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<1>
Accession Number
619777627
Author
Teniola B.; Mitchell M.; Bansal V.
Institution
(Teniola, Mitchell, Bansal) Emory University, School of Medicine, United
States
Title
Serratus anterior plane catheter for acute thoracotomy pain in a pediatric
patient.
Source
Regional Anesthesia and Pain Medicine. Conference: 42nd Annual Regional
Anesthesiology and Acute Pain Medicine Meeting, ASRA 2017. United States.
42 (6) (no pagination), 2017. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction Patients presenting for thoracotomy can be challenging to
manage due to the intensity of acute post-thoracotomy pain. Futhermore,
postthoracotomy pain can persist and can become chronic lasting for months
to years (1). Thoracic surgery affects postoperative pulmonary function,
therefore it is essential to maximize effective perioperative analgesia.
The mainstay of therapy for thoracotomy pain is thoracic epidural
placement; although generally safe, there are known risks including
reports of severe, permanent neurologic injury (2-4). The serratus
anterior plane (SAP) block is a relatively new regional anesthetic
technique that may be a viable alternative to thoracic epidural (5). The
block is performed by injecting local anesthetic into potential spaces
both superficial and deep to the serratus anterior muscle. Here, we
present the first reported case of a serratus anterior plane catheter for
thoracotomy in the pediatric population. Results/Case report A 12 year old
female patient with a history of recurrent osteosarcoma with lung
metastasis presented for right thoracotomy with wedge resection and
partial pleurectomy. Preoperatively, the patient was consented for
serratus anterior plane catheter. After the completion of the surgery, a
SAP catheter was placed prior to emergence from anesthesia. A time out was
performed; the patient was placed in the lateral decubitus position. Using
a curvilinear ultrasound probe, the serratus anterior muscle was localized
over the 5th rib in the midaxillary line in the vertical axis. The site
was prepped and draped, and the probe was aligned from the caudad to
cephalad direction, and was directed superficial to the serratus anterior
muscle under ultrasound guidance. Thereafter, 20 mL of 0.2% ropivacaine
was injected under ultrasound guidance with the use of a 22-gauge 80 mm
echogenic needle. A peripheral nerve catheter was inserted and embedded
superficial to the serratus anterior muscle under ultrasound guidance. The
site was secured using sterile dressing. A continuous infusion of 0.2%
ropivacaine at 6 ml/hr was attached to the catheter. The patient's maximum
pain score with the SAP catheter was a VAS score of 5 on POD 1. She also
received supplemental analgesia with dilaudid PCA. The catheter was
discontinued on POD 4 after removal of the patient's chest tube, and she
was discharged home on oral medications on POD 6. Discussion This case
supports that a SAP catheter is a suitable regional anesthetic technique
for thoracotomy procedures. Here, we performed the first successful
serratus anterior plane catheter in the pediatric population. Although
continuous thoracic epidural infusion is the mainstay for major
thoracotomy surgeries, limitations include the need for normal coagulation
profile and possible complications that can result in severe morbidity.
The SAP block is advantageous due to relative ease of placement, while
avoiding the more severe complications inherent with epidural techniques.
Randomized controlled clinical trials are still needed to assess the
analgesic efficacy of the serratus anterior plane block in comparison to
thoracic epidural, paravertebral, or intercostal nerve block. The SAP
catheter may prove to be an important clinical tool for the treatment of
postthoracotomy pain.

<2>
Accession Number
619777091
Author
Bunnell A.; Bebic Z.; Hagen J.
Institution
(Bunnell, Bebic, Hagen) Hofstra Northwell School of Medicine, United
States
Title
Serratus anterior block as a novel approach to postoperative pain control
after pediatric thoracotomy: A case report.
Source
Regional Anesthesia and Pain Medicine. Conference: 42nd Annual Regional
Anesthesiology and Acute Pain Medicine Meeting, ASRA 2017. United States.
42 (6) (no pagination), 2017. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction Thoracotomies result in significant postoperative pain and
effective analgesia can present a challenge, particularly in the pediatric
population. Regional techniques have been demonstrated to be safe and
effective in pediatric patients and have been gaining in popularity (3,4).
The serratus anterior block (SAB) is a relatively new technique that has
been described as a safe an effective alternative to epidural analgesia
for thoracotomy in the adult patient (1,2), but its use has not been
described in the pediatric population. This case report presents four
pediatric patients who underwent thoracotomies and received a SAB for
postoperative pain control. Results/Case report Patient 1 and 2:
18-month-old 8.6kg female and a 19-month-old 14.2kg male respectively,
both with vascular ring malformation of the aorta. Patient 3: 21-month-old
8.6kg male for repair and replantation of the right subclavian artery.
Patient 4: 6-year-old 20.9kg male with coarctation of the aorta. All
patients received a serratus anterior block intraoperatively after
induction of general anesthesia and prior to surgical incision. The chest
wall was prepped with 2% chlorohexadine solution, the ultrasound probe was
placed in the midaxillary line at the 6 intercostal space in the sagittal
plane and the latissimus dorsi, teres major, and serratus muscles were
identified. With strict asepsis and under direct visualization a 22G
stimuplex needle was inserted in-plane and local anesthetic was deposited
superficial to the serratus muscle. Intraoperative opiate consumption
ranged between 0.2-0.3mg/kg of morphine equivalent. During the first 24
hours post-operatively, patient 1 required 0.15mg/kg of morphine, patient
2 required 0.15mg/kg of morphine equivalents, patient 3 required 0.3mg/kg
of morphine, and patient 4 required 0.23mg/kg of morphine. Time to first
opiate consumption was 7 minutes for patient 3, and between 172-227
minutes for patients 1, 2, and 4. None of the four patients experienced
complications related to the block. Discussion SAB's have been
demonstrated to be a safe and effective alternative for postoperative pain
control in adult patients post thoracotomy as well as chest wall surgery
including breast procedures and rib fractures. Their use has not yet been
described for pediatric patients. Though limited by sample size, our case
report demonstrates its safe and effective use, and we believe it has a
role in the multi-modal pain regimen for pediatric patients post
thoracotomy. As well, it may prove useful in patients who could benefit
from a thoracic epidural but otherwise may not be candidates. Further,
techniques to limit opiate consumption in ex-preemies are useful to
prevent post-operative apnea/hypopnea. A future prospective trial would be
useful to further evaluate the utility of this block for pediatric
thoracotomy.

<3>
Accession Number
619771991
Author
Del Trigo M.; Munoz-Garcia A.; Latib A.; Auffret V.; Wijeysundera H.;
Nombela-Franco L.; Ibanes E.G.; Cheema A.; Serra V.; Amat-Santos I.; Kefer
J.; Benitez L.; Leclercq F.; Quevedo P.J.; Pibarot P.; Rodes-Cabau J.
Institution
(Del Trigo) Quebec Heart and Lung Istitute, Quebec City, QC, Canada
(Munoz-Garcia) Hospital Universitario Clinico Virgen De La Victoria,
Malaga, Spain
(Latib) Interventional Cardiology Institute, San Raffaele Hospital, Milan,
Italy
(Auffret) CHU Rennes Pontchaillou, Rennes, France
(Wijeysundera) Sunnybrook Health Sciences Centre, University of Toronto,
Toronto, ON, Canada
(Nombela-Franco, Quevedo) Hospital Clinico San Carlos, Madrid, Spain
(Ibanes) Instituto De Investigacion Sanitaria Gregorio Maranon, CIBER CV.,
Madrid, Spain
(Cheema) University of Toronto, Toronto, ON, Canada
(Serra) H. Vall D'Hebron, Sant Cugat Del Valles, Spain
(Amat-Santos) Institute of heart sciences (ICICOR), Hospital Clinico
Universitario, Valladolid, Spain
(Kefer) Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
(Benitez) Clinica De Occidente De Cali, Cali, Colombia
(Leclercq) University Hospital Montpellier, Montpellier, France
(Pibarot) Quebec Heart and Lung Institute, Quebec City, QC, Canada
(Rodes-Cabau) Quebec Heart and Lung Institute, Laval University, Quebec,
QC, Canada
Title
Impact of anticoagulation therapy on valve hemodynamic deterioration
following transcatheter aortic valve replacement.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B22), 2017. Date of Publication: October
2017.
Publisher
Elsevier USA
Abstract
BACKGROUND Few data exist of the impact of anticoagulation therapy upon
valve hemodynamics following transcatheter aortic valve replacement
(TAVR). We evaluated the changes in transvalvular gradients and the
incidence of valve hemodynamic deterioration (VHD) following TAVR,
according to use of anticoagulation therapy. METHODS This multicenter
study included 2466 patients (46% men; mean age 81 +/- 7 years) who
underwent TAVR with echocardiography performed at 12-month follow-up.
Anticoagulation therapy was used in 708 patients (28.7%) following TAVR
(AC group). A propensity score matching analysis was performed to adjust
for intergroup (AC vs. non- AC post-TAVR) differences. A total of 622
patients per group were included in the propensity-matched analysis. VHD
was defined as a <=10 mm Hg increase in the mean transprosthetic gradient
at follow-up (vs. hospital discharge). The mean clinical follow-up was 29
+/- 18 months. RESULTS The mean transvalvular gradient significantly
increased at follow-up in the non-AC group within the global cohort
(p=0.003), whereas it remained stable over time in the AC group (p=0.323).
The incidence of VHD was significantly lower in the AC group (0.6%)
compared to the non-AC group (3.7%, p<0.001), and these significant
differences remained within the propensity-matched populations (0.6% vs.
3.9% in the AC and non-AC groups, respectively, p<0.001). The occurrence
of VHD did not associate with an increased risk of allcause death
(P=0.468), cardiovascular death (p=0.539) or stroke (p=0.170) at
follow-up. CONCLUSION The lack of anticoagulation therapy post-TAVR was
associated with significant increments in transvalvular gradients and a
greater risk of VHD. VHD was subclinical in most cases and did not
associate with major adverse clinical events. Future randomized trials are
needed to determine if systematic anticoagulation therapy post-TAVR would
reduce the incidence of VHD.

<4>
Accession Number
619771930
Author
Testa L.; Bedogni F.
Institution
(Testa) IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
(Bedogni) Policlinico San Donato, Milano, Milan, Italy
Title
Safety and efficacy of cerebral protection devices during transcatheter
aortic valve implantation. A systematic review and meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B268-B269), 2017. Date of Publication:
October 2017.
Publisher
Elsevier USA
Abstract
BACKGROUND The use of embolic protection devices (EPD) may theoretically
reduce the occurrence of cerebral embolic lesions during transcatheter
aortic valve implantation (TAVI). Available evidences from single studies
are quite inconclusive. The aimof the presentmetaanalysis was to assess
the safety and efficacy profile of current EPD. METHODS EMBASE, PubMed,
Web of Science Core Collection, and the Cochrane Library were searched up
to May 2017 for studies that evaluated patients undergoing TAVI with or
without EPD. Endpoint of interest were: 30-day mortality, 30-day stroke,
new-single, new multiple and total number of lesions, ischemic volume per
lesion and total volume of lesions. RESULTS 13 studies involving 1040
patients were included. Overall, the EPD delivery success rate was 94.5%.
No differences in terms of clinically evident stroke (OR 0.70 (0.48-1.2;
P=0.26), or 30-day mortality (OR 0.64 (0.430-1.54), P=0.30). was observed
between patients treated with EPDs versus patient who did not. There were
no significant differences in new-single (OR 0.8 (0.55-1.4, p=0.7)),
multiple (OR 0.66, (0.44-1.42), p=0.6), or total number of lesions (OR
0.88 (0.42-1.38), p=0.8). The use of EPD was associated with a
significantly smaller ischemic volume per lesion (standardized mean
difference, (-0.52 (-0.85)- (-0.20); P=0.002) and smaller total volume of
lesions (standardized mean difference, (-0.23; (-0.42) - (-0.03); P=0.02).
A trend towards the reduction in new lesions per patient using EPD
(standardized mean difference, -0.41; 95% CI, -0.82 to 0.00; P=0.05), was
found for self-expanding devices. CONCLUSION The use of EPD is not
associated with a reduced rate of stroke and mortality. Moreover, EPD seem
unable to reduce the number of new-single, multiple, or total number of
cerebral embolic lesions. The use of EPD during TAVI is associated with
smaller volume of silent ischemic lesions and smaller total volume of
silent ischemic lesions. Available evidences are of low quality.

<5>
Accession Number
619771913
Author
Chatterjee A.; Bhatia N.; Agarwal M.; Leesar M.; Sasse M.; Watts T.;
Agrawal S.; Mohananey D.; Law M.
Institution
(Chatterjee) UAB, Birmingham, AL, United States
(Bhatia) Vanderbilt University Medical Center, Nashville, TN, United
States
(Agarwal) University of Tennessee, Memphis, TN, United States
(Leesar) University of Alabama-Birmingham, Birmingham, AL, United States
(Sasse) University of Alabama Birmingham, Vestavia, AL, United States
(Watts, Law) University of Alabama at Birmingham, Birmingham, AL, United
States
(Agrawal) St Luke's University Hospital, Bethlehem, PA, United States
(Mohananey) Cleveland Cinic, Cleveland, OH, United States
Title
Procedural outcomes of balloon valvuloplasty in patients with bicuspid
aortic valve stenosis: Insights from a national database.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B185), 2017. Date of Publication: October
2017.
Publisher
Elsevier USA
Abstract
BACKGROUND Balloon valvuloplasty (BV) is commonly performed for young
adults with bicuspid aortic valves and aortic stenosis. However there is
paucity of data regarding safety and feasibility of same. METHODS We
analyzed the National Inpatient Sample (NIS) database from 2003 to 2014
and compared clinical characteristics for all patients with a diagnosis of
bicuspid aortic valve who underwent BV with the aim to estimate need for
urgent surgical aortic valve replacement (SAVR) as a safety outcome.
RESULTS A total of 2596 unique patients were analyzed [median age 47 years
(IQR 19); 83.5% Caucasian; 23.3% female]. 3.8% (n=98) patients had
concomitant cardiogenic shock. 1.5% (n=38) patients died during the
hospital stay; 8.2% (n=215) required SAVR during same hospital stay.
Median length of stay (LOS) was 6 (IQR 3) days. Patients requiring SAVR
had longer LOS (9.9 v 5; p < 0.01). On multivariate analysis, increasing
age (median age 57 v 46; p < 0.01; Odds ratio per year increase: 1.04; 95%
confidence intervals: 1.02-1.05) and African American (OR: 5.5; 95%
CI:2.9-10.2) or Hispanic race (OR: 10.3; 95% CI: 4.3-25) increased risk of
needing SAVR whereas the procedure being performed at larger hospitals
(OR: 0.27; 95% CI: 0.13-0.56) and urban teaching hospitals (OR: 0.10; 95%
CI: 0.03-0.35) provided protection from same. Amongst patients who
received BV only, 0.6% (n=14) required blood transfusion, 1.8% (n=44) had
post procedural stroke and 1.6% (n=39) had pericardial tamponade. (Figure
presented) CONCLUSION Risk of requiring urgent SAVR after BV for bicuspid
aortic valve stenosis is not trivial in this large national database. The
risk increases with age, may have a racial determinant and is mitigated by
the procedure being performed at larger teaching hospitals. In the absence
of randomized / registry data, these results will help in better decision
making and patient counselling prior to these procedures.

<6>
Accession Number
619771907
Author
Garcia D.; Ansari M.
Institution
(Garcia) Ochsner Heart and Vascular Institute, New Orleans, LA, United
States
(Ansari) Texas Tech University, Health Sciences Center, Lubbock, TX,
United States
Title
Clinical and procedural outcomes in TAVR for bicuspid versus tricuspid
aortic valve stenosis: A meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B184-B185), 2017. Date of Publication:
October 2017.
Publisher
Elsevier USA
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is considered
safe and feasible among high to intermediate risk tricuspid aortic valve
(TAV) stenosis patients. Bicuspid aortic valve (BAV) stenosis treated with
TAVR is under investigated and there is a paucity of data comparing TAVR
outcomes between TAV and BAV. We aimed to evaluate the global experience
with a meta-analysis of all clinical studies comparing BAV to TAV. METHODS
Pub Med and Cochrane databases were systematically searched for clinical
studies comparing procedural and clinical outcomes of patients with severe
BAV or TAV stenosis who underwent TAVR. Primary outcomes included 30 days
mortality, procedure failure and >= 2 paravalvular leaking. Secondary
outcomes included pacemaker implantation, neurological events, AMI,
bleeding, conversion to open heart surgery, mean aortic gradient
post-TAVR. We used fixed (I2 < 55%) otherwise random effect analysis using
the Cochrane Handbook of Systematic Reviews. RESULTS Four studies were
included in the analysis and provided a total 3067 patients (633=BAV and
2434=TAV). Primary endpoints analysis showed significant less procedural
failure in TAV compared to BAV (3.2% vs. 13%; p<0.01). There was a trend
towards less >= 2 paravalvular leaking in the TAV group compared to BAV
(14% vs. 13%, p<0.05). There was no mortality difference between TAV and
BAV groups (7.7% vs. 4.4%; p=0.5). Secondary endpoint analysis showed
significant more conversion to open heart surgery in the BAV group
compared to TAV (2% vs. 0.4%, p<0.01). There was no difference in
pacemaker implantation, neurological events, AMI and bleeding. (Figure
presented) CONCLUSION Our analysis suggested that TAVR among patient with
BAV stenosis might be clinically safe although it might be associated with
higher procedural challenges given the less favorable procedural outcomes.
Newer TAVR devices and expansion of the population studied (low-risk)
might help to surmount these challenges.

<7>
Accession Number
619771889
Author
Baron S.; Li H.; Magnuson E.; Arnold S.; Meduri C.; Makkar R.; Bajwa T.;
Linke A.; Kereiakes D.; Waksman R.; Thourani V.; Meredith I.; Allocco D.;
Reardon M.J.; Feldman T.; Cohen D.
Institution
(Baron, Li, Magnuson) St. Luke's Mid America Heart Institute, Kansas City,
MO, United States
(Arnold, Cohen) Saint Luke's Mid America Heart Institute, Kansas City, MO,
United States
(Meduri) Piedmont Heart Institute, Atlanta, GA, United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Bajwa) Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Lukes's
Medical Centers, Brookfield, WI, United States
(Linke) University of Leipzig Heart Center, Leipzig, Germany
(Kereiakes) Christ Hospital, Cincinnati, OH, United States
(Waksman) Medstar Washington Hospital Center, Washington, DC, United
States
(Thourani) Emory University Hospital Midtown, Atlanta, GA, United States
(Meredith) Boston Scientific Corporation, Marlboro, MA, United States
(Allocco) Boston Scientific, Maple Grove, MN, United States
(Reardon) Houston Methodist DeBakey Heart and Vascular Center, Houston,
TX, United States
(Feldman) Evanston Hospital, Evanston, IL, United States
Title
Effect of a mechanical-expanding vs. Self-expanding transcatheter valve
prosthesis on health status in patients with severe aortic stenosis at
high surgical risk: Results from the REPRISE III trial.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B266-B267), 2017. Date of Publication:
October 2017.
Publisher
Elsevier USA
Abstract
BACKGROUND The REPRISE III trial compared clinical outcomes in patients
with severe aortic stenosis (AS) at high surgical risk treated with
transcatheter aortic valve replacement (TAVR) using either a
mechanical-expanding valve prosthesis (Lotus Valve [LV]) or a
selfexpanding valve prosthesis (CoreValve [CV]). While rates of disabling
stroke and moderate/severe paravalvular leak (PVL) were lower with LV, CV
was associated with a lower rate of pacemaker implantation and lower
transvalvular gradients. In order to examine the potential impact of these
differences on patient-reported outcomes, we performed a prospective
quality of life (QoL) sub-study of the REPRISE III trial. METHODS Between
9/2014 and 12/2015, 912 patients with severe AS at high surgical risk were
randomized to undergo TAVR using either LV or CV, of whom 895 were
included in the QoL substudy. QoL was assessed at baseline and at 1, 6,
and 12 months after TAVR using the Kansas City Cardiomyopathy
Questionnaire (KCCQ) and the 12-item Short Form Health Survey (SF-12).
RESULTS Over 1 year, TAVR with both LV and CV was associated with
substantial improvements in both disease-specific and generic QoL measures
as compared with baseline (Table). There were no significant differences
in QoL between the treatment groups at any time point. Treatment group
comparisons for pre-specified subgroups as well as exploratory analyses to
examine the association of treatmentspecific complications (e.g. PVL,
pacemaker, stroke) with QoL will be available for presentation in October
of 2017. CONCLUSION Among patients with severe AS at high surgical risk,
QoL improved significantly and to a similar degree with both LV and CV
through 1 year, despite differing rates of specific complications. Longer
term follow-up is needed to assess the durability of QoL improvement with
LV vs. CV in this population.

<8>
Accession Number
619771879
Author
Klomjit S.; Vutthikraivit W.; Thavaraputta S.; Laoveeravat P.;
Suchartlikitwong S.; Tantrachoti P.; Rattanawong P.; Ansari M.
Institution
(Klomjit) Texas Tech Health Sciences Center, Lubbock, TX, United States
(Vutthikraivit, Laoveeravat, Suchartlikitwong, Tantrachoti, Ansari) Texas
Tech University, Health Sciences Center, Lubbock, TX, United States
(Thavaraputta, Rattanawong) University of Hawaii, Honolulu, HI, United
States
Title
Pre-existing atrial fibrillation increases mortality after transcatheter
aortic valve replacement: A meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B164), 2017. Date of Publication: October
2017.
Publisher
Elsevier USA
Abstract
BACKGROUND Atrial fibrillation(AF) has been known to increase
complications after medical procedures. We aim to determine the effect of
pre-existing atrial fibrillation on patients who underwent transcatheter
aortic valve replacement (TAVR). METHODS Databases were searched from
inception through June 2017. The studies compared the risk of TAVR
complications in preexisting AF patients versus non-AF patients. Data from
each study were combined using the random-effects, generic inverse
variance method of DerSimonian and Laird to calculate pooled relative
risks and 95% confidence intervals. RESULTS Nine studies from 2014 to 2017
involving total 4,788 TAVR patients, including 1,435 AF patients, were
included in this meta-analysis. Compared with controls, pre-existing AF
patients had a significantly higher mortality rate in overall analysis
(pooled relative risk=1.15, (1.10- 1.21), I2=84.3%). Nevertheless, There
is no significant difference in other complications including stroke and
bleeding (pooled relative risk= 1.01 (0.95-1.06) and 1.02, (0.97-1.07)
respectively). CONCLUSION Our study demonstrates a statistically
significant increased mortality rate in AF population who underwent TAVR
procedure. There is no significant difference in developing stroke and
bleeding after TAVR in pre-existing AF and non-AF patients. This study
suggests that pre-existing atrial fibrillation might be used as one of the
pre-procedure characteristics to predict the adverse outcomes. (Table
Presented).

<9>
Accession Number
619771867
Author
Mangner N.; Crusius L.; Woitek F.; Haussig S.; Spindler A.; Schlotter F.;
Stachel G.; Leontyev S.; Kiefer P.; Holzhey D.M.; Mohr F.-W.; Schuler G.;
Linke A.
Institution
(Mangner, Woitek, Haussig, Schlotter, Stachel, Leontyev, Linke) University
of Leipzig - Heart Center, Leipzig, Germany
(Crusius, Spindler, Kiefer) University of Leipzig, Heart Center Leipzig,
Leipzig, Germany
(Holzhey, Schuler) Heart Center, Leipzig, Germany
(Mohr) Heart Center Leipzig, Leipzig, Germany
Title
Transfemoral transcatheter aortiv valve implantation under continued vs.
interrupted oral anticoagulation in patients with atrial fibrillation.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B164), 2017. Date of Publication: October
2017.
Publisher
Elsevier USA
Abstract
BACKGROUND The role of continued vs. interrupted oral anticoagulation
(OAC) in patients with atrial fibrillation (AF) undergoing transfemoral
transcatheter aortic valve implantation (TF-AVI) is uncertain. The aim of
this single center registry based investigation was to evaluate the risk
of periprocedural bleeding and thromboembolic complications in patients
undergoing TF-AVI under continued OAC. METHODS Consecutive patients with
AF and on OAC at admission (n=551) treated between 2011 and 2016 were
stratified according to interrupted OAC (iOAC) vs. continued (cOAC) vs.
continued novel oral anticoagulants (NOAC) at the time of TF-AVI. VARC-2
defined bleeding and stroke were the primary end points. 30-day and 1-year
mortality was calculated using Kaplan-Meier statistics. RESULTS Patients
with iOAC (n=299), cOAC (n=117) and NOAC (n=182) had comparable baseline
characteristics including age (80 (76; 83) vs. 80 (77; 83) vs. 80 (77;
84), p=0.229), gender (male: 42.5% vs. 47.9% vs. 48.9%, p=0.33) and
STS-Score (6.9 (4.2; 10.8) vs. 6.7 (4.2; 10.7) vs. 5.9 (3.5; 9.6),
p=0.069). The CHA2DS2-VASc-Score (p=0.791) and HAS-BLED-Score (p=0.185)
were not different between groups. The majority of patients received a
self-expendable valve (73.6% vs. 60.9% vs. 71%, p=0.218). VARC-2 defined
bleeding did not differ between iOAC, cOAC and NOAC (34.8% vs. 38.5% vs.
29.9%, p=0.339) including life threatening bleeding (4.0% vs. 4.8% vs.
3.9%) and major bleeding (14.7% vs. 12.5% vs. 11.7%). VARC-2 defined
stroke did also not differ between groups (3.6% vs. 2.9% vs. 1.9%,
p=0.612) including major stroke (2.9% vs. 1.0% vs. 0.6%) and minor stroke
(0% vs. 1.0% vs. 1.3%). Renal failure occurred more often in iOAC compared
to cOAC and NOAC (16.7% vs. 8.7% vs. 8.4%, p=0.019). 30-day mortality
tended to be lower in NOAC (iOAC: 4.4% vs. iOAC: 2.9% vs. NOAC: 0.6%,
p=0.081). 1-year-mortality was lower in NOAC (cOAC: 20.8% vs. iOAC: 14.3%
vs. NOAC: 11.8%, p=0.021). CONCLUSION TF-AVI under continued OAC seems to
be safe and effective. In particular, continued OAC using NOAC was
associated with a favourable outcome compared to interrupted OAC. An
adequately powered randomized clinical trial is necessary to prove this
hypothesis.

<10>
Accession Number
619771859
Author
Sondergaard L.; Popma J.J.; Reardon M.J.; Engstroem T.; Van Mieghem N.;
Deeb G.M.; Kodali S.; George I.; Williams M.; Yakubov S.; Kappetein A.P.;
Serruys P.
Institution
(Sondergaard) Rigshospitalet University Hospital, Copenhagen, Denmark
(Popma) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Reardon) Houston Methodist DeBakey Heart and Vascular Center, Houston,
TX, United States
(Engstroem) Heart Centre, University of Copenhagen, Copenhagen, Denmark
(Van Mieghem) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Deeb) University of Michigan Hospitals, Ann Arbor, MI, United States
(Kodali) Columbia, Hastings on Hudson, NY, United States
(George) New York Presbyterian Hospital, Columbia University Medical
Center, New York, NY, United States
(Williams) NYU Langone Medical Center, New York, NY, United States
(Yakubov) Riverside Methodist Hospital, Columbus, OH, United States
(Kappetein) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
(Serruys) Imperial College, London, United Kingdom
Title
Clinical outcomes in surtavi based on revascularization stratification.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B17), 2017. Date of Publication: October
2017.
Publisher
Elsevier USA
Abstract
BACKGROUND SURTAVI is a randomized, prospective, multicenter trial
comparing transcatheter aortic valve replacement (TAVR) to surgical aortic
valve replacement (SAVR) in an intermediate-risk population. Randomization
for SURTAVI was stratified by need for coronary revascularization. The
current analysis compares clinical outcomes for patients based on their
need for revascularization. METHODS The need for coronary
revascularization was assessed by the Heart Team during the screening
phase; patients with multivessel disease and a SYNTAX score >22 and/or
unprotected left main disease were excluded. In patients randomized to
TAVR, PCI could be concurrent or staged; coronary artery bypass surgery
was to be done concomitantly with SAVR. RESULTS Of 1,660 subjects with
attempted aortic valve implants, 332 (20%) were allocated to the need for
revascularization group. Patients intended for revascularization had a
higher STS risk score for mortality (4.8%+/-1.7 vs 4.4%+/-1.5 for no
revascularization) and were more likely to be male (65.1% vs 54.2%).
Within the TAVR group 40.7% of PCI procedures were performed concomitantly
and 59.3% were staged procedures. Clinical outcomes at 1 year are
presented per patients' randomization stratification (TABLE). There was no
significant difference between the TAVR and SAVR treatment arms in the
rates of all-cause mortality or disabling stroke for patients who required
revascularization or for those who did not require revascularization.
CONCLUSION Although the rate of all-cause mortality or disabling stroke
was higher for those undergoing revascularization vs. those not undergoing
revascularization, there was no significant difference between the TAVR
and SAVR treatment arms within each group. (Table Presented).

<11>
Accession Number
619771834
Author
Van Mieghem N.; Valgimigli M.; Mehran R.; Boersma E.; Baber U.;
Hengstenberg C.; Shi M.; Vranckx R.
Institution
(Van Mieghem, Boersma) Thoraxcenter, Erasmus Medical Center, Rotterdam,
Netherlands
(Valgimigli) Swiss Cardiovascular Center, Inselpsital, Bern, Switzerland
(Mehran, Baber) Zena and Michael A. Wiener Cardiovascular Institute, Mount
Sinai Hospital, New York, NY, United States
(Hengstenberg) Deutsches Herzzentrum Munchen, Munich, Germany
(Shi) Daiichi Sankyo Pharma Development, Basking Ridge, NJ, United States
(Vranckx) Hartcentrum Hasselt, Hasselt, Belgium
Title
Edoxaban versus standard of care and their effects on clinical outcomes in
patients having undergone transcatheter aortic valve implantation in
atrial fibrillation-rationale and design of the envisage-TAVI AF trial.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B163), 2017. Date of Publication: October
2017.
Publisher
Elsevier USA
Abstract
BACKGROUND Patients with severe aortic stenosis and intermediateto- high
operative risk are often treated with transcatheter aortic valve
implantation (TAVI). Up to 25-40% of TAVI patients have atrial
fibrillation (AF) requiring chronic oral anticoagulation (OAC). In
moderate-to-high risk AF patients, the direct factor Xa inhibitor edoxaban
(EDOX) is noninferior to vitamin K antagonists (VKA) for prevention of
stroke/systemic embolism with less bleeding and cardiovascular deaths.
METHODS ENVISAGE-TAVI AF will compare EDOX with VKA therapy in nonvalvular
AF patients. Co-primary endpoints are net adverse clinical events (NACE;
defined as the composite of all-cause death, myocardial infarction,
ischemic stroke, systemic thromboembolism, valve thrombosis, and major
bleeding) and major bleeding (International Society on Thrombosis and
Haemostasis criteria). RESULTS ENVISAGE-TAVI AF is a multinational,
multicenter, prospective, randomized, open-label, blinded-endpoint
evaluation study in 1400 patients with AF after TAVI. Patients will be
randomized 1:1 to EDOX 60 mg (dose reduced to 30 mg if a patient meets the
dose reduction criteria based on label) or VKA (dosed to attain an
international normalized ratio of 2.0-3.0 [1.6-2.6 in Japanese patients
aged <=70 years]) 12 hours to 5 days after successful TAVI. Antiplatelet
therapy may be administered per physician discretion. Randomization will
be stratified by OAC dose reduction. Treatment duration will be up to 36
months (<=6 months for last patients enrolled) or until a patient reaches
a primary endpoint. The study is powered (80%) to detect noninferiority
for NACE and major bleeding (noninferiority margin: 1.38) followed by
superiority testing for major bleeding and NACE at a significance level of
a = 0.05. Secondary endpoints will include analyses of NACE components.
CONCLUSION ENVISAGE-TAVI AF compares the clinical safety and efficacy of
EDOX vs VKA in nonvalvular AF patients with the indication for OAC after
successful TAVI. At present, this is the only TAVI study that compares
exclusively nonvalvular AF patients receiving a non-VKA OAC vs a VKA-based
therapy.

<12>
Accession Number
619771777
Author
Kapadia S.; Huded C.; Kodali S.; Svensson L.; Tuzcu E.M.; Miller D.C.;
Thourani V.; Herrmann H.; Mack M.; Szerlip M.; Makkar R.; Webb J.; Smith
C.; Rajeswaran J.; Blackstone E.H.; Leon M.
Institution
(Kapadia) Heart and Vascular Institute, Cleveland, OH, United States
(Huded) Cleveland Clinic, Cleveland Heights, OH, United States
(Kodali) New York- Presbyterian Hospital, Columbia University Medical
Center, New York, NY, United States
(Svensson) Cleveland Clinic Foundation, Cleveland, OH, United States
(Tuzcu) Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
(Miller) Stanford University, Stanford, CA, United States
(Thourani) Emory University Hospital Midtown, Atlanta, GA, United States
(Herrmann) University of Pennsylvania, Philadelphia, PA, United States
(Mack, Szerlip) Heart Hospital Baylor Plano, Plano, TX, United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Webb) Centre for Heart Valve Innovation, St. Paul's and Vancouver General
Hospital, Vancouver, BC, Canada
(Smith) NewYork- Presbyterian Hospital, Columbia University Medical
Center, New York, NY, United States
(Rajeswaran, Blackstone) Cleveland Clinic, Cleveland, OH, United States
(Leon) Columbia University Medical Center, NewYork-Presbyterian Hospital,
New York, NY, United States
Title
Neurologic events in patients treated with surgical versus transfemoral
transcatheter aortic valve replacement: Insights from the partner
(Placement of aortic transcatheter valves) trial.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B143), 2017. Date of Publication: October
2017.
Publisher
Elsevier USA
Abstract
BACKGROUND The relative risk of adverse neurologic events after surgical
aortic valve replacement (SAVR) vs. transfemoral transcatheter aortic
valve replacement (TF-TAVR) remains understudied. METHODS Of a total of
5637 patients treated with SAVR or TF-TAVR from April 2007 to October 2014
in the PARTNER 1 (1802, 32%), PARTNER 2 (2403, 43%) and PARTNER 2 S3
(1432, 25%) trials and registries, we conducted a 1:1 propensity-matched
analysis of 1204 pairs of SAVR and TF-TAVR patients. Stroke, transient
ischemic attack (TIA), any neurologic event (stroke or TIA), and death
were the study endpoints. RESULTS Among 1204 propensity-matched pairs,
comparing TFTAVR vs. SAVR, the rate of in-hospital stroke (3.3% vs. 4.6%,
p=0.12) was similar while in-hospital major stroke (1.9% vs. 3.5%,
p=0.02), inhospital death (1.8% vs. 4.3%, p=0.0004), and death <30 days
(3.1% vs. 4.8%, p=0.03) were lower in the TF-TAVR group. With timevarying
analysis, risk of early phase (0-7 days) stroke or any neurologic event in
SAVR and TF-TAVR was similar, with highest risk in the first 72 hours.
Additionally, both SAVR and TF-TAVR groups demonstrated a constant and
similar low risk of stroke, TIA, or any neurologic event in the late phase
(7 days-48 months post-procedure) (Figure). CONCLUSION The risk of
neurologic events after SAVR and TF-TAVR was similar in both the early and
late phases, with the highest period of risk within 72 hours
post-procedure for both groups. (Figure Presented).

<13>
Accession Number
619771762
Author
Mohananey D.; Sengodan P.; Reddy Anumandla A.; Banerjee K.;
Sankaramangalam K.; Krishnaswamy A.; Mick S.; White J.; Svensson L.;
Kapadia S.
Institution
(Mohananey, Sengodan, Reddy Anumandla, Banerjee, Sankaramangalam)
Cleveland Clinic, Cleveland, OH, United States
(Krishnaswamy, Mick, Svensson, Kapadia) Heart and Vascular Institute,
Cleveland, OH, United States
(White) ClevelandOHUnited States
Title
Comparative analysis of cerebrovascular events in transcatheter and
surgical aortic valve replacement-systematic review and meta-analysis of
randomized trials.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B142-B143), 2017. Date of Publication:
October 2017.
Publisher
Elsevier USA
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has become the
procedure of choice for inoperable patients and a safe alternative to
surgical aortic valve replacement (SAVR) among moderate risk patients.
Although clinical outcomes continue to improve, stroke and transient
ischemic attack (TIA) are recognized complications of TAVR that remain of
great concern. METHODS We aimed to use meta-analysis techniques to compare
the incidence of cerebrovascular events at 30 days, 1 year and between 30
days to 1 year amongst patients undergoing TAVR and SAVR in randomized
controlled trials (RCT). We also systematically review the reporting of
cerebrovascular end points and risk factors for cerebrovascular events
among the individual RCTs. Data were summarized as Mantel-Haenszel
relative risk (RR) and 95% confidence intervals (CI). Weused the Higgins'
I2 statistic to evaluate heterogeneity. Data were summarized as
Mantel-Haenszel relative risk (RR) and 95% confidence intervals (CI).
Weused the Higgins' I2 statistic to evaluate heterogeneity. RESULTS The
risk of major stroke [RR 0.89 (95% CI 0.53-1.51)], all strokes [RR
0.85(95% 0.59-1.22)] and all cerebrovascular events [RR 0.94 (95% CI
0.75-1.17) was comparable between patients undergoing TAVR and SAVR at 30
days of follow up. The risk of all all strokes [RR 0.92(95% CI
0.69-1.22)], major stroke [RR 0.92(95% CI 0.62-1.37)] and all
cerebrovascular events [RR 1.03(95% CI 0.79-1.33)] were comparable between
TAVR and SAVR at 1 year of follow up. The incidence of major stroke [RR
1.02 (95% CI 0.64-1.61), all strokes [RR 1.12 (95% CI 0.78-1.62)] and all
cerebrovascular events [RR 1.23 (95% CI 0.91-1.66)] was comparable between
TAVR and SAVR between 30 days and 1 year of follow-up. CONCLUSION In our
meta-analysis of RCTs comparing TAVR and SAVR, we show that the risk of
major stroke, all stroke and all cerebrovascular events is comparable
between the two groups. (Table Presented).

<14>
Accession Number
619771741
Author
Popma J.J.; Van Mieghem N.; Reardon M.J.; Kappetein A.P.; Yakubov S.; Deeb
G.M.; Chetcuti S.; Mumtaz M.; Gada H.; Merhi W.; Heiser J.; Serruys P.
Institution
(Popma) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Van Mieghem) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Reardon) Houston Methodist DeBakey Heart and Vascular Center, Houston,
TX, United States
(Kappetein) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
(Yakubov) Riverside Methodist Hospital, Columbus, OH, United States
(Deeb) University of Michigan Hospitals, Ann Arbor, MI, United States
(Chetcuti) University of Michigan Health Center, Ann Arbor, MI, United
States
(Mumtaz) PinnacleHealth, Harrisburg, PA, United States
(Gada) PinnacleHealth CardioVascular Institute, Wormleysburg, PA, United
States
(Merhi) West Michigan Cardiology, Grand Rapids, MI, United States
(Heiser) West Michigan Cardiothoracic Surgeons (WMCTS), Grand Rapids, MI,
United States
(Serruys) Imperial College, London, United Kingdom
Title
Functional status after transcatheter and surgical aortic valve
replacement: A two-year analysis from the surtavi trial.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B142), 2017. Date of Publication: October
2017.
Publisher
Elsevier USA
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is an alternative
to surgery (SAVR) in patients deemed intermediate risk for surgery based
on noninferior outcomes of all-cause mortality or disabling stroke. While
more rapid recovery was observed in TAVR patients, delineation of precise
health outcomes through 1 year has not been reported. METHODS We compared
the 1-year health status of 1,660 patients with symptomatic severe aortic
stenosis deemed intermediate risk for surgery who were randomized to
self-expanding TAVR or surgery. Health metrics including New York Heart
Association (NYHA), 6- minute walk test (6MW), Kansas City Cardiomyopathy
Questionnaire (KCCQ), Short Form-36 (SF-36) Physical and Mental Scores,
and the EuroQol 5 dimensions questionnaire (ED-5D) were obtained at
baseline (BL) and at intervals through 1 year. Measurements at follow-up
were compared to BL. RESULTS Health outcomes through 1 year were available
in 864 patients treated with TAVR and in 796 patients treated with SAVR
(Table). Follow-up for the KCCQ was available in 92.5% of eligible
patients at 30 days and 71.0% at 1 year. The SF-36 physical component was
superior for TAVR at 3 months (7+/-11 vs 6+/-11; p<0.05). CONCLUSION
Weconclude that in intermediate surgical risk severe aortic stenosis
patients: (1) health outcomes are improved at 30 days, (2) incremental
physical improvements are better at 3 months, and (3) 6-minute walk tests
were longer to 1 year in patients treated with TAVR as compared with
surgery. Thereafter, health outcomes were similar in both groups and were
sustained 1 year after aortic valve replacement (Table Presented).

<15>
Accession Number
619771737
Author
Khan M.; Ahmed W.; Manan M.; Hamzeh I.; Virani S.; Lakkis N.; Alam M.
Institution
(Khan) McLaren Regional Medical Center, Flint, MI, United States
(Ahmed) Nishtar Medical College, Multan, Pakistan
(Manan) King Edward Medical University, Lahore, Pakistan
(Hamzeh, Lakkis, Alam) Baylor College of Medicine, Houston, TX, United
States
(Virani) Baylor College of Medicine, Michael E DeBakey, Houston, TX,
United States
Title
Comparison of percutaneous coronary intervention and coronary artery
bypass grafting for unprotected left main coronary artery disease in
patients with diabetes: A meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B78), 2017. Date of Publication: October
2017.
Publisher
Elsevier USA
Abstract
BACKGROUND Improved Percutaneous Coronary Intervention (PCI) techniques
for Unprotected Left Main (ULM) disease have led to comparable outcomes to
Coronary Artery Bypass Grafting (CABG). Data pertaining specifically to
the optimal revascularization strategy for ULM lesions in diabetics is
scarce. METHODS A comprehensive literature search to June 2017 identified
7 studies (1 Randomized, 6 Observational) with 4193 patients (PCI=2215,
CABG=1978). We performed aggregate data meta-analyses of clinical outcomes
(all-cause mortality, cardiac mortality, repeat revascularization and
MACCE) comparing PCI and CABG in patients with diabetes and ULM disease.
Odds Ratios (OR) and 95% confidence intervals (CI) were estimated using
random-effects model. RESULTS In our analysis, for a median follow-up of
>=36 months, the composite outcome of death, MI or stroke was lower in
diabetic patients with ULM disease undergoing PCI compared to CABG (OR
0.75; 95% CI 0.59-0.96). There was no statistical difference in all-cause
mortality (OR 0.86; 95% CI 0.64- 1.15). PCI had lower rates of stroke but
higher rates of repeat revascularization and MACCE (OR 1.60; 95 % CI 1.34-
1.92) compared to CABG (Table 1. Outcomes of Percutaneous Coronary
Intervention and Coronary Artery Bypass Grafting in Unprotected Left Main
Disease in Diabetics). CONCLUSION In our analysis, for diabetic patients
with ULM disease, PCI and CABG had equivalent mortality, with lower
composite hard outcomes of Death, MI and Stroke, mostly driven by
decreased stroke rates with PCI. This study is consistent with other
similar studies showing the increased incidence of repeat
revascularization with PCI compared to CABG, tilting MACCE in favor of
CABG.

<16>
Accession Number
619771720
Author
Serruys P.; Abdelghani M.; Popma J.J.; Reardon M.J.; Kleiman N.;
Crestanello J.; Lillly S.; Van Boven A.; Willem Boonstra P.; Piazza N.;
Van Mieghem N.; Kappetein A.P.
Institution
(Serruys) Imperial College, London, United Kingdom
(Abdelghani) Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
(Popma) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Reardon, Kleiman) Houston Methodist DeBakey Heart and Vascular Center,
Houston, TX, United States
(Crestanello, Lillly) Ohio State University, Columbus, OH, United States
(Van Boven) Medisch Centrum Leeuwarden, Leeuwarden, Netherlands
(Willem Boonstra) Medisch Centrum Leeuwarden, Heart Center, Leeuwarden,
Netherlands
(Piazza) McGill University Health Center, Montreal, QC, Canada
(Van Mieghem) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Kappetein) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
Title
Clinical outcomes of surgical or transcatheter aortic-valve replacement in
intermediate-risk patients stratified by sts score: Results from the
surtavi trial.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B141-B142), 2017. Date of Publication:
October 2017.
Publisher
Elsevier USA
Abstract
BACKGROUND The Surgical Replacement and Transcatheter Aortic Valve
Implantation (SURTAVI) trial randomized patients with severe, symptomatic
aortic stenosis deemed intermediate-risk for surgical mortality by heart
team assessment. The mean STS predicted risk of mortality (PROM) score of
the patients was 4.5+/-1.6%; however, measures of frailty, disability, and
other comorbidities considered by the heart teams are not included in the
STS score. METHODS There were 1660 randomized patients in the modified
intent-to-treat analysis cohort. Patients were stratified into 3 groups
based on their STS PROM: <3%, 3-<5%, and >=5%. Clinical outcomes through 1
year were assessed for TAVR and SAVR patients based on their STS
stratification. RESULTS Baseline characteristics for each subgroup are
shown in the Table. The mean STS score for the entire TAVR cohort (N=864)
was 4.4+/-1.5% and was similar (4.5+/-1.6%) for the SAVR cohort (N=796).
The Kaplan-Meier estimates of 1-year all-cause mortality were
significantly different across the 3 STS subgroups after TAVR (1.6%
STS<3%, 5.7% STS 3-<5%, 11.4% STS>=5%; log rank p=0.0008) but were similar
for the 3 subgroups after SAVR (5.4% STS<3%, 5.7% STS 3-<5%, 9.2%, STS>=5;
log rank p=0.1621). CONCLUSION Factors other than STS score considered for
patient eligibility by heart teams seem to impact the clinical outcomes
differently after TAVR than after SAVR. Further analysis of this
observation in early and late outcomes is under way for presentation in
October. (Table Presented).

<17>
Accession Number
619771712
Author
Durko A.; Osnabrugge R.L.J.; Van Mieghem N.; Milojevic M.; Mylotte D.;
Kappetein A.P.
Institution
(Durko) Erasmus Medical Center, Rotterdam, Netherlands
(Osnabrugge) Erasmus University Medical Center, Rotterdam, Netherlands
(Van Mieghem) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Milojevic) Department of Cardiothoracic Surgery, Erasmus Medical Center,
Rotterdam, Netherlands
(Mylotte) Galway University Hospital, Galway, Ireland
(Kappetein) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
Title
Annual number of candidates for transcatheter aortic valve replacement per
country.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B261-B262), 2017. Date of Publication:
October 2017.
Publisher
Elsevier USA
Abstract
BACKGROUND The number of transcatheter aortic valve replacement (TAVR)
procedures is rapidly increasing. This has a major impact on healthcare
resource planning. However, the annual numbers of TAVR candidates per
country are unknown. The objective of this study is to provide an
up-to-date estimate of the potential number of annual TAVR candidates in
27 European countries, the United States and Canada. METHODS Systematic
literature searches and meta-analyses were performed on AS epidemiology
and decision-making in severe symptomatic AS. The incidence rate of severe
AS was determined. Findings were integrated into a model employing Monte
Carlo simulations to predict the annual number of TAVR candidates. Various
future scenarios and sensitivity analyses were explored. RESULTS Data from
37 studies (n=26,402) informed the model. The calculated incidence rate of
severe AS was 4.4&/year (95% confidence interval [CI]: 3.0& - 6.1) in
patients >=65 years. AS-related symptoms were present in 68.3% (95% CI:
60.8% to 75.9%) of patients with severe AS. Despite having severe
symptomatic AS, 41.6% (95% CI: 36.9% to 46.3%) did not undergo surgical
aortic valve replacement. Of the non-operated patients, 61.7% (95% CI:
42.0% to 81.7%) received TAVR. The model predicted 58,556 (95% CI: 35,631
to 87,738) Northern-American and 114,757 (95% CI: 69,380 to 172,799)
European TAVR candidates annually. CONCLUSION Approximately 180,000
patients can be considered potential TAVR candidates in Northern-America
and in the European Union annually. These numbers increase dramatically if
indications for TAVR will expand to low-risk patients.

<18>
Accession Number
619771679
Author
Nalluri N.; Saouma S.; Gaddam S.; Karam B.; Asti D.; Patel N.; Edla S.;
Kanotra R.; Barsoum E.; Kumar V.; Anugula D.; Chidharla A.; Abbasi S.;
Tamburrino F.; Imam M.; Maniatis G.; Kandov R.; Lafferty J.; Kliger C.;
Cohen M.
Institution
(Nalluri, Saouma, Barsoum, Kandov, Lafferty) Staten Island University
Hospital, New York, NY, United States
(Gaddam) Robertwood Johnson Hospital, Rutgers University, New Brunswick,
NJ, United States
(Karam) Staten Island University Hospital, Staten Island, NY, United
States
(Asti) Lenox Hill Hospital, New York, NY, United States
(Patel) University of Miami, Miami, FL, United States
(Edla) ST John Hospital And Medical Center, Saint Clair Shores, MI, United
States
(Kanotra) Banner Baywood Medical Center, Pheonix, AZ, United States
(Kumar) Mt. Sinai St. Luke's Roosevelt Hospital Center, New York, NY,
United States
(Anugula) CHI Health Creighton University Medical Center, Omaha, NE,
United States
(Chidharla) Univeristy of Medical Center, Kansas, KS, United States
(Abbasi) Staten Island university Hospital, New York, NY, United States
(Tamburrino) Staten Island University Hospital, Staten ISland, NY, United
States
(Imam) Stat, New York, NY, United States
(Maniatis) Rutgers University, Robert Wood Johnson Medical School, Staten
Island, NY, United States
(Kliger) Hofstra School of Medicine, New York, NY, United States
(Cohen) University of Miami Hospital, Miami, FL, United States
Title
Valve in valve trans-catheter aortic valve implantation versus redo
surgical aortic valve replacement in patients with failing aortic
bioprostehsis: A meta analysis.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B141), 2017. Date of Publication: October
2017.
Publisher
Elsevier USA
Abstract
BACKGROUND The incidence of patients presenting with failed bioprosthetic
valves is rising consistently. The treatment of these highrisk patients
poses a great challenge. Re-operation is considered the standard of care;
however, it carries a considerable risk. Trans-catheter aortic
valve-in-valve implantation (ViV-TAVI) represents a less invasive
alternative in these high-risk patients. METHODS PubMed, Embase and Google
Scholar databases were searched for studies comparing ViV-TAVI versus
redo-SAVR in patients with failing bioprosthetic aortic valve. Primary end
points include 30-day and 1-year mortality. Procedural complications such
as stroke, major bleed, permanent pacemaker implantation, paravalvular
leak and acute kidney injury were also compared. RESULTS A total of 284
patients were included from 3 observational studies, out of which 148
patients underwent ViV-TAVI and 136 patients underwent a redo-SAVR. Pooled
analysis showed no significant difference in 30- day mortality (OR=
1.32;P=0.64), 1- year mortality (OR=1.68; P =0.26), and also in the
incidence of stroke, major bleed or paravalvular leak between both the
groups. Interestingly, there was a significantly lower number of permanent
pacemaker implantations (OR=0.29; P= 0.001) and incidence of AKI (OR=
0.28; P=0.01) in ViV-TAVI group. CONCLUSION Preliminary short and mid
term-pooled data from observational studies suggest that ViV-TAVI is a
feasible and safe alternative to redo-SAVR in high-risk patients with
failing aortic bioprosthesis. However, Large comparative studies are
scarce and the need for an RCT is essential. (Figure Presented).

<19>
Accession Number
619771673
Author
Mack M.; Abraham W.; Lindenfeld J.A.; Weissman N.; Marx S.; Ellis J.;
Crosson L.A.; Shu Y.; Nie H.; Stone G.
Institution
(Mack) Heart Hospital Baylor Plano, Plano, TX, United States
(Abraham) Ohio State University, Columbus, OH, United States
(Lindenfeld) Vanderbilt University Medical Center, Nashville, TN, United
States
(Weissman) MedStar Health Research Institute, Washington, DC, United
States
(Marx) Columbia University Medical Center, New York, NY, United States
(Ellis, Crosson, Nie) Abbott Vascular, Santa Clara, CA, United States
(Shu) Abbott, Santa Clara, CA, United States
(Stone) Cardiovascular Research Foundation, Columbia University Medical
Center, NewYork-Presbyterian Hospital, New York, NY, United States
Title
Cardiovascular outcomes assessment of MitraClip therapy in heart failure
patients with functional mitral regurgitation (the COAPT trial): Baseline
characteristics and preliminary 2-year outcomes of the roll-in cohort.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B60-B61), 2017. Date of Publication:
October 2017.
Publisher
Elsevier USA
Abstract
BACKGROUND Pts with functional mitral regurgitation (FMR) and heart
failure (HF) have a poor prognosis. The COAPT Trial was designed to
determine whether transcatheter mitral valve (MV) repair with the
MitraClip (Abbott Vascular, Santa Clara, CA) is safe and effective for
reducing recurrent HF hospitalizations in pts with severe FMR. Herein we
describe the demographics and preliminary 2-year outcomes from the COAPT
roll-in cohort, performed at sites with limited or no recent MitraClip
experience. METHODS Subjects enrolled in COAPT have >=3+ FMR, are
symptomatic despite maximally tolerated guideline-directed medical
therapy, and have LVESD <=70 mm and LVEF >=20% - <=50%. A Central
Eligibility Committee confirms that each subject has been optimally
medically treated and will not undergo MV surgery. Endpoints include NYHA
Class, Six Minute Walk Distance (6MWD) and echo measures analyzed by an
independent core lab. RESULTS 51 roll-in subjects (mean age 75 yrs, 63%
male) were enrolled at 34 centers. Baseline co-morbidities included CAD
(82%), renal disease (63%), prior CABG (53%) and COPD (43%). Mean STS
score was 11+/-7% and 71% were NYHA class III/IV. Baseline 3+/4+ FMR was
present by core lab analysis in 55%/45% of patients (65% due to ischemic
cardiomyopathy (CM), 35% idiopathic CM). LVEF was 37+/-11% and mean 6MWD
was 235+/-121m. The Clip implant rate was 94% (mean 1.3 Clips), 30-day
complications were infrequent, and 30- day mortality was zero. Adverse
events and functional measures were assessed through 2 years (Table).
CONCLUSION In the COAPT roll-in experience, among high-risk symptomatic HF
pts with severe FMR, the MitraClip safely reduced MR and improved symptoms
and quality of life through 2 years. Results from the randomized COAPT
trial will determine whether reducing FMR in optimally treated pts with HF
improves prognosis.

<20>
Accession Number
619771594
Author
Giustino G.; Sabik J.; Redfors B.; Milojevic M.; Serruys P.; Kandzari D.;
Morice M.-C.; Gershlick A.; Genereux P.; Dressler O.; Zhang Z.; Mehran R.;
Kappetein A.P.; Stone G.
Institution
(Giustino) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Sabik) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic Foundation, Cleveland, OH, United States
(Redfors, Dressler, Zhang) Cardiovascular Research Foundation, New York,
NY, United States
(Milojevic) Department of Cardiothoracic Surgery, Erasmus Medical Center,
Rotterdam, Netherlands
(Serruys) Imperial College, London, United Kingdom
(Kandzari) Piedmont Heart Institute, Atlanta, GA, United States
(Morice) CERC, Massy, France
(Gershlick) University of Leicester, Leicester, United Kingdom
(Genereux) Columbia, New York, NY, United States
(Mehran) Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai
Hospital, New York, NY, United States
(Kappetein) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
(Stone) Cardiovascular Research Foundation, Columbia University Medical
Center, NewYork-Presbyterian Hospital, New York, United States
Title
Everolimus-eluting stents versus coronary artery bypass graft surgery for
left main coronary artery disease in patients with and without chronic
kidney disease.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B76), 2017. Date of Publication: October
2017.
Publisher
Elsevier USA
Abstract
BACKGROUND The optimal revascularization strategy for pts with left main
coronary artery disease (LMCAD) and chronic kidney disease (CKD) remains
unclear. METHODS We investigated the outcomes of PCI with
everolimuseluting stents vs CABG in pts with LMCAD disease and low or
intermediate SYNTAX scores according to baseline CKD from the multicenter
randomized EXCEL trial. CKD was defined as an estimated creatinine
clearance (CrCl) < 60 mL/min. The primary endpoint was the composite of
death, MI, or stroke at 3 years. Event rates were estimated with the
Kaplan-Meier method, and hazard ratios (HR) for PCI vs CABG were generated
using Cox regression models. RESULTS Of 1869 randomized pts with baseline
CrCl data, 308 (16.5%) had CKD. Continuously worse baseline renal function
was associated with an increasing risk of death, stroke, or MI at 3-year
follow-up (Figure). Compared with CABG, PCI was associated with lower
rates of in-hospital major adverse events in both CKD and no-CKD patients.
At 3 years, there were no significant differences in the rates of death,
stroke, or MI between PCI and CABG in pts with CKD (24.3% vs 19.2%;
absolute risk difference [ARD] 5.1%; HR 1.23; 95%CI 0.75-2.04) or without
CKD (13.4% vs 13.7%; ARD -0.3%; HR 0.94; 95%CI 0.71-1.23)
(Pinteraction=0.34). CONCLUSION In the EXCEL trial, worse baseline renal
function was associated with an increased risk of adverse events in pts
with LMCAD undergoing PCI or CABG. The effect of PCI vs CABG on the 3-year
rates of death, stroke, or MI was consistent in pts with and without CKD.

<21>
Accession Number
619771446
Author
Abizaid A.; Didier C.; Frey N.; Lutz M.; Weber-Albers J.; Dudek D.;
Chevalier B.; Lansky A.; Anderson J.
Institution
(Abizaid) Instituto Dante Pazzanese De Cardiologia, Sao Paulo, Brazil
(Didier) CHU Rangueil, Toulouse, France
(Frey) Department of Internal Medicine III,Cardiology and Angiology,
University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
(Lutz) Department of Cardiology and Angiology, Universitatsklinikum
Schleswig-Holstein, Campus Kiel, Kiel, Germany
(Weber-Albers) St.- Johannes-Hospital, Dortmund, Germany
(Dudek) Szpital Uniwersytecki w Krakowie, Krakow, Poland
(Chevalier) Institut Hospitalier J. Cartier, Massy, France
(Lansky) Yale School of Medicine, New Haven, CT, United States
(Anderson) REVA Medical, San Diego, CA, United States
Title
Fantom II trial: Safety & performance study of the fantom
sirolimus-eluting bioresorbable coronary scaffold-first report on initial
24 month outcomes.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B136), 2017. Date of Publication: October
2017.
Publisher
Elsevier USA
Abstract
BACKGROUND Bioresorbable vascular scaffolds ( BRS ) have been developed to
provide temporary mechanical support for the healing artery subsequent to
PCI . The Fantom scaffold (REVA Medical) is a sirolimus-eluting BRS, which
is made from a unique radiopaque polymer. It includes incorporation of
covalently bound iodine into the polymer backbone, which allows the device
to be directly visualized using conventional angiography as with metal
stents. METHODS The FANTOM II Study is a prospective, multi-center, safety
and performance evaluation. The study included patients with single de
novo lesions in native coronary vessels ranging in diameter from 2.5 to
3.5 mm and lesion lengths up to 20 mm. The primary objective of the study
was to demonstrate the safety and performance of native coronary artery
stenting by assessing the incidence of Major Adverse Cardiac Events (MACE)
and Late Lumen Loss at 6 months. In addition to the primary objective, the
FANTOM II Trial included two groups of long term imaging sub-study
patients. In the Cohort A study group up to 25 patients who received
imaging at baseline and 6 months' post implant were scheduled to return
for an additional imaging assessment at 24 months and in the Cohort B
study group up to 25 patients were scheduled to return for an additional
imaging assessment at 48 months. RESULTS The FANTOM II Study enrolled a
total of 240 patients across 28 clinical centers. The Cohort A group
included a total of 117 patients and the Cohort B group included 123
patients. All patients enrolled in the study have completed the required
follow-up through the 12-month clinical endpoint and many of the patients
are now beyond the 24-month clinical follow-up endpoint. The primary
safety endpoint of MACE at 6 months was 2.1%. The secondary safety
endpoint of MACE at 12 months was 4.2%. The preliminary results from both
the clinical follow-up at 24 months and the imaging substudy of up to 25
patients which included both angiographic and OCT assessments will be
presented at the conference. CONCLUSION The results continue to be
encouraging and confirm the initial safety and performance outcomes of the
Fantom scaffold. Patient follow-up is ongoing through 5 years.

<22>
Accession Number
619771417
Author
Linke A.; Kapadia S.; Kodali S.; Makkar R.; Alu M.; Willert P.; Dwyer M.;
Zivadinov R.; Thackeray L.; White R.; Parhizgar A.; Engels T.; Mehran R.;
Haussig S.; Woitek F.; Mangner N.; Leon M.; Van Mieghem N.
Institution
(Linke) University of Leipzig Heart Center, Leipzig, Germany
(Kapadia) Heart and Vascular Institute, Cleveland, OH, United States
(Kodali) New York- Presbyterian Hospital, Columbia University Medical
Center, New York, NY, United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Alu) Columbia University Medical Center, Chicago, IL, United States
(Willert, Parhizgar, Engels) Claret Medical, Santa Rosa, CA, United States
(Dwyer, Zivadinov) Buffalo Neuroimaging Analysis Center, University at
Buffalo, Buffalo, NY, United States
(Thackeray) NAMSA, Minneapolis, MN, United States
(White) DCRI, Durham, NC, United States
(Mehran) Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai
Hospital, New York, NY, United States
(Haussig, Woitek, Mangner) University of Leipzig - Heart Center, Leipzig,
Germany
(Leon) Columbia University Medical Center, NewYork-Presbyterian Hospital,
New York, NY, United States
(Van Mieghem) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
Title
Impact of cerebral protection in aortic stenosis patients treated with
transcatheter aortic valve replacement on functional and structural
integrity of the brain: Results of a combined patient-level analysis of
three randomized controlled trials.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B174-B175), 2017. Date of Publication:
October 2017.
Publisher
Elsevier USA
Abstract
BACKGROUND Cerebral embolization remains a major concern after
transcatheter aortic valve replacement (TAVR). This patient-level
meta-analysis pools data from three randomized, controlled trials
(CLEAN-TAVI, MISTRAL-C and SENTINEL) to evaluate the impact of the dual
filter cerebral embolic protection (CEP) system (MontageTM or Sentinel,
Claret Medical) on the occurrence of TAVR-related new brain lesions.
METHODS Patients (pts) of CLEAN-TAVI and MISTRAL-C (n=165) were randomized
1:1 to TAVR with or without CEP. The SENTINEL study randomized 363pts with
121 in the test imaging and 119 in the control imaging arm. Pts underwent
brain imaging by MRI at baseline and at 2-7days after TAVR. A single stage
approach was employed for the meta-analysis that resulted in total of
available imaging for 320pts (Treatment group n=162; Control group n=158).
The primary outcome measure was the volume of new DW-MRI positive brain
lesions at 2- 7days relative to baseline in the protected areas. RESULTS
Combining the three trials, evidence of preexisting brain damage was
observed in 316pts. No difference in median [interquartile change] volume
in pre-existing brain damage was observed between the Treatment and
Control group, 6559.8[2056.6;18704.4] vs 6259.8[3012.5;15573.6]mm3,
respectively. Total median [IQR] new lesion volume in protected areas was
118.4[36.9;345.5] for the Treatment, and 214.9[50.6;551.0]mm3 for the
Control group, resulting in a 38% reduction (p=0.02) in mean new lesion
volume in favor of CEP in the mixed effects model using transformed data.
In the protected areas, total median new lesion volume was greater for
subjects treated with a self-expandable (SE) vs balloon-expandable (BE)
valves in both the Treatment and Control groups, and as expected,
protected area total median new lesion volume was higher in the Control
group than the Treatment group for both BE (152.9 [31.6;319.0] vs
71.2[31.6;274.2]), and SE (359.3[172.9;930.3] and 173.5 [58.4;414.0])
valves. CONCLUSION This patient-level pooled analysis demonstrated that
the use of CEP resulted in significant reduction (p=0.02) in total new
lesion volume in protected territories post TAVR independent of valve type
selection and pre-existing lesion burden.

<23>
Accession Number
619771393
Author
Edwards K.; Hossepian D.; Johnson A.; Dao C.; Shah S.; Fearon W.
Institution
(Edwards, Shah) Stanford University, Stanford, CA, United States
(Hossepian, Johnson) Palo Alto University, Palo Alto, CA, United States
(Dao) Washington Township Medical Foundation, Fremont, CA, United States
(Fearon) Division of Cardiovascular Medicine, Stanford University, School
of Medicine, Stanford, CA, United States
Title
Brief cognitive behavioral therapy for patients undergoing TAVR: A
randomized controlled trial.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B174), 2017. Date of Publication: October
2017.
Publisher
Elsevier USA
Abstract
BACKGROUND Depression occurs in 15-40% of cardiac surgery patients and has
been associated with cardiac morbidity, re-hospitalization, decreased
functional status, and lower quality of life (QOL). Cognitive behavioral
therapy (CBT) is an effective, evidence-based treatment for depression and
anxiety. Preliminary studies have shown transcatheter aortic valve
replacement (TAVR) to benefit physical function and QOL, with modest gains
in mental health compared to standard therapy. However, to date no
published trials have looked at the impact of treating depression or
anxiety in these patients. METHODS Of 129 patients consented for mental
health screening prior to TAVR, 44 (34%) endorsed clinically significant
anxiety or depression at baseline. Patients were randomized to brief
bedside CBT delivered during their hospital stay (n=25) or treatment as
usual control (n=19). Self-report measures for depression (Beck Depression
Inventory-II) and QOL (Minnesota Living with Heart Failure Questionnaire)
were administered again at discharge and 1-month follow up. RESULTS
Despite randomization, baseline depression scores were not equivalent
between groups (F=4.45, p<0.05) and standard ANOVA comparisons were
non-significant. However, mean change on the BDIII from baseline to
1-month follow up was clinically significant for the CBT group
(DELTA=-6.78) but not the control group (DELTA=-4.75) and change scores
from baseline to 1-month follow up were greater for the CBT group
(DELTA=-2.85) than the control group (DELTA=-0.54; t=-1.54, p=0.05). Mean
change in QOL as measured by the MLHFQ was moderately-tomarkedly improved
in the CBT group (DELTA=19.21) vs. mildly improved in the control group
(DELTA=13.54). CONCLUSION Previous studies have established that brief CBT
targeting post-operative depression and anxiety are feasibly and
acceptable for patients undergoing CABG surgery. This is the first study
to examine a similar intervention for TAVR patients, and data suggest that
brief CBT is a promising intervention for improving mood and QOL post
discharge. Additional findings will be presented regarding health care
utilization and predictors of post-operative depression and anxiety.

<24>
Accession Number
619771360
Author
Elias J.; Van Dongen I.M.; Laanmets P.; Eriksen E.; Meuwissen M.; Bax M.;
Ioanes D.; Suttorp M.; Strauss B.; Barbato E.; Marques K.; Claessen
B.E.P.M.; Hirsch A.; Van Der Schaaf R.; Tijssen J.; Hoebers L.P.;
Henriques J.P.S.
Institution
(Elias) Academic Medical Centre (AMC), University of Amsterdam, Amsterdam,
Netherlands
(Van Dongen, Claessen, Hoebers, Henriques) Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
(Laanmets) North-Estonia Medical Centre, Tallinn, Estonia
(Eriksen) Helse-Bergen HF, Bergen, Norway
(Meuwissen) Breda Amphia Ziekenhuis, Breda, Netherlands
(Bax) Haga Teaching Hospital, Den Haag, Netherlands
(Ioanes) Sahlgrenska Sweden, Gothenburg, Sweden
(Suttorp) Department of Cardiology, St. Antonius Ziekenhuis, Nieuwegein,
Netherlands
(Strauss) Sunnybrook Health Sciences Center, Toronto, ON, Canada
(Barbato) Cardiovascular Research Center Aalst, OLV Hospital, Aalst,
Belgium
(Marques) VU University Medical Center, Amsterdam, Netherlands
(Hirsch) ErasmusMC, Rotterdam, Netherlands
(Van Der Schaaf) OLVG, Amsterdam, Netherlands
(Tijssen) AMC, Naarden, Netherlands
Title
MID-and long-term outcome of the explore trial, a global, randomized,
prospective, multicenter trial investigating the impact of recanalization
of a chronic total occlusion in patients after primary percutaneous
coronary intervention for acute ST-elevation myocardial infarction.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B8-B9), 2017. Date of Publication:
October 2017.
Publisher
Elsevier USA
Abstract
BACKGROUND In ST-elevation myocardial infarction (STEMI) patients
presenting for primary percutaneous coronary intervention (PCI) with a
concurrent chronic total occlusion (CTO), long-term effects of CTO PCI
versus no-CTO PCI are currently still unknown. METHODS In the EXPLORE
trial, STEMI patients with a concurrent CTO were included and randomly
assigned. For this study, at 1, 2, 3, 4 and 5 years clinical follow up was
obtained. Furthermore, patients were asked to undergo cardiac magnetic
resonance imaging (CMR) at 1 year. The main endpoints for the current
study are the occurrence of Major adverse cardiac events (MACE),
consisting of cardiac death, coronary artery bypass graft (CABG) and any
myocardial infarction (MI), within 5 years after randomization. All events
underwent independent monitoring and were adjudicated by an independent
critical events committee. RESULTS From October 2007 through April 2015, a
total of 302 patients were analyzed in the study (CTO PCI: 148 and no-CTO
PCI: 154). Mean age was 60+/-12 years in both groups. There were no
differences in baseline characteristics between both arms. One year
clinical follow-up was complete for all patients. The mean long-term
followup of all patients is currently 3.1+/-1.5 years. CONCLUSION The
Explore trial is the first randomized clinical trial investigating the
impact of revascularization of a CTO. The primary outcome (LVEF and LVEDV)
of the EXPLORE Trial was not met at four months. We aim to present mid-
and long-term clinical events followup and 1-year cardiac CMR follow-up.
(Figure Presented).

<25>
Accession Number
619771355
Author
Benedetto U.; Kappetein A.P.; Brown W.; Boonstra P.W.; Noiseux N.;
Dressler O.; Stone G.; Serruys P.; Sabik J.
Institution
(Benedetto) Bristol Heart Institute, University of Bristol, School of
Clinical Sciences, Bristol, United Kingdom
(Kappetein) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
(Brown) Piedmont Heart Institute CardioThoracic Surgeons, Atlanta, GA,
United States
(Boonstra) Medisch Centrum Leeuwarden, Heart Center, Leeuwarden PObox 888,
Netherlands
(Noiseux) Montreal Heart Institute, Montreal, QC, Canada
(Dressler) Cardiovascular Research Foundation, New York, NY, United States
(Stone) Cardiovascular Research Foundation, Columbia University Medical
Center, NewYork-Presbyterian Hospital, New York, NY, United States
(Serruys) Imperial College, London, United Kingdom
(Sabik) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic Foundation, Cleveland, OH, United States
Title
Off-pump versus on-pump coronary artery bypass surgery for left main
revascularization: Insights from the excel trial.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B32), 2017. Date of Publication: October
2017.
Publisher
Elsevier USA
Abstract
BACKGROUND Whether off-pump CABG in patients with left main stem (LMS)
disease is as safe and effective as on-pump surgery remains to be
determined. METHODS The EXCEL trial compared PCI with everolimus-eluting
stents vs CABG in 1905 patients undergoing left main revascularization. A
total of 271 (29%) patients assigned to CABG were treated with off-pump
surgery, while 652 (71%) were treated with on-pump surgery. We conducted a
post-hoc analysis of the EXCEL trial to compare 3-year clinical outcomes
between off-pump and on-pump surgery including death, myocardial
infarction (MI), cerebrovascular accident (CVA) and unplanned
revascularization. Due to lack of randomization between the two groups,
stepwise multivariate Cox regression was used to adjust for the effects of
off-pump vs on-pump surgery. RESULTS At 3 years, crude mortality rates in
the off-pump and onpump group were 8.7% (22) vs 4.8% (30), respectively
(P=0.04). No significant differences between off-pump and on-pump groups
were present for the unadjusted rates of MI (5.4% [14] vs 8.4% [53],
P=0.11), CVA (5.3% [13] vs 3.8% [23], P=0.36) or unplanned
revascularization (8.6% [22] vs 7.3% [44], P=0.46). After adjusting for
confounding factors, the risk of death was not significantly higher with
off-pump surgery (HR 1.68; 95%CI 0.91-3.12; P=0.10); nor was composite of
death, MI, or CVA significantly different (HR 0.95; 95%CI 0.65-1.40,
P=0.79; Figure). CONCLUSION In the EXCEL trial, off-pump and on-pump CABG
were equally safe and effective at 3 years in patients with LMS disease.
(Figure Presented).

<26>
Accession Number
619771352
Author
Rashid H.; Ihdayhid A.R.; McCormick L.; Nerlekar N.; Cameron J.; Nasis A.;
Gooley R.; Brown A.
Institution
(Rashid, Nasis) Monash Health, Melbourne, VIC, Australia
(Ihdayhid, Brown) MonashHeart, Monash Medical Centre, Clayton, VIC,
Australia
(McCormick, Gooley) MonashHeart, Monash Health, Melbourne, VIC, Australia
(Nerlekar) MonashHeart, Clayton, VIC, Australia
(Cameron) Monash University, Melbourne, VIC, Australia
Title
Bioprosthetic aortic valve leaflet thrombosis detected by multidetector
computed tomography is associated with adverse cerebrovascular events: A
meta-analysis of observational studies.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B54-B55), 2017. Date of Publication:
October 2017.
Publisher
Elsevier USA
Abstract
BACKGROUND Leaflet thrombosis (LT) is becoming increasingly recognized
following transcatheter and surgical aortic bioprosthetic valve (ABV)
replacement and can be identified by multidetector computed tomography
(MDCT). However, there is ongoing debate whether MDCTdefined LT is
associated with adverse cerebrovascular outcomes. METHODS Electronic
databases were searched for studies that performed mandatory MDCT imaging
of patients following ABV. The primary endpoint was the incidence of
cerebrovascular events, defined as the composite of stroke or transient
ischaemic attack (TIA). Secondary endpoints included major adverse
cerebrovascular and cardiovascular events (MACCE), stroke, TIA, death and
myocardial infarction. RESULTS In total, 6 studies met inclusion criteria
with 11.6% (198/1704) of patients having MDCT-defined LT. The prevalence
of LT following transcatheter and surgical ABV was 13.2% and 3.6%,
respectively. Cerebrovascular events were significantly increased in
patients with LT (Odds Ratio [OR] 3.38, 95%CI 1.78-6.41, I2=0%, p<
0.001)(Figure). The risk of MACCE (OR 2.10, 95%CI 1.21-3.64, p< 0.001) and
TIA (OR 5.86, 95%CI 2.05-16.75, p< 0.001) were also increased in patients
with LT, although there were no differences in the incidence of stroke (OR
2.43, 95%CI 1.00- 5.93, p=0.05), death (OR 0.92, 95%CI 0.42-2.03, p=0.84)
or myocardial infarction (OR 1.72, 95%CI 0.34-9.78, p=0.54) between
groups. CONCLUSION MDCT-defined LT following ABV replacement is associated
with a significantly increased risk of adverse cerebrovascular events.
Further prospective studies are required to ascertain whether LT can be
treated or prevented with pharmacological strategies.

<27>
Accession Number
619771331
Author
Ahmad Y.; Demir O.; Howard J.; Shun-Shin M.; Cook C.; Petraco R.; Al-Lamee
R.; Jabbour R.; Sutaria N.; Ariff B.; Kanaganayagam G.; Chukwuemeka A.;
Anderson J.; Francis D.; Mayet J.; Davies J.; Mikhail G.; Malik I.; Sen S.
Institution
(Ahmad, Howard, Shun-Shin, Cook, Al-Lamee, Jabbour, Mayet, Davies)
Imperial College London, London, United Kingdom
(Demir, Petraco, Sutaria, Ariff, Kanaganayagam, Chukwuemeka, Anderson,
Mikhail, Malik, Sen) Hammersmith Hospital, Imperial College Healthcare NHS
Trust, London, United Kingdom
(Francis) National Heart and Lung Institute, London, United Kingdom
Title
Aspirin is equivalent to dual antiplatelet therapy after transcatheter
aortic valve replacement: A meta-analysis of 11,781 patients.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B54), 2017. Date of Publication: October
2017.
Publisher
Elsevier USA
Abstract
BACKGROUND Guidelines recommend dual antiplatelet therapy (DAPT) post
transcatheter aortic valve replacement (TAVR), but the recommended
duration varies between guidelines. In this study we (1) performed a
structured survey of 45 TAVR centres internationally to determine if there
is consensus regarding DAPT post TAVR; and (2) performed a systematic
review, meta-analysis and meta-regression of all suitable studies to
determine if aspirin monotherapy can be used instead of DAPT. METHODS A
structured electronic survey regarding antiplatelet use post-TAVR was
completed by 45 TAVR centres. A systematic review of TAVR RCTs and
registries was performed comparing DAPT duration and incidence of stroke,
bleeding and death. A variance weighted least squared meta-regression was
then performed to determine the relationship of antiplatelet therapy and
adverse events. RESULTS 82.2% of centres routinely used DAPT post-TAVR
with most (47%) giving 3 months, 22% giving 6 months, and 18% only aspirin
monotherapy. Only 13.3% reported that their practice followed guideline
recommendations. 11,781 patients (26 studies) were eligible for the meta
analysis and regression. There was no association with duration of DAPT
over aspirin monotherapy for stroke (p=0.49), death (p=0.72) or bleeding
(p=0.91). CONCLUSION Aspirin monotherapy appears as safe and effective as
DAPT post-TAVR, with no difference in stroke, mortality or bleeding.

<28>
Accession Number
619771300
Author
Dwyer M.; Linke A.; Kraemer C.; White R.; Lazar R.; Kapadia S.; Kodali S.;
Engels T.; Parhizgar A.; Mehran R.; Makkar R.; Anwaruddin S.; Leon M.;
Zivadinov R.
Institution
(Dwyer) University at Buffalo, Buffalo, NY, United States
(Linke) University of Leipzig Heart Center, Leipzig, Germany
(Kraemer) NAMSA, Minneapolis, MN, United States
(White) DCRI, Durham, NC, United States
(Lazar) University of Alabama at Birmingham, Birmingham, AL, United States
(Kapadia) Heart and Vascular Institute, Cleveland, OH, United States
(Kodali) New York-Presbyterian Hospital, Columbia University Medical
Center, New York, NY, United States
(Engels, Parhizgar) Claret Medical, Santa Rosa, CA, United States
(Mehran) Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai
Hospital, New York, NY, United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Anwaruddin) University of Pennsylvania, Philadelphia, PA, United States
(Leon) Columbia University Medical Center, NewYork-Presbyterian Hospital,
New York, NY, United States
(Zivadinov) Buffalo Neuroimaging Analysis Center, University at Buffalo,
Buffalo, NY, United States
Title
Pre-procedural white matter lesion burden predicts MRI outcomes in
transcatheter aortic valve replacement (TAVR): The sentinel trial.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B173-B174), 2017. Date of Publication:
October 2017.
Publisher
Elsevier USA
Abstract
BACKGROUND Neurological events and brain infarction remain a concern after
transcatheter aortic valve replacement (TAVR). While Cerebral Embolic
Protection (CEP) devices provide meaningful protection, recent trials
still showed substantial variability in individual outcomes. There remains
a strong need to identify individual patient outcome predictors.
Pre-existing white matter disease (T2-FLAIR positive lesion volume) may
reflect overall susceptibility to cerebrovascular insults. In this
context, we set out to determine whether preprocedural T2-FLAIR cerebral
lesions are predictive of new brain infarction and/or neurological events
after TAVR. METHODS Data from the SENTINEL trial was analyzed post hoc.
Subjects were split into two groups, based on median baseline T2- FLAIR
lesion volume, and 30 day MACCE rates, stroke rates, and 2- 7day post-TAVR
new ischemic lesion (DWI) volumes were compared between groups. RESULTS A
total of 228 subjects were included in the analysis, with a mean age of
83.1 (+/-7.8). MACCE and stroke rates for the above-median T2-lesion
volume group were numerically higher than the belowmedian group (10.5% vs.
5.3% for MACCE and 8.8% vs. 4.4% for stroke), but the differences did not
reach significance. In contrast, median post-TAVR new ischemic lesion
volume was more than twice as large in those with high baseline T2 lesion
volume (479.9 mm3 vs. 197.8 mm3), and the difference was highly
significant (p<0.001). CONCLUSION Pre-existing T2- FLAIR lesion burden
strongly predicts new procedure-related DWI lesion volume in TAVR, and
should be included as a covariate when using that endpoint in studies. Its
relationship with MACCE and stroke rates is less clear, and needs further
study in larger cohorts.

<29>
Accession Number
619771293
Author
Villablanca P.; Olmedo W.; Weinreich M.; Mohananey D.; Gupta T.; Sanina
C.; Farooq M.; Ong E.; Brevik T.; Castellon D.; Ramakrishna H.; Garcia M.;
Pyo R.; Menegus M.; Bortnick A.; Wiley J.
Institution
(Villablanca) New York University, New York, NY, United States
(Olmedo, Gupta, Sanina, Farooq, Ong, Brevik, Garcia, Pyo, Wiley)
Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY,
United States
(Weinreich, Bortnick) Montefiore Medical Center, Bronx, NY, United States
(Mohananey) Cleveland Clinic, Cleveland, OH, United States
(Castellon) Medical University of the Americas, Devens, MA, United States
(Ramakrishna) Mayo Clinic, Phoenix, AZ, United States
(Menegus) Montefiore, Bronx, NY, United States
Title
Percutaneous intervention for concurrent chronic total occlusions in
patients with ST-elevation myocardial infarction: A systematic review and
meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B299), 2017. Date of Publication: October
2017.
Publisher
Elsevier USA
Abstract
BACKGROUND Studies have shown that the presence of concurrent chronic
total occlusion (CTO) in a non-infarct related artery (nIRA) in
ST-elevation myocardial infarction (STEMI) patients is associated with
increased mortality. Despite this, it remains unclear if revascularization
of a nIRA CTO in STEMI translates to improved outcomes. We performed a
meta-analysis to compare outcomes between patients presenting with STEMI
with concurrent CTO who underwent percutaneous coronary intervention (PCI)
of nIRA CTO vs. those who did not. METHODS We conducted an electronic
database search of all published data. The primary endpoint was major
adverse cardiovascular events (MACE) defined as a composite of all-cause
mortality, stroke, myocardial infarction (MI), and repeat
revascularization (RRV). Secondary endpoints were all-cause mortality,
cardiovascular (CV) mortality, MI, RRV either with PCI or Coronary Artery
Bypass Grafting (CABG), stroke, and heart failure readmission. Odds ratios
(OR) and 95% confidence intervals (CI) were computed using the Mantel-
Haenszel method. A fixed-effect model was used; if heterogeneity was
(I2)>25, effects were obtained using a random effects model. RESULTS Five
studies (n=876 patients) were included in the analysis. There was a
statistically significant difference in heart failure readmissions
favoring those receiving nIRA CTO PCI as compared to those who did not (OR
0.53, 95% CI 0.29-0.95). No statistically significant differences was
observed between two groups for MACE (OR 0.79, 95% CI 0.32-1.96),
all-cause mortality (OR 0.57, 95% CI 0.23-1.39), CV mortality (OR 0.54,
95% CI 0.21-1.34), MI (OR 0.92, 95% CI 0.46-1.84), RRV (OR 1.27, 95% CI
0.57-2.83), or strokes (OR 0.49, 95% CI 0.19-1.25). CONCLUSION In this
meta-analysis, CTO PCI of the nIRA CTO in patients presenting with STEMI
was associated with a significant reduction in HF readmissions, but not
with MACE, mortality, stroke, MI, or RRV among patients who underwent CTO
PCI. Additional studies are needed to fully understand the role of CTO
revascularization in STEMI patients.

<30>
Accession Number
619771209
Author
Bajaj A.; Pancholy S.; Sethi A.; Boruah P.; Sothwal A.; Malik Q.; Sidhu G.
Institution
(Bajaj, Pancholy, Boruah, Sothwal, Malik, Sidhu) Wright Center For
Graduate Medical Education, Scranton, PA, United States
(Sethi) St.Luke's Cardiology Associates, Bethlehem, PA, United States
Title
Bivalirudin versus heparin in aortic valve interventions: A meta-analysis.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B238), 2017. Date of Publication: October
2017.
Publisher
Elsevier USA
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) and Balloon
aortic valvuloplasty (BAV) bears specific procedural risks, including
bleeding, vascular complications and atheroembolism causing stroke.
Heparin is frequently used during these procedures to prevent
atheroembolic events. There is limited data on the efficacy of bivaliruin
compared with heparin in patients undergoing TAVR and BAV. We aimed to
evaluate the safety and efficacy of the periprocedural bivalirudin versus
heparin for aortic valve interventions. METHODS A systematic search of
database, including, Pubmed, Web of Science, Google scholar and Cochrane
Database were performed by two independent reviewers to identify relevant
studies. Studies were included comparing "heparin" versus "bivalirudin" in
patients undergoing TAVR or BAV for severe aortic stenosis (AS). The
primary outcome was in-hospital major bleeding. Secondary outcomes were
in-hospital major adverse cardiovascular events (MACE), in-hospital net
adverse clinical events (NACE), in-hospital all cause mortality, major
vascular complications, acute myocardial infarction (MI), stroke and acute
kidney injury (AKI). RESULTS Three studies, including 1690 patients were
included in the analysis. Overall, the incidence of major bleeding was
7.6% (6.5% in the bivalirudin group versus 9.2% in heparin group). The
incidence of major bleeding was significantly less in the bivalirudin
group as compared to heparin group (OR, 0.58 [CI 0.33, 0.99], I2=49%). The
risk of NACE and MI were also significantly less in the bivalirudin group
as compared to heparin group (NACE (OR, 0.68 [CI 0.48, 0.97], I2=26%), MI
(OR 0.41 [0.18, 0.94], I2=0). There was no significant difference in
in-hospital MACE (OR, 0.70 [CI 0.46, 1.07], I2=0%), mortality (OR, 0.81
[CI 0.46, 1.45], I2=0%), major vascular complications (OR, 0.95 [CI 0.6,
1.39]5, I2=0%), stroke (OR, 0.99 [CI 0.31, 3.17], I2=15%) and AKI (OR,
1.01 [CI 0.53, 1.90], I2=77%) between the two groups. CONCLUSION In
patients undergoing aortic valve interventions for severe AS, bivalirudin
compared with heparin is associated with better in-hospital clinical
outcomes in terms of reduced risk of major bleeding, MI and NACE.

<31>
Accession Number
619771184
Author
Tsutsui R.; Banerjee K.; Kapadia S.
Institution
(Tsutsui, Banerjee) Cleveland Clinic, Cleveland, OH, United States
(Kapadia) Heart and Vascular Institute, Cleveland, OH, United States
Title
Natural history of mitral stenosis in patients with mitral annular
calcification.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B253), 2017. Date of Publication: October
2017.
Publisher
Elsevier USA
Abstract
BACKGROUND Mitral annular calcification (MAC) is recognized as a rare
cause of mitral stenosis (MS). However, little is known regarding its
natural history. In this study, we aimed to define the progression of MS
in patients with severe versus non-severe MAC. METHODS Database for the
years 1996 through 2013 was searched for patients who had severe MAC. MAC
was graded into none (0), mild (1), moderate (2), or severe (3) in a
semi-quantitative manner. It was then grouped into severe (3) and
non-severe (1,2) groups. Patients were included if they had MAC at their
index study and underwent >= 2 studies in the period of >= 2 years.
Patients with prior mitral valve (MV) surgery, rheumatic heart disease, or
other identifiable MV disease were excluded. MV gradients were evaluated
with peak and mean MV gradients, right ventricular systolic pressure
(RVSP) and mitral valve area (MVA) from pressure half time (PHT) method.
Mixed model analysis was applied obtain the progression rates. RESULTS A
total of 2995 patients (18794 studies) were included. Data are expressed
as mean +/- standard deviation. Population age at index study was 71 +/-
11 years. Follow up time was 5.4 +/- 3.2 years. Number of echocardiograms
performed per patient was 5 +/- 3. MS progression rates between non-severe
and severe MAC were: peak gradient (0.92 vs 1.849mmHg, p <0.001), mean
gradient (0.041 vs 0.561mmHg, p< 0.001), RVSP (3.398 vs 5,249mmHg, p
<0.001), MVA (0.163 vs -0.052cm2, p < 0.001). CONCLUSION Compared to
non-severe MAC, patients with severe MAC were had faster progression of
mitral valvular gradients. Furthermore, the rate of MS progression overall
was small over time in both groups. (Table Presented).

<32>
Accession Number
619771180
Author
Patel N.; Sheth C.; Bhargava V.
Institution
(Patel) University of Southern California, Los Angeles, CA, United States
(Sheth) San Joaquin General Hospital, French Camp, CA, United States
(Bhargava) VA San Diego Healthcare System, San Diego, CA, United States
Title
Gender differences in risk profile and in-hospital outcomes of
transcatheter aortic valve replacement.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B51-B52), 2017. Date of Publication:
October 2017.
Publisher
Elsevier USA
Abstract
BACKGROUND The role of gender on in hospital outcomes after transcatheter
aortic valve replacement (TAVR) has been poorly investigated, mostly
limited to single center studies or systematic reviews/meta analysis and
lacks nationally representative US based data. Therefore, we investigated
distinct gender based risk profiles and in-hospital outcomes. METHODS We
analyzed data from HCUP's Nationwide Inpatient Sample database from
2012-2014 for ICD-9-CM procedural codes 35.05 and 35.06 for TAVR using
SAS. Chi-squared and Student's t-test were used for univariate analysis of
categorical variables and continuous variables respectively. Logistic
regression analysis using PROC Surveylogistic was used for multivariable
analysis for outcome of in hospital mortality while linear regression
using PROC Surveyreg for outcomes of length of stay and cost of care.
RESULTS 41015 (weighted) procedures from 2012 to 2014 were included in our
analysis (mean age 81.12 years, 81.3% White). 47.69% of these were female
patients. Compared to male, female group was older (mean 81.72 years vs
80.57 years, p< .0001) with significant differences in distribution of
comorbidities (Table 1a). In-patient mortality (4.88% vs 3.64%, p<
0.0001), and length of stay were higher in female group on univariate
analysis (8.34 days vs 7.7 days, p< 0.0001) but difference in cost of care
was not statistically significant ($59,178 vs $57,935, p=0.076). After
adjusting for confounders, female gender was an independent predictor of
higher odds of in-hospital mortality (odds ratio 1.4, CI 1.11-1.70, p<
0.0001), longer LOS and higher cost of care. CONCLUSION Women compared to
men undergoing TAVR have significantly different risk profile and are
associated with higher in-hospital mortality, longer hospital stay and
higher cost of care. Further randomized controlled studies confirming
these observational findings are warranted and in turn may point to new
areas of focus to continue ongoing improvement in procedural outcomes.

<33>
Accession Number
619771151
Author
Andell P.; Frobert O.; Christiansen E.; Gudmundsdottir I.; Sandhall L.;
Erlinge D.; Gotberg M.
Institution
(Andell) Department of Cardiology, Lund University, Skane University
Hospital Lund, Lund, Sweden
(Frobert) Universitetssjukhuset Orebro, Orebro, Sweden
(Christiansen) Aarhus University Hospital, Aarhus, Denmark
(Gudmundsdottir) University Hospital Iceland, Reykjavik, Iceland
(Sandhall) Helsingborg Hospital, Helsingborg, Sweden
(Erlinge) Skane University Hospital, Lund, Sweden
(Gotberg) Department of Cardiology, Lund University, Skane University
Hospital, Lund, Sweden
Title
Reclassification of revascularization strategy with instantaneous
wave-free ratio and fractional flow reserve: A report from the
IFR-swedeheart study.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B28), 2017. Date of Publication: October
2017.
Publisher
Elsevier USA
Abstract
BACKGROUND Instantaneous wave-free ratio (iFR) is an index used to measure
the severity of coronary artery stenosis. iFR has been shown to be
noninferior to fractional flow reserve (FFR) in two large prospective and
randomized controlled trials. Reclassification of coronary
revascularization strategy, i.e. how coronary physiology changes treatment
decision is well-studied with FFR, but similar reports on iFR are lacking.
METHODS The iFR-SWEDEHEART study enrolled 2037 participants with stable
angina or acute coronary syndrome with an indication for
physiologically-guided assessment of coronary artery stenosis. Eligible
patients were randomized to revascularization guided by either iFR or FFR.
The treating interventionists had to enter both the preliminary treatment
decision (i.e. optimal medical therapy (OMT), percutaneous coronary
intervention (PCI) of one, two, or three vessels, or coronary artery
bypass grafting (CABG)) based on the angiogram before iFR/FFR, and the
final treatment decision determined by the iFR/FFR measurements. RESULTS A
total of 1012 (iFR) and 1007 (FFR) patients underwent
physiologically-guided revascularization. In the iFR and FFR groups,
angiogram-based a priori strategies were OMT in 37.8% and 34.7%, PCI in
54.1% and 57.7% and CABG in 8.1% and 7.6%, respectively (p=0.25). All
patients were mandatorily treated according to the iFR/FFR measurements.
The iFR and FFR guided final treatment strategies were OMT in 46.9% and
43.3%, PCI in 43.9% and 45.4% and CABG in 9.2% and 11.3%, respectively. A
total of 405 patients (40.1%) were reclassified with iFR and 409 patients
(40.7%) were reclassified with FFR (p=0.78). The majority of
reclassifications were deferrals of PCI into OMT in both the IFR (31.4%)
and FFR (29.0%) groups, respectively (p=0.36). CONCLUSION Reclassification
of coronary revascularization strategy using iFR or FFR was common and
occurred in approximately 40% of patients. There were no significant
differences in reclassification patterns between iFR or FFR and the most
frequent reclassification was deferral of PCI in favor of OMT regardless
of measurement modality.

<34>
Accession Number
619771041
Author
Paradies V.; Smits P.; Vlachojannis G.; Royaards K.-J.; Wassing J.; Van
Der Ent M.
Institution
(Paradies) National Heart Research Institute, National Heart Centre
Singapore, Singapore, Singapore
(Smits, Van Der Ent) Maasstad Ziekenhuis, Rotterdam, Netherlands
(Vlachojannis) Maasstad Hospital, Rotterdam, Netherlands
(Royaards) RotterdamNetherlands
(Wassing) Maasstad Hospital, Capelle a/d IJssel, Netherlands
Title
Predictors of target lesion failure after drug-eluting stents implantation
at 5 years follow-up.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B294), 2017. Date of Publication: October
2017.
Publisher
Elsevier USA
Abstract
BACKGROUND The objective of this study was to define the incidence and
predictors of target lesion failure (TLF) after drug-eluting stent (DES)
implantation at long term follow-up. METHODS Patient-level data from
Compare trials were pooled (n= 4506 patients). Compare I and II trials
were prospective, randomized controlled clinical trials comparing
everolimus eluting stents (EES) to placlitaxel-eluting stents (PES) and
EES to biolimus-eluting (BES), respectively. TLF was defined as cardiac
death, target-vessel related MI or clinical indicated Target Lesion
Revascularization (TLR). Baseline clinical, procedural and angiographic
characteristics in the overall pooled population were analyzed for
associations with TLF at univariate analysis. A multiple logistic
regression analysis was then performed. RESULTS TLF occurred in 586 out of
3920 patients (14.9%) at 5 years follow-up. At multiple logistic
regression analysis the presence of diabetes mellitus, renal failure,
previous coronary artery revascularization and ostial lesions were
identified as independent predictors of TLF. CONCLUSION In this large
pooled analysis of patients undergoing percutaneous coronary intervention
with DES, the incidence of TLF at 5 years follow-up is still relevant.
Clinical as well as angiographic independent predictors can be identified.
(Table Presented).

<35>
Accession Number
619770989
Author
Verma D.R.; Pershad A.; Morse M.; Kar S.; Morris M.; Gellert G.; Whisenant
B.; Lotun K.; Nakajima Y.; Barker C.; Smalling R.; Dhoble A.; Querrey T.;
Okoh A.; Chen C.; Moualla S.; Cohen M.; Yakubov S.; Watson D.; Russo M.;
Reardon M.J.; Caskey M.; Byrne T.; Fang H.
Institution
(Verma, Morris, Fang) Banner University Medical Center, Phoenix, AZ,
United States
(Pershad, Moualla) Banner University Medical Center Phoenix, Phoenix, AZ,
United States
(Morse) St Thomas Hospital, Nashville, TN, United States
(Kar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Gellert) Banner Unversity Medical Center Phoenix, Phoenix, AZ, United
States
(Whisenant) Intermountain Medical Center, Salt Lake City, UT, United
States
(Lotun) University of Arizona, Tucson, AZ, United States
(Nakajima) Cedars Sinai Medical Center, Los Angeles, CA, United States
(Barker) Houston Methodist, Houston, TX, United States
(Smalling) UTHealth/Memorial Hermann Heart, Vascular Institute, Houston,
TX, United States
(Dhoble) University of Texas, Health Science Center, Houston, TX, United
States
(Querrey, Caskey, Byrne) Abrazo Arizona Heart Hospital, Phoenix, AZ,
United States
(Okoh, Chen, Russo) RWJ Barnabas Health, Newark Beth Israel Medical
Center, Newark, NJ, United States
(Cohen) Newark Beth Israel Medical Center, Newark, NJ, United States
(Yakubov) Riverside Methodist Hospital, Columbus, OH, United States
(Watson) Ohio Health, Columbus, OH, United States
(Reardon) Houston Methodist DeBakey Heart and Vascular Center, Houston,
TX, United States
Title
Percutaneous transcatheter mitral valve replacement via transseptal or
transapical approach in patients who are prohibitive risk for surgery: US
multicenter registry.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B191-B192), 2017. Date of Publication:
October 2017.
Publisher
Elsevier USA
Abstract
BACKGROUND Surgical mitral valve replacement in patients with failed
bioprosthetic valves, annuloplasty ring or severe mitral annular
calcification (MAC) is commonly associated with high or prohibitive risk.
METHODS Data for 88 consecutive patients undergoing transcatheter mitral
valve replacement with balloon expandable valve for failed native mitral
valves, bioprosthetic valves, annuloplasty rings or bands was collected
from 8 US centers participating in this multicenter registry. Patients
were divided into transapical (n=48) or transseptal (n=38) groups based on
the procedural access chosen for TMVR by site operators. RESULTS Baseline
patient and ECHO hemodynamic characteristics were similar for both groups.
Sapien 3 was more frequently used in transseptal group (68%) and Sapien XT
in transapical group (73%, p<0.001). Both groups had similar post-TMVR
peak and mean mitral gradients (p=ns). Transapical, compared to
transseptal group, had higher: rate of valve embolization (4.8 vs 0%,
p=0.03), rate of conversion to open surgery (10 vs 0%, p=0.02), require
blood transfusion (62.5 vs 34.2%, p=0.01), higher rate of readmission (19%
vs 43%, p=0.01). Transseptal group was more likely to undergo percutaneous
PVL closure (17% vs 6%, p=0.04). Transseptal vs transapical groups were
similar for: acute procedural success, as defined by MVARC criteria, (89
vs 92%, p=0.75), procedure type (Valve-in-valve 81 vs 76%, Valve-in-ring
13 vs 11%, Valve-in-MAC 5 vs 11% respectively, p=0.62), moderate or severe
perivalvular leak (PVL; 20 vs 12%, p=0.45), utilization of second
transcatheter valve (8% vs 5%, p=0.5), incidence of LVOT obstruction (4 vs
3.5%, p=0.2), length of hospital stay (11.3 vs 11.2 %, p=0.98) and similar
incidence of mortality (in-hospital 8 vs 10%; p=0.68 and 30-day mortality
5 vs 10%; p=0.21). (Figure presented) CONCLUSION Both transseptal and
transapical access for percutaneous transcatheter mitral valve replacement
are effective in treating patients with severe mitral valve disease who
are at high or prohibitive risk for surgical valve replacement. There is
no mortality difference associated with transapical vs transseptal access,
however transseptal access may be associated with lower patient morbidity.
Our findings need to be confirmed in prospective trials.

<36>
Accession Number
619770946
Author
Song L.; Jiang L.; Gao Z.; Xu L.; Tian J.; Xu B.; Yuan J.
Institution
(Song) National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Fuwai Hospital,
Beijing, China
(Jiang, Xu, Yuan) Fuwai Hospital, CAMS and PUMC, Beijing, China
(Gao) China Medical Association, Bejing, Hebei, China
(Song, Tian) Fuwai Hospital, Beijing, China
(Xu) Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing,
China
Title
Long-term outcome of patients with coronary triple vessels disease among
three treatment strategies in the real world of China.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B292), 2017. Date of Publication: October
2017.
Publisher
Elsevier USA
Abstract
BACKGROUND The optimal treatment strategy for triple-vessel coronary
disease (TVD) remains a critical and uncertain issue. This study aimed to
determine the long-term outcome of patients undergoing either percutaneous
coronary intervention (PCI), coronary artery bypass grafting (CABG) or
medication therapy (MT) alone in the real world of China. METHODS From
2004 to 2011, we recruited 8,943 patients angiographically confirmed >=50%
stenosis in all three major epicardial coronary arteries in a median
6.6-year follow-up. The primary end point was all-cause mortality. The
secondary end points were cardiac death and major adverse cardiovascular
and cerebrovascular events (MACCE), a composite of all-cause death,
myocardial infarction (MI), stroke or repeat revascularization and the
individual components. RESULTS PCI, CABG and MT alone were performed in
3,825 (42.8%), 2,697 (30.2%) and 2,421 (27.1%) patients respectively. The
unadjusted all-cause mortality was significantly different among groups
with the highest rate 26.5% in MT alone versus PCI 11.5% versus CABG
10.6%, p <0.001. After baseline characteristic adjustment, MT alone had
the worst outcomes comparing with PCI and CABG. CABG was associated with
lower risks of all-cause mortality (HR: 0.81; 95%CI: 0.70-0.94; p <0.001)
and MACCE (HR: 0.65; 95%CI: 0.59-0.72; p <0.001), but higher risk of
stroke versus PCI. CONCLUSION For TVD patients, CABG was associated with a
lower risk of death, MI or repeat revascularization, but a higher risk of
stroke versus PCI in long-term follow-up. Patients that received MT alone
have the worst long-term clinical outcomes. (Table Presented).

<37>
Accession Number
619770938
Author
Van Mieghem N.; Reardon M.J.; Popma J.J.; Windecker S.; Gleason T.; Lee
J.; Grube E.; Sondergaard L.; Makkar R.; Cheng W.; Serruys P.; Kappetein
A.P.
Institution
(Van Mieghem) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Reardon) Houston Methodist DeBakey Heart and Vascular Center, Houston,
TX, United States
(Popma) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Windecker) University Hospital Bern, Bern, Switzerland
(Gleason) University of Pittsburgh, School of Medicine, Pittsburgh, PA,
United States
(Lee) University of Pittsburgh Medical Center, Pittsburgh, PA, United
States
(Grube) University Hospital Bonn, Bonn, Germany
(Sondergaard) Rigshospitalet University Hospital, Copenhagen, Denmark
(Makkar, Cheng) Cedars-Sinai Medical Center, Los Angeles, CA, United
States
(Serruys) Imperial College, London, United Kingdom
(Kappetein) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
Title
Transcatheter aortic valve replacement with a self-expanding prosthesis or
surgical aortic valve replacement in intermediate-risk patients: Complete
1-year outcomes from the surtavi trial.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B47), 2017. Date of Publication: October
2017.
Publisher
Elsevier USA
Abstract
BACKGROUND The SURTAVI trial compared clinical outcomes in patients with
severe, symptomatic aortic stenosis at intermediate surgical risk. Using a
novel Bayesian statistical method, transcatheter aortic valve replacement
(TAVR) with a self-expanding bioprosthesis was shown to be noninferior to
surgical aortic valve replacement (SAVR) for the endpoint of all-cause
mortality or disabling stroke at 24 months. METHODS The SURTAVI trial was
a prospective, multinational, randomized clinical trial. Patients were
deemed intermediate risk for surgery based on the assessment by the
center's multidisciplinary heart team. At the time of the Bayesian interim
analysis, 1400 of the 1660 patients in the modified intent-to-treat groups
had reached 1- year follow-up. RESULTS Patients had a mean age of
79.8+/-6.2 years and mean STS score of 4.5+/-1.6%. Comorbidities included
diabetes (34.5%), chronic lung disease (34.5%), and frailty (5-m gait
speed >6 seconds, 52.3%; falls within 6 months, 12.2%). 30-day and 1-year
Kaplan-Meier clinical event rates for the interim 1400-patient cohort in
the TAVR and SAVR treatment groups are shown below (TABLE). Complete
1-year clinical and echocardiographic results of the full 1660-patient
cohort will be available in October. CONCLUSION The SURTAVI trial provides
a large, robust data set, with 1-year follow-up of 1660 intermediate-risk
patients randomized to SAVR or TAVR with a self-expanding bioprosthesis
available for presentation in the Fall. Continued follow-up of these
patients will be important to confirm the earlier results of the Bayesian
analysis.

<38>
Accession Number
619770909
Author
Biviano A.; Nazif T.; Dizon J.; Garan H.; Crowley A.; Malaisrie S.; Makkar
R.; Thourani V.; Mack M.; Szeto W.Y.; Fearon W.; Leon M.; Kodali S.
Institution
(Biviano, Garan) Columbia University Medical Center, New York, NY, United
States
(Nazif) NewYork-Presbyterian Hospital, Columbia University Medical Center,
New York, NY, United States
(Dizon) Cardiovascular Research Foundation, Columbia University Medical
Center, New York, NY, United States
(Crowley) Cardiovascular Research Foundation, Queens, NY, United States
(Malaisrie) Northwestern University, Feinberg School of Medicine, Chicago,
IL, United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Thourani) Emory University Hospital Midtown, Atlanta, GA, United States
(Mack) Heart Hospital Baylor Plano, Plano, TX, United States
(Szeto) University of Pennsylvania, Philadelphia, PA, United States
(Fearon) Division of Cardiovascular Medicine, Stanford University, School
of Medicine, Stanford, CA, United States
(Leon) Columbia University Medical Center, NewYork- Presbyterian Hospital,
New York, NY, United States
(Kodali) Columbia, Hastings on Hudson, NY, United States
Title
Atrial fibrillation is associated with increased mortality in
intermediate-risk patients undergoing TAVR or SAVR: Insights from the
partner 2A and partner 2 S3i trials.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B46-B47), 2017. Date of Publication:
October 2017.
Publisher
Elsevier USA
Abstract
BACKGROUND Atrial fibrillation or flutter (AF) has been associated with
worse outcomes in many cardiovascular disease states, but there are scant
data in STS-defined intermediate-risk aortic stenosis (AS) patients
undergoing transcatheter or surgical aortic valve replacement (TAVR/SAVR).
METHODS Data were evaluated in 2699 intermediate-risk patients who
underwent TAVR or SAVR in either the PARTNER (Placement of AoRTic
TraNscathetER Valve) 2A or S3i Trials. Clinical outcomes at 1- year and
2-years were compared in patients by baseline and discharge rhythm: sinus
rhythm (SR) versus AF. RESULTS For the 1905 TAVR patients, 3.3% manifested
SR baseline/ AF discharge, 17.6% AF baseline/AF discharge, and 79.1% SR
baseline/ SR discharge. The 794 SAVR patients developed more AF by
discharge: 14.2% SR/AF, 14.1% AF/AF, and 71.7% SR/SR. Total mortality at
1-year was increased in AF patients for both groups: TAVR= 15.9% SR/AF vs
7.6% SR/SR, p=0.02; SAVR= 16.0% SR/AF vs. 8.9% SR/SR, p=0.02. Mortality
occurring between 1-year and 2-year follow-up was also higher in the AF
groups: TAVR= 4.7% AF/AF vs 2.2% SR/SR, p=0.02; SAVR= 11.0% SR/AF vs. 5.7%
SR/SR, p=0.053. The 1-year composite endpoint of death, rehospitalization,
and stroke was higher in the AF groups: TAVR= 36.5% SR/AF* vs 25.7% AF/AF*
* vs. 20.7% SR/SR, p=0.002* and p=0.05* * vs. SR/SR; SAVR= 41.2% AF/AF vs.
22.8% SR/ SR, p< 0.0001. AF patients manifested significantly higher rates
of total mortality and the composite endpoint at 2-year follow-up
(Figure). CONCLUSION Intermediate-risk AS patients undergoing TAVR
manifest less AF by discharge than SAVR patients. For both TAVR and SAVR
patients, the presence of AF at discharge is associated with worse
outcomes at 1-year and 2-year follow-up.

<39>
Accession Number
619770878
Author
Rogers T.; Thomaides A.; Steinvil A.; Koifman E.; Lipinski M.; Chadi
Alraies M.; Buchanan K.; Okubagzi P.; Torguson R.; Ben-Dor I.; Pichard A.;
Satler L.; Waksman R.
Institution
(Rogers, Thomaides, Koifman, Chadi Alraies, Buchanan, Okubagzi) MedStar
Washington Hospital Center, Washington, DC, United States
(Steinvil) Medstar Washington Hospital center, Washington DC, United
States
(Lipinski, Ben-Dor, Waksman) Medstar Washington Hospital Center,
Washington, DC, United States
(Torguson, Pichard, Satler) Washington Hospital Center, Washington, DC,
United States
Title
Impact of an electrophysiology study guided ppm implantation strategy
after TAVR.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B231), 2017. Date of Publication: October
2017.
Publisher
Elsevier USA
Abstract
BACKGROUND Permanent pacemaker (PPM) implantation remains the Achilles
heel of transcatheter aortic valve replacement (TAVR) compared with
surgical aortic valve replacement (SAVR). We previously demonstrated that
an electrophysiology study (EPS) avoids PPM in over 70% of patients with
conduction abnormality but no definitive indication for pacing after TAVR.
The impact of this strategy in patients receiving contemporary valves has
not been well studied. METHODS Consecutive patients undergoing TAVR at a
single US center between 2013 and 2016 with a contemporary balloon
expandable or self-expanding TAVR device were included. PPM implantation
rates using this strategy were qualitatively compared with published data
from recent multicenter trials. RESULTS A total of 257 patients were
included in the study. The PPM implantation rate was 12.7% for the
self-expanding Medtronic Evolut R and 4.7% for the balloon-expandable
Edwards Sapien 3. Table 1 summarizes published PPM implantation rates from
recent multicenter trials according to type of TAVR device. EPS guided
strategy resulted in substantially lower PPM implantation rates compared
with most of the recent multicenter TAVR trials, and similar rates to the
next generation self-expanding Medtronic Evolut Pro. (Table presented)
CONCLUSION Further studies are required to determine whether this observed
effect is reproducible, and whether this strategy should be adopted in all
patients with conduction abnormality and equivocal pacing indication after
TAVR.

<40>
Accession Number
619770861
Author
Myat A.; Hildick-Smith D.; De Belder A.; Trivedi U.; Morice M.-C.;
Kandzari D.; Lembo N.; Brown W.; Serruys P.; Kappetein A.P.; Sabik J.;
Stone G.
Institution
(Myat) Brighton and Sussex Medical School, Brighton, United Kingdom
(Hildick-Smith, Trivedi) Royal Sussex County Hospital, Brighton, United
Kingdom
(De Belder) Brighton and Sussex University Hospitals, Overijse, United
Kingdom
(Morice) CERC, Massy, France
(Kandzari) Piedmont Heart Institute, Atlanta, GA, United States
(Lembo) Columbia University, New York, NY, United States
(Brown) Piedmont Heart Institute CardioThoracic Surgeons, Atlanta, GA,
United States
(Serruys) Imperial College, London, United Kingdom
(Kappetein) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
(Sabik) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic Foundation, Cleveland, OH, United States
(Stone) Cardiovascular Research Foundation, Columbia University Medical
Center, NewYork-Presbyterian Hospital, New York, NY, United States
Title
Geographical variation in anatomical and procedural characteristics for
left main coronary artery revascularization and their impact on clinical
outcomes: Analysis from the excel trial.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B329-B330), 2017. Date of Publication:
October 2017.
Publisher
Elsevier USA
Abstract
BACKGROUND The international EXCEL trial reported similar 3-year outcomes
for the primary endpoint of death, stroke, or MI after PCI with
everolimus-eluting stents vs CABG in pts with left main coronary artery
disease (LMCAD). Whether the outcomes are consistent for United States
(US) operators, who have less experience with LM PCI, is unknown. METHODS
We performed a pre-specified subgroup analysis in EXCEL of participating
sites in the US vs those outside the US (OUS). RESULTS Of the 1905 pts
randomized, 549 (29%) were recruited in the US, and 1356 were enrolled
from OUS (predominantly Europe, n=1075). US compared with non-US operators
more frequently used femoral access (92.3% vs 64.9%; p<0.0001), planned
hemodynamic support during PCI (11.1% vs 2.8%; p<0.0001), and IVUS (26.6%
vs OUS 16.1%; p<0.0001). US centers enrolled more ostial LM lesions (39.2%
vs 32.7%; p=0.007), and fewer LM distal bifurcation lesions (22.2% vs
39.7%; p<0.0001). Off-pump CABG was performed less often in the US (15.3%
vs 34.9%; p<0.0001). 3-year outcomes by center appear in the Table.
CONCLUSION There was substantial geographical variation in anatomical and
procedural characteristics associated with LMCAD revascularization in the
EXCEL trial. Nonetheless, the relative outcomes of PCI vs CABG were
consistent between US and OUS centers. (Table Presented).

<41>
Accession Number
619770852
Author
Thuijs D.; Habib R.; Stone G.; Serruys P.; Sabik J.; Kappetein A.P.
Institution
(Thuijs, Kappetein) Department of Cardiothoracic Surgery, Erasmus
University Medical Center, Rotterdam, Netherlands
(Habib) Society of Thoracic Surgeons, Chicago, IL, United States
(Stone) Cardiovascular Research Foundation, Columbia University Medical
Center, NewYork-Presbyterian Hospital, New York, NY, United States
(Serruys) Imperial College, London, United Kingdom
(Sabik) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic Foundation, Cleveland, OH, United States
Title
Accuracy of the society of thoracic surgeons (STS) mortality and stroke
risk scores for predicting outcomes in patients with left main coronary
artery disease undergoing CABG versus PCI: Insights from the excel trial.
Source
Journal of the American College of Cardiology. Conference: 29th Annual
Symposium Transcatheter Cardiovascular Therapeutics, TCT 2017. United
States. 70 (18 Supplement 1) (pp B328), 2017. Date of Publication: October
2017.
Publisher
Elsevier USA
Abstract
BACKGROUND Whether STS risk scores can accurately predict outcomes in
patients with left main (LM) coronary artery disease undergoing coronary
artery bypass grafting (CABG) and percutaneous coronary intervention (PCI)
is unknown. METHODS We compared the observed 30-day mortality and stroke
rates to those expected from the corresponding STS risk models for
patients undergoing LM revascularization by PCI with everolimuseluting
stents (n=948) and CABG (n=957). Comparisons were made by
observed-to-expected ratios (O/E) and for quintile subgroups (Q1=low risk,
Q5=high risk) within each treatment group. RESULTS Randomized EXCEL trial
groups had similar expected 30- day STS risk scores: mortality [mean;
median (IQR): PCI - 0.91%; 0.62% (0.37%-1.06%) vs CABG - 0.86%; 0.62%
(0.38%-1.01%); p=0.69], and stroke [0.77%; 0.59% (0.41%-0.91%) vs [0.76%;
0.62% (0.40%- 0.95%)]; p=0.42]. Observed 30-day mortality rates were
similar for CABG and PCI [10 (1.05%) vs 9 (0.95%); O/E: 1.21 vs 1.04,
p=0.83] as were 30-day stroke rates [12 (1.25%)vs 6 (0.63%); O/E= 1.64 vs
0.82; p=0.16]. Subgroup analysis of 30-day mortality O/E showed that for
patients with low STS mortality risk, observed mortality might be greater
than expected in case of PCI and lower in case of CABG[Fig, top]. Stroke
risk tended to be lower for PCI across most STS risk quintiles[Fig,
bottom]. CONCLUSION In the EXCEL trial, STS CABG risk models predicted
aggregate 30-day CABG and PCI mortality reasonably well, although CABG
appeared safer in the lowest-risk patients while PCI appeared safer for
higher-risk patients. Stroke risk tended to be less with PCI than for
CABG. (Figure Presented).

<42>
Accession Number
619778072
Author
Coger K.; Frendl G.; Sprung J.; Kor D.J.; Subramaniam B.; Ruiz R.M.; Lee
J.-W.; Henderson W.G.; Moss A.; Mehdiratta N.; Colwell M.M.; Bartels K.;
Kolodzie K.; Giquel J.; Melo M.F.V.; Fernandez-Bustamante A.
Institution
(Coger, Frendl, Sprung, Kor, Subramaniam, Ruiz, Lee, Henderson, Moss,
Mehdiratta, Colwell, Bartels, Kolodzie, Giquel, Melo,
Fernandez-Bustamante) University of Colorado, School of Medicine, United
States
Title
Postoperative pulmonary complications not increased with combined regional
+ general anesthesia compared to general anesthesia alone: A sub-analysis
of the perioperative research network study.
Source
Regional Anesthesia and Pain Medicine. Conference: 42nd Annual Regional
Anesthesiology and Acute Pain Medicine Meeting, ASRA 2017. United States.
42 (6) (no pagination), 2017. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction Postoperative pulmonary complications (PPCs) are a leading
cause of poor surgical outcomes. The Perioperative Research Network (PRN)
investigators recently investigated the incidence and impact on mortality
and hospital use of PPCs in 1,202 ASA 3 physical status patients
presenting for non-cardiothoracic surgery and requiring >=2 hours general
anesthesia and mechanical ventilation (the PRN PPC study). In this
multicenter prospective observational study, patients who had combined
regional + general anesthesia (RA+GA), compared to general anesthesia (GA)
alone, were significantly more likely to have >=1 PPC. This was surprising
considering the benefits in respiratory function presumed with regional
anesthesia. A meta-analysis of 141 trials and 9,559 patients found that
neuraxial blockade reduced respiratory depression by 59% and pneumonia by
39% (both P<0.001). Receiving RA+GA is often considered a marker of
surgery and/or patient complexity. For this sub-analysis of the PRN PPC
study patients , we hypothesized that the presence of >=1 PPC was not
increased in patients receiving RA+GA than in GA patients after adjusting
for confounders. Materials and methods (NA for case report) We performed a
secondary analysis of the PRN PPC study patient cohort described above.
The 1,202 patients participating in the original study (May to November
2014) were included. IRB approval was obtained at each participating
institution. Predefined PPCs (pneumonia, bronchospasm, ARDS, atelectasis,
pneumothorax, pleural effusion, prolonged [>1 day after end of surgery]
supplemental oxygen by nasal cannula and/or facemask, postoperative
noninvasive ventilation, and re-intubation with postoperative mechanical
ventilation) occurring within the first 7 postoperative days were
prospectively identified. For this sub-analysis patients were classified
as receiving RA+GA or GA alone. Bivariable and multivariable hierarchical
logistic regression analyses were used to investigate the association of
RA+GA with >=1 PPC. Relevant covariates adjusted for in the model were
identified as those considered clinically relevant, those with p<0.05 in
bivariable analysis, and those with no significant statistical association
with other relevant variables. Results/Case report RA+GA was performed in
266 (22.1%) and GA in 936 (77.9%) patients. RA+GA patients were more
likely to have cancer, abdominal/pelvic nonemergent surgery, greater
estimated blood loss and intravenous fluid administration than GA patients
(Table 1). RA+GA patients had a higher incidence of >=1 PPC (42.1%) than
GA patients (30.9%) (site adjusted p=0.007, Table 1). After adjusting for
other significant covariates from the bivariable analysis, RA+GA was not
independently associated with >=1 PPC (adjusted OR 1.37; 95% CI,
0.83-2.25; p=0.165) (Table 2). Discussion At least 1 PPC was more common
in patients receiving RA+GA than GA alone. However, RA+GA was not
associated with >=1 PPC after adjusting for confounders in the logistic
regression analysis. These results support that the more often presence of
PPCs in patients receiving RA+GA in the PRN PPC study is likely related to
surgical and/or patient complexity. Interpretation of associated variables
from observational studies should be cautious and requires adjusting to
confounders.

<43>
Accession Number
619777963
Author
Byram S.; Baldea K.; Santos G.D.; Ellimoottil C.; Farooq A.; Mueller E.;
Turk T.
Institution
(Byram, Baldea, Santos, Ellimoottil, Farooq, Mueller, Turk) Loyola
University Medical Center, United States
Title
Paravertebral block for percutaneous nephrolithotomy: A prospective,
randomized, double-blind placebo-controlled study.
Source
Regional Anesthesia and Pain Medicine. Conference: 42nd Annual Regional
Anesthesiology and Acute Pain Medicine Meeting, ASRA 2017. United States.
42 (6) (no pagination), 2017. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction Percutaneous nephrolithotomy (PCNL) is considered the gold
standard minimally invasive treatment for large stone burdens, but
post-operative pain control remains challenging. Paravertebral block (PVB)
has been described for breast and thoracic surgery as an effective pain
control strategy, but is not often utilized for PCNL. The objective of
this study was to evaluate the effect of paravertebral block on pain
control and opioid use following PCNL. Materials and methods (NA for case
report) This was a prospective, randomized, double-blind,
placebo-controlled study and was approved by the IRB at Loyola University
Medical Center. Willing patients undergoing unilateral PCNL for stone
disease were consented and randomized to receive either PVB or placebo
intervention in the preoperative area. PVB or the placebo injection were
performed by an attending anesthesiologist on the acute pain service,
separate from the team providing anesthesia in the operating room. The PVB
consists of a single injection of 20 mL of 0.5% bupivacaine with
epinephrine into the T10 paravertebral space under ultrasound guidance.
For the placebo intervention, the ultrasound probe is applied, the skin is
infiltrated with lidocaine, and pressure is held to mimic injection. The
patient, surgeon, and anesthesia team were blinded to the study group.
Patients received patientcontrolled analgesia (PCA) following surgery.
Outcomes were visual analog scale (VAS) pain scores, intra-operative and
post-operative opioid use, and anti-emetic use. Statistical analysis was
performed using paired t-tests for continuous variables and chi-square
tests for categorical variables. Results/Case report The 45 patients
enrolled in the study had no difference in baseline characteristics. There
were no complications attributed to the PVB. The average VAS pain score
was lower in the PVB group. Intra-operative opioid use, post operative
opioid use, frequency of opioid use, and anti-emetic use were
significantly lower in the PVB group as compared to the control group. The
time from the conclusion of surgery to the first administration of opioids
was longer in the PVB group. Discussion To our knowledge, this is the
first randomized, double-blind, placebo-controlled trial investigating the
use of PVB in PCNL. PVB prior to PCNL improved average VAS pain scores and
decreased both intra-operative and post-operative opioid use. The
reduction in opioid use likely leads to improved nausea as reflected in
decreased anti-emetic use. PVB should be considered an effective strategy
to reduce pain for patients undergoing PCNL.

<44>
Accession Number
619770352
Author
Alkharabsheh S.K.; Chung M.; Al Halabi S.
Institution
(Alkharabsheh, Chung, Al Halabi) ClevelandOHUnited States
Title
Statin therapy impact on postoperative atrial fibrillation in patients
undergoing cardiac surgery.
Source
Journal of Clinical Lipidology. Conference: 2015 Annual Scientific
Sessions of the National Lipid Association, NLA 2015. United States. 9 (3)
(pp 472-473), 2015. Date of Publication: May-June 2015.
Publisher
Elsevier Ltd
Abstract
Background/Synopsis: Postoperative Atrial fibrillation (POAF) is a common
post-operative complication of cardiac surgery. It can be seen in up to to
45% of patient. POAF has been associated with increased morbidity and
mortality. Statin have been proposed as one of the interventions which may
help reduce the incidence of POAF. Objective/Purpose: Identify role of
statin in preventing postoperative atrial fibrillation in patients
undergoing cardiac surgery. Methods: We performed a meta-analysis of
randomized controlled trials (RCTs) comparing statins to placebo in
preventing post cardiac surgery atrial fibrillation. Pubmed, Medline,
Embase, and Cochrane was searched for prospective RCTs that compared
statins to placebo on incidence of AF in patients undergoing cardiac
surgery. Study quality was assessed using the Jadad score. Heterogeneity
of the studies was analyzed by Cochran's Q statistics. Mantel Haenszel
relative risk and mean difference were calculated using the random effect
model. Results: Eight randomized control trials met our inclusion criteria
and included 2,726 patients. The use of statin preoperatively was
associated with 42% reduction in the incidence of atrial fibrillation when
compared to placebo (Table presented) (RR 0.58; 95% CI 0.41; 0.83;
P50.003). The number needed to treat to prevent one episode of
postoperative AF is 20 patients. Significant heterogeneity was noted among
the reported outcome, which was mainly driven by one trial. Upon examining
trials that looked at the use of AF in patients undergoing CABG, statin
was associated with 53% reduction in postoperative AF ((RR 0.47; 95% CI
0.34; 0.63; P,0.001). The number needed to treat to prevent one episode of
postoperative AF is three patients. No evidence of heterogeneity was
observed among the reported outcome. Conclusions: In patient undergoing
cardiac surgery, patient will likely benefit from preoperative statin
therapy to prevention POAF.

<45>
Accession Number
619770433
Author
Anonymous
Title
Scientific Poster Abstracts Selected for the National Lipid Association
2015 Annual Scientific Sessions.
Source
Journal of Clinical Lipidology. Conference: 2015 Annual Scientific
Sessions of the National Lipid Association, NLA 2015. United States. 9 (3)
(no pagination), 2015. Date of Publication: May-June 2015.
Publisher
Elsevier Ltd
Abstract
The proceedings contain 92 papers. The topics discussed include:
biomarkers of cholesterol homeostasis in a clinical laboratory database
sample comprising 667,718 patients; use of a blood-based age/sex/gene
expression test was associated with prescriptions for lipid-lowering
medications and lifestyle changes among symptomatic patients at increased
cardiovascular risk for obstructive coronary artery disease: subgroup
analysis; alirocumab treatment effect on non-HDL-C: pooled analyses of 10
phase 3 trials in the ODYSSEY program; statin therapy impact on
postoperative atrial fibrillation in patients undergoing cardiac surgery;
a comparative study of four independent methods to measure LDL particle
concentration; body mass index and apolipoproteins C-III, B, and A-I in
young adult Cherokee; an electronic phenotyping algorithm to rapidly
ascertain familial hypercholesterolemia in healthcare systems; genetic
diagnosis of familial hypercholesterolemia in a community lipid clinic;
universal vs. selective pediatric lipid screening in the diagnosis of
familial hypercholesterolemia; pradigastat, a diacylglycerol
acyltransferase 1 inhibitor, reduces fasting triglyceride levels in
familial chylomicronemia; prevalence of atherosclerotic cardiovascular
disease (ASCVD) and diabetes populations in the united states;
identification and characterization of patients with untreated or
undertreated familial hypercholesterolemia: a single center retrospective
study; coronary artery disease risk in a Saudi Arabia population,
lipoprotein subclass distribution, and gender differences; and higher
prevalence of atherogenic lipoproteins in overweight/obese T2DM
adolescents relative to T1DM counterparts.

<46>
Accession Number
614148066
Author
Meersch M.; Schmidt C.; Hoffmeier A.; Van Aken H.; Wempe C.; Gerss J.;
Zarbock A.
Institution
(Meersch, Schmidt, Van Aken, Wempe, Zarbock) Department of Anesthesiology,
Intensive Care and Pain Medicine University, Hospital Munster,
Albert-Schweitzer-Campus 1, Building A1, Munster 48149, Germany
(Hoffmeier) Department of Cardiac Surgery, University of Munster, Munster,
Germany
(Gerss) Institute of Biostatistics and Clinical Research, University of
Munster, Munster, Germany
Title
Prevention of cardiac surgery-associated AKI by implementing the KDIGO
guidelines in high risk patients identified by biomarkers: the PrevAKI
randomized controlled trial.
Source
Intensive Care Medicine. 43 (11) (pp 1551-1561), 2017. Date of
Publication: 01 Nov 2017.
Publisher
Springer Verlag (E-mail: service@springer.de)
Abstract
Purpose: Care bundles are recommended in patients at high risk for acute
kidney injury (AKI), although they have not been proven to improve
outcomes. We sought to establish the efficacy of an implementation of the
Kidney Disease Improving Global Outcomes (KDIGO) guidelines to prevent
cardiac surgery-associated AKI in high risk patients defined by renal
biomarkers. Methods: In this single-center trial, we examined the effect
of a "KDIGO bundle" consisting of optimization of volume status and
hemodynamics, avoidance of nephrotoxic drugs, and preventing hyperglycemia
in high risk patients defined as urinary [TIMP-2].[IGFBP7] > 0.3
undergoing cardiac surgery. The primary endpoint was the rate of AKI
defined by KDIGO criteria within the first 72 h after surgery. Secondary
endpoints included AKI severity, need for dialysis, length of stay, and
major adverse kidney events (MAKE) at days 30, 60, and 90. Results: AKI
was significantly reduced with the intervention compared to controls [55.1
vs. 71.7%; ARR 16.6% (95 CI 5.5-27.9%); p = 0.004]. The implementation of
the bundle resulted in significantly improved hemodynamic parameters at
different time points (p < 0.05), less hyperglycemia (p < 0.001) and use
of ACEi/ARBs (p < 0.001) compared to controls. Rates of moderate to severe
AKI were also significantly reduced by the intervention compared to
controls. There were no significant effects on other secondary outcomes.
Conclusion: An implementation of the KDIGO guidelines compared with
standard care reduced the frequency and severity of AKI after cardiac
surgery in high risk patients. Adequately powered multicenter trials are
warranted to examine mortality and long-term renal outcomes.<br/>Copyright
&#xa9; 2017, The Author(s).

<47>
Accession Number
616059009
Author
Bleiziffer S.; Bosmans J.; Brecker S.; Gerckens U.; Wenaweser P.;
Tamburino C.; Linke A.
Institution
(Bleiziffer) Clinic for Cardiovascular Surgery, Department of
Cardiovascular Surgery, German Heart Center, Technical University Munich,
Lazarettstr. 36, Munich 80636, Germany
(Bosmans) Cardiovascular Diseases Department, Antwerp University Hospital,
Edegem, Belgium
(Brecker) Cardiology Clinical Academic Group, St. George's Hospital,
London, United Kingdom
(Gerckens) Cardiology Department, Gemeinschaftskrankenhaus, Bonn, Germany
(Wenaweser) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
(Tamburino) Cardiology Unit, Ferrarotto Hospital, University of Catania,
Catania, Italy
(Linke) Department of Internal Medicine and Cardiology, University of
Leipzig Heart Center, Leipzig, Germany
Title
Insights on mid-term TAVR performance: 3-year clinical and
echocardiographic results from the CoreValve ADVANCE study.
Source
Clinical Research in Cardiology. 106 (10) (pp 784-795), 2017. Date of
Publication: 01 Oct 2017.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: Extensive evidence relating to transcatheter aortic valve
replacement (TAVR) has accumulated in recent years, but mid-term outcomes
are less reported. We investigated 996 patients after implantation of the
CoreValve prosthesis for severe aortic stenosis in a real-world setting.
Objective: To report clinical and echocardiographic 3-year results from
the ADVANCE study. Methods: ADVANCE is a prospective, multicenter, fully
monitored, nonrandomized clinical study. This analysis assessed
valve-related events, predictors of early and mid-term mortality after
TAVR, and systolic and diastolic prosthesis performance over 3 years.
Results: Three years after TAVR, the rate of major adverse
cardiac/cerebrovascular events was 38.5%. All-cause mortality was 33.7%;
cardiovascular mortality, 22.3%; VARC-1 stroke, 6.5%; and New York Heart
Association class III/IV, 19.5%. Mean effective orifice area was
consistently 1.7 cm² from discharge to 3 years, and average
mean aortic valve gradient remained <=10 mmHg. At 3 years, 12.6% of
patients had moderate and none had severe paravalvular regurgitation.
Multivariable analysis identified Society of Thoracic Surgeons (STS)
score, device migration, prior atrial fibrillation, and major vascular
complication as predictors of early mortality. Predictors of mid-term
mortality included male gender, STS score, history of chronic obstructive
pulmonary disease, history of cancer, stroke, life-threatening/disabling
or major bleeding, and valve deterioration. Conclusions: Our 3-year data
demonstrate significant hemodynamic benefits and durable symptom relief
after CoreValve prosthesis implantation. Postprocedural patient management
should be carefully considered, since postprocedural valve-related events
were identified as independent predictors of mid-term mortality. Trial
registration: ClinicalTrials.gov, NCT01074658.<br/>Copyright &#xa9; 2017,
Springer-Verlag Berlin Heidelberg.

<48>
Accession Number
618030176
Author
Kandzari D.E.; Mauri L.; Koolen J.J.; Massaro J.M.; Doros G.;
Garcia-Garcia H.M.; Bennett J.; Roguin A.; Gharib E.G.; Cutlip D.E.;
Waksman R.
Institution
(Kandzari) Piedmont Heart Institute, Atlanta, GA, United States
(Mauri) Divison of Cardiovascular Medicine, Brigham and Women's Hospital,
Boston, MA, United States
(Koolen) Catharina Hospital, Eindhoven, Netherlands
(Massaro, Doros) Department of Biostatistics and Epidemiology, Boston
University School of Public Health, Boston, MA, United States
(Doros) Baim Institute for Clinical Research, Boston, MA, United States
(Garcia-Garcia, Waksman) Division of Interventional Cardiology, MedStar
Cardiovascular Research Network, MedStar Washington Hospital Center,
Washington, DC, United States
(Bennett) Department of Cardiovascular Medicine, University Hospitals
Leuven, Leuven, Belgium
(Roguin) Department of Cardiology, Rambam Medical Center, Haifa, Israel
(Gharib) Charleston Area Medical Center, Charleston, WV, United States
(Cutlip) Beth Israel Deaconess Medical Center, Baim Institute for Clinical
Research, Boston, MA, United States
Title
Ultrathin, bioresorbable polymer sirolimus-eluting stents versus thin,
durable polymer everolimus-eluting stents in patients undergoing coronary
revascularisation (BIOFLOW V): a randomised trial.
Source
The Lancet. 390 (10105) (pp 1843-1852), 2017. Date of Publication: 21 - 27
October 2017.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background The development of coronary drug-eluting stents has included
use of new metal alloys, changes in stent architecture, and use of
bioresorbable polymers. Whether these advancements improve clinical safety
and efficacy has not been shown in previous randomised trials. We aimed to
examine the clinical outcomes of a bioresorbable polymer sirolimus-eluting
stent compared with a durable polymer everolimus-eluting stent in a broad
patient population undergoing percutaneous coronary intervention. Methods
BIOFLOW V was an international, randomised trial done in patients
undergoing elective and urgent percutaneous coronary intervention in 90
hospitals in 13 countries (Australia, Belgium, Canada, Denmark, Germany,
Hungary, Israel, the Netherlands, New Zealand, South Korea, Spain,
Switzerland, and the USA). Eligible patients were those aged 18 years or
older with ischaemic heart disease undergoing planned stent implantation
in de-novo, native coronary lesions. Patients were randomly assigned (2:1)
to either an ultrathin strut (60 mum) bioresorbable polymer
sirolimus-eluting stent or to a durable polymer everolimus-eluting stent.
Randomisation was via a central web-based data capture system (mixed
blocks of 3 and 6), and stratified by study site. The primary endpoint was
12-month target lesion failure. The primary non-inferiority comparison
combined these data from two additional randomised trials of bioresorbable
polymer sirolimus-eluting stent and durable polymer everolimus-eluting
stent with Bayesian methods. Analysis was by intention to treat. The trial
is registered with ClinicalTrials.gov, number NCT02389946. Findings
Between May 8, 2015, and March 31, 2016, 4772 patients were recruited into
the study. 1334 patients met inclusion criteria and were randomly assigned
to treatment with bioresorbable polymer sirolimus-eluting stents (n=884)
or durable polymer everolimus-eluting stents (n=450). 52 (6%) of 883
patients in the bioresorbable polymer sirolimus-eluting stent group and 41
(10%) of 427 patients in the durable polymer everolimus-eluting stent
group met the 12-month primary endpoint of target lesion failure (95% CI
-6.84 to -0.29, p=0.0399), with differences in target vessel myocardial
infarction (39 [5%] of 831 patients vs 35 [8%] of 424 patients, p=0.0155).
The posterior probability that the bioresorbable polymer sirolimus-eluting
stent is non-inferior to the durable polymer everolimus-eluting stent was
100% (Bayesian analysis, difference in target lesion failure frequency
-2.6% [95% credible interval -5.5 to 0.1], non-inferiority margin 3.85%,
n=2208). Interpretation The outperformance of the ultrathin, bioresorbable
polymer sirolimus-eluting stent over the durable polymer
everolimus-eluting stent in a complex patient population undergoing
percutaneous coronary intervention suggests a new direction in improving
next generation drug-eluting stent technology. Funding
BIOTRONIK.<br/>Copyright &#xa9; 2017 Elsevier Ltd

<49>
Accession Number
619613489
Author
Aboul-Hassan S.S.; Stankowski T.; Marczak J.; Peksa M.; Nawotka M.;
Stanislawski R.; Kryszkowski B.; Cichon R.
Institution
(Aboul-Hassan, Marczak, Peksa, Nawotka, Stanislawski) Department of
Cardiac Surgery, MEDINET Heart Center Ltd., Nowa Sol, Poland
(Stankowski) Department of Cardiac Surgery, Sana-Heart Center Cottbus,
Cottbus, Germany
(Marczak) Department of Cardiac Surgery, Wroclaw Medical University,
Wroclaw, Poland
(Kryszkowski) Department of General and Oncological Surgery, Hospital in
Jelenia Gora, Jelenia Gora, Poland
(Cichon) Department of Cardiac Surgery, Warsaw Medical University, Warsaw,
Poland
Title
The use of preoperative aspirin in cardiac surgery: A systematic review
and meta-analysis.
Source
Journal of Cardiac Surgery. 32 (12) (pp 758-774), 2017. Date of
Publication: December 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: Despite the fact that aspirin is of benefit to patients
following coronary artery bypass grafting (CABG), continuation or
administration of preoperative aspirin before CABG or any cardiac surgical
procedure remains controversial. Therefore, we performed a systematic
review and meta-analysis to assess the influence of preoperative aspirin
administration on patients undergoing cardiac surgery. Materials and
Methods: Medline database was searched using OVID SP interface. Similar
searches were performed separately in EMBASE, PubMed, and Cochrane Central
Registry of Controlled Trials. Results: Twelve randomized controlled
trials and 28 observational studies met our inclusion criteria and were
included in the meta-analysis. The use of preoperative aspirin in patients
undergoing CABG at any dose is associated with reduced early mortality as
well as a reduced incidence of postoperative acute kidney injury (AKI).
Low-dose aspirin (<=160 mg/d) is associated with a decreased incidence of
perioperative myocardial infarction (MI). Administration of preoperative
aspirin at any dose in patients undergoing cardiac surgery increases
postoperative bleeding. Despite this effect of preoperative aspirin, it
did not increase the rates of surgical re-exploration due to excessive
postoperative bleeding nor did it increase the rates of packed red blood
cell transfusions (PRBC) when preoperative low-dose aspirin (<=160 mg/d)
was administered. Conclusions: Preoperative aspirin increases the risk for
postoperative bleeding. However, this did not result in an increased need
for chest re-exploration and did not increase the rates of PRBC
transfusion when preoperative low-dose (<=160 mg/d) aspirin was
administered. Aspirin at any dose is associated with decreased mortality
and AKI and low-dose aspirin (<=160 mg/d) decreases the incidence of
perioperative MI.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<50>
Accession Number
619450210
Author
Dalbeth N.; Saag K.G.; Palmer W.E.; Choi H.K.; Hunt B.; MacDonald P.A.;
Thienel U.; Gunawardhana L.
Institution
(Dalbeth) University of Auckland, Auckland, New Zealand
(Saag) University of Alabama at Birmingham, United States
(Palmer, Choi) Massachusetts General Hospital, Harvard Medical School,
Boston, United States
(Hunt, MacDonald, Gunawardhana) Takeda Development Center Americas,
Deerfield, IL, United States
(Thienel) RRD International, Rockville, MD, United States
Title
Effects of Febuxostat in Early Gout: A Randomized, Double-Blind,
Placebo-Controlled Study.
Source
Arthritis and Rheumatology. 69 (12) (pp 2386-2395), 2017. Date of
Publication: December 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objective: To assess the effect of treatment with febuxostat versus
placebo on joint damage in hyperuricemic subjects with early gout (1 or 2
gout flares). Methods: In this double-blind, placebo-controlled study, 314
subjects with hyperuricemia (serum uric acid [UA] level of >=7.0 mg/dl)
and early gout were randomized 1:1 to receive once-daily febuxostat 40 mg
(increased to 80 mg if the serum UA level was >=6.0 mg/dl on day 14) or
placebo. The primary efficacy end point was the mean change from baseline
to month 24 in the modified Sharp/van der Heijde erosion score for the
single affected joint. Additional efficacy end points included change from
baseline to month 24 in the Rheumatoid Arthritis Magnetic Resonance
Imaging Scoring (RAMRIS) scores for synovitis, erosion, and edema in the
single affected joint, the incidence of gout flares, and serum UA levels.
Safety was assessed throughout the study. Results: Treatment with
febuxostat did not lead to any notable changes in joint erosion over 2
years. In both treatment groups, the mean change from baseline to month 24
in the modified Sharp/van der Heijde erosion score for the single affected
joint was minimal, with no between-group differences. However, treatment
with febuxostat significantly improved the RAMRIS synovitis score at month
24 compared with placebo treatment (change from baseline -0.43 versus
-0.07; P <0.001), decreased the overall incidence of gout flares (29.3%
versus 41.4%; P < 0.05), and improved serum UA control (62.8% versus 5.7%;
P < 0.001). No major safety concerns were reported. Conclusion:
Urate-lowering therapy with febuxostat improved magnetic resonance
imaging-determined synovitis and reduced the incidence of gout flares in
subjects with early gout.<br/>Copyright &#xa9; 2017 The Authors. Arthritis
& Rheumatology published by Wiley Periodicals, Inc. on behalf of American
College of Rheumatology.

<51>
Accession Number
613971249
Author
Agus M.S.; Hirshberg E.; Srinivasan V.; Faustino E.V.; Luckett P.M.;
Curley M.A.; Alexander J.; Asaro L.A.; Coughlin-Wells K.; Duva D.; French
J.; Hasbani N.; Sisko M.T.; Soto-Rivera C.L.; Steil G.; Wypij D.; Nadkarni
V.M.
Institution
(Agus, Alexander, Coughlin-Wells, French, Soto-Rivera, Steil) Boston
Children's Hospital Division of Medicine Critical Care, Harvard Medical
School, 300 Longwood Ave., Boston, MA 02115, United States
(Hirshberg) Intermountain Medical Center Division of Pulmonary and
Critical Care, University of Utah, 100 Mario Capecchi Dr., Salt Lake City,
UT 84132, United States
(Srinivasan, Sisko, Nadkarni) The Children's Hospital of Philadelphia,
University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA
19104, United States
(Faustino) Yale-New Haven Children's Hospital, Yale University, 1 Park
St., New Haven, CT 06510, United States
(Luckett) Children's Medical Center Dallas, University of Texas
Southwestern, 1935 Medical District Dr., Dallas, TX 75235, United States
(Curley) University of Pennsylvania School of Nursing, University of
Pennsylvania, 418 Curie Blvd., Philadelphia, PA 19104, United States
(Asaro, Duva, Hasbani, Wypij) Boston Children's Hospital Department of
Cardiology, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115,
United States
Title
Design and rationale of Heart and Lung Failure - Pediatric INsulin
Titration Trial (HALF-PINT): A randomized clinical trial of tight glycemic
control in hyperglycemic critically ill children.
Source
Contemporary Clinical Trials. 53 (pp 178-187), 2017. Date of Publication:
01 Feb 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives Test whether hyperglycemic critically ill children with
cardiovascular and/or respiratory failure experience more ICU-free days
when assigned to tight glycemic control with a normoglycemic versus
hyperglycemic blood glucose target range. Design Multi-center randomized
clinical trial. Setting Pediatric ICUs at 35 academic hospitals. Patients
Children aged 2 weeks to 17 years receiving inotropic support and/or acute
mechanical ventilation, excluding cardiac surgical patients. Interventions
Patients receive intravenous insulin titrated to either 80-110 mg/dL
(4.4-6.1 mmol/L) or 150-180 mg/dL (8.3-10.0 mmol/L). The intervention
begins upon confirmed hyperglycemia and ends when the patient meets
study-defined ICU discharge criteria or after 28 days. Continuous glucose
monitoring, a minimum glucose infusion, and an explicit insulin infusion
algorithm are deployed to achieve the BG targets while minimizing
hypoglycemia risk. Measurements and main results The primary outcome is
ICU-free days (equivalent to 28-day hospital mortality-adjusted ICU length
of stay). Secondary outcomes include 90-day hospital mortality, organ
dysfunction scores, ventilator-free days, nosocomial infection rate,
neurodevelopmental outcomes, and nursing workload. To detect an increase
of 1.25 ICU-free days (corresponding to a 20% relative reduction in 28-day
hospital mortality and a one-day reduction in ICU length of stay), 1414
patients are needed for 80% power using a two-sided 0.05 level test.
Conclusions This trial tests whether hyperglycemic critically ill children
randomized to 80-110 mg/dL benefit more than those randomized to 150-180
mg/dL. This study implements validated bedside support tools including
continuous glucose monitoring and a computerized algorithm to enhance
patient safety and ensure reproducible bedside decision-making in
achieving glycemic control.<br/>Copyright &#xa9; 2017 The Authors

<52>
Accession Number
610536631
Author
Cutrell J.B.; Barros N.; McBroom M.; Luby J.; Minhajuddin A.; Ring W.S.;
Greilich P.E.
Institution
(Cutrell, Barros, McBroom, Luby, Minhajuddin, Ring, Greilich) University
of Texas Southwestern Medical Center, Dallas, TX, United States
(Cutrell) Veterans Affairs North Texas Health Care System, Dallas, TX,
United States
(Barros, Luby) Parkland Health and Hospital System, Dallas, TX, United
States
Title
Risk factors for deep sternal wound infection after cardiac surgery:
Influence of red blood cell transfusions and chronic infection.
Source
American Journal of Infection Control. 44 (11) (pp 1302-1309), 2016. Date
of Publication: 01 Nov 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Deep sternal wound infection (DSWI) following cardiac surgery
is a serious complication, but risk factors associated with DSWI have not
been fully elucidated. Methods We analyzed all DSWI cases at our
institution from 2010-2013 in adult cardiac median sternotomy cases, based
on Society of Thoracic Surgeons or National Healthcare Safety Network
definitions, but with 1-year surveillance postsurgery. Controls were
matched 3:1 per case for procedure, age, and year of surgery. Demographic
and operative data were pulled from Society of Thoracic Surgeons database
and chart review. Potential variables were evaluated using univariate and
multivariate conditional logistic regression. Results Out of 1,894
surgeries performed, 39 DSWI cases (2%) and 117 controls were identified.
In univariate analyses, patients with red blood cell (RBC) transfusion>=4
units, any platelet transfusion, previous infections, and chronic
infections were associated with higher DSWI. RBC transfusion>=4 units
(P=.037) and chronic infections (P=.029) remained significant risk factors
for DSWI in multivariate analysis. Preoperative anemia alone was not
associated with more DSWI, but its interaction with RBC transfusion>=4
units was significant. Conclusions High-volume RBC transfusions and
chronic infections were strongly associated with DSWI in our population
and represent potentially modifiable areas for improvement.<br/>Copyright
&#xa9; 2016 Association for Professionals in Infection Control and
Epidemiology, Inc.

<53>
Accession Number
613351503
Author
Chang M.; Ahn J.M.; Lee C.W.
Institution
(Chang, Ahn, Lee) Duke University Medical Center, Durham, NC, United
States
(Lee) University of Ulsan, Seoul, South Korea
Title
Pooled RCTs: CABG reduces mortality more than PCI with des in nondiabetic
patients with multivessel CAD.
Source
Annals of Internal Medicine. 165 (10) (pp JC51), 2016. Date of
Publication: 15 Nov 2016.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<54>
[Use Link to view the full text]
Accession Number
608901093
Author
Hou W.-H.; Lai C.-H.; Jeng C.; Hsu C.-C.; Shih C.-M.; Tsai P.-S.
Institution
(Hou) Master Program in Long-Term Care, School of Gerontology and Health
Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
(Republic of China)
(Jeng, Tsai) Graduate Institute of Nursing, School of Nursing, College of
Nursing, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist,
Taipei City 110, Taiwan (Republic of China)
(Hou, Lai) Department of Physical Medicine and Rehabilitation, Taipei
Medical University Hospital, Taipei, Taiwan (Republic of China)
(Tsai) Sleep Science Center, Taipei Medical University Hospital, Taipei,
Taiwan (Republic of China)
(Lai) Department of Physical Medicine and Rehabilitation, School of
Medicine, Taipei Medical University, Taipei, Taiwan (Republic of China)
(Hsu) Division of Cardiovascular Surgery, Department of Surgery, Taipei
Medical University Hospital, Taipei, Taiwan (Republic of China)
(Hsu) Department of Surgery, College of Medicine, Taipei Medical
University, Taipei, Taiwan (Republic of China)
(Shih) Department of Medicine School of Medicine, College of Medicine,
Taipei Medical University, Taipei, Taiwan (Republic of China)
(Shih) Division of Cardiovascular Medicine, Department of Medicine, Taipei
Medical University Hospital, Taipei, Taiwan (Republic of China)
Title
Cardiac rehabilitation prevents recurrent revascularization in patients
with coronary heart disease: A population-based cohort study in Taiwan.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. 36 (4) (pp
250-257), 2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Purpose: To evaluate the effects of cardiac rehabilitation (CR) provided
within the first 3 months of revascularization on reducing recurrent
revascularization in patients with coronary heart disease in Taiwan.
Methods: In this population-based cohort study, we used the claims data of
1 million beneficiaries who were randomly selected from all beneficiaries
enrolled in Taiwan's National Health Insurance program from 1996 to 2000.
Between 2000 and 2007, 2838 patients underwent a first-event
revascularization. Of these patients, 442 (15.6%) underwent CR within the
first 3 months of admission for revascularization. The remaining
84.4%(n=2396) served as the non-CR group. All the study patients were
followed-up until the end of 2008 for any recurrent revascularization. A
propensity score-adjusted Cox proportional hazard model was used to
estimate the relative risk of recurrent revascularization associated with
CR. Result: During the 1- to 9-year follow-up, 69 patients (15.6%) in the
CR group and 840 (35.1%) patients in the non-CR group experienced
recurrent revascularization. The results of the propensity scoreadjusted
Cox proportional hazard regression analysis showed that CR was
significantly associated with a reduced risk of recurrent
revascularization with a hazard ratio of 0.48 (95%CI, 0.37 to - 0.62).
Conclusions: Cardiac rehabilitation within the first 3 months of
revascularization is significantly associated with a reduced risk of
recurrent revascularization. This preventive effect was more pronounced in
men compared with other subgroups of patients.<br/>&#xa9; Copyright 2016
Wolters Kluwer Health.

<55>
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

<56>
Accession Number
618256232
Author
Parma R.; Zembala M.O.; Dabrowski M.; Jagielak D.; Witkowski A.; Suwalski
P.; Dudek D.; Olszowka P.; Wojakowski W.; Przybylski R.; Gil R.;
Kusmierczyk M.; Lesiak M.; Sadowski J.; Dobrzycki S.; Ochala A.; Hoffman
P.; Kapelak B.; Kazmierczak J.; Jasinski M.; Stepinska J.; Szymanski P.;
Hryniewiecki T.; Kochman J.; Grygier M.; Zembala M.; Legutko J.; Rozanski
J.
Institution
(Parma, Wojakowski, Ochala) Division of Cardiology and Structural Heart
Diseases, SMK in Katowice, Medical University of Silesia, Katowice, Poland
(Zembala, Przybylski, Zembala) Department of Cardiac, Vascular and
Endovascular Surgery and Transplantology, Silesian Centre for Heart
Diseases, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland
(Dabrowski, Witkowski) Department of Interventional Cardiology and
Angiology, Institute of Cardiology, Warsaw, Poland
(Jagielak) Department of Cardiovascular Surgery, Medical University of
Gdansk, Gdansk, Poland
(Suwalski) Department of Cardiac Surgery, Central Clinical Hospital of the
Ministry of the Interior and Administration, Warsaw, Poland
(Dudek) Institute of Cardiology, Jagiellonian University Medical College,
Krakow, Poland
(Olszowka) Department of Cardiac Surgery, District Hospital 2, Rzeszow,
Poland
(Gil) Department of Invasive Cardiology, Central Clinical Hospital of the
Ministry of Interior and Administration, Warsaw, Poland
(Kusmierczyk, Rozanski) Department of Cardiac Surgery and Transplantology,
Institute of Cardiology, Warsaw, Poland
(Lesiak, Grygier) Department of Cardiology, Poznan University of Medical
Science, Poznan, Poland
(Sadowski, Kapelak) Department of Cardiovascular Surgery and
Transplantology, Jagiellonian University Medical College, Krakow, Poland
(Dobrzycki) Department of Invasive Cardiology, Medical University of
Bialystok, Bialystok, Poland
(Hoffman) Department of Congenital Cardiac Defects, Institute of
Cardiology, Warsaw, Poland
(Kazmierczak) Department of Cardiology, Pomeranian Medical University in
Szczecin, Poland
(Jasinski) Department of Cardiac Surgery, Wroclaw Medical University,
Wroclaw, Poland
(Stepinska) Department of Intensive Cardiac Care Clinic, Institute of
Cardiology, Warsaw, Poland
(Szymanski, Hryniewiecki) Department of Acquired Cardiac Defects,
Institute of Cardiology, Warsaw, Poland
(Kochman) 1st Department of Cardiology, Medical University of Warsaw,
Warsaw, Poland
(Legutko) 2nd Department of Cardiology, Jagiellonian University Medical
College, ul. Kopernika 17, Krakow 31-501, Poland
Title
Transcatheter aortic valve implantation. Expert Consensus of the
Association of Cardiovascular Interventions of the Polish Cardiac Society
and the Polish Society of Cardio-Thoracic Surgeons, approved by the Board
of the Polish Cardiac Society and National Consultants in Cardiology and
Cardiac Surgery.
Source
Kardiologia Polska. 75 (9) (pp 937-964), 2017. Date of Publication: 08 Sep
2017.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland. E-mail:
elzbieta.zabrocka@viamedica.pl)
Abstract
Patients with severe symptomatic aortic stenosis have a poor prognosis
with medical management alone, and surgical aortic valve replacement can
improve symptoms and survival. In recent years, transcatheter aortic valve
implantation (TAVI) has been demonstrated to improve survival in
inoperable patients and to be an alternative treatment in patients in whom
the risk of surgical morbidity or mortality is high or intermediate. A
representative expert committee, summoned by the Association of
Cardiovascular Interventions of the Polish Cardiac Society (ACVI) and the
Polish Society of Cardio-Thoracic Surgeons, developed this Consensus
Statement in transcatheter aortic valve implantation. It endorses the
important role of a multi-disciplinary "TAVI team" in selecting patients
for TAVI and defines operator and institutional requirements fundamental
to the establishment of a successful TAVI programme. The article
summarises current evidence and provides specific recommendations on
organisation and conduct of transcatheter treatment of patients with
aortic valve disease in Poland.<br/>&#xa9; Copyright Polskie Towarzystwo
Kardiologiczne 2017.

<57>
Accession Number
618680984
Author
Lv W.; Li S.; Liao Y.; Zhao Z.; Che G.; Chen M.; Feng Y.
Institution
(Lv, Liao, Zhao, Chen, Feng) Department of Cardiology, West China
Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, China
(Li, Che) Department of Thoracic Surgery, West China Hospital, Sichuan
University, Chengdu, China
Title
The 'obesity paradox' does exist in patients undergoing transcatheter
aortic valve implantation for aortic stenosis: A systematic review and
meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 25 (4) (pp 633-642),
2017. Date of Publication: 01 Oct 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Most recent studies have proposed the paradoxical benefits of obesity in
surgical populations. For patients who underwent transcatheter aortic
valve implantation (TAVI) for aortic stenosis, the prognostic roles of
obesity and high body mass index remain controversial. Therefore, the
objective of this meta-analysis was to evaluate whether the 'obesity
paradox' exists in patients undergoing TAVI. We searched in PubMed and
EMBASE to identify the eligible articles. Odds ratios and hazard ratios
with the corresponding 95% confidence intervals (CI) were adopted for
synthesizing short-term and long-term survival outcomes, respectively. The
level of heterogeneity and the publication bias between studies were also
estimated. Finally, there were 16 studies with 12 330 patients who met the
eligibility criteria and who were thus included in this review. When body
mass index was analysed as a continuous variable, each increase of 1 kg/m
2 was significantly associated with the lower 30-day mortality rate (odds
ratio = 0.95; 95% CI = 0.93-0.97; P < 0.001) and better long-term overall
survival (hazard ratio = 0.96; 95% CI = 0.94-0.97; P < 0.001) for patients
undergoing TAVI. The obese patients had a significantly lower risk of
30-day mortality after TAVI than did normal patients (odds ratio = 0.69;
95% CI = 0.50-0.95; P = 0.024). Further analyses indicated that the
obesity could be predictive of more favourable long-term overall survival
of TAVI (hazard ratio = 0.84; 95% CI = 0.72-0.97; P = 0.021). However, we
found no difference in procedural complications between the obese and
normal patients. In conclusion, higher body mass index and obesity seem to
have protective benefits on both short-term and long-term survival of TAVI
patients. Current evidence suggests that the 'obesity paradox' may really
exist in TAVI.<br/>Copyright &#xa9; The Author 2017. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<58>
Accession Number
618680863
Author
Nwaejike N.; Son A.Y.; Milano C.A.; Daneshmand M.A.
Institution
(Nwaejike, Milano, Daneshmand) Division of Cardiothoracic Surgery,
Department of Surgery, Duke University Medical Center, Durham, NC 27705,
United States
(Son) New York University School of Medicine, New York, NY, United States
Title
Is there a role for upper-extremity intra-aortic balloon counterpulsation
as a bridge-to-recovery or a bridge-to-transplant in the treatment of
end-stage heart failure?.
Source
Interactive Cardiovascular and Thoracic Surgery. 25 (4) (pp 654-658),
2017. Date of Publication: 01 Oct 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: Is there a role for
upper-extremity intra-aortic balloon pump counterpulsation (UE-IABP) in
the treatment of end-stage heart failure? Altogether 230 papers were found
using the reported search, of which 6 papers represented the best evidence
to answer the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. Of the 163
bridge-to-transplantation (BTT) patients, 141 (86.5%) were successfully
transplanted and of the 9 bridge-to-recovery (BTR) patients, 6 (66.7%)
were successfully weaned from the device. Length of support ranged from 3
to 152 days, and the most frequent complications were device malfunction
or migration necessitating exchange or repositioning, occurring at a
collective rate of 37.3%. UE-IABP is a minimally invasive and
cost-effective strategy that provides haemodynamic support while
preserving both the mediastinum and the functional status in BTR and BTT
patients who may not tolerate more invasive modes of mechanical
circulatory support. We conclude that UE-IABP can be used as a
bridge-to-recovery (BTR) or transplant (BTT) in patients with end-stage
heart failure.<br/>Copyright &#xa9; The Author 2017. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<59>
Accession Number
618680739
Author
Elsayed H.H.; Gamal M.; Raslan S.; Hamid H.A.
Institution
(Elsayed) Department of Thoracic Surgery, Ain Shams University Hospital,
Abbasia Square, Cairo 31224, Egypt
(Gamal) Department of Cardiac Surgery, Nasser Institute for Research and
Treatment, Cairo, Egypt
(Raslan) Department of Cardiothoracic Surgery, Al Azhar University, Cairo,
Egypt
(Hamid) Department of Cardiothoracic Surgery, Ain Shams University
Hospital, Cairo, Egypt
Title
Video-assisted thoracoscopic thymectomy for non-thymomatous myasthenia
gravis: A right-sided or left-sided approach?.
Source
Interactive Cardiovascular and Thoracic Surgery. 25 (4) (pp 651-653),
2017. Date of Publication: 01 Oct 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was in [patients undergoing
video-assisted thoracoscopic thymectomy for myasthenia gravis (MG)] is a
[left-sided approach] superior to a [right-sided approach] in terms of
[clinical outcome]? Two hundred and fifty-nine papers were found using the
reported search. In looking at both procedures, we selected studies with a
sizeable number of patients performing or studying both procedures and
comparing their outcome. Hence, only 4 studies represented the best
evidence to answer the clinical question. The authors, journal, date,
country, study type, patient group, relevant outcomes and results of these
papers are tabulated. Two studies compared their clinical experience with
a right-sided versus a left-sided video assisted thoracoscopic surgery
thymectomy approach, while 1 study compared using a bilateral versus a
unilateral right-sided approach in patients with non-thymomatous MG. The
number of patients studied included 31, 107 and 103 patients,
respectively. All 3 studies demonstrated no difference regarding surgical
time, intraoperative blood loss, postoperative hospital stay,
postoperative complications and therapeutic effects (the last study
compared the 5-year complete stable remission rate). All 3 studies
concluded that both approaches are feasible, effective and comparable in
operative and long-term results for the treatment of non-thymomatous MG.
One anatomical study compared both approaches in 10 cadavers, 5 in each
group. They studied the size of the specimen resected and visualization of
different anatomic sites via each approach. Visualization was superior
using the left-sided approach, while a right-sided approach resulted in
slightly higher chances of an incomplete resection. The study concluded
that a left-sided approach achieves a better chance of radical
thoracoscopic thymectomy due to anatomic considerations. In conclusion,
despite 1 cadaveric study suggesting that a left-sided approach may
achieve more complete resection, possibly due to anatomical
considerations, there are no differences in outcomes with either
unilateral approach in terms of complications, hospital stay or long-term
symptom relief.<br/>Copyright &#xa9; The Author 2017. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<60>
[Use Link to view the full text]
Accession Number
612933994
Author
Royse C.F.; Saager L.; Whitlock R.; Ou-Young J.; Royse A.; Vincent J.;
Devereaux P.J.; Kurz A.; Awais A.; Panjasawatwong K.; Sessler D.I.
Institution
(Royse, Ou-Young, Royse) Department of Surgery, University of Melbourne,
PO Box 2135, Melbourne, VIC 3050, Australia
(Royse) Department of Anaesthesia and Pain Management, Australia
(Royse) Department of Cardiothoracic Surgery, Royal Melbourne Hospital,
Melbourne, VIC, Australia
(Saager, Royse, Kurz, Awais, Panjasawatwong, Sessler) Department of
Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland,
OH, United States
(Whitlock) Department of Surgery, United States
(Whitlock, Vincent, Devereaux) Population Health Research Institute,
Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
(Devereaux, Panjasawatwong) Department of Anesthesiology, Faculty of
Medicine, Chiang Mai University, Thailand
Title
Impact of Methylprednisolone on Postoperative Quality of Recovery and
Delirium in the Steroids in Cardiac Surgery Trial: A Randomized,
Double-blind, Placebo-controlled Substudy.
Source
Anesthesiology. 126 (2) (pp 223-233), 2017. Date of Publication: 01 Feb
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background: Inflammation after cardiopulmonary bypass may contribute to
postoperative delirium and cognitive dysfunction. The authors evaluated
the effect of high-dose methylprednisolone to suppress inflammation on the
incidence of delirium and postoperative quality of recovery after cardiac
surgery. Methods: Five hundred fifty-five adults from three hospitals
enrolled in the randomized, double-blind Steroids in Cardiac Surgery trial
were randomly allocated to placebo or 250 mg methylprednisolone at
induction and 250 mg methylprednisolone before cardiopulmonary bypass.
Each completed the Postoperative Quality of Recovery Scale before surgery
and on days 1, 2, and 3 and 1 and 6 months after surgery and the Confusion
Assessment Method scale for delirium on days 1, 2, and 3. Recovery was
defined as returning to preoperative values or improvement at each time
point. Results: Four hundred eighty-two participants for recovery and 498
participants for delirium were available for analysis. The quality of
recovery improved over time but without differences between groups in the
primary endpoint of overall recovery (odds ratio range over individual
time points for methylprednisolone, 0.39 to 1.45; 95% CI, 0.08-2.04 to
0.40-5.27; P = 0.943) or individual recovery domains (all P > 0.05). The
incidence of delirium was 10% (control) versus 8% (methylprednisolone; P =
0.357), with no differences in delirium subdomains (all P > 0.05). In
participants with normal (51%) and low baseline cognition (49%), there
were no significant differences favoring methylprednisolone in any domain
(all P > 0.05). Recovery was worse in patients with postoperative delirium
in the cognitive (P = 0.004) and physiologic (P < 0.001) domains.
Conclusions: High-dose intraoperative methylprednisolone neither reduces
delirium nor improves the quality of recovery in high-risk cardiac
surgical patients.

<61>
Accession Number
612858391
Author
Ding N.; Ni B.-Q.; Wang H.; Ding W.-X.; Xue R.; Lin W.; Kai Z.; Zhang
S.-J.; Zhang X.-L.
Institution
(Ding, Wang, Ding, Xue, Zhang) Department of Respiratory and Critical Care
Medicine, First Affiliated Hospital of Nanjing Medical University, 300
Guangzhou Road, Nanjing 210029, China
(Ni, Zhang) Department of Cardiovascular Surgery, First Affiliated
Hospital of Nanjing Medical University, Guangzhou 300 Road, Nanjing
210029, China
(Lin) Department of Geriatric Medicine, First Affiliated Hospital of
Nanjing Medical University, Nanjing, China
(Kai) Pancreas Center, First Affiliated Hospital of Nanjing Medical
University, Nanjing, China
Title
Obstructive sleep apnea increases the perioperative risk of cardiac valve
replacement surgery: A prospective single-center study.
Source
Journal of Clinical Sleep Medicine. 12 (10) (pp 1331-1337), 2016. Date of
Publication: 2016.
Publisher
American Academy of Sleep Medicine (2510 N. Frontage Road, Darien IL
60561, United States)
Abstract
Study Objectives: Sleep apnea is common in patients referred for cardiac
valve replacement (CVR). We aimed to determine the association of
obstructive sleep apnea (OSA) and central sleep apnea (CSA) with
perioperative events in CVR surgery in patients with rheumatic valvular
heart disease (RVHD). Methods: Between April 2010 and April 2014, 290
patients with RVHD undergoing CVR were screened for sleep apnea 1 to 7
days before CVR. Baseline medications, cardiac function, sleep parameters,
perioperative events, and related risk factors were evaluated. Results:
OSA patients had longer duration of intensive care unit (ICU) stay and
mechanical ventilation compared with no sleep-disordered breathing and CSA
patients. Patients with CSA had a higher rate of pacemaker use and higher
first dose of dobutamine in ICU. NYHA Class and the presence of OSA were
independently associated with overall worsening of postoperative recovery
(ICU stay . 25 h). Age, NYHA class, and the presence of OSA were
independently associated with postoperative respiratory insufficiency
(mechanical ventilation . 20 h). Preoperative atrial fibrillation,
pulmonary hypertension, and OSA were independently associated with
postoperative pacemaker use. Conclusions: RVHD patients with OSA have an
increased incidence of perioperative adverse events. OSA was independently
associated with overall postoperative recovery, respiratory insufficiency,
and higher rate of postoperative pacemaker use, while CSA was not
associated with postoperative events.

<62>
Accession Number
610759916
Author
Bhatt S.P.; Connett J.E.; Voelker H.; Lindberg S.M.; Westfall E.; Wells
J.M.; Lazarus S.C.; Criner G.J.; Dransfield M.T.
Institution
(Bhatt, Westfall, Wells, Dransfield) Division of Pulmonary, Allergy and
Critical Care Medicine, UAB Lung Health Center, University of Alabama at
Birmingham, Birmingham, AL, United States
(Connett, Voelker, Lindberg) Division of Biostatistics, University of
Minnesota, Minneapolis, MN, United States
(Wells, Dransfield) Birmingham Veterans Affairs Hospital, Birmingham, AL,
United States
(Lazarus) Division of Pulmonary, Critical Care, Allergy and Sleep
Medicine, University of California, San Francisco, San Francisco, CA,
United States
(Criner) Department of Thoracic Medicine and Surgery, Temple University
Hospital, Philadelphia, PA, United States
Title
beta-Blockers for the prevention of acute exacerbations of chronic
obstructive pulmonary disease (betaLOCK COPD): A randomised controlled
study protocol.
Source
BMJ Open. 6 (6) (no pagination), 2016. Article Number: e012292. Date of
Publication: 01 Jun 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction A substantial majority of chronic obstructive pulmonary
disease (COPD)-related morbidity, mortality and healthcare costs are due
to acute exacerbations, but existing medications have only a modest effect
on reducing their frequency, even when used in combination. Observational
studies suggest beta-blockers may reduce the risk of COPD exacerbations;
thus, we will conduct a randomised, placebo-controlled trial to
definitively assess the impact of metoprolol succinate on the rate of COPD
exacerbations. Methods and analyses This is a multicentre,
placebo-controlled, double-blind, prospective randomised trial that will
enrol 1028 patients with at least moderately severe COPD over a 3-year
period. Participants with at least moderate COPD will be randomised in a
1:1 fashion to receive metoprolol or placebo; the cohort will be enriched
for patients at high risk for exacerbations. Patients will be screened and
then randomised over a 2-week period and will then undergo a dose
titration period for the following 6weeks. Thereafter, patients will be
followed for 42 additional weeks on their target dose of metoprolol or
placebo followed by a 4-week washout period. The primary end point is time
to first occurrence of an acute exacerbation during the treatment period.
Secondary end points include rates and severity of COPD exacerbations;
rate of major cardiovascular events; all-cause mortality; lung function
(forced expiratory volume in 1s (FEV 1)); dyspnoea; quality of life;
exercise capacity; markers of cardiac stretch (pro-NT brain natriuretic
peptide) and systemic inflammation (high-sensitivity C reactive protein
and fibrinogen). Analyses will be performed on an intent-to-treat basis.
Ethics and dissemination The study protocol has been approved by the
Department of Defense Human Protection Research Office and will be
approved by the institutional review board of all participating
centres.<br/>Copyright &#xa9; Published by the BMJ Publishing Group
Limited.

<63>
Accession Number
611554444
Author
Stokes E.A.; Wordsworth S.; Bargo D.; Pike K.; Rogers C.A.; Brierley
R.C.M.; Angelini G.D.; Murphy G.J.; Reeves B.C.
Institution
(Stokes, Wordsworth, Bargo) Nuffield Department of Population Health,
Health Economics Research Centre, University of Oxford, Oxford, United
Kingdom
(Bargo) Eli Lilly and Company Limited, Lilly House, Basingstoke,
Hampshire, United Kingdom
(Pike, Rogers, Brierley, Reeves) Clinical Trials and Evaluation Unit,
School of Clinical Sciences, University of Bristol, Bristol, United
Kingdom
(Angelini) Bristol Heart Institute, School of Clinical Sciences,
University of Bristol, Bristol, United Kingdom
(Murphy) Dept. of Cardiovasc. Sciences and NIHR Leicester Biomedical
Research Unit in Cardiovascular Medicine, University of Leicester,
Leicester, United Kingdom
Title
Are lower levels of red blood cell transfusion more cost-effective than
liberal levels after cardiac surgery? Findings from the TITRe2 randomised
controlled trial.
Source
BMJ Open. 6 (8) (no pagination), 2016. Article Number: e011311. Date of
Publication: 01 Jul 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective To assess the incremental cost and cost-effectiveness of a
restrictive versus a liberal red blood cell transfusion threshold after
cardiac surgery. Design A within-Trial cost-effectiveness analysis with a
3-month time horizon, based on a multicentre superiority randomised
controlled trial from the perspective of the National Health Service (NHS)
and personal social services in the UK. Setting 17 specialist cardiac
surgery centres in UK NHS hospitals. Participants 2003 patients aged >16a
..years undergoing non-emergency cardiac surgery with a postoperative
haemoglobin of <9a ..g/dL. Interventions Restrictive (transfuse if
haemoglobin <7.5a ..g/dL) or liberal (transfuse if haemoglobin <9a ..g/dL)
threshold during hospitalisation after surgery. Main outcome measures
Health-related quality of life measured using the EQ-5D-3L to calculate
quality-Adjusted life years (QALYs). Results The total costs from surgery
up to 3a ..months were 17a ..945 and 18a ..127 in the restrictive and
liberal groups (mean difference is a '182, 95% CI a '1108 to 744). The
cost difference was largely attributable to the difference in the cost of
red blood cells. Mean QALYs to 3a ..months were 0.18 in both groups
(restrictive minus liberal difference is 0.0004, 95% CI a '0.0037 to
0.0045). The point estimate for the base-case cost-effectiveness analysis
suggested that the restrictive group was slightly more effective and
slightly less costly than the liberal group and, therefore,
cost-effective. However, there is great uncertainty around these results
partly due to the negligible differences in QALYs gained. Conclusions We
conclude that there is no clear difference in the cost-effectiveness of
restrictive and liberal thresholds for red blood cell transfusion after
cardiac surgery. Trial registration number ISRCTN70923932;
Results.<br/>Copyright &#xa9; Published by the BMJ Publishing Group
Limited.

<64>
Accession Number
619679405
Author
Talwar S.; Selvam M.S.; Makhija N.; Lakshmy R.; Choudhary S.K.; Sreenivas
V.; Airan B.
Institution
(Talwar, Selvam, Makhija, Lakshmy, Choudhary, Sreenivas, Airan)
Cardiothoracic Center and Department of Biostatistics, All India Institute
of Medical Sciences, New Delhi, India
Title
Effect of administration of allopurinol on postoperative outcomes in
patients undergoing intracardiac repair of tetralogy of Fallot.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (1) (pp 335-343),
2018. Date of Publication: January 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective To determine effects of allopurinol administration on outcomes
following intracardiac repair of tetralogy of Fallot (TOF). Materials and
Methods Fifty patients undergoing TOF repair were randomized to 2 groups
of 25 each: the allopurinol group (n = 25) and the placebo group (n = 25).
Postoperatively, inotropic score, rhythm, duration of mechanical
ventilation, cardiac output, intensive care unit (ICU) stay, and hospital
stay were assessed. Plasma troponin-I, superoxide dismutase (SOD),
interleukin (IL) 1-s, IL-6, and malondialdehyde were measured serially.
Results Inotropic score was lower in the allopurinol compared with placebo
group (11.04 +/- 5.70 vs 17.50 +/- 7.83; P =.02). Duration of ICU and
hospital stay was lower in the allopurinol group. Plasma levels of SOD
preoperative were (2.87 +/- 1.21 U/mL vs 4.5 +/- 2.08 U/mL; P =.012),
immediately following release of crossclamp (2.32 +/- 0.98 U/mL vs 5.32
+/- 2.81 U/mL; P <.001), and after termination of CPB (2.18 +/- 1.0.78
U/mL vs 3.44 +/- 1.99 U/mL; P =.003) between the placebo versus
allopurinol group, respectively. Postoperative levels of IL1-s and IL-6
were lower in the allopurinol group. Malondialdehyde levels following CPB
were lower in the allopurinol group (11.80 +/- 2.94 pg/mL in the placebo
vs 9.16 +/- 3.02 g/mL in the allopurinol group; P <.001). Conclusions
Allopurinol administration in patients undergoing intracardiac repair of
TOF is associated with reduced inotropic scores, duration of mechanical
ventilation, ICU stay, and hospital stay and favorable biochemical markers
of inflammation. Further studies in multiple setups are needed before
recommending it as a routine practice.<br/>Copyright &#xa9; 2017 The
American Association for Thoracic Surgery

<65>
Accession Number
614039652
Author
Roshanov P.S.; Walsh M.; Devereaux P.J.; MacNei S.D.; Lam N.; Hildebrand
A.M.; Acedillo R.R.; Mrkobrada M.; Chow C.K.; Lee V.W.; Thabane L.; Garg
A.X.
Institution
(Roshanov, MacNei, Acedillo) 1Lilibeth Caberto Kidney Clinical Research
Unit, London Health Sciences Centre, London, ON, Canada
(Roshanov, Walsh, Devereaux, Thabane) Department of Clinical Epidemiology
and Biostatistics, McMaster University, Hamilton, ON, Canada
(Walsh, Devereaux) Department of Medicine, McMaster University, Hamilton,
ON, Canada
(Walsh, Devereaux) Population Health Research Institute, Hamilton, ON,
Canada
(MacNei) Department of Otolaryngology Head and Neck Surgery and Department
of Oncology, Western University, London, ON, Canada
(MacNei, Garg) Institute for Clinical Evaluative Sciences, London, ON,
Canada
(Lam, Hildebrand) Division of Nephrology, University of Alberta, Edmonton,
AB, Canada
(Mrkobrada, Garg) Department of Medicine, Western University, London, ON,
Canada
(Chow) George Institute for Global Health, Sydney Medical School,
University of Sydney, Sydney, NSW, Australia
(Chow) Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
(Lee) Department of Renal Medicine, Westmead Hospital, Western Sydney
Local Health District, Sydney, NSW, Australia
(Lee) Centre for Transplant and Renal Research, Westmead Institute for
Medical Research, University of Sydney, Westmead, NSW, Australia
(Thabane) Centre for Evaluation of Medicines and Biostatistics Unit, St
Joseph's Healthcare, Hamilton, ON, Canada
(Thabane) Departments of Paediatrics and Anaesthesia, McMaster University,
Hamilton, ON, Canada
(Garg) Department of Epidemiology and Biostatistics, Western University,
London, ON, Canada
Title
External validation of the Revised Cardiac Risk Index and update of its
renal variable to predict 30-day risk of major cardiac complications after
non-cardiac surgery: Rationale and plan for analyses of the VISION study.
Source
BMJ Open. 7 (1) (no pagination), 2017. Article Number: e013510. Date of
Publication: 01 Jan 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: The Revised Cardiac Risk Index (RCRI) is a popular
classification system to estimate patients' risk of postoperative cardiac
complications based on preoperative risk factors. Renal impairment,
defined as serum creatinine >2.0 mg/dL (177 mumol/L), is a component of
the RCRI. The estimated glomerular filtration rate has become accepted as
a more accurateindicator of renal function. We will externally validate
the RCRI in a modern cohort of patients undergoing non-cardiac surgery and
update its renal component. Methods and analysis: The Vascular Events in
Noncardiac Surgery Patients Cohort Evaluation (VISION) study is an
international prospective cohort study. In this prespecified secondary
analysis of VISION, we will test the risk estimation performance of the
RCRI in 34 000 participants who underwent elective noncardiac surgery
between 2007 and 2013 from 29 hospitals in 15 countries. Using data from
the first 20 000 eligible participants (the derivation set), we will
derive an optimal threshold for dichotomising preoperative renal function
quantified using the Chronic Kidney Disease Epidemiology Collaboration
(CKD-Epi) glomerular filtration rate estimating equation in a manner that
preserves the original structure of the RCRI. We will also develop a
continuous risk estimating equation integrating age and CKD-Epi with
existing RCRI risk factors. In the remaining (approximately) 14 000
participants, we will compare the risk estimation for cardiac
complications of the original RCRI to this modified version. Cardiac
complications will include 30-day non-fatal myocardial infarction,
non-fatal cardiac arrest and death due to cardiac causes. We have examined
an early sample to estimate the number of events and the distribution of
predictors and missing data, but have not seen the validation data at the
time of writing. Ethics and dissemination: The research ethics board at
each site approved the VISION protocol prior.

<66>
Accession Number
617434089
Author
Jackson E.; Eagle K.A.
Institution
(Jackson, Eagle) University of Michigan, Ann Arbor, MI, United States
Title
Evolocumab reduced CV events in patients with atherosclerotic CV disease
taking high- or moderate-intensity statins.
Source
Annals of Internal Medicine. 167 (2) (pp JC7), 2017. Date of Publication:
18 Jul 2017.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<67>
Accession Number
614488909
Author
Jennings D.L.; Baker W.L.
Institution
(Jennings) Department of Pharmacy, NewYork Presbyterian Columbia
University Irving Medical Center, New York, NY, United States
(Baker) School of Pharmacy, University of Connecticut, Storrs, CT, United
States
Title
Pre-cardiac transplant amiodarone use is not associated with postoperative
mortality: An updated meta-analysis.
Source
International Journal of Cardiology. 236 (pp 345-347), 2017. Date of
Publication: 01 Jun 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Amiodarone remains the preferred agent for the treatment and
prevention of life-threatening ventricular arrhythmias in patients with
end-stage heart failure. While several reports suggest that pre-operative
amiodarone exposure worsens outcomes in heart transplant recipients, other
studies have failed to validate this relationship. We sought to clarify
this issue by performing a meta-analysis of the available literature
surrounding this topic. Methods We searched Medline, SCOPUS and the
Cochrane Central Register of Controlled Trials through December 15th 2016,
as well as proceedings from related conferences over the prior 3 years.
Included studies evaluated patients undergoing cardiac transplantation who
had received pre-transplant amiodarone and reported postoperative
mortality. Outcomes were pooled using a Hartung-Knapp random-effects model
producing odds ratios (OR) and 95% confidence intervals (CI). Statistical
heterogeneity was evaluated using the Cochrane Q statistic p-value and
I² value. Publication bias was assessed by visual inspection of
funnel plots and using Egger's weighted regression statistic. Results Nine
studies including 16,509 participants were included in the overall
analysis. Use of pre-transplant amiodarone was not associated with an
increase in postoperative mortality versus control (OR 1.38, 95% 0.8 to
2.36). Moderate statistical heterogeneity was present (I² =
45.8%, p = 0.06); visual inspection of funnel plot analysis did not
suggest publication bias. No association was noted between a longer
duration of follow-up and higher odds of mortality with amiodarone use (p
= 0.91). Conclusion Meta-analysis of the available evidence suggests that
pre-operative amiodarone exposure does not increase mortality in cardiac
transplant recipients.<br/>Copyright &#xa9; 2017 Elsevier Ireland Ltd

<68>
Accession Number
615758096
Author
Juo Y.-Y.; Quach C.; Hiatt J.; Hines O.J.; Tillou A.; Burruss S.
Institution
(Juo, Quach, Hiatt, Hines, Tillou) Department of Surgery, David Geffen
School of Medicine at the University of California, Los Angeles,
California, United States
(Juo) Center for Advanced Surgical and Interventional Technology,
University of California, Los Angeles, California, United States
(Burruss) Department of Surgery, Loma Linda University Medical Center,
Loma Linda, California, United States
Title
Comparative Analysis of Simulated versus Live Patient-Based FAST (Focused
Assessment With Sonography for Trauma) Training.
Source
Journal of Surgical Education. 74 (6) (pp 1012-1018), 2017. Date of
Publication: November 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objective To investigate whether simulated patient (SP)-based training has
comparable efficacy as live patient (LP)-based training in teaching
Focused Abdominal Sonography for Trauma (FAST) knowledge and skill
competencies to surgical residents. Design A randomized
pretest/intervention/posttest controlled study design was employed to
compare the participants' performance in written and practical
examinations regarding FAST examination after SP-based versus LP-based
training. Setting University-based general residency program at a single
institution. Participants A total of 29 general surgery residents of
various training levels and sonographic experience were recruited by
convenience sampling. Results There was no correlation between subjects'
baseline training level or sonographic experience with either the
posttest-pretest score difference or the percentage of subjects getting
all 4 windows with adequate quality. There was no significant difference
between the improvement in written posttest-pretest scores for SP and LP
group, which were 33 +/- 9.6 and 31 +/- 6.8 (p = 0.40), respectively. With
regard to performance-based learning efficacy, a statistically higher
proportion of subjects were able to obtain all 4 windows with adequate
quality among the LP than the SP group (6/8 vs 1/8, p = 0.01). Conclusion
SP- and LP-based FAST training for surgical residents were associated with
similar knowledge-based competency acquisition, but residents receiving
LP-based training were better at acquiring adequate FAST windows on live
patients. Simulation training appeared to be a valid adjunct to LP
practice but cannot replace LP training. Future investigations on how to
improve simulation fidelity and its training efficacy for skill-based
competencies are warranted.<br/>Copyright &#xa9; 2017 Association of
Program Directors in Surgery

<69>
Accession Number
619021090
Author
Wang Y.; Xiao L.; Mu W.; Yu H.-L.; Zhang S.; Tian G.-H.; Shang H.-C.
Institution
(Wang) Department of Chinese Medicine, People's Hospital of the Inner
Mongolia Autonomous Region, Hohhot 010017, China
(Xiao) Department of Emergency, The First Affiliated Hospital of Tianjin
University of Traditional Chinese Medicine, Tianjin 300193, China
(Mu) Department of Clinical Pharmacology, The Second Affiliated Hospital
of Tianjin University of Traditional Chinese Medicine, Tianjin 300150,
China
(Yu) Department of Encephalopathy Rehabilitation, The First Affiliated
Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin
300193, China
(Zhang) Department of Integrated Traditional Chinese and Western Medicine,
Metabolic Diseases Hospital of Tianjin Medical University, Tianjin 300070,
China
(Tian) Department of Massage Pain, Dongzhimen Hospital, Beijing University
of Chinese Medicine, Beijing 100700, China
(Shang) Key Laboratory of Chinese Internal Medicine of Ministry of
Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese
Medicine, Beijing 100700, China
Title
A summary and evaluation of current evidence for myocardial infarction
with Chinese medicine.
Source
Chinese Journal of Integrative Medicine. 23 (12) (pp 948-955), 2017. Date
of Publication: 01 Dec 2017.
Publisher
Chinese Journal of Integrated Traditional and Western Medicine Press
(E-mail: cjim@jia.net)
Abstract
Objective: To provide evidence-based recommendations for clinical
application and provoke thoughts for future researchers by conducting a
comprehensive summary and evaluation of the current evidence profile for
the role of Chinese medicine (CM) in treating myocardial infarction (MI).
Methods: Online databases including PubMed, EMBase, Cochrane Library,
Chinese National Knowledge Infrastructure (CNKI), Chinese Biomedical
Medicine (CBM), VIP Journal Integration Platform, and Wanfang database
were systematically searched for literatures on CM in treating MI. After
screening, studies were categorized into 5 types, i.e. systematic review
(SR), randomized controlled trial (RCT), observational study, case report
and basic research. General information was abstracted, and the quality
levels of these studies and their conclusions were summarized and
assessed. Results: A total of 452 studies including 10 SRs, 123 RCTs, 47
observational studies, 28 case reports, and 244 basic researches were
selected. Clinical studies centered primarily on herbal decoction and
mostly were not rigorously performed. High-quality studies were
predominantly on Chinese patent medicines (CPMs) such as Danshen Injection
(), Shenmai Injection (), Shengmai Injection () and Qishen Yiqi Dripping
Pills (). The most frequently observed pattern of drug combination was
decoction plus injection. Results of SRs and clinical studies showed that
CM may reduce mortality, decrease risk of complication, reduce myocardial
injury, improve cardiac function and inhibit ventricular remodeling.
Findings from basic researches also supported the positive role of CM in
reducing infarct size and myocardial injury, promoting angiogenesis,
preventing ventricular remodeling and improving cardiac function.
According to the current evidence body, CM has proven effects in the
prevention and treatment of MI. It is also found that the effects of CPMs
vary with indications. For instance, Shenmai Injection has been found to
be especially effective for reducing the incidence of acute clinical
events, while CPMs with qi-nourishing and bloodcirculating properties have
been proven to be effective in inhibiting ventricular remodeling. High
quality evidence supports the use of CM injection for acute MI and CPM for
secondary prevention. Reports on adverse events and other safety outcomes
associated with CM for MI are scarce. Conclusions: Sufficient evidence
supported the use of CM as an adjuvant to Western medicine for preventing
and treating MI. The choice of drug use varies with disease stage and
treatment objective. However, the quality of the evidence body remains to
be enhanced.<br/>Copyright &#xa9; 2017, Chinese Association of the
Integration of Traditional and Western Medicine and Springer-Verlag GmbH
Germany, part of Springer Nature.

<70>
Accession Number
617808736
Author
Hunter B.R.
Institution
(Hunter) Indiana University School of Medicine, Indianapolis, IN, United
States
Title
In patients with chest pain, HEART score-guided and usual care did not
differ for MACE or health care use.
Source
Annals of Internal Medicine. 167 (4) (pp JC22), 2017. Date of Publication:
15 Aug 2017.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<71>
Accession Number
618234251
Author
Al Jawad M.A.; Ali I.; Shokri H.; Shorbagy M.S.
Institution
(Al Jawad, Ali) Department of Cardio-Thoracic Surgery, Ain Shams
University, Cairo, Egypt
(Shokri, Shorbagy) Department of Anesthesiology, Ain Shams University,
Abbasya Square, Cairo, Egypt
Title
Systemic versus local analgesia for chest drain removal in post cardiac
surgery patients: The taming of a beast.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. 25 (4) (pp
289-293), 2017. Date of Publication: December 2017.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background Among the most emotionally distressing experiences in cardiac
surgery is the removal of mediastinal drains. The study compared between
two commonly used methods for pain control during the procedure of chest
drain removal. We either used systemic administration of IV morphine or
local infiltration of Bupivacaine as a mode of analgesia. Our goal was to
provide effective analgesia and patient comfort, while keeping high
standards of patient safety. Methods A prospective, randomized, single
blinded observational study conducted in a single institution;
Cardio-thoracic surgery Academy, Ain -Shams University, Cairo, Egypt. 70
Patients, with valvular heart lesions needing elective surgical
intervention in the form of valve replacement/repair were enrolled in the
study. On the day after surgery, when the mediastinal drains were no
longer surgically needed, patients were randomized to one of two groups.
In the first group (Morphine group, n = 35), patients received an IV bolus
of 0.1 mg/kg morphine over a period of 2 min. The second group
(Bupivacaine group, n = 35), received 0.5% bupivacaine as subcutaneous
infiltration around the sites of drain insertion, using a standardized
technique. Drains were removed 20 min later. All the patients had their
blood pressure, heart rate and the pain score on a Visual Analog Scale
(VAS) assessed 20 min before starting the procedure (baseline values), and
were assessed one more time, 5 min after completion of the procedure
(drain removal values). Results The median difference within the
bupivacaine group between baseline and drain removal VAS scores was 19.94
+/- 2.36 mm and 9.52 +/- 2.41 mm respectively (this showed to be highly
significant, P < 0.001). Median VAS scores difference between the
bupivacaine and morphine groups on drain removal were 9.52 +/- 2.41 mm and
18.93 +/- 2.96 mm respectively (this showed to be highly significant, P <
0.001). Conclusions There was a significant difference with regards to
patients' pain control between both groups. Concerning pain scores (VAS)
reduction at post procedural point, a local subcutaneous infiltration of
0.5% bupivacaine is a superior analgesic modality.<br/>Copyright &#xa9;
2017 The Egyptian Society of Cardio-thoracic Surgery

<72>
Accession Number
618469265
Author
Omran A.M.
Institution
(Omran) National Heart Institute, Cairo 11411, Egypt
Title
Role of intra-aortic morphine in post conditioning during valvular surgery
with low ejection fraction.
Source
Journal of the Egyptian Society of Cardio-Thoracic Surgery. 25 (4) (pp
301-305), 2017. Date of Publication: December 2017.
Publisher
Egyptian Society of Cardio-thoracic Surgery
Abstract
Background The application of cardioplegia does not completely eradicate
myocardial ischemia in cardiac/reperfusion injury due to cardiac arrest.
Post conditioning is novel strategy of attaining cardioprotection.
Pharmacological post conditioning using a drug as morphine administered
before reperfusion would protect the heart against ischemia-reperfusion
injury. We investigated whether intra-aortic morphine administration has a
post conditioning effect on patients with low ejection fraction (EF)
undergoing valve surgery. Methods This prospective randomized controlled
trial in a single center involved one hundred patients scheduled for
elective valve surgery were divided into two groups: the Post conditioning
group and the Control group. The Post conditioning group (n = 50) received
a dose of morphine (0.1 mg/kg) diluted in 20 ml normal saline, injected
via a cardioplegia needle into the aortic root with warm hotshot before
aortic cross-clamp removal while the control group (n = 50) received the
same volume of saline without morphine. Both groups received antegrade
warm blood cardioplegia. To assess results EF, fractional shortening (FS),
troponin level, ABG, inotropes, postoperative ventilation time, and length
of ICU stay were assessed. Results Postoperative EF and FS revealed a
statistically significant higher readings in the Post conditioning group.
A significant reduction in the troponin levels was recorded in the study
group than the control group. Duration of postoperative ventilation and
length of ICU stay were statistically lesser in the Post conditioning
group. Conclusions Morphine administration immediately with warm hotshot
was related to improvement in the cardiopulmonary function, less inotropic
drug use, and higher left ventricular EF.<br/>Copyright &#xa9; 2017 The
Egyptian Society of Cardio-thoracic Surgery

<73>
Accession Number
614130201
Author
Wang T.K.M.; Wang M.T.M.; Gamble G.D.; Webster M.; Ruygrok P.N.
Institution
(Wang, Webster, Ruygrok) Green Lane Cardiovascular Service, Auckland City
Hospital, Auckland, New Zealand
(Wang, Wang, Gamble, Ruygrok) Department of Medicine, University of
Auckland, Auckland, New Zealand
Title
Performance of contemporary surgical risk scores for transcatheter aortic
valve implantation: A meta-analysis.
Source
International Journal of Cardiology. 236 (pp 350-355), 2017. Date of
Publication: 01 Jun 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Transcatheter aortic valve implantation (TAVI) is considered
for severe aortic valve disease at high and now intermediate risk for
surgical aortic valve replacement. Risk stratification plays a critical
role decision-making for intervention and modality. We compared the
prognostic utility of surgical risk scores for TAVI in this meta-analysis.
Methods MEDLINE, Embase, Cochrane and Web of Science databases from 1
January 1980 to 31 December 2015 were searched. Studies were
systematically reviewed for inclusion, and data extracted for pooled
analyses. Results Amongst 1688 articles searched, 47 full-text articles
were screened and 24 studies (12,346 TAVI cases) included for analyses.
Pooled c-statistics (95% confidence interval) for operative mortality were
EuroSCORE 0.62 (0.57-0.67), EuroSCORE II 0.62 (0.59-0.66), STS Score 0.62
(0.59-0.65). Pooled calibration odds ratios (95%CI) were EuroSCORE 0.31
(0.25-0.38), EuroSCORE II 1.26 (1.06-1.51), STS 0.95 (0.72-1.27).
C-statistics (95%CI) for 1-year mortality were EuroSCORE 0.62 (0.57-0.67),
EuroSCORE II 0.66 (0.61-0.71) and STS Score 0.58 (0.53-0.64). Conclusion
Surgical risk scores at most modestly discriminated operative and 1-year
mortality. The EuroSCORE grossly over-estimated operative mortality while
the EuroSCORE II and STS Scores fitted better to TAVI outcomes with their
own limitations. There is a need for the development and validation of
TAVI-specific risk models.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<74>
Accession Number
610980966
Author
Lai V.K.W.; Lee A.; Leung P.; Chiu C.H.; Ho K.M.; Gomersall C.D.;
Underwood M.J.; Joynt G.M.
Institution
(Lai, Lee, Leung, Chiu, Ho, Gomersall, Joynt) Department of Anaesthesia
and Intensive Care, Chinese University of Hong Kong, Shatin, Hong Kong
(Underwood) Division of Cardiothoracic Surgery, Department of Surgery,
Chinese University of Hong Kong, Shatin, Hong Kong
Title
Patient and family satisfaction levels in the intensive care unit after
elective cardiac surgery: study protocol for a randomised controlled trial
of a preoperative patient education intervention.
Source
BMJ Open. 6 (6) (no pagination), 2016. Article Number: e011341. Date of
Publication: 01 Jun 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Patients and their families are understandably anxious about
the risk of complications and unfamiliar experiences following cardiac
surgery. Providing information about postoperative care in the intensive
care unit (ICU) to patients and families may lead to lower anxiety levels,
and increased satisfaction with healthcare. The objectives of this study
are to evaluate the effectiveness of preoperative patient education
provided for patients undergoing elective cardiac surgery. Methods and
analysis 100 patients undergoing elective coronary artery bypass graft,
with or without valve replacement surgery, will be recruited into a
2-group, parallel, superiority, double-blinded randomised controlled
trial. Participants will be randomised to either preoperative patient
education comprising of a video and ICU tour with standard care
(intervention) or standard education (control). The primary outcome
measures are the satisfaction levels of patients and family members with
ICU care and decision-making in the ICU. The secondary outcome measures
are patient anxiety and depression levels before and after surgery. Ethics
and dissemination Ethical approval has been obtained from the Joint
Chinese University of Hong Kong - New Territories East Cluster Clinical
Research Ethics Committee (reference number CREC 2015.308). The findings
will be presented at conferences and published in peer-reviewed journals.
Study participants will receive a 1-page plain language summary of
results.<br/>Copyright &#xa9; 2016 Published by the BMJ Publishing Group
Limited.

<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. 109 (pp e792-e799), 2018. Date of Publication: January
2018.
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
619592181
Author
Elbakry A.-E.; Sultan W.-E.; Ibrahim E.
Institution
(Elbakry, Sultan, Ibrahim) Department of Anaesthesia and Intensive Care,
Faculty of Medicine, Menoufia University, Shebeen El-Kom, Egypt
Title
A comparison between inhalational (Desflurane) and total intravenous
anaesthesia (Propofol and dexmedetomidine) in improving postoperative
recovery for morbidly obese patients undergoing laparoscopic sleeve
gastrectomy: A double-blinded randomised controlled trial.
Source
Journal of Clinical Anesthesia. 45 (pp 6-11), 2018. Date of Publication:
May 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Study objective Laparoscopic sleeve gastrectomy is commonly performed
under total intravenous anaesthesia (TIVA) or balanced anaesthesia using
an intravenous and inhalation agent. It is still unclear which anaesthesia
regimen is better for this group of patients. The present study has been
conducted to compare the use of the inhalation anaesthesia technique using
desflurane with the TIVA technique, using propofol and dexmedetomidine.
Design Prospective, randomised, double-blinded study. Setting Menoufia
Univeristy Hospital. Patients This randomised trial was carried out on 100
morbidly obese patients undergoing laparoscopic sleeve gastrectomy. The
patients were randomised into two equally sized groups; one group received
the inhalation anaesthesia technique and the other received the TIVA
technique. Interventions All patients received general anaesthesia, which
was induced by propofol, remifentanil, and rocuronium. Anaesthesia was
maintained using desflurane in oxygen air mixture in the inhalation group,
whilst anaesthesia was maintained by intravenous infusion of propofol and
dexmedetomidine in the TIVA group. Measurements Intra-operative vital
signs, anaesthesia recovery time, postoperative nausea and vomiting, pain
score, post-anaesthetic care unit (PACU) stay time, total first 24 h
post-operative analgesic needs and the onset of first bowel movement were
recorded. Main results The TIVA group had lower intra-operative heart
rates and mean arterial blood pressure (P < 0.0001). The TIVA group also
had a lower post-operative visual analogue score for pain assessment (VAS)
(P < 0.0001), lower total analgesic requirements (P < 0.0001), a lower
incidence of nausea (P = 0.01) and vomiting (P = 0.03), and shorter PACU
stays (P = 0.01). There was no significant difference between groups with
regard to the onset of bowel movement (P = 0.16). Conclusions TIVA using
propofol and dexmedetomidine is a better anaesthetic regimen than
inhalation anaesthesia using desflurane for laparoscopic sleeve
gastrectomy in morbidly obese patients. The TIVA technique provided better
postoperative recovery with fewer postoperative side effects and analgesic
requirements. Clinical trial registery number NCT03029715.<br/>Copyright
&#xa9; 2017 Elsevier Inc.

<77>
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, PA, United States
(Saleem) Department of Family Medicine, Mercy Health, Janesville, WI,
United States
(Kaluski) Department of Cardiology, Rutgers Medical School, Newark, NJ,
United States
(Kaluski) The Commonwealth Medical College, Scranton, PA, United States
(Kaluski) Department of Cardiology, Guthrie Clinic/Robert Packer Hospital,
Sayre, PA, United States
Title
Transcatheter vs surgical aortic-valve replacement in low- to
intermediate-surgical-risk candidates: A meta-analysis and systematic
review.
Source
Clinical Cardiology. 40 (11) (pp 974-981), 2017. Date of Publication:
November 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.

<78>
Accession Number
619619085
Author
Lehmann H.S.; Musk G.C.; Laurence M.; Hyndman T.H.; Tuke J.; Collins T.;
Gleerup K.B.; Johnson C.B.
Institution
(Lehmann, Musk, Laurence, Hyndman, Collins) College of Veterinary
Medicine, School of Veterinary and Life Sciences, Murdoch University,
Murdoch, Australia
(Tuke) School of Mathematics, University of Adelaide, Adelaide, Australia
(Gleerup) Department of Large Animal Sciences, University of Copenhagen,
Denmark
(Johnson) Institute of Veterinary, Animal and Biomedical Sciences, Massey
University, New Zealand
Title
Mitigation of electroencephalographic and cardiovascular responses to
castration in Bos indicus bulls following the administration of either
lidocaine or meloxicam.
Source
Veterinary Anaesthesia and Analgesia. 44 (6) (pp 1341-1352), 2017. Date of
Publication: November 2017.
Publisher
Association of Veterinary Anaesthetists and American College of Veterinary
Anesthesia and Analgesia (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Objective To investigate the mitigating effects of administration of local
anaesthetic or systemic meloxicam on the electroencephalographic (EEG) and
cardiovascular responses during surgical castration of Bos indicus bull
calves. Study design Prospective, randomized, experimental study. Animals
Thirty-six 6-8 month-old Bos indicus bull calves, with a mean +/- standard
deviation weight of 237 +/- 19 kg. Methods Animals were allocated randomly
to three groups of 12 (group L, 260 mg of 2% lidocaine subcutaneously and
intratesticularly 5 minutes prior to castration; group M, 0.5 mg
kg^-1 of meloxicam subcutaneously 30 minutes prior to
castration; group C, no preoperative analgesia administered). Anaesthesia
was induced and maintained with halothane (0.9-1.1%) in oxygen.
Electroencephalogram, heart rate (HR) and mean blood pressure (MAP) were
recorded for 300 seconds prior to (baseline, B) and from the start of
surgery (first testicle removal, T1). HR and MAP were compared at 10
second intervals for 90 seconds from the start of T1. Median frequency
(F<inf>50</inf>), spectral edge frequency (F<inf>95</inf>) and total power
of the EEG (P<inf>tot</inf>) were analysed using area under the curve
comparing T1 to B. Results All EEG variables were significantly different
between B and T1 (p <= 0.0001). No differences in F<inf>50</inf> were
found between groups during T1 (p = 0.6491). F<inf>95</inf> and
P<inf>tot</inf> were significantly different between group L and groups C
and M during T1 (p = 0.0005 and 0.0163, respectively). There were
transient significant changes in HR and MAP in groups L and M compared to
group C during the 20-50 second periods. Conclusions The EEG changes
indicate nociceptive responses in all three groups during surgical
castration, greater in group L compared to groups C and M. Both analgesics
attenuated the peracute cardiovascular response. Lidocaine and meloxicam
administered prior to castration attenuated these responses in Bos indicus
bull calves. Clinical relevance These findings provide support for the
preoperative administration of lidocaine and potentially meloxicam for
castration in Bos indicus bull calves.<br/>Copyright &#xa9; 2017
Association of Veterinary Anaesthetists and American College of Veterinary
Anesthesia and Analgesia

<79>
Accession Number
619552674
Author
Tornyos A.; Aradi D.; Horvath I.G.; Konyi A.; Magyari B.; Pinter T.;
Vorobcsuk A.; Tornyos D.; Komocsi A.
Institution
(Tornyos, Horvath, Konyi, Magyari, Pinter, Vorobcsuk, Tornyos, Komocsi)
Department of Interventional Cardiology, Heart Institute, University of
Pecs, Pecs, Hungary
(Aradi) Heart Centre Balatonfured and Heart and Vascular Centre,
Semmelweis University, Budapest, Hungary
Title
Clinical outcomes in patients treated for coronary in-stent restenosis
with drug-eluting balloons: Impact of high platelet reactivity.
Source
PLoS ONE. 12 (12) (no pagination), 2017. Article Number: e0188493. Date of
Publication: December 2017.
Publisher
Public Library of Science (E-mail: plos@plos.org)
Abstract
Background: The impact of high platelet reactivity (HPR) on clinical
outcomes after elective percutaneous coronary interventions (PCI) with
drug-eluting balloons (DEB) due to in-stent restenosis (ISR) is unknown.
Objective: We sought to evaluate the prognostic importance of HPR together
with conventional risk factors in patients treated with DEB. Methods:
Patients treated with DEB due to ISR were enrolled in a single-centre,
prospective registry between October 2009 and March 2015. Only patients
with recent myocardial infarction (MI) received prasugrel, others were
treated with clopidogrel. HPR was defined as an ADP-test >46U with the
Multiplate assay and no adjustments were done based on results. The
primary endpoint of the study was a composite of cardiovascular mortality,
MI, any revascularization or stroke during one-year follow-up. Results:
194 stable angina patients were recruited of whom 90% were treated with
clopidogrel. Clinical characteristics and procedural data were available
for all patients; while platelet function testing was performed in 152
subjects of whom 32 (21%) had HPR. Patients with HPR had a higher risk for
the primary endpoint (HR: 2.45; CI: 1.01-5.92; p = 0.03). The difference
was primarily driven by a higher risk for revascularization and MI.
According to the multivariate analysis, HPR remained a significant,
independent predictor of the primary endpoint (HR: 2.88; CI: 1.02-8.14; p
= 0.04), while total DEB length and statin treatment were other
independent correlates of the primary outcome. Conclusion: HPR was found
to be an independent predictor of repeat revascularization and MI among
elective patients with ISR undergoing PCI with DEB.<br/>Copyright &#xa9;
2017 Tornyos et al. This is an open access article distributed under the
terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.

<80>
Accession Number
618244631
Author
Wiysonge C.S.; Ntsekhe M.; Thabane L.; Volmink J.; Majombozi D.; Gumedze
F.; Pandie S.; Mayosi B.M.
Institution
(Wiysonge) South African Medical Research Council, Cochrane South Africa,
Francie van Zijl Drive, Parow Valley, Cape Town, Western Cape 7505, South
Africa
(Wiysonge, Volmink, Majombozi) Stellenbosch University, Centre for
Evidence-based Health Care, Faculty of Medicine and Health Sciences, Cape
Town, South Africa
(Ntsekhe) Groote Schuur Hospital, Division of Cardiology, Observatory
7925, Cape Town, South Africa
(Thabane) McMaster University, Department of Clinical Epidemiology and
Biostatistics, 50 Charlton Ave E, St. Joseph's Healthcare, Hamilton, ON
L8N 4A6, Canada
(Gumedze) University of Cape Town, Department of Statistical Sciences,
Cape Town, South Africa
(Pandie, Mayosi) University of Cape Town, Department of Medicine, Cape
Town, South Africa
Title
Interventions for treating tuberculous pericarditis.
Source
Cochrane Database of Systematic Reviews. 2017 (9) (no pagination), 2017.
Article Number: CD000526. Date of Publication: 13 Sep 2017.
Publisher
John Wiley and Sons Ltd (Southern Gate, Chichester, West Sussex PO19 8SQ,
United Kingdom. E-mail: vgorayska@wiley.com)
Abstract
Background: Tuberculous pericarditis can impair the heart's function and
cause death; long term, it can cause the membrane to fibrose and constrict
causing heart failure. In addition to antituberculous chemotherapy,
treatments include corticosteroids, drainage, and surgery. Objectives: To
assess the effects of treatments for tuberculous pericarditis. Search
methods: We searched the Cochrane Infectious Diseases Group Specialized
Register (27 March 2017); the Cochrane Central Register of Controlled
Trials (CENTRAL), published in the Cochrane Library (2017, Issue 2);
MEDLINE (1966 to 27 March 2017); Embase (1974 to 27 March 2017); and
LILACS (1982 to 27 March 2017). In addition we searched the metaRegister
of Controlled Trials (mRCT) and the World Health Organization (WHO)
International Clinical Trials Registry Platform (ICTRP) search portal
using 'tuberculosis' and 'pericard*' as search terms on 27 March 2017. We
searched ClinicalTrials.gov and contacted researchers in the field of
tuberculous pericarditis. This is a new version of the original 2002
review. Selection criteria: We included randomized controlled trials
(RCTs) and quasi-RCTs. Data collection and analysis: Two review authors
independently screened search outputs, evaluated study eligibility,
assessed risk of bias, and extracted data; and we resolved any
discrepancies by discussion and consensus. One trial assessed the effects
of both corticosteroid and Mycobacterium indicus pranii treatment in a
two-by-two factorial design; we excluded data from the group that received
both interventions. We conducted fixed-effect meta-analysis and assessed
the certainty of the evidence using the GRADE approach. Main results:
Seven trials met the inclusion criteria; all were from sub-Saharan Africa
and included 1959 participants, with 1051/1959 (54%) HIV-positive. All
trials evaluated corticosteroids and one each evaluated colchicine, M.
indicus pranii immunotherapy, and open surgical drainage. Four trials
(1841 participants) were at low risk of bias, and three trials (118
participants) were at high risk of bias. In people who are not infected
with HIV, corticosteroids may reduce deaths from all causes (risk ratio
(RR) 0.80, 95% confidence interval (CI) 0.59 to 1.09; 660 participants, 4
trials, low certainty evidence) and the need for repeat pericardiocentesis
(RR 0.85, 95% CI 0.70 to 1.04; 492 participants, 2 trials, low certainty
evidence). Corticosteroids probably reduce deaths from pericarditis (RR
0.39, 95% CI 0.19 to 0.80; 660 participants, 4 trials, moderate certainty
evidence). However, we do not know whether or not corticosteroids have an
effect on constriction or cancer among HIV-negative people (very low
certainty evidence). In people living with HIV, only 19.9% (203/1959) were
on antiretroviral drugs. Corticosteroids may reduce constriction (RR 0.55,
0.26 to 1.16; 575 participants, 3 trials, low certainty evidence). It is
uncertain whether corticosteroids have an effect on all-cause death or
cancer (very low certainty evidence); and may have little or no effect on
repeat pericardiocentesis (RR 1.02, 0.89 to 1.18; 517 participants, 2
trials, low certainty evidence). For colchicine among people living with
HIV, we found one small trial (33 participants) which had insufficient
data to make any conclusions about any effects on death or constrictive
pericarditis. Irrespective of HIV status, due to very low certainty
evidence from one trial, it is uncertain whether adding M. indicus pranii
immunotherapy to antituberculous drugs has an effect on any outcome. Open
surgical drainage for effusion may reduce repeat pericardiocentesis In
HIV-negative people (RR 0.23, 95% CI 0.07 to 0.76; 122 participants, 1
trial, low certainty evidence) but may make little or no difference to
other outcomes. We did not find an eligible trial that assessed the
effects of open surgical drainage in people living with HIV. The review
authors found no eligible trials that examined the length of
antituberculous treatment needed nor the effects of other adjunctive
treatments for tuberculous pericarditis. Authors' conclusions: For
HIV-negative patients, corticosteroids may reduce death. For HIV-positive
patients not on antiretroviral drugs, corticosteroids may reduce
constriction. For HIV-positive patients with good antiretroviral drug
viral suppression, clinicians may consider the results from HIV-negative
patients more relevant. Further research may help evaluate percutaneous
drainage of the pericardium under local anaesthesia, the timing of
pericardiectomy in tuberculous constrictive pericarditis, and new
antibiotic regimens.<br/>Copyright &#xa9; 2017 The Cochrane Collaboration.
Published by John Wiley & Sons, Ltd.

<81>
Accession Number
614095871
Author
Cho Y.J.; Lee E.-H.; Lee K.; Kim T.K.; Hong D.M.; Chin J.-H.; Choi D.-K.;
Bahk J.-H.; Sim J.-Y.; Choi I.-C.; Jeon Y.
Institution
(Cho, Lee, Kim, Hong, Bahk, Jeon) Department of Anesthesiology and Pain
Medicine, Seoul National University Hospital, Seoul, South Korea
(Lee, Chin, Choi, Sim, Choi) Department of Anesthesiology and Pain
Medicine, Asan Medical Center, University of Ulsan College of Medicine,
Seoul, South Korea
Title
Long-term clinical outcomes of Remote Ischemic Preconditioning and
Postconditioning Outcome (RISPO) trial in patients undergoing cardiac
surgery.
Source
International Journal of Cardiology. 231 (pp 84-89), 2017. Date of
Publication: 15 Mar 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Remote ischemic conditioning has been shown to confer
myocardial protection. However, there is still no sufficient data on its
long-term clinical outcomes. We analyzed the long-term results of the
Remote Ischemic Preconditioning and Postconditioning Outcome (RISPO) trial
in cardiac surgery patients. Methods In the RISPO trial, 1280 patients
were randomized to receive remote ischemic preconditioning (RIPC) with
postconditioning (RIPostC, upper arm ischemia by four cycles of 5-min
inflation followed by 5-min deflation of a pneumatic cuff, N = 644) or
sham (N = 636) during cardiac surgery. Patient follow-up data were
collected by review of medical records, telephone interviews, and from the
National Statistical Office. The primary endpoint was major adverse
cardiac and cerebrovascular events (MACCE; a composite of all-cause
mortality, myocardial infarction (MI), stroke, and revascularization), and
the secondary endpoints were the individual components of the primary
endpoint. Results At completion of follow-up (mean 44 months), there was
no difference in MACCE between the groups (90 [14.0%] versus 101 [15.9%]
in the RIPC with RIPostC versus control groups; hazard ratio [HR], 0.893;
95% confidence interval [CI], 0.672-1.187; P = 0.435). However, MI was
reduced to half in the RIPC with RIPostC group (10 [1.6%] versus 23
[3.6%]; HR, 0.468; 95% CI, 0.222-0.984; P = 0.045). Conclusions Remote
ischemic preconditioning with RIPostC did not improve long-term MACCE
after cardiac surgery. However, MI was reduced in the RIPC with RIPostC
group compared with the control group during the follow-up period.
Clinical trial registration ClinicalTrials.gov identifier,
NCT00997217<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd

<82>
Accession Number
618001156
Author
Japaridze L.; Sadunishvili M.
Institution
(Japaridze, Sadunishvili) Amtel Hospital First Clinical, Centre of
Vascular and Heart Diseases, Tbilisi State Medical University, Chapidze
Heart Centre, Chachava str.#1, Tbilisi 0159, Georgia
Title
The short-term effect of atorvastatin plus ezetimibe therapy versus
atorvastatin monotherapy on clinical outcome in acute coronary syndrome
patients by gender.
Source
Kardiologia Polska. 75 (8) (pp 770-778), 2017. Date of Publication: 18 Aug
2017.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland)
Abstract
Background: Atorvastatin reduces low-density lipoprotein cholesterol
(LDL-C) levels and the risk of cardiovascular events, but whether the
addition of ezetimibe (EZE), a non-statin drug that reduces intestinal
cholesterol absorption, can reduce the rate of cardiovascular events
further, and if there any sex differences, is not known. Aim: To evaluate
the effects of atorvastatin and EZE combination in acute coronary syndrome
(ACS) patients on the incidence of composite endpoint in short-term
follow-up and to assess differences according their gender. Methods: We
conducted a 16-week, single-centre, prospective, randomised, open-label
clinical trial involving 323 patients who had been hospitalised for an ACS
within the preceding 14 days. They received atorvastatin 20 mg for 28
days, and after that 292 patients who had LDL-C levels >= 1.81 mmol/L were
randomised to EZE 10 mg/day co-administered with atorvastatin therapy (EZE
+ statin) or double their current atorvastatin dose. The primary endpoint
was a composite of cardiovascular death, nonfatal myocardial infarction,
unstable angina requiring rehospitalisation, coronary revascularisation
(>= 30 days after randomisation), or nonfatal stroke. Results: The
Kaplan-Meier event-free survival rate at 16 weeks was 88.1% in the EZE +
statin group patients and 77.0% in the atorvastatin monotherapy group
(absolute risk reduction: 11.1 percentage points; hazard ratio: 2.099; 95%
confidence interval: 1.165-3.781; p = 0.014). The log rank test indicated
that there was not a statistically significant difference between male and
female survival rates in both treatment groups (p = 0.897). Conclusions:
The results of our study demonstrated that when added to statin therapy,
EZE resulted in improved cardiovascular outcomes, and the response to
atorvastatin and EZE combination was similar for both men and
women.<br/>Copyright &#xa9; Polskie Towarzystwo Kardiologiczne 2017.

<83>
Accession Number
618786618
Author
Okuda M.; Go T.; Yokomise H.
Institution
(Okuda) Department of General Thoracic Surgery, Meiwa Hospital, 4-31,
Agenaruo-chou, Nishinomiya city, Hyogo, Japan
(Go, Yokomise) Department of General Thoracic, Breast and Endocrinological
Surgery, Faculty of Medicine, Kagawa University, 1750-1, Miki-cho,
Kita-gun, Kagawa, Japan
Title
Risk factor of bronchopleural fistula after general thoracic surgery:
review article.
Source
General Thoracic and Cardiovascular Surgery. 65 (12) (pp 679-685), 2017.
Date of Publication: 01 Dec 2017.
Publisher
Springer Tokyo (E-mail: orders@springer.jp)
Abstract
Objective: The aim of this article was to clarify recent risk factors for
the early bronchopleural fistula after anatomical lung resection. Methods:
Reports on early bronchopleural fistula after anatomical lung resection in
adults, including information on risk factors, published between 2006 and
2016 were reviewed and our institutional data were evaluated. The early
period was defined as within 30 days from surgery or as described early in
the manuscript. Results: A total of seven retrospective observational
articles were selected. Four articles investigated lobectomy and
pneumonectomy, while the other three articles investigated only
pneumonectomy. The surgical procedure, preoperative therapy, complications
after surgery, right side, patient age, past history, and tumor residuals
were mentioned as risk factors of bronchopleural fistula. Our data
concluded that neoadjuvant therapy and a right lower lobe location were
risk factors after a lobectomy, while a right side and complete
pneumonectomy were risk factors after a pneumonectomy. Conclusions:
Although recent studies have reached nearly the same conclusions as older
reports, continuous research of potential risk factor is needed as
therapeutic procedures continue to evolve.<br/>Copyright &#xa9; 2017, The
Japanese Association for Thoracic Surgery.

<84>
Accession Number
617023983
Author
Busch C.; Pfitzer C.; Raschzok S.; Miera O.; Berger F.; Schmitt K.R.
Institution
(Busch, Pfitzer, Raschzok, Miera, Berger, Schmitt) Department of Pediatric
Cardiology, Deutsches Herzzentrum Berlin, Germany
(Pfitzer) Berlin Institute of Health (BIH), Berlin, Germany
(Berger) Department of Pediatric Cardiology, Charite -
Universitaetsmedizin Berlin, Germany
(Berger) DZHK (German Centre for Cardiovascular Research), partner site
Berlin, Germany
Title
Clinical outcome and inflammatory response after transfusion of washed and
unwashed red blood cells in children following cardiovascular surgery.
Source
Progress in Pediatric Cardiology. 47 (pp 73-79), 2017. Date of
Publication: December 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Children frequently require red blood cell transfusion after cardiac
surgery, which can generate an inflammatory response that is associated
with increased morbidity and mortality. The aim of this study was to
evaluate the inflammatory response and clinical effect of RBC transfusion
in children. In a pediatric prospective controlled clinical trial 48
children were randomized to an unwashed or washed red blood cell
transfusion group after cardiac surgery. Red blood cells were washed using
an auto transfusion device with blood gas analyses of the packed red blood
cells performed before transfusion. Vital parameters, blood analyses, and
plasma concentrations of cytokines were measured before and 24 h after
transfusion. Forty-five children were included with 23 receiving unwashed
and 22 washed red blood cells. Washing reduced hemoglobin, potassium, and
glucose while increasing sodium concentration in the packed red blood
cells. Increased levels of hemoglobin, hematocrit, and erythrocyte counts
were observed in both groups after transfusion. Increased levels of
cytokine expression (IL-1alpha IL-6, IL-8, MCP-1, and TARC) were detected
in the group receiving unwashed red blood cells, while IL-8 levels were
reduced in patients receiving washed red blood cells. Also, the percentage
increase of cytokine concentrations (IL-6, IL-8, MCP-1, and GP-VI) before
in comparison to after transfusion was lower in patients receiving washed
red blood cells. No significant differences in clinical outcome parameters
were observed between the two groups. Transfusion of red blood cells
induces a pro-inflammatory reaction which can be diminished by washing the
red blood cells before transfusion. Further clinical trials with larger
patient cohorts receiving multiple transfusions are needed to better
evaluate the clinical outcome.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<85>
Accession Number
617315797
Author
Benedetto U.; Caputo M.; Guida G.; Bucciarelli-Ducci C.; Thai J.; Bryan
A.; Angelini G.D.
Institution
(Benedetto, Caputo, Guida, Bucciarelli-Ducci, Thai, Bryan, Angelini)
Bristol Heart Institute, University of Bristol, School of Clinical
Sciences, Bristol, United Kingdom
Title
Carbon Dioxide Insufflation During Cardiac Surgery: A Meta-analysis of
Randomized Controlled Trials.
Source
Seminars in Thoracic and Cardiovascular Surgery. 29 (3) (pp 301-310),
2017. Date of Publication: 03 Feb 2017.
Publisher
W.B. Saunders
Abstract
Despite the widespread use of carbon dioxide insufflation (CDI) in cardiac
surgery, there is still paucity of evidence to prove its benefit in terms
of neurologic protection. Therefore, we conducted a meta-analysis of
available randomized controlled trials comparing CDI vs standard de-airing
maneuvers. Electronic searches were performed to identify relevant
randomized controlled trials. Primary outcomes investigated were
postoperative stroke, neurocognitive deterioration, and in-hospital
mortality. Risk difference (RD) was used as summary statistic. Pooled
estimates were obtained by means of random-effects model to account for
possible clinical diversity and methodological variation between studies.
Eight studies were identified with 668 patients randomized to CDI (n =
332) vs standard de-airing maneuvers (n = 336). In-hospital mortality was
2.1% vs 3.0% in the CDI and control group, respectively (RD 0%; 95%
confidence interval [CI] -2% to 2%; P = 0.87; I² = 0%).
Incidence of stroke was similar between the 2 groups (1.0% vs 1.2% in the
CDI and control group, respectively; RD 0%; 95% CI -1% to 2%; P = 0.62;
I² = 0%). Neurocognitive deterioration rate was 12% vs 21% in
the CDI and control group, respectively, but this difference was not
statistically significant (RD: -7%; 95% CI -0.22% to 8%; P = 0.35;
I² = 0%). The present meta-analysis did not find any
significant protective effect from the use of CDI when compared with
manual de-airing maneuvers in terms of clinical outcomes, including
postoperative neurocognitive decline.<br/>Copyright &#xa9; 2017 Elsevier
Inc.

<86>
Accession Number
618297611
Author
Hwang I.-C.; Choi S.J.; Choi J.E.; Ko E.-B.; Suh J.K.; Choi I.; Kang
H.-J.; Kim Y.-J.; Kim J.Y.
Institution
(Hwang, Kang, Kim) Cardiovascular Center and Department of Internal
Medicine, Seoul National University Hospital, Seoul, South Korea
(Choi, Choi, Ko, Suh, Choi, Kim) National Evidence-Based Healthcare
Collaborating Agency, Seoul, South Korea
(Ko) Department of Health Administration, Yonsei University Graduate
School, Wonju, South Korea
Title
Comparison of mid- to long-term clinical outcomes between anatomical
testing and usual care in patients with suspected coronary artery disease:
A meta-analysis of randomized trials.
Source
Clinical Cardiology. 40 (11) (pp 1129-1138), 2017. Date of Publication:
November 2017.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: Controversies remain regarding clinical outcomes following
initial strategies of coronary computed tomography angiography (CCTA) vs
usual care with functional testing in patients with suspected coronary
artery disease (CAD). Hypothesis: CCTA as initial diagnostic strategy
results in better mid- to long-term outcomes than usual care in patients
with suspected CAD. Methods: We searched PubMed, Embase, and Cochrane
Library for randomized controlled trials comparing clinical outcomes
during >=6 months' follow-up between initial anatomical testing by CCTA vs
usual care with functional testing in patients with suspected CAD.
Occurrence of all-cause mortality, nonfatal myocardial infarction (MI),
and major adverse cardiovascular events (MACE), and use of invasive
coronary angiography and coronary revascularization, were compared between
the 2 diagnostic strategies. Results: Twelve trials were included (20 014
patients; mean follow-up, 20.5 months). Patients undergoing CCTA as
initial noninvasive testing had lower risk of nonfatal MI compared with
those treated with usual care (risk ratio [RR]: 0.70, 95% confidence
interval [CI]: 0.52-0.94, P = 0.02). There was a tendency for reduced MACE
following initial CCTA strategy, but not for risk of all-cause mortality.
Compared with functional testing, the CCTA strategy increased use of
invasive coronary angiography (RR: 1.53, 95% CI: 1.12-2.09, P = 0.007) and
coronary revascularization (RR: 1.49, 95% CI: 1.11-2.00, P = 0.007).
Conclusions: Anatomical testing with CCTA as the initial noninvasive
diagnostic modality in patients with suspected CAD resulted in lower risk
of nonfatal MI than usual care with functional testing, at the expense of
more frequent use of invasive procedures.<br/>Copyright &#xa9; 2017 Wiley
Periodicals, Inc.

<87>
Accession Number
619543098
Author
Buckley L.F.; Dixon D.L.; Wohlford G.F.; Wijesinghe D.S.; Baker W.L.; Van
Tassell B.W.
Institution
(Buckley, Dixon, Wohlford, Wijesinghe, Van Tassell) Department of
Pharmacotherapy and Outcomes Science, Virginia Commonwealth University,
Richmond, VA, United States
(Baker) Department of Pharmacy Practice, School of Pharmacy, University of
Connecticut, Storrs, CT, United States
Title
Intensive versus standard blood pressure control in SPRINTE-ligible
participants of ACCORD-BP.
Source
Diabetes Care. 40 (12) (pp 1733-1738), 2017. Date of Publication: 01 Dec
2017.
Publisher
American Diabetes Association Inc. (E-mail: membership@diabetes.org)
Abstract
Objective: We sought to determine the effect of intensive blood pressure
(BP) control on cardiovascular outcomes in participants with type 2
diabetes mellitus (T2DM) and additional risk factors for cardiovascular
disease (CVD). Research Design and Methods: This study was a post hoc,
multivariate, subgroup analysis of ACCORD-BP (Action to Control
Cardiovascular Risk in Diabetes Blood Pressure) participants.
Participantswere eligible for the analysis if they were in the standard
glucose control arm of ACCORD-BP and also had the additional CVD risk
factors required for SPRINT (Systolic Blood Pressure Intervention Trial)
eligibility. We used a Cox proportional hazards regression model to
compare the effect of intensive versus standard BP control on CVD
outcomes. The "SPRINT-eligible" ACCORD-BP participantswere pooledwith
SPRINT participants to determine whether the effects of intensive BP
control interacted with T2DM. Results: The mean baseline Framingham
10-year CVD risk scores were 14.5% and 14.8%, respectively, in the
intensive and standard BP control groups. The mean achieved systolic BP
values were 120 and 134 mmHg in the intensive and standard BP control
groups (P <= 0.001). Intensive BP control reduced the composite of CVD
death, nonfatal myocardial infarction (MI), nonfatal stroke, any
revascularization, and heart failure (hazard ratio 0.79; 95% CI 0.65-0.96;
P = 0.02). Intensive BP control also reduced CVD death, nonfatal MI, and
nonfatal stroke (hazard ratio 0.69; 95% CI 0.51-0.93; P = 0.01).
Treatment-related adverse events occurred more frequently in participants
receiving intensive BP control (4.1% vs. 2.1%; P = 0.003). The effect of
intensive BP control on CVD outcomes did not differ between patients with
and without T2DM (P > 0.62). Conclusions: Intensive BP control reduced CVD
outcomes in a cohort of participants with T2DM and additional CVD risk
factors.<br/>Copyright &#xa9; 2017 by the American Diabetes Association.

<88>
Accession Number
617127511
Author
Neugarten J.; Sandilya S.; Singh B.; Golestaneh L.
Institution
(Neugarten, Sandilya, Singh, Golestaneh) Nephrology Division, Department
of Medicine, Montefiore Medical Center, Albert Einstein College of
Medicine, Bronx, NY, United States
Title
Sex and the risk of AKI following cardio-thoracic surgery: A
meta-analysis.
Source
Clinical Journal of the American Society of Nephrology. 11 (12) (pp
2113-2122), 2016. Date of Publication: 2016.
Publisher
American Society of Nephrology (E-mail: email@asn-online.org)
Abstract
Background and objectives Being awoman is awell established risk factor
for the development of cardiothoracic surgery-associated AKI. In striking
contrast, women are less likely to develop AKI associated with noncardiac
surgical procedures than men. In an attempt to ascertain why being a woman
might be protective for ischemic AKI after general surgery but deleterious
in patients undergoing cardiothoracic surgery, we examined cardiothoracic
surgery-associated AKI in greater detail. Design, setting, participants, &
measurements We performed a systematic review and meta-analysis of
cardiothoracic surgery-associated AKI studies published between January of
1978 and December of 2015 to further explore the relationship between sex
and cardiothoracic surgery-associated AKI. Results Sixty-four studies were
identified that provided sex-specific data regarding the incidence of
cardiothoracic surgery-associated AKI among 1,057,412 subjects. Using
univariate analysis, womenwere more likely than men to develop AKI
postoperatively (odds ratio, 1.21; 95% confidence interval, 1.09 to 1.33;
P,0.001). However, when the analysis was restricted to the 120,464
subjects reported in 29 studies that used the Acute Kidney Injury Network
criteria, the RIFLE criteria, or the Kidney Disease Improving Global
Outcomes criteria to define AKI, there was no significant sex-related
difference in risk. Seventeen studies used multivariate analysis to assess
risk factors for cardiothoracic surgery-associated AKI and provided
sex-specific odd ratios. Among the 1,587,181 individuals included in these
studies, the risk of developing cardiothoracic surgery-associated AKI was
not significantly associated with sex (odds ratio, 1.04; 95% confidence
interval, 0.92 to 1.19; P=0.51). However, when the analysis was restricted
to the 5106 subjects reported in four studies that used the Acute Kidney
Injury Network criteria to define AKI, the risk of developing AKI was
significantly lower in women compared with in men (odds ratio, 0.75; 95%
confidence interval, 0.65 to 0.87; P,0.001). Conclusions Our systematic
review and meta-analysis contradict the generally held consensus that
being a woman is an independent risk factor for the development of
cardiothoracic surgery-associated AKI.<br/>Copyright &#xa9; 2016 by the
American Society of Nephrology.

<89>
Accession Number
619682114
Author
Abouarab A.A.; Leonard J.R.; Ohmes L.B.; Lau C.; Rong L.Q.; Ivascu N.S.;
Pryor K.O.; Munjal M.; Crea F.; Massetti M.; Sanna T.; Girardi L.N.;
Gaudino M.
Institution
(Crea, Massetti, Sanna) Catholic University, Department of Cardiovascular
Sciences, Rome, Italy
(Abouarab, Leonard, Ohmes, Lau, Rong, Ivascu, Pryor, Munjal, Girardi,
Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525
East 68th St, New York, NY 10065, United States
Title
Posterior Left pericardiotomy for the prevention of postoperative Atrial
fibrillation after Cardiac Surgery (PALACS): Study protocol for a
randomized controlled trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 593. Date of
Publication: 13 Dec 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative atrial fibrillation (POAF) is a common
complication following cardiac surgery. POAF is associated with increased
morbidity and hospital costs. We herein describe the protocol for a
randomized controlled trial to determine if performing a posterior left
pericardiotomy prevents POAF after cardiac surgery. Methods/design: All
patients submitted to cardiac surgery at our institution will be screened
for inclusion into the study. The study will consist of two parallel arms
with random allocation between groups to either receive a posterior left
pericardiotomy or serve as a control. Masking will be done in a
single-blinded fashion to the patient. Patients will be continuously
monitored postoperatively for the occurrence of atrial fibrillation until
discharge. At the follow-up clinic visit (15-30 days after surgery), the
primary endpoint (atrial fibrillation) and other secondary endpoints, such
as pleural or pericardial effusion, will be assessed. A total sample size
of 350 subjects will be recruited. Discussion: POAF is associated with
increased morbidity, prolonged hospital stay, and increased costs after
cardiac surgery. Several strategies aimed at reducing the incidence of
POAF have been investigated, including beta-blockers, amiodarone, and
statins, all with suboptimal results. Posterior left pericardiotomy has
been associated with a reduction of POAF in previous series. However,
these studies had limited sample sizes and suboptimal methodology, so that
the efficacy of posterior pericardiotomy in preventing POAF remains to be
definitively proven. Our randomized trial aims to determine the effect of
a posterior left pericardiotomy on the incidence of POAF. Trial
registration: ClinicalTrials.gov, ID: NCT02875405 , protocol record
1502015867. Registered on July 2016.<br/>Copyright &#xa9; 2017 The
Author(s).

<90>
Accession Number
619776295
Author
Ram P.; Mezue K.; Pressman G.; Rangaswami J.
Institution
(Ram, Mezue, Rangaswami) Department of Internal Medicine Einstein Medical
Center Philadelphia, Pennsylvania
(Pressman) Heart and Vascular Institute, Division of Cardiology Einstein
Medical Center Philadelphia, Pennsylvania
Title
Acute kidney injury post-transcatheter aortic valve replacement.
Source
Clinical Cardiology. (no pagination), 2017. Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Transcatheter aortic valve replacement (TAVR) is a treatment option in
high-risk patients with severe aortic stenosis who are not surgical
candidates. In light of emerging evidence, it is being increasingly
performed even in intermediate-risk patients in recent years. Patients who
develop acute kidney injury (AKI) following TAVR are known to have worse
outcomes. The objective of this concise review was to identify the
prevalence and the impact of AKI following TAVR on patient outcomes by
including the most recent literature in our search. After a thorough
search on MEDLINE, Google Scholar, and PubMed, we included all literature
relevant to AKI following TAVR. We found that AKI was caused by a variety
of reasons, such as hemodynamic instability during rapid pacing, blood
transfusion, periprocedural embolization, and use of contrast medium, to
name a few. In patients who developed AKI following TAVR, 30-day and
1-year mortality were increased. Further, in these patients, length and
cost of hospital stay were increased as well. Preventive measures such as
optimal periprocedural hydration, careful contrast use, and techniques to
prevent embolization during device implantation have been tried with
limited success. Given that TAVR is expected to be increasingly performed,
this review aimed to summarize the rapidly expanding currently available
literature in an effort to reduce procedural complications and thereby
improve patient outcomes.<br/>Copyright &#xa9; 2017 Wiley Periodicals,
Inc.

<91>
Accession Number
619769983
Author
Puymirat E.; Didier R.; Eltchaninoff H.; Lung B.; Collet J.-P.; Himbert
D.; Durand E.; Leguerrier A.; Leprince P.; Fajadet J.; Teiger E.; Chevreul
K.; Lievre M.; Tchetche D.; Leclercq F.; Chassaing S.; Le Breton H.;
Donzeau-Gouge P.; Lefevre T.; Carrie D.; Gillard M.; Blanchard D.
Institution
(Puymirat, Blanchard) Department of Cardiology, European Hospital of
Georges Pompidou Public Assistance Hospitals of Paris, Paris Descartes
University Paris France
(Didier, Gillard) Department of Cardiology Brest University Hospital Brest
France
(Eltchaninoff, Durand) Department of Cardiology Rouen University Hospital
Rouen France
(Lung, Himbert) Department of Cardiology Bichat University Hospital Paris
France
(Collet) Department of Cardiology Pitie Salpetriere University Hospital
Paris France
(Leguerrier) Department of Cardiology and Surgery Rennes University
Hospital Rennes France
(Leprince) Department of Surgery Pitie Salpetriere University Hospital
Paris France
(Fajadet, Tchetche) Department of Cardiology Clinique Pasteur Toulouse
France
(Teiger) Department of URC-ECO and Cardiology Creteil University Hospital
Paris France
(Chevreul) Public Assistance Hospitals of Paris, Hotel Dieu Hospital
Clinical Research Unit Paris France
(Lievre) UMR and Department of Cardiology Lyon University Hospital Lyon
France
(Leclercq) Department of Cardiology Montpellier University Hospital
Montpellier France
(Chassaing) Department of Cardiology Clinique Saint-Gatien Tours France
(Le Breton) Department of Cardiology Rennes University Hospital Rennes
France
(Donzeau-Gouge, Lefevre) Department of Cardiology and Surgery, I
Cardiovascular Institute Paris Sud Private Hospital Jacques Cartier Massy
France
(Carrie) Department of Cardiology, CHU Toulouse Rangueil University Paul
Sabatier Toulouse France
Title
Impact of coronary artery disease in patients undergoing transcatheter
aortic valve replacement: Insights from the FRANCE-2 registry.
Source
Clinical Cardiology. (no pagination), 2017. Date of Publication: 2017.
Publisher
John Wiley and Sons Inc. (E-mail: cs-journals@wiley.com)
Abstract
Background: Coronary artery disease (CAD) is common in patients undergoing
transcatheter aortic valve replacement (TAVR). However, the impact of CAD
distribution before TAVR on short- and long-term prognosis remains
unclear. Hypothesis: We hypothesized that the long-term clinical impact
differs according to CAD distribution in patients undergoing TAVR using
the FRench Aortic National CoreValve and Edwards (FRANCE-2) registry.
Methods: FRANCE-2 is a national French registry including all consecutive
TAVR performed between 2010 and 2012 in 34 centers. Three-year mortality
was assessed in relation to CAD status. CAD was defined as at least 1
coronary stenosis >50%. Results: A total of 4201 patients were enrolled in
the registry. For the present analysis, we excluded patients with a
history of coronary artery bypass. CAD was reported in 1252 patients
(30%). Half of the patients presented with coronary multivessel disease.
CAD extent was associated with an increase in cardiovascular risk profile
and in logistic EuroSCORE (European System for Cardiac Operative Risk
Evaluation) (from 19.3%+/-12.8% to 21.9%+/-13.5%, P<0.001). Mortality at
30days and 3years was 9% and 44%, respectively, in the overall population.
In multivariate analyses, neither the presence nor the extent of CAD was
associated with mortality at 3years (presence of CAD, hazard ratio [HR]:
0.90; 95% confidence interval [CI]: 0.78-1.07). A significant lesion of
the left anterior descending (LAD) was associated with higher 3-year
mortality (HR: 1.42; 95% CI: 1.10-1.87). Conclusions: CAD is not
associated with decreased short- and long-term survival in patients
undergoing TAVR. The potential deleterious effect of LAD disease on
long-term survival and the need for revascularization before or at the
time of TAVR should be validated in a randomized control
trial.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<92>
Accession Number
619770844
Author
Elmariah S.; Fearon W.F.; Inglessis I.; Vlahakes G.J.; Lindman B.R.; Alu
M.C.; Crowley A.; Kodali S.; Leon M.B.; Svensson L.; Pibarot P.; Hahn
R.T.; Thourani V.H.; Palacios I.F.; Miller D.C.; Douglas P.S.; Passeri
J.J.
Institution
(Elmariah, Inglessis, Palacios, Passeri) Cardiology Division, Department
of Medicine, Massachusetts General Hospital, Harvard Medical School,
Boston, Massachusetts, United States
(Elmariah) Baim Institute for Clinical Research, Boston, Massachusetts,
United States
(Fearon, Miller) Division of Cardiovascular Medicine, Department of
Medicine, Stanford University School of Medicine, Stanford, California,
United States
(Vlahakes) Division of Cardiac Surgery, Department of Surgery,
Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, United States
(Lindman) Cardiovascular Medicine Division, Department of Medicine,
Vanderbilt University Medical Center, Nashville, Tennessee, United States
(Alu, Crowley, Kodali, Leon, Hahn) Cardiovascular Research Foundation, New
York, New York, United States
(Kodali, Leon, Hahn) Division of Cardiology, Department of Medicine,
Columbia University Medical Center/New York-Presbyterian Hospital, New
York, New York, United States
(Svensson) Department of Cardiothoracic Surgery, Cleveland Clinic
Foundation, Cleveland, Ohio, United States
(Pibarot) Department of Medicine, Quebec Heart and Lung Institute, Laval
University, Quebec City, Quebec, Canada
(Thourani) Department of Cardiac Surgery, Medstar Washington Hospital
Center, Washington, DC, United States
(Douglas) Cardiology Division, Department of Medicine, Duke Clinical
Research Institute/Duke University Medical Center, Durham, North Carolina,
United States
Title
Transapical Transcatheter Aortic Valve Replacement Is Associated With
Increased Cardiac Mortality in Patients With Left Ventricular Dysfunction:
Insights From the PARTNER I Trial.
Source
JACC: Cardiovascular Interventions. 10 (23) (pp 2414-2422), 2017. Date of
Publication: 11 Dec 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The authors sought to evaluate the impact of transapical (TA)
transcatheter aortic valve replacement (TAVR) on mortality, left
ventricular (LV) ejection fraction (LVEF) improvement, and functional
recovery in patients with LV dysfunction. Background LV injury inherent to
TA access for structural heart disease interventions may be particularly
detrimental to the LV, functional recovery, and survival in patients with
LV dysfunction. Methods The study included patients enrolled within the
PARTNER I (Placement of Aortic Transcatheter Valves) trial that underwent
transfemoral (TF) or TA TAVR. Analyses of clinical outcomes were
stratified by the presence of baseline LV dysfunction (LVEF<50%) and
adjusted for the propensity of receiving TA TAVR. Results Of 2,084
subjects, 1,057 underwent TA TAVR. TA access was associated with increased
2-year all-cause mortality in those with (adjusted hazard ratio
[HR<inf>adjusted</inf>]: 1.52; 95% confidence interval [CI]: 1.12 to 2.07;
p = 0.008) and without (HR<inf>adjusted</inf>: 1.38; 95% CI: 1.10 to 1.74;
p = 0.006) LV dysfunction. TA TAVR portended increased 2-year cardiac
mortality in subjects with LVEF<50% (HR<inf>adjusted</inf>: 1.92; 95% CI:
1.21 to 3.05; p = 0.006), but not with LVEF>=50% (HR<inf>adjusted</inf>:
1.29; 95% CI: 0.87 to 1.90; p = 0.21). In those with LVEF<50%, greater
improvements in LVEF (TF-TA difference +4.04%, 95% CI: 2.39% to 5.69%; p <
0.0001) and 6-min walk distance (TF-TA difference +45.1 m, 95% CI: 18.4 to
71.9 m; p = 0.001) occurred within 30 days after TF versus TA TAVR.
Conclusions Compared with TF TAVR, TA TAVR is associated with a
disproportionate risk of cardiac mortality in patients with LV dysfunction
and with delayed and less robust improvement in LV function and overall
functional status. Caution is warranted when considering TA access for
structural heart disease interventions, particularly in patients with LV
dysfunction. (Placement of Aortic Transcatheter Valves [PARTNER];
NCT00530894)<br/>Copyright &#xa9; 2017 American College of Cardiology
Foundation

<93>
Accession Number
619739736
Author
Tang Y.; Yunhu S.
Institution
(Tang, Yunhu) National Center for Cardiovascular Disease, Chinese Academy
of Medical Sciences, Peking Union Medical College, China
Title
To commemorate the 60th year of the history of surgical treatment for
HOCM.
Source
Journal of the American College of Cardiology. Conference: 28th Great Wall
International Congress of Cardiology China Heart Society Beijing Society
of Cardiology, GW-ICC 2017. China. 70 (16 Supplement 1) (pp C160), 2017.
Date of Publication: October 2017.
Publisher
Elsevier USA
Abstract
Objectives: British surgeon Brock and pathologist Teare described the
clinical and pathological characteristics of hypertrophic obstructive
cardiomyopathy(HOCM) in 1957, which is considered the 1^st year
of HOCM study. We aim to commemorate the 60^th year of the
history of surgical treatment for HOCM and to express our sincere respect
to those who contribute a lot to this disease at this conference. Methods:
By searching the key words of 'Hypertrophic Obstructive Cardiomyopathy'
'myectomy' 'myotomy' 'idiopathic hypertrophic subaortic stenosis' 'Andrew
Glenn Morrow' in PUBMED, corresponding with Professor Braunwald and Derani
etc. we gained the literatures about HOCM from 1957 to 2017, analyzing the
evolution of our cognition and surgical treatment to HOCMResultsIn 1957,
100 years before the coming of cardiac catheterization, surgeon and
pathologist from Britain reported Hypertrophic cardiomyopathy
simultaneously by the results of surgery and autopsy respectively. In
1959, British surgeon Cleland tried to partially resect the hypertrophied
septum for patients with HOCM as a pioneer. In 1960, doctor A.G Morrow
completed his first morrow procedure. Kirklin from mayo clinic tried
myectomy via a 2 cm incision of left anterior ventricular wall in two case
in 1961, by which he could get a better surgical vision. In 1963,
professor Lillehei considered the transatrial approach was an better way
to expose the septum. In 1971, Cooley raised his view of mitral
replacement for dealing with this kind of left ventricular obstruction
while Konno believed the ventriculoaortoplasty was a better way to solve
this problem. When it came to 1990, Germany surgeon Messmer published his
surgical strategy of extended myectomy by broadening and deepening the
resection and separating the abnormal links between septum and mitral
apparatus, by which he could eliminate the SAM related mitral
regurgitation completely. However, some controversies about concomitant
mitral valvuloplasty merged later. In 1992, Mclntosh thought longitudinal
mitral plication was an optional procedure for abolishing mitral
regurgitation during surgery while Kofflard believed that the augmentation
to anterior mitral leaflet by autogenous pericardial patch could
effectively reduce the mitral insufficiency during surgery. In 2007,
professor Dearani from the Mayo Clinic summarized the surgical experience
of his team by emphasizing the extended myectomy and dividing anomalous
muscles and chordea in left ventricle. In 2016, professore Song from Fuwai
Hospital published his research, in which he believed that no concomitant
mitral procedure should be exerted in myectomy for eliminating SAM related
mitral regurgitation, because only if a satisfying myectomy was completed,
there should no SAM and mitral regurgitation remained. Conclusions: After
the 60 years development, HOCM has evolved from a less known disease to a
relatively begin disease via the appropriate clinical management(optimal
medication, surgical septal reduction therapy, septal alcohol ablation,
etc.). In the forthcoming years, multidiscipline management and
international communication and collaboration can be the vital factors to
promote the development of HOCM.

<94>
Accession Number
619739446
Author
Wang J.; Zhou Y.
Institution
(Wang) Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital
Medical University, Beijing, China
(Wang) Center for Cardiac Intensive Care, Beijing An Zhen Hospital,
Capital Medical University, Beijing, China
(Zhou) Department of Cardiology, Beijing An Zhen Hospital, Capital Medical
University, Beijing, China
Title
Predictors of TAVI-associated bleeding and its impact on short-term
mortality.
Source
Journal of the American College of Cardiology. Conference: 28th Great Wall
International Congress of Cardiology China Heart Society Beijing Society
of Cardiology, GW-ICC 2017. China. 70 (16 Supplement 1) (pp C71), 2017.
Date of Publication: October 2017.
Publisher
Elsevier USA
Abstract
Objectives: Background: This study aimed to investigate the impact of
post-Transcatheter Aortic Valve Implantation (TAVI) bleeding according to
the bleeding definition from the Valve Academic Research Consortium-2
(VARC-2) criteria on 30-day postoperative mortality and to examine the
correlation between pre-or intra-operative variables and the bleeding.
Methods: This systematic review and meta-analysis were conducted and
reported in adherence to the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA). Multiple electronic literature
databases were searched using predefined criteria, with bleeding defined
per VARC-2 criteria. A total of 10 eligible articles with 3,602 patients
were included in the meta-analysis. Differences are expressed as odds risk
(OR) with 95% confidential interval (CI). Study heterogeneity was tested
using the I2 statistic. Study heterogeneity was considered significant
when P values < 0.10 or I2 > 50%. A fixed-effects model was used when
study heterogeneity was not significant; a random effects model was used
when study heterogeneity was significant. Egger's linear regression test
was used to estimate publication bias. Meta-regression analysis was
performed to examine whether covariates, which could be potential
modifiers, can affect the end results of the meta-analysis. Results: The
meta-analysis revealed that post-TAVI bleeding was associated with a 323%
increase in 30-day postoperative mortality (OR: 4.23, 95%CI: 2.80-6.40,
P<0.0001) without significant study heterogeneity and publication bias.
Subgroup analysis found that the patients with major
bleeding/life-threatening bleeding showed 410% increase in the mortality
compared with the patients without bleeding (OR:5.10, 95%CI: 3.17-8.19,
P<0.0001). Transapical access was associated with a significant 83%
increase in the incidence of bleeding compared with transfermoral access
(OR: 1.83, 95%CI: 1.43-2.33, P<0.0001). Multiple logistic regression
analysis revealed that atrial fibrillation (AF) independently correlated
with TAVI-associated bleeding (OR: 2.63, 95% CI: 1.33-5.21, P=0.005). The
potential modifiers, such as STS Score, mortality, the logistic EuroSCORE,
aortic valve area, mean pressure gradient, LVEF, preoperative hemoglobin
and platelet levels, and study design had no effects on the end results of
the meta-analysis. Conclusions: To the best of our knowledge, this is the
first meta-analysis to use the VARC-2 definitions to investigate the
effect of TAVI-associated bleeding on 30-day postoperative mortality and
to comprehensively examine the association between prior intraprocedural
variables and post-TAVI bleeding. Our key findings are: (1) post-TAVI
bleeding, in particular major bleeding or LTB, was associated with a
significant increase in 30-day postoperative mortality; (2) TA access
significantly increased the incidence of post-TAVI bleeding; and (3)
preexisting AF independently correlated with post-TAVI bleeding.
Recognition of the importance and determinants of post-TAVI bleeding
should lead to strategies to improve outcomes.

<95>
Accession Number
619739364
Author
Liu N.; Weiwei Z.; Yang L.; Shuang W.
Institution
(Liu, Weiwei, Yang, Shuang) Department of Cardiology, Institute of
Cardiovascular Research of People's Liberation Army, China
Title
Clinical research of treatment with Tirofiban for high-risk non-ST-segment
elevation acute coronary syndrome during peri-operative intervention
operation period.
Source
Journal of the American College of Cardiology. Conference: 28th Great Wall
International Congress of Cardiology China Heart Society Beijing Society
of Cardiology, GW-ICC 2017. China. 70 (16 Supplement 1) (pp C104), 2017.
Date of Publication: October 2017.
Publisher
Elsevier USA
Abstract
Objectives: This research is to explore the clinical effects of treatment
with Tirofiban for high-risk non-ST-segment elevation acute coronary
syndrome (NSTE ACS) during peri-operative intervention operation period,
and to improve the level of clinical treatment. Methods: 90 cases of
high-risk NSTE ACS patients were randomly selected from January, 2013 to
April, 2016 as the research objects, which were divided into the control
group and the observation group. The control group received clopidogrel
anticoagulation, coronary angiography and percutaneous coronary
interventional (PCI) treatment, while the observation group took tirofiban
treatment in addition to the treatment of control group. The differences
on major adverse cardiovascular events, TIMI flow grading and
complications of the two groups were observed after treatment. Results:
There was significant difference (P < 0.05) on the distal vascular
blockage of major adverse cardiovascular events, intra-operative
no-reflow, reoccurrence of acute myocardial infarction and stenocardia and
post-PCI TIMI flow grade 2 and 3. But in terms of bleeding complications,
TIMI flow grade 0 and 1 before PCI and after PCI, there was no significant
difference (p> 0.05). Conclusions: Application of tirofiban treatment for
high-risk NSTE ACS during the peri-intervention period is safe and
effective, which can improve TIMI flow, increase tissue perfusion and
reduce postoperative complications.

<96>
Accession Number
619739183
Author
Xu Z.; Jin F.; Ou J.S.
Institution
(Xu, Ou) First Affiliated Hospital, Sun-Yat-sen University, China
(Jin) First Affiliated Hospital, Jinan University, Guangzhou Women and
Children's Medical Center, China
Title
Surgery or thrombolytic therapy for mechanical heart valve thrombosis in
pregnancy: A systematic review.
Source
Journal of the American College of Cardiology. Conference: 28th Great Wall
International Congress of Cardiology China Heart Society Beijing Society
of Cardiology, GW-ICC 2017. China. 70 (16 Supplement 1) (pp C158), 2017.
Date of Publication: October 2017.
Publisher
Elsevier USA
Abstract
Objectives: Managing mechanical heart valve thrombosis (MHVT) in pregnant
women remains challenging. We aim to evaluate the effectiveness and safety
of surgery or thrombolysis for MHVT mothers and their fetuses. Methods:
Relevant studies published before March 2017 were collected in several
databases and analyzed with SPSS 22.0. We searched studies with at least
two patients treated with surgery or thrombolysis. Results: Seventy four
studies comprising 224 pregnancies (153 adopting surgery, 71 receiving
thrombolysis) were included. Duration of cardiopulmonary bypass (CPB) time
>=120min is significantly related to the poor fetal outcome of surgery.
For patients at gestational age ranging from 26w to 36w, the fetal wastage
rate in the subgroup of caesarean delivery before cardiac surgery was
significantly lower than the patients whose delivery was carried out after
the surgery. Compared with streptokinase subgroup, the mortality rate in
the tissue-type plasminogen activator (tPA) subgroup was significantly
lower while the success rate was significantly higher. The fetal and
maternal outcomes of thrombolysis were comparable to the subgroup of
surgery whose NYHA grades were III/IV. Conclusions: For MHVT pregnant
patients with NYHA III-IV, the therapeutic effect of thrombolysis may be
comparable to the surgery. The protocol of low-dose, slow infusion of tPA
with repeated doses as needed may be the optimal regimen for these
patients. If surgery was adopted, CPB management of pregnant women should
be addressed to improve maternal and fetal outcomes. For MHVT patients at
gestational age ranging from 26w to 36w, caesarean section before surgery
may be advisable.

<97>
Accession Number
615378310
Author
Alawami M.; Chatfield A.; Ghashi R.; Walker L.
Institution
(Alawami, Chatfield) Cardiology Department, Auckland City Hospital,
Auckland, New Zealand
(Ghashi) Science Department, Auckland University, Auckland, New Zealand
(Walker) Cardiothoracic and Vascular Intensive Care Unit, Auckland City
Hospital, Auckland, New Zealand
Title
Atrial fibrillation after cardiac surgery: Prevention and management: The
Australasian experience.
Source
Journal of the Saudi Heart Association. 30 (1) (pp 40-46), 2018. Date of
Publication: January 2018.
Publisher
Elsevier B.V.
Abstract
Background Atrial fibrillation (AF) after cardiac surgery is a major
health problem that is associated with a significant financial burden.
This paper aims to highlight this problem and review the current
guidelines in the prevention and management of AF after cardiac surgery,
providing our experience in the Australasian centers. Methods We conducted
a literature review using mainly PubMed to compare the current practice
with the available evidence. EMBASE and Cochrane library were also
searched. We concurrently developed an online questionnaire to collect
data from other Australasian centers regarding their approach to this
problem. Results We identified 194 studies that were considered relevant
to our research. We did not find any formal protocols published in the
literature. From our Australasian experience; seven centers (58%) had a
protocol for AF prophylaxis. The protocols included electrolytes
replacement, use of amiodarone and/or beta-blockers. Other strategies were
occasionally used but were not part of a structured protocol. Conclusion
The development of an integrated medical and surgical protocol for the
prophylaxis of AF after cardiac surgery is an important aspect for the
care of postoperative cardiac patients. Considerations of prophylactic
strategies other than those routinely used should be included in the
protocol. This area should receive considerable attention in order to
reduce the postoperative complications and health costs.<br/>Copyright
&#xa9; 2017 The Authors

<98>
Accession Number
617548707
Author
Yi B.; Wang J.; Yi D.; Zhu Y.; Jiang Y.; Li Y.; Mo S.; Liu Y.; Rong J.
Institution
(Yi) Department of Cardiothoracic Surgery, Heart Center, the First
Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on
Assisted Circulation, Ministry of Health, Guangzhou, China
(Yi, Zhu, Jiang, Li, Mo, Rong) Department of Extracorporeal Circulation,
Heart Center, the First Affiliated Hospital, Sun Yat-Sen University, and
Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou,
China
(Wang) Department of Anesthesiology, State Key Laboratory of
Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular
Disease, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing, China
(Yi) Department of Cardiac Surgery, the Second Xiangya Hospital, Central
South University, Changsha, China
(Liu) Department of Anesthesiology, the First Affiliated Hospital, Sun
Yat-Sen University, Guangzhou, China
Title
Remote Ischemic Preconditioning and Clinical Outcomes in On-Pump Coronary
Artery Bypass Grafting: A Meta-Analysis of 14 Randomized Controlled
Trials.
Source
Artificial Organs. 41 (12) (pp 1173-1182), 2017. Date of Publication:
December 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
The purpose of this article is to perform the first pooled analysis on
remote ischemic preconditioning (RIPC) used for the improvement of
clinical outcomes of patients only undergoing on-pump coronary artery
bypass grafting (CABG) in randomized controlled trials (RCTs). A
systematic search was performed using PubMed, the Cochrane Library, and
the Web of Science to identify studies that described the effect of RIPC
on postoperative mortality in patients only undergoing on-pump CABG. The
outcomes included postoperative mortality, postoperative morbidity
(including incidence of myocardial infarction, atrial fibrillation,
stroke, acute kidney injury, and renal replacement therapy), mechanical
ventilation (MV), intensive care unit length of stay (ICU LOS), and
hospital length of stay (HLOS). A total of 14 RCTs (2830 participants)
were included. Our meta-analysis found that RIPC failed to reduce the
postoperative mortality in patients only undergoing on-pump CABG compared
with control individuals (odds ratio, 0.81; 95% confidence interval,
[0.40, 1.64]; P = 0.55; I² = 25%). Moreover, there were no
differences in postoperative morbidity, ICU LOS, and HLOS between the two
groups. However, MV in the RIPC group was shorter than that in control
individuals (standard mean difference, -0.41; 95% confidence interval,
[-0.80, -0.01]; P = 0.04; I² = 73%). The present meta-analysis
found that RIPC failed to improve most of clinical outcomes in patients
only undergoing on-pump CABG; however, MV was reduced. Adequately powered
trials are warranted to provide more evidence in the future.<br/>Copyright
&#xa9; 2017 International Center for Artificial Organs and Transplantation
and Wiley Periodicals, Inc.

<99>
Accession Number
619002488
Author
Burri H.; Muller H.; Kobza R.; Sticherling C.; Ammann P.; Zerlik H.;
Stettler C.; Klersy C.; Prinzen F.; Auricchio A.
Institution
(Burri, Muller, Stettler) University Hospital of Geneva, Switzerland
(Kobza) Luzerner Kantonsspital, Switzerland
(Sticherling) University Hospital of Basel, Switzerland
(Ammann) Kantonsspital St-Gallen, Switzerland
(Zerlik) Abbott, Switzerland
(Klersy) Service of Biometry & Clinical Epidemiology, Research Department,
IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
(Prinzen) Department of Physiology, Cardiovascular Research Institute,
University of Maastricht, Netherlands
(Auricchio) Fondazione Cardiocentro Ticino, Lugano, Switzerland
Title
RIght VErsus Left Apical transvenous pacing for bradycardia: Results of
the RIVELA randomized study.
Source
Indian Pacing and Electrophysiology Journal. 17 (6) (pp 171-175), 2017.
Date of Publication: November 2017.
Publisher
Indian Pacing and Electrophysiology Group (Pulikkottil Thondayad, Calicut
Kerala 673017, India)
Abstract
Aims To compare cardiac function when pacing from the right or left
ventricular apex in patients with preserved left ventricular systolic
function, at 1-year follow-up. Methods Prospective, multicentre centre
randomizing conventional right ventricular apical (RVA) versus left
ventricular apical (LVA) pacing using a coronary sinus lead in patients
requiring ventricular pacing for bradycardia. Follow-up was performed
using 3D-echocardiography at 6 and 12 months. Results A total of 36
patients (age 75.4 +/- 8.7 years, 21 males) were enrolled (17 patients in
the RVA group and 19 patients in the LVA group). A right ventricular lead
was implanted in 8 patients in the LVA group, mainly because of high
capture thresholds. There were no differences in the primary endpoint of
LVEF at 1 year (60.4 +/- 7.1% vs 62.1 +/- 7.2% for the RVA and LVA groups
respectively, P = 0.26) nor in any of the secondary endpoints (left
ventricular dimensions, left ventricular diastolic function, right
ventricular systolic function and tricuspid/mitral insufficiency). LVEF
did not change significantly over follow-up in either group. Capture
thresholds were significantly higher in the LVA group, and two patients
had unexpected loss of capture of the coronary sinus lead during
follow-up. Conclusions Left univentricular pacing seems to be comparable
to conventional RVA pacing in terms of ventricular function at up to 1
year follow-up, and is an option to consider in selected patients (e.g.
those with a tricuspid valve prosthesis).<br/>Copyright &#xa9; 2017 Indian
Heart Rhythm Society

<100>
Accession Number
612481745
Author
Vavuranakis M.; Siasos G.; Zografos T.; Oikonomou E.; Vrachatis D.;
Kalogeras K.; Papaioannou T.; Kolokathis M.-A.; Moldovan C.; Tousoulis D.
Institution
(Vavuranakis, Siasos, Zografos, Oikonomou, Vrachatis, Kalogeras,
Papaioannou, Kolokathis, Moldovan, Tousoulis) 1st Department of
Cardiology, 'Hippokration' Hospital, University of Athens Medical School,
Athens, Greece
(Siasos) Cardiovascular Division, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
Title
Dual or single antiplatelet therapy after transcatheter aortic valve
implantation? A systematic review and meta-analysis.
Source
Current Pharmaceutical Design. 22 (29) (pp 4596-4603), 2016. Date of
Publication: 01 Aug 2016.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has undeniably
earned a prestigious post in the quiver of interventional cardiologists
against symptomatic severe aortic stenosis. Cerebrovascular events are
listed within the most frequent complications. Methods: We performed a
systematic search of EMBASE, MEDLINE, and the Cochrane library from
inception to March 2016 for the following search terms (transcatheter AND
antiplatelet) OR (transcatheter AND antithrombotic) to retrieve studies of
dual antiplatelet treatment (DAPT) and single antiplatelet treatment
(SAPT) in patients after TAVI to study thrombotic, hemorrhagic and
cardiovascular events at 30 days post procedure. From a total of 208
records 4 studies met inclusion criteria. Results: In the included
studies, 286 patients were enrolled in the DAPT group and 354 patients in
the SAPT group. There was no difference in all-cause mortality,
cardiovascular mortality, stroke, and myocardial infraction 30 days post
TAVI between DAPT and SAPT. However, patients in the DAPT group had a
significantly increased incidence of lethal and major bleeding at 30 days
of follow-up and the incidence of the combined end-point of stroke,
spontaneous MI, all-cause mortality and major bleeding was significantly
higher in the DAPT group in comparison to the SAPT group. Conclusion: DAPT
compared to SAPT in patients after TAVI increases incidence of hemorrhagic
events with no benefits in terms of thrombotic events and cardiovascular
mortality. However, these data must be interpreted cautiously and the
choice of DAPT over SAPT must be based on an individual patient
characteristic according to medical practice criteria.<br/>Copyright
&#xa9; 2016 Bentham Science Publishers.

<101>
Accession Number
618634479
Author
Squiers J.J.; Potluri S.; Brinkman W.T.; DiMaio J.M.
Institution
(Squiers, DiMaio) Baylor Scott & White Research Institute, The Heart
Hospital Baylor Plano, Plano, Tex, United States
(Potluri) Department of Cardiology, The Heart Hospital Baylor Plano,
Plano, Tex, United States
(Brinkman, DiMaio) Department of Cardiothoracic Surgery, The Heart
Hospital Baylor Plano, Plano, Tex, United States
(Squiers) Department of General Surgery, Baylor University Medical Center,
Dallas, Tex, United States
Title
Systematic review of transcatheter aortic valve replacement after previous
mitral valve surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 155 (1) (pp 63-65.e5),
2018. Date of Publication: January 2018.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)

<102>
Accession Number
619531068
Author
Han Y.; Yang Y.; Zhang J.; Xu K.; Fu G.; Su X.; Jiang T.; Pang W.; Chen
J.; Yuan Z.; Li H.; Wang H.; Hong T.; Liu H.; Sun F.; Allocco D.J.; Zhang
M.; Dawkins K.D.
Institution
(Han, Liu, Xu) Department of Cardiology, General Hospital of Shenyang
Military Region, 83 Wenhua Road, Shenyang 10016, China
(Yang) Cardiovascular Institute, Fu Wai Hospital, Beijing, China
(Zhang) TEDA International Cardiovascular Hospital, Tianjin, China
(Fu) Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University,
Hangzhou, Zhejiang Province, China
(Su) Wuhan Asia Heart Hospital, Wuhan, China
(Jiang) Affiliated Hospital of Medical College of Chinese People's Armed
Police Force, Tianjin, China
(Pang) Shengjing Hospital of China Medical University, Shenyang, China
(Chen) Guangdong General Hospital, Guangzhou, China
(Yuan) First Affiliated Hospital of Medical College of Xi'an Jiaotong
University, Xi'an, China
(Li) Daqing Oilfield General Hospital, Daqing, China
(Wang) First Affiliated Hospital of the Fourth Military Medical
University, Xi'an, China
(Hong) Peking University First Hospital, Beijing, China
(Liu) Beijing Affiliated Hospital of Armed Police Medical College,
Beijing, China
(Sun) Beijing Hospital of the Ministry of Health, Beijing, China
(Allocco, Zhang, Dawkins) Boston Scientific Corporation, Marlborough, MA,
United States
Title
A randomised comparison of biodegradable polymer-and permanent
polymer-coated platinum-chromium everolimuseluting coronary stents in
China: The EVOLVE China study.
Source
EuroIntervention. 13 (10) (pp 1210-1217), 2017. Date of Publication:
November 2017.
Publisher
EuroPCR
Abstract
Aims: The EVOLVE China randomised study sought to evaluate the clinical
safety and effectiveness of the SYNERGY bioabsorbable polymer-coated
everolimus-eluting stent (EES) for the treatment of patients with coronary
heart disease in China. Methods and results: Eligible patients with de
novo native coronary artery lesions were randomised (1:1) to receive the
SYNERGY or PROMUS Element Plus stent. The primary endpoint was in-stent
late loss at nine months. Secondary endpoints included death, MI,
revascularisation, and stent thrombosis up to 12 months. A total of 412
subjects were randomised (205 SYNERGY; 207 PROMUS Element Plus) at 14
sites in China from October 2013 to July 2014. SYNERGY was non-inferior to
PROMUS Element Plus for the primary endpoint of nine-month in-stent late
loss: SYNERGY 0.20+/-0.33 mm vs. PROMUS Element Plus 0.17+/-0.38 mm with
an upper one-sided 97.5% confidence interval of the difference (0.10 mm),
significantly less than the non-inferiority margin (0.15 mm; p<0.0008).
Clinical adverse event rates were low and not significantly different
between groups at nine and 12 months (all p>0.05). Conclusions: In the
EVOLVE China trial, the SYNERGY bioabsorbable polymer-coated EES was
noninferior to the PROMUS Element Plus permanent polymer-coated EES for
the primary endpoint of late loss at nine months.<br/>Copyright &#xa9;
Europa Digital & Publishing 2017. All rights reserved.

<103>
Accession Number
619531049
Author
Kaul U.; Bhagwat A.; Pinto B.; Goel P.K.; Jagtap P.; Sathe S.; Wander
G.S.; Arambam P.; Bangalore S.
Institution
(Kaul) Department of Cardiology, Fortis Escorts Heart Institute, Okhla
Road, New Delhi, Delhi 110025, India
(Bhagwat) Department of Interventional Cardiology, Kamalnayan Bajaj
Hospital, Aurangabad, India
(Pinto) Department of Cardiology, Holy Family Hospital - Diagnostic
Services, Mumbai, India
(Goel) Department of Cardiology, Sanjay Gandhi Post Graduate Institute of
Medical Sciences, Lucknow, India
(Jagtap) Department of Interventional Cardiology, Wockhardt Heart
Hospital, Nagpur, India
(Sathe) Department of Cardiology, Deenanath Mangeshkar Hospital and
Research Centre, Pune, India
(Wander) Department of Cardiology, Dayanand Medical College and Hospital,
Ludhiana, India
(Arambam) Academics and Research Department, Fortis Escorts Heart
Institute, New Delhi, India
(Bangalore) Division of Cardiology, Department of Medicine, New York
University School of Medicine, New York, NY, United States
Title
Paclitaxel-eluting stents versus everolimus-eluting coronary stents in a
diabetic population: Two-year follow-up of the TUXEDO-India trial.
Source
EuroIntervention. 13 (10) (pp 1194-1201), 2017. Date of Publication:
November 2017.
Publisher
EuroPCR
Abstract
Aims: The aim of this study was to report whether the superiority of the
everolimus-eluting stent (EES) vs. the paclitaxel-eluting stent (PES) at
one-year follow-up in the Taxus Element versus Xience Prime in a Diabetic
Population (TUXEDO)-India trial was sustained at longer-term follow-up.
Methods and results: One thousand eight hundred and thirty (1, 830)
patients with diabetes mellitus and coronary artery disease were
randomised to EES vs. PES. Follow-up data up to two years were available
in 1, 701 (92.9%) patients. The primary endpoint was target vessel failure
(TVF), defined as the composite of cardiac death, target vessel myocardial
infarction (TV-MI), or ischaemia-driven target vessel revascularisation
(TVR). Treatment with EES had a lower two-year rate of TVF (4.3% vs. 6.6%,
p=0.03). Of the secondary endpoints, EES significantly reduced any MI
(1.6% vs. 3.5%, p=0.01), TV-MI (0.7% vs. 3.1%, p=0.0001), ST (0.4% vs.
2.2%, p=0.001), cardiac death or target vessel MI (2.9% vs. 4.8%, p=0.04)
and TLR (1.9% vs. 3.7%, p=0.02), compared with PES. Between one year and
two years, no significant differences in the clinical outcomes were
observed (pinteraction >0.05). Conclusions: In this adequately powered
trial, the benefits of EES vs. PES in a diabetic population seen at one
year were maintained at two years. Trial registration ctri.nic.in.
Identifier: CTRI/2011/06/001830.<br/>Copyright &#xa9; Europa Digital &
Publishing 2017. All rights reserved.

<104>
Accession Number
619605925
Author
van der Werf H.W.; Schurer R.A.J.; Vonck T.E.; Poelman J.E.; Klungel A.A.;
Cernak V.; van den Heuvel A.F.M.; van der Harst P.
Institution
(van der Werf, Schurer, Vonck, Poelman, Klungel, van den Heuvel, van der
Harst) Department of Cardiology, University of Groningen, University
Medical Centre Groningen, Netherlands
(Cernak) Department of Anaesthesiology, University of Groningen,
University Medical Centre Groningen, Netherlands
Title
Emergency transcatheter aortic valve implantation in patients with severe
aortic regurgitation and a left ventricle assist device: A case report and
systematic review.
Source
European Heart Journal: Acute Cardiovascular Care. 6 (8) (pp 719-727),
2017. Date of Publication: 01 Dec 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background: Cardiogenic shock due to severe aortic regurgitation in
patients with left ventricle assist devices is a life threatening
condition. Here, we consider transcatheter aortic valve implantation as a
treatment option. Methods and results: A patient with a left ventricle
assist device was presented to us with cardiogenic shock due to severe
aortic regurgitation. We successfully implanted a transcatheter aortic
valve in emergency setting. The patient recovered and underwent cardiac
transplantation three months afterwards. We performed a systematic
literature review and identified 10 cases of patients with a left
ventricle assist device undergoing transcatheter aortic valve
implantation. In these cases, there was no procedural related mortality
reported. In four (40%) patients, transcatheter aortic valve implantation
resulted in significant paravalvular aortic regurgitation. In two of these
cases it was due to migration of the valve towards the left ventricle.
Conclusions: Our case report and review of literature suggests that
transcatheter aortic valve implantation is a feasible and lifesaving
treatment option for left ventricle assist device patients presenting with
severe aortic regurgitation.<br/>Copyright &#xa9; 2016, &#xa9; The
European Society of Cardiology 2016.

<105>
Accession Number
619605794
Author
Siller-Matula J.M.; Petre A.; Delle-Karth G.; Huber K.; Ay C.;
Lordkipanidze M.; De Caterina R.; Kolh P.; Mahla E.; Gersh B.J.
Institution
(Siller-Matula, Petre, Delle-Karth) Department of Cardiology, Medical
University of Vienna, Austria
(Huber) 3rd Medical Department of Cardiology and Emergency Medicine,
Wilhelminen Hospital, Vienna, Austria
(Ay) Division of Haematology and Haemostaseology, Department of Medicine
I, Medical University of Vienna, Austria
(Lordkipanidze) Faculty of Pharmacy, University of Montreal; Research
Center, Montreal Heart Institute, Canada
(De Caterina) Institute of Cardiology, 'G d'Annunzio' University -
Chieti-Pescara, Chieti, Italy
(Kolh) Department of Cardiothoracic Surgery, University Hospital of Liege,
Belgium
(Mahla) Department of Anaesthesiology and Intensive Care Medicine, Medical
University of Graz, Austria
(Gersh) Division of Cardiovascular Diseases, Department of Internal
Medicine, Mayo Clinic, College of Medicine Rochester, United States
Title
Impact of preoperative use of P2Y12 receptor inhibitors on clinical
outcomes in cardiac and non-cardiac surgery: A systematic review and
meta-analysis.
Source
European Heart Journal: Acute Cardiovascular Care. 6 (8) (pp 753-770),
2017. Date of Publication: 01 Dec 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Objective: To review systematically the evidence and perform a
meta-analysis of benefits and risks associated with use of
P2Y<inf>12</inf> receptor inhibitors in coronary artery bypass graft-,
non-cardiac- and device surgery. Data selection and analysis: We performed
a meta-analysis of published studies. Patients with preoperative use of
clopidogrel, ticagrelor or prasugrel (late discontinuation: <5 days before
surgery or no discontinuation) were compared with patients without
preoperative use of the respective drug (early discontinuation: 5 days
before surgery or no users of P2Y<inf>12</inf> receptor inhibitors).
Outcomes evaluated were re-operation for major bleeding, death, myocardial
infarction, combined major adverse cardiac events (MACEs) and major
haematoma. Using a random effect model, relative risks (RRs) and 95%
confidence intervals (CI) were calculated for each outcome. Results:
Fifty-four studies met the selection criteria and included 50,048
patients. Preoperative use of clopidogrel on top of aspirin in patients
undergoing coronary artery bypass graft was associated with a 2.5-fold
increased risk of re-operation for bleeding (95% CI: 1.92-3.25; p<0.001)
and a 1.47-fold increased risk of death (95% CI: 1.25-1.72; p<0.001), but
did not diminish the risk for myocardial infarction (RR: 0.96; 95% CI:
0.75-1.25; p=0.18) or MACE (RR: 1.16; 95% CI: 0.90--1.50; p=0.30). In
patients undergoing non-cardiac surgery, preoperative use of clopidogrel
increased the RR of re-operation for major bleeding by 2.05-fold (95% CI:
1.13-3.73; p=0.002) but did not reduce the RR for MACE or death.
Clopidogrel use during cardiac device implantation raised the RR for
procedure-related haematoma by 3.0-fold (95% CI: 1.30--6.94; p=0.001).
Whereas preoperative ticagrelor use did not increase the risk for
mortality (RR: 1.03; 95% CI: 0.49-2.14), preoperative prasugrel use tended
to increase the risk for death (RR: 5.06; 95% CI: 0.54-47.65). Conclusion:
Preoperative exposure to clopidogrel on top of aspirin did not reduce the
risk of MACE but was associated with increased risk of bleeding and
mortality.<br/>Copyright &#xa9; 2015, &#xa9; The European Society of
Cardiology 2015.

<106>
Accession Number
619566363
Author
Bigna J.J.; Noubiap J.J.; Nansseu J.R.; Aminde L.N.
Institution
(Bigna) Department of Epidemiology and Public Health, Centre Pasteur of
Cameroon, Yaounde, Cameroon
(Bigna) University of Paris Sud XI, Faculty of Medicine, Le Kremlin
Bicetre, France
(Noubiap) Groote Schuur Hospital and University of Cape Town, Department
of Medicine, Cape Town, South Africa
(Nansseu) University of Yaounde 1, Department of Public Health, Faculty of
Medicine and Biomedical Sciences, Yaounde, Cameroon
(Nansseu) Sickle Cell Disease Unit, Mother and Child Centre of the Chantal
Biya Foundation, Yaounde, Cameroon
(Nansseu) Ministry of Public Health, Department of Disease, Epidemics and
Pandemics Control, Yaounde, Cameroon
(Aminde) Clinical Research Education, Networking and Consultancy (CRENC),
Douala, Cameroon
(Aminde) University of Queensland, School of Public Health, Faculty of
Medicine and Biomedical Sciences, Brisbane, Australia
Title
Prevalence and etiologies of pulmonary hypertension in Africa: A
systematic review and meta-analysis.
Source
BMC Pulmonary Medicine. 17 (1) (no pagination), 2017. Article Number: 183.
Date of Publication: 08 Dec 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Despite the recent increasing worldwide attention towards
pulmonary hypertension (PH), its epidemiology remains poorly described in
Africa. Accordingly, we performed a systematic review and meta-analysis of
PH prevalence, incidence and etiologies in Africa. Methods: We searched
PubMed, EMBASE, African Journals Online, and Africa Index Medicus.
Published observational studies until September 20, 2017, including adult
participants residing in Africa were considered. Two review authors
independently selected studies, assessed included studies for
methodological quality, and extracted data. A random-effects model was
used for meta-analysis. Heterogeneity was evaluated by the chi
² test on Cochrane's Q statistic which is quantified by
I² values. Using Newcastle-Ottawa Scale, we considered a score
of 0-4, 5-7, and 8-10 as indicative of high, moderate, and low risk of
bias in included studies, respectively. Results: Of 1611 entries, 25
studies were retained. Twelve (48%), seven (28%), and six (24%) papers had
respectively a low, moderate and high risk of bias. The prevalence of PH
widely varied across different populations: 9.8% (95% confidence interval:
3.2-19.3; I²=99.4%; 6 studies) in 11,163 people presenting with
cardiac complaints; 10.6% (4.3-19.1; I²=90.3%; 4 studies) in
937 HIV-infected people; 32.9% (17.6-50.4; I²=97.2%; 3 studies)
in 2077 patients with heart failure; 23.2% (15.2-32.2;
I²=59.4%; 3 studies) in 248 patients on hemodialysis; 12.9%
(11.8-14.0; I²=79.7%; 2 studies) in 3750 patients with
rheumatic heart disease; 36.9% (29.7-44.3; I²=79.7; 2 studies)
in 79 patients with sickle cell disease; 62.7% (49.0-74.7; 1 study) in 51
patients with chronic obstructive pulmonary disease; 25.4% (16.3-37.3; 1
study) in 63 patients with systemic lupus erythematous; 68.7% (62.8-74.1;
1 study) in 259 patients with cardiac surgery; and 7.4% (4.6-11.9; 1
study) in 202 patients with systemic sclerosis. No study reported PH
incidence. From one international study (n=209), PH etiologies were: left
heart disease (68.9%), pulmonary arterial hypertension (15.8%), lung
disease and/or hypoxia (12.0%), chronic thromboembolic PH (1.9%) and
unclear/multifactorial PH (15.8%). Conclusion: The prevalence of PH is
relatively high in some populations in Africa, perhaps mainly driven by
left heart diseases, highlighting the need for context-specific
interventions.<br/>Copyright &#xa9; 2017 The Author(s).

<107>
Accession Number
619604755
Author
Imantalab V.; Mirmansouri A.; Mohammadzadeh Jouryabi A.; Naderi Nabi B.;
Kanani G.; Nassiri Sheikhani N.; Atrkarroushan Z.; Ghazanfar Tehran S.;
Samadpour N.
Institution
(Imantalab, Mirmansouri, Mohammadzadeh Jouryabi, Naderi Nabi, Ghazanfar
Tehran) Anesthesiology Research Center, Guilan University of Medical
Sciences, Rasht, Iran, Islamic Republic of
(Kanani, Nassiri Sheikhani) Department of Cardiac Surgery, Guilan
University of Medical Sciences, Rasht, Iran, Islamic Republic of
(Atrkarroushan) Guilan University of Medical Sciences, Rasht, Iran,
Islamic Republic of
(Samadpour) Anesthesiology and Critical Care Research Center, Guilan
University of Medical Sciences (GUMS), Rasht, Iran, Islamic Republic of
Title
Comparing the effectiveness of patient control analgesia pump and bolus
morphine in controlling pain after cardiopulmonary bypass graft surgery.
Source
Anesthesiology and Pain Medicine. 7 (5) (no pagination), 2017. Article
Number: e12756. Date of Publication: October 2017.
Publisher
Kowsar Medical Publishing Company (E-mail: info@anesthpain.com)
Abstract
Background: Postoperative pain is a complex process commonly caused by
surgical trauma. It is one of the major concerns of patients undergoing
heart surgery. Despite new techniques and modern analgesic treatments,
postoperative pain is still one of the most important controversial
issues. Methods: 68 patients scheduled for elective CABG with CPB were
included in a prospective, double-blind clinical trial. They were randomly
divided into two groups. One group received PCA pump including morphine
(group P) with underlying infusion of 0.02 mg/kg/Qh, bolus dose of 1 mg,
lockout time of 15 minutes, and amaximumof 4 bolus of 0.02 mg/kg for one
hour and the other group received morphine bolus (group B). Three patients
were excluded from the study, and 33 and 32 patients participated in the
groups P and B, respectively. Variables including age, gender, pump time,
aortic clamp time, duration of surgery, complications (nausea and
vomiting, GI Bleeding, and hypoxia), level of pain based on VAS, opioid
consumption, hemodynamic, and sedation status were measured in both
groups. Results: There wasnosignificant difference between the groups
regarding age, gender,pumptime, clamp time, duration of surgery,
complication, sedation score, and hemodynamic status in most of the
assessment periods. By assessing the pain severity in the groups at
different periods, results showed a significant difference between the
groups except at enrollment, and a lower severity of pain was noted in the
group P compared to the group B. The consumed opioid was significantly
higher in the group P than in the group B. However, higher doses of
diclofenac and paracetamol were administered in the group B compared to
the group P. Conclusions: Results showed that higher morphine would be
used in patients with PCA pump after extubation following heart surgery,
and this increased dose of opioid was associated with better pain control
and lack of complication. Therefore, PCA pump with underlying infusion
could be effectively used in patients undergoing CABG that are directly
assessed in intensive care unite.<br/>Copyright &#xa9; 2017,
Anesthesiology and Pain Medicine.

<108>
Accession Number
619727877
Author
Seco M.; Zhao D.F.; Byrom M.J.; Wilson M.K.; Vallely M.P.; Fraser J.F.;
Bannon P.G.
Institution
(Seco) Sydney Medical School, The University of Sydney, Sydney, Australia;
The Baird Institute of Applied Heart and Lung Surgical Research, Sydney,
Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital,
Sydney, Australia
(Zhao) Sydney Medical School, The University of Sydney, Sydney, Australia;
The Baird Institute of Applied Heart and Lung Surgical Research, Sydney,
Australia
(Byrom, Bannon) Sydney Medical School, The University of Sydney, Sydney,
Australia; The Baird Institute of Applied Heart and Lung Surgical
Research, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince
Alfred Hospital, Sydney, Australia; Institute of Academic Surgery, Royal
Prince Alfred Hospital, Sydney, Australia; Sydney Heart and Lung Surgeons,
Sydney, Australia
(Wilson) The Baird Institute of Applied Heart and Lung Surgical Research,
Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred
Hospital, Sydney, Australia; Sydney Heart and Lung Surgeons, Sydney,
Australia; Australian School of Advanced Medicine, Macquarie University,
Sydney, Australia
(Vallely) Sydney Medical School, The University of Sydney, Sydney,
Australia; The Baird Institute of Applied Heart and Lung Surgical
Research, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince
Alfred Hospital, Sydney, Australia; Institute of Academic Surgery, Royal
Prince Alfred Hospital, Sydney, Australia; Sydney Heart and Lung Surgeons,
Sydney, Australia; Australian School of Advanced Medicine, Macquarie
University, Sydney, Australia
(Fraser) Critical Care Research Group, The Prince Charles Hospital, The
University of Queensland, Australia
Title
Long-term prognosis and cost-effectiveness of left ventricular assist
device as bridge to transplantation: A systematic review.
Source
International journal of cardiology. 235 (pp 22-32), 2017. Date of
Publication: 15 May 2017.
Abstract
RESULTS: Twenty studies reported clinical outcomes of 4575 patients (1083
LVAD BTT and 3492 OHT). Five studies reported cost-effectiveness data on
837 patients (339 VAD BTT and 498 OHT). There was no difference in
long-term post-transplantation survival (HR 1.24, 95% CI 1.00-1.54), acute
rejection (HR 1.10, 95% CI 0.93-1.30), or chronic rejection and cardiac
allograft vasculopathy (HR 0.99, 95% CI 0.73-1.36). No differences were
found in 30-day post-operative mortality (OR 0.91, 95% CI 0.42-2.00),
stroke (OR 1.64, 95% CI 0.43-6.27), renal failure (OR 1.43, 95% CI
0.58-3.54), bleeding (OR 1.56, 95% CI 0.78-3.13), or infection (OR 2.44,
95% CI 0.81-7.38). Three of the five studies demonstrated incremental
cost-effectiveness ratios below the acceptable maximum threshold. The
total cost of VAD BTT ranged from $316,078 to $1,025,500, and OHT ranged
from $179,051 to $802,200.
CONCLUSION: LVADs used as BTT did not significantly alter
post-transplantation long-term survival, rejection, and post-operative
morbidity. LVAD BTT may be cost-effective, particularly in medium and
high-risk patients with expected prolonged waiting times, renal
dysfunction, and young patients.
BACKGROUND: This systematic review aimed to evaluate the clinical outcomes
and cost-effectiveness of left ventricular assist devices (LVADs) used as
bridge to transplantation (BTT), compared to orthotopic heart
transplantation (OHT) without a bridge.
METHOD: Systematic searches were performed in electronic databases with
available data extracted from text and digitized figures. Meta-analysis of
short and long-term term post-transplantation outcomes was performed with
summation of cost-effectiveness analyses.<br/>Copyright &#xa9; 2017
Elsevier Ireland Ltd. All rights reserved.

<109>
[Use Link to view the full text]
Accession Number
619628363
Author
Hofland J.; Ouattara A.; Fellahi J.-L.; Gruenewald M.; Hazebroucq J.;
Ecoffey C.; Joseph P.; Heringlake M.; Steib A.; Coburn M.; Amour J.; Rozec
B.; Liefde I.; Meybohm P.; Preckel B.; Hanouz J.-L.; Tritapepe L.; Tonner
P.; Benhaoua H.; Roesner J.P.; Bein B.; Hanouz L.; Tenbrinck R.; Bogers
A.J.J.C.; Mik B.G.; Coiffic A.; Renner J.; Steinfath M.; Francksen H.;
Broch O.; Haneya A.; Schaller M.; Guinet P.; Daviet L.; Brianchon C.;
Rosier S.; Lehot J.-J.; Paarmann H.; Schon J.; Hanke T.; Ettel J.; Olsson
S.; Klotz S.; Samet A.; Laurinenas G.; Thibaud A.; Cristinar M.; Collanges
O.; Levy F.; Rossaint R.; Stevanovic A.; Schaelte G.; Stoppe C.; Hamou
N.A.; Hariri S.; Quessard A.; Carillion A.; Morin H.; Silleran J.; Robert
D.; Crouzet A.-S.; Zacharowski K.; Reyher C.; Iken S.; Weber N.C.;
Hollmann M.; Eberl S.; Carriero G.; Collacchi D.; Di Persio A.; Fourcade
O.; Bergt S.; Alms A.
Institution
(Hofland) From the Sector Cardiothoracic Anesthesiology, Thorax Centre,
Rotterdam, The Netherlands (J. Hofland, I.d.L.); Service
d'Anesthesie-Reanimation II, Centre Hospitalier Universitaire de Bordeaux,
Bordeaux, France (A.O.); Louis Pradel University Hospital, Lyon, France
and Department of Anesthesiology and Intensive Care Medicine and Inserm
U1060, Faculty of Medicine, Claude
Title
Effect of Xenon Anesthesia Compared to Sevoflurane and Total Intravenous
Anesthesia for Coronary Artery Bypass Graft Surgery on Postoperative
Cardiac Troponin Release: An International, Multicenter, Phase 3,
Single-blinded, Randomized Noninferiority Trial.
Source
Anesthesiology. 127 (6) (pp 918-933), 2017. Date of Publication: 01 Dec
2017.
Abstract
BACKGROUND: Ischemic myocardial damage accompanying coronary artery bypass
graft surgery remains a clinical challenge. We investigated whether xenon
anesthesia could limit myocardial damage in coronary artery bypass graft
surgery patients, as has been reported for animal ischemia models.
METHODS: In 17 university hospitals in France, Germany, Italy, and The
Netherlands, low-risk elective, on-pump coronary artery bypass graft
surgery patients were randomized to receive xenon, sevoflurane, or
propofol-based total intravenous anesthesia for anesthesia maintenance.
The primary outcome was the cardiac troponin I concentration in the blood
24h postsurgery. The noninferiority margin for the mean difference in
cardiac troponin I release between the xenon and sevoflurane groups was
less than 0.15ng/ml. Secondary outcomes were the safety and feasibility of
xenon anesthesia.
RESULTS: The first patient included at each center received xenon
anesthesia for practical reasons. For all other patients, anesthesia
maintenance was randomized (intention-to-treat: n = 492;
per-protocol/without major protocol deviation: n = 446). Median 24-h
postoperative cardiac troponin I concentrations (ng/ml [interquartile
range]) were 1.14 [0.76 to 2.10] with xenon, 1.30 [0.78 to 2.67] with
sevoflurane, and 1.48 [0.94 to 2.78] with total intravenous anesthesia
[per-protocol]). The mean difference in cardiac troponin I release between
xenon and sevoflurane was -0.09ng/ml (95% CI, -0.30 to 0.11; per-protocol:
P = 0.02). Postoperative cardiac troponin I release was significantly less
with xenon than with total intravenous anesthesia (intention-to-treat: P =
0.05; per-protocol: P = 0.02). Perioperative variables and postoperative
outcomes were comparable across all groups, with no safety concerns.
CONCLUSIONS: In postoperative cardiac troponin I release, xenon was
noninferior to sevoflurane in low-risk, on-pump coronary artery bypass
graft surgery patients. Only with xenon was cardiac troponin I release
less than with total intravenous anesthesia. Xenon anesthesia appeared
safe and feasible.

<110>
[Use Link to view the full text]
Accession Number
619744503
Author
Anonymous
Title
Erratum: Impact of methylprednisolone on postoperative quality of recovery
and delirium in the steroids in cardiac surgery trial: A randomized,
double-blind, placebo-controlled substudy (Anesthesiology (2017) 126
(223-233) DOI: 10.1097/ALN.0000000000001433).
Source
Anesthesiology. 128 (1) (pp 239), 2018. Date of Publication: 01 Jan 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
In the article beginning on page 223 in the February 2017 issue, there is
an error in the sentence, "The incidence of delirium for the control group
was 10%, which was similar to that in patients given methylprednisolone
(8%; OR, 0.31; 95% CI, 0.73 to 2.48; P = 0.357; table 3)." The correct
sentence is, "The incidence of delirium for the control group was 10%,
which was similar to that in patients given methylprednisolone (8%; OR,
0.74; 95% CI, 0.40 to 1.37; P = 0.357; table 3)." The authors regret this
error. The online version and PDF of the article have been
corrected.<br/>Copyright &#xa9; 2017, the American Society of
Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved.

<111>
Accession Number
619741433
Author
Quin J.A.; Hattler B.; Shroyer A.L.W.; Kemp D.; Almassi G.H.; Bakaeen
F.G.; Carr B.M.; Bishawi M.; Collins J.F.; Grover F.L.; Wagner T.H.
Institution
(Quin) Surgical Service, Veterans Affairs Boston Healthcare System, West
Roxbury, MA, United States
(Quin) Harvard Medical School, Boston, MA, United States
(Hattler) Department of Medicine, Division of Cardiology, Veterans Affairs
Eastern Colorado Health Care System, Denver, CO, United States
(Hattler, Grover) School of Medicine at the Anschutz Medical Campus,
University of Colorado, Aurora, CO, United States
(Shroyer) Research and Development Office, Northport Veterans Affair
Medical Center, Northport, NY, United States
(Shroyer) Research and Development Office, Eastern Colorado Health Care
System, Department of Veterans Affairs, Denver, CO, United States
(Kemp, Collins) Cooperative Studies Program Coordinating Center, Veterans
Affairs Medical Center, Perry Point, MD, United States
(Almassi) Surgical Services, Zablocki Veterans Affairs Medical Center,
Milwaukee, WI, United States
(Almassi) Department of Surgery, Division of Cardiothoracic Surgery,
Medical College of Wisconsin, Milwaukee, WI, United States
(Bakaeen) Pittsburgh VA Medical Center, Pittsburgh, PA, United States
(Bakaeen) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
(Carr, Bishawi) Research and Development Office, Northport Veterans
Affairs Medical Center, Northport, NY, United States
(Carr) Department of Emergency Medicine, Mayo Clinic, Rochester, MN,
United States
(Bishawi) Division of Cardiovascular and Thoracic Surgery, Duke University
Medical Center, Durham, NC, United States
(Grover) Department of Surgery, Veterans Affairs Eastern Colorado Health
Care System, Denver, CO, United States
(Wagner) Veterans Affairs Palo Alto Health Economics Resource Center,
Menlo Park, CA, United States
(Wagner) Department of Surgery, Stanford University, Stanford, CA, United
States
Title
Concordance between administrative data and clinical review for mortality
in the randomized on/off bypass follow-up study (ROOBY-FS).
Source
Journal of Cardiac Surgery. 32 (12) (pp 751-756), 2017. Date of
Publication: December 2017.
Publisher
Blackwell Publishing Inc. (E-mail: subscrip@blackwellpub.com)
Abstract
Background: The optimal methodology to identify cardiac versus non-cardiac
cause of death following cardiac surgery has not been determined. Methods:
The Randomized On/Off Bypass Trial was a multicenter, randomized,
controlled clinical trial of 2203 patients (February 2002-May 2008)
comparing 1-year cardiac outcomes between off-pump and on-pump bypass
surgery. In 2013, the Veterans Affairs (VA) Cooperative Studies Program
funded a follow-up study to assess 5-year outcomes including mortality.
Deaths were identified and confirmed using the National Death Index (NDI),
VA Vital Status file, and medical records. An Endpoints Committee (EC)
reviewed patient medical records and classified each cause of death as
cardiac, non-cardiac, or unknown. Using pre-determined ICD-10 codes, NDI
death certificates were independently used to classify deaths as cardiac
or non-cardiac. Cause of death was compared between the NDI and EC
classifications and concordance measured, using Kappa statistics. Results:
Of the 297 5-year deaths identified by the NDI and/or VA vital status file
and confirmed by the EC, 219 had adequate patient records for EC cause of
death determination. The EC adjudicated 141 of these deaths as non-cardiac
and 78 as cardiac, while the NDI classified 150 as non-cardiac and 69 as
cardiac; agreement was 77.6% (kappa 0.500; P < 0.001). Conclusions: Since
concordance between EC and NDI cause of death classifications was only
moderate, caution should be exercised in relying exclusively on NDI data
to determine cause of death. A hybrid approach, integrating multiple
information sources, may provide the most accurate approach to classifying
cause of death.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<112>
Accession Number
619678797
Author
Fairley J.L.; Zhang L.; Glassford N.J.; Bellomo R.
Institution
(Fairley) Alfred Hospital, Prahran, VIC 3004, Australia
(Fairley) School of Public Health and Preventive Medicine, Monash
University, Prahran, VIC 3004, Australia
(Zhang, Glassford, Bellomo) Department of Intensive Care, Austin Hospital,
145 Studley Rd, Heidelberg, Melbourne, VIC 3084, Australia
(Zhang) Department of Nephrology, West China Hospital of Sichuan
University, Chengdu, Sichuan, China
(Glassford, Bellomo) Australian and New Zealand Intensive Care Research
Centre, School of Public Health and Preventive Medicine, Monash
University, Prahran, VIC 3004, Australia
Title
Magnesium status and magnesium therapy in cardiac surgery: A systematic
review and meta-analysis focusing on arrhythmia prevention.
Source
Journal of Critical Care. 42 (pp 69-77), 2017. Date of Publication:
December 2017.
Publisher
W.B. Saunders
Abstract
Purpose To investigate magnesium as prophylaxis or treatment of
postoperative arrhythmias in cardiac surgery (CS) patients. To assess
impact on biochemical and patient-centered outcomes. Materials and methods
We searched MEDLINE, CENTRAL and EMBASE electronic databases from 1975 to
October 2015 using terms related to magnesium and CS. English-Language
RCTs were included involving adults undergoing CS with parenterally
administered magnesium to treat or prevent arrhythmias, compared to
control or standard antiarrythmics. We extracted incidence of
postoperative arrhythmias, termination following magnesium administration
and secondary outcomes (including mortality, length of stay, hemodynamic
parameters, biochemistry). Results Thirty-five studies were included, with
significant methodological heterogeneity. Atrial fibrillation (AF) was
most commonly reported, followed by ventricular, supraventricular and
overall arrhythmia frequency. Magnesium appeared to reduce AF (RR 0.69,
95% confidence interval (95%CI) 0.56-0.86, p = 0.002), particularly
postoperatively (RR 0.51, 95%CI 0.34-0.77, p = 0.003) for longer than 24
h. Maximal benefit was seen with bolus doses up to 60 mmol. Magnesium
appeared to reduce ventricular arrhythmias (RR = 0.46, 95%CI 0.24-0.89, p
= 0.004), with a trend to reduced overall arrhythmias (RR = 0.80, 95%CI
0.57-1.12, p = 0.191). We found no mortality effect or significant
increase in adverse events. Conclusions Magnesium administration post-CS
appears to reduce AF without significant adverse events. There is limited
evidence to support magnesium administration for prevention of other
arrhythmias.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<113>
Accession Number
619678740
Author
Andersen L.W.; Liu X.; Montissol S.; Holmberg M.J.; Fabian-Jessing B.K.;
Donnino M.W.
Institution
(Andersen, Liu, Montissol, Holmberg, Donnino) Center for Resuscitation
Science, Department of Emergency Medicine, Beth Israel Deaconess Medical
Center, Boston, MA, United States
(Andersen, Holmberg, Fabian-Jessing) Research Center for Emergency
Medicine, Aarhus University Hospital, Aarhus, Denmark
(Donnino) Department of Medicine, Division of Pulmonary and Critical Care,
Beth Israel Deaconess Medical Center, Boston, MA, United States
Title
Cytochrome c in patients undergoing coronary artery bypass grafting: A
post hoc analysis of a randomized trial.
Source
Journal of Critical Care. 42 (pp 248-254), 2017. Date of Publication:
December 2017.
Publisher
W.B. Saunders
Abstract
Purpose To establish whether plasma cytochrome c is detectable in patients
undergoing cardiac surgery, whether cytochrome c levels are associated
with lactate/inflammatory markers/cellular oxygen consumption, and whether
cytochrome c levels are associated with clinical outcomes. Materials and
methods This was an observational sub-study of a randomized trial
comparing thiamine to placebo in patients undergoing coronary artery
bypass grafting. Patients had blood drawn before, after, and again 6 h
after surgery. Cytochrome c, inflammatory markers, and cellular oxygen
consumption were measured. Results 64 patients were included. Cytochrome c
was detectable in 63 (98%) patients at baseline with a median cytochrome c
level of 0.18 ng/mL (quartiles: 0.13, 0.55). There was no difference from
baseline level to post-surgical level (0.19 ng/mL [0.09, 0.51], p = 0.36)
or between post-surgical level and 6-hour post-surgical level (0.17 ng/mL
[0.10, 0.57], p = 0.61). There was no difference between the thiamine and
placebo groups' change in cytochrome c levels from baseline to after
surgery (p = 0.22). Cytochrome c levels were not associated with lactate,
inflammatory markers, cellular oxygen consumption, or clinical outcomes.
Conclusions Cytochrome c levels did not increase after cardiac surgery and
was not associated with the degree of inflammation or clinical
outcomes.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<114>
Accession Number
619678731
Author
Deng Q.-W.; Tan W.-C.; Zhao B.-C.; Deng W.-T.; Xu M.; Liu W.-F.; Liu K.-X.
Institution
(Deng, Zhao, Deng, Liu, Liu) Department of Anesthesiology, Nanfang
Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North,
Guangzhou 510515, China
(Deng, Xu) Department of Anesthesiology, The First Affiliated Hospital,
Sun Yet-sen University, No.58, Zhongshan 2nd Road, Guangzhou 510080, China
(Tan) Department of Endoscopy, Sun Yet-sen University Cancer Center, No.
651, Dongfeng East Road, Guangzhou 510060, China
Title
Risk factors for postoperative acute mesenteric ischemia among adult
patients undergoing cardiac surgery: A systematic review and
meta-analysis.
Source
Journal of Critical Care. 42 (pp 294-303), 2017. Date of Publication:
December 2017.
Publisher
W.B. Saunders
Abstract
Purpose We aimed to seek risk factors for AMI among adult patients
undergoing cardiac surgery. Materials and methods We searched electronic
bibliographic databases for studies reporting risk factors for AMI among
adult patients undergoing cardiac surgery. Pooled odds ratios (OR) and
standard mean differences (SMD or MD) for risk factors between AMI and
control group were estimated. Results 11 studies with 67,195 patients met
the inclusion criteria. 14 risk factors were found to be statistically
significant: preoperative factors including age (MD 4.62 years, 95% CI
(1.97,7.27)), cardiac shock (OR 5.17, (1.17,22.81)), peripheral vascular
disease (OR 3.53, (2.05,6.09)), need for intra-aortic balloon pump (IABP)
(OR 5.89, (3.26,10.65)), emergency surgery (OR 3.75, (1.69,8.33)), and
postoperative factors including atrial fibrillation (OR 2.41,
(1.79,3.24)), CK-MB level (SMD 1.06, (0.62 to 1.50)), serum creatinine >
200 mumol/L (OR 23.39, (11.61,47.12)), blood loss (MD 358.32 mL,
(53.56,663.07)), prolonged ventilation (OR 9.04, (5.24,15.62)), need for
IABP (OR 6.32, (3.19,12.54)), inotropic treatment (OR 8.40, (3.19,22.14)),
blood transfusion (OR 9.15, (4.79,17.48)), reoperation (OR 3.30,
(1.55,7.04)). Conclusions 14 risk factors were associated with an
increased risk of AMI, which indicated that AMI might occur via stenosis
or occlusion of mesenteric vessels, reduced blood volume or
maldistribution of blood flow.<br/>Copyright &#xa9; 2017

<115>
Accession Number
617640317
Author
Kar S.
Institution
(Kar) Division of Cardiovascular Medicine, Texas Tech University Health
Sciences Center at El Paso, Paul L. Foster School of Medicine, El Paso, TX
79905, United States
Title
Transulnar cardiac catheterization and percutaneous coronary intervention:
techniques, transradial comparisons, anatomical considerations, and
comprehensive literature review.
Source
Catheterization and Cardiovascular Interventions. 90 (7) (pp 1126-1134),
2017. Date of Publication: 01 Dec 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Ulnar arterial access for cardiac catheterization and intervention is an
alternative approach compared with radial or femoral access. Ulnar access
is infrequently performed since the radial artery is readily palpable and
is commonly used worldwide to minimize vascular complications from femoral
access. Nevertheless, ulnar access provides a suitable access site in
patients who are poor candidates for femoral access, have pre-existing
radial occlusion, radial artery hypoplasia or hyperplasia from prior
radial artery procedures, radial stenosis, radial loops, radial
tortuosity, small radial arteries, and/or have future need for radial
graft for dialysis or coronary artery bypass graft. Furthermore, femoral
access is the standard default option if radial access fails.
Consequently, learning ulnar access provides a suitable forearm
alternative to avoid femoral access when deemed high risk or undesirable.
This review discusses the techniques of ulnar access, advantages and
disadvantages of ulnar versus radial access, the clinical trials on ulnar
cardiac catheterization and its associated complications.<br/>Copyright
&#xa9; 2017 Wiley Periodicals, Inc.

<116>
Accession Number
614698026
Author
Guerrero M.; Wang D.D.; Himbert D.; Urena M.; Pursnani A.; Kaddissi G.;
Iyer V.; Salinger M.; Chakravarty T.; Greenbaum A.; Makkar R.; Vahanian
A.; Feldman T.; O'Neill W.
Institution
(Guerrero, Pursnani, Salinger, Feldman) Department of Medicine, Division
of Cardiology, Evanston Hospital, Evanston, IL, United States
(Wang, Greenbaum, O'Neill) Department of Medicine Division of Cardiology,
Henry Ford Hospital, Detroit, MI, United States
(Himbert, Urena, Vahanian) Cardiology Department, Bichat-Claude Bernard
Hospital, Paris, France
(Kaddissi) Division of Cardiology, Cooper University Hospital, Camden, NJ,
United States
(Iyer) Division of Cardiology, Buffalo General Medical Center, Buffalo,
NY, United States
(Chakravarty, Makkar) Department of Medicine, Division of Cardiology,
Cedars Sinai Medical Center, Los Angeles, CA, United States
Title
Short-term results of alcohol septal ablation as a bail-out strategy to
treat severe left ventricular outflow tract obstruction after
transcatheter mitral valve replacement in patients with severe mitral
annular calcification.
Source
Catheterization and Cardiovascular Interventions. 90 (7) (pp 1220-1226),
2017. Date of Publication: 01 Dec 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: To evaluate the outcomes of the early experience of
percutaneous alcohol septal ablation in patients with severe left
ventricular outflow tract (LVOT) obstruction post transcatheter mitral
valve replacement (TMVR). Background: Severe LVOT obstruction with
hemodynamic compromise is a complication of TMVR associated with high
mortality. Percutaneous alcohol septal ablation has recently been
described as a therapeutic option in this setting. Methods: Multicenter
retrospective review of clinical outcomes of patients undergoing alcohol
septal ablation to treat LVOT obstruction after TMVR for severe mitral
stenosis with severe mitral annular calcification. Results: Six patients
underwent percutaneous alcohol septal ablation to treat LVOT obstruction
post-TMVR at six different centers. Five patients had immediate
significant reduction in LVOT obstruction with improvement in hemodynamic
status while one had persistent LVOT gradient but hemodynamic instability
improved. The first patient died on postoperative day 4 due to complete
heart block. One patient had initial improvement in LVOT gradient with
recurrence on postoperative day 1 thought to be secondary to septal edema,
was treated with surgical removal of the transcatheter valve and resection
of the anterior mitral leaflet followed by transatrial TMVR and died 3
weeks later due to multi-organ failure. The remaining four patients
improved clinically after alcohol septal ablation, were discharged from
the hospital and were clinically stable at 30-day follow-up. Conclusions:
Percutaneous alcohol ablation provides acute relief of TMVR-induced LVOT
obstruction when septal hypertrophy is a contributing factor. This may be
a safer alternative to bail-out surgery in this extremely high-risk
patient population. &#xa9; 2017 Wiley Periodicals, Inc.<br/>Copyright
&#xa9; 2017 Wiley Periodicals, Inc.

<117>
Accession Number
614293524
Author
Montone R.A.; Testa L.; Fraccaro C.; Montorfano M.; Castriota F.; Nerla
R.; Angelillis M.; Tusa M.; Giannini F.; Garatti A.; Tarantini G.;
Petronio A.S.; Brambilla N.; Bedogni F.
Institution
(Montone, Testa, Tusa, Brambilla, Bedogni) Interventional Cardiology,
IRCCS Policlinico San Donato, Milan, Italy
(Fraccaro, Tarantini) Department of Cardiology, University Hospital of
Padova, Padova, Italy
(Montorfano, Giannini) Department of Cardiology, IRCCS Ospedale San
Raffaele, Milan, Italy
(Castriota, Nerla) Interventional Cardiology, Maria Cecilia Hospital, GVM
care & research, Cotignola, Italy
(Angelillis, Petronio) Department of Cardiology, Ospedale Cisanello,
University of Pisa, Pisa, Italy
(Garatti) IRCCS Policlinico San Donato, Cardiac Surgery, Milan, Italy
Title
Procedural and 30-day clinical outcomes following transcatheter aortic
valve replacement with lotus valve: Results of the RELEVANT study.
Source
Catheterization and Cardiovascular Interventions. 90 (7) (pp 1206-1211),
2017. Date of Publication: 01 Dec 2017.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Objectives: We report procedural and 30-day clinical outcomes following
transcatheter aortic valve replacement (TAVR) with Lotus Valve system in a
high-risk population. Background: Lotus valve is a second-generation TAVR
fully repositionable and retrievable device. RELEVANT (REgistry of Lotus
valvE for treatment of aortic VAlve steNosis with Tavr) study is an
Italian prospective multicentre registry. Methods: Five major centers
performing TAVR using Lotus participated. All high-risk symptomatic
patients with severe aortic stenosis were evaluated by a heart team and
screened for eligibility for TAVR. Primary end-points were procedural and
30-day mortality. Secondary endpoints included procedural and 30-day
safety/effectiveness metrics according to Valve Academic Research
Consortium (VARC)-2 criteria. Results: Two hundred and twenty-five
patients undergoing TAVR with Lotus were enrolled. Mean age was 82.6 +/-
6.3 years, 51.6% females. Mean STS score for mortality was 8.3 +/- 5.6.
Procedural success was achieved in 98.7% of patients. All-cause mortality
was 2.2% at discharge and 2.7% at 30-day. Stroke rate was 2.2% at
discharge and 3.1% at 30-day. Patients requiring a new permanent pacemaker
implantation were 30.7% at discharge and 31.8% at 30-day. Paravalvular
regurgitation (PVR) was trace/mild in 99.1% of patients at discharge. Only
two patients (0.9%) had moderate PVR at discharge and at 30-day, whereas
none had severe PVR. Conclusions: RELEVANT study showed that TAVR using
Lotus, in a real-world population of patients with severe aortic stenosis
at high surgical risk, was associated with excellent device success
implantation and early safety according to VARC-2 definition. The
pacemaker implantation rate was about a third of patients. &#xa9; 2017
Wiley Periodicals, Inc.<br/>Copyright &#xa9; 2017 Wiley Periodicals, Inc.

<118>
Accession Number
618030509
Author
Doros G.; Massaro J.M.; Kandzari D.E.; Waksman R.; Koolen J.J.; Cutlip
D.E.; Mauri L.
Institution
(Doros) Department of Biostatistics, Boston University, Boston, MA, United
States
(Doros, Cutlip, Mauri) Baim Institute for Clinical Research, Boston, MA,
United States
(Massaro) Boston University School of Public Health, Boston, MA, United
States
(Kandzari) Piedmont Heart Institute, Atlanta, GA, United States
(Waksman) MedStar Washington Hospital Center, Washington, DC, United
States
(Waksman) Georgetown University, Washington, DC, United States
(Koolen) Catharina Hospital Eindhoven, Netherlands
(Cutlip) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Mauri) Brigham and Women's Hospital, Boston, MA, United States
(Cutlip, Mauri) Harvard Medical School, Boston, MA, United States
Title
Rationale of a novel study design for the BIOFLOW V study, a prospective,
randomized multicenter study to assess the safety and efficacy of the
Orsiro sirolimus-eluting coronary stent system using a Bayesian approach.
Source
American Heart Journal. 193 (pp 35-45), 2017. Date of Publication:
November 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Traditional study design submitted to the Food and Drug
Administration to test newer drug-eluting stents (DES) for marketing
approval is the prospective randomized controlled trial. However, several
DES have extensive clinical data from trials conducted outside the United
States that have led to utilization of a novel design using the Bayesian
approach. This design was proposed for testing DES with bioresorbable
polymer compared with DES most commonly in use today that use durable
polymers for drug elution. Study design and objectives This prospective,
multicenter, randomized, controlled trial is designed to assess the safety
and efficacy of the Orsiro bioresorbable polymer sirolimus-eluting stent
(BP SES). Up to 1,334 subjects with up to 3 de novo or restenotic coronary
artery lesions who qualify for percutaneous coronary intervention with
stenting will be randomized 2:1 to the BP SES versus the Xience durable
polymer everolimus-eluting stent (DP EES). Data from this trial will be
combined with data from 2 similarly designed trials that also randomize
subjects to BP SES and DP EES (BIOFLOW II, N = 452 and BIOFLOW IV, N =
579) by using a Bayesian approach. The primary end point is target lesion
failure at 12 months post index procedure, defined as cardiac death,
target vessel myocardial infarction, or clinically driven target lesion
revascularization, and the primary analysis is a test of noninferiority of
the BP SES versus DP EES on the primary end point according to a
noninferiority delta of 3.85%. Secondary end points include stent
thrombosis and the individual components of target lesion failure.
Subjects will be followed for 5 years after randomization. Conclusions The
BIOFLOW V trial offers an opportunity to assess clinical outcomes in
patients treated with coronary revascularization using the Orsiro BP SES
relative to a commonly used DP EES. The use of a Bayesian analysis
combines a large randomized cohort of patients 2 two smaller contributing
randomized trials to augment the efficiency of the
comparison.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<119>
Accession Number
619075443
Author
Chang H.-M.; Okwuosa T.M.; Scarabelli T.; Moudgil R.; Yeh E.T.H.
Institution
(Chang, Yeh) Center for Precision Medicine, Department of Medicine,
University of Missouri, Columbia, Missouri, United States
(Okwuosa) Division of Cardiology, Rush University Medical Center, Chicago,
Illinois, United States
(Scarabelli) Division of Cardiology, Virginia Common Wealth University,
Richmond, Virginia, United States
(Moudgil) Department of Cardiology, University of Texas, MD Anderson
Cancer Center, Houston, Texas, United States
Title
Cardiovascular Complications of Cancer Therapy: Best Practices in
Diagnosis, Prevention, and Management: Part 2.
Source
Journal of the American College of Cardiology. 70 (20) (pp 2552-2565),
2017. Date of Publication: 14 - 21 November 2017.
Publisher
Elsevier USA
Abstract
In this second part of a 2-part review, we will review cancer or cancer
therapy-associated systemic and pulmonary hypertension, QT prolongation,
arrhythmias, pericardial disease, and radiation-induced cardiotoxicity.
This review is based on a MEDLINE search of published data, published
clinical guidelines, and best practices in major cancer centers. Newly
developed targeted therapy can exert off-target effects causing
hypertension, thromboembolism, QT prolongation, and atrial fibrillation.
Radiation therapy often accelerates atherosclerosis. Furthermore,
radiation can damage the heart valves, the conduction system, and
pericardium, which may take years to manifest clinically. Management of
pericardial disease in cancer patients also posed clinical challenges.
This review highlights the unique opportunity of caring for cancer
patients with heart problems caused by cancer or cancer therapy. It is an
invitation to action for cardiologists to become familiar with this
emerging subspecialty.<br/>Copyright &#xa9; 2017 American College of
Cardiology Foundation

<120>
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.

<121>
Accession Number
618277671
Author
Lee P.H.; Lee J.-Y.; Lee C.W.; Han S.; Ahn J.-M.; Park D.-W.; Kang S.-J.;
Lee S.-W.; Kim Y.-H.; Park S.-W.; Park S.-J.
Institution
(Lee, Lee, Ahn, Park, Kang, Lee, Kim, Park, Park) Division of Cardiology,
Department of Internal Medicine, Asan Medical Center, University of Ulsan
College of Medicine, Asan Medical Center, Seoul, South Korea
(Lee) Division of Cardiology, Department of Internal Medicine, Kangbuk
Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South
Korea
(Han) Department of Applied Statistics, Gachon University, Seongnam, South
Korea
Title
Long-term outcomes of bypass grafting versus drug-eluting stenting for
left main coronary artery disease: Results from the IRIS-MAIN registry.
Source
American Heart Journal. 193 (pp 76-83), 2017. Date of Publication:
November 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
There are limited data on comparative outcomes and its determinants
following coronary artery bypass graft surgery (CABG) and percutaneous
coronary intervention (PCI) with drug-eluting stents (DES) for left main
coronary artery disease (LMCAD) in a real-world setting. Methods A total
of 3,504 consecutive patients with LMCAD treated with CABG (n = 1,301) or
PCI with DES (n = 2,203) from the IRIS-MAIN registry were analyzed. The
relative treatment effect of one strategy over another was assessed by
propensity-score matching method. The primary outcome was a composite of
death, myocardial infarction, or stroke. Results Median follow-up duration
was 4.7 years. In the matched cohort, both groups demonstrated a similar
risk for the primary outcome (adjusted hazard ratio [HR]: 0.94; 95% CI:
0.77-1.15; P =.54). Compared with CABG, PCI exhibited higher risks of
myocardial infarction (HR: 2.11; 95% CI: 1.16-3.83; P =.01) and repeated
revascularization (HR: 5.95; 95% CI: 3.94-8.98; P <.001). In the overall
population, age, presence of chronic kidney disease, and low ejection
fraction (<40%) were key clinical predictors of primary outcome regardless
of the treatment strategy. However, factors deemed to be associated with
perioperative morbidity were determinants of primary outcome in the CABG
group, whereas those generally associated with the severity of
atherosclerotic coronary artery disease were strong predictors in the PCI
group. Conclusions Among patients with significant LMCAD, the long-term
risk of the composite outcome of death, myocardial infarction, or stroke
was similar between CABG and PCI. Clinical variables that differentially
predict adverse outcomes might be useful in triaging appropriate
revascularization strategy<br/>Copyright &#xa9; 2017 Elsevier Inc.

<122>
Accession Number
612013176
Author
Lee M.S.; Shlofmitz E.; Shlofmitz R.; Sahni S.; Martinsen B.; Chambers J.
Institution
(Lee, Sahni) UCLA Medical Center, 100 Medical Plaza, Los Angeles, CA
90095, United States
(Shlofmitz) North Shore University Hospital, Manhasset, NY, United States
(Shlofmitz) St. Francis Hospital, Roslyn, NY, United States
(Martinsen) Cardiovascular Systems, Inc, St. Paul, MN, United States
(Chambers) Metropolitan Heart and Vascular Institute, Mercy Hospital,
Minneapolis, MN, United States
Title
Outcomes after Orbital Atherectomy of Severely Calcified Left Main
Lesions: Analysis of the ORBIT II Study.
Source
Journal of Invasive Cardiology. 28 (9) (pp 364-369), 2016. Date of
Publication: September 2016.
Publisher
HMP Communications
Abstract
OBJECTIVES: The ORBIT II trial reported excellent outcomes in patients
with severely calcified coronary lesions treated with orbital atherectomy.
Severe calcification of the left main (LM) artery represents a complex
coronary lesion subset. This study evaluated the safety and efficacy of
coronary orbital atherectomy to prepare severely calcified protected LM
artery lesions for stent placement. METHODS: The ORBIT II trial was a
prospective, multicenter clinical trial that enrolled 443 patients with
severely calcified coronary lesions in the United States. The major
adverse cardiac event (MACE) rate through 2 years post procedure, defined
by cardiac death, myocardial infarction (CK-MB >3x upper limit of normal
with or without a new pathologic Q-wave) and target-vessel
revascularization, was compared in the LM and non-left main (NLM) groups.
RESULTS: Among the 443 patients, a total of 10 underwent orbital
atherectomy of protected LM artery lesions. At 2 years, there was no
significant difference in the 2-year MACE rate in the LM and NLM groups
(30.0% vs 19.1%, respectively; P<=.36). Cardiac death was low in both
groups (0% vs 4.4%, respectively; P<=.99). Myocardial infarction occurred
within 30 days in both groups (10.0% vs 9.7%, respectively; P<=.99).
Severe dissection, perforation, persistent slow flow, and persistent no
reflow did not occur in the LM group. Abrupt closure occurred in 1 patient
in the LM group. CONCLUSIONS: Orbital atherectomy for patients with
heavily calcified LM coronary artery lesions is safe and feasible. Further
studies are needed to assess the safety and efficacy of orbital
atherectomy in patients with severely calcified LM artery lesions.

<123>
Accession Number
608964892
Author
Krishnamoorthy B.; Shepherd N.; Critchley W.R.; Nair J.; Devan N.; Nasir
A.; Barnard J.B.; Venkateswaran R.V.; Waterworth P.D.; Fildes J.E.; Yonan
N.
Institution
(Krishnamoorthy, Nair, Devan, Nasir, Barnard, Venkateswaran, Waterworth,
Yonan) Department of Cardiothoracic Surgery, University Hospital of South
Manchester NHS Foundation Trust, Manchester M23 9LT, United Kingdom
(Shepherd, Critchley, Fildes) Transplant Centre, University Hospital of
South Manchester NHS Foundation Trust, Manchester, United Kingdom
Title
A randomized study comparing traditional monofilament knotted sutures with
barbed knotless sutures for donor leg wound closure in coronary artery
bypass surgery.
Source
Interactive Cardiovascular and Thoracic Surgery. 22 (2) (pp 161-167),
2016. Date of Publication: 01 Feb 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES Surgical knots on the suture line provide an anchoring
function, but also represent a potential source of infection and
irritation on the donor leg after coronary artery bypass surgery. Knotless
barbed sutures were designed to prevent knot-related complications. This
study compared knot-related wound complication rates between patients
receiving traditional monofilament sutures and those receiving barbed
knotless sutures for closure of the donor leg. METHODS One hundred and
forty-two patients were randomized into two groups. Group 1 (n = 70)
received traditional monofilament sutures and Group 2 (n = 72) received
barbed knotless sutures. All wounds were assessed on postoperative days 3
and 5 and weeks 2, 4 and 6 using a validated wound scoring system.
Antibiotics usage and general practitioner and district nurse visits were
recorded. RESULTS No demographic differences were observed between groups.
Leg wound skin closure times were significantly shorter in Group 2
compared with Group 1 (P < 0.001). Group 1 demonstrated a greater
incidence of excessive scarring (P < 0.001), itching (P < 0.001),
irritation (P < 0.001) and adverse skin tissue reactions (P < 0.001) than
Group 2. Fewer general practitioner visits were recorded in Group 1
compared with Group 2 (P = 0.051). CONCLUSION Knotless barbed suture usage
significantly reduces the incidence of knot-related leg wound
complications compared with traditional monofilament knotted sutures. This
may be related to differences in the rate of absorption of the suture
material or an associated decrease in the incidence of adverse skin tissue
reactions that may delay postoperative wound healing.<br/>Copyright &#xa9;
The Author 2015.

<124>
Accession Number
613103366
Author
McClure G.R.; Belley-Cote E.P.; Singal R.K.; Jaffer I.H.; Dvirnik N.; An
K.R.; Fortin G.; Spence J.; Whitlock R.P.
Institution
(McClure, An) Michael G. DeGroote School of Medicine, McMaster University,
Hamilton, ON, Canada
(Belley-Cote, Dvirnik, Spence, Whitlock) Department of Clinical
Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
(Belley-Cote) Department of Medicine, McMaster University, Hamilton, ON,
Canada
(Belley-Cote, Dvirnik, Whitlock) Population Health Research Institute,
Hamilton, ON, Canada
(Belley-Cote, Fortin) Department of Medicine, Universite de Sherbrooke,
Sherbrooke, QC, Canada
(Singal) Department of Surgery, University of Manitoba, Manitoba, ON,
Canada
(Singal) I.H. Asper Clinical Research Institute, Winnipeg, MB, Canada
(Jaffer) Thrombosis and Atherosclerosis Research Institute (TaARI),
McMaster University, Hamilton, ON, Canada
(Jaffer, Dvirnik, Whitlock) Division of Cardiac Surgery, McMaster
University, Hamilton, ON, Canada
(Spence) Department of Anesthesia, McMaster University, Hamilton, ON,
Canada
Title
Surgical ablation of atrial fibrillation: A protocol for a systematic
review and meta-analysis of randomised controlled trials.
Source
BMJ Open. 6 (11) (no pagination), 2016. Article Number: e013273. Date of
Publication: 01 Nov 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction: Atrial fibrillation (AF) affects 10% of patients undergoing
cardiac surgery and is an independent risk factor for all-cause mortality,
ischaemic stroke and heart failure. Surgical AF ablation has been shown to
significantly improve maintenance of sinus rhythm, however, small to
medium size trials conducted to date lack the power required to assess
patient-important outcomes such as mortality, stroke, heart failure and
health-related quality of life. Moreover, a recent randomised trial (RCT)
suggested harm by surgical AF ablation with an almost threefold increase
in the requirement for permanent pacemaker postablation. We aim to perform
a systematic review and meta-analysis to evaluate efficacy and safety of
surgical AF ablation compared to no surgical ablation. Methods and
analysis: We will search Cochrane CENTRAL, MEDLINE and EMBASE for RCTs
evaluating the use of surgical AF ablation, including any lesion set,
versus no surgical AF ablation in adults with AF undergoing any type of
cardiac surgery. Outcomes of interest include mortality, embolic events,
quality of life, rehospitalisation, freedom from AF and adverse events,
including need for pacemaker and worsening heart failure. Independently
and in duplicate, reviewers will screen references, assess eligibility of
potentially relevant studies using predefined eligibility criteria and
collect data using prepiloted forms. We will pool data using a random
effects model and present results as relative risk with 95% CIs for
dichotomous outcomes and as mean difference with 95% CI for continuous
outcomes. We will assess risk of bias using the Cochrane Collaboration
tool, and quality of evidence with the Grading of Recommendations
Assessment, Development and Evaluation (GRADE) approach. Ethics and
dissemination: Our results will help guide clinical practice by providing
the most comprehensive analysis of risks and benefits associated with the
procedure. Our results will be disseminated through publication in
peer-reviewed journals and conference presentations.

<125>
[Use Link to view the full text]
Accession Number
607622745
Author
Phan K.; Huo Y.R.; Zhao D.F.; Yan T.D.; Tchantchaleishvili V.
Institution
(Phan, Huo, Zhao, Yan, Tchantchaleishvili) Collaborative Research (CORE)
Group, Macquarie University, Sydney, Australia
(Phan, Zhao, Yan) Faculty of Medicine, University of Sydney, Sydney,
Australia
(Phan, Huo) Faculty of Medicine, University of New South Wales (UNSW),
Sydney, Australia
(Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital,
Sydney, Australia
(Tchantchaleishvili) Division of Cardiac Surgery, University of Rochester,
Rochester, NY, United States
Title
Ventricular recovery and pump explantation in patients supported by left
ventricular assist devices: A systematic review.
Source
ASAIO Journal. 62 (3) (pp 219-231), 2016. Date of Publication: 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Several studies have reported that a portion of patients who exhibit
cardiac recovery during left ventricular assist device (LVAD) support can
have their device explanted with reasonable long-term survival. The aim of
this systematic review is to assess the survival and cardiac function in
patients with explanted LVADs from the current literature. Electronic
search was performed to identify all studies in English literature
assessing LVAD explantation. All identified articles were systematically
assessed using the inclusion and exclusion criteria. Selected studies were
subjected to quantitative assessment. From 5 electronic databases, 11
studies (213 patients) were included. Pooled mean perioperative mortality
rate of those explanted was 9.2% (95% CI, 5.0-14.5%; I² = 0).
Pooled mean late mortality rate was 15% (95% CI, 9.0-22.1%; I²
= 31%). The pooled 1, 5, and 10 year survival postexplant was 91, 76, and
65.7%, respectively. Pooled postweaning freedom from heart failure (HF)
recurrence reached 81.3%. Subset analysis demonstrated that patients
explanted from a continuous-flow LVAD versus pulsatile LVAD had a lower
rate of HF recurrence (6.6 vs. 28.3%, p = 0.03) and LVAD reimplantation
(7.5 vs. 37%, p = 0.001). Before LVAD explantation, overall mean left
ventricular ejection fraction (LVEF) was 49%. Weighted pooled early and
late postexplantation mean LVEF was 47.3 and 41.2%, respectively. Late
postexplantation LVEF was significantly higher in the continuous-flow
versus pulsatile LVAD subgroup (41.5 vs. 24%, p = 0.001). This review
shows encouraging safety and 10 year survival outcomes after explantation
of LVADs in carefully selected patients, with rates better than expected
after a heart transplant. Recovery of the native heart is the most
desirable clinical outcome in patients supported with LVADs and should be
actively sought.<br/>Copyright &#xa9; 2015 by the American Society for
Artificial Internal Organs.

<126>
Accession Number
607093676
Author
Schreiner W.; Dudek W.; Sirbu H.
Institution
(Schreiner, Dudek, Sirbu) Department of Thoracic Surgery, University
Hospital Erlangen, Erlangen, Germany
Title
Is salvage surgery for recurrent non-small-cell lung cancer after
definitive non-operative therapy associated with reasonable survival?.
Source
Interactive Cardiovascular and Thoracic Surgery. 21 (5) (pp 682-684),
2015. Date of Publication: 2015.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether salvage pulmonary
resection is possible and worthwhile for patients with recurrence of
non-small-cell lung cancer (NSCLC) after prior definitive non-operative
therapy. A total of nine reports were identified using the reported
search, of which four represented the best available evidence to answer
the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. All studies were retrospective. In
total, 48 pulmonary salvage resections were performed in 47 patients after
prior definitive radiation, chemoradiation or stereotactic body radiation
therapy, of which 28 were lobectomies (including 1 sleeve lobectomy), 12
pneumonectomies, 4 bilobectomies and 4 sublobar resections (2
segmentectomies and 2 wedge resections). Postoperative complications
ranged from 0 to 58% (mean from four studies 42.5%). Only one study
reported any mortality (4%), the other three had zero mortality. Median
postoperative survival was reported in two studies and ranged from 9 to 30
months. Experience with salvage lung resection for locally recurrent
NSCLC, after prior definitive non-surgical treatment, remains limited.
Therefore, this analysis was based on only 48 resections in 47 patients
from four retrospective studies. Nevertheless, the published data suggest
that salvage lung surgery for recurrent, previously non-operatively
managed non-small-cell lung cancer is a worthwhile treatment option with
good survival, acceptable morbidity and low mortality.<br/>Copyright
&#xa9; The Author 2015. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.

<127>
Accession Number
607093663
Author
Ali-Hassan-Sayegh S.; Mirhosseini S.J.; Zeriouh M.; Dehghan A.M.;
Shahidzadeh A.; Akbar Karimi-Bondarabadi A.; Sabashnikov A.; Popov A.-F.
Institution
(Ali-Hassan-Sayegh, Mirhosseini, Dehghan, Shahidzadeh, Akbar
Karimi-Bondarabadi) Cardiovascular Research Center, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran, Islamic Republic of
(Zeriouh, Sabashnikov, Popov) Department of Cardiothoracic Transplantation
and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and
Harefield NHS Foundation Trust, Middlesex, London UB9 6JH, United Kingdom
Title
Safety and efficacy of glucose-insulin-potassium treatment in coronary
artery bypass graft surgery and percutaneous coronary intervention.
Source
Interactive Cardiovascular and Thoracic Surgery. 21 (5) (pp 667-676),
2015. Date of Publication: 2015.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
The purpose of this meta-analysis was to evaluate protective effects of
glucose-insulin-potassium (GIK) on outcomes after coronary artery bypass
grafting (CABG) or percutaneous coronary intervention (PCI). We
systematically searched Medline/Pubmed, Elsevier, Embase, Web of Knowledge
and Google Scholar. A total of 1206 studies were retrieved during the
extensive literature search of all major databases; however, 38 trials
reporting the end-point of interest were selected. We performed a pooled
analysis of outcomes following PCI: incidence of cardiac arrest [odds
ratio (OR) of 0.91; 95% confidence interval (CI): 0.76-1.09; P = 0.3],
stroke (OR of 1.71; 95% CI: 0.37-1.37; P = 0.3), cardiogenic shock (OR of
1.02; 95% CI: 0.92-1.14; P = 0.6), reinfarction (OR of 0.95; 95% CI:
0.81-1.14; P = 0.5) and mortality (OR of 1.04; 95% CI: 0.96-1.13; P =
0.3); and following CABG: incidence of atrial fibrillation (OR of 0.86;
95% CI: 0.70-1.05; P = 0.1), incidence of ventricular fibrillation (OR of
0.83; 95% CI: 0.62-1.13; P = 0.2), reinfarction (OR of 0.97; 95% CI:
0.74-1.27; P = 0.8), infection (OR of 1.04; 95% CI: 0.67-1.62; P = 0.8),
length of intensive care unit stay (LIS) [standard mean differences (SMD)
of -0.27; 95% CI: -0.40 to -0.14; P = 0.000], length of hospital stay
(LHS) (SMD of -0.035; 95% CI: -0.12 to -0.05; P = 0.4) and mortality (OR
of 0.72; 95% CI: 0.41-1.26; P = 0.2). Our results showed that GIK did not
have considerable cardioprotective effects. However, patients undergoing
CABG seem to be better responders to GIK therapy compared with patients
undergoing PCI. Furthermore, in contrast to CABG, GIK therapy in patients
undergoing PCI might be associated with more complications rather than
protective effects.<br/>Copyright &#xa9; The Author 2015. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<128>
Accession Number
614326382
Author
Yanagawa B.; Verma S.; Mazine A.; Tam D.Y.; Juni P.; Puskas J.D.;
Murugavel S.; Friedrich J.O.
Institution
(Yanagawa, Verma, Mazine, Tam, Murugavel) Division of Cardiac Surgery, Li
Ka Shing Knowledge Institute, St Michael's Hospital, University of
Toronto, Toronto, Ontario, Canada
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute, St
Michael's Hospital, University of Toronto, Toronto, ON, Canada
(Puskas) Department of Cardiovascular Surgery, Icahn School of Medicine at
Mount Sinai, New York, NY, United States
(Friedrich) Critical Care and Medicine Departments, Li Ka Shing Knowledge
Institute, St Michael's Hospital, University of Toronto, Toronto, Ontario,
Canada
Title
Impact of total arterial revascularization on long term survival: A
systematic review and meta-analysis of 130,305 patients.
Source
International Journal of Cardiology. 233 (pp 29-36), 2017. Date of
Publication: 15 Apr 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Objectives This meta-analysis compares total arterial revascularization
(TAR) versus conventional coronary artery bypass and additionally to two
arterial grafts. Methods We searched MEDLINE and EMBASE Databases from
1996-to-2016 for studies comparing TAR versus non-TAR for multi-vessel
surgical revascularization. Data were extracted by 2 independent
investigators. Meta-analysis used random effects, which incorporates
heterogeneity. Results There were 4 smaller shorter follow-up randomized
controlled trials (RCTs), plus 15 matched/adjusted and 6
unmatched/unadjusted larger longer follow-up observational studies that
met inclusion criteria (N = 130.305 patients; mean follow-up range: 1-15
years). There were no differences in perioperative stroke, myocardial
infarction or mortality. However, TAR was associated with lower long term
all-cause mortality in observational studies matched/adjusted for
confounders (incident rate ratio 0.85, 95% CI: 0.81-0.89, p < 0.0001;
I² = 0%) and unmatched/unadjusted (incident rate ratio 0.67,
95% CI: 0.59-0.76, p < 0.0001; I² = 67%) for TAR. Decreases in
major cardiovascular outcomes and revascularization did not achieve
statistical significance. There were greater sternal complications with
TAR in the matched/adjusted studies (pooled risk ratio 1.21, 95% CI:
1.03-1.42, p = 0.02; I² = 0%). When compared to patients with
two arterial grafts, TAR was still associated with reduced long-term
all-cause mortality (incident rate ratio 0.85, 95% CI: 0.73-0.99, p =
0.04) with minimal heterogeneity (I² = 5%). Conclusions Data
from primarily observational studies suggest that TAR may improve
long-term survival compared with conventional coronary bypass by 15-20%
even when compared with two arterial grafts. Prospective randomized trials
of TAR with long term follow-up are needed.<br/>Copyright &#xa9; 2017
Elsevier B.V.

<129>
Accession Number
613751708
Author
Ring A.; Morris T.; Wozniak M.; Sullo N.; Dott W.; Verheyden V.; Kumar T.;
Brunskill N.; Vaja R.; Murphy G.J.
Institution
(Ring) University of the Free State, Bloemfontein, South Africa
(Ring) medac GmbH, Wedel, Germany
(Ring, Morris) Leicester Clinical Trials Unit, Leicester General Hospital,
Leicester, United Kingdom
(Wozniak, Sullo, Dott, Verheyden, Kumar, Murphy) University of Leicester,
Cardiovascular Sciences and NIHR Cardiovascular Biomedical Research Unit,
Glenfield Hospital, Leicester, United Kingdom
(Brunskill, Vaja) University Hospitals Leicester NHS Trust, Leicester,
United Kingdom
Title
A Phase I study to determine the pharmacokinetic profile, safety and
tolerability of sildenafil (Revatio) in cardiac surgery: the
REVAKI-1 study.
Source
British Journal of Clinical Pharmacology. 83 (4) (pp 709-720), 2017. Date
of Publication: 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Aims: Acute kidney injury (AKI) is a common and severe complication of
cardiac surgery. There is no effective prevention or treatment. Sildenafil
citrate (Revatio, Pfizer Inc.), a phosphodiesterase type 5
inhibitor, prevents post cardiac surgery AKI in pre-clinical studies,
however its use is contraindicated in patients with symptomatic
cardiovascular disease. The aim of this study is to assess the safety and
pharmacokinetics of intravenous sildenafil in cardiac surgery patients.
Methods: We conducted an open label, dose escalation study with six
patients per dose level. The six doses were 2.5 mg, 5 mg or 10 mg as a
bolus, either alone or followed by an additional 2 h infusion of 2.5 mg
sildenafil. Results: Thirty-six patients entered the trial, of which 33
completed it. The mean age was 69.9 years. One patient died during
surgery, two others were removed from the trial before dosing (all at dose
level 5 mg + 2.5 mg). The pharmacokinetic profile of sildenafil was
similar to previously published studies. For a dose of 10 mg administered
as a bolus followed by 2.5 mg administered over 2 h the results were
AUC<inf></inf> 537 ng h ml^-1, C<inf>max</inf> 189.4 ng
ml^-1 and t<inf>1/2</inf> 10.5 h. The drug was well tolerated
with no serious adverse events related to drug administration. Higher
sildenafil doses stabilized post-surgery nitric oxide bioavailability.
Conclusions: Pharmacokinetics of sildenafil during cardiopulmonary bypass
were comparable to those of other patient groups. The drug was well
tolerated at therapeutic plasma levels. These results support the further
evaluation of sildenafil for the prevention of AKI in cardiac
surgery.<br/>Copyright &#xa9; 2016 The British Pharmacological Society

<130>
Accession Number
617767693
Author
Jones J.D.; Chew P.G.; Dobson R.; Wootton A.; Ashrafi R.; Khand A.
Institution
(Jones, Chew, Dobson, Khand) University Hospital Aintree NHS Foundation
Trust, Liverpool, United Kingdom
(Jones, Ashrafi, Khand) University of Liverpool, Liverpool, United Kingdom
(Wootton) RMIT University, Melbourne, VIC, Australia
(Ashrafi) Bristol Heart Institute, Bristol, United Kingdom
(Khand) Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
Title
The prognostic value of heart type fatty acid binding protein in patients
with suspected acute coronary syndrome: A systematic review.
Source
Current Cardiology Reviews. 13 (3) (pp 189-198), 2017. Date of
Publication: 01 Aug 2017.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background: Heart type fatty acid protein (HFABP) is a cytosolic protein
released early after acute coronary syndrome (ACS) even in the absence of
myocardial necrosis. Objectives: The purpose of this systematic review was
to determine whether HFABP levels in patients with suspected, or confirmed
ACS, improve risk stratification when added to established means of risk
assessment. Methods: We searched Medline, Pubmed and Embase databases from
inception to July 2015 to identify prospective studies with suspected or
confirmed ACS, who had HFABP measured during the index admission with at
least 1 month follow up data. A prognostic event was defined as all-cause
mortality or acute myocardial infarction (AMI). Results: 7 trials
providing data on 6935 patients fulfilled inclusion criteria. There were
considerable differences between studies and this was manifest in
variation in prognostic impact of elevated HFABP(Odds ratio range 1.2-15.2
for death). All studies demonstrated that HFABP provide unad-justed
prognostic information and in only one study this was negated after
adjusting for covariates. A combination of both negative troponin and
normal HFABP conferred a very low event rate. No study evaluated the
incremental value of HFABP beyond that of standard risk scores. Only one
study used a high sensitive troponin assay. Conclusion: There was marked
heterogeneity in prognostic impact of HFABP in ACS between studies
reflecting differences in sampling times and population risk. Prospective
studies of suspected ACS with early sampling of HFABP in the era of high
sensitivity troponin are necessary to determine the clinical value of
HFABP. HFABP should not currently be used clinically as a prognostic
marker in patients with suspected ACS.<br/>Copyright &#xa9; 2017 Bentham
Science Publishers.

<131>
Accession Number
619081466
Author
Davidson J.A.; Urban T.T.; Baird C.; Tong S.; Woodruff A.; Twite M.;
Jaggers J.; Simoes E.A.F.; Wischmeyer P.
Institution
(Davidson, Baird, Simoes) Department of Pediatrics, Children's Hospital
Colorado/University of Colorado, Denver, Aurora CO, United States
(Urban) Research Institute, Children's Hospital Colorado, Aurora, CO,
United States
(Tong) Department of Biostatistics, University of Colorado, Denver,
Aurora, CO, United States
(Woodruff) Division of Pediatric Critical Care Medicine, Boston Children's
Hospital, Department of Anesthesia, Boston, MA, United States
(Woodruff) Harvard Medical School, Boston, MA, United States
(Twite) Department of Anesthesiology, Children's Hospital
Colorado/University of Colorado, Denver, Aurora CO, United States
(Jaggers) Department of Surgery, Children's Hospital Colorado/University
of Colorado, Denver, Aurora CO, United States
(Wischmeyer) Department of Anesthesiology, Duke University, Durham, NC,
United States
Title
Alkaline Phosphatase in Infant Cardiopulmonary Bypass: Kinetics and
Relationship to Organ Injury and Major Cardiovascular Events.
Source
Journal of Pediatrics. 190 (pp 49-55.e2), 2017. Date of Publication:
November 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives To determine the kinetics of alkaline phosphatase (AP) activity
and concentration after infant cardiopulmonary bypass, including
isoform-specific changes, and to measure the association between
postoperative AP activity and major postoperative cardiovascular events,
organ injury/dysfunction, and postoperative support requirements Study
design Prospective cohort study of 120 infants <=120 days of age
undergoing cardiopulmonary bypass. AP total and isoform-specific activity
was assessed at 6 time points (preoperation, rewarming, 6, 24, 48, and 72
hours postoperation). Low AP activity was defined as <=80 U/L. AP
concentrations and biomarkers of organ injury/dysfunction were collected
through 24 hours postoperation. Major cardiovascular events were defined
as cardiac arrest, mechanical circulatory support, or death. Results AP
activity loss occurred primarily during the operation (median decrease 89
U/L; P <.0001) secondary to decreased bone and liver 2 isoforms. Activity
declined through 24 hours in 27% of patients. AP activity strongly
correlated with serum concentration (r = 0.87-0.91; P <.0001). Persistent
low AP activity at 72 hours was associated independently with occurrence
of a major cardiac event (OR 5.6; P <.05). Early AP activity was
associated independently with subsequent vasoactive-inotropic score (P
<.001), peak lactate (P <.0001), peak creatinine (P <.0005), N-terminal
pro-brain natriuretic peptide (P <.05), and intestinal fatty acid binding
protein (P <.005). Conclusions AP activity decreases during infant
cardiopulmonary bypass and may continue to decrease for 24 hours. Activity
loss is secondary to decreased bone and liver 2 isoform concentrations.
Early low AP activity is associated independently with subsequent
postoperative support and organ injury/dysfunction, and persistence of AP
activity <=80 U/L at 72 hours is associated independently with increased
odds of major cardiovascular events.<br/>Copyright &#xa9; 2017 Elsevier
Inc.

<132>
Accession Number
614271770
Author
Xu X.; Hu J.; Song N.; Chen R.; Zhang T.; Ding X.
Institution
(Xu, Hu, Song, Chen, Zhang, Ding) Department of Nephrology, Zhongshan
Hospital, Fudan University, No.180 Fenglin Road, Shanghai 200032, China
(Xu, Hu, Song, Chen, Zhang, Ding) Shanghai Institute of Kidney Disease and
Dialysis, No.180 Fenglin Road, Shanghai 200032, China
(Xu, Hu, Song, Chen, Zhang, Ding) Shanghai Key Laboratory of Kidney
Disease and Blood Purification, No.180 Fenglin Road, Shanghai 200032,
China
Title
Hyperuricemia increases the risk of acute kidney injury: A systematic
review and meta-analysis.
Source
BMC Nephrology. 18 (1) (no pagination), 2017. Article Number: 27. Date of
Publication: 17 Jan 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Mounting evidence indicated that the elevated serum uric acid
level was associated with an increased risk of acute kidney injury (AKI).
Our goal was to systematically evaluate the correlation of serum uric acid
(SUA) level and incidence of AKI by longitudinal cohort studies. Methods:
We searched electronic databases and the reference lists of relevant
articles. 18 cohort studies with 75,200 patients were analyzed in this
random-effect meta-analysis. Hyperuricemia was defined as SUA levels
greater than 360-420 mumol/L (6-7 mg/dl), which was various according to
different studies. Data including serum uric acid, serum creatinine, and
incidence of AKI and hospital mortality were summarized using
random-effects meta-analysis. Results: The hyperuricemia group
significantly exerted a higher risk of AKI compared to the controls (odds
ratio OR 2.24, 95% CI 1.76-2.86, p < 0.01). Furthermore, there is less
difference of the pooled rate of AKI after cardiac surgery between
hyperuricemia and control group (34.3% vs 29.7%, OR 1.24, 95% CI
0.96-1.60, p = 0.10), while the rates after PCI were much higher in
hyperuricemia group than that in control group (16.0% vs 5.3%, OR 3.24,
95% CI 1.93-5.45, p < 0.01). In addition, there were significant
differences in baseline renal function at admission between hyperuricemia
and control groups in most of the included studies. The relationship
between hyperuricemia and hospital mortality was not significant. The
pooled pre-operative SUA levels were higher in AKI group than that in the
non-AKI group. Conclusions: Elevated SUA level showed an increased risk
for AKI in patients and measurements of SUA may help identify risks for
AKI in these patients.<br/>Copyright &#xa9; 2017 The Author(s).

<133>
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Accession Number
610948425
Author
Sondergaard L.; Steinbruchel D.A.; Ihlemann N.; Nissen H.; Kjeldsen B.J.;
Petursson P.; Ngo A.T.; Olsen N.T.; Chang Y.; Franzen O.W.; Engstrom T.;
Clemmensen P.; Olsen P.S.; Thyregod H.G.Ho.
Institution
(Sondergaard, Ihlemann, Ngo, Olsen, Franzen, Engstrom) Departments of
Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9,
Copenhagen 2100, Denmark
(Steinbruchel, Olsen, Thyregod) Departments of Cardiothoracic Surgery,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Nissen) Departments of Cardiology, Odense University Hospital, Odense,
Denmark
(Kjeldsen) Departments of Cardiothoracic and Vascular Surgery, Odense
University Hospital, Odense, Denmark
(Petursson) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Chang) Department of Statistics, Medtronic, Mounds View, MN, United
States
(Clemmensen) Department of Medicine, Nykoebing F Hospital, University of
Southern Denmark, Odense, Denmark
Title
Two-year outcomes in patients with severe aortic valve stenosis randomized
to transcatheter versus surgical aortic valve replacement: The all-comers
nordic aortic valve intervention randomized clinical trial.
Source
Circulation: Cardiovascular Interventions. 9 (6) (no pagination), 2016.
Article Number: e003665. Date of Publication: 01 Jun 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - The Nordic Aortic Valve Intervention (NOTION) trial was the
first to randomize all-comers with severe native aortic valve stenosis to
either transcatheter aortic valve replacement (TAVR) with the CoreValve
self-expanding bioprosthesis or surgical aortic valve replacement (SAVR),
including a lower-risk patient population than previous trials. This
article reports 2-year clinical and echocardiographic outcomes from the
NOTION trial. Methods and Results - Two-hundred eighty patients from 3
centers in Denmark and Sweden were randomized to either TAVR (n=145) or
SAVR (n=135) with follow-up planned for 5 years. There was no difference
in all-cause mortality at 2 years between TAVR and SAVR (8.0% versus 9.8%,
respectively; P=0.54) or cardiovascular mortality (6.5% versus 9.1%;
P=0.40). The composite outcome of all-cause mortality, stroke, or
myocardial infarction was also similar (15.8% versus 18.8%, P=0.43).
Forward-flow hemodynamics were improved following both procedures, with
effective orifice area significantly more improved after TAVR than SAVR
(effective orifice area, 1.7 versus 1.4 cm² at 3 months). Mean
valve gradients were similar after TAVR and SAVR. When patients were
categorized according to Society of Thoracic Surgeons Predicted Risk of
Mortality (STS-PROM) (<4% versus >=4%), there was no statistically
significant difference for TAVR and SAVR groups in the composite outcome
for low-risk (14.7%, 95% confidence interval, 8.3-21.2 versus 16.8%; 95%
confidence interval, 9.7-23.8; P=0.58) or intermediate-risk patients
(21.1% versus 27.1%; P=0.59). Conclusions - Two-year results from the
NOTION trial demonstrate the continuing safety and effectiveness of TAVR
in lower-risk patients. Longer-term data are needed to verify the
durability of this procedure in this patient population.<br/>Copyright
&#xa9; 2016 American Heart Association, Inc.

<134>
Accession Number
619718095
Author
Ando T.; Takagi H.; Grines C.L.
Institution
(Ando, Grines) Division of Cardiology, Department of Internal Medicine,
Detroit Medical Center, 3990 John R, Detroit, MI 48201, United States
(Takagi) Division of Cardiovascular Surgery, Department of Surgery,
Shizuoka Medical Center, Shizuoka, Japan
Title
Transfemoral, transapical and transcatheter aortic valve implantation and
surgical aortic valve replacement: A meta-analysis of direct and adjusted
indirect comparisons of early and mid-term deaths.
Source
Interactive Cardiovascular and Thoracic Surgery. 25 (3) (pp 484-492),
2017. Date of Publication: 01 Sep 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Clinical outcomes of transfemoral-transcatheter aortic valve implantation
(TF-TAVI) versus surgical aortic valve replacement (SAVR) or transapical
(TA)-TAVI are limited to a few randomized clinical trials (RCTs). Because
previous meta-analyses only included a limited number of adjusted studies
or several non-adjusted studies, our goal was to compare and summarize the
outcomes of TF-TAVI vs SAVR and TF-TAVI vs TA-TAVI exclusively with the
RCT and propensity-matched cohort studies with direct and adjusted
indirect comparisons to reach more precise conclusions. We hypothesized
that TF-TAVI would offer surgical candidates a better outcome compared
with SAVR and TA-TAVI because of its potential for fewer myocardial
injuries. A literature search was conducted through PUBMED and EMBASE
through June 2016. Only RCTs and propensity-matched cohort studies were
included. A direct meta-analysis of TF-TAVI vs SAVR, TA-TAVI vs SAVR and
TF-TAVI vs TA-TAVI was conducted. Then, the effect size of an indirect
meta-analysis was calculated from the direct metaanalysis. The effect
sizes of direct and indirect meta-analyses were then combined. A
random-effects model was used to calculate the hazards ratio and the odds
ratio with 95% confidence intervals. Early (in-hospital or 30 days) and
mid-term (>=1 year) all-cause mortality rates were assessed. Our search
resulted in 4 RCTs (n = 2319) and 14 propensity-matched cohort (n = 7217)
studies with 9536 patients of whom 3471, 1769 and 4296 received TF, TA and
SAVR, respectively. Direct meta-analyses and combined direct and indirect
meta-analyses of early and mid-term deaths with TF-TAVI and SAVR were
similar. Early deaths with TF-TAVI vs TA-TAVI were comparable in direct
metaanalyses (odds ratio 0.64, P = 0.35) and direct and indirect
meta-analyses combined (odds ratio 0.73, P = 0.24). Mid-term deaths with
TFTAVI vs TA-TAVI were increased (hazard ratio 0.83, P = 0.07) in a direct
meta-analysis and became significant after addition of the indirect
meta-analysis (hazard ratio 0.78, 95% confidence interval 0.67-0.92, P =
0.003). In conclusion, TF-TAVI was associated with similar early and
mid-term deaths compared with SAVR. The number of early deaths was not
significantly different between TF-TAVI and TA-TAVI, whereas there were
fewer mid-term deaths with TF-TAVI than with TA-TAVI.

<135>
Accession Number
619717698
Author
Bogachev-Prokophiev A.; Afanasyev A.; Zheleznev S.; Fomenko M.; Sharifulin
R.; Kretov E.; Karaskov A.
Institution
(Bogachev-Prokophiev, Afanasyev, Zheleznev, Fomenko, Sharifulin, Kretov,
Karaskov) Department of Heart Valves Surgery, Siberian Biomedical Research
Center, Ministry of Health Russian Federation, 15 Rechkunovskaya Street,
Novosibirsk 630055, Russian Federation
Title
Mitral valve repair or replacement in hypertrophic obstructive
cardiomyopathy: A prospective randomized study.
Source
Interactive Cardiovascular and Thoracic Surgery. 25 (3) (pp 356-362),
2017. Date of Publication: 01 Sep 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
OBJECTIVES: The optimal surgical strategy for concomitant mitral valve
intervention during myectomy remains controversial. The purpose of this
study was to compare the results of mitral valve replacement versus repair
in patients with hypertrophic obstructive cardiomyopathy and severe mitral
regurgitation. METHODS: Between 2010 and 2013, a total of 88 patients with
hypertrophic obstructive cardiomyopathy and severe mitral regurgitation
were randomly assigned to undergo either mitral valve replacement or
repair in addition to extended myectomy. RESULTS: Three patients from the
repair group were switched to mitral valve replacement after repair
failure. There was 1 early death (2.4%) in the replacement group. The
resting left ventricular outflow tract gradient was reduced from 89.1 +/-
20.4 to 18.3 +/- 5.7mmHg (P < 0.001) and from 96.6 +/- 28.1 to 14.7 +/-
5.9mmHg (P < 0.001) in the replacement and repair groups, respectively;
there was no significant difference between the groups (P = 0.458). At
2-year follow-up, overall survival was 87.2 +/- 4.9% and 96.7 +/- 3.3% (P
= 0.034); freedom from sudden cardiac death was 95.6 +/- 3.1% and 96.7 +/-
3.3% (P = 0.615); and freedom from thromboembolic events was 91.2 +/- 4.2%
and 100%, respectively (P = 0.026). CONCLUSIONS: Both mitral valve repair
and valve replacement in addition to extended myectomy are effective
methods of surgical treatment in patients with hypertrophic obstructive
cardiomyopathy who have severe mitral regurgitation. The benefits of
mitral valve repair are better overall survival and a lower rate of
thromboembolic events.<br/>Copyright &#xa9; The Author 2017.

<136>
Accession Number
619713862
Author
Ad N.; Holmes S.D.; Massimiano P.S.; Rongione A.J.; Fornaresio L.M.;
Fitzgerald D.
Institution
(Ad) Department of Cardiovascular and Thoracic Surgery, West Virginia
University, Morgantown, WVa
(Ad, Massimiano, Rongione) Adventist HealthCare, Takoma Park, Md
(Ad) Inova Fairfax Hospital, Falls Church, Va
(Holmes, Fornaresio) Heart and Vascular Institute, West Virginia
University Medicine, Morgantown, WVa
(Fitzgerald) The Medical University of South Carolina, Charleston, SC
Title
The use of del Nido cardioplegia in adult cardiac surgery: A prospective
randomized trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: The del Nido cardioplegia solution has been used extensively
in congenital heart surgery for more than 20 years and more recently for
adults. This randomized controlled trial examined whether expanding this
technique to adult cardiac surgery confers benefits in surgical workflow
and clinical outcome compared with blood-based cardioplegia. Methods:
Adult first-time coronary artery bypass grafting (CABG), valve, or
CABG/valve surgery patients requiring cardiopulmonary bypass (CPB) were
randomized to del Nido cardioplegia (n = 48) or whole blood cardioplegia
(n = 41). Primary outcomes assessed myocardial preservation. Troponin I
was measured at baseline, 2 hours after CPB termination, 12 and 24 hours
after cardiovascular intensive care unit admission. Alpha was set at P <
.001. Results: Preoperative characteristics were similar between groups,
including age, Society of Thoracic Surgeons risk score, CABG, and valve
procedures. There was no significant difference on CPB time (97 vs 103
minutes; P = .288) or crossclamp time (70 vs 83 minutes; P = .018). The
del Nido group showed higher return to spontaneous rhythm (97.7% vs 81.6%;
P = .023) and fewer patients required inotropic support (65.1% vs 84.2%; P
= .050), but did not reach statistical significance. Incidence of Society
of Thoracic Surgeons-defined morbidity was low, with no strokes,
myocardial infarctions, renal failure, or operative deaths. For del Nido
group patients, troponin levels did not increase as much as for control
patients (P = .040), but statistical significance was not reached.
Conclusions: Evidence from this study suggests del Nido cardioplegia use
in routine adult cases may be safe, result in comparable clinical
outcomes, and streamline surgical workflow. The trend for troponin should
be investigated further because it may suggest superior myocardial
protection with the del Nido solution.<br/>Copyright &#xa9; 2017 The
American Association for Thoracic Surgery.

<137>
Accession Number
619721330
Author
Peker Y.; Thunstrom E.; Glantz H.; Wegscheider K.; Eulenburg C.
Institution
(Peker) Dept of Pulmonary Medicine, Faculty of Medicine, Marmara
University, Pendik Education and Research Hospital, Sleep Medicine Center,
Pendik, Istanbul 34899, Turkey
(Peker, Thunstrom) Dept. of Molecular and Clinical Medicine/Cardiology,
Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
(Thunstrom) Dept of Cardiology, Sahlgrenska University Hospital/Ostra,
Gothenburg, Sweden
(Glantz) Dept of Internal Medicine, Skaraborg Hospital, Lidkoping, Sweden
(Wegscheider) Dept of Medical Biometry and Epidemiology, University
Medical Center Hamburg-Eppendorf, Hamburg, Germany
(Eulenburg) Medical Statistics and Decision Making, Dept of Epidemiology,
University Medical Center Groningen, Groningen, Netherlands
Title
Outcomes in Coronary artery disease patients with sleepy obstructive sleep
apnoea on CPAP.
Source
European Respiratory Journal. 50 (6) (no pagination), 2017. Article
Number: 1700749. Date of Publication: 01 Dec 2017.
Publisher
European Respiratory Society (E-mail: info@ersnet.org)
Abstract
Coronary artery disease (CAD) patients with obstructive sleep apnoea (OSA)
have increased risk for major adverse cardiovascular and cerebrovascular
events (MACCEs) compared with CAD patients without OSA. We aimed to
address if the risk is similar in both groups when OSA patients are
treated. This study was a parallel observational arm of the RICCADSA
randomised controlled trial, conducted in Sweden between 2005 and 2013.
Patients with revascularised CAD and OSA (apnoea-hypopnoea index (AHI)
>=15 events.h-1) with daytime sleepiness (Epworth Sleepiness Scale score
>=10) were offered continuous positive airway pressure (CPAP) (n=155); CAD
patients with no OSA (AHI <5 events.h-1) acted as controls (n=112), as a
randomisation of sleepy OSA patients to no treatment would not be
ethically feasible. The primary end-point was the first event of MACCEs.
Median follow-up was 57 months. The incidence of MACCEs was 23.2% in OSA
patients versus 16.1% in those with no OSA (adjusted hazard ratio 0.96,
95% CI 0.40-2.31; p=0.923). Age and previous revascularisation were
associated with increased risk for MACCEs, whereas coronary artery bypass
grafting at baseline was associated with reduced risk. We conclude that
the risk for MACCEs was not increased in CAD patients with sleepy OSA on
CPAP compared with patients without OSA.<br/>Copyright &#xa9; ERS 2017.

<138>
Accession Number
619674689
Author
Murata H.; Hida K.; Ichinomiya T.; Inoue H.; Sato S.; Hara T.
Institution
(Murata) Nagasaki University, Graduate School of Biomedical Sciences,
Department of Anesthesiology, Nagasaki, Japan
(Hida, Ichinomiya, Inoue, Hara) Nagasaki University School of Medicine,
Department of Anesthesiology, Nagasaki, Japan
(Sato) Nagasaki University Hospital, Clinical Research Center, Nagasaki,
Japan
Title
The spread of sensory block produced by programmed intermittent thoracic
paravertebral bolus of levobupivacaine: A prospective, randomized,
controlled, double-blind trial.
Source
Regional Anesthesia and Pain Medicine. Conference: 36th Annual European
Society of Regional Anaesthesia and Pain Therapy Congress, ESRA 2017.
Switzerland. 42 (5 Supplement 1) (pp e78), 2017. Date of Publication:
September-October 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Aims: This randomized, controlled, double-blind trial
compared the effectiveness of levobupivacaine delivery of a programmed
intermittent paravertebral bolus with a continuous paravertebral infusion.
Methods: This study was approved from the Institutional Review Board of
Nagasaki University Hospital. Using a computer-generated sequence, 32
consecutive patients who underwent unilateral video-assisted thoracic
surgery were randomized to receive either a programmed intermittent
paravertebral bolus of 10 mL of 0.2% levobupivacaine every 120 min (PIB
group, n = 16) or a continuous paravertebral infusion of
0.2%levobupivacaine at 5 mL/h (CI group, n = 16). Postoperatively,
mechanical infusion pump was set depending on the groups assigned after
injection of 20 mL of 0.25% levobupivacaine through the paravertebral
catheter. Patient-controlled intravenous fentanyl administration was also
started. The primary outcome was the number of blocked dermatomes 24 h
after initial bolus of levobupivacaine. The secondary outcomes included
pain at rest and coughing, cumulative fentanyl consumption and acceptance
of the analgesic technique. Arterial levobupivacaine concentration was
measured to ensure the safety. A p value < 0.05 was considered
statistically significant. Results: The number of blocked dermatomes 24 h
after initial bolus of levobupivacaine (mean [95% confidence interval])
was larger in PIB group (3.1 [2.0-4.2]) than in CI group (6.8 [5.7-7.9])
(p < 0.001). No significant differences were observed in the secondary
outcomes. The arterial levobupivacaine concentration did not reach a toxic
level. Conclusions: The programmed intermittent paravertebral bolus of
levobupivacaine provides a wider dermatomal spread of sensory block than
the continuous paravertebral infusion with an identical hourly dose of
levobupivacaine.

<139>
Accession Number
619673651
Author
Theodoraki K.; Moka E.; Argyra E.; Siafaka I.; Vadalouca A.
Institution
(Theodoraki, Argyra, Siafaka, Vadalouca) Aretaieion University
Hospital-National, Kapodistrian University of Athens, Department of
Anaesthesiology and Pain Medicine, Athens, Greece
(Moka) Creta Interclinic Hospital, Department of Anaesthesiology,
Heraklion-Crete, Greece
Title
Pro con debate 8: Sedation is to be avoidedwhen regional anaesthesia is
used.
Source
Regional Anesthesia and Pain Medicine. Conference: 36th Annual European
Society of Regional Anaesthesia and Pain Therapy Congress, ESRA 2017.
Switzerland. 42 (5 Supplement 1) (pp e10-e11), 2017. Date of Publication:
September-October 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
The patient's level of consciousness during regional anaesthesia
procedures is an area of controversy. Practitioners who avoid performing
regional blocks in anaesthetized or heavily sedated patients claim that
the anaesthetized patient cannot properly convey important early warning
information that can help prevent local anaesthetic systemic toxicity
(LAST) and neurological injury. Their primary argument is that the awake
or minimally sedated patient will be able to report developing symptoms of
LAST prior to seizures and the injection could be aborted before the
administration of a toxic dose or will be able to report pain,
paresthesias or other atypical symptoms before neurological injury
occurs1. However, these arguments remain at large unproven. Regarding
central nervous system toxicity, there are cases where being anaesthetized
or unsedated provides no concrete benefit. For example, seizures as a
result of unintentional local anaesthetic injection into the carotid or
vertebral arteries during stellate ganglion or interscalene block
performance have occurred after as little as 1.5 mL of local anaesthetic
being injected2. Additionally, when the local anaesthetic is
unintentionally injected intravenously, patients may develop seizures
before they have the time to recognize symptoms and warn the clinician
about imminent central nervous system toxicity. Finally, patient report of
symptoms is never 100% sensitive, since there is a large population of
patients who are incapable of either sensing or adequately conveying their
symptoms, such as young children, demented patients or patients with
language barriers. Therefore, the administration of a test dose and not
patient report should be considered a more reliable and accurate method of
detecting or preventing inadvertent intravascular injection. Moreover, it
has been shown that appropriate sedation may actually decrease the risk of
seizures by raising the threshold for local anesthetic-induced
seizures3,4. As to preventing cardiovascular local anaesthetic toxicity,
current data suggest that the most appropriate method to prevent
intravascular injection is by slow, incremental administration of the
local anaesthetic solution containing a marker of intravascular injection,
while simultaneously monitoring for the objective cardiovascular response,
thus obviating the need to rely on patient report of any symptoms of
intravascular injection. Therefore, there is no reason to believe that
there is any advantage in avoiding blocks in anaesthetized or heavily
sedated patients. In addition, it has been shown that sedation may prove
beneficiary since it can raise the threshold for manifestation of
cardiovascular toxicity, such as early dysrhythmias and hypertension5,6.
Supporters of not performing peripheral nerve blocks in anaesthetized or
heavily sedated patients argue that awake patients can recognize impending
nerve injury before it occurs and thus warn the clinician in time.
However, it is debatable whether paresthesias or pain from an errant
needle are specific or sensitive indicators of potential nerve injury.
From series where blocks were placed by eliciting a paresthesia and no
patient developed permanent neurological injury, it can be concluded that
a paresthesia per se is not a specific indicator of imminent nerve
injury7. There have also been cases where nerve damage developed despite
promptly terminating injections when patients complained about
pain/paresthesias, suggesting that the patient's warning is insufficient
to prevent injury and is therefore clinically useless8. There is also
always the possibility that the injury might have already occurred by the
time the patient reports the paresthesia/pain and finally, there is never
complete certainty that the reported neurological injuries were actually
caused by the block itself and not by a nonblock-related event, such as
tourniquet ischemia, surgical trauma or traction9. It has also been
claimed that even if damage to neural structures occurs by the cutting
edge of the needle, this can hardly be attenuated if noticed early, since
in no case can a disrupted group of nerve fibers spontaneously reconnect
if the needle is removed immediately after the dissection. Therefore, with
respect to the risk of nerve injury, there is insufficient data to draw
meaningful conclusions as towhether the risk is increased when performing
nerve blocks in anaesthetized or heavily sedated patients. Supporters of
performing regional blocks in anaesthetized or heavily sedated patients
claim that this practice increases safety by diminishing the chance of the
patient moving suddenly and causing damage to a vital structure. Also, it
enhances patient acceptance, thus increasing the number of patients who
will benefit from a regional technique. Finally, without general
anaesthesia or heavy sedation, regional blocks would be impossible in the
paediatric population, since infants and young children are unlikely to
accept the requisites of regional anaesthesia practice, such as needles,
nerve stimulators and cold ultrasound transducers. In addition, infants
and young children are incapable of providing the vital information of
accidental intravascular injection or articulating the feeling of
paresthesia. Still in 1996, in a multi-institutional prospective study on
85,412 paediatric anaesthetics of which 24,409 involved a regional block,
with more than 90% of which performed in fully anaesthetized infants and
children, an extremely low rate of complications was reported10. Recently,
an analysis of an observational database of more than 50,000 paediatric
regional anaesthesia blocks seeking at determining the incidence of
postoperative neurological symptoms and LAST in relation of the patient's
state at the time of block placement (conscious, sedated, anaesthetized)
showed that placing blocks under general anaesthesiawas in fact safer,
since the rate of neurological complications in awake and sedated children
was more than seven times higher than that in children under general
anaesthesia11. The authors concluded that the practice of placing blocks
under general anaesthesia should be considered safe and should remain the
prevailing standard of care11. In fact, heavy sedation or general
anaesthesia is the standard practice of most paediatric anaesthetists,
since it also makes the use of nerve stimulators and ultrasound easier,
while diminishing the risk of sudden movements. Lastly, there are adult
populations who bear the same limitations as do infants and children, such
as patients with severe dementia, profound developmental delay,
incapacitating mental illness, those with severe anxiety or chronic pain
and those with an already compromised sensorium (who will not be able to
provide appropriate feedback to the clinician even if awake). In these
situations, the benefits of ensuring cooperation and immobility outweigh
the risks of performing regional blocks under deep sedation or general
anaesthesia12,13. In these situations, the clinician might consider
performing regional blocks under heavy sedation or general anaesthesia,
thus allowing patients who otherwise cannot cooperate to benefit from
regional procedures. Finally, even in the general surgical population,
there is evidence supporting the use of general anesthesia or sedation for
block placements. In 2003, Horlocker et al reported epidural catheter
placement in 4,298 fully anaesthetized patients undergoing thoracic
surgery with no neurological complications14. Similarly, in a recent large
retrospective registry analysis of the effects of sedation and general
anaesthesia on block-related complications and patient satisfaction, LAST
and pneumothorax rates were independent of the state of consciousnesswhile
sedation during block performance enhanced the operating conditions and
therefore reduced the incidence of multiple skin punctures, the risk of
premature termination of the peripheral nerve block as well as the risk of
primary failure15. In the same analysis, sedation was associated with a
significant improvement in patient satisfaction. In conclusion, it remains
controversial whether or not to perform regional blocks in anaesthetized
or heavily sedated patients, with arguments on either side of the debate.
It is very difficult to perform randomized controlled trials aimed at
evaluating the impact of anaesthesia or heavy sedation on the risk of
complications, since the outcome of interest is very rare and most
conclusions are drawn from case reports and observational series. It is
however expected that the introduction of novel techniques, such as
ultrasound guidance and injection pressure monitoring will increase the
effectiveness and safety or regional blocks irrespective of the state of
alertness of patients, since with improvement in technology and increased
provider expertise, future anaesthetic practice will rely less on
patient's feedback and more on objective measures.

<140>
Accession Number
619673644
Author
Ajab S.; Begum S.S.S.; Stanley H.; Matthews S.; Fisher P.M.; Socci L.;
Deeley Y.; Edwards J.G.
Institution
(Ajab) Vascular Surgery, Sheffield Teaching Hospital, NHS Foundation
Trust, Sheffield, United Kingdom
(Begum) Cardiothoracic Surgery, Sheffield Teaching Hospital, NHS
Foundation Trust, Sheffield, United Kingdom
(Stanley) Mesothelioma/lung Cancer Specialist Nurse, Sheffield Teaching
Hospital, NHS Foundation Trust, Sheffield, United Kingdom
(Matthews) Radiology, Sheffield Teaching Hospital, NHS Foundation Trust,
Sheffield, United Kingdom
(Fisher, Deeley) Oncology, Sheffield Teaching Hospital, NHS Foundation
Trust, Sheffield, United Kingdom
(Socci, Edwards) Thoracic Surgery, Sheffield Teaching Hospital, NHS
Foundation Trust, Sheffield, United Kingdom
Title
Searching for MARS-2: The north trent cancer research network specialist
mesothelioma MDT screening experience.
Source
Lung Cancer. Conference: 15th Annual British Thoracic Oncology Group
Conference, BTOG 2017. Ireland. 103 (Supplement 1) (pp S76-S77), 2017.
Date of Publication: January 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Introduction: Malignant pleural mesothelioma (MPM) accounts for
approximately 2,500 deaths per annum with rising incidence. MARS-2 is a
prospective randomised trial of chemotherapy alone versus chemotherapy
with extended pleurectomy, recruiting at 15 oncology centres nationwide.
The proportion of patients eligible for the trial protocol, on a
population basis, is not known. We present the experience, since 1 January
2016, of screening for MARS-2 every patient presented at our regional
Specialist Mesothelioma MDT (SM-MDT), serving a population of 1.8 million.
Methods: All patients diagnosed with MPM within the network were discussed
at SM-MDT, and screened for MARS-2, at the regional centre. Reasons for
ineligibility were recorded prospectively, where appropriate. Local
screening and trial progress database was reviewed. Results: 57 patients
were screened in the first ten months of 2016. Reasons for enrolment
failure include: declined trial protocol (n=12, 8 were eligible for
enrolment), high performance status (n=26), previous surgery (n=2) and
unresectable tumour (n=14). 37% of patients were approached and reviewed
in thoracic surgery clinics. Of the 14 patients deemed eligible for the
trial by SM-MDT and after surgical review (25% of 57 patients screened), 5
patients (9%) were enrolled in MARS-2. Conclusion: Primary endpoints of
the feasibility phase of MARS-2 is the ability to randomise 50 patients
within the first 24 months or randomise 25 patients in any 6 month period.
These endpoints are soon to be reached. For the main trial, expansion of
recruitment, supported by robust screening, will be required. Our SM-MDT
experience suggests approximately 25% of patients with MPM may be suitable
for enrolment in MARS-2, equating to approximately 17 patients per million
population per year. These results should allow centres to help identify
patients, set trial recruitment targets and drive study recruitment.

<141>
Accession Number
619673415
Author
Theodoraki K.; Moka E.; Argyra E.; Siafaka I.; Vadalouca A.
Institution
(Theodoraki, Argyra, Siafaka, Vadalouca) Aretaieion University
Hospital-National and Kapodistrian University of Athens, Department of
Anaesthesiology and Pain Medicine, Athens, Greece
(Moka) Creta Interclinic Hospital, Department of Anaesthesiology,
Heraklion-Crete, Greece
Title
Pro con debate 2: Regional anaesthesia has significantly improved outcome
after major orthopedic, abdominal and thoracic surgery.
Source
Regional Anesthesia and Pain Medicine. Conference: 36th Annual European
Society of Regional Anaesthesia and Pain Therapy Congress, ESRA 2017.
Switzerland. 42 (5 Supplement 1) (pp e5-e6), 2017. Date of Publication:
September-October 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Over the past 30 years, neuraxial blocks, due to improvement of techniques
and broadening of indications, have become a widely used method to provide
intraoperative anaesthesia and postoperative analgesia. This has been the
result of better understanding of neurophysiology as well as advances in
technology and training expertise that have made regional anaesthesia
appealing to the clinician. Overall neuraxial techniques are associated
with well-recognized physiological advantages such as excellent pain
relief, anti-inflammatory effects, attenuation of catabolism, improved
tissue perfusion, improvement of mobilization and recovery of
gastrointestinal function, less diaphragmatic inhibition and decreased
pain chronicization.A reasonable question arises though, whether patient
outcomes are improved to a degree that justifies the use of neuraxial
techniques as a routine method. In the past, the ability of regional
anaesthesia to provide satisfactory management of postoperative pain
without a direct translation into improved long-term outcomewas considered
a sufficient reason to perform a neuraxial block1. Recently though, with
the advent of improved general anaesthesia regimens, the availability of
multimodal pain therapy, the lessening risk of perioperative morbidity and
mortality and the increasing number of patients in fast-track discharge
programs, regional anaesthesia is being reappraised and its superiority
has receded to levels that may be statistically but not clinically
significant. In the beginning of the new millennium, there was a great
deal of enthusiasm regarding performing thoracic epidurals. The technique
was highly recommended as the gold standard approach for major abdominal
surgery due to the perceived advantages of dynamic pain relief,
maintenance of bowel function, reduction in the incidence of ileus as
compared to intravenous analgesia and early mobilization3. However, a
recent meta-analysis of randomized controlled trials comparing epidurals
with an alternative analgesic technique following abdominal surgery within
an enhanced recovery after surgery program showed that epidurals are
superior in terms of pain scores but demonstrated no advantages for the
use of epidurals over other analgesic regimens in terms of overall
complications rates, rates of ileus and lengths of hospital stay4.
Similarly, in last year's Cochrane Systematic Review, enthusiasm about
thoracic epidurals seems to have faded since it was claimed that the
quality of evidence about epidurals affecting the incidence of vomiting or
anastomotic leak and reducing the length of hospital stay is lowand very
low respectively5. In a retrospective cohort study of nearly 100,000
elective open colectomies performed in the United States, combined general
and neuraxial anaesthesia as compared to just general anaesthesia was
associated with increased risk for acute myocardial infarction, urinary
tract infection, admission to Intensive Care Unit and overall higher
expense with no improvement in length of stay6. The effect of neuraxial
blocks on other outcomes, such as cardiovascular and respiratory morbidity
has also come under scrutiny in recent years. Older metaanalyses concluded
that central blocks significantly reduced serious complications and
postoperative mortality. However, most of the studies included in those
metaanalyses are today considered out-of-date and had major methodological
flaws. Today it is considered that adding epidural analgesia to general
anaesthesia does not reduce postoperative morbidity and mortality in the
general surgical population and that its benefits are limited to a
subpopulation of highrisk patients and procedures7. It is unlikely that
such evidence will appear in the next years because the overall incidence
of complications diminishes over time8. Also, the beneficial effects of
epidural analgesia on deep venous thrombosis have been diminished by
routine thromboprophylaxis. Additionally, the current trend of modern
surgery is towards less invasive procedures, which are associated with
fewer complications, further diminishing the potential benefits of
epidural analgesia.9 In another recent Cochrane Review comparing epidural
analgesia to opioid-based systemic analgesia for abdominal aortic surgery,
the level of evidence regarding reduction of time to tracheal extubation
and postoperative respiratory complications when epidural was used was
low, whereas no difference in 30-day mortality was demonstrated10. A
metaanalysis using combined data from several randomized controlled trials
of cardiac surgery showed that thoracic epidurals did not showa benefit in
reducing mortality or the risk of myocardial infarction perioperatively11.
Also, no difference in perioperative morbidity or mortality was
demonstrated in an analysis of a multicentre registry investigating the
role of the type of anaesthesia on the outcome in endovascular aneurysm
repair12. Interestingly, although postoperative delirium is usually
presumed to be less frequent after regional anaesthesia as compared to
general anaesthesia, in a metaanalysis where the primary outcome of
interest was the incidence of postoperative delirium in older adults,
there was no significant difference in the incidence of delirium between
regional and general anaesthesia13. In addition, the incidence of
postoperative cognitive dysfunction was higher in the spinal versus the
general anaesthesia group of patients submitted to extracorporeal
lithotripsy14. Moreover, no significant differenceswere demonstrated in
outcome between regional anaesthesia and non-regional anaesthesia groups
in a systematic reviewassessing functional outcomes 3, 6 and 12 months
after knee, shoulder or hip replacement surgery15. In an analysis of the
UK hip fracture national database, there was no difference in mortality up
to 30 days after surgery associated with regional as compared to general
anaesthesia16. Furthermore,when selecting a technique of central neuraxial
block, the risk/ benefit ratio should be taken into account, since the
risk of serious complications, especially in the presence of anticoagulant
therapy or local anaesthetic systemic toxicity, although small, is not
totally negligible17,18. In addition, factors such as technical block
failures, inadvertent motor blockade, postdural puncture headache,
infection as well as the need for ongoing monitoring should be taken into
consideration19. In conclusion, it appears that the use of central
neuraxial techniques can provide the most effective postoperative
analgesia but this initial functional gain does not always translate into
improved long-term outcomes, since the evidence for reduced incidence of
major complicationswhen regional anaesthesia is compared to general
anaesthesia is mixed20. Moreover, the superiority of neuraxial techniques
is offset by high failure rates and the availability of alternatives,
whereas there are circumstances where the risk of complications or
regional anaesthesia exceeds that of general anaesthesia. After an
individualized assessment of the risk/benefit ratio, central neuraxial
blocks still play a role in perioperative medicine but they should no
longer be considered the standard of care for the general surgical
population since a clear and consistent benefit of regional anaesthesia on
long-term outcome remains elusive.

<142>
Accession Number
619674597
Author
Vosoughian M.
Institution
(Vosoughian) Shahid Beheshti University of Medical Sciences,
Anesthesiology and Critical Care, Tehran, Iran, Islamic Republic of
Title
Effect of different combination doses of intrathecal hyperbaric
bupivacaine 0.5%and sufentanil on the hemodynamic profile of geriatric
patients undergoing hip surgery under spinal anesthesia.
Source
Regional Anesthesia and Pain Medicine. Conference: 36th Annual European
Society of Regional Anaesthesia and Pain Therapy Congress, ESRA 2017.
Switzerland. 42 (5 Supplement 1) (pp e193), 2017. Date of Publication:
September-October 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Aims: With the increasing number of elderly patients with
fragile hemodynamic profiles undergoing lower limb surgery, avoiding
hypotension in this population is of great importance.We intended to study
the effect of different combination doses of intrathecal hyperbaric
bupivacaine 0.5% and sufentanil on the hemodynamic profile of geriatric
patients undergoing lower limb surgery. Methods: 60 elderly patientswere
randomly allocated into three groups. Group 1 (G1: 5 mg bupivacaine plus
10 mug sufentanil intrathecally), Group 2 (G2: 10 mg bupivacaine plus 5
mug sufentanil intrathecally), and Group 3 (G3: 15 mg bupivacaine
intrathecally). Non-invasive automated blood pressure was checked every 1
minute for the first 5 minutes, and every 5 minutes for 25 minutes and
every 15 minutes for 30 minutes during surgery. Heart rate (HR) was
recorded at the same intervals. Results: A total of 60 patients met the
inclusion criteria and were enrolled in the study. Five patients had
failed spinal anesthesia whom were replaced with new patients. Mean
arterial pressure after 1 minute in Groups 2 and 3 was significantly lower
than Group 1 (86.0 +/- 9.0, 87.3 +/- 11.0, 92.2 +/- 13.0, P = 0.001). No
statistically significant difference in HR was observed in between the
three groups. The degree of motor and sensory blockwas adequate in all
three groups, and no patients required any additional analgesics.
Conclusions: Adding sufentanil as an adjuvant and decreasing the dose of
intrathecal hyperbaric bupivacaine may help maintain a stable hemodynamic
during lower limb surgery in the elderly.

<143>
Accession Number
619674550
Author
Eljezi V.; Imhoff E.; Bourdeaux D.; Pereira B.; Farhat M.; Schoeffler P.;
Azarnoush K.; Christian D.
Institution
(Eljezi, Imhoff, Schoeffler) CHU CLERMONT-FERRAND, Medecine
Perioperatoire, CLERMONT-FERRAND, France
(Bourdeaux) CHU CLERMONTFERRAND, Pharmacie Centrale, CLERMONT-FERRAND,
France
(Pereira, Christian) CHU CLERMONT-FERRAND, Direction de la Recherche
Clinique et des Innovations, CLERMONT-FERRAND, France
(Farhat, Azarnoush) CHU CLERMONT-FERRAND, Pole Cardiologie-Chirurgie
Cardio-Vasculaire, CLERMONT-FERRAND, France
Title
Bilateral sternal infusion of ropivacaine and length of stay in icuafter
cardiac surgery with increased respiratory risk. A randomised controlled
trial.
Source
Regional Anesthesia and Pain Medicine. Conference: 36th Annual European
Society of Regional Anaesthesia and Pain Therapy Congress, ESRA 2017.
Switzerland. 42 (5 Supplement 1) (pp e59-e60), 2017. Date of Publication:
September-October 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Aims: The continuous bilateral infusion of a local
anaesthetic solution around the sternotomy wound (bilateral sternal) is an
innovative technique for reducing pain after sternotomy. The aim was to
assess the effects of the technique on the need for intensive care in
cardiac patients at increased risk of respiratory complications. Methods:
Randomised, observer-blind controlled trial. 120 adults patients scheduled
for open-heart surgery with one of the following conditions: age more than
75 years, BMI>30kg m2, chronic obstructive pulmonary disease, active
smoking habit, were included. The bilateral sternal infusion of 0.2%
ropivacaine (3ml h-1 through each catheter; 'intervention' group), was
compared with standardised care ('control' group). Analgesia was provided
with paracetamol and self-administered intravenous morphine. The main
outcome (Figure presented). measure was the length of time to readiness
for discharge from ICU, blindly assessed by a committee of experts.
Results: No effect was found between groups for the primary outcome
(P=0.680, intention to treat); the median values were 42.4 and 37.7h,
respectively for the control and intervention groups (P=0.873). Similar
nonsignificant trends were noted for other postoperative delays.
Significant effects favouring the intervention were noted for dynamic
pain, patient satisfaction, occurrence of nausea and vomiting, occurrence
of delirium or mental confusion and occurrence of pulmonary complications.
In 12 patients, although no symptoms actually occurred, the total
ropivacaine plasma level exceeded the lowest value for which neurological
symptoms have been observed in healthy volunteers. Figure 1 and Tables 1
and 2 Conclusions: Because of a small size effect, and despite significant
analgesic effects, this strategy failed to reduce the time spent in ICU.

<144>
Accession Number
619674531
Author
Beaussier M.; Bossard A.E.
Institution
(Beaussier, Bossard) Departement d'Anesthesie, Institut Mutualiste
Montsouris, 42 Boulevard Jourdan, Paris 75014, France
Title
Abdominalwall blocks andwound catheters.
Source
Regional Anesthesia and Pain Medicine. Conference: 36th Annual European
Society of Regional Anaesthesia and Pain Therapy Congress, ESRA 2017.
Switzerland. 42 (5 Supplement 1) (pp e40-e41), 2017. Date of Publication:
September-October 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Abdominal surgery is characterized for a long time ago by moderate to
severe postoperative pain, mainly induced by mobilization. Postoperative
pain relief, besides to improving patient's comfort, is likely to have
beneficial effects on postoperative recovery course (1,2). But abdominal
surgery is moving to less invasive procedures, as illustrated by the
development of laparoscopic approach. These developments are associated
with less postoperative pain, less opiate requirements and less metabolic
(stress) reaction. Pain management is a cornerstone of the implementation
of Enhanced Recovery After Surgery (ERAS) protocols, allowing patients to
ambulate in the immediate postoperative period, and preventing them, at
least partly, from opiate-related side effects (3,4). In this context,
anesthesiologists have to think about the development of new strategies to
manage postoperative pain (5). Epidural analgesia (EA) is a
well-established technique and has been for a long time the gold standard
for pain management after major abdominal surgery (6). Besides to
analgesic effects, EA has demonstrated beneficial impact on postoperative
outcomes, including a decrease on pulmonary complications, a reduction of
the duration of intestinal ileus, and some beneficial metabolic properties
(7). Undoubtedly, EA remains the best analgesic technique for a lot of
procedures, such as major perineal surgery, upper abdominal and esophageal
surgery aswell as thoracic surgery. In these indications, the benefit/risk
ratio is clearly in favor of doing EA as the first line analgesic
treatment (8). However, recent reports have highlighted that epidural
analgesia may slow down recovery after laparoscopic colonic resection
within an enhanced recovery pathway, without adding obvious benefits
(9,10). It has been shown that EAwas not superior to intravenous lidocaine
infusion for pain relief after laparoscopic colorectal resections (11).
This make epidural analgesia no longer indicated for pain relief in this
setting (12). Similar conclusions were drawn for liver resection, showing
that EAwas associated with an increase use of blood transfusion and a
longer hospital stay as compared to parenteral analgesia (13,14). The
development of parietal infiltration (Local Anesthetic Wound Infiltration
= LAWI) was based on the recognition that a major component of
postoperative pain arises from surgical wound incision (15). Above all,
unlike EA, wound infiltration is very easy to implement, can be performed
in almost all patients, has a very lowfailure rate and is quite harmless.
Preperitoneal ropivacaine continuous infusion for 48 h may provide
effective pain relief after open colorectal resection, with a reduction of
opiate consumption and a shorter length of hospital stay as compared to
patient-controlled iv analgesia (16). Some recent reports have shown LAWI
to be able to be an efficient alternative to EA after abdominal surgery
(17). When the same local anesthetic regimen (10 ml/h ropivacaine 0.2%)
was administered either by LAWI or EA routes, no difference was observed
on pain relief or recovery course, with SSCAadministration being
associated with a faster return of gastrointestinal function than EA(18).
This has been further confirmed in large sample size study (19) and even
in a recent meta-analysis (20). Similar conclusions came from liver
resection where LAWI has been shown to provide similar pain relief than EA
(21). Additionally, wound infiltration is able to improve postoperative
ventilatory function, after colorectal resection (22) as well as after
liver surgery (23). Additional supports advocating for the use of LAWI
come from recent pathophysiologic data highlighting that at least a part
of the nociceptive inputs coming from the peritoneum and abdominal viscera
do not run along the spinal nociceptive pathway and could be blocked by
direct peritoneal application of local anesthetics (24). This may explain
why preperitoneal placement of the wound catheter appears as effective
(16). However, the place of LAWI is still the subject of many
controversies because there are still a lot of unresolved questions about
the best modality to use it (catheter placement, flow rate..). In the
future, it can be expected that long-lasting local anesthetic formulation
may be able to provide adequate pain relief after a single wound injection
(25). Other analgesic techniques have been developed to block parietal
innervation (somatic pain) of the abdominalwall (intercostal,
ilio-inguinal and ilio-hypogastric nerves). The use of Ultrasound-guidance
has allowed for the updating of several locoregional approaches.
Paravertebral block, usually performed for thoracic surgery, appears a
promising technique for pain relief after abdominal surgery, despite a
quite high failure rate (26). Transversus Abdominis Plane block (TAP)
seems to be effective by reducing pain scores and 24-hr opiate consumption
(27). But the magnitude of the expected benefit is still controversial
(28). It has been shown that TAP was not superior to wound infiltration
(trocar and extraction site) after laparoscopic colorectal resection (29).
Finally, ultrasound-guided Rectus Sheath block may offer an interesting
analgesic solution after midline incision (30). These parietal blocks are
usually performed as a single-shot administration, explaining a relatively
short duration of action. Several reports have documented the use of
catheter that may prolong their efficacy. It should be noted that these
techniques are restricted to parietal innervation and do not have any
local effect on wound injury, as compared to wound infusion.

<145>
Accession Number
619674489
Author
Beaussier M.; Dufour G.
Institution
(Beaussier, Dufour) Departement d'Anesthesie, Institut Mutualiste
Montsouris, 42 Boulevard Jourdan, Paris 75014, France
Title
The impact of thoracic epidural anaesthesia on hard outcome parameters.
Source
Regional Anesthesia and Pain Medicine. Conference: 36th Annual European
Society of Regional Anaesthesia and Pain Therapy Congress, ESRA 2017.
Switzerland. 42 (5 Supplement 1) (pp e39-e40), 2017. Date of Publication:
September-October 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
This article will focus on hard outcomes (severe morbidity aswell as
mortality) that could be expected to be reduced by the use of Thoracic
Epidural Anaesthesia (TEA). The story really started in 1987 with the
report by Yeager et al. showing that TEA might be associated with a
significant reduction of postoperative morbidity and mortality in high
risk patients that underwent major thoracic, intra-abdominal or vascular
surgery (1). In this randomized controlled study, morbidity rate (mostly
cardiovascular failure and infectious complications) was 9/28 in the TEA
group vs 19/25 in the control group (P = 0.002). Concomitantly,
postoperative mortality was significantly reduced in the TEA group (0/28
vs 4/25 P = 0.04). This observation was followed by a bunch of
pathophysiologic arguments demonstrating that additionally to the
analgesic effect, TEA would be likely to control the stress response to
surgery by direct neural blockade, and therefore to reduce the
sympathetic, metabolic and inflammatory reactions involved in
postoperative cardiovascular, digestive, pulmonary, catabolic and
coagulations disorders (2). This elegant concept was further developed and
has contributed to expand the indications of perioperative TEA (3,4). The
first major meta-analysis aimed at quantifying the beneficial role of
epidural anesthesia/analgesia on hard postoperative outcome, including 141
trials and almost 10,000 patients operated before 1997, came to the same
conclusions, with a positive impact on postoperative mortality (OR 0.7
[95%CI 0.54-0.99]) (5). However, it was difficult to drawn definite
conclusion from this study. Population was unselected and pain strategies
highly heterogeneous. The benefit was mostly observed on orthopaedic
surgery (lumbar epidural analgesia). Spinal anesthesia/analgesiawas mixed
with epidural, and drug regimens were very different across studies. This
casts some doubts about the clinical meaning of such conclusions. However,
these favorable results were thereafter reinforced by another concomitant
meta-analysis, which shared similar limitations, showing that TEAwas able
to reduce postoperative myocardial infarction (-5.3% [95%CI-9.9%;-0.7%] P
= 0.04) (6) and severe pulmonary infectious complications (RR = 0.54
[95%CI 0.43-0.68] after major abdominal or thoracic surgery (7). More
recently, Popping et al. released a new meta-analysis, focusing only on
epidural using local anesthetics (with or without opiate) and maintained
for at least 24 h postoperatively (8). The methodology to select articles
was rigorous and probably led to a more accurate estimation than did other
previous meta-analysis on the topic. The conclusionwas a reduction on
mortality ratewhen using TEA(3.1%vs 4.9%, OR= 0.6 [95%CI 0.39-0.93]
corresponding to a NNT = 60) (7). Whatsoever, despite a great attention
paid to the studies selection, meta-analysis mixing studies from different
periods have strong limitations (9). Developments made within
perioperative care principles during the last 10 years have provided a
major contribution to the overall reduction in postoperative
morbidity/mortality (10). The postoperative mortality rate was very high
(16%) in the Yeager study performed in 1985 (1). The incidence of
postoperative pneumonia decreased from 34% to 12% between 1966 and 2006
(8). This makes the relative benefit of TEA smaller over time. In the
meta-analysis by Popping et al., 75% of the papers are from before 2004.
Interestingly, mortality did not differ between TEA and Control in the few
studies performed after 2004 (10). Because of these numerous limitations,
conclusions from meta-analysis have to be confronted with other
methodological approaches, and above all with randomized controlled
trials. Rigg et al. performed a prospective multicenter randomized
controlled study on 915 high risk patients that underwent major abdominal
surgery with or without TEA (11). No difference was found neither on
mortality rate nor on postoperative morbidity, except for a lower
incidence of respiratory failure in the patients allocated to TEA
(NumberNeeded to Treat = 15). In the same population, Peyton et al. tried
subsequently to identify specific types of patientswhomay have had
benefits fromepidural analgesia. Once again, no differencewas observed on
hard outcome parameters according to these selected populations (12).
Almost similar conclusions were drawn form the randomized controlled study
by Park et al. performed in 1021 patients (13). It was found no difference
in morbidity/mortality rates, except for the subgroup of patient operated
on aortic abdominal surgery. Finally, another way to evaluate this
question could come from large retrospective cohort study analysis (14).
Based on administrative databases, a sample of 259037 cases were analyzed,
22% of them having received TEA, whatever the surgical procedure. TEA was
associated with a small but significant improvement of 30 days survival
(mortality = 1.7% vs 2% in control group. RR = 0.89 [95%CI 0.81-0.98] P =
0.02). The NNT was 477. This points out a very low impact in clinical
practice. In conclusion, TEA has been already extensively studied and many
data are available to demonstrate beneficial effects on pain relief,
stress reaction and paralytic ileus after major thoracic and/or abdominal
surgery. Impact on major morbidity and mortality are far more difficult to
appraise and remains still controversial. Meta-analysis tend to show a
reduction in postoperative mortality. In contrast, large prospective
comparative study did not confirm these observations. These discrepancies
could be related to time-dependent improvements in perioperative care,
confounding factors and heterogeneous practices. In particular, several
parameters, such as the direct role played by local anesthetic and the
duration of the epidural infusion are unresolved issues that may by
themselves mislead the conclusions. Additionally, since the implementation
of Enhanced Recovery Protocols (ERAS), it is known that a lot of pre-,
intra-and postoperative factors have to be controlled to significantly
improve the postoperative recovery course. Certainly TEA has a role to
play among these factors, especially during major surgical procedures. But
to date, it is difficult to build benefit/risk ratio using hard outcomes
parameters.

<146>
Accession Number
619672786
Author
McLaughlin M.A.; Tamler R.; Woodward M.; Iyengar R.L.; Maceda C.; Sahota
A.; Bar-Chama N.
Institution
(McLaughlin, Tamler, Woodward, Iyengar, Maceda, Sahota, Bar-Chama) Icahn
School of Medicine at Mount Sinai, United States
Title
Testosterone replacement in hypogonadal menwith recent coronary artery
revascularization improves exercise capacity.
Source
Journal of Sexual Medicine. Conference: 21st Annual Fall Scientific
Meeting of Sexual Medicine Society of North America, SMSNA 2015. United
States. 13 (5 Supplement 1) (pp S1), 2016. Date of Publication: May 2016.
Publisher
Elsevier B.V.
Abstract
Objectives: Current controversy regarding cardiovascular (CV) risk and
testosterone replacement (TRT) exists. However, a robust scientific
literature supports the fact that hypogonadism is a significant risk
factor for CV disease (CVD). We sought to assess potential benefit of TRT
in men with coronary artery disease (CAD) requiring revascularization in
the past year. In this study we investigated the effect of TRT on exercise
capacity and time to ischemic change on treadmill exercise testing.
Methods: Fifty-one subjects were enrolled in a randomized, double- blind,
placebo-controlled study: 31 in treatment (Androgel) group and 20 in
placebo group. Chi-squared analysis and t-tests were performed to assess
the ischemic changes (time to ST depression on stress test) and exercise
time in seconds at month(s) 0, 1, 3, and 6. Results: In those with
ischemic changes at baseline (n=21), we observed improvement in the
exercise time in the treatment group at all-time points: month 1 (589.7 vs
452.4), p=0.013, month 3 (607.6 vs 472.1), p=0.035, and month 6 (614.0 vs
470.0), p=0.087. Although there was improvement in time to ischemic change
in the treatment group, it was not significant when compared to the
placebo group. No serious adverse events (MI, stroke, death) occurred in
either group. Conclusion: Exercise capacity is an independent prognostic
factor for CVD and mortality. In this study, exercise time on treadmill
was used as a measure of exercise capacity. Those in the treatment group
showed a significant improvement in exercise capacity at month 1 and 3,
indicating the beneficial role of TRT in men to improve CV health. These
results support the role of TRT in hypogonadal men with stable CAD.
(Figure Presented).

<147>
Accession Number
619608793
Author
Mahoney L.; Rosen R.
Institution
(Mahoney, Rosen) GI/Nutrition, Boston Children's Hospital, Boston, MA,
United States
Title
Multichannel intraluminal impedance with ph testing reduces proton pump
inhibitor usage in children with nonerosive reflux.
Source
Journal of Pediatric Gastroenterology and Nutrition. Conference: North
American Society for Pediatric Gastroenterology, Hepatology and Nutrition
Annual Meeting 2017. United States. 65 (Supplement 2) (pp S20), 2017. Date
of Publication: November 2017.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Proton pump inhibitors (PPIs) are widely used in the
diagnosis and management of pediatric gastroesophageal refux disease
(GERD). However, recent data in adults and children suggests that these
medications are associated with signifcant adverse effects and should be
used judiciously. The current gold standard for diagnosing GERD remains
multichannel intraluminal impedance with pH (pH-MII) testing. However,
little is known about whether pH-MII results change management and predict
clinical outcomes. The aim of this study was to determine the prevalence
of PPI therapy for different refux phenotypes at follow-up after pH-MII
testing. Methods: Children >= 5 years who underwent upper endoscopy and
pH-MII testing for evaluation of typical refux symptoms (pain, heartburn,
chest pain, refux, or regurgitation) between 2004 and 2016 were included.
All children underwent a minimum of an 8-week PPI trial prior to
diagnostic studies, though all studies were performed off PPI therapy.
Children with eosinophilic or erosive esophagitis, a history of thoracic
or abdominal surgery and those who did not report symptoms during the
pH-MII study were excluded. The results of pH-MII testing were used to
categorize patients into nonerosive esophageal phenotypes: those with
abnormal esophageal acid exposure (pH <4 for >6% of the study) were
classifed as having nonerosive refux disease (NERD), those with normal
acid exposure but a positive symptom index (SI) were classifed as refux
hypersensitivity (RH) and those with normal acid exposure and negative SI
were classifed as functional heartburn (FH). PPI use at follow-up after
pH-MII testing was determined from review of the medical record. Results:
A total of 45 children met inclusion criteria: 29% of patients were
categorized as having NERD, 29% of children had RH and 42% had FH. 6
children were lost to follow-up after pH-MII testing (2 NERD, 1 RH and 3
FH). Follow-up medication data was available in 39 children. 79% of all
patients remained on PPI at the time of the frst follow-up visit after
pH-MII testing. Patients were using PPIs at the frst follow-up visit in
91% of NERD patients, 92% of those with RH and 63% with FH. Based on
pH-MII results in patients with NERD, 46% continued PPI at the same dose,
27% increased dose, 18% changed brands and 9% discontinued PPI. In
patients with RH, 42% continued PPI at the same dose, 17% increased dose,
25% decreased dose, 8% changed brands and 8% discontinued PPI. In patients
with FH, 31% continued PPI at the same dose, 44% discontinued PPI, 13%
changed brands, 6% increased dose and 6% decreased dose. In total, 33% of
children either discontinued PPIs or decreased the total dose based on the
results of pH-MII testing. Long-term, the total time that patients
remained on PPI after pH-MII testing was 22 +/- 18 months in the NERD
group, 18 +/- 19 months in the RH group and 8 +/- 20 months in the FH
group, though there were no signifcant differences between these groups (p
= 0.16). Conclusions: The majority of children remain on PPI therapy after
pH-MII testing. However, the results of pH-MII testing led to decreasing
the PPI dose or discontinuing the medication in one third of patients.
Children with FH were most likely to have reduced PPI usage.

<148>
Accession Number
619622982
Author
Pautier P.; Brard C.; Floquet A.; Gladieff L.; Rios M.; Piperno-Neumann
S.; Berton-Rigaud D.; Blay J-Y.; Fabbro M.; Lotz J-P.; Vinceneux A.;
Bertucci F.; De La Motte Rouge T.; Guillemet C.; Genestie C.; Duffaud F.
Institution
(Pautier) Department of Cancer Medicine, Institut De Cancerologie Gustave
Roussy, Villejuif, France
(Brard) Department of Biostatistics, Institut De Cancerologie Gustave
Roussy, Villejuif, France
(Floquet) Medical Oncology, Institute Bergonie, Bordeaux, France
(Gladieff) Medical Oncology, Institut Universitaire du Cancer -Toulouse
Oncopole, Toulouse, France
(Rios) Medical Oncology, Institut De Cancerologie De Lorraine - Alexis
Vautrin, Vandoeuvre Les Nancy, France
(Piperno-Neumann) Medical Oncology, Institut Curie, Paris, France
(Berton-Rigaud) Medical Oncology, ICO Institut De Cancerologie De l'Ouest
Rene Gauducheau, Saint-Herblain, France
(Blay) Medical Oncology, Centre Leon Berard, Lyon, France
(Fabbro) Medical Oncology, ICM Regional Cancer Institute of Montpellier,
Montpellier, France
(Lotz) Medical Oncology, APHP, CancerEst, Tenon University Hospital,
Paris, France
(Vinceneux) Medical Oncology, CHRU Bretonneau, Tours, France
(Bertucci) Medical Oncology, Institut Paoli Calmettes, Marseille, France
(De La Motte Rouge) Medical Oncology, Centre Eugene Marquis, Rennes,
France
(Guillemet) Medical Oncology, Centre Henri Becquerel, Rouen, France
(Genestie) Department of Pathology, Institut Gustave Roussy, Villejuif,
France
(Duffaud) Medical Oncology, CHU La Timone Adultes, Marseille, France
Title
A randomized clinical trial of adjuvant chemotherapy with doxorubicin,
ifosfamide and cisplatin (API), followed by radiotherapy versus
radiotherapy alone in patients with localized uterine sarcomas (SARCGYN
study). Update at 10 years.
Source
Annals of Oncology. Conference: 42nd ESMO Congress, ESMO 2017. Spain. 28
(Supplement 5) (pp v521-v522), 2017. Date of Publication: September 2017.
Publisher
Oxford University Press
Abstract
Background: There is no proven benefit of adjuvant treatment in uterine
sarcoma (US). SARCGYN was a phase-III study which compared adjuvant
polychemotherapy followed by pelvic radiotherapy (RT) (arm A) versus RT
alone (arm B). The study met its primary end point (3-year
progression-free survival (PFS)) and showed a statistical increase of the
3-year PFS in the chemo+RT arm (A) vs radiation arm (B) (55% and 41%
respectively, [P=0.048]) after a median follow-up of 4.3 years (Ann Oncol
2013). Secondary end-point was overall survival (OS) that required a
longer follow-up. Methods: Patients with FIGO stage<=III US, and
physiological age >=65 years were randomized after complete surgery and
normal thoracic, abdominal and pelvic CT scans between CT and no CT, with
a stratification between carcinosarcomas (CS) versus others. Study was
stopped earlier because of lack of recruitment. All patients received
pelvic RT (45 grays); vaginal brachytherapy was optional. Chemotherapy
consisted in four cycles of doxorubicin 50 mg/m², d1;
ifosfamide 3 g/m²/day d1-2; cisplatin 75 mg/ m2, d3; + G-CSF q
3 weeks. Results: Eighty-one patients were included: 39 in arm A and 42 in
arm B; 52 stage I, 16 stage II, and 13 stage III; 53 leiomyosarcomas, 9
undifferenciated sarcomas, and 19 carcinosarcomas. API was toxic with two
toxic deaths and one acute leukemia. After a median FU of 9.9 years
[0.3-15.1], 42/81 patients relapsed, 16 in arm A, and 26 in arm B, and 38
died, 16 in arm A, and 22 in arm B. The 5-year OS is 74% in arm A and 60%
in arm B, and the difference is not significant (p=0.16). Conclusions: In
this trial interrupted at an early stage and with a longer follow-up,
there is no statistical impact of API adjuvant CT on OS. The two toxic
deaths and the integration of carcinosarcomas may have impacted on the
global prognosis. A selection of a specific uterine population and a less
toxic chemotherapy for future studies are mandatory.

<149>
Accession Number
613228302
Author
Hallifax R.J.; Yousuf A.; Jones H.E.; Corcoran J.P.; Psallidas I.; Rahman
N.M.
Institution
(Hallifax, Yousuf, Corcoran, Psallidas, Rahman) Oxford Centre for
Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford,
United Kingdom
(Jones) Faculty of Health Sciences, School of Social and Community
Medicine, University of Bristol, Bristol, United Kingdom
Title
Effectiveness of chemical pleurodesis in spontaneous pneumothorax
recurrence prevention: A systematic review.
Source
Thorax. 72 (12) (pp 1121-1131), 2017. Date of Publication: 01 Dec 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives Spontaneous pneumothorax is a common pathology. International
guidelines suggest pleurodesis for non-resolving air leak or recurrence
prevention at second occurrence. This study comprehensively reviews the
existing literature regarding chemical pleurodesis efficacy. Design We
systematically reviewed the literature to identify relevant randomised
controlled trials (RCTs), case-control studies and case series. We
described the findings of these studies and tabulated relative recurrence
rates or ORs (in studies with control groups). Meta-analysis was not
performed due to substantial clinical heterogeneity. Results Of 560
abstracts identified by our search strategy, 50 were included in our
systematic review following screening. Recurrence rates in patients with
chest tube drainage only were between 26.1% and 50.1%. Thoracoscopic talc
poudrage (four studies (n=249)) provided recurrence rates of between 2.5%
and 10.2% with the only RCT suggesting an OR of 0.10 compared with
drainage alone. In comparison, talc administration during video-assisted
thoracic surgery (VATS) from eight studies (n=2324) recurrence was between
0.0% and 3.2%, but the RCT did not demonstrate a significant difference
compared with bleb/bullectomy alone. Minocycline appears similarly
effective post-VATS (recurrence rates 0.0-2.9%). Prolonged air leak and
recurrence prevention using tetracycline via chest drain (n=726) is likely
to provide recurrence rates between 13.0% and 33.3% and autologous blood
patch pleurodesis (n=270) between 15.6% and 18.2%. Conclusions Chemical
pleurodesis postsurgical treatment or via thoracoscopy appears to be most
effective. Evidence for definitive success rates of each agent is limited
by the small number of randomised trials or other comparative
studies.<br/>Copyright &#xa9; 2017 Published by the BMJ Publishing Group
Limited.

<150>
Accession Number
613105037
Author
Liet J.-M.; Barriere F.; Gaillard-Le Roux B.; Bourgoin P.; Legrand A.;
Joram N.
Institution
(Liet, Barriere, Gaillard-Le Roux, Bourgoin, Legrand, Joram) Hopital
Femme-Enfant-Adolescent, University Hospital Center of Nantes (CHU),
Pediatric Intensive Care Unit, 38 bd Jean-Monnet, Nantes 44093, France
(Legrand) CIC-INSERM 1413, University of Nantes, Nantes, France
Title
Physiological effects of invasive ventilation with neurally adjusted
ventilatory assist (NAVA) in a crossover study.
Source
BMC Pediatrics. 16 (1) (no pagination), 2016. Article Number: 180. Date of
Publication: 08 Nov 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Neurally Adjusted Ventilatory Assist (NAVA) is a mode of
assisted mechanical ventilation that delivers inspiratory pressure
proportionally to the electrical activity of the diaphragm. To date, no
pediatric study has focused on the effects of NAVA on hemodynamic
parameters. This physiologic study with a randomized cross-over design
compared hemodynamic parameters when NAVA or conventional ventilation (CV)
was applied. Methods: After a baseline period, infants received NAVA and
CV in a randomized order during two consecutive 30-min periods. During the
last 10 min of each period, respiratory and hemodynamic parameters were
collected. No changes in PEEP, FiO<inf>2</inf>, sedation or inotropic
doses were allowed during these two periods. The challenge was to keep
minute volumes constant, with no changes in blood CO<inf>2</inf> levels
and in pH that may affect the results. Results: Six infants who had
undergone cardiac surgery (mean age 7.8 +/- 4.1 months) were studied after
parental consent. Four of them had low central venous oxygen saturation
(ScvO<inf>2</inf> < 65 %). The ventilatory settings resulted in similar
minute volumes (1.7 +/- 0.4 vs. 1.6 +/- 0.6 ml/kg, P = 0.67) and in
similar tidal volumes respectively with NAVA and with CV. There were no
statistically significant differences on blood pH levels between the two
modes of ventilation (7.32 +/- 0.02 vs. 7.32 +/- 0.04, P = 0.34).
Ventilation with NAVA delivered lower peak inspiratory pressures than with
CV: -32.7 % (95 % CI: -48.2 to -17.1 %, P = 0.04). With regard to
hemodynamics, systolic arterial pressures were higher using NAVA: +8.4 %
(95 % CI: +3.3 to +13.6 %, P = 0.03). There were no statistically
significant differences on cardiac index between the two modes of
ventilation. However, all children with a low baseline ScvO<inf>2</inf>
(<65 %) tended to increase their cardiac index with NAVA compared to CV:
2.03 +/- 0.30 vs. 1.91 +/- 0.39 L/min.m² (median +/-
interquartile, P = 0.07). Conclusions: This pilot study raises the
hypothesis that NAVA could have beneficial effects on hemodynamics in
children when compared to a conventional ventilatory mode that delivered
identical PEEP and similar minute volumes. Trial registration:
ClinicalTrials.gov Identifier: NCT01490710. Date of registration: December
7, 2011.<br/>Copyright &#xa9; 2016 The Author(s).

<151>
Accession Number
613295781
Author
Zhou Y.; Wang Y.; Wu Y.; Zhu J.
Institution
(Zhou, Wu, Zhu) Department of Cardiology, The First Affiliated Hospital,
Zhejiang University, School of Medicine, Hangzhou 310003, China
(Wang) Department of Cardiology, Ningbo Medical Treatment Center Lihuili
Hospital, Ningbo 315000, China
Title
Transcatheter versus surgical aortic valve replacement in low to
intermediate risk patients: A meta-analysis of randomized and
observational studies.
Source
International Journal of Cardiology. 228 (pp 723-728), 2017. Date of
Publication: 01 Feb 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Transcatheter aortic valve replacement (TAVR) has become the
treatment of choice for patients with aortic stenosis and the preferred
alternative for high surgical risk patients. However, TAVR's suitability
for patients at low to intermediate risk still remains controversial.
Methods PubMed, MEDLINE and Clinical trials were systematically searched
for randomized control trials and observational cohort studies which
reported the clinical outcomes of TAVR versus surgical aortic valve
replacement (SAVR) in patients at low to intermediate surgical risk.
Clinical endpoints including death, acute kidney injury, myocardial
infarction, and major adverse cardiac and cerebrovascular events (MACCE)
were assessed. Results From 2000 to 2016, 7 clinical studies comprising
6214 patients were identified. In each time point (in-hospital or 30 days,
1 year), TAVR was associated with similar incidence of death from any
cause, cardiovascular death and MACCE. TAVR reduced short-term incidence
of myocardial infarction and cerebrovascular events. However, TAVR was
associated with a higher rate of major vascular complications and
permanent pacemaker implantation. Conclusions Comparing with SAVR in
patients at low to intermediate surgical risk, TAVR has similar rates of
mortality and MACCE, lower incidence of acute kidney injury and new-onset
atrial fibrillation, but an increase in major vascular complications and
permanent pacemaker implantation.<br/>Copyright &#xa9; 2016

<152>
Accession Number
613630476
Author
Sharma A.; Helft G.; Garg A.; Agrawal S.; Chatterjee S.; Lavie C.J.; Goel
S.; Mukherjee D.; Marmur J.D.
Institution
(Sharma, Marmur) Division of Cardiovascular Medicine, State University of
New York Downstate Medical Center, New York, NY, United States
(Helft) Institut de Cardiologie, Hopital Pitie-Salpetriere, Assistance
Publique Hopitaux de Paris, Universite Pierre et Marie Curie, Boulevard de
l'Hopital, Paris, France
(Helft) Institute of Cardiometabolism and Nutrition, Hopital
Pitie-Salpetriere, Paris, France
(Garg) Department of Medicine, James J. Peters VA Medical Center, Mount
Sinai School of Medicine, New York, NY, United States
(Agrawal) Division of Cardiology, St. Luke's University Health Network,
Bethlehem, PA, United States
(Chatterjee) Division of Cardiovascular Diseases, New York, NY, United
States
(Lavie) Department of Cardiovascular Diseases, John Ochsner Heart and
Vascular Institute, Ochsner Clinical School-the University of Queensland
School of Medicine, New Orleans, LA, United States
(Goel) Department of Cardiology, Maimonides Medical Center, New York, NY,
United States
(Mukherjee) Division of Cardiology, Texas Tech University, El Paso, TX,
United States
(Sharma) Institute of Cardiovascular Research and Technology, Brooklyn,
NY, United States
Title
Safety and efficacy of vorapaxar in secondary prevention of
atherosclerotic disease: A meta-analysis of randomized control trials.
Source
International Journal of Cardiology. 227 (pp 617-624), 2017. Date of
Publication: 15 Jan 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Objective To study the cumulative evidence for vorapaxar use in patients
with atherosclerotic cardiovascular disease. Methods A systematic review
of randomized control trials in MEDLINE, EMBASE, EBSCO, CINAHL, Web of
Science and Cochrane databases comparing vorapaxar with placebo was
performed. Pre-specified efficacy endpoints were all-cause mortality, CV
mortality, myocardial infarction (MI), ischemic stroke and repeat
revascularization. The pre-specified safety endpoint was intracranial
hemorrhage (ICH) and a composite of TIMI major and minor bleeding. Risk
ratios were used as the metric of choice by applying random effects
models. Results Five randomized controlled trials with 40,630 patients
were included in final analysis. Compared with placebo, vorapaxar led to a
statistically non-significant reduction in risk of MI [RR 0.86; 95% CI
0.80-0.93, p = 0.427] and ischemic stroke [RR 0.84; 95% CI 0.72-0.97, p =
0.920]. No differences were observed between vorapaxar and placebo with
respect to all-cause mortality [RR 0.99; 95% CI 0.90-1.08, p = 0.620],
cardiovascular mortality [RR 0.94; 95% CI 0.83-1.06, p = 0.351], repeat
revascularization [RR 0.97; 95% CI 0.82-1.15, p = 0.236], and TIMI
bleeding [RR 1.29; 95% CI 0.98-1.69, p = 0.126]. Vorapaxar was associated
with a statistically non-significant higher risk of ICH [RR 2.36; 95% CI
1.40-3.96, p = 0.137] compared with placebo. Conclusion Addition of
Vorapaxar to standard medical therapy in in patients with atherosclerotic
disease led to a statistically non-significant reduction in the risk of MI
and ischemic stroke at the cost of statistically non-significant increase
in risk of ICH.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd

<153>
Accession Number
613631736
Author
Banerjee S.; Brilakis E.S.
Institution
(Banerjee, Brilakis) University of Texas, Southwestern Medical Center,
4500 S. Lancaster Road (111a), Dallas, TX 75230, United States
(Banerjee, Brilakis) Veterans Affairs Southwestern Medical Center, Dallas,
TX, United States
(Brilakis) Minneapolis Heart Institute, Minneapolis, MN, United States
Title
Comparing drug-eluting stents to bare-metal stents for saphenous vein
graft lesion PCI.
Source
Journal of Invasive Cardiology. 28 (12) (pp E170-E171), 2016. Date of
Publication: December 2016.
Publisher
HMP Communications

<154>
Accession Number
613316303
Author
McGregor G.; Nichols S.; Hamborg T.; Bryning L.; Tudor-Edwards R.;
Markland D.; Mercer J.; Birkett S.; Ennis S.; Powell R.; Begg B.;
Haykowsky M.J.; Banerjee P.; Ingle L.; Shave R.; Backx K.
Institution
(McGregor, Ennis, Powell, Banerjee) Department of Cardiac Rehabilitation,
Centre for Exercise and Health, University Hospital, Coventry, United
Kingdom
(McGregor, Mercer, Ennis, Begg, Shave, Backx) Cardiff Centre for Exercise
and Health, Cardiff Metropolitan University, Cardiff, United Kingdom
(Nichols, Birkett, Ingle) Department of Sport, Health and Exercise
Science, University of Hull, Hull, United Kingdom
(Hamborg) Statistics and Epidemiology, Division of Health Sciences,
Warwick Medical School, Warwick, United Kingdom
(Bryning, Tudor-Edwards) Centre for Health Economics and Medicines
Evaluation, Bangor University, Bangor, Gwynedd, United Kingdom
(Markland) School of Sport, Health and Exercise Sciences, Bangor
University, Bangor, Gwynedd, United Kingdom
(Begg) Aneurin Bevan University Health Board, Gwent, United Kingdom
(Haykowsky) College of Nursing and Health Innovation, University of Texas
at Arlington, Arlington, TX, United States
(Banerjee) School of Health and Life Sciences, Coventry University,
Coventry, United Kingdom
Title
High-intensity interval training versus moderate-intensity steady-state
training in UK cardiac rehabilitation programmes (HIIT or MISS UK): Study
protocol for a multicentre randomised controlled trial and economic
evaluation.
Source
BMJ Open. 6 (11) (no pagination), 2016. Article Number: e012843. Date of
Publication: 01 Nov 2016.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Current international guidelines for cardiac rehabilitation
(CR) advocate moderate-intensity exercise training (MISS,
moderate-intensity steady state). This recommendation predates significant
advances in medical therapy for coronary heart disease (CHD) and may not
be the most appropriate strategy for the modern' patient with CHD.
High-intensity interval training (HIIT) appears to be a safe and effective
alternative, resulting in greater improvements in peak oxygen uptake (VO 2
peak). To date, HIIT trials have predominantly been proof-of-concept
studies in the laboratory setting and conducted outside the UK. The
purpose of this multicentre randomised controlled trial is to compare the
effects of HIIT and MISS training in patients with CHD attending UK CR
programmes. Methods and analysis This pragmatic study will randomly
allocate 510 patients with CHD to 8weeks of twice weekly HIIT or MISS
training at 3 centres in the UK. HIIT will consist of 10 high-intensity
(85-90% peak power output (PPO)) and 10 low-intensity (20-25% PPO)
intervals, each lasting 1min. MISS training will follow usual care
recommendations, adhering to currently accepted UK guidelines (ie, >20min
continuous exercise at 40-70% heart rate reserve). Outcome measures will
be assessed at baseline, 8weeks and 12months. The primary outcome for the
trial will be change in VO 2 peak as determined by maximal cardiopulmonary
exercise testing. Secondary measures will assess physiological,
psychosocial and economic outcomes. Ethics and dissemination The study
protocol V.1.0, dated 1 February 2016, was approved by the NHS Health
Research Authority, East Midlands-Leicester South Research Ethics
Committee (16/EM/0079). Recruitment will start in August 2016 and will be
completed in June 2018. Results will be published in peer-reviewed
journals, presented at national and international scientific meetings and
are expected to inform future national guidelines for exercise training in
UK CR. Trial registration number NCT02784873; pre-results.<br/>Copyright
&#xa9; 2016 Published by the BMJ Publishing Group Limited.

<155>
Accession Number
613091203
Author
Xu X.; Yang X.; Li S.; Luo M.; Qing Y.; Zhou X.; Xue J.; Qiu J.; Li Y.
Institution
(Xu, Yang, Luo, Qing, Zhou, Xue, Qiu, Li) Research Center for Medicine and
Social Development, Innovation Center for Social Risk Governance in
Health, School of Public Health and Management, Chongqing Medical
University, Chongqing, China
(Li) Department of Anesthesiology, The Children's Hospital of Chongqing
Medical University, Chongqing, China
Title
Risk factors of lower respiratory tract infection in patients after
tracheal intubation under general anesthesia in the Chinese health care
system: A meta-analysis.
Source
American Journal of Infection Control. 44 (11) (pp e215-e220), 2016. Date
of Publication: 01 Nov 2016.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background Lower respiratory tract infection (LRTI) after tracheal
intubation under general anesthesia poses a serious threat to worldwide
health care systems, especially those in developing countries. However, a
significant number of studies have found inconsistent results in their
investigation of the corresponding risk factors. Methods Relevant articles
published up to September 2015 were retrieved from PubMed, Ovid, Embase,
China National Knowledge Infrastructure, Chinese Biological Medical
Database, China Science and Technology Journal Database, and Wanfang Data.
The z test was used to determine the significance of the pooled odds ratio
(OR). ORs and 95% confidence intervals were used to compare the risk
factors of LRTI after intubation under general anesthesia. Results Fifteen
case-control studies that included 27,304 participants were identified. We
identified the following variables as independent risk factors: duration
of general anesthesia >3hours (OR, 2.45), age >60 years (OR, 2.35), normal
endotracheal tube (OR, 1.63), deep intubation (OR, 2.66), unpracticed
intubation (OR, 2.61), postoperative extubation time >2hours (OR, 3.76),
smoking history (OR, 3.02), chronic respiratory disease history (OR,
2.30), incomplete extubation indication (OR, 3.54), thoracic or
craniocerebral surgery (OR, 1.90), and emergent surgery (OR, 2.54).
Conclusions Eleven risk factors, including surgery, anesthesia, and health
condition, were related to LRTI after intubation under general anesthesia.
Given the limitations of this study, well-designed epidemiologic studies
with a large sample size should be performed in the future.<br/>Copyright
&#xa9; 2016 Association for Professionals in Infection Control and
Epidemiology, Inc.

<156>
Accession Number
619147414
Author
Putzu A.; Clivio S.; Belletti A.; Cassina T.
Institution
(Putzu, Clivio, Cassina) Department of Cardiovascular Anesthesia and
Intensive Care, Cardiocentro Ticino, Lugano, Switzerland
(Belletti) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Milan, Italy
Title
Perioperative levosimendan in cardiac surgery: A systematic review with
meta-analysis and trial sequential analysis.
Source
International Journal of Cardiology. 251 (pp 22-31), 2018. Date of
Publication: 15 Jan 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background Several studies suggested beneficial effects of perioperative
levosimendan on postoperative outcome after cardiac surgery. However,
three large randomized controlled trials (RCTs) have been recently
published and presented neutral results. We performed a systematic review
with meta-analysis and trial sequential analysis (TSA) to assess benefits
and harms of perioperative levosimendan therapy in cardiac surgery.
Methods Electronic databases were searched up to September 2017 for RCTs
on preoperative levosimendan versus any type of control. The Cochrane
methodology was employed. We calculated odds ratio (OR) or Risk Ratio (OR)
and 95% confidence interval (CI) using fixed-effects meta-analyses and we
further performed TSA. Results We included data from 40 RCTs and 4246
patients. Pooled analysis of 5 low risk of bias trials (1910 patients)
showed no association between levosimendan and mortality (OR 0.86 [95% CI,
0.62, 1.18], p = 0.34, TSA inconclusive), acute kidney injury, need of
renal replacement therapy, myocardial infarction, ventricular arrhythmias,
and serious adverse events, but an association with higher incidence of
supraventricular arrhythmias (RR 1.11 [95% CI, 1.00, 1.24], p = 0.05, TSA
inconclusive) and hypotension (RR 1.15 [95% CI, 1.01, 1.30], p = 0.04, TSA
inconclusive). Analysis including all 40 trials found that levosimendan
was associated with lower postoperative mortality (OR 0.56 [95% CI, 0.44,
0.71], p < 0.00001, TSA conclusive), acute kidney injury, and renal
replacement therapy, and higher incidence of hypotension. Conclusions
There is not enough high-quality evidence to neither support nor
discourage the systematic use of levosimendan in cardiac
surgery.<br/>Copyright &#xa9; 2017 Elsevier B.V.

<157>
Accession Number
619493686
Author
Fan Y.; Zhao X.; Li X.; Li N.; Hu X.
Institution
(Fan, Zhao, Li, Li, Hu) Department of Vascular and Thyroid Surgery, The
First Affiliated Hospital, China Medical University, Shenyang 110001,
China
Title
Cardiac troponin and adverse outcomes in atrial fibrillation: A
meta-analysis.
Source
Clinica Chimica Acta. 477 (pp 48-52), 2018. Date of Publication: February
2018.
Publisher
Elsevier B.V.
Abstract
Background The prognostic value of cardiac troponin elevation in atrial
fibrillation (AF) is unclear. Objective To investigate the association of
cardiac troponin elevation with adverse outcomes in AF by conducting a
meta-analysis. Methods We systematically searched the PubMed and Embase
databases until April 2017 for studies assessing the association of
cardiac troponin-T (cTnT) or troponin-I (cTnI) elevation with adverse
outcomes in AF. The outcome measures were all-cause mortality and major
adverse cardiac events (MACEs: death, stroke, myocardial infarction,
pulmonary embolism, major bleeding, or revascularization). Results Six
studies involving 22,697 AF patients were identified. Meta-analysis showed
that AF with elevated cardiac troponin was independently associated with
increased risk of all-cause mortality (HR 2.04; 95% CI 1.56-2.67) and
MACEs (HR 1.93; 95% CI 1.61-2.30). Furthermore, the prognostic value of
cardiac troponin elevation was consistently found irrespective of method
determination, type of troponin measured, sample size, and study quality
subgroup. Conclusions AF with cardiac troponin elevation was independently
associated with increased risk of all-cause mortality and MACEs.
Therefore, determination of troponin should be considered for risk
stratification in AF.<br/>Copyright &#xa9; 2017

<158>
Accession Number
619544490
Author
Anand A.; Harley C.; Visvanathan A.; Shah A.S.V.; Cowell J.; MacLullich
A.; Shenkin S.; Mills N.L.
Institution
(Anand, Shah, Mills) BHF Centre for Cardiovascular Science, University of
Edinburgh, Room SU305, Chancellor's Building, Edinburgh EH16 4SB, United
Kingdom
(Harley, Visvanathan, Cowell) Department of Geriatric Medicine, NHS
Lothian, Edinburgh, United Kingdom
(MacLullich, Shenkin) Edinburgh Delirium Research Group, Geriatric
Medicine, University of Edinburgh, Edinburgh, United Kingdom
Title
The relationship between preoperative frailty and outcomes following
transcatheter aortic valve implantation: A systematic review and
meta-analysis.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 3 (2) (pp
123-132), 2017. Date of Publication: 01 Apr 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims Transcatheter aortic valve implantation (TAVI) is an increasingly
common intervention for patients with aortic stenosis deemed high risk for
major cardiac surgery, but identifying those who will benefit can be
challenging. Frailty reflects physiological reserve and may be a useful
prognostic marker in this population. We performed a systematic review and
meta-analysis of the association between frailty and outcomes after TAVI.
Methods and results Five databases were searched between January 2000 and
May 2015. From 2623 articles screened, 54 were assessed for eligibility.
Ten cohort studies (n = 4592) met the inclusion criteria of reporting a
measure of frailty with early (=30 days) or late (>30 days) mortality and
procedural complications following TAVI as defined by the Valve Academic
Research Consortium (VARC). Frailty was associated with increased early
mortality in four studies (n = 1900) (HR 2.35, 95% CI 1.78-3.09, P <
0.001) and increased late mortality in seven studies (n = 3159) (HR 1.63,
95% CI 1.34-1.97, P < 0.001). Objective frailty tools identified an even
higher risk group for late mortality (HR 2.63, 95% CI 1.87-3.70, P <
0.001). Frail individuals undergoing TAVI have a mortality rate of 34
deaths per 100 patient years, compared with 19 deaths per 100 patient
years in non-frail patients. There was limited reporting of VARC
procedural outcomes in relation to frailty, preventing meta-analysis.
Conclusion Frailty assessment in an already vulnerable TAVI population
identifies individuals at even greater risk of poor outcomes. Use of
objective frailty tools may inform patient selection, but this requires
further assessment in large prospective registries.<br/>Copyright &#xa9;
The Author 2016.

<159>
[Use Link to view the full text]
Accession Number
619543893
Author
O'Lynn C.; Cooper A.; Blackwell L.
Institution
(O'Lynn, Blackwell) Chamberlain University, Joanna Briggs Institute
Affiliated Group, Chamberlain University College of Nursing, Chicago, IL,
United States
(Cooper) UCSF Centre for Evidence Synthesis and Implementation, Joanna
Briggs Institute Center of Excellence, San Francisco, CA, United States
Title
Perceptions, experiences and preferences of patients receiving a
clinician's touch during intimate care and procedures: A qualitative
systematic review.
Source
JBI Database of Systematic Reviews and Implementation Reports. 15 (11) (pp
2707-2722), 2017. Date of Publication: 01 Nov 2017.
Publisher
Joanna Briggs Institute (E-mail: jbi@adelaide.edu.au)
Abstract
Background Clinical practice frequently involves the practitioner touching
patients' bodies in areas that are highly personal. If inappropriately
performed, such intimate touch may result in much anxiety, confusion and
misinterpretation. Examination of evidence is necessary to guide practice
in this area to mitigate risks and foster optimal clinicianpatient
relations and care. Objectives The objective of this qualitative
systematic review was to identify and synthesize findings on the
perceptions, experiences and preferences of patients receiving a
clinician's touch during intimate care and procedures Inclusion criteria
Types of participants The current review considered studies that included
patients who had received a clinician's touch during intimate care and
procedures. Phenomena of interest The current review considered
qualitative studies that evaluated patients' perceptions, experiences and
preferences of a clinician's touch during intimate care and procedures.
Types of studies The current review considered studies that collected
qualitative data and included studies using designs such as phenomenology,
grounded theory, ethnography, action research, qualitative description,
focus group methodology and feminist research. In the absence of research
studies, other text such as opinion papers and reports were considered.
Context The current review considered studies that included patients'
perceptions, experiences and preferences of a clinician's touch during
intimate care and procedures. Intimate care is likely to occur in any
clinical setting where patients need assistance with personal care, where
physical examinations occur, or in settings were gynecologic,
genitourinary, lower intestinal, dermatologic, cardiac or other procedures
involving highly personal areas of the body are performed. Search strategy
A three-step search strategy was used to find published and unpublished
studies in English from 1970 to 2016, searching various databases which
included searches of reference lists of studies selected for appraisal.
Methodological quality Included studies were assessed for methodological
quality independently by two reviewers using the Joanna Briggs Institute
Qualitative Assessment and Review Instrument (JBI-QARI) prior to
inclusion. Of the two studies included in the review, one did not discuss
ontological and epistemological assumptions, and the other did not include
the personal assumptions and role of the researcher. Data extraction Data
were extracted using the data extraction tool from the JBI-QARI. The data
extracted included details about the phenomenon of interest, populations
and study methods. Data synthesis Qualitative findings were synthesized
using JBI-QARI. Results Two studies were included in this review. Seven
findings were organized into three categories and one synthesized finding,
"clinician respect". The finding suggests that clients prefer engaged and
meaningful communication prior to and during an intimate touch encounter,
expect autonomy over their bodies and desire shared decision making
relative to how and by whom intimate touch is provided. Conclusion The
synthesized finding from this review suggests that: Healthcare educators
introduce clinician respect as an approach to care activities that involve
intimate touch. (Grade B) Clinicians practice with overall respect toward
their patients by communicating clearly, honoring patients' concerns and
preferences, and engaging patients in decision making to improve patients'
comfort with intimate touch. (Grade B) More research is needed to explore
the perceptions and preferences for intimate touch among diverse
populations, generations, cultures and contexts. Particular exploration is
needed for populations with additional vulnerabilities to
misunderstandings, anxiety and abuse, such as pediatric and geriatric
patients, and patients with physical, mental and cognitive
impairments.<br/>Copyright &#xa9; 2017 The Joanna Briggs Institute.

<160>
Accession Number
614711907
Author
Zuliani Mauro M.F.; Mangione J.A.; Costa J.R.; Costa R.; Piva E Mattos
L.A.; Staico R.; Feres F.; Siqueira D.; Sousa A.; Abizaid A.
Institution
(Zuliani Mauro, Mangione) Department of Interventional Cardiology,
Hospital Beneficencia Portuguesa, R. Maestro Cardim, 769-Bela Vista, Sao
Paulo, SP 01323-001, Brazil
(Costa, Costa, Piva E Mattos, Staico, Feres, Siqueira, Sousa, Abizaid)
Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
Title
Randomized Angiographic and Intravascular Ultrasound Comparison of
Dual-Antiplatelet Therapy vs Triple-Antiplatelet Therapy to Reduce
Neointimal Tissue Proliferation in Diabetic Patients.
Source
Journal of Invasive Cardiology. 29 (3) (pp 76-81), 2017. Date of
Publication: March 2017.
Publisher
HMP Communications
Abstract
BACKGROUND: Previous studies have suggested a benefit of cilostazol in
addition to standard dual-antiplatelet therapy (DAPT), reducing in-stent
late luminal loss and restenosis after percutaneous coronary intervention
(PCI) with bare-metal and drug-eluting stent (DES) implantation. However,
there is a paucity of intravascular ultrasound (IVUS) assessment of
neointimal tissue hyperplasia (NIH) after triple-antiplatelet therapy
(TAPT), especially in diabetic patients treated with DES. METHODS: This
prospective, placebo-controlled trial was conducted in diabetic patients
randomized (1:1) to receive either standard DAPT (aspirin and clopidogrel)
vs TAPT with cilostazol for a minimum of 12 months after PCI with Endeavor
zotarolimus-eluting stent (E-ZES). The primary endpoint was the 9-month
comparison of percentage of NIH in both groups. Additionally, we compared
in-stent late lumen loss, binary restenosis, major adverse cardiac event
(MACE; cardiac death, non-fatal myocardial infarction, and restenosis)
rates, and the incidence of vascular/bleeding complications. RESULTS: In
total, 133 diabetic patients were enrolled (cilostazol cohort = 65
patients) with 56.4% male and mean age of 60.8 years. Overall, the two
cohorts were comparable in terms of baseline clinical and angiographic
characteristics, except for the reference vessel diameter, which was
smaller among patients randomized to cilostazol (2.48 +/- 0.46 mm vs 2.69
+/- 0.48 mm; P=.01). At 9 months, there was a non-significant trend toward
less percentage of NIH obstruction in the TAPT cohort (33.2 +/- 8.29% vs
35.1 +/- 8.45%; P=.07). However, this finding did not impact angiographic
late-lumen loss (0.60 +/- 0.46 mm cilostazol group vs 0.64 +/- 0.48 mm
control group; P=.30) and binary restenosis (9.8% vs 6.8%; P=.99). MACE
rate also did not significantly differ between the cohorts (13.8%
cilostazol group vs 8.8% control group; P=.81). Of note, the addition of a
third antiplatelet agent did not increase vascular and bleeding
complications. CONCLUSION: In diabetic patients treated with E-ZES, TAPT
with cilostazol did not add any significant benefit in terms of NIH
suppression or MACE reduction.

<161>
Accession Number
614272322
Author
Tang L.H.; Kikkenborg Berg S.; Christensen J.; Lawaetz J.; Doherty P.;
Taylor R.S.; Langberg H.; Zwisler A.-D.
Institution
(Tang, Kikkenborg Berg, Lawaetz) Department of Cardiology, The Heart
Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen,
Denmark
(Tang, Christensen, Lawaetz, Langberg) CopenRehab, Section of Social
Medicine, Department of Public Health, University of Copenhagen, Denmark
(Tang, Lawaetz) Bachelor's Degree Program in Physiotherapy, Dept. of
Rehabilitation and Nutrition, Faculty of Health and Technology,
Metropolitan University College, Copenhagen, Denmark
(Christensen) Department of Occupational Therapy and Physiotherapy,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
(Doherty) Department of Health Sciences, University of York, England,
United Kingdom
(Taylor) Institute of Health Research, University of Exeter Medical
School, Exeter, England, United Kingdom
(Taylor) National Institute of Public Health, University of Southern
Denmark, Copenhagen, Denmark
(Taylor, Zwisler) National Centre for Rehabilitation and Palliative Care,
University of Southern Denmark, Denmark
(Taylor, Zwisler) Odense University Hospital, Denmark
Title
Patients' preference for exercise setting and its influence on the health
benefits gained from exercise-based cardiac rehabilitation.
Source
International Journal of Cardiology. 232 (pp 33-39), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Objective To assess patient preference for exercise setting and examine if
choice of setting influences the long-term health benefit of
exercise-based cardiac rehabilitation. Methods Patients participating in a
randomised controlled trial following either heart valve surgery, or
radiofrequency ablation for atrial fibrillation were given the choice to
perform a 12-week exercise programme in either a supervised centre-based,
or a self-management home-based setting. Exercise capacity and physical
and mental health outcomes were assessed for up to 24 months after
hospital discharge. Outcomes between settings were compared using a time x
setting interaction using a mixed effects regression model. Results Across
the 158 included patients, an equivalent proportion preferred to undertake
exercise rehabilitation in a centre-based setting (55%, 95% CI: 45% to
63%) compared to a home-based setting (45%, 95% CI: 37% to 53%, p =
0.233). At baseline, those who preferred a home-based setting reported
better physical health (mean difference in physical component score: 5.0,
95% CI 2.3 to 7.4; p = 0.001) and higher exercise capacity (mean between
group difference 15.9 watts, 95% CI 3.7 to 28.1; p = 0.011). With the
exception of the depression score in the Hospital Anxiety and Depression
Score (F(3.65), p = 0.004), there was no evidence of a significant
difference in outcomes between settings. Conclusion The preference of
patients to participate in home-based and centre-based exercise programmes
appears to be equivalent and provides similar health benefits. Whilst
these findings support that patients should be given the choice between
exercise-settings when initiating cardiac rehabilitation, further
confirmatory evidence is needed.<br/>Copyright &#xa9; 2017

<162>
Accession Number
614075888
Author
Hongisto M.; Tarvasmaki T.; Tolppanen H.; Parissis J.; Masip J.; Harjola
V.-P.; Harjola V.; Banaszewski M.; Kober L.; Lassus J.; Mebazaa A.;
Silva-Cardoso J.; Sionis A.; Di Somma S.; Spinar J.; Koniari K.;
Voumvourakis A.; Karavidas A.; Sans-Rosello J.; Vila M.; Duran-Cambra A.;
Metra M.; Carubelli V.; Bulgari B.; Lazzarini V.; Parenica J.; Stipal R.;
Ludka O.; Palsuva M.; Ganovska E.; Kubena P.; Lindholm M.G.; Hassager C.;
Backlund T.; Jurkko R.; Jarvinen K.; Nieminen T.; Pulkki K.; Soininen L.;
Sund R.; Tierala I.; Tolonen J.; Varpula M.; Korva T.; Pietila M.; Pitkala
A.; Marino R.; Sousa A.; Sousa C.; Paiva M.; Rangel I.; Almeida R.; Pinho
T.; Julia Maciel M.; Stepinska J.; Skrobisz A.; Goral P.
Institution
(Hongisto, Tarvasmaki, Harjola) Emergency Medicine, University of
Helsinki, Department of Emergency Care, Helsinki University Hospital,
Helsinki, Finland
(Lassus, Tolppanen) Helsinki University Hospital, Heart and Lung Center,
Division of Cardiology, Helsinki, Finland
(Sionis) Intensive Cardiac Care Unit, Cardiology Department, Hospital de
la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant
Pau) Barcelona, Spain
(Lindholm) Rigshospitalet, Copenhagen University Hospital, Intensive
Cardiac Care Unit, Copenhagen, Denmark
(Banaszewski) Institute of Cardiology, Intensive Cardiac Therapy Clinic,
Warsaw, Poland
(Parissis) Attikon University Hospital, Heart Failure Clinic and Secondary
Cardiology Department, Athens, Greece
(Spinar) University Hospital Brno, Department of Internal Medicine and
Cardiology, Brno, Czech Republic
(Silva-Cardoso) University of Porto, CINTESIS, Department of Cardiology,
Porto Medical School, Sao Joao Hospital Center, Porto, Portugal
(Carubelli) Division of Cardiology, Department of Medical and Surgical
Specialties, Radiological Sciences, and Public Health, University and
Civil Hospital of Brescia, Italy
(Di Somma) Department of Medical Sciences and Translational Medicine,
University of Rome Sapienza, Emergency Medicine Sant'Andrea Hospital,
Rome, Italy
(Masip) University of Barcelona, Hospital Sant Joan Despi Moises Broggi,
Critical Care Department, Consorci Sanitari Integral, Barcelona, Spain
Title
Use of noninvasive and invasive mechanical ventilation in cardiogenic
shock: A prospective multicenter study.
Source
International Journal of Cardiology. 230 (pp 191-197), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Despite scarce data, invasive mechanical ventilation (MV) is
widely recommended over non-invasive ventilation (NIV) for ventilatory
support in cardiogenic shock (CS). We assessed the real-life use of
different ventilation strategies in CS and their influence on outcome
focusing on the use of NIV and MV. Methods 219 CS patients were
categorized by the maximum intensity of ventilatory support they needed
during the first 24 h into MV (n = 137; 63%), NIV (n = 26; 12%), and
supplementary oxygen (n = 56; 26%) groups. We compared the clinical
characteristics and 90-day outcome between the MV and the NIV groups.
Results Mean age was 67 years, 74% were men. The MV and NIV groups did not
differ in age, medical history, etiology of CS,
PaO<inf>2</inf>/FiO<inf>2</inf> ratio, baseline hemodynamics or LVEF. MV
patients predominantly presented with hypoperfusion, with more severe
metabolic acidosis, higher lactate levels and greater need for vasoactive
drugs, whereas NIV patients tended to be more often congestive. 90-day
outcome was significantly worse in the MV group (50% vs. 27%), but after
propensity score adjustment, mortality was equal in both groups.
Confusion, prior CABG, ACS etiology, higher lactate level, and lower
baseline PaO<inf>2</inf> were independent predictors of mortality, whereas
ventilation strategy did not have any influence on outcome. Conclusions
Although MV is generally recommended mode of ventilatory support in CS, a
fair number of patients were successfully treated with NIV. Moreover,
ventilation strategy was not associated with outcome. Thus, NIV seems a
safe option for properly chosen CS patients.<br/>Copyright &#xa9; 2016
Elsevier Ireland Ltd

<163>
Accession Number
619479166
Author
Nguyen L.S.; Merzoug M.; Estagnasie P.; Brusset A.; Law Koune J.-D.;
Aubert S.; Waldmann T.; Grinda J.-M.; Gibert H.; Squara P.
Institution
(Nguyen, Merzoug, Estagnasie, Brusset, Squara) CMC Ambroise Pare, Critical
Care Medicine Department, 25-27 Boulevard Victor Hugo, Neuilly-sur-Seine
92200, France
(Aubert, Waldmann, Grinda) CMC Ambroise Pare, Cardiac Surgery Department,
Neuilly-sur-Seine, France
(Law Koune, Gibert) CMC Ambroise Pare, Anesthesiology Department,
Neuilly-sur-Seine, France
Title
Low tidal volume mechanical ventilation against no ventilation during
cardiopulmonary bypass heart surgery (MECANO): Study protocol for a
randomized controlled trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 582. Date of
Publication: 02 Dec 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative pulmonary complications are a leading cause of
morbidity and mortality after cardiac surgery. There are no
recommendations on mechanical ventilation associated with cardiopulmonary
bypass (CPB) during surgery and anesthesiologists perform either no
ventilation (noV) at all during CPB or maintain low tidal volume (LTV)
ventilation. Indirect evidence points towards better pulmonary outcomes
when LTV is performed but no large-scale prospective trial has yet been
published in cardiac surgery. Design: The MECANO trial is a single-center,
double-blind, randomized, controlled trial comparing two mechanical
ventilation strategies, noV and LTV, during cardiac surgery with CPB. In
total, 1500 patients are expected to be included, without any
restrictions. They will be randomized between noV and LTV on a 1:1 ratio.
The noV group will receive no ventilation during CPB. The LTV group will
receive 5 breaths/minute with a tidal volume of 3 mL/kg and positive
end-expiratory pressure of 5 cmH2O. The primary endpoint will be a
composite of all-cause mortality, early respiratory failure defined as a
ratio of partial pressure of oxygen/fraction of inspired oxygen <200 mmHg
at 1 hour after arrival in the ICU, heavy oxygenation support (defined as
a patient requiring either non-invasive ventilation, mechanical
ventilation or high-flow oxygen) at 2 days after arrival in the ICU or
ventilator-acquired pneumonia defined by the Center of Disease Control.
Lung recruitment maneuvers will be performed in the noV and LTV groups at
the end of surgery and at arrival in ICU with an insufflation at +30 cmH20
for 5 seconds. Secondary endpoints are those composing the primary
endpoint with the addition of pneumothorax, CPB duration, quantity of
postoperative bleeding, red blood cell transfusions, revision surgery
requirements, length of stay in the ICU and in the hospital and total
hospitalization costs. Patients will be followed until hospital discharge.
Discussion: The MECANO trial is the first of its kind to compare in a
double-blind design, a no-ventilation to a low-tidal volume strategy for
mechanical ventilation during cardiac surgery with CPB, with a primary
composite outcome including death, respiratory failure and postoperative
pneumonia. Trial registration: ClinicalTrials.gov, NCT03098524. Registered
on 27 February 2017.<br/>Copyright &#xa9; 2017 The Author(s).

<164>
Accession Number
619496642
Author
Fu J.-T.; Popal M.S.; Zhang H.-B.; Han W.; Hu Q.-M.; Meng X.; Ma C.-Y.
Institution
(Fu, Popal, Zhang, Han, Hu, Meng) Department of Cardiac Surgery, Beijing
Anzhen Hospital, Capital Medical University, Beijing 100029, China
(Ma) Department of Cardiac Surgery, Baiqiuen No. 1 Hospital, Jilin
University, Changchun 130000, China
Title
A meta-analysis of late outcomes of mitral valve repair in patients with
rheumatic heart disease.
Source
Journal of Thoracic Disease. 9 (11) (pp 4366-4375), 2017. Date of
Publication: 01 Nov 2017.
Publisher
AME Publishing Company (E-mail: jtd@thepbpc.org)
Abstract
Background: Rheumatic heart disease (RHD) is a predominant health concern
in developing countries. The aim of this meta-analysis was to evaluate the
outcomes of mitral valve (MV) repair in patients with RHD, and identify
predictors that may postoperatively affect treatment outcome. Methods: A
meta-analysis of eligible studies assessing patients undergoing MV repair
with RHD and reporting the outcomes of MV repair, including 30-day
mortality and long-term follow-up survival, MV reoperation rate and
postoperative adverse events. Relevant English articles were searched up
to 1 March, 2017 in Web of Science, PubMed, Google Scholar, Cochrane
Library, EmBase, Elsevier, and Science Direct. Selected studies should
meet all inclusion criteria, and underwent data extraction. Results: A
total of ten studies with 2,770 patients met all inclusion criteria, and
were selected for assessment. Pooled analysis showed that 30-day mortality
in patients with rheumatic MV disease after MV repair surgery was 1.9%,
95% confidence interval (CI) (0.8-2.9%); long-term survival was 97.3%, 95%
CI (95.9-98.6%), and a freedom from reoperation rate of 93.6%, 95% CI
(91.4-95.9%) was obtained; freedom from adverse events was 97.5%, 95% CI
(95.2-99.8%). Conclusions: The outcome of rheumatic MV repair is
outstanding in terms of low early mortality, high long-term survival and
freedom from valve-related complications, which may be very common in
patients after rheumatic MV replacement; meanwhile, MV reoperation rate
after initial surgery is acceptable. Surgeons may try to repair MV in RHD
when it is feasible.<br/>Copyright &#xa9; Journal of Thoracic Disease.

<165>
Accession Number
619550532
Author
Gnanenthiran S.R.; Kritharides L.; D'Souza M.; Lowe H.C.; Brieger D.B.
Institution
(Gnanenthiran, Kritharides, Lowe, Brieger) Cardiology Department, Concord
Repatriation General Hospital, hospital Rd, Concord, NSW 2139, Australia
(Gnanenthiran, Kritharides, D'Souza, Lowe, Brieger) University of Sydney,
Sydney, NSW, Australia
Title
Revascularisation compared with initial medical therapy for
non-ST-elevation acute coronary syndromes in the elderly: A meta-analysis.
Source
Heart. 103 (24) (pp 1962-1969), 2017. Date of Publication: 01 Dec 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective Whether revascularisation is superior to medical therapy in
older populations presenting with non-ST-elevation acute coronary
syndromes (NSTEACS) remains contentious, with inconclusive evidence from
randomised trials. We aimed to compare routine invasive therapy with
initial medical management in the elderly presenting with NSTEACS. Methods
MEDLINE, EMBASE and Cochrane Controlled Trial Register were searched for
studies comparing routine invasive therapy with initial medical management
in patients >=75 years old presenting with NSTEACS. Endpoints included
long-term mortality, myocardial infarction (MI), revascularisation,
rehospitalisation, stroke and major bleeding reported as ORs. Results Four
randomised trials and three observational studies met inclusion criteria,
enrolling a total of 20 540 patients followed up from 6 months to 5 years.
Routine invasive therapy reduced mortality (OR 0.67, CI 0.61 to 0.74), MI
(OR 0.56, CI 0.45 to 0.70) and stroke (OR 0.53, CI 0.30 to 0.95). Analyses
restricted to randomised controlled trials (RCTs) confirmed a reduction in
MI (OR 0.51, CI 0.40 to 0.66), revascularisation (OR 0.27, CI 0.13 to
0.56) and a trend to reduced mortality (OR 0.84, CI 0.66 to 1.06) at the
expense of major bleeding (OR 2.19, CI 1.12 to 4.28). Differences in major
bleeding were unapparent in more recent studies. Conclusion Routine
invasive therapy reduces MI and repeat revascularisation and may reduce
mortality at the expense of major bleeding in elderly patients with
NSTEACS. Our findings highlight the need for further RCTs to better
determine the effect on mortality and contemporary bleeding
risk.<br/>Copyright &#xa9; 2017 Article author(s) (or their employer(s)
unless otherwise stated in the text of the article). All rights reserved.

<166>
Accession Number
619550521
Author
Foroutan F.; Guyatt G.H.; Otto C.M.; Siemieniuk R.A.; Schandelmaier S.;
Agoritsas T.; Vandvik P.O.; Bhagra S.; Bagur R.
Institution
(Foroutan, Guyatt, Siemieniuk, Schandelmaier, Agoritsas) Department of
Health Research Methods, Evidence, and Impact, McMaster University,
Hamilton, ON L8S 4L8, Canada
(Foroutan, Bhagra) Heart Failure/Transplant Program, Toronto General
Hospital, University Health Network, Toronto, ON, Canada
(Otto) Division of Cardiology, Department of Medicine, University of
Washington School of Medicine, Seattle, WA, United States
(Siemieniuk) Department of Medicine, University of Toronto, Toronto, ON,
Canada
(Agoritsas) Division of General Internal Medicine, Division of Clinical
Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
(Vandvik) Department of Internal Medicine, Innlandet Hospital
Trust-division Gjovik, Gjovik, Norway
(Vandvik) Institute of Health and Society, University of Oslo, Faculty of
Medicine, Gjovik, Norway
(Bagur) Division of Cardiology, Departments of Medicine and Epidemiology
and Biostatistics, London Health Sciences Centre, Western University,
London, ON, Canada
(Bagur) Keele Cardiovascular Research Group, Institute of Applied Clinical
Science, Centre for Prognosis Research, Keele University, Stoke-on-Trent,
United Kingdom
Title
Structural valve deterioration after transcatheter aortic valve
implantation.
Source
Heart. 103 (23) (pp 1899-1905), 2017. Date of Publication: 01 Dec 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Background Transcatheter aortic valve implantation (TAVI), widely used to
treat high-risk patients with severe symptomatic aortic stenosis, has
recently been extended to younger patients at lower operative risk in whom
long-term durability of TAVI devices is an important concern. Therefore,
we conducted a systematic review and meta-analysis of observational
studies addressing the frequency of structural valve deterioration (SVD)
after TAVI. Methods We searched Medline, Embase, Cochrane Database of
Systematic Reviews, and Cochrane CENTRAL from 2002 to September 2016. We
included observational studies following patients with TAVI for at least 2
years. Independently and in duplicate, we evaluated study eligibility,
extracted data, and assessed risk of bias for SVD post-TAVI. Our review
used the GRADE system to assess quality of evidence. We pooled incidence
rates using a random effects model. Results Thirteen studies including
8914 patients, with a median follow-up between 1.6 and 5 years, reported
an incidence of SVD post-TAVI between 0 to 1.34 per 100 patient years. The
pooled incidence of SVD was 28.08 per 10 000 patients/year (95% CI 2.46 to
73.44 per 100 patient years). Of those who developed SVD, 12% underwent
valve re-intervention. Confidence in the evidence was moderate due to
inconsistency among studies. Conclusion Structural valve deterioration is
probably an infrequent event within the first 5 years after TAVI.
Ascertaining the impact of SVD and the need for valve-related
re-interventions to inform recommendations for patients with a longer
life-expectancy will require studies including a large number of patients
with longer follow-up (>10 years).<br/>Copyright &#xa9; 2017 Article
author(s) (or their employer(s) unless otherwise stated in the text of the
article). All rights reserved.

<167>
Accession Number
614013185
Author
Neefs J.; van den Berg N.W.E.; Limpens J.; Berger W.R.; Boekholdt S.M.;
Sanders P.; de Groot J.R.
Institution
(Neefs, van den Berg, Limpens, Berger, Boekholdt, de Groot) Department of
Cardiology, Heart Center, and Medical Library, Academic Medical Center,
Amsterdam, Netherlands
(Sanders) Centre for Heart Rhythm Disorders (CHRD), South Australian
Health and Medical Research Institute (SAHMRI), University of Adelaide and
Royal Adelaide Hospital, Adelaide, Australia
Title
Aldosterone Pathway Blockade to Prevent Atrial Fibrillation: A Systematic
Review and Meta-Analysis.
Source
International Journal of Cardiology. 231 (pp 155-161), 2017. Date of
Publication: 15 Mar 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Despite advances in therapeutic interventions AF remains a
progressive and symptomatic disease. Therefore, novel therapeutic
interventions targeting the underlying arrhythmogenic substrate for AF is
needed. Atrial fibrosis is an important component of the arrhythmogenic
substrate of AF and may be initiated by aldosterone binding to the
mineralocorticoid receptor. We hypothesized that aldosterone pathway
blockade with mineralocorticoid receptor antagonists (MRA) reduces atrial
fibrosis, and thus AF. Methods We searched OVID MEDLINE, OVID EMBASE and
the Cochrane Central Register of Controlled Trials from inception to June
10th, 2016 for randomized controlled trials (RCT) and observational
studies addressing MRA and providing information on AF occurrence. Two
independent reviewers selected and appraised the data. We performed
random-effects meta-analyses. Summary odds ratios (OR) with 95% confidence
intervals (CI) were calculated. Results We included 14 studies, 5 RCT and
9 observational cohorts, with a cumulative number of 5332 patients (male:
74.9%, age: 65.3 years); 2397 (45.0%) received an MRA (spironolactone or
eplerenone). During follow-up, 204 (8.5%) patients treated with MRAs,
developed AF, compared to 547 (18.6%) patients, without MRA treatment.
Meta-analyses showed a significant overall reduction of AF risk in MRA
treated patients (OR: 0.48 CI: 0.38-0.60 p < 0.001), including a reduction
of new-onset AF (OR: 0.52 CI: 0.37-0.74 p < 0.001) and recurrent AF (OR:
0.37 CI: 0.24-0.57 p < 0.001), but not post-operative AF (POAF) (OR: 0.60
CI: 0.33-1.09 p = 0.09). Conclusions MRAs significantly reduce new-onset
AF and recurrent AF, but not POAF. MRA treatment can be considered an
additive therapeutic strategy in AF.<br/>Copyright &#xa9; 2017 The Authors

<168>
Accession Number
614006705
Author
Lee J.M.; Rhee T.-M.; Chang H.; Ahn C.; Park T.K.; Yang J.H.; Song Y.B.;
Choi S.-H.; Gwon H.-C.; Hahn J.-Y.
Institution
(Lee, Chang, Park, Yang, Song, Choi, Gwon, Hahn) Department of Internal
Medicine and Cardiovascular Center, Heart Vascular Stroke Institute,
Samsung Medical Center, Sungkyunkwan University School of Medicine, United
States
(Rhee) Department of Internal Medicine and Cardiovascular Center, Seoul
National University Hospital, Seoul, South Korea
(Ahn) Division of Biostatistics, Center for Devices and Radiological
Health, Food and Drug Administration, Silver Spring, MD, United States
Title
Deferred versus conventional stent implantation in patients with acute
ST-segment elevation myocardial infarction: An updated meta-analysis of 10
studies.
Source
International Journal of Cardiology. 230 (pp 509-517), 2017. Date of
Publication: 01 Mar 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background We sought to evaluate safety and efficacy of the deferred
stenting versus immediate stent implantation of infarct-related arteries
in patients with acute ST-segment elevation myocardial infarction (STEMI)
undergoing primary percutaneous coronary intervention (PCI). Methods A
meta-analysis using random-effects models were conducted. The primary
outcome, major adverse cardiac events (MACE), was a composite of all-cause
mortality, myocardial infarction (MI), any unplanned target vessel
revascularization (TVR), and hospitalization due to cardiac cause.
Periprocedural composite events were composed of acute re-occlusion,
no-reflow/slow flow, or distal embolization. Results Seven non-randomized
registries and three randomized trials comparing outcomes of deferred
versus immediate stenting in infarct-related arteries of 2281 STEMI
patients were selected. Risk of MACE between deferred or immediate
stenting did not differ significantly (rates, 12.8% vs 15.0%; pooled RR =
0.68, 95% CI: 0.43-1.06; p = 0.087; I² = 26.8%). Deferred
stenting was associated with significantly reduced risk of periprocedural
composite events (rates, 5.3% vs 10.2%; pooled RR = 0.36, 95% CI:
0.18-0.69; p = 0.002; I² = 68.0%) and flow abnormality in
infarct-related arteries (rates, 3.8% vs 8.4%; pooled RR = 0.29, 95% CI:
0.14-0.61; p = 0.001; I² = 58.1%). However, clinical outcomes
including all-cause mortality, MI, or any unplanned TVR, were unaffected.
Meta-regression indicated a significant relationship between prolonged
total ischemic and reduced risk of MACE after deferred stenting (OR =
0.994, 95% CI: 0.990-0.998; p = 0.027; I² residual 0.0%,
adjusted R² = 100.0%). Conclusions Although deferred stenting
carried significantly lower risk of periprocedural composite events and
abnormal flow in patients undergoing primary PCI for STEMI, such benefits
had no impact on MACE, which did not differ significantly by timing of
stent placement.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd

<169>
Accession Number
613967152
Author
Kahlert P.; Hildebrandt H.A.; Patsalis P.C.; Al-Rashid F.; Janosi R.A.;
Nensa F.; Schlosser T.W.; Schlamann M.; Wendt D.; Thielmann M.; Kottenberg
E.; Frey U.; Neuhauser M.; Forsting M.; Jakob H.G.; Rassaf T.; Peters J.;
Heusch G.; Kleinbongard P.
Institution
(Kahlert, Hildebrandt, Patsalis, Al-Rashid, Janosi, Rassaf) Department of
Cardiology and Vascular Medicine, West-German Heart and Vascular Center
Essen, Universitatsklinikum Essen, Universitat Duisburg-Essen, Germany
(Nensa, Schlosser, Schlamann, Forsting) Institute for Diagnostic and
Interventional Radiology and Neuroradiology, Universitatsklinikum Essen,
Universitat Duisburg-Essen, Germany
(Wendt, Thielmann, Jakob) Department of Thoracic and Cardiovascular
Surgery, West-German Heart and Vascular Center Essen, Universitatsklinikum
Essen, Universitat Duisburg-Essen, Germany
(Kottenberg, Frey, Peters) Klinik fur Anasthesiologie und Intensivmedizin,
Universitatsklinikum Essen, Universitat Duisburg-Essen, Germany
(Neuhauser) Institute for Medical Informatics, Biometry, and Epidemiology,
Universitatsklinikum Essen, Universitat Duisburg-Essen, Germany
(Heusch, Kleinbongard) Institute for Pathophysiology, West-German Heart
and Vascular Center Essen, Universitatsklinikum Essen, Universitat
Duisburg-Essen, Germany
(Schlamann) Department of Neuroradiology, University Hospital Giesen,
Giesen, Germany
(Kottenberg) Klinik fur Anasthesiologie, Intensivmedizin und
Schmerztherapie, Evangelisches Krankenhaus Mulheim, Germany
(Neuhauser) Department of Mathematics and Technology, Koblenz, University
of Applied Science, Remagen, Germany
Title
No protection of heart, kidneys and brain by remote ischemic
preconditioning before transfemoral transcatheter aortic valve
implantation: Interim-analysis of a randomized single-blinded,
placebo-controlled, single-center trial.
Source
International Journal of Cardiology. 231 (pp 248-254), 2017. Date of
Publication: 15 Mar 2017.
Publisher
Elsevier Ireland Ltd
Abstract
Background Remote ischemic preconditioning (RIPC) reduces myocardial
injury and improves clinical outcome in patients undergoing coronary
revascularization, but only in the absence of propofol-anesthesia. We
investigated whether RIPC provides protection of heart, kidneys and brain
and improves outcome in patients undergoing transfemoral transcatheter
aortic valve implantation (TF-TAVI). Methods Patients undergoing TF-TAVI
were randomized to receive RIPC (3 cycles of 5 min left upper arm ischemia
and 5 min reperfusion) or placebo. The primary endpoint was myocardial
injury, reflected by the area under the curve for serum troponin I
concentrations (AUC-TnI) over the first 72 h. Secondary endpoints included
the incidences of periprocedural myocardial infarction, delayed gadolinium
enhancement on postprocedural cardiac MRI, acute kidney injury,
periprocedural stroke, and the incidence and volume of new lesions on
postprocedural cerebral MRI. All-cause and cardiovascular mortality and
major adverse cardiac and cerebrovascular events (MACCE) were assessed
over 1-year follow-up. A prespecified interim-analysis was performed after
the last patient had completed 1-year follow-up (NCT02080299). Results 100
consecutive patients were enrolled between September 2013 and June 2015.
There were no significant between-group differences in the primary
endpoint of peri-interventional myocardial injury (ratio RIPC/placebo
AUC-TnI: 0.87, 95% CI: 0.57-1.34, p = 0.53) or the secondary endpoints of
cardiac, renal and cerebral impairment. There was no significant treatment
effect in subgroup-analyses of patients undergoing cardiac or cerebral
MRI. Mortality and MACCE did not differ. No RIPC-related adverse events
were observed. Conclusions RIPC did neither protect heart, kidneys and
brain nor improve clinical outcome in patients undergoing
TF-TAVI.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd

<170>
Accession Number
619592387
Author
Baron S.J.; Chinnakondepalli K.; Magnuson E.A.; Kandzari D.E.; Puskas
J.D.; Ben-Yehuda O.; van Es G.-A.; Taggart D.P.; Morice M.-C.; Lembo N.J.;
Brown W.M.; Banning A.; Simonton C.A.; Kappetein A.P.; Sabik J.F.; Serruys
P.W.; Stone G.W.; Cohen D.J.
Institution
(Baron, Chinnakondepalli, Magnuson, Cohen) Saint Luke's Mid America Heart
Institute, University of Missouri-Kansas City School of Medicine, Kansas
City, Missouri, United States
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia
(Puskas, Lembo, Brown) Mount Sinai Medical Center, New York, New York,
United States
(Ben-Yehuda, Stone) Cardiovascular Research Foundation, New York, New
York, United States
(van Es) Cardialysis, Rotterdam, Netherlands
(Taggart, Banning) Oxford University Hospitals, Oxford, United Kingdom
(Morice) Ramsay Generale de Sante, Hospital Prive Jacques Cartier, Massy,
France
(Simonton) Abbott Vascular Inc., Abbott Park, Illinois, United States
(Kappetein) Erasmus Medical Center, Rotterdam, Netherlands
(Sabik) Cleveland Clinic Foundation, Cleveland, Ohio, United States
(Serruys) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
(Stone) New York-Presbyterian Hospital, Columbia University Medical
Center, New York, New York, United States
Title
Quality-of-Life After Everolimus-Eluting Stents or Bypass Surgery for
Left-Main Disease: Results From the EXCEL Trial.
Source
Journal of the American College of Cardiology. 70 (25) (pp 3113-3122),
2017. Date of Publication: 26 December 2017.
Publisher
Elsevier USA
Abstract
Background The EXCEL (Evaluation of Xience Versus Coronary Artery Bypass
Surgery for Effectiveness of Left Main Revascularization) trial compared
outcomes in patients with unprotected left main coronary artery disease
(LMCAD) treated with coronary artery bypass graft (CABG) or percutaneous
coronary intervention (PCI) using everolimus-eluting stents. Whereas rates
of death, stroke, and myocardial infarction were similar at 36 months,
event timing and repeat revascularization rates differed by treatment
group. Objectives To understand the effects of revascularization strategy
from the patient's perspective, a prospective quality of life (QoL)
substudy was performed alongside the EXCEL trial. Methods Between
September 2010 and March 2014, 1,905 patients with LMCAD were randomized
to undergo CABG or PCI, of whom 1,788 participated in the QoL substudy.
QoL was assessed at baseline and 1, 12, and 36 months using the Seattle
Angina Questionnaire, the 12-Item Short Form Health Survey, the Rose
Dyspnea Scale, the Patient Health Questionnaire-8, and the EQ-5D.
Differences between PCI and CABG were assessed using longitudinal
random-effect growth curve models. Results Over 36 months, both PCI and
CABG were associated with significant improvements in QoL compared with
baseline. At 1 month, PCI was associated with better QoL than CABG. By 12
months though, these differences were largely attenuated, and by 36
months, there were no significant QoL differences between PCI and CABG.
Conclusions Among selected patients with LMCAD, both PCI and CABG result
in similar QoL improvement through 36 months, although a greater early
benefit is seen with PCI. Taken together with the 3-year clinical results
of EXCEL, these findings suggest that PCI and CABG provide similar
intermediate-term outcomes for patients with LMCAD. (Evaluation of Xience
Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main
Revascularization [EXCEL]; NCT01205776)<br/>Copyright &#xa9; 2017 American
College of Cardiology Foundation

<171>
Accession Number
611580794
Author
Witberg G.; Lavi I.; Assa H.V.; Orvin K.; Assali A.; Kornowski R.
Institution
(Witberg, Lavi, Assa, Orvin, Assali, Kornowski) Department of Cardiology,
Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
(Witberg, Lavi, Assa, Orvin, Assali, Kornowski) Sackler Faculty of
Medicine, Tel Aviv University, Tel Aviv, Israel
Title
Insights from 2D and 3D quantitative angiographic assessment of
bioresorbable everolimus-eluting vascular scaffolds.
Source
Israel Medical Association Journal. 18 (7) (pp 381-385), 2016. Date of
Publication: July 2016.
Publisher
Israel Medical Association (2 Twin Towers,11th Floor,35 Jabotinsky
Street,PO Box 3566, Ramat Gan 52135, Israel)
Abstract
Background: Bioresorbable vascular scaffold (BVS) is a promising
technology that potentially offers several advantages over contemporary
coronary drug-eluting stents (DES). Crucial to BVS implantation is the
correct choice of scaffold size (diameter and length) in order to avoid
"geographic miss" in length, provide the maximal support to the vessel
wall, and avoid leaving "free-floating" foreign material in the coronary
vasculature. Objectives: To assess the optimal method for measuring
coronary stenosis prior to BVS implantation. Methods: We compared the
performance of two quantitative coronary angiography assessment (QCA)
techniques: two dimensional real-time QCA (2D-QCA) and offline 3D QCA
(3D-QCA) for the evaluation of coronary lesions in patients enrolled in a
multicenter randomized controlled trial of BVS vs. metallic stents, by
calculating the weighted kappa value for agreement regarding optimal BVS
size with the reference method - CoreLab offline 2D-QCA measurements. In
addition, we collected 2 year clinical outcomes (death/myocardial
infarction/repeat revascularization/scaffold thrombosis) in BVS-implanted
patients. Results: In 17 patients with available CoreLab data, the
weighted kappa for agreement for 3D-QCA was significantly better than for
2D-QCA (0.90, 95%CI 0.72-1.00 vs. 0.439, 95%CI 0.16-0.77). The rate of
clinical events at 2 years was low (9.5%). Conclusions: Initial experience
in a small group of carefully selected patients at our institution
suggests that the use of BVS for coronary revascularization is associated
with a low rate of adverse events in suitable patients. 3D-QCA may be
superior to 2D-QCA analysis in terms of reproducibility, and results in
more patients receiving optimal size BVS.<br/>Copyright &#xa9; 2016,
Israel Medical Association. All rights reserved.

<172>
Accession Number
619544418
Author
Ariyaratne T.V.; Yap C.-H.; Ademi Z.; Rosenfeldt F.; Duffy S.J.; Billah
B.; Reid C.M.
Institution
(Ariyaratne, Yap, Ademi, Duffy, Billah, Reid) Centre of Cardiovascular
Research and Education in Therapeutics, Department of Epidemiology and
Preventive Medicine (DEPM), Monash University, 99 Commercial Rd,
Melbourne, VIC 3004, Australia
(Yap) Cardiothoracic Unit, Geelong Hospital, Geelong, VIC, Australia
(Ademi) Institute of Pharmaceutical Medicine (ECPM), University of Basel,
Basel, Switzerland
(Rosenfeldt) Cardiac Surgical Research Unit, Department of Cardiothoracic
Surgery, Alfred Hospital, Melbourne, VIC, Australia
(Duffy) Heart Centre, Alfred Hospital, Melbourne, VIC, Australia
(Reid) School of Public Health, Curtin University, Perth, WA, Australia
Title
A systematic review of cost-effectiveness of percutaneous coronary
intervention vs. surgery for the treatment of multivessel coronary artery
disease in the drug-eluting stent era.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 2 (4) (pp
261-270), 2016. Date of Publication: 01 Oct 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims The suitability of percutaneous coronary intervention (PCI), compared
with coronary artery bypass grafting (CABG), for patients with complex
multivessel coronary artery disease (MVCAD) remains a contentious topic.
While the body of evidence regarding the clinical effectiveness of these
revascularization strategies is growing, there is limited evidence
concerning their long-term cost-effectiveness. We aim to critically
appraise the body of literature investigating the cost-effectiveness of
CABG compared with PCI using stents, and to assess the quality of the
economic evidence available. Methods and results A systematic review was
performed across six electronic databases; Medline, Embase, the NHS
Economic Evaluation Database, the Database of Abstracts of Reviews of
Effects, the health technology assessment database, and the Cochrane
Library. All studies comparing economic attractiveness of CABG vs. PCI
using bare-metal stents (BMS) or drug-eluting stents (DES) in balanced
groups of patients were considered. Sixteen studies were included. These
comprised studies of conventional CABG vs. BMS (n 1/4 8), or DES (n 1/4
4); off-pump CABG vs. BMS (n 1/4 2), or DES (n 1/4 1); and minimally
invasive direct CABG vs. BMS (n 1/4 2). The majority adopted a healthcare
payer perspective (n 1/4 14). The incremental cost-effectiveness ratios
(ICERs) reported across studies varied widely according to perspective and
time horizon. Favourable lifetime ICERs were reported for CABG in three
trials. For patients with left main coronary artery disease, however, DES
was reported as the dominant (more effective and cost-saving) strategy in
one study. Conclusion Overall, CABG rather than PCI was the favoured
cost-effective treatment for complex MVCAD in the long term. While the
evidence base for the cost-effectiveness of DES compared with CABG is
growing, there is a need for more evaluations adopting a societal
perspective, and time horizons of a lifetime or 10 or more
years.<br/>Copyright &#xa9; The Author 2016.

<173>
Accession Number
619544359
Author
Gandapur Y.; Kianoush S.; Kelli H.M.; Misra S.; Urrea B.; Blaha M.J.;
Graham G.; Marvel F.A.; Martin S.S.
Institution
(Gandapur) Department of Internal Medicine, Good Samaritan/Union Memorial
Hospital, 201 East University Parkway, Baltimore, MD 21218, United States
(Kianoush, Misra, Urrea, Blaha, Marvel, Martin) Ciccarone Center for the
Prevention of Heart Disease, Division of Cardiology, Department of
Medicine, Johns Hopkins University School of Medicine, Baltimore, MD,
United States
(Kelli) Emory Clinical Cardiovascular Research Institute, Emory University
School of Medicine, Atlanta, GA, United States
(Graham) Aetna Foundation, Hartford, CT, United States
(Graham) University of Connecticut School of Medicine, Farmington, CT,
United States
Title
The role of mHealth for improving medication adherence in patients with
cardiovascular disease: A systematic review.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 2 (4) (pp
237-244), 2016. Date of Publication: 01 Oct 2016.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Cardiovascular disease is a leading cause of morbidity and mortality
worldwide, and a key barrier to improved outcomes is medication
non-adherence. The aim of this study is to review the role of mobile
health (mHealth) tools for improving medication adherence in patients with
cardiovascular disease. We performed a systematic search for randomized
controlled trials that primarily investigated mHealth tools for improving
adherence to cardiovascular disease medications in patients with
hypertension, coronary artery disease, heart failure, peripheral arterial
disease, and stroke. We extracted and reviewed data on the types of
mHealth tools used, preferences of patients and healthcare providers, the
effect of the mHealth interventions on medication adherence, and the
limitations of trials. We identified 10 completed trials matching our
selection criteria, mostly with,100 participants, and ranging in duration
from 1 to 18 months. mHealth tools included text messages,
Bluetooth-enabled electronic pill boxes, online messaging platforms, and
interactive voice calls. Patients and healthcare providers generally
preferred mHealth to other interventions. All 10 studies reported that
mHealth interventions improved medication adherence, though the magnitude
of benefit was not consistently large and in one study was not greater
than a telehealth comparator. Limitations of trials included small sample
sizes, short duration of follow-up, self-reported outcomes, and
insufficient assessment of unintended harms and financial implications.
Current evidence suggests that mHealth tools can improve medication
adherence in patients with cardiovascular diseases. However, high-quality
clinical trials of sufficient size and duration are needed to move the
field forward and justify use in routine care.<br/>Copyright &#xa9; The
Author 2016.

<174>
[Use Link to view the full text]
Accession Number
611333990
Author
Jensen L.O.; Thayssen P.; Maeng M.; Ravkilde J.; Krusell L.R.; Raungaard
B.; Junker A.; Terkelsen C.J.; Veien K.T.; Villadsen A.B.; Kaltoft A.;
Tilsted H.-H.; Hansen K.No.; Aaroe J.; Kristensen S.D.; Hansen H.S.;
Jensen S.E.; Madsen M.; Botker H.E.; Berencsi K.; Lassen J.F.;
Christiansen E.Ho.
Institution
(Jensen, Thayssen, Junker, Veien, Hansen, Hansen) Department of
Cardiology, Odense University Hospital, Sdr. Blvd 29, Odense C 5000,
Denmark
(Maeng, Krusell, Terkelsen, Kaltoft, Kristensen, Botker, Lassen,
Christiansen) Department of Cardiology, Aarhus University Hospital,
Skejby, Denmark
(Ravkilde, Raungaard, Villadsen, Tilsted, Aaroe, Jensen) Department of
Cardiology, Aalborg University Hospital, Aalborg, Denmark
(Madsen, Berencsi) Department of Clinical Epidemiology, Aarhus University,
Aalborg, Denmark
Title
Randomized comparison of a biodegradable polymer ultrathin strut
sirolimus-eluting stent with a biodegradable polymer biolimus-eluting
stent in patients treated with percutaneous coronary intervention.
Source
Circulation: Cardiovascular Interventions. 9 (7) (no pagination), 2016.
Date of Publication: 01 Jul 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Coronary drug-eluting stents with biodegradable polymers have
been designed to improve safety and efficacy. Methods and Results - The
Scandinavian Organization for Randomized Trials With Clinical Outcome
(SORT OUT) VII trial - a large-scale registry-based randomized,
multicenter, single-blind, 2-arm, noninferiority trial - compared 2
biodegradable polymer drug-eluting stents: the thin-strut cobalt-chromium
sirolimus-eluting Orsiro stent and the stainless steel biolimus-eluting
Nobori stent in an all-comer patient population. The primary end point
target lesion failure was a composite of cardiac death, myocardial
infarction (not related to other than index lesion), or target lesion
revascularization within 1 year, analyzed by intention to treat
(noninferiority margin of 3.0%). Clinically driven event detection based
on Danish registries was used. A total of 1261 patients were assigned to
receive the sirolimus-eluting stent (1590 lesions) and 1264 patients to
the biolimus-eluting stent (1588 lesions). At 1 year, the composite end
point target lesion failure occurred in 48 patients (3.8%) in the
sirolimus-eluting group and in 58 patients (4.6%) in the biolimus-eluting
group (absolute risk difference, -0.78% [upper limit of 1-sided 95%
confidence interval, 0.61%]; P<0.0001). Rates of definite stent thrombosis
occurred in 5 (0.4%) of the sirolimus-eluting group compared with 15
(1.2%) biolimus-eluting stent-treated patients (rate ratio, 0.33; 95%
confidence interval, 0.12-0.92; P=0.034), which largely was attributable
to a lower risk of subacute definite stent thrombosis: 0.1% versus 0.6%
(rate ratio, 0.12; 95% confidence interval, 0.02-1.00; P=0.05).
Conclusions - The thin-strut sirolimus-eluting Orsiro stent was
noninferior to the biolimus-eluting Nobori stent in unselected patients
for target lesion failure at 1 year.<br/>Copyright &#xa9; 2016 American
Heart Association, Inc.

<175>
Accession Number
611333974
Author
Glineur D.; Boodhwani M.; Hanet C.; De Kerchove L.; Navarra E.; Astarci
P.; Noirhomme P.; El Khoury G.
Institution
(Glineur, Boodhwani, Hanet, De Kerchove, Navarra, Astarci, Noirhomme, El
Khoury) Department of Cardiovascular Medicine and Surgery, Cliniques
Universitaires St Luc, Brussels, Belgium
(Glineur, Boodhwani) Division of Cardiac Surgery, University of Ottawa
Heart institute, Ottawa Heart Institute, Ottawa, Canada
Title
Bilateral internal thoracic artery configuration for coronary artery
bypass surgery.
Source
Circulation: Cardiovascular Interventions. 9 (7) (no pagination), 2016.
Date of Publication: 01 Jul 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background - Bilateral internal thoracic arteries (BITA) have demonstrated
superior patency and improved survival in patients undergoing coronary
artery bypass grafting. However, the optimal configuration for BITA
utilization and its effect on long-term outcome remains uncertain. Methods
and Results - We randomly assigned 304 patients undergoing coronary artery
bypass grafting using BITA to either in situ or Y grafting configurations.
The primary end point was 3-year angiographic patency. Secondary end
points included major adverse cardiac and cerebrovascular events (ie,
death from any cause, stroke, myocardial infarction, or repeat
revascularization) at 7 years. More coronary targets were able to be
revascularized using internal thoracic arteries in patients randomized to
Y grafting versus in situ group (3.2+/-0.8 versus 2.4+/-0.5
arteries/patient; P<0.01). The primary end point did not show significant
differences in graft patency between groups. Secondary end points occurred
more frequently in the in situ group (P=0.03), with 7-year rates of
34+/-10% in the in situ and 25+/-12% in the Y grafting groups, driven
largely by a higher incidence of repeat revascularization in the in situ
group (14+/-4.5% versus 7.4+/-3.2% at 7 years; P=0.009). There were no
significant differences in hospital mortality or morbidity or in late
survival, myocardial infarction, or stroke between groups. Conclusions -
Three-year systematic angiographic follow-up revealed no significant
difference in graft patency between the 2 BITA configurations. However,
compared with in situ configuration, the use of BITA in a Y grafting
configuration results in lower rates of major adverse cardiovascular and
cerebrovascular events at 7 years.<br/>Copyright &#xa9; 2016 The Authors.

<176>
[Use Link to view the full text]
Accession Number
612357996
Author
Kapadia S.; Agarwal S.; Miller D.C.; Webb J.G.; MacK M.; Ellis S.;
Herrmann H.C.; Pichard A.D.; Tuzcu E.M.; Svensson L.G.; Smith C.R.;
Rajeswaran J.; Ehrlinger J.; Kodali S.; Makkar R.; Thourani V.H.;
Blackstone E.H.; Leon M.B.
Institution
(Kapadia, Agarwal, Ellis, Tuzcu, Svensson, Rajeswaran, Ehrlinger,
Blackstone) Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United
States
(Miller) Stanford University, Medical School, CA, United States
(Webb) St. Paul's Hospital, University of British Columbia, United States
(MacK) Baylor Scott and White Health, Plano, TX, United States
(Herrmann) Hospital of the University of Pennsylvania, Philadelphia,
United States
(Pichard) MedStar Washington Hospital Center, DC, United States
(Smith, Kodali, Leon) Columbia University, Medical Center, New
York-Presbyterian Hospital, United States
(Makkar) Cedars Sinai Medical Center, Los Angeles, CA, United States
(Thourani) Emory University, Atlanta, GA, United States
Title
Insights into Timing, Risk Factors, and Outcomes of Stroke and Transient
Ischemic Attack after Transcatheter Aortic Valve Replacement in the
PARTNER Trial (Placement of Aortic Transcatheter Valves).
Source
Circulation: Cardiovascular Interventions. 9 (9) (no pagination), 2016.
Article Number: e002981. Date of Publication: 01 Sep 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background-Prior studies of stroke and transient ischemic attack (TIA)
after transcatheter aortic valve replacement (TAVR) are limited by
reporting and follow-up variability. This is a comprehensive analysis of
time-related incidence, risk factors, and outcomes of these events.
Methods and Results-From April 2007 to February 2012, 2621 patients, aged
84+/-7.2 years, underwent transfemoral (TF; 1521) or transapical (TA;
1100) TAVR in the PARTNER trial (Placement of Aortic Transcatheter Valves;
as-treated), including the continued access registry. Stroke and TIA were
identified by protocol and adjudicated by a Clinical Events Committee.
Within 30 days of TAVR, 87 (3.3%) patients experienced a stroke (TF 58
[3.8%]; TA 29 [2.7%]; P=0.09), 85% within 1 week. Instantaneous stroke
risk peaked on day 2, then fell to a low prolonged risk of 0.8% by 1 to 2
weeks. Within 30 days, 13 (0.50%) patients experienced a TIA (TF 10
[0.67%]; TA 3 [0.27%]; P>0.17). Stroke and TIA were associated with lower
1-year survival than expected (TF 47% after stroke versus 82%, and 64%
after TIA versus 83%; TA 53% after stroke versus 80%, and 64% after TIA
versus 83%). Risk factors for early stroke after TA-TAVR included more
postdilatations, pure aortic stenosis without regurgitation, and possibly
more pacing runs, earlier date of procedure, and no dual antiplatelet
therapy; high pre-TAVR aortic peak gradient was a risk factor for stroke
early after TF-TAVR. Conclusions-Risk of stroke or TIA is highest early
after TAVR and is associated with increased 1-year mortality.
Modifications of TAVR, emboli-prevention devices, and better
intraprocedural pharmacological protection may mitigate this risk.
Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique
identifier: NCT00530894.

<177>
[Use Link to view the full text]
Accession Number
612357988
Author
Hildick-Smith D.; Behan M.W.; Lassen J.F.; Chieffo A.; Lefevre T.;
Stankovic G.; Burzotta F.; Pan M.; Ferenc M.; Bennett L.; Hovasse T.;
Spence M.S.; Oldroyd K.; Brunel P.; Carrie D.; Baumbach A.; Maeng M.;
Skipper N.; Louvard Y.
Institution
(Hildick-Smith, Bennett, Skipper) Cardiac Centre, Brighton and Sussex
University Hospitals, Edinburgh Heart Centre, Edinburgh EH164SA, United
Kingdom
(Behan) Edinburgh Heart Centre, United Kingdom
(Lassen, Maeng) Department of Cardiology, Aarhus University Hospital,
Skejby, Denmark
(Chieffo) Department of Cardiology, San Raffaele Scientific Institute,
Milan, Italy
(Lefevre, Hovasse, Louvard) Institute Cardiovasculaire Paris Sud, Hospital
Prive Jacques Cartier, Massy, France
(Stankovic) Department of Cardiology, Clinical Centre of Serbia, Belgrade,
Serbia
(Stankovic) Medical Faculty, University of Belgrade, Serbia
(Burzotta) Institute of Cardiology, Catholic University of the Sacred
Heart, Rome, Italy
(Pan) Department of Cardiology, Reina Sofia Hospital, University of
Cordoba, Spain
(Ferenc) University Heart Center Freiburg, Bad Krozingen, Germany
(Spence) Department of Cardiology, Royal Victoria Hospital, Belfast,
United Kingdom
(Oldroyd) Department of Cardiology, Golden Jubilee National Hospital,
Glasgow, United Kingdom
(Brunel) Department of Cardiology, Clinique de Fontaine-les-Djon, France
(Carrie) Department of Cardiology, Rangueil Hospital, Toulouse, France
(Baumbach) Bristol Heart Institute, United Kingdom
Title
The EBC TWO Study (European Bifurcation Coronary TWO): A Randomized
Comparison of Provisional T-Stenting Versus a Systematic 2 Stent Culotte
Strategy in Large Caliber True Bifurcations.
Source
Circulation: Cardiovascular Interventions. 9 (9) (no pagination), 2016.
Article Number: e003643. Date of Publication: 01 Sep 2016.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Background-For the treatment of coronary bifurcation lesions, a
provisional strategy is superior to systematic 2-stent techniques for the
most bifurcation lesions. However, complex anatomies with large side
branches (SBs) with significant ostial disease length are considered by
expert consensus to warrant a 2-stent technique upfront. This consensus
view has not been scientifically assessed. Methods and Results-Symptomatic
patients with large caliber true bifurcation lesions (SB diameter >=2.5
mm) and significant ostial disease length (>=5 mm) were randomized to
either a provisional T-stent strategy or a dual stent culotte technique.
Two hundred patients aged 64+/-10 years, 82% male, were randomized in 20
European centers. The clinical presentations were stable coronary disease
(69%) and acute coronary syndromes (31%). SB stent diameter (2.67+/-0.27
mm) and length (20.30+/-5.89 mm) confirmed the extent of SB disease.
Procedural success (provisional 97%, culotte 94%) and kissing balloon
inflation (provisional 95%, culotte 98%) were high. Sixteen percent of
patients in the provisional group underwent T-stenting. The primary end
point (a composite of death, myocardial infarction, and target vessel
revascularization at 12 months) occurred in 7.7% of the provisional
T-stent group versus 10.3% of the culotte group (hazard ratio, 1.02; 95%
confidence interval, 0.78-1.34; P=0.53). Procedure time, X-ray dose, and
cost all favored the simpler procedure. Conclusions-When treating complex
coronary bifurcation lesions with large stenosed SBs, there is no
difference between a provisional T-stent strategy and a systematic 2-stent
culotte strategy in a composite end point of death, myocardial infarction,
and target vessel revascularization at 12 months. Clinical Trial
Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT
01560455.<br/>Copyright &#xa9; 2016 American Heart Association, Inc.

<178>
Accession Number
619661579
Author
Cordeiro A.L.; de Melo T.A.; Neves D.; Luna J.; Esquivel M.S.; Guimaraes
A.R.; Borges D.L.; Petto J.
Institution
(Cordeiro, Neves, Luna) Faculdade Nobre, Feira de Santana, BA, Brazil
(de Melo) Hospital Alianca, Salvador, BA, Brazil
(Esquivel, Petto) Research Group in Cardiovascular Physiotherapy,
Salvador, BA, Brazil
(Guimaraes) Instituto Nobre de Cardiologia, Feira de Santana, BA, Brazil
(Borges) University Hospital, Universidade Federal do Maranhao, Sao Luis,
MA, Brazil
Title
Inspiratory Muscle Training and Functional Capacity in Patients Undergoing
Cardiac Surgery.
Source
Brazilian journal of cardiovascular surgery. 31 (2) (pp 140-144), 2016.
Date of Publication: 01 Apr 2016.
Abstract
INTRODUCTION: Cardiac surgery is a highly complex procedure which
generates worsening of lung function and decreased inspiratory muscle
strength. The inspiratory muscle training becomes effective for muscle
strengthening and can improve functional capacity.
OBJECTIVE: To investigate the effect of inspiratory muscle training on
functional capacity submaximal and inspiratory muscle strength in patients
undergoing cardiac surgery.
METHODS: This is a clinical randomized controlled trial with patients
undergoing cardiac surgery at Instituto Nobre de Cardiologia. Patients
were divided into two groups: control group and training. Preoperatively,
were assessed the maximum inspiratory pressure and the distance covered in
a 6-minute walk test. From the third postoperative day, the control group
was managed according to the routine of the unit while the training group
underwent daily protocol of respiratory muscle training until the day of
discharge.
RESULTS: 50 patients, 27 (54%) males were included, with a mean age of
56.7+/-13.9 years. After the analysis, the training group had significant
increase in maximum inspiratory pressure (69.5+/-14.9 vs. 83.1+/-19.1
cmH2O, P=0.0073) and 6-minute walk test (422.4+/-102.8 vs. 502.4+/-112.8
m, P=0.0031).
CONCLUSION: We conclude that inspiratory muscle training was effective in
improving functional capacity submaximal and inspiratory muscle strength
in this sample of patients undergoing cardiac surgery.

<179>
Accession Number
619623382
Author
de Jesus L.E.; Martins A.B.; Oliveira P.B.; Gomes F.; Leve T.; Dekermacher
S.
Institution
(de Jesus, Martins, Oliveira, Gomes, Leve, Dekermacher) Pediatric Surgery
and Urology Department, Servidores do Estado Federal Hospital, Ministry of
Health, Rio de Janeiro, Brazil
Title
Negative pressure wound therapy in pediatric surgery: How and when to use.
Source
Journal of Pediatric Surgery. (no pagination), 2017. Date of Publication:
2017.
Publisher
W.B. Saunders
Abstract
Introduction: Negative pressure wound therapy (NPWT) has been widely
adopted to treat laparostomy, abdominal compartment syndrome (ACS) and
complicated wounds associated with tissue loss. The method presents
specific aspects, advantages and indications in Pediatrics. Our aim is to
review the evidence available about NPWT in children. Methods: Active
search for papers about NPWT in Pediatric patients. Papers referring to
orthopedic problems, wound complications after Cardiac Surgery or burns
were excluded. Results: The method shows good results to treat ACS,
complicated wounds and abdominal wall malformations in neonates, including
prematures. Periwound skin protection, monitoring of fluid losses and fine
tuning of negative pressure levels according to age are necessary. Less
pain, quicker recovery, less frequent dressing changes, possible recovery
of exposed surgical hardware, granulation and shrinkage of the wound are
advantages of the method over other kinds of dressing. NPWT is
contraindicated over blood vessels and exposed nerves. Debridement is
needed before usage over necrotic areas. Enteric fistulae are not
contraindications. Complications are rare, mainly foam retention and
dermatitis/skin maceration. The possibility of fistulae being caused by
NPWT remains debatable. Conclusion: NPWT is widely used in Pediatrics,
including neonates and premature, but the evidence available about the
method is scarce and low quality. Complications are uncommon and mostly
manageable. A possible causal relationship between NPWY and enteric
fistula remains unclear. Adult devices and parameters have been adapted to
children's use. Extra care is needed to protect the delicate tissues of
Pediatric patients. Comparative research to define differential costs,
indications and advantages of the method, specific indications and limits
of NWTP in Pediatrics is needed. Type of study: Review. Evidence level:
IV.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<180>
Accession Number
619601031
Author
Shah P.R.; Reynolds P.S.; Pal N.; Tang D.; McCarthy H.; Spiess B.D.
Institution
(Shah, Reynolds, Pal, Spiess) Department of Anesthesiology, Virginia
Commonwealth University-Medical College of Virginia, Richmond, VA, United
States
(Reynolds, Spiess) Department of Anesthesiology, College of Medicine,
University of Florida, Gainesville, FL 32610, United States
(Tang, McCarthy) Department of Surgery, Virginia Commonwealth
University-Medical College of Virginia, Richmond, VA, United States
Title
Hydroxocobalamin for the treatment of cardiac surgery-associated
vasoplegia: a case series.
Source
Canadian Journal of Anesthesia. (pp 1-9), 2017. Date of Publication: 05
Dec 2017.
Publisher
Springer New York LLC (E-mail: barbara.b.bertram@gsk.com)
Abstract
Purpose: Vasoplegia is a clinical syndrome marked by severe arteriolar
vasodilatation, hypotension, and low systemic vascular resistance
refractory to multiple vasopressor treatment. We report our experience
with hydroxocobalamin (B<inf>12</inf>) infusion as a potential rescue
adjunct for refractory vasoplegia during cardiopulmonary bypass (CPB).
Methods: We performed a retrospective chart review of 33 patients
undergoing cardiac surgery between 1 January 2013 and 31 December 2015,
who were given intravenous B<inf>12</inf> for refractory hypotension
during, or immediately following, CPB. We assessed mean arterial pressure
(MAP) responses using semi-parametric group-based models (trajectory
analysis). Vasopressor use was evaluated by norepinephrine-equivalent
rates calculated five minutes prior, and up to 60 min following,
B<inf>12</inf> administration. Results: Patients were mostly male (82%),
had a mean (SD) age of 53 (13) yr, and median (IQR) EuroSCORE mortality
index of 9 [4-40]. Four patterns of MAP responses to B<inf>12</inf> were
identified. In Group 1 ("poor responders") nine of 33 patients (27%) had
the highest median [IQR] mortality risk (EuroSCORE 40 [4-52]), lowest mean
pre-B<inf>12</inf> MAP (50 mmHg), and minimal hemodynamic response in
spite of continued vasopressor support. In contrast, Group 2 "responders"
(8/33, 24%) showed a brisk MAP response (> 15 mmHg) to B<inf>12</inf>,
sustained for > 60 min post-infusion, with 50% vasopressor reduction.
Groups 3 and 4 had the lowest median mortality risk (EuroSCORE 8) and
highest pre-B<inf>12</inf> MAP (72 mmHg). Although Group 3 patients
("sustainers"; 9/33, 27%) showed a sustained MAP improvement, those in
Group 4 ("rebounders"; 7/33, 21%) were characterized by hypertensive
overshoot followed by a decrease in MAP. Conclusion: These data indicate
considerable heterogeneity in patient response to B<inf>12</inf>,
potentially dependent on both patient preoperative condition and
non-standardized time of administration. B<inf>12</inf> may provide a
useful alternative therapy for refractory hypotension and vasoplegia, but
controlled clinical trials to assess efficacy are needed.<br/>Copyright
&#xa9; 2017 Canadian Anesthesiologists' Society

<181>
Accession Number
619583921
Author
Javaherforoosh Zadeh F.; Moadeli M.; Soltanzadeh M.; Janatmakan F.
Institution
(Javaherforoosh Zadeh, Moadeli, Soltanzadeh, Janatmakan) Department of
Anesthesia, Ahvaz Anesthesiology and Pain Research Center, Ahvaz
Jundishapur University of Medical Sciences, Ahvaz, Iran, Islamic Republic
of
Title
Effect of remote ischemic preconditioning on troponin I in CABG.
Source
Anesthesiology and Pain Medicine. 7 (4) (no pagination), 2017. Article
Number: e12549. Date of Publication: August 2017.
Publisher
Kowsar Medical Publishing Company (E-mail: info@anesthpain.com)
Abstract
Background: Elective open heart surgery is associated with troponin
release in some cases due to myocyte necrosis. Objectives: The aim of this
study was to measure cardiac troponin I (cTnI) preoperatively in elective
CABG after remote ischemic preconditioning. Methods: Twenty-eight patients
were selected for elective CABG. They were randomized to receive remote
ischemic preconditioning (induced by three 5-min cycles of inflation with
a pneumatic tourniquet and 5-min deflation between inflation episodes as
reperfusion). Outcomes: Primary outcomes were cardiac troponin I levels at
6 and 24 hours after the procedure, and the secondary outcomes included
creatine phosphokinase, lactate dehydrogenase, and serum creatinine
levels. Hemodynamic changes were evaluated between the treatment and
control groups. Results: Cardiac troponin I at 6 hours after
preconditioning was significantly lower compared to the control group (P =
0.036), and after 24 hours, there was still a significant difference
between the two groups (P < 0.05). Conclusions: Remote ischemic
preconditioning reduces ischemic biomarkers during coronary artery bypass
graft and attenuates procedure-related cardiac troponin I release and
eventually reduces cardiovascular events such asmyocardial infarction,
chest pain, and hemodynamic changes after cardiac surgery.<br/>Copyright
&#xa9; 2017, Anesthesiology and Pain Medicine.