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<1>
Accession Number
53225581
Author
Jimenez Ruiz C.A.; Solano Reina S.; de Granda Orive J.I.; Signes-Costa
Minaya J.; de Higes Martinez E.; Riesco Miranda J.A.; Altet Gomez N.;
Lorza Blasco J.J.; Barrueco Ferrero M.; de Lucas Ramos P.
Institution
(Jimenez Ruiz, Solano Reina, de Granda Orive, Signes-Costa Minaya, de
Higes Martinez, Riesco Miranda, Altet Gomez, Lorza Blasco, Barrueco
Ferrero, de Lucas Ramos) Grupo de trabajo del Programa Integrado de
Investigacion en Tabaquismo y del Area de Tabaquismo de la Sociedad
Espanola de Neumologia y Cirugia Toracica (SEPAR), Spain
Title
The Electronic Cigarette. Official Statement of the Spanish Society of
Pneumology and Thoracic Surgery (SEPAR) on the Efficacy, Safety and
Regulation of Electronic Cigarettes.
Source
Archivos de Bronconeumologia. 50 (8) (pp 362-367), 2014. Date of
Publication: August 2014.
Publisher
Elsevier Doyma (E-mail: editorial@elsevier.com)
Abstract
The electronic cigarette (EC) is a device formed by 3 basic elements:
battery, atomizer and cartridge. When assembled, it looks like a
cigarette. The cartridge contains different substances: propylene glycol,
glycerine and, sometimes, nicotine. When the user "vapes", the battery is
activated, the atomizer is heated and the liquid is drawn in and
vaporized. The smoker inhales the mist produced. Various substances have
been detected in this mist: formaldehyde, acetaldehyde and acrolein and
some heavy metals. Although these are found in lower concentrations than
in cigarettes, they may still be harmful for the human body. Several
surveys show that 3%-10% of smokers regularly use e-cigarettes. A
randomized study has shown that the efficacy of e-cigarettes for helping
smokers to quit is similar to nicotine patches. Nevertheless, the study
has relevant methodological limitations and reliable conclusions cannot be
deduced. This report sets down the Position Statement of the Spanish
Society of Pulmonology and Thoracic Surgery (SEPAR) on the efficacy and
safety of e-cigarettes. This statement declares that e-cigarettes should
be regulated as medicinal products.<br/>Copyright &#xa9; 2013 SEPAR

<2>
Accession Number
619087008
Author
Podlesnikar T.; Prihadi E.A.; van Rosendael P.J.; Vollema E.M.; van der
Kley F.; de Weger A.; Ajmone Marsan N.; Naji F.; Fras Z.; Bax J.J.;
Delgado V.
Institution
(Podlesnikar, Prihadi, van Rosendael, Vollema, van der Kley, Ajmone
Marsan, Bax, Delgado) Department of Cardiology, Heart and Lung Center,
Leiden University Medical Center, Leiden, Netherlands
(de Weger) Department of Cardio-Thoracic Surgery, Heart and Lung Center,
Leiden University Medical Center, Leiden, Netherlands
(Naji) Department of Cardiology and Angiology, University Medical Centre
Maribor, Maribor, Slovenia
(Fras) Internal Medicine Clinic, University Medical Centre Ljubljana,
Ljubljana, Slovenia
Title
Influence of the Quantity of Aortic Valve Calcium on the Agreement Between
Automated 3-Dimensional Transesophageal Echocardiography and Multidetector
Row Computed Tomography for Aortic Annulus Sizing.
Source
American Journal of Cardiology. 121 (1) (pp 86-93), 2018. Date of
Publication: 01 Jan 2018.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Accurate aortic annulus sizing is key for selection of appropriate
transcatheter aortic valve implantation (TAVI) prosthesis size. The
present study compared novel automated 3-dimensional (3D) transesophageal
echocardiography (TEE) software and multidetector row computed tomography
(MDCT) for aortic annulus sizing and investigated the influence of the
quantity of aortic valve calcium (AVC) on the selection of TAVI prosthesis
size. A total of 83 patients with severe aortic stenosis undergoing TAVI
were evaluated. Maximal and minimal aortic annulus diameter, perimeter,
and area were measured. AVC was assessed with computed tomography. The low
and high AVC burden groups were defined according to the median AVC score.
Overall, 3D TEE measurements slightly underestimated the aortic annulus
dimensions as compared with MDCT (mean differences between maximum,
minimum diameter, perimeter, and area: -1.7 mm, 0.5 mm, -2.7 mm, and -13
mm², respectively). The agreement between 3D TEE and MDCT on
aortic annulus dimensions was superior among patients with low AVC burden
(<3,025 arbitrary units) compared with patients with high AVC burden
(>=3,025 arbitrary units). The interobserver variability was excellent for
both methods. 3D TEE and MDCT led to the same prosthesis size selection in
88%, 95%, and 81% of patients in the total population, the low, and the
high AVC burden group, respectively. In conclusion, the novel automated 3D
TEE imaging software allows accurate and highly reproducible measurements
of the aortic annulus dimensions and shows excellent agreement with MDCT
to determine the TAVI prosthesis size, particularly in patients with low
AVC burden.<br/>Copyright &#xa9; 2017 The Author(s)

<3>
Accession Number
617562324
Author
Bongiovanni D.; Kuhl C.; Bleiziffer S.; Stecher L.; Poch F.; Greif M.;
Mehilli J.; Massberg S.; Frey N.; Lange R.; Laugwitz K.-L.; Schymik G.;
Frank D.; Kupatt C.
Institution
(Bongiovanni, Poch, Laugwitz, Kupatt) I. Medizinische Klinik und
Poliklinik, Klinikum rechts der Isar, Technical University of Munich,
Munich, Germany
(Bongiovanni, Laugwitz, Kupatt) DZHK (German Center for Cardiovascular
Research), Partner Site Munich Heart Alliance, Munich, Germany
(Kuhl, Frey, Frank) Klinik fur Innere Medizin III, Universitatsklinikum
Schleswig-Holstein, Kiel, Germany
(Kuhl, Frey, Frank) DZHK (German Center for Cardiovascular Research),
Partner Site Hamburg/Kiel/Lubeck, Lubeck, Germany
(Bleiziffer, Lange) Clinic for Cardiovascular Surgery, German Heart Center
Munich, Munich, Germany
(Stecher) Institut fur Medizinische Statistik und Epidemiologie, Technical
University of Munich, Munich, Germany
(Greif, Mehilli, Massberg) Medizinische Klinik und Poliklinik I, Klinikum
Groshadern, LMU University, Munich, Germany
(Schymik) Medizinische Klinik IV, Stadtisches Klinikum Karlsruhe,
Karlsruhe, Germany
Title
Emergency treatment of decompensated aortic stenosis.
Source
Heart. (no pagination), 2017. Date of Publication: May 30, 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: The optimal treatment of patients with acute and severe
decompensation of aortic stenosis is unclear due to recent advances in
transcatheter interventions and supportive therapies. Our aim was to
assess the early outcome of emergency transcatheter aortic valve
implantation (eTAVI) versus emergency balloon aortic valvuloplasty (eBAV)
followed by TAVI under elective circumstances.Methods: Emergency
conditions were defined as: cardiogenic shock with requirement of
catecholamine therapy, severe acute dyspnoea (NYHA IV), cardiac
resuscitation or mechanic respiratory support. The data were collected
according to the Valve Academic Research Consortium 2 (VARC-2)
criteria.Results: In five German centres, 23 patients (logistic Euroscore
37.7%+/-18.1) underwent eTAVI and 118 patients underwent eBAV (logistic
Euroscore 35.3%+/-20.8). In the eTAVI group, immediate procedural
mortality was 8.7%, compared with 20.3% for the eBAV group (p=0.19). After
30 days, cardiovascular mortality for the eTAVI group was 23.8% and for
the eBAV group 33.0% (p=0.40). Analyses adjusting for potential
confounders did not provide evidence of a difference between groups. Of
note, the elective TAVI performed after eBAV (n=32, logistic Euroscore
25.9%+/-13.9) displayed an immediate procedural mortality of 9.4% and a
cardiovascular mortality after 30 days of 15.6%. Major vascular
complications were significantly more likely to occur after eTAVI (p=0.01)
as well as stroke (p=0.01).Conclusion: In this multicentre cohort,
immediate procedural and 30-day mortality of eTAVI and eBAV were high, and
mortality of secondary TAVI subsequent to eBAV was higher than expected.
Randomised study data are required to define the role of emergency TAVI in
tertiary care centres with current device generations.<br/>Copyright
&#xa9; Article author(s) (or their employer(s) unless otherwise stated in
the text of the article) 2017.

<4>
Accession Number
52096872
Author
Mauermann W.J.; Pulido J.N.; Barbara D.W.; Abel M.D.; Li Z.; Meade L.A.;
Schaff H.V.; White R.D.
Institution
(Mauermann, Pulido, Barbara, Abel, Meade) Department of Anesthesiology,
Mayo Clinic, Rochester, Minn, United States
(Li) Department of Biomedical Statistics and Informatics, Mayo Clinic,
Rochester, Minn, United States
(Schaff) Department of Cardiovascular Surgery, Mayo Clinic, Rochester,
Minn, United States
(White) Department of Anesthesiology and Internal Medicine, Mayo Clinic,
Rochester, Minn, United States
Title
Amiodarone versus lidocaine and placebo for the prevention of ventricular
fibrillation after aortic crossclamping: A randomized, double-blind,
placebo-controlled trial.
Source
Journal of Thoracic and Cardiovascular Surgery. 144 (5) (pp 1229-1234),
2012. Date of Publication: November 2012.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objective Ventricular fibrillation occurs commonly after aortic
crossclamping in patients undergoing cardiac surgery. Ventricular
fibrillation increases myocardial oxygen consumption, and defibrillation
may harm the myocardium. Thus, a pharmacologic approach to decreasing the
incidence of ventricular fibrillation or the number of shocks required may
be beneficial. The goal of this study was to evaluate whether amiodarone
or lidocaine was superior to placebo for the prevention of ventricular
fibrillation after aortic crossclamping in patients undergoing a variety
of cardiac surgical procedures. Methods Patients undergoing cardiac
surgery requiring aortic crossclamping were randomized to receive
lidocaine 1.5 mg/kg, amiodarone 300 mg, or placebo before aortic
crossclamp removal The primary outcomes were the incidence of ventricular
fibrillation and the number of shocks required to terminate ventricular
fibrillation. Results A total of 342 patients completed the trial. On
multivariate analysis, there was no difference in the incidence of
ventricular fibrillation among treatment groups. The number of required
shocks was categorized as 0, 1 to 3, and greater than 3. On multivariate
analysis, patients receiving amiodarone required fewer shocks to terminate
ventricular fibrillation (odds ratio, 0.51; 95% confidence interval,
0.31-0.83; P =.008 vs placebo). There was no difference between lidocaine
and placebo in the number of required shocks (odds ratio, 0.86; 95%
confidence interval, 0.52-1.41; P =.541). Conclusions In patients
undergoing a variety of cardiac surgical procedures, neither amiodarone
nor lidocaine reduced the incidence of ventricular fibrillation.
Amiodarone decreased the number of shocks required to terminate
ventricular fibrillation.<br/>Copyright &#xa9; 2012 The American
Association for Thoracic Surgery

<5>
Accession Number
52139430
Author
Sezai A.; Nakai T.; Hata M.; Yoshitake I.; Shiono M.; Kunimoto S.;
Hirayama A.
Institution
(Sezai, Hata, Yoshitake, Shiono) Department of Cardiovascular Surgery,
Nihon University School of Medicine, Tokyo, Japan
(Nakai, Kunimoto, Hirayama) Department of Cardiology, Nihon University
School of Medicine, Tokyo, Japan
Title
Feasibility of landiolol and bisoprolol for prevention of atrial
fibrillation after coronary artery bypass grafting: A pilot study.
Source
Journal of Thoracic and Cardiovascular Surgery. 144 (5) (pp 1241-1248),
2012. Date of Publication: November 2012.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Background We previously performed a trial of intravenous landiolol
hydrochloride during and after cardiac surgery (the PASCAL trial) and
demonstrated a preventive effect on postoperative atrial fibrillation
(AF). In the present study, we investigated the efficacy of increasing the
dose and administration period of landiolol for prevention of
postoperative AF, as well as the effect of oral bisoprolol in the early
postoperative period. Patients and Methods A total of 105 patients who
underwent coronary artery bypass grafting were randomized to 3 groups: a
group receiving intravenous landiolol perioperatively at 5 mug/kg/min for
3 days (group L), a group receiving oral bisoprolol postoperatively
together with landiolol (group LB), and a control group without
beta-blocker therapy (group C). The primary end point was the
presence/absence of postoperative AF. Secondary end points were (1) the
early clinical outcome, (2) hemodynamics, (3) cardiac enzymes (creatine
kinase isoenzyme MB, troponin-I, and human heart fatty acid-binding
protein), (4) high-sensitivity C-reactive protein (hs-CRP) and
pentraxin-3, (5) asymmetric dimethylarginine (ADMA), and (6) brain
natriuretic peptide. Results Postoperative AF occurred in 14.5% of group
L, 9.1% of group LB, and 35.3% of group C. A significant difference was
observed between groups LB and C. Significantly higher levels of
troponin-I, human heart fatty acid-binding protein, hs-CRP, pentraxin-3,
and ADMA were noted in group C than in groups L and LB. Conclusions
Landiolol and bisoprolol prevented postoperative AF. The anti-ischemic,
anti-inflammatory, and anti-oxidant effects of these beta-blockers
presumably inhibited the onset of AF.<br/>Copyright &#xa9; 2012 The
American Association for Thoracic Surgery

<6>
Accession Number
52130988
Author
Amar D.; Zhang H.; Shi W.; Downey R.J.; Bains M.S.; Park B.J.; Flores R.;
Rizk N.; Thaler H.T.; Rusch V.W.
Institution
(Amar, Zhang) Department of Anesthesiology and Critical Care Medicine,
Memorial Sloan-Kettering Cancer Center, New York, NY, United States
(Shi, Thaler) Department of Epidemiology and Biostatistics, Memorial
Sloan-Kettering Cancer Center, New York, NY, United States
(Downey, Bains, Park, Flores, Rizk, Rusch) Department of Surgery, Memorial
Sloan-Kettering Cancer Center, New York, NY, United States
Title
Brain natriuretic peptide and risk of atrial fibrillation after thoracic
surgery.
Source
Journal of Thoracic and Cardiovascular Surgery. 144 (5) (pp 1249-1253),
2012. Date of Publication: November 2012.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives Postoperative atrial fibrillation (POAF) complicating general
thoracic surgery is a marker of increased morbidity and stroke risk. Our
goal was to determine whether increased preoperative brain natriuretic
peptide (BNP) levels are able to stratify patients by the risk of POAF.
Methods Using a prospective database of 415 patients aged 60 years or
older, who had undergone lung or esophageal surgery during a 1-year
period, the preoperative clinical data, including BNP levels, were
compared between patients who developed POAF lasting longer than 5 minutes
during hospitalization and those who did not. Results POAF occurred in 65
(16%) of the 415 patients and was more frequent among patients who had
undergone esophagectomy or anatomic lung resection (22% or 58 of 269)
compared with those who did not (5% or 7 of 146; P <.0001). After
esophagectomy or anatomic lung resection, 46 (34%) of the 135 patients
with BNP levels greater than the median (>=30 pg/mL) developed POAF
compared with only 12 (9%) of 134 patients with BNP levels less than 30
pg/mL (P <.0001). The rates of POAF in patients undergoing other thoracic
procedures were low and not associated with the BNP levels. Multivariate
logistic regression analysis showed that in patients undergoing
esophagectomy or anatomic lung resection, older age (5-year increments,
odds ratio [OR], 1.28; 95% confidence interval [CI], 1.01-1.61; P =.04),
male gender (OR, 2.61; 95% CI, 1.12-4.17; P =.02), and BNP level 30 pg/mL
or greater (OR, 4.52; 95% CI, 2.19-9.32; P <.0001) were independent risk
factors for POAF. The length of hospital stay was significantly increased
in patients who developed POAF compared with those who did not (P <.0001).
Conclusions Among patients undergoing anatomic lung resection or
esophagectomy, increased age, male gender, and preoperative BNP level of
30 pg/mL or greater were significant risk factors for the development of
POAF. The identification of patients who are more likely to develop POAF
will allow the development of trials assessing prevention strategies aimed
at reducing this complication.<br/>Copyright &#xa9; 2012 The American
Association for Thoracic Surgery

<7>
Accession Number
610556178
Author
Papachristofi O.; Jenkins D.; Sharples L.D.
Institution
(Papachristofi) MRC Biostatistics Unit, Robinson Way CB4 3EU, Cambridge,
United Kingdom
(Papachristofi, Sharples) University of Leeds, Comprehensive Health
Research Division, Leeds Institute of Clinical Trials Research, 71-75
Clarendon Road, Leeds LS2 9PH, United Kingdom
(Jenkins) Departments of Surgery, Anaesthesia and Clinical Audit, Papworth
Hospital, CB23 8RE, Cambridge, United Kingdom
Title
Assessment of learning curves in complex surgical interventions: A
consecutive case-series study.
Source
Trials. 17 (1) (no pagination), 2016. Article Number: 266. Date of
Publication: 01 Jun 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Surgical interventions are complex, which complicates their
rigorous assessment through randomised clinical trials. An important
component of complexity relates to surgeon experience and the rate at
which the required level of skill is achieved, known as the learning
curve. There is considerable evidence that operator performance for
surgical innovations will change with increasing experience. Such learning
effects complicate evaluations; the start of the trial might be delayed,
resulting in loss of surgeon equipoise or, if an assessment is undertaken
before performance has stabilised, the true impact of the intervention may
be distorted. Methods: Formal estimation of learning parameters is
necessary to characterise the learning curve, model its evolution and
adjust for its presence during assessment. Current methods are either
descriptive or model the learning curve through three main features: the
initial skill level, the learning rate and the final skill level achieved.
We introduce a fourth characterising feature, the duration of the learning
period, which provides an estimate of the point at which learning has
stabilised. We propose a two-phase model to estimate formally all four
learning curve features. Results: We demonstrate that the two-phase model
can be used to estimate the end of the learning period by incorporating a
parameter for estimating the duration of learning. This is achieved by
breaking down the model into a phase describing the learning period and
one describing cases after the final skill level is reached, with the
break point representing the length of learning. We illustrate the method
using cardiac surgery data. Conclusions: This modelling extension is
useful as it provides a measure of the potential cost of learning an
intervention and enables statisticians to accommodate cases undertaken
during the learning phase and assess the intervention after the optimal
skill level is reached. The limitations of the method and implications for
the optimal timing of a definitive randomised controlled trial are also
discussed.<br/>Copyright &#xa9; 2016 Papachristofiet al.

<8>
Accession Number
611504207
Author
Andreou I.; Takahashi S.; Tsuda M.; Shishido K.; Antoniadis A.P.;
Papafaklis M.I.; Mizuno S.; Coskun A.U.; Saito S.; Feldman C.L.; Edelman
E.R.; Stone P.H.
Institution
(Andreou, Antoniadis, Papafaklis, Feldman, Edelman, Stone) Cardiovascular
Division, Brigham and Women's Hospital, Harvard Medical School, Boston,
MA, United States
(Andreou, Edelman) Institute for Medical Engineering and Science,
Massachusetts Institute of Technology, Cambridge, MA, United States
(Takahashi, Shishido, Mizuno, Saito) Department of Cardiovascular
Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
(Tsuda) Department of Cardiovascular Medicine, Hokkaido University,
Sapporo, Japan
(Coskun) Mechanical and Industrial Engineering, Northeastern University,
Boston, MA, United States
Title
Atherosclerotic plaque behind the stent changes after bare-metal and
drug-eluting stent implantation in humans: Implications for late stent
failure?.
Source
Atherosclerosis. 252 (pp 9-14), 2016. Date of Publication: 01 Sep 2016.
Publisher
Elsevier Ireland Ltd
Abstract
Background and aims The natural history and the role of atherosclerotic
plaque located behind the stent (PBS) are still poorly understood. We
evaluated the serial changes in PBS following bare-metal (BMS) compared to
first-generation drug-eluting stent (DES) implantation and the impact of
these changes on in-stent neointimal hyperplasia (NIH). Methods
Three-dimensional coronary reconstruction by angiography and intravascular
ultrasound was performed after intervention and at 6-10-month follow-up in
157 patients with 188 lesions treated with BMS (n = 89) and DES (n = 99).
Results There was a significant decrease in PBS area (-7.2%; p < 0.001)
and vessel area (-1.7%; p < 0.001) after BMS and a respective increase in
both areas after DES implantation (6.1%; p < 0.001 and 4.1%; p < 0.001,
respectively). The decrease in PBS area significantly predicted neointimal
area at follow-up after BMS (beta: 0.15; 95% confidence interval [CI]:
0.10-0.20, p < 0.001) and DES (beta: 0.09; 95% CI: 0.07-0.11; p < 0.001)
implantation. The decrease in PBS area was the most powerful predictor of
significant NIH after BMS implantation (odds ratio: 1.13; 95% CI:
1.02-1.26; p = 0.02). Conclusions The decrease in PBS area after stent
implantation is significantly associated with the magnitude of NIH
development at follow-up. This finding raises the possibility of a
communication between the lesion within the stent and the underlying
native atherosclerotic plaque, and may have important implications
regarding the pathobiology of in-stent restenosis and late/very late stent
thrombosis.<br/>Copyright &#xa9; 2016 Elsevier Ireland Ltd

<9>
Accession Number
613098652
Author
Grupper A.; Nativi-Nicolau J.; Maleszewski J.J.; Geske J.R.; Kremers W.K.;
Edwards B.S.; Kushwaha S.S.; Pereira N.L.
Institution
(Grupper, Nativi-Nicolau, Maleszewski, Edwards, Kushwaha, Pereira)
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota,
United States
(Maleszewski) Division of Anatomic Pathology, Mayo Clinic, Rochester,
Minnesota, United States
(Geske, Kremers) Division of Biomedical Statistics and Informatics, Mayo
Clinic, Rochester, Minnesota, United States
Title
Circulating Galectin-3 Levels Are Persistently Elevated After Heart
Transplantation and Are Associated With Renal Dysfunction.
Source
JACC: Heart Failure. 4 (11) (pp 847-856), 2016. Date of Publication: 01
Nov 2016.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives This study evaluated changes in serum levels of galectin
(Gal)-3 before and after heart transplantation (HTx) and assessed the role
of pre-HTx Gal-3 as a biomarker for post-HTx outcomes. Background Gal-3 is
a novel biomarker that reflects cardiac remodeling and fibrosis. Elevated
serum Gal-3 levels are associated with poor prognosis in heart failure
patients. Whether Gal-3 levels change following HTx and the significance
of post-HTx outcomes are unknown. Methods Serum Gal-3 levels were measured
in 62 patients at 118 days (Interquartile Range [IQR]: 23 to 798 days)
before and 365 days (IQR: 54 to 767 days) post HTx. Cardiac tissue taken
during routine post-HTx endomyocardial biopsy was evaluated to assess the
correlation between tissue Gal-3 staining and serum Gal-3 levels and with
the presence of myocardial hypertrophy and fibrosis. Results Serum Gal-3
levels remained significantly elevated (>17.8 ng/ml) in 35 patients (56%)
post HTx. There was a significant inverse correlation between Gal-3 levels
and glomerular filtration rate measured before and after HTx (p > 0.005).
There was no association between Gal-3 serum level and Gal-3 staining of
myocardial tissue or with the presence of myocyte hypertrophy and
interstitial fibrosis post HTx. Elevated pre-HTx Gal-3 levels were
associated with reduced post-HTx exercise capacity, but this association
was not significant after adjustment for age, body mass index, and
glomerular filtration rate. Conclusions This is the first study to
demonstrate the fact that Gal-3 levels remain elevated in the majority of
patients despite HTx and is associated with renal dysfunction. Our
findings suggest Gal-3 is a systemic rather than cardiac-specific
biomarker.<br/>Copyright &#xa9; 2016 American College of Cardiology
Foundation

<10>
Accession Number
369592411
Author
Thielmann M.; Kottenberg E.; Kleinbongard P.; Wendt D.; Gedik N.; Pasa S.;
Price V.; Tsagakis K.; Neuhauser M.; Peters J.; Jakob H.; Heusch G.
Institution
(Thielmann, Wendt, Pasa, Price, Tsagakis, Jakob) Department of Thoracic
and Cardiovascular Surgery, Universitatsklinikum Essen, Essen, Germany
(Kottenberg, Peters) Klinik Fur Anasthesiologie und Intensivmedizin,
Universitatsklinikum Essen, Essen, Germany
(Kleinbongard, Gedik, Heusch) Institut Fur Pathophysiologie,
Universitatsklinikum Essen, Hufelandstrasse 55, 45122 Essen, Germany
(Neuhauser) Department of Mathematics and Technology, Koblenz University
of Applied Science, Remagen, Germany
Title
Cardioprotective and prognostic effects of remote ischaemic
preconditioning in patients undergoing coronary artery bypass surgery: A
single-centre randomised, double-blind, controlled trial.
Source
The Lancet. 382 (9892) (pp 597-604), 2013. Date of Publication: 2013.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Background Remote ischaemic preconditioning has been associated with
reduced risk of myocardial injury after coronary artery bypass graft
(CABG) surgery. We investigated the safety and efficacy of this procedure.
Methods Eligible patients were those scheduled to undergo elective
isolated first-time CABG surgery under cold crystalloid cardioplegia and
cardiopulmonary bypass at the West-German Heart Centre, Essen, Germany,
between April, 2008, and October, 2012. Patients were prospectively
randomised to receive remote ischaemic preconditioning (three cycles of 5
min ischaemia and 5 min reperfusion in the left upper arm after induction
of anaesthesia) or no ischaemic preconditioning (control). The primary
endpoint was myocardial injury, as reflected by the geometric mean area
under the curve (AUC) for perioperative concentrations of cardiac troponin
I (cTnI) in serum in the first 72 h after CABG. Mortality was the main
safety endpoint. Analysis was done in intention-to-treat and per-protocol
populations. This trial is registered with ClinicalTrials.gov, number
NCT01406678. Findings 329 patients were enrolled. Baseline characteristics
and perioperative data did not differ between groups. cTnI AUC was 266
ng/mL over 72 h (95% CI 237-298) in the remote ischaemic preconditioning
group and 321 ng/mL (287-360) in the control group. In the
intention-to-treat population, the ratio of remote ischaemic
preconditioning to control for cTnI AUC was 0.83 (95% CI 0.70-0.97,
p=0.022). cTnI release remained lower in the per-protocol analysis (0.79,
0.66-0.94, p=0.001). All-cause mortality was assessed over 1.54 (SD 1.22)
years and was lower with remote ischaemic preconditioning than without
(ratio 0.27, 95% CI 0.08-0.98, p=0.046). Interpretation Remote ischaemic
preconditioning provided perioperative myocardial protection and improved
the prognosis of patients undergoing elective CABG surgery.

<11>
Accession Number
619813635
Author
Penk J.S.; Lefaiver C.A.; Brady C.M.; Steffensen C.M.; Wittmayer K.
Institution
(Penk, Lefaiver, Brady, Steffensen, Wittmayer) Department of Pediatrics,
Advocate Children's Hospital, Oak Lawn, IL, United States
Title
Intermittent Versus Continuous and Intermittent Medications for Pain and
Sedation after Pediatric Cardiothoracic Surgery; A Randomized Controlled
Trial.
Source
Critical Care Medicine. 46 (1) (pp 123-129), 2018. Date of Publication: 01
Jan 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objectives: Compare continuous infusions of morphine and midazolam in
addition to intermittent doses with an intermittent only strategy for pain
and sedation after pediatric cardiac surgery. Design: Randomized
controlled trial. Setting: Advocate Children's Hospital, Oak Lawn, IL.
Patients: Sixty patients 3 months to 4 years old with early extubation
after pediatric cardiac surgery. Interventions: Patients received a
continuous infusion of morphine and midazolam or placebo for 24 hours.
Both groups received intermittent morphine and midazolam doses as needed.
Measurements and Main Results: Gender, age, bypass time, and surgical
complexity were not different between groups. Scheduled ketorolac and
acetaminophen were used in both groups and were not associated with
adverse events. The mean, median, and maximum Faces, Legs, Activity, Cry,
And Consolability score were not different between groups. There was no
significant difference in number of intermittent doses received between
groups. The total morphine dose was higher in the continuous/intermittent
group (0.90 vs 0.23 mg/kg; p < 0.01). The total midazolam dose was also
higher in the continuous/intermittent group (0.90 vs 0.18 mg/kg; p <
0.01). The hospital length of stay was longer in the
continuous/intermittent group (8.4 vs 4.9 d; p = 0.04). Conclusions: Pain
was not better controlled with the addition of continuous infusions of
morphine and midazolam when compared with intermittent dosing only. Use of
continuous infusions resulted in a significantly higher total dosage of
these medications and a longer length of stay.<br/>Copyright &#xa9; 2017
by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.
All Rights Reserved.

<12>
Accession Number
619813611
Author
Hassan N.A.; Awdallah F.F.; Abbassi M.M.; Sabry N.A.
Institution
(Hassan) Clinical Pharmacy, National Heart Institute, Giza, Egypt
(Awdallah) Critical Care Department, National Heart Institute, Giza, Egypt
(Abbassi, Sabry) Clinical Pharmacy Department, Faculty of Pharmacy, Cairo
University, Cairo, Egypt
Title
Nebulized Versus IV Amikacin as Adjunctive Antibiotic for Hospital and
Ventilator-Acquired Pneumonia Postcardiac Surgeries: A Randomized
Controlled Trial.
Source
Critical Care Medicine. 46 (1) (pp 45-52), 2018. Date of Publication: 01
Jan 2018.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
Objective: Nebulized antibiotics offer high efficacy due to significant
local concentrations and safety with minimal blood levels. This study
evaluates the efficacy and nephrotoxicity of nebulized versus IV amikacin
in postcardiothoracic surgical patients with nosocomial pneumonia caused
by multidrug-resistant Gram-negative bacilli. Design: Prospective,
randomized, controlled study on surgical patients divided into two groups.
Setting: Postcardiac surgery ICU. Interventions: The first gtroup was
administered IV amikacin 20 mg/kg once daily. The second group was
prescribed amikacin nebulizer 400 mg twice daily. Both groups were
co-administered IV piperacillin/tazobactam empirically. Patients:
Recruited patients were diagnosed by either hospital-acquired pneumonia or
ventilator-associated pneumonia where 56 (42.1%) patients were diagnosed
with hospital-acquired pneumonia, 51 (38.34%) patients were diagnosed with
early ventilator-associated pneumonia, and 26 (19.54%) patients with late
ventilator-associated pneumonia. Measurements and Main Results: Clinical
cure in both groups assessed on day 7 of treatment was the primary
outcome. Efficacy was additionally evaluated through assessing the length
of hospital stay, ICU stay, days on amikacin, days on mechanical
ventilator, mechanical ventilator-free days, days to reach clinical cure,
and mortality rate. Lower nephrotoxicity in the nebulized group was
observed through significant preservation of kidney function (p < 0.001).
Although both groups were comparable regarding length of hospital stay,
nebulizer group showed shorter ICU stay (p = 0.010), lower number of days
to reach complete clinical cure (p = 0.001), fewer days on mechanical
ventilator (p = 0.035), and fewer days on amikacin treatment (p = 0.022).
Conclusion: Nebulized amikacin showed better clinical cure rates, less ICU
stay, and fewer days to reach complete recovery compared to IV amikacin
for surgical patients with nosocomial pneumonia. It is also a less
nephrotoxic option associated with less deterioration in kidney
function.<br/>Copyright &#xa9; 2017 by the Society of Critical Care
Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

<13>
Accession Number
619679635
Author
Gupta A.; Bajaj N.S.; Arora P.; Arora G.; Qamar A.; Bhatt D.L.
Institution
(Gupta, Bajaj, Qamar, Bhatt) Heart and Vascular Center, Brigham and
Women's Hospital, Harvard Medical School, Boston, MA, United States
(Arora, Arora) Division of Cardiovascular Disease, Department of Medicine,
The University of Alabama at Birmingham, Birmingham, AL, United States
(Arora) Section of Cardiology, Birmingham Veterans Affairs Medical Center,
Birmingham, AL, United States
Title
FFR-guided multivessel stenting reduces urgent revascularization compared
with infarct-related artery only stenting in ST-elevation myocardial
infarction: A meta-analysis of randomized controlled trials.
Source
International Journal of Cardiology. 252 (pp 63-67), 2018. Date of
Publication: 01 Feb 2018.
Publisher
Elsevier Ireland Ltd
Abstract
Background Randomized controlled trials (RCTs) have shown fractional flow
reserve-guided (FFR) multivessel stenting to be superior to
infarct-related artery (IRA) only stenting in patients with ST-elevation
myocardial infarction (STEMI) and multivessel disease. This effect was
mainly driven by a reduction in overall repeat revascularization. However,
the ability to assess the effect of this strategy on urgent
revascularization or reinfarction was underpowered in individual trials.
Methods We searched Pubmed, EMBASE, Cochrane CENTRAL, and Web of Science
for RCTs of FFR-guided multivessel stenting versus IRA-only stenting in
STEMI with multivessel disease. The outcomes of interest were death,
reinfarction, urgent, and non-urgent repeat revascularization. Risk ratios
(RR) were pooled using the DerSimonian and Laird random-effects model.
Results After review of 786 citations, 2 RCTs were included. The pooled
results demonstrated a significant reduction in the composite of death,
reinfarction, or revascularization in the FFR-guided multivessel stenting
group versus IRA-only stenting group (RR [95%, Confidence Interval]: 0.49
[0.33-0.72], p < 0.001). This risk reduction was driven mainly by a
reduction in repeat revascularization, both urgent (0.41 [0.24-0.71], p =
0.002) and non-urgent revascularization (0.31 [0.19-0.50], p < 0.001).
Pooled RR for reinfarction was lower in the FFR-guided strategy, but was
not statistically significant (0.71[0.39-1.31], p = 0.28). Conclusions
This systematic review and meta-analysis suggests that a strategy of
FFR-guided multivessel stenting in STEMI patients reduces not only overall
repeat revascularization but also urgent revascularization. The effect on
reinfarction needs to be evaluated in larger trials.<br/>Copyright &#xa9;
2017 Elsevier Ireland Ltd

<14>
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.

<15>
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.

<16>
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).

<17>
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.

<18>
Accession Number
619714357
Author
Schulman-Marcus J.; Lin F.Y.; Gransar H.; Berman D.; Callister T.; DeLago
A.; Hadamitzky M.; Hausleiter J.; Al-Mallah M.; Budoff M.; Kaufmann P.;
Achenbach S.; Raff G.; Chinnaiyan K.; Cademartiri F.; Maffei E.; Villines
T.; Kim Y.-J.; Leipsic J.; Feuchtner G.; Rubinshtein R.; Pontone G.;
Andreini D.; Marques H.; Chang H.-J.; Chow B.J.W.; Cury R.C.; Dunning A.;
Shaw L.; Min J.K.
Institution
(Schulman-Marcus) Division of Cardiology, Albany Medical College, Albany,
NY, United States
(Lin, Min) Dalio Institute of Cardiovascular Imaging, Weill Cornell
Medical College, New York Presbyterian Hospital, New York, NY, United
States
(Gransar, Berman) Department of Imaging, Cedars-Sinai Medical Center, Los
Angeles, CA, United States
(Callister) Tennessee Heart and Vascular Institute, Hendersonville, TN,
United States
(DeLago) Capital Cardiology Ass., Albany, NY, United States
(Hadamitzky, Hausleiter) Division of Cardiology, Deutsches Herzzentrum
Munchen, Munich, Germany
(Al-Mallah) King Saud Bin Abdul Aziz University for Health Sciences, King
Abdullah International Medical Research Center, King Abdul Aziz Cardiac
Center, Ministry of National Guard Health Affairs, Saudi Arabia
(Budoff) Department of Medicine, Harbor UCLA Medical Center, Los Angeles,
CA, United States
(Kaufmann) University Hospital, Zurich, Switzerland
(Achenbach) Department of Medicine, University of Erlangen, Erlangen,
Germany
(Raff) William Beaumont Hospital, Royal Oaks, MI, United States
(Chinnaiyan, Cademartiri, Maffei) Cardiovascular Imaging Unit, Giovanni
XXIII Hospital, Monastier, Treviso, Italy
(Villines) Department of Medicine, Walter Reed Medical Center, Washington,
DC, United States
(Kim) Seoul National University Hospital, Seoul, South Korea
(Leipsic) Department of Medicine and Radiology, University of British
Columbia, Vancouver, BC, Canada
(Feuchtner) Department of Radiology, Medical University of Innsbruck,
Innsbruck, Austria
(Rubinshtein) Department of Cardiology, Lady Davis Carmel Medical Center,
Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel
(Pontone, Andreini) Department of Clinical Sciences and Community Health,
University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy
(Marques) Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
(Chang) Division of Cardiology, Severance Cardiovascular Hospital, Seoul,
South Korea
(Chow) Department of Medicine and Radiology, University of Ottawa, ON,
Canada
(Cury) Baptist Cardiac and Vascular Institute, Miami, FL, United States
(Dunning) Duke Clinical Research Institute, Durham, NC, United States
(Shaw) Division of Cardiology, Emory University School of Medicine,
Atlanta, GA, United States
Title
Coronary revascularization vs. medical therapy following coronary-computed
tomographic angiography in patients with low-, intermediateand high-risk
coronary artery disease: Results from the CONFIRM long-term registry.
Source
European Heart Journal Cardiovascular Imaging. 18 (8) (pp 841-848), 2017.
Date of Publication: 01 Aug 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Aims To identify the effect of early revascularization on 5-year survival
in patients with CAD diagnosed by coronarycomputed tomographic angiography
(CCTA). Methods and results We examined 5544 stable patients with
suspected CAD undergoing CCTA who were followed a median of 5.5 years in a
large international registry. Patients were categorized as having low-,
intermediate-, or high-risk CAD based on CCTA findings. Two treatment
groups were defined: early revascularization within 90 days of CCTA (n =
1171) and medical therapy (n = 4373). To account for the non-randomized
referral to revascularization, we developed a propensity score by logistic
regression. This score was incorporated into Cox proportional hazard
models to calculate the effect of revascularization on all-cause
mortality. Death occurred in 363 (6.6%) patients and was more frequent in
medical therapy. In multivariable models, when compared with medical
therapy, the mortality benefit of revascularization varied significantly
over time and by CAD risk (P for interaction 0.04). In high-risk CAD,
revascularization was significantly associated with lower mortality at 1
year (hazard ratio [HR] 0.22, 95% confidence interval [CI] 0.11-0.47) and
5 years (HR 0.31, 95% CI 0.18-0.54). For intermediate-risk CAD,
revascularization was associated with reduced mortality at 1 year (HR
0.45, 95% CI 0.22-0.93) but not 5 years (HR 0.63, 95% CI 0.33-1.20). For
low-risk CAD, there was no survival benefit at either time point.
Conclusions Early revascularization was associated with reduced 1-year
mortality in intermediate-and high-risk CAD detected by CCTA, but this
association only persisted for 5-year mortality in high-risk
CAD.<br/>Copyright &#xa9; 2017 The Author.

<19>
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.

<20>
Accession Number
619724580
Author
Okrainec K.; Lau D.; Abrams H.B.; Hahn-Goldberg S.; Brahmbhatt R.; Huynh
T.; Lam K.; Bell C.M.
Institution
(Okrainec, Abrams) University Health Network, Toronto, ON, Canada
(Okrainec, Abrams, Lam, Bell) Department of Medicine, University of
Toronto, ON, Canada
(Okrainec, Abrams, Hahn-Goldberg, Brahmbhatt, Huynh) OpenLab, University
Health Network, Toronto, ON, Canada
(Lau, Bell) Samuel Lunenfeld Research Institute, Mount Sinai Hospital,
Toronto, ON, Canada
(Bell) University of Toronto Institute of Health Policy, Management and
Evaluation, ON, Canada
(Bell) Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
Title
Impact of patient-centered discharge tools: A systematic review.
Source
Journal of Hospital Medicine. 12 (2) (pp 110-117), 2017. Date of
Publication: February 2017.
Publisher
Society of hospital medicine (E-mail: jhospitalmedicine@jjeditorial.com)
Abstract
BACKGROUND: Patient-centered discharge tools provide an opportunity to
engage patients, enhance patient understanding, and improve capacity for
self-care and postdischarge outcomes. PURPOSE: To review studies that
engaged patients in the design or delivery of discharge instruction tools
and that tested their effect among hospitalized patients. DATA SOURCES: We
conducted a search of 12 databases and journals from January 1994 through
May 2014, and references of retrieved studies. STUDY SELECTION:
English-language studies that tested discharge tools meant to engage
patients were selected. Studies that measured outcomes after 3 months or
without a control group or period were excluded. DATA EXTRACTION: Two
independent reviewers assessed the full-text papers and extracted data on
features of patient engagement. DATA SYNTHESIS: Thirty articles met
inclusion criteria, 28 of which examined educational tools. Of these, 13
articles involved patients in content creation or tool delivery, with only
6 studies involving patients in both. While many of these studies (10
studies) demonstrated an improvement in patient comprehension, few studies
found improvement in patient adherence despite their engagement. A few
studies demonstrated an improvement in self-efficacy (2 studies) and a
reduction in unplanned visits (3 studies). CONCLUSIONS: Improving patient
engagement through the use of media, visual aids, or by involving patients
when creating or delivering a discharge tool improves comprehension.
However, further studies are needed to clarify the effect on patient
experience, adherence, and healthcare utilization postdischarge. Better
characterization of the level of patient engagement when designing
discharge tools is needed given the heterogeneity found in current
studies.<br/>Copyright &#xa9; 2017 Society of Hospital Medicine.

<21>
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.

<22>
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

<23>
Accession Number
619678566
Author
Lee T.F.; Burt M.G.; Heilbronn L.K.; Mangoni A.A.; Wong V.W.; McLean M.;
Cheung N.W.
Institution
(Lee, Burt, Mangoni) Flinders University, School of Medicine, Adelaide,
Australia
(Lee, Burt) Repatriation General Hospital, Southern Adelaide Diabetes and
Endocrine Services, Daw Park, Adelaide, SA 5041, Australia
(Heilbronn) The University of Adelaide, Adelaide, Australia
(Wong, McLean, Cheung) Westmead Hospital, Centre for Diabetes and
Endocrinology Research, Sydney, Australia
Title
Relative hyperglycemia is associated with complications following an acute
myocardial infarction: A post-hoc analysis of HI-5 data.
Source
Cardiovascular Diabetology. 16 (1) (no pagination), 2017. Article Number:
157. Date of Publication: 12 Dec 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Hyperglycemia is associated with increased morbidity and
mortality in patients with an acute myocardial infarction (AMI). We
evaluated whether complications after AMI are associated with absolute or
relative glycemia. Methods: A total of 192 patients with AMI were
randomized to intensive or conventional insulin therapy. Absolute glycemia
was defined as mean blood glucose level (BGL) during the first 24 h
following randomization. Relative glycemia was defined by the stress
hyperglycaemia ratio (SHR), calculated as mean BGL divided by average
glucose concentration over the prior 3 months estimated from glycosylated
haemoglobin. The primary endpoint was a "complicated AMI", defined as an
AMI complicated by death, congestive cardiac failure, arrhythmia, cardiac
arrest, reinfarction, cardiogenic shock, inotrope use or emergency
revascularization. Results: There was not a significant association
between mean BGL and complicated AMI (odds ratio (OR) 1.05 per mmol/L
glucose increment, 95% confidence intervals (CI) 0.93-1.19). In contrast,
SHR was positively associated with a complicated myocardial infarction (OR
1.22 per 0.1 SHR increment, 95% CI 1.06-1.42), and individual
complications of death (OR 1.55, 95% CI 1.14-2.11), congestive cardiac
failure (OR 1.27, 95% CI 1.05-1.54), arrhythmia (OR 1.31, 95% CI
1.12-1.54) and cardiogenic shock (OR 1.42, 95% CI 1.03-1.97). The
relationship between SHR and a complicated AMI was independent of diabetic
status, intensive insulin therapy, sex and hypoglycemia. Conclusions:
Relative, but not absolute, glycemia during insulin treatment is
independently associated with complications after an AMI. Future studies
should investigate whether basing therapeutic glycaemic targets on
relative glycemia improves patient outcomes.<br/>Copyright &#xa9; 2017 The
Author(s).

<24>
Accession Number
615824135
Author
Cordero E.; Roca-Oporto C.; Bulnes-Ramos A.; Aydillo T.; Gavalda J.;
Moreno A.; Torre-Cisneros J.; Montejo J.M.; Fortun J.; Munoz P.; Sabe N.;
Farinas M.C.; Blanes-Julia M.; Lopez-Medrano F.; Suarez-Benjumea A.;
Martinez-Atienza J.; Rosso-Fernandez C.; Perez-Romero P.
Institution
(Cordero, Roca-Oporto, Bulnes-Ramos, Aydillo, Martinez-Atienza,
Rosso-Fernandez, Perez-Romero) Clinical Unit of Infectious
Diseases,Microbiology and Preventive Medicine, Institute of Biomedicine of
Seville, University Hospitals Virgen Del Rocio, CSIC, University of
Seville, Avda Manuel Siurot s/n, Sevilla 41013, Spain
(Gavalda) Vall d'Hebron University Hospital, Barcelona, Spain
(Moreno) University Clinic Hospital, Barcelona, Spain
(Torre-Cisneros) Maimonides Biomedical Research Institute of Cordoba,
Reina Sofia University Hospital, University of Cordoba, Spain
(Montejo) Cruces University Hospital, Bizkaia, Spain
(Fortun) University Hospital Ramon y Cajal, Madrid, Spain
(Munoz) Gregorio Maranon University Hospital, Instituto de Investigacion
Sanitaria Hospital Gregorio Maranon, CIBER Enfermedades
Respiratorias-CIBERES, Department of Medicine, School of Medicine,
Universidad Complutense de Madrid, Madrid, Spain
(Sabe) University Hospital of Bellvitge, Infectious Diseases Research
Group, L'Hospitalet de Llobregat, Barcelona, Spain
(Farinas) University Hospital Marques de Valdecilla, Santander, Spain
(Blanes-Julia) University Hospital la Fe, Valencia, Spain
(Lopez-Medrano) University Hospital 12 de Octubre, Instituto de
Investigacion Biomedica I+12, Madrid, Spain
(Suarez-Benjumea) University Hospital Virgen Macarena, Seville, Spain
Title
Two doses of inactivated influenza vaccine improve immune response in
solid organ transplant recipients: Results of TRANSGRIPE 1-2, a randomized
controlled clinical trial.
Source
Clinical Infectious Diseases. 64 (7) (pp 829-838), 2017. Date of
Publication: 01 Apr 2017.
Publisher
Oxford University Press (E-mail: jnl.info@oup.co.uk)
Abstract
Background. Influenza vaccine effectiveness is not optimal in solid organ
transplant recipients (SOTR). We hypothesized that a booster dose might
increase it. Methods. TRANSGRIPE 1-2 is a phase 3, randomized, controlled,
multicenter, open-label clinical trial. Patients were randomly assigned
(1:1 stratified by study site, type of organ, and time since
transplantation) to receive 1 dose (control group) or 2 doses (booster
group) of the influenza vaccine 5 weeks apart. Results. A total of 499
SOTR were enrolled. Although seroconversion at 10 weeks did not meet
significance in the modified intention-to-treat population, seroconversion
rates were significantly higher in the booster arm for the per-protocol
population (53.8% vs 37.6% for influenza A(H1N1)pdm; 48.1% vs 32.3% for
influenza A(H3N2); and 90.7% vs 75% for influenza B; P < .05).
Furthermore, seroprotection at 10 weeks was higher in the booster group:
54% vs 43.2% for A(H1N1)pdm; 56.9% vs 45.5% for A(H3N2); and 83.4% vs
71.8% for influenza B (P < .05). The number needed to treat to seroprotect
1 patient was <10. The clinical efficacy (99.2% vs 98.8%) and serious
adverse events (6.4% vs 7.5%) were similar for both groups. Conclusions.
In SOTR, a booster strategy 5 weeks after standard influenza vaccination
is safe and effective and induces an increased antibody response compared
with standard influenza vaccination consisting of a single
dose.<br/>Copyright &#xa9; The Author 2017. Published by Oxford University
Press for the Infectious Diseases Society of America.

<25>
Accession Number
615250695
Author
Whiting P.; Morden A.; Tomlinson L.A.; Caskey F.; Blakeman T.; Tomson C.;
Stone T.; Richards A.; Savovic J.; Horwood J.
Institution
(Whiting, Morden, Stone, Richards, Savovic, Horwood) Natl. Inst. for Hlth.
Research Collaboration for Leadership in Applied Health Research and Care
West, University Hospitals Bristol NHS Foundation Trust, Bristol, United
Kingdom
(Whiting, Morden, Caskey, Stone, Richards, Savovic, Horwood) School of
Social and Community Medicine, University of Bristol, Bristol, United
Kingdom
(Tomlinson, Caskey) UK Renal Registry, Bristol, United Kingdom
(Tomlinson) Department of Non-communicable Disease Epidemiology, London
School of Hygiene and Tropical Medicine, London, United Kingdom
(Blakeman) Centre for Primary Care, Institute of Population Health,
University of Manchester, Manchester, United Kingdom
(Blakeman) Natl. Inst. for Hlth. Res. Collaboration for Leadership in
Appl. Hlth. Res. and Care Gtr. Manchester, Centre for Primary Care,
University of Manchester, Manchester, United Kingdom
(Tomson) Department of Renal Medicine, Freeman Hospital, Newcastle Upon
Tyne Hospitals Foundation Trust, Tyne and Wear, United Kingdom
Title
What are the risks and benefits of temporarily discontinuing medications
to prevent acute kidney injury? A systematic review and meta-Analysis.
Source
BMJ Open. 7 (4) (no pagination), 2017. Article Number: e012674. Date of
Publication: 01 Apr 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objectives To summarise evidence on temporary discontinuation of
medications to prevent acute kidney injury (AKI). Design Systematic review
and meta-Analysis of randomised and non-randomised studies. Participants
Adults taking diuretics, ACE inhibitors (ACEI), angiotensin receptor
blockers (ARB), direct renin inhibitors, non-steroidal
anti-inflammatories, metformin or sulfonylureas, experiencing intercurrent
illnesses, radiological or surgical procedures. Interventions Temporary
discontinuation of any of the medications of interest. Primary and
secondary outcome measures Risk of AKI. Secondary outcome measures were
estimated glomerular filtration rate and creatinine post-AKI, urea,
systolic and diastolic blood pressure, death, clinical outcomes and
biomarkers. Results 6 studies were included (1663 participants), 3
randomised controlled trials (RCTs) and 3 prospective cohort studies. The
mean age ranged from 65 to 73a ..years, and the proportion of women ranged
from 31% to 52%. All studies were in hospital settings; 5 evaluated
discontinuation of medication prior to coronary angiography and 1 prior to
cardiac surgery. 5 studies evaluated discontinuation of ACEI and ARBs and
1 small cohort study looked at discontinuation of non-steroidal
anti-inflammatory drugs. No studies evaluated discontinuation of
medication in the community following an acute intercurrent illness. There
was an increased risk of AKI of around 15% in those in whom medication was
continued compared with those in whom it was discontinued (relative risk
(RR) 1.17, 95% CI 0.99 to 1.38; 5 studies). When only results from RCTs
were pooled, the increase in risk was almost 50% (RR 1.48, 95% CI 0.84 to
2.60; 3 RCTs), but the CI was wider. There was no difference between
groups for any secondary outcomes. Conclusions There is low-quality
evidence that withdrawal of ACEI/ARBs prior to coronary angiography and
cardiac surgery may reduce the incidence of AKI. There is no evidence of
the impact of drug cessation interventions on AKI incidence during
intercurrent illness in primary or secondary care. Trial registration
number PROSPERO CRD42015023210.<br/>Copyright &#xa9; Published by the BMJ
Publishing Group Limited. For permission to use (where not already granted
under a licence) please go to
http://www.bmj.com/company/products-services/rights-And-licensing/.

<26>
Accession Number
616331806
Author
Petr X.O.; Brinjikji W.; Murad M.H.; Glodny B.; Lanzino G.
Institution
(Petr, Lanzino) Department of Neurologic Surgery, Mayo Clinic, 200 1st St
SW, Rochester, MN 55905, United States
(Brinjikji, Lanzino) Department of Radiology, Mayo Clinic, Rochester, MN,
United States
(Murad) Division of Preventive Medicine, Mayo Clinic, Rochester, MN,
United States
(Glodny) Department of Radiology, Medical University Innsbruck, Innsbruck,
Austria
(Petr) Department of Neurosurgery, Medical University Innsbruck,
Innsbruck, Austria
Title
Selective-versus-standard poststent dilation for carotid artery disease: A
systematic review and meta-analysis.
Source
American Journal of Neuroradiology. 38 (5) (pp 999-1005), 2017. Date of
Publication: May 2017.
Publisher
American Society of Neuroradiology (E-mail: ajnrinfo@asnr.org)
Abstract
BACKROUND: The safety and efficacy of standard poststent angioplasty in
patients undergoing carotid artery stent placement have not been
well-established. PURPOSE: We conducted a systematic review of the
literature to evaluate the safety and efficacy of carotid artery stent
placement and analyzed outcomes of standard-versus-selective poststent
angioplasty. DATA SOURCES: A systematic search of MEDLINE, EMBASE, Scopus,
and the Web of Science was performed for studies published between January
2000 and January 2015. STUDY SELECTION: We included studies with >30
patients describing standard or selective poststent angioplasty during
carotid artery stent placement. DATA ANALYSIS: A random-effects
meta-analysis was used to pool the following outcomes: periprocedural
stroke/TIA, procedurerelated neurologic/cardiovascular
morbidity/mortality, bradycardia/hypotension, long-term stroke at last
follow-up, long-term primary patency, and technical success. DATA
SYNTHESIS: We included 87 studies with 19,684 patients with 20,378 carotid
artery stenoses. There was no difference in clinical (P =.49) or
angiographic outcomes (P =.93) in carotid artery stent placement treatment
with selective or standard poststent balloon angioplasty. Both selective
and standard poststent angioplasty groups had a very high technical
success of >98% and a low procedurerelated mortality of 0.9%. There were
no significant differences between both groups in the incidence of
restenosis (P =.93) or procedurerelated complications (P =.37).
LIMITATIONS: No comparison to a patient group without poststent dilation
could be performed. CONCLUSIONS: Our meta-analysis demonstrated no
significant difference in angiographic and clinical outcomes among series
that performed standard poststent angioplasty and those that performed
poststent angioplasty in only select patients.<br/>&#xa9; Copyright 2016
Stryker.

<27>
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

<28>
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.

<29>
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).

<30>
Accession Number
615059249
Author
Liao Y.; Flaherty J.H.; Yue J.; Wang Y.; Deng C.; Chen L.
Institution
(Liao, Wang, Deng, Chen) Department of Geriatrics, West China Hospital,
Sichuan University, Chengdu, Sichuan, China
(Flaherty) Division of Geriatrics, Department of Internal Medicine, Saint
Louis University, St Louis, MO, United States
(Yue) Department of Geriatrics, West China Hospital, National Center for
Geriatric Clinical Research in West China Hospital, Sichuan University,
Chengdu, Sichuan, China
Title
The incidence of delirium after cardiac surgery in the elderly: Protocol
for a systematic review and meta-analysis.
Source
BMJ Open. 7 (3) (no pagination), 2017. Article Number: 014726. Date of
Publication: 01 Mar 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Introduction Delirium is one of the most common complications after
cardiac surgery in the elderly. Future studies aimed at preventing
postoperative delirium will need an accurate estimate of incidence.
However, there are no available systematic reviews on the incidence, and
reports of incidence of postoperative delirium after a cardiac operation
vary widely with significant heterogeneity. Therefore, we aim to perform a
systematic review and meta-analysis to determine the most accurate
incidence possible of postoperative delirium in individuals aged >65 years
after cardiac surgery. Methods and analyses We will undertake a
comprehensive literature search among PubMed, EMBASE, the Cochrane
Library, PsycINFO and CINAHL, from their inception to January 2017.
Prospective cohort and cross sectional studies that described the
incidence of delirium will be eligible for inclusion. The primary outcome
will be the incidence of delirium. Risk of bias and methodological quality
for the included studies will be assessed using a risk of bias tool for
prevalence studies and the Cochrane guidelines. Heterogeneity of the
estimates across studies will be assessed. Incidence data will be pooled
by selective or emergency surgery. This systematic review will be reported
according to the Preferred Reporting Items for Systematic reviews and
Meta-Analyses (PRISMA). Ethics and dissemination This proposed systematic
review and meta-analysis is based on published data, and thus there is no
requirement for ethics approval. The study will provide an up to date and
accurate incidence of postoperative delirium among the older population
after cardiac surgery, which is necessary for future research in this
area. The findings of this study will be presented at conferences and
disseminated through publication in a peer reviewed journal. Trial
registration number CRD42016047773.<br/>Copyright &#xa9; Published by the
BMJ Publishing Group Limited.

<31>
Accession Number
614252359
Author
Harbaoui B.; Emsellem P.; Cassar E.; Besnard C.; Dauphin R.; Motreff P.;
Courand P.-Y.; Lantelme P.
Institution
(Harbaoui, Emsellem, Cassar, Besnard, Dauphin, Courand, Lantelme)
Cardiology Department, European Society of Hypertension Excellence Center,
Hopital de la Croix-Rousse, Hospices Civils de Lyon, Lyon 69004, France
(Harbaoui, Courand, Lantelme) Universite de Lyon, CREATIS, CNRS UMR5220,
INSERM U1044, INSA-Lyon, Universite Claude-Bernard Lyon 1, Hospices Civils
de Lyon, Lyon 69100, France
(Motreff) Universite d'Auvergne, Cardio-Vascular Interventional Therapy
and Imaging, Image Science for Interventional Techniques, UMR 6284,
Clermont-Ferrand 63000, France
(Motreff) University Hospital of Clermont-Ferrand, Cardiology Department,
Clermont-Ferrand 63000, France
Title
Primary angioplasty: Effect of deferred stenting on stent size.
Source
Archives of Cardiovascular Diseases. 110 (4) (pp 206-213), 2017. Date of
Publication: April 2017.
Publisher
Elsevier Masson SAS (62 rue Camille Desmoulins, Issy les Moulineaux Cedex
92442, France)
Abstract
Background Primary angioplasty with immediate stenting (IS) is the gold
standard for ST-segment elevation myocardial infarction (STEMI). Deferred
stenting (DS) has been proposed to limit periprocedural complications, and
may influence stent size because of thrombus and spasm alleviation. Aim We
sought to study the effect of DS on stent size. Methods Over the study
period, 258 patients underwent primary angioplasty for STEMI (DS, n = 84;
IS, n = 174). An informative coronary angiogram run - i.e. allowing for
proper lesion analysis - was selected and anonymized by an independent
operator. Two experienced operators randomly analysed these runs, and
proposed stent dimensions after having measured vessel diameter and lesion
length by quantitative coronary analysis. The primary objective was the
variation in stent size between the two coronary angiograms. Results The
median delay between the two coronary angiograms was 2 days. Overall, the
stent length was shorter (-1.64 mm; P = 0.030) and its diameter was larger
(+0.13 mm; P < 0.001) during the second coronary angiogram, especially in
the right coronary arteries. Conclusions DS led to the implantation of a
larger and shorter stent; this is probably because DS allows for more
accurate assessment of the residual lesion after relief of spasm and
thrombus, and may have clinical consequences in terms of stent thrombosis
and restenosis.<br/>Copyright &#xa9; 2016 Elsevier Masson SAS

<32>
Accession Number
609871338
Author
Norgaard B.L.; Hjort J.; Gaur S.; Hansson N.; Botker H.E.; Leipsic J.;
Mathiassen O.N.; Grove E.L.; Pedersen K.; Christiansen E.H.; Kaltoft A.;
Gormsen L.C.; Maeng M.; Terkelsen C.J.; Kristensen S.D.; Krusell L.R.;
Jensen J.M.
Institution
(Norgaard, Hjort, Gaur, Hansson, Botker, Mathiassen, Grove, Pedersen,
Christiansen, Kaltoft, Maeng, Terkelsen, Kristensen, Krusell, Jensen)
Department of Cardiology, Aarhus University Hospital Skejby, Aarhus,
Denmark
(Leipsic) Department of Radiology, St. Paul's Hospital, University of
British Columbia, British Columbia, Canada
(Grove) Faculty of Health, Institute of Clinical Medicine, Aarhus
University, Aarhus, Denmark
(Gormsen) Department of Nuclear Medicine, Aarhus University Hospital
Skejby, Aarhus, Denmark
Title
Clinical Use of Coronary CTA-Derived FFR for Decision-Making in Stable
CAD.
Source
JACC: Cardiovascular Imaging. 10 (5) (pp 541-550), 2017. Date of
Publication: May 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Objectives The goal of this study was to assess the real-world clinical
utility of fractional flow reserve (FFR) derived from coronary computed
tomography angiography (FFR<inf>CT</inf>) for decision-making in patients
with stable coronary artery disease (CAD). Background FFR<inf>CT</inf> has
shown promising results in identifying lesion-specific ischemia. The
real-world feasibility and influence on the diagnostic work-up of
FFR<inf>CT</inf> testing in patients suspected of having CAD are unknown.
Methods We reviewed the complete diagnostic work-up of nonemergent
patients referred for coronary computed tomography angiography over a
12-month period at Aarhus University Hospital, Denmark, including all
patients with new-onset chest pain with no known CAD and with
intermediate-range coronary lesions (lumen reduction, 30% to 70%) referred
for FFR<inf>CT</inf>. The study evaluated the consequences on downstream
diagnostic testing, the agreement between FFR<inf>CT</inf> and invasively
measured FFR or instantaneous wave-free ratio (iFR), and the short-term
clinical outcome after FFR<inf>CT</inf> testing. Results Among 1,248
patients referred for computed tomography angiography, 189 patients (mean
age 59 years; 59% male) were referred for FFR<inf>CT</inf>, with a
conclusive FFR<inf>CT</inf> result obtained in 185 (98%). FFR<inf>CT</inf>
was <=0.80 in 31% of patients and 10% of vessels. After FFR<inf>CT</inf>
testing, invasive angiography was performed in 29%, with FFR measured in
19% and iFR in 1% of patients (with a tendency toward declining FFR-iFR
guidance during the study period). FFR<inf>CT</inf> <=0.80 correctly
classified 73% (27 of 37) of patients and 70% (37 of 53) of vessels using
FFR <=0.80 or iFR <=0.90 as the reference standard. In patients with
FFR<inf>CT</inf> >0.80 being deferred from invasive coronary angiography,
no adverse cardiac events occurred during a median follow-up period of 12
(range 6 to 18 months) months. Conclusions FFR<inf>CT</inf> testing is
feasible in real-world symptomatic patients with intermediate-range
stenosis determined by coronary computed tomography angiography.
Implementation of FFR<inf>CT</inf> for clinical decision-making may
influence the downstream diagnostic workflow of patients. Patients with an
FFR<inf>CT</inf> value >0.80 being deferred from invasive coronary
angiography have a favorable short-term prognosis.<br/>Copyright &#xa9;
2017 American College of Cardiology Foundation

<33>
Accession Number
615710919
Author
Mengesha H.G.; Weldearegawi B.; Petrucka P.; Bekele T.; Otieno M.G.; Hailu
A.
Institution
(Mengesha) Adigrat University, College of Health Science, Adigrat,
Ethiopia
(Weldearegawi) Mekelle University, College of Health Science, School of
Public Health, Mekelle, Ethiopia
(Petrucka) University of Saskatchewan, College of Nursing, Adjunct Nelson
Mandela African Institute of Science and Technology, Saskatoon, Canada
(Bekele) Haramaya University, College of Health Science, Department of
Pharmacy, Harar, Ethiopia
(Otieno) Mekelle University, College of Health Science, Department of
Medical Biochemistry, Mekelle, Ethiopia
(Hailu) Mekelle University, College of Health Science, Department of
Internal Medicine, Mekelle, Ethiopia
Title
Effect of ivabradine on cardiovascular outcomes in patients with stable
angina: Meta-analysis of randomized clinical trials.
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 105. Date of Publication: 28 Apr 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Although there are established drugs for treatment of
cardiovascular diseases, due to adverse effects these drugs may not be
clinically applicable to all patients. Recent trends have seen the
emergence of drugs which act on funny current channels to induce selective
heart rate reduction. Ivabradine is one such drug developed for coronary
artery disease and heart failure. There is inconsistent evidence about the
effect of this selective inhibitor in reduction of cardiovascular related
mortality and morbidity. Such an inconsistency warrants the need for a
meta-analysis to consider the effectiveness and efficacy of Ivabradine in
the treatment of coronary artery disease and heart failure. Methods:
Randomized controlled trials with a minimum follow-up period of one year
were searched in Pub Med/Medline, Embase, Cochrane Central Register of
Controlled Trials published between 1980 and 2016.Each eligible study was
assessed for risk of bias by using the Cochrane Risk of Bias Assessment
tool. The outcomes assessed in this study included: all cause mortality,
cardiovascular-related mortality, hospitalization for new or worsening
heart failure, and adverse events. Subgroup analysis and publication bias
were assessed. We used Mantel-Haenszel method for random-effects. Analysis
was done using RevMan5.1TM.This study was registered in PROSPERO as
[PROSPERO 2016:CRD42016035597]. Result: Three trials with a total of
36,577 participants met the meta-analysis criteria. Pooled analysis showed
that ivabradine is not effective in reducing cardiovascular deaths (OR:
1.02; CI:0.91-1.15,P=0.74), all-cause mortality (OR:1.00;
CI:0.91-1.10,P=0.98), coronary revascularization (OR: 0.93, CI: 0.77-1.11,
P=0.41) and hospital admission for worsening of heart failure (OR: 0.94,
CI: 0.71-1.25, P=0.69). However, the drug was found to significantly
increase adverse events: phosphenes (OR:7.77, CI: 4.4-14.6,P<0.00001),
blurred vision (OR:3.07,CI:2.18-4.32,P<0.00001), symptomatic bradycardia
(OR: 6.23, CI: 4.2-9.26, P<0.00001), and atrial fibrillation (OR: 1.35,
CI: 1.19-1.53, P<0.0001). Subgroup analysis by duration of follow up on
cardiovascular outcomes found that there is no difference in effect of
ivabradine depending on the duration of follow up. There was no
publication bias in reporting of included studies. Conclusion: This
meta-analysis suggests that ivabradine is not effective in reducing
cardiovascular-related morbidity and mortality unless used for specific
conditions. On the contrary, the use of this drug was strongly associated
with the onset of untoward and new adverse events. This finding strongly
supports previous findings and further informs the rational and
evidence-informed clinical use of ivabradine.<br/>Copyright &#xa9; 2017
The Author(s).

<34>
[Use Link to view the full text]
Accession Number
615510276
Author
Saleh A.; Klika A.K.; Barsoum W.K.
Institution
(Saleh, Klika, Barsoum) Department of Orthopaedic Surgery, Cleveland
Clinic Foundation, Cleveland, OH, United States
Title
Reply to Letter: "glycopeptides Versus Beta-lactams for the Prevention of
Surgical Site Infections in Cardiovascular and Orthopedic Surgery: A
Meta-analysis".
Source
Annals of Surgery. 265 (5) (pp e71-e72), 2017. Date of Publication: 01 May
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)

<35>
[Use Link to view the full text]
Accession Number
615510272
Author
Dellinger E.P.
Institution
(Dellinger) Division of General Surgery, University of Washington,
Seattle, WA, United States
Title
Glycopeptides Versus Beta-lactams for the Prevention of Surgical Site
Infections in Cardiovascular and Orthopedic Surgery: A Meta-analysis.
Source
Annals of Surgery. 265 (5) (pp e70-e71), 2017. Date of Publication: 01 May
2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)

<36>
Accession Number
613458686
Author
Khan J.N.; Nazir S.A.; Greenwood J.P.; Dalby M.; Curzen N.; Hetherington
S.; Kelly D.J.; Blackman D.; Ring A.; Peebles C.; Wong J.; Sasikaran T.;
Flather M.; Swanton H.; Gershlick A.H.; McCann G.P.
Institution
(Khan, Nazir, Gershlick, McCann) Department of Cardiovascular Sciences,
University of Leicester, NIHR Leicester Cardiovascular Biomedical Research
Unit, University Hospitals of Leicester NHS Trust, Glenfield Hospital,
Leicester, United Kingdom
(Greenwood, Blackman) Multidisciplinary Cardiovascular Research Centre,
Division of Cardiovascular and Diabetes Research, Leeds Institute of
Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United
Kingdom
(Dalby, Wong, Sasikaran) Harefield Hospital, Royal Brompton and Harefield
Foundation Trust, NIHR Cardiovascular Biomedical Research Unit, Middlesex,
United Kingdom
(Curzen, Peebles) University Hospital Southampton NHS Foundation Trust and
University of Southampton, Southampton, United Kingdom
(Hetherington) Kettering General Hospital, Kettering NN16 8UZ, United
Kingdom
(Kelly) Royal Derby Hospital, Derby, United Kingdom
(Ring) Leicester Clinical Trials Unit, University of Leicester, UK,
Department of Mathematical Statistics and Actuarial Science, University of
Leicester, University of the Free State, Bloemfontein, South Africa
(Flather) Norfolk and Norwich University Hospitals NHS Foundation Trust
and Norwich Medical School, University of East Anglia, Norwich, United
Kingdom
(Swanton) Heart Hospital, University College London Hospitals, London,
United Kingdom
Title
Infarct size following complete revascularization in patients presenting
with STEMI: a comparison of immediate and staged in-hospital non-infarct
related artery PCI subgroups in the CvLPRIT study.
Source
Journal of Cardiovascular Magnetic Resonance. 18 (1) (pp 1-9), 2016. Date
of Publication: 09 Nov 2016.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: The CvLPRIT study showed a trend for improved clinical
outcomes in the complete revascularisation (CR) group in those treated
with an immediate, as opposed to staged in-hospital approach in patients
with multivessel coronary disease undergoing primary percutaneous
intervention (PPCI). We aimed to assess infarct size and left ventricular
function in patients undergoing immediate compared with staged CR for
multivessel disease at PPCI. Methods: The Cardiovascular Magnetic
Resonance (CMR) substudy of CvLPRIT was a multicentre, prospective,
randomized, open label, blinded endpoint trial in PPCI patients with
multivessel disease. These data refer to a post-hoc analysis in 93
patients randomized to the CR arm (63 immediate, 30 staged) who completed
a pre-discharge CMR scan (median 2 and 4 days respectively) after PPCI.
The decision to stage non-IRA revascularization was at the discretion of
the treating interventional cardiologist. Results: Patients treated with a
staged approach had more visible thrombus (26/30 vs. 31/62, p = 0.001),
higher SYNTAX score in the IRA (9.5, 8-16 vs. 8.0, 5.5-11, p = 0.04) and a
greater incidence of no-reflow (23.3 % vs. 1.6 % p < 0.001) than those
treated with immediate CR. After adjustment for confounders, staged
patients had larger infarct size (19.7 % [11.7-37.6] vs. 11.6 % [6.8-18.2]
of LV Mass, p = 0.012) and lower ejection fraction (42.2 +/- 10 % vs. 47.4
+/- 9 %, p = 0.019) compared with immediate CR. Conclusions: Of patients
randomized to CR in the CMR substudy of CvLPRIT, those in whom the
operator chose to stage revascularization had larger infarct size and
lower ejection fraction, which persisted after adjusting for important
covariates than those who underwent immediate CR. Prospective randomized
trials are needed to assess whether immediate CR results in better
clinical outcomes than staged CR. Trial registration: ISRCTN70913605 ,
Registered 24th February 2011.<br/>Copyright &#xa9; 2016 The Author(s).

<37>
Accession Number
618984231
Author
Cornel J.H.; Ohman E.M.; Neely B.; Jakubowski J.A.; Bhatt D.L.; White
H.D.; Ardissino D.; Fox K.A.A.; Prabhakaran D.; Armstrong P.W.; Erlinge
D.; Tantry U.S.; Gurbel P.A.; Roe M.T.
Institution
(Cornel) Medisch Centrum Alkmaar, Alkmaar, Netherlands
(Ohman, Neely, Roe) Duke Clinical Research Institute, Durham, NC, United
States
(Ohman, Roe) Division of Cardiology, Department of Medicine, Duke
University Medical Center, Durham, NC, United States
(Jakubowski) Eli Lilly and Company, Indianapolis, IN, United States
(Bhatt) Brigham and Women's Hospital Heart, Vascular Center and Harvard
Medical School, Boston, MA, United States
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Ardissino) Division of Cardiology, Azienda Ospedaliero-Universitaria di
Parma, Italy
(Fox) Centre for Cardiovascular Science, University of Edinburgh,
Scotland, United Kingdom
(Prabhakaran) Centre for Chronic Disease Control, Public Health Foundation
of India, New Delhi, India
(Armstrong) Canadian VIGOUR Centre and Division of Cardiology, University
of Alberta, Edmonton, AL, Canada
(Erlinge) Department of Cardiology, Lund University, Lund, Sweden
(Tantry, Gurbel) Sinai Center for Thrombosis Research, Baltimore, MD,
United States
Title
Relationship of Platelet Reactivity With Bleeding Outcomes During
Long-Term Treatment With Dual Antiplatelet Therapy For Medically Managed
Patients With Non-St-Segment Elevation Acute Coronary Syndromes.
Source
Journal of the American Heart Association. 5 (11) (no pagination), 2016.
Article Number: e003977. Date of Publication: November 2016.
Publisher
John Wiley and Sons Inc. (P.O.Box 18667, Newark NJ 07191-8667, United
States)
Abstract
Background--The relationship between "on-treatment" low platelet
reactivity and longitudinal risks of major bleeding dual antiplatelet
therapy following acute coronary syndromes remains uncertain, especially
for patients who do not undergo percutaneous coronary intervention.
Methods and Results--We analyzed 2428medicallymanaged acute coronary
syndromes patients fromthe Targeted Platelet Inhibition to Clarify the
Optimal Strategy to Medically Manage Acute Coronary Syndromes (TRILOGY
ACS) trial who had serial platelet reactivity measurements
(P2Y<inf>12</inf> reaction units; PRUs) and were randomized to
aspirin+prasugrel versus aspirin+clopidogrel for up to 30 months. Contal's
method was used to determine whether a cut point for steady-state PRU
values could distinguish high versus low bleeding risk using 2-level
composites: Global Use of Strategies to Open Occluded Coronary Arteries
(GUSTO) severe/life-threatening or moderate bleeding unrelated to coronary
artery bypass grafting (CABG) and non-CABG Thrombolysis In Myocardial
Infarction (TIMI) major orminor bleeding. Exploratory analyses used
3-level composites that incorporatedmild andminimalGUSTOand TIMI
events.Continuousmeasures of PRUs (per 10-unit decrease)were not
independently associatedwith the 2-levelGUSTO (adjusted hazard ratio [HR],
1.01; 95% CI, 0.96-1.06) or TIMI composites (1.02; 0.98-1.07).
Furthermore, no PRU cut point could significantly distinguish bleeding
risk using the 2-level composites.However, the PRUcut point of 75
differentiated bleeding riskwith the 3-level composites ofGUSTO(26.5% vs
12.6%; adjusted HR, 2.28; 95% CI, 1.77-2.94; P<0.001) and TIMI bleeding
events (25.9% vs 12.2%; adjusted HR, 2.30; 95% CI, 1.78-2.97; P<0.001).
Conclusions--Among medically managed non-ST-segment elevation acute
coronary syndromes patients receiving prolonged dual antiplatelet therapy,
PRU values were not significantly associated with the long-term risk of
major bleeding events, suggesting that low on-treatment platelet
reactivity does not independently predict serious bleeding
risk.<br/>Copyright &#xa9; 2016 The Authors.

<38>
Accession Number
616869226
Author
Farooqui W.; Pommergaard H.C.; Rasmussen A.
Institution
(Farooqui) Department of Surgery, Nordsjaellands Hospital, Dyrehavevej 29,
Hillerod 3400, Denmark
(Pommergaard, Rasmussen) Department of Surgical Gastroenterology and
Transplantation, Abdominal Centre, Rigshospitalet, Blegdamsvej 9,
Kobehnavn O 2100, Denmark
Title
Remote ischemic preconditioning of transplant recipients to reduce graft
ischemia and reperfusion injuries: A systematic review.
Source
Transplantation Reviews. 32 (1) (pp 10-15), 2018. Date of Publication:
January 2018.
Publisher
W.B. Saunders
Abstract
Background Solid organ transplantation is an accepted treatment for
end-stage solid organ diseases. During the procedure, ischemia and
reperfusion injury may affect graft and patient outcomes. Remote ischemic
preconditioning (rIC) has been shown to reduce ischemia and reperfusion
injury and can be performed safely. Thus, rIC may potentially improve
outcomes after solid organ transplantation. Traditionally, the focus of
rIC has been on the donor. However, preconditioning the recipient may be a
more suitable approach in transplant settings. The current review analyzed
previously published studies where rIC was performed on transplant
recipients. Methods PubMed and EMBASE databases were searched for eligible
clinical and animal studies evaluating rIC of recipients. Articles were
analyzed and compared qualitatively. Risk of bias was assessed using the
Cochrane Collaboration's tool for interventional clinical studies and
SYRCLEs risk of bias tool for animal studies. Results A total of 12
studies were included. Overall, these studies were heterogeneous due to
differences in populations and intervention set-up. Some of the studies
suggested improvement of graft function, while other studies did not show
any effect. The quality of the 12 included studies was predominantly low.
Conclusion Due to the heterogeneity and quality of the included studies
the result, that rIC may be beneficial in transplantation of some organs,
should be interpreted with caution. The result must be confirmed by
further clinical studies.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<39>
Accession Number
617457938
Author
Sales A.H.A.; Barz M.; Bette S.; Wiestler B.; Ryang Y.-M.; Meyer B.;
Bretschneider M.; Ringel F.; Gempt J.
Institution
(Sales, Barz, Ryang, Meyer, Ringel, Gempt) Technical University of Munich,
Department of Neurosurgery, Klinikum rechts der Isar, Ismaninger Str. 22,
Munich 81675, Germany
(Bette, Wiestler) Technical University of Munich, Department of
Neuroradiology, Klinikum rechts der Isar, Ismaninger Str. 22, Munich
81675, Germany
(Bretschneider) Technical University of Munich, Department of
Anesthesiology, Klinikum rechts der Isar, Ismaninger Str. 22, Munich
81675, Germany
(Ringel) Universitatsmedizin Mainz, Department of Neurosurgery,
Langenbeckstr. 1, Mainz 55131, Germany
Title
Impact of ischemic preconditioning on surgical treatment of brain tumors:
A single-center, randomized, double-blind, controlled trial.
Source
BMC Medicine. 15 (1) (no pagination), 2017. Article Number: 137. Date of
Publication: 25 Jul 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative ischemia is a frequent phenomenon in patients
with brain tumors and is associated with postoperative neurological
deficits and impaired overall survival. Particularly in the field of
cardiac and vascular surgery, the application of a brief ischemic stimulus
not only in the target organ but also in remote tissues can prevent
subsequent ischemic damage. We hypothesized that remote ischemic
preconditioning (rIPC) in patients with brain tumors undergoing elective
surgical resection reduces the incidence of postoperative ischemic tissue
damage and its consequences. Methods: Sixty patients were randomly
assigned to two groups, with 1:1 allocation, stratified by tumor type
(glioma or metastasis) and previous treatment with radiotherapy. rIPC was
induced by inflating a blood pressure cuff placed on the upper arm three
times for 5min at 200mmHg in the treatment group after induction of
anesthesia. Between the cycles, the blood pressure cuff was released to
allow reperfusion. In the control group no preconditioning was performed.
Early postoperative magnetic resonance images (within 72h after surgery)
were evaluated by a neuroradiologist blinded to randomization for the
presence of ischemia and its volume. Results: Fifty-eight of the 60
patients were assessed for occurrence of postoperative ischemia. Of these
58 patients, 44 had new postoperative ischemic lesions. The incidence of
new postoperative ischemic lesions was significantly higher in the control
group (27/31) than in the rIPC group (17/27) (p=0.03). The median infarct
volume was 0.36cm³ (interquartile range (IR): 0.0-2.35) in the
rIPC group compared with 1.30cm³ (IR: 0.29-3.66) in the control
group (p=0.09). Conclusions: Application of rIPC was associated with
reduced incidence of postoperative ischemic tissue damage in patients
undergoing elective brain tumor surgery. This is the first study
indicating a benefit of rIPC in brain tumor surgery. Trial registration:
German Clinical Trials Register, DRKS00010409. Retrospectively registered
on 13 October 2016.<br/>Copyright &#xa9; 2017 The Author(s).

<40>
[Use Link to view the full text]
Accession Number
612361767
Author
Sun E.Y.; Jadotte Y.T.; Halperin W.
Institution
(Sun) Internal Medicine Resident Physician, University of North Carolina,
126 Macnider Hall, CB #7005, Chapel Hill, NC 27599, United States
(Halperin) New Jersey Medical School, Newark, NJ, United States
(Halperin) School of Public Health, Newark Campus, Newark, NJ, United
States
(Jadotte) School of Nursing, Newark Campus, Newark, NJ, United States
(Jadotte) Northeast Institute for Evidence Synthesis and Translation,
Rutgers University, School of Nursing, Newark, NJ, United States
(Jadotte) Department of Family, Population and Preventive Medicine, Stony
Brook University, Stony Brook, NY, United States
Title
Disparities in cardiac rehabilitation participation in the United States:
A systematic review and meta-analysis.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. 37 (1) (pp
2-10), 2017. Date of Publication: 2017.
Publisher
Lippincott Williams and Wilkins (E-mail: kathiest.clai@apta.org)
Abstract
PURPOSE: Phase 2 cardiac rehabilitation (CR) is a class I recommendation
for all patients following an acute cardiac event or cardiac surgery
according to the The American Heart Association and the American College
of Cardiology Foundation. Studies have shown that there are differences in
cardiac rehabilitation participation rates between sociodemographic
groups. The purpose of this systematic review and meta-analyses was to
synthesize quantitative data on the relationship between outpatient
cardiac rehabilitation (OCR) attendance and various sociodemographic
factors. METHODS: We conducted a search of PubMed, PsycINFO, CINAHL,
Google Scholar, Dissertations & Theses A&I, and conference abstracts for
observational studies conducted in the United States that fit our
inclusion criteria. A total of 21 studies were included in our final
review and meta-analyses. RESULTS: Our meta-analyses showed that overall,
attenders were younger than nonattenders (mean difference = - 3.74 years,
95% CI = - 5.87 to - 1.61) and the odds of participation were lower among
females (OR = 0.59; 95% CI = 0.51-0.69), individuals with a high school
degree or less (OR = 0.67; 95% CI = 0.50-0.91), and the uninsured or
self-payers (OR = 0.32; 95% CI = 0.14-0.71). Full- or part-time employees
were more likely to participate than those not employed (OR = 1.45; 95% CI
= 1.08-1.95). CONCLUSIONS: Our systematic review and meta-analyses showed
that there are significant sociodemographic disparities in CR
participation. On the basis of this knowledge, clinicians and policy
makers should focus on identifying and eliminating barriers to
participation.<br/>Copyright &#xa9; 2017 Wolters Kluwer Health, Inc.

<41>
Accession Number
615776562
Author
Belczak S.Q.; Silva E.S.; Klajner R.; Puech-Leao P.; De Luccia N.
Institution
(Belczak, Silva, Puech-Leao, De Luccia) Department of Vascular Surgery,
School of Medicine, Sao Paulo University, Sao Paulo, SP, Brazil
(Klajner) Department of Vascular Surgery, Sao Camilo University, Sao
Paulo, SP, Brazil
Title
Type II Endoleaks, Left-Arm Complications, and Need of Revascularization
after Left Subclavian Artery Coverage for Thoracic Aortic Aneurysms
Endovascular Repair: A Systematic Review.
Source
Annals of Vascular Surgery. 41 (pp 294-299), 2017. Date of Publication:
May 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background The status of the left arm, the need of revascularization, and
the occurrence of type II endoleakes from de left subclavian artery (LSA)
after intention LSA coverage for thoracic aortic aneurysm endovascular
repair need to be better understood. This systematic review was developed
for contributing with such issue. Methods Systematic literature review of
studies published from January 2000 through December 2015 identified 7
studies comprising 201 patients submitted to elective endovascular repair
for thoracic aortic aneurysms requiring intentional LSA coverage. Outcomes
of interest included left-arm complications (ischemia, symptoms of
claudication, and subclavian steal syndrome [SSS]) requiring postoperative
revascularization of LSA, as well as endoleaks from the subclavian artery
requiring postoperative embolization of LSA. Results Left-arm complication
rate was 4.5% (9 patients), requiring postoperative revascularization of
LSA in 1 case (0.5%) of SSS. Type II endoleaks from the subclavian artery
requiring postoperative embolization of LSA were reported in 2 cases
(1.0%). Conclusions Low-quality evidence suggests very low rates of arm
complications with need of LSA revascularization and of type II endoleaks
requiring embolization in elective endovascular treatment of thoracic
aortic aneurysms with intentional coverage of LSA without prophylactic
revascularization of LSA.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<42>
Accession Number
614288344
Author
Lee S.M.K.; Leem J.; Park J.H.; Yoon K.H.; Woo J.S.; Lee J.M.; Kim J.-B.;
Kim W.; Lee S.
Institution
(Lee, Leem, Lee) Department of Clinical Korean Medicine, Graduate School,
Kyung Hee University, Seoul, South Korea
(Park, Yoon) Department of Acupuncture and Moxibustion, College of Korean
Medicine, Kyung Hee University, Dongdaemun-gu, South Korea
(Woo, Lee, Kim, Kim) Division of Cardiology, Kyung Hee University
Hospital, Kyung Hee University, Seoul, South Korea
Title
Close look at the experiences of patients enrolled in a clinical trial of
acupuncture treatment for atrial fibrillation in Korea: A qualitative
study nested within a randomised controlled trial.
Source
BMJ Open. 7 (2) (no pagination), 2017. Article Number: e013180. Date of
Publication: 01 Feb 2017.
Publisher
BMJ Publishing Group (E-mail: subscriptions@bmjgroup.com)
Abstract
Objective: To explore the experiences of patients with atrial fibrillation
(AF) in the context of a prospective, two-parallel-armed,
participant-blinded and assessorblinded sham-controlled randomised trial.
Design: A nested qualitative study within an ongoing randomised controlled
trial to explore acupuncture's antiarrhythmic effects on drug refractory
acupuncture in persistent atrial fibrillation (AF) (ACU-AF trial).
Participants: Participants were recruited using purposeful sampling and a
maximum variation strategy with regard to treatment allocation (treatment
or control) and protocol completion (completion or non-completion).
Setting: This was a single-centre in-depth interview qualitative study
conducted at a tertiary-level university hospital in Seoul, Republic of
Korea. Results: Data saturation was reached after 8 participants. Thematic
analysis identified that most patients were not aware of their condition
until medical check-up; physician referral was the main reason for trial
participation, and patients had high expectations regardless of previous
acupuncture experiences. Patients tended to depend on their physicians'
opinions because they felt helpless of their condition. No one questioned
their assigned treatment groups and generally believed acupuncture
treatment was different for cardiovascular diseases. A few patients
expressed disappointment in the strict and rigid protocols, in which most
practitioners refrained from explaining their acupuncture procedures.
Conclusions: For cardiovascular patients their physician's advice was one
of the biggest reasons for enrolling in the acupuncture trial therefore
relying on standard recruitment methods may not be effective. Fortunately
both real and sham acupuncture groups in our sample were receiving
treatment as intended, but in the future, designing a more pragmatic trial
(better reflecting clinical settings, expanding the inclusion criteria and
using more treatment points) will allow researchers to better explore the
comprehensive effects of acupuncture. The findings of this study will
allow researchers to improve the currently ongoing ACU-AF trial and to
further help interpretation of main trial outcomes once the trial is
completed.

<43>
Accession Number
617595638
Author
Hartman M.H.T.; Prins J.K.B.; Schurer R.A.J.; Lipsic E.; Lexis C.P.H.; van
der Horst-Schrivers A.N.A.; van Veldhuisen D.J.; van der Horst I.C.C.; van
der Harst P.
Institution
(Hartman, Prins, Schurer, Lipsic, Lexis, van Veldhuisen, van der Harst)
Department of Cardiology, University of Groningen, University Medical
Center Groningen, Hanzeplein 1, Groningen 9700 RB, Netherlands
(van der Horst-Schrivers) Department of Endocrinology and Metabolism,
University of Groningen, University Medical Center Groningen, Groningen,
Netherlands
(van der Horst) Department of Critical Care, University of Groningen,
University Medical Center Groningen, Groningen, Netherlands
Title
Two-year follow-up of 4 months metformin treatment vs. placebo in
ST-elevation myocardial infarction: data from the GIPS-III RCT.
Source
Clinical Research in Cardiology. 106 (12) (pp 939-946), 2017. Date of
Publication: 01 Dec 2017.
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Objectives: Preclinical and clinical studies suggested cardioprotective
effects of metformin treatment. In the GIPS-III trial, 4 months of
metformin treatment did not improve left ventricular ejection fraction in
patients presenting with ST-elevation myocardial infarction (STEMI). Here,
we report the 2-year follow-up results. Methods: Between January 2011 and
May 2013, 379 STEMI patients without diabetes undergoing primary
percutaneous coronary intervention were randomized to a 4-month treatment
with metformin (500 mg twice daily) (N = 191) or placebo (N = 188) in the
University Medical Center Groningen. Two-year follow-up data was collected
to determine its effect on predefined secondary endpoints: the incidence
of major adverse cardiac events (MACE), its individual components,
all-cause mortality, and new-onset diabetes. Results: For all 379 patients
all-cause mortality data were available. For seven patients (2%) follow-up
data on MACE was limited, ranging from 129 to 577 days. All others
completed the 2-year follow-up visit. Incidence of MACE was 11 (5.8%) in
metformin and 6 (3.2%) in placebo treated patients [hazard ratio (HR)
1.84, confidence interval (CI) 0.68-4.97, P = 0.22]. Three patients died
in the metformin group and one in the placebo treatment group. Individual
components of MACE were also comparable between both groups. New-onset
diabetes mellitus was 34 (17.8%) in metformin and 32 (17.0%) in placebo
treated patients (odds ratio 1.15, CI 0.66-1.98, P = 0.84). After
multivariable adjustment the incidence of MACE was comparable between the
treatment groups (HR 1.02, CI 0.10-10.78, P = 0.99). Conclusions: Four
months metformin treatment initiated at the time of hospitalization in
STEMI patients without diabetes did not exert beneficial long-term
effects. Trial registration: clinicaltrials.gov Identifier:
NCT01217307.<br/>Copyright &#xa9; 2017, The Author(s).

<44>
Accession Number
618784261
Author
Papademetriou V.; Nylen E.S.; Doumas M.; Probstfield J.; Mann J.F.E.;
Gilbert R.E.; Gerstein H.C.
Institution
(Papademetriou, Nylen) Veterans Administration Medical Center, Washington,
DC, United States
(Papademetriou) Georgetown University Medical Center, Washington, DC,
United States
(Nylen, Doumas) George Washington University Medical Centers, Washington,
DC, United States
(Doumas) Aristotle University of Thessaloniki, Greece
(Probstfield) University of Washington, Seattle, United States
(Mann) KfH kidney Center, Munchen, Germany
(Gilbert) St. Michael's Hospital, University of Toronto, Ontario, Canada
(Gerstein) Department of Medicine and Population Health Research
Institute, McMaster University and Hamilton Health Sciences, Hamilton,
Ontario, Canada
Title
Chronic Kidney Disease, Basal Insulin Glargine, and Health Outcomes in
People with Dysglycemia: The ORIGIN Study.
Source
American Journal of Medicine. 130 (12) (pp 1465.e27-1465.e39), 2017. Date
of Publication: December 2017.
Publisher
Elsevier Inc. (E-mail: usjcs@elsevier.com)
Abstract
Background Early stages of chronic kidney disease are associated with an
increased cardiovascular risk in patients with established type 2 diabetes
and macrovascular disease. The role of early stages of chronic kidney
disease on macrovascular outcomes in prediabetes and early type 2 diabetes
mellitus is not known. In the Outcome Reduction with an Initial Glargine
Intervention (ORIGIN) trial, the introduction of insulin had no effect on
cardiovascular outcomes compared with standard therapy. In this post hoc
analysis of ORIGIN, we compared cardiovascular outcomes in subjects
without to those with mild (Stages 1-2) or moderate chronic kidney disease
(Stage 3). Methods Two co-primary composite cardiovascular outcomes were
assessed. The first was the composite end point of nonfatal myocardial
infarction, nonfatal stroke, or death from cardiovascular causes; and the
second was a composite of any of these events plus a revascularization
procedure, or hospitalization for heart failure. Several secondary
outcomes were prespecified, including microvascular outcomes, incident
diabetes, hypoglycemia, weight, and cancers. Results Complete renal
function data were available in 12,174 of 12,537 ORIGIN participants. A
total of 8114 (67%) had no chronic kidney disease, while 4060 (33%) had
chronic kidney disease stage 1-3. When compared with nonchronic kidney
disease participants, the risk of developing the composite primary outcome
(nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death)
in those with mild to moderate chronic kidney disease was 87% higher;
hazard ratio (HR) 1.87; 95% confidence interval (CI), 1.71-2.04 (P
<.0001). The presence of chronic kidney disease 1-3 was also associated
with a greater than twofold higher risk for both all-cause mortality (HR
2.17; 95% CI, 1.98-2.38; P <.0001) and cardiovascular mortality (HR 2.39;
95% CI, 2.13-2.69; P <.0001). Moreover, patients with mild to moderate
chronic kidney disease had significantly higher risk for nonfatal
myocardial infarction (50%), nonfatal stroke (68%), any stroke (84%), the
above composite primary end point plus revascularization or heart failure
requiring hospitalization (59%), or a major coronary artery disease event
(56%). Furthermore, in patients with chronic kidney disease and early
diabetes mellitus type 2, the primary end point occurred 83% more
frequently as compared with nonchronic kidney disease participants (HR
1.83; 95% CI, 1.67-2.01; P <.001) and in patients with prediabetes and
chronic kidney disease 67% more frequently (HR 1.67; 95% CI,1.25-2.24; P
<.001). Conclusions In high-risk patients with dysglycemia (prediabetes
and early diabetes), mild and moderate chronic kidney disease
significantly increased cardiovascular events.<br/>Copyright &#xa9; 2017

<45>
Accession Number
616331618
Author
Kocaturk C.I.; Sezen C.B.; Aker C.; Kalafat C.E.; Bilen S.; Kutluk A.C.;
Karapinar K.; Erdogan S.; Saydam O.
Institution
(Kocaturk, Sezen, Aker, Kalafat, Bilen, Kutluk, Karapinar, Erdogan,
Saydam) Thoracic Surgery Department, Yedikule Chest Diseases and Thoracic
Surgery Training and Research Hospital, Istanbul 34020, Turkey
Title
Surgical approach to posterior mediastinal lesions and long-term outcomes.
Source
Asian Cardiovascular and Thoracic Annals. 25 (4) (pp 287-291), 2017. Date
of Publication: 01 May 2017.
Publisher
SAGE Publications Inc. (E-mail: claims@sagepub.com)
Abstract
Background Posterior mediastinal lesions are classified as solid lesions
and cysts. The treatment for both types is surgery. We evaluated the
surgical outcomes and recurrence rates after video-assisted thoracic
surgery and thoracotomy for posterior mediastinal lesions. Methods Data of
66 resections for posterior mediastinal masses between 2000 and 2014 were
reviewed retrospectively. Twenty-two patients were treated by
video-assisted thoracic surgery (group V) and 44 underwent thoracotomy
(group T); 29 (43.9%) were female and 37 (56.1%) were male, the mean age
was 45.9 +/- 14.7 years. Results Bronchogenic cyst was the most common
cystic lesion (10/12, 83.3%), and benign schwannoma was the most common
solid lesion (32/54, 59.2%). The mean diameter of solid lesions was 5.19
+/- 2.4 cm (group V 3.98 +/- 1.8 vs. group T 5.78 +/- 2.5 cm, p = 0.006).
The tumor diameter was 4.06 +/- 1.9 cm in asymptomatic patients and 6.93
+/- 2.2 cm (p < 0.001) in symptomatic patients. In group V, hospital stay
and duration of drainage were significantly shorter than in group T (p =
0.02, p = 0.01). Local recurrence was detected in 4 (6.1%) patients.
Cystic lesions had a higher recurrence rate than solid lesions (p = 0.01).
There was no significant difference in recurrence rates in groups V and T
(p = 0.59). Conclusion Video-assisted thoracic surgery is a safe method
for surgical treatment of posterior mediastinal lesions, with a shorter
drainage time and postoperative hospitalization and similar recurrence
rates. More recurrences are seen in patients with cystic
lesions.<br/>Copyright &#xa9; SAGE Publications.

<46>
Accession Number
613115280
Author
Bernabe-Garcia M.; Lopez-Alarcon M.; Salgado-Sosa A.; Villegas-Silva R.;
Maldonado-Hernandez J.; Rodriguez-Cruz M.; Rivas-Ruiz R.; Chavez-Sanchez
L.; Blanco-Favela F.A.; Mancilla-Ramirez J.; Gordillo-Alvarez V.;
Madrigal-Muniz O.
Institution
(Bernabe-Garcia, Lopez-Alarcon, Maldonado-Hernandez, Rodriguez-Cruz) Unit
of Medical Research in Nutrition, Instituto Mexicano del Seguro Social,
Mexico City, Mexico
(Salgado-Sosa, Villegas-Silva, Madrigal-Muniz) Neonatal Intensive Care
Unit, Instituto Mexicano del Seguro Social, Mexico City, Mexico
(Chavez-Sanchez, Blanco-Favela) Unit of Medical Research in Immunology,
Instituto Mexicano del Seguro Social, Mexico City, Mexico
(Gordillo-Alvarez) Pain Clinic, Hospital de Pediatria, Instituto Mexicano
del Seguro Social, Mexico City, Mexico
(Rivas-Ruiz) Coordinacion de Investigacion en Salud, Instituto Mexicano
del Seguro Social, Mexico City, Mexico
(Villegas-Silva) Neonatal Intensive Care Unit, Hospital Infantil de Mexico
Federico Gomez, Mexico City, Mexico
(Mancilla-Ramirez) Escuela Superior de Medicina, IPN, Hospital de la
Mujer, Mexico City, Mexico
Title
Enteral docosahexaenoic acid reduces analgesic administration in neonates
undergoing cardiovascular surgery.
Source
Annals of Nutrition and Metabolism. 69 (2) (pp 150-160), 2016. Date of
Publication: 01 Nov 2016.
Publisher
S. Karger AG
Abstract
Background: Neonates undergoing surgery require analgesic medication to
ameliorate acute pain. These medications produce negative side effects.
Docosahexaenoic acid (DHA) has an antinociceptive effect in animals, but
this has not been evaluated in human neonates. We evaluated the DHA effect
on cumulative dose and duration of analgesics administered to neonates
undergoing cardiovascular surgery. Methods: A secondary analysis was
performed with data from a clinical trial, in which enteral DHA was
administered perioperatively compared with sunflower oil (SO). Present
study assessed the antinociceptive effect of DHA by measuring the
cumulative dose and duration of analgesics administered during
postoperative stay in a neonatal intensive care unit. Multivariate linear
regression models were performed. Results: Seventeen neonates received DHA
and 18 received SO in the control group. Compared with the control group,
the DHA group received lower cumulative dose (14.6 +/- 2.2 vs. 25.2 +/-
4.8 mug/kg, p = 0.029) and shorter duration of buprenorphine (2 days (1-8)
vs. 4.5 days (1-12); p = 0.053). After adjusting for confounders, the DHA
group received significantly lesser buprenorphine (beta = -27 mug/kg, p =
0.028; R² model = 0.90) for shorter duration (beta = -9 days, p
= 0.003; R² model = 0.94). No differences in fentanyl or
ketorolac were detected. Conclusions: Buprenorphine administration was
reduced in neonates who received DHA, suggesting that DHA likely has
analgesic effects.<br/>Copyright &#xa9; 2016 S. Karger AG, Basel.

<47>
Accession Number
619934429
Author
Smith L.E.; Smith D.K.; Blume J.D.; Linton M.F.; Billings F.T.
Institution
(Smith, Billings) Department of Anesthesiology, Vanderbilt University
Medical Center, Nashville, TN, United States
(Smith, Blume) Department of Biostatistics, Vanderbilt University Medical
Center, Nashville, TN, United States
(Linton, Billings) Department of Biostatistics and Medicine, Vanderbilt
University Medical Center, Nashville, TN, United States
Title
High-density lipoprotein cholesterol concentration and acute kidney injury
after cardiac surgery.
Source
Journal of the American Heart Association. 6 (12) (no pagination), 2017.
Article Number: e006975. Date of Publication: 01 Dec 2017.
Publisher
American Heart Association Inc.
Abstract
Background--Acute kidney injury (AKI) after cardiac surgery is associated
with increased short- and long-term mortality. Inflammation, oxidative
stress, and endothelial dysfunction and damage play important roles in the
development of AKI. Highdensity lipoproteins (HDLs) have anti-inflammatory
and antioxidant properties and improve endothelial function and repair.
Statins enhance HDL's anti-inflammatory and antioxidant capacities. We
hypothesized that a higher preoperative HDL cholesterol concentration is
associated with decreased AKI after cardiac surgery and that perioperative
statin exposure potentiates this association. Methods and Results--We
tested our hypothesis in 391 subjects from a randomized clinical trial of
perioperative atorvastatin to reduce AKI after cardiac surgery. A
2-component latent variable mixture model was used to assess the
association between preoperative HDL cholesterol concentration and
postoperative change in serum creatinine, adjusted for known AKI risk
factors and suspected confounders. Interaction terms were used to examine
the effects of preoperative statin use, preoperative statin dose, and
perioperative atorvastatin treatment on the association between
preoperative HDL and AKI. A higher preoperative HDL cholesterol
concentration was independently associated with a decreased postoperative
serum creatinine change (P=0.02). The association between a high HDL
concentration and an attenuated increase in serum creatinine was strongest
in long-term statinusing patients (P=0.008) and was further enhanced with
perioperative atorvastatin treatment (P=0.004) and increasing long-term
statin dose (P=0.003). Conclusions--A higher preoperative HDL cholesterol
concentration was associated with decreased AKI after cardiac surgery.
Preoperative and perioperative statin treatment enhanced this association,
demonstrating that pharmacological potentiation is possible during the
perioperative period.<br/>Copyright &#xa9; 2017 The Authors.

<48>
Accession Number
619934147
Author
Kang F.; Tang C.; Han M.; Chai X.; Huang X.; Li J.
Institution
(Kang, Tang, Han, Chai, Huang, Li) Department of Anesthesiology, Anhui
Provincial Hospital Affiliated to Anhui Medical University, Anhui
Province, China
Title
Effects of Dexmedetomidine-Isoflurane versus Isoflurane Anesthesia on
Brain Injury After Cardiac Valve Replacement Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objectives: To compare dexmedetomidine combined with isoflurane versus
isoflurane anesthesia on brain injury after cardiac surgery. Design: A
prospective, randomized, single-blind study. Setting: University hospital.
Participants: Adult patients undergoing elective valve replacement
surgery. Interventions: Ninety-seven patients scheduled for valve
replacement surgery were randomly divided into 2 groups: dexmedetomidine
and isoflurane (Dex-Iso, n = 50) and isoflurane alone (Iso, n = 47).
Dexemedetomidine was infused at 0.6 mug/kg as a bolus, followed with 0.2
mug/kg/h until the end of surgery. Measurements and Main Results: Jugular
blood samples were drawn for analysis of matrix metalloproteinase-9
(MMP-9) and glial fibrillary acidic protein (GFAP) levels on time points
of: T1 (before induction); T2 (5 minutes after cardiopulmonary bypass
[CPB] onset); T3 (after CPB off); T4 (the first day after operation); T5
(the second day after operation). Plasma lactate levels in arterial and
jugular venous blood also were quantified. The difference between arterial
and jugular bulb venous blood lactate levels (AVDL) was calculated. An
antisaccadic eye movement (ASEM) test was carried out on the day before
the operation and the seventh day postoperatively. In both groups, serum
MMP-9 and GFAP concentrations increased after CPB, with the peak values
occurring after CPB. At time point T5, MMP-9 and GFAP levels were close to
those at T1. MMP-9 concentrations in the Dex-Iso group were lower than the
Iso group at T3 and T4. GFAP concentrations in the Dex-Iso group were
lower at T3 but were higher than the Iso group at T2. No significant
differences were found in AVDL between the 2 groups perioperatively except
at T2. The ASEM scores decreased significantly postoperatively. There was
no significant difference in the ASEM scores between the 2 treatment
groups before and after the operation. Conclusions: The use of
dexmedetomidine decreased the biochemical markers of brain injury but did
not improve the neuropsychological test result after cardiac
surgery.<br/>Copyright &#xa9; 2017 Elsevier Inc.

<49>
Accession Number
619924382
Author
Shehata N.; Whitlock R.; Fergusson D.A.; Thorpe K.E.; MacAdams C.; Grocott
H.P.; Rubens F.; Fremes S.; Lellouche F.; Bagshaw S.; Royse A.; Rosseel
P.M.; Hare G.; Medicis E.D.; Hudson C.; Belley-Cote E.; Bainbridge D.;
Kent B.; Shaw A.; Byrne K.; Syed S.; Royse C.F.; McGuiness S.; Hall J.;
Mazer C.D.
Institution
(Shehata) Departments of Medicine, Laboratory Medicine and Pathobiology,
Institute of Health Policy Management and Evaluation, University of
Toronto, Division of Hematology, Mount Sinai Hospital, Toronto, Ontario,
Canada
(Whitlock) Department of Surgery, Population Health Research Institute,
McMaster University, David Braley Cardiac Vascular and Stroke Research
Institute, Hamilton, Ontario, Canada
(Fergusson) Ottawa Health Research Institute, University of Ottawa, The
Ottawa Hospital, General Campus, Centre for Practice-Changing Research,
Ottawa, Ontario, Canada
(Thorpe, Hall) Applied Health Research Center, St. Michael's Hospital,
Toronto, Ontario, Canada
(MacAdams) xxxx
(Grocott) Departments of Anesthesia and Perioperative Medicine and
Surgery, University of Manitoba, St. Boniface General Hospital, Winnipeg,
Manitoba, Canada
(Rubens) Department of Surgery, University of Ottawa, Ottawa Heart
Institute, Ottawa, Ontario, Canada
(Fremes) Department of Surgery, University of Toronto, Sunnybrook Health
Sciences Centre, Toronto, Ontario, Canada
(Lellouche) Department of Medicine, University of Laval, Unite de
Recherche en Pneumologie, Quebec, Canada
(Bagshaw) Department of Critical Care Medicine, Faculty of Medicine and
Dentistry, University of Alberta, Edmonton, Alberta, Canada
(Royse, Royse) Department of Surgery, The University of Melbourne, The
Royal Melbourne Hospital, Parkville, Victoria, Australia
(Rosseel) Department of Anesthesia, Amphia Hospital, Breda, The
Netherlands
(Hare, Mazer) Department of Anesthesia, University of Toronto, St.
Michael's Hospital, Toronto, Ontario, Canada
(Medicis) Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke,
Quebec, Canada
(Hudson) Department of Anesthesia, University of Ottawa Heart Institute,
Ottawa, Ontario, Canada
(Belley-Cote) Department of Medicine, Population Health Research
Institute, McMaster University, Hamilton, Canada
(Bainbridge) Department of Anaesthesia and Perioperative Medicine, Western
University, London, Ontario, Canada
(Kent) Department of Anesthesia, Pain Management and Perioperative
Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
(Shaw) Department of Anesthesia, Vanderbilt University Medical Center,
Nashville, TN
(Byrne) Department of Anesthesia, Waikato Hospital, Hamilton, New Zealand
(Syed) Department of Anesthesia, McMaster University, Hamilton Health
Sciences, Hamilton, Ontario, Canada
(Royse) Department of Cardiothoracic Anaesthesia, Royal Melbourne
Hospital, Parkville, Victoria, Australia
(McGuiness) Medical Research Institute of New Zealand, Auckland City
Hospital, Auckland, New Zealand
Title
Transfusion Requirements in Cardiac Surgery III (TRICS III): Study Design
of a Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2017.
Date of Publication: 2017.
Publisher
W.B. Saunders
Abstract
Objectives: To determine if a restrictive transfusion threshold is
noninferior to a higher threshold as measured by a composite outcome of
mortality and serious morbidity. Design: Transfusion Requirements in
Cardiac Surgery (TRICS) III was a multicenter, international, open-label
randomized controlled trial of two commonly used transfusion strategies in
patients having cardiac surgery using a noninferiority trial design
(ClinicalTrials.gov number, NCT02042898). Setting: Eligible patients were
randomized prior to surgery in a 1:1 ratio. Participants: Potential
participants were 18 years or older undergoing planned cardiac surgery
using cardiopulmonary bypass (CPB) with a preoperative European System for
Cardiac Operative Risk Evaluation (EuroSCORE I) of 6 or more.
Interventions: Five thousand patients; those allocated to a restrictive
transfusion group received a red blood cell (RBC) transfusion if the
hemoglobin concentration (Hb) was less than 7.5 g/dL intraoperatively
and/or postoperatively. Patients allocated to a liberal transfusion
strategy received RBC transfusion if the Hb was less than 9.5 g/dL
intraoperatively or postoperatively in the intensive care unit or less
than 8.5 g/dL on the ward. Measurements and Main Results: The primary
outcome was a composite of all-cause mortality, myocardial infarction,
stroke, or new onset renal dysfunction requiring dialysis at hospital
discharge or day 28, whichever comes first. The primary outcome was
analyzed as a per-protocol analysis. The trial monitored adherence closely
as adherence to the transfusion triggers is important in ensuring that
measured outcomes reflect the transfusion strategy. Conclusion: By
randomizing prior to surgery, the TRICS III trial captured the most acute
reduction in hemoglobin during cardiopulmonary bypass.<br/>Copyright
&#xa9; 2017.

<50>
Accession Number
619924372
Author
Nieto-Cabrera M.; Fernandez-Perez C.; Garcia-Gonzalez I.; Martin-Benitez
J.C.; Ferrero J.; Bringas M.; Carnero M.; Maroto L.; Sanchez-Garcia M.
Institution
(Nieto-Cabrera, Garcia-Gonzalez, Martin-Benitez, Ferrero, Bringas,
Sanchez-Garcia) Critical Care Department, Hospital Clinico San Carlos,
Madrid, Spain
(Fernandez-Perez) Preventive Medicine Service, Hospital Clinico San
Carlos, Madrid, Spain
(Carnero, Maroto) Cardiac Surgery Department, Hospital Clinico San Carlos,
Madrid, Spain
(Fernandez-Perez) Instituto de Investigacion Sanitaria IdISSC, Hospital
Clinico San Carlos, Madrid, Spain
(Nieto-Cabrera, Bringas) Faculty of Medicine, Universidad Alfonso X el
Sabio, Madrid, Spain
(Fernandez-Perez, Martin-Benitez, Sanchez-Garcia) Faculty of Medicine,
Universidad Complutense de Madrid, Madrid, Spain
Title
Med-Score 24: A multivariable prediction model for poststernotomy
mediastinitis 24 hours after admission to the intensive care unit.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2017.
Date of Publication: 2017.
Publisher
Mosby Inc. (E-mail: customerservice@mosby.com)
Abstract
Objectives: Mediastinitis is a serious complication of heart surgery. In
this study, we developed a bedside risk score for poststernotomy
mediastinitis. Methods: Data were prospectively collected from 4625
patients admitted to our intensive care unit after heart surgery (January
2005-June 2011). Mediastinitis was defined according to Centers for
Disease Control and Prevention criteria. A logistic model was constructed
in a randomly selected subgroup of 2618 patients and validated in a second
cohort of 1352, as well as in a prospective cohort of 2615 (June
2011-December 2015). Model discriminatory power was assessed according to
the area under the receiver operating characteristic curve (AUROC). The
beta coefficients of the model were used to define 3 levels of
mediastinitis risk as a score designated Med-Score 24. Its performance to
predict mediastinitis was compared with that of the logistic EuroSCORE and
Society of Thoracic Surgeons score. Results: Ninety-four (2.36%) patients
developed mediastinitis. The risk factors identified as predictive of
mediastinitis (AUROC 0.80) were 4 preoperative variables (age >70 years,
chronic obstructive lung disease, obesity, and antiplatelet therapy) and 3
perioperative variables (prolonged ischemia, emergency reoperation, and
prolonged intubation). AUROCs for the Society of Thoracic Surgeons score
and logistic EuroSCORE were 0.63 and 0.55, respectively, both differing
significantly from the area calculated for Med-Score 24 (P < .001).
Conclusions: The score developed showed excellent predictive power 24
hours after admission to the intensive care unit for mediastinitis risk.
This simple tool helps stratify patients according to this risk, thus
identifying high-risk patients for preventive measures. In our patient
cohort, Med-Score 24 performed better than other scores used for this
purpose.<br/>Copyright &#xa9; 2017 The American Association for Thoracic
Surgery.

<51>
Accession Number
619820451
Author
Herold J.; Herold-Vlanti V.; Sherif M.; Luani B.; Breyer C.; Bonaventura
K.; Braun-Dullaeus R.
Institution
(Herold, Herold-Vlanti, Luani, Breyer, Braun-Dullaeus) Otto-von-Guericke
University of Magdeburg, Department of Internal Medicine/Cardiology and
Angiology, Leipziger Str. 44, Magdeburg 39120, Germany
(Sherif) University of Rostock, Department of Internal Medicine/Cardiology
and Angiology, Ernst-Heydemann-Strase 6, Rostock 18057, Germany
(Bonaventura) Ernst-von-Bergmannstrost Clinic, Department of Internal
Medicine/Cardiology and Angiology, Charlottenstrase 72, Potsdam 14467,
Germany
Title
Analysis of cardiovascular mortality, bleeding, vascular and
cerebrovascular events in patients with atrial fibrillation vs. sinus
rhythm undergoing transfemoral Transcatheter Aortic Valve Implantation
(TAVR).
Source
BMC Cardiovascular Disorders. 17 (1) (no pagination), 2017. Article
Number: 298. Date of Publication: 20 Dec 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has been
demonstrated to be an established therapy for high-risk, inoperable
patients with severe symptomatic aortic valve stenosis. For patients with
moderate surgical risk, TAVR is equivalent to conventional aortic valve
surgery. However, atrial fibrillation (AF) is also present in many of
these patients, thus requiring post-implantation oral anticoagulation
therapy in addition to the inhibition of thrombocyte aggregation, which
poses the risk of bleeding complications. The aim of our work was to
investigate the influence of AF on mortality and the occurrence of
bleeding, vascular and cerebrovascular complications related to TAVR
according to the VARC-2 criteria. Methods: Two hundred eighty-three
patients who underwent TAVR between March 2010 and April 2016 were
retrospectively examined. In total, 257 patients who underwent
transfemoral access were included in this study. The mean patient age was
81 +/- 6 years, 54.1% of the patients were women, and 42.4% had
pre-interventional AF. Results: Compared to patients with sinus rhythm
(SR, n = 148), patients with AF (n = 109) had an almost three-fold higher
incidence of major vascular complications (AF 14.7% vs. SR 5.4%, p =
0.016) and life-threatening bleeding (AF 11.9% vs. SR 4.1%, p = 0.028)
during the first 30 post-procedural days. However, the rate of
cerebrovascular complications (AF 3.7% vs. SR 2.7%, p = 0.726) did not
significantly differ between the two groups. Overall mortality was
significantly higher in patients with AF during the first month (AF 8.3%
vs. SR 2.0%, p = 0.032) and the first year (AF 28.4% vs. SR 15.3%; p =
0.020) following TAVR. Conclusion: Patients with AF had significantly more
severe bleeding complications after TAVR, which were significantly related
to mortality. Future prospective randomized studies must clarify the
optimal anticoagulation therapy for patients with AF after TAVR. Trial
registration:DRKS00011798on DRKS (Date 17.03.2017).<br/>Copyright &#xa9;
2017 The Author(s).

<52>
Accession Number
619742189
Author
Mazer C.D.; Whitlock R.P.; Fergusson D.A.; Hall J.; Belley-Cote E.;
Connolly K.; Khanykin B.; Gregory A.J.; De Medicis E.; McGuinness S.;
Royse A.; Carrier F.M.; Young P.J.; Villar J.C.; Grocott H.P.; Seeberger
M.D.; Fremes S.; Lellouche F.; Syed S.; Byrne K.; Bagshaw S.M.; Hwang
N.C.; Mehta C.; Painter T.W.; Royse C.; Verma S.; Hare G.M.T.; Cohen A.;
Thorpe K.E.; Juni P.; Shehata N.
Institution
(Mazer, Hare) Department of Anesthesia, St. Michael's Hospital, 30 Bond
St., Toronto, ON M5B 1W8, Canada
(Verma) Department of Surgery, Division of Cardiac Surgery, Toronto,
Canada
(Hall, Cohen) Keenan Research Centre for Biomedical Science, Li Ka Shing
Knowledge Institute of St. Michael's Hospital, Applied Health Research
Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital,
Toronto, Canada
(Fremes) Sunnybrook Health Sciences Center, Toronto, Canada
(Thorpe) AHRC, Li Ka Shing Knowledge Institute of St. Michael's Hospital,
Dalla Lana School of Public Health, Toronto, Canada
(Juni) AHRC, Li Ka Shing Knowledge Institute of St. Michael's Hospital,
Department of Medicine, Institute of Health Policy, Management and
Evaluation, Toronto, Canada
(Shehata) University of Toronto, Department of Medicine, Laboratory
Medicine, and Pathobiology, Institute of Health Policy, Management, and
Evaluation, University of Toronto, Division of Hematology, Mount Sinai
Hospital, Canadian Blood Services, Toronto, Canada
(Whitlock, Belley-Cote) Population Health Research Institute, Canada
(Whitlock, Belley-Cote, Connolly) Hamilton Health Sciences Centre,
Hamilton, ON, Canada
(Whitlock, Belley-Cote, Syed) McMaster University, Hamilton, ON, Canada
(Fergusson) Ottawa Hospital Research Institute, University of Ottawa,
Ottawa, Canada
(Gregory) Department of Anesthesia, Foothills Medical Centre, University
of Calgary, Calgary, AB, Canada
(De Medicis) Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke,
QC, Canada
(Carrier) Department of Anesthesia and Medicine, Division of Critical
Care, Centre Hospitalier de L'Universite de Montreal, Montreal, Canada
(Grocott) Department of Anesthesia and Surgery, University of Manitoba,
St. Boniface Hospital, Winnipeg, Canada
(Lellouche) Department of Anesthesiology and Critical Care Medicine,
Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Laval
University, Laval, QC, Canada
(Bagshaw) Department of Critical Care Medicine, Faculty of Medicine and
Dentistry, University of Alberta, Edmonton, Canada
(Khanykin) Department of Cardiothoracic Anesthesia, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Denmark
(McGuinness, Young) Medical Research Institute of New Zealand, Wellington,
New Zealand
(Byrne) Waikato Hospital, Hamilton, New Zealand
(Royse, Royse) Department of Surgery, University of Melbourne, Melbourne,
VIC, Australia
(Royse) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, VIC, Australia
(Painter) Department of Anaesthesia, Royal Adelaide Hospital, Discipline
of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
(Villar) Fundacion Cardioinfantil-Instituto de Cardiologia, Bogota,
Colombia
(Villar) Universidad Autonoma de Bucaramanga, Bucaramanga, Colombia
(Seeberger) University of Basel, Department of Anesthesia, Surgical
Intensive Care, Prehospital Emergency Medicine and Pain Therapy,
University Hospital Basel, Basel, Switzerland
(Seeberger) Klinik Hirslanden, Zurich, Switzerland
(Hwang) Department of Cardiothoracic Anesthesia, National Heart Center,
Singapore General Hospital, Singapore, Singapore
(Mehta) Heart Care Assoc., Ahmedabad, India
Title
Restrictive or liberal red-cell transfusion for cardiac surgery.
Source
New England Journal of Medicine. 377 (22) (pp 2133-2144), 2017. Date of
Publication: 30 Nov 2017.
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND The effect of a restrictive versus liberal red-cell transfusion
strategy on clinical outcomes in patients undergoing cardiac surgery
remains unclear. METHODS In this multicenter, open-label, noninferiority
trial, we randomly assigned 5243 adults undergoing cardiac surgery who had
a European System for Cardiac Operative Risk Evaluation (EuroSCORE) I of 6
or more (on a scale from 0 to 47, with higher scores indicating a higher
risk of death after cardiac surgery) to a restrictive red-cell transfusion
threshold (transfuse if hemoglobin level was <7.5 g per deciliter,
starting from induction of anesthesia) or a liberal red-cell transfusion
threshold (transfuse if hemoglobin level was <9.5 g per deciliter in the
operating room or intensive care unit [ICU] or was <8.5 g per deciliter in
the non-ICU ward). The primary composite outcome was death from any cause,
myocardial infarction, stroke, or newonset renal failure with dialysis by
hospital discharge or by day 28, whichever came first. Secondary outcomes
included red-cell transfusion and other clinical outcomes. RESULTS The
primary outcome occurred in 11.4% of the patients in the
restrictive-threshold group, as compared with 12.5% of those in the
liberal-threshold group (absolute risk difference, -1.11 percentage
points; 95% confidence interval [CI], -2.93 to 0.72; odds ratio, 0.90; 95%
CI, 0.76 to 1.07; P<0.001 for noninferiority). Mortality was 3.0% in the
restrictive-threshold group and 3.6% in the liberal-threshold group (odds
ratio, 0.85; 95% CI, 0.62 to 1.16). Red-cell transfusion occurred in 52.3%
of the patients in the restrictive-threshold group, as compared with 72.6%
of those in the liberal-threshold group (odds ratio, 0.41; 95% CI, 0.37 to
0.47). There were no significant between-group differences with regard to
the other secondary outcomes. CONCLUSIONS In patients undergoing cardiac
surgery who were at moderate-to-high risk for death, a restrictive
strategy regarding red-cell transfusion was noninferior to a liberal
strategy with respect to the composite outcome of death from any cause,
myocardial infarction, stroke, or new-onset renal failure with dialysis,
with less blood transfused. (Funded by the Canadian Institutes of Health
Research and others; TRICS III ClinicalTrials.gov number,
NCT02042898.)<br/>&#xa9; Copyright 2017 Massachusetts Medical Society.

<53>
Accession Number
619907460
Author
Anonymous
Title
Erratum: Department of
Error(S0140673613614506)(10.1016/S0140-6736(13)61450-6).
Source
The Lancet. 382 (9896) (pp 940), 2013. Date of Publication: 14 - 20
September 2013.
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Thielmann M, Kottenberg E, Kleinbongard P, et al. Cardioprotective and
prognostic effects of remote ischaemic preconditioning in patients
undergoing coronary artery bypass surgery: a single-centre randomised,
double-blind, controlled trial. Lancet 2013; 382: 597-604- In table 3 of
this Article (Aug 17), one of the patients in the control group died of
sepsis on day 38 after surgery, not day 20. This correction has been made
to the online version as of Sept 13, 2013.<br/>Copyright &#xa9; 2013
Elsevier Ltd

<54>
Accession Number
619885806
Author
Gao X.-Q.; Li Y.; Jiang Z.-L.
Institution
(Gao, Li, Jiang) Beijing Anzhen Hospital, Capital Medical University,
China
(Gao, Li, Jiang) Beijing Institute of Heart Lung and Blood Vessel
Diseases, Beijing, China
Title
Comparison of secondary prevention status between percutaneous coronary
intervention and coronary artery bypass patients.
Source
Arquivos Brasileiros de Cardiologia. 109 (5) (pp 466-474), 2017. Date of
Publication: November 2017.
Publisher
Arquivos Brasileiros de Cardiologia (E-mail: arquivos@cardiol.br)
Abstract
Background: Data are scarce regarding disparities in cardiovascular risk
factor management between patients treated with percutaneous coronary
intervention (PCI) and those treated with coronary artery bypass grafting
(CABG).Objective: Whether the goal achievement rates of cardiovascular
risk factors were different between PCI and CABG patients.Methods: We
retrospectively reviewed the data retrieved from a clinical record
database of patients admitted to Beijing Anzhen Hospital between January
1, 2014, and December 31, 2014, who underwent PCI or CABG.Results:
Compared with the CABG group, low-density lipoprotein cholesterol (LDL-C)
< 1.8 mmol/L (28.6% vs. 24.7%; p < 0.01), LDL-C < 2.07 mmol/L (43.5% vs.
39.4%; p < 0.01) and blood pressure (BP) < 140/90 mm Hg (85.6% vs. 77.7%;
p < 0.01) goal achievement rates were significantly higher in the PCI
group. Compared with patients >= 60 years old: patients < 60 years old had
better BP < 140/90 mm Hg goal achievement rates (87.7% vs. 84.4%; p <
0.01) in the PCI group, and better fasting blood-glucose (FBG) < 7 mmol/L
(79.4% vs.72.0%; p < 0.01) and HbA1c < 7% (79.4% vs. 70.1%; p < 0.01) goal
achievement rates in the CABG group. Compared with females: males had
better LDL-C < 2.07 mmol/L (24.7% vs. 28.5%; p < 0.01), FBG < 7 mmol/L
(71.8% vs.75.2%; p < 0.01) and HbA1c < 7% (70.4% vs. 74.1%; p < 0.01) goal
achievement rates in the PCI group.Conclusion: Patients in the PCI group
were generally more likely than those in the CABG group to achieve LDL-C <
1.8 mmol/L and BP goals. The control of cardiovascular risk factors
differed between patients >= 60 years old and < 60 years old. Female
patients were less likely to achieve LDL-C, FBG and HbA1c
goals.<br/>Copyright &#xa9; 2017, Arquivos Brasileiros de Cardiologia. All
rights reserved.

<55>
Accession Number
619892770
Author
Altun G.; Hemsinli D.; Pulathan Z.; Civelek A.
Institution
(Altun, Pulathan) Department of Cardiovascular Surgery, Karadeniz
Technical University, Faculty of Medicine, Trabzon, Turkey
(Hemsinli) Department of Cardiovascular Surgery, Kanuni Education and
Research Hospital, Trabzon, Turkey
(Civelek) Department of Cardiovascular Surgery, Medical Park Hospital,
Ordu, Turkey
Title
Emergency coronary bypass surgery in patients under the influence of dual
antiplatelet therapy: Effects of tranexamic acid and desmopressin acetate.
Source
Turkish Journal of Medical Sciences. 47 (6) (pp 1708-1714), 2017. Date of
Publication: 2017.
Publisher
Turkiye Klinikleri Journal of Medical Sciences (Talapapa Bulvary no. 102,
Hamammonu 1 06230, Turkey)
Abstract
Background/aim: Bleeding in patients undergoing coronary artery bypass
grafting (CABG) while using dual antiplatelet therapy (DAPT) is a cause of
significant morbidity and mortality. The aim of this study is to examine
the perioperative hemostatic effects of tranexamic acid (TnX-A) and
desmopressin acetate (Des) in these patients. Materials and methods: This
clinical study was planned in a prospective and randomized manner.
Fifty-four patients were enrolled and classified into 4 different groups.
They were compared in terms of various bleeding and transfusion
parameters. Results: No significant differences were observed between the
groups in pre/intraoperative data apart from closure times.
Plasmin/alpha-2 antiplasmin complex values in the TnX-A and control groups
were significantly higher than those in the Des and TnX-A+Des groups at
the end of postoperative drug infusion. Mean duration of closure times,
first 3-h and total postoperative amounts of drainage, administered
volumes of erythrocyte suspension/fresh frozen plasma, cost of blood
products, length of intubation, length of stay in the intensive care unit,
and time to discharge were also significantly higher in the Des and
control groups. Conclusion: Des had no significant effect on bleeding
control and even delayed the hemostatic efficacy of TnX-A. Use of TnX-A
infusion alone in these patient groups had a positive effect on
hemostasis-related data.<br/>Copyright &#xa9; TUBITAK.

<56>
Accession Number
619892689
Author
Savluk O.F.; Kuscu M.A.; Guzelmeric F.; Gurcu M.E.; Erkilinc A.; Cevirme
D.; Ogus H.; Kocak T.
Institution
(Savluk, Kuscu, Guzelmeric, Gurcu, Erkilinc, Ogus, Kocak) Anesthesiology
and Reanimation Clinic, Kartal Kosuyolu High Specialty Training and
Education Hospital, Istanbul, Turkey
(Cevirme) DCardiovascular Surgery Clinic, Kartal Kosuyolu High Specialty
Training and Education Hospital, Istanbul, Turkey
Title
Do preoperative oral carbohydrates improve postoperative outcomes in
patients undergoing coronary artery bypass grafts?.
Source
Turkish Journal of Medical Sciences. 47 (6) (pp 1681-1686), 2017. Date of
Publication: 2017.
Publisher
Turkiye Klinikleri Journal of Medical Sciences (Talapapa Bulvary no. 102,
Hamammonu 1 06230, Turkey)
Abstract
Background/aim: The aim of this prospective study was to determine whether
the preoperative oral intake of carbohydrate-rich drinks by patients
undergoing a coronary artery bypass graft attenuates postoperative insulin
requirements, improves postoperative patient discomfort, provides
inotropic support, shortens the length of the ICU stay, and shortens the
duration of postoperative mechanical ventilation. Materials and methods:
This randomized prospective clinical study included 152 patients with
coronary artery disease who were divided into 4 groups. Carbohydrates were
administered to 3 groups at different hours and doses before operation.
The fourth group had an 8-h preoperative fasting period. The inotropic and
vasopressor requirements, ventilation time, and ICU stay time were
recorded for all of the groups. Patient wellbeing, mouth dryness, hunger,
anxiety, and nausea were assessed using VAS scores of 1-10. Results: Mouth
dryness and hunger were significantly higher in the control group (P =
0.03, P = 0.02). The increase in blood glucose level was significantly
higher in the control group (P = 0.04). The exogenous insulin requirement
was significantly higher in the control group than in the other groups (P
= 0.04). Conclusion: The administration of carbohydrates before elective
cardiac surgery reduced insulin resistance. Based on the VAS scores, the
intake of carbohydrates reduced mouth dryness and hunger. Overall,
preoperative oral carbohydrate treatments can improve the postoperative
outcomes of coronary artery bypass graft surgeries.<br/>Copyright &#xa9;
TUBITAK.

<57>
Accession Number
619886352
Author
Onat A.
Institution
(Onat) Department of Cardiology, Cerrahpasa Medical Faculty, Istanbul
University, Istanbul, Turkey
Title
Turkey's top publications in cardiovascular medicine in the past 25 years:
Evaluation of its impact.
Source
Anatolian Journal of Cardiology. 18 (6) (pp 417-424), 2017. Date of
Publication: December 2017.
Publisher
Turkish Society of Cardiology (E-mail: kareyayincilik@gmail.com)
Abstract
Objective: To identify "genuine" publications from Turkey's institutions
since 1992 that have cumulatively contributed the most to global
cardiovascular medicine. Methods: Based on data from the Web of Science,
146 publications from Turkey were identified having received >=50
citations as of late July, 2017. Papers with more than a minor share by
international authors were excluded. Results: Hundred and ten primary
authors generated 147 medical papers which received >=50 (interquartile
range, 54; 86) citations. These articles corresponded in quality to the
top 12% global papers. Half of the articles were published from 2002 to
late 2007, with a median exposure period of 12 years. Peak performance was
reached in 2004-'07, with a mean of 15-20 papers annually, which then
regressed to five papers in 2008-'13, representing an estimated 50%
decline. Cardiology generated 105 articles (20 in collaboration with other
branches), cardiovascular surgery generated 27 articles, and pediatric
cardiology generated 5 articles. Publications arose from 26 medical
faculties, Gulhane Military Academy, and 9 hospitals not which were not
academically affiliated. The performance of many related Turkish
institutions was disappointing. Conclusion: Turkey's contribution to
cardiovascular medicine has further declined slightly in the current
assessment, particularly since 2007. To prevent a further gap in Turkey's
contribution to the field, an undelayed return is needed by building an
environment that allows focusing on research with a potential to
contribute to medicine.<br/>Copyright &#xa9; 2017 by Turkish Society of
Cardiology.

<58>
Accession Number
619898233
Author
Davis E.; Braganza D.
Institution
(Davis) Arrowe Park Hospital, Wirral, United Kingdom
(Braganza) Papworth Hospital, United Kingdom
Title
Effect on safety and cost in switching from heparinised to non-heparinised
saline during angiography.
Source
Heart. Conference: British Cardiovascular Intervention Society, BCIS 2017.
United Kingdom. 103 (Supplement 7) (pp A7-A8), 2017. Date of Publication:
December 2017.
Publisher
BMJ Publishing Group
Abstract
Background Heparinised saline has been used to flush lines during coronary
angiography to reduce the risk of sheath thrombus formation and distal
embolic events. A National Patient Safety Agency alert in 2008 cautioned
against the use of intravenous heparin flush. Data is limited for
intraarterial flushes. The rise in radial access interventions (with
routine systemic unfractionated heparin (UFH) administration) prompted a
service improvement program (SIP) where the use of heparinised saline for
diagnostic cardiac angiographic procedures was exchanged for a 2-3000 unit
UFH bolus. Methods and Results The audit focused on diagnostic femoral
angiography (FA) as this group was felt to be the most vulnerable.
Retrospective data collected from 2 patient cohorts undergoing FA prior to
and post SIP included use of oral anticoagulation or antiplatelet agents,
eGFR and an estimate of heparin delivered via the flush (pre SIP) or
actual UFH bolus administered intraarterially (post SIP). All documented
catheter-associated complications and radiological investigations seeking
complication were noted. The pre-SIP cohort received a median of 75 iu
heparin. 22/30 patients in the post-SIP group received UFH boluses; the
median dose was 3000 iu. No thrombotic complications were documented in
either group. Conclusion Although thrombotic complications are fairly
rare, this audit supports the safe use of normal saline with an UFH bolus
during angiography. Extrapolated to include diagnostic cases and
angioplasty, the switch to normal saline with UFH bolus is projected to
save in excess of 77 000 per year in our institution.

<59>
Accession Number
619900020
Author
Sergiou A.; Haghollahi S.; Shantikumar S.
Institution
(Sergiou, Haghollahi) Warwick Medical School, University of Warwick,
Coventry, United Kingdom
(Shantikumar) Department of Health Sciences, University of Leicester,
Leicester, United Kingdom
Title
Circulating biomarkers for diagnosing acute kidney injury after paediatric
cardiac surgery: A systematic review and meta-analysis.
Source
International Journal of Surgery. Conference: 2017 ASiT International
Surgical Conference. United Kingdom. 47 (Supplement 1) (pp S6), 2017. Date
of Publication: November 2017.
Publisher
Elsevier Ltd
Abstract
Aim: Up to 40% of patients develop acute kidney injury (AKI) after cardiac
surgery. AKI is diagnosed using serum creatinine, which can take several
days to rise. We systematically reviewed the diagnostic value of novel
blood biomarkers of AKI in children post-cardiac surgery. Method: A
systematic literature search was conducted with two authors independently
determining eligibility of citations. Random effects metaanalyses was
performed where at least three studies of a single biomarker reported an
area under the receiver operator characteristics curve (AUROC), with 95%
confidence interval or standard error. Result: Twenty-one studies were
included. The two most frequently studied plasma biomarkers were cystatin
C and neutrophil gelatinaseassociated lipocalin (NGAL). Meta-analysis of
cystatin C studies gave a pooled AUROC of 0.79 (95% CI 0.73-0.85, I2=55%;
5 studies). NGAL results could not be pooled, but studies reported
conflicting evidence for its diagnostic efficacy (AUROC range 0.45-0.95).
Conclusion: Cystatin C may be a useful early diagnostic marker of AKI yet
there is currently insufficient evidence for using any novel biomarker to
diagnose AKI after paediatric cardiac surgery. Large, multicentre studies
with homogenous methodology should be undertaken evaluate the value of
novel biomarkers in predicting AKI, and its complications, after
paediatric cardiac surgery.

<60>
Accession Number
619900481
Author
Heywood E.; Chebbout R.; Lee J.; Lee M.
Institution
(Heywood, Lee, Lee) Sheffield Teaching Hospitals, Sheffield, United
Kingdom
(Chebbout) University of Sheffield, Sheffield, United Kingdom
Title
Incidence of post-operative atrial fibrillation in abdominal surgery: A
systematic review.
Source
International Journal of Surgery. Conference: 2017 ASiT International
Surgical Conference. United Kingdom. 47 (Supplement 1) (pp S92), 2017.
Date of Publication: November 2017.
Publisher
Elsevier Ltd
Abstract
Introduction: Atrial fibrillation is a common cardiac arrhythmia and can
occur de novo following a surgical procedure (POAF). Whilst there is
extensive research on POAF following cardiac surgery, there is limited
evidence on AF following abdominal surgery. We set out to identify rates
and risk factors for POAF following abdominal surgery. Method: A
systematic search of the EMBASE, MEDLINE and Cochrane databases was
reported in line with PRISMA guidelines. Studies were selected if they
reported cases of AF in a general surgical population within 30 days of
operation. Result: Initial searches identified 835 records, from which 32
full texts were retrieved. Following review, 14 studies were included
involving 53,148 patients, of whom 4.4% developed POAF. Common operations
included oesophagectomy and colectomy. Identified risk factors included
increasing age, history of cardiac disease such as hypertension and heart
failure, and post-operative complications, especially pulmonary
complications such as pneumonia and pleural effusions. Conclusion:
Symptomatic POAF is a common post-operative problem in the studied
population. Despite this, there is relatively little research into its
management. Furthermore, there may be a cohort of patients with
asymptomatic POAF, adding to disease burden. Future work could define risk
factors to allow targeted prophylaxis and investigate optimum management.

<61>
Accession Number
619900326
Author
Haghollahi S.; Sergiou A.; Shantikumar S.
Institution
(Haghollahi, Sergiou) Warwick Medical School, University of Warwick,
Coventry, United Kingdom
(Shantikumar) Department of Health Sciences, University of Leicester,
Leicester, United Kingdom
Title
Novel urinary biomarkers for the diagnosis of cardiac surgery-associated
acute kidney injury in paediatric patients: A systematic review and
meta-analysis.
Source
International Journal of Surgery. Conference: 2017 ASiT International
Surgical Conference. United Kingdom. 47 (Supplement 1) (pp S24-S25), 2017.
Date of Publication: November 2017.
Publisher
Elsevier Ltd
Abstract
Aim: There is a high incidence of acute kidney injury (AKI) after cardiac
surgery in children, resulting in significant morbidity and mortality.
Compared to serum creatinine, novel biomarkers may provide a more
sensitive and earlier diagnosis of AKI. We systematically reviewed the
diagnostic value of novel urinary biomarkers in detecting AKI within 24
hours of paediatric cardiac surgery. Method: A systematic literature
search was performed, with screening of results performed independently by
two authors. Random effects meta-analyses were executed where at least
three separate studies reported an area under the receiver operator
characteristics curve (AUROC), with a 95% confidence interval (CI) or
standard error, for a single biomarker. Result: We identified 25 relevant
citations. Neutrophil gelatinase-associated lipocalin (NGAL; 6 studies)
and interleukin-18 (IL-18; 4 studies) were the most frequently studied
biomarkers, and were the only ones with sufficient data for a
meta-analysis. The pooled AUROC estimates were 0.80 (95% CI 0.74-0.87) for
NGAL and 0.74 (95% CI 0.67-0.80) for IL-18. Conclusion: Urine NGAL and
IL-8 may have good diagnostic utility in detecting AKI within 24 hours of
paediatric cardiac surgery. Larger studies are required to determine their
diagnostic/prognostic performance in predicting AKI, and its
complications, in children after cardiac surgery.

<62>
Accession Number
619900158
Author
Husain M.
Institution
(Husain) Edinburgh University, Edinburgh, United Kingdom
Title
Coronary artery bypass grafting with or without mitral valve repair for
moderate ischemic mitral valve regurgitation treatment; A meta-analysis.
Source
International Journal of Surgery. Conference: 2017 ASiT International
Surgical Conference. United Kingdom. 47 (Supplement 1) (pp S23), 2017.
Date of Publication: November 2017.
Publisher
Elsevier Ltd
Abstract
Aim: A meta-analysis of RCTs was conducted in attempt to determine whether
CABG only or CABG + mitral valve repair (MVR) are associated with better
outcomes in relation to mortality and survival rates (primary outcome).
Also, the effects on NYHA functional classification; Left Ventricular End
Systolic Volume Index (LVESVI); and hospitalization were explored as
(secondary outcomes). Method: The analysis included only RCTs looking into
patients with moderate IMR with similar baseline and operative
characteristics (Grade 2/4, ERO < 20 mm2) and MLVEF% of (40-60%) who
underwent GABG with or without mitral valve repair. Result: Primary
outcome: Mortality rate in one year after surgery showed no statistically
significant difference between the two treatment groups. Secondary
outcomes: showed immediate beneficial effects of adding MVR to CABG
procedure in regards to patients' NYHA functional class, LVESVI and
hospitalization. Conclusion: The current available evidence suggests that
adding MVR to CABG doesn't decrease the mortality rate or improve the
functionality measurements of moderate IMR patients at one year
post-surgery. Furthermore, adding MVR to CABG results in an increased
length of hospital stay duration. For future development of the quality of
evidence, larger RCTs with longer follow-up periods for patients with
moderate IMR are recommended.

<63>
Accession Number
619763064
Author
Shaefi S.; Marcantonio E.R.; Mueller A.; Banner-Goodspeed V.; Robson S.C.;
Spear K.; Otterbein L.E.; O'Gara B.P.; Talmor D.S.; Subramaniam B.
Institution
(Shaefi, Mueller, Banner-Goodspeed, O'Gara, Talmor, Subramaniam) Beth
Israel Deaconess Medical Center, Harvard Medical School, Department of
Anesthesia, Critical Care and Pain Medicine, 330 Brookline Ave, Boston, MA
02215, United States
(Marcantonio) Beth Israel Deaconess Medical Center, Harvard Medical
School, Division of General Medicine and Primary Care, 330 Brookline Ave,
Boston, MA 02215, United States
(Robson) Beth Israel Deaconess Medical Center, Harvard Medical School,
Division of Gastroenterology, 3 Blackfan Circle, Boston, MA 02215, United
States
(Spear) Beth Israel Deaconess Medical Center, Harvard Medical School,
Division of Cardiothoracic Surgery, 330 Brookline Ave, Boston, MA 02215,
United States
(Otterbein) Beth Israel Deaconess Medical Center, Harvard Medical School,
Division of Transplant Surgery, Center for Life Sciences, Boston, MA
02215, United States
Title
Intraoperative oxygen concentration and neurocognition after cardiac
surgery: Study protocol for a randomized controlled trial.
Source
Trials. 18 (1) (no pagination), 2017. Article Number: 600. Date of
Publication: 19 Dec 2017.
Publisher
BioMed Central Ltd. (E-mail: info@biomedcentral.com)
Abstract
Background: Postoperative cognitive dysfunction (POCD) is a common
complication of cardiac surgery. Studies have identified potentially
injurious roles for cardiopulmonary bypass (CPB) and subsequent
reperfusion injury. Cognitive dysfunction has also been linked to the
deleterious effects of hyperoxia following ischemia-reperfusion injuries
in several disease states, but there has been surprisingly little study
into the role of hyperoxia in reperfusion injury after CPB. The potential
for tightly regulated intraoperative normoxia to ameliorate the
neurocognitive decline following cardiac surgery has not been investigated
in a prospective manner. We hypothesize that the use of a protocolized
management strategy aimed towards maintenance of an intraoperative
normoxic level of oxygen, as opposed to hyperoxia, will reduce the
incidence of POCD in older patients undergoing cardiac surgery.
Methods/Design: One hundred patients aged 65 years and older undergoing
non-emergency coronary artery bypass grafting surgery on cardiopulmonary
bypass will be enrolled in this prospective, randomized, controlled trial.
Subjects will be randomized to receive a fraction of inspired oxygen of
either 35% or 100% while under general anesthesia throughout the
intraoperative period. The primary outcome measure will be the incidence
of POCD in the acute postoperative phase and up to 6 months. The
assessment of neurocognition will be undertaken by trained personnel,
blinded to study group, with the telephone Montreal Cognitive Assessment
(t-MoCA) tool. Secondary outcome measures will include assessment of
delirium using the Confusion Assessment Method (CAM and CAM-ICU), as well
as time to extubation, days of mechanical ventilation, length of ICU and
hospital stay and mortality at 6 months. With the aim of later identifying
mechanistic aspects of the effect of oxygen tension, blood, urine, and
atrial tissue specimens will be taken at various time points during the
perioperative period and later analyzed. Discussion: This trial will be
one of the first randomized controlled studies to prospectively assess the
relationship between intraoperative oxygen levels and postoperative
neurocognition in cardiac surgery. It addresses a promising biological
avenue of intervention in this vulnerable aging population. Trial
registration: ClinicalTrials.gov Identifier: NCT02591589 , registered
February 13, 2015.<br/>Copyright &#xa9; 2017 The Author(s).

<64>
Accession Number
619847431
Author
Canty D.J.; Heiberg J.; Yang Y.; Royse A.G.; Margale S.; Nanjappa N.;
Scott D.; Maier A.; Sessler D.I.; Chuan A.; Palmer A.; Bucknill A.; French
C.; Royse C.F.
Institution
(Canty, Yang, Royse, Bucknill) Department of Surgery University of
Melbourne Australia
(Canty) Royal Melbourne and Monash Hospitals MelbourneAustralia
(Heiberg, Royse) Department of Anesthesia and Pain Management Royal
Melbourne Hospital MelbourneAustralia
(Heiberg) Department of Anesthesia and Intensive Care Aarhus University
Hospital AarhusDenmark
(Yang, French, Royse) Department of Intensive Care Western Health
MelbourneAustralia
(Royse) Department of Cardiothoracic Surgery Royal Melbourne Hospital
MelbourneAustralia
(Margale) Northside Clinical School University of Queensland
BrisbaneAustralia
(Margale) Department of Anaesthesia and Perfusion services Prince Charles
Hospital BrisbaneAustralia
(Nanjappa) University of Adelaide Australia
(Nanjappa) Queen Elizabeth Hospital AdelaideAustralia
(Scott) School of Medicine University of Melbourne Australia
(Scott) St. Vincent's Hospital Melbourne Australia
(Maier) Department of Medicine and Aged Care Royal Melbourne Hospital
University of Melbourne Australia
(Maier) Department of Human Movement Sciences MOVE Research Institute
Amsterdam Vrije Universiteit Amsterdam the Netherlands
(Sessler) Anesthesiology Institute Cleveland Clinic Cleveland, OHUSA
(Chuan) University of New South Wales SydneyAustralia
(Chuan) Liverpool Hospital SydneyAustralia
(Palmer) Health Economics Research Unit Menzies Institute for Medical
Research University of Tasmania HobartAustralia
(Bucknill) Royal Melbourne Hospital MelbourneAustralia
Title
Pilot multi-centre randomised trial of the impact of pre-operative focused
cardiac ultrasound on mortality and morbidity in patients having surgery
for femoral neck fractures (ECHONOF-2 pilot).
Source
Anaesthesia. (no pagination), 2017. Date of Publication: 2017.
Publisher
Blackwell Publishing Ltd (E-mail:
customerservices@oxonblackwellpublishing.com)
Abstract
Hip fracture surgery is common, usually occurs in elderly patients who
have multiple comorbidities, and is associated with high morbidity and
mortality. Pre-operative focused cardiac ultrasound can alter diagnosis
and management, but its impact on outcome remains uncertain. This pilot
study assessed feasibility and group separation for a proposed large
randomised clinical trial of the impact of pre-operative focused cardiac
ultrasound on patient outcome after hip fracture surgery. Adult patients
requiring hip fracture surgery in four teaching hospitals in Australia
were randomly allocated to receive focused cardiac ultrasound before
surgery or not. The primary composite outcome was any death, acute kidney
injury, non-fatal myocardial infarction, cerebrovascular accident,
pulmonary embolism or cardiopulmonary arrest within 30 days of surgery. Of
the 175 patients screened, 100 were included as trial participants
(screening:recruitment ratio 1.7:1), 49 in the ultrasound group and 51 as
controls. There was one protocol failure among those recruited. The
primary composite outcome occurred in seven of the ultrasound group
patients and 12 of the control group patients (relative group separation
39%). Death, acute kidney injury and cerebrovascular accident were
recorded, but no cases of myocardial infarction, pulmonary embolism or
cardiopulmonary arrest ocurred. Focused cardiac ultrasound altered the
management of 17 participants, suggesting an effect mechanism. This pilot
study demonstrated that enrolment and the protocol are feasible, that the
primary composite outcome is appropriate, and that there is a treatment
effect favouring focused cardiac ultrasound - and therefore supports a
large randomised clinical trial.<br/>Copyright &#xa9; 2017 The Association
of Anaesthetists of Great Britain and Ireland.

<65>
Accession Number
619777765
Author
Krishna A.; Cheng S.
Institution
(Krishna, Cheng) New York Presbyterian, Weill Cornell Medical Center,
United States
Title
Use of pecs i and II blocks for modified radical mastectomy in a patient
with right heart failure.
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 The pectoralis nerve blocks (Pecs I and II) are recently
described techniques that are gaining use as part of the enhanced recovery
after surgery (ERAS) protocols for ambulatory patients undergoing breast
cancer surgery [1,2,4]. They have been shown to provide superior analgesia
over general anesthesia alone and are technically easier to perform with a
lower risk profile than thoracic paravertebral blocks (TPVB) [3]. We
present a case of Pecs I and II blocks used for postoperative analgesia in
a patient with complex cardiac comorbidities in whom TPVB was relatively
contraindicated. Patient consent for submission of the case report for
presentation was obtained. Results/Case report A 39 year old female with a
history of uncorrected ASD leading to pulmonary hypertension and severe
right heart failure presented for palliative modified radical mastectomy
for stage IV ductal adenocarcinoma of the breast. The patient was admitted
for cardiac optimization prior to surgery and noted that her exercise
tolerance had decreased from 10 blocks to shortness of breath at rest. She
also complained of three pillow orthopnea and worsening lower extremity
swelling. The patient underwent diuresis for one week as an inpatient
prior to presenting for surgery. The use of TPVB with minimal sedation was
discussed as a possible anesthetic plan however, on exam, the patient was
morbidly obese, tachypneic, unable to lie flat, and with a large fungating
breast mass, shown below. The decision was made to perform the case under
general anesthesia with a preinduction arterial catheter. Pecs I and II
blocks were chosen over TPVB for postoperative analgesia given the
patient's immobility and the potentially devastating consequences of a
pneumothorax, epidural or intrathecal injection in the setting of severe
right heart failure. Prior to induction, ultrasound guided left Pecs I and
II blocks were performed using 20 mLs of 0.5% bupivacaine with 1:200,000
epinephrine and 4 mg dexamethasone. Anesthetic induction and surgery
proceeded uneventfully and the patient was extubated to nasal cannula. She
received 200 mcg of fentanyl on induction and 0.6 mg of hydromorphone
during the case. She denied pain in PACU and endorsed pain scores of zero
for the first 24 hours post-operatively. Discussion Thoracic paravertebral
block has been a long standing procedure for postoperative analgesia after
breast surgery with Pecs I and II blocks emerging recently as an
alternative. Here we present a case of the preferential use of Pecs I and
II blocks over TPVB in a patient with complex comorbidities. Pecs I and II
blocks are technically easier to perform, carry less risk, provide
effective analgesia, and require minimal patient cooperation. In addition,
a recent randomized controlled trial has shown superior postoperative
analgesia in the Pecs block group over TPVB [5]. We advocate the use of
these blocks not only in healthy patients undergoing ambulatory breast
surgery, but also in complex patients in whom the anesthesiologist seeks
to minimize potential morbidity.

<66>
Accession Number
619777766
Author
Smith A.; Hartman M.; Woodson J.; Renner M.; Morton J.
Institution
(Smith) Stanford School of Medicine, Fort Worth, TX, United States
(Hartman, Woodson, Renner) Stanford School of Medicine, Irving, TX, United
States
(Morton) Stanford School of Medicine, Stanford, CA, United States
Title
The impact of cardiopulmonary metabolic exercise test and resting
echocardiogram results upon bariatric surgery outcomes.
Source
Surgery for Obesity and Related Diseases. Conference: 33rd American
Society for Metabolic Surgery Annual Meeting, ASMBS 2016. United States.
12 (7 Supplement 1) (pp S196-S197), 2016. Date of Publication: August
2016.
Publisher
Elsevier Inc.
Abstract
Background: Obesity is a major and modifiable risk factor for heart
disease. Bariatric surgery is known to be a safe, effective and enduring
treatment for obesity. A hallmark of both safety and effectiveness in
bariatric surgery is preoperative risk assessment and correlation of
testing results to weight loss. Both exercise capacity and cardiac
assessment can be difficult or slow to obtain in a bariatric surgery
clinic due to lack of either equipment and/or qualified specialists. A
potential solution to the lack of timely access to needed cardio-metabolic
testing is to have studies performed in a bariatric surgery clinic and
then confirmed by specialists. This study examines the prevalence,
improvement and correlation of weight loss to Cardiopulmonary Metabolic
Exercise Test (CMET) and Resting Echocardiogram results performed in
bariatric surgery clinics with results confirmed by specialists. Methods:
112 patients who underwent bariatric surgery and had preoperative
Cardiopulmonary Metabolic Exercise Tests (CMET) and Resting
Echocardiograms performed were included in this study. In addition, a
subset of patients had repeat testing performed postoperatively. All tests
were obtained in bariatric surgery clinics with ambulatory equipment and
read by qualified specialists. From 4 100 variables, the following
selected variables are reported: (HR) resting Heart Rate, (SysBP) Systolic
Blood Pressure, (Dia BP) Diastolic Blood Pressure, (RR) Respiratory Rate,
(Max VO2, mL/kg/min) maximal oxygen consumption, (VO2 Max VCO2 (L/min)
maximal carbon dioxide produced and exhaled at peak in liters per minute,
(VO2 Max RER) Respiratory Exchange Ratio, ratio between the amount of CO2
produced during metabolism and the O2 being consumed, (VO2 Max MET)
Metabolic equivalents of 1 MET = 3.5 mL/kg/min, AT VO2/Pred (%), Anearobic
Threshold, the point at which metabolism shifts from aerobic to anaerobic,
(VO2.Max, VO2WorkSlope.mL.min.watt) VO2 over workrate, (VO2.Max. VE.VCO2),
abnormal ventilatory response to exercise is identified by an increased
slope of ventilation vs. CO2 production to incremental workload
(VO2.Max.SpO2), Oxygen saturation at peak, PF Pre SVC (L), the maximum
volume of air that can be exhaled slowly after slow maximum inhalation, PF
Pre IC (L) inspiratory reserve volume (IRV), PF Pre ERV (L) expiratory
reserve volume (ERV), PF Pre FEV1 (L) the volume of air that can forcibly
be blown out in one second, after full inspiration, PF Pre FVC (L) volume
of air that can forcibly be blown out after full inspiration, PF Pre
FEV1/FVC (%) calculated ratio used in the diagnosis of obstructive and
restrictive lung disease, PF Pre FEF Max (L/sec) Forced expiratory flow
(FEF) PF Pre Expiratory Time (sec) 'amount of time it takes for the
patient to clear all the air from their lungs, PF Pre DLCOunc
(ml/min/mmHg) Diffusing capacity of the lungs for carbon monoxide, a
measure of how much oxygen travels from the alveoli of the lungs to the
blood stream, PF Pre FRC (N2) (L) functional residual capacity, PF Pre RV
(N2) (L) residual volume, PF Pre TLC (N2) (L) total lung capacity, LVOT
Left Ventricular Outflow Tract Diameter, MV-AV Mitral Valve-Aortic Valve
Velocity and PFVI Pulmonary Flow Velocity. Continuous and categorical data
were analyzed by T-test or Chi-Square analysis as appropriate.
Preoperative testing results were then correlated to postoperative weight
loss results by Spearman correlation. Significance was set as p<. 05. All
data were analyzed using GraphPad Prism v6.01. Results: Average patient
demographics included: Age 42 Years, BMI 44, 82% female, 64% Caucasian,
BMI Reduction Post-operative 14. The following variables were noted to be
abnormal preoperatively, (%): Rest.sysBP.mmHg (31.3), Rest.diaBP.mmHg
(19.6), VO2.Max.sysBP.mmHg (15.1), VO2.Max.diaBP.mmHg (2.6), Rest.HR. BPM
(8.03), VO2.Max.HR.Pred (27.7), Rest.RR. br.min (21.4), VO2.Max.RR.br.min
(10.7), VO2.Max.BR (100), VO2.Max.VO2.Pred (37.5), VO2.Max.RER (31.3),
VO2.Max. METS (15.2), VO2.Max.VO2WorkSlope.mL.min.watt (76.8),
VO2.Max.VE.VCO2 (3.6), VO2.Max.Max.SpO2 (25), AT.VO2. Pred (19.6),
PF.Pred.Pre.SVC.L, PF (1.8), Pred.Pre.ICL, PF (93.8), Pred.Pre.ERV.L
(17.9), PF.Pred.Pre.FEV1.L (25), PF. Pred.Pre.FVC.L (0.8), PF.Pre.FEV1.FVC
(7.1), PF.Pred.Pre.FEF. Max.L.sec (16.1), PF.Pre.Expiratory.Time.sec.
(97.3), PF.Pre. DLCOunc.ml.min.mmHg (100), PF.Pred.Pre.DLCOunc.ml.min.
mmHg. (50), PF.Pred.Pre.FRC.N2.L. (91.1), PF.Pred.Pre.RV.N2. L. (74.1),
PF.Pred.Pre.TLC.N2.L. (54.5) PF.Pre.RV.TLC.N2 (100). Variables
significantly correlated with surgical weight loss included: PF PreFEV1
(-0.77), PF PreFVC (-0.74), Rest CO (-0.83). Furthermore, PF Pre-Final was
also significantly correlated to Systolic Blood Pressure change (-0.9). In
addition, cardiac echo results demonstrated significant correlation to
change in BMI including LVOT Diameter (0.8), MV-AV Velocity (0.75) and HR
(-0.73) and PFVI (-0.83). Conclusion: This study finds multiple and
significant preoperative abnormalities in patients undergoing bariatric
surgery. These abnormal findings include cardiac, pulmonary and exercise
tolerance parameters that may have important implications for both patient
safety and effectiveness. The correlation of cardiopulmonary parameters
like preoperative CO, FEV1, FVC, LVOT Diameter, MV-AV velocity, HR And
PFVI to surgical weight loss and comorbidity remission indicate
opportunities to enhance surgical weight loss. Surgical prehabilitation
such as cardio-pulmonary training for these parameters could improve
weight loss and comorbidity remission. Abnormal preoperative
cardio-pulmonary parameters can have complication consequences.
Recognition of these abnormal values can guide the use of risk mitigation
strategies. Cardiopulmonary Metabolic Exercise Tests and Resting
Echocardiograms can enhance bariatric surgery outcomes for safety and
effectiveness.

<67>
Accession Number
619805712
Author
Nagappa M.; Ho G.; Patra J.; Wong J.; Singh M.; Kaw R.; Cheng D.; Chung F.
Title
Postoperative Outcomes in Obstructive Sleep Apnea Patients Undergoing
Cardiac Surgery: A Systematic Review and Meta-analysis of Comparative
Studies.
Source
Anesthesia and analgesia. 125 (6) (pp 2030-2037), 2017. Date of
Publication: 01 Dec 2017.
Abstract
BACKGROUND: Obstructive sleep apnea (OSA) is a common comorbidity in
patients undergoing cardiac surgery and may predispose patients to
postoperative complications. The purpose of this meta-analysis is to
determine the evidence of postoperative complications associated with OSA
patients undergoing cardiac surgery.
METHODS: A literature search of Cochrane Database of Systematic Reviews,
Medline, Medline In-process, Web of Science, Scopus, EMBASE, Cochrane
Central Register of Controlled Trials, and CINAHL until October 2016 was
performed. The search was constrained to studies in adult cardiac surgical
patients with diagnosed or suspected OSA. All included studies must report
at least 1 postoperative complication. The primary outcome is major
adverse cardiac or cerebrovascular events (MACCEs) up to 30 days after
surgery, which includes death from all-cause mortality, myocardial
infarction, myocardial injury, nonfatal cardiac arrest, revascularization
process, pulmonary embolism, deep venous thrombosis, newly documented
postoperative atrial fibrillation (POAF), stroke, and congestive heart
failure. Secondary outcome is newly documented POAF. The other exploratory
outcomes include the following: (1) postoperative tracheal intubation and
mechanical ventilation; (2) infection and/or sepsis; (3) unplanned
intensive care unit (ICU) admission; and (4) duration of stay in hospital
and ICU. Meta-analysis and meta- regression were conducted using Cochrane
Review Manager 5.3 (Cochrane, London, UK) and OpenBUGS v3.0, respectively.
RESULTS: Eleven comparative studies were included (n = 1801 patients; OSA
versus non-OSA: 688 vs 1113, respectively). MACCEs were 33.3% higher odds
in OSA versus non-OSA patients (OSA versus non-OSA: 31% vs 10.6%; odds
ratio [OR], 2.4; 95% confidence interval [CI], 1.38-4.2; P = .002). The
odds of newly documented POAF (OSA versus non-OSA: 31% vs 21%; OR, 1.94;
95% CI, 1.13-3.33; P = .02) was higher in OSA compared to non-OSA. Even
though the postoperative tracheal intubation and mechanical ventilation
(OSA versus non-OSA: 13% vs 5.4%; OR, 2.67; 95% CI, 1.03-6.89; P = .04)
were significantly higher in OSA patients, the length of ICU stay and
hospital stay were not significantly prolonged in patients with OSA
compared to non-OSA. The majority of OSA patients were not treated with
continuous positive airway pressure therapy. Meta-regression and
sensitivity analysis of the subgroups did not impact the OR of
postoperative complications for OSA versus non-OSA groups.
CONCLUSIONS: Our meta-analysis demonstrates that after cardiac surgery,
MACCEs and newly documented POAF were 33.3% and 18.1% higher odds in OSA
versus non-OSA patients, respectively.

<68>
Accession Number
619809419
Author
Bolzan D.W.; Gomes W.J.; Rocco I.S.; Viceconte M.; Nasrala M.L.; Pauletti
H.O.; Moreira R.S.; Hossne N.A.; Arena R.; Guizilini S.
Institution
(Bolzan, Gomes, Rocco, Viceconte, Nasrala, Pauletti, Moreira, Hossne,
Guizilini) Disciplina de Cirurgia Cardiovascular e Cardiologia da Escola
Paulista de Medicina da Universidade de Sao Paulo (EPM-UNIFESP), Sao
Paulo, SP, Brazil
(Rocco, Guizilini) Departamento de Ciencia do Movimento Humana, Escola de
Fisioterapia da Universidade Federal de Sao Paulo (UNIFESP), Santos, SP,
Brazil
(Arena) Department of Physical Therapy and Integrative Physiology
Laboratory, College of Applied Health Sciences, University of Illinois at
Chicago, Chicago, USA
Title
Early Open-Lung Ventilation Improves Clinical Outcomes in Patients with
Left Cardiac Dysfunction Undergoing Off-Pump Coronary Artery Bypass: a
Randomized Controlled Trial.
Source
Brazilian journal of cardiovascular surgery. 31 (5) (pp 358-364), 2016.
Date of Publication: 01 Sep 2016.
Abstract
Objective: To compare pulmonary function, functional capacity and clinical
outcomes amongst three groups of patients with left ventricular
dysfunction following off-pump coronary artery bypass, namely: 1)
conventional mechanical ventilation (CMV); 2) late open lung strategy
(L-OLS); and 3) early open lung strategy (E-OLS).
Methods: Sixty-one patients were randomized into 3 groups: 1) CMV (n=21);
2) L-OLS (n=20) initiated after intensive care unit arrival; and 3) E-OLS
(n=20) initiated after intubation. Spirometry was performed at bedside on
preoperative and postoperative days (PODs) 1, 3, and 5. Partial pressure
of arterial oxygen (PaO2) and pulmonary shunt fraction were evaluated
preoperatively and on POD1. The 6-minute walk test was applied on the day
before the operation and on POD5.
Results: Both the open lung groups demonstrated higher forced vital
capacity and forced expiratory volume in 1 second on PODs 1, 3 and 5 when
compared to the CMV group (P<0.05). The 6-minute walk test distance was
more preserved, shunt fraction was lower, and PaO2 was higher in both
open-lung groups (P<0.05). Open-lung groups had shorter intubation time
and hospital stay and also fewer respiratory events (P<0.05). Key measures
were significantly more favorable in the E-OLS group compared to the L-OLS
group.
Conclusion: Both OLSs (L-OLS and E-OLS) were able to promote higher
preservation of pulmonary function, greater recovery of functional
capacity and better clinical outcomes following off-pump coronary artery
bypass when compared to conventional mechanical ventilation. However, in
this group of patients with reduced left ventricular function, initiation
of the OLS intra-operatively was found to be more beneficial and optimal
when compared to OLS initiation after intensive care unit arrival.

<69>
Accession Number
619804628
Author
Rasheed M.A.; Majeed F.A.; Ali Shah S.Z.; Naz A.
Institution
(Rasheed) Department of Surgery, Combined Military Hospital Gujranwala,
Pakistan
(Majeed) Department of Thoracic Surgery Combined Military Hospital Lahore,
Pakistan
(Ali Shah) Cardiothoracic Surgery Unit, Ayub Teaching Hospital,
Abbottabad, Pakistan
(Naz) Combined Military Hospital Gujranwalan, Pakistan
Title
Role Of Clamping Tube Thoracostomy Prior To Removal In Non-Cardiac
Thoracic Trauma.
Source
Journal of Ayub Medical College, Abbottabad : JAMC. 28 (3) (pp 476-479),
2016. Date of Publication: 01 Jul 2016.
Abstract
BACKGROUND: The frequently encountered thoracic trauma in surgical
emergencies is a major cause of mortality and morbidity. Eighty percent of
thoracic trauma can be managed by simple insertion of tube thoracostomy.
Though guidelines for insertion are comprehensively explained in
literature, an ideal algorithm for discontinuation is not available. A
standard and safe defined protocol would eliminate hesitancy in confident
removal among general surgeons. The objective of this study was to
determine role of clamping trial prior to removal in terms of frequency of
recurrent pneumothorax.
METHODS: This study was conducted in department of Surgery Combined
military hospital/Military Hospital Rawalpindi from April 2013 to March
2014. Total 180 patients with blunt or penetrating thoracic trauma were
included in the study. Chest tube (28-36 Fr) was inserted in Trauma centre
under strict asepsis. Tubes were then connected to under water seal for
minimum six hours. Patients were randomly divided in two equal groups (90
in each). In Group A, Clamping trial was given before attempting removal
while in Group B, tube was removed immediately without clamping trial.
Patients of both groups were observed two hourly for development of
recurrent pneumothorax. Data was analysed using SPSS-18.
RESULTS: The comparison of frequency of recurrent pneumothorax in Group A
(9 patients, 10%) and in Group B (4 patients, 4.5%) was not found to be
statistically significant. (p-value 2.073).
CONCLUSIONS: Clamping trial is unnecessary prior to removal of tube
thoracostomy in blunt and penetrating non-cardiac thoracic trauma in terms
of recurrent pneumothorax.