veterans Affairs, Southern Oregon
Rehabilitation Center and Clinics, White City, OR, United States
Title
Incidental finding of Cryptococcus on prostate biopsy for prostate
adenocarcinoma following cardiac transplant: Case report and review of the
literature.
Source
American Journal of Case Reports. 18 (pp 1171-1180), 2017. Date of
Publication: 06 Nov 2017.
Publisher
International Scientific Information, Inc. (E-mail:
office@isl-science.com)
Abstract
Objective: Unusual clinical course Background: Cryptococcus is the third
most common invasive fungal organism in immunocompromised patients,
including transplant patients, and usually involves the central nervous
system and lungs, with a median time to infection of 25 months. We report
a case of Cryptococcus of the prostate gland, found as an incidental
finding on prostate biopsy for prostate adenocarcinoma, four months
following cardiac transplantation. Case Report: A 62-year-old male
African-American who had a cardiac transplant four months previously,
underwent a sixcore prostate biopsy for a two-year history of increasing
prostate-specific antigen (PSA) levels, and a recent history of
non-specific urinary tract symptoms. A prostatic adenocarcinoma, Gleason
grade 4+4=8, was diagnosed on histopathology, and 'foamy' cells were seen
in the biopsies. Histochemical stains, including Grocott methenamine
silver (GMS), and periodic acid-Schiff (PAS) showed abundant round and
oval 5-7 mum diameter fungal elements; mucicarmine highlighted the fungal
polysaccharide capsule, diagnostic for Cryptococcus. Cryptococcal antigen
detection was made by the latex agglutination test and cultures. We
reviewed the literature and found 70 published cases (from 1946-2008) of
Cryptococcus of the prostate gland, with only one previous case presenting
five years following cardiac transplantation. Conclusions: Fungal
infections of the prostate are rare, and occur mainly in immunocompromised
patients. We present a unique case of prostatic Cryptococcus found
incidentally at four months following cardiac transplantation. This case
report highlights the need to consider atypical fungal infection as a
differential diagnosis for prostatitis in immunosuppressed patients,
including transplant patients.<br/>Copyright &#xa9; Am J Case Rep.

<82>
Accession Number
619326008
Author
Fallatah R.; Elasfar A.A.; Alzubaidi S.; Alraddadi M.; Abuelatta R.
Institution
(Fallatah, Elasfar, Alzubaidi, Abuelatta) Madina Cardiac Center, Madina,
Saudi Arabia
(Fallatah) King Abdulaziz University, Jeddah, Saudi Arabia
(Elasfar) Cardiology Department, Tanta University, Egypt
(Alraddadi) King Fahad Hospital, AlMadina AlMonaoarah, Saudi Arabia
Title
Endovascular repair of a leaking aortic-arch pseudoaneurysm using graft
stent combined with chimney protection to left common carotid artery: Case
report and review of literature.
Source
Journal of the Saudi Heart Association. (no pagination), 2017. Date of
Publication: 2017.
Publisher
Elsevier B.V.
Abstract
Aortic pseudoaneurysm (PsA) is a rare but serious condition that has high
mortality and morbidity rates if untreated. We report a rare case of
leaking aortic-arch PsA repaired by thoracic endovascular aortic repair
using graft stent with the chimney technique to protect the left common
carotid artery. Unlike other cases in the literature, our case was unique,
having leaking PsA not related to previous cardiac surgery or aortic
dissection. The successful management of this patient using thoracic
endovascular aortic repair combined with the chimney technique suggests
that this approach may be an attractive therapeutic alternative to treat
aortic-arch PsA.<br/>Copyright &#xa9; 2017 The Authors.

<83>
Accession Number
619323234
Author
Oh H.-W.; Lee J.-H.; Kim H.-C.; Kim E.-H.; Song I.-K.; Kim H.-S.; Kim
J.-T.
Institution
(Oh) Department of Anaesthesiology and Pain Medicine Seoul National
University Hospital Seoul National University College of Medicine
SeoulKorea
(Lee, Kim) Department of Anaesthesiology and Pain Medicine Seoul National
University Hospital SeoulKorea
(Kim) Department of Anaesthesiology and Pain Medicine Dongsan Medical
Centre Keimyung University College of Medicine DaeguKorea
(Song) Department of Anaesthesiology and Pain Medicine Asan Medical Centre
University of Ulsan College of Medicine SeoulKorea
(Kim) Department of Anaesthesiology and Pain Medicine Seoul National
University Hospital SeoulKorea
(Kim) Department of Anaesthesiology and Pain Medicine Seoul National
University Hospital Seoul Korea
Title
The effect of 6% hydroxyethyl starch (130/0.4) on acute kidney injury in
paediatric cardiac surgery: A prospective, randomised trial.
Source
Anaesthesia. (no pagination), 2017. Date of Publication: 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
We have evaluated the effect of a colloid solution on acute kidney injury
in paediatric cardiac surgery. A total of 195 patients were ramdomly
divided into an hydroxyethyl starch group and a control group. In the
starch group, 6% hydroxyethyl starch 130/0.4 (Volulyte) was
used as the primary fluid for volume resuscitation but was limited to 30
ml.kg^-1. In the control group, only crystalloid fluid was used
during the peri-operative period. The incidence of acute kidney injury,
peri-operative transfusion, clinical outcomes and laboratory data were
compared. The incidence of acute kidney injury determined by Paediatric
Risk, Injury, Failure, Loss, End-stage renal disease (pRIFLE) and Acute
Kidney Injury Network (AKIN) criteria were no different between the two
groups (starch group 40.8% vs. control group 30.0%; p = 0.150 using
pRIFLE; 19.6% vs. 21.1% respectively, p = 0.602 using AKIN). There were no
differences in clinical outcomes such as mortality, major adverse events,
intensive care unit stay or duration of mechanical ventilation. Clotting
time as measured using rotational thromboelastometry (ROTEM) was
prolonged, and clot firmness after 10 min and maximal clot firmness were
shorter in the starch group compared with the control group after sternal
closure. There was no difference in transfusion between the two groups.
Patients with acute kidney injury had worse clinical courses than those
without acute kidney injury. We conclude that intra-operative use of 6%
hydroxyethyl starch 130/0.4 up to 30 ml.kg^-1 was not associated
with postoperative acute kidney injury in paediatric cardiac patients.
2017<br/>Copyright &#xa9; The Association of Anaesthetists of Great
Britain and Ireland.